Das frühe Diabetische Makulaödem: Ein Indikator für schlechte postoperative Ergebnisse nach Katarakt Chirurgie bei Diabetikern. Die DICAT-II-Studie

2021 ◽  
pp. 1-3
Author(s):  
Viktoria Mrugala ◽  
Albert J. Augustin
Keyword(s):  
Cataract Surgery ◽  
Negative Impact ◽  
Diabetic Macular Oedema ◽  
Postoperative Monitoring ◽  
Corrected Visual Acuity ◽  
Central Subfield Thickness ◽  
Group 2 ◽  
Hba1c Levels ◽  
Group 1

<b>Background:</b> The prospective DIabetes and CATaract Study II (DICAT II) was performed to characterise the risks of cataract surgery to the retinae of patients with early diabetic macular oedema (E-DMO). <b>Methods:</b> DICAT II was a prospective, comparative, multicentre, observational study involving six Italian clinics. Patients were aged ≥55 years, had type 1 or 2 diabetes with spectral-domain optical coherence tomography evidence of ESASO classification Early DMO. Group 1 eyes (78 eyes, 78 patients) underwent phacoemulsification-based cataract surgery. Group 2 eyes (65 eyes, 65 patients) had E-DMO and either clear media or had undergone uncomplicated cataract surgery ≥1 year previously. Central subfield thickness (CST) and best-corrected visual acuity (BCVA) were assessed in both groups. <b>Results:</b> The negative impact of surgery on CST was evident after the first postoperative week; CST peaked during the first month, then rapidly decreased. CST worsening ≥10 µm was observed in 63/78 eyes (80.7%) and 29/65 eyes (44.6%) in Groups 1 and 2, respectively (<i>p</i> &#x3c; 0.0001). CST worsening of ≥50 µm was observed in 51 eyes (65.4%) and 10 eyes (15.4%) in Groups 1 and 2, respectively (<i>p</i> &#x3c; 0.0001). Mean CST worsening was lower in Group 2 than in Group 1 (38.6 ± 30.4 µm vs 85.5 ± 55.3 µm, <i>p</i> &#x3c; 0.0001) with a lower BCVA loss (−2.6 ± 3.5 letters vs −8.2 ± 6.2 letters, <i>p</i> &#x3c; 0.0001). Higher glycaemic levels and HBA1c levels were significantly associated with the risk of &#x3e;50 μm CST worsening in eyes from both groups. <b>Conclusion:</b> Early DMO is associated with poorer outcomes after cataract surgery and requires close pre- and postoperative monitoring.

scholarly journals Outcomes of coaxial microincision cataract surgery versus conventional phacoemulsification surgery

2019 ◽  
Vol 16 (3) ◽  
pp. 168-178
Author(s):  
Anu Malik ◽  
Smruti Ranjan Dethi ◽  
Yogesh Kumar Gupta ◽  
Alka Gupta
Keyword(s):  
Cataract Surgery ◽  
Randomized Study ◽  
Corrected Visual Acuity ◽  
Age Related ◽  
Significant Difference ◽  
Induced Astigmatism ◽  
The Mean ◽  
Group 2 ◽  
Surgically Induced ◽  
Group 1

Aim: To compare surgical parameters and visual outcomes of coaxial microincision cataract surgery (MICS) with standard phacoemulsification. Methods: A prospective randomized study was conducted on 60 eyes of 60 patients with age-related uncomplicated cataract who underwent: standard phacoemulsification surgery (30 eyes) i.e., Group 1, or coaxial MICS (30 eyes) i.e., Group 2. Intraoperative parameters were mean effective phacoemulsification power (EPP), effective phacoemulsification time (EPT), and total volume of balanced salt solution (BSS) used. Best-corrected visual acuity (BCVA) and surgically induced astigmatism (SIA) were evaluated pre- and postoperatively. Results: Mean BCVA at 6 weeks was 0.04 ± 0.07 in Group 1 and 0.05 ± 0.08 in Group 2. No significant difference was observed in SIA between the two groups. Mean EPT was 29.80 ± 3.67 seconds in Group 1 and 31.93 ± 4.08 seconds in Group 2. The mean total EPP in Group 1 was 35.77 ± 5.17%, whereas it was 33.70 ± 3.05% in Group 2. There was a significant statistical difference between mean EPP and EPT in the two groups. Mean total BSS volume used in Group 1 was 128.83 ± 19.81 ml, whereas it was 139.33 ± 13.57 ml in Group 2. Conclusion: Although EPT and BSS volume used were significantly higher in coaxial MICS, the postoperative results of the two techniques were comparable.

scholarly journals Impact of glycemic variability and the fear of hypoglycemia on type 1 diabetes control

2020 ◽  
Vol 4 (6) ◽  
pp. 324-328
Author(s):  
A.R. Volkova ◽  
◽  
M.E. Chernaya ◽  
V.S. Mozgunova ◽  
M.B. Durdyeva ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Glycemic Variability ◽  
Diabetes Control ◽  
Target Level ◽  
Fear Of Hypoglycemia ◽  
Group 2 ◽  
Hba1c Target ◽  
Hba1c Levels ◽  
Group 1

Background: currently, the level of HbA1c does not necessarily allow for the understanding of glycemic control. Considering this, glycemic variability (GV) is extensively studied in recent years. Psychological component has a significant impact on GV as the fear of hypoglycemia (FOH) and its consequences can reduce the motivation for achieving target glycemia and HbA1c as well as adherence to treatment.Aim: to assess GV in patients with type 1 diabetes with the elevated and target levels of HbA1c and to analyze the effect of FOH on diabetes control.Patients and Methods: 78 patients with type 1 diabetes who received insulin therapy (multiple daily injections or continuous subcutaneous insulin infusion) were enrolled. All patients were divided into two groups based on HbA1c levels, i.e., group 1 (patients who achieved individual HbA1c target level, n=13) and group 2 (patients who did not achieve individual HbA1c target level, n=65). HbA1c levels and GV were measured in all patients using iPRO™2 Professional CGM system (Medtronic, Ireland). In addition, FOH was evaluated using the Hypoglycemia Fear Survey II (HFS-II).Results: in group 1, time in-range was significantly higher (p=0.013) while daily GV was significantly lower (p=0.023) than in group 2. HbA1c levels, the rate of severe hypoglycemia, and diabetes duration were lower among the patients with lower levels of FOH.Conclusion: studying GV can provide better understanding of diabetes control in patients with any HbA1c level. Optimized treatment strategy using HFS-II can attenuate the effects of frequent hypoglycemia on GV and HbA1c levels and improve treatment efficacy.KEYWORDS: glycemic variability, glycated hemoglobin, diabetes, continuous glucose monitoring, hypoglycemia.FOR CITATION: Volkova A.R., Chernaya M.E., Mozgunova V.S. et al. Impact of glycemic variability and the fear of hypoglycemia on type 1 diabetes control. Russian Medical Inquiry. 2020;4(6):324–328. DOI: 10.32364/2587-6821-2020-4-6-324-328.

scholarly journals Percutaneous posteroanterior screw fixation for Haraguchi type 1 posterior malleolar fracture in tri-malleolar fracture: Operative technique and randomized clinical results

2021 ◽  
Vol 29 (1) ◽  
pp. 230949902199799
Author(s):  
Tianming Yu ◽  
Jichong Ying ◽  
Jianlei Liu ◽  
Dichao Huang ◽  
Hailin Yan ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Malleolar Fracture ◽  
Malleolar Fractures ◽  
Posterior Malleolar Fracture ◽  
Post Traumatic ◽  
Group 2 ◽  
Traumatic Arthritis ◽  
Group 1

Purpose: The study described a novel surgical treatment of Haraguchi type 1 posterior malleolar fracture in tri-malleolar fracture and patient outcomes at intermediate period follow-up. Methods: All patients from January 2015 to December 2017 with tri-malleolar fracture of which posterior malleolar fractures were Haraguchi type 1, were surgically treated in this prospective study. Lateral and medial malleolar fractures were managed by open reduction and internal fixation through dual incision approaches. 36 cases of Haraguchi type 1 posterior malleolar fractures were randomly performed by percutaneous posteroanterior screw fixation with the aid of medial exposure (group 1). And 40 cases were performed by percutaneous anteroposterior screw fixation (group 2). Clinical outcomes, radiographic outcomes and patient-reported outcomes were recorded. Results: Seventy-six patients with mean follow-up of 30 months were included. There were no significant differences in the mean operation time (81.0 ± 11.3 vs. 77.2 ± 12.4), ankle function at different periods of follow-up, range of motions and visual analog scale (VAS) at 24 months between the two groups ( p > 0.05). However, the rate of severe post-traumatic arthritis (Grade 2 and 3) and the rate of step-off rather than gap in radiological evaluation were lower in group 1 than that in group 2 ( p < 0.05). Conclusion: Using our surgical technique, more patients had good outcome with a lower rate of severe post-traumatic arthritis, compared with the group of percutaneous anteroposterior screw fixation. Percutaneous posteroanterior screw fixation can be a convenient and reliable alternative in treating Haraguchi type 1 posterior malleolar fracture.

P–749 Knowledge of women undergoing surgery for endometrioma regarding the impact of the disease and its treatment on ovarian reserve and fertility

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
M Horan ◽  
L Glover ◽  
P Downey ◽  
M Wingfield
Keyword(s):  
Ovarian Reserve ◽  
Negative Impact ◽  
Histological Diagnosis ◽  
Ovarian Cysts ◽  
Medical Setting ◽  
Future Fertility ◽  
Group 2 ◽  
Ovarian Endometriomas ◽  
The Impact ◽  
Group 1

Abstract Study question Do women undergoing surgery for endometrioma due to pain, a cyst and/or subfertility understand the impact of the disease and its treatment on ovarian reserve and fertility. Summary answer The majority of women treated in a fertility setting are well informed compared to those in a general medical setting. What is known already: Infertility affects 30% to 50% of women with endometriosis. Ovarian endometriomas are reported in 17–44% of infertile women with endometriosis and are typically associated with more severe disease. Endometriomas are associated with diminished ovarian reserve, due to the endometrioma per se or due to surgical interventions required to treat and excise the disease. ESHRE guidelines recommend that women should be informed pre-operatively of the potential reduction in ovarian reserve associated with surgery and that ovarian reserve tests should be performed when future fertility is a concern. Study design, size, duration In conjunction with our histopathology colleagues we identified a cohort of women with a histological diagnosis of one or more ovarian endometriomas who underwent surgery in our unit between 2010 and 2019. We developed a scoping questionnaire, targeted at women currently over the age of 40, who had previously undergone surgery for endometrioma under the age of 35. Patients were contacted by telephone and consent obtained to send an email with a survey link. Participants/materials, setting, methods We identified 47 women who had a histological diagnosis of endometrioma. Of these, 30 were contactable by telephone, of whom 29 consented to being sent information regarding the study and a link to the questionnaire. 21 women completed the survey. Respondents were divided into 2 groups for analysis. Group 1 cited ‘fertility’ or ‘both pain and fertility’ as an indication for their surgery while group 2 had ‘pain’ or ‘ovarian cysts’ but no fertility concerns. Main results and the role of chance: The majority (62%) of patients were diagnosed with endometriosis while aged 25–34. The indication for surgery was evenly divided between pain (32%), fertility (37%) and ovarian cysts (37%). 60% of women reported having endometriomas diagnosed preoperatively. Striking differences were noted between groups 1 and 2. Of the women who cited ‘fertility’ or ‘both pain and fertility’ (n = 9) as an indication for their surgery, 78% (n = 7) reported being aware of any possible negative impact of endometriosis on their fertility, with 78% also being aware of the possible negative impact of surgery for endometriosis on their fertility. This compared to only 36% (n = 4) and 27% (n = 3) respectively in Group 2. In group 1, 56% (n = 5) remembered having an AMH level checked pre operatively while 78% (n = 7) also had an ultrasound pre-operatively. In contrast, only 33% (n = 3) of Group 2 remember having an AMH level checked pre operatively though 64% (n = 7) had an ultrasound pre-operatively. Of those whose surgery was performed by a fertility specialist, 75% (n = 6) reported being aware of the impact of endometriosis and also the impact of surgery on ovarian reserve, compared to 44% (n = 4) of those who surgery was performed by a non-fertility specialist. Limitations, reasons for caution This is a retrospective study and the numbers are small. We were only able to identify women with an endometrioma via pathology records, so those with no excision of disease (eg those who had ablation of an endometrioma) were excluded from this analysis. Wider implications of the findings: This suggests the majority of patients treated in a fertility setting are counselled regarding the benefit of surgery but also the risk to ovarian reserve. This is not the case in other settings. It is time to disseminate guidelines such as those produced by ESHRE to our general gynaecology colleagues. Trial registration number Not applicable

scholarly journals The impact of the early tenotomy of Achilles tendon on the length and results of congenital clubfoot severe forms treatment

2019 ◽  
Vol 76 (8) ◽  
pp. 795-801
Author(s):  
Zoran Rakonjac
Keyword(s):  
Achilles Tendon ◽  
Negative Impact ◽  
Ponseti Method ◽  
Congenital Clubfoot ◽  
Results Of Treatment ◽  
Analysis Of Results ◽  
Group 2 ◽  
The Impact ◽  
Group 1 ◽  
Female Subjects

Background/Aim. In this paper we present our modification of the Ponseti method which we have been using for the treatment of severe forms of congenital clubfoot since 2007. The aim of this paper was to determine, on the basis of the analysis of results, the impact of the early tenotomy of the Achilles tendon on the length and results of treatment of severe forms of congenital clubfoot. Methods. The study was prospective and lasted from 2007 to 2016 year. It was implemented in the Clinic for Children's Surgery Banjaluka. The Group 1 consisted of the subjects treated by the modified Ponseti method in the period of 9 years (2007?2016). There were a total of 30 subjects (52 feet). There were 20 (67%) of male and 10 (33%) of female subjects. There were 22 (77%) subjects with bilateral and 8 (27%) with unilateral deformity. The Group 2 consisted of the subjects treated by the classic Ponseti method in the period of 9 years (2007?2016). There were a total of 32 subjects (52 feet). There were 26 (81%) of male and 6 (19%) of female subjects. There were 20 (63%) of subjects with bilateral and 12 (37%) with unilateral deformity. We used the Pirani score for: classification of deformity according to the severity, monitoring of results of the correction, determination of indication for tenotomy of the Achilles tendon and for the analysis of results of the treatment. Results. The total length of treatment in the Group 1 was from 6 to 9 weeks (mean = 6.71 ? 0.871), and in the Group 2 from 9 to 12 weeks (mean = 9.92 ? 0.882) (r = 0.86; p = 0.001). There was no difference in the results of the treatment (?2 = 2.372 df = 2 n = 52 p = 0.936. Conclusion. Applying early tenotomy of Achilles tendon in the treatment of severe forms of congenital club foot significantly shortens the duration of treatment and has no negative impact on the results of treatment.

scholarly journals Reconstructing Foveola by Foveolar Internal Limiting Membrane Non-Peeling and Tissue Repositioning for Lamellar Hole-Related Epiretinal Proliferation

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Tzyy-Chang Ho ◽  
Allen Yi-Lun Ho ◽  
Muh-Shy Chen
Keyword(s):  
Visual Acuity ◽  
Clinical Characteristics ◽  
Internal Limiting Membrane ◽  
Lamellar Macular Hole ◽  
Ilm Peeling ◽  
Corrected Visual Acuity ◽  
Tangential Traction ◽  
Group 2 ◽  
Lamellar Hole ◽  
Group 1

Abstract Differences in the pathogenesis and clinical characteristics between lamellar macular hole (LMH) with and without LMH-associated epiretinal proliferation (LHEP) can have surgical implications. This study investigated the effects of treating LHEP by foveolar internal limiting membrane (ILM) non-peeling and epiretinal proliferative (EP) tissue repositioning on visual acuity and foveolar architecture. Consecutive patients with LHEP treated at our institution were enrolled. The eyes were divided into a conventional total ILM peeling group (group 1, n = 11) and a foveolar ILM non-peeling group (group 2, n = 22). In group 2, a doughnut-shaped ILM was peeled, leaving a 400-μm-diameter ILM without elevated margin over the foveola after EP tissue repositioning. The EP tissue was elevated, trimmed, and inverted into the LMH. Postoperatively, the LMH was sealed in all eyes in group 2, with significantly better best-corrected visual acuity (−0.26 vs −0.10 logMAR; p = 0.002). A smaller retinal defect (p = 0.003), a more restored ellipsoid zone (p = 0.002), and a more smooth foveal depression (p < 0.001) were achieved in group 2. Foveolar ILM non-peeling and EP tissue repositioning sealed the LMH, released the tangential traction, and achieved better visual acuity. The presumed foveolar architecture may be reconstructed surgically. LMH with LHEP could have a combined degenerative and tractional mechanism.

Clinical and Autopsy Analysis of Delayed Diagnosis and Missed Injuries in Trauma Patients

2006 ◽  
Vol 72 (2) ◽  
pp. 174-179
Author(s):  
Om P. Sharma ◽  
Diane M. Scala-Barnett ◽  
Michael F. Oswanski ◽  
Amy Aton ◽  
Shekhar S. Raj
Keyword(s):  
Health Care Providers ◽  
Negative Impact ◽  
Delayed Diagnosis ◽  
P Value ◽  
Care Providers ◽  
Missed Injuries ◽  
Impact On Survival ◽  
Group 2 ◽  
Trauma Deaths ◽  
Group 1

Delayed diagnosis of injury (DDI) during hospitalization and missed injuries (MI) on autopsy in trauma deaths result in untoward outcomes. Autopsy is an effective educational tool for health care providers to evaluate trauma care. A retrospective study of trauma registry patients and coroner's records was categorized into groups 1 (alive patients) and 2 (trauma deaths) and analyzed. DDI incidence was similar in group 1 (1.8%) and group 2 (1.9%). Autopsy analysis (163 patients) yielded 139 MI in 94 patients (57.6%), <3 per cent of MI had negative impact on survival. Bony injuries comprised 68 per cent of DDI and 19 per cent of MI. Group 1 DDI patients were sicker with higher injury severity score (ISS: 16.07) than their cohorts (ISS 7.13, P value <0.05). These patients had higher Glasgow Coma Scale (14.41) and lower ISS (16.07) as compared with group 2 MI patients (ISS: 33.49, GCS: 6.45, P value <0.05). Autopsy rate was 99.5 per cent in trauma deaths, 57 per cent for nontrauma deaths, and 79 per cent for all deaths. Less than 3 per cent of MI had negative impact on survival. Routine ongoing patient assessment with pertinent diagnostic workup is essential in reducing DDI. Trauma autopsies reveal MI, which aid performance improvement (PI).

scholarly journals Type 1 FSHD with 6–10 Repeated Units: Factors Underlying Severity in Index Cases and Disease Penetrance in Their Relatives Attention

2020 ◽  
Vol 21 (6) ◽  
pp. 2221
Author(s):  
Emmanuelle Salort-Campana ◽  
Farzad Fatehi ◽  
Sadia Beloribi-Djefaflia ◽  
Stéphane Roche ◽  
Karine Nguyen ◽  
...  
Keyword(s):  
Disease Severity ◽  
Facioscapulohumeral Muscular Dystrophy ◽  
Clinical Severity ◽  
Cross Sectional ◽  
Repeat Array ◽  
D4z4 Repeat ◽  
Severity Scores ◽  
Group 2 ◽  
Group 1

Molecular defects in type 1 facioscapulohumeral muscular dystrophy (FSHD) are caused by a heterozygous contraction of the D4Z4 repeat array from 1 to 10 repeat units (RUs) on 4q35. This study compared (1) the phenotype and severity of FSHD1 between patients carrying 6–8 vs. 9–10 RUs, (2) the amount of methylation in different D4Z4 regions between patients with FSHD1 with different clinical severity scores (CSS). This cross-sectional multicenter study was conducted to measure functional scales and for genetic analysis. Patients were classified into two categories according to RUs: Group 1, 6–8; Group 2, 9–10. Methylation analysis was performed in 27 patients. A total of 99 carriers of a contracted D4Z4 array were examined. No significant correlations between RUs and CSS (r = 0.04, p = 0.73) and any of the clinical outcome scales were observed between the two groups. Hypomethylation was significantly more pronounced in patients with high CSS (>3.5) than those with low CSS (<1.5) (in DR1 and 5P), indicating that the extent of hypomethylation might modulate disease severity. In Group 1, the disease severity is not strongly correlated with the allele size and is mostly correlated with the methylation of D4Z4 regions.

scholarly journals Treatment of Optic Canal Decompression Combined with Umbilical Cord Mesenchymal Stem (Stromal) Cells for Indirect Traumatic Optic Neuropathy: A Phase 1 Clinical Trial

2020 ◽  
Vol 64 (3) ◽  
pp. 398-404
Author(s):  
Jia Li ◽  
Xu Bai ◽  
Xiaoyue Guan ◽  
Hongfeng Yuan ◽  
Xiang Xu
Keyword(s):  
Visual Acuity ◽  
Adverse Events ◽  
Phase 1 ◽  
Optic Canal ◽  
Traumatic Optic Neuropathy ◽  
Corrected Visual Acuity ◽  
Group 2 ◽  
Best Corrected Visual Acuity ◽  
Group 1

<b><i>Purpose:</i></b> This study was aimed to investigate the safety and feasibility of umbilical cord-derived mesenchymal stem cell (MSC) transplantation in patients with traumatic optic neuropathy (TON). <b><i>Methods:</i></b> This is a single-center, prospective, open-labeled phase 1 study that enrolled 20 patients with TON. Patients consecutively underwent either optic canal decompression combined with MSC local implantation treatment (group 1) or only optic canal decompression (group 2). Patients were evaluated on the first day, seventh day, first month, third month, and sixth month postoperatively. Adverse events, such as fever, urticarial lesions, nasal infection, and death, were recorded at each visit. The primary outcome was changes in best-corrected visual acuity. The secondary outcomes were changes in color vision, relative afferent pupillary defect, and flash visual evoked potential. <b><i>Results:</i></b> All 20 patients completed the 6-month follow-up. None of them had any systemic or ocular complications. The change in best-corrected visual acuity at follow-up was not significantly different between group 1 and group 2 (<i>p</i> &#x3e; 0.05); however, group 1 showed better visual outcome than group 2. Both groups showed significant improvements in vision compared with the baseline (<i>p</i> &#x3c; 0.05); however, there were no statistically significant differences between the groups (<i>p</i> &#x3e; 0.05). In addition, no adverse events related to local transplantation were observed in the patients. <b><i>Conclusions:</i></b> A single, local MSC transplantation in the optic nerve is safe for patients with TON.

Effect of Unilateral Accessory Navicular Bone on Radiologic Parameters of Foot

2020 ◽  
pp. 107110072096482
Author(s):  
Mustafa Kara ◽  
Serkan Bayram
Keyword(s):  
Navicular Bone ◽  
Level Of Evidence ◽  
First Metatarsal ◽  
Metatarsal Angle ◽  
Asymptomatic Patients ◽  
Accessory Navicular ◽  
The Mean ◽  
Group 2 ◽  
Group 1

Background: This study aimed to compare the radiologic parameters of both feet in patients with unilateral accessory navicular bone (ANB) and evaluate the differences from one another. Methods: Forty-one patients with unilateral ANB volunteered to participate in this study from August 2019 to January 2020. Patient data, including age, sex, body mass index (BMI), type of ANB, and presence of symptoms were obtained. Group 1 comprised 23 patients with asymptomatic unilateral ANB, and group 2 comprised 18 patients with symptomatic unilateral ANB. Seven radiologic parameters were evaluated assessing hindfoot, midfoot, and forefoot alignment—calcaneal pitch angle, talocalcaneal angle, tibiocalcaneal angle, naviculocuboid overlap (NCO), talonavicular coverage angle (TNCA), anteroposterior talo–first metatarsal angle, and lateral talo–first metatarsal angle. Results: The mean age of patients was 40.1 years in group 1 and 42.6 years in group 2. Mean BMI was 25.2 in group 1 and 26.6 in group 2. No significant differences were noted in the radiologic parameters between the ANB and contralateral sides in all patients. The radiologic parameters of both feet in symptomatic and asymptomatic patients were not significantly different. No significant differences were noted between the affected sides of type 1 and 2 ANB and contralateral sides in terms of the radiologic parameters. BMI was significantly correlated with NCO and TNCA. Conclusion: This study demonstrated that the presence of an accessory navicular bone did not affect radiologic parameters of the foot. Radiologic parameters of both feet in symptomatic patients were not significantly different. Level of Evidence: Level III, diagnostic, comparative study.

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