Systematic review: better or (otherwise) misleading for clinical decision?

Systematic review is a method to combine multiple sources of evidence through an explicit and reproducible way ofliterature search and critical appraisal of the quality of included studies, with or without mathematical methods tosynthesis these information. Since this method was first introduced more than centuries ago, systematic review hasbeen increasingly popular and widely used particularly in the area of medicine. Systematic review is often veryuseful to physicians to help supporting the clinical decision making and significantly reducing their time to seek forappropriate evidence. However, despite its reproducible and systematic steps to substantially minimize the presenceof biases, physicians should still be aware that systematic review is not completely biases resistant. Inclusion ofpoor quality studies, heterogeneity, and publication or other reporting biases are commonly evident in systematicreview that may hinder the quality of the conclusion. This review summarizes the core principals of systematicreview and its potential biases, and discusses when the systematic review is useful or needing careful attention.Key words: treatment-scientific evidence- meta-analysis- critical appraisal-outcome

Perancangan Pengukur Kapasitansi Orde Femtofarad Berbasis Rangkaian Aktif Differensial Untuk Sistem Electrical Capacitance Volume Tomography (ECVT)

Electrical Capacitance Volume Tomography (ECVT) is an imaging technique based on the value of the capacitance from an object.  ECVT systems require signal conditioning circuit that is able to measure the capacitance value in femtofarad (fF) orde, then convert it into a voltage (C-V). The design of the signal conditioning circuit with a differential active methods created with the LTspiceIV software. The results of a design that has been prepared then realized by making the signal conditioning circuit. Tests conducted using sensors ECVT 8 channel by using multiple samples are air, water, and palm oil (crude palm oil). The calibration process is performed to determine the range of capacitance that can be measured, there are determined of normalization capacitance used object which has low permittivity, that is air (ɛ = 1) has capacitance result of 81,7 fF for the closest of electrode pair and 700,5 fF for the farthest of electrode, meanwhile for the maximum value which has high permittivity, that is water (ɛ = 80) had capacitance result of 2422,3 fF for the closest and the farthest of electrode. Meanwhile crude palm oil (ɛ = 1,75) had capacitance value of 1156,9 fF for the closest electrode pair and 192,4 fF for the farthest electrode pair.  The result of sensitivity from experience was average of 1,5982 fF/mV Keywords— ECVT, LTspiceIV, Sensitivity, Femtofarad, signal conditionin

The predictive factor for conjunctival melanoma recurrence

Conjunctival melanoma potentially deadly tumor. While many cases of conjunctival melanoma appeared to be a recurrence, there is no valid data about parameters to predict the recurrence of this tumor. This study intended to evaluate whether histopathologic features can be used as a predictor for recurrence in conjunctival melanoma. This was a retrospective study, involving patients with conjunctival melanoma by the year 2013-1017 in Dr. Sardjito General Hospital and Dr. Yap Eye Hospital, Yogyakarta. Patient’s characteristic was determined by age, sex, laterality, tumor size, tumor location, histopathological dominancy, MMC application, recurrence, and metastases. Sixteen cases were found: male (62.5%) and female (37.5%). Age from 5-79 years, mean was 56.19 years. Tumor location was in bulbar in 11 patients (68.7%), palpebral in 5 patients (31.3%).There was significant association between metastasis and the tumor recurrence (OR 13.0; 95% CI 1.9-85.4; p = 0.007). A favorable trend of association was also found between location and the recurrence of melanoma (OR 15.0; 95% CI 0.9-228.8; p = 0.06). In summary, our study showed that the patients that developing distant metastasis were at a greater risk for tumor recurrence

The eyelid tumor in Yogyakarta, Indonesia

Many types of eyelid tumors may easily be diagnosed from a clinical point of view. However only a small number of large studies exist exploring the frequency of eyelid lesions from different regions. According to the epidemiology of various eyelid lesions happened in Yogyakarta Special Region, this study was aimed to investigate the prevalence of eyelid tumors in Yogyakarta Special Region. A total of 94 patients were enrolled in a descriptive study. The data were taken retrospectively from the medical record. All patients were diagnosed with eyelid tumors from January 2014 until December 2017 by histopathological examination. Among the subjects, 56 (59.6%) were male and 38 (40.4%) were female. There was no difference found in laterality (OD 46% vs OS 50%). Sebaceous carcinoma was found in 15 (16%) patients, followed by squamous cell carcinoma (SCC) 13 (13.8%), basal cell carcinoma (BCC) 11 (11.7%), epidermoid cyst 7 (7.4%), non-Hodgkin lymphoma 7 (7.4%), and others. We also found that 11 (11.7%) of patients showed an inflammation appearance only. The therapy was varied from extirpation and biopsy (39.4%), wide excision (27.7%), excision and biopsy (18.1%), exenteration (10.6%), and also anterior and lateral orbitotomy (2.1%) for each procedure. The eyelid tumor was found equally in the right and the left eye. Sebaceous carcinoma followed by SCC and BCC were the most common eyelid tumor found in this study. A further study is needed to determine the risk factor of each tumor

The risk factor of metastatic status of retinoblastoma patient in Yogyakarta Tertiary Hospital

The metastases of the tumor become a serious problem malignancy including retinoblastoma. This study aimed to observe the correlation between several risk factors with the metastatic status of retinoblastoma patients in Yogyakarta Tertiary Hospital. Records of patients with retinoblastoma treated between 2011 and 2017 were obtained for observational analytic study. The gender, laterality, age, Body Mass Index (BMI) classification, BMI for age, type of retinoblastoma, and metastatic status were analyzed. The association was statistically analyzed by the correlation ratio of Eta test. Thirty-seven cases of retinoblastoma were enrolled in this study, with mean age 29.44 (±14.1) months; 14 females and 23 males. Ten patients (27.0%) have no metastases, while 27 patients (72.9%) exhibit metastases. The multivariate logistic regression analysis demonstrated that male gender (OR 8.3; 95% CI 1.07–64.5; p = 0.04) and age below 24 months (OR 17.6; 95% CI 1.26-248.31; p = 0.03) were a predictive of the metastatic status for retinoblastoma. On the other hand, the laterality, BMI classification, BMI for age, and types of retinoblastoma were not associated with the metastatic status of retinoblastoma. The gender and age were significantly associated with the metastatic status of retinoblastoma. Male patients and age below 24 months were more likely to have metastatic disease of retinoblastoma

Serum Apolipoprotein AI and B Are Stronger Biomarkers of Diabetic Retinopathy Than Traditional Lipids

10.2337/dc10-0793Diabetes Care342474-479DICA

Associations of <i>ARMS2</i> and <i>CFH</i> Gene Polymorphisms with Neovascular Age-Related Macular Degeneration.

PurposeThis study aimed to determine the association of ARMS2 A69S, ARMS2 del443ins54, and CFH Y402H polymorphisms with neovascular age-related macular degeneration (nAMD) for the first time in an Indonesian population.Patients and methodsOur case-control study involved 104 nAMD and 100 control subjects. AMD diagnosis was evaluated by retinal specialists based on color fundus photography and optical coherence tomography. The polymorphisms on CFH Y402H and ARMS2 A69S were analyzed by PCR-restriction fragment length polymorphism (PCR-RFLP), whereas ARMS2 del443ins54 was evaluated by PCR-based assay.ResultsSignificant allelic associations with nAMD were detected on all polymorphisms (PARMS2 A69S (OR 3.13; 95% CI 2.08-4.71; PARMS2 del443ins54 (OR 3.28; 95% CI 2.17-4.95; PCFH Y402H (OR 2.08; 95% CI 1.08-3.99; P=0.028). Genotype analysis showed a statistical difference between nAMD and the control group for all polymorphisms (PCFH Y402H (P=0.043) than for ARMS2 A69S and ARMS2 del443ins54 (PARMS2 A69S and hypertension was documented (OR 9.53; 95% CI 3.61-25.1; PConclusionOur findings indicate that ARMS2 A69S and ARMS2 del443ins54 polymorphisms are strongly associated with the risk of nAMD for the first time in an Indonesian population. The risk of nAMD increased when the presence of risk alleles from ARMS2 A69S was combined with the presence of hypertension

Retinal vascular geometry and its relationships to diabetes and diabetic retinopathy

© 2012 Dr. Sasongko, Muhammad BayuPURPOSE: Diabetic retinopathy (DR) is a major cause of visual disability worldwide. Retinal vessel diameter, measured from fundus photographs, has been shown to be predictive of DR. However, other parameters reflecting the geometry of the retinal vasculature (e.g. vessel tortuosity, branching angle) in DR are unexplored. This doctoral work presents the associations between traditional DR risk factors and retinal vascular geometry (aim 1), associations of retinal vascular geometry with DR (aim 2), and with novel markers of DR including the relative contribution of these markers and retinal vascular geometry to DR (aim 3). METHODS: This study used two specific clinical samples of children and adolescents (aged 12 to 20 years) with type 1 diabetes (N=1200) and adults (aged 18 to 70 years) with type 1 and 2 diabetes (N=244). Retinal vascular geometric parameters (tortuosity, branching angle, length to diameter ratio, optimality deviation) were measured from disc-centred fundus photographs using semi-automated computer software following standardized protocol. DR was also assessed from fundus photographs (7-field for the children sample and 2-field for the adult sample), according to modified Airlie House Classification, and categorized into mild, moderate, and vision-threatening DR (VTDR, including severe non-proliferative and proliferative DR, with or without clinically significant macular oedema). Detailed clinical characteristics (e.g. duration of diabetes, blood pressure, body mass index [BMI], the use of insulin and other medications, history of cardiovascular or other diseases) were obtained via interview with a specific questionnaire and clinical examinations. Traditional and novel biomarkers were assessed from fasting blood sample, including concurrent HbA1c level, fasting blood glucose, cholesterol and other lipid profiles, serum creatinine, apolipoprotein (Apo) AI and B, high sensitivity C-reactive proteins [CRP], soluble e-selectin, inter-cellular adhesion molecule-1 [ICAM-1], vascular adhesion molecule-1 [VCAM-1], total nitrite, and endothelin-1 [ET-1] levels. Measures of dynamic retinal and skin microvascular function were also obtained using dynamic retinal vessel analyser and skin iontophoresis. Associations of traditional and novel risk factors with retinal vascular geometry were assessed using analysis of covariance and generalized linear models. Associations of retinal vascular geometry with DR and DR severity were assessed using binary, ordinal, and multinomial logistic regression models. RESULTS: Aim 1: Associations between traditional DR risk factors and retinal vascular geometry Longer diabetes duration was associated with larger arteriolar branching angle and increased arteriolar optimality deviation; higher HbA1c was associated with increased arteriolar tortuosity; higher SBP was associated with decreased arteriolar LDR; and higher total cholesterol levels was associated with increased arteriolar LDR and decreased venular optimality deviation in the children sample. In the adult sample, longer diabetes duration was associated with increased arteriolar tortuosity. Aim 2: Associations of retinal vascular geometry with DR DR was present in 170 (18%) of the children, and in 114 (44%) of the adults. Retinal arteriolar tortuosity showed significant associations with DR, in both children (odds ratio [OR] 1.42, 95% confidence interval [CI] 1.11 – 1.83; P=0.005; per standard deviation [SD] increase in arteriolar tortuosity) and adults (OR for mild DR 1.53, 1.03 – 2.05; P=0.014; OR for moderate DR 1.67, 1.10 – 2.55; P=0.016; per SD increase). Aim 3: Associations of novel markers for DR with retinal vascular geometry and the relative contribution of retinal vascular geometry to DR Among the adults, ApoAI level was inversely associated with DR (OR 0.76, 95% CI 0.59–0.98; per SD increase), while ApoB and ApoB/AI (OR 1.31, 1.02–1.68 and OR 1.48, 1.13–1.95; per SD increase in ApoB and ApoB/AI respectively) were positively associated with DR. Increasing CRP levels were positively associated only with the presence of VTDR (OR 1.38, 1.07–1.68, per SD increase), which was more pronounced in subjects with BMI≥30 kg/m2 (OR 2.9; P=0.019 for interaction). Per SD increase in ApoAI level was inversely (mean difference in arteriolar tortuosity -2.83 x 10-5 ; P=0.044), while ApoB was positively (mean difference 1.75 x 10-5; P=0.050) associated with arteriolar tortuosity. Reduced flicker-light induced retinal vasodilation was related to more tortuous arterioles and venules (mean difference in arteriolar tortuosity 5.62 x 10-5, 4.50 – 6.72 x 10-5; P<0.001 and in venules 5.94 x 10-5, 3.33 – 8.55 x 10-5; P<0.001; comparing highest vs. lowest tertile of flicker-light vasodilation). Finally, diabetes duration contributed the most (51%) to the risk of DR, followed by ApoAI (16%), SBP (13%), retinal arteriolar tortuosity (8%), and flicker-light induced venular and arteriolar dilation (3% and 0.5% respectively). CONCLUSIONS: Key diabetes-related factors (e.g. duration of diabetes, HbA1c level) are associated with retinal microvascular geometry, mainly arteriolar tortuosity. In line with this, increased arteriolar tortuosity is also consistently associated with early stages of DR in both study samples. Furthermore, we demonstrate relationships between retinal arteriolar tortuosity and a number of novel risk markers for DR found in this study (serum ApoAI and ApoB) and also to novel markers for DR found in other studies (flicker-light induced retinal vascular function). Retinal arteriolar tortuosity and ApoAI is shown to have considerable contribution to DR risk and substantially improved the clinical performance of DR prediction model in terms of the specificity, independent of traditional risk markers. These findings provide novel evidence that variations in retinal vascular tortuosity may be markers of diabetes-related vascular damage due to adverse exposure of diabetic milieu, reflecting increased person’s susceptibility to DR

Ischemia Modified Albumin (IMA) as a New Biomarker in the Ophthalmology Field: A Brief Literature Review

Purpose: This study aimed to review the potential role of ischemia-modified albumin as a biomarker for diagnostic modalities in the ophthalmology field. Methods: Articles were reviewed without a specific date. A manual search was also performed by reviewing reference lists of meta-analyses and systematic reviews. All articles were reviewed, and a total of 18 articles were selected by the authors. Results: Oxidative stress increases structural and functional damage to proteins in many ocular diseases. The human serum albumin is a major circulating protein with antioxidative and anti-inflammatory properties. Oxidative stress has been shown to be an important part of etiology and pathogenesis in ocular diseases related to ischemia. Biomarkers that are specific to oxidative stress and ischemia-related ocular pathogenesis are needed to provide an extensive understanding regarding diagnosis, monitoring progression, and new potential target treatment. Ischemia-modified albumin (IMA) as a new promising biomarker might be useful in the early detection and treatment of ocular diseases with ischemic pathogenesis. Conclusion: IMA plays an important role in the progression of ophthalmology diseases, such as diabetic retinopathy, hypertensive retinopathy, cataract progression, seasonal allergies, and glaucoma. Further studies are needed to elaborate these results as a consideration in new testing modalities in clinical practice as well as a new target therapy research