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The aim of this work was to assess the tolerability, safety, and efficacy of an ophthalmic topical formulation containing helenalin from Arnica montana and hyaluronic acid 0.4% (HA) in patients with mild-to-moderate Dry Eye Disease (DED) exhibiting positive Matrix Metalloproteinase 9 (MMP-9) test results. Tolerability and safety were evaluated in 24 healthy subjects. Participants were instructed to apply one drop of the formulation three times a day in the study eye, for 2 weeks, followed by a clinical follow-up of 21 days. Efficacy was studied in 48 DED patients randomized into Study (Group 1/receiving the studied formulation) or Control (Group 2/Receiving HA 0.4% eye lubricant) groups for 1 month. Assessments included an MMP-9 positivity test, conjunctival impression cytology (CIC), Ocular Surface Disease Index (OSDI), non-invasive film tear breakup time (NIBUT), non-invasive average breakup time (NIAvg-BUT), ocular surface staining, Schirmer's test, and meibomiography. A crossover design with an additional 1-month follow-up was applied to both groups. Healthy subjects receiving the studied formulation exhibited good tolerability and no adverse events. Regarding the efficacy study, Group 1 exhibited a statistically significant reduction in the MMP-9 positivity rate compared to Group 2 (p < 0.001). Both Group 1 and Group 2 exhibited substantial improvements in OSDI and NIBUT scores (p < 0.001). However, Group 1 demonstrated a significant improvement in NI-Avg-BUT and Schirmer's test scores (p < 0.001), whereas Group 2 did not (p > 0.05). Finally, after the crossover, the proportion of MMP-9-positive subjects in Group 1 increased from 25% to 91.6%, while Group 2 showed a significant decrease from 87.5% to 20.8%. Overall, the topical formulation containing sesquiterpene helenalin from Arnica montana and hyaluronic acid was well tolerated and exhibited a favorable safety profile. Our formulation reduces DED symptomatology and modulates the ocular surface inflammatory process; this is evidenced by the enhancement of CIC, the improvement of DED-related tear film status, and the reduction of the MMP-9 positivity rate.

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Study design: Technical note. Purpose: To provide a technical description of the placement of Gardner-Wells tongs and the performance of awake cranio-cervical traction to reduce AO type C injuries of the sub-axial cervical spine with Gardner-Wells tongs. Methods: In this technical note, the authors present the indications, the contraindications, the pull-out of the pins, a detailed description of the technique for its proper placement, traction reduction technique, reduction maneuvers, complications and post-reduction care. Results: Awake reduction of AO type C injuries of the sub-axial cervical spine can be successfully performed using Gardner-Wells tongs. Conclusions: There is sufficient evidence to recommend the use of cranio-cervical traction in these vertebral injuries; however, we lack a detailed technical note to guide its proper placement.

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Ophthalmic drug delivery to the posterior segment of the eye has been challenging due to the complex ocular anatomy. Intravitreal injection of drugs was introduced to deliver therapeutic doses in the posterior segment. Different posterior segment diseases including age-related macular degeneration, diabetic macular edema, retinal vein occlusions, uveitis, and cystoid macular edema, among others, have been historically treated with intravitreal corticosteroids injections, and more recently with intravitreal corticosteroids drug implants. Triamcinolone acetonide (TA) is the most frequently used intraocular synthetic corticosteroid. Using nanoparticle-based TA delivery systems has been proposed as an alternative to intravitreal injections in the treatment of posterior segment diseases. From these novel delivery systems, topical liposomes have been the most promising strategy. This review is oriented to exhibit triamcinolone acetonide drug evolution and its results in treating posterior segment diseases using diverse delivery platforms.

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Background: Citrobacter koseri, a Gram-negative organism, rarely causes an epidural spinal abscess. Case Description: A 50-year-old male presented with mild paraparesis attributed to an magnetic resonance (MR)-documented spinal epidural abscess (SEA) at the T10-level. Following surgical debridement, cultures grew C. koseri, a rare Gram-negative organism. The abscess was subsequently managed with a prolonged course of antibiotics resulting in complete symptom and MR-documented radiological resolution. Conclusion: A 50-year-old male presented with a T10 SEA attributed to a rare Gram-negative organism, C. koseri. The abscess was appropriately managed with surgical decompression/debridement, followed by prolonged antibiotic therapy.

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The human ocular surface hosts a bacterial assemblage that integrates a diverse and complex microbiome. This bacterial microbiota is part of a healthy eye and plays a protective role in it. However, this ocular bacterial assemblage may alter the ocular surface inflammation response and can influence the development and progression of dry eye disease. For this reason, the present review describes the changes generated on the ocular surface by bacterial assemblages during the development of dry eye disease. Likewise, the interaction of this microbiota with the other inflammatory factors that influence the development of this disease is analyzed, as well as the use of treatments focused on modifying the bacteria on the ocular surface.

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Resumen OBJETIVO: Valorar el tratamiento a largo plazo del dolor pélvico con levonorgestrel en mujeres con endometriosis que desean posponer el embarazo y preservar su fertilidad. MATERIALES Y MÉTODOS: Estudio ambispectivo, con intervención medicamentosa, longitudinal y descriptivo de serie de casos. Parámetros de estudio: medición de la intensidad del dolor a los 12, 24 y 36 meses posteriores a la colocación de un implante único de goserelina (Zoladex de 10,6 mg, AstraZeneca AB, Gärtunavägen). Al retorno de la menstruación se colocó un dispositivo intrauterino con levonorgestrel (Mirena Bayer AG, Leverkusen). La intensidad del dolor pélvico se midió con la Escala Numérica del Dolor (Escala ENA). RESULTADOS: Se estudiaron 14 pacientes de las que 5 refirieron dolor: 4 con intensidad 1 y una con intensidad 3. El resto de las pacientes no refirió dolor. Todas las pacientes refirieron alivio general subjetivo a los 12 meses de seguimiento. CONCLUSIONES: El levonorgestrel administrado por vía intrauterina puede ser una alternativa para mantener, a largo plazo, sin dolor a pacientes con endometriosis que desean posponer el embarazo. Para confirmar lo aquí encontrado hacen falta estudios controlados, con asignación al azar y con un tamaño de muestra realmente representativo.

Abstract OBJECTIVE: To assess the long-term treatment of pelvic pain with levonorgestrel in women with endometriosis who wish to postpone pregnancy and preserve their fertility. MATERIALS AND METHODS: Ambispective study, with drug intervention, longitudinal and descriptive case series. Study parameters: measurement of pain intensity at 12, 24 and 36 months after placement of a single goserelin implant (Zoladex 10.6 mg, AstraZeneca AB, Gärtunavägen). At the return of menstruation, an intrauterine device containing levonorgestrel (Mirena Bayer AG, Leverkusen) was inserted. The intensity of pelvic pain was measured with the Numerical Pain Scale (NPS). RESULTS: Fourteen patients were studied of whom five reported pain: four with intensity 1 and one with intensity 3. The rest of the patients reported no pain. All patients reported subjective general relief at 12 months follow-up. CONCLUSIONS: Levonorgestrel administered intrauterine may be an alternative for the long-term pain-free treatment of patients with endometriosis who wish to postpone pregnancy. Controlled, randomized studies with a truly representative sample size are needed to confirm the findings.

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Background: This study correlated the extent of spinal canal compression from retropulsed traumatic burst cervical, thoracic, and lumbar spine fractures with the severity of neurological dysfunction. Methods: One hundred and sixty-nine patients with cervical, thoracic, or lumbar sub-axial traumatic burst fractures were seen in an emergency department from 2019 to 2021; 79.3% were men, averaging 37 years of age. The lumbar spine was most frequently involved (42%), followed by the thoracic (36.1%) and cervical (21.9%) levels. The extent of spinal canal compression was quantitated utilizing Hashimoto's method, and correlated with patients' extent of neurological injury based on their American Spinal Injury Association scores. Results: There was a positive correlation between the extent of cervical and thoracic spinal cord compression due to retro pulsed burst fragments and the severity of the patients' neurological deficits, but this was not true for the lumbar spine. Conclusion: The extent of spinal cord compression from retropulsed cervical and thoracic traumatic burst fractures was readily correlated with the severity of patients' neurological dysfunction. However, there was no such correlation between the extent of cauda equina compression from retropulsed lumbar burst fractures and the severity of their cauda equina syndromes.

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Background: Surgical wound complications represent an important risk factor, particularly in multilevel lumbar fusions. However, the literature regarding optimal wound closure techniques for these procedures is limited. Methods: We performed an online survey of 61 spinal surgeons from 11 countries, involving 25 different hospitals. The study included 26 neurosurgeons, 21 orthopedists, and 14 residents (Neurosurgery - 6 and orthopedics 8). The survey contained 17 questions on demographic information, closure techniques, and the use of drainage in posterior lumbar fusion surgery. We then developed a "consensus technique." Results: The proposed standardized closure techniques included: (1) using subfascial gravity drainage (i.e., without suction) with drain removal for <50 ml/day or a maximum duration of 48 h, (2) paraspinal muscle, fascia, and supraspinous ligament closure using interrupted-X stitches 0 or 1 Vicryl or other longer-lasting resorbable suture (i.e., polydioxanone suture), (3) closure of subcutaneous tissue with interrupted inverted Vicryl 2-0 sutures in two planes for subcutaneous tissue greater >25 mm in depth, and (4) skin closure with simple interrupted nylon 3-0 sutures. Conclusion: There is great variability between closure techniques utilized for multilevel posterior lumbar fusion surgery. Here, we have described various standardized/evidence-based proven techniques for the closure of these wounds.

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Man's attitudes about the environment have generated irreversible damage to the planet, emerging as an alternative to this problem Environmental Education, which aims to reorient social awareness towards a friendly and thoughtful culture. Through environmental education, we seek to make people aware of the problems of the natural and social environment from their school education in childhood to generate values, new attitudes, behaviors, and beliefs aimed at caring for the environment and learning new relationships between people. Likewise, to carry out these environmental education strategies, it is important to know some specific parameters, such as biological diversity and conservation, in addition to the conservation policies carried out by each nation. In this sense, in this work a bibliometric study was carried out based on high-impact scientific production and stipulated by ScienceDirect related to Environmental Education during a period of the last 20 years. The results were grouped into five clusters: "Environmental Education" OR "Education for Sustainable Development" OR "Education for Sustainability" OR "Education for Climate Change" OR "Eco citizenship". The union of all these clusters are connected and intertwined with each other. Them in a dependent way, which is a consequence of the study carried out(AU)

Las actitudes del hombre sobre el medio ambiente han generado daños irreversibles al planeta, surgiendo como alternativa para esta problemática la Educación Ambiental, que tiene como finalidad reorientar la conciencia social hacia una cultura amigable y reflexiva. Mediante la educación ambiental se busca concientizar a las personas sobre los problemas del ambiente natural y social desde su formación escolar en la niñez para generar valores, nuevas actitudes, comportamientos y creencias orientadas al cuidado del medio ambiente y el aprendizaje de nuevas relaciones entre las personas. Asimismo, para lleva a cabo estas estrategias de educación ambiental, es importante conocer algunos parámetros específicos, como la diversidad biológica y conservación, además de las políticas propias de conservación llevada a cabo por cada nación. En ese sentido, en este este trabajo se realizó un estudio bibliométrico basado en la producción científica de alto impacto y estipuladas por ScienceDirect relacionados con la Educación Ambiental durante un periodo de los últimos 20 años. Los resultados fueron agrupados en cinco clustes: "Environmental Education" OR "Education for Sustainable Development" OR "Education for Sustainability" OR "Education for Climate Change" OR "Eco citizenship". La unión de todos estos clústers se encuentran conectados y entrelados entre ellos de manera dependiente, lo cual es consecuencia del estudio realiz(AU)

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By December 2019, multiple cases of unexplained pneumonia were reported in some hospitals in the city of Wuhan, China. Since then, it had been confirmed that it corresponded to an acute respiratory infection caused by a new coronavirus that spread quickly, becoming pandemic in a very short time. On the other hand, this pandemic forced confinement for months, something unprecedented. In that time, millions of people went online for entertainment, education, etc. Consequently, the use of the Internet increased, bringing, on the one hand, online education, and entertainment on the Internet, ensuring social distancing; and on the other hand, it brought new new risks to human life, among them rumors. In this way and given the large number of publications that could denote the level of misinformation about COVID-19 and the impact it could have on global public health, various scientific publications were analyzed and identified from a bibliometric point of view. Potential relationships between the descriptors obtained from the bibliometric search were identified. The results were conglomerated into 5 clusters: Cluster 1, related to studies on access to information provided on COVID-19; cluster 2 shows the list of studies that have been carried out on the information on the COVID-19 vaccine, cluster 3 analyzes the different responses given by conspiracy theories, rumors and misinformation about COVID-19, the Group 4 shows cross-sectional and longitudinal research on COVID-19 and the information it provides to the health sector, and cluster 5 represents studies on scientific production and communication that have contributed to global health during the pandemic(AU)

Para diciembre de 2019, se registraron múltiples casos de una neumonía inexplicables en algunos hospitales de la ciudad de Wuhan, China. Desde ese momento se había confirmado correspondía a una infección respiratoria aguda causada por un nuevo coronavirus que se propagó rápidamente haciéndose pandémico en muy poco tiempo. Por otra parte, esta pademia obligó a un confinamiento por meses, algo sin precedente. En ese tiempo, millones de personas se conectaron en línea para entretenimiento, educación, etc. En consecuencia, el uso de Internet aumentó trayendo, por una parte, educación online y entretenimiento en Internet asegurando el distanciamiento social; y por otra parte, trajo nuevos nuevos riesgos a la vida humana, entre ellos los rumores. En ese sentido, y ante la gran cantidad de publicaciones que podrían denotar el nivel de desinformación sobre el COVID-19 y el impacto que podría tener en la salud pública mundial, se analizaron e identificaron diversas publicaciones científicas desde el punto de vista bibliométrico. Se identificaron las relaciones potenciales entre los descriptores arrojados de la búsqueda bibliométrica. Los resultados se conglomeraron en 5 clúster: El clúster 1, relacionado con los estudios sobre el acceso a la información proporcionada sobre COVID-19; el clúster 2, muestra la relación de los estudios que se han realizado sobre la información de la vacuna COVID-19, el clúster 3, analiza las distintas respuestas que dan las teorías conspirativas, los rumores y la desinformación sobre el COVID-19, el grupo 4 muestra investigaciones transversales y longitudinales sobre el COVID-19 y la información que brinda al sector salud, y el clúster 5 representa los estudios sobre producción y comunicación científicas que han contribuido a la salud mundial durante la pandemia(AU)

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