真空小梁成形术治疗原发性开角型青光眼患者的临床观察

目的：观察真空小梁成形术（PN T ）对原发性开角型青光眼患者的降眼压效果,体会患者对此治疗的依从性改变。方法选取我院2012年11月至2014年5月就诊的原发性开角型青光眼患者30例（45眼）,入选患者门诊均行眼科一般检查、超声生物显微镜（UBM ）、Humphrey视野、海德堡 HRT、24 h眼压曲线（非接触眼压计）以确诊。患者单眼或双眼进行PNT 1000型治疗仪（Ophthalmic International公司产）治疗。治疗后1天、1周、2周、1个月、2个月复测眼压。首次治疗后半月重复治疗一次,此后每2～3月根据患者依从性可重复治疗。单眼治疗者选治疗眼,双眼者随机选1眼。结果治疗后1天、1周、2周、1月、2月各时间点眼压较治疗前眼压差异有统计学意义（P＜0.01）。无1例出现严重并发症。治疗后一年内6例患者重复治疗3次,6例患者治疗2次,7例患者治疗1次,11例患者未重复治疗。结论真空小梁成形术（PN T ）可安全有效地降低原发性开角型青光眼患者眼压,可用于开角型青光眼降眼压治疗,但筛选病人条件苛刻,且病人依从性较差,对治疗易失去耐心,应用范围较窄。     

The impact of primary care organization on avoidable hospital admissions for diabetes in 23 countries

Objective: Diabetes is a so-called ambulatory care sensitive condition. It is assumed that by appropriate and timely primary care, hospital admissions for complications of such conditions can be avoided. This study examines whether differences between countries in diabetes-related hospitalization rates can be attributed to differences in the organization of primary care in these countries. Design: Data on characteristics of primary care systems were obtained from the QUALICOPC study that includes surveys held among general practitioners and their patients in 34 countries. Data on avoidable hospitalizations were obtained from the OECD Health Care Quality Indicator project. Negative binomial regressions were carried out to investigate the association between characteristics of primary care and diabetes-related hospitalizations. Setting: A total of 23 countries. Subjects: General practitioners and patients. Main outcome measures: Diabetes-related avoidable hospitalizations. Results: Continuity of care was associated with lower rates of diabetes-related hospitalization. Broader task profiles for general practitioners and more medical equipment in general practice were associated with higher rates of admissions for uncontrolled diabetes. Countries where patients perceive better access to care had higher rates of hospital admissions for long-term diabetes complications. There was no association between disease management programmes and rates of diabetes-related hospitalization. Hospital bed supply was strongly associated with admission rates for uncontrolled diabetes and long-term complications. Conclusions: Countries with elements of strong primary care do not necessarily have lower rates of diabetes-related hospitalizations. Hospital bed supply appeared to be a very important factor in this relationship. Apparently, it takes more than strong primary care to avoid hospitalizations.

• Key points

• Countries with elements of strong primary care do not necessarily have lower rates of diabetes-related avoidable hospitalization.

• Hospital bed supply is strongly associated with admission rates for uncontrolled diabetes and long-term complications.

• Continuity of care was associated with lower rates of diabetes-related hospitalization.

• Better access to care, broader task profiles for general practitioners, and more medical equipment in general practice was associated with higher rates of admissions for diabetes.

     

NOBOX is a strong autosomal candidate gene in Tunisian patients with primary ovarian insufficiency

Premature ovarian insufficiency (POI) affects approximately 1% of women before the age of 40. Genetic contribution is a significant component of POI. In this context, heterozygous mutations in NOBOX, BMP15 and GDF9 have been reported. The objective of our study was to evaluate the prevalence of these genes mutations in 125 unrelated Tunisian patients diagnosed with POI. The screening of NOBOX gene revealed three missense mutations (p.Arg117Trp; p.Gly91Trp and p.Pro619Leu) in eight patients. These mutations were not found in a 200 ethnically matched women without fertility problem. The sequencing of BMP15 and GDF9 gene revealed only previously reported variants. In contrast to previous studies, the prevalence of BMP15 variations is not higher than in the control population. Conversely, 6.4% of the cases present a NOBOX mutations; this high prevalence strengthens the consideration of NOBOX gene as strong autosomal candidate for POI.