Effects of short-term use of atropine with different concentrations and frequencies on eye safety in children / 中华实验眼科杂志

Objective:To evaluate the effect of short-term topical administration of atropine eye drops with various concentrations and frequencies on eye safety in children.Methods:A double-blind randomized controlled trial was conducted.Sevevty-two children with ametropia or pre-myopia (72 eyes) were enrolled in Tianjin Medical University Eye Hospital from December 2020 to January 2022.The subjects were randomly divided into 0.01% atropine group, 0.02% atropine group and 0.04% atropine group according to a random number table, with 24 cases (24 eyes) in each group.Automatic refraction with an automatic computer optometry device, subjective refraction with a phoropter, intraocular pressure with a non-contact tonometer, axial length by optical biometrics, the amplitude of accommodation (AMP) by the push-up method, pupil diameter with pupilometer, near visual acuity at 33 cm with a standard logarithmic visual acuity chart, tear evaluation with Keratograph 5M and Ocular Surface Disease Index (OSDI) questionnaire survey were performed among all subjects.One drop of 0.01%, 0.02%, and 0.04% atropine was administrated to the study eye according to grouping, and the pupil diameter was measured every 10 minutes until the pupil did not enlarge three times, then the data after a single treatment of the three groups were recorded.After one-week application of the corresponding concentration of atropine eye drops once at night, the data after one-week treatment were recorded.For the next week, the application frequency of 0.01% and 0.02% atropine groups changed to once daily in the morning and evening, and 0.04% atropine group maintained once at night, then the data after two-week treatment were recorded.Data of the right eyes were analyzed.The changes in pupil diameter, AMP and other eye parameters before and after atropine eye drops of the three groups were compared.This study adhered to the Declaration of Helsinki and the study protocol was approved by the Ethics Committee of Tianjin Medical University Eye Hospital (No.2020KY[L]-51). All subjects and their guardians were fully informed of the method and purpose of this study before entering the cohort.Written informed consent was obtained from guardians.Results:Pupil diameters of 0.01%, 0.02% and 0.04% atropine groups were (5.59±0.48), (5.35±0.76) and (5.65±0.43)mm before treatment respectively, (7.00±0.68), (7.17±0.58) and (8.40±1.71)mm after a single treatment, (6.67±0.62), (6.56±0.65) and (7.60±0.69)mm after one-week treatment, (6.96±0.49), (7.04±0.53) and (7.60±0.36)mm after two-week treatment.There were significant differences in pupil diameter at different time points after treatment among the three groups ( Fgroup=9.430, P<0.001; Ftime=156.620, P<0.001). The AMP of 0.01%, 0.02% and 0.04% atropine groups were (12.94±3.02), (13.25±2.81) and (13.42±2.60)D before treatment respectively, (11.62±2.61), (11.53±2.06) and (9.64±1.93)D after a single treatment, (11.14±2.61), (11.33±2.33) and (8.30±1.18)D after one-week treatment, (9.99±1.81), (8.72±1.25) and (8.76±2.12)D after two-week treatment.There was no significant difference in the AMP among the three groups ( Fgroup=2.800, P=0.063). In the three groups, the AMP at different time points after treatment were significantly lower than that before treatment ( Ftime=61.400, P<0.001). There was no difference in spherical equivalent refraction, intraocular pressure, near visual acuity, axial length, first none-invasive tear break-up time, average none-invasive tear break-up time, tear meniscus height and OSDI score among the three groups ( Fgroup=0.030, 0.630, 1.420, 0.580, 0.140, 0.120, 0.340, 0.142; all at P>0.05). There were significant differences in spherical equivalent refraction, intraocular pressure, first none-invasive tear break-up time, average none-invasive tear break-up time, tear meniscus height and OSDI score at different time points between before and after medication among the three groups ( Ftime=12.560, 4.730, 4.720, 5.220, 3.720; all at P<0.05). Conclusions:Varying pupil dilation and AMP reduction occur after the use of different concentrations of atropine and are more severe at higher concentrations.Increased administration frequency of atropine is associated with more pupil dilation and AMP reduction, but there is no intolerable adverse effect.

WALANT Technique in Percutaneous Scaphoid Osteosynthesis / WALANT na osteossíntese percutânea do escafoide

Abstract Scaphoid fractures account for 50 to 70% of all carpal bone fractures. Percutaneous scaphoid osteosynthesis can use the dorsal or volar approach, both with good results, and is most commonly performed under general anesthesia or regional nerve block. The wide-awake local anesthesia no tourniquet (WALANT) technique is already considered a safe and cost-effective technique in hand surgery around the world. Local anesthesia with epinephrine causes vasoconstriction, which obviates the need for tourniquet and, consequently, the need to use patient sedation. Thus, the possibility of testing fixation stability under physiological forces is another great advantage of using local anesthesia. In the technique described in the present paper, active wrist and hand motion can be tested immediately after scaphoid fixation. Wide-awake local anesthesia no tourniquet has been increasingly used in soft-tissue hand surgery and in the fixation of metacarpal and phalangeal fractures. However, to date, there is no published literature addressing the use of this technique in percutaneous scaphoid osteosynthesis. The purpose of the present technical note is to describe the use of WALANT for both the dorsal and volar approaches in percutaneous scaphoid osteosynthesis.

Resumo As fraturas do escafoide representam entre 50 e 70% de todas as fraturas dos ossos do carpo. A osteossíntese percutânea do escafoide pode usar a abordagem dorsal ou volar, ambas com bons resultados. É mais comumente realizada sob anestesia geral ou bloqueio nervoso regional. A técnica de anestesia local com o paciente totalmente acordado e sem torniquete (WALANT, na sigla em inglês) já é considerada uma técnica segura e eficaz na cirurgia da mão. A anestesia local com epinefrina causa vasoconstrição, o que evita o uso de torniquete e, consequentemente, a necessidade de sedação do paciente. Assim, a possibilidade de testar a estabilidade da fixação sob forças fisiológicas é outra grande vantagem do uso da anestesia local. Na técnica descrita aqui, o movimento ativo do punho e da mão pode ser testado imediatamente após a fixação escafoide. A técnica WALANT tem sido cada vez mais utilizada na cirurgia da mão em partes moles e na fixação de fraturas de metacarpo e falanges. No entanto, até o momento, não há literatura publicada abordando o uso dessa técnica na osteossíntese percutânea do escafoide. O objetivo desta nota técnica é descrever o uso de WALANT tanto para a abordagem dorsal quanto volar na osteossíntese percutânea do escafoide.

Diagnostic Lacunae and Implications of an Automated Implantable Cardioverter Defibrillator Implantation in a Child with Type 3 Long QT (LQT3) Syndrome

A diagnosis of congenital long QT interval syndrome based on history and electrocardiogram was made in a child in the absence of readily available genetic testing. A genotype 3 (LQT3) was suspected after exclusion of other variants as the child was non?responsive to beta?blocker and sodium channel blocker medication. As the child continues to show episodic bradycardia, polymorphic ventricular ectopy, and T?wave alternans, a single?chamber automated implantable cardioverter?defibrillator implantation was done successfully. This report highlights how the diagnosis of LQT3 was arrived at as well as the anesthetic challenges in the management of patients with LQTS.

Prevalence of psychotropic drug use and conformity of therapeutic dose among mental health users / Prevalencia del uso de psicotrópicos y cumplimiento de la dosis terapéutica entre los usuarios de salud mental / Prevalência do uso de psicotrópicos e conformidade da dose terapêutica entre usuários de saúde mental

ABSTRACT Objectives: to identify the prevalence of psychotropic drug use according to their Anatomical Therapeutic Chemical classification among Psychosocial Care Center users and assess their prescription compliance based on the recommended therapeutic dose. Methods: this is an analytical study, based on documents, from the study of 389 records between September 2017 and May 2018. Associations between the presence of underdose or overdose and participants' characteristics were assessed using the chi-square test, adopting a significant value of p <0.05. Results: the most used drugs were antipsychotics (74.7%), 16.0% of users with at least one medication with a dose below the therapeutic level and another 3.6% above the recommended therapeutic dose. Conclusions: greater nonconformities in the prescribed dose were related to antihistamines, antipsychotics and antidepressants, with underdosage associated with females and overdose with the report of hearing voices.

RESUMEN Objetivos: identificar la prevalencia del uso de psicofármacos según su clasificación Anatómica Terapéutica Química entre los usuarios de un Centro de Atención Psicosocial y evaluar el cumplimiento de su prescripción en base a la dosis terapéutica recomendada. Métodos: estudio analítico, basado en documentos, basado en el estudio de 389 historias clínicas entre septiembre de 2017 y mayo de 2018. Las asociaciones entre la presencia de subdosis o sobredosis y las características de los participantes se evaluaron mediante la prueba de chi-cuadrado valor significativo p<0,05. Resultados: los fármacos más utilizados fueron los antipsicóticos (74,7%), el 16,0% de los usuarios con al menos un medicamento con dosis por debajo del nivel terapéutico y otro 3,6% por encima de la dosis terapéutica recomendada. Conclusiones: las principales no conformidades en la dosis prescrita se relacionaron con antihistamínicos, antipsicóticos y antidepresivos, con infradosificación asociada a mujeres y sobredosis con el reporte de escuchar vocês.

RESUMO Objetivos: identificar a prevalência do uso de psicotrópicos conforme sua classificação Anatômico Terapêutico Químico entre usuários de um Centro de Atenção Psicossocial e avaliar a conformidade da prescrição dos mesmos com base na dose terapêutica recomendada. Métodos: estudo analítico, de base documental, a partir do estudo de 389 prontuários entre setembro de 2017 e maio de 2018. Associações entre a presença de subdose ou sobredose e as características dos participantes foram avaliadas por meio do teste qui-quadrado, adotando como valor significativo p <0.05. Resultados: os medicamentos mais utilizados foram os antipsicóticos (74,7%), 16,0% de usuários com pelo menos uma medicação com dose abaixo da terapêutica e outros 3,6% acima da dose terapêutica recomendada. Conclusões: maiores inconformidades na dose prescrita se relacionaram aos anti-histamínicos, os antipsicóticos e antidepressivos, com subdosagem associada ao sexo feminino e sobredose com o relato de audição de vozes.

Azoles de antes y ahora: una revisión / Azoles of then and now: a review

Resumen Los azoles son fármacos que inhiben la enzima 14α-esteroldemetilasa, impidiendo la unión de ergosterol; esto altera la estructura y función de la pared celular fúngica. Especialmente el grupo de los triazoles: fluconazol, itraconazol, voriconazol, posaconazol e isavuconazol, son una alternativa farmacológica para el tratamiento de la enfermedad fúngica invasora causada por Aspergillus spp, Candida spp, Cryptococcus spp, patógenos emergentes como los Mucorales, y de micosis endémicas como las ocasionadas por Histoplasma spp y Coccidioides spp. Los efectos adversos de los triazoles son menos frecuentes comparados con los ocasionados por anfotericina B, un antifúngico de uso común para estas micosis. Los principales efectos adversos de los triazoles son hepáticos, gastrointestinales y cardiovasculares como la prolongación del intervalo QT. Las interacciones farmacológicas son usuales y se presentan con moléculas que usan sustratos del citocromo CYP3A4, lo que incluye anti-retrovirales, anti-tuberculosos e inmunomoduladores. En este trabajo se revisan la historia, características farmacológicas y los ensayos clínicos que evidencian su eficacia clínica en los diferentes escenarios clínicos.

Abstract The azoles are drugs that inhibit the 14α-sterol-demethylase enzyme preventing the binding of ergosterol, altering the functionality and structure of the fungal cell wall. Especially the group of triazoles: fluconazole, itraconazole, voriconazole, posaconazole and isavuconazole, are a pharmacological alternative for the treatment of the invasive fungal disease, caused by Aspergillus spp, Candida spp, Cryptococcus spp, by emerging pathogens for example, the Mucoral and finally of endemic mycosis as those caused by Histoplasma spp. and Coccidioides spp. The adverse effects of the triazoles are less frequent compared to those caused by amphotericin B, the main ones being hepatics, gastrointestinals and cardiovasculars, such as the prolongation of the QT interval. The pharmacological interactions are common and occur with molecules that use the substrates of the CYP3A4 cytochrome, for example: antiretroviral, anti-tuberculous and immunomodulators. The history, pharmacological characteristics and clinical trials are reviewed.

Effect of low-dose dexamethasone on extra vascular lung water in patients following on-pump elective primary coronary artery bypass graft surgery

Background: The primary objective was to compare the effect of a low-dose dexamethasone as against a saline placebo on extravascular lung water index (EVLWI) in patients undergoing elective primary coronary artery bypass surgery. The secondary endpoints were to assess the effect of dexamethasone on other volumetric parameters (pulmonary vascular permeability index, global end diastolic volume index, and intrathoracic blood volume index), Vasoactive Inotrope Scores, hemodynamic parameters and serum osmolality in both groups. Settings and Design: Prospective observational study performed at a single tertiary cardiac care center. Materials and Methods: Twenty patients were randomized to receive either dexamethasone (steroid group, n = 10) or placebo (nonsteroid group, n = 10) twice before the institution of cardiopulmonary bypass (CPB). EVLWI and other volumetric parameters were obtained with the help of VolumeView™ Combo Kit connected to EV 1000 clinical platform at predetermined intervals. Hemodynamic parameters, vasoactive-inotropic Scores, hematocrit values were recorded at the predetermined time intervals. Baseline and 1st postoperative day serum osmolality values were also obtained. Results: The two groups were evenly matched in terms of demographic and CPB data. Intra- and inter-group comparison of the baseline EVLWI including other volumetric and hemodynamic parameters with those recorded at subsequent intervals revealed no statistical difference and was similar. Generalized estimating equation model was obtained to compare the changes between the groups over the entire study period which showed that on an average the changes between the steroid and nonsteroid group in terms of all volumetric parameters were not statistically significant. Conclusions: There were no beneficial effects of low-dose dexamethasone on EVLWI or other volumetric parameters in patients subjected to on-pump primary coronary bypass surgery. Hemodynamic parameters were also not affected. Probably, the advanced hemodynamic monitoring aided in optimal fluid management in the nonsteroidal group impacting EVLW accumulation.

Topical cyclosporine A 0. 05% before and after surgery to prevent pterygium recurrence / Ciclosporina A 0, 05% antes e após a cirurgia do pterígio para a prevenção da recorrência

ABSTRACT Purpose: We evaluated the role of the conjunctival flap rotation technique using 5-fluorouracil and adjuvant therapy with topical cyclosporine A at 0.05% during short pre- and postoperative periods for the prevention of primary pterygium recurrence. Methods: In this prospective study, 76 patients with primary pterygium (76 eyes) were categorized into two groups: the control group with 31 patients who did not receive cyclosporine treatment, and the cyclosporine group with 45 patients who received topical cyclosporine A (0.05%) twice a day, for 10 days before and 10 days after the pterygium excision operations. Patients were examined for disease recurrence, side effects, and complications at 10 and 21 days, and at 2 and 6 months after the operation. Data on demography, systemic diseases, and ophthalmologic histories were obtained from all patients, and these data were analyzed using descriptive statistics involving the absolute and relative percentages of frequency distribution. Goodman test was used for contrasts among multinomial populations to study the association between cyclosporine A and recurrence. Results: Most patients were between 30 and 60 years of age, and 67.1% were women. We confirmed a higher recurrence in patients with occupational sunlight exposure. The cyclosporine A used topically 10 days before and 10 days after the pterygium removal did not significantly reduce the recurrence of the pterygium. Conclusion: Topical 0.05% cyclosporine A when used for 10 days before and 10 days after the pterygium removal does not prevent or reduce the recurrence of primary pterygium.

RESUMO Objetivo: Avaliamos os resultados da técnica de rotação de retalho conjuntival com uso de 5-fluorouracil e terapia adjuvante com ciclosporina A tópica a 0,05%, usada no pré e pós-operatório por curto período, quanto à prevenção da recidiva do pterígio primário Métodos: Estudo prospectivo, com 76 pacientes portadores de pterígio primário (76 olhos), divididos em dois grupos: controle com 31 pacientes que não receberam tratamento com ciclosporina e grupo ciclosporina com 45 pacientes que receberam ciclosporina tópica A (0,05%) duas vezes ao dia, por 10 dias antes e 10 dias após a cirurgia de excisão do pterígio. Os pacientes foram avaliados quanto à recorrência, efeitos colaterais e complicações com 10, 21 dias, 2 e 6 meses de pós-operatório. Dados demográficos, doenças sistêmicas e histórico oftalmológico foram coletados de todos os pacientes e esses dados foram analisados por meio de estatística descritiva envolvendo o percentual absoluto e relativo de distribuição de frequência. O teste de Goodman para contrastes entre populações multinomiais foi utilizado para o estudo da associação entre a ciclosporina A e a recorrência Resultados: A maioria dos pacientes tinha entre 30 e 60 anos e 67,1% eram mulheres. Confirmamos uma maior recorrência em pacientes com exposição ocupacional ao sol. A ciclosporina A tópica utilizada 10 dias antes e 10 dias após a remoção do pterígio não reduziu significativamente a sua recorrência Conclusão: A ciclosporina A tópica a 0,05% quando utilizada por 10 dias no pré e 10 dias no pós-operatório, não previne ou reduz a recidiva do pterígio primário significativamente.

Meta-analysis of efficacy of iron and iodine fortified salt in improving iron nutrition status

Background: Salt fortification with iron is a potential strategy to increase population-level iron intake. The current evidence regarding double-fortified salt (DFS) in improving iron nutrition status is equivocal. Objective: To study the efficacy of DFS as compared to iodine fortified salt (IS) in improving iron nutrition status. Methods: Randomized controlled trials comparing DFS and IS until August 2016 were systematically searched across multiple databases to assess for change in mean hemoglobin (Hb), prevalence of anemia, iron deficiency (ID), ID anemia (IDA), serum ferritin, and serum transferrin receptor (TfR). Meta-analysis was performed using R software. Results: Of the initial 215 articles retrieved using the predetermined search strategy, data from 10 comparisons of DFS and IS across 8 randomized controlled trials are included. There was significant heterogeneity across included studies and the studies were of low to very low quality as per GRADE criteria. DFS significantly increased mean Hb by 0.44 g/dl (95% confidence interval [CI]: 0.16, 0.71) and significantly decreased anemia (risk difference ?0.16; 95% CI: ?0.26, ?0.06) and ID (risk difference ?0.20; 95% CI: ?0.32, ?0.08) as compared to IS. There was no statistically significant difference in change in ferritin levels (mean difference 0.62 ?g/L; 95% CI: ?0.12, 1.37), serum TfR levels (mean difference ?0.23 mg/dL; 95% CI: ?0.85, 0.38), and IDA (risk difference ?0.08; 95% CI: ?0.28, 0.11). Conclusion: DFS is a potentially efficacious strategy of addressing anemia as a public health problem at population level. There is a need for effectiveness trials before DFS can be scaled up in program mode at population level.

Anticoagulación oral en reintervenciones endovasculares de la aorta / Oral Anticoagulation in Endovascular Aortic Reinterventions

RESUMEN Introducción: La endofuga es la principal causa de reintervención después del tratamiento endovascular de aorta. Algunos pacientes necesitan anticoagulación oral prolongada, lo cual puede aumentar la incidencia de endofugas posoperatorias. Objetivos: Nuestro objetivo es determinar si la anticoagulación oral posoperatoria tiene impacto en la incidencia de endofugas. Material y métodos: Este análisis retrospectivo incluyó todos los pacientes con aneurisma de aorta abdominal tratados por vía endovascular entre 2009 y 2014 en nuestro centro. Se determinaron dos grupos de pacientes de acuerdo con la necesidad de anticoagulación oral y se comparó entre ambos grupos la mortalidad relacionada con la aorta; la supervivencia libre de reintervenciones, de cualquier endofuga y de endofugas no tipo II; supervivencia libre de un punto final compuesto por mortalidad relacionada con la aorta, reintervenciones y endofugas, y la reducción del diámetro del saco aneurismático. Resultados: De 341 pacientes tratados, 33 (9,67%) estaban anticoagulados. No hubo diferencias entre ambos grupos en términos de mortalidad relacionada con la aorta (2,59% vs. 3,03%, p = ns), supervivencia libre de reintervenciones (84,04% vs. 86,2%; p = ns), supervivencia libre de cualquier endofuga (82% vs. 89%; p = 0,81) o supervivencia libre de endofugas no tipo II (88% vs. 88%; p = 0,52). Al analizar la supervivencia libre del punto final compuesto tampoco se encontraron diferencias significativas (80% vs. 85%; p = ns). La reducción promedio del diámetro del saco aneurismático fue de 5,19 mm y 3,51 mm (p = 0,2). Conclusiones: No se registró diferencia en ninguno de los resultados analizados. La anticoagulación oral posoperatoria no tuvo impacto en los resultados del tratamiento endovascular de aorta.

ABSTRACT Introduction: Endoleak is the main cause for reintervention after endovascular aortic repair. Some patientis need prolonged oral anticoagulation, which may increase the incidence of postoperative endoleaks. Objectives: Our objective was to determine whether postoperative oral anticoagulation has an impact on the incidence of endoleaks. Methods: This retrospective analysis included all patientis with endovascular treatment of abdominal aortic aneurysm at our center between 2009 and 2014. Two groups of patientis were determined according to the need for oral anticoagulation. Aortic-related mortality, survival free from reinterventions, any endoleak and non-type II endoleaks, survival free of the composite endpoint of mortality associated with the aorta, reinterventions and endoleaks, and reduction of aneurysmal sac diameter was compared between both groups.Resultis: Among 341 treated patientis, 33 (9.67%) were anticoagulated. There were no differences between the two groups in terms of aorta-related mortality (2.59% vs. 3.03%, p=ns), reintervention-free survival (84.04% vs. 86.2%; p=ns), any endoleak- free survival (82% vs. 89%, p=0.81) or non-type II endoleak-free survival (88% vs. 88%, p=0.52). Similarly, no significant differences were found when analyzing the composite endpoint-free survival (80% vs. 85%, p=ns). The average reduction of aneurysmal sac diameter was 5.19 mm and 3.51 mm (p=0.2). Conclusions: No difference was registered in any of the resultis analyzed. Postoperative oral anticoagulation had no impact on the resultis of endovascular aortic treatment.

Analgesic and antiinflammatory activities of the essential oil from Artemisia sieberi Besser

The analgesic activity of Artemisia sieberi oil was assessed by acetic acid-induced writhing test and Eddy's hot plate method; while the acute anti-inflammatory effect was investigated by inflammatory paw edema test in rats. The administration rout of the essential oil, standard drugs and the vehicle used in all assays was intraperitoneal injection. The 1 and 2.5 mg/kg doses of the studied oil significantly decreased the number of acetic acid-induced writhes in mice. The dose of 1 mg/kg of the oil also exhibited a central analgesic effect as evidenced by a significant increase in reaction time at several time points after 15 min treatment in the hot plate method. In addition, the 1 mg/kg dose of the oil significantly reduced carrageenan induced paw edema in rats at the first hour of the test by 72.7% inhibition and lasted to the third hour of the test by 74.3% inhibition found to be very close to that of the standard drug, diclofenac sodium (50 mg/kg). The major components of the oil were characterized as camphor (31.2%) and 1,8-cineole (20.0%). The results suggest that A. sieberi essential oil has a significant effect against acute inflammation and has central and peripheral anti-nociceptive effects.

Influence of propofol dose and blood components on duration of electrical seizures in electroconvulsive therapy / Influência da dose de propofol e dos componentes sanguíneos na duração das convulsões elétricas em eletroconvulsoterapia

Abstract Background and objectives: Propofol is commonly employed as a hypnotic agent to perform electroconvulsive therapy, but it exhibits also anticonvulsant properties. The main objective was to study the effect of the weight-adjusted dose of propofol on duration of the electrical seizure. Secondary objectives were to study the effect of absolute dose of propofol on duration of electrical seizure, the effect of both absolute and weight-adjusted doses on values of bispectral index, and the influence of blood chemistry on anticonvulsant effect. Methods: After approval of the Institutional Review Board, a retrospective chart review was performed of all patients who underwent at least one electroconvulsive therapy session. Multiple lineal regression analysis adjusted for potential confounders was employed to explore the effect of propofol dosage on values of bispectral index and on duration of seizure; bivariate correlation analyses were previously performed to identify variables fulfilling confounding criteria, specifically values of Spearman's rho >0.10. Results of regression analysis were expressed as B coefficient with its 95% confident interval. Results: 76 patients received 631 acute phase sessions. Propofol showed a statistically significant negative effect on duration of seizure (specifically a reduction of 4.081 s for every mg.kg−1 of propofol; CI95%: −7906 to −0.255, p = 0.037) but not on bispectral index values. Slight anemia and hypoalbuminemia were very infrequent conditions, and the anticonvulsant effect was not influenced by these parameters. Conclusions: Propofol weight-adjusted dose is negatively related to duration of seizures. It should be carefully titrated when employed to perform electroconvulsive therapy.

Resumo Justificativa e objetivos: O propofol é comumente usado como agente hipnótico na terapia eletroconvulsiva, mas apresenta também propriedades anticonvulsivantes. O objetivo principal foi avaliar o efeito da dose de propofol ajustada ao peso na duração da convulsão elétrica. Os objetivos secundários foram avaliar o efeito da dose total de propofol na duração da convulsão elétrica, o efeito da dose tanto total quanto ajustada ao peso nos valores do índice bispectral e a influência da bioquímica do sangue no efeito anticonvulsivante. Métodos: Após aprovação do Comitê de Ética em Pesquisa, foi feita uma revisão retrospectiva dos prontuários de todos os pacientes que fizeram pelo menos uma sessão de eletroconvulsoterapia. Análise de regressão linear múltipla ajustada para potenciais confundidores foi feita para explorar o efeito da dosagem de propofol sobre os valores do índice bispectral e a duração da convulsão; análises de correlação bivariada foram previamente feitas para identificar as variáveis que atendem aos critérios de confusão, especificamente valores de r de Spearman > 0,10. Os resultados da análise de regressão foram expressos como coeficiente B com intervalo de confiança de 95%. Resultados: Setenta e seis pacientes receberam 631 sessões de fase aguda. Propofol mostrou um efeito negativo estatisticamente significativo sobre a duração da convulsão (especificamente uma redução de 4,081 segundos para cada mg.kg−1 de propofol; IC de 95%: -7906 para -0,255, p = 0,037), mas não para os valores do índice bispectral. Anemia leve e hipoalbuminemia foram condições muito raras e o efeito anticonvulsivante não foi influenciado por esses parâmetros. Conclusões: A dose de propofol ajustada ao peso está negativamente relacionada com a duração das crises convulsivas, deve ser cuidadosamente titulada quando usada na terapia eletroconvulsiva.

Is it safe to use local anesthesia with adrenaline in hand surgery? WALANT technique / É seguro o uso de anestésico local com adrenalina na cirurgia da mão? Técnica WALANT

ABSTRACT In the past it was taught that local anesthetic should not be used with adrenaline for procedures in the extremities. This dogma is transmitted from generation to generation. Its truth has not been questioned, nor the source of the doubt. In many situations the benefit of use was not understood, because it was often thought that it was not necessary to prolong the anesthetic effect, since the procedures were mostly of short duration. After the disclosure of studies of Canadian surgeons, came to understand that the benefits went beyond the time of anesthesia. The WALANT technique allows a surgical field without bleeding, possibility of information exchange with the patient during the procedure, reduction of waste material, reduction of costs, and improvement of safety. Thus, after passing through the initial phase of the doubts in the use of this technique, the authors verified its benefits and the patients' satisfaction in being able to immediately return home after the procedures.

RESUMO Aprendemos que não deveríamos usar um anestésico local com adrenalina para procedimentos nas extremidades. Esse dogma é transmitido de geração em geração. Não questionávamos a sua veracidade ou a origem da dúvida. Em muitas situações não entendíamos o benefício do uso, pois muitas vezes pensávamos não ser necessário prolongar o efeito anestésico, já que os procedimentos eram, na sua maioria, de curta duração. Após a divulgação de estudos dos cirurgiões canadenses, passamos a entender que os benefícios se estendiam além do tempo de anestesia. A técnica WALANT permite um campo cirúrgico sem sangramento, possibilidade de troca de informações com o paciente durante o procedimento, redução de material de descarte, redução de custos e melhoria da segurança. Dessa forma, após passar pela fase inicial das dúvidas quanto ao uso dessa técnica, verificamos os seus benefícios e a satisfação dos pacientes em poderem retornar de imediato para casa após os procedimentos.

Low doses of amitriptyline, pregabalin, and gabapentin are preferred for management of neuropathic pain in India: is there a need for revisiting dosing recommendations?

BACKGROUND: Current therapy for the treatment of neuropathic pain is often unsatisfactory. Considerable variation in treatment pattern still exists in spite of availability of sufficient literature from various guidelines. Recent Indian market data suggested that the utilization (sale) of drugs such as amitriptyline, pregabalin, and gabapentin was more for low-dose unit packs than that of the high-dose unit packs, raising the belief that these drugs are prescribed at a lower dose than is actually recommended in the guidelines. To test this hypothesis, a survey was conducted across speciality throughout the country to observe the prescription pattern of these drugs amongst the health care providers in India. METHODS: Three hundred fifty survey forms were distributed of which 281 forms were included for analysis. RESULTS: It was observed that the commonly used initiation and maintenance dose for amitriptyline, pregabalin, and gabapentin was 5–10 mg/day, 50–75 mg/day, and 100–300 mg/day, respectively. The reason to select the lower dosages was to have a balancing effect to achieve good efficacy with minimum side effects. Care-givers reported no side effects/not many side effects as a reason in 22.2%, 16.88%, and 23.86% patients with amitriptyline, pregabalin, and gabapentin, respectively. Sedation and giddiness were commonly reported with all three drugs. CONCLUSIONS: Commonly prescribed drugs for management of neuropathic pain, such as amitriptyline, pregabalin, and gabapentin are preferred at lower doses in Indian clinical settings. Acceptable efficacy and low tolerance to the standard dosage is believed to be the reason behind the prescribed dose.

Management of necrotizing scleritis after pterygium surgery with rituximab / Tratamento com rituximabe de esclerite necrosante após cirurgia de pterigeo

ABSTRACT The authors present a case of necrotizing scleritis after pterygium excision successfully treated with rituximab after attempts with high doses of corticosteroids and immunosuppressive drugs. A literature review revealed case reports and a phase I/II dose-ranging randomized clinical trial using rituximab for necrotizing scleritis with or without association with autoimmune disease. This is the only case report on rituximab treatment for necrotizing scleritis after pterygium surgery. In cases with refractoriness to immunosuppressive drugs, a CD20 antibody can be used.

RESUMO Os autores apresentam um caso de sucesso no tratamento com rituximabe de esclerite necrosante após cirurgia de pterígio refratário a altas doses de corticosteroides e drogas imunossupressoras. Uma revisão da literatura direcionada ao uso de rituximabe para tratamento de esclerites necrosantes revelou relatos de casos e um estudo clínico randomizando fase I/II. Este é o único caso descrito de rituximabe para o tratamento de esclerite necrosante pós cirúrgica. O uso de anticorpo anti-CD20 pode ser uma opção em casos refratários aos imunossupressores no tratamento da esclerite necrosante pós-cirúrgica.

Short-term effects of intravitreal dexamethasone implant (OZURDEX®) on choroidal thickness in patients with naive branch retinal vein occlusion / Os efeitos a curto prazo do implante de dexametasona intravítrea (OZURDEX®) na espessura da coroide em pacientes com oclusão primária de ramo da veia central da retina

ABSTRACT Purpose: The objective of this study was to evaluate subfoveal choroidal thickness (SFCT) using enhanced depth imaging optical coherence tomography (EDI-OCT) in patients with naïve branch retinal vein occlusion (BRVO) before and after intravitreal dexamethasone implant (Ozurdex®) injection. Methods: Thirty-nine patients with unilateral BRVO and 35 healthy subjects were included in this prospective study. Choroidal thickness was evaluated by EDI-OCT at baseline and 1 month after dexamethasone implant. Results: The mean SFCT measured in 39 patients with BRVO was 299.41 ± 55.86 µm, significantly greater than that in contralateral eyes (283.76 ± 57.44 µm; p=0.009) and control eyes (276.14 ± 39.06 µm; p=0.044). The mean SFCT after the treatment was 279.64 ± 50.96 µm, significantly thinner than that before intravitreal dexamethasone therapy (p=0.004). Conclusions: SFCT in treatment-naive BRVO eyes was significantly greater than that in contralateral eyes and healthy eyes and decreased significantly after intravitreal dexamethasone implantation.

RESUMO Objetivo: O objetivo deste estudo foi avaliar a espessura da coróide (SFCT) usando imagens de tomografia de coerência óptica com profundidade aprimorada (EDI-OCT) no tratamento de pacientes com oclusão primária de ramo da veia central da retina (BRVO) antes e após o implante de dexametasona intravítrea (Ozurdex®). Métodos: Trinta e nove pacientes com BRVO unilateral e 35 indivíduos saudáveis foram incluídos neste estudo prospectivo. Espessura da coróide foi avaliada por EDI-OCT na antes e um mês após o tratamento. Resultados: A média da SFCT medida em 39 pacientes com BRVO foi 299,41 ± 55,86 µm, o que foi significativamente maior do que a dos olhos contralaterias (283,76 ± 57,44 µm) e dos olhos controle (276,14 ± 39,06 µm) (p=0,009 e p=0,044, respectivamente). A média da SFCT após o tratamento foi 279,64 ± 50,96 µm, o que foi significativamente menor do que antes do mesmo (p=0,004). Conclusões: A SFCT do tratamento de olhos com BRVO primária foi significativamente maior do que a dos olhos contralaterais e dos olhos saudáveis, e diminuiu significativamente após o implante intravítreo de dexametasona.

Duración del tratamiento y administración oral de antimicrobianos en neumonía adquirida en la comunidad / Duration of treatment and oral administrad on of antibiotics in community acquired pneumonia

Community acquired pneumonia (CAP) is an important cause of morbidity and mortality around the world, with high treatment costs due to hospitalization and complications (adverse events due to medications, antibiotic resistance, healthcare associated infections, etc.). It has been proposed administration of short courses and early switch of intravenous administration to oral therapy to avoid costs and complications. There are recommendations about these topics in national and intemational guidelines, based on clinical trials which do not demónstrate diffe-rences in mortality and complications when there is an early change from intravenous administration to the oral route. There are no statistically significant differences in safety and resolution of the disease when short and long treatment schemes were compared. In this review we present the most important guidelines and clinical studies, taking into account the pharmacological differences between different medications. It is considered that early switch from intravenous to oral administration route and use of short cycles in CAP is safe and brings benefits to patients and institutions.

La neumonía adquirida en la comunidad (NAC) es una causa importante de morbilidad y mortalidad en el mundo, con costos elevados por cuenta de las hospitalizaciones y las complicaciones (infección asociada al cuidado de la salud, efectos adversos de medicamentos, resistencia antimicrobiana, etc.). Ante este panorama se ha propuesto administrar ciclos cortos y el cambio temprano de la vía administración de antimicrobianos de endovenosa a oral. Existen recomendaciones acerca de los puntos anteriores en guías locales e internacionales, así como ensayos clínicos que no demuestran diferencias en cuanto a mortalidad y complicaciones cuando se realiza un cambio temprano de vía de administración de endovenosa a oral en NAC. Tampoco hay diferencias estadísticamente significativas en seguridad y resolución de enfermedad cuando se compararon esquemas cortos y prolongados. En esta revisión se presentan las guías y estudios más importantes, considerando las diferencias farmacológicas de los diferentes medicamentos. Se considera que el cambio temprano de vía de administración y el uso de ciclos cortos en NAC es seguro y presenta beneficios para pacientes e instituciones.

Local treatment of toxoplasmic retinochoroiditis with intravitreal clindamycin and dexamethasone / Tratamento local para a retinocoroidite toxoplásmica com clindamicina e dexametasona intravítrea

ABSTRACTPurpose:To report the clinical outcomes of local treatment of toxoplasmic retinochoroiditis (TRC) with intravitreal injections of clindamycin and dexamethasone.Methods:Study population: 16 eyes (16 patients) with active TRC sparing the macula and juxtapapillary area treated with intravitreal injections of clindamycin (1 mg) and dexamethasone (1 mg) without concomitant systemic antitoxoplasmic or anti-inflammatory therapy. Measured parameters: Best-corrected visual acuity (BCVA) was measured by an Early Treatment Diabetic Retinopathy Study (ETDRS) chart. BCVA and clinical characteristics of retinochoroiditis were assessed at baseline and at 1, 3, 6, and 12 months. Primary outcome measures: Resolution of retinochoroiditis and changes in BCVA.Results:Control of TRC was achieved in all cases with a mean interval of 2.48 ± 1.03 weeks (2-6 weeks). A single injection of intravitreal clindamycin and dexamethasone was performed in 12 patients, and four patients required two intravitreal injections, during the follow-up period. Fourteen eyes (87.5%) improved ≥ 2 ETDRS lines of BCVA, of two or more Early Treatment Diabetic Retinopathy Study lines, BCVA remained stable in two eyes (12.5%), and no patient had decreased BCVA at the end of the follow-up period. No ocular or systemic adverse events were observed.Conclusion:Local treatment with intravitreal injections of clindamycin and dexamethasone without concomitant systemic therapy was associated with resolution of TRC in patients without macular or juxtapapillary involvement. Intravitreal clindamycin and dexamethasone may represent a viable treatment option in patients with allergies or inadequate responses to oral medications.

RESUMOObjetivo:Reportar os resultados clínicos do tratamento local da retinocoroidite toxoplásmica com injeções intravítreas de clindamicina e dexametasona.Métodos:População do estudo: 16 olhos (16 pacientes) com retinocoroidite toxoplásmica ativa sem comprometimento da mácula e da área juxtapapilar, tratados com injeções intravítreas de clindamicina (1 mg) e dexametasona (1 mg) sem terapia sistêmica anti-toxoplásmica ou anti-inflamatória concomitante. Procedimento de observação: A melhor acuidade visual corrigida (BCVA) foi medida através da tabela ETDRS. A BCVA e as características clínicas da retinocoroidite foram avaliadas na qualificação, primeiro, terceiro, sexto e 12º mês. Medidas do resultado principal: resolução da retinocoroidite e mudanças na BCVA.Resultados:O controle da retinocoroidite toxoplásmica foi atingido em todos os casos com um intervalo médio de 2,48 ± 1,03 semanas (intervalo de 2 a 6 semanas). Uma única injeção intravítrea de clindamicina e dexametasona foi aplicada em 12 pacientes, e quatro pacientes precisaram de duas injeções durante o seguimento. Quatorze olhos (87,5%) melhoraram ≥ 2 linhas ETDRS de BCVA, a BCVA ficou estável em 2 olhos (12,5%) e nenhum paciente apresentou diminuição da acuidade visual no final do seguimento. Não foram observados eventos adversos sistêmicos ou oculares.Conclusão:O tratamento local com injeções intravítreas de clindamicina e dexametasona sem terapia sistêmica concomitante esteve associado com a resolução da retinocoroidite toxoplásmica em pacientes sem comprometimento macular ou juxtapapilar. A clindamicina e dexametasona intravítrea representam um tratamento promissor em pacientes com intolerância, contraindicação ou resposta inadequada a medicação oral.

Comparison of the effects of subconjunctival and topical anti-VEGF therapy (bevacizumab) on experimental corneal neovascularization / Comparação do efeito da terapia anti-VEGF (bevacizumab) subconjuntival e tópica na neovascularização corneana experimental

Purpose: To compare the effects of bevacizumab applied either subconjunctivally or topically, in a rat model of corneal neovascularization induced by alkali burn. Methods: The right corneas of 24 Wistar-Albino rats were cauterized with silver nitrate sticks. The rats were divided randomly and equally into three groups: no treatment control (n=8), subconjunctival bevacizumab treatment (n=8), and topical bevacizumab treatment (n=8). Immediately following cauterization, the subconjunctival group was treated with a 0.05 ml (1.25 mg) bevacizumab subconjunctival injection. The topical group was treated with 10 mg/ml bevacizumab twice daily, and the control group received subconjunctival saline injections twice daily. The burn stimulus and neovascularization scores were evaluated using a technique previously described by Mahoney and Waterbury. Digital photographs were obtained before the eyes were enucleated and corneal sections were then analyzed by histopathology. Results: The mean burn stimulus score was 1.86 ± 0.6 and there was no statistical difference between the groups (p=0.730). The mean neovascularization scores in the subconjunctival and topical bevacizumab groups were statistically lower than the control group (p<0.05). The mean percentage area of corneal neovascularization was 82.5 ± 22.1 in the control group, 42.7 ± 15.0 in the subconjunctival group, and 55.8 ± 18.2 in the topical group. The differences between the control and treatment groups were statistically significant (p<0.05). Histopathology showed that the treatment groups presented less neovascularization, inflammation, and fibroblast activity than the control group (p<0.05). Conclusions: This study demonstrates that both subconjunctival and topical administrations of bevacizumab inhibit corneal neovascularization and decrease inflammation and fibroblast activity in a rat model of corneal neovascularization induced by alkali burn. .

Objetivo: Comparar o efeito de bevacizumab aplicado subconjuntival e topicamente em um modelo de neovascularização de córnea de ratos induzida por queimadura alcalina. Métodos: Córneas direitas de 24 ratos Wistar-Albino foram cauterizados por nitrato de prata. Os indivíduos foram divididos aleatoriamente e igualmente em três grupos: controle (n=8), o bevacizumab subconjuntival (n=8), o bevacizumab tópico (n=8). Imediatamente após a cauterização, 0,05 ml (1,25 mg) de bevacizumab foi injetado no grupo subconjuntival. Grupo tópico foi inculcado com 10 mg/ml de bevacizumab duas vezes por dia. O grupo controle recebeu solução salina normal, topicamente, duas vezes ao dia. A graduação do estímulo da queimadura e a graduação da neovascularização foram avaliados utilizando a técnica descrita por Mahoney e Waterbury. Fotografias digitais foram obtidas dos olhos serem enucleados. Seções da córnea foram analisadas por histopatologia. Resultados: A média da graduação do estímulo da queimadura foi de 1,86 ± 0,6 e não houve diferença estatisticamente entre os grupos (p=0,730). As médias das graduações da neovascularização no grupo bevacizumab subconjuntival e no grupo bevacizumab tópico foram estatisticamente menores do que o grupo controle (p<0,05). A percentagem média de área de neovascularização da córnea foi de 82,5 ± 22,1 no grupo controle, 42,7 ± 15,0 no grupo subconjuntival e 55,8 ± 18,2 no grupo tópico. As diferenças entre os grupos de tratamento e grupo de controlo foram estatisticamente significativos (p<0,05). A histopatologia mostrou que os grupos de tratamento apresentavam menos neovascularização, inflamação e atividade de fibroblastos do que o grupo controle (p<0,05). ...