Choroidal impairment and macular thinning in patients with systemic sclerosis : the acute study

Raynaud's phenomenon (RP) is a reversible vasospastic response of the extremities to cold or emotion, and can be the first manifestation or may be present before the development of an overt systemic sclerosis (SSc). The disturbance of the balance between vasodilation and vasoconstriction is not limited to the peripheral microcirculation of the skin, but it is also observed in other organs, such as the choroidal plexus of the eye. We aimed to examine the choroidal thickness (CT), the macular thickness and ganglion cell complex (GCC) average in thirty consecutive patients, without visual symptoms, classified as primary RP (pRP), RP secondary to suspected SSc, and overt SSc. All the patients underwent rheumatologic and ophthalmologic examination, capillaroscopy, test for anti-nuclear antibodies, anti-dsDNA, and anti-extractable nuclear antigens. Ophthalmologic examination included: best corrected visual acuity; slit lamp biomicroscopy; intraocular pressure measurements, fundus examination, and Spectral Domain-Optical Coherence Tomography (SD-OCT) with enhanced depth imaging scan system. Twenty-seven healthy subjects similar for gender and age were analyzed. In pRP, CT was significantly thinner than controls in the outer nasal and temporal regions. In secondary RP, the inner and outer nasal areas were significantly thinner than controls. In SSc, the central, inner inferior, inner nasal, inner superior, outer temporal, outer inferior, and outer nasal regions were significantly thinner than controls. A decreasing trend of central foveal thickness was noted. All the patients had GCC average significantly lower than controls. A thinning of choroidal and macular thickness, as well as of GCC was observed in patients with pRP and becomes more severe and extensive in RP secondary to suspected SSc and overt SSc. To our knowledge, this is the first study to analyze the choroidal features using SD-OCT in RP. These data may be clinically useful in suggesting an early involvement of ocular microcirculation with significant reduction of choroidal perfusion

Different Location and Extent Of Impaired Perfusion Of The Choroid Plexus In Primary and Secondary Raynaud’s Phenomenon

Background/Purpose: Raynaud\u2019s phenomenon (RP) is a disorder characterized by systemic vascular dysregulation which has been related with vasospasms and retinal blood flow abnormalities. Nevertheless among the potential complications of RP, eye involvement is often overlooked. The aim of this study was to evaluate the presence of vascular eye involvement measuring the choroidal and macular thickness in a cross-sectional cohort of RP at the first rheumatologic evaluation. Methods: Thirty adult consecutive RP, without visual symptoms, underwent: clinical evaluation and nailfold capillaroscopy. Sera were tested for anti-nuclear antibodies, anti-dsDNA, anti-extractable nuclear antigens. Patients underwent a complete ocular examination including: best corrected visual acuity; slit lamp biomicroscopy; intraocular pressure measurements and fundus examination; choroidal thickness by Zeiss Cirrus Spectral Domain Optical Coherence Tomography with enhanced depth imaging scan system at the fovea and up to 2 mm at intervals of 1 mm from the fovea in the superior, inferior, nasal and temporal choroid; central foveal thickness (CFT) was also measured. 27 healthy, sex and age-matched, subjects were analysed as control group. Statistical analysis was performed by one-way ANOVA and multiple comparisons. Results: Eight primary RP (pRP) (median age 53 yrs), 12 early systemic sclerosis (SSc) (median age 57 yrs), 10 RP secondary to suspected connective tissue disease (CTD) (i.e. capillaroscopy abnormalities or antibody positivity and without any symptoms/signs suggesting a CTD) (median age 54 yrs). Slitlamp biomicrocopy was within normal limits in all patients and fundus examination revealed normal arterial and venous vessels with no capillary abnormalities. The mean best corrected visual acuity was 20/40 and the mean intraocular pressure measurement was 14 mmHg. In pRP, mean choroidal thickness was significantly thinner than healthy controls in the outer nasal (224.8m vs 289m; p0.05) and outer temporal (263.3m vs 299m; p0.05) regions. In patients with RP secondary to suspected CTD the inner and outer nasal were significantly thinner (244.1m vs 297.4m; p0.05 and 199.7m vs 289m; p0.0001 respectively). In SSc all the areas examined were significantly thinner than healthy controls except for the inner temporal region which however was decreased: central (250.5m vs 313.2m; p0.01), inner inferior (239.9m vs 293.1m; p0.05), inner nasal (221m vs 297.4m; p0.001), inner superior (243.9m vs 293.2m; p0.05), outer temporal (219.3m vs 299m; p0.001), outer inferior (229.9m vs 289.8 m; p0.001), outer nasal (187m vs 289m; p0.001), outer superior (240.4m vs 293.3m; p0.05). CFT was also thinner in all the patients than healthy controls although not significant. Conclusion: A thinner choroidal and macular thickness was observed in all the patients, with progressive decrease from pRP to SSc. These data suggest an early involvement of ocular microcirculation with significant reduction of choroidal perfusion. This process likely starts from the external regions (outer nasal and temporal) in pRP, and becomes more severe and extensive in RP secondary to a suspected CTD and even more severe and in SSc

Interface homem-máquina para controle de processos de resfriamento com ar forçado visando à economia de energia Man-machine interface for the control of cooling processes with forced-air aimed at energy savings

Apresenta-se o desenvolvimento de um equipamento microprocessado, com saída de corrente, para controle da velocidade de rotação do motor do ventilador de sistemas de ar forçado, usando inversor de freqüência. Através de programação (software IHM.EXE), o usuário pode definir a massa a ser resfriada em quilogramas de produto. O equipamento calcula, através de um polinômio previamente estabelecido e programável, a freqüência de operação do inversor, que corresponde a uma vazão de ar específica, dentro dos limites estabelecidos no projeto. O equipamento foi instalado num sistema de resfriamento com ar forçado, estimando-se, pelo cálculo da variação da potência útil mecânica, uma economia de energia da ordem de 82%, com uma rotação equivalente a 56% da nominal do ventilador, proporcionando, desta forma, uma economia significativa no custo de operação do sistema.<br>The development of micro processed equipment is presented, with current exit for control of the speed of rotation of the fan motor of the system of forced air, using investing of the frequency. Through programming (software IHM.EXE), the user can define the mass to be cooled, in kilograms of the product. The equipment calculates through a programmable polynomial previously defined, the frequency of operation of the investor which corresponds to air specific flux, within the limits of the project. The equipment was installed in a forced-air cooling system, being considered by the calculation in useful mechanical power, the energy savings is estimated at around 82% with a rotation equivalent to 56% of the fan nominal, thus providing significant savings in system operating costs

Understanding Factors Associated With Psychomotor Subtypes of Delirium in Older Inpatients With Dementia

Objectives: Few studies have analyzed factors associated with delirium subtypes. In this study, we investigate factors associated with subtypes of delirium only in patients with dementia to provide insights on the possible prevention and treatments. Design: This is a cross-sectional study nested in the \u201cDelirium Day\u201d study, a nationwide Italian point-prevalence study. Setting and Participants: Older patients admitted to 205 acute and 92 rehabilitation hospital wards. Measures: Delirium was evaluated with the 4-AT and the motor subtypes with the Delirium Motor Subtype Scale. Dementia was defined by the presence of a documented diagnosis in the medical records and/or prescription of acetylcholinesterase inhibitors or memantine prior to admission. Results: Of the 1057 patients with dementia, 35% had delirium, with 25.6% hyperactive, 33.1% hypoactive, 34.5% mixed, and 6.7% nonmotor subtype. There were higher odds of having venous catheters in the hypoactive (OR 1.82, 95% CI 1.18-2.81) and mixed type of delirium (OR 2.23, CI 1.43-3.46), whereas higher odds of urinary catheters in the hypoactive (OR 2.91, CI 1.92-4.39), hyperactive (OR 1.99, CI 1.23-3.21), and mixed types of delirium (OR 2.05, CI 1.36-3.07). We found higher odds of antipsychotics both in the hyperactive (OR 2.87, CI 1.81-4.54) and mixed subtype (OR 1.84, CI 1.24-2.75), whereas higher odds of antibiotics was present only in the mixed subtype (OR 1.91, CI 1.26-2.87). Conclusions and Implications: In patients with dementia, the mixed delirium subtype is the most prevalent followed by the hypoactive, hyperactive, and nonmotor subtype. Motor subtypes of delirium may be triggered by clinical factors, including the use of venous and urinary catheters, and the use of antipsychotics. Future studies are necessary to provide further insights on the possible pathophysiology of delirium in patients with dementia and to address the optimization of the management of potential risk factors