RESUMO
BACKGROUND: Use of "orthobiologics" continues to expand for patients who have knee osteoarthritis (OA). We sought to perform a systemic review of biologic therapies relative to comparative groups, including the following: (1) platelet-rich plasma (PRP); (2) bone marrow-derived mesenchymal stem cells (BMSCs); (3) adipose-derived mesenchymal stem cells (ADSCs); and (4) amniotic-derived mesenchymal stem cells (AMSCs). We assessed the following: (1) study methodologies; (2) cell preparations and formulations; (3) patient-reported outcome scores (PROMs); and (4) structural changes. METHODS: PubMed, Cochrane Library, and Embase databases were queried (2013-2021) to conduct a systematic review of biologic therapies for knee OA, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eighty-two studies were included: PRP (51); BMSC (15); ADSC (11); and AMSC (5). Study evaluations were made using the Modified Coleman Methodology Score. PROMs included the Western Ontario and McMaster Universities Arthritis Index and the Visual Analog Scale. Structural change evaluations included ultrasounds, radiographs, or magnetic resonance imaging. RESULTS: PRP comprised a majority of the studies (n = 51), most with "fair" to "good" Modified Coleman Methodology Score. Studies had variable cell preparations and formulations, with comparison study results leading to inconsistent PROMs, and structural changes. A limited number of studies were included for BMSC, ADSC, and AMSC, all with similar findings to PRP. CONCLUSION: Available literature evaluating "orthobiologics" for knee OA remain nonsuperior to comparison cohorts. Higher level studies with larger sample sizes and improved methodologies are warranted to suggest differences. Despite a growth of "orthobiologics" in clinics, this updated systematic review highlights the uncertain efficacy for use in knee OA.
Assuntos
Osteoartrite do Joelho , Plasma Rico em Plaquetas , Humanos , Osteoartrite do Joelho/terapia , Injeções Intra-Articulares , Resultado do Tratamento , Terapia Biológica , Ácido HialurônicoRESUMO
Recently, it has been recommended that population-based studies report not only frequencies of vision impairment and blindness but also any ocular abnormalities that might lead an individual to seek for eyecare services. The current study aimed to determine prevalence of ocular findings regardless of visual acuity (VA) status in older adults from the Brazilian Amazon Region. Disturbances were grouped into: Eyelids; Anterior Segment; Posterior Segment; Increased intraocular pressure; and Overall Globe. The presence of an ocular finding was considered positive when any abnormality was noted, regardless of VA. Refractive errors were not considered. A total 2384 eligible persons were enumerated and 2041 (85.6%) examined. The prevalence of ocular disturbances in either eye was 87.0% and was associated with male gender, older age, lower education, and rural residence. Overall, main findings were pterygium, cataract, and pinguecula, occurring in 58.8%, 45.4% and 17.4%, respectively. Among individuals with 20/20 VA in both eyes, the most frequent findings were pterygium, pinguecula, and glaucoma cupping, occurring in 47.4%, 31.2% and 6.5%, respectively. The high prevalence of ocular findings observed in this population reinforces that different conditions might not immediately decrease VA but can indicate risk and/or discomfort symptoms and should be considered when planning public health ophthalmic services.
Assuntos
Oftalmopatias/epidemiologia , Avaliação Geriátrica/estatística & dados numéricos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Oftalmopatias/diagnóstico , Oftalmopatias/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Vigilância da População , Prevalência , Fatores de Risco , Acuidade VisualRESUMO
AIMS: To determine prevalence of pterygium, its role as main cause of unilateral and bilateral visual impairment and blindness and its impact on refractive errors from adults living in a high ultraviolet exposure area in the Brazilian Amazon Region. METHODS: Cluster sampling was used in randomly selecting subjects ≥45 years of age from urban and rural areas of Parintins city. Eligible subjects were enumerated through a door-to-door household survey and invited for an eye exam including refraction. Pterygium was assessed considering location (nasal, temporal or both) and size (<3 mm or ≥3 mm reaching or not pupillary margin). RESULTS: A total of 2384 persons were enumerated and 2041 (85.6%) were examined. Prevalence of pterygium was 58.8% (95% CI 53.8% to 63.7%) and associated with male gender (OR=1.63; 95% CI 1.37 to 1.94; p=0.001), while higher education was a protective factor (OR=0.63; 95% CI 0.44 to 0.92; p=0.018). Older age and rural residence were associated with pterygium ≥3 mm reaching or not pupillary margin, while higher education was a protective factor for pterygium ≥3 mm reaching pupillary margin. Prevalence of pterygium as cause of visual impairment and blindness was 14.3% and 3.9%, respectively. Significantly higher hyperopic refractive errors were found in eyes with pterygium ≥3 mm reaching or not pupillary margin. CONCLUSIONS: Pterygium was highly prevalent and the second cause of visual impairment and blindness after provision of refractive correction. Risk factors for pterygium were male gender, advanced age, lower education and rural residency. Strategies to provide pterygium early detection and proper management should be considered by healthcare authorities in this population.
Assuntos
Vigilância da População , Pterígio/epidemiologia , Erros de Refração/epidemiologia , População Rural , Acuidade Visual , Distribuição por Idade , Idoso , Brasil/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Pterígio/complicações , Erros de Refração/etiologia , Erros de Refração/fisiopatologiaRESUMO
Purpose: To determine the prevalence and causes of visual impairment and blindness in adults aged 45 years and older from Parintins, Brazilian Amazon Region. Methods: A random cluster sampling method was used to identify subjects 45 years of age and older from urban and rural census sectors of Parintins city, Amazonas State, from March 2014 to May 2015. Participants underwent a detailed ocular examination, including presenting (PVA) and best corrected visual acuity (BCVA). The main cause of PVA<20/32 per eye was determined. Results: A total of 2384 subjects were enumerated and 2041 (85.6%) examined. The prevalence of presenting mild visual impairment - MiVI (<20/32 - ≥20/63) in the better-seeing eye was 17.0% [95% CI: 15.3-18.7%], and 8.5% [95% CI: 7.3-9.7%] with best correction. The prevalence of presenting moderate visual impairment - MVI (<20/63 - ≥20/200) was 18.4% [95% CI: 16.2-20.6%], and 6.9% [95% CI: 5.8-8.0%] with best correction. The prevalence of presenting bilateral VA <20/200 was 4.3% [95% CI: 3.6-5.0%], and 3.3% [95% CI: 2.5-4.0%] with best correction and increased with older age. Cataract (47.8%) and glaucoma (7.5%) were its main causes. In less severely affected eyes, uncorrected refractive errors (MVI: 42.6%; MiVI: 79.0%), cataract (MVI: 40.6%; MiVI: 13.7%) and pterygium (MVI: 7.6%; MiVI: 2.7%) were the main causes. Conclusions: Most cases of visual impairment in Parintins are either preventable or treatable, and public health initiatives should target cataract surgical services and refraction with spectacle provision.
Assuntos
Cegueira/epidemiologia , Baixa Visão/epidemiologia , Pessoas com Deficiência Visual/estatística & dados numéricos , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Estudos Transversais , Oftalmopatias/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , População Rural/estatística & dados numéricos , Inquéritos e Questionários , População Urbana/estatística & dados numéricos , Testes Visuais , Acuidade Visual/fisiologiaRESUMO
Older adults living in remote areas with limited access to health services are at higher risk to develop visual impairment and blindness. We conducted a population-based survey to determine the vision status in subjects 45 years of age and older from urban and rural areas of Parintins city, Brazilian Amazon Region. Participants underwent ophthalmic examination, including uncorrected (UCVA), presenting (PVA) and best-corrected visual acuity (BCVA). Vision status was described as lines of visual acuity (VA) impairment and lines of VA improvement from UCVA to BCVA and from PVA to BCVA in the better-seeing eye. A total of 2384 subjects were enumerated, 2041 (85.6%) were examined, with reliable VA measurements obtained from 2025 participants. Vision status in lines of VA impairment was (mean ± standard deviation): 3.44 ± 3.53 for UCVA, 2.85 ± 3.52 for PVA and 1.50 ± 3.51 for BCVA. Female gender, older age and lower education were associated with ≥6 lines of UCVA impairment. Lines of improvement ≥3 was found in 626 (30.9%) participants and associated with female gender and rural residency. In conclusion, a third of participants could have at least three lines of VA improvement with proper refraction. Strategies to improve access to eye care and affordable glasses are needed.
Assuntos
População Rural/estatística & dados numéricos , Visão Ocular/fisiologia , Acuidade Visual/fisiologia , Distribuição por Idade , Idoso , Cegueira/fisiopatologia , Brasil , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Distribuição por Sexo , Baixa Visão/fisiopatologiaRESUMO
PURPOSE: To describe the study design, operational strategies, procedures, and baseline characteristics of the Brazilian Amazon Region Eye Survey (BARES), a population-based survey of the prevalence and causes of distance and near visual impairment and blindness in older adults residing in the city of Parintins. METHODS: Cluster sampling, based on geographically defined census sectors, was used for cross-sectional random sampling of persons 45 years and older from urban and rural areas. Subjects were enumerated through a door-to-door survey and invited for measurement of uncorrected, presenting and best-corrected visual acuity and an ocular examination. RESULTS: Of 9931 residents (5878 urban and 4053 rural), 2384 individuals (1410 urban and 974 rural) were eligible and 2041 (1180 urban and 861 rural) had a clinical examination (response rate 85.6%). The majority of participants were female (1041, 51.0%); the average age was 59.9 ± 11.1 years (60.2 ± 11.2 years for urban and 59.4 ± 11.1 years for rural); 1360 (66.6%) had primary schooling or less (58.1% in urban and 78.4% in rural) and 57.8% were resident in urban areas. The age distribution between sexes was similar (p = 0.178). Both sex and age distributions of the sample were comparable to that of the Brazilian Amazon Region population. CONCLUSIONS: The BARES cohort will provide information about the prevalence and causes of near and distance vision in this underprivileged and remote population in Brazil.