Intracameral lidocaine as supplement to classic topical anesthesia for relieving ocular pain in cataract surgery

● AIM: To evaluate safety, efficacy, and patient adherence of intracameral lidocaine as supplement of classic topical anesthetic drops in cataract surgery. ● METHODS: A prospective and controlled trial including a large cohort of 1650 individuals suffering with bilateral cataract not complicated, in program by phacoemulsification surgery, were randomly assigned to 2 different groups for the type of anesthesia received, 0.4% oxybuprocaine hydrochloride (INN) drops, and INN drops associated to intracameral 1% lidocaine hydrochloride monohydrate. At the end of surgery, tables were assigned to each patient indicating the degree of pain (0-3) felt during the operation. ● RESULTS: Thirty-two percent of patients in group 1 declared to have not felt any pain against the 77% of patients in group 2. Fifty-nine percent of patients in group 1 complained about only a slight discomfort against 20% of group 2 patients. Only a small percentage of patients in group 1 (5%) admitted severe pain, while no patient in group 2 admitted severe pain. Four patients of group 2 reported an episode of transient amaurosis, lasting several hours after surgery. ● CONCLUSION: Intracameral administration of lidocaine is a simple and secure method able to increase the analgesia during the cataract surgery, eliminating the discomfort and increasing also the cooperation of the patients during the steps of manipulation

La memoria se milita

El pasado 24 de Marzo el legado de les desaparecidxs de la última dictadura cívico-militar, eclesiástica y mediática, tomó la estación platense, utilizando como instrumentos los cuerpos, mentes y corazones de miles de jóvenes que esa jornada decidieron organizarse. Después de dos años de múltiples retrocesos en términos de organización de masas, las multitudes volvimos a tomar las calles les militantes de los 70 con su incesante lucha por los Derechos Humanos, la juventud militante, organismos de DDHH, etc.Facultad de Trabajo Socia

Myasthenia gravis exacerbation after melatonin administration: case series from a tertiary referral centre

Background: Myasthenia gravis is an autoimmune disease mediated by antibodies against proteins associated with the postsynaptic membrane of the neuromuscular junction. Several drugs may trigger an exacerbation of the disease. Melatonin supplements are widely used for the treatment of insomnia as they are well tolerated with few side effects. The role of melatonin in the immune system and its effects in autoimmune disorders remain uncertain. Case presentation: We identified three patients in our referral centre from 2014 to 2019 who presented a worsening within days or weeks of starting melatonin. Two of them stopped the treatment without clinical improvement in the next week. Increasing dose of corticosteroids did not lead to clinical improvement in the next month and one of the patients was finally administered intravenous immunoglobulins. Conclusion: Melatonin may trigger exacerbations of myasthenia gravis, probably due to an upregulation of the adaptive immune system and an interaction with the corticosteroids and other immunosuppressant treatments. We consider that melatonin should be administered with caution in these patients

Diagnóstico y cuantificación ecocardiográfica del derrame pericárdico

Transthoracic echocardiography is very useful in the management of pericardial effusion. It is the technique of choice in cardiac imaging for the diagnosis, quantification and monitoring pericardial effusion. 2015 guidelines reorder those of 2004, proposing in an essential way multimodality imaging for pericardial diseases. The aim of this article is to review the technical aspects for the diagnosis and quantification echocardiographic of pericardial effusion.El ecocardiograma transtorácico es de gran utilidad en el estudio del derrame pericárdico. Es la técnica de elección en imagen cardíaca para su diagnóstico, cuantificación y seguimiento. Las guías de práctica clínica del año 2015 reordenan las del 2004, proponiendo esencialmente la imagen cardíaca de multimodalidad para las enfermedades del pericardio. El objetivo de este artículo es revisar los aspectos técnicos para el diagnóstico y la cuantificación ecocardiográfica del derrame pericárdico

Valoración ecocardiográfica del taponamiento cardiaco

The echocardiogram is a non-invasive technique, specially useful in emergency situations such as cardiac tamponade because it is fast and safe. The objective of this article is to review the technical aspects for assessing the hemodynamic compromise on cardiac chambers in patients with pericardial effusionEl ecocardiograma es una prueba no invasiva que proporciona información rápida en situaciones de emergencia como es el caso del taponamiento cardíaco. El objetivo de este artículo es revisar los aspectos técnicos para la valoración del compromiso hemodinámico sobre las cámaras cardíacas en aquellos pacientes con derrame pericárdico

Intravenous immunoglobulins may prevent prednisone-exacerbation in myasthenia gravis

Corticosteroids may produce a paradoxical worsening of myasthenia gravis (MG) symptoms within the first weeks of treatment. We therefore wanted to assess the hypothesis that a prior infusion of intravenous immunoglobulin (IVIG) may have a protective effect. Our primary objectives were to show that the coadministration of immunoglobulins and glucocorticoids is safe and effective for controlling myasthenic symptoms, and to compare the exacerbation rate with this approach and historical practice without IVIG. We recruited 45 patients with generalized MG who required corticosteroids for the first time and we gave all IVIG before starting the full doses of prednisone. Monitoring was performed with validated scales, questionnaires, and blood tests over a 6-week period. Only 4.4% had severe adverse effects related to IVIG and 86.7% improved clinically. Notably, only 2.2% had a paradoxical symptom exacerbation in the first weeks of starting prednisone, which was statistically lower than the 42% reported in a historical series. We conclude that adjuvant therapy with IVIG when starting prednisone for the first time in patients with generalized MG is safe and effective. Given that the rate of paradoxical worsening was lower than that previously reported, the addition of IVIG may have a protective effect against such exacerbations

Eculizumab as a promising treatment in thymoma-associated myasthenia gravis

Myasthenia gravis is a chronic autoimmune disorder caused by antibodies directed against the neuromuscular junction. Some patients may have an associated thymoma, which confers a worse prognosis. Eculizumab, a monoclonal antibody that inhibits the activation of terminal complement, has recently been approved for the treatment of refractory generalized myasthenia gravis. This is an early case report of thymoma-associated refractory myasthenia gravis successfully treated with eculizumab in a real-world setting

Effect of TiO2 and Al2O3 Addition on the Performance of Chitosan/Phosphotungstic Composite Membranes for Direct Methanol Fuel Cells

: Composite chitosan/phosphotungstic acid (CS/PTA) with the addition of TiO2 and Al2O3 particles were synthesized to be used as proton exchange membranes in direct methanol fuel cells (DMFCs). The influence of fillers was assessed through X-ray diffraction, scanning electron microscopy, thermogravimetric analysis, liquid uptake, ion exchange capacity and methanol permeability measurements. The addition of TiO2 particles into proton exchange membranes led to an increase in crystallinity and a decrease in liquid uptake and methanol permeability with respect to pristine CS/PTA membranes, whilst the effect of the introduction of Al2O3 particles on the characteristics of membranes is almost the opposite. Membranes were successfully tested as proton conductors in a single module DMFC of 1 cm2 as active area, operating at 50 °C fed with 2 M methanol aqueous solution at the anode and oxygen at the cathode. Highest performance was reached by using a membrane with TiO2 (5 wt.%) particles, i.e., a power density of 40 mW cm-2, almost doubling the performance reached by using pristine CS/PTA membrane (i.e., 24 mW cm-2)

Regulatory role of rpL3 in cell response to nucleolar stress induced by Act D in tumor cells lacking functional p53

Many chemotherapeutic drugs cause nucleolar stress and p53-independent pathways mediating the nucleolar stress response are emerging. Here, we demonstrate that ribosomal stress induced by Actinomycin D (Act D) is associated to the up-regulation of ribosomal protein L3 (rpL3) and its accumulation as ribosome-free form in lung and colon cancer cell lines devoid of p53. Free rpL3 regulates p21 expression at transcriptional and post-translational levels through a molecular mechanism involving extracellular-signal-regulated kinases1/2 (ERK1/2) and mouse double minute-2 homolog (MDM2). Our data reveal that rpL3 participates to cell response acting as a critical regulator of apoptosis and cell migration. It is noteworthy that silencing of rpL3 abolishes the cytotoxic effects of Act D suggesting that the loss of rpL3 makes chemotherapy drugs ineffective while rpL3 overexpression was associated to a strong increase of Act D-mediated inhibition of cell migration. Taking together our results show that the efficacy of Act D chemotherapy depends on rpL3 status revealing new specific targets involved in the molecular pathways activated by Act D in cancers lacking of p53. Hence, the development of treatments aimed at upregulating rpL3 may be beneficial for the treatment of these cancers

Management of hypoactive sexual desire disorder in women: current and emerging therapies

Hypoactive sexual desire disorder (HSDD) is a common multifactorial condition which is characterized by a decrease in sexual desire that causes marked personal distress and/or interpersonal difficulty. The general idea that HSDD is a sexual dysfunction difficult to treat is due to the large number of potential causes and contributing factors. Indeed, a balanced approach comprising both biological and psycho-relational factors is mandatory for accurate diagnosis and tailored management in clinical practice. There are currently no approved pharmacological treatments for premenopausal women with HSDD, while transdermal testosterone is approved in Europe for postmenopausal women who experience HSDD as a result of a bilateral oophorectomy. Even though the role of sex hormones in modulating the sexual response during the entire reproductive life span of women is crucial, a better understanding of the neurobiological basis of sexual desire supports the idea that selective psychoactive agents may be proposed as nonhormonal treatments to restore the balance between excitatory and inhibitory stimuli leading to a normal sexual response cycle. We conclude that the ideal clinical approach to HSDD remains to be established in term of efficacy and safety, and further research is needed to develop specific hormonal and nonhormonal pharmacotherapies for individualized care in women