Gut microbiota and age-related macular degeneration: A growing partnership

Age-related macular degeneration (AMD) is a leading cause of severe, irreversible vision impairment in developed countries, and its prevalence is rising all over the world, increasing sharply with age. AMD represents an acquired degeneration of the retina that causes significant central visual impairment through a combination of noneovascular and neovascular derangement. The main risk factors for the development of advanced AMD are increasing age, genetic factors, and cigarette smoking; however, the exact pathophysiology of AMD is yet relatively poorly understood. In recent years, the gut microbiota has been intensively studied and linked to several pathologic processes, including ocular diseases. In this sense, the aim of this review is to gather published evidence about the relationship between gut microbiota and AMD.

Predictors and outcomes of disseminated tuberculosis in an intermediate burden setting

SETTING

University-affiliated hospital located in Porto, North Portugal, an area with a low to intermediate incidence of tuberculosis (TB).

OBJECTIVE

To identify predictors and outcomes of disseminated TB (dTB).

DESIGN

A cohort of patients diagnosed with TB between 2007 and 2013 was retrospectively analysed. Patients with dTB criteria were characterized and compared to single organ TB cases. Factors independently associated with dTB were determined by multivariate logistic regression analysis.

RESULTS

A total of 744 patients were analysed, including 145 with dTB. Independent risk factors for dTB were pharmacological immunosuppression (OR 5.6, 95% CI 2.8-11.3), HIV infection (OR 5.1, 95% CI 3.1-8.3), chronic liver failure or cirrhosis (OR 2.3, 95% CI 1.4-4.1) and duration of symptoms (OR 2.3, 95% CI 1.4-3.8). Compared to single organ TB, the clinical presentation of dTB patients differed by the absence of haemoptysis (OR 3.2, 95% CI 1.3-8.4) and of dyspnoea (OR 1.9, 95% CI 1.2-3.1), presence of weight loss (OR 1.8, 95% CI 1.1-2.9), night sweats (OR 1.7, 95% CI 1.1-2.7) and bilateral lung involvement (OR 4.4, 95% CI 2.8-7.1). Mortality and time until culture conversion were higher for dTB patients, although not reaching statistical significance.

CONCLUSION

Immunosuppressive conditions and chronic liver failure or cirrhosis were associated with increased risk of dTB. The haematogenous spread may be dependent on longer symptomatic disease and usually progresses with bilateral lung involvement.

Psychosocial adaptations of shunted hydrocephalic children

The personality, psychosomatic symptoms and family characteristics of 55 shunted hydrocephalic children older than four years were studied. Hydrocephalic childrens' self-concept, measured by the Children's Appereception Test, was found to be very significantly poorer than that of the control children. They also frequently showed behaviour disorders of the MBD-type, e.g. concentration difficulties, aggressiveness, fastidious eating and nervousness. The hydrocephalic childrens' families showed very significantly more cohesion and less rigidity, and significantly less authoritarianism than average Finnish families. When examining the parents' attitudes to their sick child, one third of the children were seen to be in a healthy role, with parental expectations realistically related to the child's abilities. One third of the children were seen as "babies", with unnecessarily over-protective attitudes on the part of their parents, and one third as "scapegoats", with accusatory attitudes from their mother and father. Those in the role of "scapegoats" had the poorest perceptual skills, the highest frequencies of behaviour disorders and the poorest self-concept.