What is new in recommendations on ophthalmological screening in patients treated with chloroquine and hydroxychloroquine? Update and literature review.

Based on the present literature, in March 2016, new recommendations of the American Academy of Ophthalmology for ophthalmic screening tests in patients treated with chloroquine and hydroxychloroquine were published. These recommendations emphasized the fact that toxicity is related to the dose calculated by real weight. The recommended hydroxychloroquine and chloroquine doses have been limited. It is no longer recommended to calculate the cumulative dose of chloroquine to establish the risk of toxicity. Kidney failure and the use of tamoxifen are proven risk factors of ocular complications in these patients. The screening agenda was established and available diagnostic methods were evaluated. Screening in patients treated with chloroquine derivatives may prevent an irreversible complication-toxic retinopathy. The present recommendations warn against making premature decision on medicine withdrawal, especially in the light of the most recent studies on their beneficial systemic influence. This paper systematizes the information on ophthalmological screening in chloroquine derivatives users.

[General anesthesia and cervical anesthesia. What changes in carotid surgery]. / Anestesia generale ed anestesia plessica. Cosa cambia in chirurgia carotidea.

Carotid surgery must be preventive; therefore cerebral protection procedures have been the centre of interest for a decade. Nowadays local cervical block anaesthesia seems to have changed the terms of the problem allowing achieve the aim of "no risk surgery". Therefore we considered our 16 year experience (352 carotids operated on 290 patients). Since 1990 we employed cervical block anaesthesia. In order to ratify as much as possible the two groups of comparison, considering that we adopted some exclusion criteria, we compared the results of the first hundred carotids that underwent surgery with general anaesthesia and the first hundred operated using cervical block anaesthesia. Since we adopted cervical block anaesthesia there was no need of intra-operative monitoring systems because we considered exclusively the patients' clinical answer to preclamping. The use of shunt decreased from 9% to 3%. Surgery performed in cervical block anaesthesia gives a positive impression. This is due to the fact that there is not only a significant reduction of the morbidity rate, especially from a neurologic point of view, but also a reduction of the post-operation hospital stay. Furthermore there is also a better organization of the surgical phases. Direct monitoring of the cerebral function allows a precise analysis of the peri-operatory neurological events. In conclusion our study suggests that cervical block anaesthesia allows clinical benefits for the patient as far as safety is concerned being also more convenient under the economic point of view.