Explore the vast range of titles available.

BackgroundGraves’ orbitopathy (GO) is subject to epidemiological and care-related changes. Aim of the survey was to identify trends in presentation of GO to the European Group On Graves’ Orbitopathy (EUGOGO) tertiary referral centres and initial management over time.MethodsProspective observational multicentre study. All new referrals with diagnosis of GO within September–December 2019 were included. Clinical and demographic characteristics, referral timelines and initial therapeutic decisions were recorded. Data were compared with a similar EUGOGO survey performed in 2012.ResultsBesides age (mean age: 50.5±13 years vs 47.7±14 years; p 0.007), demographic characteristics of 432 patients studied in 2019 were similar to those in 2012. In 2019, there was a decrease of severe cases (9.8% vs 14.9; p<0.001), but no significant change in proportion of active cases (41.3% vs 36.6%; p 0.217). After first diagnosis of GO, median referral time to an EUGOGO tertiary centre was shorter (2 (0–350) vs 6 (0–552) months; p<0.001) in 2019. At the time of first visit, more patients were already on antithyroid medications (80.2% vs 45.0%; p<0.001) or selenium (22.3% vs 3.0%; p<0.001). In 2019, the initial management plans for GO were similar to 2012, except for lid surgery (2.4% vs 13.9%; p<0.001) and prescription of selenium (28.5% vs 21.0%; p 0.027).ConclusionGO patients are referred to tertiary EUGOGO centres in a less severe stage of the disease than before. We speculate that this might be linked to a broader awareness of the disease and faster and adequate delivered treatment.

Purpose compare incidences of maternal–fetal complications during pregnancy, labor, and early puerperium according to baseline BMI in a consecutive cohort of pregnant women. Methods This retrospective cohort study compares pregnancy outcome indicators by body mass index (BMI) in 1236 pregnant women managed over the period January 2017 to May 2018. Data were collected regarding the personal history (smoking, diabetes and hypertension), obstetrics and BMI (kg/m 2 ) (normoweight 18.5–24.9, overweight 25–29.9, obese ≥ 30). Results Of the 1236 women, 354 (28.6%) were overweight and 206 (16.7%) were obese at the start of pregnancy follow-up. Mean age at this time was 33 years (SD 6). Risk factors for a cesarean-section delivery assessed through logistic regression were maternal age (OR 1.05 95% CI 2.06–6.15; p  < 0.001) and previous C-section (OR 4.21 95% CI 2.89–6.14; p  < 0.001) regardless of BMI. In a propensity score analysis, pregnancy weight gain was found lower in obese vs normoweight (− 2.73 kg 95% CI − 3.74 to − 1.72 p  < 0.001), and newborn weight higher in obese vs normoweight women (161.21 g 95% CI 57.94–264.48 p  = 0.002). Labor duration and weight gain were reduced in overweight vs normoweight subjects (− 0.72 h 95% CI − 1.27 to − 0.17 p  = 0.010 and 0.81 kg 95% CI − 1.50 to − 0.12 p  = 0.021, respectively). Conclusions In this cohort, obese women showed higher rates of prenatal complications yet obesity and overweight were not related to worse puerperium outcomes.

Massive hemorrhage (MH) is a growing pathology in military settings and increasingly in civilian settings; it is now considered a public health problem in the United States with large-scale programs. Tourniquets are the fastest and most effective intervention in MH if direct pressure is not effective.The Liaison Committee on Resuscitation (ILCOR) recognizes a knowledge gap in optimal education techniques for first aid providers. This review aims to describe training and evaluation methods for teaching tourniquet use to both health care and military professionals. The MEDLINE, CINAHL, WEB of Science, and Scopus databases were reviewed (from 2010 through April 2020). The quality of the selected studies was assessed using the Consolidated Standards of Reporting Trials (CONSORT) scale. Studies that met at least 65% of the included items were included. Data were extracted independently by two reviewers. Ten of the 172 articles found were selected, of which three were randomized clinical trials. Heterogeneity was observed in the design of the studies and in the training and evaluative methods that limit the comparison between studies. The results suggest that the training strategies studied are effective in improving knowledge, attitudes, and practical skills. There is no universal method, learning is meaningful but research should be directed to find out which ones work best.

Background To evaluate the visual and anatomic outcomes after systemic steroid treatment in non-arteritic anterior ischemic optic neuropathy (NAION). Methods Ten eyes from ten patients diagnosed with NAION and treated during the acute phase with 80 mg daily, tapering-down dose of corticosteroids were compared with a non-contemporary cohort of 27 patients that received no treatment. The visual outcomes of treated and untreated group were compared. Patients underwent complete ophthalmic examination including determination of Snellen visual acuity (VA), visual fields (VFs) (standard automated perimetry, Swedish Interactive Testing Algorithm 24–2 strategy), and optical coherence tomography (OCT) scanning of the optic nerve head at diagnosis, 6–8 weeks and 6 months after presentation. Results No statistical differences were found between steroid-treated and untreated NAION for the median change in VA (Mann–Whitney P =  0.28), median change in VF mean deviation (MD) and median change in VF pattern standard deviation (PSD) (Mann–Whitney P =  0.213 and P =  0.07 respectively). Statistical analysis showed no differences when comparing average RNFL loss ( P  = 0.871) and RNFL loss for superior, nasal, inferior and temporal optic disc quadrants between both groups. Complications occurred in three of the ten treated patients (30%); in one of them, steroid therapy had to be discontinued. Another two patients developed a NAION in their fellow eye after 2 and 3 months while on low-dose prednisone. No complications developed in the control group. The study was interrupted early due to a significantly higher rate of complications observed in the treated group ( P =  0.002) Conclusion High-dose systemic steroid treatment did not show any beneficial effect in visual and anatomic outcomes when given during the acute phase of NAION. Furthermore, it caused serious complications in a third of the patients treated.

To evaluate the visual and anatomic outcomes after systemic steroid treatment in non-arteritic anterior ischemic optic neuropathy (NAION). Ten eyes from ten patients diagnosed with NAION and treated during the acute phase with 80 mg daily, tapering-down dose of corticosteroids were compared with a non-contemporary cohort of 27 patients that received no treatment. The visual outcomes of treated and untreated group were compared. Patients underwent complete ophthalmic examination including determination of Snellen visual acuity (VA), visual fields (VFs) (standard automated perimetry, Swedish Interactive Testing Algorithm 24-2 strategy), and optical coherence tomography (OCT) scanning of the optic nerve head at diagnosis, 6-8 weeks and 6 months after presentation. No statistical differences were found between steroid-treated and untreated NAION for the median change in VA (Mann-Whitney P = 0.28), median change in VF mean deviation (MD) and median change in VF pattern standard deviation (PSD) (Mann-Whitney P = 0.213 and P = 0.07 respectively). Statistical analysis showed no differences when comparing average RNFL loss (P = 0.871) and RNFL loss for superior, nasal, inferior and temporal optic disc quadrants between both groups. Complications occurred in three of the ten treated patients (30%); in one of them, steroid therapy had to be discontinued. Another two patients developed a NAION in their fellow eye after 2 and 3 months while on low-dose prednisone. No complications developed in the control group. The study was interrupted early due to a significantly higher rate of complications observed in the treated group (P = 0.002) High-dose systemic steroid treatment did not show any beneficial effect in visual and anatomic outcomes when given during the acute phase of NAION. Furthermore, it caused serious complications in a third of the patients treated.

The causes of persistent submacular detachment after successful rhegmatogenous retinal detachment (RRD) surgery remain unknown. Its presence is associated with poor postoperative visual acuity, but due to its spontaneous resolution no additional therapeutic or diagnostic procedure is recommended. A case of central serous chorioretinopathy (CSC) that simulated persistent subfoveal fluid after RRD surgery is presented. To the authors' knowledge, no other case of visual impairment after successful retinal detachment surgery due to CSC has been reported in the PubMed database. In view of this report, CSC should be considered in the differential diagnosis of persistent subretinal fluid after successful retinal detachment surgery.

To evaluate the relationship between the displacement of the lamina cribrosa (LC) and prelaminar tissue with corneal hysteresis (CH) using spectral-domain coherence tomography (SD-OCT) after reducing intraocular pressure (IOP) with medical treatment. Sixty-one eyes of 61 patients with ocular hypertension or primary open-angle glaucoma who were going to start with treatment were imaged by means of 12 cross-sectional scans of the optic nerve using enhanced depth imaging SD-OCT before and after 1 week of treatment. We used the 'follow-up' mode to make sure that all the measurements were performed in the same location. We also measured the CH using an Ocular Response Analyzer, and we related it to the magnitude of displacement of LC and prelaminar tissue and the thickness of both structures. There was a significant variation of LC thickness from 132.66±37.40 to 160.09±41.13 µm (p<0001). LC distance was significantly reduced from 258.53±145 µm before treatment to 239.86±135 µm after it. No significant changes were found in the thickness and movement of prelaminar tissue before and after treatment. The only factors related with LC displacement were CH (R =0.48) and age (R =0.42). A significant increase in LC thickness and a reduction in the posterior displacement of LC but not in the prelaminar tissue were demonstrated after IOP reduction with medical treatment. The factors most related with LC displacement were age and CH.

Aims:The aim of the study was to compare event-based glaucoma progression analysis (GPA) I with new GPA II software and pattern deviation-based trend analyses (visual field index [VFI]) to detect progression in a glaucoma population.Methods:This was a retrospective study that included 90 eyes of 90 patients with a minimum of five reliable visual field tests and a follow-up period of at least 2 years.Results:Event-based GPA II detected progression in 16.7% of eyes in which trend analysis VFI failed. GPA detected progression 6.8 months earlier than VFI. GPA I and II showed excellent agreement (k = 0.94). Agreement between VFI and mean deviation (MD) linear analysis and with GPA criteria was k = 0.52 and k = 0.48, respectively. Mean rates of progression of MD and VFI were −0.41 dB and −1.30% annually, respectively (rho = 0.824; p<0.0001). Using VFI, mean follow-up time was 6.12 and 4.89 years (p = 0.004) and the mean number of visual field tests was 7.33 and 6.01 (p = 0.023) in eyes with and without progression, respectively.Conclusions:Event-based software GPA I and II had excellent agreement. Event analysis showed earlier and greater sensitivity for detecting progression than VFI analysis and both had only moderate agreement. Trend analysis VFI is likely to detect progression in patients with a greater number of visual field tests and a longer follow-up time. The VFI analysis seems to be more accurate than MD analysis for determining rate of progression.

Lowering the CFS pressure has an effect on the trans-LC gradient and the reverse of the anterior displacement of the LC may be an indirect sign of ICP lowering. [...]a non-invasive assessment of the LC position using SD-OCT may be used as a new tool in monitoring treatment and progression of the disease.

ObjectiveTo compare prospectively intraocular pressure (IOP) results after deep sclerectomy (DS) using a topical short-term corticosteroid treatment (STCT, 1  month) versus a topical long-term and intense corticosteroid treatment (LTCT, 6 months) in a two2  year-follow-up.MethodsPatients with medically uncontrolled open angle glaucoma were prospectively recruited and underwent a DS.ResultsWe operated 45 eyes of 45 patients, 22 in STCT group and 23 in LTCT group. Median preoperative IOP was 27 (22–36.75)  mm Hg for STCT and for 25 (22–28) mm Hg for LTCT group without significant difference (p=0.195). Median postoperative IOP was 4 (3–6.25) mm Hg in STCT group versus 2 (0–5)  mm Hg in LTCT at day 1 (p=0.003); 8.5 (5.75–11.25)  mm Hg (STCT) vs 6 (4–9) mm Hg (LTCT) at week 1 (p=0.079); 17.5 (14.75–22.25)  mm Hg (STCT) vs 13 (10–14) mm Hg (LTCT) at month 1 (p=0.001); 16 (12–20) mm Hg (STCT) vs 12 (10–15) mm Hg (LTCT) at month 3 (p=0.008); 17 (14–20) mm Hg (STCT) vs 12 (10–14) mm Hg (LTCT) at month 6 (p=0.000); 16 (14–20) mm Hg (STCT) vs 14 (10–16) mm Hg (LTCT) at year 1 (p=0.002) and 17.5 (15–19)  mm Hg (STCT) vs 14 (12–16) mm Hg (LTCT) at year 2 (p=0.001). The complete success rate was 54.5 % in STCT and 87 % in LTCT (p=0.018).ConclusionsA long-term and intensive postoperative treatment enhances success rate in DS compared with a standard protocol.