ABSTRACT
Hydrogen peroxide (H2O2) is a reactive species that is also involved in the redox regulation of cells because of it is relative stability. In numerous pathological situations, a chronic increase in the production of reactive species is observed, which is related to oxidative stress and cellular damage. This study aimed to evaluate the effects of long-term exposure to different H2O2 concentrations on oxidative stress biomarkers and mitochondrial dynamics in HL60 cells. HL60 cells were treated with a sustained production (0.1, 1.0 and 10.0 nM/s) of H2O2 for one hour. H2O2 production and malondialdehyde (MDA) levels, as a lipid peroxidation marker, increased progressively in HL60 cells in accordance with higher H2O2 exposure, with significant differences between the 10 nM/s H2O2 group and the control and 0.1 nM/s groups. Similarly, progressive increased expression in genes related to the mitochondrial antioxidant defences and mitochondrial dynamics were also observed. Significantly increased gene expression in the 10 nM/s H2O2 with respect to the control group was observed for manganese superoxide dismutase (MnSOD), peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PCG1α), nuclear respiratory factor 2 (Nrf2), mitochondrial transcription factor A (Tfam), mitofusins 1 and 2 (Mfn1 and Mfn2) and uncoupling protein 3 (UCP3), whereas no significant changes were observed in the cytochrome c oxidase subunit IV (COXIV) gene expression. In conclusion, exposure to different sustained production of H2O2 is related to a progressive increase in the gene expression of mitochondrial dynamics and redox processes in HL60 cells, but also to oxidative damage at higher H2O2 production levels.
Subject(s)
Hydrogen Peroxide , Lipid Peroxidation , Mitochondria , Oxidative Stress , Reactive Oxygen Species , Humans , Hydrogen Peroxide/metabolism , Oxidative Stress/drug effects , Lipid Peroxidation/drug effects , HL-60 Cells , Mitochondria/metabolism , Mitochondria/drug effects , Reactive Oxygen Species/metabolism , Malondialdehyde/metabolismABSTRACT
Objetivo: Analizar si informar la frecuencia de administración (FA) en el módulo de prescripción de la estación clínica de atención primaria (ECAP) del Institut Català de la Salut (ICS) mejora la adecuación de la FA de las prescripciones. Diseño: Estudio de adecuación antes-después con control no equivalente de prescripciones sin cambios en la FA. El periodo de estudio incluye desde el 1 de septiembre de 2019 hasta el 29 de febrero de 2020.Emplazamiento: Ámbito de atención primaria. Participantes: Se incluyen las prescripciones de los medicamentos con una única FA adecuada o mayoritariamente adecuada realizadas por los médicos de familia del ICS durante el periodo de estudio.IntervenciónRecomendar la FA adecuada en el módulo de prescripción. Mediciones principales: Adecuación definida como la coincidencia entre la FA prescrita y la FA adecuada. Resultados: Tras la intervención se produjo un aumento del 22,75% de prescripciones con FA adecuada. El mayor aumento se dio en los medicamentos del sistema genitourinario y hormonas sexuales. En términos absolutos, el grupo de antiinfecciosos es el que obtuvo más prescripciones con FA adecuada entre los dos periodos. Conclusiones: La intervención aumentó la adecuación en la FA de las prescripciones, lo que supone una mejora en la seguridad y en la eficacia de los tratamientos. Se evidencia que el diseño y la implantación de mejoras en los sistemas de prescripción electrónica contribuye a aumentar la calidad de la prescripción.(AU)
Objective: To assess whether reporting the dosing frequency into the prescription module of the Institut Català de la Salut (ICS) primary care electronic clinical workstation improves the dosing frequency's adequacy of the prescriptions. Design: Before and after study with non-equivalent control of prescriptions without any change in the dosing frequency. The study periods includes from September 1st, 2019 to February 29th, 2020.Location: Primary care setting. Participants: Prescriptions issued by ICS General Practitioner, during the study period of those medicines which indications have a single appropriate dosing frequency or mostly appropriate, are included.Intervention: Recommendation of the appropriate dosing frequency in the prescription module. Main measurements: Adequacy defined as the coincidence between the prescribed dosing frequency and the appropriate dosing frequency. Results: After the intervention there was a 22.75% increase in prescriptions with adequate dosing frequency. The largest increase occurred in the medicines for the genitourinary system and sex hormones. In absolute terms, the group of anti infective for systemic use is the one that obtained more prescriptions with an adequate dosing frequency between the two periods. Conclusions: The intervention increased the dosing frequency's adequacy leading to improvements in the safety and effectiveness of the treatments. It is evident that the design and implementation of improvements in electronic prescription systems contributes to increasing the quality of the prescription.(AU)
Subject(s)
Humans , Prescriptions , Insurance, Pharmaceutical Services/legislation & jurisprudence , Medication Errors , Patient Safety , Electronic Prescribing , Primary Health CareABSTRACT
OBJECTIVE: To assess whether reporting the dosing frequency into the prescription module of the Institut Català de la Salut (ICS) primary care electronic clinical workstation improves the dosing frequency's adequacy of the prescriptions. DESIGN: Before and after study with non-equivalent control of prescriptions without any change in the dosing frequency. The study periods includes from September 1st, 2019 to February 29th, 2020. LOCATION: Primary care setting. PARTICIPANTS: Prescriptions issued by ICS General Practitioner, during the study period of those medicines which indications have a single appropriate dosing frequency or mostly appropriate, are included. INTERVENTION: Recommendation of the appropriate dosing frequency in the prescription module. MAIN MEASUREMENTS: Adequacy defined as the coincidence between the prescribed dosing frequency and the appropriate dosing frequency. RESULTS: After the intervention there was a 22.75% increase in prescriptions with adequate dosing frequency. The largest increase occurred in the medicines for the genitourinary system and sex hormones. In absolute terms, the group of anti infective for systemic use is the one that obtained more prescriptions with an adequate dosing frequency between the two periods. CONCLUSIONS: The intervention increased the dosing frequency's adequacy leading to improvements in the safety and effectiveness of the treatments. It is evident that the design and implementation of improvements in electronic prescription systems contributes to increasing the quality of the prescription.
Subject(s)
Electronic Prescribing , Pharmaceutical Preparations , Humans , Pharmaceutical Preparations/administration & dosageABSTRACT
BACKGROUND: In 2008, in the context of a complete computerisation of medical records, the Institut Català de la Salut (ICS, Catalan Health Institute) implemented a system in its electronic clinical workstation (ECW) to assist decision-making at the prescription level. This system is known as Self Audit, and it supports physicians in reviewing the medication of their patients. Self Audit provides lists of patients presenting medication-related problems (MRPs) that have potential for improvement, and provides therapeutic recommendations that are easy to apply from the system itself. The aim of this study was to analyse the main results derived from the use of Self Audit in primary care (PC) in Catalonia, and the effect of an incentive-based safety indicator on the results obtained. METHODS: A descriptive cross-sectional study was carried out to analyse variations in the MRPs detected by Self Audit during 2016, 2017, and 2018 in PC in Catalonia. The effect of a safety indicator on the results obtained was also studied. This safety indicator includes the most clinically relevant MRPs (i.e., therapeutic duplications, safety alerts from the Spanish Medicines Agency, and incidences of polymedication in patients over 65 years of age). Variation in the MRPs was measured using the differences between two evaluation points (initial and final). An MRP was considered resolved if the recommendation specified in the alert was followed. The prescriptions of 6411 PC doctors of the ICS who use the ECW and provide their services to 5.8 million Catalans through 288 PC teams were analysed. RESULTS: Analysis of the total safety-based MRPs detected by Self Audit gave overall resolutions from April to December of 9% (21,547) in 2016, 7% (15,924) in 2017, and 1% (2392) in 2018 out of the total number of MRPs recorded in April each year. Examination of the 3 types of MRPs with the highest clinical relevance that were linked to the safety indicator gave overall resolutions of 41% in 2016 (17,358), 20% in 2017 (7655), and 21% in 2018 (8135). CONCLUSIONS: The ICS Self Audit tool assists in reducing the number of safety-based MRPs in a systematic manner, and yields superior results for the MRPs linked to a safety indicator included in the incentives of PC physicians.
Subject(s)
Clinical Decision-Making , Prescriptions , Cross-Sectional Studies , Humans , Primary Health Care , SpainABSTRACT
BACKGROUND: In 2008, the Institut Català de la Salut (ICS, Catalan Health Institute) implemented a prescription decision support system in its electronic clinical workstation (ECW), which automatically generates online alerts for general practitioners when a possible medication-related problem (MRP) is detected. This tool is known as PREFASEG, and at the time of beginning a new treatment, it automatically assesses the suitability of the treatment for the individual patient. This analysis is based on ongoing treatments, demographic characteristics, existing pathologies, and patient biochemical variables. As a result of the assessment, therapeutic recommendations are provided. The objective of this study is to present the PREFASEG tool, analyse the main alerts that it generates, and determine the degree of alert acceptance. METHODS: A cross-sectional descriptive study was carried out to analyse the generation of MRP-related alerts detected by PREFASEG during 2016, 2017, and 2018 in primary care (PC) in Catalonia. The number of MRP alerts generated, the drugs involved, and the acceptance/rejection of the alerts were analysed. An alert was considered "accepted" when the medication that generated the alert was not prescribed, thereby following the recommendation given by the tool. The MRP alerts studied were therapeutic duplications, safety alerts issued by the Spanish Medicines Agency, and drugs not recommended for use in geriatrics. The prescriptions issued by 6411 ICS PC physicians who use the ECW and provide their services to 5.8 million Catalans through 288 PC teams were analysed. RESULTS: During the 3 years examined, 67.2 million new prescriptions were analysed, for which PREFASEG generated 4,379,866 alerts (1 for every 15 new treatments). A total of 1,222,159 alerts (28%) were accepted. Pharmacological interactions and therapeutic duplications were the most detected alerts, representing 40 and 30% of the total alerts, respectively. The main pharmacological groups involved in the safety alerts were nonsteroidal anti-inflammatory drugs and renin-angiotensin system inhibitors. CONCLUSIONS: During the period analysed, 28% of the prescriptions wherein a toxicity-related PREFASEG alert was generated led to treatment modification, thereby helping to prevent the generation of potential safety MRPs. However, the tool should be further improved to increase alert acceptance and thereby improve patient safety.
Subject(s)
Decision Support Systems, Clinical , Medical Order Entry Systems , Pharmaceutical Preparations , Clinical Decision-Making , Cross-Sectional Studies , Drug Interactions , Humans , Medication Errors/prevention & control , Prescriptions , Primary Health Care , SpainABSTRACT
The aim of this study was to quantify the proportion of regulatory T cells (Treg ) and cytokine expression by peripheral blood mononuclear cells (PBMCs) in patients with active non-infectious uveitis, and to evaluate the effect of in-vitro treatment with infliximab, dexamethasone and cyclosporin A on Treg levels and cytokine production in PBMCs from uveitis patients and healthy subjects. We included a group of 21 patients with active non-infectious uveitis and 18 age-matched healthy subjects. The proportion of forkhead box protein 3 (FoxP3)(+) Treg cells and intracellular tumour necrosis factor (TNF)-α expression in CD4(+) T cells was determined by flow cytometry. PBMCs were also either rested or activated with anti-CD3/anti-CD28 and cultured in the presence or absence of dexamethasone, cyclosporin A and infliximab. Supernatants of cultured PBMCs were collected and TNF-α, interleukin (IL)-10, IL-17 and interferon (IFN)-γ levels were measured by enzyme-linked immunosorbent assay (ELISA). No significant differences were observed in nTreg levels between uveitis patients and healthy subjects. However, PBMCs from uveitis patients produced significantly higher amounts of TNF-α and lower amounts of IL-10. Dexamethasone treatment in vitro significantly reduced FoxP3(+) Treg levels in PBMCs from both healthy subjects and uveitis patients, and all tested drugs significantly reduced TNF-α production in PBMCs. Dexamethasone and cyclosporin A significantly reduced IL-17 and IFN-γ production in PBMCs and dexamethasone up-regulated IL-10 production in activated PBMCs from healthy subjects. Our results suggest that PBMCs from patients with uveitis express more TNF-α and less IL-10 than healthy subjects, and this is independent of FoxP3(+) Treg levels. Treatment with infliximab, dexamethasone and cyclosporin Aâ in vitro modulates cytokine production, but does not increase the proportion of FoxP3(+) Treg cells.
Subject(s)
Antibodies, Monoclonal/pharmacology , Cyclosporine/pharmacology , Dexamethasone/pharmacology , T-Lymphocytes, Regulatory/drug effects , Uveitis/drug therapy , Adult , Cells, Cultured , Cytokines/metabolism , Disease Progression , Female , Forkhead Transcription Factors/metabolism , Humans , Infliximab , Lymphocyte Count , Male , Middle Aged , T-Lymphocytes, Regulatory/immunology , Uveitis/immunology , Young AdultABSTRACT
Interleukin-6 (IL-6) is a key cytokine featuring redundancy and pleiotropic activity. It plays a central role in host defence against environmental stress such as infection and injury. Dysregulated, persistent interleukin (IL)-6 production has been implicated in the development of various autoimmune, chronic inflammatory diseases and even cancers. Significant elevation of IL-6 has been found in ocular fluids derived from refractory/chronic uveitis patients. In experimental autoimmune uveitis models with IL-6 knock-out mice, IL-6 has shown to be essential for inducing inflammation. IL-6 blockade can suppress acute T helper type 17 (Th17) responses via its differentiation and, importantly, can ameliorate chronic inflammation. Tocilizumab, a recombinant humanized anti-IL-6 receptor antibody, has been shown to be effective in several autoimmune diseases, including uveitis. Herein, we discuss the basic biology of IL-6 and its role in development of autoimmune conditions, focusing particularly on non-infectious uveitis. It also provides an overview of efficacy and safety of tocilizumab therapy for ocular inflammatory diseases.
Subject(s)
Autoimmune Diseases/metabolism , Eye Diseases/metabolism , Interleukin-6/metabolism , Receptors, Interleukin-6/metabolism , Animals , Antibodies, Monoclonal, Humanized/pharmacology , Antibodies, Monoclonal, Humanized/therapeutic use , Autoimmune Diseases/drug therapy , Autoimmune Diseases/genetics , Autoimmune Diseases/immunology , Eye Diseases/drug therapy , Eye Diseases/genetics , Eye Diseases/immunology , Humans , Interleukin-6/antagonists & inhibitors , Interleukin-6/genetics , Molecular Targeted Therapy , Receptors, Interleukin-6/antagonists & inhibitors , Signal TransductionABSTRACT
CASO CLÍNICO: Dos pacientes con lupus eritematoso sistémico consultaron por pérdida visual y fueron diagnosticadas de vasculopatía retiniana. La paciente 1 presentó vasculitis oclusiva en ojo derecho con edema macular e isquemia retiniana. Se aumentó la inmunosupresión, añadiendo rituximab iv, y realizó terapia intravítrea y panretinofotocoagulación. La paciente 2 presentó oclusión venosa central retiniana izquierda no vasculítica y fue anticoagulada por presentar síndrome antifosfolípido. Ambas pacientes mantuvieron su agudeza visual estable. DISCUSIÓN: La vasculitis oclusiva lúpica retiniana puede ocasionar graves repercusiones visuales y sistémicas (vasculitis cerebral). Es importante diferenciarla de la oclusión vascular común
CLINIC CASE: Two patients with systemic lupus erythematosus presented with vision loss, and were diagnosed with retinal vasculopathy. Patient 1 had occlusive vasculitis with macular oedema and retinal ischaemia in the right eye. Corticosteroid therapy was increased and intravenous rituximab added. Intravitreal therapy and panretinal photocoagulation were performed. Patient 2 presented with a left central retinal vein occlusion without vasculitis but was on anticoagulation therapy due to having an antiphospholipid syndrome. Both patients maintained a stable visual acuity. DISCUSSION: Occlusive lupus retinal vasculitis has severe visual and systemic consequences (central nervous system vasculitis). It is crucial to differentiate it from standard vascular occlusion syndromes
Subject(s)
Humans , Female , Lupus Erythematosus, Systemic/complications , Retinal Vasculitis/diagnosis , Lupus Vasculitis, Central Nervous System/complications , Macular Edema/etiology , Retinal Vein Occlusion/etiologyABSTRACT
CLINIC CASE: Two patients with systemic lupus erythematosus presented with vision loss, and were diagnosed with retinal vasculopathy. Patient 1 had occlusive vasculitis with macular oedema and retinal ischaemia in the right eye. Corticosteroid therapy was increased and intravenous rituximab added. Intravitreal therapy and panretinal photocoagulation were performed. Patient 2 presented with a left central retinal vein occlusion without vasculitis but was on anticoagulation therapy due to having an antiphospholipid syndrome. Both patients maintained a stable visual acuity. DISCUSSION: Occlusive lupus retinal vasculitis has severe visual and systemic consequences (central nervous system vasculitis). It is crucial to differentiate it from standard vascular occlusion syndromes.
Subject(s)
Lupus Erythematosus, Systemic/complications , Retinal Vasculitis/etiology , Retinal Vein Occlusion/etiology , Acenocoumarol/therapeutic use , Antibodies, Monoclonal, Murine-Derived/therapeutic use , Anticoagulants/therapeutic use , Antiphospholipid Syndrome/complications , Antiphospholipid Syndrome/drug therapy , Cataract/complications , Diagnosis, Differential , Female , Fluorescein Angiography , Humans , Immunosuppressive Agents/therapeutic use , Ischemia/etiology , Lupus Erythematosus, Systemic/drug therapy , Macular Edema/etiology , Middle Aged , Mycophenolic Acid/analogs & derivatives , Mycophenolic Acid/therapeutic use , Prednisone/therapeutic use , Retinal Vasculitis/diagnosis , Retinal Vasculitis/drug therapy , Retinal Vein Occlusion/diagnosis , Rituximab , Tomography, Optical CoherenceABSTRACT
OBJECTIVE: To describe the epidemiology, clinical features and visual prognosis in uveitis associated with demyelinating disease (DD) of the CNS. METHODS: A clinical, retrospective, and descriptive study was performed. Data regarding age at presentation, gender, time from onset was recorded, as well as, type of uveitis, complications, treatment and initial and final visual acuity (BCVA) on all patients with DD-associated uveitis diagnosed in our Unit between January 2009 and June 2011. RESULTS: Five women and 4 men were finally included (1.3% of 697 with uveitis). There was associated multiple sclerosis in 78% of cases. Mean age at presentation was 36.6 years for uveitis and 40 years for DD. The uveitis preceded the DD in 3 cases (33%). Typically, uveitis was bilateral (89%), chronic (89%), intermediate (89%), and associated with previous inflammation (29%), with synechiae (65%), and granulomatous (44%). The most frequent complications were cataract (71%) and macular oedema (53%). Besides local treatment, uveitis was managed with systemic steroids (78%), immunosuppressants (44%), and surgery (41% of eyes). After a mean follow up of 5 years, 47% of the eyes had a worse BCVA, among which, 12% lost ≥ 3 Snellen lines. The only patient treated with interferon (IFN), remained stable without treatment for the last 7 years. CONCLUSIONS: DD-associated uveitis typically affected young adult women with intermediate-anterior uveitis of chronic, bilateral and synechiae type. Complications are common and there is a risk of visual loss, despite treatment. IFN therapy may be an effective alternative to be investigated.
Subject(s)
Demyelinating Diseases/complications , Uveitis/etiology , Adolescent , Adrenal Cortex Hormones/therapeutic use , Adult , Aged , Cataract/etiology , Combined Modality Therapy , Female , Humans , Immunosuppressive Agents/therapeutic use , Interferon-alpha/therapeutic use , Lens Implantation, Intraocular , Macular Edema/etiology , Male , Middle Aged , Multiple Sclerosis/complications , Multiple Sclerosis/drug therapy , Myelitis, Transverse/complications , Phacoemulsification , Retrospective Studies , Treatment Outcome , Uveitis/drug therapy , Uveitis/surgery , Vitrectomy , Young AdultABSTRACT
Objetivo: Describir la epidemiología, características clínicas y pronóstico visual de las uveítis asociadas a enfermedad desmielinizante (ED) del SNC. Métodos: Estudio retrospectivo, descriptivo de serie clínica. Se recogieron la edad de presentación y el sexo, el tiempo de evolución, el tipo de uveítis, las complicaciones, el tratamiento instaurado y la agudeza visual (AVmc), basal y final, de todos los pacientes con uveítis asociada a ED diagnosticada en nuestro Servicio entre enero de 2009 y junio de 2011. Resultados: Se incluyó a cinco mujeres y cuatro hombres (1,3% de 697 uveítis atendidas). Asociaron esclerosis múltiple un 78%. La edad media de presentación de la uveítis fue de36,6 años y de la ED, 40 años. La uveítis antecedió a la ED en 3 casos (33%). La uveítis fue, típicamente, bilateral (89%), crónica (89%) e intermedia (89%) y asociada a inflamación anterior(29%), sinequiante (65%) y granulomatosa (44%). Las complicaciones más frecuentes fueron: catarata (71%) y edema macular (53%). Además del tratamiento local, la uveítis se manejó con esteroides sistémicos (78%), inmunosupresores (44%) y cirugía (41% de ojos). Tras un seguimiento medio de 5 años, un 47% de los ojos empeoró su AVmc, perdiendo ≥ 3 líneas de Snellen en un 12%. La única paciente tratada con interferón (IFN), permaneció estable sin tratamiento durante los últimos 7 años. Conclusiones: La uveítis asociada a ED afecta típicamente a mujeres adultas jóvenes con uveítis intermedias-anteriores, crónicas, bilaterales y sinequiantes. Las complicaciones son frecuentes y existe riesgo de pérdida visual, a pesar del tratamiento. La terapia con IFN podría ser una alternativa eficaz a investigar(AU)
Objective: To describe the epidemiology, clinical features and visual prognosis in uveitis associated with demyelinating disease (DD) of the CNS. Methods: A clinical, retrospective, and descriptive study was performed. Data regarding age at presentation, gender, time from onset was recorded, as well as, type of uveitis, complications, treatment and initial and final visual acuity (BCVA) on all patients with DD-associated uveitis diagnosed in our Unit between January 2009 and June 2011. Results: Five women and 4 men were finally included (1.3% of 697 with uveitis). There was associated multiple sclerosis in 78% of cases. Mean age at presentation was 36.6 years for uveitis and 40 years for DD. The uveitis preceded the DD in 3 cases (33%). Typically, uveitis was bilateral (89%), chronic (89%), intermediate (89%), and associated with previous inflammation (29%), with synechiae (65%), and granulomatous (44%). The most frequent complications were cataract (71%) and macular o edema (53%). Besides local treatment, uveitis was managed with systemic steroids (78%), immunosuppressants (44%), and surgery (41% of eyes). After a mean follow up of 5 years, 47% of the eyes had a worse BCVA, among which, 12% lost ≥3 Snellen lines. The only patient treated with interferon (IFN), remained stable without treatment for the last 7 years. Conclusions: DD-associated uveitis typically affected young adult women with intermediate-anterior uveitis of chronic, bilateral and synechiae type. Complications are common and there is a risk of visual loss, despite treatment. IFN therapy may be an effective alternative to be investigated(AU)
Subject(s)
Humans , Male , Female , Adolescent , Young Adult , Adult , Middle Aged , Uveitis , Uveitis/diagnosis , Uveitis/mortality , Uveitis/prevention & control , Uveitis/therapy , Uveitis/epidemiology , Multiple Sclerosis , Demyelinating Diseases , Myelitis, Transverse , Ophthalmology , Retrospective Studies , Epidemiology, DescriptiveABSTRACT
OBJECTIVE: To evaluate the effect of pars plana vitrectomy in the management of patients with pars planitis. METHODS: A retrospective analysis of the clinical course, post-operative complications and recurrent uveal inflammation following pars plana vitrectomy in patients with pars planitis. RESULTS: The study included 22 eyes of 19 patients. The mean follow-up was 55.7 (± 39.6) months (range 7 - 144 months). The surgical indications were, persistent vitreous opacities in 10 eyes, vitreous haemorrhage in 9 eyes, and epiretinal membrane in 3 eyes. There was an improvement in the clinical course of the uveitis in 19 of the 22 eyes (86.4%), allowing the suspension of the systemic treatment in 16 patients. An improvement of the visual acuity was observed in 20 eyes (90.9%). The most common post-operative complications were, lens opacities in 9 eyes (40.9%), and glaucoma in 4 eyes (18.2%). CONCLUSIONS: The results of this study suggest that pars plana vitrectomy has a beneficial effect on the course and visual function of patients with vitreo-retinal complications associated with pars planitis.
Subject(s)
Eye Diseases/surgery , Pars Planitis/complications , Vitrectomy/methods , Vitreoretinal Surgery/methods , Vitreous Body/surgery , Adolescent , Adult , Cataract/epidemiology , Child , Child, Preschool , Epiretinal Membrane/etiology , Epiretinal Membrane/surgery , Eye Diseases/etiology , Female , Follow-Up Studies , Humans , Male , Pars Planitis/surgery , Postoperative Complications/epidemiology , Retrospective Studies , Visual Acuity , Vitreous Hemorrhage/etiology , Vitreous Hemorrhage/surgery , Young AdultABSTRACT
ObjetivoEvaluar el efecto de la vitrectomía pars plana en pacientes diagnosticados de pars planitis.MétodosSe realizó un análisis retrospectivo del curso clínico, las complicaciones postoperatorias y recurrencia de la uveítis tras la realización de vitrectomía pars plana en pacientes con pars planitis.ResultadosSe incluyeron en el estudio 22 ojos de 19 pacientes con pars planitis. El tiempo medio de seguimiento postoperatorio fue de 55,7 meses (rango 7 144 meses). Las indicaciones quirúrgicas fueron opacidades vítreas persistentes en 10 ojos, hemorragia vítrea en 9 ojos, y membrana epirretiniana en 3 ojos. En 19 de los 22 ojos (86,4%) hubo una mejoría en el curso de la uveítis que permitió la suspensión del tratamiento sistémico en 16 pacientes. Veinte ojos (90,9%) mejoraron la agudeza visual postoperatoriamente. Las complicaciones postoperatorias más frecuentes fueron opacidad de cristalino en 9 ojos (40,9%) y glaucoma en 4 ojos (18,2%).ConclusionesLos resultados de este estudio sugieren que la vitrectomía vía pars plana tiene un efecto beneficioso en el curso y en la función visual de los pacientes con complicaciones vitreo-retinianas asociadas a pars planitis.
ObjectiveTo evaluate the effect of pars plana vitrectomy in the management of patients with pars planitis.MethodsA retrospective analysis of the clinical course, post-operative complications and recurrent uveal inflamation following pars plana vitrectomy in patients with pars planitis.ResultsThe study included 22 eyes of 19 patients. The mean follow-up was 55.7 (±39.6) months (range 7 144 months). The surgical indications were, persistent vitreous opacities in 10 eyes, vitreous haemorrhage in 9 eyes, and epiretinal membrane in 3 eyes. There was an improvement in the clinical course of the uveitis in 19 of the 22 eyes (86.4%), allowing the suspension of the systemic treatment in 16 patients. An improvement of the visual acuity was observed in 20 eyes (90.9%). The most common post-operative complications were, lens opacities in 9 eyes (40.9%), and glaucoma in 4 eyes (18.2%).ConclusionsThe results of this study suggest that pars plana vitrectomy has a beneficial effect on the course and visual function of patients with vitreo-retinal complications associated with pars planitis(AU)
Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Vitrectomy/adverse effects , Vitrectomy , Uveitis, Intermediate/complications , Uveitis, Intermediate/surgery , Vitreous Body/surgery , Vitreous Body/injuries , Visual Acuity , Retrospective Studies , Vitrectomy/methodsABSTRACT
STUDY DESIGN: Prospective longitudinal study. OBJECTIVE: To identify prognosis factors that allow us to identify patients with risk of developing chronic symptoms and disabilities after a whiplash injury. SUMMARY OF BACKGROUND DATA: The prognosis factors for poor recovery in acute whiplash are not conclusive. METHODS: We included 557 patients who suffered whiplash injury after road traffic accident and visited the Department of Physical Medicine and Rehabilitation of Mataró Hospital (Spain) for medical evaluation and rehabilitation treatment. The variables were collected following a protocol designed for the study, and all patients were assessed through the Visual Analogue Scale (VAS) for the intensity of neck pain, the Goldberg Depression and Anxiety Scale and the Northwick Park Neck Pain Questionnaire (NPH) for cervical column functionality at initial evaluation and 6 months later. RESULTS: Factors related with VAS 6 months after the whiplash injury were women, age, number of days of cervical column immobilization, previous neck pain, self-employed workers, housewives, pensioners, students, presence of headache or dizziness, and VAS, Goldberg Depression and Anxiety scale, and NPH scores at initial evaluation. In multivaried analysis, it had been found that the variables that had influence on VAS 6 months after the whiplash injury were statistically significant for age, presence of dizziness, self-employed workers, and VAS and NPH scores at initial evaluation. CONCLUSION: Our findings indicate that factors that allow us to identify patients at risk for poor recovery are age, dizziness, and initial evaluation of neck pain with VAS and cervical column functionality with NPH.
Subject(s)
Neck Pain/etiology , Whiplash Injuries/complications , Accidents, Traffic , Age Factors , Chronic Disease , Disability Evaluation , Female , Humans , Injury Severity Score , Male , Neck Pain/diagnosis , Pain Measurement , Prognosis , Prospective Studies , Recovery of Function , Risk Factors , Sex Factors , Statistics, Nonparametric , Surveys and QuestionnairesABSTRACT
Fundamentos y objetivo: El vértigo de intensidad variable es un síntoma frecuente en pacientes que han presentado un síndrome del latigazo cervical (SLC) y que presentan alteraciones del equilibrio bien documentadas. El objetivo del estudio fue evidenciar alteraciones del control postural en las fases precoces del SLC tras el accidente. Pacientes y método: Se incluyó a 99 mujeres; 54 habían presentado un SLC en las 2 semanas previas, mientras que 45 voluntarias sanas formaron el grupo control. En ambos grupos se realizó una posturografía estática sobre una plataforma de fuerza y se estudió en 4 fases secuenciales la prueba de Romberg para valorar el área de barrido (AB) como variable dependiente. Para evaluar el dolor y la funcionalidad cervical se usaron la escala analógica visual (EVA) y el Northwick Park Neck Pain Questionnaire (NPH). Resultados: El AB aumentó de forma significativa en cada una de las fases consecutivas en ambos grupos. Las diferencias de las medias del área de barrido fueron estadísticamente significativas en todas las fases del Romberg (p=0,009 a p=0,000). No se evidenció correlación entre el AB y el dolor o la funcionalidad cervical. Existió una correlación positiva con el AB en Romberg gomaespuma ojos cerrados y el tiempo de incapacidad laboral temporal (r=0,414; p=0,009). Conclusiones: Los pacientes diagnosticados de un SLC reciente muestran alteración del control postural valorado mediante posturografía estática secuencial, lo que sugiere que la alteración del equilibrio no es sólo consecuencia de la evolución tardía del SLC, por lo que debería promoverse la instauración temprana de un plan terapéutico específico si el paciente refiriera vértigos y/o síntomas relacionados (AU)
Background and objective: Dizziness of variable intensity is a frequent complaint in patients who suffered whiplash and largely documented balance disturbances. The objective of the study was to identify balance disorders in early stage of whiplash after road traffic accidents. Patients and method: Ninety nine women were included in the study. Fifty four women had suffered whiplash within two weeks and 45 were included in a healthy control group. Static posturography on a force platform was carried out in all study participants, by means of the Romberg test in four sequential phases, using the postural sway area (SA) as a dependent variable. Visual Analogic Scale (VAS) and Northwick Park Neck Pain Questionnaire (NPH) were used to evaluate pain and function. Results: Postural sway area increased significantly in each of the consecutive phases in both groups. The differences of the means of the postural sway area were statistically significant in all Romberg phases (p=.009 to P=.000). No correlation was found between SA and VAS or NPH scores. There was a positive correlation between the postural sway area standing on a thick foam cushion placed over the plate with closed eyes and the number of days of transitory incapacity (r=0.414; P=.009). Conclusions: Patients with recent whiplash show a postural control disturbance revealed trough a sequential static posturography analysis. This suggests that the balance disorder is not only a consequence of late whiplash syndrome evolution. Therefore, we should promote early instauration of a specific therapeutic approach if and when the patient refers dizziness and related symptoms (AU)
Subject(s)
Humans , Female , Whiplash Injuries/complications , Vertigo/etiology , Posture/physiology , Neck Pain/etiology , Case-Control StudiesABSTRACT
BACKGROUND AND OBJECTIVE: Dizziness of variable intensity is a frequent complaint in patients who suffered whiplash and largely documented balance disturbances. The objective of the study was to identify balance disorders in early stage of whiplash after road traffic accidents. PATIENTS AND METHOD: Ninety nine women were included in the study. Fifty four women had suffered whiplash within two weeks and 45 were included in a healthy control group. Static posturography on a force platform was carried out in all study participants, by means of the Romberg test in four sequential phases, using the postural sway area (SA) as a dependent variable. Visual Analogic Scale (VAS) and Northwick Park Neck Pain Questionnaire (NPH) were used to evaluate pain and function. RESULTS: Postural sway area increased significantly in each of the consecutive phases in both groups. The differences of the means of the postural sway area were statistically significant in all Romberg phases (p=.009 to P=.000). No correlation was found between SA and VAS or NPH scores. There was a positive correlation between the postural sway area standing on a thick foam cushion placed over the plate with closed eyes and the number of days of transitory incapacity (r=0.414; P=.009). CONCLUSIONS: Patients with recent whiplash show a postural control disturbance revealed trough a sequential static posturography analysis. This suggests that the balance disorder is not only a consequence of late whiplash syndrome evolution. Therefore, we should promote early instauration of a specific therapeutic approach if and when the patient refers dizziness and related symptoms.
Subject(s)
Posture , Vertigo/etiology , Vertigo/prevention & control , Whiplash Injuries/complications , Adult , Case-Control Studies , Cross-Sectional Studies , Female , HumansABSTRACT
Se presenta un paciente de 60 años, argentino, con antecedentes de púrpura hipergammaglobulinémica, afectando miembros inferiores y abdomen, desde hace 19 años, con vasculitis leucocitoclástica, factor reumatoideo positivo y crioglobulinemia, asociada con cirrosis por hepatitis crónica por virus C. Es posible que pacientes diagnosticados como púrpura crioglobulinémica estén afectados de hipergammaglobulinas séricas y ambas púrpuras representen una misma enfermedad
Subject(s)
Humans , Male , Middle Aged , Hepatitis C, Chronic/complications , Purpura, Hyperglobulinemic/diagnosis , Arthritis, Rheumatoid , Liver Cirrhosis/complications , Lupus Erythematosus, Systemic/complications , Multiple Myeloma/complications , Mikulicz' Disease , Purpura, Hyperglobulinemic/classification , Purpura, Hyperglobulinemic/complications , Sjogren's Syndrome/complicationsABSTRACT
Se presenta un paciente de 60 años, argentino, con antecedentes de púrpura hipergammaglobulinémica, afectando miembros inferiores y abdomen, desde hace 19 años, con vasculitis leucocitoclástica, factor reumatoideo positivo y crioglobulinemia, asociada con cirrosis por hepatitis crónica por virus C. Es posible que pacientes diagnosticados como púrpura crioglobulinémica estén afectados de hipergammaglobulinas séricas y ambas púrpuras representen una misma enfermedad (AU)