Treatment, outcomes and costs of asthma exacerbations in Chilean children: a prospective multicenter observational study.

OBJECTIVE: To describe potential regional variations in therapies for severe asthma exacerbations in Chilean children and estimate the associated health expenditures. METHODS: Observational prospective cohort study in 14 hospitals over a one-year period. Children five years of age or older were eligible for inclusion. Days with oxygen supply and pharmacological treatments received were recorded from the clinical chart. A basic asthma hospitalization basket was defined in order to estimate the average hospitalization cost for a single patient. Six months after discharge, new visits to the Emergency Room (ER), use of systemic corticosteroids and adherence to the controller treatment were evaluated. RESULTS: 396 patients were enrolled. Patients from the public health system and from the north zone received significantly more days of oxygen, systemic corticosteroids and antibiotics. Great heterogeneity in antibiotic use among the participating hospitals was found, from 0 to 92.3% (ICC 0.34, 95% CI 0.16-0.52). The use of aminophylline, magnesium sulfate and ketamine varied from 0 to 36.4% between the different Pediatric Intensive Care Units (ICC 0.353, 95% CI 0.010-0.608). The average cost per inpatient was of $1910 USD. 290 patients (73.2%) completed the follow-up six months after discharge. 76 patients (26.2%) were not receiving any controller treatment and nearly a fourth had new ER visits and use of systemic corticosteroids due to new asthma exacerbations. CONCLUSIONS: Considerable practice variation in asthma exacerbations treatment was found among the participating hospitals, highlighting the poor outcome of many patients after hospital discharge, with an important health cost.

Multi-Sensor Spectral Imaging of Geological Samples: A Data Fusion Approach Using Spatio-Spectral Feature Extraction.

Rapid, efficient and reproducible drillcore logging is fundamental in mineral exploration. Drillcore mapping has evolved rapidly in the recent decade, especially with the advances in hyperspectral spectral imaging. A wide range of imaging sensors is now available, providing rapidly increasing spectral as well as spatial resolution and coverage. However, the fusion of data acquired with multiple sensors is challenging and usually not conducted operationally. We propose an innovative solution based on the recent developments made in machine learning to integrate such multi-sensor datasets. Image feature extraction using orthogonal total variation component analysis enables a strong reduction in dimensionality and memory size of each input dataset, while maintaining the majority of its spatial and spectral information. This is in particular advantageous for sensors with very high spatial and/or spectral resolution, which are otherwise difficult to jointly process due to their large data memory requirements during classification. The extracted features are not only bound to absorption features but recognize specific and relevant spatial or spectral patterns. We exemplify the workflow with data acquired with five commercially available hyperspectral sensors and a pair of RGB cameras. The robust and efficient spectral-spatial procedure is evaluated on a representative set of geological samples. We validate the process with independent and detailed mineralogical and spectral data. The suggested workflow provides a versatile solution for the integration of multi-source hyperspectral data in a diversity of geological applications. In this study, we show a straight-forward integration of visible/near-infrared (VNIR), short-wave infrared (SWIR) and long-wave infrared (LWIR) data for sensors with highly different spatial and spectral resolution that greatly improves drillcore mapping.

Hospitalizations for asthma exacerbation in Chilean children: A multicenter observational study.

BACKGROUND: Asthma hospitalization rates in Chilean children have increased in the last 14 years, but little is known about the factors associated with this. OBJECTIVE: Describe clinical characteristics of children hospitalized for asthma exacerbation. METHODS: Observational prospective cohort study in 14 hospitals. Over a one-year period, children five years of age or older hospitalized with asthma exacerbation were eligible for inclusion. Parents completed an online questionnaire with questions on demographic information, about asthma, indoor environmental contaminant exposure, comorbidities and beliefs about disease and treatment. Disease control was assessed by the Asthma Control Test. Inhalation technique was observed using a checklist. RESULTS: 396 patients were enrolled. 168 children did not have an established diagnosis of asthma. Only 188 used at least one controller treatment at the time of hospitalization. 208 parents said they believed their child had asthma only when they had an exacerbation and 97 correctly identified inhaled corticosteroids as anti-inflammatory treatment. 342 patients used the wrong spacer and 73 correctly performed all steps of the checklist. CONCLUSIONS: Almost half of the patients were not diagnosed with asthma at the time of hospitalization despite having a medical history suggestive of the disease. In the remaining patients with an established diagnosis of asthma potentially modifiable factors like bad adherence to treatment and poor inhalation technique were found. Implementing a nationwide asthma program including continued medical education for the correct diagnosis and follow up of these patients and asthma education for patients and caregivers is needed to reduce asthma hospitalization rates in Chilean children.

Obesity during pregnancy affects sex steroid concentrations depending on fetal gender.

BACKGROUND/OBJECTIVE: It is not clear whether maternal obesity along with fetal gender affect sex steroid metabolism during pregnancy. Therefore, we compared sex steroid concentrations and placental expression of steroidogenic enzymes between non-obese and obese pregnant women with non-pathological pregnancies, and investigated the influence of fetal gender on these parameters. METHODS: In 35 normal weight (body mass index (BMI) 20-24.9 kg m-2) (controls) and 36 obese women (BMI 30-36 kg m-2) (obese), a fasting blood sample was obtained at first and at third trimester of gestation to measure progesterone, dehydroepiandrosterone (DHEA), DHEA sulfate, androstenedione, testosterone and estradiol by liquid chromatography-tandem mass spectrometry and estrone by radioimmunoassay. In a subset of women, placental mRNA and protein expression of steroidogenic enzymes was measured by quantitative PCR and western blot, respectively. The comparisons were primarily made between controls and obese, and then separately according to fetal gender. RESULTS: At first and third trimesters of gestation serum progesterone was lower whereas testosterone was higher in obese women (P<0.05, respectively). Upon analyzing according to fetal gender, lower progesterone levels were present in obese pregnant women with male fetuses at first trimester and with female fetuses at third trimester (P<0.05, respectively). Testosterone was higher in obese women with male fetuses compared to control women with male fetuses (P<0.05). The placental protein expression of P450scc was higher in obese women compared to controls (P<0.05). P450 aromatase was higher in obese women with female fetuses (P=0.009), whereas in obese women with male fetuses P450 aromatase was lower compared to control women (P=0.026). CONCLUSIONS: Obesity in non-pathological pregnancies alters the maternal serum progesterone and testosterone concentrations depending on fetal gender. These changes can be attributed to gender-related placental adaptations, as the expression of P450 aromatase is different in placentas from females compared to males.

Apoptosis inhibition of Atlantic salmon (Salmo salar) peritoneal macrophages by Piscirickettsia salmonis.

To improve the understanding of the piscirickettsiosis pathogenesis, the in vivo apoptosis modulation of peritoneal macrophages and lymphocytes was studied in juvenile Salmo salar intraperitoneally injected with Piscirickettsia salmonis. Five fish were sampled at post-exposure days 1, 5, 8 (preclinical), 20 (clinical) and 40 (post-clinical period of the disease), and the leucocytes of their coelomic washings were analysed by flow cytometry (using the JC-1 cationic dye), TUNEL and cytology to detect apoptotic cells. A selective and temporal pattern of apoptosis modulation by P. salmonis infection was observed. Apoptosis in lymphocytes was not affected, whereas it was inhibited in macrophages but only during the preclinical stage of the induced piscirickettsiosis. Hence, it is postulated that P. salmonis inhibits macrophage apoptosis at the beginning of the disease development to survive, multiply and probably be transported inside these phagocytes; once this process is complete, macrophage apoptosis is no longer inhibited, thus facilitating the exit of the bacteria from the infected cells for continuing their life cycle.

Mucosal immunization of BALB/c mice with DNA vaccines encoding the SEN1002 and SEN1395 open reading frames of Salmonella enterica serovar Enteritidis induces protective immunity.

Salmonella Enteritidis is the main cause of foodborne salmonellosis worldwide. The limited effectiveness of current interventions against this pathogen has been the main incentive to develop new methods for the efficient control of this infection. To investigate the use of DNA vaccines against S. Enteritidis in humans, immune responses stimulated by two plasmids containing the genes designated SEN1002, located in the pathogenicity island SPI-19 and encoding a Hcp protein involved in transport mechanisms, and SEN1395, located in the genomic island ΦSE14 and encoding a protein of a new superfamily of lysozymes, were evaluated. Humoral and cellular responses following intranasal immunization of two groups of BALB/c mice with the plasmids pV1002 and pV1395 plus adjuvant were evaluated and it was observed that the IgG2a/IgG1 ratios were sixfold higher than control groups. Both plasmids stimulated specific secretory IgA production. Increased proliferation of lymphocytes and IFN-γ production were detected in both experimental groups. DNA-vaccinated mice developed protective immunity against a virulent strain of S. Enteritidis, with nearly 2 logs of protection level compared to the negative control values in the spleen. Therefore, DNA vaccines are efficient at stimulating cellular and humoral immune responses at systemic and mucosal levels.

Socioeconomic status and organ damage in Mexican systemic lupus erythematosus women.

The objective of this cross-sectional study was to determine relationships between socioeconomic status and organ damage in Mexican systemic lupus erythematosus (SLE) patients. Demographic and clinical variables were assessed. Socioeconomic status was evaluated using the Graffar method and monthly household income. Lupus activity and organ damage were measured using the SLE disease activity scale, validated for the Mexican population (Mex-SLEDAI), and the Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) scale. The 143 Mexican female SLE patients included (mean age 40.1 ± 8.9 years, mean disease duration 8.9 ± 6.3 years) had a mean monthly household income of $ 407.2 ± 326.5. According to the Graffar index, 18.9%, 52.5%, and 28.7% had high/medium-high, medium, and medium-low/low socioeconomic status, respectively. Organ damage was observed in 61 patients (42.7%). Patients with organ damage had lower monthly household incomes ($241.4 ± 152.4 vs. $354.8 ± 288.3) and were more frequently unemployed (57.3% vs. 35.3%; p = 0.01) than those without. Low monthly income was not associated with lupus activity or self-reported health status. In the adjusted multivariate analysis, low monthly income ( < $300) was associated with organ damage. In conclusion, low income may be associated with organ damage in Mexican SLE patients.

Effect of iron deficiency on the expression of insulin-like growth factor-II and its receptor in neuronal and glial cells.

INTRODUCTION: Many studies have demonstrated that iron deficiency modifies the normal function of the central nervous system and alters cognitive abilities. When cellular damage occurs in the central nervous system, neuroprotective mechanisms, such as the production of neurotrophic factors, are essential in order for nervous tissue to function correctly. Insulin-like growth factor II (IGF- II) is a neurotrophic factor that was recently shown to be involved in the normal functioning of cognitive processes in animal models. However, the impact of iron deficiency on the expression and function of this molecule has not yet been clarified. METHODS: Mixed primary cell cultures from the central nervous system were collected to simulate iron deficiency using deferoxamine. The expression of IGF-I, IGF-II, IGF-IR, and IGF-IIR was determined with the western blot test. RESULTS: We observed increased expression of IGF-II, along with a corresponding decrease in the expression of IGF-IIR, in iron-deficient mixed primary cell cultures. We did not observe alterations in the expression of these proteins in isolated microglia or neuronal cultures under the same conditions. We did not detect differences in the expression of IGF-I and IGF-IR in iron-deficient cultures. CONCLUSIONS: In vitro iron deficiency increases the expression of IGF-II in mixed glial cell cultures, which may have a beneficial effect on brain tissue homeostasis in a situation in which iron availability is decreased.

Perception of patients with retinal pathology on aspects of visual function and their management.

BACKGROUND AND OBJECTIVE: Age-related macular degeneration (AMD) and diabetic retinopathy (DR) are highly prevalent. OBJECTIVE: To explore perceptions of patients with AMD or DR about the impact of the disease and treatment on their daily living activities. MATERIALS AND METHODS: Semi-structured interviews with a questionnaire developed from validated patient reported outcomes questionnaires. The questionnaire consisted of 19 questions about the disease and 9 about the treatment. The questions (items) were answered on a scale from 1 to 9. In addition, the patient interviewed was invited to make free comments on each question. Nine patients with AMD and 9 with DR were interviewed by videoconference or telephone call. A quantitative analysis of the responses and a qualitative analysis of the comments were carried out. RESULTS: The most relevant item for patients with AMD or DR is "Recognize people when they are nearby", and "Read text in normal size font in a newspaper or book", followed, in patients with AMD, by "Do things what you would like" and, in patients with DR, "Feeling frustrated by the vision problems." Regarding the treatment, the most relevant aspects for both groups is that the treatment works and receiving appropriate information before and after the treatment. The qualitative comments were focused to the disease, the treatment, and to the role of doctors and the health system. CONCLUSION: Quantitative responses and free comments can be useful to improve the care of patients with AMD or DR by physicians and the health system.

Analysis of the Population Dynamics of Whitefly (Bemisia tabaci [Hemiptera: Aleyrodidae]) Under Greenhouse Conditions.

Whiteflies (Bemisia tabaci) represent an insect pest in horticulture. It serves as a vector for transmitting phytopathogens that inhibit the correct development of plants, affecting crop performance. In this research, whitefly population model was proposed to provide a tool that predicts the pest spread within a crop under greenhouse conditions. The analysis, calibration, and validation of the models, based on logistic functions, were implemented for the three stages (egg, nymph, and adult) of the life cycle of this organism. Temperature (°C), relative humidity (%), initial population (number/cm2), and Growing Degree-Day (GDD) were considered as input variables to describe each development stage. The statistical analysis for the model validation included the coefficient of determination (R2), the percentage standard error of prediction (%SEP), the average relative variance (AVR), and the efficiency coefficient (E). The first period for calibration consisted of 43 d (204.3 GDD), and the second period for validation consisted of 36 d (171.1 GDD). The model efficiently predicts the population growth for the egg, nymph, and adult stages since the values of R2 were 0.9856, 0.9918, and 0.9436, and the values of %SEP were 12.4, 11.9, and 75.1% for the egg, nymph, and adult stages, respectively. Moreover, the validation model obtained an R2 of 0.9287 for the egg stage, 0.9645 for the nymph stage, and 0.9884 for the adult stage. Meanwhile, the values of %SEP were 10.38, 16.89, and 32.59% for the egg, nymph, and adult stages, respectively. In both cases, the values suggest an adequate fit for the model.

The BDNF rs7934165 polymorphism is a biomarker of central obesity and cardiometabolic risk in Mexican women.

OBJECTIVE: Brain-derived neurotrophic factor (BDNF) is a cornerstone in the hypothalamic regulation of food intake and energy homeostasis. Polymorphisms in the BDNF gene may thus contribute to obesity traits. The aim of this investigation was to analyze the association of rs6265 and rs7934165 BDNF polymorphisms in women from Northeast Mexico classified as obese or overweight using their BMI and waist-to-height ratio (WHtR). PATIENTS AND METHODS: A total of 296 women were enrolled and further divided into normal weight and obese overweight groups according to their BMI status and WHtR classifications, which were low and high at < 0.50 and ≥ 0.50, respectively. Genotyping of BDNF rs6265 and rs7934165 polymorphisms was performed using a TaqMan assay. Distinct anthropometric, biochemical, clinical, and dietary parameters were obtained and used as covariates in the statistical analyses. RESULTS: The rs6265-G allele and its homozygote state (GG) were the most prominent without statistically significant differences between groups (p = 0.412). The study of rs7934165 with BMI showed marginal associations. Moreover, the rs7934165-AA genotype was more frequent among individuals with a high WHtR than those with a low WHtR (43.4 vs. 25.2%, p = 0.01). This association was maintained after adjustments for age and caloric intake through logistic regression analysis (OR = 2.20, 95% CI = 1.15-4.18, p = 0.016). CONCLUSIONS: The present study indicates that the BDNF-rs7934165-AA genotype is associated with a higher WHtR which is related to central obesity and its comorbidities. This suggests that this SNP could act as a potential biomarker for central obesity and cardiometabolic risk.

Ocular Emergencies in Children: Demographics, Origin, Symptoms, and Most Frequent Diagnoses.

PURPOSE: To describe the epidemiology of ocular emergencies in children in a hospital-based emergency room (ER). METHODS: The medical reports of all children, 14 years of age and younger, who attended La Paz University Hospital (Madrid, Spain) ER from September 2015 to August 2016 were prospectively collected. Demographic data, origin, symptom for consultation, diagnostic tests, final diagnosis, and final referral of patients were recorded. RESULTS: A total of 774 children were attended: 57% boys and 43% girls. Mean age was 5 years (SD 4.10 years, range 0-14 years) without significant differences between sexes. Most children went to the ER because parents or teachers took the decision (75%), 24% were referred from the paediatric ER for evaluation, and 0.78% were referred from another hospital or by an out-clinic ophthalmologist. The reasons for consultation were red eyes (61%), traumatism (17%), referred from the paediatrician to have the fundus explored in children with headache (7%), eyelids problems (7%), and visual loss (7%). The most frequent diagnoses were infectious conjunctivitis (29%), corneal erosion (17%), normal examination (15%), and allergic conjunctivitis (13%). The most severe cases (visual loss, acute strabismus, and leucocoria) were referred by the paediatricians and represented 4.65% of the total patients. Visits occurred more frequently during the third trimester of the year (July-September), with a higher incidence of eye trauma in summer. CONCLUSIONS: Infectious conjunctivitis was the most frequent pathology. It is necessary to increase public awareness about the symptoms, the way of transmission, and treatment. Ocular trauma was also a common cause of presentation and the majority were contusional and mild. There is also a need for education of parents, teachers, and coaches regarding the potential for eye injuries. Ophthalmologists and paediatricians must take an active role in educating people about the prophylactic measures to prevent eye injuries in children.

Macular ganglion cell complex thinning in children with visual field defects due to central nervous system pathology.

PURPOSE: To study the relationship between macular ganglion cell complex (GCC) thickness and visual field defects (VFD) caused by central nervous system (CNS) lesions in children and evaluate the possibility of predicting VFD according to GCC maps. METHODS: The GCC maps of a group of children with VFD due to CNS lesions with respect of the vertical meridian in at least one eye (study group), as well as of children with other neuro-ophthalmological problems and healthy children were presented to two masked evaluators, who were asked to predict the patients' VFD on the basis of GCC damage: the evaluators classified VFD as normal, hemianopia (homonymous or heteronymous) or diffuse. RESULTS: Seventeen patients were included in the study group, with a median age of 12 years. Fifteen had brain tumours and two epilepsy. The mean MD of the affected hemifields was -26.00 dB (SD 7.89 dB) versus -5.51 dB (SD 3.52 dB) for the nonaffected hemifields, p < 0.001. The mean GCC thickness was of 56.04 µm (SD 11.95 µm) in the affected hemiretinas versus 74.31 µm (SD 10.64 µm) for the non-affected, p < 0.001. Kappa coefficients between VFD and those estimated by the evaluators were 0.705 and 0.658 (p < 0.001) for evaluators 1 and 2. CONCLUSIONS: GCC thickness can reflect damage to the visual pathway and GCC maps may be useful to identify chiasmal and retrochiasmal lesions, since GCC atrophy in most of these cases respects the vertical meridian. GCC maps might be used as a surrogate marker for visual damage in patients unable to perform perimetry.

[Use of optical coherence tomography to measure prevalence of epiretinal membranes in patients referred for cataract surgery]. / Prevalencia de membranas epirretinianas mediante tomografía de coherencia óptica en pacientes remitidos para cirugía de cataratas.

PURPOSE: To evaluate, using optical coherence tomography (OCT), the prevalence of epiretinal membranes (ERM) in patients referred for phacoemulsification, and the frequency of new ERM development in the first six months after surgery. METHODS: Patients referred by general ophthalmologists for cataract surgery underwent a new, complete ophthalmological evaluation. OCT scanning was performed using the Macular Thickness Map acquisition protocol (StratusOCT, Carl Zeiss Meditec). This baseline examination was used to determine the prevalence of ERM in patients referred for cataract surgery. All patients underwent uneventful phacoemulsification. If an ERM was already present in one eye, the other eye was chosen for cataract surgery. If no ERM was present, the eye with the poorest visual acuity was operated. Operated eyes were followed-up for six months in order to study the influence of phacoemulsification on the development of ERM. RESULTS: Forty-five patients were prospectively evaluated. In the baseline visit, ERM were detected by OCT in 7 patients (15.6%). Both eyes were affected in one patient, with the ERM being apparent on funduscopy only in her left eye. Fundus examination was unremarkable in all other cases. After six months follow-up, no new cases of epiretinal membranes were detected in the eyes that had undergone phacoemulsification, neither by fundus evaluation nor by OCT. CONCLUSIONS: Epiretinal membranes, previously thought to be secondary to cataract surgery, may be present before phacoemulsification and can be diagnosed by OCT.

[Evaluation of trypan-blue toxicity in macular hole surgery with electroretinography]. / Evaluación mediante electrorretinografía de la toxicidad del azul tripán en la cirugía del agujero macular.

PURPOSE: Concern has been raised about the retinal toxicity of vital dyes. We designed a prospective study to determine the possible toxicity of trypan-blue (TB) in macular hole surgery with TB-assisted internal limiting membrane (ILM) peeling through the performance of electroretinograms (ERGs). METHODS: Patients diagnosed with a macular hole underwent ophthalmological evaluation prior to surgery and at 6 months follow-up. All patients underwent vitrectomy and ILM-staining under air. All phakic patients underwent phacoemulsification and IOL implantation simultaneously. There were two study groups: In group 1, ILM-staining was performed with 0.06% TB, while in group 2 the procedure was performed with 0.15% TB. Preoperative ERG recordings were measured in the week prior to surgery. Postoperative ERGs were measured 3 to 6 months after surgery. The ERG data between eyes with macular hole and fellow eyes were compared in the pre- and post-operative stages. Visual acuity (VA) changes in both groups were evaluated. RESULTS: Nine patients were recruited in each group. VA improved significantly in both groups, with more than 65% of patients improving more than 2 lines. There were no statistical differences in VA gain between groups or in ERG values between affected and fellow eyes. CONCLUSION: No significant retinal toxicity of TB staining could be clinically detected.

[Surgical treatment of Duane's syndrome type I by recession of the medial rectus of the affected eye and faden operation of the contralateral medial rectus]. / Tratamiento quirúrgico del síndrome de Duane, tipo I mediante retroinserción del recto medial del lado afecto y faden del recto medial contralateral.

PURPOSE: Different surgical approaches have been described for the treatment of Duane's syndrome. The purpose of our study is to report the results of patients undergoing recession of the medial rectus (MR) muscle of the affected eye and placement of contralateral MR faden posterior fixation sutures. METHODS: Retrospective study of 11 patients treated by a 4-7 mm recession of the MR of the affected eye and 13 mm faden posterior fixation suture of the contralateral MR in order to correct abnormal head position and esotropia in primary position. RESULTS: After surgery, there was no torticolis in 81.8% of patients, with less than 10 degrees of torticolis in the remainder. In all patients, postoperative esotropia was less than 5 prismatic dioptres. CONCLUSION: This is a safe and effective procedure in Duane's syndrome type I to treat moderate esotropia and torticolis.

Phaco-non-penetrating deep sclerectomy in ocular hypertension secondary to dexamethasone intravitreal implant. / Faco-esclerectomía profunda no perforante como tratamiento de la hipertensión ocular secundaria al implante intravítreo de dexametasona.

PURPOSE: To evaluate the characteristics and progression of patients treated with a 0.7mg dexamethasone intravitreal implant (Ozurdex®) and required glaucoma filtering surgery (phaco-non-penetrating deep sclerectomy) to control ocular hypertension (OHT). METHODS: A retrospective observational study including patients treated with Ozurdex® in a tertiary-care university hospital from May 2011 to April 2016. RESULTS: In five years of follow-up, 1.10% (4/363) of patients treated with 0.7mg dexamethasone intravitreal implant required phaco-non-penetrating deep sclerectomy (PNPDS) to control OHT refractory to topical treatment. All four patients started or increased previous antihypertensive topical treatment since the first dexamethasone intravitreal implant. Three or more dexamethasone intravitreal implants were injected in the four cases before intraocular pressure (IOP) became uncontrolled and PNPDS was performed. All four patients have a successfully controlled IOP without treatment after PNPDS. Two patients required additional treatment with dexamethasone intravitreal implants after PNPDS, maintaining IOP under control without treatment. CONCLUSIONS: To the best of our knowledge, this is the first study describing the successful results of PNPDS in OHT secondary to dexamethasone intravitreal implant. All four patients have achieved controlled IOP without treatment. Re-treatment with dexamethasone intravitreal implant in those patients who underwent PNPDS is also possible, and IOP remains controlled.

[Apical orbital inflammation in giant cell arteritis]. / Inflamación orbitaria apical en arteritis de la temporal.

CASE REPORT: Our purpose is to describe a case of an acute optic neuropathy with apical muscle thickening in a patient already diagnosed with giant cell arteritis. Loss of visual acuity and perimetric concentric constriction responded rapidly to intravenous glucocorticoid therapy. There has been no relapse during continued long-term therapy with cyclophosphamide. DISCUSSION: Giant cell arteritis is a systemic, idiopathic vasculitis; among its less frequent complications is orbital pseudotumor. Our patient required urgent treatment to avoid visual acuity loss due to compressive neuropathy and perineuritis.

[Rebound tonometry in a clinical setting. Comparison with applanation tonometry]. / Tonometría de rebote en la práctica clínica. Comparación con tonometría de aplanación.

PURPOSE: Rebound tonometry has recently been modified for its use in humans. The purpose of our study was to determine the precision of the ICare(R) rebound tonometer (RBT) as compared with the Goldmann applanation tonometer (GAT). METHODS: Patients were recruited from our Hospital's Glaucoma Unit. In each patient, intraocular pressure (IOP) was measured without anaesthesia using the RBT and ten minutes later using the GAT. Central corneal thickness (CCT) was measured by pachymetry. RESULTS: Sixty-eight patients were recruited (132 eyes). Mean IOP readings with RBT were 18.9 +/- 7.2 (SD) mmHg and were 15.5 +/- 5.7 mmHg with GAT (p<0.001). There was a good correlation between both instruments (r = 0.87, p<0.001). In most cases (84.6%) the IOP measured with the RBT was greater than that measured with the GAT. The mean difference between both instruments was 3.4 +/- 3.6 mmHg. There was a trend towards greater differences between those obtained using the RBT than the GAT when IOP values were higher. A statistically significant correlation was found between IOP readings with both tonometers and CCT, with higher differences being seen as the CCT increased. CONCLUSION: The RBT can be employed in a clinical setting taking into account that it usually overestimates IOP as compared with the GAT. It could be especially useful in glaucoma screening campaigns since it can be operated by a trained technician.

[Plasma concentrations of beta-endorphins in the children of alcoholic patients]. / Niveles de beta-endorfinas en hijos de padres alcohólicos.

BACKGROUND: Of the factors identified in different studies as the possible causes of alcoholism, heredity appears to be the most important. However, environmental factors can increase or decrease the risk of an individual developing alcohol dependence. METHOD: To clarify the possible influence of heredity on alcoholism, we studied the plasma concentration of beta-endorphins in 25 families with alcoholic members: 27 children whose father was alcoholic and 7 whose father and mother were both alcoholics. The results were compared with finding in an age-matched control group of no-drinking adults and normal children in non-drinking families. RESULTS: The children of alcoholic parents had significantly lower beta-endorphin levels (p < 0.001) than control individuals, and concentrations were especially low when both parents were alcoholics. CONCLUSION: We conclude that plasma beta-endorphin concentration may have predictive value in identifying persons likely to become alcoholics.