Late reperfusion with vision improvement in central retinal artery occlusion after surgical embolectomy — a case report

BACKGROUND: The objective was to report a case of central retinal artery occlusion (CRAO) with late gradual improvement of visual acuity after surgical embolectomy. CASE PRESENTATION: A 65-year-old woman with central retinal artery occlusion in the left eye for two days and visual acuity counting fingers (20/2000, logMAR 2.0). Due to a significant decrease in visual acuity and the long-term course of the disease, it was decided to perform a vitrectomy. The technique was adjusted to the location of the embolic material and the extent of retinal ischemia. The aim of the vitrectomy was evacuation of the embolus and improvement in perfusion.RESULTS: After treatment, visual acuity gradually improved. After 18 months of observation, the patient’s visual acuity was 20/63 (LogMAR 0.5). CONCLUSION: Despite the potential risk assessment, embolectomy could be considered as a treatment option in selected cases of central retinal artery occlusion

Evaluation of antiarrythmic activity of novel imidazo[2,1-F]purine-2,4-dione and imidazolidine-2,4-dione derivatives with aminoalkyl moieties

The main goal of this study was to assess antiarrhythmic activity of novel aminoalkyl derivatives of imidazo[2,1-f]purine-2,4-dione and imidazolidine-2,4-dione exerting α1 and 5-HT1A receptors affinity. Tested compounds produced prophylactic and therapeutic antiarrhythmic activity in an adrenaline-induced model of arrhythmia. The strongest antiarrhythmic activity as well as the highest α1-adrenoreceptor affinity (Ki = 13.9 nM) was found for 5-methyl-5-phenyl-3-[3-(4-(2-methoxyphenyl)piperazin-1-yl)propyl]-imidazolidine-2,4- dione (12). The results indicated a correlation between α1-adrenoreceptor affinities and antiarrhythmic activity

Comparative effectiveness of torasemide versus furosemide in symptomatic therapy in heart failure patients: Preliminary results from the randomized TORNADO trial

Background: Recent reports suggest that torasemide might be more beneficial than furosemide inpatients with symptomatic heart failure (HF). The aim was to compare the effects of torasemide andfurosemide on clinical outcomes in HF patients.Methods: This study pilot consisted of data from the ongoing multicenter, randomized, unblindedendpoint phase IV TORNADO (NCT01942109) study. HF patients in New York Heart Association(NYHA) II–IV class with a stable dose of furosemide were randomized to treatment with equipotentialdose of torasemide (4:1) or continuation of unchanged dose of furosemide. On enrollment andcontrol visit (3 months after enrollment) clinical examination, 6-minute walk test (6MWT) andassessment of fluid retention by ZOE Fluid Status Monitor were performed. The primary endpoint wasa composite of improvement of NYHA class, improvement of at least 50 m during 6MWT and decreasein fluid retention of at least 0.5 W after 3-months follow-up.Results: The study group included 40 patients (median age 66 years; 77.5% male). During follow-up7 patients were hospitalized for HF worsening (3 in torasemide and 4 in furosemide-treated patients).The primary endpoint reached 15 (94%) and 14 (58%) patients on torasemide and furosemide, respectively(p = 0.03).Conclusions: In HF patients treated with torasemide fluid overload and symptoms improved more thanin the furosemide group. This positive effect occurred already within 3-month observation

Niewłaściwe przepisywanie zredukowanej dawki NOAC w praktyce klinicznej — wyniki Polskiego Rejestru Migotania Przedsionków (POL-AF) u hospitalizowanych pacjentów

Introduction. Prescribing non-vitamin K antagonist oral anticoagulants (NOACs) in a reduced or full dosage is important for providing patients with atrial fibrillation (AF) with efficacious and safe treatment. The study aimed to evaluate the administration frequency of reduced NOAC dosages against the guidelines and analysis of factors predisposing to such a choice in patients with AF included in the Polish Atrial Fibrillation (POL-AF) Registry. Material and methods. The study included 1003 patients with AF treated with reduced dosages of NOACs hospitalized in ten Polish cardiology centers from January to December 2019. The criteria for appropriately reduced NOAC dosages was a dosage reduction of individual NOAC from the clinical studies, which was the basis for their registration. Results. Among the 1003 patients who were treated with a reduced dosage of NOACs, inappropriately reduced dosages were observed in 242 patients (24.1%): in 120 patients (29.3%) treated with rivaroxaban, in 93 patients (33.8%) treated with apixaban and in 29 patients (9.1%) treated with dabigatran (p &lt; 0.0001). Independent predictors of the use of inappropriately reduced dosages of NOACs were heart failure (odds ratio [OR] 1.55, confidence interval [CI]: 1.08–2.22) and hospitalization due to cardiac implantable electronic device (CIED) implantations/reimplantations (OR 2.01, CI: 1.27–3.17). Factors diminishing the chances of using inappropriately reduced dosages of NOACs were age (OR 0.98, CI: 0.97–0.998), vascular disease (OR 0.29, CI: 0.21–0.40) and creatinine clearance (CrCl) &lt; 60 mL/min (OR 0.37, CI: 0.27–0.52). Conclusions. In the group of patients treated with a reduced dosage of NOAC, 24.1% of patients had an inappropriately reduced dosage prescription, most frequently the patients receiving apixaban and rivaroxaban. The factor predisposing to prescribing an inappropriately reduced dosage of NOAC was heart failure and hospitalization due to CIED implantation/reimplantation. Label adherence to NOAC dosage is important to improve clinical outcomes in AF patients, and further investigation is needed to assess the best dosage of NOACs in the AF population.Wstęp. Przepisywanie doustnych przeciwkrzepliwych leków niebędących antagonistami witaminy K (NOAC) w dawce zredukowanej lub pełnej jest istotne dla zapewnienia pacjentom z migotaniem przedsionków (AF) skutecznego i bezpiecznego leczenia. Celem badania było ocenienie częstości stosowania zredukowanych dawek NOAC w stosunku do wytycznych oraz analiza czynników predysponujących do takiego wyboru u pacjentów z AF zarejestrowanych w Polskim Rejestrze Migotania Przedsionków (POL-AF). Materiał i metody. Badanie obejmowało 1003 pacjentów z AF leczonych zredukowanymi dawkami NOAC, hospitalizowanych w 10 polskich ośrodkach kardiologicznych od stycznia do grudnia 2019 roku. Kryterium stosowania odpowiednio zredukowanych dawek NOAC była redukcja dawki indywidualnego leku NOAC na podstawie badań klinicznych, które były podstawą ich rejestracji. Wyniki. Spośród 1003 pacjentów leczonych zredukowanymi dawkami NOAC, nieodpowiednio zredukowane dawki zaobserwowano u 242 pacjentów (24,1%): u 120 pacjentów (29,3%) leczonych rywaroksabanem, u 93 pacjentów (33,8%) leczonych apiksabanem oraz u 29 pacjentów (9,1%) leczonych dabigatranem (p < 0,0001). Niezależnymi czynnikami predykcyjnymi stosowania nieodpowiednio zredukowanych dawek NOAC były: niewydolność serca (iloraz szans [OR] 1,55; przedział ufności [CI]: 1,08–2,22) oraz hospitalizacja związana z wszczepieniem/reimplantacją kardioelektronicznych urządzeń wszczepialnych (CIED) (OR 2,01; CI: 1,27–3,17). Czynnikiem zmniejszającym szanse na stosowanie nieodpowiednio zredukowanych dawek NOAC były: wiek (OR 0,98; CI: 0,97–0,998), choroba naczyniowa (OR 0,29; CI: 0,21–0,40) i klirens kreatyniny (CrCl) < 60 ml/min (OR 0,37; CI: 0,27–0,52). Wnioski. W grupie pacjentów leczonych zredukowaną dawką NOAC, 24,1% pacjentów miało nieodpowiednio przepisane dawki, najczęściej pacjenci otrzymujący apiksaban i rywaroksaban. Czynnikami predysponującymi do przepisywania nieodpowiednio zredukowanej dawki NOAC były niewydolność serca oraz hospitalizacja związana z wszczepieniem/reimplantacją CIED. Przestrzeganie zaleceń dotyczących dawek NOAC jest istotne dla poprawy wyników klinicznych u pacjentów z AF, konieczne jest również dalsze badanie w celu oceny optymalnej dawki NOAC w populacji z AF

Moral of the Novel: Rorty and Nussbaum on the Ethical Role of Literature

This paper’s aim is to provide a new interpretation of Martha C. Nussbaum’s and Richard Rorty’s views on the ethical role of literature. I pursue this aim in a threefold manner. First of all, I shortly discuss and provide a critique of previous comparisons by other authors. Afterwards, based on the presented critique of other comparisons, I present concise summaries of their respective views. Finally, I propose a double context for interpreting and assessing their views together. The main claim of the paper is the following: despite several differences in their philosophical underpinnings, Nussbaum’s and Rorty’s views on literature can be interpreted together using the context of John Rawls and Jacques Rancière. This interpretation consists of showing how uncovering a shared Rawlsian characteristic of Nussbaum’s and Rorty’s views paves a way for explaining how literature actually does ethical work, using some concepts of Rancière. Such a contextual reading allows for both a more thorough understanding of their respective projects and assessing their shared shortcomings

A question concerning the construction of a New Digital Leviathan

Celem artykułu jest analiza koncepcji „cyfrowego Lewiatana”, jaka pojawia się w literaturze na styku filozofii technologii i filozofii społecznej. Nowy Cyfrowy Lewiatan, poza oczywistym odniesieniem do klasycznej koncepcji Th. Hobbesa, stanowi kontynuację tego, co M. Hardt i A. Negri nazwali „Imperium”, a B. Bratton określił jako „Stos” (the Stack). Argumentuję, że kluczowe jest spojrzenie na nowego Lewiatana jako na trwający wciąż proces budowy, a zatem w sposób procesualny, który pozwala na wydobycie ważnych charakterystyk tego globalnego techno-politycznego konstruktu. Wskazuję, że rozbudowa cyfrowego Lewiatana ma charakter odśrodkowy i pozbawiony odgórnego planu, który by wskazywał docelowe efekty całego przedsięwzięcia. Dostrzegam w tym wynik opisywanego przez J.F. Lyotarda kryterium performatywności, a także totalizujący rys, który objawia się m.in. w tym, że rozbudowa ta angażuje nas wszystkich. Cyfrowy Lewiatan może stanowić niebezpieczne zwieńczenie drogi od Rozumu, poprzez racjonalność, aż po szaleństwo racjonalizacji. Poddaję też dyskusji konsekwencje, jakie rozbudowa Lewiatana ma dla naszej zdolności myślenia w ogóle, a w szczególności do konceptualizacji samego tego tworu. Wiążę ten temat z próbą krytyki myślenia utopijnego, akceptującego warunki „nie-miejsca”, zgodnie z ideą Negriego i Hardta. Myślenie takie, idąc za M. Heideggerem, odrywa nas od miejsca i umiejscowienia, które – jak zakładam – powinny być zawsze podstawą myślenia

Autologous Lens Capsule Flap Transplantation for Persistent Macular Holes

Purpose. To analyze the anatomical and functional outcomes after autologous lens capsule transplantation in patients with persistent macular hole. Methods. This is a retrospective observational study of five eyes of five patients treated with vitrectomy and autologous lens capsular flap transplantation. Complete ophthalmic examination was performed preoperatively and seven days and 1, 3, 6, 12, and 18 months after surgery. Results. Successful macular hole closure was achieved in all patients. The mean minimum macular hole diameter before the surgery was 666.8 µm, and the mean basal diameter was 1086.4 µm. The mean visual acuity before lens capsular flap transplantation was 20/200, while after surgery, it was 20/125. Conclusions. Autologous lens capsular flap transplantation is a potential alternative treatment for patients with large persistent macular holes after other operative techniques have failed

Encircling Scleral Buckling Surgery for Severe Hypotony with Ciliary Body Detachment on Anterior Segment Swept-Source Optical Coherence Tomography: A Case Series

This study aimed to evaluate the usefulness of an encircling scleral buckling procedure to manage severe hypotony secondary to proliferative vitreoretinopathy (PVR)-induced retinal detachment. This retrospective study included six eyes of six patients (five women and one man) with hypotony (intraocular pressure [IOP] &le; 6 mmHg) after multiple reattachment surgeries for PVR-induced retinal detachment. In patients with failure of hypotony resolution after conservative treatment (dexamethasone drops five times daily), 360&deg; scleral buckling was performed under periocular anesthesia. The light perception was evaluated immediately postoperatively. The anatomic parameters were evaluated pre- and postoperatively observed on anterior segment swept-source optical coherence tomography. Ciliary body detachment (CBD) secondary to advanced cyclitic membranes associated with PVR grades C and D was detected in all eyes with hypotony. The mean IOP increased in all eyes (4.83 mmHg preoperatively vs. 10.17 mmHg postoperatively, p = 0.006), with subsequent improvement in best-corrected visual acuity (1.91 logMAR preoperatively vs. 1.50 logMAR postoperatively, p = 0.034). However, no eye showed any significant changes in CBD postoperatively. Scleral buckling surgery might be useful to increase IOP in eyes with persistent severe hypotonia secondary to PVR-induced CBD. Further studies are needed to improve outcomes in eyes with severe PVR-induced retinal detachment