[Technical Options of Documentation of the Anterior Segment and the eye Fundus Findings within Mission]. / Technické moznosti vysetrenia a dokumentácie nálezov predného a zadného segmentu oka v rámci humanitárnych projektov.

Documentation of the anterior segment and the eye fundus with instruments that enable quality precision diagnostics is a common and important part of screening in humanitarian ophthalmology projects. It is the essential element in diagnosis, monitoring and management of eye diseases. In sub saharan countries within the screening for ophthalmologist are not available the modern technologies such as biomicroscope (slit lamp) or fundus camera. We describe our experience with photographs of anterior segment of the eye by using digital camera and Smartphone. The documentation of the eye fundus was recorded through 20D Volk spherical lens to Smartphone. MATERIAL AND METHODS: Within the screening projects in collaboration with St. Elisabeth University of Health and Social Sciences for eye diseases in the year 2014 in Bigugu, Rwanda and in 2015 in Mapuordit, South Sudan, we examined patients who were unable to reach ophthalmologic care. We used a flashlight, a direct ophthalmoscope, tables to determine visual acuity on illiterate, Schiøtz tonometer, Volk lens, Smartphone. Patients who underwent screening, and needed glasses, got from humanitarian collection already used dioptric eyeglasses or sunglasses. For documentation of the anterior segment we used a digital camera and for patients in whom it was necessary to document fundus findings detected by direct ophthalmoscopy we took the opportunity of Smartphone with 8 Mpix camera and the LED flash and Volk lens plus 20 Diopters. RESULTS: In 2014 within the project in Bigugu, Rwanda and in 2015 in Mapuordit, South Sudan, we examined patients in an improvised clinic without access to electricity.We examined in 2014 a total of 340 patients and in 2015 a total of 290 patients. Patient age was due to the unavailability of designated identification records estimated with the help of an interpreter. In both groups, the mean age of the patients was about 30 years. The most common diseases leading to blindness were cataract, trachoma, post-traumatic conditions. Infectious diseases and consequences of untreated infectious diseases were the cause of 20% of the permanent changes on the surface of the eye or the adnexa. In the group of HIV positive patients we did not mention pathological findings on the eye fundus. CONCLUSION: Anterior segment findings documentation with digital camera or mobile phone and fundus examination using a Smartphone and Volks lens with a value of plus 20D is inexpensive and manageable technique which can capture high quality and reproducible images. These techniques are suitable for photo documentation of anterior segment and also eye fundus screening within humanitarian projects of eye diseases in developing countries. KEY WORDS: anterior segment examination, eye fundus examination, Smartphone, digital camera, humanitarian screening projects of eye diseases.

An embryological point of view on associated congenital anomalies of children with Hirschsprung disease.

The most common congenital gut motility disorder is the Hirschsprung disease (HSCR). This anomaly is characterized by absence of neural crest-derived enteric neuronal ganglia. The aim of our study was to analyze the relationship between HSCR and other congenital anomalies or malfunctions. We examined 130 patients with Hirschsprung disease from Slovakia for last 10 years. During patients examination we focused not only on morphological abnormalities, but also functional anomalies. The incidence of associated congenital anomalies in our patients with HSCR was 26.1 %. But if we add functional defects (hypothyroidism, malfunction in cellular immunity, neurological deficit) to the morphological congenital abnormalities, the rate of the patients with HSCR with additional defects achieves 50.1 %. Nine of our patients (6.9 %) had syndromic HSCR. The most frequent disorder (13.6 % of patients) was primary deficiency in cellular immunity. More than 12.3 % of patients with HSCR had genitourinary abnormalities, in 10.0 % of patients variable degree of psychomotor retardation was observed, and skeletal, muscle and limb anomalies involved 7.7 % of patients. In 7.6 % cases of patients we found congenital hypothyroidism (including 2 cases of agenesis of thyroid gland). More than 6.1 % of patients presented with an associated anomaly in gastrointestinal tract (mostly anorectal malformations). Up to 5.5 % patients had congenital anomaly of heart, 3.8 % had ophthalmic and 3.1 % had craniofacial anomalies. Down syndrome was the main diagnosis in 3.8 % patients. We discussed  the relationship between HSCR and other anomalies, which are probably caused by abnormal migration, proliferation, or differentiation, of neural crest cells during embryogenesis (Tab. 1, Fig. 2, Ref. 75).

Synthesis of (19E)-3 beta,7 alpha-dihydroxy-17-oxoandrost-5-en-19-al 19-(O-carboxymethyl)oxime, a new hapten for 7 alpha-hydroxydehydroepiandrosterone (3 beta,7 alpha-dihydroxyandrost-5-en-17-one).

The title compound was prepared in 11 steps from 17,17-ethylenedioxy-19-hydroxyandrost-5-en-3 beta-yl acetate. After tert-butyldimethylsilyl protection of the 19-hydroxyl group, a 7-oxo group was introduced by oxidation with 3,5-dimethylpyrazole-chromium trioxide complex, and then selectively reduced with L-Selectride to give a 7 alpha-hydroxy derivative. This partially protected triol was acetylated and desilylated to 3,7-diacetate. Subsequent oxidation with pyridine-chromium trioxide complex gave 19-aldehyde, which was transformed into the corresponding protected 19-(O-carboxymethyl)oxime. Successive ketal cleavage, deacetylation, and methyl ester splitting gave the final (19E)-3 beta,7 alpha-dihydroxy-17-oxoandrost-5-en-19-al 19-(O-carboxymethyl)oxime, designed as a hapten for 7 alpha-hydroxydehydroepiandrosterone immunoassays.