Intraocular Pressure Correlates with Optic Nerve Sheath Diameter in Patients with Normal Tension Glaucoma

PURPOSE: 1. Identify differences in optic nerve sheath diameter (ONSD) as an indirect measure of intracranial pressure (ICP) in glaucoma patients and a healthy population. 2. Identify variables that may correlate with ONSD in primary open-angle glaucoma (POAG) and normal tension glaucoma (NTG) patients. METHODS: Patients with NTG (n = 46) and POAG (n = 61), and healthy controls (n = 42) underwent B-scan ultrasound measurement of ONSD by an observer masked to the patient diagnosis. Intraocular pressure (IOP) was measured in all groups, with additional central corneal thickness (CCT) and visual field defect measurements in glaucomatous patients. Only one eye per patient was selected. Kruskal-Wallis or Mann-Whitney were used to compare the different variables between the diagnostic groups. Spearman correlations were used to explore relationships among these variables. RESULTS: ONSD was not significantly different between healthy, NTG and POAG patients (6.09 ± 0.78, 6.03 ± 0.69, and 5.71 ± 0.83 respectively; p = 0.08). Visual field damage and CCT were not correlated with ONSD in either of the glaucoma groups (POAG, p = 0.31 and 0.44; NTG, p = 0.48 and 0.90 respectively). However, ONSD did correlate with IOP in NTG patients (r = 0.53, p < 0.001), while it did not in POAG patients and healthy controls (p = 0.86, p = 0.46 respectively). Patient's age did not relate to ONSD in any of the groups (p > 0.25 in all groups). CONCLUSIONS: Indirect measurements of ICP by ultrasound assessment of the ONSD may provide further insights into the retrolaminar pressure component in glaucoma. The correlation of ONSD with IOP solely in NTG patients suggests that the translaminar pressure gradient may be of particular importance in this type of glaucoma.

Gastroenterite Aguda por Salmonella Não Tifoide em Crianças: Revisão de 10 Anos

Introdução: A Salmonella não tifoide é o agente mais frequente das toxinfeções alimentares nos países desenvolvidos. Em Portugal, são notificados em média 450 casos por ano, 80% dos quais em crianças. Métodos: Revisão casuística dos casos confirmados por coprocultura, internados num hospital do grupo I, na região de Lisboa e Vale do Tejo, entre 1999 e 2008. Análise estatística no programa SPSS® v16.0, com aplicação do teste de Spearman e significância estatística para p< 0,05. Resultados: Identificaram-se 213 internamentos. A mediana anual foi de 21 internamentos, 39% ocorrendo no verão. A mediana das idades foi de 4,2 anos, com doze casos em lactentes até aos três meses. Houve um predomínio no sexo masculino (57%). A mediana do total de leucócitos foi de 9300/mL e da proteína C reativa de 8,8 mg/dL, não se relacionando com a ocorrência de bacteriemia. A duração média do internamento foi de 5,2 dias. As principais complicações foram desidratação (117/213), bacteriemia (8/213), convulsão febril (6/213), síndrome de Mallory-Weiss (5/213) e apendicite aguda (3/213). Os serotipos mais isolados foram: S. Enteritidis (76%), S. Typhimurium (19%), outros (S. O4,5:i-, S. Derby, S. Hayfa, S. Menden, S. Rissen) (5%). Encontraram-se 27% de resistências à ampicilina e 15% ao trimetoprim-sulfametoxazol, sem resistências ao ceftriaxone. Conclusões: Nos 10 anos estudados, o número de casos manteve-se elevado, com morbilidade relevante e resistências significativas aos antibióticos de primeira linha.

Lack of Spontaneous Venous Pulsation: Possible Risk Indicator in Normal Tension Glaucoma?

PURPOSE: Recently, the absence of spontaneous venous pulsation (SVP) has been suggested as a vascular risk factor for primary open-angle glaucoma (POAG). As the mechanism behind this phenomenon is still unknown, the authors have studied this vascular component using colour Doppler imaging (CDI). METHODS: A total of 236 patients were divided into three diagnostic groups: healthy controls (81), POAG (86) and normal tension glaucoma (NTG; 69). All subjects were submitted to CDI studies of the retrobulbar circulation, intraocular pressure measurements and assessment of SVP existence. Mann-Whitney, chi-square contingency tables and Spearman correlations were used to explore differences and correlations between variables in the diagnostic groups. RESULTS: Eighty-two percent of healthy controls had SVP (66/81), while a smaller numbers were registered in both glaucoma groups: POAG - 50% (43/86); NTG - 51% (35/69). In NTG patients, but not in POAG patients, the prevalence of the SVP phenomenon decreases with increased glaucoma damage (p = 0.04; p = 0.55, respectively). Overall glaucoma patients from both groups had lower central retinal vein (CRV) velocities than the healthy controls (p < 0.05). NTG patients with SVP had less severe visual field defects (mean defect -6.92 versus -11.1, p < 0.05), higher [correction added after online publication 21 September 2012; the word 'higher' has been inserted to replace the word 'lower'] peak systolic and mean flow velocities in the central retinal artery (p < 0.01; p < 0.05, respectively) as well as higher [correction added after online publication 21 September 2012; the word higher has been inserted to replace the word lower] maximal velocities and RI of the CRV (p < 0.02; p < 0.05, respectively). CONCLUSIONS: Glaucoma patients have a decrease in CRV velocities. SVP is less prevalent in glaucoma patients than in healthy individuals. This phenomenon apparently reflects different hemodynamic patterns in the central retinal vessels. This variable may be of particular importance in NTG patients, where it may be associated with more advanced functional damage.