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Association between vascular and structural parameters by optical coherence tomography angiography in primary congenital glaucoma 原发性先天性青光眼的光学相干断层血管造影血管和结构参数的关系
Pub Date : 2021-01-01 DOI: 10.32440/ar.2021.138.03.org03
L. Morales
Objective: To determine the association of structural and vascular parameters using optical coherence tomography (OCT) angiography (-A), in patients diagnosed with primary congenital glaucoma (PCG). Material and methods: 40 patients diagnosed with PCG were recruited (only one eye per patient was included). All study participants underwent a comprehensive ophthalmologic examination. Peripapillary and macular vascular measurements were obtained using AngioplexTM OCTA with a 4.5×4.5mm optic nerve head scan and 6x6mm macular scan. Structural parameters were collected: circumpapillary Retinal nerve fiber layer (cpRNFL) thickness (global and quadrants), ganglion cell-inner plexiform layer complex (GCL+IPL) thickness (average, minimum and sectors), rim area, average and vertical cup to disc (C/D) ratio and cup volume. Results: Global peripapillary values were: Mean flux index (FI) was 0.39 (0.05), mean perfusion density (pPD) was 42.57 (4.56) %, cpRNFL was 78.65 (22.50) microns, average c/p ratio (0.59 (0.18) and global GCL+IPL thickness was 71.71 (14.81) microns and minimum GCL+IPL thickness was 64.18 (18.63) microns. Statistical correlation was found between peripapillary structural, vascular and morphologic parameters (all p<0.023). Conclusion: OCTA measurements could offer useful and objective measurement of damage in early and severe congenital glaucoma, complementary to that offered by OCT.
目的:利用光学相干断层扫描(OCT)血管造影(a)确定原发性先天性青光眼(PCG)患者的结构和血管参数的相关性。材料和方法:招募40例诊断为PCG的患者(每例仅纳入一只眼)。所有的研究参与者都接受了全面的眼科检查。使用AngioplexTM OCTA与4.5×4.5mm视神经头扫描和6x6mm黄斑扫描获得乳头周围和黄斑血管测量。收集结构参数:乳头周围视网膜神经纤维层(cpRNFL)厚度(全局和象限)、神经节细胞-内丛状层复合体(GCL+IPL)厚度(平均、最小和扇区)、边缘面积、平均和垂直杯盘比(C/D)和杯体积。结果:全球乳头周围值:平均通量指数(FI)为0.39(0.05),平均灌注密度(pPD)为42.57 (4.56)%,cpRNFL为78.65(22.50)微米,平均c/p比(0.59)(0.18),全球GCL+IPL厚度为71.71(14.81)微米,最小GCL+IPL厚度为64.18(18.63)微米。乳突周围的结构、血管和形态参数均有统计学意义(p<0.023)。结论:OCTA测量能对早期和重度先天性青光眼损伤进行有效、客观的测量,与OCT测量相补充。
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引用次数: 0
New challenges of paediatric chronic pain in Spain: Multidisciplinary treatment 西班牙儿科慢性疼痛的新挑战:多学科治疗
Pub Date : 2021-01-01 DOI: 10.32440/ar.2021.138.03.org01
F. Reinoso-Barbero
Background. In the last two decades, pediatric patients have been identified as particularly vulnerable to the acute and chronic consequences of pain, and valid tools have been developed for the measurement and treatment of chronic pain in children. However, we do not know to what extent Spanish children receive the indicated multidisciplinary treatment when suffering chronic pain. Material and methods. We review the results of a survey based on an electronic program through social networks provided by a specialized consultancy and developed by representatives of three scientific societies aimed at parents of children with persistent or recurrent pain lasting more than three months. Results. One hundred and fifty parents whose children met the inclusion criteria were included. Eighty percent of the participants suffered almost daily pain, but only 25% admitted moderate or severe pain intensity (score 5 or more on a scale of 0-10) with impairment of their quality of life. Some patients (18.7%) did not receive any treatment and of those who did, only about half received analgesic treatment. Only 8 of the 150 patients (5%) received multidisciplinary analgesic treatment. Conclusions. In Spain, we are currently far from offering optimal analgesic treatment to patients with pediatric chronic pain and, especially, very few patients receive multidisciplinary treatment (physiotherapy, psychotherapy and medical treatment). The new challenges that this situation produces are discussed: improvement of the training of the specialists involved, creation of pediatric pain units and use of new technologies.
背景。在过去的二十年里,儿科患者被认为特别容易受到急性和慢性疼痛的影响,并且已经开发出有效的工具来测量和治疗儿童慢性疼痛。然而,我们不知道西班牙儿童在遭受慢性疼痛时接受多学科治疗的程度。材料和方法。我们回顾了一项基于电子程序的调查结果,该调查是由一家专业咨询公司通过社交网络提供的,由三个科学学会的代表开发的,针对的是持续或复发性疼痛持续三个月以上的儿童的父母。150名家长的孩子符合纳入标准。80%的参与者几乎每天都感到疼痛,但只有25%的人承认中度或重度疼痛强度(在0-10的范围内得分为5分或更高)损害了他们的生活质量。一些患者(18.7%)没有接受任何治疗,而在接受治疗的患者中,只有大约一半接受了镇痛治疗。150例患者中仅有8例(5%)接受了多学科镇痛治疗。在西班牙,我们目前还远远没有为儿童慢性疼痛患者提供最佳的镇痛治疗,特别是很少有患者接受多学科治疗(物理治疗、心理治疗和药物治疗)。讨论了这种情况产生的新挑战:改进所涉及的专家培训,创建儿科疼痛单位和使用新技术。
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引用次数: 0
A decade for healthy ageing. 2020-2030 健康老龄化的十年。2020 - 2030
Pub Date : 2021-01-01 DOI: 10.32440/ar.2021.138.03.rev02
J. R. Ribera Casado
Period 2020-2030 has been defined by the World Health Organization (WHO) as the «Healthy ageing decade». The aim of this review is to offer and comment the antecedents and reasons to justify this declaration. Main doctrinal concepts involved, as well as previous documents and recommended strategies are presented. The paper includes, also, the initial reactions that have taken place in Europe and in Spain about this declaration. Author underlines, as final remarks, the most selected messages of the review.
世界卫生组织(世卫组织)将2020-2030年确定为"健康老龄化十年"。这篇综述的目的是提供和评论证明这一声明的前提和理由。介绍了所涉及的主要理论概念,以及以前的文件和建议的策略。这篇论文还包括了欧洲和西班牙对这一宣言的最初反应。作者强调,作为最后的评论,最选定的信息。
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引用次数: 47
Genetic and Covid-19 遗传和Covid-19
Pub Date : 2020-12-30 DOI: 10.32440/ar.2020.137.03.ed01
J. M. García Sagredo
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引用次数: 0
Chronic kidney disease: the most prevalent risk factor and the risk factor that increases most the risk for lethal COVID-19 慢性肾脏疾病:最普遍的风险因素和增加致命COVID-19风险的风险因素
Pub Date : 2020-12-30 DOI: 10.32440/AR.2020.137.03.REV02
A. Ortiz, M. Sánchez-Niño
Chronic kidney disease (CKD) is defined as an estimated glomerular filtration rate (eGFR) below 60 ml/min/1.73 m2 or evidence of kidney damage, such as albuminuria greater than 30 mg/g creatinuria, which persists more than 3 months. These cut-off points mark an increased risk of progression to the need for kidney replacement therapy and of the risk of premature death. Coronavirus disease-2019 (COVID-19) is no exception. The Global Burden of Disease collaboration identified CKD as the global most prevalent risk factor for severe COVID-19. The OpenSAFELY project analyzed the factors associated with death from COVID-19 in 17 million persons. Dialysis (adjusted hazard ratio [aHR] 3.69), organ transplantation (aHR 3.53) and CKD not on dialysis (aHR 2.52 for patients with eGFR <30 ml/min/1.73 m2) represent three of the four comorbidities associated with the highest risk of mortality from COVID-19. The risk associated with CKD is greater than the risk associated with diabetes mellitus (range aHR 1.31-1.95, depending on glycemic control) or chronic heart disease (aHR 1.17), whereas hypertension is not an independent risk factor for death from COVID-19 (aHR 0.89). The high prevalence of CKD, combined with the high risk of mortality from COVID-19 in CKD, requires urgent action to protect CKD patients from COVID-19 by offering the opportunity to participate in clinical trials of vaccines and treatments for COVID-19.
慢性肾脏疾病(CKD)定义为肾小球滤过率(eGFR)低于60ml /min/1.73 m2或有肾脏损害迹象,如蛋白尿大于30mg /g肌酐尿,且持续3个月以上。这些分界点标志着进展到需要肾脏替代治疗的风险增加和过早死亡的风险增加。2019冠状病毒病(COVID-19)也不例外。全球疾病负担协作组织将CKD确定为全球最普遍的严重COVID-19风险因素。opensafety项目分析了与1700万人死于COVID-19相关的因素。透析(校正风险比[aHR] 3.69)、器官移植(aHR 3.53)和非透析CKD (eGFR <30 ml/min/1.73 m2的患者aHR 2.52)是与COVID-19死亡率最高风险相关的四种合并症中的三种。与CKD相关的风险大于与糖尿病相关的风险(范围aHR 1.31-1.95,取决于血糖控制)或慢性心脏病(aHR 1.17),而高血压不是COVID-19死亡的独立危险因素(aHR 0.89)。CKD的高患病率,加上COVID-19在CKD中的高死亡率,需要采取紧急行动,通过提供参与COVID-19疫苗和治疗的临床试验的机会,保护CKD患者免受COVID-19的侵害。
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引用次数: 0
Ageism in pandemia’s times 大流行时期的年龄歧视
Pub Date : 2020-12-30 DOI: 10.32440/AR.2020.137.03.REV06
J. M. Casado
The aim of this paper is to present some comments about ageism, and how it has been present along these months. Among the ageists´ manifestacions I underline the initial suggestion that COVID-19 is exclusively a disease of older adults in order to calm yunger people anxiety; the question of the nursing-homes and beside that, the social and health out of respect for residents along the pandemic period; the elders’ discrimination in guides and protocols; the negative image of this colective transmitted from the media; the absence of older adults in every forum of general discusión and in the decision committees; its absence in research protocols including clinical trials. Even the negative autoperception of the elders in this matter could be read as a pattern of ageism. Lastly, we offer some reflexion, open questions and suggestions on topìc.
本文的目的是提出一些关于年龄歧视的评论,以及这几个月来它是如何出现的。在年龄歧视者的表现中,我强调最初的建议,即COVID-19完全是老年人的疾病,以平息年轻人的焦虑;疗养院的问题,除此之外,在大流行期间出于对居民的尊重而产生的社会和卫生问题;长者对指南和协议的歧视;媒体传播的这个集体的负面形象;在一般discusión的每个论坛和决策委员会中都没有老年人;它在包括临床试验在内的研究方案中缺失。即使是老年人在这件事上的消极自我感知也可以被解读为一种年龄歧视的模式。最后,我们在topìc上提供一些反思、开放性问题和建议。
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引用次数: 0
Mental Health Impact of COVID-19 pandemic 新冠肺炎大流行对心理健康的影响
Pub Date : 2020-12-30 DOI: 10.32440/AR.2020.137.03.REV03
M. I. L. Alcocer
SRAS COV-19 pandemic will have an impact in mental health, for general population, for health professionals, and for those who had suffered infection and for people with previous mental health disorders.Mental health problems after in pandemic can be considered similar as those that happened in a disasters or catastrophes situations, natural or human being induce; one of the principal characteristics is that they affect healthy persons.Up to now, there are some studies that considered that the incidence of mental health problems will raised up to 30%, and therefore is very important identified risk population, and vulnerability and protection factors to give this people the attention needed.
SRAS COV-19大流行将对心理健康、普通人群、卫生专业人员、感染者和既往有心理健康障碍的人产生影响。大流行病后的心理健康问题可以被认为与自然或人类诱发的灾难或灾难中发生的问题相似;其主要特征之一是影响健康人。到目前为止,有一些研究认为,心理健康问题的发生率将提高到30%,因此是非常重要的识别风险人群,以及脆弱性和保护因素,给予这一人群所需的关注。
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引用次数: 1
SARS-CoV-2 Infection in a patient with paroxysmal nocturnal haemoglobinuria (PNH) Treated with ravulizumab: a case report ravulizumab治疗阵发性夜间血红蛋白尿症(PNH)患者的严重急性呼吸系统综合征冠状病毒2型感染:一例报告
Pub Date : 2020-12-30 DOI: 10.32440/AR.2020.137.03.CC01
P. Estival, B. Colás, Yang Dai, F. González
The clinical course of a Paroxysmal Nocturnal Hemoglobinuria (PNH) patient receiving treatment with terminal complement by ravulizumab and SARS-CoV2 infection is described.The treatment commenced in January 2016 showing adequate tolerance and symptom resolution.In April 2020 an episode of breakthrough hemolysis is observed. Chest X-Ray revealed a right infection lobar infiltrate with SARS-CoV-2 positive PCR. The patient was afebril with normal oxygen saturation. He did not require standard disease treatment and presented eventual resolution, developing only mild symptoms.Neither PNH nor ravulizumab treatment seem to influence susceptibility to Covid-19 infection. It is possible that razulizumab, a complement inhibitor, may have played a beneficial role in the favorable clinical development.
描述了一名阵发性夜间血红蛋白尿(PNH)患者接受ravulizumab终末补体治疗和严重急性呼吸系统综合征冠状病毒2型感染的临床过程。治疗于2016年1月开始,显示出足够的耐受性和症状缓解。2020年4月,观察到一次突破性溶血事件。胸部X光片显示右侧感染叶浸润严重急性呼吸系统综合征冠状病毒2型阳性聚合酶链式反应。病人没有发烧,血氧饱和度正常。他不需要标准的疾病治疗,最终得到了解决,只出现了轻微的症状。PNH和ravulizumab治疗似乎都不会影响对新冠肺炎感染的易感性。补体抑制剂拉祖利单抗可能在有利的临床发展中发挥了有益作用。
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引用次数: 0
Radiological evaluation of pulmonary sequelae in COVID-19 COVID-19肺部后遗症的影像学评价
Pub Date : 2020-12-30 DOI: 10.32440/AR.2020.137.03.DOC01
C. Muñoz-Núñez, P. Calvillo-Batllés, Enrique Zaldívar Olmeda, V. Ripollés, L. Martí-Bonmatí
Coronavirus Disease 2019 (COVID-19) is a highly transmissible and pathogenic viral infection caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The target organ is the lung. This infection appeared in Wuhan (China) in December 2019 and the WHO considered it a pandemic in March 2020. One year after the first known cases, and although there is a great amount of scientific knowledge acquired of the disease, there are still some unanswered questions. As a matter of fact, there is a lack of knowledge about which patients will suffer sequels, what kind of morphological changes and sequel types will be expected, nor the grade of functional severity. It is known that other coronavirus pneumoniae caused pulmonary sequels and therefore they are expected in COVID-19. In this work we review several COVID-19 aspects related with the development and grading of mid- and long-term pulmonary sequels, including fibrosis and vascular changes, and strengthen the role of medical imaging in this evaluation.
2019冠状病毒病(新冠肺炎)是一种由严重急性呼吸综合征冠状病毒2(SARS-CoV-2)引起的高传播性和致病性病毒感染。目标器官是肺。这种感染于2019年12月在中国武汉出现,世界卫生组织于2020年3月将其视为一种流行病。在第一例已知病例发生一年后,尽管已经获得了大量关于该疾病的科学知识,但仍有一些问题没有得到解答。事实上,对于哪些患者会出现后遗症,预计会发生什么样的形态学变化和后遗症类型,以及功能严重程度,我们都缺乏了解。已知其他肺炎冠状病毒会导致肺部后遗症,因此预计它们会在新冠肺炎中出现。在这项工作中,我们回顾了与中长期肺部后遗症的发展和分级相关的几个新冠肺炎方面,包括纤维化和血管变化,并加强了医学成像在这项评估中的作用。
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引用次数: 0
Impact of Covid-19 in the field of oncology 新冠肺炎在肿瘤学领域的影响
Pub Date : 2020-09-30 DOI: 10.32440/AR.2020.137.02.REV11
A. Collazo-Lorduy, V. Calvo, M. Provencio
The outbreak of the new coronavirus disease (COVID-19) has become the greatest threat to public health worldwide. Oncological patients have an increased risk of infection due to their oncological disease, which supresses the immune system and mielosupressive effects of antincancer treatments.Throughout this article, the impact of COVID-19 in the oncological field will be reviewed, centering in diagnosis (susceptibility, differential diagnoses, delays in diagnosis in post-COVID era, triage systems); treatment (treatment of COVID-19 infection, surgeries, oncological treatments); impact in mortality and emotional impact.Maintaining quality of care in patients as vulnerable as cancer patients is a huge challenge in the face of possible outbreaks or future times when we have to face living with the infection but maintaining quality standards in healthcare.
新型冠状病毒疾病(新冠肺炎)的爆发已成为全球公共卫生面临的最大威胁。肿瘤患者因其肿瘤疾病而感染的风险增加,肿瘤疾病会抑制免疫系统并减弱抗癌治疗的抑制作用。在这篇文章中,将回顾新冠肺炎在肿瘤学领域的影响,重点是诊断(易感性、鉴别诊断、后COVID时代的诊断延误、分诊系统);治疗(治疗新冠肺炎感染、手术、肿瘤治疗);死亡率和情绪影响。面对可能爆发的疫情或未来我们必须面对感染,但要保持医疗保健的质量标准,维持像癌症患者这样脆弱的患者的护理质量是一个巨大的挑战。
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引用次数: 0
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Anales de la Real Academia Nacional de Medicina
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