Gatifloxacin and iodopovidine preoperatively of phacectomy: influence on counting bacterial colonies / Gatifloxacino e iodopovidine no pré-operatório de facectomia: influência na contagem de colônias bacterianas

Objective: To analyze two methods of reducing conjunctivalmicrobiota in patients undergoing cataract surgery. Methods: A clinical trial with a convenience sample of 57 patients diagnosed with senile cataract (57 eyes) who underwent phacoemulsification with intraocular lens implantation in Recife from 2011 to 2013. Patients were divided into two groups: ATB (27 eyes) in which was instilled antibiotic eye drops (gatifloxacin 0.3%) and ASS (30 eyes) with antiseptic eye drops (iodopovidine 5%); both medications were instilled three times (one drop every 20 minutes, an hour prior to surgery). The groups were evaluated from two collections of conjunctival material: first before instilling some eye drops and the second one immediately after surgery. Gram stain, culture and sensitivity were performed. Results: Comparing the reduction in the number of bacteria found in the slides in the pre-and postoperative, there was no statistically significant difference in both groups. Conclusions: Both use of antiseptic or antibiotic, used as prophylaxis forendophthalmitis, can reduce the conjunctivalmicrobiota.

Objetivo: Analisar dois método de redução da microbiota conjuntival em indivíduos submetidos à facectomia. Métodos: Ensaio clínico, com amostra de conveniência de 57 pacientes, com diagnóstico de catarata senil (57 olhos), submetidos à facoemulsificação com implante de lente intraocular em Recife entre 2011 a 2013. Os pacientes foram alocados em dois grupos: ATB (27 olhos) no qual foi instilado colírio antibiótico (gatifloxacino a 0,3%) e ASS (30 olhos) colírio antisséptico (iodopovidine a 5%), ambas as medicações foram instiladas três vezes (uma gota a cada 20 minutos, uma hora previamente à cirurgia). Os grupos foram avaliados a partir de duas coletas de material conjuntival: a primeira antes de instilar algum colírio e a segunda imediatamente após a cirurgia. Foi realizada bacterioscopia, cultura e antibiograma. Resultados: Comparando-se a redução no número de bactérias encontrado nas lâminas no pré e pós-operatório, não se verificou diferença estatística significativa nos dois grupos. Conclusão: Tanto o uso do antisséptico como do antibiótico usados como profiláticos para a endoftalmite reduzem a microbiota conjuntival.

Evaluación de la medición de las resistencias pulmonares por técnica de interrupción / Assessing the measurement of airway resistance by the interrupter technique

Introducción. Las pruebas de función pulmonar permiten objetivar el grado de obstrucción bronquial en sujetos colaboradores. La medición de las resistencias pulmonares por métodos pasivos es muy útil en sujetos no colaboradores. El objetivo de este estudio fue evaluar la aplicabilidad de la medición de resistencias por interrupción (Rint) en la edad pediátrica, valorando su reproducibilidad, fabilidad y exactitud en relación con otras técnicas de medición de resistencias. Material y métodos. Estudio transversal en niños de entre 2 y 18 años, sanos y con patología obstructiva. Se midió la Rint con un aparato portátil y se comparó con las resistencias medidas por oscilometría y pletismografía. Se valoró la reproducibilidad de las mediciones y la infuencia de diferentes variables (uso de mascarilla o boquilla, sujeción de mejillas o uso de pinza nasal). Resultados. De 460 niños (47,6% menores de 7 años) se obtuvieron medidas válidas en el 82,6%. La reproducibilidad fue muy buena (CCI= 0,9412; p < 0,00001), sin encontrar diferencias entre las medidas obtenidas separadas en el tiempo (0,75 ± 0,3 contra 0,74 ± 0,28; p= 0,435). Ninguno de los factores antes mencionados afectó la reproducibilidad de las medidas. Los valores de resistencia obtenidos por pletismografía y oscilometría fueron superiores a los obtenidos por Rint, con una correlación positiva entre ambos. La correlación con la pletismografía disminuía cuanto mayor era el grado de obstrucción. Conclusiones. La medición de Rint es factible y reproducible, y se correlaciona bien con las resistencias medidas por oscilometría o pletismografía, por lo que sería de utilidad en los pacientes poco colaboradores. En los pacientes obstruidos, podría infraestimar la resistencia, difcultando su uso para el seguimiento de una patología obstructiva moderada-grave o en las pruebas de provocación bronquial.

Introduction. Pulmonary function tests allow an objective assessment of the degree of bronchial obstruction in collaborative subjects. The measurement of airway resistance using passive methods is very helpful in non-collaborative subjects. The objective of this study was to assess the applicability of measuring airway resistance by the interrupter technique (Rint) in pediatric subjects, determining its reproducibility, reliability and accuracy versus other techniques to measure airway resistance. Material and Methods. Cross-sectional study in healthy children and in children with an obstructive airway disease, all aged 2-18 years old. The Rint was measured using a portable device and results were compared to airway resistance measured by oscillometry and plethysmography. The reproducibility of measurements and the infuence of the different outcome measures (use of mask or mouthpiece, cheek support, or nose clip) were assessed. Results. Valid measurements were obtained in 82.6% of 460 children (47.6% younger than 7 years old). Reproducibility was very good (ICC= 0.9412; p <0.00001), and no differences were found among the measurements obtained at separate time intervals (0.75 ± 0.3 versus 0.74 ± 0.28; p= 0.435). None of the factors indicated before had an effect on the reproducibility of measurements. Resistance values obtained by plethysmography and oscillometry were higher than those obtained using the Rint, with a positive correlation between them. The higher the degree of airway obstruction, the worse the correlation with plethysmography. Conclusions. The Rint measurement is a plausible and reproducible technique, and has an adequate correlation with the resistance measurements obtained using oscillometry or plethysmography, thus making it useful for non-collaborative patients. In patients with airway obstruction, this technique could underestimate resistance, so it would be a hurdle to use it to follow-up subjects with a moderate to severe obstructive disease or in bronchial challenge tests.

Malformación adenomatoidea quística pulmonar: importancia del diagnóstico prenatal / Cystic adenomatoid malformation of the lung: importance of prenatal diagnosis

La malformación adenomatoidea quística pulmonar (MAQP)es una anomalía de la vía aérea pulmonar poco frecuente cuyodiagnóstico suele realizarse en el período prenatal medianteecografía. Durante el embarazo, debe realizarse seguimiento ecográfico para valorar el desarrollo pulmonar. Presentamos el caso clínico de una paciente de 4 años con diagnóstico prenatal de MAQP, no confirmado mediante radiografía de tóraxrealizada al nacimiento, lo cual retrasó el diagnóstico definitivo; fue intervenida con 4 años de edad tras haber presentado varias neumonías a repetición. Una radiografía de tórax normal realizada al nacimiento no descarta la presencia de estamalformación, por lo que es necesario realizar una tomografía computarizada a las 4 semanas del nacimiento para confirmar o descartar la MAQP. Una vez diagnosticada, el tratamiento quirúrgico debe ser precoz para evitar complicaciones.

Cystic adenomatoid malformation of the lung is a rare malformation of the lung airway which often performed diagnosed in the prenatal period by ultrasound. Ultrasound monitoring should be performed during pregnancy to assess lung development. We report the case of a 4-year-old patient with prenatal diagnosis of cystic adenomatoid malformation of the lung, not confirmed by chest radiograph at birth. The patient underwent surgery at 4 years of age after diagnosis was made for presenting recurrent pneumonia. A normal chest radiograph at birth does not exclude this malformation and a computerized tomography at 4 weeks of birth must be done to confirm or rule out this anomaly. Once the diagnosis is made, surgical treatment should be prompted to avoid complications.