Diplopía binocular por paresia o parálisis oculomotoras: resultados de las opciones de tratamiento / Binocular Diplopia due to Oculomotor Paresis or Palsies: Outcomes of Treatment Options

Objetivo: Determinar resultados de las opciones de tratamiento para la diplopía binocular en pacientes con paresia o parálisis oculomotoras. Método: Se realizó un estudio descriptivo, longitudinal y prospectivo de una serie de casos que acudieron a la consulta del Servicio de Oftalmología Pediátrica del Instituto Cubano de Oftalmología Ramón Pando Ferrer. Se evaluaron las variables: edad, sexo, etiología, opciones de tratamiento, limitación de los movimientos oculares, eliminación de diplopía, fusión y estereopsis. Resultados: La etiología más frecuente fue la microvascular. El 66,7 por ciento de la muestra estudiada se resolvió solo con tratamiento médico, de ellos el 100,0 por ciento con diagnóstico de paresias o parálisis del tercer nervio craneal, seguido por el sexto y cuarto con 63,6 por ciento y 33,3 por ciento, respectivamente. Necesitaron tratamiento médico, quirúrgico y aplicación de toxina botulínica seis pacientes, el 33,3 por ciento del cuarto y el 22,7 por ciento del sexto nervio craneal. El resto de las opciones de tratamiento solo con un paciente. No se halló asociación significativa entre opciones de tratamiento y nervio craneal afectado. El 86,6 por ciento finalizó sin limitación de los movimientos oculares. El 86,7 por ciento de los casos eliminaron la diplopía en todas las posiciones diagnósticas de la mirada. El 76,7 por ciento logró fusión y el 56,7 por ciento estereopsis. Conclusiones: El tratamiento médico y el combinado de médico más inyección de toxina botulínica y cirugía de músculos extraoculares fueron las opciones más utilizadas y permitieron alineamiento ocular y eliminación de la diplopía binocular(AU)

Objective: To determine outcomes of treatment options for binocular diplopia in patients with oculomotor paresis or paralysis. Method: A descriptive, longitudinal and prospective study was carried out of a series of cases that were assisted at the consultation of the Pediatric Ophthalmology Service at Ramón Pando Ferrer Cuban Institute of Ophthalmology. The variables evaluated were age, sex, etiology, treatment options, limitation of ocular movements, elimination of diplopia, fusion and stereopsis. Results: The microvascular etiology was the most frequent. 66.7 percent of the studied sample was resolved only with medical treatment, 100.0 percent of them had a diagnosis of paresis or paralysis of the third cranial nerve, followed by the sixth and fourth with 63.6 percent and 33.3 percent, respectively. Six patients required medical and surgical treatment and application of botulinum toxin, 33.3 percent of the fourth and 22.7 percent of the sixth cranial nerve. The rest of the treatment options with only one patient. No significant association was found between treatment options and affected cranial nerve. 86.6 percent finished without limitation of eye movements. 86.7 percent of cases eliminated diplopia in all diagnostic gaze positions. 76.7 percent achieved fusion and 56.7 percent stereopsis. Conclusions: Medical treatment and combined medical treatment plus botulinum toxin injection and extraocular muscle surgery were the most used options and allowed ocular alignment and elimination of binocular diplopia(AU)

Estrategias de tratamiento para el edema macular diabético / Treatment strategies for diabetic macular edema

RESUMEN Se hace una revisión bibliográfica acerca del tratamiento que se utiliza en el edema macular clínicamente significativo. Esta es la primera causa de mala visión en los pacientes con diabetes mellitus. Entre las líneas de tratamiento tenemos los antiangiogénicos con sus variantes, los esteroides y la cirugía por medio de la vitrectomía pars plana con pelado de la membrana limitante interna. No existe hasta el momento el tratamiento ideal. La tomografía de coherencia óptica ayuda a predecir la visión final(AU)

ABSTRACT Treatment of clinically significant diabetic macular edema is the topic of our review. This condition is the first cause of vision loss in diabetic patients. Treatment options include anti-VEFG drugs, steroids and surgery (vitrectomy with internal limiting membrane peeling). There is no an ideal treatment at present. Optic coherence tomography is a useful tool to predict final vision in these patients(AU)

Awareness and knowledge of the general public at southern region of Saudi Arabia regarding dental implants

Aims: To assess the awareness, knowledge, and information sources regarding dental implants as anoption of treatment to replace missing teeth among patients in Jazan Province, Saudi Arabia.Materials and methods: The current study consisted of 14 questions used to assess the patients’awareness, expectations and level of knowledge of dental implants. Three categories of questionswere used, with the first one related to the patients’ knowledge and options for replacement of missingteeth, the second about dental implants and their providers, and the third on the techniques, materials,care, and durability of dental implants. The collected data was analyzed using Chi-square tests, and Pvalues less than 0.005 were considered significant. Results: A total of 380 subjects were divided intotwo groups, medical (40.3%) or non-medical (59.7%) related. We found that 85% and 71.0% of themedical and non-medical subjects, respectively know the importance of replacement of missing teeth,while 50% had known the different types of dental implants with no significance (P< .001) betweenthe two groups. Dentists were the sources of the information (43.3% and 34.8% for the medical andnon-medical groups respectively). Around 50% of the medical subjects thought that dental implantscame with a screw compared with 36.6% of non-medical subjects with value of P .025. In total, 60%-70% of respondents from both groups answered that dental implants should be provided by specialistsonly. Around 29% of all patients cited “lifetime” as the survival period of implants. Also, 52%-77%of the respondents related the implant site to the “the jaw bone,” with significant difference of P .000.Conclusions: The awareness and knowledge of the subjects were acceptable with higher percentageamong respondents in the medical group. Dentists followed by friends were the main sources ofinformation for dental implants. Dental implants are considered as the best choice for replacement ofmissing teeth with excellent durability and need of much more special care than natural teeth

Treatments of Infra-Orbital Dark Circles by Various Etiologies

Dark circles refer to visible darkness of the infra-orbital areas. Dark circles are a cosmetic concern for many individuals, although not a medical concern. Moreover, clear definitions and possible causes of dark circles have not been elucidated. This study reviews the possible causes and treatment options for dark circles based on a review of the medical literature and the authors' clinical experience. Potential factors that contribute to dark circles include excessive pigmentation, shadowing due to tear troughs and infra-orbital fat herniation, shadowing due to infraorbital laxity and wrinkles, and thin, translucent skin overlying the orbicularis oculi muscle. Given the different possible causes for dark circles, therapeutic modalities must be individualized for each patient. Because various factors cause dark circles, it is useful to identify the underlying causes in order to select the appropriate treatment.

Analysis on the distribution and treatment of malaria patients in the phase of eradication of malaria in China / 中国卫生政策研究

Objective: To understand the distribution and treatment of malaria patients, and the characteristics of sampled hospitals in thephase of eradication of malaria,and provide support for medical resources allocation in the later stages of malaria eradication phase. On this basis, this study aims at promoting the realization of the ultimate goal of total eradication of malaria in China by 2020. Methods : A multi-stage stratified cluster sampling method was used. A total number of 102 hospitals in Zhejiang, Jiangsu, Anhui, Henan, Sichuan and Yunnan Provinces were selected to collect original information on in-patient and out-patient of malaria in terms of medical records and treatment costs during the periodfrom January 1st 2014 toDecember 31th2016. In order to conduct accurate statistical analysis, Excel 2016, SPSS 20. 0 and other Software were used. Results: The survey results collected a total number of 1633 malaria patients, and these patients showed a W-shaped distribution during the months of treatment. Most of malaria patients from Henan and Sichuan Provinceswere diagnosed as having been affected by falciparum and vivax malaria, and their number sharply increased. This is paper also revealed the ratios of malaria patientsin terms of their choice of health services,namely from tertiary hospitals, municipal medical institutions and provincial medical institutions; those were77.10％,52.05％ and 23.58％,respectively. Conclusions : A new period of peak incidence of malariais detected from 2014 to 2016. With hospitals' line of malaria defending ability shrinking,it was found that malaria treatment capacitiesare relatively concentrated in the high level hospitals,which plays a greater role when it comes to the prevention and control of malaria. It is recommended that regional malaria treatment lines should be built,and severe malaria treatment knowledge trainingsshould be prepared and attended in mass in orderto improve malaria treatment capacities.

Advances in research and application of copy number variants in pediatric acute lymphoblastic leukemia：reports from the 57th American Society of Hematology annual meeting / 白血病·淋巴瘤

Recent studies showed that copy number variations in certain genes are closely correlated to progression and prognosis of pediatric acute lymphoblastic leukemia. Relevant reports in the 57th American Society of Hematology(ASH) annual meeting in 2015 will be reviewed together with research progress in recent years.

Risk factors and treatment strategies for postoperative hypoxemia in patients undergoing acute Stanford A aortic dissection surgery / 中华胸心血管外科杂志

Objective To explore the risk factors and optional treatment strategies for postoperative hypoxemia in patients undergoing acute Stanford A aortic dissection surgery.Methods From December 2012 to April 2014,108 patients received acute Stanford A aortic dissection surgery in Henan Provincial People' s Hospital.Of them,74 men vs.34 women,age (43.2 ± 10.1) years old,and weight (71.3 ± 18.4) kg.The operation was performed within 14 days since disease onset.All patients received surgery under deep hypothermic circulatory arrest(DHCA) and the nasal temperature goal was below 20 ℃ .Postoperative hypoxemia was defined as the arterial partial oxygen over inspired oxygen fraction(PaO2/FiO2) more than 200 after admission to ICU.Pulmonary protective ventilation management took place immediately after hypoxemia was diagnosed.Comparison analysis was performed between hypoxemia group and non-hypoxemia group in age,gender,body mass index (BMI),smoking history,duration of cardiopulmonary bypass(CPB),duration of DHCA,blood transfusion,length of mechanical ventilation,length of ICU stay and mortality.Results The incidence of postoperative hypoxemia was 40.7％ (44/108).There were no statistical differences in age,gender,hypertension,diabetes mellitus or COPD history.In the hypoxemia group,11 cases developed pulmonary infection,3 cases underwent tracheotomy and 10 cases died.In the non-hypoxemia group,4 patients died.Postoperative hypoxemia was significantly associated with more mortality,length of ventilation time,length of ICU stay and in hospital(P ＞ 0.05).Univariate analysis showed the associated factors were BMI,smoking history,preoperative hypoxemia,LVEF ＜ 0.45,operation time,aorta clamping time,DHCA time and blood transfusion.Multivariate analysis showed the independent predictive factors were preoperative hypoxemia,DHCA ＞40 min,blood transfusion ＞ 10 U and BMI ＞25 kg/ m2.Conclusion Obesity,massive blood transfusion,long DHCA time and preoperative hypoxemia are independent risk factors of postoperative hypoxemia in patients undergoing acute Stanford A aortic dissection surgery.Perioperative pulmonary protection should be paid more attention and reinforced.

Research progress of limb salvageandamputation for severelimb trauma / 临床外科杂志

Severe limb trauma is one of the mostcommon orthopaedic emergencies,andthe choice betweenamputation andlimb salvage always plagues the clinicians who regardbody function recovery as their highest pursuit.Medical experts at home and abroad have continuously explored standards of amputa-tion or limb salvage,but each kind of scoring system has its own limitation in clinical decision.With the development of wound repair technology and microsurgical technology,clinicians have new understandings of the treatment about these diseases.This paperintegrates related clinical reports in recent yearsand analy-zes the key points of amputation or limb salvage for severe limb trauma,such as large defects of soft tis-sues,main arterial injury,and terminal osteofascial compartment syndrome.It may improve theunderstand-ingsfor these diseases and help clinicians choose more reasonable treatment plans.

On the pathophysiology of vitiligo: Possible treatment options.

Vitiligo is an acquired depigmenting disorder usually classified as non-segmental and segmental types with a higher incidence of the non-segmental ones. The cause of non-segmental vitiligo is still unknown. Currently, it is a dogma that there are several genes affecting the immune system and the pigment system that predisposes someone to develop vitiligo. A precipitating factor must then ellicit an interaction between the immune system and the melanocyte, resulting in destruction of the melanocyte population in discrete areas of the skin. Starting from the overlapping but distinct pathomechanisms, treatment should be finalized to the cellular targets and possibly related to the disease phase.

Complementary Medicine in Gynecology / 한양의대학술지

The use of complementary and alternative medicine (CAM) for health maintenance and disease management has been on a steady rise for more than 10 years. The number of visits to alternative care providers seems to have exceeded the number of visits to primary care providers. Most of these users are women who are frequently making decisions regarding treatment options without the advice of their physicians. The spectrum of CAM is broad and includes methods worthy of integration into our current practics, as well as ineffective or fraudulent practices that should be avoided. The management of many women's health issues can be enhanced by the integration of selected CAM approaches. Important issues of CAM use in the gynecologic field are menstrual disorders such as premenstrual syndrome and dysmenorrhea, Infertility and menopause. The purpose of this article is to provide the clinician with current information of CAM of the above mentioned gynecologic issues and to be helpful in providing benefits to patients with appropriate treatment options.

Current Trend in Metastatic Bone Tumor Treatment

Metastatic bone tumor is a clinical challenge to most orthopaedic surgeons, and physicians. The bone lesions present pain, can progress to pathologic fractures, and cause neurologic deficits. The adequate treatment for the lesions can mean the difference between good and poor quality of life during their remaining time. The goals of the treatment are relief of pain, preservation of function, and maintenance of independence. In orthopaedic field, the goals include prophylactic fixation of metastatic deposits when there is a risk of fracture, stabilization or reconstruction after pathological fracture, and decompression the spinal cord and nerve roots and/or stabilization the spine. To achieve the goals, we should understand the evaluation methods, a pathogenesis of metastasis and the characters of the specific metastatic site. Finally we should have a knowledge about the treatment strategy and understand what the indications of operative treatment are and which conservative managements is correct for the metastatic bone lesions. It is important to consider the type of primary cancer, location of metastasis, extent of disease, expected patient life span, comorbidities, and level of pain when making treatment recommendations. New discoveries and modifications of existing treatments such as percutaneous stabilization of spinal compression fractures and the use of bisphosphonates may decrease the need for invasive surgical management of metastatic bone lesions in the future. Metastatic bone disease should be approached systematically by multidisciplinary team that has various treatment options, and then quality of life of the patients can be improved during their remaining life span. All the doctors participating in the treatment should try to do their best to get an optimal goal, even though the patients should be informed clearly that the treatments may not be curative.