Tratamiento de la hiperpigmentación periocular con fuentes de luz / Treatment of periorbital hyperpigmentation using light devices

El tratamiento de la ojera supone una de las demandas más habituales en la consulta de estética para mejorar la imagen de cansancio, tristeza o envejecimiento que perciben nuestros pacientes. Además, se trata de un problema de etiología multifactorial y frente al que disponemos de un amplio abanico de tratamientos.El objetivo de la presente revisión es analizar la mejor evidencia disponible para el tratamiento de la ojera hiperpigmentada con fuentes de luz. Se han revisado 208 artículos que cumplían los criterios de búsqueda, incluyendo finalmente 14 para dar plena consideración en la revisión.Múltiples fuentes de luz han demostrado ser eficaces para el tratamiento de la pigmentación periorbitaria. Los resultados más prometedores se obtienen con luz pulsada intensa y láser rubí en combinación con despigmentantes. Para el tratamiento de la pigmentación junto con redensificación y disminución de arrugas destacan el láser CO2 y el láser erbium:yttrium scandium gallium garnet. Los láseres neodymium-doped yttrium aluminium garnet, alejandrita y diodo fueron los que reportaron resultados más moderados con su uso aislado. El tratamiento adyuvante con despigmentantes mejora resultados y reduce la incidencia de hiperpigmentación postinflamatoria.Es necesaria una mejor estandarización en la medida de los resultados en los cambios de la pigmentación. Además, sería recomendable realizar ensayos clínicos con resultados objetivables y que combinen varias fuentes de luz para el tratamiento no solo de la pigmentación periorbitaria, sino de la ojera de forma integral. (AU)

The treatment of dark circles is one of the most common request from the patients attending to the esthetics clinic. A tired, sad or aged appearance is perceived by our patients. Moreover, it is a multifactorial problem and we could treat it with a wide range of treatments.With this systematic review, we want to check the best available evidence regarding the treatment of periorbital hyperpigmentation using light devices. We have reviewed 208 papers, including 14 of them for full consideration.Several light sources have demonstrated to be effective treating pigmented dark circles. The best results have been reported using intense pulsed light and rubi laser together with depigmenting substances. If we want to treat periocular hyperpigmentation, soft wrinkles, rhytides and skin density we should use carbon dioxide laser or erbium:yttrium scandium gallium garnet. The neodymium-doped yttrium aluminium garnet, alexandrite and diode lasers were the ones giving the worst outcome regarding pigmentation treatment. The concomitant use of depigmenting treatment may help getting better results and reducing the rate of post-inflammatory hyperpigmentation.A better standardization and measuring of the obtained results is needed regarding pigmentation changes. We must keep on investigating on this topic with new clinical trials measuring objective results and combining different light devices for a multifactorial treatment of the dark circles. (AU)

Treatment of periorbital hyperpigmentation using light devices.

The treatment of dark circles is one of the most common request from the patients attending to the esthetics clinic. A tired, sad or aged appearance is perceived by our patients. Moreover, it is a multifactorial problem and we could treat it with a wide range of treatments. With this systematic review, we want to check the best available evidence regarding the treatment of periorbital hyperpigmentation using light devices. We have reviewed 208 papers, including 14 of them for full consideration. Several light sources have demonstrated to be effective treating pigmented dark circles. The best results have been reported using intense pulsed light and rubi laser together with depigmenting substances. If we want to treat periocular hyperpigmentation, soft wrinkles, rhytides and skin density we should use carbo dioxide laser or Erbium:Yttrium Scandium Gallium Garnet. The Neodymium-Doped Yttrium Aluminium Garnet, alexandrite and diode lasers were the ones giving the worst outcome regarding pigmentation treatment. The concomitant use of depigmenting treatment may help getting better results and reducing the rate of post inflammatory hyperpigmentation. A better standardization and measuring of the obtained results is needed regarding pigmentation changes. We must keep on investigating on this topic with new clinical trials measuring objective results and combining different light devices for a multifactorial treatment of the dark circles.

Influencia de factores endógenos (edad y sexo) en los niveles de biomarcadores de estrés oxidativo en alcatraz (Morus bassanus) / Influence of endogenous factors (age and sex) on the levels of oxidative stress biomarkers in Northern gannet (Morus bassanus)

Las aves marinas pueden ser utilizadas como bioindicadoras de las alteraciones del ambiente en que residen, identificándose en ellas distintos biomarcadores, que no informen sobre los niveles cuantitativos de contaminantes sino sobre los efectos adversos subclínicos que dichos agentes pueden causar. En el presente trabajo se han analizado los niveles de Malondialdehído (MDA) y de actividad Glutatión-S-Transferasa (GST) en muestras de hígado y riñón de 30 alcatraces (Morus bassanus) procedentes de las costas de Galicia, como posibles indicadores de estrés oxidativo en las aves. Además, se ha determinado la influencia de dos factores endógenos (sexo y edad) sobre los niveles de estos biomarcadores. En hígado los valores medios de MDA obtenidos fueron de 0,508±0,502 nmol/mg proteína, mientras que en riñón fueron de 15,67±12,18 nmol/mg proteína. La actividad GST media en hígado fue de 10,93±7,067 nmol/min/mg proteína, mucho menor que la media de los valores en riñón, que fue 62,30±26,97 nmol/min/mg proteína. En cuanto a las variaciones respecto a la edad, solo se encontraron diferencias estadísticamente significativas en riñón en la actividad GST, siendo mayor la actividad de esta enzima en alcatraces adultos que en inmaduros. Por su parte, el factor sexo no influyó en los niveles de ninguno de los biomarcadores considerados. Los resultados obtenidos apuntan a que ambos biomarcadores podrían ser de utilidad en programas de biomonitorización de contaminación ambiental centrados en el alcatraz, aunque serían necesarios estudios que consideren un mayor número de animales, incorporando un abanico más amplio de biomarcadores. (AU)

Seabirds can be used as bioindicators of changes in the environment in which they live, identifying different biomarkers in them, which do not provide information on the quantitative levels of contaminants, but on the subclinical adverse effects that these agents can cause. At the present study, the levels of Malondialdehyde (MDA) and glutathione-S-transferase (GST) activity in liver and kidney samples of 30 gannets (Morus bassanus) from the coast of Galicia have been determined, as suitable biomarkers of oxidative stress on birds. In addition, the influence of two endogenous factors (sex and age) on the levels of these biomarkers has been determined. In the liver, the mean values of MDA were 0.508 ± 0.502 nmol/mg protein, while in kidney they were 15.67 ± 12.18 nmol/mg protein. On the other hand, mean GST activity in the liver was 10.93 ± 7.067 nmol/min/mg protein, much lower than the mean activity values found in kidney, which were 62.30 ± 26.97 nmol/min/mg protein. Regarding the variations with respect to age, statistically significant differences were only found in the kidney in GST activity, the activity of this enzyme being higher in adult gannets than in immature ones. Secondly, the gender factor did not influence the levels of any of the biomarkers considered. The obtained results indicate that both biomarkers could be useful in biomonitoring programs of environmental contamination focused on the gannet, although studies that consider a larger number of animals, incorporating a broader range of biomarkers, would be necessary. (AU)

Eficacia de la hialuronidasa retrobulbar en el tratamiento de la ceguera provocada por rellenos cosméticos. Revisión sistemática / Effectiveness of retrobulbar hyaluronidase in the treatment of visual loss caused by periocular hyaluronic acid injection. A systematic review

Introducción La pérdida visual relacionada con la inyección periocular de rellenos con fines cosméticos es infrecuente pero muy grave. Como recomendaciones protocolizadas ante la pérdida visual por inyección intravascular inadvertida de ácido hialurónico se encuentran, entre otras, la inyección de hialorunidasa en el espacio retroocular. Es de esperar que, dada la creciente demanda de tratamientos de rellenos estéticos y la gran heterogeneidad de profesionales que pueden administrarlos, el número de casos y complicaciones relacionadas con estos procedimientos se incremente de manera sustancial. Objetivo Evaluar si existe evidencia científica para recomendar la inyección retroocular de hialuronidasa en el tratamiento de pérdidas visuales relacionadas con la inyección periocular de ácido hialurónico cosmético. Material y métodos Hemos realizado una búsqueda de artículos publicados en inglés y español siguiendo la declaración PRISMA sobre el uso de hialuronidasa retrobulbar para revertir la pérdida de visión producida por los rellenos de ácido hialurónico. Los artículos revisados incluyeron los casos clínicos y las investigaciones experimentales. Identificamos a un total de 13 pacientes en esta revisión siguiendo unos criterios de inclusión y exclusión definidos. Finalmente, incluimos 15 artículos en el estudio, 13 de ellos fueron casos/series de casos. Los 2artículos restantes son estudios experimentales en animales con grupo control, en los que, tras provocar una oclusión selectiva de la arteria oftálmica, se administran inyecciones seriadas de hialuronidasa retroocular con control de la función visual. Resultados De los 15 artículos incluidos en el estudio, recogimos los datos de un total de 17 pacientes que, tras inyección de ácido hialurónico facial por motivos estéticos, presentaron una disminución brusca de la visión y en los que se inyectaron dosis variables de hialuronidasa retroocular (AU)

Introduction Blindness after periocular cosmetic filler injection is a rare but devastating complication. Complication management protocols recommend injecting retrobulbar hyaluronidase if visual loss related to accidental intravascular injection of hyaluronic acid occurs. Given the dramatic increase in cosmetic filler injections and the variety of professionals that can deliver them, it is reasonable to assume that the incidence of complications will rise significantly. Objective To evaluate if there is evidence-based efficacy of retrobulbar hyaluronidase injection in visual loss secondary to periocular cosmetic filler injection. Material and methods The authors performed a search of English and Spanish language articles following the PRISMA statement published on the use of retrobulbar hyaluronidase to reverse vision loss precipitated by hyaluronic acid gel fillers. Articles reviewed included case reports/series and experimental investigations. We identified a total of 13 patients in this review following defined inclusion and exclusion criteria. Finally, we included 15 articles in the study, 12 of them were cases / case series. The 2remaining articles are experimental studies in animals with a control group, in which after causing selective occlusion of the ophthalmic artery, serial injections of retroocular hyaluronidase are administered with control of visual function. Results Of the 15 articles included in the study, we studied 17 patients treated with retrobulbar hyaluronidase for hyaluronic acid-induced blindness. Improvement was demonstrated in 3 cases. Animal studies demonstrate variable data are provided regarding the recovery of visual acuity. Conclusions There is no confirmed evidence of retrobulbar hyaluronidase injection effectiveness in treating visual loss due to accidental intravascular injection of hyaluronic acid. More studies are needed to show the efficacy of hyaluronidase as a treatment for blindness caused by hyaluronic acid (AU)

Effectiveness of retrobulbar hyaluronidase in the treatment of visual loss caused by periocular hyaluronic acid injection. A systematic review.

INTRODUCTION: Blindness after periocular cosmetic filler injection is a rare but devastating complication. Complication management protocols recommend injecting retrobulbar hyaluronidase if visual loss related to accidental intravascular injection of hyaluronic acid occurs. Given the dramatic increase in cosmetic filler injections and the variety of professionals that can deliver them, it is reasonable to assume that the incidence of complications will rise significantly. OBJECTIVE: To evaluate if there is evidence-based efficacy of retrobulbar hyaluronidase injection in visual loss secondary to periocular cosmetic filler injection. MATERIAL AND METHODS: The authors performed a search of English and Spanish language articles following the PRISMA statement published on the use of retrobulbar hyaluronidase to reverse vision loss precipitated by hyaluronic acid gel fillers. Articles reviewed included case reports/series and experimental investigations. We identified a total of 13 patients in this review following defined inclusion and exclusion criteria. Finally, we included 15 articles in the study, 12 of them were cases / case series. The 2 remaining articles are experimental studies in animals with a control group, in which after causing selective occlusion of the ophthalmic artery, serial injections of retroocular hyaluronidase are administered with control of visual function. RESULTS: Of the 15 articles included in the study, we studied 17 patients treated with retrobulbar hyaluronidase for hyaluronic acid-induced blindness. Improvement was demonstrated in 3 cases. Animal studies demonstrate variable data are provided regarding the recovery of visual acuity. CONCLUSIONS: There is no confirmed evidence of retrobulbar hyaluronidase injection effectiveness in treating visual loss due to accidental intravascular injection of hyaluronic acid. More studies are needed to show the efficacy of hyaluronidase as a treatment for blindness caused by hyaluronic acid.

Kidney graft functionality 1 year after kidney transplantation.

OBJECTIVE: To determine the evolution, associated factors and the outcomes of transplanted people one year after the evolution of a cohort in Mexico. METHOD: Kidney transplant cohort from 2013 to 2017 in Mexico. 1118 patients were analyzed. Five outcomes were studied: overall survival, kidney graft, patient survival, delayed function, and acute dysfunction. Kaplan-Meier was used for kidney graft survival. For risk, bivariate and multivariate analyzes were performed with a significant value of p < 0.05. RESULTS: Of the 1118 kidney transplant patients, 57 (5.09%) had kidney graft loss, 52 (4.65%) died during the one-year follow-up; survival of the patient of 95.35% and of the graft 90.25%. CONCLUSIONS: The risk factors for the outcomes were transplantation from a deceased donor, recipient over 50 years of age and use of polyclonal agents. Infections and age are related to the death of the patient.

OBJETIVO: Determinar la funcionalidad del injerto renal a 1 año en una cohorte retrospectiva en México. MÉTODO: Cohorte de trasplante renal de 2013 a 2017 en México. Se analizaron 1118 pacientes. Se estudiaron cinco desenlaces: supervivencia global, supervivencia del injerto renal, supervivencia del paciente, función retardada y disfunción aguda. Para la supervivencia del injerto renal se usó Kaplan-Meier. Para el riesgo se realizó análisis bivariado y multivariado con valor significativo p < 0.05. RESULTADOS: De los 1118 pacientes con trasplante renal, 57 (5.09%) tuvieron pérdida del injerto, 52 (4.65 %) fallecieron durante el año de seguimiento; la supervivencia del paciente fue del 95.35% y la supervivencia del injerto fue del 90.25%. CONCLUSIONES: Los factores de riesgo para los desenlaces fueron trasplante de donante fallecido, receptor mayor de 50 años y uso de agentes policlonales. Las infecciones y la edad están relacionadas con la muerte del paciente.

Implementation of an Enhanced Recovery After Surgery (ERAS) protocol for acute complicated and uncomplicated appendicitis.

BACKGROUND: Enhanced Recovery After Surgery (ERAS) protocols are well-documented logistic programs in elective surgery but it is still uncertain whether ERAS can benefit emergency patients, because of significant challenges facing its application to emergency surgery. The aim of this study was to evaluate the implementation of an ERAS protocol for patients with acute appendicitis (AA), both complicated and uncomplicated. METHODS: A prospective observational study was performed at two university hospitals in Spain, between January 2012 and December 2019. Inclusion criteria were patients with diagnosis of AA, undergoing appendectomy following an ERAS protocol of perioperative care. The different items of the ERAS protocol were recorded and their implementation was separately evaluated. Analyzed variables also included postoperative complications, hospital stay and readmission rate. Levels of acute phase reactants were assessed as predictors of implementation for the ERAS protocol. RESULTS: Eight hundred fifty patients were included; 498 males (58.5%) and 302 females (41.5%), with a mean age of 34.95 ± 17 years. The implementation of all the items of the protocol was achieved in 770 patients (90.6%), 86.8% of patients with complicated AA and 93.1% of patients with uncomplicated AA (p = 0.02). Higher preoperative C-reactive protein (CRP) levels were significantly associated with the impossibility of implementing all the items of the ERAS protocol (p < 0.001), establishing a cut-off point at CRP = 13.5 mg/dl. CONCLUSIONS: The implementation of ERAS protocols is safe and feasible in patients with AA. Although the implementation rate of all the items is lower in patients with complicated AA, it can be completed in 86.8% of these patients. CRP levels over 13.5 mg/dl are predictors of difficulties in the implementation of all the items of ERAS protocols.

Exploratory analysis on the usage of Pi-score algorithm over endoscopic stone treatment step 1 protocol.

BACKGROUND: The Performance Improvement score (Pi-score) has been proven to be reliable to measure performance improvement during E-BLUS hands-on training sessions. Our study is aimed to adapt and test the score to EST s1 (Endoscopic Stone Treatment step 1) protocol, in consideration of its worldwide adoption for practical training. METHODS: The Pi-score algorithm considers time measurement and number of errors from two different repetitions (first and fifth) of the same training task and compares them to the relative task goals, to produce an objective score. Data were obtained from the first edition of 'ART in Flexible Course', during four courses in Barcelona and Milan. Collected data were independently analyzed by the experts for Pi assessment. Their scores were compared for inter-rater reliability. The average scores from all tutors were then compared to the PI-score provided by our algorithm for each participant, in order to verify their statistical correlation. Kappa statistics were used for comparison analysis. RESULTS: Sixteen hands-on training expert tutors and 47 3rd-year residents in Urology were involved. Concordance found between the 16 proctors' scores was the following: Task 1=0.30 ("fair"); Task 2=0.18 ("slight"); Task 3=0.10 ("slight"); Task 4=0.20, ("slight"). Concordance between Pi-score results and proctor average scores per-participant was the following: Task 1=0.74 ("substantial"); Task 2=0.71 ("substantial"); Task 3=0.46 ("moderate"); Task 4=0.49 ("moderate"). CONCLUSIONS: Our exploratory study demonstrates that Pi-score can be effectively adapted to EST s1. Our algorithm successfully provided an objective score that equals the average performance improvement scores assigned by of a cohort of experts, in relation to a small amount of training attempts.

Ensayo estandarizado (ISO 17512) de comportamiento de evitación de suelos contaminados. Efecto del pesticida dimetoato sobre la lombriz de tierra Aporrectodea caliginosa / Standardized avoidance test (ISO 17512) for contaminated soils. Effect of the pesticide dimethoate on the earthworm Aporrectodea caliginosa

La creciente preocupación por el bienestar animal ha propiciado el rechazo por parte de la sociedad a la utilización de animales en experimentación. Por este motivo, actualmente se están desarrollando métodos alternativos que cumplan con el principio de las 3Rs (reemplazar, reutilizar y refinar). Muchos de estos métodos se basan en la utilización de organismos inferiores, como las lombrices de tierra. El presente estudio desarrolla el ensayo estandarizado de la Organización Internacional de Normalización (ISO) 17512-1:2008, en el que se evalúa la toxicidad producida por el plaguicida organofosforado dimetoato en el suelo, utilizando la capacidad de repulsión o evitación que presentan las lombrices de tierra pertenecientes a la especie Aporrectodea caliginosa. Las concentraciones seleccionadas han sido 0,06, 0,3 y 1,5 mg/kg de suelo, ensayada cada una de ellas por triplicado, empleando 10 lombrices por cada réplica. Los resultados reflejan la capacidad de las lombrices de tierra de la especie Aporrectodea caliginosa para evitar suelos contaminados con el formulado comercial de dimetoato. Por otra parte, se confirma la tendencia de las lombrices a evitar el suelo contaminado a medida que aumenta la concentración de plaguicida ensayada, con significación estadística a la dosis más alta empleada (1,5 mg/kg). (AU)

The increasing concern about animal wellness has induced the repulse of society to the use of animals in research. For this reason, alternative methods which comply with the 3Rs principle (Replace, Reuse and Refine) are currently being developed. Many of these methods are based on the use of lower organisms on the evolutionary scale, such as earthworms. The present study develops the standardized test of the International Organization of Standardization (ISO) 17512-1:2008, in which the toxicity produced by the pesticide organophosphate dimethoate in the soil is evaluated, using the capacity of repulsion or avoidance that presents the earthworms Aporrectodea caliginosa. The assayed concentrations were 0.06, 0.3 and 1.5 mg/kg of soil, each one tested in triplicated, using 10 earthworms for each repetition. The results reflect the ability of earthworms of the species Aporrectodea calliginosa to avoid soils contaminated with the commercial formulation of dimethoate. On the other hand, the tendency of worms to avoid contaminated soils is confirmed as the concentration of pesticide increases, with statistical significance at the highest concentration used (1.5 mg/kg). (AU)

Ensayo estandarizado (ISO 17512) de comportamiento de evitación de suelos contaminados II. Respuesta de distintos biomarcadores tras la exposición a dimetoato en la lombriz de tierra Aporrectodea caliginosa / Standardized avoidance test (ISO 17512) for contaminated soils II. Response of different biomarkers after exposure to dimethoate in earthworm Aporrectodea caliginosa

En la primera parte del presente estudio, publicado en 2021, se mostraron los resultados obtenidos al aplicar el ensayo estandarizado de la Organización Internacional de Normalización (ISO) 17512-1:2008. En dicho trabajo se evaluó la toxicidad producida por el plaguicida organofosforado dimetoato en el suelo, utilizando la capacidad de repulsión o evitación que presentan las lombrices de tierra de la especie Aporrectodea caliginosa. En esta segunda parte, para evaluar los efectos subletales producidos por el dimetoato sobre las lombrices, se han determinado como biomarcadores la actividad de la enzima acetilcolinesterasa (AChE, cuya inhibición es el principal mecanismo de acción de este tipo de compuestos) y la actividad glutatión S-transferasa (GST, que comúnmente se activa como mecanismo de detoxificación de plaguicidas). Las concentraciones seleccionadas han sido 0,06, 0,3 y 1,5 mg/kg de suelo, ensayada cada una de ellas por triplicado, empleando 10 lombrices por cada réplica.La actividad AChE se inhibió significativamente en la exposición a las tres concentraciones empleadas. No se ha producido aumento de la actividad GST que, por el contrario, aparece significativamente inhibida a la concentración más alta de plaguicida ensayada. La falta de una inducción de la actividad GST puede deberse a que el mecanismo de detoxificación no se ha puesto en marcha por el corto tiempo de exposición al plaguicida. Estos resultados reflejan la sensibilidad de la AChE como biomarcador de la contaminación de los suelos con organofosforados. (AU)

In the first part of this study, published in 2021, the results obtained when applying the standardized test of the International Organization of Standardization (ISO) 17512-1:2008 were shown. In this study, the toxicity produced by the pesticide organophosphate dimethoate in the soil was evaluated, using the capacity of repulsion or avoidance that presents the earthworms Aporrectodea caliginosa. To evaluate the sublethal effects produced by dimethoate on worms, the activities of the acetylcholinesterase enzyme (AChE, the inhibition of which is the main mechanism of action of this type of compound) and glutathione S-transferase enzyme (GST, which is commonly activated as a pesticide detoxification mechanism) have been determined. The commercial product called DIMAFID40, whose active substance is the organophosphate pesticide dimethoate, was used. The selected concentrations were 0.06, 0.3 and 1.5 mg / kg of soil, each one tested in triplicate, using 10 worms per replicate.The AChE activity was significantly inhibited after exposure to the three assayed concentrations. With respect to GST activity, it was not increased but significantly inhibited after exposition to the highest concentration of pesticide. The non-appearance of an induction of GST activity may be due to the fact that the detoxification mechanism has not been started because the time of exposure to the pesticide has been too short. These results reflect the sensibility of AChE as a biomarker of the contamination in soils with organophosphate. (AU)

Comparative study of esterase activities in different tissues of marine fish species Trachurus trachurus, Merluccius merluccius and Trisopterus luscus.

Pesticides are one of the most frequently anthropogenic xenobiotics detected in water. Among these, the organophosphorus pesticides (OPs) are very widely used in agriculture due to their broad spectrum of activity and their low price, but they also have high potent effects as neurotoxic compounds in non-target organisms. The aim of this study was to evaluate biomarkers acetylcholinesterase (AChE), butyrylcholinesterase (BChE), propionylcholinesterase (PChE) and carboxylesterase (CbE) in the representative Atlantic fish species Trachurus trachurus, Merluccius merluccius and Trisopterus luscus from "Rías Gallegas", a traditional Spanish fishing area. These esterase activities were evaluated in the brain, muscle and liver to determine the most adequate tissue to measure such enzymatic activities. The sensitivity of AChE and CbE activities from different tissues the widely used organophosphorus insecticide chlorpyrifos (CP), and its toxic metabolite (CP-oxon) was also tested. AChE activity was predominant in all tissues of the analysed species (particularly in brain constituting from 78.33%, 89.83% and 88.43% of total ChEs in Trachurus trachurus, Merluccius merluccius and Trisopterus luscus, respectively). Under in vitro exposure, esterases were shown to be highly sensitive to CP and especially to CP-oxon. Moreover, a similar effect observed on AChE and CbE activities could suggest that CbE activity might contribute efficiently against the toxic effects of CP, especially in muscle and the liver. The presence of BChE, PChE and upper CbE activities in muscle and the liver and their OP-sensibilities can be used to study their function in the pesticide biochemical detoxification pathways with a prominent role as a safeguarding mechanism against pesticide toxicity.

Xantogranuloma orbitario del adulto como causa de inflamación palpebral recidivante / Adult orbital xanthogranuloma as a cause of recurrent palpebral swelling

El xantogranuloma orbitario del adulto es un raro trastorno inflamatorio idiopático incluido dentro de las enfermedades xantogranulomatosas orbitarias, con posible asociación a otras condiciones sistémicas. Presentamos el caso de una mujer de 43 años que presentó una masa profunda de crecimiento rápido en el párpado superior derecho con antecedentes de nódulos amarillentos no ulcerativos en el párpado superior, bilaterales, y 2 blefaroplastias superiores previas. Se realizó biopsia-extirpación de la lesión orbitaria anterior, siendo los hallazgos anatomopatológicos compatibles con xantogranuloma histiocítico del adulto. El estudio sistémico fue negativo y la paciente se encuentra asintomática sin tratamiento. Las enfermedades xantogranulomatosas orbitarias constituyen una entidad rara potencialmente grave, por lo que el oftalmólogo debe de estar familiarizado con esta enfermedad para poder realizar un diagnóstico precoz a través de la anamnesis, exploración y la histología de lesiones que en ocasiones pueden simular xantelasmas palpebrales

Orbital adult-onset xanthogranuloma is a rare idiopathic inflammatory disorder included in the group of orbital xanthogranulomatous diseases with possible systemic associations. A 43 year-old woman presented with a deep fast-growing mass on the right upper eyelid. She had a past medical history of bilateral non-ulcerative nodules on the upper eyelid and two cosmetic upper lid blepharoplasties. An excisional biopsy was performed and the histopathology analysis confirmed the diagnosis of adult histiocytic xanthogranuloma. The systemic work up was negative and the patient is asymptomatic without treatment. Orbital xanthogranulomatous diseases are rare, but potentially life-threatening disorders. The ophthalmologist must be aware of this disease in order to make an early diagnosis using the anamnesis, clinical examination, and histology of the periocular lesions that may resemble palpebral xanthelasmas

Adult orbital xanthogranuloma as a cause of recurrent palpebral swelling. / Xantogranuloma orbitario del adulto como causa de inflamación palpebral recidivante.

Orbital adult-onset xanthogranuloma is a rare idiopathic inflammatory disorder included in the group of orbital xanthogranulomatous diseases with possible systemic associations. A 43 year-old woman presented with a deep fast-growing mass on the right upper eyelid. She had a past medical history of bilateral non-ulcerative nodules on the upper eyelid and two cosmetic upper lid blepharoplasties. An excisional biopsy was performed and the histopathology analysis confirmed the diagnosis of adult histiocytic xanthogranuloma. The systemic work up was negative and the patient is asymptomatic without treatment. Orbital xanthogranulomatous diseases are rare, but potentially life-threatening disorders. The ophthalmologist must be aware of this disease in order to make an early diagnosis using the anamnesis, clinical examination, and histology of the periocular lesions that may resemble palpebral xanthelasmas.

Effects of the application of vitamin E and silicone dressings vs conventional dressings on incisional surgical site infection in elective laparoscopic colorectal surgery: a prospective randomized clinical trial.

AIM: To compare the effect of conventional wound dressings (CD) with vitamin E and silicone (E-Sil) dressings on incisional surgical site infection (SSI) in patients undergoing elective colorectal laparoscopic surgery. PATIENTS AND METHODS: A prospective, randomized study was performed. Patients were assigned at random into two groups: an E-Sil group and a CD group. Incisional SSI, postoperative pain and acute phase reactants were investigated. RESULTS: In total, 120 patients were included in this study (60 in each group). The incisional SSI rate was 3.4% in the E-Sil group and 17.2% in the CD group (P = 0.013). Bacteroides fragilis alone grew in the cultures of infected wounds in the E-Sil group, while cultures for infected wounds in the CD group were polymicrobial. Mean postoperative pain 48 h after surgery was 27.1 [standard deviation (SD) 10.7] mm in the E-Sil group and 41.6 (SD 16.9) mm in the CD group (P < 0.001). White blood cell (WBC) count and C-reactive protein (CRP) level were lower in the E-Sil group, even after the exclusion of patients presenting with postoperative complications. CONCLUSION: Use of an E-sil dressing to cover the Pfannestiel wound after elective laparoscopic colorectal surgery leads to a reduction in the incisional SSI rate, lower postoperative pain, and a decrease in CRP level and WBC count.

Desarrollo del ensayo de toxicidad estandarizado OECD nº 207 en lombriz de tierra expuesta al pesticida organofosforado Dimetoato / Development of the OECD standardized toxicity test no. 207 on earthworms exposed to the organophosphorus pesticide Dimethoate

La importancia de los estudios toxicológicos sobre suelos es evidente, y el desarrollo y uso de los ensayos estandarizados para llevarlos a cabo es un campo en constante crecimiento. En el presente trabajo se ha procedido a realizar el ensayo de toxicidad aguda con lombrices de tierra Eisenia foetida de acuerdo con el protocolo estandarizado de la OECD nº 207. La sustancia activa de elección ha sido el insecticida organofosforado dimetoato. A partir de la concentración recomendada por el fabricante del formulado comercial DIMAFID40, y siguiendo el protocolo arriba indicado, se ha realizado una exposición a 5 concentraciones diferentes del pesticida (0,001%; 0,01%; 0,1%; 1%; 10%), estableciéndose además un grupo control. Como primer resultado merece destacar que, a mayor dosis de ensayo del producto, mayor ha sido el porcentaje de mortalidad en los animales, observándose además mayores cambios fisio-patológicos en los animales expuestos. Dichos cambios no fueron evidentes en todos los grupos de animales, si bien fueron progresivos y cada vez más claros a medida que aumentaba la concentración de pesticida. La Concentración Letal Media (CL50) del ensayo coincidió con la concentración recomendada por el fabricante, estableciéndose en 0,1%. Por su parte, el Nivel sin efecto observable (NOEL), de gran relevancia ambiental, se alcanzó a una concentración diez veces inferior a la concentración recomendada por el fabricante

It is evident the relevance of toxicological studies on soils, and the development and use of standardized tests to carry them out is a field in constant growth. In the present work, the acute toxicity test with Eisenia foetida earthworms has been performed according to the standardized protocol of the OECD nº 207. The active substance of choice has been the organophosphate insecticide Dimethoate. Starting from the concentration recommended by the manufacturer of the commercial formulation DIMAFID40, an exposure to 5 different concentrations of the pesticide (0.001%; 0.01%; 0.1%; 1%; 10%) was performed, also establishing a control group. As a first result, it is worth mentioning that, the higher the test dose of the product, the higher the percentage of mortality in the animals. Furthermore, major physical-pathological changes were observed in exposed animals. These changes were not evident in all groups of animals, although they were progressive and clearly increasing as the concentration of pesticide raised. The lethal Media Concentration (LC50) of the trial coincided with the concentration recommended by the manufacturer, being set at 0.1%. Moreover, the level with no observed effect (NOEL), of great environmental relevance, was reached at a concentration ten times lower than the concentration recommended by the manufacturer

Concentrations of chlorinated pollutants in adipose tissue of yellow-legged gulls (Larus michahellis) from Spain: Role of gender and age.

Concentrations of 7 different polychlorinated biphenyl (PCB) congeners, and eleven organochlorine pesticides (OCPs) and metabolites, including DDTs (dichlorodiphenyltrichloroethane), HCHs (hexachlorocyclohexane isomers), Endosulfan, Endosulfan sulfate, Endrin, Dieldrin and HCB (hexachlorobenzene), were determined in adipose tissue of 57 yellow-legged gulls collected from NW and N Spain. Furthermore, the possible differences due to two endogenous factors, age and gender, were determined. All the analyzed PCBs were detected in over 66% of the samples, with levels of 291.9 (PCB 180), 34.5 (PCB 118), 0.7 (PCB 28), 432.6 (PCB 153), 225.5 (PCB 138), 1.3 (PCB 101) and 0.4 (PCB 52) µg/kg of adipose tissue. With respect to the OCPs and metabolites, only 4,4'-DDE and HCB were detected in more than 50% of the samples, with means of 360.6 and 2.5 µg/kg of adipose tissue, respectively. From all the considered contaminants, only 4,4'-DDE levels presented significant differences depending on the gender, with females showing higher values than males (p < 0.01). Significant differences (p < 0.001) were also found related to age for the levels of PCBs 180, 138, 101, 28 and 153, as well as 4,4'-DDE, with adult levels being higher than those in young birds. The results of the present study constitute a baseline to better assess the environmental impacts of PCB and OCP contamination at other coastal sites for future biomonitoring studies, with particular emphasis on gender- and age-related differences.

Efectos in vivo e in vitro del insecticida organofosforado diazinón en la actividad colinesterasa del sistema nervioso de conejos (Orictolagus cuniculus) / In vivo and in vitro effects of the organophosphorus insecticide diazinon on the cholinesterase activity of the rabbit (Orictolagus cuniculus) nervous system

En el presente estudio se investigó la sensibilidad de la actividad colinesterasa del sistema nervioso del conejo (Orictolagus cuniculus) al insecticida diazinón tanto in vivo como in vitro. En el ensayo in vivo, los animales fueron expuestos oralmente a dosis únicas de diazinón (25 o 125 mg/kg) y tras 10 días fueron sacrificados para obtener el cerebro, el cerebelo y la médula espinal. En ellos se determinó la actividad colinesterasa con el fin de conocer sus valores basales en conejo (grupo control) al igual que el potencial de inhibición in vivo originado por exposición a este pesticida (grupos expuestos). Los valores basales de actividad colinesterasa, usando la acetiltiocolina como sustrato, fueron 258.5 ± 38.0, 242.4 ± 32.0 y 235.1 ± 27.2 nmol/min.mg proteínas para el cerebro, el cerebelo y la médula espinal, respectivamente. En los grupos expuestos a diazinón no se observó inhibición de la actividad colinesterasa en comparación con la actividad del grupo control. En el ensayo in vitro se expusieron homogeneizados de los tres tejidos nerviosos de conejos control a distintas concentraciones de diazinón (0.025, 0.05, 0.1, 0.2 y 0.4 mg/l). La actividad colinesterasa permaneció constantemente deprimida en relación concentración y tiempo dependiente a lo largo del periodo experimental (30 minutos, 9, 24 y 48 horas) en todos los tejidos evaluados. La Concentración Inhibitoria Media (CI50) de la actividad AChE para el diazinón se estimó en 0.154, 0.138 y 0.159 mg/l para el cerebro, el cerebelo y la médula espinal, respectivamente. Se concluye la necesidad de establecimiento de una actividad basal o de referencia en cada laboratorio cuando se pretenda utilizar esta actividad con fines diagnósticos de exposición a plaguicidas anticolinesterásicos (AU)

In the current study, the in vivo and in vitro sensitivity of nervous system cholinesterase activity to pesticide diazinon in rabbits (Orictolagus cuniculus) was investigated. In the in vivo assay, animals were orally exposed to single doses of diazinon (25 or 125 mg/kg) and after 10 days were sacrificed to obtain the brain, cerebellum and spinal cord. The cholinesterase activity in these tissues was determined to know its basal values in rabbits (control group) as well as the potential in vivo inhibition caused by exposure to this pesticide (exposed groups). The basal values of cholinesterase activity were 258.5 ± 38.0, 242.4 ± 32.0 and 235.1 ± 27.2 nmol/min.mg protein to brain, cerebellum and spinal cord,respectively, using acetylthiocholine as substrate. No inhibition of cholinesterase activity in the exposed groups compared with the control group was observed at the end of the assay. In the in vitro assay, the supernatants of the homogenized of tissues were exposed to 0.025, 0.05, 0.1, 0.2 and 0.4 mg/l of diazinon. The cholinesterase activity remained steadily depressed in a concentration and time dependent relationship throughout the experimental period (30 minutes, 9, 24 and 48 hours) in all tissues assessed. The Mean Inhibitory Concentration (IC50) of cholinesterase activity to diazinon was estimated in 0.154, 0.138 and 0.159 mg/l to brain, cerebellum and spinal cord, respectively. To determine a basal activity in each laboratory is necessary to use this enzymatic activity for diagnostic purposes of exposure to anticholinesterase pesticides (AU)

Eventos adversos en pacientes hospitalizados reportados por enfermería: un estudio multicéntrico en México / Nursing reported hospitalized patients adverse events: A multi-centric study in Mexico / Eventos adversos em pacientes hospitalizados relatados por enfermagem: um estudo multicéntrico no México

Introducción: Los eventos adversos (EA) son un daño no intencionado derivado de la atención sanitaria que se relacionan con los recursos humanos, los factores del sistema o las condiciones clínicas del paciente. Objetivo: Analizar factores relacionados con la calidad y la seguridad del paciente a través de los reportes de EA. Metodología: Diseño transversal, multicéntrico, realizado en 5 institutos nacionales de salud y en un hospital de alta especialidad, se estudiaron los EA ocurridos durante 18 meses, para lo cual se utilizó el instrumento SYREC 2007; análisis descriptivo y evaluación de asociación entre grado de evitabilidad y factores intrínsecos, extrínsecos y del sistema; se observaron los aspectos éticos vigentes. Resultados: Se analizaron un total de 540 EA, ocurrieron 55.5% en hombres, 58.7% estaban en estado de alerta, el 92.6% de los EA ocurrió en el servicio asignado, el 55.9% no se reportó a la familia, se consideró sin duda como evitable en el 70.5%, los factores del sistema estuvieron presentes en 80.6%, hubo asociación significativa entre estos y la evitabilidad del suceso. Discusión: Los principales resultados encontrados son coincidentes con otras investigaciones internacionales tales como: To err is human 1999, el estudio ENEAS de España 2006 y con el de prevalencia IBEAS 2010; en todos ellos se hizo evidente la necesidad de reforzar la cultura de la notificación de los EA y el clima para la seguridad del paciente, además de promover una reflexión interpersonal acerca de la calidad de los servicios asistenciales. Conclusiones: Los factores relacionados con el sistema tienen un mayor peso en la aparición de EA. Es de vital importancia su identificación a fin de poder evitarlos.

Introduction: Adverse events (AE) are unintended harms derived from human health attention, system factors, or clinical conditions in the patients. Objective: To analyze factors influencing the quality of patient healthcare and safety through the review of diverse records on AEs. Methodology: This transversal and multi-centric design study was carried out in five National Institutes of Health and a high specialty hospital. AEs in an 18 month period were studied using the SYREC 2007 instrument. Descriptive analysis, as well as assessments on the association between the preventability degree and the intrinsic, extrinsic, and system factors were all performed. Current ethical issues were observed. Results: A total of 540 AEs were analyzed; 55.5% occurred in men; 58.7% occurred during state of alertness; 92.6% occurred at the assigned service; 55.9% were not reported to the families; 70.5% were considered preventable; and system factors were present in 80.6% of them. A significant association between the AEs and the possibility to prevent them was found. Discussion: The main findings were consistent with those of other international studies including: ''To err is human'', 1999, the ENEAS study in Spain, 2006, and the IBEAS prevalence study, 2010. All of these studies emphasize the need to strengthen the culture of AE-notifying and to improve the patient safety climate, as well as to promote inter-personal reflections on to the quality of care services. Conclusions: System-related factors have the strongest influence on the occurrence of AEs, and thus, their identification becomes critical in order to enhance the quality of healthcare services.

Introdução: Os Eventos Adversos (EA) são um dano não intencionado derivado da atenção sanitária que se relaciona com os recursos humanos, os fatores do sistema ou as condições clínicas do paciente. Objetivo: Analisar fatores relacionados com a qualidade e a segurança do paciente a través dos relatórios de EA. Metodologia: Desenho transversal, multicéntrico, realizado em cinco Institutos Nacionais de Saúde e um hospital de alta especialidade, estudaram-se os EA ocorridos durante 18 meses, para o qual se utilizou o instrumento SYREC 2007; análise descritiva e avaliação de associação entre grau de evitabilidade e fatores intrínsecos, extrínsecos e do sistema; observaram-se os aspectos éticos vigentes. Resultados: Analisaram-se um total de 540 EA, ocorreram 55.5% em homens, 58.7% estavam em estado de alerta, o 92.6% o EA aconteceu no serviço assignado, o 55.9% não se informou à família, considerou-se sem dúvida como evitável no 70.5%, os fatores do sistema estiveram presentes em 80.6%, houve associação significativa entre estes e a evitabilidade do evento. Discussão: Os principais resultados encontrados são coincidentes com outras pesquisas internacionais tais como: ''To err is human'' 1999, o estudo ENEAS da Espanha 2006 e com o de prevalência IBEAS 2010; em todos eles se fez evidente a necessidade de reforçar a cultura da notificação dos EA e o clima para a segurança do paciente, além de promover una reflexão interpessoal acerca da qualidade dos serviços assistenciais. Conclusões: Os fatores relacionados com o sistema têm um maior peso na aparição de EA. É de vital importância sua identificação a fim de poder evitá-los.

Does gender influence the levels of heavy metals in liver of wild boar?

The aim of this study was to determine heavy metal reference levels for risk assessment studies. For this purpose, the levels of lead, cadmium, copper and zinc were determined in liver tissues of wild boars sampled in NW Spain. The mean values were 0.383, 0.326, 23.50 and 56.86mg/kg dried weight, respectively. In general, the levels detected were similar to or lower than the levels reported in literature. This study not only provides a useful baseline for biomonitoring the levels of the analyzed contaminants in wildlife in NW Spain, it also helps to understand the effects of gender on the levels of these elements. Similar to studies performed in other geographical regions, no significant gender-related differences could be detected. Although differences were not significant, the levels of zinc, cadmium and lead were modestly higher in males (55.78, 0.346 and 0.424mg/kg, respectively) compared to females (45.25, 0.305 and 0.341mg/kg). Our results indicate that, although gender did not significantly affect heavy metal uptake and toxicokinetics of contaminants in wild boars, these effects could vary between species, populations, organs, and elements. It is therefore essential to investigate gender-related differences for each species.