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.

Antagonistic Effects of Point Mutations on Charge Recombination and a New View of Primary Charge Separation in Photosynthetic Proteins

Light-induced electron-transfer reactions were investigated in wild-type and three mutant Rhodobacter sphaeroides reaction centers with the secondary electron acceptor (ubiquinone Q_A) either removed or permanently reduced. Under such conditions, charge separation between the primary electron donor (bacteriochlorophyll dimer, P) and the electron acceptor (bacteriopheophytin, H_A) was followed by P⁺H_A^– → PH_A charge recombination. Two reaction centers were used that had different single amino-acid mutations that brought about either a 3-fold acceleration in charge recombination compared to that in the wild-type protein, or a 3-fold deceleration. In a third mutant in which the two single amino-acid mutations were combined, charge recombination was similar to that in the wild type. In all cases, data from transient absorption measurements were analyzed using similar models. The modeling included the energetic relaxation of the charge-separated states caused by protein dynamics and evidenced the appearance of an intermediate charge-separated state, P⁺B_A^–, with B_A being the bacteriochlorophyll located between P and H_A. In all cases, mixing of the states P⁺B_A^– and P⁺H_A^– was observed and explained in terms of electron delocalization over B_A and H_A. This delocalization, together with picosecond protein relaxation, underlies a new view of primary charge separation in photosynthesis.

Unified Model of Nanosecond Charge Recombination in Closed Reaction Centers from Rhodobacter sphaeroides: Role of Protein Polarization Dynamics

Ongoing questions surround the influence of protein dynamics on rapid processes such as biological electron transfer. Such questions are particularly addressable in light-activated systems. In Rhodobacter sphaeroides reaction centers, charge recombination or back electron transfer from the reduced bacteriopheophytin, HA(-), to the oxidized dimeric bacteriochlorophyll, P(+), may be monitored by both transient absorption spectroscopy and transient fluorescence spectroscopy. Signals measured with both these techniques decay in a similar three-exponential fashion with lifetimes of ∼0.6-0.7, ∼2-4, and ∼10-20 ns, revealing the complex character of this electron transfer reaction. In this study a single kinetic model was developed to connect lifetime and amplitude data from both techniques. The model took into account the possibility that electron transfer from HA(-) to P(+) may occur with transient formation of the state P(+)BA(-). As a result it was possible to model the impact of nanosecond protein relaxation on the free energy levels of both P(+)HA(-) and P(+)BA(-) states relative to that of the singlet excited state of P, P*. Surprisingly, whereas the free energy gap between P* and P(+)HA(-) increased with time in response to protein reorganization, the free energy gap between P* and P(+)BA(-) decreased. This finding may be accounted for by a gradual polarization of the protein environment which stabilizes the state P(+)HA(-) and destabilizes the state P(+)BA(-), favoring productive charge separation over unproductive charge recombination.

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.