Accuracy of the new Icare rebound tonometer vs. other portable tonometers in healthy eyes

PURPOSE: The ICare (Tiolat Oy, Helsinki, Finland) is a new portable tonometer that measures intraocular pressure (IOP) with a new rebound method, in which a very light probe is used to make momentary contact with the cornea in slow motion. The purpose of this study is to assess the accuracy of the ICare IOP measurements by comparing them against other portable tonometers: Perkins applanation tonometer and Tono-Pen XL digital tonometer (Medtronic Solan, Jacksonville, FL). METHODS: Sixty-five young subjects were assessed with each of the tonometers. ICare tonometry was performed first, followed by Perkins applanation tonometry and Tono-Pen XL in a random order. Regression analysis was used to evaluate the relationship between the Perkins tonometer and the remaining tonometers used in this study. Tonometers were also compared by plotting the difference between the methods against the mean. The hypothesis of zero bias was examined by a paired t test and the 95% limits of agreement (LoA) were calculated. RESULTS: ICare and Tono-Pen XL significantly overestimate IOP when compared with Perkins applanation tonometry. The mean of the difference between Perkins and ICare and Perkins and Tono-Pen XL was (mean +/- standard deviation) -3.35 +/- 2.28 mm Hg and -2.78 +/- 2.53 mm Hg, respectively. The 95% LoA between Perkins tonometry and ICare tonometry were between -7.81 and +1.12 and between Perkins tonometry and Tono-Pen XL tonometry between -7.74 and +2.18. CONCLUSIONS: Compared with Perkins tonometry, the ICare tonometer allows clinicians to estimate IOP with a portable, rapid, and noninvasive method with similar reliability to that offered by Tono-Pen XL. Clinicians should be aware of the systematic overestimation of IOP with the ICare. Further research is needed to evaluate the performance of rebound tonometry in populations with higher IOP and assess the reliability of this technique in the early detection and follow up of glaucomatous patients

Hemorragia pós-parto: abordagens multidisciplinares não cirúrgicas para reduzir a morbimortalidade materna

A hemorragia pós-parto (HPP) é uma das principais causas de morbimortalidade materna em todo o mundo. Estratégias eficazes e abordagens multidisciplinares são essenciais para reduzir o impacto dessa complicação obstétrica grave. Este estudo teve como objetivo revisar as abordagens multidisciplinares não cirúrgicas para reduzir a morbimortalidade materna associada à hemorragia pós-parto, destacando a importância da colaboração entre diferentes profissionais de saúde. Foi realizada uma revisão sistemática da literatura, incluindo estudos que avaliaram intervenções multidisciplinares na prevenção e manejo da HPP. Foram pesquisadas bases de dados eletrônicas, como PubMed, Scielo e Lilacs, utilizando termos relacionados à hemorragia pós-parto e abordagens multidisciplinares. Diversas abordagens multidisciplinares não cirúrgicas têm sido eficazes na redução da morbimortalidade materna relacionada à hemorragia pós-parto. Entre essas abordagens, destacam-se o uso de uterotônicos, compressão uterina manual, manejo ativo da terceira fase do trabalho de parto e educação da equipe de saúde. Conclusão: Abordagens multidisciplinares não cirúrgicas desempenham um papel crucial na redução da morbimortalidade materna relacionada à hemorragia pós-parto. A colaboração entre diferentes profissionais de saúde, juntamente com a implementação de protocolos de prevenção e tratamento, é fundamental para melhorar os desfechos maternos e reduzir a incidência de complicações graves pós-parto

Surgical treatment in acromegaly: Experience in Córdoba

La acromegalia tiene una prevalencia de 35-70/millón. La cirugía transesfenoidales el tratamiento de elección, siendo la tasa de remisión del 80% en microadenomas y 50% en macroadenomas. Debido a la falta de registros, nos propusimos evaluar los resultados quirúrgicos en Córdoba y determinar factores predictivos de remisión.Métodos: Estudio retrospectivo-descriptivo de pacientes con cirugía como primera línea terapéutica. Criterios de remisión: normalización de IGF1 para edad/sexo, con GH ≤1,0 g/L.TestX2 y test exacto de Fisher y p<0,05.Resultados:Se incluyeron 38 pacientes: 61% mujeres y 39% hombres; edad promedio 45 años. Motivos de consulta más frecuentes: cefalea y crecimiento acral (26%), alteraciones visuales (20%). El 84% de los tumores fueron macroadenomas. De 37 pacientes, 54% se sometierona cirugía microscópica, 38% endoscópica y 8% transcraneal. El 29% evidenció complicaciones postquirúrgicas, siendo la diabetes insípida la más frecuente (10%). El porcentaje de las mismas fue: cirugía transcraneal el 33%, endoscópica 29% y microscópica 25% (p= 0,557). La remisión bioquímica a los 6 meses fue de 34% y a los 12 meses 55% (p=0,0001). Sin diferencias significativas entre la vía endoscópica y microscópica (p=0,071). De 36 pacientes el 31% evidenció resección tumoral completa. La mejoría clínicasubjetiva fue del 88%. No hubo factores predictivos de remisión bioquímica estadísticamente significativos. La remisión bioquímica con la cirugía fue similar a la bibliografía. No encontramos factores predictivos deremisión pero un número mayor de casos podría modificar estos resultadosAcromegaly prevalence is 35-70 / million. Transsphenoidal surgery is the first-line treatment, with a remission rate of 80% for microadenomas and 50% for macroadenomas. Our aim was to evaluate the surgical results in Córdoba and determine predictive remission factors due to the lack of records. Methods: Retrospective-descriptive study of patients with surgery as the first therapeutic line. Remission criteria: IGF1 normalization for age/sex, with GH ≤1.0 g/L. Test X2 and Fisher´s exact test with p<0.05. Results: 38 patients were included: 61% women and 39% men; Average age 45 years. Most frequent chief complaint: headache and acral growth (26%), visual disturbances (20%). Macroadenomas were the 84% of the tumors. Of 37 patients, 54% underwent microscopic surgery, 38% endoscopic and 8% transcranial. The 29% of patients showed post-operative complications and diabetes insipidus was the most frequent (10%). The percentage of them was: 33% transcranial surgery, 29% endoscopic and 25% microscopic (p = 0.557). The biochemical remission at 6 months was 34% and at 12 months 55% (p= 0.0001). No significant differences between the endoscopic and microscopic approach (p = 0.071). Of 36 patients, 31% showed complete tumor resection. The subjective clinical improvement was 88%. There weren´t predictive remission factors with significant differences. Conclusion: The surgical biochemical remission was similar to the bibliography. We didn´t find predictive remission factors but a larger number of patients could modify these results.Key words: acromegaly; neurosurgery; postoperative complications; remission inductionFil: Rendón, Matilde Inés. Departamento Neuroendocrinología. Sociedad de Endocrinología y Metabolismo de Córdoba; ArgentinaFil: Cecenarro, Laura Anahi. Departamento Neuroendocrinología. Sociedad de Endocrinología y Metabolismo de Córdoba; ArgentinaFil: Andrada, Marta Cecilia. Departamento Neuroendocrinología. Sociedad de Endocrinología y Metabolismo de Córdoba; ArgentinaFil: Barovero, Mariela Susana. Departamento Neuroendocrinología. Sociedad de Endocrinología y Metabolismo de Córdoba; ArgentinaFil: Bertolino, María Lorena. Departamento Neuroendocrinología. Sociedad de Endocrinología y Metabolismo de Córdoba; ArgentinaFil: Cagliolo, Mariela. Departamento Neuroendocrinología. Sociedad de Endocrinología y Metabolismo de Córdoba; ArgentinaFil: Carpentieri, Agata Rita. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Investigaciones en Ciencias de la Salud. Universidad Nacional de Córdoba. Instituto de Investigaciones en Ciencias de la Salud; ArgentinaFil: Damilano, Roxana Analía. Departamento Neuroendocrinología. Sociedad de Endocrinología y Metabolismo de Córdoba; ArgentinaFil: De Battista, Juan Carlos. Departamento Neuroendocrinología. Sociedad de Endocrinología y Metabolismo de Córdoba; ArgentinaFil: Estario, Paula. Departamento Neuroendocrinología. Sociedad de Endocrinología y Metabolismo de Córdoba; ArgentinaFil: Fernández, Silvia. Departamento Neuroendocrinología. Sociedad de Endocrinología y Metabolismo de Córdoba; ArgentinaFil: Marquez, Maria Eugenia. Departamento Neuroendocrinología. Sociedad de Endocrinología y Metabolismo de Córdoba; ArgentinaFil: Monteserin, Natalia. Departamento Neuroendocrinología. Sociedad de Endocrinología y Metabolismo de Córdoba; ArgentinaFil: Quintero, María Lorena. Departamento Neuroendocrinología. Sociedad de Endocrinología y Metabolismo de Córdoba; ArgentinaFil: Sala, Claudia Susana. Departamento Neuroendocrinología. Sociedad de Endocrinología y Metabolismo de Córdoba; ArgentinaFil: Sosa, Gabriela Alejandra. Departamento Neuroendocrinología. Sociedad de Endocrinología y Metabolismo de Córdoba; ArgentinaFil: Surraco, María Elena. Departamento Neuroendocrinología. Sociedad de Endocrinología y Metabolismo de Córdoba; ArgentinaFil: de Paul, Ana Lucia. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Investigaciones en Ciencias de la Salud. Universidad Nacional de Córdoba. Instituto de Investigaciones en Ciencias de la Salud; ArgentinaFil: Szafryk de Mereshian, Paula Maria. Departamento Neuroendocrinología. Sociedad de Endocrinología y Metabolismo de Córdoba; ArgentinaFil: Fux Otta, Carolina. Departamento Neuroendocrinología. Sociedad de Endocrinología y Metabolismo de Córdoba; Argentin

A study on the effect of demographic risk to the sustainability of the Philippine National Health Insurance Program

Through Republic Act No. 7875, or the National Health Insurance Act, a social health insurance program has been institutionalized to provide universal coverage and access to quality healthcare facilities for all Filipinos. At present, the Philippine National Health Insurance Program covers the employed sector, voluntary members, overseas Filipino workers, the poor, retired or senior citizens, and their dependents. However, universal coverage entails exposing the Program to demographic risks or uncontrollable changes to the population such as population aging or decrease in the number of employed citizens/contributing members. The study investigated the possible effects of changes to the demography of PhilHealths membership vis-a-vis the sustainability of the Program in terms of its collected premiums and claims incurred. Monthly records of membership, premium collections, and claims from 1998 to 2010 were extracted from PhilHealth database and were used to formulate multivariate regression models wherein the collections is the dependent variable of one model, claims for the other, and the different sectors of the PhilHealth membership, e.g. employed and voluntary sectors, serves as the independent variables of both models. The models are then subjected to Analysis of Variance (ANOVA) and t-test to determine the significance of the model and its variables, respectively. The study showed statistically that both models are significant. Furthermore, the resulting model showed that the employed, voluntary and OFW sector variables are significant. On the other hand, the resulting claims regression models employed, voluntary, OFW, sponsored and lifetime sector variables were found to be significant. Accordingly, the voluntary and OFW sectors contributes the most to the collections model, and the lifetime members notably decreases the claims amount. Since the Program follows the social insurance approach, it adheres to the principle of social adequacy, i.e. benefits among members are shared equally regardless of the contributions made. This brings about subsidies which in turn results to a dependency relationship among members. To quantitatively represent the dependency relationship between the PhilHealth membership, the NHIP real dependency ratio was derived based on the economic real dependency ratio. Afterwards, the NHIP real dependency ratios were computed using the gathered membership data. To establish the relationship between the NHIP real dependency ratio and collections and claims, regression models were likewise developed where the collections and claims are the dependent variables, while the dependency ratio is the independent variable. Using ANOVA and t-test, the study found that the two models were both statistically significant as well as their independent variables. Further analysis of the collections and claims models behavior revealed that at ratios 0.98, 1.72, and 2.5, collections and claims became equal. Moreover, the study showed that collections exceed claims if the NHIP real dependency ratio is less than 0.98 or if the ratio falls between 1.72 and 2.5. Hence, the models suggest that the NHIP membership dependency ratio should lie within the said ranges in order to sustain the Program. The models were then subjected to sensitivity analysis, wherein the models were simulated using different scenarios which depict changes in the membership demographics, for instance, effect of increase in employment rates, or there is an increase in the number of retiring citizens. The study demonstrated the various results of the simulations under different scenarios. Lastly, the study also touched on whether the claims of lifetime or retiree members will exceed the Programs collections. Using t-test, results showed that the claims of lifetime members will not surpass collections hence, the observed risk does not necessarily pose an immediate threat to the sustainability of the Program. In addition, the study revealed that PhilHealth membership are generally young and more than a majority falls in the working age throughout the data period covered, i.e. retiring or ageing members are replaced by younger members

Corn Stover Silage Inoculated with Ferulic Acid Esterase Producing <i>L. johnsonii</i>, <i>L. plantarum, L. fermentum,</i> and <i>L. brevis</i> Strains: Fermentative and Nutritional Parameters

Corn stover (CS) is an abundant lignocellulosic by-product of the grain industry. Ferulic acid esterase producing (FAE+)-lactobacilli can potentially improve ensiled forages’ nutritive value through the hydrolysis of ferulic acid ester bonds present in cell walls during the fermentation process, but this has not been addressed in CS silage. In this study, we characterized 8 FAE+ lactobacilli regarding their FAE activity and inoculant aptitude: Lactobacillus (L.) johnsonii (CRL2237, CRL2238, CRL2240), L. plantarum (ETC182, CRL046, CRL2241), L. fermentum CRL1446 and L. brevis CRL2239. Next, 25% dry matter (DM) CS mini silos were prepared and either not inoculated (UN) or inoculated with each strain (105 CFU g fresh matter−1). Compared to UN, DM loss was significantly reduced in CRL046 and CRL2239, and organic matter increased in CRL2241-inoculated silages. Although the rest of the digestibility measures were not improved, in situ acid detergent fiber degradability (ADFD) was increased by the CRL2238 strain when compared to UN. Results in inoculated silages were not correlated with FAE activity quantification or growth/acidification studies in a CS-derived culture broth. This study demonstrates the potential of several FAE+ lactobacilli strains as CS inoculants and encourages further research