Study of the impact of the vascular systemic risk factors on peripapillary vascular density by optical coherence tomography angiography.

BACKGROUND: The focus of therapeutic tools in glaucoma has been mainly to control of intraocular pressure. Recently there has been a growing interest in investigating the relationship of vascular risk factors in the development of glaucoma. The aim of this study was to assess the association between systemic arterial hypertension, diabetes mellitus and hypercholesterolemia, and peripapillary vascularization measured by Optical Coherence Tomography Angiography (OCTA) in glaucoma and healthy subjects. METHODS: In this unicenter, observational, cross-sectional study, 212 subjects, 118 glaucoma patients and 94 controls were consecutively recruited. Of these, 86 participants were excluded due to poor OCTA image quality. Therefore, 146 subjects were included in the final analysis, 74 glaucoma patients and 72 controls. Using a linear regression model, with 95% confidence and 80% statistical power, the effect of vascular risk factors on OCTA parameters in the 146 subjects included in the final analysis was studied. RESULTS: No significant impact of vascular risk factors on OCTA measurements was found. Diabetic patients tended to show a lower peripapillary perfusion vascular density than subjects without diabetes (ß 0.016, 95%CI 0.003;0.030, p 0.016). Similarly, hypercholesterolemia patients appeared to show less peripapillary flow index than non-hypercholesterolaemic patients (ß 0.029, 95%CI 0.013;0.046, p 0.001). Glaucoma patients had 0.02% lower peripapillary perfusion vascular density (ß 0.020, 95% CI 0.011;0.029, p < 0.001), 0.04% lower peripapillary flow index (ß 0.036, 95%CI 0.022;0.051, p < 0.001) and 9.62% thinner retinal nerve fibre layer (ß 9.619, 95%CI 5.495;13.744, p < 0.001). CONCLUSIONS: In conclusion glaucoma has greater effect on peripapillary vascular density parameters than any of the vascular risk factors analyzed. KEY MESSAGES: What is known: • Vascular disfunction plays an important role in the development of glaucoma. • Optical coherence tomography angiography makes it possible to assess the retinal microvasculature and the role that its alterations could have in the development of glaucoma. WHAT IS NEW: • Decrease of the peripapillary microcirculation seems to be more related to the increase in intraocular pressure and the glaucoma itself than to the presence of cardiovascular risk factors. • The effect of having diabetes, systemic arterial hypertension or hypercholesterolaemia on vascular parameters or nerve fibre layer thickness was low. • There was also no relevant impact of the systemic medication used for these diseases on the peripapillary vascular parameters studied or on nerve fibre layer thickness.

Experiences and impact of a rural Australian high-risk foot service: A multiple-methods study.

OBJECTIVE: Most podiatry-led high-risk foot services (HRFS) in Australia are located in metropolitan areas or large regional centres. In rural areas, where there are limited specialist services, individuals with diabetes-related foot ulceration are more likely to undergo amputation. This study aimed to explore clinicians' perceptions of a recently implemented HRFS in rural New South Wales, Australia, and compare trends of amputation and hospitalisation prior to and post-implementation of the service. SETTING: Rural HRFS in Tamworth, New South Wales, Australia. PARTICIPANTS: Health professionals working within the HRFS were recruited to participate. DESIGN: This was a multiple-methods study. For the qualitative arm, semi-structured interviews were conducted, which were analysed using a reflexive thematic approach. The quantitative arm of the study utilised a retrospective analytic design which applied an interrupted time series to compare amputation and hospitalisation trends pre- and post-implementation of the HRFS utilising diagnostic and procedural ICD codes. RESULTS: The qualitative arm of the study derived three themes: (1) navigating the divide, (2) rural community and rural challenges and (3) professional identity. Results of the interrupted time series indicate that there was a downward trend in major amputations following implementation of the HRFS; however, this was not statistically significant. CONCLUSION: Clinicians were aware of the inequity in DFD outcomes between rural and metropolitan areas and were committed to improving outcomes, particularly with respect to First Nations peoples. Future research will explore service use and amputation rates in the longer term to further evaluate this specialised multidisciplinary care in a rural community.

Corrigendum to "Blend to Limit OxygEN in ECMO: A RanDomised ControllEd Registry (BLENDER) trial: Study protocol and statistical analysis plan" [Crit Care Resuscit 25 (2023) 118-125].

[This corrects the article DOI: 10.1016/j.ccrj.2023.06.001.].

Conservative or liberal oxygen targets in patients on venoarterial extracorporeal membrane oxygenation.

PURPOSE: Patients receiving venoarterial extracorporeal membrane oxygenation (VA-ECMO) frequently develop arterial hyperoxaemia, which may be harmful. However, lower oxygen saturation targets may also lead to harmful episodes of hypoxaemia. METHODS: In this registry-embedded, multicentre trial, we randomly assigned adult patients receiving VA-ECMO in an intensive care unit (ICU) to either a conservative (target SaO2 92-96%) or to a liberal oxygen strategy (target SaO2 97-100%) through controlled oxygen administration via the ventilator and ECMO gas blender. The primary outcome was the number of ICU-free days to day 28. Secondary outcomes included ICU-free days to day 60, mortality, ECMO and ventilation duration, ICU and hospital lengths of stay, and functional outcomes at 6 months. RESULTS: From September 2019 through June 2023, 934 patients who received VA-ECMO were reported to the EXCEL registry, of whom 300 (192 cardiogenic shock, 108 refractory cardiac arrest) were recruited. We randomised 149 to a conservative and 151 to a liberal oxygen strategy. The median number of ICU-free days to day 28 was similar in both groups (conservative: 0 days [interquartile range (IQR) 0-13.7] versus liberal: 0 days [IQR 0-13.7], median treatment effect: 0 days [95% confidence interval (CI) - 3.1 to 3.1]). Mortality at day 28 (59/159 [39.6%] vs 59/151 [39.1%]) and at day 60 (64/149 [43%] vs 62/151 [41.1%] were similar in conservative and liberal groups, as were all other secondary outcomes and adverse events. The conservative group experienced 44 (29.5%) major protocol deviations compared to 2 (1.3%) in the liberal oxygen group (P < 0.001). CONCLUSIONS: In adults receiving VA-ECMO in ICU, a conservative compared to a liberal oxygen strategy, did not affect the number of ICU-free days to day 28.

Consumo de drogas lícitas e ilícitas por estudiantes universitarios: facultad de ingeniería Universidad de Carabobo 2006 / Consumption of licit and illicit drugs by university students: faculty of engineering University of Carabobo 2006

El objetivo fue determinar el consumo de drogas lícitas e ilícitas por estudiantes de la facultad de ingeniería de la Universidad de Carabobo. Estudio descriptivo y transversal, la muestra fue de 1055 estudiantes de ambos sexos, pertenecientes a las diferentes escuelas de la facultad de ingeniería; la recolección de los datos se realizó por medio de un cuestionario durante el período 19-06-06 al 07-07-06. El 85,3 por ciento consume alcohol y lo hacen más frecuentemente los fines de semana 34,6 por ciento, 28,1 por ciento fuma, 22.1 por ciento ha consumido drogas ilícitas alguna vez y 13,7 por ciento consume actualmente. La edad de inicio de consumo fue antes de los 20 años, la droga ilícita de más uso es la marihuana 15,2 por ciento, seguida de cocaína 9,4 por ciento, éxtasis 5 por ciento, heroína 4,8 por ciento, bazuco 3,3 por ciento, crack 2 por ciento, inhalantes 1,7 por ciento, barbitúricos 1,5 por ciento, anfetaminas 1 por ciento. La vía más frecuente de uso es la oral 59,8 por ciento y el lugar de consumo más frecuente en fiestas 29,8 por ciento, un 21,5 por ciento de los encuestados consume drogas en la universidad. Se encontró un porcentaje considerable de consumo de drogas lícitas e ilícitas en los encuestados, siendo en su mayoría del segundo año de la carrera, una parte de ellos lo hace dentro de las instalaciones universitarias

Acerca de la formación Marxista Leninista de los cuadros científico-pedagógicos del ISCM-VC / Some aspects on Leninist-Marxist formation of scientifical pedagogical staff from the higher Institute of Medical Science of Villa Clara

Se realiza un análisis de los resultados obtenidos en las promociones de los cursos de Filosofía Marxista Leninista en el ISCM de Villa Clara durante el período comprendido desde 1976 hasta 1984 y se ofrecen tablas estadísticas que ilustran al respecto. Se muestra la significación del estudio de la Filosofía Marxista Leninista para la explicación de las Ciencias Biomédicas dentro de la verdadera concepción científica del mundo. Se concluye con la observación de deficiencias en la retención de los cursos y el ofrecimiento de los mismos

Análisis del perfeccionamiento del personal científico pedagógico del Instituto Superior de Ciencias Médicas de Villa Clara a través de los cursos básicos / Analysis of scientifical pedagogical training in the higher Institute of medical Sciences of Villa Clara

Con el propósito de determinar la formación básica del personal científico-pedagógico del Claustro del ISCM de VC, se realiza un análisis de los docentes que han recibido cursos básicos de Pedagogía, Filosofía Marxista-Leninista, Idiomas, Computación y Técnicas de Información Científico-Técnica