The objective of this study was to observe the 1-year and 2-year pressure reduction in an active population of glaucoma patients treated by selective laser trabeculoplasty. We carried out a retrospective study of all patients treated in our department between January 2015 and March 2016. Patients who had already undergone Laser Trabeculoplasty (ALT or SLT) in the past were excluded from the study. Treatment was performed with a Q-Switched, frequency doubled Nd: YAG laser (Solutis - Quantel Medical, France), over 180° or 360° of the trabecular meshwork. The mean decrease in intraocular pressure and the success zrate, defi ned as a decrease in intraocular pressure superior to 20% without increasing the medical treatment, were calculated. The impact of the different clinical and technical characteristics on the decrease in pressure was also studied by multivariate analysis. One hundred and seventeen eyes, in 74 patients, were included. The mean decrease in IOP from baseline was 4.35 mmHg (20.6%) at 1 year and 3.74 mmHg (16.7%) at 2 years. The success rate was 49% at 1 year and 33.3% at 2 years. Selective trabeculoplasty is currently a therapeutic option called-upon at different stages in the progression of glaucoma. The duration of effi cacy of this laser therapy, and the retreatment frequency are yet to be defined.
Value of Medication Adherence in Chronic Vascular Disease: Fixed Effects Mode...M. Christopher Roebuck
This document summarizes a study that examined the impact of medication adherence on health services utilization and costs for patients with chronic vascular conditions. The study used claims data from over 135,000 patients to measure adherence rates and model the relationship between adherence and outcomes. The results showed that optimal adherence was associated with higher pharmacy costs but lower medical costs, leading to overall savings. Adherence had a greater impact on reducing utilization and costs for elderly patients compared to non-seniors.
Diagnoses from an on-line expert system for chronic pain confirmed by intra-o...Nelson Hendler
The Diagnostic Paradigm from www.MarylandClinicalDiagnostics.com is an on-line expert system, which gives diagnoses with a 96% correlation with diagnoses of Johns Hopkins Hospital doctors. To further confirm the accuracy of the Diagnostic Paradigm, a professor of neurosurgery from the University of Rome found 100% of the time, his intra-operative findings confirmed the diagnoses of the Diagnostic Paradigm. The Diagnostic Paradigm can be used to get pre-authorization for surgery from insurance companies, since it documents medical necessity
Interpreting population pharmacokinetic pharmacodynamic analyses – a clinical...Ming Chia Lee
Population pharmacokinetic-pharmacodynamic analyses allow modeling of drug response data from multiple individuals to quantify variability between patients and identify factors influencing this variability. A typical population model includes three elements: 1) a structural model describing the average response over time, 2) a model of heterogeneity characterizing variability between individuals, and 3) a model of uncertainty accounting for residual differences from the model. Such analyses are useful for optimizing drug dosing, designing clinical trials, and identifying covariates like age, weight or organ function that influence a drug's effects. The significance of identified covariate relationships must consider biological plausibility, clinical importance, and statistical measures.
The CABANA trial showed that catheter ablation was not superior to antiarrhythmic drug therapy for reducing cardiovascular outcomes over 5 years in patients with atrial fibrillation. The trial randomized over 2,200 patients to either ablation or drug therapy. The primary outcome of death, disabling stroke, serious bleeding, or cardiac arrest occurred in 8% of ablation patients and 9.2% of drug therapy patients, showing no significant difference. However, ablation did significantly reduce the secondary outcome of death or cardiovascular hospitalization compared to drug therapy. The PADIT trial found that using more extensive perioperative antibiotics for cardiac device implantation procedures did not significantly reduce device infections compared to a single preoperative dose of antibiotics. The SPritely trial will compare
Austin Ophthalmology is an open access, peer reviewed, scholarly journal dedicated to publish articles covering all areas of Ophthalmology.
The journal aims to promote latest information and provide a forum for doctors, researchers, physicians, and healthcare professionals to find most recent advances in the areas of Ophthalmology. Austin Ophthalmology accepts research articles, reviews, mini reviews, case reports and rapid communication covering all aspects of Ophthalmology.
Austin Ophthalmology strongly supports the scientific up gradation and fortification in related scientific research community by enhancing access to peer reviewed scientific literary works. Austin Publishing Group also brings universally peer reviewed journals under one roof thereby promoting knowledge sharing.
This document summarizes a study comparing the results of different treatments for prostate cancer. A group of experts assembled to conduct a comprehensive review of over 25,000 prostate studies published between 2000-2012. They identified 218 studies that met their criteria for comparing cancer control rates of treatments including surgery, radiation therapy, brachytherapy, high intensity focused ultrasound, and proton beam therapy. The group analyzed success rates for each treatment based on patients' prostate-specific antigen levels as an indicator of cancer progression over time.
8. a randomized clinical trial of vision therapy orthoptics versus pencil pus...Yesenia Castillo Salinas
This randomized clinical trial compared the effectiveness of vision therapy/orthoptics, pencil pushups, and placebo vision therapy/orthoptics for treating convergence insufficiency in adults aged 19-30. 46 patients were randomly assigned to receive one of the three treatments for 12 weeks. Vision therapy/orthoptics was the only treatment that significantly improved near point of convergence and positive fusional vergence. However, over half of patients receiving vision therapy were still symptomatic at the end of treatment, though symptoms were reduced. All treatments significantly improved symptoms, with 42% of vision therapy patients, 31% of placebo patients, and 20% of pencil pushup patients achieving elimination of symptoms.
This randomized clinical trial compared the effectiveness of vision therapy/orthoptics, pencil pushups, and placebo vision therapy/orthoptics for treating convergence insufficiency in adults aged 19-30. 46 participants were randomly assigned to 12 weeks of one of the three treatments. Vision therapy/orthoptics was the only treatment that significantly improved measures of near point of convergence and positive fusional vergence. However, over half of those in the vision therapy group still reported symptoms at the end of treatment, though reduced. All three groups reported statistically significant reductions in symptoms, with the highest percentage meeting the criteria for symptom elimination in the vision therapy group.
Value of Medication Adherence in Chronic Vascular Disease: Fixed Effects Mode...M. Christopher Roebuck
This document summarizes a study that examined the impact of medication adherence on health services utilization and costs for patients with chronic vascular conditions. The study used claims data from over 135,000 patients to measure adherence rates and model the relationship between adherence and outcomes. The results showed that optimal adherence was associated with higher pharmacy costs but lower medical costs, leading to overall savings. Adherence had a greater impact on reducing utilization and costs for elderly patients compared to non-seniors.
Diagnoses from an on-line expert system for chronic pain confirmed by intra-o...Nelson Hendler
The Diagnostic Paradigm from www.MarylandClinicalDiagnostics.com is an on-line expert system, which gives diagnoses with a 96% correlation with diagnoses of Johns Hopkins Hospital doctors. To further confirm the accuracy of the Diagnostic Paradigm, a professor of neurosurgery from the University of Rome found 100% of the time, his intra-operative findings confirmed the diagnoses of the Diagnostic Paradigm. The Diagnostic Paradigm can be used to get pre-authorization for surgery from insurance companies, since it documents medical necessity
Interpreting population pharmacokinetic pharmacodynamic analyses – a clinical...Ming Chia Lee
Population pharmacokinetic-pharmacodynamic analyses allow modeling of drug response data from multiple individuals to quantify variability between patients and identify factors influencing this variability. A typical population model includes three elements: 1) a structural model describing the average response over time, 2) a model of heterogeneity characterizing variability between individuals, and 3) a model of uncertainty accounting for residual differences from the model. Such analyses are useful for optimizing drug dosing, designing clinical trials, and identifying covariates like age, weight or organ function that influence a drug's effects. The significance of identified covariate relationships must consider biological plausibility, clinical importance, and statistical measures.
The CABANA trial showed that catheter ablation was not superior to antiarrhythmic drug therapy for reducing cardiovascular outcomes over 5 years in patients with atrial fibrillation. The trial randomized over 2,200 patients to either ablation or drug therapy. The primary outcome of death, disabling stroke, serious bleeding, or cardiac arrest occurred in 8% of ablation patients and 9.2% of drug therapy patients, showing no significant difference. However, ablation did significantly reduce the secondary outcome of death or cardiovascular hospitalization compared to drug therapy. The PADIT trial found that using more extensive perioperative antibiotics for cardiac device implantation procedures did not significantly reduce device infections compared to a single preoperative dose of antibiotics. The SPritely trial will compare
Austin Ophthalmology is an open access, peer reviewed, scholarly journal dedicated to publish articles covering all areas of Ophthalmology.
The journal aims to promote latest information and provide a forum for doctors, researchers, physicians, and healthcare professionals to find most recent advances in the areas of Ophthalmology. Austin Ophthalmology accepts research articles, reviews, mini reviews, case reports and rapid communication covering all aspects of Ophthalmology.
Austin Ophthalmology strongly supports the scientific up gradation and fortification in related scientific research community by enhancing access to peer reviewed scientific literary works. Austin Publishing Group also brings universally peer reviewed journals under one roof thereby promoting knowledge sharing.
This document summarizes a study comparing the results of different treatments for prostate cancer. A group of experts assembled to conduct a comprehensive review of over 25,000 prostate studies published between 2000-2012. They identified 218 studies that met their criteria for comparing cancer control rates of treatments including surgery, radiation therapy, brachytherapy, high intensity focused ultrasound, and proton beam therapy. The group analyzed success rates for each treatment based on patients' prostate-specific antigen levels as an indicator of cancer progression over time.
8. a randomized clinical trial of vision therapy orthoptics versus pencil pus...Yesenia Castillo Salinas
This randomized clinical trial compared the effectiveness of vision therapy/orthoptics, pencil pushups, and placebo vision therapy/orthoptics for treating convergence insufficiency in adults aged 19-30. 46 patients were randomly assigned to receive one of the three treatments for 12 weeks. Vision therapy/orthoptics was the only treatment that significantly improved near point of convergence and positive fusional vergence. However, over half of patients receiving vision therapy were still symptomatic at the end of treatment, though symptoms were reduced. All treatments significantly improved symptoms, with 42% of vision therapy patients, 31% of placebo patients, and 20% of pencil pushup patients achieving elimination of symptoms.
This randomized clinical trial compared the effectiveness of vision therapy/orthoptics, pencil pushups, and placebo vision therapy/orthoptics for treating convergence insufficiency in adults aged 19-30. 46 participants were randomly assigned to 12 weeks of one of the three treatments. Vision therapy/orthoptics was the only treatment that significantly improved measures of near point of convergence and positive fusional vergence. However, over half of those in the vision therapy group still reported symptoms at the end of treatment, though reduced. All three groups reported statistically significant reductions in symptoms, with the highest percentage meeting the criteria for symptom elimination in the vision therapy group.
- The study examined the effects of caffeine consumption and 24 hours of caffeine abstention on oculomotor performance as measured by videonystagmography (VNG).
- For most VNG measures, there was no statistically significant difference in performance between the caffeine and abstention conditions. The only statistically significant differences were for 40 deg/sec optokinetic nystagmography, but these differences were not considered clinically significant.
- While many participants reported caffeine withdrawal symptoms like fatigue after abstaining, these symptoms did not appear to have a clinically significant impact on oculomotor test performance.
Adjusting for Differential Item Functioning in the EQ-5D-5L Using Externally-...Office of Health Economics
Paula and Rachel's presentation on adjusting for differential item functioning in the EQ-5Q-5L using externally-collected vignettes given at the 2017 iHEA World Conference in Boston.
This randomized, double-blind, non-inferiority trial compared lacosamide monotherapy to carbamazepine-CR monotherapy for newly diagnosed epilepsy over 12 months. The primary endpoints were the proportion of patients seizure-free at 6 and 12 months and time to first seizure. Results showed that lacosamide was non-inferior to carbamazepine-CR for seizure freedom at both timepoints. Lacosamide was well-tolerated with fewer drug interactions and side effects than other antiepileptic drugs. The study establishes lacosamide as a suitable new option for epilepsy monotherapy.
ABSTRACT
Objective: Stroke is one of the leading causes of death and disabilities worldwide. Cost-effectiveness analysis helps identify neglected opportunities
by highlighting interventions that are relatively inexpensive, yet have the potential to reduce the disease burden substantially. In India, there are
wide social and economic disparities. Socioeconomic environment influences occupation, lifestyle, and nutrition of social classes which in turn would
influence the prevalence and profile of stroke. By reduction of delays in access to hospital and improving provision of affordable treatments can
reduce morbidity and mortality in patients with stroke in India. This study is designed to measure and compare the costs (resources consumed) and
consequences (clinical, economic, and humanistic) of pharmaceutical products and services and their impact on individuals, healthcare systems and
society.
Methods: The purpose of this study is to analyze and conduct a cost-effectiveness analysis for the treatment of stroke in Guntur City Hospitals.
The patients were treated either with aspirin or clopidogrel. The health outcomes were measured using Modified Rankin Scale, A prominent risk
assessment scale for stroke. The pharmacoeconomic data were computed from the patient data collection forms.
Result: The incremental cost-effectiveness ratio of aspirin and clopidogrel were calculated to be Rs. 8046.2/year.
Conclusion: The study concludes that aspirin has the increased socioeconomic impact when compared to Clopidogrel and we can see that the earlier
therapy has supported discharge, home-based rehabilitation along with reduced hospital stay and hence preferable.
Keywords: Stroke, Pharmacoeconomics, Cost-effectiveness analysis, Aspirin, Clopidogrel, Incremental cost-effectiveness ratio.
This document provides an overview of a presentation on study designs, fundamentals of interpretation, and research topics. It includes 10 learning objectives covering key concepts in clinical study design such as validity, bias, study hierarchies, and statistical measures. It also presents 10 self-assessment questions pertaining to examples of study designs including randomized controlled trials, meta-analyses, and institutional review boards. The introduction explains why pharmacists need knowledge of study design and interpretation for tasks involving drug information, evidence-based medicine, research, and educating others.
This meta-analysis evaluated the effects of lutein and zeaxanthin supplementation on visual function in age-related macular degeneration (AMD) patients. Eight randomized controlled trials were included. The results showed lutein and zeaxanthin supplementation significantly improved visual acuity and contrast sensitivity in AMD patients. Improvement in visual outcomes was positively associated with increased macular pigment optical density. However, more large, long-term randomized controlled trials are still needed to confirm these findings.
Module 4 Submodule 4. 2 Final June 2007Flavio Guzmán
The document discusses key considerations for clinicians in evaluating the results of drug clinical trials. It emphasizes the importance of critically assessing trial design, results, and whether the findings warrant changing clinical practice. Clinicians are advised to consider factors like trial methodology, potential biases, statistical/clinical significance, applicability to their patients, and safety. The document provides guidance on how to distinguish high-quality trials that produce useful results for patient care.
Effect of rosuvastatin on rheumatoid arthritis clinical disease activity inde...Alexander Decker
This document summarizes a study that evaluated the effects of the drug rosuvastatin on clinical disease activity and functional disability in patients with rheumatoid arthritis. The study involved a randomized, double-blind, placebo-controlled trial of 40 rheumatoid arthritis patients treated with either rosuvastatin 10mg or a placebo for 8 weeks. The study found that while rosuvastatin reduced measures of disease activity and functional disability to a clinically relevant degree, the changes were not statistically significant compared to the placebo group. The study concluded that rosuvastatin may provide benefit as an adjuvant therapy for rheumatoid arthritis, but a larger, longer study is needed.
Laos: Hospital treatment costs and tertiary careHealthSpace.Asia
The Regional Forum on Health Care Financing on its 2nd day (3 May 2012) started with a keynote from Prof. Soonman Kwon on Asia health financing experience. Other presentations covered the issue of hospital financing and primary care financing. Very insightful as the first day.
This document discusses cardiovascular risk and adherence to treatment. It defines key terms like adherence, compliance, persistence, and non-adherence. It notes that poor adherence is a major reason for suboptimal clinical benefits. It also discusses factors that influence adherence like the medication, patient, and healthcare system. Non-adherence can increase risks of stroke, death, hospitalizations and costs. Long-term adherence to medications for conditions like hypertension and statins is often low, around 50%. Improving adherence requires addressing multiple barriers and ensuring patients are involved in treatment decisions.
This document summarizes clinical trial evidence for the drug edaravone in the treatment of ALS. A Phase 3 trial of 137 patients with ALS found that edaravone significantly reduced the decline in ALSFRS-R scores over 24 weeks compared to placebo. This provides evidence that edaravone slows progression of ALS in well-defined populations. However, limitations include the short study duration and stringent inclusion criteria, so longer term efficacy in broader populations remains unclear.
1. The document describes Resolution Health's Glidepath predictive modeling approach to identify patients who are likely to undergo elective orthopedic surgeries well in advance, in order to provide targeted interventions for informed decision making.
2. Logistic regression models were developed using claims data to predict likelihood of low back surgery and knee replacement. Significant predictors for low back surgery included diagnoses, medications, treatments, and follow-up visits.
3. The models identified patients at various risk levels, achieving sensitivity over 40% and PPV over 16% at standard risk thresholds. This allows targeting interventions appropriately.
This randomized, double-blind, placebo-controlled clinical trial tested whether a genetically-informed biomarker of nicotine metabolism (nicotine metabolite ratio or NMR) could predict responses to nicotine patch or varenicline for smoking cessation. 1246 smokers were randomized to receive placebo, nicotine patch, or varenicline. The primary outcome was 7-day point abstinence at end of treatment. For normal metabolizers, varenicline was more effective than nicotine patch, but for slow metabolizers there was no difference. Secondary outcomes and side effects also varied by treatment and NMR group. The authors concluded the NMR may help direct therapy selection to increase quit rates while decreasing side effects.
This randomized controlled trial compared the efficacy of topical captopril cream (0.5%) to topical diltiazem cream (2%) for the treatment of chronic anal fissure over 8 weeks. It found that both treatments were equally effective at reducing pain, bleeding, and perianal irritation. However, captopril caused a significantly higher incidence of pruritus, with nearly half of patients in the captopril group still experiencing pruritus at the end of the trial. The study concludes that while captopril and diltiazem are similarly effective for chronic anal fissure symptoms, captopril is not recommended due to the high rate of pruritus it causes.
This document summarizes a review study comparing treatment results for prostate cancer. Over 21,000 prostate studies published between 2000-2011 were reviewed, with 145 meeting criteria for inclusion. Experts from various treatment disciplines (e.g. surgery, radiation) assembled to conduct a complete literature review on prostate cancer treatment success rates based on PSA levels. Results are presented separating patients into low, intermediate, and high risk groups.
This document summarizes a study comparing the standard olanzapine tablet formulation to the oral dissolving olanzapine tablet (olimelt) in treating schizophrenia. Data was collected through surveys given to doctors at conferences and by sales representatives. The surveys focused on doctors' experiences with weight gain and patient preference between the two formulations. Statistical analysis using tools like the chi-square test was conducted on the survey responses to determine if preferences differed significantly between the formulations. The goal was to understand doctors' perceptions and develop national estimates of olimelt adoption over the standard tablet.
Selective Laser Trabeculoplasty as a Replacement Therapy in Open Angle Glauco...CrimsonpublishersMSOR
The aim of this study was to investigate the long-term effect of selective laser trabeculoplasty in open angle glaucoma patients as a replacement for medical therapy. 64 eyes of 64 primary open angle glaucoma (POAG) patients under therapy with glaucoma drugs and controlled Intra Ocular Pressure (IOP) were reviewed for 36 months. 360o selective laser therapy (SLT) sessions were performed in two sessions and the medical therapy was stopped. The patients were controlled and evaluated postoperatively 1, 3, 6, 12, 24 and 36 months after surgery for glaucoma progression. In 36 (56.3%) of the 64 patients SLT was successful and there was no need to medical treatment at 36th month. In 28 patients (43.7%) medical treatment was started due to IOP rising. In Logistic regression analysis baseline IOP was found to be significantly effective on success rate of SLT (R2: 0.718, p<0.001).
The Ocular Hypertension Treatment Study (OHTS) was a landmark randomized controlled trial that showed treating patients with ocular hypertension reduced the risk of developing primary open-angle glaucoma by more than 50% compared to observation alone. Increased risk factors for developing glaucoma included older age, larger cup-to-disc ratios, higher baseline intraocular pressure, and thinner central corneal thickness. The Early Manifest Glaucoma Trial found that treating newly diagnosed glaucoma patients lowered their intraocular pressure by 25% on average and reduced the risk of visual field progression by about 20% compared to no treatment. The Collaborative Initial Glaucoma Treatment Study found that both medical and surgical treatment were effective for initially lowering intra
Treatment of Diabetic Macular Edema with Aflibercept and Micropulse Laser (DA...haha haha
This clinical trial investigated the safety and efficacy of combining intravitreal aflibercept injections with micropulse laser treatment for diabetic macular edema. Thirty patients were randomized to receive either injections with sham laser (Group 1) or injections with micropulse laser (Group 2). Both groups showed improvements in visual acuity and macular thickness after 48 weeks, with no significant differences between groups. While micropulse laser did not reduce the number of injections needed or further improve outcomes, it also did not cause any adverse effects when combined with anti-VEGF therapy.
- The study examined the effects of caffeine consumption and 24 hours of caffeine abstention on oculomotor performance as measured by videonystagmography (VNG).
- For most VNG measures, there was no statistically significant difference in performance between the caffeine and abstention conditions. The only statistically significant differences were for 40 deg/sec optokinetic nystagmography, but these differences were not considered clinically significant.
- While many participants reported caffeine withdrawal symptoms like fatigue after abstaining, these symptoms did not appear to have a clinically significant impact on oculomotor test performance.
Adjusting for Differential Item Functioning in the EQ-5D-5L Using Externally-...Office of Health Economics
Paula and Rachel's presentation on adjusting for differential item functioning in the EQ-5Q-5L using externally-collected vignettes given at the 2017 iHEA World Conference in Boston.
This randomized, double-blind, non-inferiority trial compared lacosamide monotherapy to carbamazepine-CR monotherapy for newly diagnosed epilepsy over 12 months. The primary endpoints were the proportion of patients seizure-free at 6 and 12 months and time to first seizure. Results showed that lacosamide was non-inferior to carbamazepine-CR for seizure freedom at both timepoints. Lacosamide was well-tolerated with fewer drug interactions and side effects than other antiepileptic drugs. The study establishes lacosamide as a suitable new option for epilepsy monotherapy.
ABSTRACT
Objective: Stroke is one of the leading causes of death and disabilities worldwide. Cost-effectiveness analysis helps identify neglected opportunities
by highlighting interventions that are relatively inexpensive, yet have the potential to reduce the disease burden substantially. In India, there are
wide social and economic disparities. Socioeconomic environment influences occupation, lifestyle, and nutrition of social classes which in turn would
influence the prevalence and profile of stroke. By reduction of delays in access to hospital and improving provision of affordable treatments can
reduce morbidity and mortality in patients with stroke in India. This study is designed to measure and compare the costs (resources consumed) and
consequences (clinical, economic, and humanistic) of pharmaceutical products and services and their impact on individuals, healthcare systems and
society.
Methods: The purpose of this study is to analyze and conduct a cost-effectiveness analysis for the treatment of stroke in Guntur City Hospitals.
The patients were treated either with aspirin or clopidogrel. The health outcomes were measured using Modified Rankin Scale, A prominent risk
assessment scale for stroke. The pharmacoeconomic data were computed from the patient data collection forms.
Result: The incremental cost-effectiveness ratio of aspirin and clopidogrel were calculated to be Rs. 8046.2/year.
Conclusion: The study concludes that aspirin has the increased socioeconomic impact when compared to Clopidogrel and we can see that the earlier
therapy has supported discharge, home-based rehabilitation along with reduced hospital stay and hence preferable.
Keywords: Stroke, Pharmacoeconomics, Cost-effectiveness analysis, Aspirin, Clopidogrel, Incremental cost-effectiveness ratio.
This document provides an overview of a presentation on study designs, fundamentals of interpretation, and research topics. It includes 10 learning objectives covering key concepts in clinical study design such as validity, bias, study hierarchies, and statistical measures. It also presents 10 self-assessment questions pertaining to examples of study designs including randomized controlled trials, meta-analyses, and institutional review boards. The introduction explains why pharmacists need knowledge of study design and interpretation for tasks involving drug information, evidence-based medicine, research, and educating others.
This meta-analysis evaluated the effects of lutein and zeaxanthin supplementation on visual function in age-related macular degeneration (AMD) patients. Eight randomized controlled trials were included. The results showed lutein and zeaxanthin supplementation significantly improved visual acuity and contrast sensitivity in AMD patients. Improvement in visual outcomes was positively associated with increased macular pigment optical density. However, more large, long-term randomized controlled trials are still needed to confirm these findings.
Module 4 Submodule 4. 2 Final June 2007Flavio Guzmán
The document discusses key considerations for clinicians in evaluating the results of drug clinical trials. It emphasizes the importance of critically assessing trial design, results, and whether the findings warrant changing clinical practice. Clinicians are advised to consider factors like trial methodology, potential biases, statistical/clinical significance, applicability to their patients, and safety. The document provides guidance on how to distinguish high-quality trials that produce useful results for patient care.
Effect of rosuvastatin on rheumatoid arthritis clinical disease activity inde...Alexander Decker
This document summarizes a study that evaluated the effects of the drug rosuvastatin on clinical disease activity and functional disability in patients with rheumatoid arthritis. The study involved a randomized, double-blind, placebo-controlled trial of 40 rheumatoid arthritis patients treated with either rosuvastatin 10mg or a placebo for 8 weeks. The study found that while rosuvastatin reduced measures of disease activity and functional disability to a clinically relevant degree, the changes were not statistically significant compared to the placebo group. The study concluded that rosuvastatin may provide benefit as an adjuvant therapy for rheumatoid arthritis, but a larger, longer study is needed.
Laos: Hospital treatment costs and tertiary careHealthSpace.Asia
The Regional Forum on Health Care Financing on its 2nd day (3 May 2012) started with a keynote from Prof. Soonman Kwon on Asia health financing experience. Other presentations covered the issue of hospital financing and primary care financing. Very insightful as the first day.
This document discusses cardiovascular risk and adherence to treatment. It defines key terms like adherence, compliance, persistence, and non-adherence. It notes that poor adherence is a major reason for suboptimal clinical benefits. It also discusses factors that influence adherence like the medication, patient, and healthcare system. Non-adherence can increase risks of stroke, death, hospitalizations and costs. Long-term adherence to medications for conditions like hypertension and statins is often low, around 50%. Improving adherence requires addressing multiple barriers and ensuring patients are involved in treatment decisions.
This document summarizes clinical trial evidence for the drug edaravone in the treatment of ALS. A Phase 3 trial of 137 patients with ALS found that edaravone significantly reduced the decline in ALSFRS-R scores over 24 weeks compared to placebo. This provides evidence that edaravone slows progression of ALS in well-defined populations. However, limitations include the short study duration and stringent inclusion criteria, so longer term efficacy in broader populations remains unclear.
1. The document describes Resolution Health's Glidepath predictive modeling approach to identify patients who are likely to undergo elective orthopedic surgeries well in advance, in order to provide targeted interventions for informed decision making.
2. Logistic regression models were developed using claims data to predict likelihood of low back surgery and knee replacement. Significant predictors for low back surgery included diagnoses, medications, treatments, and follow-up visits.
3. The models identified patients at various risk levels, achieving sensitivity over 40% and PPV over 16% at standard risk thresholds. This allows targeting interventions appropriately.
This randomized, double-blind, placebo-controlled clinical trial tested whether a genetically-informed biomarker of nicotine metabolism (nicotine metabolite ratio or NMR) could predict responses to nicotine patch or varenicline for smoking cessation. 1246 smokers were randomized to receive placebo, nicotine patch, or varenicline. The primary outcome was 7-day point abstinence at end of treatment. For normal metabolizers, varenicline was more effective than nicotine patch, but for slow metabolizers there was no difference. Secondary outcomes and side effects also varied by treatment and NMR group. The authors concluded the NMR may help direct therapy selection to increase quit rates while decreasing side effects.
This randomized controlled trial compared the efficacy of topical captopril cream (0.5%) to topical diltiazem cream (2%) for the treatment of chronic anal fissure over 8 weeks. It found that both treatments were equally effective at reducing pain, bleeding, and perianal irritation. However, captopril caused a significantly higher incidence of pruritus, with nearly half of patients in the captopril group still experiencing pruritus at the end of the trial. The study concludes that while captopril and diltiazem are similarly effective for chronic anal fissure symptoms, captopril is not recommended due to the high rate of pruritus it causes.
This document summarizes a review study comparing treatment results for prostate cancer. Over 21,000 prostate studies published between 2000-2011 were reviewed, with 145 meeting criteria for inclusion. Experts from various treatment disciplines (e.g. surgery, radiation) assembled to conduct a complete literature review on prostate cancer treatment success rates based on PSA levels. Results are presented separating patients into low, intermediate, and high risk groups.
This document summarizes a study comparing the standard olanzapine tablet formulation to the oral dissolving olanzapine tablet (olimelt) in treating schizophrenia. Data was collected through surveys given to doctors at conferences and by sales representatives. The surveys focused on doctors' experiences with weight gain and patient preference between the two formulations. Statistical analysis using tools like the chi-square test was conducted on the survey responses to determine if preferences differed significantly between the formulations. The goal was to understand doctors' perceptions and develop national estimates of olimelt adoption over the standard tablet.
Selective Laser Trabeculoplasty as a Replacement Therapy in Open Angle Glauco...CrimsonpublishersMSOR
The aim of this study was to investigate the long-term effect of selective laser trabeculoplasty in open angle glaucoma patients as a replacement for medical therapy. 64 eyes of 64 primary open angle glaucoma (POAG) patients under therapy with glaucoma drugs and controlled Intra Ocular Pressure (IOP) were reviewed for 36 months. 360o selective laser therapy (SLT) sessions were performed in two sessions and the medical therapy was stopped. The patients were controlled and evaluated postoperatively 1, 3, 6, 12, 24 and 36 months after surgery for glaucoma progression. In 36 (56.3%) of the 64 patients SLT was successful and there was no need to medical treatment at 36th month. In 28 patients (43.7%) medical treatment was started due to IOP rising. In Logistic regression analysis baseline IOP was found to be significantly effective on success rate of SLT (R2: 0.718, p<0.001).
The Ocular Hypertension Treatment Study (OHTS) was a landmark randomized controlled trial that showed treating patients with ocular hypertension reduced the risk of developing primary open-angle glaucoma by more than 50% compared to observation alone. Increased risk factors for developing glaucoma included older age, larger cup-to-disc ratios, higher baseline intraocular pressure, and thinner central corneal thickness. The Early Manifest Glaucoma Trial found that treating newly diagnosed glaucoma patients lowered their intraocular pressure by 25% on average and reduced the risk of visual field progression by about 20% compared to no treatment. The Collaborative Initial Glaucoma Treatment Study found that both medical and surgical treatment were effective for initially lowering intra
Treatment of Diabetic Macular Edema with Aflibercept and Micropulse Laser (DA...haha haha
This clinical trial investigated the safety and efficacy of combining intravitreal aflibercept injections with micropulse laser treatment for diabetic macular edema. Thirty patients were randomized to receive either injections with sham laser (Group 1) or injections with micropulse laser (Group 2). Both groups showed improvements in visual acuity and macular thickness after 48 weeks, with no significant differences between groups. While micropulse laser did not reduce the number of injections needed or further improve outcomes, it also did not cause any adverse effects when combined with anti-VEGF therapy.
The document summarizes several studies on angle recession glaucoma following blunt ocular trauma.
The first study found that ultrasound biomicroscopy is useful for detecting angle pathology when the media is hazy. Surgical treatment resulted in more stable and normal intraocular pressure compared to medical treatment alone.
The second study in Bangladesh found that conservative treatment controlled intraocular pressure in most cases, while a small percentage required surgery.
The third study found that trabeculectomy with antimetabolic drugs was most effective for uncontrolled angle recession glaucoma, but carried a higher risk of late bleb infection.
This document provides details of a study evaluating changes in retinal nerve fibre layer (RNFL) thickness using optical coherence tomography (OCT) in patients undergoing ethambutol treatment. The study aims to detect RNFL thinning early to prevent progression to toxic optic neuropathy and irreversible vision loss. It will be a prospective observational study conducted on 73 patients receiving ethambutol treatment over 3 months. Parameters like visual acuity, pupillary response, anterior segment evaluation, refractive errors, posterior segment evaluation, colour vision and RNFL thickness will be assessed at baseline and after 3 months of treatment using OCT. The results will be analyzed to determine if any significant RNFL changes occur early during ethambutol treatment.
12:25 Vano - Decreasing X-ray exposure in CTO proceduresEuro CTO Club
This document discusses decreasing x-ray exposure in complex coronary total occlusion (CTO) procedures. It notes that CTO procedures can result in several grays of radiation exposure to the skin of patients, increasing their risk of radiation injury. It also notes that without proper protection, interventional staff could receive milligrays of exposure per procedure to the lens of their eyes, increasing their risk of radiation-induced cataracts. The document recommends maintaining radiation doses as low as reasonably achievable for both patients and staff by following diagnostic reference levels, avoiding injuries through clinical follow-up of high dose procedures, and using protective equipment to reduce staff occupational exposures.
- This study compared the efficacy of ranibizumab injections plus panretinal photocoagulation (PRP) versus PRP alone for the treatment of high-risk proliferative diabetic retinopathy over 12 months.
- The primary outcome was regression of neovascularization, which occurred in 92.7% of eyes receiving ranibizumab+PRP and 70.5% of eyes receiving PRP alone, a statistically significant difference.
- Secondary outcomes also favored the combination treatment, including a higher rate of complete neovascularization regression, shorter time to complete regression, and thinner macular retinal thickness at intermediate visits.
The RAPIDO trial tested a new experimental treatment for locally advanced rectal cancer that involved short-course radiotherapy followed by chemotherapy before surgery, compared to the standard treatment of long-course chemoradiotherapy followed by surgery and then chemotherapy. The results showed that the experimental treatment led to a lower rate of disease-related treatment failures and distant metastases, along with a doubled rate of pathologic complete responses, without increasing toxicities or compromising survival rates. This provides evidence that the experimental approach may be a new standard of care for high-risk locally advanced rectal cancer.
The Ocular Hypertension Treatment Study (OHTS) was a randomized clinical trial that evaluated whether treatment with ocular hypotensive medication could prevent or delay the onset of primary open-angle glaucoma (POAG) in individuals with ocular hypertension. The study found that medication reduced the 5-year incidence of POAG from 9.5% to 4.4% compared to observation alone. A follow up study (OHTS Phase 2) found that delaying treatment in the observation group resulted in a higher cumulative incidence of POAG after 13 years compared to the early treatment group. Risk factors for developing POAG included older age, larger cup-to-disc ratio, higher baseline IOP, and thinner central
1) Trabeculectomy is the most common glaucoma surgery but scarring can lead to bleb failure. OloGen collagen implant may help control wound healing to maintain drainage.
2) This study compares outcomes of trabeculectomy with and without OloGen implant in 60 eyes over 6 months. Success rates and complications were similar between groups with no significant differences.
3) While OloGen did not provide clear advantages in this pilot study, larger trials with longer follow up are needed to fully evaluate its safety and efficacy in trabeculectomy.
Management of early glaucoma: Evidence based medicineHind Safwat
This document summarizes key findings from several clinical trials related to the management of primary open angle glaucoma. It discusses trials comparing medical vs. surgical treatment, different drug therapies, and surgical techniques. Some of the main conclusions are: 1) Early treatment of glaucoma is associated with less progression, but not all untreated patients progress; 2) Targeted IOP reduction can delay progression but rates vary individually; 3) Surgical options generally lower IOP more but with more complications versus medical management. Screening high-risk groups may help detect glaucoma earlier.
Learning Effect and Test-Retest Variability in Healthy Subjects and Patients ...inventionjournals
Aim: To study learning effect (LE) and test retest variability (TRV) in healthy subjects and patients with primary open angle glaucoma (POAG) using Rarebit perimetry (RBP). To determine normative ranges of RBP. Methods: 61 eyes of 35 subjects underwent visual field testing with standard automated perimetry (SAP) and RBP. TRV and LE were assessed in repeated examinations conducted in 3 different days. First two examinations were conducted within 3 days and the last one within one month. LE was assessed by comparing results from the three sessions. TRV was evaluated by calculating differences between retest for each combination of single tests. To determine normative ranges of RBP were included 34 eyes of 21 healthy subjects and 62 eyes of 47 subjects with preperimetric and early POAG. Cut off value was determined between the two groups using ROC analysis. Results: No significant LE was observed in POAG group. There was a significant LE in the control group but only in the visual field zones with eccentric location. TRV was higher in POAG group and in central visual field zone. The mean MHR in control group was 94.88 (SD 2.21) and 83.56 (SD 6.95) in POAG group. Cut off value for discriminating between healthy subjects and patient with POAG was 91.50% with AUROC 0.985 (p<0.001, ROC analysis). Conclusion: RBP is fast and easy to perform test. RBP testing did not show a significant LE in glaucoma group, however, TRV was consistent. MHR can be successfully used for differentiation of healthy eye from those with early glaucoma changes.
This study evaluated changes in aqueous humor dynamics (AHD) after selective laser trabeculoplasty (SLT) treatment for glaucoma. 31 patients underwent baseline AHD measurements including IOP, aqueous flow, outflow facility, and other parameters before and 3 months after SLT. SLT significantly lowered IOP at 9 AM and noon through an increase in outflow facility as measured by fluorophotometry and tonography. No changes in aqueous flow or other AHD parameters were observed. Higher baseline aqueous flow and lower baseline outflow facility were associated with greater IOP lowering from SLT.
Patient Compliance To Treatment In The Management Of Glaucoma And Factors Aff...Dr. Jagannath Boramani
This document discusses a study examining patient compliance with glaucoma treatment and factors affecting compliance. The study aims to prospectively analyze at least 100 glaucoma patients to assess compliance and its determinants. So far 15 patients have been enrolled, with poor overall compliance observed. Majority of noncompliant patients had low socioeconomic status and education. The study recommends various local and general measures to improve compliance, such as educational materials, family involvement, and assistance programs.
This document discusses diabetic macular edema (DME), its causes and prevalence, current treatments, and evidence for the use of ranibizumab (Lucentis) in the treatment of DME. Some key points:
- DME is the main cause of central vision loss in diabetic retinopathy and can affect 10-25% of diabetics depending on type of diabetes and insulin use.
- Current treatments include controlling blood sugar, blood pressure, lipids as well as laser photocoagulation and pharmacologic therapies like steroids and anti-VEGF drugs.
- Studies like RESOLVE, READ-2 and DRCR.net trials showed ranibizumab led to significant gains in
This document discusses diabetic macular edema (DME), its causes and prevalence, current treatments, and evidence for the use of ranibizumab (Lucentis) in the treatment of DME. Some key points:
- DME is the main cause of central vision loss in diabetic retinopathy and can affect 10-25% of diabetics depending on type of diabetes and insulin use.
- Current treatments include controlling blood sugar, blood pressure, lipids, and ocular treatments like laser photocoagulation and pharmacologic therapies like steroids and anti-VEGF drugs.
- Studies like RESOLVE, READ-2, and RESTORE showed ranibizumab significantly improved visual
Modelling radiation toxicity is challenging due to issues such as low event rates, the influence of radiation dose, and the need for large, high-quality datasets. Subjective evaluations of toxicity are difficult to analyze quantitatively. Different components of acute and late toxicity need to be considered separately. Choosing the appropriate measure of toxicity severity (e.g. peak grade vs. average grade) and follow-up length can impact results. Improving modelling may involve techniques like mixture models accounting for incomplete follow-up and graded response models avoiding cutoff choices. The patient perspective is also important to consider.
Topical dorzolamide for macular edema in the early phase after vitrectomy and...Avaleks-Kiev
Background: The purpose of this study was to evaluate prospectively the efficacy of a topical carbonic anhydrase inhibitor in macular edema after vitrectomy.
Цель: оценка перспективы использования топического ингибитора карбоангидразы для профилактики развития макулярного отека после витрэктомии.
http://ophthalmolog.kiev.ua/
Patient Dose Audit in Computed Tomography at Cancer Institute of GuyanaRamzee Small
This document summarizes a study that audited patient radiation doses from computed tomography (CT) scans at a cancer institute in Guyana. The study measured radiation doses from common CT exams using a dose measurement device and compared the measured doses to the doses estimated by the CT scanner. They found that the scanner generally overestimated doses for patient exams and underestimated doses for free-air scans. The study aims to help optimize radiation protocols to safely deliver the minimum necessary doses to patients.
Similar to International Journal of Ophthalmology & Vision Research (20)
A 5-year old boy, with an established diagnosis of a topic
dermatitis, previously treated by topical corticosteroids and emollient cream with a good improvement, developed widespread papules on his legs, hands and forearm that appeared 5 months ago.
Methods: Retrospectively, the file records of the patients who underwent sleeve gastrectomy were examined. Demographic features, Body Mass Index (BMI), the mouth opening, Mallampati score, thyromental distance, sternomental distance, neck circumference measurements and videolaryngoscopic examination results were recorded Results: In a total of 140 consecutive patients (58 male, 82 female) were included in the study. The mean age of the study participants was 35.40 ± 9.78 and the mean BMI of the patients was 44.33 ± 7.52 kg/m2
. The mean mouth opening of the patients was 4.82 ± 0.54 cm
and the mean neck circumference was 43.52 ± 4.66 cm. The mean thyromental distance was 8.02 ± 1.00 cm and the mean sternomental distance was16.58 ± 1.53 cm. Difficult intubation was determined in 8 (5.7%) patients. In logistic regression analysis, age (p : 0.446), gender (p : 0.371), BMI (p : 0.947), snoring (p : 0.567), sleep apnea (p : 0.218), mouth opening (p : 0.687), thyromental distance (p :0.557), sternomental (p : 0.596) and neck circumference (p : 0.838) were not the independent predictors of difficult intubation. However, Mallampati score (p : 0.001) and preoperative direct laryngoscopy findings (p : 0.037) performed in outpatient clinic were the significant
predictors of difficult intubation. Interestingly, all patients with grade 4 laryngoscopy findings had difficult intubation.
Introduction: Laparoscopic surgery has been performed in Mexico since 1989, but no reports about training tendencies exist. We conducted a national survey in 2015, and here we report the results concerning training characteristics during the surgical residence of the respondents. Materials and Methods: A prospective study was conducted through a survey questioning demographic data, laparoscopic training during pre and post surgical residency and other of areas of laparoscopic practice. The sample was calculated and survey piloted before
application. Special interest in this report was placed on type and quality of training received. Data are reported in percentages.
Heterotopic Ossification (HO) is defined as pathological bone formation at locations where bone normally does not exist. The
presence of HO has been found to be a rare complication after stroke in several studies, whereas there are only sporadic references relating HO to Cerebral Palsy (CP) and few for CP and stroke. No effective treatment for HO has yet been found, whereas the cellular and molecular mechanisms have not been completely understood. Therefore, increased awareness among physicians is required, as a challenge for early diagnosis and treatment. A case of a male patient with CP, who developed HO on the paretichip joint following an ischemic stroke is presented.
Objectives: To assess the practice of food hygiene and safety, and its associated factors among street food vendors in urban areas of Shashemane, West Arsi Zone, Oromia Ethiopia, 2019.
Methods: Cross-sectional study design was applied from December 28, 2019 to January 27, 2020. Data was collected from 120 food handlers, which were selected by purposive sampling techniques. Information was gathered from interview and field observation by conducting food safety survey and using questionnaires via face to face interview. The collected data was entered using Epi Data 3.1 and finally, it was analyzed using SPSS VERSION 20.
A Division I football player experienced acute posterior leg pain while playing. An ultrasound examination revealed an unusual injury - a complete rupture of the plantaris tendon mid-substance. This type of isolated plantaris tendon injury has rarely been reported. Ultrasound was useful for diagnosis and guided rehabilitation by monitoring healing over time. The athlete was able to return to full competition within 3 weeks through a progressive rehabilitation program focused on restoring range of motion and strength. This case suggests isolated plantaris tendon injuries may allow for faster return to play than other potential causes of posterior leg pain.
Type 1 Diabetes (T1D), is a severe disease, representing 5-10% of all reported cases of diabetes worldwide. Fulminant Type 1 Diabetes Mellitus (FT1D) is a subtype of type 1 diabetes mellitus that is largely characterized by the abrupt onset of Diabetic Ketoacidosis (DKA) and severe hyperglycemia without insulin defi ciency. Viral infections have been hypothesized to play a major role in the pathogenesis of Fulminant Type 1 Diabetes Mellitus (FT1D) through the complete and rapid destruction of pancreatic beta cells. Coxsackie viral infection has been detected in islets of 50% of the pancreatic tissue recovered from recent-onset Type 1 Diabetes (T1D) patients. In this report we have highlighted a case where the patient developed a Group B Coxsackie virus infection culminating in the development of Fulminant Type 1 Diabetes Mellitus (FT1D).
Methods: Cercariae are released by infected water snails. To determine the occurrence of cercariae-emitting snails in SchleswigHolstein, 155 public bathing places were visited and searched for fresh water snails. Family and genus of the collected snails were determined and the snails were examined for the shedding of cercariae, using a standard method and a newly developed method.
Objective: To generate preliminary information about of enteroviruses and Enterovirus 71 (EV71) in patients with aseptic meningitis in Khartoum State, Sudan.
Method: Cerebrospinal fluid specimens were collected from 89 aseptic meningitis patients from different Khartoum Hospitals
(Mohammed Alamin Hamid Hospital, Soba Teaching Hospital, Omdurman Military Hospital, Alban Gadeed Teaching Hospital and Police Hospital) within February to May 2015. Among these 89 patients, 43 (48%) were males and 46 (52%) were females. The patient’s age ranged between 1 day and 30 years old. The collected specimens were assayed to detect enteroviruses and EV71 RNA using Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) technique
Femoral hernias, comprise 2% to 4% of all hernias in the inguinal region, and occur most commonly in women. Th ey present typically with a mass below the level of the inguinal ligament. The sac may contain preperitoneal fat, omentum, small bowel, or other structures and have a high rate of incarceration and strangulation due to the small size of the hernia neck orifice, requiring emergency surgery. We present the case of a 54-year-old female patient with intestinal occlusion due to incarcerated femoral hernia, repaired by laparoscopic approach, that gave the patient the opportunity to attend her daughter’s wedding the same day.
Small Supernumerary Marker Chromosome (sSMC) is a rare genetic condition marked by the presence of an extra chromosome to the 46 human chromosomes. This case report describes a 4 year old child with SSMC on the 46th chromosome. The child presented with delayed speech and language development, seizures and mild developmental delay. Speech and Language evaluation was carried out and management options are discussed.
A catheter is a thin tube made from medical grade materials that serve a broad range of functions, but mainly catheters are medical devices that can be inserted in the body to treat disease or perform surgical procedures. Catheters have been inserted into body cavities, ducts, or vessels to allow for drainage, administration of therapeutic fluids or gases, operational access for surgery. Catheters help perform tasks in various systems such as cardiovascular, urological, gastrointestinal, neurovascular, and ophthalmic systems. A dataset of 12 patients with varying “weights” and “heights” was recorded along with the lengths of their catheter tubes. This data set was found from two revered statistical textbooks on linear regression and the Department of Scientific Computing at Florida State University. This data set was not able to be linked to any particular clinical or experimental research studies, but the data set can be used to help catheter manufacturers and medical professionals better decide on what particular catheter lengths to use for patients knowing only their height & weight. These research insights could be helpful to healthcare professionals that have patients with incomplete or no healthcare records
to decide what catheter length to use. The main investigative inquiry that needed to be answered was how does patient weight & height influence catheter length together and separately? We conducted linear regression and other statistical analysis procedures in R program & Microsoft Excel and discovered that this data exhibited a quality called multi collinearity. With multi collinearity, all predictors (2 or more
independent variables) are not significant in an all encompassing linear aggression, but the predictors might be significant in their own individual linear regressions. Individual linear regression analyses were conducted for both patient height & weight to see how much they both contribute to varying catheter length. Patient weight was found to be more impatful than patient height in relationship to catheter length, even though height and weight are a classical example of multi collinearity predictors.
Bovine mastitis has a negative impact through economic losses in the dairy sector across the globe. A cross sectional study was carried out from September 2015 to July 2016 to determine the prevalence of bovine mastitis, associated risk factors and isolation of major causative bacteria in lactating dairy cows in selected districts of central highland of Ethiopia. A total of 304 lactating cows selected randomly from five districts were screened by California Mastitis Test (CMT) for subclinical mastitis. Based on CMT result and clinical examination, over all prevalence of mastitis at cow level was 70.62% (214/304).
Two hundred fourteen milk samples collected from CMT positive cows were cultured for isolation of major causative bacteria. From 214 milk samples,187 were culture positive and the most prevalent isolates were Staphylococcus aureus 42.25% (79/187) followed by Streptococcus agalactiae 14.43%
(27/187). Other bacterial isolates were included Coagulase Negative Staphylococcus species 12.83% (24/187), Streptococcus dysgalactiae 5.88% (11/187), Escherichia coli 13.38% (25/187) and Entrococcus feacalis 11.23% (21/187) were also isolated. Moreover, age, parity number, visible teat abnormalities,husbandry practice, barn fl oor status and milking hygiene were considered as risk factors for the occurrence of bovine mastitis and they were found significantly associated with the occurrence of mastitis (p < 0.05). The findings of this study warrants the need for strategic approach including dairy extension that focus on enhancing dairy farmers’ awareness and practice of hygienic milking, regular screening for subclinical mastitis, dry cow therapy and culling of chronically infected cows.
A 36-year-old female developed right upper quadrant pain and nausea after taking the herbal supplement kratom for two weeks to manage back pain. Laboratory tests showed elevated liver enzymes. A liver biopsy ruled out other causes and determined she had drug-induced liver injury from kratom use. Her symptoms and liver enzymes gradually returned to normal over six weeks after stopping kratom. The case report discusses kratom's potential for hepatotoxicity and advises clinicians to consider its effects on patient health.
The assessment, diagnosis and treatment of critically ill patients is extremely challenging. Patients often deteriorate whilst being
reviewed and their rapidly changing pathophysiology barrages healthcare professionals with new data. Furthermore, comprehensive assessments must be postponed until the patient has been stabilised. So, important data and interventions are often missed in the heat of the moment. In emergency situations, suboptimal management decisions may cause signifi cant morbidity and mortality. Fortunately, standardisation and careful design of documentation (i.e. proformas and checklists) can enhance patient safety. So, I have developed a series of checklist proformas to guide the assessment of critically ill patients. These proformas also promote the systematic recording and presentation of information to facilitate the retrieval of the precise data required for the management for critically ill patients. The proformas have been modifi ed extensively over the last twenty years based on my personal experience and extensive consultation with colleagues in several world-renowned centres of excellence. The proformas were originally developed for use in the intensive therapy unit
or high dependency unit. However, they have been adapted for use by outreach teams reviewing patients admitted outside of critical care areas. The use of these tools can direct eff orts to provide appropriate organ support and provides a framework for diagnostic reasoning.
This review article discusses microvascular and macrovascular disease in systemic hypertension. It summarizes that:
1) Cardiac imaging plays a crucial role in risk stratifying hypertensive patients and identifying management strategies by properly diagnosing microvascular and coronary artery disease.
2) The nitric oxide synthase (eNOS) G298 gene allele may be a marker for microvascular angina in hypertensive patients, as studies have found it to be more prevalent in hypertensive patients with chest pain and reversible myocardial defects but normal coronary arteries.
3) Both structural changes like capillary rarefaction and functional changes like endothelial dysfunction can cause microvascular dysfunction and angina in hypertensive individuals in the absence of
This study characterized dengue infections in Pakistan by analyzing hematological and serological markers in 154 suspected dengue cases and 146 control patients with other febrile illnesses. NS1 antigen was detected in 55% of dengue cases, IgM antibodies in 30%, and both in 15%. Control groups primarily had malaria (71%) and enteric fever (20%). Hematological markers (platelet count, hematocrit, WBC) measured before and after treatment showed significant differences for platelet count and hematocrit but not WBC count between the groups. Analysis of clinical symptoms and serological/hematological markers helps diagnose dengue, assess prognosis, and inform prevention efforts to reduce morbidity, mortality and spread of the disease.
Researchers from Utrecht recently published yet another paper on the use of Magnetic Resonance Imaging (MRI)demonstrating an additional failed attempt to understand the importance of qualitative versus quantitative imaging, and anatomic versus physiologic imaging. Th e implications of this failure here cannot be overstated.
Introduction: Stroke is an even more dramatic major public health problem in young people. Goal of the study: Contribute to the knowledge of strokes in young people. Methodology: This was a retrospective study carried out over a period of 02 years (January 2017 to December 2018) including the files of patients aged 18 to 49 years hospitalized for any suspected case of stroke in the Neurology department of the University Hospital
Center of the Sino-Central African Friendship (CHUSCA) of Bangui.
Background: This report describes a unique case of a patient that developed psychotic symptoms believed to be secondary
to a tentorial meningioma with associated hydrocephalus. These psychotic symptoms subsequently abated with placement of a
ventriculoperitoneal shunt. Case description: 60-year-old female was admitted to an inpatient psychiatric facility on a psychiatric involuntary commitment petition due to progressive paranoia, homicidal ideation and psychosis. The work up showed a calcified six cm tentorial meningioma with associated hydrocephalus. The patient initially rejected treatment but later became amenable to placement of Ventriculoperitoneal Shunt
(VPS).
More from SciRes Literature LLC. | Open Access Journals (20)
Kosmoderma Academy, a leading institution in the field of dermatology and aesthetics, offers comprehensive courses in cosmetology and trichology. Our specialized courses on PRP (Hair), DR+Growth Factor, GFC, and Qr678 are designed to equip practitioners with advanced skills and knowledge to excel in hair restoration and growth treatments.
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
The skin is the largest organ and its health plays a vital role among the other sense organs. The skin concerns like acne breakout, psoriasis, or anything similar along the lines, finding a qualified and experienced dermatologist becomes paramount.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
2. SCIRES Literature - Volume 3 Issue 1 - www.scireslit.com Page -08
International Journal of Ophthalmology & Vision Research ISSN: 2640-5660
INTRODUCTION
Glaucoma treatment is designed to achieve a lasting and effective
reduction in Intraocular Pressure (IOP) in affected patients, in order
to prevent the progressive and irreversible loss of optic nerve fibres.
To this end, in addition to medical and surgical techniques, laser
techniques to weaken the trabecular meshwork have been developed
since the 1980s, following the pilot study by Wise and Witter [1].
In 1998, a study by Latina demonstrated that it is possible to
target only the pigmented cells in the trabecular meshwork, by using
a low-power pulsed laser. This marked the start of Selective Laser
Trabeculoplasty (SLT) [2,3].
The technique was soon proven to be effective [4], with results
indicating a reduction in IOP of between 16 and 32% of the baseline
value at one year [5]. However, the effects of SLT on IOP are not
permanent, and can vary depending on the indications and the
technical characteristics of the trabeculoplasty process.
The aim of our study was to assess pressure reduction at one year
andtwoyearsinanactivepopulationofglaucomapatientstreatedwith
SLT. The secondary aims were to determine the treatment’s success
rate, to ascertain whether SLT helps reduce the number of topical
treatments, and to identify the technical and clinical characteristics
that may have an impact on the efficacy of the treatment.
MATERIALS AND METHODS
This was a retrospective, observational, single-centre study of 117
eyes in glaucoma patients treated with SLT between January 2015 and
March 2016.
Population
The inclusion criteria were: aged over 18 years, with chronic open-
angle glaucoma suitable for laser treatment (primary open-angle
glaucoma, pigmentary or pseudoexfoliative glaucoma, traumatic
glaucoma, steroid-induced glaucoma). Laser treatment could be
used for the following reasons: changes in central visual field or IOP
that remained poorly controlled despite well-conducted medical
treatment or filtration surgery, intolerance to or failure to comply
with topical drug therapy, or primary therapy to delay the initiation
of topical treatment in young patients. Both eyes could be included.
The exclusion criteria were a history of argon laser
trabeculoplasty or SLT.
The treatment was indicated once patients had given their
oral informed consent.
Pre-trabeculoplasty data
A full eye examination was conducted in all patients prior to
the trabeculoplasty. The following criteria were assessed: patient
demographic characteristics (age, sex, ethnicity); glaucoma type
(primary, pigmentary, pseudoexfoliative, traumatic, steroid-
induced); reason for treatment; extent of iridocorneal angle
pigmentation (graded 0 to 4 based on the SCHEIE classification
system); IOP, measured using the Goldmann applanation tonometer;
corneal thickness; number of pressure-lowering drugs used topically;
and history of filtration surgery.
Technique used
The treatment was carried out under topical anaesthesia with
Oxybuprocaine hydrochloride 0.4% and using a Latina contact lens.
The solutis laser (Quantel Medical®, France) was used, which can
deliver pulses of 0.2 mJ to 2.0 mJ. The initial pulses were fired at the
trabecular meshwork at the device’s lowest energy level, which was
then gradually increased to reach the lowest energy level required
to create a bubble upon impact. The treatment was then performed
over 180° or 360°, at the physician’s discretion, comprising fifty pulses
for each half of the trabecular meshwork. The technical parameters
used for each patient were recorded (energy level and circumference
treated: 180° or 360°).
Preoperative pressure-lowering treatment was continued and a
topical NSAID treatment (Bromfenac) was added for 10 days, at a
dose of one drop four times daily.
4.4. Post-trabeculoplasty data
The post-SLT data collected at one year and two years included
IOP measured by applanation tonometer, number of pressure-
lowering drugs used topically, and adverse effects linked to the
treatment (early hypertonia, anterior chamber inflammation, macular
oedema, corneal oedema).
The primary endpoint studied was pressure reduction at one
and two years in the general population, and we also carried out a
subgroup analysis based on the therapeutic indications (“primary
therapy”, “poor compliance and poor tolerance” and “progression
under well-conducted treatment”).
Treatment success, defined as a decrease in pressure greater than
or equal to 20% of the baseline value with no increase in drug therapy,
was assessed in our population at one and two years. We then studied
the impact of SLT treatment on the reduction in the number of topical
ABSTRACT
The objective of this study was to observe the 1-year and 2-year pressure reduction in an active population of glaucoma patients treated by selective
laser trabeculoplasty.
We carried out a retrospective study of all patients treated in our department between January 2015 and March 2016. Patients who had already
undergone Laser Trabeculoplasty (ALT or SLT) in the past were excluded from the study. Treatment was performed with a Q-Switched, frequency doubled
Nd: YAG laser (Solutis - Quantel Medical, France), over 180° or 360° of the trabecular meshwork. The mean decrease in intraocular pressure and the success
rate, defined as a decrease in intraocular pressure superior to 20% without increasing the medical treatment, were calculated. The impact of the different
clinical and technical characteristics on the decrease in pressure was also studied by multivariate analysis.
One hundred and seventeen eyes, in 74 patients, were included. The mean decrease in IOP from baseline was 4.35 mmHg (20.6%) at 1 year and 3.74
mmHg (16.7%) at 2 years. The success rate was 49% at 1 year and 33.3% at 2 years. Selective trabeculoplasty is currently a therapeutic option called-upon
at different stages in the progression of glaucoma. The duration of efficacy of this laser therapy, and the retreatment frequency are yet to be defined.
Keywords: Selective laser trabeculoplasty; Intra ocular pressure
3. SCIRES Literature - Volume 3 Issue 1 - www.scireslit.com Page -09
International Journal of Ophthalmology & Vision Research ISSN: 2640-5660
pressure-lowering drugs. Finally, we looked for any factors that could
predict treatment success.
Statistical analysis
The quantitative data were expressed as mean and standard
deviation. Since the variables were not normally distributed, the
Wilcoxon signed-rank test was used to compare pre- and post-
trabeculoplasty IOP and the number of topical treatments pre- and
post-trabeculoplasty. Bivariate and multivariate analysis based on
logistic regression models was used to look for factors predictive of
treatment success.
Statistical significance was set at p < 0.05
RESULTS
Demographic characteristics
We studied 117 eyes in 74 patients. The demographic
characteristics of these patients are described in table 1.
Clinical characteristics prior to trabeculoplasty
The clinical characteristics recorded prior to the treatment are
described in table 2. In terms of aetiology, the majority of patients
had primary glaucoma (88%).
Reason for SLT treatment
Selective laser trabeculoplasty treatment was chosen due to
progression of the disease despite well-observed topical treatment
(IOP not controlled, progression of central visual field or structural
changes) in 85 patients (72.6%) and poor tolerance of or poor
compliance with topical treatment in 24 patients (20.5%), while 8
patients (6.8%) were given SLT as primary therapy after glaucoma
was diagnosed.
Technique used
The technical characteristics of the treatment (circumference
of treated trabecular meshwork and energy level used during the
procedure) are described in table 3. Results of the 117 eyes included
in the study, 100 were examined at 1 year (average follow-up 11 ± 2.6
months).
At 2 years (average follow-up 23 ± 3.3 months), just 87 eyes were
assessed: 9 eyes (7.7%) were excluded from the statistical analysis
due to subsequent filtration surgery being performed and 1 eye was
excluded due to a second course of SLT treatment, while 20 patients
were lost to follow-up.
A significant improvement in IOP was observed at each follow-
up stage. At 1 year, IOP had decreased by 4.35 mmHg on average,
corresponding to 20.6% (± 22.2) of the baseline value. At 2 years, IOP
had decreased by 3.74 mmHg on average, corresponding to 16.7% (±
22.5) of the baseline value (Table 4).
When the patients were assessed in subgroups based on the reason
for the treatment, the mean pressure reduction remained significant
at one and two years for the “poor compliance and poor tolerance”
and “progression under well-conducted treatment” groups. However,
it was not significant for the group of patients who received SLT as
primary therapy (Table 5).
Based on the definition used for the study, the treatment success
rate was 49.0% at 1 year and 33.3% at 2 years. For patients with a
history of filtration surgery, this was 55.6% at 1 year and 57.1% at 2
years.
Table 2: Description of clinical characteristics of studied eyes.
N % / mean
Standard
deviation
Min. Max.
Glaucoma type
Primary 101 88.00%
Pigmentary 4 3.40%
Pseudoexfoliative 1 0.90%
Traumatic 5 4.30%
Steroid-induced 4 3.40%
Iridocorneal angle
pigmentation
Data missing 57
0 2 3.30%
1 10 16.70%
2 35 58.30%
3 10 16.70%
4 3 5.00%
Corneal thickness (μm) 85 540.8 43.6 410 643
No. of topical drugs
prior to SLT
117 2.1 1.1 0 4
History of filtration
surgery
10 8.50%
IOP prior to SLT (mmHg) 116 20 5 11 42
Table 1: Description of population characteristics.
N
% /
Standard deviation Min. Max.
mean
Age (years) 117 62 12.1 23 89
Sex
M 59 50.4
F 58 49.6
Side
Right 64 54.70%
Left 53 45.30%
Ethnicity
Caucasian 114 97.40%
Hispanic 3 2.60%
Table 3: Technical characteristics of SLT treatment.
N %
Treated circumference
Data missing 12
180° 24 22.9
360° 81 77.1
Energy level used (mJ)
Data missing 42
0.8 2 2.7
1.1 1 1.3
1.2 41 54.7
1.3 9 12
1.5 16 21.3
2 6 8
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International Journal of Ophthalmology & Vision Research ISSN: 2640-5660
There was no evidence of a reduction in the number of pressure-
lowering treatments used topically. The average number of drugs was
2.1 (± 1.1) prior to the SLT and 2.0 (± 1.1) at 1 year and 2 years.
Our multivariate analysis identified a significant link between the
likelihood of SLT treatment success and high initial IOP, with an OR
of 1.2 at 2 years (p = 0.0047), as well as age above the median (63
years), with an OR of 3.6 (p = 0.0320).
The bivariate and multivariate analysis of the impact of different
clinical parameters on reduction in IOP at 1 year and 2 years found
no statistically significant links for sex, ethnicity, corneal thickness,
glaucoma type, iridocorneal angle pigmentation, number of topical
treatments prior to SLT, reason for treatment, treated circumference
or energy level used.
Only one minor adverse effect was found in our population: a
reduction in visual acuity caused by pigment dispersion. This occurred
immediately after the laser treatment and resolved spontaneously.
DISCUSSION
Selective laser trabeculoplasty is well known to effectively reduce
intraocular pressure in the short term, but its efficacy remains difficult
to assess over the longer term. In our population, we demonstrated its
therapeutic efficacy in both the short and medium term. We found
a mean reduction in IOP of 19.6% at 1 year and the trabeculoplasty
success rate-defined as a reduction in IOP of at least 20% of the
baseline value-was 49%. These figures are comparable to those of
other similar study populations in the literature. The percentage
reduction in IOP in the various prospective and retrospective studies
assessing SLT efficacy at one year ranges from 16.9% to 31.6% of the
baseline value [5]. Using the same definition of success, in patients
not controlled by medical treatment. Sayin et al., found a one-year
success rate of 64,5% [6], Hodge et al., recorded 60% [7], Kontic et al.,
report 64.58% [8] and Schlote et al., report 59.09% [9]. These success
rates are slightly higher than that observed with our patients. This
is partly due to the fact that we did not exclude from the study any
patients at an advanced stage of the disease, particularly those with a
history of filtration surgery.
It is now accepted that the effect of SLT diminishes over time. We
therefore wanted to continue our analysis after two years of follow-
up, in order to assess the durability of the treatment in the medium
term in our patients. The treatment remained effective for a good
length of time in our study, since the two-year success rate was 33.3%
compared to rates of 11.1% to 41% in the literature [10,11]. The mean
reduction in IOP at 2 years was 3.74 mmHg, corresponding to 16.7%
of the baseline value. In a population of 269 patients, Best et al., found
a reduction in IOP of 12.1% at 2 years [12].
Certain studies with a low number of subjects found that the
treatment remained effective for up to 12 months after it was
performed [13,14].
There is no consensus around the discontinuation of drug
therapy after trabeculoplasty. Certain authors achieve a significant
reduction in medical treatment, which can be explained by a different
treatment protocol, characterised by a wash-out period prior to
the SLT and the resumption of topical treatment on a case-by-case
basis depending on the IOP measured at post-laser check-ups [10].
In our patient population, the number of topical treatments did not
decrease significantly at one year and two years. Since the patients
treated for glaucoma in our department are often difficult to stabilise,
trabeculoplasty was used as an adjuvant treatment to medical
treatment, which was systematically continued, unless intolerance or
poor compliance were an issue.
Different clinical, therapeutic and technical factors have been
suggested as predictors of the success of this treatment. We found a
significant link between the IOP value prior to trabeculoplasty and
the likelihood of treatment success, which corroborates the data in
the literature [7] [15-19]. We also found a link between advanced
age and SLT treatment success, which has again been described
previously [19].
Certain epidemiological factors, such as African ethnicity, appear
to have a positive impact on the efficacy of SLT, but were not found in
our study, due to the demographic characteristics of our population
[20].
In terms of therapeutic factors, the use of a prostaglandin prior
to SLT appears to be a factor in weaker efficacy (18). This could be
linked to a common mechanism of action within the Schlemm’s canal
Table 4: Mean pressure reduction at the two assessment points.
N assessed Mean reduction p - value
Absolute in mmHg
Between T1 and T0 100 4.35 ( ± 5.29) < 0.0001
Between T2 and T0 87 3.74 ( ± 5.24) < 0.0001
Relative as percentage of
baseline IOP
Between T1 and T0 100 20.6% ( ± 22.2) < 0.0001
Between T2 and T0 87 16.7% ( ± 22.5) < 0.0001
T1 = 1 year; T2 = 2 years.
Table 5: Mean pressure reduction at 1 and 2 years, assessed based on reason
for treatment.
N Mean reduction p - value
Absolute in mmHg
Between T1 and T0
Primary therapy 8 0.25 0.773
Poor eye drop tolerance/compliance 23 6 < 0.0001
Progression 69 4.28 < 0.0001
Between T2 and T0
Primary therapy 8 0.25 0.844
Poor eye drop tolerance/compliance 19 5.11 0.0008
Progression 60 3.77 < 0.0001
Relative as percentage of baseline
IOP
Between T1 and T0
Primary therapy 8 8.00% 0.727
Poor eye drop tolerance/compliance 23 28.10% < 0.0001
Progression 69 20.40% < 0.0001
Between T2 and T0
Primary therapy 8 4.10% 0.906
Poor eye drop tolerance/compliance 19 21.70% 0.001
Progression 60 17.20% < 0.0001
T1 = 1 year; T2 = 2 years.
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International Journal of Ophthalmology & Vision Research ISSN: 2640-5660
epithelial cells [21]. The number of responders appears to be higher
in patients who used none or few pressure-lowering drugs prior to
treatment [22].
We did not find that the trabeculoplasty technical parameters
had any significant impact on the efficacy of the treatment. At
present, there is no consensus as to the appropriate circumference
to be treated. The majority of authors find no significant differences
in pressure reduction between 180° and 360° treatment [23,24].
However, higher energy pulses could potentially correlate with
a higher success rate [19] [25]. Lee et al., place the optimal total
treatment energy at 226.1 mJ [26]. Wong et al., estimate that pressure
reduction is greater with 160 pulses over 360° than with 120 pulses
over the same circumference [27].
This easy-to-use technique [28] is associated with few adverse
effects. The most commonly cited adverse effect in the literature is
an early IOP spike, generally transient, which affects between 2% and
26% of treated patients [29]. Other reported complications include
uveitis, hyphema, macular oedema and corneal complications (haze,
corneal oedema, transient reduction in endothelial density [30,31].
One case of bilateral choroidal effusion was recently reported [32]. In
our population, we observed just one case of transient reduced visual
acuity due to pigment dispersion.
Since several studies have shown that SLT is no worse than drug
therapy, laser treatment is increasingly offered as primary therapy for
newly diagnosed patients [33]. This avoids the adverse effects of eye
drops and can improve patient quality of life [34], as well as saving
money [35,36].
A randomised, multi-centre clinical trial including 718 patients
is currently being conducted to establish whether SLT is superior
to drug therapy in glaucoma patients who have yet to receive any
treatment [37]. In our cohort, the pressure reduction was not
statistically significant for patients treated with SLT as primary
therapy, which can be explained by the very small number of patients
in this subgroup.
SLT also tends to be particularly effective as a replacement therapy
for effective topical treatment, even where this is well tolerated.
De Keyser et al., managed to fully replace drug therapy 18 months
after SLT in 77% of patients out of a cohort of 143 eyes with well
controlled glaucoma [38]. Replacing effective drug therapy with SLT
is particularly relevant in clinical situations where topical drugs can
prove dangerous, such as during pregnancy: SLT has been shown to
effectively control the disease during this period [39].
When performed alongside optimal medical treatment, SLT can
delay the need for surgery as a result of uncontrolled glaucoma [8].
Sayin et al., achieved a 64.5% success rate in a cohort of patients whose
glaucoma remained uncontrolled despite well-conducted optimal
drug therapy [6]. SLT also appears to effectively reduce pressure in
eyes that have undergone previous filtration surgery: Sharpe et al.,
found no differences in terms of 1-year success rate in eyes with and
without a history of glaucoma surgery [40). Our results corroborate
this, with a success rate of 55.6% at 1 year and 57.1% at 2 years in the
patient group with a history of filtration surgery.
Since the reduction in pressure achieved by SLT fades over time,
several studies have attempted to assess the efficacy of a second SLT
treatment. Several authors have found that the efficacy of the second
treatment is lower than that of the first [41], while others have found
no difference in efficacy between the two treatments [42]. In all cases,
the second treatment does not appear to result in worse adverse
effects.
Our study confirms the value of using this recent treatment
to manage all types of glaucoma patients in an ophthalmology
department-provided the iridocorneal angle offers sufficient access to
the trabecular meshwork-regardless of the stage of the disease.
CONCLUSION
SLT is a safe and effective technique for reducing IOP. It can be
used at any stage of the disease and fully merits its inclusion in the
therapeutic options for chronic open-angle glaucoma. Among our
patients, the success rate was 49% at 1 year and 33.3% at 2 years. Due
to the depletion of the pressure-lowering effect over time, it would
be valuable to study the change in IOP over the longer term and in a
larger number of patients, as well as the efficacy of retreatment.
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