Sensorineural hearing loss in pseudoexfoliation

BACKGROUND: Pseudoexfoliation (PEX), which affects anterior segment structures, is thought to be a systemic disorder. The purpose of this study was to determine the possible relation between PEX and sensorineural hearing loss. METHODS: The study group included 51 patients with PEX and 22 controls without PEX. The patients and controls underwent complete ophthalmic and otorhinolaryngologic examinations. Hearing levels were evaluated with audio-tympanogram battery in all cases, and pure-tone audiogram hearing levels were classified into 6 groups. RESULTS: The mean age of PEX subjects was 67.5 years. All patients had PEX in at least one eye. Seventeen eyes had no evidence of PEX syndrome or glaucoma, 14 eyes had PEX but no glaucoma, and 71 eyes had both PEX and glaucoma. Thirty-four patients had bilateral PEX while 17 patients had unilateral PEX. One hundred and two ears of the 51 PEX patients and 44 ears of 22 controls were evaluated with pure-tone audiogram after otologic examination. In PEX patients 34/102 ears (33.3%) had normal hearing level, and 68 (66.7%) had hearing loss at various levels. The mean age of the control group was 61 years. In this group, 27/44 ears (61.4%) had no hearing loss, and 17 (38.6%) ears had hearing loss. There was a statistically significant difference between control and PEX subjects (p<0.01) in terms of hearing loss. INTERPRETATION: This study shows that sensorineural hearing loss appears to be associated with PEX.     

Visual Functioning Questionnaire: reevaluation of psychometric properties for a group of working-age adults.

PURPOSE: The Visual Functioning Questionnaire (VFQ-25) is one of the most widely used measures of vision-related quality of life. However, the questionnaire does not meet some psychometric quality criteria. The objectives of this study were first to obtain the factor structure of the VFQ-25, and second, to obtain interval scales by Rasch analysis. METHODS: The questionnaire was administered to 129 visually impaired adults (mean age 42.1 years; range 21 to 67 years). First, the items of the VFQ-25 were subjected to an exploratory factor analysis with Promax rotation. Next, we performed a separate Rasch analysis on each factor. We examined step thresholds and goodness of fit statistics of the items. Finally, we examined differential item functioning. RESULTS: Factor analysis indicated four factors: Near Activities, Distance Activities and Mobility, Mental Health and Dependency, and Pain and Discomfort. They accounted for 46.37% of the total variance. Most items showed some degree of disordering. After collapsing response categories, all items showed ordered thresholds. The Near Activities domain showed excellent fit, whereas the Distance Activities and Mobility domain, the Mental Health and Dependency domain, and the Pain and Discomfort domain had an unsatisfactory fit. There were two items showing uniform differential item functioning. CONCLUSIONS: The four-factor structure of the VFQ-25 largely confirms the structure of the questionnaire. However, the results of this study suggest that modifications of the original VFQ-25 structure are necessary.     

Cytokines, chemokines and soluble adhesion molecules in aqueous humor of children with uveitis

Uveitis in childhood is a visual threatening disease with a complication rate of more than 75%. Despite extensive research, the etiology of uveitis is still unclear although the general opinion is now that uveitis is a T-cell mediated disease. The purpose of this study was to investigate the profile of cytokines, chemotactic cytokines (chemokines) and soluble adhesion molecules in the aqueous humor (AqH) of children with uveitis in order to identify the factors that control the immune response in the eye. In this clinical laboratory investigation we analyzed, with a multiplex immunoassay, 16 immune mediators in the AqH of 25 children with uveitis and 6 children without uveitis. Increased levels of interleukin-2 (IL-2), IL-6, IL-10, IL-13, IL-18, interferon-gamma, tumor necrosis factor-alpha, soluble intercellular adhesion molecule-1, RANTES, IL-8 and interferon-inducible 10-kDa protein were found in the AqH of children with uveitis compared with controls. No significant differences were found for IL-1 beta, IL-4, IL-12 p-70, soluble vascular cell adhesion molecule 1 and Eotaxin. Lower levels of IL-10 and IL-8 were found in quiet stage uveitis (surgical) samples compared with active uveitis (diagnostic) samples and in samples of patients treated with methotrexate (MTX) compared with samples of patients not treated with MTX. Lower levels of IL-10 were as well found in samples taken during the first 3 months after the diagnosis of uveitis than samples taken later during the disease process. No significant differences were found between patients treated with or without topical or systemic (perioperative and long term) corticosteroids. In conclusion, in children with uveitis, multiple intraocular cytokines, chemokines and soluble adhesion molecules are increased in the AqH regardless of active or inactive inflammation. Whether the IL-8 and IL-10 levels in AqH of children with uveitis are correlated with uveitis activity, early or late phase of the course of the disease and systemic treatment with MTX needs further investigation in a bigger study population.     

MR imaging of facial nerve enhancement in Bell palsy or after temporal bone surgery

The authors evaluated magnetic resonance (MR) images obtained with intravenously administered gadolinium in ten patients who had facial paralysis and no facial nerve tumor. In patients with either Bell palsy (four patients) or facial paralysis after temporal bone surgery (six patients), intratemporal facial nerve enhancement was seen. Facial nerve enhancement on MR images proved to be a nonspecific finding.     

Eustachian tube function before recurrence of otitis media with effusion

OBJECTIVE: To study the role of eustachian tube function in the development of recurrent otitis media with effusion (OME) in children treated with tympanostomy tubes for OME. DESIGN: Prospective cohort study. SETTING: Three academic and general hospitals. PATIENTS: Children aged 2 to 7 years with a first clinical episode of OME that persisted for at least 3 months; 136 (81%) of 168 eligible children participated. All children received tympanostomy tubes for bilateral OME at study entry. MAIN OUTCOME MEASURE: Recurrence of OME within 6 months of tube extrusion. RESULTS: No statistically significant differences were present in eustachian tube function test results between ears that developed recurrent OME and those that did not. The difference in passive ventilatory function between ears with and without OME recurrence was 10 daPa (95% confidence interval, -24 to 43 daPa) for opening pressure and -3 daPa (95% confidence interval, -18 to 11 daPa) for closing pressure. The overall difference in the proportion of ears with and without OME recurrence that could not equilibrate positive and negative applied pressures was 12% (95% confidence interval, -2% to 26%). The proportions of ears with and without OME recurrence that induced negative pressure in the middle ear by forcefully sniffing were 22% and 31%, respectively (P = .75). CONCLUSION: Measurement of ventilatory and protective eustachian tube function using the forced response test, the pressure equilibration test, and the sniff test has no value in predicting whether children have an increased risk of OME recurrence.     

Recombinant human monoclonal autoantibodies specific for citrulline-containing peptides from phage display libraries derived from patients with rheumatoid arthritis

OBJECTIVE: To isolate and characterize monoclonal autoantibodies (Mab) directed to citrullinated antigens from patients with rheumatoid arthritis (RA). METHODS: Using lymphocytes from bone marrow or peripheral blood from RA patients, we constructed antibody fragment libraries representing the antibody repertoire of these individuals. Antibody fragments recognizing a citrulline-containing peptide were selected from these patient libraries. Individual antibody clones were analyzed for germline gene usage and reactivity toward citrullinated (auto)-antigens. RESULTS: Sequence analysis of the cDNA encoding the 21 distinct antibody fragments that were obtained revealed a restricted germline gene usage. Individual antibody clones were positive in both antiperinuclear factor (APF) and antikeratin antibody (AKA) tests, stained citrullinated filaggrin and fibrinogen on Western blots, and reacted with subsets of citrulline-containing peptides in ELISA, but not with noncitrullinated peptides. CONCLUSION: Our report describes the first recombinant human Mab fragments reactive with citrulline-containing peptides. The restricted germline gene usage of these antibodies, and the fact that the VH alleles used are not present in all individuals, may indicate the existence of a genetic predisposition for the development of anticitrulline antibodies in individuals with these germline alleles. The selected antibody clones may facilitate studies on the role of these autoantibodies and their target antigens in the development of RA.