Longitudinal Assessment of Intraretinal Microvascular Abnormalities in Diabetic Retinopathy Using Swept-Source Optical Coherence Tomography Angiography.

Purpose: To longitudinally investigate the changes in intraretinal microvascular abnormalities (IRMAs) over time, employing swept-source optical coherence tomography angiography in eyes with diabetic retinopathy. Methods: In this retrospective, longitudinal study, we evaluated 12 × 12-mm swept-source optical coherence tomography angiography centered on the macula at baseline and last available follow-up visit for (1) IRMA changes during follow-up, defined as (a) stable, (b) regressed, (c) obliterated, and (d) progressed; and the (2) development of new neovascularization (NV) and their origins. Competing-risk survival analysis was used to assess the factors associated with these changes. Results: In total, 195 eyes from 131 participants with diabetic retinopathy were included. Stable, regressed, obliterated, and progressed IRMA were observed in 65.1%, 12.8%, 11.3%, and 19% of eyes with diabetic retinopathy, respectively. Anti-VEGF injections during the follow-up periods and a slower increase of foveal avascular zone were associated with IRMA regression (P < 0.001 and P = 0.039). Obliterated IRMA were correlated with previous panretinal photocoagulation (P < 0.001) and a lower deep capillary plexus vessel density at baseline (P = 0.007), as well as with follow-up anti-VEGF injections (P = 0.025). A higher baseline ischemia index (ISI) and panretinal photocoagulation during the follow-up periods were associated with IRMA progression (P = 0.049 and P < 0.001). A faster increase in ISI predicted the development of NV elsewhere (NVE) from veins (P < 0.001). No significant factors were found to be associated with NVE originating from IRMA. Conclusions: Changes in IRMA closely correlated with the severity of retinal ischemia and treatment. Notably, our study confirmed the potential, yet relatively rare, development of NVE from IRMA in a large cohort; however, the risk factors associated with this transformation require further exploration.

Contrast Sensitivity Better Reflects Wide-Field Swept-Source Optical Coherence Tomography Angiography Vascular Metrics Among Healthy Eyes Compared to Visual Acuity.

BACKGROUND AND OBJECTIVE: To evaluate the association between widefield swept-source optical coherence tomography angiography (WF SS-OCTA) and visual function in healthy eyes. PATIENTS AND METHODS: Fifty-seven eyes of 45 patients were evaluated with visual acuity (VA), contrast sensitivity (CS), and WF SS-OCTA (3 × 3, 6 × 6, and 12 × 12 mm images) on the same day. Mixed-effects multivariable regression analyses were performed. RESULTS: Contrast sensitivity metrics, including CS between 6 to 18 cycles per degree (cpd) and area under the logarithm CS function, were significantly associated with vessel density (VD) and vessel skeletonized density (VSD), whereas VA was not. The largest effect size was between CS at 18 cpd and VD (ß = 0.41, P = 0.007) and VSD (ß = 0.42, P = 0.006) on 12 × 12 mm images. CONCLUSIONS: Reduced VSD and VD on WF SSOCTA was significantly associated with decreased CS, whereas VA was not. These results suggest CS could serve as a screening tool for early stage retinal and neurologic disorders. [Ophthalmic Surg Lasers Imaging Retina 2024;55:XX-XX.].

Decreased Macular Choriocapillaris Perfusion Correlates with Contrast Sensitivity Function in Dry Age-related Macular Degeneration.

PURPOSE: To investigate the relationships between contrast sensitivity (CS), choriocapillaris perfusion and other structural optical coherence tomography (OCT) biomarkers in dry age-related macular degeneration (AMD). DESIGN: Cross-sectional, observational study. PARTICIPANTS: One hundred AMD eyes (22 early, 52 intermediate and 26 late) from 74 patients and 45 control eyes from 37 age-similar subjects. METHODS: All participants had visual acuity (VA) assessment, quantitative contrast sensitivity function (qCSF) testing, macular OCT, and 6x6-mm swept-source OCT angiography (OCTA) scans on the same day. OCT volumes were analyzed for subretinal drusenoid deposits and hyporeflective drusen cores, and to measure thickness of the outer nuclear layer (ONL). OCTA scans were utilized to calculate drusen volume, inner choroid flow deficit percentage (IC-FD%), and to measure the area of choroidal hypertransmission defects (HTD). IC-FD% was measured from a 16 µm-thick choriocapillaris slab after compensation and binarization with Phansalkar's method. Generalized linear mixed-effects models were used to evaluate the associations between functional and structural variables. MAIN OUTCOME MEASURES: To explore the associations between qCSF-measured CS, ICFD% and various AMD imaging biomarkers. RESULTS: AMD exhibited significantly reduced qCSF metrics eyes across all stages compared to controls. Univariate analysis revealed significant associations between various imaging biomarkers, reduced qCSF metrics and VA in both groups. Multivariate analysis confirmed that higher IC-FD% in the central 5 mm was significantly associated with decreases in all qCSF metrics in AMD eyes (ß= -0.74 to -0.25, all p<0.05), but not with VA (p>0.05). ONL thickness in the central 3 mm correlated with both VA (ß= 2.85, p<0.001) and several qCSF metrics (ß= 0.01-0.90, all p<0.05), especially in AMD eyes. Further, larger HTD areas were associated with decreased VA (ß=-0.89, p<0.001) and reduced CS at low-intermediate frequencies across AMD stages (ß= -0.30 to -0.29, p<0.001). CONCLUSIONS: The significant association between IC-FD% in the central 5 mm and qCSF-measured CS reinforces the hypothesis that decreased macular choriocapillaris perfusion contributes to visual function changes in AMD, which are more pronounced in CS than in VA.

Quantitative Contrast Sensitivity Function and the Effect of Aging in Healthy Adult Eyes: A Normative Database.

BACKGROUND AND OBJECTIVE: We sought to establish normative quantitative contrast sensitivity function (qCSF) values in healthy adult eyes and investigate the effect of age on qCSF. PATIENTS AND METHODS: Healthy eyes underwent qCSF testing (adaptive sensory technology) and Snellen's visual acuity (VA). Descriptive statistics and mixed-effects multivariable linear regressions were evaluated. RESULTS: A total of 334 eyes (290 patients) with median age 61 years (range 21 to 88) had qCSF values as follows: area under the log contrast sensitivity function curve: 1.18; contrast acuity: 1.32; contrast sensitivity (CS) at 1 cycle per degree (cpd): 1.32; CS at 1.5 cpd: 1.37; CS at 3 cpd: 1.38; CS at 6 cpd: 1.20; CS at 12 cpd: 0.69; CS at 18 cpd: 0.22. Linear reductions in qCSF values per decade of age ranged from -0.02 to -0.07 vs 0.01 for visual acuity (VA). Age had a greater effect on the majority of qCSF values than VA (beta standardized regression coefficient ranged from -0.309 to -0.141 for qCSF values vs 0.177 for VA). CONCLUSIONS: We herein establish a normative database for qCSF and quantify the effect of age on qCSF values, adding evidence towards the validation of qCSF as a clinical endpoint. [Ophthalmic Surg Lasers Imaging Retina 2024;55:212-219.].

Surgical demographics of acute thigh compartment syndrome.

BACKGROUND: The objective of this study was to identify demographic, injury-related, and treatment-related characteristics of patients who underwent decompressive fasciotomies for acute thigh compartment syndrome. METHODS: A cohort of 38 adult patients with acute thigh compartment syndrome treated with fasciotomy at two tertiary care referral centers over a 10-year time period from January 1, 2006 to June 30, 2015 were retrospectively identified. We searched the electronic medical record for patient-related variables (e.g., age, sex, race, smoking status, diabetes mellitus), injury-related variables (e.g., mechanism of injury, associated fractures, other traumatic injuries), treatment-related variables (e.g., delay to treatment, compartments released, number of debridements, use of split-thickness grafts), and outcomes (e.g., amputation, death, sensory/motor impairments at final follow-up). RESULTS: The mean age of our cohort was 47 years, and 35 patients (92%) were male. There were various mechanisms of injury, but the most common mechanisms were spontaneous hematoma (21%), followed by motor vehicle accidents (16%). Associated leg fractures were present in 15 (39%) patients. Delay between time of injury and fasciotomy was greater than 24 hours in 27 patients (71%), 12 to 24 hours in 6 patients (16%), and less than 6 hours in 3 patients (8%). The most frequently released compartment was the anterior compartment only (68%), followed by both the anterior and posterior compartments (16%) and the posterior compartment only (11%). Six patients (16%) had motor impairment, and 2 patients (5%) had sensory impairment at final follow-up. There were 2 deaths (5%) recorded in the hospital course for this cohort, none of which were directly related to compartment syndrome of the thigh. CONCLUSION: Delays to fasciotomy are frequent in the treatment of acute thigh compartment syndrome. The demographics of acute thigh compartment syndrome demonstrate a strong male predominance. Treating providers should recognize spontaneous hematoma and motor vehicle accidents as the most common causes of acute thigh compartment syndrome.

COVID-19 and its impact on the control of Aedes (Stegomyia) aegypti mosquito and epidemiological surveillance of arbovirus infections.

In American countries, simultaneously with the coronavirus disease 2019 (COVID-19) pandemic, epidemics caused by different arboviruses (dengue, chikungunya and Zika viruses) are occurring. In Mexico, several of the strategies to control the Aedes aegypti mosquito, which transmits arboviruses, involve the interaction of health personnel with the community. Due to the COVID-19 pandemic, social distancing and home confinement measures have been implemented. To obey these measures and avoid the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission, the National Center for Preventive Programs and Disease Control (CENAPRECE) has presented the vector control strategy in the scenario of simultaneous dengue and COVID-19 transmission in Mexico. In this work, we mention the routine comprehensive mosquito control measures and describe the adaptations that have been made. Furthermore, we discuss the relevance of medical personnel training and supervision, especially focusing on the similarity of symptoms between both pathologies.

En países americanos, simultáneas a la pandemia de enfermedad por coronavirus 2019 (COVID-19) se están dando epidemias ocasionadas por diferentes arbovirus (del dengue, chikunguña y virus del Zika). En México, varias de las estrategias para control del mosquito Aedes aegypti, transmisor de arbovirus, involucran la interacción del personal salubrista y los moradores. Debido a la pandemia de COVID-19 se han implementado medidas de distanciamiento social y resguardo domiciliario. Para respetar estas medidas y evitar riesgo de contagio por coronavirus 2 del síndrome respiratorio agudo grave (SARS-CoV-2), el Centro Nacional de Programas Preventivos y Control de Enfermedades (CENAPRECE) ha presentado la estrategia de control de vectores en el escenario de transmisión simultánea por dengue y COVID-19 en México. En este trabajo mencionamos las medidas habituales de manejo integral de mosquito y mencionamos las adaptaciones realizadas. De igual forma, discutimos la relevancia de la capacitación y la supervisión al personal médico, esto debido a la similitud entre la sintomatología entre ambas patologías.

COVID-19 y su impacto en el control del mosquito Aedes (Stegomyia) aegypti y la vigilancia epidemiológica de infecciones por arbovirus / COVID-19 and its impact on the control of Aedes (Stegomyia) aegypti mosquito and the epidemiological surveillance of arbovirus infections

Resumen En países americanos, simultáneas a la pandemia de enfermedad por coronavirus 2019 (COVID-19) se están dando epidemias ocasionadas por diferentes arbovirus (del dengue, chikunguña y virus del Zika). En México, varias de las estrategias para control del mosquito Aedes aegypti, transmisor de arbovirus, involucran la interacción del personal salubrista y los moradores. Debido a la pandemia de COVID-19 se han implementado medidas de distanciamiento social y resguardo domiciliario. Para respetar estas medidas y evitar riesgo de contagio por coronavirus 2 del síndrome respiratorio agudo grave (SARS-CoV-2), el Centro Nacional de Programas Preventivos y Control de Enfermedades (CENAPRECE) ha presentado la estrategia de control de vectores en el escenario de transmisión simultánea por dengue y COVID-19 en México. En este trabajo mencionamos las medidas habituales de manejo integral de mosquito y mencionamos las adaptaciones realizadas. De igual forma, discutimos la relevancia de la capacitación y la supervisión al personal médico, esto debido a la similitud entre la sintomatología entre ambas patologías.

Abstract Countries of Latin America are dealing with a simultaneous COVID-19 and vector borne disease (VBDs, Dengue, Zika and Chikungunya) outbreaks. In Mexico, certain activities to control Aedes aegypti mosquito (the main VBDs vector) comprise community participation through the interaction between householders and vector control personnel. Preventive measures against COVID-19 include social distancing and stay-at-home strategy, to obey these policies, and reduce the risk of infection, the National Center for Preventive Programs and Disease Control of Mexico (CENAPRECE) has adapted the vector control approaches in the country. In this paper we mention routine prevention and control activities to control mosquitoes and show the adapted measures. Because, a number of symptoms of the COVID-19 and dengue fever overlap with each other, we also discuss the relevance of accurate disease surveillance and medic’s training and supervision.

Organic compounds percutaneous penetration in vivo in man: Relationship to mathematical predictive model.

Human skin is a common pathway through which chemicals in our environment enter the body. To aid with risk management of environmental chemicals, the US EPA utilizes mathematical models to estimate percutaneous penetration when experimental data is not available. Here, the accuracy of predicted flux by the Potts and Guy model based on in vitro penetration is compared to human in vivo data of percutaneous absorption of various organic compounds. For most chemicals, the flux was over- or underestimated by a factor 10-100. In vitro flux was significantly correlated to experimental human in vivo flux; however, the physiochemical parameters used in the Potts and Guy equation, Kp, Koctanol, and molecular weight, did not correlate significantly with in vivo flux. We discuss possible explanations for why the computer model did not accurately predict in vivo flux. Further research is needed with different types of chemicals encountered in the environment, and/or as used in clinical practice. This manuscript discusses limitations to the mathematical models currently used, and why the models should be further refined for use.

Calidad de vida en adultos mayores con trastornos temporomandibulares / Qualidade de vida dos idosos com disfunçao temporomandibular / Quality of life of older adults with temporomandibular disorders

Introducción: los trastornos temporomandibulares (TTM) son una condición músculo esquelética dolorosa que afecta los músculos de la masticación, la articulación temporomandibular (ATM) y varias estructuras anatómicas del sistema estomatognático. Objetivo: comparar la calidad de vida; determinada con el instrumento OHIP 49-Mx, de adultos mayores con trastornos temporomandibulares (TTM) vs. libres de TTM. Método: se realizó un estudio observacional analítico en la población de adultos mayores en una Unidad Gerontológica de Puebla, México. Se estableció el diagnóstico de TTM en las instalaciones; con los criterios diagnósticos para TTM propuesto por Dworkin y mejorados por Schiffman en el 2014 por investigadora previamente capacitada. Adicionalmente, se evaluó la calidad de vida (OHIP 49-Mx) por la misma investigadora. El manejo estadístico fue realizado con U de MannWhitney (contraste de medianas) con valor significativo ≤0.05, en el programa SPSS v.21. Resultados: se evaluaron 192 adultos mayores; 131 (68,2 por ciento) con TTM; 84 por ciento mujeres. Los pacientes con TTM, presentaron medianas superiores en la mayoría de las dimensiones del instrumento OHIP 49 Mx: limitación funcional Md=16 vs. 13, p=0,06; dolor Md=8,0 vs. 4,0 p=0.02; incomodidad psicológica Md=3 vs. 3, p=0,31; inhabilidad física Md=11 vs. 3, p≤0,00; inhabilidad psicológica Md=1 vs. 1; p=0,03; inhabilidad social, Md=0 vs. 0; p=0,90 e incapacidad Md=1 vs. 1, p=0,03. Conclusiones: los adultos mayores con TTM, denotaron una menor calidad de vida relacionada con la salud bucal; específicamente en las dimensiones de limitación funcional, inhabilidad física, psicológica y dolor(AU)

Introduction: temporomandibular disorders (TMD) are a painful skeletal muscle condition that affects the muscles of the mastication, the temporomandibular joint (TMJ) and various anatomical structures of the stomatognathic system. Objective: to compare the quality of life; determined with the OHIP instrument 49-Mx, of older adults with temporomandibular disorders (TMD) vs. free of TTM. Method: an analytical observational study was conducted in the elderly population in a Gerontological Unit of Puebla, Mexico. The diagnosis of TMD was established in the facilities; with the diagnostic criteria for TTM proposed by Dworkin and improved by Schiffman in 2014 by a previously trained researcher. Additionally, the quality of life (OHIP 49-Mx) was evaluated by the same researcher. The statistical management was performed with Mann-Whitney U (medium contrast) with significant value ≤0.05, in the SPSSv.21 program. Results: 192 older adults were evaluated; 131 (68.2 per cent) with TTM; (84 per cent) women Patients with TMD had higher medians in most dimensions of the OHIP instrument 49 Mx: limitación functional Md=16 vs. 13, p=0,06; dolor Md=8,0 vs. 4,0 p=0.02; incomodidad psicológica Md=3 vs. 3, p=0,31; inhabilidad física Md=11 vs. 3, p≤0,00; inhabilidad psicológica Md=1 vs. 1; p=0,03; inhabilidad social, Md=0 vs. 0; p=0,90 e incapacidad Md=1 vs. 1, p=0,03. Md=16 vs. 13, p=0.06; pain Md=8.0 vs. 4.0, p=0.02; psychological discomfort Md=3 vs. 3, p=0.31; physical disability Md=11 vs. 3, p≤0.00; psychological disability Md=1 vs. one, p=0.03; social disability Md=0 vs. 0, p=0.90 and disability Md=1 vs. 1, p=0.03. Conclusions: the elderly with TMD, showed a lower quality of life related to oral health; specifically in the dimensions of functional limitation, physical, psychological and pain disability(AU)

Introdução: as disfunções temporomandibulares (DTM) são uma condição dolorosa do músculo esquelético que afeta os músculos da mastigação, a articulação temporomandibular (ATM) e diversas estruturas anatômicas do sistema estomatognático. Objetivo: comparar a qualidade de vida; determinado com o instrumento OHIP 49-Mx, de idosos com disfunção temporomandibular (DTM) vs. livre de TTM. Método: estudo observacional analítico foi realizado na população idosa em uma Unidade Gerontológica de Puebla, México. O diagnóstico de DTM foi estabelecido nas instalações; com os critérios diagnósticos para TTM propostos por Dworkin e aprimorados por Schiffman em 2014 por um pesquisador previamente treinado. Além disso, a qualidade de vida (OHIP 49-Mx) foi avaliada pelo mesmo pesquisador. O tratamento estatístico foi realizado com o teste Mann-Whitney U (meio de contraste) com valor significativo ≤0,05, no programa SPSS v.21. Resultados: 192 idosos foram avaliados; 131 (68,2 por cento) com TTM; 84por cento mulheres Pacientes com DTM apresentaram medianas mais altas na maioria das dimensões do instrumento OHIP 49 Mx: limitação funcional Md = 16 vs. 13, p = 0,06; dor Md = 8.0 vs. 4,0 p = 0,02; desconforto psicológico Md = 3 vs. 3, p = 0,31; deficiência física Md = 11 vs. 3, p <0,00; incapacidade psicológica Md = 1 vs. 1; p = 0,03; deficiência social, Md = 0 vs. 0; p = 0,90 e incapacidade Md = 1 vs. 1, p = 0,03. Conclusões: os idosos com DTM apresentaram menor qualidade de vida relacionada à saúde bucal; especificamente nas dimensões de limitação funcional, física, psicológica e incapacidade de dor(AU)

Percutaneous penetration and pharmacodynamics: Wash-in and wash-off of sunscreen and insect repellent.

Increased awareness of skin cancer and mosquito-transmitted diseases has increased use of insect repellents and sunscreens. The challenge in setting recommendations for use and reapplication, especially when used concomitantly, lies in finding the balance between applying a durable product effective in withstanding natural and physical factors such as water, sweat, temperature and abrasion, while limiting percutaneous absorption and decreasing risk of potential dermal and systemic toxicity. Inorganic sunscreens show no or little percutaneous absorption or toxic effects in comparison to organic sunscreens, which show varying levels of dermal penetration and cutaneous adverse effects. An alternative to N,N-diethyl-m-toluamide (DEET), the traditional gold standard compound in insect repellents, picaridin appears as efficacious, has lower risk of toxicity, and when used simultaneously with sunscreen may decrease percutaneous absorption of both compounds. Conversely, combined use of DEET and sunscreen results in significantly higher absorption of both compounds. It is important to increase consumer awareness of "washing in" of various compounds leading to increased risk of toxicity, as well as differences in reapplication need due to "washing off" caused by water, sweat and abrasion. Although much remains to be studied, to maximize efficacy and decrease toxicity, contemporary research tools, including dermatopharmokinetics, should aid these prospective advances.

Gluteal lift with subfascial implants.

BACKGROUND: Gluteal enhancement surgery includes buttock implants, gluteal flaps, lipografting, and gluteal lifts. However, no information is available on the outcomes achievable using the gluteal lift combined with subfascial gluteal implants. METHODS: A retrospective study was performed to analyze the outcomes of gluteal lift combined with subfascial gluteal implants performed during a 7-year period by a single surgeon at a single institution. RESULTS: During the study period, 114 patients (228 implants) ages 27-68 years (mean 47 years) were found. The follow-up period was 1-7 years (mean 4.5 years). The findings showed seroma in 11.4 % of the patients, hematoma in 5.26 %, minor wound dehiscence in 19.29 %, major wound dehiscence in 1.75 %, minor infection in 1.75 %, implant exposure in 0 %, capsular contracture Becker 3 and 4 in 3.5 %, implant rupture in 0 %, implant malposition in 5.25 %, long-term numbness of the buttock in 0 %, palpability of the implant in 0 %, implant rippling in 0 %, implant rupture in 0 %, wide scars in 41.2 %, need for secondary surgery in 26.31 %, and dissatisfaction with the final volume in 10.52 %. A patient satisfaction rate of 9.6 in 10 was found. CONCLUSIONS: The study showed that the gluteal lift combined with gluteal implants placed in the subfascial pocket provided good long-lasting results with an acceptable rate of complications, very high patient satisfaction, and easily concealed scars. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

How do perceptions about cessation outcomes moderate the effectiveness of a gain-framed smoking cessation telephone counseling intervention?

The distinction between prevention and detection behaviors provides a useful guideline for appropriately framing health messages in terms of gains or losses. However, this guideline assumes that everyone perceives the outcomes associated with a behavior in a consistent manner, as prevention or detection. Individuals' perceptions of a behavior vary, and so the effects of framed messages may be optimized by considering individuals' perceptions rather than the prevention or detection function of the behavior. The authors tested this message-framing paradigm in a secondary analysis of data from a trial evaluating gain-framed smoking cessation counseling delivered through a state quitline (Toll et al., 2010 ). Smokers (N = 2,032) who called a state quitline received either gain-framed or standard care messages. Smokers' beliefs about the positive consequences of stopping smoking (outcome expectancies) were evaluated at baseline. Smoking status and self-efficacy were assessed at 3 months. Outcome expectancies moderated the framing effects among men but not among women. Men in the gain-framed counseling condition who had positive outcome expectancies were more likely to quit and had more confidence in their ability to quit or to remain abstinent than men who were uncertain of the positive outcome of smoking cessation. Among men, self-efficacy mediated the moderated framing effects of the intervention on quit status. These findings suggest that it may be useful to consider sex and individual differences in outcome expectancies when delivering gain-framed smoking cessation messages in the context of a state quitline.