A large-scale analysis of refractive errors in students attending public primary schools in Mexico.

A cross-sectional, retrospective study was conducted from September 2013 through July 2014 to determine the prevalence of refractive errors among students attending public primary schools in Mexico. Among 3,861,156 students at 14,566 public primary schools in all 32 states of Mexico, teachers identified reduced visual acuity in 1,253,589 (32.5%) using visual acuity measurement. Optometrists confirmed 391,498 [31.2%, mean (SD) age: 8.8 (1.9) years; 204,110 girls (52.9%)] had refractive errors using visual acuity measurement and noncycloplegic static retinoscopy. Among 288,537 (72.4%) of children with previous eyeglasses usage data reported, 241,505 (83.7%) had uncorrected refractive errors. Before prescription eyeglasses were provided, 281,891 students (72%) had logMAR visual acuity ≤ 0.2; eyeglasses corrected vision loss in 85.6% (n = 241,352) of them. Simple myopic astigmatism was the most frequent refractive error (25.7%, n = 100,545). Astigmatism > - 1.00 diopters was present in 54.6% of all students with ametropia. The anisometropia rate based on spherical equivalent difference between right and left eye ≥ 1.50 diopters was 3.9% (n = 15,402). Uncorrected refractive errors are an important issue in primary school students in Mexico. An updated study is needed to analyze the evolving trends over the past decade.

Retinoblastoma seeds: impact on American Joint Committee on Cancer clinical staging.

AIM: To investigate whether the American Joint Committee on Cancer (AJCC) clinical category cT2b needs to be subclassified by the type and distribution of retinoblastoma (RB) seeding. METHODS: Multicentre, international registry-based data were collected from RB centres enrolled between January 2001 and December 2013. 1054 RB eyes with vitreous or subretinal seeds from 18 ophthalmic oncology centres, in 13 countries within six continents were analysed. Local treatment failure was defined as the use of secondary enucleation or external beam radiation therapy (EBRT) and was estimated with the Kaplan-Meier method. RESULTS: Clinical category cT2b included 1054 eyes. Median age at presentation was 16.0 months. Of these, 428 (40.6%) eyes were salvaged, and 430 (40.8%) were treated with primary and 196 (18.6%) with secondary enucleation. Of the 592 eyes that had complete data for globe salvage analysis, the distribution of seeds was focal in 143 (24.2%) and diffuse in 449 (75.8%). The 5-year Kaplan-Meier cumulative globe-salvage (without EBRT) was 78% and 49% for eyes with focal and diffuse RB seeding, respectively. Cox proportional hazards regression analysis confirmed a higher local treatment failure risk with diffuse seeds as compared with focal seeds (hazard rate: 2.8; p<0.001). There was insufficient evidence to prove or disprove an association between vitreous seed type and local treatment failure risk(p=0.06). CONCLUSION: This international, multicentre, registry-based analysis of RB eyes affirmed that eyes with diffuse intraocular distribution of RB seeds at diagnosis had a higher risk of local treatment failure when compared with focal seeds. Subclassification of AJCC RB category cT2b into focal vs diffuse seeds will improve prognostication for eye salvage.

Mifepristone pretreatment followed by misoprostol 200 mcg buccal for the medical management of intrauterine fetal death at 14-28 weeks: A randomized, placebo-controlled, double blind trial.

OBJECTIVE: To evaluate whether fetal and placental expulsion is more likely within 48 h if women receive mifepristone pre-treatment vs placebo pre-treatment followed by misoprostol 200 mcg buccally for treatment of fetal death at 14 weeks 0 days to 28 weeks and 6 days gestation. STUDY DESIGN: We randomized 176 women with a confirmed fetal death between 14 weeks and 0 days to 28 weeks and 6 days to mifepristone 200 mg or placebo; 24 h later all participants received misoprostol 200 mcg buccally every 3 h for up to 16 doses or 48 h. The trial took place in Hanoi, Vietnam and Mexico City in 2015-2018. RESULTS: Complete expulsion of the fetus and placenta within 48 h of misoprostol administration occurred in 74 of 90 women (82.2%, 95% confidence interval (CI), 72.7%-89.5%) in the mifepristone-misoprostol group and in 70 of 86 women (81.4%, 95% CI, 71.6%-89.0%) in the placebo-misoprostol group (Relative Risk (RR) 1.01, 95%CI 0.87-1.16, p = 0.887). The median time from the start of the misoprostol induction to fetal expulsion was shorter among women who received mifepristone-misoprostol compared to women assigned to placebo-misoprostol (7 h vs ±5 vs 12 ± 13 h; p < 0.001). Women in the mifepristone-misoprostol group were more likely to expel the fetus within 24 h of the start of misoprostol administration (96% vs 78%; RR 1.22 (1.09-1.39) p = 0.009). CONCLUSION(S): Mifepristone-misoprostol did not result in a higher rate of complete expulsion of the fetus and the placenta within 48 h of the start of misoprostol administration without any additional surgical intervention or medication (e.g. additional misoprostol doses or oxytocin) than placebo-misoprostol. However, treatment with mifepristone-misoprostol did result in a shorter time to expulsion than placebo misoprostol. IMPLICATIONS: Pretreatment with mifepristone followed by misoprostol bucally resulted in a shorter treatment time for medical management of fetal death than treatment with misoprostol alone. Pre-treatment with mifepristone may be more acceptable to women and providers by both reducing the length of hospital stay and the amount of misoprostol required.

Bioconversion of lutein using a microbial mixture--maximizing the production of tobacco aroma compounds by manipulation of culture medium.

The generation of aroma compounds by carotenoid cleavage in the 9-10 position was studied, due to the importance of these compounds in the flavor and fragrance industry. The bioconversion of the carotenoid lutein to C(13) norisoprenoids utilizing a microbial mixture composed of Trichosporon asahii and Paenibacillus amylolyticus was carried out by a fermentation process. Applying an experimental design methodology, the effects of nutritional factors on the production of aroma compounds present in the tobacco profile were studied. After an assessment of the significance of each nutritional factor, the levels of the variables yielding the maximum response were calculated. Glucose, tryptone, and yeast extract exerted a strong negative effect over the objective function, with glucose being the strongest. Lutein possessed a positive effect over the tobacco aroma production, while sodium chloride and trace elements showed no influence over the process. The yield attained after culture medium manipulation was almost ten-fold higher, compared with the base medium; and the aroma mixture was characterized as: 7,8-dihydro-beta-ionol (95.2%), 7,8-dihydro-beta-ionone (3.7%), and beta-ionone (1.1%).

Cirugía de Glenn en el departamento de cardiopediatría INCOR-EsSalud / Glenn's surgery in the department of cardiopediatric incor-EsSalud

Objetivo: En el presente estudio retrospectivo realizado en el INCOR tiene como objetivo principal analizar los factores determinantes en el resultado quirúrgico de la cirugía de Glenn. Material y Métodos: Entre enero de 1999 y diciembre de 2002 se intervinieron 37 niños con esta técnica quirúrgica en el INCOR-EsSalud, cuyas edades oscilaron entre 5 meses y catorce años, los pesos fueron desde 4.5 hasta 41 kilos, hubieron 25 hombres y 11 mujeres, procedentes 5 ciudades de altura, 23 de la región costa y tres de la selva. Resultados: La mortalidad fue 8.1 por ciento y se asoció un valor de la presión de la arteria pulmonar igual o superior a 30 mmHg a mayor morbimortalidad. De igual manera un peso menor de 7 kilos, edad menor de un año, anormalidades anatómicas cardiacas complejas y pacientes con antecedente de enfermedades respiratorias frecuentes tuvieron una mayor estancia en la UCI post quirúrgica, los pacientes con fisiopatología de bajo flujo pulmonar no condicionaron una variable clínica de importancia en la morbimortalidad. La tasa de supervivencia a tres años fue del 92 por ciento. Conclusiones: Este tipo de cirugía es una buena alternativa terapéutica para las cardiopatías congénitas de corazón univentricular. La presión de la arteria pulmonar, el peso, la edad, así como los antecedentes pre-quirúrgicos, son variables importantes relacionadas con la evolución de estos pacientes.

Growth and pectinase production by Aspergillus Mexican strain protoplast regenerated under acidic stress.

Protoplasts from Aspergillus sp. FP-180 and Aspergillus awamori NRRL- 3112 were released and regenerated at extreme acidic conditions. The best conditions for protoplast release were 0.8 M KCI, pH 5.8, and 3 h of digestion using mycelia from 12- to 16-h cultures from either Aspergillus sp. FP-180 or A. awamori NRRL-3112. The addition of fresh mycelia to an ongoing digestion after 1 h increased protoplast 4.5-5 times. A regeneration efficiency of 90% was attained at pH 6.0, and it was possible to regenerate protoplasts at pH 1.7 with a regeneration efficiency of 0.5% for Aspergillus sp. FP-180. The LpH-10 strain, derived from protoplast from Aspergillus sp FP-180, was able to regenerate at pH 1.7 and grow at pH values as low as 1.5, values at which the original strain is unable to grow. Regeneration at extreme pH improved the performance of LpH-10 strain. It showed a twofold increase in cell growth at pH 2.0 in liquid culture and a higher pectinolytic activity in relation to that produced by the original strain.

Luxación de cristalino como presentación del síndrome del niño maltratado / Lens dislocation as a presentation of child abuse syndrome

El síndrome del niño maltratado o de Kempe es uno de los problemas más serios encontrados en el servicio de urgencias en pediatría, y las manifestaciones oculares son encontradas en la mayoría de los niños que sufren abuso físico.Se trata de un niño de 13 semanas de edad quien presenta trauma facial que le provoca luxación del cristalino, glaucoma y aumento de volumen del globo ocular derecho, presenta además fractura de fémur derecho antigua con encefalomalacia asociada, siendo manejado para evitar el desprendimiento de retina con vitrectomía pars plana y lensectomía.La luxación del cristalino debe ser considerada en el diagnóstico del síndrome de Kempe. Enfatizamos la necesidad de hacer un examen oftalmológico completo en cada caso donde se sospeche maltrato infantil.

Caracterización cinética preliminar del efecto de la galamina sobre la unión de [üH] - QNB al receptor colinérgico muscarínico: efecto sobre las tasas de asociación y disociación / Comparation of the effect of copper and zink on [üH] - QMB binding to muscarinic acetylcholine receptors

Diversas sustancias pueden unirse al receptor colinérgico muscarínico (RCM) como moduladores alostéricos. Por esta razón, se decidió el estudio de los efectos de la galamina, un ligando alostérico, sobre la tasa de asociación y disociación en la unión del benzilato de [üH]- N - metil - quinuclidinilo ([üH] - QNB) a los RCM de Corteza Frontal Humana. Los ensayoss se llevaron a cabo en ausencia y presencia de galamina en concentraciones de 10 a 10-ü M. los datos se analizaron por regresión no lineal. Tanto la asociación como la disociación del [üH] - QNB de los RCMs fueron modulados en forma bifásica: bajas dosis de galamina aceleraron la disociación y retrasaron la asociación, mientras que, a dosis mayores, se obtenían los efectos contrarios. Para todos los ensayos, la galamina redujo la unión de [üH] - QNB de manera dosis - dependiente. Estos hallazgos sugieren que la galamina podría ejercer efectos alostéricos característicos sobre la unión de antagonistas de los RCM cerebrales dependiendo de la concentración, ofreciendo un camino para el desarrollo de acciones farmacológicas más específicas

Tratamiento del glaucoma de difícil control en pediatría con válvula de Ahmed / Uncontrolled glaucoma pediatric treatment with Ahmed valve implant

Presentamos los resultados iniciales con el uso de la válvula de Ahmed, en el tratamiento de cinco pacientes pediátricos (seis ojos), con antecedente de cirugías de glaucoma previas insatisfactorias. Durante el periodo de seguimiento (5 a 34 meses), ningún paciente presentó complicaciones que ocasionaran disminución de la agudeza visual, alteraciones de la movilidad ocular o rechazo al dispositivo. Cuatro pacientes tuvieron disminución adecuada de la presión intraocular. Concluimos que la válvula de Ahmed es una opción viable en el manejo del glaucoma de difícil control en pediatría

Toxocariasis ocular: tratamiento médico y quirúrgico

La toxocariasis es una parasitosis de distribución mundial que afecta principalmente a niños y adolecentes. El globo coular es afectado en su segmento posterior, existiendo varias presentaciones clínicas. Este trabajo describe retrospectivamente 4 pacientes con un diagnóstico clinico y serológico de toxocariasis ocular. Los pacientes fueron tratados médicamente con albendazol y prednisona. El tratamiento quirúrgico consistió en vitrectomía y membranectomía. Los resultados visuales dependieron del sitio y tipo de lesión encontrada en la retina que condicionó la posibilidad de tratamiento quirúrgico, y no del tipo de evolución de la enfermedad.