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INTRODUCTION: To ascertain differences in intraocular pressure (IOP) measurement and their repeatability between dynamic contour tonometry (DCT) and Goldmann/Perkins applanation tonometry (GAT) at two different atmospheric pressures. MATERIALS AND METHODS: Forty-one eyes of 41 healthy consenting subjects were enrolled for this observational, cross-sectional study. Pachymetry and IOP measurements with DCT and GAT for both eyes of each subject at Acapulco (0 m from sea level) and at Mexico City (2,234 m from sea level) were done by the same observer. The IOP was compared between tonometers at each of the altitudes, and also for repeatability of each tonometer at different altitudes. Pearson's correlation coefficient and Bland-Altman plots were used to assess reliability of measurements and their differences at the two altitudes. RESULTS: The mean age of patients was 41.7 (28-66 years); 22 were females. Mean IOP with DCT was 16.1 ± 2.2 mm Hg at sea level and 15.9 ± 2.1 mm Hg at 2,234 m above sea level, not a significant difference. Mean GAT IOP at the two altitudes was 13.1 ± 1.8 and 11.5 ± 1.7 mm Hg respectively, a statistically sig -nificant difference. In contrast, central corneal thickness (CCT) was not significantly changed (548.3 to 549.4 µm, p = 0.496). CONCLUSION: Repeatability of single-observer measurements with GAT remains clinically acceptable, but not at different altitudes. The DCT seems to more consistently measure a similar IOP at different altitudes in the same subjects. The two tonometers may not be used interchangeably in the serial follow-up of patients at any of the altitudes.How to cite this article: Albis-Donado O, Bhartiya S, Gil-Reyes M, Casale-Vargas G, Arreguin-Rebollar N, Kahook MY. Citius, Altius, Fortius: Agreement between Perkins and Dynamic Contour Tonometry (Pascal) and the Impact of Altitude. J Curr Glaucoma Pract 2018;12(1):40-44.

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Over the last 20 years, many reports have described an excess of cases of chronic kidney disease (CKD) in the Pacific coastal area of Central America, mainly affecting male farmworkers and signaling a serious public health problem. Most of these cases are not associated with traditional risk factors for CKD, such as aging, diabetes mellitus, and hypertension. This CKD of nontraditional causes (CKDnT) might be linked to environmental and/or occupational exposure or working conditions, limited access to health services, and poverty. In response to a resolution approved by the Directing Council of the Pan American Health Organization (PAHO) in 2013, PAHO, the U.S. Centers for Disease Control and Prevention, and the Latin American Society of Nephrology and Hypertension (SLANH) organized a consultation process in order to expand knowledge on the epidemic of CKDnT and to develop appropriate surveillance instruments. The Clinical Working Group from SLANH was put in charge of finding a consensus definition of a confirmed clinical case of CKDnT. The resulting definition establishes mandatory criteria and exclusion criteria necessary for classifying a case of CKDnT. The definition includes a combination of universally accepted definitions of CKD and the main clinical manifestations of CKDnT. Based on the best available evidence, the Clinical Working Group also formulated general recommendations about clinical management that apply to any patient with CKDnT. Adhering to the definition of a confirmed clinical case of CKDnT and implementing it appropriately is expected to be a powerful instrument for understanding the prevalence of the epidemic, evaluating the results of interventions, and promoting appropriate advocacy and planning efforts

En los 20 últimos años, en muchos informes se ha descrito un número inusual de casos de enfermedad renal crónica (ERC) en la costa del Pacífico de Centroamérica, que afecta principalmente a trabajadores agrícolas varones y señala un grave problema de salud pública. La mayoría de estos casos no se asocia con los factores de riesgo tradicionales de ERC, como envejecimiento, diabetes mellitus e hipertensión. Esta ERC de causas no tradicionales (ERCnT) podría estar vinculada con la exposición laboral o ambiental o las condiciones de trabajo, el escaso acceso a los servicios de salud y la pobreza. En respuesta a una resolución aprobada por el Consejo Directivo de la Organización Panamericana de la Salud (OPS) en el 2013, la OPS, los Centros para el Control y la Prevención de Enfermedades de los Estados Unidos y la Sociedad Latinoamericana de Nefrología e Hipertensión (SLANH) organizaron un proceso de consulta para ampliar los conocimientos sobre la epidemia de ERCnT y elaborar instrumentos apropiados para la vigilancia. El Grupo Clínico de Trabajo de la SLANH tuvo la responsabilidad de consensuar una definición de caso clínico confirmado de ERCnT. En la definición resultante se establecen criterios obligatorios y criterios de exclusión necesarios para clasificar un caso como de ERCnT. La definición incluye una combinación de definiciones de ERC universalmente aceptadas y las principales manifestaciones clínicas de ERCnT. Sobre la base de los mejores datos científicos disponibles, el Grupo Clínico de Trabajo también formuló recomendaciones generales acerca del manejo clínico, que se aplican a cualquier paciente con ERCnT. Se espera que la adopción de la definición de caso confirmado de ERCnT y su aplicación adecuada sean una herramienta poderosa para conocer la prevalencia de la epidemia, evaluar los resultados de las intervenciones y promover acciones apropiadas de sensibilización y planificación.

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RESUMO

Over the last 20 years, many reports have described an excess of cases of chronic kidney disease (CKD) in the Pacific coastal area of Central America, mainly affecting male farmworkers and signaling a serious public health problem. Most of these cases are not associated with traditional risk factors for CKD, such as aging, diabetes mellitus, and hypertension. This CKD of nontraditional causes (CKDnT) might be linked to environmental and/or occupational exposure or working conditions, limited access to health services, and poverty. In response to a resolution approved by the Directing Council of the Pan American Health Organization (PAHO) in 2013, PAHO, the U.S. Centers for Disease Control and Prevention, and the Latin American Society of Nephrology and Hypertension (SLANH) organized a consultation process in order to expand knowledge on the epidemic of CKDnT and to develop appropriate surveillance instruments. The Clinical Working Group from SLANH was put in charge of finding a consensus definition of a confirmed clinical case of CKDnT. The resulting definition establishes mandatory criteria and exclusion criteria necessary for classifying a case of CKDnT. The definition includes a combination of universally accepted definitions of CKD and the main clinical manifestations of CKDnT. Based on the best available evidence, the Clinical Working Group also formulated general recommendations about clinical management that apply to any patient with CKDnT. Adhering to the definition of a confirmed clinical case of CKDnT and implementing it appropriately is expected to be a powerful instrument for understanding the prevalence of the epidemic, evaluating the results of interventions, and promoting appropriate advocacy and planning efforts.

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El propósito del estudio fue averiguar la influencia del sexo, edad y clase social de maestros de primaria respecto del Trastorno por Déficit de Atención e Hiperactividad (TDAH), sus causas y como tratarlo. El estudio también averiguó la influencia del grado escolar y del tamaño del grupo que atendían los maestros, así como del tipo de escuela en la que trabajaban. Maestros de primaria (N = 691) señalaron si sabían qué era el TDAH y en caso afirmativo escribieron en qué consiste. También escribieron las conductas que creían emitiría en el salón de clases un niño etiquetado y cómo lo tratarían. Los resultados mostraron que en comparación con sus contrapartes, una proporción mayor de mujeres, de maestros mayores de 43 años, de clase social media, que enseñaban en 5°- 6°, que atendían grupos pequeños y de escuelas privadas dijeron saber qué es el TDAH. Estos mismos maestros consideraron que el TDHA se trata de una enfermedad orgánica, esperarían un peor comportamiento de los niños y estarían más inclinados a etiquetarlos. Los maestros dijeron que emplearían técnicas como sentar al niño etiquetado cerca de ellos para fomentar su atención y disminuir su distracción. Los resultados se discuten contrastando el punto de vista psiquiátrico y el psicológico sobre el concepto de conducta anormal.

The purpose of the study was to determine the influence of sex, age and social class of elementary school teachers on their knowledge about the attention deficit hyperactivity disorder (ADHD). The study also determined the influence of the school grade in which the teachers taught, the size of their group and the kind of school in which they worked. Elementary school teachers (N = 691) mentioned whether they knew what ADHD was and if they did, wrote down their definition of ADHD. Teachers also wrote down the specific behaviors they expected from a child with ADHD and how will they treat that child during their classes. Results showed that compared with their counterparts, a greater percentage of women, teachers older than 43 years, of middle social class, that taught in fifth and sixth grades, that had small groups and that worked in private schools said they knew what ADHD was. Those teachers considered that ADHD has an organic cause, expected children to behave worse and be willing to label their students more often than their counterparts. The majority of teachers said they would use strategies such as sitting a student with ADHD next to them to foster his/her attention and to avoid distractions. Results are discussed contrasting the psychiatric and psychological approximations to abnormal behavior.

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Se hace una revisión histórica del síndrome de dispersión pigmentaria. Se presentan los argumentos que proponen diferentes investigadores para apoyar que la presencia del pigmento es la causa, por azolve, del aumento de la presión intraocular, así como las teorías que abogan que es la lesión de las células endoteliales trabeculares el factor producto del glaucoma. Se hace referencia a los estudios genéticos con relación a la determinación de la presencia clínica de este síndrome. Se discute sobre los posibles mecanismos de aumento de la presión con el ejercicio y el cuadro clínico y la evolución natural de la enfermedad. Se hace un análisis de los métodos de tratamiento médico y quirúrgico

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