RESUMO
El glaucoma es la principal causa de ceguera no reversible en el mundo, afectando al 2 por ciento de la población. Actualmente se considera una neuropatía óptica, donde la presión intraocular juega un rol fundamental en la patogenia y las características del daño óptico producido. Con el tratamiento actual, se busca prevenir el daño en la estructura del nervio óptico, para preservar el campo visual, persiguiendo mantener la calidad de vida del paciente. Existen nuevos métodos imaginológicos que junto al examen clínico y campo visual, predicen daño y avance de enfermedad. Se incluyen en la comprensión de la patología la apoptosis y el concepto de neuroprotección. Nuevos fármacos buscan mantener una adecuada reducción en la presión intraocular sin fluctuaciones, evitando efectos adversos y mejorando la adherencia al tratamiento. Nuevas herramientas terapéuticas como la trabeculoplastía selectiva láser y nuevas cirugías como el implante de tubos de drenaje, aumentan las posibilidades de evitar la ceguera por glaucoma.
Glaucoma is the main non-reversible blindness cause worldwide, affecting 2 percent of the population. Nowadays, it is considered an optic neuropathy, and the intraocular pressure doing a fundamental role in its physiopathology and optic disc damage features. Actual treatment seeks to prevent the damage of the optic nerve structure, in order to prevent the visual field to keep the quality of life. New imaging methods exist to predict onset and continuing damaging in the optic head, beside clinical examination and visual fields. It has been included in the comprehension of the glaucomatous pathology, the concept of apoptosis and neuroprotection. New drugs are searching to maintain an adequate intraocular pressure reduction, without fluctuations, avoiding side effects and improving the treatment adherence. New therapeutic tools, such as selective laser trabeculoplasty, and new surgeries like tubes or valves, have increased the odds of avoiding blindness due to glaucoma.
Assuntos
Humanos , Glaucoma/diagnóstico , Glaucoma/terapia , Glaucoma/cirurgia , Glaucoma/fisiopatologia , Apoptose , Pressão IntraocularRESUMO
Background: Acute bacterial meningitis still has a high mortality and rate of complications. Aim: To assess the impact of anti H influenzae vaccination on the epidemiology of acute bacterial meningitis in Chilean children. Material and methods: A retrospective study of hospital discharge records of patients with acute bacterial meningitis. Causative agents were studied globally, by hospital and by age group. The changes in etiology from 1989 to 1995 were also assessed. Between 1996 and 1998, only those patients with acute bacterial meningitis caused by H influenzae were recollected. Results: In the period prior to vaccination (1989-1995), 1000 cases were registered. The main causative agents were N meningitidis in 33.8 percent, H influenzas type b in 21.9 percent and S pneumoniae in 15.4 percent. The incidence of H influenzae decreased in the period from 36.4 to 9.9 percent (p<0.001) and the incidence of N meningitidis increased from 22.9 to 52.1 percent (p <0.001). The incidence of S pneumoniae did not change significantly. H influenzae predominated in children between 4 and 24 months of age and N meningitidis predominated in children over 25 months of age. In the period after the introduction of vaccination (1995-1998), there was a further decrease in the incidence of H influenzae from 10 to 2 percent (p <0.001). Until 1997, there was a considerable increase in the incidence of N meningitidis, specially in children over 25 months of age. It declined in 1998 to 38 percent. Conclusions: There was a reduction in the incidence of acute bacterial meningitis caused by H influenzae prior to the introduction of the vaccine against H influenzae type b. The decrease was more pronounced after the introduction of the vaccine