Accommodative–vergence disorders in a paediatric ophthalmology clinical setting in Argentina

Purpose: To determine the frequency of potential non-strabismic accommodative-vergence anomalies (NSAVA) and investigate associations between NSAVA, refractive errors, and age among children attending a paediatric ophthalmology clinic. Methods: This study included children and adolescents aged 5-19 years attending an ophthalmology clinic with at least two follow-up visits. At their first visit, children had a comprehensive ophthalmic examination, including refractive error measurement by cycloplegic autorefraction, and spectacles were prescribed if necessary. At the second visit, children had an examination of best-corrected visual acuity, convergence, and accommodation to identify potential NSAVA. The relationship between age, sex, heterophoria refractive error, and potential NSAVA was assessed by a multivariable logistic regression model. Results: A total of 384 children and adolescents were evaluated. Their mean age was 10.97 ± 3.07 years and 58.9% were females. Forty-two percent of children failed the NSAVA tests and 34.1% had myopia (≤-0.50 D). Children who failed NSAVA tests self-reported a higher proportion of reading problems (73.7%) compared to those who passed the tests (26.3%; p 0.05). Conclusions: NSAVA was a frequent cause of vision problems found in a sample of children from an ophthalmology paediatric clinic. Thus, further research is necessary to understand the potential of public health policies to prevent, refer, diagnose, and treat those conditions.info:eu-repo/semantics/publishedVersio

Non-miotic improvement in binocular near vision with a topical compound formula for presbyopia correction

Introduction: The aim of this case series was to examine the association between unaided binocular visual acuity for near vision and pupil change after the instillation of a special topical formulation for presbyopia treatment. Methods: This was a case series consisting of consecutive participants with presbyopia aged 40-70 years who were tested for visual acuity and pupil diameter before and 2 h after the instillation of a formulation of pilocarpine and phenylephrine drops (FOV Tears) for presbyopia. Participants underwent subjective refraction, photopic and scotopic pupil diameter measurement, and unaided monocular and binocular visual acuity testing by logMAR for distance and near vision both pre- and post-instillation of eye drops. Results: The study enrolled 363 subjects (n = 176 women, 48%) with a mean (± standard deviation) age of 50.4 ± 5.8 years. The mean spherical equivalent (SE) changed significantly (- 0.17 Diopters) after the instillation of the FOV Tears formulation (p < 0.001). Post-instillation of eye drops, the scotopic pupil diameter decreased by 0.97 ± 0.98 mm, and the near visual acuity by logMAR improved significantly by nearly two lines (p < 0.01). In the linear regression analyses, age (p < 0.001) and SE pre-drop instillation (p < 0.001) were associated with unaided binocular visual acuity. The changes in photopic pupil diameter and scotopic pupil diameter were not associated with unaided binocular visual acuity. Conclusions: The use of the pilocarpine and phenylephrine formulation (FOV Tears) improved binocular visual acuity for near vision in presbyopic patients, and the effect was independent of pupil change.info:eu-repo/semantics/publishedVersio

Prevalencia de errores refractivos en ópticas de la ciudad de Mendoza, Argentina

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Análisis de discapacidad visual en Buenos Aires, Argentina: La miopía patológica es la principal causa en edad laboral

Este trabajo estudia las causas de la discapacidad visual durante una década en la Ciudad de Buenos Aires. Se presenta una serie de casos retrospectiva donde se revisó la base de datos de certificados de discapacidad visual emitidos por el Ministerio de Salud de la Ciudad de Buenos Aires entre 2009 y 2017. En Argentina, la discapacidad visual se define como una agudeza visual ≤ 20/200 en el mejor ojo, o un campo visual correspondiente de menos de 20 grados en el ojo menos deteriorado. La base de datos incluyó las siguientes variables: año de emisión, edad, sexo y causa de la discapacidad visual. Entre 2009 y 2017 se certificaron un total de 7656 sujetos con ceguera legal. La edad media de la muestra fue de 57 ± 21 años y el 52.1% fueron mujeres. La distribución por edades mostró que el 62.8% de los certificados fueron dados a pacientes mayores de 50 años y que solo el 6.6% se otorgó a menores de 20 años. Las principales causas de discapacidad visual fueron la degeneración macular asociada a la edad (DMAE) (15.5%), la miopía degenerativa (14.4%), el glaucoma primario de ángulo abierto (11.3%) y la retinopatía diabética (6.6%). En los menores de 50 años, la miopía degenerativa fue la primera causa de discapacidad visual. Resulta interesante que, en Argentina, donde la prevalencia de miopía es baja, la miopía degenerativa sea la principal causa de discapacidad visual en adultos de mediana edad.This study assessed the causes of visual impairment over a decade in Buenos Aires City. This is a retrospective case series where we reviewed the database of visual disability certificates issued by the Buenos Aires City Ministry of Health between 2009 and 2017. In Argentina, visual disability is defined as a visual acuity ≤ 20/200 in the better eye, or a corresponding visual field of less than 20 degrees in the less impaired eye. The database included the following variables: year of issue, age, gender, and cause of visual disability. Between 2009 and 2017 a total of 7656 subjects were certified as legally blind. The mean age of the sample was 57 ± 21 years and 52.1% were females. The emission was near 700 certificates per year. The age distribution showed that 62.8% of certificates were from patients older than 50 years and that only 6.6% were given to subjects under 20. The leading causes of visual disability in Buenos Aires City were age-related macular degeneration (ARMD) with a rate of 15.5%, degenerative myopia (14.4%), primary open-angle glaucoma (11.3%) and diabetic retinopathy (6.6%). In subjects younger than 50, degenerative myopia was the first cause of visual disability. Interestingly in Argentina, where the prevalence of myopia is low, degenerative myopia is found to be the major cause of visual disability in middle-aged adult subjects. Population and clinical methods to avoid this preventable disease should need to be implemented as a matter of urgency.Fil: Franco, Pablo Javier. Hospital Santa Lucía; ArgentinaFil: Suwezda, Alejandro. Fundacion Hospitalaria; ArgentinaFil: Schlottmann, Patricio. Organizacion Medica de Investigacion (omi);Fil: Destefanis, María Pía. Hospital Santa Lucía; ArgentinaFil: Rosenstein, Ruth Estela. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Centro de Estudios Farmacológicos y Botánicos. Universidad de Buenos Aires. Facultad de Medicina. Centro de Estudios Farmacológicos y Botánicos; Argentina. Universidad de Buenos Aires. Facultad de Medicina. Laboratorio de Neuroquímica Retiniana y Oftalmología Experimental; ArgentinaFil: Iribarren, Rafael. No especifíca;Fil: Grzybowski, Andrzej. Institute For Research In Ophthalmology; Poloni

Prevalência de erros refrativos em óticas da cidade de Mendoza, Argentina

RESUMEN - Objetivo: El propósito de este estudio fue estimar los errores de refracción a partir de los datos de venta de anteojos en Mendoza, Argentina. Materiales y métodos: Se trata de un estudio transversal en el que se analizaron los datos de venta de lentes oftálmicas en las ópticas La Pirámide de la ciudad de Mendoza, Argentina. Los datos proporcionados incluyeron la edad y la potencia esférica, la potencia cilíndrica, el eje de las prescripciones de gafas para la distancia y la adición de cerca. Se realizó un análisis descriptivo de los errores de refracción por edad (proporciones dadas por porcentaje). Resultados: Se incluyeron los datos de venta de gafas de un total de 12.510 sujetos de ambos sexos con una edad media de 51,6 ± 22,2 años (rango 2-103 años). La media del equivalente esférico (SE) fue de -0,30 ± 2,16 D y la media de la adición de cerca fue de +2,15 ± 0,97 D. En total, el 57,6% (n=7.206) de los sujetos tenía astigmatismo, el 35% tenía miopía (n=4.375) y el 2,86% (n=358) tenía miopía alta. El 28,7% (n=3.593) de los sujetos presentaba hipermetropía, el 11,8% (n=1.479) anisometropía y el 8,4% (n=1.045), anisoastigmatismo. Conclusiones: El astigmatismo y la miopía estaban presentes en la mayoría de las prescripciones de gafas. Las campañas de concientización pueden ser importantes para informar a la comunidad sobre la carga que suponen las deficiencias visuales derivadas de los errores de refracción no corregidos. Además, pueden ser necesarios los programas de cribado para la detección precoz y las estrategias preventivas, como los programas al aire libre.ABSTRACT - Objective: The aim of this study was to estimate refractive errors using spectacle lens sales data in Mendoza, Argentina. Methods: This was a cross-sectional study that analyzed the spectacle lens sales data at La Pirámide optician stores in the city of Mendoza, Argentina. The data provided included age and spherical power, cylindrical power, the axis of spectacle prescriptions for distance, and the near addition. A descriptive analysis of refractive errors by age (proportions given by percentage) was carried out. Results: Spectacle lens sales data on a total of 12,510 subjects of both genders with an average age of 51.6 ± 22.2 years (range 2-103 years) was included. The mean spherical equivalent (SE) was -0.30 ± 2.16 D and the mean near addition was +2.15 ± 0.97 D. In total, 57.6% (n=7,206) of the subjects had astigmatism, 35% had myopia (n=4,375) and 2.86% (n=358) had high myopia. Hyperopia was found in 28.7% (n=3,593) of the subjects, anisometropia was present in 11.8% of the subjects (n=1,479), and anisoastigmatism in 8.4% (n=1,045). Conclusions: Astigmatism and myopia were present in most of the spectacle prescriptions. Awareness campaigns may be important to inform the community about the burden of vision impairment from uncorrected refractive errors. In addition screening programs for early detection and preventive strategies, such as outdoor programs, may be necessary.RESUMO - Objetivo: O objetivo deste estudo foi estimar os erros de refração a partir de dados de vendas de óculos em Mendoza, Argentina. Materiais e métodos: Trata-se de um estudo transversal no qual foram analisados os dados sobre a venda de lentes oftálmicas nas óticas La Pirámide na cidade de Mendoza, Argentina. Os dados fornecidos incluíram idade e potência esférica, potência cilíndrica, eixo de prescrições de óculos para longe e para perto. Foi realizada uma análise descritiva dos erros refrativos por idade (proporções dadas por percentagem). Resultados: Foram incluídos dados de venda de óculos de um total de 12.510 indivíduos de ambos os se-xos com média de idade de 51,6 ± 22,2 anos (variação de 2-103 anos). O equivalente esférico médio (SE) foi -0,30 ± 2,16 D e a média próxima à adição foi +2,15 ± 0,97 D. No geral, 57,6% (n = 7.206) dos indivíduos tinham astigmatismo, 35% tinham miopia (n=4.375) e 2,86% (n=358) apresentavam alta miopia. 28,7% (n=3.593) dos indivíduos apresentavam hipermetropia, 11,8% (n=1.479) anisometropia e 8,4% (n=1.045) anisoastigmatismo. Conclusões: O astigmatismo e a miopia estiveram presentes na maioria das prescrições de óculos. Campanhas de conscientização podem ser importantes para informar a comunidade sobre o ônus da deficiência visual resultante de erros refrativos não corrigidos. Além disso, programas de triagem para detecção precoce e estratégias preventivas, como programas ao ar livre, podem ser necessários.info:eu-repo/semantics/publishedVersio

Energy impact of the air infiltration in residential buildings in the Mediterranean area of Spain and the Canary islands

Air infiltration through the building envelope has already been proven to have a significant energy impact in dwellings. Different studies have been carried out in Europe, but there is still a lack of knowledge in this field regarding mild climates. An experimental field study has been carried out in the Mediterranean climate area of Spain and the Canary Islands in order to assess the air permeability of the building envelope and its energy impact. A wide characterization and Blower Door tests have been performed in 225 cases in Alicante, Barcelona, Málaga, Sevilla and Las Palmas de Gran Canaria for this purpose. The obtained mean air permeability rate for the 225 studied cases was 6.56 m3/(h·m2). The influence of several variables on airtightness was statistically analysed, although only location, climate zone and window material were found to be significant. Air infiltration has an energy impact between 2.43 and 16.44 kWh/m2·year on the heating demand and between 0.54 and 3.06 kWh/m2·year on the cooling demand.This work was supported by the Spanish Ministry of Economy and Competitiveness (BIA2015-64321-R) under the research project INFILES: Repercusión energética de la permeabilidad al aire de los edificios residenciales en España: estudio y caracterización de sus infiltraciones

Tranexamic acid attenuates inflammatory response in cardiopulmonary bypass surgery through blockade of fibrinolysis: a case control study followed by a randomized double-blind controlled trial

INTRODUCTION: Extracorporeal circulation induces hemostatic alterations that lead to inflammatory response (IR) and postoperative bleeding. Tranexamic acid (TA) reduces fibrinolysis and blood loss after cardiopulmonary bypass (CPB). However, its effects on IR and vasoplegic shock (VS) are not well known and elucidating these effects was the main objective of this study. METHODS: A case control study was carried out to determine factors associated with IR after CPB. Patients undergoing elective CPB surgery were randomly assigned to receive 2 g of TA or placebo (0.9% saline) before and after intervention. We performed an intention-to-treat analysis, comparing the incidence of IR and VS. We also analyzed several biological parameters related to inflammation, coagulation, and fibrinolysis systems. We used SPSS version 12.2 for statistical purposes. RESULTS: In the case control study, 165 patients were studied, 20.6% fulfilled IR criteria, and the use of TA proved to be an independent protective variable (odds ratio 0.38, 95% confidence interval 0.18 to 0.81; P < 0.01). The clinical trial was interrupted. Fifty patients were randomly assigned to receive TA (24) or placebo (26). Incidence of IR was 17% in the TA group versus 42% in the placebo group (P = 0.047). In the TA group, we observed a significant reduction in the incidence of VS (P = 0.003), the use of norepinephrine (P = 0.029), and time on mechanical ventilation (P = 0.018). These patients showed significantly lower D-dimer, plasminogen activator inhibitor 1, and creatine-kinase levels and a trend toward lower levels of soluble tumor necrosis factor receptor and interleukin-6 within the first 24 hours after CPB. CONCLUSION: The use of TA attenuates the development of IR and VS after CPB. TRIAL REGISTRATION NUMBER: ISRCTN05718824

IMI-Onset and Progression of Myopia in Young Adults

Myopia typically starts and progresses during childhood, but onset and progression can occur during adulthood. The goals of this review are to summarize published data on myopia onset and progression in young adults, aged 18 to 40 years, to characterize myopia in this age group, to assess what is currently known, and to highlight the gaps in the current understanding. Specifically, the peer-reviewed literature was reviewed to: characterize the timeline and age of stabilization of juvenile-onset myopia; estimate the frequency of adult-onset myopia; evaluate the rate of myopia progression in adults, regardless of age of onset, both during the college years and later; describe the rate of axial elongation in myopic adults; identify risk factors for adult onset and progression; report myopia progression and axial elongation in adults who have undergone refractive surgery; and discuss myopia management and research study design. Adult-onset myopia is common, representing a third or more of all myopia in western populations, but less in East Asia, where onset during childhood is high. Clinically meaningful myopia progression continues in early adulthood and may average 1.00 diopters (D) between 20 and 30 years. Higher levels of myopia are associated with greater absolute risk of myopia-related ocular disease and visual impairment, and thus myopia in this age group requires ongoing management. Modalities established for myopia control in children would be options for adults, but it is difficult to predict their efficacy. The feasibility of studies of myopia control in adults is limited by the long duration required.</p

Safety and Effectiveness of two treatment regimes with tranexamic acid to minimize inflammatory response in elective cardiopulmonary bypass patients: a randomized double-blind, dose-dependent, phase IV clinical trial

<p>Abstract</p> <p>Background</p> <p>In cardiopulmonary bypass (CPB) patients, fibrinolysis may enhance postoperative inflammatory response. We aimed to determine whether an additional postoperative dose of antifibrinolytic tranexamic acid (TA) reduced CPB-mediated inflammatory response (IR).</p> <p>Methods</p> <p>We performed a randomized, double-blind, dose-dependent, parallel-groups study of elective CPB patients receiving TA. Patients were randomly assigned to either the single-dose group (40 mg/Kg TA before CPB and placebo after CPB) or the double-dose group (40 mg/Kg TA before and after CPB).</p> <p>Results</p> <p>160 patients were included, 80 in each group. The incident rate of IR was significantly lower in the double-dose-group TA2 (7.5% vs. 18.8% in the single-dose group TA1; <it>P </it>= 0.030). After adjusting for hypertension, total protamine dose and temperature after CPB, TA2 showed a lower risk of IR compared with TA1 [OR: 0.29 (95% CI: 0.10-0.83), (<it>P </it>= 0.013)]. Relative risk for IR was 2.5 for TA1 (95% CI: 1.02 to 6.12). The double-dose group had significantly lower chest tube bleeding at 24 hours [671 (95% CI 549-793 vs. 826 (95% CI 704-949) mL; <it>P </it>= 0.01 corrected-<it>P </it>significant] and lower D-dimer levels at 24 hours [489 (95% CI 437-540) vs. 621(95% CI: 563-679) ng/mL; <it>P </it>= 0.01 corrected-<it>P </it>significant]. TA2 required lower levels of norepinephrine at 24 h [0.06 (95% CI: 0.03-0.09) vs. 0.20(95 CI: 0.05-0.35) after adjusting for dobutamine [F = 6.6; <it>P </it>= 0.014 corrected-<it>P </it>significant].</p> <p>We found a significant direct relationship between IL-6 and temperature (rho = 0.26; <it>P </it>< 0.01), D-dimer (rho = 0.24; <it>P </it>< 0.01), norepinephrine (rho = 0.33; <it>P </it>< 0.01), troponin I (rho = 0.37; <it>P </it>< 0.01), Creatine-Kinase (rho = 0.37; <it>P </it>< 0.01), Creatine Kinase-MB (rho = 0.33; <it>P </it>< 0.01) and lactic acid (rho = 0.46; <it>P </it>< 0.01) at ICU arrival. Two patients (1.3%) had seizure, 3 patients (1.9%) had stroke, 14 (8.8%) had acute kidney failure, 7 (4.4%) needed dialysis, 3 (1.9%) suffered myocardial infarction and 9 (5.6%) patients died. We found no significant differences between groups regarding these events.</p> <p>Conclusions</p> <p>Prolonged inhibition of fibrinolysis, using an additional postoperative dose of tranexamic acid reduces inflammatory response and postoperative bleeding (but not transfusion requirements) in CPB patients. A question which remains unanswered is whether the dose used was ideal in terms of safety, but not in terms of effectiveness.</p> <p>Current Controlled Trials number</p> <p>ISRCTN: <a href="http://www.controlled-trials.com/ISRCTN84413719">ISRCTN84413719</a></p