Clinical outcomes of combined Preserflo Microshunt implantation and cataract surgery in open-angle glaucoma patients.

To assess the effectiveness and safety of the Preserflo Microshunt (PMS) implantation combined with cataract surgery in open-angle glaucoma (OAG) patients. Retrospective, open-label study conducted on insufficiently controlled OAG patients, who underwent a PMS implant procedure with mitomycin-C 0.2%, either alone or in combination with cataract surgery, and were followed for at least 12 months. Success was defined as an intraocular pressure (IOP) ≤ 18 mmHg and a reduction of at least 20% without (complete) or with (qualified) hypotensive medication. Fifty-eight eyes were included in the study, 35 eyes underwent PMS alone and 23 underwent PMS + Phaco. In the overall study sample, mean IOP was significantly lowered from 21.5 ± 3.3 mmHg at baseline to 14.6 ± 3.5 mmHg at month 12 (p < 0.0001). The IOP was significantly reduced in both groups; p < 0.0001 each, respectively. Ocular hypotensive medication was significantly reduced (p < 0.0001) in both groups. No significant differences were observed in IOP lowering or medication reduction between groups. At month 12, 62.1% eyes were considered as complete success and 82.8% eyes as qualified success. The most common adverse events were device close-to-endothelium, conjunctival fibrosis, and wound leakage. PMS, either alone or in combination with phacoemulsification, may be considered as a valuable option for treating OAG patients.

Resultados de la aplicación de Heberprot-P para el tratamiento de la úlcera del pie diabético / Results of the application of Heberprot-P for the treatment of diabetic foot ulcer

RESUMEN Fundamento: la diabetes mellitus es una enfermedad crónica. Una de sus complicaciones frecuentes es el pie diabético, para cuyo tratamiento se utiliza el Heberprot-P. Objetivo: describir los resultados de la aplicación de Heberprot-P para el tratamiento de la úlcera del pie diabético. Métodos: estudio descriptivo prospectivo realizado en la Consulta de Atención al Diabético, durante el periodo de abril 2009 a abril 2016. La muestra estuvo conformada por los 41 pacientes con úlcera de pie diabético mayores de 20 años, a los cuales se les ha aplicado el tratamiento con Heberprot-P. Se analizó: edad, enfermedades asociadas, años de evolución de la enfermedad, dosis del medicamento y cicatrización. Resultados: predominaron las pacientes femeninas (56,1 %); el grupo etario de 60-69 años (34,2 %) y la hipertensión arterial como enfermedad asociada (48,8 %); el 43, 9 % tenía una evolución de la diabetes de 10-19 años; según clasificación Wagner predominó el grupo III con un 48, 8 % y el II con un 31, 7 %; se aplicaron de 5 a 9 dosis de Heberprot-P en el 43,5 %. El 78 % logró una cicatrización completa. Conclusiones: en las tres cuartas partes de los pacientes con úlcera del pie diabético se logró la cicatrización completa con la aplicación de la terapéutica del Heberprot-P.

ABSTRACT Foundation: diabetes mellitus is a chronic disease. One of its frequent complications is the diabetic foot. For its treatment Heberprot-P is used. Objective: to describe the results of the application of Heberprot-P for the treatment of diabetic foot ulcer. Methods: prospective descriptive study conducted in the Diabetic Care Consultation, during the period from April 2009 to April 2016. The sample consisted of the 41 patients with diabetic foot ulcer older than 20 years, to whom the treatment with Heberprot-P. We analyzed: age, associated diseases, years of evolution of the disease, medication dose and healing. Results: female patients predominated (56.1%); the age group of 60-69 years (34.2%) and hypertension as an associated disease (48.8%); 43, 9% had an evolution of diabetes of 10-19 years; according to the Wagner classification, group III prevailed with 48.8% and II with 31.7%; 5 to 9 doses of Heberprot-P were applied in 43.5%. 78% achieved complete healing. Conclusions: in three quarters of patients with diabetic foot ulcer complete healing was achieved with the application of Heberprot-P therapy.

La visita integral a la familia. Guía metodológica para su ejecución / The integral visit to the family. Methodological guide for its execution

RESUMEN Fundamento: la visita integral a la familia contribuye al logro de las acciones y las funciones específicas declaradas en el Programa del Médico y Enfermera de la Familia en Cuba. Debe ser ejecutada por los equipos básicos de salud en cada uno de los consultorios médicos. Objetivo: proponer una guía metodológica para la visita integral a la familia por los miembros del equipo básico de salud. Métodos: la investigación responde a un proyecto de desarrollo y se ejecutó de marzo a septiembre de 2018. Se aplicó la técnica de grupo nominal con la participación de expertos (metodólogos de posgrado de las diferentes áreas y municipios de la provincia) siguiendo las etapas establecidas: confección de las listas, presentación de las listas, votación y valoración y debate de los resultados que se logran con la aportación de todos los miembros del grupo. Se logró la inclusión de los juicios individuales hasta encontrar consenso en las propuestas. Resultados: la guía aporta todos los pasos a seguir en la visita integral a la familia, dentro de los que se destacan: características, estado de salud, condiciones materiales, higiénico-sanitaras y epidemiológicas, familiograma, funcionamiento familiar, etc., incluyendo plan de acción conjunto médico-familia, para solucionar los problemas detectados. Conclusiones: la guía metodológica para el desarrollo de la visita integral a la familia por los miembros del equipo básico contribuye al logro de esta actuación básica con la calidad requerida, cumplimentando los objetivos que se proponen en el Programa del Médico y Enfermera de la Familia.

ABSTRACT Foundation: the comprehensive visit to the family contributes achieving the actions and the specific functions declared in the Program of the Family Doctor and Nurse in Cuba. It must be executed by basic health teams in each of the doctor's offices. Objective: to propose a methodological guide for the comprehensive visit to the family by the members of the basic health team. Methods: this research responds to a development project and was carried out from March to September 2018. The nominal group technique was applied with the participation of experts (postgraduate methodologists from different areas and municipalities of the province) following the established stages: list preparation, list presentation, voting and assessment and debate of the results achieved with the contribution of all the members of the group. The inclusion of individual trials was achieved until arriving to a consensus in the proposals. Results: the guide provides the steps to follow in the comprehensive visit to the family, among which stand out: characteristics, state of health, material, hygienic-sanitary and epidemiological conditions, family scheme, family functioning, etc., including a joint action doctor-family plan, to solve the problems detected. Conclusion: the methodological guide for developing the comprehensive visit to the family by the basic team members contributes to the achievement of main basic action with the required quality, fulfilling the proposed objectives in the Program of the Family Doctor and Nurse.

La interconsulta en la atención primaria de salud. Una mirada reflexiva

En la Atención Primaria de Salud, la interconsulta favorece al cumplimiento exitoso del Programa de Trabajo del Médico y Enfermera de la Familia. Ella tiene como objetivo establecer un diagnóstico, definir un pronóstico y/o precisar una conducta. Sin embargo, a casi treinta y cinco años del nacimiento de la medicina familiar cubana y con pleno convencimiento de que la interconsulta es una actuación necesaria, surge una pregunta paradójica: ¿cuáles son los elementos que condicionan que, a pesar de contar en Cuba con un Programa de Medicina Familiar bien estructurado que constituye una prioridad gubernamental y que cuenta con estrategias bien intencionadas para la atención de calidad integral, continua y sistemática, aún prevalezca en la atención primaria un grupo de debilidades que provocan insatisfacciones en el proceso de interconsulta? Reflexionar el respecto es el objetivo de este trabajo.

In Primary Health Care, inter-consultation favors the successful fulfillment of the, define a prognosis Program of Family Doctor and Nurse. Its objective is to establish a diagnosis, define a prognosis and/or specify a management. However, almost at 35 years of Cuban family medicine birth and convinced that inter-consultation is necessary it emerges a a controversial question: what are the elements which determine that there are still some weaknesses causing dissatisfaction in the process of inter-consultation, in spite that it is a governmental priority, that it counts well intentioned strategies for its comprehensive, continue, and systematic quality? To reflect on this problem is the objective of this work.

A propósito del Día Mundial de la Salud / Regarding the World Health Day

Cuando un médico de familia cubano conoce una noticia sobre el acceso y la cobertura universal a la salud, es algo tan cercano que apenas puede valorar estas palabras; sin embargo su consideración se hace extraordinaria cuando se cumple la tarea de colaboradores internacionalistas en algún otro país, donde la pobreza y las inequidades persisten. En este trabajo se reflexiona sobre la sólida estrategia en materia de salud desarrollada por Cuba, país subdesarrollado, cuya política le ha permitido cumplir con las aspiraciones de salud para todos, teniendo como pilar la Atención Primaria de Salud.

When a Cuban family doctor knows about the access and universal health coverage, it is something so close that it is almost impossible to value these words.; however considering them becomes extraordinary when accomplishing an international collaboration task , where poverty and inequalities persist. In this work It is reflected on the solid health strategy developed by Cuba, an underdeveloped country, whose policy has allowed to fulfill the wish of health for everyone, having as a base the Primary Health Care System.

Comportamiento sexual de estudiantes de primer año de medicina de la Facultad de Ciencias Médicas de Cienfuegos. Influencia del rol de género en las conductas de riesgo / Sexual behavior of first year medical students at the Cienfuegos Medical Faculty. Influence of the gender role in risky conducts

Fundamento: numerosos autores han relacionado no solo el inicio, sino el ejercicio de la sexualidad en los adolescentes con el género como conducta social que les es asignada. A esto se relacionan también algunas conductas de riesgo como edad y motivo de inicio de la relación, número de parejas, entre otras. Objetivo: determinar el comportamiento sexual de estudiantes de primer año de medicina y la influencia del género en sus conductas de riesgo. Métodos: estudio descriptivo, transversal desarrollado en la Facultad de Ciencias Médicas de Cienfuegos. Fueron seleccionados de manera aleatoria 147 estudiantes. Se aplicó una encuesta para recoger las variables: edad, sexo, edad de inicio de las relaciones sexuales, tiempo transcurrido desde la primera relación sexual hasta la actualidad, número de parejas sexuales, hábitos tóxicos, uso de condón, motivaciones para iniciar la vida sexualmente activa y persona seleccionada para su iniciación, número de compañeros o compañeras en un mismo periodo de tiempo. Resultados: las relaciones sexuales comienzan más tempranamente en varones, quienes tienen mayor número de parejas sexuales, mayor consumo de café, alcohol y cigarrillos. La utilización del condón se refiere como habitual más en hombres que en mujeres, el amor como motivación para el inicio de las relaciones sexuales aparece en mayor por ciento en las femeninas; solo una décima parte de los masculinos iniciaron las prácticas sexuales con la novia. Conclusiones: se identificaron conductas de riesgo en ambos sexos, íntimamente ligadas a las representaciones sociales de género.

Foundation: many authors have related not only sexuality beginning but also sexuality in adolescents with the gender as a social conduct which is assigned to them. Other risky conducts are also related to this such as age, motive of starting the relation, number of partners among others.Objective: to determine the sexual behavior of first year students at Medical Faculty and gender influence in risky conducts. Methods: cross descriptive study developed at the Cienfuegos Medical Faculty. A number of 147 were randomly selected and a survey was applied to know: age, sex, age at beginning sexual relations, time from the first sexual relation to the present time, number of sexual partners, toxic habits, use of condom, motivations for starting a sexually active life and person selected for its beginning, number of partners (Male or female) in the period of time. Results: sexual relations start earlier in boys, who have more sexual partners, more consumption of coffee, alcohol and cigarettes. The use of condom is more commonly referred in boys than in girls, with love as the motivation for having sexual relations appears in a higher percentage in the female sex, only one tenth of the male students began sexual practice with their girlfriends. Conclusion: risky behaviors in both sexes were identified, closely related to social gender representations.

Consumo de bebidas alcohólicas en adolescentes del Área IV del municipio de Cienfuegos / Alcoholic beverage consumption in adolescents of Area IV of the Cienfuegos municipality

Fundamento: actualmente se aprecia un incremento del consumo de bebidas alcohólicas en adolescentes, lo cual puede convertirse en un importante problema de salud.Objetivo: describir el consumo de bebidas alcohólicas en adolescentes.Métodos: estudio descriptivo realizado de enero 2014 a enero del 2015, en el área IV de salud del Municipio Cienfuegos, que incluyó 315 adolescentes seleccionados mediante muestreo aleatorio simple. Se analizaron las siguientes variables: edad, sexo, consumo de alcohol, edad de inicio al consumo de alcohol, primera bebida alcohólica que consumió, frecuencia del consumo, lugar donde consume, si ha sufrido de estado de embriaguez y sensación experimentada, consumo de alcohol por los familiares con los que convive y por amigos o compañeros de colegio, información sobre de los efectos indeseables del alcohol y quién le proporcionó la información. Resultados: todos los adolescentes refirieron que consumen bebidas alcohólicas; el 58, 4 % lo inició con la ingestión de cerveza; el 22 % consume una vez por semana; el 88, 9 % lo hace en bares, discotecas y lugares públicos; 50, 5 % de los consumidores son fumadores y el 73, 6 % refirió a la familia como fuente para obtener información sobre consumo de alcohol. La edad de inicio del consumo en general es entre los 14 y 16 años, con un inicio más temprano en el sexo femenino. Casi la totalidad refirió consumo de alcohol por familiares, se presentó una relación casi similar por amigos o compañeros de la escuela y la totalidad conocen los efectos indeseables del alcohol. Conclusiones: el consumo de bebidas alcohólicas en adolescentes constituye un problema de salud en el territorio.

Foundation: There is currently an increase in the consumption of alcoholic beverages in adolescents, which can become an important health problem. Objective: To describe alcoholic beverages consumption in adolescents. Method: A descriptive study conducted from January 2014 to January 2015, in Area of health IVof the Cienfuegos Municipality, which included 315 adolescents selected through simple random sampling. The following variables were analyzed: age, sex, alcohol consumption, age of onset of alcohol consumption, first alcoholic beverage consumed, frequency of consumption, place of consumption, if experienced drunkenness and experienced sensation, alcohol consumption by relatives with whom he lives and by friends or schoolmates, information on the undesirable effects of alcohol and who provided the information. Results: All adolescents reported consuming alcoholic beverages; 58, 4% started it with the ingestion of beer; 22% consume once a week; 88, 9% do it in bars, discos and public places; 50, 5% of consumers are smokers and 73, 6% referred to the family as a source for information on alcohol consumption. The age of onset of consumption in general is between 14 and 16 years, with an earlier onset in the female sex. Almost all referred alcohol consumption by relatives, showed a near similar relationship by friends or school friends and the whole know the undesirable effects of alcohol. Conclusion: Alcoholic beverage consumption is a health problem in the Territory.

Consumo de bebidas alcohólicas en adolescentes del Área IV del municipio de Cienfuegos / Alcoholic beverage consumption in adolescents of area IV of the Cienfuegos municipality

Fundamento: actualmente se aprecia un incremento del consumo de bebidas alcohólicas en adolescentes, lo cual puede convertirse en un importante problema de salud. Objetivo: describir el consumo de bebidas alcohólicas en adolescentes. Métodos: estudio descriptivo realizado de enero 2014 a enero del 2015, en el área IV de salud del Municipio Cienfuegos, que incluyó 315 adolescentes seleccionados mediante muestreo aleatorio simple. Se analizaron las siguientes variables: edad, sexo, consumo de alcohol, edad de inicio al consumo de alcohol, primera bebida alcohólica que consumió, frecuencia del consumo, lugar donde consume, si ha sufrido de estado de embriaguez y sensación experimentada, consumo de alcohol por los familiares con los que convive y por amigos o compañeros de colegio, información sobre de los efectos indeseables del alcohol y quién le proporcionó la información. Resultados: todos los adolescentes refirieron que consumen bebidas alcohólicas; el 58, 4 por ciento lo inició con la ingestión de cerveza; el 22 por ciento consume una vez por semana; el 88, 9 por ciento lo hace en bares, discotecas y lugares públicos; 50, 5 por ciento de los consumidores son fumadores y el 73, 6 por ciento refirió a la familia como fuente para obtener información sobre consumo de alcohol. La edad de inicio del consumo en general es entre los 14 y 16 años, con un inicio más temprano en el sexo femenino. Casi la totalidad refirió consumo de alcohol por familiares, se presentó una relación casi similar por amigos o compañeros de la escuela y la totalidad conocen los efectos indeseables del alcohol.Conclusiones: el consumo de bebidas alcohólicas en adolescentes constituye un problema de salud en el territorio(AU)

Foundation: There is currently an increase in the consumption of alcoholic beverages in adolescents, which can become an important health problem.Objective: To describe alcoholic beverages consumption in adolescents.Method: A descriptive study conducted from January 2014 to January 2015, in Area of health IVof the Cienfuegos Municipality, which included 315 adolescents selected through simple random sampling. The following variables were analyzed: age, sex, alcohol consumption, age of onset of alcohol consumption, first alcoholic beverage consumed, frequency of consumption, place of consumption, if experienced drunkenness and experienced sensation, alcohol consumption by relatives with whom he lives and by friends or schoolmates, information on the undesirable effects of alcohol and who provided the information. Results: All adolescents reported consuming alcoholic beverages; 58, 4 percent started it with the ingestion of beer; 22 percent consume once a week; 88, 9 percent do it in bars, discos and public places; 50, 5 percent of consumers are smokers and 73, 6 percent referred to the family as a source for information on alcohol consumption. The age of onset of consumption in general is between 14 and 16 years, with an earlier onset in the female sex. Almost all referred alcohol consumption by relatives, showed a near similar relationship by friends or school friends and the whole know the undesirable effects of alcohol. Conclusion: Alcoholic beverage consumption is a health problem in the Territory(AU)

El proceso pedagógico de posgrado en la especialización de Medicina General Integral: hacia una praxis sustentada desde el enfoque histórico cultural del desarrollo humano / The Graduate Pedagogical Process in the Comprehensive General Medicine Specialization: towards a Practice based on the Cultural-historical Approach to Human Development

La educación cubana concibe sus programas y procesos desde el enfoque histórico cultural del desarrollo humano, por ser esta la teoría que de manera más completa logró, gracias a su fundador Lev Semionich Vigotsky, superar los enfoques que fragmentaban el análisis y comprensión del desarrollo debido a la hiperbolización que hacían otras corrientes de las diferentes condicionantes del desarrollo y al desconocimiento de la relación dialéctica entre ellos en la formación y desarrollo de la personalidad, sus procesos y propiedades. Mediante todo el aparato conceptual y metodológico del materialismo dialéctico, Vigotsky desarrolló diferentes categorías: la ley genética del desarrollo (interiorización), la zona de desarrollo próximo, la situación social de desarrollo, el carácter mediatizado de los procesos psíquicos, así como el concepto de vivencia y el de la relación entre educación y desarrollo. El objetivo de este trabajo es precisar la importancia del enfoque histórico cultural en el proceso pedagógico contextualizado en la especialización en Medicina General Integral en la educación médica de posgrado, para lo que se realizó una sistematización teórica y metodológica con importantes repercusiones para el acercamiento a una praxis con una visión emergente, sustentada en los núcleos invariantes de dicho enfoque que superan prácticas tradicionalistas y enriquecen las múltiples potencialidades presentes en la formación de estos profesionales en nuestras universidades médicas.

Cuban educators conceive programs and processes using the cultural-historical approach to human development, since this is the theory that, thanks to its founder Lev Semiónovich Vygotsky, could overcome the approaches that fragmented the analysis and understanding of the human development. Such currents of thought hyperbolized the different conditioning factors of this development and ignored the dialectical relationship between them in terms of personality formation and development, its processes, and properties. By using the conceptual and methodological apparatus of dialectical materialism, Vygotsky developed different concepts: the genetic law of development (internalization), the zone of proximal development, the social situation of development, the mediated nature of mental processes, as well as the concept of lived experience, and the relationship between education and development. The aim of this paper is to highlight the importance of the cultural-historical approach in the pedagogical process carried out in graduate medical education, specifically in the Comprehensive General Medicine specialization. For this purpose, we conducted a theoretical and methodological systematization with important implications for a practice conceived with an emerging vision based on the invariant core of the cultural-historical approach that prevails over traditionalist practices and increases the multiple potentialities of the training of these professionals in our medical universities.

Topical intraocular pressure therapy effects on pregnancy.

PURPOSE: To assess the course of intraocular pressure (IOP), visual field progression, and adverse effects of antiglaucoma medication used during pregnancy. METHODS: Thirteen eyes of eight patients with glaucoma were examined. Their clinical records were reviewed to compare IOP, number of medications, and visual field indices (VFI) before, during, and after pregnancy using a two-tailed paired t-test. RESULTS: In seven (87.5%) of the eight patients, no disease progression was observed. IOP (mmHg) remained stable (baseline 17.3 ± 3.6; first trimester 17.4 ± 5.2, P = 0.930; second trimester 18.1 ± 4.7, P = 0.519; third trimester 20.2 ± 8.7, P = 0.344; and postpartum 21.5 ± 7.6, P = 0.136). The mean number of glaucoma treatments fell from 1.7 ± 0.52 before pregnancy to 0.83 ± 0.75 (P = 0.04) in the second and third trimesters. In one patient, IOP increased during pregnancy and there was further visual field loss. In the only patient kept on fixed combination timolol-dorzolamide therapy throughout pregnancy, labor was induced because of delayed intrauterine growth. CONCLUSIONS: No changes in IOP and VFI were detected in most patients despite a reduction in the number of hypotensive agents required. Delayed intrauterine growth in one patient under fixed combination timolol-dorzolamide treatment was observed whereas no other adverse effects were detected.

Comparing corneal variables in healthy subjects and patients with primary open-angle glaucoma.

PURPOSE: This study was designed to identify possible differences between healthy subjects and patients with primary open-angle glaucoma (POAG) in keratometry, central corneal thickness, overall corneal thickness, mean thickness of a circular zone centered at the corneal apex of 1-mm radius (zone I), and mean thickness of several concentric rings also centered at the apex of 1-mm width (zones II to VI, respectively). METHODS: These variables were recorded in 126 healthy subjects and 130 patients with POAG. Corneal thicknesses and the power of the flattest and steepest axes were compared between the two populations using a t-test and the position of the flattest axis using a Mann-Whitney U test. A binary logistic regression procedure was used to determine the diagnostic capacity of the corneal variables using the area under the receiver operator characteristic curve (AUC) to select the best regression equation. RESULTS: Significant differences between subjects and patients were detected in mean corneal thickness and in mean thicknesses of zones I to VI. The logistic regression model included as predictors the mean corneal thickness and the mean thicknesses of zones IV and VI; for this model, the AUC was 0.711, sensitivity was 67.7%, and specificity was 65.5%. CONCLUSIONS: Healthy subjects and glaucoma patients differ significantly in terms of mean overall corneal thickness and thicknesses of the corneal zones I to VI defined here. The variables mean corneal thickness and mean thicknesses of zones IV and VI are able to discriminate between subjects with or without glaucoma.

Calidad de vida: algo más que un concepto / Quality of life: more than just a concept

El concepto de calidad de vida es controvertido y ambiguo; constituye para muchos profesionales de la salud un tema difícil de analizar ya que maneja escalas cualitativas. Su medición depende de diferentes variables que deben ser referidas por el propio paciente. Los logros de las políticas sociales aplicadas en Cuba dan respuesta con creces a todos y cada uno de los derechos a la calidad de la vida reconocidos en los instrumentos jurídicos de la Organización de las Naciones Unidas. La consulta especializada de planificación de la familia y riesgo reproductivo del Área III de Cienfuegos, constituyó una oportunidad para el desarrollo de la evaluación de la calidad de vida en las mujeres dispensarizadas como riesgo preconcepcional pertenecientes a dicha área de salud. Se realizó un estudio durante un año, se comparó el comportamiento de las diferentes escalas de la calidad de vida en las pacientes estudiadas al ingresar en los servicios especializados de planificación familiar y al año de la intervención, se apreció en la investigación que el índice total de la calidad de vida de las pacientes que conformaron el universo de estudio durante la primera consulta fue inferior al encontrado al año de la intervención en la consulta multidisciplinaria(AU)

The concept of life quality is controversial and ambiguous; for many health professionals it is an issue that posses difficulties when being discussed because it deals with qualitative scales. Its measurement depends on several variables that must be referred and provided by the patient. The achievements of social policies applied in Cuba, allow guaranteeing the accomplishment with all the life quality rights recognized in the legal instruments of United Nations. The specialized consultation for family planning and reproductive risk in the Area III Polyclinic of Cienfuegos provided an opportunity to develop the assessment of life quality in women whose records accounted for preconception risk. A one year study was conducted. The performances of different scales of life quality in the patients studied were compared at the point of admission in the specialized services and one year after the intervention. This research showed that the overall life quality rate in patients who integrated the universe of the study during the first consultation was inferior to the one perceived a year after the intervention in the multidisciplinary consultation(AU)

Comparison of ocular hypotensive actions of fixed combinations of brimonidine/timolol and dorzolamide/timolol.

OBJECTIVE: To compare brimonidine/timolol fixed combination (BrTFC; Combigan *) with dorzolamide/timolol fixed combination (DTFC; Cosopt dagger) in terms of ability to lower intraocular pressure (IOP) in primary open-angle glaucoma (POAG). METHODS: This was a prospective, randomized, double-masked, crossover study. After 6 weeks of therapy with timolol maleate 0.5% twice daily, patients were randomized to BrTFC twice daily or DTFC twice daily for 6 weeks, before being crossed over to the other treatment arm for a further 6 weeks. At all follow-up visits, IOP was measured at 09.00 (pre-instillation) 12.00 and 16.00. The primary outcome measure was change in mean diurnal IOP from baseline at 6 weeks. The secondary outcome was percentage of patients with IOP <18 mmHg at 6 weeks. Data were analyzed from all patients who completed the study. RESULTS: Twenty-five patients were randomized and 20 completed the study. Mean diurnal IOP (mean +/- standard deviation [SD]) was 20.28 +/- 2.03 mmHg at timolol-treated baseline. After 6 weeks, mean diurnal IOP was 16.28 +/- 2.07 mmHg following BrTFC and 17.23 +/- 2.29 mmHg following DTFC (difference: 0.95 mmHg, 95% CI 0.10-1.80, p = 0.03). Mean IOP at 09.00 was 20.95 +/- 2.31 mmHg at baseline. This was reduced to 15.85 +/- 2.56 mmHg following BrTFC and 17.55 +/- 2.67 mmHg following DTFC (difference: 1.70, 95% CI 0.80-2.60, p = 0.001). For the 12.00 and 16.00 timepoints, the mean changes from baseline in the two arms were comparable. Percentages of patients achieving a target IOP of <18 mmHg were 85% following BrTFC and 60% following DTFC (p = NS [not significant]). No treatment-related adverse events were reported with either therapy. Key limitations include the small size of the study population and the 6-week duration of treatment periods, which prevents drawing conclusions regarding long-term therapy. CONCLUSION: Reductions from baseline in mean diurnal IOP and morning IOP were greater with BrTFC than with DTFC.

Comparison of rebound tonometer and Goldmann handheld applanation tonometer in congenital glaucoma.

PURPOSE: To compare intraocular pressure (IOP) measurements obtained using the rebound tonometer (RBT) and the handheld Goldmann applanation tonometer (Perkins) in children with congenital glaucoma. METHODS: Using both tonometers, the IOP was prospectively determined in 68 eyes of 68 patients with congenital glaucoma aged 3 to 13 years. Corneal curvature, central corneal thickness (CCT), and axial length were also measured in each patient. The ease of the use of each tonometer was scored using a visual analog scale. RESULTS: IOP readings obtained using the RBT and Perkins tonometer showed good correlation (r=0.869, P<0.001) although RBT readings were consistently higher (mean difference: 3.1 +/-4.0 mm Hg). According to the Bland-Altman plot, the 95% limits of agreement between the 2 methods were -4.8 to 10.9 mm Hg (slope=0.589, P<0.001). When estimating CCT, the 2 tonometers behaved similarly and correlation was observed between IOP measurements and CCT, with higher IOPs obtained as the CCT increased. In contrast, no correlation was detected between corneal curvature or axial length and the IOPs recorded using either tonometer. Ease of use scores awarded by the examiner was higher for the RBT. CONCLUSIONS: The RBT overestimates the IOP compared with the Perkins tonometer in patients with congenital glaucoma. Differences in readings between the 2 tonometers become larger as the CCT increases.

Effect of corneal thickness on dynamic contour, rebound, and goldmann tonometry.

PURPOSE: To identify correlations among intraocular pressure (IOP) measurements obtained using the rebound tonometer (RBT), the dynamic contour tonometer (DCT), and the Goldmann applanation tonometer (GAT). The effects of corneal thickness on the measures obtained using each of the 3 tonometers also were examined. DESIGN: Cross-sectional study. PARTICIPANTS: One hundred forty-six eyes of 90 patients with ocular hypertension or glaucoma. METHODS: Intraocular pressure measurements were obtained in all patients using RBT, DCT, and GAT. Central corneal thickness was determined by ultrasound pachymetry. Patients were divided randomly into 6 groups to vary the order in which the tonometers were used. All IOP measurements were made by the same examiner, who was masked to the readings obtained. MAIN OUTCOME MEASURES: Intraocular pressure and central corneal thickness. RESULTS: There was good correlation between IOP readings obtained using the RBT and GAT (r = 0.864; P<0.0001), between DCT and GAT (r = 0.871; P<0.0001), and between RBT and DCT (r = 0.804; P<0.0001). Rebound tonometer and DCT readings consistently were higher than GAT measurements (RBT-GAT median difference, 1.4+/-2.7 mmHg; DCT-GAT median difference, 4.4+/-2.6 mmHg). A Bland-Altman plot indicated that the 95% limits of agreement between RBT and GAT were -4.3 to 6.4 mmHg (slope = 0.056; P = 0.218), those between DCT and GAT were -0.7 to 9.5 mmHg (slope = 0.016; P = 0.717), and those between RBT and DCT were -3.1 to 9.8 mmHg (slope = -0.041; P = 0.457). Using RBT, the point that best discriminated between patients with an IOP 21 mmHg or less and more than 21 mmHg as determined by GAT was >23.3 mmHg (sensitivity, 66.7%; specificity, 92.1%); using DCT, this point was >22.7 mmHg (sensitivity, 95.6%; specificity, 71.3%). In terms of pachymetry, GAT and RBT behaved similarly. Using these instruments, differences of approximately 3 mmHg were detected between the groups of patients with the thinnest (<531 mum) and thickest (>565 mum) corneas, whereas a significantly lower difference (0.5 mmHg) was noted for the DCT. CONCLUSIONS: Measurements obtained both with the RBT and DCT show excellent correlation with those provided by applanation tonometry. Both tonometers tend to overestimate the IOP measured with the GAT, particularly the DCT. This last tonometer seems to be less affected by the corneal thickness.

Ocular response analyzer versus Goldmann applanation tonometry for intraocular pressure measurements.

PURPOSE: To establish correlations between intraocular pressure (IOP) measurements obtained with the ocular response analyzer (ORA) and the Goldmann applanation tonometer (GAT). The effects of central corneal thickness on the measures obtained were also examined. METHODS: This was a cross-sectional study. IOP was determined in 48 eyes of 48 patients with glaucoma In all patients, central corneal thickness (CCT) was measured by ultrasound pachymetry. RESULTS: ORA readings were consistently higher than GAT measurements (Goldmann-correlated IOP - IOP GAT mean difference, 7.2 +/- 3.5 mm Hg; corneal-compensated IOP - IOP GAT mean difference, 8.3 +/- 4.0 mm Hg) However, differences were not constant and increased with increasing IOP GAT readings, both with respect to Goldmann-correlated IOP (slope = 0.623, P < 0.0001) and corneal-compensated IOP (slope = 0.538, P < 0.0001). Both pressure measurements provided by the ORA showed significant correlation with CCT (CCT versus Goldmann-correlated IOP: r = 0.460, P = 0.001; CCT versus corneal-compensated IOP: r = 0.442, P = 0.001). No significant effects of corneal curvature or refraction on any of the pressures were observed. CONCLUSIONS: The ORA significantly overestimates IOP compared with the GAT. Differences between both sets of measures increase as the GAT-determined IOP increases. ORA readings seem to be affected by central corneal thickness.

Trastornos lipídicos en pacientes de 15 a 64 años en un consultorio médico del municipio de Rodas / Lipid disorders in patients of 15 to 64 years old in a medical doctor's office in the municipalty of Rodas

Dentro de las enfermedades crónicas no trasmisibles, las de índole vascular encabezan a escala mundial lo registros de morbi-mortalidad de la población adulta. Los trastornos lipídicos aumentan estas afecciones. Determinar la presencia de trastornos lipídicos en pacientes de 15 a 64 años, del consultorio 3 del área de salud urbana del municipio de Rodas, Cienfuegos. Estudio descriptivo y de corte transversal, realizado en un universo constituido por 438 pacientes con edades comprendidas entre los 15 y 64 años, del que se obtuvo una muestra representativa de 263 pacientes, mediante la aplicación del método estratificado por sexo y edad, tomándose como grupo de edades estratos de 10 años y por sexo. A todos los pacientes se les realizó la prueba de frío y los exámenes de colesterol y triglicéridos. Resultados y Conclusiones: Los factores de riesgo que más se relacionaron con el tipo de hiperlipoproteinemia fueron la ingestión de bebidas alcohólicas, la alimentación inadecuada, el sedentarismo y el sobrepeso. El 26, 9 porciento de los pacientes objeto de estudio presentaron diagnóstico de hiperlipoproteinemia, de ellos el 63, 4 porciento pertenecen al sexo masculino y el 50,7 porciento al grupo de edad de 45 a 54 años que fue el que predominó en nuestro trabajo. El tipo de hiperlipoproteinemia que se encontró con mayor porcentaje fue la tipo IIb con un 38 porciento, seguida de la tipo IIa y la tipo IV con 23, 9 porciento y 22, 5 porciento respectivamente. Las enfermedades no trasmisibles que más se asociaron fueron la hipertensión arterial con un 29, 6 porciento, la diabetes mellitus con un 18, 3 porciento y la angina de pecho un 12, 7 porciento(AU)