Comparison of Cardiovascular Risk and Events among Spanish Patients with and without Ocular Pseudoexfoliation.

The purpose of this study was to calculate and compare individual cardiovascular risk (CVR) and the development of cardiovascular events and mortality in patients with and without ocular pseudoexfoliation (PEX). A cohort study was carried out to compare two groups of patients who underwent cataract surgery: patients with (n = 99) and without PEX (n = 239). The CVR factors were recorded for all the subjects, and CVR was calculated for each individual using ERICE risk assessment charts. After a six-year follow-up, the cardiovascular events and mortality rates were compared between the two groups. The mean CVR was 36.41% in the PEX group and 33.72% in the non-PEX group (p = 0.13). High blood pressure was detected in significantly more PEX patients (71.4%) than non-PEX patients (58.6%, p = 0.035), yet no differences were found in the other CVR factors. The prevalence of cardiovascular events in the PEX and non-PEX patients was 17.1% and 12.5%, respectively (p = 0.26), with 5% of patients in the PEX group and 5% in the non-PEX group suffering an acute coronary event (p = 0.9). Moreover, 12% of the PEX patients and 7.5% of the non-PEX patients experienced a stroke (p = 0.17), and the six-year mortality rate was 29.3% in the PEX group and 25.9% in the non-PEX group (p = 0.52). PEX was associated with high blood pressure in our cohort of patients, although cardiovascular risk was not shown to be higher in this group. In addition, patients with PEX did not experience more cardiovascular events or have a higher mortality rate than patients without PEX during the period studied.

Recommendations for ophthalmologic practice during the easing of COVID-19 control measures.

In the context of the COVID-19 pandemic, this paper provides recommendations for medical eye care during the easing of control measures after lockdown. The guidelines presented are based on a literature review and consensus among all Spanish Ophthalmology Societies regarding protection measures recommended for the ophthalmologic care of patients with or without confirmed COVID-19 in outpatient, inpatient, emergency and surgery settings. We recommend that all measures be adapted to the circumstances and availability of personal protective equipment at each centre and also highlight the need to periodically update recommendations as we may need to readopt more restrictive measures depending on the local epidemiology of the virus. These guidelines are designed to avoid the transmission of SARS-CoV-2 among both patients and healthcare staff as we gradually return to normal medical practice, to prevent postoperative complications and try to reduce possible deficiencies in the diagnosis, treatment and follow-up of the ophthalmic diseases. With this update (5th ) the Spanish Society of Ophthalmology is placed as one of the major ophthalmology societies providing periodic and systematized recommendations for ophthalmic care during the COVID-19 pandemic.

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

OBJETIVO: Minimizar la exposición al virus SARS-CoV-2, reducir las posibilidades de transmisión cruzada entre pacientes y personal sanitario, y evitar el desarrollo de complicaciones postoperatorias por la atención a pacientes con enfermedades oculares durante la pandemia de Enfermedad por Coronavirus 2019 (COVID-19). MÉTODOS: Elaboración de un documento de revisión del estado del conocimiento sobre COVID-19 y consenso entre diferentes sociedades oftalmológicas españolas y afines, al objeto de proporcionar guías y recomendaciones de máximos recursos primariamente condicionadas por el estado de alerta, confinamiento y distanciamiento social que acontece en España desde el 16 de marzo de 2020. RESULTADOS: Las recomendaciones promoverán la adopción de medidas de actuación y protección para el desarrollo de la actividad asistencial en consultas externas, área quirúrgica y hospitalización, tanto para pacientes no confirmados - asintomáticos y sintomáticos - como confirmados de COVID-19. Deberán ser adaptadas a las circunstancias y disponibilidad de Equipos de Protección Individual (EPI) en cada uno de los Centros y Comunidades Autónomas, debiendo ser actualizadas en función de las fases de la pandemia y de las medidas que adopte el Gobierno de la Nación. CONCLUSIONES: Durante la pandemia COVID-19, la atención a los potenciales riesgos de salud para la población ocasionados por el coronavirus deberá prevalecer sobre la posible progresión de enfermedades oculares comunes. Tanto médicos oftalmólogos como restantes profesionales de la salud ocular deberán asumir una posible progresión de dichas enfermedades ante la imposibilidad de un seguimiento adecuado de los pacientes

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 máximum 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 (PPE) 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

Influence of depth of neuromuscular blockade on surgical conditions during low-pressure pneumoperitoneum laparoscopic cholecystectomy: A randomized blinded study.

STUDY OBJECTIVE: To evaluate the influence of neuromuscular blockade (NMB) on surgical conditions during low-pressure pneumoperitoneum (8mmHg) laparoscopic cholecystectomy (LC), while comparing moderate and deep NMB. Secondary objective was to evaluate if surgical conditions during low-pressure pneumoperitoneum LC performed with deep NMB could be comparable to those provided during standard-pressure pneumoperitoneum (12mmHg) LC. DESIGN: Prospective, randomized, blinded clinical trial. SETTING: Operating room. PATIENTS: Ninety ASA 1-2 patients scheduled for elective LC. INTERVENTIONS: Patients were allocated into 3 groups: Group 1: low-pressure pneumoperitoneum with moderate-NMB (1-3 TOF), Group 2: low-pressure pneumoperitoneum with deep-NMB (1-5 PTC) and Group 3: standard pneumoperitoneum (12mmHg). Rocuronium was used to induce NMB and acceleromiography was used for NMB monitoring (TOF-Watch-SX). MEASUREMENTS: Three experienced surgeons evaluated surgical conditions using a four-step scale at three time-points: surgical field exposure, dissection of the gallbladder and extraction/closure. MAIN RESULTS: Low-pressure pneumoperitoneum (Group 1 vs. 2): good conditions: 96.7 vs. 96.7%, 90 vs. 80% and 89.6 vs. 92.3%, respectively for the time-points, p>0.05. No differences in optimal surgical conditions were observed between the groups. Surgery completion at 8mmHg pneumoperitoneum: 96.7 vs. 86.7%, p=0.353. Standard-pressure pneumoperitoneum vs. low-pressure pneumoperitoneum with deep NMB (Group 3 vs. 2): good conditions: 100% in Group 3 for the three time-points (p=0.024 vs. Group 2 at dissection of the gallbladder). Significantly greater percentage of optimal conditions during standard-pressure pneumoperitoneum LC at the three time points of evaluation. CONCLUSIONS: The depth of NMB was found not to be decisive neither in the improvement of surgical conditions nor in the completion of low-pressure pneumoperitoneum LC performed by experienced surgeons. Surgical conditions were considered better with a standard-pressure pneumoperitoneum, regardless of the depth of NMB, than during low-pressure pneumoperitoneum with deep NMB.

Effect of depth of neuromuscular blockade on the abdominal space during pneumoperitoneum establishment in laparoscopic surgery.

STUDY OBJECTIVE: To evaluate the effect of neuromuscular blockade (NMB) upon the abdominal space during pneumoperitoneum establishment in laparoscopic surgery, comparing moderate NMB and deep NMB. DESIGN: Prospective, randomized, crossover clinical trial. SETTING: Operating room. PATIENTS: Seventy-six American Society of Anesthesiologists 1 to 2 patients scheduled for elective laparoscopic surgery. INTERVENTIONS: Two independent evaluations were performed at the establishment of pneumoperitoneum for a preset intraabdominal pressures (IAPs) of 8 and 12 mm Hg, both during moderate NMB (train-of-four count, 1-3) and deep NMB (posttetanic count, <5). Rocuronium was used to induce NMB, and sugammadex was used for reversal. MEASUREMENTS: We evaluated (i) the volume of CO2 introduced in 41 patients and (ii) the skin-sacral promontory distance in 35 patients, at pneumoperitoneum establishment. RESULTS: Compared to moderate NMB, deep NMB increased, in a significant manner, both the intraabdominal volume of CO2 insufflated (mean [SD], 2.24 [1.10] vs 2.81 [1.13] L at 8 mm Hg IAP, P<.001, and 3.52 [1.31] vs 4.09 [1.31] L at 12 mm Hg IAP, P<.001) and the skin-sacral promontory distance (11.78 [1.52] vs 12.16 [1.51] cm at 8 mm Hg IAP, P=.002, and 13.34 [1.87] vs 13.80 [1.81] cm at 12 mm Hg IAP, P<.001). Increase in intraabdominal volume after inducing deep NMB was observed in 88% and 81.7% of patients at 8 and 12 mm Hg pneumoperitoneum, with a volume increase of mean of 36.8% (95% confidence interval [CI], 22.8-50.8) and 25% (95% CI, 13.7-36.4), respectively (P=.003). Increase in distance was observed in 61% and 82% of patients at 8 and 12 mm Hg pneumoperitoneum, with a mean distance increase of 3.3% (95% CI, 1.3-5.4) and 3.6% (95% CI, 1.9-5.2), respectively (P=.840). CONCLUSIONS: Deep NMB, in comparison to moderate NMB, increased in a significant manner the abdominal space at pneumoperitoneum establishment. However, the effective increase in the abdominal cavity dimensions could be low, the increase showed a great interindividual variability, and it was not observed in every patient. Clinical significance of this increase on surgical conditions is yet to be demonstrated.

Hemibalismo secundario a descompensación hiperglucémica hiperosmolar / Hemiballism due to hyperglycemic hyperosmolar syndrome

El síndrome hiperglucémico hiperosmolar no cetósico (SHNC) se ha asociado con diversas alteraciones neurológicas, incluidos los trastornosd el movimiento. Es la segunda causa más frecuente de hemicoreahemibalismo, que se produce como consecuencia de la afectación delputamen contralateral. Presentamos a una paciente de 95 años con un SHNC que desarrolló un hemibalismo secundario a una lesión putaminal (AU)

Non-ketotic hyperglycemia has occasionally been associated with various neurological abnormalities including movement disorders. Hyperglycemichyperosmolar syndrome (HHS) is the second most common cause of hemiballism-hemichorea, which is due to acontralateral putaminal lesion. We describea 95-year-old woman with HHS who developed hemichorea-hemiballism syndrome due to a putaminal lesión (AU)

Hemiballism due to hyperglycemic hyperosmolar syndrome.

Non-ketotic hyperglycemia has occasionally been associated with various neurological abnormalities including movement disorders. Hyperglycemic hyperosmolar syndrome (HHS) is the second most common cause of hemiballism-hemichorea, which is due to a contralateral putaminal lesion. We describe a 95-year-old woman with HHS who developed hemichorea-hemiballism syndrome due to a putaminal lesion.

Análisis de viabilidad poblacional de la Taruka Hippocamelus antisensis (D'Órbigny, 1834) (Cervidae) en el sur del Perú / Population viability analysis of the Taruka, Hippocamelus antisensis (D'Órbigny, 1834) (Cervidae) in southern Peru

Se analiza las probabilidades de supervivencia de una población de tarukas (Cervidae: Hippocamelus antisensis) en el sur del Perú usando datos obtenidos en el campo, datos de otros estudios y el programa informático de simulación Vortex. Un total de 900 km2 de la sección norte de la Zona Reservada Aymara Lupaca fueron evaluados en 1997. El análisis de viabilidad poblacional mostró que esta población de tarukas es altamente sensible a cambios en la mortalidad del primer año, inmigración y fragmentación de la población. El tamaño de la población y las probabilidades de supervivencia no mostraron sensibilidad a cambios en la capacidad de carga del área o en la variación medioambiental. Los resultados de este estudio están abiertos a otras alternativas de interpretación, sin embargo la conservación y manejo de la población de tarukas en la Zona Reservada Aymara Lupaca pueden ser asistidos por los resultados del análisis de viabilidad poblacional. El análisis de viabilidad de población es una herramienta muy efectiva de bajo costo para identificar los factores que pueden afectar la supervivencia de las tarukas en el sur del Perú.

This study analyzes the probabilities of survival for a population of tarukas (Cervidae: Hippocamelus antisensis) in southern Peru using data gathered in the field, data from other studies and the computer-based Vortex simulation program. A total of 900km2 of the northern part of the Aymara-Lupaca Reserved Zone were evaluated in 1997. The population viability analysis showed that this taruka population exhibited a high sensitivity to changes in first-year mortality, immigration and fragmentation of the population. Taruka population size and survival probabilities did not exhibit sensitivity to changes in the carrying capacity of the area or to changes in environmental variation. Although the results of this study are open to alternative interpretation, the conservation and management of taruka in the Aymara-Lupaca Reserved Zone may be helped by the findings of the viability analysis. Population viability analysis is a cost-effective tool in identifying factors that might affect the survival of taruka in southern Peru.

Acidosis láctica por metformina / Metformin-induced lactic acidosis

La acidosis láctica es un efecto secundario de la metformina poco frecuente, que es más probable que se produzca en pacientes con ciertas condiciones predisponentes. Presentamos el caso de un paciente con hipertensión arterial tratada con indapamida y captopril y diabetes mellitus tipo 2 tratada con insulina y metformina con función renal previa normal, que tras toma de antiinflamatorios no esteroideos presenta cuadro de vómitos, dolor abdominal, diarrea, oliguria y acidosis láctica. En la analítica al ingreso, se objetivó urea a 227 mg/dl, creatinina a 13,2 mg/dl, pH 6,98, bicarbonato a 7,1 mmol/l y ácido láctico a 105,4 mg/dl (normal hasta 19,8 mg/dl). Tras tratamiento con dos sesiones de hemodiálisis, el paciente evoluciona favorablemente, aunque al alta persiste la insuficiencia renal. La acidosis láctica es una seria complicación del tratamiento con metformina que es más frecuente en casos de insuficiencia renal y otros procesos intercurrentes (AU)

Lactic acidosis is an uncommon side effect of metformin use, which is more likely to arise in patients with certain predisposing factors. We present the case of a patient with hypertension treated with indapamide and captopril and type 2 diabetes mellitus treated with insulin and metformin. Previous renal function was normal. After taking non-steroidal anti-inflammatory drugs, the patient developed vomiting, abdominal pain, diarrhea, oliguria, and lactic acidosis. Tests on admission showed urea 227 mg/dl, creatinine 13.2 mg/dl, pH 6.98, bicarbonate 7.1 mmol/l, and lactic acid 105.4 mg/dl (normal below 19.8 mg/dl). After two hemodialysis sessions, the patient improved, although kidney failure persisted after discharge. Lactic acidosis is a serious complication of metformin therapy and is more frequent in patients with kidney failure and other intercurrent complaints (AU)