Reduced corneal endothelial cell density after toxic anterior segment syndrome (TASS) caused by inadvertent intraocular ointment migration: A case report.

INTRODUCTION AND IMPORTANCE: Toxic anterior segment syndrome (TASS) is an acute sterile inflammation of the anterior segment which may occur after surgery. This case presents endothelial cell density (ECD) loss due to months of TASS caused by intraocular migration of ocular ointment. The chronicity of this case and the clinical consequences are rare in the literature. CASE PRESENTATION: A Colombian 71-year-old man developed TASS secondary to intraocular ointment migration after uneventful cataract surgery with phacoemulsification and intraocular lens placement in the capsular bag. The main complaint for the patient was a chronic red eye, no pain or visual disturbance were reported, rheumatologic diseases were discarded. It was documented the presence of intraocular ointment in the anterior chamber, over the iris and in the anterior chamber angle. The ECD was reduced secondary to TASS and the long-term presence of ointment moving in the anterior chamber, so it had to be removed. CLINICAL DISCUSSION: It is important to avoid using ocular ointment after intraocular surgeries to avoid the risk of ointment migration into the anterior chamber. Intraocular ointments should be removed promptly to reduce ECD loss as documented in the present case report in which after ointment elimination ECD remains stable for 7 years. CONCLUSION: Topical ointments should not be used after routine cataract surgery because of the risk of intraocular ointment migration and subsequent risk of developing TASS and reduced ECD.

CpG-creating mutations are costly in many human viruses.

Mutations can occur throughout the virus genome and may be beneficial, neutral or deleterious. We are interested in mutations that yield a C next to a G, producing CpG sites. CpG sites are rare in eukaryotic and viral genomes. For the eukaryotes, it is thought that CpG sites are rare because they are prone to mutation when methylated. In viruses, we know less about why CpG sites are rare. A previous study in HIV suggested that CpG-creating transition mutations are more costly than similar non-CpG-creating mutations. To determine if this is the case in other viruses, we analyzed the allele frequencies of CpG-creating and non-CpG-creating mutations across various strains, subtypes, and genes of viruses using existing data obtained from Genbank, HIV Databases, and Virus Pathogen Resource. Our results suggest that CpG sites are indeed costly for most viruses. By understanding the cost of CpG sites, we can obtain further insights into the evolution and adaptation of viruses.

Validation of the Jefferson Scale of Physician Empathy in Spanish medical students who participated in an Early Clerkship Immersion programme.

BACKGROUND: The Jefferson Scale of Physician Empathy is the most widely used instrument to measure empathy in the doctor-patient relationship. This work pursued cultural adaptation and validation of the original scale, in its health professions version (JSE-HP), for medical students who participate in an Early Clerkship Immersion Programme of a Spanish university. METHODS: The questionnaire was replied by 506 1st, 2nd, 3rd and 5th year medical students from Universidad Francisco de Vitoria, Madrid, in 2014 and 2016. Internal consistency was analysed by means of Cronbach's alpha, and reliability by means of test-retest using the intraclass correlation coefficient and the Bland-Altman method. The construct validity was checked by means of confirmatory factor analysis and association with other empathy-related variables. Criterion validity was compared using Davis' Interpersonal Reactivity Index. RESULTS: Cronbach's alpha was 0.82 (range 0.80-0.85). Item-total score correlations were positive and significant (median 0.45, p <  0.01). The test-retest intraclass correlation coefficient was 0.68 (0.42-0.82). The factor analysis confirmed the three original factors: "perspective taking", "compassionate care" and "standing in the patient's shoes". Women and students who preferred specialities focused on persons obtained the best scores. The JSE-HP scores were positively correlated with Interpersonal Reactivity Index, personality traits were associated with empathy, clinical interview skills and Objective Structured Clinical Examinations. CONCLUSION: The results support the validity and reliability of JSE-HP applied to Spanish medical students.

Nuevos métodos de valoración de la enfermedad pulmonar obstructiva crónica, su adecuación a la evaluación del menoscabo y la incapacidad / New evaluating methods of chronic obstructive pulmonary disease: adaptation for damage and incapacity evaluation

La enfermedad pulmonar obstructiva crónica es la patología crónica respiratoria más frecuente y que con más frecuencia puede producir incapacidad. La manera tradicional de evaluar la gravedad de la enfermedad es mediante la espirometría. Pero la presentación clínica de la enfermedad no es homogénea y se conoce que no hay una buena correlación entre los resultados de la espirometría y la situación clínica real del enfermo. En los últimos años se han desarrollado procedimientos para evaluar la enfermedad combinando varios parámetros, o sea haciendo una evaluación multidimensional. Esto consigue predecir mucho mejor el pronóstico y la gravedad de la patología. Los médicos que hacemos evaluación de la incapacidad debemos conocer y manejar estas herramientas para hacer nuestras valoraciones más precisas. Se presentan dos de estas herramientas la derivada de la Iniciativa GOLD y la desarrollada en España, la GesEPOC. Se explica su aplicación y su uso en la evaluación de la incapacidad

Chronic obstructive pulmonary disease is the most common chronic respiratory disease and the one that most often can lead to disability. Spirometry is the traditional way to assess the severity of the disease. But its clinical presentation is not homogeneous and it is known that there is no good correlation between spirometry results and the clinical situation of the patient. In recent years, evaluating methods for the disease have been developed by combining certain parameters, i.e. making a multidimensional assessment. This way, the prognosis and severity of the disease is much better predicted. Physicians like us, who do assessment of disability, must know and manage these tools to make our accurate assessments. Two of these tools are given, the derivative of the GOLD Initiative and the one developed in Spain, the GesEPOC. This application and its use is further explained in the evaluation of the disability

Recurrent hematuria caused by nutcracker syndrome.

A 26-year-old woman presented to the emergency department complaining of left flank pain, and proteinuria and hematuria were detected during urinalysis. A renal ultrasound did not reveal any disorder, and after performing a computed tomography angiography scan, compression of the left renal vein between the superior mesenteric artery and the aorta was seen. This compression is known as Nutcracker syndrome. From among the different treatment options available, it was decided, with patient consensus, to use open surgical management, performing a transposition of the left renal vein to a more distal level in the inferior vena cava. The immediate postoperative care progressed without complications and the symptoms resolved; after 1 year of surveillance, the patient continues to be asymptomatic. Nutcracker syndrome is a rare phenomenon, with few cases described. There are different therapeutic options for the treatment of Nutcracker syndrome, such as open surgery, endovascular treatment, or conservative treatment; because of the low prevalence of this syndrome, there are no sufficiently large series at present or with the necessary long-term surveillance to decide on the most suitable treatment. Distal transposition of the left renal vein in the inferior cava vein has proved to offer good long-term results, and this option offers a higher chance of resolution without the need for as many postsurgery controls as would be required with endovascular treatment.

Primary photoprocesses in a fluoroquinolone antibiotic sarafloxacin.

The photophysical properties of the fluoroquinolone antibiotic sarafloxacin (SFX) were investigated in aqueous media. SFX in water, at pH 7.4, shows intense absorption with peaks at 272, 322 and 335 nm, (epsilon=36800 and 17000 dm3 mol(-1) cm(-1), respectively). Both the absorption and emission properties of SFX are pH-dependent; pKa values for the protonation equilibria of both the ground (5.8 and 9.1) and excited singlet states (5.7 and 9.0) of SFX were determined spectroscopically. SFX fluoresces weakly, the quantum yield for fluorescence emission being maximum (0.07) at pH 8. Laser flash photolysis and pulse radiolysis studies have been carried out in order to characterize the transient species of SFX in aqueous solution. Triplet-triplet absorption has a maximum at 610 nm with a molar absorption coefficient of 17,000+/-1000 dm3 mol(-1) cm(-1). The quantum yield of triplet formation has been determined to be 0.35+/-0.05. In the presence of oxygen, the triplet reacts to form excited singlet oxygen with quantum yield of 0.10. The initial triplet (3A*) was found to react with phosphate buffer to form triplet 3B* with lower energy and longer lifetime and having an absorption band centered at 700 nm. SFX triplet was also found to oxidize tryptophan to its radical with concomitant formation of the anion radical of SFX. Hence the photosensitivity of SFX could be initiated by the oxygen radicals and/or by SFX radicals acting as haptens.

Formation of secondary triplet species after excitation of fluoroquinolones in the presence of relatively strong bases.

Laser flash photolysis of 7-(piperazin-1-yl) fluoroquinolones leads to the formation of a triplet excited state (3A*) at the end of the pulse (lambdamax 520, 610, and 620 nm for enoxacin, ciprofloxacin, and norfloxacin, respectively). Phosphate and bicarbonate buffers react with 3A* to form a secondary triplet (3B*, reaction rates (0.8-9.9) x 108 M-1 s-1), whose T-T absorption is red-shifted (lambdamax 670 nm for enoxacin, 700 nm for ciprofloxacin and norfloxacin). The formation of a secondary triplet is not a common process and disagrees with previous work suggesting that electron transfer occurs between phosphate buffer and the primary triplet excited state with the formation of the anion radical of the fluoroquinolone (FQ.-). We have shown that the FQ.- transient absorption spectrum is quite distinct from that of 3B*. The photophysical characteristics of 3B* have been determined by energy transfer to naproxen, and it has been found that its energy is lower than that of 3A*.

Primary photophysical properties of moxifloxacin--a fluoroquinolone antibiotic.

The photophysical properties of the fluoroquinolone antibiotic moxifloxacin (MOX) were investigated in aqueous media. MOX in water, at pH 7.4, shows two intense absorption bands at 287 and 338 nm (epsilon = 44,000 and 17,000 dm(3) mol(-1) cm(-1), respectively). The absorption and emission properties of MOX are pH-dependent, pK(a) values for the protonation equilibria of both the ground (6.1 and 9.6) and excited singlet states (6.8 and 9.1) of MOX were determined spectroscopically. MOX fluoresces weakly, the quantum yield for fluorescence emission being maximum (0.07) at pH 8. Phosphorescence from the excited triplet state in frozen ethanol solution has a quantum yield of 0.046. Laser flash photolysis and pulse radiolysis studies have been carried out to characterize the transient species of MOX in aqueous solution. On laser excitation, MOX undergoes monophotonic photoionization with a quantum yield of 0.14. This leads to the formation of a long-lived cation radical whose absorption is maximum at 470 nm (epsilon(470) = 3400 dm(3) mol(-1) cm(-1)). The photoionization process releases hydrated electron which rapidly reacts (k = 2.8 x 10(10) dm(3) mol(-1) s(-1)) with ground state MOX, yielding a long-lived anion radical with maximum absorption at 390 nm (epsilon(390) = 2400 dm(3) mol(-1) cm(-1)). The cation radical of MOX is able to oxidize protein components tryptophan and tyrosine. The bimolecular rate constants for these reactions are 2.3 x 10(8) dm(3) mol(-1) s(-1) and 1.3 x 10(8) dm(3) mol(-1) s(-1), respectively. Singlet oxygen sensitized by the MOX triplet state was also detected only in oxygen-saturated D(2)O solutions, with a quantum yield of 0.075.

Estudio de prevalencia de isquemia crónica de miembros inferiores y de aneurisma de aorta abdominal en mayores de 65 años / A study of the prevalence of chronic ischaemia in the lower limbs and abdominal aortic aneurysms in persons over the age of 65

Introducción. El aumento de la expectativa de vida ha conducido a que patologías vasculares, especialmente prevalentes en el segmento de población con más edad, se hayan constituido en problemas de salud. Objetivo. Determinar la prevalencia de la isquemia crónica (IC) y de los aneurismas de aorta abdominal (AAA) infrarrenal en la población mayor de 65 años del Área Sanitaria V (Gijón) del Servicio de Salud del Principado de Asturias. Pacientes y métodos. Se diseña un estudio descriptivo transversal, incluyendo finalmente 232 pacientes, 114 hombres y 118 mujeres, seleccionados aleatoriamente a partir de los datos de la tarjeta sanitaria. Se les explora, se realiza un eco-Doppler de la aorta abdominal y se calcula el índice tobillo-brazo. Resultados. La prevalencia de la IC es del 9,9% y de un 2,6% para el AAA. Se desagregan los resultados por sexos y dos grupos de edad, de 65-74 años y mayores de 75. La prevalencia de la IC está seis puntos por encima en el grupo de los mayores de 75 años (13,4%) y la del AAA es más de siete veces superior (5,2%). Conclusión. La prevalencia es más elevada en los mayores de 75 años y los varones para la IC y el AAA, con diferencias estadísticamente significativas. Este estudio abre las puertas a un seguimiento de los integrantes de la muestra, que permita determinar la incidencia de las diversas patologías

Introduction. As life expectancy has increased, vascular pathologies, which are especially prevalent in the most elderly segment of the population, have become a health problem. Aim. To determine the prevalence of chronic ischaemia (CI) and infrarenal abdominal aortic aneurysms (AAA) in a population of persons over 65 years of age from Health Care District V (Gijón) of the Principality of Asturias Health Service. Patients and methods. A cross-sectional descriptive study was designed, which finally included 232 patients (114 males and 118 females) who were selected at random from the data contained in their health card. They were examined, submitted to a Doppler ultrasound scan of the abdominal aorta and their ankle-brachial index was calculated. Results. The prevalence of CI was found to be 9.9% and 2.6% for AAA. Results were broken down by sexes and two age groups: 65-74 years and over 75 years of age. The prevalence of CI was six points higher in the group of over 75s (13.4%) and that of AAA was seven times higher (5.2%). Conclusions. For CI and AAA, prevalence was higher in persons over 75 years old and males, with statistically significant differences. This study opens the way to a follow-up of the participants in the sample, which would allow us to determine the incidence of several different pathologies

Comparative study of atomic fluorescence spectroscopy and inductively coupled plasma mass spectrometry for mercury and arsenic multispeciation.

Mercury and arsenic are two elements of undoubted importance owing to their toxic character. Although speciation of these elements has been developed separately, in this work for the first time the speciation of As and Hg using two atomic fluorescence detectors in a sequential ensemble is presented. A coupling based on the combination of high-performance liquid chromatography (where mercury and arsenic species are separated) and two atomic fluorescence detectors in series, with several online treatments, including photooxidation (UV) and hydride generation, has allowed the determination of mercury and arsenic compounds simultaneously. The detection limits for this device were 16, 3, 17, 12 and 8 ng mL(-1) for As(III), monomethylarsinic acid, As(V), Hg2+ and methylmercury, respectively. This coupling was compared with an analogous one based on inductively coupled plasma-mass spectrometry (ICP-MS) detection, with detection limits of 0.7, 0.5, 0.8, 0.9 and 1.1 ng mL(-1), respectively. Multispeciation based on ICP-MS exhibits better sensitivity than the coupling based on tandem atomic fluorescence, but this second device is a very robust system and exhibits obvious advantages related to the low cost of acquisition and maintenance, as well as easy handling, which makes it a suitable system for routine laboratories.

Diagnosis hidrogeologica aplicada a problemas de fundaciones en el parque industrial Tandil

El trabajo marca la importancia de los estudios de geologia basica como herramienta en las tareas de planeamiento para el asentamiento urbano e industrial.Como consecuencia de la falta de estos estudios,fueron detectados inconvenientes fundacionales en el Parque Industrial Tandil,lo que obligo a una planificacion racional del espacio en base a la caracterizacion geologica e hidrogeologica del terreno