Consecutive strabismus after infantile nystagmus syndrome surgery and potential risk factors.

PURPOSE: The aim of this study is to evaluate the incidence of consecutive strabismus after infantile nystagmus surgery and its potential risk factors. METHODS: A retrospective study including 89 patients was conducted. Patients presented infantile nystagmus (idiopathic or ocular disease-associated nystagmus) without previous or coincidental strabismus. Sex, age at surgery, amblyopia, botulinum toxin (BT) injection before surgery, spherical equivalent, anisometropia, surgery procedure (Anderson's or retroequatorial recessions of four horizontal recti), and follow-up were analyzed. Kaplan-Meier and univariate Cox regression were performed. RESULTS: The median age at surgery was 5 years. The median follow-up was 36 months. The incidence of consecutive strabismus was 11.2%. There were eight patients with exotropia and two patients with esotropia. Consecutive strabismus was associated with severe bilateral amblyopia (p = 0.036), previous treatment with BT injection (p = 0.025), and large recessions of the four horizontal muscles (p = 0.001). The hazard ratio for patients with severe bilateral amblyopia was 5.4 (95% CI 1.1-25.8), and for patients previously treated with BT was 6.1 (1.3-29.3). The survival rate was 95.4% at 6 months and 88.5% at 3 years. CONCLUSION: Severe bilateral amblyopia, previous BT treatment, and type of surgery seem to be associated with consecutive strabismus after infantile nystagmus surgery. Most cases appear within the first months after surgery.

Strabismus-associated myopia. Review. / Revisión del estrabismo en miopes.

INTRODUCTION: The treatment of strabismus associated with myopia is often a therapeutic challenge for the ophthalmologist. The strabismus associated with myopia has certain peculiarities and there are even certain types of strabismus that occur exclusively in myopia, such as strabismus fixus, requiring treatments with specific surgical techniques. MATERIALS AND METHODS: It is important to make a correct differential diagnosis, because there are many conditions described with this association. A review is presented of strabismus associated with myopia, together with its treatment adjusted to refractive error. RESULTS: Measurements of strabismus may be altered by the prismatic effect of the spectacles. Surgical results may be unpredictable if myopia is not taken into account. Better results were obtained with the techniques of anatomical replacement described by Yokoyama than with traditional retro-insertion-resection. CONCLUSION: For the diagnosis and appropriate treatment of strabismus, it is important to make a correct measurement of the angle of deviation, and perform image tests prior to surgery in certain cases. The anatomical characteristics of the myopic eye should also be taken into account during surgery.

Epidemiology of hospitalization for acute bronchiolitis in children: differences between RSV and non-RSV bronchiolitis.

We study the clinical, management and outcome differences between respiratory syncytial virus (RSV) positive and negative bronchiolitis. A retrospective review of the medical records of children ≤ 2 years of age with acute bronchiolitis between January 1995 and December 2006 was done. There were 2,384 patients hospitalized for acute bronchiolitis, and 1,495 (62.7%) were RSV infections. Overall, hospitalization rate was 55/1,000 admissions. Mortality occurred in 0.08% of cases. Bronchiolitis due to RSV was more frequent from November to March (97%). RSV bronchiolitis had longer hospital stays (6 vs. 5 days, P<0.0001), higher risk of intensive care unit (ICU) admission (OR 2.7; 95%CI 1.87-3.9) and more oxygen use (OR 2.2; 95%CI 1.8-2.6). Infants < 2 months had longer median hospital stay (6 vs. 5 days, P <0.0001) and higher risk of ICU admission (OR 3.4; 95%CI 2.5-4.6). Prematures of < 32 gestational weeks, congenital heart disease, and atelectasis/condensation were the main risk factors for ICU admission in both RSV and non-RSV bronchiolitis. The introduction of palivizumab in prematures diminished hospitalization for RSV bronchiolitis, oxygen need, length of hospital stay and mechanical ventilation. In conclusion, this study supports that RSV bronchiolitis seems to be a more severe disease than that caused by other viruses.

Melamine urinary bladder stone.

We report a unique case of a melamine bladder urinary stone. A physiopathologic mechanism of formation is proposed and discussed.

Consumption costs of inappropriate medicines estimated from bulk purchase data: The example of NSAids in Guatemala.

OBJECTIVE: In contexts where access to medicines is limited or troublesome, it may be important to identify the cases in which there exists access to medicines, but where this access is "inefficient" because it results in non-healing, avoidable toxicity or excessive cost in conditions of similar efficacy. Despite obvious limitations, bulk medicines purchase data of public institutions used to be the only available approximation on what is consumed in some countries. The aim of this study was to describe the results of a qualitative analysis of bulk consumption data, focusing on nonsteroidal anti-inflammatory drugs (NSAIDs) as an example. METHOD: The list of all drugs purchased by the Health Ministry of Guatemala in 2004 was quantitatively and qualitatively analyzed both according to the number of units and value. All NSAIDs bought during that period were analyzed in order to find potential intervention areas which could be addressed to improve drug selection. RESULTS: The studied list included 693 products with a value of 102 million US dollars. Among the top-20 purchased medicines by defined daily doses (DDDs) were several NSAIDs (including aceclofenac, meloxicam and piroxicam). Ranitidine, ciprofibrate and dimethicone were also among these top-20 drugs. In addition, aceclofenac was among the top-20 drugs according to value. The cost of "second-line" NSAIDs was several times higher than the "first-line" diclofenac or ibuprofen. Providing equal efficacy and similar toxicity exists, a theoretical switch from second- to first-line NSAIDs could save up to 2,377 million US dollars/year. CONCLUSIONS: Although it is an old and well-known method, the analysis of bulk consumption data continues to provide information that may help to identify areas of potential improvement in settings without many resources. In the present theoretical example, educative interventions addressed to rational selection of NSAIDs could save more than 2% of the annual drug expenditure of the country. Co-ordinated actions addressed to other drugs could decrease inefficient drug expenditure and improve the quality of health-care.

[Resistance of Mycobacterium tuberculosis in Mexican patients. I. Clinical features and risk factors]. / Resistencia de Mycobacterium tuberculosis en pacientes mexicanos. I. Características clínicas y factores de riesgo.

OBJECTIVE: To determine the clinical manifestations associated with resistant M. tuberculosis infection and the antimicrobial resistance in isolates from Mexican patients. STUDY DESIGN: Epidemiological surveillance. PATIENTS: Tuberculosis confirmed cases. METHODS: Primary resistance: no history of treatment prior to diagnosis. The following critical concentrations (micrograms/mL) were used for susceptibility: isoniazid 0.2 and 1; rifampin 1 and 5; ethambutol 5 and 10; streptomycin 2 and 10; ethionamide 5; kanamycin 6; and para-aminosalicylic acid (PAS) 2 and 10. RESULTS: Eighty-four patients with a mean age of 44.7 years were included; 54 men (64%) and 30 women (36%); most patients were from the Mexico City metropolitan area. In 34 patients there was clinical information available, 26 presented fever and weight loss and 8 respiratory symptoms. Fifty-nine patients (70%) were infected by pan-susceptible M. tuberculosis, and 25 (30%) by a resistant isolate; 17 (68%) of them were resistant to at least two drugs, 16 (64%) to isoniazid and rifampin. The proportion of resistance was: isoniazid 24%, rifampin 19%, streptomycin 12%, ethambutol 10%, PAS 9%, etionamide 7%, and kanamycin 6%. Of 47 patients without previous treatment, eight had a resistant microorganism (17%): 9% resistant to isoniazid, 6% to rifampin, 2% to streptomycin, 6% to PAS and 6% multiresistant. Of 37 patients with history of previous treatment for tuberculosis, 17 (46%) had a resistant isolate; 44% were resistant to isoniazid, 35% to rifampin, 24% to streptomycin, 19% to ethambutol, 12% to PAS and 35% multiresistant. Of the 84 patients, four were physicians infected by a resistant isolate, and seven HIV-infected patients, one with a multiresistant isolate, and another with isoniazid resistance. CONCLUSIONS: Antimicrobial resistance among M. tuberculosis is alarmingly high in Mexico City; these results emphasize the importance of case detection and early isolation of patients.

The maternal-infant center in the control of hepatitis B.

A seroepidemiologic survey of HBV infection was carried out in four population groups served by the Maternity Hospital of Majorca, an island in the Mediterranean. The prevalence of HBV markers (HBsAg, anti-HBs, anti-HBc), determined by enzyme-immunoassay, reached 17.2% among 864 parturients, 17.2% in 783 hospital personnel, 2.7% and 19.2% among the 186 children and 73 husbands of parturients with no HBV markers, 22.8% and 43.8%, respectively, among the 44 children and 48 husbands of HBsAg chronic carrier parturients. The prevalences of HBsAg in the same groups reached 0.9%, 1.5%, 0% and 0%, 11.4% and 2.1%, respectively. The carrier state represents 50% of all infection cases among children and 4.8% among husbands of carrier women. The prevalence of markers, which was especially high among personnel working in maintenance services (39.1%), on surgical wards (35.3%), among midwives (27.6%) and in cleaning and laundry services (27.1%), and laboratories (21.4%), is used as an indicator in defining priorities for the vaccination of people at risk. Sixty-seven newborn babies of HBsAg carrier mothers were administered one dose of HBIG and three doses of hepatitis B vaccine; at 12 months of age, the seroconversion rate was 98.5%, whereas 1 child (1.5%) became a chronic carrier. Maternity hospitals represent the ideal centers in which to carry out the detection of HBsAg in pregnant women prior to parturition, to ensure that all newborns of chronic carrier women receive passive-active immunization, and to screen their family contacts and vaccinate those who are found susceptible to the infection.

Nonsurgical management of neonatal multiple brain abscesses due to Proteus mirabilis.

A newborn infant with Proteus mirabilis meningitis developed multiple brain abscesses with diameters ranging from 2 to 4 cm. Intravenous antibiotic therapy alone without surgical intervention led to the complete resolution of this complication. The case supports that this may be an acceptable treatment of multiple brain abscesses in neonates. However, the clinical outcome was relatively poor, since a porencephalic cyst, hypodense areas in CT scan, and psychomotor retardation were found at one year of age.

Timing of permanent tooth emergence in a Southeastern Dominican schoolchildren population sample.

The purpose of this study was to establish the mean timing of permanent tooth emergence in a low to middle socioeconomic level schoolchildren population sample from the Southeastern part of the Dominican Republic. A total of 900 children (15.6% of the 5-14-year-old schoolchildren from this city) were studied. Girls were relatively advanced in their emergence times except for the canine and second premolar in the maxilla and the first premolar in the mandible. The mean emergence times were, in general, relatively advanced when compared with those of United States whites and blacks, Danish, Canadian Eskimos, French-Canadians, Greenland Eskimos, Icelandics, Southern Chinese and South Africans.