Cystoid Macular Edema: Causes, Diagnosis and Treatment

The purpose of this paper is to conduct a review of studies on cystoid macular edema published in the last seven years. Cystoid macular edema is a major cause of loss of visual acuity. It is the final common pathway of many diseases and can be caused by numerous processes including inflammatory, vascular, adverse drug reactions, retinal dystrophy or intraocular tumors. These processes disrupt the blood-retinal barrier, with fluid extravasation to the macular parenchyma. Imaging tests are essential for both detection and monitoring of this pathology. Fluorescein angiography and autofluorescence show the leakage of liquid from perifoveal vessels into the tissue where it forms cystic spaces. Optical coherence tomography is currently the gold standard technique for diagnosis and monitoring. This allows objective measurement of retinal thickness, which correlates with visual acuity and provides more complete morphological information. Based on the underlying etiology, the therapeutic approach can be either surgical or medical with anti-inflammatory drugs. We found that disruption of the blood-retinal barrier for various reasons is the key point in the pathogenesis of cystoid macular edema, therefore we believe that studies on its treatment should proceed on this path.

Herramientas innovadoras en el diagnóstico del síndrome respiratorio bovino (SRB)

A pesar de todos los avances realizados en las últimas décadas en el conocimiento sobre numerosos aspectos del Síndrome Respiratorio Bovino (SRB), entre los que se encuentran los factores de riesgo, la etiopatogenia, las características de los agentes causales, el diagnóstico, la terapéutica o la profilaxis y sus efectos globales, el SRB continúa siendo la enfermedad de mayor impacto económico en el ganado vacuno de cebo. Además, parece que tanto su incidencia como las pérdidas que origina siguen estables en los cebaderos de todo el mundo desde hace varias décadas. Sus principales características indican que debemos considerar que es una enfermedad de difícil control dado su carácter multifactorial y con la que, por tanto, debemos acostumbrarnos a convivir aunque aspirando a minimizar tanto su incidencia, como la gravedad de sus consecuencias. Por otro lado, aunque existen muchas técnicas diagnósticas a nuestra disposición, aún no se puede decir que exista una técnica de referencia o “gold standard” para el diagnóstico del SRB, y mucho menos una técnica estandarizada para su diagnóstico precoz. Establecer y estandarizar protocolos para la detección de grupos de animales en riesgo y su monitorización más intensa en fases posteriores del cebo para reducir el consumo de antibióticos de uso preventivo o metafiláctico es de gran interés. Hasta ahora, este tipo de estrategias se han basado en la detección de evidencias de contacto con gérmenes patógenos pulmonares (principalmente análisis de serología). Sin embargo, no debemos olvidar que la identificación de un agente patógeno en ausencia de una lesión y/o signos clínicos atribuibles al mismo, tan sólo es indicativa de contacto previo (no de padecimiento de un proceso de enfermedad) y que, por otro lado, la mayoría de los agentes microbiológicos ligados al SRB son comensales habituales de las vías respiratorias altas. De modo que la identificación de un agente sólo prueba enfermedad si se diagnostica junto con los signos clínicos compatibles de enfermedad y la lesión...

Assessment of MALDI-TOF MS as Alternative Tool for Streptococcus suis Identification

The accuracy of matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) for identifying Streptococcus suis isolates obtained from pigs, wild animals, and humans was evaluated using a PCR-based identification assay as the gold standard. In addition, MALDI-TOF MS was compared with the commercial multi-tests Rapid ID 32 STREP system. From the 129 S. suis isolates included in the study and identified by the molecular method, only 31 isolates (24.03%) had score values ≥2.300 and 79 isolates (61.24%) gave score values between 2.299 and 2.000. After updating the currently available S. suis MALDI Biotyper database with the spectra of three additional clinical isolates of serotypes 2, 7, and 9, most isolates had statistically significant higher score values (mean score: 2.65) than those obtained using the original database (mean score: 2.182). Considering the results of the present study, we suggest using a less restrictive threshold score of ≥2.000 for reliable species identification of S. suis. According to this cut-off value, a total of 125 S. suis isolates (96.9%) were correctly identified using the updated database. These data indicate an excellent performance of MALDI-TOF MS for the identification of S. suis.

Valoración del dolor en el paciente con trauma grave y ventilación mecánica no comunicativo

Pain is defined since 1979 by the International Association for the Study of Pain (IASP) as "unpleasant subjective, sensory and emotional experience associated with actual or potential damage of tissue", with the concept more acceptable in our days. The Intensive Care Unit (ICU) is a complex environment to assess pain, where the difficulty in communication with the patient is the biggest barrier to getting your "selfreport", which is considered the gold standard in pain assessment. Many factors alter communication with critically ill patients, as the low level of consciousness, mechanical ventilation, sedation, and the patient's own pathology, besides, there are other limitations such as excessive technology or devices that can divert professional attention to the patient's pain behavior, and lack of training and guidance for management. The multicenter study SUPPORT, it showed that 50-65% of critical patients included suffered pain, and 15% of them reported moderate to severe intensity for more than half the period of hospitalization. Critically ill patients experience pain due to high volume of potentially painful techniques applied to them during their ICU admission, emphasizing nursing care and tracheal suctioning, mobilization, wound healing and channeling of catheters and others. The underestimation of pain involves physiological and hemodynamic effects such as increased blood pressure and/or heart rate, altered breathing pattern, and psychological and anxiety. Also an increase of sedation and mechanical ventilation time and ICU stay of increasing the morbidity and mortality of critically ill patients...