Glaucoma triage system: results of implementing a virtual clinic.

PURPOSE: This study describes the virtual clinic triage system implementation process at Hospital Santa Maria-Centro Hospitalar Universitário Lisboa Norte (HSM-CHULN) and analyzes its results regarding healthcare outcomes for the patients and the system. METHODS: A retrospective analysis was performed, comparing two cohorts (pre-virtual cohort; virtual triage cohort). Outcomes related to waiting time, number of hospital visits, decisions at first contact, and ancillary exam-based decisions were reported. RESULTS: Two hundred and ninety-two charts were reviewed (pre-virtual cohort: 132; virtual cohort: 160). Mean waiting time between referral and the first medical contact with the glaucoma department decreased on average by 71.3 days (human contact: 286.6 days; virtual triage contact: 215.3 days). Triage system significantly decreased waiting time for glaucoma patients, with an average decrease of 326.8 days between referral and treatment decision. Triage staging allowed to label 107 (66.9; 95% confidence intervals (CI): 59.6%, 74.2%) as non-urgent; 30 (18.8%; 95% CI: 12.7%, 24.9%) as urgent, and 23 (14.3%; 95% CI: 8.9%, 19.7%) as immediate contact, with the scheduling of future appointments reflecting National Institute for Health and Care Excellence (NICE) guidelines in every patient. Moreover, the number of visits to perform the same exams and obtain the same clinical decisions was reduced by 63.6%. CONCLUSION: Our virtual screening strategy significantly decreased waiting time, number of hospital visits, and increased chances of data-assisted clinical decision. While results can be further improved, this system can add value in an overburdened healthcare system, where triage systems with remote decision-making may be valuable tools in optimizing glaucoma care, even without allocation of extra resources.

TabPath: interactive tables for metabolic pathway analysis.

Motivation: Information about metabolic pathways in a comparative context is one of the most powerful tool to help the understanding of genome-based differences in phenotypes among organisms. Although several platforms exist that provide a wealth of information on metabolic pathways of diverse organisms, the comparison among organisms using metabolic pathways is still a difficult task. Results: We present TabPath (Tables for Metabolic Pathway), a web-based tool to facilitate comparison of metabolic pathways in genomes based on KEGG. From a selection of pathways and genomes of interest on the menu, TabPath generates user-friendly tables that facilitate analysis of variations in metabolism among the selected organisms. Availability and implementation: TabPath is available at http://200.239.132.160:8686. Contact: lmmorei@gmail.com.

Maculopapular rash of unsuspected cause: systemic contact dermatitis to cinchocaine.

Topical medications are frequently neglected as the potential cause of systemic drug reactions. In this case report, a patient with a maculopapular eruption attributed to a drug hypersensitivity reaction was submitted to skin patch tests in order to clarify the drug implicated. Incidentally, a positive reaction to cinchocaine was observed. With the ulterior confirmation of the application of an antihemorrhoidal ointment containing cinchocaine, which was omitted during the initial anamnesis, the diagnosis of systemic contact dermatitis to cinchocaine was made.

Idiopathic perniosis of the buttocks and thighs - clinical report.

Perniosis manifests as inflammatory cutaneous lesions mostly located on acral skin in association with cold and damp conditions. Perniosis of the thighs is quite uncommon and has been associated in the literature with horse riding (equestrian perniosis) or with other recreational activities with long time exposure to cold and humidity. We report a rare case of perniosis of the buttocks and thighs in a 34-year-old healthy woman without a previous history of horse riding or other high-risk activities. In this case, the use of thin and tight clothes is believed to have been enough for the development of perniosis in this susceptible subject.

Design and Development of a Web-Based Prospective Nationwide Registry for Ocular Inflammatory Diseases: UVEITE.PT - The Portuguese Ocular Inflammation Registry.

Uveitis is a heterogeneous collection of infrequent diseases, which poses significant challenges to cost-effective research in the field. Medical registries are being increasingly recognized as crucial tools to provide high-quality data, thus enabling prospective clinical research. This paper describes the design and technical structure development of an innovative countrywide electronic medical record for uveitis, Uveite.pt, and gives an overview of the cohort registered since its foundation, March 2020.Uveite.pt is an electronic medical record platform developed by the Portuguese Ocular Inflammation Group (POIG), a scientific committee of the Portuguese Ophthalmology Society. This is a nationwide customized web-based platform for uveitis patients useful for both clinical practice and real-world-based research, working as a central repository and reporting tool for uveitis. This paper describes the technical principles, the design and the development of a web-based interoperable registry for uveitis in Portugal and provides an overview of more than 400 patients registered in the first 18 months since inception.In infrequent diseases, the existence of registries enables to gather evidence and increase research possibilities to clinicians. The adoption of this platform enables standardization and improvement of clinical practice in uveitis. It is useful to apprehend the repercussion of medical and surgical treatments in uveitis and scleritis, supporting clinicians in the strict monitoring of drug adverse reactions and surgical outcomes.

Bleb morphology of glaucoma drainage devices on magnetic resonance imaging.

PURPOSE: To evaluate bleb morphology features of different glaucoma drainage devices (GDD) using magnetic resonance imaging (MRI). MATERIALS AND METHODS: Prospective cohort study of GDD and bleb morphology in consecutive glaucoma patients implanted with Ahmed Glaucoma Valve (AGV), Paul Glaucoma Implant (PGI), Baerveldt Glaucoma Implant (BGI) and Ahmed ClearPath (ACP) devices. Thirty-six eyes from 30 consecutive patients underwent standardized GDD implantation followed by MRI at least 1 month after surgery. Main outcomes included bleb volume and endplate position relative to the optic nerve. Secondary outcomes included intraocular pressure (IOP), medication and surgical complications during a 12-month follow-up. RESULTS: Seven eyes were implanted with the AGV (19%), 5 with BGI (14%), 16 with PGI (44%) and 8 with ACP (22%). MRI scans were obtained 85 ± 66 days after surgery. Mean total bleb volume was 563 ± 390 mm3 . This bleb volume was inversely correlated with early post-operative IOP (day 7; rs = -0.3326, p = 0.0475) but positively correlated with IOP at 12 months (rs = 0.3592, p = 0.0341). No significant difference in total bleb volume was found between GDD types (p = 0.1223). A double-layered bleb was observed in 34 eyes (94%). The inferior bleb volume was significantly larger in PGI devices versus other GDD types (380 ± 205 vs. 193 ± 161 mm3 ; p = 0.0043). Distance from the endplate to the optic nerve was 9.5 ± 4.0 mm, similar across GDDs (p = 0.2519). CONCLUSIONS: Double-layered blebs are a common finding with GDDs. Bleb volume showed different correlations with IOP at distinct timepoints and the PGI device formed larger blebs. A standardized GDD implantation technique ensures a safe distance from the GDD endplate to the optic nerve.

Asymptomatic chronic red eye: A surgical technique case report.

Introduction and importance: Ocular Surface Squamous-cell Neoplasia (OSSN) is an infrequent diagnosis whose clinical suspicion assumes great importance and should not be overlooked. The following case-report aims to describe the diagnosis and treatment of a patient with OSSN whose complaints were mild in comparison to the severity of the disease. The chosen surgical technique was paramount for a disease-free outcome while minimizing the scarring effects of surgical removal. CASE PRESENTATION: Patient presented mild discomfort right eye and painless persistent hyperaemia. Slit-lamp observation showed a clear diagnosis and lesion's extent evaluated through multimodal imaging. After surgical excision the patient underwent topical ocular treatment with mitomycin-C for a higher margin of safety even before the pathology results were available. DISCUSSION: Ancillary exam technology improvement has allowed a higher margin of safety while determining the extent of OSSN lesions. In the absence of clear diagnostic criteria and guidelines, clinical reasoning and OSSN awareness are critical for timely diagnosis and treatment, as several treatment options are available, allowing an increasing number of patients to be treated non-invasively. In this case-report, we highlight the importance of early-recognition and the reasoning for choosing a combined treatment option with a higher margin of safety. CONCLUSION: Early recognition and prompt treatment of OSSN lesions is of paramount importance to avoid ocular invasiveness and potentially preclude both ocular and systemic complication. The choice of a combined surgical and medical approach may provide a higher margin of safety for suitable cases. This patient is currently disease-free at 6-month follow-up.

Cutaneous thrombosis related to paroxysmal nocturnal hemoglobinuria: clinical report.

Paroxysmal nocturnal hemoglobinuria is a clonal stem cell disorder typically characterized by hemolysis, bone marrow failure, and venous thrombosis. The latter can affect up to 40 percent of patients and is a significant cause of mortality. Despite being recognized as a possible complication, cutaneous thrombosis is quite uncommon and a variety of findings have been reported. Owing to the rarity of this complication and the importance of its correct and timely diagnosis, we report the case of a 64-year-old man with paroxysmal nocturnal hemoglobinuria who presented with isolated and well-demarcated erythematous-violaceous plaques, mainly located on the neck and trunk. Given the history and the histological features, the diagnosis of cutaneous thrombosis related to paroxysmal nocturnal hemoglobinuria was assumed and the patient was successfully treated with therapeutic anticoagulation. The early identification of these patients is essential for necessary surveillance because they could carry a higher probability of recurrence compared with those with no prior complications.

Pioneering evaluation of GaN transistors in geostationary satellites.

In this paper, we present the results of a 6-year experiment in space that studied the effects of radiation in Gallium Nitride (GaN) electronics in geostationary orbit. Four GaN transistors in a Colpitts oscillator configuration were flown in the Component Technology Test-Bed aboard the Alphasat telecommunication satellite. A heuristic analysis was performed by observing the variation in the power output of the oscillators with the total ionizing dose gathered during the mission. The total ionizing dose was measured with a Radiation Sensing Field Effect Transistors (RadFET) placed close to the GaN devices. The experiment showed that GaN is a robust technology that can be used in the space radiation environment of a geostationary orbit. The work presented here starts with a brief introduction of the subject, the motivation, and the main goal. This is followed by the description of the experimental setup, including the details of the oscillator design and simulations, as well as the implementation of the test-bed and the Components Technology Test-Bed. Finally, the results obtained during the 6 years of experience in space are discussed.

Seasonal Variation in Mycorrhizal Community of Different Cerrado Phytophysiomies.

Purpose: Understanding the dynamics of mycorrhizal fungi in the Cerrado is fundamental for the adoption of conservation practices and for understanding the resilience of this biome in relation to long periods of drought. Thus, this work aimed to verify the dynamics of the mycorrhizal population in five phytophysiognomies of the Cerrado biome. Methods: The samples were taken from the Chapada dos Veadeiros National Park, a permanent preservation with native Cerrado vegetation without any anthropic influence. The five main phytophysiognomies of the Cerrado biome were chosen: the Campo Limpo, Campo Sujo, Cerrado Strictu Sensu, Cerradão, and Veredas. Rhizospherical soil samples were collected in both the wet and dry seasons. Spore density, mycorrhizal colonization rate, easily extractable glomalin, and associated mycorrhizal fungi genera were identified. Results: The values of spore density, mycorrhizal colonization rate, and glomalin were higher in the samples performed during the dry season compared to the samples performed in the rainy season. The same behavior was observed when comparing the different phytophysionomies. Conclusion: Mycorrhizal activity is higher in dry periods when compared to rainy periods. There is no specificity of genera of arbuscular mycorrhizal fungi within the Cerrado phytophysiognomies.

Malignant lues in an immunocompetent patient.

Malignant lues is a rare form of secondary syphilis mostly associated with HIV infection. It is an uncommon presentation of syphilis even rarer in immunocompetent patients. We present the case of a 57-year-old homosexual man referred to our department due to a 4-month history of a disseminated, slightly painful, nodular-ulcerative cutaneous eruption associated with low-grade fever, malaise and aesthenia. Regarding the clinical features and serological and histopathological findings, the diagnosis of syphilis maligna was assumed. Serology for HIV was repeatedly negative. This case is interesting, not only because a very uncommon form of secondary syphilis was identified but also for being diagnosed in an immunocompetent patient. Lack of awareness of this type of presentation delays the diagnosis and treatment, leading to an increase in morbidity and spread of infection.

Scleredema associated with Sjögren's syndrome.

Scleredema adultorum of Buschke is a rare disorder characterized by diffuse swelling and non-pitting induration of the skin usually involving the face, neck, arms and upper trunk. It has been associated with previous infectious diseases, diabetes, paraproteinemia and, more rarely, malignant neoplasms or autoimmune disorders. We report the case of a 30-year-old man who presented with a 2-year history of scleredema. Further investigation led to the diagnosis of primary Sjögren's syndrome. The association between scleredema and autoimmune disorders has been rarely seen. To our knowledge, there are no other reports describing the association between primary Sjögren's syndrome and scleredema adultorum of Buschke.

Mindfulness in Education and Paulo Freire: a reflective approach / Mindfulness en la Educación y Paulo Freire: un abordaje reflexivo / Mindfulness na Educação e Paulo Freire: uma abordagem reflexiva

This essay makes a theoretical reflection upon possible conceptual proximities between the contemporary application of Mindfulness in education and the educational proposals of Paulo Freire. The study manages to approximate Freire to Mindfulness through a few concepts such as "openness to the new" and 'critical curiosity', which are related to a certain kind of development of awareness. We conclude that the contributions of mindfulness to the educational process as understood by Paulo Freire are related to the ability to develop a state of presence that brings more awareness to mental and emotional states, as much as it leads to conscious actions opposed to actions in the autopilot. Awareness (which is close to the concept of action-reflection in Freire) becomes, thus, a keyword for transformation towards lesser mental, emotional, physical and social/interpersonal suffering, both in Freire and in Mindfulness.(AU)

Este ensayo proporciona una reflexión teórica sobre la posible proximidad conceptual entre la aplicación contemporánea de Mindfulness (atención plena) en la educación y las propuestas educativas de Paulo Freire. El estudio consigue aproximar los conceptos de Freire del cuadro de referencia de la Atención Plena, por medio de conceptos tales como "apertura a lo nuevo" y "curiosidad crítica", relacionados con cierto tipo de desarrollo de la conciencia (awareness). Se concluye que las contribuciones de la atención plena para el proceso educativo, conforme entendido por Paulo Freire, se relacionan con la capacidad de desarrollar un estado de presencia que brinde más conciencia de los estados mentales y emocionales, además de llevar las acciones conscientes en oposición a las inconscientes. La conciencia, concepto próximo al de reflexión-acción en Freire, se convierte, por lo tanto, en una palabra clave para la transformación hacia la disminución del sufrimiento mental, emocional, físico y social/interpersonal, tanto en Freire como en Mindfulness.(AU)

Este ensaio traz uma reflexão teórica sobre a possível proximidade conceitual entre a aplicação contemporânea de Mindfulness (Atenção Plena) na Educação e as propostas educacionais de Paulo Freire. O estudo consegue aproximar os conceitos de Freire do quadro referencial da Atenção Plena, por meio de conceitos como "abertura ao novo" e "curiosidade crítica", relacionados a certo tipo de desenvolvimento da consciência (awareness). Conclui-se que as contribuições da Atenção Plena para o processo educacional, conforme entendido por Paulo Freire, relacionam-se à capacidade de desenvolver um estado de presença que traga mais consciência aos estados mentais e emocionais, além de levar a ações conscientes em oposição a ações inconscientes. Consciência, conceito próximo ao de reflexão-ação em Freire, torna-se, portanto, uma palavra-chave para a transformação em direção à diminuição do sofrimento mental, emocional, físico e social/interpessoal, tanto em Freire quanto no Mindfulness.(AU)

Variants of dermatofibroma--a histopathological study.

Several variants of dermatofibroma have been described. They are essentially distinguished by their clinical and histopathological features. To review the mainfeaturesof these variants, a retrospective study of skin biopsies and tissue excisions of dermatofibromasperformed in the dermatology and venereology service at the Hospital Garcia de Orta between May 2007 and April 2012 was carried out. During that period, 192 dermatofibromas were diagnosed in 181 patients, the lesions being more common in women. Median age of the study population was 48 years. The most common lesion site was the limbs (74% of patients). The histopathological types found were common fibrous histiocytoma (80%) and the aneurysmal (5.7%),hemosiderotic (5.7%), epithelioid (2.6%), cellular (2.1%), lipidized (2.1%), atrophic (1.0) and clear cell (0.5%) variants. Based on these findings, this review focuses on the clinical and histological features of the various variants of dermatofibroma in terms of their clinical presentation, distinct histopathological features, differential diagnosis and prognosis.

Using 80% trichloroacetic acid in the treatment of ingrown toenails.

BACKGROUND: Ingrown nails are a very common problem. There are different stages of disease and diverse therapeutic options. Phenol and sodium hydroxide are commonly used agents for chemical matricectomy but both frequently entail excessive healing times. OBJECTIVE: This prospective study aimed mainly to evaluate the efficacy of partial nail avulsion and selective chemical cauterization of the matrix using 80% TCA in the treatment of the ingrowing nail. METHODS: One-hundred-and-thirty-three patients with 197 ingrown toenails were included in this study. Preoperatively, we tried to find predisposing factors to the disease. In the postoperative period, patients were evaluated for potential complications at days 3, 30, 180, 270 and 360. Pain was measured before surgery, as well as 24 hours and 72 hours after surgery. RESULTS: There were only 3 cases (out of 197) of ingrown nail recurrence. Preoperatively, we found the presence of drainage in 82% of patients, which, following the first visit after surgery, was reduced to 19%. Persistent granulation tissue was found in 3% of the patients (versus 75% prior to surgery). The most frequent predisposing factors for the ingrown nail were excessive trimming of the lateral nail plate (63%), plantar hyperhidrosis (58%) and heavy nail folds (39%). Pain was substantially reduced after surgery. CONCLUSION: It is assumed that chemical procedures for the ingrown toenail are associated with delayed healing times but our results demonstrated quick recovery. Using 80% TCA for selective matricectomy in the ingrown toenail is an effective, quick and easy method.

Scleredema associated with Sjögren’s syndrome

Scleredema adultorum of Buschke is a rare disorder characterized by diffuse swelling and non-pitting induration of the skin usually involving the face, neck, arms and upper trunk. It has been associated with previous infectious diseases, diabetes, paraproteinemia and, more rarely, malignant neoplasms or autoimmune disorders. We report the case of a 30-year-old man who presented with a 2-year history of scleredema. Further investigation led to the diagnosis of primary Sjögren’s syndrome. The association between scleredema and autoimmune disorders has been rarely seen. To our knowledge, there are no other reports describing the association between primary Sjögren’s syndrome and scleredema adultorum of Buschke.