Colágeno polivinilpirrolidona versus mitomicina C en trabeculectomía en pacientes con glaucoma primario de ángulo abierto. Seguimiento a 36 meses / Outcomes of trabeculectomy with polyvinylpyrrolidone collagen versus mitomycin in primary open angle glaucoma. 36-month follow-up

Propósito Describir y comparar los efectos de la aplicación intraoperatoria de colágeno polivinilpirrolidona (PVP) versus mitomicina C (MMC) en el patrón de cambio de la presión intraocular (PIO) y del número de medicamentos hipotensores utilizados en un seguimiento a 36 meses en pacientes con glaucoma primario de ángulo abierto (GPAA) operados de trabeculectomía. Métodos Estudio prospectivo, comparativo y aleatorizado. Veintiséis ojos de 26 pacientes con diagnóstico de GPAA, sin cirugías incisionales de glaucoma previas, fueron operados de trabeculectomía y aleatorizados a recibir PVP o MMC durante el procedimiento. Todos los pacientes cumplieron un seguimiento de 36 meses. Los resultados principales medidos fueron cambios en la PIO y el número de medicamentos hipotensores durante el seguimiento. Resultados El análisis multivariado reveló que la reducción de la PIO media del preoperatorio a los 36 meses de seguimiento fue de 7,62mmHg (3,05; 12,18) en el grupo de MMC y de 8,15mmHg (−0,64; 16,95) en el grupo de la PVP. La reducción media porcentual de la PIO fue del 37,09% (15,93; 58,17) en el grupo de MMC y del 36,08% (5,16; 67,20) en el grupo de la PVP. El cambio en el número de medicamentos del preoperatorio a los 36 meses de seguimiento fue de −0,92 medicamentos (-2,38; +1,54) para el grupo de MMC y de −1 medicamentos (−3,12, +1,12) para el grupo de la PVP. Ambos grupos tuvieron una disminución estadísticamente significativa de la PIO durante el seguimiento (p<0,001), pero no hubo una diferencia discernible entre los grupos (p=0,5975). El análisis de sensibilidad mostró que un modelo de tendencia lineal es adecuado para describir la reducción de la PIO durante el seguimiento. Ambos grupos tuvieron una reducción estadísticamente significativa de medicamentos del preoperatorio al final del seguimiento (p<0,05), tampoco hubo una diferencia discernible entre los grupos (p=0,2917)(AU)

Purpose Describe and compare the effects of intraoperative application of Polyvinylpyrrolidone Collagen (PVP) versus Mitomycin C (MMC) on the pattern of change in mean IOP reduction and mean number of medications over 36-months follow-up in patients with primary open angle glaucoma (POAG) undergoing trabeculectomy. Methods Prospective, randomized, comparative study. Twenty-six eyes of 26 patients with POAG and no previous incisional glaucoma surgery underwent trabeculectomy and were randomized to PVP or MMC and completed a 36-month follow-up. Main outcome measures were IOP and number of glaucoma medications. Multivariate longitudinal analysis was performed by fitting a linear trend model adjusting for baseline response for the IOP outcome and a log-linear regression model with within-subject associations for the number of hypotensive medications outcome. Sensitivity analysis was performed to assess lower and higher order polynomial trends over time in IOP. Results The univariate analysis revealed that the mean IOP reduction from baseline to 36 months was 7.62mmHg (3.05; 12.18) in the MMC group and 8.15mmHg (−0.64; 16.95) in the PVP group. Mean percentage IOP reduction from baseline was 37.09% (15.93; 58.17) and 36.08% (5.16; 67.20) in the PVP group. Mean change in number of medications from baseline to 36 months was −0.92 medications (−3.38; +1.54) for the MMC group and −1 medication (−3.12; +1.12) for the PVP group. Both groups had a statistically significant decline in mean IOP over the follow-up period (p<0.001) but there was no discernible difference between the two exposure groups in the rate of change in IOP (p=0.5975). Sensitivity analysis showed that a linear trend model is adequate to describe the IOP reduction over the follow-up period. Both groups had a statistically significant change in the number of hypotensive medications used between baseline and month 36 (p<0.05) but there was no discernible difference between exposure groups (p=0.2917) (AU)

Outcomes of trabeculectomy with polyvinylpyrrolidone collagen versus mitomycin in primary open angle glaucoma. 36-month follow-up. / Colágeno polivinilpirrolidona versus mitomicina C en trabeculectomía en pacientes con glaucoma primario de ángulo abierto. Seguimiento a 36 meses.

PURPOSE: Describe and compare the effects of intraoperative application of Polyvinylpyrrolidone Collagen (PVP) versus Mitomycin C (MMC) on the pattern of change in mean IOP reduction and mean number of medications over 36-months follow-up in patients with primary open angle glaucoma (POAG) undergoing trabeculectomy. METHODS: Prospective, randomized, comparative study. Twenty-six eyes of 26 patients with POAG and no previous incisional glaucoma surgery underwent trabeculectomy and were randomized to PVP or MMC and completed a 36-month follow-up. Main outcome measures were IOP and number of glaucoma medications. Multivariate longitudinal analysis was performed by fitting a linear trend model adjusting for baseline response for the IOP outcome and a log-linear regression model with within-subject associations for the number of hypotensive medications outcome. Sensitivity analysis was performed to assess lower and higher order polynomial trends over time in IOP. RESULTS: The univariate analysis revealed that the mean IOP reduction from baseline to 36 months was 7.62mmHg (3.05; 12.18) in the MMC group and 8.15mmHg (-0.64; 16.95) in the PVP group. Mean percentage IOP reduction from baseline was 37.09% (15.93; 58.17) and 36.08% (5.16; 67.20) in the PVP group. Mean change in number of medications from baseline to 36 months was -0.92 medications (-3.38; +1.54) for the MMC group and -1 medication (-3.12; +1.12) for the PVP group. Both groups had a statistically significant decline in mean IOP over the follow-up period (p<0.001) but there was no discernible difference between the two exposure groups in the rate of change in IOP (p=0.5975). Sensitivity analysis showed that a linear trend model is adequate to describe the IOP reduction over the follow-up period. Both groups had a statistically significant change in the number of hypotensive medications used between baseline and month 36 (p<0.05) but there was no discernible difference between exposure groups (p=0.2917). Both the PVP and MMC groups showed an initial reduction in number of medications until month 12 and a relatively linear increase towards month 36. A longer follow-up may be warranted to reveal differences in the number of medications between the two exposure groups. Postoperative complications were less frequent in the PVP group. CONCLUSIONS: The use of PVP during trabeculectomy achieves and maintains a statistically significant IOP reduction from baseline to 36 months and decreases the number of glaucoma medications. Secondary outcome measures showed a lower incidence of adverse events in the PVP group.

Clustered lot quality assurance sampling: a pragmatic tool for timely assessment of vaccination coverage.

OBJECTIVES: To evaluate oral poliovirus vaccine (OPV) coverage of the November 2009 round in five Northern Nigeria states with ongoing wild poliovirus transmission using clustered lot quality assurance sampling (CLQAS). METHODS: We selected four local government areas in each pre-selected state and sampled six clusters of 10 children in each Local Government Area, defined as the lot area. We used three decision thresholds to classify OPV coverage: 75-90%, 55-70% and 35-50%. A full lot was completed, but we also assessed in retrospect the potential time-saving benefits of stopping sampling when a lot had been classified. RESULTS: We accepted two local government areas (LGAs) with vaccination coverage above 75%. Of the remaining 18 rejected LGAs, 11 also failed to reach 70% coverage, of which four also failed to reach 50%. The average time taken to complete a lot was 10 h. By stopping sampling when a decision was reached, we could have classified lots in 5.3, 7.7 and 7.3 h on average at the 90%, 70% and 50% coverage targets, respectively. CONCLUSIONS: Clustered lot quality assurance sampling was feasible and useful to estimate OPV coverage in Northern Nigeria. The multi-threshold approach provided useful information on the variation of IPD vaccination coverage. CLQAS is a very timely tool, allowing corrective actions to be directly taken in insufficiently covered areas.

[Does heart sarcoma mimick lupus erythematosus and vasculitis? Report of 2 cases]. / El sarcoma cardiaco simula lupus eritematoso y vasculitis? Informe de 2 casos.

Primary heart tumors are rare. The most common one is myxoma. It may synthetize IL-6 and frequently shown systemic clinical manifestations that confuse the diagnosis. Primary heart sarcomas are even more rare, as far as we know they have been not associated with systemic illnesses. We observed two cases with a presumptive diagnosis of systemic lupus erythematosus who were identified as primary sarcomatous heart neoplasms after surgical excision.

[The dynamic morphology of the endothelial cells of aortocoronary vessels cultured in vitro]. / Morfología dinámica de las células endoteliales de los vasos aortocoronarios cultivados in vitro.

The morphologic and functional meaning of the endothelial cell, as the first cellular element between blood and tissues, has been investigated since the earliest histological knowledge of the vascular tree. Although there have been multiple attempts for its study, through different biological branches, very little has been comprehended in its dynamic biology, due to technical difficulties and to the apparent simplicity of this extraordinary cellular type. In this research we pretend to establish a morphodynamic pattern of the endothelial cells from the aortocoronary segment, using the particular advantages of tissue culture. Our results, have been obtained through careful observations with light microscopy under different optical systems and the help provided by spaced microcinematography. Our results showed the reality of the images in the different cellular phenomena, particularly, endocytotic pinocytosis, the dynamic of the cellular membrane, and the cell-cell linkages established in vitro.

[Spectrum of biventricular aortic connection and double outlet chamber of the right ventricle produced experimentally in the chicken heart by hypothermia (34.5 degrees C)]. / Espectro de conexión biventricular de la aorta y doble cámara de salida de ventrículo derecho producidos experimentalmente en el corazón de pollo por hipothermia (34.5 grados C).

In this experimental work, fertilized chicken eggs were subjected to hypothermia (34.5 degrees) as to inhibit the incorporation of the aortic infundibulum into the left ventricle. This produced a spectrum of biventricular connection of the aorta including double outlet right ventricle (DORV), a cardiopathy seen naturally in man and in chicken. It represents the persistence in the postnatal heart of the spectrum of embryonic aortic dextroposition, a fact which allowed us to establish a precise anatomoembryologic correlation. Pathogenetically, the failure in the connection of the aortic infundibulum with the left ventricle is due to inhibition, in different degrees, of the leftward morphogenetic movement of the infundibular segment, an embryologic process which is discussed in relation to different theories on the origin of DORV. The role played by cell death in normal and pathologic morphogenesis, is emphasized and some methodological aspects on experimental teratogeneses are mentioned.

Espectro de conexion biventricular de la aorta y doble camara de salida de ventriculo derecho producidos experimentalmente en el corazon de pollo por hipotermia (34.5 grados C) / Spectrum of biventricular conexion of the aorta and double outlet of right ventricle experimentally produced in chicken heart by hypothermia (34.5 centigrades)

En este trabajo experimental se utilizaron huevos embrionados de pollo sometidos a la accion de la hipotermia (34.5oC) con el objetivo de inhibir, la incorporacion del infundibulo aortico hacia el ventriculo izquierdo lo que produjo un espectro de conexion biventricular de la aorta incluyendo la doble camara de salida del ventriculo derecho, el cual se presenta de manera natural en el hombre y en el pollo y representa la persistencia en el corazon postnatal del espectro de dextroposicion aortica embrionaria, hecho que nos permitio establecer una correlacion anatomoembriologica precisa. Patogeneticamente la falla en la conexion del infundibulo aortico con el ventriculo izquierdo se debe a la inhibicion en diferentes grados del movimiento del segmento infundibular hacia la izquierda, hecho que se discute en relacion a diferentes teorias sobre supuestos mecanismos patogeneticos. Se enfatiza sobre el papel que juega la mortalidad celular en la morfogenesis normal y patologica y se mencionan algunos aspectos metodologicos sobre teratogenesis experimental