Topical tacrolimus in high-risk corneal transplants.

PURPOSE: The purpose of this study was to assess the use of topical tacrolimus ointment in preventing rejection in high-risk corneal grafts, when added to the standard immunosuppressive regimen. METHODS: We conducted an observational, retrospective study using clinical data of high-risk patients subjected to penetrating keratoplasty, who were treated with topical tacrolimus ointment 0.2 mg/g twice a day plus topical dexamethasone 0.1 mg/ml 6 id and compared it with a similar control group treated with topical dexamethasone 0.1 mg/ml 6 id alone. High-risk status was attributed to patients with previous ipsilateral corneal graft failure, two or more quadrants with corneal neovascularization or an infectious or inflammatory corneal disease. RESULTS: We analysed 53 patients in the trial group versus 53 patients in the control group, with similar age, baseline diagnosis and risk factors, and median follow-up times of 30 and and 24 months, respectively. Survival analysis showed a higher graft survival rate at all follow-up periods for patients treated with topical tacrolimus (p < 0.01). No adverse reactions were reported. DISCUSSION: This study shows that topical tacrolimus ointment increases the survival rate of the graft if added to the previous topical steroid regimen in high-risk patients. CONCLUSION: Topical tacrolimus is safe and effective in prolonging graft survival in high-risk patients.

Comparison of outcomes between cross-linking plus topoguided excimer laser ablation and intrastromal corneal ring segments for keratoconus.

OBJECTIVE: To compare cross-linking (CXL) plus topography-guided photorefractive keratectomy (t-PRK) and intrastromal corneal ring segments (ICRS) in keratoconus patients, at 12 months of follow-up. METHODS: This was a longitudinal, retrospective multi-center study. We included a referred sample of 154 eyes from 149 patients with grade I-III Amsler-Krümeich keratoconus with insufficient corrected-distance visual acuity (CDVA). In group 1 (CXL plus t-PRK, 87 eyes), another possible indication for surgery was evidence of progression. Group 2 (ICRS, 67 eyes) included only eyes with paracentral keratoconus (thinnest point at the inferotemporal quadrant) with coincident axes, and evidence of stabilization was required. A subgroup analysis was performed regarding the disease topographic phenotype. At 12 months postoperatively, visual, refractive, and topographic outcomes were evaluated. RESULTS: Comparison of the outcomes between CXL plus t-PRK (group 1) and ICRS (group 2) showed similar improvements in CDVA (in group 1, CDVA improved 0.18 logMAR, and in group 2 0.12 logMAR, P = .18) and K2 (-2,45 [6.46] D in group 1 and -2.13 [1.67] D in group 2, P = .34) The improvement in cylinder power was greater in group 2 (-2.37 [2.07] D in group 2 versus -1.18 [2.63] D in group 1, P = .003); group 1 had a higher decrease in Kmax (- 3.26 [3.64] versus-1.74 [2.67], P = .001). CONCLUSIONS: Both CXL plus t-PRK and ICRS were equally effective in improving CDVA and topographic parameters in a similar group of keratoconus patients at 12 months.

Percepção de enfermeiros sobre as práticas colaborativas interprofissionais na atenção básica em Palmas, TO / Nurses' perception about interprofessional collaborative practices concerning primary care in Palmas, TO

Com objetivo de evidenciar a percepção de enfermeiros(as) sobre as práticas colaborativas interprofissionais na Atenção Básica no município de Palmas (TO), foi realizado este estudo de abordagem qualitativa, conduzido em 34 Unidades Básicas de Saúde sobre onde as práticas colaborativas são vivenciadas. Os dados foram analisados pela técnica do Discurso do Sujeito Coletivo com base na Teoria da Representação Social. As práticas colaborativas relatadas foram: reuniões de equipe, grupos de trabalho, atendimento compartilhado, atividades em conjunto na comunidade, discussão de casos, planos terapêuticos integrados e rodas de conversa. Referiram como facilitadores: comunicação interprofissional; perfil da equipe; parceria, confiança e respeito; flexibilização da agenda para os encontros; e uma liderança colaborativa. Na percepção dos participantes, as práticas colaborativas favorecem maior eficácia na resolução de problemas complexos e intensificam os vínculos profissionais entre os membros da equipe. Ressaltaram que as práticas colaborativas são de grande relevância no âmbito da Atenção Primária à Saúde melhorando a ambiência, a satisfação no trabalho e a qualidade do serviço.

In order to evidence the perception of nurses about interprofessional collaborative practices in Primary Care in the city of Palmas, TO, this qualitative study was conducted in 34 Basic Health Units where collaborative practices are experienced. Data were analyzed using the Collective Subject Discourse technique, based on the Social Representation Theory. The collaborative practices reported were: team meetings, work groups, shared care, joint activities in the community, case discussions, integrated therapeutic plans and conversation circles. They mentioned interprofessional communication as facilitators; team profile; partnership, trust and respect; flexible schedule for meetings and collaborative leadership. In the participants' perception, collaborative practices favor greater effectiveness in solving complex problems and intensify professional bonds between team members. They emphasized that collaborative practices are of great relevance in the scope of Primary Health Care, improving the ambience, job satisfaction and the quality of the service.

Perfil de estilo de vida de pacientes com doença renal crônica em hemodiálise / Lifestyle profile of patients with chronic renal disease in hemodialysis

O objetivo deste estudo foi avaliar o perfil de estilo de vida de pacientes com doença renal crônica em hemodiálise. Trata-se de investigação transversal de abordagem quantitativa, do tipo analítico-descritiva. A coleta de dados foi efetivada no Hospital Regional do Baixo Amazonas, no município de Santarém, Estado do Pará. Os participantes responderam questionário sociodemográfico e de fatores associados criado pelos autores da pesquisa, e para análise do estilo de vida utilizou-se o Instrumento Perfil de Estilo de Vida Individual. Foram avaliados 70 pacientes renais crônicos prevalentemente do sexo masculino e faixa etária entre 21 e 71 anos. A pontuação média do questionário de estilo de vida global foi 20,8±7 pontos, 15,7% apresentaram classificação do estilo de vida negativo, 72,2% regular e 8,5% positivo. Para 24,2% a doença tem um impacto importante na vida. Concluiu-se que houve prevalência de estilo de vida classificado como regular, bem como autorrelato de impacto importante da doença renal crônica sobre a vida do paciente, o que pode ser potencialmente atenuado por componentes de um estilo de vida promotor de saúde.

This study aimed to evaluate the lifestyle profile of patients with chronic kidney disease undergoing hemodialysis. This was a quantitative, cross-sectional, analytical and descriptive study. Data were collected at Baixo Amazonas Regional Hospital, in the municipality of Santarém, state of Pará. The participants answered a sociodemographic, associated factors questionnaire created by the authors, and for lifestyle analysis, the Individual Lifestyle Profile Instrument was used. Seventy chronic kidney patients, predominantly male and aged between 21 and 71 years, were evaluated. The average score of the global lifestyle questionnaire was 20.8 ± 7 points, 15.7% had a negative lifestyle rating, 72.2% regular and 8.5% positive. For 24.2%, the disease has an important impact on life. There was a prevalence of regular lifestyle, as well as self-report of important impact of chronic kidney disease on the patient's life, which can potentially be mitigated by components of a health-promoting lifestyle.

Violência na Infância e Adolescência: Perfil notificado na mesorregião do Baixo Amazonas / Violence in Childhood and Adolescence: Profile reported in the mesoregion of the Low Amazon / Violencia en la Infancia y Adolescencia: Perfil notificado en la mesorregión del Bajo Amazonas

O artigo pretende traçar um perfil da violência infantil notificada na região oeste do Estado do Pará, com ênfase na violência física e sexual. Trata-se de investigação descritiva, retrospectiva e quantitativa realizada por meio de análise documental, a partir das fichas de atendimentos as ocorrências de violência no Programa Pro Paz Integrado, nos anos de 2012 a 2015. Os dados apresentam-se em estatísticas descritivas. Dos 2.078 registros de violência notificados, 72% se deram em vítimas do sexo feminino, 31% das violências ocorridas na casa da vítima. A violência física foi a mais frequente (32%). A faixa etária mais atingida de 12 a 17 anos. Predominou o agressor intrafamiliar (17%) e as violências notificadas concentraram-se nas regiões periféricas (60%). Caracteriza-se um perfil prevalente de violências físicas, precedidas das sexuais, em vítimas do sexo feminino, adolescentes, de baixa renda e escolaridade, cor parda, religião católica, ocorridas na casa da vítima e com agressor intrafamiliar. Conclui-se a urgência desses resultados estarem inseridos na agenda de políticas locais de enfrentamento

The article aims to trace a profile of reported child violence in the western region of the State of Pará, with emphasis on physical and sexual violence. It is a descriptive, retrospective and quantitative research carried out through documentary analysis, from the records of attendance to the occurrences of violence in the Program Pro Paz Integrado, in the years 2012 to 2015. Data are presented in descriptive statistics. Of the 2,078 records of reported violence, 72% occurred in female victims, 31% of the violence occurred in the victim's home. Physical violence was the most frequent (32%). The most affected age group was 12 to 17 years. The intrafamily aggressor predominated (17%) and reported violence was concentrated in the peripheral regions (60%). The prevailing profile of victims is characterized by physical violence, preceded by sexual violence, female, adolescent, low income, low schooling, brown color, Catholic, and violence occurs in the victim's home and with intrafamily aggressor. It is concluded that these results are included in the agenda of local coping policies

El artículo pretende trazar un perfil de la violencia infantil notificada en la región oeste del Estado de Pará, con énfasis en la violencia física y sexual. Se trata de una investigación descriptiva, retrospectiva y cuantitativa realizada por medio de análisis documental, a partir de las fichas de atención a las ocurrencias de violencia en el Programa Pro Paz Integrado, en los años 2012 a 2015. Los datos se presentan en estadísticas descriptivas. De los 2.078 registros de violencia notificados, el 72% se dio en víctimas del sexo femenino, el 31% de las violencias ocurridas en la casa de la víctima. La violencia física fue la más frecuente (32%). El grupo de edad más afectado de 12 a 17 años. Predominó el agresor intrafamiliar (17%) y las violencias notificadas se concentraron en las regiones periféricas (60%). Se caracteriza un perfil prevalente de violencias físicas, precedidas de las sexuales, en víctimas del sexo femenino, adolescentes, de baja renta y escolaridad, color parda, religión católica, ocurridas en la casa de la víctima y con agresor intrafamiliar. Se concluye la urgencia de que estos resultados estén insertados en la agenda de políticas locales de enfrentamiento

Experiência de educação em saúde sobre sexualidade com adolescentes institucionalizados / Experience in health education on sexuality with institutionalized adolescents / Experiencia con educación en salud sobre la sexualidad de adolescentes institucionalizados

Objetivo: Descrever a experiência de um projeto de ação que consistiu em fomentar a reflexão e a aprendizagem sobre sexualidade saudável por meio da educação em saúde. Síntese dos dados: Trata-se de um relato de experiência de uma atividade de extensão universitária realizada em novembro de 2015, com envolvimento de graduandos e mestrandos, em uma unidade da Fundação Centro de Atendimento Socioeducativo do Adolescente ­ Fundação CASA, no município de São Paulo/SP, Brasil. Na experiência, houve participação de 75 adolescentes internos do sexo masculino. O projeto enfatizou o envolvimento dos adolescentes e gestores em etapas como: 1. Levantamento de questionamentos na temática; 2. Discussão e busca de fontes de pesquisa pelos mestrandos; 3. Elaboração, aplicação e avaliação do projeto de ação, em formato carrossel, alternando três grupos: anatomia e cuidados com o aparelho reprodutor masculino, doenças sexualmente transmissíveis (DSTs), e estilo de vida saudável e sexualidade. Conclusão: Por meio da ação educativa em saúde foi proposta a reflexão por um pensar a sexualidade, tanto na dimensão higiênica preventiva como na orientação a hábitos de vida promotores de saúde.

Objective: To describe the experience of a project that consisted in fostering reflection and learning about healthy sexuality through health education. Data synthesis: This is an experience report on an university extension activity carried out in November 2015, with the involvement of undergraduates and students of a master's program, at an institutional unit of the Fundação Centro de Atendimento Socioeducativo do Adolescente - Fundação CASA, in the municipality of São Paulo, SP, Brazil. The experiment had the participation of 75 institutionalized male adolescents. The project emphasized the involvement of adolescents and managers in steps such as: 1. Survey of questions on the theme; 2. Discussion and search for research sources by the graduate students; 3. Elaboration, application and evaluation of the action project, in carousel format, with alternation of three groups: anatomy and care with the male reproductive system, sexually transmitted diseases (STDs), and healthy lifestyle and sexuality. Conclusion: Through the health educational activity, the reflexion on thinking the sexuality was proposed, both in the preventive hygienic dimension and in the orientation towards health-promoting life habits.

Objetivo: Describir la experiencia de un proyecto de acción para fomentar la reflexión y el aprendizaje sobre la sexualidad saludable a través de la educación en salud. Síntesis de los datos: Se trata de un relato de experiencia de una actividad de extensión universitaria realizada en noviembre de 2015 con alumnos de la graduación y máster en una unidad de la Fundación Centro de Atención Socioeducativa del Adolescente ­ Fundación CASA del municipio de São Paulo/SP, Brasil. En la experiencia participaron 75 adolescentes internos del sexo masculino. El proyecto enfatizó la interacción de los adolescentes y gestores en las etapas como: 1. Búsqueda de dudas sobre el tema; 2. Discusión y búsqueda de fuentes de investigación de parte de los alumnos del máster; 3. Elaboración, aplicación y evaluación del proyecto de acción en la forma de carrusel alternando tres grupos: anatomía y cuidados con el aparato reproductor masculino, enfermedades de transmisión sexual (ETS) y el estilo de vida saludable y la sexualidad. Conclusión: A través de la acción educativa para la salud se propuso la reflexión para pensar sobre la sexualidad en la dimensión de la higiene de prevención y la orientación de hábitos de vida promotores de salud.

Irregular Astigmatism After Corneal Transplantation--Efficacy and Safety of Topography-Guided Treatment.

PURPOSE: To analyze the efficacy and safety of topography-guided photorefractive keratectomy (TG-PRK) to treat irregular astigmatism after corneal transplantation. METHODS: This was a retrospective observational case series. Eyes with irregular astigmatism after penetrating keratoplasty treated with TG-PRK (Allegretto Wave Eye-Q) with the topography-guided customized ablation treatment protocol were included. All treatments had been planned to correct the topographic irregularities, as well as to reduce the refractive error after neutralizing the induced refractive change. Clinical records, treatment plan, and the examinations performed were reviewed and the following data were collected: corrected and uncorrected distance visual acuities; manifest refraction; topographic parameters, and corneal endothelial cell count. RESULTS: We included 31 eyes [30 patients; mean age 45.0 ± 13.4 (SD) years]. At the last postoperative follow-up (mean 9.2 ± 8.2 months), we observed a significant improvement in corrected (P = 0.001) and uncorrected distance visual acuities (P < 0.001). There was a gain of ≥1 uncorrected distance visual acuity line in 96.8% (n = 30) of the eyes. Similarly, the refractive parameters also improved (cylinder P < 0.001; spherical equivalent P = 0.002). At the last visit, 54.8% (n = 17) of the patients presented a spherical equivalent of ±1 D. The 3-mm topographic irregularity also decreased significantly (P < 0.001). There was no significant variation of the corneal endothelial cell count. CONCLUSIONS: This is the largest case series of TG-PRK to treat irregular astigmatism in postcorneal transplantation eyes. Our results confirm that TG-PRK is an efficient treatment, associated with significant improvements of both visual acuity and refractive parameters.

Photorefractive keratectomy for myopia and myopic astigmatism correction using the WaveLight Allegretto Wave Eye-Q excimer laser system.

To analyze photorefractive keratectomy (PRK) outcomes in myopia and myopic astigmatism correction using the WaveLight Allegretto Wave Eye-Q(®) excimer laser system (WaveLight Laser Technologie AG, Erlangen, Germany). 222 eyes of 151 patients underwent PRK (mean age 33.5 ± 6.8 years). Pre-operative best spectacle-corrected visual acuity (BSCVA) ranged from 0.4 to -0.1 logMAR (mean -0.03 ± 0.06). Mean spherical equivalent (SE) was -3.29 ± 1.20 D. Efficacy, predictability and safety were evaluated. Minimum follow-up was 3 months. Accountability at 3 and 6 months was 100 and 54 %, respectively (median follow-up 5 months, mean 5.2 ± 2.6 months). At 3 months, mean uncorrected visual acuity (UCVA) was -0.02 ± 0.07 logMAR, BSCVA -0.03 ± 0.05 logMAR, efficacy index 0.98 and safety index 1.02. UCVA was ≥20/16 in 40.1 %, ≥20/20 in 86.5 % and ≥20/25 in 98.2 %. Mean SE was -0.02 ± 0.20 D. Residual refractive error was ± 0.13 D in 81.5 %, ± 0.25 D in 88.7 % and ± 0.50 D in 97.7 %. At 6 months, outcomes were similar: mean UCVA was -0.02 ± 0.07 logMAR, BSCVA -0.03 ± 0.06 logMAR, efficacy index 1.00 and safety index 1.03. UCVA was ≥20/16 in 43.7 %, ≥20/20 in 86.6 % and ≥20/25 in 96.6 %. Mean SE was -0.02 ± 0.17 D. Residual refractive error was ± 0.13 D in 86.6 %, ± 0.25 D in 93.3 % and ± 0.50 D in 98.3 %. Refractive stability was achieved at 3 months. No patient lost more than one line of BSCVA. There were no retreatments. The WaveLight Allegretto Wave Eye-Q is effective, predictable and safe in low-to-moderate myopia and myopic astigmatism PRK correction.

Femtosecond laser versus mechanical microkeratomes for flap creation in laser in situ keratomileusis and effect of postoperative measurement interval on estimated femtosecond flap thickness.

PURPOSE: To prospectively compare laser in situ keratomileusis (LASIK) flaps created with a femtosecond laser or a mechanical microkeratome and analyze the effect of the postoperative measurement interval on estimated femtosecond flap thickness using ultrasound (US) pachymetry. SETTING: Department of Ophthalmology, University Hospital of Coimbra, and Coimbra Surgical Centre, Coimbra, Portugal. METHODS: Flaps were created with a Hansatome Zero Compression microkeratome (Group 1), Zyoptix XP keratome (Group 2), or IntraLase 60 kHz femtosecond laser (Groups 3 and 4). Flap thickness was determined by intraoperative US pachymetry immediately after flap creation in Groups 1, 2, and 3. In Group 4, pachymetry was performed 20 minutes after the laser treatment. The main outcome measures were flap thickness and deviation from the target value. RESULTS: Eighty patients had LASIK for myopia or myopic astigmatism. The mean flap thickness was 149.1 microm +/- 24.9 (SD) in Group 1, 124.7 +/- 23.8 microm in Group 2, 143.1 +/- 18.4 microm in Group 3, and 115.5 +/- 12.5 microm in Group 4. The difference in flap thickness between Group 3 and Group 4 was statistically significant (P<.01). The flap thickness deviation from the target value was 22.8 microm in Group 1, 19.0 microm in Group 2, 26.1 microm in Group 3, and 10.4 microm in Group 4. CONCLUSIONS: Results indicate that the time of measurement after femtosecond affects the estimated flap thickness. Waiting 20 minutes after laser treatment permitted easier separation and may eliminate the effect of variable corneal dehydration on flap measurement by subtraction pachymetry.