A rare case of spasmus nutans in an infant

@#We report a case of an otherwise healthy 23-month-old boy who presented with nystagmus, head shaking, and abnormal head posture suggestive of spasmus nutans. Neuro-ophthalmologic exam revealed bilateral, low-amplitude, high-frequency, horizontal, disconjugate nystagmus that was more prominent in one eye along with head shaking and a head tilt or face turn. The rest of the exam and the systemic physical examination were normal. Magnetic resonance imaging of the brain did not disclose optic pathway glioma, which has been reported to cause spasmus nutans-like disease. Electroretinogram (ERG) was also recommended to rule out occult retinopathies. However, it was not done due to unavailability of the appropriate corneal electrode for his age. Instead, close follow-up was advised to monitor spontaneous improvement or resolution, or until the child comes of age that he can undergo ERG. This case highlights the management approach and rationale of patients with presumed spasmus nutans. Recognition of the triad of spasmus nutans allows for quick diagnosis and more focused and efficient investigation.

Recovery in schizophrenia: Perspectives from psychiatrists in the Philippines

BACKGROUND@#A reliable and socially validated definition of recovery in schizophrenia is essential to decrease stigma associated with the illness. This study aimed to define recovery in schizophrenia in the Philippine context, determine its specific elements, and describe methods of assessment in clinical practice.@*METHODS@#We invited a group of purposively selected Filipino psychiatrists to participate in six simultaneous roundtable discussions to gather their opinions and perspectives on recovery in schizophrenia. Transcripts of the discussions were then subjected to framework analysis.@*RESULTS AND CONCLUSION@#Most Filipino psychiatrists were of the considered opinion that recovery in schizophrenia is possible, and their vision of a recovered patient resembles a combination of psychological and medical models. The mini-FROGS tool was deemed generally applicable in the Philippine setting except for self-esteem and sense of independence primarily because it is difficult to evaluate. The SWN was received with mixed reactions among the psychiatrists. Spirituality as an element of recovery and the family-oriented culture of the Filipinos were emphasized as important considerations in assessing patients. Other suggestions were given to tailor-fit these tools to the Philippine context.

Predictors for failure of primary trabeculectomy

Objective@#This study determined the success and failure rates of primary trabeculectomy in a university hospital and identified the factors predictive of failure. A retrospective, nested case-control study was conducted involving primary trabeculectomies done in a university hospital from January 2005 to December 2007 with at least one year of follow-up. Depending on the outcomes, patients were classified as cases or controls. Cases were those with failed trabeculectomies defined as intraocular pressure (IOP) >21 mm Hg in all patients and >15 mm Hg in advanced glaucoma at 1 year follow-up. Eyes requiring further glaucoma surgery were also considered failure. Controls were those with successful trabeculectomies defined as IOP <21 mm Hg in all patients and <16 mm Hg in advanced glaucoma, and at least 20% reduction from the presenting IOP and on no more than 2 antiglaucoma medications at one-year follow-up. Preoperative, intraoperative, and postoperative variables were collected and analyzed by bivariate analyses and multiple logistic regression.@*Results@#At one-year follow-up, the success rate was 79.8%. Age at the time of surgery, gender, eye laterality, presence of diabetes, history of intraocular surgery, previous laser treatment, maximum IOP, glaucoma diagnosis, and total number and duration of preoperative antiglaucoma medications were not shown to affect outcome of surgery. Variations in the intraoperative technique, including conjunctival flap approach, location and shape of the scleral flap, suturing technique, and surgeon’s competency were not associated with outcome. Postoperative IOP at 1 month, 3 months, and 6 months were predictors of successful outcome at 1 year. Postoperative subconjunctival 5FU injection, bleb manipulation, and laser suture lysis did not alter outcome.@*Conclusion@#Early postoperative IOP at 1 month is already predictive of the outcome of primary trabeculectomy at 1 year.