(1) Purpose: To assess the main corneal response differences between normal and subclinical keratoconus (SCKC) with a Corvis
ST device. (2) Material and Methods: We selected 183 eyes of normal ...patients, of a mean age of 33 ± 9 years and 16 eyes of patients with SCKC of a similar mean age. We measured best corrected visual acuity (BCVA) and corneal topography with a Pentacam HD device to select the SCKC group. Biomechanical measurements were performed using the Corvis
ST device. We carried out a non-parametric analysis of the data with SPSS software (Wilcoxon signed rank-test). (3) Results: We found statistically significant differences between the control and SCKC groups in some corneal biomechanical parameters: first and second applanation time (
= 0.05 and
= 0.02), maximum deformation amplitude (
= 0.016), highest concavity radius (
= 0.007), and second applanation length and corneal velocity ((
= 0.039 and
= 0.016). (4) Conclusions: Our results show that the use of normalised biomechanical parameters provided by noncontact tonometry, combined with a discriminant function theory, is a useful tool for detecting subclinical keratoconus.
In this study, effects of smoking on colour vision with the Farnsworth−Munsell 100 Hue test (FM100h) and achromatic (A), red-green (RG), and blue-yellow (BY) contrast sensitivity functions were ...evaluated. In total, 50 non-smoker controls and 25 smokers, divided into two groups (group 1, less than 10 cigarettes per day, with 15 patients, and group 2, >10 cigarettes per day, with 10 patients) took part in the experiments. Best-corrected visual acuity (BCVA), FM100h, and A, RG, and BY contrast sensitivity functions were measured. Total and partial RG and BY error scores (TES and PTES) and colour axis index (CA) were used in the analysis. No differences between smoker and non-smoker groups were found in BCVA, CA and A and BY contrast sensitivity, but TES and PTES values and RG contrast sensitivity at 1 cpd were statistically different. Differences between smoker groups were not significant. Error scores in smokers were positively correlated with the number of cigarettes smoked per day, and in BY also with age. Tobacco caused discrimination losses in both chromatic mechanisms but affected the red-green pathway more than the blue-yellow, and therefore, a partial RG score of FM100h test seems to be a good predictor of smoker colour deficiencies.
FUNDAMENTOS // La valoración funcional forma parte de la valoración geriátrica. No se conoce bien cómo se realiza en los servicios de Urgencias
hospitalarios (SUH) y menos aún su valor pronóstico. El ...objetivo de este trabajo fue investigar si la dependencia funcional basal para realizar las actividades
básicas de la vida diaria (ABVD) era un factor pronóstico independiente de muerte tras la visita índice al SUH durante la primera ola pandémica de la
COVID-19 y si tuvo un impacto diferente en pacientes con y sin diagnóstico de COVID-19.
MÉTODOS // Se realizó un estudio observacional retrospectivo de la cohorte EDEN-Covid (Emergency Department and Elder Needs during COVID) formada
por todos los pacientes de edad mayor o igual a 65 años atendidos en 52 SUH españoles, seleccionados por oportunidad durante siete días consecutivos
(del 30 de marzo al 5 de abril de 2020). Se analizaron variables demográficas, clínicas, funcionales, mentales y sociales. La dependencia se categorizó con
el índice de Barthel (IB) en independiente (IB=100), dependencia leve-moderada (100>IB>60) y dependencia grave-total (IB<60), y se evaluó su asociación
cruda y ajustada con la mortalidad a 30, 180 y 365 días mediante modelos de riesgos proporcionales de COX.
RESULTADOS // De 9.770 pacientes incluidos con una media de edad de 79 años, un 51% eran hombres, 6.305 (64,53%) eran independientes, 2.340 (24%)
tenían dependencia leve-moderada y 1.125 (11,5%) dependencia grave-total. El número de fallecidos a 30 días en estos tres grupos fue 500 (7,9%), 521 (22,3%) y 378 (33,6%), respectivamente; a 180 días fue 757 (12%), 725 (30,9%) y 526 (46,8%); y a 365 días 954 (15,1%), 891 (38,1%) y 611 (54,3%). En relación a los pacientes independientes, los riesgos (hazard ratio) ajustados de fallecer a 30 días, asociados a dependencia leve-moderada y grave-total, fueron 1,91 (IC 95%: 1,66-2,19) y 2,51 (2,11-2,98); a 180 días fueron de 1,88 (1,68-2,11) y 2,64 (2,28-3,05); y a 365 días fueron 1,82 (1,64-2,02) y 2,47 (2,17-2,82). Este impacto negativo de la dependenciasobre la mortalidad fue mayor en pacientes diagnosticados de COVID-19 que en los no COVID-19 (p interacción a 30, 180 y 365 días de 0,36, 0,05 y 0,04).
CONCLUSIONES // La dependencia funcional de los pacientes mayores que acuden a SUH españoles durante la primera ola pandémica se asocia a
mortalidad a 30, 180 y 365 días, y este riesgo es significativamente mayor en los pacientes atendidos por COVID-19.
BACKGROUND // Functional assessment is part of geriatric assessment. How it is performed in hospital Emergency Departments (ED) is poorly understood,
let alone its prognostic value. The aim of this paper was to investigate whether baseline disability to perform basic activities of daily living (BADL) was
an independent prognostic factor for death after the index visit to the ED during the first wave of the COVID-19 pandemic and whether it had a different
impact on patients with and without diagnosis of COVID-19.
METHODS // A retrospective observational study of the EDEN-Covid (Emergency Department and Elder Needs during COVID) cohort was carried out, consisting
of all patients aged ≥65 years seen in 52 Spanish EDs selected by chance during 7 consecutive days (30/3/2020 to 5/4/2020). Demographic, clinical, functional,
mental and social variables were analyzed. Dependence was categorized with the Barthel index (BI) as independent (BI=100), mild-moderate dependence
(100>BI>60) and severe-total dependence (BI<60), and their crude and adjusted association was evaluated with mortality at 30, 180 and 365 days using COX
proportional hazards models.
RESULTS // Of 9,770 enrolled patients with a mean age of 79 years, 51% were men, 6,305 (64.53%) were independent, 2,340 (24%) had mild-moderate
dependence, and 1,125 (11.5%) severe-total dependence. The number of deaths at 30 days in these three groups was 500 (7.9%), 521 (22.3%) and 378 (33.6%),
respectively; at 180 days it was 757 (12%), 725 (30.9%) and 526 (46.8%); and at 365 days 954 (15.1%), 891 (38.1%) and 611 (54.3%). In relation to independent
patients, the adjusted risks (hazard ratio) of dying within 30 days associated with mild-moderate and severe-total dependency were 1.91 (95% CI: 1.66-2.19) and
2.51. (2.11-2.98); at 180 days they were 1.88 (1.68-2.11) and 2.64 (2.28-3.05); and at 365 days they were 1.82 (1.64-2.02) and 2.47 (2.17-2.82). This negative impact of dependency on mortality was greater in patients diagnosed with COVID-19 than in non-COVID-19 (p interaction at 30, 180 and 365 days of 0.36, 0.05 and 0.04).
CONCLUSIONS // The functional dependence of older patients who attend Spanish EDs during the first wave of the pandemic is associated with mortality
at 30, 180 and 365 days, and this risk is significantly higher in patients treated for COVID-19.
Effects of cataract surgery on blinking Talens-Estarelles, Cristian; Díez-Ajenjo, María Amparo; Pons, Álvaro M ...
Journal of cataract and refractive surgery,
02/2023, Volume:
49, Issue:
2
Journal Article
Peer reviewed
To assess the effects of cataract surgery on the spontaneous blinking pattern and blinking kinematics.
FISABIO Oftalmología Médica Eye Hospital, Valencia, Spain.
Observational descriptive clinical ...study.
Patients with senile cataract were evaluated before (visit 1) and at 1 month (visit 2) and 3 months (visit 3) after undergoing phacoemulsification cataract surgery. The blinking of patients was recorded for 90 seconds using an eye-tracking device. Blinks were analyzed by means of image analysis to obtain a noninvasive detailed description of blinking including blink rate, number of complete and incomplete blinks, percentage of incomplete blinks, and kinematic parameters, including amplitude, closing, contact, opening, and total durations and closing and opening speeds.
50 patients were included in this study. The blink rate was significantly smaller at visit 3 compared with baseline ( P = .03) and visit 2 ( P = .001). Likewise, the number of complete blinks was significantly smaller, and the percentage of incomplete blinks was significantly higher at 3 months postoperatively compared with baseline ( P = .02 and P = .01, respectively), although no differences were observed at 1 month postoperatively ( P > .05). Conversely, no differences in the number of incomplete blinks or any kinematic parameter were observed between visits ( P = .12).
Cataract surgery significantly altered the blinking pattern at 3 months postoperatively, although kinematic parameters remained unvaried. Clinicians should be aware of potential alterations in blinking after phacoemulsification cataract surgery and the implications this may have on the ocular surface of patients.
This article discusses the convenience of adopting an approach of Collective Spatial Analysis in the P/PGIS processes, with the aim of improving the collection and integration of knowledge and local ...expertise in decision-making, mainly in the fields of planning and adopting territorial policies. Based on empirical evidence, as a result of the review of scientific articles from the Web of Science database, in which it is displayed how the knowledge and experience of people involved in decision-making supported by P/PGIS are collected and used, a prototype of a WEB-GSDSS application has been developed. This prototype allows a group of people to participate anonymously, in an asynchronous and distributed way, in a decision-making process to locate goods, services, or events through the convergence of their views. Via this application, two case studies for planning services in districts of Ecuador and Italy were carried out. Early results suggest that in P/PGIS local and external actors contribute their knowledge and experience to generate information that afterwards is integrated and analysed in the decision-making process. On the other hand, in a Collective Spatial Analysis, these actors analyse and generate information in conjunction with their knowledge and experience during the process of decision-making. We conclude that, although the Collective Spatial Analysis approach presented is in a subjective and initial stage, it does drive improvements in the collection and integration of knowledge and local experience, foremost among them is an interdisciplinary geo-consensus.
Purpose: Considering that peripheral corneal thinning occurs in keratoconus (KC), the anterior scleral thickness (AST) profile was measured to compare thickness variations in healthy and KC eyes ...across several meridians. Methods: This cross-sectional case–control study comprised 111 eyes of 111 patients: 61 KC eyes and 50 age- and axial-length-matched healthy eyes. The AST was explored at three scleral eccentricities (1, 2, and 3 mm from the scleral spur) across four scleral zones (nasal, temporal, superior, and inferior) by using swept-source optical coherence tomography. The AST variations among eccentricities and scleral regions within and between groups were investigated. Results: The AST significantly varied with scleral eccentricity in healthy eyes over the temporal meridian (p = 0.009), whereas in KC eyes, this variation was observed over the nasal (p = 0.001), temporal (p = 0.029) and inferior (p = 0.006) meridians. The thinnest point in both groups was 2 mm posterior to the scleral spur (p < 0.001). The sclera was thickest over the inferior region (control 581 ± 52 μm, KC 577 ± 67 μm) and thinnest over the superior region (control 448 ± 48 μm, KC 468 ± 58 μm) in both populations (p < 0.001 for all eccentricities). The AST profiles were not significantly different between groups (p > 0.05). The inferior–superior thickness asymmetry was statistically different 2 mm posterior to the scleral spur between groups (p = 0.009), specifically with subclinical KC (p = 0.03). There is a trend where the asymmetry increases, although not significantly, with the KC degree (p > 0.05). Conclusions: KC eyes presented significant thickness variations among eccentricities over the paracentral sclera. Although AST profiles did not differ between groups, the inferior–superior asymmetry differences demonstrated scleral changes over the vertical meridian in KC that need further investigation.
To evaluate the repeatability of an optical device for measuring the Zernike coefficients of toric intraocular lenses (IOLs) and assess whether its toricity has any impact in its repeatability.
An ...experienced technician used the NIMO TR1504 to measure the Zernike coefficients 30 times for an aperture of 4.50 mm for all lenses included. The IOLs included were divided into two group: toric and non-toric ones. The cylindrical powers of the toric lenses included in the present study were 1.00, 1.50, 2.25, 3.00 and 3.75 D. Finally, the repeatability of the NIMO TR1504 was described in terms of within subject standard deviation (Sw) and repeatability limit.
The Sw was smaller than 0.011 µm for both lens groups and all Zernike coefficients, and the difference between both groups was smaller than 0.004 µm for all Zernike coefficients. Regarding the repeatability limit, this value was smaller than 0.025 µm for the toric lens group, and smaller than 0.031 µm for the non-toric lens one for all Zernike coefficients. Furthermore, the maximum difference between both lens groups was 0.010 µm.
The repeatability of the NIMO TR1504 to measure the optical quality is high and independent of the lens toricity. These results reflect that this system is robust and could be used to measure the
optical quality of either toric or non-toric IOLs.
Abstract The purpose of this study was to evaluate the effect of axillary lavage with a gentamicin solution before wound closure on drainage volume. Patients and methods A prospective, randomized ...study was performed. Inclusion criteria were a diagnosis of breast neoplasms and plans to undergo an elective axillary lymph node dissection due to axillary metastasis. The patients were randomized into 2 groups: patients undergoing 2 lavages with 500 ml normal saline (Group 1) and patients first undergoing lavage with 500 ml normal saline followed by a second lavage with a 500 ml of a gentamicin (240 mg) solution (Group 2). Microbiological samples were obtained before any lavage, after each lavage and at the time of drain removal. Results 40 patients were included. Mean number of days maintaining the drain in place was 7.7 ± 3.2 days in Group 1 and 4.3 ± 1.4 days in Group 2 ( p = 0.001). Total drainage volume before removal was 465 ± 250.9 ml in Group 1 and 169 ± 102.2 ml in Group 2 ( p = 0.003). After a second lavage with normal saline in Group 1 and after a lavage with gentamicin solution in Group 2, microbiological culture was positive in 10 patients (50%) in Group 1 and 1 case (5%) in Group 2 ( p = 0.016). Positive cultures were associated with higher drainage volumes. Conclusion The postoperative drainage volume of the axillary drain is significantly lower in the patients undergoing a lavage of the surgical bed with a gentamicin solution than in the control group undergoing a lavage with normal saline. A significant reduction in the contamination is only obtained after a lavage with gentamicin solution. Clinical trial registration number: NCT01700504.
In this paper we describe a new method for measuring the intraocular lens (IOL) power using a focimeter, a negative ophthalmic lens and a saline solution (0.9% NaCl). To test this we measured the ...power of 58 different IOLs and we compared them with the power stated by the manufacturer. Despite the limitations, the results show a good correlation.
•We present a fast method for measuring intraocular lens power with a focimeter.•We avoided some problems described by the ISO (expensive, time-consuming or different depending on the lens design).•This method can improve the speed in future research and it could be used by groups on a low budget.
Introduction
The diagnosis or treatment of breast cancer is sometimes delayed. A lengthy delay may have a negative psychological impact on patients. The aim of our study was to evaluate the ...sociodemographic, clinical and pathological factors associated with delay in the provision of surgical treatment for localised breast cancer, in a prospective cohort of patients.
Methods
This observational, prospective, multicentre study was conducted in ten hospitals belonging to the Spanish national public health system, located in four Autonomous Communities (regions). The study included 1236 patients, diagnosed through a screening programme or found to be symptomatic, between April 2013 and May 2015. The study variables analysed included each patient’s personal history, care situation, tumour history and data on the surgical intervention, pathological anatomy, hospital admission and follow-up. Treatment delay was defined as more than 30 days elapsed between biopsy and surgery.
Results
Over half of the study population experienced surgical treatment delay. This delay was greater for patients with no formal education and among widows, persons not requiring assistance for usual activities, those experiencing anxiety or depression, those who had a high BMI or an above-average number of comorbidities, those who were symptomatic, who did not receive NMR spectroscopy, who presented a histology other than infiltrating ductal carcinoma or who had poorly differentiated carcinomas.
Conclusions
Certain sociodemographic and clinical variables are associated with surgical treatment delay. This study identifies factors that influence surgical delays, highlighting the importance of preventing these factors and of raising awareness among the population at risk and among health personnel.
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