A comparison of fibrin glue with sutures for conjunctival autografts in pterygium excision surgery

A dissertation submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Medicine in Ophthalmology Johannesburg 2015To assess post-operative patient comfort and graft success following conjunctival autografts with sutures compared with Tisseel glue for pterygium surgery, and to identify which procedure was the more cost-effective surgical option. Design and Methods: A prospective randomized comparison of 60 patients undergoing primary pterygium surgery at St John Eye Hospital between April 2012 and September 2012. A post-operative comfort scale was used to assess foreign body sensation, sensitivity to light, tearing and itchiness. Graft success was defined as a graft that was still adherent at one month following surgery. Results: Patients in the Tisseel glue group experienced significantly less foreign body sensation (p=0.038) and itchiness (p=0.018) on day-one after surgery, compared to those in the suture group. At one-month follow-up patients had significantly less foreign body sensation (p=0.042), sensitivity to light (p=0.001), and itchiness (p=0.009) in the Tisseel glue group compared to the suture group. Autograft adherence was seen in all 60 patients at the one-month follow-up visit. Both the surgical time and the indirect costs of the procedure were reduced in the Tisseel glue group. Conclusions: The use of Tisseel glue for attaching autografts in pterygium surgery is an effective method with global autograft success, less post-operative discomfort and shorter operating times

Diagnósticos de enfermagem para pacientes com anemia de Fanconi submetidos a transplante de célula-tronco hematopoética

Orientadora: Prof.a Dra. Carmem M. S. BonfimCoorientadora: Prof.a. Dra. Letícia PontesDissertação (mestrado) - Universidade Federal do Paraná, Setor de Ciências da Saúde, Programa de Pós-Graduação em Saúde da Criança e do Adolescente. Defesa : Curitiba, 26/04/2019Inclui referências: p. 89-98Área de concentração: Hemato Oncologia e Genética PediátricaResumo: Este estudo identificou os Diagnósticos de Enfermagem (DE) para pacientes submetidos a Transplante de Células-Tronco Hematopoéticas (TCTH) por Anemia de Fanconi, segundo a taxonomia da NANDA Internacional, Inc. (NANDA-I); caracterizou o perfil sociodemográfico, identificou as complicações clínicas desenvolvidas na hospitalização e apontou as principais intervenções de enfermagem relacionadas aos DE identificados. Trata-se de um estudo observacional, transversal com coleta retrospectiva dos dados. Os dados foram coletados por meio de instrumento idealizado pela pesquisadora, utilizando a linguagem Visual Basic, no programa Microsoft Excel 97® e analisados por métodos estatísticos simples com auxílio do programa IBM® SPSS® Statistics versão 22. A população contemplou 85 pacientes, 54,1% do sexo masculino, com mediana de idade de nove anos, 58,8% na faixa etária escolar, 64,7% brancos, 58,9% naturais da região Sul e 69,4% estudantes. Quanto às malformações congênitas, 72,9% estão localizadas na cabeça e face. Como comorbidade destaca-se a cardiovascular (14,1%). Todos os transplantes foram alogênicos, 58,8% TCTH Aparentado e, destes, 21,2% Haploidênticos. Entre os doadores aparentados compatíveis, a maioria são irmãos (58%). Quanto à fonte de células-tronco hematopoética destacase a medula óssea (97,6%). Todos os pacientes transfundiram plaquetas e 92,9% hemácias. O quimerismo no dia + 30, 57,6% apresentaram quimerismo completo. Quanto às complicações clínicas, a perda de peso ocorreu em 91,8% dos pacientes em diferentes graus. Infecções bacterianas na corrente sanguínea estiveram presentes em 12,9% dos pacientes. Todos apresentaram algum grau de mucosite. As reações transfusionais estiveram presentes em 62,4% dos pacientes e o sintoma mais comum foi o prurido (49%). A doença do enxerto contra o hospedeiro (DECH) ocorreu em 12,9%, com maior prevalência de DECH de pele (72,7%). Houve rejeição do enxerto em 3,5% dos casos. O óbito ocorreu em 1,2% durante o internamento e 16,7% após a primeira alta hospitalar. As complicações clínicas prevalentes foram: neutropenia (100%); plaquetopenia (98,8%); leucócitos diminuídos (98,8%); alopecia (97,7%); dor (97,6%); vômito (95,3%); náusea (90,6%), diarreia (90,6%), disfagia (89,4%), hemoglobinemia (85,9%), hipertensão (81,2%), reação alérgica (56,5%) e ansiedade (52,9%). Assim, aos DE identificados, todos os pacientes apresentaram: Proteção ineficaz; Risco de motilidade gastrointestinal disfuncional; Risco de infecção; Integridade da pele prejudicada; Integridade tissular prejudicada; Mucosa oral prejudicada; Risco de sangramento; Conforto prejudicado e Isolamento social. As intervenções apontadas são relacionadas a cada DE identificado. Os resultados desta pesquisa evidenciam a importância do planejamento da assistência de enfermagem, a partir da identificação dos DE e, sobretudo da sistematização da avaliação clínica diária.Abstract: This study identified the Nursing Diagnoses (ND) for patients submitted to Hematopoietic Stem Cell Transplantation for Fanconi's Anemia, according to the taxonomy of NANDA International, Inc. (NANDA-I); characterized the sociodemographic profile, identified the clinical complications developed during hospitalization and pointed out the main nursing interventions related to the identified ND. It is an observational, cross-sectional study with retrospective data collection. The data were collected using an instrument designed by the researcher using the Visual Basic language in the Microsoft Excel 97® program and analyzed by simple statistical methods with the help of the IBM® SPSS® Statistics version 22 program. The population consisted of 85 patients, 54.1% males, with a median age of nine years, 58.8% in the school age group, 64.7% are white, 58.9% in the Southern region and 69.4% students. As for congenital malformations, 72.9% are located in the head and face. As comorbidity, the cardiovascular (14.1%) stands out. All transplants were allogenic, 58.8% TCTH Apparent, and of these 21.2% Haploidentical. Among the compatible donors most are brothers (58%). As for the source of hematopoietic stem cells, the bone marrow (97.6%) stands out. All patients transfused platelets and 92.9% red blood cells. Chimerism on day + 30, 57.6% showed complete chimerism. Regarding the clinical complications weight loss occurred in 91.8% of patients to different degrees. Bacterial infections in the bloodstream were present in 12.9% of patients. All had some degree of mucositis. Transfusion reactions were present in 62.4% of patients and the most common symptom was pruritus (49%). Graft versus host disease (GVHD) occurred in 12.9% with a higher prevalence of skin GVHD (72.7%). There was rejection of the graft in 3.5% of the cases. Death occurred in 1.2% during hospitalization and 16.7% after the first hospital discharge. The prevalent clinical complications were: neutropenia (100%); thrombocytopenia (98.8%); decreased leukocytes (98.8%); alopecia (97.7%); pain (97.6%); vomiting (95.3%); diarrhea (90.6%), dysphagia (89.4%), hemoglobinemia (85.9%), hypertension (81.2%), allergic reaction (56.5%) and anxiety (52.9%). Thus, the nD identified, all patients presented: Ineffective protection, Dysfunctional gastrointestinal motility risk, Infection risk, Impaired skin integrity, Impaired tissue integrity, Impaired oral mucosa, Bleeding risk, Impaired comfort and Social isolation. The interventions indicated are related to each identified SD. The results of this research show the importance of nursing care planning, based on the identification of ND and, above all, the systematization of the daily clinical action

Carcinoma adenóide cístico do pulmão : Adenoid cystic carcinoma of the lung

Introdução: O carcinoma adenóide cístico primário de pulmão é uma neoplasia torácica de crescimento lento e com malignidade de baixo grau. Representa 0,04 a 0,2% de todos os tumores pulmonares, sendo considerada uma neoplasia rara. Apresentação do caso: Paciente, sexo masculino, 49 anos de idade, foi admitido no Hospital Santa Casa de Misericórdia de Goiania, apresentando tosse persistente, dispneia, hemoptise e cerca de 4 episódios previos de pneumonia; negou comorbidades, etilismo e tabagismo, uso de medicamentos e alergias conhecidas. Discussão: O adenocarcinoma pulmonar possui como subtipo o carcinoma adenóide cístico. Anteriormente conhecido como cilindroma. Têm baixo grau de malignidade principalmente pelo seu lento crescimento e curso clínico estendido. Conclusão: Por se tratar de uma baixa malignidade, a sobrevida a longo prazo é satisfatoriamente prevista

Cisto cavum interpositum: Cavum interpositum cyst

Introdução: O velum interpositum (VI) é uma membrana no subaracnóideo formado por uma invaginação da pia-máter preenchido por líquido cefalorraquidiano (LCR). Sua formação ocorre durante o período embrionário e regridem posteriormente. A persistência dessa estrutura primitiva pode acarretar em sua dilatação, sendo denominado cavum veli interpositum (CVI) e, se maior que 10 mm em medida transversal axial, cisto cavum veli interpositum. Sua prevalência é maior em recém nascidos e prematuros. Apresentação do caso: paciente do sexo masculino, recém-nascido de 10 dias, foi admitido no Hospital Materno Infantil (HMI), por quadro de vômitos intermitentes, associado a febre de 39.5ºC. A mãe relata prematuridade de 31 semanas, trabalho de parto prolongado, cesariana e apresentação pélvica. RN teve um episódio convulsivo minutos antes da chegada à unidade. Nega outras queixas. A ressonância magnética destaca-se como exame padrão ouro, seguido da tomografia computadorizada de crânio. Discussão: Os cistos de CVI não apontam fisiopatologia e quadro clínico bem definidos, mas os conhecimentos acerca de sua localização são importantes para correlacionar sinais e sintomas neurológicos que condizem com efeito de massa, sendo um diagnóstico diferencial de lesões císticas intracranianas da linha média. A terapêutica ainda é restrita, mas há muitos relatos de casos em que a técnica de fenestração endoscópica minimamente invasiva foi preconizada para o tratamento dos cistos de CVI. Conclusão: Quanto ao prognóstico, em âmbito radiológico, estudos demonstram redução do cisto e do efeito de massa em imagem de ressonância magnética pós-operatória. E, apesar da resposta clínica ser dependente se os sintomas são decorrentes direta ou indiretamente do cisto, também demonstraram melhora nessa esfera

Guidelines for the use and interpretation of assays for monitoring autophagy (4th edition)1.

In 2008, we published the first set of guidelines for standardizing research in autophagy. Since then, this topic has received increasing attention, and many scientists have entered the field. Our knowledge base and relevant new technologies have also been expanding. Thus, it is important to formulate on a regular basis updated guidelines for monitoring autophagy in different organisms. Despite numerous reviews, there continues to be confusion regarding acceptable methods to evaluate autophagy, especially in multicellular eukaryotes. Here, we present a set of guidelines for investigators to select and interpret methods to examine autophagy and related processes, and for reviewers to provide realistic and reasonable critiques of reports that are focused on these processes. These guidelines are not meant to be a dogmatic set of rules, because the appropriateness of any assay largely depends on the question being asked and the system being used. Moreover, no individual assay is perfect for every situation, calling for the use of multiple techniques to properly monitor autophagy in each experimental setting. Finally, several core components of the autophagy machinery have been implicated in distinct autophagic processes (canonical and noncanonical autophagy), implying that genetic approaches to block autophagy should rely on targeting two or more autophagy-related genes that ideally participate in distinct steps of the pathway. Along similar lines, because multiple proteins involved in autophagy also regulate other cellular pathways including apoptosis, not all of them can be used as a specific marker for bona fide autophagic responses. Here, we critically discuss current methods of assessing autophagy and the information they can, or cannot, provide. Our ultimate goal is to encourage intellectual and technical innovation in the field

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Omecamtiv mecarbil in chronic heart failure with reduced ejection fraction, GALACTIC‐HF: baseline characteristics and comparison with contemporary clinical trials

Aims: The safety and efficacy of the novel selective cardiac myosin activator, omecamtiv mecarbil, in patients with heart failure with reduced ejection fraction (HFrEF) is tested in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTIC‐HF) trial. Here we describe the baseline characteristics of participants in GALACTIC‐HF and how these compare with other contemporary trials. Methods and Results: Adults with established HFrEF, New York Heart Association functional class (NYHA) ≥ II, EF ≤35%, elevated natriuretic peptides and either current hospitalization for HF or history of hospitalization/ emergency department visit for HF within a year were randomized to either placebo or omecamtiv mecarbil (pharmacokinetic‐guided dosing: 25, 37.5 or 50 mg bid). 8256 patients [male (79%), non‐white (22%), mean age 65 years] were enrolled with a mean EF 27%, ischemic etiology in 54%, NYHA II 53% and III/IV 47%, and median NT‐proBNP 1971 pg/mL. HF therapies at baseline were among the most effectively employed in contemporary HF trials. GALACTIC‐HF randomized patients representative of recent HF registries and trials with substantial numbers of patients also having characteristics understudied in previous trials including more from North America (n = 1386), enrolled as inpatients (n = 2084), systolic blood pressure < 100 mmHg (n = 1127), estimated glomerular filtration rate < 30 mL/min/1.73 m2 (n = 528), and treated with sacubitril‐valsartan at baseline (n = 1594). Conclusions: GALACTIC‐HF enrolled a well‐treated, high‐risk population from both inpatient and outpatient settings, which will provide a definitive evaluation of the efficacy and safety of this novel therapy, as well as informing its potential future implementation