CAAE Number Research Articles

Association of Therapeutic Monitoring of Tacrolimus with Laboratory Markers of Kidney Function in Receptors of Kidney Allograft

Introduction: Kidney transplantation is the most commonly performed type of transplant in Brazil. Tacrolimus is one of the primary drugs used in post-transplant immunosuppressive therapy, and one of its main adverse effects is nephrotoxicity. Laboratory tests to assess renal function are of great importance in monitoring post-kidney transplant patients, helping to diagnose events indicative of graft dysfunction. Objective: !e present study aimed to evaluate the association between laboratory changes in renal function and blood levels of tacrolimus in post-kidney transplant patients. Methods: Observational, analytical and cross-sectional study. !e results of blood levels of tacrolimus and measurements of urea, creatinine and estimated Glomerular Filtration Rate (eGFR) were analyzed, as well as the sociodemographic data of kidney transplant recipients followed at a university hospital who underwent laboratory tests between months from January 2021 to July 2022 in a period close to 1 year after the transplant. !e variables analyzed in the research were collected from the patient's medical records and subsequently analyzed; the statistical analyses considered p < 0.05. !e project was approved by the Ethics Committee of the Walter Cantídio University Hospital under opinion number 5,436,434 and CAAE number 57396622.1.0000.5045. Results: !e sample was mainly composed of males, mixed race, with an average age of 51.5 years (SD ± 12.5) and from cities in the interior of Ceará. Regarding the percentage of patients with laboratory changes, 50.62% (n = 45) showed changes in tacrolimus blood levels. 56.79% (n = 46) had changes in serum creatinine levels, 49.38% (n = 40) had changes in serum urea levels, and 59.26% (n = 48) had altered eGFR. !e correlation analyses suggested a low signi#cance between variations of the variables studied. Conclusion: !e results indicate no relationship between variations in tacrolimus blood concentrations and the appearance of changes in the results of classic renal biomarkers at the end of the #rst year post-transplant. However, it is necessary to carry out new studies to understand better the impact of changes in blood levels of tacrolimus on the renal function of renal allograft recipients.

Compromised end-of-life syndrome in cancer patients: A clinical validation study.

To identify the prevalence of the nursing diagnosis of compromised end-of-life syndrome in patients in end-of-life care. This is a clinical validation based on a cross-sectional epidemiological clinical study conducted at the National Cancer Institute in Rio de Janeiro, Brazil. The defining characteristics of a syndrome diagnosis were identified, defined as a "subset of nursing diagnoses," using sensitivity and specificity measures through the application of latent class statistical methods. The statistical results revealed seven nursing diagnoses characterizing the syndrome: imbalanced nutrition: less than body requirements, nausea, anxiety, ineffective breathing pattern, disturbed sleep pattern, ineffective thermoregulation, and fatigue. Compromised end-of-life syndrome was present in 76% of the sample. The study demonstrated the presence of compromised end-of-life syndrome in most end-of-life patients from the sample. Recognizing the presence of the syndrome diagnosis enables nurses to have efficient and effective clinical reasoning for implementing the nursing process in palliative care. CAAE Number: 85415618.0.3001.5274.

A importância da antropometria e semiologia craniana para o diagnóstico precoce da trigonocefalia: relato de caso

Trigonocephaly is a type of craniosynostosis in which there is premature closure of the metopic suture, in order to determine an abnormal growth of the skull. In a minority of cases, trigonocephaly can cause increased intracranial pressure and the onset of neurological disorders. When present, these complications can be prevented or mitigated if the diagnosis and treatment occur between 6 and 12 months of life. The objective of the study is to report a case of craniosynostosis in an infant and reaffirm the importance of anthropometry and cranial semiology. On physical examination, a 4-month-old infant had a head circumference: 41 cm, metopic suture mounted, biparietal diameter: 23 cm, fronto-occipital diameter: 28 cm. Cranial computed tomography with 3D reconstruction confirmed the diagnosis of trigonocephaly, and he was referred to pediatric surgery. The study was submitted to the Human Research Ethics Committee approved under CAAE number 53607821.7.0000.5237. The diagnosis of trigonocephaly is made through the analysis of anthropometric measurements of the skull, represented by the head circumference, anteroposterior distance and binaural distance, and confirmed through computed tomography with 3D reconstruction. In pediatric practice, it is common to only measure the head circumference, which is often normal, with changes only in the anteroposterior and binaural distances. Consequently, there is a delay in the diagnosis of craniosynostosis. Thus, the importance of routinely measuring the three anthropometric measurements of the skull is emphasized for the early diagnosis of craniosynostosis and for the prevention and reduction of its complications, even though they are rare.

Apendicite aguda em um adolescente com situs inversus totalis: relato de caso

Appendicitis is the most common surgical emergency in pediatrics, being present in 1% to 8% of children with acute abdominal pain. The classical clinical presentation is characterized by the presence of acute migrating abdominal pain in the right iliac fossa. However, in patients with situs inversus totalis, the pain manifests in the left iliac fossa, which may delay the diagnosis and predispose to the development of complications. Thus, the aim of this study is to report a case of appendicitis in an adolescent with situs inversus totalis. METHODS: This study is case report of appendicitis in an adolescent with situs inversus totalis. The research was submitted to the Ethics in Human Research Committee and approved under CAAE number 53591321.0.0000.5237. RESULTS: The incidence of appendicitis in patients with situs inversus totalis is 0.016% to 0.024%. Due to the atypical clinical presentation in these patients, there is a tendency to delay the diagnosis of appendicitis, especially when the situs inversus totalis was not previously identified. Thus, there is a greater risk of developing severe complications such as intestinal perforation and sepsis, which considerably increases morbidity and mortality. CONCLUSIONS: We emphasize the importance of listing appendicitis as a possible diagnosis in patients with acute abdominal pain in the left iliac fossa because of the possibility of situs inversus totalis.

Intravitreal bevacizumab plus propranolol for neovascular age-related macular degeneration (the BEVALOL study): a phase I clinical trial

BackgroundGiven the persistently large public health impact of neovascular age-related macular degeneration (nARMD) despite many years of anti-VEGF therapy as the first-line treatment and the demonstrated ability of b-blockers to reduce neovascularization, a synergistic effect between an anti-VEGF agent and an intravitreal beta-blocker is important to investigate in the quest for therapeutic alternatives that maximize efficacy and/or reduce costs. The main purpose of this study is to investigate the safety of a 0.1 ml intravitreal injection of a combination of bevacizumab (1.25 mg/0.05 ml) and propranolol (50 g/0.05 ml) to treat nARMD.MethodsProspective phase I clinical trial that included patients with nARMD. Comprehensive ophthalmic evaluation was performed at baseline and included Early Treatment Diabetic Retinopathy Study (ETDRS) best-corrected visual acuity (BCVA), biomicroscopy of the anterior and posterior segments, binocular indirect ophthalmoscopy, color fundus photography, spectral domain optical coherence tomography (OCT), OCT angiography (OCT-A), fluorescein angiography (Spectralis, Heidelberg), and full-field electroretinography (ERG). All eyes were treated with a 0.1 ml intravitreal injection of a combination of bevacizumab (1.25 mg/0.05 ml) and propranolol (50 g/0.05 ml) within 1 week of baseline evaluation. The patients were reexamined at weeks 4, 8 and 12, and clinical evaluation and SD-OCT were performed at all follow-up visits. Additional injections of combination bevacizumab (1.25 mg/0.05 ml) and propranolol (50 g/0.05 ml) were administered at weeks 4 and 8. At the final study evaluation (week 12), color fundus photography, OCT-A, fluorescein angiography, and full-field ERG were repeated.ResultsEleven patients (11 eyes) completed all study visits of the 12 week study. Full field ERG b-waves did not show significant (p < 0.05) changes at week 12 compared to baseline. During the 12 week follow-up period, none of the study eyes developed intraocular inflammation, endophthalmitis or intraocular pressure elevation more than 4 mmHg over baseline. Mean ± SE BCVA (logMAR) was 0.79 ± 0.09 at baseline and was significantly (p < 0.05) improved to 0.61 ± 0.10 at week 4; 0.53 ± 0.10 at week 8; and 0.51 ± 0.09 at week 12. Mean ± SE central subfield thickness (CST) (μm) was 462 ± 45 at baseline and was significantly (p < 0.05) lower at 4, 8 and 12 weeks (385 ± 37; 356 ± 29 and 341 ± 24, respectively).ConclusionsIn this 12 week trial of a combination of intravitreal bevacizumab and propranolol for treatment of nARMD, no adverse events or signals of ocular toxicity were observed. Further studies using this combination therapy are warranted.Trial Registration Project registered in Plataforma Brasil with CAAE number 28108920.0.0000.5440 and approved in ethics committee of Clinics Hospital of Ribeirao Preto Medicine School of São Paulo University—Ribeirão Preto, São Paulo, Brazil (appreciation number 3.999.989 gave the approval).

Sedentary behaviour and traumatic dental injuries in adolescents: A population-based study.

Analyse factors associated with dental trauma in 12-year-old adolescents. An epidemiological survey was carried out in the five largest cities in the state of Mato Grosso do Sul, Brazil. Data on traumatic dental injuries (TDI) based on the World Health Organization (WHO), sociodemographic characteristics and individual clinical and behavioural characteristics in 615 adolescents were collected. Univariate and adjusted multilevel logistic regressions were performed to test the association of dental trauma with behavioural and sociodemographic factors. The study was approved by the Ethics Committee (CAAE number 85647518.4.0000.0021). The prevalence of TDI at 12 years was 3.4% (95% CI 1.8; 6.4). In the adjusted models, clinical characteristics of adolescents such as overjet >3 mm (OR = 1.51 [95% CI 1.00; 2.41]) were associated with trauma. Sociodemographic characteristics such as female sex (OR = 0.13 [95% CI 0.07; 0.25]), income above the poverty level (OR = 0.34 [95% CI 0.15; 0.78]), who declared themselves white (OR = 0.23 [95% CI 0.11; 0.47]) and with sedentary behaviour (OR = 0.69 [95% CI 0.59; 0.80]) were associated with trauma, as protective factors. Sociodemographic, behavioural and individual clinical characteristics were associated with TDI in adolescents. Oral health teams should focus on the most vulnerable groups, encouraging the use of mouthguards and access to treatment services.

Differential Angiogenic Induction Impacts Nasal Polyp Tissue Growth.

In chronic rhinosinusitis with nasal polyps, inflammatory edema drives tissue remodeling favoring anomalous growth of the nasal mucosa, but a proangiogenic contribution of nasal polyp in support of tissue growth is still controversial. The chorioallantoic membrane of chicken embryo model was employed to address the potentiality of nasal tissue fragments to modulate angiogenesis. Fifty-seven fertilized eggs were implanted with polyp or healthy nasal mucosa tissue or were kept as non-implanted controls. The embryos' size, length, and development stage, and chorioallantoic membrane vasculature morphology were evaluated after 48h. Quantitative computer vision techniques applied to digital chorioallantoic membrane images automatically calculated the branching index as the ratio between the areas of the convex polygon surrounding the vascular tree and the vessels' area. Ethics approval and consent to participate: the study was approved by the Human Research Ethics Committee of the Federal University of São Paulo (CAAE number: 80763117.1.0000.5505) and by the Animal Research Ethics Committee of University of São Paulo (nº CEUA 602-2019). Mucosal, but not polyp tissue implants, hampered embryo development and induced underdeveloped chorioallantoic membranes with anastomosed, interrupted, and regressive vessels. Vessels' areas and branching indexes were higher among the chorioallantoic membranes with polyp implants and controls than among those with healthy mucosa implants. Nasal polyp presents differential angiogenic induction that impacts tissue growth.

A importância da antropometria e semiologia craniana para o diagnóstico precoce da Trigonocefalia: Relato de caso

Trigonocephaly is a type of craniosynostosis in which there is premature closure of the metopic suture, in order to determine an abnormal growth of the skull. In a minority of cases, trigonocephaly can cause increased intracranial pressure and the onset of neurological disorders. When present, these complications can be prevented or mitigated if the diagnosis and treatment occur between 6 and 12 months of life. The objective of the study is to report a case of craniosynostosis in an infant and reaffirm the importance of anthropometry and cranial semiology. On physical examination, a 4-month-old infant had a head circumference: 41 cm, metopic suture mounted, biparietal diameter: 23 cm, fronto-occipital diameter: 28 cm. Cranial computed tomography with 3D reconstruction confirmed the diagnosis of trigonocephaly, and he was referred to pediatric surgery. The study was submitted to the Human Research Ethics Committee approved under CAAE number 53607821.7.0000.5237. The diagnosis of trigonocephaly is made through the analysis of anthropometric measurements of the skull, represented by the head circumference, anteroposterior distance and binaural distance, and confirmed through computed tomography with 3D reconstruction. In pediatric practice, it is common to only measure the head circumference, which is often normal, with changes only in the anteroposterior and binaural distances. Consequently, there is a delay in the diagnosis of craniosynostosis. Thus, the importance of routinely measuring the three anthropometric measurements of the skull is emphasized for the early diagnosis of craniosynostosis and for the prevention and reduction of its complications, even though they are rare.

Identification of pharmacogenomic variants associated with oncology treatments in Brazilian Amazonian Amerindians.

e15082 Background: Adverse drug reactions are an important cause of morbidity and mortality commonly found in different therapeutic regimens, particularly in oncologic. About 20-30% of these reactions are due to the individual genetic variability of patients. Pharmacogenomics focuses on the identification of genetic variants that influence drug efficacy, response, and/or toxicity by changes in pharmacokinetics/pharmacodynamics. Pharmacogenomic investigations are known to have a population bias. There is a gap in the accumulated about pharmacogenomic variants in poorly studied populations, such as the Amerindian population from the Brazilian Amazon region. The objective of this work is to describe the pharmacogenetic variability regarding 160 pharmacogenes involved in pharmacokinetic processes and biological pathways of different therapies, including oncology treatments, based on data obtained through complete exome sequencing of 64 individuals from different Amerindian groups of the Brazilian Amazon. Methods: The present study was approved by the National Committee for Ethics in Research and the Research Ethics Committee of the UFPA Tropical Medicine Center, under CAAE number 20654313.6.0000.5172. All participants signed a free-informed consent. The DNA extraction was performed using phenol-chloroform. Libraries were prepared using the Nextera Rapid Capture Exome and SureSelect Human All Exon V6 kits. Bioinformatic analysis was performed by ViVa software. Results: Our results show a total of 3,311 variants found in the study subjects. Of this, 167 are exclusive variants found in the Amerindians. Among these new variants, we found a non-synonymous coding variant in the DPYD gene with an allelic frequency of 3%, and variants with high allelic frequencies in intronic regions, which may regulate gene expression: MTHFR (5.56%), TYMS (11.5%) GSTT1 (54.1%), and three variants in the CYP2D6 gene with frequencies of 54%, 62.3%, and 65.6%. The DPYD is a pivotal gene involved with the efficacy of fluoropyrimidine-based treatment; the MTHFR and TYMS genes also participate in the biological pathways of these drugs, responsible for variation in response rates. The GSTT1 is a gene associated with platinum-based treatments, such as carboplatin and cisplatin. And, finally, CYP2D6 is one of the main pharmacogene described, involved in several drug schemes, including tamoxifen and gefitinib, used to treat breast and lung cancer, respectively. Conclusions: Understanding the diversity of genetic markers in Amazonian Amerindian is crucial to the implementation of pharmacogenomic-guided oncology treatment protocols, since pharmacogenomic data validated in other ancestral groups may not be fully applicable in these populations due to their unique genetic profile. Keywords: Exome, Native American populations, fluoropyrimidine, platinum-based drugs, tamoxifen, gefitinib.

Correlation between Amerindian ancestry and neuromyelitis optica spectrum disorders (NMSOD) among patients in Midwestern Brazil.

Neuromyelitis optica spectrum disorder (NMOSD) is the second most frequently demyelinating, autoimmune, and inflammatory Central Nervous System (CNS) disease, and its prevalence varies greatly according to geography and ethnicity. To determine the prevalence and phenotype of NMOSD at a reference center for demyelinating diseases in Goiás State. This was a cross-sectional study, approved under CAAE number 8380.9317.9.0000.5078. All patients fulfilled the 2015 international consensus criteria. Our study showed NMOSD as 9.37% of all demyelinating diseases registered in. It occurred predominantly in women (81%) and non-white individuals (83.4% had self-declared mixed skin color), and the median age at onset was 48 years. Amerindian ancestry was significantly higher (68.75%) than others. Longitudinally extensive transverse myelitis (LETM) alone ≥3 vertebral segments (35%) and optic neuritis (ON) alone (35%) were the most common onset manifestations. The median length of time from disease beginning to study enrollment was 48 months. A relapsing course and moderate disability (Expanded Disability Status Scale (EDSS) 3.0-4.0) were most commonly observed. The worst neurological impairments, characterized by EDSS>4.5, occurred more frequently in males (44.5% among men versus 20.5% among women). The majority of the patients had been receiving immunosuppressive treatment with azathioprine since the diagnosis of NMSOD: 77% (37) had a good therapeutic response. The prevalent outcome (84%) was permanent disability: 52% became physically handicapped; 54% had permanent visual impairment (25% with bilateral and 75% with unilateral amaurosis) and 30% had sphincter disability (82% with neurogenic bladder and 18% with ostomy). The estimated prevalence of NMOSD in Goiás is 0.79/per 100,000 inhabitants. The predominant phenotype comprises women, non-whites, onset in the fourth decade of life, relapsing course, and permanent moderate disability. Our study was the first on the epidemiology of NMOSD in Goiás, where NMOSD predominantly correlates with Amerindian ancestry.

Significados atribuídos pelos docentes às vivências envolvendo direitos humanos no ambiente acadêmico

Abstract: Introduction: Human Rights are inherent to the human condition, considering all aspects of life: the right to life, to an education, to freedom, to religion, to security and to work. Given that, it is important to nurture a Human Rights culture in educational institutions, aiming at improving inter-personal dynamics and the educational environment. The tutors’ development, in this aspect, becomes fundamental. Objective: To understand the meanings attributed by tutors to their experiences involving Human Rights situations in the academic environment as the first step to implement teacher development in this area. Methods: qualitative study involving tutors from a college located in northeastern Brazil, which employs the Problem-Based Learning methodology, between December of 2019 and September of 2020. The collection was performed through focal groups with intentional selection. The script for the discussion was based in the National Plan for Human Rights Education, The Human Rights Education Manual, The Universal Human Rights Declaration and articles related to the discussion topic. Bardin content analysis was used. The project was approved by the Ethics Committee under CAAE number 22696919.3.0000.5569. Results: The studied analytic categories were: gender and sexuality, communication and freedom of speech, social minorities and student self-esteem and stigmatization. During the process of reinterpreting the collected content, the following empirical subcategories were identified: ableism, fatphobia, psychophobia and interpersonal conflicts. The tutors revealed having experienced conflicts involving Human Rights, as follows: gender oppression; homophobia by students and teachers; lack of racial representativeness among the college student population; fatphobia in the academic environment; decrease in student’s performance due to mental health issues. The participant tutors also expressed insecurity when it came to intervening and giving feedback in such situations, as well as some lack of knowledge about Human Rights. Conclusion: The tutors reported episodes that demonstrated Human Rights violation practices in the academic environment and showed to be insecure about intervening in such situations, especially when these situations led to conflict between the students.

Intravitreal bevacizumab (IVB) versus IVB in combination with pars plana vitrectomy for vitreous hemorrhage secondary to proliferative diabetic retinopathy: a randomized clinical trial

BackgroundThe main purpose of this study is to compare the vitreous hemorrhage (VH) score reduction and visual acuity outcomes in patients with VH secondary to proliferative diabetic retinopathy (PDR) treated with intravitreal injections of bevacizumab (IVB) versus IVB and pars plana vitrectomy (IVB and PPV).MethodsPatients with VH secondary to PDR were randomized into 2 groups: in Group A, patients were treated with a total of 3 IVB (1.5 mg/0.06 ml) at 8-week intervals; and in Group B, patients received a single IVB (1.5 mg/0.06 ml) and, 7 days later, underwent PPV. Patients received an ophthalmic evaluation that included best-corrected visual acuity (BCVA), indirect ophthalmoscopy, and mode B echography at weeks 8, 16 and 24. VH was classified according to the Diabetic Retinopathy Vitrectomy Study classification as grade 1, 2 or 3. Change in VH score was the primary outcome measure and change in BCVA was the secondary outcome.ResultsSeventy-three eyes of 66 patients were randomized and 70 eyes completed the 24-week follow-up visit. Mean VH score reduction (± SEM) of 0.4571 ± 0.0283 (p = 0.0014), 1.3429 ± 0.0393 (p < 0.0001) and 1.8286 ± 0.0438 (p < 0.001) was observed in Group A at 8, 16 and 24 weeks after treatment, respectively (Table 2; Fig. 2). In Group B, the reduction of VH score (± SEM) was 2.2571 ± 0.0720 (p = 0.0014), 2.2857 ± 0.0606 (p < 0.0001) and 2.2286 ± 0.0726 (p < 0.001) at 8, 16 and 24 weeks after treatment, respectively. Group comparison revealed a significantly greater reduction in mean VH score in Group B at 8 and 16 weeks after treatment (p < 0.0001). However, at 24 weeks this difference was no longer statistically significant (p = 0.1854). In Group A, mean (± SEM) BCVA showed an improvement of 0.00285 ± 0.0004 (p = 0.971), 0.5371 ± 0.0072 (p < 0.0001), 0.8143 ± 0.0001 (p < 0.0001) and 0.8543 ± 0.0008 (p < 0.0001) compared to baseline at 1, 8, 16 and 24 weeks after treatment, respectively. In Group B, mean (± SEM) BCVA showed an improvement of 0.3657 ± 0.0507 (p = 0.0002), 0.8857 ± 0.0385 (p < 0.0001), 0.9457 ± 0.0499 (p < 0.0001) and 0.9629 ± 0477 (p < 0.0001) compared to baseline at 1, 8, 16 and 24 weeks after treatment, respectively. No significant difference in BCVA improvement was observed between groups at 24 weeks after treatment.ConclusionPPV with preoperative IVB is associated with more rapid clearance of VH and improvement in BCVA than IVB injections alone. However, after 24 weeks of follow-up, the reduction in VH score and BCVA were similar between both treatment strategies.Trial RegistrationThe project is registered in Plataforma Brasil with CAAE number 927354.7.0000.5440 and was approved by the Ethics Committee of the Clinics Hospital of Ribeirao Preto Medicine School of São Paulo University—Ribeirão Preto, São Paulo, Brazil (appreciation number 3.053.397 gave the approval).

Drawing technique in understanding the meaning of adolescent pregnancy

Objective: to investigate the meanings of adolescents about pregnancy. Method: qualitative study of ethnographic aspect, performed with eight pregnant teenagers. The data collection technique was the narrative interview, which was subjected to thematic analysis, and drawing as a complementary technique. The study was initiated after approval by the Ethics Committee with CAAE number 00554512.0.0000.5346. Results: the use of the drawing produced meanings of the bodily changes, which were of reflection about their silhouette, timidity in representing themselves in a drawing and satisfaction with the corporal alterations caused by the pregnancy. In the representations, they were alone, only one included the partner. Conclusion: the drawing allows a more communicative and participatory position during the interviews. Thereby, it recognizes the relevance of using this technique in data collection work with anthropological approach.

A Comparison Standard for Assessing the Adapted Version of the Brazilian Functionality Index

Background: This study aimed to determine the best method of achieving consensus between examiners and workers with disabilities in Brazil regarding their perceived severity of the disability and eligibility for an early retirement pension. Methods: We analysed the agreement between evaluators’ perceptions to create a reference standard for the classification of the disability severity of applicant workers with disabilities. Pairs of expert physicians and social workers applied a computer index, and then assigned their perceived level of severity, independent of the computer classification. Findings: A total of 17,350 applicants aged 18 and 76 years were included in the analysis. The best-perceived agreement represented the ideal comparison standard for validating the index in the future. The severity perceptions of the evaluators and the workers with disabilities yielded three agreement tables portraying the perceived disability severity. Physicians and social workers demonstrated the greatest level of agreement (weighted kappa: 0·2351, 95% confidence interval: 0·2229–0·2473) and the combination of their assessments provided the best standard. To the best of our knowledge, this is the first time that this method has been used to create a reference standard. Evaluators’ perceptions of disability severity formed the basis for choosing a standard to further analysis the index’s accuracy and validity. Funding Statement: This work was supported by a grant from the Brazilian Ministry of Social Security (No. 44000.001814/2013-60; FUB Technical Cooperation Agreement of 11/21/2013). Declaration of Interests: We declare no competing interests. Ethics Approval Statement: This research was conducted according to Brazilian regulations and in conformance with the Principles of the Declaration of Helsinki, and the study protocol was approved by the Internal Review Board of the School of Health Sciences at the University of Brasilia, (CAAE number: 37058914.5.0000.0030). The requirement for informed consent for this database analysis was waived because the study was based on a retrospective analysis of routinely-collected data.

Pedicle internal limiting membrane flap technique for very large macular holes: a preliminary report

BackgroundConventional vitrectomy technique for macular hole surgery has a good outcome in small and medium macular holes, but for very large macular holes (minimum linear diameter higher than 700 μm) other techniques were developed aiming to achieve greater rates of closure and visual acuity gain. The purpose of this article is to report the anatomical and functional outcomes of four very large macular hole (MH) cases which have undergone vitrectomy with the pedicle internal limiting membrane (ILM) flap technique.MethodsThis is a retrospective series of four patients with large MH who were treated with vitrectomy and the pedicle ILM flap technique. Comprehensive ophthalmologic evaluation was performed before surgery and included ETDRS best-corrected visual acuity (BCVA) and spectral domain optical coherence tomography (SD-OCT) for MH measures: height, minimum linear diameter (MLD) and external base diameter. The particular detail of this technique is related to ILM flap creation. During the peeling, the ILM was not removed completely from the retina but was left attached to the edges of the macular hole and subsequently trimmed with the vitrectomy probe using the scissors mode.ResultsFour patients with very large MH underwent PPV and the pedicle ILM flap technique was used to pursue macular closure. Median preoperative BCVA was 20/400 (range: 20/320 to 20/400) and median postoperative BCVA was 20/200 (range: 20/320 to 20/200). Of the 4 cases reported, 3 obtained anatomical closure (75%), and also presented BCVA improvement after surgery, considering the last follow-up visit of each case. No additional procedures were performed in either case. One patient demonstrated no anatomic and functional improvement.ConclusionThe present study describes the first Brazilian case series of very large MH treated by the inverted pedicle ILM flap technique. This technique was associated with anatomic and visual improvement in most cases, and represents an alternative therapeutic approach for large macular holes.Trial Registration Project registered in Plataforma Brasil with CAAE number 30163520.0.0000.5440 and approved in ethics committee from Ribeirão Preto Medical School Clinics Hospital, University of São Paulo—Ribeirão Preto, São Paulo, Brazil (appreciation number 3.948.426 gave the approval).

A sexualidade de mulheres durante o climatério: percepções e vivências

Objetivo: conhecer as percepções e vivências de mulheres acerca da sexualidade durante o climatério. Metodologia: trata-se de um estudo de campo, descritivo, exploratório, de abordagem qualitativa, realizado por meio de entrevistas semiestruturadas com dez mulheres climatéricas, em uma Unidade Básica de Saúde. Os dados foram submetidos à análise de conteúdo do tipo temática. O estudo foi aprovado por Comitê de Ética em Pesquisa, CAAE número 05287312.0.0000.5323. Resultados: a sexualidade foi percebida de diferentes formas, apenas como relação sexual ou associada à feminilidade, sensualidade e cuidado de si. Foi manifestada a perda do desejo sexual e houve associação de um convívio conjugal baseado no diálogo e apoio para uma melhor vivência da sexualidade. Conclusão: é fundamental que o enfermeiro contemple, no desenvolvimento de ações de saúde, um olhar mais atento e singular em relação à sexualidade das mulheres climatéricas para que elas consigam vivenciar esta fase de forma saudável e qualitativa.

Combined pars plana vitrectomy (PPV) and phacoemulsification (phaco) versus PPV and deferred phaco for phakic patients with full-thickness macular hole (FTMH) and no significant cataract at baseline: 1-year outcomes of a randomized trial combined PPV/phaco vs PPV/deferred phaco for MH.

To compare functional and anatomic outcomes of combined pars plana vitrectomy (PPV) and phacoemulsification (phaco) versus PPV and deferred phaco in patients with full-thickness macular hole (FTMH) and no significant cataract. Thirty-four patients were randomized to group 1 (combined PPV/phaco) and 34 to group 2 (PPV/deferred phaco). Group 2 patients could undergo phaco any time after FTMH surgery if significant cataract developed. Sixty-five patients (33 group 1 and 32 group 2) completed the 12-month visit. Mean ± SEM logMAR best-corrected visual acuity (BCVA) was 0.92 ± 0.04 and 0.90 ± 0.04 at baseline and improved significantly to 0.60 ± 0.05 and 0.58 ± 0.05 at month 12 (p < 0.0001) in groups 1 and 2, respectively. There was no significant difference between the groups in mean BCVA at baseline or at month 12. Mean macular sensitivity (dB) was 18.22 ± 0.93 and 16.72 ± 0.93 at baseline and increased to 21.13 ± 0.86 and 21.07 ± 0.85 in groups 1 and 2, respectively (p < 0.05) with no significant difference between the groups (p = 0.449) at month 12. FTMH closure rate was 73% and 75% in groups 1 and 2, respectively (p = 0.834). Among patients with FTMH and no significant cataract at baseline, combined PPV/phaco was associated with similar BCVA, microperimetry, and FTMH closure outcomes at 1-year compared with PPV/deferred phaco. ( clinicaltrials.gov.br ): Ensaios clínicos brasileiros: RBR-3wmd9s; UTN number: U1111-1190-5013; Plataforma Brasil CAAE number: 50455415.3.0000.5440; IRB number: 1.433.000.

Hepatitis C screening, diagnosis, and cascade of care among people aged >\u200940\u2009years in Brasilia, Brazil

BackgroundIdentifying patients with hepatitis C virus (HCV) infection and enhancing the cascade of care are essential for eliminating HCV infection. This study aimed to estimate the prevalence of positive anti-HCV serology in Brasilia, Brazil, and evaluate the efficiency of the cascade of care for HCV-positive individuals.MethodsThis cross-sectional study analyzed 57,697 rapid screening tests for hepatitis C in individuals aged > 40 years between June 2018 and June 2019. HCV-positive patients were contacted and scheduled to undergo the HCV RNA viral test, genotyping, and transient elastography.ResultsThe prevalence of positive serology was 0.27%. Among 161 patients with positive anti-HCV serology, 124 (77%) were contacted, 109 (67.7%) were tested for HCV RNA viral load, and 69 (42.8%) had positive results. Genotype 1 (75%) was the most prevalent genotype. Among 65 patients (94.2%) who underwent transient elastography, 30 (46.2%) presented with advanced fibrosis. Additionally, of the 161 patients, 55 (34.1%) were referred for treatment, but only 39 (24.2%) complied, with 36 (22.4%) showing sustained virological response. By the end of the study, 16 patients were still awaiting to receive medication.ConclusionsThe prevalence of HCV-positive patients was low in Brasilia, and the gaps in the cascade of care for these patients were significantly below the targets of HCV infection elimination. This study opens new avenues for eliminating HCV infection and suggests that partnerships with clinical laboratories to conduct anti-HCV tests are a useful strategy to improve HCV diagnosis.Trial registrationResearch Ethics Committee of the Faculty of Health Sciences of the University of Brasília - UNB (CAAE number 77818317.2.0000.0030) and by the Ethics Committee of the Health Science Teaching and Research Foundation - FEPECS/SES/DF (CAAE number 77818317.2.3001.5553).

Patients with Impaired Descending Nociceptive Inhibitory System Present Altered Cardiac Vagal Control at Rest

Background: Patients with chronic musculoskeletal pain have a higher chance of presenting impairment in cardiovascular autonomic modulation, which may have implications for cardiovascular events. The autonomic nervous system plays an important role in pain modulation. However, it is unclear whether patients with inefficient descending nociceptive inhibition have poorer cardiovascular autonomic modulation. Objective: To compare the cardiovascular autonomic modulation of patients with musculoskeletal pain who had normal versus impaired functioning of descending nociceptive inhibitory system (DNIS). Study Design: A cross-sectional study. Setting: Physiotherapy outpatient service. Methods: Fifty-six patients with musculoskeletal pain were included. Conditioned pain modulation was assessed by the difference of algometric values held in the dorsal forearm and tibialis anterior muscle, before and after a thermal pain stimulus was employed via the cold pressure test (CPT). Patients with inefficient DNIS in both sites were classified as impaired responders (n = 14). The others were classified as normal responders (n = 42). Cardiac autonomic modulation was monitored at rest by heart rate variability (HRV). The blood pressure response to the CPT was used as a proxy of sympathetic responsiveness. Results: Most of the patients were women (60%) and had chronic pain (75%). The groups had similar demographic characteristics. Patients with impaired DNIS showed lower HRV [RMSSD (P = 0.020), SDRR (P = 0.009), HF (ms2 ) (P = 0.027), LF (ms2 ) (P = 0.004), and total power (P = 0.002)]. The blood pressure response to CPT was similar between groups (systolic pressure, P = 0.813; diastolic pressure, P = 0.709). Limitation: Physical activity level, emotional changes, and visceral pathologies can alter the autonomic nervous system and may represent potential confounders. The low number of patients may have biased the results. Conclusion: Patients with impaired DNIS presented lower resting HRV, indicating an altered vagal control of the heart. In contrast, the blood pressure response to a sympathoexcitatory stimulus was preserved. The study was approved by the Research Ethics Committee of Augusto Motta University Centre (CAAE number: 46245215.9.0000.5235), and all patients signed the Informed Consent Form. Key words: Musculoskeletal pain, autonomic nervous system, heart rate, chronic pain, diffuse noxious inhibitory control, blood pressure, sympathetic nervous system, parasympathetic nervous system

Analysis of the cycle of domestic violence against women

Introduction: Violence against Women (VAW) has been produced under the hierarchical organization of male dominance in social relations between genders. It is a type of social relationship that is historically bounded, culturally legitimized and cultivated, in which the woman is exposed to objective and subjective aggression, both in public as well as private sectors. The consequences of the violence suffered by women materialize in biological, psychological and social harms that hamper them fully experiencing human and social equalities. The persistence and the multiplicity of forms of expressing violence against women, throughout history, indicate the importance of the theme and the need to investigate how this practice interferes with the process of living, illness and death of the victim. Objective: To analyse the cycle of domestic violence against women. Methods: This is a population-based survey, and cross-sectional, exploratory and descriptive study, using a quantitative approach. The study was conducted in the city of Joao Pessoa-PB, from August 2013 to December 2015. The population consisted of 424 women over 18 years old, and residing in the city of study. For data collection, two instruments were used: the WHO VAW STUDY and the WHOQOL BREF scale, validated for assessing quality of life. A descriptive analysis was performed, from absolute and relative frequencies for the following variables: sociodemographic; Domestic Violence against Women (DVAW) and QOL, in addition to the average for continuous variables; under CAAE number 20418813.0.0000.5183. Results: The women averaged an overall score of 61.59 for the quality of life index, on a scale from 0 to 100. Regarding scores for each domain, the domain of social relations had the highest average among the domains (69.84), whereas the environment domain had the lowest average (51.03). Conclusions: Domestic Violence against Women directly and adversely affects the quality of life of the victimized women in numerous aspects, because it interferes with the physical and psychological health of women in society and in their social relations, also bringing consequences for the health system.