Optimal Social Insurance and Health Inequality

This paper integrates into public economics a biologically founded, stochastic process of individual ageing. The novel approach enables us to quantitatively characterize the optimal joint design of health and retirement policy behind the veil of ignorance for today and in response to future medical progress. Calibrating our model to Germany, we find that future progress in medical technology calls for a potentially drastic increase in health spending that typically should be accompanied by a lower pension savings rate and a higher retirement age. Interestingly, medical progress and higher health spending are in conflict with the goal to reduce health inequality

Updating the approaches to define susceptibility and resistance to anti-tuberculosis agents: implications for diagnosis and treatment

11 páginas, 2 figuras, 1 tablaInappropriately high breakpoints have resulted in systematic false-susceptible AST results to anti-TB drugs. MIC, PK/PD and clinical outcome data should be combined when setting breakpoints to minimise the emergence and spread of antimicrobial resistance.I. Comas was supported by PID2019-104477RB-I00 from the Spanish Science Ministry and by ERC (CoG 101001038)Peer reviewe

The Configuration of Peripapillary Tissue in Unilateral Glaucoma

• We compared the peripapillary scleral and choroidal halos and crescents in the two eyes of 42 patients with unilateral glaucoma. In most cases, the edge of the three tissue layers (the retinal pigment epithelium [RPE], the choroid, and the sclera) that encircle the optic nerve head of the glaucomatous eye superimposed exactly on the mirror images of the edges in the fellow nonglaucomatous eye. Although the size of the peripapillary crescent or halo was the same in both eyes, it and the scleral rim were often more conspicuous in the eye with glaucomatous damage because the tissue edges were seen more easily through the reduced thickness of nerve fiber layer tissue. There were nine exceptions. In five cases, the peripapillary choroidal crescent (the area of choroid not covered by RPE) was larger in the glaucomatous eye. In four eyes, however, the crescent was larger in the nonglaucomatous eye, although the magnitude of the asymmetry was less in these four cases. Thus, in late stages of optic nerve damage, there was some RPE atrophy, but in most cases of glaucoma, the area of bared choroid was the inherent anatomic configuration of the optic nerve exit canal

Comparison of silicone and polypropylene Ahmed Glaucoma Valve implants

Purpose: To compare the efficacy and safety of silicone and polypropylene Ahmed Glaucoma Valves (AGVs) in patients with refractory glaucoma.Methods: A retrospective chart review of 180 eyes of 166 patients who underwent AGV implantation with a minimum follow-up period of 3 months was performed. All patients who underwent implantation of either the AGV model S-2 (polypropylene) or model FP-7 (silicone) were included, unless previous laser cyclophotocoagulation had been performed. the primary outcome measures were the change in intraocular pressure (IOP) and visual acuity after surgery and the rate of postoperative complications.Results: No significant differences were seen in the baseline characteristics of patients in each group. Baseline IOP was statistically equivalent in the 2 groups (silicone = 33.8 +/- 11.9 mm Hg, polypropylene 33.0 +/- 10.3 mm Hg, P = 0.6). A significant reduction in IOP from baseline was achieved after both silicone and polypropylene AGV implantation (silicone = -17.7 +/- 11.8 mm Hg, polypropylene = -17.7 +/- 11.3 mm Hg, both P 0.09). the mean number of postoperative antiglaucoma medications was also similar in the silicone and the polypropylene AGV groups at each time point (all P > 0.2). the rate of complications and the change in visual acuity did not differ between the 2 groups (P > 0.6 and P > 0.3, respectively).Conclusions: Silicone and polypropylene AGVs have similar results with respect to both safety and efficacy in the treatment of patients with refractory glaucoma.Cleveland Clin Fdn, Cole Eye Inst, Cleveland, OH 44195 USAUniversidade Federal de São Paulo, Dept Ophthalmol, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Ophthalmol, São Paulo, BrazilWeb of Scienc

The Response of Retinal Vasculature to Angiotensin

A retinal arterial constriction was produced in anesthetized cats with a continuous transvitreal infusion of angiotensin I or antiotensin II (Ile-5). Constriction of vessels near the infusion cannula tip occurred over a range of angiotensin II concentrations from 10~9 to 10~4 molar, and was reversibly blocked by a ten-fold excess of the competitive antagonist saralasin. Constriction did not occur in response to angiotensin I if angiotensin-converting enzyme was blocked with Captopril. Control infusions of saline did not elicit a contraction of the retinal arteries. Severe axonal and inner retinal damage and necrosis occurred when angiotensin II produced a prolonged vasospasm, but not after infusion with control solutions, or whenconstriction caused by angiotensin was brief. Invest Ophthalmol Vis Sci 28: [676][677][678][679][680][681][682] 1987 While studying the effects of elevated intraocular pressure on the physiology of the optic nerve head, Sossi and Anderson 1 found that the blockage of axonal transport by elevated intraocular pressure was augmented when angiotensin was used to elevate the systemic arterial blood pressure. These findings suggested that angiotensin is capable of constricting the vessels of the optic nerve head, or at least capable of preventing autoregulatory dilation of the vessels when the adequacy of blood flow is challenged by elevation of intraocular pressure. There are interesting potential clinical correlations and implications if such a pathophysiologic mechanism participates in the optic nerve damage of glaucoma. 2 Constriction of vessels in the central nervous system (CNS), including the retina and optic nerve, 3 ' 4 might be expected as an autoregulatory response to elevated blood pressure. Such an indirect autoregulatory response (not due to angiotensin acting on receptors of the vessels) should not incapacitate the autoregulatory system, or produce constriction that is excessive to the point of interfering with neuronal physiology. Thus the interference with axonal transport suggests that angiotensin may be exerting direct vasoconstrictive action on the vessels of the optic nerve head, with the muscular tone preventing their redilation as an autoregulatory response to tissue ischemia. Such a direct effect on CNS vessels (including the retina and optic nerve) is unexpected, because the tight junctions of the endothelium should preclude access of circulating octapeptide angiotensin II (MW: 1067 Daltons) to the muscular coat of the vessels. Thus, the vessels should not have a direct response to angiotensin, unless either there are angiotensin receptors on the endothelium, which in turn transmit a message to the muscular coat, or else there is access to the muscular coat through a breach in the blood-brain barrier. We are attracted to the latter explanation for our experimental result, because the axonal transport abnormalities were localized at the optic nerve head, where there exists a breach in the blood-brain barrier by virtue of unimpeded diffusion of substances from the choroid. 5 Although our experiments indicated that these vessels may constrict in response to extravasated angiotensin, there is reason to doubt that the exterior wall of CNS vessels would have receptors for a circulating hormone to which they are not exposed under normal circumstances. Therefore, experiments were conducted to determine whether or not CNS vessels (specifically those of the retina and optic nerve head) exhibit a specific direct response to angiotensin when it bathes the exterior surface of the vessel. Materials and Methods All applicable federal and ARVO guidelines for care and use of animals for experimentation were followed. Cats of either sex (weight 1.5-5.0 Kg) were anesthetized with intraperitoneal nembutal (30 mg/kg) and atropine (0.035 mg/kg). Animals with signs of ocular trauma, inflammation, synechiae, or retinal scarring were not used. Some animals were given intravenous indo

Zonular Dialysis During Extracapsular Cataract Extraction in Pseudoexfoliation Syndrome

• Five patients with pseudoexfoliation syndrome (PES) and glaucoma developed extensive zonular dialyses during extracapsular cataract extractions. Weakness of the lens zonules or their attachments to the ciliary processes, which has been described in association with PES, may explain this complication. We believe that patients with PES are at particular risk for developing large zonular dialyses during extracapsular surgery. Preoperative phakodonesis, anterior chamber depth asymmetry, and excessive lens movement during the anterior capsulotomy should alert the surgeon to this problem