IntroductionValsalva retinopathy may occur as a sudden, dramatic loss of central vision due to the premacular location of the haemorrhage. It has been described in different clinical settings, and there are several options for its treatment.Case presentationsWe present the cases of six patients with sudden visual acuity loss caused by Valsalva retinopathy, treated in our hospital in the last ten years. Case 1 involves a 32-year-old Caucasian man with a unilateral premacular haemorrhage after vomiting. A neodymium-doped yttrium aluminium garnet laser was used due to sufficient depth of the haemorrhage pocket, but it was unsuccessful. Instead, 20G pars plana vitrectomy was performed with excellent visual recuperation (visual acuity:1.0). Case 2 was of a 36-year-old Caucasian woman with Valsalva retinopathy after vomiting during pregnancy. A neodymium-doped yttrium aluminium garnet laser was also insufficient due to the coagulated blood. After labour, 23G pars plana vitrectomy was performed, and her final visual acuity was 1.0. Case 3 involved a 52-year-old Caucasian man with premacular bleeding due to vomiting after general anaesthesia. The haemorrhage did not resolve spontaneously, so 23G pars plana vitrectomy was performed, with excellent visual outcomes (visual acuity:1.0). Case 4 was a 24-year-old Caucasian man with a macular haemorrhage after thoracic trauma. He was observed over four weeks, after which we performed 23G pars plana vitrectomy, with complete visual restoration (visual acuity:1.0). Case 5 involved a 28-year-old man who developed a premacular bleed after vigorous dancing. After a period of observation, 23G pars plana vitrectomy was performed. A retinal break with a small haemorrhage around the break occurred, related to the peribulbar anaesthesia manoeuvers, but was resolved successfully. His final visual acuity was 1.0. Case 6 was a 22-year-old Caucasian woman who developed a premacular haemorrhage after weightlifting. Conservative management was performed due to the small size of her haemorrhage. It resolved spontaneously within one month, and her final visual acuity was 1.0.ConclusionValsalva retinopathy is a rare condition that causes a sudden loss of visual acuity. In patients with too dense haemorrhage, the best option could be the vitrectomy, with excellent visual outcomes, although surgery is not free of risks.

Sedimentation on reef communities at Bahías de Huatulco, Oaxaca, Mexico. Although coral reef sedimentation is important because it modifies processes like symbioses, reproduction, recruitment and coral growth, Mexican Pacific studies are lacking. On this regard, spatio-temporal variations in sedimentation rate were investigated in six coral reef communities from Oaxaca. During February 2006-January 2007 (excluding April, July and August) two sediment structures, with four sediment traps each, were randomly installed. Sediment traps were replaced with a mean periodicity of 38 days, and the sediments were washed, filtered, dried and weighted in order to calculate sedimentation rate. Sedimentation rate was heterogeneous among localities (F 5,36 = 7.06, P < 0.01). It was high at Isla Montosa (653.31 kg m -2 year -1 ) and Isla Cacaluta (450.09 kg m -2 year -1 ), intermediate at San Agustín, Jicaral-Chachacual and Dos Hermanas (155.18-92.53 kg m -2 year -1 ) and low at La Entrega (14.33 kg m -2 year -1 ). Sedimentation rate was homogeneous through time (F 7,34 = 0.85, P > 0.5); nonetheless, during the dry season (November-March) sedimentation rate in the area oscillated between 6.8-73.5 mg cm -2 day -1 , whereas during the rainy season (May-October) the values were 141-1088 % higher (74.5-147.6 mg cm -2 day -1 , Mann-Whitney U = 137, n = 42, P = 0.03). There was a significant relationship between sedimentation rate and pluvial precipitation (Spearman R = 0.83, n = 8, P = 0.009), suggesting that the amount of sediment reaching coral communities is closely tied to regional precipitation. Sedimentation rates recorded at Isla Montosa (366.64 mg cm -2 day -1 ) and Isla Cacaluta (366.03 mg cm -2 day -1 ) during the rainy season can be considered lethal-sublethal considering sediment tolerance and rejection efficiency of stony corals. The absence of coral mortality during the rainy season may result from: a) high efficiency of active sediment removal, b) increased physiological tolerance to sediments, and c) a high degree of passive sediment removal via turbulence. Nonetheless, the combined effect of natural and anthropogenic induced sedimentation may cause a shift in coral community structure and eventually a loss of the reef areas in Bahías de Huatulco. Rev. Biol. Trop. 56 (3): 1179-1187. Epub 2008 September 30.

Introduction Spontaneous closure of traumatic macular holes is described as a common event in the peer-reviewed literature. However, the spontaneous closure of stage III and IV full-thickness idiopathic macular holes has been reported in less than 15 cases in the literature, this being an extremely rare event, with their reopening being even more infrequent. We report a case of a spontaneous closure of stage IV idiopathic full-thickness macular hole and late reopening as a lamellar macular hole. Case presentation A 67-year-old Spanish man was referred to our hospital with a complaint of decreased vision in his right eye and metamorphopsia for approximately 11 months. He did not report any trauma. Diagnosis was based on fundoscopic and optical coherence tomography. They revealed a stage IV full-thickness idiopathic macular hole and a small epiretinal membrane. Three months later the hole spontaneously closed, and two years later we appreciated its reopening as a lamellar macular hole. Conclusions The contraction of the epiretinal membrane could have contributed to cystic spaces and their fusion, subsequently, to the formation of a lamellar macular hole. To the best of our knowledge this is the first report in the literature of a spontaneously closed full-thickness idiopathic macular hole with reopening as a partial thickness macular defect.

We discuss the case of a 17-year-old male who at the age of 7 was diagnosed with celiac disease (CD) together with ulcerative colitis (UC) and primary sclerosing cholangitis (PSC). The patient was treated with gluten-free diet and immunosuppressive drugs (azathioprine), and currently remains asymptomatic. The patient's younger, 12-year-old sister was diagnosed with CD when she was 1.5 years old, and at 7 years she developed type-I diabetes mellitus, which was difficult to control. A family study was made, and both parents were found to be affected with silent CD. All were DQ2 (+). In relation to the case and family study, we provide a series of comments related to CD and its complications.

Using the National Notifiable Disease Surveillance System (NNDSS) and Minimum Basic Data Set (MBDS) for hospital discharges we evaluated pulmonary tuberculosis (PTB) surveillance and estimated real PTB incidence and human immunodeficiency virus (HIV) coinfection in Seville in 1998. In addition, we assessed the sensitivity and the positive predictive value (PPV) of the surveillance system. Real incidence of pulmonary tuberculosis was estimated by the capture-recapture method. In 1998, the province of Seville reported 225 cases of pulmonary tuberculosis to the NNDSS, an incidence of 13.2 per 100,000 population. Of the 225 cases reported, 18.2% presented with HIV coinfection, while a total of 194 had confirmed diagnoses. The MBDS accounted for 106 new cases. Of these, 24.8% presented with HIV coinfection and were 58% less likely to be reported to the NNDSS (25-76%, p = 0.001). Applying the capture-recapture method, 426 cases were estimated, an overall incidence of 25.6 per 100,000 population (21.5-28.8). Completeness for each source was similar (47%), and for both jointly was 72.7%. The NNDSS had a sensitivity of 65.3% and a PPV of 89.3%. In conclusion, the NNDSS underestimates PTB and PTB-HIV coinfection in Seville. The high incidence observed in young adults suggests a high degree of tuberculosis endemicity. Hospital records provide a readily accessible, low-cost means of estimating disease incidence.

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Background: The COVID-19pandemic has significantly impacted the dental sector worldwide.Methods: The impact of the pandemic on dentistsfrom Latin America was investigated by an online survey with professionals working in 11 Spanish-speaking countries in September–December 2020. The invitations were sent to registered professionals. An open campaign was promoted on social media. The questions investigated dental care routines, work practice changes, andfeelings about the pandemic, in addition toreasons for engaging in furthersurveys.Descriptive statistics were used to identify frequencies and distributions of variables. Proportions were compared using chi-square tests.Results: A total of 2,127 responses were collected from a samplewith diverse demographic, sex, work, and education characteristics. The impact of the pandemic was considered high/very high by 60% of respondents.The volume of patients assisted weekly was significantly lower compared with the pre-pandemic period (mean reduction=14 ±15 patients). A high rate of fear to contracting the COVID-19 at work was observed (85%); 4.9% of participants had a positive COVID-19 test. The mask most frequently worn was PFF2/N95 (42%). The main professional challenges faced by respondents were reduction in the number of patientsor financial gain (35%), fear of contracting COVID-19 (34%), and burden with or difficulty in purchasing new PPE (22%).The fear to contracting COVID-19 was influenced by the number of weekly appointments. A positive test by the dentists was associated with their reports of having assisted COVID-19 patients. The most cited feelings about the pandemic were uncertainty, fear, worry, anxiety, and stress. When asked about incentives to participating in further surveys, the most common responses were receiving articles that originated from the investigation (44%)and priority access to research data (15%). Conclusion:This multi-countrysurvey indicated a high impact of the pandemic on dental care routines in Latin American offices.