Conversion of the etiology of autoimmune hemolytic anemia / Conversión de etiología de anemia hemolítica autoinmune

Autoimmune hemolytic anemia (AIHA) is disorder that involves the destruction of erythrocytes, differentiating between warm AIHA (WAIHA) with extravascular hemolysis mediated by IgG, cold agglutinin disease (CAD) with intravascular hemolysis mediated by IgM/Cd3 or mixed AIHA. Treatment of WAIHA consists of corticosteroids, immunoglobulins, rituximab, immunosuppressants, cyclophosphamide and splenectomy, whereas in CAD the response to corticosteroids is low.The 46-year-old patient came to the emergency department with a drop of 4.5 hemoglobin points in 15 days, associated with tachycardia, muco-cutaneous pallor and dyspnea. After analytical parameters compatible with AIHA and Coombs test Cd3+/IgM-, a diagnosis of CAD was made and rituximab and warm transfusion support were started. When intravascular haemolysis intensified, intravenous immunoglobulin, plasmapheresis and darbepoetin alpha were associated with no clinical improvement, later receiving bortezomib as third line and eculizumab due to refractoriness. The Coombs’ test was repeated, with a result compatible with WAIHA and slight splenomegaly associated due to extravascular hemolysis, so a splenectomy was performed achieving stabilization of analytical parameters and allowing the patient to be discharged. This clinical case evidences a conversion in the etiology of AIHA, with initial diagnosis of CAD since Coombs’ test was Cd3+/IgG- and converted to WAIHA after 37 days of admission since Coombs’ test changed to Cd3-/IgG+. (AU)

La anemia hemolítica autoinmune (AIHA) es una patología que conlleva la destrucción de eritrocitos, diferenciando entre AIHA por anticuerpos calientes (WAIHA) con hemólisis extravascular por IgG, AIHA por crioaglutininas (CAD) con hemólisis intravascular por IgM/Cd3 o AIHA mixtas. El tratamiento de AIHA por anticuerpos calientes consiste en corticoides, inmunoglobulinas, rituximab, inmunosupresores, ciclofosfamida y esplenectomía, mientras que en AIHA por crioaglutininas la respuesta a corticoides es baja. La paciente de 46 años acudió a urgencias con caída de 4,5 puntos de hemoglobina en 15 días, asociando taquicardia, palidez y disnea. Tras parámetros analíticos compatibles con AIHA y test de Coombs Cd3+/IgM- se diagnosticó de CAD e inició rituximab y transfusiones con calentador. Ante una intensificación de la hemólisis intravascular se asoció inmunoglobulina intravenosa, plasmaféresis y darbepoetina alfa sin mejoría clínica, recibiendo posteriormente bortezomib como tercera línea y eculizumab ante refractariedad. Se repitió el test de Coombs evidenciando en ese momento un diagnóstico por WAIHA, con ligera esplenomegalia asociada a la hemólisis extravascular, por lo que se realizó una esplenectomía alcanzando una estabilización de los parámetros analíticos y permitiendo el alta de la paciente. Este caso clínico evidencia una conversión en la etiología de la AIHA, con diagnóstico inicial de CAD ante test de Coombs Cd3+/IgG- y cambio a WAIHA después de 37 días de ingreso ante Coombs Cd3-/IgG+. (AU)

Cetylpyridinium Chloride Mouthwash to Reduce Shedding of Infectious SARS-CoV-2: A Double-Blind Randomized Clinical Trial.

The airborne transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) via respiratory fluids and droplets suggests that mouthwashes containing substances with virucidal activity can help reduce viral spread. We conducted a multicenter, double-blind, placebo-controlled, randomized trial to assess the virucidal activity of cetylpyridinium chloride (CPC) mouthwashes. Outpatients who tested positive for SARS-CoV-2 infection with or without symptoms were randomized to perform washes and gargles for 1 min with 15 mL of either colored distilled water or 0.07% CPC (Vitis CPC Protect) mouthwash. The study outcomes were the SARS-CoV-2 log10 viral RNA load and the nucleocapsid protein levels, both in saliva at 1 and 3 h after the intervention. In total, 118 patients were enrolled and randomized (mean [SD], age 46 [14] y). Thirteen of 118 participants (11%) did not complete follow-up or had insufficient sample volume for testing and were excluded from the analysis. The assessment of the viral load showed no significant differences between groups at any of the investigated points. However, the levels of SARS-CoV-2 nucleocapsid protein of lysed viruses were significantly higher in the CPC group compared with the control group at 1 h (adjusted difference 269.3 pg/mL; 95% confidence interval [CI], 97.1-441.5) and at 3 h postintervention (561.1 pg/mL; 95% CI, 380.0-742.2). In nonhospitalized patients with asymptomatic or mild symptomatic SARS-CoV-2 infection, a 0.07% CPC mouthwash, compared to placebo, was associated with a significant increase of nucleocapsid protein levels in saliva, indicating enhanced disruption of viral particles.

Recommendations for eye care during the alarm state by the coronavirus disease pandemic COVID-19. / Recomendaciones para la atención oftalmológica durante el estado de alarma por la pandemia de enfermedad por coronavirus COVID-19.

OBJECTIVE: Minimize exposure to the SARS-CoV-2, reduce the chances of cross-transmission between patients and healthcare personnel, and prevent the development of postoperative complications from the management of patients with eye diseases during the 2019 coronavirus disease pandemic (COVID-19). METHODS: COVID-19 literature review and consensus establishment between different Spanish ophthalmology societies in order to provide guidelines and recommendations of maximum resources primarily conditioned by the state of alert, confinement and social distancing that occurs in Spain since March 16, 2020. RESULTS: The recommendations will promote the adoption of action and protection measures for eye care in outpatient clinics, surgical areas and hospitalization, for unconfirmed (asymptomatic and symptomatic) and confirmed COVID-19 patients. Measures must be adapted to the circumstances and availability of personal protective equipment in each of the centers and Autonomous Communities, which will be updated according to the pandemic phases and the measures adopted by the Spanish Government. CONCLUSIONS: During the COVID-19 pandemic, attention to the potential health risks to the population caused by coronavirus should prevail over the possible progression of the common eye diseases. Ophthalmologists and other eye care professionals must assume a possible progression of these diseases due to the impossibility of adequate patient follow-up.

Giant retroperitoneal sarcoma: case report.

OBJECTIVE: To report a new case of giant retroperitoneal mass with silent beginning. METHODS: We present the case of a 36 year old man with a giant retroperitoneal liposarcoma 35 × 15 cm in size. The only symptom was a one month history of minimal abdominal pain. CONCLUSION: Liposarcoma is the most frequent retroperitoneal mass. In most of the cases clinical symptoms are silent, being this the reason why diagnosis is late and the size is large. The best image options are CT scan or MRI but final diagnosis is based on pathology results. Its treatment is surgery and relapse is very usual.

Liposarcoma retroperitoneal gigante: presentación de un nuevo caso / Giant retroperitoneal sarcoma: case report

OBJETIVO: Presentar un nuevo caso de masa retroperitoneal gigante. MÉTODOS: Se presenta el caso de un varón de 36 años con un liposarcoma retroperitoneal gigante de 35 x 15 cm cuyo único síntoma actual es una molestia abdominal de un mes de evolución. CONCLUSIÓN: El liposarcoma supone la masa retroperitoneal más frecuente, dando lugar en la mayoría de los casos a una sintomatología silente, lo que implica un retraso en su diagnóstico y un gran incremento en su tamaño. Las pruebas de imagen más concluyentes son la Tc o la Rmn pero el diagnóstico de certeza es histológico. Su tratamiento es quirúgico, el objetivo es la exéresis completa pero la recidiva es la norma(AU)

OBJECTIVE: To report a new case of giant retroperitoneal mass with silent beginning. METHODS: We present the case of a 36 year old man with a giant retroperitoneal liposarcoma 35 x 15 cm in size. The only symptom was a one month history of minimal abdominal pain. CONCLUSION: Liposarcoma is the most frequent retroperitoneal mass. In most of the cases clinical symptoms are silent, being this the reason why diagnosis is late and the size is large. The best image options are CT scan or MRI but final diagnosis is based on pathology results. Its treatment is surgery and relapse is very usual(AU)

Non-specific binding of Na+ and Mg2+ to RNA determined by force spectroscopy methods.

RNA duplex stability depends strongly on ionic conditions, and inside cells RNAs are exposed to both monovalent and multivalent ions. Despite recent advances, we do not have general methods to quantitatively account for the effects of monovalent and multivalent ions on RNA stability, and the thermodynamic parameters for secondary structure prediction have only been derived at 1M [Na(+)]. Here, by mechanically unfolding and folding a 20 bp RNA hairpin using optical tweezers, we study the RNA thermodynamics and kinetics at different monovalent and mixed monovalent/Mg(2+) salt conditions. We measure the unfolding and folding rupture forces and apply Kramers theory to extract accurate information about the hairpin free energy landscape under tension at a wide range of ionic conditions. We obtain non-specific corrections for the free energy of formation of the RNA hairpin and measure how the distance of the transition state to the folded state changes with force and ionic strength. We experimentally validate the Tightly Bound Ion model and obtain values for the persistence length of ssRNA. Finally, we test the approximate rule by which the non-specific binding affinity of divalent cations at a given concentration is equivalent to that of monovalent cations taken at 100-fold concentration for small molecular constructs.

The effects of manual therapy and exercise directed at the cervical spine on pain and pressure pain sensitivity in patients with myofascial temporomandibular disorders.

No studies have investigated the effects of the treatments directed at the cervical spine in patients with temporomandibular disorders (TMD). Our aim was to investigate the effects of joint mobilization and exercise directed at the cervical spine on pain intensity and pressure pain sensitivity in the muscles of mastication in patients with TMD. Nineteen patients (14 females), aged 19-57 years, with myofascial TMD were included. All patients received a total of 10 treatment session over a 5-week period (twice per week). Treatment included manual therapy techniques and exercise directed at the cervical spine. Outcome measures included bilateral pressure pain threshold (PPT) levels over the masseter and temporalis muscles, active pain-free mouth opening (mm) and pain (Visual Analogue Scale) and were all assessed pre-intervention, 48 h after the last treatment (post-intervention) and at 12-week follow-up period. Mixed-model anovas were used to examine the effects of the intervention on each outcome measure. Within-group effect sizes were calculated in order to assess clinical effect. The 2 x 3 mixed model anova revealed significant effect for time (F = 77.8; P < 0.001) but not for side (F = 0.2; P = 0.7) for changes in PPT over the masseter muscle and over the temporalis muscle (time: F = 66.8; P < 0.001; side: F = 0.07; P = 0.8). Post hoc revealed significant differences between pre-intervention and both post-intervention and follow-up periods (P < 0.001) but not between post-intervention and follow-up period (P = 0.9) for both muscles. Within-group effect sizes were large (d > 1.0) for both follow-up periods in both muscles. The anova found a significant effect for time (F = 78.6; P < 0.001) for changes in pain intensity and active pain-free mouth opening (F = 17.1; P < 0.001). Significant differences were found between pre-intervention and both post-intervention and follow-up periods (P < 0.001) but not between the post-intervention and follow-up period (P > 0.7). Within-group effect sizes were large (d > 0.8) for both post-intervention and follow-up periods. The application of treatment directed at the cervical spine may be beneficial in decreasing pain intensity, increasing PPTs over the masticatory muscles and an increasing pain-free mouth opening in patients with myofascial TMD.

Surface AFM microscopy of unworn and worn samples of silicone hydrogel contact lenses.

PURPOSE: To evaluate the qualitative and quantitative topographic changes in the surface of worn contact lenses (CLs) of different materials using atomic force microscopy (AFM). METHODS: The topography of five different CL materials was evaluated with AFM over a surface of 25 microm(2) according to previously published experimental setup. Average roughness (R(a)) and root mean square (Rms) values were obtained for unworn and worn samples. RESULTS: The R(a) value increased for balafilcon A (11.62-13.68 nm for unworn and worn samples, respectively), lotrafilcon A (3.67-15.01 nm for unworn and worn samples, respectively), lotrafilcon B (4.08-8.42 nm for unworn and worn samples, respectively), galyfilcon A (2.81-14.6 nm for unworn and worn samples, respectively), and comfilcon A (2.87-4.63 nm for unworn and worn samples, respectively). Differences were statistically significant for all lenses except Rms and R(a) for comfilcon A, and R(a) parameter for balafilcon A (p > 0.05). The least relative increase was observed for some balafilcon A samples and for some of these samples the roughness decreased after the lenses had been worn. CONCLUSION: The changes in surface roughness between unworn and worn lenses are different for different silicone-hydrogel materials. Overall all CLs increased the degree of surface roughness after being worn, even for very short periods of time. However, for samples of balafilcon A, roughness increases at a lower extent or even can decrease as compared to unworn samples of the same material due to filling of the macropores.

Dynamic in vitro dehydration patterns of unworn and worn silicone hydrogel contact lenses.

PURPOSE: To evaluate the effect of wear on dynamic in vitro dehydration of silicone hydrogel (Si-Hi) contact lens (CL) using a previously described gravimetric procedure. METHODS: Five different silicone hydrogel (Si-Hi) contact lenses (CL) were evaluated after being worn by patients under daily wear conditions for 15 days to 1 month. Lenses were conditioned and disinfected with a multipurpose solution after each day of wear. Lenses were left to dehydrate in an analytical balance under controlled conditions of temperature and relative humidity and the results compared with data from new lens samples of the same power and material. Several quantitative parameters were obtained and compared between worn and unworn samples. RESULTS: The quantitative parameters derived from the dehydration curves showed statistically significant differences between worn and unworn lenses regarding the initial dehydration rate and ability to maintain their original hydration. Worn lenses showed shorter phase I duration (decreased by 30 to 60% compared to unworn samples), a significantly faster initial dehydration rate (increased by about 1%/minute), and lower water retention index (decreased by 10 to 20%) as derived from the initial cumulative dehydration. All the differences were statistically significant for all lenses (p < 0.05). CONCLUSION: The initial dehydration rates were significantly increased in all CL after wear. This could be of clinical interest because it represents the average initial dehydration rates during the first moments when the lens is left to dehydrate after a blink. This study suggests that even after the lenses had been equilibrated in saline solution for several days, the materials lose their ability to retain water.

First Report of Globodera rostochiensis in Mallorca Island, Spain.

Potato (Solanum tuberosum) is one of the most important crops in the Balearic Islands with a yield of 35,000 t in 2004, distributed in 1,100 ha and mostly located in the Sa Pobla Region of Mallorca Island. Potato cyst nematode (PCN) species are widespread in potato crop regions of the Iberian Peninsula and Canary Islands, but only Globodera pallida is known to be present in Sa Pobla (1) where it causes significant yield reductions if it is not properly managed. In the spring of 2000, goldencolored females were detected in several root samples of plant potatoes. In 2001, 2002, and 2003, soil and root samples were collected at harvest from 28 fields to identify and quantify PCN species in this area. According to the European Plant Protection Organization (EPPO) diagnostic protocol, the identification of Globodera spp. populations was based on: (i) morphological and morphometrics characteristics of cyst vulval area and stylets of second-stage juveniles; (ii) protein electrophoresis patterns by isoelectric focusing (2); and (iii) DNA analysis by random amplified polymorphic DNA polymerase chain reaction techniques (2). PCN infestation was detected in 16 potato fields sampled. Mixed populations of G. rostochiensis and G. pallida were found in 14 fields distributed all around Sa Pobla, while two fields contained only G. pallida. The proportion of G. rostochiensis in mixed populations was low, rarely exceeding 20%. The origin of G. rostochiensis introduction in Mallorca is unknown since there is no direct link with other potato-growing areas of Spain. To our knowledge, this is the first report of G. rostochiensis in the Balearics Islands. The identification of G. rostochiensis in the Sa Pobla potato-production fields is very important for the development of a successful integrated pest management (IPM) program in this region. References: (1) M. L. Martinez-Beringola et al. Nematol. Medit. 15:183, 1987. (2) S. K. Ibrahim et al. Pest Manag. Sci. 57:1068, 2001.

Biological oxygen apparent transmissibility of hydrogel contact lenses with and without organosilicon moieties.

The instrument oxygen transmissibility (IOT) of organosilicon hydrogels, measured by electrochemical procedures, is 5-10 times larger than that of conventional hydrogels. A method is described that allows the estimation of the oxygen tension at the lens-cornea interface for closed- and open-eyelids situations by combining the IOT of the hydrogels and corneal parameters such as corneal thickness, corneal permeability and oxygen flux across the cornea. From these results the biological oxygen apparent transmissibility (BOAT) is obtained, an important parameter which an multiplication with the pressure of oxygen on the external part of the lens gives the oxygen flux onto the cornea. Contact lenses with oxygen transmissibility higher than 100 Dk/t units [1 Dk/t unit=10(-9) [cm(3) O(2) (STp) cm(-2)s(-1)(mmHg)(-1)] posses a large oxygen tension at the lens-cornea interface that substantially reduces the oxygen flux onto the cornea. Lenses whose oxygen transmissibility is lower than 50 Dk/t units allow a rather small oxygen flux onto the cornea under closed eyelids condition that prevent their use for extended wear.

Presence in the Balearic Islands (Spain) of the midges Culicoides imicola and Culicoides obsoletus group.

An outbreak of the livestock viral disease bluetongue (BT) was detected during September and October 2000 in the Balearic Islands, Spain. Due to the lack of information about the species of Culicoides (Diptera: Ceratopogonidae) reported in the affected area, six farms in Majorca, four in Minorca and one in Ibiza were selected to carry out surveillance of Culicoides adults using light traps. Here, for the first time, we report the presence in the Balearic Islands of Culicoides imicola Keiffer, the main vector of BT, and the Culicoides obsoletus Meigen group.

[Recent psychophysical deterioration in the elderly patient: a potentially severe medical emergency. Assessment and attitudes]. / Deterioro psicofísico reciente en ancianos: una urgencia médica potencialmente grave. Valoración y actitudes.

An atypical presentation of diseases is common in the elderly patient. Also, a number of conditions in the elderly are commonly associated with deterioration of the functional status, that is, the independence level for daily life activities. This loss of autonomy occasionally calls the physicians attention, masking other symptoms. On the other hand, the high prevalence of social problems in the elderly adds a distorting element to the clinical evaluation of the patient. Four patients with a main complaint of recent physical and psychical deterioration are here reported. The complementary tests were inconclusive and patients were classified as social problems, thus posing the problem of home discharge. All patients were later demonstrated to have potentially severe conditions amenable to hospital admission (hypothyroidism, meningitis, arrhythmia, which prompted the implantation of a pacemaker, and digital intoxication). The recent loss of autonomy should be considered as a potentially severe medical emergency among the elderly. Failure to identify this problem may lead to minimizing the symptoms and overestimating the social problems, thus leading to inappropriate hospital discharges.

Deterioro psicofísico reciente en ancianos: una urgencia médica potencialmente grave. Valoración y actitudes / Recent psychophysical deterioration in the elderly patient: a potentially severe medical emergency. Assessment and attitudes

La presentación atípica de las enfermedades es frecuente en pacientes de edad avanzada. Asimismo, en los ancianos muchos procesos se acompañan con frecuencia de deterioro en la capacidad funcional, entendiendo como tal el nivel de independencia para las actividades de la vida diaria. Esta pérdida de la autonomía en ocasiones puede acaparar toda la atención, enmascarando el resto de síntomas. Por otra parte, la alta prevalencia de problemas sociales en ancianos añade un elemento distorsionador en la valoración clínica del caso. Se presentan 4 pacientes ancianos cuyo motivo principal de consulta a urgencias fue un deterioro reciente físico y psíquico en sus capacidades. Las exploraciones complementarias no fueron concluyentes y fueron catalogados de 'problemas sociales', planteándose el alta al domicilio. Posteriormente se demostró que todos tenían enfermedades potencialmente graves y susceptibles de ingreso hospitalario (hipotiroidismo, meningitis, arritmia que requirió marcapasos e intoxicación digitálica). La pérdida reciente de la autonomía debe ser considerada como una urgencia médica potencialmente grave en pacientes ancianos. La no identificación de este problema puede llevar a la minimización de los síntomas y a la sobrevaloración de la problemática social, pudiéndose producir altas hospitalarias inadecuadas. (AU)

Evaluación clínica objetiva y estructurada en geriatría. Resultados del primer proyecto realizado en España / Objetive and structured clinical evaluation in geriatrics. Results of the first project performed in Spain

OBJETIVO: Presentar los resultados de la primera prueba piloto de evaluación clínica objetiva y estructurada (ECOE) para evaluar los conocimientos y habilidades en geriatría desarrollada por la Sociedad Catalano-Balear de Geriatría y Gerontología (SCBGG) .MATERIAL Y MÉTODOS: Expertos de la SCBGG, con el asesoramiento técnico del Institut d'Estudis de la Salut (IES), diseñaron la prueba que consistió en un circuito de 22 situaciones clínicas paradigmáticas de la especialidad y en las que se utilizaron diversos instrumentos evaluativos. Participaron voluntariamente 38 médicos invitados por la SCBGG, que al finalizarla cumplimentaron un cuestionario de opinión a propósito de la misma. Para el análisis de los datos se utilizó el programa estadístico SPSS/PC+ para Windows. RESULTADOS: La puntuación media (desviación estándar [DE]) en la edición de 2000 fue de 52,6 (5,8) y en la de 2001, de 49,1 (8,6). El estadístico alfa de Cronbach (coeficiente global de fiabilidad) fue de 0,71 en la primera y de 0,84 en la segunda. En 2001 se realizó el análisis de resultados según la formación de los participantes, y obtuvieron mejores resultados aquellos formados por vía MIR. La opinión de los participantes en las dos ediciones fue muy positiva. CONCLUSIONES: La primera prueba ECOE en geriatría se presenta como un método evaluativo de la competencia profesional fiable, válido, factible y bien aceptado por los profesionales que han participado en ella (AU)

Oxygen permeability of hydrogel contact lenses with organosilicon moieties.

Oxygen transport through two extended wear (day and night) hydrogel contact lenses that contain organosilicon moieties (balafilcon A and lotrafilcon A) was studied in the hydrate (hydrogel) and dry (xerogel) states. The water uptake increased the oxygen permeability [(Dk)app] and transmissibility [Dk/L(av)] coefficients of the dry materials by about 70%. The (Dk)app for the hydrated lenses was determined following the so-called stack procedure. The values obtained were 107 +/- 4 barrer for balafilcon A and 141 +/- 5 barrer for lotrafilcon A, about 5-10 times larger than those previously reported for conventional (without organosilicon moieties) extended wear hydrogels contact lenses. The Dk/L(av) for -3.00 diopter lenses (harmonic average thickness, L(av) = 75 +/- 2 microm for lotrafilcon, and 85 +/- 2 microm for balafilcon) was 123 +/- 6 barrer/cm for balafilcon A and 183 +/- 8 barrer/cm for lotralicon A. The minimum oxygen transmissibility 87 barrer/cm stipulated by Holden and Mertz to avoid corneal edema with extended wear contact can be easily achieved with lotrafilcon and balafilcon lenses of diverse dioptric powers if the central and peripheral thickness of the lenses are kept below the critical level of oxygen transmissibility.

Corticosteroid-binding globulin synthesis and distribution in rat white adipose tissue.

Corticosterone binding (CB) capacity was determined in visceral and subcutaneous white adipose tissue (WAT), as well as in plasma of lean Zucker rats. Perfusion of rats with saline eliminated most liver and kidney corticosterone binding but did not affect CB in WAT. The cytosol extracts of isolated cells, however, did not bind corticosterone in detectable amounts. By means of a RT-PCR procedure it was found that corticosterone-binding globulin (CBG) was expressed in WAT. By immunohistochemical detection in WAT sections, CBG was seen in a thin layer surrounding the cells near the plasma membrane. These data suggest that the CBG layer surrounding the cells may act as a protective barrier limiting the access of glucocorticoids to adipocytes.

Comparative study of the hydration of hydrophilic contact lenses by refractive index and gravimetry.

PURPOSE: To compare the percent hydration by wet weight of hydrogel contact lenses given by the manufacturers with the values obtained using the refractive index and the gravimetry methods. METHODS: We used a Valentine refractometer to determine the refractive index of new hydrogel contact lenses at equilibrium swelling in the original solution and container. From the refractive indexes we then obtained the percent hydration of the lenses using a previously prepared graph of refractive index vs percent hydration of saccharose in a phosphate buffer solution (pH 7.0). We used an electronic analytical balance of 0.01 mg resolution to obtain the weights of new lenses when dry and at equilibrium swelling dry, and calculated the percent hydration of the lenses from the difference of the wet and dry weights. RESULTS: The hydration values of the contact lenses obtained from the index of refraction differed more than those obtained by gravimetry from the values given by the manufacturers. Acuvue lenses were an exception-the difference for them was negligible. CONCLUSION: Gravimetry is more accurate, but more cumbersome and time-consuming than the index of refraction for the determination of the hydration of the hydrogel contact lenses. However, when a fast and easy method is required to obtain the approximate hydration of hydrogel contact lenses, the use of the refractive index method can give acceptable results for most applications.

Ancianos en los servicios de urgencias: ¿problema sanitario o social? / Elderly patients in the emergency department: sanitary or social problem?

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