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This article presents three cases of Descemet's membrane detachment (DMD) occurring during 'ab externo' phacocanaloplasty procedures in three patients with uncontrolled primary open-angle glaucoma (OAG) and discusses the management of this condition by reviewing the available literature. Following a successful 360° cannulation of Schlemm's canal (SC), the microcatheter was withdrawn while an ophthalmic viscosurgical device (OVD) was injected into the canal. During passage through the inferonasal quadrant, a spontaneous separation of the posterior layer of the cornea was observed. Each case was managed differently after diagnosis, with the third case being drained intraoperatively based on experience gained from the previous cases. On the first postoperative day, slit-lamp biomicroscopy (BMC) revealed multiple DMDs in case one and a hyphema in the lower third of a deep anterior chamber. In the other two cases, a single DMD was observed. The second case developed hemorrhagic Descemet membrane detachment (HDMD), while the other two were non-hemorrhagic. In all three cases, anterior segment optical coherence tomography (AS-OCT) revealed the presence of retrocorneal hyperreflective membranes indicative of DMDs. These membranes were located in the periphery of the cornea and did not impact the visual axis. After evaluation, a small incision was made in the inferotemporal DMD of the first case. However, for the two remaining cases, a strategy of watchful waiting was deemed appropriate due to the location and size of the DMDs, as they did not affect the best-corrected visual acuity (BCVA). Over time, the patients demonstrated progressive improvement with a gradual reduction in the size of the DMDs. [ABSTRACT FROM AUTHOR]

Neurofibromatosis type 1 (NF1) is one of the central nervous system's most common autosomal dominant conditions. The diagnosis is based on the clinical diagnostic criteria and/or a molecularly confirmed mutation in the NF1 gene. This study investigated the possibility of substantiating choroidal nodules as a diagnostic criterion for the disease, including patients affected with and without high myopia. A cross-sectional study was carried out in 60 eyes of 30 adult patients diagnosed with NF1. A total of 30 healthy individuals of equivalent age and sex served as control. The Spectralis HRA+OCT MultiColor (Heidelberg Engineering GmbH, Heidelberg, Germany) evaluated the presence of choroidal abnormalities with near-infrared reflectance imaging. Secondly, the presence of iridian Lisch nodules was evaluated by slit lamp examination. Near-infrared reflectance imaging showed the presence of choroidal hyperreflective nodules in 83% of the patients diagnosed with NF1, while these choroidal abnormalities were not observed in any control subject. The patients diagnosed with NF1 associated with high myopia were the only ones who did not present the characteristic choroidal disorders. Therefore, when excluding patients diagnosed with high myopia, choroidal nodules were more frequent than Lisch nodules in a statistically significant proportion. Hyperreflective nodules detected by near-infrared reflectance imaging are as regular as Lisch nodules or even significantly more frequent when excluding high myope patients. Our observation of the mutual exclusion of choroidal hyperreflective nodules and high myopia in the NF1 patients seems a novel and interesting remark. [ABSTRACT FROM AUTHOR]

Background/Objectives: Glucocorticoids are drugs that are increasingly used in oral surgery to reduce trismus, inflammation, and postoperative pain, three frequent complications after the surgical extraction of impacted lower third molars. The aim of this study was to compare the effect of 8 mg dexamethasone versus 40 mg methylprednisolone in the prevention of postoperative complications after third molar surgery. Methods: A randomized double-blind clinical trial was conducted following CONSORT guidelines. In detail, 84 patients were included in the study, who randomly received a single preoperative submucosal dose of dexamethasone (8 mg) or methylprednisolone (40 mg). The variables analyzed, as primary outcomes, were trismus, inflammation, and postoperative pain. The measurements were performed at baseline (0 h), 3 h, 7 h, 24 h, 48 h, and 7 th day using a Visual Analog Scale (VAS), Verbal Rating Scale (VRS), and the Gabka–Matsumara method. Results: Dexamethasone reduced trismus, inflammation, and postoperative pain significantly better than methylprednisolone. Conclusions: Preoperative submucosal administration of 8 mg dexamethasone is effective and safe in reducing the severity of postoperative complications following surgical extraction of impacted lower third molars. [ABSTRACT FROM AUTHOR]

The objective is to establish the frequency of STEC infections in household contacts of HUS patients. We studied 292 household contacts of 82 HUS patients attended from 2010 to 2018. In HUS cases, diagnostic criteria were (1) isolation and characterization of STEC strains, (2) detection of free fecal Shiga toxin (FFStx), and (3) detection of anti-O serogroup-specific antibodies. Contacts were studied by screening of stx genes by polymerase chain reaction and/or STEC isolation from stool samples. Clonal relation of STEC strains was established by pulsed-field gel electrophoresis (PFGE). Frequencies of HUS patients without STEC isolation with STEC-positive contacts were determined. Serotypes and stx-genotypes in patients and contacts were analyzed. Thirty (36.6%) HUS patients had 36 STEC-positive contacts. Fourteen (38.8%) were children, 20 adults, and 2 dogs. One sibling developed HUS, 6 contacts had gastrointestinal symptoms, and the rest were asymptomatic. In 5 of 30 HUS patients, STEC infection could not be confirmed, and 2 cases were diagnosed only by FFStx detection. Of the remaining 23 HUS patients, 16 had E. coli O157 and 7 E. coli O145 infection. Serotype and/or stx-genotype concordance was established in 19 (83%) of 23 HUS patients and their contacts. Five HUS cases and their contacts studied by PFGE showed macrorestriction patterns with more than 90% similarity. Nearly one third of HUS patients had STEC-positive family contacts, and one third of them were children. Early identification is important to prevent ongoing contamination among family and institutional contacts and to facilitate prompt detection of HUS in STEC-positive contacts. [ABSTRACT FROM AUTHOR]

Purpose: To describe the clinical characteristics, the surgical management and the evolution after cataract surgery in a patient with nanophthalmos. Methods: We present the case of a 57‐year‐old woman with a progressive decrease in visual acuity referred for evaluation of a cataract intervention. As history, he presented high hyperopia [Right Eye (OD): +15.50; Left Eye (OS): +16.25], not corrected with glasses in childhood; episode of pupillary block 3 years ago treated with iridotomies in OD and chronic treatment with topical prostaglandin in both eyes. The best corrected visual acuity (BCVA) is 20/50 in both eyes. Slit‐lamp examination revealed very narrow anterior chambers, patent iridotomies, iridocrystalline synechiae, and advanced nuclear cataracts. Intraocular pressure is 21 mmHg in both eyes with latanoprost. Biometry reveals an axial length of 16.59 mm in OD and 16.60 mm in OS. A cataract was diagnosed in patient with bilateral nanophthalmos and it was decided to intervene in the OD. In surgery, 2 lamellar scleral incisions were made followed by suturing of the overlying conjunctiva and phacoemulsification with a 40D intraocular lens implant in the posterior chamber. Systemic corticosteroids were administered postoperatively. Results: Postoperative complications observed were: posterior synechiae and anterior capsule phimosis that required Nd‐YAG laser capsulotomy. Despite the good evolution, no improvement was obtained in visual acuity with respect to pre‐surgical values, and the patient currently has a BCVA of 20/50. Conclusions: Eyes with nanophthalmos require the recognition of cardinal signs of paramount importance for their diagnosis, as well as follow‐up and search for possible complications over time, and the use of extensive preoperative precautionary measures when surgical approach is necessary. [ABSTRACT FROM AUTHOR]

We evaluated risk factors for sporadic Shiga toxin-producing Escherichia coli (STEC) infection among children in Argentina. We conducted a prospective case-control study in 2 sites and enrolled 150 case-patients and 299 controls. The median age of case-patients was 1.8 years; 58% were girls. Serotype O157:H7 was the most commonly isolated STEC. Exposures associated with infection included eating undercooked beef, living in or visiting a place with farm animals, and contact with a child <5 years of age with diarrhea. Protective factors included the respondent reporting that he or she always washed hands after handling raw beef and the child eating more than the median number of fruits and vegetables. Many STEC infections in children could be prevented by avoiding consumption of undercooked beef, limiting exposure to farm animals and their environment, not being exposed to children with diarrhea, and washing hands after handling raw beef. [ABSTRACT FROM AUTHOR]

The article examines the role of institutional communication within universities and colleges, specifically the Universidad de Murcia (University of Murcia) in Spain. The 21st century has brought upon increased visibility and dependence on information and communication. Society has not only depended on developing information sources within the traditional modes of mass media (newspapers, magazines, television and the Internet), but also communication within organizations and institutions. The article explores institutional communication organization within Spain's university system, providing an analysis if its strengths and weaknesses.

Collagen membranes are currently the most widely used membranes for guided bone regeneration; however, their rapid degradation kinetics means that the barrier function may not remain for enough time to permit tissue regeneration to happen. The origin of collagen may have an important effect on the resistance to degradation. The aim of this study was to investigate the biodegradation pattern of five collagen membranes from different origins: Biocollagen, Heart, Evolution X-fine, CopiOs and Parasorb Resodont. Membranes samples were submitted to different degradation tests: (1) hydrolytic degradation in phosphate buffer saline solution, (2) bacterial collagenase from Clostridium histolyticum solution, and (3) enzyme resistance using a 0.25% porcine trypsin solution. Immersion periods from 1 up to 50 days were performed. At each time point, thickness and weight measurements were performed with a digital caliper and an analytic microbalance, respectively. ANOVA and Student–Newman–Keuls tests were used for comparisons (p < 0.05). Differences between time-points within the same membranes and solutions were assessed by pair-wise comparisons (p < 0.001). The Evolution X-fine collagen membrane from porcine pericardium attained the highest resistance to all of the degradation tests. Biocollagen and Parasorb Resodont, both from equine origin, experienced the greatest degradation when immersed in PBS, trypsin and C. histolyticum during challenge tests. The bacterial collagenase solution was shown to be the most aggressive testing method. [ABSTRACT FROM AUTHOR]

Implant stability is one of the main indicators of successful osseointegration. Although it has been measured in numerous studies, there has been little research on implant stability in regenerated bone. The study compares primary and secondary stability between implants placed in regenerated versus native bone and evaluates the influence of bone quality on the results. Sixty implants were placed in 31 patients: 30 implants inserted in native bone (non-regenerated) after a healing period of at least 6 months post-exodontia and 30 inserted in regenerated bone at 6 months after grafting with xenograft. Resonance frequency analysis (RFA) was used to obtain implant stability quotient (ISQ) values at baseline (implant placement), 8 weeks, and 12 weeks. Statistically significant differences were found between implants placed in regenerated bone and those placed in native bone at all measurement time points (p < 0.05). ISQ values were significantly influenced by bone quality at baseline (p < 0.05) but not at 8 or 12 weeks. Greater stability was obtained in implants placed in native bone; however, those placed in regenerated bone showed adequate primary and secondary stability for prosthetic loading. Bone quality influences the primary but not secondary stability of the implants in both native and regenerated bone. [ABSTRACT FROM AUTHOR]

Background: 'Periodontitis' refers to periodontal destruction of connective tissue attachment and bone, in response to microorganisms forming subgingival biofilms on the root surface, while 'apical periodontitis' refers to periapical inflammatory processes occurring in response to microorganisms within the root canal system. The treatment of both diseases is based on the elimination of the bacterial challenge, though its predictability depends on the ability of disrupting these biofilms, what may need adjunctive antibacterial strategies, such as the next‐generation antibacterial strategies (NGAS). From all the newly developed NGAS, the use of polymeric nanotechnology may pose a potential effective approach. Although some of these strategies have only been tested in vitro and in preclinical in vivo models, their use holds a great potential, and therefore, it is relevant to understand their mechanism of action and evaluate their scientific evidence of efficacy. Objectives: To explore NGAS based on polymeric nanotechnology used for the potential treatment of periodontitis and apical periodontitis. Method: A systemic search of scientific publications of adjunctive antimicrobial strategies using nanopolymers to treat periodontal and periapical diseases was conducted using The National Library of Medicine (MEDLINE by PubMed), The Cochrane Oral Health Group Trials Register, EMBASE and Web of Science. Results: Different polymeric nanoparticles, nanofibres and nanostructured hydrogels combined with antimicrobial substances have been identified in the periodontal literature, being the most commonly used nanopolymers of polycaprolactone, poly(lactic‐co‐glycolic acid) and chitosan. As antimicrobials, the most frequently used have been antibiotics, though other antimicrobial substances, such as metallic ions, peptides and naturally derived products, have also been added to the nanopolymers. Conclusion: Polymeric nanomaterials containing antimicrobial compounds may be considered as a potential NGAS. Its relative efficacy, however, is not well understood since most of the existing evidence is derived from in vitro or preclinical in vivo studies. [ABSTRACT FROM AUTHOR]

Barrier membranes are employed in guided bone regeneration (GBR) to facilitate bone in-growth. A bioactive and biomimetic Zn-doped membrane with the ability to participate in bone healing and regeneration is necessary. The aim of the present study is to state the effect of doping the membranes for GBR with zinc compounds in the improvement of bone regeneration. A literature search was conducted using electronic databases, such as PubMed, MEDLINE, DIMDI, Embase, Scopus and Web of Science. A narrative exploratory review was undertaken, focusing on the antibacterial effects, physicochemical and biological properties of Zn-loaded membranes. Bioactivity, bone formation and cytotoxicity were analyzed. Microstructure and mechanical properties of these membranes were also determined. Zn-doped membranes have inhibited in vivo and in vitro bacterial colonization. Zn-alloy and Zn-doped membranes attained good biocompatibility and were found to be non-toxic to cells. The Zn-doped matrices showed feasible mechanical properties, such as flexibility, strength, complex modulus and tan delta. Zn incorporation in polymeric membranes provided the highest regenerative efficiency for bone healing in experimental animals, potentiating osteogenesis, angiogenesis, biological activity and a balanced remodeling. Zn-loaded membranes doped with SiO2 nanoparticles have performed as bioactive modulators provoking an M2 macrophage increase and are a potential biomaterial for promoting bone repair. Zn-doped membranes have promoted pro-healing phenotypes. [ABSTRACT FROM AUTHOR]

Presents a letter to the editor about sporadic hemolytic uremic syndrome caused by home-prepared hamburger in Argentina.

Context. The bright heads of penumbral filaments, penumbral grains (PGs), show apparent horizontal motions inward, toward the umbra, or outward, away from the umbra. Aims. We aim to ascertain statistically whether the direction of PGs' apparent motion is related to the inclination of the surrounding magnetic field. Methods. We used spectropolarimetric observations of five sunspot penumbrae to compare magnetic inclinations inside PGs with those in their surroundings. The data were taken by three observatories: the Hinode satellite, the Swedish Solar Telescope, and the GREGOR solar telescope. The direction of PGs' motion was determined by feature tracking. The atmospheric conditions in PGs and their surroundings, including magnetic field information, were retrieved by means of height-stratified spectropolarimetric inversions. Results. Out of a sample of 444 inward-moving PGs and 269 outward-moving ones, we show that 43% of the inward-moving PGs have a magnetic inclination larger by 8° ±4° than the inclination in their surroundings and 51% of the outward-moving PGs have an inclination smaller by 13° ±7° than the surrounding one. The opposite relation of inclinations is observed in only one fifth of the inward- and outward-moving PGs. Conclusions. Rising hot plasma in PGs surrounded by a less inclined magnetic field may adapt its trajectory to be more vertical, causing an inward apparent motion of PGs. Conversely, it may be dragged by a more horizontal surrounding magnetic field such that an outward apparent motion is observed. [ABSTRACT FROM AUTHOR]

Background and objective: Primary stability (PS) is remarkable for secondary stability and implant success. Surgical technique modifications seem to improve primary stability, especially in poor quality bone. The aim of this study was to compare the insertion torque (IT) and implant stability quotients (ISQ) of implants placed with underpreparation, expanders, and standard surgical instrumentation in different bone types. Material and methods: This randomized controlled clinical trial enrolled 108 patients (n=108 implants) distributed in three study groups: group 1 (n=36) underpreparation technique, group 2 (n=36) expander technique, and group 3 (n=36) conventional drilling. IT was recorded with a torque indicator. ISQ was recorded with resonance frequency analysis immediately after surgery. Results: ISQ values were associated with the patient's bone quality and were higher in bone quality type II (76.65) and type III (73.60) and lower in bone quality type IV (67.34), with statistically significant differences (p<0.0001). Lower stability results were obtained when conventional drilling (69.31) was used compared to the use of underpreparation (74.29) or expanders (73.99) with a level of significance of p=0.008 and p=0.005, respectively. Conclusions: The surgical technique influences the PS when there is low-quality bone. In low-quality bones, conventional drilling obtains lower ISQ values. Clinical relevance: Replace the conventional drilling technique for an alternative, underpreparation or expanders, in low-quality bone in order to achieve greater primary stability. [ABSTRACT FROM AUTHOR]

The main target of bone tissue engineering is to design biomaterials that support bone regeneration and vascularization. Nanostructured membranes of (MMA)1-co-(HEMA)1/(MA)3-co-(HEA)2 loaded with 5% wt of SiO2-nanoparticles (Si-M) were doped with zinc (Zn-Si-M) or doxycycline (Dox-Si-M). Critical bone defects were effectuated on six New Zealand-bred rabbit skulls and then they were covered with the membranes. After six weeks, a histological analysis (toluidine blue technique) was employed to determine bone cell population as osteoblasts, osteoclasts, osteocytes, M1 and M2 macrophages and vasculature. Membranes covering the bone defect determined a higher count of bone cells and blood vessels than in the sham group at the top regions of the defect. Pro-inflammatory M1 appeared in a higher number in the top regions than in the bottom regions, when Si-M and Dox-Si-M were used. Samples treated with Dox-Si-M showed a higher amount of anti-inflammatory and pro-regenerative M2 macrophages. The M1/M2 ratio obtained its lowest value in the absence of membranes. On the top regions, osteoblasts were more abundant when using Si-M and Zn-Si-M. Osteoclasts were equally distributed at the central and lateral regions. The sham group and samples treated with Zn-Si-M attained a higher number of osteocytes at the top regions. A preferential osteoconductive, osteoinductive and angiogenic clinical environment was created in the vicinity of the membrane placed on critical bone defects. [ABSTRACT FROM AUTHOR]

Purpose: To describe the clinical manifestations and diagnosis of choroidal haemangioma with the aid of different multimodal images, as well as its usefulness for making a differential diagnosis. Methods: A case of a patient who comes due to blurred vision is described, who underwent different complementary tests of multimodal images: optical coherence tomography (OCT), fluorescein angiography (FA), indocyanine green angiography (ICGA), autofluorescence (AF), ultrasound eye exam and retinography to achieve the accurate diagnosis. Results: We present the case of a 50‐year‐old patient who debuted with recently‐onset blurred vision in the left eye (LE). In the eye fundus of LE, a yellow‐orange temporal‐inferior lesion of 3 disc diameter (DD) with neurosensory detachment of 4 DD that affects the fovea is observed. An OCT is performed that shows a choroidal mass associated with subretinal and intraretinal fluid with hyperrefringent points, the B‐scan ultrasound shows a hyperechoic lesion in the posterior pole, and both ICGA and FA reveal a hyperfluorescent pattern in all its phases, being the choroidal vessels of better visualization in the latter phase (without double vascularization pattern). AF shows hyperautofluorescence. After the definitive diagnosis of choroidal haemangioma, he was referred for treatment with Argon laser with favourable results. Conclusions: Choroidal haemangioma is a rare benign vascular tumour that occurs in middle‐aged adults and can be circumscribed (CCH) or diffuse depending on its extension. For the diagnosis of intraocular tumours it is very important to make a good differential diagnosis with the help of multimodal images: OCT, FA, ICGA, AF, Ultrasound and retinography; in order to differentiate it from similar posterior pole lesions with worse prognosis. CCH itself is benign and asymptomatic, and its treatment consists of observation; but it can present inflammatory signs with subretinal fluid and affect the macular area and therefore a more invasive treatment is indicated. References. 1. Singh AD, Kaiser PK, Sears JE. Choroidal hemangioma. Ophthalmol Clin North Am. 2005;18(1):151–61, ix. 2. Berry M, Lucas LJH. Circumscribed choroidal hemangioma: A case report and literature review. J Optom. 2017;10(2):79–83. [ABSTRACT FROM AUTHOR]

Purpose: Corneal neovascularization (CNV) in the paediatric population has a variety of etiologies including bacterial ulcers, herpes keratitis, exposure keratopathy, blepharokeratoconjunctivitis and corneal anaesthesia. Monotherapy with antiangiogenic agents or corneal fine‐needle diathermy (FND) alone do not completely resolve CNV; however, the combined treatment of these two seems to offer better results. Methods: We present the results of FND with adjuvant injection of intrastromal and subconjunctival Bevacizumab in a child with CNV of herpetic origin. Results: A 3‐year‐old patient who has been treated in our hospital for corneal involvement in the left eye (LE) due to herpetic keratitis of weeks of evolution comes to our consultation. Examination under general anaesthesia reveals in LE an inferior paracentral corneal leukoma with partial involvement of the visual axis and CNV that enters through the limbus from 5 to 8 h and begins to involve corneal stroma; no epithelial lesions, no corneal oedema or inflammatory activity in the anterior segment. After not improvement, it was decided to perform FND of lower CNV in conjunction with an intrastromal injection and another subconjunctival injection of Bevacizumab. Subsequently, it remains stable with topical and oral antiherpetic treatment, and topical corticosteroid therapy. At 3 months, the CNV reactivated, for which FND + intrastromal and subconjunctival bevacizumab was performed again. Finally, at 2 months, the patient is asymptomatic with VA LE of 1.0, with 2 corneal leukomas without CNV or epithelial lesions, and continues to be treated with oral acyclovir at prophylactic doses. Conclusions: FND of CNV together with adjuvant treatment with intrastromal and subconjunctival Bevacizumab is a good choice in children to treat those active corneal neovascularizations that do not respond to corticosteroid. References 1. Yeung SN, Lichtinger A, Kim P, Amiran MD, Slomovic AR. Combined use of subconjunctival and intracorneal bevacizumab injection for corneal neovascularization. Cornea. 2011; 30(10): 1110–4. 2. Koenig Y, Bock F, Kruse FE, Stock K, Cursiefen C. Angioregressive pretreatment of mature corneal blood vessels before keratoplasty: Fine‐needle vessel coagulation combined with Anti‐VEGFs. Cornea. 2012; 31(8): 887–92. [ABSTRACT FROM AUTHOR]

Background: Short implants are proposed as a less invasive alternative with fewer complications than standard implants in combination with sinus lift. The aim of this systematic review and meta-analysis was to state the efficacy of placing short implants (≤ 6 mm) compared to standard-length implants (≥ 8 mm) performing sinus lift techniques in patients with edentulous posterior atrophic jaws. Efficacy will be evaluated through analyzing implant survival (IS) and maintenance of peri-implant bone (MBL). Methods: Screening process was done using the National Library of Medicine (MEDLINE by PubMed), EMBASE, the Cochrane Oral Health, and Web of Science (WOS). The articles included were randomized controlled trials. Risk of bias was evaluated according to The Cochrane Collaboration's tool. Weighted means were calculated. Heterogeneity was determined using Higgins (I2). A random-effects model was applied. Secondary outcomes such as surgical time, patient satisfaction, mucositis and peri-implantitis, pain, and swelling were analyzed. Results: Fourteen studies (597 patients and 901 implants) were evaluated. IS was 1.02 risk ratio, ranging from 1.00 to 1.05 (CI 95%) (p = 0.09), suggesting that IS was similar when both techniques were used. MBL was higher in patients with standard-length implants plus sinus lift elevation (p = 0.03). MBL was 0.11 (0.01–0.20) mm (p = 0.03) and 0.23 (0.07–0.39) mm (p = 0.005) before and after 1 year of follow-up, respectively, indicating that the marginal bone loss is greater for standard-length implants. Discussion: Within the limitations of the present study, as relatively small sample size, short dental implants can be used as an alternative to standard-length implants plus sinus elevation in cases of atrophic posterior maxilla. Higher MBL was observed in the groups where standard-length implants were used, but implant survival was similar in both groups. Moreover, with short implants, it was observed a reduced postoperative discomfort, minimal invasiveness, shorter treatment time, and reduced costs. Clinical Clinical relevance: The low MBL promoted by short implants does contribute to a paradigm shift from sinus grafting with long implants to short implants. Further high-quality long-term studies are required to confirm these findings. [ABSTRACT FROM AUTHOR]

Objective: Resonance frequency analysis (RFA) provides an evaluation of implant stability over time. This analysis is a non-invasive, precise, and objective method. Several studies compare the RFA system with other devices. However, few investigations analyze repeatability and reproducibility between different operators. The aim of this study was to evaluate the intra- and inter-operator concordance of the Osstell® ISQ. Material and methods: RFA measurements were performed with Osstell® ISQ in a total of 37 implants placed in 21 patients. At the time of implant placement, 6 measurements per implant were taken by three different experienced operators. Three measurements were carried out consecutively and three by removing and placing the SmartPeg-Osstell® to assess intra-operator and inter-operator agreement. Results: Intra-operator concordance according to the intraclass correlation coefficient (ICC) showed high concordance. The ICC values were higher than 0.9 (p < 0.0001) for consecutive measures and alternative measures, being almost perfect of Landis & Koch classification. For inter-operator concordance The ICC was 0.709 (p < 0.0001) and 0.670 (p < 0.0001) for consecutive and alternative measures, respectively, both estimates being in the substantial category. In torque and ISQ values, no statistically significant differences were observed when operators and measurements were compared. Conclusions: Osstell® ISQ system was stable both in intra-operator and inter-operator measurements. This device has excellent repeatability and reproducibility, demonstrating reliability to measure the stability of dental implants. Clinical relevance: Resonance frequency analysis (RFA) is a non-invasive, objective, and reliable diagnostic method to determine the ideal moment to load the implant, as well as to predict possible failures. [ABSTRACT FROM AUTHOR]

Background: Passive immunotherapy has been evaluated as a therapeutic alternative for patients with COVID-19 disease. Equine polyclonal immunotherapy for COVID-19 (EPIC) showed adequate safety and potential efficacy in a clinical trial setting and obtained emergency use authorization in Argentina. We studied its utility in a real world setting with a larger population. Methods: We conducted a retrospective cohort study at "Hospital de Campaña Escuela-Hogar" (HCEH) in Corrientes, Argentina, to assess safety and effectiveness of EPIC in hospitalized adults with severe COVID-19 pneumonia. Primary endpoints were 28-days all-cause mortality and safety. Mortality and improvement in modified WHO clinical scale at 14 and 21 days were secondary endpoints. Potential confounder adjustment was made by logistic regression weighted by the inverse of the probability of receiving the treatment (IPTW) and doubly robust approach. Findings: Subsequent clinical records of 446 non-exposed (Controls) and 395 exposed (EPIC) patients admitted between November 2020 and April 2021 were analyzed. Median age was 58 years and 56.8% were males. Mortality at 28 days was 15.7% (EPIC) vs. 21.5% (Control). After IPTW adjustment the OR was 0.66 (95% CI: 0.46–0.96) P = 0.03. The effect was more evident in the subgroup who received two EPIC doses (complete treatment, n = 379), OR 0.58 (95% CI 0.39 to 0.85) P = 0.005. Overall and serious adverse events were not significantly different between groups. Conclusions: In this retrospective cohort study, EPIC showed adequate safety and effectiveness in the treatment of hospitalized patients with severe SARS-CoV-2 disease. [ABSTRACT FROM AUTHOR]

Gingival recessions are a prevalent oral mucosa alteration. To solve this pathology, palatal mucosa or polymeric soft tissue substitutes are used when performing coronal advanced flap (CAF) or tunnel (TUN) surgical techniques. To evaluate which is the most successful approach, a literature review and meta-analysis were conducted. For the electronic search the National Library of Medicine, the Cochrane Oral Health Group Trials Register, EMBASE and WOS were used. Pooled data for the percentage of root coverage was collected and weighted means were calculated. Heterogeneity was determined using the Higgins (I2) statistic and a random-effects model was applied. Thirteen studies were included in the systematic review (12 randomized and 1 controlled clinical trials) in which both techniques (394 patients) were compared with a follow-up of 4 to 12 months. Galbraith and Baujat plots were used to control for the presence of potential outliers. After performing the meta-analysis (11 studies), the mean root coverage was similar when using the TUN or CAF techniques (p = 0.49). The only differences between the two were found for single recessions, where CAF offered a higher percentage of root coverage (mean difference = 4.98%; p = 0.006). There were no differences when applying an autograft or a polymeric substitute with either of the two tested surgical techniques (p = 0.445). [ABSTRACT FROM AUTHOR]

Polymeric membranes are frequently used for bone regeneration in oral and periodontal surgery. Polymers provide adequate mechanical properties (i.e., Young's modulus) to support oral function and also pose some porosity with interconnectivity to permit for cell proliferation and migration. Bacterial contamination of the membrane is an event that may lead to infection at the bone site, hindering the clinical outcomes of the regeneration procedure. Therefore, polymeric membranes have been proposed as carriers for local antibiotic therapy. A literature search was performed for papers, including peer-reviewed publications. Among the different membranes, collagen is the most employed biomaterial. Collagen membranes and expanded polytetrafluoroethylene loaded with tetracyclines, and polycaprolactone with metronidazole are the combinations that have been assayed the most. Antibiotic liberation is produced in two phases. A first burst release is sometimes followed by a sustained liberation lasting from 7 to 28 days. All tested combinations of membranes and antibiotics provoke an antibacterial effect, but most of the time, they were measured against single bacteria cultures and usually non-specific pathogenic bacteria were employed, limiting the clinical relevance of the attained results. The majority of the studies on animal models state a beneficial effect of these antibiotic functionalized membranes, but human clinical assays are scarce and controversial. [ABSTRACT FROM AUTHOR]

The long polar fimbriae (Lpf) is one of few adhesive factors of Shiga toxin-producing Escherichia coli (STEC) and it is associated with colonization of the intestine. Studies have demonstrated the presence of lpf genes in several pathogenic E. coli strains, and classification of variants based on polymorphisms in the lpfA1 and lpfA2 genes has been adopted. Using a collection of Argentinean locus of enterocyte effacement (LEE)-negative STEC strains, we determined that the different lpfA types were present in a wide variety of serotypes with no apparent association between the types of lpfA1 or lpfA2 genes and the severity of human disease. The lpfA2-1 was the most prevalent variant identified, which was present in 95.8% of the isolates, and lpfA1-3 and lpfA2-2, proposed as specific biomarkers of E. coli O157:H7, were not found in any of the serotypes studied. The prevalence of lpf genes in a large number of strains is useful to understand the genetic diversity of LEE-negative STEC and to define the association of some of these isolates carrying specific lpf-variants with disease. [ABSTRACT FROM AUTHOR]

[Display omitted] • ML-doped polymeric nanoparticles avoided degradation of root dentin interface. • Undoped NPs provoked peak broadening and poor crystallinity with decreased hardness. • ML-NPs inducted preferred and randomly oriented crystallites influencing hardness. To investigate the effect of novel polymeric nanoparticles (NPs) doped with melatonin (ML) on nano-hardness, crystallinity and ultrastructure of the formed hydroxyapatite after endodontic treatment. Undoped-NPs and ML-doped NPs (ML-NPs) were tested at radicular dentin, after 24 h and 6 m. A control group without NPs was included. Radicular cervical and apical dentin surfaces were studied by nano-hardness measurements, X-ray diffraction and transmission electron microscopy. Mean and standard deviation were analyzed by ANOVA and Student-Newman-Keuls multiple comparisons (p < 0.05). Cervical dentin treated with undoped NPs maintained its nano-hardness values after 6 m of storage being [24 h: 0.29 (0.01); 6 m: 0.30 (0.02) GPa], but it decreased at apical dentin [24 h: 0.36 (0.01); 6 m: 0.28 (0.02) GPa]. When ML-NPs were used, nano-hardness was similar over time [24h: 0.31 (0.02); 6 m: 0.28 (0.03) GPa], at apical dentin. Root dentin treated with ML-NPs produced, in general, high crystallinity of new minerals and thicker crystals than those produced in the rest of the groups. After 6 m, crystals became organized in randomly oriented polyhedral, square polygonal block-like apatite or drop-like apatite polycrystalline lattices when ML-NPs were used. Undoped NPs generated poor crystallinity, with preferred orientation of small crystallite and increased microstrain. New polycrystalline formations encountered in dentin treated with ML-NPs may produce structural dentin stability and high mechanical performance at the root. The decrease of mechanical properties over time in dentin treated without NPs indicates scarce remineralization potential, dentin demineralization and further potential degradation. The amorphous stage may provide high hydroxyapatite solubility and remineralizing activity. [ABSTRACT FROM AUTHOR]

Collagen matrices have become a great alternative to the use of connective tissue grafts for soft tissue augmentation procedures. One of the main problems with these matrices is their volume instability and rapid degradation. This study has been designed with the objective of examining the degradation of three matrices over time. For this purpose, pieces of 10 × 10 mm2 of Fibro-Gide, Mucograft and Mucoderm were submitted to three different degradation tests—(1) hydrolytic degradation in phosphate buffer solution (PBS); (2) enzyme resistance, using a 0.25% porcine trypsin solution; and (3) bacterial collagenase resistance (Clostridium histolyticum)—over different immersion periods of up to 50 days. Weight measurements were performed with an analytic microbalance. Thickness was measured with a digital caliper. A stereomicroscope was used to obtain the matrices' images. ANOVA and Student–Newman–Keuls tests were used for mean comparisons (p < 0.05), except when analyzing differences between time-points within the same matrix and solution, where pair-wise comparisons were applied (p < 0.001). Fibro-Gide attained the highest resistance to all degradation challenges. The bacterial collagenase solution was shown to constitute the most aggressive test as all matrices presented 100% degradation before 14 days of storage. [ABSTRACT FROM AUTHOR]

Soft tissues have been shown to be critical for the maintenance of both teeth and implants. Currently, regenerative soft tissue techniques propose the use of collagen matrices, which can avoid the drawbacks derived from the obtainment of autogenous tissue graft. A systematic review and meta-analysis were conducted to ascertain the efficacy of collagen matrices (CM) compared to autogenous connective tissue graft (CTG) to improve soft tissue dimensions. An electronic and manual literature searches were performed to identify randomized clinical trials (RCT) or controlled clinical trials (CCT) that compared CTG and CM. Pooled data of width of keratinized tissue (KT) and mucosal thickness (MT) were collected and weighted means were calculated. Heterogeneity was determined using Higgins (I2). If I2 > 50% a random-effects model was applied. Nineteen studies were included based on the eligibility criteria. When using CTG a higher MT gain (0.32 mm, ranging from 0.49 to 0.16 mm) was obtained than when employing CM. Similar result was obtained for the width of KT gain, that was 0.46 mm higher (ranging from 0.89 to 0.02 mm) when employing CTG. However, it can be stated that, although autogenous CTG achieves higher values, CM are an effective alternative in terms of total width of KT and MT gain. [ABSTRACT FROM AUTHOR]

Aims/Purpose: To present a case report of a 64‐year‐old man with dislocation of a dexamethasone anterior chamber (AC) implant, who underwent secondary implantation with the Canabrava technique. Methods: A male patient underwent surgery for a secondary implant in the left eye using the Canabrava technique. Post‐operatively, cystic macular oedema was observed on optical coherence tomography (OCT). After 15 days, with no anatomical improvement despite treatment with Nevanac eye drops, a dose of intravitreal injection with Ozurdex® was prescribed. A few days later, the patient came to the emergency department and reported seeing a foreign body in the treated eye. On biomicroscopic examination, an Ozurdex® insert was found in the AC. When the patient was questioned again, he stated that he had been in the praying position the previous days. A new macular OCT was performed, showing resolution of the foveal oedema. Dilation of the LAA with phenylephrine was performed with cephalic manoeuvres in the supine decubitus position, achieving the repositioning of the dexamethasone implant in the vitreous chamber. Finally, an OCT of the anterior pole shows that the secondary implant is normally positioned without complications. Results: After initial treatment with Ozurdex® intravitreal implant, total resolution of the post‐operative cystic macular oedema is achieved, even with dislocation to the anterior chamber. After outpatient management of the dislocation of the implant, we were able to relocate it to the vitreous chamber without the need for surgical management of the patient. Conclusions: In the clinical case, it is demonstrated that the anti‐inflammatory effect of Ozurdex® remains active despite dislocation of the implant to the anterior chamber. Likewise, a good ambulatory technique in the supine position with directed cephalic manoeuvres may be sufficient to reposition the implant without the need for surgery. [ABSTRACT FROM AUTHOR]

Introduction: Introduction: the use of natural nutritional supplements can be used as a coadjuvant therapy since they have several phytochemicals with potential antioxidant effects that could influence lipid and glycemic metabolism. Objectives: to determine the effect of natural propolis supplementation on lipid metabolism and liver antioxidant activity. Material and methods: 20 male Wistar albino rats (8 weeks) were divided into two groups of 10 animals each. Subsequently, they were fed two different types of diet for 90 days: a standard diet for the control group (diet C) and a standard diet + 2 % propolis (diet P). Hematological and biochemical parameters were assessed. The livers were extracted and washed with saline solution, and the cytosolic fractions were prepared fresh for additional analysis of antioxidant enzymes catalase, superoxide dismutase, glutathione peroxidase, and glutathione reductase. Results: after consuming the diet supplemented with propolis, we found a reduction in glucose (p < 0,01), total cholesterol (p < 0,001), GOT (p < 0,05) and GPT (p < 0,01), whereas the propolis supplement induced an increase in the hepatic activity of SOD (p < 0,001), CAT (p < 0,01) and GR (p < 0,05). Conclusion: the present study reveals that a dietary propolis supplement (2 %) can improve the lipid and glycemic profiles, also increasing antioxidant enzimes and reducing the release of liver transaminases. [ABSTRACT FROM AUTHOR]

Background Shiga toxin–producing Escherchia coli (STEC) O157:H7 is a zoonotic pathogen that causes numerous food and waterborne disease outbreaks. It is globally distributed, but its origin and the temporal sequence of its geographical spread are unknown. Methods We analyzed whole-genome sequencing data of 757 isolates from 4 continents, and performed a pan-genome analysis to identify the core genome and, from this, extracted single-nucleotide polymorphisms. A timed phylogeographic analysis was performed on a subset of the isolates to investigate its worldwide spread. Results The common ancestor of this set of isolates occurred around 1890 (1845–1925) and originated from the Netherlands. Phylogeographic analysis identified 34 major transmission events. The earliest were predominantly intercontinental, moving from Europe to Australia around 1937 (1909–1958), to the United States in 1941 (1921–1962), to Canada in 1960 (1943–1979), and from Australia to New Zealand in 1966 (1943–1982). This pre-dates the first reported human case of E. coli O157:H7, which was in 1975 from the United States. Conclusions Inter- and intra-continental transmission events have resulted in the current international distribution of E. coli O157:H7, and it is likely that these events were facilitated by animal movements (eg, Holstein Friesian cattle). These findings will inform policy on action that is crucial to reduce the further spread of E. coli O157:H7 and other (emerging) STEC strains globally. [ABSTRACT FROM AUTHOR]

Shiga toxin-producing Escherichia coli (STEC) is th etiological agent of gastrointestinal diseases as haemorrhagic colitis and haemolytic-uraemic syndrome (HUS). Shiga toxin (Stx) is the main virulence factor. There are two types, Stx1 and Stx2, and several subtypes. Other virulence factors are involved in pathogenesis. While O157:H7 is the predominant serotype, at present non-O157 STEC strains are increasingly recognized as foodborne pathogens worldwide. In Argentina, STEC O174 stands out as an emerging pathogen and is one of the four most prevalent non-O157 STEC serogroups. The aim of this study was to characterize 41 O174:[H21, H28] STEC strains isolated from animals, food, and humans. Isolates were characterized by stx genotyping, adhesion factors ( afa C, eae , iha , lpf O113 , saa , and tox B), additional toxins ( cdt V, ehx A, sub A) and clonal relationship by pulsed-field gel electrophoresis (PFGE). Among 30 O174:H21 strains, the most prevalent stx subtype was stx 2c (56.7%), and among 11 O174:H28 strains, the most prevalent was stx 2a (90.9%). Regarding virulence factors, all strains were positive for afa C gene and negative for eae and tox B genes. In O174:H21, the frequency of additional factors was lpf O113 (96.6%), iha (83.3%), ehx A and saa (10%), and sub A (3.3%), meanwhile in O174:H28 strains the frequency was iha and sub A (100%), lpf O113 (90.9%), ehx A and saa (90.9%), and cdt V (9.09%). By Xba l-PFGE, 29 patterns were established with 64.01% similarity and three clusters were detected. Given the fact that the O174 serogroup is a local emergent, it is important to study the virulence profiles to understand its potential pathogenicity. [ABSTRACT FROM AUTHOR]

Purpose: We describe a case of Fish‐Eye Disease (FED) in which the clinical features and visual function were investigated using anterior‐segment optical coherence tomography (AS‐OCT). Methods: A 38‐year‐old Spanish man with a known history of dyslipidemia came to our Hospital referring mild blurred vision and whitening of both eyes. Visual acuity was 1.00 (decimal). Slit‐lamp examination showed bilateral, peripheral yellowish‐white corneal opacities, causing corneal clouding. An AS‐OCT was then performed, showing homogeneously hyper‐reflective corneal stroma. On systemic examination, the patient had low plasma high‐density lipoprotein cholesterol levels. Results: Both slit‐lamp examination and AS‐OCT imaging revealed a corneal opacification compatible with FED, a clinical feature secondary to a lecithin‐cholesterol acyltransferase (LCAT) deficiency. The patient was sent to genetic counselling to study the mutation, which was later found to be positive for LCAT gene. Conclusions: Although it is not a common genetic disorder, FED should be included in the differential diagnosis of corneal clouding. The findings from this case suggest that a complete eye examination, both with slit‐lamp and AS‐OCT, can be useful for an early FED diagnosis despite good visual acuity. [ABSTRACT FROM AUTHOR]

Purpose: To describe a case of pupillary block in a pseudophakic patient secondary to synechiae between the iris and the intraocular lens implanted in the capsular bag. Methods: 60‐year‐old woman presented severe diabetic retinopathy and cataract in her right eye. Phacoemulsification + hydrophobic monofocal intraocular lens in capsular bag was decided. The next day, we found a hemovitreous in right eye, observation was decided after performing ultrasound. As the condition did not resolve, a pars plana vitrectomy was performed. Seventeen days after the second surgery, the patient presented intense pain in her right eye, visual acuity of hand motion, IOP of 70 mm Hg, intense corneal edema, iris bombe, wide chamber and narrow in the periphery. Correct pseudophakia. Irregular pupil with mild non‐reactive miosis. Closed angle. Topical hypotensive drugs, oral acetazolamide, and IV mannitol were prescribed without response. Peripheral iridotomies were performed with good response. Mydriatics are added to force pupillary dilation. Results: The next day she presented an IOP 10. One month after the iridotomies she presented an IOP 12 and visual acuity of 0.6. Conclusions: Pseudophakic pupillary blocks rarely occur with current phacoemulsification techniques and capsular bag intraocular lens implantation. Complications inherent to surgery and patients (glaucoma, diabetes, children, previous early surgery) that predispose to a greater inflammatory context may be associated with the potential development of synechiae between the iris and the anterior intraocular lens / capsule, preventing the correct flow of the aqueous humour due to the pupillary block. In a study of the type of intraocular lens in a uveitic context, a greater association was found with hydrophobic intraocular lens than with other types. The ocation where the intraocular lens is implanted is also related, being greater in the intraocular lens in the anterior chamber or sulcus. Peripheral YAG laser iriditomies are a good therapeutic option but are not recommended intraoperatively because they can cause more complications than benefits. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effectiveness (lowering medication) of a single trabecular microbypass stent (iStent Inject® W, Glaukos) implantation in combination with phacoemulsification in open‐angle glaucoma eyes over a 12‐month period. Methods: Non‐randomized, single‐centre, retrospective case series of glaucoma eyes undergoing iStent implantation with phacoemulsification. Patients with no prior glaucoma surgery and intolerant or non‐compliant with medications were eligible for inclusion. Primary outcome effectiveness measures include reduction number of glaucoma medications and stabilization of intraocular pressure (IOP). Results: 30 eyes of 24 patients (mean age 74.9 ± 8.4) were included in this study. Mean baseline IOP was 17.7 ± 3.5 mmHg and was reduced to 16.1 ± 2.6 and 15.7 ± 2.5 at 6‐ and 12 months respectively (p = 0.002). Mean number of medications was 2.3 ± 1 at baseline and was significantly reduced to 0.7 ± 0.9 at 12 months (p < 0.001; −68%). No eye was medication free at baseline versus 50% (n = 15) at 12 months. In controlled glaucoma eyes (≤18 mmHG), mean IOP was stable (15.5 ± 2.1 at baseline; 15.3 ± 2.4 at 12‐month) while medications were reduced from 1.9 ± 0.7 at baseline to 0.5 ± 0.6, whereas in uncontrolled glaucoma eyes (>18mmHG at baseline) both IOP and medications were reduced from 20.7 ± 2.5 and 2.7 ± 1.2 at baseline to 16.2 ± 2.6 and 1.1 ± 1.1 at 12‐month respectively. There was no statistically significant change in retinal nerve fibre layer (RNFL) thickness at 12 months (p = 0.32). No eyes have experienced adverse events such as postoperatively IOP spikes or hyphema. Conclusions: iStent Inject W implantation with phacoemulsification results in a significant reduction in mean glaucoma medications in glaucoma eyes. IOP was also reduced and there was no loss of visual acuity or RNFL. In uncontrolled IOP eyes, the stent implantation has brought IOP under control and reduced the number of medications, while in controlled IOP eyes, it has lowered the number of medications. [ABSTRACT FROM AUTHOR]

Purpose: Optic disc pit (ODP) is a rare congenital disorder that affects one in 10 000 people. Serous detachment of macula is the most common complication and the natural history of untreated ODP maculopathy is a gradual deterioration with significant visual loss. A multitude of interventions have been designed for the treatment but none has been established as the treatment of choice. Pars plana vitrectomy is one of the most commonly used procedure in recent years. We present a case report with surgical treatment and management of complications. Methods: An interventional case report of a 63‐year‐old man who attended the emergency room due to sudden visual loss and best corrected visual acuity (BCVA) of 20/200 in the right eye (RE). Upon his arrival, a visual field was performed in which complete abolition of the right field was observed, severely affecting the central area. A papillary pit was found in the eye fundus. Optical coherence tomography (OCT) revealed a serous retinal detachment (RD) with macular involvement and surgical management was decided. Results: A successful pars plana vitrectomy (PPV) with peeling of the internal limiting membrane and application of an endolaser was performed. Three months later, he came back with a higher serous RD and a worsening of BCVA. We performed a second PPV with sulfur hexafluoride (SF6) with good anatomical results. One year later, cataract and an inferior rhegmatogenous retinal detachment with proliferative vitreoretinopathy (PVR) was treated with intraocular lens implantation and PPV with silicone oil. Five months later, supero‐temporal retina was detached, so a new PPV was carried out with silicone oil again. One year later, the silicone oil was removed and a retinal detachment was noted 3 months later. Finally, the last surgery was performed practicing encircling band, PPV, application of endolaser and again using silicone oil. Conclusions: Surgical management of serous retinal detachment caused by papillary pit continues being a challenge for retinal specialists. Complications of surgery are no usually publish in literature and this case report make us take into account. Since it ranges from observation to surgical approach using different techniques and procedures without any showing clear superiority. [ABSTRACT FROM AUTHOR]

Purpose: To study retinal thickness using optical coherence tomography (OCT) (Spectralis OCT) in patients after undergone pars plana vitrectomy to repair rhegmatogenous retinal detachment (RRD) during different time points over 1 year follow up. OCT can detect retinal thickness changes in RRD. These changes can modify in the follow up time. RRD by itself or due to the surgical procedure could induces macular thickness changes. Methods: We performed a single‐center cross‐sectional descriptive study including 49 eyes of patients with macula OFF RRD after 23 PPV + SF6 as tamponade; the contralateral eye was used as the control group. All participants underwent a complete ophthalmic examination that included refraction, axial length (AL), and Spectralis spectral‐domain (SD)‐OCT. Results: Thirty‐six of the patients were male and 16 female; 40.8% of the eyes were right one. Central foveal thickness was diminished in 1 month and 3 months time points. There were not differences in the 6‐ and 12‐months examination. The parafoveal ring was similar in both groups but there were statistically significant differences in the inferior and nasal outer ring of the ETDRS grid, in the 1 month follow up. After 1 year, differences were only found in the outer temporal and nasal rings. Conclusions: The findings of this study suggest that retinal thickness remains similar 1 year after RRD was successfully treated. These may indicate that there is a progressive anatomical restoration in the macular area. References 1. Zghal I, et al. Macula analysis by spectral domain OCT in rhegmatogenous retinal detachment surgery. J Fr Ophthalmol. 2015; 38(3): 181–92. 2. Han KJ, et al. Optical coherence tomography automated layer segmentation of macula after retinal detachment repair. Plos One. 2019; 13 (5). 3. Terauchi G, et al. Recovery of photoreceptor inner and outer segment layer thickness after reattachment of rhegmatogenous retinal detachment. Br J Ophthalmol. 2015; 99(10): 1323–1327. [ABSTRACT FROM AUTHOR]

Purpose: To present the assessment and surgical approach to late pseudophakic bullous keratopathy in a case of pseudophakia with Baikoff type anterior chamber (AC) IOL implantation with haptics synechiated to the iridian stroma. We opted for Descemet Stripping with Automated Endothelial Keratoplasty (DSAEK), which allowed us to solve the corneal decompensation. Methods: We present the case of a 72‐year‐old male with a history of traumatic cataract and superior iridodialysis, who was surgically treated with lens extraction and implantation of a three‐haptic Baikoff‐type AC IOL. During the 30 years after surgery, the patient remained stable. However, in 2021, he went for a revision with a decrease in visual acuity. During the slit‐lamp biomicroscopic examination and the images obtained, the presence of synechiae of the three haptics of the lens to the peripheral iridian stroma was evidenced, as well as the presence of generalized edema with increased thickness and loss of corneal transparency, which did not subside with medical treatment. Results: Given the need for surgical intervention, the risk–benefit of performing a lens explant was studied. It was decided to perform a DSAEK endothelial transplantation keeping the IOL in its position, given the existence of a wide iridian dialysis and a wide anterior chamber. During the operation, the implanted gas bubble allowed the graft to adhere properly, although it did not remain in the anterior chamber, due to the presence of the traumatic superior iridodialysis. However, in the immediate postoperative period, the graft of the posterior corneal layers remained adhered without the need of the gas bubble, resolving the previous bullous keratopathy. Conclusions: Late corneal decompensation is a complication to be taken into account in eyes with AC IOL. On the other hand, DSAEK offers advantages in the ease of positioning and maintenance of the graft compared to DMEK in cases with iridodialysis, obtaining a prompt recovery with good refractive results. [ABSTRACT FROM AUTHOR]

Purpose: To present a case of persistent corneal edema after endothelial disease of unknown cause and with a severe decrease in the endothelial count and clinical improvement after DWEK (descemetorhexis without endothelial keratoplasty). Methods: A 61‐year‐old immunocompetent male patient, with no relevant ophthalmological or systemic history, who after multiple episodes of subacute endotheliitis with retrokeratic precipitates and diffuse iridian atrophy in his right eye, showed central persistent corneal edema, secondary to a marked decrease in endothelial count and severe decrease in best‐corrected visual acuity (0.2) after several months of inflammatory stability. Results: During flare‐ups of inflammation, treatment with corticosteroids, topical ganciclovir and oral acyclovir was prescribed, with a good clinical response. Aqueous humour samples were taken during the outbreaks without yielding results for herpesviruses. The endothelial count remained low at the central level several months later, although the peripheral count was good. The fellow eye showed a normal count. It was decided to perform DWEK in the endothelial zone of retrokeratic precipitates as a diagnostic measure. The analyses of the endothelial sample FOR THE HERPESVIRIDAE FAMILY do not show results, however, a progressive improvement in corneal edema and visual acuity was observed from the first month after DWEK. He is currently stable, with mild paracentral edema and a best‐corrected visual acuity of 0.7. Conclusions: DWEK is reserved for cases of slightly advanced endothelial dystrophy, in which the central endothelial denudation causes a centripetal migration of the peripheral endothelial reserve. In this case, the clinical findings suggest a viral aetiology of the endothelial loss, therefore, DWEK was considered as a diagnostic procedure, to obtain samples for PCR and as a first step prior to DMEK. The improvement after DWEK in the area of retrokeratic precipitates without the need for a subsequent transplant suggests localized endothelial involvement in cases of endothelial loss associated with localized inflammatory precipitates. [ABSTRACT FROM AUTHOR]

Shiga toxin-producing Escherichia coli strains of serotype O113:H21 have caused severe human diseases, but they are unusual in that they do not produce adherence factors coded by the locus of enterocyte effacement. Here, a PCR microarray was used to characterize 65 O113:H21 strains isolated from the environment, food, and clinical infections from various countries. In comparison to the pathogenic strains that were implicated in hemolytic-uremic syndrome in Australia, there were no clear differences between the pathogens and the environmental strains with respect to the 41 genetic markers tested. Furthermore, all of the strains carried only Shiga toxin subtypes associated with human infections, suggesting that the environmental strains have the potential to cause disease. Most of the O113:H21 strains were closely related and belonged in the same clonal group (ST-223), but CRISPR analysis showed a great degree of genetic diversity among the O113:H21 strains. [ABSTRACT FROM AUTHOR]

Hemolytic uremic syndrome (HUS) is the major complication of gastrointestinal infections with enterohemorrhagic Escherichia coli (EHEC) and is mediated by the production of Shiga toxins (Stx). Although it has been previously reported that not only HUS patients but healthy children have anti-Stx antibodies, very little is known about how these infections impact on mucosal immune system to generate a specific immune response. This work aimed to evaluate the immune responses elicited after a single oral dose of EHEC in a mouse model of HUS at weaning. We found sequential activation of T and B lymphocytes together with an increased percentage of IgA-bearing B cells in Peyer's patches and mesenteric lymph nodes. We also found fecal anti-EHEC IgA and serum anti-Stx2 IgG in EHEC-inoculated mice. Besides, these mice were partially protected against an intravenous challenge with Stx2. These data demonstrate that one episode of EHEC infection is enough to induce activation in the gut-associated lymphoid tissue, especially the B cell compartment, and lead to the production of specific IgA in mucosal tissue and the generation of systemic protection against Stx2 in a percentage of intragastrically inoculated mice. These data also support the epidemiologic observation that a second episode of HUS is very rare. [ABSTRACT FROM AUTHOR]

Purpose: To describe a case of bilateral sixth nerve palsy in the setting of an atypical Miller Fisher Syndrome (MFS), extremely rare in the pediatric population and barely documented in the literature Methods: We present a case of a 12‐year‐old girl who came to the emergency room for diplopia of 24 hours. She had no history of a previous infectious or febrile process, except for an episode of abdominal pain 8 days earlier. The examination revealed bilateral sixth nerve palsy. Hospital admission was decided. Two days later the clinical picture worsened, appearing swallowing difficulty, decreased strength and muscle tone in all 4 extremities. The tendon reflexes were preserved. Craniospinal MRI and lumbar puncture were normal. The electroneurogram was consistent with early stage of polyradiculoneuritis. Autoimmunity tests showed positive anti‐GT1a antibodies and negative anti‐GQ1b antibodies. Results: Based on the findings, treatment with immunoglobulin and intravenous corticosteroids was decided. Clinical resolution was progressive and the oculomotor alteration completely remitted at 2 months. Conclusions: MFS is a rare autoimmune disease characterized by the classic triad of ophthalmoplegia, ataxia, and areflexia. It is considered a variant of Guillain‐Barré syndrome. There are few cases or series of cases described in the literature on MFS and its behavior in pediatrics. Therefore, almost all clinical and laboratory findings have been described in adults, but in pediatrics, there is still uncertainty. This can lead to difficulties in the diagnosis of MFS in these patients. MFS should always be suspected in the context of acute diplopia or oculomotor paralysis in pediatrics, especially if it is bilateral; despite that its bilateral character seems to be less than in adults. Fortunately, even in these patients, it maintains its self‐limited behavior, so a full recovery is expected. Mane S, (2020) Miller Fisher in a Child. Journal of Pediatric Neurosciences. [ABSTRACT FROM AUTHOR]

Purpose: To describe the importance of applying an urgent protocol in cases of lens subluxation into the anterior chamber (AC) in order to diminish the risk of corneal decompensation. Methods: A 60‐year‐old man with a history of ocular trauma in his youth and pseudoexfoliation syndrome, presented pupillary block in the right eye 2 months after an accidental fall without ocular involvement. Visual acuity was 0.05 (decimal) and intraocular pressure was 55 mmHg. Slit lamp examination and anterior segment Optical Coherence Tomography showed a lens subluxation towards AC (lower portion) with endothelial contact and corneal edema. In funduscopy, an inferior giant tear with associated retinal detachment was observed. Results: After treating ocular hypertension with hypotensive agents, Pars Plana Vitrectomy 25 Gauge + Lensectomy + Endolaser + SF6 Tamponading gas were performed, leaving the patient in aphakia for subsequent intraocular lens implantation surgery. Two months later, a substantial loss of endothelial cell count was observed (777 cells right eye VS 2223 cells left eye). Conclusions: In this type of pathology, it is imperative to take immediate pharmacological, postural and surgical measures to reduce contact between the lens and the cornea, in order to minimize endothelial damage and improve the visual prognosis of these patients. Bibliography: Ke G, Zhou E, Zhu K, Wei Y, Wang Z, Jia Y, Wang S, Gu Y. Retinal break associated with traumatic lens dislocation or subluxation requiring vitrectomy. Graefes Arch Clin Exp Ophthalmol. 2020 Mar;258(3):693–697. doi: 10.1007/s00417‐019‐04530‐9. Epub 2019 Nov 28. PMID: 31781882. Salehi‐Had H, Turalba A. Management of traumatic crystalline lens subluxation and dislocation. Int Ophthalmol Clin. 2010 Winter;50(1):167–79. doi: 10.1097/IIO.0b013e3181c567de. PMID: 20057305. [ABSTRACT FROM AUTHOR]

Purpose: To describe an atypical case of conjunctival herpetic dendritic ulceration in an immunocompetent patient with no history of herpetic primary infection. Methods: This is a single observational case report and a review of the literature. The patient was followed in successive appointments. Results: Ocular involvement by the herpes simplex virus (HSV) in its recurrent form is characteristic for dendritic ulcers in the corneal epithelium, which are postulated to obtain this form due to the corneal nerve plexus. We describe the first case to date of an immunocompetent patient, age > 70 years and without prior immunosuppressive treatment, with a primary herpetic infection clinically diagnosed by presenting a dendritic ulcer in the bulbar conjunctiva. The patient had nonspecific corneal involvement, and the case was subsequently confirmed with polymerase chain reaction for HSV‐1. Conclusions: The presentation of a dendritic ulcer in the bulbar conjunctiva in a case of ocular herpes infection is a rare finding, and the physiopathology is unknown. It casts doubt on the theory that corneal dendritic ulcer morphology is only formed because of the corneal sub‐basal nerve plexus involvement. This suggests that conjunctiva examination is of vital importance in herpetic ocular infection, and that it can used a diagnostic methodology if no other eye conditions are found. [ABSTRACT FROM AUTHOR]

Purpose: Kearns‐Sayre Syndrome (KSS) is a congenital mitochondrial myopathy initially described by the triad: Progressive external ophthalmoplegia, pigmentary retinopathy, heart block. Surgical procedures to alleviate ptosis can cause corneal injury from exposure. The lack of blinking can lead to a difficult contraction of the muscles responsible for squeezing the meibomian glands causing their dysfunction (MGD). Therefore, the follow‐up is of special interest in those cases where we suspect KSS due to the probable appearance of complications. Methods: We present the case of a male of 9 years old who presented a sudden‐onset ptosis and bilateral internuclear ophthalmoplegia. Initially, he was diagnosed with Myasthenia. At the age of 12, resection of the elevator upper eyelid was performed in both eyes (BE). In the successive visits: negative Bell's sign, a progressive MGD and significant corneal thinning in the lower half of the BE were observed, and the right eye (RE) was affected with an infiltrated ulcer. Results: Treatment with high hydration in BE and RE was treated with antibiotics eye drops and antibiotic ophthalmic ointment. After reviewing the history and given the high suspicion of KSS, genetic tests were requested to confirm it. Maintenance treatment was settled in BE with high hydration, 20% autologous serum and therapeutic contact lens. After a year of exhaustive monthly follow‐up, the patient remains stable and there is no progression of the corneal thinning. Conclusions: It is important to take care of the ocular surface in these cases of KSS due to the corneal exposure after ptosis surgery. We must achieve stability in terms of symptoms and visual acuity without incurring other complications such as infections or perforation. [ABSTRACT FROM AUTHOR]

Purpose: To describe corneal changes after birth trauma from forceps delivery, using anterior segment optical coherence tomography (AS‐OCT), in order to reduce the risk of potential anisometropic amblyopia. Methods: A 73‐year‐old female patient came to the ocular surface section consulting for dry eye disease symptoms. At the slit lamp examination, a vertical endothelial stria was observed in the right eye. After an exhaustive anamnesis, the patient referred having a traumatic birth in which forceps had been used. Results: An AS‐OCT was performed, showing a vertical rupture in the Descemet membrane secondary to traumatic birth with forceps. Conclusions: Descemet's membrane rupture can cause corneal oedema which usually clears over time, but those ruptures often persist. The residual corneal changes can result in anisometropia and the main cause of vision loss after such injury is anisometropic amblyopia. The AS‐OCT is a useful diagnostic tool to detect these alterations at early stages. Bibliography: Sarma P, Borgohain M, Tayab S, Sangma CA. Descemet's membrane rupture secondary to forceps‐induced birth injury. Indian J Ophthalmol. 2020;68(10):2253. https://doi.org/10.4103/ijo.IJO%5f149%5f20 Alobaidy R, Srinivasan S. Forceps‐induced birth injury to the cornea. BMJ Case Rep. 2014;2014:bcr2013201786. Published 2014 Apr 9. https://doi.org/10.1136/bcr‐2013‐201786 [ABSTRACT FROM AUTHOR]

Purpose: To describe a case of interlamellar keratitis induced by elevated intraocular pressure (IOP) in a patient with a history of LASIK surgery and the importance of having a strong diagnostic suspicion for establishing adequate treatment. Methods: Intraocular pressure‐induced interlamellar keratitis is one of the potential complications of LASIK refractive surgery. The cases described generally occur a few months after surgery although there are some cases that have been described several years after surgery, usually in a context of uveitis and corticosteroid treatment or silent glaucoma. We present a case of 43‐year‐old woman who came to the emergency room with visual acuity (VA) impairment in the left eye in the setting of elevated intraocular pressure‐induced interlamellar keratitis secondary to the intravitreal corticosteroid implant in her left eye due to a diabetic retinopathy. She underwent LASIK surgery 14 years ago. Results: The treatment was based on lowering the intraocular pressure. Oral acetazolamide and topical timolol, bimatoprost and brinzolamide were used. The patient recovered her baseline VA and the IOP were properly controlled posteriorly. Conclusions: This case shows the importance of considering this diagnosis in patients with corneal haze, elevated intraocular pressure and a history of LASIK surgery to establish an adequate treatment. A full recovery is expected. Bibliography: 1. Galal A, Artola A, Belda J, (2006) Interface corneal edema secondary to steroid‐induced elevation of intraocular pressure simulating diffuse lamellar keratitis. Journal of refractive surgery. 2. Lee V, Sulewski M, Zaidi A (2010) Elevated Intraocular Pressure–Induced Interlamellar Stromal Keratitis Occurring 9 Years After Laser In Situ Keratomileusis. Corneal Journal. 3. Lyle W, Jin G, Jin Y (2003) Interface fluid after laser in situ keratomileusis. Journal of refractive surgery. 4. Tourtas T, Kopsachilis N, Meiller R, et al. (2010). Pressure‐Induced Interlamellar Stromal Keratitis After Laser In Situ Keratomileusis. Corneal Journal. [ABSTRACT FROM AUTHOR]

Long polar fimbriae ( Lpf) are intestinal adhesins and important virulence factors of pathogenic Escherichia coli strains. We cloned and sequenced the lpf2-1 operon ( lpf2ABCD ) and its flanking regions of an intimin- and Shiga toxin-negative atypical E. coli O157: H43 strain of bovine origin and also sequenced the lpf2-1 operon of six additional atypical O157 bovine E. coli strains of various serotypes. Nucleotide sequence comparison of these lpf operons showed sequence conservation as they contained only four polymorphic nucleotide positions. Investigation of these O157 strains as well as 13 E. coli Reference Collection ( ECOR) strains carrying the lpf2-1 allele revealed high degree of sequence conservation in the lpf2 flanking regions. The lpf2-1 allele is also present in a bovine Shiga toxin-producing E. coli STEC O136: H12 strain, and in vitro adherence assays revealed that the absence of lpf2-1 in this strain did not affect its host cell-binding properties. Our data indicate that lpf2 loci are highly conserved in E. coli isolates; however, its role in adherence might be masked by other uncharacterized adhesins. [ABSTRACT FROM AUTHOR]

Abstract: For comparison purposes, the prevalence of 8 virulence markers was investigated, by PCR, in 153 cattle and 47 human Locus for Enterocyte Effacement (LEE)-negative Shiga toxin-producing Escherichia coli (STEC) strains isolated in Argentina. Also, their correlation with severe disease was established. The virulence markers studied comprises 5 fimbrial and nonfimbrial adhesin-encoding genes (fimA, iha, efa1, lpfA O113, and saa) and 3 toxin genes (cdt-V, subAB and astA) in addition to the Shiga toxins. The most prevalent virulence marker found was that encoded by the lpfA O113 gene (199/200, 99%). Comparatively, the lpfA O113, fimA, iha, saa, subAB, cdt-V and astA genes were detected in 100%, 92.8%, 85%, 52.9%, 36%, 11.8% and 9.8% of the cattle strains and in 97.9%, 95.7%, 89.4%, 40.4%, 32%, 17% and 10.6% of the human strains, respectively. All STEC strains were efa1 negative. The most prevalent profile observed among cattle and human STEC strains was lpfA O113 iha fimA. These results show that bovine LEE-negative STEC strains possessed genes encoding virulence factors present in human LEE-negative STEC strains that are associated with disease. Despite a great diversity of virulence profiles observed, further studies comparing wild type strains and their allelic mutants are needed to evaluate the role of each factor in the pathogenesis of LEE-negative STEC strains during human infections. [Copyright &y& Elsevier]

We examined O157:non-H7 strains isolated from various sources and geographical locations and found 15/57 strains to carry eae alleles, including α, β, ℇ and κ/δ, suggesting that these strains may be prevalent. All strains were serologically and genetically confirmed to be O157, but none were the H7 serotype or carried any trait virulence factors of the Escherichia coli O157:H7 serotype. Genetic H typing of the eae-positive strains showed that the α- eae-bearing strain was H45, while the β- and ℇ- eae strains were H16 and the κ/δ- eae strains were H39. The β- and ℇ- eae-bearing O157:H16 strains shared ∼90% pulsed-field gel electrophoresis (PFGE) similarity and were distinct from the other strains that had other eae alleles. Interestingly, an ℇ- eae O157:H16 strain isolated from meat in France shared PFGE similarity to the O157:H16 strains from water in the United States. Multilocus sequence typing showed that there is clonal diversity within the O157 serogroup, as some O157:non-H7 strains clustered with EPEC clonal groups, while others clustered within the ST-171 group of diverse strains and serotypes that had not previously included any strains from the O157 serogroup. Clonal analysis also showed that none of the eae-positive O157:non-H7 strains we examined were closely related to the pathogenic O157:H7 serotype. [ABSTRACT FROM AUTHOR]

Abstract: We describe the isolation and characterization of Shiga toxin (Stx)-producing Escherichia coli (STEC) O157:H7 from cooked and uncooked beef and chicken burgers and from chicken carcasses collected during sampling procedures in 2001 and 2002 in Buenos Aires City, Argentina. Of the 24 STEC O157:H7 strains isolated, 20 were recovered from 19 (6.8%) out of 279 samples of beef and chicken burgers, and 4 strains from 4 (10.3%) out of 39 chicken carcasses. The samples were analyzed following the USDA/FSIS 2002 method. The prevalent stx genotype was stx 2 and stx 2c (12 strains, 50%). All strains were characterized as eae and ehxA-positive. By XbaI-PFGE, the strains yielded 10 different patterns. Eighteen out of 24 strains were grouped in four clusters: #1 (4 strains, AREXHX01.0043), #2 (4 strains, AREXHX01.0022), #3 (8 strains, AREXHX01.0139), and #4 (2 strains, AREXHX01.0200). Identical strains by phage typing, stx genotyping and PFGE were detected in uncooked and cooked beef and chicken burgers in different restaurants, which had been collected on the same or different sampling dates. These findings help to underline the importance of STEC O157 detection in meat products, to improve active surveillance, and to define control strategies in order to prevent new cases of STEC infection. [Copyright &y& Elsevier]