Prevalência de nascimentos prematuros como desfechos de infecções pela COVID-19 na gestação / Prevalence of Preterm Birth as an Outcome of COVID-19 Infections during Pregnancy / Prevalencia de nacimientos prematuros producto de la infección por COVID-19 durante el embarazo

Objetivo: estimar a prevalência de nascimento prematuro em gestantes infectadas pela Covid-19, comparar índices de prematuridade entre infectadas e não infectadas e elucidar fatores associados à prematuridade. Métodos: coorte retrospectiva, com coleta de dados por inquérito online, de abril a dezembro de 2022, com mulheres que estiveram gestantes durante a pandemia, com acesso à internet, idade superior a 18 anos e que preencheram o primeiro inquérito online. Protocolo de pesquisa aprovado pelo Comitê de Ética. Resultados: primeiro inquérito respondido por 304 gestantes/puérperas, e o segundo por 82 (27%), compondo a amostra final. O índice de prematuridade no primeiro inquérito foi de 7,2% (n=14), já no segundo, 8,5% (n=7). A infecção pela Covid-19 não foi associada à prematuridade. A prematuridade associou-se a baixo peso, à necessidade de internação em centros de terapia intensiva neonatal e internações após o nascimento. Conclusão: a infecção pela Covid-19 não influenciou no aumento de nascimentos prematuros.

Objective: to estimate the prevalence of preterm birth in pregnant women infected with Covid-19, compare prematurity rates between infected and non-infected, and elucidate factors associated with prematurity. Methods: a retrospective cohort study was conducted using online survey data collected from April to December 2022, involving women who were pregnant during the pandemic, had internet access, were over 18 years old, and completed the initial online survey. The research protocol was approved by the Ethics Committee. Results: the initial survey was completed by 304 pregnant/postpartum women, and the follow-up survey by 82 (27%), comprising the final sample. The preterm birth rate in the initial survey was 7.2% (n=14), and in the follow-up survey, it was 8.5% (n=7). Covid-19 infection was not associated with prematurity. Prematurity was associated with low birth weight, the need for neonatal intensive care unit admission, and postnatal hospitalizations. Conclusion: Covid-19 infection did not influence an increase in preterm births.

Objetivo: estimar la prevalencia de partos prematuros en gestantes infectadas por Covid-19, comparar las tasas de prematuridad entre gestantes infectadas y no infectadas y determinar los factores asociados a la prematuridad. Métodos: estudio de cohorte retrospectivo, con recolección de datos mediante encuesta online, de abril a diciembre de 2022, con mujeres que estuvieron embarazadas durante la pandemia, con acceso a internet, mayores de 18 años y que completaron la primera encuesta online. El protocolo de investigación fue aprobado por el Comité de Ética. Resultados: la primera encuesta fue respondida por 304 gestantes/puérperas, y la segunda por 82 (27%), que conformaron la muestra final. La tasa de prematuridad en la primera encuesta fue del 7,2% (n=14), en la segunda, del 8,5% (n=7). La infección por Covid-19 no se asoció con la prematuridad. La prematuridad se asoció con bajo peso, necesidad de internación en centros de cuidados intensivos neonatales e internaciones después del nacimiento. Conclusión: La infección por Covid-19 no influyó en el aumento de nacimientos prematuros.

Hyaline cartilage at the portal plate and gallbladder in biliary atresia

ABSTRACT Biliary atresia (BA) is a fibro-obliterative cholestatic disease of infancy. The presence of cartilage in the resected tissue is an uncommon finding. We documented the presence of both mature and immature hyaline cartilage in the portal plate and the wall of the gallbladder in a 2-month-old girl infant with BA who had undergone Kasai portoenterostomy. The presence of cartilage could be part of a heterotopia or an uncommon connective tissue metaplasia. The presence of immature cartilage with the merging of the perichondrium with the soft tissue highlights a metaplastic etiology in the index case.

Human papillomavirus in women infected with human immunodeficiency virus: association with viral load and lymphocyte count

ABSTRACT Women living with human immunodeficiency virus are at an increased risk of developing cancers related to human papillomavirus (HPV). Thus, it is important to combine clinical assessments, serological screening, and HPV data for planning prevention policies. This study aimed to identify HPV and its specific types in the cervical, anal, and oral mucosa of HIV-seropositive women, associating it with viral load and lymphocyte count. Sociodemographic characteristics, health data (CD4+ and CD8+ T cell counts and viral load), and biological samples (cervical, anal, and oral) were collected from 86 HIV-positive women undergoing antiretroviral therapy. Data were classified according to the presence or absence of HPV-DNA, HPV-DNA presence at one or more anatomic sites, and level of oncogenic risk, considering low- and high-risk oncogenic HPV-DNA groups. The presence of HPV in the cervicovaginal site was 65.9%, 63.8% in anal canal, and 4.2% in oral mucosa. A viral load ≥75 HIV copies/mL was associated with the presence of HPV-DNA. There was an association between viral load and the low-risk HPV or high-risk HPV groups. We found a high prevalence of HPV infection in HIV-seropositive women, particularly in the cervical and anal mucosa, with viral load ≥75 HIV copies/mL being associated with HPV-DNA presence.

Traditional Galactogogues and the Practices Related to Their Use by Post-Natal Women of India

@#Introduction: Traditional galactogogue recipes are still being used, though not widely, and scientific studies on their use are scanty. This research aimed to study commonly used traditional galactogogue-recipes using primary sources, to bring about nutritional enhancement in most popular recipes and compare the standard and nutrified galactogogue-recipes for nutrients, phytochemicals and sensory qualities. Methods: A cross-sectional survey was carried out among 120 mothers (older than 20 years) residing in Indian states of Rajasthan and Uttar-Pradesh in their 0-1 year of lactation period who consented to be a part of the study. Background-information and use of galactogogues was collected with the help of self-designed, pre-tested questionnaires. Nutritive-value (moisture, ash, protein, fat, dietary-fibre, carbohydrate, iron, and calcium) of two of the most popular galactogogues ajwain-laddu and harira were calculated to find out the nutrient(s) lacking in it. Ajwain-laddu was nutrified using whole milk-powder, drumstick leaves powder and additional amount of clarified-butter. Harira was nutrified using poppy-seeds, niger-seeds and carrots. Results: The commonly used galactogogues were ajwain-laddu, harira, Gond-laddu, and Sonth-laddu. There was a significant difference between nutrient content of standard and nutrified-recipes (p<0.05) whereas no statistical difference was observed for hedonic rating-scores (p>0.05). Conclusion: Mothers were consuming traditional galactogogues foods in order to increase milk production and strongly believed that regular consumption of galactogogues has enhanced their milk production. To optimize the nutritional value of galactogogues, it is advisable to integrate ingredients abundant in phytochemicals and micronutrients. This can be accomplished while preserving the authentic taste and presentation of these galactogogue-recipes.

Vigilancia activa en cáncer de próstata en un grupo de pacientes asistidos en el Centro Docente Asociado de Oncología Médica Rivera: Cooperativa Médica de Rivera (COMERI) / Active surveillance in prostate cancer in a group of patients assisted at the Rivera Associated Teaching Center for Medical Oncology: Rivera Medical Cooperative (COMERI) / Vigilância ativa do câncer de próstata em um grupo de pacientes atendidos no Rivera Associated Teaching Center for Medical Oncology: Rivera Medical Cooperative (COMERI)

Introducción: En Uruguay el cáncer de próstata ocupa el primer lugar en incidencia y el tercer lugar en mortalidad en el hombre. La mayoría de estos cánceres se diagnostican en estadios precoces. Hoy en día, para pacientes con adenocarcinoma de muy bajo riesgo, bajo riesgo o riesgo intermedio favorable, la vigilancia activa es una opción adecuada. Objetivos: Describir una población de pacientes con cáncer de próstata de muy bajo riesgo, bajo riesgo o riesgo intermedio favorable, en vigilancia activa en COMERI. Material y métodos: Estudio descriptivo, observacional, retrospectivo. Se incluyeron pacientes con cáncer de próstata de muy bajo riesgo, bajo riesgo o riesgo intermedio favorable, tratados entre 2010 y 2018 en COMERI. Se recopilaron datos en el sistema de registro clínico electrónico. Resultados: Se incluyeron 33 pacientes, la mediana de edad al diagnóstico fue de 74 años. Todos los pacientes fueron sometidos a controles clínicos y determinación de PSA cada 3 meses. El tacto rectal se realizó en forma anual. El tiempo mediano de vigilancia activa fue de 33 meses. Durante el seguimiento, se observaron pocas variaciones en los valores de PSA. El 21% de los pacientes fue sometido a una nueva biopsia durante el seguimiento activo, y en todos los casos, el Gleason se mantuvo incambiado. Ningún paciente abandonó la modalidad de vigilancia activa. Conclusión: En nuestro entorno, la vigilancia activa se considera una opción terapéutica válida para pacientes altamente seleccionados con cáncer de próstata de muy bajo riesgo, bajo riesgo o riesgo intermedio favorable, y es bien aceptada por ellos.

Introduction: In Uruguay, prostate cancer ranks first in incidence and third in mortality among men. The majority of these cancers are diagnosed at early stages. Nowadays, active surveillance is an appropriate option for patients with adenocarcinoma of very low risk, low risk, or favorable intermediate risk. Objectives: To describe a population of patients with prostate cancer of very low risk, low risk, or favorable intermediate risk under active surveillance at COMERI. Materials and Methods: Descriptive, observational, retrospective study. Patients with prostate cancer of very low risk, low risk, or favorable intermediate risk treated between 2010 and 2018 at COMERI were included. Data were collected from the electronic clinical registry system. Results: Thirty-three patients were included, with a median age at diagnosis of 74 years. All patients underwent clinical monitoring and PSA determination every 3 months. Digital rectal examination was performed annually. The median time of active surveillance was 33 months. During follow-up, there were few variations in PSA values. 21% of patients underwent a repeat biopsy during active surveillance, and in all cases, the Gleason score remained unchanged. No patient discontinued active surveillance. Conclusion: In our setting, active surveillance is considered a valid therapeutic option for highly selected patients with prostate cancer of very low risk, low risk, or favorable intermediate risk, and it is well accepted by them.

Introdução: No Uruguai, o câncer de próstata ocupa o primeiro lugar em incidência e o terceiro lugar em mortalidade entre os homens. A maioria desses cânceres é diagnosticada em estágios precoces. Atualmente, para pacientes com adenocarcinoma de risco muito baixo, baixo risco ou risco intermediário favorável, a vigilância ativa é uma opção adequada. Objetivos: Descrever uma população de pacientes com câncer de próstata de risco muito baixo, baixo risco ou risco intermediário favorável sob vigilância ativa em COMERI. Material e métodos: Estudo descritivo, observacional, retrospectivo. Foram incluídos pacientes com câncer de próstata de risco muito baixo, baixo risco ou risco intermediário favorável, tratados entre 2010 e 2018 em COMERI. Os dados foram coletados no sistema de registro clínico eletrônico. Resultados: Foram incluídos 33 pacientes, com mediana de idade no diagnóstico de 74 anos. Todos os pacientes foram submetidos a controles clínicos e determinação de PSA a cada 3 meses. O toque retal foi realizado anualmente. O tempo médio de vigilância ativa foi de 33 meses. Durante o acompanhamento, houve poucas variações nos valores de PSA. 21% dos pacientes foram submetidos a uma nova biópsia durante a vigilância ativa, e em todos os casos, o Gleason permaneceu inalterado. Nenhum paciente abandonou a modalidade de vigilância ativa. Conclusão: Em nosso ambiente, a vigilância ativa é considerada uma opção terapêutica válida para pacientes altamente selecionados com câncer de próstata de risco muito baixo, baixo risco ou risco intermediário favorável, e é bem aceita por eles.

Bundle para quantificação de perda sanguínea pós-parto vaginal / Bundle para la cuantificación de pérdida sanguínea posparto vaginal / Bundle for quantifying vaginal blood loss after childbirth

Resumo Objetivo Construir e validar o conteúdo de um bundle para quantificação da perda sanguínea pós-parto vaginal. Métodos Estudo metodológico desenvolvido de fevereiro a agosto de 2022, em três etapas: levantamento bibliográfico, construção do instrumento e validação de conteúdo por 14 experts. O instrumento para validação foi composto por 11 itens selecionados a partir de revisão sistemática. Para cada item do bundle aplicou-se escala Likert e para verificar a concordância entre experts, calculou-se o Índice de Concordância. Consideraram-se válidos os itens com concordância acima de 80%. A validação de conteúdo foi realizada em uma única rodada de avaliação. Resultados A versão final do bundle foi composta por nove itens. Os cuidados propostos estão relacionados à quantificação direta do sangramento pós-parto e seu registro, observação da puérpera, a utilização de protocolos institucionais em casos de hemorragia pós-parto, assim como a capacitação da equipe. Conclusão O estudo permitiu construir e validar bundle para quantificação da perda sanguínea pós-parto vaginal, com vistas à melhora do diagnóstico de hemorragia pós-parto.

Resumen Objetivo Elaborar y validar el contenido de un bundle para la cuantificación de pérdida sanguínea posparto vaginal. Métodos Estudio metodológico, llevado a cabo de febrero a agosto de 2022, en tres etapas: análisis bibliográfico, construcción del instrumento y validación de contenido por 14 expertos. El instrumento para validación consistió en 11 ítems seleccionados a partir de revisión sistemática. Se aplicó la escala Likert para cada ítem del bundle; y para verificar la concordancia entre expertos, se calculó el Índice de Concordancia. Se consideraron válidos los ítems con concordancia superior a 80 %. La validación de contenido se realizó en una única ronda de evaluación. Resultados La versión final del bundle consistió en nueve ítems. Los cuidados propuestos están relacionados con la cuantificación directa del sangrado posparto y su registro, la observación de la puérpera, la utilización de protocolos institucionales en casos de hemorragia posparto, así como también la capacitación del equipo. Conclusión El estudio permitió elaborar y validar un bundle para la cuantificación de pérdida sanguínea posparto vaginal, con el fin de mejorar el diagnóstico de hemorragia posparto.

Abstract Objective To construct and validate the content of a bundle to quantify vaginal blood loss after childbirth. Methods This is a methodological study developed from February to August 2022, divided into bibliographic survey, instrument construction and content validity, by 14 experts. The instrument for validity consisted of 11 items selected from a systematic review. For each item in the bundle, a Likert scale was applied, and to check agreement among experts, the Concordance Index was calculated. Items with agreement above 80% were considered valid. Content validity was carried out in a single round of assessment. Results The final version of the bundle consisted of nine items. The proposed care is related to direct quantification of postpartum bleeding and its recording, observation of postpartum women, use of institutional protocols in cases of postpartum hemorrhage as well as team training. Conclusion The study allowed constructing and validating a bundle for quantifying vaginal blood loss after childbirth, with a view to improving postpartum hemorrhage diagnosis.

Mesenteric cystic lymphangioma in adults: a rare entity presenting as acute abdomen - a report of two cases

ABSTRACT Lymphangiomas are rare benign tumors that mainly involve the head and neck region in pediatric patients. Lymphangiomas of the small bowel mesentery in adults are rarer. We present two cases of mesenteric lymphangioma with acute abdominal pain on presentation. Case 1: A 38-year-old female presented with abdominal pain, vomiting, fever, and difficult evacuation. On abdominal examination, she had an ill-defined, tender lump, and radiological findings raised a possibility of perforation peritonitis. Thus, exploratory laparotomy was planned. Per-operatively, a mesenteric mass was found, which, on histopathological evaluation, was found to be a mesenteric lymphangioma involving the bowel. Case 2: A 27-year-old male presented with abdominal pain and difficult evacuation. Radiological evaluation revealed a multilobulated lesion involving the mesentery and with differential diagnoses of mesenteric fibromatoses and inflammatory pseudotumor. Histopathological assessment of the resected mass revealed a lymphangioma that was limited to the mesentery. Owing to their rarity and non-specific presentation, mesenteric lymphangiomas are often misdiagnosed on clinical examination and imaging. Thus, histopathological examination is the gold standard to reach a definitive diagnosis.

Gestações e nascimentos em tempos de COVID-19 / Embarazos y nacimientos en tiempos de COVID-19 / Pregnancies and births in times of COVID-19

Resumo Objetivo Identificar o perfil de nascimentos das gestações de mulheres com acesso à internet que cursaram com a infecção pelo SARS-CoV-2 e seus desfechos. Métodos Estudo transversal integrado a uma coorte prospectiva, com coleta entre agosto de 2021 e fevereiro de 2022, baseado nas respostas de 304 mulheres que tiveram gestações e/ou partos durante o período pandêmico. Resultados Do total, 25,7% das entrevistadas tiveram COVID-19, com predomínio de diagnósticos no terceiro trimestre. Queixas de anosmia, fadiga e cefaleia prevaleceram como relacionados à infecção. As variáveis: utilizar o Sistema Único de Saúde para atendimento (p = 0,084); diabetes gestacional (p = 0,141); baixo peso de nascimento (p = 0,117); necessidade de internação em unidade neonatal (p = 0,120) foram inseridas no modelo de regressão por terem valores de p inferiores a 0,20. A variável referente ao tipo de parto (p=1,000) foi inserida no modelo por se tratar de uma variável de interesse e com descrição de relevância na literatura. A prematuridade foi a única variável que apresentou associação estatística com a infecção pelo SARS-CoV-2 durante a gestação (p = 0,008) na análise bivariada, explicando o desfecho da infecção na gestação (<0,001), comprovado no modelo de Regressão Robusta de Poisson. Conclusão Observou-se alta prevalência de COVID-19 na amostra, com variação de sintomas e predomínio de partos operatórios. No entanto, a infecção pelo SARS-CoV-2 explicou apenas a maior ocorrência de nascimentos prematuros.

Resumen Objetivo Identificar el perfil de nacimientos de los embarazos de mujeres con acceso a internet que lo cursaron con la infección por SARS-CoV-2 y sus desenlaces. Métodos Estudio transversal integrado a una cohorte prospectiva, con recopilación entre agosto de 2021 y febrero de 2022, basado en las respuestas de 304 mujeres que tuvieron embarazos o partos durante el período pandémico. Resultados Del total, el 25,7 % de las entrevistadas tuvieron COVID-19, con predominio de diagnósticos en el tercer trimestre. Prevalecieron quejas de anosmia, fatiga y cefalea como relacionadas a la infección. Las variables utilización del Sistema Único de Salud para atención (p = 0,084), diabetes gestacional (p = 0,141), bajo peso de nacimiento (p = 0,117), necesidad de internación en unidad neonatal (p = 0,120) se introdujeron en el modelo de regresión por tener valores de p inferiores a 0,20. Se introdujo la variable relacionada al tipo de parto (p = 1,000) en el modelo por tratarse de una variable de interés y con descripción de relevancia en la literatura. La prematuridad fue la única variable que presentó asociación estadística con la infección por SARS-CoV-2 durante el embarazo (p = 0,008) en el análisis bivariado, lo que explica el desenlace de la infección en el embarazo (>0,001), comprobado en el modelo de regresión robusta de Poisson. Conclusión Se observó alta prevalencia de COVID-19 en la muestra, con variación de síntomas y predominio de partos operatorios. Sin embargo, la infección por SARS-CoV-2 explicó solamente la mayor incidencia de nacimientos prematuros.

Abstract Objective Identify the profile of births of pregnancies of women with internet access who were infected with SARS-CoV-2 and their outcomes. Methods Cross-sectional study integrated into a prospective cohort, with collection between August 2021 and February 2022, based on the responses of 304 women who had pregnancies and/or deliveries during the pandemic period. Results Of the total, 25.7% of the interviewees had COVID-19, with a predominance of diagnoses in the third quarter. Complaints of anosmia, fatigue and headache prevailed as related to the infection. The variables using the Unified Health System for care (p = 0.084); gestational diabetes (p = 0.141); low birth weight (p = 0.117); need for admission to a neonatal unit (p = 0.120) were included in the regression model because they had p values lower than 0.20. The variable referring to the type of delivery (p=1.000) was inserted in the model because it is a variable of interest and with a description of relevance in the literature. Prematurity was the only variable that was statistically associated with SARS-CoV-2 infection during pregnancy (p = 0.008) in the bivariate analysis, explaining the outcome of infection during pregnancy (<0.001), confirmed in the Poisson Robust Regression model. Conclusion There was a high prevalence of COVID-19 in the sample, with varying symptoms and a predominance of operative deliveries. However, SARS-CoV-2 infection only explained the higher occurrence of premature births.

Comparative analysis of SARS-CoV-2 variants Alpha (B.1.1.7), Gamma (P.1), Zeta (P.2) and Delta (B.1.617.2) in Vero-E6 cells: ultrastructural characterization of cytopathology and replication kinetics

Abstract This study compares the effects of virus-cell interactions among SARS-CoV-2 variants of concern (VOCs) isolated in Brazil in 2021, hypothesizing a correlation between cellular alterations and mortality and between viral load and transmissibility. For this purpose, reference isolates of Alpha, Gamma, Zeta, and Delta variants were inoculated into monolayers of Vero-E6 cells. Viral RNA was quantified in cell supernatants by RT‒PCR, and infected cells were analyzed by Transmission Electron Microscopy (TEM) for qualitative and quantitative evaluation of cellular changes 24, 48, and 72 hours postinfection (hpi). Ultrastructural analyses showed that all variants of SARS-CoV-2 altered the structure and function of mitochondria, nucleus, and rough endoplasmic reticulum of cells. Monolayers infected with the Delta variant showed the highest number of modified cells and the greatest statistically significant differences compared to those of other variants. Viral particles were observed in the cytosol and the cell membrane in 100 % of the cells at 48 hpi. Alpha showed the highest mean particle diameter (79 nm), and Gamma and Delta were the smallest (75 nm). Alpha and Gamma had the highest particle frequency per field at 48 hpi, while the same was observed for Zeta and Delta at 72 hpi and 24 hpi, respectively. The cycle threshold of viral RNA varied among the target protein, VOC, and time of infection. The findings presented here demonstrate that all four VOCs evaluated caused ultrastructural changes in Vero-E6 cells, which were more prominent when infection occured with the Delta variant.

Percepções das mães que são profissionais de saúde sobre as relações na unidade neonatal / Health professionals mothers' perceptions about relationships in the neonatal unit / Percepciones de las madres profesionales de la salud sobre las relaciones en la unidad neonatal

Objetivo: discutir as percepções das mães que são profissionais de saúde sobre as relações na unidade neonatal. Método: estudo qualitativo, apoiado no Interacionismo Simbólico, com 11 mães de recém-nascidos pré-termo que são profissionais da saúde. Após aprovação pelo Comitê de Ética em Pesquisa, os dados foram coletados de maio a outubro de 2021, por meio de entrevistas individuais, e submetidos à análise de conteúdo temática. Resultados: apesar de as mães serem profissionais da saúde, as relações na unidade neonatal foram difíceis, sofridas, desconfortantes e restritivas ao processo de 'ser e tornar-se mãe'. Estas desvelaram sentimentos de não pertencimento ao cuidado e de afastamento de suas crianças. Conclusão: as relações entre mães e profissionais da saúde atuantes na unidade neonatal estiveram marcadas por sofrimentos, limitações e desconfortos, sendo lacunares em processos colaborativos, na contramão do Cuidado Centrado na Família(AU)

Objective: to discuss the perceptions of mothers who are health professionals about relationships in the neonatal unit. Method: a qualitative study, based on Symbolic Interactionism, with 11 mothers of preterm newborns who are health professionals. After approval by the Research Ethics Committee, data was collected from May yo October 2021, through individual interviews, and subjected to thematic content analysis. Results: despite the mothers being health professionals, relationships in the neonatal unit were difficult, painful, uncomfortable, and restrictive to the process of 'being and becoming a mother'. They revealed feelings of not belonging to care and of being away from their children. Conclusion: the relationships between mothers and health professionals working in the neonatal unit were marked by suffering, limitations, and discomfort, and were lacking in collaborative process, going against Family-Centered Care(AU)

Objetivo: discutir las percepciones de las madres profesionales de salud sobre las relaciones en la unidad neonatal. Método: estudio cualitativo, basado en el Interaccionismo Simbólico, con 11 madres de recién nacidos prematuros que son profesionales de la salud. Previa aprobación del Comité de Ética en Investigación, se recolectaron los datos de mayo a octubre de 2021, mediante entrevistas individuales y los sometieron a análisis temático de contenido. Resultados: aunque las madres eran profesionales de salud, las relaciones en la unidad neonatal fueron difíciles, dolorosas, incómodas y restrictivas al proceso de 'ser y volverse madre'. Revelaron sentimientos de no pertenencia a los cuidados y de alejamiento de sus hijos. Conclusión: las relaciones entre las madres y los profesionales sanitarios que trabajan en la unidad neonatal estaban marcadas por el sufrimiento, las limitaciones y la incomodidad, y carecían de procesos de colaboración, lo que iba en contra de la Atención Centrada en la Familia(AU)

Children and adolescents with non-Hodgkin lymphoma in Brazil: A national survey identifies the challenges encountered and documents the diversity of care

ABSTRACT Introduction: Brazil has many inequities in the healthcare provided nationwide. Therefore, in order to access challenges in treatment, available resources and current practices, to identify barriers in delivering a good quality of care among Brazilian centers treating children and adolescents with Non-Hodgkin Lymphoma (NHL) and to generate a future prospective guideline, a customized online survey was distributed to pediatric hematologists and oncologists across the country. Results: A total of 97 surveys were completed (35% response rate), from 47 cities in all Brazilian regions and 79 units of care, with a median of 1 answer by the center (range 1 - 5). Most respondents work at an institution supported exclusively by public/philanthropic resources (58%), with an average of 5 to 9 new cases/year (49%), and 41% have 4 to 6 oncologists/centers. Additionally, 22% have no easy access to the intensive care unit, 26% have no access to Rasburicase, 28% have no access to Rituximabe as front-line therapy and 41% have unreliable methotrexate monitoring levels. Those differences cannot be explained thoroughly by regional wealth variances, nor by the financing model. Regarding the pathology service, 70% consider having reasonable quality assistance, but the timeframe to deliver diagnosis is satisfactory to 46%. There is no uniform management of care, with the current guideline from the Sociedade Brasileira de Oncologia Pediátrica being adopted by 54 to 59%, depending on the NHL subtype. Conclusion: This study provides insights into the heterogeneity of care among Brazilian centers. Recognizing those diversities will support the design of effective strategies and collaboration nationwide.

Refractive error changes and associated asthenopia observed after COVID-19 infection: Case reports from two continents

COVID-19 infection has been linked to various ocular complications and complaints, but not to refractive errors. In this case report, we present ethnically diverse patients who reported asthenopic symptoms shortly after recovering from COVID-19 infection. The hyperopic shift in the refractive error, post-COVID could indicate the ciliary body muscle’s inability to sustain accommodation, resulting in asthenopia. Hence, refractive errors should also be considered as a post-COVID complication, even if the magnitude is small, especially when patients have a headache and other asthenopic symptoms. Performing dynamic retinoscopy and cycloplegic refraction will also aid in the better management of these patients

Simplifying biometry in oil-filled eyes: A novel formula for axial length calculation in eyes with 1000 cSt silicone oil

Purpose: To derive a formula for accurate axial length (AL) assessment using routine ultrasound in silicone oil?filled eyes, where optical biometry is unavailable or not possible. Methods: This was a prospective, consecutive, nonrandomized study of 50 eyes of 50 patients conducted in a tertiary care hospital in North India. AL measurements were taken using both manual A?scan and IOL master, both in silicone oil?filled status and 3 weeks after silicone oil removal. A correction factor of 0.7 was used for AL adjustment in oil?filled eyes. The corrected AL (cAL) was compared with IOL master values in oil?filled eyes. Agreement analysis was carried out using Bland Altman plot. Linear regression analysis was done using uncorrected manual AL to find a new equation. Data was analyzed using Stata 14. A P value <0.05 was taken as significant. Results: The study included 40 males and 10 females, with an age range of 6–83 years (mean 41.9 years). The mean AL of the oil?filled eye as measured by manual A?scan was 31.76 mm ± 3.09 and by IOL master was 24.7 mm ± 1.74. Linear regression analysis was performed in randomly selected 35 eyes of the observed data to obtain a new equation: predicted AL (PAL) = 14 + 0.3 × manual AL. The mean difference between PAL and optically measured AL with silicone oil in situ was 0.98 ± 1.67. Conclusion: We propose a new formula for better prediction of the correct AL in silicone oil?filled eyes using ultrasound?based AL measurement.

Cognitive Function in Children With ?-Thalassemia Major

Objectives: To assess intelligence Quotient (IQ) in transfusion dependent ?-thalassemia major patients using Malin Intelligence Scale for Indian Children (MISIC) and to correlate verbal IQ (VIQ), performance IQ (PIQ) and full scale IQ (FSIQ) with serum ferritin levels and annual blood transfusion requirements. Methods: Cross-sectional study design, enrolling 100 patients of transfusion-dependent ?-thalassemia aged 6 years to 15 years 11 months. IQ was assessed using MISIC. Results: Mean (SD) full scale IQ was 95.96 (7.23). IQ was ‘average’ in most of the patients. There was a significant negative correlation of serum ferritin levels with object assembly (r=-0.215, P=0.034) component of PIQ; annual blood requirement with general comprehension component of VIQ (r=-0.275, P=0.006) and age at diagnosis with PIQ (r=-0.273, P=0.006). There was a significant linear correlation of PIQ (r=0.280, P=0.005) and FSIQ (r=0.274, P=0.006) with pre-transfusion hemoglobin. Conclusion: IQ correlates with age at diagnosis and average annual pre-transfusion hemoglobin. This highlights the importance of early diagnosis and maintenance of satisfactory hemoglobin levels

Reconstruction Plate Fracture: Mechanism and Recent Advances

Reconstruction plates with or without bone grafts are used to restore mandibular continuity, form and function following segmental resection of mandible. Fracture of reconstruction plate is observed in 2.9 % to 10% of cases reported in the literature excluding other complications. In this case, we report the fracture of stainless steel reconstruction plate used without bone graft and its management using locking reconstruction plate with non vascularised iliac crest graft following removal of the fractured plate. Review of literature describing incidence, pattern and causes of reconstruction plate fracture and its management is discussed.

Desafios e potencialidades para a estruturação e o funcionamento dos Conselhos Locais de Saúde de Porto Alegre

O objetivo deste trabalho foi identificar a presença, bem como formas de atuação e funcionamento dos Conselhos Locais de Saúde (CLS) da cidade de Porto Alegre, visto o seu fomento como meta de gestão neste município, incluída por iniciativa do Conselho Municipal de Saúde. Metodologia: Trata-se de uma pesquisa exploratória e descritiva. Primeiramente, determinou-se a quantidade de CLS ativos. Em seguida, procurou-se agendar uma entrevista semiestruturada em grupo com os CLS encontrados, utilizando um instrumento desenvolvido e validado. Foi feita a estatística descritiva com a determinação de frequências. Resultados e Discussão: Foram encontrados 56 CLS ativos e 32 entrevistas foram realizadas. Os CLS têm uma Coordenação Local instituída e presente, com reuniões ocorrendo com pautas definidas, onde são discutidos assuntos de saúde e da vida comunitária, ainda que com baixa participação da comunidade. Os CLS usam a estrutura descentralizada de conselhos bem como outros canais como sistema de justiça e representantes políticos para encaminhar as demandas. Considerações finais: A inclusão de CLS como meta de gestão mostrou um resultado positivo no aumento dos CLS. Porém se deve pensar mais em cada território e suas particularidades, com ações que diversifiquem as formas de mobilização.

Unraveling congenital ptosis with the aid of the pediatric perimeter device

Background: Ocular morbidity with an early onset can have a significant impact on the long-term development of an individual. Hence, careful assessment of visual functions early on is very important. However, testing infants always poses a challenge. Standard tools to assess infants’ visual acuity, ocular motility, and so on rely on the clinician’s quick subjective judgments of an infant’s looking behavior. Eye movements are usually observed from head rotations or spontaneous eye movements in infants. Judging eye movements in the presence of strabismus is even more challenging. Purpose: This video shows a 4-month-old infant’s viewing behavior captured during a visual field screening study. The recorded video aided in the examination of this infant that was referred to a tertiary eye care clinic. The additional information captured through the perimeter testing is discussed. Synopsis: The Pediatric Perimeter device was developed to address visual field extent and gaze reaction time assessment in the pediatric population. As a part of a large-scale screening study, infants’ visual fields were tested. During this screening, a 4-month-old infant presented with a ptosis in the left eye. The infant was consistently missing the light stimuli presented in the left upper quadrant in the binocular visual field testing. The infant was referred to a tertiary eye care center to a pediatric ophthalmologist for further examination. During clinical examination, the infant was suspected to either have congenital ptosis or monocular elevation deficit. But the diagnosis of the eye condition was unsure owing to the poor cooperation of the infant. With the aid of Pediatric Perimeter, the ocular motility was consistent with limitation of elevation in abduction, indicating a possible monocular elevation deficit with congenital ptosis. The infant was also noted to have Marcus Gunn jaw-winking phenomenon. The parents were assured and asked for a review in 3 months. In the subsequent follow-up, the Pediatric Perimeter testing was performed, and the recording showed a full extraocular motility in both eyes. Hence, the diagnosis was changed to only congenital ptosis. The probable explanation for missing the target in the left upper quadrant in the first visit is postulated further. The left upper quadrant is the superotemporal visual field of the left eye and the superonasal visual field of the right eye. As the left eye had ptosis, the superotemporal visual field could have been obstructed and hence the stimuli missed. The normative extent for the nasal and superior visual field is just about 30° for a 4-month-old infant. Hence, the right eye also perhaps missed the stimuli in its superonasal visual field extent. This video highlights the utility of the Pediatric Perimeter device in providing a magnified view of the infant’s face along with greater visibility of ocular features from the infrared video imaging. This can potentially help the clinician to easily observe different ocular/facial abnormalities such as extraocular motility disorders, lid functions, and in identifying unequal pupil size, media opacities, and nystagmus. Highlights: The presence of congenital ptosis in younger infants might predispose as superior visual field defect and could also masquerade as a limitation in elevation.