Ensayo clínico controlado aleatorio de dos técnicas quirúrgicas para pterigión primario en pacientes de la selva: cauterización versus sutura / Randomized Controlled Clinical Trial of Two Surgical Techniques for Primary Pterygium in Jungle Patients: Cauterization versus Suturing

RESUMEN Objetivo: Comparar dos técnicas quirúrgicas para extirpar el pterigión, mediante la evaluación de la sintomatología postoperatoria y la incidencia de la recidiva. Métodos: Ensayo clínico controlado aleatorizado con dos grupos paralelos y diseño simple ciego en 80 pacientes con pterigión primario de la Clínica Oftalmológica de la Selva. El primer grupo consideró la técnica de autoplastia fijada con cauterio bipolar (n=40) y el segundo la técnica convencional de autoplastia fijada con puntos (n=40). Se evaluaron los síntomas a las 72 horas postoperatorias y la recidiva a los seis meses. Resultados: A las 72 horas postcirugía el 6 % de los operados con la técnica electrocauterio presentaron sintomatología en comparación a un 41 % de los operados con sutura (p<0,05). Se evidenció recurrencia de 1 caso en el grupo de electrocauterio y 4 en el grupo de sutura (2,5 % vs. 10 %, p<0,05). Conclusiones: La técnica con cauterio demostró una recuperación más favorable, con menor sintomatología y recurrencia en comparación a la técnica convencional. Estos hallazgos sugieren que la técnica con cauterio puede ser más efectiva y mejor tolerada en pacientes de este estudio.

ABSTRACT Objective: To compare two surgical techniques for excising pterygium, by evaluating postoperative symptoms and the incidence of recurrence. Methods: Randomized controlled clinical trial with two parallel groups and a single-blind design involving eighty patients with primary pterygium from the Ophthalmological Clinic of the Jungle. The first group considered the autograft fixation technique with bipolar cautery (n=40), and the second group considered the conventional autograft fixation technique with sutures (n=40). Symptoms were assessed at 72 hours postoperatively, and recurrence was evaluated at six months. Results: At 72 hours post-surgery, 6% of patients operated with the electrocautery technique exhibited symptoms, compared to 41% of those operated with sutures (p < 0.05). Recurrence was observed in 1 case in the electrocautery group and 4 in the suture group (2.5% vs. 10%, p < 0.05). Conclusions: The cautery technique demonstrated a more favorable recovery, with fewer symptoms and recurrence compared to the conventional technique. These findings suggest that the cautery technique may be more effective and better tolerated in patients in this study.

Picadura de insecto en la córnea, a propósito de un caso

Introducción : Es de vital importancia considerar que la toxina del veneno de la avispa puede ocasionar una reacción violenta que daña la función visual, es por ello que presentamos el siguiente caso relacionado. Cuadro Clínico : Mujer de 32 años con antecedente de picadura de avispa hace 24 horas en ojo derecho; disminución de la agudeza visual, enrojecimiento, lagrimeo, dolor, secreción; agudeza visual de cuenta dedos a 2 metros del ojo derecho y 20/25 ojo izquierdo, con presiones intraoculares de 12 y 13; biomicroscopía hiperemia conjuntival con inyección periciliar 3+, cuerpo extraño en córnea hasta estoma con edema 3+, estrías en la Descemet ojo derecho. Resultados : Se procede a la extracción del cuerpo extraño con previa protección antimicrobiana con antibiótico tobramicina, antiinflamatorio esteroideo prednisolona, hipertónicas y lubricante mixto carboximetilcelulosa y glicerina. A la semana, se observa la formación de una opacidad capsular anterior con signos de atrofia iridiana que empieza a dar un "cambio de color del iris", a las dos semanas se evidencia la dilatación de la vasculatura periciliar, a horas 4, y a las 3 semanas el paciente presenta una agudeza visual de 20/25 ambos ojos, con transparencia corneal, persistencia de la atrofia iridiana y catarata traumática capsular anterior, con remisión de sintomatología en el paciente. Conclusiones : No se sabe el componente exacto del veneno que produce los signos previamente descritos, existen teorías de que puede deberse a un componente con acción parasimpaticomimética, el mismo que se relaciona a otras observaciones clínicas de despigmentación local y heterocromía.

Introduction : It is very important to consider that the toxin present in wasp venom may lead to a severe reaction damaging visual function. This is the reason why we present the following case. Clinical Picture : This is a 32-year-old-female who was bitten by a wasp 24 hours ago in her right eye. She had visual acuity reduction, reddening, tearing, pain, and secretion. Her visual acuity was counting fingers at two-meter distance from her right eye and 20/25 in the left eye. Intraocular pressure was 12 and 13. Biomicroscopy showed conjunctival hiperemia with 3+ periciliary injection. There was a foreign body in the cornea towards the stoma, with 3+ edema. There were striae in the right Descemet. Resultados: We took out the foreign body with previous antimicrobial protection including an antibacterial (tobramycin) and a steroid anti-inflammatory compound (prednisolone). Hypertonic solution and mixed lubricants were also administered, including a mixed lubricant, carboxymethylcellulose, and glycerin. One week afterwards, we observed the formation of an anterior capsular opacity with signs of iris atrophy which led to a 'change of color in the iris'. Two weeks afterwards we observed periciliary vascular dilatation, at 4-hour meridian; and on the third week, the patient had 20/25 visual acuity in both eyes. Her cornea was transparent, there was persistence of iris atrophy, and there was an anterior capsular cataract. Her symptoms subsided. Conclusiones : The exact component of wasp venom leading to the described signs is not known. It has been proposed that it may be a compound with parasympathomimetic action, and this has been related with other clinical observations indicating local depigmentation and heterochromia.

Emotions, inequalities and crises: Ecuadorian migrants in Europe during the COVID-19 pandemic.

This article examines narratives of transnational belonging and transnational practices of care between a group of Ecuadorian migrants in Spain and Italy and their families and friends in Ecuador during the first semester of the COVID-19 pandemic in 2020. Drawing on the concepts of transnational affective economies (Wilding et al., International Journal of Cultural Studies, 2020, 23, 639), the circulation of care (Baldassar & Merla, Transnational families, migration and the circulation of care: understanding mobility and absence in family life. Routledge Taylor and Francis Group, London, New York, 2014) and transnational forms of belonging (Boccagni & Baldassar, Emotions, Space and Society, 2015, 16, 73), we look at how despite their still precarious social and labour conditions in destination-which were exacerbated during the pandemic-Ecuadorian migrants activated different forms of belonging and transnational care. Findings reveal that emotions had a crucial role in enabling the transnational circulation of care between family members and friends and a revival of migrants' sense of national belonging. We argue that the crisis generated by COVID-19 was the occasion for migrants to revisit their sense of belonging as well as their awareness of south-north inequalities since they experienced the crisis simultaneously in Ecuador, Spain and Italy. At the same time, emotions such as fear, anxiety, anger and concern for their families and communities triggered subjective understandings of local and global inequalities that reaffirmed their migration project.

Towards a typology of social protection for migrants and refugees in Latin America during the COVID-19 pandemic.

The COVID-19 health crisis has put to the test Latin America's already precarious social protection systems. This paper comparatively examines what type of social protection has been provided, by whom, and to what extent migrant and refugee populations have been included in these programmes in seven countries of the region during the COVID-19 pandemic, between March and December 2020. We develop a typology of models of social protection highlighting the assemblages of actors, different modes of protection and the emerging migrants' subjectification in Brazil, Chile, Colombia, Ecuador, Mexico, Peru, and Uruguay in relation to Non-Contributory Social Transfer (NCST) programmes and other actions undertaken by state and non-state actors. The analysis is based on 85 semi-structured interviews with representatives of national and local governments, International Organisations, Civil Society Organisations, and migrant-led organisations across 16 cities, and a systematic review of regulatory frameworks in the country-case studies. The proposed typology shows broad heterogeneity and complexity regarding different degrees of inclusion of migrant and refugee populations, particularly in pre-existing and new NCST programmes. These actions are furthering notions of migrant protection that are contingent and crisis-driven, imposing temporal limitations that often selectively exclude migrants based on legal status. It also brings to the fore the path-dependent nature of policies and practices of exclusion/inclusion in the region, which impact on migrants' effective access to social and economic rights, while shaping the broader dynamics of migration governance in the region.

Oftalmomiasis causada por Oestrus sp. en la selva peruana: a propósito de un caso / Ophthalmomyiasis caused by Oestrus sp in the Peruvian Amazon forest: apropos of a case

La oftalmomiasis es una patología poco descrita en Sudamérica, con presencia en la Amazonía peruana, causado por la larva de distintas moscas. Una de las especies más prevalentes pero poco reportada en nuestra región es Oestrus sp. Se reporta el caso de un adolescente de 14 años, con molestias oculares y presencia de una larva de mosca a nivel subconjuntival diagnosticado como oftalmomiasis externa, el cual se logró extraer mediante métodos médicos y alternativos; así como, control antibiótico y antiparasitario para prevenir las complicaciones. El manejo de las oftalmomiasis es muy variado y empírico, por lo que este tipo de reportes pueden ayudar a los profesionales de la salud que ejercen en la selva peruana, a brindar un diagnóstico oportuno y un tratamiento rápido.

Ophthalmomyiasis is a condition that has rarely been described in South America, it is present in the Peruvian Amazon forest, and it is caused by larvae from different fly species. One of the most prevalent but seldom reported species in this region is Oestrus sp. We report the case of a 14-year-old subject that presented with eye disturbances and the presence of a fly larva in the subconjunctival space, which was diagnosed as external ophthalmomyiasis. The larva was excised using medical and alternative methods, antibiotics and antiparasitic drugs were also used, aiming to prevent complications. There is no standard management protocol for ophthalmomyiasis, so this report may be of help for healthcare professionals working in the Peruvian Amazon forest, aiming to achieve a timely diagnosis and prompt therapy.

Análisis comparado de los sistemas de información de profesionales de la salud en los países de centroamérica / Comparative analysis of the information systems of health professionals in the countries of Central America

La presente publicación, realizada en el marco de la Acción "Migración de Profesionales de la Salud entre América Latina y Europa. Oportunidad para el Desarrollo Compartido", ha sido elaborada con la asistencia de la Unión Europea. El contenido de la misma es responsabilidad exclusiva de sus autores y en ningún caso debe considerarse que refleja los puntos de vista de la Unión Europea ni de las entidades asociadas a esta Acción. La Acción "Migración de Profesionales de la Salud entre América Latina y Europa. Oportunidad para el Desarrollo Compartido", financiada por la Comisión Europea en el marco del Programa Temático de Cooperación con Países Terceros en los ámbitos de Migración y Asilo (Contrato Nº DCI-MIGR/2012/283-036), es desarrollada por la Escuela Andaluza de Salud Pública en sociedad con la Organización Panamericana de la Salud (OPS/OMS) y en colaboración con la Organización Mundial de la Salud (OMS) y el Ministerio de Salud Pública de la República Oriental del Uruguay, que ostenta la Secretaría Técnica de la Red Iberoamericana Ministerial de Migraciones Profesionales de Salud- RIMPS.