Effect of hormone replacement therapy in women on ocular refractive status and aberrations

PURPOSE: To evaluate the effects of hormone replacement therapy (HRT) on refractive status, corneal topography, and aberrations of the eye in postmenopausal women. METHODS: Thirty-six healthy postmenopausal women (72 eyes) were included in the study. All patients received HRT that consisted of 0.625 mg/day conjugated estrogen and 5 mg/day medroxyprogesterone acetate in a continuous combined regimen. Schirmer II test and tear film break-up time (BUT) were performed on all patients at the time of enrollment and 6 months after initiation of HRT. Refractive status, corneal topography, and wavefront aberrations were evaluated with the NIDEK Optical Path Difference-Scan before and 6 months after HRT was initiated. RESULTS: Mean patient age was 50.8 +/- 2.6 years (range: 47 to 57 years). The mean duration of menopause was 2.7 +/- 0.8 years (range: 1.4 to 3.5 years). The Schirmer II test and tear film BUT measurements were significantly lower after HRT (P < .05). Before HRT, the mean spherical equivalent refraction was -0.19 +/- 1.79 diopters (D) (range: -4.38 to +3.00 D). After HRT, the mean spherical equivalent refraction was -0.22 +/- 1.81 D (range: -4.63 to +/- 2.63 D). No significant differences were noted between refractive status, corneal topography, and wavefront aberrations of eyes of patients before and 6 months after HRT (P > .05). CONCLUSIONS: Hormone replacement therapy in postmenopausal women does not significantly affect refractive status, corneal topography, and wavefront aberrations of the eye at 6-month follow-up.     

Magnification-corrected photodynamic therapy

Background To present a method for performing photodynamic therapy (PDT) with a constant predictable light fluence based on actual laser spot magnification. Methods A calibrated Gullstrand-type model eye with a scale of half circles in the centre of the artificial fundus was used for this study. The axial length of the model eye was set to different values ranging from 20 to 31 mm, and the actual laser spot magnification of four indirect condensing laser lenses were determined using a PDT laser unit. Results Equations for determining the actual laser spot magnification were calculated for each laser lens. The total change in laser spot magnification from hyperopia (axial length 20 mm) to myopia (axial length 31 mm) was −20% to +24.8% for Mainster Standard lens (Ocular Instruments Inc, Bellevue, Washington, USA), −15.7% to +27.7% for Mainster Wide Field lens (Ocular Instruments Inc), −16.3% to +33.1% for Volk Transequator lens (Volk Optical Inc, Mentor, Ohio, USA), and −19.2% to +24.4% for Volk PDT Laser lens (Volk Optical Inc). Conclusions Axial length of the eye has a considerable effect on PDT laser spot magnification when an indirect laser lens is used. By calculating the actual laser spot magnification in conjunction with knowledge of the true greatest linear dimension of the neovascular lesion, the clinician may be able to deliver a constant predictable amount of light fluence to the fundus independent of the axial length of the PDT treating eye. No Grant/Financial Support. The authors have no financial interest in any of the products discussed in this article.     

A case of folliculitis decalvans involving the beard, face and nape

Folliculitis decalvans is a rare and chronic progressive hair disorder leading to scarring alopecia and atrophy. Its etiology is still unclear. It starts with areas of perifollicular erythema, and follicular papules and pustules spread peripherally, leaving central scarred patches of alopecia. We report a 27-year-old man who presented with folliculitis decalvans involving the scalp, face, nape, and beard. There were pustules, crusts, and scarring alopecia on the scalp and beard.     

New onset egg allergy in an adult.

We report newly presenting systemic and local allergic reactions to egg in a 55-year-old woman. The patient did not have a history of egg allergy in childhood or occupational exposure to egg proteins; nor did she report any disease that is known to be related to food allergy. A skin prick test with commercial extracts, prick-to-prick test, CAP radioallergosorbent assay, and a double-blind, placebo-controlled food challenge test were used to prove egg allergy. Because egg allergy mainly affects children and symptoms frequently disappear with age, the late onset in this patient is rare.     

A Chryseobacterium meningosepticum outbreak observed in 3 clusters involving both neonatal and non-neonatal pediatric patients

Three clusters of Chryseobacterium meningosepticum infections in a tertiary health center in July 2006 and January 2007 involving 8 newborns and 5 older children were investigated. The index patient was from the neonatal intensive care unit, and the older patients were from other pediatric wards. Cultures were obtained from the environment and from health care workers' hands as part of an outbreak investigation. C meningosepticum was isolated from hand cultures obtained from a senior resident and from environmental cultures obtained from powdered infant formula, an electrical button, a computer keyboard, phone, a doorknob, and an Ambu bag. Antibiogram typing and enterobacterial repetitive intergenic consensus sequence polymerase chain reaction indicated that all of the isolates were epidemiologically related. Nine patients improved on antimicrobial treatment, and 4 premature infants died after the infection. C meningosepticum is a well-known etiologic agent for nosocomial infections involving newborns and immunocompromised patients. Wet and dry environmental surfaces and equipment may act as a source or play a role in disseminating the microorganism. Outbreaks may be controlled with strong emphasis on infection control measures.     

Expression of matrix metalloproteinases in vasculitic neuropathy

The aim of this study was to investigate the expression pattern and cellular source of matrix metalloproteinases (MMP) in vasculitic neuropathy. Matrix metalloproteinases are endopeptidases degrading components of extracellular matrix proteins, and they have been implicated in the pathogenesis of inflammatory demyelination. They are induced by cytokines, secreted by inflammatory cells, and enhance T cell migration. Vasculitic neuropathy occurs as a component of systemic vasculitis or as an isolated angiitis of the peripheral nervous system, and T cell-mediated inflammation is detected in its pathogenesis. Nerve biopsy sections of eight patients with nonsystemic vasculitic neuropathy (NSVN) and four with systemic vasculitic neuropathy were examined for the presence of CD4+, CD8+, and CD68+ cells and immunohistochemically for MMP-2 and MMP-9 expression. Nerve biopsies of eight patients with noninflammatory neuropathy were used as a control group. Semiquantitative polymerase chain reaction analysis was performed to detect MMP-2 and MMP-9 mRNA. The predominant cells were CD8+ and CD68+ T cells. Expression of MMP-9, but not MMP-2, was increased in perivascular inflammatory infiltrate in nerve tissues of vasculitic neuropathy patients. This MMP-9 expression correlated positively with immunostaining of CD8+ T cells. No difference was detected between immunostaining patterns of nonsystemic and systemic vasculitic neuropathies with the antibodies used, except in MMP-9 immunostaining, which was found to be enhanced in NSVN group. Polymerase chain reaction analysis revealed elevated mRNA levels of MMP-9 and MMP-2 compared with controls, but this did not reach statistical significance. Our results imply a pathogenic role for MMP-9 secreted from CD8+ cells in vasculitic neuropathy.     

Pregnancy-related low back pain in women in Turkey: Prevalence and risk factors

Objectives

To investigate the prevalence of pregnancy-related low back pain (PRLBP) in women in Turkey, identify the factors associated with PRLBP and predict the risk of PRLBP.

Management of acquired punctal stenosis with perforated punctal plugs

Purpose

To evaluate the efficiency of perforated punctal plug in acquired punctal stenosis.

Materials and methods

Forty-five eyes of 33 patients who had epiphora due to punctal stenosis were included in this study. After biomicroscopic examination and lacrimal dilatation punctal stenosis was managed with the perforated punctal plugs in all patients. In the following period epiphora, plug tolerance, lacrimal drainage were evaluated and graded. Lacrimal drainage was evaluated with fluorescein dye disappearing test.

Results

The age of the patients ranged between 31 and 80 (mean 55.78 ± 13.11). Preoperatively punctal dilatation and lacrimal system irrigations were performed on all patients. Lacrimal system irrigation was positive in all patients. Perforated punctal plugs were placed in the inferior puncti in all patients. The plugs were explanted 6 months after operation. The follow-up period ranged between 6 and 24 months. Plug tolerance was good in 97.8% of the eyes in the 1st month visit. Epiphora decreased remarkably in 88.9% of the patients 1 month after plug implantation, except one whose plug dropped off spontaneously in 2 weeks. Fluorescein disappearing times were found under 3 min in 97.8% of the eyes after plug explanations.

Conclusion

Punctum stenosis is one of the several disorders that cause lacrimal drainage obstruction. Perforated punctal plugs are found convenient and effective in managing punctal stenosis.     

The spectrum of diseases causing fever of unknown origin in Turkey: a multicenter study.

OBJECTIVE: The purpose of this trial was to determine the spectrum of diseases with fever of unknown origin (FUO) in Turkey. METHODS: A prospective multicenter study of 154 patients with FUO in twelve Turkish tertiary-care hospitals was conducted. RESULTS: The mean age of the patients was 42+/-17 years (range 17-75). Fifty-three (34.4%) had infectious diseases (ID), 47 (30.5%) had non-infectious inflammatory diseases (NIID), 22 (14.3%) had malignant diseases (MD), and eight (5.2%) had miscellaneous diseases (Mi). In 24 (15.6%) of the cases, the reason for high fever could not be determined despite intensive efforts. The most common ID etiologies were tuberculosis (13.6%) and cytomegalovirus (CMV) infection (3.2%). Adult Still's disease was the most common NIID (13.6%) and hematological malignancy was the most common MD (7.8%). In patients with NIID, the mean duration of reaching a definite diagnosis (37+/-23 days) was significantly longer compared to the patients with ID (25+/-12 days) (p=0.007). In patients with MD, the mean duration of fever (51+/-35 days) was longer compared to patients with ID (37+/-38 days) (p=0.052). CONCLUSIONS: Although infection remains the most common cause of FUO, with the highest percentage for tuberculosis, non-infectious etiologies seem to have increased when compared with previous studies.