Outcome of combined peribulbar ropivacaine 0.75% block and general anesthesia for retinal detachment surgery: A randomized controlled study

AbstractBackgroundRetinal detachment surgery (RDS) is frequently associated with a high incidence of significant perioperative pain and oculocardiac reflex (OCR) intra-operatively. The peribulbar block has gained wide acceptance in ophthalmic anesthetic practice in the recent times. However, there is little current knowledge regarding its efficacy in RDS.This prospective randomized clinical study evaluated the effect and feasibility of peribulbar block when used in conjunction with general anesthesia on perioperative outcome.Methods98 patients, ASA II-III, were randomly allocated to one of two groups to receive either peribulbar block in conjunction with general anesthesia (n=49) or general anesthesia alone (n=49).Parameters compared were incidence of OCR, surgical bleeding, duration of surgery, postoperative pain and patient‘s satisfaction.Results and discussionPatients with PB block had a significantly lower incidence of intraoperative OCR (n=4 vs. n=13, p<0.05). It also provided more effective post-operative analgesia with fewer patients requiring rescue analgesia medication (n=19 vs. n=27; p=0.105). Surgical bleeding was more profuse in the general anesthesia group (n=5 vs. n=27, p<0.001), with no cases of bleeding interfering with surgery in the peribulbar group.ConclusionsPB block combined with GA improved significantly operating conditions and lower incidence of OCR. Patients in the block group also had better postoperative analgesia

Deployment characterization of a floatable tidal energy converter on a tidal channel, Ria Formosa, Portugal

This paper presents the results of a pilot experiment with an existing tidal energy converter (TEC), Evopod 1 kW floatable prototype, in a real test case scenario (Faro Channel, Ria Formosa, Portugal). A baseline marine geophysical, hydrodynamic and ecological study based on the experience collected on the test site is presented. The collected data was used to validate a hydro-morphodynamic model, allowing the selection of the installation area based on both operational and environmental constraints. Operational results related to the description of power generation capacity, energy capture area and proportion of energy flux are presented and discussed, including the failures occurring during the experimental setup. The data is now available to the scientific community and to TEC industry developers, enhancing the operational knowledge of TEC technology concerning efficiency, environmental effects, and interactions (i.e. device/environment). The results can be used by developers on the licensing process, on overcoming the commercial deployment barriers, on offering extra assurance and confidence to investors, who traditionally have seen environmental concerns as a barrier, and on providing the foundations whereupon similar deployment areas can be considered around the world for marine tidal energy extraction.Acknowledgements The paper is a contribution to the SCORE project, funded by the Portuguese Foundation for Science and Technology (FCT e PTDC/ AAG-TEC/1710/2014). Andre Pacheco was supported by the Portu- guese Foundation for Science and Technology under the Portuguese Researchers' Programme 2014 entitled “Exploring new concepts for extracting energy from tides” (IF/00286/2014/CP1234). Eduardo GGorbena has received funding for the OpTiCA project from the ~ Marie Skłodowska-Curie Actions of the European Union's H2020- MSCA-IF-EF-RI-2016/under REA grant agreement n [748747]. The authors would like to thank to the Portuguese Maritime Authorities and Sofareia SA for their help on the deployment.info:eu-repo/semantics/publishedVersio

Brazil’s more doctors programme and infant health outcomes: a longitudinal analysis

Background Providing sufficient numbers of human resources for health is essential for effective and accessible health services. Between 2013 and 2018, the Brazilian Ministry of Health implemented the Programa Mais Médicos (PMM) (More Doctors Programme) to increase the supply of primary care doctors in underserved areas of the country. This study investigated the association between PMM and infant health outcomes and assessed if heterogeneity in the impact of PMM varied by municipal socioeconomic factors and health indicators. Methods An ecological longitudinal (panel) study design was employed to analyse data from 5,565 Brazilian municipalities over a 12-year period between 2007 and 2018. A differences-in-differences approach was implemented using longitudinal fixed effect regression models to compare infant health outcomes in municipalities receiving a PMM doctor with those that did not receive a PMM doctor. The impact of PMM was assessed on aggregate and in municipality subgroups. Results On aggregate, the PMM was not significantly associated with changes in infant or neonatal mortality, but the PMM was associated with reductions in IMR (of -0.21; 95% CI: -0.38,-0.03) in municipalities with highest IMR prior to the programme’s implementation (where IMR >25.2 infant deaths per 1,000 live births). The PMM was also associated with an increase in the proportion of expectant mothers receiving seven or more prenatal care visits but only in municipalities with a lower IMR at baseline and high density of non-PMM doctors and community health workers before the PMM. Conclusions The PMM was associated with reduced infant mortality in municipalities with the highest infant mortality rate prior to the programme. This suggests effectiveness of the PMM was limited only to the areas of greatest need. New programmes to improve the equitable provision of human resources for health should employ comprehensive targeting approaches balancing health needs and socioeconomic factors to maximize effectiveness

Multilocus sequence types of invasive Corynebacterium diphtheriae isolated in the Rio de Janeiro urban area, Brazil

Invasive infections caused by Corynebacterium diphtheriae in vaccinated and non-vaccinated individuals have been reported increasingly. In this study we used multilocus sequence typing (MLST) to study genetic relationships between six invasive strains of this bacterium isolated solely in the urban area of Rio de Janeiro, Brazil, during a 10-year period. Of note, all the strains rendered negative results in PCR reactions for the tox gene, and four strains presented an atypical sucrose-fermenting ability. Five strains represented new sequence types. MLST results did not support the hypothesis that invasive (sucrose-positive) strains of C. diphtheriae are part of a single clonal complex. Instead, one of the main findings of the study was that such strains can be normally found in clonal complexes with strains related to non-invasive disease. Comparative analyses with C. diphtheriae isolated in different countries provided further information on the geographical circulation of some sequence types

Robot-assisted rehabilitation architecture supported by a distributed data acquisition system

Rehabilitation robotics aims to facilitate the rehabilitation procedure for patients and physical therapists. This field has a relatively long history dating back to the 1990s; however, their implementation and the standardisation of their application in the medical field does not follow the same pace, mainly due to their complexity of reproduction and the need for their approval by the authorities. This paper aims to describe architecture that can be applied to industrial robots and promote their application in healthcare ecosystems. The control of the robotic arm is performed using the software called SmartHealth, offering a 2 Degree of Autonomy (DOA). Data are gathered through electromyography (EMG) and force sensors at a frequency of 45 Hz. It also proves the capabilities of such small robots in performing such medical procedures. Four exercises focused on shoulder rehabilitation (passive, restricted active-assisted, free active-assisted and Activities of Daily Living (ADL)) were carried out and confirmed the viability of the proposed architecture and the potential of small robots (i.e., the UR3) in rehabilitation procedure accomplishment. This robot can perform the majority of the default exercises in addition to ADLs but, nevertheless, their limits were also uncovered, mainly due to their limited Range of Motion (ROM) and cost.info:eu-repo/semantics/publishedVersio

Use of the Hospital Anxiety and Depression Scale (HADS) in a Cardiac Emergency Room – Chest Pain Unit

OBJECTIVE: To determine the prevalence of anxiety and depression in patients complaining of chest pain who seek a chest pain unit attendance. INTRODUCTION: Patients arriving at a Chest Pain Unit may present psychiatric disorders not identified, isolated or co-morbid to the main illness, which may interfere in the patient prognosis. METHODOLOGY: Patients were assessed by the "Hospital Anxiety and Depression Scale" as a screening instrument wile following a systematized protocol to rule out the diagnosis of acute coronary syndrome and other potentially fatal diseases. Patients with 8 or more points in the scale were considered "probable case" of anxiety or depression. RESULTS: According to the protocol, 59 (45.4%) of 130 patients studied presented Chest Pain of Determined Cause, and 71 (54.6%) presented Chest Pain of Indefinite Cause. In the former group, in which 43 (33.1%) had acute coronary syndrome, 33.9% were probable anxiety cases and 30.5% depression cases. In the second group, formed by patients without acute coronary syndrome or any clinical conditions involving greater morbidity and mortality risk, 53.5% were probable anxiety cases and 25.4% depression. CONCLUSION: The high anxiety and depression prevalence observed may indicate the need for early and specialized approach to these disorders. When coronary arterial disease is present, this may decrease complications and shorten hospital stay. When psychiatric disorder appears isolated, is possible to reduce unnecessary repeated visits to emergency room and increase patient's quality of life

Effects of experimental bleaching agents on the mineral content of sound and demineralized enamels

High concentrations of hydrogen peroxide can cause adverse effects on composition and structure of teeth. However, the addition of calcium and fluoride in bleaching agents may reduce enamel demineralization. Objective: To evaluate chemical changes of sound and demineralized enamels submitted to high concentrations of hydrogen peroxide containing fluoride (F) or calcium (Ca). Material and Methods: Enamel blocks of bovine incisors with standard dimensions were obtained and half of them were submitted to pH-cycling to promote initial enamel caries lesions. Sound and demineralized enamel samples were divided into (n=10): (C) Control (no whitening treatment); (HP) 35% hydrogen peroxide; and two experimental groups: (HPF) 35% HP+0.2% F and (HPC) 35% HP+0.2% Ca. Experimental groups were submitted to two in-office bleaching sessions and agents were applied 3 times for 15 min to each session. The control group was kept in remineralizing solution at 37°C during the bleaching treatment. The surface mineral content of sound and demineralized enamels was determined through Fourier Transform Raman spectroscopy (FT-Raman), Energy dispersive Micro X-ray fluorescence spectroscopy (μ-EDXRF); and the subsurface, through cross-sectional microhardness (CSMH). In addition, polarized light microscopy (PLM) images of enamel subsurface were observed. Results: According to three-way (FT-Raman and μ-EDXRF analyses) or two-way analysis of variance (ANOVA) (CSMH) and Tukey test (α=5%), the calcium or fluoride added to high-concentrated bleaching agents increased phosphate and carbonate concentrations on sound and demineralized enamels (p&lt;0.05). However, HPC and HPF were unable to completely reverse the subsurface mineral loss promoted by bleaching on sound and demineralized enamels. The calcium/ phosphate (Ca/P) ratio of sound enamel decreased after HP treatment (p&lt;0.001). Conclusion: Even though experimental bleaching agents with Ca or F reduced mineral loss for both sound and demineralized enamel surfaces, these agents were unable to reverse the enamel subsurface demineralization

Design of experimental design as a tool for the processing and characterization of HDPE composites with sponge-gourds (Luffa-Cylindrica) agrofiber residue.

Sponge-gourd (Luffa-Cylindrica) agrofiber residue (LC)-HDPE composites were manufactured by extrusion and injection moulding. The effects of fiber content, fiber size, screw speed and barrel zones temperatures on tensile strength at yield (TS) point, modulus of elasticity (MOE), flexure stress (FS) and Izod pendulum impact resistance were evaluated by using a design of experiments (DOE)-24 Factorial with centerpoint. Furthermore, a model was also determined for each response variable as well as to generate foreknowledge for additional combinations of the experimental factors. The design analysis showed that the LC-fiber content is the most important experimental factor, since it significantly affected three out of the four mechanical properties studied, specifically MOE, FS and Izod Impact resistance. The second most important parameter is the LC-fiber size. Additionally, the design analysis showed that screw speed and temperature of barrel zones did not present any influence on the properties investigated. Finally, the models were validated by comparing the results from additional experimental runs with the predicted values obtained from the respective model