Uveitis: Retinal Immune Cells Serve as Gatekeepers to the Central Nervous System

MedicalResearch.com Interview with:

Kip Connor, Ph.D.Harvard Medical SchoolAssociate Professor of Ophthalmology Department of OphthalmologyMassachusetts Eye and EarMGH ECOR Ophthalmology RepresentativeAssociate Scientist

Dr. Connor

Kip Connor, Ph.D.
Harvard Medical School
Associate Professor of Ophthalmology
Department of Ophthalmology
Massachusetts Eye and Ear
MGH ECOR Ophthalmology Representative
Associate Scientist

MedicalResearch.com: What is the background for this study?

Response: Classically, the retina and the central nervous system (CNS) have long been considered immunoprivileged sites within the body. This is not to say that these sites lack immunity; rather, they are capable of exhibiting a contained yet modifiable form of immunological response. Indeed, an intricate immune surveillance system exists within the retina that can interact with the retinal cellular milieu both during development and in response to injury or disease. While activation of this surveillance system can help protect and repair the delicate neural tissue of the retina in certain disease states, over-activation of this system can exacerbate disease pathology, thereby worsening vision loss.

Microglia are the resident immune cells of the central nervous system, including the retina, and are thought to function acutely in the homeostatic maintenance of the neuro-retinal microenvironment.  However in chronic conditions, like autoimmune uveitis, we hypothesized that microglia become neurodegenerative.

In our current study we show for the first time a role for microglia in directing the initiation of this autoimmune disease by orchestrating the inflammatory response within the retina through the retinal vessels.

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Is There a Risk of Bleeding With Ibuprofen After Tonsillectomy ?

MedicalResearch.com Interview with:

Gillian R. Diercks, MD, MPHInstructor in Otolaryngology, Harvard Medical SchoolDepartment of OtolaryngologyMassachusetts Eye and Ear InfirmaryBoston, Massachusetts

Dr. Diercks

Gillian R. Diercks, MD, MPH
Instructor in Otolaryngology, Harvard Medical School
Department of Otolaryngology
Massachusetts Eye and Ear Infirmary
Boston, Massachusetts 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Pediatric tonsillectomy is a commonly performed procedure, representing the second most common ambulatory surgery performed on children in the United States, with over half a million children undergoing the surgery annually.  A major concern for surgeons, patients, and their families is the issue of postoperative pain control as pain can last up to 10-14 days after surgery, be quite severe, and result in readmission to the hospital or ED visits for medications and dehydration.

In young children and children with sleep apnea we cannot safely administer narcotic pain medications at home.  This leaves limited options for pain control, including acetaminophen and ibuprofen.  However, there are concerns that ibuprofen could potentially increase bleeding risk after surgery because of its effects on platelet function in the blood.  At baseline, the risk of postoperative hemorrhage within the first two weeks after tonsillectomy is around 4.5%, with about 1-1.5% of children requiring a return to the operating room to control severe bleeding.  Our study set out to show that the risk of severe postoperative bleeding when ibuprofen is given for 9 days after tonsillectomy was not increased compared with the bleeding risk when acetaminophen was administered instead.

Our study could not conclude that the risk of bleeding is no different when ibuprofen is used, and was suggestive that the bleeding risk may actually be higher. Continue reading