Trauma ocular y politrauma / Ocular trauma and multitrauma

Se realizó una revisión sobre el trauma ocular y su manejo en pacientes politraumatizados. Entre las causas más frecuentes de trauma ocular se encuentran los accidentes domésticos, laborales, juegos, actividades recreativas y deportivas. Involucran en un alto por ciento a niños y jóvenes, y predomina el sexo masculino en casi todos los trabajos revisados. No solo en Cuba sino en el mundo, el trauma ocular es fuente importante de ceguera unilateral o bilateral. Se presenta un breve compendio de los términos y definiciones actuales que son utilizados para el manejo del trauma ocular, su clasificación y la ventaja que ofrece aplicar el Puntaje del Trauma Ocular, OTS (Ocular Trauma Score), para el pronóstico de la agudeza visual final de acuerdo a los hallazgos clínicos encontrados en la evaluación inicial. Se hace referencia a los pacientes con politrauma y los aspectos a tener en cuenta por el oftalmólogo para tomar conducta cuando estos presentan heridas penetrantes o perforantes y tienen compromiso vital. En estos casos se hace necesaria la colaboración urgente de múltiples especialistas para primero mantener al paciente con vida y luego disminuir las complicaciones que repercuten en su pronóstico visual(AU)

A review was made on the ocular trauma and its management in multitrauma patients. The most common causes comprise domestic and occupational accidents, games, recreational and sport activities. It involves more frequently a high percentage of young people, with male prevalence in almost all the reviewed papers. Ocular trauma is an important source of unilateral or bilateral blindness not only in Cuba but worldwide as well. A brief summary of the current terms and definitions used to manage ocular trauma, their classification and the advantage of the Ocular Trauma Score (OTS) to know the possible final visual acuity, according to the clinical findings at the emergency room, were presented. Reference was also made to the multitrauma patients and to those elements that the ophthalmologist must take into account to adopt appropriate actions when the patients wounds are penetrating or perforating and life-threatening. These cases require efficient cooperation among many specialists to preserve patient's life and to reduce complications affecting the final visual prognosis(AU)

Prospective validation of the Ocular Trauma Score as a prognostic model to predict vision survival in injured adult patients from a developing country.

PURPOSE: To assess the prognostic value of the Ocular Trauma Score (OTS) in patients with eye injury treated in a University Hospital in South America. METHODS: One hundred and ninety subjects who were victims of eye trauma with different degrees of severity were evaluated and treated accordingly. Initial OTS categories were calculated for each patient and compared to the final visual result by transforming the achieved best-corrected visual acuity (BCVA) after treatment into OTS values. RESULTS: OTS visual acuity showed good correlation with the final BCVA after treatment [Spearman's ρ = 0.857, 95 % confidence interval (CI) 0.813-0.891, P < 0.0001). No difference between the predicted BCVA and achieved BCVA was noticed (P < 0.0001, Chi-square test). CONCLUSION: The OTS provided useful information on outcomes treatment after eye trauma and can be used as a prognostic model to predict vision survival in injured adult patients from a developing country.

Trauma ocular y politrauma / Ocular trauma and multitrauma

Se realizó una revisión sobre el trauma ocular y su manejo en pacientes politraumatizados. Entre las causas más frecuentes de trauma ocular se encuentran los accidentes domésticos, laborales, juegos, actividades recreativas y deportivas. Involucran en un alto por ciento a niños y jóvenes, y predomina el sexo masculino en casi todos los trabajos revisados. No solo en Cuba sino en el mundo, el trauma ocular es fuente importante de ceguera unilateral o bilateral. Se presenta un breve compendio de los términos y definiciones actuales que son utilizados para el manejo del trauma ocular, su clasificación y la ventaja que ofrece aplicar el Puntaje del Trauma Ocular, OTS (Ocular Trauma Score), para el pronóstico de la agudeza visual final de acuerdo a los hallazgos clínicos encontrados en la evaluación inicial. Se hace referencia a los pacientes con politrauma y los aspectos a tener en cuenta por el oftalmólogo para tomar conducta cuando estos presentan heridas penetrantes o perforantes y tienen compromiso vital. En estos casos se hace necesaria la colaboración urgente de múltiples especialistas para primero mantener al paciente con vida y luego disminuir las complicaciones que repercuten en su pronóstico visual.

A review was made on the ocular trauma and its management in multitrauma patients. The most common causes comprise domestic and occupational accidents, games, recreational and sport activities. It involves more frequently a high percentage of young people, with male prevalence in almost all the reviewed papers. Ocular trauma is an important source of unilateral or bilateral blindness not only in Cuba but worldwide as well. A brief summary of the current terms and definitions used to manage ocular trauma, their classification and the advantage of the Ocular Trauma Score (OTS) to know the possible final visual acuity, according to the clinical findings at the emergency room, were presented. Reference was also made to the multitrauma patients and to those elements that the ophthalmologist must take into account to adopt appropriate actions when the patient’s wounds are penetrating or perforating and life-threatening. These cases require efficient cooperation among many specialists to preserve patient's life and to reduce complications affecting the final visual prognosis.

Utilidad del "Ocular Trauma Score" como herramienta de pronóstico visual en lesiones traumáticas oculares / Usefulness of the Ocular Trauma Score as a visual prognostic tool in ocular trauma injuries

OBJETIVO: Analizar la utilidad y aplicabilidad del Sistema de Puntaje del Trauma Ocular para el pronóstico visual en pacientes con trauma en el Servicio de Oftalmología del Hospital Clínicoquirúrgico "Calixto García". MÉTODOS: Se realizó un estudio descriptivo, longitudinal, retrospectivo, incluyéndose 171 pacientes adultos con diagnóstico de trauma ocular severo, admitidos para ingreso en el periodo comprendido entre enero del 2005 y 2008. Se evaluó a cada paciente inicialmente con el Ocular Trauma Score y se analizó como variable dependiente, la agudeza visual final como mínimo tras 6 meses de seguimiento. Esta variable se analizó con fines comparativos con su valor inicial categorizado y estratificado según el Ocular Trauma Score y con el rango esperado de la misma chi-cuadrado, así como se determinó posibles correlaciones entre esta y otras variables. Se tomaron como significativos valores de p £ 0,05. RESULTADOS: Se realizó un seguimiento promedio de 17,6 meses. La edad promedio fue de 43,89 años, con predominio del sexo masculino (83,32 por ciento). Las lesiones traumáticas "A Globo Cerrado" fueron las más frecuentes (59,5 por ciento), fundamentalmente las contusiones (47,5 por ciento). Las lesiones oculares "A Globo Abierto" se correlacionaron con una baja agudeza visual inicial (r²= 0,78; p= 0,045) y final (r²= 0,86; p= 0,02). Los valores de agudeza visual final real vs. esperada para cada categoría del OTS presentaron correlación significativa (r² > 0,98; p < 0,002) sin diferencias según el test de chi-cuadrado en 25 de las 29 probabilidades pronósticas visuales. CONCLUSIONES: El Ocular Trauma Score es un sistema que proporciona un adecuado y acertado pronóstico en cuanto a la agudeza visual final en pacientes con trauma ocular severo.

OBJECTIVE: To analyze the usefulness and applicability of the Ocular Trauma Score (OTS) for visual prognosis in patients with ocular trauma at the ophthalmology service of "Calixto García" clinical and surgical hospital. METHODS: A retrospective, cross-sectional and descriptive study including 171 patients diagnosed with severe ocular trauma and admitted to hospital from January 2005 to January 2008 was conducted. Each patient was evaluated by the OTS at the beginning, and the depending variable of the best corrected visual acuity (BCVA) after six-month follow-up was analyzed. This variable was analyzed to compare its initial value, ranked and stratified according the OTS and chi². The correlations between this variable and the others were determined. Accepted values of p £ 0.05 were considered as significant values. RESULTS: The average length of follow-up was 17.6 months. The mean age was 43.89 years and the male sex prevailed in 83.32 percent of cases. The ocular injuries "Closed globe" were the most frequent (59.5 percent), mainly contusions (47.5 percent). The ocular injuries "Open globe" correlated with low initial visual acuity (r²= 0.78; p= 0.045) and low final visual acuity (r²= 0.86; p= 0.02). The values of real vs expected final visual acuity for each OTS category showed significant correlation (r²> 0.98; p< 0.002), without differences on chi² test in 25 of 29 prognostic visual probabilities. CONCLUSIONS: The Ocular Trauma Score is a system that provides an adequate and accurate prognosis of final visual acuity in patients with severe ocular trauma.

Carboidratos não estruturais e acúmulo de forragem em pastagens de Cynodon spp. sob lotação contínua

Organic reserves are chemical substances that may determine the vigour of regrowth of forage plants and may alter their persistence in grazed swards. Non structural carbohydrates (NEC) are among those substances. The concentration and the amount (pool) of total non structural carbohydrates were evaluated in samples of 'Tifton-85', 'Florakirk' and 'Coastcross' pastures, established on an Eutric Kandiudalf, during the winter, spring and summer. Treatments corresponded to four "steady state" sward conditions characterised by sward surface heights (SSH) of 5, 10, 15 and 20 cm maintained by sheep under continuous stocking. The experimental design was a complete randomised block, with treatments arranged in split-plot with four replications. Grass cultivars were allocated to plots and SSH to sub-plots. Samples for determination of NEC were collected monthly using 15cm diameter and 50cm long steel tubes. NEC concentrations were determined by acid digestion and rates of dry matter accumulation were measured with exclosure cages. Cynodon spp. cultivars presented a seasonal pattern of variation related to the allocation of NEC in the stubble and roots. NEC concentrations did not reach limits that could be considered harmful to sward persistence and productivity. 'Tifton-85' presented the highest NEC pool for the stubble and root components and that could be an indication of a higher tolerance to periods of stress.

Reservas orgânicas são compostos capazes de determinar o vigor e a velocidade da rebrota de plantas forrageiras influenciando sua persistência na pastagem. Dentre os compostos constituintes das reservas orgânicas estão os carboidratos não estruturais (CNE). Os teores e a quantidade de CNE foram avaliados em amostras de pastagens de 'Tifton-85', 'Florakirk' e 'Coastcross', estabelecidas em Nitossolo Vermelho eutroférrico, durante as estações de inverno, primavera e verão. Os tratamentos corresponderam a quatro situações de "steady state" do relvado, caracterizadas por alturas de pasto de 5, 10, 15 e 20 cm mantidas por ovinos sob regime de lotação contínua. O delineamento experimental foi em blocos completos casualizados, com um arranjo de parcelas subdivididas e quatro repetições. Os cultivares foram alocados nas parcelas e alturas de pasto nas subparcelas. As coletas das amostras para determinação de CNE foram realizadas mensalmente utilizando-se tubos de aço de 15 cm de diâmetro por 50 cm de altura. Os teores de CNE foram quantificados através de metodologia analítica baseada em digestão ácida e as taxas de acúmulo de matéria seca foram mensuradas através de gaiolas de exclusão. Os cultivares de Cynodon spp. avaliados apresentaram um padrão de variação sazonal quanto à prioridade de alocação de CNE para os órgãos de reserva (base do colmo e raízes). Os teores de CNE obtidos não atingiram níveis que pudessem ser considerados danosos à perenidade e à produtividade das pastagens de 'Tifton-85', 'Florakirk' e 'Coastcross'. 'Tifton-85' apresentou maior quantidade de CNE na base do colmo e raízes, o que poderia contribuir para uma maior tolerância a períodos de estresse.

Carboidratos não estruturais e acúmulo de forragem em pastagens de Cynodon spp. sob lotação contínua

Organic reserves are chemical substances that may determine the vigour of regrowth of forage plants and may alter their persistence in grazed swards. Non structural carbohydrates (NEC) are among those substances. The concentration and the amount (pool) of total non structural carbohydrates were evaluated in samples of 'Tifton-85', 'Florakirk' and 'Coastcross' pastures, established on an Eutric Kandiudalf, during the winter, spring and summer. Treatments corresponded to four "steady state" sward conditions characterised by sward surface heights (SSH) of 5, 10, 15 and 20 cm maintained by sheep under continuous stocking. The experimental design was a complete randomised block, with treatments arranged in split-plot with four replications. Grass cultivars were allocated to plots and SSH to sub-plots. Samples for determination of NEC were collected monthly using 15cm diameter and 50cm long steel tubes. NEC concentrations were determined by acid digestion and rates of dry matter accumulation were measured with exclosure cages. Cynodon spp. cultivars presented a seasonal pattern of variation related to the allocation of NEC in the stubble and roots. NEC concentrations did not reach limits that could be considered harmful to sward persistence and productivity. 'Tifton-85' presented the highest NEC pool for the stubble and root components and that could be an indication of a higher tolerance to periods of stress.

Reservas orgânicas são compostos capazes de determinar o vigor e a velocidade da rebrota de plantas forrageiras influenciando sua persistência na pastagem. Dentre os compostos constituintes das reservas orgânicas estão os carboidratos não estruturais (CNE). Os teores e a quantidade de CNE foram avaliados em amostras de pastagens de 'Tifton-85', 'Florakirk' e 'Coastcross', estabelecidas em Nitossolo Vermelho eutroférrico, durante as estações de inverno, primavera e verão. Os tratamentos corresponderam a quatro situações de "steady state" do relvado, caracterizadas por alturas de pasto de 5, 10, 15 e 20 cm mantidas por ovinos sob regime de lotação contínua. O delineamento experimental foi em blocos completos casualizados, com um arranjo de parcelas subdivididas e quatro repetições. Os cultivares foram alocados nas parcelas e alturas de pasto nas subparcelas. As coletas das amostras para determinação de CNE foram realizadas mensalmente utilizando-se tubos de aço de 15 cm de diâmetro por 50 cm de altura. Os teores de CNE foram quantificados através de metodologia analítica baseada em digestão ácida e as taxas de acúmulo de matéria seca foram mensuradas através de gaiolas de exclusão. Os cultivares de Cynodon spp. avaliados apresentaram um padrão de variação sazonal quanto à prioridade de alocação de CNE para os órgãos de reserva (base do colmo e raízes). Os teores de CNE obtidos não atingiram níveis que pudessem ser considerados danosos à perenidade e à produtividade das pastagens de 'Tifton-85', 'Florakirk' e 'Coastcross'. 'Tifton-85' apresentou maior quantidade de CNE na base do colmo e raízes, o que poderia contribuir para uma maior tolerância a períodos de estresse.