Improving the standard of care for patients with spondyloarthritis-related immune inflammatory conditions: results of a Delphi study and proposal for early detection.

BACKGROUND: Our objective was to provide consensus recommendations on the optimal management of the immune-mediated inflammatory diseases (IMIDs) seen in patients with spondyloarthritis (SpA) using a multidisciplinary approach, and to develop a simple tool to help earlier recognition and referral of coexisting IMIDs in patients who already have one type of IMID. METHODS: A total of 28 experts in the multidisciplinary management of the SpA-associated IMIDs assessed two questionnaires: one with statements focused on the multidisciplinary management of IMIDs, and a second questionnaire focused on questions useful for early recognition and referral. Panelists assessed the statements with a 9-point ordinal scale (1 = strongly disagree, 9 = strongly agree) using a modified Delphi methodology. RESULTS: Consensus was reached on 72 out of the 82 statements (87.8%). Panelists agreed that the multidisciplinary approach to IMIDs is not sufficiently developed. The creation of multidisciplinary IMID units might be necessary. These units might focus primarily on patients with two or more coexisting IMIDs, or on IMIDs that are especially complex from a diagnostic or therapeutic point of view. Specialists who attend to patients with IMIDs should perform a screening for other coexisting IMIDs. A simple tool to help earlier recognition and referral of coexisting IMIDs is proposed. CONCLUSIONS: There is a need to improve care for patients with SpA-associated IMIDs. We provide expert recommendations to guide the adoption of a multidisciplinary approach for these cases, and a simple tool that may be useful for earlier recognition of coexisting IMIDs.

Siameses céfalo-toracópagos / Cephalothoracopagus twins: a case report

El diagnóstico temprano de los siameses es el punto clave de esta patología, tanto para la interrupción de la gestación como para la posible intervención posnatal de los mismos. Se presenta un caso clínico de siameses unidos por la cabeza, el tórax y el abdomen (céfalo-toracópago), destacando la clasificación de los siameses y la importancia del diagnóstico prenatal temprano ecográfico (AU)

Early diagnosis of conjoined twins is essential, both for pregnancy interruption and for possible postnatal intervention. We report a case of Siamese twins joined at the head, thorax and abdomen (cephalothoracopagus). The classification of conjoined twins and the importance of early ultrasonographic diagnosis are highlighted (AU)

Prospective study of the Acri.LISA bifocal intraocular lens.

PURPOSE: To assess the visual results after bilateral implantation of the bifocal Acri.LISA 366D intraocular lens (IOL) (Acri.Tec AG). SETTING: Fernández-Vega Ophthalmological Institute, Oviedo, Spain. METHODS: Eighty-one patients had bilateral implantation of the distance-dominant bifocal Acri.LISA 366D IOL in a prospective study. Monocular and binocular best corrected distance visual acuity and best distance-corrected near visual acuity, binocular best distance-corrected intermediate visual acuity, and distance contrast sensitivity under photopic (85 cd/m(2)) and mesopic (5 cd/m(2)) conditions were determined. RESULTS: At the 3-month postoperative visit, the mean binocular best corrected distance acuity was 0.048 +/- 0.111 logMAR and the mean binocular best distance-corrected near acuity, 0.012 +/- 0.0084 logMAR (both approximately 20/20). The mean binocular best distance-corrected intermediate acuity changed significantly as a function of the distance of the test, from 0.012 +/- 0.084 logMAR (approximately 20/20) at 33 cm to 0.265 +/- 0.099 logMAR (approximately 20/40) at 70 cm (P<.01). Contrast sensitivity was within normal limits under photopic and mesopic conditions. Binocular contrast sensitivity was statistically significantly better than monocular contrast sensitivity at all spatial frequencies under both illumination levels (P<.01). CONCLUSION: The Acri.LISA 366D IOL provided a satisfactory full range of vision; a high level of uncorrected and corrected distance, intermediate, and near acuity; and improved contrast sensitivity under photopic and mesopic conditions.

Quality of vision with the Acri. Twin asymmetric diffractive bifocal intraocular lens system.

PURPOSE: To assess the quality of vision in patients who had implantation of asymmetric Acri. Twin bifocal diffractive intraocular lenses (IOLs) by evaluating distance and near visual acuities and photopic and mesopic contrast sensitivity under monocular and binocular conditions. SETTING: Fernández-Vega Ophthalmological Institute, Oviedo, Spain. METHODS: The study comprised 343 consecutive patients who had bilateral implantation of the Acri. Twin system: a distance-weighted 737D IOL and a near-weighted 733D IOL. Monocular and binocular best corrected distance visual acuities, best distance corrected near visual acuity, and distance contrast sensitivity under photopic (85 cd/m(2)) and mesopic (5 cd/m(2)) conditions were determined. RESULTS: Eyes with the 737D IOL had better best corrected distance acuity than eyes with the 733D IOL (mean 0.036 +/- 0.061 logMAR versus 0.141 +/- 0.131 logMAR) (P<.0001). Eyes with the 733D IOL had better best distance corrected near acuity than eyes with the 737D IOL (mean 0.015 +/- 0.115 logMAR versus 0.059 +/- 0.091 logMAR) (P = .0027). Binocularly, the Acri. Twin system allowed good distance and near vision; the means were 0.031 +/- 0.059 logMAR and 0.005 +/- 0.024 logMAR, respectively. Contrast sensitivity with the Acri. Twin system was within normal limits under photopic and mesopic conditions. Contrast sensitivity was statistically significantly better with the Acri. Twin system, followed by the 737D IOL and the 733D IOL under both illumination levels. CONCLUSIONS: Asymmetric bilateral implantation of the Acri. Twin IOL gave good simultaneous distance and near vision with improved contrast sensitivity under photopic and mesopic conditions. Differences between monocular and binocular visual acuity and contrast sensitivity were obtained because of the distance-/near-weighted light distribution of Acri. Twin IOLs.