Perception of difficulties with vision-related activities of daily living among patients undergoing unilateral posterior capsulotomy

OBJECTIVES: To assess the influence of Nd:YAG (neodymium: yttrium-aluminum- garnet) laser unilateral posterior capsulotomy on visual acuity and patients' perception of difficulties with vision-related activities of daily life. METHODS: We conducted an interventional survey that included 48 patients between 40 and 80 years of age with uni- or bilateral pseudophakia, posterior capsule opacification, and visual acuity <0.30 (logMAR) in one eye who were seen at a Brazilian university hospital. All patients underwent posterior capsulotomy using an Nd:YAG laser. Before and after the intervention, patients were asked to complete a questionnaire that was developed in an exploratory study. RESULTS: Before posterior capsulotomy, the median visual acuity (logMAR) of the included patients was 0.52 (range 0.30-1.60). After posterior capsulotomy, the median visual acuity of the included patients improved to 0.10 (range 0.0-0.52). According to the subjects' perceptions, their ability to perform most of their daily life activities improved after the intervention (p<0.05). CONCLUSIONS: After patients underwent posterior capsulotomy with an Nd:YAG laser, a significant improvement in the visual acuity of the treated eye was observed. Additionally, subjects felt that they experienced less difficulty performing most of their vision-dependent activities of daily living

Advances in the phylogenetic study of the tribe Cinchoneae (Rubiaceae) with emphasis on the genus Cinchona and Ladenbergia

In its current circumscription, the Cinchoneae tribe includes 9 genera of neotropical distribution. Its species occur mostly in the Andes in South America, with few reaching Central America. Preliminary phylogenetic studies have suggested the monophyly of Cinchoneae but intrageneric relationships are still debatable. In this study, we sampled 8 genera of Cinchoneae (with ca 50% of species for Cinchona and Ladenbergia) and obtained multiple single-copy nuclear loci (ca 207 genes) by using the “Angiosperm353 universal probe set”, which was complemented with a taxonomic review of Cinchoneae. Phylogenetic inferences were realized with multispecies pseudo-coalescent (ASTRAL III) and gene concatenation analysis (ML). Our results strongly support the monophyly of the tribe and most of the genera, except for Ladenbergia. Furthermore, Ciliosemina, Ladenbergia, and Remijia formed a clade, although the position of Ciliosemina (= Remijia pedunculata) and Ladenbergia muzonensis is still elusive. The position of Ladenbergia muzonensis is intriguing due to its intermedíate floral morphology, which resembles both Remijia and Ladenbergia species. Additionally, our phylogeny also supports the recognition of a new species in Cinchona. Finally, our results show that sequencing data using the probe set designed for multiple gene capture is a useful tool for phylogenetic reconstructions in taxonomically complex groups

Técnica modificada de postioplastia en toros cebuínos con balanopostitis ulcerativa del trópico mexicano

El objetivo del presente trabajo es mostrar los resultados de toros con postitis que se les practicó Técnica Modificada de Postioplastia como manejo quirúrgico de esta patología. Se realizó un estudio de tipo descriptivo no probabilístico en toros reproductivamente activos que presentaron postitis crónica ulcerativa. Los casos clínico-quirúrgicos se presentaron en diferentes ranchos de la zona sur de Veracruz. Los pacientes fueron 10 toros cebús de los cuales 7 eran de la raza brahmán, 1 indubrasil y 2 Sardo Negro, con buena condición corporal y con postitis crónica ulcerativa. Ninguno de los animales había recibido tratamiento quirúrgico. Se aplicó xilacina al 2 % a la dosis de 0,1 mg/kg de peso vivo como tranquilizante por vía intramuscular. Posteriormente, para la anestesia, se infiltró clorhidrato de lidocaína al 2 % a dosis de 1 ml/cm3 de tejido en la base del prepucio. Una vez tranquilizado el paciente y realizadas las maniobras de derribo, se hizo lavado y evaluación detallada de la lesión. Se realizó una incisión en el limbo mucocutáneo y no en piel para reducir las posibilidades de fimosis cicatrizal. Se ligaron los vasos de gran calibre con puntos de transfixión con material absorbible acidó poliglicólico del calibre 0. Para la hemostasia de los vasos pequeños fue suficiente el pinzamiento y torsión. La divulsión se realiza en 360° hasta conseguir el desprendimiento de todo el tejido afectado incluyendo la mucosa prepucial dañada. Una vez practicada la correcta hermostasis se procedió sujetar la mucosa con pinzas de goma para evitar la retracción, así mismo se le colocaron 4 puntos de forma cardinal con sutura de  nylon monofilico para expandir la mucosa y poder suturarla a la piel, esos mismo puntos de sujeción se fijaron con punto de cirujano y posteriormente se colocaran 4 puntos entre ellos. Los 10 toros operados con la técnica descrita tuvieron recuperación en un período de 90 días posoperatorio en promedio, dos de ellos tuvieron complicación de estenosis cicatrizal.  Se concluye que la técnica quirúrgica empleada en este estudio tuvo resultados favorables. Se considera que si el posoperatorio no se lleva correctamente trasciende seriamente en el éxito o fracaso de esta cirugía

Levothyrox® new and old formulations: are they switchable for millions of patients?

International audienceIn France, more than 2.5 million patients are currently treated with levothyroxine, mainly as the marketed product Levothyrox ®. In March 2017, at the request of French authorities, a new formulation of Levothyrox ® was licensed, with the objective of avoiding stability deficiencies of the old formulation. Before launching this new formulation, an average bioequivalence trial, based on European Union recommended guidelines, was performed. The implicit rationale was the assumption that the two products, being bioequivalent, would also be switchable, allowing substitution of the new for the old formulation, thus avoiding the need for individual calibration of the dosage regimen of thyroxine, using the thyroid-stimulating hormone level as the endpoint, as required for a new patient on initiating treatment. Despite the fact that both formulations were shown to be bioequivalent, adverse drug reactions were reported in several thousands of patients after taking the new formulation. In this opinion paper, we report that more than 50% of healthy volunteers enrolled in a successful regulatory average bioequivalence trial were actually outside the a priori bioequivalence range. Therefore, we question the ability of an average bioequivalence trial to guarantee the switchability within patients of the new and old levothyroxine formulations. We further propose an analysis of this problem using the conceptual framework of individual bioequivalence. This involves investigating the bioavailability of the two formulations within a subject, by comparing not only the population means (as established by average bioequivalence) but also by assessing two variance terms, namely the within-subject variance and the variance estimating subject-by-formulation interaction. A higher within individual variability for the new formulation would lead to reconsideration of the appropriateness of the new formulation. Alternatively, a possible subject-by-formulation interaction would allow a judgement on the ability, or not, of doctors to manage patients effectively during transition from the old to the new formulation