Vascular and vegetative factors of glaucoma attack

Purpose. To study the involvement of vascular and vegetative factors in the pathogenesis of glaucoma attack. Material and methods. 12 patients (24 eyes) aged 49 to 82 — 5 men and 7 women, including 3 patients with acute glaucoma and 9 patients with subacute glaucoma were subjected to an ophthalmological examination that included visometry, tonometry, automated static perimetry, OCT and OCT angiography. They were also tested for heart rate variability (HRV) using a Polar heart rate monitor, and for plasminogen content and products of fibrin/fibrinogen degradation in the tear. For comparison, the contralateral eyes of these patients were examined. Results. In the eyes with an acute glaucoma attack, the vascular network was noticeably weakened, especially in the area of the deep peripapillary vascular plexus at the lamina cribrosa level, and focal capillary loss was observed. The peripapillary density of the deep vascular plexus in the eyes with an acute attack was 33.0 ± 5.6 % (М ± m), which was significantly (p < 0.01) lower as compared to 50.0 ± 4.7 % in the unaffected eyes. This indicator correlated with the thickness of the ganglion cell complex (GCC) (p < 0.01). In unaffected eyes, no correlations were found between these glaucoma-related parameters. A significant amount of fibrin/fibrinogen degradation products was found in the tear of glaucoma patients, which may point to a violation of blood circulation in the optic nerve vessels. It has been established that glaucoma attack occurs with increased activity of sympathetic regulation of blood flow. Conclusion. When monitoring this contingent of patients, it is essential to determine the sympathetic-parasympathetic status of the patient. Taking into account the vascular component of the condition, it is expedient to introduce the necessary additions into its treatment plans

Management and outcome of spontaneous cervical epidural hematoma: Case report and review of the literature

Spontaneous spinal epidural hematomas are rare and potentially disabling neurological emergencies. Its lead to devastating neurologic outcomes and most patient does not recover completely. The clinical presentation is diverse and includes a severe acute attack, radiating pain at the back, interscapular, or neurological deficits. We report a case of a young woman, 24-year-old, that was admitted to our department for sudden non-traumatic cervical spinal cord compression syndrome (Type A of the American Spinal Cord Injury Association “ASIA A”) including intense cervical back pain, sensory loss, and tetraplegia. Her past medical history was unremarkable. The MRI confirmed a cervical mass responsible for the spinal cord compression and the emergent surgical intervention allow us to evacuate acute C3-C7 hematoma. The patient never recovers from the neurologic deficit despite the emergent management of her case followed by functional musculoskeletal rehabilitation for two years.

Efficacy and safety of plasma exchange or immunoadsorption for the treatment of option neuritis in demyelinating diseases: A systematic review and meta-analysis

Background There are no systematic reviews yet that evaluated the effects of PE/IA in patients with optic neuritis (ON) in demyelinating diseases. A meta-analysis of available study is needed to further explore the value of plasma exchange (PE) or immunoadsorption (IA) in treating ON in demyelinating diseases. Methods All relevant articles published on PubMed, Web of Science, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), VIP Database, Wanfang, Sinomed and ophthalmology professional websites were searched. Study characteristics, demographic characteristics, clinical features and outcome measures were extracted. Response rate, adverse events (AE) rate, serious adverse event (SAE) rate, the log of the minimum angle of resolution (logMAR), visual outcome scale (VOS) and expanded disability status scales (EDSS) were evaluated using a random-effects model. Results 35 studies were included between 1985 and 2020, containing 1191 patients. The response rates of PE and IA in acute attack of ON were 68% and 82% respectively. LogMAR (−0.60 to − 1.42) and VOS (−1.10 to −1.82) had been significantly improved from within 1 month to more than 1 month after PE treatment. Besides, we found that logMAR improved 1.78, 0.95 and 0.38, respectively ,when the time from symptom onset to the first PE/IA was less than 21 days, 21–28 days, and more than 28 days. The pooled mean difference of EDSS was −1.14.Adverse effects rate in patients with PE or IA were 0.20 and 0.06, respectively. Conclusion The meta-analysis provided evidence that PE/IA treatment was an effective and safe intervention, and it is recommended that early initiation of PE/IA treatment is critical.

DEVELOPMENT OF AN AUTOMATED SYSTEM FOR DIAGNOSING EYE DISEASES BASED ON PRODUCTION RULES

В статье рассматриваются вопросы диагностики заболеваний органов зрения и его придаточного аппарата. Медико-социальное значение болезней органов зрения и его придаточного аппарата в современных условиях велико и определяется, прежде всего, их крайне высокой частотой среди различных контингентов населения. Так как зрение является для человека важнейшим из всех органов чувств, без которого невозможна полноценная жизнь, необходимо вовремя выявлять различные патологии и применять незамедлительные меры лечения. Одним из средств повышения эффективности диагностики заболеваний глаз является автоматизация обработки диагностических данных с использованием современных технологий, а именно компьютерной системы поддержки принятия решений. Данная статья посвящена разработке автоматизированной системы диагностики заболеваний глаза на основе продукционных правил. Следует отметить, что процесс медицинского офтальмологического исследования занимает значительное время на различного рода лабораторные анализы, инструментальную диагностику, опрос больного или физического исследования. Автоматизированная компьютерная система диагностики глазных заболеваний предназначена для автоматического установления по характерным признакам таких диагнозов как острый конъюнктивит, острый ирит, острый приступ глаукомы и катаракта. Разработанная программа, реализованная в системе визуального объектно-ориентированного программирования С++, представляется пользователям как консультант для автоматизации работы, что позволит повысить эффективность процесса диагностики заболеваний органов зрения и его придаточного аппарата The article deals with the diagnosis of diseases of the organs of vision and its accessory apparatus. The medical and social significance of diseases of the organs of vision and its accessory apparatus in modern conditions is great and is determined, first of all, by their extremely high frequency among various contingents of the population. Since vision is the most important of all sense organs for a person, without which a full life is impossible, it is necessary to identify various pathologies in time and apply immediate treatment measures. One of the means to increase the effectiveness of the diagnosis of eye diseases is the automation of diagnostic data processing using modern technologies, namely a computer decision support system. This article is devoted to the development of an automated system for diagnosing eye diseases based on production rules. It should be noted that the process of medical ophthalmological examination takes considerable time for various kinds of laboratory tests, instrumental diagnostics, patient interview or physical examination. The automated computer system for the diagnosis of eye diseases is designed to automatically establish the characteristic signs of such diagnoses as acute conjunctivitis, acute iritis, acute attack of glaucoma and cataract. The developed program, implemented in the C++ visual object-oriented programming system, is presented to users as a consultant for automating work, which will increase the efficiency of the process of diagnosing diseases of the visual organs and its accessory apparatus

Micropulse cyclophotocoagulation – a new approach to the surgical treatment of glaucoma

The article studies the clinical efficacy and safety of the use of micropulse cyclophotocoagulation (MCPC) in the treatment of patients with glaucoma. The analysis of the results of performing mCPK in 121 patients with glaucoma was carried out. The Maklakov IOP level before surgery averaged 32.4 ± 3.8 mm Hg. Various laser and surgical antiglaucomatous interventions were previously performed on 83 eyes. The observation period was 1 year. MPCP was performed using a Cyclo G6 Glaucoma Laser System console and a MicroPulseParsPlanaProbe (MP3) probe (Iridex Corporation, USA). All operations were carried out without complications. On the first day after surgery, the IOP level in all eyes decreased to an average of 21.7 ± 1.9 mm Hg. Thus, MCPC is an effective and safe operation for normalizing IOP in patients with primary openangle glaucoma and primary angleclosure glaucoma, an acute attack with a followup period of 1 year

Abdominal hereditary angio-oedema caught on magnetic resonance imaging

A 17-year-old woman presented with a 3-year history of recurrent, severe abdominal pain with spontaneous resolution within a few days. An ultrasound revealed nothing more than free fluid within the pelvis. An MRI of the small bowel was done within 24 hours of abdominal pain onset, which revealed extensive submucosal oedema associated with moderate volume ascites. A repeat MRI of the small bowel after 72 hours showed near-complete resolution of these changes. Checking C1 inhibitor levels confirmed a diagnosis of hereditary angio-oedema with an abdominal presentation. This is a rare cause of recurrent abdominal pain and, to our knowledge, the first case in which MR images have been obtained during and after an acute attack.

Elucidation of presence of increased risk formation of primary angle-closure glaucoma among patients with hyperopia in department of refractive surgery

Important physiological feature of the anatomically «short» eye is the disproportionately large volume of the lens relative to the volume of the eye. A gradual and continuous increase in the volume of the lens contributes to the anterior displacement of the irido-lenticular diaphragm, causing the functional block of the anterior chamber angle. This leads to persistent disorders of the hydrodynamics of the eye, up to the development of an acute attack of angle-closure glaucoma. Purpose. To study incidence of increased risk formation of primary angle-closure glaucoma (PACG) and its acute attack in young patients with moderate and high hyperopia (Hm). Material and methods. Clinical material was presented by 58 patients (116 eyes) with indicators of axial length of the eyes less than 23 mm. The main group consisted of 33 patients (66 eyes) with moderate and high Hm. The comparison group was represented by 25 patients (50 eyes) with PACG. Results. The study made it possible to identify group of increased risk of the formation of PACG, which included 19 people (58%), from selected general population of young patients with moderate and high Hm. Conclusion. Comparative analysis of morphometric parameters of structures of the anterior segment of the anatomically «short» eyes in young patients with moderate and high Hm, on the one hand, and in patients with PACG, on the other, revealed statistically significant differences between them in the anterior chamber depth in the central zone, the thickness of the lens, the anterior chamber volume, the peripheral anterior chamber depth, of the anterior chamber angle. Key words: primary angle-closure glaucoma, acute attack of angle-closure glaucoma, hyperopia, refractive surgery.

Changes in the spectrum of protein components and the concentration of phospholipids of the erythrocyte membrane in patients with ulcerative colitis

Ulcerative colitis is a chronic inflammatory bowel disease with unclear etiology. An insufficient amount of data on the etiopathogenetic mechanisms of the disease creates opportunities to research them at the cellular level, including the membrane level. Since the functional state of the cytoplasmic membrane largely depends on protein-lipid interactions, we studied the effect of the proportional ratio of three proteins (glucose transporter, glyceraldehyde-3-phosphate dehydrogenase (GAPDH) and glutathione-S-transferase (GST)) on the level of phosphatidylethanolamine and phosphatidylcholine in the erythrocyte membrane of patients with ulcerative colitis during an acute attack. The study involved 51 patients with ulcerative colitis during the acute attack and 26 clinically healthy individuals. The groups are comparable by gender and age to study the proteins of the cytoplasmic membrane, Laemmli electrophoresis technique in polyacrylamide gel was used, followed by an assessment of the intensity of protein bands staining on electropherograms. Phospholipid fractions were obtained using thin-layer chromatography and their content was assessed using the Mathcad 2001 Professional system. Statistical processing was carried out by the program Statistica 10.0 for Windows. Changes of phosphatidylcholine and phosphatidylethanolcholine levels in patients and healthy individuals are not of the same type and are interrelated with changes in the proportion of membrane proteins of the glucose transporter, GAPDH and GST. The proportions of proteins that affect the level of phospholipids have calculated. In patients with ulcerative colitis, a decrease in the level of the studied membrane lipids have revealed in comparison with the clinically healthy group, in addition, an increase in the proportion of the glucose transporter and a decrease in the proportion of GST have noted. In addition, the relationship between an increase in the level of the cytoplasmic membrane phospholipids in ulcerative colitis and a change in the proportion of GAFDH in a smaller direction, which slows down the process of glucose oxidation, was determined. The obtained data confirm the strengthening of the processes of antioxidant protection and the increased need for energy supply of the cell membrane in patients with ulcerative colitis during an acute attack.