RT-PCR/MALDI-TOF mass spectrometry-based detection of SARS-CoV-2 in saliva specimens.

As severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infections continue, there is a substantial need for cost-effective and large-scale testing that utilizes specimens that can be readily collected from both symptomatic and asymptomatic individuals in various community settings. Although multiple diagnostic methods utilize nasopharyngeal specimens, saliva specimens represent an attractive alternative as they can rapidly and safely be collected from different populations. While saliva has been described as an acceptable clinical matrix for the detection of SARS-CoV-2, evaluations of analytic performance across platforms for this specimen type are limited. Here, we used a novel sensitive RT-PCR/MALDI-TOF mass spectrometry-based assay (Agena MassARRAY®) to detect SARS-CoV-2 in saliva specimens. The platform demonstrated high diagnostic sensitivity and specificity when compared to matched patient upper respiratory specimens. We also evaluated the analytical sensitivity of the platform and determined the limit of detection of the assay to be 1562.5 copies/ml. Furthermore, across the five individual target components of this assay, there was a range in analytic sensitivities for each target with the N2 target being the most sensitive. Overall, this system also demonstrated comparable performance when compared to the detection of SARS-CoV-2 RNA in saliva by the cobas® 6800/8800 SARS-CoV-2 real-time RT-PCR Test (Roche). Together, we demonstrate that saliva represents an appropriate matrix for SARS-CoV-2 detection on the novel Agena system as well as on a conventional real-time RT-PCR assay. We conclude that the MassARRAY® system is a sensitive and reliable platform for SARS-CoV-2 detection in saliva, offering scalable throughput in a large variety of clinical laboratory settings.

Comparison of SARS-CoV-2 detection from nasopharyngeal swab samples by the Roche cobas 6800 SARS-CoV-2 test and a laboratory-developed real-time RT-PCR test.

The urgent need to implement and rapidly expand testing for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection has led to the development of multiple assays. How these tests perform relative to one another is poorly understood. We evaluated the concordance between the Roche Diagnostics cobas 6800 SARS-CoV-2 test and a laboratory-developed test (LDT) real-time reverse transcription-polymerase chain reaction based on a modified Centers for Disease Control and Prevention protocol, for the detection of SARS-CoV-2 in samples submitted to the Clinical Laboratories of the Mount Sinai Health System. A total of 1006 nasopharyngeal swabs in universal transport medium from persons under investigation were tested for SARS-CoV-2 as part of routine clinical care using the cobas SARS-CoV-2 test with subsequent evaluation by the LDT. Cycle threshold values were analyzed and interpreted as either positive ("detected" or "presumptive positive"), negative (not detected), inconclusive, or invalid. Statistical analysis was performed using GraphPad Prism 8. The cobas SARS-CoV-2 test reported 706 positive and 300 negative results. The LDT reported 640 positive, 323 negative, 34 inconclusive, and 9 invalid results. When excluding inconclusive and invalid results, the overall percent agreement between the two platforms was 95.8%. Cohen's κ coefficient was 0.904 (95% confidence interval, 0.875-0.933), suggesting almost perfect agreement between both platforms. An overall discordance rate of 4.2% between the two systems may reflect differences in primer sequences, assay limit of detection, or other factors, highlighting the importance of comparing the performance of different testing platforms.

The antibacterial and anti-biofilm activity of gold-complexed sulfonamides against methicillin-resistant Staphylococcus aureus.

The drug-resistant strains of Staphylococcus aureus have been considered as one of the serious health threats, which are related to high patient hospitalization rates. Besides, Staphylococcus aureus biofilm formation exhibits a drug-tolerant nature and shows nonspecific resistance against a broad-spectrum of antibiotics. The emergence of drug-resistant bacteria stimulated the development of novel medicines as a strategy to control infections. In this study, we evaluated the antibacterial and anti-biofilm activity of gold-complexed sulfonamides against Staphylococcus aureus strains such as methicillin-resistant S. aureus and clinical isolates. Our data showed that the exposure of gold-complexed sulfonamides promoted a remarkable reduction in the bacterial adhesion. Also, confocal microscopy displayed the effects of the compounds on in the bacterial cell biofilm, revealed that the compounds decreased the biofilm formation. Our results also demonstrated that gold-complexed sulfonamides exhibited potent antibacterial activity against Staphylococcus aureus strains. Besides, all compounds presented a synergic antibacterial activity when were associated with classical antibiotics. Gold-complexed sulfonamide compounds did not promote toxic effects on Caenorhabditis elegans. Thus, our results showed that the coordination of sulfonamide with gold is a promising alternative in the development of safe and active compounds against methicillin-resistant and clinical isolates S. aureus.

Sulfamethoxazole derivatives complexed with metals: a new alternative against biofilms of rapidly growing mycobacteria.

Biofilms are considered important sources of infections on biomedical surfaces, and most infections involving biofilm formation are associated with medical device implants. Therefore, there is an urgent need for new antimicrobial compounds that can combat microbial resistance associated with biofilm formation. In this context, this work aimed to evaluate the antibiofilm action of sulfamethoxazole complexed with Au, Cd, Cu, Ni and Hg on rapidly growing mycobacteria (RGM), as well as to evaluate their safety through cytotoxic assays. The results demonstrate potentiation of the novel compounds in antibiofilm activity, mainly in the complex with Au, which was able to completely inhibit biofilm formation and had the capacity to destroy the biofilm at all the concentrations tested. All cytotoxic data suggest that the majority of sulfamethoxazole metallic derivatives are antimicrobial alternatives, as well as safe molecules, which could be used as potential therapeutic agents for bacterial and biofilm elimination.

Antibiofilm effect of antimicrobials used in the therapy of mycobacteriosis.

Rapidly growing mycobacteria (RGM) are opportunistic pathogens found in the environment. When in biofilms, mycobacteria is highly resistant to antibacterial treatments. The purpose of this study is to evaluate the antibiofilm activity of antimicrobials commonly used in therapy against mycobacteria. The antimicrobial susceptibility of Mycobacterium abscessus, Mycobacterium fortuitum and Mycobacterium massiliense was determined in planktonic and sessile populations. The antimicrobials amikacin, ciprofloxacin, clarithromycin, doxycycline, imipenem and sulfamethoxazole were tested. For each drug, it was evaluated the susceptibility of the pathogen, the ability to inhibit biofilm formation and the resistance of biofilms to antimicrobial activity. Results showed although, the antimicrobials tested are used as an alternative therapy for RGM, M. abscessus proved to be resistant to clarithromycin, beside that, M. massiliense showed a resistant profile to clarithromycin and sulfamethoxazole. Moreover, the inhibition of biofilm formation and its destruction have not been fully met. Considering that the biofilms are a known form of bacterial resistance, the failure of alternatives to inhibit or destroy biofilms can trigger the recurrence of infections. In RGM, besides causing treatment failures, biofilms are a factor of pathogenic risk, since these microorganisms are found in environmental sources and can cause infections easily.

Identification of antimicrobial activity among new sulfonamide metal complexes for combating rapidly growing mycobacteria.

Mycobacteriosis is a type of infection caused by rapidly growing mycobacteria (RGM), which can vary from localized illness, such as skin disease, to disseminated disease. Amikacin, cefoxitin, ciprofloxacin, clarithromycin, doxycycline, imipenem and sulfamethoxazole are antimicrobial drugs chosen to treat such illnesses; however, not all patients obtain the cure. The reason why the treatment does not work for those patients is related to the fact that some clinical strains present resistance to the existing antimicrobial drugs; thereby, the research of new therapeutic approaches is extremely relevant. The coordination of antimicrobial drugs to metals is a promising alternative in the development of effective compounds against resistant microorganisms. Sulfonamides complexed with Au, Cd, Ag, Cu, and Hg have shown excellent activity against a variety of microorganisms. Considering the importance of fighting against infections associated with RGM, the objective of this study is to evaluate the antimycobacterial activity of metal complexes of sulfonamides against RGM. Complexed sulfonamides activity were individually tested and in association with trimethoprim. The minimum inhibitory concentration (MIC) and time-kill curve of compounds against the standard strains of RGM [Mycobacterium abscessus (ATCC 19977), Mycobacterium fortuitum (ATCC 6841) and Mycobacterium massiliense (ATCC 48898)] was determined. The interaction of sulfonamides with trimethoprim was defined by inhibitory concentration index fractional for each association. The results showed that sulfonamides complexed whit metals have outstanding antimicrobial activity when compared to free sulfamethoxazole, bactericidal activity and synergistic effect when combined with trimethoprim.

Programmable Crowding and Tunable Phases in a Binary Mixture of Colloidal Particles under Light-Driven Thermal Convection.

We employ photothermally driven self-assembly of colloidal particles to design microscopic structures with programmable size and tunable order. The experimental system is based on a binary mixture of "plasmonic heater" gold nanoparticles and "assembly building block" microparticles. Photothermal heating of the gold nanoparticles under visible light causes a natural convection flow that efficiently assembles the microscale building block particles (diameter 1-10 µm) into a monolayer. We identify the onset of active Brownian motion of colloidal particles under this convective flow by varying the conditions of light intensity, gold nanoparticle concentration, and sample height. We realize a crowded assembly of microparticles around the center of illumination and show that the size of the particle crowd can be programmed using patterned light illumination. In a binary mixture of gold nanoparticles and polystyrene microparticles, we demonstrate the formation of rapid and large-scale crystalline monolayers, covering an area of 0.88 mm2 within 10 min. We find that the structural order of the assembly can be tuned by varying the surface charge of the nanoparticles and the size of the microparticles, giving rise to the formation of different phases-colloidal crystals, crowds, and gels. Using Monte Carlo simulations, we explain how the phases emerge from the interplay between hydrodynamic and electrostatic interactions, as well as the assembly kinetics. Our study demonstrates the promise of self-assembly with programmable shapes and structural order under nonequilibrium conditions using an accessible setup comprising only binary mixtures and LED light.

Donation Process and Evaluation of Corneal Tissue in a Slit Lamp.

BACKGROUND: The process of capturing and classifying the viability of corneal tissue for corneal transplantation is complex. The biomicroscopic examination is one of the techniques used to evaluate the quality of corneal tissues. The aim of this study was to analyze the relationship between the evaluation criteria used in biomicroscopic examination using a slit lamp and the classification of the quality of corneal tissue. METHODS: This is a longitudinal, retrospective cohort study, performed at the Human Ocular Tissue Bank in the state of Rio Grande do Norte, Brazil. The sample consisted of 419 corneas donated between 2005 to 2016. RESULTS: After the evaluation, the 419 corneas were classified as excellent (8 -1.91%), good (217 - 51.79%), regular (85 - 20.29%), and bad (109 - 26.01%). The classification of corneal quality attributed by ophthalmologists considered 13 criteria: senile arch, scars, epithelial defect, epithelial exposure, stromal infiltrate, subepithelial opacity, pterygium, Descemet's folds, stromal edema, stromal streak, cornea guttata, specular reflex, and cell loss endothelial. The quality of the cornea classified as excellent and good showed a statistically significant association (P value < .05) with senile arch, scar, epithelial defect, epithelial exposure, Descemet's folds, stromal edema, stromal streak, cornea guttata, specular reflex, and losses of endothelial cells; they had evaluated criteria that were absent or slightly present. CONCLUSIONS: The evaluation of the corneal quality for corneal transplantation should involve the implementation of reliable techniques and trained, qualified professionals. There is a need to create evaluation instruments that consider the criteria according to their degree of interference in the quality of corneal tissue.

Estimation of Current and Future Physiological States in Insular Cortex.

Interoception, the sense of internal bodily signals, is essential for physiological homeostasis, cognition, and emotions. While human insular cortex (InsCtx) is implicated in interoception, the cellular and circuit mechanisms remain unclear. We imaged mouse InsCtx neurons during two physiological deficiency states: hunger and thirst. InsCtx ongoing activity patterns reliably tracked the gradual return to homeostasis but not changes in behavior. Accordingly, while artificial induction of hunger or thirst in sated mice via activation of specific hypothalamic neurons (AgRP or SFOGLUT) restored cue-evoked food- or water-seeking, InsCtx ongoing activity continued to reflect physiological satiety. During natural hunger or thirst, food or water cues rapidly and transiently shifted InsCtx population activity to the future satiety-related pattern. During artificial hunger or thirst, food or water cues further shifted activity beyond the current satiety-related pattern. Together with circuit-mapping experiments, these findings suggest that InsCtx integrates visceral-sensory signals of current physiological state with hypothalamus-gated amygdala inputs that signal upcoming ingestion of food or water to compute a prediction of future physiological state.

Tracking Calcium Dynamics and Immune Surveillance at the Choroid Plexus Blood-Cerebrospinal Fluid Interface.

The choroid plexus (ChP) epithelium is a source of secreted signaling factors in cerebrospinal fluid (CSF) and a key barrier between blood and brain. Here, we develop imaging tools to interrogate these functions in adult lateral ventricle ChP in whole-mount explants and in awake mice. By imaging epithelial cells in intact ChP explants, we observed calcium activity and secretory events that increased in frequency following delivery of serotonergic agonists. Using chronic two-photon imaging in awake mice, we observed spontaneous subcellular calcium events as well as strong agonist-evoked calcium activation and cytoplasmic secretion into CSF. Three-dimensional imaging of motility and mobility of multiple types of ChP immune cells at baseline and following immune challenge or focal injury revealed a range of surveillance and defensive behaviors. Together, these tools should help illuminate the diverse functions of this understudied body-brain interface.

Clinical and surgical factors and intraoperative complications in patients who underwent penetrating keratoplasty. / Fatores clínicos e cirúrgicos e as complicações intraoperatórias em pacientes que realizaram ceratoplastias penetrantes.

OBJECTIVE: to identify the main intraoperative complications of patients who underwent keratoplasty and relationship between these complications and clinical and surgical factors. METHOD: cross-sectional observational study. A census of the patients submitted to keratoplasty was carried out, which totaled 258 procedures. RESULTS: twenty-two intraoperative complications were recorded, all in penetrating keratoplasty surgeries, of which 59.09% were performed in male patients with a mean age of 58.5 years. The main intraoperative complication was vitreous loss (36.36%). A statistically significant relationship was found between the variable "intraoperative complication" and the variables "previous surgery", "combined keratoplasty and cataract extraction" and "corneal host button greater than 8.0 mm". CONCLUSION: identifying the main intraoperative complications of keratoplasty enables nurses to understand which factors may interfere with these procedures, point out possible predictors of complications, and seek control measures so that such complications do not occur.

[Use of medicines by the elderly in Santa Rosa, Rio Grande do Sul State, Brazil]. / Perfil de utilização de medicamentos em idosos da zona urbana de Santa Rosa, Rio Grande do Sul, Brazil.

Medicines are one of the most important health care items for the elderly, who are particularly prone to use multiple drugs with a higher number of adverse reactions. The current study aimed to assess the profile of pharmaceutical consumption by the elderly. A cross-sectional epidemiological study used household interviews in a random sample of 294 elderly living in Santa Rosa, Rio Grande do Sul State, Brazil. The elderly represent 9% of the local population. The results showed a mean consumption of 2.79 medicines per individual. The prevalence rate for use of medicines in the previous week was 82%, and of the 827 medicines used by the elderly, 794 (96%) had been prescribed. The most widely used pharmacological classes were anti-hypertensives (21.3%) and diuretics (11.3%). Prevalence of pharmaceutical use was comparable to the results from other studies, thus confirming the importance of medicines in the health of the elderly. The percentage of medicines used without a medical prescription was low. The most frequently reported medicines and formulations were those usually prescribed and dispensed free of cost in the municipal basic health care system, which has been organized for more than 10 years, with coverage of nearly 100%.

Conducta Alimentaria Materna Asociada A La Composición Corporal Del Hijo Adolescente En La Población De Allende-México

Introducción: Los rasgos del apetito (RA) forman parte de la conducta alimentaria de la persona, con una serie de respuestas continuas que se relaciona con la elección y consumo de alimentos y, también, con aspectos al momento en que se realiza la alimentación como son la frecuencia de las comidas, el lugar, la compañía con la que se comparten, entre otros. Estos factores pueden tener un impacto significativo en la forma en que se alimenta una persona y en su salud a largo plazo. Objetivo: Analizar la posible asociación entre la conducta alimentaria materna y la composición corporal del adolescente, de una preparatoria de la ciudad de Allende, Nuevo León, en México. Método: Se realizó un estudio cuantitativo, transversal y correlacional. El periodo del presente estudio fue de febrero a agosto de 2022. La población fue de 41 binomios (madre e hijo adolescente entre 15 y 17 años) de una preparatoria del Municipio de Allende, Nuevo León, México. Para probar la hipótesis, se utilizó el coeficiente de correlación de Spearman. Resultados : Al correr la prueba estadística se encontró que no existe una correlación significativa entre el nivel de conducta alimentaria de la madre y la composición corporal del adolescente (rs = -0,174, p = 0,277), por lo cual se rechaza la hipótesis de investigación. Conclusiones : Se encontró que la conducta alimentaria de la madre no se relaciona significativamente con la composición corporal del adolescente, de acuerdo a la muestra considerada en el presente estudio.

[Penetrating keratoplasty indications in "Hospital das Clínicas-UNICAMP"]. / Indicações para ceratoplastia penetrante no Hospital das Clínicas-UNICAMP.

PURPOSE: To determine the main causes of penetrating keratoplasty indications at "Hospital das Clínicas-UNICAMP" (January, 1999 to December, 2003). METHODS: A non-comparative, retrospective series of case studies. The authors reviewed the files of 857 patients who underwent penetrating keratoplasty at "Hospital das Clínicas-UNICAMP" between 1999-2003 and classified them into different categories according to diagnostic indication for surgery. RESULTS: The age range was between 0-88 years (average 44 years +/-1.2). The main causes of penetrating keratoplasty were: keratoconus in 427 cases (49.82%); 152 cases (17.74%) of corneal ulceration (perforated or not); corneal graft failure in 87 cases (10.15%); bullous keratopathy, 72 cases (8.40%); Fuchs dystrophy in 59 cases (6.88%); trachoma complications in 28 cases (3.27%); other causes, 32 (3.74%). In children under 10 years of age, the main cause of penetrating keratoplasty indications was infectious ulcer (77.78%) and between 11-50 years of age, keratoconus was the main cause (71.65%). CONCLUSION: This study was composed of a young population, and the main causes of penetrating keratoplasty were keratoconus and therapeutic keratoplasty.

Trastornos del sueño en emergencias y desastres / Sleep disorders in emergencies and disasters

Los trastornos del sueño son frecuentes en la población y una causa importante de morbilidad. El objetivo de esta revisión es evaluar las alteraciones del sueño en periodos de emergencia y desastres. A lo largo de la historia, la esfera biopsicosocial y el sueño de las personas ha sido abrumada por múltiples eventos a gran escala, tales como desastres naturales, tragedias provocadas por el hombre, conflictos bélicos, crisis sociales y pandemias, cuya experiencia puede derivar en problemas de salud a corto, mediano y/o largo plazo. En los estudios analizados, se ha observado el impacto negativo de las emergencias y desastres en el sueño, por lo que ha cobrado gran relevancia la difusión y promoción de medidas que incentiven el buen dormir. Debido a la llegada del COVID-19 y a la situación de confinamiento por periodos prolongados en el hogar para prevenir su propagación, han surgido importantes consecuencias a nivel social. Ciertos factores ocupacionales y características de los desastres se asocian a mayor comorbilidad, un alto riesgo de experimentar agotamiento físico, trastornos psicológicos e insomnio en grupos altamente vulnerables, como lo son los profesionales de la salud, rescatistas y socorristas. El insomnio es el trastorno de sueño más frecuente en la población general y su empeoramiento en el contexto de pandemia por COVID-19 representa un nuevo problema en salud pública. Es por ello, que es indispensable promover campañas de prevención de salud física y mental orientados a la pesquisa precoz y manejo de patologías de la esfera psicosocial, dentro de las posibilidades socioeconómicas.

Sleep disorders are common in the population and are major cause of morbidity. The objective of this review is to assess sleep disturbances in times of emergency and disasters. Throughout history, the biopsychosocial field and sleep have been affected by multiple large-scale events, such as natural disasters, man-caused tragedies, armed conflicts, social crises and pandemics, the experience of which can lead to short, medium and/or long term health problems. In several studies, the negative impact of emergencies and disasters on sleep have been analyzed, emphasizing the importance of the diffusion and promotion of measures that encourage good sleep. The arrival of COVID-19 and consequent home confinement for prolonged periods caused important social consequences. Certain occupational factors and characteristics of disasters are associated with greater comorbidity: a high risk of experiencing physical exhaustion, psychological disorders and insomnia, especially in highly vulnerable groups, such as health professionals, rescuers and first aids-responders. Insomnia is the most frequent sleep disorder in the general population and its worsening in the context of the COVID-19 pandemic, represents a new public health problem. It is essential to promote physical and mental health prevention campaigns, aimed at early screening and management of pathologies in the psychosocial sphere, within socioeconomic possibilities.

Profile of continuous use drugs prescribed in primary health care and presence in list of essential drugs

Objectives: To evaluate the profile of the drugs for continuous use prescribed in Primary Health Care (PHC) in Santa Rosa / RS and to identify presence in the official lists of essential drugs. Methods: Cross-sectional, analytical and quantitative study, with analysis of the digital prescriptions of users of primary health care in Santa Rosa. There was no gender restriction and patients who used at least one chronic drug were included. Data were collected through a printed report from users. Results: The study included 642 participants, with a mean age of 60.40±14.48, 64.3% were female and 47.4%, using polypharmacy. A total of 3.009 drugs were identified, with an average of 4.69±2.82 medications/prescription. There was a higher frequency of the cardiovascular system (46.9%), nervous system (16.8%) and digestive tract and metabolism (14.8%). The most commonly used drugs were hydrochlorothiazide, fluoxetine and omeprazole. Regarding the presence of drugs in the official lists, 90.9% are in RENAME and 90.8% in REMUME, and 80% of users have obtained full access to medicines. In the prescriptions, 0.3% contained antibiotics, 1.3% injectable drugs and all drugs were prescribed by the generic name and in a computerized way. Conclusions: The pharmacotherapeutic profile is similar to the national reality and most indicators are as recommended by the WHO, demonstrating the organization of the PA of the city, which facilitates the access of users to essential medicines. However, there was a high number of drugs per prescription and presence of polypharmacy, evidencing the importance of access to it as well as the promotion of the rational use of these drugs.

Fatores clínicos e cirúrgicos e as complicações intraoperatórias em pacientes que realizaram ceratoplastias penetrantes / Clinical and surgical factors and intraoperative complications in patients who underwent penetrating keratoplasty / Factores clínicos y quirúrgicos y las complicaciones intraoperatorias en pacientes que realizaron queratoplastias penetrantes

Objetivo identificar as principais complicações intraoperatórias dos pacientes que realizaram ceratoplastias e sua relação com fatores clínicos e cirúrgicos. Método estudo transversal, observacional. Realizou-se um censo dos pacientes submetidos a ceratoplastias que totalizou 258 procedimentos. Resultados foram registradas 22 complicações intraoperatórias, todas em ceratoplastias penetrantes. Do total, 59,09% foram realizadas em pacientes do sexo masculino com idade média de 58,5 anos. A principal complicação intraoperatória notificada foi a perda vítrea (36,36%). Encontrou-se relação estatisticamente significativa entre a variável "complicação intraoperatória" e as variáveis "cirurgia prévia", "ceratoplastia combinada com extração de catarata" e "botão corneano do receptor maior que 8,0 mm". Conclusão identificar as principais complicações intraoperatórias da ceratoplastia possibilita à enfermagem compreender quais fatores podem interferir nesses procedimentos, apontar possíveis fatores preditores das complicações e buscar medidas de controles para que tais complicações não ocorram.

Objective to identify the main intraoperative complications of patients who underwent keratoplasty and relationship between these complications and clinical and surgical factors. Method cross-sectional observational study. A census of the patients submitted to keratoplasty was carried out, which totaled 258 procedures. Results twenty-two intraoperative complications were recorded, all in penetrating keratoplasty surgeries, of which 59.09% were performed in male patients with a mean age of 58.5 years. The main intraoperative complication was vitreous loss (36.36%). A statistically significant relationship was found between the variable "intraoperative complication" and the variables "previous surgery", "combined keratoplasty and cataract extraction" and "corneal host button greater than 8.0 mm". Conclusion identifying the main intraoperative complications of keratoplasty enables nurses to understand which factors may interfere with these procedures, point out possible predictors of complications, and seek control measures so that such complications do not occur.

Objetivo identificar las principales complicaciones intraoperatorias de los pacientes que realizaron queratoplastias y su relación con factores clínicos y quirúrgicos. Método estudio transversal, observacional. Se realizó un censo de los pacientes sometidos a las queratoplastias que tuvo un total de 258 procedimientos. Resultados fueron registradas 22 complicaciones intraoperatorias, todas en queratoplastias penetrantes. Del total, 59,09% fueron realizadas en pacientes del sexo masculino con edad media de 58,5 años. La principal complicación intraoperatoria notificada fue la pérdida vítrea (36,36%). Fue encontrada relación estadísticamente significativa entre la variable "complicación intraoperatoria" y las variables "cirugía previa", "queratoplastia combinada con extracción de catarata" y "botón corneal del receptor mayor que 8,0 mm". Conclusión identificar las principales complicaciones intraoperatorias de la queratoplastia posibilita a la enfermería comprender cuáles factores pueden interferir en estos procedimientos, apuntar posibles factores predictores de las complicaciones y buscar medidas de controles para que tales complicaciones no ocurran.

Distracción osteogénica maxilar con distractor rígido externo en pacientes con fisura labio-palatina. Revisión bibliográfica / Maxillary distraction osteogenesis in cleft lip and palate patients using rigid external distractor. A review of the literature

La fisura labio-palatina es la malformación congénita más común entre las anomalías craneofaciales y causa una serie de alteraciones a nivel funcional, fisiológico, estético y social. Una de las características comúnmente asociada a estos pacientes, es la hipoplasia maxilar severa producto de la gran resistencia opuesta por los tejidos cicatrizales de labio y paladar, como consecuencia de la cirugía primaria. Tradicionalmente, el tratamiento ha sido la cirugía ortognática convencional al término del crecimiento, sin embargo, este enfoque ha demostrado tener ciertas limitaciones. La distracción osteogénica mediante un distractor rígido externo ha resultado ser una buena alternativa para el manejo de estos pacientes, ya que permite la distracción gradual del maxilar y de los tejidos asociados, mejorando los resultados a corto y largo plazo. Se realizó una revisión de la literatura actual disponible con el objetivo de describir el alcance del tratamiento de la distracción osteogénica maxilar con distractor rígido externo en los pacientes con fisura labio-pala-tina e hipoplasia maxilar severa. Se concluye que la distracción osteogénica maxilar con distractor rígido externo es un procedimiento efectivo, confiable y relativamente estable, con mínimas complicaciones asociadas y que podría superar a la cirugía convencional en el manejo de pacientes que requieran un avance maxilar severo. Palabras clave: Osteogénesis por distracción; Labio leporino; Fisura del paladar; Maxilar (fuente: DeCS BIREME).

The cleft lip and palate is the most common congenital malformation among craniofacial anomalies and causes a series of functional, physiological, aesthetic and social altera-tions. One commonly characteristic associated with these patients is a severe maxillary hypoplasia as a result of the great resistance opposed by scar lip and palate tissue from a primary surgery. Traditionally, the suggested treatment has been conventional orthogna-thic surgery at the end of skeletal maturity. However, this approach has revealed certain limitations. Distraction osteogenesis using a rigid external distractor has shown to be a good alternative for these patients' treatment, since it allows the gradual distraction of the maxilla and the associated tissues, thereby improving the short and long term results. A review of the available literature was performed to describe the maxillary distraction os-teogenesis treatment scope using a rigid external distractor in cleft lip and palate patients with severe maxillary hypoplasia. It was concluded that maxillary distraction osteogenesis using a rigid external distractor is an effective, reliable and relatively stable procedure, with minimal associated complications. This could be a better alternative compared to conventional surgery for patients' care having severe maxillary hypoplasia. Keywords: Distraction osteogenesis; Cleft lip; Cleft palate; Maxilla (source: MeSH NLM).

Consideraciones en el tratamiento ortodóncico de pacientes con necesidades especiales. Revisión de la literatura / Considerations in the orthodontic treatment of patients with special needs. Review of the literature

Las necesidades especiales en salud han sido definidas por la Asociación Americana de Odontopediatría como "toda condición o limitación física, del desarrollo, mental, sen- sorial, conductual, cognitiva o deterioro emocional que requiere tratamiento médico, intervención de atención de la salud, y/o el uso de servicios o programas especializados". Actualmente, los pacientes con necesidades especiales en salud presentan una mayor tasa de supervivencia y expectativas de vida mayores. Además, presentan una mayor preva- lencia y severidad de anomalías dento-maxilares que impactan negativamente su salud general y calidad de vida. La creciente preocupación de los padres y profesionales por el aspecto estético y funcional, ha llevado a un aumento en la demanda por tratamiento de ortodoncia, sin embargo, el acceso a él sigue siendo limitado. El objetivo de la presente revisión es describir según la literatura disponible, las consideraciones para el tratamiento ortodóncico en pacientes con necesidades especiales en salud. Se concluye que el tra- tamiento no debe ser denegado solo por presentar una discapacidad; no obstante, el compromiso de los padres y/o cuidadores con el tratamiento es crucial para el éxito. El tratamiento debe ser planificado en etapas, siendo la fase de adaptación a la atención de gran importancia. La longitud de tratamiento en estos pacientes, es similiar a la de individuos sanos, pero se requiere un mayor tiempo-sillón y los resultados obtenidos suelen ser inferiores. El tratamiento de ortodoncia puede mejorar la estética y función en pacientes con situación de discapacidad, facilitando su integración social e impactando positivamente en su calidad de vida

The American Academy of Pediatric Dentistry defines Special Health Care Needs as "any physical, developmental, mental, sensory, behavioral, cognitive, or emotional impair- ment condition or limitation that requires medical management, health care interven- tion, and/or the use of specialized services or programs". Currently, patients with special health needs present a higher survival rate and higher life expectancies. In addition, they present a higher prevalence and severity of malocclusion that negatively impact their general health and quality of life. The growing concern of parents and professionals for the aesthetic and functional aspect, has led to an increase in the demand for orthodontic treatment, however, the health care access still remains limited. A review of the availa- ble literature was performed aiming at describing the considerations in the orthodontic treatment of special health care needs patients. It is concluded that the treatment should not be denied just for presenting a disability. Notwithstanding, it is crucial for the treat- ment success parents and/or caregivers commitment. The treatment should be planned in stages, being of great importance the care adaptation phase. The overall treatment time is similar to those patients without special needs, but still requires longer armchair time and the results obtained are usually lower. Orthodontic treatment can improve aesthetics and function in patients with disabilities, facilitating their social integration and positively impact in their quality of life.

Psychological suffering of patients transplanted with hematopoietic stem cells / Sofrimento psicológico de pacientes transplantados com células-tronco hematopoéticas

Hematopoietic stem cell transplantation (HSCT) affects serious risks for the patient, including death. For this reason, it is considered a treatment that can cure or can present morbidities and lead to death. In this context, patients experience the first psychological conflicts before this transplant. To describe the psychological suffering developed by patients transplanted with hematopoietic stem cells from a referral service in the state of Rio Grande do Norte. This is a cross-sectional study with a quantitative, descriptive, hospital-based approach developed with patients submitted to HSCT at a referral service in the state of Rio Grande do Norte. Data were collected between March and September of 2016, through the evaluation of the medical records of 43 patients who underwent HSCT and developed some type of psychological distress. Among 43 patients with psychological disorders, 51.16% were female, 62.79% developed anxiety 32.56% developed insomnia and 20.93% developed depression. Of these, 27.91% had a main diagnosis indicating the transplantation of Multiple Myeloma (MM), and 58.14 received autologous transplantation. It was observed that the patient had psychological suffering from the diagnosis until the end. The health professional praxis also must go beyond the resolution of physical human responses and, especially in these cases, it should aim at the early identification of signs and symptoms of psychological distress, being possible to achieve the real health needs and treat them with effectiveness.

O Transplante de Células-Tronco Hematopoéticas (TCTH) acarreta sérios riscos para o paciente, inclusive o de morte. Por esse motivo é considerado um tratamento que pode curar ou que pode apresentar morbidades e levar ao óbito. Diante desse contexto, os pacientes vivenciam os primeiros conflitos psicológicos que antecedem o transplante em si. Descrever o sofrimento psicológico desenvolvido por pacientes transplantados com células-tronco hematopoéticas de um serviço de referência do estado do Rio Grande do Norte. Trata de um estudo do tipo transversal, com abordagem quantitativa, descritiva, de base hospitalar, desenvolvida com pacientes submetidos ao TCTH em um serviço de referência do estado do Rio Grande do Norte. Os dados foram coletados entre os meses de março e setembro de 2016, mediante avaliação dos prontuários de 43 pacientes que realizaram o TCTH e desenvolveram algum tipo de sofrimento psicológico. Dentre os 43 pacientes que apresentaram distúrbios psicológicos, 51,16% eram do sexo feminino, 62,79% desenvolveram ansiedade, 32,56% insônia e 20,93% depressão. Destes, 27,91% tinham como diagnóstico principal que indicou o transplante o Mieloma Múltiplo (MM), 58,14 receberam transplante autólogo. Observou-se que o sofrimento psicológico acompanhou o paciente desde o diagnóstico até o desfecho. Ademais, a práxis do profissional de saúde deve ir para além da resolução de respostas humanas físicas e, especialmente para estes casos, deve visar a identificação precoce dos sinais e sintomas de sofrimento psicológico para que seja possível alcançar as reais necessidades de saúde e tratá-las com efetividade.