PROGNOSTIC FACTORS PREDICTING FUNCTIONAL OUTCOME AT FOUR MONTHS FOLLOWING ACUTE ANKLE SPRAIN

PROGNOSTIC FACTORS PREDICTING FUNCTIONAL OUTCOME AT FOUR MONTHS FOLLOWING ACUTE ANKLE SPRAINBleakley C.M.1, O'Connor S.R.1, Tully M.A.2, Rocke L.G.3, MacAuley D.C.1, Bradbury I.4, Keegan S.4, McDonough S.M.11University of Ulster, Health & Rehabilitation Sciences Research Institute, Newtownabbey, United Kingdom, 2Queen's University, UKCRC Centre of Excellence for Public Health (NI), Belfast, United Kingdom, 3Royal Victoria Hospital, Department of Emergency Medicine, Belfast, United Kingdom, 4Frontier Science (Scotland), Kincraig, Inverness-shire, United KingdomPurpose: To identify clinically relevant factors assessed following acute ankle sprain that predict functional recovery at four months post-injury.Relevance: Ankle sprains are one of the most common musculoskeletal injuries with an estimated 5000 new cases occurring each day in the United Kingdom. In the acute phase, ankle sprains may be associated with pain and loss of function. In the longer-term there is a risk of residual problems including chronic pain or reinjury. Few studies have sought to examine factors associated with a poor long-term prognosis.Participants: 101 patients (Age: Mean (SD) 25.9 (7.9) years; Body Mass Index (BMI): 25.3 (3.5) kg/m2) with an acute grade 1 or 2 ankle sprain attending an accident and emergency department or sports injury clinic. Exclusion criteria included complete (grade 3) rupture of the ankle ligament complex, bony ankle injury or multiple injuries.Methods: Participants were allocated as part of a randomised controlled trial to an accelerated intervention incorporating intermittent ice and early therapeutic exercise or a standard protection, rest, ice, compression, and elevation intervention for one week. Treatment was then standardised in both groups and consisted of ankle rehabilitation exercises focusing on muscle strengthening, neuromuscular training, and sports specific functional exercises for a period of approximately four to six weeks. On initial assessment age, gender, mechanism of injury, presence of an audible pop or snap and the presence of contact during the injury were recorded. The following factors were also recorded at baseline and at one and four weeks post-injury: weight-bearing dorsi-flexion test, lateral hop test, presence of medial pain on palpation and a positive impingement sign. Functional status was assessed using the Karlsson score at baseline, at week four and at four months. Reinjury rates were recorded throughout the intervention phase and at four months.Analysis: A mixed between-within subjects analysis of variance (ANOVA) was used to determine the effect of each factor on functional status at week four and at four months. Significance was set at a Bonferroni adjusted level of 0.0125 (0.05/4).Results: Eighty-five participants (84%) were available at final follow-up assessment. Pain on weight-bearing dorsi-flexion and lateral hop tests at week four were both associated with a lower functional score at four months post-injury (P = 0.011 and P = 0.001). No other significant interactions were observed at any other timepoint (baseline or week one). There were only two reinjuries within the four month follow-up period with a further two reported at approximately six months post-injury. We were therefore unable to determine whether any factors were associated with an increased risk of reinjury.Conclusions: Potential prognostic factors on initial or early examination after acute ankle sprain did not help predict functional recovery at four months post-injury. However, pain on weight-bearing dorsi-flexion and lateral hop tests observed at four weeks were associated with a slower rate of recovery.Implications: Some clinical tests may help identify patients at risk of poor functional recovery after acute ankle sprain. However, further work is required to examine factors which may be predictive on initial assessment.Key-words: 1. Prognostic factors 2. Recovery 3. Ankle sprainFunding acknowledgements: Physiotherapy Research Foundation, Chartered Society of Physiotherapy, Strategic Priority Fund; Department of Employment and Learning, Northern Ireland.Ethics approval: Office for Research Ethics Committee (UK).

Fatigue two months after myocardial infarction may indicate risk for persistent fatigue

Fatigue two months after myocardial infarction may indicate risk for persistent fatigue

Quantitative evaluation of visual function 12 months after bilateral implantation of a diffractive trifocal IOL

PURPOSE: To quantitatively evaluate visual function 12 months after bilateral implantation of the Physiol FineVision® trifocal intraocular lens (IOL) and to compare these results with those obtained in the first postoperative month. METHODS: In this prospective case series, 20 eyes of 10 consecutive patients were included. Monocular and binocular, uncorrected and corrected visual acuities (distance, near, and intermediate) were measured. Metrovision® was used to test contrast sensitivity under static and dynamic conditions, both in photopic and low-mesopic settings. The same software was used for pupillometry and glare evaluation. Motion, achromatic, and chromatic contrast discrimination were tested using 2 innovative psychophysical tests. A complete ophthalmologic examination was performed preoperatively and at 1, 3, 6, and 12 months postoperatively. Psychophysical tests were performed 1 month after surgery and repeated 12 months postoperatively. RESULTS: Final distance uncorrected visual acuity (VA) was 0.00 ± 0.08 and distance corrected VA was 0.00 ± 0.05 logMAR. Distance corrected near VA was 0.00 ± 0.09 and distance corrected intermediate VA was 0.00 ± 0.06 logMAR. Glare testing, pupillometry, contrast sensitivity, motion, and chromatic and achromatic contrast discrimination did not differ significantly between the first and last visit (p>0.05) or when compared to an age-matched control group (p>0.05). CONCLUSIONS: The Physiol FineVision® trifocal IOL provided satisfactory full range of vision and quality of vision parameters 12 months after surgery. Visual acuity and psychophysical tests did not vary significantly between the first and last visit.

Patient-reported outcomes and visual acuity after 12 months of anti-VEGF-treatment for sight-threatening diabetic macular edema in a real world setting

Aims To examine objective visual acuity measured with ETDRS, retinal thickness (OCT), patient reported outcome and describe levels of glycated hemoglobin and its association with the effects on visual acuity in patients treated with anti-VEGF for visual impairment due to diabetic macular edema (DME) during 12 months in a real world setting. Methods In this cross-sectional study, 58 patients (29 females and 29 males; mean age, 68 years) with type 1 and type 2 diabetes diagnosed with DME were included. Medical data and two questionnaires were collected; an eye-specific (NEI VFQ-25) and a generic health-related quality of life questionnaire (SF-36) were used. Results The total patient group had significantly improved visual acuity and reduced retinal thickness at 4 months and remains at 12 months follow up. Thirty patients had significantly improved visual acuity, and 27 patients had no improved visual acuity at 12 months. The patients with improved visual acuity had significantly improved scores for NEI VFQ-25 subscales including general health, general vision, near activities, distance activities, and composite score, but no significant changes in scores were found in the group without improvements in visual acuity. Conclusions Our study revealed that anti-VEGF treatment improved visual acuity and central retinal thickness as well as patient-reported outcome in real world 12 months after treatment start.

Curricular training report: 7 months as a study coordinator at Blueclinical LTD

The present report describes in detail the activities undertaken under the coordination of clinical and observational studies during the curricular internship at Blueclinical Ltd., inserted in the Master of Pharmaceutical Biomedicine. Blueclinical Ltd.company operates in three different areas: R&D consultancy, management and coordination of trial centers, and a phase I unit. The curricular internship had the duration of seven months during which I was able to perform different tasks relating to coordination of clinical trials in Centro Hospitalar do Baixo Vouga, E.P.E., (CHBV) in Aveiro, Portugal. This academic internship allowed me to develop theoretical and practical skills in the field of clinical trials and observational studies. I also had the opportunity to further the knowledge I gained throughout my academic journey. During this internship, I had the opportunity to interact with different health professionals and develop my knowledge in the field of several therapeutic indications. I also could interact with distinct monitors and sponsors. This experience allowed me to improve time management, communication and problems resolution skills.

Quantitative evaluation of visual function 12 months after bilateral implantation of a diffractive trifocal IOL

PURPOSE: To quantitatively evaluate visual function 12 months after bilateral implantation of the Physiol FineVision® trifocal intraocular lens (IOL) and to compare these results with those obtained in the first postoperative month. METHODS: In this prospective case series, 20 eyes of 10 consecutive patients were included. Monocular and binocular, uncorrected and corrected visual acuities (distance, near, and intermediate) were measured. Metrovision® was used to test contrast sensitivity under static and dynamic conditions, both in photopic and low-mesopic settings. The same software was used for pupillometry and glare evaluation. Motion, achromatic, and chromatic contrast discrimination were tested using 2 innovative psychophysical tests. A complete ophthalmologic examination was performed preoperatively and at 1, 3, 6, and 12 months postoperatively. Psychophysical tests were performed 1 month after surgery and repeated 12 months postoperatively. RESULTS: Final distance uncorrected visual acuity (VA) was 0.00 ± 0.08 and distance corrected VA was 0.00 ± 0.05 logMAR. Distance corrected near VA was 0.00 ± 0.09 and distance corrected intermediate VA was 0.00 ± 0.06 logMAR. Glare testing, pupillometry, contrast sensitivity, motion, and chromatic and achromatic contrast discrimination did not differ significantly between the first and last visit (p>0.05) or when compared to an age-matched control group (p>0.05). CONCLUSIONS: The Physiol FineVision® trifocal IOL provided satisfactory full range of vision and quality of vision parameters 12 months after surgery. Visual acuity and psychophysical tests did not vary significantly between the first and last visit.

The tolerance of steers (Bos taurus) to sorghum ergot (Claviceps africana) in a feedlot during the cooler months in sub-tropical Queensland

Two experiments tested the tolerance of steers (Bos taurus) to sorghum ergot (Claviceps africana) during cooler months in south-east Queensland. Sorghum grain containing 2.8% ergot and 28 mg/kg ergot alkaloids (84% dihydroergosine, 10% dihydroelymoclavine, 6% festuclavine) was incorporated into feedlot rations. In a previous study in summer–autumn, ergot (1.1–4.4 mg alkaloids/kg ration) severely reduced performance in steers when the temperature–humidity index (THI; dry bulb temperature °C + 0.36 dew-point temperature °C + 41.2) was ~70, whereas a THI of ~79 was tolerated by steers fed ergot-free rations. Experiment 1 was conducted in winter–spring, with rations containing 0, 2.8, 5.6, 8.2 or 11.2 mg ergot alkaloids/kg ration. All ergot inclusions depressed feed intake (14% average reduction) and growth rate (34% average reduction), even when the weekly average daily THI was less than 65. Rectal temperatures were occasionally elevated in ergot-fed steers (P < 0.05), primarily when the THI exceeded ~65. All ergot inclusions depressed plasma prolactin concentrations in steers. Experiment 2 was predominantly carried out in winter, with weekly average daily THI <65 throughout the experiment. Rations containing 0, 0.28, 0.55 or 1.1 mg ergot alkaloids/kg were fed for 4 weeks but produced no significant effect on feed intakes and growth rates of steers. Alkaloid concentrations were then changed to 0, 2.1, 4.3 and 1.1 mg/kg, respectively. Subsequently, feed intakes declined by 17.5% (P < 0.05), and growth rates by 28% (P > 0.05) in the group receiving 4.3 mg/kg alkaloid, compared with Controls. Plasma prolactin concentrations were depressed, relative to the Controls, by dietary alkaloid inclusion greater than 1.1 mg/kg, with alkaloid intake of 4.3 mg/kg causing the greatest reduction (P < 0.05). Cattle performance in these studies shows steers can tolerate up to ~2 mg ergot alkaloid/kg (0.2% ergot) in feedlot rations under low THI conditions (< ~60–65), but previous findings indicate a much lower threshold will apply at higher THI (>65).

The tolerance of steers (Bos taurus) to sorghum ergot (Claviceps africana) in a feedlot during the cooler months in sub-tropical Queensland

Two experiments tested the tolerance of steers (Bos taurus) to sorghum ergot (Claviceps africana) during cooler months in south-east Queensland. Sorghum grain containing 2.8% ergot and 28 mg/kg ergot alkaloids (84% dihydroergosine, 10% dihydroelymoclavine, 6% festuclavine) was incorporated into feedlot rations. In a previous study in summer–autumn, ergot (1.1–4.4 mg alkaloids/kg ration) severely reduced performance in steers when the temperature–humidity index (THI; dry bulb temperature °C + 0.36 dew-point temperature °C + 41.2) was ~70, whereas a THI of ~79 was tolerated by steers fed ergot-free rations. Experiment 1 was conducted in winter–spring, with rations containing 0, 2.8, 5.6, 8.2 or 11.2 mg ergot alkaloids/kg ration. All ergot inclusions depressed feed intake (14% average reduction) and growth rate (34% average reduction), even when the weekly average daily THI was less than 65. Rectal temperatures were occasionally elevated in ergot-fed steers (P < 0.05), primarily when the THI exceeded ~65. All ergot inclusions depressed plasma prolactin concentrations in steers. Experiment 2 was predominantly carried out in winter, with weekly average daily THI <65 throughout the experiment. Rations containing 0, 0.28, 0.55 or 1.1 mg ergot alkaloids/kg were fed for 4 weeks but produced no significant effect on feed intakes and growth rates of steers. Alkaloid concentrations were then changed to 0, 2.1, 4.3 and 1.1 mg/kg, respectively. Subsequently, feed intakes declined by 17.5% (P < 0.05), and growth rates by 28% (P > 0.05) in the group receiving 4.3 mg/kg alkaloid, compared with Controls. Plasma prolactin concentrations were depressed, relative to the Controls, by dietary alkaloid inclusion greater than 1.1 mg/kg, with alkaloid intake of 4.3 mg/kg causing the greatest reduction (P < 0.05). Cattle performance in these studies shows steers can tolerate up to ~2 mg ergot alkaloid/kg (0.2% ergot) in feedlot rations under low THI conditions (< ~60–65), but previous findings indicate a much lower threshold will apply at higher THI (>65).