Low Expression of Vitamin D Receptor in Patients With Dry Eye Disease.

PURPOSE: This study aimed to compare the expression of vitamin D receptor (VDR) on the ocular surface of patients with dry eye disease (DED) and controls without ophthalmological pathologies. METHODS: Patients with DED without previous treatment were studied and compared with healthy subjects. Ocular Surface Disease Index assessement and ocular surface cytology were performed in all patients. The immunohistochemical expression of VDR was evaluated using fully automated immunohistochemistry. The evaluation involved multiplying the percentage of nuclear-labeled cells (0-100) by their intensity (0-3), resulting in a score ranging from 0 to 300 (VDR H-score). Squamous metaplasia was morphologically evaluated using liquid-phase cytology with Papanicolaou/periodic acid-Schiff staining using Nelson's grade (scale 0-3, higher grade to higher metaplastic change). RESULTS: Eighteen patients with DED without previous treatment and 10 healthy subjects were studied. Squamous metaplasia was observed in 74% of patients with DED, in contrast to 0% in the control group. In patients with DED, there was a lower expression of VDR than in the control group (VDR H-score: 11.2 ± 13.9 vs. 80.9 ± 56; P = 0.0001). Furthermore, an inverse correlation was observed between Nelson grade and VDR H-score (P = 0.0001, rs = -0.71). No correlation was observed between Ocular Surface Disease Index and VDR H-score. CONCLUSIONS: This is the first study to evaluate the VDR in patients with DED. These patients presented with a lower expression of VDR than healthy subjects. No correlation was found with more severe symptoms. Patients with DED also had a higher frequency of squamous metaplasia.

TFOS Lifestyle Report: Impact of environmental conditions on the ocular surface.

Environmental risk factors that have an impact on the ocular surface were reviewed and associations with age and sex, race/ethnicity, geographical area, seasonality, prevalence and possible interactions between risk factors are reviewed. Environmental factors can be (a) climate-related: temperature, humidity, wind speed, altitude, dew point, ultraviolet light, and allergen or (b) outdoor and indoor pollution: gases, particulate matter, and other sources of airborne pollutants. Temperature affects ocular surface homeostasis directly and indirectly, precipitating ocular surface diseases and/or symptoms, including trachoma. Humidity is negatively associated with dry eye disease. There is little data on wind speed and dewpoint. High altitude and ultraviolet light exposure are associated with pterygium, ocular surface degenerations and neoplastic disease. Pollution is associated with dry eye disease and conjunctivitis. Primary Sjögren syndrome is associated with exposure to chemical solvents. Living within a potential zone of active volcanic eruption is associated with eye irritation. Indoor pollution, "sick" building or house can also be associated with eye irritation. Most ocular surface conditions are multifactorial, and several environmental factors may contribute to specific diseases. A systematic review was conducted to answer the following research question: "What are the associations between outdoor environment pollution and signs or symptoms of dry eye disease in humans?" Dry eye disease is associated with air pollution (from NO2) and soil pollution (from chromium), but not from air pollution from CO or PM10. Future research should adequately account for confounders, follow up over time, and report results separately for ocular surface findings, including signs and symptoms.

Results of the COVID-19 mental health international for the health professionals (COMET-HP) study: depression, suicidal tendencies and conspiracism.

INTRODUCTION: The current study aimed to investigate the rates of anxiety, clinical depression, and suicidality and their changes in health professionals during the COVID-19 outbreak. MATERIALS AND METHODS: The data came from the larger COMET-G study. The study sample includes 12,792 health professionals from 40 countries (62.40% women aged 39.76 ± 11.70; 36.81% men aged 35.91 ± 11.00 and 0.78% non-binary gender aged 35.15 ± 13.03). Distress and clinical depression were identified with the use of a previously developed cut-off and algorithm, respectively. STATISTICAL ANALYSIS: Descriptive statistics were calculated. Chi-square tests, multiple forward stepwise linear regression analyses, and Factorial Analysis of Variance (ANOVA) tested relations among variables. RESULTS: Clinical depression was detected in 13.16% with male doctors and 'non-binary genders' having the lowest rates (7.89 and 5.88% respectively) and 'non-binary gender' nurses and administrative staff had the highest (37.50%); distress was present in 15.19%. A significant percentage reported a deterioration in mental state, family dynamics, and everyday lifestyle. Persons with a history of mental disorders had higher rates of current depression (24.64% vs. 9.62%; p < 0.0001). Suicidal tendencies were at least doubled in terms of RASS scores. Approximately one-third of participants were accepting (at least to a moderate degree) a non-bizarre conspiracy. The highest Relative Risk (RR) to develop clinical depression was associated with a history of Bipolar disorder (RR = 4.23). CONCLUSIONS: The current study reported findings in health care professionals similar in magnitude and quality to those reported earlier in the general population although rates of clinical depression, suicidal tendencies, and adherence to conspiracy theories were much lower. However, the general model of factors interplay seems to be the same and this could be of practical utility since many of these factors are modifiable.

Metodología para la evaluación automatizada de la expresión del receptor de vitamina D mediante técnica inmunocitoquímica / Methodology of automated Vitamin D receptor immunocytochemical expression análisis

Introducción: la citología permite examinar células de un tejido de manera mínimamente invasiva, sin embargo, la capacidad de realizar técnicas complementarias como la inmunocitoquímica (ICQ) no está exenta de dificultades. Es el objetivo de nuestro trabajo presentar una metodología que permita la utilización de ICQ automatizada asociada a un análisis automatizado mediante técnica de patología digital. Métodos: se incluyeron 5 sujetos sanos y se obtuvieron muestras de superficie ocular utilizando un citocepillo. La muestra fue procesada de manera automatizada mediante citología en fase líquida. Posteriormente se realizó ICQ automatizada para detectar la positividad nuclear del receptor de vitamina D. Para la evaluación, se utilizaron dos métodos: cuantificación directa bajo microscopio de luz y análisis automatizado usando analizador de imágenes en las diapositivas digitales obtenidas con un Scanner. El porcentaje de positividad encontrado con ambos métodos fueron comparados utilizando la prueba de Kappa. Resultados: todas las muestras presentaron una celularidad adecuada. En todos los casos fue posible realizar ICQ automatizada, más aún, todas las muestras presentaron una calidad óptima. Al comparar ambos métodos (manual versus automatizado) se observó un nivel de acuerdo sustancial (Kappa=0,69). Conclusiones: la metodología presentada en este manuscrito permite la evaluación automatizada de marcadores inmunohistoquímicos de la superficie ocular de manera mínimamente invasiva, siendo similar al conteo manual, pero más objetivo y reproducible. Esta técnica podría ser útil para el estudio proteómico en patologías como la enfermedad por ojo seco.

Introduction: Cytology tests use small amounts of tissue samples for diagnosis as a minimally invasive technique; however, the ability to perform complementary methods such as immunocytochemistry (ICC) is not without difficulties. The aim of our work is to present a method that allows the use of automated ICC associated with an automated image analysis using digital pathology. Methods: Five healthy subjects were included, and ocular surface samples were obtained using a cytobrush. The sample was processed as liquid-based cytology. Automated ICC was subsequently performed to detect vitamin D receptor nuclear positivity. Two methods were used for evaluation: manual counting under a light microscope and automated analysis using an image analyzer on digitized slides. The percentage of positivity found in both methods was compared using the Kappa test. Results: All samples presented adequate cellularity. In all cases, it was possible to perform automated ICC; moreover, all samples presented optimal quality. When comparing both methods (manual versus automated), a substantial level of agreement was seen (Kappa=0.69). Conclusions. The method presented in this manuscript allows the minimally invasive automated evaluation of ocular surface ICC markers, being like manual counting but more objective and reproducible. This technique could be useful for proteomic study in pathologies such as dry eye disease.

Evidence of autophagic vesicles in a patient with Lisch corneal dystrophy / Evidência de vesículas autofágicas em paciente com distrofia corneana de Lisch

ABSTRACT Lisch corneal dystrophy is a rare corneal disease characterized by the distinctive feature of highly vacuolated cells. Although this feature is important, the nature of these vacuoles within corneal cells remains unknown. Here, we sought to analyze corneal cells from a patient diagnosed with Lisch dystrophy to characterize the vacuoles within these cells. Analyses using histopathology examination, confocal microscopy, and transmission electron microscopy were all consistent with previous descriptions of Lisch cells. Importantly, the vacuoles within these cells appeared to be autophagosomes and autolysosomes, and could be stained with an anti-microtubule-associated protein 1A/1B-light chain 3 (LC3) antibody. Taken together, these findings indicate that the vacuoles we observed within superficial corneal cells of a patient with Lisch corneal dystrophy constituted autophagosomes and autolysosomes; this finding has not been previously reported and suggests a need for further analyses to define the role of autophagy in this ocular disease.

RESUMO A distrofia corneana de Lisch é uma doença rara, caracterizada principalmente pela presença de células altamente vacuoladas. Embora esta característica seja importante, a natureza desses vacúolos dentro das células da córnea permanece des conhecida. Aqui, procuramos analisar as células da córnea de um paciente diagnosticado com distrofia de Lisch para caracte rizar os vacúolos dentro dessas células. Análises utilizando exame histopatológico, microscopia confocal e microscopia eletrônica de transmissão foram todas consistentes com descrições previas de células de Lisch. Importante, os vacúolos dentro dessas células pareciam ser autofagossomos e autolisossomos, e po deriam ser corados com um anticorpo proteico 1A/1B-cadeia leve 3 (LC3) da proteína anti-microtúbulo associado a microtúbulos. Em conjunto, esses achados indicam que os vacúolos observados nas células superficiais da córnea de um paciente com distrofia corneana de Lisch constituíram autofagossomos e autolisossomos. Esse achado não foi relatado anteriormente e sugere a necessidade de mais análises para definir o papel da autofagia nessa doença ocular.

Evidence of autophagic vesicles in a patient with Lisch corneal dystrophy.

Lisch corneal dystrophy is a rare corneal disease characterized by the distinctive feature of highly vacuolated cells. Although this feature is important, the nature of these vacuoles within corneal cells remains unknown. Here, we sought to analyze corneal cells from a patient diagnosed with Lisch dystrophy to characterize the vacuoles within these cells. Analyses using histopathology examination, confocal microscopy, and transmission electron microscopy were all consistent with previous descriptions of Lisch cells. Importantly, the vacuoles within these cells appeared to be autophagosomes and autolysosomes, and could be stained with an anti-microtubule-associated protein 1A/1B-light chain 3 (LC3) antibody. Taken together, these findings indicate that the vacuoles we observed within superficial corneal cells of a patient with Lisch corneal dystrophy constituted autophagosomes and autolysosomes; this finding has not been previously reported and suggests a need for further analyses to define the role of autophagy in this ocular disease.

Evaluación histopatológica en las muestras de cirugía de pterigión ¿Es necesario? / Histopathological evaluation of pterygium surgical samples: is this important?

Introducción: la neoplasia escamosa de superficie ocular (NESO) puede llevar a problemas estéticos y funcionales oculares. El pterigión en cambio es una patología benigna que cuando tiene un manejo quirúrgico las muestras son desechadas sin análisis histopatológico. El objetivo es hacer una revisión acerca de la fisiopatología, factores de riesgo e incidencia de NESO en lesiones clínicamente diagnosticadas como pterigión. Métodos: artículo de revisión. Se revisó la base de datos electrónica pubmed utilizando palabras claves como pterygium AND OSSN. Se revisaron los artículos en inglés y español que tuvieran información pertinente para dar respuesta a nuestro objetivo. Resultados: ambas patologías comparten características clínicas que hacen difícil diferenciarlas sólo en base al examen físico, y eventualmente pueden coexistir. No existen en Chile estudios relacionados a la prevalencia ni menos a la coexistencia de ambas patologías. Se encontraron frecuencias de NESO en pterigión entre 0,65 y 9,8 por ciento dependiendo de la región geográfica. Conclusiones: es importante mantener un alto nivel de sospecha para diagnosticar una NESO en pterigión y es importante crear conciencia en los oftalmólogos que estas lesiones pueden coexistir. Se requieren estudios prospectivos para analizar la incidencia de las NESO en pterigión en las distintas latitudes de nuestro país.(AU)

Introduction: ocular surface squamous neoplasia (OSSN) can lead to aesthetic and functional ocular problems. Pterygium, on the other hand, is a benign pathology that, when it has a surgical management, the samples are discarded without histopathological analysis. The objective is to review the pathophysiology, risk factors and incidence of OSSN in clinically diagnosed lesions such as pterygium. Methods: review article. The pubmed electronic database was reviewed using keywords such as pterygium AND OSSN. We reviewed articles in English and Spanish that had relevant information to respond to our objective. Results: both pathologies share clinical characteristics that make it difficult to differentiate them only based on the physical examination, and eventually they can coexist. There are no studies in Chile related to prevalence or less to the coexistence of both pathologies. Frequencies of OSSN in pterygium were found between 0.65 and 9.8 percent depending on the geographical region. Conclusions: is important to maintain a high level of suspicion to diagnose OSSN in pterygium and it is important to create awareness in ophthalmologists that these lesions can coexist. Further prospective studies are necessary to analyze the incidence of OSSN in pterygium in the different latitudes of our country .(AU)

Clinical presentation and causes of recurrent corneal erosion syndrome: review of 100 patients.

PURPOSE: To study the clinical features and etiology of recurrent corneal erosion syndrome (RCES). METHODS: We examined a total of 100 patients (117 eyes) with the diagnosis of RCES who presented at our institution (Instituto Clinico Quirúrgico de Oftalmología, Bilbao, Spain). Studied data included demography, etiology, corneal location, and association with meibomian gland dysfunction (MGD). RESULTS: The mean age of patients was 44.5 (range, 14-80) years. Attributed causes of RCES were previous minor trauma (46 eyes, 39.3%), epithelial basement membrane corneal dystrophy (20 eyes, 17.1%), photorefractive keratectomy (20 eyes, 17.1%), laser-assisted in situ keratomileusis (9 eyes, 7.7%), and of unknown origin (22 eyes, 18.8%). The most frequent site of RCES was the inferior paracentral cornea (68.4%), followed by the upper cornea (21.3%) and widespread location (21.3%). An association with MGD was found in 59% of patients. CONCLUSIONS: RCES has various etiologies, which explains the variety in the clinical presentation of the disorder. Interestingly, a significant number of RCES patients begin to manifest the syndrome after keratorefractive surgery, and a high percentage of patients also present with MGD.

Treatment of a large corneal perforation with a multilayer of amniotic membrane and TachoSil.

OBJECTIVE: To describe a novel surgical technique for the sealing of large corneal perforations. METHOD: Case report of a perforated, 3-mm, postherpetic, corneal ulcer. A single layer of amniotic membrane was sewn to the internal surface of the cornea. An absorbable fibrin sealant patch (TachoSil) was placed in the area of the perforation, and a folded double layer of amniotic membrane was finally sewn to the external face of the cornea. RESULT: Surgery without complications, leading to restoration of the anterior chamber and good subjective tolerance. CONCLUSION: The reported technique seems to represent a good alternative emergency procedure for the management of corneal perforations larger than 2 mm.

Efficacy of plasma rich in growth factors for the treatment of dry eye.

PURPOSE: To evaluate the efficacy of plasma rich in growth factors (PRGF) for the treatment of moderate/severe dry eye. METHODS: PRGF treatment was administered to 16 patients who had moderate/severe dry eye diagnosed and who had not responded previously to other standard treatments. We quantified several growth factors present in the PRGF of each patient and obtained quantitative registers of the symptoms (modified score dry eye questionnaire), both before and after PRGF treatment. We also performed impression cytology to determine the degree of squamous metaplasia before and after PRGF treatment. RESULTS: PRGF treatment was associated with a statistically significant improvement in score dry eye questionnaire values (P < 0.001). Results from impression cytology corroborated this improvement, but the reduction in the degree of squamous metaplasia was not statistically significant. In 75% of patients treated with PRGF, no further treatments were required, whereas in the remaining 25% other ocular treatments could be reduced. CONCLUSIONS: PRGF led to symptom improvement in patients with moderate/severe dry eye. Surprisingly, the symptoms recorded in the dry eye questionnaire do not always agree with the degree of squamous metaplasia measured by impression cytology.

A multicenter study of bipolar disorder among emergency department patients in Latin-American countries.

OBJECTIVE: This multicenter study estimated the prevalence of bipolar disorder (BPD) among emergency department (ED) patients in Latin America. METHODS: To identify patients with BPD, a combination of DSM IV-criteria interview and the Mood Disorder Questionnaire (MDQ) was used. Data from 1,505 patients from hospitals in Argentina, Brazil, Chile, Colombia, and Mexico was analyzed. RESULTS: The prevalence ofBPD in this sample was 5.2% (95% CI = 4.5% to 6.9%). The mean age was 37 years (response rate of 83.0%). Compared to non-BPD patients, BPD patients were more likely to report asthma (16.7% vs. 9%), thyroid problems (12.8% vs. 5.8%), seizures (23.1% vs. 3.0%), obesity (39.7% vs. 26.9%), alcohol abuse (30.8% vs. 10.0%), attention deficit hyperactivity disorders (50.0% vs. 12.0%), depression (81.6% vs. 45.7%), obsessive compulsive disorder (20.1% vs. 3.0%), panic disorders (23.1% vs. 12.3%), phobic disorders (11.2% vs. 3.1%), and any anxiety disorder (82.1 % vs. 41.8%; all p < or = 0.05). Suicidal plans and attempts were also significant higher in the bipolar group (11.5% vs. 2.8% and 10.3% vs. 1.8% respectively). Multivariate analysis identified ADHD, depression, alcohol abuse, anxiety disorder, and last month suicide plans and attempts to be independently associated with BPD. CONCLUSION: Our study supports that BPD is prevalent in ED in Latin-American countries and that comorbidity is the rule, not the exception. Patients presenting at ED with irritability, anxiety, pressure speech, euphoria, with suicidal tendencies, involved in risky behaviors, alcohol abuse, dependence or those with history of mental health hospitalization in the past 12 months must be assessed for comorbid BPD.

A multicenter study of major depressive disorder among emergency department patients in Latin-American countries.

This multicenter study estimated the prevalence of major depressive disorder (MDD) among emergency department patients in Latin America. To identify patients with MDD, we used a combination of DSM IV- criteria interview and a questionnaire screen including the center for Epidemiological Studies Depression Scale. We analyzed data from consecutive adult patients from hospitals in Argentina, Brazil, Chile, Colombia, and Mexico and described the demographic and health status differences between MDD and non-MDD patients. Prevalence of MDD ranges from 23.0 to 35.0%. The estimates are based on a total of 1,835 patients aged 18 years and over, with response rates of 83.0%. Compared to non-MDD patients, MDD patients were more likely to be middle-aged, female, smokers, of lower socioeconomic status, and to report a diagnosis of asthma or arthritis/rheumatism. Multivariate analysis identified a lower level of education, smoking, and self-reported anxiety, chronic fatigue, and back problems to be independently associated with MDD. Our data suggest that the prevalence of MDD is elevated among emergency department patients in Latin American countries. The integration of depression screening into routine emergency care merits serious consideration, especially if such screening can be linked to psychiatric treatment.

Aspirina en retinopatía diabética / Aspirin in diabetic retinopathy

La retinopatía diabética es un causa importante de discapacidad por ceguera en el mundo occidental. Se han explorado múltiples intervenciones farmacológicas destinadas a su tratamiento. En ese sentido destacan dos estudios multicéntricos (ETDRS y DAMAD), en los cuales se comparó el efecto de la aspirina contrastada con placebo, no encontrando diferencias de significado clínico entre ambos grupos, en términos de la progresión de la enfermedad, ni tampoco un aumento en la morbilidad, específicamente de la complicaciones hemorrágicas a nivel ocular. Posteriormente, de observaciones realizadas tanto en seres humanos, pero principalmente en animales, se ha postulado el rol de un fenómeno inflamatorio en la génesis de los cambios fisiopatológicos observados en la retinopatía diabética con un efecto beneficioso de la aspirina cuando ésta es administrada en un rango de dosis en las que este fármaco presenta un efecto antiinflamatorio. Estas observaciones realizadas en modelos experimentales resultan promisorias y han de ser corroboradas idealmente en ensayos clínicos randomizados para su aplicación en clínica. Dado el estado actual del conocimiento, resulta indicado el uso de aspirina en profilaxis de eventos cardiovasculares en pacientes de riesgo con retinopatía diabética, ya que no existe evidencia de un riesgo incrementado de eventos hemorrágicos a nivel ocular en este grupo de pacientes.

Interconsultas de pediatría a psiquiatría infantil / Pediatric referral to child psychiatry

Este trabalho informa sobre la demanda por interconsulta al Servicio de Psiquiatria Infantil del Hospital Luis Calvo Mackenna. Este estudio forma parte de una evaluación más amplia de salud mental infantil en el SSMO, con el objeto de detectar necesidades de capacitación. Se muestra que los problemas psiquiátricos infantiles constituyen una demanda importante y difícil de atender en el nivel secundario. Los diagnósticos principales son los trastornos emocionales, síndrome hiperquinético/déficit atencional y trastornos de la conducta. La demanda satisfecha es cercana e un 40%, y la concordancia diagnóstica entre el médico de atención primaria y el especialista es alta (73,4%). Se efectúan algunas consideraciones acerca de las líneas de trabajo a futuro: perfeccionamiento y ampliación de normas, organización del servicio especializado y programa de capacitación primario