Analysis of Retinal Layers in Fibromyalgia Patients with Premium Protocol in Optical Tomography Coherence and Quality of Life

PURPOSE

To evaluate the inner retinal layers in fibromyalgia (FM) patients compared to control subjects using posterior pole protocol (PPole) analysis in optical coherence tomography (OCT) and to correlate structural retinal changes with subjective quality of life.

METHODS

Seventy-four eyes of healthy subjects and 55 eyes of those with FM were analyzed. All subjects underwent retinal evaluation using the PPole protocol for Spectralis OCT (Heidelberg Engineering) to obtain measurements of the retinal nerve fiber layer (RNFL) and the ganglion cell layer (GCL) in the macular area. The EuroQol (EQ-5D) questionnaire and Fibromyalgia Impact Questionnaire (FIQ) were performed to analyze health-related quality of life. Additionally, the FM group was divided into three groups depending on the disease phenotype (atypical, depressive and biological).

RESULTS

: Patients with FM presented with a reduction of the RNFL thickness compared to controls in 17/64 cells of the PPole area, and a reduction of the GCL thickness in 47/64 cells. Depressive FM phenotype showed the greatest number of cells with significant reduction compared with the control group in both RNFL and GCL layers. A correlation between temporal-inferior cells of the GCL and the EuroQol 5D questionnaire results was observed.

CONCLUSIONS

Patients with FM present with a reduction of the inner retinal layers in the macular area. This degeneration correlates with disease severity/reduced quality of life in these patients. The PPole protocol for OCT is a non-invasive and fast tool that might help clinicians diagnose and monitor neurodegeneration in FM patients.

Evaluating the efficacy of an Advanced Care Planning Program for Health Decisions in patients with advanced heart failure: protocol for a Randomized Clinical Trial

Background

An Advanced Care Planning (ACP) program of health decisions is the result of a process of reflection and relationship-building between the patient, their relatives and health professionals. It is based on respect for patients’ autonomy, involving them in making decisions about their disease in a way that is shared between the medical team, the patient and their relatives. Up until now, the efficacy of an ACP has not been measured in the existing literature, and therefore it is unknown if these programs reach their goal. The main objective of our study is to evaluate the efficacy of an ACP program for decision-making in patients with advanced heart failure (HF) in comparison to usual follow up and care. This objective will be evaluated by the Patient Activation Measure test, which measures the participation and self-management of the patient in decision-making. Secondary objectives: to evaluate the effect of the program on quality of life, to know if the patients wishes expressed through the ACP program are fulfilled, to measure the impact of the program on patients’ caregivers, to determine the satisfaction of patients included in the program and to evaluate the effect on quality of death.

Methods

Randomized multicentre clinical trial at four hospitals in Madrid. Once they are included in the study, patients’ allocation to groups (control vs intervention) will be made by alternative sampling. ACP will be applied to the intervention group, whereas in the Control Group usual follow-up will be carried out in HF units. All patients will fulfil questionnaires and tests related to the objectives of the study again after a 12-month follow-up period in order to gauge the effect of ACP in patients with advanced HF.

Discussion

The characteristics of patients with advanced HF make them a model for designing ACP programs, given the high prevalence of this disease, the progressive increase in its incidence and it’s clinical characteristics. Until now, the efficacy of this type of program has not been measured, so this Clinical Trial can provide relevant data for future ACP projects.

Trial registration ClinicalTrials.gov Identifier: NCT04424680. Registered 9 June 2020. Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04424680?term=NCT04424680&draw=2&rank=1.

Phenotypical differences among B. cinerea isolates from ornamental plants

B. cinerea is a common pathogenic fungus which causes Botrytis blight (Grey mould) in most ornamental plants. It may be responsible for serious preharvest diseases and postharvest losses in fruits, vegetables and flowers. In this work, several B. cinerea isolates from ornamental plants (Chamelaucium uncinatum, Pelargonium x hortorum, Euphorbia pulcherrima, Lantana camara, Lonicera japonica, Hydrangea macrophylla, and Cyclamen persicum) affected by Botrytis blight in the south of Spain were studied. All the isolates were confirmed as B. cinerea by PCR using a specific 750-bp molecular marker, which is present in all strains of this species but absent from other species of Botrytis. The isolates were evaluated by reference to mature conidia length, sclerotia production, and growth rate. Conidia, conidiophores and hyphae were described by light microscopy and some by cryogenic scanning electron microscopy (Cryo-SEM). Conidium length was measured by using an eyepiece micrometer at 400x power, whereas the growth rate was assessed from differences in colony diameter between the third and fourth day of growth in potato-dextrose agar culture medium at 26 degrees C. B. cinerea showed a high degree of phenotypical variability among isolates, not only as regards visual aspects of the colonies but also in some morphological structures such as conidium length, conidiophores, sclerotia production, and hyphae. Differences were also observed in the growth rates. Conidiation was insignificant in the isolates from H. macrophylla, and P. x hortorum, where the overall appearance was white in all the growing stages, whereas isolates from L. camara, C. persicum and C. uncinatum were mainly grey or brown in mature stages. The longest conidia were obtained in isolates from H. macrophylla and C. persicum (17-18 microm) and the lowest in C. uncinatum (9 microm). All the isolates, except L. camara, developed mature sclerotia after approximately 16 days in the conditions used. H. macrophylla had around 72 sclerotia per colony, whereas C. persicum had only nine after 28 days. The growth rate of isolates from L. camara was the highest (1.64 cm/day). Such phenotypical variability may result in a differential response to plant growth regulators if plants are infected by Botrytis in the early stages of growth. In this way, we confirm, as we have done in other published studies, that isolates show different responses to some plant hormones and inhibitors.