Rol de la Clorhexidina en sus Diferentes Formatos para la Prevención de la Alveolitis Seca: Revisión Sistemática Exploratoria

El objetivo de este estudio fue investigar el rol de la clorhexidina en sus diferentes formatos en la prevención de la alveolitis seca posterior a la extracción dental. Se realizó una búsqueda electrónica en las bases de datos de PubMed, Scopus, Web of Science. hasta el año 2021. Dos revisores de forma independiente realizaron el análisis de los artículos. La búsqueda inicial dio como resultado 192 artículos. Se descartaron 59 artículos duplicados y se realizó una revisión general inicial de títulos y resúmenes, verificando que se cumplan los criterios de inclusión y exclusión preestablecidos. De 192 estudios, 25 cumplieron con los criterios de inclusión. De los 25 artículos, 10 incluyeron pacientes con factores de riesgo asociados a alveolitis seca. Respecto al sitio de extracción dental, 19 artículos incluyeron pacientes con terceros molares mandibulares. Dentro de los artículos filtrados se utilizaron tres formatos de clorhexidina: enjuague, gel bioadhesivo e irrigante; estos en diferentes concentraciones, y comparadas con distintos grupos placebos. De los estudios incluidos, 18 informaron que la clorhexidina en sus diferentes formatos proporcionaba disminución en la incidencia de alveolitis seca versus el grupo control. El uso de clorhexidina en sus diferentes formatos después de la extracción dental es altamente efectivo en la prevención de la alveolitis seca. Sin embargo, inferimos que se necesitan nuevas líneas investigativas que incluyan pacientes con factores de riesgo asociados, y estudios que no utilicen terapias complementarias, puesto que, estos factores pueden conducir a confusión en los resultados obtenidos.

The objective of this study was to investigate the role of chlorhexidine in its different formats in the prevention of dry socket after dental extraction. The electronic search was performed using keywords and MeSH terms in the databases of PubMed, Scopus, Web of Science, until 2021. The reviewers independently performed the analysis of the articles. The initial search resulted in 192 articles. 59 duplicate articles were discarded, and an initial general review of titles and abstracts was performed, verifying that the pre-established inclusion and exclusion criteria were met. Of 192 studies, 25 met the inclusion criteria. Of the 25 articles, 10 included patients with risk factors associated with dry socket. Regarding the site of dental extraction, 19 articles included patients with mandibular third molars. Within the filtered articles, three formats of chlorhexidine were used: rinse, bioadhesive gel and irrigant, in different concentrations, and compared with different placebo groups. Of the included studies, 18 reported that chlorhexidine in its different formats provided a decrease in the incidence of dry socket versus the control group. The use of chlorhexidine in its different formats after dental extraction, is highly effective in preventing dry socket. However, we infer that new research lines are needed that include patients with associated risk factors, and studies that do not use complementary therapies.

Comparison of Congenital Rubella Syndrome Cases at a Philippine Tertiary Hospital from 2009-2012 to 2019-2022

Background and Objective@#The Philippines does not have a national congenital rubella syndrome (CRS) surveillance or registry. Regular monitoring of CRS cases in hospitals, including in a Philippine tertiary hospital, helped in the past to provide clinico-epidemiologic data on CRS. This study aimed to continue providing clinico-epidemiologic data on CRS cases seen in the Philippine tertiary hospital from 2009-2012 and 2019-2022 and compare the cases seen from said timelines.@*Methods@#A cross-sectional study was used, employing chart review of patients newly diagnosed with CRS from 2009-2012 and 2019-2022 in the Department of Ophthalmology and Visual Sciences at the Philippine tertiary hospital.@*Results@#Forty-two patients newly diagnosed with CRS from 2009-2012 and 2019-2022 were included. Only 14 (33%) were serologically-confirmed cases (albeit qualitatively). Median age (first and third interquartile ranges) at consult was 1 year (0.4, 2.5). Twenty-four (57%) patients had maternal history of rashes and/or fever. Trimester of pregnancy when mother became symptomatic was not significantly correlated with chief complaint (p=0.20) and numbers of ophthalmic (p=0.68) and systemic manifestations (p=0.32). Cataract was the most common ophthalmic manifestation present in 40 (95%) patients. Twenty-six (62%) patients had other associated systemic findings of which hearing loss was the most common. Only 29 of 40 patients with cataract underwent lensectomy, with 23 patients having poor visual prognosis prior to surgery (5 with nystagmus alone, 10 with nystagmus and strabismus, and 8 with strabismus alone). @*Discussion@#Using ophthalmic manifestations as primary indicator, this study provided an update on the CRS cases in the country. Laboratory confirmation remains a challenge in diagnosing CRS as the tests are costly and not widely available. There was increase from 2009-2012 compared to 2019-2022 in number of patients who underwent surgical treatment for cataract but visual outcomes were suboptimal due to delay in consultation. Although there was a decrease in number of CRS cases seen in the Philippine tertiary hospital, this cannot be attributed to increased rubella-containing vaccine (RCV) coverage alone. @*Conclusion@#Provision of data from individual hospital-based studies similar to this highlights the need for a national CRS surveillance system or registry. This can better gauge the burden of CRS and identify the gap in RCV coverage.

Effects of prolonged waiting time on visual outcomes of patients with pediatric cataract in a Tertiary Public Hospital

Background@#Pediatric cataract is one of the most common preventable cause of childhood blindness worldwide. Early and timely intervention of pediatric cataract is important to maximize the visual outcomes and start prompt visual rehabilitation.@*Objectives@#This study aimed to determine the average time from the day of initial consult at the outpatient clinic to the day of the cataract surgery and compare the effects of delayed surgery on visual outcomes of patients.@*Methods@#This is a retrospective chart review of medical records from January 2015 to June 2022. The dates of the different steps in the process up to the day of intervention were noted and the average interval duration and the total waiting time were determined. Patients operated on within 2 weeks from initial consult was defined as no delay while those operated >2 weeks had delayed surgery. Pre-operative and post-operative best corrected log MAR visual acuity were compared within each group to determine if delay in surgical intervention has a significant effect on the visual outcomes of patients.@*Results@#Median age at initial consult was 4.9 years while median age at surgery was 5.2 years. Ninety-nine (99) patients had developmental cataract and 123 patients had bilateral cataract. Leukocoria was the most common chief complaint (63.45%). Pre-operatively, 94 patients had strabismus, 49 had eye preference, 48 had nystagmus, and 43 had amblyopia in the diagnosis. There was significantly faster admission to cataract surgery during the pandemic compared to pre-pandemic period but there was no difference in the total waiting time. Patients with congenital cataract had the least total waiting time followed by developmental, and rubella cataract. There is no significant difference in visual outcomes between patients operated without delay and with delay.@*Conclusion@#There is delayed age at diagnosis and surgery of pediatric cataract patients in the Philippine General Hospital. Early surgery did not reflect better visual outcomes compared to delayed surgery probably due to delay in consultation of patients.

Prevention and control of infection related to peripheral arterial catheter management / Prevención y control de infecciones relacionadas con el manejo del catéter arterial periférico / Prevenção e controle de infecção relacionada ao manejo de cateter arterial periférico

ABSTRACT Objective: to describe scientific evidence on good practices for peripheral arterial catheter management. Method: this is an integrative review, carried out through a search in the Latin American and Caribbean Literature in Health Sciences, Virtual Health Nursing Library, National Library of Medicine, Cochrane Library, Cumulative Index to Nursing & Allied Health, Excerpta Medica dataBASE, SciVerse Scopus TopCited and Web of Science databases in March 2021. Articles in Portuguese, English and Spanish, without time limits in the search, were included. Results: forty-nine articles were found. At insertion, measures involved hand hygiene, skin preparation, no-touch technique, aseptic technique and protective barrier, sterile components and transducers, peripheral arterial catheter insertion, insertion attempts, ultrasound and comfort measure use. During maintenance, issues regarding insertion site, invasive blood pressure circuit, connectors, dressing and stabilization were identified, and, during removal, aspects such as local and systemic complications after peripheral arterial catheter removal. Conclusion: the study provides crucial information for the effective management of peripheral arterial catheters, contributing to the reduction of complications and improvement of clinical results. By updating their practices, healthcare professionals can ensure greater safety and well-being for patients, always seeking to provide excellent care.

RESUMEN Objetivo: describir la evidencia científica sobre buenas prácticas para el manejo de catéteres arteriales periféricos. Método: revisión integradora, realizada a través de una búsqueda en las bases de datos Literatura Latinoamericana y del Caribe en Ciencias de la Salud, Biblioteca Virtual en Enfermería en Salud, National Library of Medicine, Cochrane Library, Cumulative Index to Nursing & Allied Health, Excerpta Medica dataBASE, SciVerse Scopus TopCited y Web of Science en marzo de 2021. Se incluyeron artículos en portugués, inglés y español, sin límite de tiempo en la búsqueda. Resultados: se encontraron 49 artículos. En la inserción, las medidas incluyeron higiene de manos, preparación de la piel, técnica de no contacto, técnica aséptica y barrera protectora, componentes y transductores estériles, Inserción de catéter arterial periférico, intentos de inserción, uso de ultrasonido y medidas de comodidad. Durante el mantenimiento se identificaron problemas relacionados con el sitio de inserción, circuito de presión arterial invasiva, conectores, vendaje y estabilización y, durante el retiro, aspectos como complicaciones locales y sistémicas, luego del retiro del catéter arterial periférico. Conclusión: el estudio proporciona información crucial para el manejo eficaz de los catéteres arteriales periféricos, contribuyendo a la reducción de complicaciones y mejora de los resultados clínicos. Al actualizar sus prácticas, los profesionales de la salud pueden garantizar una mayor seguridad y bienestar a los pacientes, buscando siempre brindar una excelente atención.

RESUMO Objetivo: descrever as evidências científicas sobre as boas práticas para o manejo de cateter arterial periférico. Método: revisão integrativa, realizada por meio de busca nas bases de dados Literatura Latino-Americana e do Caribe em Ciências da Saúde, Biblioteca Virtual em Saúde Enfermagem, National Library of Medicine, Cochrane Library, Cumulative Index to Nursing & Allied Health, Excerpta Medica dataBASE, SciVerse Scopus TopCited e Web of Science em março de 2021. Foram incluídos artigos em português, inglês e espanhol, sem delimitação de tempo na busca. Resultados: foram encontrados 49 artigos. Na inserção, as medidas envolveram higienização das mãos, preparo da pele, técnica no touch, técnica asséptica e barreira de proteção, componentes estéreis e transdutores, inserção do cateter arterial periférico, tentativas de inserção, uso do ultrassom e medidas de conforto. Na manutenção, questões sobre o sítio de inserção, circuito da pressão arterial invasiva, conectores, curativo e estabilização foram identificadas e, na retirada, aspectos como complicações locais e sistêmicas, após retirada do cateter arterial periférico. Conclusão: o estudo fornece informações cruciais para o eficaz manejo do cateter arterial periférico, contribuindo para a redução de complicações e aprimoramento dos resultados clínicos. Ao atualizar suas práticas, os profissionais de saúde podem assegurar maior segurança e bem-estar aos pacientes, buscando sempre oferecer um atendimento de excelência.

A spatial case-control study on symptomatic and inapparent primary dengue infections in an endemic city in Brazil

ABSTRACT We conducted a spatial case-control study nested in a dengue incidence cohort to explore the role of the spatial and socioeconomic factors in the proportion of symptomatic (cases) and inapparent primary dengue virus infections (controls). Cohort participants were children and adolescents (2 to 16 years of age) at the beginning of the follow-up. Case definitions were, for symptomatic cases, fever plus a positive lab result for acute dengue (NS1, RT-PCR, ELISA IgM/IgG), and for inapparent infection a positive result for dengue IgG (ELISA) in subjects without symptoms and with a previously negative result at baseline. The covariates included sociodemographic factors, residential location, and socioeconomic context variables of the census tracts of residence of cases and controls. We used principal component analysis to reduce the contextual covariates, with the component values assigned to each one based on their residences. The data were modeled in a Bayesian context, considering the spatial dependence. The final sample consisted of 692 children, 274 cases and 418 controls, from the first year of follow-up (2014-2015). Being male, older age, higher educational level of the head of the family and having a larger number of rooms in the household were associated with a greater chance of presenting dengue symptomatic infection at the individual level. The contextual covariates were not associated with the outcome. Inapparent dengue infection has extensive epidemiological consequences. Relying solely on notifications of symptomatic dengue infections underestimates the number of cases, preserves a silent source of the disease, potentially spreading the virus to unaffected areas.

Avaliação da qualidade do sono em profissionais de saúde da emergência / Evaluación de la calidad del sueño en profesionales de la salud de emergencia / Sleep quality assessment in emergency health professionals

Resumo Objetivo Avaliar a qualidade do sono de profissionais dos serviços de emergência e sua associação com o nível de fadiga e qualidade de vida. Métodos Estudo descritivo, transversal e correlacional, realizado nas unidades do Serviço de Atendimento Móvel de Urgência (SAMU) e na Unidade de Pronto Atendimento (UPA), no ano de 2021, com 108 participantes. Para avaliação da qualidade do sono, foi utilizado o Índice de Qualidade do Sono de Pittsburgh versão Brasileira (PSQI-BR); para avaliação da Fadiga, foi utilizada a Escala de Fadiga de Chalder, em conjunto com a Escala de Necessidade de Descanso (ENEDE); e para avaliação da qualidade de vida, foi utilizado o World Health Organization Quality of Life Brief Version (WHOQOL-bref), sendo que os instrumentos utilizados foram adaptados para a língua portuguesa em estudos anteriores. Foram aplicados testes de associação para a análise estatística, tendo sido utilizados o Teste Qui-Quadrado de Pearson, o Teste U Mann-Whitney ou Kruskal Wallis e a correlação de Spearman. Valores de p <0,05 foram considerados como significativos. Resultados Foi identificado que 72,2% dos participantes apresentaram má qualidade do sono e 75,9% estavam fadigados. Foi observada associação significativa entre a qualidade do sono e a fadiga, a necessidade de descanso e a qualidade de vida. Conclusão Foi identificado que os profissionais de saúde que trabalham em serviço de urgência e emergência apresentam má qualidade do sono e de vida e níveis elevados de fadiga e necessidade de descanso, o que pode impactar diretamente suas atividades pessoais e profissionais.

Resumen Objetivo Evaluar la calidad del sueño de profesionales de los servicios de emergencia y su relación con el nivel de fatiga y calidad de vida. Métodos Estudio descriptivo, transversal y correlacional, realizado en las unidades del Servicio de Atención Móbil de Urgencia (SAMU) y en la Unidad de Pronta Atención (UPA), en el año 2021, con 108 participantes. Para evaluar la calidad del sueño, se utilizó el Índice de Calidad del Sueño de Pittsburgh, versión brasileña (PSQI-BR). Para evaluar la fatiga, se utilizó la Escala de Fatiga de Chalder, junto con la Escala de Necesidad de Descanso (ENEDE). Para evaluar la calidad de vida, se utilizó el World Health Organization Quality of Life Brief Version (WHOQOL-bref). Los instrumentos utilizados fueron adaptados al idioma portugués en estudios anteriores. Se aplicaron pruebas de asociación para el análisis estadístico, para lo cual se utilizó la Prueba χ2 de Pearson, la Prueba U de Mann-Whitney o la prueba de Kruskal-Wallis y la correlación de Spearman. Se consideraron valores de p<0,05 como significativos. Resultados Se identificó que el 72,2 % de los participantes presentó una mala calidad de sueño y el 75,9 % tenía fatiga. Se observó una asociación significativa entre la calidad del sueño y la fatiga, la necesidad de descanso y la calidad de vida. Conclusión Se identificó que los profesionales de la salud que trabajan en servicios de urgencia y emergencia presentaron mala calidad de sueño y de vida y niveles elevados de fatiga y necesidad de descanso, lo que puede impactar directamente en sus actividades personales y profesionales.

Abstract Objective To assess emergency service professionals' sleep quality and its association with the level of fatigue and quality of life. Methods A descriptive, cross-sectional and correlational study, carried out in the units of the Mobile Emergency Care Service (SAMU) and in the Emergency Care Unit (ECU), in 2021, with 108 participants. To assess sleep quality, the Pittsburgh Sleep Quality Index, Brazilian version (PSQI-BR), was used; to assess fatigue, the Chalder Fatigue Scale was used, together with the Need for Recovery Scale (NFR); and to assess quality of life, the World Health Organization Quality of Life Brief Version (WHOQOL-bref) was used, and the instruments used were adapted to Portuguese in previous studies. Association tests were applied for statistical analysis, using Pearson's chi-square test, Mann-Whitney U test or Kruskal Wallis and Spearman's correlation. P-values <0.05 were considered significant. Results It was identified that 72.2% of participants had poor sleep quality and 75.9% were fatigued. A significant association was observed between sleep quality and fatigue, the need for recovery and quality of life. Conclusion It was identified that health professionals working in emergency services have poor sleep quality and life, and high levels of fatigue and need for recovery, which can directly impact their personal and professional activities.

Trastornos respiratorios del sueño en pediatría: avances en tiempos pandémicos

Los avances en medicina del sueño son de gran relevancia para enfrentar adecuadamente los trastornos del sueño en niños y adolescentes, procurando mitigar sus efectos multisistémicos y llevando a la práctica conductas de un mejor estándar. Este artículo de revisión se enfoca en mostrar los principales avances sobre trastornos respiratorios del sueño, refiriéndonos a las experiencias publicadas durante estos años de pandemia sobre avances epidemiológicos, consecuencias cardiovasculares, lectura de estudios de sueño y estudios domiciliarios; finalmente aspectos sobre tratamiento quirúrgico versus conservador, soporte ventilatorio y dispositivos autorregularles ambulatorios para titulación.

Advances in sleep medicine are of great relevance to adequately address sleep disorders in children and adolescents, seeking to reduce their multisystem effects and implementing better standard behaviors. This review article focuses on showing the main advances on sleep-disordered breathing, referring to the experiences published during these pandemic years on epidemiological advances, cardiovascular consequences, reading sleep studies and home studies; finally, aspects of surgical versus conservative treatment, ventilatory support and ambulatory self-regulating devices for titration.

The impact of the COVID-19 pandemic on sleep disorders among Nursing professionals / O impacto da pandemia de COVID-19 nas alterações do sono de profissionais de enfermagem / Impacto de la pandemia de COVID-19 en los trastornos del sueño de profesionales de enfermería

Abstract Objective: to analyze the factors related to sleep disorders reported by Nursing professionals during the COVID-19 pandemic. Method: this is a cross-sectional and analytical study conducted with Nursing professionals from all Brazilian regions. Sociodemographic data, working conditions and questions about sleep disorders were collected. The Poisson regression model with repeated measures was used to estimate the Relative Risk. Results: 572 answers were analyzed, which revealed that non-ideal sleep duration, poor sleep quality and dreams about the work environment were predominant during the pandemic, with 75.2%, 67.1% and 66.8% respectively; as well as complaints of difficulty sleeping, daytime sleepiness and non-restorative sleep during the pandemic were reported by 523 (91.4%), 440 (76.9%) and 419 (73.2%) of the Nursing professionals, respectively. The relative risk of having such sleep disorders during the pandemic was significant for all variables and categories studied. Conclusion: non-ideal sleep duration, poor sleep quality, dreams about the work environment, complaints regarding difficulty sleeping, daytime sleepiness and non-restorative sleep were the predominant sleep disorders among Nursing professionals during the pandemic. Such findings point to possible consequences on health, as well as on the quality of the work performed.

Resumo Objetivo: analisar os fatores relacionados às alterações no sono relatadas pelos profissionais de enfermagem durante a pandemia de COVID-19. Método: trata-se de um estudo transversal e analítico, realizado com profissionais de enfermagem de todas as regiões do Brasil. Foram coletados dados de caracterização sociodemográfica, condições de trabalho e questões sobre alterações de sono. Para estimar o Risco Relativo foi utilizado o modelo de regressão de Poisson com medidas repetidas. Resultados: foram analisadas 572 respostas, as quais revelaram que a duração não ideal do sono, a má qualidade do sono e os sonhos com o ambiente de trabalho foram predominantes durante a pandemia, com 75,2%, 67,1% e 66,8% respectivamente, assim como as queixas de dificuldade ao dormir, sonolência diurna e sono não restaurador durante a pandemia foram relatadas por 523 (91,4%), 440 (76,9%) e 419 (73,2%) dos profissionais de enfermagem, respectivamente. O risco relativo de apresentar tais alterações de sono, durante a pandemia foi significativo para todas as variáveis e as categorias estudadas. Conclusão: duração não ideal do sono, má qualidade do sono, sonhos com o ambiente de trabalho, queixas de dificuldade ao dormir, sonolência diurna e sono não restaurador foram as alterações do sono predominantes entre os profissionais de enfermagem durante a pandemia. Estes achados apontam para possíveis consequências na saúde, bem como na qualidade do trabalho realizado.

Resumen Objetivo: analizar los factores relacionados con los trastornos del sueño que informaron los profesionales de enfermería durante la pandemia de COVID-19. Método: se trata de un estudio transversal y analítico realizado con profesionales de enfermería de todas las regiones de Brasil. Se recolectaron datos sobre caracterización sociodemográfica, condiciones de trabajo y preguntas sobre trastornos del sueño. Para estimar el Riesgo Relativo se utilizó el modelo de regresión de Poisson con medidas repetidas. Resultados: se analizaron 572 respuestas, que revelaron que durante la pandemia predominaron la duración del sueño no ideal, la mala calidad del sueño y los sueños sobre el ambiente laboral, con 75,2%, 67,1% y 66,8% respectivamente, además 523 (91,4%), 440 (76,9%) y 419 (73,2%) profesionales de enfermería manifestaron quejas de dificultad para conciliar el sueño, somnolencia diurna y sueño no reparador durante la pandemia, respectivamente. El riesgo relativo de padecer trastornos del sueño durante la pandemia fue significativo para todas las variables y categorías estudiadas. Conclusión: la duración del sueño no ideal, la mala calidad del sueño, los sueños sobre el ambiente laboral, las quejas de dificultad para conciliar el sueño, la somnolencia diurna y el sueño no reparador fueron los trastornos del sueño predominantes en los profesionales de enfermería durante la pandemia. Estos hallazgos indican posibles consecuencias para la salud, así como para la calidad del trabajo realizado.

Validation of the Filipino translation of the impact of vision impairment for children (IVI_C) questionnaire among school children

Background@#Quality of life questionnaires provide valuable information in assessing the effects of health interventions and public health campaigns. In the Philippines, we only have a few validated questionnaires targeted specifically for children.@*Objective@#To translate to Filipino and validate the translated Impact of Vision Impairment for Children Questionnaire (IVI_C).@*Methods@#This is a translation and validation study of the IVI_C. The IVI_C was translated following international guidelines of forward–translation and back-translation methods. After completion of the Filipino IVI_C version, pretesting was performed on school-aged children 8 to 18 years old through convenience sampling in the outpatient department and Pediatric Ophthalmology and Motility Clinic at Sentro Oftalmologico Jose Rizal, Philippine General Hospital from January 1 to August 31, 2018.@*Results@#We included 130 participants in the study. The calculated Cronbach’s alpha coefficient of 0.88 for the translated Filipino version of the IVI_C suggested high reliability and internal consistency. Rasch analysis showed comparability of the Filipino translation to the original English version of the questionnaire.@*Conclusion@#Our study showed that the Filipino version of IVI_C questionnaire was of high reliability and validity.

Outcome of strabismus surgery for exotropia in a 4-year-old with silver-russell syndrome (SRS): A case report

@#Silver-Russell Syndrome (SRS) is a rare disorder associated with prenatal and postnatal growth retardation with associated characteristic facial and ocular features including strabismus. We report the outcome of strabismus surgery performed for exotropia in a 4-year-old patient with SRS. The patient presented with decreased visual acuity and constant exotropia of the right eye noted since 3 months of age. Systemic SRS characteristics consisted of relative macrocephaly, short stature, forehead prominence and stunted growth pattern. An X-pattern exotropia is consistent with bilateral tight lateral recti muscles with overelevation in adduction of the left eye was present. Patient underwent unilateral right lateral rectus recession and right medial rectus resection for a 50-prism diopter constant exotropia. Patient had a favorable outcome of within 8 prism diopters from orthotropia at 1st, 3rd-, 6th- and 12th-month post-operatively.

Ocular manifestations of two Filipinos with congenital fibrosis of the extraocular muscles

@#Congenital fibrosis of the extraocular muscles (CFEOM) is a rare, congenital, non-progressive disorder presenting with partial or total ophthalmoplegia, with variable degrees of ptosis in both eyes. We present the clinical manifestations of congenital fibrosis of the extraocular muscles in two patients. Both patients presented with bilateral ptosis and variable ophthalmoplegia with a chin-up posture. The ocular deviations have been noted since birth. No patient demonstrated a Marcus-Gunn jaw-winking phenomenon. Both patients had a mild refractive error with with-the-rule astigmatism. Deviation for both patients revealed exotropia with varying amounts of hypotropia and limitations in the movement of extraocular muscles. Both patients presented no abnormalities in the pupils. Neuroimaging revealed atrophy of the extraocular muscles. Diagnosis of CFEOM in a resource-poor setting is also challenging due to inaccessible gene testing. Manifestations of CFEOM vary across affected patients. CFEOM proposes challenges to the ophthalmologist with regards to management.

Spontaneous consecutive exotropia after conservative management of accommodative esotropia

@#Spontaneous consecutive exotropia (SCXT) in conservatively managed accommodative esotropia is not widely discussed. The author presents a case series of 4 patients with SCXT describing patient characteristics and possible risk factors. Management modifications based on this series are proposed. Four cases of patients who initially presented with accommodative esotropia and later developed SCXT are presented. The age range at presentation was between 4 months to 3 years, with total follow-up ranging between 8–15 years. All four cases presented with esotropia on or before the age of 3 years, with initial hyperopia ranging between +1.50 to +4.25. The SCXT occurred between ages 2–7 years. Possible risk factors identified include amblyopia, dissociated vertical deviation, rapid control of esodeviation, inferior oblique overaction, and poor follow-up during the course of their strabismus. The author recommends earlier tapering of hyperopia correction following initial control with full cycloplegic refraction. Identified risk factors should alert the specialists to be wary of SCXT.

Long term follow-up of retropupillary fixation of iris-clipped intraocular lens for children with inadequate capsular support

@#Children with weak or absent capsular support requiring lens removal and intraocular lens implantation present as one of the more challenging cases in pediatric ophthalmology practice. The authors present a case series with postoperative follow-up of at least five years after retropupillary fixation of iris-clipped lenses. All cases had improved visual acuity with only minor focal iris atrophy as complication in one case. Retropupillary fixation of iris-clipped IOL should be included in an ophthalmologist's armamentarium when operating on cases with weak or absent capsular support.

Pandemic challenge accepted: The Philippine Board of Ophthalmology shifts to online administration of its certifying examinations

@#The ongoing global COVID-19 pandemic triggered a series of events that resulted in the disruption of the delivery of various certifying examinations including that which was given by the Philippine Board of Ophthalmology (PBO). This paper shares the experience of the PBO using digital technology in administering its first ever online delivery of its certifying examinations. Online platform requirements used for delivering the examination are enumerated, online proctoring described, as well as the conduct of oral panel examinations and skills evaluation via video submission. Challenges encountered, feedback reported by both examinee and examiner, lessons learned from this endeavor, and future directions are discussed.

Assistência à saúde mental nos serviços médicos de emergência: revisão integrativa / Asistencia a la salud mental en los servicios médicos de emergencia: revisión integrativa / Mental health care in emergency medical services: an integrative review

Objetivos: conhecer as características da assistência à saúde mental dispensada por profissionais de enfermagem nos serviços médicos de emergência. Método: revisão integrativa de literatura nas bases de dados Literatura Latino-Americano e do Caribe em Ciências da Saúde (LILACS), Publisher Medline (PUBMED), SciVerse Scopus (SCOPUS) e Cumulative Index to Nursing and Allied Health Literature (CINAHL), no período de março a junho de 2023, utilizando-se critérios de inclusão e exclusão previamente definidos. Resultados: obteve-se uma amostra final de 59 artigos os quais foram agrupados nas seguintes categorias temáticas: concepções em saúde mental, comunicação, intervenções, atendimento em rede, competência em cuidado em saúde mental e barreiras durante os atendimentos. Conclusão: o cuidado é feito de forma incipiente e permeado por elementos dificultadores. Os achados do presente estudo servem para rever e repensar práticas e políticas de cuidado em saúde mental e promover estratégias de aperfeiçoamento dos processos de trabalho.

Objetivos: conocer las características de la asistencia a la salud mental dispensada por profesionales de enfermería en los servicios médicos de emergencia. Método: revisión integrativa de literatura en las bases de datos Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS), Publisher Medline (PUBMED), SciVerse Scopus (SCOPUS) y Cumulative Index to Nursing and Allied Health Literature (CINAHL), en el período de marzo a junio de 2023, utilizando criterios de inclusión y exclusión previamente definidos. Resultados: se obtuvo una muestra final de 59 artículos los cuales fueron agrupados en las siguientes categorías temáticas: concepciones en salud mental, comunicación, intervenciones, atención en red, competencia en atención en salud mental y barreras durante los atendimientos. Conclusión: el cuidado es hecho de forma incipiente y permeado por elementos difíciles. Los hallazgos del presente estudio sirven para revisar y repensar prácticas y políticas de cuidado en salud mental y promover estrategias de perfeccionamiento de los procesos de trabajo.

Objective: to know the characteristics of mental health care provided by nursing professionals in emergency medical services. Method: integrative literature review in the databases Latin American and Caribbean Health Sciences Literature (LILACS), Publisher Medline (PUBMED), SciVerse Scopus (SCOPUS) and Cumulative Index to Nursing and Allied Health Literature (CINAHL), from March to June 2023, using previously defined inclusion and exclusion criteria. Results: the final sample included 59 articles, which were grouped into the following thematic categories: conceptions in mental health, communication, interventions, network care, competence in mental health care and barriers during care. Conclusion: care is done incipient and permeated by difficult elements. The findings of this study serve to review and rethink mental health care practices and policies and promote strategies for improving work processes.

Antiproliferative effects of 13α/ß-steroids on triple-negative MDA-MB-231 breast cancer cells: unraveling intracellular signaling without ERα

Abstract This study aimed to investigate the activities of novel 20(R)-3,20-dihydroxy-19-norpregn-1,3,5(10)-trienes (kuz7 and kuz8b) of natural 13ß- and epimeric 13α-series against triple-negative MDA-MB-231 breast cancer cells. High antiproliferative activity of synthesized compounds kuz8b and kuz7 against MDA-MB-231 triple-negative cancer cells was revealed. The steroid kuz7 of natural 13ß-configuration was more active against MDA-MB-231 cells than the 13α-steroid kuz8b. Cell cycle analysis revealed common patterns for the action of both tested compounds. The number of cells in the subG1 phase increased in a dose-dependent manner, indicating induction of apoptosis, which was also verified by PARP cleavage. In contrast, the number of cells in the G0/G1 phase decreases with increasing compound concentration. Steroid kuz7 at micromolar concentrations reduced the expression of GLUT1, a glucose transporter. High efficacy of the combination of kuz7 with biguanide metformin was shown, and synergistic effects on MDA-MB-231 cell growth and expression of the anti-apoptotic protein Bcl-2 were revealed. According to the obtained results, including the high activity of kuz7 against triple-negative cancer cells, the detected induction of apoptosis, and the decrease in GLUT1 expression, 13ß-steroid kuz7 is of interest for further preclinical studies both alone and in combination with the metabolic drug metformin

Secondary prevention in coronary artery disease: development and content validity of educational messages for mobile phones / Prevenção secundária na doença arterial coronariana: desenvolvimento e validade de conteúdo de mensagens educativas para celulares / Prevención secundaria en la enfermedad de las arterias coronarias: desarrollo y validez de contenido de mensajes educativos para teléfonos móviles

ABSTRACT Objective: To identify information needs of patients with coronary artery disease and develop and validate the content of educational messages for mobile phones for these patients. Method: The study was carried out in three phases: 1) Identification of information needs in relation to coronary artery disease of patients hospitalized for an acute coronary event; 2) Development of templates containing text and pictures about the disease and treatment; 3) Content validity analysis of template evidence through the assessment of 10 experts. Templates were considered validated when the Content Validity Ratio (CVR) was equal to or greater than 0.80. Results: A total of 67 patients were included, and all the information that emerged about the disease was classified as important to very important. Thirty templates were developed (heart function, recommendations on nutrition and exercise, treatments and medications, and clinical signs related to the disease and risk factor control), and the CVR obtained was greater than 0.80. Conclusion: All information needs were categorized by patients as important or very important. The templates were developed and validated considering content and design.

RESUMO Objetivo: Identificar as informações sobre necessidades de pacientes com doença arterial coronariana e desenvolver e validar o conteúdo de mensagens educativas para celulares para esses pacientes. Método: O estudo foi realizado em três fases: 1) Identificação das informações sobre necessidades em relação à doença arterial coronariana de pacientes internados por evento coronariano agudo; 2) Desenvolvimento de templates contendo textos e imagens sobre a doença e tratamento; 3) Análise da validade de conteúdo das evidências do template por meio da avaliação de 10 especialistas. Os templates foram considerados validados quando a Razão de Validade de Conteúdo (RVC) foi igual ou superior a 0,80. Resultados: Foram incluídos 67 pacientes, e todas as informações que surgiram sobre a doença foram classificadas como importantes a muito importantes. Foram desenvolvidos 30 templates (função cardíaca, recomendações de nutrição e exercícios, tratamentos e medicamentos, sinais clínicos relacionados à doença e controle de fatores de risco), e a RVC obtida foi superior a 0,80. Conclusão Todas as necessidades de informação foram categorizadas pelos pacientes como importantes ou muito importantes. Os templates foram desenvolvidos e validados considerando conteúdo e design.

RESUMEN Objetivo: Identificar las necesidades de información de los pacientes con enfermedad de las arterias coronarias y desarrollar y validar el contenido de mensajes educativos para teléfonos celulares para estos pacientes. Método: El estudio se realizó en tres fases: 1) Identificación de necesidades de información sobre enfermedad de las arterias coronarias en pacientes hospitalizados por evento coronario agudo; 2) Desarrollo de templates que contienen textos e imágenes sobre la enfermedad y el tratamiento; 3) Análisis de la validez de contenido de la evidencia del template a través de la evaluación de 10 expertos. Los templates se consideraron validadas cuando el Razón de Validez de Contenido (RVC) fue igual o superior a 0,80. Resultados: Se incluyeron 67 pacientes y toda la información que surgió sobre la enfermedad se clasificó como importante a muy importante. Se desarrollaron 30 templates (función cardiaca, recomendaciones de nutrición y ejercicio, tratamientos y medicamentos, signos clínicos relacionados con la enfermedad y control de factores de riesgo), y la RVC obtenida fue superior a 0,80. Conclusión: Todas las necesidades de información fueron categorizadas por los pacientes como importantes o muy importantes. Los templates fueron desarrollados y validados considerando contenido y diseño.

Quality of life of nurse practitioners during the COVID-19 pandemic / Calidad de vida de los profesionales de enfermería durante la pandemia del COVID-19 / Qualidade de vida dos profissionais de enfermagem durante a pandemia de COVID-19

ABSTRACT Objective: to assess the quality of life of nurse practitioners during the COVID-19 pandemic and analyze related factors. Methods: cross-sectional and analytical study carried out with nurse practitioners. A questionnaire on sociodemographic characterization, work activities and changes perceived with the pandemic and WHOQOL-bref were used. To compare the groups of interest, analysis of covariance was used. Results: 572 professionals participated, who had a mean total quality of life score of 56.79 (SD=13.56). In the relationship of variables with WHOQOL-bref, having two or more jobs and being a nurse were associated with better quality of life, but being a woman and working more than 50 hours a week was associated with a worse perception of the construct. Conclusions: the factors analyzed indicate a lower perception of quality of life associated with the social domain, requiring interventions that reduce the damage to professionals' health and contribute to quality of care provided.

RESUMEN Objetivo: evaluar la calidad de vida de los profesionales de enfermería durante la pandemia del COVID-19 y analizar los factores relacionados. Métodos: estudio transversal y analítico realizado con profesionales de enfermería. Se utilizó un cuestionario sobre caracterización sociodemográfica, actividades laborales y cambios percibidos con la pandemia y WHOQOL-bref. Para comparar los grupos de interés se utilizó el análisis de covarianza. Resultados: participaron 572 profesionales, quienes tuvieron una puntuación media de calidad de vida total de 56,79 (DE=13,56). En la relación de las variables con el WHOQOL-bref, tener dos o más trabajos y ser enfermera se asociaron a una mejor calidad de vida, pero ser mujer y trabajar más de 50 horas semanales se asoció a una peor percepción del constructo. Conclusiones: los factores analizados indican una menor percepción de la calidad de vida asociada al dominio social, requiriendo intervenciones que reduzcan el daño a la salud de los profesionales y contribuyan a la calidad de la atención brindada.

RESUMO Objetivo: avaliar a qualidade de vida dos profissionais de enfermagem durante a pandemia de COVID-19 e analisar os fatores relacionados. Métodos: estudo transversal e analítico, realizado com profissionais de enfermagem. Utilizaram-se questionário de caracterização sociodemográfica, atividades do trabalho e mudanças percebidas com a pandemia e WHOQOL-bref. Para comparar os grupos de interesse, adotou-se a análise de covariância. Resultados: participaram 572 profissionais, os quais apresentaram escore total médio de qualidade de vida de 56,79 (DP=13,56). Na relação das variáveis com o WHOQOL-bref, ter dois ou mais vínculos de trabalho e ser enfermeiro estavam associados à melhor qualidade de vida, mas ser mulher e cumprir carga horária superior a 50 horas semanais associou-se à pior percepção do construto. Conclusões: os fatores analisados indicam menor percepção de qualidade de vida associados ao domínio social, sendo necessárias intervenções que reduzam os prejuízos à saúde dos profissionais e contribuam com a qualidade da assistência oferecida.

Conhecimento e atitudes de pais de crianças/adolescentes sobre papillomavirus humano: estudo transversal / Conocimiento y actitudes de padres de niños/adolescentes sobre el virus del papiloma humano: estudio transversal / Knowledge and attitudes of parents of children/adolescents about human papillomavirus: cross-sectional study

Resumo Objetivo Analisar as características associadas aos pais de crianças e adolescentes que ouviram falar sobre o Papillomavirus humano, bem como o conhecimento sobre a infecção e a intenção de vacinar seus filhos. Métodos Estudo transversal com abordagem quantitativa, realizado por meio de entrevista utilizando instrumento estruturado. Entrevistaram-se 376 pais de crianças e adolescentes que aguardavam atendimento pediátrico em unidades de saúde de Três Lagoas/MS. Os dados coletados (características sociodemográficas; características reprodutivas e sexuais; conhecimento sobre o Papillomavirus humano e intenção de vacinar o/a filho/a) foram analisados por meio de técnica de estatística descritiva, teste de associação Qui-quadrado ou exato de Fisher e Teste T Student. Resultados Dentre os entrevistados, 327 (87,0%) afirmaram ter ouvido falar sobre o Papillomavirus humano. Identificou-se associação entre os pais que nunca ouviram falar sobre a infecção e sexo masculino, idade entre 18 e 25 anos e ensino fundamental incompleto. Dentre os pais que ouviram falar sobre o Papilomavírus Humano, 152 (46,5%) afirmaram que é uma infecção sexualmente transmissível, 245 (74,9%) garantiram que a transmissão ocorre através da relação sexual desprotegida, 275 (75,5%) desconhecem seus sinais e sintomas, 218 (66,7%) afirmaram erroneamente que tal infecção tem cura e 283 (86,5%) sabem da existência da vacina. Dentre todos os entrevistados, 98,1% levariam seu(ua) filho(a) para vacinar contra o vírus. Conclusão Observaram-se lacunas no conhecimento dos pais de crianças e adolescentes sobre o Papillomavirus humano, mostrando a necessidade de educação em saúde e divulgação de ações de enfrentamento à infecção em meios de comunicação e redes sociais.

Resumen Objetivo Analizar las características asociadas a padres de niños y adolescentes que escucharon hablar sobre el virus del papiloma humano, así como el conocimiento sobre la infección y la intención de vacunar a sus hijos. Métodos Estudio transversal, con enfoque cuantitativo, realizado por medio de encuesta con instrumento estructurado. Se encuestaron 376 padres de niños y adolescentes que esperaban atención pediátrica en unidades de salud de Três Lagoas, estado de Mato Grosso do Sul. Los datos recopilados (características sociodemográficas, características reproductivas y sexuales, conocimiento sobre el virus del papiloma humano e intención de vacunar al hijo/a) se analizaron por medio de técnica de estadística descriptiva, prueba de asociación ji cuadrado o prueba exacta de Fisher y test-T Student. Resultados Entre los encuestados, 327 (87,0 %) afirmaron haber escuchado hablar sobre el virus del papiloma humano. Se identificó relación entre los padres que nunca escucharon hablar sobre la infección y el sexo masculino, edad entre 18 y 25 años y educación primaria incompleta. De los padres que escucharon hablar sobre el virus del papiloma humano, 152 (46,5 %) afirmaron que es una infección de transmisión sexual, 245 (74,9 %) aseguraron que la transmisión ocurre a través de las relaciones sexuales sin protección, 275 (75,5 %) desconocen sus signos y síntomas, 218 (66,7 %) afirmaron erróneamente que tal infección tiene cura, y 283 (86,5 %) saben de la existencia de la vacuna. Entre los encuestados, el 98,1 % llevaría a su hijo/a vacunarse contra el virus. Conclusión Se observaron vacíos de conocimiento en los padres de niños y adolescentes sobre el virus del papiloma humano, lo que muestra la necesidad de educación para la salud y difusión de acciones para enfrentar la infección en medios de comunicación y redes sociales.

Abstract Objective Analyze the characteristics associated with the parents of children and adolescents who have heard about the human papillomavirus, as well as the knowledge about the infection and the intention to vaccinate their children. Methods Cross-sectional study with quantitative approach, conducted through a structured interview. We interviewed 376 parents of children and adolescents who were awaiting pediatric care at health services in Três Lagoas/MS. The collected data (sociodemographic characteristics; reproductive and sexual characteristics; knowledge about human papillomavirus and intention to vaccinate the child) were analyzed using descriptive statistics, Fisher's exact test or the chi-square association test and Student's t-test. Results Among the respondents, 327 (87.0%) said they had heard about the human papillomavirus. An association was identified between parents who had never heard of the infection and male sex, age between 18 and 25 years and unfinished primary education. Among the parents who had heard about the human papillomavirus, 152 (46.5%) stated that it is a sexually transmitted infection, 245 (74.9%) assured that the transmission occurs through unprotected sexual intercourse, 275 (75.5%) are unaware of its signs and symptoms, 218 (66.7%) mistakenly stated that this infection is curable and 283 (86.5%) know of the existence of the vaccine. Among all respondents, 98.1% would take their child to get vaccinated against the virus. Conclusion Gaps were observed in the knowledge of the parents of children and adolescents about the human papillomavirus, showing the need for health education and dissemination of actions to cope with the infection in the media and social networks.

Fishing methods and occupational safety practices of fishermen in a coastal municipality of Central Luzon

@#<p style="text-align: justify;"><strong>Objective:</strong> This study aims to explore the fishing methods and occupational safety practices of fisherfolk in a coastal municipality in Central Luzon.</p><p style="text-align: justify;"><strong>Methods:</strong> Key informant interviews were conducted with leaders of fishing organizations and the Municipal Agricultural Officer using a semi-structured interview guide.</p><p style="text-align: justify;"><strong>Results:</strong> Fisherfolk in the selected municipality adopted a variety of fishing practices, equipment, and methods suitable for each individual or group of fisherfolk. Safety practices were either self-learned from observation of elders and family members or arose from a trial-and-error basis, with an emphasis on precautionary measures to avoid injury.</p><p style="text-align: justify;"><strong>Conclusion:</strong> Fishing practices highly varies, the most prominent of which is using numerous equipment for catching fish and other marine products by hand. Occupational safety practices are mainly focused on the avoidance of hazards.</p>