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Trabalhos Publicados em Revistas Nacionais ou Internacionais com Arbitragem Científica de Drª. Sofia Santareno

Está registada com o Open Researcher and Contributor ID (ORCID) 0000-0002-3793-4718. Durante o
Internato Complementar de Cirurgia Plástica publicou dois trabalhos científico em revistas internacionais com
arbitragem científica.


1) Concept of Anatomic Columellar Strut Grafting in Rhinoplasty: An Algorithmic Approach.
Santareno S, Taş S.
Aesthet Surg J. 2019 Nov 1. pii: sjz272.
doi: 10.1093/asj/sjz272.PMID: 31675056


The use of a columellar strut in rhinoplasty is a powerful tool in order to achieve stability of the tip. Here, some surgical options about strut grafting have been demonstrated for a more natural appearance. The new columellar strut should be suitable for the natural columellar anatomy taking in consideration not only the interdomal and columellarlobular angles, but also the middle crus angle. Based on our clinical experience and best surgical knowledge, the anatomic γ columellar strut concept of rhinoplasty is described, as well as its approach algorithm, in order to obtain an aesthetic and supported tip.


Keywords: Anatomic, columella, nose, rhinoplasty, strut, tip

 


2) Lyell's Syndrome and Antimalarials: A Case Report and Clinical Review.
Nunes JM, Santareno S, Guerreiro L, Margalho AF.
Journal of Global Infectious Diseases. 2017 Jan-Mar;9(1):23-30.
doi: 10.4103/0974-777X.199994 PMID: 28250622


Toxic epidermal necrolysis (TEN) or Lyell's syndrome is a rare, however, life-threatening mucocutaneous disorder with an epidermal detachment of a total body surface area (TBSA) of >30%. It is triggered by an idiosyncratic immune-allergic reaction to a drug, with many possible drugs implicated. Treatment success relies on early diagnosis and withdrawal of suspected/causative drug(s) and supportive care. Clinical evidence for specific therapies is still sparse. It is described a case of Lyell syndrome by sulfonamides for chemoprophylaxis of malaria. The patient presented with an extensive, rapidly evolving skin detachment, which progressed, despite supportive therapy, involving about 80% of TBSA. This led us to initiate a course of immunoglobulin with good clinical response. The aim of this work is to provide a discussion of the case and simultaneously make a practical literature review of TEN.

Keywords: Immunoglobulin; Lyell syndrome; malaria; sulfonamides; toxic epidermal necrolysis

3) Papel do tecido adiposo e dos macrófagos no estado de inflamação crónica associado a obesidade – Implicações clínicas (Artigo de Revisão)
Santareno S, Cerqueira J., Cruz J., Português J., Guimarães R.
Acta Médica Portuguesa. 2008 Sep-Oct; 21:489-496. PMID: 19187692


Nas últimas décadas, a transformação do estilo de vida, e em particular a mutação dos padrões alimentares, determinou uma pandemia sem precedentes na história da Humani- dade – a obesidade. Num passado recente, as únicas funções significativas atribuídas ao tecido adiposo eram o armazenamento e a libertação de ácidos gordos. Actualmente, encontra-se bem documentado que o tecido adiposo também contribui para a produção de moléculas pró-inflamatórias (citocinas, adipocinas e factores quimiotáticos) envolvi- das no estado de inflamação crónica sistémica de baixo índice observado na obesidade. Os adipócitos têm um papel activo no estabelecimento deste estado inflamatório quer pela produção de mediadores inflamatórios (adipocinas) quer pela sua interacção célula- acélula com os macrófagos residentes. O tecido adiposo é igualmente pouco vascularizado e a proporção do fluxo encontra-se ainda mais diminuída em indivíduos obesos, podendo a hipoxia ser um factor crítico no aparecimento do estado inflamatório associado à obesi- dade. Estes dois tipos celulares interagem, não só pela potenciação da produção de citocinas e proteínas de fase aguda pelo tecido adiposo e outros tecidos, mas também pela conversão de pré-adipócitos a macrófagos. Os macrófagos, um dos componentes do sistema fagocítico mononuclear, desempenham um papel dominante no estado de infla- mação crónica associada à obesidade. Estas células encontram-se proporcionalmente aumentadas em número e tamanho no tecido adiposo em função do Índice de Massa Corporal, podendo atingir cerca de 60% dos componentes deste tecido. A acumulação proporcional dos macrófagos com o aumento da quantidade e do tamanho dos adipócitos poderá conduzir ao aumento da expressão de moléculas pró-inflamatórias e contribuir, de forma significativa, para este estado inflamatório.

Quanto à reversão do estado inflamatório observado na obesidade, parece que a redução do Índice de Massa Corporal e consequente perda de tecido adiposo conduzem a uma redução da produção de citocinas e quimiocinas pró-inflamatórias e ao aumento de medi- adores anti-inflamatórios, com redução concomitante do risco de patologias associadas. O objectivo deste trabalho é descrever o impacto das interacções entre o tecido adiposo e os macrófagos no estado de inflamação crónica subjacente à obesidade e a sua implica- ção da génese de patologias associadas, efectuando uma revisão crítica da literatura científica dos últimos cinco anos.

 

Este artigo publicado em 2008 mas que foi alvo dum processo de roubo intelectual, tendo sido decretada a alteração da autoria com a devida correcção através de inquérito académico interno da Faculdade de Medicina do Porto. Neste momento o processo encontra-se concluído e foi publicado na errata na edição de Março 2020 da Acta Médica Portuguesa.

Encontram-se em processo de publicação ainda três outros artigos:

 


4) Dynamic video-photo studio: a major revolution in rhinoplasty documentation
Safaryan D, Santareno S, Taş S.
Annals of Plastic Surgery


Background: Photographic documentation of the nose is the standard for many rhinosurgeons around the world. One of the most challenging views for photo documentation is the frontal one: it requires special photographic skills and still may create bias. Our dynamic video recording allows us to increase the quality of our evaluation, make it more convenient and gives rise to a new era of rhinoplasty documentation database. Objectives: Our aim is to present our photo-video studio concept, which ensures standardized, high-quality documentation of the rhinoplasty patients. According to our best knowledge, this tool has not published before.


Methods: We´ve created a rotational platform that allows a dynamic evaluation of the patient under the same standardized photo settings (patient´s position, camera and lighting features) through a video recording. Results: We demonstrate that the quality of our rotational video is similar to the standardized photos. Plus, this dynamic evaluation helps to avoid Photoshop® edition which may result in bias.


Conclusions: This high quality evaluation takes photo-documentation in the modern era of rhinoplasty to the next level. It avoids several bias and is a great tool, not only for documentation of pre and post-surgical results, but also for educational purposes and presentations.


Keywords: photograph, video, studio, rhinoplasty, documentation, objective, evaluation

 


5) Non surgical rhinoplasty guidelines
Santareno S, Taş S.
Annals of Plastic Surgery


Initial reports of injectable contouring or nonsurgical rhinoplasty date back to the middle of the 1980s. They were abandoned due to some complications based on the filler properties at that time (silicone, parafine). The new dermal fillers (hyaluronic acids (HA) and calcium hydroxylapatite(CaHA)) are safe and have greater longevity and rheological properties. Though they remain an off-label application in the nose reshaping, nonsurgical rhinoplasty is becoming increasingly more popular since it’s a noninvasive method for nasal reshaping, with no down-time and low cost. Its off-the-shelf availibity also make them an attractive option to address some small contour irregularities after a surgical rhinoplasty. In this work, we will explore simplified but complete guidelines of the so called “nonsurgical rhinoplasty”.


Keywords: rhinoplasty, fillers, non-surgical, guidelines

6) Posterior reversible encephalopathy syndrome and digital gangrene in a patient with granulomatosis with polyangiitis – a rare case report
Santareno S, Taş S.
Annals of Plastic Surgery
Patrícia Martins1,2, Ana Valido,1,2, Ana Teresa Melo1,2, Sofia Santareno3, Rita Sousa4, João R. Inácio4, Filipa Oliveira-Ramos1,2, Cristina Ponte1,2, José Carlos Romeu1
1 – Serviço de Reumatologia e Doenças Ósseas Metabólicas, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Centro Académico de Medicina de Lisboa
2 – Unidade de Investigação em Reumatologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa
3 – Serviço de Cirurgia Plástica, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Centro Académico de Medicina de Lisboa
4 – Serviço de Imagiologia, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Centro Académico de Medicina de Lisboa
498/500 words; 5/5 references


Introduction: Granulomatosis with Polyangiitis (GPA) is an antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), classically associated with the presence of proteinase 3 (PR3)-ANCA.1 GPA has a wide range of clinical manifestations, involving almost every organ, particularly upper respiratory tract, lungs and kidneys. One of its rarest manifestations is digital ischemia or gangrene that accounts for <1% of cases.2 Posterior reversible posterior leukoencephalopathy syndrome (PRES) is a syndrome characterized by headache, visual changes, confusion, and seizures, accompanied by distinctive neuroimaging features, which are usually reversible. Rare cases of its association with vasculitis, including GPA, have been described.3


Case report: A 64-year-old female was referred for Rheumatology observation at a University Hospital due to a one-week history of a rapidly progressive decrease in strength and sensitivity of the left hand, and 2nd, 4th and 5th left toes, associated with pain, swelling, and digital discoloration. Over the last 18 months, she complained of weight-loss (30% of total body-weight), recurrent fever, arthralgia, purpura in the upper and lower limbs, and progressive decrease of lower limbs’ strength for which she underwent nerve biopsy showing necrotizing vasculitis of the small vessels and was started on 10 mg of prednisolone daily. She denied otorhinolaryngologic and cardiorespiratory symptoms. On physical examination, she was emaciated, with muscular atrophy, and presented purpuric lesions on extremities, necrosis of the 2nd, 4th, and 5th left toes (Fig. 1A-B), and necrosis of the 2nd to the 5th left fingers (Fig. 1C-D). Cardiopulmonary auscultation and abdominal examination were unremarkable.
Laboratory tests showed normocytic normochromic anemia (Hb 7.8 gm/dL), ESR 84 mm/hr, CRP 5.8 mg/dL, creatinine 3.71 mg/dL, active urine sediment with a 24-hour proteinuria of 1106 mg, and positive ANCA-PR3 (390.8 UQ); other relevant autoimmunity screens and laboratory workup for appropriate infectious agents were negative.
One-week after hospital admission, she developed dyspnea and episodes of diffuse headache with associated confusion. Chest X-Ray and computed tomography showed pulmonary infiltrates (Figure 2A-B), with subsequent bronchoscopy consistent with alveolar hemorrhage, and brain MRI revealed findings compatible with PRES (Figure 3A). The patient was classified as having GPA4 and treated initially with IV methylprednisolone (three pulses of 1g), followed by oral prednisone (1mg/kg/day) and rituximab (two pulses of 1g). Given the presence of alveolar hemorrhage, digital ischemia and PRES plasmapheresis was additionally started. The patient showed significant improvement of renal and pulmonary function and complete resolution of neurological symptoms; follow-up brain 
MRI demonstrated resolution of PRES changes (Figure 3B). Unfortunately, digital gangrene was irreversible, and patient underwent amputation of the necrotic areas (Figure 4).


Conclusion: PRES and digital ischemia or gangrene are unusual manifestations of GPA, a disease itself quite rare.
To the best of our knowledge, only 6 cases of GPA-associated PRES and 17 cases of GPA-associated digital ischemia or gangrene have been reported in the literature, none of which with patients presenting both features.2,3 It is crucial that cases of AAV are treated at reference centers with multidisciplinary expertise in the management of these diseases.5 In the present case, early diagnosis and treatment could have improved disease progression and outcome.


References:
1. Jennette JC, Falk RJ, Bacon PA, Basu N, Cid MC, Ferrario F, Flores-Suarez LF, Gross WL, Guillevin L, Hagen EC, Hoffman GS, Jayne DR, Kallenberg CGM, Lamprecht P, Langford CA, Luqmani RA, Mahr AD, Matteson EL, Merkel PA, Ozen S, Pusey CD, Rasmussen N, Rees AJ, Scott DGI, Specks U, Stone JH, Takahashi K, Watts RA. 2012 Revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Arthritis Rheum. 2013;65:1–11.
2. Lau RA, Bains R, Suraweera D, et al. A Rare Case of Digital Ischemia and Gangrene in ANCA-Associated Vasculitis with Review of the Literature. Case Rep Rheumatol. 2017; 2017:2421760.
3. Arteaga-Müller G, Camara-Lemarroy CR, Rizo-Topete L, Guerrero-González E, Sánchez-Martinez C, Cruz-Valdez J. Granulomatosis with polyangiitis and posterior reversible encephalopathy syndrome. J Neurol Sci.
2016;362:204–205.
4. Leavitt RY, Fauci AS, Bloch DA, et al. The American College of Rheumatology 1990 criteria for the classification of Wegener's granulomatosis. Arthritis Rheum. 1990;33(8):1101–1107.
5. Yates M, Watts RA, Bajema IM, et al. EULAR/ERA-EDTA recommendations for the management of ANCAassociated vasculitis. Annals of the Rheumatic Diseases. 2016;75:1583-1594.

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