Essential infantile esotropia in neurologically impaired pediatric patients: is botulinum toxin better primary treatment than surgery?

A prospective study was performed over a 10 year period on 25 children with infantile esotropia and neurological problems to answer this question. From November 1996 to March 2006 they were treated with injections of botulinum toxin (Botox) of both medial rectus extraocular muscles. Mean age was 26.4 months, (range 9-76 months) and mean initial angle was 35 prism diopters (PD)(range 20-60 PD). RESULTS: 18 patients (72%) remained orthotropic+/-10 PD at 29 months (range 6-59 months). Average number of injection treatments was 1.5 per patient. We compared our success rate data with those obtained with primary conventional strabismus surgical procedures in 2 previously published series. Treatment with botulinum toxin seemed to produce better results than one surgical series and at least equally similar results to the other one. Because there are, as well, so many other advantages to the injection procedure including superior safety and economy, we now use botulinum injections as our primary treatment in these patients.     

Cysticercosis in a female Nicaraguan traveler

Cysticercosis is a tissue infestation with Taenia solium (pork tapeworm) larvae and should feature in the differential diagnosis of all soft tissue swellings arising after travel to Central and South America, Eastern Europe, China, and India. We describe a patient who presented 8 months after travel to Nicaragua with pea-sized, intermittently tingling nodules in limbs and trunk and a lump in her mouth, which moved constantly. Various British practitioners misdiagnosed the patient's complaint as sebaceous cysts, diffuse lipomata, neurosis, and gnathostomiasis. The diagnosis was finally made by immunoblot assay testing for cysticercosis immunoglobulin (Ig)G, and the patient was cured with a course of albendazole 400 mg, taken twice daily for 30 days. This case illustrates the importance of careful history taking and appropriate investigations.     

Diagnosis of "Maladie des feuilles cassantes" or Brittle leaf disease of date palms by detection of associated chloroplast encoded double stranded RNAs

The "Maladie des feuilles cassantes" (MFC) or "Brittle leaf disease" of date palms is associated with the accumulation of two populations of small, chloroplast-encoded RNAs. A plasmid vector containing a cDNA with partial sequences of both of these RNA populations was used to synthesize a DIG-labeled bifunctional probe by PCR. The probe has been tested to detect, by molecular hybridization, MFC-associated RNAs from dsRNA-enriched palm leaflet preparations. Leaflet samples from MFC-affected date palm trees consistently gave a positive hybridization signal regardless of the date palm cultivar, severity of symptoms, or geographical location, whereas samples from date palm trees affected by other biotic and abiotic stresses tested negative. The assay is specific for MFC and can be used for early diagnostic purposes.     

Acceptability of dietary supplements of the national Mexican program "Oportunidades"

OBJECTIVE: To identify cultural beliefs and practices to evaluate the acceptability of dietary supplements of Oportunidades Program. MATERIAL AND METHODS: Ethnographic study with in-depth interviews (n=43)--mothers of children less than five years of age and pregnant and breasfeeding women (PBW)--, key informants (n=9); focus groups (n=8) and direct observation, in four communities from North, Central, South and Southwest of Mexico. RESULTS: The supplement was prepared in several different ways.The liquid preparation was best accepted; generally the supplement was mixed with milk. Initially, the supplement caused nausea, vomiting and diarrhea, but these symptoms disappeared with continued consumption. Acceptance was highest among PBW. CONCLUSIONS: The supplement tends to replace milk as a food product in the daily diet. There is a necessity to develop culturally specific evaluations in regions with different food intake practices. The study results should be interpreted in the context of other program components, such as health care and education.     

Controlling retinal pigment epithelium injury after experimental detachment of the retina

PURPOSE: Damage induced by detachment of the neural retina and the retinal pigment epithelium (RPE) can be reduced by dark adaptation. The authors evaluated the influence of the duration of dark adaptation, time of day, and modification of the melatonin-dopamine pathway on acute RPE lesions induced by mechanical detachment. METHODS: BALB/c mice were studied at different times of day and different periods of dark adaptation. Some mice were treated with melatonin or sulpiride, a D2 dopamine receptor antagonist. Enucleated eyes and different saline solutions were used in experiments ex vivo. Retinal detachments in vivo were made by subretinal injections of hyaluronic acid. RPE cell damage was quantitatively evaluated with a dye exclusion procedure, and their viability was tested by preservation of tight junctions in culture. Lectin histochemistry was used to examine the interphotoreceptor matrix (IPM). RESULTS: Significant propidium iodide (PI) incorporation in RPE cells was detected after ex vivo separation during daytime, but it was very low when detachment took place at night after 24 to 48 hours of dark adaptation. PI exclusion was achieved during daytime after a single hour of dark adaptation when mice were pretreated with melatonin or sulpiride. Reduction of RPE cell damage was accompanied by decreased lectin binding to cone sheaths. CONCLUSIONS: A combination of time of day and length of dark adaptation decreased damage induced by detachment of the retina ex vivo and in vivo. Melatonin or sulpiride could replace these environmental factors. Therefore, melatonin and dopamine pathways might be involved in the control of IPM properties and retina/RPE interactions.     

Frequency domain near-infrared spectroscopy technique in the assessment of brain oxygenation: a validation study in live subjects and cadavers

BACKGROUND: Studies with continuous wave near infrared spectroscopy (CW-NIRS) have shown little difference in brain oxygenation of dead compared to live subjects. We determined brain oxyhemoglobin (OHb) and deoxyhemoglobin (HHb) concentrations in healthy volunteers and cadavers using frequency domain near infrared spectroscopy (FD-NIRS). METHODS: Regional OHb and HHb, brain oxygen saturation (SO2), and total hemoglobin (tHb) were determined. Nine patients who died in the hospital were evaluated by FD-NIRS in the morgue 7-96 h after death was confirmed. Ten volunteers served as a control group. RESULTS: Absolute concentrations of brain tissue OHb and HHb were 24.9 +/- 9.1 uM and 13.8 +/- 32 uM, respectively, in live subjects. In dead subjects, OHb was 1.3 +/- 2.1 uM and HHb was 30.8 +/- 14.4 uM (both P < 0.05 compared to live). OHb showed a 90% decrease within 7h of death. There was a significant trend for a continued decrease in OHb from 7 to 96 h. CONCLUSION: OHb decreased and HHb increased in dead patients compared to live volunteers. Depletion of OHb primarily occurred within 7 h of death but continued gradually over 96 h. FD-NIRS was a novel technique for determining OHb and HHb changes following death.