ABSTRACT.Purpose: To assess the value of colour Doppler imaging (CDI) of the ophthalmic artery (OA) and short posterior ciliary arteries (SPCAs) in prognosis of disease progression in patients with primary open-angle glaucoma (POAG). Methods: A total of 49 eyes of 49 patients with POAG were included in a prospective cohort study. At baseline and every 6 months for 36 months, we measured the resistive indices (RIs) of the OA and SPCAs using CDI, visual field examination, intraocular pressure (IOP) and blood pressure measurements. The predictive capacity of the RIs of these vessels was investigated by Cox regression. Receiver operating characteristics curves were plotted for the OA and SPCAs RIs, and predictive values, likelihood ratios and post-test probabilities were calculated. Results: After 36 months, 23 eyes had progressed. In the eyes that progressed, the mean (SD) RI was 0.82 (0.007) for the OA and 0.73 (0.006) for the SPCAs; in the eyes that did not progress the mean RI was 0.70 (0.007) for the OA and 0.63 (0.006) for the SPCAs. The optimal points for the RIs were 0.72 for the OA and 0.65 for the SPCAs. With these cut-off points, the positive post-test probability was 90.5% in the OA. Conclusion: In eyes with POAG and elevated IOP, the RIs of the OA or SPCAs may reliably predict visual field progression.
The RNFL in the temporal quadrant was found to be thinner in migraine patients. In addition, we found a strong correlation between migraine severity and the RNFL average thickness parameters.
Cryptococcosis is a major fungal disease caused by members of the Cryptococcus gattii and Cryptococcus neoformans species complexes. After more than 15 years of molecular genetic and phenotypic studies and much debate, a proposal for a taxonomic revision was made.
Recent Cryptococcus gattii infections in humans and animals, including several outbreaks in goats, were the basis of this environmental survey in six provinces of Spain. A total of 479 samples from 20 tree species were studied. Cryptococcus gattii was found for the first time in autochthonous Mediterranean trees in Spain. Fourteen isolates of this pathogen were obtained from seven trees of three different species: 12 from carob (Ceratonia siliqua), one from Mediterranean stone pine (Pinus halepensis) and another from eucalyptus (Eucalyptus camaldulensis). All C. gattii isolates were genotype AFLP4/VGI and mating type alpha, and were found to be genetically identical with C. gattii strains isolated from humans and animals in Spain. This supports the hypothesis that these trees may be a natural source for infection of humans and mammals in the Mediterranean area.
A domestic ferret (Mustela putorius furo) was presented with lymphadenopathy and acute bilateral blindness. Cytologic evaluation and biopsy of an affected lymph node revealed pyogranulomatous lymphadenitis with intralesional yeast consistent with Cryptococcus sp. Subsequent studies demonstrated Cryptococcus gattii serotype B VGI/AFLP4 as the causative agent. The ferret was treated with fluconazole and prednisone. After one month of therapy, an improvement of the clinical symptoms was detected although blindness persisted. Seven months after presentation, the disease progressed to a severe neurologic condition, and it was euthanized. Postmortem exam revealed disseminated cryptococcosis with prominent neurologic involvement. Nasal swabs of other ferrets and humans from the same household revealed that two ferrets and two humans to be asymptomatic carriers of the same strain of cryptococcus as the necropsied ferret. These findings stress the importance of veterinary diagnostic work with pets and epidemiological investigations for disease prevention in them and in their owners.
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