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Toniato de Rezende Freschi J, Cristelli MP, Viana LA, Ficher KN, Nakamura MR, Proença H, Dreige YC, de Marco R, de Lima MG, Foresto RD, Aguiar WF, Medina-Pestana J, Tedesco-Silva H. A Head-to-head Comparison of De Novo Sirolimus or Everolimus Plus Reduced-dose Tacrolimus in Kidney Transplant Recipients: A Prospective and Randomized Trial. Transplantation 2024; 108:261-275. [PMID: 37525373 DOI: 10.1097/tp.0000000000004749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
BACKGROUND Mammalian target of rapamycin inhibitors (mTORi), sirolimus (SRL) and everolimus (EVR), have distinct pharmacokinetic/pharmacodynamics properties. There are no studies comparing the efficacy and safety of de novo use of SRL versus EVR in combination with reduced-dose calcineurin inhibitor. METHODS This single-center prospective, randomized study included first kidney transplant recipients receiving a single 3 mg/kg antithymocyte globulin dose, tacrolimus, and prednisone, without cytomegalovirus (CMV) pharmacological prophylaxis. Patients were randomized into 3 groups: SRL, EVR, or mycophenolate sodium (MPS). Doses of SRL and EVR were adjusted to maintain whole blood concentrations between 4 and 8 ng/mL. The primary endpoint was the 12-mo incidence of the first CMV infection/disease. RESULTS There were 266 patients (SRL, n = 86; EVR, n = 90; MPS, n = 90). The incidence of the first CMV event was lower in the mTORi versus MPS groups (10.5% versus 7.8% versus 43.3%, P < 0.0001). There were no differences in the incidence of BK polyomavirus viremia (8.2% versus 10.1% versus 15.1%, P = 0.360). There were no differences in survival-free from treatment failure (87.8% versus 88.8% versus 93.3%, P = 0.421) and incidence of donor-specific antibodies. At 12 mo, there were no differences in kidney function (75 ± 23 versus 78 ± 24 versus 77 ± 24 mL/min/1.73 m 2 , P = 0.736), proteinuria, and histology in protocol biopsies. Treatment discontinuation was higher among patients receiving SRL or EVR (18.6% versus 15.6% versus 6.7%, P = 0.054). CONCLUSIONS De novo use of SRL or EVR, targeting similar therapeutic blood concentrations, shows comparable efficacy and safety. The reduced incidence of CMV infection/disease and distinct safety profile of mTORi versus mycophenolate were confirmed in this study.
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Affiliation(s)
| | | | | | | | | | | | | | - Renato de Marco
- Immunogenetics Institute, Associação Fundo de Incentivo à Pesquisa, São Paulo, Brazil
| | - Maria Gerbase de Lima
- Immunogenetics Institute, Associação Fundo de Incentivo à Pesquisa, São Paulo, Brazil
| | | | - Wilson Ferreira Aguiar
- Hospital do Rim, Fundação Oswaldo Ramos, São Paulo, Brazil
- Urology Division, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Jose Medina-Pestana
- Hospital do Rim, Fundação Oswaldo Ramos, São Paulo, Brazil
- Nephrology Division, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Helio Tedesco-Silva
- Hospital do Rim, Fundação Oswaldo Ramos, São Paulo, Brazil
- Nephrology Division, Universidade Federal de São Paulo, São Paulo, Brazil
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Ferreira AN, Felipe CR, Cristelli M, Viana L, Mansur J, de Paula M, Wagner D, de Marco R, Gerbase-DeLima M, Proença H, Aguiar W, Medina-Pestana J, Tedesco-Silva Junior H. Prospective randomized study comparing everolimus and mycophenolate sodium in de novo kidney transplant recipients from expanded criteria deceased donor. Transpl Int 2019; 32:1127-1143. [PMID: 31278785 DOI: 10.1111/tri.13478] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 03/25/2019] [Accepted: 06/26/2019] [Indexed: 12/12/2022]
Abstract
The optimal immunosuppressive regimen for recipients of expanded criteria donor (ECD) kidneys has not been identified. In this single-center study, 171 recipients of ECD kidney transplants were randomized to receive antithymocyte globulin induction, and delayed introduction of reduced dose tacrolimus, prednisone and everolimus (r-ATG/EVR, n = 88), or mycophenolate (r-ATG/MPS, n = 83). No cytomegalovirus (CMV) pharmacological prophylaxis was used. The primary endpoint was the incidence of CMV infection/disease at 12 months. Secondary endpoints included treatment failure [first biopsy-proven acute rejection (BPAR), graft loss, or death] and safety. Patients treated with EVR showed a 89% risk reduction (13.6 vs. 71.6%; HR 0.11, 95% CI 0.06-0.220, P < 0.001) in the incidence of first CMV infection/disease. Incidences of BPAR (16% vs. 5%, P = 0.021), graft loss (11% vs. 1%, P = 0.008), death (10% vs. 1%, P = 0.013), and treatment discontinuation (40% vs. 28%, P = 0.12) were higher in the r-ATG/EVR, leading to premature study termination. Mean glomerular filtration rate was lower in r-ATG/EVR (31.8 ± 18.8 vs. 42.6 ± 14.9, P < 0.001). In recipients of ECD kidney transplants receiving no CMV pharmacological prophylaxis, the use of everolimus was associated with higher treatment failure compared with mycophenolate despite the significant reduction in the incidence of CMV infection/disease (ClinicalTrials.gov.NCT01895049).
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Affiliation(s)
| | - Claudia Rosso Felipe
- Nephrology Division, Hospital do Rim, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Marina Cristelli
- Nephrology Division, Hospital do Rim, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Laila Viana
- Nephrology Division, Hospital do Rim, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Juliana Mansur
- Nephrology Division, Hospital do Rim, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Mayara de Paula
- Nephrology Division, Hospital do Rim, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Daniel Wagner
- Infectious Diseases Division, Hospital do Rim, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Renato de Marco
- Immunogenetics, Instituto de Imunogenética - AFIP, São Paulo, Brazil
| | | | - Henrique Proença
- Pathology Division, Hospital do Rim, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Wilson Aguiar
- Urology Division, Hospital do Rim, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Jose Medina-Pestana
- Nephrology Division, Hospital do Rim, Universidade Federal de São Paulo, São Paulo, Brazil
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Santos DW, Proença H, Medina-Pestana JO, Rangel ÉB. Fungal sinusitis in simultaneous pancreas-kidney transplant. J Clin Pathol 2019; 72:720. [PMID: 31358535 DOI: 10.1136/jclinpath-2018-205258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 05/28/2018] [Accepted: 06/26/2018] [Indexed: 11/03/2022]
Affiliation(s)
- Daniel W Santos
- Nephrology Department, Federal University of São Paulo/Hospital do Rim e Hipertensão, Sao Paulo, SP, Brazil
| | - Henrique Proença
- Nephrology Department, Federal University of São Paulo/Hospital do Rim e Hipertensão, Sao Paulo, SP, Brazil
| | - Jose O Medina-Pestana
- Nephrology Department, Federal University of São Paulo/Hospital do Rim e Hipertensão, Sao Paulo, SP, Brazil
| | - Érika B Rangel
- Nephrology Department, Federal University of São Paulo/Hospital do Rim e Hipertensão, Sao Paulo, SP, Brazil.,Instituto de Ensino e Pesquisa, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
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Tavares MG, Cristelli MP, Ivani de Paula M, Viana L, Felipe CR, Proença H, Aguiar W, Wagner Santos D, Tedesco‐Silva Junior H, Medina Pestana JO. Early hospital readmission after kidney transplantation under a public health care system. Clin Transplant 2019; 33:e13467. [DOI: 10.1111/ctr.13467] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 11/27/2018] [Accepted: 12/02/2018] [Indexed: 12/15/2022]
Affiliation(s)
| | | | - Mayara Ivani de Paula
- Nephrology Division, Hospital do Rim Federal University of São Paulo São Paulo Brazil
| | - Laila Viana
- Nephrology Division, Hospital do Rim Federal University of São Paulo São Paulo Brazil
| | - Claudia Rosso Felipe
- Nephrology Division, Hospital do Rim Federal University of São Paulo São Paulo Brazil
| | - Henrique Proença
- Nephrology Division, Hospital do Rim Federal University of São Paulo São Paulo Brazil
| | - Wilson Aguiar
- Nephrology Division, Hospital do Rim Federal University of São Paulo São Paulo Brazil
| | - Daniel Wagner Santos
- Nephrology Division, Hospital do Rim Federal University of São Paulo São Paulo Brazil
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Abstract
PURPOSE To evaluate serum prolactin levels in Behçet disease (BD) and correlate with phenotypic expression of the disease. METHODS This was a prospective, nonrandomized comparative trial. Twenty-two patients fulfilling BD Research Committee criteria and 21 healthy control subjects were included. Patients were classified in complete-type or incomplete-type BD subgroups according to clinical characteristics such as recurrent oral ulcers, genital ulcers, skin lesions, and ocular disease. Age, sex, HLA phenotyping, and therapy were recorded for comparative analysis between groups. Serum prolactin levels were determined by electrochemiluminescence immunoassay on a Modular Analytics E170 analyzer. RESULTS Prolactinemia was significantly higher (mean=19.34 ng/mL) in BD patients vs controls (mean=9.83 ng/mL) (p=0.009). This value was also statistically higher in complete-type BD sub-group vs controls (p=0.02). Younger patients (<30 y) required corticosteroids plus immunosuppressives more often (75%), suggesting an association between age and disease severity, al-though not statistically significant. CONCLUSIONS Results suggest the role of prolactin in BD pathogenesis and its association with disease expression, especially in complete-type BD.
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Affiliation(s)
- H Proença
- Department of Ophthalmology, Visual Sciences Research Centre, University of Lisbon, Lisbon, Portugal.
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Affiliation(s)
- H. Proença
- Department of Ophthalmology, Visual Sciences Research Centre, University of Lisbon, Lisbon - Portugal
| | - C. Ferreira
- Department of Ophthalmology, Visual Sciences Research Centre, University of Lisbon, Lisbon - Portugal
| | - M. Miranda
- Department of Ophthalmology, Visual Sciences Research Centre, University of Lisbon, Lisbon - Portugal
| | - A. Castanheira-Dinis
- Department of Ophthalmology, Visual Sciences Research Centre, University of Lisbon, Lisbon - Portugal
| | - M. Monteiro-Grillo
- Department of Ophthalmology, Visual Sciences Research Centre, University of Lisbon, Lisbon - Portugal
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Bouatou Y, Kers J, Chevalier-Florquin MSN, Claessen N, Nguyen TQ, Damman J, Proença H, Roelofs JJTH, Florquin S. Diagnostic accuracy of immunofluorescence versus immunoperoxidase staining to distinguish immune complex-mediated glomerulonephritis and C3 dominant glomerulopathy. Histopathology 2017; 72:601-608. [PMID: 28881045 DOI: 10.1111/his.13385] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 09/03/2017] [Indexed: 11/29/2022]
Abstract
AIMS The technique used for classification of membranoproliferative glomerulonephritis (MPGN) has been changed from an electron microscopy-based to an immunofluorescence (IF)-based semiquantitative technique with immunoperoxidase (IP) staining as a backup option when IF is not possible. Since data on that matter is lacking, our aims were to study the interobserver variability, the correlation and the reclassification of MPGN based on these two techniques. METHODS AND RESULTS We retrospectively analysed cases of type 1 MPGN. We repeated IF staining and performed IP staining for IgG, kappa, lambda, C3c and C4d in 35 renal biopsies, among which 19 biopsies had matched IP and IF samples. We observed substantial to near-perfect agreement among the seven observers for both IF and IP (W coefficients from 0.66 for IF lambda to 0.89 for IF C4d). Of the 19 cases with matched IP and IF samples, five (26%) turned out to have different diagnoses on IF and on IP. Also, the ability of C4d to discriminate immune complex-mediated glomerulonephritis (ICGN) from C3 glomerulopathy (C3G) was poor, with areas under the curve of 0.44 [95% confidence interval (CI) 0.24-0.63] and 0.66 (95% CI 0.50-0.81) for the receiver operating characteristic curves of IF and IP respectively. Limitations include the fact that no clinical data regarding complement activation were available. CONCLUSION The diagnosis of ICGN versus C3GN depends on the immunochemical technique used. Also, the use of C4d failed to discriminate ICGN from C3G in our study. Further validation studies are required to avoid misdiagnosis based on kidney biopsy.
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Affiliation(s)
- Yassine Bouatou
- Department of Pathology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.,Division of Nephrology, Geneva University Hospitals, Geneva, Switzerland
| | - Jesper Kers
- Department of Pathology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Nike Claessen
- Department of Pathology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Tri Q Nguyen
- Department of Pathology, University Medical Centre Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - Jeffrey Damman
- Department of Pathology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Henrique Proença
- Department of Pathology, Hospital do Rim e Hipertensão, São Paulo, Brazil
| | - Joris J T H Roelofs
- Department of Pathology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Sandrine Florquin
- Department of Pathology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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Gama I, Proença H, Gonçalves A, Faria M, Almeida L, Bernardo T, Couceiro R, Monteiro-Grillo M. Macular choroidal thickness after vitreoretinal surgery: Long-term effect of pars plana vitrectomy with and without encircling scleral buckling surgery. Arch Soc Esp Oftalmol 2017; 92:577-584. [PMID: 28684047 DOI: 10.1016/j.oftal.2017.03.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 02/27/2017] [Accepted: 03/20/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE To evaluate the macular choroidal thickness (CT) of eyes subjected to pars plana vitrectomy (PPV) whether or not combined with encircling scleral buckling (ESB) surgery for primary rhegmatogenous retinal detachment repair at 6 months or more after surgery. METHODS This observational study included: 15 eyes (15 patients) submitted to combined ESB+PPV; 15 eyes submitted to PPV and their respective 30 normal fellow eyes (FE). Two 6mm lineal perpendicular optical coherence tomography B-scans centred on the fovea with enhanced depth imaging were performed on each eye. CT was measured at several macular locations: subfoveal (SF-CT) and at a radius of 1, 2, and 3mm from the fovea. CTs of the eyes in the CE+PPV group were compared to CT in the PPV group and the CTs of all operated eyes were compared to the CTs of their FE. RESULTS SF-CT of the eyes in the ESB+PPV group was significantly increased compared to their FE (P=.001). CT at a radius of 1, 2, and 3mm from the fovea of the ESB+PPV group were significantly increased (P=.001, P=.005, and P=.001, respectively). The SF-CT of the PPV group was similar to their FE (P=.691). The SF-CT of the ESB+PPV group was significantly increased compared to SF-CT of the PPV group (P=.019). CONCLUSIONS The CT of the eyes subjected to combined ESB and PPV was significantly increased at 6 months or more after surgery compared to the CT of their FE and to the CT of the eyes subjected to PPV alone, which could be explained by a venous engorgement caused by the ESB.
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Affiliation(s)
- I Gama
- Servicio de Oftalmología, Clínica Universitaria de Oftalmología, Hospital Santa Maria, Centro Hospitalario Lisboa Norte, Lisboa, Portugal; Facultad de Medicina, Universidad de Lisboa, Lisboa, Portugal.
| | - H Proença
- Servicio de Oftalmología, Clínica Universitaria de Oftalmología, Hospital Santa Maria, Centro Hospitalario Lisboa Norte, Lisboa, Portugal; Facultad de Medicina, Universidad de Lisboa, Lisboa, Portugal
| | - A Gonçalves
- Servicio de Oftalmología, Clínica Universitaria de Oftalmología, Hospital Santa Maria, Centro Hospitalario Lisboa Norte, Lisboa, Portugal; Facultad de Medicina, Universidad de Lisboa, Lisboa, Portugal
| | - M Faria
- Servicio de Oftalmología, Clínica Universitaria de Oftalmología, Hospital Santa Maria, Centro Hospitalario Lisboa Norte, Lisboa, Portugal; Facultad de Medicina, Universidad de Lisboa, Lisboa, Portugal
| | - L Almeida
- Servicio de Oftalmología, Clínica Universitaria de Oftalmología, Hospital Santa Maria, Centro Hospitalario Lisboa Norte, Lisboa, Portugal; Facultad de Medicina, Universidad de Lisboa, Lisboa, Portugal
| | - T Bernardo
- Servicio de Oftalmología, Clínica Universitaria de Oftalmología, Hospital Santa Maria, Centro Hospitalario Lisboa Norte, Lisboa, Portugal
| | - R Couceiro
- Facultad de Medicina, Universidad de Lisboa, Lisboa, Portugal; Servicio de Oftalmología, Hospital de Vila Franca de Xira, Vila Franca de Xira, Portugal
| | - M Monteiro-Grillo
- Servicio de Oftalmología, Clínica Universitaria de Oftalmología, Hospital Santa Maria, Centro Hospitalario Lisboa Norte, Lisboa, Portugal; Facultad de Medicina, Universidad de Lisboa, Lisboa, Portugal
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Ferreira A, Felipe C, Cristelli M, Viana L, Basso G, Stopa S, Mansur J, Ivani M, Bessa A, Ruppel P, Aguiar W, Campos E, Gerbase-DeLima M, Proença H, Tedesco-Silva H, Medina-Pestana J. Donor-Specific Anti-Human Leukocyte Antigens Antibodies, Acute Rejection, Renal Function, and Histology in Kidney Transplant Recipients Receiving Tacrolimus and Everolimus. Am J Nephrol 2017; 45:497-508. [PMID: 28511172 DOI: 10.1159/000475888] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 04/12/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND This analysis compared efficacy, renal function, and histology in kidney transplant recipients receiving tacrolimus (TAC) combined with everolimus (EVR) or mycophenolate (MPS). METHODS This was a retrospective analysis from a randomized trial in kidney transplant recipients who received a single 3 mg/kg dose of rabbit antithymocyte globulin (r-ATG), TAC, EVR, and prednisone (PRED; r-ATG/EVR, n = 85), basiliximab (BAS), TAC, EVR, and PRED (BAS/EVR, n = 102) or BAS, TAC, MPS, and PRED (BAS/MPS, n = 101). We evaluated the incidence of de novo donor-specific anti-human leukocyte antigens antibodies (DSA) and histology on protocol biopsies at 12 months, and the incidence of acute rejection, estimated glomerular filtration rate (eGFR) and proteinuria at 36 months. RESULTS At 12 months, there were no differences in de novo DSA (6.4 vs. 3.4 vs. 5.5%) or in subclinical inflammation (2.0 vs. 4.8 vs. 10.2%), interstitial fibrosis/tubular atrophy (57.1 vs. 58.5 vs. 53.8%) and C4d deposition (2.0 vs. 7.3 vs. 2.6%). At 36 months, there were no differences in the incidence of treatment failure (19.0 vs. 27.7 vs. 27.7%, p = 0.186), first biopsy-proven acute rejection (9.5 vs. 21.8 vs. 16.8%, p = 0.073), and urine protein/creatinine ratios (0.53 ± 1.05 vs. 0.62 ± 0.75 vs. 0.71 ± 1.24). eGFR was lower in the BAS/EVR compared to that in the BAS/MPS group (53.4 ± 20.9 vs. 50.8 ± 19.5 vs. 60.7 ± 21.2 mL/min/1.73 m2, p = 0.017) but comparable using a sensitive analysis (49.5 ± 23 vs. 47.5 ± 22.6 vs. 53.6 ± 27.8 mL/min/1.73 m2, p = 0.207). CONCLUSION In this cohort, the use of EVR and reduced TAC concentrations were associated with comparable efficacy, renal function, and histological parameters compared to the standard-of-care immunosuppressive regimen.
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Affiliation(s)
- Alexandra Ferreira
- Nephology Division, Hospital do Rim, Universidade Federal de São Paulo, São Paulo, Brazil
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Cordeiro Sousa D, Leal I, Couceiro R, Bigotte Vieira M, Lopez N, Resina C, Neves F, Gomes da Costa A, Pinto F, Marques-Neves C, Proença H. Changes in choroidal thickness and mean ocular perfusion pressure with hemodialysis. Acta Ophthalmol 2016. [DOI: 10.1111/j.1755-3768.2016.0626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Leal I, Cordeiro Sousa D, Couceiro R, Bigotte Vieira M, Noélia L, Resina C, Neves F, Gomes da Costa A, Pinto F, Marques-Neves C, Proença H. Ultrafiltration rate in hemodialysis does not affect mean ocular perfusion pressure or intraocular pressure in end-stage renal disease. Acta Ophthalmol 2016. [DOI: 10.1111/j.1755-3768.2016.0495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Paramés F, Paulo S, Barbeiro P, Sampaio J, Proença H, Melo-Cristino J. Prevalence of hepatitis delta virus infection among hepatitis b virus surface antigen positive patients diagnosed in a Central Hospital in Portugal, a 5 years retrospective study. J Clin Virol 2016. [DOI: 10.1016/j.jcv.2016.08.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Calhaz-Jorge C, Leal F, Cordeiro I, Proença H, Barata M, Pereira-Coelho AM. Pituitary down-regulation in IVF cycles: is it necessary to use strict criteria? J Assist Reprod Genet 1995; 12:615-9. [PMID: 8580660 DOI: 10.1007/bf02212585] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
PURPOSE In a retrospective study we have reviewed the data of 570 consecutive IVF cycles in which a GnRH agonist (GnRHa) was started in the early follicular phase (long protocol). Cycles were divided in groups according to estradiol levels before HMG administration: A, < 20 pg/ml; B, 20 to 50 pg/ml; C, 51 to 100 pg/ml. Our objective was to determine if the degree of pituitary suppression had any effect on the ovarian response to stimulation by exogenous gonadotropins, and/or on the IVF outcome. RESULTS There were no significant differences in cycle cancellation rates, no. of days of stimulation and ampoules of HMG, serum estradiol after HMG, no. of oocytes retrieved and fertilization rates between groups. Pregnancy rates (19.4%, 21% and 31.8%/cycle, and 24.1%, 27.5% and 37.8% / embryo transfer, respectively) and live-birth rates (16.2%, 16.1% and 25.0%/cycle, 20.1%, 21.2% and 29.7%/embryo transfer, respectively) were also not significantly different. CONCLUSIONS The degree of pituitary suppression had no effects on either the ovarian response to gonadotropins (including HMG requirements) or the overall IVF results.
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Affiliation(s)
- C Calhaz-Jorge
- Department of Obstetrics and Gynecology, Santa Maria's Hospital, Lisboa, Portugal
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14
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Cordeiro I, Calhaz-Jorge C, Barata M, Leal F, Proença H, Coelho AM. [The effect of the woman's age, the rate of cleavage and embryo quality on obtaining a pregnancy by in-vitro fertilization]. ACTA MEDICA PORT 1995; 8:145-50. [PMID: 7484241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Multiple factors influence the probability of obtaining a pregnancy through in vitro fertilization (IVF) and embryo transfer (ET). This retrospective study was designed to assess their importance in order to improve prognostic ability and treatment success. 341 consecutive embryo transfer cycles using the same ovarian stimulation protocol were considered and divided in two main groups: 92 cycles in which a clinical pregnancy was achieved and 249 cycles without success. All the embryo transfers were performed in patients from the in vitro fertilization program of the Human Reproductive Unit, Santa Maria Hospital, Lisbon, between January 1991 and December 1993. No significant differences were found between the two groups studied concerning the IVF indications, ovarian response to the stimulation, sperm quality, oocyte maturation and mean number of oocytes retrieved per patient. The women's age was higher in the group which did not achieve a pregnancy, when compared with the pregnant group (p < 0.001), showing a decline of success after the age of 35. Overall oocyte fertilization rate was 88.2% in cycles with pregnancy and 83.5% in cycles without pregnancy (p < 0.02). In the pregnant patients, there was a significantly higher rate of embryo transfers in which all the embryos received had reached at least the four-cell stage at 42-43 hr postinsemination, compared with the non pregnant patients (82% versus 63%, p < 0.001). All the 92 pregnancies originated from transfers of at least one embryo that had undergone two or more mitotic divisions.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- I Cordeiro
- Unidade Pluridisciplinar de Reprodução Humana, Hospital de Santa Maria, Lisboa
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Araujo e Sá G, Proença H, Sassetti L, Lopes S, Barros FB, Rosa FC. [Urinary calcium, magnesium and uric acid in normal children]. ACTA MEDICA PORT 1992; 5:128-30. [PMID: 1595379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In a group of 327 normal children, aged 4 to 11, we measured Calcium (Ca) and Creatinine (Cr) in the second morning urine. In 226 of them, Magnesium (Mg) and Uric Acid (UA) were also calculated. Means and SD were respectively Ca/Cr: 0.11 +/- 0.09, Mg/Cr: 0.10 +/- 0.03, Mg/Ca: 1.56 +/- 1.48 and UA/Cr: 0.093 +/- 0.29. Distribution was not normal, so we used the 97.5 centile for the upper acceptable limit. This value was higher for Ca/Cr (0.37) and different for Mg/Cr (0.17), compared to the previous reports. Our values of Mg/Ca were related to age (p less than 0.01). These results suggest the need for local establishment of normal ranges and a better definition of hypercalciuria and hypermagnesiuria.
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Affiliation(s)
- G Araujo e Sá
- Unidade de Nefrologia Pediátrica, Hospital de Santa Maria, Universidade de Lisboa
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