Severe epithelial ingrowth after pars plana vitrectomy ten years after LASIK relifting.

Epithelial ingrowth is one of the most significant complications of Laser in Situ Keratomileusis (LASIK) refractive surgery. We present the case of a 72-year-old male with a history of myopic LASIK (1999), who underwent cataract surgery and a second thin LASIK sub-Bowman flap to correct refractive error. Then, three months after pars plana vitrectomy for an epiretinal membrane, the patient complained of progressive vision loss. A diffuse haze of the corneal stroma that did not exist before surgery was observed. As the main suspicion was epithelial ingrowth, the flap was lifted and meticulous de-epithelialization of the stromal bed was performed. Mitomycin C 0.02% was applied, the flap was sutured with 10-0 Nylon, and a bandage contact lens was placed. The epithelialization of the interface after vitrectomy in a patient with LASIK could occur even when it is a rare complication and without obvious flap traumatism.

A two-component model of hair cortisol concentration in fibromyalgia: Independent effects of pain chronicity and severity.

BACKGROUND: Fibromyalgia (FM) is a chronic pain disorder of unknown aetiopathogenesis, in which the role of activity of the hypothalamic-pituitary-adrenal (HPA) axis is not clearly established. METHODS: This study analysed the modulatory effects of disease chronicity and severity on cortisol levels. Hair cortisol concentrations (HCC) and clinical evaluation data (pain severity, impact of FM on daily activities, depression, anxiety, fatigue and insomnia) were collected from 47 female patients with FM and 36 healthy women (HW). RESULTS: The results showed that disease chronicity, with a negative effect, and symptom severity, with a positive effect, were independent predictors of HCC. Patients with a shorter disease duration had higher HCC than patients with a longer disease duration and healthy participants. Furthermore, patients with greater symptom severity had higher HCC than those patients with lower clinical severity and healthy participants. While disease chronicity in FM was associated with a decrease in HCC, clinical severity increased HCC. CONCLUSIONS: These results support the existence of a dysfunction in the regulation of the HPA axis in FM and its possible contribution to chronic pain development. SIGNIFICANCE: This is the first study to assess hair cortisol concentrations in a specific sample of patients with fibromyalgia (FM). This method is especially useful for the assessment of long-term regular cortisol excretion. Results showed a two-component model for explaining cortisol levels: disease chronicity, with a negative effect, and symptom severity, with a positive effect. This suggests that severe pain/stress evokes higher cortisol levels at earlier stages of FM, while in the longer term a decrease in cortisol levels was observed.

El glistening de las lentes intraoculares: revisión de la literatura / Glistening on intraocular lenses: a review

El glistening en las lentes intraoculares (LIO) es un fenómeno en el que se forman diminutas microvacuolas llenas de agua dentro del material de la LIO, lo que hace que la luz se disperse y cree un efecto centelleante o reluciente. La presencia del glistening es frecuente en muchos tipos de materiales y modelos de LIO, y se ha estudiado ampliamente en los últimos años para conocer su incidencia, factores de riesgo, evolución y posible relevancia clínica. Clásicamente se ha estudiado in vitro en laboratorio o mediante fotografía obtenida con lámpara de hendidura. Sin embargo, son técnicas que requieren de un explorador experto, además de requerir mucho tiempo y un complejo procesado de las imágenes. En los últimos años, han surgido propuestas basadas en la cámara de Scheimpflug y en la tomografía de coherencia óptica como forma de simplificar el análisis del glistening en las LIO. Se ha descrito que tanto el proceso de fabricación, como el propio material acrílico hidrofóbico, y el tiempo desde la cirugía son factores de riesgo relacionados con la aparición de glistening. Además, aún se desconocen numerosas cuestiones relacionadas con este fenómeno, como la cantidad de puntos o el tamaño de los mismos necesarios para causar afectación de la función visual, ya que se han descrito diferentes fenómenos ópticos relacionados con el glistening de las LIO (AU)

The glistening in intraocular lenses (IOLs) is a phenomenon in which tiny water-filled microvacuoles form within the IOL material, causing light to scatter and create a sparkling or shimmering effect. The presence of glistening is common in many types of IOL materials and models and has been extensively studied in recent years to determine its incidence, risk factors, evolution, and possible clinical relevance. Classically, it has been studied in vitro in the laboratory or by means of photography obtained with a slit lamp, but these were techniques that required either specific technology or an expert explorer, complex image processing, and required a lot of time. In recent years, proposals based on the Scheimpflug camera and optical coherence tomography have emerged to try to simplify the analysis of glistening in IOLs. It has been described that the manufacturing process, the hydrophobic acrylic material, or the time since surgery are risk factors for the appearance of glistening. In addition, many issues related to this phenomenon are still unknown, such as not knowing from what number of points or their size they may have relevance to visual function since different optical phenomena related to glistening have been described on the IOLs (AU)

Evaluación de las modificaciones biométricas del ojo durante la succión del LASIK / Assessment of the biometric modifications of the eye in LASIK during suction

Objetivo Estudiar las modificaciones biométricas del globo ocular durante la succión en la cirugía de queratomileusis in situ asistida por láser (LASIK). Métodos Estudio observacional transversal. Se estudiaron 43 pacientes intervenidos de miopía y astigmatismo miópico. La edad media fue de 38,3 ± 11,5 años, 19 eran mujeres (44,2%). Se realizó una cirugía LASIK convencional con microqueratomo manual. Antes y durante la maniobra de succión se midieron los siguientes parámetros mediante una sonda biométrica de 11 Mhz: profundidad acuosa (AQD), espesor del cristalino (EC), longitud de la cavidad vítrea (LCV) y longitud axial (LA). Se utilizó la prueba t pareada para comparar las medidas biométricas antes y durante la succión. Resultados El equivalente esférico medio fue de -4,5 ± 2,3 dioptrías. Durante la succión, la AQD no aumentó significativamente (p = 0,231). Sin embargo, la LA y LCV aumentaron en 0,12 mm y 0,2 mm, respectivamente (p = 0,039 y < 0,01) y EC disminuyó en 0,20 mm (p < 0,01). La LA aumentó en 42% de los ojos y disminuyó en 16%, mientras que la LCV aumentó en 70% de los ojos y disminuyó en 9%, y el EC se redujo en 67% de los ojos. Conclusiones Las maniobras de succión durante la cirugía LASIK producen cambios de poca magnitud en el globo ocular, principalmente disminución de EC y aumento de LCV y LA. Por lo tanto, es esperable que estas modificaciones produzcan alteraciones anatómicas mínimas (AU)

Purpose To study the biometric modifications of the eyeball during suction in laser assisted in situ keratomileusis (LASIK). Methods Observational and cross-sectional study. We studied 43 patients who underwent surgery for myopia and myopic astigmatism. Mean age was 38.3±11.5 years, and 19 were female (44.2%). Conventional LASIK surgery with a manual microkeratome was performed. Before and during the suction maneuvre the following parameters were measured using an 11 MHz biometric probe: aqueous depth (AQD), lens thickness (LT), vitreous cavity length (VCL) and axial length (AXL). Paired t-test was used to compare the biometric measurements before and during suction. Results The mean spherical equivalent refractive error was −4.5±2.3 diopters. During suction, the AQD did not change significantly (p = 0.231). However, AXL and VCL increased by 0.12 mm and 0.22 mm respectively (p = 0.039 and <0.01) and LT decreased by 0.20 mm (p<0.01). AXL increased in 42% of the eyes and decreased in 16%, VCL increased in 70% of the eyes and decreased in 9%, and the LT was reduced in 67% of the eyes. Conclusions Suction maneuvres during LASIK surgery produce changes of little magnitude in the eye globe, mainly a decrease in LT and an increase in VCL and AXL. Therefore, these modifications are expected to produce minimal anatomic alterations (AU)

Assessment of the biometric modifications of the eye in LASIK during suction.

PURPOSE: To study the biometric modifications of the eyeball during suction in Laser assisted in Situ Keratomileusis (LASIK). METHODS: Observational and cross-sectional study. We studied 43 patients who underwent surgery for myopia and myopic astigmatism. Mean age was 38.3 ±â€¯11.5 years, and 19 were female (44.2%). Conventional LASIK surgery with a manual microkeratome was performed. Before and during the suction maneuvre the following parameters were measured using an 11 Mhz biometric probe: aqueous depth (AQD), lens thickness (LT), vitreous cavity length (VCL) and axial length (AXL). Paired t-test was used to compare the biometric measurements before and during suction. RESULTS: The mean spherical equivalent refractive error was -4.5 ±â€¯2.3 diopters. During suction, the AQD did not change significantly (p = 0.231). However, AXL and VCL increased by 0.12 mm and 0.22 mm respectively (p = 0.039 and <0.01) and LT decreased by 0.20 mm (p < 0.01). AXL increased in 42% of the eyes and decreased in 16%, VCL increased in 70% of the eyes and decreased in 9%, and the LT was reduced in 67% of the eyes. CONCLUSIONS: Suction maneuvres during LASIK surgery produce changes of little magnitude in the eye globe, mainly a decrease in LT and an increase in VCL and AXL. Therefore, these modifications are expected to produce minimal anatomic alterations.

Glistening on intraocular lenses: A review.

The glistening in intraocular lenses (IOLs) is a phenomenon in which tiny water-filled microvacuoles (MVs) form within the IOL material, causing light to scatter and create a sparkling or shimmering effect. The presence of glistening is common in many types of IOL materials and models and has been extensively studied in recent years to determine its incidence, risk factors, evolution, and possible clinical relevance. Classically, it has been studied in vitro in the laboratory or by means of photography obtained with a slit lamp, but these were techniques that required either specific technology or an expert explorer, complex image processing, and required a lot of time. In recent years, proposals based on the Scheimpflug camera and optical coherence tomography have emerged to try to simplify the analysis of glistening in IOLs. It has been described that the manufacturing process, the hydrophobic acrylic material, or the time since surgery are risk factors for the appearance of glistening. In addition, many issues related to this phenomenon are still unknown, such as not knowing from what number of points or their size they may have relevance to visual function since different optical phenomena related to glistening have been described on the IOLs.

Creating a kidney organoid-vasculature interaction model using a novel organ-on-chip system.

Kidney organoids derived from human induced pluripotent stem cells (iPSCs) have proven to be a valuable tool to study kidney development and disease. However, the lack of vascularization of these organoids often leads to insufficient oxygen and nutrient supply. Vascularization has previously been achieved by implantation into animal models, however, the vasculature arises largely from animal host tissue. Our aim is to transition from an in vivo implantation model towards an in vitro model that fulfils the advantages of vascularization whilst being fully human-cell derived. Our chip system supported culturing of kidney organoids, which presented nephron structures. We also showed that organoids cultured on chip showed increased maturation of endothelial populations based on a colocalization analysis of endothelial markers. Moreover, we observed migration and proliferation of human umbilical vein endothelial cells (HUVECs) cultured in the channels of the chip inside the organoid tissue, where these HUVECs interconnected with endogenous endothelial cells and formed structures presenting an open lumen resembling vessels. Our results establish for the first-time vascularization of kidney organoids in HUVEC co-culture conditions using a microfluidic organ-on-chip. Our model therefore provides a useful insight into kidney organoid vascularization in vitro and presents a tool for further studies of kidney development and drug testing, both for research purposes and pre-clinical applications.

Incidence and prevalence of multiple sclerosis in Spain: a systematic review.

INTRODUCTION: Greater understanding of the prevalence and incidence of multiple sclerosis in Spain and their temporal trends is necessary to improve the allocation of healthcare resources and to study aetiological factors. METHODS: We performed a systematic search of the MedLine database and reviewed the reference lists of the articles gathered. We collected studies reporting prevalence or incidence rates of multiple sclerosis in any geographical location in Spain, with no time limits. In 70% of cases, data were extracted by 2 researchers (FGL and EAC); any discrepancies were resolved by consensus. RESULTS: We identified 51 prevalence and 33 incidence studies published between 1968 and 2018. In the adjusted analysis, the number of prevalent cases per 100 000 population increased by 26.6 (95% confidence interval [CI], 21.5-31.8) every 10 years. After adjusting for year and latitude, the number of incident cases per 100 000 population increased by 1.34 (95% CI, 0.98-1.69) every 10 years. We observed a trend toward higher prevalence and incidence rates at higher latitudes. CONCLUSIONS: The prevalence of multiple sclerosis in Spain has increased in recent decades, although case ascertainment appears to be incomplete in many studies. Incidence rates have also increased, but this may be due to recent improvements in the detection of new cases.

Consensus statement on the use of alemtuzumab in daily clinical practice in Spain.

INTRODUCTION: Alemtuzumab is a highly effective drug approved by the European Medicines Agency as a disease-modifying drug for the treatment of relapsing-remitting multiple sclerosis. OBJECTIVE: A consensus document was drafted on the management of alemtuzumab in routine clinical practice in Spain. DEVELOPMENT: A group of multiple sclerosis specialists reviewed articles addressing treatment with alemtuzumab in patients with multiple sclerosis and published before December 2017. The included studies assessed the drug's efficacy, effectiveness, and safety; screening for infections and vaccination; and administration and monitoring aspects. The initial proposed recommendations were developed by a coordinating group and based on the available evidence and their clinical experience. The consensus process was carried out in 2 stages, with the initial threshold percentage for group agreement established at 80%. The final document with all the recommendations agreed by the working group was submitted for external review and the comments received were considered by the coordinating group. CONCLUSION: The present document is intended to be used as a tool for optimising the management of alemtuzumab in routine clinical practice.

Bio-distribution and longevity of mesenchymal stromal cell derived membrane particles.

Vesicle-based medicines hold great promise for therapy development but essential knowledge on the bio-distribution and longevity of vesicles after administration is lacking. We generated vesicles from the membranes of human mesenchymal stromal cells (MSC) and we demonstrated earlier that these so-called membrane particles (MP) mediate immunomodulatory and regenerative responses in target cells. In the present study we examined the bio-distribution and longevity of MP after intravenous administration in mice. While most vesicle tracking methods are based on imaging techniques, which require labeling of vesicles and can only detect dense accumulations of vesicles, we used proteomics analysis to detect the presence of MP-derived proteins in multiple organs and tissues. MP proteins were mainly present in plasma and leukocytes at 1 h after injection, indicating that MP - in contrast to whole MSC - do not accumulate in the lungs upon first passage but remain in circulation. After 24 h, MP proteins were still present in plasma but were most abundant in the liver. RNA sequencing of livers demonstrated that MP impact liver function and in particular induce metabolic pathways. These data provide a clear view of the bio-distribution and longevity of MP, which is likely extrapolatable to other types of vesicles, and demonstrate that MP circulate for up to 24 h and may be a tool for targeting the liver.

Ratio of Women with POP Using Pessary, Improvement in Urination and Quality of Life

Introduction: Pelvic organ prolapse (POP) has a general incidence of > 10% in the female population of the Western world. The pessary is a silicone device, it is inserted into the vagina to provide support to the pelvic organs. It is used as a conservative treatment to improve prolapse symptoms. Objective: To evaluate urination among women with a pessary and women without a pessary and to evaluate the effectiveness of pessary treatment in pelvic organ prolapse with voiding difficulties. Material and Methods: A prospective and quasi-experimental observational study of an analytical nature was conducted. It will consist of analyzing the results of treatment with vaginal pessaries in women with POP. A total of 60 women were chosen as a sample of the study, 50% were placed with the pessary. PGI test and uroflujometry were used. Results: The placement of pessary shows how there is a significant correlation between the quality of life of women and urination Conclusions: There is a relationship between the improvement of the quality of life and the improvement of the mycological dynamics of women in pessary treatment. However, the improvement in the quality of life cannot be attributed solely to the improvement of urinary flow, but also to the well-being caused by the reduction of POP (AU)

Introducción: El prolapso de órganos pélvicos (POP)presenta una incidencia general de > 10% en la poblaciónfemenina del mundo occidental. El pesario es un dispositivo de silicona, se introduce en la vagina para proveer soporte a los órganos pélvicos. Se utiliza como tratamientoconservador para mejorar los síntomas del prolapso.Objetivo: Evaluar las micciones entre las mujeres conpesario y las mujeres sin pesario y evaluar la efectividad deltratamiento del pesario en los prolapsos de órganos pélvicosque tienen dificultad miccionalMaterial y Métodos: Se llevó a cabo un estudioobservacional prospectivo y cuasi experimental, de carácter analítico. Consistirá en analizar los resultados detratamiento mediante pesarios vaginales en mujeres conPOP. Un total de 60 mujeres fueron elegidas como muestradel estudio, al 50% se les colocó el pesario. Se utilizó eltest PGI y la uroflujometría.Resultados: La colocación del pesario muestra comoexiste una correlación significativa entre la calidad de vidade las mujeres con POP y las micciones.Conclusiones: Existe relación entre la mejora de lacalidad de vida y la mejora de las dinámicas miccionalesde las mujeres en tratamiento con pesario. Sin embargo,la mejora de la calidad de vida no se puede atribuir únicamente a la mejora del flujo urinario, sino también al bienestar provocado por la reducción del POP (AU)

Longitudinal study of the newborn small for gestational age. Growth recovery and conditioning factors / Estudio longitudinal del recién nacido pequeño para la edad gestacional. Crecimiento recuperador y factores condicionantes

Background: small-for-gestational-age (SGA) newborns present a higher morbidity and mortality rate when compared to infants born appropriate for gestational age (AGA), as well as insufficient growth, with height far from their target and in some cases a low final height (< -2 SDs). Objective: the aim of this study was to determine when catch-up growth (CUG) in height occurs in these children, and which factors are associated with lack of CUG. Material and methods: this is a retrospective study of SGAs born between 2011 and 2015 in a secondary hospital. Anthropometric measurements were taken consecutively until CUG was reached, and fetal, placental, parental, newborn, and postnatal variables were studied. Results: a total of 358 SGAs were included from a total of 5,585 live newborns. At 6 and 48 months of life, 93.6 % and 96.4 % of SGAs achieved CUG, respectively. By subgroups, symmetric SGAs performed worse than asymmetric SGAs with CUG in 84 % and 92 % at 6 and 48 months of life, respectively. The same occurred in the subgroup of preterm SGAs with respect to term SGAs, with worse CUGs of 88.2 % and 91.2 % at 6 and 48 months of life, respectively. Prematurity, symmetrical SGA, intrauterine growth retardation (IUGR), preeclampsia, previous child SGA, perinatal morbidity, and comorbidity during follow-up were associated with absence of CUG. Conclusions: the majority of SGAs had CUG in the first months of life. The worst outcomes were for preterm and symmetric SGAs (AU)

Antecedentes: el recién nacido pequeño para la edad gestacional (PEG) presenta mayor morbimortalidad que el recién nacido con peso adecuado (PAEG), así como un crecimiento insuficiente con talla alejada de la talla diana y, en algunos casos, talla final baja (< -2 DE). Objetivo: el objetivo de este estudio fue determinar en qué momento se produce el crecimiento compensador (CUG) de la talla en estos niños y conocer qué factores se asocian a la falta de dicho crecimiento compensador. Material y métodos: estudio retrospectivo de los recién nacidos PEG entre los años 2011 y 2015 en un hospital secundario. Se tomaron medidas antropométricas de forma consecutiva hasta alcanzar el CUG y se estudiaron las variables fetales, placentarias, parentales, neonatales y posnatales. Resultados: se incluyeron 358 PEG de un total de 5585 recién nacidos vivos. A los 6 y 48 meses de vida alcanzaron el CUG el 93,6 % y 96,4 % de los PEG, respectivamente. Por subgrupos, los PEG simétricos obtuvieron peores resultados que los PEG asimétricos, con CUG del 84 % y 92 % a los 6 y 48 meses de vida, respectivamente. Lo mismo ocurrió en el subgrupo de PEG prematuros respecto de los PEG a término, con CUG peores del 88,2 % y 91,2 % a los 6 y 48 meses de vida, respectivamente. La prematuridad, el PEG simétrico, la restricción del crecimiento intrauterino, la preeclampsia, tener un hijo previo PEG, la morbilidad perinatal y la comorbilidad durante el seguimiento se asociaron a la ausencia de CUG. Conclusiones: la mayoría de los PEG alcanzaron el CUG en los primeros meses de vida. Los peores resultados fueron para los PEG prematuros y simétricos (AU)

Planes de atención a niños y adolescentes con asma en España, un análisis por comunidades autónomas / Care plans for children and adolescents with asthma in Spain, an analysis by autonomous communities

Introducción y objetivo: describir cómo realizan los pediatras de Atención Primaria (PAP) el manejo de los niños y adolescentes con asma en España. Material y métodos: estudio transversal, observacional y descriptivo para conocer los planes/guías de atención al asma en edad pediátrica por comunidades autónomas (CC. AA.), y ciudades autónomas de Ceuta y Melilla, la inclusión de esta actividad en sus carteras de servicios (CS) y cómo se registra en la historia clínica informatizada del paciente, mediante encuesta telemática a las asociaciones autonómicas de PAP, y telefónica para Ceuta y Melilla. En los planes encontrados, se evaluó la presencia de criterios diagnósticos, tratamiento y seguimiento del asma, recursos disponibles e indicadores de calidad asistencial, de acuerdo con un protocolo definido y adaptado a las recomendaciones de las guías de práctica clínica, y el grado de variabilidad de los mismos. Resultados: el 50% de las CC. AA. españolas tienen planes para el manejo de niños y adolescentes con asma, en diez se incluye esta actividad en su CS y 11 disponen de módulo de registro informático específico. De los nueve documentos encontrados, tres son planes y seis guías. Los primeros obtienen mayor puntuación global al aplicar el protocolo. De los parámetros estudiados, solo tener documento escrito y clasificar la gravedad del asma al diagnóstico figuran en todos los planes. Conclusiones: en España hay una gran variabilidad en la atención al asma en Pediatría y no todas las CC. AA. tienen implementados planes de trabajo, ni registro informatizado de esta actividad. Para garantizar la equidad en el manejo de estos pacientes convendría que todas las regiones implantasen un plan integral de atención actualizado (AU)

Introduction and objective: to describe the management of children and adolescents with asthma by primary care paediatricians (PCPs) in Spain.Materials and methods: we conducted a cross-sectional descriptive study to assess the paediatric asthma care plans/guidelines of the autonomous communities (ACs) of Spain and Ceuta and Melilla, the inclusion of an asthma care pathway in the list of services covered by regional health systems and the documentation of asthma care in health records. The study was performed through an online survey of regional primary care paediatrics associations and by telephone for the autonomous cities of Ceuta and Melilla. We evaluated the identified documents using a reference protocol that we developed based on current clinical practice guidelines and included items pertaining to asthma diagnosis, treatment, and monitoring, available resources and care quality indicators, and assessed the differences in these documents.Results: We found that 50% of ACs in Spain have care plans/guidelines for the management of asthma in children and adolescents. In 10 ACs, asthma care is included in the official list of health care services, and in 11, the electronic health records included a specific module devoted to asthma. Of the 9 asthma care documents identified in the survey, 3 were care plans and 6 were guidelines. The former achieved higher global scores in the comparison with the reference. Of all parameters under study, the only 2 fulfilled by all the plans/guidelines were the existence of a print asthma management document and the classification of the severity of asthma at diagnosis... (AU)

A Review of the EUSO-Balloon Pathfinder for the JEM-EUSO Program.

EUSO-Balloon is a pathfinder for JEM-EUSO, the mission concept of a spaceborne observatory which is designed to observe Ultra-High Energy Cosmic Ray (UHECR)-induced Extensive Air Showers (EAS) by detecting their UltraViolet (UV) light tracks "from above." On August 25, 2014, EUSO-Balloon was launched from Timmins Stratospheric Balloon Base (Ontario, Canada) by the balloon division of the French Space Agency CNES. After reaching a floating altitude of 38 km, EUSO-Balloon imaged the UV light in the wavelength range ∼290-500 nm for more than 5 hours using the key technologies of JEM-EUSO. The flight allowed a good understanding of the performance of the detector to be developed, giving insights into possible improvements to be applied to future missions. A detailed measurement of the photoelectron counts in different atmospheric and ground conditions was achieved. By means of the simulation of the instrument response and by assuming atmospheric models, the absolute intensity of diffuse light was estimated. The instrument detected hundreds of laser tracks with similar characteristics to EASs shot by a helicopter flying underneath. These are the first recorded laser tracks measured from a fluorescence detector looking down on the atmosphere. The reconstruction of the direction of the laser tracks was performed. In this work, a review of the main results obtained by EUSO-Balloon is presented as well as implications for future space-based observations of UHECRs.

Consensus statement on the use of alemtuzumab in daily clinical practice in Spain. / Consenso de expertos sobre el uso de alemtuzumab en la práctica clínica diaria en España.

INTRODUCTION: Alemtuzumab is a highly effective drug approved by the European Medicines Agency as a disease-modifying drug for the treatment of relapsing-remitting multiple sclerosis. OBJECTIVE: A consensus document was drafted on the management of alemtuzumab in routine clinical practice in Spain. DEVELOPMENT: A group of multiple sclerosis specialists reviewed articles addressing treatment with alemtuzumab in patients with multiple sclerosis and published before December 2017. The included studies assessed the drug's efficacy, effectiveness, and safety; screening for infections and vaccination; and administration and monitoring aspects. The initial proposed recommendations were developed by a coordinating group and based on the available evidence and their clinical experience. The consensus process was carried out in 2 stages, with the initial threshold percentage for group agreement established at 80%. The final document with all the recommendations agreed by the working group was submitted for external review and the comments received were considered by the coordinating group. CONCLUSION: The present document is intended to be used as a tool for optimising the management of alemtuzumab in routine clinical practice.

Morbimortalidad en pacientes sometidas a ligadura de arterias hipogástricas con riesgo de hemorragia obstétrica / Morbi-mortality in patients undergoing ligation of hypogastric arteries at risk of obstetric haemorrhage

Antecedentes: La hemorragia obstétrica es la principal causa de mortalidad materna en países subdesarrollados; representan un tercio de las muertes. Existen técnicas quirúrgicas alternativas para detener la hemorragia como lo es la ligadura de arterias hipogástricas. Objetivo: Determinar la morbimortalidad materna en pacientes sometidas a ligadura de arterias hipogástricas con riesgo de hemorragia obstétrica de junio a diciembre de 2012 en el Hospital General Regional n.o 36 del Instituto Mexicano del Seguro Social, Puebla (HGR n.o 36, IMSS, Puebla). Material y métodos: Estudio descriptivo, observacional, transversal, retrospectivo, homodémico. Se incluyeron pacientes con riesgo de hemorragia obstétrica sometidas a «ligadura de arterias hipogástricas» de junio a diciembre de 2012 en el HGR n.o 36, IMSS, Puebla, de cualquier edad materna y gestacional. El tipo y tamaño de muestra fue finita, no probabilística. Método estadístico: descriptivo y odds. Resultados: Treinta y ocho pacientes se sometieron a ligadura de arterias hipogástricas. Edad promedio: 26,9 años. El acretismo placentario (44,74%) fue la indicación más frecuente (odds=0,78), seguida de hipotonía uterina (7,89%; odds=0,07) y placenta previa (7,89%; odds=0,07). Se registraron 22 (57,8%) pacientes con hemorragia obstétrica, 15 (68,18%) contaron con antecedente de cesárea previa (odds=2,12). La razón de probabilidad de culminar en histerectomía por hemorragia obstétrica odds=4,2. Se documentó un (2,63%) paciente con complicación ureteral posterior a la ligadura (odds=0,027). Mortalidad materna y perinatal del 0%. Conclusión: La complicación posterior a la ligadura de arterias hipogástricas se presentó en un paciente con ligadura ureteral. No hubo complicaciones vasculares. La mortalidad materna y perinatal fue de 0 pacientes.(AU)

Background: Obstetric haemorrhage is the leading cause of maternal death in underdeveloped countries, accounting for a third of deaths. There are alternative surgical techniques to stop bleeding, such as ligation of the hypogastric arteries. Objective: To determine maternal morbidity and mortality in patients sometimes linked to hypogastric arteries at risk of obstetric haemorrhage from June to December 2012 in Hospital General Regional n.o 36, Instituto Mexicano del Seguro Social, Puebla (HGR # 36, IMSS, Puebla). Material and methods: Descriptive, observational, cross-sectional, retrospective, homodemic study. Patients at risk of obstetric haemorrhage undergoing “hypogastric artery ligation” from June to December 2012 were included in the HGR # 36, IMSS, Puebla, of any maternal and gestational age. Sample type and size was finite, not probabilistic. Statistical method: descriptive and Odds. Results: Thirty-eight patients underwent a ligation of the hypogastric arteries. Average age: 26.9 years. Placental accretion (44.74%) was the most frequent indication Odds=.78, subsequent uterine hypotonia (7.89%) Odds=.07 and placenta previa (7.89%) Odds=.07. 22 (57.8%) patients with obstetric haemorrhage were considered, 15 (68.18%) had a history of prior caesarean section Odds=2.12. The probability ratio of completing a hysterectomy for obstetric haemorrhage=4.2. One (2.63%) patient with ureteral complication after ligation was documented Odds=.027. Maternal and perinatal mortality in 0 patient. Conclusion:The complication after ligation of the hypogastric arteries presented in 1 patient with ureteral ligation. There were no vascular complications. Maternal mortality was 0%. Perinatal mortality was 0%.(AU)

Agreement between optical coherence and Scheimpflug tomography: Vault measurements and reproducibility after implantable collamer lens implantation.

PURPOSE: To evaluate the agreement between Scheimpflug tomography (Pentacam, Oculus) and anterior segment optical coherence tomography (AS-OCT, RTVue 100, Optovue) as well as the reproducibility of each technique in assessing the lens-ICL distance (vault) after implantable collamer lens (ICL) implantation. METHODS: The vault was measured manually with Scheimpflug tomography and AS-OCT. Intraclass correlation coefficients (ICC) and Bland-Altman plots were used to determine the reproducibility of measurements and the agreement between them. Multivariate regression analysis was performed to identify predictors of differences in vault measurements between devices. RESULTS: 80 eyes of 46 ICL patients were analyzed. Mean patient age was 33.8±7.4 years (range, 21 to 51), and 27 (59%) were women. The preoperative spherical equivalent refraction ranged from -26 to 8.5 diopters (D). The mean vault measured by AS-OCT was 558.8±240.2µm (range, 162 - 1220) vs. 430.1±215.3µm (range, 0 to 1070) by Pentacam. AS-OCT yielded vault values, on average, 128.1±64.6µm higher than the Pentacam (range, -22 to 293µm). The ICC values for consistency and absolute agreement were 0.960 and 0.928, respectively. Reproducibility of vault measurements was excellent for both devices (ICC≥0.946). Four parameters-vault, pupil diameter (PD), PD differences between devices, and preoperative spherical equivalent refraction-were significant predictors of differences in vault measurements (adjusted-R2=0.412; P<0.001). CONCLUSIONS: Agreement between AS-OCT and Pentacam for vault measurement was good. Vaults were higher when measured by AS-OCT. These differences are clinically relevant, and therefore these devices cannot be used interchangeably to measure vault.

Manejo de los efectos adversos de apremilast desde un abordaje multidisciplinar / Multidisciplinary Management of the Adverse Effects of Apremilast

En el presente artículo, en base a una revisión de la literatura y su experiencia personal, un equipo multidisciplinar de 14 profesionales sanitarios (incluyendo dermatólogos, reumatólogos, neurólogos, gastroenterólogos, farmacéuticos y enfermeras) ha elaborado una serie de recomendaciones generales y específicas (basadas en la fisiopatología) para el manejo de los efectos adversos secundarios a apremilast que con mayor frecuencia conducen a la suspensión del tratamiento (diarrea, náuseas y cefalea). Se aportan algoritmos sencillos de manejo que incluyen aspectos clínicos de evaluación y sugerencias de tratamiento farmacológico. Los efectos adversos de apremilast pueden ser abordados desde un punto de vista multidisciplinar y la optimización en su manejo pretende proporcionar un beneficio clínico a los pacientes que los sufren

We present a series of general and specific recommendations based on pathophysiologic considerations for managing the most common adverse effects of apremilast that lead to treatment discontinuation: diarrhea, nausea, and headache. The recommendations are based on a review of the literature and the experience of a multidisciplinary team of 14 experts including dermatologists, rheumatologists, neurologists, gastroenterologists, pharmacists, and nurses. We propose a series of simple algorithms that include clinical actions and suggestions for pharmacologic treatment. The adverse effects of apremilast can be managed from a multidisciplinary approach. The purpose of optimizing management is to bring clinical benefits to patients

Multidisciplinary Management of the Adverse Effects of Apremilast. / Manejo de los efectos adversos de apremilast desde un abordaje multidisciplinar.

We present a series of general and specific recommendations based on pathophysiologic considerations for managing the most common adverse effects of apremilast that lead to treatment discontinuation: diarrhea, nausea, and headache. The recommendations are based on a review of the literature and the experience of a multidisciplinary team of 14 experts including dermatologists, rheumatologists, neurologists, gastroenterologists, pharmacists, and nurses. We propose a series of simple algorithms that include clinical actions and suggestions for pharmacologic treatment. The adverse effects of apremilast can be managed from a multidisciplinary approach. The purpose of optimizing management is to bring clinical benefits to patients.