The reality of an Obesity Surgical Treatment Center in Portugal

Introduction: Obesity surgery is used as the most effective treatment for morbid obesity, with better cost-benefit, less morbidity and mortality. The present study aimed to analyze the results of a surgical center for obesity treatment and integrate them with the most recent scientific evidence. Methods: Retrospective cross-sectional observational study involving 270 patients aged 18 years or older, who underwent bariatric surgery between July 2008 and February 2020 in a private hospital in Portugal. Results: The sample presented an average age of 44 ± 12 years, being mostly female (83.7%). The average pre-surgery Body Mass Index was 41.1 ± 4.9 kg/m2 . The most performed surgery was Gastric Bypass (80.4%), followed by Gastric Banding (14.8%) and Gastric Sleeve (4.8%). One month after surgery, there was a percentage of excess weight lost (% EWL) of 25.2 ± 9.6%. After 6 months, there was an average % EWL of 67.2 ± 23.2%. One year after surgery, the average % EWL was 75.7 ± 25.7%, the average Body Mass Index was 29.3 ± 4.6 kg/m2 and the average weight loss percentage was 29.5 ± 9.4%. Conclusion: Gastric Bypass is the mostly performed surgery, because it is the Gold Standard method for surgical treatment of obesity in this center. On average, all surgeries performed have extremely positive results of excess weight lost. After 1 year, patients maintained an average weight loss percentage of 29.5 ± 9.4%, in line with data presented in a study that estimated an average recorded weight loss percentage of 28.9%. Data like those presented by the American Society for Nutrition (ASN), the Obesity Action Coalition (OAC), the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO), the International Society for the Perioperative Care of the Obese Patient (ISPCOP) and the American Society for Parenteral and Enteral Nutrition (ASPEN) (2019), indicate a target weight loss percentage between 20 and 45%.info:eu-repo/semantics/publishedVersio

Food Intake in Pregnant Women with Gestational Diabetes Mellitus

Rationale: The aim of the present study was to verify the fulfillment of the nutritional requirements of macronutrients of pregnant women diagnosed with Gestational Diabetes Mellitus (GDM) at Lusíadas Lisboa Hospital. Inadequate glycemic control in GDM increases the risk of maternal, fetal and neonatal consequences, in this sense, nutritional therapy is essential during the follow-up of these pregnant women. Methods: Cross-sectional observational study. The study sample included 20 pregnant women diagnosed with GDM. Participants were asked to answer a questionnaire that included relevant data and to complete a three-day food record, for which they gave consent. A statistical analysis was performed with IBM® SPSS® 25. Results: The mean age measured was 35±4 years and 75% of the sample were in the 3º trimester. In the pre-gestational period, the sample had a Body Mass Index (BMI) of 26,2±5,3kg/m2 . The mean fasting capillary blood glucose was 89±9mg/dL and the postprandial was 119±19mg/dL. 75% reached the fasting glycemic objective and 95% the postprandial. It was also found that pregnant women who didn´t meet the goal set for fasting blood glucose, had higher pre-gestational BMI. In terms of macronutrients, it was found that 75% of the sample didn´t reach Total Energy Requirements (TER), 50% didn´t reach protein (1,1g/kg of current weight/day and 15-20% TER), 10% lipid (30% TER) and all carbohydrates (50-55% TER), with only 35% reaching the daily minimum of carbohydrates (175g). It was also found that sample didn´t reach 28g/day of fiber. Conclusions: The present study demonstrated the importance of an individualized nutritional intervention by a nutritionist with pregnant women diagnosed with GDM. The importance of this intervention is based on adherence to an adequate dietary pattern that prevents nutritional deficits, enhances clinical outcomes and contributes to the prevention of the incidence of GDM.info:eu-repo/semantics/publishedVersio

Non-Orthogonal Refractive Lenses for Non-Orthogonal Astigmatic Eyes.

Purpose: To present a novel design method for non-orthogonal lenses to reduce the problem of residual astigmatism in non-orthogonal, astigmatic eyes Methods: A method to create spectacle trial lenses with non-orthogonal power axes was developed based on a novel optimised light ray-tracing algorithm rather than conventional lens design methods which could not fully eliminate spherical aberration. Using this method, three sets of refraction trial lenses were made with the angles between power axes of each set controlled at 80°, 70° and 60°, respectively. Within each set, the cylindrical power varied from -1.00 D to -6.00 D in 1.00 D steps in addition to a -0.50 D lens. Computer-based numerical simulation of the lenses optical performance was carried out to apply orthogonal and non-orthogonal lenses on simulated astigmatic eyes. Subsequently, three clinical trial cases were investigated. Results: Computer-simulated optical performance of non-orthogonal lenses showed the ability to achieve high performance in correcting non-orthogonal astigmatism. Subsequently, three patients with irregular astigmatism were refracted with the non-orthogonal lens sets, and clinically observed improvement at least two lines in the LogMAR chart was achieved in all three cases, compared with correction with orthogonal lenses, along with subjective improvement in image quality. Conclusions: Non-orthogonal astigmatism, which is commonly ignored by current eye prescription systems, is taken into account in this study in the design of spectacle and soft contact lenses. The new approach considers the possible non-orthogonal positions of the eye's two optical power meridians and appears to be better able to correct the vision of irregular astigmatic eyes and significantly reduce residual astigmatism

Positions of Ocular Geometrical and Visual Axes in Brazilian, Chinese and Italian Populations

ABSTRACTPurpose: To identify the relative positions of geometrical and visual axes of the eye and present a method to locate the visual center when the geometrical axis is taken as a reference.Meth..

Assessment of "social" and "economic" sustainability in peri-urban territories: A proposal of methodological framework and its application to Lisbon Metropolitan Area

Carried out within the framework of the multidisciplinary research project PERIURBAN (Peri-urban areas faced with the challenges of sustainability: developing scenarios for Lisbon Metropolitan Area) this article aims to propose, discuss and implement criteria for assessing the sustainability of peri-metropolitan territories at the social and economic level, starting from its application to the specific case of 5 parishes in Lisbon Metropolitan area.info:eu-repo/semantics/publishedVersio

The Efficiency of Using Mirror Imaged Topography in Fellow Eyes Analyses of Pentacam HR Data

Purpose: To investigate the effectiveness of flipping left corneas topography and analysethem quantitively along with fellow right corneas based on the assumption that they are mirror images of each other. Methods: The study involved scanning both eyes of 177 healthy participants (aged 35.3 ± 15.8) and 75 keratoconic participants (aged 33.9 ± 17.8). Clinical tomography data were collected for both eyes using the Pentacam HR and processed by a fully automated custom-built MATLAB code. For every case, the right eye was used as a datum fixed surface while the left cornea was flipped around in the superior–inferior direction. In this position, the root-mean-squared difference (RMS) between the flipped left cornea and the right cornea was initially determined for both the anterior and posterior corneal surfaces. Next, the iterative closest point transformation algorithm was applied on the three-dimensional flipped cornea to allow the flipped left corneal anterior surface to translate and rotate, minimising the difference between it and the right corneal anterior surface. Then, the RMS differences were recalculated and compared. Results: A comparison of the dioptric powers showed a significant difference between the RMS of both the flipped left eyes and the right eyes in the healthy and the KC groups (p Conclusions: Although fellow eyes are highly related in their clinical parameters, they should be treated with care when one eye topography is flipped and processed with the other eye topography in an optic-related research analysis where translation might be needed. In KC, an asymmetric disease, it was observed that a portion of the asymmetry was due to a corneal apex shift interfering with the image acquisition. Therefore, transforming the flipped left eyes by rotation and translation results in a fairer comparison between the fellow KC corneas

Limbus misrepresentation in parametric eye models

PurposeTo assess the axial, radial and tangential limbus position misrepresentation when parametric models are used to represent the cornea and the sclera.MethodsThis retrospective study included 135 subjects aged 22 to 65 years (36.5 mean ±9.8 STD), 71 females and 64 males. Topography measurements were taken using an Eye Surface Profiler topographer and processed by a custom-built MATLAB code. Eye surfaces were freed from edge-effect artefacts and fitted to spherical, conic and biconic models.ResultsWhen comparing the radial position of the limbus, average errors of -0.83±0.19mm, -0.76±0.20mm and -0.69±0.20mm were observed within the right eye population for the spherical, conic and biconic models fitted up to 5mm. For the same fitting radius, the average fitting errors were -0.86±0.23mm, -0.78±0.23mm and -0.73±0.23mm for the spherical, conic and biconic models respectively within the left eye population. For the whole cornea fit, the average errors were -0.27±0.12mm and -0.28±0.13mm for the spherical models, -0.02±0.29mm and -0.05±0.27mm for the conic models, and -0.22±0.16mm and 0.24±0.17mm for the biconic models in the right and left eye populations respectively.ConclusionsThrough the use of spherical, conic and biconic parametric modelling methods, the eye's limbus is being mislocated. Additionally, it is evident that the magnitude of fitting error associated with the sclera may be propagating through the other components of the eye. This suggests that a corneal nonparametric model may be necessary to improve the representation of the limbus

Characterization of cone size and centre in keratoconic corneas

A novel method to locate the centre of keratoconus (KC) and the transition zone between the pathological area and the rest of the corneal tissue is proposed in this study. A spherical coordinate system was used to generate a spherical height map measured relative to the centre of the optimal sphere fit, and normal to the surface. The cone centre was defined as the point with the maximum height. Second derivatives of spherical height were then used to estimate the area of pathology in an iterative process. There was mirror symmetry between cone centre locations in both eyes. The mean distance between cone centre and corneal apex was 1.45 ± 0.25 mm (0.07–2.00), the mean cone height normal to the surface was 37 ± 23 µm (2–129) and 75 ± 45 µm (5–243) in the anterior and posterior surfaces, respectively. There was a significant negative correlation between the cone height and the radius of the sphere of optimal fit (p < 0.05 for both anterior and posterior surfaces). On average, posterior cone height was larger than the corresponding anterior cone height by 37 ± 24 µm (0–158). The novel method proposed can be used to estimate the cone centre and area, and explore the changes in anterior and posterior corneal surfaces that take place with KC progression. It can help improve understanding of keratoconic corneal morphology and assist in developing customized treatments

Performance of Zernike polynomials in reconstructing raw-elevation data captured by Pentacam HR, Medmont E300 and Eye Surface Profiler

PURPOSE: To investigate the capability of Zernike polynomials fitting to reconstruct corneal surfaces as measured by Pentacam HR tomographer, Medmont E300 Placido-disc and Eye Surface Profiler (ESP). METHODS: The study utilised a collection of clinical data of 527 participants. Pentacam HR raw elevation data of 660 eyes (430 healthy and 230 keratoconic) were fitted to Zernike polynomials of order 2 to 20. Same analyses were carried out on 158 eyes scanned by Medmont E300 Placido-disc and 236 eyes were scanned by ESP for comparison purposes. The Zernike polynomial ​fitting was carried out using a random 80% of each individual eye surface's data up to a corneal radius of 5 mm and the root means squared fitting error (RMS) was calculated for the unused 20% portion of the surface data. The process was carried out for the anterior and posterior surfaces of the corneal measurements of the Pentacam HR and the anterior surfaces only with the ESP and the Medmont E300 measurements. RESULTS: Statistical significances in reduction of RMS were noticed up to order 14 among healthy participants (p < 0.0001 for right eyes, p = 0.0051 for left eyes) and up to order 12 (p < 0.0001 for right eyes, p = 0.0002 for left eyes) in anterior surfaces measured by the Pentacam. Among keratoconic eyes, statical significance was noticed up to order 12 in both eyes (p < 0.0001 for right eyes, p = 0.0003 for left eyes). The Pentacam posterior corneal data, both right and left, healthy and keratotic eyes recorded significance (p < 0.0001) in reduction of RMS up to order 10 with same RMS values of 0.0003 mm with zero standard deviation. RMS of fitting Zernike polynomials to Medmont data up to order 20 showed a consistent reduction in RMS with the increase of the fitting order with no rise at high fitting orders. Minimum RMS = 0.0047 ± 0.0021 mm, 0.0046 ± 0.0019 mm for right and left eyes respectively were recorded at order 20 and were more than 15 times the minimum RMS of the Pentacam. RMS of fitting Zernike polynomials to ESP data also showed a consistent reduction in RMS with the increase of the fitting order with no sign of any rise at high fitting orders. Similar to the Medmont, minimum RMS of 0.0005 ± 0.0003 mm, 0.0006 ± 0.0003 mm was recorded at order 20 for right and left eyes respectively and was 2 times the minimum RMS of the Pentacam for right eyes and 1.7 times the minimum RMS of the Pentacam for left eyes. CONCLUSIONS: Orders 12 and 10 Zernike polynomials almost perfectly matched the raw-elevation data collected from Pentacam for anterior and posterior surfaces, respectively for either healthy or keratoconic corneas. The Zernike fitting could not perfectly match the data collected from Medmont E300 and ESP