Cationic exchange SPE combined with triple quadrupole UHPLC-MS/MS for detection of GHRHs in urine samples

The use of growth hormone-releasing hormones (GHRHs) is prohibited in sports according to the regulations of the World Anti-Doping Agency (WADA). Considering the complexity of urine samples and the low concentrations at which these analytes should be detected, analyzing GHRHs is a challenging task. In most of the studies, GHRHs are analyzed using UHPLC-HRMS with an orbitrap. The present developed and validated method for some GHRHs (tesamorelin, CJC-1295, sermorelin (GRF 1-29), sermorelin (3-29)-NH2, somatorelin) is based on the triple quadrupole UHPLC/MS-MS method with solid phase extraction (SPE) with weak cation exchange and is able to detect concentrations as low as 0.2 ng/mL (LOD), a limit of quantification (LOQ) at 0.6 ng/mL, and linearity across the range of 0.1 ng/mL to 1.2 ng/mL. The present method developed by our doping control laboratory was validated according to WADA technical documents for selectivity, limit of detection (LOD), carryover, reliability of detection, stability and recovery. The results show that the method has adequate recoveries and sensitivity, hence, it can be employed for routine screening in anti-doping laboratories.

Identifying Optical Coherence Tomography Markers for Multiple Sclerosis Diagnosis and Management

BACKGROUND

Multiple sclerosis (MS) is a common neurological disease affecting the optic nerve, directly or indirectly, through transsynaptic axonal degeneration along the visual pathway. New ophthalmological tools, arguably the most important being optical coherence tomography (OCT), could prove paramount in redefining MS diagnoses and shaping their follow-up protocols, even when the optic nerve is not involved.

METHODS

A prospective clinical study was conducted. In total, 158 eyes from patients previously diagnosed with relapsing remitting MS (RRMS)-with or without optic neuritis (ON), clinically isolated syndrome (CIS) with or without ON, and healthy controls were included. Each patient underwent an ophthalmologic exam and OCT evaluation for both eyes (a posterior pole analysis (PPA) and the optic nerve head radial circle protocol (ONH-RC)).

RESULTS

The macular retinal thickness (the 4 × 4, respectively, 2 × 2 grid) and thickness of the peripapillary retinal nerve fiber layer (pRNFL) were investigated. Various layers of the retina were also compared. Our study observed significant pRNFL thinning in the RRMS eyes compared to the control group, the pRNFL atrophy being more severe in the RRMS-ON eyes than the RRMS-NON eyes. In the ON group, the macular analysis showed statistically significant changes in the RRMS-ON eyes when compared only to the CIS-ON eyes, regarding decreases in the inner plexiform layer (IPL) thickness and inner nuclear layer (INL) on the central 2 × 2 macular grid. The neurodegenerative process affected both the inner retina and pRNFL, with clinical damage appearing for the latter in the following order: CIS-NON, CIS-ON, RRMS-NON, and RRMS-ON. In the presence of optic neuritis, SMRR patients presented an increase in their outer retina thickness compared to CIS patients.

CONCLUSIONS

To differentiate the MS patients from the CIS patients, in the absence of optic neuritis, OCT Posterior Pole Analysis could be a useful tool when using a central 2 × 2 sectors macular grid. Retinal changes in MS seem to start from the fovea and spread to the posterior pole. Finally, MS could lead to alterations in both the inner and outer retina, along with pRNFL.

The key role of the ophthalmologist in diagnosing botulism: two case reports

Introduction

Botulinum toxin, the strongest known neurotoxin, is the cause of a rare fatal neuroparalytic disease characterized by the so-called "four Ds": diplopia, dysarthria, dysphagia, dry mouth. If left untreated, botulism may cause paralysis of the respiratory muscles, impairing the respiratory function which can ultimately lead to death.

Case report

We describe the cases of two patients who presented, two years apart, with similar ocular symptoms such as blurred vision due to accommodation palsy, diplopia, accompanied by xerostomia and swallowing disorders, which were further confirmed as botulism. Both cases had a similar clinical presentation of the intoxication and a positive response to treatment with botulinum antitoxin, while only the first case had a laboratory confirmation of the disease.

Conclusions

The key to diagnose botulism correctly is based on high clinical suspicion and requires a medical multidisciplinary approach and urgent specific treatment. Ophthalmology specialists must be aware of the disease, especially in cases in which ophthalmic manifestation appear at the onset.

Cardiac amyloidosis is not a single disease: a multiparametric comparison between the light chain and transthyretin forms

Background

Systemic amyloidoses represent a heterogeneous group of diseases resulting from the deposition of misfolded proteins as amyloid fibrils into the extracellular matrix of different organs. Based on this precursor protein, cardiac amyloidosis (CA) can be most frequently classified as: light chain (AL) and transthyretin (ATTR) amyloidosis, with different management and prognosis.

Purpose

The purpose of this study is to establish a differential diagnosis algorithm targeted towards these two most frequent subtypes of CA. Although confirmation through invasive or non-invasive diagnostic algorithms is still mandatory for a final diagnosis, a series of clinical, paraclinical and imaging differences could possibly guide the choice for more complex diagnostic steps.

Methods

We prospectively included all consecutive patients with ATTR and AL evaluated between 2018 and 2022 in our center. All patients had a complete clinical, paraclinical and imaging evaluation including myocardial deformation study, and confirmation of the final diagnosis, according to the current international recommendations.

Results

The study population included 81 patients divided into 2 groups: ATTR (group 1, n=32: 30 variant and 2 wild type) and AL (group 2, n=49).

ATTR patients were younger (50.7±13.9 vs. 60.2±7.3 years, p=0.0001), had predominantly more neurological symptoms, milder cardiac symptoms and lower values of cardiac biomarkers than AL: NT-proBNP (3095±4433 vs. 10382±9008 ng/ml, p=0.001) and high sensitive troponin I (0.0129±0.01 vs 0.177±0.2 ng/ml, p=0.0002), with better renal function (mean GFR 84.74±26.9 vs. 64.5±29.45 mL/min, p=0.003). We found no significant differences in terms of ECG changes.

Moreover, at similar left ventricular (LV) wall thickness and ejection fraction, ATTR group had less pericardial effusions (53.6 vs. 86.8%, p=0.0027), better LV global longitudinal strain (−12.0±3.7 vs. −9.7±4.6%, p=0.03), RV strain (RVFW strain −19.7±6.2 vs. −14.5±11.0%, p=0.03) and also better reservoir and contractile function of the LA (LASr 17.2±12.3 vs. 11.2±7.4%, p=0.02).

Based on this multiparametric comparison we proposed a prediction algorithm to differentiate between the 2 forms of CA. A score of equal or more than 4 from a maximum of 9 points, has been able to differentiate between AL and ATTR with a sensitivity and specificity of 78 and 80%, respectively; AUC= 0.82.

Conclusions

CA is a complex entity and requires extensive testing through serum biomarkers, imaging, and invasive confirmation of amyloid infiltration in some cases. This study highlighted a series of non-invasive checkpoints, which can be useful in guiding the decision making process towards a more accurate and rapid differential diagnosis, in cases where a final diagnosis is crucial to be immediately established.

Funding Acknowledgement

Type of funding sources: None.

Bilateral multifocal and recurrent chorioretinopathy - case report

Objective: The aim of this report is to highlight a rare condition that raises serious diagnosis and treatment difficulties. Case presentation: A 34-year-old male patient presented at the Department of Ophthalmology accusing reduced visual acuity (VA), dyschromatopsia and slight photophobia in his left eye (OS). Posterior pole examination revealed serous retinal detachment superior to the optic nerve head in his right eye (OD) and a well-defined macular oedema in the OS. Optical coherence tomography (OCT) confirmed the presence of subretinal fluid accumulations, fundus fluorescein angiography (FFA) revealed punctate hyperfluorescent pinpoint foci in the macular region of both eyes in the early venous phase and dye pooling in the late phase. The first diagnosis was Probable Vogt-Koyanagi-Harada (VKH) syndrome, but the evolution under corticosteroid therapy and shifting of the position of the serous retinal detachments in time, changed the diagnosis to multifocal, recurrent central serous choroidopathy. The patient received treatment with anti-vascular endothelial growth factor (VEGF) agents and presented multiple episodes of partial remission and shift of the subretinal fluid. Conclusions: The persistent, recurrent, multifocal and bilateral exudative retinal detachments raised significant diagnosis difficulties. In the absence of a well-established treatment, the current prognosis is unfavorable. Abbreviations: MARC = multifocal and recurrent choroidopathy, CSCR = Central Serous Chorioretinopathy, RPE = retinal pigment epithelium, CFH = complement factor H, VA = visual acuity, OD = right eye, OS = left eye, OCT = ocular coherence tomography, VEGF = vascular endothelial growth factor, FFA = Fundus fluorescein angiography, p-ANCA = Perinuclear anti-neutrophil cytoplasmic antibodies, PR3 = IgG antibodies against proteinase 3, ANA = antinuclear antibodies, CIC = Circulating immune complexes, CMV = Cytomegalovirus, VKH = Vogt-Koyanagi-Harada.

Conjunctival Lymphangiectasia - case report

Conjunctival lymphangiectasia is a rare pathology that represents the enlargement of the lymphatic vessels localized in the conjunctiva. Patients may be asymptomatic or experience symptoms such as foreign body sensation, congestion, irritation, dryness, and blurry vision. There are various methods of therapy for patients with severe and symptomatic conjunctival lymphangiectasia. Surgical excision has the lowest rates of recurrence. We present a case of a 24-year-old woman with conjunctival lymphangiectasia and a history of left lower limb enlargement and bilaterally enlarged submandibular and upper jugular lymph nodes without an identifiable cause, who presented to the ophthalmology clinic accusing ocular discomfort, foreign body sensation and transparent conjunctival cystic lesions in the left eye for the last five months. Abbreviations: OD = right eye, OS = left eye, OCT = optical coherence tomography, VEGF = vascular endothelial growth factor.

Migraine or Acute Angle Closure?

This paper aimed to present a relatively frequent misinterpretation of a migraine with visual aura. Sometimes, patients with aura and migraine are referred to the ophthalmologic unit with the diagnosis of acute angle closure attack. Thus, we discussed the way an ophthalmologist could make a difference between these two entities.

Ocular cicatricial pemphigoid

Ocular cicatricial pemphigoid (OCP) is an autoimmune ocular disease that causes severe dry eye syndrome, conjunctival scarring with inferior fornix shortening and entropion along with trichiasis. Corneal keratinization and corneal ulcers may lead to permanent vision loss. The therapeutic approach of OCP is a challenging one. Thus, the treatment consists of a systemic therapy that includes immunosuppressive as well as corticosteroid medication. Also, surgical procedures for modifications of eyelid position, symblepharon and cataract may aggravate the evolution of the disease. Dry eye syndrome, which is known to be a multifactorial disorder of the ocular surface secondary to qualitative or quantitative alteration of the tear film, is a severe and frequent complication of OCP. In this article, we presented 3 patients diagnosed with OCP, who developed severe dry eye syndrome, entropion, corneal erosions and ultimately, permanent vision loss.

P216 Cardiac amyloidosis is not a single disease: an echocardiographic study of light chain vs transthyretin forms

Background

Cardiac amyloidosis (CA) is described as one entity. However, several subtypes of amyloid can infiltrate the heart: light chain (AL) and tranthyretin (ATTR) are the most common.

Purpose

To characterize the specific findings of the CA subtypes as a tool to aid differential diagnosis between AL and ATTR CA.

Material and methods: Consecutive patients with CA were evaluated by clinical examination, ECG, cardiac biomarkers and echocardiography with both conventional and myocardial deformation study of the left ventricle (LV), left atrium (LA) and right ventricle (RV). Amyloid subtype was described using light chain assessment for AL-CA and 99Tc-HMPD scintigraphy and TTR gene sequencing for ATTR-CA.

Results

32 patients with CA were included, 13 with ATTR and 19 with AL. Patients in AL group were significantly older, with higher levels of cardiac biomarkers. At similar LV EF and wall thickness, they had lower GLS. LA function parameters were also lower in AL pts (table). Using ROC curves, the best predictors for AL diagnosis were NTproBNP (AUC 0.937) and Tn levels (AUC 0.958), as well as LV GLS and pericardial fluid presence (both AUC 0.750).

Conclusions

At similar LV wall thickness and ejection fraction, cardiac dysfunction appears to be more severe in AL pts, with lower global LV longitudinal strain, worse LA function, higher sPAP and NTproBNP.

ATTR (13 pts) AL (19 pts) p Age (years) 50 ± 12 60 ± 8 0.01 NTproBNP (pg/mL) 3066 ± 3720 11755 ± 9114 0.02 hsTnI (ng/mL) 0.005 ± 0.008 0.147 ± 0.161 0.04 Pericardial fluid (%) 53% 100% 0.002 LVEDV (mL) 88 ± 25 75 ± 38 NS LVMi (g/m2) 166 ± 47 168 ± 41 NS LVEF (%) 50 ± 8 49 ± 16 NS LV GLS (%) -12.1 ± 3.8 -8.9 ± 4.5 0.04 Septal Basal/Apical LS 0.33 ± 0.17 0.25 ± 0.27 NS LAVi (mL/m2) 46 ± 21 45 ± 14 NS LAEF 4CV (%) 35 ± 21 24 ± 8 0.05 LA systolic strain (%) 17.4 ± 11.9 10.5 ± 5.0 0.02 RV free wall thickness (mm) 7.0 ± 1.5 7.6 ± 1.4 NS RV 6-segments strain (%) -15 ± 4 -10 ± 8 0.09 sPAP (mmHg) 36.6 ± 12.0 48.6 ± 17.2 0.04

THERAPEUTIC PARTICULARITIES OF CHRONIC SUPPURATED CHOLESTEATOMATOUS OTOMASTOIDITIS

Chronic suppurated otomastoiditis is a chronic inflammatory damage of the middle ear and mastoid process that exceeds 12 weeks and which leads to the permanent perforation of the eardrum’s membrane. There is local damage such as osteitis, osteonecrosis and cholesteatoma, while a general view reveals an  asymptomatic evolution, with a good general state, otorrhea being the only local symptom. This paper brings to light a case resulting from the thorough analysis of case studies run by the ENT Clinic of the Emergency County Hospital "Sf. Apostol Andrei” of Galaţi, through the fact that otomastoiditis progresses given the presence of a congenital hemangioma located on the left half of the cephalic extremity, at a cervical, thoracic and abdominal level. The patient, aged 41, has been suffering from this disease since childhood and has undergone numerous surgeries up to this moment, but none has proven to be adequate for the extent of the lesion due to the malformation and the difficulty in providing general anesthesia with orotracheal intubation, the hemangioma being present in the oropharynx, hypopharynx and larynx. Given the overlapping of the two disorders, the surgical-medical approach to the ear damage has proven insufficient in time due to the risk of massive bleeding, taking into account the fact that the hemangioma was extended to the left ear duct, pharynx and larynx. For this reason, the disease has progressed, leading to extended erosive cholesteatoma with left otomastoiditis. The particularities of the therapeutic approach are presented along with anesthesiologic and surgical problems involved by the hemangioma. Although the risk of hemorrhaging was great, approaching the condition by choosing to provide general anesthesia and making the incisions only with the help of an electric scalpel, the case was eventually solved successfully from a surgical point of view.

Optical coherence tomography as a marker of vision in children with optic pathway gliomas

PURPOSE

Optic pathway gliomas (OPG) represent an important cause of visual loss in pediatric population. The indication of treatment is based on clinical or neuroimaging progression. Visual acuity loss is the most important symptom of disease progression, but children with OPG are frequently unable to complete the testing of visual function. Optical coherence tomography (OCT) was suggested as an objective tool for visual assessment. A literature review was performed in order to determine the role of retinal OCT as a surrogate marker of vision in children with OPG.

METHODS

The search was performed using PubMed, Embase, and Web of Science databases and was restricted to articles published in English between 2000 and 2016, with a minimum of ten participants enrolled.

RESULTS

Eleven studies met the eligibility criteria and were included in the present review. Both neurofibromatosis-1 associated and sporadic OPG were investigated.

CONCLUSIONS

Retinal OCT is a promising tool to be considered as a screening or follow-up test in children with OPG, and further multicenter research is encouraged.

Dynamic behavior of a nematic liquid crystal mixed with CoFe2O4 ferromagnetic nanoparticles in a magnetic field

The dynamic behavior of a mixture of 4-cyano-4'-pentylbiphenyl (5CB) with 1% CoFe2O4 nanoparticles was analyzed. Experimental data indicate a high stability of the nematic director in the mixture compared to a reference 5CB sample in the magnetic field. The ferrite nanoparticles agglomerate forming long chains as observed in polarized microscopy images. These chains have a very high influence on the magneto-optic effect of the cell. When the magnetic field is applied on the mixture, the chains tend to align with the field direction but, due to their large size, they remain oriented obliquely between the support plates. Thus, the nematic molecules anchored on their surface can not reorient with the field and only a small distortion angle of the liquid crystal molecular director is observed. A comparison with a previously developed theoretical model confirms this small deviation.

Case report: bilateral optic nerve head drusen and glaucoma

Optic nerve head drusen is an incidental finding in current ophthalmological practice. Although patients rarely display symptoms, structural, and functional defects, there are exceptional cases when clinical appearance can make it difficult to diagnose underlying or coexisting conditions, such as glaucoma. The following case report demonstrates how overlapping optic nerve pathologies can interfere in clinical judgement and therapeutic decision making in a young male patient, with relevant family history for both glaucoma and bilateral optic nerve head drusen.

Optical coherence tomography impacts the evaluation of visual pathway tumors

The objective of this systematic literature review is to assess the role of retinal optical coherence tomography (OCT) in the evaluation of patients with tumors of the visual pathway. We performed a PubMed database search according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The search was restricted to articles published in English between 2000 and 2016, with at least 10 human adult participants enrolled. Twenty-seven articles met the eligibility criteria. All studies investigated tumors of the anterior visual pathway. Both time-domain and spectral-domain OCT technologies were used and the role of OCT as diagnostic and/or prognostic tool was studied. Retinal OCT provides structural information about ganglion cell axon integrity and is complementary to visual function examination. OCT is a prognostic factor for post-operative visual outcome.

ANTERIOR CHAMBER SYNCHYSIS SCINTILLANS: A CASE REPORT

Synchysis scintillans is a vitreous condition in which multiple golden brown opacities are formed as a result of chronic vitreous hemorrhage. Anterior chamber synchysis scintillans was described in patients with afakia or lens subluxation. We report a case of a 63-year-old man with a history of left eye trauma and complete loss of vision, who presented for left eye discomfort. The slit lamp examination revealed crystals of synchysis scintillans and rare inflammatory cells in the anterior chamber, stromal iris atrophy, circumferential posterior iris synechiae, and complete lens opacity. Total retinal detachment was observed on ocular ultrasonography. Intraocular pressure value was in normal range. The distinctiveness of this case is the mechanism of vitreous crystals mobilization into the anterior chamber through an atrophic iris while intraocular pressure remains normal.

Bilateral central vein occlusion in a case of diaphragmatic eventration

Central Retinal Vein Occlusion (CRVO) is a severe retinal pathology, which causes visual impairment usually after the age of 40. Mostly unilateral, less than 10% of cases are bilateral. Affected young adults (under the age of 40), usually exhibit a hidden, underlying systemic disease. Thorough testing has to be done in order to spot the pathogenic agent. We present the case of a 25 years old woman with bilateral CRVO caused by Diaphragmatic Eventration and Chronic Respiratory Failure.

The Role of Oxidative Stress and Vascular Insufficiency in Primary Open Angle Glaucoma

Primary Open Angle Glaucoma (POAG) is a chronic, irreversible optic neuropathy leading to the progressive death of retinal ganglion cells, clinically observed as silent visual field loss along with a decrease in colour and contrast sensitivity. Multiple pathogenic theories have been issued and some of them have proven their involvement in disease development: mechanical damage due to increased intraocular pressure, variable susceptibility of the optic nerve, mutation in specific nuclear genes, increased glutamate levels, alteration in nitric oxide (NO) metabolism, changes in the mitochondrial genome, vascular disturbances, and toxic effects and oxidative damage caused by reactive oxygen species [1].

The aim of this article is to highlight the pathogenic role of vascular disturbances and reactive oxygen species in POAG with the further possibilities for prevention and gene therapy.

Nonlinear analysis of saccade speed fluctuations during combined action and perception tasks

BACKGROUND

Saccades are rapid eye movements used to gather information about a scene which requires both action and perception. These are usually studied separately, so that how perception influences action is not well understood. In a dual task, where the subject looks at a target and reports a decision, subtle changes in the saccades might be caused by action-perception interactions. Studying saccades might provide insight into how brain pathways for action and for perception interact.

NEW METHOD

We applied two complementary methods, multifractal detrended fluctuation analysis and Lempel-Ziv complexity index to eye peak speed recorded in two experiments, a pure action task and a combined action-perception task.

RESULTS

Multifractality strength is significantly different in the two experiments, showing smaller values for dual decision task saccades compared to simple-task saccades. The normalized Lempel-Ziv complexity index behaves similarly i.e. is significantly smaller in the decision saccade task than in the simple task.

COMPARISON WITH EXISTING METHODS

Compared to the usual statistical and linear approaches, these analyses emphasize the character of the dynamics involved in the fluctuations and offer a sensitive tool for quantitative evaluation of the multifractal features and of the complexity measure in the saccades peak speeds when different brain circuits are involved.

CONCLUSION

Our results prove that the peak speed fluctuations have multifractal characteristics with lower magnitude for the multifractality strength and for the complexity index when two neural pathways are simultaneously activated, demonstrating the nonlinear interaction in the brain pathways for action and perception.

Clinical study on cervical phlegmons

The purpose of this paper is to develop an algorithm for the diagnosis and treatment of cervical phlegmons in order to increase the diagnostic accuracy, to reduce the intra and postoperative risks and complication rates and to increase the number of cases with restitutio ad integrum. This is a retrospective clinical study on 21 patients diagnosed with cervical phlegmon. The study group consists of patients with lateral and retropharyngeal phlegmon (18 cases, of which two pharyngeal or cervical oesophagus effractions by foreign body- chicken or fish bone - with pneumomediastinum), retropharyngeal abscess and posttraumatic mediastinal (one case),peritonsillar phlegmon fused in the parapharyngeal space complicated by parapharyngeal haemorrhage after spontaneous drainage of purulent collections (2 cases). Surgical treatment was applied in all cases, associated with intravenous antibiotic medication; the treatment was individualized according to the particularities of each case: the location and extent of the phlegmon, complications, duration of evolution, mechanisms of production, etiology, associated general conditions, age and, not least, the patient's choice.

[Choroidal melanoma - evolution and prognosis]

Choroidal melanoma is the most common primary intraocular malignant tumor. We present the case of a 62 year old patient who was diagnosed with intraocular tumor in his right eye, for about three years. Regarding the fact that the patient refused any kind of treatment during this period, we just had the opportunity to monitor this case. Finally, the diagnosis was choroidal melanoma, confirmed by the histopathological exam.

[Congenital aniridia]

Aniridia is a rare congenital, hereditary, bilateral disease which is associated with various systemic and ocular defects. We present the case of a 61 year old patient who was admitted in the hospital of ophthalmology Cluj Napoca, for the symptoms caused by the ocular defects associated with aniridia. In this case, aniridia is autosomal dominant transmitted with incomplete penetrance and it is not accompanied by any systemic defects. The disease also affects three of her sons and two nephews of the patient.

[Practical aspects of automated perimetry]

Visual field testing is a subjective method, but yet a very important part for diagnosis and in follow-up of ocular or neurological diseases. In order to do a correct exam of the visual field, one must know well the equipment and all the factors that could induce errors. Basic skills for working with Optopol or Humphrey perimeter are discussed in this paper.

[Immunoglobulin-G4-related disease: a challenging diagnosis]

INTRODUCTION

Immunglobulin G4 (IgG4)-related disease was recently described and represents a systemic lymphoproliferative disorder. The orbital form of the disease manifests as chronic lid swelling and proptosis. Visual disturbances may occur due to apical orbital lesions.

CASE REPORT

A 65-year old pacient presents with the impossibility of maintaining his right eye open due to a progressive swelling of the upper lid. The general clinical examination shows adenopathy at 3 lymph node stations of the head. On ophthalmologic examination, a large tumor of the upper lid is observed in the right eye and proptosis and central retinal vein occlusion are noted in the left eye. The serum levels of the IgG are very high. A lymph node biopsy was performed.

DISCUSSION

The differential diagnosis between the IgG4-related orbital disease and non-Hodgkin lymphoma is discussed. CONCLUSION The diagnosis criteria for IgG4-related disease are both the high serum levels of IgG4 and the specific immunohistochemistry stains.

[Dry eye syndrome and the PC screen]

OBJECTIVE

To study the correlation between PC screen exposure of over 8 hours and Dry Eye Syndrome in 18-25 years-old students.

METHODS

This is a cross-sectional, cohort clinical study, carried out in March 2012 - February 2013. All subjects completed a questionnaire, underwent a slit lamp examination and measurement of visual acuity.

RESULTS

Among the 59 participants of this study, 26 were EXPOSED (> 8 hours of PC screen exposure = EXPOSED) and 33 were NONEXPOSED. The 18-25 - year old participants who were exposed over 8 hours to the PC screen had a relative risk of 5,5 to develop Dry Eye Syndrome, compared to NONEXPOSED participants. Results indicate that Dry Eye Syndrome incidence and intensity of symptoms had increased proportionally with the hours of exposure. Tear Film Breakup Time, the Ocular Protection Index and the PC Ocular Protection Index decreased with the hours of PC screen exposure, suggesting a behavioral change in the EXPOSED participants.

CONCLUSION

Exposure of over 8 hours to the PC screen caused Dry Eye Syndrome in 18-25 - year old students, with a relative risk of 5,5.

[Compliance of treatment in glaucoma patients]

PURPOSE

To evaluate the treatment compliance level of glaucoma patients and the correlation between the compliance level and a series of patient's demographic characteristics.

METHODS

We conducted an observational study in which we studied 100 glaucoma patients who answered the questions we included into a questionnaire. We defined and calculated a broad compliance score and a narrow score, and we investigated the connection between the first score and age, gender, demographic location (urban versus rural), education level, current occupation and duration of disease respectively.

RESULTS

The mean of the broad compliance score was 9.64 +/- 1.72, which represents 80% of the maximum value of the score, and the mean of the narrow compliance score was 4.73 +/- 1.12, (78% of the maximum value). The correlation coefficient between score and age was z = -0.09 (p value = 0.19), the Z value for the evaluation of the connection between score and gender was -1.16 (p value = 0.24), and for the connection between compliance score and demographic location Z value = -2.42 (p value = 0.01). Chi-square value for the evaluation of the relation between the score and education level was 14.66 (p value = 0.001), and for the current occupation Chi-square value = 3.47 (p value = 0.06). The correlation coefficient between score and disease duration was tau = 0.09 (p value = 0.23).

DISCUSSIONS

According to the answers the patients gave, we identified the parameters that require more attention in the ophthalmologist - glaucoma patient communication: genetic transmission of glaucoma, treatment's side effects, number of visits to the ophthalmologist, awareness of the life-long gradului period of treatment.

CONCLUSIONS

In this study, the compliance level of glaucoma patients is relatively high and we observe a correlation between the compliance level and demographic location, and between the compliance level and patient's education level respectively.,

[Effect of physical and psychological stress on the course of primary open angle glaucoma]

PURPOSE

Analyzing how mutch mental or physical stress influences the elevation of intraocular pressure (lOP) and therefore the influence of stress over the progress of primary open angle glaucoma (POAG), monitoring the changes of the glaucoma parameters that occur either under stress or under normal life conditions.

METHODS

Observational analytical prospective nonexposed-exposed study that took place over a period of 18 months and reviewed 151 patients.

RESULTS

Of the 64 patients that had mental stress before presenting to the doctor, in 47 (73%) of them, were foud increased lOP and visual field changes at regular consultation and 17 (27%) have experienced mental stress without increasing lOP values or any visual field change. Of the 69 patients that reported insomnia, 47 (68%) had elevated lOP, while 22 (32%) had unchanged IOP values. Of the 42 patients that had an increased stress score due to physical fatigue, 22 (52%) had increased lOP and visual field changes (CV) and 20 (48%) had no change in lOP or visual field.

CONCLUSIONS

The presence of mental stress in a glaucomatous patient increases lOP values and leads to the worsening of the disease, while insomnia represents only a potential risk factor for POAG and physical exercise might even have a beneficial effect.

[A new risk factor in glaucoma?]

We observed that intraocular pressure was higher at the same glaucoma patient when he/she was fatigued or under a great stress. Several questions appeared: is this fact a rule? If yes, is there a critical level of fatigue to decompensate intraocular pressure? Does it appear in normal individuals? What is the pathogenesis?

[Avastin a treatment of diabetic macular edema]

Macular edema is the first cause of visual impairment in diabetic patient. This paper is a retrospective evaluation of a group of patients with diabetic retinopathy and macular edema, treated with intravitreal Avastin (Bevacizumab) injection. The patients have been monitored mainly by assessing the evolution of visual acuity and macular thickness (OCT), after treatment, and the results have been compared with preexisting literature data.

Similarity analysis for DNA sequences based on chaos game representation. Case study: the albumin

Using chaos game representation we introduce a novel and straightforward method for identifying similarities/dissimilarities between DNA sequences of the same type, from different organisms. A matrix is associated to each CGR pattern and the similarities result from the comparison between the matrices of the sequences of interest. Three different methods of analysis of the resulting difference matrix are considered: a 3-dimensional representation giving both local and global information, a numerical characterization by defining an n-letter word similarity measure and a statistical evaluation. The method is illustrated by implementation to the study of albumin nucleotides sequences from eight mammal species taking as reference the human albumin.

[Which value of intraocular pressure is more important--inclinostatic or orthostatic?]

HYPOTHESIS

Because there are differences between IOP measured in sitting position and IOP measured in laying position, we asked ourselves if these data are important in the management of glaucoma.

MATERIAL AND METHOD

We investigated two groups: patients known with open angle glaucoma well compensated with medication (62 eyes), and non glaucoma patients (40 eyes). Both groups underwent same protocol IOP was measured with hand hold applanation tonometry Perkins, during day light at 9, 12, 15, 18, 21 hours, first in sitting position then they lay down for 5 minutes and the exam was performed again. Every data was the mean of two measurements taken in the sequence right eye- left eye- right eye- left eye. In the study there are another two groups of patients who underwent a single exam during a day, but we respect the same method of exam.

RESULTS

Patients with OAG showed smaller variations of IOP measured in sitting position per day light than those obtained in laying position. Differences between IOP measured in varied positions are similar with those of IOP in laying position during day light. Non glaucoma patients had a bigger disorder regarding IOP values during day The great majority of non glaucoma patients had small (0-4 mmHg) differences between IOP in varied positions, but we must underline there are few with big differences (8-10 mmHg) and these patients kept or enlarged this difference during day

CONCLUSIONS

IOP values obtained in sitting position compared with IOP values in laying down position at the same moment, offer to the clinicians a more accurate picture of the stress created by tensional variation within the eye. We consider this kind of examination of truly help in evaluating both glaucoma and "suspect of glaucoma" patients.

[Changes in lacrimal secretion in rabbits according to meibomian glands activity]

PURPOSE

The purpose of this issue is to create an experimental animal model of dry eye and study the alteration of lachrymal secretion in time.

MATERIALS AND METHODS

We used a group of 8 rabbits in which the Meibomian gland orifices of the right eye were individually closed by cauterization, the results being related to the sound left eye.

RESULTS

We studied: the quantitative alteration of the lachrymal secretion using Schirmer 1 test; the alteration of lachrymal film using rose-bengal and fluorescein staining; the variation in tear protein concentration and histopathological changes in conjunctiva.

CONCLUSIONS

We found histopathological changes in conjunctiva and in the lachrymal secretion consisting in conjunctival goblet-ceil density decrease and watery secretion increase, probably due to lachrymal viscosity decrease mechanism.

[The influence of ocular surgery for lacrimal secretion]

Dry eye syndrome remains a constant health problem while more and more patients are being involved and final data concerning the etiopathology is still missing. This study investigates the hypothesis that ocular surgery inflicts damage on the tear production (regarding quantity, quality or the compositional aspect). Ocular symptoms were registered with the help of a questionnaire. Lacrimal tests were applied before and after surgery at 6 weeks. Basic and reflex tear secretion was differentiated through Schirmer tests and tear quality was assessed with BUT. Proteomic analysis (global proteins, electrophoresis) and conjunctival biopsy was realized before surgery. Open eye surgery altered tear secretion in 91% of the 22 patients examined.

[Dry eye--etiopathogenic and histopathologic correlations]

AIMS

To assess the role of the common inflammatory mechanism in the pathogenesis of the dry eye syndrome.

METHODS

64 patients with eye surface symptoms were studied using a diagnostic algorithm: questionnaire (eye symptoms were graded and a symptomatology SCORE was calculated), objective eye examination (including Schirmer's test and the tear film breakup time-BUT). Histopathological examination of 14 conjunctival bioptic fragments was performed.

RESULTS

59.37% of the patients had a positive Shirmer's test, while only 23% tested positively for the BUT. No statistically significant correlation was established between Schirmer's test and the BUT or the symptomatology SCORE. There was a significant correlation between BUT and the symptomatology SCORE (p<0.05) and between BUT and the duration of the disease (p<0.01). The histopathological examination of the dry eye conjunctival samples evidenced the following alterations: loss of calyciforme cells, squamous metaplasia of the epithelium, subepithelial inflammation.

CONCLUSIONS

The histological analysis confirms the implication of inflammation in the pathogenesis of the disease. The time of onset of the inflammation cannot be established, it may be initial or it may occur with the quantitative decrease of tears or with eye surface alterations.

[Orbital lymphoma--a case report]

We present the case of a patient with an uncommon diagnosis in ophthalmologic practice. Clinical exam and complex investigations, including ocular echography and Doppler established the diagnosis of non-Hodgkin orbital and parotid lymphoma. With specific therapy (cytostatics) the evolution has been favorable.

Evidence for superfluidity of ultracold fermions in an optical lattice

The study of superfluid fermion pairs in a periodic potential has important ramifications for understanding superconductivity in crystalline materials. By using cold atomic gases, various models of condensed matter can be studied in a highly controllable environment. Weakly repulsive fermions in an optical lattice could undergo d-wave pairing at low temperatures, a possible mechanism for high temperature superconductivity in the copper oxides. The lattice potential could also strongly increase the critical temperature for s-wave superfluidity. Recent experimental advances in bulk atomic gases include the observation of fermion-pair condensates and high-temperature superfluidity. Experiments with fermions and bosonic bound pairs in optical lattices have been reported but have not yet addressed superfluid behaviour. Here we report the observation of distinct interference peaks when a condensate of fermionic atom pairs is released from an optical lattice, implying long-range order (a property of a superfluid). Conceptually, this means that s-wave pairing and coherence of fermion pairs have now been established in a lattice potential, in which the transport of atoms occurs by quantum mechanical tunnelling and not by simple propagation. These observations were made for interactions on both sides of a Feshbach resonance. For larger lattice depths, the coherence was lost in a reversible manner, possibly as a result of a transition from superfluid to insulator. Such strongly interacting fermions in an optical lattice can be used to study a new class of hamiltonians with interband and atom-molecule couplings.

[Choroidal hemangioma and epiretinal membrane]

Choroidal hemangiomas are benign vascular hamartomas developed from birth, but undetected until the 4th and 5th decade. They have been seldom described in association with epiretinal membranes. Here we present a patient with associated pathology choroidal hemangioma with atypical fluorescein angiography pattern, undetected on ocular echography hence the difficulties in establishing a positive diagnosis and epiretinal membrane observed both clinically and on fluorescein angiography. Visual acuity is impaired by cystoid macular edema, with a complicated pathogenetic mechanism.

[Hyperpneumatization of sphenoid sinus--a possible etiology of posterior optic neuropathy]

We take in debate a rare cause of compressive retrobulbar optic neuropathy. We present three patients with bilateral retrobulbar optic neuropathy in which these could not be found any other cause, but the hyperpneumatization of sphenoid sinus. We emphasize the role of cranial computer tomography in the diagnosis of this disease and the necessity to keep in mind this possible etiology of posterior optic neuropathy.

Membrane sweeping for induction of labour

BACKGROUND

Sweeping of the membranes, also named stripping of the membranes, is a relatively simple technique usually performed without admission to hospital. During vaginal examination, the clinician's finger is introduced into the cervical os. Then, the inferior pole of the membranes is detached from the lower uterine segment by a circular movement of the examining finger. This intervention has the potential to initiate labour by increasing local production of prostaglandins and, thus, reduce pregnancy duration or pre-empt formal induction of labour with either oxytocin, prostaglandins or amniotomy. This is one of a series of reviews of methods of cervical ripening and labour induction using standardised methodology.

OBJECTIVES

To determine the effects of membrane sweeping for third trimester induction of labour.

SEARCH STRATEGY

We searched the Cochrane Pregnancy and Childbirth Group trials register (6 July 2004) and bibliographies of relevant papers.

SELECTION CRITERIA

Clinical trials comparing membrane sweeping used for third trimester cervical ripening or labour induction with placebo/no treatment or other methods listed above it on a predefined list of labour induction methods.

DATA COLLECTION AND ANALYSIS

A strategy was developed to deal with the large volume and complexity of trial data relating to labour induction. This involved a two-stage method of data extraction.

MAIN RESULTS

Twenty-two trials (2797 women) were included, 20 comparing sweeping of membranes with no treatment, three comparing sweeping with prostaglandins and one comparing sweeping with oxytocin (two studies reported more than one comparison). Risk of caesarean section was similar between groups (relative risk (RR) 0.90, 95% confidence interval (CI) 0.70 to 1.15). Sweeping of the membranes, performed as a general policy in women at term, was associated with reduced duration of pregnancy and reduced frequency of pregnancy continuing beyond 41 weeks (RR 0.59, 95% CI 0.46 to 0.74) and 42 weeks (RR 0.28, 95% CI 0.15 to 0.50). To avoid one formal induction of labour, sweeping of membranes must be performed in eight women (NNT = 8). There was no evidence of a difference in the risk of maternal or neonatal infection. Discomfort during vaginal examination and other adverse effects (bleeding, irregular contractions) were more frequently reported by women allocated to sweeping. Studies comparing sweeping with prostaglandin administration are of limited sample size and do not provide evidence of benefit.

AUTHORS' CONCLUSIONS

Routine use of sweeping of membranes from 38 weeks of pregnancy onwards does not seem to produce clinically important benefits. When used as a means for induction of labour, the reduction in the use of more formal methods of induction needs to be balanced against women's discomfort and other adverse effects.

Cervical cancer in pregnant women: laparoscopic evaluation before delaying treatment

BACKGROUND

Cervical carcinoma diagnosed during pregnancy generates conflicting concerns between control of malignancy and continuation of pregnancy.

CASE

An invasive cervical carcinoma FIGO Stage IB2 was diagnosed in a 33-year-old primigravida during the first trimester of pregnancy. Because the patient strongly desired to preserve her pregnancy, laparoscopic lymphadenectomy was performed at 16 weeks of gestation to determine the extension of disease. Negative lymph node status was found and the patient was counseled about the possibility of proceeding until adequate fetal maturity had been achieved. An elective cesarean section and radical hysterectomy were performed at 36 weeks, followed by postoperative chemoradiation therapy. The clinical and Pap smear follow-up remain normal after four years.

CONCLUSION

Pregnant women diagnosed with early stage cervical carcinoma should receive a complete evaluation including lymphadenectomy before considering delayed therapy. This strategy seems to be an acceptable option in well-defined conditions, and offers these patients the possibility of maternity.

[Posterior scleritis--diagnostic difficulties--a case report]

We present a patient with pain and trouble vision in her right eye, we want to show how difficult it is to diagnose a posterior scleritis before any complication might occur. Diagnosis was established by ocular ultrasound. Treatment included steroids for several months.

[Bilateral malignant glaucoma--case report]

Patient hospitalized for angle closure glaucoma in right eye underwent trabeculectomies in both eyes. In the right eye, six months after surgery, he presented intraocular hypertension, shallow anterior chamber and cataract, considered to be intumescent cataract. The left eye (operated six months after the right eye) showed same signs two weeks after surgery. Diagnosis was malignant glaucoma in spite of missing of ultrasound signs- pooling of aqueous in vitreous body. Note the relapse episodes of intraocular hypertension, shallow anterior chamber in left eye, with complete resolution after cicloplegics-mydratics drops only.

Dynamic control by sinusoidal perturbation and by Gaussian noise of a system of two nonlinear oscillators: computation and experimental results

In this paper we report numerical and experimental studies of the dynamic control of the inter-anode plasma of a double electrical discharge and of a system of two coupled nonlinear oscillators modeling this plasma. We compare the transition between chaotic dynamics and periodic dynamics induced by a sinusoidal perturbation and by small-dispersion Gaussian noise. Besides considerable differences between the effect of the two types of perturbation we also find important similarities. For small amplitude, both the sinusoidal and the white noise perturbations can induce the system to change from chaotic to regular dynamics. In the case of sinusoidal perturbation, the transition time from the chaotic to regular state has a definite duration that depends on the values of the perturbation parameters. The suppression of the perturbation has no influence on the state - the system remains in the same regular state. Subsequent reinstatement of the same type of perturbation with the same amplitude does not change the periodic state of the system but, for considerably higher amplitude, the system is switched back to its chaotic state. For moderate-amplitude sinusoidal perturbation, intermittent transitions between the chaotic and regular states is observed. Most of these predictions of the model have been observed experimentally in a system of two coupled electrical discharges. Our results suggest practical methods that can be used for controlling the discharge plasma dynamics.

[Trigeminal neuropathy, diagnostic and treatment problems]

AIM OF THE STUDY

Clinical evaluation of patients with the diagnosis of Sturge-Weber syndrome (encephalotrigeminal angiomathosis) for establishing an accurate diagnosis and therapy.

MATERIAL AND METHOD

The paper presents 5 cases of encephalotrigeminal angiomathosis (4 of them associating glaucoma) admitted in our clinic in the last 5 years, pointing out the peculiarities concerning the clinical, diagnostic, therapeutically aspects and outcome.

RESULTS

The analysis of our cases showed that glaucoma does not correlate with the extension of skin lesion (nevus flammeus). The outcome of glaucoma's therapy is dictated by the adjustment of the therapy to the type of glaucoma.

CONCLUSION

Glaucoma associated with the Sturge-Weber syndrome has always proved to be a therapeutic challenge and remains one of the causes of increased intraocular pressure, difficult to control. The management of glaucoma in Sturge-Weber syndrome includes surgical and drug therapy. These patients need long-term follow-up from the clinical and imagistic point of vue.