Corneal Transplantation under Difficult Conditions : Clinical Pictures, Indications, Technique and Results.

As the rate of partial thickness corneal transplantations has increased in the last decade, the need for penetrating keratoplasty (PKP) has decreased. Microsurgeons tend to avoid large-diameter PKP (LDPKP) because of the risk for intra- and postoperative complications. Nevertheless, PKP is still the treatment of choice in cases requiring transplantation of all corneal layers, such as combined endothelial and stromal disease, severe corneal opacity precluding evaluation of endothelium status, severe keratoconus, and complicated infectious keratitis. In the first study, we report on the indications and outcomes of 8.5/8.6-mm excimer laser-assisted PKP. It could be shown that this type of PKP is an excellent treatment option in cases of ectatic disorders for which an 8.0-mm graft seems too small, and for corneal scars that require larger grafts to completely remove the lesion. This applies especially in cases of repeat PKP, in order to excise the previous graft completely. However, in complex cases of keratitis, the prognosis with 8.5/8.6-mm excimer laser-assisted PKP may be poor due to the consequences of the infectious disease itself. In the second study, we assess the prevalence, clinical manifestations, required keratoplasties, follow-up, and outcomes in patients with Herpes Simplex Virus Keratitis. PKP was indicated in cases of scars impairing visual acuity, corneal decompensation, deep corneal ulcers, or corneal perforations. In this study, a total of 288 keratoplasties was performed. At the last follow-up, 90% of the elective PKPs, but only 55% of the emergency PKPs remained clear. The risk for emergency keratoplasty is expected to decrease further, due to good results with amniotic membrane transplantation (AMT) for the treatment of herpetic corneal ulcers. In the third study, we report on the indications and outcomes of penetrating keratoplasties with a graft diameter >8.5 mm in severe corneal diseases. We concluded that complex cases of infectious keratitis unresponsive to conservative management and with a history of previous transplants require these oversized grafts up to 15 mm to remove the complete pathology and preserve the integrity of the eye. The visual outcomes are poor not only because of the well-known immunological risks of large-diameter keratoplasties but also because of the consequences of the infectious disease itself. Finally, 17% of these eyes required enucleation. This knowledge is important for adequate counseling of these patients preoperatively. Difficult corneal predispositions may require special types of corneal transplantation “beyond routine”.Der Bedarf an perforierenden Keratoplastiken (PKP) ist zurückgegangen, da die Rate der lamellären Hornhauttransplantationen im letzten Jahrzehnt zugenommen hat. Mikrochirurgen neigen dazu, die PKP mit großem Durchmesser zu vermeiden, weil ein höheres Risiko für intra- und postoperative Komplikationen besteht. Dennoch ist die PKP immer noch die Behandlung der Wahl in Fällen, in denen alle Hornhautschichten transplantiert werden müssen, wie z. B. bei kombinierter Endothel- und Stromaerkrankung, schwerer Hornhauttrübung, die eine Beurteilung des Endothelstatus ausschließt, schwerem Keratokonus und komplizierter infektiöser Keratitis. In der ersten Studie berichten wir über die Indikationen und Ergebnisse der 8,5/8,6-mm Excimerlaser-assistierten PKP. Es konnte gezeigt werden, dass diese Art der PKP eine hervorragende Behandlungsoption bei ektatischen Erkrankungen ist, für die ein 8,0-mm-Transplantat zu klein erscheint, sowie bei Hornhautnarben, die größere Transplantate erfordern, um die Läsion vollständig zu entfernen. Dies ist besonders bei Fällen von wiederholter PKP der Fall, um das vorherige Transplantat vollständig zu entfernen. In komplexen Fällen von Keratitis kann die Prognose bei 8,5/8,6-mm-Excimerlaser-assistierter PKP jedoch schlecht sein aufgrund von Folgen der Infektionskrankheit selbst. In der zweiten Studie untersuchen wir die Prävalenz, die klinischen Manifestationen, die erforderlichen Keratoplastiken, das Follow-up und die Ergebnisse bei Patienten mit Herpes Simplex Virus Keratitis. Die PKP wurde bei visusbeeinträchtigenden Narben, Hornhautdekompensation, tiefen Hornhautulzera oder Hornhautperforationen indiziert. In dieser Studie wurden insgesamt 288 Keratoplastiken durchgeführt. Bei der letzten Nachuntersuchung waren 90% der elektiven PKPs, aber nur 55% der Notfall-PKPs klar. Es wird erwartet, dass das Risiko für Notfall-Keratoplastiken aufgrund der guten Ergebnisse bei der Amnionmembrantransplantation (AMT) zur Behandlung von herpetischen Hornhautulzera weiter abnimmt. In der dritten Studie berichten wir über die Indikationen und Ergebnisse von perforierenden Keratoplastiken mit einem Transplantatdurchmesser >8,5 mm bei schweren Hornhauterkrankungen. Wir kamen zu dem Schluss, dass komplexe Fälle von infektiöser Keratitis, die nicht auf eine konservative Behandlung ansprechen und in der Vergangenheit bereits transplantiert wurden, diese übergroßen Transplantate bis zu 15 mm benötigen, um die gesamte Pathologie zu entfernen und die Integrität des Auges zu erhalten. Die visuellen Ergebnisse sind nicht nur wegen den bekannten immunologischen Risiken von Keratoplastiken mit großem Durchmesser, sondern auch wegen der Folgen der Infektionskrankheit selbst schlecht. Schließlich war bei 17% dieser Augen eine Enukleation erforderlich. Dieses Wissen ist wichtig für eine adäquate präoperative Beratung und Aufklärung der Patienten. Schwierige korneale Ausgangssituationen erfordern nicht selten spezielle Typen von Hornhauttransplantationen „jenseits der Routine“

Nivel de conocimiento de los internos de Medicina en el diagnóstico y tratamiento inicial de la Anemia Ferropénica

Objetivo: Describir el nivel de conocimiento de los internos de medicina en el diagnóstico y tratamiento inicial de la anemia ferropénica, de setiembre a diciembre del 2023, en un hospital de tercer nivel de Trujillo. Materiales y métodos: Tipo básica, con enfoque cuantitativo. El diseño metodológico fue descriptivo y de corte transversal, la muestra fue de 55 internos de medicina. La técnica de recolección de datos fue encuesta, utilizando un cuestionario de 3 dimensiones con 32 preguntas. Resultados: Del total de internos de medicina, el promedio de edades fue 26.4 ± 4.14 años, 60% fueron mujeres, 89.09% no tenían otro empleo adicional, 67.27% provenían de universidades privadas y el 89.09% no recibió capacitaciones en este año. El 41.82% obtuvo nivel de conocimiento aprobatorio y el 58.18% desaprobatorio. Las características respecto al nivel de conocimiento, el de mayor diferencia fue la ocupación con un 44.9% de aprobados en los que solo eran internos de medicina y un 16.67% de aprobados en los que tenían otro empleo adicional. Conclusiones: La mayoría obtuvo un nivel de conocimiento desaprobatorio. Las características respecto al nivel de conocimiento, el sexo no obtuvo una diferencia, la ocupación fue la de mayor diferencia y, la universidad de origen y recibir capacitaciones tampoco obtuvieron una diferencia

Resistencia a la compresión del mortero y conductividad térmica al sustituir el cemento por Mejillón 10% y 15%

La presente investigación tuvo como objetivo determinar la resistencia y conductividad térmica de un mortero experimental para el mejoramiento de un mortero tradicional. En Chimbote las patologías en los muros confinados son daños y/o defectos que aparecen en las edificaciones a causa de diferentes factores. Estos pueden ser defectos propios de las piezas, de los morteros o provocados por agentes externos. También pueden aparecer defectos debido a movimientos estructurales, por estar afectadas las cimentaciones u otros elementos constructivos. Tales problemas pueden originarse durante el proceso de fabricación de las piezas, o durante la puesta en obra o durante la vida útil de la edificación según Comesaña en el 2015 quien hizo un estudio en Chimbote. Es por ello lo que me motivo a realizar este proyecto fue los escasos recursos que tienen las personas para construir sus viviendas y con este proyecto disminuirá los gastos para la adquisición del cemento, porque a diferencia del cemento tradicional este nuevo cemento costará mucho menos y beneficiará a los pobladores de Chimbote En este proyecto nos hicimos el siguiente cuestionamiento la cual fue si sustituimos el cemento por choro (10% y 15%) de Chimbote ¿aumentará o disminuirá su resistencia a la compresión y su conductividad térmica? Para ello primero se estudió el choro en la cual hicimos un ensayo de calcinación del choro a una temperatura adecuada ya que para ello se realizó el ensayo del ATD (análisis térmico diferencial), que consiste en obtener a que temperatura va trabajar mejor el choro, la cual a 890°C ; otro factor importante es el ensayo granulométrico en la cual nos ayudara a que los materiales que utilizamos puedan ser finos lo cual usaremos la malla Nº 200 en donde según la norma dice que lo que pase de esa 5 malla será material fino. Después de realizar el ensayo granulométrico pasaremos a realizar el ensayo de fluorescencia de rayos X que consiste en estudiar la composición de la ceniza del choro para obtener una mayor información acerca de los componentes que estamos estudiando la cual nos arrojó que contiene un elevado porcentaje de óxido de calcio, una vez realizado este ensayo hicimos el estudio de pH en la que consiste en el estudio de acidez o alcalinidad de una disolución en este caso será de la ceniza del choro que obtuvo un 13.64 (85% de cemento y 15% de choro). Después realizamos un ensayo para encontrar la relación de agua cemento que expresa la íntima relación que existe entre el peso del agua utilizada en la mezcla y el peso del cemento (la cual obtuvimos una relación de 0.64) una vez obtenido la relación agua cemento comenzamos a elaborar la mezcla del mortero patrón y experimental.Tesi

Measurement of National Non-Visible Wealth through Intellectual Capital

The economy of knowledge requires measures of national wealth that take into account aspects not contemplated by GDP, in order to portray the situation of a country more truthfully. In this paper, we use a new model to measure the intellectual capital of nations, adapted from microeconomics. It is based on the observation of hidden capital as implicit generator of long-term wealth, considering not only sustainability and social wellbeing, but also intangible assets such as human development, economic structure, international trade, foreign image and innovation. This empirical study reveals the importance of hidden capital in a nation’s wealth, making the difference where economic growth is concerned, as the most developed countries record the highest scores of efficiency in terms of intangible capital.knowledge economy indicators, hidden wealth, intangibles, GDP

An Analysis Of The Temporal Evolution Of Agrarian Prices

At the end of 2007 and principles of 2008 took place the greater nourishing crisis of the last decades. This crisis was caused by a spectacular increase in the prices of some agricultural raw materials and in the costs of the agrarian production. Since the end of 2008 the prices of the agricultural raw materials have decreased with similar intensity as when they raised. In the upward period, the increases of prices quickly were moved to the final consumer prices without great impact in the farmer’s income but when the prices decreased they do not allow seeing so fast in the final consumers prices. In this paper, we analyse the evolution of the agricultural activity results over the last years. In order to do so, we consider the prices of agricultural raw materials and products made with these, without forgetting the production costs. This study analyses the evolution of: the differential between the producer (farmer and stockman) prices and the prices charged for agrarian products to the final consumers and the differential between the producer price and the production cost

In Vivo Corneal Microstructural Changes in Herpetic Stromal Keratitis: A Spectral-Domain Optical Coherence Tomography Analysis

Purpose: To describe and analyze the microstructural changes in herpetic stromal keratitis (HSK) observed in vivo by spectral-domain ocular coherence tomography (SD-OCT) at different stages of the disease. Methods: A prospective, cross-sectional, observational, and comparative SD-OCT analysis of corneas with active and inactive keratitis was performed, and the pathologic differences between the necrotizing and non-necrotizing forms of the disease were analyzed. Results: Fifty-three corneas belonging to 43 (81.1%) women and 10 (18.8%) men with a mean age of 41.0 years were included for analysis. Twenty-four (45.3%) eyes had active keratitis, and 29 (54.7%) had inactive keratitis; the majority (83.0%) had the non-necrotizing form. Most corneas (79.1%) with active keratitis showed stromal edema and inflammatory infiltrates. Almost half of the active lesions affected the visual axis, were found at mid-stromal depth, and had a medium density. By contrast, corneas with inactive keratitis were characterized by stromal scarring (89.6%), epithelial remodeling (72.4%), and stromal thinning (68.9%). In contrast to non-necrotizing corneas, those with necrotizing HSK showed severe stromal scarring, inflammatory infiltration, and thinning. Additionally, most necrotizing lesions (77.7%) affected the visual axis and had a higher density (P = 0.010). Conclusion: Active HSK is characterized by significant epithelial and stromal thickening and the inactive disease manifests epithelial remodeling at sites of stromal thinning due to scarring. Necrotizing keratitis is characterized by distorted corneal architecture, substantial stromal inflammatory infiltration, and thinning. In vivo SD-OCT analysis permitted a better understanding of the inflammatory and repair mechanisms occurring in this blinding corneal disease

Trazos biográficos de "Mi señora" desde la cultura escrita: Mencía de Velasco (†1523)

Aquest article té com a objectiu la recapitulació i presentació de notícies històriques sobre Mencía de Velasco. Els documents conservats pel llinatge permeten de radiografiar el perfil d'una gran dama lletraferida de l’alta noblesa que va viure sense casar-se ni professar els vots eclesiàstics. Les seves últimes voluntats –fundacions d'hospitals i convent, testaments i inventaris post mortem– proporcionen una gran quantitat d'informació relativa als seus llibres i papers, a la seva  biblioteca i al seu arxiu, dos espais inclosos al final de la seva vida en el monestir de santa Clara de Medina de Pomar i gestionats pel seu criat Diego de Isla.The purpose of this article is to recapitulate and present historical information about Mencía de Velasco. The documents preserved by the lineage allow us to analyze the profile of a high nobility literate lady who lived without marrying or professing ecclesiastical vows. Her last dispositions –foundations of hospitals and convents, wills and post mortem inventories– provide a great deal of information regarding her books and papers, library and archive, two spaces included at the end of her life in the monastery of Santa Clara de Medina de Pomar and managed by her servant Diego de Isla.Este artículo tiene como objetivo la recapitulación y presentación de noticias históricas sobre Mencía de Velasco. Los documentos conservados por el linaje permiten radiografiar el perfil de una dueña letrada de la alta nobleza que vivió sin casarse ni profesar los votos eclesiásticos. Sus últimas disposiciones –fundaciones de hospitales y convento, testamentos e inventarios post mortem– proporcionan una gran cantidad de información relativa a sus libros y papeles, biblioteca y archivo, dos espacios incluidos al final de su vida en el monasterio de santa Clara de Medina de Pomar y gestionados por su criado Diego de Isla

Decoloration of an Effluent from Textile Industry using Moringaoleifera Seed Extract

This research evaluated the removal of textile dyes by the physicochemical process of coagulation-flocculation using a natural coagulant extracted from the seed of the Moringaoleifera tree. The seed was collected and two different coagulants extracts were prepared: simple extract and saline extract. For the experimental essays, synthetic samples were prepared in the laboratory using three azo dyes with different chemical structures; direct blue 71, reactive red 2 and acid yellow 23, its decoloration was evaluated individually and in mixtures. Also, a wastewater sampling was carried out in a textile plant located in the municipality of Zinapecuaro, Michoacan and tests of coagulant activity and determination of optimal parameters for the process were carried out, this was accomplished through the simulation of jar test and measurement of absorbance using an ultraviolet-visible light spectrophotometer to determine the percentage of visible color removal

Fluoride Removal from Aqueous Solutions by Mechanically Modified Guava Seeds

Removal of fluoride ions by mechanically modified guava seeds (MGS) from aqueous solutions in batch systems was investigated. The kinetic parameters as well as the sorption capacity of MGS were evaluated. The effect of different parameters such as particle size, initial fluoride concentration and contact time was studied on the sorption process. The rate of sorption for fluoride was rapid in the first 150 minutes and reached a maximum in 300 minutes. It was observed that particle size plays an important role in the kinetics of fluoride removal by this biosorbent since biosorption rate increased as particle size decreased. Sorption kinetic data were fitted to Lagergren, pseudo-second order and Elovich models. It was found that the pseudo second-order kinetic model describes the sorption kinetic experimental data and the Langmuir-Freundlich model describes biosorption isotherm, indicating that this system presents chemisorption on heterogeneous surfaces. It was also found that. Fluoride removal was evidenced by FTIR and SEM. Guava seeds showed a high affinity for fluoride ions compared with conventional adsorbents; therefore, it can be considered as a good low-cost biosorbent for defluoridation of water

Performance Management in Collaborative Networks: Difficulties and Barriers

Abstract. Global competitiveness obliges to enterprises to collaborate in many processes such as new product and services development in order to shorten the lifecycle, development and commercialization. Therefore, the competence has drifted from an individual focus to a supply chain management one and, from some years, to a collaborative enterprises network approach. It is common to find frameworks for measuring/managing the performance within extended enterprises, supply chains, virtual enterprises, etc. However, few authors deal with a higher level: the collaborative networks one. This concept of enterprises management set up bigger difficulties regarding not only from a conceptual and structural point of view but also considering both the design and posterior development of systems capable of managing the performance achieved in this type of organizations. This work describes both the main difficulties and barriers when trying to apply performance management concepts to collaborative networks. In this sense, it is highlighted the weaknesses of the existing intra-organizational frameworks that cannot be projected, as they are conceived, to manage performance within collaborative networks