Mid-term results of patterned laser trabeculoplasty for uncontrolled ocular hypertension and primary open angle glaucoma.

AIM: To describe the safety and efficacy of patterned laser trabeculoplasty (PLT) as an adjunctive treatment in primary open angle glaucoma (POAG) and ocular hypertension (OHT) after 18-month follow-up in Hispanic population. METHODS: A single-center, retrospective study was conducted. All patients with OHT or POAG undergoing PLT from June 2016 to August 2016 were included in the study. Investigated parameters were intraocular pressure (IOP), the number of IOP-lowering medications, best corrected visual acuity (BCVA), laser parameters and postoperative adverse events. Primary efficacy outcome measures were the proportion of eyes achieving an IOP reduction ≥20% at 18mo versus baseline medicated IOP or a reduction in the number of medications while maintaining IOP values. RESULTS: From 40 PLT-treated eyes (mean baseline IOP 20.3±1.7 mm Hg), 24 patients were analyzed (age 63.4±7.3y). The mean IOP reductions from baseline across visits (months 1, 3, 6, 9, 12, and 18) ranged from 14.1% to 20.8%. Success rate after 18-month follow-up was 61.7% with a mean IOP of 16±3.2 mm Hg (P<0.001). The number of glaucoma IOP-lowering medications per eye (preoperative 2.1±1.1 and postoperative 2.3±1.1, P=0.86) and the mean BCVA (preoperative 0.10±0.22 and postoperative 0.11±0.22 logMAR, P=0.42) remained stable. Adverse events comprised transitory IOP spikes in 4 eyes (10%) and peripheral anterior synechiae in 7 eyes (17.5%). CONCLUSION: Mid-term results of PLT show that this procedure may be an efficacious and safe technique to approach medically uncontrolled OHT or POAG patients.

Is myopia another clinical manifestation of insulin resistance?

Myopia is a multifactorial visual refraction disease, in which the light rays from distant objects are focused in front of retina, causing blurry vision. Myopic eyes are characterized by an increased corneal curvature and/or ocular axial length. The prevalence of myopia has increased in recent decades, a trend that cannot be attributed exclusively to genetic factors. Low and middle income countries have a higher burden of refractive error, which we propose could be a consequence of a shorter exposure time to a westernized lifestyle, a phenomenon that may also explain the rapid increase in cardiometabolic diseases, such as diabetes, among those populations. We suggest that interactions between genetic, epigenetic and a rapidly changing environment are also involved in myopia onset and progression. Furthermore, we discuss several possible mechanisms by which insulin resistance may promote abnormal ocular growth and myopia to support the hypothesis that insulin resistance and hyperinsulinemia are involved in its pathogenesis, providing a link between trends in myopia and those of cardiometabolic diseases. There is evidence that insulin have direct ocular growth promoting effects as well an indirect effect via the induction of insulin-like growth factors leading to decreases insulin-like growth factor-binding protein, also implicated in ocular growth.

Preeclampsia como factor de riesgo independiente para el trastorno por déficit de atención con hiperactividad. estudio de casos y controles. Bucaramanga, Colombia / A pré-eclâmpsia como um factor de risco independente para o transtorno do déficit de atenção com hiperatividade. estudo caso-control. Bucaramanga, Colômbia / Preeclampsia as an independent risk factor for attention deficit hyperactivity disorder. case control study. Bucaramanga, Colombia

Introducción: El trastorno por déficit de atención e hiperactividad es una condición mental que afecta a niños y adolescentes con prevalencia estimada de 5.3% en la población mundial y en Colombia es de 19-24% en hombres y 10-12% en mujeres. Su etiología es multifactorial, entre ellos se encuentra la hipoxia como factor del medio ambiente uterino; presentándose en entidades como la preeclampsia, donde se ha considerado determinante en el desarrollo del trastorno por déficit de atención e hiperactividad, siendo importante evaluar su asociación. Objetivo: Determinar la asociación entre el diagnóstico trastorno por déficit de atención e hiperactividad y el antecedente perinatal de preeclampsia. Metodología: Estudio de casos y controles retrospectivo de 411 casos de trastorno por déficit de atención e hiperactividad y 404 controles no emparentados sin trastorno ni otros trastornos disruptivos del comportamiento. La evaluación psiquiátrica se hizo entre el 2005–2011, mediante entrevista estructurada que incluyó indagar el antecedente de preeclamsia en el embarazo de cada paciente. Resultados: El antecedente de preeclampsia se presentó en el 3.7% de los pacientes con trastorno por déficit de atención e hiperactividad y en el 5.5% de los controles (OR 0.66, IC95% 0.34 – 1.29; p=0.221). Esta falta de asociación se mantuvo luego de ajustar por género, ser adoptado, haber nacido por cesárea y edad de inicio del trastorno que llevó a consultar al paciente (OR 0.51, IC95% 0.22 – 1.17; p=0.115). Conclusión: El estudio no encontró significancia estadística entre el antecedente de preeclampsia materna y el trastorno por déficit de atención e hiperactividad como factor principalmente asociado en la muestra de pacientes seleccionados.

Background: Attention deficit hyperactivity disorder is a mental disorder that affects children and adolescents. Its prevalence is 5.3% in the global population, in Colombia is 19-24% in men and 10-12% in women. It´s etiology is multifactorial, including hypoxia as a factor of the uterine environment; performing in entities such as preeclampsia, has been considered in the development of attention deficit hyperactivity disorder, been important to evaluate the association. Objective: Determine the association between attention deficit hyperactivity disorder diagnosis and perinatal history of preeclampsia. Methodology: Retrospective case-control study. 411 cases with attention deficit hyperactivity disorder and 404 unrelated controls without psychiatric or other disruptive behavior disorders. The psychiatric evaluation was made between 2005–2011 by structured interview, which will assess the obstetric history of mothers in search of preeclampsia. Results: The history of preeclampsia occurred in 3.7% of patients with attention deficit hyperactivity disorder and 5.5% of controls (OR 0.66, 95% CI 0.34 – 1.29, P= 0.221). This lack of association remains after adjusting for gender, if adopted, would have been born by caesarean section and age of onset of the disorder that led to refer the patient (OR 0.51, 95% CI 0.22 – 1.17, P= 0.115). Conclusions: The study did not find satatistical significance between maternal history of preeclampsia and attention deficit hyperactivity disorder as the main factor associated in the sample of selected patients.

Introdução: O transtorno do déficit de atenção com hiperactividade é uma condicção mental que afeta crianças e adolescentes. A sua prevalencia é de 5.3% da população mundial, e na Colômbia a sua incidência é de 19-24% nos homens e 10-12% nas mulheres. Sua etiologia é multifatorial, incluindo hipóxia como um fator do ambiente uterino; apreentando se em entidades como a pré-eclâmpsia, onde é considerado crucial para o desenvolvimento do transtorno do déficit de atenção com hiperactividade, constituindo dados importantes para avaliar sua associação. Objetivo: Determinar a associação entre o diagnóstico do transtono do déficit de atenção com hiperactividade e a história perinatal de pré- eclâmpsia. Metodologia: Estudo caso-control retrospectivo. 411 casos, com transtorno do déficit de atenção com hiperactividade e 404 controles independentes sem disturbios de comportamento disruptivo psiquiátricos ou outros. A avaliação psiquiátrica foi feita entre 2005-2011 por meio de entrevista estruturada, que incluía investigação da história obstétrica das mães, para verificar antecedentes de pré-eclâmpsia. Resultados: Histórico de pré-eclâmpsia foi detectado em 3.7 % dos pacientes com transtorno do déficit de atenção com hiperactividade e em 5.5 % dos controles (OU 0.66, IC 95% 0.34-1,29; p=0.221). A falta de associação permanece após o juste pelo gênero, para ser adotado, nascer por cesariana e idade de início da doença que levou a consultar do paciente (OU 0.51, IC 95% 0.22-1.17; p=0.115). Conclusões: O estudo Não encontrau significancia estatística entre história materna de pré-eclâmpsia e transtorno do déficit de atenção com hiperactividade como o principal fator, asociado na amostra de pacientes selecionados.

Variables pre-analíticas que afectan la cuantificación sérica de Proteína-C-Reactiva e IL-6 en primigestantes preeclámpticas y controles sanos / Pre-analytical variables involving the quantification of serum C-reactive protein and IL-6 in preeclamptic primiparas and healthy control

Introducción: La Preeclampsia está asociada con un incremento de la respuesta inflamatoria; dos moléculas asociadas a este proceso son la PCR e IL-6. En la detección de los niveles séricos de estas moléculas, existen factores preanalíticos que pueden modificar su concentración. El presente estudio, busca establecer si existe variabilidad en niveles de IL-6 y PCR según los tiempos de separación y temperatura de almacenamiento, en muestras de primigestantes preeclampticas y controles sanos. Metodología: Se extrajo sangre periférica, usando dos tubos (A y B) de 7 ml, sin anticoagulante. El tubo A se refrigeró a 4°C por siete días, al termino se centrifugó y almaceno a -70°C. El tubo B fue centrifugado inmediatamente y fraccionado, la primera fracción (B1) se almacenó a -70°C (tubo de referencia), mientras que las demás se refrigeraron a 4°C y se congelaron a -70°C al cabo de 15 días, uno, dos y tres meses. Finalmente se cuantificaron los niveles séricos de IL-6 y PCR. Resultados: Se cuantificaron 75 muestras para PCR y 58 para IL-6. Se encontraron diferencias en las concentraciones de PCR dadas por la demora en la centrifugación tras siete días de almacenamiento a 4 °C. En cuanto a la IL6, no se observaron diferencias significativas. Conclusión: Las concentraciones de PCR e IL-6, pueden variar por la exposición a variables preanalíticas. En este estudio corroboramos que los niveles séricos de PCR se alteran significativamente si la muestra es refrigerada sin centrifugarse; para las demás variables analizadas no se evidenció cambio en la cuantificación. Salud UIS 2012; 44 (3): 25-30.

Introduction: Preeclampsia is associated with an increase in the inflammatory response; two molecules associated with this process are the CRP and IL-6. In the detection of serum levels of these molecules, there are preanalytical factors that can modify its concentration. This study seeks to establish whether there is variability in levels of IL-6 and CRP according to the times of separation and storage temperature on samples of preeclamptic primiparas and healthy controls. Methods: Peripheral blood was drawn using two tubes (A and B) of 7 ml without anticoagulant. Tube A was cooled to 4 °C for 7 days, at the end was centrifuged and stored at -70 °C. Tube B was centrifuged immediately and fractionated, the first fraction (B1) was stored at -70 ° C (reference tube), while others were refrigerated at 4 ° C and frozen at -70 ° C after 15 days, one, two and three months. Finally, we quantified the serum levels of IL-6 and CRP. Results: 75 samples were quantified for CRP and 58 for IL-6. Differences in CRP concentrations found given by the delay of centrifugation after 7 days of storage at 4 °C. With regarding to IL 6, there were no significant differences. Conclusion: CRP and IL-6, may vary by exposure to preanalytical variables. In this study corroborate that serum CRP levels are significantly altered if the sample is centrifuged without be chilled; for the other variables analyzed showed no change in the quantification. Salud UIS 2012; 44 (3): 25-30.