Smile dynamics: A comparative study of Fijians and NZ Europeans.

BACKGROUND: The Fijian 'Bula Smile' is often described as the world's friendliest; however, its description remains anecdotal. OBJECTIVE: This study aimed to describe and compare the dynamics of Fijians' smiles with those of New Zealand Europeans. METHODS: An observational study was conducted on two ethnic groups, Fijians (FJ; N = 23) and New Zealand Europeans (NZ; N = 23), age- and gender-matched. All participants were asked to watch amusing videos, and their reactions were video recorded. The videos were analysed by software to assess the frequency, duration, intensity and genuineness of smiling episodes. Based on the Facial Action Coding System, Action Unit 6 (AU6-cheek raiser), Action Unit 12 (AU12-lip corner puller) and Action Unit 25 (AU25-lips apart) were assessed. Data were analysed by generalised linear models after adjusting for personality traits. RESULTS: Fijians smiled longer than New Zealand Europeans (+19.9%; p = .027). Mean intensity of AU6 (+1.0; 95%CIs = 0.6-1.5; p < .001), AU12 (+0.5; 95%CIs = 0.1-0.9; p = .008) and AU25 (+22.3%; 95%CIs = 7.3%-37.3%; p = .005) were significantly higher in FJ group than the NZ group. CONCLUSION: Smiling features of Fijians and New Zealanders showed objective differences, the most distinctive being a higher activation of the Duchenne's marker (AU6) in the Fijian group, which is regarded as a sign of smile genuineness.

Neumotórax y bulla como complicación tardía en un paciente con neumonía por COVID-19. Reporte de un caso y revisión de la literatura / Pneumothorax and bullae as a late complication in a patient with COVID-19 pneumonia. Case report and literature review / Pneumotórax e bulas como complicação tardia em paciente com pneumonia COVID-19. Relato de caso e revisão da literatura

Resumen: El neumotórax y la presencia de bullas se han reportado como complicaciones tardías asociadas a la neumonía por COVID-19 en pacientes con mala evolución. Se desconoce el mecanismo exacto que ocasiona estas complicaciones y su papel en el curso clínico de la enfermedad. A continuación se expone el caso de paciente masculino de 56 años de edad con neumotórax y bulla como complicación tardía de neumonía por COVID-19.

Abstract: Pneumothorax and the presence of bullae have been reported as late complications associated with COVID-19 pneumonia in patients with poor evolution. The exact mechanism that causes these complications and their role in the clinical course of the disease are unknown. The following is the case of a 56-year-old male patient with pneumothorax and bulla as a late complication of COVID-19 pneumonia.

Resumo: O pneumotórax e a presença de bulas foram relatados como complicações tardias associadas à pneumonia por COVID-19 em pacientes com má evolução. O mecanismo exato que causa essas complicações e seu papel no curso clínico da doença são desconhecidos. A seguir, o caso de um paciente do sexo masculino de 56 anos com pneumotórax e bula como complicação tardia de pneumonia por COVID-19.

Bulas de medicamentos cardiovasculares: elas têm informações sobre precauções necessárias aos idosos? / Cardiovascular drug labeling: Do they have information on necessary precautions for older people?

OBJETIVO: Analisar a existência de informações, em bulas destinadas aos profissionais de saúde, sobre precaução de uso de medicamentos cardiovasculares em idosos. METODOLOGIA: Trata-se de estudo documental realizado por meio de análise de dados contidos em bulas de medicamentos. Analisou-se a existência, na bula, de informações sobre precauções no uso de medicamentos para idosos, conforme descrito no Consenso Brasileiro de Medicamentos Potencialmente Inapropriados para Idosos de 2016. RESULTADOS: Dos 29 medicamentos pertencentes ao grupo do sistema cardiovascular que devem ser evitados por idosos e estão disponíveis no Brasil, 15 independem da condição clínica prévia do paciente para que sejam vetados para os idosos. Desses 15, apenas 3 medicamentos (20%) têm informações explícitas concordantes com o Consenso (metildopa, digoxina e espironolactona); 2 (13,33%) têm informações explícitas ausentes; 4 (26,66%) têm informações explícitas discordantes; e 6 bulas (40%) foram categorizadas como informações não explícitas. Quanto às precauções dos medicamentos de acordo com a condição clínica do paciente, incluíram-se 14 medicamentos que devem ser evitados por idosos e estão disponíveis no Brasil. Destes, 12 (85,71%) têm em suas bulas recomendações concordantes com o Consenso, porém não explícitas, e 2 (14,28%) não têm as contraindicações. CONCLUSÕES: A maioria das bulas carece de informações sobre precauções de uso de medicamentos para a população idosa.

OBJECTIVE: To analyze the existence of information on drug labeling intended for health professionals on the precaution of cardiovascular drugs use in older people. METHODS: This is a documentary study, carried out with the analysis of data contained in drug labelings. The existence of information on precautions in the use of drugs for older people as described in the 2016 Brazilian Consensus on Potentially Inappropriate Drugs for Older People (Consenso Brasileiro de Medicamentos Potencialmente Inapropriados para Idosos de 2016). RESULTS: Of the 29 drugs belonging to the cardiovascular system group that should be avoided by older people and are available in Brazil, 15 are independent of the clinical condition. Of these fifteen, only three drugs (20%) have explicit information in accordance with the Consensus (methyldopa, digoxin, and spironolactone); two (13.33%) have missing explicit information; four (26.66%) have explicitly discordant information; and six drug labels (40%) were categorized as non-explicit information. Regarding drug precautions according to clinical condition, 14 drugs were included. Of these, 12 (85.71%) have equal contraindications of that of Consensus on their drug labels, however, non-explicit; and two (14.28%) contraindications are missing. CONCLUSION: Most drug labels lack information on the precautions for the use of drugs in older people.

Análise técnica das bulas dos antibióticos utilizados no tratamento da tuberculose / Technical analysis of the leaflets of antibiotics used in the treatment of tuberculosis

Objetivo: Descrever a apresentação das informações presentes nas bulas dos antibióticos utilizados no tratamento da tuberculose conforme as exigências da ANVISA. Metodologia: Trata-se de um estudo exploratório, descritivo e reflexivo da estrutura e conteúdo das bulas adquiridas através do site da Agência Nacional de Vigilância Sanitária. Verificou-se se os itens apresentados são aqueles exigidos pela portaria regulamentadora. As informações destinadas ao paciente foram refletidas, buscando compreender se essas são objetivas, organizadas e escritas numa linguagem compreensível ao público. Resultados: Detectou-se, na estrutura geral, a ausência de alguns tópicos preconizados pela portaria regulamentadora. Na seção de informação aos pacientes notou-se ausência de algumas informações, bem como informações com variado grau de precisão, a exemplo da ausência da ação esperada do medicamento, imprecisão nos cuidados de armazenamento, e uso de frases subjetivas como 'refeições leves' e 'problemas no sangue'. Conclusão: O desenvolvimento desse estudo corrobora com outras pesquisas realizadas, onde algumas exigências legais não foram cumpridas. É possível inferir que as bulas atendem a maioria dos requisitos, porém, necessitam de adequações. Salienta-se a importância dos profissionais de saúde esclarecerem dúvidas sobre o uso desses antibióticos aos seus usuários, e assim contribuir para uma terapia medicamentosa de sucesso

Objective: Describe the presentation of the information present in the package inserts of the antibiotics used in the treatment of tuberculosis as required by ANVISA. Methodology: This is exploratory, descriptive and reflective study of the structure and content of the package inserts acquired through the website of the National Sanitary Surveillance Agency. It was verified that the items presented are those required by the regulatory authority. The information destined to the patient was reflected, trying to understand if these are objective, organized and written in a language understandable to the public. Results: In the general structure, we detected the absence of some topics recommended by the regulatory decree. In the section of information to the patients it was noticed absence of some information, as well as information with varied degree of precision, such as absence of expected drug action, inaccuracy in storage care, and use of subjective phrases such as 'light meals' and 'blood problems'. Conclusion: The development of this study corroborates with other researches carried out, where some legal requirements were not fulfilled. It is possible to infer that the package inserts meet most requirements, but still require adjustments. It is important to emphasize the importance of health professionals to clarify doubts about the use of these antibiotics to their users, and contribute to the successful drug therapy.

A reliable method for intraoperative detection of lateral malleolar malrotation using conventional fluoroscopy.

OBJECTIVE: To introduce a new method for intraoperative detection of rotational malreduction of the lateral malleolus using conventional fluoroscopy. MATERIAL AND METHODS: From January 2014 to December 2017, 56 Weber type C unstable lateral malleolar fractures with syndesmosis injury were identified. The fibular fracture patterns were simple oblique or transverse in 20, comminuted in 25, and Maisonneuve injury with fibular neck fractures in 11 cases. 47 cases were operated with ORIF, and 9 cases of Maisonneuve fractures were operated with CRIF. The mortise view of the contralateral uninjured ankle was used for intraoperative comparison. Two indexes were applied for fluoroscopic detection of distal fibula malrotation, i.e. the contour profile change in lateral malleolar shape, and the intrinsic structure appearance of lateral malleolar fossa cortex. Postoperative talofibular joint congruency was measured on axial CT scan to confirm the reduction quality. RESULTS: Using the two radiographic parameters for intraoperative fluoroscopic evaluation, we finally achieved satisfying reduction and fixation of the lateral malleolus in all 56 cases. A more spoon-shaped fibula profile and disappearance of the lateral fossa cortex shadow indicates an internal rotation, while a more pointed blade-shaped fibula profile and disappearance of lateral fossa cortex shadow indicates an external rotation. Postoperative CT scanning identified distal fibular no rotation in 44 cases (78.6%), mild rotation less than 5° in 12 cases (21.4%), with 7 cases internal rotation (mean 3.1°) and 5 cases external rotation (mean 2.8°). CONCLUSION: Using conventional intraoperative fluoroscopy on mortise view, new radiographic parameters can provide reliable method to detect rotational malreduction of the lateral malleolus.

Major Histocompatibility Complex Dmα/ß Genes and Their Expressional Diversity in Healthy and Diseased Water Buffalo Bubalus bubalis.

BACKGROUND/AIMS: The major histocompatibility complex (MHC) categorized into three (I, II and III) classes elicits the immunogenic response by presenting exogenous peptides to T cells. The MHC-II DM is composed of DMα and DMß, two polypeptide chains, both are encoded by separate MHC genes involved in antigen processing and presentation. Despite the acknowledged role of MHC complex in humans, the literature is silent on the organization and expression of these genes in water buffalo Bubalus bubalis, an agriculturally important animal species. METHODS: We deduced the full-length mRNA sequences of DMα and DMß genes, localized them onto the chromosome 2, assessed their copy number per haploid genome and studied tissue and disease specific expression. RESULTS: The Real Time PCR showed higher expression of both the genes and their seven interacting partners in spleen, gonads and spermatozoa. Significantly, upregulation of DMα and DMß genes and their interacting partners were detected in diseased group of buffaloes as compared to that in healthy ones. CONCLUSION: The upregulation of Bubalus bubalis (BuLA)-DMα and DMß genes and their interacting partners reflect their role in regulating immune responses towards the amelioration of diseases. Work on this line would enhance our understanding on the overall roles of MHC locus, allowing development of possible therapeutic treatment strategies.

What do Visitors to Fiji Perceive About The “Bula Smile”

Background@#A “smile” is universal in all cultures as being a friendly greeting. The successes of many tourism industries come through the uniqueness of their country. The phrase “Bula Smile” has been widely used by overseas visitors in promoting Fiji. @*Methodology@#A cross-sectional study was conducted with 32 participants who were international visitors accommodated at the Capricorn Hotel in Suva. Data was collected with a questionnaire, which documented the awareness and the effects of the different types of Bula Smile on visitor perceptions. @*Results@#The most common positive observation of the people of Fiji was their friendliness (47%) followed by the Bula Smile (34%). Majority agreed that the Bula Smile of the employees was appealing and gave a positive impression, while those with decayed, missing or poorly filled front teeth changed the impression of 38% of the visitors and gave a negative impression of the health status of Fijians. @*Conclusion@#Results suggest that the Bula Smile is being noticed, while also creating a positive impression of Fiji. Moreover, the onus is on those in the tourism industry to exploit the many positives of the Bula Smile, using it to recruit new visitors while also influencing a return visit to Fiji.

Intermolecular Interactions Between DMα and DMß Proteins in BuLA-DM Complex of Water Buffalo Bubalus bubalis.

The major histocompatibility complex (MHC) with its three classes represents a cluster of tightly linked genes with defined immunological and non-immunological functions. The DM, a MHC class II molecule is formed by the non-covalent association of DMα and DMß chains. It binds with the processed peptide antigens and presents them to T lymphocytes, thereby triggering the immune responses. Startlingly, the expression pattern and structural organization of DMα and DMß proteins in buffalo remains undefined. We isolated and purified the DMα and DMß proteins from Bubalus bubalis using gel filtration chromatography. Employing western blotting and immunohistochemistry, highest expression of these proteins was observed in spleen and were later localized in the cytoplasm. We modelled 3D structures of the proteins and assessed the binding interface of BuLA-DM docked complex. In the process, we uncovered 9 DMα and 8 DMß specific residues participating in the formation of BuLA-DM complex. Our work demonstrated active participation of the critical amino acid residues engaged in the formation of BuLA-DM complex facilitating deeper understanding on the structure-function relationship of these proteins. J. Cell. Biochem. 118: 4254-4266, 2017. © 2017 Wiley Periodicals, Inc.

Methods for estimating the volume of the tympanic bulla in the big hairy armadillo Chaetophractus villosus (Mammalia, Xenarthra, Dasypodidae) / Métodos para la estimación del volumen de bula timpánica en el quirquincho grande Chaetophractus villosus (Mammalia, Xenarthra, Dasypodidae)

Two methods of measurement of bullar dimensions (callipers and scaling from digital images) and subsequent application of four volume formulae (rectangular prism, cylinder, ellipse and elliptical cone) were tested to find the most appropriate non-destructive method for estimating the bullar volume in Chaetophractus villosus. Material for the study consisted in clean adult skull (n=22). Real volume was obtained from latex casts of the tympanic bulla. Each estimation was corrected by a factor based on the differences between the estimated and the real volumes. Highest accuracy (5-7 % of underestimation) and precision (coefficient of variation: 13.27 %) were obtained from callipers and application of rectangular prism, cylinder and ellipse formulae. The corresponding correction factors were 0.31, 0.39 and 0.58, respectively.

Se evaluaron dos métodos para la obtención de medidas de la bula (calibre y escalado a partir de imágenes digitales), con posterior aplicación de cuatro fórmulas de volumen (prisma rectangular, cilindro, elipse y cono elíptico), a fin de hallar el método no destructivo más adecuado para el cálculo de volumen de bula en Chaetophractus villosus. El material de estudio consistió en cráneos limpios de individuos adultos (n=22). El volumen real fue obtenido a partir de moldes de látex de la bula timpánica. Cada estimación fue corregida mediante un factor basado en las diferencias entre los volúmenes reales y estimados. La mayor precisión (coeficiente de variación: 13,27 %) y exactitud (subestimaciones del 5-7 %) fueron obtenidas a partir de mediciones con calibre y aplicación de fórmulas de prisma rectangular, cilindro y elipse (factores de corrección: 0,31, 0,39 y 0,58, respectivamente).

Analise epidemiol¢gica do cisto ¢sseo simples por meio do tratamento conservador / Epidemiological analysis of simple bone cyst by conservative treatment

O Cisto àsseo Traum tico (COS) ‚ uma lesÆo rara, que tem alta incidˆncia na mand¡bula, principalmente na segunda d‚cada de vida. A descoberta do COS ocorre durante os exames de rotina, sendo assintom tica. A etiologia do COS geralmente encontra-se associada a algum tipo de trauma local, sem rela‡Æo causal com gˆnero ou ra‡a. O tratamento desta lesÆo ocorre na grande maioria dos relatos por meio de explora‡Æo cir£rgica, revelando-se eficaz e seguro. O objetivo deste estudo foi avaliar retrospectivamente os casos de COS, tratados entre janeiro de 1999 a julho de 2011. Foram avaliados 10.543 prontu rios, onde 12 pacientes apresentaram COS. Todos os casos ocorreram em pacientes que estavam na segunda d‚cada de vida, com m‚dia de idade de 15,2 anos. A mand¡bula estava envolvida em 100% dos casos, com elevada incidˆncia na s¡nfise (55%), seguido pelo corpo (36%) e ramo da mand¡bula (9%). Seis pacientes relataram a hist¢ria pregressa de trauma (2-9 anos) antes do diagn¢stico da lesÆo. Todos os pacientes foram submetidos … bi¢psia incisional associada … explora‡Æo cir£rgica da cavidade c¡stica, o que representou o tratamento definitivo. O tempo m‚dio de proserva‡Æo foi de 35,7 meses. No per¡odo de acompanhamento (7 a 85 meses), nÆo foi observada recidiva da lesÆo. O tratamento por meio de cirurgia explorat¢ria, realizada no momento da bi¢psia, foi eficaz em todos os casos deste estudo

The simple bone cyst (SBC) is a rare asymptomatic injury diagnosed during routine examinations. The etiology of SBC is usually associated with a local trauma, with no relation with gender or race. The treatment through surgical exploration has proved to be effective and safe. The goal of this study was to evaluate retrospectively the cases of SBC, treated between January/1999 to July/2011. The study evaluated 10.543 clinical handbooks, in which 12 patients presented SBC. In all cases patients were in the second decade of life, with mean age of 15.2 years. Mandible was involved in 100% of the cases, with high incidence on the symphisis (55%), followed by body (36%), and mandibular ramus (9%). Six patients reported trauma (2-9 years) prior to the diagnosis. All patients were submitted to an incisional biopsy associated to a surgical exploration of the cystic cavity, that represented the definitive treatment. The average time of proservation was 35.7 months. In the follow-up period (7 to 85 months) was not observed any recurrence. The treatment through exploratory surgery, carried through the moment of the biopsy, was effective in all cases

A bula de medicamentos e a regulação de suas configurações em termos de forma e conteúdo no Brasil / The medicine package leaflet and the regulation of its configurations in terms of form and content in Brazil

A bula é um documento técnico – científico, direcionado a profissionais da saúde e pacientes, que acompanha o medicamento para informar sua composição, características e uso. Considerando a importância e complexidade dessas informações técnico-científicas, houve transformações na regulação de seu conteúdo e de seus elementos representativos. Questiona-se, contudo, quais as representações que a informação técnico-científica assumiu em relação à compreensão de seus usuários. Com o objetivo de conhecer e analisar as diversas configurações contemporâneas que a bula de medicamento tem sofrido sob influência dos marcos regulatórios ao longo do tempo, evidenciaram-se as representações que a informação técnico-científica da bula de medicamento vêm assumindo para compreensão de seus usuários. Para tanto, realizou-se este estudo qualitativo centrado em levantamento, identificação, sistematização e análise comparativa dos instrumentos jurídicos que compõem o marco regulatório nacional dessas bulas. Os resultados demonstram que sua regulação possui um arcabouço legal histórico, que vem se desenvolvendo há sete décadas, juntamente com a criação de órgãos de fiscalização em saúde e em vigilância sanitária. É possível notar que o desenvolvimento do processo regulatório das bulas de medicamento, apesar de ocorrer entre longos espaços de tempo, a partir da criação da Agência Nacional de Vigilância Sanitária (1999) e das consultas públicas, começou a ser realizado com um pouco mais de frequência. Assim, nos últimos dez anos, a regulação da bula de medicamento passou a ser mais específica, principalmente quanto aos aspectos de forma e conteúdo...

The medicine package leaflet (MPL) is a technical – scientific document regulated by the government, directed at health professionals and patients in order to inform and instruct its users about the use of a medicine. Considering the importance and complexity of the MPL technical - scientific information for its users, there have been changes in the regulation of MPL´s content and representative elements. It is questionable, however, which representation the MPL technical – scientific information assumed for users’ comprehension. In order to identify and analyze the various configurations the MPL has undergone over time due to the influence of regulatory frameworks, we looked at the representations the MPL technical – scientific information has taken to become adaptable to users’ comprehension. A qualitative study was conducted, focused on surveying, identifying, organizing and reading the legal instruments that constitute the MPL national regulatory framework, observing changes in the regulation over time. The results show that its regulation has a legal history, which has been developing for seven decades, along with the establishment of institutions in health and health surveillance by the government. It is also observed that, in spite of MPL´s regulatory process development occurring over long periods of time, since the foundation of the National Agency for Sanitary Surveillance (1999) and its public inquiries, this process started to be renewed and improved with a little more frequency. Thus, in the last ten years, MPL regulation has become more specific, regarding form and content...

Uso de medicamentos off-label e não licenciados em unidade de tratamento intensivo neonatal e sua associação com escores de gravidade / Use of off-label and unlicensed drugs in the neonatal intensive care unit and its association with severity scores

OBJETIVO: Avaliar a frequência da prescrição de medicamentos de uso não licenciado (UL) e off-label (OL) em recém-nascidos internados em unidade de tratamento intensivo neonatal de hospital de nível terciário e verificar a associação do seu uso com a gravidade dos pacientes. MÉTODOS: Estudo observacional de coorte dos medicamentos prescritos no período de 6 semanas da internação de neonatos, entre julho e agosto de 2011. Os medicamentos foram classificados em UL e OL para dose, frequência, apresentação, faixa etária e indicação, de acordo com bulário eletrônico aprovado pela Food and Drug Administration. Os pacientes foram acompanhados até alta hospitalar ou 31 dias de internação, com registro diário do Neonatal Therapeutic Intervention Scoring System. RESULTADOS: Foram identificados 318 itens de prescrição para 61 pacientes (média de cinco itens/paciente) e apenas 13 pacientes com uso de medicamentos adequados (21%). Identificaram-se prevalências de 7,5% para prescrições UL e de 27,7% para OL. O uso OL mais prevalente foi para medicamentos não padronizados para faixa etária - 19,5%. Computaram-se 57 medicações - um paciente recebeu 10 fármacos UL/OL na internação. A prevalência de usos OL foi maior em prematuros < 35 semanas e nos com escores de gravidade mais elevados (p = 0,00). CONCLUSÕES: A prevalência de neonatos expostos a medicamentos UL/OL durante a internação hospitalar foi elevada, especialmente naqueles com maior escore de gravidade no Neonatal Therapeutic Intervention Scoring System. Embora haja apreciação geral de que neonatos, especialmente pré-termo, tenham alta taxa de uso de medicamentos, uma avaliação incluindo diferentes culturas e países é necessária para priorizar áreas de pesquisa futura na farmacoterapêutica dessa população vulnerável.

OBJECTIVE: To analyze the frequency of unlicensed (UL) and off-label (OL) prescriptions in neonates admitted to the neonatal intensive care unit of a tertiary care hospital and to determine their association with patients' severity. METHODS: Observational cohort study including drugs prescribed during hospitalization of neonates over a 6-week period between July and August 2011. The drugs were classified as UL and OL for dose, frequency, presentation, age group, or indication, according to an electronic list of drugs approved by the Food and Drug Administration. Patients were followed until hospital discharge or 31 days of hospitalization, with daily records of the Neonatal Therapeutic Intervention Scoring System (NTISS). RESULTS: We identified 318 prescription items for 61 patients (average of five items/patient); there were only 13 patients with appropriate use of medications (21%). A prevalence of 7.5% was identified for UL prescriptions and 27.7% for OL, and the most prevalent OL use was that related to age group - 19.5%. Fifty-seven medications were computed - one patient received 10 UL/OL drugs during hospitalization. The prevalence of OL uses was higher in preterm infants < 35 weeks and in those with higher severity scores (p = 0.00). CONCLUSIONS: The prevalence of neonates exposed to UL/OL drugs during hospitalization was high, especially for those with higher NTISS scores. Although there is general appreciation that neonates, especially preterm infants, have a high rate of drug use, an assessment including different cultures and countries is still needed to prioritize areas for future research in the pharmacotherapy of this vulnerable population.

Efectividad de cistotomía de cápsula de Tenon con aguja fina en fallo de ampolla de filtración / Effectiveness Tenon capsule cystotomy with Fine needle on bleb failure

La trabeculectomía es generalmente un procedimiento exitoso parareducir la presión intraocular en pacientes con glaucoma. Sin embargo,el fallo de la ampolla de filtración puede ocurrir, provocando unincremento de la presión intraocular; lo que conlleva a una intervenciónmédica o quirúrgica adicional. Se realiza una breve revisión bibliográficasobre la cistotomía transconjuntival, asociada o no al uso deantimetabolitos (mitomicina C o 5-fluorouracilo), demostrando que esun procedimiento mínimamente invasivo, con escasas complicaciones;que constituye un método eficaz, fácil, de bajo costo para restablecer eldrenaje acuoso y disminuir la presión intraocular(AU)

Trabeculectomy is a successful method in reducing intraocular pressure in glaucoma patients. However, the failure of the filtration bleb can occur, leading to increased intraocular pressure, which leads to a surgical intervention. A brief bibliographical review is done on the transconjunctival cystotomy, with or without the use of antimetabolites (mitomycin C or 5-fluorouracil), showing that it is a minimally invasive procedure with few complications, which is an effective, easy and inexpensive method to re-establish the aqueous drainage and reduce intraocular pressure(AU)

Revisión con agujas y uso de mitomicina C en bulas de filtración encapsuladas / Needle revision and use of Mitomycin-C to manage encapsulated filtering blebs

La trabeculectomía es uno de los tratamientos de elección en los pacientes con glaucoma. La causa más común de fallo de esta cirugía en su primer trimestre es la bula de filtración encapsulada. Usualmente es resultado de la proliferación fibrótica subconjuntival que lleva a fallo de la bula, como por ejemplo en los glaucomas traumáticos. La revisión con agujas y la mitomicina C constituyen una opción efectiva y relativamente segura para restaurar la función de la cirugía de filtración. Se presenta un paciente donde se restableció el flujo de humor acuso con este proceder(AU)

Trabeculectomy is the surgical treatment of choice for many patients with glaucoma. The most common cause of failure during the first trimester after trabeculectomy is encapsulated bleb. Generally, that results from scarring in the subconjunctival space with a resultant intrableb fibrosis and the development of a failed bleb, for example in traumatic glaucoma. Needling bleb revision with mitomycin-C appears to be an effective and relatively safe way to revive the function of the filtration surgery. This was the case report of a patient whose aqueous humor flow was reestablished with this treatment(AU)

Revisión por aguja de la bula de filtración, una alternativa terapÚutica en pacientes trabeculectomizados / Needle review of the filtering bleb as an alternative in the treatment of patients undergoing trabeculectomy

La trabeculectomía es generalmente un procedimiento exitoso para reducir la presión intraocular en pacientes con glaucoma. Sin embargo, el fallo de la ampolla de filtración puede ocurrir y provocar un incremento de la presión intraocular. Esto conllevaría a una intervención médica o quirúrgica adicional. Se realiza una revisión bibliográfica sobre la cistitomía transconjuntival, asociada al uso de antimetabolitos (mitomicina C o 5-fluorouracilo) o no. Se demuestra que es mínimamente invasiva, con escasas complicaciones y que constituye un método eficaz, fácil y barato para restablecer el drenaje acuoso y disminuir la presión intraocular(AU)

Trabeculectomy is usually a successful procedure to reduce intraocular pressure in glaucoma patients. However, the failure of the filtering bleb can occur, leading to increased intraocular pressure and to a further medical or surgical intervention. A literature review on transconjunctival cystotomy, with or without the use of mitomycin C or 5-fluorouracil, was made. It was demonstrated that this method is minimally invasive with few complications, effective, easy-to-apply and inexpensive to restore aqueous drainage and lowering intraocular pressure(AU)

Microscopia confocal de barrido láser y su relación con la morfología de la bula de filtración / Confocal laser scanning microscopy and its association to the morphology of the filtering bleb

Objetivo: describir los hallazgos de la microscopia confocal de barrido láser y su relación con la morfología de la bula de filtración.Métodos: estudio observacional descriptivo de corte transversal en 100 ojos. Se les realizó microscopia confocal de barrido láser con el HRT II y el módulo corneal de Rostock. Se aplicó la prueba de significación estadística de Mc. Nemar para una p=0,05.Resultados: predominó el grupo entre 61 y 80 años de edad (55,8 porciento) y el color de la piel blanca (46,8 porciento). En el grupo de descenso de la presión intraocular en más del 30 porciento se ubicó la mayor cantidad de bulas de todos los tamaños. Las bulas de mediano tamaño fueron las que más disminuyeron las cifras de presión intraocular, con 24 ojos (55,8 porciento, p=0,00), seguidas por las de pequeño tamaño (p=0,14). Las bulas de filtración aplanadas fueron las más frecuentes en 55 porciento de los casos (p=0,00), y 67,4 porciento de estas se ubicaron en el grupo de descenso de presión intraocular de más de 30 porciento (p=0,01). Las bulas medianas presentaron la mayor cantidad de estroma en malla porosa (60 porciento) y de microquistes epiteliales (56 porciento) p=0,00.Conclusiones: la configuración aplanada y el tamaño mediano de la bula de filtración se relacionaron con la presencia de variables histológicas que infieren buen funcionamiento de la bula (microquistes epiteliales y estroma en malla porosa). También se relacionaron con un mayor descenso de la presión intraocular(AU)

Objective: to describe the findings in the confocal laser scanning microscopy and its relation with the morphology of the filtering bleb.Methods: cross-sectional, observational and descriptive study of 100 eyes that underwent confocal laser scanning microscopy with the Retinal Heidelberg Tomography and the Rostock corneal module. Mc Nemars statistical significance test was made to obtain p=0,05.Results: the 61-80 years old age group (55,8 percent) and the caucasians predominated. The group of eyes with over 30 percent decrease of the intraocular pressure showed the highest amount of filtering blebs of all sizes. The medium-size blebs were the ones that decreases the IOP in a higher percentage (24 eyes; 55,8 percent) for p=0,00, followed by the small blebs (p=0,14). The flat blebs were predominant in 55 percent of cases (p=0,00) and the 67,4 percent of them were consistent with the major range of decrease of the intraocular pressure (p=0,01). The medium size blebs presented the major number of stromas in porous mesh (60 percent), and of epithelial mycrocists (56 percent) for p=0,00.Conclusions: the flat configuration and the medium size of the blebs were related with the presence of the histological variables that infer adequate function of the filtrating blebs (stroma in porous mesh and epithelial mycrocists). They were also associated with higher decrease of intraocular pressure(AU)

Microscopia confocal de barrido láser y su relación con la morfología de la bula de filtración / Confocal laser scanning microscopy and its association to the morphology of the filtering bleb

Objetivo: describir los hallazgos de la microscopia confocal de barrido láser y su relación con la morfología de la bula de filtración.Métodos: estudio observacional descriptivo de corte transversal en 100 ojos. Se les realizó microscopia confocal de barrido láser con el HRT II y el módulo corneal de Rostock. Se aplicó la prueba de significación estadística de Mc. Nemar para una p=0,05.Resultados: predominó el grupo entre 61 y 80 años de edad (55,8 porciento) y el color de la piel blanca (46,8 porciento). En el grupo de descenso de la presión intraocular en más del 30 porciento se ubicó la mayor cantidad de bulas de todos los tamaños. Las bulas de mediano tamaño fueron las que más disminuyeron las cifras de presión intraocular, con 24 ojos (55,8 porciento, p=0,00), seguidas por las de pequeño tamaño (p=0,14). Las bulas de filtración aplanadas fueron las más frecuentes en 55 porciento de los casos (p=0,00), y 67,4 porciento de estas se ubicaron en el grupo de descenso de presión intraocular de más de 30 porciento (p=0,01). Las bulas medianas presentaron la mayor cantidad de estroma en malla porosa (60 porciento) y de microquistes epiteliales (56 porciento) p=0,00.Conclusiones: la configuración aplanada y el tamaño mediano de la bula de filtración se relacionaron con la presencia de variables histológicas que infieren buen funcionamiento de la bula (microquistes epiteliales y estroma en malla porosa). También se relacionaron con un mayor descenso de la presión intraocular

Objective: to describe the findings in the confocal laser scanning microscopy and its relation with the morphology of the filtering bleb. Methods: cross-sectional, observational and descriptive study of 100 eyes that underwent confocal laser scanning microscopy with the Retinal Heidelberg Tomography and the Rostock corneal module. Mc NemarÆs statistical significance test was made to obtain p=0,05. Results: the 61-80 years old age group (55,8 per cent) and the caucasians predominated. The group of eyes with over 30 per cent decrease of the intraocular pressure showed the highest amount of filtering blebs of all sizes. The medium-size blebs were the ones that decreases the IOP in a higher percentage (24 eyes; 55,8 per cent) for p=0,00, followed by the small blebs (p=0,14). The flat blebs were predominant in 55 per cent of cases (p=0,00) and the 67,4 per cent of them were consistent with the major range of decrease of the intraocular pressure (p=0,01). The medium size blebs presented the major number of stromas in porous mesh (60 per cent), and of epithelial mycrocists (56 per cent) for p=0,00. Conclusions: the flat configuration and the medium size of the blebs were related with the presence of the histological variables that infer adequate function of the filtrating blebs (stroma in porous mesh and epithelial mycrocists). They were also associated with higher decrease of intraocular pressure

Revisión por aguja de la bula de filtración, una alternativa terapÚutica en pacientes trabeculectomizados / Needle review of the filtering bleb as an alternative in the treatment of patients undergoing trabeculectomy

La trabeculectomía es generalmente un procedimiento exitoso para reducir la presión intraocular en pacientes con glaucoma. Sin embargo, el fallo de la ampolla de filtración puede ocurrir y provocar un incremento de la presión intraocular. Esto conllevaría a una intervención médica o quirúrgica adicional. Se realiza una revisión bibliográfica sobre la cistitomía transconjuntival, asociada al uso de antimetabolitos (mitomicina C o 5-fluorouracilo) o no. Se demuestra que es mínimamente invasiva, con escasas complicaciones y que constituye un método eficaz, fácil y barato para restablecer el drenaje acuoso y disminuir la presión intraocular

Trabeculectomy is usually a successful procedure to reduce intraocular pressure in glaucoma patients. However, the failure of the filtering bleb can occur, leading to increased intraocular pressure and to a further medical or surgical intervention. A literature review on transconjunctival cystotomy, with or without the use of mitomycin C or 5-fluorouracil, was made. It was demonstrated that this method is minimally invasive with few complications, effective, easy-to-apply and inexpensive to restore aqueous drainage and lowering intraocular pressure

Revisión con agujas y uso de mitomicina C en bulas de filtración encapsuladas / Needle revision and use of Mitomycin-C to manage encapsulated filtering blebs

La trabeculectomía es uno de los tratamientos de elección en los pacientes con glaucoma. La causa más común de fallo de esta cirugía en su primer trimestre es la bula de filtración encapsulada. Usualmente es resultado de la proliferación fibrótica subconjuntival que lleva a fallo de la bula, como por ejemplo en los glaucomas traumáticos. La revisión con agujas y la mitomicina C constituyen una opción efectiva y relativamente segura para restaurar la función de la cirugía de filtración. Se presenta un paciente donde se restableció el flujo de humor acuso con este proceder

Trabeculectomy is the surgical treatment of choice for many patients with glaucoma. The most common cause of failure during the first trimester after trabeculectomy is encapsulated bleb. Generally, that results from scarring in the subconjunctival space with a resultant intrableb fibrosis and the development of a failed bleb, for example in traumatic glaucoma. Needling bleb revision with mitomycin-C appears to be an effective and relatively safe way to revive the function of the filtration surgery. This was the case report of a patient whose aqueous humor flow was reestablished with this treatment

Uso off label de medicamentos em crianças e adolescentes / Off label use of medicines in children and adolescents

De acordo com a definição de uso off label (ou seja, quando um medicamento é indicado ao paciente de maneira diferente daquela que foi autorizada pelo órgão regulatório em um país), o objetivo deste estudo foi identificar a presença desse tipo de prescrição, diferente da recomendação aprovada pela FDA e ANVISA, para crianças e adolescentes do nascimento até 18 anos. Para isso, foram analisadas as solicitações de medicamentos feitas por ordem judicial ao CEMEPAR/ SESA-PR (Centro de Medicamentos do Paraná / Secretaria de Saúde do Paraná) no ano de 2008. Foram impetradas 934 solicitações, sendo que, destas, 142 (15,20%) tinham indicação diferente da recomendada quando comparadas com informações da FDA, além de outras 112 (12%) quando comparadas com informações da ANVISA. Das prescrições analisadas, 22,54% estavam relacionadas à faixa etária diferente da recomendada de acordo com a FDA e 26,79% de acordo com a ANVISA. Considerando-se a importância do tema para a saúde pública, ressalta-se a necessidade da divulgação de informações e regulamentações sobre o assunto no Brasil.

Noting the definition of off-label use (ie, when a drug is indicated for a patient with a condition for which it has not been authorized by the regulatory agency of the country), the aim of this study was to identify the presence of this type of prescription, at variance with the recommendations of the FDA and (in Brazil) ANVISA, for children and adolescents from birth up to 18 years of age. To this end, the requests for drugs made by court order to CEMEPAR / SESA-PR (Paraná State Medicine Center) in 2008 have been analyzed. A total of 934 requests were filed, out of which 142 (15.20%) contained indications other than the recommended ones, according to information from FDA, and another 112 (12%) indicated a use conflicting with information from ANVISA. Out of the prescriptions analyzed, 22.54% were for patients whose age differed from the range recommended by FDA and 26.79% from the ANVISA range. Considering the importance of the issue to public health, the study highlights the need to spread information on the regulations on these practices in Brazil.