Visual performance, safety and patient satisfaction after bilateral implantation of a trifocal intraocular lens in presbyopic patients without cataract.

BACKGROUND: The aim was to evaluate the safety and efficacy of a trifocal intraocular lens (IOL) for the correction of presbyopia and to assess patient satisfaction. METHODS: Records from three centres were reviewed to select presbyopic patients having undergone bilateral refractive lens exchange and implantation of the AT LISA tri 839MP multifocal IOL. Postoperatively, monocular and binocular distance, intermediate and near visual acuities, corrected and uncorrected, and subjective refraction were measured. Patients also completed a quality of life questionnaire. Safety evaluation included IOL stability and postoperative complications. RESULTS: 72 eyes (36 patients) were analysed. No clinically significant difference between pre- and postoperative corrected distance visual acuity (CDVA) was found for monocular or binocular measurements. Mean postoperative monocular CDVA was 0.02 ± 0.04 logMAR. Mean refractive values all improved statistically significantly compared with preoperative baseline (p ≤ 0.0064). Overall, 82.4% of eyes had spherical equivalent within ± 0.5 D and 97.1% within ± 1.0 D of emmetropia with a mean accuracy of -0.10 ± 0.41 D. Spectacle independence for distance, intermediate and near visual acuity was 87.5%, 84.4% and 78.1% respectively, and 78.1% of patients were satisfied with their postoperative, spectacle-free vision. Eight eyes received Nd:YAG laser treatment. No other IOL-related safety issues were reported. CONCLUSION: AT LISA tri 839MP multifocal IOL bilaterally implanted in presbyopic patients provided excellent distance, intermediate and near visual outcomes with very accurate correction of refraction. These results were associated with a high level of spectacle independence and patient satisfaction. TRIAL REGISTRATION: Trial registered on https://clinicaltrials.gov/ under the identification NCT03790592 (31/12/2018).

Orbital and intracranial metastasis secondary to thyroid carcinoma.

INTRODUCTION: An exponential increase in thyroid cancer has been reported in Mexico with 12,122 new cases in 2018 it represents the most common endocrinological cancer described by the World Health Organization. Attributing it local and distant metastatic lesions, being unusual the orbital condition. CLINICAL CASE: A 56-year-old woman diagnosed with chronic myeloid leukemia 19 years ago, presented with left eye proptosis and tearing, headaches, worsening left facial neuralgia. CONCLUSIONS: In these cases, the surgical treatment is essential to improve patient's symptoms and quality of life.

INTRODUCCIÓN: En México existe un aumento exponencial del cáncer de tiroides, con 12,122 nuevos casos en 2018, representando el cáncer endocrinológico más frecuente descrito por la Organización Mundial de la Salud. Se le atribuyen lesiones metastásicas locales y a distancia, siendo una presentación inusual la afección orbitaria. CASO CLÍNICO: Mujer de 56 años diagnosticada de leucemia mieloide crónica hace 19 años, que acude por cefalea, proptosis e hiperemia conjuntival con limitación a la abducción, y dolor facial izquierdo. CONCLUSIONES: En estos casos, el tratamiento quirúrgico es indispensable para mejorar la sintomatología y la calidad de vida del paciente.

Developmental changes in oxygen consumption and hypoxia tolerance in the heat and hypoxia-adapted tabasco line of the Nile tilapia Oreochromis niloticus, with a survey of the metabolic literature for the genus Oreochromis.

The genus Oreochromis is among the most popular of the tilapiine cichlid tribe for aquaculture. However, their temperature and hypoxia tolerance, if tested at all, is usually tested at temperatures of 20-25°C, rather than at the considerably higher temperatures of 30-35°C typical of tropical aquaculture. We hypothesized that both larvae and adults of the heat and hypoxia-adapted Tabasco-line of the Nile tilapia Oreochromis niloticus would be relatively hypoxia-tolerant. Oxygen consumption rate ( M ˙ O 2 ), Q10 and aquatic surface respiration (ASR) was measured using closed respirometry at 2 (c. 0.2 g), 30 (c. 2-5 g), 105 c. (10-15 g) and 240 (c. 250 g) days of development, at 25°C, 30°C and 35°C. M ˙ O 2 at 30°C was inversely related to body mass: c. 90 µM O2 g-1 /h in larvae down to c. 1 µM O2 g-1 /h in young adults. Q10 for M ˙ O 2 was typical for fish over the range 25-35°C of 1.5-2.0. ASR was exhibited by 50% of the fish at pO2 of 15-50 mmHg in a temperature-dependent fashion. However, the largest adults showed notable ASR only when pO2 fell to below 10 mmHg. Remarkably, pcrit for M ˙ O 2 was 12-17 mmHg at 25-30°C and still only 20-25 mmHg across development at 35°C. These values are among the lowest measured for teleost fishes. Noteworthy is that all fish maintain equilibrium, ventilated their gills and showed routine locomotor action for 10-20 min after M ˙ O 2 ceased at near anoxia and when then returned to oxygenated waters, all fish survived, further indicating a remarkable hypoxic tolerance. Remarkably, data assembled for M ˙ O 2 from >30 studies showed a > x2000 difference, which we attribute to calculation or conversion errors. Nonetheless, pcrit was very low for all Oreochromis sp. and lowest in the heat and hypoxia-adapted Tabasco line.

Global respiratory syncytial virus-associated mortality in young children (RSV GOLD): a retrospective case series.

BACKGROUND: Respiratory syncytial virus (RSV) infection is an important cause of pneumonia mortality in young children. However, clinical data for fatal RSV infection are scarce. We aimed to identify clinical and socioeconomic characteristics of children aged younger than 5 years with RSV-related mortality using individual patient data. METHODS: In this retrospective case series, we developed an online questionnaire to obtain individual patient data for clinical and socioeconomic characteristics of children aged younger than 5 years who died with community-acquired RSV infection between Jan 1, 1995, and Oct 31, 2015, through leading research groups for child pneumonia identified through a comprehensive literature search and existing research networks. For the literature search, we searched PubMed for articles published up to Feb 3, 2015, using the key terms "RSV", "respiratory syncytial virus", or "respiratory syncytial viral" combined with "mortality", "fatality", "death", "died", "deaths", or "CFR" for articles published in English. We invited researchers and clinicians identified to participate between Nov 1, 2014, and Oct 31, 2015. We calculated descriptive statistics for all variables. FINDINGS: We studied 358 children with RSV-related in-hospital death from 23 countries across the world, with data contributed from 31 research groups. 117 (33%) children were from low-income or lower middle-income countries, 77 (22%) were from upper middle-income countries, and 164 (46%) were from high-income countries. 190 (53%) were male. Data for comorbidities were missing for some children in low-income and middle-income countries. Available data showed that comorbidities were present in at least 33 (28%) children from low-income or lower middle-income countries, 36 (47%) from upper middle-income countries, and 114 (70%) from high-income countries. Median age for RSV-related deaths was 5·0 months (IQR 2·3-11·0) in low-income or lower middle-income countries, 4·0 years (2·0-10·0) in upper middle-income countries, and 7·0 years (3·6-16·8) in high-income countries. INTERPRETATION: This study is the first large case series of children who died with community-acquired RSV infection. A substantial proportion of children with RSV-related death had comorbidities. Our results show that perinatal immunisation strategies for children aged younger than 6 months could have a substantial impact on RSV-related child mortality in low-income and middle-income countries. FUNDING: Bill & Melinda Gates Foundation.

Cardiorespiratory physiological phenotypic plasticity in developing air-breathing anabantid fishes (Betta splendens and Trichopodus trichopterus).

Developmental plasticity of cardiorespiratory physiology in response to chronic hypoxia is poorly understood in larval fishes, especially larval air-breathing fishes, which eventually in their development can at least partially "escape" hypoxia through air breathing. Whether the development air breathing makes these larval fishes less or more developmentally plastic than strictly water breathing larval fishes remains unknown. Consequently, developmental plasticity of cardiorespiratory physiology was determined in two air-breathing anabantid fishes (Betta splendens and Trichopodus trichopterus). Larvae of both species experienced an hypoxic exposure that mimicked their natural environmental conditions, namely chronic nocturnal hypoxia (12 h at 17 kPa or 14 kPa), with a daily return to diurnal normoxia. Chronic hypoxic exposures were made from hatching through 35 days postfertilization, and opercular and heart rates measured as development progressed. Opercular and heart rates in normoxia were not affected by chronic nocturnal hypoxic. However, routine oxygen consumption M˙O2 (~4 µmol·O2/g per hour in normoxia in larval Betta) was significantly elevated by chronic nocturnal hypoxia at 17 kPa but not by more severe (14 kPa) nocturnal hypoxia. Routine M˙O2 in Trichopodus (6-7 µmol·O2/g per hour), significantly higher than in Betta, was unaffected by either level of chronic hypoxia. PCrit, the PO2 at which M˙O2 decreases as ambient PO2 falls, was measured at 35 dpf, and decreased with increasing chronic hypoxia in Betta, indicating a large, relatively plastic hypoxic tolerance. However, in contrast, PCrit in Trichopodus increased as rearing conditions grew more hypoxic, suggesting that hypoxic acclimation led to lowered hypoxic resistance. Species-specific differences in larval physiological developmental plasticity thus emerge between the relatively closely related Betta and Trichopodus Hypoxic rearing increased hypoxic tolerance in Betta, which inhabits temporary ponds with nocturnal hypoxia. Trichopodus, inhabiting more permanent oxygenated bodies of water, showed few responses to hypoxia, reflecting a lower degree of developmental phenotypic plasticity.

Topical Tacrolimus for Corneal Subepithelial Infiltrates Secondary to Adenoviral Keratoconjunctivitis.

PURPOSE: The objective of this study was to determine the efficacy and safety of topical tacrolimus compounded in the Pharmacy Service for the treatment of subepithelial corneal infiltrates (SEIs) secondary to adenoviral keratoconjunctivitis. METHODS: This retrospective study included patients who had been dispensed topical tacrolimus for the treatment of SEIs during the previous year. Patients were treated with tacrolimus 0.03% eye drops twice daily or tacrolimus 0.02% ointment once daily. The following data were recorded: length of treatment, visual acuity before and after treatment, intraocular pressure before, during, and at the end of treatment, previous treatments, and the presence of SEIs after treatment. The subjective symptoms of the patients were also assessed. RESULTS: Fifty-five patients (85 eyes) were included, 54.5% with bilateral involvement. A total of 31 (36.5%) eyes were treated with tacrolimus ointment and 54 eyes (63.5%) with tacrolimus eye drops. The median length of treatment was 185 days (p25-75: 93.5-426), and the mean follow-up duration was 363 days (p25-75: 148-540). In 62.35% of the eyes, the SEIs were reduced in number and size, and in 31.76%, they were eliminated. The patients had better visual acuity after treatment with highly statistically significant differences. Tolerance was good overall, being better in the eye drops group. CONCLUSIONS: Topical tacrolimus, compounded in the pharmacy, seems to be an effective and safe alternative for the treatment of SEIs secondary to adenovirus keratoconjunctivitis.

Direct solid sample analysis with graphite furnace atomic absorption spectrometry­a fast and reliable screening procedure for the determination of inorganic arsenic in fish and seafood.

Direct solid sample analysis with graphite furnace atomic absorption spectrometry (SS-GF AAS) was investigated initially with the intention of developing a method for the determination of total As in fish and other seafood. A mixture of 0.1% Pd+0.06% Mg+0.06% Triton X-100 was used as the chemical modifier, added in solution over the solid samples, making possible the use of pyrolysis and atomization temperatures of 1200 °C and 2400 °C, respectively. The sample mass had to be limited to 0.25 mg, as the integrated absorbance did not increase further with increasing sample mass. Nevertheless, the recovery of As from several certified reference materials was of the order of 50% lower than the certified value. Strong molecular absorption due to the phosphorus monoxide molecule (PO) was observed with high-resolution continuum source AAS (HR CS AAS), which, however, did not cause any spectral interference. A microwave-assisted digestion with HNO3/H2O2 was also investigated to solve the problem; however, the results obtained for several certified reference materials were statistically not different from those found with direct SS-GF AAS. Accurate values were obtained using inductively coupled plasma mass spectrometry (ICP-MS) to analyze the digested samples, which suggested that organic As compounds are responsible for the low recoveries. HPLC-ICP-MS was used to determine the arsenobetaine (AB) concentration. Accurate results that were not different from the certified values were obtained when the AB concentration was added to the As concentration found by SS-GF AAS for most certified reference materials (CRM) and samples, suggesting that SS-GF AAS could be used as a fast screening procedure for inorganic As determination in fish and seafood.

Establishment of a method for determination of arsenic species in seafood by LC-ICP-MS.

An analytical method for determination of arsenic species (inorganic arsenic (iAs), methylarsonic acid (MA), dimethylarsinic acid (DMA), arsenobetaine (AB), trimethylarsine oxide (TMAO) and arsenocholine (AC)) in Brazilian and Spanish seafood samples is reported. This study was focused on extraction and quantification of inorganic arsenic (iAs), the most toxic form. Arsenic speciation was carried out via LC with both anionic and cationic exchange with ICP-MS detection (LC-ICP-MS). The detection limits (LODs), quantification limits (LOQs), precision and accuracy for arsenic species were established. The proposed method was evaluated using eight reference materials (RMs). Arsenobetaine was the main species found in all samples. The total and iAs concentration in 22 seafood samples and RMs ranged between 0.27-35.2 and 0.02-0.71 mg As kg(-1), respectively. Recoveries ranging from 100% to 106% for iAs, based on spikes, were achieved. The proposed method provides reliable iAs data for future risk assessment analysis.

Aneurismas coronarios gigantes en la enfermedad de Kawasaki / Giant coronary aneurysms in Kawasaki disease

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Escala de peligro para interacción grave: una herramienta para la priorización de estrategias de mejora en la seguridad de la prescripción en medicina de familia / A hazard scale for severe interactions: a tool for establishing prioritising strategies to improve the safety of the prescription in family medicine

Objetivo: Localizar de forma efectiva los medicamentos más implicados en interacciones graves,como base para diseñar actividades de mejora en la seguridad de los pacientes en AtenciónPrimaria.Diseño: Estudio transversal de las prescripciones realizadas en OMI-AP, la historia clínica electrónicade Atención Primaria.Emplazamiento: Áreas I, VI, VII y IX de Murcia (723.664 habitantes).Participantes: 362.271 pacientes que disponen de OMI-AP, son mayores de 14 años y estánadscritos a un médico que usa OMI-AP habitualmente.Mediciones principales: Analizamos los fármacos que cada paciente pudiera estar tomando enbusca de interacciones graves. Construimos una escala de peligro para interacción grave (e-PIG)calculando: 1) la probabilidad de que un paciente no seleccionado este tomando un fármacodeterminado, y 2) la probabilidad de que un medicamento produzca una interacción grave. Conello estimamos el riesgo de producir interacción grave para cada medicamento, que se traducea una escala logarítmica de 5 puntos.Resultados: Hallamos 83.138 pacientes (22,9%) en riesgo (toman 2 o más fármacos). Identificamos466.940 prescripciones provenientes de 939 fármacos y 5.597 interacciones graves(prevalencia 5,8%). En ellas hay implicados 167 fármacos, de los que e-PIG identifica 5 (3%)con valor extremo: omeprazol, diazepam, acenocumarol, ibuprofeno y calcio.Conclusiones: e-PIG es una expresión logarítmica del riesgo de que prescribir un determinadomedicamento produzca una interacción grave en un escenario de lugar y tiempo determinados.Su monitorización puede convertirse en un elemento de priorización que facilite el diseño deestrategias de mejora de la seguridad del uso de medicamentos(AU)

Objective: To effectively locate the drugs most implicated in severe interactions as a basis ofdesigning actions to improve patient safety in Primary Care.Design: Cross-sectional study of prescriptions using the Primary Care computerised medicalrecords database (OMI-PC).Setting: Murcia (Spain) Health Areas I, VI, VII and IX (723,664 inhabitants).Participants: There are 362,271 patients over 14 years-old available in the OMI-PC and areassigned to a doctor who uses the OMI-PC regularly.Main measurements: We analysed the drugs that each patient could be taking, looking forsevere interactions. We constructed a severe interaction hazard scale (e-PIG) calculating [1]the probability that a non-selected patient may be taking a particular drug and [2] the probabilitythat a drug may produce a severe interaction. With this, we estimated the risk ofproducing a severe interaction for each drug, which was converted into a 5 point logarithmicscale.Results: We found 83,138 patients (22.9%) at risk (they took 2 or more drugs). We identified466,940 prescriptions providing 939 drugs and 5,597 severe interactions (prevalence 5.8%).In these, 167 drugs were involved, of which e-PIG identified 5 (3%) with an extreme value:omeprazole, diazepam, acenocoumarol, ibuprofen and calcium.Conclusions: e-PIG is a logarithmic expression of the risk that prescribing a particular drug mayproduce a severe interaction in a determined setting and time. Its monitoring could become aprioritisation element that may assist the design of strategies for improving the safety of theuse of drugs(AU)

A randomized trial of the effectiveness and efficiency of interventions to reduce potential drug interactions in primary care.

The authors tested the effectiveness and estimated the cost of several interventions aimed at reducing drug interactions in primary care by designing a 15-month cluster-controlled trial. The trial involved 265 family physicians and their patients who were randomized into 4 groups: control, report (received feedback reports), session (group sessions), and face-to-face (personal interviews). The outcome was the mean of relevant interactions detected on electronic medical records. Cost-effectiveness was defined as the incremental cost to reduce drug interactions by 1%. The authors detected a baseline mean of 6.7 interactions per 100 patients, which was reduced to 5.3 interactions after follow-up. No improvement was seen in the report group when compared with the control group, whereas progressive improvement in the other groups was noted (P < .001). Incremental cost was higher in the face-to-face group (69.4€ vs 50.7€); cost-effectiveness results were slightly better in the session group (4.2€ vs 4.5€).

[A hazard scale for severe interactions: a tool for establishing prioritising strategies to improve the safety of the prescription in family medicine]. / Escala de peligro para interacción grave: una herramienta para la priorización de estrategias de mejora en la seguridad de la prescripción en medicina de familia.

OBJECTIVE: To effectively locate the drugs most implicated in severe interactions as a basis of designing actions to improve patient safety in Primary Care. DESIGN: Cross-sectional study of prescriptions using the Primary Care computerised medical records database (OMI-PC). SETTING: Murcia (Spain) Health Areas I, VI, VII and IX (723,664 inhabitants). PARTICIPANTS: There are 362,271 patients over 14 years-old available in the OMI-PC and are assigned to a doctor who uses the OMI-PC regularly. MAIN MEASUREMENTS: We analysed the drugs that each patient could be taking, looking for severe interactions. We constructed a severe interaction hazard scale (e-PIG) calculating [1] the probability that a non-selected patient may be taking a particular drug and [2] the probability that a drug may produce a severe interaction. With this, we estimated the risk of producing a severe interaction for each drug, which was converted into a 5 point logarithmic scale. RESULTS: We found 83,138 patients (22.9%) at risk (they took 2 or more drugs). We identified 466,940 prescriptions providing 939 drugs and 5,597 severe interactions (prevalence 5.8%). In these, 167 drugs were involved, of which e-PIG identified 5 (3%) with an extreme value: omeprazole, diazepam, acenocoumarol, ibuprofen and calcium. CONCLUSIONS: e-PIG is a logarithmic expression of the risk that prescribing a particular drug may produce a severe interaction in a determined setting and time. Its monitoring could become a prioritisation element that may assist the design of strategies for improving the safety of the use of drugs.

Duodenal duplication cyst and pancreas divisum causing acute pancreatitis in an adult male.

Duodenal duplication cysts are rare congenital abnormalities which are more commonly diagnosed in infancy and childhood. However, in rare cases, these lesions can remain asymptomatic until adulthood. The combination of duplication cyst and pancreas divisum is extremely rare and both conditions have been linked with acute recurrent pancreatitis. We present the case of a 37 years-old patient who presented with repeated episodes of acute pancreatitis. By means of magnetic resonance imaging and endoscopic ultrasonography we discovered a duplication cyst whose cavity received drainage from the dorsal pancreas. After opening the cyst cavity to the duodenal lumen with a needle knife the patient presented no further episodes in the clinical follow-up. Comparable literature findings and therapeutic options for these abnormalities are discussed with regard to the presented case.

Prevalence and typology of potential drug interactions occurring in primary care patients.

PURPOSE: To investigate the prevalence and types of potential drug interactions in primary care patients to detect risky prescriptions as an essential condition to design intervention policies leading to an improvement in patient safety. METHODS: Cross-sectional descriptive study. SETTING: Two areas in Spain comprising 715,661 inhabitants. PATIENTS: 430,525 subjects with electronic medical records and assigned to a family doctor regularly updating them. RESULTS: On a random day, 29.4% of the population was taking medication. Of these, 73.9% were at risk of suffering interactions, and these were found in 20.6% of them. The amount of interactions was higher among people with chronic conditions, the elderly, females and polymedicated patients. From the total of interactions, 55.1% belonged to the highest clinical relevance 'A' level, and 28.3% should have been avoided. The active ingredients primarily involved were hydrochlorothiazide and ibuprofen and, when focusing on those that should be avoided, omeprazole and acenocoumarol. The most frequent 'A' interaction that should be avoided was between non-conjugated excreted benzodiazepines and proton-pump inhibitors, followed by some NSAIDs and diuretics. CONCLUSIONS: 1 in 20 Spanish citizens is currently undergoing a potential drug interaction, including a high rate of clinically relevant ones that should be avoided. These results confirm the existence of a serious safety issue that should be approached and where all parties involved (physicians, health services, medical societies and patients) must do our bit to improve. Health services should foster the implementation of prescription alert systems linked with electronic medical records including clinical data.

Panorama epidemiológico de exposición a plaguicidas inhibidores de colinesterasa en 17 departamentos del país / An epidemiological panorama of exposure to cholinesterase pesticides in 17 of the country's departaments

Los organofosforados y carbamatos son los responsables de la mayor parte de intoxicaciones por plaguicidas que se presentan en el país; son potentes inhibidores de la enzima acetilcolinesterasa, causando graves intoxicaciones agudas de tipo laboral como también efectos a largo plazo. Ante esta problemática, en 1982, el Instituto Nacional de Salud (INS), a través del Laboratorio de Salud Ambiental creó el Programa de Vigilancia Epidemiológica de plaguicidas organofosforados y carbamatos (VEO), empleando el método Lovibond para la determinación de la acetilcolinesterasa (ACHE) como indicador, con el fin de detectar precozmente los casos de absorción elevada de plaguicidas. A partir de 1993, se cuenta con información de 17 departamentos del país, datos que se analizaron. La totalidad de las personas que participó en el estudio de 1993 a 1995 fueron 41.899, las cuales tenían antecedentes de exposición a plaguicidas organofosforados o carbamatos. el 80 por ciento de los trabajadores que ingresaron al estudio pertenecían al género masculino, siendo el grupo de edad más afectado el de 18 a 40 años. Las mayores prevalencias de anormalidad para ACHE, según actividad económica, fue para la aplicación urbana y en relación a los oficios, para mezclador-tanqueador-formulador. Con relación a la seguridad social de 23.917 trabajdores, tan sólo 31,7 por ciento se encontraba afiliada a entidades de este tipo. Los datos obtenidos permitieron establecer el panorama epidemiológico de la intoxicación por plaguicidas inhibidores de colinesterasa, determinando la población de mayor riesgo, lo que conllevará a plantear nuevos estudios de investigación en esta población