Could a lipid oxidative biomarker be applied to improve risk stratification in the prevention of cardiovascular disease?

There is significant evidence demonstrating the influence of oxidative stress on atherosclerosis and cardiovascular diseases (CVD). However, oxidative biomarkers have not been applied to follow patients under primary or secondary prevention. Many factors can explain this paradox: the higher complexity of the methods applied to quantify oxidative markers, the high variability observed among the studies, the lack of reference values, and the weak correlation with clinical endpoints. This review presents the role of the major reactive oxygen species (ROS) involved in cardiovascular pathophysiology and how they can be neutralized by endogenous and exogenous antioxidants based on classical and recent studies, highlighting the importance of the secondary products of fatty acid oxidation as potential biomarkers. Furthermore, we discuss the great variability of oxidative stress biomarkers, using as an example data obtained from 55 studies. Among the molecules directly formed from lipid oxidation, such as malondialdehyde (MDA), oxidized LDL (oxLDL), and isoprostanes (F2-IsoP), and those associated with general oxidative conditions (ferric-reducing antioxidant power (FRAP), superoxide dismutase (SOD), glutathione (GSH)), MDA was the most lipid biomarker evaluated in the treatments and proved to be an independent factor compared with traditional markers used in the algorithms to stratify the patient's risk. Finally, this review suggests four steps to follow, aiming to include MDA in the algorithms applied to estimate CVD risk.

Could a lipid oxidative biomarker be applied to improve risk stratification in the prevention of cardiovascular disease?

There is significant evidence demonstrating the influence of oxidative stress on atherosclerosis and cardiovascular diseases (CVD). However, oxidative biomarkers have not been applied to follow patients under primary or secondary prevention. Many factors can explain this paradox: the higher complexity of the methods applied to quantify oxidative markers, the high variability observed among the studies, the lack of reference values, and the weak correlation with clinical endpoints. This review presents the role of the major reactive oxygen species (ROS) involved in cardiovascular pathophysiology and how they can be neutralized by endogenous and exogenous antioxidants based on classical and recent studies, highlighting the importance of the secondary products of fatty acid oxidation as potential biomarkers. Furthermore, we discuss the great variability of oxidative stress biomarkers, using as an example data obtained from 55 studies. Among the molecules directly formed from lipid oxidation, such as malondialdehyde (MDA), oxidized LDL (oxLDL), and isoprostanes (F2-IsoP), and those associated with general oxidative conditions (ferric-reducing antioxidant power (FRAP), superoxide dismutase (SOD), glutathione (GSH)), MDA was the most lipid biomarker evaluated in the treatments and proved to be an independent factor compared with traditional markers used in the algorithms to stratify the patient's risk. Finally, this review suggests four steps to follow, aiming to include MDA in the algorithms applied to estimate CVD risk.

Implementation in the "real world" of an evidence-based social and emotional learning program for teachers: effects on children social, emotional, behavioral and problem solving skills.

Introduction: The delivery of social and emotional learning (SEL) programs that are developmentally school-based and evidence-based has the potential to benefit many children, and as such, greater efforts are needed to disseminate these programs more widely within the community. The Incredible Years® Teacher Classroom Management (IY-TCM) has shown promising results when applied by teachers in preschool centers and primary schools, as seen in several randomized control trials conducted worldwide, including in Portugal. Methods: The current study presents a model of the implementation of the program within the framework of a nationwide initiative undertaken in Portugal: the Academias Gulbenkian do Conhecimento. Additionally, results of the program's impact on children were explored using ANOVA, which compared pre- to post- treatment outcomes. To assess which factors affected the efficacy of the intervention, moderation analyses were conducted using the MEMORE macro. Ninety teachers and 535 children (2 to 10 years old) were assessed. Results: Results revealed that children showed significant increases in social and emotional skills (e.g., social adjustment, empathy) and significant reductions in problem behavior when assessed by their teachers, and in social-cognitive problem solving strategies as evaluated by a set of problem-solving tasks. Moderation analyses showed that, in general, interaction effects were not found, meaning that the intervention was effective for almost all conditions. Nevertheless, significant moderation effects were found for factors pertaining to the child and the mother with respect to pro-social and emotional skills (children who benefited most from the intervention exhibited more behavioral difficulties at the baseline according to the teachers' perceptions and had mothers without a university degree; children attending primary school took less benefit from the intervention than those attending pre-school). Discussion: The findings contribute both to the reinforcement of the effectiveness of the IY-TCM program as a universal intervention in "real world" schools and to the development of some guidelines for the promotion of effective scaling up and sustainability of program effects.

Clinical relevance of oxidative stress biomarkers in cardiovascular prevention / Relevância clínica de biomarcadores de estresse oxidativo na prevenção cardiovascular

Cardiovascular diseases involve hyperlipidemia, inflammation and oxidative stress. Although this relationship is well established, only biomarkers associated with hyperlipidemia and inflammation are currently in clinical practice for diagnosis and evaluation of patient treatment. Our hypothesis is that oxidative stress biomarkers may be an independent risk factor and may assist in cardiovascular risk stratification and contribute to improving current scores. Thus, the objective of this study was to investigate which are the biomarkers and methodologies were used in clinical studies in humans with different health conditions. With the results obtained in the first part, we selected studies conducted in healthy individuals and in individuals under primary and secondary cardiovascular prevention in order to evaluate the most frequent biomarkers, the results obtained according to the individual's profile and the methodology used, and correlate with different health conditions. We observed that malondialdehyde (MDA) was the most frequent lipid biomarker of oxidative stress applied in the studies, but it presented significant variability in the results and a weak correlation with clinical outcomes. The result of this study demonstrates the importance of carrying out a multicentric study to validate the MDA values in individuals with different health conditions and the standardization of the methodology based on high performance liquid chromatographyy (HPLC)

As doenças cardiovasculares envolvem hiperlipidemia, inflamação e estresse oxidativo. Embora essa relação esteja bem estabelecida, apenas biomarcadores associados à hiperlipidemia e inflamação são atuais na prática clínica para diagnóstico e avaliação do tratamento do paciente. Nossa hipótese é que biomarcadores de estresse oxidativo podem ser um fator de risco independente e podem auxiliar na estratificação de risco cardiovascular e contribuir para melhorar os escores atuais. Assim, o objetivo deste estudo foi investigar primeiramente quais são os biomarcadores e metodologias utilizados nos estudos clínicos em humanos em diferentes condições de saúde. Com os resultados obtidos na primeira etapa, selecionamos os estudos conduzidos em indivíduos saudáveis e em prevenção cardiovascular primária e secundária a fim de avaliar os biomarcadores mais utilizados, os resultados obtidos conforme o perfil do indivíduo e a metodologia utilizada e finalmente correlacionar com as diferentes condições de saúde. Observamos que o malondialdeído (MDA) foi o biomarcador lipídico de estresse oxidativo mais frequente nos estudos, porém apresentou importante variabilidade nos resultados e fraca correlação com desfechos clínicos. O resultado desse estudo demonstra a importância da realização de um estudo multicentrico para validação dos valores de MDA nos diferentes perfis de indivíduos e a padronização metodológica baseada na cromatografia líquida de alta eficiência (HPLC)

Prevalence of Choroidal Abnormalities and Lisch Nodules in Children Meeting Clinical and Molecular Diagnosis of Neurofibromatosis Type 1.

PURPOSE: To determine the prevalence of choroidal abnormalities (CAs) and Lisch nodules (LNs) in children who met the clinical diagnostic criteria (CDC) alone and those with a molecularly confirmed diagnosis (MCD) of neurofibromatosis type 1 (NF1), and to ascertain any differences between the groups. METHODS: This was a cross-sectional observational study. All children who met the CDC and/or had MCD of NF1 and underwent eye examination were included. At least two CAs or LNs between the two eyes were set as a threshold to define the presence of either abnormality. Frequencies alongside 95% confidence intervals (CIs) were calculated. The relationship between patient age and the presence of LNs and/or CAs was estimated using logistic regression. RESULTS: The study cohort included 94 patients; CAs (64%) were more prevalent than LNs (41%) (0.22; 95% CI, 0.08-0.36; P = 0.0023). The probability of the presence of LNs was lower than that of CAs across all ages (odds ratio = 0.37; 95% CI, 0.20-0.69; P = 0.00173). CAs were exclusively found in 37% of patients and LNs in 16%; 80% had either CAs or LNs, or both. In the CDC group (n = 41), the difference in prevalence (CAs = 68%, LNs = 51%) did not attain statistical significance (0.17; 95% CI, -0.06 to 0.40; P = 0.18). In the MCD group (n = 53), the difference in prevalence (CAs = 60%, LNs = 34%) was significant (0.26; 95% CI, 0.006-0.47; P = 0.023). CONCLUSIONS: CAs were more frequent than LNs in pediatric NF1 patients regardless of age and MCD status. Combining ophthalmological exams with near-infrared imaging will increase the diagnostic reach in pediatric NF1. TRANSLATIONAL RELEVANCE: CAs detected on near-infrared imaging are objective biomarkers in NF1. They are more prevalent and detected earlier in the pediatric population compared with LNs. Hence, the presence of CAs should be routinely ascertained in children suspected with NF1.

Combined immunodeficiencies

Abstract Objectives: Inborn Errors of Immunity (IEI), also known as primary immunodeficiencies, correspond to a heterogeneous group of congenital diseases that primarily affect immune response components. The main clinical manifestations comprise increased susceptibility to infections, autoimmunity, inflammation, allergies and malignancies. The aim of this article is to review the literature on combined immunodeficiencies (CIDs) focusing on the diagnosis and treatment and the particularities of the clinical management of these patients. Source of data: Critical integrative review, aimed to present articles related to primary immunodeficiencies combined with a searchin the PubMed and SciELO databases, with evaluation of publications from the last twenty years that were essential for the construction of knowledge on this group of diseases. Summary of data: We highlight the main characteristics of CIDs, dividing them according to their pathophysiological mechanisms, such as defects in the development of T cells, TCR signaling, co-stimulatory pathways, cytokine signaling, adhesion, migration and organization of the cytoskeleton, apoptosis pathways, DNA replication and repair and metabolic pathways. In CIDs, clinical manifestations vary widely, from sinopulmonary bacterial infections and diarrhea to opportunistic infections, caused by mycobacteria and fungi. Neonatal screening makes it possible to suspect these diseases before clinical manifestations appear. Conclusions: The CIDs or IEI constitute a complex group of genetic diseases with T-cell involvement. Neonatal screening for these diseases has improved the prognosis of these patients, especially in severe ones, known as SCIDs.

Combined immunodeficiencies.

OBJECTIVES: Inborn Errors of Immunity (IEI), also known as primary immunodeficiencies, correspond to a heterogeneous group of congenital diseases that primarily affect immune response components. The main clinical manifestations comprise increased susceptibility to infections, autoimmunity, inflammation, allergies and malignancies. The aim of this article is to review the literature on combined immunodeficiencies (CIDs) focusing on the diagnosis and treatment and the particularities of the clinical management of these patients. SOURCE OF DATA: Critical integrative review, aimed to present articles related to primary immunodeficiencies combined with a searchin the PubMed and SciELO databases, with evaluation of publications from the last twenty years that were essential for the construction of knowledge on this group of diseases. SUMMARY OF DATA: We highlight the main characteristics of CIDs, dividing them according to their pathophysiological mechanisms, such as defects in the development of T cells, TCR signaling, co-stimulatory pathways, cytokine signaling, adhesion, migration and organization of the cytoskeleton, apoptosis pathways, DNA replication and repair and metabolic pathways. In CIDs, clinical manifestations vary widely, from sinopulmonary bacterial infections and diarrhea to opportunistic infections, caused by mycobacteria and fungi. Neonatal screening makes it possible to suspect these diseases before clinical manifestations appear. CONCLUSIONS: The CIDs or IEI constitute a complex group of genetic diseases with T-cell involvement. Neonatal screening for these diseases has improved the prognosis of these patients, especially in severe ones, known as SCIDs.

PHENOTYPIC HETEROGENEITY IN A FAMILY WITH X-LINKED FAMILIAL EXUDATIVE VITREORETINOPATHY WITH PREVENTION OF VISUAL LOSS IN AN AFFECTED MALE CHILD WITH LASER TREATMENT IN INFANCY.

PURPOSE: To present the scope of prenatal diagnosis and early treatment of patients with clinically heterogeneous phenotypic retinal dysplasia associated with NDP gene variants. METHODS: Retrospective. Review of electronic medical records. RESULTS: Twenty-nine-year-old woman known to carry a NDP gene variant presented to the eye clinic for consultation and risk assessment at her second pregnancy. Her 11-year-old son had bilateral retinal detachment, despite surgical treatment. The family declined prenatal testing. The patient was born full term, was examined, and underwent genetic testing after birth. He was found to have bilateral retinal avascular periphery abnormalities and preretinal hemorrhages on the left eye. The patient received bilateral laser treatment at 2 months of age. He was found to be doing well at 16 months after treatment with adequate visual acuity and flat maculae. The asymptomatic mother and maternal grandfather of the proband were found to have retinal periphery abnormalities with unremarkable posterior pole and excellent visual acuity. CONCLUSION: NDP gene variants associated with X-linked familial exudative vitreoretinopathy phenotype benefit from early treatment. Providers who take care of these patients need to monitor closely the pregnancy and delivery of a male child born to a female carrier to offer appropriate and timely treatment.

Dark without pressure retinal changes in a paediatric age group.

BACKGROUND/OBJECTIVES: We aim to describe the clinical and imaging characteristics of young children with dark without pressure- a well-defined area of dark retina in the mid periphery associated with attenuated hyperreflective outer segment bands on spectral domain OCT. SUBJECTS/METHODS: Retrospective medical chart review. We reviewed the charts and retinal images of children with dark without pressure (DWP) seen in the paediatric eye clinic that had undergone retinal imaging. RESULTS: We identified 6 children (3 males, 3 females) ranging in age from 3 to 13 years with DWP lesions. These were an incidental finding in children referred for other disorders. The lesions spared the macula and were typically in the mid-peripheral retina. In those children who could cooperate with detailed imaging, the DWP lesions were hypoautofluorecent on fundus autofluorescence imaging and OCT imaging showed reduced reflectance of the outer segments and EZ line as has been described in older children and adults. In two of the six subjects a DWP lesion appeared in an area of previously normal fundus; in no subjects did the lesion resolve over the period of follow up. CONCLUSIONS: The clinical and imaging characteristics of DWP lesions are similar in young children to those described in adults. The site of dysfunction appears to be at the level of the outer retina, but the precise cause is unknown. Recognition of this benign disorder will prevent patient anxiety and unnecessary further investigation.

Tecnologias não invasivas para o alívio da dor na parturição / Non-invasive technologies for pain relief in parturition / Tecnologías no invasivas para el alivio del dolor durante en el parto

Objetivo: Analisar as tecnologias não invasivas de alívio da dor no parto e nascimento. Método: Revisão integrativa de literatura, com 13 artigos obtidos nas bases de dados Web of Science, Cumulative Index to Nursing and Allied Health Literature, Literatura Latino-Americana e do Caribe em Ciências da Saúde, SciVerse Scopus TopCited, Medical Literature Analysis and Retrieval System Online e a biblioteca virtual Scientific Electronic Library Online entre o período de 2010 a 2016. Resultados: Observou o uso de mais de duas tecnologias não farmacológicas no processo de parto e nascimento, como aromaterapia isolada ou somada a mais uma tecnologia; aplicação isolada de frio e/ou calor; uso da bola suíça/bola de parto. Conclusão: A utilização de novas tecnologias no processo parturitivo resgata a autonomia da mulher frente ao seu corpo

Objective: To analyze the non-invasive technologies of pain relief in labor and birth. Method: Integrative literature review, with 13 articles from the Web of Science database, Cumulative Index to Nursing and Allied Health Literature databases, Latin American and Caribbean Literature in Health Sciences, SciVerse Scopus TopCited, Medical Literature Analysis and Retrieval System Online, and the library Scientific Electronic Library Online between 2010 and 2016. Results: Observed the use of more than two non-pharmacological technologies in the delivery and birth process, such as aromatherapy alone or added to another technology; isolated application of cold and / or heat; use of the Swiss ball / birth ball. Conclusion: The use of new technologies in the parturition process rescues the autonomy of women in front of their bodies

Objetivo: Analizar tecnologías no invasivas de alivio del dolor en el parto y el nacimiento. Método: Revisión integrativa de literatura, con 13 artículos de las bases de datos de Web of Science, de Contenido etiquetado de la literatura y la literatura en América Latina y el Caribe, en Ciencias de la Salud, SciVse Scopus TopCited, Medical Literature Analysis and Retrieval System Online y la biblioteca Scientific Electronic Library virtual en línea entre el periodo de 2010 a 2016. Resultados: Observó el uso de más de dos tecnologías no farmacológicas en el parto y el proceso de parto, como la aromaterapia sola o agregada a otra tecnología; aplicación aislada de frío y / o calor; uso de la bola suiza / bola de nacimiento. Conclusión: El uso de nuevas tecnologías en el proceso de parto rescata la autonomía de las mujeres frente a sus cuerpos

Potential benefits and risks of omega-3 fatty acids supplementation to patients with COVID-19.

Studies have shown that infection, excessive coagulation, cytokine storm, leukopenia, lymphopenia, hypoxemia and oxidative stress have also been observed in critically ill Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) patients in addition to the onset symptoms. There are still no approved drugs or vaccines. Dietary supplements could possibly improve the patient's recovery. Omega-3 fatty acids, specifically eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), present an anti-inflammatory effect that could ameliorate some patients need for intensive care unit (ICU) admission. EPA and DHA replace arachidonic acid (ARA) in the phospholipid membranes. When oxidized by enzymes, EPA and DHA contribute to the synthesis of less inflammatory eicosanoids and specialized pro-resolving lipid mediators (SPMs), such as resolvins, maresins and protectins. This reduces inflammation. In contrast, some studies have reported that EPA and DHA can make cell membranes more susceptible to non-enzymatic oxidation mediated by reactive oxygen species, leading to the formation of potentially toxic oxidation products and increasing the oxidative stress. Although the inflammatory resolution improved by EPA and DHA could contribute to the recovery of patients infected with SARS-CoV-2, Omega-3 fatty acids supplementation cannot be recommended before randomized and controlled trials are carried out.

Positive predictive value and screening performance of GoCheck Kids in a primary care university clinic.

PURPOSE: To determine the positive predictive value (PPV) of GoCheck Kids, a smartphone-based photoscreener, to detect refractive amblyopia risk factors (ARFs) in children 3-48 months of age. METHODS: The medical records of all children ≤48 months of age who failed GoCheck Kids photoscreening at a University of California, San Francisco, pediatric clinic between February 2017 and August 2018 and subsequently examined at the pediatric ophthalmology clinic were reviewed retrospectively. The PPV of GoCheck Kids was determined, where a true positive represents an abnormal cycloplegic refractive error according to the 2013 American Association of Pediatric Ophthalmology and Strabismus Vision Screening Committee criteria. For patients ≤12 months of age, refractive error thresholds were based on the 2017 American Academy of Ophthalmology Preferred Practice Patterns Pediatric Eye Evaluation guidelines. RESULTS: A total of 2,963 children were screened with GoCheck Kids. Of these, 172 (5.8%) failed the screening, of whom 115 (67%) were evaluated in the pediatric ophthalmology clinic. The mean age was 24.9 ± 11.1months (range, 3-48). Fifty-seven patients met ARF criteria yielding a PPV of 50% (95% CI, 41%-60%). The PPV was higher in patients of Latino/hispanic ethnicity (75%; 95% CI, 57%-100%; P < 0.01) and changed significantly with increasing age (P = 0.03). Patients who were screened between age 3-12 months had the lowest PPV at 26% (95% CI, 14%-47%). CONCLUSIONS: Modifying refractive error thresholds based on patient age and prevalence of ARFs in a population may improve the PPV of GoCheck Kids in a community-based screening program.

Percepção das enfermeiras obstétricas na assistência ao parto: resgate da autonomia e empoderamento da mulher / Perception of obstetric nurses on the assistance to childbirth: reestablishing women's autonomy and empowerment / Percepción de las enfermeras obstétricas en la asistencia al parto: rescate de la autonomía y empoderamiento de la mujer

Objetivo: compreender a percepção das enfermeiras obstétricas sobre a assistência de enfermagem no Centro de Parto Normal. Método: estudo descritivo, exploratório, de abordagem qualitativa, realizado entrevista semiestruturada com dezoito enfermeiras obstétricas no Centro de Parto Normal do Hospital da Mulher Mariska Ribeiro, e submetidas a analise de conteúdo na modalidade temática. Resultados: identificou-se a transição do modelo obstétrico e a interface com a enfermagem obstétrica, com a prática das enfermeira obstétricas pautadas no conhecimento técnico-científico, favorecendo um modelo humanizado para o resgate da autonomia da mulher, e a inibição de práticas intervencionistas. Conclusão: conclui-se que a valoração das práticas humanizadas no contexto do parto e nascimento é integrante da atuação da enfermeira obstétrica, e tem a possibilidade de repensar o modelo de atenção a mulher no parto e nascimento, com ruptura e engajamento político, social e econômico da humanização

Objective: The study's main purpose has been to understand the perception of obstetric nurses vis-à-vis nursing care at Centers for Natural Childbirth. Methods: It is a descriptive-exploratory study with a qualitative approach, which was performed through semi-structured interviews with eighteen obstetric nurses at the Center for Natural Childbirth from the Municipal Maternity Mariska Ribeiro and submitted to content analysis under the thematic modality. Results: There were identified the obstetric model transition and the interface with obstetric nursing, where the practice of obstetric nurses were based on technical-scientific knowledge, favoring a humanized model for the rescue of women's autonomy, and the inhibition of interventionist practices. Conclusion: Therefore, it is concluded that the appraisal of humanized practices in the childbirth and birth framework is part of the performance of obstetric nurses, moreover, it holds the possibility of reconsidering the care model towards women undergoing childbirth and birth, with rupture and political, social and economic engagement of humanization

Objetivo: comprender la percepción de las enfermeras obstétricas acerca de la asistencia de enfermería en Centro de Parto Normal. Método: estudio descriptivo, exploratorio, de abordaje cualitativo, por medio de entrevista semi estructurada con dieciocho enfermeras obstétricas en Centro de Parto Normal del Hospital da Mulher Mariska Ribeiro, sometidas a análisis de contenido en la modalidad temática. Resultados: se identificó transición del modelo obstétrico e interfaz con enfermería obstétrica, con práctica das enfermeras obstétricas basadas en el conocimiento técnico-científico, lo que favorece un modelo humanizado para el rescate de la autonomía de la mujer, además de la inhibición de prácticas intervencionistas. Conclusión: se constata que la valoración de las prácticas humanizadas en el contexto del parto y nacimiento es integrante de la actuación de la enfermera obstétrica y es una posibilidad de repensar el modelo de atención a la mujer en el parto y nacimiento, con ruptura e implicación política, social y económica de la humanización

Pars plana vitrectomy combined with scleral buckle versus pars plana vitrectomy for giant retinal tear.

BACKGROUND: A giant retinal tear (GRT) is a full-thickness neurosensory retinal break extending for 90° or more in the presence of a posterior vitreous detachment. OBJECTIVES: To evaluate the effectiveness and safety of pars plana vitrectomy combined with scleral buckle versus pars plana vitrectomy alone for eyes with giant retinal tear. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 8), which contains the Cochrane Eyes and Vision Trials Register; Ovid MEDLINE; Embase.com; PubMed; Latin American and Caribbean Literature on Health Sciences (LILACS); ClinicalTrials.gov; and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). We did not use any date or language restrictions in our electronic search. We last searched the electronic databases on 16 August 2018. SELECTION CRITERIA: We included only randomized controlled trials (RCTs) comparing pars plana vitrectomy combined with scleral buckle versus pars plana vitrectomy alone for giant retinal tear regardless of age, gender, lens status (e.g. phakic or pseudophakic eyes) of the affected eye(s), or etiology of GRT among participants enrolled in these trials. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed titles and abstracts, then full-text articles, using Covidence. Any differences in classification between the two review authors were resolved through discussion. Two review authors independently abstracted data and assessed risk of bias of included trials. MAIN RESULTS: We found two RCTs in abstract format (105 participants randomized). Neither RCT was published in full. Based on the data presented in the abstracts, scleral buckling might be beneficial (relative risk of re-attachement ranged from 3.0 to 4.4), but the findings are inconclusive due to a lack of peer reviewed publication and insufficient information for assessing risk of bias. AUTHORS' CONCLUSIONS: We found no conclusive evidence from RCTs on which to base clinical recommendations for scleral buckle combined with pars plana vitrectomy for giant retinal tear. RCTs are clearly needed to address this evidence gap. Such trials should be randomized, and patients should be classified by giant retinal tear characteristics (extension (90º, 90º to 180º, > 180º), location (oral, anterior, posterior to equator)), proliferative vitreoretinopathy stage, and endotamponade. Analysis should include both short-term (three months and six months) and long-term (one year to two years) outcomes for primary retinal reattachment, mean change in best corrected visual acuity, study eyes that required second surgery for retinal reattachment, and adverse events such as elevation of intraocular pressure above 21 mmHg, choroidal detachment, cystoid macular edema, macular pucker, proliferative vitreoretinopathy, and progression of cataract in initially phakic eyes.

Observação da interação professor-aluno no jardim de infância: O Teacher-Pupil Observation Tool / Observation of teacher-student interaction in preschool: the teacher-pupil observation tool / Observación de la interacción profesor-alumno en la educación infantil: el teacher-pupil observation tool

Este estudo teve como objetivo apresentar a versão portuguesa do Teacher-Pupil Observation Tool (T-POT), no que diz respeito ao acordo e fidedignidade entre observadores e às categorias de comportamentos observadas nos professores na sua utilização em contexto pré-escolar. Três observadores receberam treinamento na cotação de 11 categorias de comportamentos do professor do T-POT. Posteriormente, 65 professoras de jardim de infância foram observadas durante 25 minutos, numa situação de interação nas suas salas com um pequeno grupo de crianças. Obteve-se uma média de acordo entre observadores de 74% nas sessões de treinamento e coeficientes de correlação intraclasse de 0,90-0,99. Os resultados indicam que as categorias do T-POT mais utilizadas pelas professoras nas suas interações com as crianças são questões, confirmações e ordens. A discussão salienta as implicações para a prática e a pesquisa da utilização de medidas de observação na avaliação da interação professor-aluno nas salas de jardim de infância. (AU)

The purpose of this study was to present the Portuguese version of the Teacher-Pupil Observation Tool (T-POT), in terms of agreement and reliability among observers and the categories of behaviors observed in teachers when used in preschool setting. Three observers were trained in scoring 11 T-POT teacher's behavior categories. Subsequently, 65 preschool teachers were observed with T-POT during 25 minutes, while interacting in their classrooms with a small group of children. A mean of 74% of agreement was reached between observers for the training sessions and intraclass correlation coefficients of 0,90-0,99. The results indicate that the T-POT categories most used by teachers in their interactions with children are questions, acknowledgments and commands. The discussion highlights the implications for practice and research on the use of observation measures in the assessment of teacher-student interaction in preschool classrooms. (AU)

Este estudio tuvo como objetivo presentar la versión portuguesa del Teacher-Pupil Observation Tool (T-POT), en lo que se refiere al acuerdo y la confiabilidad entre observadores y, por otro lado, las categorías de comportamiento observadas en los profesores en la utilización del test en el contexto preescolar. Tres observadores recibieron entrenamiento en la cotización de 11 categorías de comportamiento del profesor del T-POT. Posteriormente, 65 profesoras de la educación infantil fueron observadas utilizando el T-POT durante 25 minutos, en una situación de interacción en sus aulas con un pequeño grupo de niños. Se obtuvo un acuerdo medio del 74% entre observadores en las sesiones de entrenamiento y coeficientes de correlación intraclase de 0,90-0,99. Los resultados indican que las categorías del T-POT más utilizadas por las profesoras en sus interacciones con los niños son cuestiones, confirmaciones y órdenes. La discusión destaca las implicaciones para la práctica y la investigación de la utilización de medidas de observación en la evaluación de la interacción profesor-alumno en la educación infantil. (AU)

Tecnologias do cuidado na enfermagem obstétrica: contribuição para o parto e nascimento / Tecnologías del cuidado en la enfermería obstétrica: contribución para el parto y nacimiento / Care technologies in obstetric nursing: contribution for the delivery and birth

RESUMO Objetivo identificar as tecnologias do cuidado utilizadas por enfermeiras obstétricas em um Centro de Parto Normal. Método estudo descritivo, realizado no Centro de Parto Normal de uma maternidade do município do Rio de Janeiro, com dezoito enfermeiras obstétricas, mediante entrevistas semiestruturada entre junho e setembro de 2016. Os dados coletados foram submetidos à análise de conteúdo na modalidade temática. Resultado a enfermeira obstétrica utiliza métodos não farmacológicos como banho de aspersão, massagem, bola suíça, cavalinho, aromaterapia, musicoterapia, livre movimentação, ambiente acolhedor e presença do acompanhante, como práticas do seu cuidado junto às mulheres. Conclusão a utilização das tecnologias do cuidado permite que as enfermeiras obstétricas valorizem as práticas humanizadas no contexto do parto e nascimento.

RESUMEN Objetivo identificar las tecnologías del cuidado utilizadas por enfermeras obstétricas en un Centro de Parto Normal. Método estudio descriptivo, realizado en el Centro de Parto Normal de una maternidad del municipio de Río de Janeiro, con dieciocho enfermeras obstétricas, mediante entrevistas semiestructuradas entre junio y septiembre de 2016. Los datos recogidos fueron sometidos al análisis de contenido en la modalidad temática. Resultado la enfermera obstétrica utiliza métodos no farmacológicos como baño de aspersión, masaje, bola Suiza, caballito, aromaterapia, musicoterapia, movimientos libres, ambiente acogedor y presencia de acompañante, como prácticas de cuidado a mujeres embarazadas. Conclusión la utilización de las tecnologías del cuidado permite que las enfermeras obstétricas valoricen las prácticas humanizadas en el contexto del parto y nacimiento

ABSTRACT Objective to identify the care technologies used by obstetric nurses in a Normal Birth Center. Method a descriptive study, performed at the Normal Birth Center of a maternity hospital in the city of Rio de Janeiro, with eighteen obstetric nurses, using semi-structured interviews between June and September 2016. The data collected were submitted to thematic type content analysis. Result the obstetric nurse uses non-pharmacological methods such as a spray bath, massage, Swiss ball, horse, aromatherapy, music therapy, free movement, warm environment and presence of the companion, as care practices together with the women. Conclusion the use of care technologies allows obstetric nurses to valorize humanized practices in the context of the delivery and birth.

Ocular injury during fetal endoscopy surgery.

A premature infant born at 31 weeks' gestational age was evaluated for periocular laceration and retrobulbar hematoma secondary to injury during a percutaneous fetal procedure. He later developed optic nerve atrophy.