Gyrate atrophy of the choroid and retina: Update on diagnosis and treatment.

Gyrate atrophy of the choroid and retina (GACR) is a rare autosomal recessive disease characterised by elevated plasma ornithine levels due to deficiency of the enzyme ornithine aminotransferase (OAT). The accumulation of this amino acid in plasma leads to the development of patches of chorioretinal atrophy in the peripheral retina extending into the macular area. Patients usually present with night blindness followed by constriction of the visual field and, finally, decreased central vision and blindness. The disease is diagnosed by the presence of the characteristic clinical picture, the presence of hyperornithinaemia in plasma and the detection of mutations in the OAT enzyme gene. There is currently no effective gene therapy and the most common therapeutic intervention mainly involves dietary modifications with arginine restriction. This article aims to summarise the pathogenesis, clinical and diagnostic findings and treatment options in patients with GACR.

Bilateral macular edema in sistemic sclerosis.

Systemic sclerosis is a chronic, autoimmune, multisystem disease characterized by vascular dysfunction, chronic inflammation and widespread fibrosis. Although vascular involvement commonly manifests in the skin, it can also affect other organs, including the eyes. The characteristic vascular alteration is an obliterative fibroproliferative vasculopathy leading to hypoxia and tissue ischemia. We present a case of bilateral macular edema in a patient diagnosed with systemic sclerosis, as a consequence of retinal and choroidal vascular changes.

Obscure digestive bleeding.

A 50-year-old woman presented to the emergency department with several episodes of melena in the last week. The patient was not hemodynamically compromised and was conservatively managed. Urgent upper gastrointestinal endoscopy and colonoscopy showed no source of bleeding. Abdominal CT demonstrated three mural nodular lesions up to 2cm in the mid jejunum with hypervascular characteristics in arterial phase without active bleeding in venous phase. Angiography (Figure 1A) revealed three tumours with neo-angiogenesis and no active bleeding. Each lesion was stained with methylene blue and followed by embolization with coils. Exploratory laparotomy (Figure 1B) showed the three nodules marked by angiography. Intestinal resection of the affected segment was performed. Histopathological study proved the diagnosis of suspicion (Figure 2).

Emergence and dissemination of three mild outbreaks of Neisseria gonorrhoeae with high-level resistance to azithromycin in Barcelona, 2016-18.

BACKGROUND: Neisseria gonorrhoeae (NG) isolates with high-level azithromycin resistance (HL-AziR) have emerged worldwide in recent decades, threatening the sustainability of current dual-antimicrobial therapy. OBJECTIVES: This study aimed to characterize the first 16 NG isolates with HL-AziR in Barcelona between 2016 and 2018. METHODS: WGS was used to identify the mechanisms of antimicrobial resistance, to establish the MLST ST, NG multiantigen sequence typing (NG-MAST) ST and NG sequence typing for antimicrobial resistance (NG-STAR) ST and to identify the clonal relatedness of the isolates with other closely related NG previously described in other countries based on a whole-genome SNP analysis approach. The sociodemographic characteristics of the patients included in the study were collected by comprehensive review of their medical records. RESULTS: Twelve out of 16 HL-AziR isolates belonged to the MLST ST7823/NG-MAST ST5309 genotype and 4 to MLST ST9363/NG-MAST ST3935. All presented the A2059G mutation in all four alleles of the 23S rRNA gene. MLST ST7823/NG-MAST ST5309 isolates were only identified in men who have sex with women and MLST ST9363/NG-MAST ST3935 were found in MSM. Phylogenomic analysis revealed the presence of three transmission clusters of three different NG strains independently associated with sexual behaviour. CONCLUSIONS: Our findings support the first appearance of three mild outbreaks of NG with HL-AziR in Spain. These results highlight the continuous capacity of NG to develop antimicrobial resistance and spread among sexual networks. The enhanced resolution of WGS provides valuable information for outbreak investigation, complementing the implementation of public health measures focused on the prevention and dissemination of MDR NG.

Do Season and Environment Have a Role in the Incidence of Anterior Uveitis Attacks?

PURPOSE: To investigate the seasonal influence on the incidence of uveitis attacks. METHODS: An ecological study was designed including 731 uveitis attacks in 594 patients diagnosed at the eye emergency of a hospital in Madrid between 2014 and 2017. The incidence of uveitis attacks, B27+, and presumed herpetic attacks were calculated, and their correlations with seasonal and environmental variables in the same timeframe were analyzed. The analyzed variables were precipitation, barometric pressure, temperature, humidity, wind speed, global solar radiation, ultraviolet radiation, air pollution components (particulate matter and polluting gases), and the incidence of influenza. RESULTS: The incidence of attacks was significantly higher in the winter than in the autumn (p = .025). It showed a significant correlation to the number of rainy days per month (r = 0.612;p = .04), and the average wind speed (r = 0.469;p = .02) after Bonferroni correction. CONCLUSION: Uveitis episodes happened more frequently under rainy and windy conditions. Most factors were not significantly correlated to attacks.

Aspectos galénicos de las soluciones de inyección submucosa para su utilización en polipectomía endoscópica / Galenic aspects of submucosal injection solutions for use in endoscopic polypectomy

La disección submucosa endoscópica submucosa (DSE) y la resección mucosa endoscópica mucosa (RME) o mucosectomía son las principales técnicas empleadas en la extirpación endoscópica de pólipos del tubo digestivo. En ambas técnicas se inyecta una solución submucosa para crear un habón debajo de la lesión que separe la mucosa de la capa muscular propia. Esto permite una mejor delimitación de la lesión y facilita su resección. En la práctica clínica, se han probado diferentes soluciones para este uso, utilizándose en la mayoría de los casos fuera de indicación en ficha técnica y sin control galénico, fisicoquímico ni microbiológico, a pesar de ser soluciones de administración parenteral. El objetivo de este trabajo es llevar a cabo una revisión de las principales soluciones utilizadas, así como de sus limitaciones y de los principales avances realizados en este ámbito

Endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) are the main techniques used in the removal of intestinal polyps. In both techniques a submucosal solution is injected to create a hub under the lesion that separates the mucosa from the muscular layer itself. This allows a better delimitation of the lesion and facilitates its resection. In clinical practice, many solutions have been tested for this use, being used in most cases out off-label and without galenic, physicochemical or microbiological control, despite being parenteral administration solutions. The objective of this study is to carry out a review of the main solutions used, as well as their limitations and the main advances made in this area

Abundance of total and metabolically active Candidatus Microthrix and fungal populations in three full-scale wastewater treatment plants.

The abundances of total and metabolically active populations of Candidatus Microthrix and Fungi were evaluated by quantitative PCR (qPCR) and retrotranscribed qPCR of ribosomal molecular markers in three different full-scale wastewater treatment plants (WWTPs), in absence of bulking/foaming episodes. Significant differences of the abundance of rDNAs and rRNAs of Candidatus Microthrix and Fungi were observed among the three WWTPs. The average relative abundances of 16S rDNA copies of Candidatus Microthrix to those of Bacteria ranged 3.4-8.9%. Biota-environment analysis (BIO-ENV) demonstrated that the number of copies of both 16S rDNA and rRNA of Candidatus Microthrix increased at longer hydraulic and solids' retention times and with higher nitrate concentrations in the activated sludge. The abundance of Candidatus Microthrix correlated strongly and positively with the removal efficiencies of organic matter and total nitrogen in the tested WWTPs, highlighting the role of these particular microbial group in the performance of these engineered systems.

Evaluation of biocompatible monomers as substitutes for TEGDMA in resin-based dental composites.

This works reports the synthesis and characterization of diallyl(5-(hydroxymethyl)-1,3-phenylene) dicarbonate (HMFBA) and 5-(hydroxymethyl)-1,3-phenylene bis(2-methylacrylate) (HMFBM) monomers and its evaluation as Bis-GMA eluents in the formulation of composite resins for dental use. The experimental materials formulated with HMFBA and HMFBM monomers presented flexural strength values similar to those of the control group formulated with Bis-GMA/TEGDMA. Regarding volumetric contraction percentage, the values obtained of experimental materials with HMFBA was 1.88% and for HMFBM was 4.15%, both lower than control resin (4.68%). In the case of double bond conversion, the resin formulated with HMFBA monomer exhibited a greater degree of conversion (87%). Besides, the DMA analyses proved that the values for Tg guarantee a good mechanical performance at body temperature. The new resins formulated with HMFBA and HMFBM monomers exhibit a cellular viability close to 100%, which indicates the absence of cytotoxicity towards fibroblastic cells.

Synthesis of an allyl carbonate monomer as alternative to TEGDMA in the formulation of dental composite resins.

Over the past years, significant effort has been dedicated to synthesizing low-shrinking formulations, however, development of dental composites with low volumetric shrinkage continues to be challenging. The purpose of this study was to synthesize a bisphenol allylic derivate (BPhADAC) and evaluate its inclusion in the formulation of a photopolymerizable dental composite resin, as a BisGMA diluent. Experimental (BisGMA/BPhADAC) and control (BisGMA/TEGDMA) photopolymerizable composites were prepared. Double bond conversion, polymerization kinetics, volumetric shrinkage, water sorption, solubility, and flexural properties were investigated. The experimental composite showed higher degree of conversion values, less volumetric shrinkage and less water sorption than the control composite (p < 0.05). In addition, flexural strength between the materials was found to be similar. The overall properties prove that the allylic monomer BPhADAC could be potentially useful in the formulation of low-shrinking dental composite resins.

Assessing the abundance of fungal populations in a full-scale membrane bioreactor (MBR) treating urban wastewater by using quantitative PCR (qPCR).

The abundance of fungi in a full-scale membrane bioreactor (MBR) treating urban wastewater and experiencing seasonal foaming was assessed by quantitative PCR (qPCR), comparing three different sets of widely used universal fungal primers targeting the gene encoding the small ribosomal subunit RNA, 18S-rDNA, (primers NS1-Fung and FungiQuant) or the internal transcribed spacer ITS2 (primers ITS3-ITS4). Fungi were a numerically important fraction of the MBR microbiota (≥106 18S-rDNA copies/L activated sludge), and occurred both in the aerated and anoxic bioreactors. The numbers of copies of fungal markers/L activated sludge calculated using the NS1-Fung or ITS3-ITS4 primer sets were up to 2 orders of magnitude higher than the quantifications based on the FungiQuant primers. Fungal 18S-rDNA counts derived from the FungiQuant primers decreased significantly during cold seasons, concurring with foaming episodes in the MBR. Redundancy analysis corroborated that temperature was the main factor driving fungi abundance, which was also favored by longer solid retention time (SRT), lower chemical oxygen demand/biochemical oxygen demand at 5 days (COD/BOD5) of influent water, and lower biomass accumulation in the MBR.

Linking nitrous oxide emissions to population dynamics of nitrifying and denitrifying prokaryotes in four full-scale wastewater treatment plants.

Ammonia-oxidizing bacteria (AOB), ammonia oxidizing archaea (AOA) and N2O-reducing denitrifiers were measured by quantitative real-time PCR (qPCR) in activated sludge samples from four full-scale wastewater treatment plants (WWTPs) in South Spain, and their abundances were linked to the generation of N2O in the samples using multivariate analysis (Non-metric multidimensional scaling, MDS, and BIO-ENV). The average abundances of AOA remained in similar orders of magnitude in all WWTPs (106 copies amoA/L activated sludge mixed liquor), while significant differences were detected for AOB (105-109copies amoA/L) and N2O-reducers (107-1010copies nosZ/L). Average N2O emissions measured in activated sludge samples ranged from 0.10 ±â€¯0.05 to 6.49 ±â€¯8.89 mg N2O-N/h/L activated sludge, and were strongly correlated with increased abundances of AOB and lower counts of N2O-reducers. A significant contribution of AOA to N2O generation was unlikely, since their abundance correlated negatively to N2O emissions. AOB abundance was favoured by higher NO3- and NO2-concentrations in the activated sludge.

Effect of salinity variation on the autotrophic kinetics of the start-up of a membrane bioreactor and hybrid moving bed biofilm reactor-membrane bioreactor at low hydraulic retention time.

A membrane bioreactor (MBR) and a hybrid moving bed biofilm reactor-membrane bioreactor (hybrid MBBR-MBR) for municipal wastewater treatment were studied to determine the effect of salinity on nitrogen removal and autotrophic kinetics. The biological systems were analyzed during the start-up phase with a hydraulic retention time (HRT) of 6 h, total biomass concentration of 2,500 mg L-1 in the steady state, and electric conductivities of 1.05 mS cm-1 for MBR and hybrid MBBR-MBR working under regular salinity and conductivity variations of 1.2-6.5 mS cm-1 for MBR and hybrid MBBR-MBR operating at variable salinity. The variable salinity affected the autotrophic biomass, which caused a reduction of the nitrogen degradation rate, an increase of time to remove ammonium from municipal wastewater and longer duration of the start-up phase for the MBR and hybrid MBBR-MBR.

The diagnostic usefulness of the negative electroretinogram. / La utilidad diagnóstica del electrorretinograma negativo.

The definition of the negative response of the full field electroretinogram is the presence of a b-wave with less amplitude than the a-wave (b/a ratio<1) in the combined response of cones and rods. The presence of this pattern reflects an alteration in the bipolar cells, the Müller cells, or in the transmission of the stimulus from the photoreceptors to the bipolar cells, with preserved photoreceptor function. This finding can be seen bilaterally and symmetrically in different hereditary conditions, such as congenital stationary night blindness, juvenile X-linked retinoschisis, and Duchenne and Becker muscular dystrophies. On the other hand, it can also be found unilaterally (or asymmetrically) in acquired pathologies, such as some types of immuno-mediated retinitis (Birdshot retinochoroiditis), autoimmune retinopathies, cancer/melanoma associated retinopathy, or retinal toxicity. The objective of this review is to summarise the characteristics of the pathologies in which this finding can be observed, in order to highlight its usefulness in the differential diagnosis of retinal conditions.

Electroless controllable growth of ZnO films and their morphology-dependent antimicrobial properties.

An electroless deposition process was used to synthesize with a controlled morphology, polycrystalline ZnO on glass substrates as antimicrobial coatings. The influence of deposition temperature (Tdep) on the physicochemical and antimicrobial properties of the ZnO films was analyzed. The results indicated that a change in deposition temperature greatly affected the morphology and the degree of crystallinity of the films. Scanning electron microscope images show that the film surface is porous at a deposition temperature of 40 and 50 °C, whereas hexagonal-plate shaped morphology predominated at 60 °C and finally at 70 and 80 °C the films consisted of rod-like particles. The films showed good transparency in the visible region. All ZnO films presented notable antimicrobial activity against the gram-negative bacteria Escherichia coli (E. coli) and the gram-positive Staphylococcus aureus (S. aureus). It was found that the antimicrobial efficiency is strongly dependent on morphology and structural properties. The best antimicrobial performance was recorded for the films consisting of rod-like morphology with a high degree of crystallinity. The procedure used in this investigation is strongly recommended for the development of functional surfaces.

Negative pressure wound therapy with instillation, a cost-effective treatment for abdominal mesh exposure.

PURPOSE: Negative pressure wound therapy with instillation (NPWTi) has been proved to be a safe and effective treatment option for abdominal wall wound dehiscence with mesh exposure. Our aim in this study is to examine whether it is also cost-effective. METHODS: We performed a retrospective cohort study with 45 patients treated for postoperative abdominal wall wound dehiscence and exposed mesh: 34 were treated with conventional wound therapy (CWT) and 11 with NPWTi. We carried out a cost analysis for each treatment group using the Diagnosis-related group (DRG) system and a second evaluation using the calculated costs "per hospital stay". The differences between NPWTi and CWT were calculated with both evaluation systems. Comparative analysis was performed using the Mann-Whitney U test. RESULTS: Mean costs using the DRG estimation were 29,613.71€ for the CWT group and 15,093.37€ for the NPWTi group, and according to the calculated expenses "per hospital stay", 17,322.88€ for the CWT group and 15,284.22€ for the NPWTi group. NPWTi showed a reduction in the total expense of treatment, related to a reduction in episodes of hospitalization and number of surgeries required to achieve wound closure. However, differences were not statistically significant in our sample. CONCLUSIONS: NPWTi proves to be an efficient treatment option for abdominal wall wound dehiscence with mesh exposure, compared to CWT. More trials aimed to optimize treatment protocols will lead to an additional increase in NPWTi efficiency. In addition, to generalize our results, further studies with larger samples would be necessary.

Full-scale photobioreactor for biotreatment of olive washing water: Structure and diversity of the microalgae-bacteria consortium.

The performance of a full-scale photobioreactor (PBR) for the treatment of olive washing water (OWW) was evaluated under different HRTs (5-2days). The system was able to treat up to 3926L OWWday-1, and consisted of an activated-carbon pretreatment column and a tubular PBR unit (80 tubes, 98.17L volume, 2-m height, 0.25m diameter). PBR was an effective and environmentally friendly method for the removal of phenols, COD, BOD5, turbidity and color from OWW (average efficiencies 94.84±0.55%, 85.86±1.24%, 99.12±0.17%, 95.86±0.98% and 87.24±0.91%, respectively). The diversity of total bacteria and microalgae in the PBR was analyzed using Illumina-sequencing, evaluating the efficiency of two DNA extraction methods. A stable microalgae-bacteria consortium was developed throughout the whole experimentation period, regardless of changes in HRT, temperature or solar radiation. MDS analyses revealed that the interplay between green algae (Sphaeropleales), cyanobacteria (Hapalosiphon) and Proteobacteria (Rhodopseudomonas, Azotobacter) played important roles in OWW bioremediation.