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Savastano MC, Fossataro C, Carlà MM, Cestrone V, Biagini I, Sammarco L, Giannuzzi F, Fasciani R, Apa R, Lanzone A, Diterlizzi A, Policriti M, Di Stasio E, Killian R, Rizzo C, Rizzo S. Chorioretinal biomarkers in hypothalamic amenorrhea. Graefes Arch Clin Exp Ophthalmol 2024:10.1007/s00417-023-06346-0. [PMID: 38407592 DOI: 10.1007/s00417-023-06346-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 11/14/2023] [Accepted: 12/12/2023] [Indexed: 02/27/2024] Open
Abstract
PURPOSE The aim of our study was to evaluate changes in the retinal and choriocapillaris circulations in patients with hypothalamic amenorrhea. METHODS Prospective, cross-sectional observational study on 25 patients (50 eyes) diagnosed with hypothalamic amenorrhea and 25 age-matched healthy women. Optical coherence tomography angiography (OCTA) was used to evaluate the vessel density (VD) of superficial capillary plexus (SCP), deep capillary plexus (DCP), and choriocapillaris VD layers in whole 6.4 × 6.4-mm image and in fovea grid-based image. In patients' group, systemic parameters were collected: body mass index (BMI), endometrial rhyme thickness, follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin, insulin, and cortisol. RESULTS SCP and DCP did not show any statistical difference when comparing patients and controls (all p > 0.05). Differently, choriocapillaris VD in the whole region showed a non-significant tendency toward higher values in the patients group in both eyes (p = 0.038 for right eye [RE], p = 0.044 for left eye [LE]). Foveal choriocapillaris VD was higher in hypothalamic amenorrhea women vs. healthy controls (66.0 ± 2.4 vs. 63.7 ± 6.6%, p = 0.136 for RE; 65.0 ± 2.4 vs. 61.6 ± 7.0%, p = 0.005 for LE). Focusing on correlation with systemic parameters, SCP and DCP foveal density had a medium/high effect size with endometrial rhyme, along with DCP in the fovea area vs. cortisol and SCP in the whole area vs. FSH. CONCLUSION When comparing hypothalamic amenorrhea patients to healthy subjects, OCTA detected changes in the choriocapillaris layer, showing increased VD in the early stage of the systemic pathology, suggesting that microvascular "compaction" could be a first phase of hypoestrogenism adaptation.
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Affiliation(s)
- Maria Cristina Savastano
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli, IRCCS,", Largo A. Gemelli, 8, 00168, Rome, Italy
- Catholic University "Sacro Cuore,", Rome, Italy
| | - Claudia Fossataro
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli, IRCCS,", Largo A. Gemelli, 8, 00168, Rome, Italy
- Catholic University "Sacro Cuore,", Rome, Italy
| | - Matteo Mario Carlà
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli, IRCCS,", Largo A. Gemelli, 8, 00168, Rome, Italy.
- Catholic University "Sacro Cuore,", Rome, Italy.
| | - Valentina Cestrone
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli, IRCCS,", Largo A. Gemelli, 8, 00168, Rome, Italy
- Catholic University "Sacro Cuore,", Rome, Italy
| | - Ilaria Biagini
- Department NEUROFARBA, University of Florence, Florence, Italy
| | - Leonardo Sammarco
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli, IRCCS,", Largo A. Gemelli, 8, 00168, Rome, Italy
- Catholic University "Sacro Cuore,", Rome, Italy
| | - Federico Giannuzzi
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli, IRCCS,", Largo A. Gemelli, 8, 00168, Rome, Italy
- Catholic University "Sacro Cuore,", Rome, Italy
| | - Romina Fasciani
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli, IRCCS,", Largo A. Gemelli, 8, 00168, Rome, Italy
- Catholic University "Sacro Cuore,", Rome, Italy
| | - Rosanna Apa
- Catholic University "Sacro Cuore,", Rome, Italy
- Obstetric Pathology Unit, "Fondazione Policlinico Universitario A. Gemelli, IRCCS,", 00168, Rome, Italy
| | - Antonio Lanzone
- Catholic University "Sacro Cuore,", Rome, Italy
- Obstetric Pathology Unit, "Fondazione Policlinico Universitario A. Gemelli, IRCCS,", 00168, Rome, Italy
| | - Alice Diterlizzi
- Catholic University "Sacro Cuore,", Rome, Italy
- Obstetric Pathology Unit, "Fondazione Policlinico Universitario A. Gemelli, IRCCS,", 00168, Rome, Italy
| | - Martina Policriti
- Catholic University "Sacro Cuore,", Rome, Italy
- Obstetric Pathology Unit, "Fondazione Policlinico Universitario A. Gemelli, IRCCS,", 00168, Rome, Italy
| | - Enrico Di Stasio
- Department of Basic Biotechnological Sciences, Intensive Care and Perioperative Clinics Research, Catholic University of the Sacred Heart, Milan, Italy
- "Fondazione Policlinico Universitario A. Gemelli, IRCCS,", 00168, Rome, Italy
| | - Raphael Killian
- Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Clara Rizzo
- Ophthalmology Unit, Department of Surgery, University Hospital, 56100, Pisa, Italy
| | - Stanislao Rizzo
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli, IRCCS,", Largo A. Gemelli, 8, 00168, Rome, Italy
- Catholic University "Sacro Cuore,", Rome, Italy
- Neuroscience Institute, Italian National Research Council, CNR, Pisa, Italy
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Savastano A, Gambini G, Carlà MM, Caporossi T, Giannuzzi F, Rizzo C, Killian R, Rizzo S. Eyewatch adjustable drainage device in vitrectomized eyes with refractory glaucoma. Eur J Ophthalmol 2023; 33:2303-2308. [PMID: 37437594 DOI: 10.1177/11206721231188153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
BACKGROUND To describe the efficacy and safety of the adjustable system eyeWatch in vitrectomized glacomatous eyes. METHODS Prospective, non-comparative, small case series of 2 patients who underwent glaucoma drainage device implant with the eyeWatch system. Intraocular pressure, number of medications and early and late complications were evaluated. RESULTS None of the operated eyes developed early or late complications. After 1 week post operatively, the IOP raised at 28 mmHg in the first eye and 25 mmHg in the second one. The eyeWatch Pen was used to open and set the device into position 3 (that means implant half opened) After waiting for 30 min, IOP was 15 mmHg and 11 mmHg, respectively. Thirty days after surgery we set the EyeWatch into position 0 (that means implant full opened) even though the IOP was under control. A new IOP measurement was done and we registered that IOP was 14 mmHg and 10 mmHg respectively, and it remained stable after six months of follow up. CONCLUSION In conclusion, in our case series the use of eyeWatch adjustable system allows a safe and gradual regulation of the flow during post-operative management also in vitrectomized eyes. Considering the percentage of hypotony related complications in vitrectomized eyes this system is an effective and safe technique to handle glaucoma in post vitreoretinal surgery eyes.
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Affiliation(s)
- Alfonso Savastano
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy
- Catholic University "Sacro Cuore", Rome, Italy
| | - Gloria Gambini
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy
- Catholic University "Sacro Cuore", Rome, Italy
| | - Matteo Mario Carlà
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy
- Catholic University "Sacro Cuore", Rome, Italy
| | - Tomaso Caporossi
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy
- Catholic University "Sacro Cuore", Rome, Italy
| | - Federico Giannuzzi
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy
- Catholic University "Sacro Cuore", Rome, Italy
| | - Clara Rizzo
- Ophthalmology Unit, Department of Surgery, University Hospital, Pisa, Italy
| | - Raphael Killian
- Ophthalmology Unit, Department of Surgery, University Hospital, Pisa, Italy
| | - Stanislao Rizzo
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy
- Catholic University "Sacro Cuore", Rome, Italy
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Oexle N, Becker T, Boege I, Buschek D, Fegert J, Killian R, Noterdaeme M, Rassenhofer M, Ruesch N, Schulze U. Ecological momentary intervention to reduce suicide risk among adolescents (EMIRA). Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Suicide is among the leading causes of death among adolescents and suicide risk is particularly high after discharge from psychiatric inpatient care. Therefore, interventions to reduce suicidal thoughts and behaviours (STBs) among adolescents discharged from psychiatric inpatient care are integral for successful suicide prevention among this group. However, such interventions are scarce. EMIRA aims to close this important gap in mental health services by developing an ecological momentary intervention (i.e., intervention delivered in real-time and within one's natural setting) consisting of a personalized, automatically triggered crisis support smartphone app to reduce STBs after discharge from psychiatric inpatient care among adolescents aged 14-21 years at risk for suicide. First, we will conduct qualitative interviews with adolescents aged 14-21 years who previously experienced STBs, their parents and health care providers to identify their intervention needs and safety concerns regarding ecological momentary assessment (EMA). Next, we will investigate the short-term variability of STBs and their cognitive and physiological risk factors among adolescents aged 14-21 years using EMA (app-based self-report + wrist worn device). Based on our results and past research we will develop a personalized crisis support smartphone app (mobile safety planning) that is not only self-accessible but starts automatically based on the presence of pre-identified STB risk factors. Finally, we will conduct two consecutive studies to test the feasibility, efficacy and cost-effectiveness of the developed ecological momentary intervention in reducing STBs after discharge from psychiatric inpatient care among adolescents aged 14-21 years at risk for suicide. EMIRA has great potential to close a crucial gap in adolescent mental health services and significantly improve suicide prevention among this group.
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Affiliation(s)
- N Oexle
- Department of Psychiatry II, University of Ulm and BKH Guenzburg, Ulm, Germany
| | - T Becker
- Department of Psychiatry II, University of Ulm and BKH Guenzburg, Ulm, Germany
| | - I Boege
- Clinic for Child and Adolescent Psychiatry, Ravensburg, Germany
| | - D Buschek
- Department of Computer Science, University of Bayreuth, Bayreuth, Germany
| | - J Fegert
- Clinic for Child and Adolescent Psychiatry, University of Ulm, Ulm, Germany
| | - R Killian
- Department of Psychiatry II, University of Ulm and BKH Guenzburg, Ulm, Germany
| | - M Noterdaeme
- Clinic for Child and Adolescent Psychiatry, Augsburg, Germany
| | - M Rassenhofer
- Clinic for Child and Adolescent Psychiatry, University of Ulm, Ulm, Germany
| | - N Ruesch
- Department of Psychiatry II, University of Ulm and BKH Guenzburg, Ulm, Germany
| | - U Schulze
- Clinic for Child and Adolescent Psychiatry, Boeblingen, Germany
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Abstract
This study investigates the provision of general medical and foot care, the barriers to access for foot care, and the awareness of foot risks in an urban diabetic population. A survey composed of 26 questions was mailed to 2375 diabetic patients in the San Francisco Bay area who are members of the American Diabetes Association (ADA). Three hundred ninety-two surveys were returned for a response rate of 16%. Of the 392 respondents, 7 (1.8%) indicated that they were not receiving any medial care for their diabetes, with another 15 (3.8%) receiving general medical care from an alternative health care provider. Among the respondents, 87 (22%) did not have their feet examined by any health care provider. The remainder of the patients were receiving foot care from a health care provider with 191 (48.7%) under the care of a provider other than a podiatrist. Of those not receiving any foot care, 53 (61%) reported that they did not seek any pedal care because they do not have any apparent foot or leg problems. Another 12 (13.8%) indicated that they did not know whom to see for their lower extremity problems. Lack of insurance or inability to afford medical care was the main reason that prevented 7 (8%) of the patients from receiving routine foot care. With respect to the patient's knowledge of diabetes-associated foot disorders, the majority (72%-79%) knew that poor circulation, neuropathy, ulcers, painful leg and foot conditions, infection, and amputation were associated with diabetes. From all the surveyors, 106 (27%) reported that they were not advised or educated on the potential lower extremity complications of diabetes by their health care provider. The results of this study indicate that in an urban population of diabetic patients, all of whom were members of ADA, a significant number are not adequately educated on the importance of routine foot care.
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Affiliation(s)
- R Mirmiran
- California College of Podiatric Medicine, San Francisco, USA
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