Evolution and associated factors of hand hygiene compliance in a pediatric tertiary hospital.

BACKGROUND: The objective is to know the evolution of the Degree of Compliance with Recommendations (DCR) on hand hygiene (HH) and its associated factors in the pediatric care areas (PCAs) of a tertiary hospital. METHODS: Observational, cross-sectional study, repeated over time, with direct observation of the DCR on HH during the daily activity of health care workers. Over 13 years, 9226 HH opportunities were observed. Associations between DCR, PCA and other variables (eg, age, sex, and professional position) were examined using χ² and adjusted odds ratios (aOR) with 95% confidence intervals (CI). RESULTS: DCR on HH in 9 PCAs was 64.3% (95% CI, 63.3-65.3), and in the group of non-pediatric areas it was 49.6% (95% CI, 49.1-50.1). The areas with the highest degree of compliance were Oncology 72.8% (95% CI, 69.2-76.4), Neonatology 73.2% (95% CI, 71.3-75.1), and Neonatal intensive care unit 70.0% (95% CI, 67.5-72.6). These were the areas with the strongest association with HH compliance, with aOR:2.8 (95% CI, 2.2-3.6); aOR, 3.0 (95% CI, 2.6-3.6) aOR:2.6 (95% CI, 2.1-3.1), respectively. Other associated factors were the indications "after an activity," aOR, 1.6 (95% CI, 1.5-1.8) and the availability of pocket-size alcohol-based solution, aOR, 2.1(95% CI, 1.9-2.3). CONCLUSIONS: The DCR on HH in PCAs is higher than in other areas, although there is still margin for improvement. We have identified modifiable factors that have an independent association with HH compliance in PCAs. Focusing on modifiable factors will increase compliance with HH with the ultimate goal of reducing healthcare associated infections.

[Evolution of treatment of syphilis through history]. / Evolución del tratamiento de la sífilis a lo largo de la historia.

In this article, we present a historical revision of syphilis treatment since the end of the XV century up until the current days. For centuries, it was understood that syphilis had been brought to Spain by Columbus after coming back from America. It became an epidemic soon after. Later on, it was spread all over Europe. The chronologic and geographic origin of this illness have been debated in recent years, however, there has been no agreement about it as yet. Mercury was the main used therapy for four and a half centuries, until the discovery of penicillin in 1943. This discovery changed the therapeutic approach to syphilis since then. Other remedies were used during this period. Guaiacum was one of them, but it was dismissed in the mid-sixteenth century. Iodides were also used, especially in the tertiary symptoms of the disease. The discovery of arsphenamine (Salvarsan) at the beginning of the XX century, used by itself at its onset and associated to mercury or bismuth later on, was a significant therapeutic contribution. Bismuth was in itself a great therapeutic asset. It displaced the use of mercury in an important way until 1943, when the appearance of penicillin became the treatment of choice.

Physiological and metabolic responses in newborn piglets associated with the birth order.

The objective of this study was to evaluate the effect of birth order on the physiological and metabolic responses of the newborn piglet the first hours after birth. A total of 281 randomly selected newborn piglets were included, classified according to birth order in 12 groups (L1-L12). The expulsion interval, neonatal vitality, latency in connecting to the maternal teat and physiological profile were recorded for each piglet. The number of piglets born alive and dead was also recorded. The blood gases, electrolytes and glucose levels of the neonates were obtained by means of an automatic blood gas and electrolyte analyzer. Groups L1, L2, L11, and L12 had the least score on the vitality scale, the longest expulsion intervals, and longest latency to connect with the maternal teat, as well as greater physiological alterations (hyperglycemia, hyperlactatemia and hypercapnia) compared to groups L4 to L9. Likewise, type-II stillbirths only occurred in the first and last quarter of the birth order of the litter. In conclusion, piglets born in the first and last quarter of the birth order of the litter had a greater risk of having physiological and behavioral alterations during farrowing.

Yellow-Cedar, Callitropsis (Chamaecyparis) nootkatensis, Secondary Metabolites, Biological Activities, and Chemical Ecology.

Yellow-cedar, Callitropsis nootkatensis, is prevalent in coastal forests of southeast Alaska, western Canada, and inland forests along the Cascades to northern California, USA. These trees have few microbial or animal pests, attributable in part to the distinct groups of biologically active secondary metabolites their tissues store for chemical defense. Here we summarize the new yellow-cedar compounds identified and their biological activities, plus new or expanded activities for tissues, extracts, essential oils and previously known compounds since the last review more than 40 years ago. Monoterpene hydrocarbons are the most abundant compounds in foliage, while heartwood contains substantial quantities of oxygenated monoterpenes and oxygenated sesquiterpenes, with one or more tropolones. Diterpenes occur in foliage and bark, whereas condensed tannins have been isolated from inner bark. Biological activities expressed by one or more compounds in these groups include fungicide, bactericide, sporicide, acaricide, insecticide, general cytotoxicity, antioxidant and human anticancer. The diversity of organisms impacted by whole tissues, essential oils, extracts, or individual compounds now encompasses ticks, fleas, termites, ants, mosquitoes, bacteria, a water mold, fungi and browsing animals. Nootkatone, is a heartwood component with sufficient activity against arthropods to warrant research focused toward potential development as a commercial repellent and biopesticide for ticks, mosquitoes and possibly other arthropods that vector human and animal pathogens.

Bilateral solar retinopathy. Autofluorescence and optical coherence tomography. / Retinopatía solar bilateral. Autofluorescencia y tomografía de coherencia óptica.

CASE REPORT: A 33-year-old man referred decreased bilateral visual acuity for five years, with no history of interest. Military profession and probably previous sun exposure. Focal pigmented lesions in the macular area of the fundus were observed, with impairment of the photoreceptor layer in the fovea, observed by optical coherence tomography (OCT), in various sectors of the fovea. DISCUSSION: Solar retinopathy is associated with professions at risk of sun exposure. The diagnosis is based on autofluorescence and macular OCT, that later will provide key data to establish the cause.

Catheter-related bloodstream infection: burden of disease in a tertiary hospital.

BACKGROUND: Surveillance programmes have become the most effective tool for controlling catheter-related bloodstream infections (CRBSI). However, few studies have investigated programmes covering all hospital settings. AIM: To describe the results of a control and prevention programme for CRBSI based on compliance with recommendations for insertion and maintenance, using annual burden of disease in a tertiary level hospital. METHODS: A CRBSI control and prevention programme involving all hospital settings was implemented. The programme consisted of CRBSI surveillance, direct observation of insertion and maintenance of catheters to determine performance, and education for healthcare workers. FINDINGS: In total, 2043 short-term catheters were inserted in 1546 patients for 18,570 catheter-days, and 279 long-term catheters were inserted in 243 patients for 40,440 catheter-days. The annual incidence density was 5.98 (first semester 6.40, second semester 5.64) CRBSI per 1000 catheter-days for short-term catheters, and 0.57 (first semester 0.66, second semester 0.43) CRBSI per 1000 catheter-days for long-term catheters. One hundred and forty insertion procedures were observed, with an average insertion time of 13 (standard deviation 7) min. Compliance with recommendations was as follows: hand hygiene, 86.8%; use of alcoholic chlorhexidine solution for skin disinfection, 35.5%; use of mask, 93.4%; use of gloves, 98.7%; use of gown, 75.0%; use of sterile cloth, 93.8%; use of cap, 92.2%; bandage application, 62.7%; and use of aseptic technique, 89.5%. Forty-five maintenance procedures were observed, and compliance rates were as follows: hand hygiene, 42.1%; use of gloves, 78.1%; and port disinfection with alcoholic chlorhexidine solution, 32.5%. CONCLUSION: The CRBSI control and prevention programme implemented at the study hospital has decreased the rate of CRBSI, provided important information about the total burden of disease, and revealed possible ways to improve interventions in the future.

[Variability and reproducibility of 3 methods for measuring the thickness of the nerve fiber layer]. / Variabilidad interindividual y reproducibilidad de tres métodos de medida del espesor de la capa de fibras nerviosas.

OBJECTIVE: To estimate the variability and reproducibility of confocal tomography (HRT), scanning laser polarimetry (GDx) and optical coherence tomography (OCT-Cirrus) to determine the thickness of the layer of ganglion fibers. METHOD: A total of 75 normal eyes were examined twice. Inter-individual variability was analyzed after standardizing the results. The coefficient of variation was used to measure the variability between tests, and the Pearson coefficient was used to analyze the correlation between variables. RESULTS: The inter-individual variability was similar in GDx (8.9%) and OCT (11.1%), but very high in HRT (30.0%). No instrument detected significant changes with age. The coefficient of variation of the total thickness between the examinations of the same subject was significantly lower (P<.05) in GDx (1.4) than in OCT (2.0), but very high in HRT (6.4). The same was true when analyzing the upper fibers (GDx=1.8, OCT=2.9, HRT = 6.6), but not with the lower ones, where the only significant differences were observed with HRT (GDx = 2.2, OCT = 2.7, HRT = 7.0). Among the results of OCT and GDx, there was a significant correlation when comparing the first (r=0.46, P<.0001) and second examinations (r=0.52, P<.0001). However there was no significant relationship between the data provided by HRT for the two remaining instruments (P>.05). CONCLUSIONS: There is a wide variation in the inter-individual and inter-test measurement of the thickness of the of nerve fibers layers using HRT. GDx has, in this respect, slight advantages over OCT.

Effect of plant sterols and tannins on Phytophthora ramorum growth and sporulation.

Elicitin-mediated acquisition of plant sterols is required for growth and sporulation of Phytophthora spp. This study examined the interactions between elicitins, sterols, and tannins. Ground leaf tissue, sterols, and tannin-enriched extracts were obtained from three different plant species (California bay laurel, California black oak, and Oregon white oak) in order to evaluate the effect of differing sterol/tannin contents on Phytophthora ramorum growth. For all three species, high levels of foliage inhibited P. ramorum growth and sporulation, with a steeper concentration dependence for the two oak samples. Phytophthora ramorum growth and sporulation were inhibited by either phytosterols or tannin-enriched extracts. High levels of sterols diminished elicitin gene expression in P. ramorum; whereas the tannin-enriched extract decreased the amount of 'functional' or ELISA-detectable elicitin, but not gene expression. Across all treatment combinations, P. ramorum growth and sporulation correlated strongly with the amount of ELISA-detectable elicitin (R (2) = 0.791 and 0.961, respectively).

Risk of advanced proximal neoplasms according to distal colorectal findings: comparison of sigmoidoscopy-based strategies.

BACKGROUND: Screening for colorectal cancer with sigmoidoscopy benefits from the fact that distal findings predict the risk of advanced proximal neoplasms (APNs). This study was aimed at comparing the existing strategies of postsigmoidoscopy referral to colonoscopy in terms of accuracy and resources needed. METHODS: Asymptomatic individuals aged 50-69 years were eligible for a randomized controlled trial designed to compare colonoscopy and fecal immunochemical test. Sigmoidoscopy yield was estimated from results obtained in the colonoscopy arm according to three sets of criteria of colonoscopy referral (from those proposed in the UK Flexible Sigmoidoscopy, Screening for COlon REctum [SCORE], and Norwegian Colorectal Cancer Prevention [NORCCAP] trials). Advanced neoplasm detection rate, sensitivity, specificity, and number of individuals needed to refer for colonoscopy to detect one APN were calculated. Logistic regression analysis was performed to identify distal findings associated with APN. All statistical tests were two-sided. RESULTS: APN was found in 255 of 5059 (5.0%) individuals. Fulfillment of UK (6.2%), SCORE (12.0%), and NORCCAP (17.9%) criteria varied statistically significantly (P < .001). The NORCCAP strategy obtained the highest sensitivity for APN detection (36.9%), and the UK approach reached the highest specificity (94.6%). The number of individuals needed to refer for colonoscopy to detect one APN was 6 (95% confidence interval [CI] = 4 to 7), 8 (95% CI = 6 to 9), and 10 (95% CI = 8 to 12) when the UK, SCORE, and NORCCAP criteria were used, respectively. The logistic regression analysis identified distal adenoma ≥10 mm (odds ratio = 3.77; 95% CI = 2.52 to 5.65) as the strongest independent predictor of APN. CONCLUSIONS: Whereas the NORCCAP criteria achieved the highest sensitivity for APN detection, the UK recommendations benefited from the lowest number of individuals needed to refer for colonoscopy.

[Pulsar perimetry. A review and new results]. / Pulsarperimetrie. Überblick und neue Ergebnisse.

We present a review and update on Pulsar perimetry, which combines temporal frequency, contrast and spatial frequency stimuli. The effects of age, visual acuity, and learning on results are described. Data on threshold fluctuation, signal-to-noise ratio, and the possibility of reducing noise with filtering techniques are provided. We describe its dynamic range and the possibility of compensating for profound defects. Finally, we show the results obtained in normal patients and in those with ocular hypertension or initial glaucoma, as well as an analysis of glaucoma progression.

[Comparing the ranges of defect measured with standard white on white and Pulsar perimetries]. / Comparación del rango de medida de defectos entre la perimetría estándar blanco/blanco y la perimetría Pulsar.

OBJECTIVES: Normal thresholds on Pulsar perimetry fall faster than those of standard perimetry in the peripheral visual field. Two related studies were performed. Firstly, the frequency distributions of glaucoma defects on standard automated perimetry (SAP) and the relationship of the centre and periphery (Study A) were studied first, followed by an attempt to establish the limits of pulsar perimetry (Study B). MATERIAL AND METHOD: A: frequency of defects was calculated in 78.663 SAP perimetries (G1-TOP, Octopus 1-2-3, Haag-Streit). Study B: 204 eyes with mean defect (MD-SAP) lower than 9 dB were examined 8.92 ± 4.19 times with SAP (TOP-32, Octopus 311) and temporal modulation perimetry (T30W, Pulsar Perimeter, Haag-Streit). RESULTS: Study A: 50.7% of the SAP examinations showed MD values lower than 9 dB and 32.7% bellow 6 dB. The MD correlation of the central 20° with the MD of the most peripheral points was r=0.933. Study B: in cases with MD-TOP-32 lower than 6 dB, SAP had the maximum possibility of detecting defect in 0.02% of points and Pulsar in 0.29%. In subjects with MD-TOP-32 between 6 and 9 dB frequencies were 0.38% in SAP and 3.5% in Pulsar (5.1% for eccentricities higher than 20°). CONCLUSIONS: Pulsar allows detecting defects, without range limitations, in the initial half of SAP frequencies expected on glaucoma patients. In order to study the progression of deeper defects the examination should focus on the central points, where the dynamic range of both systems is more equivalent.

Specificity of the program threshold noiseless trend for perimetric progression analysis.

PURPOSE: To evaluate the specificity of the Threshold Noiseless Trend program (TNT), designed to measure progression in visual fields, using four procedures. MATERIALS AND METHODS: A. In 63 eyes with ocular hypertension, whose last examination showed no perimetric or morphological defects, we performed a mean of 7.70 +/- 1.71 follow-up examinations during 2.2 +/- 0.6 years. B. In 81 glaucomatous eyes examined twice with a bracketing strategy (Octopus 1-2-3 perimeter), we calculated mean threshold value and long-term fluctuation. We simulated 12 different visual fields, adding a random component to simulate an equivalent fluctuation of amplitude. C. Seventy-two glaucomatous eyes, with and without progression, were examined 7.76 +/- 1.25 times during 4.88 +/- 1.39 years using the Humphrey-Sita Standard strategy. Visual field tests were randomly disordered and analyzed using TNT. D. 1221 eyes were examined 7.19 +/- 3.5 times during 3.50 +/- 1.45 years (10,407 visual fields) using TOP-G1 program. We detected progression in 204 eyes using TNT. They were re-evaluated after random disordering of visual field tests. RESULTS: The four procedures indicated specificity > or = 95% as from the seventh examination; this reduced to 90% in experiment C with six examinations, and in experiments A and C with five examinations. CONCLUSIONS: The specificity of TNT may be considered to be over 95% with a large number of examinations, and 90-100% with fewer examinations. At least five examinations are required for a basic interpretation of progression, and preferably more than six to guarantee the specificity of the result.

Angiotensin-II type 1 receptor (AT1R) and alpha-1D adrenoceptor form a heterodimer during pregnancy-induced hypertension.

Pregnancy courses with low response to angiotensin II and adrenergic agonists. In preeclampsia, both effects are reverted. It is known that angiotensin II regulates adrenergic system. It is not known, however, the interaction between both systems receptors. Our aim was to study if AT(1)R and alpha1D adrenoceptor heterodimerize in preeclampsia. We used subrenal aorctic coarctation in pregnant rats. Aortic tissues were prepared for confocal imaging and coimmunoprecipitated for alpha1D and AT(1) receptors. We found that AT(1)R and alpha1D adrenoceptor heterodimerize in both, healthy and preeclamptic groups. In healthy pregnant rats, heterodimer is barely detected. In preeclamptic rats however, we found higher heterodimerization. These results suggest that AT(1)R and alpha1D -adrenoceptor may form heterodimers, and may play a role in preeclampsia.

Detection of morphological and functional progression in initial glaucoma.

BACKGROUND: To observe the prospective follow-up results of functional and morphological data in patients with early, moderate and suspected glaucoma. METHODS: Eyes (n=156; average mean defect (MD)=2.2 dB) were examined every 3 months for an average of 3.6 years. Progression was estimated using regression analysis of the indices rim area and Glaucoma Probability Score of the Heidelberg retinal tomograph, mean thickness of the fibre layer using laser polarimetry with corneal compensation, MDs of standard, Pulsar and frequency doubling technology perimetries, and the threshold noiseless trend (TNT) program for the standard and Pulsar perimetries. RESULTS: TNT showed more than twice the diagnostic capacity of other methods. The maximum diagnostic sensitivity was obtained with TNT Pulsar. This procedure indicated progression in 40% of cases after seven examinations, and presented the lowest number of cases of progression not confirmed in two consecutive examinations. Most of the progressions of initial glaucoma were diffuse, without changes in the lens or loss of visual acuity. Heidelberg retinal tomograph and laser polarimetry made few diagnoses of progression. The diagnostic agreement between different methods was low, but higher between functional than morphological procedures. CONCLUSION: Functional indices, especially Pulsar, showed better detection of progression than morphological indices.

Hematological, immunological and neurochemical effects of chronic amphetamine treatment in male rats.

In the present study, we have analyzed the effect of chronic amphetamine sulfate (AMPH) treatment on haematological, immunological and neurochemical parameters in the male rat. AMPH increased the total peripheral leukocyte count, and altered its differential counts, decreasing lymphocytes and increasing neutrophils. Flow cytometry study showed that the decline in circulating lymphocytes was caused by the loss of a particular lymphocyte subset, B-cell, which reduced both in percentage and in absolute number by 50%. T-cell population increased by 15% but not in absolute number, however there was no difference in either CD4+ or CD8+ T lymphocyte subsets between experimental groups. Neurochemically, AMPH reduced norepinephrine (NE) and serotonin (5-HT) contents in the hypothalamus and increased dopamine (DA) content in the striatum. Chronic AMPH increased in a dose-dependent manner serum corticosterone levels, had no effect on circulating catecholamines, reduced adrenal weights, and did not affect spleen weights although reduced their cellularities. These results show that chronic AMPH have important effects on immune function, particularly on humoral immune response because it reduced the circulating B cell population by half. In addition, AMPH plays an important role in the redistribution and trafficking of leukocytes, and both effects seem to be mediated by sympathetic innervation of the lymphoid organs.

Structure-function relationship depends on glaucoma severity.

BACKGROUND/AIMS: To determine the structure-function relationship throughout the different stages of glaucoma. SUBJECTS: 228 controls and 1007 suspected, early, moderate, or advanced glaucomas. In controls, Pearson coefficient of variation (PCV) of standard automated perimetry mean sensitivity (SAP-MS) and global mean retinal nerve fibre layer thickness (RNFL, Heidelberg Retina Tomograph) were calculated. Piecewise linear regression was used to evaluate if the data were related better to two separate regression lines in all population. RESULTS: PCV for SAP-MS and RNFL was 6.19% and 29.27%, respectively. For SAP-MS >22.42 dB (piecewise linear regression-obtained breakpoint, p<0.05), the logarithmic and linear relationships between SAP-MS and mean RNFL thickness were not different (r = 0.182, r = 0.185 respectively; p = 0.950). For SAP-MS <22.42 dB, the logarithmic and linear relationships between SAP-MS and mean RNFL thickness were not different (r = 0.353, r = 0.344 respectively; p = 0.884). CONCLUSION: The logarithmic and linear relationships between SAP-MS and mean RNFL thickness did not differ when individuals were stratified using the piecewise linear regression-obtained cut-off point. The curvilinear relationship between the morphological and perimetric results may be due to the wide variability in normal morphology and limitations in the dynamic range of the morphological tests in cases with moderate and severe defects.

[Clinical relevance of haptoglobin/IgG index and Boyer's score to the differential diagnosis of bacterial and viral meningitis]. / Relevancia clínica del índice haptoglobina/IgG y la escala de Boyer en el diagnóstico diferencial de las meningoencefalitis bacterianas y víricas.

INTRODUCTION: The meningitis is one of the most severe diseases in children due to its mortality or sequels. However, timely knowledge of whether the infection is bacterial or viral in origin and applied a specific therapeutic would be beneficial for the patients and clinician. The haptoglobin/IgG index and Boyer's score have been use in this purpose. PATIENTS AND METHODS: 39 pediatric patients, 14 suffering from viral meningoencephalitis and 25 from bacterial meningoencephalitis were study. Boyer's score and Hp/IgG index were applied in order to evaluate its diagnostic accuracy. The clinical relevance of haptoglobin/IgG index and Boyer's score were compared by the analysis of the receiver-operating characteristic (ROC) curves. RESULTS: There were no association between Boyer's score and the cause of the meningitis. The sensitivity and specificity of haptoglobin/IgG index were de 71.4 and 64%, respectively. The same parametric to Boyer's score were de 28 and 100%. Increased haptoglobin/IgG index presents bigger precision for the differential diagnostic of the bacterial and viral meningitis than the scale of Boyer according to the curves ROC. CONCLUSION: The index haptoglobin/IgG showed its diagnostic superiority with relationship to the scale of Boyer to establish the origin of the meningoencephalitis.

Long-term fluctuation of standard automatic perimetry, pulsar perimetry and frequency-doubling technology in early glaucoma diagnosis.

PURPOSE: Analyze the stability and accuracy of 3 perimetric techniques. METHODS: A total of 104 stable eyes (65 subjects) with ocular hypertension and early glaucoma [group G, mean defect = 1.08 dB, SD = 2.0, in standard TOP automatic perimetry (SAP)] were examined 5 times during 18 months using: (a) SAP; (b) Pulsar temporal modulation perimetry (T30W), and (c) frequency-doubling technology (FDT N30). Ninety eyes from 90 normal controls were compared with the first set of examinations of group G. RESULTS: The learning effect was minimal in the 3 techniques but higher in Pulsar (1.0 src, p < 0.05) than in SAP and FDT (0.4 dB). Long-term fluctuation (F) was significantly higher in FDT (3.1 dB, SD = 1.4, p < 0.0001) than in SAP (2.3 dB, SD = 1.1) and in Pulsar (1.9 src, SD = 0.7). Pulsar and FDT reduce F when increasing the number of examinations. F seems equivalent in SAP and FDT and lower in Pulsar, considering small-scale differences of the 3 perimeters. CONCLUSIONS: A slight learning effect would be expected on FDT and SAP in patients with previous experience with SAP. The stability and sensitivity of Pulsar is greater than on the other 2 systems. For early diagnosis of glaucoma it is essential to prove the reproducibility and coincidence of perimetric results.

Topographical spatial summation in glaucoma.

PURPOSE: Stimulus luminance (L) and area (A) are related by the equation L x A(k)=constant. The authors evaluated the k value at 66 positions of the central visual field in patients with glaucoma, to modify L and A simultaneously in order to examine advanced glaucomas with a bigger dynamic range. METHODS: The luminance limitation of a computer screen with automatic photometric control was compensated for by increasing the stimulus area in the range between 0 and 17 dB, using the k topographic values previously calculated on normal subjects. Four initial series of 21, 12, 10, and 10 glaucomas were sequentially examined with the Octopus 311 in which the stimulus size cannot be freely changed during the examination, and with the experimental method (Pulsar-SAP) modifying stimulus sizes to equal the results. k Final estimation was verified in 60 new cases. RESULTS: k values increase progressively with defect deepness. Values higher than those of the normal population with equivalent topographic differences were obtained. Correlation between indices was as follows: MD: r=0.94 (p<0.0001); square root of the loss of variance (sLV): r=0.93 (p<0.0001). Frequency of local defects was similar in both procedures. Average topographic differences between thresholds were usually less than 1 dB. The average threshold difference favored Pulsar-SAP by 0.45 dB at those points where the average threshold of both examinations was less than 18 dB and 0.37 dB where such average was higher than or equal to 18 dB. CONCLUSIONS: k value is higher in patients with glaucoma than in normal subjects, although the topographic features are similar. It is feasible to design a scale combining stimulus luminance and sizes to use screens with relative low brightness as surfaces for visual field examination.

[Diagnostic capability of PULSAR, FDT y HRT-II in glaucoma suspects]. / Capacidad diagnóstica del HRT-II y de las perimetrías TOP, PULSAR y FDT en pacientes sospechosos de sufrir glaucoma.

PURPOSE: To determine the diagnostic capability of PULSAR-T30W, FDT-Threshold-N30 and HRT-II in glaucoma suspects. METHODS: Forty-seven eyes from 47 referred glaucoma suspects (GS) were examined twice with each technique. Cases with TOP-WW-MD>6dB were excluded. Results were compared with those of 70 eyes from 70 normal controls (C). RESULTS: Mean MD value using TOP-WW in the GS group (0.96dB. sd=1.7) was not significantly different from C (0.8dB. sd=1.77) (p>0.05). Disc area in GS group (2.12 mm(2). sd=0.34) was significantly greater than in C (1.97 mm2. sd=0.45) (p<0.01). For 95.7% specificity, PULSAR-sLV showed the highest sensitivity of 30.9% in individual examinations. The highest reproducible sensitivity in the two examinations was obtained using HRT-II maximum contour elevation (23.4%) and reference height (23.4%), and was 14.9% for various indices after correcting for the influence of disc area (cup area, cup/disc area ratio, maximum contour depression and mean RNFL thickness). Reproducible sensitivity of the perimetric indices was: PULSAR-MD=8.5%, PULSAR-sLV=17%, FDT-MD=6.4%, FDT-PSD=4.3%. The association of perimetric and HRT-II indices achieved high sensitivity but low diagnostic reproducibility. CONCLUSIONS: The most effective indices were maximum contour elevation, reference height and PULSAR-sLV, although the inclusion of the optic nerve head assessment in the selection of the GS sample may have favored the HRT-II results.