The Utilization of Emergency Department and Outpatient Clinics among Evacuated Victims after the 2023 Turkey Earthquake.

BACKGROUND: After the 2023 Turkey earthquake, thousands of people evacuated to different fields. Earthquake victims still need health care in the evacuation location. This study aims to determine the emergency department (ED) and outpatient clinic utilization characteristics of the evacuated earthquake victims outside the earthquake zone and to provide suggestions for planning the health care facilities in the regions where the evacuated earthquake victims will be placed. METHODS: This retrospective, observational study was conducted in a tertiary university hospital from February 7, 2023 through February 20, 2023. All evacuated earthquake victims who presented to the study hospital were included in the study. Non-victim patients were included as the control group. Missing medical records were excluded. Demographic characteristics of the patients, outpatient clinics, International Statistical Classification of Diseases and Related Health Problems-10th Revision (ICD-10) codes, and outcomes were recorded. RESULTS: A total of 15,128 patients were included in the final analysis. Six-hundred-nine (4.0%) of the patients were evacuated victims. Three-hundred forty-six (56.8%) evacuated victims used the ED. One-hundred fifty-six (25.6%) earthquake victims were in the pediatric age group. Earthquake victims used the ED more than the control group in adult and pediatric age groups (22.5% versus 51.7% and 30.2% versus 71.8%; P <.001, respectively). Earthquake victims frequently presented to the hospital during night shifts in both age groups (P <.05). Pediatric victims were more hospitalized than the control group (4.8% versus 10.9%; P = .001). Diseases of the respiratory system were the most common emergency diagnosis of the victims in both age groups (26.5% and 57.1%, respectively). The most frequently used outpatient clinic was ophthalmology in both age groups (14.6% and 20.5%, respectively). CONCLUSIONS: Evacuated victims, especially pediatric victims, used the ED more than other outpatient clinics. Diseases of the respiratory system were the most common emergency diagnosis of the victims, and the most frequently preferred outpatient clinic was ophthalmology. The most common diseases and frequently preferred clinics should be considered in planning health care for the evacuated earthquake victims.

Prevalence and associated risk factors of post-traumatic stress disorder among survivors of the 2023 Turkey earthquake.

BACKGROUND: Earthquakes can cause psychological trauma among survivors as well as physical trauma. This study aims to determine the prevalence of post-traumatic stress disorder (PTSD) and identify associated risk factors among earthquake survivors after the 2023 Turkey earthquake. METHODS: This prospective cross-sectional study was conducted in the emergency department of a tertiary university hospital between May 6, 2023, and May 16, 2023. An online questionnaire was sent to the participants. The questionnaire form consisted of three parts. In the first part, the sociodemographic characteristics of the participants were included. In the second part, the participants were asked about their experiences with the earthquake. In the third part, the post-traumatic stress disorder checklist for the Diagnostic and Statistical Manual of Mental Disorders, which screens PTSD among the participants, was included. Participants who did not complete all the questions and had severe communication disorders were excluded. RESULTS: The prevalence of probable PTSD among the participants was 51.4% (n = 197). Age (OR: 0.96 95% CI: 0.93-99), female gender (OR: 4.54 95% CI: 2.39-8.61), being the head of the family (OR: 2.00 95% CI: 1.04-3.82), bereavement (OR: 1.71 95% CI: 1.03-2.82), lost loved ones (OR: 3.15 95% CI: 1.67-5.92), low social support (OR: 1.80 95% CI: 1.12-2.90) and receiving emergency care at the field (OR: 6.67 95% CI: 1.03-43.2) were the associated risk factors of PTSD among earthquake survivors. CONCLUSIONS: The prevalence of PTSD among survivors three months after the 2023 Turkey earthquake is over half of the survivors. Younger age, female gender, being the head of the family, bereavement, lost loved ones, low social support, and receiving emergency care in the field were the associated risk factors of PTSD among earthquake survivors. Considering survivors may visit EDs until other outpatient clinics are re-established and the high rate of PTSD, rapid psychological evaluations can be performed in emergency departments. Emergency physicians should be aware of possible risk factors and high rate of PTSD.

The role of cyclin D1, BCL-2, p53 and Ki-67 in epithelial cells in the etiopathogenesis of pterygium.

CONTEXT: Pterygium is a degenerative disease that consists of conjunctival epithelia and fibrovascular tissue. Some studies suggest that there is a defect in the regulation of apoptosis in the epithelial cell cycle characterized by the development of the disease. But, still this matter being debated. AIMS: In this study, the clinical, histopathological data, and the expression of the cell cycle regulator Cyclin D1, anti-apoptotic BCL-2, tumor suppressor p53, and cell proliferation marker Ki-67 were searched in pterygium samples. SUBJECTS AND METHODS: The study enrolled 62 cases of primary pterygium who underwent excision between 2014 and 2017. Recurrent and pseudo-pterygium cases were excluded from series. The clinical data were obtained from the patient files and the slides were reevaluated for the histopathological data. Slides of all were stained by Cyclin D1, BCL-2, and Ki-67 by the immunohistochemical method. For each immunohistochemical marker, first the staining was determined as negative or positive. Then if there is a staining, the hot zone (the area containing more positive cells) was determined and staining percentage (SP) was assessed by counting positive cells/100 epithelial cells). RESULTS: Solar elastosis, edema, inflammation, and epithelial dysplasia were found statistically different between the control group and the patient group (P value <0.001, <0.001, <0.001 <0.001, respectively). A significant difference was found for staining percentage (SP) of Ki-67, p53, BCL-2 between the control group and the patient group (P values <0.001, 0.002, <0.001, respectively). There were no significant differences in the SP of Cyclin D1 between the two groups (p: 0,133). CONCLUSIONS: Our results indicate an abnormal expression of p53, BCL-2 and elevated proliferation measured by Ki-67 in pterygium samples when compared to normal conjunctiva. Besides the mesenchymal changes, the increased proliferation and the failure of apoptosis in the epithelial cells participate in the development of pterygium, as well.

Investigation of relationship between colour discrimination ability and stereoscopic acuity using Farnsworth Munsell 100 hue test and stereo tests.

OBJECTIVE: To evaluate the effect of colour discrimination ability on the stereoscopic acuity by comparing individuals having congenital colour vision deficiency (CCVD) with healthy individuals. DESIGN: A comparative study. PARTICIPANTS: The study included 53 binocular males, of whom 26 (mean age, 36.04 ± 9.30 years) were in the healthy group and 27 (mean age, 33.04 ± 9.81 years) were in the CCVD group. METHODS: The following tests were used: the Ishihara pseudo-isochromatic plate test for detecting CCVD, the Farnsworth Munsell 100 (FM100) hue test for colour discrimination ability, the TNO and Titmus stereo tests for stereoscopic acuity. RESULTS: In the CCVD group, 20 males were deutan and 7 males were protan. According to the FM100 hue test, total error score (TES), blue/yellow (b/y) local error score (LES), and red/green LES were significantly lower in the healthy group (30.23 ± 18.78, 15.15 ± 10.38, and 13.88 ± 11.93, respectively) than in the CCVD group (133.59 ± 67.45, 41.15 ± 22.03, and 89.15 ± 52.16, respectively) (p < 0.01 for each). The stereo test scores revealed significantly higher stereoscopic acuity in the healthy group (43.85 ± 33.92 arcsec for the TNO test and 40.00 ± 0.00 arcsec for the Titmus test) than in the CCVD group (93.33 ± 90.51 arcsec for TNO stereo test and 52.96 ± 24.62 arcsec for the Titmus test) (p < 0.05 for each). The TNO test score was significantly and positively correlated with the TES (r = 0.390, p = 0.049) and b/y LES (r = 0.490, p = 0.011) in the healthy group. CONCLUSIONS: Colour discrimination ability affected stereoscopic acuity. Moreover, stereoscopic acuity increased with increasing colour discrimination ability, which could be originated from the b/y colour region.

Is age-related macular degeneration a local manifestation of systemic disorder? Changes in nailfold capillaries at age-related macular degeneration.

AIMS: Determining whether nailfold capillary involvement is present in patients with Age-related macular degeneration (AMD) and whether there are different nailfold capillaroscopy findings between wet and dry types. METHODS: From January 2016 to December 2017, with an initial diagnosis of AMD, 53 consecutive adult patients (AMD group) and 91 age- and sex-matched healthy individuals were studied prospectively. There was no history of any other ocular disease and other disease affecting nailfold capillaries. All subjects underwent a complete ophthalmic examination. The classified and advanced stages of wet and dry types were not included. All nailfold capillaroscopy examinations were performed by the same rheumatologist. RESULTS: It was found that the frequency of major capillaroscopic findings such as capillary ectasia, micro-hemorrhage, tortuosity, neo-formation, bizarre capillary, and bushy capillaries increased in the AMD group according to the normal group, but no significant relationship was found for capillary aneurysm. In dry or wet type of AMD in terms of ectasia, micro-hemorrhage, tortuosity, neo-formation, bizarre structure, bushy structure, or aneurism of nailfold capillaries, no significant correlation was found. CONCLUSIONS: Nailfold capillaroscopy can detect microvascular changes in the nailfold capillary, in early and late stages of AMD. There were morphological changes in the nailfold capillaries of AMD patients, suggesting that there are systemic superficial microvascular changes that may be due to the systemic nature of the disease.

Optical coherence tomography angiography findings in malignant hypertensive retinopathy / Achados da angiografia por tomografia de coerência óptica na retinopatia hipertensiva maligna

ABSTRACT A 33-year-old male presented to our clinic with low vision in both eyes that started during the previous week. Visual acuity was 20/63 in the right eye and 20/50 in the left eye. Fundus examination revealed signs of hypertensive retinopathy; thus, a multidisciplinary approach was adopted for the diagnosis and treatment of this patient. We consulted the nephrology and cardiology departments on this case. Upon diagnosing malignant hypertension and renal failure, the patient was put on hemodialysis. His visual acuity was 20/20 at 6 months, whereas foveal assessment on optical coherence tomography angiography revealed neither marked superficial and deep capillary density loss and foveal avascular zone enlargement nor a decrease in disc flow and radial peripapillary capillary density. Early diagnosis and treatment of malignant hypertension are critical in preventing progression of end-organ damage including the eyes. Optical coherence tomography angiography may be useful in cases when fundus fluorescein angiography is relatively contraindicated (e.g., renal failure).

RESUMO Um homem de 33 anos apresentou-se à nossa clínica com baixa visão em ambos os olhos que começou uma semana antes. A acuidade visual foi de 20/63 no olho direito e 20/50 no olho esquerdo. O exame de fundo de olho revelou sinais de retinopatia hipertensiva; então, adotou-se uma abordagem multidisciplinar para o diagnóstico e tratamento desse paciente. Consultamos os departamentos de nefrologia e cardiologia neste caso. Ao diagnosticar hipertensão maligna e insuficiência renal, o paciente foi colocado em hemodiálise. Sua acuidade visual era 20/20 aos 6 meses, enquanto a avaliação foveal com angiotomografia de coerência óptica não revelou perda de densidade capilar superficial e profunda acentuada e aumento da zona avascular foveal nem uma diminuição no fluxo de disco e na densidade capilar peripapilar radial. O diagnóstico precoce e o tratamento da hipertensão maligna são fundamentais na preveção da progressão de danos nos órgãos-alvo, incluindo os olhos. A Angiografia por tomografia de coerência óptica pode ser útil nos casos em que a angiografia com fluoresceína do fundo de olho é relativamente contraindicada (por exemplo, insuficiência renal).

Optical coherence tomography angiography findings in malignant hypertensive retinopathy.

A 33-year-old male presented to our clinic with low vision in both eyes that started during the previous week. Visual acuity was 20/63 in the right eye and 20/50 in the left eye. Fundus examination revealed signs of hypertensive retinopathy; thus, a multidisciplinary approach was adopted for the diagnosis and treatment of this patient. We consulted the nephrology and cardiology departments on this case. Upon diagnosing malignant hypertension and renal failure, the patient was put on hemodialysis. His visual acuity was 20/20 at 6 months, whereas foveal assessment on optical coherence tomography angiography revealed neither marked superficial and deep capillary density loss and foveal avascular zone enlargement nor a decrease in disc flow and radial peripapillary capillary density. Early diagnosis and treatment of malignant hypertension are critical in preventing progression of end-organ damage including the eyes. Optical coherence tomography angiography may be useful in cases when fundus fluorescein angiography is relatively contraindicated (e.g., renal failure).

The relation between scapula fracture and the severity of trauma in blunt thoracic trauma

Background/aim: The aim of this study was to determine the level of presence of scapula fractures (SFs) in cases of blunt thoracic trauma and to identify other injuries accompanying SF. Materials and methods: Blunt thoracic trauma cases with SF determined on direct radiography or computerized tomography (CT) were categorized as Group 1. Group 2 was constituted by selecting cases with high injury severity score (ISS) with no SF. The demographic characteristics and all injuries of the patients were evaluated. Results: SF was determined in 77 (11.3%) patients (Group 1), and Group 2 consisted of 607 patients. The ISS was significantly higher in Group 1 (27.7 ± 16.1) than Group 2 (15.9 ± 9.5) (P < 0.001). The rate of SF with direct radiography was only 9.1%, and more than 90% of patients were evaluated using CT. The most common accompanying injury to SF was rib fracture (44.2%), and the odds ratio was 2.4 (95% CI: 1.51­3.72). Conclusion: The incidence of SF in cases of blunt trauma was higher than in previous studies. The use of CT in blunt trauma can determine SF that cannot be identified through physical examination or radiography, and the most commonly observed accompanying damage in these patients is rib fracture.

The effect of different types of honey on healing infected wounds.

OBJECTIVE:: To investigate the effects of treatments of 'mad honey', blossom honey and nitrofurazone on infected wound healing. METHOD:: Male albino Wistar rats were randomly divided into four groups: 'mad honey' (MH), blossom honey (BH), nitrofurazone (N) and control (C). All rats were anaesthetised intraperitoneally. A circular skin incision was made to the back regions. Grafts containing slime-producing Staphylococcus epidermidis were placed on the incision area and then sutured to the skin. Infection in the wound area was confirmed after 48 hours. Wounds were dressed twice daily with the various treatment materials. Rats were randomly euthanised on days 7 or 14, and tissue samples taken. Tissue samples were assessed for hydroxyproline (HP), tensile strength (TS) and macroscopic measurement (area and intensity). RESULTS:: HP levels were higher in the treatment groups (MH, BH, N) at days 7 and 14 compared with the control group. 'Group x day' interaction was found in the HP levels (p=0.015). Increases in HP levels in the MH and N groups between days 7 and 14 were significantly higher than those in the other groups (p<0.05). Intensity was significantly lower in the control group and significantly higher in group MH compared with the other groups. Significant 'group x day' interaction was observed in intensity (p=0.006). TS was significantly lower on day 7 than on day 14 (p=0.022). No marked difference was observed between the groups, nor any 'group x day' interaction, in terms of TS. CONCLUSION:: Honey administration successfully healed infected wounds. However, there was no significant difference between the effect of MH and that of N in terms of wound healing.

Effect of hypothermia on apoptosis in traumatic brain injury and hemorrhagic shock model.

INTRODUCTION: The neuroprotective mechanisms of therapeutic hypothermia against trauma-related injury have not been fully understood yet. In this study, we aimed to investigate the effects of therapeutic hypothermia on biochemical and histopathological markers of apoptosis using Traumatic brain injury (TBI) and hemorrhagic shock (HS) model. METHODS: A total of 50 male albino-wistar rats were divided into five groups: Group isolated TBI, Group NT (HT+HS+normothermia), Group MH (HT+HS+mild hypothermia), Group MoH (HT+HS+moderate hypothermia) and Group C (control). Neurological deficit scores were assessed at baseline and at 24h. The rats were, then, sacrificed to collect serum and brain tissue samples. Levels of Caspase-3,6,8, proteoglycan-4 (PG-4), malondialdehyde (MDA), and nitric oxide (NO) were measured in serum and brain tissue samples. Histopathological examination was performed in brain tissue. RESULTS: There were significant differences in the serum levels of Caspase-3 between Group NT and Group C (p=0.018). The serum levels of Caspase-6 in Group NT (0.70±0.58) were lower than Group MH (1.39±0.28), although the difference was not statistically significant (p=0.068). There were significant differences in the brain tissue samples for Caspase-3 levels between Group NT and Group C (p=0.049). A significant difference in the Caspase-8 brain tissue levels was also observed between Group NT and Group C (p=0.022). Group NT had significantly higher scores of all the pathological variables (for edema p<0.017; for gliosis p<0.001; for congestion p<0.003, for hemorrhage p<0.011) than Group C. CONCLUSION: Our study results suggest that hypothermia may exert its neuroprotective effects by reducing markers of apoptotic pathway, particularly Caspase-3 on TBI and HS.

The Frequency of Primary Sjogren's Syndrome and Fibromyalgia in Irritable Bowel Syndrome.

OBJECTIVE: To determine the frequency of sicca complex, Sjogren's Syndrome (SS) and Fibromyalgia (FM) in patients with Irritable Bowel Syndrome (IBS). METHODS: Seventy seven IBS patients who fulfilled the Rome-III criteria were included in the study. All patients were assessed for FM according to the American College of Rheumatology (ACR) 2010 criteria. After examination for objective evidence of sicca complex by Schirmer test, TBUT and Ocular Staining Score (OSS), serological tests were performed. And the diagnosis of SS was made according to the American College of Rheumatology (ACR) classification criteria for SS - 2012. RESULTS: Thirteen (16.9%) of IBS patients had FM. Dry eye was detected in 20(26.0%), 7(9.1%) and 29(37.7%) patients by OSS, Schirmer test and TBUT, respectively. Of 77 patients with IBS, the diagnosis of SS was established in two patients (2.6%). CONCLUSION: The frequency of Sjogren's Syndrome among patients with IBS is relatively higher than the general population. All IBS patients should be questioned for dryness of the mouth and eyes, and if necessary, should be evaluated for SS.

Primary Sjögren's syndrome in patients with celiac disease.

BACKGROUND/AIM: Many autoimmune diseases occur concomitantly with celiac disease (CD). We aimed to determine the frequency of Sjögren's syndrome (SS) in CD patients based on SS-specific serology verified by minor labial salivary biopsy. MATERIALS AND METHODS: Eight-two patients with CD were included in the study. After examination for objective evidence of sicca complex, all patients were tested for serological presence of rheumatoid factor (RF) and antinuclear antibodies (ANAs) and for ANA profile. Minor labial salivary biopsy was performed for patients with positive serology and/or clinical signs of SS. RESULTS: Of the patients included, 24 (29.3%) had dry eye symptoms while 20 (24.4%) had dry mouth symptoms. Dry eye was detected by Schirmer test in 10 patients (12.2%) and by ocular staining score in only 2 patients (2.4%). All samples were negative for RF while 12 (14.6%) samples were positive for ANAs. Of 82 patients with CD, the diagnosis of SS was established in only one patient (1.2%), while one patient (1.2%) was diagnosed with morphea and 4 patients (4.9%) were classified as having undifferentiated connective tissue disease. CONCLUSION: The prevalence of SS in CD is low, so there is no need for serologic screening of all patients with CD for SS.

Carbon monoxide poisoning cases presenting with non-specific symptoms.

Carbon monoxide (CO) is a colourless and odourless gas appearing as a result of incomplete combustion of carbon-containing fuels. Many domestic or occupational poisonings are caused by CO exposure. Malfunctioning heating systems, improperly ventilated motor vehicles, generators, grills, stoves and residential fires may be listed in the common sources of CO exposure. The aim of this study was to emphasize the significance of early diagnosis of CO poisoning with non-invasive measurement of CO levels of the patients with non-specific symptoms using a pulse oximeter device in the triage. Our study was a cross-sectional study. Patients who presented to the emergency department (ED) due to non-specific symptoms and had a Canadian Triage and Acuity scale level of 4 or 5 were included in the study; 106 (5.9%) of 1788 patients admitted during the study period were diagnosed with CO poisoning. Patients with CO poisoning and the other patients had statistically significant differences in terms of presenting symptoms, namely, headache, dizziness, nausea, and vomiting. More CO poisoning cases were admitted in the fall and winter compared to the spring and summer. The number of CO poisoning victims can be decreased if preventive measures like CO monitoring systems and well-designed ventilation systems are generalized at homes and workplaces. Measurement of carboxyhaemoglobin levels of patients presenting to ED due to non-specific symptoms like headache and dizziness during cold seasons and winter months using a pulse CO-oximeter should be a part of the routine of emergency medicine triage.

Effect of exposure to violence on the development of burnoutsyndrome in ambulance staff.

BACKGROUND/AIM: The aim of this study is to determine the condition of ambulance staff (AS) who have been exposed to any kind of violence and to predict risk of development of burnout syndrome. MATERIALS AND METHODS: Our study was performed with 120 AS working for the Kirikkale Ambulance Services. During the research, questionnaires collecting descriptive information and the extent of violence to which the AS were exposed were administered; participants were asked to fill out the questionnaire themselves. RESULTS: It was found that 81 (67.5%) participants had been subjected to at least one type of violence (verbal or physical). Sixty-two percent were exposed to verbal abuse and 55.8% to verbal threats. Rates of physical threats and attacks were higher among male staff (P = 0.036, P = 0.022), while the rate of personal accomplishment was determined to be significantly lower in males (P = 0.006). Emotional exhaustion and depersonalization scores were determined to be significantly higher in those who perceived less support from administrators (P = 0.014, P = 0.032). CONCLUSION: All kinds of negative situations exhaust an individual physically and mentally and lead to the development of burnout syndrome. AS are more prone to these kinds of situations.

Cognitive performance of primary open-angle glaucoma and normal-tension glaucoma patients.

PURPOSE: To assess cognitive performance differences among primary open-angle glaucoma (POAG) patients, normal-tension glaucoma (NTG) patients, and healthy control (C) subjects. METHODS: A total of 60 participants (20 POAG, 20 NTG, and 20 C subjects) were included in this study. A detailed ophthalmologic examination was performed on all participants. A spectral domain-optical coherence tomography (SD-OCT) system was used to measure the ganglion cell-inner plexiform layer (GC-IPL) and retinal nerve fiber layer (RNFL) thicknesses. To assess the cognitive performance of all participants, detailed neurological examinations, including the mini-mental state examination (MMSE), were performed by the same neurologist. RESULTS: There were no significant differences among the groups in terms of age (p =0.348) or gender (p =0.935). The mean RNFL thicknesses were significantly different among the groups (85.2 ± 14.7, 76.8 ± 10.3, and 91.4 ± 7.7 µm in the POAG, NTG, and C subjects, respectively; p <0.001). The mean GC-IPL thicknesses were 77.5 ± 9.7 µm in the POAG group, 73.4 ± 7.8 µm in the NTG group, and 78.8 ± 3.8 µm in the C group. Differences among the groups were not statistically significant (p =0.085). MMSE scores were 26.1 ± 1.4, 25.7 ± 2.3, and 28.8 ± 0.9 in the POAG, NTG, and C groups, respectively. There were significant differences among the three groups (p <0.001). Specifically, there were significant differences between the NTG and C groups (p <0.001), and between the POAG and C groups (p =0.001). There was no significant difference between the POAG and NTG groups (p =0.595). CONCLUSIONS: There appear to be similar risk factors in glaucoma and neurodegenerative disorders that cause deterioration in cognitive performance. Comparing the low MMSE scores of the POAG and NTG patients with the scores of healthy C participants supports our hypothesis. Consequently, it is recommended that a neurologist should also examine glaucoma patients.

Cognitive performance of primary open-angle glaucoma and normal-tension glaucoma patients / Desempenho cognitivo em pacientes com glaucoma primário de ângulo aberto e glaucoma de pressão normal

ABSTRACT Purpose: To assess cognitive performance differences among primary open-angle glaucoma (POAG) patients, normal-tension glaucoma (NTG) patients, and healthy control (C) subjects. Methods: A total of 60 participants (20 POAG, 20 NTG, and 20 C subjects) were included in this study. A detailed ophthalmologic examination was performed on all participants. A spectral domain-optical coherence tomography (SD-OCT) system was used to measure the ganglion cell-inner plexiform layer (GC-IPL) and retinal nerve fiber layer (RNFL) thicknesses. To assess the cognitive performance of all participants, detailed neurological examinations, including the mini-mental state examination (MMSE), were performed by the same neurologist. Results: There were no significant differences among the groups in terms of age (p =0.348) or gender (p =0.935). The mean RNFL thicknesses were significantly different among the groups (85.2 ± 14.7, 76.8 ± 10.3, and 91.4 ± 7.7 µm in the POAG, NTG, and C subjects, respectively; p <0.001). The mean GC-IPL thicknesses were 77.5 ± 9.7 µm in the POAG group, 73.4 ± 7.8 µm in the NTG group, and 78.8 ± 3.8 µm in the C group. Differences among the groups were not statistically significant (p =0.085). MMSE scores were 26.1 ± 1.4, 25.7 ± 2.3, and 28.8 ± 0.9 in the POAG, NTG, and C groups, respectively. There were significant differences among the three groups (p <0.001). Specifically, there were significant differences between the NTG and C groups (p <0.001), and between the POAG and C groups (p =0.001). There was no significant difference between the POAG and NTG groups (p =0.595). Conclusions: There appear to be similar risk factors in glaucoma and neurodegenerative disorders that cause deterioration in cognitive performance. Comparing the low MMSE scores of the POAG and NTG patients with the scores of healthy C participants supports our hypothesis. Consequently, it is recommended that a neurologist should also examine glaucoma patients.

RESUMO Objetivos: Avaliar as diferenças de desempenho cognitivo entre pacientes com glaucoma primário de ângulo aberto (POAG), glaucoma de pressão normal (NTG) e controle de indivíduos saudáveis (C). Métodos: Um total de 60 pessoas (20 POAG, 20 NTG e 20 indivíduos saudáveis) foram incluídos neste estudo. Um exame oftalmológico detalhado foi realizado em todos os participantes. Um sistema de tomografia de coerência óptica de domínio espectral (SD-OCT) foi utilizado para medir as espessuras da camada de células ganglionares plexiforme interna (GC-IPL) e da camada de fibras nervosas da retina (RNFL). Para avaliar o desempenho cognitivo de todos os participantes, foi realizado pelo mesmo neurologista um exame neurológico detalhado, incluindo mini-exame do estado mental (MMSE). Resultados: Não houve diferenças significativas entre os grupos em termos de idade (p=0,348) e sexo (p=0,935). Espessuras médias da RNFL foram significativamente diferentes, sendo 85,2 ± 14,7, 76,8 ± 10,3 e 91,4 ± 7,7 µm nos grupos POAG, NTG e controles, respectivamente (p<0,001). As espessuras médias da GC-IPL observadas foram 77.5 ± 9.7 μm no grupo POAG, 73,4 ± 7,8 µm no grupo NTG e 78,8 ± 3,8 µm nos controlos. As diferenças entre os grupos não foram estatisticamente significantes (p=0,085). Graduações do MMSE foram 26,1 ± 1,4, 25,7 ± 2,3 e 28,8 ± 0,9 nos grupos POAG, NTG e controles, respectivamente. Houve diferenças significativas entre os três grupos (p<0,001). Houve diferença significativa entre NTG e saudáveis (p<0,001). Houve diferença significativa entre POAG e saudáveis (p=0,001). Não houve diferença significativa entre o POAG e NTG (p=0,595). Conclusões: Parecem haver fatores de risco semelhantes no glaucoma e nos distúrbios neurodegenerativos que causam deterioração no desempenho cognitivo. Comparando a baixa graduação do MMSE de pacientes com POAG e NTG com controles saudáveis referenda nossa hipótese. Consequentemente recomenda-se que um neurologista também examine os pacientes de glaucoma.

Higher serum lipids and oxidative stress in patients with normal tension glaucoma, but not pseudoexfoliative glaucoma.

This study entailed a cross-examination of oxidant/antioxidant balance, high-density lipoprotein (HDL)-linked paraoxonase 1 (PON1) phenotypes, and levels of serum routine lipids among patients with normal tension glaucoma (NTG) or pseudoexfoliative glaucoma (PEXG) compared with healthy control groups. We aimed to investigate the links between oxidative stress (OS), HDL-related antioxidant enzyme activities and dyslipidemia in distinct subtypes of glaucoma. The study included 32 patients with NTG, 31 patients with PEXG, and 40 control subjects. Levels of PON1 and arylesterase enzymatic activity, total oxidant status (TOS), and total antioxidant status were measured by spectrophotometry and OS indexes (OSI) were calculated. The phenotype distribution of PON1 was determined using the dual substrate method. Blood serum levels of HDL, low-density lipoprotein, total cholesterol (TC), and triglyceride (TG) were measured. The TOS and OSI values in the NTG group were significantly higher compared with the other groups (both p < 0.01). The phenotype distribution found in the glaucoma and control groups were NTG: QQ, 59.4%; QR, 37.5%; RR, 3.1%; PEXG: QQ, 45.1%; QR, 48.4%; RR, 6.5%; and in the control group: QQ, 42.5%; QR, 50.0%; RR, 7.5%. Serum TC levels were significantly higher than the control in both NTG and PEXG groups, whereas TG was significantly higher in NTG only (p < 0.01 and p < 0.02, respectively). Hyperlipidemia, OS and variations in phenotype distribution of PON1 may play a role in the pathogenesis of different types of glaucoma.

CHOROIDAL THICKNESS IN INFANTS WITH RETINOPATHY OF PREMATURITY.

PURPOSE: To evaluate choroidal thickness in premature infants and its relationship with stage of retinopathy of prematurity (ROP) using spectral domain optical coherence tomography (SD-OCT). METHODS: Spectral domain optical coherence tomography imaging for measuring subfoveal choroidal thickness was performed for 80 premature infants. Subfoveal choroidal thickness was defined as the distance from the hyperreflective line of the outermost retinal pigment epithelium (RPE) to the innermost hyperreflective line of the choroidoscleral junction. Each measurement was performed at the central fovea (CF) and 0.75 mm to 1.5 mm nasal (N1 and N2) and temporal (T1 and T2) to the fovea. Subfoveal choroidal thickness and grading of cystoid macular edema (CME) were analyzed statistically. RESULTS: Choroidal thickness of CF was found to be significantly greater than nasal (N1 and N2) and temporal (T1 and T2) choroidal thickness (P < 0.05). There was no significant relationship between stage of ROP and nasal (N1 and N2) choroidal thickness (P = 0.057, P = 0.282, respectively). However, CF and temporal (T1 and T2) choroidal thickness was found to be significantly lower at a higher stage of ROP (P = 0.005, P = 0.01 and P = 0.001). No significant relationship was found between subfoveal choroidal thickness and the grades of cystoid macular edema (P > 0.05). The choroidal thickness of CF was found to be correlated with birth weight (r = 0.267, P = 0.017) but not birth week (r = 0.140, P = 0.217). Maximum stage of ROP was found to be negatively correlated with choroidal thickness, at N1, T1, and T2 (r < -0.250, P < 0.02). CONCLUSION: The subfoveal choroid in premature infants can be effectively evaluated using a portable SD-OCT device. Choroidal thickness gets thinner with the severity of ROP and the decrease is more prominent at the central and temporal location. Cystoid macular edema is not correlated with choroidal thickness in premature infants.