Seguridad del implante de lente fáquica ACR-128 tras un año de seguimiento / Safety of an ACR-128 phakic lens implant after one year's follow-up

Objetivo: Determinar la seguridad de los lentes fáquicos ACR-128 en la corrección de la alta miopía tras un año de implantados. Método: Se realizó un estudio transversal en 67 ojos de 36 pacientes con miopía corregida con lente fáquica ACR-128 (31 con ambos ojos y 5 con un solo ojo). Se determinó preoperatorio y posoperatorio: tensión ocular, pérdida celular endotelial según conteo, coeficiente de variación celular y hexagonalidad. Además de complicaciones posoperatorias y posición del lente respecto a endotelio y cristalino. El análisis estadístico se realizó con la prueba T para datos pareados, con una significación del 95 por ciento. Resultados: Edad media 28,06 ± 6,14 (25 mujeres y 11 hombres). Las complicaciones inmediatas fueron hipotonía OD: 1 (3,03 por ciento), OI: 1 (2,94 por ciento). La irregularidad de la pupila se presentó OD: 1 (3,03 por ciento), OI: 1 (2,94 por ciento) mediata y OD: 1 (3,03 por ciento), OI: 2 (5.88 por ciento) tardía. Tensión ocular promedio total preoperatorio 14,09 ± 2,51 y posoperatorio 14,22 ± 2,64 (p = 0,90). El conteo celular preoperatorio 2667,27 ± 228,72 y posoperatorio 2591,96 ± 301,21, con 2,94 por ciento pérdida endotelial total 75,31 ± 237,41 (p = 0,06). No hubo diferencias en el coeficiente de variación (p = 0,60) ni la hexagonalidad (p = 0,57). Posición del lente respecto al endotelio 2,09 mm y al cristalino 1,08 mm. Conclusiones: El implante de lente fáquica ACR-128 en la corrección de la alta miopía es un tratamiento seguro al no existir complicaciones posquirúrgico ni modificaciones en la tensión ocular y en el endotelio corneal tras un año del implante(AU)

Objective: Determine the safety of ACR-128 phakic lenses for high myopia correction one year after implantation. Method: A cross-sectional study was conducted of 67 eyes of 36 patients with myopia corrected with ACR-128 phakic lens implants (31 in both eyes and 5 in one eye). Pre- and postoperative determination was made of ocular tension, endothelial cell loss by count, cell variation coefficient and hexagonality, as well as of postoperative complications and lens position with respect to the endothelium and the crystalline lens. Statistical analysis was based on the paired T-test with a significance level of 95 percent Results: Mean age was 28.06 ± 6.14 (25 women and 11 men). An immediate complication was hypotonia: RE: 1 (3.03 percent), LE: 1 (2.94 percent). Pupil irregularity was mediate: RE: 1 (3.03 percent), LE: 1 (2.94 percent) and late: RE: 1 (3.03 percent), LE: 2 (5.88 percent). Total average ocular tension was 14.09 ± 2.51 preoperative and 14.22 ± 2.64 postoperative (p = 0.90). Cell count was 2667.27 ± 228.72 preoperative and 2591.96 ± 301.21 postoperative, with 2.94 percent total endothelial loss 75.31 ± 237.41 (p = 0.06). Differences were not found in the variation coefficient (p = 0.60) or in hexagonality (p = 0.57). Lens position was 2.09 mm with respect to the endothelium and 1.08 mm with respect to the crystalline lens. Conclusions: ACR-128 phakic lens implantation for high myopia correction is a safe procedure with no postoperative complications or modifications in ocular tension or the corneal endothelium after one year's follow-up(AU)

Síndrome de contracción capsular bilateral / Bilateral capsule contraction syndrome

El síndrome de contracción capsular se describe como una reducción progresiva y acelerada del diámetro de la capsulorrexis y del saco capsular tras la extracción extracapsular del cristalino. Se reporta el caso de una paciente femenina, con antecedentes de miopía elevada, a quien se le realizó cirugía de catarata de ambos ojos sin complicaciones transquirúrgicas, y regresa con síndrome de contracción capsular bilateral al mes de operada. Se comenta la conducta seguida en ambos ojos(AU)

Capsule contraction syndrome is described as progressive, accelerated reduction in capsulorhexis and capsular bag diameter after extracapsular crystalline lens extraction. A case is presented of a female patient with a history of high myopia who underwent cataract surgery of both eyes without any intraoperative complication. One month after surgery the patient presents with bilateral capsule contraction syndrome. Comments are made on the clinical management of each eye(AU)

Sorpresa refractiva tras la cirugía de catarata en paciente con lente fáquica / Refractive surprise after cataract surgery in a patient with a phakic lens implant

El implante de una lente intraocular fáquica puede resultar una opción lógica para los pacientes sumamente miopes que buscan liberarse de las gafas y de los lentes de contacto. Esta es una alternativa para corregir los grados de miopía extremos, y se diseñaron para permanecer dentro del ojo por muchos años. Con el cursar del tiempo, fisiológicamente comienza a opacarse el cristalino. Ante la necesidad de removerlo y de calcular una lente de potencia adecuada para el saco capsular y así conseguir la emetropía, surge un nuevo reto. El cálculo inexacto de la potencia dióptrica de la lente a implantar en la intervención quirúrgica es un problema y con él aparece la sorpresa refractiva; de ahí el objetivo de presentar con este caso la causa más frecuente de sorpresa refractiva tras la cirugía de catarata en un paciente miope con lente fáquica implantada. Se destaca la importancia de la longitud axil, sobre todo si esta se modifica después del implante de la lente fáquica para el correcto cálculo de la lente a implantar, así como el método ideal para su obtención: la interferometría óptica, sin olvidar la historia clínica previa al implante de la lente fáquica(AU)

Phakic intraocular lens implantation may be a logical option for extremely myopic patients who wish to get rid of their eyeglasses and contact lenses. This alternative was developed to correct extremely high degrees of myopia and remain inside the eye for many years. However, with the passing of time and due to physiological processes, the crystalline lens tends to become opaque. A new challenge is posed by the need to remove it and select a lens with an optical power appropriate to the capsular sac, thus achieving emmetropia. Inaccurate calculation of the dioptric power of the lens to be implanted in the surgical intervention is a problem leading to refractive surprise. Hence the interest in presenting a case illustrating the most common cause of refractive surprise after cataract surgery in a myopic patient with a phakic lens implant. The importance of axial length is highlighted, particularly whether it is modified after phakic lens implantation for accurate calculation of the lens to be implanted and the ideal method to obtain it: optical interferometry, without disregarding the medical record data preceding the phakic lens implantation(AU)

Efectividad del implante de lente fáquica ACR-128 tras un año de seguimiento / Effectiveness of an ACR-128 phakic lens implant after one year's follow-up

Introducción: La corrección de ametropías moderadas-severas mediante lentes fáquicas permite conservar la acomodación, además, de obtener una mejor calidad óptica, reversibilidad del procedimiento y la opción de corregir defectos refractivos residuales mediante cirugía corneal mínima invasiva. Objetivo: Determinar la efectividad de los lentes fáquicos ACR-128 en la corrección de la alta miopía tras un año de su implante. Método: Se realizó un estudio transversal en 67 ojos de 36 pacientes con miopía corregida con lente fáquica ACR-128. Se determinaron las características biométricas y refractivas por ojo, relación entre el componente esférico esperado y el observado, distribución por ojos el componente esférico esperado y el observado, relación entre cilindro queratométrico pre y posoperatorio y relación entre la agudeza visual sin corrección y la agudeza visual mejor corregida en el pre y posoperatorio. Resultados: La edad media fue 28,06 ± 6,14(25 mujeres, 11 hombres) el equivalente esférico preoperatorio OD promedio de -10,77 ± 4,23 dioptrías y OI promedio de -10,77 ± 3,72 dioptrías. El componente esférico en dioptrías esperado (-0,56 ± 0,38) y observado (-0,43 ± 0,69) sin diferencias estadísticamente significativas (p = 0,14). El cilindro queratométrico en dioptrías, pre (1,41 ± 0,74) y posoperatorio (1,24 ± 0,88) sin astigmatismo inducido (p = 0,12). El 100 por ciento tenía agudeza visual sin corrección preoperatoria ≤ 0,1 y posoperatoria ≥ 0,5. Conclusiones: Un año después del implante de lente fáquica ACR-128 en la corrección de la alta miopía el tratamiento continúa efectivo, pues reduce el componente esférico al deseado y mantenerlo, no inducir astigmatismo y mantener mejor agudeza visual(AU)

Introduction: Correction of moderate-severe ametropia with phakic lenses makes it possible to preserve accommodation and provides better optical quality, reversibility of the procedure and the option of correcting residual refractive defects by minimally invasive corneal surgery. Objective: Determine the effectiveness of ACR-128 phakic lenses for high myopia correction one year after implantation. Method: A cross-sectional study was conducted of 67 eyes of 36 patients with myopia corrected with ACR-128 phakic lenses. Determination was made of the biometric and refractive characteristics of each eye, the relationship between the expected and the observed spherical component, the distribution of the expected and the observed spherical component per eye, the relationship between the pre- and postoperative keratometric cylinder, and the relationship between pre- and postoperative uncorrected and best corrected visual acuity. Results: Mean age was 28.06 ± 6.14 (25 women, 11 men). Average preoperative spherical equivalent was -10.77 ± 4.23 diopters RE and -10.77 ± 3.72 diopters LE. Spherical component in diopters: expected (-0.56 ± 0.38) and observed (-0.43 ± 0.69), without statistically significant differences (p= 0.14). Keratometric cylinder in diopters: preoperative (1.41 ± 0.74) and postoperative (1.24 ± 0.88), without induced astigmatism (p = 0.12). In 100 percent visual acuity without correction was #8804; 0.1 preoperative and ≥ 0.5 postoperative. Conclusions: One year after ACR-128 phakic lens implantation for high myopia correction, the treatment remains effective, reducing the spherical component and maintaining it at the desired level, not inducing astigmatism and preserving best visual acuity(AU)

Evaluation of a Psychological Intervention for Patients with Chronic Pain in Primary Care.

According to evidence from recent decades, multicomponent programs of psychological intervention in people with chronic pain have reached the highest levels of efficacy. However, there are still many questions left to answer since efficacy has mainly been shown among upper-middle class patients in English-speaking countries and in controlled studies, with expert professionals guiding the intervention and with a limited number of domains of painful experience evaluated. For this study, a program of multicomponent psychological intervention was implemented: (a) based on techniques with empirical evidence, but developed in Spain; (b) at a public primary care center; (c) among patients with limited financial resources and lower education; (d) by a novice psychologist; and (e) evaluating all domains of painful experience using the instruments recommended by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT). The aim of this study was to evaluate this program. We selected a consecutive sample of 40 patients treated for chronic non-cancer pain at a primary care center in Utrera (Seville, Spain), adults who were not in any employment dispute, not suffering from psychopathology, and not receiving psychological treatment. The patients participated in 10 psychological intervention sessions, one per week, in groups of 13-14 people, which addressed psychoeducation for pain; breathing and relaxation; attention management; cognitive restructuring; problem-solving; emotional management; social skills; life values and goal setting; time organization and behavioral activation; physical exercise promotion; postural and sleep hygiene; and relapse prevention. In addition to the initial assessment, measures were taken after the intervention and at a 6-month follow-up. We assessed the program throughout the process: before, during and after the implementation. Results were analyzed statistically (significance and effect size) and from a clinical perspective (clinical significance according to IMMPACT standards). According to this analysis, the intervention was successful, although improvement tended to decline at follow-up, and the detailed design gave the program assessment a high degree of standardization and specification. Finally, suggestions for improvement are presented for upcoming applications of the program.

Randomized trial to reduce emergency visits or hospital admissions using telephone coaching to complex patients.

Background: Comorbidity remains a matter of international interest, given growing prevalence of chronic conditions. Objective: To evaluate the impact that adding a telephone coaching intervention by a family physician to usual care has on reducing resource consumption and improving health status, caregiver burden and quality of life among complex chronic patients (CCP) compared with usual care. Methods: A randomized controlled trial was conducted on a random sample of CCP from three primary care teams in Barcelona. Patients were randomly allocated into intervention or control groups. Evaluations were conducted at baseline and after six-month follow-up. Intervention patients were phoned twice a month by a family physician. Both groups received usual care. Primary endpoint was change in total number of urgent visits per patient. Secondary endpoints were changes in health and mental status, quality of life and caregiver burden. Results: Hundred and sixty-one CCP were included. During follow-up, 9 patients died and 2 were lost. At baseline, patients' characteristics and resource consumption were similar for both groups. After six months, urgent visits per patient decreased in intervention (1.27 baseline versus 0.89 follow-up, P = 0.091) and control (1.06 baseline versus 0.86 follow-up, P = 0.422) groups, mean difference 0.18 [confidence interval (CI) 95% -0.48 to 0.84]. Intervention patients improved in the physical component of the SF-12 questionnaire, while worsening in control patients, mean difference 4.71 (CI 95% -9.03 to -0.41). Differences were not found in the rest of the endpoints. Conclusion: The intervention did not reduce urgent visits among CCP neither improved patient's health.

Factores asociados a ingreso hospitalario en una cohorte de pacientes ancianos incorporados a un programa de atención domiciliaria / Factors associated with hospitalization in a cohort of elderly patients included in a home care program

Fundamento y objetivo: Identificar los factores que se asocian a que exista un ingreso hospitalario durante el año siguiente en pacientes ancianos dependientes que viven en su domicilio (ADD), visitados por equipos de atención primaria. Pacientes y método: Estudio longitudinal de una cohorte de pacientes ADD incluidos en un programa de atención domiciliaria. En el momento del reclutamiento se realizó una evaluación global (nivel de salud y situación social, cuidados formales e informales recibidos y utilización previa de servicios sanitarios). Durante el año de seguimiento se registraron las visitas a domicilio, así como el uso de servicios sociales, de urgencias y hospitalarios, incluyendo ingresos. Resultados: Se incluyó un total de 1.093 pacientes. Doscientos cincuenta y ocho pacientes (23,6%) fueron ingresados en el hospital y 170 (15,6%) fueron perdidos durante el seguimiento. Se observó que los pacientes hospitalizados habían recibido el mismo volumen de atención primaria y social domiciliarias que los no hospitalizados. Como factores independientes predictivos de ingreso se encontraron: utilizar las urgencias telefónicas centralizadas (061) (odds ratio [OR] 2,50, intervalo de confianza del 95% [IC 95%] 1,56-4,01) y comorbilidad evaluada por el índice de Charlson al reclutamiento (OR 1,16, IC 95% 1,06-1,27). Por el contrario, el sexo femenino (OR 0,59, IC 95% 0,40-0,85) y una alta valoración subjetiva del estado físico de salud medida por el cuestionario SF-12 (OR 0,97, IC 95% 0,95-0,99), predecían un bajo riesgo de hospitalización. Conclusiones: Los ingresos hospitalarios de pacientes ADD se relacionan con el sexo, la comorbilidad, el estado de salud subjetiva al reclutamiento y la falta de continuidad en la información y protocolos asistenciales entre niveles asistenciales, más que con la atención sanitaria recibida durante el seguimiento (AU)

Background and objective: The objective is to identify the features associated with next year hospital admissions among elderly dependent patients living at home (EDLH) and visited by primary care teams at their home setting. Patients and method: Longitudinal cohort study of a sample of EDLH patients admitted to a home care programme delivered by 72 primary care teams. A global health assessment was performed at recruitment in all patients (health and social status, informal and formal carer characteristics and burden of care). We further collected data on visits by primary care personnel and the use of social, emergency and hospital services by EDLH patients throughout one year after recruitment. Results: A sample of 1,093 EDLH patients was included. 258 (23,6%) patients were admitted to hospital during follow-up and 170 (15.6%) were lost to follow-up. Hospitalised patients received the same volume of primary care and social care services at home than those that were not hospitalised. Independent predictors of high risk of hospital admission were calling and using the after-hours emergency community services (odds ratio [OR]= 2.50, 95% confidence interval [95% CI] 1.56-4.01) and comorbidity as measured by the Charlson Index (OR= 1.16, 95% CI 1.06-1.27) at recruitment. Similarly, female sex (OR= 0.59, 95% CI 0.40-0.85) and high subjective physical health status scores as measured by the SF12 questionnaire (OR 0.97, 95% CI 0.95-0.99) predicted a low-risk of hospital admission. Conclusions: Hospital admission among EDLH patients is related to comorbidity, gender, subjective health status and the use of uncoordinated emergency services as measured at recruitment, rather than to the use of services during the one-year follow-up (AU)

[Factors associated with hospitalization in a cohort of elderly patients included in a home care program]. / Factores asociados a ingreso hospitalario en una cohorte de pacientes ancianos incorporados a un programa de atención domiciliaria.

BACKGROUND AND OBJECTIVE: The objective is to identify the features associated with next year hospital admissions among elderly dependent patients living at home (EDLH) and visited by primary care teams at their home setting. PATIENTS AND METHOD: Longitudinal cohort study of a sample of EDLH patients admitted to a home care programme delivered by 72 primary care teams. A global health assessment was performed at recruitment in all patients (health and social status, informal and formal carer characteristics and burden of care). We further collected data on visits by primary care personnel and the use of social, emergency and hospital services by EDLH patients throughout one year after recruitment. RESULTS: A sample of 1,093 EDLH patients was included. 258 (23,6%) patients were admitted to hospital during follow-up and 170 (15.6%) were lost to follow-up. Hospitalised patients received the same volume of primary care and social care services at home than those that were not hospitalised. Independent predictors of high risk of hospital admission were calling and using the after-hours emergency community services (odds ratio [OR]= 2.50, 95% confidence interval [95% CI] 1.56-4.01) and comorbidity as measured by the Charlson Index (OR= 1.16, 95% CI 1.06-1.27) at recruitment. Similarly, female sex (OR= 0.59, 95% CI 0.40-0.85) and high subjective physical health status scores as measured by the SF12 questionnaire (OR 0.97, 95% CI 0.95-0.99) predicted a low-risk of hospital admission. CONCLUSIONS: Hospital admission among EDLH patients is related to comorbidity, gender, subjective health status and the use of uncoordinated emergency services as measured at recruitment, rather than to the use of services during the one-year follow-up.

El papel del reumatólogo en el uso adecuado del laboratorio: a propósito de anticuerpos antinucleares / The role of rheumatologist in the adequate use of laboratory tests: in connection with antinuclear antibodies

La solicitud de anticuerpos antinucleares (AAN) por técnica de inmunofluorescencia, es muy frecuente y muchas veces sin base clínica adecuada, especialmente cuando la realizan médicos generales o especialistas distintos al reumatológo. Se revisó esta situación en nuestro hospital. De 1806 estudios de anticuerpos antinucleares solicitados, se pudo demostrar positividad en 487 (27 por ciento) y 1319 (73 por ciento) fueron negativos. Se revisaron expediente tratando de relacionar el motivo de la solicitud y los resultados del examen. Se discuten características generales: patrones y especificidad predominantes relacionados con enfermedad reumática generalizada y algunos conceptos de costo-eficiencia a considerar para el uso apropiado del laboratorio

Anticuerpos contra mitocondrias, corazón y perinúcleo. ¿Asociación con el título de anticuerpos anticardiolipina en el síndrome antifosfolípido primario?: estudio exploratorio / Seric antibodies as antiheart, antimithocondrial and antiperinuclear. These antibodies es related to the anticardiolipin antibodies level. Exploratory study

En el suero de pacientes con síndrome antifosfolípido primario se han descrito anticuerpos antimitocondriales (AM), anticorazón (ACOR) y contra perinúcleo (AP); algunos se nagativizan al inhibir los sueros con micelas de cardilipina. Decidimos evaluar si la fecuencia de AM, ACOR y AP tiende a aumentar en proporción directa al título de anticuerpos anticardiolipina (aCL). Se incluyeron sueros de pacientes: 12 con SAFP y 3 con lupus eritematoso sistémico. Se distribuyeron en 3 grupos de 5 sueros cada uno según el título de aCL (ensayo inmunoenzimático, punto de corte densidad óptica 0.21). Grupo bajo (DO de 0.816 a 1.360) y grupo alto (DO de 1.850 a 3.000). Detección de AM, ACOR y AP por inmunofluorescencia indirecta. Los resultados fueron: positivos, grupo bajo (O), grupo medio MA y ACOR en 1/5 y AP en 1/5 respectivamente, grupo alto ACOR y AP en el 20 por ciento (1/5), ACOR en el 20 por ciento (1/5), y AP en el 40 por ciento (2/5) y AM en 0 por ciento. Observamos tendencia a mayor frecuencia de ACOR y AP en relación directa a título de aCL y aunque el tamaño de la muestra no permite ser concluyente, los resultados justifican estudios posteriores para dilucidar este aspecto