Understanding low functioning cerebral visual impairment: An Indian context

For several reasons, cerebral visual impairment (CVI) is emerging as a major cause of visual impairment among children in the developing world and we are seeing an increasing number of such children in our clinics. Owing to lack of early training about CVI and it being a habilitation orientated subject, we need to become equipped to optimally help the affected children. In this paper we have explained our pragmatic approach in addressing children who present with low functioning CVI. Initially we explain briefly, how vision is processed in the brain. We then present what should be specifically looked for in these children in regular clinics as a part of their comprehensive ophthalmic examination. We discuss the process of functional vision evaluation that we follow with the help of videos to explain the procedures, examples of how to convey the conclusions to the family, and how to use our findings to develop intervention guidelines for the child. We explain the difference between passive vision stimulation and vision intervention, provide some common interventions that may be applicable to many children and suggest how to infuse interventions in daily routines of children so that they become relevant and meaningful leading to effective learning experiences.

Visual function assessment, ocular examination, and intervention in children with developmental delay: A systematic approach. Part 1

Children with special needs form a unique subset with regards to visual function and examination techniques needed to assess them. With more awareness among the general public, neurologists, and pediatricians, these children are referred for assessment to the ophthalmologist or optometrist and sometimes even to the rehabilitation professional at an early age. This clinical practice guideline and review gives a systematic approach for examining the visual functions of a child with special needs. It outlines the procedures to be followed with equipment needed in clinical practice. Functional vision assessment guidelines are also included. This is the first part in a two-part series, with the first part presenting clinical examination guidelines and the second presenting intervention and vision enhancement techniques.

Estudio de sensibilidad antiviral de virus herpes simplex en pacientes trasplantados / [Antiviral sensitivity of herpes simplex virus in immunocompromised patients]

The Herpes simplex Virus (HSV) resistance to acyclovir (ACV) occurs in a 5

of the inmunocompromised patients, approximately. The treatment with analogs of nucleosides, causes the appearance of resistent HSV-ACV stocks (ACVr) which can be produced by alteration in genes coding for the TK or the DNA-polymerase. A previous large-scale clinical study on ACVr HSV strains isolated from patients infected with human immunodeficiency virus indicated that 96

of ACVr HSV mutants were low producers of, or deficient in, TK activity (TK-), with 4

being TK mutants with an altered substrate specificity. No DNA Pol mutants were isolated. The pirophosphate analogs generate resistance in the gene of DNA-polymerase by mutation. In this paper we show the methodology used for the determination of sensibilite profiles to ACV and Phoscarnet (PFA) in a population of inmunocompromised patients. We analized 46 HSV strain from vesicular injuries of transplanted patients. All samples, were inoculated in human fibroblasts and the HSV isolates were identified by inmunofluorescence whith monoclonal antibodies. These strains were amplified and the profile of susceptibility determinated in Vero cells, using 100 tissue culture inhibition dosis 50 (TCID50) of each Viral stock and the specific antiviral drugs in different concentrations. The cytopathic effect (CPE) was evaluated after 72hs. post infection. The 50

inhibitory concentration (CI50) was calculated from the percentage of inhibition of the ECP based on the concentration of the drug. From 46 isolations, 26 were HSV-1 and 20 were HSV-2. Two of them, one HSV-1 and one HSV-2, were resistant to ACV and none of the isolates were resistant to PFA.

Feohifomicosis y mucormisosis (zigomicosis) en un paciente receptor de un trasplante de riñón cadavérico / Phaeohyphomicosis and mucormycosis in cadeverous kidney transplant recipient

Se presentan los datos clínicos, microbiológicos y terapéuticos de un paciente que presentó una micosis doble en el miembro superior izquierdo. Era un enfermo de 49 años de edad, de sexo masculino, que había recibido un trasplante de riñón cadavérico y fue internado en el Hospital Argerich de Buenos Aires con lesiones inflamatorias seudotumorales ubicadas en el hombro y en la muñeca del brazo izquierdo. Había sufrido una insuficiencia renal crónica compensada con hemodiálisis y en julio de 1993 se le efectuó un trasplante de riñón cadavérico. Se le administró un tratamiento inmunodepresor que incluía metilprednisona, ciclosporina y azatioprina. Presentó dos episodios de rechazo agudo del trasplante que fueron controlados con altas dosis de corticosteriodes por vía intravenosa. En 1993 se le detectó una diabetes que fue tratada con glibenclamida. El paciente vivía en el Gran Buenos Aires en una casa de madera, sin instalaciones sanitarias adecuadas. Trabajaba como jardinero y cultivando vegetales, en ambas tareas manejaba abonos. No había tenido antecedentes de infecciones previas y había abandonado el control médico varios meses antes de su internación. En el momento de su ingreso se comprobaron una lesión abscedada en el hombro izquierdo, una placa con grandes nódulos en la muñeca izquierda y un nódulo aislado en el ángulo del maxilar inferior derecho. Se llevaron a cabo punciones aspirativas, drenajes quirúrgicos y resecciones de los cuales se obtuvieron muestras para los exámenes histopatológicos y microbiológicos. Los estudios microbiológicos acusaron: 1) en el hombro izquierdo hifas hialinas anchas no septadas y desarrollo de un hongo del género Mucor; 2) de la lesión de la muñeca izquierda hifas septadas, estrechas y pardas y desarrollo de un hongo dermatiáceo que no pudo ser clasificado por no presentar fructificación y 3) del nódulo del maxilar se obtuvo el desarrollo de Streptococcus viridans y Porphyromonas sp. Las infecciones micóticas fueron tratadas exitosamente con anfotericina B acompañada de drenaje quirúrgico y resección. La infección bacteriana se controló con amoxicilina/ácido clavulánico. Se efectuó un tratamiento supresivo con itraconazol para evitar la recaída de la feohifomicosis durante 6 meses y se prosiguió el control del paciente durante 1 año, sin haber presentado recaídas