Uveitis and Dry Eye Disease in Children: A Cross-Sectional Comparative Study.

PURPOSE: This study aims to evaluate the ocular surface characteristics in children diagnosed with uveitis and explore the association between uveitis and dry eye disease (DED). METHODS: We included 84 children, 42 with uveitis and 42 healthy children. We performed the OSDI questionnaire and several ocular surface tests, including osmolarity, NITBUT, Schirmer test, and vital staining. We used Fisher's exact test and Mann-Whitney to compare variables and a binomial logistic regression to determine the factors associated with DED. RESULTS: The difference in the prevalence of DED between uveitis (54.8%) and healthy (31%) groups was statistically significant (p < 0.05). Most patients with uveitis had mixed DED, and none of the healthy subjects had a severe form of the disease. There were no statistically significant differences in most of the tear film tests. However, all parameters tended to worsen in the uveitis group, and lipid layer thickness was thinner (p < 0.036). The uveitis group exhibited significantly more symptoms (p < 0.05). In the multivariate logistic regression, uveitis was associated with an odds ratio (OR) of 3.0 (95% CI: 1.07-8.42, p < 0.05) for DED. CONCLUSIONS: Our findings demonstrate a significantly higher prevalence of DED in children with uveitis compared to their healthy counterparts. Furthermore, our analysis indicates that the risk of DED in pediatric patients with uveitis is threefold higher than in healthy children. Therefore, it is crucial for clinicians to vigilantly monitor the development of DED in pediatric patients with uveitis and consider the implementation of preventive treatments.

High Prevalence of Abnormal Ocular Surface Tests in a Healthy Pediatric Population.

PURPOSE: To describe ocular surface characteristics and tests' results in a healthy pediatric population. METHODS: We performed a cross-sectional study with 60 healthy children, obtaining consent, OSDI and screen use survey and conducting ocular surface tests. Statistical univariate analysis for categorical and quantitative variables was made. To describe the correlation of the results in both eyes, we used a model of random effects. To characterize the possible profiles of device use, we applied the mixed-cluster methodology. RESULTS: Sixty healthy children between 7 and 17 years old were evaluated. Girl's proportion was 41.6%. Mean Ocular Surface Disease Index Score was 9.98±8.49 points. Daily screen time was 5.59±2.77 hours and the most popular screen was the smartphone. Mean results (with standard deviations or confidence intervals) of ocular surface tests were blink frequency while reading on paper, 6.8±5.68 times per minute; blink frequency while reading on screen, 8.7±7.14 times per minute; tear meniscus height, 0.19[0.18-0.2] mm; non-invasive tear break-up time, 12.44[10.99-13.9] seconds; nasal conjunctival redness, 0.86[0.77-0.94]; temporal conjunctival redness, 0.96[0.87-1.04]; tear osmolarity, 299.3[295.14-303.45] mmol; and Schirmer test, 23.73[21.28-26.18] mm. Lid margin was irregular in three eyes; 44.7% had thin lipid layer; lissamine green staining was positive in 70.8%; fluorescein staining was positive in 47.4%; 36.64% exhibited partial meibomian gland loss. CONCLUSION: Considering the scarcity of specific pediatric values of ocular surface tests, we performed a clinical investigation involving the complete pool of ocular surface tests in children. Although healthy children were included in this study, we found that all the participants had at least one abnormal result and 33.33% had dry eye disease diagnosis, according to the TFOS DEWS II. It would be relevant to carry out further multicentric studies to compare our ocular surface tests' results with other groups of children.

Urinary Incontinence in Pregnant Young Women and Adolescents: An Unrecognized At-Risk Group.

OBJECTIVES: The aims of this study were to determine the prevalence of urinary incontinence (UI) in pregnant young women and adolescents, characterize UI subtype, and identify characteristics associated with UI. METHODS: This was a cross-sectional study of pregnant females aged 25 years or below, presenting for routine obstetrical care at a New York City community hospital. Subjects were stratified into 2 groups: adolescents (age, ≤19 years) and young adults (age, >19 years). Demographic and obstetric data were collected. The 3 Incontinence Questions questionnaire was used to screen and evaluate UI symptoms. RESULTS: A total of 98 young females with a mean age of 20.3 ± 2.6 years were enrolled. Most participants were nulliparous (64%). Of parous women, route of previous obstetric delivery was primarily vaginal (83%). Mean gestational age at recruitment was 34.5 ± 7.5 weeks. The prevalence of UI was 52%. Urinary incontinence was associated with the following conditions: strenuous activity, 73%; urinary urgency, 67%; and absence of either, 20%. However, the most predominant UI subtype was with strenuous activity (63%). There was no statistical difference detected in demographic characteristics (such as age, parity, mode of delivery, race, education, and trimester of pregnancy) between continent and incontinent pregnant females (P > 0.18). No differences were appreciated between pregnant adolescents and young adult females with UI (P > 0.18). CONCLUSIONS: Urinary incontinence was present in 52% of pregnant females aged 25 years or below. By age group, approximately 50% of both adolescents and young adults reported UI during pregnancy. Continent and incontinent patients did not seem to differ demographically. Our study highlights the extent of UI in this segment of the population. This data may support the need for services targeting UI prevention and early intervention in this newly identified at-risk group.

Comparación en la medición de presión intraocular con los tonómetros de Goldmann, Pascal® y ORA (Ocular Response Analyzer) / Intraocular pressure measurement with Goldmann, Pascal and ORA tonometers

Introducción: el glaucoma es la principal causa de ceguera irreversible en el mundo, siendo la presión intraocular alta el factor de riesgo más importante para desarrollarlo, por eso la importancia de realizar una adecuada medición de la presión intraocular (PIO) durante el examen oftalmológico. Objetivo: evaluar la concordancia de la medida de la presión intraocular tomada con los tonómetros de Goldmann, Pascal® y ORA, en pacientes con glaucoma de la consulta externa del servicio de oftalmología del Hospital de San José. Diseño: estudio descriptivo, de corte transversal y concordancia. Métodos: se compararon las medidas de Goldmann corregido, Pascal® y ORA corregido en 90 pacientes (167 ojos) con diagnóstico de glaucoma que asisten a consulta de oftalmología del Hospital de San José. Resultados: el coeficiente de correlación y concordancia de Lin entre Goldmann corregido y Pascal® es de 0.61; entre Goldmann corregido y ORA corregido de 0.64 y entre Pascal® y ORA corregido de 0.81. Conclusiones: se encontró una concordancia moderada para los tres tonómetros en la medición de la PIO en los ojos con glaucoma del servicio de oftalmología del Hospital de San José. Los tres métodos no son reemplazables, por lo tanto el seguimiento de los pacientes siempre debe ser tomado con un mismo método.

Introduction: glaucoma is the leading cause of worldwide irreversible blindness, high intraocular pressure remains the most important risk factor; because of that, it is essential to measure accurately the intraocular pressure (IOP). Objective: to evaluate the intraocular pressure correspondence of Goldmann-correlated IOP, Pascal® dynamic contour tonometer and Reichert Ocular Response Analyzer ORA tonometers in patients with glaucoma diagnosis at Ophthalmology Service, Hospital de San José. Design: a descriptive, cross-sectional and matching. Methods: measurements of Goldmann correlated IOP, Pascal® and ORA corneal compensated IOP were compared, in patients (167 eyes) diagnosed with glaucoma attending at ophthalmology Hospital San José. Results: the correlation coeffi cient and concordance Lin between Goldmann correlated IOP and Pascal® is 0.61; between ORA and Goldmann correlated IOP is 0.64 and between Pascal® and ORA is 0.81. Conclusions: we found a moderate agreement for the three tonometers for measuring IOP in eyes glaucoma attending at ophthalmology Hospital San José. The three methods are not replaceable, therefore monitoring of patients should always be taken with the same method.

Advanced extrauterine pregnancy at 33 weeks with a healthy newborn.

Abdominal pregnancy is a very rare form of ectopic pregnancy, associated with high morbidity and mortality for both fetus and mother. It is, and often, seen in poor resource nations, where early diagnosis is often a major challenge due to poor prenatal care and lack of medical resources. An advanced abdominal pregnancy with a good fetal and maternal outcome is therefore a more extraordinary occurrence in the modern developed world. We present a case of an abdominal pregnancy at 33.4 weeks in an individual with no documented prenatal care, who arrived in a hospital in the Bronx, in June 25th 2014, with symptoms of generalized, severe lower abdominal pain. Upon examination it was found that due to category III fetal tracing an emergent cesarean section was performed. At the time of laparotomy the fetus was located in the pelvis covered by the uterine serosa, with distortion of the entire right adnexa and invasion to the right parametrium. The placenta invaded the pouch of Douglas and the lower part of the sigmoid colon. A massive hemorrhage followed, followed by a supracervical hysterectomy. A viable infant was delivered and mother discharged on postoperative day 4.

Induction of labor at 41 weeks of pregnancy among primiparas with an unfavorable Bishop score.

OBJECTIVE: To determine the rate and factors associated with the successful Induction of Labor (IOL) in nulliparous patients undergoing scheduled IOL at 41 weeks of gestational age (GA) with an unfavorable cervix. DESIGN: This was a retrospective analysis that included nulliparous patients who presented to the Labor and Delivery unit at the Bronx Lebanon Hospital Center between 2011 and 2012 for elective IOL at 41 weeks of GA. The Bishop score was assessed upon admission and IOL agents were used in compliance with ACOG guidelines in different combinations, based on the obstetrical team preference. SETTING: Labor and Delivery Unit of the Bronx Lebanon Hospital. POPULATION: Nulliparous patients with 41 weeks of pregnancy for elective induction of labor. SAMPLE: Seventy-six patients were included in the study. GA was confirmed using a combination of the last menstrual period and a dating sonogram during pregnancy. METHODS: This was a retrospective chart review that included nulliparous patients who presented to the Labor and Delivery unit at the Bronx Lebanon Hospital Center between October 2011 and October 2012 for elective IOL at 41 weeks of gestational age with an unfavorable cervix defined as a Bishop score of 6 or less. MAIN OUTCOME MEASURES: The overall successful rate of IOL in a combination of different maternal factors with different agents for induction in nulliparous patients undergoing scheduled IOL with an unfavorable Bishop score at 41 weeks of GA was 51.32 %. RESULTS: Factors associated with successful IOL were younger age [22.3 years vs. 25.1(p = 0.015)], lower BMI [25 vs. 28.1(p = 0.46)] and lower maternal weight [64.75 kg vs. 74.02 (p = 0.28)]. Maternal height was not a contributing factor; the artificial rupture of membranes, epidural anesthesia and the prostaglandins used did not contribute. Use of cervical balloon and oxytocin was associated with failed IOL. CONCLUSIONS: Patients undergoing IOL at 41 weeks with an unfavorable cervix had a successful rate of 51.32 %. Younger maternal age, lower weight, and lower BMI were associated with successful IOL.