Attention-deficit/hyperactivity disorder genomics: update for clinicians.

Attention deficit, hyperactivity disorder (ADHD) is familial and highly heritable. Several candidate genes involved in neurotransmission have been identified, however these confer minimal risk, suggesting that for the most part, ADHD is not caused by single common genetic variants. Advances in genotyping enabling investigation at the level of the genome have led to the discovery of rare structural variants suggesting that ADHD is a genomic disorder, with potentially thousands of variants, and common neuronal pathways disrupted by numerous rare variants resulting in similar ADHD phenotypes. Heritability studies in humans also indicate the importance of epigenetic factors, and animal studies are deciphering some of the processes that confer risk during gestation and throughout the post-natal period. These and future discoveries will lead to improved diagnosis, individualized treatment, cures, and prevention. These advances also highlight ethical and legal issues requiring management and interpretation of genetic data and ensuring privacy and protection from misuse.

A Pilot Study on the Effect of Alternate Nostril Breathing and Foot Reflexology on Intraocular Pressure in Ocular Hypertension.

The purpose of this study is to investigate the effects of alternate nostril breathing (ANB) and foot reflexology (FR) on lower intraocular pressure (IOP) in patients with ocular hypertension (OHTN). This prospective pilot study recruited 11 patients from 2014 to 2016 from Temple opthamology outpatient clinic. Patients had OHTN with ages of 48-78 years. Patients were excluded if they currently performed ANB or FR, were unable to perform the task, had previous eye surgery or laser, were receiving other complementary and alternative medicine for OHTN, or were unable to complete drug washout period. After a 30-day drug washout, patients were randomly assigned to complete either ANB or FR for 5 min. After instruction, patients completed either ANB or FR, and completed the alternate task 2 weeks later. IOP was measured before the task, immediately after the task, and then every 30 min for 2 h. Decrease in IOP compared with baseline IOP was significant for ANB and FR at all time points. Baseline IOP was 25.86 ± 3.19 mmHg for ANB and 25.41 ± 3.54 mmHg for FR (N = 22 eyes). There was only one significant difference between IOP for the right and left eyes for FR at 120 min. Otherwise, there was no difference between eyes for both ANB and FR. There was a significant decrease in IOP at 30 min post task with IOP decrease of 1.98 ± 1.70 mmHg for ANB and 3.59 ± 1.89 mmHg for FR (both p < 0.0001) and at 60 min post task with IOP decrease of 2.39 ± 2.05 mmHg for ANB and 3.86 ± 1.89 mmHg for FR (both p < 0.0001). The decrease in IOP at 90 and 120 min post task was less but remained significant (p < 0.0001). Both FR and ANB had a small but significant IOP lowering effect. These alternative therapies could serve as possible adjunctive treatments for lowering IOP.

Philadelphia glaucoma detection and treatment project: ocular outcomes and adherence to follow-up at a single health centre.

OBJECTIVES: To determine ocular outcomes and factors associated with adherence to ophthalmic follow-up in a medically underserved population at a single health centre in Philadelphia. DESIGN: Retrospective chart review. PARTICIPANTS: Patients from a community glaucoma screening program. METHODS: Chart review was conducted for participants who received a complete eye examination at the Philadelphia District Health Center 5 between January 1, 2012 and May 31, 2014 within the Philadelphia Glaucoma Detection and Treatment Project. Multivariate logistic regression was used to determine factors related to ophthalmic follow-up adherence. RESULTS: A total of 249 participants completed an eye examination (mean age = 57.7 ± 6.9 years). Most were African American (n = 220; 88.4%); female (n = 129; 51.8%). Forty-seven participants (18.9%) received glaucoma-related diagnoses, 20 (8.0%) were prescribed ocular medication, and 26 (10.4%) underwent laser therapy. Ninety (36.1%) attended their recommended follow-up eye examination at the health centre. Glaucoma-related diagnosis (p ≤ 0.001), recommendation of a 4- to 6-week follow-up period (p < 0.001), prescribed eye drops (p < 0.001), or received laser therapy (p = 0.047) were factors most predictive of ophthalmic follow-up adherence. CONCLUSIONS: The collaborative effort of eye care providers and health centres offers an important opportunity to detect, treat, and manage glaucoma and other ocular pathology in medically underserved communities. Having a glaucoma-related diagnosis, initiating treatment, and scheduling regular follow-up visits are the most important factors influencing adherence to follow-up eye appointments.

The prevalence and characteristics of chronic ocular itch: a cross-sectional survey.

INTRODUCTION: In this cross-sectional study, we aimed to determine the prevalence and characteristics of chronic ocular itch in an outpatient ophthalmology and optometry clinic. METHODS: Four hundred patients from an outpatient ophthalmology and optometry clinic were enrolled. The presence and characteristics of chronic ocular itch were assessed by a questionnaire. Data regarding ophthalmologic, dermatologic, and systemic conditions as well as current medications were extracted from medical records. RESULTS: Chronic ocular itch was present in 118 (29.5%) of 400 participants. Chronic ocular pruritus was significantly more prevalent in females [P=0.015; odds ratio (OR)=1.8; 95% confidence interval (CI), 1.1-2.8] and was significantly associated with the presence of allergic conjunctivitis [51.8% (n=45); P<0.001; OR=5.0; 95% CI, 3.0-8.3], dry eye syndrome [40.1% (75); P<0.001; OR=2.6; 95% CI, 1.7-4.1], blepharitis [43.8% (n=21); P=0.021; OR=2.0; 95% CI, 1.1-3.8], and atopic dermatitis [50.0% (n=10); P=0.023; OR=2.6; 95% CI, 1.1-5.8]. Chronic ocular itch was not significantly associated with systemic conditions, or the use of prescribed ophthalmologic medications. DISCUSSION: Chronic ocular itch is common and may be related to ophthalmologic or dermatologic pathologies. The present findings highlight the importance of identifying and managing this uncomfortable symptom that may negatively impact the quality of life and sleep of affected patients.