The role of environmental factors and hereditary predisposition in the causation of low myopia

Various environmental factors have been implicated in the etiology of myopia. An attempt was made quantitatively to estimate some such environmental factors, as based on the presence or absence of a family history of myopia. Age range was 10-21 years. The 200 subjects included in the study were further divided according to emmetropia/myopia. The factors studied in the four subgroups were amount of near work done per day, head posture and illumination level while doing near work, acute fevers, chronic illness, acute or recurrent diarrhea, nutritional status, and income levels. A correlation was found between myopia and near work, head posture and income levels.

Alpha4beta2 nicotinic receptor status in Alzheimer's disease using 123I-5IA-85380 single-photon-emission computed tomography

BACKGROUND

Loss of the alpha4beta2 nicotinic receptor subtype is found at autopsy in Alzheimer's disease.

OBJECTIVE

To investigate in vivo changes in this receptor using single-photon-emission CT (SPECT) with 123I-5-iodo-3-[2(S)-2-azetidinylmethoxy] pyridine (5IA-85380), a novel nicotinic acetylcholine receptor ligand which binds predominantly to the alpha4beta2 receptor.

METHODS

32 non-smoking subjects (16 with Alzheimer's disease and 16 normal elderly controls) underwent 123I-5IA-85380 and perfusion (99mTc-hexamethylenepropyleneamine oxime (HMPAO)) SPECT scanning. Region of interest analysis was performed with cerebellar normalisation.

RESULTS

Significant bilateral reductions in nicotinic receptor binding were identified in frontal (left, p = 0.004; right, p = 0.002), striatal (left, p = 0.004; right, p = 0.003), right medial temporal (p = 0.04) and pons (p<0.001) in patients with AD compared to controls. There were no significant correlations with clinical or cognitive measures. The pattern of nicotinic binding significantly differed from that of perfusion in both patients with AD and controls. Both 123I-5IA-85380 and 99mTc-HMPAO SPECT imaging demonstrated similar diagnostic performance in correctly classifying controls and patients with AD.

CONCLUSION

Using 123I-5IA-85380 SPECT we found changes consistent with significant reductions in the nicotinic alpha4beta2 receptor in cortical and striatal brain regions. This method could facilitate diagnosis and may be useful for monitoring progression of the disease and response to treatment in patients with AD and related diseases.

Deliberate self-harm in older people revisited

BACKGROUND

Deliberate self harm (DSH) in later life is under researched and is believed to be related to both mental illness and suicide.

AIMS

The aim of the study was to examine deliberate self-harm (DSH) in older people presenting to acute hospital services over three years.

METHOD

This was a retrospective observational study. We reviewed 97 episodes of DSH involving 82 patients aged 65 and over referred to the Liaison Psychiatric Service of the Tees and North East Yorkshire NHS Trust South Locality from 2000 to 2002.

RESULTS

There was a year on year increase in the number of older people presenting with DSH, especially in men. Twenty-one percent of older men had no discernible psychiatric diagnosis. There were a small number of people who repeated DSH within a year and males were as likely to be repeaters as females. Twenty-three percent of all patients saw a General Practitioner (GP) in the 7 days before the episode of DSH and this increased to 58% in the 4 weeks preceding the episode of DSH. More males (56%) than females (26%) who presented with DSH were married. The most common method of DSH (93%) was medication overdose of which 66% used prescribed medication. There was no difference in the methods used to self-harm between men or women.

CONCLUSION

DSH in the elderly may start to mirror some of the characteristics seen in younger adults with DSH. While the numbers of DSH per year are small among the elderly compared to younger adults, the observations suggest an increase in DSH in men. Marriage may no longer be a protective factor in prevention of DSH among older men. Longer-term observational studies of DSH in older people are required to confirm these changing patterns. GPs may have an important role to play in prevention of DSH in later life.

Clinical predictors of response to Acetyl Cholinesterase Inhibitors: experience from routine clinical use in Newcastle

BACKGROUND

Acetyl Cholinesterase Inhibitors (AChEIs) have been in clinical use for the past five years in the UK for the symptomatic treatment of Alzheimer's disease (AD). There are few data on the patterns and predictors of response to AChEI therapy in routine clinical practice. We therefore investigated clinical variables that may distinguish between AChEI responders and non-responders.

METHODS

A retrospective sample of 160 consecutive patients with dementia who were treated on clinical grounds with an AChEI was studied. Treatment response was defined in two ways: (a) A clinical response was achieved when there was no deterioration or there was an improvement on a global clinical assessment (CGI) and (b) a Mini-Mental-State-Examination (MMSE) response when there was an improvement of 2 or more MMSE points.

RESULTS

A total of 62 (45%) patients achieved an MMSE response. A diagnosis of dementia with Lewy Bodies (DLB) and Parkinson's disease+Dementia (PDD) was associated with a MMSE response, as were hallucinations, and lower MMSE scores at baseline. 125 (78%) patients achieved a CGI response for which there were no clinical predictors.

CONCLUSIONS

Severity of illness, a diagnosis of DLB and PDD, and presence of hallucinations at baseline were predictive of a MMSE response. Non-AD dementia and severe dementia responded equally well to AChEI treatment and results of further randomised, placebo-controlled studies are needed to clarify the role of AChEI in the treatment of these disorders.

Alport's syndrome--ocular manifestations and unusual features

An unusual case of familial Alport's syndrome is presented with ophthalmic manifestations of both anterior and posterior lenticonus with midperipheral retinal flecks. The case highlights the varying clinical presentations of this syndrome.

External ophthalmomyiasis associated with herpes zoster ophthalmicus

Ophthalmomyiasis is a rare entity caused by infestation with certain dipterous larvae. We describe a 71-year-old farmer with herpes zoster ophthalmicus on the left side of the face in whom the blisters became secondarily infested with Chrysomyia bezziana maggots. The maggots were removed mechanically, and the corneal involvement secondary to zoster ophthalmicus responded to therapy with topical steroids and cycloplegics. To our knowledge this is the first report of external ophthalmomyiasis due to C. bezziana.

Klippel-Trenaunay-Weber syndrome variant

We describe a patient with soft-tissue and bony hypertrophy of all four limbs. The upper limbs were erythematous, with associated finger deformity. The soft-tissue irregular hypertrophy and engorgement subsided when the limbs were elevated. Retinal examination showed large, dilated, tortuous veins, with no dye leakage on fluorescein angiography. We feel that this case represents an unusual variant of the Klippel-Trenaunay-Weber syndrome.