Thesis (M.Sc.)--Memorial University of Newfoundland, 2004. / Includes bibliographical references.

Thesis (Ph.D.)--Baylor University, 2006. / Includes bibliographical references (p. 88-90).

Orientador: Eliane Chaves Jorge / Abstract: Background: The standard treatment of retinopathy of prematurity (ROP) is the ablation of the avascular retina with laser or cryotherapy. However, this therapy may leave permanent structural and visual sequelae and may not be effective in cases of posterior and aggressive ROP. Vascular endothelial growth factor (VEGF) is involved in the pathogenesis of ROP, and antiangiogenic therapy is an option in cases of failure of standard treatment. The potential adverse effects of the use of antiangiogenic drugs in preterm neonates and the lack of concrete evidence on the efficacy of these drugs justify a systematic review of the literature. Objective: To evaluate the efficacy and safety of antiangiogenic therapy, when compared with laser photocoagulation, cryotherapy or combination therapy, in the treatment of ROP. Method: A systematic review of the literature was conducted using the Cochrane collaboration methodology and electronic search platforms to identify studies using antiangiogenic drugs in the treatment of ROP. The quality of the evidence was evaluated by the GRADE system (Grading of Recommendations Assessment, Development, and Evaluation). Results: Twelve studies were included in this review (six randomized controlled trials - RCTs and six non-randomized observational studies), including 677 preterm infants. Through the meta-analyzes, there was a statistical difference benefiting anti-VEGF therapy in the occurrence of progression to retinal detachment (RR 0.14 [95% CI 0.05, ... (Complete abstract click electronic access below) / Resumo: Introdução: O tratamento padrão da retinopatia da prematuridade (ROP) é a ablação da retina avascular com laser ou crioterapia. No entanto, esta terapia pode deixar sequelas estruturais e visuais permanentes e não ser efetiva em casos de ROP posterior e agressiva. O fator de crescimento do endotélio vascular (VEGF) está envolvido na patogênese da ROP e a terapia antiangiogênica é opção nos casos de falha do tratamento padrão. Os potenciais efeitos adversos com o uso de antiangiogênicos em neonatos prematuros e a falta de evidências concretas sobre a eficácia destas drogas justifica uma revisão sistemática da literatura. Objetivo: Avaliar a eficácia e a segurança da terapia antiangiogênica, quando comparada com fotocoagulação a laser, crioterapia ou terapia combinada, no tratamento da ROP. Método: Uma revisão sistemática da literatura foi realizada, utilizando a metodologia da colaboração Cochrane e plataformas eletrônicas de busca para identificar estudos utilizando drogas antiangiogênicas no tratamento da ROP. A qualidade da evidência foi avaliada pelo sistema GRADE (Grading of Recommendations Assessment, Development and Evaluation). Resultados: Doze estudos foram incluídos nesta revisão (seis ensaios clínicos randomizados e seis estudos observacionais não randomizados), incluindo 677 recém-nascidos pré-termo (1288 olhos). Pelas metanálises, houve diferença estatística beneficiando a terapia anti-VEGF na ocorrência de progressão para descolamento de retina (RR 0.14 [IC 95% 0... (Resumo completo, clicar acesso eletrônico abaixo) / Mestre

Submitted by MATHEUS SENNA PEREIRA OGATA (mspogata@gmail.com) on 2018-09-18T00:16:15Z No. of bitstreams: 1 Dissertação (REFERENCIAS CORRGIIDAS) - Matheus Senna Pereira Ogata.pdf: 3338159 bytes, checksum: a4719346512d617a2a7beeb12f2c4a85 (MD5) / Approved for entry into archive by ROSANGELA APARECIDA LOBO null (rosangelalobo@btu.unesp.br) on 2018-09-18T17:16:07Z (GMT) No. of bitstreams: 1 ogata_msp_me_bot.pdf: 3338159 bytes, checksum: a4719346512d617a2a7beeb12f2c4a85 (MD5) / Made available in DSpace on 2018-09-18T17:16:07Z (GMT). No. of bitstreams: 1 ogata_msp_me_bot.pdf: 3338159 bytes, checksum: a4719346512d617a2a7beeb12f2c4a85 (MD5) Previous issue date: 2018-07-25 / Introdução: O tratamento padrão da retinopatia da prematuridade (ROP) é a ablação da retina avascular com laser ou crioterapia. No entanto, esta terapia pode deixar sequelas estruturais e visuais permanentes e não ser efetiva em casos de ROP posterior e agressiva. O fator de crescimento do endotélio vascular (VEGF) está envolvido na patogênese da ROP e a terapia antiangiogênica é opção nos casos de falha do tratamento padrão. Os potenciais efeitos adversos com o uso de antiangiogênicos em neonatos prematuros e a falta de evidências concretas sobre a eficácia destas drogas justifica uma revisão sistemática da literatura. Objetivo: Avaliar a eficácia e a segurança da terapia antiangiogênica, quando comparada com fotocoagulação a laser, crioterapia ou terapia combinada, no tratamento da ROP. Método: Uma revisão sistemática da literatura foi realizada, utilizando a metodologia da colaboração Cochrane e plataformas eletrônicas de busca para identificar estudos utilizando drogas antiangiogênicas no tratamento da ROP. A qualidade da evidência foi avaliada pelo sistema GRADE (Grading of Recommendations Assessment, Development and Evaluation). Resultados: Doze estudos foram incluídos nesta revisão (seis ensaios clínicos randomizados e seis estudos observacionais não randomizados), incluindo 677 recém-nascidos pré-termo (1288 olhos). Pelas metanálises, houve diferença estatística beneficiando a terapia anti-VEGF na ocorrência de progressão para descolamento de retina (RR 0.14 [IC 95% 0.05, 0.38] p=0.0001, I2 = 0%) e ocorrência de miopia ( Diferença de média ponderada 0.25 [IC 95% 0.14, 0.37] p<0.0001, I2 = 76%). No desfecho recorrência de ROP houve diferença estatística beneficiando o laser (RR 1.88 [IC 95% 1.34, 2.63] p=0.0003, I2 = 82%). Não houve porém, diferença entre a terapia anti-VEGF e o laser quanto à ocorrência de complicações oculares (RR 0.84 [IC 95% 0.34, 2.08] p=0.71, I2 = 0%). Na análise de sub grupo, na comparação entre as zonas de acometimento da ROP, o anti-VEGF apresentou menor risco de recorrência exigindo retratamento que o laser, em prematuros com ROP em zona I (RR 0.23 [IC 95% 0.11, 0.49] p=0.0001, I2 = 61%). A qualidade da evidência pelo GRADE variou de muito baixa a baixa. Conclusões: Há evidências de que a terapia anti-VEGF, usada como monoterapia, quando comparada ao laser, reduz o risco de progressão para descolamento de retina, a ocorrência de miopia e o risco de recorrência de ROP em prematuros com doença na zona I. No entanto, ainda faltam evidências de qualidade que permitam atestar a segurança da terapia, especialmente quanto aos potenciais efeitos sistêmicos em prematuros. Palavras-chave: Retinopatia da Prematuridade, antiangiogênicos, metanálise. / Background: The standard treatment of retinopathy of prematurity (ROP) is the ablation of the avascular retina with laser or cryotherapy. However, this therapy may leave permanent structural and visual sequelae and may not be effective in cases of posterior and aggressive ROP. Vascular endothelial growth factor (VEGF) is involved in the pathogenesis of ROP, and antiangiogenic therapy is an option in cases of failure of standard treatment. The potential adverse effects of the use of antiangiogenic drugs in preterm neonates and the lack of concrete evidence on the efficacy of these drugs justify a systematic review of the literature. Objective: To evaluate the efficacy and safety of antiangiogenic therapy, when compared with laser photocoagulation, cryotherapy or combination therapy, in the treatment of ROP. Method: A systematic review of the literature was conducted using the Cochrane collaboration methodology and electronic search platforms to identify studies using antiangiogenic drugs in the treatment of ROP. The quality of the evidence was evaluated by the GRADE system (Grading of Recommendations Assessment, Development, and Evaluation). Results: Twelve studies were included in this review (six randomized controlled trials - RCTs and six non-randomized observational studies), including 677 preterm infants. Through the meta-analyzes, there was a statistical difference benefiting anti-VEGF therapy in the occurrence of progression to retinal detachment (RR 0.14 [95% CI 0.05, 0.38] p = 0.0001, I2 = 0%) and myopia occurrence (Weighted mean difference 0.25 [95% CI 0.14, 0.37] p <0.0001, I2 = 76%). At the end of ROP recurrence, there was a statistical difference benefiting the laser (RR 1.88 [95% CI 1.34, 2.63], p = 0.0003, I2 = 82%). There was, however, no difference between the anti-VEGF therapy and the laser in the occurrence of ocular complications (RR 0.84 [95% CI 0.34, 2.08] p = 0.71, I2 = 0%). In the subgroup analysis, in the comparison between the ROP involvement zones, the anti-VEGF presented a lower risk of recurrence requiring retreatment than the laser in premature infants with zone I ROP (RR 0.23 [95% CI 0.11, 0.49] p = 0.0001, I2 = 61%).The quality of the GRADE evidence varied from very low to low. Conclusions: There is evidence that anti-VEGF therapy, used as monotherapy, when compared to laser, reduces the risk of progression to retinal detachment, the occurrence of myopia, and the risk of recurrence of ROP in preterm infants with the disease in zone I.However, there is still a lack of quality evidence to attest to the safety of therapy, especially regarding potential systemic effects in preterm infants.

Orientador: Mônica Barbosa de Melo / Dissertação (mestrado) - Universidade Estadual de Campinas, Instituto de Biologia / Made available in DSpace on 2018-08-20T09:58:06Z (GMT). No. of bitstreams: 1 Cruz_PedroRodriguesSousada_M.pdf: 4934964 bytes, checksum: 906273ac9e66e4d8efa634ae942458bf (MD5) Previous issue date: 2012 / Resumo: As doenças falciformes são...Observação: O resumo, na íntegra, poderá ser visualizado no texto completo da tese digital / Abstract: Sickle cell diseases are...Note: The complete abstract is available with the full electronic document / Mestrado / Genetica Animal e Evolução / Mestre em Genética e Biologia Molecular

The accurate assessment of human diabetic somatic polyneuropathy (DSPN) is important to define at risk patients, predict deterioration, and assess the efficacy of pathogenetic treatments. Corneal confocal microscopy (CCM) has been proposed as a surrogate endpoint for DSPN. Approximately 50% of patients with DSPN experience neuropathic pain or symptoms and the underlying reasons are not clearly elucidated. Vitamin D deficiency has been associated with diabetic complications including DSPN and diabetic retinopathy (DR). However there is a paucity of data regarding the interaction of vitamin D status with diabetic complications. This thesis shows that CCM can readily detect small fibre neuropathy prior to large fibre involvement and assess rapidly progressive nerve fibre loss prior to conventional thermal threshold testing. CCM has a superior diagnostic capabilities compared to intra-epidermal nerve fibres and correlates better with nerve conduction studies. Patients with LADA have a greater prevalence of small fibre neuropathy compared to matched patients with type 2 diabetes. Vitamin D deficiency is highly prevalent in patients with diabetes and despite relatively aggressive replacement regimens are inadequate in raising vitamin D levels in a significant proportion of patients. Vitamin D deficiency is not associated with DR but there is a strong association between painful DSPN and vitamin D insufficiency and more so with overt deficiency.

Magister Public Health - MPH / Untreated and unmonitored diabetic retinopathy (DR) can lead to vision loss. This may have many negative implications on society. Currently, there is a dearth of evidence regarding the factors that influence compliance behaviour to treatment among patients diagnosed with DR in South Africa’s public healthcare system. The current study sought to fill this research gap and explore patient-, institution-, treatment-, and COVID-19- related factors associated with compliance behaviour among patients living with diabetes that have been referred for suspected vision-threatening DR in the Northern/Tygerberg sub-structure (NTSS) of Cape Town, South Africa. Methodology: A qualitative research approach was used. The study population included 19 years and older South Africans living with diabetes who were screened and referred for vision-threatening retinopathy within the last 18 months at public primary healthcare facilities in the NTSS.

The blind have generally been considered to be a homogeneous population whose deficits arise from an interaction of loss of vision, age of onset and socialization. Sequelae are posited to exist merely due to the limiting effects of blindness on experience. This is believed to affect all blind persons equally regardless of cause of blindness provided that independent secondary disabilities do not exist. This study investigated the possibility that different causes of blindness are related to specific neuropsychological deficits which cannot be explained by the mere presence of blindness. It was found that neuropsychological differences existed among specific sub-populations of blind persons. These results suggested that the cause of blindness may be a marker for specific Central Nervous System involvement.

京都大学 / 0048 / 新制・課程博士 / 博士(社会健康医学) / 甲第21266号 / 社医博第89号 / 新制||社医||10(附属図書館) / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 辻川 明孝, 教授 中山 健夫, 教授 小杉 眞司 / 学位規則第4条第1項該当 / Doctor of Public Health / Kyoto University / DFAM

The Temple University Hospital System Ophthalmology Department implemented a telemedicine screening program for diabetic retinopathy to improve patient care and community engagement. The program screened over 1900 patients in the Philadelphia area from March 2016 to March 2020 and identified a significant number of patients who required further in-person examination and treatment. The implementation of a telemedicine screening program for diabetic retinopathy raises important ethical issues and merits discussion of the impact of social determinants of health on healthcare outcomes. In these community initiatives, the principles of agency, beneficence, non-maleficence, social justice, and solidarity in bioethics should be considered as they pertain to the specific needs of the community in which they are implemented. Overall, the COVID-19 pandemic has highlighted the importance of considering the ethical implications of healthcare practices, including diabetic retinopathy screenings. The risks and barriers to access must be taken into account, especially for vulnerable populations in urban areas. As such, promoting primary care engagement, providing accurate and culturally appropriate education and outreach, and addressing social determinants of health can help ensure that all patients have access to comprehensive and equitable care. By considering these factors, diabetic retinopathy screenings can be conducted in an ethical and effective manner. / Urban Bioethics