Intravitreal anti-VEGF therapy for choroidal neovascularisation secondary to pathological myopia: 4-year outcome

OBJECTIVE: To report the visual outcome after 4-year follow-up in a series of highly myopic eyes with choroidal neovascularisation (CNV) treated with antivascular endothelial growth factor (anti-VEGF) drugs. METHODS: A retrospective, non-randomised, multicentre, consecutive, interventional case series study was performed. 92 highly myopic eyes with subfoveal CNV were treated with intravitreal injection (IVI) of anti-VEGF. The initial protocol (1 vs 3 injections) was dictated by surgeons' preferences and followed by an as-needed monthly regime. Best-corrected visual acuity (BCVA) was evaluated at baseline and then monthly. The primary aim was to analyse BCVA changes. The effect of age, spherical equivalent (SE) and treating drug were evaluated as secondary objectives. RESULTS: The mean age of the patients was 57 years (SD 14, range 30-93). The mean number of letters read was 46.1 (SD 16.8, range 5-70) at baseline, 55.5 (SD 18.6, range 10-85) at 12 months, 50.1 (SD 20.1, range 5-82) at 24 months, 54.2 (SD 21.9, range 2-85) at 36 months and 53.1 (SD 22.5, range 1-83) at 48 months (p=0.000, initial vs 12, 24 and 36 months; p=0.01 initial vs 48 months; Student t test for paired data). The mean total number of IVI was 4.9 (SD 5.4, range 1-29). SE and treating drug had no influence on the final visual outcome and number of injections required. CONCLUSIONS: Intravitreal bevacizumab and ranibizumab are effective therapies and show similar clinical effects in highly myopic CNV. Visual acuity gain is maintained at 4-year follow-up

Cardboard floor: about the barriers for social progression and their impact on the representativeness of epidemiological studies.

This is the author accepted manuscript. The final version is available from BMJ Publishing via the DOI in this record The most disadvantaged extreme of the social continuum is usually underrepresented in epidemiological studies. We discuss the consequences of excluding this segment of the population and suggest different approaches for addressing this issue. In particular, we describe/analyse a barrier that tends to perpetuates people in the most disadvantaged extreme of the social continuum, hereinafter referred to as the “cardboard floor”. Besides, we propose different approaches to accessing to the least favoured, segment in order to study the cardboard floor. The adoption of these strategies could help to visualize this barrier, allowing to better monitoring social mobility and their expected health improvements, as well as increasing the representativity of population health studies.Medical Research Council (MRC

Improvement of the drug therapy results in patients with high blood pressure at a community pharmacy

En el presente trabajo se analizan las consecuencias de la actividad asistencial del farmacéutico en un grupo depacientes hipertensos de una ofi cina de farmacia. Se han estudiado los diferentes Problemas Relacionados con laMedicación (PRM) que podrían dar lugar a la aparición de Resultados Negativos asociados a la Medicación (RNM),clasifi cándolos y relacionándolos con las cualidades de necesidad, efectividad y seguridad de la farmacoterapia. Laincidencia de la vía de comunicación utilizada en la intervención (farmacéutico-paciente o farmacéutico-pacientemédico)sobre el resultado fi nal de ésta fue investigada, observándose un mejor resultado si se requería la colaboracióndel médico. En este estudio se ha puesto de manifi esto la necesidad de solucionar determinadas trabas quedifi cultan la mejor aplicación del servicio de seguimiento farmacoterapéutico a los pacientes y la inclusión de unmayor número de personas en éste.In the present work, the consequences of the sanitary assistance activity of the pharmacist in a group of patientswith high blood pressure are analyzed. The Drug Related Problems (DRP), detected in these patients at a communitypharmacy, that could generate Negative Results Associated to the Medication (NRM) were studied, carrying out aclassifi cation with respect to the pharmacotherapy qualities of necessity, effectiveness and security. The impact ofthe communication channel used in the intervention (pharmacist-patient or pharmacist-patient-doctor) in its fi nalresult was also studied. Better result was obtained when the collaboration with the doctor was selected. This studyalso remarks the need to overcome some barriers that hinders a better application of this pharmacotherapeuticmonitoring service and a greater integration of patients

Detection of possible undiagnosed cases of diabetes in customers at a community pharmacy

Entre el 28 de marzo y el 28 de junio de 2005 se desarrolló una campaña de detección de posibles diabéticos nodiagnosticados, de excelente aceptación y repercusión entre los usuarios de una ofi cina de farmacia. El Test deRiesgo de Diabetes de la American Diabetes Association (ADA) fue utilizado en la selección de las personas que sesometerían a una determinación de glucemia capilar en ayunas, mediante metodología basada en reacciones colorimétricas.Una puntuación de diez puntos o más en este test, fue el requisito preciso para ello. El 53,0 % de lostest obtuvieron una puntuación igual o superior a diez y el 36,4 % de las determinaciones de glucemia realizadasdieron un resultado mayor o igual a 110 mg/dL, de lo que se deduce la utilidad del test ADA en el enriquecimientode la muestra objeto de estudio. Las personas con estos valores elevados de glucemia, fueron remitidas al médicopara su valoración.As part of a localised health care initiative, a campaign for the detection of possible undiagnosed cases of diabeteswas carried out from the 28th of March to the 28th of June 2005, at a local community pharmacy, giving good resultsand a high level of acceptance from pharmacy customers. The diabetes risk test proposed by the American DiabetesAssociation (ADA) was used in the selection process of persons for blood glucose testing under conditions of previousfasting (8-10 hrs). The ADA test is based on a points scoring system, in which a score of 10 points is considered ascause for recommendation for blood glucose testing. The methodology used for the determination of blood glucoselevels in this research was that based on colorimetric reactions. In the ADA test, 53.0% of cases scored ten points orover, while 36.4% of blood glucose determinations resulted in levels equal to or over 110 mg/dL, thus indicating theusefulness of this tool for the purposes of research. Persons with such high levels of blood glucose were referred to aphysician for analysis

Diabetes mellitus remission in three cats with hypersomatotropism after cabergoline treatment

Three diabetic cats presented with polyuria, polydipsia, polyphagia and poor glycemic control. Cat 1 displayed prognathia inferior and had a body condition score (BCS) of 4/5; cat 2 had a BCS of 5/5; and cat 3 had broad facial features. Serum insulin-like growth factor 1 concentrations were compatible with hypersomatotropism in cat 1 and cat 2 (>1500 ng/ml and 1200 ng/ml, respectively) and just below the cut-off of 1000 ng/ml (947 ng/ml) in cat 3; in this last cat diagnosis was further supported by the presence of pituitary enlargement on MRI. Oral cabergoline (10 μg/kg q48h) was initiated. Insulin requirements progressively reduced, as evidenced by daily blood glucose monitoring and weekly blood glucose curves. Diabetic remission occurred in all three cats between the second and third months of cabergoline treatment. At the time of writing, remission has persisted thus far (cat 1: 23 months; cat 2: 14 months; cat 3: 38 months). Relevance and novel information: To our knowledge, these are the first reported cases of diabetic remission in cats with hypersomatotropism after cabergoline treatment, despite previous reports of this being an ineffective treatment. Further work is indicated to determine why some cats do, and others do not, respond to this treatment.Fil: Miceli, Diego Daniel. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Biología y Medicina Experimental. Fundación de Instituto de Biología y Medicina Experimental. Instituto de Biología y Medicina Experimental; Argentina. Universidad de Buenos Aires; ArgentinaFil: Vidal, Patricia Noemi. Universidad de Buenos Aires; ArgentinaFil: Pompili, Gustavo A. Universidad de Buenos Aires; ArgentinaFil: Castillo, Víctor A. Universidad de Buenos Aires; ArgentinaFil: Soler Arias, Elber A. Universidad de Buenos Aires; ArgentinaFil: Niessen, Stijn JM. Royal Veterinary College University ; Reino Unid

Blood Pressure and Hypertension in Adults Permanently Living at High Altitude: A Systematic Review and Meta-Analysis.

Aryal, Nirmal, Mark Weatherall, Yadav Kumar Deo Bhatta, and Stewart Mann. Blood pressure and hypertension in adults permanently living at high altitude: a systematic review and meta-analysis. High Alt Med Biol. 17:185-193, 2016.-The objective of this study was to estimate the associations between altitude and mean blood pressure (BP) (or prevalence of hypertension [HT]) in adults who live permanently at high altitude. A literature search was conducted in December 2014 using PubMed, Scopus, and OvidSP (MedLine and EMBASE) databases to identify relevant observational studies. Inclusion criteria were reports of studies in populations permanently living at an altitude of ≥2400 m and in those 18 years or older. Meta-regression was used to estimate the association between average BP and HT and altitude. We identified 3375 articles and inclusion criteria were met for 21 reports, which included a total of 40,854 participants. Random-effects meta-regression estimated that for every 1000 m elevation the average systolic BP (SBP) (95% confidence interval [CI]) increased by 17 mmHg (0.2 to 33.8), p = 0.05 and diastolic BP (DBP) by 9.5 mmHg (0.6 to 18.4), p = 0.04 in participants with Tibetan origin. By contrast, in participants with non-Tibetan origin, average SBP decreased by 5.9 mmHg (-19.1 to 7.3), p = 0.38 and DBP by 4 mmHg (-13 to 5), p = 0.38. The odds ratios (95% CI) for the proportion of participants with HT per 1000 m increment in the altitude were 2.01 (0.37 to 11.02), p = 0.446 and 4.05 (0.07 to 244.69), p = 0.489 for Tibetan and non-Tibetan participants, respectively. Sensitivity analysis excluding two studies with older participants (≥60 years) reversed the direction of this effect in non-Tibetans with odds ratio (95% CI) of 0.10 (0.004 to 2.22) per 1000 m, p = 0.143. Overall, this review suggests weak association between BP and altitude in Tibetan origin populations

Wilson loops stability in the gauge/string correspondence

We study the stability of some classical string worldsheet solutions employed for computing the potential energy between two static fundamental quarks in confining and non-confining gravity duals. We discuss the fixing of the diffeomorphism invariance of the string action, its relation with the fluctuation orientation and the interpretation of the quark mass substraction worldsheet needed for computing the potential energy in smooth (confining) gravity background. We consider various dual gravity backgrounds and show by a numerical analysis the existence of instabilities under linear fluctuations for classical string embedding solutions having positive length function derivative $L'(r_0)>0$. Finally we make a brief discussion of 't Hooft loops in non-conformal backgrounds.Comment: 34 pages, 36 figures. Reference added. Final version JHEP accepte

Valuation of EuroQol Five-Dimensional Questionnaire, Youth Version (EQ-5D-Y) and EuroQol Five-Dimensional Questionnaire, Three-Level Version (EQ-5D-3L) Health States: The Impact of Wording and Perspective

© 2018 ISPOR–The Professional Society for Health Economics and Outcomes Research Background: Valuations of health states were affected by the wording of the two instruments (EQ-5D-3L and EQ-5D-Y) and by the perspective taken (child or adult). Objectives: There is a growing demand for value sets for the EQ-5D-Y (EQ-5D instrument for younger populations). Given the similarities between EQ-5D-Y and EQ-5D-3L, we investigated whether valuations of health states were affected by the differences in wording between the two instruments and by the perspective taken in the valuation exercise (child or adult). Study Design: Respondents were randomly assigned to EQ-5D-3L or EQ-5D-Y (instrument) and further into two groups that either valued health states for an adult or for a 10-year-old child (perspective). The valuation tasks were composite time trade-off (C-TTO) and discrete choice experiments (DCE), including comparisons with death (DCE + death). Members of the adult general population in four countries (Germany, Netherlands, Spain, England) participated in computer-assisted personal interviews. Methods: Two-way multivariate analysis of variance (MANOVA) and post hoc tests were used to compare C-TTO responses and chi-square tests were conducted to compare DCE + death valuations. Results: A significant interaction effect between instrument and perspective for C-TTO responses was found. Significant differences by perspective (adult and child) occurred only for the EQ-5D-3L. Significant differences in values between instruments (EQ-5D-3L and EQ-5D-Y) occurred only for the adult perspective. Both significant results were confirmed by the DCE + death results. When comparing EQ-5D-3L for adult perspective and EQ-5D-Y for child perspective, values were also significantly different. Conclusions: The results identified an interaction effect between wording of the instrument and perspective on elicited values, suggesting that current EQ-5D-3L value sets should not be employed to assign values to EQ-5D-Y health states