Anestesia sub-Tenoniana versus Anestesia Peribulbar en Cirugía Extracapsular de Catarata

Con el objeto de comparar la efectividad de la anestesia sub-tenoniana con la peribulbar en cirugía extracapsular de catarata, se seleccionaron aleatoriamente en la Fundación Visión de Asunción (Paraguay), 35 pacientes adultos para recibir anestesia sub-tenoniana (8 mujeres y 9varones) o anestesia peribulbar (13 mujeres y 5 varones). La presión intraocular (PIO) antes, al primer y a los diez minutos de la anestesia fue medida, como así también la motilidad de los músculos rectos a los 10 minutos de la anestesia, el grado de dolor del paciente durante y altérmino de la cirugía y el grado de satisfacción del cirujano. La elevación de la PIO con la peribulbar fue estadísticamente significativa (p<0,008) al minuto de la inyección, retornando a los diez minutos a los niveles basales en ambos grupos. Diez minutos después de la aplicación delanestésico se encontraron diferencias estadísticamente significativas entre los grupos en la elevación (p=0,005), abducción (p=0,02) y depresión (p=0,01) de los músculos rectos; como así también en los niveles de dolor intraquirúrgico (p=0,04), pero no en los niveles de dolor debido a laaplicación de la anestesia o en el grado de satisfacción del cirujano. En conclusión, la anestesia subtenoniana produjo menor elevación de la PIO que la peribulbar y la aquinesia parcial obtenida con ella no fue un factor limitante para el cirujano. Aunque mayor porcentaje del grupo de la anestesia sub-tenoniana refirió algún grado de dolor intraquirúrgico, fue considerado tolerable debido a que no fue necesario refuerzo del anestésico

Polymerase chain reaction in the diagnosis and prognosis of Mediterranean visceral leishmaniasis in immunocompetent children

OBJECTIVE: To assess the usefulness of a polymerase chain reaction (PCR) assay amplifying the small subunit rRNA coding region of Leishmania species performed on peripheral blood (PB) and bone marrow (BM) aspirates for the diagnosis and follow-up of visceral leishmaniasis (VL) in children living in the Mediterranean basin. DESIGN: A prospective study was conducted on children consecutively hospitalized over a 1-year period at our Infectious Diseases Department in Sicily (Italy) presenting with fever, hepatosplenomegaly, and/or pancytopenia and a positive Leishmania serology (> or =1:40). RESULTS: Among the 14 patients hospitalized with signs and symptoms suggestive of the disease and a positive serology, we identified 10 cases of Mediterranean VL. PCR performed on PB and BM aspirates was positive in all cases and concordant with microscopy and/or culture performed on BM. Leishmania DNA was cleared from PB a median of 6 days after the start of treatment; during follow-up (median: 9 months; range: 6-12 months) 1 child relapsed. In this case, BM PCR remained positive with rapid reappearance of a positive signal also in PB. CONCLUSIONS: PB PCR allows a rapid and noninvasive parasitologic diagnosis of Mediterranean VL among immunocompetent children and is at least as sensitive as a diagnosis made on the basis of BM aspirates. The lack of disappearance from BM and the reappearance of positive PCR on PB is predictive of clinical relapse. Qualitative and semiquantitative PCR may be the standard method for monitoring response to therapy in immunocompetent childre

Luminex technology for anti-HLA antibody screening : evaluation of performance and of impact on laboratory routine

The recent introduction of new technologies such as Luminex has provided alternative methods to the Complement Dependent Cytotoxicity (CDC) test for HLA specific antibody detection. In this study we compared the results obtained with CDC to those obtained using a Luminex method with the aim of evaluating the impact of this new technology on antibody screening policies in our transplant setting. A total of 1,421 sera, acquired from patients on the waiting list for a kidney transplant or following transplantation, were tested by both methodologies. CDC was performed using a whole lymphocyte population comprising a panel of 52 cells. The percentage panel reactive antibodies (PRA) and antibody specificity were evaluated using Lambda Scan Analysis software. For the Luminex method sera screening and identification of antibody specificity were carried out using the LABScreen Mixed and LABScreen PRA respectively. The overall concordance between the results obtained using the CDC and the Luminex methods was 85%. HLA antibody specificity was confirmed in 96% of the sera which tested positive using the Luminex system and serum positivity corresponded with a previous sensitisation event in these individuals. Using the Luminex method 18% of patients on the waiting list were considered and managed as sensitised as compared to 7% when testing with CDC alone. The Luminex method was able to detect a number of antibody specificities significantly more frequently than the CDC method and in addition the CDC method failed to detect some of the antibody specificities detected by the Luminex system. Based on this comparison study we have incorporated the Luminex methodology into our screening strategy

Prevalence and risk determinants of HIV-1 and HIV-2 infections in pregnant women in Bissau

Objectives : To analyse the risk determinants of HIV-1 and HIV-2 infections in pregnant women in Bissau. Methods Pregnant women attending the antenatal clinics of Bissau between January 2002 and June 2006 were consecutively tested unless they opted out. Results Among 23,869 tested women the overall prevalence of HIV-1 was 5.7%, that of HIV-2 was 2.4%, and these included the 0.7% prevalence of HIV-1 and HIV-2 duals. The main factors associated with the risk of HIV-1 infection were older age, occupation and number of sexual partners. Beafada and Mandinga ethnic groups were at greater risk of presenting HIV-1, and Bijago and Papel at lower risk. The factors associated with the risk of HIV-2 were age, literacy and occupation; the Beafada were at greater risk than the other ethnic groups. Conclusions : The prevalence of HIV-2 infection decreased overtime, whereas that of HIV-1 infection remained substantially stable, but was higher than that observed in previous studies. The rapid decline in the rates of HIV-2 infection suggests that many of the factors that allowed its exponential growth in the past have now been partially removed, and that sexual and vertical transmission have not been sufficient to maintain and extend the epidemic

Utilizzo del “lung donor score” nei donatori nitp (Nord Italia Transplant Program) proposti per trapianto polmonare nel 2010

Obiettivo dello studio \ue8 analizzare retrospettivamente la casistica dei donatori multiorgano proposti per polmone utilizzando uno score numerico di funzione polmonare, il \u201cLung Donor Score\u201d come descritto da Oto1. Lo score prende in considerazione et\ue0, fumo, radiografia del torace, secrezioni e ossigenazione (PaO2/FiO2), ai quali viene assegnato un punteggio tra 0 e 3, ad eccezione dell\u2019ossigenazione a cui viene attribuito un punteggio doppio (0-6). Su 201 donatori proposti 59 (29.4%) hanno donato i polmoni, gruppo \u201cutilizzati\u201d (eseguiti 66 trapianti: 47 bipolmonari e 19 monopolmonari). I restanti 142 donatori (70.6%) sono stati rifiutati per cause non correlate alla funzione polmonare, gruppo \u201cGeneral exclusion\u201d (GE) o per cause polmonari, gruppo \u201cLung exclusion\u201d (LE). I GE sono stati 28 (13.9%, per: ricevente non compatibile, sospetta neoplasia, infezione) mentre gli LE sono stati 114 (56.7%). Le mediane Lung Score nei tre gruppi sono risultate differenti: \u201cutilizzati\u201d 1(0-3), GE 4(2.5-6.5), LE 7(5-9), One-way Anova, p<0.001. Suddividendo il gruppo LE in sopra e sotto la mediana 7 abbiamo osservato che vi sono differenze in tutti i parametri dello Score ad esclusione della radiografia torace (t-test, p<0.001). Nel 22% dei donatori abbiamo anche confrontato PaO2/FiO2 all\u2019inizio e alla fine dell\u2019osservazione. Lo Score aumenta significativamente solo nel gruppo7 \ue8 gi\ue0 elevato. In conclusione Lung Donor Score \ue8 uno strumento semplice in grado di predire l\u2019utilizzo del polmone a scopo di trapianto ed \ue8 utile per fare confronti tra popolazioni. Strategie di protezione polmonare potrebbero aumentare il numero dei potenziali donatori