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SUMMARY: Object. The following study was carried out in order to evaluate through guidelines the best evidence in occupational therapy for daily activities and quality of life of patients with hip prostheses. Methods. Recommendations were generated following the grading method of the National Program for Guidelines/National System Guidelines (PNLG-SNLG), a system for developing guidelines for recommendations in clinical practice. The Appraisal of Guidelines Research and Evaluation in Europe (AGREE) tool was also applied. Results. A total of seven studies were included in this research: one randomized controlled trial, two systematic reviews, two outcomes research studies, and two observational studies. We found that, for the three clinical questions we proposed, more research on the effectiveness of treatments is required. Conclusions. The evidence resulting from this study is not sufficient to determine whether the rehabilitation techniques under consideration are effective.
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Terapia Ocupacional , Europa (Continente) , Humanos , Evaluación de Resultado en la Atención de Salud , Calidad de VidaRESUMEN
PURPOSE: To analyze the changes in ganglion cell complex and peripapillary retinal nerve fiber layer thickness, in central macular thickness and choroidal thickness on spectral domain optical coherence tomography in patients with neovascular age-related macular degeneration treated with intravitreal ranibizumab injections. METHODS: All consecutive patients with untreated neovascular age-related macular degeneration received loading phase of three monthly intravitreal ranibizumab, followed by retreatments on a pro re nata protocol for 12 months. PRIMARY OUTCOME: changes in ganglion cell complex and retinal nerve fiber layer at the end of follow-up. Secondary outcome: changes in best-corrected visual acuity, central macular thickness, and choroidal thickness at the end of follow-up. Choroidal thickness was measured at 500 µm, 1000 µm, and 1,500 µm intervals nasally, temporally, superiorly, and inferiorly to the fovea, respectively, on horizontal and vertical line scans centered on the fovea. RESULTS: Twenty-four eyes were included. Ganglion cell complex and peripapillary retinal nerve fiber layer thickness did not show statistically significant changes through 12 months (55.6 ± 18.5 and 81.9 ± 9.9 µm at baseline, 52.7 ± 19.3 and 84.6 ± 15.5 µm at month 12, P > 0.05). Central macular thickness showed progressive decrease from baseline to month 12, with maximum reduction at month 3 (P < 0.001). Statistically significant reduction in choroidal thickness was registered in the nasal 500, 1000, and 1,500 µm from the fovea, corresponding to the papillomacular region (from 169.6 ± 45.3 to 153.9 ± 46.9, P < 0.001). CONCLUSION: Intravitreal ranibizumab injections did not affect retinal nerve fiber layer and ganglion cell complex thickness in 1-year follow-up. Choroidal thickness in papillomacular area and central macular thickness was significantly reduced at the end of treatment. Further studies, with larger sample, longer follow-up, and greater number of injections, are warranted.
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Fóvea Central/efectos de los fármacos , Fibras Nerviosas/efectos de los fármacos , Ranibizumab/administración & dosificación , Células Ganglionares de la Retina/efectos de los fármacos , Tomografía de Coherencia Óptica/mortalidad , Degeneración Macular Húmeda/tratamiento farmacológico , Anciano , Inhibidores de la Angiogénesis/administración & dosificación , Femenino , Angiografía con Fluoresceína , Fóvea Central/patología , Fondo de Ojo , Humanos , Inyecciones Intravítreas , Masculino , Fibras Nerviosas/patología , Células Ganglionares de la Retina/patología , Resultado del Tratamiento , Degeneración Macular Húmeda/diagnósticoRESUMEN
PURPOSE: To describe the morphological macular changes detected by spectral domain optical coherence tomography (SD-OCT) in eyes with retinitis pigmentosa (RP) and to analyze their correlation with the visual function. METHODS: Twenty-two patients (44 eyes) patients affected by RP were recruited. The following structures were evaluated on SD-OCT: outer plexiform layer (OPL), outer nuclear layer (ONL), external limiting membrane (ELM), photoreceptor inner/outer segment (IS/OS) junction, photoreceptor outer segment/retinal pigmented epithelium (OS/RPE) junction, inner limiting membrane thickening (ILMT), ganglion cell complex (GCC), and cystoid macular edema (CME). The relation between each SD-OCT finding and BCVA was evaluated at uni- and multivariate analysis. RESULTS: Mean age and mean best-corrected visual acuity (BCVA) were 51 ± 17.5 years and 0.4 ± 0.5 LogMAR, respectively. Univariate linear regression model revealed a correlation between BCVA and the absence of ELM, IS/OS, ONL, and OS/RPE layers (R (2) values were, respectively, 0.51, 0.57, 0.48, and 0.68, with p values all <0.0001). At multivariate regression analysis, the absence of OS/RPE and ELM layers remained the only variables independently associated with a decrease of BCVA (R (2) = 0.85, t = 3.49, p = 0.0014). CONCLUSIONS: Data show that in patients afflicted with RP, ELM and OS/RPE layers are independently associated with BCVA on multivariate regression analysis. These results highlight the key-role of external retinal layers in determining the visual function impairment attributable to RP.
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Retina/diagnóstico por imagen , Retinitis Pigmentosa/diagnóstico , Tomografía de Coherencia Óptica/métodos , Agudeza Visual/fisiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Retinitis Pigmentosa/cirugía , Índice de Severidad de la Enfermedad , VitrectomíaRESUMEN
PURPOSE: To assess agreement between one ultrasonic (US) and nine optical instruments for the measurement of central corneal thickness (CCT), and to evaluate intra- and inter-operator reproducibility. METHODS: In this observational cross-sectional study, two masked operators measured CCT thickness twice in 28 healthy eyes. We used seven spectral-domain optical coherence tomography (SD-OCT) devices, one time-domain OCT, one Scheimpflug camera, and one US-based instrument. Inter- and intra-operator reproducibility was evaluated by intraclass correlation coefficient (ICC), coefficient of variation (CV), and Bland-Altman test analysis. Instrument-to-instrument reproducibility was determined by ANOVA for repeated measurements. We also tested how the devices disagreed regarding systemic bias and random error using a structural equation model. RESULTS: Mean CCT of all instruments ranged from 536 ± 42 µm to 577 ± 40 µm. An instrument-to-instrument correlation test showed high values among the 10 investigated devices (correlation coefficient range 0.852-0.995; p values <0.0001 in all cases). The highest correlation coefficient values were registered between 3D OCT-2000 Topcon-Spectral OCT/SLO Opko (0.995) and Cirrus HD-OCT Zeiss-RS-3000 Nidek (0.995), whereas the lowest were seen between SS-1000 CASIA and Spectral OCT/SLO Opko (0.852). ICC and CV showed excellent inter- and intra-operator reproducibility for all optic-based devices, except for the US-based device. Bland-Altman analysis demonstrated low mean biases between operators. CONCLUSIONS: Despite highlighting good intra- and inter-operator reproducibility, we found that a scale bias between instruments might interfere with thorough CCT monitoring. We suggest that optimal monitoring is achieved with the same operator and the same device.
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Córnea/anatomía & histología , Técnicas de Diagnóstico Oftalmológico/instrumentación , Adulto , Paquimetría Corneal/instrumentación , Estudios Transversales , Femenino , Voluntarios Sanos , Humanos , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Oftalmoscopios , Tamaño de los Órganos , Fotograbar/instrumentación , Reproducibilidad de los Resultados , Tomografía de Coherencia Óptica/instrumentaciónRESUMEN
PURPOSE: To investigate the Ganglion Cell Complex (GCC) thickness change and visual recovery correlation after surgery for an idiopathic epiretinal membrane (ERM). METHODS: In this prospective, observational, case control study 30 eyes underwent vitrectomy for idiopathic ERM. We analysed best-corrected visual acuity (BCVA), mean macular thickness and mean GCC thickness one day before surgery, seven days and six months after surgery. Internal segment/outer segment junction, external limiting membrane, cone outer segment tips defects and intraretinalfluid were also investigated throughout the follow-up. RESULTS: Baseline GCC thickness was higher in patients with ERM (130 ± 13 µm) compared with healthy eyes (94 ± 5 µm; p < 0.0001). GCC thickness decreased after surgery to 89 ± 11 µm (p < 0.0001), reaching a value similar to controls (p = 0.12). Preoperative macular thickness was 318 ± 32 µm and decreased to 281 ± 18 µm (p < 0.0001), remaining significantly higher than controls (260 ± 8 µm; p < 0.0001). The GCC proportion of the whole macular thickness was also reduced six months after surgery (p < 0.0001). Post-operative BCVA gain showed direct correlation with GCC reduction (R = 0.67, p < 0.0001), but did not correlate with the mean macular thickness reduction (R < 0.01, p = 0.97). CONCLUSIONS: Ganglion cell complex thickness is higher in eyes with idiopathic ERM, and after surgery turns back to similar values of healthy eyes. Post-operative GCC reduction is proportionally higher than thinning of the whole retina, and this reduction is correlated with visual restoration.
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Membrana Basal/cirugía , Membrana Epirretinal/cirugía , Fibras Nerviosas/patología , Recuperación de la Función/fisiología , Células Ganglionares de la Retina/patología , Agudeza Visual/fisiología , Anciano , Estudios de Casos y Controles , Membrana Epirretinal/fisiopatología , Femenino , Humanos , Masculino , Estudios Prospectivos , Segmento Interno de las Células Fotorreceptoras Retinianas/patología , Segmento Externo de las Células Fotorreceptoras Retinianas/patología , Tomografía de Coherencia Óptica , VitrectomíaRESUMEN
The purpose of this paper is to give an updated review of the last clinical entities in pathological myopia proposed by means of new generation optical coherence tomography (OCT), including enhanced depth imaging (EDI-OCT) and swept source OCT (SS-OCT). PubMed and Google engine search were carried out using the terms "pathological myopia" associated with "coherence tomography," "enhanced depth imaging," and "swept source OCT." Latest publications up to Jan 2015 about myopia-related complications, including open-angle chronic glaucoma, peripapillary retinal changes, acquired macular diseases, and choroidal neovascularization, have been reviewed. New OCT technologies have led to a greater insight in pathophysiology of high-grade myopia. However, further investigation is needed in order to prevent irreversible visual loss and optic nerve damage.
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Neovascularización Coroidal/diagnóstico , Miopía Degenerativa/diagnóstico , Enfermedades de la Retina/diagnóstico , Tomografía de Coherencia Óptica/métodos , Neovascularización Coroidal/etiología , Humanos , Degeneración Macular/diagnóstico , Miopía Degenerativa/complicaciones , Enfermedades de la Retina/etiologíaRESUMEN
BACKGROUND: Vitreoretinal adhesions play a key role in the vector forces exerted on the vitreoretinal interface, leading to tractional retina deformation and macular hole formation. The aim of this study was to identify the presence of vitreopapillary and vitreofoveal adhesions in idiopathic epiretinal membranes (ERMs) with spectral-domain optical coherence tomography (SD-OCT) and to evaluate their influence on the vitreoretinal interface. METHODS: Sixty-five eyes (65 patients) with idiopathic ERM and 64 healthy eyes (64 patients) underwent SD-OCT analysis. We studied vitreopapillary and vitreofoveal adhesion prevalence in eyes with idiopathic ERM using different SD-OCT patterns ("adherent" or "tractional"). We analyzed their influence on central foveal thickness (CFT), on retinal nerve fiber layer (RNFL) thickness, and on morphological modifications (foveal depression profile and inner/outer photoreceptor junction). RESULTS: Vitreopapillary adhesion was present in 51.6 % of normal eyes and in 24.6 % of eyes with idiopathic ERM, while vitreofoveal adhesion was found in 14.1 % of normal eyes and in 15.4 % of eyes with ERM. Vitreopapillary adhesion prevalence was significantly higher in the tractional ERM subgroup (p = 0.01), than in the adherent ERM subgroup. Both adhesions had no influence on CFT, RNFL thickness, or inner segment/outer segment junction status. CONCLUSIONS: Our study suggests that vitreoretinal adhesions may influence the pathogenesis and course of idiopathic ERM. The absence of vitreopapillary adhesion in the adherent type, and its presence in the tractional type, seems to play a key role in ERM characterization.
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Membrana Epirretinal/diagnóstico , Enfermedades de la Retina/diagnóstico , Tomografía de Coherencia Óptica , Cuerpo Vítreo/patología , Estudios Transversales , Femenino , Humanos , Masculino , Microscopía Acústica , Persona de Mediana Edad , Fibras Nerviosas/patología , Oftalmoscopía , Prevalencia , Células Ganglionares de la Retina/patología , Adherencias Tisulares/diagnóstico , Agudeza Visual/fisiologíaRESUMEN
OBJECTIVE: The purpose of this study was to develop and evaluate the performance of RPC-Net (Recursive Prosthetic Control Network), a novel method using simple neural network architectures to translate electromyographic activity into hand position with high accuracy and computational efficiency. METHODS: RPC-Net uses a regression-based approach to convert forearm electromyographic signals into hand kinematics. We tested the adaptability of the algorithm to different conditions and compared its performance with that of solutions from the academic literature. RESULTS: RPC-Net demonstrated a high degree of accuracy in predicting hand position from electromyographic activity, outperforming other solutions with the same computational cost. Including previous position data consistently improved results across subjects and conditions. RPC-Net showed robustness against a reduction in the number of electromyography electrodes used and shorter input signals, indicating potential for further reduction in computational cost. CONCLUSION: The results demonstrate that RPC-Net is capable of accurately translating forearm electromyographic activity into hand position, offering a practical and adaptable tool that may be accessible in clinical settings. SIGNIFICANCE: The development of RPC-Net represents a significant advancement. In clinical settings, its application could enable prosthetic devices to be controlled in a way that feels more natural, improving the quality of life for individuals with limb loss.
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Algoritmos , Electromiografía , Mano , Aprendizaje Automático , Procesamiento de Señales Asistido por Computador , Humanos , Electromiografía/métodos , Mano/fisiología , Masculino , Adulto , Redes Neurales de la Computación , Femenino , Adulto Joven , Fenómenos Biomecánicos/fisiología , Miembros Artificiales , Antebrazo/fisiologíaRESUMEN
BACKGROUND: To report the morphological macular findings detected by spectral domain optical coherence tomography (SD-OCT) and to determine their prevalence in patients with retinitis pigmentosa (RP). METHODS: SD-OCT scans of 176 eyes from 90 patients affected by RP were reviewed. A careful evaluation was carried out on photoreceptor inner/outer segment (IS/OS) junction, external limiting membrane (ELM), inner limiting membrane thickening (ILMT), epiretinal membranes (ERMs), retinal micropseudocysts (MPCs), cystoid macular edema (CME), macular holes (MHs) and choroidal neovascularization (CNV). RESULTS: The photoreceptor IS/OS junction was absent in the foveal region of 24 eyes (13.6%) and disrupted in 84 eyes (47.7%). The ELM was absent in 24 eyes (13.6%), whereas the ILMT was found in 118 eyes (67%). The presence of an ERM was detected in 48 eyes (27.3%). Some sort of vitreomacular alteration (ILMT and/or ERM) was identifiable in a total of 94.3% of eyes with RP. The presence of MPCs was detected in 32 eyes (18.2%). An evident CME was found in 22 eyes (12.5%). We also found MHs in 8 eyes (4.5%) and CNV in 3 eyes (1.7%). CONCLUSIONS: Our data indicate that RP is associated with alterations of many retinal layers. In particular, the vitreoretinal interface is affected in 94% of patients, and MPC can be identified in 18% of eyes. SD-OCT may contribute to the understanding of the pathophysiological mechanism involved in RP.
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Retinitis Pigmentosa/patología , Tomografía de Coherencia Óptica/métodos , Adolescente , Adulto , Anciano , Niño , Membrana Epirretinal/patología , Femenino , Angiografía con Fluoresceína , Humanos , Masculino , Persona de Mediana Edad , Segmento Interno de las Células Fotorreceptoras Retinianas/patología , Segmento Externo de las Células Fotorreceptoras Retinianas/patología , Estudios Retrospectivos , Adulto JovenRESUMEN
BACKGROUND: Limited data are available on the efficacy of catheter ablation (CA) for sport-associated atrial fibrillation (AF), in particular at long term follow-up. Moreover, the impact of AF CA on Quality of Life (QoL) in this population remains unknown. We aimed to determine AF CA efficacy in athletes, to assess the impact on athletes' QoL (with SF36 score) and on training capabilities in a long-term follow-up (FU). METHODS: A total of 1215 AF patients' candidates to CA between January 2007 and December 2012, were retrospectively screened. Athletes were defined as patients performing ≥5 h/week of vigorous sports, achieving a total of ≥1500 h lifetime sport activity, for at least one year before AF first symptomatic episode. RESULTS: Out of 1215 AF patients, 133 were considered competitive athletes and underwent CA. Overall, 43% of our cohort showed typical or atypical atrial flutter, which required a more extensive ablation procedure. Before AF, athletes used to practice for a mean of 8.5±2.7 h/week, while after the first AF episode the mean practice duration decreased to 2.8±2.5 h/week. At 10-year follow-up, 83% of athletes did not present any recurrent event, and training capabilities increased up to 5.6±3.6 h/week after the procedure. Moreover, intense physical activity before AF CA was related to long-term AF recurrence rates (P=0.05). QoL scores significantly improved in each single domain (P<0.05). CONCLUSIONS: AF CA represents an effective procedure to maintain sinus rhythm in athletes, with a significant improvement in QoL.
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Fibrilación Atrial , Ablación por Catéter , Atletas , Fibrilación Atrial/epidemiología , Fibrilación Atrial/cirugía , Ablación por Catéter/métodos , Humanos , Calidad de Vida , Recurrencia , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
PURPOSE: To identify by noninvasive means early retinal abnormalities that may predict diabetic macular edema. METHODS: The authors analyzed retrospectively data from consecutive patients with Type 1 (n = 16) or Type 2 (n = 23) diabetes who presented for routine follow-up of early retinopathy, had no clinical signs or symptoms of diabetic macular edema, and were evaluated with spectral-domain optical coherence tomography. Age- and gender-matched nondiabetic subjects provided normative data. RESULTS: Spectral-domain optical coherence tomography revealed in the macular region of diabetic patients small hyporeflective areas (median diameter, 55 µm) contained within discrete retinal layers that we named micropseudocysts (MPCs). Micropseudocysts are associated with vascular leakage. The patients showing MPCs had more frequently systemic hypertension and increased central foveal thickness than those without MPCs. The association with increased central foveal thickness was only in the patients with Type 2 diabetes. CONCLUSION: Macular MPCs in patients with mild diabetic retinopathy appear to reflect leakage and can precede macular thickening. The association of MPCs with increased central foveal thickness in patients with Type 2 diabetes, but not in patients with Type 1 diabetes, points to a greater tendency to retinal fluid accumulation in patients with Type 2 diabetes. Studies in larger cohorts will determine the usefulness of MPCs in strategies to abort diabetic macular edema.
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Quistes/diagnóstico , Retinopatía Diabética/diagnóstico , Enfermedades de la Retina/diagnóstico , Adulto , Anciano , Quistes/complicaciones , Diabetes Mellitus Tipo 1/complicaciones , Diabetes Mellitus Tipo 2/complicaciones , Retinopatía Diabética/clasificación , Retinopatía Diabética/complicaciones , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedades de la Retina/complicaciones , Estudios Retrospectivos , Tomografía de Coherencia ÓpticaRESUMEN
BACKGROUND: Heart diseases due to iron overload are still the main cause of mortality in patients affected by beta-thalassemia. Detection of cardiac iron overload in pre-clinical stage allows tailoring of chelation therapy and follow-up strategies. Echocardiographic longitudinal strain analysis may be a useful tool for early detection of cardiac functional impairment iron-related. METHODS: We examined 58 patients with beta-thalassemia on regular blood transfusion and iron chelation, without overt cardiac disease who had recent Biosusceptometry SQUID to quantify liver iron concentration and cardiac assessment by CMR T2*. RESULTS: Average global longitudinal strain (GLS) was able to identify abnormal (<20 ms) cardiac T2* values with 96% specificity and negative predictive value of 92% (AUC 0.84, P=0.01). Apical 4-ch GLS may help identify early longitudinal impairment associated with severe liver iron overload with 96% specificity and negative predictive value of 92% (AUC 0.84, P=0.02). Patients with severe liver iron overload had lower average Global Longitudinal Strain values compared to other patients (P-value =0.005). CONCLUSION: GLS was a sensitive marker to detect both myocardial and liver iron overload in a population that is still free from cardiac symptoms. Thus, strain echocardiography may be a useful tool for early detection of iron overload in Beta-thalassemia.
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BACKGROUND: Subcutaneous implantable cardioverter defibrillator (S-ICD) is a well-established therapy for sudden death prevention. Considering the painful nature of the procedure anaesthesia may be required for analgo-sedation. Hypnosis is emerging as a promising therapeutic strategy for pain control. Few data are available regarding the use of hypnosis as adjunctive technique for pain control during S-ICD implantation. METHODS: Thirty consecutive patients referred to our centre for S-ICD implantation were prospectively and alternatively allocated with 1:1 ratio in two groups: A) Standard analgo-sedation approach (Hypnosis non responder patients) B) Standard analgo-sedation approach with the addition of hypnotic communication (Hypnosis responder patients). Peri-procedural pain perception and anxiety, perceived procedural length, type and dosage of administered analgesic drugs have been measured using validate scores and compared. RESULTS: Hypnotic communication was offered to 15 patients of which was successful in 11 patients (73%). There were no statistical differences between the two study groups according to baseline characteristics. Hypnosis communication resulted in significant pain perception reduction (Group A 6,9 ± 1,6 Vs Group B 1,1 ± 0,9, p value < 0,01), peri-procedural anxiety (Group A 3,5 ± 1,6 Vs Group B 1,9 ± 0,5, p value < 0,01) and reduced perceived procedural length (Group A 58,7 ± 13,4 min Vs Group B 44,7 ± 5,5 min, p value < 0,01). Fentanyl dosage was significantly lower in Group B patients. CONCLUSIONS: Our results demonstrated a significant reduction of perceived pain, anxiety, procedural time and use of analgesic drugs in hypnosis responder patients. These results reinforce the beneficial effects of the hypnotic technique in patients undergoing S-ICD implantation.
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Angiografía con Fluoresceína , Oclusión de la Arteria Retiniana/diagnóstico , Arteria Retiniana/patología , Enfermedades de la Retina/diagnóstico , Enfermedad Aguda , Anciano , Colorantes , Humanos , Verde de Indocianina , Masculino , Oclusión de la Arteria Retiniana/fisiopatología , Enfermedades de la Retina/fisiopatología , Tomografía de Coherencia ÓpticaRESUMEN
BACKGROUND AND OBJECTIVE: Optical coherence tomography angiography (OCTA) comparison between vessel density in patients with degenerative-subtype lamellar macular hole (LMH) and healthy individuals. Unaffected fellow eyes were also included in the study. PATIENTS AND METHODS: This observational, cross-sectional study examined 32 eyes affected by unilateral degenerative-subtype LMH, as well as the 32 fellow eyes of the enrolled population. Thirty healthy eyes were used as controls. ImageJ software was used to calculate macular vessel density in the three vascular plexuses (superficial capillary plexus [SCP], deep capillary plexus [DCP], choriocapillaris [CC]) in two regions: (1) a fovea-centered 1.5-mm diameter circular area after subtracting the foveal avascular zone (FAZ) area, obtaining a "ring" in the immediate FAZ proximity (peri-FAZ); (2) the area external to (1) included in the scan. RESULTS: In the peri-FAZ, the SCP of both LMH and fellow eyes showed higher vascular density than in controls (P = .004 for LMH; P = .015 for fellow eye), whereas no difference was evident between LMH and fellow eyes (P = .190). No changes were found in the DCP or the CC. No differences in vessel density of the three plexuses in the area outside the peri-FAZ were evident in any of the three groups. The FAZ in the SCP was larger in the LMH (0.39 ± 0.16 mm2) and in the fellow eye (0.39 ± 0.21 mm2) groups compared with controls (0.27 ± 0.07 mm2; P = .021 for LMH; P = .0043 for fellow eye), whereas it was similar between LMH and fellow eyes (P = .967). CONCLUSIONS: Degenerative-subtype LMH in the immediate proximity of the FAZ has a larger FAZ and higher vascular density in the SCP compared with healthy eyes. Unaffected fellow eyes also have increased vascular density compared with controls. Microvascular changes are evident in both LMH and unaffected fellow eyes and might play a role in disease pathogenesis. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:e112-e117.].
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Capilares/diagnóstico por imagen , Angiografía con Fluoresceína/métodos , Mácula Lútea/irrigación sanguínea , Perforaciones de la Retina/diagnóstico , Vasos Retinianos/diagnóstico por imagen , Tomografía de Coherencia Óptica/métodos , Agudeza Visual , Estudios Transversales , Femenino , Estudios de Seguimiento , Fondo de Ojo , Humanos , Mácula Lútea/diagnóstico por imagen , Masculino , Persona de Mediana EdadRESUMEN
Retinal capillary hemangioma (RCH) is a benign retinal tumor defined by a vascular proliferation localized in the peripheral retina, juxtapapillary retina, or the intraneural portion of the optic nerve. In most cases, diagnosis of RCH is performed by fundus evaluation and confirmed by fluorescein fundus angiography. Nevertheless, a small RCH localized on or adjacent to the optic nerve head could be difficult to detect by fundus examination. Here, the authors report an atypical case of RCH, not ophthalmoscopically visible, but successfully detected first by optical coherence tomography (OCT) and then by OCT angiography, which confirmed its vascular nature. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:e81-e83.].
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Técnicas de Diagnóstico Oftalmológico , Angiografía con Fluoresceína/métodos , Hemangioma Capilar/diagnóstico , Neoplasias de la Retina/diagnóstico , Tomografía de Coherencia Óptica/métodos , Adulto , Femenino , HumanosRESUMEN
BACKGROUND: Non-invasive ischaemia tests and biomarkers are widely adopted to rule out acute coronary syndrome in the emergency department. Their diagnostic accuracy has yet to be precisely defined. METHODS: Medline, Cochrane Library CENTRAL, EMBASE and Biomed Central were systematically screened (start date 1 September 2016, end date 1 December 2016). Prospective studies (observational or randomised controlled trial) comparing functional/imaging or biochemical tests for patients presenting with chest pain to the emergency department were included. RESULTS: Overall, 77 studies were included, for a total of 49,541 patients (mean age 59.9 years). Fast and six-hour highly sensitive troponin T protocols did not show significant differences in their ability to detect acute coronary syndromes, as they reported a sensitivity and specificity of 0.89 (95% confidence interval 0.79-0.94) and 0.84 (0.74-0.9) vs 0.89 (0.78-0.94) and 0.83 (0.70-0.92), respectively. The addition of copeptin to troponin increased sensitivity and reduced specificity, without improving diagnostic accuracy. The diagnostic value of non-invasive tests for patients without troponin increase was tested. Coronary computed tomography showed the highest level of diagnostic accuracy (sensitivity 0.93 (0.81-0.98) and specificity 0.90 (0.93-0.94)), along with myocardial perfusion scintigraphy (sensitivity 0.85 (0.77-0.91) and specificity 0.92 (0.83-0.96)). Stress echography was inferior to coronary computed tomography but non-inferior to myocardial perfusion scintigraphy, while exercise testing showed the lower level of diagnostic accuracy. CONCLUSIONS: Fast and six-hour highly sensitive troponin T protocols provide an overall similar level of diagnostic accuracy to detect acute coronary syndrome. Among the non-invasive ischaemia tests for patients without troponin increase, coronary computed tomography and myocardial perfusion scintigraphy showed the highest sensitivity and specificity.
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Síndrome Coronario Agudo/sangre , Dolor en el Pecho/sangre , Vasos Coronarios/diagnóstico por imagen , Imagen de Perfusión Miocárdica/métodos , Tomografía Computarizada por Rayos X/métodos , Síndrome Coronario Agudo/diagnóstico por imagen , Biomarcadores/sangre , Dolor en el Pecho/diagnóstico por imagen , Ecocardiografía de Estrés/métodos , Servicio de Urgencia en Hospital , Prueba de Esfuerzo/métodos , Femenino , Glicopéptidos/sangre , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Cintigrafía/métodos , Sensibilidad y Especificidad , Troponina T/sangreRESUMEN
OBJECTIVE: The aim of the study was to translate and culturally adapt the Physical Activity Scale for the Elderly into Italian (PASE-I) and to evaluate its psychometric properties in the Italian older adults healthy population. METHODS: For translation and cultural adaptation, the "Translation and Cultural Adaptation of Patient-Reported Outcomes Measures" guidelines have been followed. Participants included healthy individuals between 55 and 75 years old. The reliability and validity were assessed following the "Consensus-Based Standards for the Selection of Health Status Measurement Instruments" checklist. To evaluate internal consistency and test-retest reliability, Cronbach's α and Intraclass Correlation Coefficient (ICC) were, respectively, calculated. The Berg Balance Score (BBS) and the PASE-I were administered together, and Pearson's correlation coefficient was calculated for validity. RESULTS: All the PASE-I items were identical or similar to the original version. The scale was administered twice within a week to 94 Italian healthy older people. The mean PASE-I score in this study was 159±77.88. Cronbach's α was 0.815 (p < 0.01) and ICC was 0.977 (p < 0.01). The correlation with the BBS was 0.817 (p < 0.01). CONCLUSIONS: The PASE-I showed positive results for reliability and validity. This scale will be of great use to clinicians and researchers in evaluating and managing physical activities in the Italian older adults population.