Update on the diagnosis and treatment of normotensive glaucoma.

The increased Knowledge of the multifactorial origin of glaucoma, and especially the vascular involvement in normotensive glaucoma, can be seen in the high number of publications on this subject in recent years, which obliges us to review its diagnosis and treatment.

In-phase millennial-scale glacier changes in the tropics and North Atlantic regions during the Holocene.

Based on new and published cosmic-ray exposure chronologies, we show that glacier extent in the tropical Andes and the north Atlantic regions (TANAR) varied in-phase on millennial timescales during the Holocene, distinct from other regions. Glaciers experienced an early Holocene maximum extent, followed by a strong mid-Holocene retreat and a re-advance in the late Holocene. We further explore the potential forcing of TANAR glacier variations using transient climate simulations. Since the Atlantic Meridional Overturning Circulation (AMOC) evolution is poorly represented in these transient simulations, we develop a semi-empirical model to estimate the "AMOC-corrected" temperature and precipitation footprint at regional scales. We show that variations in the AMOC strength during the Holocene are consistent with the observed glacier changes. Our findings highlight the need to better constrain past AMOC behavior, as it may be an important driver of TANAR glacier variations during the Holocene, superimposed on other forcing mechanisms.

Psychotic symptoms following oxycodone withdrawal, case report and update.

Opiate withdrawal-induced psychosis is an uncommon clinical manifestation. We present a 36-year-old male patient, with no prior personal or familiar psychiatric history, in treatment with several analgesic drugs (including oxycodone) for non-inflammatory chronic rachialgia. The patient is hospitalized after exhibiting psychotic symptomatology (delusions of harm and contamination, olfactory hallucinations, and aberrant behavior). This psychotic symptomatology first manifested after abruptly interrupting his prescribed oxycodone intake. It had a fluctuating course over time (alternating between lucid states and delusional ones) and eventually subsided after the prescription of antipsychotic drugs. In this case report, we describe the follow-up of the patient and discuss the influence and relevance of oxycodone withdrawal on the psychotic symptomatology.

Soybean-fragmented proteoglycans against skin aging.

OBJECTIVE: The majority of age-dependent skin changes happen in the dermis layer inducing changes in skin collagen and in the proteoglycans. The main aim of this work is to study the efficacy of a Proteum serum, containing soybean-fragmented proteoglycans, against skin aging. MATERIALS AND METHODS: In vitro tests were performed to evaluate the Proteum serum ability on activating the production of collagen and proteoglycans. An in vivo long-term study was performed to determine the efficacy of the Proteum serum when applied on skin. Protection of healthy skin against detergent-induced dermatitis and the antioxidant properties of the applied Proteum serum were also studied. RESULTS AND DISCUSSION: The in vitro tests demonstrated that the Proteum serum was able to elevate the production of molecules which are essential for supporting the dermal extracellular matrix organization. These results were correlated by the in vivo measurements where a clear trend on improving the measured skin parameters due to the Proteum serum application was found. CONCLUSIONS: A beneficial effect of the Proteum serum was demonstrated with an improvement in the skin roughness and a reinforcement of the skin barrier function. Moreover, a significant protector effect on human stratum corneum against lipids peroxides (LPO) was demonstrated.

Preliminary Experience with Transdermal Oxybutynin Patches for Hyperhidrosis. / Experiencia inicial con oxibutinina transdérmica en el tratamiento de la hiperhidrosis.

BACKGROUND AND OBJECTIVE: Hyperhidrosis is very common and has a considerable impact on patients' quality of life. While oral oxybutynin is associated with good response rates, adverse effects are common and frequently cause patients to stop treatment. Following the recent launch of oxybutynin in a transdermal patch formulation in Spain, we undertook a preliminary study to assess treatment response and adverse effects in patients with hyperhidrosis. MATERIAL AND METHODS: This prospective study of 25 patients treated twice weekly with transdermal oxybutynin patches over 10 weeks assessed treatment response on 2 subjective scales: the Hyperhidrosis Disease Severity Scale (HDSS) and a visual analog scale (VAS) for sweating. RESULTS: Sixty percent of patients showed an improvement in HDSS scores. VAS scores improved in all cases, and 68% of patients achieved a reduction of 3 points or more. Just 2 patients (8%) experienced treatment-related adverse effects (irritant dermatitis at the patch application site in both cases). CONCLUSIONS: Although our results are based on a small sample, they suggest that transdermal oxybutynin could be a useful option for the treatment of hyperhidrosis and that it has an excellent safety and tolerability profile.

[Patient satisfaction as a quality indicator in mental health]. / Satisfacción del paciente como indicador de calidad en salud mental.

OBJECTIVE: To improve the quality of care in a Mental Health Hospital and identify the level of patient satisfaction. MATERIAL AND METHOD: A descriptive, longitudinal, and retrospective study was conducted on 666 patients who completed treatment in the Mental Health Day Hospital of Salamanca, during the period 1994-2012, using the Hospital Management Annual Reports. A questionnaire designed for this purpose was used as the measurement tool. RESULTS: Most of the patients satisfactorily valued aspects, such as the general impression of the treatment (90% said «good/fairly good¼) and perception of being helped (94% perceived «very/fairly helped¼); with 83% believing that the hospital is accessible. As regards empathy-understanding, it was noted that 14% feel discontent. While 18% of patients expected to be completely cured, the 83% of patients that finished their treatment have said that, in their opinion, the symptoms have subsided «very or somewhat¼. As regards the knowledge that they have about their disease, 30% believe it has advanced «a lot.¼ CONCLUSIONS: Based on the perceptions reported by patients, it may be said that in general, the level of user satisfaction in the Mental Health Day Hospital is high. Assessing quality through the user opinions helps control the quality, considering that patient satisfaction is a good indicator of result of the care received during their hospitalisation.

Metabolic acidosis: neo-considerations for general surgeons.

Hyperchloraemic metabolic acidosis is a documented complication of neobladder formation. However, it usually improves with time and is mild. Severe and persistent metabolic acidosis may manifest when patients undergo further surgery for other reasons. Neobladder formation following radical cystectomy or cystoprostatectomy is becoming increasingly common, and surgeons treating patients with neobladders should recognise and treat metabolic acidosis with intravenous fluids and bicarbonate.

A rare case of perforated caecum after acute pancreatitis.

Isolated caecal perforation following pancreatitis is a rare event. We report a case of severe non-necrotising pancreatitis complicated by caecal perforation that was managed successfully.

Evolution of the Fermi surface across a magnetic order-disorder transition in the two-dimensional Kondo lattice model: a dynamical cluster approach.

We use the dynamical cluster approximation, with a quantum Monte Carlo cluster solver on clusters of up to 16 orbitals, to investigate the evolution of the Fermi surface across the magnetic order-disorder transition in the two-dimensional doped Kondo lattice model. In the paramagnetic phase, we observe the generic hybridized heavy-fermion band structure with large Luttinger volume. In the antiferromagnetic phase, the heavy-fermion band drops below the Fermi surface giving way to hole pockets centered around k=(pi/2,pi/2) and equivalent points. In this phase Kondo screening does not break down, but the topology of the resulting Fermi surface is that of a spin-density wave approximation in which the localized spins are frozen.

Is 44-hour better than 24-hour ambulatory blood pressure monitoring in hemodialysis?

The aim of this study is to evaluate if hemodialysis (HD) patients with similar blood pressure (BP) in the whole inter-HD period could have different target organ lesions and survival if the behavior of BP differs from the first to the second day of the inter-HD period. The present study compares 44-hour ambulatory BP monitoring (ABPM) patterns in 45 HD patients. Three BP patterns emerged: group A (n = 15) had similar BPs throughout (138 +/- 11/88 +/- 12 in the first 22 h vs. 140 +/- 11/87 +/- 12 mm Hg in the second 22-hour period); group B (n = 15) had a significant systolic BP rise from the first to the second period (132 +/- 15/80 +/- 12 vs. 147 +/- 12/86 +/- 13 mm Hg, p < 0.05); group C (n = 15) had significantly higher BPs (p < 0.05) than the other 2 groups throughout the whole inter-HD period, with no significant change between the 2 halves (172 +/- 14/108 +/- 12 vs. 173 +/- 18/109 +/- 14 mm Hg). Ventricular mass and survival during the 30-month follow-up period were statistically significantly better in group A, intermediate in group B and worse in group C. The data suggest that a 44-hour ABPM is more accurate than a 24-hour one in evaluating organ lesion and prognosis in HD patients.

Using information theory to search for co-evolving residues in proteins.

MOTIVATION: Some functionally important protein residues are easily detected since they correspond to conserved columns in a multiple sequence alignment (MSA). However important residues may also mutate, with compensatory mutations occurring elsewhere in the protein, which serve to preserve or restore functionality. It is difficult to distinguish these co-evolving sites from other non-conserved sites. RESULTS: We used Mutual Information (MI) to identify co-evolving positions. Using in silico evolved MSAs, we examined the effects of the number of sequences, the size of amino acid alphabet and the mutation rate on two sources of background MI: finite sample size effects and phylogenetic influence. We then assessed the performance of various normalizations of MI in enhancing detection of co-evolving positions and found that normalization by the pair entropy was optimal. Real protein alignments were analyzed and co-evolving isolated pairs were often found to be in contact with each other. AVAILABILITY: All data and program files can be found at http://www.biochem.uwo.ca/cgi-bin/CDD/index.cgi

Acquisition of resistance to extended-spectrum cephalosporins by Salmonella enterica subsp. enterica serovar Newport and Escherichia coli in the turkey poult intestinal tract.

Salmonella enterica subsp. enterica serovar Newport resistant to the extended-spectrum cephalosporins (ESCs) and other antimicrobials causes septicemic salmonellosis in humans and animals and is increasingly isolated from humans, animals, foods, and environmental sources. Mechanisms whereby serovar Newport bacteria become resistant to ESCs and other classes of antimicrobials while inhabiting the intestinal tract are not well understood. The present study shows that 25.3% of serovar Newport strains isolated from the turkey poult intestinal tract after the animals were dosed with Escherichia coli harboring a large conjugative plasmid encoding the CMY-2 beta-lactamase and other drug resistance determinants acquired the plasmid and its associated drug resistance genes. The conjugative plasmid containing the cmy-2 gene was transferred not only from the donor E. coli to Salmonella serovar Newport but also to another E. coli serotype present in the intestinal tract. Laboratory studies showed that the plasmid could be readily transferred between serovar Newport and E. coli intestinal isolates. Administration of a single dose of ceftiofur, used to prevent septicemic colibacillosis, to 1-day-old turkeys did not result in the isolation of ceftiofur-resistant E. coli or Salmonella serovar Newport. There was a remarkable association between serotype, drug resistance, and plasmid profile among the E. coli strains isolated from the poults. This study shows that Salmonella serovar Newport can become resistant to ESCs and other antibiotics by acquiring a conjugative drug resistance plasmid from E. coli in the intestines.

Association between hypervolemia and ventricular hypertrophy in hemodialysis patients.

BACKGROUND: Left ventricular hypertrophy (LVH) is a well-known predictor of cardiovascular mortality in patients who have end-stage renal disease and are maintained on hemodialysis (HD), and LVH is not always correlated with the severity of hypertension in these patients. The purpose of this study was to investigate the role of other factors contributing to LVH. METHODS: A total of 50 patients with HD were classified in three groups according to whether their LV mass index (LVMI) was higher than (n = 15), equal to (n = 20), or lower than (n = 15) that predicted by a formula based on their ambulatory blood pressure monitoring (ABPM). RESULTS: Subjects with higher LVMI than predicted had significantly greater inter-HD weight gain (3.4 +/- 0.8 v 2.7 +/- 0.8 and 2.6 +/- 05 kg, respectively, in the other two groups, P < .05), and subjects with lower LVMI than predicted had a tendency toward a more pronounced nocturnal dipping pattern of BP (P = .07 v the other two groups), although daytime and night-time average BP levels did not differ between groups. All other clinical and laboratory parameters were similar among the three groups except higher cardiac output and various indices of LVH, which were more pronounced in the group with higher LVMI by ABPM. This group had also the lowest survival rate over the 2 to 3 years of follow-up, with five deaths versus two in each of the other two groups. CONCLUSIONS: The data suggest that correct management of inter-HD weight gain by nutritional counseling and shorter inter-HD intervals may prevent LVH and improve survival independently of BP control.

The silent period in patients with chronic renal failure undergoing hemodialysis.

Silent period was evaluated in 20 adult male patients with chronic renal failure undergoing hemodialysis. Readings were obtained by supramaximal stimulus to the median nerve, during maximum isometric effort of the abductor pollicis brevis muscle against resistance. Two types of abnormalities were observed, motor neuron hypoexcitability with elongated silent period, and motor neuron hyperexcitability with reduction or absence of silent period. Some abnormalities are probably linked with dialysis duration, but show no correlation to presence or absence of peripheral neuropathy. The silent period alterations described in this study could possibly correlate with some other clinical feature frequently seen in patients with chronic renal failure such as hypereflexia of the deep tendon reflexes.

Reducing overtriage without compromising outcomes in trauma patients.

HYPOTHESIS: Changing category 1 criteria to include primarily physiologic and anatomic indicators of injury, eliminating mechanism of injury criteria, decreases the rate of overtriage without compromising outcomes. METHODS: Retrospective review of our American College of Surgeons-verified level I trauma registry from January 1, 1996, to December 31, 1998, comparing patients before and after trauma alert criteria changes. RESULTS: There was a significant decrease in category 1 alerts, representing a reduction in overtriage. There was a concomitant increase in injury severity and mortality in category 1 patients. There was no significant change in injury severity or mortality for category 2 patients. CONCLUSIONS: There was a significant reduction in overtriage of trauma patients demonstrated without an appreciable impact on patient outcome. Changing trauma response criteria to more physiologic and anatomic indicators allowed improved triage of trauma patients, which improves resource allocation.

Acute cellulitis: an unusual manifestation of meningococcal disease.

We describe 2 patients who both developed cellulitis due to Neisseria meningitidis and review 8 other cases reported since 1966. Female patients outnumbered male patients by 8 to 2, and there were 5 children and 5 adults. Four cases were caused by the serogroup C meningococcus, 2 cases by serogroup B and 2 others by serogroup Y (the nature of the meningococcal group was not available in 2 cases). Diverse medical underlying conditions were present in 4 of the adult patients. The periorbital region (in all 5 children), limb (in 3 adults), neck (in 1 adult) and face and neck (in 1 adult) were the locations of the meningococcal cellulitis. In all 10 patients, a favorable clinical response to the antibiotic therapy was documented and no relapses occurred. These cases indicate that N. meningitidis should be considered as a causative agent of cellulitis in the appropriate clinical setting, particularly in children with signs of periorbital infection or adults with underlying diseases.

Focused abdominal sonography for trauma (FAST) in children with blunt abdominal trauma.

BACKGROUND: Focused abdominal sonography for trauma (FAST) has been well reported in adults, but its applicability in children is less well established. We decided to test the hypothesis that FAST and computed tomography (CT) are equivalent imaging studies in the setting of pediatric blunt abdominal trauma. METHODS: One hundred seven hemodynamically stable children undergoing CT for blunt abdominal trauma were prospectively investigated using FAST. The ability of FAST to predict injury by detecting free intraperitoneal fluid was compared with CT as the imaging standard. RESULTS: Thirty-two patients had CT documented injuries. There were no late injuries missed by CT. FAST detected free fluid in 12 patients. Ten patients had solid organ injury but no free fluid and, thus, were not detected by FAST. The sensitivity of FAST relative to CT was only 0.55 and the negative predictive value was only 0.50. CONCLUSION: FAST has insufficient sensitivity and negative predictive value to be used as a screening imaging test in hemodynamically stable children with blunt abdominal trauma.

Survival of critically ill surgical patients discharged to extended care facilities.

BACKGROUND: Rates of discharge of surgical ICU (SICU) patients to extended care facilities (ECF) increase as SICU length of stay (LOS) increases. Increased SICU LOS and APACHE II scores have been related to increased hospital mortality. This study evaluated factors influencing ECF survival after SICU patient discharge. STUDY DESIGN: We did a longitudinal followup study of patients admitted to our tertiary care SICU during a 2-year period who were eventually discharged to ECF Demographic data, SICU admission APACHE II score, and LOS data were obtained prospectively. Patient followup was obtained 2 years after discharge by telephone interviews with patients themselves or next of kin to ascertain current status or date of demise. RESULTS: Of 1,799 SICU patients admitted during the study period, 160 patients (9%) were discharged to an ECF Telephone followup was obtained from 150 patients (94%). Mean length of followup was 21 months after hospital discharge (range 7 to 34 months), mean patient age 64 years (range 16 to 96 years), mean SICU admission APACHE II score 13 (range 2 to 29), and mean SICU LOS 11 days (range 1 to 146 days). At followup, 45% of patients had died, 37% had been discharged home, and 18% still resided in an ECF or hospital. Elderly patients (above age 65) had significantly worse 1-year (p < 0.001) and 2-year (p < 0.001) ECF survival than nonelderly patients. Patients admitted to the SICU after otolaryngologic procedures also had significantly worse 1- and 2-year ECF survival than all other patients. Severity of illness as estimated by admission APACHE II scores or SICU LOS does not seem to influence survival. CONCLUSIONS: Outcomes of ECF discharge after SICU admission is poor, with nearly 50% 2-year mortality. ECF mortality seems significantly higher for the elderly, with patients undergoing otolaryngologic procedures being at highest risk. Severity of illness at the time of SICU admission and SICU LOS does not seem to influence ECF outcomes.