Assessment of two-year clinical outcomes after keratoconus treatment using two different crosslinking protocols.

OBJECTIVE: This study aims to compare the long-term outcomes of standard corneal collagen crosslinking with accelerated corneal collagen crosslinking (CXL) for progressive keratoconus. PATIENTS AND METHODS: This prospective, comparative study included 79 eyes with progressive keratoconus, which were randomly assigned: 42 eyes received a standard CXL procedure, and 37 eyes were treated with the accelerated CXL protocol. We evaluated the following parameters, before the procedure and 1 month, 6 months, 12 months and 24 months postoperatively: best corrected visual acuity (BCVA), manifest refraction spherical equivalent (MRSE), cylindrical values, corneal dioptric powers on the steepest meridian (Kmax), central corneal thickness (CCT); demarcation line depth (DLD) preoperatively and 1 month after the CXL procedure. RESULTS: The BCVA, MRSE, cylindrical values, Kmax, CCT improved significantly, after both the accelerated and the standard CXL procedure. Throughout the 24-months follow-up, BCVA improvement was achieved sooner in the accelerated group (after 1 month, vs. after 3 months). However, there were no statistically significant differences between the two groups in these aspects. The DLD-to-CCT was significantly greater in the standard group (66% vs. 62%, p = 0.02). CONCLUSIONS: Standard and accelerated CXL are effective in stabilizing keratoconus progression in the long term. In clinical practice, the accelerated protocol has the added benefit of a faster visual recovery, in addition to the known reduced treatment time and increased comfort.

[Etiology of ventilator-associated pneumonia at the Cardiovascular Surgery Clinic of Iasi]. / Etiologia pneumoniei asociata ventilatiei mecanice la clinica de chirurgie cardiovasculara din Iasi.

AIM: We want to assess the etiology of ventilator-associated pneumonia (VAP) and emergence of resistant phenotypes for greater efficiency of the first-line antimicrobial treatment post-cardiac surgery. The study focuses on patients with VAP post-cardiac surgery at the Institute of Cardiovascular Surgery between April 2nd 2002 and August 27th 2008, divided in two groups, before and after June 14th, 2005. MATERIAL AND METHODS: The tracheal aspirates were examined quantitatively (microscopy, culture). The isolates with clinical significance (> or = 106 CFU/mL) were identified by standard methods and tested by disk difussion or with the breakpoints method for susceptibility to antibiotics. RESULTS: Among the 1527 operated patients, 28 of them were diagnosed with VAP through the clinical pulmonary infection score > or = 6. The 9 most common pathogens in VAP etiology were Pseudomonas aeruginosa 23.81%, Acinetobacter baumannii 19.05%, Stenotrophomonas maltophilia 11.91%, Candida albicans 9.53%, while Klebsiella pneumoniae, Escherichia coli, Staphylococcus aureus, Corynebacterium striatum/amycolatum, Pneumocystis jirovecii amounted 4.76% each. Acinetobacter baumannii and S.maltophilia appear starting with June 15th, 2005. From that moment on we isolated with a higher frequency the gram-negative bacilli which produce extended-spectrum beta-lactamases 15.62%, with multidrug resistance (MDR) 46.86%. The MDR phenotype was more frequent at A.baumannii (15.62%), S. maltophilia (15.62%) and P. aeruginosa (12.50%) compared to K .pneumoniae (3.12%) or E. coli (0%). Methicillin-resistant S. aureus was isolated with a 6.25% frequency. CONCLUSIONS: The most common etiologic agents of ventilator-associated pneumonia post-cardiac surgery are Pseudomonas aeruginosa, Acinetobacter baumannii, Stenotrophomonas maltophilia and Candida albicans. The large use of antibiotics selects infectious agents with intrinsic resistance and multiresistant