Documentation of optic nerve pit with macular schisis-like cavity by spectral domain OCT.

The authors report using spectral domain optical coherence tomography (OCT) to observe a patient with an optic nerve pit and macular schisis-like spaces. An 8-microm axial resolution prototype spectral domain OCT and stereo fundus photography were used to observe the patient. A macular schisis-like cavity was present at baseline and additional cystic changes developed in the nerve fiber layer over a period of 16 months; however, the visual acuity remained stable at 20/20. Spectral domain OCT provides greater detail of the changes in morphology and structure of macular schisis and edema associated with an optic nerve pit.     

PGD15 Veterans'' Satisfaction with H2-Receptor Antagonist (H2RA) Drug Conversion

OBJECTIVES: To determine the relative cost-effectiveness of the inhaled corticosteroids beclomethasone dipropionate (BDP), budesonide (BUD), and fluticasone propionate (FP), for managing moderate to severe asthma in adults over a one-year time horizon from the perspective of the Ministry of Health (MOH) in Canada.
METHODS: A single-arm meta-analysis of randomized control trials containing at least one of FP, BUD, and BDP was performed in order to derive estimates of effectiveness and tolerance. A decision tree analysis was then used to model the cost-effectiveness analysis. Only direct medical costs were included in the analysis (i.e., inpatient care, emergency visits, physician services, nursing services, drugs, diagnostic tests). The time horizon of the study was 52 weeks, precluding discounting. All costs are presented in 1996 Canadian dollars (CDN$). The cost-effectiveness was the cost per additional symptom-free day ($/SFD).
RESULTS: 69 of 398 articles were included in the metaanalysis. The Monte Carlo base case analysis showed that FP and BUD resulted in an annual cost of $1,383 and $1,147 respectively (p > 0.01). FP produced 216 SFDs while BUD resulted in 214 SFDs, which were not significantly different at p = 0.01 (corrected for multiple comparisons). BDP cost $1,343/year and yielded 213 SFD/year (BDP was excluded from the final analysis, dominated by BUD). With no difference in effectiveness, a cost-minimization analysis showed that BUD was the cost-effective alternative, costing $236 CDN less than the FP strategy.
CONCLUSIONS: Of the inhaled corticosteroids available on the MOH Formulary in Canada, BUD is a costeffective alternative for the treatment of adults with moderate to severe asthma.     

Demographics and diagnosis of obstructive sleep apnea

This article reviews the terminology of obstructive sleep apnea and the associated diagnostic tests and provides an overview of the risk factors for this chronic condition. Sleep apnea affects 2% to 4% of middle-aged working adults in the general population, however, a considerable number of affected individuals remain undiagnosed. Patients with the disease may be at a higher risk for adverse perioperative outcomes. Knowledge of factors associated with an increased risk of obstructive sleep apnea is vital to the perioperative assessment and anesthetic plan.     

A simplified method for measuring critical pressures during sleep in the clinical setting

Upper airway critical pressure measurements correlate with the degree of upper airway obstruction during sleep and may have a role in the diagnosis and treatment of obstructive sleep apnea. Nevertheless, the utility of the critical pressure has not yet been realized in the clinical setting because significant technical expertise is still required for the acquisition and analysis of pressure-flow data. Using segmented regression, we developed and validated a simplified approach to analyze the pressure-flow relationship and to determine the effects of protocol-related factors in 44 subjects with sleep apnea. When compared with expert visual analysis, segmented regression method was found to accurately determine the critical pressure (-0.98 +/- 2.47 cm H(2)O vs. -1.07 +/- 2.47 cm H(2)O, respectively; p = 0.46). Furthermore, it was found that two series of measurements acquired at varying nasal pressure levels with two or more breaths per level were sufficient to determine the critical pressure with a minimum of variability. Therefore, this analytic approach has the potential for standardizing and simplifying the ascertainment of the critical pressure for studies examining the effect of therapeutic devices and agents on upper airway collapsibility during sleep.     

Does treated systemic hypertension affect progression of optic nerve damage in glaucoma suspects?

PURPOSE: To evaluate whether treatment of systemic hypertension has an effect on progression of optic nerve parameters in glaucoma suspects using confocal scanning laser ophthalmoscopy. METHODS: Two hundred eyes of 103 glaucoma suspect patients were included in this retrospective cohort study. Thirty-one patients (of whom 59 eyes were included in the study) had systemic hypertension under treatment (based on medical history). The remaining 72 age-matched normotensive controls (of whom 141 eyes were included in the study) were not on blood-pressure-lowering medications. Each patient had a follow-up period of at least 4 years with a minimum of four Heidelberg retinal tomograph tests (one baseline and three follow-up scans). The slopes of progression of optic nerve head parameters with time were studied and compared between these two groups using mixed effects regression models. RESULTS: Patients with systemic hypertension showed a statistically significant increase in cup area (slope 0.2, p = 0.03), cup-to-disk area ratio (slope 0.01, p = 0.007), and decrease in rim area (slope -0.4, p = 0.03), rim-to-disk area ratio (slope -0.01, p = 0.005), and global Retinal Nerve Fiber Layer (RNFL) thickness (p = 0.008) with time. The differences in slopes of progression of many parameters between hypertensives and normotensives were statistically significant. CONCLUSIONS: Systemic hypertension treated with hypotensive medications may be a risk factor for increased progression of optic nerve parameters in glaucoma suspects compared with age-matched normotensive subjects.     

Bone marrow aspirate culture superior to streptokinase clot culture and 8 ml 1:10 blood-to-broth ratio blood culture for diagnosis of typhoid fever

We compared the sensitivities of bone marrow aspirate culture (BMAC), 3 ml 1:4 and 8 ml 1:10 blood-to-broth ratio blood cultures (BC), 8 ml streptokinase clot culture (STKCC) and rectal swab culture (RSC) for isolating Salmonella typhi and S. paratyphi A from 61 patients with typhoid or paratyphoid fever in Jakarta, Indonesia. BMAC (92%) was significantly more sensitive than 8 ml BC (62%), 8 ml STKCC (51%), 3 ml BC (44%), RSC (56%) and the 19 ml combination of all three BC methods (71%). The combination of the three BC methods and RSC had an isolation rate of 87%. In Jakarta the diagnosis of typhoid fever cannot be confidently excluded unless a BMAC is done.