Quantification of RAPD by an automated pupillometer in asymmetric glaucoma and its correlation with manual pupillary assessment

Purpose: The relative afferent pupillary defect (RAPD) is an important sign of asymmetrical retinal ganglion cell damage. The purpose of this study was to quantify RAPD by a pupillometer (RAPiDo, Neuroptics) and assess its correlation with asymmetric glaucoma and manual pupillary assessment. Methods: A total of 173 subjects were enrolled in the study and categorized into glaucoma, n = 130, and control, n = 43. Subjects were all recruited in the Glaucoma Clinic of the Aravind Eye Hospital in Madurai during their follow-up. They were 18 years and older, with best corrected visual acuity of 6/36 or better. Exclusion criteria included all retinal pathologies, optic atrophies, ocular injuries, severe uveitis, cloudy corneas, dense cataracts, or use of mydriatics or miotic drugs. RAPD was assessed in all subjects using an automated pupillometer and the results were compared with the swinging flash light test conducted on the same subjects by an experienced ophthalmologist. We looked at the correlation between RAPD and the intereye difference in cup-to-disc ratio (CDR), mean deviation (MD) of visual field testing, and retinal nerve fiber layer (RNFL) thickness. Sensitivity and specificity were assessed by area under the receiver operator characteristic (AUROC) analysis. Results: Glaucoma patients had significant RAPD (0.55 � 0.05 log units) when compared with the controls (0.25 � 0.05 log units), P < 0.001. Significant intereye differences in CDR, MD, and RNFL between glaucoma and control (P < 0.001) were seen. There was a good correlation between the magnitude and sign of RAPD and these intereye differences in CDR (r = 0.52, P < 0.001), MD (r = 0.44, P < 0.001) and RNFL thickness (r = 0.59, P < 0.001). When compared with the experienced ophthalmologist, AUROC was 0.94, with 89% sensitivity and 91.7% specificity. Conclusion: The good correlation between the magnitude of RAPD, as measured by the automated pupillometer, and intereye differences in MD, CDR, and RNFL thickness in glaucomatous, and the good sensitivity and specificity when compared with the experienced ophthalmologist, suggest that pupillometry may be useful as a screening tool to assess asymmetric glaucoma.

Ventilación con liberación de presiones en la vía respiratoria en un paciente con trauma de tórax / Airway pressure release ventilation in a patient with thorax´s trauma

Introducción: Los traumatismos torácicos son causa importante de morbi-mortalidad. El volet costal con contusión pulmonar ensombrece el pronóstico. Objetivo: Presentar una estrategia ventilatoria para estabilizar la pared torácica, corregir la hipoxemia y proteger el parénquima pulmonar. Caso clínico: Paciente con volet costal, neumotórax bilateral y contusión pulmonar que produjo un distress respiratorio, requirió ventilación mecánica. Ante la necesidad de estabilizar la pared tóracica y reclutar el parénquima pulmonar se ventiló con liberación de presiones en la vía aérea. Requirió toracotomía para solucionar definitivamente la lesión pulmonar y se realizó toracoplastia. El paciente egresó sin secuelas luego de 21 días de hospitalización. Conclusiones: La ventilación con liberación de presiones en la vía aérea se propone como una estrategia que facilita la estabilidad de la pared torácica, el reclutamiento alveolar, teóricamente ofrece ventajas en protección pulmonar y en la respuesta inflamatoria sistémica. En este caso particular se lograron los objetivos esperados con el empleo de esta modalidad como puente para la cirugía correctiva(AU)

Introduction: Thoracic trauma is an important cause of morbidity and mortality. The costal volet with pulmonary contusion overshadows the prognosis Objective: To present a ventilatory strategy to stabilize the chest wall, correct hypoxemia and protect the lung parenchyma. Clinical case: A patient with costal volet, bilateral pneumothorax and pulmonary contusion that produced a respiratory distress; required mechanical ventilation. Given the need to stabilize the thoracic wall and recruit the lung parenchyma, it was ventilated with release of airway pressures. A thoracotomy was required to definitively resolve the lung lesion and thoracoplasty was performed. The patient withdrew without sequelae after 21 days of hospitalization. Conclusions: The APRV is proposed as a strategy that facilitates the stability of the thoracic wall, the alveolar recruitment, theoretically offers advantages in pulmonary protection and in the systemic inflammatory response. In this particular case the expected objectives were achieved with the use of this modality as a bridge for corrective surgery(AU)

Gênero, sexualidade e swing: a ressignificação de valores através da troca de casais / Género, sexualidad y swing: la resignificación de valores a través del intercambio de parejas / Gender, sexuality and swinging: resignification of values through partner exchange

O objeto de estudo deste artigo é o swing, também chamado de troca de casais. Pretende-se compreender questões fundamentais que norteiam este universo no que diz respeito à sexualidade e às identidades de gênero dos praticantes. A análise é feita a partir de trabalho de campo realizado em um clube de swing na região de Lisboa e em entrevistas com seis casais adeptos da prática. Procura-se entender de que maneira as identidades de gênero e sexuais são reproduzidas, ressignificadas ou negadas no swing, bem como o que caracteriza a feminilidade e a masculinidade neste universo. Esta pesquisa também aponta algumas particularidades da troca de casais não apenas para o relacionamento afetivo-sexual, mas também para os indivíduos envolvidos...

Este artículo trata del swing, también llamado intercambio de parejas. Se busca comprender cuestiones fundamentales que orientan este universo, en lo que respecta a la sexualidad y las identidades de género de sus practicantes. El análisis se basa en trabajo de campo realizado en un club de swing en la región de Lisboa y en entrevistas con 6 parejas que lo practican. Se procura entender de qué manera son reproducidas, resignificadas o negadas en el swing las identidades sexuales y de género, así como qué caracteriza a la feminidad y a la masculinidad en este universo. La investigación señala también algunas particularidades del intercambio de parejas, no sólo para la relación afectivo-sexual sino también para los individuos implicados...

The subject of this article is swinging, also known as partner exchange or swinging lifestyle. It addresses fundamental issues that guide this universe with regard to practitioners' sexuality and gender identities. The analysis is based on an ethnography conducted at a swingers' club in the Lisbon area, and on interviews with six swinger couples. It seeks to understand how gender and sexual identities are reproduced, resignified or denied in swinging, as well as what characterizes femininity and masculinity in this universe. This research also points out some peculiarities of swinging not only for conjugal life, but also for the individuals involved...

Effects of a Videotaped Arm Swinging Exercise Program on Gait in Parkinson's Disease Patients / The Japanese Journal of Rehabilitation Medicine

Gait disturbance is a serious problem in Parkinson's disease (PD). Exercise therapy is used to alleviate this complaint. We investigated the effects of a videotaped arm swinging-based home exercise program on gait in PD patients. The subjects included 25 outpatients aged between 55 and 77 years (average age 68.9 years) with PD in Hoehn and Yahr stages II-IV. We prepared a master video tape in which a trainer was shown to be performing an arm swinging exercise or steps in synchrony with a metronome. The exercise menu consisted of 4 parts : arm swinging in a seated position, arm swinging in an upright position without stepping, arm swinging with stepping, and walking on the floor or taking a walk. The patients performed the arm swinging exercise while watching a video tape everyday for a period of 3.4 weeks. Of the 25 patients, 22 completed the exercise program. Following the program, these patients showed significant improvements in their walking times for a 20m walk (10 m, return, 10 m) (before/after=29.6/24.3 sec, <i>p</i>=0.002) and in the step length (before/after=43.7/50.1 cm, <i>p</i><0.001). Frozen gait was a negative factor to complete the programs. Improvement of gait speed after the exercise was related with less frequency of cadence. Loss of arm swinging in PD may be associated with a disturbance in the internal rhythm formation process. Arm swinging exercises are one of the exercise methods that use rhythmic cues. This study suggests that a videotaped arm swinging-based home exercise therapy is effective in such patients.

Simultaneous septorhinoplasty / 中华医学美学美容杂志

Objective To introduce a new septorhinoplastic method for twisted nose, humped nose and hawk nose as well as deviation of nasal septum, and to evaluate its operative method and effect. Methods The incision of cleft between lateral nasal cartilage and greater alar cartilage was employed in all patients. The method of unilateral mucoperiosteal flap osteotomy was used to correct nasal pyramid deformity, and swinging-door operation was performed to correct the deviation of nasal septum simultaneously. Results The operative results of 36 cases were effective and satisfactory. Postoperative follow-up ranged from one year to fifteen years. Based on the results of follow-up in the 32 cases, no recurrence and complications were found in all the cases. Conclusion This new method for septorhinoplasty avoids the detachment and move of nasal bone and nasal septum cartilage and injury of nasal mucoperiosteum, and maintains the blood supply of nasal bone and nasal septum cartilage. It corrects extero-nasal deformity as well as deviation of nasal septum. The operation is effective in nose aesthetic and ventilatory function.