Survival After Hematopoietic Stem Cell Transplantation in Severe Combined Immunodeficiency (SCID): A Worldwide Review of the Prognostic Variables.

This study aims to perform an extensive review of the literature that evaluates various factors that affect the survival rates of patients with severe combined immunodeficiency (SCID) after hematopoietic stem cell transplantation (HSCT) in developed and developing countries. An extensive search of the literature was made in four different databases (PubMed, Embase, Scopus, and Web of Science). The search was carried out in December 2022 and updated in July 2023, and the terms such as "hematopoietic stem cell transplantation," "bone marrow transplant," "mortality," "opportunistic infections," and "survival" associated with "severe combined immunodeficiency" were sought based on the MeSH terms. The language of the articles was "English," and only articles published from 2000 onwards were selected. Twenty-three articles fulfilled the inclusion criteria for review and data extraction. The data collected corroborates that early HSCT, but above all, HSCT in patients without active infections, is related to better overall survival. The universal implementation of newborn screening for SCID will be a fundamental pillar for enabling most transplants to be carried out in this "ideal scenario" at an early age and free from infection. HSCT with an HLA-identical sibling donor is also associated with better survival rates, but this is the least common scenario. For this reason, transplantation with matched unrelated donors (MUD) and mismatched related donors (mMRD/Haploidentical) appear as alternatives. The results obtained with MUD are improving and show survival rates similar to those of MSD, as well as they do not require manipulation of the graft with expensive technologies. However, they still have high rates of complications after HSCT. Transplants with mMRD/Haplo are performed just in a few large centers because of the high costs of the technology to perform CD3/CD19 depletion and TCRαß/CD19 depletion or CD34 + selection techniques in vitro. The new possibility of in vivo T cell depletion using post-transplant cyclophosphamide could also be a viable alternative for performing mMRD transplants in centers that do not have this technology, especially in developing countries.

Correlation between retinal sensitivity assessed by microperimetry and structural abnormalities on optical coherence tomography after successful epiretinal membrane surgery.

BACKGROUND: To verify the correlation between retinal sensitivity (RS) assessed by the microperimetry (MP) and optical coherence tomography (OCT) parameters measured in eyes submitted to pars-plana vitrectomy (PPV) for idiopathic epiretinal membrane (ERM) treatment. METHODS: 43 patients underwent PPV. Best-corrected visual acuity (BCVA) and OCT imaging were acquired preoperatively and 6 months after surgery. The RS values were recorded 6 months after the surgery. Total macular thickness (TMT) measurements and OCT-evaluated structural findings were also analyzed. The MP examination tested 44 points, with direct topographic correspondence with the OCT-ETDRS map. Correlations between BCVA, RS, and OCT parameters were assessed. RESULTS: TMT measurements in patients were significantly thicker preoperatively and reduced after surgery. All patients demonstrated BCVA improvements after surgery. The RS parameters after surgery were significantly lower in patients. For OCT structural analyses, patients with lower RS at the fovea correlated with the preexisting disorganization of retinal inner layers (DRIL). In addition, lower RS values were associated with DRIL, outer retinal changes (ORC), and intraretinal microcysts after surgery. CONCLUSIONS: The RS values after surgery were significantly lower when compared to controls. The DRIL presence before and after surgery, and microcysts and ORC after surgery were related to worse visual outcomes.

Dermatite de contato pigmentada por cosmético / Pigmented cosmetic contact dermatitis

A dermatite de contato pigmentada se destaca por sua raridade, sendo associada a inúmeros alérgenos cosméticos e têxteis. Acomete predominantemente mulheres de meia idade e fototipos altos. O teste de contato é imprescindível para a identificação do agente causal. O tratamento indicado consiste no afastamento do agente causal, no uso de fotoprotetores, clareadores tópicos e, por vezes, procedimentos dermatológicos abrasivos. Relatamos um caso de dermatite de contato pigmentada por cosmético motivado pela exuberância clínica e desfecho satisfatório, ressaltando a importância da suspeição diagnóstica e do manejo adequado impactando neste desfecho.

Pigmented contact dermatitis is a rare condition associated with numerous cosmetic and textile allergens. It predominantly affects middle-aged women with high phototypes. The patch test is essential to identify the causative agent. Treatment includes removal of the causative agent, sunscreen use, administration of topical bleaching agents, and occasionally abrasive dermatologic procedures. We report a case of pigmented cosmetic contact dermatitis motivated by its clinical exuberance and satisfactory outcome, emphasizing the importance of diagnostic suspicion and adequate management impacting this outcome.

Patrimônio e memória de interesse público em tempos de pandemia: um estudo sobre a comunicação de memórias e histórias da covid-19 em narrativas digitais / Heritage and memory of public interest in times of pandemic: a study on the communication of memories and stories about covid-19 through digital narratives / Patrimonio y memoria de interés público en tiempos de pandemia: un estudio sobre la comunicación de memorias e historias sobre covid-19 en narrativas digitales

A pandemia da covid-19 gerou aumento de repositórios de dados digitais que registram a memória das pessoas sobre a pandemia, originando diversas comunidades virtuais que promovem a produção de memórias por meio do envio de relatos de histórias de vida em diversas mídias. Com base num estudo exploratório de natureza documental, este trabalho apresenta um levantamento amplo e significativo de plataformas digitais provenientes de diversas ações e instituições universitárias, culturais e de meios de comunicação e associações da sociedade civil que lançaram repositórios digitais para coletar e compartilhar relatos sobre as experiências das pessoas durante a pandemia de covid-19. A análise e a comparação dos registros memoriais existentes em tais repositórios indicam a importância de relatos de histórias de vida integrados às narrativas visuais compostas por fotografias e vídeos para a construção de uma rede de memórias mais inclusiva da pandemia de covid-19, ou seja, uma rede pautada nas vivências de diversos públicos e/ou comunidades, constituindo-se como memória de interesse público e contribuindo para a construção de um patrimônio cultural desse contexto. Os resultados também indicam a importância das novas tecnologias como meios de comunicação e informação desses dados de interesse público, com destaque para as narrativas transmídia, presentes em algumas das plataformas analisadas, como formas narrativas contemporâneas que possibilitam a participação ativa e o engajamento de públicos diversos

The covid-19 pandemic has generated an increase in digital data repositories that record people's memories of the pandemic, giving rise to several virtual communities that promote the production of memories by sending life stories in different media. Based on an exploratory and documental study, this work presents a survey of digital platforms from different actions and university, cultural and media institutions, and civil society associations that have launched digital repositories to collect and share reports about people's experiences about the covid-19 pandemic. The analysis and the comparison of the memorial records of the repositories indicate the importance of life stories integrated with visual narratives composed of photographs and videos to build a more inclusive network of memories of the covid-19 pandemic, that is, a network based on the experiences of different publics and/or communities, constituting itself as a memory of public interest for the construction of a cultural heritage of this context. The results indicate the importance of new technologies as means of communication and information on this data of public interest, with emphasis on transmedia narratives ­ that are present in some of the platforms analyzed ­ as contemporary narrative forms that enable the active participation and engagement of different audiences

La pandemia de covid-19 generó un aumento de los repositorios de datos digitales que registran los recuerdos de las personas sobre la pandemia, dando lugar a varias comunidades virtuales que promueven la producción de memorias a través del envío de historias de vida en diferentes medios. A partir de un estudio exploratorio de carácter documental, este trabajo presenta una amplia y significativa relación de plataformas digitales de diferentes acciones y asociaciones universitarias, culturales, de medios de comunicación y de la sociedad civil que han puesto en marcha repositorios digitales para recopilar y compartir relatos sobre las experiencias de las personas sobre la pandemia de covid-19. El análisis y la comparación de los registros memoriales existentes en dichos repositorios indican la importancia de las historias de vida integradas con narrativas visuales compuestas de fotografías y videos para la construcción de una red de memorias más inclusiva de la pandemia del covid-19, es decir, un red a partir de las experiencias de diferentes públicos y/o comunidades, constituyéndose como una memoria de interés público para la construcción de un patrimonio cultural. Los resultados también indican la importancia de las nuevas tecnologías como medios de comunicación e información sobre estos datos de interés público, con énfasis en las narrativas transmedia, presentes en algunos de los analizados, como formas narrativas contemporáneas, que posibilitan la participación activa y el compromiso de diferentes audiencias

Severe bilateral visual loss as the first sign of IgA nephropathy / Perda visual bilateral grave como o primeiro sinal da nefropatia por IgA

ABSTRACT We describe a case of a 33-years-old woman who presents with severe acute bilateral visual loss secondary to massive exudative hypertensive maculopathy as the first sign of immunoglobulin A nephropathy. The patient's ophthalmic examination showed bilateral cotton-wool spots, flame-shaped retinal hemorrhages, diffuse narrow arterioles, optic disk edema, and exudative maculopathy. Systemic workup demonstrated a systolic and diastolic blood pressure of 240 mmHg and 160 mmHg, respectively, proteinuria, and hematuria, suggesting kidney disease as the causative condition. A kidney biopsy confirmed immunoglobulin A nephropathy. She was treated with systemic corticosteroids, antihypertensive drugs, and a single bilateral intravitreal injection of aflibercept. There was a prompt resolution of macular edema and vision improvement. Our case draws attention to the fact that severe bilateral visual loss can be the first sign of severe hypertension. Secondary causes, such as immunoglobulin A nephropathy, should be ruled out.

RESUMO Nosso objetivo é descrever uma paciente de 33 anos de idade, com perda visual bilateral grave por maculopatia hipertensiva exsudativa como o primeiro sinal da nefropatia por imunoglobulina A. A fundoscopia revelou a presença de manchas algodonosas, hemorragias em chama-de-vela, estreitamento arteriolar difuso, edema de disco óptico e maculopatia exsudativa bilateral. A pressão arterial sistólica foi de 240mmHg e a diastólica de 160 mmHg associado a proteinúria e hematúria, sugerindo a presença de doença renal. A biópsia renal confirmou a nefropatia por imunoglobulina A. A paciente foi tratada como corticoide sistêmico, drogas anti-hipertensivas e uma única dose intravítrea de Aflibercept em ambos os olhos. Houve rápida melhora do edema macular e da acuidade visual. Nosso caso chama a atenção para o fato de que a perda visual bilateral grave pode ser a primeira apresentação de uma doença hipertensiva sistêmica. Causas secundárias como a nefropatia por imunoglobulina A devem ser afastadas.

Compliance in handling of donated raw breast milk to human milk banks regarding microbiological quality / Conformidade no manuseio do leite materno cru doado aos bancos de leite humano em relação à qualidade microbiológica

Abstract Objectives: microbiological quality of raw human milk (HM) from donors at the HMB (Human Milk Bank) of Santa Casa de Misericórdia de Ouro Preto was evaluated. Methods: the microbiological quality of milk from each of 10 donors in triplicate (30 samples) was evaluated by enumeration of Staphylococcus aureus and total aerobic mesophiles (surface plating) and total and thermotolerant coliforms (Most Probable Number - MPN). A questionnaire and a checklist were applied after the end of sample collection to verify the compliance of milk extraction and storage procedures by the donors. Results: inadequacies in the procedures for expression and storage of donated HM were observed. The presence of all microorganisms studied were verified in the milk of all donors, and in some cases exceeded the safety limits. The checklist indicated that some necessary hygienic-sanitary procedures were not carefully performed, making it important to properly guide the donors. Conclusions: this study points to an unfavorable scenario for the safety and quality of donated HM, and it is important to encourage further studies to be conducted so that the Brazilian network of HMB adopts stricter criteria for instructions on procedures and support for HM donors.

Resumo Objetivos: avaliou-se a qualidade microbiológica do leite humano (LH) cru de doadoras do Banco de Leite Humano (BLH) da Santa Casa de Misericórdia de Ouro Preto. Métodos: a qualidade microbiológica do leite de cada uma das 10 doadoras em triplicata (30 amostras) foi avaliada por meio da enumeração de Staphylococcus aureus e mesóflos aeróbios totais (plaqueamento em superfície) e coliformes totais e termotolerantes (Número Mais Provável -NMP). Para verificar a conformidade dos procedimentos de extração e armazenamento do leite pelas doadoras, aplicou-se um questionário e um checklist após o término da coleta das amostras. Resultados: observou-se inadequações nos procedimentos de expressão e armazenamento do LH doado. A presença de todos os microrganismos estudados foram verificados no leite de todas as doadoras e, em alguns casos, excedeu os limites de segurança. O checklist indicou que alguns procedimentos higiênico-sanitários necessários não foram realizados criteriosamente, tornando importante orientar adequadamente as doadoras. Conclusões: este estudo aponta um cenário desfavorável para a segurança e a qualidade do LH doado, sendo importante incentivar mais estudos a serem realizados para que a rede brasileira de BLH adote critérios mais rigorosos de instruções sobre procedimentos e suporte para doadoras de LH.

Antimicrobial and Antioxidant Activity of Apricot (Mimusopsis comersonii) Phenolic-Rich Extract and Its Application as an Edible Coating for Fresh-Cut Vegetable Preservation.

Edible coatings have several advantages in preserving foods, such as avoiding water loss, controlling microbial growth, and reducing the need for preservatives added directly to the product. Antimicrobial action can be obtained by adding antimicrobial substances including phenolic compounds commonly found in plant extracts. This study evaluated the phenolic compounds content, antioxidant and antimicrobial activity of pulp, and seed extracts of Mimusopsis comersonii (popularly known in Brazil as abrico), besides the phenolic compounds were identified and quantified in the pulp extract. Edible coatings were incorporated with pulp extract in order to evaluate the preservation of minimally processed apples and baroa potatoes against foodborne bacteria, and enzymatic browning was also determined. Myricetin-3-glucoside, quercetin-3-glucoside, and kaempferol-3-glucoside were identified as major flavonoids in the apricot pulp extract. The seed and pulp extracts inhibited all tested microorganisms, especially Staphylococcus aureus and Salmonella Typhimurium. Edible coatings added with 9% of phenolic extract showed in vitro antimicrobial activity, in addition to being effective in preventing enzymatic browning in minimally processed apples and baroa potatoes for up to 15 days of storage. They were also effective in reducing up to 2 log CFU/g of aerobic mesophiles after 15 days of storage for apples, even though no microbial inhibition in baroa potatoes was observed under the same conditions. The addition of pulp phenolic extract in edible coatings proved to be an alternative in the preservation of apples and in the antibrowning activity of minimally processed baroa potatoes.

Severe bilateral visual loss as the first sign of IgA nephropathy.

We describe a case of a 33-years-old woman who presents with severe acute bilateral visual loss secondary to massive exudative hypertensive maculopathy as the first sign of immunoglobulin A nephropathy. The patient's ophthalmic examination showed bilateral cotton-wool spots, flame-shaped retinal hemorrhages, diffuse narrow arterioles, optic disk edema, and exudative maculopathy. Systemic workup demonstrated a systolic and diastolic blood pressure of 240 mmHg and 160 mmHg, respectively, proteinuria, and hematuria, suggesting kidney disease as the causative condition. A kidney biopsy confirmed immunoglobulin A nephropathy. She was treated with systemic corticosteroids, antihypertensive drugs, and a single bilateral intravitreal injection of aflibercept. There was a prompt resolution of macular edema and vision improvement. Our case draws attention to the fact that severe bilateral visual loss can be the first sign of severe hypertension. Secondary causes, such as immunoglobulin A nephropathy, should be ruled out.

O transtorno depressivo maior está associado ao diabetes mellitus tipo 2 em pacientes com hepatite C crônica / Major depressive disorder is associated with type 2 diabetes in patients with chronic hepatitis c infection

ABSTRACT BACKGROUND: Major depressive disorder (MDD) is commonly reported in patients with chronic hepatitis C (CHC); however, the factors behind the co-occurrence of these conditions have not been completely clarified yet. OBJECTIVE: We aimed to evaluate the frequency of mental disorders in CHC patients and to investigate variables associated with MDD. METHODS: CHC patients (n=151) attending a referral Centre for hepatitis were evaluated using the Mini-International Neuropsychiatry Interview and the Cut-Annoyed-Guilty-Eye (CAGE) Questionnaire. Multivariate analysis was used to evaluate independent covariates associated with current MDD. RESULTS: Seventy-six (50.3%) patients had, at least, one current psychiatric diagnosis with MDD (33.1%) being the most common. Current MDD was independently associated with age (≤50 yr.) (OR=2.57; 95%CI=1.25-5.29; P=0.01) and type 2 diabetes mellitus (OR=2.80, 95%CI=1.17-6.70; P=0.02). Cirrhosis was associated with type 2 diabetes mellitus (OR=5.09; 95%CI=1.73-15.04; P=0.03) and current alcohol abuse/dependence (OR=2.54; 95%CI=1.04-6.22; P=0.04). DISCUSSION: MDD is associated with type 2 diabetes in CHC patients. Even in the direct-acting antivirals (DAAs) era, characterized by great perspectives for the first ample cure of a chronic viral infection, we should ensure that the screening for psychiatric disorders takes place in the course of routine clinical care of patients chronically infected with hepatitis C virus.

RESUMO CONTEXTO: O transtorno depressivo maior (TDM) é comumente detectado em pacientes com hepatite C crônica. Entretanto, fatores potencialmente associados à coocorrência destas condições não são completamente conhecidos. OBJETIVO: Avaliar a frequência de transtornos mentais em pacientes com hepatite C crônica e investigar variáveis associadas ao TDM. MÉTODOS: Pacientes com hepatite C crônica (n=151) atendidos em um centro de referência para hepatite foram avaliados usando o Mini-International Neuropsychiatry Interview e o questionário Cut-Annoyed-Guilty-Eye (CAGE). Análise multivariada foi usada para avaliar as covariáveis independentes associadas ao TDM atual. RESULTADOS: Setenta e seis (50,3%) pacientes apresentaram pelo menos um diagnóstico psiquiátrico atual; dentre eles destaca-se o TDM (33,1%). TDM atual foi independentemente associado à idade (≤50 anos) (OR=2,57; IC95% = 1,25-5,29; P=0,01) e diabetes mellitus tipo 2 (OR=2,80, IC95% = 1,17-6,70; P=0,02). Cirrose foi associada ao diabetes mellitus tipo 2 (OR=5,09; IC95% = 1,73-15,04; P=0,03) e abuso/dependência de álcool atual (OR=2,54; IC95% = 1,04-6,22; P=0,04). DISCUSSÃO: TDM está associado a diabetes tipo 2 em pacientes com hepatite C crônica. Em vigência da era dos antivirais de ação direta, caracterizada por grandes perspectivas para a primeira cura ampla de uma infecção viral crônica, devemos assegurar que a triagem dos transtornos psiquiátricos ocorra durante o atendimento clínico de rotina de pacientes com infecção crônica pelo vírus da hepatite C.

A Relação entre Regurgitação Mitral e Implante Transcateter de Válvula Aórtica: um Estudo de Acompanhamento Multi-Institucional / Relationship between Mitral Regurgitation and Transcatheter Aortic Valve Implantation: a Multi-Institutional Follow-up Study

Resumo Fundamento A regurgitação mitral (RM) é prevalente em pacientes submetidos a implante transcateter de válvula aórtica (TAVI). Há algumas controvérsias sobre o impacto prognóstico da RM na sobrevida de pacientes submetidos a TAVI. Objetivo Examinar a relação entre TAVI e RM em uma população de pacientes do Registro Brasileiro de TAVI. Métodos Setecentos e noventa e cinco pacientes do Registro Brasileiro de TAVI foram divididos na linha de base, alta e acompanhamento de acordo com o grau da RM da maneira seguinte: ausente/leve (RMAL) ou moderado/grave (RMMG). Eles foram subsequentemente reagrupados de acordo com as mudanças imediatas e tardias na gravidade da RM após TAVI da maneira seguinte: RM sem mudança, melhora ou piora. Foram analisados os preditores e o impacto prognóstico na linha de base, bem como as mudanças na gravidade da RM. A significância estatística foi estabelecida em p < 0,05. Resultados RMMG basal estava presente em 19,3% dos pacientes e foi um preditor de aumento da mortalidade tardia. Imediatamente após o TAVI, 47,4% dos casos melhoraram para RMAL, previsto por uma pontuação mais alta da Society of Thoracic Surgeons e um grau mais alto de regurgitação aórtica basal. No acompanhamento, 9,2% dos casos de RMAL pioraram para RMMG, enquanto 36,8% dos casos de RMMG melhoraram para RMAL. Fração de ejeção do ventrículo esquerdo (FEVE) mais baixa na linha de base e melhora na FEVE durante o acompanhamento foram preditores de melhora da RM. Piora progressiva da RM no acompanhamento foi um preditor independente de maior mortalidade tardia após TAVI (p = 0,005). Conclusões A RMMG na linha de base é um preditor de mortalidade tardia após TAVI. FEVE mais baixa e melhora na FEVE durante o acompanhamento são preditores de melhora da RM após TAVI. A pior progressiva da gravidade da RM durante o acompanhamento é um preditor independente de mortalidade tardia; isto é um achado raro na literatura.

Abstract Background Mitral regurgitation (MR) is prevalent in patients undergoing transcatheter aortic valve implantation (TAVI). There are some controversies about the prognostic impact of MR in survival of TAVI patients. Objective To examine the relationship between TAVI and MR in a patient population from the Brazilian TAVI Registry. Methods Seven hundred and ninety-five patients from the Brazilian TAVI Registry were divided at baseline, discharge, and follow-up according to their MR grade as follows: absent/mild (AMMR) or moderate/severe (MSMR). They were subsequently regrouped according to their immediate and late changes in MR severity after TAVI as follows: no change, improved, or worsened MR. Predictors and prognostic impact on baseline as well as changes in MR severity were analyzed. Statistical significance was set at p < 0.05. Results Baseline MSMR was present in 19.3% of patients and was a predictor of increased late mortality. Immediately after TAVI, 47.4 % of cases improved to AMMR, predicted by a higher Society of Thoracic Surgeons score and a higher grade of baseline aortic regurgitation. Upon follow-up, 9.2% of cases of AMMR worsened to MSMR, whereas 36.8% of cases of MSMR improved to AMMR. Lower baseline left ventricular ejection fraction (LVEF) and improvement in LVEF at follow-up were predictors of MR improvement. Progressive worsening of MR upon follow-up was an independent predictor of higher late mortality after TAVI (p = 0.005). Conclusions Baseline MSMR predicts late mortality after TAVI. Lower LVEF and improved LVEF at follow-up predict MR improvement after TAVI. Progressive worsening of MR severity at follow-up is an independent predictor of late mortality, which is a rare finding in the literature.

O desafio do HIV em idosos: uma análise qualitativa da atuação de médicos da atenção primária à saúde em Porto Alegre/RS / The challenge of HIV among the elderly population: a qualitative analysis of the performance of primary care physicians in Porto Alegre city, Brazil / El desafio del HIV en ancianos: una analisis qualitativa de la atuación de los medicos de la atención primária de la salud en Porto Alegre/RS

Introdução: A transição demográfica que ocorre no território brasileiro traz para discussão o processo de transição epidemiológica que vivemos, onde as doenças infectas parasitárias somam-se às doenças crônicas não transmissíveis. Objetivo: Descrever a atuação dos médicos da Atenção Básica na prevenção primária e secundária em relação à infecção pelo HIV na população idosa atendida pela Atenção Primária à Saúde (APS) do município de Porto Alegre/RS. Metodologia: Estudo transversal, misto, realizado com médicos que atuam na APS em Porto Alegre/RS. Resultados: Evidenciou-se que a temática da sexualidade, infecções sexualmente transmissíveis, situações e grupos de risco e tratamento para o HIV são temas de menos conhecimento. Conclusões: Os médicos da rede básica de saúde não realizam prevenção primária e secundária para a infecção pelo HIV em idosos de forma rotineira

Introduction: The demographic transition that takes place in the Brazilian territory brings to the discussion the process of epidemiological transition that we live in, where infectious diseases add to non-communicable chronic diseases. Objective: To compare the performance of the doctors regarding primary and secondary prevention for HIV infection in the elderly population in Primary Care in the city of Porto Alegre/RS. Methodology: This is a cross-sectional, mixed study, applied to physicians working at Primary Care in Porto Alegre/RS. Results: It was evident that the theme of sexuality, sexually transmitted infections, situations and groups at risk and treatment for HIV are less well-known topics. Conclusions: Primary care physicians do not perform primary and secondary prevention for HIV infection in the elderly on a routine basis

Introducción: La transición demográfica que ocurre en el territorio brasileño trae para discusión el proceso de transición epidemiológica que vivimos, donde las enfermedades infectoparasitarias se suman a las enfermedades crónicas no transmisibles. Objetivo: Describir la actuación de los médicos en la prevención primaria y secundaria en relación a la infección por el VIH en la población anciana atendida por la Atención Primaria a la Salud (APS) del municipio de Porto Alegre/ RS. Metodología: Es un estudio transversal, mixto, relaizado con los médicos de la APS en Porto Alegre / RS. Resultados: Se envidenció que la tematica de la sexualidad, infecciones sexualmente trasmisibles, situaciones y grupos de riesgo y tratamiento para el VIH son temas de menos conocimiento. Conclusiones: Los médicos de la red basica de salud no pratican la prevención primária y secundária para la infección por el VIH en ancianos de manera rutinera

Ultrastructural changes detected using swept-source optical coherence tomography in severe vitreopapillary traction: a case report / Alterações ultraestruturais detectadas pela tomografia de coerência óptica de fonte de varredura em tração vitreopapilar grave: relato de caso

ABSTRACT Vitreopapillary traction is an uncommon condition characterized by strong adhesion and the traction of the posterior hyaloid onto the optic disc and peripapillary retina, leading to optic disc elevation and visual loss. An 85-year-old man presented with a 6-month history of slow, progressive visual loss in the left eye along with optic disc edema. Swept-source optical coherence tomography B-scans revealed circumpapillary anterior-posterior persistent traction of dense vitreous strands onto the optic disc. Visual field examination demonstrated mild, generalized, diffuse sensitivity loss and blind-spot enlargement. A 25-gauge posterior vitrectomy was performed with posterior hyaloid separation from the optic disc, resulting in significant anatomical and visual improvement. In conclusion, swept-source optical coherence tomography aids in understanding the mechanism underlying visual loss in vitreopapillary traction. Moreover, posterior vitrectomy can effectively promote anatomical and visual improvements in these cases.

RESUMO A tração vitreopapilar é uma condição incomum caracterizada por forte adesão e tração da hialoide posterior no disco óptico e retina peripapilar, levando à elevação do disco óptico e à perda visual. Um homem de 85 anos apresentou uma história de 6 meses de perda visual lenta e progressiva no olho esquerdo, juntamente com edema do disco óptico. A tomografia de coerência óptica por fonte de varredura revelou tração persistente ântero-posterior peripapilar com traves vítreas densas sobre o disco óptico. Exame de campo visual demonstrou perda de sensibilidade difusa, generalizada, leve e aumento do ponto cego. Uma vitrectomia posterior de calibre 25 foi realizada com separação hialóide posterior do disco óptico, resultando em melhora anatômica e visual significativa. Em conclusão, a tomografia de coerência óptica por fonte de varredura auxilia na compreensão do mecanismo subjacente à perda visual na síndrome de tração vitreopapilar. Além disso, a vitrectomia posterior pode efetivamente promover melhorias visuais e anatômicas nesses casos.

Ultrastructural changes detected using swept-source optical coherence tomography in severe vitreopapillary traction: a case report.

Vitreopapillary traction is an uncommon condition characterized by strong adhesion and the traction of the posterior hyaloid onto the optic disc and peripapillary retina, leading to optic disc elevation and visual loss. An 85-year-old man presented with a 6-month history of slow, progressive visual loss in the left eye along with optic disc edema. Swept-source optical coherence tomography B-scans revealed circumpapillary anterior-posterior persistent traction of dense vitreous strands onto the optic disc. Visual field examination demonstrated mild, generalized, diffuse sensitivity loss and blind-spot enlargement. A 25-gauge posterior vitrectomy was performed with posterior hyaloid separation from the optic disc, resulting in significant anatomical and visual improvement. In conclusion, swept-source optical coherence tomography aids in understanding the mechanism underlying visual loss in vitreopapillary traction. Moreover, posterior vitrectomy can effectively promote anatomical and visual improvements in these cases.

The combined polymorphisms of interleukin-6-174GG genotype and interleukin-10 ATA haplotype are associated with a poor quality of life in patients with chronic hepatitis C.

PURPOSE: Chronic hepatitis C (CHC) is associated with a decreased health-related quality of life (HRQOL). More recent studies have pointed toward a genetic basis of patient-reported quality of life outcomes. Taking into account that the influence of single-nucleotide polymorphisms (SNPs) on the HRQOL of CHC patients has not been studied, we investigated the combined IL10-1082G/A, - 819C/T, and - 592C/A SNPs, and IL6-174G/C SNP. We also evaluated the association between demographic, clinical, psychiatric, virological, and genetic variables with domains and summaries of HRQOL in CHC patients. METHODS: 132 consecutive CHC patients and 98 controls underwent psychiatric evaluation by using the Mini International Neuropsychiatric Interview. HRQOL was assessed by a generic questionnaire, the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36), and by the specific Liver Disease Quality of Life Questionnaire (LDQOL). IL6 and IL10 polymorphisms were evaluated by Taqman SNP genotyping assay. Multivariate analysis was used to evaluate the associations. RESULTS: Major depressive disorder was associated with lower SF-36 and LDQOL scores in seven and ten domains, respectively. Diabetes and hypertension were also associated with reduced HRQOL. CHC patients carrying the combination of IL10 ATA haplotype/IL6-GG genotype had lower scores in the SF-36-physical functioning domain, and reduced scores in the LDQOL effects of liver disease on activities of daily living, quality of social interaction, and sexual function domains than the non-carriers of the combined haplotype/genotype. CONCLUSION: This is the first study to demonstrate that combined IL6 high-producer GG genotype and IL10 low-producer ATA haplotype is associated with poorer HRQOL in CHC patients.

Interleukin-10 promoter gene polymorphisms are associated with the first major depressive episode in chronic hepatitis C patients.

AIMS: To investigate the association of IL10 SNPs in chronic hepatitis C (CHC) patients with and without the first major depressive episode (MDE), as well as their association with plasma levels of target cytokines. METHODS: A hundred and thirty two CHC patients (32 with and 100 without first MDE) and 98 controls were prospectively enrolled in this cross-sectional study. MDE was diagnosed by a psychiatrist, using the Mini International Neuropsychiatric Interview Plus 5.0. IL10 polymorphisms (-1082 G/A, -819C/T and -592C/A IL10 SNPs) were evaluated by Taqman SNP genotyping assay. Plasma concentrations of IL-2, IL-6, IL-10, IFN-γ and TNF-α were determined using the Human Th1/Th2 Cytometric Bead Array kit. The associations were investigated by logistic models. RESULTS: The frequencies of the studied IL10 SNPs did not differ between the CHC patients and controls. The first MDE was positive and independently associated with the IL10-1082*A, IL10-819*T and IL10-592*A (ATA) low producer haplotype (OR = 1.50; 95% CI = 1.11-2.04; P = 0.009) and current alcohol misuse (OR = 4.29; 95% CI = 1.22-15.05; P = 0.02), and inversely associated with increasing age (OR = 0.94; 95% CI = 0.91-0.98; P = 0.006). In addition, plasma level of TNF-α was significantly higher in the carriers than in the non-carriers of the IL10 ATA haplotype in patients with the first MDE. The IL-10 and IL-2 plasma levels were significantly higher in the carriers than in non-carriers of the IL10 GCC high producer haplotype, demonstrating the functionality of the studied IL10 polymorphisms. CONCLUSIONS: This is the first study to demonstrate that the IL10 low producer ATA haplotype is associated with the first MDE in patients with CHC.

Nonarteritic anterior ischemic optic neuropathy following pars plana vitrectomy for macular hole treatment: case report.

Herein, we report a case of nonarteritic anterior ischemic optic neuropathy (NAION) following uneventful pars plana vitrectomy for macular hole treatment. A 56-year-old previously healthy woman presented with a full-thickness macular hole in right eye (OD) and small cup-to-disc ratios in both eyes. Five days after surgery, she noticed sudden painless loss of vision in OD and was found to have an afferent pupillary defect and intraocular pressure of 29 mmHg. Fundus examination showed right optic disc edema and the resolution of a macular hole with an inferior altitudinal visual field defect. Erythrocyte sedimentation rate, C-reactive protein levels, and general physical examination findings were normal. She was treated with hypotensive eyedrops and oral prednisone, resulting in mild visual improvement and a pale optic disc. A combination of face-down position and increased intraocular pressure due to a small optic disc cup were considered as potential mechanisms underlying NAION in the present case. Vitreoretinal surgeons should be aware of NAION as a potentially serious complication and be able to recognize associated risk factors and clinical findings.

Nonarteritic anterior ischemic optic neuropathy following pars plana vitrectomy for macular hole treatment: case report / Neuropatia óptica isquêmica anterior não arterítica pós vitrectomia pars plana para tratamento do buraco macular: relato de caso

ABSTRACT Herein, we report a case of nonarteritic anterior ischemic optic neuropathy (NAION) following uneventful pars plana vitrectomy for macular hole treatment. A 56-year-old previously healthy woman presented with a full-thickness macular hole in right eye (OD) and small cup-to-disc ratios in both eyes. Five days after surgery, she noticed sudden painless loss of vision in OD and was found to have an afferent pupillary defect and intraocular pressure of 29 mmHg. Fundus examination showed right optic disc edema and the resolution of a macular hole with an inferior altitudinal visual field defect. Erythrocyte sedimentation rate, C-reactive protein levels, and general physical examination findings were normal. She was treated with hypotensive eyedrops and oral prednisone, resulting in mild visual improvement and a pale optic disc. A combination of face-down position and increased intraocular pressure due to a small optic disc cup were considered as potential mechanisms underlying NAION in the present case. Vitreoretinal surgeons should be aware of NAION as a potentially serious complication and be able to recognize associated risk factors and clinical findings.

RESUMO Nosso objetivo é descrever a ocorrência de neuropatia óptica isquêmica anterior não-arterítica (NOIA-NA) após vitrectomia posterior para tratamento do buraco macular. Uma mulher de 56 anos de idade previamente hígida apresentou buraco macular de espessura total no olho direito (OD) e uma relação escavação disco pequena em ambos os olhos. No quinto dia de pós-operatório ela notou uma perda visual súbita e indolor OD associado a presença de um defeito pupilar aferente relativo e pressão intraocular de 29 mmHg neste mesmo olho. A avaliação do fundo de olho revelou a presença de edema de disco óptico e buraco macular fechado OD associado a presença de defeito de campo visual altitudinal inferior. A velocidade de hemossedimentação e a dosagem da proteína C reativa foram normais, assim como o exame físico geral. A paciente foi tratada com colírios hipotensores e prednisona oral e evoluiu com discreta melhora visual e palidez de disco óptico. Acreditamos que a combinação de posição de cabeça virada para baixo associado a um aumento da pressão intraocular em um paciente com relação escavação disco pequena são os possíveis mecanismos para a ocorrência de NOIA-NA neste presente caso. Os cirurgiões de retina e vítreo devem estar atentos a esta possível grave complicação e reconhecer os seus fatores de risco relacionados assim como sua apresentação clinica.

Monitoria acadêmica e o cuidado da pessoa com estomia: relato de experiência / Academic mentoring and care for a person with a stoma: experience report / Prácticas academicas y atención para personas ostomizadas: relato de la experiencia

Este estudo tem como objetivo relatar uma experiência de monitoria do curso de graduação em Enfermagem com uma equipe de monitores que foi composta de cinco estudantes sobre o processo de cuidar no período pré-operatório de cirurgia geradora de estomia. Método: estudo descritivo, tipo relato de experiência, desenvolvido no hospital universitário na cidade de Belém-PA, Brasil, no período de março de 2011 a dezembro de 2012, durante aulas práticas na Atividade Curricular Enfermagem Médico-Cirúrgica, tomando como referência o processo decuidar de pessoas com estomia. Resultados: a monitoria é processo de ensino-aprendizagem que contribui para o desenvolvimento acadêmico concretamente. Conclusão: as atividades desenvolvidas na monitoria impulsionam o aprendizado dos demais estudantes sob a responsabilidade docente e, principalmente, as ações de educação em saúde frente ao processo de reabilitação de pessoas com estomia.

This study aimed to report an experience of academic mentoring of the care process in the perioperative period of ostomy surgery in anundergraduate nursing course, with a group of mentors consisting of five students. Method: A descriptive experience report study conducted at theuniversity hospital in Belém/PA/Brazil, from March of 2011 to December of 2012, during clinical classes on curricular activity in medical-surgical nursing, taking as reference the process of caring for people with a stoma. Results: Mentoring is a teaching-learning process that contributes toconcrete academic development. Conclusion: The mentoring activities stimulate learning by other students under the teaching responsibility, alongwith the actions of health education across the rehabilitation process of people with a stoma.

Este estudio tiene como objetivo describir una experiencia de monitoreo del curso de grado en Enfermería con un equipo de 5 monitores durante elperíodo pre operatorio de cirugía de ostomía. Se trata de un estudio descriptivo, tipo relato de experiencia, desarrollado en el hospital universitariode la ciudad de Belém / PA / Brasil, entre marzo de 2011 y diciembre de 2012, durante las clases prácticas de la asignatura Enfermería Médico quirúrgica,tomando como referencia el proceso de atención de pacientes ostomizados. El monitoreo es el proceso de enseñanza-aprendizaje que contribuye al desarrollo académico específicamente. Estas prácticas impulsan el aprendizaje de los demás estudiantes bajo responsabilidad de los docentes y, principalmente, las acciones de educación en salud ante el proceso de rehabilitación de los pacientes ostomizados.

Depression rather than liver impairment reduces quality of life in patients with hepatitis C

Objective: Patients with chronic hepatitis C (CHC) have a poorer quality of life than those with other chronic liver diseases. However, some of the factors that determine health-related quality of life (HRQOL) in these patients, such as the degree of liver fibrosis, are still controversial. Therefore, the aim of the present study was to investigate the impact of CHC on HRQOL by conducting clinical, psychiatric, and sociodemographic evaluations. Methods: One hundred and twenty-four consecutive patients attending a referral center for hepatitis were evaluated using the Mini-International Neuropsychiatry Interview, the Hamilton Depression Rating Scale, the Hospital Anxiety and Depression Scale, and the Medical Outcomes Study 36-Item Short-Form Health Survey. Multiple linear regression analyses were used to quantify independent associations between HRQOL and the clinical, psychiatric, and sociodemographic variables of interest. Results: Reduced HRQOL was independently associated with major depressive disorder (MDD) and with elevated levels of alanine aminotransferase, but was not associated with hepatic cirrhosis. Conclusions: MDD rather than the grade of liver fibrosis was strongly associated with HRQOL impairment in patients with CHC. These findings highlight that, in patients with CHC, the psychological effects of the disease deserve more attention and the implementation of integrated medical, psychiatric, and psychological care may be helpful. .