Diagnostic Algorithm for Intracranial Lesions in the Emergency Department: Effectiveness of the Relative Brain Volume and Hounsfield Unit Value Measured by Perfusion Tomography.

Background Early treatment of intracranial lesions in the emergency department is crucial, but it can be challenging to differentiate between them. This differentiation is essential because the treatment of each type of lesion is different. Cerebral computed tomography perfusion (CTP) imaging can help visualize the vascularity of brain lesions and provide absolute quantification of physiological parameters. Compared to magnetic resonance imaging, CTP has several advantages, such as simplicity, wide availability, and reproducibility. Purpose This study aimed to assess the effectiveness of Hounsfield units (HU) in measuring the density of hypercellular lesions and the ability of CTP to quantify hemodynamics in distinguishing intracranial space-occupying lesions. Methods A retrospective study was conducted from March 2016 to March 2022. All patients underwent CTP and CT scans, and relative cerebral blood volume (rCBV) and HU were obtained for intracranial lesions. Results We included a total of 244 patients in our study. This group consisted of 87 (35.7%) individuals with glioblastomas (GBs), 48 (19.7%) with primary central nervous system lymphoma (PCNSL), 45 (18.4%) with metastases (METs), and 64 (26.2) with abscesses. Our study showed that the HUs for METs were higher than those for GB (S 57.4% and E 88.5%). In addition, rCBV values for PCNSL and abscesses were lower than those for GB and METs. The HU in PCNSL was higher than those in abscesses (S 94.1% and E 96.6%). Conclusion PCT parameters provide valuable information for diagnosing brain lesions. A comprehensive assessment improves accuracy. Combining rCBV and HU enhances diagnostic accuracy, making it a valuable tool for distinguishing between lesions. PCT's widespread availability allows for the use of both anatomical and functional information with high spatial resolution for diagnosing and managing brain tumor patients.

Anterior Scleral Thickness and Anterior Segment Biometrics Measured with Swept Source Ocular Coherence Tomography in High Myopic Eyes with and without Glaucoma: A Comparative Study.

Background: To assess the anterior scleral thickness (AST), Schlemm's canal diameter (SCD), trabecular meshwork diameter (TMD) and conjunctiva tenon capsule thickness (CTT) in high myopic (HM) subjects and HM subjects with glaucoma (HMG) compared to control eyes. Methods: One hundred and twenty eyes were included, and AST at 0, 1, 2 and 3 mm from the scleral spur, SCD, TMD and CTT were measured. Results: Mean age was 64.2 ± 11.0 years, and the temporal SCD and temporal TMD were significantly longer in the HMG subjects compared to the controls (380.0 ± 62 µm vs. 316.7 ± 72 µm, p = 0.001) and (637.6 ± 113 µm vs. 512.1 ± 97 µm, p = 0.000), respectively. There were no significant differences between the HM and HMG subjects in SCD and TMD (all p > 0.025). Compared to the HM subjects, the temporal AST0 (432.5 ± 79 µm vs. 532.8 ± 99 µm, p = 0.000), temporal AST1 (383.9 ± 64 µm vs. 460.5 ± 80 µm, p = 0.000), temporal AST2 (404.0 ± 68 µm vs. 464.0 ± 88 µm, p = 0.006) and temporal AST3 (403.0 ± 80 µm vs. 458.1 ± 91 µm, p = 0.014) were significantly thinner in the HMG group. No differences were found between the CTT in the three groups (all p > 0.025). Conclusions: Our data indicate a thinner AST in HMG subjects and no differences in SCD and TMD between HM and HMG subjects.

Influence of posterior staphyloma in myopic maculopathy and visual prognosis.

BACKGROUND/OBJECTIVES: Posterior staphyloma is a hallmark of high myopia and its presence associates to greater degrees of myopic maculopathy. Nonetheless, its development, repercussion on visual function and relationship with maculopathy components, is still unclear. The objective was to analyze the impact of posterior staphyloma on the incidence and severity of myopic maculopathy and its repercussion on visual prognosis. SUBJECTS/METHODS: Cross-sectional study conducted on 473 consecutive eyes of 259 highly myopic patients examined at Puerta de Hierro-Majadahonda University Hospital (Madrid, Spain). All patients underwent complete ophthalmologic examination including best corrected visual acuity (BCVA), axial length (AL), myopic maculopathy classification according to ATN system (atrophic/traction/neovascularization), determined the presence of posterior staphyloma, pathologic myopia (PM) and severe PM. Multimodal imaging were performed including fundus photography, optical coherence tomography (OCT), OCT-angiography, fundus autofluorescence and/ or fluorescein angiography. RESULTS: Out of the total, 70.65% were female patients (n = 173/259), mean BCVA was 0.41 ± 0.54 logMAR units and mean AL was 29.3 ± 2.6 mm (26-37.6). Posterior staphyloma was present in 69.4% of eyes. Eyes with posterior staphyloma compared to non-staphyloma were older (p < 0.05), had greater AL (p < 0.01), worse BCVA (p < 0.01) and higher stage in ATN components (p < 0.01). Moreover, compound subgroup showed worse BCVA (p < 0.01) and greater stage in each of the ATN components (p < 0.01). Staphylomas with macular involvement presented worse BCVA (p < 0.01), higher AL (p < 0.01), and greater ATN (p < 0.05). The risk of posterior staphyloma presence in eyes with PM and severe PM eyes was 89.8% and 96.7%, respectively. Posterior staphyloma was the best predictor for BCVA in myopic patients (p < 0.01). CONCLUSIONS: Posterior staphyloma's presence determines high risk of myopic maculopathy and therefore worse visual prognosis, especially those with macular involvement. Posterior staphyloma represented the best predictor for BCVA in highly myopic patients.

Analysis of Bilaterality and Symmetry of Posterior Staphyloma in High Myopia.

The purpose of this study was to examine bilaterality and symmetry of posterior staphyloma (PS) in high myopic eyes. Methods: This cross-sectional and non-interventional study assessed 473 high myopic eyes [axial length (AL) ≥ 26 mm] of 259 patients. Patients underwent an ophthalmological examination including multimodal-imaging and myopic maculopathy grading according to Atrophic/Tractional/Neovascular (ATN) system, presence and subtype of PS, and severe pathologic myopia (PM). Bilaterality of PS and subtype's symmetry between eyes of the same patient was assessed. Four groups were analyzed: (1) bilateral vs. unilateral PS's eyes. Within bilateral group, symmetric vs. asymmetric subtypes according to (2) Curtin's classification, (3) Ohno-Matsui's classification, and (4) primary/compound subtypes. Results: Out of the total, 334 myopic eyes of 167 patients were included. The 92.8% (n = 310/334) of the eyes presented PS and was bilateral in 85.6% (n = 143/167) of the patients. Bilateral eyes showed significantly (p < 0.01) greater AL, severe PM, A and N components vs. unilateral PS. AL-difference between both eyes was greater in unilateral PS (p < 0.01). Among bilateral PS, the subtype was symmetric in 79 (55.2%), 84 (58.7%), and 115 (80.4%) patients according to Curtin's classification, Ohno-Matsui's classification, and primary/compound; respectively. The asymmetric group presented worse best-corrected visual acuity (p < 0.01), higher AL (p < 0.01), incidence of PM, and severe PM (p < 0.05). Conclusions: PS was bilateral in most of the patients without clinical differences between both eyes, being symmetrical in more than half of bilateral cases. Patients with bilateral PS showed higher myopic maculopathy, AL, and incidence of severe PM than unilateral PS.

Relative cerebral blood volume as response predictor in the treatment of recurrent glioblastoma with anti-angiogenic therapy.

BACKGROUND: Glioblastoma is one of the most common brain tumors in adult populations, usually carrying a poor prognosis. While several studies have researched the impact of anti-angiogenic therapies, especially anti-VEFG treatments in glioblastoma, few have attempted to assess its progress using imaging studies. PURPOSE: We attempted to analyze whether relative cerebral blood volume (rCBV) from dynamic susceptibility-weighted contrast-enhanced MRI (DSC-MRI) could predict response in patients with glioblastoma undergoing Bevacizumab (BVZ) treatment. METHODS: We performed a retrospective study evaluating patients with recurrent glioblastoma receiving anti-angiogenic therapy with BVZ between 2012 and 2017 in our institution. Patients were scheduled for routine MRIs at baseline and first-month follow-up visits. Studies were processed for DSC-MRI, cT1, and FLAIR images, from which relative cerebral blood volume measurements were obtained. We assessed patient response using the Response Assessment in Neuro-Oncology (RANO) working group criteria and overall survival. RESULTS: 40 patients were included in the study and were classified as Bevacizumab responders and non-responders. The average rCBV before treatment was 4.5 for both groups, and average rCBV was 2.5 for responders and 5.4 for non-responders. ROC curve set a cutoff point of 3.7 for rCBV predictive of response to BVZ. Cox Multivariate analysis only showed rCBV as a predictive factor of OS. CONCLUSION: A statistically significant difference was found in rCBV between patients who responded and those who did not respond to BVZ treatment. rCBV may be a low-cost and effective marker to assess response to Bevacizumab treatment in GBM.

ASSESSMENT AND ROLE OF ARTERY-VEIN COMPLEX IN MYOPIC CHOROIDAL NEOVASCULARIZATION USING OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY.

PURPOSE: To analyze the presence of an artery-vein complex (AVC) underneath myopic choroidal neovascularization (mCNV) and to determine its relationship with neovascular activity. METHODS: Retrospective analysis of 681 eyes from 362 patients with high myopia defined by an axial length of >26 mm using optical coherence tomography (OCT) and OCT angiography imaging. Patients with clinical diagnosis of mCNV and good quality OCT angiography images were then selected. An AVC was defined by the identification of both perforating scleral vessels and dilated choroidal veins under or in contact with the mCNV in the same case. Swept source OCT (SS-OCT) and SS-OCT angiography images (TRITON; Topcon Corporation, Tokyo, Japan) were reviewed to detect AVC in the mCNV area. RESULTS: Fifty eyes of 49 highly myopic patients with mCNV were analyzed. Eyes with AVC were statistically older (69.95 ± 13.53 vs. 60.83 ± 10.47 years old; P < 0.01), needed less intravitreal injections/year along the follow-up period (0.80 ± 0.62 vs. 1.92 ± 0.17; P < 0.01), and showed less relapses/year (0.58 ± 0.75 vs. 0.46 ± 0.42; P < 0.05) when compared with eyes without AVC. Moreover, eyes with AVC were less likely to relapse during the first year from mCNV activation (n = 5/14 vs. n = 14/16; P < 0.01; P < 0.01). No significant differences were found regarding either axial length (30.55 ± 2.31 vs. 29.65 ± 2.24, P > 0.05) or best-corrected visual acuity (0.4 ± 0.5 vs. 0.4 ± 0.5 Logarithm of the Minimum Angle of Resolution (logMAR), P > 0.05) between groups. CONCLUSION: AVC complex has an influence over myopic choroidal neovascularization activity resulting in less aggressive neovascular lesions than those with perforating scleral vessels only.

Dual polarization Fourier transform processor using geometric-phase lenses.

This work presents a novel optical system for polarization image processing using geometric-phase (Pancharatnam-Berry) lenses. Such lenses are half-wave plates where the orientation of the fast (slow) axis follows a quadratic relation with the radial coordinate, and they present the same focal length but opposite sign for left and right circular polarizations. Therefore, they split an input collimated beam in a converging beam and a diverging beam with opposite circular polarizations. This coaxial polarization selectivity introduces a new degree of freedom in optical processing systems and makes it interesting for imaging and filtering applications that require polarization sensitivity. Here we profit from these properties to build an optical Fourier filter system with polarization sensitivity. A telescopic system is used to have access to two real Fourier transform planes, one for each circular polarization. A second symmetric optical system is used to recombine the two beams onto a single final image. As a result, polarization sensitive optical Fourier filtering can be applied, as demonstrated with simple bandpass filters.

Update on the Utility of Optical Coherence Tomography in the Analysis of the Optic Nerve Head in Highly Myopic Eyes with and without Glaucoma.

Glaucoma diagnosis in highly myopic subjects by optic nerve head (ONH) imaging is challenging as it is difficult to distinguish structural defects related to glaucoma from myopia-related defects in these subjects. Optical coherence tomography (OCT) has evolved to become a routine examination at present, providing key information in the assessment of glaucoma based on the study of the ONH. However, the correct segmentation and interpretation of the ONH data employing OCT is still a challenge in highly myopic patients. High-resolution OCT images can help qualitatively and quantitatively describe the structural characteristics and anatomical changes in highly myopic subjects with and without glaucoma. The ONH and peripapillary area can be analyzed to measure the myopic atrophic-related zone, the existence of intrachoroidal cavitation, staphyloma, and ONH pits by OCT. Similarly, the lamina cribosa observed in the OCT images may reveal anatomical changes that justify visual defects. Several quantitative parameters of the ONH obtained from OCT images were proposed to predict the progression of visual defects in glaucoma subjects. Additionally, OCT images help identify factors that may negatively influence the measurement of the retinal nerve fiber layer (RNFL) and provide better analysis using new parameters, such as Bruch's Membrane Opening-Minimum Rim Width, which serves as an alternative to RNFL measurements in highly myopic subjects due to its superior diagnostic ability.

Posterior Staphyloma as Determining Factor for Myopic Maculopathy.

PURPOSE: The aim of this study was to determine the influence of posterior staphyloma (PS) on the development of myopic maculopathy. DESIGN: Cross-sectional study. METHODS: A total of 467 highly myopic eyes (axial length [AL] ≥26 mm) of 246 patients were included. Patients underwent a complete ophthalmological examination, including multimodal imaging. Presence of PS was defined as the main variable analyzed between groups (PS vs non-PS): age, AL, best-corrected visual acuity (BCVA), atrophy/traction/neovascularization (ATN) components, and presence of severe pathologic myopia (PM). Two different cohorts were studied (age-matched and AL-matched) comparing PS vs non-PS eyes. RESULTS: In all, 325 eyes (69.59%) presented with PS. Eyes without PS were younger and had lower AL, ATN components, and prevalence of severe PM than those with PS (P < .001). Moreover, non-PS eyes had better BCVA (P < .001). Analyzing the age-matched cohort (P = .96); mean AL, A, and T components, and severe PM were significantly higher in the PS group (P < .001), as well as the N component (P < .005), showing worse BCVA (P < .001). Regarding the AL-matched cohort (P = .93), the PS group showed worse BCVA (P < .01), older age (P < .001), A (P < .001), and T components (P < .01), and severe PM (P < .01). The risk of PS increased by 10% per year of age (odds ratio = 1.109, P < .001) and by 132% per each millimeter of growth of AL (odds ratio = 2.318, P < .001). CONCLUSIONS: Posterior staphyloma is associated with myopic maculopathy, worse visual acuity, and higher prevalence of severe PM. AL and age, in this order, constitute the main factors associated with the onset of PS.

Atrophic, Tractional, and Neovascular Grading System in a Dome-Shaped Macula and Ridge-Shaped Macula Highly Myopic Cohort.

INTRODUCTION: The aim of this study was to analyze the atrophic, tractional, and neovascular (ATN) components grading in highly myopic patients with dome-shaped macula (DSM) and ridge-shaped macula (RSM). METHODS: This was a cross-sectional, noninterventional study. 57 eyes of 38 different patients were included. They were classified as DSM or RSM based on the number of radial scans that showed an inward protrusion ≥50 µm in the swept-source optical coherence tomography (SS-OCT) (12 = DSM; <12 = RSM). All patients underwent a complete ophthalmological examination in addition to SS-OCT. They were graded using the ATN system for myopic maculopathy by 2 masked retina specialists that assessed the atrophic (A), tractional (T), and neovascular (N) components in order to analyze the differences between the groups. As complementary measurements, age, axial length, and best-corrected visual acuity were collected. Height and orientation of the macular bulge and the presence of Bruch's membrane defects, scleral perforating vessels, and staphyloma were recorded. RESULTS: Out of total 57 eyes, 13 eyes (22.8%) were classified as DSM. Regarding the atrophic component (A), there were statistically significant differences between groups, with DSM group showing a greater stage of atrophy (predominantly stage A3 in 69.2% of the sample) compared to the RSM group (predominantly stage A2 in 61.3% of the sample) (p < 0.05). For the T and N components, there were no significant differences between groups. The presence of Bruch's membrane defects was more frequently seen in DSM (p < 0.05). CONCLUSIONS: DSM group showed more Bruch's membrane defects and a greater stage of the atrophy component, based on the ATN grading system, compared with RSM group. As Bruch's membrane may have biomechanical properties in terms of strength, the defects found around the macula, added to the major atrophic component, may be a cause of a local relaxation that induce a central bulge forming the dome.

Retrieving the phase of diffraction orders generated with tailored gratings.

A technique is performed to quantitatively evaluate the intensity and phase of the diffraction orders generated by tailored phase gratings displayed onto a liquid-crystal spatial light modulator (LC-SLM). The SLM displays the grating together with a lens to obtain the Fourier transform. The setup is converted into a polarization common-path interferometer by simply rotating a polarizer. This configuration allows a phase-shifting interferometry algorithm to be applied to retrieve the phase of the diffraction orders. The quadratic phase arising in the system, which must be subtracted, is calibrated using triplicator gratings of varying periods. Various tailored designs with controlled phase shift between diffraction orders are experimentally tested to prove the advantage and simplicity of the technique.

OPHTHALMOLOGIC INVOLVEMENT IN PATIENTS WITH HEREDITARY TRANSTHYRETIN AMYLOIDOSIS.

PURPOSE: The aim of this study was to determine the ophthalmologic involvement in patients with hereditary transthyretin amyloidosis and its correlation with the mutations described in the literature. METHODS: Cross-sectional, noninterventional study. Fifty-two eyes of 26 consecutive patients diagnosed with hereditary transthyretin amyloidosis who visited the Puerta de Hierro-Majadahonda University Hospital from September 2019 to March 2022. All patients underwent complete ophthalmologic examination and multimodal imaging. Cardiologic, neurologic, digestive, and renal examinations were also recorded. RESULTS: Eighteen eyes of the total (34.61%) showed amyloid-related ocular involvement, vitreous amyloid deposits being the most common ocular manifestation (18/52). Statistically significant differences were found for the presence of vitreous amyloid deposits ( P < 0.01), crystalline amyloid deposits ( P < 0.05), parenchymal amyloid deposits ( P < 0.01), and vascular alterations ( P < 0.01) when comparing affected and unaffected eyes. Moreover, affected eyes showed worse best-corrected visual acuity ( P < 0.01). CONCLUSION: Ocular manifestations are present in a substantial number of patients with ATTR that could potentially lead to devastating consequences to patients' best-corrected visual acuity and quality of life. Therefore, it is important to emphasize the importance of multidisciplinary management and ophthalmologic assessment, follow-up and surgical treatment when necessary. To the best of our knowledge, this represents the largest series in Spain of amyloidosis' ophthalmologic involvement.

A Modeled High-Density Fed-Batch Culture Improves Biomass Growth and ß-Glucans Accumulation in Microchloropsis salina.

Algae and microalgae are used as a source of different biomolecules, such as lipids and carbohydrates. Among carbohydrates, polysaccharides, such as ß-glucans, are important for their application as antioxidants, antisepsis, and immunomodulators. In the present work, the ß-glucans production potential of Microchloropsis salina was assessed using two different culture conditions: a high-density batch and a modeled high-density fed-batch. From the biochemical parameters determined from these two cultures conditions, it was possible to establish that the modeled high-density fed-batch culture improves the biomass growth. It was possible to obtain a biomass productivity equal to 8.00 × 10-2 ± 2.00 × 10-3 g/(L × day), while the batch condition reached 5.13 × 10-2 ± 4.00 × 10-4 g/(L × day). The same phenomenon was observed when analyzing the ß-glucans accumulation, reaching volumetric productivity equal to 5.96 × 10-3 ± 2.00 × 10-4 g of product/(L × day) against the 4.10 × 10-3 ± 2.00 × 10-4 g of product/(L × day) obtained in batch conditions. These data establish a baseline condition to optimize and significantly increase ß-glucan productivity, as well as biomass, adding a new and productive source of this polymer, and integrating its use in potential applications in the human and animal nutraceutical industry.

Assessing the Malignancy Risk of a Meningioma by Its Location.

BACKGROUND: Meningiomas represent 30% of primary intracranial tumors. The current incidence is up to 4.5 cases per 100,000 habitants worldwide. Although there is no prognostic difference among benign histopathological subtypes, atypical meningiomas and malignant meningiomas (WHO grade II and III respectively) may extend to the adjacent brain parenchyma, dura mater, and osseous tissue with a recurrence score (21-49%). This manuscript analyzes the malignancy risk according to neoplastic localization through a logistic retrospective analysis from a total sample of 452 patients with grade I, II, and III (WHO) meningiomas. METHODS: Detailed data collection through a three-year retrospective analysis (January 2008 to December 2011) was applied at Mexico's National Neurology and Neurosurgery Institute including patients with intracranial or spinal-cord meningioma, preoperative imaging study availability and post-surgical histopathological diagnosis. Formal written consent was not required with a waiver by the appropriate national research ethics committee in accordance with the provisions of the regulations of the general health law of Mexico. RESULTS: Convexity lesions displayed an increased risk of malignancy turning for non-benign meningiomas with an odds ratio of 3.1 (95% CI 1.6 to 5.7, p=0.0002) meanwhile skull-base meningiomas present an inverse risk with an odds ratio of 0.4 (95% CI 0.2 to 0.9, p=0.02), as well as spinal-cord meningiomas with an odds ratio of 0.3 (95% CI 0.1 to 0.9). CONCLUSION: Skull base and spinal cord meningiomas usually have benign behavior, meanwhile grade II or III meningiomas within this location are rare. The present work provides an additional criterion for decision making, according to the meningioma's location.

Clinical, Therapeutic, and Prognostic Experience in Patients With Glioblastoma.

BACKGROUND: Glioblastoma (GB) represents the most aggressive type of glioma with a poor prognosis despite the therapies used. As of today, data availability for therapeutic and prognosis experiences is limited. The cornerstone for this study is to create a framework overview of Mexico´s experience throughout 17 years of research. METHODS: Retrospective analysis from 2000 to 2017 including patients with a histological diagnosis of GB was performed. Data were collected from the ABC Medical Center and the Neurology and Neurosurgery National Institute. RESULTS: One hundred and thirty-seven patients were included with a mean age of 54 years. Histological diagnosis was made in all patients, of which 58.1% had a total resection, 31.6% had a partial resection, and 10.3% of them underwent biopsy. In all cases, patients received treatment under the following conditions: 10 patients were treated exclusively with stereotactic radiotherapy (RT). In 55 patients, a combination of RT and TMZ was used, the other 40 patients received RT plus CBP. Eighteen patients RT added to nitrosourea medication and lastly, 14 patients received a combination of RT/TMZ and Bevacizumab, a monoclonal antibody that inhibits the formation of blood vessels (BVZ). The progression-free survival (PFS) and overall survival (OS) were higher in the RT/TMZ/BVZ group (16.5 to 22.9 months) and the RT/TMZ group (11 to 17 months), the prognostic parameters included: Isocitrate dehydrogenase 1 mutation (IDH1), usage of BVZ and TMZ in the PLS and OS, considering as well, age range (<70 years) as a favorable prognostic factor. CONCLUSIONS: GB represents the most frequent intracranial neoplasia. Combined fractionated stereotactic RT added to Temozolomide and Bevacizumab received in our population reports favorable and superior results compared to the ones described in the literature. Further studies are necessary to know the biological behavior of our population.

Safeguarding human-wildlife cooperation.

Human-wildlife cooperation occurs when humans and free-living wild animals actively coordinate their behavior to achieve a mutually beneficial outcome. These interactions provide important benefits to both the human and wildlife communities involved, have wider impacts on the local ecosystem, and represent a unique intersection of human and animal cultures. The remaining active forms are human-honeyguide and human-dolphin cooperation, but these are at risk of joining several inactive forms (including human-wolf and human-orca cooperation). Human-wildlife cooperation faces a unique set of conservation challenges, as it requires multiple components-a motivated human and wildlife partner, a suitable environment, and compatible interspecies knowledge-which face threats from ecological and cultural changes. To safeguard human-wildlife cooperation, we recommend: (i) establishing ethically sound conservation strategies together with the participating human communities; (ii) conserving opportunities for human and wildlife participation; (iii) protecting suitable environments; (iv) facilitating cultural transmission of traditional knowledge; (v) accessibly archiving Indigenous and scientific knowledge; and (vi) conducting long-term empirical studies to better understand these interactions and identify threats. Tailored safeguarding plans are therefore necessary to protect these diverse and irreplaceable interactions. Broadly, our review highlights that efforts to conserve biological and cultural diversity should carefully consider interactions between human and animal cultures. Please see AfricanHoneyguides.com/abstract-translations for Kiswahili and Portuguese translations of the abstract.

Expert Panel Consensus for Addressing Anti-VEGF Treatment Challenges of Diabetic Macular Edema in Spain.

Purpose: The treatment of diabetic macular edema (DME) has evolved rapidly in the past decade, highlighting the need to address the challenges of routine clinical practice decision-making through expert consensus agreements. Methods: After a literature review and discussion of real-world experience on DME management, a group of ten retina specialists agreed on a consensus of recommendations for the most appropriate management of DME patients using vascular endothelial growth factor inhibitors (anti-VEGF) in Spain. Results: The panel recommended early treatment initiation in DME patients with worse baseline visual acuity (VA) to maintain or improve outcome. For patients with good VA, an observation strategy was recommended, considering the presence of diabetic retinopathy, optical coherence tomography biomarkers, and impact on patient's quality of life. Based on the available evidence and clinical experience, the panel recommended the use of anti-VEGF intensive loading doses with the objective of achieving anatomic and visual responses as soon as possible, followed by a Treat & Extend (T&E) strategy to maintain VA improvement. Aflibercept was recommended for patients with a baseline decimal VA <0.5, followed by a T&E strategy, including the possibility to extend frequency of injections up to 16 weeks. Conclusion: An expert panel proposes a consensus for the management of DME in Spain. Early treatment initiation with anti-VEGF in DME patients is recommended to maintain or improve VA; aflibercept is recommended for patients with a poor baseline VA.

Organic mulching modulated native populations of entomopathogenic nematode in vineyard soils differently depending on its potential to control outgrowth of their natural enemies.

The entomopathogenic nematodes (EPNs) are biological control agents that are widespread in crop soils. However, traditional agricultural management practices such as cultivation and agrochemical usage can alter the soil balance that enables their occurrence and activity. Alternative strategies like mulching are commonly employed to prevent weed growth, enhance below-ground biodiversity by improving soil, organic matter content, fertility, and moisture. We hypothesized that organic mulches would favor biotic conditions for nematofauna development in crop soil, including EPNs, compared to herbicide application or tillage. Traditional (insect baits) and molecular (qPCR analysis) tools were used in this study to assess the abundance and activity of native EPNs, and the abundance of potential natural enemies, such as free-living nematode (FLN) competitors, nematophagous fungi (NF), and ectoparasitic bacteria, in soils managed with different organic mulches or traditional practices. As a model agroecosystem, we selected the vineyard, one of the most intensively managed crop systems. We compared mulches of grape pruning debris (GPD-M), straw (Str-M), and spent mushroom compost (SMC-M) in two commercial vineyards, which employed either integrated or organic pest and disease management. Following a completely randomized design, we retrieved two composite samples per plot (n = 3 per treatment in each vineyard) in April, June, and October 2020. Numbers of EPNs and selected members of their soil food web were higher in the organic than the integrated managed vineyard. Supporting our hypothesis, organic mulching overall favored nematode occurrence in both vineyards. We found higher NF abundance for Str-M, and GPD-M in the organic vineyard, which plausibly explained the lower EPN activity and occurrence compared to SMC-M in both vineyards. We conclude that the organic mulches can provide appropriate conditions for increasing nematofauna numbers but, depending on the mulch type, may also adversely affect EPNs by increasing their natural enemies. Our findings highlight the need to explore alternative farming practices to unravel complex biotic interactions that affect beneficial soil organisms in agroecosystems.

The economic burden of pulmonary arterial hypertension in Spain.

BACKGROUND: Pulmonary Arterial Hypertension (PAH) is a rare, debilitating, and potentially fatal disease. This study aims to quantify the economic burden of PAH in Spain. METHODS: The study was conducted from a societal perspective, including direct and indirect costs associated with incident and prevalent patients. Average annual costs per patient were estimated by multiplying the number of resources consumed by their unit cost, differentiating the functional class (FC) of the patient. Total annual costs per FC were also calculated, taking the 2020 prevalence and incidence ranges into account. An expert committee validated the information on resource consumption and provided primary information on pharmacological consumption. Unit costs were estimated using official tariffs and salaries in Spain. A deterministic sensitivity analysis was conducted to test the uncertainty of the model. RESULTS: The average annual total cost was estimated at €98,839 per prevalent patient (FC I-II: €65,233; FC III: €103,736; FC IV: €208,821), being €42,110 for incident patients (FC I-II: €25,666; FC III: €44,667; FC IV: €95,188). The total annual cost of PAH in Spain, taking into account a prevalence between 16.0 and 25.9 cases per million adult inhabitants (FC I-II 31.8%; FC III 61.3%; FC IV 6.9%) and an incidence of 3.7, was estimated at €67,891,405 to €106,131,626, depending on the prevalence considered. Direct healthcare costs accounted for 64% of the total cost, followed by indirect costs (24%), and direct non-healthcare costs (12%). The total costs associated with patients in FC I-II ranged between €14,161,651 and €22,193,954, while for patients in FC III costs ranged between €43,763,019 and €68,391,651, and for patients in FC IV between €9,966,735 and €15,546,021. In global terms, patients with the worst functional status (FC IV) account for only 6.9% of the adults suffering from PAH in Spain, but are responsible for 14.7% of the total costs. CONCLUSIONS: PAH places a considerable economic burden on patients and their families, the healthcare system, and society as a whole. Efforts must be made to improve the health and management of these patients since the early stages of the disease.