Applications of Infrared Thermography in Ophthalmology.

Body temperature is one of the key vital signs for determining a disease's severity, as it reflects the thermal energy generated by an individual's metabolism. Since the first study on the relationship between body temperature and diseases by Carl Reinhold August Wunderlich at the end of the 19th century, various forms of thermometers have been developed to measure body temperature. Traditionally, methods for measuring temperature can be invasive, semi-invasive, and non-invasive. In recent years, great technological advances have reduced the cost of thermographic cameras, which allowed extending their use. Thermal cameras capture the infrared radiation of the electromagnetic spectrum and process the images to represent the temperature of the object under study through a range of colors, where each color and its hue indicate a previously established temperature. Currently, cameras have a sensitivity that allows them to detect changes in temperature as small as 0.01 °C. Along with its use in other areas of medicine, thermography has been used at the ocular level for more than 50 years. In healthy subjects, the literature reports that the average corneal temperature ranges from 32.9 to 36 °C. One of the possible sources of variability in normal values is age, and other possible sources of variation are gender and external temperature. In addition to the evaluation of healthy subjects, thermography has been used to evaluate its usefulness in various eye diseases, such as Graves' orbitopathy, and tear duct obstruction for orbital diseases. The ocular surface is the most studied area. Ocular surface temperature is influenced by multiple conditions, one of the most studied being dry eye; other diseases studied include allergic conjunctivitis and pterygium as well as systemic diseases such as carotid artery stenosis. Among the corneal diseases studied are keratoconus, infectious keratitis, corneal graft rejection, the use of scleral or soft contact lenses, and the response to refractive or cataract surgery. Other diseases where thermographic features have been reported are glaucoma, diabetic retinopathy, age-related macular degeneration, retinal vascular occlusions, intraocular tumors as well as scleritis, and other inflammatory eye diseases.

Clinical outcomes of the piggyback secondary implantation of a novel multifocal lens in the ciliary sulcus: A case series.

PURPOSE: Evaluate the clinical outcomes of the secondary piggyback add-on IOL implantation in the ciliary sulcus for pseudophakic patients previously implanted with a monofocal IOL, who pursue a spectacle-free option after IOL surgery. METHODS: A prospective case series including seven pseudophakic patients who underwent an in-the-bag monofocal IOL implantation. All eyes underwent a piggyback IOL implantation of the new sulcus designed A4 AddOn IOL in the ciliary sulcus as a secondary procedure for pseudophakic patients pursuing a spectacle-free option for near and intermediate distance after IOL surgery. RESULTS: Seven eyes from six patients were included in this study, from which 4 (71.43%) were female, with a mean age of 58.33 ± 3.5 years (range 54-63; 95% CI 54.66, 62.01). The postoperative spherical equivalent at the 3-month visit was -0.10 m ± 0.82. Also, the UDVA was 0.11 ± 0.08 logMAR, the UIVA 0.01 ± 0.03, and the UNVA 0.01 ± 0.03 3 months after their surgical procedure. CONCLUSIONS: The A4 AddOn multifocal IOL's secondary piggyback implant is an efficient alternative for monofocal pseudophakic patients seeking presbyopia solutions. This sulcus-designed IOL provides an optimal visual outcome for near and distance vision.

Novel RB1 germline mutation in a healthy man.

BACKGROUND: Retinoblastoma (Rb) most frequently presents as a unilateral sporadic disease up to 40% of cases, however, arise from a monoallelic germline pathogenic variant. Only 10% of the germline mutations are inherited, and high penetrance is seen in up to 90% of these cases. As an effort to optimize counseling and screening, mutations are classified according to inheritance patterns. However, RB1 spectrum is highly heterogeneous, and information for unaffected carriers remains scarce. MATERIALS AND METHODS: The Mexican family of a 5-month-old patient diagnosed with Rb was studied. The family consisted of five individuals (father, mother, and three siblings). Genetic testing using a next-generation sequencing assay targeting RB1 with oligonucleotide baits designed to capture its exons and 20 bases flanking intronic sequences was performed in every family member. Clinical history and a complete ophthalmological examination (best-corrected visual acuity, slit-lamp biomicroscopy, macular optical coherence tomography, fundus autofluorescence, optical coherence tomography angiography, and electrophysiological studies) were performed in members testing positive to RB1 mutation. RESULTS: The father and her five-month-old daughter tested positive for a non-synonymous RB1 mutation c.459del (p.Lys154Serfs*21). The girl presented with bilateral retinoblastoma, successfully treated with cryotherapy and intravenous chemotherapy. The father had no relevant findings on imaging studies or ophthalmologic evaluation. CONCLUSIONS: This report describes a rare case of a novel low-penetrance RB1 germline mutation. Long-term follow-up of the father will include periodic evaluation of the eyes and orbits, and surveillance for systemic sarcoma and secondary malignancies. Implications for unaffected individuals need to be further studied.

Agreement between the Swept-Source Optical Coherence Tomography and the Image-Guided System for Biometry Assessment in Cataract Surgery.

PURPOSE: To assess the agreement on biometric data obtained using the Verion image-guided surgery system and the swept-source-OCT biometer IOL Master 700. MATERIALS AND METHODS: All patients underwent biometry using the SS-OCT and the Image-Guide System. The comparison between instruments was assessed using the Intraclass correlation coefficient (ICC). Level of Agreement (LoA) employing the Bland-Altman analysis. RESULTS: The image-based system produced significantly higher keratometry values, evidencing a low LoA between the SS-OCT and the image-based system, ranging from -1.30 D to 0.65 D (1.95 D), -1.04 D to 0.72 D (1.76 D), and -1.31 D to 0.65 D (1.96 D), respectively. The LoA for the Cylinder ranged from -0.46 D to 0.74 D (1.2 D) and from 0.82 to 0.94 mm for WTW. CONCLUSIONS: In our study, the SS-OCT biometer and the Image-based System evidenced statistically significant differences in measuring the main biometric parameters except for the WTW.

Análisis ortopantomográfico en la determinación de la posición recurrente de terceros molares / Orthopantomographic analysis in determining the recurrent position of third molars

Objetivo: caracterizar las posiciones recurrentes en terceros molares a través del análisis ortopantomográfico en pacientes del Centro Especializado en Odontología "Dr. Mario Cerda e Hijos" en la ciudad de Riobamba durante el periodo 2015-2018. Material y Métodos: se realizó un estudio de tipo observacional, descriptivo y de corte transversal, en el que se analizaron ortopantomografías de pacientes del entorno de investigación. Se trabajó con la totalidad de la población, constituida por de 172 radiografías, analizando la posición de 688 terceros molares, en pacientes con edades comprendidas entre 15 a 50 años. Los datos fueron recolectados a partir de la técnica de la medición, utilizando el negatoscopio y la regla milimetrada, los que fueron agrupados según las clasificaciones de Winter y de Pell y Gregory. Resultados: de 688 terceros molares analizados, el 48,1% se observó en posición vertical, seguido de la posición mesioangular con el 31,2%; clase II con 43,3%, clase I en 31,8% y clase III con 18,8%; nivel B con 35,6%, nivel C en 34,9% y nivel A con 23,4%. Conclusión: la posición vertical, la clase I y el nivel C, resultaron más frecuente en los terceros molares del maxilar; mientras que en la mandíbula fueron la posición mesioangular, la clase II y el nivel B.

Objective: to characterize the recurrent positions in third molars through the orthopantomographic analysis in patients of the Specialized Center in Dentistry "Dr. Mario Cerda e Hijos" in the city of Riobamba-Ecuador during the period 2015-2018. Material and Methods: an observational, descriptive, and cross-sectional study was carried out, in which orthopantomographies of patients were analyzed in this research. The studied population was made up of 172 radiographs, the position of 688 third molars was analyzed in patients aged between 15 to 50 years. Considering the technique, the data collected was the measurement using the negatoscope and the millimeter ruler, which were grouped according to the Winter and Pell and Gregory classifications. Results: 688 third molars were analyzed, the 48.1% was observed in vertical position, followed by the mesioangular position with 31.2%; class II with 43.3%, class I in 31.8% and class III with 18.8%; level B with 35.6%, level C with 34.9% and level A with 23.4%. Conclusion: The vertical position, class I and level C were more frequent in the maxillary third molars; while in the mandible they were the mesioangular position, class II, and level B.

Ángulos de convergencia en preparaciones dentarias realizadas en tipodontos por estudiantes de Odontología, Unach / Convergence angles in dental preparations performed on typodont by students of dentistry, UNACH

El objetivo de esta investigación fue analizar los ángulos de convergencia en preparaciones dentarias para coronas realizadas en tipodontos, por estudiantes de décimo semestre de Odontología Unach. Las preparaciones dentales para coronas poseen características de retención y resistencia, principios fundamentales que ofrecen éxito y longevidad de la corona definitiva. Varios investigadores a nivel mundial han desarrollado diversos métodos para evaluar los ángulos de convergencia de las preparaciones extracoronarias; sin embargo, en nuestro medio, no existen estudios acerca de la medición de estos ángulos. Esta investigación fue de carácter experimental, transversal y observacional, se obtuvieron 32 preparaciones dentarias para coronas de recubrimiento completo, cada estudiante tuvo 60 minutos para tallar dos preparaciones dentarias en simuladores clínicos. Los tipodontos fueron escaneados y digitalizados mediante el escáner CAD-CAM Ceramill Database versión 1.0 año 2010 del Laboratorio "BrothersDent" para producir imágenes tridimensionales. El software iTero midió los ángulos vestíbulo-lingual (VL) y mesio-distal (MD) de cada preparación. Los ángulos más pequeño y más grande observados fueron 3.1° y 102.5° para molares mandibulares. El promedio del ángulo VL para dientes anteriores fue 40,38 ±4,38° en varones y 36,97 ±3,95° en mujeres y el promedio del ángulo MD fue 44,68 ±5,51° en varones y 40,08 ±3,99° en mujeres. Para dientes posteriores el promedio VL fue 27,46 ±7,82° en varones y 40,98 ±4,63° en mujeres; y el promedio del ángulo MD fue 40,73 ±5,95° en varones y 50,62 ±7,00° en mujeres. En conclusión, los ángulos de convergencia logrados por estudiantes fueron mayores que los ideales recomendados según Shillingburg.

This research aimed to analyze the angles of convergence in dental preparations for crowns performed on typodont, by 10th semester students of school of dentistry, UNACH. Dental preparations for crowns have retention and resistance characteristics, fundamental principles that offer success and longevity of the final crown. Various researchers worldwide have developed various methods to evaluate the convergence angles of extra coronary preparations; however, in our context, there are no studies on the measurement of these angles. This research was experimental, cross-sectional and observational, 32 dental preparations were obtained for fully covered crowns, each student had 60 minutes to carve two dental preparations in clinical simulators. The typodonts were scanned and digitized using the scanner CAD-CAM Ceramill Database version 1.0 - 2010 of "BrothersDent" Laboratory in order to produce three-dimensional images. The iTero software measured the vestibule-lingual (VL) and mesio-distal (MD) angles of each preparation. The smallest and largest angles observed were 3.1 ° and 102.5 ° for mandibular molars. The mean VL angle for anterior teeth was 40.38 ± 4.38 ° in males and 36.97 ± 3.95 ° in females, and the mean MD angle was 44.68 ± 5.51 ° in males and 40, 08 ± 3.99 ° in women. For posterior teeth the average VL was 27.46 ± 7.82 ° in men and 40.98 ± 4.63 ° in women; and the mean MD angle was 40.73 ± 5.95 ° in men and 50.62 ± 7.00 ° in women. In conclusion, the convergence angles achieved by students were greater than the recommended ideals according to Shillingburg.

Clorhexidina al 0,12% y ácido acético al 5% como desinfectantes de, cepillos dentales / 0.12% Chlorhexidine and 5% Acetic Acid as disinfectants for toothbrushes

El presente estudio fue de tipo observacional comparativo; para lo cual se analizaron 40 cepillos dentales de la marca OralDent, los que fueron usados durante un mes por los integrantes de la Cooperativa de taxis "Simón Bolívar" de la ciudad de Riobamba, Ecuador; con el propósito de comparar la eficacia del ácido acético al 5% y la clorhexidina al 0,12% como desinfectantes. El análisis microbiológico arrojó la presencia de microorganismos en los cepillos dentales usados por los individuos que voluntariamente los cedieron para el estudio, tales como: C. albicans en mayor proporción, seguida de S. viridans, S. epidermidis y S. mutans, A. tubingensis, K. pneumoniae, E. coli, E. faecalis, P. vulgaris. En las muestras con concentraciones de microorganismos de 100.000 UFC/mL, una vez generado el proceso de desinfección con clorhexidina al 0,12% existió una disminución a valores menores de 20.000 UFC/mL o su eliminación completa. El ácido acético al 5% logró una asepsia en el 100% de los cepillos dentales sin importar la edad o el género del individuo que lo utilizó.

The present study was of a comparative observational type. 40 OralDent toothbrushes were analyzed for this reserach, which were used for a month by the members of the "Simón Bolívar" Taxi Cab Company in the city of Riobamba, Ecuador. It aimed to compare the efficacy of 5% acetic acid and 0.12% chlorhexidine as disinfectants. The microbiological analysis showed the presence of microorganisms in the toothbrushes used by the individuals who voluntarily gave them up for the study, for exmaple: C. albicans in a greater proportion, followed by S. viridans, S. epidermidis and S. mutans, A. tubingensis, K. pneumoniae, E. coli, E. faecalis, P. vulgaris. Once the disinfection process with 0.12% chlorhexidine was generated in the samples with microorganism concentrations of 100,000 CFU / mL, there was a decrease to values less than 20,000 CFU / mL or its complete elimination. 5% acetic acid achieved asepsis in 100% of toothbrushes regardless of the age or gender of the individual who used it.

Palmitic Acid-Induced NAD+ Depletion is Associated with the Reduced Function of SIRT1 and Increased Expression of BACE1 in Hippocampal Neurons.

Increased levels of circulating fatty acids, such as palmitic acid (PA), are associated with the development of obesity, insulin resistance, type-2 diabetes and metabolic syndrome. Furthermore, these diseases are linked to an increased risk of cancer, cardiovascular diseases, mild cognitive impairment and even Alzheimer's disease (AD). However, the precise actions of elevated PA levels on neurons and their association with neuronal metabolic disruption that leads to the expression of pathological markers of AD, such as the overproduction and accumulation of the amyloid-ß peptide, represent an area of intense investigation. A possible molecular mechanism involved in the effects of PA may be through dysfunction of the NAD+ sensor enzyme, SIRT1. Therefore, the aim of the present study was to analyze the relationship between the effects of PA metabolism on the function of SIRT1 and the upregulation of BACE1 in cultured hippocampal neurons. PA reduced the total amount of NAD+ in neurons that caused an increase in p65 K310 acetylation due to inhibition of SIRT1 activity and low protein content. Furthermore, BACE1 protein and its activity were increased, and BACE1 was relocated in neurites after PA exposure.

Reproducibility of the measurement of central corneal thickness in healthy subjects obtained with the optical low coherence reflectometry pachymeter and comparison with the ultrasonic pachymetry.

BACKGROUND: Corneal pachymetry is widely used for refractive surgery and follow up in keratoconus, accurate measurement is essential for a safe surgery. OBJECTIVE: To assess intraobserver reliability of central corneal thickness (CCT) measurements using optical low-coherence reflectometry (OLCR) technology and its agreement with ultrasonic pachymeter (US). METHOD: Randomized and prospective comparative evaluation of diagnostic technology. One randomly healthy eye of subjects was scanned three times with both devices. Intraobserver within-subject standard deviation (Sw), coefficient of variation (CVw) and intraclass correlation coefficient (ICC) were obtained for reliability analysis; for study agreement, data were analyzed using the paired-sample t test and the Bland-Altman LoA method. The mean of three scans of each equipment was used to assess the LoA. RESULTS: The study enrolled 30 eyes of 30 subjects with average age of 28.70 ± 8.06 years. For repeatability, the Sw were 3.41 and 5.96 µ, the intraobserver CVw was 2 and 4% and ICC 0.991 and 0.988, for OLCR and US respectively. The mean CCT difference between OLCR and US was 8.90 ± 9.03 µ (95% confidence interval: 5.52-2.27 µ), and the LoA was 35.40 µ. CONCLUSIONS: OLCR technology provided reliable intraobserver CCT measurements. Both pachymetry measurements may be used interchangeably with minimum calibration adjustment.

ANTECEDENTES: La paquimetría corneal es ampliamente utilizada para la cirugía refractiva y el seguimiento de pacientes con queratocono. La medición exacta es esencial para una cirugía refractiva segura. OBJETIVO: Evaluar la reproducibilidad intraobservador en la medición del grosor corneal central (GCC) utilizando reflectometría óptica de baja coherencia (OLCR) y su concordancia con la paquimetría ultrasónica. MÉTODO: Estudio prospectivo, comparativo y aleatorizado de una tecnología diagnóstica. Se midió de forma aleatorizada un ojo de cada sujeto en tres ocasiones con ambos equipos. Para el análisis de fiabilidad se obtuvieron la desviación estándar (DE) intrasujeto, el coeficiente de variación (CV) y el coeficiente de correlación intraclase (CCI). Para el estudio de concordancia se analizaron los datos usando una prueba t pareada simple, además de los límites de acuerdo de Bland-Altman (LA). Para la evaluación de los LA se utilizó el promedio de las tres mediciones de cada equipo. RESULTADOS: El estudio incluyó 30 ojos de 30 sujetos con una edad promedio de 28.70 ± 8.06 años. Para la repetibilidad, la DE intrasujeto fue de 3.41 y 5.96µ, el CV del 2 y el 4%, y el CCI de 0.991 y 0.988, para el OLCR y el paquímetro ultrasónico, respectivamente. La diferencia del GCC promedio entre el OLCR y el paquímetro ultrasónico fue de 8.90 ± 9.03µ (intervalo de confianza del 95%: 5.52-2.27µ), y el LA fue de 35.40µ. CONCLUSIONES: La tecnología de OLCR proporciona medidas del GCC intraobservador fiables. Ambas mediciones paquimétricas pueden usarse de forma intercambiable con mínimos ajustes de calibración.

Autopercepción de capacidades de autocuidado en estudiantes universitarios sobre enfermedades crónicas, sexualidad y adicciones / Self-perception of self-care skills in university students concerning chronic diseases, sexuality and addictions

Introducción: en el mundo hay aproximadamente 1800 millones de jóvenes entre los 10 y 24 años de edad, los cuales constituyen 25% del total de la población mundial. Esto genera un potencial de avance económico y social y, en consecuencia, un incremento en la incidencia de enfermedades crónicas no transmisibles (ECNT), infecciones de transmisión sexual (ITS) y adicciones. Objetivo: analizar en estudiantes universitarios de nuevo ingreso el nivel de autopercepción de capacidades de autocuidado (CAc) ante las ECNT, la salud sexual y reproductiva (SSyR) y prevención de adicciones con base en la teoría del déficit de autocuidado. Métodos: estudio analítico correlacional en una muestra por conveniencia de 2342 estudiantes de nuevo ingreso. Se utilizó un instrumento diseñado y validado en el año 2015 para identificar las CAc en ECNT, SSyR, y prevención de adicciones, con un alfa de Cronbach de 0.88. Asimismo, se hizo un análisis bivariado, con las pruebas no paramétricas U de Mann-Whitney, H de Kruskal-Wallis y ANOVA de Kruskal-Wallis. También se empleó la prueba de correlación Rho de Spearman (p < 0.05). Resultados: el nivel de autopercepción de los estudiantes en cuanto a sus CAc fue bueno (61%) ante las ECNT, la SSyR y la prevención de adicciones. Se encontró que el nivel de autopercepción de CAc es diferente entre los estudiantes de las tres divisiones académicas (p = 0.000). Conclusiones: aunque la autopercepción de las CAc en los estudiantes tiene un nivel bueno, es necesario que durante la trayectoria académica se promuevan hábitos de vida saludables.

Introduction: In the world there are approximately 1800 million young people between 10 and 24 years, which constitute 25% of total world population. This creates a potential for economic and social advance and, consequently, an increase in the incidence of chronic non- communicable diseases (CNCDs), sexually transmitted infections (STIs) and addictions. Objective: To analyze the level of self-perception of self-care skills (SCS) in new university students in the presence of CNCDs, sexual and reproductive health (SRH) and addiction prevention. Methods: Correlational analytical study in a convenience sample of 2342 new students. An instrument designed and validated in 2015 was used to identify SCSs in CNCDs, SRH, and addiction prevention, with a Cronbach's alpha of 0.88. It was performed a bivariate analysis, with non-parametric tests Mann-Whitney U, Kruskal-Wallis H, and Kruskal-Wallis ANOVA. It was used Rho Spearman's correlation test (p < 0.05) as well. Results: The level of self-perception of the students in terms of their SCSs was good (61%) in the face of CNCDs, SRH and addiction prevention. It was found that the level of self-perception of SCSs is different among the students of the three academic divisions (p = 0.000). Conclusions: Although self-perception of SCS in the students is at a good level, it is necessary the promotion of healthy habits of living during the academic career.

Spanish Registry of Recent-onset Psoriatic Arthritis (REAPSER study): Aims and methodology. / Registro Español de Artritis Psoriásica de Reciente Comienzo (estudio REAPSER). Objetivos y metodología.

AIMS: To describe the methodology of REAPSER (Spanish Registry of Recent-onset Psoriatic Arthritis), its strengths and limitations. The aim of this study is to identify prognostic factors for the clinical and radiographic course in a cohort of patients with psoriatic arthritis (PsA) diagnosed within 2years of symptom evolution. METHODS: Multicenter, observational and prospective study (with 2-year follow-up including annual visits). Baseline visit intended to reflect patient situation before the disease course was modified by treatments prescribed in rheumatology departments. Patients were invited to participate consecutively in one of their routine visits to the rheumatologist. 211 patients were included. Following data were collected: sociodemographic variables; employment situation; family history; personal history and comorbidities; anthropometric data; lifestyle; use of healthcare services; clinical situation at the time of PsA diagnosis; joint involvement and spinal pain; pain and overall assessment; enthesitis, dactylitis and uveitis; skin and nail involvement; functional situation and quality of life; radiographic evaluation; analytical determinations; treatment; axial and peripheral flare-ups. CONCLUSIONS: The REAPSER study includes a cohort of patients with recent-onset PsA, before the disease course was modified by disease-modifying antirheumatic drugs prescribed in rheumatology departments. Exhaustive information collected in each visit is expected to be an important data source for future analysis.

PI3K Signaling in Neurons: A Central Node for the Control of Multiple Functions.

Phosphoinositide 3-kinase (PI3K) signaling contributes to a variety of processes, mediating many aspects of cellular function, including nutrient uptake, anabolic reactions, cell growth, proliferation, and survival. Less is known regarding its critical role in neuronal physiology, neuronal metabolism, tissue homeostasis, and the control of gene expression in the central nervous system in healthy and diseased states. The aim of the present work is to review cumulative evidence regarding the participation of PI3K pathways in neuronal function, focusing on their role in neuronal metabolism and transcriptional regulation of genes involved in neuronal maintenance and plasticity or on the expression of pathological hallmarks associated with neurodegeneration.

Reproducibility of the measurement of central corneal thickness in healthy subjects obtained with the optical low coherence reflectometry pachymeter and comparison with the ultrasonic pachymetry. / Evaluación de la reproducibilidad en la medición del grosor corneal central con el paquímetro de reflectometría óptica de baja coherencia y comparación con el paquímetro ultrasónico en sujetos sanos

Background: Corneal pachymetry is widely used for refractive surgery and follow up in keratoconus, accurate measurement is essential for a safe surgery. Objective: To assess intraobserver reliability of central corneal thickness (CCT) measurements using optical low-coherence reflectometry (OLCR) technology and its agreement with ultrasonic pachymeter (US). Method: Randomized and prospective comparative evaluation of diagnostic technology. One randomly healthy eye of subjects was scanned three times with both devices. Intraobserver within-subject standard deviation (Sw), coefficient of variation (CVw) and intraclass correlation coefficient (ICC) were obtained for reliability analysis; for study agreement, data were analyzed using the paired-sample t test and the Bland-Altman LoA method. The mean of three scans of each equipment was used to assess the LoA. Results: The study enrolled 30 eyes of 30 subjects with average age of 28.70 ± 8.06 years. For repeatability, the Sw were 3.41 and 5.96 µ, the intraobserver CVw was 2 and 4% and ICC 0.991 and 0.988, for OLCR and US respectively. The mean CCT difference between OLCR and US was 8.90 ± 9.03 µ (95% confidence interval: 5.52-2.27 µ), and the LoA was 35.40 µ. Conclusions: OLCR technology provided reliable intraobserver CCT measurements. Both pachymetry measurements may be used interchangeably with minimum calibration adjustment.

Antecedentes: La paquimetría corneal es ampliamente utilizada para la cirugía refractiva y el seguimiento de pacientes con queratocono. La medición exacta es esencial para una cirugía refractiva segura. Objetivo: Evaluar la reproducibilidad intraobservador en la medición del grosor corneal central (GCC) utilizando reflectometría óptica de baja coherencia (OLCR) y su concordancia con la paquimetría ultrasónica. Método: Estudio prospectivo, comparativo y aleatorizado de una tecnología diagnóstica. Se midió de forma aleatorizada un ojo de cada sujeto en tres ocasiones con ambos equipos. Para el análisis de fiabilidad se obtuvieron la desviación estándar (DE) intrasujeto, el coeficiente de variación (CV) y el coeficiente de correlación intraclase (CCI). Para el estudio de concordancia se analizaron los datos usando una prueba t pareada simple, además de los límites de acuerdo de Bland-Altman (LA). Para la evaluación de los LA se utilizó el promedio de las tres mediciones de cada equipo. Resultados: El estudio incluyó 30 ojos de 30 sujetos con una edad promedio de 28.70 ± 8.06 años. Para la repetibilidad, la DE intrasujeto fue de 3.41 y 5.96 µ, el CV del 2 y el 4%, y el CCI de 0.991 y 0.988, para el OLCR y el paquímetro ultrasónico, respectivamente. La diferencia del GCC promedio entre el OLCR y el paquímetro ultrasónico fue de 8.90 ± 9.03 µ (intervalo de confianza del 95%: 5.52-2.27 µ), y el LA fue de 35.40 µ. Conclusiones: La tecnología de OLCR proporciona medidas del GCC intraobservador fiables. Ambas mediciones paquimétricas pueden usarse de forma intercambiable con mínimos ajustes de calibración.

Comparison of biometric measurements obtained by the Verion Image-Guided System versus the auto-refracto-keratometer.

PURPOSE: To compare the biometric measurements obtained from the Verion Image-Guided System to those obtained by auto-refracto-keratometer in normal eyes. METHODS: This is a prospective, observational, comparative study conducted at the Asociación para Evitar la Ceguera en México I.A.P., Mexico. Three sets of keratometry measurements were obtained using the image-guided system to assess the coefficient of variation, the within-subject standard deviation and intraclass correlation coefficient (ICC). A paired Student t test was used to assess statistical significance between the Verion and the auto-refracto-keratometer. A Pearson's correlation coefficient (r) was obtained for all measurements, and the level of agreement was verified using Bland-Altman plots. RESULTS: The right eyes of 73 patients were evaluated by each platform. The Verion coefficient of variation was 0.3% for the flat and steep keratometry, with the ICC being greater than 0.9 for all parameters measured. Paired t test showed statistically significant differences between groups (P = 0.0001). A good correlation was evidenced for keratometry values between platforms (r = 0.903, P = 0.0001 for K1, and r = 0.890, P = 0.0001). Bland-Altman plots showed a wide data spread for all variables. CONCLUSION: The image-guided system provided highly repeatable corneal power and keratometry measurements. However, significant differences were evidenced between the two platforms, and although values were highly correlated, they showed a wide data spread for all analysed variables; therefore, their interchangeable use for biometry assessment is not advisable.

Comparison of cumulative dissipated energy delivered by active-fluidic pressure control phacoemulsification system versus gravity-fluidics.

PURPOSE: To compare the cumulative dissipated energy (CDE), aspiration time and estimated aspiration fluid utilized during phacoemulsification cataract surgery using two phacoemulsification systems . METHODS: A total of 164 consecutive eyes of 164 patients undergoing cataract surgery, 82 in the active-fluidics group and 82 in the gravity-fluidics group were enrolled in this study. Cataracts graded NII to NIII using LOCS II were included. Each subject was randomly assigned to one of the two platforms with a specific configuration: the active-fluidics Centurion ® phacoemulsification system or the gravity-fluidics Infiniti ® Vision System. CDE, aspiration time (AT) and the mean estimated aspiration fluid (EAF) were registered and compared. RESULTS: A mean age of 68.3 ± 9.8 years was found (range 57-92 years), and no significant difference was evident between both groups. A positive correlation between the CDE values obtained by both platforms was verified (r = 0.271, R 2 = 0.073, P = 0.013). Similarly, a significant correlation was evidenced for the EAF (r = 0.334, R 2 = 0.112, P = 0.046) and AT values (r = 0.156, R 2 = 0.024, P = 0.161). A statistically significantly lower CDE count, aspiration time and estimated fluid were obtained using the active-fluidics configuration when compared to the gravity-fluidics configuration by 19.29, 12.10 and 9.29%, respectively (P = 0.001, P < 0.0001 and P = 0.001). CONCLUSIONS: The active-fluidics Centurion ® phacoemulsification system achieved higher surgical efficiency than the gravity-fluidics Infiniti ® IP system for NII and NIII cataracts.

Ureteroscopia con litotripsia para el tratamiento de la litiasis ureteral inferior: casuística del Servicio de Urología del Hospital Luis Vernaza en el período 2015 ­ 2017 / Ureteroscopy with lithotripsy for the treatment of lower ureteral lithiasis: case reports from Urology Department of the Luis Vernaza Hospital in the period 2015 - 2017

En Ecuador la litiasis renal y del uréter causan alrededor de diez mil egresos hospitalarios a nivel nacional. La endolitotomía ha tenido una transición de la litotripsia balística al láser. Objetivo Comparar los datos quirúrgicos y tasa de éxitos de ureteroscopias semirrígidas usando litotripsia balística o laser. Diseño Estudio retrospectivo Lugar y sujetos Un total de 137 pacientes con litiasis ureteral distal, atendidos en el Hospital Luis Vernaza de Guayaquil-Ecuador, entre enero 2015 y junio 2017. Mediciones principales Datos clínicos de los pacientes, ubicación y dimensión del cálculo, tiempo quirúrgico, complicaciones y tasa de éxitos. Resultados Los pacientes (39.3% hombres y 60.7% mujeres) tuvieron una edad media de 52.4 ± 2.1 años. La mayoría tuvieron cólico nefrítico (77.0%), por litiasis en uréter inferior (izquierdo [45.8%] o derecho [38.7%]) o uréter medio (izquierdo [8.9%] o derecho [6.0%]). Hasta el 90% de los casos fueron de cálculos únicos. Los pacientes fueron tratados con láser (n=50) o con litotripsia balística (n=87). En el grupo de láser, la dimensión del cálculo fue mayor (12.6 ± 1.29 vs. 11.5 ± 0.8 mm; p=0.001), el procedimiento quirúrgico tuvo más duración (66.9 ± 7.4 vs. 58.8 ± 5.3 minutos; p=0.001) y hubo más tiempo postoperatorio previo al egreso (2.22 ± 0.57 vs. 1.7 ± 0.2 días; p=0.001). La taza libre de litiasis fue similar en ambos grupos (98.0% vs. 91.9%; p=ns). Las complicaciones fueron pocas (n=14; 10.2%) y en igual frecuencia con ambas técnicas, pero hubo más casos de retropulsión del cálculo con la litrotripsia balística (n=7) que con el láser (n=1). Conclusión La endolitotomía láser tiene mayores beneficios en cuanto al tamaño del cálculo que puede ser tratado y pocos eventos de retropulsión. La litotripsia balística tuvo mejor tiempo quirúrgico y menos días de egreso postoperatorio. No obstante, la tasa de éxitos aparentemente es similar con ambas técnicas.

Prevalence of ocular surface disease symptoms and risk factors in group of university students in Monterrey, Mexico.

BACKGROUND: The objective of this study was to determine the prevalence of symptoms of ocular surface disease and its relationship with associated risk factors in students from the University of Monterrey using Ocular Surface Disease (OSDI) questionnaire. METHODS: A cross-sectional survey was conducted between October and December 2014 to assess the prevalence and risk factors for ocular surface disease in a group of students from Universidad de Monterrey in Monterrey, Mexico. The severity of the disease was measured via the Ocular Surface Disease Index (OSDI) questionnaire. RESULTS: The OSDI average value was 26.85 ± 20.79 points, with 70.4% of students (579) had OSDI score higher than 12 points. Women had ocular surface disease 1.63 times more than men (OR 1.29, 95% CI 1.13,1.48). Students who used ophthalmic drops have an OR 2.00 (95% CI 1.65,2.40), and students who smoke have an OR 1.24 (95% CI 1.06,1.46). Use of contact lenses, hours in front of computer or history of refractive surgery has low-estimated effect on the probability of presenting an ocular disease. CONCLUSIONS: University students have a prevalence of 70.4% of ocular surface disease (OSD). OSD was associated with gender (women have a higher prevalence), smoking and the use of eye drops. A program to modify these risk factors to reduce the prevalence is needed.

Dissection of the antibody response against herpes simplex virus glycoproteins in naturally infected humans.

UNLABELLED: Relatively little is known about the extent of the polyclonal antibody (PAb) repertoire elicited by herpes simplex virus (HSV) glycoproteins during natural infection and how these antibodies affect virus neutralization. Here, we examined IgGs from 10 HSV-seropositive individuals originally classified as high or low virus shedders. All PAbs neutralized virus to various extents. We determined which HSV entry glycoproteins these PAbs were directed against: glycoproteins gB, gD, and gC were recognized by all sera, but fewer sera reacted against gH/gL. We previously characterized multiple mouse monoclonal antibodies (MAbs) and mapped those with high neutralizing activity to the crystal structures of gD, gB, and gH/gL. We used a biosensor competition assay to determine whether there were corresponding human antibodies to those epitopes. All 10 samples had neutralizing IgGs to gD epitopes, but there were variations in which epitopes were seen in individual samples. Surprisingly, only three samples contained neutralizing IgGs to gB epitopes. To further dissect the nature of these IgGs, we developed a method to select out gD- and gB-specific IgGs from four representative sera via affinity chromatography, allowing us to determine the contribution of antibodies against each glycoprotein to the overall neutralization capacity of the serum. In two cases, gD and gB accounted for all of the neutralizing activity against HSV-2, with a modest amount of HSV-1 neutralization directed against gC. In the other two samples, the dominant response was to gD. IMPORTANCE: Antibodies targeting functional epitopes on HSV entry glycoproteins mediate HSV neutralization. Virus-neutralizing epitopes have been defined and characterized using murine monoclonal antibodies. However, it is largely unknown whether these same epitopes are targeted by the humoral response to HSV infection in humans. We have shown that during natural infection, virus-neutralizing antibodies are principally directed against gD, gB, and, to a lesser extent, gC. While several key HSV-neutralizing epitopes within gD and gB are commonly targeted by human serum IgG, others fail to induce consistent responses. These data are particularly relevant to the design of future HSV vaccines.

Repertoire of epitopes recognized by serum IgG from humans vaccinated with herpes simplex virus 2 glycoprotein D.

The results of a clinical trial of a subunit vaccine against genital herpes were recently reported (R. B. Belshe, P. A. Leone, D. I. Bernstein, A. Wald, M. J. Levin, J. T. Stapleton, I. Gorfinkel, R. L. Morrow, M. G. Ewell, A. Stokes-Riner, G. Dubin, T. C. Heineman, J. M. Schulte, C. D. Deal, N. Engl. J. Med. 366: 34-43, 2012, doi:10.1056/NEJMoa1103151). The vaccine consisted of a soluble form of herpes simplex virus 2 (HSV-2) glycoprotein D (gD2) with adjuvant. The goal of the current study was to examine the composition of the humoral response to gD2 within a selected subset of vaccinated individuals. Serum samples from 30 vaccine recipients were selected based upon relative enzyme-linked immunosorbent assay (ELISA) titers against gD2; 10 samples had high titers, 10 had medium titers, and the remaining 10 had low ELISA titers. We employed a novel, biosensor-based monoclonal antibody (MAb)-blocking assay to determine whether gD2 vaccination elicited IgG responses against epitopes overlapping those of well-characterized MAbs. Importantly, IgGs from the majority of gD2-immunized subjects competed for gD binding with four antigenically distinct virus-neutralizing MAbs (MC2, MC5, MC23, and DL11). Screening of patient IgGs against overlapping peptides spanning the gD2 ectodomain revealed that about half of the samples contained antibodies against linear epitopes within the N and C termini of gD2. We found that the virus-neutralizing abilities of the 10 most potent samples correlated with overall gD-binding activity and to an even greater extent with the combined content of IgGs against the epitopes of MAbs MC2, MC5, MC23, and DL11. This suggests that optimal virus-neutralizing activity is achieved by strong and balanced responses to the four major discontinuous neutralizing epitopes of gD2. Importance: Several herpes simplex virus 2 (HSV-2) subunit vaccine studies have been conducted in human subjects using a recombinant form of HSV-2 glycoprotein D (gD2). Although several distinct, well-characterized virus-neutralizing epitopes on gD2 are targeted by murine monoclonal antibodies, it is not known whether the same epitopes are targeted by the humoral response to gD2 in humans. We have developed a novel, biosensor-based competition assay to directly address this important question. Using this approach, we identified epitopes that elicit strong humoral responses in humans, as well as other epitopes that elicit much weaker responses. These data provide new insight into the human response to known neutralizing gD2 epitopes and reveal characteristics of this response that may guide future vaccine development.