ABSTRACT
The aim of this study was to assess the stability and differences between objective (O-Rx) and subjective (S-Rx) refraction for the assessment of the prediction error (PE). A secondary aim was to report the results of a monofocal intraocular lens (IOL). 100 subjects were included for whom S-Rx and O-Rx were obtained for all visits, and for visual performance, posterior capsular opacification incidence and Nd:YAG rates at 12 months. Either S-Rx and O-Rx showed a hyperopic shift from 1 to 6 months (p < 0.05) and stabilization after 6 months. S-Rx was related with the axial length (rho = -0.29, p = 0.007), obtaining a major tendency towards hyperopia in short eyes implanted with high-power IOLs. O-Rx showed a myopic shift in comparison to S-Rx (p < 0.05). This resulted in a decrease of the number of eyes in ±0.50 D and ±1.00 D from 79 to 67% and from 94 to 90%, respectively. The median (interquartile range) uncorrected and corrected visual acuities were 0.1 (0.29) and 0 (0.12) logMAR, respectively, and seven eyes required Nd:YAG capsulotomy at 12 months. Some caution should be taken in PE studies in which O-Rx is used or S-Rx is measured in a 1-month follow-up. Constant optimization should be conducted for this IOL after S-Rx stabilization.
ABSTRACT
La mielitis transversa (MT) es un síndrome clínico caracterizado por una inflamación y desmielinización aguda de la médula espinal. Esta entidad tomó relevancia pública en septiembre de 2020 cuando fueron suspendidos los ensayos clínicos de la vacuna ChAdOx1 para SARS-CoV-2, desarrollada por AstraZeneca y la Universidad de Oxford, por casos de MT en tres participantes. Al respecto, esta investigación se plantea recopilar la información disponible que relacione casos de MT con vacunas a nivel mundial. En este sentido, se llevó a cabo una investigación descriptiva, con diseño documental, donde se efectuó la revisión sistemática de publicaciones disponibles en las bases de datos: "PubMed", "Redalyc" y "SciELO", desde el 01/2000 al 04/2021, que presentan casos clínicos de MT post vacunación. Se estudiaron 49 casos de MT posterior a la vacunación contra diferentes virus y bacterias, 81,8 % de los mismos sucedieron en el primer mes. Se argumenta que los antígenos de las vacunas o sus adyuvantes pueden propiciar complicaciones autoinmunes que explican este fenómeno. Sin embargo, los análisis estadísticos no encuentran relación causal clara, mientras que existe evidencia que sugiere que las vacunas pueden contribuir a que se manifieste un trastorno autoinmune subyacente. El riesgo de MT pos-vacunación parece ser muy pequeño o depender del azar, mientras que el beneficio derivado de la vacunación está demostrado, incluso para disminuir los trastornos autoinmunitarios. No obstante, es importante notificar y estudiar estos casos para la realización de estimaciones certeras en el futuro, contribuyendo al desarrollo de la medicina de precisión y personalizada
Transverse myelitis (TM) is a clinical syndrome characterized by acute inflammation and demyelination of the spinal cord. This entity gained public relevance in September 2020 when clinical trials of the ChAdOx1 vaccine for SARS-CoV-2, developed by AstraZeneca and the University of Oxford, were suspended due to possible cases of MT in three participants. For this reason, this research aims to compile the available information that relates MT cases to vaccinations worldwide. In this sense, a descriptive research with documentary design was carried out through a systematic review of the publications available in the databases "PubMed", "Redalyc" y "SciELO" that presented clinical cases of post-vaccination TM from 01/2000 to 04/2021. We studied 49 cases of post-vaccination MT for different viruses and bacteria, 81.8 % of which occurred in the first month. In this sense, It's argued that vaccine antigens or their adjuvants may promote autoimmune complications that explain this phenomenon. However, statistical analyses find no certain causal relationship, while there is evidence to suggest that vaccines may contribute to the development of an underlying autoimmune disorder. The risk of postvaccination MT appears to be very small or dependent on chance, whereas the benefit derived from vaccination is certain, including in decreasing autoimmune disorders. However, it is important to report and study these cases for accurate estimates in the future, contributing to the development of precise and personalized medicine
ABSTRACT
PURPOSE: To evaluate in a large sample of patients from 10 different European centers the results of cataract surgery, characterizing the relationship between patient-reported outcomes (PROMs) and clinician-reported outcome measures (CROMs). METHODS: Prospective non-interventional multicenter observational descriptive study analyzing the clinical outcomes of a total of 3799 cases undergoing cataract surgery (mean age: 72.7 years). In all cases, the cataract surgery standard developed by the International Consortium for Health Outcomes Measurements (ICHOM) was used to register the clinical data. Three-month postoperative visual acuity and refraction data were considered CROMs, whereas Rasch-calibrated item 2 (RCCQ2) and total Catquest-9SF score (CQ) were considered PROMs. RESULTS: Postoperative corrected distance visual acuity (CDVA) was 0.3 logMAR or better in 88.7% (2505/2823) of eyes. Mean differences between preoperative and postoperative RCCQ2 and CQ scores were -3.09 and -2.39, respectively. Visual function improvement with surgery was reported by 91.5% (2163/2364) of patients. Statistically significant, although weak, correlations of postoperative CDVA with postoperative refraction, PROMs, and complications were found (0.133 ≤ r ≤0.289, p < 0.001). A predictive model (R2: 0.254) of postoperative CDVA considering 10 variables was obtained, including preoperative CDVA, different ocular comorbidities, age, gender and intraoperative complications. Likewise, another predictive model (R2: 0.148) of postoperative CQ considering a total of 14 variables was obtained, including additionally preoperative CQ, target refraction and previous surgeries. CONCLUSIONS: Cataract surgery provides an improved functional vision in most of patients although this improvement can be limited by ocular comorbidities and complications. The relationship between PROMs and CROMs is multifactorial and complex.
Subject(s)
Cataract Extraction , Cataract , Humans , Postoperative Period , Prospective Studies , Surveys and Questionnaires , Vision, Ocular , Visual AcuityABSTRACT
Desde el punto de vista clínico muchas de las lesiones neoplásicas y seudoneoplásicas del párpado y la conjuntiva son confundibles, por lo que se hace necesario realizar un examen anatomopatológico para el diagnóstico y tratamiento correcto. Se presenta el caso de una paciente de 84 años, atendida en el Servicio de Oftalmología del Hospital Gustavo Aldereguía Lima, de Cienfuegos, por presentar una lesión amplia, ulcerada y vascularizada que se encontraba en párpado superior en su porción interna, cabeza de la ceja del ojo derecho y párpado inferior del ojo izquierdo. Se le realizó biopsia, mediante la que se detectó un carcinoma epidermoide, para lo que se le realizó una exéresis amplia de la región afectada mediante tratamiento quirúrgico y se le reconstruyó toda la zona a través de la técnica de Tenzel para poder mejorar la calidad de vida de la paciente. Por haberse presentado de manera bilateral, lo que es poco frecuente, se decidió la presentación del caso.
From a clinical point of view, many neoplastic and pseudoneoplastic lesions of the eyelids and conjunctiva can be confused. Consequently, a pathological examination must be performed to establish the correct diagnosis and treatment. We present the case of an 84-year-old woman treated at the Ophthalmology Department of Dr. Gustavo Aldereguía Lima Hospital in Cienfuegos due to ulcerated and vascularized lesions on the inner part of the upper lid and the head of the right eyebrow and left lower lid. The biopsy revealed a squamous cell carcinoma. A wide excision of the affected region was performed and the entire area was reconstructed using the Tenzel technique to improve the patient’s quality of life. This case is of interest given the bilateral presentation of the carcinoma.
ABSTRACT
Se presenta el caso clínico de una mujer de 25 años con estreñimiento crónico en quien inicialmente se confundió el diagnóstico con enfermedad ginecológica versus tumor pélvico; en laparotomía exploratoria se evidencia lesión quística dependiente del sacro en su cara anterior por lo que se recurre a toma de imágenes diagnósticas con tomografía computarizada donde se observa meningocele sacro anterior, y posteriormente resonancia magnética para descartar otras lesiones asociada. Se plantea manejo quirúrgico con abordaje posterior para resección de cele y laminectomía con buenos resultados postoperatorios. En control de los 3 meses se encuentra paciente sin déficit neurológico, sin pérdida de sensibilidad en región perineal ni alteraciones de su sistema nervioso vegetativo.
A case is presented of a 25 year-old woman with chronic constipation in whom the diagnosis was initially confused with a gynaecological disease or a tumour. The exploratory laparotomy showed evidence of a cystic lesion hanging from the anterior side of the sacrum. Diagnostic imaging with computed tomography was performed in which an anterior sacral meningocele was observed. Magnetic resonance was then used to rule out any other associated lesions. It was decided to treat it surgically with a posterior approach for resection and laminectomy of the meningocele, with a good post-surgical outcome. In the follow-up at 3 months the patient showed no neurological deficit, no loss of sensitivity in the perineal region, and no changes in her autonomic nervous system.
Subject(s)
Humans , Female , Adult , Meningocele , Sacrum , Genetic Diseases, Inborn , ConstipationABSTRACT
Estudio descriptivo retrospectivo que busca valorar la frecuencia de infección en trauma craneoencefálico que fue manejado con esteroides. Se recolectó una muestra de 153 pacientes y de las historias clínicas se extrajeron las variables demográficas (edad, género, mortalidad) y las características clínicas (infección, uso de esteroides). Los resultados no evidenciaron aumento de la frecuencia de infecciones en los pacientes con trauma craneoencefálico que recibieron manejo con esteroides...
This descriptive retrospective study sought to assess the frequency of infectious complications in steroid recipients for central nervous system (CNS) trauma. A sample of 153 patients was collected and demographic variables (age, gender, mortality) and clinical features (infection, steroid use) were obtained from medical records. Results did not evidence an increase in the frequency of infectious complications in patients treated with steroids for CNS trauma...
Subject(s)
Humans , Male , Female , Middle Aged , Infections , Craniocerebral Trauma , Steroids , MortalityABSTRACT
Se presenta el caso de un paciente de 76 años de edad con un carcinoma epidermoide de conjuntiva. La manifestación clínica principal fue la molestia, el dolor y el ojo rojo. Al examen físico ocular se encontró lesión blanquecina, con vasos sanguíneos en el ángulo interno, por encima del pterigion en ojo derecho. Se diagnosticó como carcinoma epidermoide de la conjuntiva, el cual evolucionó de forma rápida e invasiva. Se intervino quirúrgicamente en tres ocasiones debido a las recurrencias(AU)
The case of a 76 years old male patient with a conjunctival squamous cell carcinoma is presented. The main clinical manifestation was discomfort, pain and redness in the eye. Physical ocular examination revealed a whitish eye injury, with blood vessels in the inner corner, above the right eye pterygium. It was diagnosed as squamous cell carcinoma, which evolved rapidly and invasively. Due to recurrences, three surgeries were performed(AU)
Subject(s)
Humans , Male , Aged , Carcinoma, Squamous Cell/surgery , Conjunctival Neoplasms/surgery , Eye Enucleation/methodsABSTRACT
Fundamento: el progresivo envejecimiento poblacionales uno de los fenómenos demográficos más característicos de las últimas décadas, los ancianos constituyen un grupo de riesgo, pues a los factoresdesencadenantes de trastornos psicopatológicos propios de la sociedad actual se le asocian otros más específicos inherentes a la etapa de pérdida que constituye la ancianidad. Objetivo: valorar la repercusión de la cirugía de catarata en el estado psicológico del adulto mayor. Métodos: estudio descriptivo correlacional que incluyó 80 ancianos que acudieron a la consulta de pre operatorio de catarata del Hospital de Cienfuegos, con alguna afectación en el funcionamiento afectivo. Se analizaron variables psicosociales como ansiedad, depresión, autovaloración, estilo de vida y variables sociodemográficas como edad, sexo, color de la piel, residencia, convivencia, escolaridad y ocupación. Resultados: predominaron el sexo femenino, color de piel blanca y los mayores de 71 años, con escolaridadmedia, casados, de residencia urbana, que viven en el seno de una familia multigeneracional. El grado de depresión alta (30 por ciento) antes de la cirugía, bajó a 5 por ciento después de esta; asimismo la ansiedad alta descendió de un 53 por ciento a un 10 por ciento; la autovaloración inadecuadaantes de la operación (65 por ciento) descendió a 20 por ciento despuésde ella. Conclusiones: la operación de catarata repercute favorablemente en el estado psicológico del adulto mayor(AU)
Background: Progressively aging populations are one of the most distinctive demographic phenomena of the last decades. The elderly represent a particular risk group because typical characteristics of this stage of life,commonly associated with loss, are added to regular causes of psychopathologic disorders in today's social life. Objective: To assess the impact of cataract surgery on the psychological state of the elderly. Methods: A descriptive correlational study was conducted. The sample included 80 elder patients who attended the outpatient cataract pre-surgery consultation in the General University Hospital of Cienfuegos. They allpresented some kind of affective disorder. The following psychosocial variables were analyzed: anxiety,depression, self-esteem and lifestyle. Sociodemographic variables such as age, sex, skin color, personal address,people they live with, education and occupation were also considered. Results: Predominant groups werethose of females, white skinned, over 71 years old, average school level, married, living in urban residencesand within a multigenerational household. Depression levels were high (30 percent) before surgery. After surgery they decreased in a 5 percent. High levels of anxiety also decreased from 53 percent to 10 percent Inadequate self-esteem before surgery (65 percent) decreased to 20 percent after surgery. Conclusions: Cataract surgery has a favorable effect onthe psychological status of the elderly(AU)
