Dry eye: etiopathogenesis and treatment

Olho seco é uma doença multifatorial das lágrimas e da superfície ocular que resulta em desconforto, distúrbios visuais e instabilidade do filme lacrimal. É uma desordem comum que afeta principalmente adultos e mulheres e que pode causar impacto na qualidade de vida comparável a enxaqueca, dispnéia e insuficiência renal crônica, dependendo dos sintomas ou complicações que a acompanham. Novos conceitos com relação à fisiopatologia, classificação e tratamento têm sido apresentados e devem ser conhecidos pelos oftalmologistas pela sua larga aplicação no dia-a-dia. Estima-se que haja 100 medicações diferentes em uso para olho seco atualmente, além de outros métodos de tratamento, sendo necessário se estabelecer o que é realmente seguro e eficaz. Este texto faz uma revisão sobre etiopatogênese e tratamento da síndrome do Olho Seco.Dry eye is a multifactorial disease of tears and ocular surface that causes discomfort, visual disturbance and tear film instability. It is a common disorder that affects specially adults and women and can cause quality of life impairment comparable to migraine, shortness of breath and chronic renal insufficiency, depending on its symptoms or complications. New concepts regarding physiopathology, classification and treatment have been presented and should be known by ophthalmologists because of their relevance on day-by-day application. There are about 100 different medications currently in use for dry eye besides other methods of treatment, so it is necessary to establish what is really safe and effective for dry eye. This paper presents a review about Dry Eye Syndrome etiopathogenesis and treatment

Efeito do programa Melhor em Casa sobre os gastos hospitalares

OBJETIVO: Verificar se o programa Melhor em Casa consegue reduzir gastos com as internações hospitalares. MÉTODOS: Utilizamos como estratégia empírica um desenho de regressão descontínua, o que reduz problemas de endogeneidade de nosso modelo. Realizamos também testes de respostas heterogêneas e de robustez. Os dados da variável dependente, despesas ou gastos com internações hospitalares, foram coletados no Departamento de Informática do Sistema Único de Saúde (Datasus), usando o conjunto de microdados do Sistema de Internações Hospitalares do Sistema Único de Saúde referente ao período de 2010 a 2013, totalizando 3.609.384 observações nos três anos de análise. As covariáveis ou variáveis de controle utilizadas foram a idade e os gastos com pacientes na unidade de terapia intensiva, também coletadas no Datasus e referentes ao mesmo período. RESULTADOS: Os resultados apontam que o efeito do programa Melhor em Casa efetivamente reduziu os gastos com internações hospitalares em aproximadamente 4,7% em 2011, 5,8% em 2012 e 10,2% em 2013. CONCLUSÕES: A partir das análises, observamos que manter o programa é uma forma altamente eficaz de melhorar a gestão de recursos públicos, pois conseguiu reduzir as despesas com as internações nos três anos em análise. O programa obteve redução nas despesas com internação dos grupos de risco e também em situações que elevam as despesas hospitalares, como falta de equipamentos e internações eletivas. Assim, pode-se afirmar que o programa consegue reduzir as despesas com as internações, principalmente nos grupos com maior vulnerabilidade, mostrando-se eficiente como política pública.OBJECTIVE: To verify if the Melhor em Casa program can actually reduce hospitalization costs. METHODS: We use as an empirical strategy a Regression Discontinuity Design, which reduces endogeneity problems of our model. We also performed tests of heterogeneous responses and robustness. Data on the dependent variable, namely hospitalization costs, were collected in the Department of Informatics of the Unified Health System (DATASUS), using the microdata set from the Hospital Admissions System of the Unified Health System (SUS) from 2010 to 2013, totaling 3,609,384 observations. The covariates or control variables used were age and costs with patients in the intensive care unit, also from DATASUS. RESULTS: The results point out that the Melhor em Casa program effectively reduced hospitalization costs by approximately 4.7% in 2011, 5.8% in 2012 and 10.2% in 2013. CONCLUSIONS: Based on the analyses, we observed that maintaining the program can effectively improve the management of public resources, since it reduced the hospitalization costs in the three years studied. The program reduced hospitalization costs of risk groups and also in situations that usually increase hospital costs such as lack of equipment and elective hospitalizations. Thus, it can be affirmed that the program can reduce hospitalization costs, especially in risk and more vulnerable groups, showing efficiency as a public policy

Extendiendo BPMN2 para soportar workflows científicos de ESTECO

En la última década, los procesos de negocio han adquirido gran popularidad, y derivado de ello han surgido diversos estudios al respecto. Un proceso de negocio es un conjunto de actividades coordinadas, diseñadas para producir una salida específica. Por otra parte, la empresa ESTECO tiene una amplia experiencia en el ámbito de workflows de ingeniería aplicada en el contexto industrial. ESTECO utiliza un modelo de workflow propietario que ha demostrado ser útil en el contexto de procesos de ingeniería. Si bien el modelo propietario cubre las necesidades actuales, el uso de un estándar permitiría claramente construir modelos de manera unificada. Hay numerosos estándares para el modelado de procesos de negocios, pero por lo general no son directamente aplicables al ámbito de procesos de ingeniería o computación científica. BPMN (Business Process Model and Notation) es un estándar clave en el modelado de procesos de negocio. Su notación gráfica muestra las distintas etapas de un proceso de negocio. Además su metamodelo está diseñado para ser extensible, esto permite extenderlo manteniendo la compatibilidad. La última versión del estándar ha sido desarrollada teniendo en cuenta algunas limitaciones y dándole mayor importancia a los objetos de datos persiguiendo el objetivo de poder interpretar y ejecutar directamente los modelos.Eje: Ingeniería de SoftwareRed de Universidades con Carreras en Informática (RedUNCI

Evaluation of the microleakage of restorative materials in deciduous teeth

Analisou-se a infiltração marginal nas paredes cervical e oclusal de cavidades classe V, preparadas na face vestibular de 40 caninos decíduos extraídos e restauradas com os materiais Chelon-Fil, Vitremer, Compoglass-F e Z100. Compararam-se ainda dois métodos de avaliação da penetração do corante no teste de infiltração: escore e medida linear até a parede da câmara pulpar. Os espécimes passaram por ciclagem térmica de 500 ciclos nas temperaturas de 5 e 55ºC, foram imersos em solução de fucsina básica a 0,5% por 24 horas e seccionados para visualização da infiltração marginal nas paredes cervical e oclusal. Observou-se que o Chelon-Fil apresentou maior grau de infiltração que os demais materiais. Vitremer, Compoglass-F e Z100 apresentaram infiltração semelhante. O Chelon-Fil e o Vitremer apresentaram infiltração maior na parede cervical que na oclusal, fenômeno este que não ocorreu com o Compoglass-F e a Z100, que apresentaram infiltração semelhante em ambas as paredes. Não houve diferença entre os métodos de avaliação da penetração do corante (p < 0,01).The microleakage of Chelon-Fil, Vitremer, Compoglass-F and Z100 was evaluated in deciduous teeth. Class V restorations were placed in the buccal aspect of 40 extracted primary canines; they were thermocycled, and immersed in 0.5% basic fuchsin. Three slices of each tooth were obtained in order to analyze the penetration of dye in the gingival and occlusal walls, under magnification of 40 X. The results showed that Chelon-Fil had the highest degree of marginal leakage. Vitremer, Compoglass-F and Z100 presented similar penetration of dye. The microleakage of Chelon-Fil and Vitremer was greater in the gingival wall than in the occlusal wall. Microleakage was the same in both gingival and occlusal walls when cavities were filled, either with Z100 or with Compoglass-F

Métodos alternativos para estimar a velocidade da máxima fase estável de lactato em adultos jovens fisicamente ativos

The aim of this study was to compare the velocities found in the protocols used to measure the indirect individual anaerobic threshold (IATind), glucose threshold (GT) and critical velocity (CV) with the gold standard, the maximum lactate steady state (MLSS) protocol. Fourteen physically active young adults (23±3.1 years; 72±10.97 kg; 176±7 cm; 21±5.36% body fat) performed a 3000-m track running test to determine IATind using the prediction equation and an incremental test on a treadmill to determine GT. The CV was identified by linear regression of the distance-time relationship based on 3000-m and 500-m running performance. The MLSS was identified using two to five tests on different days to identify the intensity at which there was no increase in blood lactate concentration greater than 1 mmol/L between the 10th and 30th minute. A significant difference was observed between mean CV and MLSS (P≤0.05) and there was a high correlation between MLSS and IATind (R2=0.82; P≤0.01) and between MLSS and GT (R2=0.72; P≤0.01). The Bland-Altman method showed agreement between MLSS and IATind [mean difference -0.24 (confidence interval -1.72 to 1.24) km/h] and between MLSS and GT [0.21 (-1.26 to 1.29) km/h]. We conclude that the IATind and GT can predict MLSS velocity with good accuracy, thus making the identification of MLSS practical and efficient to prescribe adequate intensities of aerobic exercise.O objetivo do presente estudo foi comparar as velocidades encontradas nos protocolos de Limiar Anaeróbio Individual Indireto (LAIind), Limiar Glicêmico (LG) e Velocidade Crítica (VC) com o padrão ouro, o protocolo de identificação da máxima fase estável do lactato (MFEL). Participaram 14 adultos jovens fisicamente ativos (23±3,1 anos; 72±10,97 kg; 1,76±0,07 m; 21±5,36 % gordura corporal) que realizaram um teste de 3000m em pista para determinar o LAIind através de equação de predição; teste incremental em esteira ergométrica para determinação do LG; a VC foi identificada por regressão linear através da relação distância-tempo com base no desempenho em corridas nas distâncias de 3.000m e 500m; a MFEL foi identificada utilizando de dois a cinco testes em dias distintos até encontrar a intensidade onde não houve aumento da concentração de lactato sanguíneo maior que 1 mmol.L-1 entre os minutos 10 e 30. Houve diferença estatística entre os valores médios da VC e a MFEL (P≤0,05), elevada correlação entre MFEL e LAIind (R2=0,82; P≤0.01) e MFEL e LG (R2=0,72; P≤0.01). Através do método Bland-Altman foram encontradas as concordâncias entre MFEL e LAIind [diferença média -0,24 (intervalo de confiança -1,72 a 1,24) km/h] e MFEL e LG [0,21 (-1,26 a 1,29) km/h]. Concluímos que o LAIind e o LG são testes que podem predizer com boa precisão a velocidade da MFEL, tornando sua identificação prática e eficiente para prescrição de intensidades adequadas para o treinamento aeróbio.Universidade Federal de São Paulo (UNIFESP)Faculdade Anhanguera de BauruUniversidade Federal de São Paulo (UNIFESP) Departamento de Ciências do Movimento HumanoUNIFESP, Depto. de Ciências do Movimento HumanoSciEL

DNA microarrays to identify etiological agents, as sensors of environmental wellbeing

Background: The epidemiologic transition in Mexico has generated a change of paradigm in public health. Morbidity is characterized by infectious diseases and the mortality is due to chronic degenerative diseases. The three most important infectious diseases in the country are: respiratory infections, diarrhea, and urinary tract infections.Method: The objective of this work was to build a tool to monitor the presence of health risks in the environment in a timely manner and to demonstrate its application in different sicknesses, especially those that are water related. In this study, we analyzed water samples from five cenotes with high tourist flow in the State of Yucatan. We developed a DNA microarray for the adequate and prompt detection of viruses, bacteria, fungi, and parasites. This microarray could be used in samples of different origin including air, water (fresh, brackish and saltwater), food, inert surfaces or wounds. Clinically, it would allow prompt and precise detection of etiological agents of infectious diseases to prevent outbreaks. It would also be useful for the identification of those agents that cannot be detected in our laboratories with the traditional methods. It includes 38,000 probes that detect 252 etiological agents of diseases in humans and antimicrobial resistance genes. Results from DNA samples can be obtained in 24 h, which would be difficult or impossible using other technologies.Results: The results are readily available within 24 h. Samples from five cenotes (sinkholes) with high flow of people, were analyzed with the microarray. The water samples analyzed detected 228 different bacteria, viruses, fungi, and protozoa. They are amongst the most important etiological agents for infectious diseases in Mexico.Conclusions: The microarray provides the opportunity for precise and early detection of various infectious agents in individuals, hospitals and natural environments. This could help reduce the global burden of diseases, the severity of outbreaks, and reduce antibiotic resistance

The ITASAT – The Lessons Learned from the Mission Concept to the Operation

The ITASAT Project was initiated as an effort of the Brazilian Space Agency (AEB), the Technological Institute of Aeronautics (ITA) and the National Institute of Space Research (INPE) to train human resources to the Aerospace sector due to the lack of experience of the students in practical projects in the aerospace segment in Brazil. In this effort students were challenged to design, build and operate a satellite in a hands-on project. Along the project years several changes happened on the satellite configuration, going through a 100 kg satellite to a 6U CubeSat and this last configuration was designed, assembled and tested. In December ITASAT was launched and since its launch has been tracked and operated by the ground operation team. In this paper we will discuss the lessons learned during the project, since the decision to change the satellite size and re-thinking the scope of the project objectives, focusing on system engineering, Assembly Integration and Testing (AIT), Verification and Validation (V&V) and ground operations. The paper will present the challenges of the group of students in this hands-on project, the mistakes and hits along the project phases

Hospitais: espaços de cura e lugares de memória da saúde

O presente artigo pretende analisar o Hospital Gaffrée e Guinle, construído na década de 1920, na cidade do Rio de Janeiro, em um processo de tomada de controle, pela administração pública, da gestão da assistência hospitalar na capital federal. Esse hospital representa o encontro da filantropia com um projeto de saúde pública posto em prática no Distrito Federal à mesma época. A instituição sintetiza também o desenvolvimento da medicina e sua tradução na arquitetura hospitalar, bem como a efervescência intelectual do período, mais especificamente das idéias nacionalistas, interpretadas tanto na escolha do estilo arquitetônico - o neocolonial - quanto na questão da salvação da raça através do combate e controle da sífilis.This paper analyzes the Gaffrée & Guinle Hospital, built in Rio de Janeiro during the 1920s as the result of a process whereby the government took over the management of hospital care in the federal capital. The hospital is the point of convergence between philanthropy and a public healthcare project implemented in the Federal District at that time. It also synthesizes the development of medicine and how the latter translates into hospital architecture, as well as the intellectual effervescence at the time, more specifically the nationalist ideas which can be identified both in the choice of architectural style - namely the neocolonial - and in the theme of salvation of a race through the combat and control of syphilis

Prophylactic Clipping After Colorectal Endoscopic Resection Prevents Bleeding of Large, Proximal Polyps: Meta-Analysis of Randomized Trials

Background & Aims The benefits of prophylactic clipping to prevent bleeding after polypectomy are unclear. We conducted an updated meta-analysis of randomized trials to assess the efficacy of clipping in preventing bleeding after polypectomy, overall and according to polyp size and location. Methods We searched the Medline/PubMed, EMBASE, and Scopus databases randomized trials that compared effects of clipping vs not clipping to prevent bleeding after polypectomy. We performed a random-effects meta-analysis to generate pooled relative risks (RRs) with 95% CIs. Multilevel random-effects meta-regression analysis was used to combine data on bleeding after polypectomy and estimate associations between rates of bleeding and polyp characteristics. Results We analyzed data from 9 trials, comprising 7197 colorectal lesions (22.5% 20 mm or larger, 49.2% with proximal location). Clipping, compared with no clipping, did not significantly reduce the overall risk of post-polypectomy bleeding (2.2% with clipping vs 3.3% with no clipping; RR, 0.69; 95% CI, 0.45–1.08; P=.072). Clipping significantly reduced risk of bleeding after removal of polyps that were 20 mm or larger (4.3% had bleeding after clipping vs 7.6% had bleeding with no clipping; RR, 0.51; 95% CI, 0.33–0.78; P=.020) or that were in a proximal location (3.0% had bleeding after clipping vs 6.2% had bleeding with no clipping; RR, 0.53; 95% CI, 0.35–0.81; P<.001). In multilevel meta-regression analysis that adjusted for polyp size and location, prophylactic clipping was significantly associated with reduced risk of bleeding after removal of large proximal polyps (RR, 0.37; 95% CI, 0.22–0.61; P=.021) but not small proximal lesions (RR, 0.88; 95% CI, 0.48–1.62; P=0.581). Conclusions In a meta-analysis of randomized trials, we found that routine use of prophylactic clipping does not reduce risk of post-polypectomy bleeding, overall. However, clipping appeared to reduce bleeding after removal of large (more than 20 mm), proximal lesions