Ophthalmologic Findings in Children with Neurofibromatosis Type 1.

The purpose of this study was to evaluate the ophthalmologic findings in children with neurofibromatosis type 1 (NF1) and compare these findings in eyes with and without optic pathway gliomas (OPGs). We carried out a retrospective chart review of children with NF1. We recorded demographic characteristics, clinical manifestations of disease, and ophthalmologic findings including visual acuity, intraocular pressure, cup-to-disc ratio, visual field testing, and optical coherence tomography findings. Ophthalmologic findings were examined for the cohort for initial and final appointments. These findings were also compared between eyes with and without OPGs. The study included 119 participants with 238 total eyes. The most common clinical manifestations of NF1 in this cohort were café au lait macules (98%), axillary or inguinal freckling (91%), Lisch nodules (66%), and cutaneous neurofibromas (57%). Thirty-seven participants had imaging that allowed evaluation for choroidal abnormalities, and 28 (76%) had choroidal lesions. Twenty-seven participants (23%) had OPGs, and 44 eyes were affected. On initial assessment, eyes with OPGs had worse visual acuity. On final examination, eyes with OPGs were more likely to have a worse visual acuity and a thinner generalised retinal nerve fibre layer (RNFL) thickness, inferior RNFL thickness, and temporal RNFL thickness. This study provides longitudinal follow-up of children affected by NF1 with and without OPGs. Eyes with OPGs were found to be associated with worse visual acuity and thinner RNFLs overall on final testing.

Netarsudil in the management of refractory pediatric glaucoma.

We performed a retrospective review of patients with refractory pediatric glaucoma who were started on netarsudil at the Wilmer Eye Institute. We found minimally sustained IOP lowering over a 6-month period in 29 eyes of 23 patients. Our results suggest that although netarsudil is an alternative medication in the management of pediatric glaucoma, its efficacy may be limited in refractory pediatric glaucoma patients. In addition, careful cornea examination is required to evaluate for signs of corneal decompensation, especially in patient with preexisting cornea disease.

Maternity and family leave experiences among female ophthalmologists in the United States.

OBJECTIVE: To evaluate family and maternity leave policies and examine the social and professional impacts on female ophthalmologists. PARTICIPANTS: Participants were recruited through the Women in Ophthalmology online list-serv to complete a survey evaluating maternity leave policies and their impacts. Survey questions were repeated for each birth event after medical school for up to five birth events. RESULTS: The survey was accessed 198 times, and 169 responses were unique. Most participants were practicing ophthalmologists (92%), with a minority in residency (5%), in fellowship (1.2%), on disability/leave (0.6%), or retired (0.6%). Most participants (78%) were within their first ten years of practice. Experiences were recorded for each leave event, with 169 responses for the first leave, 120 for the second, 28 for the third, and 2 for the fourth. Nearly half of participants reported the information they received about maternity leave to be somewhat or extremely inadequate (first: 50%; second: 42%; third: 41%). Many reported a greater sense of burnout after returning to work (first: 61%, second: 58%, third: 46%). A minority of participants received full pay during the first through third maternity leave events, 39%, 27%, and 33%, respectively. About a third of participants reported being somewhat or very dissatisfied with their maternity leave experience (first: 42%, second: 35%; third: 27%). CONCLUSIONS: Female ophthalmologists have varying experiences with maternity leave, but many encounter similar challenges. This study demonstrates that many women receive inadequate information about family leave, desire more weeks of leave, experience a wide variation in pay practices, and lack support for breastfeeding. Understanding the shared experiences of women in ophthalmology identifies areas where improvements are needed in maternity leave practices within the field to create a more supportive environment for physician mothers.

Nível de conhecimento de estudantes do curso de graduação em Odontologia sobre cigarros eletrônicos / Level of knowledge of undergraduate dental students about electronic cigarettes

O cigarro eletrônico vem despontando como uma opção ao cigarro convencional, sendoconsiderado por alguns como uma alternativa para quem deseja parar de fumartabaco. Muitos jovens também têm usado o dispositivo em busca de novas experiências, sensações e diversão. O objetivo desse estudo foi avaliar o nível de conhecimento dos alunos do Curso de Graduação em Odontologia da UniversidadeFederal de Santa Catarinasobreos cigarros eletrônicos, com base em um questionário. Tambémforam coletadas informações sobre o interessepara experimentar o dispositivo, a abordagem do assunto durante o curso de graduação e a autopercepção sobre o preparo para orientar pacientes sobre este assunto.O questionário foi aplicadoem abril e maio de 2019a 209 estudantes maiores de 18 anos, que foram divididos em 3 grupos: ingressantes (1ª e 2ªfasesdo curso), intermediários (4ª e 5ª fases) e concluintes (9ª e 10ªfases).A análise descritiva foi realizada em todas as questões, e naestatística analíticaassumiu-se onível de significância de 95%. A análise dos resultados demonstrou que estudantes concluintes possuem mais conhecimento sobre o cigarro eletrônico que ingressantes ou intermediários. No entanto, o nível de conhecimento foi considerado insatisfatório, pois mesmo entre os concluintes apenas cerca de 40% alcançaram o conceito considerado satisfatório(e que corresponderia a pelo menos 60% de acertos). A maioria dos estudantes relatou não ter tido contato com o tema durante o Curso de Graduação. Da mesmaforma, a maioria dos concluintes declarou não se sentir preparada para orientar pacientes sobre cigarros eletrônicos. Os resultados deste estudo apontam para a necessidade de o currículo contemplar este conteúdo na formação dos futuros cirurgiões-dentistas, para capacitá-los a orientar seus pacientes sobre riscos e benefícios da utilização dos cigarros eletrônicos (AU).

The electronic cigarette has emerged as an alternative to the conventional cigarette, being considered by some as asmoking cessationaid. The device has attracted the interest of many young people in search of new experiences, sensations,and recreation. The aim of this study was to assess,using a questionnaire, the level of knowledge of undergraduate dental students fromthe Federal University of Santa Catarina(Florianópolis, Brazil)about electronic cigarettes. Information was also collected on the interest intryingthe device, theapproach ofthe subjectin the course,and the self-perceived abilityto informpatients aboutelectronic cigarettes. The questionnaire was applied in April and May 2019 to 209 students over 18 years old, who were divided into 3 groups: freshmen(1st and 2nd semestersof the course), junior(4th and 5th semesters),and senior(9th and 10th semesters). Thedescriptive and statistical analyses wereperformed, andthe significance level of 95% was adopted. The results showed that senior students hadhigherknowledge about electronic cigarettes than freshmenor juniorstudents. However, the level of knowledge was considered unsatisfactory, as about 40% of the senior students had adequatelevel of knowledge (at least 60% of correct answers). Most students reported not having had contact with the topic during the undergraduate course. Likewise, most senior studentsreported not feelingprepared to advise patients on electronic cigarettes. The results of this study indicate the dentalcurriculum shouldinclude this topicin the training of future dentists, enablingthem to informtheir patients about the risks and benefits of using electronic cigarettes (AU).

Emotional approach coping among young adults with cancer: Relationships with psychological distress, posttraumatic growth, and resilience.

OBJECTIVE: Cancer, particularly, during young adulthood, can evoke difficult emotions, interfere with normative developmental activities, and challenge coping responses. Emotion-regulating coping efforts aimed at active emotional processing (EP) and emotional expression (EE) can be beneficial to cancer adjustment and perceptions of positive growth. However, it may be that EP and EE work differently to influence well-being. This study examines relationships of EP and EE with psychological distress, posttraumatic growth (PTG), and resilience. We expect that EP will be positively associated with PTG and resilience, whereas EE will be negatively associated with psychological distress. METHODS: Young adults with cancer (M age  = 34.68, N = 57) completed measures of emotional; approach coping (EP and EE), psychological distress (depressive symptoms, fear of cancer; recurrence [FCR]) and indicators of positive adjustment and growth (resilience and PTG). RESULTS: Greater use of EP was associated with higher resilience (ß = 0.48, p = 0.003) and PTG (ß = 0.27, p = 0.05), whereas greater use of EE was associated with lower resilience (ß = -0.33, p = 0.04). The EE × EP interaction was significant for FCR (ß = 0.29, p = 0.04) such that low EE was associated with lower FCR in those with high EP. Interaction effects were not significant for depressive symptoms, resilience, or PTG. CONCLUSIONS: Findings highlight differing relationships between EP and EE among young adults with cancer. Interventions aimed at increasing emotion-regulating coping strategies may prove useful in facilitating positive adjustment and growth, strengthening young adults' ability to cope with the diverse effects of disease, treatment, and survivorship.

Diagnostic Challenge and Clinical Management of Juvenile Mandibular Chronic Osteomyelitis.

Juvenile mandibular chronic osteomyelitis (JMCO) is a rare, idiopathic disease of chronic bone inflammation without suppuration, sinus tract formation, or sequestration. As the name suggests, this condition predominately affects children. The few cases of JMCO reported in the literature describe different treatments, and thus a standard therapy protocol has not yet been established. The aim of this paper is to report a clinical case in a 9-year-old girl that was misdiagnosed and unsuccessfully treated for 1 year. After experiencing persistent symptoms, a correct diagnosis was subsequently rendered based on the physical and radiographic examination as well as successful treatment with non-steroidal anti-inflammatory drugs (NSAIDs). The patient received drug therapy followed by periods of remission over a 4 year follow-up period. Diagnosis and treatment of JMCO is a challenge given the rarity and nonspecific signs and symptoms of this condition. Treatment with NSAIDs and regular follow-up is a conservative option for these patients.

The use of tools to support oral lesion description in oral medicine referrals.

Poor description of oral lesions jeopardize the prioritization of appointments in Oral Medicine. The present study investigated whether the use of support tools changes the quality of descriptions focusing on health care prioritization. Two oral lesions (A and B) were described by 64 dental students and 48 dentists using three methods: (a) without support tools (free); (b) using the oral examination form from the Specialties Manual in Oral Health/Brazilian Ministry of Health (SMOH form); and (c) using the OralDESC guideline. The descriptions were compared with a gold standard and percentage of agreement was analyzed by the Kruskal-Wallis and Dunn's tests (p<0.05). Descriptions with the OralDESC presented higher information quality. Considering items essential for prioritization, the OralDESC demonstrated better performance for lesion A; for lesion B, free descriptions and descriptions using the OralDESC were of higher quality than those using SMOH form. Therefore, the OralDESC offered greater support for the description of oral lesions for health care prioritization in Oral Medicine.

The use of tools to support oral lesion description in oral medicine referrals

Abstract: Poor description of oral lesions jeopardize the prioritization of appointments in Oral Medicine. The present study investigated whether the use of support tools changes the quality of descriptions focusing on health care prioritization. Two oral lesions (A and B) were described by 64 dental students and 48 dentists using three methods: (a) without support tools (free); (b) using the oral examination form from the Specialties Manual in Oral Health/Brazilian Ministry of Health (SMOH form); and (c) using the OralDESC guideline. The descriptions were compared with a gold standard and percentage of agreement was analyzed by the Kruskal-Wallis and Dunn's tests (p<0.05). Descriptions with the OralDESC presented higher information quality. Considering items essential for prioritization, the OralDESC demonstrated better performance for lesion A; for lesion B, free descriptions and descriptions using the OralDESC were of higher quality than those using SMOH form. Therefore, the OralDESC offered greater support for the description of oral lesions for health care prioritization in Oral Medicine.

Dental treatment in patients with leukemia.

Dental treatment of patients with leukemia should be planned on the basis of antineoplastic therapy which can be chemotherapy with or without radiotherapy and bone marrow transplantation. Many are the oral manifestations presented by these patients, arising from leukemia and/or treatment. In addition, performing dental procedures at different stages of treatment (before, during, or after) must follow certain protocols in relation to the haematological indices of patients, aimed at maintaining health and contributing to the effectiveness of the results of antineoplastic therapy. Through a literature review, the purpose of this study was to report the hematological abnormalities present in patients with leukemia, trying to correlate them with the feasibility of dental treatment at different stages of the disease. It is concluded in this paper that dental treatment in relation to haematological indices presented by patients with leukemia must follow certain protocols, mainly related to neutrophil and platelet counts, and the presence of the dentist in a multidisciplinary team is required for the health care of this patient.

Proposta de um roteiro de apoio à descrição de lesões bucais como instrumentalização para a comunicação profissional / Proposal for a guideline for the description of oral lesions as a support tool for professional communication in Oral Medicine

A boa comunicação escrita é uma habilidade essencial para a troca de informações entre profissionais da saúde. No contexto do SUS, essa troca ocorre por meio de documentos de referência e contrarreferência. Considerando as lesões bucais que necessitam de avaliação na atenção secundária, documentos de referência permitem avaliar a necessidade clínica e a urgência de cada caso, com impactos na priorização do acesso. A falta de detalhamento e concisão dos documentos de referência impacta na agilidade do fluxo do paciente entre os níveis de atenção à saúde e, consequentemente, na qualidade do cuidado a ele oferecido. Visando aprimorar o detalhamento dos documentos de referência em Estomatologia na região da Grande Florianópolis, Santa Catarina, foi desenvolvido o OralDESC - um roteiro de apoio à descrição de lesões bucais. O roteiro também vem sendo utilizado pelas disciplinas relacionadas ao Diagnóstico Bucal na Universidade Federal de Santa Catarina. Além de apresentar o roteiro, este trabalho procura ampliar a análise da questão, apresentando alguns desafios para a implantação dos complexos regulatórios no Brasil, bem como as dificuldades relatadas no país e em outras parte do mundo no que se refere à qualidade dos documentos de referência. Adicionalmente, apresenta a visão de alguns autores sobre o potencial educativo dos processos de referência e contrar-referência e a importância da formação para a comunicação escrita. São partilhadas, ainda, reflexões sobre a necessidade de inclusão, nos currículos acadêmicos, de atividades que permitam o desenvolvimento de habilidades de comunicação por estudantes de Odontologia, de forma a capacitá-los à atuação em redes de atenção que privilegiam a interação multiprofissional, interdisciplinar e transdisciplinar (AU).

Good written communication is an essential skill for the exchange of information between health professionals. In the context of Brazilian National Health Service, this exchange occurs via referral and reply letters. With regard to oral lesions that require evaluation in secondary care, referral letters allow the assessment of clinical need and the urgency for consultation with the oral health specialist. These factors determine the access priority in the secondary health system. The lack of details and conciseness of the referral letters impacts the patient flow throughout the healthcare levels and hence the quality of healthcare services. In order to improve the quality of information of the referral letters to specialists in Oral Medicine in the Greater Florianopolis city, Santa Catarina, Brazil, a guideline for supporting the description of oral lesions - the OralDESC ­ has been developed. The guideline is being used in the courses related to oral diagnosis consultations at the Federal University of Santa Catarina. This paper extends the analysis of the problem, discussing some challenges for the implementation of the referral procedures in Brazil as well as the difficulties reported in the country and in other countries regarding the quality of referral letters. Additionally, the paper provides views of some authors on the educational potential of referral and reply letters and the necessity of training health students for written communication. The authors share some thoughts about the need for inclusion of activities in the Brazilian Dentistry curricula aiming at developing communication skills in the students so as to prepare them to work in multidisciplinary, interdisciplinary and transdisciplinary teams (AU).

Plataforma colaborativa multimídia para apoio ao diagnóstico de lesões bucais em ambientes de teleodontologia / Collaborative multimedia platform to support oral diagnosis in teledentistry environments

Este artigo tem por objetivo apresentar uma solução tecnológica desenvolvida para permitir atividades colaborativas de diagnóstico de lesões bucais em ambientes de Teleodontologia. Trata-se de uma plataforma totalmente baseada na web e que permite o gerenciamento e compartilhamento de imagens clínicas, radiográficas e histopatológicas, dispensando a instalação de qualquer programa adicional no computador do usuário. Como suporte à colaboração através do navegador, as ações efetuadas por um usuário são replicadas e visíveis ao outro usuário conectado, sendo possível a discussão e troca de informações sobre o caso através de chat e/ou áudiovideoconferência. Ferramentas de Telessaúde podem ofereçe diferentes oportunidades para assistência e educação em Odontologia. Ao permitir a visualização de diferentes aspectos da doença do paciente, a solução aqui apresentada tem potencial para viabilizar: (1) a troca de informações entre profissionais de saúde atuantes em distintos níveis de assistência e (2) a tutoria, à distância, nos diferentes níveis de formação (graduação, pós-graduação e educação continuada) (AU).

This paper presents a technological solution developed to enabling collaborative activities in Teledentistry environments. This is a platform composed by a set of tools for the management and sharing of clinical, radio graphic and histopathologic images. The proposed solution is fully web-based, requiring only a web browser installed; it's not necessary to install any other software on the user's computer. As collaboration support, the actions performed by a user with mouse and keyboard are replicated and visible to the other connected user. This toolkit allows the discussion of disease via chat and/or videoconferen ing. Telehealth's tools offer opportunities for assistance and education in Dentistry. By allowing realtime viewing and discussion of different aspects of a disease this technological solution has potential to facilitate: (1) exchange of information between health professionals at different levels of assistance and (2) distance tutoring at different levels of training (undergraduate, postgraduate and continuing education) (AU).