Visual rehabilitation indicating neuroplasticity in an esotropic adult patient with diplopia after sudden visual acuity loss in the non-amblyopic eye: A case report.

BACKGROUND: The aim of this case report is to present the successful management of both diplopia and amblyopia in a specific clinical situation, demonstrating neuroplasticity of the visual system in an adult patient. Causes of diplopia include eye pathologies in monocular diplopia and ischemic ocular motor nerve palsies, sudden life-threatening and chronic conditions in central nervous system in binocular diplopia. Strabismic amblyopia and nonarteritic anterior ischemic optic neuropathy are quite often ophthalmic conditions, first one is caused by suppression during developmental period and the latter one by ischemia of the optic nerve in adults. Coexistence of aforementioned conditions may cause unusual clinical situation in which ability of nervous system to functional reorganization could be demonstrated. CASE PRESENTATION: In our adult patient, diplopia was incited by the loss of suppression of the strabismic amblyopic eye, which was the consequence of a sudden decrease of the visual acuity in the previously better eye in the course of nonarteritic anterior ischemic optic neuropathy. This led to impairment in daily activities. RESULTS: Visual training rehabilitation improved distance and near visual acuity in the amblyopic eye over three months, and prescribing two pairs of glasses with prisms enabled the patient to return to daily activities. CONCLUSION: The discussed patient lost the suppression of the strabismic amblyopic eye. Management of amblyopia is usually undertaken in children, however considering neuroplasticity we successfully attempted to improve visual functioning of our patient, despite lower intensity of neuroplasticity functions in an adult brain.

Lipid-lowering pharmacotherapy in Central and Eastern European countries in cardiovascular prevention: self-reported prescription patterns of primary care physicians.

AIMS: The aims of this study were (1) to explore physicians' self-reported treatment of patients with dyslipidemia and (2) to identify intercountry differences and associations between physicians' characteristics and treatment patterns. METHODS: A cross-sectional survey was performed in primary health care in 9 Central and Eastern European countries. An anonymous questionnaire, which included questions devoted to dyslipidemia treatment, was distributed. RESULTS: A total of 3000 physicians were randomly chosen and 867 responded. The mean percentage of physicians in all countries who reported regular use of statins in primary prevention of cardiovascular diseases (CVD) was 86.4 (range between 91.0% of Polish physicians and 75.7% of Czech physicians; P < .01). In secondary prevention, the mean percentage was only a little higher, 89.9. The use of fibrates for primary prevention was reported by 40.3% of the respondents from Bulgaria and by 2% of the respondents from Estonia (P < .01). Also, significant differences between countries were found in the use of fibrates and combination therapy in secondary prevention. Atorvastatin and simvastatin were the most prescribed drugs in everyday practice (the mean percentage of physicians in all countries was 72.5% and 68.0%, respectively). More than three-fourth of the respondents reported prescribing lifelong treatment with statins. Inconsistent associations were found between the characteristics of physicians and their treatment patterns. CONCLUSIONS: There are significant variations in the use of lipid-lowering drugs in Central and Eastern European countries; however, statin monotherapy predominates. Some physicians' decisions are made without supporting evidence from clinical trials. There is still scope to improve preventive care of CVD.

An evaluation of family physicians' educational needs and experiences in health promotion and disease prevention in Poland and Lithuania--a qualitative study.

BACKGROUND: The aim of this study is to explore the views of family physicians/general practitioners about the most important competences in health promotion and diseases prevention and areas where these competences might be below the desired level. METHODS: A qualitative, descriptive study, combining two data collection techniques, was conducted in two Eastern European countries in June and July 2009. Focus groups numbering 10 and 9 physicians, respectively, practising in various clinical settings, were held in Poland and Lithuania. Seven well-informed health care experts were recruited in both countries to provide information during the in-depth interviews. In both formats, questions were devoted to three main areas of health promotion and disease prevention competences: (1) educational, (2) clinical, (3) organisational. A qualitative content analysis was performed. RESULTS: Lithuanian and Polish family physicians/general practitioners view preventive care as one of their main responsibilities. Among 3 areas of competences, participants identified clinical competences as the most important in everyday practice. They also acknowledged that organisational and educational competences might be below the level required for effective preventive care. Only clinical competences were indicated as sufficiently developed during under- and post-graduate medical education. CONCLUSIONS: In addressing current health promotion and disease prevention challenges, teachers of family medicine need to critically consider the training that currently exists for physicians. Development of a high-quality preventive service is not only a matter of proper education in the clinical field but also requires training in practice organisation and patient education.