Acute iris depigmentation following systemic moxifloxacin

Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM) HospitalUNIFESP, EPM, HospitalSciEL

DRESS syndrome in ophthalmic patients

ABSTRACT Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare and potentially fatal adverse drug reaction associated with skin rash, fever, eosinophilia, and multiple organ injury. A number of pharmacological agents are known to cause DRESS syndrome such as allopurinol, anticonvulsants, vancomycin, trimethoprime-sulfamethoxazole, and pyrimethamine-sulfadiazine. Here, we describe two patients who developed DRESS syndrome during ocular treatment. The first case was being treated for late postoperative endophthalmitis with topical antibiotics, intravenous cephalothin, meropenem, and intravitreal injection of vancomycin and ceftazidime before symptoms developed. We were unable to identify the causal drug owing to the large number of medications concurrently administered. The second case presented with DRESS syndrome symptoms during ocular toxoplasmosis treatment. In this case, a clearer association with pyrimethamine-sulfadiazine was observed. As a result of the regular prescription of pharmacological agents associated with DRESS syndrome, ophthalmologists should be aware of the potentially serious complications of DRESS syndrome

Miosite do músculo reto medial como forma atípica de apresentação de linfoma tipo MALT: relato de caso

Here we describe the rare case of a 55-year-old man with medial rectus muscle myositis as an atypical presentation of non-Hodgkin B-cell mucosa-associated lymphoma (MALT). Pathology and immunohistochemistry of the affected muscle confirmed the diagnosis of a neoplasm. The primary etiology of orbital myositis is Graves' ophthalmopathy, but several other diseases may cause this clinical presentation. Therefore, the neoplastic causes must be eliminated from the differential diagnoses. non-Hodgkin B-cell mucosa-associated lymphoma is the most common histological type of lymphoma in the orbit, with the conjunctiva and lacrimal glands being the most commonly affected sites. However, it may also present in atypical forms involving others sites and tissues.Descrevemos um raro caso de miosite do músculo reto medial como forma atípica de apresentação de linfoma não-Hodgkin de células B tipo MALT. A anatomia patológica e imuno-histoquímica do músculo afetado confirmaram o diagnóstico definitivo do caráter neoplásico da doença. As miosites orbitárias têm como principal etiologia a oftalmopatia de Graves, porém diversas outras causas podem apresentar-se dessa forma. Sendo assim, as causas neoplásicas devem ser descartadas. O linfoma não-Hodgkin de células B tipo MALT é o tipo histológico mais comum de linfoma orbitário, as regiões mais frequentemente acometidas são a conjuntiva e glândula lacrimal. No entanto, pode apresentar-se com formas clínicas atípicas, acometendo outras regiões e tecidos.Universidade Federal de São Paulo (UNIFESP) Department of OphthalmologyUNIFESP, Department of OphthalmologySciEL

Segurança Alimentar e Nutricional e comportamento de usuários em Unidades de Alimentação e Nutrição / Food and Nutrition Security and user behavior in Food and Nutrition Units

O estudo buscou identificar a existência de relação entre diferentes modelos de distribuição das refeições em unidades de alimentação e nutrição e comportamentos de risco de usuários. No restaurante denominado “Usuário” o comensal serve todas as preparações em seu prato; no restaurante identificado como “Manipulador” os consumidores têm toda sua refeição servida pelos manipuladores de alimentos; já no restaurante “Misto” os manipuladores e os usuários servem a refeição. O estudo foi do tipo exploratório, com utilização da técnica de observação não participante. Os responsáveis pelos restaurantes foram previamente contatados e somente foram incluídos após a autorização, concordância e assinatura do termo de consentimento.   Por meio de análise estatística foi verificado se houve diferença significativa na ocorrência dos comportamentos de risco dos usuários entre os restaurantes, utilizando a regressão de Poisson nas variáveis explicativas (tipo de serviço) e resposta (comportamentos de risco). Para analisar a significância da diferença estatística foi utilizado o teste Qui-Quadrado (p < 0,05). Apesar da ocorrência, não houve diferença estatística significativa entre os restaurantes em relação às variáveis: conversar sobre a comida, deixar a roupa tocar na comida, tossir sobre a comida e espirrar sobre a comida. No restaurante Usuário houve maior chance de ocorrer comportamentos de risco em relação aos restaurantes Manipulador e Misto.

ESTUDO FITOQUÍMICO E POTENCIAL ANTIBACTERIANO DO LÁTEX DE Himatanthus drasticus (MART.) PLUMEL

Himatanthus drasticus (Mart.) Plumel, popularly known as janaguba, is a latex medicinal plant widely used in the region of Cariri (CE) and used as an alternative source for the treatment of numerous diseases. The objective of the present work was to test the antibacterial and modulatory potential of the latex in natura (LIHD) and ethyl acetate extract of H. drasticus latex (EAEHD) alone and in combination with aminoglycoside antibiotics (amikacin and gentamicin) against standard and multiresistant strains, following the method of microdilution in Brain Heart Infusion (BHI) broth. In the evaluation of the minimum inhibitory concentration (MIC) results were obtained ≥ 1024 μg / mL against the standard strains of Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa and Klebsiella pneumoniae for both LIHD and EAEHD. The natural products presented synergism in the activity of the aminoglycosides to strains of multiresistant bacteria Escherichia coli (EC 27), Staphylococcus aureus (SA 358) and Klebsiella pneumoniae (KP 10031), however they presented antagonism to Pseudomonas aeruginosa (PA 03). In the quantification of phenols, LIHD had 62.6 mg / g and EAEHD 51.8 mg / g gallic acid / g extract, and for total flavonoids, LIHD had 16.5 and EAEHD had 13.4 mg / g of flavonoids. Further research is needed for a possible use of these natural products combined with antimicrobials tested (aminoglycosides) against pathogenic strains. Through the results it was concluded that the natural products represent promising sources in the fight against bacterial resistance.Keywords: Aminoglycosides; Antimicrobian activity; Inhibitory Minimum Concentration; Himatanthus drasticus.Himatanthus drasticus (Mart.) Plumel, conhecida popularmente como janaguba, é uma espécie medicinal produtora de látex bastante utilizado na região do Cariri (CE) e empregada como fonte alternativa para o tratamento de inúmeras enfermidades. O presente trabalho teve como principal objetivo testar o potencial antibacteriano e modulador do látex in natura (LIHD) e do extrato acetato de etila do látex de H. drasticus (EAEHD) isoladamente e em associação com antibióticos aminoglicosideos (amicacina e gentamicina), frente às cepas bacterianas padrão e multirresistentes, seguindo o método de microdiluição em caldo Brain Heart Infusion (BHI). Na avaliação da concentração inibitória mínima (CIM) foram obtidos resultados ≥ 1024µg/mL frente às cepas padrão de Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa e Klebsiella pneumoniae tanto para LIHD, quanto para o EAEHD. Os produtos naturais apresentaram sinergismo na atividade dos aminoglicosídeos perante cepas de bactérias multirresistentes Escherichia coli (EC 27), Staphylococcus aureus (SA 358) e Klebsiella pneumoniae (KP 10031), entretanto apresentaram antagonismo perante Pseudomonas aeruginosa (PA 03). Na quantificação de fenóis o LIHD possui 62,6 mg/g e o EAEHD 51,8 mg/g de ácido gálico/g de extrato, e para flavanóides totais o LIHD apresentou 16,5 e o EAEHD 13,4 mg/g de flavanóides. Mais pesquisas são necessárias para uma possível utilização desses produtos naturais combinados aos antimicrobianos testados (aminoglicosídeos) frente às linhagens patogênicas. Através dos resultados concluiu-se que os produtos naturais representam fontes promissoras no combate à resistência bacteriana.Palavras chave: Aminoglicosídeos, Atividade antimicrobiana, Concentração Inibitória Mínima, Himatanthus drasticus

Com o diabo no corpo: os terríveis papagaios do Brasil colônia

Desde a Antiguidade, papagaios, periquitos e afins (Psittacidae) fascinaram os europeus por seu vivo colorido e uma notável capacidade de interação com seres humanos. A descoberta do Novo Mundo nada faria além de acrescentar novos elementos ao tráfico de animais exóticos há muito estabelecido pelos europeus com a África e o Oriente. Sem possuir grandes mamíferos, a América tropical participaria desse comércio com o que tinha de mais atrativo, essencialmente felinos, primatas e aves - em particular os papagaios, os quais eram embarcados em bom número. Contudo, a julgar pelos documentos do Brasil colônia, esses voláteis podiam inspirar muito pouca simpatia, pois nenhum outro animal - exceto as formigas - foi tantas vezes mencionado como praga para a agricultura. Além disso, alguns psitácidas mostravam-se tão loquazes que inspiravam a séria desconfiança de serem animais demoníacos ou possessos, pois só três classes de entidades - anjos, homens e demônios - possuíam o dom da palavra. Nos dias de hoje, vários representantes dos Psittacidae ainda constituem uma ameaça para a agricultura, enquanto os indivíduos muito faladores continuam despertando a suspeita de estarem possuídos pelo demônio. Transcendendo a mera curiosidade, essa crença exemplifica o quão intrincadas podem ser as relações do homem com o chamado “mundo natural”, revelando um universo mais amplo e multifacetado do que se poderia supor a princípio. Nesse sentido, a existência de aves capazes de falar torna essa relação ainda mais complexa e evidencia que as dificuldades de estabelecer o limite entre o animal e o humano se estendem além dos primatas e envolvem as mais inusitadas espécies zoológicas.Since ancient times, parrots and their allies (Psittacidae) have fascinated Europeans by their striking colors and notable ability to interact with human beings. The discovery of the New World added new species to the international exotic animal trade, which for many centuries had brought beasts to Europe from Africa and the Orient. Lacking large mammals, tropical America participated in this trade with its most appealing species, essentially felines, primates and birds - especially parrots - which were shipped in large numbers. It should be noted, however, that at times these birds were not well liked. In fact, according to documents from colonial Brazil, only the ants rank higher than parrots as the animals most often mentioned as agricultural pests. On the other hand, some of these birds were so chatty that people suspected them to be demonic or possessed animals, since only three classes of beings - angels, men and demons - have the ability to speak. Nowadays, several Psittacidae still constitute a threat to agriculture, and the suspicion that extremely talkative birds were demon possessed has also survived. More than a joke or a mere curiosity, this belief exemplifies how intricate man’s relationships with the “natural world” may be. In this sense, the existence of birds that are able to speak adds a further twist to these relationships, demonstrating that the problem of establishing a boundary between the animal and the human does not only involve primates, but also includes some unusual zoological species

Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

BACKGROUND: Measurement of changes in health across locations is useful to compare and contrast changing epidemiological patterns against health system performance and identify specific needs for resource allocation in research, policy development, and programme decision making. Using the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we drew from two widely used summary measures to monitor such changes in population health: disability-adjusted life-years (DALYs) and healthy life expectancy (HALE). We used these measures to track trends and benchmark progress compared with expected trends on the basis of the Socio-demographic Index (SDI). METHODS: We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 for all-cause mortality, cause-specific mortality, and non-fatal disease burden to derive HALE and DALYs by sex for 195 countries and territories from 1990 to 2016. We calculated DALYs by summing years of life lost and years of life lived with disability for each location, age group, sex, and year. We estimated HALE using age-specific death rates and years of life lived with disability per capita. We explored how DALYs and HALE differed from expected trends when compared with the SDI: the geometric mean of income per person, educational attainment in the population older than age 15 years, and total fertility rate. FINDINGS: The highest globally observed HALE at birth for both women and men was in Singapore, at 75·2 years (95% uncertainty interval 71·9-78·6) for females and 72·0 years (68·8-75·1) for males. The lowest for females was in the Central African Republic (45·6 years [42·0-49·5]) and for males was in Lesotho (41·5 years [39·0-44·0]). From 1990 to 2016, global HALE increased by an average of 6·24 years (5·97-6·48) for both sexes combined. Global HALE increased by 6·04 years (5·74-6·27) for males and 6·49 years (6·08-6·77) for females, whereas HALE at age 65 years increased by 1·78 years (1·61-1·93) for males and 1·96 years (1·69-2·13) for females. Total global DALYs remained largely unchanged from 1990 to 2016 (-2·3% [-5·9 to 0·9]), with decreases in communicable, maternal, neonatal, and nutritional (CMNN) disease DALYs offset by increased DALYs due to non-communicable diseases (NCDs). The exemplars, calculated as the five lowest ratios of observed to expected age-standardised DALY rates in 2016, were Nicaragua, Costa Rica, the Maldives, Peru, and Israel. The leading three causes of DALYs globally were ischaemic heart disease, cerebrovascular disease, and lower respiratory infections, comprising 16·1% of all DALYs. Total DALYs and age-standardised DALY rates due to most CMNN causes decreased from 1990 to 2016. Conversely, the total DALY burden rose for most NCDs; however, age-standardised DALY rates due to NCDs declined globally. INTERPRETATION: At a global level, DALYs and HALE continue to show improvements. At the same time, we observe that many populations are facing growing functional health loss. Rising SDI was associated with increases in cumulative years of life lived with disability and decreases in CMNN DALYs offset by increased NCD DALYs. Relative compression of morbidity highlights the importance of continued health interventions, which has changed in most locations in pace with the gross domestic product per person, education, and family planning. The analysis of DALYs and HALE and their relationship to SDI represents a robust framework with which to benchmark location-specific health performance. Country-specific drivers of disease burden, particularly for causes with higher-than-expected DALYs, should inform health policies, health system improvement initiatives, targeted prevention efforts, and development assistance for health, including financial and research investments for all countries, regardless of their level of sociodemographic development. The presence of countries that substantially outperform others suggests the need for increased scrutiny for proven examples of best practices, which can help to extend gains, whereas the presence of underperforming countries suggests the need for devotion of extra attention to health systems that need more robust support. FUNDING: Bill & Melinda Gates Foundation

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat