Skin problems in children under five years old at a rural hospital in Southern Ethiopia

Objective: To examine the prevalence of cutaneous disorders in children under 5 years old who attended a rural hospital in Southern Ethiopia.Methods: A prospective cross-sectional study was conducted from January 26 to February 20, 2015 in children under 5 years old who attended Gambo Rural Hospital in West Arsi of the Oromia Region, Ethiopia.Results: A total of 324 children were included(59.6% male) whose median age was 16.4months. In total, 147 children [45.4%; 95% confidence interval(CI): 40.0%–50.8%]under 5 years had a skin problem, of which 101(68.7%) consulted for that reason. The other 46(31.3%) consulted for a general health problem and the dermatological condition was a secondary finding during the physical exploration. In 93 children(28.7%; 95% CI:20%–33.8%), it was the main disease, and in 54 children(16.5%; 95% CI: 13.0%–21.1%)it was concomitant with other diseases. The most common dermatological disease was scabies(n = 44, 13.6%; 95% CI: 10.3%–17.7%). Impetigo was diagnosed in 32 children(9.9%; 95% CI: 7.1%–13.3%), of which 23(71.9%) had complicated impetigo. Nineteen children(5.9%; 95% CI: 3.8%–9.0%) had eczema, 10(3.1%) had eczema associated to other conditions. The following most frequent skin problems were tinea(n = 9; 2.8%),infected wound and ulcer(n = 7; 2.2%), and burns(n = 6; 1.9%).Conclusions: Skin problems, mainly scabies, impetigo, and eczema were common in young children attended at a rural hospital in Southern Ethiopia. Children under 5 years should be examined thoroughly to rule out skin diseases, especially scabies.

Gender differences related to the presence of atrial fibrillation in older hypertensive patients

AIM: To determine whether there are gender differences in the epidemiological profile of atrial fibrillation (AF) and to characterise the clinical, biochemical, and therapeutic factors associated with AF. METHODS: Each investigator (primary care physicians or physicians based in hospital units for hypertension treatment) recruited the first 3 patients with an age of ≥ 65 years and a clinical diagnosis of hypertension (ambulatory blood pressure monitoring and an electrocardiogram, were performed) on the first working day of the week for 5 wk and identified those individu-als with atrial fibrillation. A binary logistic regression was performed, including all of the variables that were significant in the univariate analysis, to establish the variables that were associated with the presence of arrhythmia. RESULTS: A total of 1028 patients were included in the study, with a mean age of 72.8 ± 5.8 years. Of these patients, 47.3% were male, 9% were smokers, 27.6% were diabetics, 48.3% had dyslipidaemia, 10.9% had angina, and 6.5% had experienced a myocardial infarction. Regarding gender differences, the men exhibited a larger waist circumference, a lower body mass index, less obesity, and a more extensive history of diabetes, smoking, ischaemic heart disease, kidney failure, peripheral arterial disease and carotid disease than the women. There were no differences, however, in the prevalence of AF between the men and the women (11.5% vs 9.2%, respectively; P = no significant). Regarding treatment, the women received antiplatelet agents and diuretics less frequently, but there were no other differences in the use of antihypertensive and antithrombotic therapies. In the multivariate analysis, AF in the total study population was associated with age, alcohol consumption, the presence of heart disease, and decreased glomerular filtration. In the women, AF was associated with all of the factors included in the overall analysis, as well as the presence of left ventricle hypertrophy. In contrast, in the men, the only risk factors associated with AF were age, the presence of heart disease and alcohol consumption. CONCLUSION: In patients with hypertension over 65 years of age, there are relevant gender differences in the factors associated with AF.

Corneal surgery in keratoconus: which type, which technique, which outcomes?

Keratoconus is a disease characterized by progressive thinning,bulging,and distortion of the cornea.Advanced cases usually present with loss of vision due to high irregular astigmatism.A majority of these cases require surgical intervention.This review provides an update on the current treatment modalities of corneal surgery available for the management of advanced corneal ectasias.

The use of intracorneal ring segments in keratoconus

Keratoconus is a corneal degeneration that usually appears during puberty and may seriously deteriorate the quality of life of the patients.This corneal disease is today the first indication of corneal transplantation in young patients.Until the last decade of the XX century,keratoplasty procedures were the only alternative to treat this pathological condition.In the beginning of the XXI century,intracorneal ring segments implantation was proposed as a therapeutic choice for treating keratoconus patients.Since then,several published articles have reported the benefits of this surgical procedure in treating this type of corneal ectatic disorder.The purpose of the present investigative work is to summarize the characteristic of the intracorneal ring segments and also to review the different features published in the literature in relation to this surgical technique for the treatment of keratoconus patients.

Pharmacological treatments of presbyopia:a review of modern perspectives

Introduction:Presbyopia affects people from the 4^(th) decade of life and is characterized by accommodative loss that leads to negative effects on vision-targeted health-related quality of life.A non-invasive pharmacological treatment providing near-lenses independence would be a truly groundbreaking approach in the treatment of presbyopia.The purpose of this review is to analyze the emerging pharmacological solutions proposed to address presbyopia.Results:Several ophthalmic eye drops compounds solutions have been described in peer-reviewed papers or presented in ophthalmological tabloids and congresses.Each topical treatment deals with drug combinations aimed to modify one or more factors involved in the accommodative process and have been proposed to be instilled either monocularly or binocularly.It remains unclear how much each drug in the final combined form is involved in the achievement of the outcome and contributes to it.Conclusion:Despite the lack of a completely well understood mechanism,pharmacological control of presbyopia seems to be a possible and very attractive alternative for presbyopic patients.The studies mentioned in this review are to be considered pilot investigations as they involve either a small number of subjects or are single case series.Complete studies are needed to confirm which will be the more effective pharmacological compound for the treatment of presbyopia.

Unveiling Plant mTERF Functions

Chloroplasts and mitochondria genomes contain a few dozen genes required for gene expression, photosynthesis, and the electron transport chain. However, proteomic and bioinformatic studies suggest that approximately 2000 and 2600 proteins are located in plant mitochondria and chloroplasts, respectively; most of them are encoded by nuclear genes, synthesized in the cytoplasm, and targeted to organelles. Despite the simplicity of organelle genomes, their transcriptional regulation is complex and can only be partially explained by currently known transcriptional machinery components, suggesting that additional unidentified regulatory factors exist （Liere et al., 2011）.

Clinical outcomes with a newvdesign in multifocal intraocular lens:a pilot study

Purpose:To evaluate the clinical and visual outcomes,quality of near vision and the influence of photic phenomena in patients bilaterally implanted with a new Precizon Presbyopic multifocal intraocular lens(IOL).Methods:In this prospective consecutive case series,20 eyes of 10 patients were included(mean age 63.80±12.55 years).Uncorrected and corrected visual acuity(far,intermediate and near),subjective refraction,binocular defocus curve,contrast sensitivity(CSV-1000)and quality of vision and satisfaction questionnaires were measured.The follow-up was 12 months after surgery.Results:At 12 months after surgery,uncorrected distance visual acuity(UDVA)improved with surgery(P=0.001)with a value of 0.08±0.08 logMAR.Uncorrected near visual acuity(UNVA)was 0.22±0.12 logMAR and distance corrected near visual acuity(DCNVA)was 0.16±0.13 logMAR.Intermediate distance visual acuity(UIVA)was 0.22±0.10 logMAR.Contrast sensitivity outcomes were similar to normal population in photopic conditions and slightly reduced in mesopic conditions of lighting.Defocus curve showed that this multifocal iOL was able to provide a visual acuity(VA)equal to or better than 0.16 logMAR between defocus levels of+1.00 to-2.50 D.Good patient satisfaction was obtained in quality of vision and satisfaction questionnaires outcomes.Conclusions:The Precizon Presbyopic NVA IOL(OPHTEC BV)provides good visual outcomes.This multifocal IOL provides a high percentage of spectacle independence due to good VA at far,intermediate and near distances and satisfactory contrast sensitivity.High patient satisfaction was observed in quality of vision and satisfaction questionnaires with a low percentage of patients manifesting photic phenomena.

Safety and visual outcomes following posterior chamber phakic intraocular lens bilensectomy

Background:To evaluate the safety,efficacy,refractive outcomes and causes for bilensectomy[phakic intraocular lens(plOL)explantation with cataract surgery and pseudophakic intraocular lens(IOL)implantation]in patients previously implanted with posterior chamber plOLs(PC plOLs).Methods:This multi-center retrospective study included 87 eyes of 55 patients who underwent bilensectomy for PC plOL with a follow-up time of 12 months.The uncorrected and corrected distance visual acuities(UDVA,CDVA),endothelial cell density before and after bilensectomy were assessed,as well as the cause of bilensectomy and intra or postoperative complications.Results:There was a statistically significant improvement in UDVA and CDVA after bilensectomy(P=0.00).The main reason for bilensectomy was cataract development(93.1%of the cases),followed by miscalculation of lens size,and corneal edema.The endothelial cell count remained stable without a statistically significant change after surgery(P=0.67).The refractive efficacy index was 0.8,none of the patients lost lines of CDVA after surgery,73%of the patients were within±1.0D(spherical equivalent)of the target refraction.Intraoperative complications were one posterior capsule rupture with the IOL implanted in the sulcus,and three eyes required the use of pupil expanders for adequate pupil dilation.Postoperatively,one eye developed retinal detachment.The three plOLs models explanted were the implantable collamer lens(ICL);implantable phakic contact lens(IPCL)and the phakic refractive lens(PRL).Conclusions:Good safety and visual outcomes were observed one year after bilensectomy for PC plOLs.There were few intra and postoperative complications and there was no significant endothelial cell loss after the bilensectomy procedure.

Corneal transplantation outcomes after the extrusion of an intrastromal keratoprosthesis:a pilot study

This short report includes 5 eyes of 5 patients(mean age 63.2±12 years)who underwent a tectonic keratoplasty[deep anterior lamellar keratoplasty(DALK)or penetrating keratoplasty(PK)]in order to rehabilitate the eye after the extrusion of the non-perforating keratoprosthesis(Kpro)KeraKlear(KeraMed,USA).The non-perforating Kpro was extruded after a mean period of 21.4±21.8 months due to melting.In two cases,the keratoplasty was performed the same day of the non-perforating Kpro removal due to a severe melting,while in the other three cases it was performed 1 to 3 months later.Two eyes received a DALK,but in 3 eyes a macroscopic Descemetzs membrane perforation forced the conversion into a PK.The mean follow-up period after the keratoplasty was 16.8±6.6 months.No cases of rejection were recorded.All the 5 eyes achieved"anatomical success"(transparent graft,with no signs of infection or inflammation).Two eyes showed limited functional success"because the achievement of the best visual potential was prevented by the development of glaucomatous optic atrophy during the follow-up period.In conclusion,this short report presents an unexpected success of a keratoplasty performed with a tectonic purpose after the extrusion of the non-perforating Kpro because the corneal graft remained transparent,without neovascularization or scarring during the follow-up period.This initial evidence shows some encouraging results reg a rd i ng graft survival rate and the achievement of a useful visual rehabilitation with keratoplasty after a nonperforating Kpro failure in stead of repeating the Kpro implantation.