Is Routine Pupil Dilation Safe among Asian Patients with Diabetes?

PURPOSE. To investigate the risk of acute angle closure (AAC), changes in intraocular pressure (IOP), and factors associated with these outcomes after routine pupil dilation in a cohort of Asian subjects with diabetes mellitus. METHODS. The study was a prospective observational case series of 1910 consecutive Asian subjects newly referred for assessment of diabetic retinopathy at a tertiary clinic. All subjects underwent routine pupil dilation unless there was a prior history of angle-closure glaucoma. Noncontact air-puff tonometry was used to assess IOP, which was measured by the same observer before and 1 hour after pupil dilation. Subjects were assessed for signs and symptoms of AAC before leaving the clinic, and their charts were also subsequently reviewed for revisits with AAC. RESULTS. Of the 1910 subjects who participated, none developed AAC. Sixty-nine subjects (3.6%, 95% CI: 2.8%-4.5%) showed an increase in IOP of Ն5 mm Hg in the either eye, 37 subjects (1.9%, 95% CI: 1.4%-2.6%) had a postdilation IOP Ͼ25 mm Hg in either eye, and only 10 subjects (0.52%, 95% CI: 0.25%-0.96%) had an increase in IOP Ն5 mm Hg and had a postdilation IOP Ͼ25 mm Hg in either eye. The level of predilation IOP and a known history of glaucoma were significant risk factors for a postdilation IOP Ն25 mm Hg. CONCLUSIONS. In this cohort of Asian persons with diabetes, the risk of AAC was insignificant after routine dilation of pupils for fundus examination. These data substantiate the safety of routine dilation of pupils in Asian patients with diabetes. (Invest Ophthalmol Vis Sci. 2009;50:4110 -4113

Priorities for research on neuromodulatory subcortical systems in Alzheimer's disease: Position paper from the NSS PIA of ISTAART

The neuromodulatory subcortical system (NSS) nuclei are critical hubs for survival, hedonic tone, and homeostasis. Tau-associated NSS degeneration occurs early in Alzheimer's disease (AD) pathogenesis, long before the emergence of pathognomonic memory dysfunction and cortical lesions. Accumulating evidence supports the role of NSS dysfunction and degeneration in the behavioral and neuropsychiatric manifestations featured early in AD. Experimental studies even suggest that AD-associated NSS degeneration drives brain neuroinflammatory status and contributes to disease progression, including the exacerbation of cortical lesions. Given the important pathophysiologic and etiologic roles that involve the NSS in early AD stages, there is an urgent need to expand our understanding of the mechanisms underlying NSS vulnerability and more precisely detail the clinical progression of NSS changes in AD. Here, the NSS Professional Interest Area of the International Society to Advance Alzheimer's Research and Treatment highlights knowledge gaps about NSS within AD and provides recommendations for priorities specific to clinical research, biomarker development, modeling, and intervention. HIGHLIGHTS: Neuromodulatory nuclei degenerate in early Alzheimer's disease pathological stages. Alzheimer's pathophysiology is exacerbated by neuromodulatory nuclei degeneration. Neuromodulatory nuclei degeneration drives neuropsychiatric symptoms in dementia. Biomarkers of neuromodulatory integrity would be value-creating for dementia care. Neuromodulatory nuclei present strategic prospects for disease-modifying therapies

Cystoid Macular Edema in Acute Presentation of Central Retinal Artery Occlusion

A seventy-six-year-old lady with poor vision of the left eye due to previous retinal detachment presented with acute visual loss of her right eye secondary to central retinal artery occlusion. Clinical examination showed a pale right optic disc, macular edema, and a cherry red spot. Optical coherence tomography done four hours after onset showed right acute cystoid macular edema and diffuse inner retinal thickening. Subsequent treatment with intravenous carbonic anhydrase inhibitor resulted in some visual improvement. Central retinal artery occlusion has been known to produce diffuse intraretinal edema instead of cystoids changes. We would like to discuss a case of acute cystoid macular edema in acute central retinal artery occlusion

Published text: A case of ovarian fibromatosis and massive ovarian oedema associated with intra-abdominal fibromatosis, sclerosing peritonitis and Meig's syndrome

Abstract Purpose: To discuss a case of ovarian fibromatosis/massive ovarian oedema, intra-abdominal fibromatosis, sclerosing peritonitis and Meig's syndrome. To review the reported therapeutic options. Patients: Case report of a 27-year-old female with the combined pathology of ovarian fibromatosis/massive ovarian oedema, intra-abdominal fibromatosis, sclerosing peritonitis and Meig's syndrome. Methods: This patient was treated with supportive care and cytotoxic chemotherapy. Results: Despite the benign nature of the ovarian pathology, this patient presented with life-threatening complications. Response to treatment was probably multi-factorial combining the effects of cytotoxics, use of steroids and good supportive care. She remains in complete remission 4 years post completion of chemotherapy. Conclusion: There are reports in the literature of ovarian fibromatosis/massive ovarian oedema, luteinised thecomas, intraabdominal fibromatosis and Meig's syndrome occurring together in a variety of combinations. Treatment has been described with radiotherapy, cytotoxic and non-cytotoxic chemotherapy regimens. This case provides a link between ovarian fibromatosis/massive ovarian oedema, intra-abdominal fibromatosis, sclerosing peritonitis and Meig's syndrome not previously described. Presentation of case AP is a 27-year-old female who presented to her local accident and emergency department in July 1999 with a history of bloating, abdominal pain and altered bowel habit. On examination she was found to have an abdominal mass and clinical ascites. An ultra-sound scan confirmed bilateral ovarian enlargement with significant ascites. Beta-HCG, CA-125 and alpha-fetoprotein were within normal range. Past medical history was significant for a termination of pregnancy 2 years previously and a renal calculus. There was no history of colonic polyps and no significant family history. The patient was taking the combined oral contraceptive at the time of presentation. A laparotomy with bilateral ovarian biopsies was undertaken. At laparotomy, 4.5 l of ascites were drained and the abdominal structures appeared normal. The histology from the ovarian biopsies was thought to be consistent with a sclerosing stromal tumour of the ovary. Bilateral salpingo-oophorectomy and infra-colic omentectomy was then undertaken. Following the second laparotomy the patient became increasingly symptomatic with worsening ascites and vomiting. A barium follow-through revealed incomplete small bowel obstruction in the pelvis as well as a 15 cm stricture in the sigmoid colon thought to be due to extrinsic compression. A flexible sigmoidoscopy was performed and biopsies taken which revealed inflammation only. The subacute bowel obstruction was initially managed conservatively and the patient commenced total parenteral nutrition (TPN). At the end of July 1999 a third laparotomy was undertaken for persistent small bowel obstruction and clinical evidence of recurring mass in the abdomen. At laparotomy the entire pelvis and lower abdomen were involved in a retroperitoneal mass matting the bowel together. Biopsies were taken from the retroperitoneal mass, the omentum and the sigmoid colon

A Comparative Study of Tree-based and Mesh-based Overlay P2P Media Streaming

Streaming media technology has seen tremendous growth and is currently a popular research area. While most of the work on streaming media technology is on ensuring the quality of the video playback and the scalability of the overall media streaming solution, there are few researches that are being conducted to address the limitations of the network, computer hardware nor the streaming media characteristics. These are the other factors that causes network capacity bottleneck. It is generally accepted that a Peer-to-Peer network is suitable for streaming media network and these can be classified into two main network architectures; a tree-based architecture and a mesh-based architecture. In this paper, we investigate and evaluate the network limitations between a Peer-to-Peer tree-based architecture and the more popular mesh-based architecture for media streaming performance. The simulations were conducted under various real-world scenarios and evaluated using different critical performance metrics that affects the reliability of the streaming quality and performance

A comparative study of tree-based and mesh-based overlay P2P media streaming

Streaming media technology has seen tremendous growth and is currently a popular research area. While most of the work on streaming media technology is on ensuring the quality of the video playback and the scalability of the overall media streaming solution, there are few researches that are being conducted to address the limitations of the network, computer hardware nor the streaming media characteristics. These are the other factors that causes network capacity bottleneck. It is generally accepted that a Peer-to-Peer network is suitable for streaming media network and these can be classified into two main network architectures; a tree-based architecture and a mesh-based architecture. In this paper, we investigate and evaluate the network limitations between a Peer-to-Peer tree-based architecture and the more popular mesh-based architecture for media streaming performance. The simulations were conducted under various real-world scenarios and evaluated using different critical performance metrics that affects the reliability of the streaming quality and performance