Notes

COVID-19-induced Guillain-Barre Malady: An uncommon Complications regarding SARS-CoV-2 Infection.
The Ambulatory Clinic for Cataract Surgery (CACC) is a public department of the Bourges Medical Center, with a fast-track protocol without perioperative anesthesia care launched in 2015. This study aimed to evaluate the benefits of the CACC in terms of access to cataract surgery.

This retrospective study included all patients undergoing cataract surgery between 2012 and 2018. Data were collected from the French PMSI database. In order to evaluate the impact of the CACC, the surgical activity and change in indicators of patient flow and usage, as well as clinical and economic factors were analyzed.

Between 2012 and 2018, with the same number of ophthalmologists, surgical activity increased by 50.2% in the Cher (vs. a mean increase of 22.7% in France). The patient loss ratio decreased by 5.9 points, the attraction and self-sufficiency ratios increased by 2.3 and 8.6 points respectively. The standardized rate of healthcare utilization for cataract surgery increased by 4.3 points (from 11.6 to 15.9 surgeries per 1000 inhabitants). As a result, Cher became the second highest French Department in 2018 in terms of utilization rate despite its 96th place out of 109 Departments in terms of density of ophthalmologists.

The ambulatory cataract surgery center without anesthesia for selected patients might represent a solution in medical deserts to improve access to cataract surgery without increasing costs.
The ambulatory cataract surgery center without anesthesia for selected patients might represent a solution in medical deserts to improve access to cataract surgery without increasing costs.Regression after corneal refractive surgery is a complex phenomenon which seems inevitable. The choice of surgical technique has very little influence on regression for low myopia or myopic astigmatism. However, LASIK and SMILE are the two techniques of choice in the correction of high myopia. LASIK is also better for the correction of hyperopia, hyperopic astigmatism and mixed astigmatism. Intraoperatively, the choice of a wide optical zone and adherence to a thick residual stromal bed provide stability. Regression may also be reduced by modulating anti-inflammatory therapy, treating dry eye, and using mitomycin C in PKR. In all cases, obtaining keratometry during patient follow-up helps to identify the cause of the regression. The objective of this review is to synthesize recent data from the literature on regression in refractive surgery as a function of the ablation profiles used.
Intraocular lens (IOL) calculation and biometry have evolved significantly in recent decades. However, present outcomes are still suboptimal. Our objective is to summarize the results reported in the literature with regard to a new variable, the value of the relationship between anterior and posterior corneal curvature in the biometric calculation of IOL power.

We have created a narrative revision of the existing evidence regarding the posterior to anterior corneal curvature ratio in IOL calculation.

The corneal posterior/anterior ratio (P/A ratio), also called Gullstrand ratio, has a standard deviation of 2.4% in normal people, hence causing a possible IOL power miscalculation error of up to 0.75 diopters (D). This error is magnified in pathological corneas or in those with previous refractive surgery. Including the P/A ratio in the IOL formula reduces errors in the calculation of IOL power.

Measurement of the posterior corneal surface should be recommended prior to IOL calculation, given the demonstrated results regarding the P/A ratio for IOL power calculation. Regarding toric IOL calculation, we suggest incorporation of all internal astigmatic vectors, for instance, posterior corneal surface, IOL tilt induced toricity, and retinal astigmatism. All of these factors may improve surgical outcomes.
Measurement of the posterior corneal surface should be recommended prior to IOL calculation, given the demonstrated results regarding the P/A ratio for IOL power calculation. Regarding toric IOL calculation, we suggest incorporation of all internal astigmatic vectors, for instance, posterior corneal surface, IOL tilt induced toricity, and retinal astigmatism. All of these factors may improve surgical outcomes.Alternative polyadenylation (APA)-associated genetic variants have been proposed to impact diverse human phenotypes and disorders. In a recent study, Li et al. established a landscape of 3'-untranslated region (UTR) APA quantitative trait loci (3'aQTLs) across multiple human tissues, revealing substantial 3'aQTLs that contribute to complex human traits and diseases.Recently, few reports have described a serious condition linked to SARS-CoV-2 that mimics Kawasaki disease called Multisystem inflammatory syndrome, especially in children (MIS-C) and young adults. In this work, we report on a severe form of MIS in a young female adult previously infected by SARS-CoV-2. She was treated by plasmapheresis with albumin and steroids, however outcome was fatal. We discuss the pathogenesis of this rare and life threatening entity and suggest some therapeutic regimen. This syndrome should not be misdiagnosed with an infectious or a drug induced cutaneous rash in the current context of COVID-19 pandemic.Exudative retinal detachment (ERD) is a rare complication that occurring in 1% of patients with preeclampsia, its incidence is increased when it is associated with HELLP syndrome. Preeclampsia is defined by the development of arterial hypertension and proteinuira occurs after 20 weeks of gestation until postpartum. HELLP syndrome (low platelets, hemolysis and elevated liver enzymes) is a severe form of preeclampsia. MEK inhibitor ERD in preeclampsia is related to choroidal ischaemia, in the vast majority of the cases associated with hypertensive retinopathy. However, it has been proposed that the combination of hypertension with a microangiopathic hemolysis, hipercoagulability and hypoalbuminemia are the main factors contributing to the development of ERD. Its treatment includes a rapid resolution of labor to reverse ocular manifestations and prevent visual sequels. We describe the case of a pregnant woman with atypical preeclampsia who, in the postpartum of a cesarean, presented an ERD concomitantly with a HELLP syndrome.Remote intracranial hemorrhage (ICH) is a rare but dreaded complication after spinal surgery. The physiopathology of this phenomenon is closely related to a loss of cerebrospinal fluid (CSF) after an incidental durotomy during spine surgery. The most common remote ICH location is cerebellar, but few articles report intraventricular hemorrhage. Its clinic is associated with cerebral hypotension due to decreased CSF, mainly headache, dysarthria, hemiparesis, an impaired level of awareness and seizures. The diagnosis of remote ICH after a non-cranial surgery can be a challenge to anesthesiologists, this pathology should be suspected face an immediate neurological deterioration after anesthetic awakening. Non-specific symptoms make it difficult to identify the origin of intracranial hemorrhagic from other differential diagnoses. We present a patient with an impaired level of awareness and seizures who suffered a hemorrhage in the right ventricle with cerebral and cerebellar edema in the immediate postoperative period after spinal surgery.Thrombotic microangiopathies (TMA) are a group of clinical syndromes associated with haemolytic anaemia, thrombocytopenia and organ dysfunction, mainly renal or neurological. They are associated with significant morbidity and mortality, so early diagnosis and treatment are essential. In this article we report two cases of TMA; a patient with thrombotic thrombocytopenic purpura (TTP) and a patient with atypical haemolytic uraemic syndrome (aHUS).
The disease COVID-19 produces serious complications that can lead to cardiorespiratory arrest. Quality cardiopulmonary resuscitation (CPR) can improve patient prognosis. The objective of this study was to evaluate the performance of the specialty of Anaesthesiology in the management of CPR during the pandemic.

A survey was carried out with Google Forms consisting of 19 questions. The access link to the questionnaire was sent by email by the Spanish Society of Anesthesia (SEDAR) to all its members.

225 responses were obtained. The regions with the highest participation were Madrid, Catalonia, Valencia and Andalusia. 68.6%% of the participants work in public hospitals. 32% of the participants habitually work in intensive care units (ICU), however, 62.1% have attended critical COVID-19 in the ICU and 72.6% have anesthetized them in the operating room. 26.3% have attended some cardiac arrest, 16.8% of the participants admitted to lead the manoeuvres, 16.8% didn't participate in the CPR, and 66.2% was part of the team, but did not lead the assistance. Most of the CPR was performed in supine, only 5% was done in prone position. 54.6% of participants had not taken any course of Advance Life Support (ALS) in the last 2 years. 97.7% of respondents think that Anaesthesia should lead the in-hospital CPR.

The specialty of Anesthesiology has actively participated in the care of the critically ill patient and in the management of CPR during the COVID-19 pandemic. However, training and/or updating in ALS is required.
The specialty of Anesthesiology has actively participated in the care of the critically ill patient and in the management of CPR during the COVID-19 pandemic. However, training and/or updating in ALS is required.The life-saving discovery of insulin in Toronto in 1921 is one of the most impactful achievements in medical history, at the time being hailed as a miracle treatment for diabetes. The insulin molecule itself, however, is poorly amenable as a pharmacological intervention, and the formidable challenge of optimizing insulin therapy has been ongoing for a century. We review early academic insights into insulin structure and its relation to self-association and receptor binding, as well as recombinant biotechnology, which have all been seminal for drug design. Recent developments have focused on combining genetic and chemical engineering with pharmaceutical optimization to generate ultra-rapid and ultra-long-acting, tissue-selective, or orally delivered insulin analogs. We further discuss these developments and propose that future scientific efforts in molecular engineering include realizing the dream of glucose-responsive insulin delivery.
Shigella is the second leading cause of diarrhoeal mortality especially in children <5 years of age in African and Asian countries. Rapid changes are occurring in the epidemiology of shigellosis and Shigella are increasingly becoming highly drug resistant. To determine the serogroup distribution and antimicrobial resistance of Shigella isolated at our tertiary care centre in North India.

A retrospective study was conducted where demographic details along with antimicrobial susceptibility data of Shigella isolated from stool specimens from 1
January 2015 till 31
December 2019 were retrieved from records and analyzed by WHONET 2019 software.

Shigella species was isolated in 1.31% (n = 137) of a total of 10,456 stool samples. Males predominated (n = 82; 59.8%) and majority of cases were admitted (n = 94; 68.6%). Children ≤5 years of age (n = 47; 34.3%) were the most commonly affected. Adults in the 21-40 age group contributed 27% of cases (n = 37). Overall, Shigella flexneri (n = 87; 63.5%) was the most common serogroup followed by non-agglutinable Shigella (n = 28; 20.
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