A Case of Sterile Corneal Stromal Infiltration with Hypotonic Maculopathy Under Brimonidine Treatment.

INTRODUCTION: Brimonidine is a commonly used drug for glaucoma treatment, which has been linked to ocular autoimmune disorders like uveitis and conjunctivitis. Corneal pathology under brimonidine is generally less common. CASE DESCRIPTION: Here, we report a 78 -year-old male patient suffering from immune corneal stromal inflammation with hypotony and resulting hypotonic maculopathy after 6 weeks after introduction of brimonidine treatment. Systemic work-up for system autoimmune and infectious diseases was negative. We discontinued brimonidine and administered topical prednisolone under which inflammatory corneal signs and intraocular pressure normalized. Chorioretinal folds persisted after 9 months. CONCLUSION: Our case report suggests monitoring patients under brimonidine for sterile corneal infiltration.

Monitoring therapy in anterior necrotizing scleritis with inflammation with anterior segment optical coherence tomography.

INTRODUCTION: Early diagnosis and initiation of immunosuppression can prevent the necessity of surgical intervention in necrotizing scleritis with inflammation and lowers the risk of perforation and loss of vision. However, clinical signs for early diagnosis and methods for monitoring response to immunosuppressive therapy are missing. METHODS: Here, we present a case of necrotizing scleritis with inflammation where avascular plaques precede scleral defects. We use slit lamp imaging and anterior segment optical coherence tomography to evaluate evolution lesions depth and impact on scleral structure. RESULTS: The patient presented 5 months after detection of avascular plaques with a new scleral ulcer of the left eye. After 3-day-administration of i.v. corticosteroids anterior segment optical coherence tomography showed progressive scleral thickening. The patient was therefore spared surgical intervention and discharged resulting in complete remission under decreasing doses of oral corticosteroids. CONCLUSIONS: Avascular plaques can precede necrotizing scleritis with inflammation by several months and may therefore qualify as early clinical signs. Anterior segment optical coherence tomography enables objective evaluation of scleral structure for making rational decisions about surgical intervention.

Proyecto de cooperación sanitaria en Kamuzu Central Hospital (Malawi) / A healthcare cooperation project in Kamuzu Central Hospital (Malawi)

Malawi es un país africano que cuenta con un 44% de población pediátrica (menores de 15 años). Es el país con menos personal médico y enfermero titulado por habitante del mundo, uno de los más pobres y con una de las tasas de mortalidad infantil más altas del planeta. En este contexto surge un proyecto de cooperación que persigue desde 2008 reducir la mortalidad infantil, con el trabajo formativo-asistencial de equipos de Enfermería y Pediatría que se desplazan hasta el hospital terciario de referencia Kamuzu Central Hospital (KCH) durante varios meses al año. Para optimizar la asistencia pediátrica de los hasta 3.000 ingresos mensuales, en el KCH se han implantado diversas medidas como establecer un sistema de triaje, ubicación de los pacientes según criterios de gravedad, optimización de la antibioterapia e implantación de mejoras en el manejo de la patología respiratoria. Se han observado en los últimos años drásticos descensos de mortalidad en menores de 5 años, fundamentalmente en las primeras horas de ingreso, así como un marcado incremento de la esperanza de vida poblacional. La asistencia pediátrica en Malawi (KCH) progresa con gratificantes y esperanzadores resultados, aportando a los profesionales de Enfermería y Pediatría que se implican una formación humana y profesional incomparable. La constancia y continuidad del proyecto de cooperación es una gran oportunidad de mejora para la Pediatría, la supervivencia infantil en Malawi y para el aprendizaje y desarrollo de todos los profesionales que lo llevan a cabo.(AU)

Malawi is an African country with 44% of paediatric population (<15-year-old). It is the country with the lowest medical and nursing qualified staff per inhabitant in the world, one of the poorest and with one of the highest paediatric mortality rates in the planet. In this setting, a cooperation project was set up in 2008, with the goal to reduce child mortality, through the training-care work by Nursing and Paediatric teams who travelled to Kamuzu Central Hospital (KCH), a Third-Level Hospital of Reference, during some months per year. In order to optimize the paediatric care of the almost 3,000 patients admitted per month, different measures have been implemented at the KCH, such as establishing a triage system, classifying patients according to severity criteria, optimization of antibiotic therapy, and implementation of improvements in the management of respiratory conditions. In recent years, a dramatic reduction in mortality for <5-year-olds has been observed, particularly during the first hours after admission, as well as a pronounced increase in the life expectancy of the population. Paediatric care in Malawi (KCH) keeps progressing with rewarding and hopeful outcomes, providing an unmatched human and professional training to those Nursing and Paediatric professionals involved. The consistency and continuity of the cooperation project represents a major opportunity for the improvement of Paediatrics, child survival in Malawi, and training and development for all professionals involved.(AU)

Neumorraquis postraumático masivo con afectación global del raquis / Massive traumatic pneumorrhachis involving the entire spinal canal

No disponible

Malformación congénita grave de la columna cervical / Severe congenital malformation of the cervical spine

No disponible

Sistemas de presión positiva continua de la vía aérea en países socioeconómicamente diferentes / Continuous Positive Airway Pressure Systems in patients with socio-economic differences

Para las autoras de este trabajo, la experiencia en el Kamuzu Central Hospital (KCH) de Malawi, país en vías de desarrollo, les sirvió para poder hacer una comparativa entre el uso de sistemas de mantenimiento de presión positiva continua de la vía aérea (CPAP) empleados en ese hospital con muy pocos recursos, y el uso de los mismos en los centros hospitalarios españoles con buenos recursos en los que trabajan normalmente. El objetivo del presente trabajo es plantear las diferencias que se pueden encontrar en el afrontamiento de esta patología entre un país desarrollado y un país con bajos recursos, así como dar a conocer la forma en que el déficit de material y la escasa economía destinada a la sanidad agudiza el ingenio y fomenta la elaboración de métodos alternativos, siendo estos eficaces en el tratamiento de enfermedades como la neumonía, patología de alta prevalencia en las urgencias pediátricas. La principal conclusión fue que el uso del CPAP "casero" es eficaz en el tratamiento de la neumonía: se observó mejoría tras su uso en la mayoría de los casos, ofreciendo unos resultados favorables

The experience in the Kamuzu Central Hospital (KCH) in Malawi, a developing country, was useful to the writers of this article, in order to compare the use of Continuous Positive Airway Pressure Systems (CPAPs) in this hospital with very little resources, and their use in Spanish hospitals with good resources, where they usually work. The objective of this article is to outline the differences which can be found, when facing this condition, between a developed country and a country with low resources, as well as to report the way in which lack of materials and low economic resources for healthcare leads to ingenuity and encourages the use of alternative methods, which are effective in the treatment of diseases such as pneumonia, a condition highly prevalent in paediatric emergencies. The main conclusion was that the use of "home" CPAP is effective in the treatment of pneumonia: an improvement was observed after its use in the majority of cases, with favourable outcomes