Peripapillary and optic nerve head vessel density of glaucoma and healthy subjects from Afro-Caribbean and European descent: A pilot study.

PURPOSE: To compare the peripapillary and optic nerve head vessel density (PP-ONH VD) between glaucoma patients (all, early, moderated, and advanced) and healthy subjects of Afro-Caribbean descent (AD) and European descent (ED). METHODS: This was a cross-sectional study. One eye was evaluated in 90 subjects, including 66 glaucoma patients and 24 healthy subjects, who underwent PP-ONH VD imaging using SPECTRALIS® Optical Coherence Tomography Angiography (OCT-A). We analysed the superficial vascular complex using the AngioTool version 0.6a software. The correlation between the PP-ONH VD and visual field mean deviation (MD) was evaluated using a scatter plot and Spearman's rho correlation coefficient. RESULTS: Among the healthy subjects, the AD group had a lower superficial PP-ONH VD [43.29±3.25% (mean±standard deviation)] than the ED group (46.06±1.75%) (P=0.016). Overall, superficial PP-ONH VD did not show any significant differences between the total AD and ED glaucoma patients or in the subgroup analyses (early/moderate/advanced) (AD: 32.73±6.70%, 37.11±5.72%, 32.48±5.73%, 27.76±4.74%, respectively; ED: 33.94±6.89%, 38.52±3.82%, 35.56±4.18%; 27.65±6.31%, respectively) (P>0.05 for all). A strong, statistically significant correlation was established between vessel density and mean deviation among AD and ED glaucoma patients (r=0.709 and r=0.704, respectively) (P<0.001 for both). CONCLUSION: This pilot study shows that healthy subjects of AD had lower peripapillary and optic nerve head superficial vessel density than healthy subjects of ED, but no significant differences were found between AD and ED glaucoma groups (all, early, moderate, or advanced).

Comparision of intraocular pressure measured using the new icare 200™ rebound tonometer and the Perkins™ applanation tonometer in healthy subjects and in patients with primary congenital glaucoma. / Comparación entre el tonómetro de rebote IC200 y el tonómetro de aplanación Perkins en sujetos sanos y pacientes con glaucoma congénito.

OBJECTIVE: To compare intraocular pressure (IOP) measurements obtained using the Icare 200™ (IC200) rebound tonometer and the hand-held version of the Goldmann Applanation Tonometer (Perkins™ tonometer, GAT) in patients with primary congenital glaucoma (PCG) and in healthy subjects. MATERIAL AND METHODS: A total of 42 eyes of healthy subjects (G1) and 40 patients with PCG (G2) were analysed. The following clinical data were collected: gender, age, Cup/Disc ratio, central corneal thickness (CCT). IOP was determined in the examination room using the IC200 and GAT tonometers, in the same order. Agreement between both tonometers was determined using the intraclass correlation coefficient (ICC) and Bland-Altman plot. A linear regression analysis was used to establish the IOP was affected by the studied variables. RESULTS: Mean IOP between both tonometers (IC200 minus GAT) was: G1=15.91 (2.57) mmHg vs. 15.06 (2.12) mmHg (mean difference, MD=0.84 (0.50) mmHg; P<.101) and G2=20.10 (6.37) vs.19.12 (5.62) (MD=0.98 (1.36); P=.474). Excellent agreement was found between IC200 and GAT in both groups (ICC=G1: 0.875 (95% CI; 0.768-0.933; P<.001); G2: 0.924 (95% CI; 0.852-0.961; P<.001), and there was a statistically significant correlation between the IOP difference measured with IC200 and GAT and CCT in G1 (B=0.021; 95% CI; 0.005-0.037; P=.008), but was not statistically significant in G2. CONCLUSION: There was excellent agreement between the IC200 and GAT tonometers, both in healthy subjects and PCG, with a trend to overestimate IOP when measured with IC200. There was no influence by CCT on IOP measurements in patients with PGC.

The Mars Environmental Dynamics Analyzer, MEDA. A Suite of Environmental Sensors for the Mars 2020 Mission.

NASA's Mars 2020 (M2020) rover mission includes a suite of sensors to monitor current environmental conditions near the surface of Mars and to constrain bulk aerosol properties from changes in atmospheric radiation at the surface. The Mars Environmental Dynamics Analyzer (MEDA) consists of a set of meteorological sensors including wind sensor, a barometer, a relative humidity sensor, a set of 5 thermocouples to measure atmospheric temperature at ∼1.5 m and ∼0.5 m above the surface, a set of thermopiles to characterize the thermal IR brightness temperatures of the surface and the lower atmosphere. MEDA adds a radiation and dust sensor to monitor the optical atmospheric properties that can be used to infer bulk aerosol physical properties such as particle size distribution, non-sphericity, and concentration. The MEDA package and its scientific purpose are described in this document as well as how it responded to the calibration tests and how it helps prepare for the human exploration of Mars. A comparison is also presented to previous environmental monitoring payloads landed on Mars on the Viking, Pathfinder, Phoenix, MSL, and InSight spacecraft.

Agreement between slit lamp examination and optical coherence tomography in estimating cup-disc ratios.

PURPOSE: To compare optical coherence tomography (OCT) cup-disc ratio measurements with those estimated by two independent examiners using the slit lamp in an evaluation of the optic nerve head (ONH). METHODS: In 47 eyes each of 47 patients with glaucoma and 47 healthy subjects, the ONH was examined using the slit lamp with a 78 D lens. Two examiners subjectively determined the cup-disc area ratio (A-CDR), the horizontal cup-disc ratio (H-CDR), and the vertical cup-disc ratio (V-CDR). These measurements were compared to objective OCT readings obtained by a third examiner blind to the slit lamp results. RESULTS: For the three variables determined, correlation indices between the OCT readings and the two sets of slit lamp measurements were significantly higher for the glaucoma group than the control group. In the patients with glaucoma, the OCT tended to underestimate A-CDR and overestimate H-CDR. For both these variables, Bland-Altmann analysis revealed significant differences between the two methods that persisted across the whole range of CDRs examined. In contrast, differences in V-CDR varied with disc size. CONCLUSIONS: The OCT is a diagnostic tool that provides a complete automatic evaluation of the ONH. However, its measurements vary significantly from those obtained in subjective evaluations performed by experienced ophthalmologists.

[Correlating cup-to-disc ratios measured by HRT-III, SD-OCT and the new color imaging Laguna ONhE procedure]. / Correlación de la relación excavación/papila óptica medida mediante HRT-III, SD-OCT y el dispositivo de colorimetría fotográfica Laguna OnhE.

OBJECTIVE: To examine correlations between cup-to-disc (C/D) ratios determined by the new Laguna ONhE (optic nerve hemoglobin) color imaging procedure, spectral domain optical coherence tomography (OCT), confocal scanning laser tomography using Heidelberg retina tomography (HRT), and examining retinal images. METHODS: C/D ratio measurements were made on 154 eyes of 154 subjects (52 healthy controls, 36 with ocular hypertension and 66 with primary open-angle glaucoma) using the Laguna ONhE, HRT-III (Heidelberg Engineering) and OCT Spectralis (Heidelberg Engineering) instruments and photographs of the optic disc were examined by a blinded observer (experienced glaucoma specialist). RESULTS: Global intraclass correlation coefficients (ICC) were: 0.379 (95% CI: 0.233-0.508) for Laguna ONhE-HRT, 0.621 (95% CI: 0.513-0.709) for Laguna ONhE-OCT, and 0.558 (95% CI: 0.398-0.678) for the Laguna ONhE-observer, indicating significant agreement in each case (P<.001). The highest ICC was recorded for OCT- observer (0.715; 95% CI: 0.605-0.795). CONCLUSIONS: C/D ratios measured using the Laguna ONhE procedure correlated well with OCT measurements and retinography measurements made by an experienced observer. Best correlation was observed for OCT versus observer measurements. Agreement was good between the Laguna ONhE, OCT and observer measurements, and was somewhat lower between HRT and the remaining procedures.

Pigment dispersion syndrome associated with optic nerve melanocytoma.

CASE REPORT: A 60-year old patient was referred for cataract surgery. The examination showed retrokeratic pigment in the left eye, which had an intraocular pressure of 24 mm Hg. The funduscopy showed a brown lesion on the left optic disk, with adjacent vitreous seeding of pigment. The patient was thus diagnosed with secondary pigment dispersion syndrome due to optic disk melanocytoma. DISCUSSION: Although melanocytoma is most commonly a benign, stationary tumor, it may present with major complications leading to significant visual loss. A patient with melanocytoma of the optic disk should be examined periodically.

Corneal Segmentation Analysis Increases Glaucoma Diagnostic Ability of Optic Nerve Head Examination, Heidelberg Retina Tomograph's Moorfield's Regression Analysis, and Glaucoma Probability Score.

Purpose. To study whether a corneal thickness segmentation model, consisting in a central circular zone of 1 mm radius centered at the corneal apex (zone I) and five concentric rings of 1 mm width (moving outwards: zones II to VI), could boost the diagnostic accuracy of Heidelberg Retina Tomograph's (HRT's) MRA and GPS. Material and Methods. Cross-sectional study. 121 healthy volunteers and 125 patients with primary open-angle glaucoma. Six binary multivariate logistic regression models were constructed (MOD-A1, MOD-A2, MOD-B1, MOD-B2, MOD-C1, and MOD-C2). The dependent variable was the presence of glaucoma. In MOD-A1, the predictor was the result (presence of glaucoma) of the analysis of the stereophotography of the optic nerve head (ONH). In MOD-B1 and MOD-C1, the predictor was the result of the MRA and GPS, respectively. In MOD-B2 and MOD-C2, the predictors were the same along with corneal variables: central, overall, and zones I to VI thicknesses. This scheme was reproduced for model MOD-A2 (stereophotography along with corneal variables). Models were compared using the area under the receiver operator characteristic curve (AUC). Results. MOD-A1-AUC: 0.771; MOD-A2-AUC: 0.88; MOD-B1-AUC: 0.736; MOD-B2-AUC: 0.845; MOD-C1-AUC: 0.712; MOD-C2-AUC: 0.838. Conclusion. Corneal thickness variables enhance ONH assessment and HRT's MRA and GPS diagnostic capacity.

Management of diarrhoea in HIV-infected patients.

Human immunodeficiency virus (HIV) infection can weaken the immune system causing its inability to combat opportunistic infections. Managing the complexity of these opportunistic infections has created a challenge for healthcare professionals. Our knowledge on the aetiological agents causing opportunistic infections in immunocompromised hosts has increased over the last decade. Diarrhoeal diseases are frequent complications associated with HIV-infected patients. For most of the causes of diarrhoea, the clinical signs are non-specific, and the laboratory diagnostic workup is neither easy nor fast. This review provides data on aetiological approaches of common diarrhoeal diseases including viral, microbacterial, parasitic, bacterial and fungal infections, and HIV enteropathy; diagnostic evaluation; and treatment of diarrhoea in HIV-infected patients. This article will be helpful for those who are in the practice of managing diarrhoea in such patients.

[Paradoxical cessation in a case of Charles Bonnet syndrome]. / Cese paradójico de un caso de síndrome de Charles Bonnet.

CASE REPORT: 78-year-old male patient diagnosed with Charles Bonnet syndrome (CBS) showing secondary visual deficit toward end-stage glaucoma. He progressed to amaurosis, with an abrupt disappearance of hallucinations in parallel to the loss of residual vision. DISCUSSION: The paradoxical cessation of CBS occurs when the patient loses residual vision and progresses to amaurosis. The lack of stimulation, both in the corresponding retina and the cortex, lead to the disappearance of hallucinations because the desafferented and hyper-excited neurons lose the necessary stimulus that triggers CBS.

Functional analysis of ldlr genetic variants identified in hypercholesterolemic patients in brazil, USING CRISPR/CAS9

BACKGROUND AND AIMS: Introduction: The familial hypercholesterolemia (FH) is one of the main causes of cardiovascular diseases, and it is mainly caused by genetic variants at the low-density lipoprotein receptor (LDLR). Although ultrasequencing technology has allowed the identification of several genetic variants, few of them was functional analyzed. The CRISPR/ Cas9 tool promotes precise genetic editing and allows the creation of experimental models, therefore contributing to the functional validation process. Aim: To use the CRISPR/Cas9 tool to perform in vitro functional analysis of LDLR variants identified in FH patients. METHODS: Two missense LDLR variants were selected within a group of variants identified in FH patients, based on in silico data, the affected protein domain and MAF. Three sgRNAs were designed for each of the variants c.551G>A and c.1118G>A, to analyze the accuracy of the sgRNAs. The sgRNAs were inserted on PX458 plasmid, cloned, purified in E. coli DH5a, and then co-transfected with the DNA template at HepG2 cells. The DNAs templates were designed to contain the selected variants. RESULTS: HepG2 cells co-transfected with PX458 constructs and DNA templates showed considerably transfection rate, being possible to visualize it at fluorescence microscopy. However, it was noted that single transfection of sgRNAs showed a higher transfection efficiency than cotransfection. CONCLUSIONS: We designed sgRNA for c.551G>A and c.1118G>A variants, being able to analyze the transfection efficiency. In further steps, we will select new sgRNAs for LDLR variants that have not been described yet, and functional analysis will be performed to determine the clinical relevance of these variants.

Comparación entre el tonómetro de rebote IC200 y el tonómetro de aplanación Perkins en sujetos sanos y pacientes con glaucoma congénito / Comparision of intraocular pressure measured using the new icare 200™ rebound tonometer and the Perkins™ applanation tonometer in healthy subjects and in patients with primary congenital glaucoma

Objetivo Comparar las medidas de presión intraocular (PIO) obtenidas con el tonómetro de rebote iCare 200 (IC200) con las obtenidas mediante la versión portátil del tonómetro de aplanación Goldmann, Perkins (GAT) en pacientes con glaucoma congénito primario (GCP) y en sujetos sanos. Material y métodos Se incluyeron 42 sujetos sanos (G1) y 40 pacientes con GCP (G2). Se incluyó un ojo por paciente. Se recogieron las variables clínicas de interés: sexo, edad, grosor corneal central (GCC) y se midió la PIO mediante los tonómetros IC200 y GAT en el mismo orden, en consulta. Se estudió la concordancia entre tonómetros mediante el coeficiente de correlación intraclase y el gráfico de Bland Altman. La influencia de las variables se analizó mediante test de regresión lineal. Resultado Las medias de PIO obtenidas mediante IC200 y GAT fueron: G1=15,91 (2,57) vs. 15,06 (2,12) mmHg (diferencia de medias, DM=0,84 (0,50) mmHg; p=0,101) y en el G2=20,10 (6,37) vs.19,12 (5,62) (DM=0,98 [1,36]; p=0,474). Se observó excelente concordancia entre IC200/GAT en ambos los grupos (coeficiente de correlación intraclase=G1: 0,875 [IC 95%: 0,768-0,933; p<0,001]; G2: 0,924 [IC 95% 0,852-0,961; p<0,001]), así como la influencia del GCC en la diferencia entre tonómetros en el G1 (B=0,021; IC 95%: 0,005-0,037; p=0,008), sin significación estadística en el G2. Conclusión Se ha encontrado una excelente concordancia entre ambos tonómetros, IC200 y GAT tanto en sujetos sanos como en pacientes con GCP, con una tendencia a la sobreestimación de la PIO de IC200 sobre Perkins. No se ha demostrado la influencia del GCC en los pacientes con GCP (AU)

Objective To compare intraocular pressure (IOP) measurements obtained using the Icare 200™ (IC200) rebound tonometer and the hand-held version of the Goldmann Applanation Tonometer (Perkins™ tonometer, GAT) in patients with primary congenital glaucoma (PCG) and in healthy subjects Material and method a total of 42 eyes of healthy subjects (G1) and 40 patients with PCG (G2) were analysed. The following clinical data were collected: gender, age, Cup/Disc ratio, central corneal thickness (CCT). IOP was determined in the examination room using the IC200 and GAT tonometers, in the same order Agreement between both tonometers was determined using the intraclass correlation coefficient (ICC) and Bland-Altman plot. A linear regression analysis was used to establish the IOP was affected by the studied variables. Results Mean IOP between both tonometers (IC200 minus GAT) was: G1=15.91 (2.57) mmHg vs. 15.06 (2.12) mmHg (mean difference, MD=0.84 (0.50) mmHg; P<.101) and G2=20.10 (6.37) vs.19.12 (5.62) (MD=0.98 (1.36); P=.474). Excellent agreement was found between IC200 and GAT in both groups (ICC=G1: 0.875 (95% CI; 0.768-0.933; P<.001); G2: 0.924 (95% CI; 0.852-0.961; P<.001), and there was a statistically significant correlation between the IOP difference measured with IC200 and GAT and CCT in G1 (B=0.021; 95% CI; 0.005–0.037; P=.008), but was not statistically significant in G2. Conclusion There was excellent agreement between the IC200 and GAT tonometers, both in healthy subjects and PCG, with a trend to overestimate IOP when measured with IC200. There was no influence by CCT on IOP measurements in patients with PGC (AU)

Consulta de preanestesia en cirugía mayor ambulatoria / No disponible

La consulta de preanestesia en la unidad de cirugía mayor ambulatoria, es un elemento muy importante desde el punto de vista organizativo, ya que gracias a un buen planteamiento de la misma podemos obtener un mayor rendimiento así como mejorar la seguridad del paciente. En este trabajo se presenta de manera descriptiva el modo en el que estamos organizados, que se divide fundamentalmente en tres aspectos: a) el cuestionario de salud, que es rellenado por el paciente, consiguiendo así que participen en su salud; b) los algoritmos o flujo gramas que en base a la edad, estado físico, comorbilidades y tipo de cirugía orientan a la hora de pedir pruebas complementarias, consiguiendo así una indicación más precisa de las mismas; y por último c) la clasificación del tipo de cirugía, realizada en base a la experiencia acumulada en nuestro centro y el tipo de cirugía. Este diseño de entre muchos válidos es muy dinámico, permitiendo su adaptación a las necesidades de cada centro, mejorando así el rendimiento y la seguridad del paciente (AU)

Pre-anaesthetic evaluation constitutes an important organizational component in a day surgery unit. A careful set up may lead to major efficiency and improved patient safety. This work presents a description of the organizational model of our unit, which consists of three fundamental elements: a) the health questionnaire, filled in by the patient, thus achieving implication in her/his health related questions; b)the algorithms or flow-charts which, based on patients’ age, ASA, comorbidities, and type of surgery, indicate more precisely the complementary analyses to be done; and c) finally classification of the surgery to be carried out, based on the body of experience accumulated in our centre. This design is, among many other valid ones, very dynamic and permits being adapted to the necessities of varying centres obtaining better efficiency and patient safety (AU)