The gut microbiome and primary open angle glaucoma: Evidence for a 'gut-glaucoma' axis?

Glaucoma presents an epidemiological burden as the leading cause of irreversible blindness globally and the most common cause of preventable blindness. While elevated intraocular pressure is the strongest modifiable risk factor, the exact mechanisms of retinal ganglion cell damage leading to progressive vision loss are not entirely understood. Studies of other neurodegenerative diseases show a potential for human gut microbiome dysbiosis to play a pathogenic role. An investigation into whether the microbiome, a potential modifiable risk factor, has significance in glaucoma enables exploration of prophylactic or additive treatments. Elevated population levels of specific bacterial species have been noted in glaucoma patients, particularly Prevotellaceae, Enterobacteriaceae and Escherichia coli, while Megomonas is speculated to be protective. Evidence also points to systemic neuro-inflammation and disruption of autoimmune processes as a result of imbalances in both human and animal models, where heat shock proteins may contribute to pathogenesis. Further research into the influence of gut microbiome on pathogenesis offers a chance to minimise irreversible vision loss in glaucoma.

Patient characteristics, treatment patterns, and adherence to lipid-lowering therapies following an acute coronary syndrome.

Despite dyslipidaemia management guidelines, many patients do not reach low-density lipoprotein cholesterol targets due to insufficiently intensive regimens or lack of adherence to their medication. This was a retrospective cohort study on the Pharmacoepidemiologic General Research eXtension (PGRx)-acute coronary syndrome (ACS) registry. Patients included were ≥ 18 years old who suffered an ACS between 2013 and 2016, and treated with lipid-lowering therapy (LLT) at hospital discharge or within 92 days. Patients were followed up to 12 months' post index ACS, a new cardiovascular event, loss to follow-up or death. Treatment intensity (high, moderate and low intensity statins ± ezetimibe) and adherence (proportion of days covered > 80%) are described. A total of 2,695 patients were included; mean age [SD] was 63.1 [12.8] years, and 77% were men. High, moderate and low intensity statins were started in 56% (1,520), 36% (971), and 3% (86) of patients, respectively. A further 2% (46) were on statin/ezetimibe combination, 2% (42) on other LLT and 1% (30) on ezetimibe alone. At follow-up, around 70% of patients were adherent to LLT, with those on moderate intensity treatments showing better adherence (76%) than those on low (63%) or high (67%) intensity treatments. Despite guideline recommendations, many patients following an ACS are not treated with high intensity statins, and adherence remains far from optimal. Effort should be made to increase the proportion of patients treated with high intensity statins following an ACS and to further improve treatment adherence.

Superimposed elastic stockings: pressure measurements.

BACKGROUND: High-compression stockings over 40 mmHg are often difficult or even impossible to apply. A specific technique is frequently used to overcome this problem: a high-compression stocking is replaced by two or even three lower compression stockings that are applied on top of each other, thereby reducing the effort of application. To our knowledge, however, no study concerning therapeutic stockings has demonstrated that the forces exerted by two or three superimposed stockings are additive. OBJECTIVE: The objective was to evaluate if the pressures exerted by two or three superimposed elastic stockings are additive. MATERIAL AND METHODS: A series of measurements was performed in vitro using an apparatus fitted with a pressure sensor on four different premade elastic stockings applied separately and then superimposed. The actual pressure measurement obtained with superimposed stockings was compared to arithmetic sum of the pressures produced by each of the stockings used. RESULTS: The pressures produced by superimposed stockings are adequately predicted from the pressure given by each of the stockings used in the superposition, with correlation coefficients higher than 0.9. CONCLUSION: Under our experimental conditions, the superimposed elastic stocking pressures additivity hypothesis is confirmed. In vivo studies should be conducted to confirm those results.