Choroidal thickness and granulocyte colony-stimulating factor in tears improve the prediction model for coronary artery disease.

BACKGROUND: Coronary artery disease (CAD) detection in asymptomatic patients still remains controversial. The aim of our study was to evaluate the usefulness of ophthalmologic findings as predictors of the presence of CAD when added to cardiovascular classic risk factors (CRF) in patients with acute coronary cardiopathy suspicion. METHODS: After clinical stabilization, 96 patients with acute coronary cardiopathy suspicion were selected and divided in two groups: 69 patients with coronary lesions and 27 patients without coronary lesions. Their 192 eyes were subjected to a complete routine ophthalmologic examination. Samples of tear fluid were also collected to be used in the detection of cytokines and inflammatory mediators. Logistic regression models, receiver operating characteristic curves and their area under the curve (AUC) were analysed. RESULTS: Suggestive predictors were choroidal thickness (CT) (OR: 1.02, 95% CI 1.01-1.03) and tear granulocyte colony-stimulating factor (G-CSF) (OR: 0.97, 95% CI 0.95-0.99). We obtained an AUC of 0.9646 (95% CI 0.928-0.999) when CT and tear G-CSF were added as independent variables to the logistic regression model with cardiovascular CRF: sex, age, diabetes, high blood pressure, hypercholesterolemia, smoking habit and obesity. This AUC was significantly higher (p = 0.003) than the prediction derived from the same logistic regression model without CT and tear G-CSF (AUC = 0.828, 95% CI 0.729-0.927). CONCLUSIONS: CT and tear G-CSF improved the predictive model for CAD when added to cardiovascular CRF in our sample of symptomatic patients. Subsequent studies are needed for validation of these findings in asymptomatic patients.

COVID-19, una nueva oportunidad para la educación sanitaria global / COVID-19, a new opportunity for global health education

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Infectious crystalline keratopathy: Management of three cases with different risk factors.

We present the management of three cases of infectious crystalline keratopathy. The first one, in a 46-year-old patient with two previous penetrating keratoplasties; the second one, in a 46-year-old patient with chronic alcoholism and limbal insufficiency; and the third one, in a 70-year-old patient with bullous keratopathy. Other systemic conditions that may mimic infectious crystalline keratopathy, such as multiple myeloma, gout or cystinosis were ruled out on each patient by laboratory testing. The cases were managed with topical or topical and systemic treatment that led to the disappearance of the symptoms. Infectious crystalline keratopathy is a chronic and indolent pathology in which interlamellar bacterial plaques are observed in absence of apparent ocular inflammatory signs. Microorganisms penetrate the cornea through epithelial defects, commonly after a penetrating keratoplasty, although other risk factors may be present.

Chorioretinitis sclopetaria caused by an intraorbital metallic foreign body.

A 44-year-old man was referred for evaluation of pain and temporal floaters after receiving a rebounded bullet impact to his right eye. Typical funduscopic findings, together with the confirmed presence of an intraorbital metallic foreign body, led to the diagnosis of chorioretinitis sclopetaria. Conservative management was performed as no severe symptoms were observed. The favorable clinical outcome was confirmed in subsequent reviews. Chorioretinitis sclopetaria is characterized by a proliferative chorioretinal inflammation as a consequence of the expansive wave caused by the entrance of a bullet between the eyeball and the orbit.

Chorioretinitis sclopetaria caused by an intraorbital metallic foreign body / Coriorretinite esclopetária causada por um corpo estranho metálico intraorbitário

ABSTRACT A 44-year-old man was referred for evaluation of pain and temporal floaters after receiving a rebounded bullet impact to his right eye. Typical funduscopic findings, together with the confirmed presence of an intraorbital metallic foreign body, led to the diagnosis of chorioretinitis sclopetaria. Conservative management was performed as no severe symptoms were observed. The favorable clinical outcome was confirmed in subsequent reviews. Chorioretinitis sclopetaria is characterized by a proliferative chorioretinal inflammation as a consequence of the expansive wave caused by the entrance of a bullet between the eyeball and the orbit.

RESUMO Um homem de 44 anos foi encaminhado para avaliação de dor e flutuadores temporais após receber um impacto de bala ressaltado em seu olho direito. Achados fundoscópicos típicos, juntamente com a presença confirmada de um corpo estranho metálico intraorbitário, levaram ao diagnóstico de coriorretinite esclopetária. O manejo conservador foi realizado, pois não foram observados sintomas graves. O desfecho clínico favorável foi confirmado em revisões subsequentes. A coriorretinite esclopetária é caracterizada por uma inflamação coriorretiniana proliferativa como consequência da onda expansiva causada pela entrada de uma bala entre o globo ocular e a órbita.

Immunohistochemical study of macrophage and cytokine dynamics in the gut of scrapie-infected mice.

To study numerical changes in intestinal macrophages and variations in cytokine production by immune cells in the intestine, conventional C57BL/6J mice were orally infected with the Rocky Mountain Laboratory strain of scrapie. Animals were sacrificed at different timepoints, and samples were taken and processed by routine methods for morphological and immunohistochemical analysis. The results point to a possible role for macrophages in the uptake and transport of the infective agent to Peyer's patches. The observed increase in macrophage numbers in subepithelial sites, taken in conjunction with a drop in tumour necrosis factor-alpha production at these sites, suggests a possible secretory inhibition that could be induced by the disease-associated prion protein (PrPd). On the other hand, cytokine dynamics indicated the presence of an impaired Th1-Th2 cell mediated response, which could facilitate the spread of PrPd to the central nervous system. Further research is required to confirm these hypotheses.

Insulin-like growth factor I gene transfer to cirrhotic liver induces fibrolysis and reduces fibrogenesis leading to cirrhosis reversion in rats.

UNLABELLED: We investigated whether gene transfer of insulin-like growth factor I (IGF-I) to the hepatic tissue was able to improve liver histology and function in established liver cirrhosis. Rats with liver cirrhosis induced by carbon tetrachloride (CCl(4)) given orally for 8 weeks were injected through the hepatic artery with saline or with Simian virus 40 vectors encoding IGF-I (SVIGF-I), or luciferase (SVLuc). Animals were sacrificed 8 weeks after vector injection. In cirrhotic rats we observed that, whereas IGF-I was synthesized by hepatocytes, IGF-I receptor was predominantly expressed by nonparenchymal cells, mainly in fibrous septa surrounding hepatic nodules. Rats treated with SVIGF-I showed increased hepatic levels of IGF-I, improved liver function tests, and reduced fibrosis in association with diminished alpha-smooth muscle actin expression, up-regulation of matrix metalloproteases (MMPs) and decreased expression of the tissue inhibitors of MMPs TIM-1 and TIM-2. SVIGF-I therapy induced down-regulation of the profibrogenic molecules transforming growth factor beta (TGFbeta), amphiregulin, platelet-derived growth factor (PDGF), connective tissue growth factor (CTGF), and vascular endothelium growth factor (VEGF) and induction of the antifibrogenic and cytoprotective hepatocyte growth factor (HGF). Furthermore, SVIGF-I-treated animals showed decreased expression of Wilms tumor-1 (WT-1; a nuclear factor involved in hepatocyte dedifferentiation) and up-regulation of hepatocyte nuclear factor 4 alpha (HNF4alpha) (which stimulates hepatocellular differentiation). The therapeutic potential of SVIGF-I was also tested in rats with thioacetamide-induced liver cirrhosis. Also in this model, SVIGF-I improved liver function and reduced liver fibrosis in association with up-regulation of HGF and MMPs and down-regulation of tissue inhibitor of metalloproteinase 1 (TIMP-1). CONCLUSION: IGF-I gene transfer to cirrhotic livers induces MMPs and hepatoprotective factors leading to reversion of fibrosis and improvement of liver function. IGF-I gene therapy may be a useful alternative therapy for patients with advanced cirrhosis without timely access to liver transplantation.

Role of hepatic macrophages during the viral haemorrhagic fever induced by African Swine Fever Virus.

To ascertain the role played by the various liver monocyte-macrophage populations in the course of a viral hemorrhagic fever, fifteen pigs were inoculated intramuscularly with the highly virulent isolate of African Swine Fever Virus (ASFV) España-70 and slaughtered at 1-7 days post-inoculation (dpi). Samples of liver were fixed in different solutions and routinely processed for morphological, immunohistochemical and ultrastructural studies. Viral antigen (vp73) was detected from 3 dpi onward, mainly in circulating monocytes of sinusoid and Kupffer's cells (KC), as well as in portal macrophages and hepatocytes from 5 dpi. Anti-SWC3 immunolabelled cells were increased from 1 dpi, peaking between 3 and 5 dpi, thereafter declining until the end of the experiment. The significant increase in the number of sinusoidal circulating monocytes and KC expressing IL-1alpha, TNFalpha and IL-6 from 1 dpi, confirmed the secretory activation of these cells. The results show that in the course of an ASFV-induced hemorrhagic syndrome, hepatic macrophage populations undergo major quantitative and biosynthetic changes prior to virus detection, suggesting the existence of a mechanism by which the virus concentrates infectable cells, which subsequently spread the virus around the body.