Fatal Budd-Chiari syndrome associated with Hemodialysis Reliable Outflow (HeRO) graft.

Population aging and prolonged time on dialysis pose challenges to vascular access for nephrologists and vascular surgeons. HeRO grafts are an option used for patients with central venous obstruction and without the possibility of other vascular access on upper limbs. Some long-term complications, namely access thrombosis, infection, and limb ischemia, have already been reported. There are few data on thromboembolic complications associated with this device. We report the first case in the literature of Budd-Chiari Syndrome associated with the HeRO graft.

Distanciamento social na covid-19: análise dos casos de violência sexual em um municipio de triplice fronteira durante a pandemia / Social distancing in covid-19: analysis of sexual violence in a municipality of triplice border during the pandemic / Distancia social en covid-19: análisis de casos de violencia sexual en un municipio triplical transfronterizo durante pandemia

Durante a pandemia da COVID-19, o distanciamento social e a quarentena tiveram um impacto significativo no aumento do número de casos de violência sexual. Embora essas medidas tenham sido essenciais para conter a propagação do vírus, elas também criaram um ambiente propício para o aumento da violência doméstica e sexual. Este estudo teve como objetivo identificar o perfil dos casos de violência sexual notificados no município de Foz do Iguaçu durante o período da pandemia da Covid-19 (2020 a 2022). Trata-se de uma pesquisa transversal, descritiva e exploratória de caráter quantitativo, realizado com as fichas de notificação compulsória dos casos de violência sexual, da vigilância epidemiológica do município de Foz do Iguaçu-PR, durante os anos de 2020 a 2022. Identificou-se predomínio de violência sexual no sexo feminino, com idade entre 1 a 15 anos. O primeiro trimestre de 2020 e 2021 tiveram maiores números de registros. Os agressores em sua maioria foram conhecidos, padrastos e o pai. A maioria dos casos ocorreram na própria residência. O distanciamento social e a quarentena criaram condições propícias para o aumento desses casos, colocando as vítimas em situações de maior vulnerabilidade e limitando seu acesso a recursos de apoio.

During the COVID-19 pandemic, social distancing and quarantine have had a significant impact on the increase in the number of cases of sexual violence. While these measures have been essential to contain the spread of the virus, they have also created an environment conducive to increased domestic and sexual violence. This study aimed to identify the profile of cases of sexual violence reported in the municipality of Foz do Iguaçu during the COVID-19 pandemic period (2020 to 2022). This is a cross- sectional, descriptive and exploratory survey of a quantitative nature, carried out with the compulsory notification sheets of cases of sexual violence, the epidemiological surveillance of the municipality of Foz do Iguaçu-PR, during the years 2020 to 2022. A predominance of sexual violence was identified in the female sex, aged between 1 and 15 years. The first quarter of 2020 and 2021 had higher numbers of registrations. The aggressors were mostly known, stepfathers and father. Most of the cases occurred at home. Social distancing and quarantine have created favorable conditions for the increase in such cases, placing victims in situations of greater vulnerability and limiting their access to support resources.

Durante la pandemia COVID-19, el distanciamiento social y la cuarentena tuvieron un impacto significativo en el aumento del número de casos de violencia sexual. Aunque estas medidas eran esenciales para contener la propagación del virus, también creaban un entorno favorable para el aumento de la violencia doméstica y sexual. El objetivo de este estudio fue identificar el perfil de violencia sexual reportada en el municipio de Foz do Iguaçu durante el periodo de pandemia Covid-19 (2020-2022). Se trata de un estudio transversal, descriptivo y exploratorio de carácter cuantitativo, realizado con las fichas obligatorias de notificación de violencia sexual, la vigilancia epidemiológica del municipio de Foz do Iguaçu-PR durante los años 2020-22. El predominio de la violencia sexual se identificó en el sexo femenino, de edades comprendidas entre 1 y 15 años. El primer trimestre de 2020 y 2021 tuvo un mayor número de registros. Los agresores en su mayoría eran conocidos, padrastro y padre. La mayoría de los casos ocurrieron en casa. El distanciamiento social y la cuarentena han creado las condiciones para aumentar esos casos, situando a las víctimas en situaciones de mayor vulnerabilidad y limitando su acceso a los recursos de apoyo.

Crenças sobre a doença em famílias com doença crónica pediátrica: Estudo preliminar da versão portuguesa do instrumento Iceland-Family Illness Beliefs Questionnaire / Illness beliefs in families with pediatric chronic diseases: Preliminar study of the portuguese version of the iceland-family illness beliefs questionnaire instrument

A doença crónica apresenta-se como uma doença de longa duração e, geralmente, com progressão lenta, que exige cuidados médicos continuados ao longo dos anos. Apresentando-se a doença crónica pediátrica como uma problemática crescente, centenas de crianças ou adolescentes, bem como as suas famílias, sofrem, todos os dias, com os efeitos que esta doença apresenta no seu quotidiano. Reconhecendo que a adaptação à doença crónica não é determinada apenas pelos aspetos clínicos da patologia, mas também por outras variáveis como as crenças acerca da doença, torna-se imperativo o estudo das crenças da família sobre a doença. O presente estudo é parte integrante do projeto internacional denominado "Integração da doença crónica pediátrica: Estudo longitudinal internacional" e apresenta como objetivos traduzir para o português de Portugal, adaptar culturalmente e estudar as propriedades psicométricas do instrumento Iceland-Family Illness Beliefs Questionnaire (ICE-FIBQ), caracterizar as crenças sobre a doença em famílias de crianças ou adolescentes com doença crónica e estudar a associação existente entre as crenças sobre a doença em famílias de crianças com doença crónica, a perceção de saúde e a perceção familiar de suporte oferecido pelos profissionais de saúde. Trata-se de um estudo do tipo quantitativo, transversal e descritivo correlacional, apresentando, ainda, um carácter metodológico. Participaram no estudo 135 pais de crianças ou adolescentes portadores de uma ou mais doenças crónicas, acompanhados nas consultas externas de três instituições hospitalares do Norte do país. O questionário é composto por duas partes, sendo que a primeira apresenta questões de caracterização sociodemográfica e clínica e a segunda parte integra os instrumentos Iceland-Family Illness Beliefs Questionnaire e Iceland-Family Perceived Support Questionnaire. Para o estudo da estrutura da versão portuguesa do ICE-FIBQ procedeu-se a uma análise fatorial exploratória que revelou a existência de dois fatores com consistência interna satisfatória, Fator 1 (α de Cronbach = 0.69) e Fator 2 (α de Cronbach = 0.67). A ICE-FIBQ demonstrou que os pais das crianças ou adolescentes com doença crónica apresentam uma boa convicção acerca das suas crenças. O estudo da associação entre as crenças da família e o suporte percebido revelou uma correlação positiva baixa, significativa, entre as variáveis (r=0.21, p<0.05). Este estudo sugere que a versão portuguesa do instrumento ICE-FIBQ é um instrumento válido e fiel para avaliar as crenças sobre as doenças das famílias portuguesas, porém, existe a necessidade de se proceder ao estudo da validação através de uma amostra de maiores dimensões que permita a análise fatorial confirmatória e o teste-reteste

The chronic disease is a long-lasting and generally slow-progressing illness that requires continuous medical care over the years. Since pediatric chronic disease is a growing problem, hundreds of children or adolescents and their families suffer every day with the effects that this disease has on their daily lives. Recognizing that the adaptation to chronic disease is not only determined by the clinical aspects of the pathology, but also by the beliefs of children or adolescents and their families, the study of family illness beliefs becomes imperative. This study, which is part of the international project "Integration of pediatric chronic disease: International longitudinal study", aims to translate into Portuguese, culturally adapt and study the psychometric properties of the Iceland-Family Illness Beliefs Questionnaire (ICE-FIBQ) instrument, assess illness beliefs in families of children with chronic disease and evaluate the correlation between illness beliefs in families of children with chronic disease and the family perception of support offered by health professionals. This is a quantitative, cross-sectional, and descriptive correlational study, also presenting a methodological component. The study included 135 parents of children or adolescents with one or more chronic diseases, who were followed-up in the outpatient consultations of three hospital institutions in the North of Portugal. The questionnaire applied in the study is divided into two parts: the first part presents questions on sociodemographic and clinical characterization and the second part is composed of the data collection instruments Iceland-Family Illness Beliefs Questionnaire and Iceland-Family Perceived Support Questionnaire. To study the structure of the portuguese version of the ICE-FIBQ, an exploratory factor analysis was carried out, which revealed the existence of two factors with satisfactory internal consistency, Factor 1 (Cronbach's α = 0.69) and Factor 2 (Cronbach's α = 0.67). ICE-FIBQ has shown that parents of children or adolescents with chronic illness have a good conviction about their beliefs. The study of the association between family beliefs and perceived support revealed a low, significant positive correlation between the variables (r=0.21, p<0.05). This study suggests that the Portuguese version of the ICE-FIBQ instrument is a valid and faithful instrument to assess the beliefs about diseases of Portuguese families, however, there is a need for confirmatory factor analysis and test-retest using a larger sample

Distribution of genetically characterized yeasts and its antifungals susceptibility in the hospital environment.

Candida spp. is one of the main pathogens associated with nosocomial infection in Brazil and worldwide. The aim of this study was to evaluate the distribution of Candida yeasts in the ICU and their susceptibility to the antifungal agents terbinafine and fluconazole. The samples were collected by swabbing nine surfaces in the ICU of a hospital located in Pelotas, RS. These isolates were genetically characterized by sequencing the internal transcript spacer (ITS) using the primers ITS1 and ITS4. The test against antifungals was performed by Microdilution in Broth (CLSI-M27-A4). 64 yeasts identified as Candida parapsilosis (45.31%; n = 29), Meyerozyma (Pichia) guilliermondii (28.12%; n = 18), Claviceps lusitaneae (25%; n = 16) and Candida tropicalis (1, 56%; n = 1) mostly at the counter used for handling medicines and food distribution (68.75%; n = 44). Susceptibility to antifungals varied between species. These results describe potentially pathogenic Candida species as contaminants in the ICU environment. The study environment is a potential source of exogenous infection for hospitalized patients.

The Learning Incubator: an innovative teaching and learning technology in nursing.

OBJECTIVE: To understand the meaning of the Learning Incubator as a teaching and learning technology in the nursing area. METHOD: Qualitative research, supported by grounded theory. Data was collected from March to November 2019, through interviews with guiding questions and hypotheses directed at two different groups. The analysis was done by comparative data analysis and included open, axial and integrated coding, as proposed by the method. The theoretical sample included 23 participants, which were nurses, technicians, and nursing students. RESULTS: The delimitation of the categories converged in the phenomenon (Re)signifying knowledge and practices in the Learning Incubator. Guided by the paradigmatic model, the categories were named according to the three following components: Condition: Recognizing that the being and the professional practice are inextricable; Action/interaction: Revisiting professional practices that are repetitive and mechanic; Consequence: Referring to the reflections and knowledge constructed in the Learning Incubator. CONCLUSION: The Learning Incubator, as seen by the study participants, is not limited to the Incubator meetings or the themes addressed in it. Beyond a welcoming physical space, the Incubator expands itself and becomes a tool that promotes self-reflection and self-assessment of professional behaviors and attitudes.

Amblyopia screening effectiveness at 3-4 years old: a cohort study.

OBJECTIVE: To study the effectiveness of amblyopia screening at ages 3-4. METHODS AND ANALYSIS: From a population with no previous screening, a cohort of 2300 children with 3-4 years old attending school (91% of children this age attend school in Portugal), were submitted to a complete ophthalmological evaluation. Amblyopia was diagnosed, treated and followed. Amblyopia prevalence, treatment effectiveness, absolute risk reduction (ARR), number needed to screen (NNS) and relative risk reduction (RRR) were estimated. RESULTS: Past/present history of amblyopia was higher than 3.1%-4.2%, depending on amblyopia definition normatives. Screening at age 3-4, had estimated ARR=2.09% (95% CI 1.50% to 2.68%) with a reduced risk of amblyopia in adulthood of 87% (RRR). NNS was 47.8 (95% CI 37.3 to 66.7). Treatment effectiveness of new diagnosis was 88% (83% if we include children already followed). 91% of new amblyopia diagnoses were refractive (of which 100% surpassed amblyopia Multi-Ethnic Pediatric Eye Disease Study criteria after treatment), while most strabismic amblyopias were already treated or undertreatment. Only 30% of children with refractive amblyopia risk factors that were not followed by an ophthalmologist, ended up having amblyopia at age 3-4. Eye patch was needed equally in new-diagnosis versus treated-earlier refractive amblyopia. CONCLUSIONS: Screening amblyopia in a whole-population setting at age 3-4 is highly effective. For each 48 children screened at age 3-4, one amblyopia is estimated to be prevented in the future (NNS). Screening earlier may lead to overdiagnosis and overtreatments: Treating all new diagnosis before age 3-4 would have a maximal difference in ARR of 0.3%, with the possible burden of as much as 70% children being unnecessary treated before age 3-4.Involving primary care, with policies for timely referral of suspicious/high-risk preverbal children, plus whole screening at age 3-4 seems a rational/effective way of controlling amblyopia.

The Learning Incubator: an innovative teaching and learning technology in nursing / Incubadora de Aprendizaje: tecnología innovadora de enseñanza y aprendizaje en la enfermería / Incubadora de Aprendizagem: tecnologia inovadora de ensino e aprendizagem na enfermagem

ABSTRACT Objective: To understand the meaning of the Learning Incubator as a teaching and learning technology in the nursing area. Method: Qualitative research, supported by grounded theory. Data was collected from March to November 2019, through interviews with guiding questions and hypotheses directed at two different groups. The analysis was done by comparative data analysis and included open, axial and integrated coding, as proposed by the method. The theoretical sample included 23 participants, which were nurses, technicians, and nursing students. Results: The delimitation of the categories converged in the phenomenon (Re)signifying knowledge and practices in the Learning Incubator. Guided by the paradigmatic model, the categories were named according to the three following components: Condition: Recognizing that the being and the professional practice are inextricable; Action/interaction: Revisiting professional practices that are repetitive and mechanic; Consequence: Referring to the reflections and knowledge constructed in the Learning Incubator. Conclusion: The Learning Incubator, as seen by the study participants, is not limited to the Incubator meetings or the themes addressed in it. Beyond a welcoming physical space, the Incubator expands itself and becomes a tool that promotes self-reflection and self-assessment of professional behaviors and attitudes.

RESUMEN Objetivo: Comprender el significado de la Incubadora de Aprendizaje como tecnología de enseñanza e instrucción en enfermería. Método: Es una investigación cualitativa basada en la teoría fundamentada en los datos, los cuales se recopilaron entre marzo y noviembre de 2019 mediante entrevistas compuestas por preguntas orientadoras e hipótesis dirigidas a dos grupos diferentes. Se consideró la técnica del análisis comparativo de los datos, a partir de la codificación abierta, axial e integral, propuesta por el método, llegando al muestreo teórico con 23 participantes enfermeros, técnicos y estudiantes de enfermería. Resultados: La delimitación de las categorías convergió en el fenómeno, (Re)significar el conocimiento y las prácticas a través de la Incubadora de Aprendizaje. A partir del modelo paradigmático, las categorías se denominaron en función de tres componentes: Condición: Reconocer la inseparabilidad entre el ser y el hacer profesional; Acción/interacción: Revisar las posturas profesionales rutinarias y mecanicistas; Consecuencia: Remitirse a las reflexiones y conocimientos construidos en la Incubadora de Aprendizaje. Conclusión: La Incubadora de Aprendizaje, tal y como la entienden los participantes del estudio, no se reduce al momento de la Incubación ni a los temas tratados. Además de ser un espacio acogedor, la incubadora se expande y se traduce en una herramienta que induce a la autorreflexión y a la autoevaluación de actitudes y posturas profesionales.

RESUMO Objetivo: Compreender o significado da Incubadora de Aprendizagem como tecnologia de ensino e aprendizagem na área de enfermagem. Método: Pesquisa qualitativa, apoiada na teoria fundamentada nos dados. A coleta de dados ocorreu entre março e novembro de 2019, por meio de entrevistas com questões norteadoras e hipóteses direcionadas a dois diferentes grupos. Considerou-se a técnica de análise comparativa dos dados, a partir da codificação aberta, axial e integralizada, conforme proposto pelo método, atingindo-se amostragem teórica com 23 participantes, os quais eram enfermeiros, técnicos e alunos de enfermagem. Resultados: A delimitação das categorias confluiu para o fenômeno, (Re)significando saberes e práticas por meio da Incubadora de Aprendizagem. Norteadas pelo modelo paradigmático, as categorias foram denominadas com base nos três componentes: Condição: Reconhecendo a indissociabilidade entre o ser e fazer profissional; Ação/interação: Revisitando posturas profissionais rotineiras e mecanicistas; Consequência: Remetendo-se às reflexões e aos saberes construídos na Incubadora de Aprendizagem. Conclusão: A Incubadora de Aprendizagem, conforme significado pelos participantes do estudo, não se reduz ao momento da Incubação ou às temáticas abordadas. Para além de espaço acolhedor, a incubadora amplia e traduz-se em ferramenta indutora de autorreflexão e autoavaliação de atitudes e posturas profissionais.

Access to original canal trajectory after deviation and perforation with guided endodontic assistance.

Procedural accidents are eventualities that may occur during endodontic treatment because of lack of attention to detail or even unforeseeable situations. Knowledge of the root canal anatomy and its variations is a prerequisite for successful endodontic treatment. This case report describes an endodontic treatment where there was an intercurrence, generating deviation and perforation, which was solved with the aid of guided endodontics. A 37 years old, ASA1, was referred to the clinic for localisation and treatment of a calcified canal of the second right upper premolar. The tomographic images revealed the presence of only one canal and deviation with apical perforation. With the help of CBCT and CAD/CAM, it was possible to perform the guided access technique even after deviation and root perforation. Once again, this technique proved to be safe and predictable, allowing for a favourable prognosis in the long term.

Avaliação antifúngica de uma solução à base de glucoprotamina e do óleo essencial de Cymbopogon citratus em leveduras de ambiente hospitalar / Antifungal action of a solution based on the glucoprotamine and the essential oil from Cymbopogon citratus on the yeasts from the hospital environment

O objetivo deste estudo foi de avaliar a atividade antifúngica de uma solução à base de glucoprotamina (GLU) e de óleo essencial (OE) de Cymbopogon citratus. Candida tropicalis, Claviceps lusitaniae, Meyerozyma (Pichia) guilliermondii e Candida parapsilosis foram isoladas das superfícies de um hospital público de Pelotas, RS. A atividade antifúngica da GLU foi analisada nas concentrações de 0,25% a 0,0005%, e para o OE, obtido por Clevenger, foi utilizado nas concentrações de 17.500 μg/mL a 0,034 μg/mL. A análise cromatográfica foi efetuada por meio de CG/MS. A atividade anti-Candida foi analisada pela técnica de Microdiluição em Caldo para determinar a Concentração Inibitória Mínima (CIM) e a Concentração Fungicida Mínima (CFM). A inibição pela GLU ocorreu em todas as concentrações testadas, enquanto o OE apresentou resultado de CIM que oscilou de 2846 a 5450 μg/mL, e CFM de 2853 a 5330 μg/mL. Alfa–citral (37,10%), beta–citral (32,77% e beta-mirceno (18,75%) foram considerados como os compostos majoritários do OE. Os dados obtidos neste trabalho destacam a atividade antifúngica da solução à base de GLU e do OE de C. citratus na eliminação dos isolados de Candida spp ambientais.

This study aimed at evaluating the antifungal activity of glucoprotamine solution (GLU) and the essential oil from Cymbopogon citratus (EO). Candida tropicalis, Claviceps lusitaniae, Meyerozyma (Pichia) guilliermondii and Candida parapsilosis were isolated from the samples, which were collected from the surfaces of a public hospital located in Pelotas, RS. The antifungal activity of GLU was detected at the concentrations from 0.25% to 0.0005%, while the EO, by Clevenger, was used at concentrations from 17.500 μg mL to 0.034 μg/mL. Chemical analysis was determined by GC/MS. The anti-Candida activity was performed by using Broth Microdilution technique to determine the Minimal Fungicidal Concentration (MFC) and the Minimal Inhibitory Concentration (MIC). The inhibition by GLU occurred at all of the tested concentrations, whereas the EO showed MIC ranging from 2.846 to 5.450 μ/mL and the CFM from 2.853 to 5.330 μg/mL. Alfa–citral (37.10%), beta–citral (32.77%) and beta-mirceno (18.75%) were the majority compounds in the EO. The data obtained in the present study highlight the effectiveness of the solution based on GLU and EO for eliminating the environmental isolates of Candida spp.

Avaliação antifúngica de uma solução à base de glucoprotamina e do óleo essencial de Cymbopogon citratusem leveduras de ambiente hospitalar / Antifungal action of a solution based on the glucoprotamine and the essential oil from Cymbopogon citratus on the yeasts from the hospital environment

O objetivo deste estudo foi de avaliar a atividade antifúngica de uma solução à base de glucoprotamina (GLU) e de óleo essencial (OE) de Cymbopogon citratus. Candida tropicalis, Claviceps lusitaniae, Meyerozyma (Pichia) guilliermondii e Candida parapsilosis foram isoladas das superfícies de um hospital público de Pelotas, RS. A atividade antifúngica da GLU foi analisada nas concentrações de 0,25% a 0,0005%, e para o OE, obtido por Clevenger, foi utilizado nas concentrações de 17.500 µg/mL a 0,034 µg/mL. A análise cromatográfica foi efetuada por meio de CG/MS. A atividade anti-Candidafoi analisada pela técnica de Microdiluição em Caldo para determinar a Concentração Inibitória Mínima (CIM) e a Concentração Fungicida Mínima (CFM). A inibição pela GLU ocorreu em todas as concentrações testadas, enquanto o OE apresentou resultado de CIM que oscilou de 2846 a 5450 µg/mL, e CFM de 2853 a 5330 µg/mL. Alfa­citral (37,10%), beta­citral (32,77% e beta-mirceno (18,75%) foram considerados como os compostos majoritários do OE. Os dados obtidos neste trabalho destacam a atividade antifúngica da solução à base de GLU e do OE de C. citratus na eliminação dos isolados de Candida spp ambientais. (AU)

This study aimed at evaluating the antifungal activity of glucoprotamine solution (GLU) and the essential oil from Cymbopogon citratus (EO). Candida tropicalis, Claviceps lusitaniae, Meyerozyma(Pichia) guilliermondii and Candida parapsilosis were isolated from the samples, which were collected from the surfaces of a public hospital located in Pelotas, RS. The antifungal activity of GLU was detected at the concentrations from 0.25% to 0.0005%, while the EO, by Clevenger, was used at concentrations from 17.500 µg mL to 0.034 µg/mL. Chemical analysis was determined by GC/MS. The anti-Candida activity was performed by using Broth Microdilution technique to determine the Minimal Fungicidal Concentration (MFC) and the Minimal Inhibitory Concentration (MIC). The inhibition by GLU occurred at all of the tested concentrations, whereas the EO showed MIC ranging from 2.846 to 5.450 µ/mL and the CFM from 2.853 to 5.330 µg/mL. Alfa­citral (37.10%), beta­citral (32.77%) and beta-mirceno (18.75%) were the majority compounds in the EO. The data obtained in the present study highlight the effectiveness of the solution based on GLU and EO for eliminating the environmental isolates of Candida spp. (AU)

Quality of life and mental health in amblyopic children treated with and without occlusion therapy.

PURPOSE: To assess the long-term (≥1 year) psychosocial effects of occlusion therapy in children with refractive amblyopia and their caregivers. METHODS: Multiple self-reported questionnaires were used to investigate HRQoL, anxiety, depression, and stress in a cross-sectional study of children with refractive amblyopia and their caregivers. Children were divided into two subgroups: those treated with glasses only and those treated with both glasses and occlusion therapy who had stopped wearing a patch at least 1 year earlier. RESULTS: A total of 79 children were included: 32 in the refraction-only group and 47 in the glasses + occlusion group. Median age of subjects was 12 years (IQR = 3.0). Mean age of the 79 caregivers was 41.9 ± 5.0 years. No significant differences were found for any of the psychosocial outcomes analyzed between children treated with glasses and patching and those treated with glasses only. The differences remained insignificant between children according to age of first occlusion (<6 vs ≥6 years). The only significant (but not clinically relevant) difference observed for caregivers was a higher score in the depression dimension of the Hospital Anxiety and Depression Scale for caregivers of children treated with glasses only (P = 0.036; effect size = 0.23). CONCLUSIONS: In our study cohort, patching was not associated with long-term negative psychosocial outcomes in children with refractive amblyopia treated with occlusion therapy.

Predicting participation of people with impaired vision in epidemiological studies.

BACKGROUND: The characteristics of the target group and the design of an epidemiologic study, in particular the recruiting methods, can influence participation. People with vision impairment have unique characteristics because those invited are often elderly and totally or partially dependent on help to complete daily activities such as travelling to study sites. Therefore, participation of people with impaired vision in studies is less predictable than predicting participation for the general population. METHODS: Participants were recruited in the context of a study of prevalence and costs of visual impairment in Portugal (PCVIP-study). Participants were recruited from 4 Portuguese public hospitals. Inclusion criteria were: acuity in the better eye from 0.5 decimal (0.30logMAR) or worse and/or visual field of less than 20 degrees. Recruitment involved sending invitation letters and follow-up phone calls. A multiple logistic regression model was used to assess determinants of participation. The J48 classifier, chi-square and Fisher's exact tests were applied to investigate the possible differences between subjects in our sample. RESULTS: Individual cases were divided into 3 groups: immediate, late and non-participants. A participation rate of 20% was obtained (15% immediate, 5% late). Factors positively associated with participation included years of education, annual hospital attendance, and intermediate visual acuity. Females and greater distance to the hospital were inversely associated with participation. CONCLUSION: In our study, a letter followed by a phone call was efficient to recruit a significant number of participants from a larger group of people with impaired vision. However, the improvement in participation observed after the phone call might not be cost-effective. People with low levels of education and women were more difficult to recruit. These findings need to be considered to avoid studies whose results are biased by gender or socio-economic inequalities of their participants. Young subjects and those at intermediate stages of vision impairment, or equivalent conditions, may need more persuasion than other profiles.

Suction-induced retinopathy: optical coherence tomography correlations.

We report a clinical case of a teenager whose eyes were exposed to highly negative suction pressures for brief seconds. The patient presented with a bilateral cystoid macular oedema associated with a thickening of outer nuclear layer evidenced by optical coherence tomography. The patient's constellation of findings is most easily explained by the abrupt expansion and traction of a cohesive vitreous base onto the retinal layers.

Cystic Fibrosis Newborn Screening in Portugal: PAP Value in Populations with Stringent Rules for Genetic Studies.

Newborn screening (NBS) for cystic fibrosis (CF) has been shown to be advantageous for children with CF, and has thus been included in most NBS programs using various algorithms. With this study, we intend to establish the most appropriate algorithm for CF-NBS in the Portuguese population, to determine the incidence, and to contribute to elucidating the genetic epidemiology of CF in Portugal. This was a nationwide three-year pilot study including 255,000 newborns (NB) that were also screened for congenital hypothyroidism (CH) and 24 other metabolic disorders included in the Portuguese screening program. Most samples were collected in local health centers spread all over the country, between the 3rd and 6th days of life. The algorithm tested includes immunoreactive trypsinogen (IRT) determination, pancreatitis associated protein (PAP) as a second tier, and genetic study for cases referred to specialized clinical centers. Thirty-four CF cases were confirmed positive, thus indicating an incidence of 1:7500 NB. The p.F508del mutation was found in 79% of the alleles. According to the results presented here, CF-NBS is recommended to be included in the Portuguese NBS panel with a small adjustment regarding the PAP cut-off, which we expect to contribute to the improvement of the CF-NBS performance. According to our results, this algorithm is a valuable alternative for CF-NBS in populations with stringent rules for genetic studies.

Characterization of all Surgical Specimens Provided by a Portuguese Department of Ophthalmology over a 13 Year Period.

INTRODUCTION: We intend to evaluate clinically, topographically and morphologically all surgical specimens sent by the Department of Ophthalmology of Hospital de Braga to the Department of Pathology of the same hospital. MATERIAL AND METHODS: Two hundred and fifty eight surgically obtained specimens, from the Department of Ophthalmology of Hospital de Braga, analyzed in the Department of Pathology, from January 2002 to June 2015, were characterized. Data was arranged according to year, age, sex, topography and morphological diagnosis according to the SNOMED® coding system. RESULTS: Mean age at time of diagnosis was 54.6 years old; 52.3% were male subjects. The number of specimens was relatively stable until the year 2010, with a significant increase between 2011 and 2013. Most specimens sent corresponded to eyelid (54.7%), followed by conjunctiva (26.7%); the most common pathological diagnosis was malignant epithelial lesions (22.48%), followed by melanocytic tumours (22.09%) and benign epithelial lesions (17.05%). DISCUSSION: The results are distinct from previous publications presumably because of differences between the populations submitted to analysis. CONCLUSION: This is the first indexed publication characterizing surgical specimens from a Department of Ophthalmology in Portugal; moreover, it also includes an extensive review of global epidemiological data about ophthalmic surgical specimens.

Introdução: Pretende-se avaliar clínica, topográfica e morfologicamente todos as amostras biológicas enviadas pelo Serviço de Oftalmologia do Hospital de Braga para o Serviço de Anatomia Patológica do mesmo Hospital. Material e Métodos: Duzentas e cinquenta e oito amostras biológicas obtidas cirurgicamente pelo Serviço de Oftalmologia do Hospital de Braga e analisadas pelo Serviço de Anatomia Patológica (Hospital de Braga), no período de janeiro de 2002 a junho de 2015. Os dados foram organizados de acordo com o ano, idade, sexo, topografia e diagnóstico patológico de acordo com sistema de codificação SNOMED®. Resultados: A idade média dos doentes à altura do diagnóstico foi de 54,6 anos, sendo 52,3% destes indivíduos do sexo masculino. O número de amostras oscilou pouco até ao ano 2010, verificando-se um aumento importante entre 2011 e 2013. A maioria das amostras biológicas enviadas foi de pele de pálpebra (54,7%), seguida de conjuntiva (26,7%); os diagnósticos morfológicos mais comuns foram as lesões epiteliais malignas (22,48%), seguido pelos tumores melanocíticos (22,09%) e as lesões epiteliais benignas (17,05%). Discussão: Os resultados são distintos das publicações anteriores, presumivelmente devido a diferenças entre as populações analisadas. Conclusão: Esta é a primeira publicação indexada caracterizando as amostras biológicas de um Serviço de Oftalmologia em Portugal; além disso, inclui uma extensa revisão de dados epidemiológicos sobre amostras biológicas oftalmológicas a nível global.

Eyelid Edema: A Rare Cause of a Common Sign.

We report a 48-year-old female patient who presented to the emergency room with right eyelid edema, with 3 days of evolution. She had suffered minor trauma to this eye one week before. She reported episodes of right eyelid swelling of spontaneous resolution since the occurrence of a traumatic brain injury 5 years ago. Ophthalmological examination showed a soft and painless eyelid edema of the right eye. Brain computed tomography showed an area of bone discontinuity of the orbital roof with brain herniation and a CSF leak into the eyelid (blepharocele). Magnetic resonance confirmed the result of TC and revealed an area of frontal encephalomalacia. Ibuprofen (800 mg/day) was prescribed, with complete resolution within 20 days. She was evaluated by Neurosurgery with no indication of surgery due to the resolution of the edema and absence of symptoms. Blepharocele is a rare entity that should be considered in the differential diagnosis of unilateral eyelid edema. It can be secondary to an orbital fracture or congenital lesion.

Antiallodynic effect of ß-caryophyllene on paclitaxel-induced peripheral neuropathy in mice.

Painful peripheral neuropathy is a common side effect of paclitaxel (PTX). The use of analgesics is an important component for management of PTX-induced peripheral neuropathy (PINP). However, currently employed analgesics have several side effects and are poorly effective. ß-caryophyllene (BCP), a dietary selective CB2 agonist, has shown analgesic effect in neuropathic pain models, but its role in chemotherapy-induced neuropathic pain has not yet been investigated. Herein, we used the mouse model of PINP to show the therapeutic effects of BCP in this neuropathy. Male Swiss mice receiving PTX (2 mg kg-1, ip, four alternate days) were treated with BCP (25 mg kg-1, po, twice a day) either during or after PTX administration. Some groups were also pretreated with AM630 (CB2 antagonist, 3 mg kg-1, ip) or AM251 (CB1 antagonist, 1 mg kg-1, ip). Spinal cord samples were collected in different time points to perform immunohistochemical analysis. BCP attenuated the established mechanical allodynia induced by PTX (p < 0.0001) in a CB2-dependent manner. Of note, when given concomitantly with PTX, BCP was able to attenuate the development of PINP (p < 0.0001). Spinal cord immunohistochemistry revealed that preventive treatment with BCP reduced p38 MAPK and NF-κB activation, as well as the increased Iba-1 and IL-1ß immunoreactivity promoted by PTX. Our findings show that BCP effectively attenuated PINP, possibly through CB2-activation in the CNS and posterior inhibition of p38 MAPK/NF-κB activation and cytokine release. Taken together, our results suggest that BCP could be used to attenuate the establishment and/or treat PINP.

Vertical muscle transposition with silicone band belting in VI nerve palsy.

A woman aged 60 years developed a Millard-Gubler syndrome after a diagnosis of a cavernous angioma in the median and paramedian areas of the pons. In this context, she presented a right VI nerve palsy, right conjugate gaze palsy, facial palsy and left hemiparesis. To improve the complete VI nerve palsy, we planned a modified transposition approach, in which procedure we made a partial transposition of vertical rectus with a silicone band that was fixated posteriorly. After the procedure, the patient gained the ability to slightly abduct the right eye. We found no compensatory torticollis in the primary position of gaze. There was also an improvement of elevation and depression movements of the right eye. We obtained satisfactory results with a theoretically reversible technique, which is adjustable intraoperatively with no need of muscle detachment, preventing anterior segment ischaemia and allowing simultaneous recession of the medial rectus muscles, if necessary.