1,721,167 research outputs found
Are visual disturbances (Excluding diabetic retinopathy) more common in geriatric dm patients? are they risks factor for the progression of disability?
No full textGeriatric DM patients should undergo regular, annual, comprehensive eye examinations to measure visual functioning and assess diabetic retinopathy and associated complications, as well as other frequent eye disorders (e.g., dry eyes, keratopathy, cataracts, glaucoma, age-related macular degeneration) for which both aging and DM are important risk factors.
Most geriatric DM patients have a high risk of cardiovascular and cerebrovascular thrombosis thus, if a clinically significant diabetic macular edema is diagnosed in one or both eyes, the first recommended line of therapy is intravitreal administration of long-acting corticosteroid drugs.
More attention should be paid to vision rehabilitation programs that minimize the impact of visual loss on cognitive functioning and quality of life, which many visually impaired geriatric DM patients in the general population experience.
The management of DM patients can be improved through the use of multidisciplinary, multi-specialist care networks that systematically apply Artificial Intelligence (AI)-based procedures, especially for diabetic retinopathy screening and for developing treatment algorithms for diabetic macular edema
Patient's self-monitoring with preferential hyperacuity perimetry and unconventional tele-monitoring procedures provided by out-patient clinic services in decision-making process to determine the necessity of intravitreal retreatment with anti-angiogenic drugs in patients affected by neovascular age-related macular degeneration [Auto-monitoraggio e tele-monitoraggio dei pazienti con DMLE neovascolare -Procedure di auto-monitoraggio con test perimetrico di iper-acuità preferenziale e di tele-monitoraggio non convenzionale vagliate nell’ambito di servizi ambulatoriali essenziali nel processo decisionale di ritrattamento intravitreale con farmaci anti-angiogenici dei pazienti affetti da forme neovascolari di degenerazione maculare legata all’età]
No full textRF-2016-02362267 (Finanziamento del Progetto Ordinario di Ricerca Finalizzata 2016; Tipo di Ricerca: Change-promoting; Bando 2016 Ministero della Salute
X-Chromosome Insight for Targeting Gene Therapy
No full textInherited retinal dystrophies are a heterogeneous group of genetic vision-threatening diseases primarily affecting the photoreceptor cells. Retinitis pigmentosa (RP) is the most frequent form of inherited retinal dystrophy with a worldwide prevalence of approximately 1 in 4000. The human genetics of RP is extremely complex, and after the first report describing the linkage of an RP locus to a DNA marker on the X-chromosome in 1984, [1] over 150 genes have been associated with either non-syndromic or syndromic forms of RP. A listing can be reviewed at https://sph.uth.edu/retnet/ (accessed on 6 December 2019). RP is usually inherited as autosomal-dominant, autosomal-recessive or X-linked monogenic disease, but digenic and mitochondrial patterns are also described making gene-therapy for RP very challenging. At present, mutations in three genes have been identified as causative of X-linked retinitis pigmentosa (XLRP): retinitis pigmentosa 2 (RP2; OMIM 312600), retinitis pigmentosa GTPase regulator (RPGR or RP3; OMIM 312610), and oral-facial-digital syndrome 1 (OFD1; OMIM300170). In the large majority of XLRP patients the phenotypic manifestations of the disease are severe and ingravescent, portraying one of the most harmful forms of an inherited retinal dystrophy which are often characterized by legal blindness for visual field restriction already starting from the late adolescence or early adulthood. Approximately 70-80% of the total cases of XLRP is caused by mutations of RPGR gene, which encodes a protein involved in the regulation of intra-flagellar proteins trafficking at the level of photoreceptor connecting cilium. It is estimated that the numerous rare variants of the RPGR gene represent one of the most frequent cause of RP overall (about 15% of non-syndromic RP cases), also underlying many cases of atypical inherited retinal dystrophy diagnosed in several heterozygous female carriers belonging to families with a provisional diagnosis of autosomal dominant RP. [2, 3] In this intriguing scenario of multifaceted genotype-phenotype correlations observed in the pedigrees with XLRP, at least three RPGR gene therapy trials are recruiting affected male patients for the completion of their phases 2 or 3 (see https://www.clinicaltrials.gov: ClinicalTrials.gov Identifier NCT03116113, NCT03252847, and NCT03316560, accessed on 6 December 2019), but no explanatory data had been hitherto reported with regard to the female carriers in whom XLRP can manifest with a wide spectrum of possible retinopathies ranging from asymptomatic to severe clinical features similar to those observed in male probands. In this issue of Ophthalmology Retina, Fahim and co-workers [4] finally focus an essential new insight on the role of X-chromosome inactivation (XCI) in determining the phenotypic severity of inherited retinal dystrophy among women with pathogenic RPGR heterozygoses. An extensive knowledge of genotype-phenotype correlations will be required to optimize both candidate identification and treatment timing of gene therapy, quantifying the contribution of genotype, genetic modifiers, and skewing of the XCI ratio from the expected 50:50 ratio to the different retinal phenotypes of each female member of XLRP families. Because of the possibly high penetrance of the retinal pathologic patterns among heterozygotes carriers of RPGR mutations, particular attention is recommended to monitor the likely clinical worsening in the young adults with significant or extreme XCI, who have high risk of XLRP-like disease’s severity for the presence of a lower manifesting-disease threshold in comparison with what has been reported for other X-linked disorders. The recent availability of gene replacement therapy voretigene neparvovec-rzyl, for the treatment of RPE65-related inherited retinal dystrophies has paved the way for anticipated approval of other gene-based therapies such as those utilized in the ongoing clinical trials conducted on XLRP patients with RPGR mutations, whose results are awaited with positive expectations even if they might be counteracted by nonfunctional or detrimental products of RPGR gene. [5] On the other hand, the development of XCI-based models of disease’s expressivity in mutant heterozygous female RPGR carriers can be helpful to rationally plan gene-based interventional strategies by silencing the anomalous gene products. However, in each specific patient-case, a pro-treatment decision-making process will have to be plausibly motivated by indications that the gene therapy is cost-effective compared with standard care using an appropriate spending threshold per quality-adjusted life-year
Rating triggers, market risk and the need for more regulation
Full text linkA rating trigger is a particular type of debt covenant that mandates the borrower to maintain its own credit rating above a certain rating threshold, requiring, in the event of a rating downgrade, the adoption of specific enforceable actions aimed at securing the lender claims from the borrower's higher risk level. Rating triggers lower the cost of borrowing capital, but when activated, they exacerbate the borrower's need for liquidity just at the moment when its credit risk is higher, making the borrower's default more likely to occur. Despite the potential threat posed by rating triggers on debt markets, these contractual devices remain almost unregulated both in the US and in Europe. The purpose of this paper is first to analyse the effects rating triggers can have on overall market risk and second to assess the proliferation of rating triggers among large US and non-US companies in order to establish whether these contractual devices need stricter regulation. The article is divided in two parts. Sections 2 to 5 provide an overview of the different types of triggers and analyse the rationale behind their use in terms of advantages and disadvantages for both issuers and investors. In sections 6 to 9, I perform an empirical analysis by assessing the rating triggers that have been used by Dow Jones Industrial Average Index companies. I then examine the correlation between the use of rating triggers and the companies' risk profiles by measuring their credit ratings and their Altman's Z-Scores in order to find out whether triggers are mostly used by risky companies, capable of being impaired by the triggers' activation and thus posing a threat to market stability. In section 10, I strengthen the analysis by examining whether such correlation also applies to non-US companies which use rating triggers. In section 11 conclusions are drawn suggesting the introduction by US and European regulators of a specific duty to disclose all the rating triggers that listed companies include in bond indentures and in financial contracts every year. © T.M.C. Asser Press
Quale rating assegnare alle nuove regole sulle agenzie di rating?
No full textL'articolo analizza le modifiche apportate alla disciplina sulle agenzie di rating dal Dodd-Frank Act negli Stati Uniti e dal Regolamento UE n. 513/2011 in Europa
Editorial: Biotransformations by marine microorganisms and their enzymes
Full text linkThese contributions provide the reader with relevant up-to-date insights on the use of enzymes and whole cells from marine ecosystems as biocatalyst
Assessing the cost-effectiveness of switching from a beta-blocker to latanoprost in the treatment of ocular hypertension
No full textSSRIs and intraocular pressure modifications: evidence, therapeutic implications and possible mechanisms
No full textDiabetic macular edema: Safe and effective treatment with intravitreal triamcinolone acetonide (Taioftal)
No full textPurpose To suggest the safety and efficacy of preservative-free triamcinolone acetonide intravitreal injectable suspension (Taioftal) for the treatment of diabetic macular edema. Methods A prospective clinical study involved 49 patients (49 eyes), that were treated with Taioftal and followed-up for six months. Complete ophthalmic examination, including spectral domain optical coherence tomography, was performed at baseline, and at month 1, 3, 6 after the intravitreal injection. Accurate collection and analysis of best-corrected visual acuity (BCVA), central foveal thickness (CFT), intraocular pressure (IOP), and adverse events (AEs) were carried out in order to evaluate visual function and macular morphology before and after treatment Results Median BCVA value chosen as comparing statistics was significantly improved at every follow-up time points (gain of 6 letters at month 1, 12 at month 3 –improvement up to 24% at month 3 with stabilization until month 6) compared to baseline, as certified by Kruskal-Wallis rank sum test (P<0.05). Median CFT significantly waned at each follow-up times (decrease of about 65 μm at month 1, 155 at month 3 –reduction up to 28% at month 3 keeping good outcome until month 6) compared to baseline (P<0.05). IOP elevation, with no severe increases, was the most common among spotted AEs (median of 23 mmHg at month 1, 20 at month 3). Conclusion Intravitreal injection of preservative-free triamcinolone (Taioftal) is an effective, safe and inexpensive drug used to improve visual acuity and reduce central foveal thickness in eyes affected by diabetic macular edema during an average time of 6 months. Temporary, never severe, elevation of IOP is totally manageable with topical medications. No serious vision-threatening complications are related to the use of intravitreal triamcinolone injections
Psoriatic uveitis is not an exploded myth
No full textPsoriatic uveitis, a distinct clinical entity quoted for 7% to 25% in psoriatic ophthalmic patients with spondyloarthritis, and for 25.,% +/- 2,3 in meta-analysis of rheumatic patients with a prevalence of HLA-B27 quoted as for 40%-50%, is often misdiagnosed. The model proposed by Conti & Coll. [Clinical Dermatology 2017;5(1):30-36]merits also to drive attention of Dermatologist, Radiologist, General Practitioner to submit those psoriatic patients to an ophthalmological screening
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