Intraocular pressure values during the water drinking test in a Colombian population / Comportamiento de la presión intraocular durante la prueba de sobrecarga hídrica en población colombiana

Background: Intraocular pressure (IOP) peaks are key factors on the onset and progression of glaucoma. The water drinking test (WDT) detects IOP fluctuations and estimates the maximum IOP. Objective: To assess the IOP variations during the WDT in patients diagnosed or suspected of glaucoma treated at an ophthalmology clinic. Methods: This is an observational, descriptive, and retrospective study, using clinical records of patients whom underwent the WDT between January 2017 and August 2019. Results: The study included 300 eyes. The WDT was positive in 23.3% of the eyes. Basal IOP at 15, 30, and 45 min, as well as the maximum pressure, presented a similar mean, median, and mode, as well as a varying coefficient without much variability. The negative test group had a maximum IOP of 18.9 mmHg, compared with 20.3 mmHg in the positive test group. Conclusion: In a Colombian cohort of patients with diagnosed or suspected glaucoma whom underwent a WDT, 23.3% had positive result. 90% of the tests were positive at the 30-min interval. This test is a complementary tool in the follow-up of patients with glaucoma.

Introducción: Los picos de presión intraocular son factores importantes para la aparición y progresión del glaucoma. La prueba de sobrecarga hídrica permite detectar fluctuaciones de presión intraocular y estimar la presión máxima. Objetivo: Evaluar las variaciones en la presión intraocular durante la prueba de sobrecarga hídrica en pacientes de una clínica oftalmológica. Métodos: Estudio observacional, descriptivo, retrospectivo de revisión de historias clínicas de pacientes sometidos a la prueba de sobrecarga hídrica entre enero de 2017 y agosto de 2019. Resultados: Se incluyeron 300 ojos. La prueba de sobrecarga hídrica fue positiva en el 23,3% de los ojos. La presión intraocular basal, a los 15, 30 y 45 min, al igual que la presión máxima, tuvieron una media, mediana y moda similares, con un coeficiente de variación sin mucha variabilidad. El grupo con resultados negativos tuvo una presión intraocular máxima de 18,9 mmHg comparado con 20,3 mmHg del grupo con resultados positivos. Conclusión: En una cohorte colombiana de pacientes con diagnóstico o sospecha de glaucoma quienes se les realizó la prueba de sobrecarga hídrica, el 23,3% tuvo resultados positivos. El 90% de las pruebas fueron positivas en el intervalo de 30 min. Esta prueba es una herramienta complementaria en el seguimiento de pacientes con glaucoma.

Splitting test experimental dataset of hollow concrete blocks.

Masonry structures are widely used nowadays for their advantages like low-cost workmanship, efficiency and fast construction techniques. The compressive strength of the materials that compose masonry (block and mortar) is very important to the behavior of the system, but the tensile strength is even more significant for the standards and building codes. In this work, a dataset for indirect tensile tests of hollow concrete blocks is obtained. Splitting tests as described in ASTM C-1006-13 are applied. Two sets of blocks were tested, one with medium compressive strength and the other with high compressive strength. The first set was tested in three directions named A, B, and C; the second one was tested in two directions, A and B. The data was collected with a servo-hydraulic machine. The data is presented in tables and can be used by material researchers, as well as in numerical modeling.

Caracterización de pacientes con enfermedad de ojo seco en una institución de referencia en la ciudad de Medellín, Colombia / Characterization of patients with dry eye disease from distinguished ophthalmology clinic in Medellín, Colombia

Introducción: La enfermedad de ojo seco ha sido definida como una entidad multifactorial en la cual se pierde la homeostasis de la película lagrimal. Objetivo: Caracterizar a los pacientes con enfermedad de ojo seco atendidos en la unidad de ojo seco de la Clínica de Oftalmología Sandiego. Materiales y métodos: Estudio observacional, descriptivo, de cohorte retrospectiva. Se documentaron pruebas cualitativas, cuantitativas, cuestionario OSDI y tipo de ojo seco de los pacientes que consultaron en el periodo de marzo de 2016 a diciembre de 2017 con diagnóstico confirmado de enfermedad de ojo seco. Resultados: En 107 pacientes se confirmó el diagnóstico de ojo seco, 80.4% fueron mujeres. La mediana de edad fue 53 años (38-69). El 64.5% tenía ojo seco evaporativo, 12.2% acuodeficiente y 23.4% mixto. El OSDI fue mayor a 33 en 67 pacientes. La osmolaridad lagrimal y la MMP-9 estuvieron alteradas en 78.5 y 76.6%, respectivamente. Conclusión: La realización de pruebas clínicas, laboratorio y cuestionarios de síntomas, permiten realizar el diagnóstico integral de la enfermedad ojo seco según las recomendaciones del DEWS II, apoyando la clasificación del mismo, reconocimiento de factores de riesgo y planteamiento de posibles etiologías que ayudan en el tratamiento.

ackground: Dry eye disease has been defined by DEWS II as a multifactorial entity in which tear film homeostasis is altered. Objective: To characterize patients with dry eye disease evaluated in the dry eye unit of Clínica de Oftalmología Sandiego. Materials and methods: Observational, descriptive, retrospective cohort study. Information was collected from patients who consulted the dry eye unit in the period from March 2016 to December 2017 and who were diagnosed with dry eye disease. The results of qualitative and quantitative tests, as well as the dry eye symptoms questionnaire, were documented.

Tendencia de publicación de ensayos clínicos con resultados negativos financiados por industrias farmacéuticas durante el periodo 2007-2012 / Publication Trend of Clinical Trials with Negative Results Funded by Pharmaceutical industries for the 2007-2012 Period / Tendência de publicação de ensaios clínicos com resultados negativos financiados por indústrias farmacêuticas durante o período 2007-2012

Objetivo: Evaluar los resultados de ensayos clínicos financiados por la industria farmacéutica durante el periodo 2007-2012 en una revista médica general. Materiales y métodos: Se realizó un estudio observacional de corte transversal donde se revisaron ensayos clínicos originales financiados por la industria farmacéutica publicados entre el año 2007 y 2012 en la revista The New England Journal of Medicine (http://www.nejm.org). Se empleó la prueba de χ² de tendencia para evaluar los resultados de los estudios a través de los años. Se creó una base de datos con las diferentes variables, identificando el número de publicaciones y el periodo de mayor publicación de estudios negativos así como la especialidad médica e industria farmacéutica financiadora. Resultados: Se analizaron 321 ensayos clínicos. Se calculó el Odds Ratio para cada año evaluado, encontrando un χ² de tendencia lineal en estudios negativos de 2,91 con valor p 0,08 y en los estudios positivos de 1,16 con valor p 0,28. Se encontró que en el periodo 2007-2009 se publicaron 123 estudios, de los cuales el 40 % presentaron resultados negativos; a diferencia del periodo 2010-2012 en el cual se publicaron 198 ensayos clínicos, de los cuales 142 presentaron resultados negativos. OR 1,68 IC 95 % (1,02-2,78) valor p 0,03. El mayor año de publicación de estudios negativos fue el 2007 con 44,7%. Conclusiones: Se ha visto una disminución progresiva en el número de publicaciones con resultados negativos en general por año. No se encontró una diferencia estadísticamente significativa en la publicación de estudios negativos por año entre el período 2007-2012. La especialidad médica con mayor número de publicaciones totales y negativas en los dos periodos fue cardiología y las industrias farmacéuticas que más patrocinaron ensayos clínicos totales y con resultados negativos en los dos periodos fueron Merck, Glaxo SmithKline y Sanofi-Aventis. El 50 % de las publicaciones de neurología mostraron resultados negativos.

Objective: To evaluate the results of clinical trials financed by the pharmaceutical industries during the period 2007-2012 in a general medical journal. Materials and methods: We performed an observational cross sectional study where originals clinical trials financed by the pharmaceutical industry published between 2007 and 2012 in the journal The New England Journal of Medicine (http://www.nejm.org) were reviewed. Trend χ² test was used to evaluate the results of studies over the years. A database was created with different variables, identifying the number of publications and the period of greater publishing negatives studies, as well as the medical specialty and pharmaceutical industry funding. Results: 321 clinical trials were analyzed. The Odds Ratio was calculated for each year evaluated, finding a χ²of linear trend in negatives studies of 2.91 with value p 0.08 and positive studies of 1.16 with value p 0.28. It was found that in the period 2007-2009 123 studies were published, 40% of which presented negative results; unlike the 2010-2012 period in which 198 clinical trials where published, 142 of them, showed positive results, OR 1.68, 95 % CI (1.02-2.78) value p 0.03. The highest figures of negative results were published in 2007: 44.7 %. Conclusions: A progressive decrease in the number of publications with annual general negative results has been observed. A statistically significant difference in the publication of negative studies per year was not found between the periods 2007-2012. The medical specialty that showed the largest number of total and negative publications in both periods was cardiology. The pharmaceutical industry that sponsored most total clinical trials with negative results in both periods did so through Merck, Glaxo SmithKline, and Sanofi-Aventis. 50 % of neurology publications showed negative results.

Objetivo: avaliar os resultados de ensaios clínicos financiados pela indústria farmacêutica durante o período 2007-2012 em uma revista médica geral. Materiais e métodos: realizou-se um estudo observacional de corte transversal onde revisaram-se ensaios clínicos originais financiados pela indústria farmacêutica publicados entre o ano 2007 e o ano 2012 na revista The New England Journal of Medicine (http://www.nejm.org). Empregou-se o teste do χ²de tendência para avaliar os resultados dos estudos através dos anos. Criou-se uma base de dados com as diferentes variáveis, identificando o número de publicações e o período de maior publicação de estudos negativos assim como a especialidade médica e indústria financiadora. Resultados: analisaram-se 321 ensaios clínicos. Calculou-se o Odds Ratio para cada ano avaliado, encontrando um χ² de tendência lineal em estudos negativos de 2,91 com valor p 0,08 e nos estudos positivos de 1,16 com valor p 0,28. Encontrou-se que no período 2007-2009 se publicaram 123 estudos, dos quais o 40% apresentaram resultados negativos; ao contrário do período 2010-2012 no qual se publicaram 198 ensaios clínicos, dos quais 142 apresentaram resultados negativos 1,68 IC 95% (1,02-2,78) valor p 0,03. O ano com maior quantidade de publicações de estudos negativos foi 2007 com 44,7%. Conclusões: Tem-se identificado uma diminuição progressiva no número de publicações com resultados negativos em geral por ano. Não se encontrou uma diferença estatisticamente significativa na publicação de estudos negativos por ano entre o período 2007-2012. A especialidade médica com maior número de publicações totais e negativos nos dois períodos foi cardiologia e as indústrias farmacêuticas que mais patrocinaram ensaios clínicos totais e com resultados negativos nos dois períodos foram Merck, Glaxo SmithKline e Sanofi-Aventis. O 50% das publicações de neurologia mostraram resultados negativos.

Standing hand-assisted laparoscopic ovariectomy in 65 mares.

OBJECTIVE: To review the efficacy and safety of unilateral ovariectomy by use of a standing hand-assisted laparoscopic approach and evaluate the effect of ovary size on posttransection hemorrhage after application of a linear stapling device. STUDY DESIGN: Case series. ANIMALS: Horses (n=65) aged 2-20 years. METHODS: Medical records of mares that had ovariectomy performed by use of a standing hand-assisted laparoscopic approach were reviewed. Data retrieved were signalment, ovary removed (left, right), ovarian size, ovarian pathology, intraoperative and postoperative complications, and length of hospitalization. RESULTS: Mean ovarian diameter was 17 cm. Histopathology (52 mares) confirmed 41 granulosa cell tumors (79%), 8 ovarian cysts (15%), 1 teratoma (2%), and 2 ovaries (4%) without abnormalities. Hemorrhage was observed laparoscopically in 16 mares after transection of the mesovarium. Complications encountered during surgery included 1 mare collapsing in the stocks and 1 mare that hemorrhaged excessively from the incision. Postoperative complications included 2 cases of mild colic. Overall complication rate was 6%. CONCLUSIONS: All attempts to remove the target ovary were successful. The approach is safe for the mare, as complications encountered were similar to those recently reported for other approaches.

Standing surgical removal of inspissated guttural pouch exudate (chondroids) in ten horses.

OBJECTIVE: To report use of a modified Whitehouse approach in standing horses for management of inspissated guttural pouch empyema. STUDY DESIGN: Retrospective study. ANIMALS: Adult horses (n=10) with guttural pouch empyema. METHODS: Inspissated exudate in 1 or both guttural pouches was removed surgically through a modified Whitehouse approach, with the horses standing and sedated. Medical records of affected horses were reviewed to determine history; physical, endoscopic, and radiological examination findings; surgical technique; complications, and outcome. RESULTS: All horses had purulent nasal discharge; 3 horses had dysphagia, 2 had recurrent laryngeal neuropathy on the side affected by guttural pouch empyema, and 1 had persistent soft palate displacement. Inspissated exudate was removed safely without causing apparent discomfort. Eight horses returned to their previous level of athletic activity after surgery; 1 horse dysphagic before surgery, was euthanatized because of persistent dysphagia after surgery, and 1 horse died 1 week after surgery for unknown reasons. Streptococcus equi subsp equi was isolated from the affected guttural pouch of 3 horses. CONCLUSIONS: Inspissated exudate can be removed surgically from the guttural pouch in standing horses through a modified Whitehouse approach. CLINICAL RELEVANCE: To eliminate risks associated with general anesthesia and avoid surgical suite contamination, removal of chondroids can be performed in standing sedated horses through a modified Whitehouse approach.

Púrpura fulminans asociada al embarazo / Pregnancy-associated purpura fulminans (PF)

La púrpura fulminans (PF) es una enfermedad cutánea purpúrica aguda asociada a un síndrome de coagulación intravascular diseminada (CID). Sus causas conocidas incluyen infecciones virales y bacterianas así como trombofilias. Es sabido que durante el embarazo existen alteraciones en los mecanismos hemostáticos; sin embargo, no se ha demostrado que estos fenómenos por sí solos ayuden al desarrollo de la PF.Se describe el caso de una mujer de 22 años, quien tuvo PF en circunstancias inusuales tales como el desarrollo de su cuadro durante el embarazo y el origen probable en una infección por E. coli. Se presentan los hallazgos clínicos, las intervenciones médicas y quirúrgicas y el desenlace. La paciente sobrevivió pero hubo necesidad de amputarle las falanges distales de tres artejos del pie izquierdo.

PF is a serious cutaneous purpuric disease, associated with an intravascular disseminated coagulation syndrome. Among its known causes, besides those of thrombophilia, are viral and bacterial infections, mostly Neisseria meningitidis. During pregnancy there are alterations in the hemostatic mechanism. However, by themselves, they have not been shown to lead to PF. The case of a 22-year-old woman who developed PF during pregnancy, presumably due to her Escherichia coli urinary tract infection, is presented including clinical, paraclinical, therapeutic and surgical aspects. She recovered but suffered amputation of the distant phalanges of three toes in the left foot

Manifestaciones clínicas y paraclínicas de la hepatitis autoinmune en 48 pacientes de la ciudad de Medellín, 1980-2004 / Clinical and paraclinical manifestations of autoimmune hepatitis in 48 patients from Medellín, Colombia

Objetivo: describir las características clínicas, bioquímicas, histológicas, sociodemográficas y de tratamiento de los pacientes con hepatitis autoinmune (HAI). Metodología: estudio descriptivo retrospectivo de una serie de casos con 48 pacientes de la ciudad de Medellín con diagnóstico de HAI según los criterios del Grupo Internacional de Hepatitis Autoinmune.Resultados: la edad promedio al momento del diagnóstico fue 34 años, 40 pacientes (83.3 por ciento) eran mujeres. Los hallazgos clínicos más frecuentes fueron fatiga (89.6 por ciento) e ictericia (81.3 por ciento). Las medianas de los hallazgos de laboratorio pretratamiento fueron: AST 626 U/L, ALT 547.5 U/L, bilirrubina total 5.64 mg/dL, bilirrubina directa 3.4 mg/dL. Las medianas de los valores de laboratorio postratamiento fueron: AST 40.5 U/L, ALT 44.4 U/L, bilirrubina total 1.1 mg/dL, bilirrubina directa 0.4 mg/dL (p <0.000). El valor promedio de las gamaglobulinas fue 2.2 g/dL; 81.3 por ciento de los pacientes tuvieron biopsia hepática y de ellos 97.4 por ciento tenían hallazgos compatibles con HAI. Cuarenta pacientes tenían anticuerpos antinucleares positivos. Se hallaron enfermedades autoinmunes concurrentes en 19 pacientes, la más frecuente fue la tiroiditis. El tratamiento más frecuentemente administrado fue prednisona más azatioprina en 56.3 por ciento de los pacientes. Cuarenta y un pacientes (85.4 por ciento) respondieron completamente y 12 (25 por ciento) recayeron.Conclusiones: las características sociodemográficas de este grupo de pacientes no son comparables con las encontradas en otras series. Los hallazgos clínicos, histológicos y bioquímicos son similares a los reportados en la literatura, lo que no se observó con las enfermedades autoinmunes asociadas. La mayoría de los pacientes pertenecen al subtipo 1 de la enfermedad.

Use of dressings and bandages in equine wound management.

The use and aims of various wound dressings are discussed. Application and indications in the horse vary according to the type and location of the wound as well as the nature and availability of the dressing material. Coaptation and immobilization are essential to promote healing in certain locations. Techniques used for bandage application in horses are described, with special emphasis on problem areas.

Effects of 3 biologic dressings on healing of cutaneous wounds on the limbs of horses.

Three biologic dressings [split-thickness allogeneic skin (STS)], allogeneic peritoneum (P), and xenogenic porcine small intestinal submucosa (PSIS)] were studied to determine their effects on bacterial proliferation, inflammatory reaction, vascularization, and overall healing and to compare the effects of these dressings with the effects of a nonbiologic dressing, a nonadherent synthetic pad (NASP). A medial wound (3 cm in diameter) and 2 lateral wounds (2 cm in diameter) were created at the junction of the proximal and middle thirds of each metacarpus and metatarsus in 5 horses. Each medial wound and the proximolateral wound received an STS, P, PSIS, or NASP dressing on day 8 after wounding. The other lateral wound received an NASP dressing. Bacterial proliferation, inflammatory reaction (histologic changes), and drhessing vascularization were evaluated 6 d after application of the dressing. Percentages of contraction and epithelialization, as well as healing time, were determined when the wounds had completely epithelialized. The practical applicability of the different dressings to equine wound management was also assessed. No significant difference was detected in the parameters evaluated among the treated wounds or between the treated and control wounds. The biologic dressings had no effect on infection, inflammatory response, or healing time. Vascularization was not identified in any of the biologic dressings. The PSIS and P dressings required numerous applications over the study period. The STS dressings are more practical than PSIS and P dressings owing to ease of application and stability. Thus, these biologic dressings offer no apparent advantage over a nonbiologic dressing for treatment of small granulating wounds.