2013-2017 State Plan on Brain Injuries - Progress Report, March 9, 2016

The 2013-2017 State Plan for Brain Injuries was developed by the Iowa Advisory Council on Brain Injuries (ACBI) as guidance for brain injury services and prevention activities in Iowa. The following outlines progress made on the plan’s goals from date of implementation through December 2015.

An anti-TNF--α antibody mimetic to treat ocular inflammation

Infliximab is an antibody that neutralizes TNF-α and is used principally by systemic administration to treat many inflammatory disorders. We prepared the antibody mimetic Fab-PEG-Fab (FpFinfliximab) for direct intravitreal injection to assess whether such formulations have biological activity and potential utility for ocular use. FpFinfliximab was designed to address side effects caused by antibody degradation and the presence of the Fc region. Surface plasmon resonance analysis indicated that infliximab and FpFinfliximab maintained binding affinity for both human and murine recombinant TNF-α. No Fc mediated RPE cellular uptake was observed for FpFinfliximab. Both Infliximab and FpFinfliximab suppressed ocular inflammation by reducing the number of CD45+ infiltrate cells in the EAU mice model after a single intravitreal injection at the onset of peak disease. These results offer an opportunity to develop and formulate for ocular use, FpF molecules designed for single and potentially multiple targets using bi-specific FpFs.

Ocular manifestations of microcephaly with or without chorioretinopathy, lymphedema or intellectual disability (MCLID) syndrome associated with mutations in KIF11

Purpose Microcephaly with or without chorioretinopathy, lymphedema or intellectual disability (MCLID) is an autosomal dominant condition. Mutations in KIF11 have been found to be causative in approximately 75% of cases. This study describes the ocular phenotype in patients with confirmed KIF11 mutations. Methods Standard ophthalmic examination and investigation including visual acuity, refraction and fundus examination was carried out in all patients. Fundus autofluorescence imaging (FAF) was performed in three patients, and four patients underwent spectral domain optical coherence tomography (OCT). Flash electroretinography (ERG) was performed in seven patients, and five underwent additional pattern electroretinography (PERG). Results The patients ranged in age from 2 to 10 years. Most presented with visual acuity loss. Fundus examination revealed lacunae of chorioretinal atrophy. Pigmentary macular changes and optic disc pallor were present in three of seven patients. Fundus autofluorescence demonstrated hypoautofluorescence at the macula in two of three patients. The lacunae of chorioretinal atrophy were hypoautofluorescent. The OCT showed atrophic maculae in three of four patients. Follow-up in one patient showed no deterioration of the vision over a 9-year period. The lesions appear not to be progressive on the follow-up imaging. Electrophysiology showed generalized rod and cone dysfunction and severe macular dysfunction. Inner retinal dysfunction was evident in three of seven patients. Conclusions Patients with KIF11 mutations show a specific ocular phenotype with variable expressivity and intrafamilial variability. Macular atrophy and dysfunction have not been consistently documented before. The fundus lesions appear non-progressive. The findings assist in providing an accurate diagnosis and thus improving the management and follow-up of patients with this syndrome.

Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015 : a systematic analysis for the Global Burden of Disease Study 2015

Global, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990–2015 : a systematic analysis for the Global Burden of Disease Study 2015

Diagnosis of intra-abdominal injuries can be challenging in multitrauma patients with associated injuries. Our experience and review of the literature

ntroduction. Trauma is the most common cause of death and disability among patients during the first four decades of life. Abdominal trauma is reported to be the 3rd most common injured region. Clinical examination may be unreliable in the evaluation of these patients especially in the presence of associated injuries. Therefore the use of diagnostic tools is essential in the management of the injured patient with abdominal trauma and additional injuries. Patients and Methods. During 1 year period from December 2010 to November 2011 we recorded the patients that presented to the emergency department of our hospital and were found to suffer from intra-abdominal injuries. These patients were divided in two groups depending on whether they had additional comorbid injuries or not. Several parameters were recorded and compared between the two groups, such as mechanism of injury, general status and hemodynamic stability of the patient on presentation, physical examination, use of imaging modalities and concomitant findings, need for surgical intervention and mortality rates. Furthermore the discrepancy between physical findings and final diagnosis after the use of diagnostic adjuncts is reported. Results. We recorded 31 patients with abdominal trauma. 13 (42%) patients were found to suffer from abdominal trauma and associated injuries (Group I), whereas 18 (58%) presented with abdominal trauma alone (Group II). The patients of the first group presented hemodynamic instability in 38% of cases while the patients of the second in 22% of cases. Reduced consciousness was present in 38% in group I versus 17% in group II. Signs of abdominal injury during clinical examination were present in only 15% in group I versus 72% in group II that represented a remarkable difference between the two groups. Conservative treatment was possible in 15% of patients with additional injuries and in 22% of patients with abdominal injury alone. In group I there were two deaths whereas in group II all patients survived. Conclusion. In patients with abdominal trauma, associated injuries seem to add to the severity of injury and indicate a worse prognosis. Clinical examination is unreliable and misleading in the majority of these patients and the use of diagnostic tools cannot be overemphasized.

Biliary duct injuries in the laparoscopic era: our experience

Aim. The main aim of our study is to evaluate the incidence, the type, the causes and the therapy of biliary duct injuries which occurred after the video laparoscopic cholecystectomies performed in our Department during the period from 1990 to 2012. Patients and methods. A retrospective analysis of 1186 VLC has been made in our Department from March 1990 to June 2012. Before the cholecystectomy all patient were evaluated with trans abdominal echography. Beyond the incidence of BDI was evaluated damaging mechanism, etiology, therapy and time of diagnosis. Results. From 1990 to 2012 a total of 9 BDIs occurred, with an incidence of 0,75%. Out of 9 patients 4 had major lesions and 5 had minor lesions; the most common BDI was Strasberg A (45%), the most common etiology was the presence of anatomical variations. In four cases the diagnosis has been intraoperative, in five cases has been postoperative. Conclusions. Our clinical experience shows that the main cause of BDI are the surgeon experience and the bile ducts anatomical variation.

Delayed presentation of blunt duodenal injuries in children. Case report and review of literature

Background. Duodenal injuries are rare in children and classically present following a fall over the handle bar. Retroperitoneal location of the duodenum may lead to delay in diagnosis, and missed injuries are associated with increased morbidity and mortality. Case report. A 5-year-old child was admitted to the National Trauma Center, in Tirana (Albania), 28 hours after a Motor Vehicle Crash (MVC), complaining of mild abdominal pain. He was febrile (39°C) and had a white blood cells count of 18,000 mm3. On physical exam he had mild tenderness. Plain abdominal X-rays and Focused Abdominal Sonography for Trauma (FAST) were negative for free air or free fluid. The CT scan of the abdomen demonstrated free air and fluid in the retroperitoneal space. At laparatomy, a perforation of the second portion of the duodenum was found. A single layer suture repair of the duodenum with wide drainage was performed. The patient was discharged from the hospital tolerating oral feeding 8 days later. Conclusion. Duodenal injuries in children are rare. Most duodenal hematomas are managed non-operatively. This is a case of MCV with delayed presentation that was treated surgically for perforation successfully.

Pediatric ocular rosacea, a misdiagnosed disease with high morbidity: Proposed diagnostic criteria

Ocular rosacea is an important and underdiagnosed chronic inflammatory disorder observed in children. A clinical spectrum ranging from chronic eyelid inflammation, recurrent ocular redness, photophobia and/or hordeola/chalazions and conjunctival/corneal phlyctenules evolving to neovascularization and scarring may occur. Visual impairment and consequent amblyopia are frequent and corneal perforation although rare is the most feared complication. Ocular manifestations usually precede cutaneous lesions. Although few cases of pediatric ocular rosacea (POR) have been reported in the literature, many cases must have been underdiagnosed or misdiagnosed. The delay in diagnosis is greater than one year in the large majority of cases and may lead to serious ocular sequelae. This review aims to highlight the clinical features of POR, its epidemiology, easy diagnosis and effective treatment. We also propose new diagnostic criteria, in which at least three of the five clinical criteria must be present: (1) Chronic or recurrent keratoconjunctivitis and/or red eye and/or photophobia; (2) Chronic or recurrent blepharitis and/or chalazia/ hordeola; (3) Eyelid telangiectasia documented by an ophthalmologist; (4) Primary periorificial dermatitis and/ or primary features of rosacea; and (5) Positive familial history of cutaneous and/or ocular rosacea.

Perfil de morbilidad visual y ocular en Bolivia 2010

Tesis (Maestría en Ciencias de la Visión).-- Universidad de La Salle. Maestría en Ciencias de la Visión, 2014

Ocular Risk Factors for Exudative AMD: A Novel Semiautomated Grading System

Purpose. To evaluate the contribution of the ocular risk factors in the conversion of the fellow eye of patients with unilateral exudative AMD, using a novel semiautomated grading system. Materials and Methods. Single-center, retrospective study including 89 consecutive patients with unilateral exudative AMD and ≥3 years of followup. Baseline color fundus photographs were graded using an innovative grading software, RetmarkerAMD (Critical Health SA). Results. The follow-up period was 60.9 ± 31.3 months. The occurrence of CNV was confirmed in 42 eyes (47.2%). The cumulative incidence of CNV was 23.6% at 2 years, 33.7% at 3 years, 39.3% at 5 years, and 47.2% at 10 years, with a mean annual incidence of 12.0% (95% CI = 0.088-0.162). The absolute number of drusen in the central 1000 and 3000  μ m (P < 0.05) and the absolute number of drusen ≥125 µm in the central 3000 and 6000 µm (P < 0.05) proved to be significant risk factors for CNV. Conclusion. The use of quantitative variables in the determination of the OR of developing CNV allowed the establishment of significant risk factors for neovascularization. The long follow-up period and the innovative methodology reinforce the value of our results. This trial is registered with ClinicalTrials.gov NCT00801541.

Tuberculose ocular

Relato de quatro casos de tuberculose ocular presumida, com comprometimento do segmento posterior em três destes casos. Nos dois primeiros casos, relata-se comprometimento do segmento anterior do olho e antecedente de tuberculose, em um caso sistêmica e no outro ocular. No terceiro caso, paciente apresenta lesão coriorretiniana no olho esquerdo. No quarto caso, descrita lesão serpiginosa-like. Os pacientes evoluíram favoravelmente com o tratamento específico. As lesões oculares da tuberculose são diversas e devemos continuar atentos a esta enfermidade.

Prevalence of biomicroscopic findings in the anterior segment and ocular adnexa among schoolchildren in Natal/Brazil

Objective: To determine the prevalence of ocular findings of the external structures and anterior segment of the eye, detected by biomicroscopic examination in schoolchildren in Natal (RN) - Brazil. Methods: After previous random selection, 1,024 pupils from elementary and secondary public and private schools in the city of Natal were evaluated from March to June 2001. All were submitted to preestablished standard research norms, consisting of identification, demographic information, ophthalmologic biomicroscopic examination, with slit lamp, performed by ophthalmologists from the “Onofre Lopes” University Hospital. Results: Alterations of the conjunctival and palpebral conditions were the most prevalent (10.4% and 6.2% respectively). Follicles (4.2%) and papillae (3.0%) were the frequent conjunctival lesions, while blepharitis (3.5%) and meibomitis (1.1%) were the most detected abnormalities in the eyelids. Upon examining the cornea, iris, lens and anterior vitreous, the most encountered findings were nubecula (0.5%), papillary membrane reliquiae (0.5%), posterior capsula opacity (0.8%) and hyaloid arteria reliquiae (2.0%). Conclusion: The most prevalent findings affecting the external structures of the eye such as eyelids and conjunctiva, consisted of blepharitis followed by follicular reaction of the conjunctiva. The most prevalent abnormalities in the cornea, iris, lens and anterior vitreous were nubecula, papillary membrane reliquiae, posterior capsular opacity and hyaloid arteria reliquiae, in that order

Activation of Sonic hedgehog signaling in ventricular cardiomyocytes exerts cardioprotection against ischemia reperfusion injuries

International audience

INJURIES RELATED TO COMPETITIVE AND NONCOMPETITIVE SPORTS IN ELDERLY MEN

Objective: To verify the sociodemographic profile and the frequency of musculoskeletal injuries in elderly people who practice competitive and noncompetitive sports activities in the city of Pelotas, RS. Methods: Descriptive study, including 29 male subjects, aged 65 years or older, who practiced sports modalities in a competitive and noncompetitive way, in the city of Pelotas, in 2015. Data collection was performed through the application of a questionnaire with questions addressing economic, sociodemographic, nutritional and behavioral issues, and injuries sustained in sports activities. Statistical analysis was performed by calculating measures of central tendency for continuous variables and proportions for categorical variables. Results: The current practice of competitive sports was described by 58.6% (n=17) of the subjects, and the most practiced sports were 7-a-side football (53.0%, n=9), tennis (23.5%, n=4) and swimming (23.5%, n=4). Noncompetitive sports were practiced by 44.8% (n=13), and tennis was the most popular sport played (92.3%, n=12). The frequency of injuries among individuals practicing competitive and noncompetitive sports was, respectively, 35.3% (n=6), and 38.5% (n=5). The most frequent injuries were epicondylitis (50.0%, n=3) and meniscus injuries (60.0%, n=3), and the most affected body regions were knee (27.3%, n=3), elbow (27.3%, n=3), and shoulder (18.2%, n=2). The injuries occurred during the sports activities, and the dominant side was the one affected in 63.6% (n=7). Conclusion: This study verified that the occurrence of injuries in elderly individuals who practice sports is relevant, even among those who practice them noncompetitively, with epicondylitis as the most frequent among them, whereas meniscus injuries are the most frequent among those who practice competitive sports.