Refractive, biometric and corneal topographic parameter changes during 12 months of orthokeratology

Background The aim of this study was to monitor refractive, topographic and biometric changes in Singaporean myopic children fitted with orthokeratology over a period of 12 months. Methods Data from 62 myopic eyes from an Asian population corrected with orthokeratology were retrospectively collected from an optometric clinic in Singapore. Anterior segment parameters were analysed with a Pentacam. Axial length was measured using the IOLMaster and refraction was assessed by subjective examination before the treatment and after one night, one week, and one, three, six and 12 months. A logistic regression model was built to evaluate the probability of slower (= 0.10 mm/year). Results Subjects had a mean age of 12.2 +/- 3.9 years (range 5-19 years), and 71 per cent were female. Baseline myopia was -3.95 +/- 1.59 D (range -1.50 and -8.75 D). Statistically significant differences were found after 12 months of treatment for refractive error, parameters of the central anterior corneal surface (curvature and elevation) and central corneal thickness. Topographic and thickness changes stabilised after one week of treatment. During 12 months of orthokeratology treatment there was a significant increase of axial length (difference = 0.11 +/- 0.18 mm, p < 0.001) while refraction remained stable. Changes in axial length of subjects above 11 years were not statistically significantly independent of the baseline myopia, and in subjects with baseline myopia greater than 4.00 D. Logistic regression showed that each additional year of age and each additional dioptre of baseline myopia decreased the probability of faster axial elongation (odds ratio [OR] = 1.23, 2.19 95% CI; OR = 1.08, 3.47 95% CI, respectively). Conclusion Corneal parameters in orthokeratology treatment were stable after one week, particularly for myopes under 4.00 D. Axial length did not change significantly in children older than 11 years of age or in subjects with myopia above 4.00 D undergoing orthokeratology treatment.- (undefined

Reproducibility and construct validity of three non-invasive instruments for assessing the trunk range of motion in patients with low back pain

Mismo con una gran variabilidad de métodos e instrumentos disponibles para evaluar la amplitud de movimiento de la columna, son raros los métodos cuantitativos precisos de mensuración. El objetivo de eso estudio fue verificar la reproductibilidad intra- e inter-examinadores y validad del constructo entre medidas de amplitud de movimiento de la columna en pacientes con dolor en la región lumbar, las cuales fueron obtenidas con los instrumentos goniómetro, inclinómetro y electrogoniómetro. La reproductibilidad y validad del constructo de instrumentos fueron testadas en 58 pacientes con dolor en la región lumbar en un diseño de test y re-test, en la línea de base y después de 24 a 72 horas. Todos los instrumentos presentaron buena correlación entre sí (r>;0,60), lo que reflete buena validad del constructo, y tuvieron buenos niveles de confiabilidades inter- e intra-examinadores. Entre todos los movimientos evaluados, el inclinómetro presentó un error absoluto inter- e intra-examinador que varió del 6,20 al 7,52 y 6,75 al 11,89 grados; y lo goniómetro mostró uno del 15 al 7,85 y 2,83 al 8,06 grados; y lo electrogoniómetro con uno entre 3,27 al 16,42 y 2,72 al 8,06 grados. Por lo tanto, los instrumentos aplicados pueden ser considerados con buenos niveles de validad del constructo y reproducibles para evaluación de la amplitud de movimiento en pacientes con dolor en la región lumbar.Although there is a wide variety of methods and instruments aiming to assess the trunk range of motion, there is uncertainty regarding their construct validity and reproducibility. The objective of this study was to verify the construct validity and intra and inter-rater reproducibility of the goniometer, inclinometer and electrogoniometer in measuring the trunk range of motion in patients with history of low back pain. The measurement properties of reliability, agreement and construct validity were tested in 58 patients with low back pain using a test-retest design at baseline and after 24 to72 hours. All instruments showed good construct validity (r>;0.60) as well as good levels of intra and inter-rater reliability with measurement errors ranging from 2.83 to 16.42 degrees. Among the assessed movements, the inclinometer, goniometer and electrogoniometer instruments can be considered as having good levels of construct validity and reproducibility for the assessment of trunk range of motion in patients with low back pain.Apesar da grande variabilidade de métodos e instrumentos disponíveis para avaliar a amplitude de movimento da coluna, são escassos os métodos quantitativos precisos de mensuração. O objetivo do estudo foi verificar a reprodutibilidade intra e interexaminadores e a validade de construto entre as medidas de amplitude de movimento da coluna em pacientes com dor lombar, obtidas com os instrumentos goniômetro, inclinômetro e eletrogoniômetro. A reprodutibilidade e a validade do construto dos instrumentos foram testadas em 58 pacientes com dor lombar num delineamento de teste-reteste, na linha de base e após 24 a 72 horas. Todos os instrumentos apresentaram boa correlação entre si (r>;0,60), refletindo boa validade do construto, e obtiveram bons níveis de confiabilidades inter e intraexaminadores. Entre todos os movimentos avaliados, o inclinômetro apresentou um erro absoluto inter e intraexaminador que variou de 6,20 a 7,52 e 6,75 a 11,89 graus respectivamente; o goniômetro mostrou um erro de 3,15 a 7,85 e 2,83 a 8,06 graus, respectivamente; e o eletrogoniômetro, entre 3,27 a 16,42 e 2,72 a 8,06 graus, respectivamente. Dessa forma, todos os instrumentos utilizados podem ser considerados com bons níveis de validade do construto e reprodutíveis para avaliação da amplitude de movimento em pacientes com dor lombar

Avaliação do emprego de sistemas GNSS RTK nas reduções batimétricas em sondagens multifeixe / Evaluation of the use of GNSS RTK systems in bathymetric reductions in multibeam soundings

O processo de coleta de dados geoespaciais para a Hidrografia, vem progressivamente sendo beneficiado pela viabilidade do uso de sistemas diferenciais de posicionamento GNSS (Global Navigation Satellite System) em tempo real, sejam eles empregados juntamente com equipamentos robustos a bordo de embarcações tripuladas, ou mesmo embarcados em ASVs (Autonomous Surface Vehicles). Este artigo apresenta testes executados em uma área de estudos da Marinha do Brasil, para avaliar as diferenças entre a utilização do sistema topocêntrico dos marégrafos referenciado ao geoide e do sistema geocêntrico global empregado nas observações GNSS, por meio do método de posicionamento RTK (Real Time Kinematic) em batimetria multifeixe. A coleta dos dados foi feita em duas áreas, uma próxima e outra mais afastada do marégrafo da Ponta da Armação na DHN (Diretoria de Hidrografia e Navegação). Foram feitas comparações com os marégrafos da Ponta da Armação, Ilha Fiscal e Boqueirão sendo gerados modelos hidrodinâmicos com transferência e fixação do nível da água para o elipsoide. Na metodologia utilizada foram realizadas comparações entre todos os modelos em função dos levantamentos utilizando a aplicação dos marégrafos e da diferença de nível gerada pela altura geométrica da embarcação fornecida pelo receptor GNSS a bordo em relação à linha d’água. Esta pesquisa permitiu validar a técnica de levantamento RTK que pode potencialmente ser utilizada em áreas onde os dados locais não existem ou são difíceis de se obter.

Paraneoplastic Hypercalcemia Secondary to Canine Mammary Tumors

Background: Paraneoplastic syndromes are complexes symptom that occur at a distinct site from the primary tumor or its metastasis by the production of hormone by the tissue in which the tumor appears. Paraneoplastic hypercalcemia is associated with an abnormal elevation of serum calcium levels and the mainly tumor related to this syndrome in canine is lymphoma, anal sac apocrine gland adenocarcinoma and multiple myeloma. In mammary tumors, the most frequent tumor that affect female dogs, this syndrome was also observed. The aims of this study were to evaluate serum calcium levels in female dogs with malignant mammary tumors and correlate calcium levels with clinicopathological parameters.Materials, Methods &amp; Results: It was evaluated fifty-one female dogs with mammary carcinomas (simple carcinomas and carcinoma in mixed tumors) for serum calcium levels using colorimetric test. Clinical-histopathological data as spray status, pseudopregnancy, tumor size, ulceration, clinical staging, histopathological type and tumor grade were also evaluated in association with serum calcium levels. All dogs were treated with unilateral mastectomy. It was observed that 18 animals (35%) had calcium serum levels increased (&gt;11.5 mg/dL) and 56% (10/18 cases) of these animals had serum calcium levels higher than 12 mg/dL. All dogs with hypercalcemia were asymptomatic, including two female dogs that presented the highest levels (13.43 mg/dL and 14.28 mg/dL). Hypercalcemia of malignancy was related to mammary carcinomas after the exclusion of other causes of hypercalcemia through laboratory tests (complete blood count and serum biochemistry) and abdominal ultrasound. No correlation was verified between the corrected serum calcium values with clinical and histopathological parameters evaluated.Discussion: In this study, it was observed a high incidence of paraneoplastic hypercalcemia associated with canine mammary tumors (35%). In humans, this syndrome is related in up to 10% of all patients with advanced cancer and with worse prognosis. The most frequent clinical signs of hypercalcemia are nonspecific and can be confused with other diseases, such as polyuria, polydipsia, anorexia, constipation, lethargy and weakness. The treatment of this syndrome is based on tumor resection and when necessary other treatments can be performed with fluid containing 0.9% sodium chloride, furosemide, prednisolone and calcitonin. Patients with asymptomatic or mildly symptomatic hypercalcemia (calcium levels &lt;12 mg/ dL) do not require immediate treatment. Clinical signs occur more frequently with serum calcium levels higher than 15 mg/dL. Calcium levels higher than 18 mg/dL are considered a medical emergency and the clinical signs observed are trigger seizures, cardiac arrhythmia, acute renal failure and death. Most animals of this study presented mild hypercalcemia, that could justify the absence of clinical signs related to this syndrome, and the treatment for this syndrome was the tumor removal. The high serum calcium levels did not show correlation with more aggressive tumors and poorer prognosis, conditions evaluated by histological type, tumor grade and clinical stage. The evaluation of serum calcium levels is an important clinical test to be done in female dogs with mammary tumors, besides to be an affordable and technically simple test. The clinical signs related to this syndrome are nonspecific and may be confused with other diseases commonly observed in older dogs. The data suggest that there are no correlation between serum calcium levels with aggressiveness of canine mammary tumors and with other clinical features

Is the total mixed ration the best option for feeding crossbred dairy cows using diets based on cactus cladodes on family farms?

The study aimed to evaluate the effects on the performance of lactating cows of different strategies for supplying diets based on cactus cladodes. Eight Girolando cows at 97 ?? 7.6 days into lactation, producing 12.2 ?? 0.26 kg milk/day, were assigned to 4 treatments in two 4 ?? 4 Latin squares. The feeding strategies were: total mixed ration (TMR) based on a mixture of concentrates, cactus cladodes [Opuntia stricta (Haw.) Haw.] and sugarcane (Saccharum officinarum L.) fed after milking; concentrate fed during milking with cactus cladodes and sugarcane offered later (Con/CC+SC); cactus cladodes combined with concentrate fed after milking with sugarcane offered later (CC+Con/SC); and sugarcane combined with concentrate fed after milking with cactus cladodes offered later (SC+Con/CC). Intakes of neutral detergent fiber (NDF; 4.54 ?? 0.09 kg/d) and total digestible nutrients (TDN; 9.30 ?? 0.50 kg/d) were similar (P>0.05) for all feeding strategies and there was no effect of feeding strategy on milk yield (12.2 ?? 0.26 kg/d). The different feeding strategies did not change the ingestive behavior or performance of lactating Girolando cows. Since the shortage of labor prohibits the feeding of TMRs on family farms because of labor required for preparation, these rations would be appropriate only on large farms where the costs of machines to prepare diets efficiently might be available. Cows fed concentrate during milking spent longer to consume the concentrate than the time to milk, resulting in inefficient usage of scarce labor. Appropriate feeding strategies for family farms appear to be SC+Con/CC and CC+Con/SC, i.e. partial separation of dietary ingredients, and all feeding should be done after milking

Reducing overcrowding in an emergency department: a pilot study

OBJETIVO Explorar o uso de modelos de previsão e ferramentas de simulação para estimar a demanda e reduzir o tempo de espera dos pacientes em Departamentos de Emergência (DE). METODOLOGIA A análise foi baseada em dados coletados em maio de 2013, no DE do Recanto das Emas, Distrito Federal, Brasil, que utiliza o Protocolo de Manchester como sistema de triagem. Um total de 100 pacientes consecutivos foram incluídos: 70 amarelos (70%) e 30 verdes (30%). Padrões de fluxo, tempo de espera observado e tempos entre as chegadas dos pacientes foram registrados. Mapas de processo, demanda e dados de capacidade foram utilizados na construção de uma simulação que foi calibrada de acordo com o fluxo observado. Uma análise do tipo “e se...” foi conduzida para reduzir os tempos de espera. RESULTADOS Os padrões de tempo de chegada para pacientes verdes e amarelos foram semelhantes, mas os tempos entre chegadas foram 5 e 38 minutos, respectivamente. O tempo de espera foi de 14 minutos para pacientes amarelos e 4 horas para pacientes verdes. A equipe médica era composta por quatro médicos por turno. Uma simulação previu que a inclusão de mais um médico por turno reduziria o tempo de espera para 2,5 horas para pacientes verdes, com um impacto pequeno no tempo de espera dos pacientes amarelos. A manutenção de quatro médicos e a inclusão de um médico exclusivamente para pacientes verdes reduziria o tempo de espera para 1,5 horas para pacientes verdes e aumentaria em 15 minutos para os pacientes amarelos. O melhor cenário simulado utilizou cinco médicos por plantão, com dois médicos exclusivos para pacientes verdes. CONCLUSÃO Os tempos de espera podem ser reduzidos equilibrando a distribuição de médicos para pacientes verdes e amarelos e relacionando a disponibilidade dos médicos aos padrões de demanda previstos. Simulações de DE podem ser utilizadas para gerar e testar soluções para diminuir a superlotação.OBJECTIVE Exploring the use of forecasting models and simulation tools to estimate demand and reduce the waiting time of patients in Emergency Departments (EDs). METHODS The analysis was based on data collected in May 2013 in the ED of Recanto das Emas, Federal District, Brasil, which uses a Manchester Triage System. A total of 100 consecutive patients were included: 70 yellow (70%) and 30 green (30%). Flow patterns, observed waiting time, and inter-arrival times of patients were collected. Process maps, demand, and capacity data were used to build a simulation, which was calibrated against the observed flow times. What-if analysis was conducted to reduce waiting times. RESULTS Green and yellow patient arrival-time patterns were similar, but inter-arrival times were 5 and 38 minutes, respectively. Wait-time was 14 minutes for yellow patients, and 4 hours for green patients. The physician staff comprised four doctors per shift. A simulation predicted that allocating one more doctor per shift would reduce wait-time to 2.5 hours for green patients, with a small impact in yellow patients’ wait-time. Maintaining four doctors and allocating one doctor exclusively for green patients would reduce the waiting time to 1.5 hours for green patients and increase it in 15 minutes for yellow patients. The best simulation scenario employed five doctors per shift, with two doctors exclusively for green patients. CONCLUSION Waiting times can be reduced by balancing the allocation of doctors to green and yellow patients and matching the availability of doctors to forecasted demand patterns. Simulations of EDs’ can be used to generate and test solutions to decrease overcrowding

Turner syndrome, Hashimoto's thyroiditis and Crohn's disease in sisters: case report

A Síndrome de Turner é caracterizada citogeneticamente pela presença de um cromossomo X e perda total ou parcial do segundo cromossomo sexual, ocorrendo em aproximadamente 1:2.130 nascidos vivos do sexo feminino. A Tireoidite de Hashimoto é um distúrbio autoimune decorrente de resposta imune anormal à glândula tireoide, tanto do ponto de vista humoral como celular. A doença de Crohn é uma doença crônica recidivante que afeta todas as partes do tubo digestivo, sendo multifatorial, em que fatores de ordem genética, imunológica e ambientais têm uma relevância preponderante no início e na perpetuação da lesão tecidual imunomediada. O objetivo deste trabalho foi relatar o caso de três pacientes de uma mesma família. Caso 1, primeira gemelar (dizigótica), 8 anos de idade, sexo feminino, com diagnóstico de Tireoidite de Hashimoto. Caso 2 (segunda gemelar), sexo feminino, com o diagnóstico de Síndrome de Turner. Caso 3 (primogênita), sexo feminino, com diagnóstico de Doença de Crohn.&nbsp; Duas filhas de um casal hígido manifestaram doenças autoimunes, as quais têm incidência aumentada na síndrome de Turner. Doenças endócrinas autoimunes possuem mecanismos complexos com a participação de vários fatores, como a susceptibilidade genética, eventos ambientais e resposta autoimune, porém, neste caso, não se encontrou história familiar positiva além da geração estudada. Outros estudos familiares, como este que se propõe, com múltiplos membros acometidos, poderão identificar associações cada vez mais consistentes entre essas doenças, além daquelas ainda não suspeitadas.&nbsp;&nbsp; Palavras-chave: Síndrome de Turner, Tireoidite de Hashimoto, Doença de Crohn, Hereditariedade. ABSTRACT Turner syndrome is characterized cytogenetically by the presence of an X chromosome and total or partial loss of the second sex chromosome, occurring in approximately 1:2,130 live female births. Hashimoto's Thyroiditis is an autoimmune disorder resulting from an abnormal immune response to the thyroid gland, both from a humoral and cellular point of view. Crohn's disease is a chronic recurrent disease that affects all parts of the digestive tract, being multifactorial, in which genetic, immunological and environmental factors have a preponderant relevance at the beginning and the perpetuation of immune-mediated tissue injury. The objective of this study was to report the case of three patients from the same family. Case 1, first twin (dizygotic), 8 years old, female, with diagnosis of Hashimoto's Thyroiditis. Case 2 (second twin), female, with the diagnosis of Turner Syndrome. Case 3 (first-born), female, with diagnosis of Crohn's Disease. Two daughters of a healthy couple have manifested autoimmune diseases, which have an increased incidence in Turner syndrome. Autoimmune endocrine diseases have complex mechanisms with the participation of several factors, such as genetic susceptibility, environmental events and autoimmune response, but in this case, no positive family history was found beyond the generation studied. Other family studies, such as this one proposed, with multiple affected members, will be able to identify increasingly consistent associations between these diseases, in addition to those not yet suspected. Keywords: Turner syndrome, Hashimoto's thyroiditis, Crohn's disease, Heredity

Effect of Facial Massage on Static Balance in Individuals with Temporomandibular Disorder – a Pilot Study

Introduction: The influence of the neuromuscular system on the cervical region and mastication is directly associated with mandibular movements and neck posture. Normal occlusal homeostasis depends on complex sensory feedback mechanisms of the periodontal ligament, temporomandibular joint and other structures of the stomatognathic system. This feedback serves as a regulatory mechanism that helps determine the force and nature of muscle contractions. Alterations in the muscles of mastication, neck muscles, and occlusal characteristics constitute causal factors of imbalances in the postural muscle chains, leading to alterations in the center of pressure (CoP) of the feet. Thus, therapies that seek occlusal reestablishment, such as muscle relaxation techniques, may lead to a restructuring of the global equilibrium of the neuromuscular system and an improvement in body posture. Purpose: The aim of the present pilot study was to investigate the immediate effect of facial massage on the CoP in the anteroposterior (CoPAP) and mediolateral (CoPML) directions in individuals with temporomandibular disorder (TMD). Methods: Twenty individuals with a diagnosis of TMD based on the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) were submitted to a facial massage technique. CoPAP and CoPML were evaluated using a force plate. Evaluations were performed under two visual conditions (eyes open and eyes closed) prior to resting in dorsal decubitus (baseline), after 10 minutes of rest (premassage) and after the administration of the massage technique (postmassage). Results: No significant differences were found regarding CoPAP velocity with eyes open or the following aspects under either visual condition (eyes open or closed): CoPML velocity, RMS of CoPAP, RMS of CoPML, and sway area. The only significant difference was found for mean CoPAP velocity with eyes closed. Conclusions: While the results of the present study demonstrate the reliability of the reproduction of the data, facial massage had no immediate influence on postural control in individuals with TMD