ALTERNATIVE INTRAVITREAL ANTIBIOTICS: A Systematic Review for Consideration in Recalcitrant or Resistant Endophthalmitis.

PURPOSE: To organize, categorize, and create a quick reference guide for the use of intravitreal antibiotic alternatives to the standard combination of vancomycin and ceftazidime for the treatment of endophthalmitis. METHODS: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. The authors searched for all available information regarding intravitreal antibiotics in the last 21 years. Manuscripts were selected according to relevance, level of information, and the available data regarding intravitreal dose, potential adverse effects, bacterial coverage, and relevant pharmacokinetic information. RESULTS: The authors included 164 of 1810 manuscripts. The antibiotics were classified according to their class into fluoroquinolones, cephalosporins, glycopeptide and lipopeptide, penicillins and beta-lactams, tetracyclines, and miscellaneous. The authors also included information regarding intravitreal adjuvants for the treatment of endophthalmitis and one ocular antiseptic. CONCLUSION: The treatment of infectious endophthalmitis is a therapeutic challenge. The current review summarizes the properties of possible intravitreal antibiotic alternatives that should be considered in cases of suboptimal response to initial treatment.

Age and sex-related changes in rat brain mitochondrial oxidative status.

Mitochondria are the main source of free radical species and the most direct target for their damaging effects, which especially affect the brain mitochondrial function, which is better maintained by females than males. The aim of this work was to investigate the age-related changes in rat brain mitochondrial oxidative status focusing on sex differences. Male and female rat brain from four different age groups (6, 12, 18 and 24 months old) were analyzed. Oxidative damage accumulates in rat brain throughout aging, related to the increasing activity of mitochondrial respiratory chain (MRC) and failure of several antioxidant defenses. The aging effect was less marked in females, which accumulated less oxidative damage than males due in part to their greater antioxidant capacity, such as higher GPx activity and higher UCP5 level. This sexual dimorphism gradually increased during aging.

Age and sex-related changes in rat brain mitochondrial function.

Aging is responsible for the decline in the function of mitochondria and their increase in size and number--adaptive mechanism to restore mitochondrial function. Estrogens increase mitochondrial function, especially in female rats. The aim of this study was to determine the age-related changes in rat brain mitochondrial function focusing on sex differences. Cellular and mitochondrial protein and DNA content, mitochondrial oxidative and phosphorylative function in male and female rat brain from four different age groups (6, 12, 18 and 24 months old) were analyzed. Mitochondria protein/DNA content decreased with aging shifting toward lesser mitochondrial functional capacity and the mitochondria number increased. A sex dimorphism was determined, with female rat brain showing mitochondria with greater functional capacity than males. These sex differences gradually increased during aging.

Early-onset L-dopa-responsive parkinsonism with pyramidal signs due to ATP13A2, PLA2G6, FBXO7 and spatacsin mutations.

Seven autosomal recessive genes associated with juvenile and young-onset Levodopa-responsive parkinsonism have been identified. Mutations in PRKN, DJ-1, and PINK1 are associated with a rather pure parkinsonian phenotype, and have a more benign course with sustained treatment response and absence of dementia. On the other hand, Kufor-Rakeb syndrome has additional signs, which distinguish it clearly from Parkinson's disease including supranuclear vertical gaze palsy, myoclonic jerks, pyramidal signs, and cognitive impairment. Neurodegeneration with brain iron accumulation type I (Hallervorden-Spatz syndrome) due to mutations in PANK2 gene may share similar features with Kufor-Rakeb syndrome. Mutations in three other genes, PLA2G6 (PARK14), FBXO7 (PARK15), and Spatacsin (SPG11) also produce clinical similar phenotypes in that they presented with rapidly progressive parkinsonism, initially responsive to Levodopa treatment but later, developed additional features including cognitive decline and loss of Levodopa responsiveness. Here, using homozygosity mapping and sequence analysis in families with complex parkinsonisms, we identified genetic defects in the ATP13A2 (1 family), PLA2G6 (1 family) FBXO7 (2 families), and SPG11 (1 family). The genetic heterogeneity was surprising given their initially common clinical features. On careful review, we found the FBXO7 cases to have a phenotype more similar to PRKN gene associated parkinsonism. The ATP13A2 and PLA2G6 cases were more seriously disabled with additional swallowing problems, dystonic features, severe in some, and usually pyramidal involvement including pyramidal weakness. These data suggest that these four genes account for many cases of Levodopa responsive parkinsonism with pyramidal signs cases formerly categorized clinically as pallido-pyramidal syndrome.

Sex-dependent differences in aged rat brain mitochondrial function and oxidative stress.

Females show lower incidences of several neurodegenerative diseases related to oxidative stress and mitochondrial dysfunction than males. In addition, female rats show more differentiated mitochondria than males in several tissues. The aim of this work was to investigate the existence of sex-dependent differences in brain mitochondrial bioenergetics and oxidative balance in aged rats. Results showed that aged female rat brain had a lower mitochondria content than aged male brain but with a greater differentiation degree given the higher mitochondrial protein content and mitochondrial complex activities in females. Female rat brain also showed a better oxidative balance than that of males, reflected by the fact that higher mitochondrial respiratory chain function is accompanied by a similar ROS production and greater antioxidant enzyme activities, which could be responsible for the lesser oxidative damage observed in proteins and lipids in this sex. Interestingly, levels of UCP4 and UCP5--proteins related to a decrease in ROS production--were also higher in females. In conclusion, aged female rat brain had more differentiated mitochondria than male brain and showed a better control of oxidative stress balance, which could be due, in part, to the neuroprotective effect of UCPs.

Differences in mitochondrial function and antioxidant systems between regions of human glioma.

Metabolic features and oxidative stress have been extensively studied in cancer cells. However, comparative studies between cancer cell populations that coexist in human neoplastic tissue are not frequently available. The aim of the present study was to characterize markers of oxidative status and mitochondrial function in center vs. periphery of human fresh glioma samples; therefore, antioxidant systems, oxidative stress and mitochondrial parameters were assessed in gross total resections of gliomas. Mitochondrial protein and mitochondrial DNA content, enzymatic activities of mitochondrial oxidative and phosphorylative system, antioxidant mechanisms, mitochondrial H(2)O(2) production, oxygen consumption and cellular oxidative damage were measured in human gliomas. Concentric regions of human glioma tissue showed similar mitochondrial structural markers; conversely, the functionality of their isolated mitochondria was significantly different. In this way, the tumor periphery exhibited higher respiratory rate and fewer antioxidant systems than tumor center. Our results have expanded previous investigations, which report the presence of cell populations with different oxidative susceptibility in human brain tumor samples. This is, to our knowledge, the first study to investigate metabolic differences in concentric regions of gross total resections of glioma. Interestingly, the cancer cell population that exhibits an increased antioxidant capacity within the tumor mass might be responsible for tumor resistance to chemotherapy and radiotherapy.

Caloric restriction retards the age-related decline in mitochondrial function of brown adipose tissue.

Caloric restriction (CR) has been shown to prevent the age-associated loss of mitochondrial function and biogenesis in several tissues such as liver, heart, and skeletal muscle. However, little is known about the effects of CR on a tissue in which the mitochondria have no adenosine triphosphate (ATP)-producing purpose but show a high degree of uncoupling, namely brown adipose tissue (BAT). Hence, the aim of the present study was to analyze the effect of long-term CR on BAT mitochondrial function and biogenesis. BAT mitochondria obtained from 24-month-old male and female rats previously subjected to 40% CR for 12 months were compared with mitochondria from old (24 months) and young (6 months) ad libitum fed rats. Old restricted rats compared to old ad libitum fed ones showed a reduction in BAT size with respect to fat content and adipocyte number. Mitochondrial DNA content in BAT increased with age and even more so in restricted rats, indicating a summative effect of age and CR on mitochondrial proliferation. CR induced resistance to lose total and mitochondrial protein, COX activity, and uncoupling capacity with advancing age, in relation with a lower decrease of mitochondrial transcription factor A (TFAM). In summary, our results demonstrate CR prevents the age-associated decline in mitochondrial function in BAT, probably in relation with a lower impairment of mitochondrial biogenesis.

Tratamiento de las fracturas del cuello del fémur / Proccessing of the fractures of the neck of fémur

Se analiza retrospectivamente los ingresos al Hospital Carlos Andrade Marín con diagnóstico de fracturas de cuello femoral, predominando el sexo femenino (n=48, 71,64 por ciento) sobre el masculino (n=19, 28,35 por ciento). El rango de edad es amplio, desde los 21 años hasta los 91 años. La etiología de la fractura fue un trauma de baja energía (caída de propia altura) en 59 individuos (88 por ciento) y trauma de alta energía (atropellamiento, n=4, 5,9 por ciento; caída de más de dos metros de altura, n=4, 5,9 por ciento). Respecto al tratamiento, un número importante de casos requirió el uso de prótesis (n=47, 70,1 por ciento) mientras que los casos restantes se emplearon clavos de Ender (n=5, 7,4 por ciento)...

Consecuencia del trauma de órbita (naso-orbitaria) / Consequence of the orbit trauma (naso-orbitaria)

Las fracturas orbitarias se presentan cerca del 70 por ciento de traumas faciales; se clasifican en dos grupos: las "fracturas externas" que involucran desunión directa del borde orbitario e incluye las fracturas naso-orbitarias. El segundo grupo llamado "fracturas internas" o fracturas de estallamiento, en las cuales una o más paredes orbitarias son indirectamente rotas. Pueden ser comminutas y podrían involucrar tanto al borde y paredes de la órbita. Cualquier porción de la órbita puede ser involucrada en este tipo de fracturas siendo las de la pared interna y el piso son de mayor importancia oftalmológica. Las fracturas más comunes son las nasales y las fracturas de estallamiento orbitario. El fracaso para reconocer y tratar mínimas fracturas usualmente no conducen a complicaciones...

Factores de riesgo y pronóstico de vida en pacientes con cancer de pene en el Hospital Goyeneche, 1960 a 1994

Nuestra población estuvo constituida por 25 pacientes diagnósticados con cáncer de pene, de los cuales 10 no cumplieron con los criterios de inclusión, por lo que nuestra población se redujo a 15 pacientes. Utilizamos como instrumento una ficha de recolección de datos usando estadística epidemiológica Microsta y Epiinfo: caso-control para evaluar los factores de riesgo, y para evaluar el pronóstico de vida se utilizó la tabla maestra de Guerrero. Los factores de riesgo más frecuentes fueron: -En primer lugar los malos hábitos higiénicos concluyendo que los sujetos que presentan dichos hábitos, tienen 5.29 veces más probabilidades de desarrollar cáncer de pene que los que no los tienen. -En segundo lugar el bajo nivel socio-económico con 4.6 veces más probabilidades de desarrollar esta neoplasia en los que tienen este nivel que en los que no lo tienen. -En tercer lugar la fimosis, en cuyos portadores se encuentra una probabilidad 22 veces menor de desarrollar cáncer de pene que en los sujetos normales. Finalmente las infecciones venéreas y el cáncer de cuello uterino en la compañera sexual con probabilidades relativas de 1.97 y 3.14 respectivamente. El pronóstico de vida general, alcanzaron una supervivencia a los 5 años el 26.8 por ciento de los pacientes y a los 9 años el 13.4 por ciento. El cáncer de pene es más frecuente entre las edades de 41 a 80 años, que representa el 80 por ciento de la población estudiada; siendo la edad promedio de 61.27 años ñ 16.80. El único tipo encontrado fue el carcinoma epidermoide; dentro del cual el grado de diferenciación histológica más frecuente fue el bien diferenciado presente en 66.7 por ciento de los casos, seguido del medianamente diferenciado con un 26.7 por ciento de casos