Nitrogen retention in hair sheep lambs with a gradient of Haemonchus contortus infection.

The impact of Haemonchus contortus infections on nitrogen retention (NR) of hair sheep lambs is unknown. This study estimated the feed intake, digestibility, NR, haematocrit (HT), and their relationship with the gradient of H. contortus infection in hair sheep lambs. Twenty-four hair sheep lambs, 3-4 months old, reared parasite-free were used (live weight (LW) 16.7 ± 1.7 kg). Six lambs were kept parasite-free, nine lambs received a dose of 300 H. contortus infective larvae (L3)/kg LW, and the remaining nine lambs received 500 H. contortus L3/kg LW. Infection doses ranged from 3870 to 9,500 L3. Lambs were individually fed for an average daily gain (ADG) of 100 g. On days 1 (P < 0.01) and 7 (P < 0.001) post-infection (PI), the L3 doses were positively associated with HT, possibly due to platelet recruitment. On week 1 PI, the infection (L3) reduced the crude protein (CP) intake (g/kg metabolic LW) (P < 0.05). A reduction of 1% HT corresponded to 1200 eggs per gram of faeces (EPG) for day 21 PI (P < 0.05), 2300 EPG for day 28 PI (P < 0.001), 2400 EPG for day 35 (P < 0.001), and 1300 EPG for day 41 PI (P < 0.001). However, the HT levels were never lower than 21 %. A lower CP digestibility was associated with EPG only on week 5 PI (P < 0.05). There was no significant association between EPG, Total egg in faeces, or worm burden (WB) with intake, dry matter digestibility (DMD), ADG or NR. The NR of lambs was positive along the different weeks of study irrespective of infection level. The WB was negatively associated only with HT on day 41 PI (P < 0.001), where a 1 % HT reduction was estimated for every 257 worms hosted. In conclusion, no relationship was found between H. contortus infection and DMD, ADG or NR in hair sheep lambs. The cost of H. contortus infection resulted only from the HT reduction and depended on the gradient and stage of the infection.

An in vitro approach to evaluate the nutraceutical value of plant foliage against Haemonchus contortus.

Nutraceutical plants provide nutrients for the animal as well as secondary compounds that can affect the biology and survival of gastrointestinal nematodes (GIN). Current screening of nutraceutical plants is based on in vitro evidence of anthelmintic (AH) activity against different life stages of GIN, but nutritional information is omitted or scarce. This study proposes an integral in vitro screening protocol to identify the nutraceutical value of the foliage from plant species consumed by small ruminants, using Haemonchus contortus as a biological model. The leaves from Acacia collinsii, A. pennatula, Bunchosia swartziana, Gymnopodium floribundum, Havardia albicans, Leucaena leucocephala, Lysiloma latisiliquum, Mimosa bahamensis, Piscidia piscipula, and Senegalia gaumeri were evaluated for their chemical composition and in vitro digestibility. Acetone:water extracts (70:30) from leaves of each plant were evaluated using the egg hatch assay and larval exsheathment inhibition assay. Respective effective concentrations 50% (EC50) were determined for each assay. The ten plant species showed good nutritional value for ruminants, including crude protein (> 10%), metabolizable energy (> 2.9 MJ/kg DM), and varied CT content (from 1.0 to 37.6%). The best AH activity against H. contortus eggs (EC50 = 401.8 µg/mL) and L3 (EC50 = 83.1 µg/mL) was observed for S. gaumeri extract. Although all the plant species showed in vitro nutraceutical potential, the leaves of S. gaumeri had the best values. The proposed in vitro protocol showed to be useful for the integral assessment of the nutraceutical potential of different plant species as it included the nutritional value and the AH activity against eggs and L3 in the selected plant species.

A protocol of human animal interaction to habituate young sheep and goats for behavioural studies.

Animal habituation is key to obtain reliable data on behavioural studies but detailed procedures to achieve it are scarce. This study designed a set of actions to habituate sheep and goats to human observers. Pelibuey sheep (n = 15) and Criollo goats (n = 10) were classified as (a) avoider, flight from human interaction, or (b) follower, seek human interaction. Habituation was measured by the reduction of flight distance by avoiders, or number of followers in the presence of observers. The habituation protocol consisted of a gradually increased series of five manoeuvres, either challenge (for avoiders) or evasion (for seekers), performed first inside a pen and subsequently in a grass paddock. Habituation was considered successful when animals could be observed from a 1-m distance without flight or following the observer. In the pen, habituation took 12 and 13 days for sheep and goats, respectively. Meanwhile, in the grass paddock habituation took 10 days, for both species. The number of challenge and evasion series was negatively correlated with the flight distance in sheep and with the number of followers in goats. This protocol is simple and practical to implement and enables animal habituation for behavioural studies.

Feed resource selection of Criollo goats artificially infected with Haemonchus contortus: nutritional wisdom and prophylactic self-medication.

Previous cafeteria studies suggested that a moderate natural gastrointestinal nematode (GIN) infection did not modify the resource selection of adult Criollo goats towards tannin-rich plants compared with worm-free goats. A higher infection with Haemonchus contortus could trigger a change in the resource selection behaviour towards tannin-rich foliage. Alternatively, goats might select plant species solely to meet their nutritional requirements. A cafeteria study investigated the effect of a high artificial infection with H. contortus on the feed resource selection of goats. Adult Criollo goats (37.5±4.8 kg BW) with browsing experience were distributed in two groups: the infected group (IG) with six animals artificially infected with H. contortus (6000 L3/animal); and the non-infected group (NIG) with six animals maintained worm-free. The experiment included two 5-day periods with additional 5-day adaptation period. In the first period, animals were offered foliage of five plant species with a decreasing gradient of condensed tannins (CT) (Mimosa bahamensis, Gymnopodium floribundum, Havardia albicans, Acacia pennatula, Lysiloma latisiliqum), and three plant species with negligible CT content (Leucaena leucocephala, Piscidia piscipula and Brosimum alicastrum). In the second period the foliage of B. alicastrum was withdrawn. A grain-based concentrate feed was offered daily at 1% BW in DM basis. Dry matter and nutrient intake was determined. Foliage selection of each experimental group was determined using the Chesson selection index. The H. contortus egg count per gram of faeces (EPG) was determined for infected goats twice daily. Chesson index showed a similar pattern of foliage selection on periods 1 and 2. Mean EPG of goats in IG was 2028±259 EPG during period 1 and 1 293±198 EPG during period 2 (P>0.05). During period 1, the selection pattern was highest for B. alicastrum (tannin-free), followed by a tannin-rich plant (M. bahamensis). These two plants remained as highly selected during period 2. The Chesson index showed that both experimental groups (IG and NIG) selected the same plant species in both periods. Thus, a high H. contortus infection did not affect selection of goats fed with CT-rich plants. Apparently, goats balanced their nutrient intake with the plants selected, showing evidence of nutritional wisdom. This balance may have helped to prevent excess protein in the diet and also to maintain a low GIN infection, both considered as examples of prophylactic self-medication.

Estudios farmacogenéticos en cáncer, VIH y trasplante / Pharmacogenetic studies in cancer, HIV and transplantation

INTRODUCCIÓN La farmacogenética predice cómo un individuo responde a la administración de un fármaco, con la finalidad de personalizar la terapia, incrementar la efectividad y minimizar las reacciones adversas. Ciertas variaciones genéticas pueden conducir a efectos adversos graves (hipersensibilidad al antirretroviral abacavir, toxicidad a 5-fluorouracilo y capecitabina) o a inefectividad (rechazo agudo a trasplante renal por escasa biodisponibilidad de tacrolimus). OBJETIVOS Determinar el genotipo en pacientes tratados con estos fármacos en la ciudad de San Juan y establecer la prevalencia de los tres polimorfismos genéticos en la población general. MÉTODOS La población consistió en 15 pacientes con diagnóstico certero de cáncer, 15 seropositivos para VIH y 1 que había recibido trasplante renal. Se seleccionó además a 45 individuos sanos. En todos los casos se firmó el consentimiento informado. Se hallaron las frecuencias génicas y genotípicas mediante la reacción en cadena de polimerasa (PCR). RESULTADOS Para la variación genética HLA-B*57 01, las frecuencias genotípicas y alélicas fueron de 0,000 para los individuos seropositivos y 0,022 para la población general. Se obtuvo una prevalencia de 2,00%. Para el polimorfismo DYPD, las frecuencias genotípicas y alélicas fueron de 0,000 tanto para los pacientes con cáncer como para los sujetos sanos, y la prevalencia fue de 0,00%, es decir que el 100% de los sujetos estudiados presentó la variante homocigota G/G normal. Idénticas frecuencias se obtuvieron para el polimorfismo CYP 3A5. DISCUSIÓN Dado que el número de individuos fue muy bajo, no se pudieron realizar cambios de esquemas terapéuticos o ajustes de dosis en los pacientes estudiados. Sin embargo, se obtuvo un valor de prevalencia para HLA-B*57:01 comparable a otros reportados, el cual permite estimar en San Juan la existencia de aproximadamente 15000 individuos portadores de la variación, para los que la genotipificación previa podría disminuir la aparición de efectos adversos.

Gastrointestinal nematode infection does not affect selection of tropical foliage by goats in a cafeteria trial.

It is important to determine whether gastrointestinal nematodes (GINs) affect foliage choice of goats leading to confirm the expression of a self-medication behavior. This study investigated the effect of GIN infection on tropical foliage selection by goats. During experimental stage 1 (10 days), goats had a natural mixed GIN infection, and at stage 2 (10 days), goats were treated with effective anthelmintics to maintain them free of GIN infection. During stage 1 the twelve adult goats (32 ± 2.3 kg live weight [LW]) were assigned to three groups (n = 4) according to their initial GIN infection status: HI group, with fecal egg count (FEC) between 1450 and 2150 eggs per g/feces (EPG); MI group, medium FEC (592-1167 EPG); and the NI group, free from GIN infection. Fresh foliage of four tropical plants were offered to goats ad libitum for 1 h daily: Gymnopodium floribundum (high condensed tannin [CT] content, 37-40 %), Mimosa bahamensis (medium CT content, 16-17 %), Leucaena leucocephala (low CT content, 3-5 %), and Viguiera dentata (negligible CT content, 0.6-0.9 %). Jacobs' selection indexes (JSIs) were estimated for the experimental foliage based on dry matter (DM), CT, or crude protein (CP) intake. During both study stages, individual fecal egg counts were estimated. The JSI patterns of different plant species, based on DM, CT, or CP, were similar irrespective of infection level during stage 1 (HI, MI, and NI) or no GIN infection (stage 2). Thus, irrespective of GIN infection, goats actively selected M. bahamensis (high CT, low CP content) and V. dentata (negligible CT, high CP content) but avoided G. floribundum (high CT, low CP content) and L. leucocephala (medium CT and high CP content). Thus, natural GIN infection did not influence goats' foliage selection.

Síndrome de encefalopatía posterior reversible en un paciente trasplantado: reporte de caso / Posterior reversible encephalopathy in a transplanted patient: case report

El trasplante de órganos es una alternativa terapéutica cada vez más frecuente en nuestro medio y con ello las complicaciones y efectos de las medicaciones inmunosupresoras que afectan el sistema nervioso central (SNC). El síndrome de encefalopatía posterior reversible (SEPR) es un trastorno caracterizado por manifestaciones neurológicas potencialmente reversibles, asociadas a cambios en las neuroimágenes, en estrecha asociación con factores precipitantes, dentro de los cuales, se destacan el uso de medicamentos inmunosupresores, quimioterapéuticos y algunas condiciones médicas como hipertensión arterial y enfermedades renales.Las características clinico-radiológicas de este trastorno usualmente revierten con la suspensión de los factores precipitantes; sin embargo el diagnóstico tardío puede llevar a un desenlace fatal. Se presenta un caso de SEPRen una paciente joven a quien se le realizó trasplante cardiaco de urgencia. Durante su manejo post-operatoriorecibió tacrolimus como parte del tratamiento del paciente trasplantado. En la cuarta semana de post-operatorioy quinto día de tratamiento con tacrolimus desarrolló cefalea asociada a cifras tensionales elevadas, deterioro de la conciencia y episodios convulsivos tónico-clónicos generalizados; las manifestaciones neurológicas revirtieron en las 48 horas siguientes al retiro del tacrolimus, al igual que los cambios en las neuroimagenes que resolvieron un mes después de las manifestaciones iniciales.

The organ transplantation is a therapeutic alternative increasingly common in our country, thus, the complications and effects of immunosuppressive medications that affect the Central Nervous System (CNS). The Posterior Reversible Encephalopathy Syndrome (PRES) is characterized by neurological manifestations associated with changes in neuroimaging, together with precipitating factors, among which the use of immunosuppressive, chemotherapy and certain medical conditions such as hypertension and kidney diseases stand out. Theclinical radiological features of this disorder are usually reversible with discontinuation of the precipitating factors; however a delayed diagnosis may lead to a fatal outcome. A case of PRES on a young patient who underwent an emergency heart transplant occurred in our institution. During his post operative care received tacrolimus as part of the transplant management. In the fourth week of post operative treatment and the fifth day of the use of tacrolimus, the patient presented headache associated with high pressure values, impaired consciousness and episodes of generalized tonic-clonic seizure, the neurological symptoms reversed within 48 hours after the withdrawal of tacrolimus, as well as changes in neuroimaging who decided one month after the initial manifestations.

Immunohistochemical distribution of S-100 protein and subunits (S100-alpha and S100-beta) in the swamp-type water buffalo (Bubalus bubalis) testis.

The distribution and localization of S-100 protein (S-100) and its subunits (S100-alpha and S100-beta) in the testis of swamp-type water buffalo were investigated using immunohistochemistry. S-100 was detected in the Sertoli cells in the convoluted seminiferous tubules, modified Sertoli cells lining the terminal segment of the seminiferous tubules and in the intratesticular excurrent ducts (straight tubules and rete testis). S100-beta showed the same distribution and localization with that of S-100. However, the cytoplasmic extension of the Sertoli cells in S100-beta staining showed less staining intensity compared with that of S-100. S100-alpha showed a positive staining only in the modified Sertoli cells of the terminal segment of the seminiferous tubule. Endothelial cells of blood vessels were also positive with the proteins while the Leydig and spermatogenic cells showed a negative reaction. The localization of S-100 in the testis of the water buffalo was in parallel with that of other artiodactyls which supports the hypothesis that this protein is a multifunctional protein. S100-beta in the Sertoli cells suggests that this protein is involved in establishing blood-testis barrier. Its presence in the modified Sertoli cells and in the epithelium of the excurrent ducts suggest secretory and absorptive function, respectively. Meanwhile, S100-alpha, which was detected only in the modified Sertoli cells, is involved in the secretory activity of these cells that are related to exocrine function.

Immunohistochemical study of the neuropeptides in the stellate ganglion of the water buffalo.

The localization of some neuropeptides including neuropeptide Y (NPY), substance P (SP), calcitonin gene related peptide (CGRP), vasoactive intestinal peptide (VIP), galanin (Gal), methionine enkephalin (M-ENK), tyrosine hydroxylase (TH) immunoreactivity was studied in the stellate ganglion (SG) of water buffalo. NPY, SP, Gal and TH immunoreactivities were present in almost all of the ganglion cells. NPY, SP, Gal, SP, CGRP, VIP and M-ENK immunoreactive nerve fibers were also seen in the SG. The localization and pattern of distribution of these peptides in the water buffalo stellate ganglion were compared with those in stellate ganglia of other mammalian species.

Neosynephrine pack for flat and shallow anterior chamber after cataract extraction

1. Ten percent neosynephrine cotton pact for 30 to 60 minutes in the lower fornix is a simple, convenient and effective procedure in restoring the depth of flat and shallow anterior chamber after cataract extraction. It succeeds where atropine and neosynephrine drops fail2. It relieves whatever relative insufficiency exists in the openings in the iris-hyaloid diaphragm and by lessening aqueous information, it decreases the pressure posterior to the diaphragm3. Sealing whatever leaks there is in the operative wound tends to raise the pressure anterior to the iris-hyaloid diaphragm and enhances its backward replacement4. It is preferable to apply the pack on the third day after the anterior chamber has become flat or shallow5. Its complications and side reactions are rare and mild. (Conclusions)

Disturbances of the associated or conjugate movements of the eye

Disturbances of divergence and convergence should be kept in mind in cases where diplopia is a complaint and can be elicited throughout the visual field, especially when no definite squinting is presentIn any case of disturbance of the associated or conjugate ocular movements a brain tumor and encephalitis should be considered among other causes. Whenever a brain tumor is suspected, the presence of paralysis of any associated or conjugate movement is a localizing finding. (Summary and conclusion)

Some ophthalmological misconceptions in medical practice in the Philippines

We should get rid of the concept and practice of waiting for the cataract to become fully mature before extracting it, not only because of the mental torture and the social and economic sacrifices which the period of waiting entails to the patient, but also with the use of forceps, sutures, other safety devices,and intracapsular extraction, the removal of immature cataract is technically not more difficult, if not really easier; and the visual results are equal to, if not actually better than, that of the mature cataract. This statement is based on my experience with, and of the results obtained in 300 consecutive cataract extractions during a period of 22 months. Of these cases, 103 were immature, and 46 private cases with corrected postoperative vision were followed up. Out of the 30 uncomplicated cases, 87% had a vision of 20/20 to 20/30, while 95% had a vision of 20/50 or better. Old age, over 75 years, slight to moderate cough, diabetes, and hypertension are not contraindications to cataract extraction if proper precautions are takenWe should enjoy freedom from fear of trachoma in the Philippines. Studies have revealed that, while trachoma exists in this country, mostly among Chinese, Hindus, and Indo-Chinese, it is a rarity among Filipinos; and blindness from trachoma among Filipinos is practically nil. Folliculosis and follicular conjunctivitis are common among our children and these are mistaken for trachoma. These children should not be required to undergo scraping of their conjunctivae before they are allowed to attend classes because of the mistaken concept that they have trachomaAcute non-bacterial kerato-conjunctivitis of viral origin exists here in endemic form with occasional epidemic flare-upsThere should be a widespread concern for glaucoma, because this is the most frequent cause of irremediable blindness in this country. To combat glaucoma, not only should the public be made aware of its dangers but the opticians, medical practitioners and specialists should also be more informed about itSquinting should be treated and if necessary, operated on during the pre-school age, in order to prevent the development of inferiority complex in the child and crumpling of his personality, to avoid blindness from amblyopia, to secure more permanent and better cosmetic results, and to insure binocular single visionThe ophthalmologists should do more ophthalmic plastic surgery and get rid of the fear of excising lid tumors before they cause suffering and threaten lifeAn "oculist" or "ophthalmologist" should not be confused with an "optician" and "optometrist."Refraction is only a part of an ophthalmological examination for eyestrain, the causes of which are many times not an error of refraction, but improper or overuse of the eyes in an unfavorable internal and external environment. Hence, the treatment of eyestrain is not always the wearing of correct glasses or exercises for the extraocular muscular imbalance, but also the proper use of the eyes, providing sufficient lighting and elimination of glare, together with improvement of some medical internal trouble or the relief of some psychosomatic problems. (Summary)

The extraction of the immature cataract

1. The classification of the senile cataract into immature and mature stages based on either an objective or subjective criterion will be found confusing and not reliable as a guide for surgical intervention2. The basis for the time of surgical intervention should be not so much the maturity or immaturity of the cataract, but more the degree of visual impairment of the better seeing eye, in relation to the particular work or temperament of the patient3. By the use of intracapsular extraction, and the aid of sutures and other safety devices of modern cataract surgery, the removal of the immature cataract is technically not more difficult, if not actually easier, than that of mature cataract4. In a series of 100 private and charity cases of cataract extraction, 25 cases were found to be immature, based arbitrarily on a middle ground classification of a visual acuity of counting fingers at one foot as the subjective criterion dividing the immature from the mature cataract. The results from these extractions compare favorably, if not better than, the mature cataracts of the series5. The Filipino physicians and ophthalmologists should get rid of the concept and practice of waiting for the cataract to become fully mature before extracting it. Because of the mental torture and the social and economic sacrifices which the period of waiting entails to the patient, the public should be mroe fully informed that it is unnecessary under modern methods to wait for a caratact to mature before it can be operated. (Conclusion)

The glaucoma problem in the Philippines

Glaucoma is the cause of the greatest number of irremediable blindness in adults in the Philippines. I have reviewed and analyzed 80 private cases of glaucoma at the St. Lukes Hospital Eye Clinic, and 65 charity cases at the Philippine General Hospital, for the purpose of finding out the various phases of our glaucoma problem in this country. I have cited specific cases for illustration. Some suggestions are made to our eye physicians, medical practitioners, opticians, and the general public on the recognition and management of glaucomaWhile the basic problem of glaucoma is etiologic, in the Philippines it is primarily education about its dangers, earlier recognition, and more up-to-date management. There must be a campaign against this major cause of blindness in this country. The education of the educators and ophthalmologists should go hand in hand with increasing the knowledge of our medical practitioners and of the public about glaucoma. (Summary)

Microscopic conjunctival keratinization in ocular hypovitaminosis A

The pipette and the scraping methods for exfoliative cytology of the conjunctiva and cornea for keratinization were compared. Eskelung, Papanicolau, Giemsa and Mallory connective tissue stains were tried to demonstrate the keratinized cells. Using the scraping method and Mallory stain, among groups of 102 and 20normal individuals, one-half had 1 to 4 with an average of 2 keratinized cells. All 13 children from Leyte from 3 to 16 years old and two adults 23 and 41 years old, with complaints of night blindness and 20/20 visual acuity, with dryness and wrinkling of the conjunctiva with or without Bitots spots had hyperkeratinization of the corneae and all portions of the conjunctivae. These varied from 71 to 100 keratinized cells with an average of 82.2 anucleated and 12.5 nucleated. Bitots spots showed keratinization with hyperplasia of its deeper portions. Local instillation of vitamin A did not improve the night blindness nor change the gross appearance of the conjunctiva and cornea. There was however less keratinization in Bitots spots and the cells became less polygonalAmong 35 children of the slum area in Leveriza, Manila, 12 were found fairly nourished and 23 malnourished by the weight-height criterion of WHO. These two groups were examined by exfoliative cytology for conjunctival keratinization and for vitamin A content of the blood by the micro method of triflouroacetic acid. About half of them were also tested for night blindness by a color test designed at the Philippine Eye Research Institute. Only 2 of the 12 fairly nourished children had very slight keratinization above normal. Sixty-five percent of the malnourished children had slight to moderate hyperkeratinization of the conjunctiva. The vitamin A content of the serum was low in about 30 of them. Only one who was complaining of night blindness gave a negative color responseLocal and available foreign literature on the tests for ocular and systemic vitamin A deficiency and its manifestations, the metabolism of vitamin A, keratinization and vitamin A, genetics and the biological bases of medicine were reviewed to assess the meaning and implications of our observations. This is the first report on the microscopic conjunctival keratinization as a test for ocular and systemic hypovitaminosis A. Based on our findings and current medical and ophthalmological concepts, a classification of the manifestations of ocular hypovitaminosis A is made. The fundamental implications are discussed and concepts on the mechanism of conjunctival keratinization and Bitots spot formation in vitamin A deficiency are formulatedThe practical applications of microscopic conjunctival keratinization in ocular hypovitaminosis are enumerated. (Summary)

Psychosomatic aspects of ophthalmology

I have not mentioned hysterical blindness, or malingering, which has definite psychosomatic tice-ups, because they are well covered in our textbooks. I have discussed the less obvious but more frequent psychosomatic aspects of ophthalmologic practice in this country. I think that ophthalmologists should at least know how to spot a psychosomatic patient; and if he has the time, he should develop an inclination and sufficient knowledge to handle them, before referring him to a psychiatristWith all the interest we can develop in, and all the information we can gather about, psychosomatic medicine, we must follow up our patients if we are to gain in knowledge of this aspect of ophthalmology. (Conclusions)

Freezing in vascularized cornea

As far as we can ascertain in the literature, this is the first time cryogenic procedure has been applied to the difficult problem of obliterating or artificially regressing corneal blood vesselsUtilizing-50 degree celsius we froze a series of 25 cases of vascularized corneas and have carefully and systematically observed clinically the obliteration and complete regression of the blood vessels by the aid of biomicroscope, operating microscope and with the help of intravenous flourescein. Diagrams of the individual vessels were recorded and photographs of various stages of regression were takenHistopathological examinations of the frozen corneal tissues were made. Photomicrographs of the sections showed the death, disintegration, disapperance of the endotholial cells of the blood vesel with extravasation, some inflammatory reaction and complete disappearance of the vessels. The changes in the non-vascular, cellular and non-cellular structures have been shown. Several cases of frozen vascularized cornea have been subjected to keratoplasty after 4 to 5 months with more favorable results than if the corneal freezing had not been done. (Summary)

A national research program for the Philippines

For many years there has been a feeling and thinking among our medical scientist and medical research supporters that there is something fundamentally lacking in our total research activities. Several meetings and conferences have been called to crystalize and spell out our national medical research problems. All these brought out that our main problems are those of direction and more effectiveness in our research efforts. This led to the realization that what we need as a starting point is the formulation of a national medical research program for the Philippines (Author)

The concept of focal infections in ophthalmology

The state of controversy over the concept of focal infection is mentioned. Its role in ophthalmology in the light of local clinical materials and experience is discussed and illustrated by representative and instructive case reports. The clinical deduction from these cases as well as the objections to the concept of focal infection are summarized and a scheme of the workings of the concept is presented aided by diagram. Although the authors believe in the concept of focal infection in ophthalmology they take a balanced, cautious attitude toward it. They are against indiscriminate removal of any focus of infection. Individualization of cases is advocated and multiplicity of factors is emphasized. They hold the concept "not with the over enthusiasm of faith, but with the hope and modesty of knowledge."(Summary)