Tocilizumab for the Management of Corticosteroid-Resistant Mild to Severe Graves’ Ophthalmopathy,a Report of Three Cases

ABSTRACT

Purpose: To discuss the use of tocilizumab in mild to severe Graves’ ophthalmopathy as corticosteroid-adjunctive therapy.

Methods: Retrospective case reports.

Results: Three patients with corticosteroid-resistant or advanced diplopia-associated Graves’ ophthalmopathy were subsequently treated with monthly intravenous tocilizumab at a dose of 8 mg/kg. None reported a past or present history of dysthyroidism. The adjunction of interleukin-6-receptor monoclonal antibody treatment was associated with a significant improvement in ocular symptoms, notably diplopia and proptosis, and functional prognosis in all patients, with one relapse approximately two months after the end of the treatment.

Conclusion: These clinical reports confirm the relative efficacy and tolerability profile of intravenous tocilizumab in severe or corticosteroid-resistant Graves’ ophthalmopathy.     

Prolonged mechanical ventilation after cardiac surgery: substudy of the Transfusion Requirements in Cardiac Surgery III trial

Purpose

Prolonged mechanical ventilation (MV) is a major complication following cardiac surgery. We conducted a secondary analysis of the Transfusion Requirements in Cardiac Surgery (TRICTS) III trial to describe MV duration, identify factors associated with prolonged MV, and examine associations of prolonged MV with mortality and complications.

Methods

Four thousand, eight hundred and nine participants undergoing cardiac surgery at 71 hospitals worldwide were included. Prolonged MV was defined based on the Society of Thoracic Surgeons definition as MV lasting 24 hr or longer. Adjusted associations of patient and surgical factors with prolonged MV were examined using multivariable logistic regression. Associations of prolonged MV with complications were assessed using odds ratios, and adjusted associations between prolonged MV and mortality were evaluated using multinomial regression. Associations of shorter durations of MV with survival and complications were explored.

Results

Prolonged MV occurred in 15% (725/4,809) of participants. Prolonged MV was associated with surgical factors indicative of complexity, such as previous cardiac surgery, cardiopulmonary bypass duration, and separation attempts; and patient factors such as critical preoperative state, left ventricular impairment, renal failure, and pulmonary hypertension. Prolonged MV was associated with perioperative but not long-term complications. After risk adjustment, prolonged MV was associated with perioperative mortality; its association with long-term mortality among survivors was weaker. Shorter durations of MV were not associated with increased risk of mortality or complications.

Conclusion

In this substudy of the TRICS III trial, prolonged MV was common after cardiac surgery and was associated with patient and surgical risk factors. Although prolonged MV showed strong associations with perioperative complications and mortality, it was not associated with long-term complications and had weaker association with long-term mortality among survivors.

Study registration

www.ClinicalTrials.gov (NCT02042898); registered 23 January 2014. This is a substudy of the Transfusion Requirements in Cardiac Surgery (TRICS) III trial.

     

Ultrabiomicroscopic Findings in Acute Uveitic,Convalescent and Chronic Recurrent Stage of Vogt-Koyanagi-Harada Syndrome

ABSTRACT

Purpose

To describe the ultrabiomicroscopy (UBM) characteristics in patients with uveitic, convalescent, and recurrent Vogt-Koyanagi-Harada (VKH) disease.     

The FINDRISC questionnaire capacity to predict diabetes mellitus II,arterial hypertension and comorbidity in women from low-and-middle-income countries

Abstract

The Finnish Diabetes Risk Score (FINDRISC) has been implemented to assess diabetes risk. The authors aimed in this study to determine the prediction capacity of FINDRISC for the early detection of cardiovascular diseases in women. A prevalence study was carried out on 441 women of Pueblo Libre (Peru). Anthropometric variables, blood pressure, blood glucose and comorbidity were measured and entered in FINDRISC. 4.8% of the studied women suffered from DM2, 14.3% from AHT, 33% obesity and 8.6% comorbidity. We found that FINDRISC was the best method to discriminate DM, AHT and comorbidity. FINDRISC is an effective non-invasive tool for women from low-and-middle-income countries.     

Praying to win this battle: Cancer Metaphors in Latina and Spanish Women’s Narratives

ABSTRACT

This study closely examines 51 breast cancer narratives Latina and Spanish women wrote for other patients to illuminate how they conceptualize their health, with insights for addressing health disparities. Using discourse analysis of the role of language and culture in health care communication, this study focuses on the use of metaphors in the narratives. This provides revelations about the cultural and linguistic aspects of how the writers conceptualize their disease. Building on past research on metaphor use in cancer discourse in the English language, this study reveals the prevalence of metaphors comparing cancer to combat, or more generally, violence (e.g., “my battle against cancer”), or a journey (e.g., “my path with cancer”). Writers used this metaphorical language to offer advice to others with cancer and to mark their membership in a larger community of people with cancer. We also find that Spanish women use metaphors more frequently than Latinas and that they differed in their metaphorical portrayals of cancer. This research uncovers culturally embedded themes that are central to how women with cancer think about the disease, such as the prominence of spirituality in Latinas’ metaphorical constructions, a pattern not evident in Spanish women’s narratives.     

Checklist para pacientes con diabetes mellitus tipo 2 en consulta telemática

Las circunstancias actuales provocadas por la COVID-19 nos obligan a los profesionales de atención primaria a idear nuevas formas de garantizar la atención sanitaria de nuestros pacientes con diabetes tipo 2 (DM2). Existen evidencias que respaldan la eficacia de la telemedicina en el control glucémico de los pacientes con DM2. Ante la rápida adaptación de la práctica clínica al uso de la telemedicina, el Grupo de Trabajo de Diabetes de la Sociedad Española de Medicina Familiar y Comunitaria (SemFyC) optó por elaborar un documento de consenso plasmado en un algoritmo de actuación/seguimiento telemático en la atención de los pacientes con DM2.Palabras clave: Telemedicina, Diabetes mellitus tipo 2, COVID-19     

The use of technology and sampling frequency to measure variables of tactical positioning in team sports: a systematic review

ABSTRACT

The aim of the study was to assess the use of different positioning systems and sampling frequencies to measure spatial-positioning variables in team sports. Articles were selected when the sampling frequency was detailed. 2,194 articles were identified and 59 works were selected for the systematic review. The sampling frequency used to measure tactical behaviour differed considerably among studies. For Global Navigation Satellite System, the sampling frequency ranged from 5- to 15 Hz for raw data, the most commonly used sampling frequency being 5 Hz. For Optic-based tracking systems, the sampling frequency ranged from 10- to 30 Hz. For Local Position System, the sampling frequency ranged from 45- to 100 Hz, the most commonly used sampling frequency being 42 Hz and 57.7 Hz. There is no common criterion in the sampling frequency used to measure each tactical variable. Further studies should investigate the impact of the sampling frequency on the measurement of the tactical variables.     

The Neurology of Acquired Pedophilia

ABSTRACT

The clinicoanatomic cases of acquired pedophilia that have been published in the medical and forensic literature up to 2019 are reviewed. Twenty-two cases fit our inclusion criteria. All but one were men, and in only one case the injury was localized to the left hemisphere. Hypersexuality was present in 18 cases. The damaged areas fell within the frontotemporoinsular cortices and related subcortical nuclei; however, the anterior hypothalamus was spared. Damage to parts of the right frontotemporoinsular lobes with sparing of the anterior hypothalamus seems to be critical for the emergence of acquired pedophilia.     

Twelve tips for implementing a community of practice for faculty development

Abstract

Teaching and learning practices often fail to incorporate new concepts in the ever-evolving field of medical education. Although medical education research provides new insights into curricular development, learners’ engagement, assessment methods, professional development, interprofessional education, and so forth, faculty members often struggle to modernize their teaching practices. Communities of practice (CoP) for faculty development offer an effective and sustainable approach for knowledge management and implementation of best practices. A successful CoP creates and shares knowledge in the context of a specific practice toward the development of expertise. CoPs’ collaborative nature, based on the co-creation of practical solutions to daily problems, aligns well with the goals of applying best practices in health professions education and training new faculty members. In our article, we share 12 tips for implementing a community of practice for faculty development. The tips were based on a comprehensive literature review and the authors’ experiences.