Prophylaxis of postoperative endophthalmitis following cataract surgery: Results of the ESCRS multicenter study and identification of risk factors

PURPOSE: To identify risk factors and describe the effects of antibiotic prophylaxis on the incidence of postoperative endophthalmitis after cataract surgery based on analysis of the findings of the European Society of Cataract & Refractive Surgeons (ESCRS) multicenter study. SETTING: Twenty-four ophthalmology units in Austria, Belgium, Germany, Italy, Poland, Portugal, Spain, Turkey, and the United Kingdom. METHODS: A prospective randomized partially masked multicenter cataract surgery study recruited 16 603 patients. The study was based on a 2 2 factorial design, with intracameral cefuroxime and topical perioperative levofloxacin factors resulting in 4 treatment groups. The comparison of case and non-case data was performed using multivariable logistic regression analyses. Odds ratios (ORs) associated with treatment effects and other risk factors were estimated. RESULTS: Twenty-nine patients presented with endophthalmitis, of whom 20 were classified as having proven infective endophthalmitis. The absence of an intracameral cefuroxime prophylactic regimen at 1 mg in 0.1 mL normal saline was associated with a 4.92-fold increase (95% confidence interval [CI], 1.87-12.9) in the risk for total postoperative endophthalmitis. In addition, the use of clear corneal incisions (CCIs) compared to scleral tunnels was associated with a 5.88-fold increase (95% CI, 1.34-25.9) in risk and the use of silicone intraocular lens (IOL) optic material compared to acrylic with a 3.13-fold increase (95% CI, 1.47-6.67). The presence of surgical complications increased the risk for total endophthalmitis 4.95-fold (95% CI, 1.68-14.6), and more experienced surgeons were more likely to be associated with endophthalmitis cases. When considering only proven infective endophthalmitis cases, the absence of cefuroxime and the use of silicone IOL optic material were significantly associated with an increased risk, and there was evidence that men were more predisposed to infection (OR, 2.70; 95% CI, 1.07-6.8). CONCLUSIONS: Use of intracameral cefuroxime at the end of surgery reduced the occurrence of postoperative endophthalmitis. Additional risk factors associated with endophthalmitis after cataract surgery included CCIs and the use of silicone IOLs

Follicular conjunctivitis caused by Chlamydia trachomatis in an infant Saharan population: molecular and clinical diagnosis

Aims: To ascertain the prevalence of acute trachoma as a supposed endemic disease among infants in the Saharan refugee camps of Tindouf (Algeria) and to evaluate the efficacy of treatment with a single dose of azithromycin. Methods: 527 children aged between 3 and 17 were evaluated in the camp schools in October 2001. All the children were clinically and microbiologically examined, including slit lamp checks of anterior segment and two conjunctival swabs, one for the detection of membrane lipopolysaccharide by quick immunoassay test Clearview Chlamydia MF and the other for the detection of specific DNA by chlamydia plasmid specific polymerase chain reaction (PCR) assay. After examination, a single dose of azithromycin was administered to each child. One month later samples from positive children and 12 random negative children by the first PCR were taken to perform a new PCR assay. Results: Chlamydia trachomatis was suspected in 2.47% of the children, papillary hypertrophy being the most frequently seen clinical sign. Scarring changes secondary to trachoma were detected in 11.7% of the children. Only four cases (0.8%) were positive to the immunoassay test and 12 cases (2.27%) were positive by PCR. After treatment a second PCR was performed on positive children and they were negative of chlamydia DNA amplification. However, one child who was negative and received the treatment was positive in the second PCR assay. Conclusion: Acute trachoma prevalence is much lower than expected among infants in this Saharan population. The possible reasons could be the recent improvements in hygiene and health care. Cicatricial trachoma is more frequent. The Clearview immunoassay test has very low sensitivity in the detection of this disease. A single dose of azithromycin is sufficient to treat chlamydial conjunctivitis. However, a programme of improvement in hygiene and health care is necessary to prevent re-infectio

Sepsis materna en adolescente atendida en un hospital de III nivel, Lima-2018

La sepsis materna corresponde a "la disfunción orgánica potencialmente mortal causada por una respuesta desregulada del huésped a la infección", es una afección potencialmente mortal durante el embarazo, el parto, post-aborto, o período post-parto. Presentamos el caso clínico de gestante adolescente, primigesta, quién acude a la emergencia de un hospital de nivel III. Se reconoció como factores de riesgo: etapa de vida adolescente, pobreza materna (caso fiscalía por abandono familiar), anemia, desnutrición, primiparidad, infecciones cervico-vaginales. Es evaluada por médico especialista en gineco-obstétricia, quien realiza el diagnóstico de sepsis con punto de partida urinario; inmediatamente es hospitalizada en la unidad de cuidados especiales gineco-obstétricos. Paciente evoluciona favorablemente y es dada de alta diez días después. Este trabajo académico tiene por objetivos: analizar los factores de riesgo teóricos para la sepsis, comprobar el diagnóstico oportuno de la sepsis durante el embarazo e identificar el manejo obstétrico adecuado en el tratamiento de la Sepsis durante el embarazo. Es una revisión de caso de carácter descriptivo y retrospectivo, empleando como fuente la historia clínica de paciente con diagnóstico de sepsis materna en hospital III-1 de la ciudad de Lima-Perú. En conclusión, el diagnóstico fue oportuno y el tratamiento adecuado, y que se siguieron los protocolos internacionales reportados para esta entidad

Iron, Fuel and Slags: Reconstructing the Ironworking Process in Iberian Iron Age (Valencian Region)

In this paper we present the archaeological data related to ironworks in the territory of Kelin (4th-3rd centuries BC). We have analysed the different phases of the process through the distribution of raw materials, iron oxides, production waste and manufactured products as well as some structures such as furnaces and forges. Furthermore, metallographic analysis allows us to know the nature and the phases of the ironworking process. Our goal is to reconstruct the operative chain from the mines to the resulting iron tools and weapons in order to approach deeply the importance and organization of ironworks in the Iberian society.In this paper we present the archaeological data related to ironworks in the territory of Kelin (4th-3rd centuries BC). We have analysed the different phases of the process through the distribution of raw materials, iron oxides, production waste and manufactured products as well as some structures such as furnaces and forges. Furthermore, metallographic analysis allows us to know the nature and the phases of the ironworking process. Our goal is to reconstruct the operative chain from the mines to the resulting iron tools and weapons in order to approach deeply the importance and organization of ironworks in the Iberian society.En este trabajo se presenta toda la información disponible en la actualidad sobre la siderurgia del territorio de Kelin entre los siglos IV y III a.C. Se analizan las diferentes fases del proceso de producción desde la distribución de materias primas, los desechos de producción y los productos manufacturados así como los hornos y forjas. Además, los análisis metalográficos aportan información sobre las fases del proceso siderúrgico. El objetivo es reconsruir la cadena operativa desde el trabajo en las minas a las herramientas y armamento, así como profundizar en la importancia y la organización de lo talleres siderúrgicos en la sociedad ibérica

Endophthalmitis Caused by Fusarium proliferatum

Fusarium proliferatum caused endophthalmitis after cataract surgery. Diagnosis was established by classical microbiology and molecular biology methods (PCR and DNA typing). The treatment with local amphotericin B, oral ketoconazole, and topical natamycin was successfu

Wegener's granulomatosis : description of a case with oral manifestation

Wegener?s granulomatosis is a multisystemic granulomatous vasculitis that predominantly affects the airways and the kidneys, but may affect any organ. Otorhinolaryngological manifestations may be oral ulcers, gingival swelling or septal perforations that can cause saddle nose deformities, rhinitis, sinusitis and hearing loss. The oral ulcers usually occur when the disease is advanced. Renal involvement is characterized by focal and segmental glomerulosclerosis, and determines the evolution. The diagnosis is made by clinical symptoms and signs, the presence of c-ANCA and a positive biopsy. The anatomic pathology is characterized by vasculitis, granulomatous inflammation with multinuclear giant cells and necrosis. The prognosis has improved as a result of treatment with immunosuppressants associated with corticosteroids. We report a case of a 53-year-old patient with Wegener?s granulomatosis with oral manifestation, which began as chronic mastitis

Postoperative Corynebacterium macginleyi endophthalmitis

A 72-year-old man with chronic endophthalmitis who received steroid treatment for 3 months came to our center. Sterile endophthalmitis after cataract extraction had been diagnosed. Aqueous samples including smears, classic cultures, and polymerase chain reaction were taken for microbiological study. Amplified DNA was sequenced to identify the pathogen. Polymerase chain reaction amplification was positive for bacteria. Sequence analysis showed Corynebacterium macginleyi as the causal agent in 48 hours. The culture and smear stains from the ocular samples were negative. The patient was successfully treated with vancomycin. Polymerase chain reaction and subsequent DNA-typing were useful in detecting the microorganisms that caused the chronic endophthalmitis

Polymerase chain reaction diagnosis in fungal keratitis caused by Alternaria alternata

PURPOSE: To contribute toward assessing the effectiveness of polymerase chain reaction as a rapid method in diagnosis of torpid keratitis caused by opportunistic fungi. METHODS: Interventional case report. A 50-year-old man with a corneal abscess in the right eye treated for a period of 6 months with different combinations of broad-spectrum antibiotics and steroids was referred to our center. Corneal scraping was taken for microbiological study, including classic cultures and polymerase chain reaction. Amplified DNA was sequenced to identify the pathogen. RESULTS: Polymerase chain reaction amplification was negative for Acanthamoeba species and positive for fungi. The sequence analysis showed Alternaria alternata as the causal agent in 24 hours. Cultures confirmed the identification in 10 days. CONCLUSION: Polymerase chain reaction amplification with subsequent DNA-typing was revealed to be a useful method for detection of ocular pathogens such as A. alternata involved in cases of torpid keratitis, even in the presence of broad-spectrum antimicrobial therap

Rapid Molecular Diagnosis of Posttraumatic Keratitis and Endophthalmitis Caused by Alternaria infectoria

The first case of Alternaria infectoria ocular infection is reported. Keratitis and endophthalmitis developed after eye-perforating trauma from a lemon tree branch. Two months after surgery and empirical steroid and antibiotic treatment, diagnosis by molecular methods was performed. PCR amplification was positive for a fungus after 4 h. Antifungal treatment with amphotericin B and fluconazole was initiated immediately. DNA sequence analysis showed Alternaria infectoria to be the causal agent. After topical and systemic administration of antifungal treatment, ocular inflammation disappeared and visual acuity improved. DNA typing was found to be a useful tool to achieve early identification of the causal agen