Graft survival of Descemet membrane endothelial keratoplasty (DMEK) in corneal endothelial decompensation after glaucoma surgery.

PURPOSE: This study aims to assess the results, rebubbling rate, and graft survival after Descemet membrane endothelial keratoplasty (DMEK) with regard to the number and type of previous glaucoma surgeries. METHODS: This is a clinical retrospective review of 1845 consecutive DMEK surgeries between 07/2011 and 08/2017 at the Department of Ophthalmology, University of Cologne. Sixty-six eyes were included: group 1 (eyes with previous glaucoma drainage devices (GDD); n = 27) and group 2 (eyes with previous trabeculectomy (TE); n = 39). Endothelial cell loss (ECL), central corneal thickness, graft failure, rebubbling rate, and best spectacle-corrected visual acuity (BSCVA) up to 3 years after DMEK were compared between subgroups of patients with different numbers of and the two most common types of glaucoma surgeries either GDD or TE or both. RESULTS: Re-DMEK rate due to secondary graft failure was 55.6% (15/27) in group 1 and 35.9% in group 2. The mean graft survival time in group 1 was 25 ± 11 months and 31.3 ± 8.6 months in group 2 (p = 0.009). ECL in surviving grafts in group 1 was 35% (n = 13) at 6 months, 36% at 12 months (n = 8), and 27% (n = 4) at 2 years postoperatively. In group 2, ECL in surviving grafts was 41% (n = 10) at 6 months, 36% (n = 9) at 12 months, and 38% (n = 8) at 2 years postoperatively. Rebubbling rate in group 1 was 18.5% (5/27) and 35.9% (14/39) in group 2 (p = 0.079). CONCLUSION: Eyes with previous GDD had no higher risk for an increased rebubbling rate but a higher risk for a re-DMEK due to secondary graft failure with a mean transplant survival time of about 2 years. Compared to eyes with preexisting glaucoma drainage device, eyes after trabeculectomy had less secondary graft failures and a longer mean graft survival rate.

Interrupción voluntaria del embarazo en Latinoamérica, superando barreras / Voluntary interruption of the pregnancy in Latin America, overcoming barriers

Resumen Introducción: El embarazo no planeado o no intencional y el aborto son situaciones que afectan la vida de mujeres a nivel mundial, sin distinción de etnia, edad, riqueza, o ubicación geográfica, sin embargo, tiene una mayor posibilidad de presentarse y generar consecuencias negativas en mujeres con ciertas determinantes sociales. Objetivo: Mostrar el estado actual de la interrupción voluntaria del embarazo en países de Latinoamérica y del Caribe con énfasis en el reciente avance de la legislación argentina sucedido durante diciembre del 2020. Metodología: Se realizó una búsqueda no estructurada de información sobre la legislación del aborto en países de Latinoamérica y del Caribe y se hizo una revisión de tema sobre aspectos actuales y relevantes de la interrupción voluntaria del embarazo. Conclusiones: Es necesario que prestadores de servicios de salud y sociedad latinoamericana repasen las lecciones aprendidas de diferentes países sobre las consecuencias negativas para la salud de las mujeres y sus familias debido a las restricciones para acceder al aborto seguro. El mejoramiento de la calidad y las capacidades de los sistemas de salud en los países de bajos y medianos recursos, con mayor inversión e investigación en temas de salud sexual y reproductiva, resultará en la eliminación de barreras e inequidades en la prestación de atención médica a las mujeres, respetando sus derechos y autonomía.

Abstract Introduction: Unplanned or unintended pregnancy and abortion are situations that affect the lives of women worldwide without distinction of ethnicity, age, economic level, or geographical location. However, they have a greater probability of occurring and negative consequences in women with certain social determinants. Objective: Our main objective is to show the current state of the Voluntary Interruption of Pregnancy in Latin American and Caribbean countries with special emphasis on the recent advance of the legislation of Argentina that occurred last December. Methodology: An unstructured search for information about Abortion Legislation in Latin American and Caribbean countries was carried out and a subject revision on current and relevant aspects of Voluntary Interruption of Pregnancy was made. Conclusions: It is necessary that as Health Service providers and as a Latin American Society, we review the lessons learned from different countries about the negative consequences on the health of women and their families due to the restrictions for accessing legal abortions. Improving the quality and capacity of the health system in low- and middle- income countries, in addition to greater investment and research in sexual and reproductive health issues, will derive a removal of barriers and inequity related to the provision of medical attention for women while respecting their rights and autonomy.

Increased rates of intensive care unit admission in patients with Mycoplasma pneumoniae: a retrospective study.

Mycoplasma pneumoniae is a leading cause of respiratory disease. In the Intensive Care Unit (ICU) setting M. pneumoniae is not considered a common pathogen. In 2010-13 an epidemic of M. pneumoniae-associated infections was reported and we observed an increase of M. pneumoniae patients admitted to ICU. We analysed the cohort of all M. pneumoniae-positive patients' admissions during 2007 to 2012 at the Hadassah-Hebrew University Medical Centre (a 1100-bed tertiary medical centre). Mycoplasma pneumoniae diagnosis was made routinely using PCR on throat swabs and other respiratory samples. Clinical parameters were retrospectively extracted. We identified 416 M. pneumoniae-infected patients; of which 68 (16.3%) were admitted to ICU. Of these, 48% (173/416) were paediatric patients with ICU admission rate of 4.6% (8/173). In the 19- to 65-year age group ICU admission rate rose to 18% (32/171), and to 38.8% (28/72) for patients older than 65 years. The mean APACHE II score on ICU admission was 20, with a median ICU stay of 7 days, and median hospital stay of 11.5 days. Of the ICU-admitted patients, 54.4% (37/68) were mechanically ventilated upon ICU admission. In 38.2% (26/68), additional pathogens were identified mostly later as secondary pathogens. A concomitant cardiac manifestation occurred in up to 36.8% (25/68) of patients. The in-hospital mortality was 29.4% (20/68) and correlated with APACHE II score. Contrary to previous reports, a substantial proportion (16.3%) of our M. pneumoniae-infected patients required ICU admission, especially in the adult population, with significant morbidity and mortality.

[Development of a PCR for the detection and quantification of parasitism by Demodex folliculorum infestation in biopsies of skin neoplasms periocular area]. / Desarrollo de una PCR para la detección y cuantificación de la parasitación por Demodex folliculorum en biopsias de neoplasias cutáneas del área periocula.

OBJECTIVE: To standardize the relative quantification by mass of tissue parasitism by Demodex folliculorum infestation from neoplastic skin biopsies periocular using molecular amplification to study the possible relationship of the appearance of eyelid basal cell carcinoma with the presence and density of the mite in later works. METHODS: A quantitative PCR was developed real-time probes TaqMan. PCR was tested in a pilot 46 actual biopsy samples nodular basal cell carcinoma series. RESULTS: The sensitivity was placed with a detection limit of between 1 and 10 copies / µl. 50% (23/46) of the biopsies were positive for D. folliculorum. The specificity was 100% confirmed by sequencing. CONCLUSIONS: The technique shows good results for sensitivity and specificity that can make it useful as a tool for studies of cause and effect D. folliculorum and basal cell carcinoma.

Déjà vu: Ralstonia mannitolilytica infection associated with a humidifying respiratory therapy device, Israel, June to July 2011.

Following a bloodstream infection in June 2011 with Ralstonia mannitolilytica in a premature infant treated with a humidifying respiratory therapy device, an investigation was initiated at the Hadassah Medical Centres in Jerusalem. The device delivers a warmed and humidified mixture of air and oxygen to patients by nasal cannula. The investigation revealed colonisation with R. mannitolilytica of two of 15 patients and contamination of components of five of six devices deployed in the premature units of the Hadassah hospitals. Ten isolates from the investigation were highly related and indistinguishable from isolates described in an outbreak in 2005 in the United States (US). Measures successful in containing the US outbreak were not included in user instructions provided to our hospitals by the distributor of the device.

Ongoing epidemic of Mycoplasma pneumoniae infection in Jerusalem, Israel, 2010 to 2012.

A substantial epidemic of Mycoplasma pneumonia infection was reported in late 2011 in some European countries. We report here an epidemic of M. pneumonia infection that began in Jerusalem during 2010 and is still ongoing. This report complements current information on what might be a worldwide epidemic of M. pneumoniae infection that might require substantial coordinated international public health intervention.

Pichia farinosa bloodstream infection in a lymphoma patient.

We describe a case of Pichia farinosa bloodstream infection in a lymphoma patient. Phenotypic methods failed to identify the isolate, which was identified by sequence-based methods. This case highlights the importance of implementing molecular methods for the identification of rare fungal pathogens.

[EasyScope - an alternative to the conventional Macintosh laryngoscope?]. / Das EasyScope - Eine Alternative zum bewährten Macintosh-Laryngoskop?

OBJECTIVE: This study was conducted to compare two different techniques used for tracheal intubation (TI). We evaluated airway management conditions for a conventional Macintosh laryngoscope and the Brummert EasyScope, a new device. METHODS: A prospective trial was conducted with 20 medical students who had no prior airway management experience. Intubation was performed on an Ambu manikin. Following didactic instruction, each participant took turns performing TI using the Macintosh and EasyScope devices under direct supervision. Time required for TI, the number of attempts, and the number of times teeth were contacted were documented for each device. All participants also completed a questionnaire to determine self-assessed comfort and skill level for both the Macintosh and EasyScope devices. RESULTS: Time required for TI was comparable for both devices, although a trend toward slightly lower times for the EasyScope was observed. There was a lower rate of tooth contact during laryngoscopy and a lower rate of unsuccessful intubation attempts while using the EasyScope. Furthermore, the students felt the EasyScope was subjectively easier to use and required less effort during TI when compared with the Macintosh laryngoscope. CONCLUSION: Personnel not accustomed to a particular airway management technique achieved comparable outcomes when using either the Macintosh laryngoscope or the EasyScope device for TI. Possible reduction of effort required for tracheal intubation or better dental protection have to be evaluated for the EasyScope in further clinical studies.

Mixed agonistic-antagonistic cytokine response in whole blood from patients undergoing abdominal aortic aneurysm repair.

OBJECTIVE: To characterize the impact of abdominal aortic aneurysm repair (AAAR) on spontaneous as well as lipopolysaccharide (LPS)-induced gene expression of pro- and anti-inflammatory cytokines. DESIGN: Prospective, controlled in vivo/ex vivo study. SETTING: University hospital. PATIENTS AND INTERVENTIONS: Whole blood from 14 consecutive patients undergoing AAAR withdrawn prior to surgery (T1), at the end of ischemia (T2), 90 min after declamping (T3) and on the first postoperative day (T4) was cultured in the absence or presence of LPS. Five patients undergoing elective inguinal hernia repair served as controls. MEASUREMENTS AND RESULTS: While tumor necrosis factor (TNF), Interleukin (IL)-1 and IL-10 plasma concentrations did not increase significantly, IL-6 was elevated at each time point, as compared with T1. Despite the spontaneous release of trace amounts of IL-6, the ability of cultured whole blood to mount a cytokine response in vitro to LPS was impaired for all cytokines studied at T2 (TNF-62%, IL-1-51%, IL-6 -20%, IL-10-51%). The stimulated IL-6 response was restored early after declamping (T3: +56 %) and enhanced 1 day after operation (T4: +144%). In contrast, stimulated TNF and IL-1 responses remained depressed at T3 (TNF -48%, IL-1-64%) and T4 (TNF-40%, IL-1-24%). A biphasic pattern was observed for IL-10 with initial depression at T3 (-51%) and restoration at T4 (+40%). Among the different cytokines monitored, only impaired TNF responsiveness at early reperfusion (T3) correlated with the postoperative course, as reflected by APACHE II. Cytokine response to LPS was maintained or even increased during and after surgery in the whole blood from patients undergoing hernia repair. CONCLUSIONS: Despite consistent development of clinical signs of systemic inflammatory response syndrome (SIRS) and spontaneous release of IL-6 abdominal aortic aneurysm repair produces a state of impaired pro-inflammatory cytokine response upon a subsequent in vitro Gram-negative stimulus. This early impairment of TNF responsiveness seems to correlate with an unfavorable postoperative course.

Characterization of monoclonal antibodies for prostate-specific antigen and development of highly sensitive free prostate-specific antigen assays.

BACKGROUND: The recent elucidation of the importance of serological free prostate-specific antigen (PSA) in the diagnosis of prostate cancer has created a demand for immunoassays specific for free PSA. METHODS: We developed and characterized 11 monoclonal antibodies with high affinities for PSA (Ka values from 1.1 x 10(8) to 1.8 x 10(10)L/mol), only 3 of which cross-react with human glandular kallikrein (hK2). Using these antibodies and PSA antibodies developed by others, in conjunction with time-resolved fluorometry, we developed ultrasensitive sandwich immunoassays specific for the free form of PSA. RESULTS: The analytical detection limit of these immunoassays is 0.001 microg/L. To our knowledge, this is the most sensitive free PSA assay reported to date. The free PSA immunoassays exhibit <1% cross-reactivity with PSA-alpha1-antichymotrypsin, show no cross-reactivity with hK2, and correlate well with established free PSA kits. The 11 antibodies developed by our group, in conjunction with 4 commercially available antibodies, were used to generate a putative epitope map of the PSA molecule. CONCLUSION: The highly sensitive free PSA immunoassays may be used for measuring PSA subfractions in female serum, an application currently impossible with other reported free PSA immunoassays.

[Specific humoral response in Balb/c mice inoculated with a genome library of expression of Trypanosoma cruzi]. / Respuesta humoral específica en ratones Balb/c inoculados con una librería genómica de expresión de Trypanosoma cruzi.

A genomic expression library of Trypanosoma cruzi (T. cruzi) was made using plasmid pcDNA3 as a vector, with which male mice from the Balb/c isogenic line were intramuscullary inoculated. It was used a positive control group that was administered soluble antigens of T. cruzi. Other 2 groups received genomic and plasmid DNA, respectively. One group was not immunized. Weekly blood samples were obtained from all the animals until the fourth week and 2 weeks after reimmunization to study the response of specific antibodies against the microorganism antigens by an indirect immunoenzymatic assay (ELISA). It was observed a significant increase of specific antibodies in the animals reimmunized with 50 micrograms of the library, as well as in the group immunized with soluble antigens of T. cruzi.

An enzymatic method for measuring serum mannitol and its use in hemodialysis patients.

We evaluated two chemical methods for quantifying mannitol in serum, based on the oxidation of mannitol by periodate, and measurement of the formaldehyde formed with chromotropic acid (colorimetry) or acetylacetone (fluorometry). We found interference in these methods by serum glycerol. Additionally, a high-performance liquid chromatography (HPLC) method was evaluated and found to be specific but impractical for routine use. We therefore, developed an enzymatic fluorometric procedure, based on the oxidation of mannitol by beta-NAD to fructose and NADH, in the presence of the enzyme mannitol dehydrogenase (MD). MD is not commercially available and was partially purified from cultures of Leuconostoc mesenteroides. This new method is specific, sensitive, simple, and accurate and is proposed as the method of choice for measuring mannitol in the serum of patients who received this sugar alcohol during routine hemodialysis treatment.

Renal function in patients receiving long-term lithium therapy.

Renal function was assessed in 42 stable outpatients who had been taking lithium for an average of 4 1/2 years. Impaired ability to concentrate the urine was found in 61% of the 41 patients who provided a urine sample for an osmolality measurement, and a moderate reduction in creatinine clearance was present in 12% of the entire group; 1 patient showed both defects. Urine microscopy revealed an excess of cells in 40%. It is suggested that lithium therapy produces a self-limiting lesion of the distal nephron that does not usually progress to chronic renal failure. The lesion is not dangerous, except that it may predispose to acute neurotoxic effects in the event of intercurrent illness or dehydration.