Intraocular pressure and prevalence of glaucoma in elderly people in Finland: a population-based study

The distribution of intraocular pressure (IOP) and the prevalence of glaucoma and their correlates were studied in a population-based study of inhabitants aged 70 years or older of three communities in the county of Oulu, Finland. 500 of the 560 eligible subjects (89%) were examined. IOP was measured using applanation tonometry. The diagnosis of glaucoma (or suspected glaucoma) was based on previous history and/or characteristic optic disc changes assessed first by ophthalmoscopy and later by photographic evaluation.No correlation existed between IOP level and age, but IOP was higher in women than in men. Glaucoma occurred in 12% of the participants (60 of 500 persons). In 42 of the 60 persons (8% of the participants) glaucoma had been diagnosed before this survey: non-exfoliative open-angle glaucoma in 15 persons (3.0%), bilateral or unilateral exfoliative open-angle glaucoma in 19 persons (3.8%), and congestive glaucoma in 8 persons (1.6%). In another 18 persons (4% of the participants) new open-angle glaucoma was detected, one third of these were exfoliative. In addition, 6% of the study population had suspected glaucomatous disc changes. In all new glaucoma cases and in all suspected cases the IOP was lower than 25 mmHg. Ocular hypertension (>25 mmHg) without disc changes was found in 2%.     

Incidence of spinal deformity in children after multiple level laminectomy for selective posterior rhizotomy

Fifty-five children with cerebral palsy had multiple-level laminectomies for selective posterior rhizotomies for the relief of spasticity. They were followed up clinically and radiologically to assess their spinal stability and the possible development of post-laminectomy deformity of the spine. The majority of the deformities found were related to cerebral palsy and did not appear to be due to the laminectomy: 16% had scoliosis, 5% kyphosis, 7% lordosis, and 9% spondylolysis/spondylolisthesis. Spondylolysis is the only abnormality that appeared to be more common in this group than in children with cerebral palsy.     

Contrast sensitivity after resolution of central serous retinopathy

The contrast sensitivity of 21 patients was measured using TV equipment (Wavetek 143 function generator and Sony PVM90CE video monitor) and the Vistech test 6–15 years after the acute stage of central serous retinopathy. In the majority of cases contrast sensitivity was lower in the affected eye. The difference between the affected and the fellow eye was statistically significant at 1 and 6 cycles/degree (c/d) but not at 19 c/d. In 13/21 cases (62%) the results of the Vistech test were consistent with those of the TV test. Contrast sensitivity did not correlate with the duration of the disease or with the ultimate clinical picture of the macula. At 6 c/d there was a statistically significant correlation between visual acuity and contrast sensitivity. If the visual acuity was less than 1.0, contrast sensitivity was decreased, but decreased contrast sensitivity was also observed in four eyes with normal visual acuity, indicating that the level of visual deficit may not be established by measurement of visual acuity alone.     

Training medical students to manage a chronic pain patient: both knowledge and communication skills are needed.

Most studies concerning pain education of undergraduate medical students focus on knowledge, but little is known about the interviewing skills and pain evaluation. At the end of the fifth study year and at the beginning of the sixth year the students were asked to answer an electronical questionnaire to evaluate how the IASP curriculum on pain had been covered during the studies. In addition, the interviewing skills of the fifth year medical students were assessed using an objective structured clinical examination (OSCE). The students met a standardized patient suffering from postherpetic neuralgia, who was instructed to express depressive and exhausted feelings. A total of 97 students received the questionnaire and 35% responded with identification. All students answering the IASP questionnaire evaluated teaching of postherpetic pain and antidepressant treatment as sufficient. OSCE appeared as a feasible instrument in the assessment of chronic pain education. Eighty-eight percent of the students made the correct diagnosis. However, only 35% asked about sleep disturbances and 16% about depression. When developing a curriculum on pain education, attention should be paid to pedagogic methods about helping the students to implement the learned knowledge in their practice. Formative assessment of both knowledge and skills is essential for the development of a functional pain curriculum.     

Intravitreal injection of triamcinolone combined with bevacizumab for choroidal neovascularization associated with large retinal pigment epithelial detachment in age-related macular degeneration

Purpose  

To discuss the effect and outcome of a combined intravitreal triamcinolone acetonide (IVTA) injection with intravitreal bevacizumab (IVB) in treating choroidal neovascularization (CNV) associated with large retinal pigment epithelial detachment (PED) in age-related macular degeneration (AMD).     

Biological conversion of a water-soluble prodrug of cyclosporine A.

UNIL088 is a water-soluble prodrug of cyclosporine A (CsA) designed for topical ocular delivery. The pro-moiety is grafted via an ester function to CsA and the solubilizing group is a phosphate ion. The aim of this study was to elucidate the conversion mechanisms by which UNIL088 generates CsA. UNIL088 was incubated in rabbit tears at physiological temperature to study its enzymatic and chemical conversion, respectively. Metabolites and intermediates were identified using a quadrupole-time of flight (QqTOF) mass spectrometer, which allowed biotransformation pathways to be deduced. Conversion is activated by the chemical or enzymatic hydrolysis of the terminal ester function of the pro-moiety, leading to the phospho-serine-sarcosine-cyclosporine A that spontaneously converts into CsA. In addition to the main biotransformation pathway, a secondary reaction involved hydrolysis of the phosphate ester group of the pro-moiety, probably by phosphatases present in tears.     

Neuroprotective effects of high-dose vs low-dose melatonin after blunt sciatic nerve injury

Introduction Melatonin, the secretory product of the pineal gland, has potent antioxidant properties. The aim of this study was to compare the effects of low-dose (10 mg/kg) vs high-dose (50 mg/kg) melatonin on early lipid peroxidation levels and ultrastructural changes in experimental blunt sciatic nerve injury (SNI). We believe this to be the first study to assess the dose-dependent neuroprotective effects of melatonin after a blunt peripheral nerve injury. Materials and methods Rats were randomly allocated into 5 groups of 10 animals each. The SNI only rats underwent a nerve injury procedure. The SNI plus vehicle group received SNI and intraperitoneal injection of vehicle (diluted ethanol) as a placebo. The SNI plus low-dose or high-dose melatonin groups received intraperitoneal melatonin at doses of 10 mg/kg or 50 mg/kg, respectively. Controls had no operation, melatonin or vehicle injection. SNI was induced by clamping the sciatic nerve at the upper border of the quadratus femoris for 2 min. Results Sciatic nerve samples were harvested 6 h after nerve injury and processed for biochemical and ultrastructural analysis. Trauma increased the lipid peroxidation of the sciatic nerve by 3.6-fold (153.85 ± 18.73 in SNI only vs 41.73 ± 2.23 in control rats, P < 0.01). Low (P = 0.02) and high (P < 0.01) doses of melatonin attenuated the nerve lipid peroxidation by 25% and 57.25%, respectively (65.76 ± 2.47 in high-dose vs 115.08 ± 7.03 in low-dose melatonin groups). Discussion Although low-dose melatonin reduced trauma-induced myelin breakdown and axonal changes in the sciatic nerve, high-dose melatonin almost entirely neutralized any ultrastructural changes. Conclusion Our results suggest that melatonin, especially at a dose of 50 mg/kg, has a potent neuroprotective effect and can preserve peripheral neural fibers from lipid peroxidative damage after blunt trauma. With further investigations, we hope that these data may prove useful to clinicians who treat patients with nerve injuries.