Surgical management of late in-the-bag IOL dislocation : a case series

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2021Introdução: A luxação espontânea tardia do complexo lente intra-ocular (LIO)-saco é uma complicação cada vez mais reportada da cirurgia das cataratas, com uma incidência reportada de 0,05 a 3%. Ocorre frequentemente devido à insuficiência zonular progressiva que pode surgir devido a factores tais como lesões induzidos às fibras zonulares durante a cirurgia das cataratas, e pode ser potenciada por outras condições, reportadamente pseudoexfoliação, aumento do comprimento axial ocular, cirurgia vítrea anterior, certas doenças do tecido conjuntivo e retinite pigmentar. Apesar da falta de consenso quanto à melhor solução cirúrgica, tanto o reposicionamento da LIO como a troca de LIO são opções viáveis, com resultados semelhantes. Diferenças em relação às complicações foram descritas. Diferentes técnicas cirúrgicas podem ser utilizadas, e novas técnicas cirúrgicas foram desenvolvidas nos últimos anos, incluindo o reposicionamento de LIO através de sutura escleral ou através de fixação sem sutura. Recentemente, surgiram também novos designs de LIO, como as lentes Carlevale. Objetivos: Avaliar uma série de casos de luxação espontânea tardia do complexo LIO-saco em relação ao tipo de cirurgia, tipo de lente, complicações e resultados, e comparar os resultados obtidos com os resultados reportados na literatura revista. Material e Métodos: Foi avaliada uma série de casos de luxação espontânea tardia do complexo LIO-saco submetidos a intervenção cirúrgica no Departamento de Oftalmologia do Hospital Universitário de Santa Maria, Portugal, entre 1 de Março de 2019 e 30 de Abril de 2021. O período de seguimento mínimo foi de 1 mês. Os parâmetros medidos incluem idade, género, tempo desde a cirurgia das cataratas até à luxação do complexo LIO-saco, tipo de cirurgia, tipo de lente, complicações cirúrgicas, melhor acuidade visual corrigida pré-operatória e pós-operatória (BCVA) e astigmatismo. Results: LIO Carlevale de fixação escleral sem suturas e LIO iris-claw (Verisyse) retropupilar parecem ser opções de tratamento cirúrgico seguras para luxação espontânea tardia do complexo saco-LIO, com bons resultados visuais e com poucas complicações, maioritariamente ligeiras e transitórias.Introduction: Late spontaneous in-the-bag dislocation of an intraocular lens (IOL) is an increasingly reported late complication of cataract surgery with a reported incidence of 0,05 to 3%. It often occurs due to progressive zonular insufficiency that may arise from factors such as damage induced to the zonula fibers during cataract surgery, and can be potenciated by other conditions, reportedly pseudoexfoliation (PEX), increased eye axial lenght, previous vitreoretinal surgery, certain connective tissue diseases and retinitis pigmentosa. Despite the lack of consensus regarding optimal surgical management, both IOL repositioning and IOL exchange are viable options, with similar outcomes. Differences regarding complications have been described. Different surgical techniques can be employed, and novel surgical techniques have been developed in recent years, including IOL repositioning via scleral suture or via sutureless fixation. Recently, new IOL designs have also been developed, such as Carlevale lens. Objetives: To evaluate a case series of spontaneous late in-the-bag IOL dislocations regarding type of surgery, type of lens, complications and outcomes, and to compare the obtained results with the results reported in the reviewed literature. Materials and Methods: A case series of spontaneous late in-the-bag IOL dislocation submitted to surgical intervention in the Department of Ophthalmology of the Santa Maria University Hospital, Portugal, between March 1, 2019 and April 30, 2021, were evaluated. The follow-up period was of 1 month. The parameters measured include age, gender, time from cataracts surgery until IOL dislocation, type of lens, type of surgery, surgical complications, preoperative and post-operative best corrected visual acuity (BCVA) and astigmatism. Results: Sutureless scleral-fixated Carlevale IOL and retro-pupillary iris-claw IOL appear to be safe surgical options for management of spontaneous late in-the-bad IOL dislocation, yielding good visual outcomes with few, mostly mild and transient complication

Predictors of Cognitive Decline in the Early Stages of Parkinson's Disease: A Brief Cognitive Assessment Longitudinal Study

Our objectives were to perform a longitudinal assessment of mental status in early stage Parkinson's disease (PD) patients, with brief neuropsychological tests, in order to find predictive factors for cognitive decline. Sixty-one, early stage, and nondemented patients were assessed twice, over a 2-year interval, with a global cognitive test (mini-mental state examination (MMSE)) and a frontal function test (frontal assessment battery (FAB)) and motor function scales. Dementia and hallucinations were diagnosed according to the DSM-IV criteria. Cognitive function scores did not decrease significantly, except for FAB lexical fluency score. Four patients presented with dementia at followup. The MMSE score below cut-off, worse gait dysfunction, the nontremor motor subtype, and hallucinations were significantly related to dementia. Rigidity and speech dysfunction were related to dementia and a decrease in FAB scores. We can conclude that decline in the MMSE and FAB scores is small and heterogeneous in the early stages of PD. Scores below cut-off in the MMSE could be helpful to predict dementia. Nontremor motor deficits could be predictive factors for frontal cognitive decline and dementia.publishersversionpublishe

Too Many Is Too Bad: Long-Term Net Negative Effects of High Density Ungulate Populations on a Dominant Mediterranean Shrub

Plant–animal interactions imply costs and benefits with net balance depending on interacting species and ecological context. Ungulates, in particular, confer costs (e.g., plant leaf consumption, flower bud predation) and benefits (e.g., plant overcompensation, seed dispersal) to plants. Magnitude of costs and benefits may be altered by habitat management or ecological conditions favoring high density ungulate populations. Little is known however on whether plant costs or benefits predominate over the years, or the long-term outcomes of plant-animal interactions in habitat types sustaining high density ungulate populations. We investigated how high density ungulate populations alter plant costs and benefits by quantifying ungulate long-term effects on the shrub Cistus ladanifer (Cistaceae) individual size, seed weight and number, seed bank, and population density, through a 12-year ungulate exclusion experiment in a Mediterranean scrubland. We monitored plant size and flower buds in plants exposed or protected from ungulates and number of developed capsules and seeds consumed (potential seed dispersal) by ungulates during three reproductive seasons. We found that ungulates negatively affected shrub size and led to a dramatically decline of shrub reproductive structures and seed production, affecting the plant reproductive cycle. Number of buds was 27 times higher and number of developed seed 5 times higher in ungulate-excluded as compared to ungulate-exposed plots. After 9 years of ungulate exclusion, the C. ladanifer seed bank was 2.6 times higher in ungulate-excluded plots. The population density of C. ladanifer was 4 times higher in ungulate-excluded plots. Our long-term experiment showed that high density ungulate populations can alter plant-animal interactions by reducing plant benefits and increasing plant costs.Peer reviewe

Soil Microbial Biomass And Activity In A Cork Oak Savanna

Cork oak savannas are composed by a sparse tree canopy (30-70 trees/ha) and a grassland understory predominantly composed of C3 annuals that survive the hot and dry Mediterranean summers as seeds in the soil. Microbial communities can be more or less efficient at converting organic substrates into microbial biomass carbon depending on the quantity and quality of organic matter inputs. The cork oak savannas have two distinct types of plant litter that can affect soil microbial biomass and activity differently: herbaceous litter and the more recalcitrant woody plant litter resulting from the trees. Spatial variability of soil microbial biomass and activity due to the tree-grassland component of cork oak savannas were evaluated in order to better understand the soil carbon dynamics of these systems.

To quantify changes in soil microbial biomass and activity, measurements were performed in a Cork oak savanna in Southern Portugal. At this site 8 plots were randomly established under mature cork oak trees and paired with 8 open grassland plots. During one year soil cores (0-10 cm) were monthly collected at each site for measuring soil microbial biomass C and other eco-physiology parameters.


Results/Conclusion

Soil microbial biomass carbon (Cmic) and nitrogen (Nmic) were always higher under the tree canopy than in the open grasslands. Organic carbon (Corg) was also higher under the tree canopies. The Cmic/Corg ratio relates to the microbial activity and its potential to mineralize organic substances. The Cmic/Corg ratio was lower under the tree canopies than in the open grasslands. Less microbial biomass was supported per unit of Corg. Basal activity was always higher under the canopy than in the open grassland.

Trees scattered in the savanna function as islands inducing larger soil microbial communities and higher basal activity under the canopies. Lower Cmic/Corg ratio under the tree canopies suggests a more recalcitrant nature of the litter and a decrease in relative availability of organic matter under the trees.
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Selection of trees for rubbing by red and roe deer in forest plantations

Antler rubbing is a form of behaviour by which deer may damage and ultimately induce mortality of trees. Understanding factors affecting selection of trees for rubbing may contribute to mitigation of negative effects of such behaviour in plantations or woodlands. We analysed characteristics of trees rubbed by red and roe deer along transects established in plantations of Pinus pinaster (Aiton), Pseudotsuga menziesii (Mirbel) Franco, Betula alba L. and Quercus robur L. in Northeast Portugal. Transects were walked during five sampling periods covering mating seasons of red and roe deer. Red deer preferentially rubbed trees adjacent to the edge of plantations and large clearings whilst roe deer selected those inside plantations within small clearings. There was seasonal segregation in the number of trees rubbed by each deer species with red deer rubbing trees mainly between September and February and roe deer mainly between December and June. Both red and roe deer selected trees with smaller diameter than those of available trees although trees selected by red deer had larger diameters than those selected by roe deer. Roe, but not red deer, tended to avoid trees protected by shrubs. Overall, the selection of trees for rubbing was site-dependent suggesting that generalizations across sites should be made with caution. Mitigating measures, such as deer control, tree protection or provision of alternative rubbing posts should target stands of particular tree species, location of trees in relation to stand clearings and tree size classes

Stand structural characteristics are the most practical biodiversity indicators for forest management planning in Europe

ReviewIncluding biodiversity assessments in forest management planning is becoming increasingly important due to the importance of biodiversity for forest ecosystem resilience provision and sustainable functioning. Here we investigated the potential to include biodiversity indicators into forest management planning in Europe. In particular, we aimed to (i) identify biodiversity indicators and data collection methods for biodiversity assessments at the stand and landscape levels, and (ii) evaluate the practicality of those indicators for forest management planning. We performed a literature review in which we screened 188 research studies published between 1990 and 2020. We selected 94 studies that fulfilled the inclusion criteria and examined in more detail. We considered three aspects of biodiversity: structure, composition, and function, and four forest management categories: unmanaged, managed, plantation, and silvopastoral. We used three criteria to evaluate the practicality of forest biodiversity indicators: cost-e ectiveness, ease of application, and time-e ectiveness. We identified di erences in the practicality of biodiversity indicators for their incorporation into management plans. Stand-level indicators are more practical than landscape-level indicators. Moreover, structural biodiversity indicators (e.g., large trees, canopy openness, and old forest stands) are more useful in management plans than compositional indicators, as these are easily observable by non-professionals and can be obtained by forest inventories. Compositional indicators such are vascular plants, fungi, bryophyte, lichens, and invertebrate species are hard to identify by non-professionals and thus are impractical. Functional indicators (e.g., nutrient cycling) are not su ciently addressed in the literature. Using recently updated existing databases (e.g., national forest inventories and bird atlases) is very time and cost-e cient. Remote sensing and other technology (e.g., smartphone applications) are promising for e cient data collection in the future. However, more research is needed to make these tools more accurate and applicable to a variety of ecological conditions and scales. Until then, forest stand structural variables derived from inventories can help improve management plans to prepare European forests towards an uncertain futureinfo:eu-repo/semantics/publishedVersio

Global optimal eBURST analysis of multilocus typing data using a graphic matroid approach

<p>Abstract</p> <p>Background</p> <p>Multilocus Sequence Typing (MLST) is a frequently used typing method for the analysis of the clonal relationships among strains of several clinically relevant microbial species. MLST is based on the sequence of housekeeping genes that result in each strain having a distinct numerical allelic profile, which is abbreviated to a unique identifier: the sequence type (ST). The relatedness between two strains can then be inferred by the differences between allelic profiles. For a more comprehensive analysis of the possible patterns of evolutionary descent, a set of rules were proposed and implemented in the eBURST algorithm. These rules allow the division of a data set into several clusters of related strains, dubbed clonal complexes, by implementing a simple model of clonal expansion and diversification. Within each clonal complex, the rules identify which links between STs correspond to the most probable pattern of descent. However, the eBURST algorithm is not globally optimized, which can result in links, within the clonal complexes, that violate the rules proposed.</p> <p>Results</p> <p>Here, we present a globally optimized implementation of the eBURST algorithm – goeBURST. The search for a global optimal solution led to the formalization of the problem as a graphic matroid, for which greedy algorithms that provide an optimal solution exist. Several public data sets of MLST data were tested and differences between the two implementations were found and are discussed for five bacterial species: <it>Enterococcus faecium</it>, <it>Streptococcus pneumoniae</it>, <it>Burkholderia pseudomallei</it>, <it>Campylobacter jejuni </it>and <it>Neisseria spp.</it>. A novel feature implemented in goeBURST is the representation of the level of tiebreak rule reached before deciding if a link should be drawn, which can used to visually evaluate the reliability of the represented hypothetical pattern of descent.</p> <p>Conclusion</p> <p>goeBURST is a globally optimized implementation of the eBURST algorithm, that identifies alternative patterns of descent for several bacterial species. Furthermore, the algorithm can be applied to any multilocus typing data based on the number of differences between numeric profiles. A software implementation is available at <url>http://goeBURST.phyloviz.net</url>.</p

Selection of trees for rubbing by red and roe deer in forest plantations

Antler rubbing is a form of behaviour by which deer may damage and ultimately induce mortality of trees. Understanding factors affecting selection of trees for rubbing may contribute to mitigation of negative effects of such behaviour in plantations or woodlands. We analysed characteristics of trees rubbed by red and roe deer along transects established in plantations of Pinus pinaster (Aiton), Pseudotsuga menziesii (Mirbel) Franco, Betula alba L. and Quercus robur L. in Northeast Portugal. Transects were walked during five sampling periods covering mating seasons of red and roe deer. Red deer preferentially rubbed trees adjacent to the edge of plantations and large clearings whilst roe deer selected those inside plantations within small clearings. There was seasonal segregation in the number of trees rubbed by each deer species with red deer rubbing trees mainly between September and February and roe deer mainly between December and June. Both red and roe deer selected trees with smaller diameter than those of available trees although trees selected by red deer had larger diameters than those selected by roe deer. Roe, but not red deer, tended to avoid trees protected by shrubs. Overall, the selection of trees for rubbing was site-dependent suggesting that generalizations across sites should be made with caution. Mitigating measures, such as deer control, tree protection or provision of alternative rubbing posts should target stands of particular tree species, location of trees in relation to stand clearings and tree size classes.http://www.sciencedirect.com/science/article/B6T6X-4HGM78R-2/1/29fe58190c40581f0716e977b7847d3

Role of the cerebellum in cognitive and behavioural control: scientific basis and investigation models

Although classically considered to be involved only in motor coordination, the cerebellum has more recently been implicated also in cognitive control. Anatomical studies have shown the cerebellum to be linked to pre-frontal, occipito-parietal and temporal cortical associative areas, as well as to the limbic system, in a closed loop circuit. Functional studies revealed activation of the cerebellum during performance on cognitive tasks not related to movement. Pathological, morphological and functional imaging studies have shown the cerebellum to be one of the cerebral structures affected in some of the cognitive and behavioural developmental disorders, like Attention Deficit with Hyperactivity Disorder, Autism and Schizophrenia. Neuropsychological studies in patients with degenerative cerebellar ataxia also showed cognitive dysfunction, mainly of the executive type. Investigation performed with child and adult patients with focal lesions of the cerebellum has helped to better discriminate the cognitive role of specific areas on the cerebellum, revealing a characteristic constellation of cognitive deficits, affecting executive, visual-spatial, linguistic and behavioural functions. However, much remains to be explained on the precise nature of cerebellar contributions to cognition, in part because of the difficulty in finding adequate investigation models. Studies performed on primates have contributed to better delineate the connections between the cerebellum and cortical cognitive domains, but is always uncertain to transfer this kind of data to the human brain. Functional imaging studies although useful to investigate directly in the human model and in real time, are not yet able to completely isolate cerebellar cognitive and behavioural functions. Degenerative and developmental disorders are not the most adequate model for studying cerebellar influence on higher mental functions, as they affect other regions besides the cerebellum. Young patients with isolated cerebellar stroke provide a useful clinical model for investigating cerebellar cognitive functions, because they permit to isolate in space and time the specific contribution of the cerebellum to the cognitive deficits.publishersversionpublishe

correlation and impact on Quality of Life and Activities of Daily Living

The prevalence of non-motor symptoms (NMS) in Parkinson's Disease (PD) has varied between studies. Their interrelation isn't totally understood. Also, the relative importance of each symptom, regarding its impact on activities of daily living (ADL) and health related quality of life (HRQL), remains debatable. We assessed all PD patients attending a Portuguese tertiary movement disorders center during one year (n = 134), with ADL, HRQL and other clinical scales approved for identifying the most relevant NMS in PD. All patients had at least one NMS. Sleep/fatigue, affect/cognition, attention/memory were the most frequent complaints, and their prevalence, above 80%, was higher than in most studies. There were significantly correlations between: sleepiness, psychosis and cognition; gastrointestinal, cardiovascular symptoms and pain; depression and apathy; anxiety and insomnia; olfaction, weight and hyperhidrosis. Depression/apathy exerted the strongest influence on HRQL and non-tremor motor dysfunction on ADL. Compared to studies in other countries, we found a higher prevalence of NMS, which could be specific of this population. The interrelation between NMS could be related to degeneration of different brain structures. NMS exert a stronger influence than MS in HRQL, which should be taken in account regarding treatment options.publishersversionpublishe