Caretakers' barriers to pediatric antiretroviral therapy adherence in Vietnam - A qualitative and quantitative study

BACKGROUND

Poor antiretroviral therapy (ART) adherence leads to drug resistance and treatment failures. The options for second and third line ART regimens, particularly for pediatric patients, are very limited in low and middle-income countries. HIV-infected children are mostly passive drug-takers, thus caretakers play a very important role in assuring ART adherence. Pediatric ART adherence is still a challenging problem in Vietnam since non-adherence is the major risk factor for treatment failure. Our study explores and measures caretakers' barriers in order to improve pediatric ART adherence in future.

METHODS

Exploring caretakers' barriers was conducted through a qualitative study with Focus Group Discussion (FGD) on two topics: 1. Current society - family support and difficulties in taking care children under ART; 2. Stigma experience. Based on the finding from the qualitative study a quantitative study measuring caretakers' barriers was conducted through a designed questionnaire. Study methods strictly followed the consolidated criteria with 32-item checklist for interviews and focus groups.

RESULTS

In total eight FGDs with 53 participants were conducted. Common caretakers' barriers to children's ART adherence, were financial burden, lack of ART KP (Knowledge-Practice), stigma, depression, shifting caretaker, drug taste and side effects, lack of family support, fixed health check-up schedule and HIV non-disclosure. In the questionnaire study a total of 209 caretakers participated. The most commonly reported caretakers' barriers were: financial burden (144; 69%), KP burden (143; 68%), depression (85; 41%) and stigma (30; 14.8%). Some caretakers' characteristics that significantly associated with reported barriers (p<0.05). Rural caretakers reported significantly more financial burden (OR=2.26) and stigma (OR=3.53) than urban. Caretakers with under high school level education reported significantly more financial burdens (OR=2.08) and stigma (OR=4.15) compared to caretakers with high school education or over.

CONCLUSION

Financial burden, KP burden, depression and stigma were common reported caretakers' barriers to pediatric ART adherence. Family residence, caretaker's education level and job were considered as the key factors determining caretakers' barriers related to financial burden and stigma. These findings may be important for policy makers and researchers in order to develop effective interventions regarding to caretakers' burdens and associated factors. Furthermore, a tool for nurses in monitoring caretakers' barriers to pediatric ART adherence was developed first with FDG, and then interview questionnaire. This tool could be applied and modified easily in any pediatric ART clinic settings in accordance to economic, social and cultural circumstances.

Ketamine treatment involves medial prefrontal cortex serotonin to induce a rapid antidepressant-like activity in BALB/cJ mice

Unlike classic serotonergic antidepressant drugs, ketamine, an NMDA receptor antagonist, exhibits a rapid and persistent antidepressant (AD) activity, at sub-anaesthetic doses in treatment-resistant depressed patients and in preclinical studies in rodents. The mechanisms mediating this activity are unclear. Here, we assessed the role of the brain serotonergic system in the AD-like activity of an acute sub-anaesthetic ketamine dose. We compared ketamine and fluoxetine responses in several behavioral tests currently used to predict anxiolytic/antidepressant-like potential in rodents. We also measured their effects on extracellular serotonin levels [5-HT]_ext in the medial prefrontal cortex (mPFCx) and brainstem dorsal raphe nucleus (DRN), a serotonergic nucleus involved in emotional behavior, and on 5-HT cell firing in the DRN in highly anxious BALB/cJ mice. Ketamine (10 mg/kg i.p.) had no anxiolytic-like effect, but displayed a long lasting AD-like activity, i.e., 24 h post-administration, compared to fluoxetine (18 mg/kg i.p.). Ketamine (144%) and fluoxetine (171%) increased mPFCx [5-HT]_ext compared to vehicle. Ketamine-induced AD-like effect was abolished by a tryptophan hydroxylase inhibitor, para-chlorophenylalanine (PCPA) pointing out the role of the 5-HT system in its behavioral activity. Interestingly, increase in cortical [5-HT]_ext following intra-mPFCx ketamine bilateral injection (0.25 μg/side) was correlated with its AD-like activity as measured on swimming duration in the FST in the same mice. Furthermore, pre-treatment with a selective AMPA receptor antagonist (intra-DRN NBQX) blunted the effects of intra-mPFCx ketamine on both the swimming duration in the FST and mPFCx [5-HT]_ext suggesting that the AD-like activity of ketamine required activation of DRN AMPA receptors and recruited the prefrontal cortex/brainstem DRN neural circuit in BALB/c mice. These results confirm a key role of cortical 5-HT release in ketamine's AD-like activity following the blockade of glutamatergic NMDA receptors. Tight interactions between mPFCx glutamatergic and serotonergic systems may explain the differences in this activity between ketamine and fluoxetine in vivo. This article is part of the Special Issue entitled 'Ionotropic glutamate receptors'.

Obesity and preference-weighted quality of life of ethnically diverse middle school children: the HEALTHY study

To date, studies examining the relation between body mass index percentile (BMI%) categories and health-related quality of life (QOL) measurements have not reported preference-weighted scores among ethnically diverse children. We report the associations between BMI% categories and preference-weighted scores among a large cohort of ethnically diverse sixth grade children who participated in the HEALTHY school-based type 2 diabetes risk factor prevention study. Health Utility Index 2 (HUI2) and Health Utility Index 3 (HUI3) and the feeling thermometer (FT) were the preference-weighted QOL instruments used to measure student's preference scores. Of 6358 consented students, 4979 (78.3%) had complete QOL, height, weight, and covariate data. Mean (SD) preference scores were 0.846 (0.160), 0.796 (0.237), and 0.806 (0.161) for the HUI2, HUI3, and FT, respectively. After adjusting for age, sex, blood glucose and insulin, Tanner stage, race/ethnicity, family history of diabetes, and educational attainment, children with severe obesity (>99%) had significantly lower preference scores compared to normal weight on all three instruments (HUI2 P = 0.013; HUI3 P = 0.025; and FT P < 0.001). Obese and severe obese categories were significantly associated with lower HUI2 functional ratings in the mobility domain and with lower HUI3 functional ratings in the speech domain.

The crossmodal facilitation effect is disrupted in alcoholism: a study with emotional stimuli

AIMS

Chronic alcoholism is classically associated with major deficits in the visual and auditory processing of emotions. However, the crossmodal (auditory-visual) processing of emotional stimuli, which occurs most frequently in everyday life, has not yet been explored. The aim of this study was to explore crossmodal processing in alcoholism, and specifically the auditory-visual facilitation effect.

METHODS

Twenty patients suffering from alcoholism, and 20 matched healthy controls had to detect the emotion (anger or happiness) displayed by auditory, visual or auditory-visual stimuli. The stimuli were designed to elicit a facilitation effect (namely, faster reaction times (RTs) for crossmodal condition than for unimodal ones). RTs and performance were recorded.

RESULTS

While the control subjects elicited a significant facilitation effect, alcoholic individuals did not present this effect, as no significant differences between RTs according to the modality were shown. This lack of facilitation effect is the marker of an impaired auditory-visual processing.

CONCLUSIONS

Crossmodal processing of complex social stimuli (such as faces and voices) is crucial for interpersonal relations. This first evidence for a crossmodal deficit in alcoholism contribute in explaining the contrast observed between experimental results describing, up to now, mild impairments in emotional facial expression (EFE) recognition in alcoholic subjects (e.g. Oscar-Berman et al.,1990), and the many clinical observations suggesting massive problems.

Évaluation du trouble de la personnalité sadique en relation avec la psychopathie auprès de patients internés en hôpital psychiatrique sécuritaire

The population was composed of 76 male patients (mean age=36.14). All of them having committed a violent offence indexed in their institutional file: (1) sexual offences on children; (2) rapes of adult women; (3) homicide offence; and (4) assaults and batteries. TPS was defined by the following 8 diagnostic criteria as described in DSM III-R: 1) has used physical cruelty or violence for the purpose of establishing dominance in a relationship; 2) humiliates or demeans people in the presence of others; 3) has treated or disciplined someone under his or her control unusually harshly; 4) is amused by, or takes pleasure in, the psychological or physical suffering of others; 5) has lied for the purpose of harming or inflicting pain on others 6) gets other people to do what he or she wants by frightening them 7) restricts the autonomy of people with whom he or she has a close relationship; 8) is fascinated by violence, weapons, martial arts, injury, or torture. These criteria were assessed from (a) clinical and institutional files and (b) clinical collateral informations. TPS assessment was conducted by two -trainees in clinical psychology (kappa=0.87; n=20). The assessment of psychopathy was conducted according to the guidelines of the Hare psychopathy checklist manual (PCL-R, 1991, 2003): coding of clinical and institutional files and semi-structural clinical interviews. The PCL-R is mainly composed by 2 factors: factor 1 "Emotional detachment" describing the core psychological component of psychopathy, and factor 2 "Chronically antisocial factor" reflecting behavioral instability and antisocial life style. The total cut-off score for the inclusion of the diagnosis was 25. The prevalence of TPS in the population was 25% (n=19) and is congruent with the large range described in the literature (0.5 to 33%). The most frequent criteria were 6 (gets other people to do what he or she wants by frightening them), 1 (has used using physical cruelty or violence for the purpose of establishing dominance in a relationship) and 3 (has treated or disciplined someone under his or her control unusually harshly). The most sensible criteria were: 7 (restricts the autonomy of people with whom he or she has a close relationship), 8 (major interest for violence) and 4 (pleasure in the psychological or physical suffering of others). The most specific criteria were: 3 (has treated or disciplined someone under his or her control unusually harshly), 6 (gets other people to do what her or she wants by frightening them), 4 (takes pleasure in the psychological or physical suffering of others) and 1 (has used physical -cruelty or violence for the purpose of establishing dominance in a relationship). As concerns psychopathy, the mean of factor 1, factor 2 and the PCL-R total scores were 7.40, 9.08 and 18.67. Thus, 38% of patients were considered as "low psychopaths", 36% were considered as "moderate psychopaths" and 26% were considered as "high psychopaths". In spite of few significant positive correlations between some TPS and PCL-R criteria, TPS diagnosis was not significantly correlated with factors 1, factor 2, nor with total score of the PCL-R. The mean psychopathy total score did not differ between sadistic and non-sadistic patients. Moreover, a two ways ANOVA comparing PCL-R factors 1 and 2 did not reveal any differences between sadism and non-sadism. Again, these comparisons did not support hypothesis of a strong association between TPS and psychopathy.

Fascioliasis in Vietnam

A confirmed diagnosis of human fascioliasis was rare in Vietnam until 1978 when two cases were reported in humans. Since 1997, we have confirmed 500 cases of human fascioliasis. The majority of cases come from the central provinces of Vietnam: Da Nang, Quang Ngai, Binh Dinh, Phu Yen and Khanh Hoa. Patients were treated in hospitals in Ho Chi Minh City. All had high peripheral blood eosinophilic counts (16-70%) and positive serology with Fasciola gigantica antigen with positive titers of 1/1,600 to 1/12,800. We are unsure whether this represents an endemic pattern of disease or whether improved specific laboratory tools now facilitate better diagnosis. It is also possible that with changes in environmental factors and in the number and breeds of herbivorous domestic animals, Fasciola is increasing in frequency and easily contaminates the food.

A large arteriovenous malformation of the external ear in an adult: report of a case and approach to management

OBJECTIVES/HYPOTHESIS

Arteriovenous malformations involving the external ear are relatively uncommon in adults. Arteriovenous malformations in the head and neck can poses difficult therapeutic challenges.

STUDY DESIGN

Case report.

METHODS

We report a case of a large arteriovenous malformation in the external ear in a 41-year-old man.

RESULTS

Extensive enlargement of the previously latent and asymptomatic arteriovenous malformation was triggered by blunt trauma to the ear.

CONCLUSION

We discuss the definition, clinical findings, diagnostic approaches, and therapeutic management of arteriovenous malformations.

Monitoring tumor response during photodynamic therapy using near-infrared photon-migration spectroscopy

Benzoporphyrin-derivative (BPD)-monoacid-ring A photodynamic therapy (PDT) was performed on subcutaneous tumor implants in a rat ovarian cancer model. In order to assess PDT efficacy the tumor and normal tissue optical properties were measured noninvasively prior to and during PDT using frequency-domain photon migration (FDPM). FDPM data were used to quantify tissue absorption and reduced scattering properties (given by the parameters mu a and mu's, respectively) at four near-infrared (NIR) wavelengths (674, 811, 849 and 956 nm). Tissue physiologic properties, including the in vivo concentration of BPD, deoxy-hemoglobin (Hb), oxy-hemoglobin (HbO2), total hemoglobin (TotHb), water (H2O) and percent tissue hemoglobin oxygen saturation (%StO2), were calculated from optical property data. PDT efficacy was also determined from morphometric analysis of tumor necrosis in histologic specimens. All the measured tumor properties changed significantly during PDT. [Hb] increased by 9%, while [HbO2], [TotHb] and %StO2 decreased by 18, 7 and 12%, respectively. Using histologic data we show that long-term PDT efficacy is highly correlated to mean BPD concentration in tumor and PDT-induced acute changes in [HbO2], [TotHb] and %StO2 (correlation coefficients of 0.829, 0.817 and 0.953, respectively). Overall, our results indicate that NIR FDPM spectroscopy is able to quantify noninvasively and dynamically the PDT-induced physiological effects in vivo that are highly correlated with therapeutic efficacy.

Monitoring tumor response during photodynamic therapy using near-infrared photon-migration spectroscopy

Benzoporphyrin-derivative (BPD)-monoacid-ring A photodynamic therapy (PDT) was performed on subcutaneous tumor implants in a rat ovarian cancer model. In order to assess PDT efficacy the tumor and normal tissue optical properties were measured noninvasively prior to and during PDT using frequency-domain photon migration (FDPM). FDPM data were used to quantify tissue absorption and reduced scattering properties (given by the parameters mu a and mu's, respectively) at four near-infrared (NIR) wavelengths (674, 811, 849 and 956 nm). Tissue physiologic properties, including the in vivo concentration of BPD, deoxy-hemoglobin (Hb), oxy-hemoglobin (HbO2), total hemoglobin (TotHb), water (H2O) and percent tissue hemoglobin oxygen saturation (%StO2), were calculated from optical property data. PDT efficacy was also determined from morphometric analysis of tumor necrosis in histologic specimens. All the measured tumor properties changed significantly during PDT. [Hb] increased by 9%, while [HbO2], [TotHb] and %StO2 decreased by 18, 7 and 12%, respectively. Using histologic data we show that long-term PDT efficacy is highly correlated to mean BPD concentration in tumor and PDT-induced acute changes in [HbO2], [TotHb] and %StO2 (correlation coefficients of 0.829, 0.817 and 0.953, respectively). Overall, our results indicate that NIR FDPM spectroscopy is able to quantify noninvasively and dynamically the PDT-induced physiological effects in vivo that are highly correlated with therapeutic efficacy.

Cross-sectional study of sexual behaviour and knowledge about HIV among urban, rural, and minority residents in Viet Nam

OBJECTIVE

A cross-sectional survey was conducted in three districts of Quang Ninh province, Viet Nam, to find out what proportion of the people who lived there engaged in behaviour that put them at risk of becoming infected with HIV, and to measure their knowledge about HIV infection and AIDS.

METHODS

The survey was conducted in a rural district, Yen Hung; a mountainous district inhabited primarily by ethnic minority groups, Binh Lieu; and an urban district, Ha Long. Participants aged 15-45 years were randomly selected from the general population to be interviewed.

FINDINGS

A total of 630 people from 707 households were interviewed; 8% were not home despite repeated visits and 3% refused to participate. The prevalence of premarital intercourse ranged from 9% to 16% among married men and 4% to 7% among married women. Among single men the proportion who had ever had intercourse ranged from 6% to 16%. Fewer than 3% reported having ever had sex with a sex worker. The median number of extramarital sex partners was 1. Knowledge about HIV/AIDS was high in the urban and rural areas but low in the mountainous area. Being male and being 20-29 years old were associated with having multiple sex partners.

CONCLUSION

The low prevalence of individuals reporting that they had had intercourse with sex workers and partners other than their spouse may explain the low rates of HIV infection among the heterosexual population; these rates are in contrast to the high rates of HIV infection found among injecting drug users. The association between having extramarital partners and being a younger man suggests that the tendency to have more sexual partners may increase in the future. If this happens, the potential for HIV to be spread through heterosexual sex will increase.

Quantifying the absorption and reduced scattering coefficients of tissuelike turbid media over a broad spectral range with noncontact Fourier-transform hyperspectral imaging

Absorption (mu(a)) and reduced scattering (mu(s)') spectra of turbid media were quantified with a noncontact imaging approach based on a Fourier-transform interferometric imaging system (FTIIS). The FTIIS was used to collect hyperspectral images of the steady-state diffuse reflectance from turbid media. Spatially resolved reflectance data from Monte Carlo simulations were fitted to the recorded hyperspectral images to quantify mu(a) and mu(s)' spectra in the 550-850-nm region. A simple and effective calibration approach was introduced to account for the instrument response. With reflectance data that were close to and far from the source (0.5-6.5 mm), mu(a) and mu(s)' of homogeneous, semi-infinite turbid phantoms with optical property ranges comparable with those of tissues were determined with an accuracy of +/-7% and +/-3%, respectively. Prediction accuracy for mu(a) and mu(s)' degraded to +/-12% and +/-4%, respectively, when only reflectance data close to the source (0.5-2.5 mm) were used. Results indicate that reflectance data close to and far from the source are necessary for optimal quantification of mu(a) and mu(s)'. The spectral properties of mu(a) and mu(s)' values were used to determine the concentrations of absorbers and scatterers, respectively. Absorber and scatterer concentrations of two-chromophore turbid media were determined with an accuracy of +/-5% and +/-3%, respectively.

Quantifying the properties of two-layer turbid media with frequency-domain diffuse reflectance

Noncontact, frequency-domain measurements of diffusely reflected light are used to quantify optical properties of two-layer tissuelike turbid media. The irradiating source is a sinusoidal intensity-modulated plane wave, with modulation frequencies ranging from 10 to 1500 MHz. Frequency-dependent phase and amplitude of diffusely reflected photon density waves are simultaneously fitted to a diffusion-based two-layer model to quantify absorption (mu(a)) and reduced scattering (mu(s)') parameters of each layer as well as the upper-layer thickness (l). Study results indicate that the optical properties of two-layer media can be determined with a percent accuracy of the order of +/-9% and +/-5% for mu(a) and mu(s)', respectively. The accuracy of upper-layer thickness (l) estimation is as good as +/-6% when optical properties of upper and lower layers are known. Optical property and layer thickness prediction accuracy degrade significantly when more than three free parameters are extracted from data fits. Problems with convergence are encountered when all five free parameters (mu(a) and mu(s)' of upper and lower layers and thickness l) must be deduced.

Subjective and autonomic responses to emotion induction in psychopaths

It has been theorized that psychopaths have a fundamental deficit with respect to emotions (Cleckley, 1941). This study compares psychopaths with control subjects (Hare, 1991) in terms of their physiological and subjective responses to video clips depicting different emotions: joy, fear, anger, sadness, and disgust. Physiological measures assessed cardiovascular, respiratory, electrodermal, electromyographic responding, as well as skin temperature. Subjective measures assessed bodily sensations and subjective emotional appraisal. The principal physiological difference was a lower blood pressure among psychopaths before and during emotional stimulation. Thus, while psychopaths's autonomic base-line may be generally hyporeactive, they do not seem to have any emotion-specific physiological deficit. Globally, the results suggested no specific psychophysiological deficits among psychopaths in a context using daily emotions. Subjective measures also revealed that, compared to control subjects, psychopaths reported less intense bodily sensations during emotional stimulation. There was no difference between the two groups in terms of emotional appraisal.

Quantitative near-infrared spectroscopy of cervical dysplasia in vivo

The aims of this study were: (i) to quantify near-infrared optical properties of normal cervical tissues and high-grade squamous intra-epithelial lesions (H-SIL); (ii) to assess the feasibility of differentiating normal cervical tissues from H-SIL on the basis of these properties; and (iii) to determine how cervical tissue optical properties change following photodynamic therapy (PDT) of H-SIL in vivo. Using the frequency domain photon migration technique, non-invasive measurements of normal and dysplastic ecto-cervical tissue optical properties, i.e. absorption (mu(a)) and effective scattering coefficients, and physiological parameters, i.e. tissue water and haemoglobin concentration, percentage oxygen saturation (%SO(2)), were performed on 10 patients scheduled for PDT of histologically-proven H-SIL. Cervix absorption and effective scattering parameters were up to 15% lower in H-SIL sites compared with normal cervical tissue for all wavelengths studied (674, 811, 849, 956 nm). Following PDT, all mu(a) values increased significantly, due to elevated tissue blood and water content associated with PDT-induced hyperaemia and oedema. Tissue total haemoglobin concentration ([TotHb]) and arterio-venous oxygen saturation measured in H-SIL sites were lower than normal sites ([TotHb]: 88.6 +/- 35.8 micromol/l versus 124.7 +/- 22.6 micromol/l; %SO(2): 76.5 +/- 14.7% versus 84.9 +/- 3.4%).

Intrauterine light probe for photodynamic ablation therapy

BACKGROUND

Endometrial ablation by means of photodynamic therapy is currently being evaluated as an outpatient treatment for dysfunctional uterine bleeding. Photodynamic therapy requires the activation of a photosensitizer by laser light. We describe a new device specifically designed to provide light delivery to the uterus for endometrial photodynamic therapy.

INSTRUMENT

The intrauterine light probe consists of the three flexible optical fibers converging to one bundle resembling the shape of the uterine cavity. Each of the fibers contains a cylindrical light diffuser.

EXPERIENCE

The intrauterine light probe was tested in removed human uteri for its capability to distribute light in a tissue-simulating scattering medium and to deliver sufficient light throughout the endometrium. The light distribution of the intrauterine light probe in the scattering medium is uniform on eight axes tested around the diffusing fibers. The pattern of light distribution in human uteri is similar to that in the medium. At the endomyometrial junction, there is still one third of the light applied to the endometrial surface whereas deeper in the myometrium, the light power drops to less than 10%.

CONCLUSION

We propose a device that will deliver light to the uterine cavity to induce endometrial ablation by means of photodynamic therapy.

[Psychometric evaluation of the Hare Psychopathy Questionnaire in a Belgian prison population]

The PCL-R (Hare, 1991) presents high reliability and validity characteristics. The instrument is the measure of choice for the assessment of psychopathic personality. The PCL-R has never been submitted to psychometric analysis in french speaking european samples. The study examines the psychometric characteristics of the PCL-R on an Belgian prison sample. The study assessed the inter-raters reliability parameters, the Alpha Cronbach coefficient and the PCL-R mean scores. The two correlated factors extracted were compared with those of others European and Nord American samples. The study also described the concomitant validity of the instrument by computing the correlations between the PCL-R scores and the type of offence.

[Angioplasty in the stenosed hemodialysis shunt: experiences with 100 patients and 166 interventions]

PURPOSE

Failing dialysis fistulas are a severe complication for patients treated by chronic haemodialysis. This study was undertaken to evaluate the technical aspects of percutaneous transluminal angioplasty (PTA) of shunts and to report on our experience in 100 patients.

PATIENTS AND METHODS

In a 4-year period a total of 166 PTA procedures was performed in 100 haemodialysis patients with stenosis and occlusion of Brescia Cimino shunts and PTFE grafts (polytetrafluoroethylene). Patency rates were retrospectively evaluated for type and location of lesions, patient age, sex and the success of PTA.

RESULTS

Technical success was achieved in 97% (n = 161). Complications appeared in 11 cases (6.6%). Shunt occlusion or rupture of a vein is rare. The cumulative patency rate for primary PTA treatment was 55% at 6 months, 47% at 12 months and 32% at 24 months and for repeat PTA treatment 87% at 6 months, 80% at 12 months and 70% at 24 months. Residual stenosis and diabetes mellitus significantly reduced the patency rate.

CONCLUSION

PTA is an ideal method for accomplishing recurrent fistula failure due to its cost effectiveness and minimally invasive procedure. Recurrent stenosis has been a major problem of PTA as also in equal measure with surgical intervention.

Case report: acanthosis nigricans in association with primary biliary cirrhosis: resolution after liver transplantation

A case is described of a 58 year old Caucasian male with primary biliary cirrhosis (PBC) who first presented with acanthosis nigricans of both axillae, skin pigmentation, which was pronounced over the posterior surface of the neck, and generalized pruritus. Following orthotopic liver transplantation for progressive liver disease, the skin pigmentation, pruritus and acanthosis nigricans resolved. It is believed that this is the first reported case of acanthosis nigricans occurring in association with PBC, a phenomenon that resolved after liver transplantation.

Coeliac disease in adults. Presentation and management

Coeliac disease, also known as gluten-sensitive enteropathy or non-tropical sprue, is a relatively uncommon condition. The dietary presence of gliadin, an alcohol-soluble subfraction of gluten, in immunologically susceptible hosts will lead to small intestinal mucosal inflammation and subsequent mucosal villous atrophy which results in nutrient and vitamin malabsorption. The symptomatic presentations of patients with coeliac disease are related to this malabsorption process which can be reversed in the vast majority of patients with a gluten-free diet.

[The characteristic interrelationships of the anterior chamber angle in myopia]

Comprehensive ophthalmologic examinations of the anterior chamber angle were carried out in 130 patients (259 eyes) aged 16 to 39 (mean age 22.9 +/- 0.55 years) with myopia of 0.5 to 13.6 diopters. Study of the pattern of gonioscopic signs distribution has shown that the most characteristic factor related to myopia development and progress is the presence of goniodysgenesis signs, namely, expressed development of ligamentum pectinatum iridis, marked anterior position of Schlemm's canal combined with a wide anterior chamber corner, and pigmentation of anterior chamber corner. Analysis of gonioscopic signs, their mutual influences and relationships with other anatomicofunctional parameters will help assess the role of these signs in the development of complicated myopia, prediction of myopia course, and differential diagnosis of its pathogenetic forms.