External carotid artery to ophthalmic artery flow associated with internal carotid artery stenosis.

PURPOSE: One of the most devastating complications of facial filler injection is sudden ischemic blindness. However, its mechanisms and predisposing factors are poorly understood. The purpose of this study was to investigate the prevalence of external carotid artery (ECA) to ophthalmic artery (OA) anterograde flow in patients with internal carotid artery (ICA) stenosis and in a control population without carotid disease. METHODS: In this cross-sectional cohort study, two groups of patients who underwent catheter cerebral angiography over a 5-year period were identified: patients with symptomatic ICA stenosis and a control group of patients with refractory epistaxis undergoing embolization. Angiograms were reviewed by an interventional neuroradiologist. The primary outcome measure was the presence of ECA to OA flow, defined as choroidal blush before filling of the circle of Willis. Secondary outcome measures included the percentage and location of ICA stenosis and ECA anastomotic branches involved. RESULTS: The study included 149 patients with ICA stenosis and 69 control patients. ECA to OA flow was more prevalent in patients with ICA stenosis (34.9%) compared to controls (2.9%) (p < .001). Logistic regression demonstrated that for each 10% increase in ICA stenosis over 70%, there was 2.8 times increased risk of ECA to OA flow (p < .001). CONCLUSIONS: ECA to ICA anterograde flow can be demonstrated in approximately 3% of control patients and in over 1/3 of patients with symptomatic carotid stenosis. This provides a plausible pathway for small filler particles to pass with blood flow from the facial to the ophthalmic circulation.

Abnormalities in subsets of B and T cells in Mexican patients with inborn errors of propionate metabolism: observations from a single-center case series.

BACKGROUND: Propionate inborn errors of metabolism (PIEM), including propionic (PA) and methylmalonic (MMA) acidemias, are inherited metabolic diseases characterized by toxic accumulation of propionic, 3-hydroxypropionic, methylcitric, and methylmalonic organic acids in biological fluids, causing recurrent acute metabolic acidosis events and encephalopathy, which can lead to fatal outcomes if managed inadequately. PIEM patients can develop hematological abnormalities and immunodeficiency, either as part of the initial clinical presentation or as chronic complications. The origin and characteristics of these abnormalities have been studied poorly. Thus, the aim of the present work was to evaluate and describe lymphoid, myeloid, and erythroid cell population profiles in a group of clinically stable PIEM patients. METHODS: This was a retrospective study of 11 nonrelated Mexican PIEM patients. Clinical, biochemical, nutritional, hematological, and lymphocyte subsets were analyzed. RESULTS: Despite being considered clinically stable, 91% of patients had hematological or immunological abnormalities. The absolute lymphocyte subset counts were low in all patients but one, with CD4+ T-cell lymphopenia, being the most common one. Furthermore, of the 11 studied subjects, nine presented with a low CD4/CD8 ratio. Among the observed hematological alterations, bicytopenia was the most common (82%) one, followed by anemia (27%). CONCLUSION: Our results contribute to the landscape of immunological abnormalities observed previously in PIEM patients; these abnormalities can become a life-threatening chronic complications because of the increased risk of opportunistic diseases. These findings allow us to propose the inclusion of monitoring immune biomarkers, such as subsets of lymphocytes in the follow up of PIEM patients.

Coronary heart disease mortality is decreasing in Argentina, and Colombia, but keeps increasing in Mexico: a time trend study.

BACKGROUND: Mortality rates due to coronary heart disease (CHD) have decreased in most countries, but increased in low and middle-income countries. Few studies have analyzed the trends of coronary heart disease mortality in Latin America, specifically the trends in young-adults and the effect of correcting these comparisons for nonspecific causes of death (garbage codes). The objective of this study was to describe and compare standardized, age-specific, and garbage-code corrected mortality trends for coronary heart disease from 1985 to 2015 in Argentina, Colombia, and Mexico. METHODS: Deaths from coronary heart disease were grouped by country, year of registration, sex, and 10-year age bands to calculate age-adjusted and age and sex-specific rates for adults aged ≥25. We corrected for garbage-codes using the methodology proposed by the Global Burden of Disease. Finally, we fitted Joinpoint regression models. RESULTS: In 1985, age-standardized mortality rates per 100,000 population were 136.6 in Argentina, 160.6 in Colombia, and 87.51 in Mexico; by 2015 rates decreased 51% in Argentina and 6.5% in Colombia, yet increased by 61% in Mexico, where an upward trend in mortality was observed in young adults. Garbage-code corrections produced increases in mortality rates, particularly in Argentina with approximately 80 additional deaths per 100,000, 14 in Colombia and 13 in Mexico. CONCLUSIONS: Latin American countries are at different stages of the cardiovascular disease epidemic. Garbage code correction produce large changes in the mortality rates in Argentina, yet smaller in Mexico and Colombia, suggesting garbage code corrections may be needed for specific countries. While coronary heart disease (CHD) mortality is falling in Argentina, modest falls in Colombia and substantial increases in Mexico highlight the need for the region to propose and implement population-wide prevention policies.

[Dental caries and early childhood development: a pilot study]. / Caries dental y desarrollo infantil temprano. Estudio piloto.

OBJECTIVE: To investigate the association between dental caries and early childhood development in 3-year-olds from Talca, Chile. METHOD: A pilot study with a convenience sample of 3-year-olds from Talca (n = 39) who attend public healthcare centers. Child development was measured by the Psychomotor Development Index (PDI), a screening tool used nationally among pre-school children to assess language development, fine motor skills and coordination areas. Dental caries prevalence was evaluated by decayed, missing, filled teeth (DFMT) and decayed, missing, filled tooth surfaces (DFMS) ceo-d and ceo-s indexes. The children were divided into two groups according to the PDIscore: those with a score of 40 or more were considered developmentally normal (n = 32), and those with a score below 40 were considered as having impaired development (n = 7). RESULTS: The severity of caries (DMFT) was negatively correlated with PDI (r = -0.82), and children with the lowest TEPSI score had the highest DFMT values. The average DMFT in children with normal development was 1.31, and 3.57 for those with impaired development. CONCLUSION: This pilot study indicates that the severity of dental caries is correlated with early childhood development.

Evaluation of particle size and feed form on performance, carcass characteristics, nutrient digestibility, and gastrointestinal tract development of broilers at 39 d of age.

The objective of this study was to evaluate combined effects of corn particle size and feed form on performance, carcass characteristics, nutrient digestibility, and gastrointestinal tract development of broilers from 1 to 39 d of age. A total of 1,800 days old, male Cobb 500 broilers were randomly assigned to 9 dietary treatments with 8 replicate pens (25 birds/pen). The experiment consisted of a factorial arrangement of 3 corn particle sizes (750, 1,150, and 1,550 µm) and 3 feed forms (mash, 3- and 4-mm pellets) provided from 1 to 39 d. Titanium dioxide (TiO2) was added as an indigestible marker (0.5%) during the finisher phase (27-39 d) to determine nutrient digestibility. Feed intake (FI), body weight (BW), and feed conversion ratio (FCR) were determined at 17, 27, and 39 d of age, with FCR adjusted for mortality. On d 40, 10 birds/pen were randomly selected and processed for meat yield determination. Data were analyzed as a 3×3 factorial (particle size x feed form) arrangement of treatments. Broilers fed 3- and 4-mm pellets had increased (P < 0.05) BW, FI, and lower FCR than broilers fed mash diets at 39 d of age. At 39 d of age, broilers fed diets with 750 µm corn particle size had heavier (P < 0.05) BW and increased FI than broilers fed diets with corn particle sizes of 1,150 and 1,550 µm. At 39 d of age FCR was unaffected by corn particle size. Heavier (P < 0.05) carcass and breast weights were observed for broilers fed 3-mm pellets. Broilers fed diets with corn particle size of 750 µm had heavier (P < 0.05) carcass and breast weight than broilers fed diets with 1,550 µm. Digestibility of nutrients was higher (P < 0.05) in pelleted diets, particularly when corn particle size was increased from 750 to 1,550 µm. Breast myopathies such as wooden breast (WB) and spaghetti meat (SM), were greater (P < 0.05) in broilers fed 3-mm pellets compared to mash diets. In conclusion, broilers fed 3- and 4-mm pelleted diets had greater nutrient digestibility and improved broiler performance compared to broilers fed mash diets.

Evaluation of carryover effects of dietary lysine intake by Cobb 500 broiler breeder hens.

Two experiments were conducted to examine the progeny performance of broiler breeder (BB) hens fed diets differing in digestible lysine (dLys). A total of 240 Cobb 500 BB pullets and 40 cockerels, 20 wk of age, were used for each of 2 experiments. In experiment 1, treatment diets were fed from 35 to 45 wk of age. Treatment 1 and 2 diets were formulated with common feed ingredients and BB had dLys daily intakes of 1,200 (IDL-1,200) and 1,010 mg/hen per d (ID-1,010), respectively. Treatments 3 and 4 were composed of semipurified diets formulated to dLys intakes of 1,010 (SPL-1,010) and 600 mg/hen per d (SP-600), respectively. In experiment 1, chick weight at hatch was lower (P < 0.05) for those that came from the SP-600 and SPL-1,010-fed hens, but 42 and 56 d BW was similar for all treatments. Improvements (P < 0.10) in feed conversion ratio were seen at 42 and 56 d for chicks from ID-1,010-fed hens compared with IDL-1,200 hens. For experiment 2, diets were fed to BB hens from 24 to 42 wk of age. Treatment 1 was composed of corn-soybean meal and formulated to a dLys intake of 1,000 mg/hen per d (CS-1,000). Treatments 2, 3, and 4 had inclusion of 25% distillers dried grains with solubles (DDGS) with dLys intake levels of 1,000 (DDGS-1,000), 800 (DDGS-800), and 600 (DDGS-600) mg/hen per d, respectively. Progeny performance was evaluated from eggs collected at wk 26, 31, and 36. Chick hatch weight was similar for all 3 hatches. Chicks from 26-wk-old BB hens and fed DDGS-600 diets resulted in lower (P < 0.05) BW, carcass weight, and breast weight, and higher (P < 0.05) back half (drumsticks and thighs) yield, at 42 d of age. Growout studies performed on eggs laid during wk 31 and 36 revealed no effect on growth or carcass parameters. In conclusion, the results from experiments 1 and 2 may not be comparable, and therefore, the impact on progeny performance needs to be further evaluated.

Study of the senescence of rice leaves through stationary and time-resolved photoluminescence.

This work describes the relationship between the complex of photosystem I and photosystem II in the senescence process of rice leaves observed through changes in the optical response. We studied three varieties of rice plants at different aging times using time-resolved photoluminescence to measure the time decay of the emission, and stationary photoluminescence, to measure the emission wavelength. The spectra obtained with the former technique were fitted with decreasing exponential functions. Two relaxation times were obtained, one ranging between 1.0 and 1.7 ns, and the other, from 5.0 to 10.5 ns. They are associated with the electron's deexcitation of PSI and PSII, respectively, and these decay times increase as the leaf senescence process takes place. The spectra obtained with stationary photoluminescence were fitted with Voigt functions. These spectra exhibit two main peaks around 683 and 730 nm, which could be associated mainly with PSII and PSI emissions, respectively. The PSI de-excitation exhibits higher dispersive processes because chlorophyll-a molecules in it move away from each other, decreasing their concentration. Therefore, it takes longer for electrons to recombine during photosynthesis, as seen in the time-resolve response. Articulating the results of both photoluminescence techniques, the changes in the response of the photosystems of the living rice leaves during senescence are evidenced.

How common is extra-articular knee deformity? How to achieve a ''safe zone'' alignment total knee arthroplasty in patients with extra-articular deformity.

The need for total knee arthroplasty is increasing considerably and one of the goals is to achieve post-surgical coronal alignment. Robotic surgical assistance achieves a functional alignment, which is a hip-knee-ankle angle of 0°. However, it is not possible to provide robotic assisted surgery to all our patients so we must include the full-length hip-to-ankle AP weight-bearing radiograph in preoperative planning to obtain a "safe zone" alignment, which is a post-surgical hip-knee-ankle Angle of 0 ± 3°. How can we achieve a "safe zone" alignment total knee arthroplasty in patients with extra-articular deformity?

La necesidad de artroplastia total de rodilla está aumentando considerablemente y uno de los objetivos es lograr la alineación coronal postquirúrgica. La asistencia quirúrgica robótica consigue una alineación funcional, que es un ángulo cadera-rodilla-tobillo de 0°. Sin embargo, no es posible ofrecer cirugía asistida por robot a todos nuestros pacientes, por lo que debemos incluir la radiografía AP de soporte de peso de cadera a tobillo de cuerpo entero en la planificación preoperatoria para obtener una alineación de "zona segura", que es un ángulo postquirúrgico cadera-rodilla-tobillo de 0 ± 3°. ¿Cómo podemos conseguir una artroplastia total de rodilla con alineación de "zona segura" en pacientes con deformidad extraarticular?

Factors influencing combined exposure to three indicator polychlorinated biphenyls in an adult cohort from Bolivia.

Polychlorinated biphenyls are persistent organic pollutants that have been used for decades in several industrial applications. Although production of polychlorinated biphenyls was restricted from the 1970s in most countries, substantial amounts remain in old equipment and buildings and they have been detected in various environmental and biological matrices. The main objective of this study was to analyze predictors of the combined exposure to three non-dioxin-like polychlorinated biphenyls (congeners 138, 153 and 180) in serum and adipose tissue from an adult cohort (n=112) living in the city of Santa Cruz de la Sierra (Bolivia) and surrounding towns/villages. A second aim was to identify modifiers that might influence the statistical associations found, using crude, partially-adjusted, and global multiple linear regression models. Main predictors of serum concentrations were occupation and fatty food consumption, while those for adipose tissue concentrations included age, smoking habit, fatty food consumption, and residence. The differences between the two matrices might be derived from their biological meaning, given that adipose tissue concentrations are an indicator of chronic exposure to polychlorinated biphenyls while serum levels are a good predictor of ongoing exposure and the mobilization of polychlorinated biphenyls stored in fatty tissues. Body mass index was found to be an important modifier of these associations.

Dietary influence of digestible lysine concentration on Cobb 500 hen broiler breeder reproductive performance.

A study was conducted to examine the reproductive parameters of Cobb 500 broiler breeder hens fed 2 different types of diets varying in digestible lysine concentration. In total, 240 Cobb 500 broiler breeder pullets were placed in individual cages and given experimental diets from 35 to 45 wk of age. Treatments 1 and 2 were diets formulated using only commercially available feed ingredients and consisted of digestible lysine intakes of 1,200 (IDL) and 1,010 mg/hen per day (ID). Treatments 3 and 4 consisted of semipurified diets with the inclusion of l-glutamic acid to maintain isonitrogenous conditions with digestible lysine intakes of 1,010 (SPL) and 600 mg/hen per day (SP). Hens fed the SPL and SP diets had lower hen-day egg production than hens fed the ID diet, with hens receiving the IDL diet yielding intermediate values. Hens fed the SP diet had the lowest (P < 0.05) egg weight, but no differences were observed among dietary treatments for egg specific gravity. Fertility and hatchability of eggs set were lowest (P < 0.05) for hens fed the SPL dietary treatment. No differences were observed for early and middle embryonic mortality, contaminated, or pipped eggs. Late embryonic mortality was observed to be higher (P < 0.05) in hens fed the SP diet. A decrease in the daily intake of digestible lysine appeared to improve broiler breeder reproductive performance when hens were fed a semipurified diet. In contrast, the same effect was not observed when hens were fed a standard industry-type diet that contained less lysine.

Genotypic spectrum underlying tetrahydrobiopterin metabolism defects: Experience in a single Mexican reference center.

Background: Pterin profiles or molecular analyses of hyperphenylalaninemia (HPA) caused by phenylalanine hydroxylase (PAH) deficiency or tetrahydrobiopterin deficiency (BH4D) are not always available in low- or middle-income countries, including Mexico, limiting information regarding the phenotypic and genotypic characteristics of patients exhibiting BH4D. Objective: To report the genotypes underlying BH4D and the clinical presentation in unrelated Mexican HPA pediatric patients with normal PAH genotypes who attended a single metabolic reference center in Mexico. Methods: Automated Sanger sequencing of the PTS, QDPR, and PCBD1 genes of 14 HPA patients was performed. Predicted effects on protein structure caused by missense variants were assessed by in silico protein modeling. Results and discussion: A high prevalence of BH4D was noted in our HPA cohort (9.8%, N = 14/142). Clinically relevant biallelic genotypes were identified in the PTS (N = 7/14 patients), QDPR (N = 6/14 patients), and PCBD1 (N = 1/14 patients) genes. Four novel QDPR variants [c.714dup or p.(Leu239Thrfs*44), c.106-1G>T or p.(?), c.214G>T or p.(Gly72*), and c.187_189dup or p.(Gln63dup)] were identified. In silico protein modeling of six missense variants of PTS [p.(Thr67Met), p.(Glu81Ala), and p.(Tyr113Cys)], QDPR [p.(Cys161Phe) and p.(Pro172Leu)], and PCBD1 [p.(Glu97Lys)] supports their pathogenicity. Progressive neurological symptoms (mainly intellectual and motor impairment and even death in three patients) were noted in all patients with biallelic QDPR genotypes and in 5/7 patients bearing biallelic PTS genotypes. The single homozygous PCBD1 p.(Glu97Lys) patient remains asymptomatic. Conclusion: A higher proportion of BH4D (9.8 vs. 1%-2% worldwide), attributable to a heterogeneous mutational spectrum and wide clinical presentation, was noted in our Mexican HPA cohort, with the PTS-related HPA disorder being the most frequent. Sequencing-based assays could be a reliable approach for diagnosing BH4D in our population.

Evaluation of limit feeding varying levels of distillers dried grains with solubles in non-feed-withdrawal molt programs for laying hens.

An experiment was conducted with 672 Hy-Line W-36 Single Comb White Leghorn hens (69 wk of age) to evaluate the effects of feeding varying levels of corn distillers dried grains with solubles (DDGS) with corn, wheat middlings, and soybean hulls on long-term laying hen postmolt performance. The control molt treatment consisted of a 47% corn:47% soybean hulls (C:SH) diet fed ad libitum for 28 d. Hens fed the other 7 treatments were limit fed 65 g/hen per day for 16 d, and then fed 55 g/hen per day for 12 d. Hens on treatments 2 and 3 were fed 49% C:35% wheat middlings (WM) or SH:10% DDGS diets (C:WM:10DDGS, C:SH:10DDGS). Hens on treatments 4 and 5 were fed 49% C:25% WM or SH:20% DDGS diets (C:WM:20DDGS, C:SH:20DDGS). Those on treatments 6 and 7 were fed 47% C:47% DDGS (C:DDGS) or 47% WM:47% DDGS (WM:DDGS) diets. Those on treatment 8 were fed a 94% DDGS diet. At 28 d, all hens were fed a corn-soybean meal layer diet (16% CP) and production performance was measured for 36 wk. None of the hens fed the molt diets went completely out of production, and only the C:SH and C:SH:10DDGS molt diets decreased hen-day egg production to below 5% by wk 4 of the molt period. Postmolt egg production was lowest (P < 0.05) for the C:WM:20DDGS treatment. No differences (P > 0.05) in egg weights were detected among treatments throughout the postmolt period. In addition, no consistent differences were observed among treatments for egg mass throughout the postmolt period. Overall results of this study indicated that limit feeding diets containing DDGS at levels of 65 or 55 g/hen per day during the molt period did not cause hens to totally cease egg production.

Evaluation of limit feeding corn and distillers dried grains with solubles in non-feed-withdrawal molt programs for laying hens.

An experiment was conducted using 504 Hy-Line W-36 Single Comb White Leghorn hens (69 wk of age) randomly assigned to 1 of 7 treatments. These treatments consisted of a 47% corn:47% soy hulls diet (C:SH) fed ad libitum; a 94% corn diet fed at a rate of 36.3, 45.4, or 54.5 g/hen per day (CORN 36, CORN 45, and CORN 54, respectively); and a 94% corn distillers dried grains with solubles (DDGS) diet fed at the same rates as the previous corn diets (DDGS 36, DDGS 45, and DDGS 54, respectively) during the molt period of 28 d. The intent was to feed the DDGS diets for 28 d; however, all hens on these diets had very low feed intakes and greater than anticipated BW loss. Thus, they were switched to a 16% CP corn-soybean meal layer diet on d 19 of the molt period. At d 28, hens on all treatments were fed the same corn-soybean meal layer diet for 39 wk (73 to 112 wk of age). All DDGS diets and the CORN 36 diet resulted in total cessation of egg production during the molt period and egg production of hens fed the CORN 45, CORN 54, and C:SH diets had decreased to 3 and 4%, respectively, by d 28. Body weight loss during the 28-d molt period ranged from 14% for the CORN 54 diet to approximately 23% for the 3 DDGS diets. Postmolt egg production (5 to 43 wk) was higher for hens fed the DDGS molt diets than those fed the corn diets. There were no consistent differences in egg mass, egg-specific gravity, feed efficiency, or layer feed consumption among molt treatments for the postmolt period. These results indicate that limit feeding corn diet and DDGS diet in non-feed-withdrawal molt programs will yield long-term postmolt performance that is comparable to that observed by ad libitum feeding a C:SH diet.

Evaluation of the nutritional equivalency of soybean meal with the genetically modified trait DP-3O5423-1 when fed to laying hens.

An experiment using 336 Hy-Line W-36 Single Comb White Leghorn hens was conducted to evaluate transgenic soybeans containing the gm-fad2-1 gene fragment and the gm-hra gene. Transcription of the gm-fad2-1 gene fragment results in an increased level of oleic acid (18:1) in the seed, and expression of the soybean acetolactate synthase protein (GM-HRA) encoded by the modified gm-hra gene, is used as a selectable marker during transformation. Pullets (20 wk of age) were placed in cage lots (7 hens/cage, 2 cages/lot) and were randomly assigned to 1 of 4 corn-soybean meal dietary treatments (6 lots/treatment) formulated with the following soybean meals: nontransgenic near-isoline control (control), nontransgenic commercial reference soybean meal A (92M72), nontransgenic commercial reference soybean meal B (93B15), or transgenic soybean meal produced from soybeans containing event DP-3Ø5423-1 (305423). Weeks 20 to 24 were a preconditioning period, and the 4 experimental diets were then fed from 25 to 36 wk of age. Differences between the 305423 and control group means were evaluated, with statistical significance at P < 0.05. Body weight, hen-day egg production, egg mass, feed consumption, and feed efficiency for hens fed the 305423 soybean meal were not significantly different from the respective values for hens fed diets formulated with the near-isoline soybean meal. Likewise, egg component weights, Haugh unit measures, and egg weights were similar regardless of the soybean meal source. This research indicates that performance of hens fed diets containing 305423 soybean meal, as measured by egg production and egg quality, was similar to that of hens fed diets formulated with the near-isoline control and commercial soybean meals.

IMMPACT-recommended outcome measures and tools of assessment in burning mouth syndrome RCTs: an international Delphi survey protocol.

BACKGROUND: A core outcome set (COS) represents the agreed minimum set of domains and measurement instruments that should be measured and reported in any clinical trial for a given condition. In BMS randomized controlled trials (RCTs), the outcomes identified in the existing literature regarding the efficacy of therapeutic interventions are numerous and diverse. Although the standardized IMMPACT core outcome domains has been developed for measurement of outcomes in chronic pain RCTs, no BMS-specific COS have been adopted and validated. With the evolving landscape of BMS management end points and the development of new therapies, a consensus on a COS for use in future BMS trials is paramount to reduce heterogeneity in outcome reporting. The aim of this study was to reach a consensus for adopting the standardized Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) outcome domains, and their tools of assessment, for burning mouth syndrome (BMS) clinical trials and clinical practice. METHODS: A BMS-specific COS will be developed using the method recommended by the Core Outcome Measures in Effective Trials (COMET) initiative (Registration: http://www.comet-initiative.org/studies/details/1357 ). Selection of questionnaire outcome measures was informed by the IMMPACT consensus and previous systematic review of RCTs in BMS conducted by the consortium. An international group of clinicians and researchers will be invited to participate in several rounds of a Delphi survey. A consensus meeting will be held with the objective of ratifying the outcomes for inclusion in the COS. A finalized COS explanatory document will be drafted, including all outcomes and measurements as determined by the Delphi rounds and consensus meeting. DISCUSSION: A COS for the management of BMS will improve the quality of future RCTs, reduce outcome reporting heterogeneity, and facilitate more vigorous data synthesis of management interventions for systematic reviews and meta-analysis. This would ensure enhanced quality evidence for clinical management of the condition.

Intense pulsed light therapy: A promising complementary treatment for dry eye disease. / Terapia de luz pulsada intensa regulada: un tratamiento complementario prometedor para la enfermedad de ojo seco.

OBJECTIVE: To propose the Intense Pulsed Light (IPL) therapy as a helpful supplementary treatment in patients with dry eye disease. MATERIAL AND METHODS: Retrospective cross sectional design. Medical records of patients in whom dry eye disease symptoms were not satisfactorily controlled with medical therapy alone and who underwent additional IPL with at least three sessions completed. Data were analyzed before therapy and 3weeks after its completion to asses improvement. Determination of symptoms, through a visual analog scale; tear film stability, through tear Break Up Time (tBUT); measurement of tear secretion, through Schirmer Test; and ocular surface staining with Van Bijsterveld score were evaluated. SPSS software and nonparametric analysis of repeated measures were used. The study was approved by the ethics committee. RESULTS: 50 eyes from 25 subjects were reviewed. There were 9 males (36%) and 16 females (64%), with a median age of 59years (IQR 52-64). The median of the symptoms scale was 8 (IQR 8-9) and 3 (IQR 2-4) before and after the therapy respectively (P<.05). The median of BUT was 4 (IQR 3-5) and 10 (IQR 8-11), Schirmer test was 13 (IQR 12-15) and 15 (IQR 13-20), and Van Bijsterveld score was 3 (RIC 3-4) and 2 (IQR 2-3) before and after the therapy respectively (P<.05, for all measurements). CONCLUSION: IPL treatment has excellent results regarding both: dry eye disease symptoms improvement and in office objective tests such as tBUT, Schirmer test and Van Bijsterveld score; IPL could be considered as an effective adjunct for dry eye disease.

Descriptive observational study on early functional recovery and postoperative pain in knee joint replacement surgery. / Estudio observacional descriptivo sobre recuperación funcional temprana y dolor postoperatorio en cirugía de reemplazo articular de rodilla.

INTRODUCTION: The management of postoperative pain in joint replacement surgery represents a challenge. Therefore, the advent of new strategies in the management of pain such as local infiltration analgesia (LIA) and the adductor canal block, allowed an adequate postoperative pain control and early rehabilitation of the patient in total knee arthroplasty. MATERIALS AND METHODS: A descriptive, observational and longitudinal study of a prospective cohort of patients operated by the group of joint replacements between September 29, 2017 and November 30, 2017 was conducted. They were evaluated with the analog pain scale for postoperative pain at 5 different times (1:Upon leaving recovery; 2:On the first postoperative day; 3:Before initiating in-hospital physical therapy; 4:At the end of physical therapy, and 5:Upon departure from the clinic). RESULTS: Of the 141 patients operated on, 70.9% of the patients were managed with LIA and 29.1% with adductor canal block. There were no differences between groups in postoperative pain assessment during the 5 different times (P≥.45). DISCUSSION: Our results indicate that LIA and the adductor canal blockade demonstrated the same efficacy for the control of postoperative pain and rehabilitation.

Leaf-inhabiting genera of the Gnomoniaceae, Diaporthales.

The Gnomoniaceae are characterised by ascomata that are generally immersed, solitary, without a stroma, or aggregated with a rudimentary stroma, in herbaceous plant material especially in leaves, twigs or stems, but also in bark or wood. The ascomata are black, soft-textured, thin-walled, and pseudoparenchymatous with one or more central or eccentric necks. The asci usually have a distinct apical ring. The Gnomoniaceae includes species having ascospores that are small, mostly less than 25 mum long, although some are longer, and range in septation from non-septate to one-septate, rarely multi-septate. Molecular studies of the Gnomoniaceae suggest that the traditional classification of genera based on characteristics of the ascomata such as position of the neck and ascospores such as septation have resulted in genera that are not monophyletic. In this paper the concepts of the leaf-inhabiting genera in the Gnomoniaceae are reevaluated using multiple genes, specifically nrLSU, translation elongation factor 1-alpha (tef1-alpha), and RNA polymerase II second largest subunit (rpb2) for 64 isolates. ITS sequences were generated for 322 isolates. Six genera of leaf-inhabiting Gnomoniaceae are defined based on placement of their type species within the multigene phylogeny. The new monotypic genus Ambarignomonia is established for an unusual species, A. petiolorum. A key to 59 species of leaf-inhabiting Gnomoniaceae is presented and 22 species of Gnomoniaceae are described and illustrated.

Reacciones adversas a betalactámicos: una revisión de tema / Adverse reactions to beta-lactams: a topic review / Reações adversas a beta-lactâmicos: uma revisão de tópico

Las reacciones adversas a medicamentos son una de las principales causas de muerte en el mundo, producen muchos ingresos hospitalarios y aumentan los costos de atención. Dentro de los medicamentos que más se asocian con estas reacciones están los antibióticos y de estos los más comunes son los betalactámicos, ampliamente utilizados en las instituciones de salud. Las manifestaciones más frecuentes de las reacciones adversas a betalactámicos son alérgicas, dermatológicas, gastrointestinales, renales, hepáticas y neurológicas. Se realiza una revisión general de las reacciones adversas de estos medicamentos, se mencionan los distintos antibióticos betalactámicos con su clasificación y espectro de acción y más precisamente se explican las distintas reacciones adversas por uso de betalactámicos según el sistema comprometido.

Adverse drug reactions are one of the leading causes of death in the world. They are also responsible for an increase in hospital admissions and higher care costs. Among the most associated drugs with these reactions are antibiotics and of these the most common are beta-lactams, which are widely used in health institutions. The most fre-quent manifestations of adverse reactions to beta-lactams are allergic, dermatological, gastrointestinal, renal, hepatic and neurological reactions. A general review of the adverse reactions to these drugs is carried out. Also, the different beta-lactam antibiotics are described along with their classification and spectrum of action, and an accurate explanation of the different adverse reactions due to the use of beta-lactams according to the compromised system is made.

As reações adversas a medicamentos são uma das principais causas de morte no mundo, resultam em muitas admissões hospitalares e aumentam os custos do atendimento. Entre os medicamentos que mais se associam a essas reações estão os antibióticos e, destes, os mais comuns são os beta-lactâmicos, amplamente utilizados em instituições de saúde. As manifestações mais frequentes de reações adversas aos beta-lactâmicos são alérgicas, dermatológicas, gastrointestinais, renais, hepáticas e neurológicas. Faz-se uma revisão geral das reações adversas desses medicamentos, são mencionados os diferentes antibióticos beta-lactâmicos com sua classificação e espectro de ação, e mais precisamente explicam as diferentes reações adversas devidas ao uso de beta-lactâmicos de acordo com o sistema comprometido

Determination of vitamin A in blood. Some practical considerations on the time of collection of the specimens and the stability of the vitamin.

The stability of vitamin A and retinol-binding protein (RBP) in serum separated from the clot at different times after blood extraction and the effect of ingesting a vitamin A-rich breakfast on postprandial serum levels of retinol, carotenoids, and RBP were investigated. In the stability trials, venous blood was drawn from 12 well-nourished young adult subjects and sample aliquots were maintained, respectively, at 4 degree C or at room temperature (26 to 28 degrees C). The serum was separated from the clot either immediately after blood clotting or at 2, 4, 6, 12, and 24 h after blood extraction. Serum retinol and RBP were stable either at 4 degrees C or at room temperature, even if the serum was separated from the clot 24 h after blood extraction. In the breakfast experiment, seven young adult subjects ingested a meal containing 291 microgram of retinol equivalents. The serum levels of retinol, carotenoids, and RBP were measured pre- and postprandially up to a period of 4 h. The ingestion of the breakfast meal did not alter significantly the postprandial serum levels of retinol, carotenoids, or RBP. These results are of practical importance for the performance of vitamin A nutrition surveys involving field work, when as is common, blood specimens cannot be collected under fasting and, in addition, they have to be transported from far away localities to the laboratory.