Evaluation of the perception of physical and emotional health of ophthalmologists in Spain and the influence of the COVID-19 pandemic

Objective

The main objective was to study the perception of physical and emotional health of Spanish ophthalmologists and their health habits, as well as the possible influence of the COVID-19 pandemic.

Methods

An observational, cross-sectional, non-randomized and uncontrolled study was carried out among at Spanish ophthalmologists through an online survey of 47 questions on eating habits, tobacco, alcohol, physical exercise, workload, and perception of physical and emotional state.

Results

Of a total of 2,179 ophthalmologists, 260 (11.9%) of whom 55% were men responded to the survey, with a mean age of 52.9 ± 11.4 years. 5.8% were smokers. In total, 51.5% reported good physical health, with a mean Body Mass Index of 24.4 kg/m². Overall, 53.5% reported depression, 66.9% tiredness, 34.6% difficulty sleeping, and 57.3% considered their work hard. Up to 28.5% of those surveyed had thought about leaving their job and 60.8% about reorganizing their workload. In total, 91.9% would continue to choose Ophthalmology as a specialty. In total, 36.2% reported an increase in workload, 42.3% worsening of physical state and 63.8% worsening of emotional state as a consequence of the COVID-19 pandemic.

Conclusions

Spanish ophthalmologists have a positive perception of their physical and emotional health, despite having life habits that are not always healthy and feeling mostly down. The COVID-19 pandemic has had a negative influence on the physical and emotional health of ophthalmologists.

Peripapillary and optic nerve head vessel density of glaucoma and healthy subjects from Afro-Caribbean and European descent: A pilot study

PURPOSE

To compare the peripapillary and optic nerve head vessel density (PP-ONH VD) between glaucoma patients (all, early, moderated, and advanced) and healthy subjects of Afro-Caribbean descent (AD) and European descent (ED).

METHODS

This was a cross-sectional study. One eye was evaluated in 90 subjects, including 66 glaucoma patients and 24 healthy subjects, who underwent PP-ONH VD imaging using SPECTRALIS® Optical Coherence Tomography Angiography (OCT-A). We analysed the superficial vascular complex using the AngioTool version 0.6a software. The correlation between the PP-ONH VD and visual field mean deviation (MD) was evaluated using a scatter plot and Spearman's rho correlation coefficient.

RESULTS

Among the healthy subjects, the AD group had a lower superficial PP-ONH VD [43.29±3.25% (mean±standard deviation)] than the ED group (46.06±1.75%) (P=0.016). Overall, superficial PP-ONH VD did not show any significant differences between the total AD and ED glaucoma patients or in the subgroup analyses (early/moderate/advanced) (AD: 32.73±6.70%, 37.11±5.72%, 32.48±5.73%, 27.76±4.74%, respectively; ED: 33.94±6.89%, 38.52±3.82%, 35.56±4.18%; 27.65±6.31%, respectively) (P>0.05 for all). A strong, statistically significant correlation was established between vessel density and mean deviation among AD and ED glaucoma patients (r=0.709 and r=0.704, respectively) (P<0.001 for both).

CONCLUSION

This pilot study shows that healthy subjects of AD had lower peripapillary and optic nerve head superficial vessel density than healthy subjects of ED, but no significant differences were found between AD and ED glaucoma groups (all, early, moderate, or advanced).

Biometry data and prevalence of corneal astigmatism in caucasian spanish candidates for cataract surgery

PURPOSE

To describe ocular biometric parameters and the prevalence of corneal astigmatism as well as age and gender correlations in a population of cataract surgery candidates and to estimate the number of eyes that would be candidates for a toric intraocular lens (IOL).

METHODS

In consecutive patients requiring cataract surgery over a one-year period (June 2016 to June 2017), the following optical biometry measurements were performed on an IOLMaster 700 or Lenstar 900: axial length (AL), anterior chamber depth (ACD), lens thickness (LT), mean keratometry (K), flat keratometry (K1), steep keratometry (K2), corneal astigmatism (Cyl) and white-to-white diameter (WTW). Descriptive statistics for the demographic and biometric data were analyzed.

RESULTS

The study sample included 6111 eyes of 3332 patients (59.3% women), with a mean age of 74.78±9.7years. The means of the compiled data are as follows: AL 23.58±1.55mm, ACD 3.08±0.41mm, LT 4.55±0.52mm,K 44.15±1.54 diopters (D), K1 43.64±1.57 D, K2 44.69±1.61 D, Cyl 1.0±0.81. D and WTW 11.88±0.46mm. The male patients had significantly larger eyes (higher AL, ACD and WTW) and flatter corneas (lower flat and steep K). Older patients had significantly lower AL, ACD and WTW, while their LT values were higher. Corneas became significantly steeper with age. 60.5% of eyes had less than 1 D of corneal astigmatism, while 3.1% had ≥3.0 D.

CONCLUSIONS

Less than 1 D of corneal astigmatism was present in the majority of cataract surgery candidates. 3.1% of eyes were candidates for a toric IOL. This study provides useful information on inventory requirements for planning hospital resources.

Biomarkers and intermediate-high risk non-muscle invasive bladder cancer: a multivariate analysis of three different cellular pathways with pronostic implications

PURPOSE

To determine the presence of a group of mutations, and establish the prognostic value for recurrence and progression.

MATERIALS AND METHODS

Prospective observational study. Intermediate-to-high-risk non-muscle invasive bladder cancer (NMIBC) was evaluated. Data from genetic analyses were included in a database along with clinicopathological variables of interest.

RESULTS

Seventy-four patients. Twenty-five (33.8%) recurred and 3 (4.1%) progressed. Median time to recurrence: 8 months (5.7-12.7). Median time to progression: 14 months (P75: 12). Mutation distribution: KRAS codon 12: one patient (1.4%), BAT25: five patients (6.8%), BAT-26: four patients (5.4%), and D2S123: 6 patients (8.1%). Arg72Pro polymorphism: 50 patients (67.6%) exhibited homozygous mutations, 23 (31.1%) were heterozygous, and 1 patient (1.4%) did not present the mutation. We found an association between presence of MSI at BAT26 and female sex (p < 0.05) and tumor stage and the TP53 Arg72Pro polymorphism. Recurrence-free survival (RFS) was significantly associated with presence of MSI at D2S123, with a HR of 5.44 for patients presenting the mutation (95% CI 1.83-16.16). On multivariate analysis, we found a statistically significant increase in risk of recurrence among patients with MSI at D2S123 (HR 5.15; p < 0.05) and more than 2 previous transurethral bladder resections (TURBs) (HR 5.07; p < 0.05) adjusted for tumor stage and grade. Harrell's concordance index revealed an accuracy of 0.74 (p < 0.05).

CONCLUSION

An association was found between presence BAT26 MSI and female sex, Arg72Pro polymorphism with tumor stage and D2S123 and more than 2 TUR procedures were associated with RFS adjusted to tumor stage and grade.

Validation of the Spanish-language version of the Montreal Cognitive Assessment as a screening test for cognitive impairment in multiple sclerosis

INTRODUCTION

The neuropsychological batteries traditionally used for the assessment of cognitive impairment (CI) in patients with multiple sclerosis are complex tests requiring a long time to administer. Simpler tests are needed to detect cognitive impairment in daily clinical practice.

OBJECTIVE

We aimed to evaluate the diagnostic validity and reliability of the Montreal Cognitive Assessment (MoCA) test as a screening tool for CI in patients with multiple sclerosis, as compared against the Brief Neuropsychological Battery.

MATERIAL AND METHODS

We recruited 52 patients with multiple sclerosis (61.5% women; mean age [standard deviation]: 41.7 [11.5] years). We analysed the reliability (internal consistency, interobserver reliability, and test-retest reliability), construct validity (factor analysis, Pearson correlation coefficient, and coefficient of determination), and criterion validity (ROC curve, sensitivity, specificity, total agreement, positive and negative predictive values, positive and negative likelihood ratios, and Fagan nomogram) of the MoCA test in this population.

RESULTS

The prevalence of CI was 21.2% according to findings from the Brief Neuropsychological Battery, and 25% according to the MoCA test. The MoCA test showed good internal consistency (Cronbach alpha, 0.822) and interobserver and test-retest reliability (intraclass correlation coefficient 0.80 and 0.96, respectively). The correlation coefficient between total Brief Neuropsychological Battery and MoCA test scores was 0.82. The optimal cut-off point on the ROC curve was 25-26, yielding 91% sensitivity and 93% specificity.

CONCLUSION

The MoCA test is a valid and reliable tool for screening for CI in patients with multiple sclerosis.

Assessment of ocular redness measurements obtained with keratograph 5M and correlation with subjective grading scales

OBJECTIVE

To examine correlations between ocular redness scores provided by the Keratograph 5M and those determined using two image-based grading scales.

METHODS

Observational prospective cross-sectional study. Two hundred and twenty six eyes of two hundred and twenty six participants (175 patients using anti-glaucoma eye drops and 51 subjects untreated). All subjects were scored automatically using the keratograph 5M. These redness scores (RS) were then correlated with the gradings provided by the Efron and McMonnies/Chapman-Davies scale (MC-D) scales (two observers).

RESULTS

Excellent reproducibility was observed for both the Efron (weighted K=0.897, 95% CI 0.823-0.904) and MC-D (weighted K=0.783, 95% CI 0.752-0.795) scales. Keratograph RS and the scores obtained with both Efron (Spearman's Rho=0.43, P<0.001) and MC-D (Spearman's Rho=0.48, P<0.001) scales were significantly correlated. RS for the bulbar and limbal - nasal and temporal quadrants also correlated moderately with the two subjective scales. Through Bland Altman analysis, poor agreement was detected between the objective and subjective methods: agreement values for the Efron scale or MC-D scale (matching scorers between observers) versus overall RS showed high biases (-15.58 and -22.05 respectively) and wide limits of agreement (LOA) (-46.169 to 15.005 and -52.534 to 8.19 respectively). Lowest bias was observed between temporal limbal RS and Observer 2 Efron score (-0.04).

CONCLUSIONS

Although it emerged as a reliable objective method, the keratograph 5M overestimated the scores compared with the subjective grading scales when used to grade the degree of ocular redness. Therefore, they should not be interchangeable methods.

Fibrin glue conjunctival autograft for primary pterygium: Overall outcomes and outcomes in expert versus trainee ophthalmologists

INTRODUCTION

To determine outcomes of conjunctival autograft attached with fibrin glue (FG) for primary pterygium, and compare these outcomes in expert versus closely supervised trainee ophthalmologists.

METHODS

This was a retrospective, comparative, non-randomized, interventional study. Patients were recruited among those with primary nasal pterygium undergoing FG conjunctival autograft. Surgery was performed by expert (136 eyes) or closely supervised trainee (128 eyes) ophthalmologists. Mean follow-up was 7.82±8.23months. Main outcome measures were recurrence rate, reoperation rate and complications.

RESULTS

The study sample comprised 264 eyes of 225 patients. Participants were of mean age 47.09±12.89years; 46.7% were male, 28.4% Caucasian and 70.5% Hispanic. Recurrence was recorded in 6.4%: 5.9% in the expert group and 7% in the trainee group (P=0.704) and reoperation in 1.9%: 0.7% and 3.1% (P=0.202), respectively. Both groups showed similar rates of complications such as transient graft edema, graft dehiscence, hematoma or ocular hypertension. Reoperation was slightly more frequent in patients younger than 40years (P=0.064).

CONCLUSIONS

Good outcomes were observed for FG conjunctival autografting in primary pterygium surgery, with no differences recorded between supervised trainee and expert surgeons. Our findings suggest the need to supervise pterygium surgeries during training.

RECALMIN II. Eight years of hospitalisation in Internal Medicine Units (2007-2014). What has changed?

OBJECTIVES

To analyse the evolution of care provided by the internal medicine units (IMU) of the Spanish National Health System from 2007 to 2014.

MATERIAL AND METHODS

We analysed all discharges from the IMU of the Spanish National Health System in 2007 and 2014, using the Minimum Basic Data Set. We compared the risk factors by episode, mortality and readmissions between the two periods. We prepared specific fits for the risk for mortality and readmissions in heart failure, pneumonia and chronic obstructive pulmonary disease, as well as the Charlson index for all activity.

RESULTS

Discharges from the IMU between the two periods increased 14%. The average patient age increased by 2.8 years (71.2±17.1 vs. 74±16.2; p<.001), with a marked increase in comorbidity (Charlson index, 4±3.7 vs. 4.7±3.9; p<.001; 24% increase in risk factors per episode). The adjusted mortality rates decreased slight but significantly, with a slight increase in readmissions.

CONCLUSIONS

During the analysed period, there was an increase of almost 3 years in the mean age of patients treated in the IMU of the Spanish National Health System, with a marked increase in comorbidity. These results should lead to a more appropriate assignment of nurse workloads and an increased implementation of good practices in clinical management.

Agreement and clinical comparison between a new swept-source optical coherence tomography-based optical biometer and an optical low-coherence reflectometry biometer

PurposeTo compare measurements taken using a swept-source optical coherence tomography-based optical biometer (IOLmaster 700) and an optical low-coherence reflectometry biometer (Lenstar 900), and to determine the clinical impacts of differences in their measurements on intraocular lens (IOL) power predictions.MethodsEighty eyes of 80 patients scheduled to undergo cataract surgery were examined with both biometers. The measurements made using each device were axial length (AL), central corneal thickness (CCT), aqueous depth (AQD), lens thickness (LT), mean keratometry (MK), white-to-white distance (WTW), and pupil diameter (PD). Holladay 2 and SRK/T formulas were used to calculate IOL power. Differences in measurement between the two biometers were determined using the paired t-test. Agreement was assessed through intraclass correlation coefficients (ICC) and Bland-Altman plots.ResultsMean patient age was 76.3±6.8 years (range 59-89). Using the Lenstar, AL and PD could not be measured in 12.5 and 5.25% of eyes, respectively, while IOLMaster 700 took all measurements in all eyes. The variables CCT, AQD, LT, and MK varied significantly between the two biometers. According to ICCs, correlation between measurements made with both devices was excellent except for WTW and PD. Using the SRK/T formula, IOL power prediction based on the data from the two devices were statistically different, but differences were not clinically significant.ConclusionsNo clinically relevant differences were detected between the biometers in terms of their measurements and IOL power predictions. Using the IOLMaster 700, it was easier to obtain biometric measurements in eyes with less transparent ocular media or longer AL.

Effect of pharmacological pupil dilation on measurements and iol power calculation made using the new swept-source optical coherence tomography-based optical biometer

PURPOSE

To determine whether pupil dilation affects biometric measurements and intraocular lens (IOL) power calculation made using the new swept-source optical coherence tomography-based optical biometer (IOLMaster 700^©; Carl Zeiss Meditec, Jena, Germany).

PROCEDURES

Eighty-one eyes of 81 patients evaluated for cataract surgery were prospectively examined using the IOLMaster 700^© before and after pupil dilation with tropicamide 1%. The measurements made were: axial length (AL), central corneal thickness (CCT), aqueous chamber depth (ACD), lens thickness (LT), mean keratometry (MK), white-to-white distance (WTW) and pupil diameter (PD). Holladay II and SRK/T formulas were used to calculate IOL power. Agreement between measurement modes (with and without dilation) was assessed through intraclass correlation coefficients (ICC) and Bland-Altman plots.

RESULTS

Mean patient age was 75.17±7.54 years (range: 57-92). Of the variables determined, CCT, ACD, LT and WTW varied significantly according to pupil dilation. Excellent intraobserver correlation was observed between measurements made before and after pupil dilation. Mean IOL power calculation using the Holladay 2 and SRK/T formulas were unmodified by pupil dilation.

CONCLUSIONS

The use of pupil dilation produces statistical yet not clinically significant differences in some IOLMaster 700^© measurements. However, it does not affect mean IOL power calculation.

A systematic review of sugammadex vs neostigmine for reversal of neuromuscular blockade

We reviewed systematically sugammadex vs neostigmine for reversing neuromuscular blockade. We included 17 randomised controlled trials with 1553 participants. Sugammadex reduced all signs of residual postoperative paralysis, relative risk (95% CI) 0.46 (0.29-0.71), p = 0.0004 and minor respiratory events, relative risk (95% CI) 0.51 (0.32-0.80), p = 0.0034. There was no difference in critical respiratory events, relative risk (95% CI) 0.13 (0.02-1.06), p = 0.06. Sugammadex reduced drug-related side-effects, relative risk (95% CI) 0.72 (0.54-0.95), p = 0.02. There was no difference in the rate of postoperative nausea or the rate of postoperative vomiting, relative risk (95% CI) 0.94 (0.79-1.13), p = 0.53, and 0.87 (0.65-1.17), p = 0.36 respectively.

The EuroPrevall outpatient clinic study on food allergy: background and methodology

BACKGROUND

The EuroPrevall project aimed to develop effective management strategies in food allergy through a suite of interconnected studies and a multidisciplinary integrated approach. To address some of the gaps in food allergy diagnosis, allergen risk management and socio-economic impact and to complement the EuroPrevall population-based surveys, a cross-sectional study in 12 outpatient clinics across Europe was conducted. We describe the study protocol.

METHODS

Patients referred for immediate food adverse reactions underwent a consistent and standardized allergy work-up that comprised collection of medical history; assessment of sensitization to 24 foods, 14 inhalant allergens and 55 allergenic molecules; and confirmation of clinical reactivity and food thresholds by standardized double-blind placebo-controlled food challenges (DBPCFCs) to milk, egg, fish, shrimp, peanut, hazelnut, celeriac, apple and peach.

RESULTS

A standardized methodology for a comprehensive evaluation of food allergy was developed and implemented in 12 outpatient clinics across Europe. A total of 2121 patients (22.6% <14 years) reporting 8257 reactions to foods were studied, and 516 DBPCFCs were performed.

CONCLUSIONS

This is the largest multicentre European case series in food allergy, in which subjects underwent a comprehensive, uniform and standardized evaluation including DBPCFC, by a methodology which is made available for further studies in food allergy. The analysis of this population will provide information on the different phenotypes of food allergy across Europe, will allow to validate novel in vitro diagnostic tests, to establish threshold values for major allergenic foods and to analyse the socio-economic impact of food allergy.

[Incidence of strokes in Spain: the Iberictus study. Data from the pilot study]

INTRODUCTION

In a population-based study of the incidence of stroke conducted on a broad denominator, it is wise first to carry out a pilot study.

AIM

To present the results of the pilot phase of the study on stroke incidence in Spain, entitled Iberictus.

PATIENTS AND METHODS

Population of the study: all cases involving the first episode of acute cerebrovascular disease (stroke or transient ischaemic attack) diagnosed among residents over 17 years of age with their habitual place of abode registered in the areas of study between 15th and 31st October 2005 (total denominator: 1,440,997 inhabitants).

SOURCE OF DATA

prospective, hospital records (basic minimum data set, discharge abstracts) and casualty department registers. Standardised definitions: diagnostic categorisation and pathological, topographical and aetiological classification. Inter-observer agreement analysis among researchers (kappa).

RESULTS

A total of 128 cases were identified. Age range, 37-103 years; mean age, 75.7 +/- 13.4 years; 54% were females. In all, 71.1% of the cases were collected by means of a basic minimum data set. There were 91 ischaemic events (29.7% atherothrombotic and 29.7% cardioembolic). Of the 15 haemorrhagic strokes, 40% due to arterial hypertension, six were lobar hemispheric, six were deep basal ganglia, and there were three cerebellar haemorrhages. The incidence of stroke was seen to increase exponentially with age. Inter-observer agreement was good for the classifications that were employed (range of kappa indices, 0.57-0.78). Several problems were detected and corrected in the fieldwork.

CONCLUSIONS

The Iberictus pilot study yielded data that were consistent with the literature and provided us with the opportunity to detect and correct issues that would hinder us from conducting the main study.

Prevalence of low HDL cholesterol, and relationship between serum HDL and cardiovascular disease in elderly Spanish population: the PREV-ICTUS study

OBJECTIVE

To assess the prevalence of low serum high-density lipoprotein cholesterol (HDL-C) concentration and the relationship between HDL-C and established cardiovascular disease (CVD) in an elderly Mediterranean population.

METHODS

Analysis of Prevención del Riesgo de Ictus, a population-based study on Spanish subjects aged > or = 60 years. Low HDL-C was defined following the European guidelines for cardiovascular prevention [men: < 40 mg/dl (< 1.0 mmol/l); women: < 46 mg/dl (< 1.2 mmol/l)]. The relationship between low HDL-C or HDL-C concentration (in quintiles) and CVD was assessed through multivariate models that included cardiovascular risk factors, statins and subclinical organ damage.

RESULTS

On 6010 subjects (71.7 years, 53.5% women), low HDL-C was present in 17.5% [95% confidence interval (CI): 16.5-18.5] and was more frequent in women [20.4% (19.0-21.8) vs. 14.1% (12.8-15.4) in men p < 0.001] and in patients with diabetes, CVD or statin therapy. Low HDL-C was independently associated with CVD [adjusted odds ratio (OR): 1.46, 95% CI: 1.22-1.74, p < 0.001]. The prevalence of CVD was higher as HDL-C concentration was lower (chi-square trend < 0.001). Compared with the highest quintile [> 65 mg/dl (> 1.67 mmol/l)], adjusted OR for CVD were 1.39 (1.10-1.76), 1.41 (1.11-1.80), 1.49 (1.18-1.89) and 1.91 (1.52-2.39), respectively for those in the fourth [57-65 mg/dl (1.46-1.67 mmol/l)], third [51-56 mg/dl (1.31-1.45 mmol/l)], second [46-50 mg/dl (1.18-1.30 mmol/l)] and first [< 46 mg/dl (< 1.18 mmol/l)] quintiles of HDL-C. This association was seen in males and females.

CONCLUSIONS

A total of 17.5% of this Spanish population aged > or = 60 years had low HDL-C. We found a strong, independent and inverse association between HDL-C concentrations and established CVD, even at ranges of HDL-C considered as normal.

[Incidence of strokes in Spain. Methodological foundations of the Iberictus study]

INTRODUCTION

Epidemiological data on the incidence of cerebrovascular diseases in our country are scarce. A representative population-based study with a large denominator is required.

AIM

To present the design of the study on stroke incidence in Spain, entitled Iberictus.

SUBJECTS AND METHODS

We conducted a prospective, population-based study on the incidence of strokes and transient ischemic attacks, in which it is possible to distinguish: 1) population with a steady risk, which was well defined and had a broad denominator. We included all the cases in which the first episode of acute cerebrovascular disease was diagnosed among those over the age of 17 years (with no upper age limit) with their habitual residence in the areas of study between the 1st January and 31st December 2006: Lugo, Segovia, Talavera de la Reina, Mallorca and Almeria (total denominator, 1,440,997 inhabitants; minimum denominator per area, 100,000 inhabitants); 2) source of multiple and complementary data: hospital records (minimum basic data set, discharge abstracts), emergency and primary care records for the area with diagnostic codes 430-39 and 674.0 (International Classification of Diseases-9), population-based mortality records; 3) standardised definitions: diagnostic categorisation (MONICA-World Health Organisation, 1987), pathological classification (ischaemia, haemorrhagic), topography and aetiology; 4) presentation of data in suitable age groups, by sex and overall; 5) pilot study and analysis of inter-observer agreement among researchers.

CONCLUSIONS

With this design, the Iberictus study satisfies the methodological criteria as an 'ideal' study of the incidence of acute cerebrovascular diseases proposed by Malgrem, Sudlow and Warlow, and represents a unique opportunity to further our knowledge of the epidemiology of strokes in our country.

Decline in the workload associated with the serodiagnosis of syphilis in a general hospital: 1994-2004

Syphilis re-emergence is a cause of concern. Our objective was to quantify the laboratory workload, incident cases and patient follow-up that syphilis has generated for 11 years in a large teaching hospital. An ecologic study including all samples submitted for syphilis serodiagnosis at our hospital from January 1994 to December 2004 was undertaken. Our laboratory processed 58,832 samples for syphilis serodiagnosis. From 1994 to 2004, the number of samples submitted for syphilis testing dropped by 11% (95% confidence interval [CI] 10-12, p<0.001). Syphilis was diagnosed in 443 patients. The incidences were 11, 3 and 8 per 100,000 inhabitants/year in 1994, 2000 and 2004, respectively. Only 42% (185) of patients had repeat tests and in 79% (146) of cases, the 1-year follow-up data were missing. The median follow-up was 9 months (interquartile range [IQR] 3-26). We detected a reduction in the effort to detect syphilis, despite an increase in its incidence and the low cost of syphilis screening. Efforts should be intensified to improve physician compliance with syphilis screening and follow-up guidelines.

Combined Pegaptanib sodium (Macugen) and photodynamic therapy in predominantly classic juxtafoveal choroidal neovascularisation in age related macular degeneration

AIMS

This prospective, open label, non-comparative, observational case series evaluates 6-month results of Pegaptanib Sodium (Macugen) and Photodynamic Therapy (PDT) in predominantly classic juxtafoveal choroidal neovascularisation (CNV) in age-related macular degeneration (AMD) in seven eyes of seven patients.

RESULTS

Best corrected visual acuity (BCVA) diminished with a mean of five letters. Initial area of CNV increased significantly from 1.4 mm2 to 2.7 mm2. There was a significant increase in the greatest linear dimension (GLD) from 1280.3 microm to 2065.7 microm at the 24-week follow-up.

CONCLUSION

Predominantly classic juxtafoveal CNVs are highly aggressive lesions that demonstrate poor response despite combined therapy using PDT and Macugen.

[Prevalence of diabetic retinopathy in the city of Badajoz 2002 (Extremadura project to prevent blindness)]

OBJECTIVE

To establish the prevalence of diabetic retinopathy (DR), types and risk factors in a diabetic population in the city of Badajoz.

METHODS

A cross-sectional study, with prospective data collection, was performed in 2002 on 762 randomly selected diabetic patients belonging to two Primary Care Centers. We evaluated age, gender, type, treatment, duration of diabetes and blood pressure levels. Two color fundus photographs were taken and ophthalmoscopy performed on both eyes. Data were analyzed using SPSS (11.5).

RESULTS

The mean age of the patients was 66.2 (DS 11.4) years, 4.7% were type 1 diabetics, 29% were insulin-treated and 52.8% had elevated blood pressure. Prevalence of DR was 29.8%, macular edema 1.4% and proliferative DR 4.8%. Multivariate analysis showed that patients with an evolution of between 5 and 10 years had a frequency 1.13 times higher (ORaj 1.13; IC 95% 0.68-1.88; p=0.648) than those of less than 5 years evolution, while those with more than 15 years evolution had a frequency 3.12 times higher (ORaj 3.12; IC 95% 1.85-5.26; p<0.001). Patients receiving treatment with oral antidiabetic agents had an RD prevalence 2.39 times higher (ORaj 2.39; IC 95% 1.21-4.74; p=0,012) than those treated with diet only. Patients treated with insulin had a 10.32 higher frequency (ORaj 10.32; IC 95% 5.07-21.00; p<0.001) than those treated with diet.

CONCLUSIONS

29.8% of the diabetic population in the city of Badajoz is affected by DR. Although this prevalence is lower than that observed in previous studies performed by the same team, further studies should be carried out to detect risk sub-groups to allow us to act to decrease such a high prevalence.

The 4G/4G PAI-1 genotype is associated with elevated plasma PAI-1 levels regardless of variables of the metabolic syndrome and smoking status. A population-based study in Spanish population

Reported data about the effect of the 4G/5G PAI-1 polymorphism on plasma PAI-1 levels are controversial. This study was designed to determine the relative effect of the 4G/5G PAI-1 polymorphism on high plasma PAI-1 levels after adjustment for metabolic syndrome - related variables, and to test if this effect is modified by the smoking status. Six hundred and thirty one unrelated subjects (292 men; 35-74 years), from a cross-sectional population-based epidemiological survey in the province of Segovia (Spain) were studied. The higher frequency of high PAI-1 levels was found in 4G/4G subjects (5G/5G 19.4%, 4G/5G 21.6%, 4G/4G 33.7%, p = 0.003). A multiple regression model, adjusted for gender, age, BMI, waist circumference, triglycerides, HDL-cholesterol, HOMA IR and leptin, showed this adjOR: 4G/4G vs 5G/5G: 2.22, p = 0.008. When smoking status - 4G/5G PAI-1 interaction was included as an independent variable these results were not modified. Our results indicate that the 4G/4G PAI-1 genotype might be strongly associated with high PAI-1 levels regardless of metabolic syndrome-related variables and smoking status.

Meta-análisis de la eficacia diagnóstica de la PET-FDG en pacientes con sospecha de recurrencia por cáncer de ovario

AIM

The aim of this paper was to perform a meta-analysis of the literature to evaluate the accuracy of FDG-PET in recurrence detection in patients with ovarian cancer.

METHODS

The search strategy consisted in identifying papers published between November 1972 and October 2003 indexed in MEDLINE and CANCERLITE. Inclusion criteria were publications that evaluated recurrence with FDG-PET in patients with ovarian carcinoma. Exclusion criteria were duplicated papers or those outdated by subsequent ones. The statistical analysis included 95 % confidence intervals (CI) of sensitivity (S), specificity (Sp) and natural logarithm of the odds ratio (Ln OR).

RESULTS

Seventeen publications fulfilled the inclusion criteria and were analyzed. The S and Sp were 0.94 (95% CI, 0.93-0.96) and 0.65 (95% CI, 0.46-0.85), respectively. The Ln OR presented global homogeneity and significant values in > 75% of the studies.

CONCLUSION

According to our meta-analysis, FDG-PET has high S and intermediate Sp, with few false negative results. These preliminary findings suggest that FDG-PET may be an effective means of identifying patients with recurrent ovarian cancer.

Impacto de la tomografía por emisión de positrones mediante 18-Fluoro-2-Desoxi-D-Glucosa (PET-FDG) en el manejo terapéutico de pacientes con recurrencia secundaria a cáncer de ovario

AIM

Recurrent ovarian cancer is a major problem and an accurate diagnosis can often change patients' management. This study aimed to assess the impact on management of FDG-PET in recurrent ovarian cancer.

MATERIAL AND METHODS

Forty-three patients in whom FDG-PET scan was performed due to suspected recurrent ovarian cancer were included. FDG-PET results were confirmed by histopathology and clinical follow-up of at least 12 months. To assess impact on management the treatment plan based on conventional imaging methods was compared with the treatment plan based on inclusion of PET findings, classifying FDG-PET impact on management as high, medium, low or no impact. Management changes, when present, were classified as intermodality or intramodality.

RESULTS

FDG-PET had a high impact on therapeutic management in 28 patients (65.1 %), medium impact in 2 patients (4.6 %), low impact in 9 patients (20.9 %), and no impact in 4 patients (9.3 %). FDG-PET induced an intermodality change in management in 27 patients (62,8 %); intramodality changes were induced in 3 patients (7 %). Finally, it produced no treatment changes in 13 patients (30.2 %).

CONCLUSION

FDG-PET supplied additional information when compared to conventional diagnostic procedures and allowed adequate management changes in most patients.

Does renal mass exert an independent effect on the determinants of antigen-dependent injury?

The aim of this retrospective study was to determine whether nephron mass may exert a direct, independent effect on immunological tolerance. To this end, data corresponding to patients transplanted with en block pediatric kidneys (EBPK) (n=48) were compared with those of renal transplants with a low risk of hyperfiltration (LRH) comprised of recipients of a kidney from young donors (age 5-40 years) (n=173), and transplants with a high risk of hyperfiltration (HRH) comprised of patients who had received a graft from an elderly donor (older than 55 years) (n=91). All the patients had been subjected to the same immunosuppressive treatment. The median follow-up period was 54 months (6-127 months). The EBPK group showed lowest serum creatinine and highest creatinine clearance levels at each follow-up time. The rate of proteinuria >500 mg/day was 5.7% in EBPK, 7.4% in LRH, and 27.3% in HRH (P=0.000). The incidence of acute corticoresistant rejection was minor in EBPK (7.0% in EBPK, 21.3% in LRH, and 23.3% in HRH; P=0.04). Logistic regression analysis showed that the type of transplant was predictive of acute corticoresistant rejection [RR 5.33 (95% confidence interval (CI) 1.15-24.62) for HRH and RR 4.75 (95%CI 1.06-21.27) for LRH, P=0.03]. Multivariate analyses for graft failure due to chronic rejection and for graft failure due to acute rejection according to Cox's regression analysis demonstrated that HRH transplant was a significant predictive variable of both types of failure [4.08 (95%CI 1.27-13.04) for graft loss due to chronic rejection and 8.69 (95%CI 1.69-44.67) for graft loss due to acute rejection]. The present stratification of data according to nephronal mass would appear to indicate that the greater the mass, the lower the incidence of both acute and chronic rejection. This finding lends support to the hypothesis that a large mass of transplanted tissue relative to recipient mass may dampen the immune response.

Influenza virus immunization effectivity in kidney transplant patients subjected to two different triple-drug therapy immunosuppression protocols: mycophenolate versus azathioprine

BACKGROUND

Due to possible complications and treatment limitations, the prevention of influenza in renal transplant (RT) patients is highly indicated.

METHODS

Forty-nine patients with a 1-year functioning RT subjected to two different immunosuppressive regimens and 37 healthy relatives (HR) were administered the anti-influenza vaccine as recommended for 1996 to 1997. Anti-influenza antibody, creatinine, and immunological markers were estimated at 1 and 3 months after vaccination.

RESULTS

Three months after vaccination, 46.2% of the RT patients and 69% of the HR (P=0.06) showed protective antibody titers to influenza A (relative risk [RR]; 0.67; 95% confidence interval: 0.44-1.02). A total of 20.5% of the RT patients and 44.8% of the HR showed antibodies to influenza B (P=0.03). Despite these differences, the incidence of illness was similar. The immunosuppressive regimen had no effect on the antibody response.

CONCLUSIONS

Although the RT patients showed a reduced antibody response, no negative effects on graft outcome were observed.

[Comparative clinico-radiological study of lacunar infarcts of the cerebral hemispheres and brain stem in 110 cases]

INTRODUCTION

Lacunar infarcts (LI) are small deep infarcts due to occlusion of perforating branches.

OBJECTIVE

Our objective was to outline the clinical and epidemiological characteristics which differentiate hemispherical lacunar infarcts (HLI) from those of the brain stem (SLI).

PATIENTS AND METHODS

We present 110 cases of LI (80 HLI, 30 SLI) analysing risk factors, clinical syndromes, findings on neurological examination (dysarthria, gravity, distribution and proportional paresia), form of clinical presentation, evolution whilst in hospital, site and results of carotid duplex. Diagnosis was made in 72 patients using magnetic resonance (MR) and in 38 patients using computerized axial tomography (CT).

RESULTS

The commonest characteristics of SLI, as compared with HLI, with statistical significance (p < 0.05) was the appearance of supranuclear facial paresia (OR = 2.68), severe motor involvement (OR = 4.23), form of presentation with previous TIA (OR = 6.33), fluctuating evolution of the symptoms (OR = 5.78) and progression of the paresia (OR = 6.41). Also, in the pontine LI there was significant correlation between site and gravity: the lower the site of the lesion, the more serious was the paresia. Patients with multiple LI presented with no previous risk factors significantly more frequently than those with a single LI.

CONCLUSION

The different clinical profiles may help to establish the subgroups of IL, according to where they occur.

Multivariate time series analysis in nosocomial infection surveillance: a case study

BACKGROUND

The present study describes the use of time series analysis in the evaluation of the incidence of nosocomial infection. The main hypothesis analysed was that monthly occurrence of nosocomial infection in a hospital may be related to work-related factors such as the control and training of personnel imposed by a surveillance system, strikes supported by medical personnel and movement of personnel. Time series analysis was used to quantify, model and statistically evaluate these interventions.

METHODS

The data employed (March 1982-December 1990) were supplied by the nosocomial infection surveillance system of a primary-care general hospital. The monthly time series incidence of nosocomial infections (measured as percentage cumulative incidence) was analysed by curve fitting, autoregressive, integrated and moving average (ARIMA) modelling (Box-Jenkins) and intervention and dynamic regression analysis.

RESULTS

The imposed control and training of personnel by the surveillance system was associated with a 3.63% decrease in the accumulated monthly incidence of nosocomial infection from 7.82% to a baseline level of 4.19%. There was a strong indication that an increase of infection incidence of 4.34% corresponded to a medical strike. This increase was maintained over the following months raising the baseline level to 4.84%. An increase of 0.18% was associated with each new nursing contract. Evidence was obtained for the possible relationship between incidence of nosocomial infection and vacation periods.

CONCLUSIONS

The results suggest the need for strict control of the activities of hospital personnel and for the adoption of certain preventative measures during vacation periods to avoid an undesirable increase in the incidence of nosocomial infections.