140 research outputs found
A new model for management of intravitreal injections: Bari Policlinico real world experience
No full textPurpose: Worldwide real-world data showed that the letters gain was much lower than pivotal trials. This gap can have many reasons, including the onset of intravitreal therapy was too late both for delay in diagnosis and for long waiting list; the number of injections was much lower than ideal. Here, we shared our experience on a new model for management of IVI in naïve patients with neovascular Age-related Macular Degeneration (nAMD).
Setting/Venue: Intravitreal Injection Centre of Eye Clinic, Policlinico of Bari, Italy.
Methods: The IVI Centre was designed to allow a one-way and fast track to patients needing an IVI of any drug. Every patient access is recorded in electronic form and data are collected in a single database. The center consists of five main rooms: waiting room, reception, examination room, operating room provided with ArcSterile, discharge room. Best correct VA (BCVA) was assessed by means of Early Treatment Diabetic Retinopathy Study (ETDRS) letters chart. Each patient performed optical coherence tomography (OCT) and OCT angiography (OCTA) in both eyes. The treatment schedule was confirmed or modified, based on the current examination. Then, the patient received IVI of ranibizumab or aflibercept.
Results: Among 1795 eyes treated during the first year of activity of new IVI Center, 310 eyes naïve with nAMD were selected. To limit possible confounding factors, we decided to study only the 197 patients with a unilateral disease. 52.8% were male, average age was 77±8 years. 4.6 weeks is the middle time between the first IVI and the second one, 9.3 weeks between the first and the third one. Among patients that completed 52 weeks of follow-up, the average number of IV was 7±2.2. BCVA improved of 9±16.4 letters on average and macular thickness decrease of 102±163.8 μm, with no significant difference between ranibizumb and aflibercept groups (p>0.05).
Conclusions: A diagnostic and therapeutic center dedicated only to IVI seemed to be useful in the management of nAMD, improving the functional and anatomic outcome after IVI and the patients’ compliance too
Retinal vessel analysis on OCTA immediately after intravitreal injection
No full textPurpose: to evaluate papillary, peripapillary and macular vascular change within 5 minutes from intravitreal injection (IVI) performed in ArcSterile setting.
Setting/Venue: Intravitreal Injection Centre of Eye Clinic, Policlinico in Bari, Italy. This diagnostic and surgical setting was a one-way track, from reception, examination, IVI under Arc Sterile and discharge. The presence of instrument in adjacent room allowed us to repeat examination in few minutes after the IVI, when iop spike occurred.
Methods: from January 2018 to May 2018, we prospectively selected participants from patients scheduled to perform an IVI. Inclusion criteria were: diagnosis of wet-Age related Macular Degeneration (wAMD) or active myopic Choroidal NeoVascularisation (mCNV). Exclusion criteria were: antiglaucoma treatment or intraocular pressure (IOP) > 21 mmHg, previous intraocular operation other than cataract, significant media opacity, best correct visual acuity (BCVA) < 20/200, poor compliance. All patients underwent to air-puff tonometry, spectral-domain optical coherence tomography (SD-OCT) and SD-OCT Angiography (OCTA), before and immediately after IVI (no later than 5 minutes), because the instruments were placed just outside the room of ArcSterile cabin. Data collected were: age, systemic comorbidity (such as hypertension), use of anticoagulant or antiplatelet, central retinal thickness (CRT), retinal nerve fiber layer (RNFL) thickness, ganglion cell complex (GCC) thickness, papillary, peripapillary and macular vessel density (VD) in 3x3 OCTA.
Results: 73 patients (78 eyes) were enrolled in the study, 39 male (53.4%) with an average age of 73 ±12 years. Indications for IVI were wAMD (92.3%) and mCNV (7.7%). The drugs administered were ranibizumab (55.1%) and aflibercept (44.9%). After IVI, IOP increased (17.9±2.2 vs 32.6±10.2 mmHg, p<0.01); the superficial vascular plexus vessel density reduced only in parafoveal area with a significantly difference (44.5±5.2 vs 40.8±5.8, p<0.01). Peripapillary fibre layer decreased (100.3±22.2 vs 99.1±21.3, p<0.05). Area and flow area of neovascular membrane unchanged.
Conclusions: after the IOP rise caused by IVI, vessel density in SCP and RNFL peripapillary thickness reduced, but neovascular membranes VD, despite their thin wall, did not statistically vary
Sudden death due to catecholaminergic polymorphic ventricular tachycardia following negative stress-test outcome: genetics and clinical implications.
No full textThis paper discusses the case of a young boy who died suddenly during a football match. The victim's personal and family medical histories were negative for cardiac events. He had undergone a cardiological investigation some months before his death, enabling him to participate in competitive sports. Only post-mortem molecular analysis allowed for a clearer determination of the most plausible cause of death, which was identified as inherited arrhythmogenic heart disease, known as catecholaminergic polymorphic ventricular tachycardia. It was possible to detect a novel, previously undescribed, variant in the RYR2 gene. This case report highlights the importance of a meaningful forensic multidisciplinary investigation in such cases, and also discusses possible medical malpractice claims
Valutazione della stabilità ossidativa di oli extravergini di oliva mediante reattore Oxitest(R)
No full textL’alterazione principale cui possono andare incontro le sostanze grasse è l’ossidazione lipidica, che incide fortemente sulla shelf-life di tali sostanze, in quanto ne pregiudica sia le caratteristiche organolettiche che nutrizionali. Rispetto ad altri oli vegetali, l’olio d’oliva ha una maggiore stabilità rispetto all’ossidazione, per la minor presenza di acidi grassi insaturi. L’olio extravergine di oliva, sia per la elevata qualità della materia prima che per le condizioni di estrazione utilizzate, è più protetto dall’ossidazione per la maggior presenza di antiossidanti naturali, particolarmente polifenoli ed α-tocoferolo. E’ stata valutata la stabilità ossidativa di oli extravergini di oliva con lo strumento Oxitest® che prevede il trattamento del campione in condizioni di elevata temperatura ed elevata pressione di O2, senza impiego di solventi e reagenti chimici, con evidenti vantaggi sia sul costo dell’analisi che in un’ottica di sostenibilità ambientale
Choroidal neovascularization due to choroidal osteoma treated with anti–vascular endothelial growth factor therapy: An optical coherence tomography angiography study
No full textPurpose: To evaluate the response to anti–vascular endothelial growth factor therapy for choroidal neovascularization secondary to choroidal osteoma using optical coherence tomography angiography. Methods: This retrospective study included four eyes of four females with choroidal osteoma complicated by choroidal neovascularization, treated with ranibizumab. All patients underwent full ophthalmologic examination, including ocular ultrasound, retinography, fluorescein angiography, spectral-domain or swept-source optical coherence tomography, and optical coherence tomography angiography. These images were analyzed to measure choroidal osteoma and to study choroidal neovascularization changes after intravitreal anti–vascular endothelial growth factor. Results: In all cases, fluorescein angiography revealed the presence the choroidal neovascularization, as an early hyperfluorescence area increasing during the exam. Optical coherence tomography showed both the choroidal osteoma and choroidal neovascularization and intra- or subretinal fluid as activity sign. In optical coherence tomography angiography, choroidal osteoma vessels were valuable in outer retina and choroidal slabs, and were irregular and did not change after ranibizumab injection; neovascular network correlating with choroidal neovascularization showed a hyperflow tangled vessels in outer retina, decreasing in density after anti–vascular endothelial growth factor therapy. Conclusion: Optical coherence tomography angiography seems to be a useful tool in visualizing and distinguishing vascular networks of choroidal osteoma and of choroidal neovascularization secondary to choroidal osteoma better than fluorescein angiography
Ciliochoroidal effusion syndrome associated with mebendazole systemic treatment
No full textMebendazole (Vermox; Johnson & Johnson Inc, New Brunswick, NJ) is an effective antiparasite drug used for the treatment of Oxyurus vermicularis infections (oxyuriasis).1 Although theoretically considered as a well-tolerated drug with few adverse effects, we report a unique case of transient ciliochoroidal effusion that occurred in temporal association with mebendazole therapy
Short-term peripapillary structural and vascular changes following anti-VEGF vs. Dexamethasone intravitreal therapy in patients with DME
No full textPurpose To evaluate short-term peripapillary structural and vascular changes in DME after treatment with dexamethasone implant (DEX-I) and anti-VEGFs using OCT-A. Methods Sixty-five patients with naive center-involving DME were enrolled. 33 of sixty five patients (group 1) underwent with single DEX-I 0.7 mg (Ozurdex, Allergan, Inc., USA), 32 of sixty-five (group 2) underwent with intravitreal injection of aflibercept 0.5 mg (Eylea, Bayer, Genentech, San Francisco, USA). The OCT acquisition was completed at the following visits: (i) "T1 visit" corresponding to the intravitreal injection of DEX-I or aflibercept in patients with naive center-involving DME (ii) "T2 visit" corresponding to the examination performed 2 weeks after intravitreal injection of aflibercept and 1 month after DEX-I. The parameters analyzed were: (i) RPC vasculature density (VD); (ii) peripapillary retinal nerve fiber layer (pRNFL) thickness, and (iii) intraocular pressure (IOP). Results The RPC analysis showed a VD increase at T2 in both groups, although values did not reach statistical significance (48.12 +/- 4.17 and 49.04 +/- 4.23; P = 0.081 in Group 1 and 46.93 +/- 3.16 and 47.17 +/- 3.70; P = 0.087 in Group 2). Likewise, the pRNFL thickness and IOP fluctuations did not show statistically significant changes in in both groups among the different study visits. Conclusions After intravitreal injection (anti-VEGF or DEX-I), no significant short-term changes were found in peripapillary microvasculature, IOP and pRNFL thickness in diabetic eyes treated with anti-VEGF or DEX-I
Estrazione dei composti fenolici di oli di oliva vergini ed effetti di ritenzione sui fenoli ossidati
No full textL'interesse relativo agli antiossidanti naturali provenienti da matrici vegetali hanno mostrato in questi ultimi anni una tendenza all’aumento. In particolare il frutto dell'oliva ed i suoi derivati rappresentano un'importante parte nella dieta Mediterranea ed è stata riconosciuta una sorgente antiossidanti fenolici naturali. Questi composti svolgono effetti chemioprotettivi sulla salute umana oltre a contribuire alle proprietà sensoriali dell'olio vergine di oliva come piccante e amaro. Inoltre, l'alta stabilità degli oli vergini di oliva è correlata sia all'alto rapporto tra acidi grassi monoinsaturi e polinsaturi ma anche alla presenza di composti fenolici che svolgono azione antiossidante. Gli estratti idrofili dell'olio vergine di oliva contengono alcuni composti fenolici come fenoli semplici, lignani e secoiridoidi.
Inoltre, per determinare il reale contenuto di fenoli dell'olio di oliva è importante disporre di un metodo analitico capace di fornire buoni recuperi in fase di estrazione. In letteratura sono riportate principalmente due tecniche per l'estrazione dei composti fenolici dall'olio vergine di oliva: estrazione su fase solida (SPE) ed estrazione liquido-liquido (LLE). Oltre ai composti fenolici, negli ultimi cinque anni, è incrementato significativamente l'interesse verso i composti fenolici ossidati in relazione alla possibilità di risalire allo stato di freschezza/invecchiamento degli oli vergini di oliva. Lo scopo di questo lavoro è quello di valutare l'influenza di due differenti metodi di estrazione (i più utilizzati) nella separazione dei composti fenolici ossidati
SEVERE VISUAL LOSS DURING ANTI-VEGF INTRAVITREAL INJECTIONS IN NEOVASCULAR AGE-RELATED MACULAR DEGENERATION: TIMING, PROGNOSIS, AND OPTICAL COHERENCE TOMOGRAPHY FINDINGS
No full textPurpose: Intravitreal injection (IVI) of anti-vascular endothelial growth factor (VEGF) is the standard of care for neovascular age-related macular degeneration (nAMD). However, a small subgroup of patients still experience severe visual impairment, which may be related to the number of IVI administered. Methods: This retrospective observational study analyzed data from patients with sudden severe visual decline (≥15 Early Treatment Diabetic Retinopathy Study [ETDRS] letters loss between two consecutive IVIs) during anti-VEGF treatment for nAMD. Best correct visual acuity examination, optical coherence tomography (OCT) and OCT angiography (OCTA) were performed before every IVI and central macular thickness (CMT) and drug injected were collected. Results: 1019 eyes received anti-VEGF IVI for nAMD from December 2017 to March 2021. Severe VA loss occurred in 15.1% after a median of 6 (range 1-38) IVI. Ranibizumab was injected in 52.8%, and aflibercept in 31.9% of cases. Functional recovery after 3 months was significant, without further improvement at 6 months. Visual prognosis relative to the percentage of CMT change showed better visual outcome in eyes with no substantial change in CMT compared to an increase of >20% or a decrease of >5%. Conclusion: In this first real-life study exploring severe VA loss during anti-VEGF treatment in patients with nAMD, we found that it was not unusual for a ≥15 ETDRS letters loss to occur between two consecutive IVIs, often within 9 months of diagnosis and 2 months after the last IVI. Close follow-up and a proactive regimen should be preferred, at least in the first year
Determinazione di oli vegetali miscelati con oli di oliva mediante una strategia graduale basata sul profilo 1H-NMR
No full textL'alto prezzo a cui è venduto l'olio di oliva, il suo profilo sensoriale peculiare e la sua reputazione come fonte salutare di grassi alimentari lo rendono un ottimo bersaglio per le frodi. Le tipologie più comuni di frode nell'olio di oliva sono, tra le altre, la miscelazione illegale con altri oli vegetali (VO) o con oli di oliva di più bassa qualità, l'etichettatura deliberatamente errata di categorie merceologiche di oli di oliva a più basso prezzo, di altri oli vegetali e le loro miscele con oli di oliva. L'adulterazione nell'olio di oliva, essendo una delle principali frodi nel settore alimentare, ha messo in luce la necessità di aggiomare e armonizzre i metodi analitici per il controllo della qualità e autenticità dell'ollio di oliva. In questo lavoro sono stati studiati oli delle categorie merceologiche "olio di oliva vergine" (VOO) e "olio di oliva" (OO) e loro miscele con i VO più comuni quali: girasole, girasole alto oleico, nocciona, avocado, soia, mais, oleina di palma e olio di girasole alto oleico deterolato. Inoltre, viene proposta una nuova strategia progressiva basata sull'impronta digitale 1H-NMR degli oli commestibili e succesiva elaborazione chemometrica al fine di garantire l'autenticità e la tracciabilità degli oli di oliva e delle loro miscele dichiarate con VO. Inoltre, tale approccio, può essere utilizzato sia per rilevare miscele illegati tra OO e VO, sia miscele "legali" falsamente etichettate rispetto alla natura botanica degli oli miscelati e/o alla percentuale di ciascun olio nella miscela dichiarata.Fil: Alonso Salces, Rosa Maria. Universidad Nacional de Mar del Plata; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mar del Plata; ArgentinaFil: Berrueta, Luis Angel. Universidad del País Vasco; EspañaFil: Quintanilla Casas, Beatríz. Universidad de Barcelona. Facultad de Farmacia. Departamento de Nutrición, Ciencias de la Alimentación y Gastronomía.; EspañaFil: Vichi, Stefania. Universidad de Barcelona. Facultad de Farmacia. Departamento de Nutrición, Ciencias de la Alimentación y Gastronomía.; EspañaFil: Tres, Alba. Universidad de Barcelona. Facultad de Farmacia. Departamento de Nutrición, Ciencias de la Alimentación y Gastronomía.; EspañaFil: Asensio Regalado, Carlos. Universidad del País Vasco; EspañaFil: Viacava, Gabriela Elena. Universidad Nacional de Mar del Plata. Facultad de Ingeniería. Departamento de Ingeniería Química. Grupo de Investigación en Ingeniería en Alimentos; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mar del Plata; ArgentinaFil: Poliero, Aimará Ayelén. Universidad Nacional de Mar del Plata; ArgentinaFil: Valli, Enrico. Universidad de Bologna; ItaliaFil: Bendini, Alessandra. Universidad de Bologna; ItaliaFil: Gallina Toschi, Tullia. Universidad de Bologna; ItaliaFil: Martínez Rivas, José Manuel. Instituto de la Grasa; España. Consejo Superior de Investigaciones Científicas; EspañaFil: Moreda, Wenceslao. Instituto de la Grasa; España. Consejo Superior de Investigaciones Científicas; EspañaFil: Gallo, Blanca. Universidad del País Vasco; Españ
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