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Introduction: Up to 60% of hospitalised neonates may develop incontinence-associated dermatitis (IAD). Our aim was to adapt the Clinical Evaluation Scale for Characterization of the Severity of Diaper Dermatitis to the Spanish population and to find out the nationwide frequency of IAD in hospitalized neonates., Methods: Cross-cultural adaptation and assessment of content validity of the scale. We carried out a prospective, multicentre observational study of the incidence of nappy rash in postnatal wards and neonatal intensive care units in 6 Spanish hospitals., Results: We obtained a content validity index of 0.869 for the total scale (95% CI, 0.742-0.939). The sample included 196 neonates. The cumulative incidence of IAD was 32.1% (9.1% mild-moderate, 8% moderate and 1.6% severe). The incidence rate was 2.2 IAD cases per 100 patient days. A stool pH of less than 5.5, a greater number of bowel movements a day, a greater daily urine output and the use of oral drugs were among the factors associated with the development of IAD., Conclusion: The Spanish version of the Clinical Evaluation Scale for Characterization of the Severity of Diaper Dermatitis had an adequate content validity for the assessment of DAI in the hospitalised neonatal population. Mixed feeding, treatment with oral drugs and the use of medical devices in the perianal area were associated with an increased risk of nappy dermatitis in infants., (Copyright © 2024 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.)

Background: a large tibial defect significantly increases the chances of nonunion fractures, changes in the quality of life, and pain. Tibial osteotomy with a large gap size is an unfavorable condition to complete healing., Purpose: to describe the treatment of a complex case of a six-month nonunion tibial diaphysis osteotomy using conventional pulsed ultrasound therapy (cput)., Case Description: a 46-year-old man, 1.65 m tall, weighing 63 kg, and homeless was diagnosed with a nonunion tibial diaphysis fracture and underwent osteotomy of the tibial diaphysis with an opening gap and external fixation with circular rings and thin wires (ilizarov). An interdisciplinaty approach including social work, nutrition, and physiotherapy including exercise reconditioning was initiated over a period of two years. After six months of nonunion following a tibial osteotomy, cput was used with a frequency of 1 mhz, duty cycle of 20%, spatially averaged temporally averaged (sata) intensity of 0.1 w/cm 2 , frequency of 100 hz, 20 min of duration, for 2-3 times for 20 weeks., Outcomes: there was an improvement in the amount of bone in the fracture gap with a total restoration of function, resolution of pain, and gait without crutches after 35 sessions of cput., Conclusion: an interdisciplinary approach including mechanical stimulus from cput assisted in the healing process in a patient with chronic tibial osteotomy nonunion.

Purpose: To assess the incidence and risk factors of Descemet membrane detachment due to laser application in femtosecond laser-assisted cataract surgery (FLACS)., Methods: In this retrospective case series, all patients who underwent FLACS with the LenSx system (Alcon Laboratories, Inc) were eligible to participate. The medical records were reviewed to collect data regarding potential risk factors related to Descemet membrane detachment, including patients' demographics, laser parameters, and ocular measurements. The eyes were separated into two groups based on the clinical diagnosis of Descemet membrane detachment as the femto-second laser was performing the corneal incisions., Results: Five hundred ten eyes (304 patients) were included. Descemet membrane detachment occurred in 20 (3.9%) eyes of 16 (5.3%) patients. Four (1.3%) patients had a detachment in both eyes. In 16 (3.1%) eyes, the Descemet membrane detachment occurred in the secondary incision site. The eyes that had a detachment had a statistically lower mean endothelial cell density (2,193.40 ± 313.37 versus 2,385.08 ± 357.80 cells/ mm 2 ; P = .019), and a statistically higher prevalence of corneal guttata (25.0% versus 8.8%; P = .015). None of the other analyzed variables statistically differed between the groups ( P > .05). The risk of having Descemet membrane detachment was statistically higher among eyes with guttata (odds ratio = 3.47; P = .015) and in those with an endothelial cell density of less than 2,000 cells/mm 2 (odds ratio = 3.26; P = .014)., Conclusions: The incidence of Descemet membrane detachment due to laser application in FLACS was 3.9%, with the associated risk factors being endothelial cell density of less than 2,000 cells/mm 2 and corneal guttata. [ J Refract Surg . 2021;37(7):466-471.] .

Approximately 300 million people worldwide were living with chronic hepatitis B virus infection as of 2016, however, this number does not account for those who might be living with occult hepatitis B virus infection due to difficulty diagnosing this condition. The multiple genotypes and the ability of the hepatitis B virus to acquire mutations that down-regulate its expression make occult hepatitis B virus infection a very elusive diagnosis. This is especially worrisome when there is a need to start immunosuppressive therapies, since there is a risk of reactivation in undiagnosed patients. We present a case of female patient who was referred to the consultation because she was about to start chemotherapy with an anti-CD20 agent and had a positive anti-HBc and anti-HBs. During routine workup an occult hepatitis B virus infection was diagnosed. Upon further study mutations in the PreCore and Basal Core Promoter regions were identified, as well as, a double genotype D/C. Therapy with tenofovir was initiated before the patient was started on chemotherapy. This case highlights the importance of comprehensive studying of patients who present with apparently resolved chronic hepatitis B virus infection, especially when they are about to start immunosuppressive therapies., (© 2019 The Author(s).)

Purpose: To assess the prevalence of macular abnormalities not suspected by the biomicroscopic fundus examination and identified only by macular optical coherence tomography (OCT) in the preoperative evaluation for cataract surgery in a large series of Brazilian patients., Setting: Private practice, Recife, Brazil., Design: Retrospective case series., Methods: All eyes that had cataract surgery by the same physician between August 2014 and July 2016 were eligible. Excluded were eyes with a previous diagnosis of macular abnormalities, with a suspicious biomicroscopic fundus examination, and without OCT results. Based on the preoperative macular OCT, patients were divided into the following 2 groups: those with a normal OCT and those with an abnormal OCT., Results: Nine hundred fifty-two eyes (614 patients) were included in the study. Macular OCT identified abnormalities in 47 eyes (4.9%) of 44 patients (7.2%). Thirty-one eyes (3.3%) had epiretinal membrane, 7 (0.7%) had age-related macular degeneration, 4 (0.4%) had intraretinal cysts, 4 (0.4%) had a lamellar hole, and 1 (0.1%) had a macular hole. Patients with an abnormal OCT had a statistically significant higher mean age (P = .004)., Conclusion: In the preoperative evaluation for cataract surgery in Brazilian patients, 7.2% of those with a normal biomicroscopic fundus examination had macular abnormalities that were identified only by OCT., (Copyright © 2019 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To assess the efficacy of using a nonste-roidal anti-inflammatory drug preoperatively and of applying the re-dilation technique when necessary to minimize pupil size variation when comparing the degree of mydriasis before femtosecond laser pretreatment with that at the beginning of phacoemulsification., Methods: This retrospective study included patients who underwent cataract surgery using the LenSx (Alcon Laboratories, Inc., Fort Worth, TX). Our routine dilating regimen with flurbiprofen, tropicamide, and phenylephrine was used. The re-dilation technique was applied on eyes that manifested with a pupillary diameter that was smaller than the programmed capsulotomy diameter after laser pretreatment. The technique consists of overcoming pupillary contraction by instilling tropicamide and phenylephrine before phacoemulsification. Pupil size was assessed before femtosecond laser application and at the beginning of phacoemulsification., Results: Seventy-five eyes (70 patients) were included. Nine (12%) eyes underwent the re-dilation technique. There was no significant difference in mean pupillary diameter and mean pupillary area between the two studied surgical time points (p=0.412 and 0.437, respectively). The overall pupillary area constriction was 2.4 mm2. Immediately before opening the wounds for phacoemulsification, none of the eyes presented with a pupillary diameter <5 mm, and 61 (85.3%) eyes had a pupillary diameter >6 mm., Conclusion: Preoperative administration of nonsteroidal anti-inflammatory drug and the re-dilation technique resulted in no significant pupil size variation in eyes that were pretreated with the femtosecond laser, when comparing the measurements made before the laser application and at the beginning of phacoemulsification. This approach can avoid the need to proceed with cataract extraction with a constricted pupil.

This study investigated starch content, amount of pathogen DNA and density of occluded vessels in healthy and Verticillium dahliae infected olive shoots and stems. Starch hydrolysis is considered a mechanism to refill xylem vessels that suffered cavitation by either, drought conditions or pathogen infections. The main objective of this work was to evaluate this mechanism in olive plants subjected to V. dahliae infection or to drought conditions, in order to know the importance of cavitation in the development of wilting symptoms. In initial experiments starch content in the shoots was studied in trees of cultivars differing in the level of resistance growing in fields naturally infested with V. dahliae . The starch content, esteemed by microscopic observation of stem transversal sections stained with lugol, decreased with the level of symptom severity. Results were confirmed in a new experiment developed with young plants of cultivars 'Picual' (highly susceptible), 'Arbequina' (moderately susceptible) and 'Frantoio' (resistant), growing in pots under greenhouse conditions, either inoculated or not with V. dahliae . In this experiment, the pathogen DNA content, quantified by real-time PCR, and the density of occluded vessels, recorded by microscopic observations of transversal sections stained with toluidine blue, were related to the symptoms severity caused by the pathogen. Finally, a drought experiment was established with young plants of the cultivar 'Picual' grown in pots under greenhouse conditions in order to compare the effects caused by water deficit with those caused by the pathogen infection. In both cases, results show that starch hydrolysis occurred, what indirectly evidence the importance of xylem cavitation in the development of the symptoms caused by V. dahliae but in the water stressed plants no vessel occlusion was detected.

Purpose: To compare biometry measurements and intraocular lens (IOL) power calculations obtained by a new optical A-scan interferometer biometer (Galilei G6) (new biometer) and a partial coherence interferometer biometer (IOLMaster 500) (reference biometer)., Setting: Private practice, Recife, Brazil., Design: Retrospective comparative study., Methods: Cataract patients who had biometric measurements with the new biometer and the reference biometer were included in the study. Comparisons were performed for axial length (AL), keratometry (K), anterior chamber depth (ACD), and IOL power calculation to reach emmetropia with an Acrysof SN60WF IOL using the Haigis formula. The Pearson correlation coefficient and the 95% limits of agreement (LoA) were calculated. The paired Student t test and the Wilcoxon test were used to assess differences between devices., Results: Eighty-eight eyes (88 patients) were studied. Both biometers provided statistically similar mean IOL power to reach emmetropia, AL, keratometry, and ACD measurements (P > .05). The differences in these variables did not vary as their mean values increased, and there was a strong positive correlation between the values obtained by both devices for each variable. The 95% LoA values for AL, mean keratometry, ACD, and IOL power were 0.27 mm, 1.08 diopters (D), 0.66 mm, and 1.56 D, respectively., Conclusions: The 2 devices were comparable with regard to mean IOL power, mean AL, K, and ACD measurements. However, the wide range of differences between the devices suggests they should not be used interchangeably., (Copyright © 2016 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Objective: to perform the cultural adaptation to Portuguese of the Nursing Clinical Facilitators Questionnaire (NCFQ), which was designed by the Centre for Learning and Teaching at the University of Technology of Sydney, and to validate this instrument., Methods: this methodological study involved the cultural adaptation of the questionnaire by using translation, back-translation, semantic comparison, idiomatic and conceptual equivalence, and validation through validity and reliability analyses and used a sample of 767 students in their second year of the Nursing Program., Results: construct validity had a two-factor solution according to the varimax rotation method. In addition, there was a high overall internal consistency for the questionnaire (Cronbach's alpha of 0.977) and for the factors found (0.966 and 0.952, respectively)., Conclusion: the Portuguese version has good psychometric characteristics; therefore, it is adequate to obtain reliable information on the perception of nursing students concerning the type of supervision that is provided in clinical practice, and this version is adequate to improve teaching practices., Objetivo: realizar a adaptação cultural para a língua portuguesa do Nursing Clinical Facilitators Questionnaire (NCFQ) concebido pelo Centre for Learning and Teaching, University of Technology de Sydney e proceder à validação do instrumento., Métodos: estudo metodológico de adaptação cultural do questionário através de tradução, retroversão, comparação semântica, idiomática e equivalência conceitual, seguido de validação em uma amostra de 767 estudantes do 2º ano do Curso de Licenciatura em Enfermagem, por meio de análise da validade e confiabilidade., Resultados: a validade de constructo apresenta uma solução bifatorial após rotação varimax. A consistência interna global do questionário é elevada (alfa de Cronbach 0,977), assim como dos fatores encontrados (respectivamente, 0,966 e 0,952)., Conclusão: a versão portuguesa apresenta boas características psicométricas, sendo um instrumento válido para obter informação fidedigna acerca da percepção dos estudantes de enfermagem relativamente ao tipo de orientação tida em contexto clínico, revelando-se importante para melhoria das práticas pedagógicas., Objetivo: llevar a cabo la adaptación cultural al portugués del Nursing Clinical Facilitators Questionnaire (NCFQ), diseñado por el Centre for Learning and Teaching, University of Technology Sydney, y validar este instrumento., Métodos: este estudio metodológico implicó la adaptación cultural del cuestionario usando la traducción, la retrotraducción, la comparación semántica, la equivalencia idiomática y conceptual, y la validación usando una muestra de 767 estudiantes del segundo curso del Programa de Enfermería mediante análisis de validez y de fiabilidad., Resultados: la validez del constructo presentó una solución bifactorial según el método de rotación Varimax. Además, hubo una consistencia interna total alta para el cuestionario (alfa de Cronbach de 0,977) y para los factores encontrados (de 0,966 y 0,952, respectivamente)., Conclusión: la versión en portugués cuenta con buenas características psicométricas y, por lo tanto, es adecuada para obtener información fiable sobre la percepción de los estudiantes de enfermería sobre el tipo de supervisión proporcionada en la práctica clínica, y esta versión es adecuada para la mejora de las prácticas pedagógicas.

Infections of central nervous system (CNS) include a broad group of conditions and pose a particular challenge to physicians, especially in immunocompromised individuals. This case refers to a 26-year-old male patient with a history of smoked hashish and drug abuse admitted to the infectious disease department with hemiballismus of left hemibody and a positive HIV serologic test. A magnetic resonance imaging (MRI) study showed lesions at lower left and right cerebellar hemisphere, one of them thalamus - mesencephalic suggesting an opportunistic infection or an HIV associated encephalopathy. Lumbar puncture, brain biopsy and successive neuroimaging were not conclusive for one disease and despite the use of directed therapy for cerebral toxoplasmosis, meningeal tuberculosis, anti-retrovirals and sedative medication, after over 6 weeks of hospitalization pallidotomy was performed. After 5 months of oral and surgical treatment the patient showed clinical, immunological and radiological recovery.

Purpose: To identify areas of consensus and disagreement in the management of paediatric cataract using a modified Delphi approach among individuals recognised for publishing in this field., Design: A modified Delphi method., Participants: International paediatric cataract experts with a publishing record in paediatric cataract management., Methods: The process consisted of three rounds of anonymous electronic questionnaires followed by a face-to-face meeting, followed by a fourth anonymous electronic questionnaire. The executive committee created questions to be used for the electronic questionnaires. Questions were designed to have unit-based, multiple choice or true-false answers. The questionnaire included issues related to the preoperative, intraoperative and postoperative management of paediatric cataract., Main Outcome Measure: Consensus based on 85% of panellists being in agreement for electronic questionnaires or 80% for the face-to-face meeting, and near consensus based on 70%., Results: Sixteen of 22 invited paediatric cataract surgeons agreed to participate. We arrived at consensus or near consensus for 85/108 (78.7%) questions and non-consensus for the remaining 23 (21.3%) questions., Conclusions: Those questions where consensus was not reached highlight areas of either poor evidence or contradicting evidence, and may help investigators identify possible research questions., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

Purpose: To evaluate the incidence of posterior capsule opacification (PCO) four years after the implantation of a hydrophilic acrylic intraocular lens (IOL)., Methods: Fifty-eight randomly selected eyes from 58 patients were analyzed four years after phacoemulsification and Ioflex IOL implantation. The patients underwent an ophthalmic examination to detect PCO and a detailed medical history was obtained. The patients' charts were reviewed for their corrected distance visual acuity prior to the IOL implantation, as well as for one month postoperatively. The Student's t-test was used for statistical analysis., Results: The mean age of patients without PCO was 74.6 ± 9.5 years, compared to 70.3 ± 15 years in patients with PCO. Four years after surgery, 39 of the 58 eyes (67%) had detectable PCO and 24 eyes (41.3%) had decreased visual acuity (VA) due to PCO. These patients were referred for Nd:YAG laser capsulotomy. Three patients (5.1%) had decreased VA due to glaucoma, IOL opacification, or age-related macular degeneration. Twelve eyes (20.7%) presented mild PCO with unchanged VA. Systemic arterial hypertension was reported by 45% of the patients, and in 3.5% of these cases this was associated with diabetes mellitus., Conclusion: This study found the incidence of PCO to be 67% four years after phacoemulsification and Ioflex IOL implantation.

Purpose: To compare the outcomes of congenital cataract surgery using intraoperative intracameral triamcinolone versus postoperative oral prednisolone to modulate ocular inflammation., Setting: Department of Congenital Cataract, Altino Ventura Foundation, Recife, Brazil., Design: Randomized clinical trial., Methods: Children younger than 2 years were randomly divided into 2 groups. The study group received an intraoperative intracameral injection of 1.2 mg/0.03 mL of triamcinolone acetonide. The control group (29 eyes) received 1 mg/kg per day of prednisolone syrup for 15 days postoperatively, which was then tapered over the following 2 weeks. Intraocular pressure (IOP), central corneal thickness (CCT), cell deposits on the intraocular lens (IOL), posterior synechiae, visual axis obscuration, additional surgical procedures, and IOL centration were assessed 12 months postoperatively., Results: The mean patient age at surgery was 10.45 months±6.22 (SD) in the study group (31 eyes) and 10.0±6.15 months in the control group (29 eyes) (P=.779). In both groups, the mean IOP and CCT did not change significantly postoperatively (study group P=.922 and P=.149, respectively; control group P=.483 and P=.416, respectively). The groups had similar incidences of cell deposits (P=.517) and posterior synechiae (P=.247). No eye developed visual axis obscuration or had additional surgical procedures. All eyes had a clinically centered IOL., Conclusion: One year postoperatively, the outcomes were similar with intraoperative intracameral triamcinolone injection and postoperative oral prednisolone for modulating inflammation after congenital cataract surgery., Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned., (Copyright © 2014 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Introduction: Chronic kidney disease is a serious health problem in El Salvador. Since the 1990s, there has been an increase in cases unassociated with traditional risk factors. It is the second leading cause of death in men aged >18 years. In 2009, it was the first cause of in-hospital death for men and the fifth for women. The disease has not been thoroughly studied., Objective: Characterize clinical manifestations (including extrarenal) and pathophysiology of chronic kidney disease of nontraditional causes in Salvadoran farming communities., Methods: A descriptive clinical study was carried out in 46 participants (36 men, 10 women), identified through chronic kidney disease population screening of 5018 persons. Inclusion criteria were age 18-59 years; chronic kidney disease at stages 2, 3a and 3b, or at 3a and 3b with diabetes or hypertension and without proteinuria; normal fundoscopic exam; no structural abnormalities on renal ultrasound; and HIV-negative. Examinations included social determinants; psychological assessment; clinical exam of organs and systems; hematological and biochemical parameters in blood and urine; urine sediment analysis; markers of renal damage; glomerular and tubular function; and liver, pancreas and lung functions. Renal, prostate and gynecological ultrasound; and Doppler echocardiography and peripheral vascular and renal Doppler ultrasound were performed., Results: Patient distribution by chronic kidney disease stages: 2 (32.6%), 3a (23.9%), 3b (43.5%). Poverty was the leading social determinant observed. Risk factor prevalence: agrochemical exposure (95.7%), agricultural work (78.3%), male sex (78.3%), profuse sweating during work (76.3%), malaria (43.5%), NSAID use (41.3%), hypertension (36.9%), diabetes (4.3%). General symptoms: arthralgia (54.3%), asthenia (52.2%), cramps (45.7%), fainting (30.4). Renal symptoms: nycturia (65.2%), dysuria (39.1%), foamy urine (63%). Markers of renal damage: macroalbuminuria (80.4%), ß2 microglobulin (78.2%), NGAL (26.1%). Renal function: hypermagnesuria (100%), hyperphosphaturia (50%), hypernatriuria (45.7%), hyperkaluria (23.9%), hypercalciuria (17.4%), electrolyte polyuria (43.5%), metabolic alkalosis (45.7%), hyponatremia (47.8%), hypocalcemia (39.1%), hypokalemia (30.4%), hypomagnesemia (19.6%). Imaging: Ultrasound showed fatty liver (93.5%) and vascular Doppler showed tibial artery damage (66.7%). Neurological symptoms: abnormal tendon reflexes (45.6%), Babinski sign and myoclonus (6.5%), sensorineural hearing loss (56.5%)., Conclusions: This chronic kidney disease studied behaves clinically like chronic tubulointerstitial nephropathy, but with systemic manifestations not attributable to kidney disease. While male agricultural workers predominated, women and adolescents were also affected. Findings support a hypothesis of multifactorial etiology with a key role played by nephrotoxic environmental agents.

Diencephalic syndrome is a rare condition associated with central nervous system tumors. The most common presentation is secondary failure to thrive with proper caloric intake and no statural impairment. Despite the importance of this syndrome, little is known of its pathophysiology. Some reports have documented changes in human growth hormone and insulin levels at the onset, whereas others have described endocrine disorders of hypothalamic insufficiency resulting from surgery of the tumor. It has been suggested that the hormonal changes described, such as increased human growth hormone and ghrelin or decreased insulin and leptin levels, are related to a patient's BMI. These findings support the role of these 4 hormones as indicators of the patient's nutritional status but not as mediators or potential therapeutic targets of the disease. We report the case of an infant who initially presented with tumor progression and, after chemotherapy, progressive weight gain and reduced tumor size. Because he presented no hormonal deficiencies or obesity after therapy, we were able to analyze his hormonal status uninfluenced by effects of metabolic treatment or excess weight. Although ghrelin and leptin levels have been related to nutritional status, our patient's leptin levels fell when tumor size decreased and weight increased: an extraordinary finding because leptin concentration is expected to increase with weight gain. This paradoxical response suggests that leptin may be dysregulated in diencephalic syndrome or that the diencephalic astrocytoma may have had an effect on leptin secretion.

Purpose: To report the visual outcomes and complications of congenital cataract surgery with primary intraocular lens implantation in microphthalmic eyes of children younger than 4 years of age., Methods: This retrospective interventional case series included 14 microphthalmic eyes from 10 children who underwent congenital cataract surgery with primary intraocular lens implantation younger than 4 years of age. Seven patients had bilateral cataracts (11 eyes met the study's inclusion criteria) and 3 patients had unilateral cataract. Patients' medical charts were reviewed to obtain information regarding the preoperative and postoperative ophthalmological examination. Main outcome measures were intraocular pressure (IOP), best-corrected visual acuity, and intraoperative and postoperative complications., Results: Mean age at the time of surgery was 21.7 ± 2.9 months. Mean ocular axial length was 19.2 ± 0.9 mm. Mean preoperative IOP was 9.7 ± 1.7 mmHg and 10.3 ± 3.1 mmHg on final follow-up (P=0.18). There were no intraoperative complications. Two (15.4%) eyes developed secondary visual axis opacification, of which only one needed to be reoperated due to significantly decreased vision (0.5 logMAR). Preoperative and postoperative best-corrected visual acuity was 2.09 ± 0.97 logMAR and 0.38 ± 0.08 logMAR in bilateral cases and 1.83 ± 1.04 logMAR and 0.42 ± 0.13 logMAR in unilateral cases, respectively., Conclusion: Primary intraocular lens implantation in congenital cataract surgery in microphthalmic eyes resulted in a significant best-corrected visual acuity improvement with no intraoperative complications and minimal postoperative complications.

Purpose: To report the incidence of late postoperative opacification of a hydrophilic acrylic foldable intraocular lens (IOL)., Setting: Altino Ventura Foundation, Pernambuco, Brazil., Design: Cross-sectional study., Methods: Patients were examined 4 years after phacoemulsification with Ioflex IOL implantation in the rural areas of Pernambuco, Brazil, as part of a community campaign for underprivileged people. The patients had a detailed ophthalmic examination to detect late IOL opacification. The patients' charts were reviewed for preexisting ocular pathology and corrected distance visual acuity (CDVA) before and 1 month after surgery. The IOL opacification was classified according to its location and severity., Results: All surgeries were uneventful intraoperatively and postoperatively. Six (7%) of the 87 eyes (58 patients) examined had a diagnosis of late IOL opacification; asteroid hyalosis and high myopia were associated ocular findings in 2 of the eyes. The preoperative CDVA ranged from hand motions (HM) to 20/80. The postoperative CDVA ranged from 20/20 to 20/40 except in 1 eye with posterior segment disease. Over the 4-year follow-up, 2 of the 6 eyes had a decrease in visual acuity to HM and 20/80, respectively, as a result of late IOL opacification. They had IOL replacement and CDVA improved to 20/60 and 20/20, respectively. A third eye with severe late opacification was not referred for IOL replacement because of macular disease., Conclusion: Intraocular lens opacification was observed in 7% of the eyes studied. No risk factors could be determined., (Copyright © 2012 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate the change in intraocular pressure (IOP) and central corneal thickness (CCT) of children who underwent congenital cataract surgery with injection of triamcinolone acetonide into the anterior chamber at the end of the procedure., Methods: Fifty-three eyes of 34 children <2 years of age who underwent congenital cataract surgery with injection of 1.2 mg/0.03 mL of preservative-free triamcinolone acetonide into the anterior chamber at the end of the procedure were included in this study. IOP and CCT were measured preoperatively and at a mean of 2 and 12 months' follow-up., Results: The mean IOP was 8.7 ± 0.4 mm Hg preoperatively, 8.4 ± 0.6 mm Hg at the 2-month follow-up, and 8.1 ± 0.3 mm Hg at the 12-month follow-up. The mean CCT was 562 ± 11 μm preoperatively, 563 ± 10 μm at the 2-month follow-up, and 570 ± 10 μm at the 12-month follow-up. There was no significant change in either pre- or postoperative IOP (P = 0.700) or CCT (P = 0.419) over the study period., Conclusions: Injection of 1.2 mg triamcinolone acetonide at the end of congenital cataract surgery in children <2 years of age did not significantly affect IOP or CCT in the first year after surgery., (Copyright © 2012 American Association for Pediatric Ophthalmology and Strabismus. Published by Mosby, Inc. All rights reserved.)

Purpose: To evaluate the impact of visual impairment on the quality of life of the elderly population living in the western countryside of Pernambuco State, located in northeast of Brazil., Methods: Five hundred and eighty subjects over 59 years of age were interviewed using the Visual Functioning Questionnaire (VFQ). All subjects underwent complete eye examination. The results of the quantitative parameters were expressed by mean ± SD. The results of categorical parameters were expressed by their frequencies., Results: Mean age was of 70 ± 8.1 years. About 86% of the interviewed elderly were illiterate or had incomplete education. The mean complaints were low visual acuity (71.1%) and itching/burning (69.0%). The visual acuity was not normal in 37.4% of the elderly. About 75.0% of the subjects reported to have regular or bad health, and 77.0% reported to have regular or bad vision. The reported quality of life decreased according to the worsening of the visual acuity., Conclusion: Visual impairment had a negative impact on the quality of life of the elderly population from the western countryside of Pernambuco State.

Objective: To describe and analyze current developments in the Brazilian child and adolescent mental health public policy, focusing on the Centers for Psychosocial Care for Children and Adolescents and in a potential child and adolescent mental health care system, derived from other child and adolescent public policies in the national context., Method: Examination of publications and official data produced by the Brazilian government about the implementation and/or distribution of public services for children and adolescents in the country., Results: The Brazilian child and adolescent mental health policy has as one of its main strategies the implementation of Centers for Psychosocial Care for Children and Adolescents to cover persistent child psychiatric disorders with severe levels of impairment. In addition, there is a potential intersectorial system which would become effective once specific child mental health actions are articulated with the sectors of general health, education, child welfare and justice/rights. This articulation will play an important role in responding to psychiatric disorders which are frequent with impairment of very specific areas of functioning., Discussion: In Brazil, improvement of the child and adolescent mental health care system relies upon the expansion of the mental health specialty sector as well as in its articulation with other public sectors responding to child and adolescent needs.

Purpose: To report pars plana vitrectomy results of intravitreous use of liquid perfluorocarbon as a short-term postoperative tamponade in retinal detachment due to giant tears in a series of patients., Methods: Ten of those patients, all of them complicated by proliferative vitreoretinopathy grade B or worse, with tear extension varying from 90 masculine to 210 masculine were studied. Perfluorocarbon liquid was injected via pars plana until the posterior tear limit, remaining in the postoperative period during five days, with the patients in supine position. After this period, the patients underwent a second surgical procedure to exchange the liquid perfluorocarbon for gas or silicone oil., Results: The retinas of eight patients were attached (80%) after a mean follow-up of 16.2 +/- 12.4 months (from 2 to 43 months). It was necessary to repeat this technique in one (10%) case, and there was no attachment of the retina in two (20%) cases due to advanced proliferative vitreoretinopathy. Visual acuity improved in five (50%) cases., Conclusion: Good results (80%) and improvement of the visual acuity (50%) were observed with the use of intravitreous liquid perfluorocarbon as short-term tamponade in the postoperative period in patients with retinal detachments due to giant tears.

Mitomycin C is an antimetabolite agent that blocks DNA and RNA replication and protein synthesis. It has been used in several ophthalmologic areas, and recently as a modulator of corneal wound healing in excimer laser surgeries. A single application of mitomycin C during surface corneal photoablative surgery seems a safe and efficient therapeutic option for eyes with corneal opacity and/or as prophylaxis in eyes with high risk for corneal opacity development. The use of this drug in photoablative surgery should be cautious until long-term safety results have been reported. The present text presents a review about corneal wound healing with the use of mitomycin C.

The advantage of high-speed time-of-flight-mass spectrometry (TOF-MS) detection for ultrafast qualitative supercritical fluid chromatography/mass spectrometry (SFC/MS) applications allows the superior resolving power of SFC to be exploited in high-throughput analysis. A chromatographic comparison of quadrupole MS and TOF-MS shows high-speed TOF total ion current data point sampling to be more indicative of fast SFC separations and corresponding short (1-2 s) baseline peak widths. Results shown for analysis of a six-compound mixture with two peaks eluting at 0.86 and 0.89 min exhibit >50% resolution by high-speed TOF data sampling, whereas the same peaks appear to coelute using quadrupole MS data sampling. Additionally, a marked improvement in the peak baseline widths is afforded by fast TOF data acquisition of 0.1 s/spectrum, resulting in a reduction in the baseline width, 1.6 s, of sulfanilamide in a four-compound mixture that is more than 2-fold greater than that achieved at the slower data acquisition of 0.5 s/spectrum. The resulting increase in resolution and improved peak shapes allow automatic integration routines to perform more effectively. For most classes of compounds amenable to high performance liquid chromatography, including druglike species, steroids, and polymers, the union of SFC with TOF-MS provides the maximum density of chemical information per unit time available with any high-speed chromatographic/mass spectrometric method.

Rio de Janeiro State has one of the largest networks of psychiatric hospitals in Brazil, one of them the Dr. Eiras Paracambi Hospital (CSDE-P). In late 2000, the current Mental Health Advisory Division of the Rio de Janeiro State Health Department conducted a clinical and psychosocial census of patients hospitalized in the CSDE-P. The hospital population consisted of 1,494 individuals, the majority men (53.4%), single (81.6%), working-age (66.4%), and with limited schooling (only 11.5% with a complete primary education or more). Most had been in hospital for at least two years (77.6%), received visits from relatives (60.5%), but did not have hospital leave (73.8%). The predominant diagnoses were schizophrenia (53.6%) and mental retardation (26.4%). The main therapeutic approach was psychiatric (84.1%). Only 13.3% took part in systematic activities during the day, although 36% were in a condition to do so. CSDE-P is a mega-hospital where most patients have precarious social links, demanding treatment strategies which take this characteristic into account.

A supercritical fluid chromatograph was previously interfaced to a mass spectrometer (SFC/MS) and the system evaluated for applications requiring high sample throughput using negative-mode atmospheric-pressure chemical ionization (APCI) (Ventura et al. Anal. Chem. 1999, 71, 2410-2416). This report extends the previous work demonstrating the effectiveness of SFC/MS, using positive ion APCI for the analysis of compounds with a wide range of polarities. Substituting SFC/MS for LC/MS results in substantial time saving, increased chromatographic efficiency, and more precise quantitation of sample mixtures. Flow injection analysis (FIA) also benefits from our SFC/MS system. A broader range of solvents is compatible with the SFC mobile phase compared with LC/MS, and solutes elute more rapidly from the SFC/MS system, reducing sample carryover and cycle time. Our instrumental setup also allows for facile conversion between LC/MS and SFC/MS modes of operation.

Coronary microvascular spasm and platelet hyperreactivity have been implicated in the pathogenesis of Chagas' cardiomyopathy. To clarify further the role of the microvasculature in this disease, alterations in cytokine gene expression due to Trypanosoma cruzi infection of human umbilical vein endothelial cells were examined. Northern blot analysis of total RNA from endothelial cells demonstrated that interleukin (IL)-1 beta, IL-6, and colony-stimulating factor 1 (CSF-1) mRNA expression was absent or minimal in uninfected cells but significantly increased in infected cells. c-sis mRNA levels diminished with increased time of infection. In situ hybridization studies also demonstrated high levels of IL-6 mRNA in individual infected cells. Significant levels of IL-6 and IL-1 beta protein were detected in the supernatants of infected endothelial cells. The serum of an acutely infected individual contained high levels of IL-6 protein, suggesting the potential importance of cytokines secreted by the vascular endothelium in the pathogenesis of Chagas' cardiomyopathy.

In order to optimize the results of kidney transplant, i.e. patient's acceptance and speedy recovery, the available organ resources must be combined with appropriate "preparation" of the patient's mental state. In order to plot the "mental deterioration curve" of patients on a hemodialysis program, the present study was made on 62 patients in a general hospital in Spain. The possible repercussions of treatment of kidney disease on intellectual (Weschler's Adult Intelligence Scale-WAIS test) and perceptive (Benton test) capacity were investigated. Samples were grouped according to whether they had been on dialysis for up to four years (less than 4) or more than four years (greater than 4). The WAIS test for the greater than 4 group indicated a lower I.Q. These results indicated that it was after four years on dialysis that greater negative effects began to be seen in perceptive-intellectual capacity. The Benton test indicated that time on hemodialysis adversely affected the patient's capacities. A sharp decline was seen particularly between two and four years in the less than 4 group, suggesting that patients' mental conditions vary with time on dialysis but that their resources and capacities are still fairly untroubled by the treatment in the first two years. In the light of these findings, the deterioration curve should be taken into account when planning kidney transplant, in order to take advantage of the initial period if possible.

Among 1,142 patients who underwent total correction of tetralogy of Fallot from May of 1960 to december of 1986, five (0.43%) presented refractory cardiac failure. Pre and postoperative control was based on symptoms and clinical signals, electrocardiogram, conventional radiographies, cardiac catheterism, cineangiocardiography, and necropsy in one case. The evolution in immediate and late postoperative periods were not good. One patient deceased in the first day after surgery: the others had complications as severe pulmonary insufficiency, diffuse and severe hypocontractibility of the right ventricle, with three late decreases. Only one patient is alive, with congestive cardiac failure hardly controllable.

Unlabelled: The object of this study was to detect the influence of time under treatment on haemodialysis on the personality. The samples are a group on haemodialysis (EXT, n = 62) and a control group (CON, n = 33). The haemodialysis patients were grouped by years under treatment (EX1 less than 4 years, and EX2 greater than 4 years). To study personality variables, the Eysenck Personality Inventory test was used. The results showed, using t test, significant differences on neuroticism (N), extraversion (E) and lie or dissimulation (L), between both experimental subgroups (N, p less than 0.01; E, p less than 0.05 and L, p less than 0.02) as well as between experimental and control groups (N, p less than 0.01; E, p less than 0.01 and L, p less than 0.001). On the experimental group (EXT) a high neuroticism (mean = 73.1) level was observed associated with a low level of extraversion (mean = 41.8) and lie or dissimulation (mean = 29.9). According to the observed results, the length of time on haemodialysis affects the groups in a different, significant way. In the EX2 it is observed that the scores decrease on the three personality dimensions, their differences being significant., Conclusions: This chronic illness places patients first on a very high level of neuroticism, as a confrontation to the stress provoked by their situation. Following this, due to the patients' awareness of their own chronic state, the level of neuroticism decreases, their high level of introversion and the absence of lie as a possible defense mechanism of denial facing their hard reality being more significant.