The value of consciousness coaching in Parkinson's disease: Experiences and possible impact of holistic coaching.

Background: People with a chronic condition such as Parkinson's disease (PD) struggle with acceptance and finding meaning in life. Consciousness coaching could be a valuable addition in addressing these issues. Objective: We aim to evaluate the user experiences and potential effectiveness of consciousness coaching for people with PD (PwPD). Methods: We performed a pilot randomized controlled trial including PwPD in Hoehn & Yahr stage 1-3. People with cognitive impairments, severe psychiatric disorders, or those who did not have a clear issue to address with consciousness coaching, were excluded. PwPD were randomly allocated to either receiving 6 months of consciousness coaching in addition to usual care or to usual care alone. To explore experiences we performed semi-structured qualitative interviews with all PwPD in the intervention group. Potential effects were explored using questionnaires on quality of life, activities of daily life, self-management and non-motor symptoms at baseline and after 6 months. Results: We included 39 PwPD, 19 participants in the intervention group and 20 in the control group. Based on the interviews, we identified a number of themes and codes. In general PwPD experienced consciousness coaching as confronting but supportive in reaching their goals and in taking more responsibility for their lives. Quantitatively, we did not find a difference between groups for any of the outcomes. Conclusions: Consciousness coaching was considered valuable by most participants in this study and may be an interesting addition to PD treatment. We did not find any effects of the intervention on PD symptoms or quality of life.

Adhesion of Acanthamoeba on Scleral Contact Lenses According to Lens Shape.

Purpose: To investigate the adhesion of Acanthamoeba to scleral contact lens (ScCL) surface according to lens shape. Methods: Two strains of A. polyphaga (CDC:V062 and ATCC 30461) and one clinical Acanthamoeba isolate, were inoculated onto five contact lens (CL): one first-generation silicone hydrogel (SHCL; lotrafilcon B; adhesion control) containing plasma surface treatment; two ScCL (fluorosilicone acrylate) one containing surface treatment composed of plasma and the other containing plasma with Hydra-PEG, and two CL designed with a flat shape having the same material and surface treatments of the ScCL. Trophozoites that adhered to the lens's surfaces were counted by inverted optical light microscopy. Possible alterations of the lens surface that could predispose amoeba adhesion and Acanthamoeba attached to these lens surfaces were evaluated by scanning electron microscopy (SEM). Results: All strains revealed greater adhesion to the ScCL when compared with the flat lenses (P < 0.001). The clinical isolate and the ATCC 30461 had a higher adhesion (P < 0.001) when compared with the CDC:V062. A rough texture was observed on the surface of the lenses that have been examined by SEM. Also, SEM revealed that the isolates had a rounded appearance on the surface of the ScCL in contrast with an elongated appearance on the surface of the silicone hydrogel. Conclusions: The findings revealed that the curved shape of the ScCL favors amoeba adhesion.

Usability and utility of a remote monitoring system to support physiotherapy for people with Parkinson's disease.

Background: Physiotherapy for persons with Parkinson's disease (PwPD) could benefit from objective and continuous tracking of physical activity and falls in daily life. Objectives: We designed a remote monitoring system for this purpose and describe the experiences of PwPD and physiotherapists who used the system in daily clinical practice. Methods: Twenty-one PwPD (15 men) wore a sensor necklace to passively record physical activity and falls for 6 weeks. They also used a smartphone app to self-report daily activities, (near-)falls and medication intake. They discussed those data with their PD-specialized physiotherapist (n = 9) during three regular treatment sessions. User experiences and aspects to be improved were gathered through interviews with PwPD and physiotherapists, resulting in system updates. The system was evaluated in a second pilot with 25 new PwPD (17 men) and eight physiotherapists. Results: We applied thematic analysis to the interview data resulting in two main themes: usability and utility. First, the usability of the system was rated positively, with the necklace being easy to use. However, some PwPD with limited digital literacy or cognitive impairments found the app unclear. Second, the perceived utility of the system varied among PwPD. While many PwPD were motivated to increase their activity level, others were not additionally motivated because they perceived their activity level as high. Physiotherapists appreciated the objective recording of physical activity at home and used the monitoring of falls to enlarge awareness of the importance of falls for PwPD. Based on the interview data of all participants, we drafted three user profiles for PwPD regarding the benefits of remote monitoring for physiotherapy: for profile 1, a monitoring system could act as a flagging dashboard to signal the need for renewed treatment; for profile 2, a monitoring system could be a motivational tool to maintain physical activity; for profile 3, a monitoring system could passively track physical activity and falls at home. Finally, for a subgroup of PwPD the burdens of monitoring will outweigh the benefits. Conclusions: Overall, both PwPD and physiotherapists underline the potential of a remote monitoring system to support physiotherapy by targeting physical activity and (near-)falls. Our findings emphasize the importance of personalization in remote monitoring technology, as illustrated by our user profiles.

Visual Outcomes and Aberrometric Changes With Topography-Guided Photorefractive Keratectomy Treatment of Irregular Astigmatism After Penetrating Keratoplasty.

PURPOSE: To evaluate the visual acuity and keratometric and aberrometric changes in patients with corneal transplants (PKP), who underwent topography-guided photorefractive keratectomy (TG-PRK) with mitomycin C (MMC). METHODS: In this case study, 15 patients with spherical equivalents ranging from -11.00 to -0.25 diopters (D) who underwent penetrating corneal transplantation and had irregular astigmatism ranging from -7.5 to -2.0 D underwent TG-PRK with MMC. Corneal topography and wavefront of all patients were measured preoperatively and 12 months postoperatively. RESULTS: Twelve months after TG-PRK with MMC, 46% of eyes achieved a best spectacle-corrected visual acuity (BSCVA) of 20/20 compared with 1 eye preoperatively (P = 0.0221, χ test). The BSCVA did not improve in 1 patient and increased by 1 line or more in all others. Astigmatism decreased significantly (P = 0.003) from 5.10 ± 0.4 D to 3.37 ± 0.06 D, the corneal best-fit sphere increased and keratometry measurements flattened significantly (P = 0.0001 for both comparisons), and the corneal total root mean square aberrations and trefoil decreased significantly (P = 0.0077 and P = 0.0054, respectively) from 9.11 ± 2.56 µm to 7.58 ± 3.15 µm and 2.00 ± 1.2 to 1.38 ± 0.27 µm, respectively, as measured by wavefront aberrometry. CONCLUSIONS: Twelve months postoperatively, the BSCVA improved significantly, the lines of vision increased, and astigmatism, corneal best-fit sphere, mean keratometry, corneal thickness, corneal root mean square total, and corneal spherical aberrations decreased. TG-PRK with MMC is a good alternative for correcting post-PKP cases with irregular astigmatism with elevated higher-order aberrations.

Diabetic limb salvage procedure with bone allograft and free flap transfer: a case report.

The aim of this case report was to describe a successful diabetic limb salvage procedure in the treatment of an infected diabetic foot ulcer through a multidisciplinary team approach and complex surgical reconstruction involving a femoral head bone allograft and musculocutaneous latissimus dorsi free flap. The decision to proceed with aggressive staged efforts at diabetic limb salvage should be made only after careful consultation with the patient, his or her family, and the rest of the multidisciplinary healthcare team.

Pemphigoid gestationis: Toward a better understanding of the etiopathogenesis.

Pemphigoid gestationis (PG) is the only autoimmune disease exclusively emerging in pregnancy. It belongs to the pemphigoid group of disorders, a class of autoimmune blistering skin diseases featuring an immune response against different hemidesmosomal proteins. PG is caused by a break of immunotolerance against the hemidesmosomal protein BP180. Several lines of evidence suggest that this break of immunotolerance is linked to specific maternal major histocompatibility complex (MHC) class II gene variants and aberrant expression of MHC class II molecules in the placenta. The close time association of the emergence of PG with pregnancy and the obviously very short period required from the initial break of immunotolerance to the onset of skin inflammation set PG into a unique position among autoimmune diseases in view of the fact that, for other autoimmune diseases, the time and site of the break of immunotolerance are usually vastly elusive and the period of silent disease can only be speculated on. In this review we highlight the features of PG and summarize current knowledge about its pathogenesis. We believe that this disease offers the best opportunity to elucidate comprehensively all phases of the pathogenesis of an autoantibody-driven disease.

Anti-inflammatory activity and acute toxicity studies of hydroalcoholic extract of Herissantia tiubae

ABSTRACT Hydroalcoholic extract of aerial parts of Herissantia tiubae (K. Schum.) Brizicky, Malvaceae, was evaluated in experimental models of inflammation and toxicity. For toxicity assays, male and female Swiss mice were orally treated with hydroalcoholic extract of H. tiubae (2000 mg/kg) and analyzed by consumption of water and food, body weight, mortality and rates of major organ weights, as well as biochemical and hematological indexes. For anti-inflammatory effect, phlogistic agents such as carrageenan or acetic acid were used to evaluate paw edema, cell migration and cytokine production. It was also investigated the hydroalcoholic extract of H. tiubae in RAW 264.7 macrophage lineage by nitric oxide and cytokine productions. Swiss mice treated with hydroalcoholic extract of H. tiubae showed low toxicity and (50 or 100 mg/kg) was able to reduce significantly (p < 0.01, p < 0.001) polymorphonuclear cell migration, TNF-α and IL-1β production in the carrageenan-induced peritonitis. However the hydroalcoholic extract of H. tiubae (50, 100 or 200 mg/kg) did not reduce carrageenan-induced paw edema. Additionally, hydroalcoholic extract of H. tiubae did not present cytotoxicity at concentrations of 6.25, 12.5, 25 or 50 µg/ml but induced significantly decrease of NO, TNF-α and IL-6 production in macrophage lineage. This study suggests that hydroalcoholic extract of H. tiubae has anti-inflammatory activity by inhibiting cell migration mainly by decreasing the inflammatory cytokine levels at the inflamed site independently of the anti-edematogenic effect.

Nuclear medicine annual external occupational dose distribution: Rio de Janeiro, Brazil, year 2005.

Brazil has about 300 nuclear medicine services (NMS), 44 of them located in the state of Rio de Janeiro (RJ). Most nuclear medicine staff are routinely monitored for external dose. This paper makes a statistical analysis of all the RJ NMS annual external occupational doses in year 2005. Around 100 professionals of RJ NMS received annual doses >4.0 mSv, considering only external doses, but no one receives doses higher than the mean annual dose limit of 20 mSv. Extremities dosemeters are used by about 10 % of the staff. In some cases, these doses are more than 10 times higher than the dose in thorax. The maximum ratio of extremity dose/thorax dose, in 2005, was 72. This study shows the importance to improve radiation protection procedures in nuclear medicine, mainly because the number of occupational individuals in nuclear medicine and their external doses are increasing.

Controlled transscleral drug delivery formulations to the eye: establishing new concepts and paradigms in ocular anti-inflammatory therapeutics and antibacterial prophylaxis.

IMPORTANCE OF THE FIELD: The use of topical agents poses unique and challenging hurdles for drug delivery. Topical steroids effectively control ocular inflammation, but are associated with the well-recognized dilemma of patient compliance. Although administration of topical antimicrobials as prophylaxis is acceptable among ophthalmologists, this common practice has no sound evidence base. Developing a new antimicrobial agent or delivery strategy with enhanced penetration by considering the anatomical and physiological constraints exerted by the barriers of the eye is not a commonly perceived strategy. Exploiting the permeability of the sclera, subconjunctival routes may offer a promising alternative for enhanced drug delivery and tissue targeting. AREA COVERED IN THIS REVIEW: Ocular drug delivery strategies were reviewed for ocular inflammation and infections clinically adopted for newer class of antimicrobials, which use a multipronged approach to limit risks of endophthalmitis. WHAT THE READER WILL GAIN: The analysis substantiates a new transscleral drug delivery therapeutic approach for cataract surgery. TAKE HOME MESSAGE: A new anti-inflammatory and anti-infective paradigm that frees the patient from the nuisance of topical therapeutics is introduced, opening a large investigative avenue for future improved therapies.

A single intraoperative sub-tenon's capsule injection of triamcinolone and ciprofloxacin in a controlled-release system for cataract surgery.

PURPOSE: To compare intraoperative injection of triamcinolone and ciprofloxacin in a controlled-release system (DuoCat) with prednisolone and ciprofloxacin eye drops after cataract surgery. METHODS: In this randomized, double-masked, controlled trial, a total of 135 patients undergoing cataract surgery were randomly allocated to two groups: 67 patients treated after surgery with prednisolone 1% and ciprofloxacin 3% eye drops four times daily (week 1), three times daily (week 2), twice daily (week 3), and once daily (week 4) and 0.3% ciprofloxacin drops four times daily (weeks 1 and 2), and 68 patients treated at the end of surgery with a sub-Tenon's injection of 25 mg triamcinolone and 2 mg ciprofloxacin in biodegradable microspheres. The patients were examined on postoperative days 1, 3, 7, 14, and 28. The main outcome measures were postoperative anterior chamber cell and flare, intraocular pressure (IOP), lack of anti-inflammatory response, and presence of infection. RESULTS: No significant differences were observed between the groups in anterior chamber cell (P > 0.14) and flare (P > 0.02) at any postoperative visits. The mean (99% confidence interval) differences in IOP between the prednisolone and triamcinolone groups on days 1, 3, 7, 14, and 28 were -0.4 mm Hg (-2.1 to 1.3), 0.0 mm Hg (-1.4 to 1.3), 0.0 mm Hg (-1.1 to 1.1), -0.2 mm Hg (-1.1 to 0.8), and -0.1 mm Hg (-1.1 to 0.9), respectively. No patient had a postoperative infection. CONCLUSIONS: One injection of DuoCat had a therapeutic response and ocular tolerance that were equivalent to conventional eye drops in controlling inflammation after cataract surgery. (ClinicalTrials.gov number, NCT00431028.).

Composición, propiedades e indicaciones de las cerámicas libres de metal de uso en odontología. Revisión bibliográfica / No disponible

En la actualidad la porcelana dental es el material que se considera ideal por sus propiedades, ya que, proporciona estética, biocompatibilidad y estabilidad. Su evolución ha sido rápida y creciente, debido a la búsqueda de la restauración de porcelana más resistente, estal la resistencia obtenida que se ha propuesto como substituto al tradicional metal-cerámica. Es necesario tomar en cuenta múltiples factores para elegir un material restaurador totalmente cerámico, por ejemplo: grado de translucidez; requerimientos del paciente y zona a restaurar, para determinar la resistencia que debe tener el material; diseño de la restauración; tipo de cemento a utilizar; ajuste marginal y técnica de procesado. Son muchos los sistemas para realizar coronas y prótesis parciales fijas total-cerámicas, cada uno con propiedades e indicaciones diferentes. Es por esto necesario saber que material es el que nos brinda más beneficios según cada caso (AU)

Currently the dental porcelain is the ideal material by its properties because provided esthetics, biocompatibility and stability. Its evolution has been fast and growing, due to the search of the most resistant restoration of porcelain, is such the resistance obtained that they are substituting progressively to the commonly utilized restorations metal-ceramics. Is necessary look multiples factors to choose a complete ceramic restaurateur material, for example: degree of translucence; requests of the patient and zone to restore, for determine the resistance that should have the material; design of the restoration; type of cement to utilize; marginal adjustment and technique of processed. They are many systems to carry out crowns and fixed partial dentures total-ceramics, each one with properties and different indications. It is for this necessary to know that material is the one that offers us more benefits according to each case (AU)

Cryptococcus neoformans varieties isolated from patients with aids referred to a hospital of São Paulo city during 1996-1999

Cryptococcus neoformans é uma levedura capsulada que apresenta tropismo pelo sistema nervoso central causando meningoencefalite. É a micose mais freqüente em pacientes com AIDS, e é responsável pela alta morbidade e mortalidade. Há duas variedades: var. neoformans e var. gattii. C. neoformans var.neoformans está distribuído mundialmente e é comumente encontrado em fezes de aves, principalmente de pombo. C. neoformans var. gattii está geograficamente limitado a regiões tropicais e subtropicais e está associado a algumas espécies de árvores, principalmente, Eucalyptus sp. A proposta desse estudo foi de avaliar a prevalência das variedades de Cryptococcus neoformans isoladas de 452 amostras de líquido cefalorraquiano (LCR) provenientes de 183 pacientes com AIDS, internados no Instituto de Infectologia Emílio Ribas – São Paulo-SP, de 1996 a...

Cryptococcus neoformans is an encapsulated yeast that presents tropism for central nervous system, and causes meningoencephalitis. Cryptococcosis is the most frequent mycosis in patients with AIDS, and itis the cause of high morbidity and mortality. C. neoformans presents two varieties var. neoformans andvar. gattii. Cryptococcus neoformans var. neoformans has been world-wide isolated from avian feces, especially pigeon excreta. C. neoformans var. gattii is geographically restricted to tropical and subtropical regions, and it is associated with some trees species, mainly Eucalyptus sp. The proposal of this study was to evaluate the prevalence of Cryptococcus neoformans varieties isolated from 452 cerebrospinalfluid (CSF) samples from 183 patients with AIDS referred to the Instituto de Infectologia Emilio Ribas- São Paulo-SP, from 1996 to 1999. CSF samples were cultured on canavanine-glycine-bromothymolblue...

Effect of chronic systemic use of trimethoprim-sulfamethoxazole in the conjunctival bacterial flora of patients with HIV infection.

PURPOSE: To investigate the effect of orally administered trimethoprim-sulfamethoxazole (TMP-SMZ) on the prevalence, species distribution, and resistance of the conjunctival bacterial flora in adults with human immunodeficiency virus (HIV) infection. DESIGN: Cross-sectional study, with clinical and experimental laboratory investigation. METHODS: Samples from the inferior conjunctival fornix were collected and submitted for culture to evaluate aerobic flora. RESULTS: Sixty samples were collected. Negative cultures were found in 17 (56.7%) eyes of the TMP-SMZ group and in 10 (33%) of the control group (P = .036). All Staphylococcus species isolates in the TMP-SMZ group were resistant to the drug, whereas 50% of the control group presented this finding (P = .025). In the study group, all bacteria were resistant to TMP-SMZ, compared with only 47% of the microorganisms in the control group. CONCLUSION: Orally administered TMP-SMZ in patients with HIV infection seems to exert a selection pressure in the microorganisms present on the conjunctiva.

HCH distribution and microbial parameters after liming of a heavily contaminated soil in Rio de Janeiro.

The closing down of a lindane factory near Rio de Janeiro, over 45 years ago, left an area heavily contaminated with hexachlorocyclohexane (HCH). Remediation by soil liming was applied by government authorities in 1995. This study aims to evaluate the HCH distribution and impact on soil microbiota due to contamination and liming. Microcosm experiments with uncontaminated soil mixed with HCH and lime indicated that lime-promoted dechlorination of HCH molecules led to leaching and volatilization of metabolites. The treatment applied transformed but did not solve the problem as most of the HCH remains in the soil. Reduced microbial respiratory activity was measured in contaminated field samples. Higher respiration rates in uncontaminated soil were reduced by HCH and lime addition; the sole addition of HCH caused a temporary increase in soil respiration, and stimulation occurred with oxygen and/or nutrient addition. A heterotrophic bacterial population around 10(9)CFU/g was found in polluted field soil, some well-known degraders having been isolated. Native soil microbiota showed resistance to high amounts of HCH and alkaline pH. The results allow considering bioremediation rather than chemical treatments to clean up the area.

Does amniotic membrane transplantation improve the outcome of autologous limbal transplantation?

PURPOSE: To evaluate the additional benefits of amniotic membrane transplantation (AMT) when combined with conjunctival limbal autograft (CLAU) in the treatment of chronic chemical burns. METHODS: Thirty eyes of 30 rabbits underwent a chemical burn to create limbal deficiency. Forty-five days later, the animals were randomized into three groups of 10 rabbits each. Eyes from group 1 were treated with CLAU, group 2 underwent CLAU and AMT, and group 3 served as control without surgery. Corneal vascularization and opacity were documented with external photographs at postoperative days 30, 60, and 90. The rabbits were killed 3 months after surgery, and their corneas divided into two halves. One half was prepared for hematoxylin-eosin and periodic acid-Schiff staining and the other for frozen sections and immunostaining with AM3 (to MUC 5AC mucin) and AE5 (to K3 keratin). Final clinical outcome was also scored using external photographs at the last follow-up examination. RESULTS: After chemical burn, all groups showed similar degrees of conjunctivalization. After transplantation, corneal vascularization was worse in controls at 60 and 90 days (p < 0.001). At 30 days, eyes from group 1 had less corneal opacity (p < 0.05). At 90 days, corneal opacity was worse in controls but the same in groups 1 and 2 (p < 0.05). At the same time, limbal deficiency was significantly worse in controls (p < 0.05) but similar between groups 1 and 2. Corneal phenotype was present in 70% of the eyes in group 1, 50% in group 2, but in 10% of the controls. Clinical success with clear corneas was significantly more common in groups 1 and 2 when compared with controls (p < 0.001). CONCLUSIONS: CLAU is effective in treating limbal deficiency. The concurrent AMT does not add benefits in this rabbit model of chemical burns.

A uniform & unified system for ophthalmic microsurgery

Apresentamos um novo sistema unificado e aperfeiçoado para microcirurgia ocular, o qual pode utilizar todos os tipos de instrumentos disponíveis atualmente para a cirurgia tanto do segmento anterior quanto do posterior. Os aparelhos dispostos de uma forma modular e compacta säo controlados por apenas um pedal com múltiplas funçöes o qual é ligado a um seletor que permite o uso de dois aparelhos simultaneamente. As caracteristicas básicas e vantagens práticas tanto do sistema como dos aparelhos modificados säo descritas

Instrumentacao basica em vitrectomia via pars plana. / Basic instrumentation in vitrectomy via pars plana

As funcoes basicas dos instrumentos para vitrectomia via pars plana sao apresentadas em diversos aparelhos. A selecao de um determinado equipamento deve considerar fatores como qualidade, eficacia, combinacao com acessorios, metodo de esterilizacao, manutencao e custo. Como ainda nao existe um sistema ideal para vitrectomia via pars plana deve-se considerar que a maioria dos aparelhos pode ser utilizada com seguranca atraves do conhecimento das vantagens e desvantagens de cada tipo de instrumental