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Objective: Because there are few studies on the clinical implications of colonization by carbapenem-resistant gram-negative bacteria (CRB) this was analyzed in rectal smears (RS) and pharyngeals (PS) and its ability to predict infection/colonization., Methods: A cross-sectional, retrospective study from adult inpatients between January 2016 and December 2019 was conducted. The isolates were characterized by MicroScan and spectrometry of masses applying EUCAST 2018 cutoff points. The detection of carbapenemases was performed by PCR and Sanger sequencing; sequencies was assigned by MLST. The genetic relationship between the clinical isolates was made by pulsed field electrophoresis using the enzymes Xbal, Spel or Apal., Results: A total of 308 (86.03%) RS and 50 (13.97%) positive PS were detected, the RS had a 85% sensibility, 100% specificity, 100% positive predictive value and 97% negative predictive value. In RS, the following were isolated: 44% (n=135) Acinetobacter baumannii, 26% (n =80) Enterobacterales (20 KPC, 29 OXA-48, 22 VIM, 2 IMP, 7 NDM), 17% (n=53) Pseudomonas aeruginosa and 13% (n=40) Stenotrophomonas maltophilia. In the PS were isolated 44% (n=22) S. maltophilia, 40% (n = 20) A. baumannii, 8% (n=4) P. aeruginosa and 8% (n=4) Enterobacterales (3 VIM, 1 OXA). From the patients with simultaneous RS and PS, 41 (40.6%) had positivity in both smears, 45 (44.6%) only in RS and 15 (14.9%) only in PS. Colonization preceded infection in 81.3% (n=13) of the isolates; association between infection and colonization was found (p<0.001; χ2); and the episodes where the information was found all the isolates from the clinical samples and from the smears were similar., Conclusions: The probability of predicting infection through the CRB colonized in different clinical samples is feasible. The RS has a major sensibility to detect colonization., (©The Author 2021. Published by Sociedad Española de Quimioterapia. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)(https://creativecommons.org/licenses/by-nc/4.0/).)

Cases Reports: Three myopic components of a same family came for study because presented severely degraded vitreous, equatorial membranes, retinal pigment epithelium hyperplasia, vascular sheathed and sclerosis of peripheral predominance. A genetic study confirmed the diagnosis of Stickler syndrome with a variant in the mutation of the COL2A1 gene., Discussion: Stickler's syndrome should be suspected in families with a characteristic phenotype with vitreous syneresis and alterations in the retina, but there may be genetic variants that do not express the classic phenotype., (Copyright © 2017 Sociedad Española de Oftalmología. Publicado por Elsevier España, S.L.U. All rights reserved.)

Cases Reports: The cases are presented of three women of 22, 36 and 55 years old with bilateral myopic retinochoroidosis. They had unilateral decreased visual acuity, normal bilateral tonometry, and biomicroscopy. Funduscopy showed bilateral and unilateral myopic maculopathy, and Optical Coherence Tomography (OCT) showed a dome shaped macula with neurosensory detachment. Treatment was started with spironolactone and an improvement by OCT was shown in all cases., Discussion: The etiopathogenic mechanism of the dome shaped macula is discussed. OCT demonstrated to be the fundamental test in the follow-up of this condition. After the evidence shown, initial treatment with spironolactone is suggested., (Copyright © 2016 Sociedad Española de Oftalmología. Publicado por Elsevier España, S.L.U. All rights reserved.)

Case Report: 78 year-old female patient being investigated for a left orbital pseudotumour of 17 days onset. She had proptosis, pain, with no limitation of eye movements, periorbital oedema, and upper eyelid ptosis, compatible with an orbital pseudotumour. The MRI showed an upper outer left orbital mass adjacent to the side of eyeball and an increase in soft tissue at the level of lacrimal gland. The histopathology study of an eyelid lesion demonstrated the presence of non-caseating granulomas., Discussion: A definitive diagnosis of orbital sarcoidosis was made. Oral treatment with corticosteroids and methotrexate achieved gradual control of the disease., (Copyright © 2014 Sociedad Española de Oftalmología. Published by Elsevier España, S.L.U. All rights reserved.)

Case Report: A 17 year-old male patient, who since 2000 has referred to a progressive bilateral decrease in visual acuity. A "bicycle wheel" macula pattern was observed in his retina. The electroretinogram showed a decrease in the b-wave amplitude. The visual evoked potentials were normal. Optical coherence tomography showed bilateral macular edema. All this supported the diagnosis of X-linked retinoschisis., Discussion: Genetic counseling was given and the pattern of X-linked inheritance was explained. A significant improvement of the macular thickness was observed after treatment with topical dorzolamide and oral acetazolamide., (Copyright © 2011 Sociedad Española de Oftalmología. Published by Elsevier Espana. All rights reserved.)

Purpose: To report a case of complicated exposed scleral buckle in which amniotic membrane was used to repair the extremely thin sclera that showed the underlying choroid., Methods: Interventional case report. A 65-year-old man presented to our Department with severe eye pain after retinal detachment repair with scleral buckling technique 7 years ago., Results: Examination of the left eye revealed extrusion of the buckle with conjunctival and scleral erosion that allowed distinguishing the choroid. The buckle was removed and successful scleral repair was achieved through the use of amniotic membrane., Conclusion: Amniotic membrane graft is a safe and useful scleral substitute that should be considered to cover scleral defects, in the absence of infection.

Purpose: To report a case of central retinal artery occlusion (CRAO) in a patient with biopsy-verified Wegener's granulomatosis (WG) with positive C-ANCA., Methods: A 55-year-old woman presented with a 3-day history of acute painless bilateral loss of vision; she also complained of fever and weight loss. Examination showed a CRAO in the left eye and angiographically documented choroidal ischemia in both eyes., Results: The possibility of systemic vasculitis was not kept in mind until further studies were carried out; methylprednisolone pulse therapy was then started. Renal biopsy disclosed focal and segmental necrotizing vasculitis of the medium-sized arteries, supporting the diagnosis of WG, and cyclophosphamide pulse therapy was administered with gradual improvement, but there was no visual recovery., Conclusion: CRAO as presenting manifestation of WG, in the context of retinal vasculitis, is very uncommon, but we should be aware of WG in the etiology of CRAO. This report shows the difficulty of diagnosing Wegener's granulomatosis; it requires a high index of suspicion, and we should obtain an accurate medical history and repeat serological and histopathological examinations. It emphasizes that inflammation of arteries leads to irreversible retinal infarction, and visual loss may occur.

Background and Objective: The aim of the present study is to define the risk factors associated with different retinal occlusive diseases, such as retinal venous thrombosis, arterial emboli and ischaemic anterior optic neuritis. Patients with any of these entities entered the study., Patients and Method: A cross-sectional study on 284 consecutive subjects, aged 25-93, who were initially attended at the ophthalmology unit and then sent to the internal medicine unit., Results: We included 284 patients, 52% men, 48% women, aged 62+/-12 years (range 25-93). Retinal vein thrombosis was observed in 66% (IC 95%: 60.4-71.5), followed by anterior ischemic optic neuropathy in 21% (IC 95%: 16.1-25.8) and arterial embolism in 11% (IC 95 %: 7.29-14.7). Vascular risk factors were frequently recorded, especially hypertension in 50% (IC 95%: 44. 0-55.9) and metabolic syndrome in 39% (IC 95%: 33.2-44.7). Venous thrombosis showed an association with hypertension and with left ventricular hypertrophy, especially central vein thrombosis (54%, p<0.009). Among those with arterial embolism obesity was less frequently observed (p=0.04), but these patients showed significantly (p<0.001) more vascular bruits, carotideal atheromatous plaques and extraocular vascular disease. Anterior optic ischaemic neuritis was significantly associated with obesity, overweight, and diabetes. No differences were observed regarding inflammatory markers (CRP, TNF alpha, IL-6 and IL-10) among the different retinal occlusive diseases analysed., Conclusions: Occlusive retinal diseases are associated with vascular risk factors, but the association is specific for each entity., (Copyright 2008 Elsevier España, S.L. All rights reserved.)

Objective: Diabetes mellitus is considered the most common cause of blindness in the working population of industrialized countries, with diabetic macular edema being the most common cause of decreased visual acuity and proliferative diabetic retinopathy (PDR) being responsible for the most severe visual deficits. We have therefore tried to establish a guide for clinical intervention whose purpose is to provide orientation on the treatment of diabetic retinopathy and its complications. This is necessary at a time when many treatment options have emerged whose role is not yet fully defined., Method: A group of expert retina specialists selected by the SERV (Vitreous-Retina Spanish Society) assessed the published results of different treatment options currently available, suggesting lines of action according to the degree of diabetic retinopathy present and the presence or absence of macular edema., Results: PDR is primarily treated with pan-retinal photocoagulation. For clinically significant diabetic macular edema without signs of vitreomacular traction, the treatment of choice continues to be focal/grid photocoagulation. Similarly, retinovitreal surgery is indicated for both conditions. The use of antiangiogenic drugs was also analyzed but remains inconclusive., Conclusion: Laser therapy is effective in the management of diabetic retinopathy and diabetic macular edema. The role of antiangiogenics is not yet sufficiently defined.

We present general guidelines to help us with the treatment of diabetic retinopathy (DR) at a time when numerous therapeutic alternatives have been developed although their role has not yet been adequately defined. This protocol is not directed at experienced retinologists but rather at general ophthalmologists who require a practical and up to date guide of a pathology as prevalent as RD. The different therapeutic options available, and their most accepted indications depending on the degree of diabetic retinopathy that patients have, are reviewed. We propose what to do in cases of mild, moderate and severe non-proliferative diabetic retinopathy as well as in cases of proliferative diabetic retinopathy (panphotocoagulation/antiangiogenic drugs/vitreorretinal surgery). The treatment of diabetic macular edema depending on its angiographic and topographic characteristics is also discussed. The importance of metabolic control of the patient is stressed (tight glycemic control, control of arterial hypertension and dyslipemia) in aiding the treatment of diabetic retinopathy. This therapeutic proposal has been discussed widely by retinologists from the four largest hospitals in the Canary Islands, and is therefore an agreed text based on recent scientific literature.

Violence in the family setting is a serious social problem of obliged concern to all health professionals. The victims are mainly children, women and the elderly. Due to the defenselessness characterizing childhood and the requirements of Spanish law, the dentist must be aware of the magnitude of the situation in order to act in favor of the affected child. The problems encountered in this aspect comprise physical abuse, sexual abuse, physical neglect, emotional abuse and emotional neglect. Any of these problems can have irreversible consequences for the psychological and physical development of the child. A review is made of the characteristic orofacial lesions that should alert dental professionals to the possible existence of abuse, with a discussion of the approach to be adopted within the context of current legislation.

Purpose: To discover the prevalence of visual alterations in a static child population, like that of El Hierro island, and to evaluate the efficacy of having infant teachers carrying out visual screening in infants., Methods: Infant teachers tested the visual acuity of children between 3 and 5 years of age, and referred those who did not reach a previously established visual level to the Ophthalmology Department of the island's Hospital. There, a complete ophthalmological study was undertaken. Subsequently, a group of children that the teachers considered normal was also checked., Results: Of the 240 children between 3 and 5 years of age who live on the island, 205 had the visual acuity tested by teachers. It was found that 21 did not achieve the desired visual level for their age. Of these, 9 were truly pathological (6 of them were amblyopes). The other 12 were normal, ophthalmologically speaking. Of the 184 children which the teachers considered normal, 81 were studied in the ophthalmology department. Two children were found to be pathological (2.5% of false negatives), both being slightly myopic. The degree of correlation between the visual acuity taken by the teachers and by the ophthalmologists was r=0.6 and the mean difference was 0.07., Conclusions: We believe that infant teachers are a good choice for initial screening of visual abnormalities in infancy. Strategies are being discussed to diminish the high rate of false positives