Numerical Study of Nanofluid Irreversibilities in a Heat Exchanger Used with an Aqueous Medium.

Heat exchangers play an important role in different industrial processes; therefore, it is important to characterize these devices to improve their efficiency by guaranteeing the efficient use of energy. In this study, we carry out a numerical analysis of flow dynamics, heat transfer, and entropy generation inside a heat exchanger; an aqueous medium used for oil extraction flows through the exchanger. Hot water flows on the shell side; nanoparticles have been added to the water in order to improve heat transfer toward the cold aqueous medium flowing on the tube side. The aqueous medium must reach a certain temperature in order to obtain its oil extraction properties. The analysis is performed for different Richardson numbers (Ri = 0.1-10), nanofluid volume fractions (φ = 0.00-0.06), and heat exchanger heights (H = 0.6-1.0). Results are presented in terms of Nusselt number, total entropy generation, Bejan number, and performance evaluation criterion. Results showed that heat exchanger performance increases with the increase in Ri when Ri > 1 and when reducing H.

Concordancia de los trastornos de contractibilidad en el ecocardiograma con el compromiso del vaso coronado en el cateterismo cardíaco en pacientes con infarto agudo del miocardio / Concordance of contractibility disorders in echocardiography with coronary vessel involvement in cardiac catheterization in patients with acute myocardial infarction

Objetivo: determinar la concordancia entre el cateterismo cardiaco y el ecocardiograma en pacientes con diagnóstico de síndrome coronario en las primeras 48 horas de su ingreso al servicio de urgencias. Métodos: estudio descriptivo de concordancia, se incluyeron pacientes con diagnóstico de angina inestable e infarto agudo del miocardio (IAM) con y sin elevación del segmento ST y se obtuvo la información de las dos pruebas en las historias clínicas. Se calculó el grado de acuerdo entre los hallazgos de contractibilidad y el compromiso de obstrucción por medio del índice kappa. Resultados: se incluyeron 129 pacientes con edad promedio de 65.2 años (DE 12.15), 65.1% fueron mujeres. La frecuencia de oclusión del flujo coronario en el cateterismo fue 74.4%, la alteración de contractibilidad en el ecocardiograma 69.8%. Se observó una baja concordancia entre los hallazgos de estas pruebas diagnósticas (acuerdo: 70.5%; kappa: 0.27, p=0.001). El principal trastorno de contractilidad fue la hipoquinesia (42.6%) y en la mayoría se presentó obstrucción de un único vaso (44.2%). Conclusiones: aunque la concordancia entre el ecocardiograma y el cateterismo es baja en este estudio, el primero junto con la valoración clínica es un procedimiento importante en el diagnóstico y seguimiento de los pacientes con patología cardiaca en el servicio de urgencias, para proceder a una intervención temprana y disminuir el riesgo de lesión miocárdica, así como la mortalidad y la morbilidad.

Objective: to determine agreement between findings on cardiac catheterization and echocardiogram in patients diagnosed with coronary syndrome within 48 hours of admission to the emergency department (ED). Methods: a descriptive study on agreement. Patients diagnosed with unstable angina and ST-segment elevation or non-ST-segment elevation acute myocardial infarction (AMI), were included, obtaining data on the two tests from clinical records. The level of agreement between contractility and coronary flow obstructive findings was reported using the kappa coefficient. Results: the study included 129 patients with mean age 65.2 years (SD 12.15), of which 65.1% were women. The coronary occlusion rate on catheterization was 74.4%, and contractility alteration on echocardiogram was 69.8%. Low agreement between findings on these two tests was observed (agreement: 70.5%; kappa: 0.27, p=0.001). The main contractility alteration was hypokinesia (42.6%) and most presented obstruction of only one artery (44.2%). Conclusion: although agreement is low between echocardiogram and catheterization in this study, echocardiogram coupled with clinical examination constitutes an important diagnostic and follow-up procedure for patients with cardiovascular disease at the ED, in order to permit an early intervention minimizing the risk of myocardial damage, as well as, mortality and morbidity.

Growth and reproductive potential of Eisenia foetida (Sav) on various zoo animal dungs after two methods of pre-composting followed by vermicomposting.

Disposal of animal manure without treatment can be harmful to the environment. In this study, samples of four zoo animal dungs and one horse dung were pre-composted in two ways: (a) traditional composting and (b) bokashi pre-composting for 1month, followed by vermicomposting for 3months. The permanence (PEf) and reproductive potential (RP) of Eisenia foetida as well as the quality of vermicompost were evaluated. The PEf values and RP index of E. foetida were higher for samples pre-composted using the traditional composting method (98.7-88% and 31.85-16.27%, respectively) followed by vermicomposting (92.7-72.7% and 22.96-13.51%, respectively), when compared with those for bokashi pre-composted samples followed by vermicomposting, except for the horse dung sample (100% for both the parameters). The values of electrical conductivity (EC), cation exchange capacity (CEC), organic C, total N, available P, C/N ratio, and pH showed that both treatments achieved the norms of vermicompost (<4mScm-1, 40cmolkg-1, 20-50%, 1-4%, ≤20, 5.5-8.5, respectively). However, the maturity indices of vermicompost, namely, organic matter loss, N loss, and CEC/organic carbon (OC) ratio indicated that bokashi pre-composting followed by vermicomposting produced the highest values (98.7-70.7%, 97.67-96.65%, and 2.7-1.97%, respectively), when compared with the other method adapted in this study. Nevertheless, further studies with plants for plant growth evaluation are needed to assess the benefits and limitations of these two pre-composting methods prior to vermicomposting.

Frequency and risk factors associated with dry eye in patients attending a tertiary care ophthalmology center in Mexico City.

PURPOSE: The purpose of this study was to ascertain the frequency and risk factors of dry eye (DE) among patients attending a tertiary care ophthalmology center in Mexico. METHODS: Approximately 338 consecutive new patients attending a tertiary care ophthalmology center in Mexico City underwent an ocular surface examination, which included tear film break-up time, fluorescein corneal staining, Schirmer's test, and evaluation of meibum quality. Symptoms of DE were evaluated by the Ocular Surface Disease Index and Dry Eye Questionnaire-5. Information on demographics, exposures, past medical and ocular history, and medications was also collected. RESULTS: The frequency of severe DE symptoms was found to be 43% based on the Ocular Surface Disease Index and 30% based on Dry Eye Questionnaire-5. Risk factors significantly associated with increased DE symptoms included dry mouth and gastrointestinal ulcer medications. With regard to signs, aqueous tear deficiency was a less-frequent finding (22%) in our population than evaporative deficiency (94%). Risk factors associated with aqueous tear deficiency were dry mouth and diuretic use. No risk factors were associated with evaporative deficiency. Risk factors associated with meibomian gland dysfunction included old age, male sex, arthritis, and use of an antihypertensive. The only risk factor associated with corneal staining was dry mouth. CONCLUSION: This is the first study to demonstrate the frequency of symptomatic and clinical DE in a tertiary care ophthalmology center in Mexico. The frequency of DE ranged from 30% using a symptomatic definition to 94% using objective measures. Different risk factors were found for different aspects of DE, suggesting differing underlying pathophysiologies behind different DE subtypes.

The Effects of Ketamine on Cognitive Function in Elderly Patients Undergoing Ophthalmic Surgery: A Pilot Study.

BACKGROUND: Acute postoperative cognitive dysfunction is characterized by neurocognitive dysfunction and confusion. In this study, we compared the cognitive status of a geriatric population undergoing ophthalmic surgery, as assessed by the Short Portable Mental Status Questionnaire (SPMSQ) before and after ketamine administration. METHODS: Eighty patients were enrolled and randomly assigned in a double-blind study to receive either ketamine (0.3 mg/kg dose) or physiologic solution (control group). Sixty-five (control, n = 32; ketamine, n = 33) patients completed the trial. Cognitive performance was assessed with an abbreviated version of the SPMSQ. Measurements of analgesia, sedation, intraocular pressure, and hemodynamic variables were recorded. RESULTS: With respect to cognitive performance, the baseline evaluation was similar for the control and ketamine groups. Postoperative evaluation showed an improvement only in the ketamine group. No increase in intraocular pressure or a secondary nystagmus was observed. The average dose of midazolam was higher in the control group, but the difference was not clinically significant. After surgery, analgesic behavior was better in the ketamine group than in the control group. There were no differences between groups in the sedation scale or in hemodynamic variables. CONCLUSIONS: The administration of 0.3 mg/kg ketamine during ophthalmic surgery in geriatric patients changed their cognitive status as assessed by the SPMSQ, decreased the required dose of anesthetics, and produced no increase in intraocular pressure or in hemodynamic variables. However, because the evaluation only analyzed the immediate effects of the administered drug, further research will be required to examine the impact of ketamine on the postoperative cognitive performance of geriatric patients before the drug can be formally recommended for this purpose.

Estigmatización de la depresión mayor en estudiantes universitario del sector salud

Introducción. Además de la discapacidad que deriva de los trastornos mentales, las personas que los padecen, sufren las consecuencias relacionadas a las actitudes sociales de rechazo. Así el estigma asociado a dichos trastornos, es uno de los obstáculos que encuentran estas personas para incluirse en la comunidad. La estigmatización se expresa por medio de actitudes negativas de miembros de la sociedad, como también entre los profesionales de la salud, lo cual genera dificultades en el acceso de los servicios de salud. Por lo cual, se hace necesario contar con profesionales de la salud mental comprometidos con el cuidado y la atención a personas con trastornos mentales. Objetivo. El estudio examinó los niveles de estigmatización hacia la depresión mayor por parte de de los estudiantes de grado de las carreras afines al campo de la salud de la Universidad Nacional de Córdoba. Así mismo se busco la asociación entre diferentes variables socio-demográficas y de experiencia previa con el trastorno depresivo, y los niveles de estigma de los participantes, de acuerdo a la carrera cursada

ABSTRACT Introduction Apart from the disability that results from mental disorders, people affected by them suffer the consequences related to social attitudes of rejection. Consequently, the stigma associated with these disorders is one of the obstacles these people face to be included in the community. The stigma is expressed through negative attitudes from the members of society, as well as among health professionals, which creates difficulties in the access and utilization of health services. Therefore, it is necessary to have mental health professionals committed to the care for people with mental disorders

Atypical Bilateral Fuchs Uveitis: Diagnostic Challenges.

UNLABELLED: Bilateral Fuchs uveitis associated with vitreous infiltration and posterior segment involvement requires a thorough diagnostic evaluation. The lack of well-defined diagnostic criteria makes identification of this entity difficult. The aim of this case report was to present the characteristics of a patient with atypical Fuchs uveitis and the procedures needed to rule out the differential diagnosis with specific attention to the utility of in vivo confocal microscopy (IVCM). CASE REPORT: One case of chronic bilateral uveitis with severe vitreous opacities is presented. After extensive systemic workup, including vitrectomy, the case had no identifiable systemic etiology. IVCM of the cornea revealed the presence of dendritiform keratic precipitates. CONCLUSION: The diagnosis of Fuchs uveitis is based on clinical findings as no confirmatory laboratory tests are available. A high index of suspicion is key to an early diagnosis, especially in the cases with vitreous opacities and posterior segment manifestations. Auxiliary tests such as IVCM may aid the clinician in the diagnosis of Fuchs uveitis.

Treatment of Acanthamoeba keratitis by corneal cross-linking.

PURPOSE: To evaluate the efficacy of corneal cross-linking (CXL; riboflavin/ultraviolet A) as a simple therapy for Acanthamoeba keratitis. METHODS: Twenty rabbits were systemically anesthetized and the stroma of their right corneas was inoculated with a suspension of Acanthamoeba. Rabbits were divided into 2 groups: one group was treated with corneal CXL 3 days after infection and the other did not receive any treatment (control). All eyes in both groups were examined before (days 0 and 3) and after (day 7) CXL treatment. On day 7, the eyes were enucleated; 18 corneal buttons (9 of each group) were sent for microbiological examination and 2 (1 of each group) for histopathologic examination. RESULTS: All animals developed Acanthamoeba keratitis. There was no statistically significant difference between groups before treatment (day 0, P = 1, and day 3, P = 0.684). The treated corneas had a higher score (3.48 ± 0.30) at the time of enucleation compared with control corneas (2.60 ± 0.26). This difference was statistically significant (P = 0.008). Microbiological analysis revealed that the treated corneas had a higher protozoal count (2.86 ± 0.09) compared with the control corneas (2.18 ± 0.07); this difference was statistically significant (P = 0.001). CONCLUSIONS: Treatment of Acanthamoeba keratitis by corneal CXL (riboflavin/ultraviolet A) did not prove effective in decreasing the intensity and severity of Acanthamoeba keratitis.

Brimonidine-timolol fixed combination induced granulomatous inflammation of the eye.

We report on two cases of granulomatous conjunctivitis and uveitis related with the use of a brimonidine-timolol fixed combination. Case report and a review of medical literature. A 64-year-old man was diagnosed with marked granulomatous uveitis and a 57-year-old woman was diagnosed with granulomatous conjunctivitis. Both patients were using a topical fixed combination of brimonidine 0.2 %-timolol 0.5 % for open angle glaucoma. Bilateral granulomatous uveitis and conjunctivitis were diagnosed after 16 months of treatment with a fixed combination of brimonidine-timolol in both cases. Granulomatous inflammation resolved with the cessation of antiglaucomatous drugs and topical corticosteroid treatment. When the inflammation had resolved completely, both patients were rechallenged with topical brimonidine in one eye only to determine causality. Conjunctival hyperemia is a common side effect of glaucoma medications and is sometimes overlooked. Hyperemia may be associated with other signs such as iritis and keratic precipitates or conjunctival inflammation. In such cases, granulomatous inflammation may be considered in the differential diagnosis. The fixed-combination of brimonidine-timolol may cause this clinical picture.

In vitro differentiation of adult adipose mesenchymal stem cells into retinal progenitor cells.

INTRODUCTION: It has been previously shown that adult mesenchymal stem cells (MSCs) differentiate into neural progenitor cells (NPCs) and that the differentiation process was completed in 24-48 h. In this previous study, MSCs from a bone marrow or fat source were co-incubated with homologous autoaggressive cells (ECs) against nerve tissue, and these NPCs were successfully used in human regenerative therapeutic approaches. The present study was conducted to investigate whether a similar differentiation method could be used to obtain autologous retinal progenitor cells (RPCs). METHODS: Human Th1 cells against retinal tissue were obtained by challenging human blood mononuclear cells with an eye lysate of bovine origin; negative selection was performed using a specific immunomagnetic bead cocktail. Fat MSCs were obtained from a human donor through mechanical and enzymatic dissociation of a surgical sample. The ECs and MSCs were co-cultured in a serum-free medium without the addition of cytokines for 0, 24, 48 and 72 h. The plastic adherent cells were morphologically examined using inverted-phase microscopy and characterized by immunofluorescent staining using antibodies against Pax 6, TUBB3, GFAP, Bestrophin 2, RPE 65, OPN1 SW, and rhodopsin antigens. RESULTS: The early signs of MSC differentiation into RPCs were observed at 24 h of co-culture, and the early differentiated retinal linage cells appeared at 72 h (neurons, rods, Müller cells, retinal ganglion cells and retinal pigmented epithelial cells). These changes increased during further culture. CONCLUSION: The results reported here support the development of a method to obtain a large number of autologous adult RPCs, which could be used to treat different retinopathies.

Staining of the internal limiting membrane with the use of heavy brilliant blue G.

BACKGROUND: Brilliant blue G (BBG) is frequently used in chromovitrectomy to facilitate internal limiting membrane (ILM) peeling. A study was initiated to evaluate if heavy BBG is safe and effective in staining the ILM. METHODS: We studied 30 eyes, 23 with idiopathic macular holes and 7 of patients with diabetic macular edema. Removal of the ILMs was assisted by heavy BBG staining. In cases with histopathological correlation the ILMs were evaluated with hematoxylin and eosin, Masson's trichrome, periodic acid-Schiff and glial fibrillary acidic protein staining. In addition, immunohistochemistry was also performed using specific antibodies for vimentin, neuron-specific enolase, factor VIII and CD68. Using the Image-Pro Plus software of Media Cybernetics Co. we found an average thickness in ILMs. RESULTS: Of the ILM specimens sent, 19/30 (63.33%) could not be processed properly because of the limited sample material, recognizing only fragments of dispersed fibrillar material. In macular hole ILMs we found an average thickness of 1.3 ± 0.65 µm, and in diabetic macular edema ILMs an average thickness of 6.2 ± 1.4 µm. CONCLUSIONS: In heavy BBG-assisted ILM peeling we observed no intraoperative or postoperative complications after a mean follow-up of 12 months. Heavy BBG could be an effective and safe vehicle for staining the ILM.

[Systemic treatment of ocular cicatricial pemphigoid]. / Tratamiento sistémico del penfigoide cicatrizal ocular.

Ocular cicatricial pemphigoid (OCP) is a blistering autoimmune disease that can produce severe conjunctival damage. Its response to immunosuppressive treatment is poorly known. We describe a group of 76 patients, 62 women and 14 men. Mean age at diagnosis was 67±14 years old, with a delay to diagnosis of 7.5±10 years. Sixty patients continued their follow up in our services for 19±21 months. Nineteen out of 51 had mild disease, 19 moderate, 5 severe and 8 very severe at onset of treatment. The more frequently prescribed drugs were dapsone, in 35 (23 discontinued it because of adverse effects), and methotrexate in 42 patients, nine of them stopped it. Other patients received azathioprine, cyclophosphamide and ciclosporine. Seventeen received oral steroids in addition to immunosuppressive drugs. Four patients combined two immunosuppressive drugs to control their disease. In three refractory cases IV immunoglobulin (Ig) was administered with good response. From 48 evaluated patients, 39 improved with treatment, eight remained stable and one progressed. In our experience, methotrexate and azathioprine were effective drugs, with low toxicity. Dapsone was useful in mild cases, with frequent adverse effects. IVIg was effective for refractory cases.

Tratamiento sistémico del penfigoide cicatrizal ocular / Systemic treatment of ocular cicatricial pemphigoid

El penfigoide cicatrizal ocular (PCO) es una enfermedad ampollar autoinmune que produce daño conjuntival grave. Se conoce poco acerca de la respuesta del PCO al tratamiento inmunosupresor. Describimos un grupo de 76 pacientes con PCO, 62 mujeres y 14 hombres. La edad media al diagnóstico fue de 67 ± 14 años, con un retraso de 7.5 ± 10 años. Sesenta se siguieron en nuestro servicio por 19 ± 21 meses. De 51 en quienes se describe la gravedad de la enfermedad al inicio del tratamiento, fue leve en 19 pacientes, moderada en 19, grave en cinco y muy grave en ocho. Las drogas mayormente prescriptas fueron dapsona en 35 pacientes, de los que 23 la discontinuaron por efectos adversos, y metotrexate en 42, de los que nueve lo suspendieron. Otros recibieron azatioprina, ciclofosfamida y ciclosporina. A 17 se les indicaron corticoides orales, además del inmunosupresor. Cuatro combinaron dos drogas para controlar la enfermedad. Tres pacientes refractarios recibieron gammaglobulina EV con buena respuesta. De 48 evaluados, 39 mostraron mejoría, ocho no tuvieron cambios y uno progresó. En nuestra experiencia, metotrexate y azatioprina son efectivos, con baja toxicidad. Dapsona es útil en casos leves, con efectos adversos frecuentes. La gammaglobulina EV fue efectiva en casos refractarios.(AU)

Ocular cicatricial pemphigoid (OCP) is a blistering autoimmune disease that can produce severe conjunctival damage. Its response to immunosuppressive treatment is poorly known. We describe a group of 76 patients, 62 women and 14 men. Mean age at diagnosis was 67±14 years old, with a delay to diagnosis of 7.5±10 years. Sixty patients continued their follow up in our services for 19±21 months. Nineteen out of 51 had mild disease, 19 moderate, 5 severe and 8 very severe at onset of treatment. The more frequently prescribed drugs were dapsone, in 35 (23 discontinued it because of adverse effects), and methotrexate in 42 patients, nine of them stopped it. Other patients received azathioprine, cyclophosphamide and ciclosporine. Seventeen received oral steroids in addition to immunosuppresive drugs. Four patients combined two immunosupressive drugs to control their disease. In three refractory cases IV immunoglobulin (Ig) was administered with good response. From 48 evaluated patients, 39 improved with treatment, eight remained stable and one progressed. In our experience, methotrexate and azathioprine were effective drugs, with low toxicity. Dapsone was useful in mild cases, with frequent adverse effects. IVIg was effective for refractory cases.(AU)

Tratamiento sistémico del penfigoide cicatrizal ocular / Systemic treatment of ocular cicatricial pemphigoid

El penfigoide cicatrizal ocular (PCO) es una enfermedad ampollar autoinmune que produce daño conjuntival grave. Se conoce poco acerca de la respuesta del PCO al tratamiento inmunosupresor. Describimos un grupo de 76 pacientes con PCO, 62 mujeres y 14 hombres. La edad media al diagnóstico fue de 67 ñ 14 años, con un retraso de 7.5 ñ 10 años. Sesenta se siguieron en nuestro servicio por 19 ñ 21 meses. De 51 en quienes se describe la gravedad de la enfermedad al inicio del tratamiento, fue leve en 19 pacientes, moderada en 19, grave en cinco y muy grave en ocho. Las drogas mayormente prescriptas fueron dapsona en 35 pacientes, de los que 23 la discontinuaron por efectos adversos, y metotrexate en 42, de los que nueve lo suspendieron. Otros recibieron azatioprina, ciclofosfamida y ciclosporina. A 17 se les indicaron corticoides orales, además del inmunosupresor. Cuatro combinaron dos drogas para controlar la enfermedad. Tres pacientes refractarios recibieron gammaglobulina EV con buena respuesta. De 48 evaluados, 39 mostraron mejoría, ocho no tuvieron cambios y uno progresó. En nuestra experiencia, metotrexate y azatioprina son efectivos, con baja toxicidad. Dapsona es útil en casos leves, con efectos adversos frecuentes. La gammaglobulina EV fue efectiva en casos refractarios.(AU)

Ocular cicatricial pemphigoid (OCP) is a blistering autoimmune disease that can produce severe conjunctival damage. Its response to immunosuppressive treatment is poorly known. We describe a group of 76 patients, 62 women and 14 men. Mean age at diagnosis was 67ñ14 years old, with a delay to diagnosis of 7.5ñ10 years. Sixty patients continued their follow up in our services for 19ñ21 months. Nineteen out of 51 had mild disease, 19 moderate, 5 severe and 8 very severe at onset of treatment. The more frequently prescribed drugs were dapsone, in 35 (23 discontinued it because of adverse effects), and methotrexate in 42 patients, nine of them stopped it. Other patients received azathioprine, cyclophosphamide and ciclosporine. Seventeen received oral steroids in addition to immunosuppresive drugs. Four patients combined two immunosupressive drugs to control their disease. In three refractory cases IV immunoglobulin (Ig) was administered with good response. From 48 evaluated patients, 39 improved with treatment, eight remained stable and one progressed. In our experience, methotrexate and azathioprine were effective drugs, with low toxicity. Dapsone was useful in mild cases, with frequent adverse effects. IVIg was effective for refractory cases.(AU)

Tratamiento sistémico del penfigoide cicatrizal ocular / Systemic treatment of ocular cicatricial pemphigoid

El penfigoide cicatrizal ocular (PCO) es una enfermedad ampollar autoinmune que produce daño conjuntival grave. Se conoce poco acerca de la respuesta del PCO al tratamiento inmunosupresor. Describimos un grupo de 76 pacientes con PCO, 62 mujeres y 14 hombres. La edad media al diagnóstico fue de 67 ± 14 años, con un retraso de 7.5 ± 10 años. Sesenta se siguieron en nuestro servicio por 19 ± 21 meses. De 51 en quienes se describe la gravedad de la enfermedad al inicio del tratamiento, fue leve en 19 pacientes, moderada en 19, grave en cinco y muy grave en ocho. Las drogas mayormente prescriptas fueron dapsona en 35 pacientes, de los que 23 la discontinuaron por efectos adversos, y metotrexate en 42, de los que nueve lo suspendieron. Otros recibieron azatioprina, ciclofosfamida y ciclosporina. A 17 se les indicaron corticoides orales, además del inmunosupresor. Cuatro combinaron dos drogas para controlar la enfermedad. Tres pacientes refractarios recibieron gammaglobulina EV con buena respuesta. De 48 evaluados, 39 mostraron mejoría, ocho no tuvieron cambios y uno progresó. En nuestra experiencia, metotrexate y azatioprina son efectivos, con baja toxicidad. Dapsona es útil en casos leves, con efectos adversos frecuentes. La gammaglobulina EV fue efectiva en casos refractarios.

Ocular cicatricial pemphigoid (OCP) is a blistering autoimmune disease that can produce severe conjunctival damage. Its response to immunosuppressive treatment is poorly known. We describe a group of 76 patients, 62 women and 14 men. Mean age at diagnosis was 67±14 years old, with a delay to diagnosis of 7.5±10 years. Sixty patients continued their follow up in our services for 19±21 months. Nineteen out of 51 had mild disease, 19 moderate, 5 severe and 8 very severe at onset of treatment. The more frequently prescribed drugs were dapsone, in 35 (23 discontinued it because of adverse effects), and methotrexate in 42 patients, nine of them stopped it. Other patients received azathioprine, cyclophosphamide and ciclosporine. Seventeen received oral steroids in addition to immunosuppresive drugs. Four patients combined two immunosupressive drugs to control their disease. In three refractory cases IV immunoglobulin (Ig) was administered with good response. From 48 evaluated patients, 39 improved with treatment, eight remained stable and one progressed. In our experience, methotrexate and azathioprine were effective drugs, with low toxicity. Dapsone was useful in mild cases, with frequent adverse effects. IVIg was effective for refractory cases.

Treatment of fungal keratitis from Fusarium infection by corneal cross-linking.

PURPOSE: To evaluate the efficacy of corneal cross-linking (CXL) (riboflavin-UV-A) as a simple therapy in Fusarium keratitis. METHODS: Twenty-four rabbits were systemically anesthetized, and the stromata of their right corneas were inoculated with Fusarium solani [10(5) colony-forming units (CFU) per milliliter]. Rabbits were divided into 2 groups: one was treated with CXL 72 hours after infection and the other did not receive any treatment (control). All eyes in both the groups were examined before (days 0 and 3) and after (day 7) CXL treatment. The eyes were enucleated, and corneal buttons were sent for microbiological and histological examinations. RESULTS: All animals developed Fusarium keratitis; there was no statistically significant difference between groups before treatment (day 0, P = 0.397 and day 3, P = 0.702). After CXL treatment, the difference in clinical scores on day 7 between groups was statistically significant (P = 0.00); the CXL group showed significant lower clinical score. The CXL group had 22.45 ± 5.09 CFU/g compared with 42.5 ± 3.12 CFU/g in the control group; this difference was statistically significant (P = 0.01). In the 3 buttons of the control group, similar amounts of Fusarium hyphae and inflammatory cells were observed. In 2 of the 3 buttons analyzed from the CXL group, fewer Fusarium hyphae, inflammatory cells, and nonspecific stromal changes were observed compared with the control group. CONCLUSIONS: Treatment of fungal keratitis with CXL seems to be effective in decreasing the intensity and severity of infectious keratitis by F. solani. This therapy may be useful as a coadjuvant in the medical treatment of resistant infections.

Evaluación de la indicación de oxigenoterapia en pacientes hospitalizados. Hospital Nacional Arzobispo Loayza, Octubre 2010-Abril 2011 / Evaluation of the indication of oxygen therapy in hospitalized patients. National Hospital Archbishop Loayza, October 2010-Abril 2011

Para evaluar la indicación de oxigenoterapia hospitalaria se realizo un estudio descriptivo, transversal, tipo serie de casos, en los pacientes que usaron oxigenoterapia durante su hospitalización en los servicios de medicina y cirugía del Hospital Nacional Arzobispo Loayza durante el periodo de octubre 2010 a abril del 2011. Este estudio se realizó mediante la elección de todos los pacientes que durante su hospitalización estuvieran utilizando oxigeno, revisando sus historias clínicas, además del llenado de una tabla de tabulación de datos elaborada para tal fin. El total de pacientes evaluados fue de 40, de los cuales 21 fueron mujeres (52,5 por ciento) y 19 (47,5 por ciento) varones, siendo la media de edad en los pacientes evaluados de 63,5 años. En cuanto al tipo de Indicación de Oxigeno solo el 40 por ciento (16 pacientes) de las indicaciones en los pacientes hospitalizados fueron Indicaciones Adecuadas, siendo el otro 60 por ciento (24 pacientes) Indicaciones Inadecuadas. En los casos de Indicación adecuada, la mayoría de estas indicaciones fueron por patologías neumológicas (93,1 por ciento) y sólo el 6,9 por ciento por no neumológicas. En los casos de Indicación Inadecuada las patologías que motivaron la mayor indicación corresponden a patologías neumológicas (70,8 por ciento) y solo un 29,2 por ciento corresponde a las no neumológicas. Respecto al profesional médico que indica oxigeno, la mayor cantidad de indicaciones fueron realizadas por Médicos Internistas (82,5 por ciento), siendo solo el 17,5 por ciento dadas por otros especialistas. Con respecto al tipo de indicación, los Médicos Intemistas son responsables de las mayores Indicaciones Inadecuadas (79,2 por ciento) siendo los otros especialistas solo responsables del 20,8 por ciento. El valor de Presión Parcial de Oxígeno Arterial en los casos de Indicación Inadecuada fue de 73,5 mm Hg, con un mínimo de 63,5 mm Hg y un máximo de 98 mm Hg. Con respecto al tipo de flujo y dispositivo utilizado en el total de las indicaciones se tiene que mayormente son indicaciones de Bajo Flujo (72,5 por ciento) y solo 125 por ciento son de Alto Flujo, además en un 2,5 por ciento de los casos se indicó Ventilación Mecánica. El promedio de cantidad de oxigeno administrado a los todos los pacientes fue de 4,62 litros por minuto y en los casos de administración Inadecuada fue de 4,46 litros por minuto. Se concluye que: -La mayor indicación de oxigeno terapia encontrada fue inadecuada. -La mayoría de los pacientes que utilizan oxigenoterapia durante su hospitalización son adultos mayores. -La indicación inadecuada fue dada en su gran mayoría en los servicios de medicina interna. -El dispositivo de oxigeno mayormente utilizado fue el de bajo flujo

Fine needle aspiration biopsy with liquid-based cytology and adjunct immunohistochemistry in intraocular melanocytic tumors.

PURPOSE: To determine the efficacy of liquid-based cytology (LBC) and immunohistochemistry in the evaluation of fine needle aspiration biopsy (FNAB) of intraocular melanocytic tumors. METHODS: Cytologic diagnosis was necessary in 25 patients with intraocular melanocytic tumors to deliver a therapeutic course of treatment. The patients' clinical, cytologic, and histologic diagnoses were correlated. All samples were stained with hematoxylin and eosin, and studied through standardized monolayer techniques, with a mean cellular concentration of 60,000 cells/mm2. Immunohistochemistry was performed using Vimentin, S 100, HMB 45, Melan A, cytokeratin, and as prognostic factors, B and T lymphocyte, CD68 (macrophage), and antibody Ki 67 (growth factor). RESULTS: The positive predictive value was 100%; the negative predictive value was 80%. Sensitivity and specificity of LBC for detecting malignancy were 95.2% and 100%, respectively. The FNAB LBC with immunohistochemistry findings resulted in a revision of treatment in 32% of patients. There was no evidence of local tumor dissemination or a recurrence associated with biopsy in any patient. CONCLUSIONS: Fine needle aspiration biopsy (LBC and immunohistochemistry) is a safe, sensitive, and specific method of establishing tissue diagnosis in a subset of patients with intraocular melanocytic tumors, particularly in cases where sample material is scarce. The routine use of immunohistochemical stain increases the diagnostic utility, and prognosis factor determination may change clinical management.