Calcium dynamics and associated temporal patterns of milk constituents in early-lactation multiparous Holsteins

At the onset of lactation, calcium (Ca) homeostasis is challenged. For the transitioning dairy cow, inadequate responses to this challenge may result in subclinical hypocalcemia at some point in the postpartum period. It has been proposed that dynamics of blood Ca and the timing of subclinical hypocalcemia allow cows to be classified into 4 Ca dynamic groups by assessing serum total Ca concentrations (tCa) at 1 and 4 days in milk (DIM). These differing dynamics are associated with different risks of adverse health events and suboptimal production. Our prospective cohort study aimed to characterize the temporal patterns of milk constituents in cows with differing Ca dynamics to investigate the potential of Fourier-transform infrared spectroscopic (FTIR) analysis of milk as a diagnostic tool for identifying cows with unfavorable Ca dynamics. We sampled the blood of 343 multiparous Holsteins on a single dairy in Cayuga County, New York, at 1 and 4 DIM and classified these cows into Ca dynamic groups using threshold concentrations of tCa (1 DIM: tCa <1.98 mmol/L; 4 DIM: tCa <2.22 mmol/L) derived from receiver operating characteristic curve analysis based on epidemiologically relevant health and production outcomes. We also collected proportional milk samples from each of these cows from 3 to 10 DIM for FTIR analysis of milk constituents. Through this analysis we estimated the milk constituent levels of anhydrous lactose (g/100 g of milk and g/milking), true protein (g/100 g of milk and g/milking), fat (g/100 g of milk and g/milking), milk urea nitrogen (mg/100 g of milk), fatty acid (FA) groups including de novo, mixed origin, and preformed FA measured in grams/100 g of milk, by relative percentage, and grams/milking, as well as energy-related metabolites including ketone bodies and milk-predicted blood nonesterified FA. Individual milk constituents were compared among groups at each time point and over the entire sample period using linear regression models. Overall, we found differences among the constituent profiles of Ca dynamic groups at approximately every time point and over the entire sample period. The 2 at-risk groups of cows did not differ from each other at more than one time point for any constituent, however prominent differences existed between the milk of normocalcemic cows and the milk of the other Ca dynamic groups with respect to FA. Over the entire sample period, lactose and protein yield (g/milking) were lower in the milk of at-risk cows than in the milk of the other Ca dynamic groups. In addition, milk yield per milking followed patterns consistent with previous Ca dynamic group research. Though our use of a single farm does limit the general applicability of these findings, our conclusions provide evidence that FTIR may be a useful method for discriminating between cows with different Ca dynamics at time points that may be relevant in the optimization of management or development of clinical intervention strategies.

Patterns of Fourier-transform infrared estimated milk constituents in early lactation Holstein cows on a single New York State dairy

Cows undergo immense physiological stress to produce milk during early lactation. Monitoring early lactation milk through Fourier-transform infrared (FTIR) spectroscopy might offer an understanding of which cows transition successfully. Daily patterns of milk constituents in early lactation have yet to be reported continuously, and the study objective was to initially describe these patterns for cows of varying parity groups from 3 through 10 d postpartum, piloted on a single dairy. We enrolled 1,024 Holstein cows from a commercial dairy farm in Cayuga County, New York, in an observational study, with a total of 306 parity 1 cows, 274 parity 2 cows, and 444 parity ≥3 cows. Cows were sampled once daily, Monday through Friday, via proportional milk samplers, and milk was stored at 4°C until analysis using FTIR. Estimated constituents included anhydrous lactose, true protein, and fat (g/100 g of milk); relative % (rel%) of total fatty acids (FA) and concentration (g/100 g of milk) of de novo, mixed, and preformed FA; individual fatty acids C16:0, C18:0, and C18:1 cis-9 (g/100 g of milk); milk urea nitrogen (MUN; mg/100 g of milk); and milk acetone (mACE), milk β-hydroxybutyrate (mBHB), and milk-predicted blood nonesterified fatty acids (mpbNEFA) (all expressed in mmol/L). Differences between parity groups were assessed using repeated-measures ANOVA. Milk yield per milking differed over time between 3 and 10 DIM and averaged 8.7, 13.3, and 13.3 kg for parity 1, 2, and ≥3 cows, respectively. Parity differences were found for % anhydrous lactose, % fat, and preformed FA (g/100 g of milk). Parity differed across DIM for % true protein, de novo FA (rel% and g/100 g of milk), mixed FA (rel% and g/100 g of milk), preformed FA rel%, C16:0, C18:0, C18:1 cis-9, MUN, mACE, mBHB, and mpbNEFA. Parity 1 cows had less true protein and greater fat percentages than parity 2 and ≥3 cows (% true protein: 3.52, 3.76, 3.81; % fat: 5.55, 4.69, 4.95, for parity 1, 2, ≥3, respectively). De novo and mixed FA rel% were reduced and preformed FA rel% were increased in primiparous compared with parity 2 and ≥3 cows. The increase in preformed FA rel% in primiparous cows agreed with milk markers of energy deficit, such that mpbNEFA, mBHB, and mACE were greatest in parity 1 cows followed by parity ≥3 cows, with parity 2 cows having the lowest concentrations. When measuring milk constituents with FTIR, these results suggest it is critical to account for parity for the majority of estimated milk constituents. We acknowledge the limitation that this study was conducted on a single farm; however, if FTIR technology is to be used as a method of identifying cows maladapted to lactation, understanding variations in early lactation milk constituents is a crucial first step in the practical adoption of this technology.

Limited Diagnostic Utility of Alpha Defensin in the Diagnosis of Periprosthetic Joint Infection

Introduction/Objective

A key component of laboratory stewardship is appropriate test utilization. We evaluated the utility of alpha defensin (AD), a synovial fluid biomarker, in the diagnosis of periprosthetic joint infection (PJI). Since PJI remains a diagnostic challenge in the orthopedic community, the Musculoskeletal Infection Society (MSIS) created the PJI score, a point-based criteria to help risk stratify the likelihood of infection. The score includes AD, synovial fluid white blood cell count, synovial fluid percent neutrophils, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). AD is a specialized test which adds substantial cost to the evaluation of PJI .The purpose of this study was to investigate the diagnostic utility of the PJI score with AD and without AD (routine laboratory testing of serum and synovial fluid).

Methods/Case Report

Retrospective chart review was completed on 222 patients with suspected PJI identified at Geisinger Health between January 2019 – March 2021. Data was retrieved through Geisinger’s Phenomic and Analytics Data Core and imported into Excel and JMP v.12 for analysis. All available components of MSIS diagnostic criteria were collected for each patient.

Results (if a Case Study enter NA)

Of the 222 patients with AD testing, 81% of results were negative (n=178) and 19% results were positive (n=44). AD results corresponded with synovial fluid white blood cell count in 96 % of patients (213/ 222). All components of the PJI diagnostic criteria were collected in 69% of the patients (157/222). Diagnostic criteria calculated without AD showed 43% infected (68/157), 37% possibly infected (58/157), and 20% infected (31/157). Diagnostic criteria calculated with AD showed 43% infected (68/157), 35% possible infected (55/157), and 22% infected (34/157). PJI score including AD compared to PJI score excluding AD showed similar correlation (R2 = 0.93).

Conclusion

It was found that AD testing does not provide substantial diagnostic value in the evaluation of PJI. Synovial fluid cell count was found to directly correlate with alpha defensin suggesting it’s potential use as a surrogate marker for clinical decision making. Diagnostic criteria obtained through routine testing of serum (ESR, CRP) and synovial fluid (WBC, percent neutrophils) provides sufficient data for diagnosis.

Evaluation of indeterminate SARS-CoV-2 results with repeat testing on an alternative platform

Introduction/Objective

Accurate SARS-CoV-2 results are crucial for patient management and infection prevention. Result confidence decreases with low viral load because near the assay’s limit of detection (LOD), test results may alternate between positive and negative, as characterized by Poisson distribution for target analytes at low density. Low positive results may indicate past infection, early infection, a vaccinated individual with low level viral shed, or a false-positive result. EUA methods provide guidance on test interpretation, but laboratories should assess clinical accuracy. The purpose of this study was to assess clinical accuracy of specimens with low positive results.

Methods/Case Report

Respiratory specimens were tested by Cepheid Xpert® Xpress SARS-CoV-2 assay with positive results up to a Ct of 45. A low positive (defined as Ct ≥35), which could not be confirmed by Hologic Aptima® SARS-CoV-2 assay was reported as indeterminate and repeat testing recommended. Repeat testing occurred by Cepheid, Hologic, BioFire, Roche, or Quest assays. Retrospectively, final results were extracted from the LIS (Epic Beaker, Madison, WI, version May 2020) for 5-months (12/1/2020 to 5/31/2021), and chart review performed.

Results (if a Case Study enter NA)

A total of 19,969 tests were performed; 10.4% (n=2,083) were positive, 89% (n=17,728) negative, and 0.79% (n=158) indeterminate. Previous infection (up to 3 months prior) was documented in 18% (n=28) of indeterminate results and defined as true positive. Of remaining indeterminate results, 43% (n=68) had repeat testing as recommended by laboratory; 26% (n=18) were positive and 74% (n=50) were negative. The average number of days between indeterminate and negative result was 7.25 (range 1-38).

Conclusion

Result discordance occurred in < 1% of all samples, excellent agreement. For low positive samples, discordance was higher, as expected. It’s impossible to determine if negative results from the 50 repeat samples were false-positive by Cepheid or false-negative by other methods. In summary, 32% (50/158) of indeterminant samples did not repeat as positive. Overall concordance was high and results fluctuate when low virus is present. In absence of symptoms, we conclude repeat testing is not routinely recommended. Laboratories must recognize that normal variability occurs near assay LOD and must critically assess performance against other methods with similar LODs to fully assess performance of EUA methods.

Lipoxin A4 inhibits UV radiation-induced skin inflammation and oxidative stress in mice

BACKGROUND

Lipoxin A4 (LXA4) is a metabolic product of arachidonic acid. Despite potent anti-inflammatory and pro-resolution activities, it remains to be determined if LXA4 has effect on ultraviolet (UV) radiation-induced skin inflammation.

OBJECTIVE

To investigate the effects of systemic administration with LXA4 on UV radiation-induced inflammation and oxidative damage in the skin of mice.

METHODS

Varied parameters of inflammation and oxidative stress in the skin of mice were evaluated after UV radiation (4.14 J/cm2).

RESULTS

Pretreatment with LXA4 significantly inhibited UV radiation-induced skin edema and myeloperoxidase activity. LXA4 efficacy was enhanced by increasing the time of pre-treatment to up to 72 h. LXA4 reduced UV radiation-induced skin edema, neutrophil recruitment (myeloperoxidase activity and LysM-eGFP+ cells), MMP-9 activity, deposition of collagen fibers, epidermal thickness, sunburn cell counts, and production of pro-inflammatory cytokines (TNF-α, IL-1β, IL-6 and IL-33). Depending on the time point, LXA4 increased the levels of anti-inflammatory cytokines (TGF-β and IL-10). LXA4 significantly attenuated UV radiation-induced oxidative damage returning the oxidative status to baseline levels in parameters such as ferric reducing ability, scavenging of free radicals, GSH levels, catalase activity and superoxide anion production. LXA4 also reduced UV radiation-induced gp91phox [nicotinamide adenine dinucleotide phosphate (NADPH) oxidase 2 (NOX2) subunit] mRNA expression and enhanced nuclear factor erythroid 2-related factor 2 (Nrf2) and its downstream target enzyme nicotinamide adenine dinucleotide (phosphate) quinone oxidoreductase (Nqo1) mRNA expression.

CONCLUSION

LXA4 inhibited UV radiation-induced skin inflammation by diminishing pro-inflammatory cytokine production and oxidative stress as well as inducing anti-inflammatory cytokines and Nrf2.

Efficacy of Cerebrolysin in the reduction of spasticity during stroke rehabilitation

AIM

This study assessed the efficacy of Cerebrolysin on post-stroke spasticity, motor recovery, and global functions in an outpatient rehabilitation setting.

METHODS

In this retrospective comparison study, Cerebrolysin was administered at a daily dosage of 10 ml for over 30 days as an intramuscular injection. Control patients did not receive Cerebrolysin. All the patients participated in a standardized physical and occupational rehabilitation therapy for one month at least two times per week. Efficacy was assessed at day 30 by using the Modified Ashworth Scale (MAS) for spasticity and the Manual Muscle Testing (MMT) for motor recovery. Global function was assessed by the modified Rankin Scale (mRS) at day 30.

RESULTS

A total of 50 patients were eligible for participation according to the inclusion and exclusion criteria. Of these, 23 patients were treated with Cerebrolysin and 27 patients represented the control group. No significant group differences were observed at baseline. Patients treated with Cerebrolysin experienced a significant reduction of spasticity in muscles of the upper and lower limbs, whereas only minor changes were observed in the control group. In the Cerebrolysin group, differences were statistically significant at day 30. Significant improvements of muscle strength and global functions were observed in both groups at day 30. Cerebrolysin was safe and well tolerated.

CONCLUSION

Cerebrolysin had a beneficial effect on post-stroke spasticity in an outpatient rehabilitation setting; intramuscular treatment for over 30 days was safe and well tolerated.

Natriuretic effect of equol

A furosemide-sensitive Na-K-Cl cotransporter (NKCC2 isoform) accounts for almost all luminal NaCl reabsorption in the thick ascending limb of Henle's loop (TALH). The activity of this transport protein is regulated by humoral factors known as cotransport inhibitory factors. One family of these compounds is represented by the urinary phytoestrogens equol and genistein, which inhibit cotransport fluxes at concentrations similar to furosemide. Moreover, they possess salidiuretic potency similar to furosemide in the isolated perfused rat kidney, but are less potent than furosemide (in vivo). Thus, dietary phytoestrogens can be responsible, at least in part, for the low blood pressure of vegetarians.

Managed care in three states: experiences of low-income African Americans and Hispanics

This article examines the experiences of low-income, nonelderly Hispanics, African Americans, and whites in managed care (MC), and compares them to their racial/ethnic counterparts enrolled in fee-for-service (FFS) health plans. Survey findings from Florida, Tennessee, and Texas show that MC and FFS enrollees do not differ substantially on most access and satisfaction measures, with a few notable exceptions. When compared with their FFS counterparts, African-American MC enrollees are twice as likely to report problems in obtaining needed care, and Hispanic MC enrollees are nearly twice as likely to rate the extent to which their providers care about them as "fair" or "poor." In contrast, whites in MC are less likely to be without a regular provider than their FFS counterparts, but report greater dissatisfaction with the extent to which providers care about them.

Public health departments adapt to Medicaid managed care

Millions of Medicaid beneficiaries have recently moved into private managed care plans across the country. Public health departments--which have acted as providers of primary care and other services for some Medicaid patients--are often not explicitly included in contracts between these designated Medicaid plans and the states. As a result, many of the 3,000 city and county public health agencies nationwide have lost both patients and significant revenue to plans. This Issue Brief describes how public health departments are adapting to this shift in state policy. According to our research conducted in 1997, many are de-emphasizing the delivery of direct health care services in favor of core public health functions, such as investigating community health problems and health promotion. Some are initiating new partnerships with Medicaid managed care plans.

Salidiuretic action by genistein in the isolated, perfused rat kidney

The urinary isoflavonoid genistein inhibits membrane Na-K-Cl cotransporters at similar concentrations as furosemide, but the significance of this action is unknown. Genistein was therefore investigated in rats for its potential salidiuretic actions. In the isolated, perfused rat kidney, genistein induced a maximal salidiuretic action similar to that of furosemide but was 3 to 5 times less potent than furosemide in terms of active doses (natriuresis EC50, 237+/-92 versus 56+/-20 micromol/L for genistein and furosemide, respectively). Genistein and furosemide had no additive salidiuretic actions. Genistein had no significant effect on glomerular filtration rate but was able to significantly reduce renal vascular resistance with respect to vehicle isolated perfused kidney. Indomethacin (10 micromol/L), a blocker of prostaglandin biosynthesis, reduced salidiuresis and renal vasorelaxation by genistein. Subcutaneous genistein (15 mg/kg) induced a statistically significant increase in diuresis and natriuresis with respect to vehicle during the first 6 hours of administration in rats. In conclusion, genistein compares well with furosemide in vitro for its salidiuretic profile and potency in the isolated perfused rat kidney and is also natriuretic by the subcutaneous route in the rat. Further studies are required to investigate potential natriuretic and perhaps hypotensive actions of dietary genistein.

Renal and vascular actions of equol in the rat

BACKGROUND

The urinary isoflavonoid equol inhibits membrane Na-K-Cl cotransporters at similar concentrations to those at which furosemide inhibits them, but the significance of this action is not known.

OBJECTIVE

To investigate the potential salidiuretic and vascular actions of equol in the rat.

METHODS

Renal functioning was assessed in vitro in the isolated perfused kidney and in vivo in conscious rats. The vascular contractility of isolated aorta was assessed.

RESULTS

In the isolated perfused kidney equol was concentrated 50- to 70-fold in the urinary fluid, it was 3-4 times less potent than furosemide at increasing diuresis, natriuresis and kaliuresis (the difference was due to its higher protein-binding affinity), and it induced a modest but significant increase in glomerular filtration rate. In vivo, orally administered equol was a modest natriuretic agent, about 8-fold less potent than orally administered furosemide (in molar terms). In isolated aortic rings precontracted by administration of phenylephrine, administration of equol relaxed the contracted aorta at 10-fold lower concentrations (concentration for half-maximal activity 58.9 +/- 16 micromol/l, n = 3) than did furosemide (concentration for half-maximal activity 633 +/- 145 micromol/l, n = 3).

CONCLUSIONS

Equol is a modest natriuretic and vasorelaxant agent in the rat. Further studies are required in order to investigate the potential natriuretic and perhaps hypotensive actions of dietary equol precursors (daidzein).

Purification and chemical characterization of a potent inhibitor of the Na-K-Cl cotransport system in rat urine

A potent inhibitor of the Na-K-Cl cotransport system was purified from urines of salt-loaded rats. Mass spectroscopy revealed a molecular mass of 242 Da. Nuclear magnetic resonance showed a spectrum identical to that of 3,4-dihydro-3-(4-hydroxyphenyl)-2H-1-benzopyran-7-ol (an "estrogen-like" isoflavonoid: equol). This compound inhibited cotransport fluxes at similar concentrations (IC50=16-24 microM) as furosemide (IC50 approximately 10 microM). Cotransport inhibitory activity of urines from rats drinking tap water was fully explained by urinary equol concentrations (approximately 27 microM, measured by high-performance liquid chromatography). Slat-loading increased urinary equol excretion, but not sufficiently high to fully explain the very important increase in cotransport inhibitory potency. We conclude that: (i) under basal conditions urinary equol can regulate Na-K-Cl cotransport activity in the kidney and (ii) salt-loading should evoke the appearance of other cotransport inhibitors.

Film oxygen transmission rate effects on ground chicken meat quality

Effects of the packaging film oxygen transmission rate (OTR) on the odor, color, aerobic plate count, and cooked volatile compounds in ground chicken leg meat were evaluated over a 14-d refrigerated storage (4 C) period. Freshly desinewed and ground chicken leg meat was packaged under minimal vacuum in five films of different OTR. Films ranged from 30 to 12,000 mL oxygen/m2 per 24 h. Odor scores of meat in packages opened after 10 d were lower for the lowest OTR film than films with higher OTR. Aerobic plate counts increased at a faster rate in the higher OTR films, and cooked meat volatile profiles showed little variation due to OTR film type. Specific products will require different packaging to optimize shelf-life quality. For ground chicken leg meat, an intermediate OTR film is best to maintain a majority of the quality attributes during refrigerated storage.

The effects of ultrapasteurization with and without homogenization on the chemical, physical, and functional properties of aseptically packaged liquid whole egg

The effects of ultrapasteurization with and without homogenization on some chemical, physical, and functional properties of liquid whole egg were observed. Heat treatments of 64, 68, and 72 C each at 30, 60, and 95 s were conducted on liquid whole egg, unhomogenized and homogenized [10.34 mPa (1,500 psi)]. The viscosity of the egg increased with increased processing temperature, and unhomogenized egg was more viscous than homogenized egg. alpha-Amylase was inactivated at 68 C for 30 s. Although cake height was highly correlated to soluble protein content, this relationship did not hold for all time-temperature combinations. Due to homogenization effects on soluble protein results, soluble protein is not a reliable predictor of egg functionality when homogenization is used in the process. Homogenization had no effect on the population reduction of aerobic bacteria in all but three of the nine time-temperature combinations.

[Cutaneous microcirculation in systemic sclerosis. Morpho-functional research using capillaroscopy and laser-Doppler]

Our previous researches proved that, in patients affected by Raynaud disease, microcirculatory alterations were greater in those cases in which the small vessels showed evocative appearances of a sclerodermatous connectivopathy. In this study we evaluated cutaneous microvasculature in 18 patients suffering from clear systemic sclerosis, compared with a group of 16 subjects affected by primitive Raynaud disease and a group of healthy subjects. We used videocapillaroscopy and laser-Doppler fluxmetry for morphological and functional study respectively. In patients affected by systemic sclerosis the rest flow was clearly reduced and morphological pattern of cutaneous small vessels deranged. The response to ischemic test allowed us to subdivide the skin-bounds in two subgroups: "no responders" 8 subjects (44%), in which reactive hyperaemia was completely absent, "responders" 10 patients (56%) in which the hyperaemia was completely overlapped with that of the two other groups, but with longer reaction times. In skinbounds the capillaroscopic pattern was clearly severe in comparison with other two groups (18.8 +/- 5.7 vs 5.7 +/- 2.3 and 3.6 +/- 1). Thus, in advanced stage of the pathology, is microangiopathy (in its tromboischemic and inflammatory aspects) that plays a very important role in the development of organ damage. Therefore, all those clinical and instrumental tests which may allow a differential early diagnosis between a primitive and a secondary Raynaud phenomenon be done, for its prognostic value in connection with the appearance of systemic sclerosis.

Latina and African American women: continuing disparities in health

Women of all races have faced incredible challenges as they sought to realize the promises of America. For women of color, these challenges were compounded by the second-class citizenship of U.S. racial and ethnic minority population groups. In an effort to assess the quality of life experienced by Latina and African American women, this article provides descriptive information on racial/ethnic differences in women's social conditions, health status, exposure to occupational and environmental risks, and use of health services. When possible, indices are stratified by family income to limit the effects of social class on the comparison of racial differences. The authors provide evidence that Latina and African American women are more likely than nonminority women to encounter social environments (e.g., poverty, densely populated neighborhoods, hazardous work conditions) that place them at risk for ill-health and injury. Although persistent racial disparities in health are often attributed to the lifestyle behaviors of racial minority populations, they are undoubtedly a consequence of poorer social conditions as well as barriers in access to quality health services. To achieve further gains, public policies must reduce social inequalities (i.e., by gender, race, and social class) and assure greater equity in access to resources that facilitate healthier environments and lifestyles. Public health initiatives should be community-based, reflecting a shared partnership that actively engages minority women in decision-making about their lives.

Who won't tell: predictors of refusal to report number of sex partners

Data from 1475 respondents to a telephone survey are used to examine whether those who refused to report the number of their sex partners in the 12-month period prior to the interview are more likely to engage in HIV risk behaviours than those who did report this number. Logistic regression shows that refusal is associated with being single of low education (OR(adj) = 8.0, 95% CI 2.7-23.7), using condoms in the last year (OR(adj) = 4.2, 95% CI 1.6-11.1), self-reporting of HIV-risk behaviours (OR(adj) = 3.6, 95% CI 1.3-9.6), and being male (OR(adj) = 2.7, 95% CI 1.1-6.6). These associations apply only to a subsample of individuals who provided complete information for HIV risk and other related behaviours. Results from the total sample indicate that individuals in our study who did not report their number of partners are more likely to have characteristics that are compatible with a higher probability of HIV risk practices. This pattern of associations suggests that refusers are indeed at higher risk for HIV infection than those sexually active individuals who did report the number of partners.

Cutaneous circulation in Raynaud's phenomenon during emotional stress. A morphological and functional study using capillaroscopy and laser-Doppler

In order to assess the effects of emotional stress on the cutaneous microcirculation in patients suffering from Raynaud's phenomenon (RP) a group of 18 patients with this pathology and 16 healthy control subjects underwent an "arithmetical test". The microcirculatory response was examined using a laser Doppler apparatus. The results obtained showed a constantly reduced flow during mental stress in normal subjects; in the RP group it was possible to observe: a first subgroup with a reduced flow similar to that seen in normal subjects, and a second subgroup with a paradoxically increased flow. It is likely that the normal vasoconstrictor response is the expression of the functional impairment of the microcirculation alone (primary RP), whereas vasodilatation in response to mental stress is a sign, of the organic development of the disease right from an early stage.

Intramuscular onchocercoma. Case report

Onchocerciasis is characterized by the presence of numerous microfilariae in the skin, formation of subcutaneous nodules and eye lesions that can lead to blindness. We present a case, rather uncommon in our environment, in which an incomplete life cycle of the parasite, led to a single intramuscular nodule. The clinical symptoms and histological features are described, together with the treatment, using Ivermectin.

[Argon laser trabeculoplasty in simple glaucoma]

In June 1984 the authors started a prospective study on the treatment of open-angle glaucoma with argon laser trabeculoplasty. The technique used was to treat 180 degrees of the anterior nonpigmented part of the trabecular meshwork with 80 to 100 burns. For retreatment the posterior pigmented part of the trabecular meshwork was coagulated with 80 to 100 burns. The burns were always applied to the pretreated half of the meshwork. At present the study includes 47 eyes treated posteriorly. Of these cases 12 eyes required retreatment. Five eyes had previously undergone an unsuccessful trabeculectomy. The preliminary results are satisfactory. The average reduction in intraocular pressure was 5.9 mm Hg; the mean intraocular pressure before therapy was 23 mm Hg. In 8 cases the trabeculoplasty failed, making a fistulating procedure necessary. The treatment was always well tolerated and there were only minor side effects which never led to any lasting damage.

[Change in corneal refractive power following artificial lens implantation]

Report on the changes in the corneal refractive power of 284 eyes surgically treated for cataract, in which an IOL had been implanted. The mean corneal refractive power of the eyes was 43.31 +/- 1.43 D preoperatively and 43.39 +/- 1.46 D postoperatively (16th week). The postoperative astigmatism of 215 eyes in which a PCL had been implanted after ECCE was not higher than 1.1 +/- 1.1 D in the 16th postoperative week after selected removal of the nylon sutures. This study demonstrates that there is no statistically significant change in the mean corneal refractive power after cataract surgery with IOL implantation.

Stereoselective total synthesis of (±)-isocostic and (±)-3-oxoisocostic acids

Stereoselective total synthesis of the title compounds, two new sesquiterpenes isolated from a Mexican plant, are described. The key step in the synthesis is based on classical santon in syntheses by the stereoselective Michael addition of the potassium salt of ethyl α-cyanoacetate to the dienone(4), to give the cis adduct (5), in an 8 : 2 ratio with the trans isomer. Further appropriate transformation of this cis adduct (5) leads to formation of either isocostic acid (1) or 3-oxoisocostic acid (2).