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INTRODUCTION: Surgery is the standard treatment for pancreatic neuroendocrine tumors (pNETs), obtaining favorable results but associating high morbidity and mortality rates. This study assesses stereotactic body radiation therapy (SBRT) as a radical approach for small (< 2 cm) nonfunctioning pNETs. MATERIALS AND METHODS: From January 2017 to June 2023, 20 patients with small pNETs underwent SBRT in an IRB-approved study. Endpoints included local control, tolerance, progression-free survival, and overall survival (OS). Diagnostic assessments comprised endoscopy, CT scans, OctreScan or PET-Dotatoc, abdominal MRI, and histological confirmatory samples. RESULTS: In a 30-month follow-up of 20 patients (median age 55.5 years), SBRT was well-tolerated with no grade > 2 toxicity. 40% showed morphological response, 55% remained stable. Metabolically, 50% achieved significant improvement. With a median OS of 41.5 months, all patients were alive without local or distant progression or need for surgical resection. CONCLUSION: SBRT is a feasible and well-tolerated approach for small neuroendocrine pancreatic tumors, demonstrating effective local control. Further investigations are vital for validation and extension of these findings.
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PURPOSE: the os trigonum is a supernumerary bone that may lead to posterior ankle impingement syndrome. The present study aims to assess the prevalence of this bone. METHODS: A meta-analysis regarding the presence of the os trigonum was performed. For this, the MEDLINE and SciElo databases were searched using "os trigonum" as the keyword. Only original articles, theses, books, dissertations, and monographs were included. Papers with a sample size of < 50 individuals were excluded. The data extracted from the articles were: the total sample size, the prevalence of the trigonum, the method of analysis, the region of the sample, and data regarding sex and side (left or right). Statistical analysis was performed using MedCalc Statistical Software version 14.8.1 (MedCalc Software bvba, Ostend, Belgium). The heterogeneity between the studies was assessed using the I² estimation and the Cochran Q test. For all analyses, a random effect was used and a value of p < 0.05 was considered significant. RESULTS: 249 papers were found, while 18 were included in the meta-analysis. A total of 17,626 ankles were included. The pooled prevalence of the os trigonum was 10.3% (95% CI 7-14.1%) in the present study. There was no significant difference regarding sex or side, while studies conducted in imaging exams showed a higher prevalence in comparison to cadaveric studies. CONCLUSION: Our results suggest that the os trigonum is relatively common. Knowledge of the prevalence of the os trigonum may help surgeons and clinicians diagnose posterior ankle impingement syndrome.
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Articulação do Tornozelo , Tálus , Humanos , Prevalência , Tálus/anormalidades , Variação Anatômica , Feminino , MasculinoRESUMO
Monitoring is essential to ensure that environmental goals are being achieved, including those of sustainable agriculture. Growing interest in environmental monitoring provides an opportunity to improve monitoring practices. Approaches that directly monitor land cover change and biodiversity annually by coupling the wall-to-wall coverage from remote sensing and the site-specific community composition from environmental DNA (eDNA) can provide timely, relevant results for parties interested in the success of sustainable agricultural practices. To ensure that the measured impacts are due to the environmental projects and not exogenous factors, sites where projects have been implemented should be benchmarked against counterfactuals (no project) and control (natural habitat) sites. Results can then be used to calculate diverse sets of indicators customized to monitor different projects. Here, we report on our experience developing and applying one such approach to assess the impact of shaded cocoa projects implemented by the Instituto de Manejo e Certificação Florestal e Agrícola (IMAFLORA) near São Félix do Xingu, in Pará, Brazil. We used the Continuous Degradation Detection (CODED) and LandTrendr algorithms to create a remote sensing-based assessment of forest disturbance and regeneration, estimate carbon sequestration, and changes in essential habitats. We coupled these remote sensing methods with eDNA analyses using arthropod-targeted primers by collecting soil samples from intervention and counterfactual pasture field sites and a control secondary forest. We used a custom set of indicators from the pilot application of a coupled monitoring framework called TerraBio. Our results suggest that, due to IMAFLORA's shaded cocoa projects, over 400 acres were restored in the intervention area and the community composition of arthropods in shaded cocoa is closer to second-growth forests than that of pastures. In reviewing the coupled approach, we found multiple aspects worked well, and we conclude by presenting multiple lessons learned.
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DNA Ambiental , Tecnologia de Sensoriamento Remoto , Brasil , Agricultura , Florestas , Biodiversidade , Conservação dos Recursos Naturais , Monitoramento Ambiental/métodosRESUMO
Fundamento: la orientación educativa a las familias de niños con discapacidad físico-motora es esencial para su correcta rehabilitación e inserción en la sociedad. Objetivo: aplicar un sistema de acciones de orientación educativa a la familia de un niño con discapacidad físico-motora. Métodos: se realizó un estudio cualitativo de investigación acción práctica a la familia de un niño con diagnóstico de una parálisis cerebral percibida como una discapacidad físico-motora en el período julio 2021-diciembre 2022, perteneciente al área de salud del Policlínico Docente "Marta Abreu". Los métodos teóricos utilizados fueron: analítico-sintético; inductivo-deductivo y la modelación. Entre los métodos empíricos se aplicaron: la observación participante; entrevista en profundidad; análisis de documentos; diario del investigador y estudio de casos. Resultados: el diagnóstico realizado demostró la necesidad de la preparación de la familia de un niño con discapacidad fisico-motora para afrontar con calidad esta nueva etapa de sus vidas, por lo que se diseñó y aplicó un sistema de acciones el cual fue estructurado en tres subsistemas: primero, acciones para el manejo de las técnicas de aseo; segundo, para las técnicas de alimentación; y tercero, los cuidados posturales y las transferencias. Fue valorado por especialistas vinculados con esta temática, quienes lo consideraron muy pertinente y viable. Conclusiones: el sistema de acciones de orientación a las familias de niños con discapacidad fisico-motora resultó efectivo pues se evidenciaron cambios importantes en cuanto al manejo de este niño por la familia.
Background: educational guidance for families of children with physical-motor disabilities is essential for their correct rehabilitation and insertion into society. Objective: apply a system of educational guidance actions to the family of a child with physical-motor disability. Methods: a qualitative practical action research study was carried out on the family of a child with a diagnosis of cerebral palsy perceived as a physical-motor disability from July 2021 to December 2022, from "Marta Abreu" University Polyclinic health area theoretical methods used were: analytical-synthetic; inductive-deductive and modeling: empirical ones: participant observation; depth interview; document analysis; researcher diary and case study. Results: the diagnosis carried out demonstrated the need to prepare the family of the child with a physical-motor disability to face this new stage of their lives with quality, so a system of actions was designed and applied which was structured in three subsystems: first, actions to manage grooming techniques; second, for feeding techniques; and third, postural care and transfers. It was evaluated by specialists linked to this topic, who considered it very pertinent and viable. Conclusions: the system of guidance actions for the family of a child with a physical-motor disability was effective as important changes were evident in terms of the management of this child by the family.
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SUMMARY: The os intermetatarseum is an accessory bone located in the foot, usually between the first 2 metatarsals and the cuneiform bone. It can be presented as free, articulated or in a fused fashion. It is a very unusual variation found in less than 13 % of the population. A 27-year-old patient presented to the emergency service due to an ankle lesion. Physical exam showed pain and limited range of motion while supporting partial load. Radiographic imaging showed a bony trace near the base of the first and second metatarsals, diagnosed as the os intermetatarseum. Formation of this supernumerary bone begins as a separate ossification center. Most cases are asymptomatic; however, compression of the deep peroneal nerve branches by the os intermetatarseum can lead to pain. Some authors suggest that the presence of this bone may cause hallux valgus. The intermetatarseum can lead to diagnostic confusion, mainly related to Lisfranc fracture. Its origin is still little understood.
El os intermetatarseum es un hueso accesorio ubicado en el pie, generalmente entre los 2 primeros metatarsianos y el hueso cuneiforme. Puede presentarse de forma libre, articulada o fusionada. Es una variación muy inusual que se encuentra en menos del 13 % de la población. Paciente de 27 años que acude a urgencias por lesión en tobillo. El examen físico mostró dolor y rango de movimiento limitado mientras soportaba una carga parcial. Las imágenes radiológicas mostraron un rastro óseo cerca de la base del primer y segundo metatarsianos, diagnosticado como os intermetatarseum. La formación de este hueso supernumerario comienza como un centro de osificación separado. La mayoría de los casos son asintomáticos; sin embargo, la compresión de las ramas profundas del nervio fibular en el espacio intermetatarsiano puede provocar dolor. Algunos autores sugieren que la presencia de este hueso puede provocar hallux valgus. El hueso intermetatarsiano puede llevar a confusión diagnóstica, principalmente relacionada con la fractura de Lisfranc. Su origen aún es poco comprendido.
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Humanos , Masculino , Adulto , Ossos do Metatarso/anormalidades , Variação AnatômicaRESUMO
Objetivo: Determinar parámetros aberrométricos de la córnea para la detección del queratocono subclínico. Métodos: Se realizó un estudio observacional, analítico de corte transversal que incluyó 36 pacientes con queratocono subclínico (grupo de estudio) y 36 estudiantes con córneas aparentemente sanas (grupo control), que asistieron a la consulta de córnea del Instituto Cubano de Oftalmología Ramón Pando Ferrer, entre mayo de 2018 y junio de 2022. Se analizaron topografía y aberrometría corneal con el tomógrafo corneal Pentacam AXL. Resultados: El grupo queratocono subclínico mostró valores similares para la queratometría, asfericidad corneal, paquimetría y el valor total de desviación en comparación con el grupo normal. Hubo diferencias estadísticamente significativas en los parámetros aberrométricos, como el coma a 90º (Z3 -1), y la raíz cuadrada media de las aberraciones de alto orden, de cara anterior, posterior y total corneal, en queratocono subclínico en comparación con el grupo normal. El coma posterior a 90º presentó un área bajo la curva (0,894) mayor dentro de las aberrometrías, con un punto de corte de -0,013 µm, con sensibilidad del 86,1 por ciento y especificidad del 88,9 por ciento. Conclusiones: El coma posterior a 90º (parámetro aberrométrico) presenta una alta sensibilidad y especificidad para el diagnóstico de queratocono subclínico, mediante el análisis tomográfico Pentacam AXL(AU)
Objective: To determine corneal aberrometric parameters for the detection of subclinical keratoconus. Methods: An observational, analytical, cross-sectional study was performed including 36 patients with subclinical keratoconus (study group) and 36 students with apparently healthy corneas (control group), who attended the cornea consultation at the Cuban Institute of Ophthalmology Ramón Pando Ferrer, between May 2018 and June 2022. Corneal topography and aberrometry were analyzed with the Pentacam AXL corneal tomographer. Results: The subclinical keratoconus group showed similar values for keratometry, corneal asphericity, pachymetry and total deviation value compared to the normal group. There were statistically significant differences in aberrometric parameters, such as coma at 90° (Z3-1), and root mean square of high-order anterior, posterior and total corneal aberrations in subclinical keratoconus compared to the normal group. The 90° posterior coma presented a higher area under the curve (0.894) within the aberrometries, with a cutoff point of -0.013 µm, with sensitivity of 86.1 percent and specificity of 88.9 percent. Conclusions: Coma posterior to 90º (aberrometric parameter) presents high sensitivity and specificity for the diagnosis of subclinical keratoconus, using Pentacam AXL tomographic analysis(AU)
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Humanos , Feminino , Córnea/anormalidades , Aberrometria/métodos , Ceratocone/etiologia , Estudos Observacionais como AssuntoRESUMO
Objetivo: Evaluar la densitometría corneal en pacientes con queratocono. Métodos: Se realizó un estudio observacional descriptivo de corte transversal que incluyó 90 pacientes con queratocono (grupo de estudio) y 30 estudiantes con córneas aparentemente sanas (grupo control), que asistieron a la consulta de córnea del Instituto Cubano de Oftalmología Ramón Pando Ferrer, entre mayo del 2018 y junio del 2019. Se seleccionó el ojo derecho de cada caso. Se analizaron densitometría corneal con el tomógrafo corneal Pentacam AXL. Resultados: La densitometría fue mayor en el queratocono respecto a la córnea aparentemente sana, de 0 a 2 mm, en la capa anterior, central, y posterior, respectivamente (p < 0,001). La densitometría aumentó en los 0 a 2 mm en la capa anterior en el grupo moderado y en el grupo avanzado (p < 0,001), y entre los 2-6 mm en la capa central, de 10,86 ± 0,54 en el control, en el queratocono avanzado a 12,35 ± 1,16 y en el moderado a 12,16 ± 1,45 (p < 0,001). La densitometría aumentó en el avanzado de 27,64 ± 3,81, de 22,77 ± 2,14 en el leve, y de 24,04 ± 2,83 en el moderado y en los 0-2 mm, en la capa anterior. Conclusiones: La densitometría es mayor en la córnea queratocónica respecto a la córnea aparentemente sana, además que se incrementa al aumentar la gravedad del queratocono en el área central(AU)
Objective: To evaluate corneal densitometry in patients with keratoconus. Methods: A cross-sectional descriptive observational cross-sectional study was performed including 90 patients with keratoconus (study group) and 30 students with apparently healthy corneas (control group), who attended the cornea consultation at the Cuban Institute of Ophthalmology Ramón Pando Ferrer, between May 2018 and June 2019. The right eye of each case was selected. Corneal densitometry was analyzed with the Pentacam AXL corneal tomographer. Results: Densitometry was higher in keratoconus relative to apparently healthy cornea, from 0 to 2 mm, in the anterior, central, and posterior layer, respectively (p < 0.001). Densitometry increased in the 0 to 2 mm in the anterior layer in the moderate group and in the advanced group (p < 0.001), and between 2-6 mm in the central layer, from 10.86 ± 0.54 in the control, in the advanced keratoconus to 12.35 ± 1.16 and in the moderate to 12.16 ± 1.45 (p < 0.001). Densitometry increased in advanced from 27.64 ± 3.81, from 22.77 ± 2.14 in mild, and from 24.04 ± 2.83 in the moderate and 0-2 mm, in the anterior layer. Conclusions: Densitometry is higher in the keratoconic cornea with respect to the apparently healthy cornea, moreover it increases with increasing severity of keratoconus in the central area(AU)
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Humanos , Densitometria/métodos , Tomografia de Coerência Óptica/métodos , Ceratocone , Epidemiologia Descritiva , Estudos Observacionais como AssuntoRESUMO
Objective: To determine whether long-term sun exposure has a protective role in subclinical cardiovascular disease in adult Mexican women. Materials and Methods: We conducted a cross-sectional analysis of a sample of women from the Mexican Teachers' Cohort (MTC) study. Sun exposure was assessed in the MTC 2008 baseline questionnaire, in which women were asked about their sun-related behavior. Vascular neurologists measured carotid intima-media thickness (IMT) using standard techniques. Multivariate linear regression models were used to estimate the difference in mean IMT and 95% confidence intervals (95% CIs), according to categories of sun exposure and multivariate logistic regression models were used to estimate the odds ratio (OR) and 95% CIs for carotid atherosclerosis. Results: The mean age of participants was 49.6 ± 5.5 years, the mean IMT was 0.678 ± 0.097 mm, and the mean accumulated hours of weekly sun exposure were 2.9 ± 1.9. Prevalence of carotid atherosclerosis was 20.9%. Compared with women in the lowest quartile of sun exposure, women in the highest quartile had lower mean IMT, but this was not significant in the multivariable adjusted analysis. (Adjusted mean % difference: -0.8; 95% CI: -2.3 to 0.8). The multivariate adjusted ORs of carotid atherosclerosis were 0.54 (95% CI: 0.24-1.18) for women who were exposed 9 hours. For women who denied regular sunscreen use, those in the higher exposure category (9 hours) had lower mean IMT compared with those in the lower category (multivariable-adjusted mean % difference = -2.67; 95% CI: -6.9 to -1.5). Conclusions: We observed that cumulative sun exposure was inversely associated with IMT and subclinical carotid atherosclerosis. If these findings are further replicated and seen for other cardiovascular outcomes, sun exposure could be an easy, affordable strategy to lower overall cardiovascular risk.
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Doenças das Artérias Carótidas , Espessura Intima-Media Carotídea , Adulto , Humanos , Feminino , Pessoa de Meia-Idade , Estudos de Coortes , Estudos Transversais , Luz Solar , Fatores de Risco , Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/epidemiologiaRESUMO
La imagen es parte de la columna vertebral en la medicina y que llega a su máximo punto en la Oftalmología. La importancia de la fotografía ocular va desde registrar condiciones médicas específicas, rastrear la progresión de enfermedades y crear ilustraciones para la publicación y la enseñanza; en resumen, una herramienta indispensable para el diagnóstico. Los aditamentos que en la presente publicación mostramos, son el resultado de una investigación de desarrollo que se realizó en el Instituto Cubano de Oftalmología "Ramón Pando Ferrer", durante el año 2021 con el objetivo de crear aditamentos que, acoplados a los teléfonos inteligentes, permiten tomar imágenes en el área de la Oftalmología utilizando la tecnología de impresión 3D. Inicialmente se identificaron los lugares que permitan crear imágenes en la especialidad con un aditamento y el teléfono inteligente, posteriormente se procederá a diseñar los aditamentos de acuerdo a las características del lugar donde se van a utilizar y finalmente mostramos la utilidad de los prototipos diseñados en la práctica docente(AU)
Imaging is part of the backbone in medicine and it reaches its peak in Ophthalmology. The importance of ocular photography ranges from recording specific medical conditions, tracking disease progression, and creating illustrations for publication and teaching; in short, an indispensable tool for diagnosis. The attachments, which we show in the present publication, are the result of a development research that was carried out at the Cuban Institute of Ophthalmology "Ramón Pando Ferrer" during the year 2021 with the aim of creating attachments that, coupled to smartphones, allow taking images in the area of Ophthalmology using 3D printing technology. Initially we identified the places that allow creating images in the specialty with an attachment and the smartphone, then we will proceed to design the attachments according to the characteristics of the place where they will be used and finally we show the usefulness of the designed prototypes in the teaching practice(AU)
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Humanos , Oftalmologia , Fotografia/métodosRESUMO
Las membranas neovasculares coroidea representan el crecimiento de nuevos vasos sanguíneos originados de la coriocapilar hacia el epitelio pigmentario de la retina o el espacio subretinal por una disrupción de la membrana de Bruch ocasionado por la inflamación prolongada. El desarrollo de las membranas neovasculares coroidea está estrechamente conectado a la morbilidad asociada con la coroidopatía punteada interna y puede ser su primera forma de presentación. La coroidopatía punteada interna es clasificada como una de las enfermedades de los síndromes de puntos blancos evanescentes, es una enfermedad infrecuente, bilateral y de origen desconocido. Se presenta un caso clínico de un paciente al cual se le diagnostica membranas neovasculares coroidea en el curso de una coroidopatía punteada interna con una presentación atípica o previa a las lesiones de coroiditis. La coroidopatía punteada interna complicada con membranas neovasculares coroidea compromete la visión central de forma considerable en pacientes jóvenes(AU)
Choroidal neovascular membranes represent the growth of new blood vessels originating from the choriocapillaris into the retinal pigment epithelium or subretinal space due to disruption of Bruch's membrane caused by prolonged inflammation. The development of choroidal neovascular membranes is closely connected to the morbidity associated with punctate inner choroidopathy and may be its first form of manifestation. Punctate Inner choroidopathy is classified as one of the evanescent white dot syndromes diseases, is a rare, bilateral disease of unknown origin. We present a case report of a patient diagnosed with choroidal neovascular membranes while suffering from punctate inner choroidopathy with an atypical manifestation or prior to choroiditis lesions. Punctate Inner choroidopathy when complicated with choroidal neovascular membranes compromises significantly the central vision in young patients(AU)
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Humanos , Neovascularização de Coroide/diagnósticoRESUMO
Objetivo: Describir la discapacidad visual por catarata en la población de 50 años y más de edad y la cobertura de la atención oftalmológica en Cuba durante el año 2016. Métodos: Se realizó una investigación epidemiológica, descriptiva y transversal en personas de 50 años o más, que tomó la encuesta rápida de ceguera evitable realizada en Cuba en el año 2016. Con los datos obtenidos en los cuestionarios se confeccionó una base de datos. La muestra estuvo conformada por 3 920 habitantes distribuida en 112 conglomerados. Las variables estudiadas fueron la discapacidad visual, tipo de cirugía, tiempo de operados, resultados visuales y causas de malos resultados. Resultados: La prevalencia de ceguera bilateral fue de un porciento, para la discapacidad visual severa 2,7 por ciento, y moderada un 9,0 por ciento. El 66,2 por ciento de los ojos estudiados presentó buenos resultados visuales, de los cuales al 69,2 por ciento se le implantó una lente intraocular. Las comorbilidades oculares (67,1 por ciento) fueron la causa más frecuente de malos resultados visuales posquirúrgicos y representó el 44,7 por ciento en el total de ojos afectados. Conclusiones: El riesgo de presentar ceguera por catarata es del 1 por ciento. La discapacidad visual moderada es la más prevalente. En todos los rangos de discapacidad, la catarata bilateral no presenta diferencias entre sexo, pero en la unilateral el sexo masculino es el más frecuente. La primera causa de malos resultados posquirúrgicos son los trastornos refractivos en discapacidad visual moderada y las comorbilidades oculares para la discapacidad visual severa y ceguera(AU)
Purpose: To describe visual disability due to cataract in the population aged 50 years and older and the coverage of ophthalmologic care in Cuba during 2016. Methods: An epidemiological, descriptive and cross-sectional research was conducted in people aged 50 years and older, who took the rapid survey of avoidable blindness conducted in Cuba in 2016. With the data obtained from the questionnaires, a database was made. The sample, distributed in 112 clusters, consisted of 3 920 inhabitants. The variables studied were visual impairment, type of surgery, time of surgery, visual results and causes of poor results. Results: The prevalence of bilateral blindness was 1 percent, for severe visual impairment, 2.7 percent and for moderate visual impairment 9.0 percent. Good visual outcomes were observed in 66.2 percent of the eyes studied, of which 69.2 percent were implanted with an intraocular lens. Ocular comorbidities (67.1 percent) were the most frequent cause of poor postsurgical visual outcomes and accounted for 44.7 percent in the total number of affected eyes. Conclusions: The risk of presenting blindness due to cataract is 1 percent. Moderate visual impairment is the most prevalent. In all ranges of disability, bilateral cataract does not show differences between genders, but in unilateral cataract the male gender is the most frequent. The first cause of poor postoperative outcomes are refractive disorders in moderate visual impairment and ocular comorbidities for severe visual impairment and blindness(AU)
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Humanos , Transtornos da Visão/epidemiologia , Epidemiologia Descritiva , Estudos TransversaisRESUMO
PURPOSE: To investigate the association between serious financial difficulties (SFD), stress, and cardiovascular health in women. METHODS: We categorized 1759 employed and insured disease-free women from the Mexican Teachers' Cohort according to their response to a question on SFD included in the Life Stressor Checklist-Revised administered in 2012 and 2016. We also measured perceived stress (n = 1598) and hair cortisol levels (n = 539) in study participants. Carotid intima-media thickness was measured, and carotid atherosclerosis determined in all participants. RESULTS: Multivariable regression models indicated that women exposed to SFD had 1.6% (95% CI: 0.05, 3.2) higher mean intima-media thickness and 1.37 (95% CI: 1.02, 1.85) higher odds of carotid atherosclerosis relative to women without SFD. The magnitude of the observed associations was higher in women reporting longer duration of the event and higher emotional burden. Mediation analyses suggested a potential role of perceived stress and body mass index in these associations. Cortisol levels did not differ between groups. CONCLUSIONS: SFD was associated with subclinical cardiovascular disease among employed and insured women. Limiting stress and adiposity may be potential targets for interventions.
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Doenças Cardiovasculares , Doenças das Artérias Carótidas , Doenças Cardiovasculares/epidemiologia , Espessura Intima-Media Carotídea , Estudos Transversais , Feminino , Humanos , Hidrocortisona , Fatores de Risco , Estresse Psicológico/epidemiologiaRESUMO
ABSTRACT BACKGROUND: The intensity of the thromboprophylaxis needed as a potential factor for preventing inpatient mortality due to coronavirus disease-19 (COVID-19) remains unclear. OBJECTIVE: To explore the association between anticoagulation intensity and COVID-19 survival. DESIGN AND SETTING: Retrospective observational study in a tertiary-level hospital in Spain. METHODS: Low-molecular-weight heparin (LMWH) status was ascertained based on prescription at admission. To control for immortal time bias, anticoagulant use was analyzed as a time-dependent variable. RESULTS: 690 patients were included (median age, 72 years). LMWH was administered to 615 patients, starting from hospital admission (89.1%). 410 (66.7%) received prophylactic-dose LMWH; 120 (19.5%), therapeutic-dose LMWH; and another 85 (13.8%) who presented respiratory failure, high D-dimer levels (> 3 mg/l) and non-worsening of inflammation markers received prophylaxis of intermediate-dose LMWH. The overall inpatient-mortality rate was 38.5%. The anticoagulant nonuser group presented higher mortality risk than each of the following groups: any LMWH users (HR 2.1; 95% CI: 1.40-3.15); the prophylactic-dose heparin group (HR 2.39; 95% CI, 1.57-3.64); and the users of heparin dose according to biomarkers (HR 6.52; 95% CI, 2.95-14.41). 3.4% of the patients experienced major hemorrhage. 2.8% of the patients developed an episode of thromboembolism. CONCLUSIONS: This observational study showed that LMWH administered at the time of admission was associated with lower mortality among unselected adult COVID-19 inpatients. The magnitude of the benefit may have been greatest for the intermediate-dose subgroup. Randomized controlled trials to assess the benefit of heparin within different therapeutic regimes for COVID-19 patients are required.
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Humanos , Adulto , Idoso , Tromboembolia Venosa , COVID-19 , Heparina de Baixo Peso Molecular/uso terapêutico , SARS-CoV-2 , Pacientes Internados , Anticoagulantes/uso terapêuticoRESUMO
BACKGROUND: The intensity of the thromboprophylaxis needed as a potential factor for preventing inpatient mortality due to coronavirus disease-19 (COVID-19) remains unclear. OBJECTIVE: To explore the association between anticoagulation intensity and COVID-19 survival. DESIGN AND SETTING: Retrospective observational study in a tertiary-level hospital in Spain. METHODS: Low-molecular-weight heparin (LMWH) status was ascertained based on prescription at admission. To control for immortal time bias, anticoagulant use was analyzed as a time-dependent variable. RESULTS: 690 patients were included (median age, 72 years). LMWH was administered to 615 patients, starting from hospital admission (89.1%). 410 (66.7%) received prophylactic-dose LMWH; 120 (19.5%), therapeutic-dose LMWH; and another 85 (13.8%) who presented respiratory failure, high D-dimer levels (> 3 mg/l) and non-worsening of inflammation markers received prophylaxis of intermediate-dose LMWH. The overall inpatient-mortality rate was 38.5%. The anticoagulant nonuser group presented higher mortality risk than each of the following groups: any LMWH users (HR 2.1; 95% CI: 1.40-3.15); the prophylactic-dose heparin group (HR 2.39; 95% CI, 1.57-3.64); and the users of heparin dose according to biomarkers (HR 6.52; 95% CI, 2.95-14.41). 3.4% of the patients experienced major hemorrhage. 2.8% of the patients developed an episode of thromboembolism. CONCLUSIONS: This observational study showed that LMWH administered at the time of admission was associated with lower mortality among unselected adult COVID-19 inpatients. The magnitude of the benefit may have been greatest for the intermediate-dose subgroup. Randomized controlled trials to assess the benefit of heparin within different therapeutic regimes for COVID-19 patients are required.
Assuntos
COVID-19 , Tromboembolia Venosa , Adulto , Idoso , Anticoagulantes/uso terapêutico , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Pacientes Internados , SARS-CoV-2RESUMO
El edema macular es el engrosamiento anormal de la mácula asociado con la acumulación de líquido en el espacio extracelular de la retina neurosensorial. En algunos casos también se ha observado edema intracelular que comprende las células de Muller. Una de estas causas es el edema macular poscirugía de catarata. Presentamos un caso masculino de 57 años de edad de la raza negra con antecedentes de haber sido operado de catarata en ambos ojos. El ojo izquierdo carecía de visión a causa de un rechazo al trasplante corneal penetrante que le fue realizado. El ojo derecho presentaba edema macular con subluxación de la lente intraocular. Le realizamos biomicroscopia de segmento anterior y posterior, tomografía de coherencia óptica, agudeza visual con corrección y presión intraocular. Se constató edema macular con membrana epirretinal y subluxación de la lente intraocular. Decidimos fijar la lente a la esclera utilizando la técnica de Yamane, ya que se trataba de una lente de 3 piezas de acrílico con háptica de fluoruro de polivinildeno configuración en C (CT Lucia 602 de Zeiss), ideal para esta técnica. Colocamos una dosis de Ozurdex en el ojo derecho para tratar el edema macular, después de ver que los colirios tópicos antinflamatorios no fueron efectivos en este caso, y tuvimos una mejoría del edema por aproximadamente 3 meses. En el edema macular posquirúrgico no solo es necesario tratar la inflamación, sino también la causa que la ha producido(AU)
Macular edema is the abnormal thickening of the macula associated to fluid accumulation in the extracellular space of the neurosensory retina. Some cases also present intracellular edema with involvement of Müller cells. One of these causes is macular edema after cataract surgery. A case is presented of a male 57-year-old patient of black skin color with a history of cataract surgery in both eyes. The left eye had no vision, due to rejection to the penetrating corneal transplantation performed. The right eye presented macular edema with intraocular lens subluxation. Examination included biomicroscopy of the anterior and posterior segments, optical coherence tomography, visual acuity with correction and intraocular pressure. A diagnosis was confirmed of macular edema with epiretinal membrane and intraocular lens subluxation. It was decided to fix the lens to the sclera using the Yamane technique, since it was a three-piece lens with a C-shaped polyvinylidene fluoride haptic (CT Lucia 602 from Zeiss), ideal for this technique. An Ozurdex dose was administered in the right eye to treat the macular edema, since topical anti-inflammatory eyedrops were not effective in this case, and improvement of the edema was achieved for about three months. In postoperative macular edema, it is not only necessary to treat the inflammation, but also its cause(AU)
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Vitrectomia/métodos , Edema Macular/etiologia , Tomografia de Coerência Óptica/métodos , Lentes Intraoculares/efeitos adversos , Soluções Oftálmicas/uso terapêutico , Pressão IntraocularRESUMO
Objetivo: Determinar las características clínicas y epidemiológicas de la neovascularización coroidea en los pacientes con uveítis. Métodos: Se realizó un estudio observacional, descriptivo y transversal en pacientes con diagnóstico de neovascularización coroidea asociada a uveítis, atendidos en el Servicio de Uveítis e Inflamaciones Oculares del Instituto Cubano de Oftalmología "Ramón Pando Ferrer". Resultados: Esta entidad predominó en el sexo femenino, en edad pediátrica y en jóvenes. Se asoció con mayor frecuencia a enfermedades infecciosas, como la toxoplasmosis ocular, y un pequeño número de pacientes desarrolló membrana neovascular coroidea bilateral. Las membranas localizadas con mayor frecuencia fueron las subfoveales. Por angiografía fluoresceínica predominaron las clásicas, mientras el grosor de la membrana neovascular coroidea fue mayor que el grosor foveal central. La agudeza visual mejor corregida en la mayoría de nuestros pacientes fue menor de 85 VAR. Conclusión: La membrana neovascular coroidea asociada a las uveítis es reconocida como una complicación infrecuente, pero compromete de forma severa la visión en estos pacientes(AU)
Objective. To determine the clinical-epidemiological characteristics of choroidal neovascularization in patients with uveitis. Method. An observational, descriptive, cross-sectional study was carried out in patients with a diagnosis of choroidal neovascularization associated with uveitis, attended in the Uveitis and Ocular Inflammations Service of the Cuban Institute of Ophthalmology "Ramón Pando Ferrer". Results. This entity predominated in the female sex, in pediatric age and youth. It was more frequently associated with infectious diseases, such as ocular toxoplasmosis, and a small number of patients developed bilateral choroidal neovascular membrane. The most frequent location of the membranes were the subfoveal ones, by fluorescein angiography the predominantly classic ones and the thickness of the choroidal neovascular membrane was greater than the central foveal thickness. The best corrected visual acuity in most of our patients was less than 85 VAR. Conclusion. CNVM associated with uveitis is recognized as an uncommon complication but one that severely compromises vision in these patients(AU)
Assuntos
Humanos , Feminino , Criança , Adolescente , Uveíte/etiologia , Angiofluoresceinografia/métodos , Toxoplasmose Ocular/epidemiologia , Neovascularização de Coroide/diagnóstico , Epidemiologia Descritiva , Estudos Transversais , Estudos Observacionais como AssuntoRESUMO
BACKGROUND AND AIMS: Many dietary guidelines encourage low-fat dairy products; however, recent studies have found null and inverse associations between high-fat dairy intake and cardiovascular disease (CVD) risk. We examined the association between the intake of total dairy and different types of dairy and carotid intima-media thickness (IMT), a marker of subclinical atherosclerosis, in Mexican women. METHODS AND RESULTS: Dairy consumption was assessed using a validated food-frequency questionnaire (FFQ) in 1759 women in the Mexican Teachers' Cohort (MTC) study who were free of CVD or cancer. We categorized participants according to total dairy intake and consumption of four mutually exclusive dairy groups: high-fat, low-fat, yogurt, and dairy with added sugars. IMT and atherosclerotic plaque were measured by B-mode ultrasonography. Subclinical atherosclerosis was defined as an IMT ≥0.8 mm and/or the presence of plaque. Multivariable linear regression and logistic regression models were used to respectively assess the mean percentage difference of mean IMT and odds ratios (OR) for subclinical atherosclerosis across quantiles of dairy consumption. Mean (±SD) age was 45.4 ± 5.0 years and the median (interquartile range: IQR) total dairy consumption was 11.0 (6.6, 17.1) servings/week. After adjusting for lifestyle, clinical, and dietary factors, comparing the highest category of consumption, to the lowest, total dairy was associated with increased IMT (2.6%, 95% confidence interval (CI): 0.6, 4.3; p-trend<0.01). Moreover, yogurt consumption was associated with lower odds of subclinical atherosclerosis (OR = 0.65, 95% CI: 0.47, 0.91; p-trend = 0.01). CONCLUSIONS: While total dairy consumption was associated with carotid wall thickening, yogurt consumption was related to lower subclinical atherosclerosis.
Assuntos
Doenças das Artérias Carótidas/epidemiologia , Laticínios/efeitos adversos , Dieta/efeitos adversos , Açúcares da Dieta/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Assintomáticas , Doenças das Artérias Carótidas/diagnóstico por imagem , Espessura Intima-Media Carotídea , Estudos Transversais , Dieta com Restrição de Gorduras , Progressão da Doença , Feminino , Humanos , México/epidemiologia , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Fatores Sexuais , Iogurte/efeitos adversosRESUMO
Objetivo: Describir la discapacidad visual del diabético de 50 años y más de edad y la cobertura de la atención oftalmológica en Cuba durante el año 2016. Métodos: Se realizó una investigación epidemiológica, descriptiva y transversal que tomó la encuesta rápida de ceguera evitable realizada en Cuba en el año 2016, la cual incluyó la retinopatía diabética validada por la Organización Mundial de la Salud. Con los datos obtenidos en los cuestionarios se confeccionó una base de datos donde se tomaron todos los diabéticos conocidos o no con discapacidad visual. Resultados: La prevalencia de cualquier tipo de discapacidad visual en el diabético es de 25,4 por ciento (21,8-28,9). El riesgo de desarrollar discapacidad visual moderada, grave y ceguera es de 19,4 por ciento (16,5-22,3), 2,8 por ciento (1,0-4,6) y 3,2 por ciento (1,5-4,8) respectivamente. La catarata es la primera causa de discapacidad. El riesgo de discapacidad visual en el diabético es similar para uno y otro sexo y se incrementa con la edad. Las coberturas de tratamiento son bajas. Conclusiones: En Cuba, alrededor de un cuarto de los diabéticos tienen algún riesgo de discapacidad visual. El diabético tiene mayor riesgo de discapacidad visual moderada; sin embargo, el riesgo de discapacidad visual grave y de ceguera es el mismo para toda la población de 50 años y más de edad. La catarata y la retinopatía diabética son las causas más frecuentes de discapacidad visual en el diabético. Se evidencian dificultades con la atención oftalmológica, que incluye el examen y la cobertura de tratamiento de la catarata y del láser para la retinopatía diabética(AU)
Objective: Describe visual impairment among diabetics aged 50 years and over, and the coverage of ophthalmological care in Cuba in the year 2016. Methods: A descriptive cross-sectional epidemiological study was conducted based on the Rapid Assessment of Avoidable Blindness survey developed in Cuba in the year 2016, which included diabetic retinopathy with validation by the World Health Organization. The data obtained from the questionnaires were transferred to a database of visually impaired known and unknown diabetics. Results: Prevalence of any sort of visual impairment among diabetics is 25.4 percent (21.8-28.9). Risk of developing moderate visual impairment, severe visual impairment or blindness is 19.4 percent (16.5-22.3), 2.8 percent (1.0-4.6) and 3.2 percent (1.5-4.8), respectively. Cataract is the leading cause of impairment. Risk of visual impairment among diabetics is similar in the two sexes and increases with age. Treatment coverage is low. Conclusions: In Cuba, about one fourth of the diabetics are at some risk of visual impairment. Diabetics are at a higher risk of moderate visual impairment. However, the risk of severe visual impairment and blindness is the same as for the population aged 50 years and over. Cataract and diabetic retinopathy are the most common causes of visual impairment among diabetics. Difficulties were found in ophthalmological care, including examination and treatment coverage for cataract and laser therapy for diabetic retinopathy(AU)
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Catarata/epidemiologia , Cegueira/prevenção & controle , Diabetes Mellitus/etiologia , Retinopatia Diabética/epidemiologia , Terapia a Laser/métodos , Estudos Epidemiológicos , Epidemiologia Descritiva , Estudos Transversais , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Acute and agent-specific chronic infections have been associated with increased cardiovascular risk, however data on the burden of common recurrent infections on cardiovascular disease is limited. We hypothesized women with greater exposure to uncomplicated common infectious events had an increased risk of subclinical cardiovascular disease (sCVD). METHODS: In a cross-sectional study, we assessed the relation of recurrent infections and carotid artery intima-media thickness (IMT) in 1946 disease-free women from the Mexican Teachers' Cohort. Through 2012-2016, participants answered structured questions on respiratory, urinary and vaginal infections during the previous year and their IMT was measured using ultrasound by standardized neurologists. We defined sCVD as mean right and left IMT ≥0.8 mm or the presence of atheromatous plaque. Multivariable linear and logistic regression analyses were used to evaluate the association of infectious events with IMT and sCVD adjusting for age, sociodemographic, and cardiovascular risk factors. RESULTS: Among participants (50±5 years) 13% reported no infections, 20% one infection and 67% three or more episodes. Overall prevalence of sCVD was 12%(n = 240). Adjusted models for logistic regression showed that women with 2 or more infections had 91% higher odds of sCVD (OR 1.91; 95%CI 1.16, 3.13) compared to women without infections (p-trend:0.015). Sub-analyses by type of infection resulted not significant. Linear regression analysis did not show a significant association between mean IMT and recurrent infections. CONCLUSIONS: Recurrent infectious events in young adult women are associated with greater sCVD, which supports the hypothesis of low-grade chronic inflammation in the pathophysiology of cardiovascular disease.