ABSTRACT
Non-arteritic anterior ischemic optic neuropathy (NAION) is after glaucoma the most common optic neuropathy in patients over 50 years. It is known that high blood pressure (HBP) is an important risk factor for the development of NAION. It is also known that malignant arterial hypertension (MAH) could be accompanied by optic disc edema. However, MAH has not classically been considered a cause of NAION. We report the case of a 32-year-old patient who presented irreversible visual loss with a pattern compatible with NAION as the only manifestation of a hypertensive crisis.
ABSTRACT
Una mujer de raza negra de 62 años de edad que presentaba glaucoma crónico de ángulo estrecho no controlado en tratamiento con tres fármacos fue sometida a faco-esclerectomía profunda no perforante (facoEPNP) de su ojo izquierdo (OI). Durante la cirugía se puso de manifiesto que presentaba rasgo de zónula larga. Precisó goniopunción y desbridamiento de la ampolla posteriormente, presentando una sinequia de iris en la goniopunción que pudo ser reducida de forma conservadora. Este rasgo debe sospecharse en aquellos pacientes que presentan un ángulo estrecho combinado con un síndrome de dispersión pigmentaria. El manejo de la hipertensión ocular y el glaucoma que puede aparecer asociado a este rasgo no está protocolizado. En esta comunicación se reflexiona acerca de la mejor actuación ante esta infrecuente forma de glaucoma.(AU)
A 62-year-old black woman with uncontrolled chronic narrow-angle glaucoma on 3-drug therapy underwent phaco-non-perforating deep sclerectomy of her left eye. During surgery it was revealed that she had long zonule trait. She later required goniopuncture and conjuntival needling, presenting an iris synechia on the goniopuncture that could be reduced conservatively. Long anterior zonule trait should be suspected in those patients presenting with a combination of narrow angle and pigment dispersion syndrome. The management of ocular hypertension and glaucoma associated to this trait is not protocolized. This communication discusses on the best action in this rare form of glaucoma.(AU)
Subject(s)
Humans , Male , Middle Aged , Glaucoma , Glaucoma, Angle-Closure , Ophthalmologic Surgical Procedures , Eye Injuries , Cataract Extraction , Inpatients , Physical Examination , Ophthalmology , CataractABSTRACT
A 62-year-old black woman with uncontrolled chronic narrow-angle glaucoma on 3-drug therapy underwent phaco-non-perforating deep sclerectomy of her left eye. During surgery it was revealed that she had long zonule trait. She later required goniopuncture and conjuntival needling, presenting an iris herniation in the goniopuncture that could be reduced conservatively. Long anterior zonule trait should be suspected in those patients presenting with a combination of narrow angle and pigment dispersion syndrome. The management of ocular hypertension and glaucoma associated to this trait is not protocolized. This communication discusses on the best action in this rare form of glaucoma.
Subject(s)
Glaucoma, Open-Angle , Glaucoma , Ocular Hypertension , Humans , Female , Middle Aged , Intraocular Pressure , Glaucoma, Open-Angle/surgery , Iris/surgerySubject(s)
Aneurysm, False , Aneurysm, False/diagnostic imaging , Aneurysm, False/etiology , Drainage , Humans , Iatrogenic Disease , RuptureABSTRACT
Objetivo: El objetivo del presente estudio fue evaluar la Calidad de Vida Relacionada con la salud (CVRS) en personas con Esclerosis Múltiple (EM) mediante el cuestionario MSQOL-54 y analizar su relación con la salud de las personas cuidadoras principales a través del cuestionario GHQ-12 y un cuestionario de salud física autopercibida. Metodología: Se evaluó a 115 personas con diagnóstico de EM y a 79 personas cuidadoras principales. Resultados: Los resultados obtenidos señalan la significativa afectación de la CVRS de las personas con EM y su relación con la salud de las personas cuidadoras principales. Se encontraron relaciones significativas entre la salud física y mental de la persona con EM y un mayor número de enfermedades, peor salud mental y menor autopercepción de salud en la persona cuidadora. Conclusiones: Los resultados obtenidos señalan la significativa afectación de la CVRS de las personas con EM y su relación directa con la salud de las personas cuidadoras principales. (AU)
Subject(s)
Humans , Male , Female , Young Adult , Adult , Middle Aged , Quality of Life , Multiple Sclerosis , Surveys and Questionnaires , Spain , Mental Health , CaregiversABSTRACT
OBJECTIVE: This study aimed to develop and validate a patient-reported outcome measure (PROM) in acute pancreatitis (AP) as an endpoint centred on the patient. DESIGN: A PROM instrument (PAtieNt-rePoRted OutcoMe scale in acute pancreatItis, an international proSpEctive cohort study, PAN-PROMISE scale) was designed based on the opinion of patients, professionals and an expert panel. The scale was validated in an international multicentre prospective cohort study, describing the severity of AP and quality of life at 15 days after discharge as the main variables for validation. The COSMIN (COnsensus-based Standards for the selection of health status Measurement INstruments) methodology was applied. Both the design and validation stages considered the content and face validity of this new instrument; the metric properties of the different items, reliability (reproducibility and internal consistence), the construct, structural and criterion validity, responsiveness and interpretability of this scale. RESULTS: PAN-PROMISE consists of a seven-item scale based on the symptoms that cause the most discomfort and concern to patients with AP. The validation cohort involved 15 countries, 524 patients. The intensity of symptoms changed from higher values during the first 24 hours to lower values at discharge and 15 days thereafter. Items converged into a unidimensional ordinal scale with good fit indices. Internal consistency and split-half reliability at discharge were adequate. Reproducibility was confirmed using test-retest reliability and comparing the PAN-PROMISE score at discharge and 15 days after discharge. Evidence is also provided for the convergent-discriminant and empirical validity of the scale. CONCLUSION: The PAN-PROMISE scale is a useful tool to be used as an endpoint in clinical trials, and to quantify patient well-being during the hospital admission and follow-up. TRIAL REGISTRATION NUMBER: NCT03650062.
Subject(s)
Pancreatitis/therapy , Patient Reported Outcome Measures , Adult , Aged , Cohort Studies , Female , Hospitalization , Humans , Male , Middle Aged , Pancreatitis/complications , Pancreatitis/psychology , Predictive Value of Tests , Quality of Life , Reproducibility of Results , Symptom AssessmentABSTRACT
BACKGROUND AND RATIONALE: Thromboembolic complications are a serious, preventable and common event in cancer patients that contributes to increasing morbidity and mortality. Despite increasing knowledge on cancer-associated thrombosis (CAT), there are still several aspects of diagnosis, clinical management, treatment and prognosis with uncertainties that are under-represented in randomized clinical trials. For this reason, the Spanish Society of Medical Oncology (SEOM) launched in June 2018 a registry of CAT. METHODS/DESIGN: TESEO is an ongoing prospective, non-interventional, multicentric study in consecutive cancer patients with newly diagnosed of thromboembolic event (TEE). Eligibility criteria include being > 18 years with a histologically confirmed diagnosis of cancer and a symptomatic or incidental TEE confirmed with an imaging technique in the previous month or any time after the cancer diagnosis and signing of informed consent. The study consists of two types of integrated but independent prospective registries. Regular CAT sub-registry includes information on patient's cancer´s characteristics, anticoagulant treatment provided and outcome data. Special CAT sub-registry includes variables related to special situations of CAT that comprise patients with severe kidney failure, thrombocytopenia, high risk of bleeding related to the cancer or with coexistence of bleeding and patients who receive new treatments such a targeted therapy, antiangiogenics agents and immunotherapy. The registry considers the status of the cancer and the time to assess how the prognosis is changed based on when the thrombus occurs. Some outcomes such as rethrombosis, major bleeding, tumor progression and survival will be valued in various time intervals including 1, 3, 6 and 12 months after the even in the first year; and then every 6 months until the patient's death. RESULTS: After 18 months and with 35 centers and researchers, the registry has 1128 patients. CONCLUSION: TESEO registry will provide clinical real-world evidence for prevention, treatment and complications of CAT in different scenarios that are under-represented in randomized clinical trials.
Subject(s)
Neoplasms/complications , Registries/statistics & numerical data , Thromboembolism/epidemiology , Angiogenesis Inhibitors/therapeutic use , Anticoagulants/therapeutic use , Disease Progression , Hemorrhage/epidemiology , Humans , Immunotherapy , Medical Oncology , Molecular Targeted Therapy , Neoplasms/therapy , Prognosis , Recurrence , Renal Insufficiency/epidemiology , Societies, Medical , Spain/epidemiology , Thrombocytopenia/epidemiology , Thromboembolism/drug therapy , Thromboembolism/etiology , Thromboembolism/prevention & control , Treatment Outcome , Venous Thromboembolism/drug therapy , Venous Thromboembolism/epidemiology , Venous Thromboembolism/etiologyABSTRACT
OBJECTIVE: To describe the experience of treatment with baricitinib (BARI) and/or tocilizumab (TCZ), in monotherapy or combined, in patients admitted for interstitial pneumonia secondary to COVID19, and for 30 days after discharge. METHODS: Medical records of patients admitted with COVID19 and IP with PaO2/FiO2<300, treated with BARI and/or TCZ, and compared with patients who did not, were retrospectively reviewed. RESULTS: Sixty patients were included; 43 (72%) are males, mean age 67 (SD: 14) years (<50 years: 17%; 51-70: 30%; >70: 53%), with 8.5 (SD: 1) days of symptoms. Sixteen (27%) patients required ICU (94% in <70 years). Fifteen (25%) patients died, 67% in >70 years; 11 (18%) patients died in the first 15 days of admission and 4 (7%) between days 16 to 30. Twenty-three (38%) patients received BARI, 12 (52%) monotherapy (Group 1), during 6 (SD: 2.6) days on average, none required ICU and 2 (17%) died. Thirty-one (52%) patients received TCZ, 20 (33%) as monotherapy (Group 2), 16 (52%) patients required ICU and 4 (20%) died. In the 11 (18%) patients who received BARI (2.8 [SD: 2.5] days average) and TCZ combined (Group 3), 3 (27%) required ICU and died. There were no severe side effects in BARI or TCZ patients. In the 17 (28%) patients who received neither BARI nor TCZ (Group 4), none required ICU and 6 (35%) died. Mean (SD) PaO2/FiO2 at admission between groups was respectively: 167 (82.3), 221 (114.9), 236 (82.3), 276 (83.2). CONCLUSION: Treatment with BARI and TCZ did not cause serious side effects. They could be considered early in patients with NI secondary to COVID19 and impaired PaO2/PaFi
OBJETIVO: Describir la experiencia con baricitinib (BARI) y/o tocilizumab (TCZ), en monoterapia o combinados en pacientes ingresados por neumonía intersticial (NI) por COVID-19 y durante los 30 días después del alta. MÉTODO: Se revisaron retrospectivamente las historias clínicas de los pacientes ingresados por COVID-19 y NI, con PaO2/FiO2<300, tratados con BARI y/o TCZ y se compararon con pacientes que no los recibieron. RESULTADOS: Se incluyeron 60 pacientes; 43 (72%) varones, edad media 67 (DE: 14) años (< 50 años: 17%; 51-70: 30%; > 70: 53%), y 8,5 (DE: 1) días de síntomas. Dieciséis (27%) ingresaron en la unidad de cuidados intensivos (UCI) (94% < 70 años). Quince (25%) fallecieron (67% > 70 años); 11 (18%) de ellos en los primeros 15 días del ingreso y cuatro (7%) entre los días 16 y 30. Veintitrés (38%) pacientes recibieron BARI, 12 (52%) en monoterapia (Grupo 1), durante seis (DE: 2.6) días de promedio, ninguno de ellos ingresó en UCI y dos (17%) fallecieron. Treinta y un (52%) pacientes recibieron una dosis de TCZ, 20 (33%) en monoterapia (Grupo 2), 16 (52%) ingresaron en UCI y cuatro (20%) fallecieron. Entre los 11 (18%) pacientes que recibieron BARI (2,8 [DE: 2,5] días de promedio) y TCZ combinados (Grupo 3), tres (27%) ingresaron en UCI y fallecieron. No hubo efectos secundarios graves entre los que recibieron BARI y/o TCZ. Entre los 17 (28%) pacientes que no recibieron ni BARI ni TCZ (Grupo 4), ninguno ingresó en UCI y seis (35%) fallecieron. La PaO2/FiO2 media (DE) al ingreso entre los grupos fue respectivamente: 167 (82,3), 221 (114,9), 236 (82,3), 276 (83,2). CONCLUSIÓN: El tratamiento con BARI y TCZ no provocó efectos secundarios graves. Podrían considerarse precozmente en pacientes con NI secundaria a COVID-19 y deterioro de PaO2/PaFi
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Coronavirus Infections/complications , Coronavirus Infections/drug therapy , Lung Diseases, Interstitial/drug therapy , Lung Diseases, Interstitial/virology , Antibodies, Monoclonal, Humanized/administration & dosage , Pneumonia, Viral/complications , Pneumonia, Viral/drug therapy , Pandemics , Drug Therapy, Combination , Treatment Outcome , Retrospective StudiesABSTRACT
The paper is concerned with the consensus problem in a multi-agent system such that each agent has boundary constraints. Classical Olfati-Saber's consensus algorithm converges to the same value of the consensus variable, and all the agents reach the same value. These algorithms find an equality solution. However, what happens when this equality solution is out of the range of some of the agents? In this case, this solution is not adequate for the proposed problem. In this paper, we propose a new kind of algorithms called supportive consensus where some agents of the network can compensate for the lack of capacity of other agents to reach the average value, and so obtain an acceptable solution for the proposed problem. Supportive consensus finds an equity solution. In the rest of the paper, we define the supportive consensus, analyze and demonstrate the network's capacity to compensate out of boundaries agents, propose different supportive consensus algorithms, and finally, provide some simulations to show the performance of the proposed algorithms.
Subject(s)
Algorithms , Artificial Intelligence , Consensus , Models, StatisticalABSTRACT
Varón de 21 años en seguimiento en el servicio de oftalmología por drusas del nervio óptico (DNO). En una revisión rutinaria se evidenció la presencia de neovascularización coroidea (NVC) bajo el haz papilomacular en el ojo derecho (OD). El paciente fue tratado con 2 inyecciones intravítreas de anti-vascular endothelial growth factor (anti-VEGF, por sus siglas en inglés) con buena respuesta. La aparición de NVC en el haz papilomacular es una complicación infrecuente en los pacientes con DNO. Estas NVC presentan una buena respuesta al tratamiento con inyecciones intravítreas de anti-VEGF
A 21-year-old man was seen for follow-up of optic nerve head drusen (ONHD) in the ophthalmology department. Funduscopy revealed the presence of choroidal neovascularisation (CNV) in the papillomacular bundle of his right eye (RE). The patient was successfully treated with two intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF). Peri-papillary choroidal neovascularisation in papillomacular bundle is a rare complication in patients with ONHD. These forms of CNV show a good response to anti-VEGF treatment
Subject(s)
Humans , Male , Young Adult , Choroidal Neovascularization/diagnostic imaging , Choroidal Neovascularization/therapy , Optic Disk Drusen/complications , Optic Disk Drusen/diagnostic imaging , Optic Disk Drusen/pathology , Intravitreal Injections , Visual Acuity , Tomography, Optical Coherence/methods , Angiography , Bevacizumab/administration & dosage , Fundus OculiABSTRACT
A 21-year-old man was seen for follow-up of optic nerve head drusen (ONHD) in the ophthalmology department. Funduscopy revealed the presence of choroidal neovascularisation (CNV) in the papillomacular bundle of his right eye (RE). The patient was successfully treated with two intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF). Peri-papillary choroidal neovascularisation in papillomacular bundle is a rare complication in patients with ONHD. These forms of CNV show a good response to anti-VEGF treatment.
Subject(s)
Choroidal Neovascularization/etiology , Optic Disk Drusen/complications , Humans , Male , Young AdultABSTRACT
Population aging is associated with greater numbers of older people with cancer. Thanks to treatment advances, not only are more seniors diagnosed with cancer, but there are also more and more older cancer survivors. This upward trend will continue. Given the heterogeneity of aging, managing older patients with cancer poses a significant challenge for Medical Oncology. In Spain, a Geriatric Oncology Task Force has been set up within the framework of the Spanish Society for Medical Oncology (SEOM). With the aim of generating evidence and raising awareness, as well as helping medical oncologists in their training with respect to seniors with cancer, we have put together a series of basic management recommendations for this population. Many of the patients who are assessed in routine clinical practice in Oncology are older. CGA is the basic tool by means of which to evaluate older people with cancer and to understand their needs. Training and the correct use of recommendations regarding treatment for comorbidities and geriatric syndromes, support care, and drug-drug interactions and toxicities, including those of antineoplastic agents, as detailed in this article, will ensure that this population is properly managed
No disponible
Subject(s)
Humans , Aged , Neoplasms/therapy , Geriatric Assessment/methods , Neoplasms/epidemiology , Health of the Elderly , Multiple Chronic Conditions/epidemiology , Polypharmacy , Drug-Related Side Effects and Adverse Reactions/prevention & control , Granulocyte Colony-Stimulating Factor/therapeutic use , Erythropoietin/therapeutic useABSTRACT
No disponible
Subject(s)
Humans , Female , Aged, 80 and over , Permeability , Conjunctiva/diagnostic imaging , Conjunctiva/surgery , Orbital Implants , Glaucoma/surgery , Minimally Invasive Surgical Procedures , Filtering Surgery , Anterior Chamber/diagnostic imaging , Prosthesis ImplantationABSTRACT
No disponible
Subject(s)
Humans , Colonoscopy/methods , Colonic Neoplasms/diagnostic imaging , Colonoscopy/trends , Colonic Neoplasms/epidemiologySubject(s)
Filtering Surgery/instrumentation , Glaucoma, Open-Angle/surgery , Stents , Aged, 80 and over , Air , Female , Humans , Permeability , PressureABSTRACT
No disponible
Subject(s)
Humans , Male , Adult , Pars Planitis/diagnosis , Tattooing/adverse effects , Tuberculosis, Ocular/diagnosis , Tuberculin/analysis , Tuberculin Test , Tuberculosis, Ocular/etiologyABSTRACT
Population aging is associated with greater numbers of older people with cancer. Thanks to treatment advances, not only are more seniors diagnosed with cancer, but there are also more and more older cancer survivors. This upward trend will continue. Given the heterogeneity of aging, managing older patients with cancer poses a significant challenge for Medical Oncology. In Spain, a Geriatric Oncology Task Force has been set up within the framework of the Spanish Society for Medical Oncology (SEOM). With the aim of generating evidence and raising awareness, as well as helping medical oncologists in their training with respect to seniors with cancer, we have put together a series of basic management recommendations for this population. Many of the patients who are assessed in routine clinical practice in Oncology are older. CGA is the basic tool by means of which to evaluate older people with cancer and to understand their needs. Training and the correct use of recommendations regarding treatment for comorbidities and geriatric syndromes, support care, and drug-drug interactions and toxicities, including those of antineoplastic agents, as detailed in this article, will ensure that this population is properly managed.