Ophthalmic adverse drug reactions to systemic drugs: a systematic review

PURPOSE: To perform a comprehensive and systematic review regarding ophthalmic adverse drug reactions (ADRs) to systemic drugs to: (i) systematically summarize existing evidence, (ii) identify areas, ophthalmic ADRs or drugs that lacked systematization or assessment (namely drugs with original studies characterizing specific ophthalmic ADRs but without causality assessment nor without meta-analysis). METHODS: Systematic review of several electronic databases (last search 1/7/2012): Medline, SCOPUS, ISI web of knowledge, ISI Conference Proceedings, International Pharmaceutical Abstracts and Google scholar. Search query included: eye, ocular, ophthalmic, ophthalmology, adverse and reaction. Inclusion criteria were: (i) Primary purpose was to assess an ophthalmic ADR to a systemic medication; (ii) Patient evaluation performed by an ophthalmologist; (iii) Studies that specified diagnostic criteria for an ocular ADR. Different types of studies were included and analyzed separately. Two independent reviewers assessed eligibility criteria, extracted data and evaluated risk of bias. RESULTS: From 562 studies found, 32 were included (1 systematic review to sildenafil, 11 narrative reviews, 1 trial, 1 prospective study, 6 transversal studies, 6 spontaneous reports and 6 case series). Drugs frequently involved included amiodarone, sildenafil, hydroxychloroquine and biphosphonates. Frequent ophthalmic ADRs included: keratopathy, dry eye and retinopathy. CONCLUSIONS: To increase evidence about ophthalmic ADRs, there is a need for performing specific systematic reviews, applying strictly the World Health Organization's (WHO) definition of ADR and WHO causality assessment of ADRs. Some ophthalmic ADRs may be frequent, but require ophthalmological examination; therefore, ophthalmologists' education and protocols of collaboration between other specialties whenever they prescribe high-risk drugs are suggestions for the future

Papel da análise discriminante no aprimoramento da avaliação da satisfação dos usuários

OBJECTIVE: To test discriminant analysis as a method of turning the information of a routine customer satisfaction survey (CSS) into a more accurate decision-making tool. METHODS: A 7-question, 10-multiple choice, self-applied questionnaire was used to study a sample of patients seen in two outpatient care units in Valparaíso, Chile, one of primary care (n=100) and the other of secondary care (n=249). Two cutting points were considered in the dependent variable (final satisfaction score): satisfied versus unsatisfied, and very satisfied versus all others. Results were compared with empirical measures (proportion of satisfied individuals, proportion of unsatisfied individuals and size of the median). RESULTS: The response rate was very high, over 97.0% in both units. A new variable, medical attention, was revealed, as explaining satisfaction at the primary care unit. The proportion of the total variability explained by the model was very high (over 99.4%) in both units, when comparing satisfied with unsatisfied customers. In the analysis of very satisfied versus all other customers, significant relationship was identified only in the case of the primary care unit, which explained a small proportion of the variability (41.9%). CONCLUSIONS: Discriminant analysis identified relationships not revealed by the previous analysis. It provided information about the proportion of the variability explained by the model. It identified non-significant relationships suggested by empirical analysis (e.g. the case of the relation very satisfied versus others in the secondary care unit). It measured the contribution of each independent variable to the explanation of the variation of the dependent one.OBJETIVO: Testar a análise discriminante como um método de transformar a informação obtida num inquérito de satisfação dos usuários de rotina numa acurada ferramenta de tomada de decisão. MÉTODOS: Utilizou-se questionário auto-aplicável com sete questões de dez opções numa amostra dos pacientes atendidos em duas unidades ambulatórias públicas, em Valparaíso, Chile, sendo uma de cuidados primários (n=100) e a outra de atenção secundária (n=249). Utilizaram-se dois pontos de corte na variável dependente (índice final de satisfação): satisfeitos vs insatisfeitos e muito satisfeitos vs os demais. Os resultados foram comparados com medidas empíricas habitualmente utilizadas (proporção de satisfeitos, proporção de insatisfeitos e dimensão da mediana). RESULTADOS: O nível de resposta foi muito elevado (sempre acima de 97,0%). Uma variável adicional revelou-se (atendimento médico), explicando a satisfação com o atendimento na unidade primária. Ao comparar satisfeitos com insatisfeitos, a proporção total da variabilidade explicada pelo modelo foi muito elevada (acima de 99,4%) em ambas unidades. Ao comparar muito satisfeitos com os demais, observou-se relação significativa apenas no caso da unidade primária. Explicou-se uma baixa proporção da variabilidade (41,9%). CONCLUSÕES: A análise discriminante revelou relações não percebidas pela análise empírica e indicou a proporção exata da variabilidade explicada pelo modelo utilizado. A técnica afastou como não significativas relações sugeridas pela análise empírica (por exemplo, muito satisfeitos versus os demais no caso da unidade secundária). A técnica permitiu medir a intensidade da contribuição de cada variável na explicação da variação da satisfação

The deformation of metal powder particles: Hardness and microstructure

© 2017 The Authors. Published by Elsevier Ltd. The modelling of powder densification requires knowledge about the material properties of the particles. Some models use the material properties of the material in bulk as inputs for modelling the densification of assemblies of powder particles. It is important to understand how these properties differ when the material is in powder form. Existing works tend to analyse bulk material or powder exclusively and rarely compare properties such as hardness between the two. This work compares the microstructures and hardness of metal powder with bulk material with the aim of guiding the assumptions made in the modelling of metal powder densification. It is expected that the rapid solidification typical in the atomisation of metals results in significant differences in behaviour when compared with material produced via casting and hot/cold working

Púrpura de Henoch-Schönlein Associada a Adenocarcinoma do Pulmão

Introduction: The Henoch-Schönlein purpura (HSP) is an immunoglobulin A (IgA)-mediated smallvessel systemic vasculitis, rare in adults. The association with solid tumours has been described, especially with lung cancer. Case Report: We present the case of a 60-year-old Caucasian male, diagnosed with lung adenocarcinoma that underwent surgical resection without (neo)adjuvant theraphy. Two months latter he was admitted for abdominal pain, purpuric rash on his lower extremities and acute kidney injury, with serum creatinine (Scr) of 2 mg/dl. Urinalysis revealed haematuria and 24h proteinuria (P24h) of 1.5 g. The serum protein electrophoresis, complement components C3 and C4, circulating immune complexes, cryoglobulins, ANCA, ANA, anti-dsDNA and the remaining immunologic study as screening for viral infections (HCV, HBV and HIV) were negative. Renal ultrasound was normal and kidney biopsy revealed mild mesangial proliferation; 2 cellular glomerular crescents and 1 fibrinoid necrosis lesion; large amounts of red blood cell casts; lymphocytic infiltration in the intertubular interstitial capillaries; moderate arteriolar hyalinosis. Immunofluorescence demonstrated mesangial and parietal deposits of IgA. The diagnosis of HSP was assumed, and the patient started prednisolone 1 mg/kg/day. Ten months after diagnosis the patient’s baseline Scr is 1.4 mg/dl with P24h of 0.18g, without haematuria. Conclusion: Although this is a rare association and the exact mechanism behind the disease is yet unknown, physicians should be aware of it. The early recognition and treatment may prevent renal disease progression

Chylothorax in the neonate-A stepwise approach algorithm

Background: Chylothorax in neonates results from leakage of lymph from thoracic lymphatic ducts and is mainly congenital or posttraumatic. The clinical course of the effusion is heterogeneous, and consensus on treatment, timing, and modalities of measures has not yet been established. This review aims to present, along with levels of evidence and recommendation grades, all current therapeutic possibilities for the treatment of chylothorax in neonates. Methods: An extensive search of publications between 1970 and 2020 was performed in the PubMed, Cochrane Database of Systematic Reviews, and UpToDate databases. A stepwise approach algorithm was proposed for both congenital and traumatic conditions to guide the clinician in a rational and systematic way for approaching the treatment of neonates with chylothorax. Discussion and conclusion: The treatment strategy for neonatal chylothorax generally involves supportive care and includes drainage and procedures to reduce chyle flow. A stepwise approach starting with the least invasive method is advocated. Progression in the invasiveness of treatment options is determined by the response to previous treatments. A practical stepwise approach algorithm is proposed for both, congenital and traumatic chylothoraces

May measurement month 2018: an analyses of blood pressure screening results from Cabo Verde.

Raised blood pressure (BP) is the biggest contributor to mortality and disease burden in Cabo Verde. May Measurement Month (MMM) is a global campaign set up in 2017 to raise awareness of high BP. In 2018, we aimed to expand the campaign by including a greater number of centres to increase awareness. Nine islands participated in MMM 2018. Volunteers (≥18 years) were recruited through opportunistic sampling at a variety of screening sites. Each participant had three BP measurements and completed a questionnaire on demographic, lifestyle, and environmental factors. Hypertension was defined as a systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg, or taking antihypertensive medication. In total, 98.0% of screenees provided three BP readings and multiple imputation using chained equations was used to impute missing readings. A total of 8008 individuals (mean age 40.4 years; 68.5% female) were screened. After multiple imputation, 2666 (33.3%) individuals had hypertension, of whom 74.8% were aware of their previous diagnosis and 55.8% were taking antihypertensive medication. Of those on medication, 39.1% were controlled and of all hypertensives, 21.8% were controlled. We detected 44.2% of individuals with untreated hypertension and 60.9% of treated individuals were inadequately treated. The Cape Verdean population is ageing and consequently cardiovascular disease is increasing, with hypertension being an important risk factor. Corrective actions need to be taken by the government. MMM is an ideal initiative to reach the public by raising awareness of this major cardiovascular risk factor

Molecular Responses of Mussel Mytilus galloprovincialis Associated to Accumulation and Depuration of Marine Biotoxins Okadaic Acid and Dinophysistoxin-1 Revealed by Shotgun Proteomics

The molecular pathways behind the toxicity of diarrheic shellfish toxins (DSTs) in bivalves have been scarcely studied. Thus, a shotgun proteomics approach was applied in this work to understand bivalves’ molecular responses to the dinoflagellate Prorocentrum lima (1.0 × 106 cells/L). Protein expression along with toxins levels were analyzed in the gills and digestive gland of the mussel Mytilus galloprovincialis during and after exposure to this toxic strain. Results revealed an accumulation of OA and DTX1 only in the digestive gland with maximum amounts attained at the end of uptake phase (day 5; 2819.2 ± 522.2 µg OA/kg and 1107.1 ± 267.9 µg DTX1/kg). At the end of the depuration phase (day 20), 16% and 47% of total OA and DTX1 concentrations remained in the digestive gland tissues, respectively. The shotgun proteomic analyses yielded 3051 proteins in both organs. A total of 56 and 54 differentially expressed proteins (DEPs) were revealed in the digestive gland and gills, respectively. Both organs presented the same response dynamics along the experiment, although with tissue-specific features. The early response (3 days uptake) was characterized by a high number of DEPs, being more marked in gills, in relation to the latter time points (5 days uptake and depuration). Functional enrichment analysis revealed the up-regulation of carboxylic (GO:0046943) and organic acid transmembrane transporter activity (GO:0005342) pathways after 3 days uptake for digestive gland. Matching to these pathways are a group of proteins related to transmembrane transport and response to toxic substances and xenobiotics, namely P-glycoprotein (ABCB11), Sodium-dependent proline transporter (SLC6A7), and Sideroflexin-1 (SFXN1). According to Clusters of Orthologous Groups (GOs) categories, most of the DEPs found for digestive gland in all time-points were related with “cellular processes and signaling” and involving signal transduction mechanisms, cytoskeleton and post-translational modification, protein turnover, chaperone functions. In gills, the early uptake phase was marked by a balance between DEPs related with “cellular processes and signaling” and “metabolism.” Depuration is clearly marked by processes related with “metabolism,” mainly involving secondary metabolites biosynthesis, transport, and catabolism. Proteomic data are available via ProteomeXchange with identifier PXD022293.This work was funded by Portuguese Science Foundation (Fundação para a Ciência e a Tecnologia, FCT) and under the Projects MOREBIVALVES (PTDC/ASP-PES/31762/2017) and by the Strategic Funding UIDB/04423/2020 and UIDP/04423/2020 through national funds provided by FCT and European Regional Development Fund (ERDF), in the framework of the program PT2020. This work had also support from the Portuguese Mass Spectrometry Network, integrated in the National Roadmap of Research Infrastructures of Strategic Relevance (ROTEIRO/0028/2013 and LISBOA-01-0145-FEDER-022125)

The postoperative venous thromboembolism (TREVO) study – risk and case mortality by surgical specialty

Introdução e objetivos: O tromboembolismo venoso, cujo risco está aumentado no doente cirúrgico, é uma causa evitável de morbimortalidade. O objetivo primário deste estudo foi estimar o risco de tromboembolismo venoso sintomático pós‐operatório global e por especialidade cirúrgica, num hospital terciário. Secundariamente, foram analisadas a gravidade e mortalidade dos eventos tromboembólicos. Métodos: Foi realizado um estudo retrospetivo para a identificação de casos de tromboembolismo venoso pós‐operatório intra‐hospitalar, codificados pela Classificação Internacional de Doenças – 9.ª revisão, pelos critérios da Joint Commission International. Foram incluídos episódios de internamento de doentes adultos, operados, no período 2008‐2012. Resultados: Em 67 635 episódios de internamento com cirurgia identificaram‐se 90 casos de tromboembolismo venoso pós‐operatório (mediana de idades: 59 anos), correspondendo a um risco de 1,33/1000 episódios (intervalo de confiança a 95% [IC95%], 1,1‐1,6/1000). A neurocirurgia apresentou maior risco (4,07/1000), seguida pela urologia e pela cirurgia geral p < 0,001. Houve 50 episódios de embolia pulmonar, dos quais 11 foram fatais. Dos 90 casos, 12,2% decorreram sob anestesia do neuro‐eixo e 55,1% em doentes em estado físico ASA III. Foi administrada dose profilática de anticoagulante injetável no pós‐operatório a, pelo menos, 37,7% dos doentes. O risco decresceu de 2008 até 2012. A mortalidade associada aos eventos de tromboembolismo venoso durante o internamento foi 21,1% (IC95%, 13,6‐30,4). Conclusões: O risco de tromboembolismo venoso sintomático pós‐operatório foi de 1,33/1000. A neurocirurgia apresentou maior risco. A mortalidade foi de 21,1%

How equal is equality? Discussions about same-sex marriage in Portugal

In Portugal, public and political discussions about same-sex marriage have been going on since the 1990s. In 2010, same-sex marriage was legalized under intense dispute since it excludes same-sex couples from adoption and reproductive rights. During parliamentary debates, political parties and civil organizations linked to the Catholic Church resorted to conflicting ideas of ‘equality’ and ‘difference’ to advance their claims. In this article, we analyse the contents of petitions, bills and parliamentary proceedings concerning the legal recognition of same-sex unions, highlighting the presence of conflicting notions of equality linked to pervasive beliefs about the inadequacy of homo-erotic desire and practices

Healthy excessive weight in Portuguese women 4years after delivery of a liveborn

OBJECTIVE: To quantify the prevalence of healthy excessive weight and determinants of metabolic profile, considering women's reproductive life. METHODS: We evaluated 1847 mothers of a birth cohort assembled after delivery and reevaluated 4years later. A healthy profile was defined as the absence of hypertension, diabetes, dyslipidemia, C-reactive protein <3mg/l and being below the second tertile of HOMA-IR. Adjusted odds ratios (OR) and confidence intervals (95% CI) were computed using multinomial logistic regression, taking women with normal BMI as the reference category of the outcome. RESULTS: Four years after delivery, 47% of women had normal BMI, 33% were overweight and 20% obese. In each BMI class, 61%, 33% and 12% presented a healthy metabolic profile, respectively. Family history of CVD/cardiometabolic risk factors was associated with a higher probability of obesity with a not healthy metabolic profile (OR=1.39 95% CI: 0.98-1.98). Women who breastfed the enrolled child for >26weeks and practiced physical exercise were less likely to be obese and metabolically unhealthy (OR=0.39 95% CI: 0.23-0.68; OR=0.48 95% CI: 0.33-0.70, respectively), with no effect on healthy excessive weight. CONCLUSIONS: These results support the existence of a healthy excessive weight phenotype in women after motherhood, influenced by anthropometrics, genetic and lifestyles characteristics