Treatment of periorbital hyperpigmentation using light devices.

The treatment of dark circles is one of the most common request from the patients attending to the esthetics clinic. A tired, sad or aged appearance is perceived by our patients. Moreover, it is a multifactorial problem and we could treat it with a wide range of treatments. With this systematic review, we want to check the best available evidence regarding the treatment of periorbital hyperpigmentation using light devices. We have reviewed 208 papers, including 14 of them for full consideration. Several light sources have demonstrated to be effective treating pigmented dark circles. The best results have been reported using intense pulsed light and rubi laser together with depigmenting substances. If we want to treat periocular hyperpigmentation, soft wrinkles, rhytides and skin density we should use carbo dioxide laser or Erbium:Yttrium Scandium Gallium Garnet. The Neodymium-Doped Yttrium Aluminium Garnet, alexandrite and diode lasers were the ones giving the worst outcome regarding pigmentation treatment. The concomitant use of depigmenting treatment may help getting better results and reducing the rate of post inflammatory hyperpigmentation. A better standardization and measuring of the obtained results is needed regarding pigmentation changes. We must keep on investigating on this topic with new clinical trials measuring objective results and combining different light devices for a multifactorial treatment of the dark circles.

Clinical update in nanophthalmos: Features, diseases and complications associated.

Nanophthalmos is a rare congenital condition of the eyeball that is characterised by a smaller size of the anterior and posterior segments without associated ocular malformations. Typical features that have traditionally been described in these eyes are short axial length, thickened sclera, cornea with a smaller diameter, narrow anterior chamber, and an increased lens to globe volume ratio. However, at present, there is still a lack of recognised diagnostic criteria for nanophthalmos and a classification of its severity. Its clinical relevance stems from the increased risk of multiple ocular conditions, such as high hyperopia, amblyopia, angle-closure glaucoma, retinal detachment, and cataracts. Likewise, in relation to surgery in these eyes, there are particularities in cataract and glaucoma surgery and with a greater risk of associated intra- and postoperative complications. In this way, the treatment of nanophthalmos focuses on controlling the associated eye conditions and reducing and controlling surgical complications. This review aims to update what has been published in recent years regarding nanophthalmos.

Comparative analysis of the quality of life among different retinal diseases.

PURPOSE: To assess the impact on the quality of life (QoL) among different retinal diseases such as diabetic macular edema (DME), retinal vein occlusion (RVO), pathologic myopia (PM), neovascular age-related macular degeneration (nAMD) and central serous chorioretinopathy (CSC). METHODS: A cross-sectional study was carried out in 241 patients, affected by DME (n=44), RVO (n=41), PM (n=34) and nAMD (n=85) receiving intravitreal injections due to the presence of macular edema or choroidal neovascularization. The CSC patients included (n=37) were candidates for laser treatment. The patients included completed the National Eye Visual Functioning Questioning-25 (NEI VFQ-25). Best eye visual acuity (BEVA) was recorded using the Early Treatment Diabetic Retinopathy Study (ETDRS) scale. RESULTS: There were significant differences between subgroups for all the domains, except for the general vision in which all scores among diseases ranged from 40.7 to 45.2 out of 100 (P=.436), despite the difference in BEVA (CSC: 86.3±11.9; RVO: 78.5±15.5, DME: 73.3±15.2, nAMD: 72.9±12.6 and PM: 68.5±18.1 letters respectively; P<.001). The lowest VFQ-25 total score was observed in the PM patients (52.1±20.9), followed by nAMD (55.3±20.8), RVO (65.0±22.3), DME (68.6±21.0) and CSC (70.9±16.2). The DME group reported the worst score for general health (38.9±21.4). Mental health and role difficulties were lowest for PM (48.2±28.8 and 48.2±31.9, P<.007). CONCLUSIONS: This study reveals the differences in the QoL among DME, RVO, nAMD, PM and CSC, describing the different repercussions that they can suffer, observing a higher impact in PM and nAMD.

Primary hyperaldosteronism in Acute Central Serous Chorioretinopathy: a real need for screening?

PURPOSE: Central Serous Chorioretinopathy (CSCR) is a prevalent ocular disease classified in the pachychoroidal spectrum with an elevated morbidity. Although the pathogenesis is yet unclear, mineralocorticoid-mediated pathways seem to be implicated. Primary hyperaldosteronism (PA) is a relatively frequent, albeit underdiagnosed, cause of hypertension, and has a specific therapy. A previous study assessed the prevalence of CSCR-like signs in a cohort of patients diagnosed with PA and found signs in seven out of thirteen PA patients. The present study aims to study the contrary, screening for PA in a cohort of acute CSCR patients. METHODS: Between March 2017 and September 2018 all patients with acute CSCR were systematically referred to Endocrinology Department after complete ophthalmic evaluation was performed with visual acuity, spectral domain optical coherence tomography, fundus autofluorescence, fluorescein and indocyanine green angiography. The method applied for detection of PA was the 2-h 25 mg captopril challenge test (CCT). RESULTS: Of the nineteen patients screened, two of them had a CCT positive for PA (2-h plasma aldosterone/renin ratio > 50 and/or an aldosterone level of 130 pg/ml or higher), and were treated with mineralocorticoid receptor antagonists (MRA). No ophthalmic pattern was identified in them in terms of time to resolution, recurrences or features of the acute episode. The only differential feature in the fundus of PA patients was pathological arteriovenous crossings (AVC) as well as elevated BP levels. CONCLUSION: a high incidence of PA was found among acute CSCR patients. This preliminary study suggests a need for screening for PA in hypertensive CSCR patients in real clinical practice.

Differential diagnosis of endophthalmitis after intravitreal drug injection for age related macular degeneration: sterile vs. infectious.

The recent release of brolucizumab and the development of new antiangiogenic molecules as abicipar pegol has increased the interest towards inflammatory complications after intravitreal drug injection. Those drugs are associated to a higher rate of inflammatory adverse events compared to classic drugs. In this context it is essential to differentiate between sterile and infectious cases for a fast and effective treatment. The clinical similarities between infectious and sterile cases, the high rate of culture negative patients and the heterogeneity in the terminology used are obstacles for a correct diagnosis and report of these complications. Sterile cases appear early after the injection, before 48 h; or 20 days after in brolucizumab-related vasculitis cases. Infectious cases show up around the third day after injection and up to a week after it. A severe visual impairment, severe pain, severe hyperemia, hypopyon and a more severe intraocular inflammatory process are signs of a likely infectious origin. If the cause of the inflammation is uncertain we must follow up the patient closely or "tap and inject" antimicrobial agents in order to prevent the eventual complications of an infectious endophthalmitis. On the other hand, sterile endophthalmitis might be observed in mild cases or treated with steroids according to the severity of the inflammation.

Movement Velocity as an Indicator of Mechanical Fatigue and Resistance Exercise Intensity in Cross Modalities.

Purpose: This study analyzed the acute mechanical response to three workouts of the day (WOD) protocols in as many repetitions as possible (AMRAP), every minute on the minute (EMOM), and for time (FT) models by quantifying the degree of mechanical fatigue induced by popular resistance exercises in the Cross modalities, front squat (FS), and shoulder press (SP). We also analyzed whether the exercises' fastest velocity (Vfastest) could be an objective indicator of relative intensity (%1RM). Methods: Nine trained men performed three FS and SP exercises protocols. The degree of fatigue was quantified by the velocity loss (VL) achieved in both exercises and the velocity loss achieved in the WOD (VLWOD). Results: The VLWOD in the AMRAP, EMOM, and FT protocols was 73.2 ± 10.9%, 61.6 ± 15.1%, and 76.1 ± 8.8%, respectively. In the AMRAP and FT protocol, the Vfastest showed very strong relationships with the %1RM for FS and SP (r = -0.83, -0.75, respectively, p < .01); while in the EMOM protocol, there was a strong relationship between these variables, only for the SP (r = -0.61, p < .05). In the FT protocol, we observed an extremely strong relationship for FS (r = -0.91, p < .001) and very strong (r = -0.71, p < .05) for SP between these variables. Conclusion: Therefore, the AMRAP and FT training models induce the highest degrees of mechanical fatigue in the FS and SP exercises, and the Vfastest is a reliable tool for estimating relative intensity in resistance exercises of Cross modalities.

Monitoring of the Training Load and Well-Being of Elite Rhythmic Gymnastics Athletes in 25 Weeks: A Comparison between Starters and Reserves.

The objective of this study was to monitor the training loads (TL) and well-being of elite rhythmic gymnastics (RG) athletes, as well as compare these variables between starters and reserve gymnasts during 25 weeks of training. Ten athletes from the Brazilian national RG team (17.4 ± 1.1 y of age) were monitored during the general preparatory period (GPP), specific preparatory period (SPP), and pre-competitive period (PCP). The internal TL was quantified with the use of sessional ratings of perceived exertion (sRPE). We assessed well-being daily with a well-being scale. The TL, duration, monotony, and strain were calculated weekly. We found that the internal TL and session durations were 9242 ± 2511 AU and 2014 ± 450 min, respectively. The internal TL, strain, and monotony were greater in the PCP than in the GPP and SPP for starters. In the SPP, there were statistical differences in internal TL (p = 0.036) and strain (p = 0.027) between starters and reserves. In the PCP, there were also statistical differences between starters vs. reserves athletes regarding internal TL (p = 0.027) and strain (p = 0.05). There was no statistically significant difference in well-being between the periods assessed. In conclusion, RG athletes display a higher TL magnitude during the PCP, whereas only reporting non-significant minor variations in well-being. In addition, there is a discrepancy in the TL between starters and reserves.

Different types of functional training on the functionality and quality of life in postmenopausal women: a randomized and controlled trial.

BACKGROUND: Physical exercise is widely recommended for improving physical fitness. However, the most effective training method in improving the daily life of postmenopausal women is not clear. Therefore, this study compares different ways of functional training, focused on the task, and directed to the physical abilities on the functionality and quality of life of the postmenopausal women. METHODS: Forty-seven participants were randomly assigned into three groups: element-based functional training (EBFT); task-specific-based functional training (TSBFT); and the control group (CG). The intervention lasted fourteen weeks, with three weekly sessions stimulating several physical valences in the same session. The global functionality, functional reach, gait speed, handgrip strength, jumping ability, and quality of life before and after the intervention were evaluated. RESULTS: A similar increase was detected in both experimental groups for the variables-analyzed when compared to the initial moment (P<0.05), except in the dynamic postural control (P>0.05), which showed no difference. However, in the tests of rising from the floor and handgrip strength, only the task-specific-based functional training showed difference over time (P<0.05). CONCLUSIONS: Functional training protocols improve the performance in daily activities of postmenopausal women. However, task-specific-based functional training is more effective when compared to the control group in the analyzed variables.

Prevalence of Injuries in Exercise Programs Based on Crossfit®, Cross Training and High-Intensity Functional Training Methodologies: A Systematic Review.

Current literature shows studies that question the safety of the practices carried out in high-intensity training modalities such as CrossFit®, Cross Training or High-Intensity Functional Training, which may lead to a greater risk in the prevalence of injuries. The aim of this study was to analyze in detail the prevalence of injuries occurring in training based on the CrossFit®, Cross Training or High-Intensity Functional Training modalities, through a systematic review, as well as evaluating the methodological quality of the included studies. We used the recommendations of the PRISMA protocol. For the quality analysis of the studies, we applied the tool proposed by the National Institute of Health (United States). The areas that mainly present a higher risk of injury during CrossFit, Cross Training or High-Intensity Functional Training practices are shoulders, knees and back. Additionally, 11 of the 12 included studies displayed a poor methodological quality according to the quality tool used.

Effects of Ibuprofen Intake in Muscle Damage, Body Temperature and Muscle Power in Paralympic Powerlifting Athletes.

The aim of this study is to evaluate the effect of ingesting ibuprofen on post-workout recovery of muscle damage, body temperature and muscle power indicators in Paralympic powerlifting athletes. The study was carried out with eight Paralympic powerlifting athletes (aged 27.0 ± 5.3 years and 79.9 ± 25.5 kg of body mass) competing at the national level, with a minimum training experience of 12 months, who all submitted to two experimental conditions: Ibuprofen (2 × 00 mg) and control. The maximal isometric force of the upper limbs and rate of force development, thermography, and serum biochemical analyzes of creatine kinase, lactate dehydrogenase, aspartate aminotransferase and alanine aminotransferase were measured before, after, 24 h after and 48 h after the intervention. Maximal isometric force only decreased in the placebo condition, which increased back to baseline levels, while no substantial decline in baseline force was seen in the ibuprofen condition, although no effect for exercise condition was detected. After the exercise, the rate of force development decreased significantly for both conditions and did not exceed baseline levels again after 48 h. Muscle temperature decreased significantly at 48-h post-exercise in the placebo condition, when compared with the previous day of measurement; and deltoid muscle temperature at 48-h post-exercise was higher with the ibuprofen condition. Although the results indicate some positive effects of ibuprofen use, they do not enable a clear statement regarding its positive effects on muscle function and muscle damage. Ibuprofen seems to have caused a delay in the anti-inflammatory response following exercise.

Effects of different multicomponent training methods on functional parameters in physically-active older women.

BACKGROUND: Negative functionality changes are among the effects of aging. The multicomponent training performed on conventional machines or with new implements and features directed to daily activities is strongly recommended among attenuation strategies. However, the efficiency of both types of training is not yet clear in the recent literature. The aim was to compare the effects of different multicomponent training methods on functional parameters in older women. METHODS: Thirty-seven volunteers were randomly selected into the functional multicomponent training (MFT: N.=15), traditional multicomponent training (MTT: N.=14) and control group (CG: N.=8). They were assessed in the tests: Six-Minute Walk Test (6MWT), Ten-Minute Fast Walking Test (10FWT), Timed Up and Go test (TUG), Functional Reach Test (FRT), Ankle Test (AKT), Sit To Stand Modified test (STSM), and quality of life (QOL). ANOVA (3×2) followed by the Bonferroni post-hoc was used, adopting P≤0.05 for statistical significance. RESULTS: When compared pre-post values, MFT showed significant differences in all functional tests evaluated (AKT: P<0.01; STSM: P<0.01; FRT: P<0.01; QOF: P<0.01; 10FWT: P<0.01; 6MWT: P<0.01; TUG: P<0.05). In the same comparison, MTT showed a significant change in all tests (AKT: P<0.01; STSM: P<0.01; FRT: P<0.01; QOF: P<0.05; 6MWT: P≤0.05; TUG: P<0.05) except 10FWT. When compared to CG, MFT showed a significant difference in all walking tests and MTT showed a better performance in 10FWT and TUG. CONCLUSIONS: Both experimental protocols were effective to improve functional parameters in older women. However, the MFT was performed better in most tests that required efficiency in gait ability.

Inter-day reliability of the Upper Body Test for shoulder and pelvic girdle stability in adults.

BACKGROUND: There are a limited number of tests for the assessment of shoulder and pelvic girdle stability. Reliable instruments are important to evaluate movement dysfunction at these joints in order to provide more objective parameters. OBJECTIVE: To evaluate the inter-day reliability of the Upper Body Test in young adults. METHODS: A reliability study was carried out with three assessments of the shoulder and pelvic girdle stability within 48-h intervals (Monday, Wednesday, and Friday). The OctoBalance® platform was used to perform the Upper Body Test in 31 active young adults (24.5±8 years). Intraclass Correlation Coefficient (ICC2,2) two-way mixed model, Coefficient of Variation, and Bland-Altman plots were used to verify the reliability of the test. The standard error of measurement (SEM) and the minimum detectable difference (MDD95%) were calculated for clinical applicability. RESULTS: The Intraclass Correlation Coefficient ranged from 0.87 to 0.94 - Featuring a mean difference of 0.89 (95%CI=-0.19-1.97) to left and 0.95 (95%CI=-0.38-2.27) for the right side, with a low variation coefficient (3.31-5.91%) between the second and third days of assessment. There was a statistically significant difference between the first assessment day and the other test sessions. The Bland-Altman analyses revealed low bias with scores within the limits of agreement. Minimum detectable difference scores were between 4.02 and 5.10, and standard error of measurement between 1.75 and 2.72, depending on the movement side. CONCLUSION: The Upper Body Test presented good inter-day reliability for assessing the stability of the shoulder and pelvic girdle in young active healthy adults.

Functional Training Induces Greater Variety and Magnitude of Training Improvements than Traditional Resistance Training in Elderly Women.

The objective was to investigate the effects of functional (FT) and traditional (TT) training on trunk muscles maximal isometric strength, rate of force development and endurance with trained elderly women. Forty-five elderly women were directed into three groups: FT (n =1 6), TT (n = 14) and Control (n = 15). The FT (multi-planar, and multi-articular movements) and TT (primarily machine-based resistance exercises) performed mobility, muscle strength and power exercises. Both training groups also performed intermittent cardiometabolic activities. The maximum strength and endurance of the trunk muscles were verified, both at baseline and after 12 weeks of training (3xweek for 50 min each). Data were analyzed using a 2-way ANCOVA with contrast of adjusted mean values. FT significantly increased all variables: maximum trunk flexor strength (p = 0.002, 22%); rate of flexor force development (p = 0.001, 84%); trunk extensors maximal strength (p = 0.003, 17%); trunk extensor rate of force development (p = 0.05, 16%); trunk flexors (p = 0.001, 19%) and extensors (p = 0.017, 13%) endurance compared to baseline. TT showed an increase only in RFD of trunk extensors (p = 0.003, 53%), and flexors (p = 0.033, 42%), and trunk flexors endurance (p = 0.008, 11%). However, there was no statistically significant difference between groups. FT promoted improvement in all variables; strength, endurance and rate of force development of the trunk flexors and extensors of the elderly. On the other hand, TT improved only the rate of force development of trunk flexors and extensors and endurance of the trunk flexors. FT is recommended for elderly women as it improves a broader array of physiological parameters.

Reliability of a Test for Assessment of Isometric Trunk Muscle Strength in Elderly Women.

OBJECTIVE: The aim of this study was to analyze the reproducibility of a protocol using the maximal isometric strength test of the trunk in elderly women aged above 60 years, without low back pain. METHODS: Twenty-one physically inactive elderly women, who had not engaged in any activity or exercise program in the past three months, participated in the cross-sectional study that consisted of two days of evaluations for the maximal isometric strength of the extensor and flexor muscles of the trunk, with a 48 h interval between the sessions. A platform with fixed seating was used, which allowed the fixation of the hip and lower limbs, with a load cell connected to a linear encoder. To verify the reliability of the test, the interclass correlation coefficient, variation coefficient, minimum detectable difference (MDD), standard error of measurement, and Bland-Altman graphs were calculated. RESULTS: No statistical difference was observed between the first and second evaluation, which indicates that there was no learning effect. Interclass correlation coefficient values were classified as very high and high for extensor (0.98) and flexor (0.86) muscles, respectively, besides low variation (9% for both muscle groups) and acceptable values for minimum detectable difference (extensors = 51.1 N, flexors = 48.9 N). In addition, the Bland-Altman analysis revealed low bias and values within the limits of agreement. CONCLUSION: It is concluded that the test of maximum isometric strength of the trunk in healthy and trained elderly people presents high reliability. These values proved to be reliable if performed in at least two evaluation sessions, which confirms the hypothesis of the authors by the consistency of the measurement test.