RAND-like Appropriateness Methodology Consensus for Primary Open-Angle Glaucoma in Latin America

PURPOSE: To report the results of a Latin American consensus panel regarding the diagnosis and management of primary open-angle glaucoma and to compare these results with those from a similar panel in the United States. DESIGN: A RAND-like (Research and Development) appropriateness methodology was used to assess glaucoma practice in Latin America. METHODS: The 148 polling statements created for the RAND-like analysis in the United States and 10 additional statements specific to glaucoma care in Latin America were presented to a panel of Latin American glaucoma experts. Panelists were polled in private using the RAND-like methodology before and after the panel meeting. RESULTS: Consensus agreement or disagreement among Latin American experts was reached for 51.3% of statements before the meeting and increased to 66.5% in the private, anonymous meeting after polling (79.0% agreement, 21.0% disagreement). Although there was a high degree of concordance (111 of 148 statements; 75%) between the results of this Latin American panel and the United States panel, there were some notable exceptions relating to diagnostic and therapeutic decision making. CONCLUSIONS: This RAND-like consensus methodology provides a perspective of how Latin American glaucoma practitioners view many aspects of glaucoma and compares these results with those obtained using a similar methodology from practitioners in the United States. These findings may be helpful to ophthalmologists providing glaucoma care in Latin America and in other regions of the world. (Am J Ophthalmol 2012;154: 460-465. (C) 2012 by Elsevier Inc. All rights reserved.)

Distribution of major elements in Atlantic surface sediments (36 degrees N-49 degrees S): Imprint of terrigenous input and continental weathering

Numerous studies use major element concentrations measured on continental margin sediments to reconstruct terrestrial climate variations. The choice and interpretation of climate proxies however differ from site to site. Here we map the concentrations of major elements (Ca, Fe, Al, Si, Ti, K) in Atlantic surface sediments (36 degrees N-49 degrees S) to assess the factors influencing the geochemistry of Atlantic hemipelagic sediments and the potential of elemental ratios to reconstruct different terrestrial climate regimes. High concentrations of terrigenous elements and low Ca concentrations along the African and South American margins reflect the dominance of terrigenous input in these regions. Single element concentrations and elemental ratios including Ca (e. g., Fe/Ca) are too sensitive to dilution effects (enhanced biological productivity, carbonate dissolution) to allow reliable reconstructions of terrestrial climate. Other elemental ratios reflect the composition of terrigenous material and mirror the climatic conditions within the continental catchment areas. The Atlantic distribution of Ti/Al supports its use as a proxy for eolian versus fluvial input in regions of dust deposition that are not affected by the input of mafic rock material. The spatial distributions of Al/Si and Fe/K reflect the relative input of intensively weathered material from humid regions versus slightly weathered particles from drier areas. High biogenic opal input however influences the Al/Si ratio. Fe/K is sensitive to the input of mafic material and the topography of Andean river drainage basins. Both ratios are suitable to reconstruct African and South American climatic zones characterized by different intensities of chemical weathering in well-understood environmental settings.

Importância dos vírus respiratórios na febre sem sinais localizatórios em crianças menores de 36 meses

INTRODUÇÃO Cerca de 20% das crianças menores de 36 meses trazidas ao setor de emergência por febre apresentam febre sem sinais localizatórios (FSSL). Nos últimos anos, vários estudos estabeleceram critérios para a identificação dos pacientes com risco de infecção bacteriana grave (IBG), além de demonstrarem a aplicabilidade da pesquisa de vírus respiratórios (PVR) na avaliação destes pacientes. Entretanto, não existem estudos abordando a identificação de vírus respiratórios em crianças menores de 36 meses com FSSL no nosso meio. OBJETIVOS Descrever a frequência dos vírus respiratórios na febre sem sinais localizatórios (FSSL) em crianças menores de 36 meses de idade CASUÍSTICA E MÉTODOS Estudo prospectivo e observacional de crianças menores de 36 meses no setor de emergência pediátrico, durante o período de abril de 2011 a abril de 2013, com diagnóstico de FSSL. Foram excluídas crianças portadoras de doenças de base que implicavam em alteração da imunidade e uso de antibiótico até 14 dias antes da consulta. Os pacientes foram avaliados laboratorialmente de acordo com o protocolo institucional para avaliação de FSSL. Além de hemograma completo, análise do sedimento urinário e culturas de sangue e urina, foi coletada amostra de secreção de nasofaringe para pesquisa de vírus respiratórios por imunoflourescência indireta. Resultados Foram estudados 232 crianças menores de 36 meses com diagnóstico de FSSL, sendo 53% do sexo masculino, com idade mediana de 10,7 meses (5,4 - 16,1). Em 57 (24,6%) destes pacientes, foi identificado vírus respiratórios, sendo o adenovírus (33 casos - 57,9%) o agente mais identificado, seguido do parainfluenza 3 (17,5%) e do influenza A (12,3%). CONCLUSÃO Em torno de 25% dos casos de FSSL do nosso meio foram identificados vírus respiratórios, mostrando que a PVR é uma ferramenta útil na avaliação do paciente com FSSL, possibilitando a redução do número de retornos hospitalares e uso de antibioticoterapia empírica.

Morphologischer und biochemischer Aufbau von Silikatnadeln der Hexactinelliden am Beispiel von Monorhaphis chuni

Schon 1904 beschrieb Schulze den Aufbau von Silikatnadeln des Schwammes Monorhaphis chuni, eines Mitglieds der zweiten Familie von biosilifizierenden Schwämmen, den Hexactinelliden (Glasschwämmen). Weitergehende morphologische Untersuchungen und biochemische Analysen insbesondere mit modernen Methoden wurden an Hexactinelliden bisher kaum durchgeführt. Ziel der vorliegenden Arbeit bestand deshalb darin, Untersuchungen zur Morphologie, der chemischen Zusammensetzung, der Verteilung und Charakterisierung der beteiligten anorganischen und organischen Komponenten sowie einen molekularbiologischer Nachweis der Existenz von Silicatein in Hexactinelliden durchzuführen. Für diese Untersuchungen wurden zwei Spezies verwendet: Monorhaphis chuni und Crateromorpha meyeri. Mittels Elektronen-Mikrosonden-Technik wurde an Querschnitten der Pfahlnadel von M. chuni die Verteilung der Elemente innerhalb der Nadel untersucht. Am äußeren Rand der Nadel (150 µm) traten im Vergleich zur Nadelmitte prägnante Unterschiede in der Konzentration von Kaliumoxid und Natriumoxid auf. Diese Ergebnisse deuten auf das Vorhandensein eines ähnlichen Transportsystems zur Anreicherung von Silizium/Silikat bei der Nadelbildung hin, wie es bereits in S. domuncula bekannt ist. Mit elektronen- und lichtmikroskopischen Untersuchungen wurden die organischen Substanzen der Silikatnadel nachgewiesen und deren Verteilung innerhalb dieser Nadeln analysiert. In der lamellaren Zone befindet sich, eine säurelabile organische Netzstruktur, sowie eine, die Silikatschichten durchspannende, säulenähnliche Struktur. Im Axialzylinder zeigt das organische Material eine leicht verzweigte fibrilläre Anordnung. Mit biochemischen Verfahren wurden die organischen Komponenten der Nadeln detaillierter untersucht. Mehrere Proteine mit Molekulargewichten von 17, 24, 27 ,30, 36 und 70 kDa wurden durch gelelektrophoretische Analysen von Material der Pfahlnadel identifiziert. Die Analyse isolierter Anteile der lamellaren Zone zeigte ausschließlich ein 27 kDa Protein. Die restlichen Proteinbanden konnten hier nicht nachgewiesen werden. Das 27 kDa Protein reagierte im Westernblot mit Antikörpern gegen Silicatein aus S. domuncula. Ein weiteres Protein wurde näher charakterisert. Ein positiver Agglutinationsassay wies ein lectinähnliches Molekül innerhalb der Nadeln nach, wie es aus S. domuncula bekannt ist. Nach einer Deglycolysierung der Proteine reduzierte sich das scheinbare Molekulargewicht der 36 kDa Bande auf 30 kDa. Durch molekularbiologische Untersuchungen wurde erstmals in Hexactinelliden die Existenz von Silicatein nachgewiesen. Nach Isolierung der Gesamt-RNA von Crateromorpha meyeri, RT-PCR und Amplifizierung mit silicateinspezifischen Primern wurde eine 549 kBp Nukleotidsequenz gefunden, die auf Aminosäureebene starke Homologien (76% identische Aminosäuren) zu bekannten Silicateinen der Demospongia aufweist. Die Aminosäuren der katalytische Triade des Silicateins, essenziell für die enzymatische Katalyse des Enzyms, sind an den selben Positionen wie bei bekannten Silicateinen vorhanden.

Retrospective evaluation of postoperative nasotracheal tubes for oxygen supplementation in dogs following surgery for brachycephalic syndrome: 36 cases (2003-2007)

OBJECTIVE: To assess the utility of nasotracheal tubes in postoperative oxygen supplementation in dogs following corrective surgery for brachycephalic syndrome. DESIGN: Retrospective study 2003-2007. SETTING: University teaching hospital. ANIMALS: Thirty-six client-owned dogs that underwent corrective surgery for brachycephalic syndrome. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Medical records were reviewed for animals that underwent surgical interventions for brachycephalic syndrome including palatoplasty, ventriculectomy, and rhinoplasty. Data collected included signalment, presenting complaints, analgesic and surgical interventions, type of supplemental oxygen therapy, complications and mortality occurring during hospitalization. A nasotracheal tube (NTT) was placed in 20 dogs at the end of surgery; 16 dogs received other forms of oxygen supplementation (8) or no oxygen supplementation (8) during recovery. The total number of postoperative complications was similar in both groups (8/20 dogs with NTTs and 7/16 in those without NTTs). However, respiratory distress was observed in 5 dogs without NTTs but was not observed in any dog while an NTT was in place. One dog in each group died postoperatively. CONCLUSION: Placement of an NTT was found to be easy and may offer benefit in dogs with brachycephalic syndrome as a noninvasive means of delivering oxygen. The use of NTT may minimize severe postoperative morbidity, in particular by reducing postoperative respiratory distress.