Differentiating Ischemic Optic Neuropathy from Glaucoma Using Diagnostic Tests

INTRODUCTION

Anterior ischemic optic neuropathy (AION) can mimic glaucoma and consequently cause difficulties in differential diagnosis. The purpose of this paper was to summarize differences in diagnostic tests that can help perform a correct diagnosis.

METHODS

The search strategy was performed according to the PRISMA 2009 guidelines, and four databases were used: MEDLINE, Embase, Web of Science, and Cochrane. Totally, 772 references were eligible; 39 were included after screening with respect to inclusion criteria that included English language and published in the 20 years before search date.

RESULTS

Ninety percent (n = 35) of included studies used optical coherence tomography (OCT). Glaucomatous eyes had a significantly greater cup area, volume and depth, cup-to-disk ratio, a lower rim volume and area, and a thinner Bruch's membrane opening-minimum rim width. Retinal nerve fiber layer (RNFL) thinning in glaucomatous eyes occurred primarily at the superotemporal, inferotemporal, and inferonasal sectors, while AION eyes demonstrated mostly superonasal thinning. Glaucoma eyes showed greater macular ganglion cell layer thickness, except at the inferotemporal sector. OCT angiography measurements demonstrated a significant decrease in superficial and deep macular vessel density (VD) in glaucoma compared to AION with similar degree of visual field damage; the parapapillary choroidal VD was spared in AION eyes compared to glaucomatous eyes.

CONCLUSION

By use of OCT imaging, optic nerve head parameters seem most informative to distinguish between glaucoma and AION. Although both diseases affect the RNFL thickness, it seems to do so in different sectors. Differences in structure and vascularity of the macula can also help in making the differential diagnosis.

A perirenal fibrosarcoma in a newborn calf

Congenital tumors are rare in cattle. In this case report, a calf with a congenital perirenal fibrosarcoma is described. A newborn Belgian Blue calf that succumbed shortly after caesarian section was submitted for necropsy at the diagnostic lab of the ARSIA (Association Régionale de Santé et d’Identification Animales). At necropsy, a hemorrhagic firm mass was found surrounding the left kidney. Histopathological examination of the mass revealed a neoplastic cell population. Additional immunohistochemical stainings were performed to identify the tumor. The majority of neoplastic cells stained positive for vimentin but were negative for neurofilaments (NFs), desmin, CD3, CD20, Von Willebrand factor and cytokeratin, indicating a mesenchymal origin. The tumor was diagnosed as a fibrosarcoma. To the authors’ knowledge, this is the first case of a congenital perirenal fibrosarcoma reported in a Belgian Blue calf in Belgium.

The N-terminal p.(Ser38Cys) TIMP3 mutation underlying Sorsby fundus dystrophy is a founder mutation disrupting an intramolecular disulfide bond

Sorsby fundus dystrophy (SFD) is a macular degeneration caused by mutations in TIMP3, the majority of which introduce a novel cysteine. However, the exact molecular mechanisms underlying SFD remain unknown. We aimed to provide novel insights into the functional consequences of a distinct N-terminal mutation. Haplotype reconstruction in three SFD families revealed that the identified c.113C>G, p.(Ser38Cys) mutation is a founder in Belgian and northern French families with a late-onset SFD phenotype. Functional consequences of the p.(Ser38Cys) mutation were investigated by high-resolution Western blot analysis of wild type and mutant TIMP3 using patient fibroblasts and in vitro generated proteins, and by molecular modeling of TIMP3 and its interaction partners. We could not confirm a previous hypothesis on dimerization of mutant TIMP3 proteins. However, we identified aberrant intramolecular disulfide bonding. Our data provide evidence for disruption of the established Cys36-Cys143 disulfide bond and formation of a novel Cys36-Cys38 bond, possibly associated with increased glycosylation of the protein. In conclusion, we propose a novel pathogenetic mechanism underlying the p.(Ser38Cys) TIMP3 founder mutation involving intramolecular disulfide bonding. These results provide new insights into the pathogenesis of SFD and other retinopathies linked to mutations in TIMP3, such as age-related macular degeneration.

Dispersal capacity of Haematopota spp. and Stomoxys calcitrans using a mark-release-recapture approach in Belgium

The dispersion potential of mechanical vectors is an important factor in the dissemination of pathogens. A mark-release-recapture experiment was implemented using two groups (unfed and partially fed) of the Tabanidae (Diptera) (Haematopota spp.) and biting Muscidae (Diptera) (Stomoxys calcitrans) most frequently collected in Belgium in order to evaluate their dispersion potential. In total, 2104 specimens of Haematopota spp. were collected directly from horses and 5396 S. calcitrans were collected in a cattle farm using hand-nets. Some of these insects were partially fed in vitro and all were subsequently coloured. Overall, 67 specimens of S. calcitrans (1.2%) and 17 of Haematopota spp. (0.8%) were recaptured directly on horses. Stomoxys calcitrans flew maximum distances of 150 m and 300 m when partially fed and unfed, respectively. Haematopota spp. travelled maximum distances of 100 m and 200 m when partially fed and unfed, respectively. Segregation measures seem essential in order to reduce the risk for pathogen transmission. A distance of 150 m appears to be the minimum required for segregation to avoid the risk for mechanical transmission, but in areas of higher vector density, this should probably be increased.

Q Fever Serological Survey and Associated Risk Factors in Veterinarians, Southern Belgium, 2013

A sero-epidemiological survey was organized among veterinarians working in Southern Belgium to estimate the seroprevalence of Q fever and the risk factors associated with exposure. A total of 108 veterinarians took part to this cross-sectional study, with a majority practicing with livestock animals. The overall seroprevalence was 45.4%, but it increased to 58.3% among veterinarians having contact with livestock. Three main serological profiles were detected (relatively recent, past and potentially chronic infections). The contact with manure during the prior month was the risk factor associated with seropositivity after multivariate logistic regression analysis. Classification and regression tree analysis identified the age as the most predictive variable to exclude potentially chronic infection in apparently healthy seropositive veterinarians. In conclusion, livestock veterinarians practicing in Southern Belgium are highly exposed to Q fever, a neglected zoonosis for which serological and medical examinations should be envisaged in at risk groups.

[An 87-year-old-man with late-onset frontotemporal dementia: a case-study]

An 87-year-old man showed behavioral disinhibition and nocturnal restlessness as well as short-term memory problems. We diagnosed late-onset frontotemporal dementia (LO-FTD), a relatively rare disease. Based on the course of the disease progress, we ruled out medication-induced mania and bipolar disorder. Given the results of the CT-scan, we also dismissed the possibility that the patient was suffering from dementia based on Alzheimer's disease and vascular factors that followed an atypical course. Our article illustrates the complexity of the diagnostic process investigating LO-FTD.

Culicoides monitoring in Belgium in 2011: analysis of spatiotemporal abundance, species diversity and Schmallenberg virus detection

In 2011, Culicoides (Diptera: Ceratopogonidae) were collected at 16 locations covering four regions of Belgium with Onderstepoort Veterinary Institute (OVI) traps and at two locations with Rothamsted suction traps (RSTs). Quantification of the collections and morphological identification showed important variations in abundance and species diversity between individual collection sites, even for sites located in the same region. However, consistently higher numbers of Culicoides midges were collected at some sites compared with others. When species abundance and diversity were analysed at regional level, between-site variation disappeared. Overall, species belonging to the subgenus Avaritia together with Culicoides pulicaris (subgenus Culicoides) were the most abundant, accounting for 80% and 96% of all midges collected with RSTs and OVI traps, respectively. Culicoides were present during most of the year, with Culicoides obsoletus complex midges found from 9 February until 27 December. Real-time reverse-transcription polymerase chain reaction screening for Schmallenberg virus in the heads of collected midges resulted in the first detection of the virus in August 2011 and identified C. obsoletus complex, Culicoides chiopterus and Culicoides dewulfi midges as putative vector species. At Libramont in the south of Belgium, no positive pools were identified.

Testing the hypothesis that psychotic illness begins when subthreshold hallucinations combine with delusional ideation

OBJECTIVE

While hallucinations and delusions are often considered as a single class of 'positive symptoms', little is known about their dynamic cooccurrence in relation to clinical outcome in non-help-seeking people.

METHOD

The Netherlands Mental Health and Incidence Study (NEMESIS-1) is a longitudinal study of mental disorders (n = 7075) with three measurements over a 3-year period. Risk factors, persistence of psychotic experiences, and clinical outcome were analyzed for groups with: i) no psychotic experiences, ii) only delusions, iii) only hallucinations, and iv) both delusions and hallucinations.

RESULTS

Hallucinations and delusions occurred together more often (T0, 3.5%; T1, 1.0%; T2, 0.9%) than that predicted by chance (T0, 1.0%; T1, 0.1%; T2, 0.04%). The group with both symptoms showed more 'first-rank'-like delusions compared with the group with only delusions. Having both hallucinations and delusions, compared to isolated symptoms, was associated more strongly with risk factors, comorbid affective symptoms, negative symptoms, and persistence of psychotic experiences. This was not an artifact of having more symptoms in general.

CONCLUSION

Experiencing both delusions and hallucinations is an indicator of greater etiological load resulting in more clinical outcome. A specific 'hallucinatory-delusional state' may represent an early phase of exacerbation of aberrant attribution of salience, increasing risk for clinical outcome.

Prognosis of severely hypoxemic patients receiving long-term oxygen therapy

Two hundred seventy severely hypoxemic (PaO2 < or = 55 mm Hg: mean +/- SD = 48 +/- 6) COPD patients (232 men) were selected for long-term oxygen therapy (LTOT). They were old (mean = 66 +/- 8 years), with severe airflow limitation (FEV1 = 30 +/- 12 percent of predicted), some CO2 retention (PaCO2 = 47 +/- 9 mm Hg), and compensated respiratory acidosis. Eighteen percent of the patients presented some complicating pleuropulmonary diseases (pleural thickening, sequelae of tuberculosis, etc). Overall survival proportion was poor: 70, 50, and 43 percent at 1, 2, and 3 years, respectively. The Cox model showed that the factors which independently reduced survival were lower CO transfer coefficient, smaller intrathoracic gas volume, more severe bronchial obstruction, the fact that oxygen administration did not increase PaO2 above 65 mm Hg, increasing age, and the presence of chest wall abnormalities. When the patients were divided into three groups according to mortality risk, the mean clinical and functional profile of the high-mortality risk group was consistent with the prevalence of emphysematous lesions. Moreover, the best survivors fitted better into the "bronchitic" type; they showed a higher mean PaCO2, suggesting that some degree of hypoventilation could delay muscular fatigue and improve survival. The difference in the proportion of "emphysematous" and "bronchitic" patients is a possible explanation for the variability of the mortality rate reported in literature.

Place of education in the management of chronic lung disease: role of the educational coordinator

The aim of patient education is more than just improve compliance to treatment. Teaching the patient to take an active part in the management of his handicap needs special communication skills and involves much more than just giving courses. Unfortunately all medical professionals are not necessarily good educators. As amateurism in patient education is a thing of the past, the role of the Health Education Coordinator in a pulmonary rehabilitation programme becomes essential to the quality of the programme.

Proposal for a European COPD network

Over the past few years, pulmonary rehabilitation programs have become more usual in Europe. Even COPD patients on LTOT no longer feel home-bound or grounded. Nevertheless, they experience anxiety when leaving their usual medical environment. The SEP would like to encourage COPD patients to travel by creating a European COPD network. The objectives of this network would be (1) to record all the pulmonary centers in Europe that are involved in pulmonary rehabilitation; (2) to know the availability of oxygen in the different European countries and pulmonary centers; (3) to record those of these centers that would agree to take under supervision COPD patients traveling in their respective area and to provide all technical and medical assistance; (4) to select the most suitable holiday resorts for COPD patients according to ambient temperature, altitude, hotel accommodation, pollution, and possibility for COPD patients to walk around and take excursions; (5) to include oxygen suppliers and medical equipment companies involved in the technical assistance of these COPD patients traveling with all their paraphernalia. Such a European network would enable COPD patients to travel securely, being sure to find medical and technical assistance in all of these "SEP-recommended" places (SEP Guide).

CO transfer capacity as a determining factor of survival for severe hypoxaemic COPD patients under long-term oxygen therapy

The transfer capacity for carbon monoxide is a commonly used method in clinical practice but is rarely considered as a prognostic factor for patients under long term oxygen therapy (LTOT). LTOT was applied to 217 stable, severely hypoxaemic (arterial oxygen tension (PaO2 less than 7.3 kPa or 55 mmHg) chronic obstructive pulmonary disease (COPD) patients, according to the usual recommendations. The average survival rate of this series is rather poor: 46% at 24 months. There is nevertheless an important difference between patients with a normal transfer coefficient and those with a decreased one (79% survival at 2 yrs as compared to 37%). On the other hand, the degree of airflow limitation has no prognostic value in the present series of very disabled patients. We can conclude that hypoxaemic COPD patients with a severely decreased transfer coefficient have a poor prognosis, even under LTOT, compared to patients with an equivalent impairment of airflow limitation and hypoxaemia but with a normal CO transfer factor/alveolar ventilation ratio (TLCO/VA).

CO transfer capacity as a determining factor of survival for severe hypoxaemic COPD patients under long-term oxygen therapy

The transfer capacity for carbon monoxide is a commonly used method in clinical practice but is rarely considered as a prognostic factor for patients under long term oxygen therapy (LTOT). LTOT was applied to 217 stable, severely hypoxaemic (arterial oxygen tension (PaO2 less than 7.3 kPa or 55 mmHg) chronic obstructive pulmonary disease (COPD) patients, according to the usual recommendations. The average survival rate of this series is rather poor: 46% at 24 months. There is nevertheless an important difference between patients with a normal transfer coefficient and those with a decreased one (79% survival at 2 yrs as compared to 37%). On the other hand, the degree of airflow limitation has no prognostic value in the present series of very disabled patients. We can conclude that hypoxaemic COPD patients with a severely decreased transfer coefficient have a poor prognosis, even under LTOT, compared to patients with an equivalent impairment of airflow limitation and hypoxaemia but with a normal CO transfer factor/alveolar ventilation ratio (TLCO/VA).