[Descemet's stripping automated endothelial keratoplasty (DEAEK). Systematic review of clinical-effectiveness and safety]. / Queratoplastia endotelial automatizada con pelado de membrana de Descemet (DSAEK). Revisión sistemática sobre efectividad y seguridad.

OBJECTIVE: To conduct a systematic review of the efficacy/effectiveness, safety and cost of Descemet's stripping automated endothelial keratoplasty (DSAEK) technique in patients with corneal endothelial failure. METHODS: Comprehensive literature search conducted in the main biomedical databases from January-May 2012. RESULTS: Following a critical perusal of the total of 485 abstracts retrieved, 16 case series and one economic evaluation study were included. Corrected distance visual acuity and uncorrected distance visual acuity improved after treatment with DSAEK, attaining values of 0.6 to 0.8 and 0.5 respectively. The degree of post-DSAEK astigmatism was not significant with respect to baseline values. The main complications were graft dislocation-detachment (1.5-23%), primary failure (0-12%) and endothelial rejection (0.8-8.5%). CONCLUSIONS: In Fuchs' dystrophy and bullous keratopathy, data on the effectiveness of DSAEK indicate post-intervention improvement in uncorrected and corrected distance visual acuity. Astigmatism arising after DSAEK was not significant. The most significant post-DSAEK complications are linked to the viability of the graft, with the most frequent complications being dislocation-detachment and, to a lesser extent, endothelial rejection. The studies that assess DSAEK are case series, and for the most part retrospective. The quality of this type of studies is both low and limited.

Atherogenic dyslipidemia in patients with established coronary artery disease.

BACKGROUND AND AIMS: Patients with stable coronary heart disease (CHD) and atherogenic dyslipidemia (AD) have a high-risk of recurrence and are those who derive most benefit from treatment with lipid-lowering agents. The aim of this study was to examine the prevalence of AD in patients with stable coronary heart disease and to investigate associated factors. METHODS: Cross-sectional study involving 7823 subjects admitted for a coronary event between 6 months and 10 years previously. AD was considered to be the concurrent presence of low HDL-cholesterol (<1.03 mmol/L [40 mg/dL] in males, <1.29 mmol/L [50 mg/dL] in females) and elevated triglycerides (≥1.7 mmol/L [150 mg/dL]). RESULTS: Mean age was 65.3 (10.1) years, 73.6% were males and 80.3% were receiving treatment with statins. Low HDL-cholesterol was observed in 26.3% of the participants, 39.7% had elevated triglyceride concentration and 13.0% had AD. The percentage of AD in patients with criteria for metabolic syndrome was 30.9%. Factors associated directly and independently with the presence of AD in the multivariate analysis were female sex, history of coronary syndrome without ST elevation or coronary revascularization, presence of atrial fibrillation, body mass index, LDL-cholesterol, systolic blood pressure and blood glucose levels, while age and glomerular filtration rate were significantly and inversely associated with AD. CONCLUSION: A significant proportion of patients with coronary disease could benefit from interventions aimed at increasing HDL-cholesterol and reducing triglycerides.

[Prevalence of metabolic syndrome in patients with stable coronary disease: therapeutic objectives and utilization of cardiovascular drugs]. / Prevalencia de síndrome metabólico en pacientes con enfermedad coronaria estable: objetivos terapéuticos y utilización de fármacos cardiovasculares.

OBJECTIVE: The achievement of the therapeutic objectives in patients with ischemic heart disease and metabolic syndrome is unknown. This study has aimed to evaluate whether the prevalence of risk factors, the prescription rate of evidence-based cardiovascular therapies and the attainment of therapeutic goals differ in coronary patients with and without the metabolic syndrome (MS). METHODS: A multicenter, cross-sectional study carried out with the participation of 7,600 patients with stable coronary heart disease (mean age 65.3 years, 82% males, 37.7% with MS) attended in primary care. Data on drug prescription and goal attainment were extracted from clinical records. MS was defined according to the National Cholesterol Education Program (NCEP) criteria. RESULTS: Patients with MS had a higher prevalence of cardiovascular risk factors and cardiovascular disease. They also had a higher prescription rate of blood-pressure lowering drugs, statins and antidiabetic agents, without differences in the rate of use of antithrombotics and beta-blockers. After adjusting for cardiovascular risk factors and co-morbidity, only fibrates and angiotensin II receptor blockers were used more frequently in MS patients. A lower percentage of subjects with MS achieved therapeutic goals of LDL cholesterol (23.4% vs 27.7%, P<.001), blood pressure (29.1% vs 52.2%, P<.001) and, in diabetics, of glycated hemoglobin (54.7% vs 75.9%, P<.001). CONCLUSION: Patients with stable coronary disease and MS do not reach therapeutic objectives as frequently as those without MS, in spite of receiving a higher amount of cardiovascular drugs.

[Loiasis. Approach to a form of ocular parasitosis]. / Loiasis. Aproximación a una forma de parasitosis ocular.

CASE REPORT: We present the case of a man from Cameroon who was referred because of the presence of a worm in both eyes, intermittently, over a five-year period. Slit-lamp examination revealed a creeping worm under the conjunctiva. Its surgical removal enabled microbiologic confirmation of a mature form of Loa-Loa. DISCUSSION: Loiasis is a parasitic disease endemic in Africa. Because of the increase of African emigration to Spain, the possibility of this condition must be considered in Spain.

[Present situation of antibiotic resistances in tonsillar infections]. / Situación actual de las resistencias a antibióticos en infecciones amigdalares.

OBJECTIVE: To obtain the main responsible organisms, its sensitivity and resistances to antibiotics in tonsillitis. MATERIAL AND METHODS: We have studied the post-surgical tonsils, carrying out a microbiologic study, its culture and sensitivity. RESULTS: The most frequent isolated organisms were Staphylococcus aureus (29.3%), followed by Streptococcus pyogenes (23.4%), and Haemophilus influenzae (12.1%). The highest resistances were for the S. aureus (penicillin 91%, erythromycin 18% and 5% to the rest of the beta-lactams), followed by H. influenzae (50% clarithromycin, 30% amoxyciIlin and 2% cephalosporins) and S. pyogenes (28% erytromycin, 10% clindamycin and 3% penicillin). CONCLUSIONS: We noticed the minimal resistance found to cephalosporins, and for this reason they appear to be the safest option, except in children under five years old, in which amoxicillin is still the first line treatment, because the causative agent is S. pyogenes, sensitive to that antibiotic.

[Satisfaction and recovery of normal activity with rizatriptan 10 mg. Results from the open, prospective, observational 4M study]. / Satisfacción y retorno a la actividad normal con 10 mg de rizatriptán. Resultados del estudio abierto, prospectivo y observacional 4M.

BACKGROUND: To evaluate the impact of the treatment with rizatriptan 10 mg (Maxalt) on the return to normal activity and satisfaction with treatment in the general population with migraine. PATIENTS AND METHOD: We conducted an open, prospective study in patients with migraine (International Headache Society [IHS] criteria) who were followed for up to 3 migraine attacks. We measured the degree of functional disability at 0 and 2 hours after treatment, and satisfaction at 24 hours. Other domains of satisfaction were evaluated after three migraine attacks. The relationship between baseline pain severity, satisfaction after 24 hours and functional disability was analyzed. RESULTS: 2,469 patients were enrolled who experienced 6,323 migraine attacks. A return to normal activity was achieved two hours after treatment in 67% of all attacks treated with rizatriptan 10 mg. The percentage of attacks causing severe functional disability decreased from 39% before therapy to 3.6% two hours after treatment. In more than 90% of moderate or severe attacks, a normal or slightly impaired functional capacity was restored two hours after treatment. In 76.3% of the attacks the patients were fully or very satisfied 24 hours after treatment with rizatriptan 10 mg. After treating three migraine attacks, the proportion of patients fully or very satisfied with rizatriptan was over 79% for all the domains explored. CONCLUSIONS: The patients were highly satisfied after 24 hours and following three migraine attacks treated with rizatriptan 10 mg. In more than two-thirds of the attacks treated with rizatriptan 10 mg, the patients returned to normal activity two hours after treatment.

[Ocular decompression retinopathy after trabeculectomy]. / Retinopatía por descompresión ocular tras la trabeculectomía.

PURPOSE: Two cases of ocular decompression retinopathy associated with glaucoma filtering surgery are described. CONCLUSIONS: Both patients were young males, intraocular pressures were 35 and 40 mm Hg before surgery. The retinal haemorrhages resolved, and in the only case where it was possible to estimate the visual acuity, it had improved significantly. In the few cases that were reported, most involve young males with markedly high intraocular pressures before surgery and occasionally myopic.

[The evidence for higher blood pressures in children and adolescents of the rural interior of Galicia than in other locations in Spain]. / Evidencia de presiones arteriales más elevadas en niños y adolescentes del interior rural de Galicia que en otras localizaciones en España.

AIM: To analyze differences in blood pressure levels in children and adolescents in Galicia with those of peers living in other parts of Spain. DESIGN: Cross-sectional study done in a rural area in Galicia. PARTICIPANTS: 870 boys and girls 6 to 16 years old. They are compared with published data from the RICARDIN study, that includes 10,042 participants selected at the schools in nine centers of Spain (one was the center in Galicia). MEASUREMENTS: Standardized methodology and certification procedures were used in Galicia and Spain to measure weight, height, Quételet index, systolic (SBP) and fifth-phase diastolic blood pressure (DBP5) and sexual maturation. Data are presented by sex and age group (1 year) both in Galicia and Spain. RESULTS: From 11 years and above, girls in Galicia present higher SBP than in Spain. In boys, the difference appears later. Galicia shows higher DBP5 levels than Spain in every age-sex group. In relation to obesity, the differences are of a small magnitude in the Quételet index, again, higher values in Galicia. CONCLUSIONS: This is the first population-based study available that rules out the possibility that the observed differences, previously already suggested, could be attributed to methodological problems. The differences in blood pressure and obesity between Galicia and other areas of Spain, already previously suggested in adults, can be the reflection of differences present from childhood.

Prevalence of diabetes mellitus in the population aged 40-69 years in Galicia, northwest Spain.

A cross-sectional study of the prevalence and distribution of diabetes among 40- to 69-year olds in Galicia (NW Spain) is presented. A (R)Reflotron system was used to measure the capillary fasting glucaemia in 1275 subjects randomly chosen from the electoral roll, who also answered a short questionnaire and were weighed and measured. The prevalence of diabetes was 7.5% regardless of sex or habitat (urban or rural), and increased significantly with age. These data are in keeping with the scant available information from other parts of Spain and the world in general. The lack of difference between urban and rural habitats was unexpected in view of previously reported dietary differences between both areas.

The use of hybrid isoelectric focusing for the detection of polymorphic proteins in blood stains.

alpha1-Antitrypsin (Pi), transferrin (Tf) and orosomucoid (ORM) were determined in bloodstain extracts by isoelectric focusing (IEF) with carrier ampholytes (CA) and also with a mixture of immobilines (HIEF). HIEF yields superior results from proteins typing in bloodstain extracts, since phenotypes are better distinguished and the bands are straighter and sharper. Also the sensitivity of HIEF is similar to IEF with CA.

Determination of phosphoglucomutase (PGM1), acid phosphatase (ACP), and esterase D (ESD) in human bloodstains by hybrid isoelectric focusing (HIEF).

PGM1, ESD, and ACP were determined in bloodstain extracts by isoelectric focusing (IEF) with carrier ampholytes (CA) and HIEF. HIEF yields superior results in PGM typing from bloodstain extracts, whereas for ESD and ACP typing isoelectric focusing with carrier ampholytes seems to be the method of choice.

Comparison between isoelectric focusing methods for the detection of orosomucoid phenotypes.

Orosomucoid (ORM) polymorphism was investigated by different methods including isoelectric focusing in acid pH ranges followed by silver staining, print immunofixation of desialyzed ORM, fixation using a lectin from the sea-weed Codium tomentosum, isoelectric focusing followed by immunofixation in miniaturized gels and isoelectric focusing in immobilized pH gradients. Population genetics studies were carried out in Galicia (NW Spain) and two new ORM variants were found.

Correlation between native and desialyzed forms of orosomucoid.

The correlation between ORM phenotypes in untreated serum and ORM phenotypes after isoelectric focusing of neuraminidase-treated serum is demonstrated. ORM subtypes were determined using isoelectric focusing in immobilized pH gradients. Population genetic studies of ORM polymorphism in the Galician population were also carried out.