A Descriptive Study of Corneal Graft Failure in Retransplant Patients.

OBJECTIVE: To identify the main predictors for corneal graft failure in patients who underwent retransplantation. METHOD: This is a cross-sectional research with a quantitative and analytical approach, conducted based on data from secondary sources of a Human Eye Tissue Bank (HETB) in Northeast Brazil. Data were collected from the medical charts of all patients transplanted between January 2010 and December 2014. Descriptive statistics were used for the univariate analysis by means of absolute and relative frequencies and means. For the inferential analysis, the chi-square (X²) and the Fisher's Exact tests were used. RESULTS: A total of 241 records were reviewed, representing 258 keratoplasties, of which 27 (10.46%) were retransplantations due to corneal graft failure. Of the total, 55.56% of the individuals were female, with a mean age of 58.56 years, 55.56% of the population was brown, and the highest relative frequency of housing found was in the Central Mesoregion. Of the corneal graft failure cases, 88.89% were due to late failure, 30.77% of cases were classified as pseudophakic and 11.57% as aphakic. Through inferential analysis, a statistical association was obtained among the variable "corneal graft failure" and mesoregion of the state, presence of glaucoma, vascularization, and classification of the eye. CONCLUSION: The prognosis of keratoplasty is of multifactorial nature. Factors such as mesoregion of the State (place of residence), glaucoma, corneal vascularization, and aphakic eyes represent predictors for graft failure in the analyzed sample.

Non-Donors of Organs and Tissues Due to Medical Refusal in a Transplant Referral Service.

BACKGROUND: Obtaining organs for transplants through a deceased donor occurs exclusively through donation. However, some open protocols with potential donors do not become effective donors due to medical refusal. Our aim was to identify the profile of non-donors of organs and tissues due to medical refusal in a state reference service for transplants. METHODS: This is a cross-sectional study with retrospective data collection from medical records of patients who died and had a protocol opened to evaluate brain death and procurement of organs and tissues in 2019. RESULTS: The sample consisted of 27 patients, the majority of whom were female, aged over 71 years, had primary education, and were married. The main causes of medical refusal were age above the recommended age and septicemia. Brain death was mostly confirmed within 12 hours, and the main cause of hospitalization was a vascular event. CONCLUSIONS: Identifying the profile of non-donors due to medical refusal is necessary for services to identify possible misattributed medical contraindications and thus contribute to reducing the disproportion between supply and demand for organs and tissues for transplants.

Polyp detection in the cecum and ascending colon by dye based chromoendoscopy - Is its routine use justified?

INTRODUCTION: colonoscopy is the best method for detecting polyps, with a reduction in colorectal cancer mortality of 29% and reaching 47% for distal tumors. However, it fails to demonstrate a significant reduction in proximal colon cancer mortality, and is the most common segment with interval neoplasm. The present study aimed to evaluate the impact on detection of polyps of a second sequential evaluation of cecum and ascending colon, with or without the use of indigo carmine chromoendoscopy. METHODS: prospective, non-randomized clinical trial. Patients were divided into two groups. The first (G1) underwent a routine colonoscopy, followed by a second endoscopy assessment of ascending colon and cecum. The second group (G2) underwent a routine colonoscopy, followed by a second assessment of the ascending colon and cecum with indigo carmine chromoendoscopy. RESULTS: In total, 203 patients were analyzed, 101 in the G1 and 102 in the G2. Newer polyps were identified in both groups after the second assessment with a significantly higher number of polyps detected in the patients in the G2 (p=0.0001). The number of patients who had at least one polyp in the two endoscopic assessments was significantly higher in the G2 (53 or 52% vs 27 or 26.7%, p=0.0002). In the second endoscopic assessment, the number of polyps found was also significantly higher in the G2 (50 or 76.9%) compared to the G1 (15 or 23.1%), p<0.0001. CONCLUSIONS: the second assessment with dye-based chromoendoscopy increases the detection of polyps in the ascending colon and cecum.

Polyp detection in the cecum and ascending colon by dye based chromoendoscopy - Is its routine use justified? / Uso de cromoscopia com corante para detecção de pólipos em ceco e cólon ascendente - Deve ser utilizado de rotina?

ABSTRACT Introduction: colonoscopy is the best method for detecting polyps, with a reduction in colorectal cancer mortality of 29% and reaching 47% for distal tumors. However, it fails to demonstrate a significant reduction in proximal colon cancer mortality, and is the most common segment with interval neoplasm. The present study aimed to evaluate the impact on detection of polyps of a second sequential evaluation of cecum and ascending colon, with or without the use of indigo carmine chromoendoscopy. Methods: prospective, non-randomized clinical trial. Patients were divided into two groups. The first (G1) underwent a routine colonoscopy, followed by a second endoscopy assessment of ascending colon and cecum. The second group (G2) underwent a routine colonoscopy, followed by a second assessment of the ascending colon and cecum with indigo carmine chromoendoscopy. Results: In total, 203 patients were analyzed, 101 in the G1 and 102 in the G2. Newer polyps were identified in both groups after the second assessment with a significantly higher number of polyps detected in the patients in the G2 (p=0.0001). The number of patients who had at least one polyp in the two endoscopic assessments was significantly higher in the G2 (53 or 52% vs 27 or 26.7%, p=0.0002). In the second endoscopic assessment, the number of polyps found was also significantly higher in the G2 (50 or 76.9%) compared to the G1 (15 or 23.1%), p<0.0001. Conclusions: the second assessment with dye-based chromoendoscopy increases the detection of polyps in the ascending colon and cecum.

RESUMO Introdução: a colonoscopia é o melhor método para detecção de pólipos, com redução da mortalidade por câncer colorretal de 29% e chegando até 47% para tumores distais. No entanto, existe falha em demonstrar redução significativa na mortalidade no cólon proximal sendo o segmento mais comum de neoplasia de intervalo. O presente estudo avaliou o impacto na detecção de pólipos em uma segunda avaliação sequencial do ceco e cólon ascendente, com ou sem o uso de cromoendoscopia com Indigo carmim. Métodos: estudo prospectivo, não randomizado. Os pacientes foram divididos em dois grupos. O primeiro (G1) foi submetido à colonoscopia de rotina, seguida de segunda avaliação endoscópica do cólon ascendente e ceco. O segundo grupo (G2) foi submetido à colonoscopia de rotina, seguida de segunda avaliação do cólon ascendente e ceco com cromoendoscopia com índigo carmim. Resultados: no total, foram analisados 203 pacientes, sendo 101 do G1 e 102 do G2. Novos pólipos foram identificados em ambos os grupos após a segunda avaliação com número significativamente maior de pólipos detectados nos pacientes do G2 (p=0,0001). O número de pacientes que apresentaram pelo menos um pólipo nas duas avaliações endoscópicas foi significativamente maior no G2 (53 ou 52% vs 27 ou 26,7%, p=0,0002). Na segunda avaliação endoscópica, o número de pólipos encontrados também foi significativamente maior no G2 (50 ou 76,9%) em relação ao G1 (15 ou 23,1%), p<0,000. Conclusão: a segunda avaliação com cromoendoscopia com índigo carmim aumenta a detecção de pólipos no cólon ascendente e no ceco.

Analysis of the temporal trend of mortality from sickle cell anemia in Brazil.

OBJECTIVES: To analyze the temporal trend of mortality from sickle cell anemia in Brazil, by region, in the period 1997-2017. METHODS: epidemiological study, with an ecological design, with a temporal trend, carried out with data from the Mortality Information System. For descriptive analysis, absolute and relative frequencies were used. In the correlation analysis, the ANOVA test was used, followed by Tukey's post-test. The temporal trend was obtained using the cubic polynomial regression test. RESULTS: 6,813 deaths from sickle cell anemia were registered. Brown individuals (50.87%) were more frequent, with a predominance of males (50.4%), aged between 25 and 34 years and a higher incidence of deaths in the Midwest (0.25/100 thousand inhabitants). The time curve showed an increasing trend of deaths in the country between 1997 and 2015 (R2 = 0.98). CONCLUSIONS: sickle cell anemia showed increasing mortality in the 21 years analyzed and alerts health professionals and managers.

Clinical-Epidemiological Characteristics and Mortality in Patients with Sickle Cell Anemia: A Retrospective Cohort Study of 1980 at 2018.

PURPOSE: To analyze the clinical-epidemiological characteristics and mortality in patients with sickle-cell anemia (SCA). PATIENTS AND METHODS: A cohort study with retrospective data, conducted in two reference hospitals for SCA treatment from January 1980 to December 2018, recorded in two reference services. With a 5% significance level, the Chi-Square and Student's t-tests were employed in the inferential statistical analysis. RESULTS: A total of 128 patients with SCA were studied. Diagnosis up to the fifth day of life was made in 10 patients. There were 19 deaths, of which 12 (63.2%) were female, and the average age at death was 27.05 (± 14.78) years. The leading causes of death were septic shock and cardiogenic shock. The use of invasive medical devices was considered a risk factor for death (RR=2.63; 95% CI=1.16-5.96; p=0.018), and monitoring time up to 20 years presented a 31% reduction in the risk of dying (RR=0.31; 95% CI=0.12-0.82; p=0.011) when compared to the monitoring of more than 20 years. CONCLUSION: These findings are to be considered in the treatment of patients with SCA, mainly regarding early diagnosis and access to the treatment immediately afterward, since they are fundamental in improving survival and reducing severe complications.

Analysis of the temporal trend of mortality from sickle cell anemia in Brazil / Análisis de la tendencia temporal de la mortalidad por anemia de células falciformes en Brasil / Análise da tendência temporal da mortalidade por anemia falciforme no Brasil

ABSTRACT Objectives: To analyze the temporal trend of mortality from sickle cell anemia in Brazil, by region, in the period 1997-2017. Methods: epidemiological study, with an ecological design, with a temporal trend, carried out with data from the Mortality Information System. For descriptive analysis, absolute and relative frequencies were used. In the correlation analysis, the ANOVA test was used, followed by Tukey's post-test. The temporal trend was obtained using the cubic polynomial regression test. Results: 6,813 deaths from sickle cell anemia were registered. Brown individuals (50.87%) were more frequent, with a predominance of males (50.4%), aged between 25 and 34 years and a higher incidence of deaths in the Midwest (0.25/100 thousand inhabitants). The time curve showed an increasing trend of deaths in the country between 1997 and 2015 (R2 = 0.98). Conclusions: sickle cell anemia showed increasing mortality in the 21 years analyzed and alerts health professionals and managers.

RESUMEN Objetivos: analizar tendencia temporal de mortalidad por anemia falciforme en Brasil, por regiones, entre 1997 y 2017. Métodos: estudio epidemiológico, de delineamento ecológico, de tendencia temporal, realizado con datos del Sistema de Informaciones sobre Mortalidad. Utilizado frecuencias absolutas y relativas para análisis descriptivo. Utilizado la prueba ANOVA seguido por la prueba de Tukey en el análisis de correlación. La tendencia temporal fue obtenida mediante la prueba de regresión polinomial cúbico. Resultados: fueron registrados 6.813 óbitos por anemia falciforme. Indivíduos pardos (50,87%) fueron más frecuentes, con predominio del sexo masculino (50,4%), con franja etaria de 25 a 34 años y mayor incidencia de óbitos en Centro-Oeste (0,25/100 mil habitantes). La curva temporal presentó tendencia creciente de óbitos en el país entre 1997 a 2015 (R2 = 0,98). Conclusiones: la anemia falciforme presentó mortalidad creciente en los 21 años analizados y despierta el alerta a profesionales de salud y gestores.

RESUMO Objetivos: analisar a tendência temporal da mortalidade por anemia falciforme no Brasil, por regiões, no período compreendido entre 1997 e 2017. Métodos: estudo epidemiológico, de delineamento ecológico, de tendência temporal, realizado com dados do Sistema de Informações sobre Mortalidade. Para análise descritiva, utilizaram-se frequências absolutas e relativas. Na análise de correlação, utilizou-se o teste ANOVA seguido pelo pós-teste de Tukey. A tendência temporal foi obtida mediante o teste de regressão polinomial cúbico. Resultados: foram registrados 6.813 óbitos por anemia falciforme. Indivíduos pardos (50,87%) foram mais frequentes, com predomínio do sexo masculino (50,4%), com faixa etária de 25 a 34 anos e maior incidência de óbitos no Centro-Oeste (0,25/100 mil habitantes). A curva temporal apresentou tendência crescente de óbitos no país entre 1997 a 2015 (R2 = 0,98). Conclusões: a anemia falciforme apresentou mortalidade crescente nos 21 anos analisados e desperta o alerta aos profissionais de saúde e gestores.

System Management Software for Emergency Call.

Present the experience of the development of a system as an effective communication strategy between the user/requester and the mobile prehospital care service. APPROACH: It is a methodological study, fragmented into five stages, developed by health and technology professionals and students. RESULT: The five stages were followed to reach the final product. CONCLUSION: The app is groundbreaking and contributes to the safe and efficient communication with healthcare professionals and users.

Dental glass ionomer cement reinforced by cellulose microfibers and cellulose nanocrystals.

The aim of this work was to evaluate if the addition of cellulose microfibers (CmF) or cellulose nanocrystals (CNC) would improve the mechanical properties of a commercial dental glass ionomer cement (GIC). Different amounts of CmF and CNC were previously prepared and then added to reinforce the GIC matrix while it was being manipulated. Test specimens with various concentrations of CmF or CNC in their total masses were fabricated and submitted to mechanical tests (to evaluate their compressive and diametral tensile strength,modulus, surface microhardness and wear resistance) and characterized by scanning electron microscopy (SEM), energy dispersive X-ray spectroscopy (EDS), transmission electron microscopy (TEM) and Fourier transform infrared spectroscopy (FTIR). The incorporation of CmF in the GIC matrix did not greatly improve the mechanical properties of GIC. However, the addition of a small amount of CNC in the GIC led to significant improvements in all of the mechanical properties evaluated: compressive strength (increased up to 110% compared with the control group), elastic modulus increased by 161%, diametral tensile strength increased by 53%, and the mass loss decreased from 10.95 to 3.87%. Because the composites presented a considerable increase in mechanical properties, the modification of the conventional GIC with CNC can represent a new and promising dental restorative material.

Does an L-glutamine-containing, glucose-free, oral rehydration solution reduce stool output and time to rehydrate in children with acute diarrhoea? A double-blind randomized clinical trial.

This study assessed whether an oral rehydration solution (ORS) in which glucose is replaced by L-glutamine (L-glutamine ORS) is more effective than the standard glucose-based rehydration solution recommended by the World Health Organization (WHO-ORS) in reducing the stool volume and time to rehydrate in acute diarrhoea. In a double-blind, randomized controlled trial in a Mexican hospital, 147 dehydrated children, aged 1-60 month(s), were assigned either to the WHO-ORS (74 children), or to the L-glutamine ORS (73 children) and followed until successful rehydration. There were no significant differences between the groups in stool output during the first four hours, time to successful rehydration, volume of ORS required for rehydration, urinary output, and vomiting. This was independent of rotavirus-associated infection. An L-glutamine-containing glucose-free ORS seems not to offer greater clinical benefit than the standard WHO-ORS in mildly-to-moderately-dehydrated children with acute non-cholera diarrhoea.

Prevalence and genetic diversity of human astroviruses in Mexican children with symptomatic and asymptomatic infections.

The prevalence and type diversity of human astroviruses (HAstV) in children with symptomatic and asymptomatic infections were determined in five localities of Mexico. HAstV were detected in 4.6 (24 of 522) and 2.6% (11 of 428) of children with and without diarrhea, respectively. Genotyping of the detected strains showed that at least seven (types 1 to 4 and 6 to 8) of the eight known HAstV types circulated in Mexico between October 1994 and March 1995. HAstV types 1 and 3 were the most prevalent in children with diarrhea, although they were not found in all localities studied. HAstV type 8 was found in Mexico City, Monterrey, and Mérida; in the last it was as prevalent (40%) as type 1 viruses, indicating that this astrovirus type is more common than previously recognized. A correlation between the HAstV infecting type and the presence or absence of diarrheic symptoms was not observed. Enteric adenoviruses were also studied, and they were found to be present in 2.3 (12 of 522) and 1.4% (6 of 428) of symptomatic and asymptomatic children, respectively.

Cáncer gástrico en los andes peruanos: 170 casos observados en Huaraz / Gastric cancer in peruvian andes: 170 cases in Huaraz

En Huaraz (3100 m.s.n.m), con el objeto de contribuir al conocimiento del cáncer gástrico, se hizo un estudio observacional descriptivo sobre 170 casos que se presentaron consecutivamente al Hospital "Víctor Ramos Guardia" de Huaraz MINSA, entre el 01-08-92 al 31-07-98. Todos los casos tuvieron estudio anatomopatológico. La incidencia acumulada fue de 138.2 casos por 100,000 habitantes, incidencia promedio anual 35.8 casos/año, incidencia por endoscopía 16.7 por ciento y el 100 por ciento fueron cáncer gástrico avanzado. Todos nativos de la sierra de Ancah, sexo masculino 52.4 por ciento, de área rural 80 por ciento, agricultores y esposas de agricultores 91.7 por ciento. Alimentación a partir de tubérculosis, legumbres, jamón y productos salados, se sugiere poca fruta, 71.8 por ciento. La edad promedio fue 60.6 años (32-90), en mujeres 61.6 y en varones 59.8 años. Al diagnóstico se encontró dolor abdominal 81.2 por ciento, palidez 64.7 por ciento, hematemesis/melena 38.2 por ciento, tumoración palpable 37.7 por ciento y síndrome pilórico 28.8 por ciento. El 97.7 por ciento adenocarcinomas y el 2.3 por ciento linfomas; de los 166 adenocarcinomas, 72.9 por ciento clasificaron como intestinal y 27.1 por ciento difuso. El tipo intestinal más frecuente en varones (77.6 por ciento) que en mujeres (67.9 por ciento) y el tipo difuso más frecuente en mujeres (32.1 por ciento) que en varones (22.4 por ciento). Las lesiones se clasificaron como BORRMANN, I, II, III, IV al 0.6 por ciento, 22.4 por ciento y 14.1 por ciento respectivamente. El cáncer gástrico se localizó en el tercio inferior, medio, dos regiones(cuerpo y antro) y superior, en el 41.7 por ciento, 26.5 por ciento, 20.6 por ciento y 11.2 por ciento respectivamente. El 8.4 por ciento se localizó en el cardias. El tipo intestinal fue más frecuente en el tercio inferior 77.5 por ciento y medio 73.3 por ciento; el tipo difuso fue más frecuente en el tercio superior 42.1 por ciento de casos. En el seguimiento se perdieron 30 casos y al 30-04-99, fallecieron el 95 por ciento de casos. Concluimos que es muy probable que el cáncer gástrico tenga alta incidencia en la sierra de Ancah, presentación en estadíos avanzados, predomina el tipo intestinal ó epidémico y que es causa importante de morbimortalidad en la población adulta en riesgo.

[GASTRIC CANCER IN PERUVIAN ANDES: 170 CASES IN HUARAZ] / Cáncer gátrico en los andes peruanos: 170 casos observados en huaraz.

As a contribution to the knowledge of gastric cancer, a study took place at "Victor Ramos Guardia Hospital" in the city of Huaraz (3,100 meters above sea level), from August 1992 to July 1998. 170 cases were reported. All of them had biopsy exam.The accumulated incidence was of 138.2 cases per 100,000. The annual mean was 35.8 cases per year. The endoscopy incidence was of 16.7%. And 100% were advanced cancer. All of them were from the sierra of Ancash. 52.4% were males. 80% came from rural zones. And 91.7% were dedicated to agriculture. Food was mainly tubers, vegetables, ham and other salad meats. Ingestion of fruits was very scarce. Mean age was 60.6 years (32?90). 61.6 for females and 59.8 for males. When diagnosis was made 81.2% referred abdominal pain, 67.4% were pale, 38.2% had hematemesis/ melena, abdominal tumor was found in 37.7% and 28.8% had pyloric syndrome.97.7% of the biopsies were reported as adenocarcinoma. And 2.3% as linfomas. Of the 166 adenocarcinomas, 72.9% were of the intestinal type and 27.1% the diffuse type. The intestinal type was more frequent on males (77.6%) that on females (67.9%). Otherwise the diffuse type was more frequent on females (32.1%) that on males (22.4%). Lesions were classified as Bormann: I (0.6%), II (22.9%); III (62.4%) and IV (14.1%).Gastric cancer was found in the distal body in 41.7% of cases. In 2 regions: antrum and body in 26.5% and in the proximal body in 11.2%. 8.4% was localized in the cardias. The intestinal type was more frequently found an the distal body (77.5%). And on the medium body (73.3%). The diffuse type was mostly found on the proximal body (42.1%). On the following up 30 patients were lost and by April 1999, 95% were dead.We conclude that gastric cancer, probably, has a high incidence in the sierra of Ancash. The onset is of advanced gastric cancer. The intestinal type is predominant. And it is an important cause of disease and mortality in risk population.