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- The impact on productivity costs of reducing unemployment in patients with advanced breast cancer: A model estimation based on a Portuguese nationwide observational studyPublication . Vasconcelos de Matos, L; Borges, M; Oliveira, AT; Bulhosa, C; Miguel, LS; Fidalgo de Freitas, T; Cunha, R; Mendes, AD; Arede, AJ; Marques, C; Costa, DA; Correia, JA; Brito, M; Fontes e Sousa, M; Guimarães, T; Cardoso, FThis study aimed to characterize the employment status and work-related conditions of patients with advanced breast cancer (ABC) in Portugal and quantify the productivity costs of premature abandonment of the work market while evaluating strategies to promote employment. The analysis was based on a cumulative incidence model for estimation of ABC prevalence and on a cross-sectional study characterizing the employment status of patients with ABC. This study was conducted in Portuguese hospitals, between Nov2021-Dec2022 and included patients diagnosed with ABC for at least 6 months, aged 66 or less and consenting for a self-answered questionnaire regarding work status. A total of 2151 working-aged women were estimated to have ABC in 2019 in Portugal, with productivity costs amounting to 28,676,754€ over 2019-2021. 112 patients from 9 hospitals were included in the study, average age was 52yr, 48 % had a postsecondary educational degree level and 87 % reported having a paid job at the time of diagnosis, mostly full-time. At the time of the study, only 38 % of the patients maintained the job status. The remaining were unemployed (51 %), on medical leave (25 %) or retired (24 %). Stop working was a personal choice for only 5 %. A subsidized part-time employment regimen, despite increased government costs, would allow a reduction in productivity costs, leading to a positive balance of 2,431,329€ over the same period. This study suggests that the majority of patients with ABC abandon the labor market before the age of retirement. Flexible work arrangements would benefit the patient, the government and the society.
- Lumbar paraspinal intramuscular myxoma: A case reportPublication . Hipólito-Reis, J; Roque, D; Teixeira, JCBackground: With an estimated incidence of about 1 case/million patients, paravertebral intramuscular myxomas represent a rare cause of lumbar pain. Rather, they typically occur in the heart and in bone tissues. Case description: A 64-year-old female presented with a protracted course of nocturnal lumbar pain that radiated to the anterior aspect of the right thigh accompanied by numbness. She reported a slow-growing right paramedian lumbar mass in the previous months. The magnetic resonance (MR) showed a right lumbar paravertebral intramuscular mass at the L3 level (i.e., 70 × 50 mm) that had well-defined margins, and markedly enhanced with gadolinium. Following gross total "en bloc" tumor resection, the patient fully recovered. Pathologically, the myofibroblastic lesion proved to be an intramuscular myxoma without malignant changes. Conclusion: A 64-year-old female presented with a slow-growing MR-documented right paramedian lumbar L3 mass responsible for proximal right-thigh numbness. Following "en bloc" gross total removal of the benign intramuscular myxoma, the patient was asymptomatic.
- Secondary Endothelial Keratoplasty—A Narrative Review of the Outcomes of Secondary Corneal Endothelial AllograftsPublication . Moura-Coelho, N; Cunha, JP; Morral, M; Gris, O; Manero, F; Güell, JLBackground: We review the literature on the efficacy and safety outcomes of secondary Descemet stripping endothelial keratoplasty (DSEK) and Descemet membrane endothelial keratoplasty (DMEK). Methods: Literature search of English-written publications up to September 27, 2020 in PubMed database, using the terms "endothelial keratoplasty" in combination with keywords "secondary" or "repeat." In addition, we manually searched the references of the primary articles. Results: Twenty-seven studies (n = 651 eyes) were retained and reviewed, including 10 studies on repeat DSEK, 8 studies on repeat DMEK, 6 studies of DMEK following DSEK, and 3 studies of DSEK after failed DMEK. All studies reported significant improvement in visual acuity after secondary endothelial keratoplasty (EK). Twelve studies compared visual outcomes between primary and secondary EK, reporting conflicting findings. Sixteen studies reported endothelial cell loss rates after secondary EK, and only 1 study reported significantly increased endothelial cell loss rates compared with primary EK. Allograft rejection episodes occurred in 1.8% of eyes (range, 0%-50%). Six studies compared complication rates between primary and secondary EK eyes, and only 1 study found a higher median number of complications. However, 2 studies reported higher regraft failure rates compared with primary EK eyes. Conclusions: Secondary EK is surgically feasible and renders significant visual improvement after failed primary EK, although it is not clear whether visual outcomes and allograft survival are comparable with primary EK, raising the question of whether secondary EK eyes are "low risk" as primary EK eyes. Further larger, prospective studies are encouraged to obtain additional quality data on secondary corneal endothelial allotransplantation.
- DMEK for the treatment of interface fluid syndrome secondary to failed DSAEK graft: A case report and review of the literaturePublication . Moura-Coelho, N; Arrondo, E; Papa-Vettorazzi, MR; Cunha, JP; Güell, JLPurpose: To report a case of Descemet membrane endothelial keratoplasty (DMEK) for the management of post-laser in situ keratomileusis (LASIK) interface fluid syndrome (IFS) secondary to failed Descemet stripping automated endothelial keratoplasty (DSAEK) graft, and to provide a literature review on endothelial keratoplasty (EK) for this indication. Observations: A 52-year-old patient presented with LASIK interface fluid accumulation and a non-functioning primary DSAEK graft. Past ophthalmic history was relevant for: (1) phakic intraocular lens (PIOL) implantation with later refinement by LASIK; (2) combined PIOL explantation and refractive lens exchange due to accelerated endothelial cell loss (ECL); (3) primary DSAEK due to corneal decompensation.A secondary EK graft (DMEK) was performed, and the patient was prospectively followed for 6 months (M6). DMEK surgery was uneventful, without postoperative graft detachment. Corneal clearing and resolution of interface fluid accumulation occurred during the first postoperative month. Best-corrected visual acuity (BCVA) improved from 20/800 Snellen to 20/25 Snellen at 3-month follow-up, remaining stable at M6. Due to a persistent rise in intraocular pressure (IOP), the patient underwent uneventful non-penetrating deep sclerectomy 2 months after DMEK, with controlled IOP and without accelerated ECL. Conclusions and importance: DMEK is feasible, effective, and safe in the management of IFS in cases where corneal endothelial failure plays a major role, even in complex eyes with previous EK grafts. Aggressive postoperative IOP control is warranted to decrease the risk of interface fluid recurrence and damage to the optic nerve. Studies with larger patient numbers are encouraged to ascertain the role of EK for this indication.