Eficacia del diclofenaco tópico vs. nepafenaco tópico en la reducción del dolor durante la fotocoagulación panretiniana

ResumenPropósitoComparar la eficacia del diclofenaco tópico 0.1% vs. nepafenaco tópico en reducir el dolor asociado a la fotocoagulación panretiniana con láser argón.Material y métodosEnsayo clínico aleatorizado doble enmascarado, 132 pacientes (183 ojos) con diagnóstico de retinopatía diabética proliferativa tratados con fotocoagulación panretiniana. Aleatorización en 2 grupos: diclofenaco y nepafenaco tópicos. Se aplicaron 2 dosis de los analgésicos tópicos previas a la fotocoagulación panretiniana, se evaluó el dolor inmediatamente y 15min después. Se analizó nivel de dolor, efectos adversos y síntomas asociados al finalizar la fotocoagulación retiniana.ResultadosLa mediana de la edad para ambos grupos fue de 55 años, relación H:M de 1:1.4. El nivel de dolor inmediato fue de 35.5 (RIC 14-72) para el nepafenaco y de 45 (RIC 14-70) para el diclofenaco (p=0.48). A los 15min fue de 30 (RIC 4-50) para el nepafenaco y de 20 (RIC 2-50) para el diclofenaco (p=0.48). No hubo diferencias significativas en síntomas asociados entre los grupos ni efectos adversos en la superficie ocular.ConclusionesEl tratamiento previo con nepafenaco y diclofenaco tópicos es igualmente eficaz y seguro para reducir el dolor asociado a la fotocoagulación panretiniana en pacientes con retinopatía diabética proliferativa.AbstractPurposeTo compare the efficacy of topical diclofenac 0.1% vs topical nepafenac in reducing pain associated to argon laser retinal photocoagulationMaterial and methodsDouble blinded, randomized clinical trial. One hundred thirty two patients with diagnosis of proliferative diabetic retinopathy treated with retinal photocoagulation. Randomization in to 2 groups: topical diclofenac and nepafenac. Before retinal photocoagulation 2 doses of topical non-steroidal anti-inflammatory drugs were applied, pain was assessed immediately and 15minutes after. Level of pain, adverse effects and associated symptoms at the end of retinal photocoagulation were analyzed.ResultsThe median for age in both groups was 55 years, M:F ratio of 1:1.4. The immediate level of pain was 35.5 (ICR 14-72) for nepafenac and 45 (ICR 14-70) for diclofenac (P=.48). At 15minutes the pain level was 30 (ICR 4-50) for nepafenac and 20 (ICR 2-50) for diclofenac. There was no difference in associated symptoms or adverse effects among groups.ConclusionsThe preventive treatment with topical nepafenac and diclofenac is equally effective and safe for reducing the pain associated with retinal photocoagulation in patients with proliferative diabetic retinopathy

LASIK monocular en pacientes adultos con ambliopía por anisometropía

ResumenObjetivoDeterminar la eficacia y la seguridad del LASIK en el tratamiento de la ambliopía por anisometropía en pacientes adultos.MétodosSerie de casos. Estudiamos a 12 pacientes adultos ambliopes por anisometropía a los cuales se realizó LASIK monocular de nuestro servicio de Córnea y Cirugía Refractiva. Evaluamos el error refractivo pre y postoperatorio, equivalente esférico (ES), la agudeza visual sin corrección (AVSC) y la agudeza visual mejor corregida (AVMC). La agudeza visual medida por la cartilla de Snellen fue convertida a LogMAR con fines de análisis estadístico.ResultadosLa edad promedio fue de 31.92 (± 12.13) años. El ES preoperatorio promedio en el ojo tratado fue de –3.49 D (± 3.24), el ES promedio del ojo no tratado fue de 0.25 D (± 0.30). La AVSC preoperatoria fue de 1.12 (± 0.3) LogMAR y la AVMC preoperatoria fue 0.31 (± 0.1) LogMAR. El seguimiento promedio fue de 19.1 (rango 6-74) meses. El ES promedio postoperatorio disminuyó a –0.28 (± 0.48). Cinco pacientes (42%) ganaron una línea de visión, un (8%) paciente ganó 2 líneas de visión y un (8%) paciente ganó 3 líneas de visión. El resto (42%) permaneció sin cambios comparados a la AVMC preoperatoria. Se encontraron diferencias estadísticamente significativas entre la AVSC preoperatoria (1.12 [±0.3]) y la AVSC postoperatoria (0.27 [±0.1]) (p=0.002, Z-Wilcoxon) y entre la AVMC postoperatoria (0.23 [±0.12]) y la AVMC preoperatoria (0.31 [±0.1]) (p=0.014, Z-Wilcoxon). No hubo complicaciones relacionadas con la cirugía.ConclusionesLa cirugía refractiva monocular en pacientes con ambliopía por anisometropía es una opción terapéutica segura y efectiva que ofrece resultados visuales satisfactorios, preservando o incluso mejorando la AVMC preoperatoria.AbstractPurposeTo investigate the efficacy and safety of LASIK for the correction of anisometropic amblyopia in adult patients.MethodsA retrospective, case series. We found 12 amblyopic adult patients that underwent monocular LASIK for anisometropía in our Cornea and Refractive service. We evaluated the preoperative and postoperative refractive error, spherical equivalent (SE), uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA). Snellen visual acuity measurements were converted to LogMAR for statistical purposes.ResultsThe mean age was 31.92 (±12.13) years. The average preoperative SE in the treated eyes was -3.49 (±3.24), the average SE of the untreated eye was 0.25(±0.30). Preoperative UCVA was 1.12 (±0.3) and average preoperative BCVA was 0.31 (±0.1). All patients had LASIK with an average follow-up time of 19.1(6-74) months. The average postoperative SE decreased to -0.28 (±0.48). Five patients (42%) gained 1 line of vision, 1 (8%) patient gained 2 lines of vision, 1 (8%) patient gained 3 lines of vision and the rest (42%) remained unchanged compared to preoperative BCVA. Statistically significant differences were observed between the preoperative UCVA [1.12 (±0.3)] with the postoperative UCVA [0.27 (±0.1)](p=0.002, Z-Wilcoxon) and between the postoperative BCVA [0.23 (±0.12)] with the preoperative BCVA [0.31 (±0.1)] (p=0.014, Z-Wilcoxon). There were no complications related to the surgical procedures.ConclusionsMonocular refractive surgery in adult patients with anisometropic amblyopia is a safe and effective therapeutic option that offers a satisfactory visual outcome, preserving or even improving the preoperative BCVA

Perfil microbiológico y sensibilidad a antibióticos de microorganismos aislados de infecciones conjuntivales en el Instituto de Oftalmología Fundación Conde de Valenciana. Reporte del año 2012

ResumenIntroducciónLa conjuntiva es el tejido ocular que se infecta con mayor frecuencia. Los agentes patógenos más frecuentes de la conjuntivitis suelen ser los virus y las bacterias. El uso indiscriminado de antibióticos de amplio espectro para tratar la conjuntivitis ha generado microorganismos resistentes.ObjetivoIdentificar los microorganismos más frecuentes aislados de muestras de origen conjuntival y conocer su susceptibilidad antibiótica.Material y métodosRevisión retrospectiva de cultivos provenientes de raspados conjuntivales obtenidos durante el 2012.ResultadosSe obtuvieron 44 muestras de origen conjuntival. Estas provinieron de 21 varones y 23 mujeres. La mediana (25%, 75%) de la edad fue 62 años (39-68). El cultivo fue positivo en 13 de las muestras obtenidas, identificándose 5 microorganismos diferentes. Staphylococcus epidermidis fue el microorganismo aislado con mayor frecuencia (9 cepas). Todas las cepas de S. epidermidis fueron sensibles a vancomicina, gentamicina, cefotaxima, moxifloxacino y ofloxacino. La mayoría de las cepas de S. epidermidis (6/9) mostraron resistencia a múltiples antibióticos.ConclusionesStaphylococcus epidermidis fue el microorganismo aislado con mayor frecuencia en muestras provenientes de infecciones conjuntivales. Todas las cepas de S. epidermidis fueron sensibles a vancomicina, gentamicina y moxifloxacino y la mayoría de ellas fueron multirresistentes a los antibióticos en evaluación.AbstractIntroductionThe conjunctiva is the tissue of the eye that gets infected with more frequency. The most common pathogens of conjunctivitis are viruses and bacteria. The indiscriminate use of broad-spectrum antibiotics to treat conjunctivitis generated resistant microorganisms.ObjectiveIdentify the most common microorganisms isolated from samples of conjunctival origin and know their antibiotic susceptibility.Material and methodsRetrospective review of culture from conjunctival swabs obtained during 2012.ResultsWe collected 44 samples of conjunctival origin. They came from 21 males and 23 women. The median (25%, 75%) of age was 62 years (39-68). The culture was positive in 13 samples, identifying five different microorganisms. Staphylococcus epidermidis was the most common isolated microorganism (9 strains). All strains of S. epidermidis were sensitive to vancomycin, gentamicin, cefotaxime, ofloxacin and moxifloxacin. The multiple antibiotic resistance was identified in the majority of strains of S. epidermidis (6/9).ConclusionsStaphylococcus epidermidis was the most common isolated microorganism from samples of conjuntival infections. All strains of S. epidermidis were sensitive to vancomycin and moxifloxacin and most of them showed multidrug resistance to antibiotics

Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Formación en ética y profesionalismo para las nuevas generaciones de médicos

The medical profession is a specific kind of occupation that responds to the economic, political and social requirements of the community. Nevertheless, in the health care professions, that concept goes even further when the ethical perspective becomes involved. Ideally, health care professionals give priority to the needs of others—individually or collectively— and place their own needs second. In this way, medicine becomes in not just an occupation, but a vocation and a way of life ruled by ethical principles and guided by high professional standards. To restore medicine’s distinctive vocation, it is essential to analyze the intrinsic motivations and life ethics of new generations of physicians and, on that basis, to begin to develop —in the manner of profi ciencies— the knowledge, abilities, attitudes and values that enhance professionalism. In the end, this will provide for a better physician-patient relationship, by invariably giving priority to the patient’s best interests.A profissão médica é uma ocupação específica que responde às demandas econômicas, políticas e sociais da comunidade. No entanto, no domínio das profissões relacionadas com a saúde, o conceito vai além deste ambiente, já que entra em jogo a perspectiva ética, na que –idealmente– o profissional de saúde põe os interesses dos outros acima dos seus próprios. Por tanto, esta profi ssão torna-se um modo de vida orientado por princípios éticos e guiado por altos padrões de profi ssionalismo. Conseqüentemente, é uma vocação e não uma simples ocupação. Se desejamos que a profissão retorne a sua vocação distinta, é essencial analisar as motivações intrínsecas e a ética de vida das novas gerações de médicos e, a partir daí, desenvolver conhecimento, habilidades, atitudes e valores –semelhantes a competências– conducentes ao desenvolvimento do profissionalismo para conseguir uma melhor relação médico-paciente cujo interesse primário seja o bem-estar de este último.DOI: 10.5294/pebi.2010.14.1.2 La profesión médica es un tipo específico de ocupación que da respuesta a los requerimientos económicos, políticos y sociales de la comunidad. Sin embargo, en el ámbito de las profesiones relacionadas con la salud, dicho concepto trasciende este entorno al entrar en juego la perspectiva ética en la que, idealmente, el profesional de la salud antepone los intereses de los demás a los propios. De esta manera, la profesión médica se convierte en una forma de vida regida por principios éticos y guiada por los más altos estándares de profesionalismo, constituyéndose en una vocación y no en una simple ocupación. Para devolver a la profesión médica su vocación distintiva, es esencial analizar las motivaciones intrínsecas y la ética de vida de las nuevas generaciones de médicos y, a partir de ahí, desarrollar —a manera de competencias— conocimientos, habilidades, actitudes y valores que propicien el desarrollo del profesionalismo, logrando fi nalmente una mejor relación médico-paciente, situando el bienestar de este último como principal interés. DOI: 10.5294/pebi.2010.14.1.