RESUMO
Tirzepatide is a novel antidiabetic medication a single-molecule, agonist to the glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptors. It is approved in the USA and EU for the treatment of type 2 diabetes mellitus (T2DM) and obesity. Due to the potential novelty represented by incorporating tirzepatide to clinical practice, we aim to review practical aspects of tirzepatide use in T2DM and the supporting scientific evidence. A group of ten endocrinologists involved as investigators in the phase 3 SURPASS clinical trial program followed a nominal group technique, a qualitative research methodology designed as a semi-structured group discussion to reach a consensus on the selection of a set of practical aspects. The scientific evidence for tirzepatide has been reviewed with respect to a number of patients' clinical profiles and care goals. Information of interest related to adverse events, special warnings and precautions, and other considerations for tirzepatide use has been included. Finally, information provided to the patients has been summarized. The practical aspects reported herein may be helpful in guiding physicians in the use of tirzepatide and contribute to optimizing the management of T2DM.
RESUMO
We report the therapeutic outcome of 14 eyes of 11 patients with chronic clinically significant pseudophakic cystoid macular edema refractory to medical management who underwent argon laser photocoagulation of the perifoveal area. Inclusion criteria included chronic cystoid macular edema of more than six months duration of decreased visual acuity (20/100 or less), positive fluorescein angiogram and contact lens examination, pseudophakos with posterior chamber intraocular lens and intact posterior capsule, normal fasting blood sugar, failed medical treatment and minimal follow up of six months. Fifty per cent of the eyes improved after laser treatment (p = .0345, relative to unchanged plus worsened cases). Further prospective, randomized, clinical trials are recommended to define the effectiveness of this treatment protocol
Assuntos
Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fotocoagulação a Laser , Edema Macular/cirurgia , Idoso de 80 Anos ou mais , Argônio , Doença Crônica , Seguimentos , Estudos ProspectivosRESUMO
Levels of serum antibodies against lens alpha, beta H and beta L crystallins were determined in 15 patients before and after endocapsular cataract extraction. The most abundant antibody at the time of surgery was anti-beta L, followed by anti-beta H and anti-alpha. An increase in the basal levels of these antibodies was seen after surgery in 93 percent of the cases. Relative increase was highest for anti-alpha, followed by anti-beta H and anti-beta L. There were individual variations both in the shape of the time-dependent antibody response after surgery and in the relative intensity of the response to the different antigens. The endocapsular technique therefore leads to the release of crystallins into the anterior chamber in sufficient amounts to provoke in many patients a humoral immune response
Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Anticorpos/sangue , Cristalinas/imunologia , Extração de Catarata/métodos , Idoso de 80 Anos ou mais , Seguimentos , Período Pós-Operatório , Fatores de TempoRESUMO
The smallport system is a new technology that brings to surgeons who begin in phacoemulsification more advantages and control in surgery, more security and less time required for learning. The authors show the differences (advantages and disadvantages) between standard systems and the endocapsular ®smallport®. In nuclei up to grade 3 hardness we have good results with low phaco power (5-10 per cent ) and higher linear aspiration (200 mmHg) causing minimal loss of endothelial cells and quick visual rehabilitation
Assuntos
Humanos , Catarata/terapia , Extração de Catarata/métodos , Terapia por Ultrassom , Extração de Catarata/instrumentaçãoRESUMO
A single center, single surgeon, nonrandomized, prospective clinical trial was performed comparing the keratometric induced astigmatism by different types of incisions and closures, one day, one week, one month and three months after 255 cataract surgeries. After phacoemulsification, or in rare cases after extracapsular cataract extraction, through a scleral pocket or limbal incision, patients received either a 5 x 6 mm, 5.5 mm, or 6 mm diameter polymethylmethacrylate optic posterior chamber intraocular lens. Incision was closed with either none, one horizontal or radial, or running 10-0 nylon suture. Vector analysis calculations of prism diopters of mean postoperative-induced keratometric astigmatism showed a trend to lesser values at each interval in scleral pocket incisions but statistically significant difference only at 1 day and 1 week between 9-mm and 6-mm limbal, and 5-mm and 6-mm scleral pocket incisions. Other subgroup analyses, including incision shape and distance from limbus, and type of suture, did not reach statistical significance. Horizontal, 5-mm, sutureless scleral tunnel incision showed less induced astigmatism with more rapid stable refraction