Diabetic maculopathy: multicolour and SD-OCT versus fundus photography

Objective The English Diabetic Eye Screening (DES) programme recommends patients with M1 diabetic maculopathy to be referred to hospital eye services. DES uses flash fundus photography as the reference standard for maculopathy grading. We compared multicolour versus non-stereoscopic fundus photography at identifying M1 maculopathy, with spectral domain optical coherence tomography (SD-OCT) identifying macular thickening. Methods and analysis This cross-sectional study included 345 patients with R1M1 referred from DES and reviewed in secondary care with fundus photographs, multicolour and SD-OCT. Maculopathy was graded based on DES exudate criteria on both multicolour and fundus photography in a blind fashion by two independent graders. Macular thickness was ascertained on SD-OCT. Results Intergrader agreement on grading maculopathy using fundus photography (Cohen’s κ=0.91) and multicolour (Cohen’s κ=0.82) was ‘almost perfect’. Agreement between fundus photography and multicolour on grading maculopathy (Cohen’s κ=0.76) was ‘substantial’. Compared with fundus photography, multicolour had sensitivity of 87% (95% CI 81% to 93%) and specificity of 90% (95% CI 87% to 94%) in detecting M1 maculopathy. SD-OCT identified 84 eyes with macular thickening, 47 of which were graded as M0 by fundus photography. 5 eyes with exudates and severe macular oedema requiring urgent intervention were also missed on fundus photography but not on multicolour. Multicolour, when complemented by SD-OCT, did not miss any clinically significant macular oedema. Conclusion Multicolour integrates synergistically in a single platform with SD-OCT providing effective monitoring of M1 diabetic maculopathy. The need for fundus photography is eliminated by multicolour/SD-OCT in dedicated R1M1 virtual clinics not requiring parallel diabetic retinopathy grading.Publisher PDFPeer reviewe

Calcific Myonecrosis of the Leg: A Rare Entity

Calcific myonecrosis is a rare disease that has been shown to be a late sequela of trauma. This article presents a 68-year-old man with calcific myonecrosis of the leg 40 years after a tibial fracture complicated with peroneal nerve palsy. The soft tissue mass increased in size after another injury to the leg that occurred two years before his presentation. Physical examination at presentation showed a palpable extra-osseous mass at the anterior aspect of the left leg; the mass was not adherent to adjacent soft-tissues and bone, and it was painless but tender to palpation. Radiographs of the left leg showed extensive calcification at the soft-tissue of the anterior and posterior leg. An ultrasonography-guided trocar biopsy was done; histological findings were indicative of calcific myonecrosis. Given the benign entity of the lesion and known high rate of complications, he was recommended for no further treatment except for clinical and imaging observation. Located at the site of the biopsy, he experienced infection with drainage that eventually healed after six months with antibiotics and wound dressing changes. During the last follow-up examination, two years after diagnosis, the patient was asymptomatic without progression of the mass

A educação ambiental no processo de higienização e producão de resíduos sólidos nos hospitais

Monografia (especialização)—Universidade de Brasília, Centro de Excelência em Turismo, 2009.Esta pesquisa tem como objetivo principal discutir a importância da Educação ambiental como fator diferencial na gestão dos processos de higienização e produção de resíduos sólidos de saúde nos hospitais, no sentido de promover a conscientização sobre a necessidade de preservação e conservação do meio em que se vive. Enfatiza os padrões de higienização necessários às instituições de saúde, bem como a segregação dos resíduos de forma correta e com uma proposta de que sejam reciclados os possíveis resíduos resultantes do hospital. Aponta intervenção governamental com a participação da sociedade e com ações pedagógicas que amenizará a degradação ambiental, principalmente com a reciclagem dos resíduos sólidos e orgânicos gerados pelas instituições de saúde. Aborda propostas de mudanças e capacitação profissional dos colaboradores da higienização sendo esta proposta em parceria com os próprios gestores hospitalares e ou empresas especializadas, no sentido de buscar um aperfeiçoamento dos serviços. Ressalta o grande problema do impacto ambiental e da preservação da natureza cuja resolução é de difícil solução, pois engloba mudanças de conceitos do homem. Aponta para uma revisão no currículo escolar no sentido de conscientizar a população desde cedo à preservação ambiental e conservação dos locais públicos.This research mainly aims at discussing the importance of environmental education as a differential factor in the management of processes and hygienic production of solid waste in health in hospitals, to promote awareness of the need to preserve and conserve the environment in which we live. Emphasizes the hygienic standards required for health institutions, as well as segregation of waste properly and with a proposal to recycle all possible waste resulting from the hospital. Points of government intervention with the participation of society and pedagogical actions that will alleviate environmental degradation, mainly from recycled and organic waste generated by healthcare institutions. Discusses proposed changes and professional training of staff hygiene, and this proposal in partnership with their own managers and hospital or specialized companies in order to seek an improvement of services. Highlights the major problem of environmental and nature conservation issues which are difficult to solve, because it includes changes in concepts of man. Points to a revision in the school curriculum to raise awareness early environmental preservation and conservation of public places

Current concepts from diagnosis to management in Gorham–Stout disease: a systematic narrative review of about 350 cases

• Patients with Gorham–Stout disease (GSD) present progressive destruction and resorption of bone. • Typical bone-related symptoms include swelling, pain and functional impairment in the region involved. • The three aspects of GSD etiopathology are osteoclasts, angiogenesis/lymphangiogenesis and osteoblast function. • Multi-targeted pharmacological approach includes innovative options and represent milestones of treatment, sometimes associated with radiotherapy. • Surgery is mainly used to treat complications: pathologic/impending fractures, spinal instability or deformities and chylothorax. • In this narrative review, we highlight current standards in diagnosis, clinical management and therapeutic strategies

Giant cell reparative granuloma of the scapula: report of a case and literature review

Giant cell reparative granulomas (GCRGs) are non-neoplastic inflammatory lesions, usually observed in the maxilla, mandible or small bones of the hands and feet. These lesions present a wide range of morphology and the misinterpretation with other giant cell lesions can often occur. We report the case of a 47-year-old woman with GCRG in the left scapula, presenting some uncommon features: the location (scapula) and age at presentation, the lack of underlying bone disease such as Paget's disease or fibrous dysplasia, the large aggressive expansile aspect of the lesion. This was a therapeutic study, level IV (case series with no or a historical control group)

The Orthopedic-Vascular Multidisciplinary Approach Improves Patient Safety in Surgery for Musculoskeletal Tumors: A Large-Volume Center Experience

Objective: Wide-margin resection is mandatory for malignant bone and soft tissue tumors. However, this increases the complexity of resections, especially when vessels are involved. Patients in this high-risk clinical setting could be surgically treated using the multidisciplinary orthopedicvascular approach. This study was carried out in this healthcare organization to evaluate patient safety in term of oncologic outcomes and reduction of the complication rate. Materials and Methods: We retrospectively reviewed 74 patients (37 males, 37 females; mean age 46 years, range 9\u201388) who underwent surgical excision for bone/soft tissue malignant tumors closely attached to vascular structures from October 2015 to February 2019. Vascular surgery consisted of isolation of at least one vessel (64 patients), bypass reconstruction (9 patients), and end-to-end anastomosis (1 patient). Mean follow-up was 27 months. Patients\u2019 demographics, tumor characteristics, adjuvant treatments, type of orthopedic and vascular procedures, and oncologic and functional outcomes and complications were recorded. Results: Overall survival was 85% at 3 years follow-up. In total, 22 patients experienced at least one major complication requiring further surgery and 13 patients experienced at least one minor complication, whereas 17 reported deviations from the normal postoperative course without the need for pharmacological or interventional treatment. Major complications were higher in pelvic resections compared to limb-salvage procedures (p = 0.0564) and when surgical time was more than 4 h (p = 0.0364 at univariate analysis, whereas the most important multivariate independent predictors for major complications were pelvic resection (p = 0.0196) and preoperative radiotherapy (p = 0.0426). Conclusions: A multidisciplinary ortho-vascular approach for resection of malignant bone and soft tissue tumors tightly attached to important vascular structures should be considered a good clinical practice for patient safety

Timing anticipation in adults and children with Developmental Dyslexia: evidence of an inefficient mechanism

Developmental Dyslexia (DD) is a learning disorder characterized by specific difficulties in learning to read accurately and fluently, which has been generally explained in terms of phonological deficits. Recent research has shown that individuals with DD experience timing difficulties in the domains of language, music perception and\ua0motor control, probably due to impaired rhythmic perception, suggesting that timing deficit might be a key underlying factor to explain such a variety of difficulties. The present work presents two experiments aimed at assessing the anticipatory ability on a\ua0given rhythm of 9-year old Italian children and Italian adults with and without\ua0DD. Both adults and children with DD displayed a greater timing error and were more variable than controls in high predictable stimuli. No difference between participants with and without DD\ua0was found in the control condition, in which the uncertain timing of the beat did not permit the extraction of regularities. These results suggest that both children and adults with DD are unable to exploit temporal regularities to efficiently anticipate the next sensory event whereas control participants easily are. By showing that the anticipatory timing system of individuals with Developmental Dyslexia appears affected, this study adds another piece of evidence to the multifaceted reality of Developmental Dyslexia

Dyslexic children fail to comply with the rhythmic constraints of handwriting

In this study, we sought to demonstrate that deficits in a specific motor activity, handwriting, are associated to Developmental Dyslexia. The linguistic and writing performance of children with Developmental Dyslexia, with and without handwriting problems (dysgraphia), were compared to that of children with Typical Development. The quantitative kinematic variables of handwriting were collected by means of a digitizing tablet. The results showed that all children with Developmental Dyslexia wrote more slowly than those with Typical Development. Contrary to typically developing children, they also varied more in the time taken to write the individual letters of a word and failed to comply with the principles of isochrony and homothety. Moreover, a series of correlations was found among reading, language measures and writing measures suggesting that the two abilities may be linked. We propose that the link between handwriting and reading/language deficits is mediated by rhythm, as both reading (which is grounded on language) and handwriting are ruled by principles of rhythmic organization

Rare aneurysmal bone cysts: multifocal, extraosseous, and surface variants

Multifocal, extraosseous, and surface aneurysmal bone cysts are rare variants of the primary lesions. The clinicopathological features are similar, and the optimal treatment is surgical. Although local recurrences may occur, the prognosis is excellent. This review article introduces the readers to a rare diagnosis which they may have been previously unfamiliar with, presents the clinicopathological and imaging features of these rare aneurysmal bone cyst variants, and discusses their diagnosis and treatment. The clinicians who treat patients with aneurysmal bone cysts should be familiar with these uncommon entities and their differential diagnosis