There are multiple treatment strategies proposed for the management of vision loss related to the injection of soft tissue fillers. Currently, there is no internationally accepted consensus on the ...immediate management of soft tissue filler induced vision loss (STFIVL). A recent systematic review of the literature concluded that there is not enough evidence to support retrobulbar hyaluronidase, and alternative treatments require exploration. The available literature demonstrates the inconsistent and unproven success of retrobulbar and peribulbar hyaluronidase in reversal of soft filler induced vision loss. Various therapeutics have been used to aid the reversal of vision loss but with mixed outcomes. The current evidence base does not support the use of retrobulbar and peribulbar hyaluronidase. The use of retrobulbar hyaluronidase for reversing soft tissue filler induced vision loss is controversial. Its efficacy remains unproven and there is mixed evidence within the literature. The current evidence suggests that there may be an increased risk of introducing severe adverse events associated with retrobulbar hyaluronidase and may even exacerbate the problem for those clinicians who are not ophthalmology trained. Therefore, we recommend two alternative treatment pathways for ophthalmology and non-ophthalmology trained practitioners. The suggested goal of this publication is to understand the pathophysiology of STFIVL, recognize signs and symptoms, and to propose algorithms to manage vision loss for both non-ophthalmology and ophthalmology trained clinicians. Clinicians must act swiftly and arrange immediate transfer to an emergency department or ophthalmology specialist setting to give the patient the best chance of vision restoration. The focus of any intervention for non-ophthalmology trained clinicians should be based around the immediate use of non-invasive techniques.
Vascular occlusions can occur with injection of dermal fillers, causing devastating outcomes for the patient. Hyaluronidase is an enzyme that was first used in general medicine in 1949, but has ...gained widespread use in aesthetic medicine to dissolve hyaluronic acid (HA)-based dermal fillers. Knowledge of this drug and its use for other aesthetic indications is evolving, and there is often anxiety attached to the administration of animal-derived product due to fears of an allergic reaction. This paper provides guidance on the indications for use when dissolving HA filler with hyaluronidase. It discusses formulation differences, adverse events, allergy to wasp and bee stings, and how this increases risk of allergy to hyaluronidase. It also discusses incidence of allergy, which includes a discussion of types of allergic response and how this correlates to skin tests and a discussion on skin testing for allergy.
The
Aids to Management
are a product of the Global Campaign against Headache, a worldwide programme of action conducted in official relations with the World Health Organization. Developed in ...partnership with the European Headache Federation, they update the first edition published 11 years ago.
The common headache disorders (migraine, tension-type headache and medication-overuse headache) are major causes of ill health. They should be managed in primary care, firstly because their management is generally not difficult, and secondly because they are so common. These
Aids to Management
, with the
European principles of management of headache disorders in primary care
as the core of their content, combine educational materials with practical management aids. They are supplemented by translation protocols, to ensure that translations are unchanged in meaning from the English-language originals.
The
Aids to Management
may be individually downloaded and, as is the case for all products of the Global Campaign against Headache, are available without restriction for non-commercial use.
Molecular-based allergy (MA) diagnostics is an approach used to map the allergen sensitization of a patient at a molecular level, using purified natural or recombinant allergenic molecules (allergen ...components) instead of allergen extracts. Since its introduction, MA diagnostics has increasingly entered routine care, with currently more than 130 allergenic molecules commercially available for in vitro specific IgE (sIgE) testing.MA diagnostics allows for an increased accuracy in allergy diagnosis and prognosis and plays an important role in three key aspects of allergy diagnosis: (1) resolving genuine versus cross-reactive sensitization in poly-sensitized patients, thereby improving the understanding of triggering allergens; (2) assessing, in selected cases, the risk of severe, systemic versus mild, local reactions in food allergy, thereby reducing unnecessary anxiety for the patient and the need for food challenge testing; and (3) identifying patients and triggering allergens for specific immunotherapy (SIT).Singleplex and multiplex measurement platforms are available for MA diagnostics. The Immuno-Solid phase Allergen Chip (ISAC) is the most comprehensive platform currently available, which involves a biochip technology to measure sIgE antibodies against more than one hundred allergenic molecules in a single assay. As the field of MA diagnostics advances, future work needs to focus on large-scale, population-based studies involving practical applications, elucidation and expansion of additional allergenic molecules, and support for appropriate test interpretation. With the rapidly expanding evidence-base for MA diagnosis, there is a need for allergists to keep abreast of the latest information. The aim of this consensus document is to provide a practical guide for the indications, determination, and interpretation of MA diagnostics for clinicians trained in allergology.
BACKGROUND.
The demand for minimally invasive aesthetic procedures has driven requests by physicians for guidance on their use in Asian patients, who have unique cultural preferences, social trends, ...and anatomy. However, few guidelines exist, particularly on combination treatment strategies for different facial shapes or indications such as the modification of face shapes to the “oval ideal.”Physicians must, therefore, apply Caucasian patient-optimized guidelines to their Asian patients.
METHODS.
Eleven specialists developed a consensus on the use of botulinum toxin A (BoNT-A), calcium hydroxylapatite (CaHA) and hyaluronic acid (HA) fillers, and microfocused ultrasound with visualization (MFU-V) devices in Asian patients on upper-, middle-, and lower-face indications, including strategies to modify different facial shapes to the oval shape. Approval from 70 to 90 percent of all participants led to moderate consensus, while 90 percent agreement denoted a strong consensus.
RESULTS.
For early intervention/enhancement and restoration, most combination strategies are similar between Asian and Caucasian patients. Compared to Caucasian patients, however, beautification is a more common focus in Asian patients. The “ideal” oval facial shape can be created using different interventions depending on the patient’s baseline characteristics.
CONCLUSIONS.
Although treatments and treatment sequences for early intervention/enhancement and restoration for beautification in Asian patients are similar to those in Caucasian patients, different treatment strategies may be required.
Consensus reaching processes play an increasingly important role in the resolution of group decision making problems: a solution acceptable to all the experts participating in a problem is necessary ...in many real-life contexts. A large number of consensus approaches have been proposed to support groups in such processes, each one with its own characteristics, such as the methods utilized for the fusion of information regarding the preferences of experts. Given this variety of existing approaches in the literature to support consensus reaching processes, this paper considers two main objectives. Firstly, we propose a taxonomy that provides an overview and categorization of some existing consensus models for group decision making problems defined in a fuzzy context, taking into account the main features of each model. Secondly, the paper presents AFRYCA, a simulation-based analysis framework for the resolution of group decision making problems by means of different consensus models. The framework is aimed at facilitating a study of the performance of each consensus model, as well as determining the most suitable model/s for the resolution of a specific problem. An experimental study is carried out to show the usefulness of the framework.
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