Range of Clinical Neuro-Ophthalmopathology: more than Tumors

The importance of close co-operation of ophthalmologists, neurologists, neurosurgeons and neuro-ophthalmopathologists as well in clinical as in scientific settings is underlined. Typical neuro-ophthalmopathological examples of frequent and rare cases from pathology of the eyelid, the cornea, intraocular tumors, ocular trauma and tumors of the orbit are presented as well as systemic pathologies such as inflammatory diseases of the eye, phakomatoses, malformations and mitochondrial disorders in which the histopathological investigation by neuro-ophthalmopathologists may contribute to diagnosis and therapeutic decision-making. The chosen examples should provide a narrow focus on some clinical queries answered by neuro-ophthalmopathology and exemplify methodological options, but – in the given frame – cannot represent the full range of eye pathology. Relevant literature is included for further reading. Ophthalmologists, neurologists and neurosurgeons should be aware from the additional value of a concise neuro-ophthalmopathological diagnosis for the optimal treatment of eye diseases and should insist in a professional neuro-ophthalmopathological investigation whenever and wherever possible.

Hipericão na perturbação depressiva: revisão crítica de autor

Objetivos: Rever a evidência existente quanto à eficácia, tolerabilidade e segurança do hipericão no tratamento da perturbação depressiva (PD). Fontes de dados: NICE, Canadian Medical Association Infobase, PubMed – Clinical Queries, The Cochrane Library, BMJ, Bandolier e DARE – Centre for Reviews and Dissemination. Método: Foi realizada a pesquisa de artigos científicos em plataformas online de medicina baseada na evidência, com as palavras-chave Hypericum e Depressive Disorder. A seleção dos artigos foi feita com base no título, ano de publicação e resumo. Resultados: Foram incluídas nesta revisão duas normas de orientação clínica (NOC), três meta-análises (MA), duas revisões sistemáticas (RS) e um artigo original (AO). Uma NOC referiu que o hipericão pode ser usado como primeira linha na PD major ligeira a moderada e como tratamento adjuvante de segunda linha na PD major moderada a grave. A outra NOC não aconselha o seu uso. As MA e as RS concluíram que o hipericão apresenta uma eficácia superior ao placebo no tratamento da PD, sendo que duas MA e duas RS acrescentaram que não há aumento dos efeitos adversos. Duas RS referiram o risco de interações com outros fármacos. O AO também afirma a eficácia do hipericão nas mulheres na pós-menopausa. Conclusão: Existe evidência quanto à eficácia do hipericão na PD ligeira a moderada. Os dados disponíveis parecem ser consistentes quanto à sua boa tolerabilidade, mas também quanto ao risco de interações com outros fármacos. As limitações da recomendação prendem-se essencialmente com o facto dos mecanismos de ação não estarem completamente esclarecidos.

KOLABORASI PUSTAKAWAN DALAM PENGAMBILAN KEPUTUSAN KLINIS BERBASIS BUKTI TERKINI (EVIDENCE BASED MEDICINE ): STUDI KASUS DI FAKULTAS KEDOKTERAN, KESEHATAN MASYARAKAT DAN KEPERAWATAN UNIVERSITAS GADJAH MADA

Evidence Based Medicine (EBM) merupakan pemanfaatan bukti ilmiah berdasarkan penelitian klinis mutakhir yang sahih dalam tatalaksana proses penyembuhan penyakit. Salah satu syarat utama untuk memfasilitasi pengambilan keputusan klinik yang evidence-based, adalah dengan menyediakan bukti-bukti ilmiah yang relevan. Tipe kajian diutamakan yang berupa hasil review sistematik, meta-analisis, dan randomised controlled trial (RCT). Salah satu dari lima langkah dalam evidence based medicine yaitu yaitu menelusur bukti dari sumber database hasil penelitian yang memuat bukti-bukti ilmiah. PubMed Clinical Queries dan The Cochrane Library merupakan database berisi hasil riset sekunder (systematic-review/meta-analysis) yang mensintesis hasil riset primer. Kolaborasi pustakawan dalam pengambilan keputusan klinis yaitu dengan memberikan pelatihan atau menelusur artikel hasil penelitian yang akan digunakan dalam pengambilan klinis dari database yang memuat bukti ilmiah.

Trialstreamer: A living, automatically updated database of clinical trial reports

Objective Randomized controlled trials (RCTs) are the gold standard method for evaluating whether a treatment works in health care but can be difficult to find and make use of. We describe the development and evaluation of a system to automatically find and categorize all new RCT reports. Materials and Methods Trialstreamer continuously monitors PubMed and the World Health Organization International Clinical Trials Registry Platform, looking for new RCTs in humans using a validated classifier. We combine machine learning and rule-based methods to extract information from the RCT abstracts, including free-text descriptions of trial PICO (populations, interventions/comparators, and outcomes) elements and map these snippets to normalized MeSH (Medical Subject Headings) vocabulary terms. We additionally identify sample sizes, predict the risk of bias, and extract text conveying key findings. We store all extracted data in a database, which we make freely available for download, and via a search portal, which allows users to enter structured clinical queries. Results are ranked automatically to prioritize larger and higher-quality studies. Results As of early June 2020, we have indexed 673 191 publications of RCTs, of which 22 363 were published in the first 5 months of 2020 (142 per day). We additionally include 304 111 trial registrations from the International Clinical Trials Registry Platform. The median trial sample size was 66. Conclusions We present an automated system for finding and categorizing RCTs. This yields a novel resource: a database of structured information automatically extracted for all published RCTs in humans. We make daily updates of this database available on our website (https://trialstreamer.robotreviewer.net).

Artificial Intelligence for Rapid Meta-Analysis: Case Study on Ocular Toxicity of Hydroxychloroquine

Background Rapid access to evidence is crucial in times of an evolving clinical crisis. To that end, we propose a novel approach to answer clinical queries, termed rapid meta-analysis (RMA). Unlike traditional meta-analysis, RMA balances a quick time to production with reasonable data quality assurances, leveraging artificial intelligence (AI) to strike this balance. Objective We aimed to evaluate whether RMA can generate meaningful clinical insights, but crucially, in a much faster processing time than traditional meta-analysis, using a relevant, real-world example. Methods The development of our RMA approach was motivated by a currently relevant clinical question: is ocular toxicity and vision compromise a side effect of hydroxychloroquine therapy? At the time of designing this study, hydroxychloroquine was a leading candidate in the treatment of coronavirus disease (COVID-19). We then leveraged AI to pull and screen articles, automatically extract their results, review the studies, and analyze the data with standard statistical methods. Results By combining AI with human analysis in our RMA, we generated a meaningful, clinical result in less than 30 minutes. The RMA identified 11 studies considering ocular toxicity as a side effect of hydroxychloroquine and estimated the incidence to be 3.4% (95% CI 1.11%-9.96%). The heterogeneity across individual study findings was high, which should be taken into account in interpretation of the result. Conclusions We demonstrate that a novel approach to meta-analysis using AI can generate meaningful clinical insights in a much shorter time period than traditional meta-analysis.

Childhood Alopecia Areata: An Overview of Treatment and Recent Patents

Background: Alopecia Areata (AA) is a systemic autoimmune condition which usually starts in childhood. Objective: This article aims to review genetics, therapy, prognosis and recent patents for AA. Methods: We used clinical queries and keywords of “alopecia areata” AND “childhood” as search engine. Patents were searched using the key term “alopecia areata” in Patents.google.com and freepatentsonline.com. Results: Due to an immune mediated damage of the hair follicles, hair is lost from the scalp and other areas of the body temporarily or even permanently. Children with AA are generally healthy. Evidence of genetic association and increased predisposition for AA was found by studying families with affected members. Pathophysiologically, T- lymphocytes attack hair follicles and cause inflammation and destruction of the hair follicles and hair loss. In mild cases, there would be well demarcated round patchy scalp hair loss. The pathognomonic “exclamation mark hairs” may be seen at lesion periphery. In more severe cases, the hair loss may affect the whole scalp and even the whole body. The clinical course is also variable which may range from transient episodes of recurrent patchy hair loss to an indolent gradually deteriorating severe hair loss. The treatment of AA depends on factors including patients’ age, extent of the hair loss, duration of disease, psychological impact, availability and side effect profile of the treatments. For localized patchy alopecia, topical application of corticosteroids and/or intralesional corticosteroids are the treatment of choice. Other topical treatments include minoxidil, anthralin, coal tar and immunotherapy. In severe resistant cases, systemic immunosuppressants may be considered. Although herbal medicine, acupuncture, complementary and alternative medicine may be tried on children in some Asian communities, the evidence to support these practices are lacking. To date, only few recent patents exist in topical treatments including Il-31, laser and herbal medications. Clinical efficacy is pending for these treatment modalities. Conclusions: None of the established therapeutic options are curative. However, newer treatment modalities including excimer laser, interleukin-31 antibodies and biologics are evolving so that there may be significant advances in treatment in the near future. AA can be psychosocially devastating. It is important to assess the quality of life, degree of anxiety, social phobia and mood of the patients and their families. Psychological support is imperative for those who are adversely affected psychosocially.

Trialstreamer: a living, automatically updated database of clinical trial reports

Objective Randomized controlled trials (RCTs) are the gold standard method for evaluating whether a treatment works in healthcare, but can be difficult to find and make use of. We describe the development and evaluation of a system to automatically find and categorize all new RCT reports. Materials and Methods Trialstreamer, continuously monitors PubMed and the WHO International Clinical Trials Registry Platform (ICTRP), looking for new RCTs in humans using a validated classifier. We combine machine learning and rule-based methods to extract information from the RCT abstracts, including free-text descriptions of trial populations, interventions and outcomes (the 'PICO') and map these snippets to normalised MeSH vocabulary terms. We additionally identify sample sizes, predict the risk of bias, and extract text conveying key findings. We store all extracted data in a database which we make freely available for download, and via a search portal, which allows users to enter structured clinical queries. Results are ranked automatically to prioritize larger and higher-quality studies. Results As of May 2020, we have indexed 669,895 publications of RCTs, of which 18,485 were published in the first four months of 2020 (144/day). We additionally include 303,319 trial registrations from ICTRP. The median trial sample size in the RCTs was 66. Conclusions We present an automated system for finding and categorising RCTs. This yields a novel resource: A database of structured information automatically extracted for all published RCTs in humans. We make daily updates of this database available on our website (trialstreamer.robotreviewer.net).

Artificial Intelligence for Rapid Meta-Analysis: Case Study on Ocular Toxicity of Hydroxychloroquine (Preprint)

BACKGROUND Rapid access to evidence is crucial in times of an evolving clinical crisis. To that end, we propose a novel approach to answer clinical queries, termed rapid meta-analysis (RMA). Unlike traditional meta-analysis, RMA balances a quick time to production with reasonable data quality assurances, leveraging artificial intelligence (AI) to strike this balance. OBJECTIVE We aimed to evaluate whether RMA can generate meaningful clinical insights, but crucially, in a much faster processing time than traditional meta-analysis, using a relevant, real-world example. METHODS The development of our RMA approach was motivated by a currently relevant clinical question: is ocular toxicity and vision compromise a side effect of hydroxychloroquine therapy? At the time of designing this study, hydroxychloroquine was a leading candidate in the treatment of coronavirus disease (COVID-19). We then leveraged AI to pull and screen articles, automatically extract their results, review the studies, and analyze the data with standard statistical methods. RESULTS By combining AI with human analysis in our RMA, we generated a meaningful, clinical result in less than 30 minutes. The RMA identified 11 studies considering ocular toxicity as a side effect of hydroxychloroquine and estimated the incidence to be 3.4% (95% CI 1.11%-9.96%). The heterogeneity across individual study findings was high, which should be taken into account in interpretation of the result. CONCLUSIONS We demonstrate that a novel approach to meta-analysis using AI can generate meaningful clinical insights in a much shorter time period than traditional meta-analysis.