Uso da realidade virtual durante a punção venosa em crianças hospitalizadas: estudo descritivo / Use of virtual reality during venipuncture procedures in hospitalized children: a descriptive study / Uso de realidad virtual durante la venopunción en niños hospitalizados: estudio descriptivo

OBJETIVO: Descrever o uso da realidade virtual durante a punção venosa em crianças hospitalizadas. MÉTODO: Estudo descritivo, de abordagem quantitativa, realizado por meio de observação da punção venosa em crianças em uso de óculos de realidade virtual, em uma unidade de internação pediátrica de um hospital da região noroeste do Paraná. Os dados foram coletados no período de agosto a setembro de 2019. RESULTADOS: Foram observadas 16 crianças com idades entre quatro e oito anos que receberam o procedimento concomitante ao uso dos óculos. Os escores de dor foram predominantemente leves em ambas as faixas etárias e o comportamento psicotomotor mais evidenciado foi um desconforto pequeno. CONCLUSÃO: O estudo demonstrou que as punções realizadas com o uso da realidade virtual apresentaram escores de dor leves e no tangente ao manejo da dor, seu uso pode ser uma alternativa benéfica dentro da assistência pediátrica na realização de procedimentos dolorosos.

OBJECTIVE: To describe the use of Virtual Reality during venipuncture procedures in hospitalized children. METHOD: A descriptive study with a quantitative approach, carried out through observation of venipuncture procedures in children using Virtual Reality glasses at a pediatric inpatient unit of a hospital in the Northwest region of Paraná. The data were collected from August to September 2019. RESULTS: A total of 16 children were observed, aged between four and eight years old and who were subjected to the procedure along with use of the glasses. The pain scores were predominantly mild in both age groups and the most evident psychomotor behavior was minor discomfort. CONCLUSION: The study showed that the punctures performed using Virtual Reality presented mild pain scores and that, in terms of pain management, its use can be a beneficial alternative within pediatric care in the performance of painful procedures.

OBJETIVO: Describir el uso de la realidad virtual durante la venopunción en niños hospitalizados. MÉTODO: Estudio descriptivo, con enfoque cuantitativo, realizado mediante la observación de la venopunción en niños que usaban lentes de realidad virtual, en una unidad de hospitalización pediátrica de un hospital en la región noroeste de Paraná. Los datos se recolectaron de agosto a septiembre de 2019. RESULTADOS: se observaron 16 niños de cuatro a ocho años que recibieron el procedimiento concomitantemente con el uso de lentes. En ambas franjas etarias predominaron los puntajes de dolor leves y el comportamiento psicomotor más evidente fue el malestar leve. CONCLUSIÓN: El estudio demostró que las punciones realizadas durante el uso de realidad virtual presentaron puntajes de dolor leve y en lo que respecta al manejo del dolor, su uso puede ser una alternativa beneficiosa dentro de la atención pediátrica en la realización de procedimientos dolorosos.

Development of fluorescent- and radio-traceable T1307-polymeric micelles as biomedical agents for cancer diagnosis: biodistribution on 4T1 tumor-bearing mice

Abstract In recent years, nanocarriers have been studied as promising pharmaceutical tools for controlled drug-delivery, treatment-efficacy follow-up and disease imaging. Among them, X-shaped amphiphilic polymeric micelles (Tetronic®, poloxamines) display great potential due to their biocompatibility and non-toxic effects, among others. In the present work, polymeric micelles based on the T1307 copolymer were initially decorated with a 4,4-difluoro-4-bora-3a,4a-diaza-s-indacene (BODIPY)-fluorophore in order to determinate its in vivo biodistribution on 4T1 tumor-bearing mice. However, unfavorable results with this probe led to two different strategies. On the one hand, the BODIPY-micelle-loaded, L-T1307-BODIPY, and on the other hand, the 99mTc-micelle-radiolabeled, L-T1307- 99m Tc, were analyzed separately in vivo. The results indicated that T1307 accumulates mainly in the stomach, the kidneys, the lungs and the tumor, reaching the maximum organ-accumulation 2 hours after intravenous injection. Additionally, and according to the results obtained for L-T1307- 99m Tc, the capture of the polymeric micelles in organs could be observed up to 24 hours after injection. The results obtained in this work were promising towards the development of new radiotracer agents for breast cancer based on X-shaped polymeric micelles.

Effects of exogenous ghrelin on the tissue structure and somato-statin secretion in the pancreas of African ostrich chicks / Efectos de la grelina exógena en la estructura del tejido y la secreción de somato-estatinas en el páncreas de los polluelos de avestruz africanos

SUMMARY: This study aimed to investigate the effect of exogenous ghrelin on pancreatic growth and development in African ostrich chicks. Sixteen 40-day-old African ostrich chicks (male or female) were randomly divided into four groups and injected intravenously metatarsal vein with saline (control) or ghrelin (10, 50, and 100 μg/kg) for 6 days. Body and pancreas weight were determined, structural characteristics were observed using HE staining, somatostatin-immunopositive cells were detected using immunohistochemistry. The results were as follows: 1. The 50 and 100 μg/kg groups showed lower relative pancreas weight than the control group (P 0.05. Moreover, compared with the control, the islet cells in treatment groups were loosely arranged and showed reduced cytoplasm. In the exocrine pancreas, the volume of acinar cells in the 10, 50, and 100 μg/kg groups all decreased to varying degrees. 3. Somatostatin immunopositive cells were mainly located around the periphery of the islets and sporadically distributed in the center. The density of the somatostatin immunopositive cells in the 10, 50, and 100 μg/kg groups was higher than that in the control (P < 0.05). These findings suggest that exogenous ghrelin increases the area and number of islets and number of somatostatin immunopositive cells but reduces relative pancreas weight and effects the morphological and structural development of the pancreas, which may inhibit the pancreatic growth and development in African ostrich chicks.

RESUMEN: Este estudio tuvo como objetivo investigar el efecto de la grelina exógena sobre el crecimiento y desarrollo del páncreas en polluelos de avestruz africana. Dieciséis pollos de avestruz africana de 40 días (machos o hembras) se dividieron al azar en cuatro grupos y se inyectaron por vía intravenosa con solución salina (control) o grelina (10, 50 y 100 μg / kg) durante 6 días. determinadas, se observaron las características estructurales mediante tinción Hematoxilina-Eosina, se detectaron células inmunopositivas a somatostatina mediante inmunohistoquímica. Los resultados fueron los siguientes: ¨Los grupos de 50 y 100 μg / kg mostraron un menor peso relativo del páncreas que el grupo de control (P <0,05). El área de islotes por unidad de área del páncreas fue mayor en los grupos de 10, 50 y 100 μg / kg grupos que en el grupo de control (P <0,05). El número de islotes por unidad de área del páncreas fue menor en el grupo de 10 μg / kg que en el control (P <0,05). Además, en comparación con el control, las células de los islotes en los grupos de tratamiento estaban dispuestas de forma holgada y mostraban un citoplasma reducido. En el páncreas exocrino, el volumen de células acinares en los grupos de 10, 50 y 100 μg / kg disminuyó en diversos grados. Las células inmunopositivas de somatostatina se ubicaron principalmente alrededor de la periferia de los islotes y se distribuyeron esporádicamente en el centro. La densidad de las células inmunopositivas a la somatostatina en los grupos de 10, 50 y 100 μg / kg fue mayor que la del control (P <0,05). Estos hallazgos sugieren que la grelina exógena aumenta el área y el número de islotes y el número de células inmunopositivas a la somatostatina, pero reduce el peso relativo del páncreas, lo que puede inhibir el crecimiento y desarrollo pancreático en los polluelos de avestruz africana.

Percepção da criança hospitalizada acerca do brinquedo terapêutico instrucional na terapia intravenosa / Percepción del niño hospitalizado acerca del juguete terapéutico instructivo en la terapia intravenosa / Perception of the hospitalized child about the instructional therapeutic play in intravenous therapy

Resumo Objetivo analisar a percepção da criança hospitalizada quanto ao uso do brinquedo terapêutico instrucional no preparo para a terapia intravenosa. Método estudo descritivo, com abordagem qualitativa, realizado em um hospital pediátrico público no município de Juazeiro do Norte - Ceará, entre os meses de julho a setembro de 2019. Participaram do estudo 31 crianças em idade pré-escolar e escolar. Os dados foram coletados por meio de uma entrevista semiestruturada e, posteriormente, analisados por meio do software IRAMUTEQ. Resultados diante da percepção das crianças acerca da terapia intravenosa, foi averiguado que elas compreenderam a técnica a partir da utilização do brinquedo terapêutico instrucional. Quando a criança tem a oportunidade de brincar e dramatizar a terapia intravenosa, por meio do brinquedo terapêutico instrucional, a ansiedade, a dor, a angústia, a solidão, o medo e o choro são atenuados. Conclusões e implicações para a prática orientar as crianças quanto à realização da terapia intravenosa favorece sua compreensão quanto aos reais benefícios desta técnica para a sua saúde, possibilitando, ainda, a compreensão do enfermeiro quanto às condições que representam riscos para a criança e intervenha em tempo hábil por meio da utilização de estratégias que favoreçam a recuperação da saúde e a minimização de traumas subsequentes advindos da hospitalização.

Resumen Objetivo Analizar la percepción del niño hospitalizado cuanto al uso del juguete terapéutico instructivo en la preparación para la terapia intravenosa. Método Estudio descriptivo, con enfoque cualitativo, realizado en un hospital pediátrico público de la ciudad de Juazeiro do Norte - Ceará, entre julio y septiembre de 2019. Participaron 31 niños en edad preescolar y escolar. Los datos se recogieron mediante entrevista semiestructurada, posteriormente analizados con el software IRAMUTEQ. Resultados En vista de la percepción de los niños acerca de la terapia intravenosa, se encontró que ellos comprendieron la técnica a partir del uso del juguete terapéutico instructivo. Cuando tienen la oportunidad de jugar y dramatizar la terapia intravenosa, a través del juguete terapéutico instructivo, la ansiedad, el dolor, la angustia, la soledad, el miedo y el llanto son mitigados. Conclusiones e implicaciones para la práctica Orientar a los niños sobre la realización de la terapia intravenosa favorece su comprensión sobre los beneficios reales de esta técnica para su salud, permitiendo además que la enfermera comprenda las condiciones que suponen riesgos para el niño e intervenga de forma oportuna, mediante el uso de estrategias que favorezcan la recuperación de la salud y la minimización de traumas posteriores a la hospitalización.

Abstract Objective to analyze the perception of the hospitalized child regarding the use of the instructional therapeutic play in preparation for intravenous therapy. Method descriptive study, with a qualitative approach, performed in a public pediatric hospital in the city of Juazeiro do Norte - Ceará, between the months of July and September 2019. A total of 31 pre-school and school children participated in the study. The data were collected through a semi-structured interview, and later analyzed through IRAMUTEQ software. Results in view of the children's perception of intravenous therapy, it was found that they understood the technique, from the use of the instructional therapeutic play. When the child has the opportunity to play and dramatize intravenous therapy, through the instructional therapeutic play, the anxiety, the pain, the anguish, the loneliness, the fear and the crying are mitigated. Conclusion and implications for practice Orienting children in the performance of intravenous therapy favors their understanding of the real benefits of this technique for their health, allowing the nurse to understand the conditions that pose risks to the child, and intervene in a timely manner, through the use of strategies that favor the recovery of health and the minimization of subsequent trauma from hospitalization.

Endogenous endophthalmitis due to Kingella Kingae infectious endocarditis / Endoftalmite endógena por endocardite infecciosa devido a Kingella Kingae

Abstract This report presents a rare case of endogenous endophthalmitis due to Kingella kingae infectious endocarditis. Endogenous endophthalmitis is a rare condition that has a systemic underlying cause, with hematogenic dissemination of a pathogen that will eventually reach and infect the eye. In this article, we present a case of a 54-year-old woman with fever, chills and decreased visual acuity and pain in the right eye. The slit-lamp exam showed conjunctival injection, anterior chamber reaction with a great amount of fibrinous material obscuring her visual axis. Ultrasound echography revealed profuse exudates and scarce membranous formation in the posterior segment. Blood culture was positive for Kingella kingae, and the patient was treated with intravenous ceftriaxone, along with topic dexamethasone and mydriatic. After 15 days of intravenous antibiotic therapy, the patient exhibited best visual acuity of 20/60. Endogenous endophthalmitis is an ocular emergency that demands quick diagnosis and aggressive intervention in order to preserve vision. Therefore, it is important to recognize its signs and symptoms with no retard.

Resumo O presente relato apresenta um raro caso de endoftalmite endógena por endocardite devido à Kingella kingae. Endoftalmite endógena é uma doença pouco comum com uma causa sistêmica subjacente. A disseminação hematogênica de um microrganismo infeccioso leva à infecção ocular. Nesse artigo, apresentamos o caso de uma mulher com 54 anos, febre, calafrios, baixa da acuidade visual e dor em olho direito. Ao exame na lâmpada de fenda apresentava injeção conjuntival, reação de câmara anterior e acúmulo de fibrina no eixo visual. Ultrassonografia revelou exsudatos profusos e escassa formação membranosa em segmento posterior.A hemocultura foi positiva para Kingella kingae e a paciente foi tratada com ceftriaxone venoso conjuntamente com dexametasona e midriático tópicos. Após 15 dias de terapia antibiótica endovenosa, a paciente apresentou acuidade visual corrigida de 20/60. Endoftalmite endógena é uma emergência ocular que demanda rápido diagnóstico e intervenção agressiva para preservar a visão. Portanto, é importante o reconhecimento precoce dos sinais e sintomas.

Intraoperative Use of Analgesics in Tonsillar Fossa and Postoperative Evaluation with Visual analogue Scale Scores-A Prospective, Randomized, Placebo-Controlled, Double-Blind Clinical Trial

Abstract Introduction Posttonsillectomy pain results in significant morbidity to the patients. There is a disagreement in the literature regarding the use of local anesthetics during tonsillectomy. The aim of this placebo-controlled, double-blind study is to evaluate the effect of peritonsillar administration of local anesthetics. Objective To evaluate the role of intraoperative use of analgesics in tonsillar fossa and postoperative evaluation with visual analogue scale (VAS) scores in achieving pain relief after tonsillectomy procedure Methods In this study, 180 patients were randomized to 1 of the 6 groups: bupivacaine infiltration, lidocaine infiltration, normal saline infiltration, bupivacaine packing, lidocaine packing, and normal saline packing. Pain caused by speaking, swallowing, and on rest was assessed using VAS at 4, 8, 12, 16 hours, and at discharge. Results Significant analgesia was obtained in patients who received bupivacaine infiltration and packing compared with placebo (p < 0.05). The majority of the study subjects had no postoperative complications, and patients receiving bupivacaine infiltration required less additional analgesics in the first 24 hours after surgery. Conclusion We advocate the use of bupivacaine infiltration or packing immediately following the procedure to achieve adequate postoperative analgesia.

¿Puede el fentanilo intratecal disminuir la aparición de náuseas y vómito en comparación con ondansetrón intravenoso durante cesárea electiva? Revisión sistemática de la literatura y metaanálisis / Can intrathecal fentanyl decrease the occurrence of nausea and vomiting compared with intravenous ondansetron during elective cesarean section? Literature Systematic review and meta-analysis

Elective caesarean section is one of the surgeries with the highest intraoperative incidence of nausea, retching and vomiting (IONV), due, among other causes, to the use of anesthetics during the procedure. Some clinical trials have associated the use of low-dose intrathecal (IT) fentanyl with a lower incidence of nausea, retching and vomiting compared to other anesthetics used during caesarean sections. In this context, the objective of this meta-analysis was to evaluate the decrease in the appearance of nausea and vomiting during elective caesarean section with the application of IT fentanyl when compared with the use of intravenous ondansetron (EV). A systematic search was conducted in the main databases (PubMed, EMBASE, ClinicalTrials.gov, Cochrane Library and Google Scholar) for Randomized Clinical Trials (RCTs) that evaluated the use of IT fentanyl compared to ondansetron EV to decrease the occurrence and incidence of IONV during elective caesarean section. The meta-analysis showed a reduction in the incidence of nausea (RR 0.52, 95% CI 0.29-0.93, P = 0.03), gagging (RR 0.39, 95% CI 0, 18-0.88, P = 0.02) and vomiting (RR 0.26, 95% CI 0.11-0.64, P = 0.003) in the group of patients treated with IT fentanyl compared to the group treated with EV ondansetron. From the results, it is suggested that the administration of 12.5 to 20 µg of IT fentanyl may decrease the incidence of IONV in patients undergoing elective caesarean section, although the importance of more high-quality RCTs is highlighted.

La cesárea electiva es una de las cirugías con mayor incidencia intraoperatoria de náuseas, arcadas y vómito (NAV), debido entre otras causas, al uso de anestésicos durante el procedimiento. Algunos ensayos clínicos han asociado el uso de fentanilo intratecal (IT) a dosis bajas con una menor incidencia de náuseas, arcadas y vómito en comparación con otros anestésicos usados durante las cesáreas. En este contexto el objetivo de este metaanálisis fue evaluar la disminución en la aparición de náuseas y vómito durante cesárea electiva con la aplicación de fentanilo IT al compararlo con el uso de ondansetrón intravenoso (EV). Se realizó una búsqueda sistemática en las principales bases de datos (PubMed, EMBASE, ClinicalTrials.gov, Cochrane Library y Google Scholar) para ensayos clínicos aleatorizados (ECA) que evaluaron el uso del fentanilo IT en comparación con ondansetrón EV para disminuir la aparición e incidencia de IONV durante cesárea electiva. En el metaanálisis se evidenció una reducción en la incidencia de náusea (RR 0,52, 95% IC 0,29-0,93, P = 0,03), arcada (RR 0,39, 95% IC 0,18-0,88, P = 0,02) y vómito (RR 0,26, 95% IC 0,11-0,64, P = 0,003) en el grupo de pacientes tratados con fentanilo IT comparado con el grupo tratado con ondansetrón EV. A partir de los resultados, se sugiere que la administración de 12,5 a 20 µg de fentanilo IT puede disminuir la incidencia de NAV intraoperatorias en pacientes sometidas a cesárea electiva, aunque se resalta la importancia de más ECA de alta calidad.

Práticas de medicações injetáveis: conduta referida de profissionais de enfermagem / Prácticas de medicaciones inyectables: conducta referida de los profesionales de enfermería / Injectable medications: self-reported practices of nursing professionals

RESUMO Objetivo: Identificar a conduta referida de profissionais da enfermagem, do estado de São Paulo, sobre Práticas de Medicações Injetáveis. Método: Estudo tipo survey que identificou a frequência referida sobre Práticas de Medicações Injetáveis mediante resposta de questionário eletrônico, validado, entre setembro e dezembro de 2017. Resultados: Considerando as 1.295 respostas computadas, foram identificadas inconformidades como compartilhamento de frascos multidoses para dois ou mais pacientes (10,8%), reutilização de insumos de uso único, como seringas para salinização de pacientes diferentes (1,2%) e reencape de agulhas após uso (4,9%). Foram referidas maior adesão ao uso de luvas para administração de injeções endovenosas (80,5%) e falta de treinamento para manipulação de dispositivos de segurança (13%). Dados correlacionais apontaram que, quanto maior a idade, melhor era a conduta referida na prática de injetáveis. Conclusão: Embora a maioria das condutas configure-se dentro das Boas Práticas de Medicações Injetáveis, há relatos de práticas de risco, como compartilhamento de insumos de uso único. O treinamento para uso de dispositivos de segurança ainda não é uma realidade para todos os profissionais, visto que muitos o referiram como raro.

RESUMEN Objetivo: Identificar la conducta de profesionales de enfermería del estado de São Paulo sobre Prácticas de Medicaciones Inyectables. Método: Se trata de un estudio tipo survey, el cual identificó la frecuencia de Prácticas de Medicaciones Inyectables mediante respuesta de un cuestionario electrónico, validado entre septiembre y diciembre de 2017. Resultados: Teniendo en cuenta las 1.295 respuestas computadas, se identificaron inconformidades como el uso de frascos de dosis múltiples para dos o más pacientes (10,8%), la reutilización de insumos de un solo uso, como jeringas para la salinización de diferentes pacientes (1,2%) y el reencapuchado de agujas después de su uso (4,9%). Sobresalió la adhesión al uso de guantes para las inyecciones intravenosas (80,5%) y la falta de capacitación sobre la manipulación de dispositivos de seguridad (13%). Los datos correlativos señalaron que, a mayor edad, mejor la conducta referida en la práctica de los inyectables. Conclusión: Aunque la mayoría de las conductas se configuran dentro de las Buenas Prácticas de Medicaciones Inyectables, se informa sobre la existencia de prácticas de riesgo, como el compartir insumos de un solo uso. La capacitación en el uso de dispositivos de seguridad aún no es una realidad para todos los profesionales y muchos han declarado que raramente se los entrena en esa área.

ABSTRACT Objective: To identify the self-reported injectable medications of nursing professionals in the state of São Paulo. Method: Survey study that assessed the self-reported frequency of injection medications through a validated electronic questionnaire, applied from September to December 2017. Results: The 1,295 computed responses showed non-compliances such as sharing multidose vials for two or more patients (10.8%), reusing single-use supplies, such as use of saline flush syringes for different patients (1.2%) and needle recapping after use (4.9%). Greater adherence to glove use for administration of intravenous injections (80.5%) and lack of training for handling safety devices (13%) were reported. Correlational data showed that, the older the age, the better the self-reported injecting practices. Conclusion: Although most practices are within Safe Injecting practices, there are reports of risky practices, such as sharing single-use supplies. Training for the use of safety devices is not yet a reality for all professionals, since many reported it as rare.

Adrenal insufficiency and glucocorticoid use during the COVID-19 pandemic

The coronavirus disease 2019 (COVID-19) is an emerging pandemic challenge. Acute respiratory distress syndrome (ARDS) in COVID-19 is characterized by a severe cytokine storm. Patients undergoing glucocorticoid (GC) replacement therapy for adrenal insufficiency (AI) represent a highly vulnerable group that could develop severe complications due to the SARS-CoV-2 infection. In this review, we highlight the strategies to avoid an adrenal crisis in patients with AI and COVID-19. Adrenal crisis is a medical emergency and an important cause of death. Once patients with AI present symptoms of COVID-19, the dose of GC replacement therapy should be immediately doubled. In the presence of any emergency warning signs or inability to administer oral GC doses, we recommend that patients should immediately seek Emergency services to evaluate COVID-19 symptoms and receive 100 mg hydrocortisone by intravenous injection, followed by 50 mg hydrocortisone intravenously every 6 h or 200 mg/day by continuous intravenous infusion.

Prevention of infection from contrast agents

Until now, automatic contrast agent injector syringes licensed for consecutive one-time use have been employed with a number of patients. In 2016, regulation of automatic injector syringes ensured their single use, and reuse was strictly limited by law. However, this regulation creates the social problems of rising medical costs and resource waste. Many doctors are not significantly concerned about infection from contrast agent injection because the needle and connection lines on the patient side are set up for single use, the connections between syringes and contrast agents are reusable, and there are no reports of excessive infection. However, infection can nevertheless occur with injection of contrast agents. We should therefore implement the correct and safe use of contrast agents and take precautions against infection. To prevent infection due to contrast agents, syringes and connection lines for injection of such agents should be used once per patient, or multi-use licensed products should be used. In the latter case, reverse flow prevention filters must be used on the patient's side.

Two Case Reports of a Purtscher-like Retinopathy Occurring after Retrobulbar Anesthesia

PURPOSE: Although there are significant risks, retrobulbar anesthesia is commonly used for eye surgery. We report two cases of Purtscher-like retinopathy, a rare complication. CASE SUMMARY: (Case 1) A 76-year-old female visited our hospital because of decreased vision. She underwent right cataract surgery with retrobulbar anesthesia. After 7 days, she had decreased visual acuity (VA) and a constricted visual field. Multiple white spots and cotton wool spots around the optic nerve and post pole, macular edema (ME), and subretinal fluid (SRF) were found using a fundus examination. A non-perfusion area and staining of the vascular wall were seen using fluorescence angiography. Although carotid arterial angiography, thrombolysis, and intravenous injection of high-dose steroids were performed, the ME and SRF persisted. After intravitreal aflibercept was injected twice (2-month interval), the ME and SRF decreased and remained stable. (Case 2) A 61-year-old male underwent left cataract surgery with retrobulbar anesthesia. After anesthesia, the VA of the left eye was 10 cm finger count. The fundus examination showed multiple hemorrhage blots and retinal hemorrhages, and hyperfluorescence around the optic nerve and post pole; vascular wall staining revealed a Purtscher-like retinopathy. Left carotid arterial angiography, thrombolysis, and intravenous injection of high-dose steroids were then performed. After treatment, the VA of the left eye, ME, and SRF were improved at the 4-month follow-up. CONCLUSIONS: We report rare complications of retrobulbar anesthesia, with active and timely treatment having a positive impact on the visual prognosis.

Visual Loss with Ophthalmoplegia after Prone Position Spinal Surgery

PURPOSE: We report a case of acute visual loss with ophthalmoplegia after prone position spinal surgery who had blood supply dependence on collateral circulation due to occlusion of the Internal carotid artery. CASE SUMMARY: A 74-year-old man was referred to the department of ophthalmology for acute visual loss and ophthalmoplegia after lumbar spine surgery performed in prone position. On the initial visit, his right visual acuity was 0.8 and the left visual acuity was negative light perception. Intraocular pressure was normal. There was a relative afferent pupillary defect and ophthalmoplegia of all directions in the left eye. Because of the ptosis of the upper eyelid in the left eye, it was impossible to tune the eye voluntarily. The cherry red spot and pale retina were observed on the fundus examination. On brain magnetic resonance imaging angiography, we found complete obstruction of the left internal carotid artery. He had intravenous injection of 1 g methylprednisolone for 3 days, and discharged with per oral medicine. After 1 month of treatment, the ophthalmoplegia was slightly improved, but visual acuity was not recovered. CONCLUSIONS: In this case, unlike previous reports, acute visual loss and ophthalmoplegia occurred after spinal surgery the patient who had collateral circulation for ocular blood supply because of complete obstruction of the left internal carotid artery. This report highlights the importance of being aware of the anatomical variant in possible complications of external ocular compression after non-ocular surgery.

High-resolution Mapping of Hyperglycemia-induced Gastric Slow Wave Dysrhythmias

BACKGROUND/AIMS: It is now recognised that gastric dysrhythmias are best characterised by their spatial propagation pattern. Hyperglycemia is an important cause of gastric slow wave dysrhythmia, however, the spatiotemporal patterns of dysrhythmias in this context have not been investigated. This study aims to investigate the relationship between hyperglycemia and the patterns of dysrhythmias by employing high-resolution (multi-electrode) mapping simultaneously at the anterior and posterior gastric serosa. METHODS: High-resolution mapping (8 × 16 electrodes per serosal) was performed in 4 anesthetized hounds. Baseline recordings (21 ± 8 minutes) were followed by intravenous injection of glucagon (0.5 mg per dose) and further recordings (59 ± 15 minutes). Blood glucose levels were monitored manually using a glucose sensing kit at regular 5-minute intervals. Slow wave activation maps, amplitudes, velocity, anisotropic ratio, and frequency were calculated. Differences were compared between baseline and post glucagon injection. RESULTS: Baseline slow waves propagated symmetrically and antegrade. The blood glucose levels were increased by an average of 112% compared to the baseline by the end of the recordings. All subjects demonstrated elevated incidence of slow wave dysrhythmias following injection compared to the baseline (48 ± 23% vs 6 ± 4%, P < 0.05). Dysrhythmias arose simultaneously or independently on anterior and posterior serosa. Spatial dysrhythmias occurred before and persisted after the onset and disappearance of temporal dysrhythmias. CONCLUSIONS: Infusion of glucagon induced gastric slow wave dysrhythmias, which occurred across a heterogeneous range of patterns and frequencies. The spatial dysrhythmias of gastric slow waves were shown to be more prevalent and persisted over a longer period of time compared to the temporal dysrhythmias.

Effect of esmolol and lidocaine on agitation in awake phase of anesthesia among children: a double-blind, randomized clinical study / 中华医学杂志(英文版)

BACKGROUND@#Sevoflurane is widely used to anesthetize children because of its rapid action with minimal irritation of the airways. However, there is a high risk of agitation after emergence from anesthesia. Strabismus surgery, in particular, can trigger agitation because patients have their eyes covered in the postoperative period. The aim of this study was to determine whether or not esmolol and lidocaine could decrease emergence agitation in children.@*METHODS@#Eighty-four patients aged 3 to 9 years undergoing strabismus surgery were randomly assigned to a control group (saline only), a group that received intravenous lidocaine 1.5 mg/kg, and a group that received intravenous esmolol 0.5 mg/kg and lidocaine 1.5 mg/kg. Agitation was measured using the objective pain score, Cole 5-point score, and Richmond Agitation Sedation Scale score at the end of surgery, on arrival in the recovery room, and 10 and 30 min after arrival.@*RESULTS@#The group that received the combination of esmolol and lidocaine showed lower OPS and RASS scores than the other two groups when patients awoke from anesthesia (OPS = 0 (0-4), RASS = -4 [(-5)-1]) and were transferred to the recovery room (OPS = 0 (0-8), RASS = -1 [(-5)-3]) (P  0.05).@*CONCLUSIONS@#When pediatric strabismus surgery is accompanied by sevoflurane anesthesia, an intravenous injection of esmolol and lidocaine could alleviate agitation until arrival in the recovery room.@*TRIAL REGISTRATION@#Clinical Research Information Service, No. KCT0002925; https://cris.nih.go.kr/cris/en/search/search_result_st01.jsp?seq=11532.

Establishment of new evaluation standards for systemic anaphylactoid reactions using mouse model / 中国中药杂志

The detection of drug-induced anaphylactoid reactions remains a global challenge,still lacking mature and reliable animal models or test methods. Therefore,the purpose of this paper is to explore and establish the test methods and evaluation standards for anaphylactoid reactions that apply to injection drugs. Based on the anaphylactoid reaction symptoms of mice induced by intravenous injection drugs C48/40 and Tween 80,a list of systemic anaphylactoid reaction symptoms in mice was sorted out and an evaluation standard of anaphylactoid reactions symptoms was established by applying symptom intensity coefficient K( that can represent these verity of anaphylactoid reaction symptoms) and its calculation formula Accordingly,histamine,tryptase,and Ig E were selected as blood indicators of anaphylactoid reactions,so that a test method combining symptoms evaluation and blood makers detection was established.This test method could be used to evaluate the characteristics of anaphylactoid reactions: coefficient K,blood histamine levels were highly and positively correlated with C48/80 and Tween 80 dose; The log value of histamine was highly and positively correlated with K; tryptase level may rise,or remain steady,or drop,possibly associated with the characteristics of the tested object and time for blood taking; and Ig E level would drop or remain steady,but it would not rise,which can be clearly distinguished from type I allergic reactions. On this basis,tiohexol,iopromide,paclitaxel,Xuesaitong Injection,Shuanghuanglian Injection and Shengmai Injection were used to investigate the applicability. The testing results showed a high degree of consistency with the actual clinical situation. The results suggest that the method of systemic anaphylaxis test in mice has high sensitivity,specificity and good consistency with clinical practice.It is suggested to be further validated and popularized.

Appropriate Prophylactic Antibiotic Use in Clean Wound Surgery Under Local Anesthesia

BACKGROUND: Although guidelines to prevent surgical site infections (SSIs) were published more than a decade ago, prophylactic antibiotics are still used subjectively in clinical practice. In this study, we evaluated the safety of single-dose preoperative intravenous antibiotics without postoperative antibiotics in the field of clean wound surgery performed under local anesthesia. We also surveyed the present clinical conditions for prophylactic antibiotic use in the plastic surgery departments of training hospitals in Korea. METHODS: A total of 360 consecutive patients who underwent clean wound surgery under local anesthesia in an outpatient clinic from March 2018 to October 2018 were reviewed. In the study group, a single surgeon administered first-generation cephalosporins intravenously within 1 hour of skin incision and did not prescribe additional antibiotics. In the control group, 2 other surgeons prescribed oral first-generation cephalosporins postoperatively for 2 to 3 days without preoperative antibiotics. A telephone survey about perioperative antibiotic regimens was conducted at the departments of plastic surgery in training hospitals. RESULTS: There were 128 patients in the study group and 232 patients in the control group. There were no significant differences between the 2 groups regarding SSIs and other surgical complications. A total of 41 training hospitals answered the survey and every hospital had protocols of prescribing postoperative oral antibiotics routinely at the time of discharge with a mean duration of 3.9 days. Only 11 hospitals (26.8%) prescribed parenteral antibiotics before surgery as well as postoperative oral antibiotics. CONCLUSION: Intravenous injection of single-dose first-generation cephalosporins 1 hour before surgery without postoperative antibiotics did not increase the incidence of SSIs compared with the usual practice of giving only postoperative antibiotics prescription for 2 to 3 days in cases of clean wound surgery performed under local anesthesia. Proper antibiotic prophylaxis should be performed by surgeons in training hospitals without hesitation.

The Clinical Investigation Study of Pancreatitis Developed in Burn Patients

PURPOSE: To find progression and prognosis of pancreatitis developed in massive burn patients through retrospective analysis. METHODS: A retrospective study was conducted on 32 patients with abnormal increase of serum lipase level among 2523 acute burn patients admitted to our burn center from January 1, 2017 to June 30, 2018. Pancreatitis in this study was defined as a serum lipase concentration level that is higher than 180 IU/L which is three times more than the normal level (less than 60 IU/L). In this study, a retrospective analysis was performed on patients with serum lipase level higher than 300 IU/L to better understand causality of burns and pancreatitis. RESULTS: 32 patients (1.27%) had serum lipase level higher than 180 IU/L among 2523 acute burn subjects. And 13 patients (0.52%) of these 32 patients had serum lipase level elevated more than 300 IU/L. The study indicated serum lipase level was increased around 7 days after the injury. It returned to normal level early as after 1 to 2 weeks and late as after 4 to 6 weeks of injury. The serum amylase level was increased as similar modality as to the serum lipase level increase. The serum bilirubin, AST, ALT, LD, and GGT were also observed to be elevated when serum lipase was more than 1000 IU/L. CONCLUSION: The pancreatitis developed in burn patients are mostly as mild symptom. It could due to the ischemic injury and can easily be treated by a temporary fasting, TPN, and Gabexate intravenous injection.

Polymeric Nanoparticles Containing Both Antigen and Vitamin D₃ Induce Antigen-Specific Immune Suppression

The active form of vitamin D3, 1,25-dihydroxyvitamin D₃ (aVD₃), is known to exert beneficial effects in the treatment of autoimmune diseases because of its immunosuppressive effects. However, clinical application of aVD₃ remains limited because of the potential side effects, particularly hypercalcemia. Encapsulation of aVD₃ within biodegradable nanoparticles (NPs) would enhance the delivery of aVD₃ to antigen presenting cells, while preventing the potential systemic side effects of aVD₃. In the present study, polymeric NPs containing ovalbumin (OVA) and aVD₃ (NP[OVA+aVD₃]) were prepared via the water-in-oil-in-water double emulsion solvent evaporation method, after which their immunomodulatory effects were examined. Bone marrow-derived immature dendritic cells (DCs) treated with NP(OVA+aVD₃) did not mature into immunogenic DCs but were converted into tolerogenic DCs, which express low levels of co-stimulatory molecules and MHC class II molecules, produce lower levels of pro-inflammatory cytokines while increasing the production of IL-10 and TGF-β, and induce the generation of Tregs. Intravenous injection with NP(OVA+aVD₃) markedly suppressed the generation of OVA-specific CTLs in mice. Furthermore, OVA-specific immune tolerance was induced in mice orally administered with NP(OVA+aVD₃). These results show that biodegradable NPs encapsulating both antigen and aVD₃ can effectively induce antigen-specific immune suppression.

A case of potentially lethal vascular variation in association with palmaris profundus muscle / 대한해부학회지

Arterial variations in upper limbs are often reported commonly. Superficial arterial variations accounting for 4.2% of all arterial variations are hazardous during any invasive procedures of the upper limb, from routine intravenous injections to surgeries. Arterial variations are usually associated with inverted or absent palmaris longus. Palmaris profundus, a rare anomalous variation of palmaris longus has been reported in carpal tunnel syndrome as its tendon was associated with median nerve in the carpal tunnel. The authors reported a unique variation in the upper limb arterial pattern—the presence of bilateral superficial brachioulnar artery associated with unilateral palmaris profundus muscle and an abnormal radicle of musculocutaneous nerve to the median nerve in the left side.

User-Friendly Vendor-Specific Guideline for Pediatric Cardiothoracic Computed Tomography Provided by the Asian Society of Cardiovascular Imaging Congenital Heart Disease Study Group: Part 1. Imaging Techniques

Optimal performance of pediatric cardiothoracic computed tomography (CT) is technically challenging and may need different approaches for different types of CT scanners. To meet the technical demands and improve clinical standards, a practical, user-friendly, and vendor-specific guideline for pediatric cardiothoracic CT needs to be developed for children with congenital heart disease (CHD). In this article, we have attempted to describe such guideline based on the consensus of experts in the Asian Society of Cardiovascular Imaging CHD Study Group. This first part describes the imaging techniques of pediatric cardiothoracic CT, and it includes recommendations for patient preparation, scan techniques, radiation dose, intravenous injection protocol, post-processing, and vendor-specific protocols.