Dengue virus identification by transmission electron microscopy and molecular methods in fatal dengue hemorrhagic fever.

Dengue virus is the most significant virus transmitted by arthropods worldwide and may cause a potentially fatal systemic disease named dengue hemorrhagic fever. In this work, dengue virus serotype 4 was detected in the tissues of one fatal dengue hemorrhagic fever case using electron immunomicroscopy and molecular methods. This is the first report of dengue virus polypeptides findings by electron immunomicroscopy in human samples. In addition, not-previously-documented virus-like particles visualized in spleen, hepatic, brain, and pulmonary tissues from a dengue case are discussed.

Cystoid Macular Edema after an uncomplicated Gonioscopy- Assisted Transluminal Trabeculotomy on a previously vitrec- tomized patient.

Purpose: The main purpose of this study was to report a case of cystoid macular edema (CME) after gonioscopy-assisted transluminal trabeculotomy (GATT). Methods: We describe the case of a 73-year-old woman with ocular hypertension and history of cataract surgery combined with posterior vitrectomy and epiretinal membrane peeling 2 years before, who developed CME after uncomplicated GATT procedure. Results: Uneventful GATT surgery was performed in an eye with ocular hypertension. A month after GATT surgery, the patient com-plained of blurry vision. Best corrected visual acuity had deteriorated from 20/20 on Snellen chart, to 20/70. The patient was diagnosed with CME. Treatment with topical non-steroidal anti-inflammatory drug (NSAID) and topical corticosteroids for one month, and oral carbonic anhydrase inhibitor for one week achieved a total CME regression with recovery of a normal macular and foveal architecture. Conclusions: Surgery-induced CME may occur following stand-alone microinvasive glaucoma surgery (MIGS) such as GATT. It would be worthwhile to conduct studies to explore whether the prophylactic use of NSAID and corticosteroids is justified.

Regulation of peripheral lymph node genesis by the tumor necrosis factor family member TRANCE.

Proper lymph node (LN) development requires tumor necrosis factor-related activation-induced cytokine (TRANCE) expression. Here we demonstrate that the defective LN development in TRANCE(-/)- mice correlates with a significant reduction in lymphotoxin (LT)alphabeta(+)alpha(4)beta(7)(+)CD45(+)CD4(+)CD3(-) cells and their failure to form clusters in rudimentary mesenteric LNs. Transgenic TRANCE overexpression in TRANCE(-/)- mice results in selective restoration of this cell population into clusters, and results in full LN development. Transgenic TRANCE-mediated restoration of LN development requires LTalphabeta expression on CD45(+) CD4(+)CD3(-) cells, as LNs could not be induced in LTalpha(-/)- mice. LTalpha(-/)- mice also showed defects in the fate of CD45(+)CD4(+)CD3(-) cells similar to TRANCE(-/)- mice. Thus, we propose that both TRANCE and LTalphabeta regulate the colonization and cluster formation by CD45(+) CD4(+)CD3(-) cells in developing LNs, the degree of which appears to correlate with the state of LN organogenesis.

Antibiotic resistance profile in eye infections in a reference centre in Floridablanca, Colombia. / Perfil de resistencia antibiótica en infecciones oculares en un centro de referencia en Floridablanca, Colombia.

BACKGROUND AND OBJECTIVE: In view of the increasing bacterial resistance to antibiotics, it is necessary to determine it locally in order to serve as a guide in clinical management. The purpose of this study was to characterise the pattern of antibiotic sensitivity in cases of eye infections in a third level ophthalmological institution in Floridablanca (Colombia). MATERIALS AND METHODS: An observational cross-sectional study in which an analysis was made of the culture and antibiogram reports of specimens taken from cases of conjunctivitis, infectious keratitis, and endophthalmitis between January 2013 and June 2016. RESULTS: A total of 833 specimens were positive for bacteria. Considering both gram-positive and gram-negative microorganisms gentamicin, tobramycin, and ciprofloxacin showed high resistance rates (64.4%, 40.3%, and 29.1%, respectively). Moxifloxacin, vancomycin, imipenem, and gatifloxacin showed low percentages of resistance: 2.6%, 2.1%, 0.6%, and 0.4%, respectively. When comparing the results with previous studies in our institution, there was a decrease in sensitivity to the fourth-generation quinolones and imipenem, especially within the gram-negative ones. CONCLUSION: Fourth generation quinolones, imipenem and vancomycin continue to have a low in vitro resistance to bacteria that cause eye infections. However, there was a tendency to an increase in the resistance of gram-negative bacteria. Measures should be taken to try to control this phenomenon, and consider possible antimicrobial therapy alternatives to infections caused by these microorganisms.

Endoscopic vein harvest for coronary artery bypass grafting: technique and outcomes.

BACKGROUND: The greater saphenous vein is a common conduit for coronary revascularizations. Traditional vein harvesting uses long incision(s) that can lead to significant morbidities. A minimally invasive technique has been developed that allows the harvest of much of the saphenous vein with one incision and fewer morbidities. METHODS: Our technique and outcomes on 110 patients with minimally invasive harvest (endoscopic vein harvesting) is presented. Comparisons are made with an equivalent retrospective group within the same hospital and to a smaller (n = 28) prospective group at other hospitals. RESULTS: Endoscopic vein harvesting has evolved to one above-knee incision of 3 cm length that allows for the harvest of 35 cm of vein. Harvest times were longer for endoscopic vein harvesting, showed a learning curve, and appeared to reach a baseline of 35 minutes. Incision closure times were less for the endoscopic vein harvesting group. Total skin to skin operating times for the entire cardiovascular procedure did not differ between the groups. In relatively homogeneous populations, leg infection rates did not differ, but other leg morbidities were less for the patients who underwent endoscopic vein harvesting. Hospital readmissions for leg wound care were low in both groups although the number of office visits required for leg care was higher for patients undergoing traditional vein harvesting. Pain perception by the patients was much less for the endoscopic vein harvesting and remained lower for up to 4 weeks. CONCLUSIONS: Although endoscopic vein harvesting is a relatively new procedure, it is safe, effective, and less painful for the patient and carries fewer morbidities.

Factores de riesgo para el desarrollo de infecciones intrahospitalarias en pacientes quemados. Hospital S. Juan de Dios, Costa Rica: Enero 2003-Diciembre 2005. Parte I / Risk factors for development of intrahospitalary infections in burned patients. Hospital S. Juan de Dios, Costa Rica: January 2003-December 2005. Part I

La infección intrahospitalaria es una de las principales causas de morbilidad y mortalidad en los pacientes quemados. El presente estudio caracteriza a los ingresados por quemadura(s) y la presencia de esta clase de infección en la Unidad Nacional de Quemados del Hospital San Juan de Dios, en Costa Rica, entre los años 2003y 2005.Realizamos un análisis descriptivo de la infección intrahospitalaria en el sitio de la quemadura según las características de los pacientes y de la quemadura así como el total de días de estancia hospitalaria, utilizando para ello un diseño de estudio tipo cohorte retrospectiva. La incidencia acumulada de la infección intrahospitalaria en el sitio de la quemadura fue de 19.0%. Los meses posteriores al ingreso clases presentaron un mayor número de hospitalizaciones por quemaduras. La edad, la superficie corporal total quemada, el número de segmentos corporales quemados, la profundidad de la quemadura y los días de estancia hospitalaria presentaron diferencias significativas entre los individuos infectados y no infectados. El tipo de accidente que produjo la quemadura y el sexo no presentaron diferencias significativas entre ambos grupos de pacientes. La electricidad fue el agente causal más frecuente en los pacientes con infección, mientras que el agua caliente lo fue en los pacientes sin infección. Concluimos que las características fisiopatológicas de las quemaduras favorecen infección en los pacientes quemados; asimismo, existen factores que pueden y deben ser tomados en cuenta para controlar y prevenir la infección y sus efectos (AU)

Intrahospitalary infection in burned patients is one of the most important causes of morbidity and mortality. This study characterizes the admitted burn victims and the presence of inner-hospital infection at the National Burn Victims Unit , San Juan de Dios Hospital, Costa Rica, between 2003 and 2005.We made a descriptive analyze of intrahospital infection in the burned area according characteristics of the patients and their burn(s), as well as the total number of days of hospital stay, using prospective cohort. The accumulated incidence for intra hospital infection in the burned area was 19.0%. In the months following the beginning of the school year, the number of burn victims admitted in the hospital increased. Age, total burnt surface, the number of burnt body segments, the depth of the burn and the days of hospital stay varied significantly between infected and not infected individuals. Theca use of the burn and the victim’s gender did not reveal any relevant differences between the groups of patients. For patients that developed intrahospital infection in the burned area, electricity was the most frequent causing agent, as was hot water for patients without intra hospital infection in the burned area. As a conclusion, physiopathology characteristics of the burns favour the occurrence of the intra hospital infection in the burned area; furthermore, there are factors than can and must be taken into account to control and prevent intrahospital infection in the burned area and its effects (AU)

Factores de riesgo para el desarrollo de infecciones intrahospitalarias en pacientes quemados. Hospital S. Juande Dios, Costa Rica: Enero 2003-Diciembre 2005. Parte II / Risk factors for development of intrahospitalary infections in burned patients. Hospital S. Juan de Dios, Costa Rica: January 2003-December 2005. Part II

En los pacientes quemados, existen diferentes factores como la edad, sexo y días de estancia hospitalaria entre otros, que influyen en el desarrollo de infección intrahospitalaria (IIH). Debido a la mayor frecuencia de este tipo de infecciones en los pacientes quemados, pretendemos identificar qué factores influyen en la presentación y predicción de la infección intrahospitalaria en el sitio de la quemadura (IISQ).El presente estudio es una cohorte retrospectiva, sobre 298 registros de expedientes clínicos de pacientes ingresados en la Unidad Nacional de Quemados del Hospital San Juan de Dios (UNQ-HSJD) en Costa Rica, continuando otra investigación del mismo grupo de autores publicada anteriormente en Cirugía Plástica Ibero latinoamericana. A cada factor de riesgo estudiado se le calcularon los dos ratio crudos en un análisis univariado definiendo como variables de exposición principal la superficie corporal total quemada (SCTQ) y la profundidad de la quemadura (PQ). Observamos con este cálculo que el tipo de accidente no presentaba asociación cola IISQ. Después, realizamos un modelo multivariado logístico, no condicional, en el que se introdujeron los siguientes factores de riesgo: SCTQ,PQ, edad, número de segmentos corporales quemados (NSCQ), días de estancia hospitalaria previos a la infección intrahospitalaria en el sitio de la quemadura (DEHP-IISQ) y el agente causal de la quemadura. Consideramos variables confesora y modificadora de efecto al NSCQ y DEHP-IISQ. Determinamos que las principales variables predictoras para la IISQ fueron SCTQ (OR=3.02; 1.20-7.84), PQ (OR=11.44; 4.90-26.71),NCSQ (OR=2.80; 1.13-6.95), y DEHP-IISQ (9 a 14 días: OR=2.43; 0.52-11.29, >19 días: OR=31.89; 2.17-467.68). Pese a que no mostró significancia estadística, también se introdujo la edad en el modelo, debido a la tendencia aumentar el riesgo conforme ésta aumentaba ( >64 años: OR=3.15; 0.61-16.29) (..) (AU)

In burn victims, different factors such as age, gender and days of hospitalization among others, are influential in the development of inner-hospital infections (IHI). Due to a higher incidence of IHI in burn victims, it is pretended to identify which factors influence the presence and prediction of inner-hospital infections in the burned area (IHIBA).This study is a retrospective cohort that recruited 298 registries of medical reports from patients admitted into the National Burn Victims Unit as an Juan de Dios Hospital (NBVU-HSJD), Costa Rica, and following previous report in this journal. The odds ratio (OR) were calculated for each risk factor in a univariated analysis, and defined as principal exposition variables were the total burn surface (TBS) and the depth of the burn (DB).It was deduced from this calculation that the type of accident did not show any association with IHIBA. Subsequently, a multivariate logistic not conditioned study was carried out, in which, the following risk factors were introduced: TBS, DB, age, number of burnt body segments (NBBS), days of hospital stay previous to the IHIBA (DHSP-IHIBA) and the burn’s causing agent. Confusing and modifying variables of effect were also considered, respectively, for the NBBS and the DHSP-IHIBA. It was concluded that the main predicting variables for the IHIBA were (..) (AU)