A Critical Review of Risk Assessment Models for Listeria monocytogenes in Produce.

A review of quantitative risk assessment (QRA) models of Listeria monocytogenes in produce was carried out, with the objective of appraising and contrasting the effectiveness of the control strategies placed along the food chains. Despite nine of the thirteen QRA models recovered being focused on fresh or RTE leafy greens, none of them represented important factors or sources of contamination in the primary production, such as the type of cultivation, water, fertilisers or irrigation method/practices. Cross-contamination at processing and during consumer's handling was modelled using transfer rates, which were shown to moderately drive the final risk of listeriosis, therefore highlighting the importance of accurately representing the transfer coefficient parameters. Many QRA models coincided in the fact that temperature fluctuations at retail or temperature abuse at home were key factors contributing to increasing the risk of listeriosis. In addition to a primary module that could help assess current on-farm practices and potential control measures, future QRA models for minimally processed produce should also contain a refined sanitisation module able to estimate the effectiveness of various sanitisers as a function of type, concentration and exposure time. Finally, L. monocytogenes growth in the products down the supply chain should be estimated by using realistic time-temperature trajectories, and validated microbial kinetic parameters, both of them currently available in the literature.

A Critical Review of Risk Assessment Models for Listeria monocytogenes in Seafood.

Invasive listeriosis, due to its severe nature in susceptible populations, has been the focus of many quantitative risk assessment (QRA) models aiming to provide a valuable guide in future risk management efforts. A review of the published QRA models of Listeria monocytogenes in seafood was performed, with the objective of appraising the effectiveness of the control strategies at different points along the food chain. It is worth noting, however, that the outcomes of a QRA model are context-specific, and influenced by the country and target population, the assumptions that are employed, and the model architecture itself. Studies containing QRA models were retrieved through a literature search using properly connected keywords on Scopus and PubMed®. All 13 QRA models that were recovered were of short scope, covering, at most, the period from the end of processing to consumption; the majority (85%) focused on smoked or gravad fish. Since the modelled pathways commenced with the packaged product, none of the QRA models addressed cross-contamination events. Many models agreed that keeping the product's temperature at 4.0-4.5 °C leads to greater reductions in the final risk of listeriosis than reducing the shelf life by one week and that the effectiveness of both measures can be surpassed by reducing the initial occurrence of L. monocytogenes in the product (at the end of processing). It is, therefore, necessary that future QRA models for RTE seafood contain a processing module that can provide insight into intervention strategies that can retard L. monocytogenes' growth, such as the use of bacteriocins, ad hoc starter cultures and/or organic acids, and other strategies seeking to reduce cross-contamination at the facilities, such as stringent controls for sanitation procedures. Since risk estimates were shown to be moderately driven by growth kinetic parameters, namely, the exponential growth rate, the minimum temperature for growth, and the maximum population density, further work is needed to reduce uncertainties.

A Critical Review of Risk Assessment Models for Listeria monocytogenes in Meat and Meat Products.

A review of the published quantitative risk assessment (QRA) models of L. monocytogenes in meat and meat products was performed, with the objective of appraising the intervention strategies deemed suitable for implementation along the food chain as well as their relative effectiveness. A systematic review retrieved 23 QRA models; most of them (87%) focused on ready-to-eat meat products and the majority (78%) also covered short supply chains (end processing/retail to consumption, or consumption only). The processing-to-table scope was the choice of models for processed meats such as chorizo, bulk-cooked meat, fermented sausage and dry-cured pork, in which the effects of processing were simulated. Sensitivity analysis demonstrated the importance of obtaining accurate estimates for lag time, growth rate and maximum microbial density, in particular when affected by growth inhibitors and lactic acid bacteria. In the case of deli meats, QRA models showed that delicatessen meats sliced at retail were associated with a higher risk of listeriosis than manufacture pre-packed deli meats. Many models converged on the fact that (1) controlling cold storage temperature led to greater reductions in the final risk than decreasing the time to consumption and, furthermore, that (2) lower numbers and less prevalence of L. monocytogenes at the end of processing were far more effective than keeping low temperatures and/or short times during retail and/or home storage. Therefore, future listeriosis QRA models for meat products should encompass a processing module in order to assess the intervention strategies that lead to lower numbers and prevalence, such as the use of bio-preservation and novel technologies. Future models should be built upon accurate microbial kinetic parameters, and should realistically represent cross-contamination events along the food chain.

Eco-friendly fabricated multibioactive Ca(II)-antibiotic coordination framework coating on zinc towards improved bone tissue regeneration.

Zinc is a biodegradable candidate material for bone regeneration; however, concomitant implant-related infection and rejection require new solutions to raise the biomedical potential of zinc. Functionalization towards localized drug administration with bioactive frameworks can be a solution. It is herein reported for the first time an eco-friendly approach for coating zinc with multibioactive antibiotic coordination frameworks (ACF). ACF1, a new 1D framework with deprotonated nalidixic and salicylic acids, obtained by mechanochemistry, results from the coordination of Ca(II) centers to the organic acids anions. To maximize ACF1 loading and cells' adhesion, the surface area was increased by creating a porous 3D Zn layer. A coverage of ∼70% of the surface with ACF1, achieved by electrophoretic deposition in an aqueous solution, preserved the desired Zn degradation as |Z| in the order of 103 Ω.cm2 is attained for both bare and coated samples in physiological conditions. The bioactivities of the ACF1 powder are a strong antibacterial activity against Escherichia coli (MIC of 1.95 µg/mL) and weaker against Staphylococcus aureus (MIC of 250 µg/mL), while osteoblasts' cytocompatibility is achieved for concentration ranging between 10 and 100 µg/mL. In its coating form, the degradation of Zn coated with ACF1 results in nalidixic acid release, which may convey antibacterial activity to the implant. The osteoinduction observe over this new biomaterial relates to the precipitation of an apatite layer built from the Ca(II) of ACF1. The work described herein, where unexplored eco-friendly approaches were used, presents a new trend for the design of multibioactive coatings on bioresorbable metallic materials.

Suitable areas for invasive insect pests in Brazil and the potential impacts for eucalyptus forestry.

BACKGROUND: Brazil is among the world's largest producers of eucalyptus and the damage caused by native and invasive insect pests is one of the main factors affecting eucalyptus yield. The recent history of biological invasions of eucalyptus pests in Brazil prompts demand for phytosanitary measures to prevent new invasions. This study used ecological niche models to estimate suitable areas for nine eucalyptus pests. This information was used to assess the potential ports of entry, generate invasion risk maps considering the likelihood of introducing invasive species, and estimate the eucalyptus producing municipalities and areas within the species' suitable range. RESULTS: A large distribution range was predicted for Eucalyptolyma maideni (Hempitera: Aphalaridae), Orgya postica (Lepidoptera: Erebidae), Sinoxylon anale (Coleoptera: Bostrichidae), and Trachymela sloanei (Coleoptera: Chrysomelidae) in Brazil, while a comparatively smaller distribution was predicted for Ophelimus maskelli (Hymenoptera: Eulophidae), Mnesampela privata (Lepidoptera: Geometridae), Paropsis atomaria (Coleoptera: Chrysomelidae), Paropsisterna beata, and P. cloelia (Coleoptera: Chrysomelidae). High-risk areas of invasion near airports and seaports were predicted mainly in southern, southeastern, and northeastern Brazil. A large proportion of the municipalities (24.4% to 93.7%) and areas with eucalyptus plantations (31.9% to 98.3%) are within the climatically suitable areas estimated for the pests, especially in southern and southeastern regions, which comprises 61.5% of the Brazilian eucalyptus production. CONCLUSION: The results indicate that eucalyptus forestry may be significantly impacted by biological invasion. The findings provided by our study can assist decision-makers in developing phytosanitary measures to prevent new invasions of forest pests in Brazil. © 2022 Society of Chemical Industry.

First Survey about Current Practices of Environmental Monitoring Programs within French Agri-Food Industries.

Food safety is a constant challenge for stakeholders in the food industry. To manage the likelihood of microbiological contamination, food safety management systems must be robust, including food and environmental testing. Environmental monitoring programs (EMP) have emerged this last decade aiming to validate cleaning-sanitation procedures and other environmental pathogen control programs. The need to monitor production environments has become evident because of recent foodborne outbreaks. However, the boundaries of environmental monitoring are not only limited to the management of pathogens but also extend to spoilage and hygiene indicators, microorganisms, allergens, and other hygiene monitoring. Surfaces in production environments can be a source of contamination, either through ineffective cleaning and disinfection procedures or through contamination during production by flows or operators. This study analyses the current practices of 37 French agri-food industries (small, medium, or large), reporting their objectives for EMPs, microbial targets, types, numbers and frequency of sampling, analysis of results, and types of corrective actions.

Harvesting rainwater for food security: farmers' perceptions of the Boardwalk Cisterns Program in Alagoas, Brazil.

INTRODUCTION: Boardwalk Cisterns is a government program that aims to attend a population with precarious access to water in Brazil. Developed as part of the Zero Hunger strategy, it intends to increase food security and contribute to the realization of the human right to food. The objective of this study was to assess farmers' perceptions of the Boardwalk Cisterns program and its impact on the food security situation of beneficiary households. METHODS: Data were collected through a descriptive cross-sectional quali-quantitative survey. Questionnaires were applied to farming families selected from two municipalities in the state of Alagoas (Northeast Brazil), containing questions on sociodemographic characteristics, production methods, and food security status. The Free Evocation Technique for social representation, analyzed through the software Ensemble of Programs Permettant L'analyze des Évocations, was used to ascertain farmers' perceptions of the program. RESULTS: The study showed a positive perception of the interviewees in relation to the boardwalk cisterns. The program brought some improvement in the agricultural production conditions and, consequently, in the food security situation of the households. Corn, beans and cassava were the most common crops, with almost half of this production (48.3%) destined for consumption by the families themselves. Farmers also reported having more water, allowing them to plant more fruit trees, as well as medicinal and ornamental plants. Nevertheless, 79.1% of the households interviewed were still in a situation of food insecurity, of which 28.1% were classified as mild food insecurity, 26% as moderate food insecurity, and 25% as severe food insecurity. CONCLUSION: Farmers were correct in their perception that the Boardwalk Cisterns program improved their food security situation. The program resulted in greater access to water, and greater production and consumption of food. However, by itself, the Boardwalk Cisterns program was not enough to raise beneficiary families above their food-insecure status. The program alleviated the problem of food insecurity, but other complementary government interventions are needed to guarantee the food security of families living in extreme poverty.

Public health risk-benefit assessment of red meat in France: Current consumption and alternative scenarios.

Consumption of red meat has been associated with the risks of colorectal cancer (CRC), cardiovascular disease (CVD), foodborne-pathogen related diseases and with the potential benefit obtained by reduction of iron deficiency anemia (IDA). Based on probabilistic models, current risks and benefit for the French population were aggregated into a single metric, the disability adjusted life years (DALY). In France, per 100,000 people, current red meat consumption was responsible for a mean of 19 DALYs due to CRC, 21 DALYs to CVD and 7 DALYs to foodborne diseases. Current consumption of iron throughout the diet led to a mean of 15 DALYs due to IDA. To mitigate the risks, scenarios were built per sub-population of age and gender. Among adult and elderly population, the big meat eaters would benefit to adhere to the current recommendation (less than 500 g/w): the risks of CRC and CVD would decrease. Regarding IDA (scenario built with fixed ground beef amount), for young population, a consumption of 375g/w would be sufficient to eliminate the burden while for 25-44 years-old females, 455g/w would reduce IDA, but not entirely. This study highlighted the importance of assessing health risk-benefit per sub-populations and the necessity of communicating the results accordingly.

A Systematic Review of Beef Meat Quantitative Microbial Risk Assessment Models.

Each year in Europe, meat is associated with 2.3 million foodborne illnesses, with a high contribution from beef meat. Many of these illnesses are attributed to pathogenic bacterial contamination and inadequate operations leading to growth and/or insufficient inactivation occurring along the whole farm-to-fork chain. To ensure consumer health, decision-making processes in food safety rely on Quantitative Microbiological Risk Assessment (QMRA) with many applications in recent decades. The present study aims to conduct a critical analysis of beef QMRAs and to identify future challenges. A systematic approach, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, was used to collate beef QMRA models, identify steps of the farm-to-fork chain considered, and analyze inputs and outputs included as well as modelling methods. A total of 2343 articles were collected and 67 were selected. These studies focused mainly on western countries and considered Escherichia coli (EHEC) and Salmonella spp. pathogens. Future challenges were identified and included the need of whole-chain assessments, centralization of data collection processes, and improvement of model interoperability through harmonization. The present analysis can serve as a source of data and information to inform QMRA framework for beef meat and will help the scientific community and food safety authorities to identify specific monitoring and research needs.

Padrão alimentar, comorbidades e grau de obesidade de mulheres em seguimento ambulatorial multiprofissional / Patrón alimentario, comorbilidades y grado de obesidad de mujeres en seguimiento ambulatorio multiprofesional / Eating pattern, comorbidities and degree of obesity in women in a multidisciplinary outpatient follow-up

Objetivo: descrever o padrão alimentar de mulheres com excesso de peso e caracterizar o índice de massa corpórea e as comorbidades associadas. Método: estudo descritivo quantitativo realizado em ambulatório de referência em obesidade com 101 mulheres com excesso de peso. Os dados foram avaliados por questionários específicos e analisados por meio da estatística descritiva. Resultados: predominaram mulheres com obesidade grau III (31,7%) e com hipertensão arterial (61,4%). O consumo de alimentos com frequência igual ou superior a cinco dias por semana foi: feijão/leguminosas (45,0%), verduras/legumes/salada cozidos (54,0%) e cru (47,0%), carnes vermelhas (45,5%), frango (35,0%) e peixes (3,0%). A maioria retirava a gordura visível das carnes vermelhas (89,7%) e do frango (85,9%) e adotava a forma cozida, assada ou grelhada como preparo (93,9%). Bebidas açucaradas eram consumidas por 18,0% das entrevistadas. Conclusão: o padrão de consumo alimentar de mulheres com excesso de peso apresentou-se abaixo do recomendado.

Objetivo: describir el patrón alimentario de mujeres con sobrepeso y caracterizar el índice de masa corporal y las comorbilidades asociadas. Método: estudio descriptivo cuantitativo, en clínica de obesidad de referencia, con 101 mujeres con sobrepeso. Datos se evaluaron mediante cuestionarios específicos y se analizaron a través de estadística descriptiva. Resultados: predominaron mujeres con obesidad de grado III (31,7%) e hipertensión arterial (61,4%). El consumo de alimentos con frecuencia igual o mayor a cinco días a la semana fue: frijoles/legumbres (45,0%), verduras/ensaladas cocidas (54,0%) y crudas (47,0%), carnes rojas (45,5%), pollo (35,0%) y pescado (3,0%). La mayoría eliminó la grasa visible de las carnes rojas (89,7%) y del pollo (85,9%) y adoptó la forma cocida, asada o a la parrilla como preparación (93,9%). Las bebidas azucaradas fueron consumidas por 18,0% de las entrevistadas. Conclusión: el patrón de consumo de alimentos de mujeres con exceso de peso fue inferior al recomendado.

Objective: to describe the eating pattern of women with excess weight and to characterize the body mass index and the associated comorbidities. Method: quantitative, descriptive study conducted in an outpatient clinic reference in obesity with 101 women with excess weight. The data were assessed by specific questionnaires and analyzed through descriptive statistics. Results: there was prevalence of women with class III obesity (31.7%) and hypertension (61.4%). The consumption of foods with a frequency equal to or greater than five days per week was: beans/legumes (45.0%), stewed (54.0%) and raw (47.0%) vegetables/pulses/salad, red meat (45.5%), chicken (35.0%) and fish (3.0%). The majority removed the visible fat of red meat (89.7%) and chicken (85.9%) and adopted the stewed, baked or broiled way as preparation (93.9%). Sugary drinks were consumed by 18.0% of interviewees. Conclusion: the pattern of food consumption in women with excess weight was below the recommended levels.

Percepções de enfermeiros da atenção primária no atendimento às mulheres vítimas de violência sexual / Perceptions of nurses from primary care to care to women sexual violence victims / Percepciones de enfermeras de atención primaria a atención a mujeres víctimas de violencia sexual

Objetivo: analisar a percepção dos enfermeiros sobre o atendimento às mulheres vítimas de violência sexual na atenção primária. Método: estudo de natureza descritivo-exploratório com abordagem qualitativa, desenvolvido com sete enfermeiros de uma unidade básica de saúde do Distrito Federal. Os dados foram coletados a partir de entrevistas e analisadas mediante análise de conteúdo. A pesquisa foi aprovada pelo Comitê de Ética em Pesquisa UNIP sob o parecer nº 3.425.175. Resultados: a empatia foi um sentimento presente nos enfermeiros, bem como a frustação; a falta de conhecimento específico sobre a temática e a dificuldade na identificação dos casos de violência sexual também estiveram presentes e podem resultar na subnotificação dos casos na atenção primária. Conclusão: torna-se necessário uma abordagem indireta do enfermeiro às mulheres através de questionamentos sobre a ocorrência de violência sexual, bem como a incorporação da temática na graduação e a realização de educação permanente aos profissionais. (AU)

Objective: to analyze nurses' perception of the care provided to women victims of sexual violence in primary care. Method: this is a descriptive and exploratory study with a qualitative approach, developed with seven nurses from a basic health unit in the Federal District. Data were collected from interviews and analyzed using content analysis. The UNIP Research Ethics Committee under opinion nº 3.425.175 approved the research. Results: empathy was a feeling present in nurses, as well as frustration; the lack of specific knowledge on the subject and the difficulty in identifying cases of sexual violence were also present and may result in underreporting of cases in primary care. Conclusion: it is necessary to take an indirect approach from the nurse to women through questions about the occurrence of sexual violence, as well as the incorporation of the theme in graduation and the realization of permanent education for professionals.(AU)

Objetivo: analizar la percepción de las enfermeras sobre la atención brindada a las mujeres víctimas de violencia sexual en atención primaria. Método: estudio descriptivo-exploratorio con enfoque cualitativo, desarrollado con siete enfermeras de una unidad básica de salud en el Distrito Federal. Los datos se recopilaron de entrevistas y se analizaron mediante análisis de contenido. La investigación fue aprobada por el Comité de Ética en Investigación UNIP bajo la opinión nº 3.425.175. Resultados: la empatía era un sentimiento presente en las enfermeras, así como la frustración; la falta de conocimiento específico sobre el tema y la dificultad para identificar casos de violencia sexual también estuvieron presentes y pueden dar como resultado un subregistro de casos en atención primaria. Conclusión: es necesario adoptar un enfoque indirecto de la enfermera a las mujeres a través de preguntas sobre la ocurrencia de violencia sexual, así como la incorporación del tema en la graduación y la realización de educación permanente para profesionales.(AU)

Estimation of the Burden of Iron Deficiency Anemia in France from Iron Intake: Methodological Approach.

: Dietary iron deficiency (ID) is the first nutritional deficiency in the world, in terms of disability adjusted life years (DALY). This nutritional deficiency may lead to anemia, especially among children, adolescents, and adult women. The aim of this study was to build an original probabilistic model to quantitatively assess the ID, the iron deficiency anemia (IDA) and the subsequent health burden in France expressed in DALY, per age class and gender. The model considered the distribution of absorbed iron intake, the iron requirement distribution established by the European Food Safety Authority and the iron status in France. Uncertainty due to lack of data and variability due to biological diversity were taken into account and separated using a second-order Monte Carlo procedure. A total of 1290 (95% CI = 1230-1350) IDA cases corresponding to 16 (95% CI = 11-20) DALY were estimated per 100,000 individuals per year. The major contributors to IDA burden were menstruating females aged from 25 to 44 years old. Then, a consumption scenario was built with ground beef as intake, an increase in red meat consumption to 100 g/d would not eliminate entirely the IDA burden. The quantitative methodology applied here for France could be reused for other populations.

Estimation of the burden of disease attributable to red meat consumption in France: Influence on colorectal cancer and cardiovascular diseases.

The consumption of red meat has been associated with colorectal cancer (CRC) and cardiovascular disease (CVD) worldwide. The objective of this study was to assess quantitatively the burden of disease of CRC and CVD due to the consumption of red meat in France. A probabilistic risk assessment model quantifying the risk, deaths and disability adjusted life years (DALY) of both outcomes was built. In the model, uncertainty and variability were propagated separately. The model used data on current CRC and CVD incidence and red meat consumption in France, as well as dose-response from epidemiological studies. Results were given by age class and gender. A total of 19 [95% CI = 8-33] DALY per 100,000 people per year for CRC associated with red meat consumption was estimated. For CVD, 21 [95% CI = 12-32] DALY per 100,000 people per year was estimated. The uncertainty was mainly due to the dose-response, as revealed by a sensitivity analysis. A scenario analysis, performed on red meat intake, highlighted that consumption of less than 65 g per day could limit the risk of CRC and CVD in the most affected sub-populations.

Pituitary Metastasis of Thyroid Carcinoma: A Case Report.

BACKGROUND Pituitary metastasis of thyroid carcinoma is a rare entity. Differential diagnosis with other lesions in the sellar/parasellar region, through clinical, histopathological, immunohistochemical, and imaging is challenging but essential for adequate treatment. CASE REPORT This case report describes a 58-year-old patient with the previous diagnosis of follicular thyroid carcinoma, with metastasis to cervical lymph nodes, bone, and lung, initially evolving to left palpebral ptosis. In the investigation, laboratory tests showed hypopituitarism, and magnetic resonance imaging of the skull showed a suprasellar formation measuring 2.2×3.5×2.5 cm, which increased in size in a few months. The patient underwent transcranial neurosurgery and subsequent immunohistochemical analysis, which confirmed pituitary metastasis of follicular thyroid carcinoma. The patient underwent chemotherapy and radiotherapy but died 26 months after the onset of symptoms. CONCLUSIONS The differential diagnosis of pituitary metastasis from a benign lesion is difficult. Therefore, a careful analysis of the history and clinical evolution, use of complementary imaging tests, and, where possible, the histopathological and immunohistochemical analysis of the lesion for diagnostic elucidation are necessary.

O projeto clínico-assistencial e de formação do Instituto Raul Soares: posição de laço com a rede / The clinical-assistance and training project at the Raul Soares Institute: a bond position with the network / El proyecto clínico-asistencial y de formación del Instituto Raúl Soares: posición de vínculo con la red

A proposta de um projeto clínico-assistencial e de formação para o Instituto Raul Soares está assentada em uma pergunta fundamental: qual a vocação clínica desta instituição, quais são os seus princípios operadores da clínica e das suas atividades assistenciais e como podemos transmitir essa vocação clínica aos nossos trabalhadores e parceiros de trabalho da rede de atenção psicossocial? É com base nessa pergunta que desenvolvemos este texto, expondo algumas ideias sobre como tem se dado a efetivação de um projeto clínico-assistencial e de formação de uma instituição de tratamento e ensino que privilegia uma posição de laço com a rede. O nosso orientador para o projeto institucional do IRS é a palavra, e a nossa causa, o laço com o território, com a rede, com a cidade, para a vida do sujeito falante.

The proposal of a clinical-assistance and training project for the Raul Soares Institute (RSI) is based on a fundamental question: what is the clinical vocation of this institution, what are its principles, operating the clinic and its assistance activities and how we can transmit this clinic vocation to our employees and workmates within the psychosocial assistance network? It is based on this question that we have developed this work, unveiling some ideas about how the effectiveness of a clinical-assistance project and the formation of a treatment and teaching institution that privileges a position of bond with the network is being developed. Our guideline to the RSI’s institutional design is the speech, and our cause is the bond with the territory, with the network, the city, for the life of the speaking subject.

La propuesta de un proyecto clínico-asistencial y de formación para el Instituto Raul Soares está asentada en una pregunta fundamental: ¿cuál es la vocación clínica de esta institución, cuáles son sus principios operadores de la clínica y de sus actividades asistenciales y cómo podemos transmitir esta vocación clínica a nuestros trabajadores y socios de trabajo de la red de atención psicosocial? A partir de esta pregunta desarrollamos este texto, exponiendo algunas ideas sobre cómo se ha dado la efectivación de un proyecto clínico-asistencial y de formación de una institución de tratamiento y enseñanza que privilegia una posición de vínculo con la red. Nuestro orientador para el proyecto institucional del IRS es la palabra y nuestra causa el vínculo el territorio, con la red, con la ciudad, para la vida del sujeto hablante.

Endophthalmitis as a first manifestation of right-sided endocarditis in a patient with patent foramen ovale.

Endogenous endophthalmitis is a rare complication of endocarditis, rendering poor visual prognosis. We report a case of a 66-year-old female with renal failure who presented with fever, ocular pain, and purulent eye discharge. After a diagnosis of endogenous endophthalmitis, she was treated with antibiotics and enucleation of the eye. Due to persistent fever and positive blood cultures, a transesophageal echocardiography was undertaken, disclosing a large mural vegetation in the right atrium, catheter-associated vegetations, and a patent foramen ovale. Endocarditis is an uncommon source of endogenous endophthalmitis, and has rarely been associated to right-sided endocarditis and paradoxical septic embolization.

Qualidade de vida em sobreviventes de acidente vascular cerebral: instrumentos de avaliação e seus resultados: [revisão] / Quality of life in stroke survivors: assessment instruments and their outcomes: [review]

OBJETIVOS: Os objetivos deste estudo foram identificar os instrumentos genéricos e específicos utilizados na avaliação da qualidade de vida (QV) e os seus resultados em sobreviventes de acidente vascular cerebral (AVC). MÉTODOS: Realizou-se revisão da literatura dos últimos dez anos, com população acima de 18 anos, nos bancos de dados MedLine e Lilacs, cujas publicações utilizassem instrumentos padronizados e validados no país de origem. Combinaram-se os descritores quality of life, cerebrovascular accident, stroke, QV e acidente cerebrovascular. RESULTADOS: Consideraram-se relevantes 96 estudos e 31 entram neste trabalho, de acordo com os critérios de inclusão. Foram encontrados cinco tipos diferentes de instrumentos genéricos/perfil, nove genérico/utility e dois específicos. O mais freqüente foi o SF-36, em 45,2 por cento dos estudos. Observou-se que a baixa QV relacionou-se, principalmente, ao déficit da função física, à presença de depressão ou de seus sintomas, ser do sexo feminino e ser mais idoso. De modo geral, os sujeitos no pós-AVC possuíam pior QV do que aqueles que não sofreram o evento. CONCLUSÃO: Foram encontrados 16 instrumentos para avaliação da QV. A baixa QV foi prevalente nos sobreviventes pós-AVC e se correlacionou com a função física, a depressão, o sexo e a idade.

OBJECTIVE: The purpose of this study is to identify generical and specific instruments used for valueing quality of life (QOL) and their outcomes in stroke survivors. METHODS: Review of literature of last 10 years, with people above 18 years old, in MedLine and Lilacs database. The instruments used on the studies were validated for the their countries. 96 articles have been considered relevant and 31 were in accordance with inclusion criteria. Five kind of generic/profile, nine generic/utility and two specific instruments were found. The more frequent was SF-36, on the 45,2 percent of the studies. It has been observed that poverty in quality of life was related to defective the physical function, to the presence of depression or its symptoms, to the feminine gender and to being older. In general, survivors of cerebrovascular accident had worse QOL than the ones who did not suffer it. CONCLUSION: It has been found 16 instruments for QOL' assessment. The poverty of QOL was frequent on stroke survivors and was related to physical function, depression, sex and age.