Uso del cigarrillo electronico y riesgo de padecer enfermedades respiratorias en adolescentes y adultos jóvenes

Objetivo: Determinar el riesgo de padecer enfermedades respiratorias por el uso del cigarrillo electrónico. Materiales y métodos: Revisión integrativa, basada en el análisis de artículos científicos completos en bases de datos como: PubMed, Scopus y SciELO utilizando el método PRISMA, en el periodo 2018-2023, en los idiomas inglés y español. Resultados: Se obtuvo 95 artículos científicos, de los cuales se excluyeron un total de 75 por no cumplir con los criterios de selección, quedando seleccionados 20 artículos científicos que responden a los objetivos planteados. Conclusiones: Este estudio identificó los riesgos de padecer enfermedades respiratorias por el uso del cigarrillo electrónico, siendo las más relevantes: enfermedad pulmonar obstructiva crónica, neumonía, lesión pulmonar asociada al cigarrillo electrónico o al vapeo, síndrome de distrés respiratorio, hipertensión pulmonar y asma, además de acompañarse de signos y síntomas como infección de las vías aéreas, el desarrollo de enfermedades cardiovasculares, gastrointestinales y el inicio de adicciones. El estudio identificó que el sexo masculino es el predominante en exponerse más al riesgo de enfermedades respiratorias y la edad oscila entre los 14 a 35 años, convirtiéndose en un problema de salud pública que cada año va en aumento.

Objective: To determine the risk of respiratory diseases due to the use of electronic cigarettes. Materials and Methods: Integrative review, based on the analysis of complete scientific articles in databases such as: PubMed, Scopus and SciELO, using the PRISMA method, in the period 2018-2023, in English and Spanish. Results: Of the 95 scientific articles that were obtained, 20 met the selection criteria and were selected to meet the stated objectives. The remaining 75 articles were excluded. Conclusions: This study identi fied the risks of suffering from respiratory diseases associated with the use of electronic cigarettes. The most significant risks include chronic obstructive pulmonary disease, pneumonia, lung injury associated with electronic cigarettes or vaping, respiratory distress syndrome, pulmonary hypertension, and asthma. Symptoms may also include signs and symptoms of respiratory infections, development of cardiovascular and gastrointestinal diseases, and the onset of addiction. The study found that males are more susceptible to respiratory diseases, with the 14-35 age group being particularly affected. This is becoming a growing public health concern.

Objetivo: Determinar o risco de doenças respiratórias devido ao uso de cigarros eletrônicos. Materiais e métodos: Revisão integrativa, baseada na análise de artigos científicos completos em bases de dados como: PubMed, Scopus e SciELO, utilizando o método PRISMA, no período de 2018 a 2023, em inglês e espanhol. Resultados: Foram obtidos 95 artigos científicos, dos quais um total de 75 foram excluídos por não atenderem aos critérios de seleção, restando 20 artigos científicos selecionados que respondem aos objetivos estabelecidos. Conclusões: Este estudo identificou os riscos de doenças respiratórias decorrentes do uso de cigarros eletrônicos, sendo as mais relevantes a doença pulmonar obstrutiva crônica, pneumonia, lesão pulmonar associada ao cigarro eletrônico ou vaping, síndrome do desconforto respiratório, hipertensão pulmonar e asma, além de serem acompanhadas de sinais e sintomas como infecção das vias aéreas, desenvolvimento de doença cardiovascular, doença gastrointestinal e início de dependência. O estudo identificou que o sexo masculino está predominantemente exposto ao risco de doenças respiratórias e a idade varia de 14 a 35 anos, tornando-se um problema de saúde pública que aumenta a cada ano.

Central Retinal Artery Occlusion with Concomitant Intracranial Hemorrhage Secondary to Streptococcus Gordonii Endocarditis.

Purpose: To report a case of central retinal artery occlusion (CRAO) associated with subacute Streptococcus gordonii endocarditis secondary to a dental infection. Observations. A 27-year-old male presented with acute monocular vision loss in the setting of a stroke and seizure. A fundus exam revealed macular whitening and a cherry-red spot. Edema of the inner retinal layers was confirmed on macular optical coherence tomography, consistent with CRAO. Initial imaging (carotid Doppler, EKG, and transthoracic echocardiography) and a comprehensive laboratory workup did not reveal an etiology for the stroke or vision loss. Brain magnetic resonance imaging showed T1 hyperintensity with surrounding edema, which prompted a workup for possible septic emboli versus occult malignancy. Subsequent blood cultures led to the detection and diagnosis of Streptococcus gordonii endocarditis. It was subsequently revealed that the patient had self-extracted his molar two months prior to the onset of symptoms. Conclusions: Endocarditis has been associated with Roth spots and inflammatory findings in the posterior segment. However, CRAO caused by vegetal septic embolism is rare. To our knowledge, this represents the first reported case of endocarditic CRAO with Streptococcus gordonii confirmed as the causative microbe. Retinal vascular occlusion in a young patient with no distinct risk factors should prompt a comprehensive dental history and infectious workup, with consideration given to early transesophageal echocardiography.

Economic Evaluation of Artificial Intelligence Systems Versus Manual Screening for Diabetic Retinopathy in the United States.

BACKGROUND: The objective of this economic modeling study was to compare the cost effectiveness of fully automated retinal image screening (FARIS) to the current practice of universal ophthalmologist referral for diabetic retinopathy in the United States (US) health care system. METHODS: A Markov decision-analytic model was used to compare the automated versus manual screening and management pathway for diabetic patients with unknown retinopathy status. Costs (in 2021 US dollars), quality-adjusted life year (QALY) gains, and incremental cost-effectiveness ratios were calculated. Sensitivity analysis was performed against a $50,000/QALY willingness-to-pay threshold. RESULTS: FARIS was the dominant screening strategy, demonstrating cost savings of 18.8% at 5 years with equivalent net QALY gains to manual screening. Cost-effectiveness status was dependent on FARIS detection specificity, with a threshold value of 54.8%. CONCLUSION: Artificial intelligence-based screening represents an economically advantageous screening modality for diabetic retinopathy in the US, offering equivalent long-term utility with significant potential cost savings. [Ophthalmic Surg Lasers Imaging Retina 2023;54:272-280.].

Association Between Parental Leave and Ophthalmology Resident Physician Performance.

Importance: Although parental leave is essential in enhancing resident wellness and fostering inclusive workplace environments, residents may often feel discouraged from using parental leave owing to perceived stigma and concerns about possible negative effects on their training. Objective: To examine parental leave usage across multiple institutions and compare residency performance metrics between residents who took parental leave vs their peers who did not take leave. Design, Setting, and Participants: This was a retrospective cross-sectional analysis conducted from April 1, 2020, to July 28, 2022, of educational records. Multicenter data were obtained from 10 Accreditation Council for Graduate Medical Education (ACGME)-accredited ophthalmology programs across the US. Included ophthalmology residents graduated between 2015 and 2019. Data were analyzed from August 15, 2021, to July 25, 2022. Exposures: Performance metrics of residents who used parental leave during residency were compared with those of residents who did not take parental leave. Main Outcomes and Measures: Measures of performance included the Ophthalmic Knowledge Assessment Program (OKAP) scores, ACGME milestones scores, board examination pass rates, research activity, and surgical volumes. Results: Of the 283 ophthalmology residents (149 male [52.7%]) included in the study, 44 (15.5%) took a median (IQR) parental leave of 4.5 (2-6) weeks. There were no differences in average OKAP percentiles, research activity, average ACGME milestones scores, or surgical volume between residents who took parental leave and those who did not. Residents who pursued fellowship were less likely to have taken parental leave (odds ratio [OR], 0.43; 95% CI, 0.27-0.68; P < .001), and residents who practiced in private settings after residency were more likely to have taken parental leave (OR, 3.56; 95% CI, 1.79-7.08; P < .001). When stratified by sex, no differences were identified in performance between female residents who took parental leave compared with residents who did not take leave, except a mild surgical number difference in 1 subspecialty category of keratorefractive procedures (difference in median values, -2; 95% CI, -3.7 to -0.3; P = .03). Conclusions and Relevance: In this multicenter cross-sectional study, no differences in performance metrics were identified between residents taking parental leave compared with their peers. These findings may provide reassurance to trainees and program directors regarding the unlikelihood, on average, that taking adequate parental leave will affect performance metrics adversely.

Spontaneous regression and quiescence of choroidal neovascularization secondary to traumatic choroidal rupture depicted on OCT angiography.

INTRODUCTION: Choroidal rupture is a tear/break within the Bruch's membrane, retinal pigment epithelium and choroid following blunt trauma. Choroidal neovascularization is a well-known complication of traumatic choroidal rupture that is typically treated with intravitreal injections of Bevacizumab. This case describes an early detection of choroidal neovascular complex secondary to traumatic choroidal rupture and its spontaneous regression and quiescence without treatment followed using optical coherence tomography (OCT) angiography. CASE DESCRIPTION: A healthy 19 year old female presented with decreased vision in her left eye following a blunt non-penetrating closed globe injury two weeks prior. A complete ophthalmic examination with ancillary testing was consistent with sub-foveal choroidal neovascularization secondary to traumatic choroidal rupture. Five weeks later, there was spontaneous regression of the choroidal neovascular complex as depicted on OCT angiography and complete resolution of subretinal fluid/exudation on structural OCT. A conservative approach without intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections was chosen for management. CONCLUSION: To the authors' knowledge this is a first case describing a unique evolution with spontaneous regression and quiescence of choroidal neovascularization secondary to traumatic choroidal rupture without treatment followed using OCT angiography. Expectant management may be a viable treatment option for this condition.

Lactic Acidosis as an Unusual Finding in Undifferentiated Carcinoma.

Lactic acidosis associated with solid neoplasms is a rare complication; its occurrence is poorly described, and it is associated with a poor prognosis. We present the case of an 84-year-old woman who was admitted to the internal medicine department with a diagnosis of urinary tract infection accompanied by a blood gas analysis showing lactic acidosis. During her admission, an abdominal mass was evidenced and finally diagnosed as undifferentiated carcinoma. We wanted to emphasize the importance of correlating clinical and laboratory data at the time of making a diagnostic approach and also highlight other possible explanations of lactic acidosis that should be considered in addition to hypoperfusion due to sepsis, especially in the elderly who are at increased risk of malignancy.

Aplicación de la escala de MELD en los pacientes del Programa de Trasplante Hepático / Application of the MELD scale in patients of the Liver Transplant Program

INTRODUCCIÓN. La escala Model for End-Stage Liver Desease se utiliza para conocer el estadio de la enfermedad hepática y para la asignación de órganos en los pacientes candidatos a trasplante. OBJETIVO. Validar la utilidad de la escala en pacientes adultos del Programa de Trasplante Hepático y su aplicación en la priorización de injertos para pacientes en lista de espera. MATERIALES Y MÉTODOS. Estudio observacional, descriptivo. De una población de 103 Historias Clínicas, se tomó una muestra de 95 registros del Programa de Trasplante Hepático del Hospital de Especialidades Carlos Andrade Marín en el período mayo 2016 a marzo 2020. Criterios de inclusión: datos de pacientes con diagnóstico de enfermedad hepática terminal, de ambos sexos, con edades comprendidas entre 14 y 65 años. La información se tomó del sistema AS400 y se analizaron en el programa estadístico International Business Machines Statistical Package for the Social Sciences, versión 23.0 y el estimador Kaplan-Meier. RESULTADOS. La sobrevida en lista de espera fue del 86,3% (82; 95) y en el post trasplante del 72,5% (44; 62) a los 12 meses y 68,9% (42; 62) a los 46 meses de seguimiento. DISCUSIÓN. Esta escala se consideró para los pacientes graves, asignándoles un puntaje que les permitió tener la opción de recibir un trasplante en relación a otros pacientes. CONCLUSIÓN. Se validó la utilidad de la escala, no se encontró diferencia significativa, pero mantuvo el principio de prioridad para los pacientes con mayor severidad.

INTRODUCTION. The Model for End-Stage Liver Desease scale is used to determine the stage of liver disease and for organ allocation in transplant candidates. OBJECTIVE. To validate the usefulness of the scale in adult patients of the Liver Transplantation Program and its application in the prioritization of grafts for patients on the waiting list. MATERIALS AND METHODS. Observational, descriptive study. From a population of 103 Medical Records, a sample of 95 records was taken from the Liver Transplantation Program of the Carlos Andrade Marín Specialty Hospital in the period may 2016 to march 2020. Inclusion criteria: data from patients with a diagnosis of terminal liver disease, of both sexes, aged between 14 and 65 years. The information was taken from the AS400 system and analyzed using the International Business Machines Statistical Package for the Social Sciences, version 23.0 and the Kaplan-Meier estimator. RESULTS. Survival on the waiting list was 86,3% (82; 95) and post-transplant survival was 72,5% (44; 62) at 12 months and 68,9% (42; 62) at 46 months of follow up. DISCUSSION. This scale was considered for seriously ill patients, assigning them a score that allowed them to have the option of receiving a transplant in relation to other patients. CONCLUSIONS. The utility of the scale was validated, no significant difference was found, but it maintained the principle of priority for patients with greater severity.

Gender Differences in Case Volume Among Ophthalmology Residents.

IMPORTANCE: Although almost equal numbers of male and female medical students enter into ophthalmology residency programs, whether they have similar surgical experiences during training is unclear. OBJECTIVE: To determine differences for cataract surgery and total procedural volume between male and female residents during ophthalmology residency. DESIGN, SETTING, PARTICIPANTS: This retrospective, longitudinal analysis of resident case logs from 24 US ophthalmology residency programs spanned July 2005 to June 2017. A total of 1271 residents were included. Data were analyzed from August 12, 2017, through April 4, 2018. MAIN OUTCOMES AND MEASURES: Variables analyzed included mean volumes of cataract surgery and total procedures, resident gender, and maternity or paternity leave status. RESULTS: Among the 1271 residents included in the analysis (815 men [64.1%]), being female was associated with performing fewer cataract operations and total procedures. Male residents performed a mean (SD) of 176.7 (66.2) cataract operations, and female residents performed a mean (SD) of 161.7 (56.2) (mean difference, -15.0 [95% CI, -22.2 to -7.8]; P < .001); men performed a mean (SD) of 509.4 (208.6) total procedures and women performed a mean (SD) of 451.3 (158.8) (mean difference, -58.1 [95% CI, -80.2 to -36.0]; P < .001). Eighty-five of 815 male residents (10.4%) and 71 of 456 female residents (15.6%) took parental leave. Male residents who took paternity leave performed a mean of 27.5 (95% CI, 13.3 to 41.6; P < .001) more cataract operations compared with men who did not take leave, but female residents who took maternity leave performed similar numbers of operations as women who did not take leave (mean difference, -2.0 [95% CI, -18.0 to 14.0]; P = .81). From 2005 to 2017, each additional year was associated with a 5.5 (95% CI, 4.4 to 6.7; P < .001) increase in cataract volume and 24.4 (95% CI, 20.9 to 27.8; P < .001) increase in total procedural volume. This increase was not different between genders for cataract procedure volume (ß = -1.6 [95% CI, -3.7 to 0.4]; P = .11) but was different for total procedural volume such that the increase in total procedural volume over time for men was greater than that for women (ß = -8.0 [95% CI, -14.0 to -2.1]; P = .008). CONCLUSIONS AND RELEVANCE: Female residents performed 7.8 to 22.2 fewer cataract operations and 36.0 to 80.2 fewer total procedures compared with their male counterparts from 2005 to 2017, a finding that warrants further exploration to ensure that residents have equivalent surgical training experiences during residency regardless of gender. However, this study included a limited number of programs (24 of 119 [20.2%]). Future research including all ophthalmology residency programs may minimize the selection bias issues present in this study.

Manifestaciones Neuropsiquiatricas De La Enfermedad De Whipple En Una Adolescente: A Propósito De Un Caso / Neuropsiquiatric Manifestations Of Whipple Disease In An Adolescent: Case Report

RESUMEN La enfermedad de Whipple (EW) es una rara infección sistémica crónica producida por el actinomiceto Tropheryma Whipplei. Las manifestaciones clínicas son principalmente intestinales, si bien en ocasiones se asocian presentaciones extraintestinales (articulares, cardiacas, pulmonares neurológicas…), e incluso pueden presentarse sólo éstas últimas. Se presenta una paciente de 15 años derivada al servicio de Psiquiatría , con el diagnóstico de depresión, con un evolución de 6 meses con empeoramiento, ingreso por intento autolítico y paralelamente refiere sintomatología neurológica atípica. Se le remite a Neurología para descartar patología orgánica, incluyendo patologías autoinmunes (encefalitis antiNMDA), encontrándose en el estudio, PCR positivo a Tropheryma Whipplei en LCR, diagnosticándose de enfermedad de Whipple con afectación neurológica. Se realizó tratamiento antibiótico según las pautas establecidas, repitiéndose al finalizar el tratamiento la punción lumbar, resultando ésta negativa y con mejoría clínica tanto neurológica como psiquiátrica.

SUMMARY Whipple disease (WD) is a rare chronic systemic infection caused by the actinomycete Tropheryma Whipplei. The clinical manifestations are mainly intestinal, although occasionally may present extraintestinal locations (joints, heart, pulmonary, central nervous system ...) , and even the last can be the only symptom. We present a 15-year-old female patient referred to the psychiatry service, with a diagnosis of depression, with a 6-month evolution with worsening, admission due to autolytic attempt and, at the same time, atypical neurological symptomatology. She is referred to Neurology to rule out organic pathology, including autoimmune pathologies (antiNMDA encephalitis, ...), finding in the study, PCR positive Tropheryma Whipplei, and being diagnosed of Whipple disease with neurological involvement. Antibiotic treatment was performed according to the established guidelines, repeated at the end of the treatment the lumbar puncture, resulting this negative and with clinical neurological improvement as well as psychiatric.

Platelet-Activating Factor (PAF) Receptor Antagonism Modulates Inflammatory Signaling in Experimental Uveitis.

BACKGROUND: The phospholipid mediator platelet-activating factor (PAF) activates an inflammatory response that includes arachidonic acid release and prostaglandin production in the eye, increasing vascular permeability and inflammation. The purpose of this study is to investigate the action of LAU-0901, a novel PAF receptor antagonist, on experimental uveitis. METHODS: Uveitis was induced in Lewis rats by lipopolysaccharide treatment. LAU-0901 was then delivered systemically in different concentrations at plus 4 and 16 hours, or vehicle injected as controls. Additional animals were used for histological analyses of untreated, uveitis, and uveitis-plus-LAU-0901 retinas. Conventional histological and immunohistochemical methods were employed. A slit lamp and Spectral Domain-Ocular Coherence Tomography (SD-OCT) retinal imager was used for anterior segment photography and posterior pole OCT. Rats were euthanized 4 hours after the second LAU-0901 injection in this 24-hour model. Aqueous humor was collected and quantified, and also analyzed for tumor necrosis factor alpha (TNF-α). RESULTS: Uveitic eyes demonstrated hypopyon formation, leukocyte infiltration, and an increase in aqueous protein and TNF-α levels. LAU-0901 treatment resulted in a dose-dependent reduction in inflammation, reflected by reduced total protein levels (up to a 64% reduction). Moreover, hypopyon was prevented, leukocytes were absent in vitreous and aqueous humor, and TNF-α levels were reduced by 91%. CONCLUSIONS: The PAF receptor antagonist LAU-0901 decreases ocular inflammation in a rat model of anterior uveitis in a dose-dependent manner, suggesting that use of this molecule may provide a means to attenuate inflammation onset and offer a future alternative or adjunctive treatment for ocular inflammation.

Influencia de la correcta identificación en la interpretación de las pruebas de sensibilidad en aislados de Aeromonas spp. productoras de bacteriemia / The relevance of correct identification and interpretation of susceptibility testing of Aeromonasspp. bacteremia isolates

OBJETIVO: Estudiar la importancia de la correcta identificación a nivel de especie así como la interpretación de las pruebas de sensibilidad en aislados de Aeromonas spp. productoras de bacteriemia mediante los métodos convencionales rutinarios y los nuevos métodos moleculares. MATERIAL Y MÉTODOS: El estudio incluyó a 22 pacientes con bacteriemia por Aeromonas hydrophila grupo, identificadas mediante el sistema MicroScan. La identificación posterior a nivel de especie se realizó por espectrometría de masas y se confirmó mediante la secuenciación del gen rpoB. La actividad de imipenem, cefotaxima, piperacilina/tazobactam, ciprofloxacino y cotrimoxazol se estudió por microdilución comercial y tiras de gradiente de antibiótico con bajo y alto inóculo. La detección de carbapenemasas se realizó mediante el test de Hodge modificado y su confirmación mediante la detección por PCR del gen cphA. RESULTADOS: Se identificaron 9 (40,9%) aislamientos como Aeromonas hydrophila, 8 (36,4%) como Aeromonas veronii y los 5 (22,7%) restantes como Aeromonas caviae. La resistencia a los antibióticos betalactámicos mediante microdilución comercial y tiras de gradiente de CMI fue, respectivamente, del 36-50% para imipenem; del 4-56% para cefotaxima; y de 27-56% para piperacilina/tazobactam. La concordancia entre el sistema automatizado y el sistema de difusión con tira de gradiente antibiótico fue, globalmente para las 3 especies, del 68% para imipenem, del 50% para cefotaxima y del 46% para piperacilina/tazobactam. No se detectó resistencia a cotrimoxazol y ciprofloxacino por ambos métodos, aunque el 22,7% de las cepas fueron resistentes a ácido nalidíxico. CONCLUSIONES: Es fundamental la identificación a nivel de especie de los aislamientos de Aeromonas spp. ya que la resistencia a betalactámicos es especie y método dependiente. Los altos porcentajes de resistencia antibiótica encontrados no aconsejan el uso de antibióticos betalactámicos y quinolonas como tratamiento empírico de la infección invasiva por Aeromonas ssp

OBJECTIVE: To assess the relevance of correct identification and interpretation of susceptibility testing of Aeromonas spp. bacteremia isolates using newly developed molecular methods in comparison to previous conventional methods. MATERIAL AND METHODS: The study included 22 patients with bacteremia due to Aeromonas hydrophila group, microbiologically characterized using the MicroScan system. Further identification to species level was performed by mass spectrometry, and confirmed by sequencing the rpoB gene. The MIC of imipenem, cefotaxime, piperacillin-tazobactam, ciprofloxacin and cotrimoxazole was studied using a commercial broth microdilution and antibiotic gradient strips with low and high inocula. Detection of carbapenemase production was performed using the modified Hodge test, and was confirmed by amplifying the cphA gene by PCR. RESULTS: A total of 9 (40.9%) isolates were identified as Aeromonas hydrophila, 8 (36.4%) as Aeromonas veronii, and the remaining 5 (22.7%) isolates as Aeromonas caviae. Resistance to beta-lactams according to both the commercial microdilution and MIC gradient strips methods was: 36%-50% to imipenem; 4%-56% to cefotaxime, and 27%-56% to piperacillin/tazobactam. The agreement between results generated by the automated system and the diffusion antibiotic gradient strip was, for all 3 species, 68% for imipenem, 50% to cefotaxime, and 46% to piperacillin/tazobactam. No resistance to cotrimoxazole and ciprofloxacin was found by either of the two methods, although 22.7% of the strains were resistant to nalidixic acid. CONCLUSIONS: It is essential to identify the isolates of Aeromonas spp. at the species level, due to the fact that beta-lactam resistance is species- and method-dependent. The high rate of resistance to beta-lactam and quinolones reduce their application as empiric treatments for invasive infection by Aeromonas ssp

[The relevance of correct identification and interpretation of susceptibility testing of Aeromonas spp. bacteremia isolates]. / Influencia de la correcta identificación en la interpretación de las pruebas de sensibilidad en aislados de Aeromonas spp. productoras de bacteriemia.

OBJECTIVE: To assess the relevance of correct identification and interpretation of susceptibility testing of Aeromonas spp. bacteremia isolates using newly developed molecular methods in comparison to previous conventional methods. MATERIAL AND METHODS: The study included 22 patients with bacteremia due to Aeromonas hydrophila group, microbiologically characterized using the MicroScan system. Further identification to species level was performed by mass spectrometry, and confirmed by sequencing the rpoB gene. The MIC of imipenem, cefotaxime, piperacillin-tazobactam, ciprofloxacin and cotrimoxazole was studied using a commercial broth microdilution and antibiotic gradient strips with low and high inocula. Detection of carbapenemase production was performed using the modified Hodge test, and was confirmed by amplifying the cphA gene by PCR. RESULTS: A total of 9 (40.9%) isolates were identified as Aeromonas hydrophila, 8 (36.4%) as Aeromonas veronii, and the remaining 5 (22.7%) isolates as Aeromonas caviae. Resistance to beta-lactams according to both the commercial microdilution and MIC gradient strips methods was: 36%-50% to imipenem; 4%-56% to cefotaxime, and 27%-56% to piperacillin/tazobactam. The agreement between results generated by the automated system and the diffusion antibiotic gradient strip was, for all 3 species, 68% for imipenem, 50% to cefotaxime, and 46% to piperacillin/tazobactam. No resistance to cotrimoxazole and ciprofloxacin was found by either of the two methods, although 22.7% of the strains were resistant to nalidixic acid. CONCLUSIONS: It is essential to identify the isolates of Aeromonas spp. at the species level, due to the fact that beta-lactam resistance is species- and method-dependent. The high rate of resistance to beta-lactam and quinolones reduce their application as empiric treatments for invasive infection by Aeromonas ssp.

[Right heart failure after pacemaker implantation]. / Insuficiencia cardiaca derecha tras el implante de un marcapasos.

BACKGROUND AND OBJECTIVE: Severe tricuspid regurgitation (TR) secondary to interference pacemaker (PM) cable is a rare cause of progressive right heart failure (HF), which can worsen patient outcomes. MATERIAL AND METHODS: We present 3 clinical cases of right HF secondary to TR after PM implantation. RESULTS: In these patients the clinic is right HF, which can appear early, as in our second patient, or after years of implementation of the PM, as in the first and third patients. The diagnosis is confirmed by echocardiography, the most accurate 3D, followed by transesophageal. The 2D transthoracic can not detect it, because it has low sensitivity for TR associated with PM. Medical treatment is always the first choice, since any other procedure carries significant morbidity and mortality. CONCLUSIONS: Probably this is a condition that we will diagnose with increasing frequency, because there are more and more patients with devices and, at the same time, the diagnostic tools are improving.

Gestante de 14 semanas con sepsis secundaria a corioamnionitis por Peptoniphilus harei / A pregnant woman at 14 weeks with sepsis caused by chorioamnionitis due to Peptoniphilus harei

Las corioamnionitis precoces suelen producirse vía ascendente a partir de una infección vaginal o bien tras técnicas invasivas sobre el útero. La vaginosis bacteriana es prevalente entre gestantes, pero la infección ascendente con corioamnionitis y sepsis es infrecuente, más aún tan precozmente como en la semana 14. Para prevenir las complicaciones de la vaginosis se ha propuesto su cribado, sin que exista actualmente evidencia de su beneficio, al menos en gestantes de bajo riesgo. Sí parece establecido que el riesgo de recidiva a pesar del tratamiento adecuado es alto, por lo se recomienda el seguimiento de la gestante (AU)

Early chorioamnionitis most often occurs as a result of ascending infection from the vagina or after invasive procedures on the uterus. Bacterial vaginosis is prevalent among pregnant women, but ascending infection with chorioamnionitis and sepsis is rare, especially as early as week 14. Screening has been proposed to avoid the complications of vaginosis, with no current evidence of benefit, at least in low-risk pregnant women. However, it is well established that the risk of recurrence is high, despite adequate treatment, and therefore monitoring is recommended in pregnant woman with vaginosis (AU)

Gestante de 14 semanas con sepsis secundaria a corioamnionitis por Peptoniphilus harei / A pregnant woman at 14 weeks with sepsis caused by chorioamnionitis due to Peptoniphilus harei

Las corioamnionitis precoces suelen producirse vía ascendente a partir de una infección vaginal o bien tras técnicas invasivas sobre el útero. La vaginosis bacteriana es prevalente entre gestantes, pero la infección ascendente con corioamnionitis y sepsis es infrecuente, más aún tan precozmente como en la semana 14. Para prevenir las complicaciones de la vaginosis se ha propuesto su cribado, sin que exista actualmente evidencia de su beneficio, al menos en gestantes de bajo riesgo. Sí parece establecido que el riesgo de recidiva a pesar del tratamiento adecuado es alto, por lo se recomienda el seguimiento de la gestante (AU)

Early chorioamnionitis most often occurs as a result of ascending infection from the vagina or after invasive procedures on the uterus. Bacterial vaginosis is prevalent among pregnant women, but ascending infection with chorioamnionitis and sepsis is rare, especially as early as week 14. Screening has been proposed to avoid the complications of vaginosis, with no current evidence of benefit, at least in low-risk pregnant women. However, it is well established that the risk of recurrence is high, despite adequate treatment, and therefore monitoring is recommended in pregnant woman with vaginosis (AU)

Retinal arterial and venous oxygen saturation is altered in diabetic patients.

PURPOSE: To determine the retinal oxygen saturation trend with onset of diabetes and increasing severity of diabetic retinopathy by comparing diabetic groups with and without retinopathy to controls. METHODS: A fundus camera-based dual-wavelength snapshot oximeter imaged retinas of healthy subjects and patients with and without diabetic retinopathy. The images were analyzed to determine oxygen saturation in major retinal arteries and veins, which is inversely proportional to optical density ratio. RESULTS: Control retinal oxygen saturation (n = 14) in arteries was 92.3 ± 4.2% and in veins, 57.2 ± 6.0%. Retinal oxygen saturation for diabetic patients with no signs of diabetic retinopathy (NDR, n = 45) in arteries was 96.3 ± 8.6% (P = 0.662) and in veins, 58.7 ± 7.5% (P = 0.998). Retinal oxygen saturation for diabetics with mild to moderate nonproliferative diabetic retinopathy (NPDR, n = 23) in arteries was 97.7 ± 5.8% (P = 0.590) and in veins, 61.1 ± 7.6% (P = 0.658). Retinal oxygen saturation for diabetics with severe NPDR (n = 12) in arteries was 102 ± 10.2% (P = 0.023) and in veins, 66.8 ± 8.4% (P < 0.001). Retinal oxygen saturation for patients with proliferative diabetic retinopathy (PDR, n = 13) in arteries was 103.6 ± 8.7% (P = 0.003) and in veins, 66.6 ± 10.2% (P = 0.026). Retinal oxygen saturation for all diabetics with retinopathy combined (all DR, n = 48) in arteries was 100.4 ± 7.6% (P = 0.004) and in veins, 64.2 ± 8.4% (P = 0.007). CONCLUSIONS: A trend of increasing retinal oxygen saturation was found from controls to NDR group to increasing levels of diabetic retinopathy, though significance was only reached for the comparison of controls to severe-NPDR, PDR, and all-DR groups.

Dynamic indocyanine green angiography-guided focal thermal laser treatment of fibrotic choroidal neovascularization.

PURPOSE: Fibrotic choroidal neovascular membranes (CNV) are the end-stage outcomes of neovascular age-related macular degeneration (AMD). No treatment is currently available for fibrotic CNV. We investigated the role of focal thermal laser ablation of the perfusing afferent arteriole as determined by dynamic indocyanine green angiography (ICGA). METHODS: We conducted a retrospective study of 20 patients with fibrotic CNV associated with significant subretinal fluid or retinal edema, who also demonstrated well-defined perfusing arterioles by dynamic ICGA. Patients underwent focal thermal laser occlusion of the perfusing afferent arteriole. Six, 12 and 24 weeks post-treatment, eyes underwent repeat examination with optical coherence tomography (OCT) and visual acuity testing, and ICGA at 12 weeks. RESULTS: Therapeutic closure of the perfusing afferent arterioles was achieved in 17 of 20 eyes immediately post-treatment. All 17 of these eyes demonstrated significant resolution of retinal edema and subretinal fluid, as evidenced by OCT, which was dramatic in some cases. Seven eyes demonstrated an improvement in visual acuity of 1 line or more. While most eyes demonstrated reperfusion within 3 months, many lesions suggested reduced vascularity and flow. CONCLUSION: Eyes with fibrotic CNV and associated retinal edema often demonstrate well-defined vascularity of the fibrosis with discrete perfusing arterioles when imaged by dynamic ICGA. Thermal laser occlusion of these arterioles can result in resolution of subretinal fluid, and occasionally an improvement in vision. This represents a potential therapeutic intervention for an advanced stage of AMD currently regarded as stable.

PEDF Promotes Biosynthesis of a Novel Anti-inflammatory and Anti-apoptotic Mediator NPD1 in Retinal Pigment Epithelial Cells.

PURPOSE: Neuroprotectin D1 is a stereospecific cytoprotective messenger synthesized from docosahexaenoic acid in retinal pigment epithelial cells challenged by oxidative stress. A key step in neuroprotectin D1 synthesis is to define how growth factors may modulate its formation and its bioavailability. Here we have explored the action of pigment epithelium derived factor, a neurotrophin made in retinal pigment epithelial cells, on neuroprotectin D1. METHODS: ARPE-19 cells were serum starved and exposed to TNFα/H(2)O(2) in the presence and absence of pigment epithelium derived factor (10 mg/mL). Cells and incubation media were collected. LC-PDA-MS-MS-based lipidomic analysis was used to identify and quantitate neuroprotectin D1. Immunostaining for BCLxL was performed. RESULTS: Oxidative stress promotes increases in neuroprotectin D1 levels in ARPE-19 cells, showing a rapid increase up to 6 hrs of incubation of 12 folds measured on cell pellets. Cell media, on the other hand, show time dependent accumulation of neuroprotectin D1 up to 55-fold after 12 hrs incubation. Treatment with 50 nM pigment epithelium derived factor increased such profile by at least two fold. Deuterated docosahexaenoic acid was incorporated to cell membranes and converted into neuroprotectin D1. After cells are exposed to oxidative stress, BCLxL appears to shift to the nucleus of the cell. With the addition of pigment epithelium derived factor and docosahexaenoic acid, this translocation seems to be prevented. CONCLUSIONS: Here we demonstrate that pigment epithelium derived factor is an activator of neuroprotectin D1 synthesis in ARPE-19 cells exposed to oxidative stress. A major action of pigment epithelium derived factor-stimulated neuroprotectin D1 synthesis shown here is retinal pigment epithelial cytoprotection. Since the retinal pigment epithelial cell is impaired in retinal degeneration, these novel mechanisms potentially may be targeted in macular degeneration and other retinal degenerative diseases as a new therapeutic avenue and may be applicable for neuroprotection in glaucoma and in other neurodegenerative diseases.

Conformational polymorphism in bicalutamide.

Two crystalline forms (forms I and II) and an amorphous phase of bicalutamide were fully characterized through combined results of differential scanning calorimetry, X-ray powder and single crystal diffraction and Raman spectroscopy. Each polymorph crystallizes with one molecule in the asymmetric unit and the molecular conformations are quite different between them. The main difference is provided by C12-C11-S8-C5 torsion angle, which assumes a value of -88.3(4) degrees (-Syn-Clinal) and 72.5(4) degrees (+Syn-Clinal) in forms I and II, respectively. Consequently, molecules in form I show an open folding and molecules in form II a closed one. The relative stability between forms I and II is presented in an energy versus temperature diagram, where forms I and II are considered as a monotropic system, being form I the more stable one. The amorphous phase was observed very metastable and it converts to form II spontaneously at RT in around a week.

Quantitative enumeration of vascular smooth muscle cells and endothelial cells derived from bone marrow precursors in experimental choroidal neovascularization.

Choroidal neovascularization (CNV) is characterized by the subretinal invasion of a pathologic new vessel complex from the choriocapillaris. Although CNV is traditionally considered to consist of endothelial cells, the cellular population of CNV is likely more complex in nature, comprising several different cell types. In addition, recent studies suggest that the CNV cell population has a dual origin (circulating versus resident populations). In this study we sought to determine the contribution and origin of different cell types in experimental CNV. Laser-induced CNV was performed on chimeric mice generated by reconstituting C57BL/6 mice with bone marrow from green fluorescent protein (GFP)-transgenic mice. In these mice, bone marrow-derived cells are GFP-labeled. Immunofluorescence staining was used to examine both flatmount preparations of the choroid and cross sections of the posterior pole for macrophages, endothelial cells, vascular smooth muscle cells, retinal pigment epithelial (RPE) cells, lymphocytes, or neutrophils at day 3, 7, 14 and 28 post-laser (n=5 per group). Cell types present in CNV included macrophages (20% of the cells in CNV), endothelial cells (25%), vascular smooth muscle cells (11%), RPE cells (12%) and non-labeled cells (32%). The macrophage population was mostly derived from circulating monocytes at all timepoints studied (70% were GFP labeled), while endothelial and vascular smooth muscle cells were partly bone marrow derived (50-60% were GFP labeled), and RPE cells appeared to be entirely derived from preexisting tissue resident cells. These results demonstrate that bone marrow-derived progenitor cells contribute significantly to the vascular and inflammatory components of CNV. Knowledge of the cellular composition and origin might help understand the pathogenic mechanisms controlling CNV severity as well as indicate potential targets for therapeutic intervention.