An unusual ophthalmologic finding in a patient with congenital central hypoventilation syndrome.

INTRODUCTION: Congenital Central Hypoventilation Syndrome (CCHS) is a rare disease due to a severely impaired central control of breathing and dysfunction of the autonomic nervous system. Ophthalmologic abnormalities are common in patients with CCHS and include horizontal strabismus, pupil and iris abnormalities and ptosis. We report a unique case of CCHS in association with monocular elevation deficit (MED) in a boy diagnosed with CCHS at birth. CASE DESCRIPTION: We report a case of a boy with a confirmed diagnosis of CCHS (complete sequencing of the paired-like homeobox 2b (PHOX2B) gene) after presenting little respiratory effort and cyanosis at birth. The ophthalmological examination shows an impaired elevation of the left eye, both in adduction and abduction, associated with mild and variable left ptosis. His mother has observed that the left eyelid elevates when the child feeds. A deviation in the primary gaze position or a chin-up position are not present. The funduscopic examination is normal. Given that deviation is limited to upgaze, the ptosis is mild and the patient's age, observation is decided. CONCLUSIONS: Ophthalmologic abnormalities are common in patients with CCHS and include horizontal strabismus, pupil and iris abnormalities and ptosis. To the best of our knowledge, this is the first report of MED in association with CCHS. Further studies are needed to determine if an association between MED and CCHS exists or is just a casual finding in this case.

Descemet's Membrane Detachment during Phacocanaloplasty: Case Series and In-Depth Literature Review.

This article presents three cases of Descemet's membrane detachment (DMD) occurring during 'ab externo' phacocanaloplasty procedures in three patients with uncontrolled primary open-angle glaucoma (OAG) and discusses the management of this condition by reviewing the available literature. Following a successful 360° cannulation of Schlemm's canal (SC), the microcatheter was withdrawn while an ophthalmic viscosurgical device (OVD) was injected into the canal. During passage through the inferonasal quadrant, a spontaneous separation of the posterior layer of the cornea was observed. Each case was managed differently after diagnosis, with the third case being drained intraoperatively based on experience gained from the previous cases. On the first postoperative day, slit-lamp biomicroscopy (BMC) revealed multiple DMDs in case one and a hyphema in the lower third of a deep anterior chamber. In the other two cases, a single DMD was observed. The second case developed hemorrhagic Descemet membrane detachment (HDMD), while the other two were non-hemorrhagic. In all three cases, anterior segment optical coherence tomography (AS-OCT) revealed the presence of retrocorneal hyperreflective membranes indicative of DMDs. These membranes were located in the periphery of the cornea and did not impact the visual axis. After evaluation, a small incision was made in the inferotemporal DMD of the first case. However, for the two remaining cases, a strategy of watchful waiting was deemed appropriate due to the location and size of the DMDs, as they did not affect the best-corrected visual acuity (BCVA). Over time, the patients demonstrated progressive improvement with a gradual reduction in the size of the DMDs.

Pancreatitis aguda y el valor de la ecografía en su diagnóstico inicial / Acute pancreatitis and the value of ultrasound in its initial diagnosis

RESUMEN Introducción: la pancreatitis aguda es el proceso inflamatorio agudo del páncreas. Su diagnóstico se sustenta en pilares clínicos, humorales e imagenológicos; la ecografía es de gran utilidad como método diagnóstico inicial. Objetivo: determinar el valor de la ecografía en el diagnóstico inicial de la pancreatitis aguda en pacientes del Hospital Universitario Clínico-Quirúrgico «Arnaldo Milián Castro», durante el período de octubre de 2018 a junio de 2019. Métodos: se realizó un estudio descriptivo y longitudinal en los pacientes con diagnóstico de pancreatitis aguda que fueron atendidos en el Servicio de Imagenología del Hospital Universitario Clínico-Quirúrgico «Arnaldo Milián Castro», desde octubre de 2018 hasta junio de 2019. El universo de estudio estuvo constituido por 75 pacientes, de los cuales se seleccionó una muestra no probabilística de 66 pacientes con ecografía abdominal y tomografía axial computarizada realizada. Resultados: prevalecieron los pacientes masculinos entre 50-59 años de edad. La obesidad y el alcoholismo fueron los factores de riesgo más frecuentes en las pancreatitis agudas leves y moderadas, mientras que las graves se asociaron a obesidad y litiasis vesicular. Predominó el grado de gravedad moderado. Los hallazgos ecográficos fundamentales fueron: contornos irregulares, textura heterogénea, glándula hipoecogénica y aumento difuso de tamaño del páncreas. El ultrasonido muestra un porciento de sensibilidad elevado en la detección de: hallazgos extrapancreáticos, colecciones peripancreáticas e irregularidad de los contornos del órgano. Conclusiones: el ultrasonido es un estudio muy útil en el diagnóstico inicial de la pancreatitis aguda.

ABSTRACT Introduction: acute pancreatitis is the acute inflammatory process of the pancreas. Its diagnosis is based on clinical, humoral and imaging pillars; ultrasound is very useful as an initial diagnostic method. Objective: to determine the value of ultrasound in the initial diagnosis of acute pancreatitis in patients seen at "Arnaldo Milián Castro" Clinical and Surgical University Hospital from October 2018 to June 2019. Methods: a descriptive and longitudinal study was carried out in patients diagnosed with acute pancreatitis in the Imaging service at "Arnaldo Milián Castro" Clinical and Surgical University Hospital from October 2018 to June 2019. The study universe consisted of 75 patients, from which a non-probabilistic sample of 66 patients was selected with abdominal ultrasound and computerized axial tomography performed. Results: male patients aged 50 to 59 years prevailed. Obesity and alcoholism were the most common risk factors for mild and moderate acute pancreatitis, while severe ones were associated with obesity and gallstones. Moderate severity predominated. Irregular contours, heterogeneous texture, hypoechoic gland and diffuse enlargement of the pancreas were the main ultrasound findings. Ultrasound shows a high percentage of sensitivity in the detection of extrapancreatic findings, peripancreatic collections and irregularity of the organ contours. Conclusions: ultrasound is a very useful study in the initial diagnosis of acute pancreatitis.

Effects of 3% trehalose as an adjuvant treatment after LASIK.

PURPOSE: To evaluate the effect of 3% trehalose as an adjuvant in the standard treatment after laser-assisted in situ keratomileusis. DESIGN: Interventional prospective comparative single-blind study. SETTING: Department of Ophthalmology, Hospital Quirón Zaragoza, Spain. METHODS: A total of 26 eyes (13 patients) were included, of which 12 eyes (group 1) received conventional treatment with lubricant drops of hyaluronic acid (0.15%) and 14 eyes (group 2) received, additionally, an ophthalmic solution of 3% trehalose. Pre- and postoperative quality-of-life tests and vital stains, tear breakup time, and osmolarity measurements were made. RESULTS: We obtained statistically significant differences between the groups in the Symptom Assessment in Dry Eye test in all visits with respect to severity, and in the postoperative day 1 visit with respect to frequency, in all cases favoring the trehalose treatment. The values of osmolarity were not significantly different between groups. However, we did find significant differences in the Oxford scale in day 90 for the trehalose treatment (P<0.001), and in the National Eye Institute scale in day 30 (P=0.02). CONCLUSION: The results of this exploratory study indicate that the adjuvant treatment with 3% trehalose could be superior with respect to the standard treatment, with improvements in the objective and subjective parameters of tear quality.

Study of spectral-domain optical coherence tomography in children: normal values and influence of age, sex, and refractive status.

PURPOSE: To establish normal values for retinal nerve fiber layer (RNFL), macular thickness, and macular volume in children using spectral-domain optical coherence tomography (OCT). METHODS: A descriptive cross-sectional study was performed in healthy children between 3 and 14 years of age. Each child underwent a comprehensive ophthalmic examination that included 3 OCT scans with Spectralis (Heidelberg Engineering, Heidelberg, Germany). All measurements were performed by the same operator, and one eye was randomly selected. The influence of age, sex, and refraction on OCT measurements was analyzed. RESULTS: The sample consisted of 162 Caucasian subjects, mean age 8.1 ± 3.03 years. The spherical equivalent was 0.03 ± 0.19 D (range ±4 D, astigmatism <1 D). The average values were 263.69 ± 4.54 µm for central macular thickness, 0.21 ± 0.01 mm3 for central macular volume, and 100.45 ± 1.98 µm for RNFL. A significant correlation between RNFL and spherical equivalent was found for the nasal (p = 0.001), inferior (p = 0.009), and inferior nasal (p = 0.005) sectors. No differences were found with regard to sex (p>0.05). However, central macular thickness and central macular volume were correlated with age (p = 0.027, p = 0.02). CONCLUSIONS: This study provides reference values for macular thickness, macular volume, and RNFL in healthy children.

Acciones de salud sobre la familia para incrementar la lactancia materna exclusiva / Family health actions for increasing exclusive breastfeeding

Después de detectar los bajos índices de lactancia materna exclusiva en una zona periférica del municipio de Placetas, se creó una estrategia dirigida a los familiares de la futura madre para conseguir el apoyo de toda la familia en el proceso de lactación. Se presenta un plan de actividades, con el objetivo de incrementar la lactancia materna exclusiva hasta los seis meses de edad(AU)

CHOROIDAL THICKNESS AND VOLUME IN A HEALTHY PEDIATRIC POPULATION AND ITS RELATIONSHIP WITH AGE, AXIAL LENGTH, AMETROPIA, AND SEX.

PURPOSE: To evaluate choroidal thickness (CT) and volume in healthy pediatric individuals using enhanced depth imaging spectral domain optical coherence tomography (SD-OCT), as well as its association with age, sex, axial length (AL), and refractive error. METHODS: Ninety-three eyes from 93 healthy pediatric individuals were examined. An Early Treatment Diabetic Retinopathy Study grid was applied to analyze CT and volume map in each of its nine sectors. RESULTS: The mean subfoveal CT and volume were 314.22 ± 55.48 µm and 0.25 ± 0.04 mm, respectively. The nasal CT and volume of both the inner and the outer rings were significantly lower than the temporal area of the same ring and lower than the subfoveal choroidal thickness. A significant negative correlation between the subfoveal CT and AL (r = -0.250, P = 0.015) and a significant positive correlation between the subfoveal CT and refractive error (r = 0.238, P = 0.006) were found. The estimation of the variation in the subfoveal CT in relationship to the AL was -13.55 µm per millimeter. The variation in the subfoveal CT with refractive error was 7.52 µm per diopter. The estimation of the variation in the total choroidal volume related to the AL and ametropia was, respectively, -0.2354 mm per millimeter and 0.1412 mm per diopter. CONCLUSION: Healthy pediatric subjects exhibit choroidal differences in refractive error and AL. In the study population, CT and volume show an increase with age after adjusting for AL.

Necesidades de aprendizajes sobre el desempeño del tutor de la asignatura Salud Pública / Learning requirements on the performance of tutors in the subject Public Health

Fundamento: la enseñanza tutelar constituye un pilar esencial en la formación del médico, pues le permite al educando lograr un mayor grado de independencia, creatividad y de cambios conductuales. Objetivo: diseñar acciones de capacitación para un mejor desempeño de los tutores especialistas de Medicina General Integral que imparten la asignatura de Salud Pública en el Policlínico Universitario Sur Placetas. Métodos: se realizó una investigación de desarrollo tecnológico en el Policlínico Universitario Sur Placetas, constituyeron el universo 48 estudiantes de quinto año de Medicina, profesores y tutores, la muestra quedó constituida por 37 estudiantes, seis profesores y nueve tutores, para un total de 52 individuos. Se utilizaron los métodos: revisión documental, entrevista semiestructurada a los tutores, grupo focal con estudiantes y grupo nominal con profesores. Resultados: se detecta que los médicos presentan dificultades pedagógicas en el dominio de temas de la asignatura que les permitan realizar una adecuada educación del trabajo para lograr la formación de los recursos humanos de calidad en la práctica profesional, se diseñó un curso postgrado con una propuesta curricular para dar solución a esta problemática. Conclusiones: el curso de postgrado aborda las temáticas encontradas deficitarias en el diagnóstico previo efectuado. La propuesta de superación fue valorada como positiva por especialistas, por considerarla necesaria, abarcadora y muy actualizada.

Background: tutorial education is an essential pillar in doctor's training, as it enables the learner to achieve a greater degree of independence, creativity and behavioral changes. Objective: to design training activities for a better performance of Comprehensive General Medicine specialists who are tutors and teach the subject of Public Health at the Sur University Polyclinic of Placetas. Methods: a documentary analysis, a semi-structured interview with doctors acting as tutors, a focus group with students and a nominal group with teachers. Results: it was found that doctors have an important number of pedagogical difficulties, and in the mastery of topics of the subject, for providing a proper work education in order to train quality human resources in professional practice. A postgraduate course was designed, with a curriculum that allowed solving this problem. Conclusions: the learning needs of Comprehensive General Medicine specialists were identified in relation to their work as tutors in the subject Public Health. It was found that the level of knowledge on its topics was insufficient, according to the assessment of the results. Based on their learning needs, an update postgraduate course was designed. It was structured in order to improve the knowledge, skills and values that these professionals must have in this field. The improvement proposal was rated as positive by experts who found it necessary, comprehensive and very much updated.

Necesidades de aprendizajes sobre el desempeño del tutor de la asignatura Salud Pública / Learning requirements on the performance of tutors in the subject Public Health

Fundamento: la enseñanza tutelar constituye un pilar esencial en la formación del médico, pues le permite al educando lograr un mayor grado de independencia, creatividad y de cambios conductuales. Objetivo: diseñar acciones de capacitación para un mejor desempeño de los tutores especialistas de Medicina General Integral que imparten la asignatura de Salud Pública en el Policlínico Universitario Sur Placetas.Métodos: se realizó una investigación de desarrollo tecnológico en el Policlínico Universitario Sur Placetas, constituyeron el universo 48 estudiantes de quinto año de Medicina, profesores y tutores, la muestra quedó constituida por 37 estudiantes, seis profesores y nueve tutores, para un total de 52 individuos. Se utilizaron los métodos: revisión documental, entrevista semiestructurada a los tutores, grupo focal con estudiantes y grupo nominal con profesores.Resultados: se detecta que los médicos presentan dificultades pedagógicas en el dominio de temas de la asignatura que les permitan realizar una adecuada educación del trabajo para lograr la formación de los recursos humanos de calidad en la práctica profesional, se diseñó un curso postgrado con una propuesta curricular para dar solución a esta problemática. Conclusiones: el curso de postgrado aborda las temáticas encontradas deficitarias en el diagnóstico previo efectuado. La propuesta de superación fue valorada como positiva por especialistas, por considerarla necesaria, abarcadora y muy actualizada(AU)

Changes in frequency-doubling perimetry in patients with type I diabetes prior to retinopathy.

PURPOSE: To evaluate the ability of frequency-doubling technology (FDT) perimetry in detecting visual field defects in young adults with type I diabetes prior to retinopathy or with minor retinovascular changes. METHODS: This comparative cross-sectional study included 30 healthy subjects and 73 age-matched patients with type I diabetes mellitus. All subjects underwent a full ocular examination including an FDT with the threshold C-20-5 strategy. Only one eye per subject was randomly included in the statistical analysis. FDT results and time to perform the test were compared between the groups. RESULTS: The mean age was 27.1 years in the control group and 26.6 years in the diabetic group (P = 0.875). The mean period from the onset of diabetes was 12.6 ± 6.7 years, while minimal retinovascular changes were observed in 18 eyes. Mean deviation of FDT did not differ between the groups. Although global indices of FDT were within normal limits, pattern standard deviation of FDT was higher in the diabetic group (P = 0.035). The area under the receiver operating characteristic curve was 0.647 for pattern standard deviation of FDT (standard error = 0.052; P = 0.017). CONCLUSION: FDT can detect retinal dysfunctions in diabetic patients prior to the onset of significant vascular complications.

Keratitis after Implantation of Intrastromal Corneal Rings with Spontaneous Extrusion of the Segment.

PURPOSE: To report a case of bacterial keratitis in a patient with a history of intrastromal corneal ring segments (INTACS®) implantation to correct keratoconus. METHODS: The patient's history, clinical presentation, pathological analysis and therapeutic management were reviewed. RESULTS: A 36-year-old-man was referred to our department due to decreased vision and intense pain in his left eye, 40 days after INTACS® implantation for keratoconus. Slit-lamp examination revealed epithelial defects and stromal infiltrates in the lower channel without evidence of the inferior ring. The anterior chamber also showed a significant fibrin reaction to hypopyon. A low-tension suture was removed at the site of the incision. Microbiological study of the conjunctival swab was positive for Staphylococcus epidermidis, but the corneal culture was sterile. The patient was treated with topical fortified and systemic antibiotics. The infection slowly resolved, leaving opacity at the inferior segment site. CONCLUSIONS: Infectious keratitis following INTACS implantation is an infrequent complication that can have important consequences without suitable and early therapeutic management.