Conditional Cash Transfers and Education Quality in the Presence of Credit Constraints

We investigate the relative merits of unconditional cash transfers (UCT), conditional cash transfers (CCT), and improvements in education quality on efficiency and welfare. In our setting some parents under-invest in their children's education because capital market imperfections prevent them from borrowing. When credit constrained households can be perfectly targeted by the government, we show that CCT are more effective than UCT in enhancing efficiency and equivalent in terms of welfare. When public education quality is very low, raising quality is welfare improving, but is never efficiency enhancing. If the government cannot target constrained households, UCT may be the best policy both in terms of efficiency and welfare.conditional cash transfers, public education, education quality, unconditional cash transfers, credit constraint, efficiency, welfare

Treatment chronic macular edema in Vogt-Koyanagi Harada syndrome with dexamethasone intravitreal implant: description of three case

Purpose: To report our experience with dexamethasone intravitreal implant (Ozurdex, DEX implant) in the chronic cystic macular edema (ME )with Vogt-Koyanagi-Harada (VKH) Syndrome. Method: A retrospective chart review of three patients with (VKH) treated with sustained-release dexamethasone 0.7 mg intravitreal implant was performed.Complete ophthalmic examination included: best corrected visual acuity; ocular tonometry, were also evaluated signs of inflammatory activity of the anterior segment with biomicroscopy slit-lamp, and posterior segment with fundus biomiocrosopy, fundus photography and fluorescein angiography; measurement of macular morphology and thickness, optical with coherence tomography; and tolerability of the implant. Mean follow-up time post-injection was 6 months. All three eyes received 1Ozurdex implants during the follow-up period. The duration of effect of the implant was 4 to 6 months. No serious ocular or systemic adverse events were noted during the follow-up period. Results: In all three eyes, were observed a remarkable decrease ME, in angiographic and OCT , following placement intravitreal DEX implant Conclusions: The DEX implant 0.7 mg may be an effective treatment option for reduction ME in VGT, met the primary efficacy endpoint for improvement in visual acuity (VA) and safety profile was also acceptabl

Ropivacaine vs tetracaine in topical anesthesia for intravitreal injection

Aim: The object of the study was to evaluate the long term efficacy and safety of ropivacaine 0,5% vs tetracaine 0,5% for topical anesthesia in intravitreal injection of dexamethasone in patients with diabetic macular edema (DME) and anti-vascular endothelial growth factor (VEGF) therapy. Methods: Thirty-seven patients were enrolled in the study. Intravitreal anti-vascular endothelial growth factor (VEGF) and Dexamethasone were placed in DME patients. Intravitreal administration determines appropriate and long-lasting drug's concentration without systemic side effects. Topical anesthesia under ropivacaine 0,5% vs tetracaine 0,5% was performed. Results: Intravitreal injection without any supplemental anesthesia and sedation was realized. Patients reported mild pain (recorded by a 0 to 10 scale) during the procedure with optimal operative result. Conclusions: Topical anesthesia with ropivacaine and tetracaine is safe and effective in intravitreal injection. The long-lasting anesthesia secured low pain during this limited but unpleasant procedure

Aislamiento de pacientes con gérmenes multirresistentes en la unidad de terapia intensiva

Las infecciones hospitalarias por gérmenes multirresistentes en las unidades de cuidados intensivos (UCI) van tomando mayor amplitud con el tiempo, relacionados con principales factores de riesgo como son: asistencia respiratoria mecánica, cateterismo vesical y cateterismo endovascular central. Estos gérmenes, incluyendo el estaphylococcus aureus, enterococo resistente a vancomicina y algunos bacilos gram negativos tienen una significancia importante en el control de las infecciones. Aunque la transmisión de los gérmenes multirresistentes es más frecuentemente documentada en las instituciones de salud de los servicios de áreas críticas (terapia intensiva, quemados, cuidados neonatales), otros servicios también se ven afectados por microorganismos multirresistentes. Es por todo esto que una buena organización de enfermería para la atención de este tipo de pacientes se convierte en el centro de atención para disminuir la propagación de los patógenos. El acercamiento a la prevención y control de los mismos es necesario para adaptar a las necesidades específicas de cada institución. La incorporación de nuevos conocimientos de forma continua, mejora de la conducta, hábitos, respetando las medidas de aislamiento establecidas por el comité de infectología de cada institución y la disponibilidad de recurso financiero, humano, incluyendo un adecuado liderazgo administrativo, provocaría un estímulo positivo que puede resultar en grandes logros. De este modo la educación sigue siendo el pilar fundamental para que el personal involucrado realice el buen aislamiento y evitar nuevas incidencias de casos, prolongaciones de la estadía de los pacientes, uso de tratamientos de altos costos y aumento de la mortalidad. Este trabajo de investigación tiene como objetivo determinar qué factores relacionados a la organización de la atención de enfermería inciden en el aumento de las infecciones por gérmenes multirresistentes en la unidad de terapia intensiva del Hospital Central, en Mendoza en el año 2011.Fil: Pizarro, María Elena. Universidad Nacional de Cuyo. Facultad de Ciencias Médicas. Escuela de Enfermería..Fil: Taquichiri, Sandra Fernanda. Universidad Nacional de Cuyo. Facultad de Ciencias Médicas. Escuela de Enfermería.

Management of anterior chamber dislocation of a dexamethasone intravitreal implant: a case report

Background Ozurdex is a 700 mcg dexamethasone intravitreal implant, approved for the management of macular edema secondary to retinal vein occlusion, and other related pathoglogiesAnterior chamber dislocation of Ozurdex represents an uncommon complication of the intravitreal injection, which can be managed by repositioning the implant into the vitreous cavity. We describe the case of a successful repositioning of an Ozurdex implant by mobilization and subsequent balanced saline solution injection in the anterior chamber. Case presentation An 83-year-old white woman presented to our Emergency Unit complaining of pain and vision loss in herright eye lasting a week. Her anamnesis revealed a history of persistent cystoid macular edema after phacoemulsification with scleral-fixated posterior chamber intraocular lens implantation, recently treated with an intravitreal Ozurdex implant. She also took a long-distance flight 2 days after the injection. An anterior segment examination showed corneal edema and the rod implant adherent to corneal endothelium. To avoid corneal decompensation, we opted for a implant repositioning. Under topical anesthesia, a 30-gauge needle was introduced through a limbar incisionto mobilize the dislocated rod. Balanced saline solution was injected, with a successful repositioning of the implant into the vitreous cavity. Topical 5 % hypertonic saline solution and 0.2 % betamethasone associated with 0.5 % chloramphenicol drops were administered four times a day. To prevent redislocation of the Ozurdex implant, she was instructed to avoid prone position, any kind of physical effort, and not to undertake long-distance flights during the first postoperative week. One week after surgery, an anterior segment examination showed an improvement of corneal edema. Funduscopy showed that the Ozurdex implant was settled into the vitreous cavity. Conclusions Anterior chamber dislocation of Ozurdex from the vitreous cavity is rare. In our patient, in addition to the posterior capsule tearing, the long-distance flight could have contributed to implant dislocation. Repositioning of the implant is necessary to avoid endothelial decompensation. It can be carried out by using saline balanced solution with the same efficacy as other surgical procedures reported in the literature. A possible disadvantage of this procedure could be implant migration

Six months follow up of a single intravitreal injection of ocriplasmin for symptomatic vitreomacular adhesion

Purpose: To evaluate the efficacy and the safety of the enzymatic vitreolysis with a single intravitreal injection of ocriplasmin 125 μg across a group of patients with symptomatic vitreomacular adhesion (sVMA) during 6 months follow up. Design: A randomized, placebo-controlled, double-masked, 6-month follow up study. Participants: A total of 28 patients (12 M / 16F) (19 receiving ocriplasmin; 9 receiving placebo), mean aged 71 years old, diagnosed with sVMA, VMT, FTMH e ERM by optical coherence tomography. Methods: A single intravitreal injection of ocriplasmin 125 μg or placebo. Primary endpoint was sVMA resolution or FTMH closure. Secondary endpoint included the integrity of the external membrane and the inner and outer segments of the photoreceptor interface using OCT. The evaluation was carried out at baseline and during 6 months after intravitreal injection of ocriplasmin or placebo. Results: After a 6 months follow-up period, the rate of VMA resolution was 42.1% in the Ocriplasmin group vs the 22% in the placebo group. FTMH closure rate was 50% in the Ocriplasmin group vs 0% in the placebo group. The best results were optained within 28 days from the treatment. No case of uveitis, endophthalmitis, retinal tears, retinal detachment or bleeding during followup were reported. One patient reported floaters and transitional photopsias. Conclusions: The study confirmed the efficacy and safety of Ocriplasmin injection for patients with VMT, including when associated with full-thickness macular holes during six months follow up. Long term studies are certainly needed to confirm these results

Comparison between “early” or “late” intravitreal injection of dexamethasone implant in branch (BRVO) or central (CRVO) retinal vein occlusion: six months follow-up

AIM: The aim of this study was to compare early and late injections of intravitreal dexamethasone implant in patients affected by central retinal vein occlusion (CRVO) or branch retinal vein occlusion (BRVO) with a six-months follow-up. We assessed whether an earlier treatment start (within seven days from diagnosis) could be more beneficial than a delayed (or late) treatment start (after seven days). MATERIALS AND METHODS: The study included 81 patients (81 eyes) affected by retinal vein occlusion. Best corrected visual acuity was assessed through Early Treatment Diabetic Retinopathy Study (ETDRS) while central macular thickness (CMT) was measured by spectral-domain optical coherence tomography. RESULTS: Both types of patients had a positive therapeutic response to dexamethasone, with an increase in visual acuity (ETDRS) and CMT reduction. CRVO patients were characterized by lower ETDRS values at baseline and at the end of the follow-up as compared to BRVO. CRVO patients showed higher CMT values at baseline, after three and six months from injection. No significant differences in therapeutic response to dexamethasone were observed between patients treated early or late, regardless of RVO type. CONCLUSIONS: This study demonstrates that the therapeutic properties of dexamethasone implant are not significantly influenced by an early or late treatment start in patients affected by BRVO and CRVO, although its therapeutic efficacy seems greater in the former type

Glycosaminoglycans in the human cornea: age-related changes

Abstract AIM: To investigate possible age-related changes in glycosaminoglycans (GAGs) in the human cornea. The substances today called GAGs were previously referred to as mucopolysaccharides. METHODS: Samples of human cornea were taken from 12 younger (age 21 ± 1.2) and 12 older (age 72 ± 1.6) male subjects. Samples were weighed, homogenized, and used for biochemical and molecular analyses. All the quantitative results were statistically analyzed. RESULTS: The human cornea appears to undergo age-related changes, as evidenced by our biochemical and molecular results. The total GAG and hyaluronic acid counts were significantly higher in the younger subjects than in the older subjects. The sulfated heavy GAGs, such as chondroitin, dermatan, keratan, and heparan sulfate, were lower in the younger subjects than in the older subjects. DISCUSSION: GAGs of the human cornea undergo numerous age-related changes. Their quantity is significantly altered in the elderly in comparison with younger subjects. GAGs play an important role in age-related diseases of the human cornea