Endophthalmitis is a severe eye infection that may result in permanent loss of useful vision in the affected eye. Most cases are exogenous and occur as a complication of cataract surgery, an ...intravitreal injection, or penetrating ocular trauma. Endogenous endophthalmitis results from hematogenous seeding of the eye by bacteria or fungi, but bacteremia or fungemia may be transient and patients may present without symptoms of systemic infection. Nearly all endophthalmitis patients present with decreased vision, and some also have eye pain. Eye examination usually reveals a hypopyon and intraocular inflammation. Diagnosis is clinical, supported by cultures of the vitreous and/or aqueous or by blood cultures in some endogenous cases. Molecular diagnostic techniques have been used in research laboratories for pathogen identification in endophthalmitis and offer the possibility of rapid diagnosis, including in culture-negative cases. Intravitreal injection of antibiotics is the most important component of treatment; some cases also benefit from surgical debridement of the vitreous by a vitrectomy. The visual outcome depends partly on the pathogen: coagulase-negative staphylococcal endophthalmitis has a better prognosis than does streptococcal endophthalmitis, for example. Endophthalmitis is a medical emergency, and prompt diagnosis and treatment are essential for saving vision.
The net primary productivity, carbon (C) stocks and turnover rates (i.e. C dynamics) of tropical forests are an important aspect of the global C cycle. These variables have been investigated in ...lowland tropical forests, but they have rarely been studied in tropical montane forests (TMFs). This study examines spatial patterns of above‐ and belowground C dynamics along a transect ranging from lowland Amazonia to the high Andes in SE Peru. Fine root biomass values increased from 1.50 Mg C ha⁻¹ at 194 m to 4.95 ± 0.62 Mg C ha⁻¹ at 3020 m, reaching a maximum of 6.83 ± 1.13 Mg C ha⁻¹ at the 2020 m elevation site. Aboveground biomass values decreased from 123.50 Mg C ha⁻¹ at 194 m to 47.03 Mg C ha⁻¹ at 3020 m. Mean annual belowground productivity was highest in the most fertile lowland plots (7.40 ± 1.00 Mg C ha⁻¹ yr⁻¹) and ranged between 3.43 ± 0.73 and 1.48 ± 0.40 Mg C ha⁻¹ yr⁻¹ in the premontane and montane plots. Mean annual aboveground productivity was estimated to vary between 9.50 ± 1.08 Mg C ha⁻¹ yr⁻¹ (210 m) and 2.59 ± 0.40 Mg C ha⁻¹ yr⁻¹ (2020 m), with consistently lower values observed in the cloud immersion zone of the montane forest. Fine root C residence time increased from 0.31 years in lowland Amazonia to 3.78 ± 0.81 years at 3020 m and stem C residence time remained constant along the elevational transect, with a mean of 54 ± 4 years. The ratio of fine root biomass to stem biomass increased significantly with increasing elevation, whereas the allocation of net primary productivity above‐ and belowground remained approximately constant at all elevations. Although net primary productivity declined in the TMF, the partitioning of productivity between the ecosystem subcomponents remained the same in lowland, premontane and montane forests.
Endophthalmitis Durand, M.L.
Clinical microbiology and infection,
March 2013, Letnik:
19, Številka:
3
Journal Article
Recenzirano
Odprti dostop
Endophthalmitis means bacterial or fungal infection inside the eye involving the vitreous and/or aqueous humors. Most cases are exogenous and occur after eye surgery, after penetrating ocular trauma, ...or as an extension of corneal infection. An increasing number of cases are occurring after intravitreal injections of anti-vascular endothelial growth factor (VEGF) medications. Endophthalmitis may also be endogenous, arising from bacteraemic or fungaemic seeding of the eye. The infected eye never serves as a source of bacteraemia or fungaemia, however. The most common pathogens in endophthalmitis vary by category. Coagulase-negative staphylococci are the most common causes of post-cataract endophthalmitis, and these bacteria and viridans streptococci cause most cases of post-intravitreal anti-VEGF injection endophthalmitis, Bacillus cereus is a major cause of post-traumatic endophthalmitis, and Staphylococcus aureus and streptococci are important causes of endogenous endophthalmitis associated with endocarditis. In Taiwan and other East Asian nations, Klebsiella pneumoniae causes most cases of endogenous endophthalmitis, in association with liver abscess. Endogenous fungal endophthalmitis in hospitalized patients is usually caused by Candida species, particularly Candida albicans. Acute endophthalmitis is a medical emergency. The most important component of treatment is the intravitreal injection of antibiotics, along with vitrectomy in severe cases. Systemic antibiotics should be used in cases of endogenous endophthalmitis and exogenous fungal endophthalmitis, but their role in exogenous bacterial endophthalmitis is uncertain. Repeated intravitreal injections of antibiotics may be necessary if there is no response to the initial therapy. Many eyes that receive prompt and appropriate treatment will recover useful vision.
Analyser la morbidité néonatale dans une cohorte monocentrique rétrospective (1999–2008) en fonction des consommations maternelles de substances psychoactives (SPA) et du contexte sociodémographique.
...Cent-soixante dix nouveau-nés (NN) de mères ayant consommé au moins 2SPA en début de grossesse. Base de données de 168 variables sociodémographiques, addictologiques et périnatales et recherche des corrélations avec les principales morbidités néonatales.
Les consommations ont changé au fil des années avec moins d’héroïnomanes et plus de consommatrices de cannabis associé à d’autres SPA. Les pratiques ont également évolué avec une participation accrue de la mère aux soins de son NN, un allaitement maternel plus fréquent, une diminution du recours au traitement médicamenteux pour des syndromes de sevrage néonatals (SSNN) de même sévérité. La prématurité et l’hypotrophie étaient principalement corrélées au nombre de SPA consommées en fin de grossesse (prématurité à 17,3 % si≤3 et à 31,3 % si≥4 –p<0,001), à la précarité psychosociale et à la qualité du suivi de grossesse. La sévérité du SSNN (23 % avec score de Lipsitz>9 dont un quart traités par morphine) était surtout corrélée à l’exposition in utero aux opiacés, notamment associés à des benzodiazépines, et à la consommation de plus de 3SPA. Les décisions de placement judiciaire (15 %) étaient survenues surtout en cas d’absence de domicile personnel, de polyconsommation, de précarité psychosociale, de grossesses non désirées mal suivies et de troubles de l’attachement.
Les facteurs les plus liés à des complications néonatales sont la polyconsommation et la précarité psychosociale ; une prise en charge adaptée en diminue la fréquence.
To analyze neonatal morbidity in a single-center retrospective cohort (1999–2008) according to the mothers’ polydrug use and to the social and demographic context.
One hundred and seventy newborns were identified whose mothers used two or more substances (such as heroin, cocaine, opioid maintenance treatment, tobacco, alcohol, hashish, amphetamines, benzodiazepines, or other psychotropics) at the beginning of their pregnancies. The database included 168 sociodemographic variables describing mothers’ living conditions and their drug-abuse characteristics; perinatal variables such as gestational age, weight, neonatal abstinence syndrome, and modalities of discharge; and correlations with the main neonatal morbidities.
The mothers’ mean age at delivery was 31.6yrs. It was the first pregnancy for 35.2% of the mothers but the mean number of previous abortions was 1.14 and 16.3% already had previous children in foster care. At delivery only 8.2% used only one product, 52.9% 2 or 3 products, and 37.6% four or more substances. All sociodemographic variables, the deprivation score, the number of previous abortions and miscarriages, and poor prenatal monitoring were significantly different for the mothers using four products or more. The uses changed along the years of study: fewer mothers used heroin but more used hashish, combined with other substances. The medical care also changed: greater participation on the part of mothers in neonatal care, more frequent breastfeeding, less medication for neonatal abstinence syndrome with the same severity score: i.e., 45.5% of infants with a Lipsitz score between 8 and 12 received a morphine treatment in 1999–2000 versus only 5.5% in 2005–2006 and none in 2007–2008. The mean gestational age was 38.1weeks. Preterm births (22.2%) and intrauterine growth restriction (18% with birth weight <10th percentile) were mainly correlated with the number of substances at delivery (17.3% preterm if three substances or less and 31.3% if four substances or more; p<0.001), social deprivation, poor prenatal care, and mothers having gained less than 5kg in weight during pregnancy (57.1% of intrauterine growth restriction versus 14.5%). Birth weight, height, and head circumference were significantly different for mothers having drunken alcohol. Among the newborns, seven showed complete fetal alcohol syndrome. The neonatal abstinence syndrome severity (23% with a Lipsitz score>9, one-quarter of whom were medicated with morphine) was correlated with an in-utero exposure to opiates, mainly in combination with benzodiazepines, and with the use of four or more substances. The mean age of infants at discharge was 18.1days (SD 3.39): 21.1% stayed 30 days or more in the hospital, mainly because of prematurity or intrauterine growth restriction, a high neonatal abstinence syndrome score, maternal polydrug use, psychosocial deprivation, or foster care placement decisions. Decisions for foster care placement (15%) applied to polydrug users, with social deprivation, undermonitored pregnancies, or bonding difficulties.
The main factors correlated with poor neonatal results were polydrug use, maternal psychiatric pathologies, and social deprivation. Overall, prenatal and postnatal care such as rooming-in improved the results.
Bacterial endophthalmitis is a sight threatening infection of the interior structures of the eye. Incidence in the US has increased in recent years, which appears to be related to procedures being ...performed on an aging population. The advent of outpatient intravitreal therapy for management of age-related macular degeneration raises yet additional risks. Compounding the problem is the continuing progression of antibiotic resistance. Visual prognosis for endophthalmitis depends on the virulence of the causative organism, the severity of intraocular inflammation, and the timeliness of effective therapy. We review the current understanding of the pathogenesis of bacterial endophthalmitis, highlighting opportunities for the development of improved therapeutics and preventive strategies.
The purpose of this study was to evaluate the ability of three resin composite systems to mask a severely discolored background by the application of a layering technique through CIELAB and CIEDE2000 ...analysis. Ninety 1.5-mm-thick disc specimens were produced from three different resin composite restoration systems: IPS Empress Direct (Ivoclar Vivadent), Charisma Diamond (Heraeus Kulzer), and Filtek Z350 XT (3M-ESPE). The specimens were divided into groups according to the restoration system and the resin composite shade combination used for the layering technique (enamel, body, and dentin shades). Color measurements were performed by a reflectance spectrophotometer (SP60, EX-Rite) against a C4 shade background and an inherent color background, which simulates a severely discolored background and a tooth surface with no discoloration, respectively. The total color difference between both color measurements was calculated by CIELAB (ΔE*
) and CIEDE2000 (ΔE
) formulas. The mean ΔE
* and ΔE
values were analyzed by analysis of variance (general linear models) and Tukey's post hoc tests (α=0.05). Three groups presented clinically acceptable color difference values (ΔE*≦3.46 and ΔE
≦2.25): 1.5 mm dentin, 1.0 mm dentin/0.5 mm body, and 1.0 mm dentin/0.5 mm enamel; ie, all the groups from the Z350 XT restoration system. The resin composite layering technique is an effective way to mask severely discolored backgrounds. The Filtek Z350 XT system was the only restoration system capable of masking the C4 background.
Objectives/Hypothesis
Determine the time of onset and microbiology of surgical site infections (SSIs) following head and neck free flap reconstructive surgeries.
Study Design
Retrospective cohort ...study.
Methods
All 504 free flap surgical cases (484 patients) performed April 1, 2009 to September 30, 2013 were reviewed; SSIs occurring ≤30 days postoperatively were evaluated. Admission screening for methicillin‐resistant Staphylococcus aureus (MRSA) colonization was performed on all patients.
Results
Flap‐recipient site infections (flap SSIs) occurred in 67 cases (13.3%), one‐third week 1 postoperatively, one‐third week 2, one‐third days 15 to 30; 45% occurred after hospital discharge. Wound cultures were polymicrobial, but 25% grew only normal oral flora, whereas 75% grew pathogens not part of normal oral flora, such as gram‐negative bacilli (44% of cases), MRSA (20%), and methicillin‐sensitive S aureus (MSSA) (16%). The frequency of these pathogens did not vary significantly by the time of SSI onset. In 67%, cultures included at least one pathogen resistant to the prophylactic antibiotic used. Clindamycin prophylaxis was a significant risk factor for flap SSI and for early partial or complete flap loss from infection. Donor SSIs occurred in 22 cases (4.4%), 95% >1 week postoperatively, and MRSA or MSSA were the primary pathogens in 89%. Of the 25 patients colonized with MRSA on admission, 40% developed a flap or donor SSI, a rate significantly higher than in non‐colonized patients.
Conclusions
Gram‐negative bacilli, MRSA, and MSSA were significant SSI pathogens, and late onset of infection was common. Better screening, decolonization, and prophylaxis may reduce SSI rates.
Level of Evidence
2b Laryngoscope, 125:1084–1089, 2015
To study the clinical features of endogenous endophthalmitis (EE) in sample patient populations from the USA and South Korea over an 8-year period.
We reviewed data from 128 eyes of 60 American and ...48 Korean patients diagnosed with EE and compared their clinical characteristics.
Fungemia and liver abscess were the most common extraocular infection sources among American (26.7%) and Korean patients (33.3%), respectively. Klebsiella pneumoniae and Candida species were the most common pathogens of EE in the Korean and the American patients, respectively. Endophthalmitis caused by fungi had a better visual prognosis than that caused by bacteria (p = 0.001). Vitrectomy was beneficial for eyes with EE due to virulent bacteria presenting with worse than counting finger vision.
The predisposing conditions and responsible organisms for EE vary in different regions of the world. The visual prognosis was strongly influenced by the underlying pathogen.
Objective: To determine the effect of systemic arterial hypertension on the indices of aortic stenosis (AS) severity. Methods: A severe supravalvar AS was created in 24 pigs. The maximum and mean ...pressure gradients across the stenosis were measured by Doppler echocardiography and by catheterisation. Both echocardiography and catheter data were used to calculate stenosis effective orifice area, energy loss coefficient, and peak systolic left ventricular wall stress. Measurements were taken both at normal aortic pressures and during hypertension induced by banding of the distal thoracic aorta in 14 pigs and by intravenous administration of phenylephrine in 10 pigs. Results: During hypertension, systemic arterial resistance downstream from the stenosis increased greatly (all animals: 71 (40)%), whereas total systemic arterial compliance decreased significantly (−38 (21)%). Hypertension resulted in a moderate increase in effective orifice area (29 (14)%) and energy loss coefficient (25 (17)%) and substantial decreases in catheter gradients (maximum: −40 (20)%; mean: −43 (20)%; peak to peak: −70 (23)%) and Doppler gradients (maximum: −35 (17)%; mean: −37 (16)%). In multivariate analysis, peak to peak gradient was significantly (p < 0.001) related to the energy loss coefficient, mean flow rate, and arterial compliance, whereas maximum and mean catheter gradients were related only to the energy loss coefficient and flow rate. Of major importance, maximum systolic left ventricular wall stress increased greatly during hypertension (43 (23)%). Conclusions: The severity of AS may be partially masked by the presence of coexisting hypertension. The markers of AS severity should thus be interpreted with caution in hypertensive patients and be re-evaluated when the patient is in a normotensive state.
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