Evaluation of dry eye

Dry eye is a common yet complex condition. Intrinsic and extrinsic factors can cause dysfunction of the lids, lacrimal glands, meibomian glands, ocular surface cells, or neural network. These problems would ultimately be expressed at the tear film-ocular surface interface. The manifestations of these problems are experienced as symptoms such as grittiness, discomfort, burning sensation, hyperemia, and secondary epiphora in some cases. Accurate investigation of dry eye is crucial to correct management of the condition. Techniques can be classed according to their investigation of tear production, tear stability, and surface damage (including histological tests). The application, validity, reliability, compatibility, protocols, and indications for these are important. The use of a diagnostic algorithm may lead to more accurate diagnosis and management. The lack of correlation between signs and symptoms seems to favor tear film osmolarity, an objective biomarker, as the best current clue to correct diagnosis.     

Impact of Treatment Attributes of Peginterferon for Hepatitis C on Quality of Life and Treatment Preference

ObjectivesA key aim of hepatitis C virus (HCV) treatment development is to maximize efficacy while minimizing adverse events that impact on patient health-related quality of life (HRQL) and adherence, a significant issue for HCV treatment efficacy. In order to inform treatment development priorities, this study aimed to capture HRQL impact of flu-like symptoms experienced after peginterferon treatment injections and capture the value to patients of less frequent treatment injections.Study DesignAn online survey was conducted with 72 patients who were receiving peginterferon treatment. The survey comprised: patient experience of flu-like symptoms as a result of peginterferon treatment injections; utility values for impact of these symptoms on HRQL; patient preferences for treatment attributes of injection frequency, days experiencing flu-like symptoms and efficacy.ResultsOver 90% of participants had experienced flu-like symptoms after a peginterferon treatment injection. Mean HRQL for HCV patients with no flu-like symptoms was 0.73, while mean HRQL for HCV patients with current flu-like symptoms was 0.43. Increase in frequency of treatment injections per 4 weeks (odds ratio [OR] 0.57, 95% confidence interval [CI] 0.52-0.63, P < 0.001), days per month of experiencing flu-like symptoms (OR 0.73, 95% CI 0.69-0.76, P < 0.001), and percentage treatment efficacy (OR 1.05, 95% CI 1.05-1.06, P < 0.001) were all independent predictors of patient treatment preferences.ConclusionFlu-like symptoms experienced as a result of peginterferon treatment injections have a substantial HRQL impact for patients. This study demonstrates how important avoiding flu-like symptoms and reducing treatment injections are for patients in addition to treatment efficacy.     

Detection and Grading of Hypertensive Retinopathy Using Vessels Tortuosity and Arteriovenous Ratio

Hypertensive retinopathy (HR) refers to changes in the morphological diameter of the retinal vessels due to persistent high blood pressure. Early detection of such changes helps in preventing blindness or even death due to stroke. These changes can be quantified by computing the arteriovenous ratio and the tortuosity severity in the retinal vasculature. This paper presents a decision support system for detecting and grading HR using morphometric analysis of retinal vasculature, particularly measuring the arteriovenous ratio (AVR) and retinal vessel tortuosity. In the first step, the retinal blood vessels are segmented and classified as arteries and veins. Then, the width of arteries and veins is measured within the region of interest around the optic disk. Next, a new iterative method is proposed to compute the AVR from the caliber measurements of arteries and veins using Parr–Hubbard and Knudtson methods. Moreover, the retinal vessel tortuosity severity index is computed for each image using 14 tortuosity severity metrics. In the end, a hybrid decision support system is proposed for the detection and grading of HR using AVR and tortuosity severity index. Furthermore, we present a new publicly available retinal vessel morphometry (RVM) dataset to evaluate the proposed methodology. The RVM dataset contains 504 retinal images with pixel-level annotations for vessel segmentation, artery/vein classification, and optic disk localization. The image-level labels for vessel tortuosity index and HR grade are also available. The proposed methods of iterative AVR measurement, tortuosity index, and HR grading are evaluated using the new RVM dataset. The results indicate that the proposed method gives superior performance than existing methods. The presented methodology is a novel advancement in automated detection and grading of HR, which can potentially be used as a clinical decision support system.

     

Mucosal innate immunity as a determinant of HIV susceptibility

Most human immunodeficiency virus (HIV) is acquired during sex, across a mucosal membrane. Despite many advances in our understanding of HIV pathogenesis, the initial events during mucosal transmission have been poorly characterized, and a better understanding of these events will probably be a key to the development of successful microbicide(s) and/or a preventative HIV vaccine. While a vast majority of mucosal HIV exposures do not result in productive infection, implying that innate mucosal immune defenses are highly protective, failure of these mucosal defenses resulted in over 3 million new HIV infections in 2006. We review recent findings regarding HIV mucosal immunopathogenesis, emphasizing the importance of innate immunity in natural protection from infection, and examine how natural or induced perturbations in the mucosal innate system may underpin HIV transmission. Given the great challenges to the development of HIV microbicides and vaccines, identification and enhancement of 'natural' innate immune defenses present attractive avenues for development of safe, non-toxic microbicides.     

Endobronchial carcinoid presenting as Focal bronchiectasis in a young woman with systemic lupus erythematosus

Non‐resolving pulmonary symptoms in a patient with SLE require evaluation to exclude rare pulmonary lesions, such as carcinoid tumors.