RESUMEN
PURPOSE: To compare the refractive outcomes of sutureless scleral-fixated Carlevale® intraocular lenses versus Artisan® iris-claw-fixated lenses in terms of surgically induced astigmatism. SETTING: We included patients from the Quinze-Vingts National Ophthalmology Hospital, Paris, from August 2020 to December 2020. DESIGN: This was a single-center retrospective study. METHODS: Each patient included had undergone surgery with a sutureless scleral-fixated Carlevale® foldable intraocular lens or an Artisan® iris-claw lens in the context of secondary implantation. Exclusion criteria included a history of retinal detachment or any other retinal disease. We analyzed postoperative refractive data three months after surgery for the Carlevale group and three months after removal of all sutures for the Artisan group. RESULTS: A total of 25 eyes of 25 patients were included in the Carlevale group and 37 eyes of 36 patients in the Artisan group. At three months, the best-corrected visual acuity was not statistically different, at 0.33(±0.35) and 0.32(±0.33) LogMAR, respectively (P=0.99), and surgically induced astigmatism was significantly lower in the Carlevale group, at 0.538 (±0.560) and 2.30 (±3.97) Diopters, respectively (P<0.001). CONCLUSIONS: In this first comparative study, Carlevale® intraocular lenses appear to offer better refractive accuracy and less induced astigmatism than Artisan® iris-claw lenses, without increasing mean surgical time.
Asunto(s)
Astigmatismo , Lentes Intraoculares , Astigmatismo/cirugía , Humanos , Implantación de Lentes Intraoculares/efectos adversos , Lentes Intraoculares/efectos adversos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Estudios Retrospectivos , Esclerótica/cirugíaRESUMEN
PURPOSE: This study aimed to evaluate the ability of a freely accessible internet algorithm to correctly identify the need for emergency ophthalmologic consultation for correct diagnosis and management. METHOD: This retrospective observational cohort study was based on the first 100 patients who requested recommendations on the necessity of breaking the lockdown for emergency ophthalmology consultation during the period from March to May 2020. RESULTS: Ninety-one patients completed questionnaires. Forty-nine were directed to emergency consultation and 42 to differed scheduled visits or telemedicine visits. One patient sent for emergency consultation had an overestimated severity and could have been seen later, while two patients initially recommended for a scheduled visit were considered appropriate for emergency consultation. However, these patients' management did not suffer as a consequence of the delay. The sensitivity of the algorithm, defined as the number of emergency consultations suggested by the algorithm divided by the total number of emergency consultations deemed appropriate by the practitioner's final evaluation, was 96.0%. The specificity of the algorithm, defined as the number of patients recommended for delayed consultation by the algorithm divided by the number of patients deemed clinically appropriate for this approach, was 97.5%. The positive predictive value, defined as the number of appropriate emergency consultations divided by the total number of emergency consultations suggested by the algorithm, was 97.9%. Finally, the negative predictive value, defined as the number of appropriately deferred patients divided by the number of deferred patients recommended by the algorithm, was 95.2%. CONCLUSION: This study demonstrates the reliability of an algorithm based on patients' past medical history and symptoms to classify patients and direct them to either emergency consultation or to a more appropriate deferred, scheduled appointment. This algorithm might allow reduction of walk-in visits by half and thus help control patient flow into ophthalmologic emergency departments.
Asunto(s)
Algoritmos , Citas y Horarios , COVID-19/epidemiología , Urgencias Médicas , Oftalmopatías/terapia , Oftalmología/organización & administración , Cuarentena , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Control de Enfermedades Transmisibles/normas , Urgencias Médicas/epidemiología , Servicios Médicos de Urgencia/organización & administración , Servicio de Urgencia en Hospital/organización & administración , Servicio de Urgencia en Hospital/normas , Oftalmopatías/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Paris/epidemiología , Derivación y Consulta/organización & administración , Derivación y Consulta/normas , Reproducibilidad de los Resultados , Estudios Retrospectivos , Encuestas y Cuestionarios , Telemedicina/organización & administración , Telemedicina/normas , Adulto JovenAsunto(s)
COVID-19/epidemiología , Urgencias Médicas/epidemiología , Oftalmopatías/epidemiología , Oftalmopatías/terapia , Cuarentena , Consulta Remota/estadística & datos numéricos , Adulto , Anciano , Control de Enfermedades Transmisibles/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Oftalmología/estadística & datos numéricos , Pandemias , Paris/epidemiología , Satisfacción del Paciente/estadística & datos numéricos , Percepción , Cuarentena/psicología , Cuarentena/estadística & datos numéricos , SARS-CoV-2 , Telemedicina/estadística & datos numéricosRESUMEN
This prospective observational cohort study is based on the first 500 patients who requested emergency teleconsultation during the initial days of the COVID-19 lockdown in Paris, France between 20 March and 10 April 2020. It is the first study to assess the utility of emergency teleophthalmology with a simple smartphone application or web browser and a webcam to manage emergency eye care in a population with sudden restricted access to ophthalmologists. In this study, every patient who asked for an ophthalmic emergency consultation in a single specialized center in Paris ('SOS Åil') first had to undergo a teleconsultation appointment to evaluate the indication for a physical consultation to preserve lockdown. Under medical advice only, a physical appointment was given within a day (if necessary). The aim of the study was to describe the population and diagnoses and evaluate the main judgment criteria, defined as the 'ability of teleconsultation to properly indicate a physical consultation for fair diagnosis and treatment in eye emergencies'. This organization has permitted physicians and patients to preserve social distancing while avoiding 3 or 4 physical consultations per person. Notably, 27% of teleconsultations were followed by a physical appointment. There was a mean 4.12-day delay between symptom apparition and consultation, and less than 1 day for traumas, superficial corneal foreign body and neuro-ophthalmological emergencies. There was a 96% sensitivity and 95% specificity to properly evaluate the indication of a physical consultation and only 1.0% misdiagnoses that lead to delayed care. Hence, teleconsultation maintained satisfactory healthcare access to patients with severe ophthalmological disorders while preserving social distancing and sanitary precautions. Therefore, teleconsultation may be seriously considered as a way to efficiently regulate ophthalmic emergencies, especially for patients with limited access to a specialist.
Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/epidemiología , Oftalmología/estadística & datos numéricos , Neumonía Viral/epidemiología , Cuarentena , Telemedicina/estadística & datos numéricos , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Citas y Horarios , COVID-19 , Niño , Preescolar , Errores Diagnósticos , Urgencias Médicas/epidemiología , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Oftalmología/organización & administración , Pandemias , Paris/epidemiología , Estudios Prospectivos , SARS-CoV-2 , Sensibilidad y Especificidad , Distribución por Sexo , Telemedicina/métodos , Adulto JovenAsunto(s)
4-Hidroxicumarinas/efectos adversos , Anticoagulantes/efectos adversos , Sobredosis de Droga/complicaciones , Indenos/efectos adversos , Degeneración Macular/tratamiento farmacológico , Desprendimiento de Retina/inducido químicamente , Hemorragia Retiniana/inducido químicamente , Vitamina K/antagonistas & inhibidores , 4-Hidroxicumarinas/administración & dosificación , Anciano de 80 o más Años , Alopurinol/uso terapéutico , Anticoagulantes/administración & dosificación , Interacciones Farmacológicas , Sobredosis de Droga/diagnóstico , Humanos , Enfermedad Iatrogénica , Indenos/administración & dosificación , Degeneración Macular/diagnóstico , Masculino , Fenindiona/análogos & derivados , Desprendimiento de Retina/diagnóstico , Hemorragia Retiniana/diagnóstico , Vitamina K/administración & dosificación , Vitamina K/efectos adversosRESUMEN
Our model of the human m1 muscarinic receptor has been refined on the basis of the recently published projection map of bovine rhodopsin. The refined model has a slightly different helix arrangement, which reveals the presence of an extra hydrophobic pocket located between helices 3, 4 and 5. The interaction of series of agonists and antagonists with the m1 muscarinic receptor has been studied experimentally by site-directed mutagenesis. In order to account for the observed results, three-dimensional models of m1 ligands docked in the target receptor are proposed. Qualitatively, the obtained models are in good agreement with the experimental observations. Agonists and partial agonists have a relatively small size. They can bind to the same region of the receptor using, however, different anchoring receptor residues. Antagonists are usually larger molecules, filling almost completely the same pocket as agonists. They can usually produce much stronger interactions with aromatic residues. Experimental data combined with molecular modelling studies highlight how subtle and diverse receptor-ligand interactions could be.
Asunto(s)
Modelos Moleculares , Conformación Proteica , Receptores Muscarínicos/química , Secuencia de Aminoácidos , Animales , Sitios de Unión , Bovinos , Simulación por Computador , Humanos , Cinética , Datos de Secuencia Molecular , Agonistas Muscarínicos/química , Agonistas Muscarínicos/metabolismo , Antagonistas Muscarínicos/química , Antagonistas Muscarínicos/metabolismo , Mutagénesis Sitio-Dirigida , Receptor Muscarínico M1 , Receptores Muscarínicos/metabolismo , Proteínas Recombinantes/química , Proteínas Recombinantes/metabolismo , Reproducibilidad de los Resultados , Rodopsina/química , Programas InformáticosRESUMEN
BACKGROUND: Urinary detection of prenatal drug exposure in the neonate may give false-negative results. We report our experience on meconium and hair testing, in addition to urine testing in order to improve diagnosis of fetal drug exposure. POPULATION AND METHODS: Thirty-one infants (aged 1-45 days) whose mothers were confirmed (n = 12) or suspected (n = 19) to be drug-addicted were included in the study. One or more specimens of urine, meconium or hair were collected in the 31 infants, two of the specimens in 17 and three in six. Drugs and their metabolites were detected by immunoenzymologic techniques and positive results were confirmed by gas-exchange chromatography. All the mothers and families were interviewed during admission and the information was compared to those provided by medical and social services; the results of laboratory analysis were not known by the investigators at this time of the study. RESULTS: The maternal drug addiction was confirmed after clinical investigation in 18 cases including the 12 cases detected by prenatal interview (group 1), and recused in 13 other cases (group 2). In group 1, nine infants of 12 had a positive urine test (seven opiate, one cocaine, one cannabis), 11 of 11 a positive meconium test (nine opiate, one cocaine, one cannabis), ten of 19 a positive hair test (eight opiate, one cocaine, one cannabis); all infants in this group had at least one positive result. In group 2, all tests were negative except one urine test positive for opiate after cesarean delivery performed under anesthesia including opiate analgesia. CONCLUSIONS: Urine, meconium and hair testing versus urine testing alone increase the sensitivity of laboratory analysis for detection of prenatal drug exposure.