Quemadura corneal grave debida a la aplicación accidental de ácido salicílico envasado en un frasco gotero plástico

Eye burns due to the accidental application of pharmacological or nonpharmacological substances packaged in plastic dropper bottles have been described for more than three decades and continue to occur. These burns can cause potentially serious corneal injuries. We report the case of a patient who mistakenly applied salicylic acid to the right eye after confusing it with an eye lubricant, which caused him a severe corneal burn. Fortunately, after aggressive medical and surgical management (including oxygen therapy and amniotic membrane grafting), the visual results were good.We suggest conducting educational campaigns and taking legislative measures in our country to avoid packaging corrosive substances in this type of dropper bottle to reduce the risk of accidental burns.Las quemaduras oculares por aplicación accidental de sustancias farmacológicas o no farmacológicas envasadas en frascos goteros plásticos, se han descrito desde hace más de tres décadas y siguen ocurriendo. Estas quemaduras pueden causar lesiones potencialmente graves de la córnea.Se presenta el caso de un paciente que se aplicó ácido salicílico en el ojo derecho al confundir el envase con el de un lubricante ocular, lo que le causó una grave quemadura corneal. Afortunadamente, tras un manejo médico y quirúrgico agresivo (incluida oxigenoterapia e injerto de membrana amniótica) los resultados visuales fueron buenos.Se sugiere hacer campañas educativas y adoptar normas en el país para evitar el envase de sustancias corrosivas en este tipo de frascos goteros, con el fin de disminuir el riesgo de quemaduras accidentales

Secuelas oftalmológicas secundarias a Síndrome de Stevens - Johnson

Figure A. Symblepharon, i.e., adhesion from the edges of the two eyelids (white arrow) and keratinization of the sclerocorneal limbus (yellow arrow) in the right eye. Figure B. Right eye: irregularity from the edge of the lower eyelid with complete obstruction and keratinization of the excretory ducts of the Meibomian glands, due to chronicity of the inflammation in consequence to Stevens - Johnson syndrome. Figure C. Right eye: showing complete conjunctivalization due to limbus failure and loss of the corneal epithelium in the patient’s right eye, leading to corneal haze as a sequel to chronic severe dry eye secondary to Stevens - Johnson syndrome. Figure D. Left eye: Boston type I keratoprosthesis in situ. As showed, the central cylinder allows light to enter through the eye. The holes seen through the tissue are on the titanium plate that holds the optical cylinder in place on the corneal tissue of a donor, sutured to the patient’s peripheral cornea. This donor corneal tissue is completely conjunctivalized and hazy, but since the end of the optical cylinder is made of synthetic material, it remains transparent. Keratinization of the surface is evident, with an accumulation of keratin in the interface between the synthetic material of the cylinder and the corneal tissue.Figura A. Simblefaron, es decir adherencia de los bordes de los dos párpados (flecha blanca) y queratinización del limbo esclero-corneal (flecha amarilla) en el ojo derecho. Figura B. Ojo derecho: irregularidad del borde del párpado inferior con obstrucción completa y queratinización de los puntos de drenaje de las Glándulas de Meibomio, como consecuencia de la inflamación crónica secundaria al Síndrome de Stevens - Johnson. Figura C. Ojo derecho: conjuntivalización completa por falla del limbo y pérdida del epitelio corneal en el ojo derecho de la paciente, llevando a una córnea totalmente opaca como secuela del ojo seco severo crónico secundario al síndrome de Stevens - Johnson. Figura D. Ojo izquierdo: queratoprótesis de Boston Tipo I in situ. Se aprecia el cilindro central que permite el paso de la luz al interior del ojo. Los agujeros que translucen a través del tejido se encuentran en la placa de titanio que sostiene fijo el cilindro óptico al tejido corneal de un donante, que se suturó a la córnea periférica de la paciente. Ese tejido corneal donante se encuentra completamente conjuntivalizado y opaco, pero el extremo del cilindro óptico, al ser de material sintético, mantiene la transparencia. Se evidencia queratinización de la superficie con acúmulo de queratina en la interfase entre el material sintético del cilindro y el tejido corneal

A global experiment on motivating social distancing during the COVID-19 pandemic

Finding communication strategies that effectively motivate social distancing continues to be a global public health priority during the COVID-19 pandemic. This cross-country, preregistered experiment (n = 25,718 from 89 countries) tested hypotheses concerning generalizable positive and negative outcomes of social distancing messages that promoted personal agency and reflective choices (i.e., an autonomy-supportive message) or were restrictive and shaming (i.e., a controlling message) compared with no message at all. Results partially supported experimental hypotheses in that the controlling message increased controlled motivation (a poorly internalized form of motivation relying on shame, guilt, and fear of social consequences) relative to no message. On the other hand, the autonomy-supportive message lowered feelings of defiance compared with the controlling message, but the controlling message did not differ from receiving no message at all. Unexpectedly, messages did not influence autonomous motivation (a highly internalized form of motivation relying on one’s core values) or behavioral intentions. Results supported hypothesized associations between people’s existing autonomous and controlled motivations and self-reported behavioral intentions to engage in social distancing. Controlled motivation was associated with more defiance and less long-term behavioral intention to engage in social distancing, whereas autonomous motivation was associated with less defiance and more short- and long-term intentions to social distance. Overall, this work highlights the potential harm of using shaming and pressuring language in public health communication, with implications for the current and future global health challenges

Two-Way Coupled Aero-Structural Optimization of Stable Flying Wings

An aero-structural algorithm to optimize a flying wing in cruise conditions for preliminary design is developed using two-way interaction between the structure and aerodynamics. A particle swarm routine is employed to solve the multi-objective optimization, aiming to reduce the weight of the structure and the aerodynamic drag at the design point. Different shapes are evaluated during the optimization process until the algorithm reaches the optimal wing aspect ratio, taper ratio, angle of incidence, twist angle, swept angle, and airfoil shape, where a six-parameters method is employed to allow reflex airfoils. A main isotropic I-beam models the wing structure. An extended vortex lattice model is employed to model the aerodynamics, along with a high-order panel method with fully coupled viscous interaction. The finite element method is used to solve the flying-wing structure under static loads. An algorithm is developed to iterate between the deflection of the wing and its impact on the aerodynamics until convergence is reached. Different constraints are implemented into the objective function to fulfil the structural criteria and the longitudinal static stability. A comparison against a baseline optimization is carried out, achieving higher efficiency and promising results in elliptical lift distribution, and a high static margin, without the use of non-constant twist. The results suggest that combining both reflex airfoils and sweep with washout is the optimal solution to reduce the drag and weight, keeping the longitudinal static stability criteria for tailless aircraft in the lower end of the transonic regime

Revisión del estado actual de la cirugía de reasignación genital en pacientes con disforia de género enfocada en el contexto colombiano

Gender dysphoria or transsexualism is a condition that includes people who suffer from deep discomfort or rejection of biological sex because they identify with the opposite sex. Therefore, it is associated with biopsychosocial dysfunction and severe compQ4Revista Nacional - IndexadaCN

Visual and satisfaction results with implantation of the trifocal Panoptix® intraocular lens in cataract surgery

Purpose: To assess visual results (including the Lapid-Kushlin defocus coefficient), and satisfaction, following the implantation of PanOptix® a trifocal intraocular lens. Methods: Observational, retrospective cohort study. 130 eyes of 65 subjects with bilateral implantation were included. Binocular uncorrected visual acuities [distance (Binocular UDVA), intermediate (Binocular UIVA) and near (Binocular UNVA)] were measured. Also, the manifest refraction, binocular defocus curve and binocular contrast sensitivity were determined. The Lapid-Kushlin defocus coefficient, a new single numerical parameter based on the area under the curve of the defocus curve, was calculated. The validated Spanish CATQUEST-9SF satisfaction survey was applied. Results: Postoperative visual acuity ranges were: binocular UDVA 0.18 to 0.0 LogMAR, binocular UIVA 0.30 to 0.0 LogMAR and Binocular UNVA 0.18 to 0.0 LogMAR. The levels of contrast sensitivity both in bright light conditions (with and without glare) and low light conditions with glare, remained within the limits of normality. Under scotopic conditions without glare values below normality were found at lower spatial frequencies. The binocular defocus curve showed a plateau without a clearly evident peak. The Lapid-Kushlin defocus coefficient was 0.199. Two patients (3.1%) needed glasses after the procedure for near and intermediate vision. No patient manifested great visual difficulties or was dissatisfied with the results. Conclusions: The trifocal platform showed very good results in this series of patients. 96.9% of the patients achieved independence of the glasses and expressed a high degree of satisfaction. The Lapid-Kushlin defocus coefficient was better than those calculated from literature, for other multifocal intraocular lenses

Ecuador : debates, balances y desafíos post-progresistas

Los progresismos nacieron en medio de, o como el resultado de la devastación provocada por el neoliberalismo y caminaron sobre el cascajo de los partidos tradicionales. En Ecuador, el gobierno de la denominada "Revoluvión Ciudadana" fue un intenso fenómeno político de más de una década que cultivó varios éxitos electorales y sociales. Su promesa emergió en medio de una crisis profunda que había quebrado la hegemonía política de las élites y desgastado los engranajes del sistema político representativo. Las páginas de este libro, fruto de un extraordinario esfuerzo colectivo, ensayan una explicación sobre los significados y herencias de los gobiernos progresistas con un énfasis especial en la experiencia ecuatoriana, atendiendo a los profundos efectos que tuvieron en la sociedad, la economía y los Estados de los países involucrados. Al mismo tiempo, este libro aborda los primeros signos del ciclo post-progresista en el que emerge el neogolpismo, el Estado de excepción, la anti-política tanto como la emergencia de fuerzas alternativas. Ecuador. Balances, debates y desafíos post-progresistas propone un acercamiento plural y crítico sobre el presente histórico del Ecuador a través de lecturas que conjugan perspectivas locales, nacionales y regionales

Familia, escuela y desarrollo humano : rutas de investigación educativa

Hay una ruptura entre familia y escuela. La familia tiende a mirar la escuela como guardería, o el sitio seguro donde sus hijos pueden estar mientras los padres trabajan; y la tiende a considerar como lo mínimo que puede ofrecer para que su descendencia sea alguien en la vida. La escuela, por su parte, tiende a observar a la familia como un contexto lejano a ella que no debe entrometerse en los asuntos curriculares ni en la planeación institucional. Las relaciones de la escuela con la familia suelen ser más burocráticas y sancionatorias que de colaboración. Frente a esto, no es banal indagar acerca de las relaciones entre familia y escuela, entre familia y profesionales de la educación, pues se plantea la necesidad de un entendimiento mutuo entre ambos contextos de desarrollo y aprovechar el potencial educativo de la relación entre las dos instituciones