Possible usefulness of echocardiographic Z-scores in autopsy routine of the foetal great vessels

Background: Abnormal diameters of foetal vessels are common findings in congenital heart defects. However, it is difficult for pathologist to assess whether the diameters of the vessels are normal or not and to compare with echocardiographic data. The Z-score is a dimensionless quantity representing the distance between the raw score and population mean in standard deviation units. Using Z-score, we can compare single cases to average standards in the population. Aim: To compare diameters of great arteries measured in specimens fixed in 10% formalin solution to normal values obtained on echocardiography using Z-scores. Material and methods: The study was performed on 43 formalin-fixed normal foetal hearts aged from 19 to 40 weeks of gestation. Each specimen was dissected and the following diameters were measured: aortic valve (AoV), ascending aorta (AAo), descending aorta (DAo), aortic isthmus (AoI), ductus arteriosus (DA), pulmonary trunk valve (PV), and pulmonary arteries (RPA and LPA). Z-score parameters were calculated for all structures using the Foetal Echo Z-score Calculator. Results: Z-score values of all measured foetuses were mostly found to fit within the echocardiographic norms, although the most reliable results were obtained for foetuses aged 23 weeks. This group was represented by the highest number of specimens. The minimal and maximal Z-score values were, respectively: AoV –3.45, 1.4; AAo –4.24, –0.11; DAo –2.12, 1.29; PV –3.21, 0.69; RPA –3.4, 0.84; LPA –2.25, 0.31; AoI –1.97, 0.96; DA –3.56, –1.52. Conclusions: The diameters of great arteries measured on autopsy are comparable to the results obtained from echocardiographic measurement. Z-score values for foetal echocardiography can be applied to post-mortem examination

Blood pressure and glaucoma: At the crossroads between cardiology and ophthalmology

Glaucoma is an optic nerve neuropathy of undetermined cause. Although many mechanisms are thought to be involved in the development and progression of the disease, only an increased intraocular pressure has been established as a clinically significant modifiable risk factor. Nevertheless, up to 40% of patients develop glaucoma without evidence of increased intraocular pressure.  Ample evidence suggests that alterations in the control of arterial blood might negatively affect optic nerve function. However, evidence-based guidelines on the management of arterial blood pressure in glaucoma patients are lacking. Regrettably, intraocular pressure is generally not included as a secondary end-point in clinical trials on arterial hypertension. Considering the relative simplicity of intraocular pressure measurements and large number of patients included in hypertension studies, the benefits of including intraocular pressure as a secondary end-point could be of a great value for improving care for glaucoma patients. Therefore, closer collaboration between cardiologists and ophthalmologists is needed.

Corneal ring infiltrate- far more than Acanthamoeba keratitis: review of pathophysiology, morphology, differential diagnosis and management

Abstract Objective Ring infiltrates usually accompany numerous infectious and sterile ocular disorders. Nevertheless, systemic conditions, drugs toxicity and contact lens wear may present with corneal ring infiltrate in substantial part. Considering its detrimental effect on vision, detailed knowledge on etiology, pathophysiology, differential diagnosis, and management should be considered essential for every ophthalmologist. Methods The PUBMED database was searched for “corneal ring infiltrate” and “ring infiltrate” phrases, “sterile corneal infiltrate” and “corneal infiltrate”. We analyzed articles written in English on risk factors, pathophysiology, clinical manifestation, morphological features, ancillary tests (anterior-segment optical coherence tomography, corneal scraping, in vivo confocal microscopy), differential diagnosis and management of corneal ring infiltrate. Results Available literature depicts multifactorial origin of corneal ring infiltrate. Dual immunological pathophysiology, involving both antibodies-dependent and -independent complement activation, is underlined. Furthermore, we found that the worldwide most prevalent among non-infectious and infectious ring infiltrates are ring infiltrates related to contact-lens wear and bacterial keratitis respectively. Despite low incidence of Acanthamoeba keratitis, it manifests with corneal ring infiltrate with the highest proportion of the affected patients (one third). However, similar ring infiltrate might appear as a first sign of general diseases manifestation and require targeted treatment. Every corneal ring infiltrate with compromised epithelium should be scraped and treat as an infectious infiltrate until not proven otherwise. Of note, microbiological ulcer might also lead to immunological ring and therefore require anti-inflammatory treatment. Conclusion Corneal ring infiltrate might be triggered not only by ocular infectious and non-infectious factors, but also by systemic conditions. Clinical assessment is crucial for empirical diagnosis. Furthermore, treatment is targeted towards the underlying condition but should begin with anti-infectious regimen until not proven otherwise

Bio-knowledge-based filters improve residue-residue contact prediction accuracy

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