Analysis of OPD-Scan and Pentacam Parameters for Early Keratoconus Detection.

BACKGROUND: PURPOSE: To evaluate Pentacam and OPD-Scan parameters in the early detection of keratoconus. DESIGN: Retrospective case-control study. METHODS: Case group included 50 clinically unaffected fellow eyes diagnosed with asymmetric keratoconus showing subtle qualitative changes at the 0.5-D sensitivity OPD-Scan scale, as well as normal anterior and back elevation difference map at Belin/Ambrósio enhanced ectasia display (BAD) at the Pentacam. Control group included 172 normal eyes that underwent Lasik surgery and presented no complications throughout the 2-year follow-up period. OPD-Scan and Pentacam parameters were compared, calculating sensitivity, specificity, and area under the receiver operating characteristic curve (AUC). A multivariate analysis was performed using Pentacam or OPD-Scan variables, and a model using variables of both devices. RESULTS: Pentacam variables with AUC ≥0.8 were keratoconus index (0.85), index of height decentration (0.81), and overall deviation at BAD (0.8). OPD-Scan variables with AUC ≥0.8 were keratoconus prediction index (0.83), surface asymmetry index (0.83), and total of higher-order trefoil aberration (0.8). In the multivariate analysis, the AUC was 0.85 in the case of OPD-Scan whereas it was 0.89 in the case of Pentacam. When combining all variables from the 2 devices, the AUC was 0.93, with a sensitivity of 82% and a specificity of 94%. CONCLUSIONS: Several parameters of OPD-Scan and Pentacam can be useful to differentiate cases from normal control eyes, demonstrating even better results when combining parameters of both devices. Anterior corneal indexes were the most important parameters to discriminate both groups.

Incidence and risk factors of preoperative anxiety in Spanish-speaking children living in a Spanish-speaking country.

BACKGROUND: Most research on preoperative anxiety has focused on non-Latino populations. A study performed in the USA found that children from Spanish-speaking Latino families experienced higher anxiety than children from English-speaking families. AIMS: To report the incidence and level of preoperative anxiety in native Spanish-speaking children living in their home country and to assess risk factors associated with higher anxiety levels. METHODS: Data were collected from 204 children aged 2-12 undergoing elective surgery in a Chilean hospital. Patients' demographic data, surgery-related information, and self-reported parental anxiety were collected. Children's anxiety was measured using the Modified Yale Preoperative Anxiety Scale. An anxiety score greater than 30 indicated significant anxiety. The main outcome for analyzing risk factors was children's anxiety level in the operating room. RESULTS: Significant preoperative anxiety was observed in 41.7% (95% CI: 34.8%-48.8%) of patients, with median anxiety score of 26.6 (IQR, 23.4-46.6). A significant positive correlation was observed between self-reported parental anxiety in the preoperative holding room and children's anxiety in the operating room (r = .153, P = .02), with a higher median difference when mothers are present in anesthesia induction (36.8 vs 30.7, respectively; P = .006). Linear regression analysis found previous negative surgical experience to be associated with higher anxiety levels in the operating room (ß = 16.057, P = .014). CONCLUSIONS: Spanish-speaking children undergoing elective surgery in their home country experienced significant rates of preoperative anxiety. Parental anxiety and previous negative surgical experience were risk factors associated with higher anxiety levels.

Principios quirúrgicos en fracturas de platillos tibiales con compromiso de columna posterior / Surgical principles in posterior column tibial plateau fractures

Las fracturas de platillos tibiales son lesiones complejas que incluyen una variedad de patrones morfológicos cada vez mejor caracterizados en la literatura. Históricamente, los esquemas de clasificación se han basado en evaluar los rasgos de fractura en el plano frontal y las técnicas quirúrgicas en lograr la fijación de esos fragmentos, sin tomar en consideración el compromiso óseo que ocurre en la región posterior de los platillos tibiales. Con el advenimiento de la clasificación columnar basada en tomografía computada, se han logrado desarrollar estrategias de fijación optimizada, dando cada vez más relevancia a la columna posterior. Este artículo realiza una revisión extensa de la literatura, otorgando los fundamentos quirúrgicos que explican la importancia del tratamiento específico de la columna posterolateral y posteromedial, con el fin de restablecer la biomecánica normal de la rodilla y el razonamiento quirúrgico de las diversas vías de abordaje específicas para una reducción y osteosíntesis satisfactoria de esos fragmentos.

Tibial plateau fractures are complex injuries which include a variety of morphological patterns that have been increasingly better characterized in the literature. Historically, classifications have focused on description of fracture patterns in the frontal plane, while surgical techniques have focused on reduction of these fragments not considering the osseous defects that occur on the posterior region of the tibial plateau. With new CT scan column based classifications, strategies to optimize fixation have been developed, giving relevance to the posterior column. This article is an exhaustive review of the literature, providing the surgical foundations that explain the importance of specific treatment of the posterolateral and posteromedial column, aiming to restore normal knee biomechanics. Furthermore, this article provides the diverse specific surgical approaches rationale for a satisfactory open reduction and internal fixation of these fragments.