Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 341
Filter
1.
Orbit ; : 1-4, 2024 May 26.
Article in English | MEDLINE | ID: mdl-38796753

ABSTRACT

An 88-year-old male patient presented with a large mass on the left lateral bulbar conjunctiva. The tumor appeared two months after the resection of a conjunctival atypical fibroxanthoma (AFX) performed by a cornea specialist. Magnetic resonance imaging of the orbits showed deep orbital invasion along the lateral rectus muscle. The mass and the entire conjunctival sac were totally excised with lid-sparing orbital exenteration. Histopathological analysis confirmed that the mass was an extension of the AFX. Two weeks after surgery, large B-cell lymphoma was diagnosed in the oropharynx. Chemotherapy was initiated, and after seven months of follow-up, there was no recurrence of the AFX. The authors believe that this is the first report of orbital invasion by AFX.

2.
Ophthalmic Plast Reconstr Surg ; 40(3): 336-339, 2024.
Article in English | MEDLINE | ID: mdl-38738711

ABSTRACT

PURPOSE: To investigate the relationship between the kinematics of spontaneous blinks and the anterior area of the levator palpebrae superioris muscle in patients with Graves orbitopathy (GO). METHODS: This is a case-control study. The authors measured the margin reflex distance of the upper eyelid (margin reflex distance 1), the kinematics of spontaneous blinks, and the anterior area of levator palpebrae superioris muscle in CT coronal scans of patients with Graves upper eyelid retraction (GO) and a control group. The eye with the greatest margin reflex distance 1 was selected for analysis in each group. RESULTS: A total of 68 participants were included, with 36 in the GO group and 32 in the control group. In the GO group, the mean margin reflex distance 1 measured 6.5 mm, while in the control group, it was 3.9 mm. Almost all parameters related to the closing phase of spontaneous blinking activity, including amplitude, velocity, blinking rate, and interblink time, did not differ between the two groups. However, the effectiveness of the blink's amplitude (ratio of blink amplitude to margin reflex distance 1) and the main sequence (relationship between amplitude and velocity) were significantly reduced in the GO group compared with the control group. The area of the levator palpebrae superioris muscle was significantly larger in GO than in controls, with 71.4% of patients' muscles outside of the maximum range of the controls. CONCLUSIONS: In patients with GO, there is a reduction in blinking effectiveness, also known as blink lagophthalmos, which is a factor in the common occurrence of ocular surface symptoms. The increase in velocity with amplitude is also reduced in GO.


Subject(s)
Blinking , Eyelids , Graves Ophthalmopathy , Oculomotor Muscles , Humans , Blinking/physiology , Female , Graves Ophthalmopathy/physiopathology , Graves Ophthalmopathy/complications , Graves Ophthalmopathy/diagnosis , Male , Middle Aged , Oculomotor Muscles/physiopathology , Adult , Case-Control Studies , Eyelids/physiopathology , Eyelid Diseases/physiopathology , Eyelid Diseases/diagnosis , Aged , Tomography, X-Ray Computed , Lagophthalmos
3.
Digit Health ; 10: 20552076231225889, 2024.
Article in English | MEDLINE | ID: mdl-38528968

ABSTRACT

Introduction: Digital health coaching interventions for behaviour change (BC) are effective in addressing various health conditions. Implementing these requires accurate descriptions of components and health coaches (HC) delivery methods, alongside understanding patients' perceptions of these interactions. The HC-patient relationship significantly influences BC outcomes. Here, empathy is an important driver that enables HCs to offer tailored advice that resonates with patients' needs, fostering motivation. Yet, defining and measuring empathy remains a challenge. In this study, we draw on various BC frameworks and Pounds' empathy appraisal approach to categorise HCs responses to patient cues and explore the interplay between empathy and BC. Methods: Using a two-round survey, we collected responses from 11 HCs to 10 patient messages from the Bump2Baby and Me trial in a simulated interaction. We analysed 88 messages to identify empathic responses and behaviour change techniques. Results: Patients' implicit empathy opportunities showed higher response rates than explicit ones. HCs prioritised positive reinforcement and employed various strategies to achieve similar objectives. The most common empathic response was 'Acceptance' for patients' implicit positive expressions of self-judgement. HCs emphasised relatedness-support and competence-promoting techniques for implicit negative feelings and judgements, such as 'Show unconditional regard' and 'Review behaviour goals', and 'Action planning and Problem-solving' techniques to address explicit negative appreciations and feelings. Conclusion: The use of different techniques with the same objective highlights the complexity of BC interactions. Further research is needed to explore the impact of this variability on patient outcomes and programme fidelity.

5.
Arq. bras. oftalmol ; 87(6): e2022, 2024. graf
Article in English | LILACS-Express | LILACS | ID: biblio-1513692

ABSTRACT

ABSTRACT Orbital decompression is widely performed for the management of proptosis for cosmetic and functional cases of Graves orbitopathy. The main side effects include dry eye, diplopia, and numbness. Blindness after orbital decompression is extremely rare. The mechanisms of vision loss after decompression are not well described in the literature. Considering the devastating effect and rarity of this complication, this study presented two cases of blindness after orbital decompression. In both cases, vision loss was provoked by slight bleeding in the orbital apex.


RESUMO A descompressão orbitária é uma cirurgia amplamente empregada para correção da proptose em casos cosméticos e funcionais da orbitopatia de Graves. Os principais efeitos colaterais induzidos pela descompressão são olho seco, diplopia e parestesias. Amaurose pós descompressão é uma complicação extremamente rara e cujos mecanismos são pouco discutidos na literatura. Considerando o efeito devastador representado pela perda visual e a escassez de relatos dessa complicação, os autores apresentam dois relatos de amaurose após descompressão orbitária. Nos dois casos a perda visual ocorreu devido a sangramento de pequena monta no ápice orbitário.

6.
Arq Bras Oftalmol ; 86(6): 1006, 2023.
Article in English | MEDLINE | ID: mdl-38126533
7.
Arq Bras Oftalmol ; 87(6): e20220006, 2023.
Article in English | MEDLINE | ID: mdl-37851738

ABSTRACT

Orbital decompression is widely performed for the management of proptosis for cosmetic and functional cases of Graves orbitopathy. The main side effects include dry eye, diplopia, and numbness. Blindness after orbital decompression is extremely rare. The mechanisms of vision loss after decompression are not well described in the literature. Considering the devastating effect and rarity of this complication, this study presented two cases of blindness after orbital decompression. In both cases, vision loss was provoked by slight bleeding in the orbital apex.


Subject(s)
Graves Ophthalmopathy , Humans , Graves Ophthalmopathy/surgery , Orbit/surgery , Decompression, Surgical/adverse effects , Blindness/etiology , Retrospective Studies
8.
Braz. j. otorhinolaryngol. (Impr.) ; 89(5): 101316, Sept.-Oct. 2023. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1520497

ABSTRACT

Abstract Objective: The present study revisited three classification systems of orbital complications of acute rhinosinusitis (ARS) (Chandler, Mortimore & Wormald, and Velasco e Cruz & Anselmo-Lima) and observed which of them presented the best clinical applicability. Methods: Clinical data and CT scan findings of patients with orbital infection were retrospectively collected. To compare the three classification systems, we revised and graded all CT images accordingly, and divided the patients into four groups: Eyelid cellulitis (EC), orbital cellulitis (OC), subperiosteal abscess (SA), and orbital abscess (OA). The groups were compared regarding the presence of sinus opacification, the need for hospitalization and/or surgical treatment, and the presence of further complications/sequelae. Results: 143 patients were included. The median number of sinuses involved in patients in the OC, SA, and OA groups was 2.0. ARS was rarely associated with signs of EC (present in both Chandler's and Mortimore & Wormald's classifications. The hospitalization rate was significantly lower in the EC group compared to the other three groups. Surgery was performed in all cases in the OA group, in 58.1% in the SA group, 19.4% in the OC group, and 12.5% in the EC group (p-value < 0.0001 ). Complications were present at higher rates in the OA group compared to the other three groups. Conclusions: ARS was rarely associated with Eyelid Cellulitis. The stratification in the other three groups showed to be clinically relevant. Velasco e Cruz & Anselmo-Lima's classification system proved valid, simple, and effective for categorizing orbital complications of ARS. Level of evidence: 3.

9.
Braz J Otorhinolaryngol ; 89(5): 101316, 2023.
Article in English | MEDLINE | ID: mdl-37678009

ABSTRACT

OBJECTIVE: The present study revisited three classification systems of orbital complications of acute rhinosinusitis (ARS) (Chandler, Mortimore & Wormald, and Velasco e Cruz & Anselmo-Lima) and observed which of them presented the best clinical applicability. METHODS: Clinical data and CT scan findings of patients with orbital infection were retrospectively collected. To compare the three classification systems, we revised and graded all CT images accordingly, and divided the patients into four groups: Eyelid cellulitis (EC), orbital cellulitis (OC), subperiosteal abscess (SA), and orbital abscess (OA). The groups were compared regarding the presence of sinus opacification, the need for hospitalization and/or surgical treatment, and the presence of further complications/sequelae. RESULTS: 143 patients were included. The median number of sinuses involved in patients in the OC, SA, and OA groups was 2.0. ARS was rarely associated with signs of EC (present in both Chandler's and Mortimore & Wormald's classifications. The hospitalization rate was significantly lower in the EC group compared to the other three groups. Surgery was performed in all cases in the OA group, in 58.1% in the SA group, 19.4% in the OC group, and 12.5% in the EC group (p-value < 0.0001). Complications were present at higher rates in the OA group compared to the other three groups. CONCLUSIONS: ARS was rarely associated with Eyelid Cellulitis. The stratification in the other three groups showed to be clinically relevant. Velasco e Cruz & Anselmo-Lima's classification system proved valid, simple, and effective for categorizing orbital complications of ARS.


Subject(s)
Orbital Cellulitis , Orbital Diseases , Rhinitis , Sinusitis , Humans , Retrospective Studies , Abscess/diagnostic imaging , Abscess/etiology , Rhinitis/complications , Rhinitis/diagnostic imaging , Rhinitis/surgery , Orbital Cellulitis/diagnostic imaging , Orbital Cellulitis/etiology , Sinusitis/complications , Sinusitis/diagnostic imaging , Sinusitis/surgery , Acute Disease , Orbital Diseases/etiology , Orbital Diseases/complications
12.
Animal ; 17(5): 100806, 2023 May.
Article in English | MEDLINE | ID: mdl-37148624

ABSTRACT

The objective of the present on-farm study was to evaluate the adequacy of existing models in predicting the pasture herbage DM intake (PDMI) of lactating dairy cows grazing semi-natural grasslands. The prediction adequacy of 13 empirical and semi-mechanistic models, which were predominantly developed to represent stall-fed cows or cows grazing high-quality pastures, were evaluated using the mean bias, relative prediction error (RPE), and partitioning of mean square error of prediction, where models with an RPE ≤ 20% were considered adequate. The reference dataset comprised n = 233 individual animal observations from nine commercial farms in South Germany with a mean milk production, DM intake, and PDMI (arithmetic means ± one SD) of 24 kg/d, (±5.6), 21 kg/d (±3.2), and 12 kg/d (±5.1), respectively. Despite their adaptation to grazing conditions, the behaviour-based and semi-mechanistic grazing-based models had the lowest prediction adequacy among the evaluated models. Their underlying empirical equations likely did not fit the grazing and production conditions of low-input farms using semi-natural grasslands for grazing. The semi-mechanistic stall-based model Mertens II with slight modifications achieved the highest and a satisfactory modelling performance (RPE = 13.4%) when evaluated based on the mean observed PDMI, i.e., averaged across animals per farm and period (n = 28). It also allowed for the adequate prediction of PDMI on individual cows (RPE = 18.5%) that were fed < 4.8 kg DM of supplement feed per day. Nevertheless, when used to predict PDMI of individual animals receiving a high supplementation level, the model Mertens II also did not meet the threshold for an acceptable adequacy (RPE = 24.7%). It was concluded that this lack of prediction adequacy for animals receiving greater levels of supplementation was due to a lack of modelling precision, which mainly could be related to inter-animal and methodological limitations such as the lack of individually measured supplement feed intake for some cows. The latter limitation is a trade-off of the on-farm research approach of the present study, which was chosen to represent the range in feed intake of dairy cows across the diverse low-input farming systems using semi-natural grasslands for grazing.


Subject(s)
Diet , Lactation , Female , Cattle , Animals , Diet/veterinary , Farms , Grassland , Eating , Milk , Animal Feed
13.
Farm. comunitarios (Internet) ; 15(2): 5-11, 14 abr. 2023. tab
Article in Spanish | IBECS | ID: ibc-219036

ABSTRACT

Introducción: se han realizado algunos estudios preliminares que muestran la aparición de factores de riesgo no investigados previamente relativos al sistema sanitario que pueden reducir la adherencia y/o persistencia de los tratamientos farmacológicos. De su conocimiento se pueden explorar posibles soluciones. Objetivo: estimar la incidencia de los factores de riesgo relativos al sistema sanitario que pueden reducir la adherencia/persistencia a los tratamientos asociados a problemas de acceso a los mismos en farmacia comunitaria. Método: estudio prospectivo aleatorizado transversal en farmacias comunitarias del Principado de Asturias y Aragón. La variable principal es la incidencia de nuevos factores de riesgo que hacen que la prescripción sea inadecuada para su dispensación. Se analizan diferentes subgrupos en función de tipo de factor de riesgo, tipo de población y tipo de prescripción.Resultados: el paciente tipo es una persona vulnerable en función de su edad (65,4 años), pluripatología y polifarmacia (6,8 medicamentos). Tras la evaluación de 138.697 dispensaciones en 98 farmacias comunitarias se detectaron 2.009 pacientes con 2.221 dispensaciones con factores de riesgo frente a la adherencia y/o persistencia (1,6  % de del total de dispensaciones). El tipo de incidencia más frecuentemente observado fue caducidad de la receta (54,7 %; IC95 %=52,6-56,8), seguido de ausencia de receta (18,7 %; IC95 %: 17,1-20,3). Por su parte los problemas de suministro alcanzaron el 10,2 % (IC95 %= 10,6 %-10,9 %). Los grupos terapéuticos más comprometidos fueron los grupos N-Sistema Nervioso (27,6 %), C-Aparato Cardiovascular (20,3 %) y A-Aparato Digestivo (15,3 %) (AU)


Subject(s)
Humans , Health Services Accessibility , Treatment Adherence and Compliance , Cross-Sectional Studies , Prospective Studies , Risk Factors , Pilot Projects
14.
Orbit ; 42(3): 343-346, 2023 Jun.
Article in English | MEDLINE | ID: mdl-34974797

ABSTRACT

We report the case of a 64-year-old male patient with a 5 month history of proptosis, motility limitation and vision loss in OD. Visual acuity (VA) was 20/200 in OD and 20/20 in OS. CT showed a large, round, intraconal lesion, with bony density and no apparent connection to adjacent orbital walls. MRI showed a T1-weighted hypointense lesion surrounded by a contrast enhancing capsule. The orbital tumor was excised through a lateral orbitotomy revealing a nodular, round, osseous structure. Histological examination disclosed well-formed lamellar bone trabeculae, with no necrosis or mitosis figures. Immunohistochemical staining was negative for MDM2 and CDK4. After 3 years, there was no evidence of tumor recurrence and VA had improved to 20/30. Intraconal osteomas with no clear attachment to orbital walls are extremely rare. We are aware of a few reported cases in the lid, hand, thigh, tongue, pterygopalatine fossa and brain. To the authors' knowledge, this is the first report in English literature of an orbital intraconal osteoma without any visible relation to the orbital walls.


Subject(s)
Orbital Neoplasms , Osteoma , Male , Humans , Middle Aged , Neoplasm Recurrence, Local , Osteoma/diagnostic imaging , Osteoma/surgery , Orbital Neoplasms/diagnostic imaging , Orbital Neoplasms/surgery , Tomography, X-Ray Computed , Magnetic Resonance Imaging
17.
Nat Commun ; 13(1): 4374, 2022 07 28.
Article in English | MEDLINE | ID: mdl-35902577

ABSTRACT

Exposure to traumatic stress can lead to fear dysregulation, which has been associated with posttraumatic stress disorder (PTSD). Previous work showed that a polymorphism in the PACAP-PAC1R (pituitary adenylate cyclase-activating polypeptide) system is associated with PTSD risk in women, and PACAP (ADCYAP1)-PAC1R (ADCYAP1R1) are highly expressed in the hypothalamus. Here, we show that female mice subjected to acute stress immobilization (IMO) have fear extinction impairments related to Adcyap1 and Adcyap1r1 mRNA upregulation in the hypothalamus, PACAP-c-Fos downregulation in the Medial Amygdala (MeA), and PACAP-FosB/ΔFosB upregulation in the Ventromedial Hypothalamus dorsomedial part (VMHdm). DREADD-mediated inhibition of MeA neurons projecting to the VMHdm during IMO rescues both PACAP upregulation in VMHdm and the fear extinction impairment. We also found that women with the risk genotype of ADCYAP1R1 rs2267735 polymorphism have impaired fear extinction.


Subject(s)
Pituitary Adenylate Cyclase-Activating Polypeptide/metabolism , Receptors, Pituitary Adenylate Cyclase-Activating Polypeptide , Animals , Extinction, Psychological , Fear/physiology , Female , Humans , Hypothalamus/metabolism , Mice , Receptors, Pituitary Adenylate Cyclase-Activating Polypeptide/genetics , Receptors, Pituitary Adenylate Cyclase-Activating Polypeptide/metabolism
18.
Geophys Res Lett ; 49(3): e2021GL096069, 2022 Feb 16.
Article in English | MEDLINE | ID: mdl-35859568

ABSTRACT

Water storage plays an important role in mitigating heat and flooding in urban areas. Assessment of the water storage capacity of cities remains challenging due to the inherent heterogeneity of the urban surface. Traditionally, effective storage has been estimated from runoff. Here, we present a novel approach to estimate effective water storage capacity from recession rates of observed evaporation during precipitation-free periods. We test this approach for cities at neighborhood scale with eddy-covariance based latent heat flux observations from 14 contrasting sites with different local climate zones, vegetation cover and characteristics, and climates. Based on analysis of 583 drydowns, we find storage capacities to vary between 1.3 and 28.4 mm, corresponding to e-folding timescales of 1.8-20.1 days. This makes the urban storage capacity at least five times smaller than all the observed values for natural ecosystems, reflecting an evaporation regime characterized by extreme water limitation.

19.
O.F.I.L ; 32(3): 295-297, julio 2022. graf
Article in Spanish | IBECS | ID: ibc-208786

ABSTRACT

La leucemia mieloblástica aguda (LMA) es una enfermedad heterogénea caracterizada por el crecimiento descontrolado de precursores mieloides indiferenciados que provoca un fallo medular. Según datos del programa de Vigilancia, Epidemiología y Resultados Finales (SEER) se estima una incidencia anual de 4,2 por cada 100.000 habitantes. El porcentaje de incidencia en menores de 20 años es 5,1% y en personas entre 65-84 años, es 46,5%. La tasa de supervivencia a 5 años varía en función de la edad de los pacientes, siendo en menores de 20 del 67% y en mayores a dicha edad disminuye al 25%. La leucemia mieloide aguda representa el 40% del total de leucemias y la mediana de edad de los pacientes es 65 años. Las alteraciones citogenéticas más frecuentes son: traslocación (8;21), inversión cromosoma 16, traslocación (16;16), trisomía del cromosoma 8, deleciones en los cromosomas 5 y 7, y mutación en el gen FLT3 (13q12), la cual está presente en el 30% de los nuevos diagnósticos. El tratamiento estándar de quimioterapia sigue basándose en el esquema intensivo 3+7 que consiste en citarabina con antraciclinas. El objetivo de las nuevas terapias en LMA es el tratamiento dirigido debido a los avances en el diagnóstico y la tipificación. (AU)


Acute myeloblastic leukemia (AML) is a heterogeneous disease characterized by uncontrolled growth of undifferentiated myeloid precursors leading to bone marrow failure. According to data from the Surveillance, Epidemiology and End Results (SEER) program, the annual incidence is estimated at 4.2 per 100,000 population. The incidence rate in children under 20 years of age is 5.1% and in people between 65-84 years of age, it is 46.5%. The 5-year survival rate varies according to the age of the patients, being 67% in those under 20 years of age and 25% in those older than 20 years of age. Acute myeloid leukemia represents 40% of all leukemias and the median age of the patients is 65 years. The most frequent cytogenetic alterations are: translocation (8;21), inversion of chromosome 16, translocation (16;16), trisomy of chromosome 8 and deletions in chromosomes 5 and 7, mutation in the FLT3 gene (13q12), which is present in 30% of new diagnoses. Standard chemotherapy treatment is still based on the intensive 3+7 scheme consisting of cytarabine with anthracyclines. The focus of new therapies in AML is targeted therapy due to advances in diagnosis and typing. (AU)


Subject(s)
Humans , Male , Middle Aged , Leukemia, Myeloid, Acute , Therapeutics , Patients
20.
Orbit ; : 1-7, 2022 Jun 01.
Article in English | MEDLINE | ID: mdl-35642653

ABSTRACT

We describe two cases of extensive indolent calvarial osteomyelitis after rhino-orbital-mucormycosis in diabetic patients previously diagnosed with COVID-19. Both patients presented with acute rhino-orbital symptoms about one month after being diagnosed with COVID-19. Treatment with intravenous liposomal Amphotericin B and prompt radical surgical debridement was instituted, but calvarial osteomyelitis ensued and persisted chronically despite maintenance of antifungal therapy and partial debridement of necrotic calvarial bone. The patients were discharged to continue antifungal therapy on a day-hospital regime. After more than 8 months of treatment, they remain with radiological signs of osteomyelitis but with no symptoms or intracranial extension of the infection. Calvarial indolent osteomyelitis secondary to mucormycosis is extremely rare, and little is known regarding its treatment. We believe it can be controlled with medical treatment and partial bony debridement although more studies are necessary to better define therapy.

SELECTION OF CITATIONS
SEARCH DETAIL
...