Intensive Urbanization, Urban Meteorology and Air Pollutants: Effects on the Temperature of a City in a Basin Geography.

A qualitative study of thermal transfers is carried out from a record of measurements (time series) of meteorological variables (temperature, relative humidity and magnitude of wind speeds) and pollutants (PM10, PM2.5 and CO) in six localities located at different heights in the geographic basin of Santiago de Chile. The measurements were made in two periods, 2010-2013 and 2017-2020 (a total of 2,049,336 data), the last period coinciding with a process of intense urbanization, especially high-rise construction. The measurements, in the form of hourly time series, are analyzed on the one hand according to the theory of thermal conduction discretizing the differential equation of the temporal variation in the temperature and, on the other hand, through the theory of chaos that provides the entropies (S). Both procedures demonstrate, comparatively, that the last period of intense urbanization presents an increase in thermal transfers and temperature, which affects urban meteorology and makes it more complex. As shown by the chaotic analysis, there is a faster loss of information for the period 2017-2020. The consequences of the increase in temperature on human health and learning processes are studied.

Bilateral retinal vasculopathy associated with autosomal dominant dyskeratosis congenita.

PURPOSE: To report a case of autosomal dominant dyskeratosis congenita (AD-DC) complicated by bilateral retinal vasculopathy and proliferative retinopathy with vitreous hemorrhage in the right eye, in the absence of pancytopenia.
 METHODS: We report a 32-year-old woman who presented with floaters in her right eye. She underwent complete ophthalmic examination and fundus fluorescein angiography.
 RESULTS: Funduscopic examination revealed vascular sheathing in the temporal periphery of both eyes and a vitreous hemorrhage in the right eye. Fluorescein angiography showed retinal neovascularization in the right eye and bilateral temporal peripheral capillary nonperfusion. Treatment consisted of laser photocoagulation directed to the areas of capillary nonperfusion in both eyes. A point mutation in the TERC gene confirmed the diagnosis of AD-DC.
 CONCLUSIONS: Autosomal dominant dyskeratosis congenita is a rare form of inherited bone marrow failure and its presentation is milder than seen in patients with X-linked and autosomal recessive mutations. These patients may lack the classic clinical triad, so it is important to have a high index of suspicion and to be aware of retinal vasculopathy as a complication of dyskeratosis congenita as it may severely compromise vision. Appropriate treatment includes prompt laser photocoagulation to areas of retinal nonperfusion.

Factors determining visual outcome in endogenous Candida endophthalmitis.

PURPOSE: To determine factors affecting the visual outcome of eyes with endogenous Candida endophthalmitis. METHODS: Retrospective cohort study of 44 eyes from 36 patients diagnosed with candida endophthalmitis at 2 tertiary referral uveitis centers. Outcome measures included the development of retinal detachment and the occurrence of visual loss (visual acuity of <20/40) and severe visual loss (visual acuity of ≤ 20/200). RESULTS: Twenty four of 44 eyes (55%) had visual loss and 16 of 44 eyes (32%) had severe visual loss by the end of the study. Early vitrectomy significantly reduced the risk of retinal detachment (P = 0.02). Factors associated with poor visual outcome included poor presenting visual acuity (relative risk = 2.38; 95% confidence interval, 1.01-5.55; P < 0.05) and centrally located fungal lesions (relative risk = 5.01; 95% confidence interval, 1.00-2.52; P < 0.05). CONCLUSION: Candida endophthalmitis is associated with a high rate of visual loss, particularly in patients with poor presenting visual acuity or centrally located lesions. Early vitrectomy reduces the risk of retinal detachment.

Intravitreal triamcinolone acetonide as adjunctive treatment with systemic therapy for uveitic macular edema.

PURPOSE: To report the outcome of a single intravitreal triamcinolone acetonide (IVTA) injection as an adjunctive treatment with systemic medication for refractory uveitic cystoid macular edema (CME). METHODS: This was a retrospective, noncomparative, interventional case series. Medical records of 25 patients (35 eyes) with quiescent uveitic CME who were treated with oral immunosuppressive therapy and underwent 4 mg/0.1 mL IVTA injection were reviewed. Data was collected 6 months post-injection and included details of uveitis, best-corrected visual acuity (BCVA), CME, systemic therapy required, and potential complications of IVTA injection. RESULTS: Thirty eyes (85%) responded with improvement in vision. The mean BCVA improvement was 0.33 (from 0.67 to 0.34 logarithm of the minimum angle of resolution; Snellen equivalent, between 2 and 3 lines) (p<0.001), at a mean time of 6.2 weeks (range 2-16). Resolution of CME was achieved in 31 (88%) of the treated eyes. Following initial response to IVTA, CME relapsed in 8 eyes (26%) after a mean time of 4.2 months (range 2.5-5.5). The dosage of oral corticosteroids and/or second-line immunosuppressive agents was able to be reduced or stopped in 22 patients, 29 of 35 eyes (82.8%). The most common adverse effect was increased intraocular pressure, in 17 (49%) of the treated eyes. Steroid-induced cataract was observed in 6 eyes (17%). CONCLUSIONS: Intravitreal triamcinolone acetonide appears to be an effective supplementary tool in the management of CME refractory to systemic immunosuppressive therapy. Retreatment might be required in some and may be associated with elevated intraocular pressure and cataract.

Oral moxifloxacin and topical amikacin for Mycobacterium abscessus keratitis after laser in situ keratomileusis.

We report a case of Mycobacterium abscessus keratitis after elective laser in situ keratomileusis in a 19-year-old woman. The infection started 3 weeks after uneventful surgery, and the patient received multiple antimicrobial treatments without response. A corneal scrape isolate showed an acid-fast bacterium that was subsequently confirmed by culture to be M abscessus. Prompt treatment of oral moxifloxacin 400 mg twice daily and hourly topical amikacin 2.5% was started. Recovery occurred within the first week of treatment, with complete resolution 3 weeks after presentation. The final uncorrected distance visual acuity was 6/9. We comment on other reports of post-LASIK keratitis caused by M abscessus, the in vitro sensitivity to antibiotic agents described in the literature, and the use of oral moxifloxacin as a potential good alternative treatment based on its good ocular bioavailability, which in our case allowed resolution without the need for surgical intervention.

Pole to pole intraocular transit of tarantula hairs-an intriguing cause of red eye.

This intriguing case report provides novel images and a description of the anterior and rarer posterior segment findings seen in ocular inflammation associated with tarantula spider hair exposure. We present an interventional case report of a 9-year-old boy who presented with a red, sore eye. Slit lamp examination revealed right eye injection, multiple small hairs at differing levels of the cornea with associated opacities and inflammation within the anterior and posterior segments of the eye. Only after detailed and repeated questioning did the aetiology become apparent. Conservative management in the form of topical steroid and antibiotics was commenced and he did well with no obvious sequelae in the medium term. Healthcare personnel (and indeed pet shop owners, arachnid enthusiasts and even parents) should be aware of the potential ocular complications of tarantula hair exposure and clinicians should perhaps specifically ask about pet-keeping when presented with an unusual red eye.

Intraocular methotrexate in the treatment of uveitis and uveitic cystoid macular edema.

OBJECTIVE: A pilot study to evaluate the use of intravitreal methotrexate (MTX) for the treatment of uveitis and uveitic cystoid macular edema (CME). DESIGN: Prospective, consecutive, interventional case series. PARTICIPANTS: Fifteen eyes of 15 patients with a unilateral exacerbation of noninfectious intermediate, posterior uveitis, or panuveitis and/or CME such that visual acuity (VA) was 20/40 or worse, together with a history of increased intraocular pressure (IOP) in response to corticosteroid administration. INTERVENTION: Intravitreal injection of 400 microg in 0.1 ml MTX. MAIN OUTCOME MEASURES: The primary outcome measure was VA (using the Early Treatment Diabetic Retinopathy Study chart). Other outcome measures included ocular inflammation scores, time to relapse, levels of systemic corticosteroid and immunosuppressive therapy, and ocular coherence tomography. Potential complications of intravitreal MTX injection, including cataract progression, vitreous hemorrhage, retinal detachment, and corneal epitheliopathy, were assessed. RESULTS: VA improved at all time points and was statistically significant at the 3- and 6-month follow-up examinations. The mean visual improvement was 4 lines at 3 months and 4.5 lines at 6 months, with no statistical difference between the best VA obtained after MTX injection and after previous corticosteroid treatment, including intravitreal triamcinolone acetate injection. Five patients relapsed after a median of 4 months; a similar improvement was seen after re-injection. Ocular inflammation scores improved at all time points, and systemic immunosuppressive medication was reduced in 3 of 7 patients taking this at the start of the trial. CONCLUSIONS: In patients with uveitis and uveitic CME, intravitreal MTX can improve VA and reduce CME and, in some patients, allows the reduction of immunosuppressive therapy. Relapse occurs at a median of 4 months in some patients, but reinjection has similar efficacy.

Azathioprine in the management of autoimmune uveitis.

PURPOSE: To evaluate the role of azathioprine as an immunosuppressive for steroid-resistant autoimmune uveitis (AIU). METHODS: Patients using oral prednisolone for active AIU without clinical response were recruited. A standard protocol of oral prednisolone and azathioprine was used. RESULTS: Twenty-seven patients participated in the study: 3 with anterior uveitis, 1 pars planitis, 4 idiopatic panuveitis, 8 Vogt-Koyonagi-Harada syndrome, 3 Behcet disease, and 8 choroidoretinopathies. Complete response was observed in 92%. Eleven patients had well-tolerated minor side effects. CONCLUSION: Azathioprine is safe and effective in controlling steroid-resistant AIU.

[Role of Azathioprine in steroid resistant non infectious ocular inflammatory diseases]. / Eficacia de la azatioprina en la enfermedad ocular inflamatoria no infecciosa resistente a tratamiento esteroidal sistémico.

BACKGROUND: Topical and systemic steroids are the first line of treatment of non infectious inflammatory ocular disease. Immunosuppresants are reserved as a second line treatment. AIM: To evaluate the role of Azathioprine (AZA) as a coadyuvant immunosuppressive treatment for non infectious ocular inflammatory diseases (OIDs) resistant to systemic steroid therapy in a retrospective, noncomparative interventional case series. PATIENTS AND METHODS: Patients using oral Prednisone due to an active or recurrent OID, without clinical response, and not receiving any other immunosuppressive treatment were studied. A standard protocol of oral Prednisone (0.5 mg/kg/ day) and oral AZA (2-3 mg/kg/day) during one year was used. Ocular and systemic monthly evaluations were done including relapse rate, steroid dosage, inflammatory score and visual acuity. RESULTS: Thirty patients (10 male) aged 18-75 years (mean 44 years) were studied. Three had bilateral anterior uveitis, one had pars planitis, four had diffuse uveitis, eight Vogt-Koyanahi-Harada syndrome, three Behget's disease, three necrotizing scleritis and eight had retinochoroidopathy A complete initial response was observed in 26 patients (87%). The time of response was between 1 to 6 months (mean 2.65 months). Seventeen percent of these had a relapse 6 to 12 months after AZA was started. In 61 %, visual acuity improved. The ocular inflammatory score decreased in 86.5%. Eleven patients had mild controlled side effects that did not require discontinuation of AZA. CONCLUSIONS: Combined systemic steroid and oral AZA therapy is safe and effective in controlling steroid resistant non infectious inflammatory ocular diseases.

Eficacia de la azatioprina en la enfermedad ocular inflamatoria no infecciosa resistente a tratamiento esteroidal sistémico / Role ofAzathioprine in steroid resistant non infectious ocular inflammatory diseases

Background: Topical and systemic steroids are the first line of treatment of non infectious inflammatory ocular disease. Immunosuppresants are reserved as a second line treatment. Aim: To evaluate the role ofAzathioprine (AZA) as a coadyuvant immunosuppressive treatment for non infectious ocular inflammatory diseases (OIDs) resistant to systemic steroid therapy in a retrospective, noncomparative interventional case series. Patients and methods: Patients using oral Prednisone due to an active or recurrent OID, without clinical response, and not receiving any other immunosuppressive treatment were studied. A standard protocol of oral Prednisone (0.5 mg/kg/ day) and oral AZA (2-3 mg/kg/day) during one year was used. Ocular and systemic monthly evaluations were done including relapse rate, steroid dosage, inflammatory score and visual acuity. Results: Thirty patients (10 male) aged 18-75 years (mean 44 years) were studied. Three had bilateral anterior uveitis, one had pars planitis, four had diffuse uveitis, eight Vogt-Koyanahi-Harada syndrome, three Behget's disease, three necrotizing scleritis and eight had retinochoroidopathy A complete initial response was observed in 26 patients (87 percent). The time of response was between 1 to 6 months (mean 2.65 months). Seventeen percent of these had a relapse 6 to 12 months after AZA was started. In 61 percent, visual acuity improved. The ocular inflammatory score decreased in 86.5 percent. Eleven patients had mild controlled side effects that did not require discontinuation of AZA. Conclusions: Combined systemic steroid and oral AZA therapy is safe and effective in controlling steroid resistant non infectious inflammatory ocular diseases.

[Carotid cavernous fistula: the importance of its opportune diagnosis and treatment to prevent blindness]. / Fistula carótido-cavernosa: importancia de su diagnóstico y tratamiento oportunos para prevenir la ceguera.

A carotid cavernous fistula is an abnormal communication between a branch of the carotid artery and the cavernous sinus generating an arteriovenous fistula that can cause severe ocular damage. We hereby report two cases of carotid cavernous fistulas. A 69-year-old male with a 2-month history of right eyelid swelling and red eye aggrarated by diplopia, exophthalmus, and limitation of ocular movements one week before consulting. On admisson his visual acuity, in the right eye was good (0.5) and biomicroscopy showed arterialization of conjunctival vessels. All orbital CAT scan showed a dilatation of the superior orbital vein characteristic of carotid cavernous fistula. A balloon balloon tramponade of the fistula was performed too late (after 3 weeks) and the eye went blind. A 39-year-old female consulted for an acute proptosis of the right eye and severe visual loss. Biomicroscopy showed arterialization of the conjunctival vessels and the CAT scan disclosed a dilatation of the superior orbital vein. She was immediately subjected to a neuroradiological fistula closure with recovery of visual acuity to 1.0 (20/20). Our main purpose is to emphasize the importance of the opportune diagnosis and treatment of these fistulas to prevent visual loss and eventual blindness, as occurred in our first patient.

Infección respiratoria aguda baja del niño en atención primaria / Lower respiratory tract infection in children attending primary health care centers

El síndrome bronquial obstructivo (SBO) y las neumonías (N) son afecciones frecuentes en los niños, motivan la mayor cantidad de consultas en atención primaria y pueden originar hospitalizaciones, predisponer a enfermedades crónicas e incluso producir la muerte del menor. El objetivo del presente estudio es conocer el comportamiento del SBO y N en el niño entre los 0 y 14 años de edad. Se determina en cada niño la frecuencia de episodios, consultas, hospitalizaciones, días de hospitalización, calculando el riesgo de enfermar por edad y sexo en 475 menores de 15 años beneficiarios de un consultorio del área norte de Santiago. Ellos consultaron al menos una vez por estas causas entre abril y julio de 1999 y se observaron durante ocho meses, siendo tratados según las normas ministeriales vigentes. Para obtener la información se adhirió un cuestionario a la ficha del niño en la primera consulta. Resultados: la tasa de enfermedad fue de 26,9 cada 100 meses-niño observación. Esta disminuye de 38 por ciento en menores de un año a 29,5 por ciento entre los 1 y 2 años, 23 por ciento en preescolares y alrededor de 20 por ciento en los escolares. El 60,2 por ciento de los niños presentó solo SBO, 29,7 por ciento N y el resto ambas. El 61,7 por ciento de los niños tuvieron 1 ó 2 episodios; el máximo de episodios fue 14. El 69,3 por ciento de los niños estuvo enfermo entre 3 y 15 días; la mediana de consultas fue de 3,8, el máximo 22. Requirieron hospitalización 5,2 por ciento de los niños. Los riesgos de enfermar son significativamente mayores en los varones y en los menores de un año. Se destaca que en más de la mitad de los hogares de estos niños se fuma dentro de la casa. Con los resultados de este estudio se pretende dar a conocer el comportamiento del SBO y N en el niño de 0 a 14 años, en cuanto a riesgos y consultas. Se demuestra que estas enfermedades son importantes en todos los grupos de edad, aunque su magnitud es diferente