Incidence and Clinical Course of Acute Endophthalmitis after Idiopathic Epiretinal Membrane Surgery with Microincision Vitrectomy

Purpose@#To investigate the incidence and clinical course of acute endophthalmitis after idiopathic epiretinal membrane (iERM) surgery employing microincision vitrectomy (MIVS). @*Methods@#We retrospectively reviewed the medical records of eyes with acute endophthalmitis developing after iERM surgery via 23- or 25-gauge MIVS from 2011 to 2021. The incidence, culture-positive rate (and responsible bacteria), final visual acuity (VA), and factors affecting poor visual outcomes were assessed. @*Results@#Acute endophthalmitis developed in 20 of the 12,921 eyes (0.15%) after MIVS. Of these, 14 of 3,180 eyes treated via iERM (0.44%, one per 227 procedures) developed endophthalmitis; the incidence ratio (iERM versus non-iERM) was 7.1 (p < 0.001, 95% confidence interval [CI] = 2.6-22.7). At least one sclerotomy remained unsutured in all eyes after iERM surgery. Thirteen eyes (92.9%) were given intravitreal antibiotic injections after emergency vitrectomy, and one eye was treated with intravitreal antibiotic injection alone. Staphylococcus epidermidis was cultured from four eyes (28.6%); three strains were methicillin-resistant. All final VAs were not better than the initial VAs; the average VA decreased from 20/42 to 20/259 (p < 0.001). Six eyes (42.9%) attained legal blindness status (final VA < 20/200); Macular invasion was a unique risk factor for such blindness (p = 0.020, odds ratio = 35.0, 95% CI = 1.7-703.0). @*Conclusions@#Acute endophthalmitis developing after iERM surgery with MIVS was more common than such endophthalmitis after other retinal surgery. Approximately 40% of the former patients became legally blind, and the risk was higher in eyes with macular involvement of endophthalmitis.

Incidence and Risk Factors of Recurrent Anterior Uveitis in Initial Acute-Onset Vogt-Koyanagi-Harada Disease

Purpose@#We report the estimated incidence of, and risk factors for, recurrent anterior uveitis in patients with initial acute-onset Vogt-Koyanagi-Harada (VKH) disease using survival analyses. @*Methods@#Patients who were diagnosed with initial acute-onset VKH disease during 2003–2022 at two university hospitals were included. Recurrent anterior uveitis was defined as the first occurrence of the granulomatous anterior uveitis with anterior chamber cells and flare of 2+ or more by the Standardization of Uveitis Nomenclature (SUN) Working Group grading scheme, after the disappearance of conspicuous uveitis and serous retinal detachment for at least 3 months, regardless of systemic or local treatment. The univariate log-rank test and multivariate Cox regression analyses were performed, including patients’ demographic characteristics, underlying diseases, presence of prodromal symptoms, duration of visual symptoms, visual acuity, slit-lamp and fundus findings, and height of serous retinal detachment. The treatment method and response to treatment were also included. @*Results@#The estimated incidence was 39.3% at 10 years. Fifteen of 55 patients (27.3%) had recurrent anterior uveitis during the mean follow-up of 4.5 years. The presence of focal posterior synechiae at the diagnosis increased the risk of recurrent anterior uveitis 6.97-fold compared to the absence of synechiae (95% confidence interval [CI], 2.20–22.11; p < 0.001). Use of systemic high-dose steroid therapy more than 7 days after the development of visual symptoms resulted in a hazard ratio of 4.55 (95% CI, 1.27–16.40; p = 0.020). @*Conclusions@#This study reports the estimated incidence and risk factors of recurrent anterior uveitis in VKH disease from survival analyses. However, because of the retrospective nature of this study, it is hard to confirm the consistency of the medical records regarding risk factors, thus, the presence of focal posterior synechiae can be inconclusive as a risk factor. Further studies are warranted.

ILM Insertion for the Treatment of Macular Hole Associated with Phakic Intraocular Lens Implantation

Purpose@#To report a case of macular hole closure using an internal limiting membrane (ILM) flap following implantation of a posterior chamber phakic implantable contact lens (ICL).Case summary: An 18-year-old female patient presented with visual loss of the left eye after ICL implantation. She had high myopia of -12.5 diopter (spherical equivalent) and a corrected visual acuity of 2/100. The fundus photograph and optical coherence tomography showed a full-thickness macular hole measuring 688 µm in width and 976 µm in length. The ILM around the hole was detached from the retinal surface, which was greater in size than the macular hole. The initial surgical intervention involved vitrectomy, inverted ILM flap placement, and gas tamponade. The decrease in gas volume was associated with a loss of the ILM flap. For hole closure, the remaining ILM flap in the peripheral macula was harvested and inserted in the hole during the second surgery. The silicone oil was used for tamponade. One month after ILM insertion, complete closure of the hole was observed. The visual acuity improved to 20/40 after silicone oil removal. @*Conclusions@#A large full-thickness macular hole developed after ICL implantation in a patient with high myopia. Macular hole surgery using ILM insertion and prolonged tamponade closed the hole and effectively improved the visual acuity.

Predictive Accuracy of Refraction after Transscleral Fixation of Intraocular Lenses in Trabeculectomized Eyes with Glaucoma

Purpose@#To investigate the predictive accuracy of refraction and any change in intraocular pressure (IOP) after transscleral fixation of intraocular lenses (IOLs) in trabeculectomized eyes with glaucoma. @*Methods@#We retrospectively reviewed the medical records of glaucoma patients who underwent trabeculectomy, followed by transscleral fixation of dislocated IOLs combined with vitrectomy. The refraction predicted by the SRK/T formula and the postoperative refraction were converted into spherical equivalents. Predictive refraction accuracies were analyzed when the differences between the two values were within ± 0.5 diopters (D) and ± 1.0 D. The IOP was measured before and after surgery. @*Results@#Eleven eyes of 11 men (mean age, 67.27 ± 10.55 years) were included. The mean axial length was 23.64 ± 1.26 mm; the mean predicted and postoperative refractions were -0.02 ± 0.46 D and -0.80 ± 0.98 D, respectively (p = 0.029). The refractive outcome was more myopic (by -0.78 ± 1.11 D) than predicted. The predictive accuracies were 36.4% and 72.7% when the differences were ± 0.5 and ± 1.0 D, respectively. The IOP did not change during follow-up (13.18 ± 4.56, 12.82 ± 5.88, and 12.73 ± 4.58 mmHg at baseline, 1 week, and 3 months, respectively). @*Conclusions@#In trabeculectomized eyes, transscleral IOL fixation did not affect the IOP, but the refractive outcome was more myopic than predicted. This difference should be considered when choosing IOL target power.

Atlas of African Health Statistics 2022: Health situation analysis of the WHO African Region - Country profiles

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An Adenocarcinoma Associated with Bilateral, Diffuse, Uveal Melanocytic Proliferation

Purpose@#We report bilateral, diffuse, uveal melanocytic proliferation caused by a stomach adenocarcinoma.Case summary: A 78-year-old male complained of visual impairment 3 months in duration. He had diabetes and had undergone cataract surgery on both eyes 4 years prior. His best-corrected visual acuity was counting fingers in the right eye and 20/160 in the left eye. Both intraocular pressures were normal. The anterior segments yielded no specific findings. The maculae exhibited multiple, round, patchy, pigmented or depigmented lesions with exudative retinal detachment. Fluorescein angiography revealed multiple hyperfluorescent lesions. Optical coherence tomography revealed that the hyper-reflective exudates lay between the neurosensory retina and the retinal pigment epithelium. We diagnosed bilateral, diffuse, uveal melanocytic proliferation and performed a systemic evaluation. Computed tomography revealed several mass lesions in the lung, stomach, and lymph nodes; these appeared to be malignant. An esophagogastroduodenoscopic biopsy confirmed that the lesions were adenocarcinomas. @*Conclusions@#A bilateral, diffuse, uveal melanocytic proliferation induced by a primary malignant tumor exhibited multiple, pigmented subretinal exudates associated with exudative macular retinal detachment. In patients with such findings, it is necessary to evaluate the malignant tumor status of remote organs.

Intraocular Cytokine Changes in Patients with Polypoidal Choroidal Vasculopathy Treated with Ranibizumab

Purpose@#To investigate the changes in intraocular cytokines after ranibizumab treatment in patients with polypoidal choroidal vasculopathy (PCV). @*Methods@#This multicenter, prospective study enrolled patients with PCV treated with three monthly ranibizumab followed by a pro re nata regimen for 24 weeks. Best corrected visual acuity, slit lamp examination, fundus photography, and optical coherence tomography were performed every 4 weeks. Aqueous humor was collected to measure intraocular cytokines at baseline, week 8, and the time of recurrence or week 20. The association of changes in intraocular cytokines with visual acuity, central macular thickness, central choroidal thickness, area of abnormal vessels, and polyp closure was assessed. @*Results@#This study included 25 eyes. The mean patient age was 70.3 ± 6.1 years. The vascular endothelial growth factor (VEGF) concentration decreased at week 8, but only interferon (IFN)-γ, tissue inhibitors of matrix metalloproteinases (TIMP)-2, and monocyte chemoattractant protein (MCP)-2 decreased at the time of recurrence. The recurrence interval was positively associated with the baseline epithelial-neutrophil activating peptide (ENA)-78, interleukin (IL)-17, leptin, and transforming growth factor-β1, and baseline central macular thickness was positively correlated with the baseline fibroblast growth factor-4 and IL-10. Thick central choroidal thickness was associated with a low basic fibroblast growth factor and high IFN-γ at baseline. The MCP-3 and Tie-2 levels decreased in two eyes with polyp closure. @*Conclusions@#Ranibizumab significantly reduced intraocular VEGF concentrations and consequently improved PCV. However, the cytokines IFN-γ, TIMP-2, and MCP-2, rather than VEGF, were associated with PCV recurrence. Further studies of intraocular cytokines involved in neovascularization in PCV are needed.

Factors associated with chemsex in Portugal during the COVID-19 pandemic / Fatores associados à prática de chemsex em Portugal durante a pandemia da COVID-19 / Factores asociados a la práctica de chemsex en Portugal durante la pandemia de COVID-19

Objective: to investigate the factors associated with the practice of sex under the influence of drugs (chemsex) among Portuguese men who have sex with men during the period of social distancing to prevent the COVID-19. Method: online survey applied in May 2020 to a sample of 1,301 participants living in Portugal, recruited according to Respondent Driven Sampling and via social media Facebook®. Descriptive and bivariate analyses were performed along with logistic regression to calculate adjusted Odds Ratio (ORa). Results: the prevalence of chemsex was 20.2%. The likelihood of practicing chemsex increased with group sex (ORa: 28.4, 95%CI 16.93-47.49); unprotected sex (ORa: 7.1 95%CI 4.57-10.99); the use of pre-exposure prophylaxis (PrEP) to prevent COVID-19 (ORa: 4.2, 95%CI 2.71-6.39) and COVID-19 testing (ORa: 1.9, 95%CI 1.15-3.10). Conclusion: the practice of chemsex among men who have sex with men during the COVID-19 pandemic in Portugal was very frequent and may support greater understanding of the role and impact of sexual behavior on the COVID-19 transmission rates and the current pandemic situation in Portugal.

Objetivo: investigar os fatores associados à prática do sexo sob o efeito de drogas (chemsex) entre homens que fazem sexo com homens (HSH) portugueses durante o período de distanciamento social pela COVID-19. Método: inquérito on-line aplicado em maio de 2020 a uma amostra de 1301 participantes residentes em Portugal recrutados pelo método Respondent Driven Sampling na rede social Facebook®. Realizaram-se as análises descritiva e bivariada e a regressão logística para o cálculo dos Odds ratio ajustado (ORa). Resultados: a prevalência de chemsex foi de 20,2%. A chance de praticar chemsex aumentou com: o sexo grupal (ORa: 28.4, IC95% 16.93 - 47.49); o não uso de preservativo (ORa: 7,1 IC95% 4,57 - 10,99); fazer uso da profilaxia pré-exposição (PrEP) como medida protetiva para a COVID-19 (ORa: 4,2, IC95% 2,71 - 6,39) e realizar teste para a COVID-19 (ORa: 1,9, IC95% 1,15 - 3,10). Conclusão: a prática de chemsex entre homens que fazem sexo com homens, no período da pandemia da COVID-19 em Portugal, foi elevada e pode fornecer subsídios para entender o papel e o impacto que as relações sexuais possuem nas taxas de transmissão e na atual situação pandêmica no país.

Objetivo: investigar los factores asociados a la práctica de sexo bajo el efecto de drogas (chemsex), entre hombres que tienen sexo con hombres portugueses, durante período de distanciamiento social por COVID-19. Método: encuesta online aplicada en mayo de 2020 a una muestra de 1.301 participantes, residentes en Portugal, reclutados por el método Respondent Driven Sampling en la red social Facebook®. Se realizó análisis descriptivo, bivariado y regresión logística para cálculo de los Odds Ratio ajustado (ORa). Resultados: la prevalencia de chemsex fue de 20,2%. La chance de practicar chemsex aumentó con: el sexo grupal (ORa: 28.4, IC95% 16.93 - 47.49); no usar preservativo (ORa: 7,1 IC95% 4,57 - 10,99); hacer uso de la profilaxis antes de la exposición (PrEP) como medida protectora para la COVID-19 (ORa: 4,2, IC95% 2,71 - 6,39) y realizar el test para COVID-19 (ORa: 1,9, IC95% 1,15 - 3,10). Conclusión: la práctica de chemsex entre hombres que tienen sexo con hombres, en el período de la pandemia de la COVID-19, en Portugal, fue elevada y puede suministrar informaciones para entender el papel e impacto que relaciones sexuales poseen en las tasas de transmisión y actual situación de la pandemia en el país.

Psychometric properties of the Work Limitations Questionnaire applied to nursing workers / Propriedades psicométricas do Work Limitations Questionnaire aplicado a trabalhadores de enfermagem / Propiedades psicométricas del Work Limitations Questionnaire aplicado a trabajadores de enfermería

Objective: to evaluate the psychometric properties of the Work Limitations Questionnaire and to measure presenteeism in a sample of nursing workers. Method: a cross-sectional study, with non-probabilistic sampling. Data was collected between July 2018 and February 2019 in two high-complexity hospitals, and the sample was composed of 304 participants. The validity analysis of the Work Limitations Questionnaire was performed by means of Confirmatory Factor Analysis. Results: most of the participants were women (88.5%), with a mean age of 40.9 years old. The validities of the factorial, convergent and discriminant construct and the reliability of the complete version and of the 16-item version of the instrument were adequate after adjusting the models to the sample. A statistically significant and negative correlation (p<0.001) was verified between the workload, working time and the Time Management and Physical Demands dimensions; as well as a statistically significant (p<0.001) correlation between working time and the Mental-Interpersonal Demands and Production Demands dimensions. Gender and professional category did not influence presenteeism. The rate of loss of productivity at work was 19.51%. Conclusion: the Work Limitations Questionnaire showed adequate validity and reliability and can be considered a valid and reliable instrument for assessing presenteeism in the nursing team.

Objetivo: avaliar as propriedades psicométricas do Work Limitations Questionnaire e mensurar o presenteísmo em uma amostra de trabalhadores de enfermagem. Método: estudo transversal, com amostragem não probabilística. Os dados foram coletados entre julho de 2018 e fevereiro de 2019 em dois hospitais de alta complexidade e a amostra foi composta por 304 participantes. A análise da validade do Work Limitations Questionnaire foi realizada por meio da Análise Fatorial Confirmatória. Resultados: a maioria dos participantes eram mulheres (88,5%), com média de idade de 40,9 anos. As validades de construto fatorial, convergente e discriminante e a confiabilidade da versão completa e da versão de 16 itens do instrumento foram adequadas após ajustamento dos modelos. Verificou-se correlação estatisticamente significativa e negativa (p<0,001) entre carga horária, tempo de trabalho e as dimensões Gerência de Tempo e Demandas Físicas; correlação estatisticamente significativa (p<0,001) entre tempo de trabalho e as dimensões Demandas Mentais-Interpessoais e Demandas de Produção. Sexo e categoria profissional não influenciaram o presenteísmo. O índice de perda de produtividade no trabalho foi de 19,51%. Conclusão: o Work Limitations Questionnaire apresentou adequada validade e confiabilidade e pode ser considerado um instrumento válido e confiável para avaliação do presenteísmo na equipe de enfermagem.

Objetivo: evaluar las propiedades psicométricas del Work Limitations Questionnaire y medir el presentismo en una muestra de trabajadores de enfermería. Método: se trata de un estudio transversal, con muestreo no probabilístico. Los datos se recolectaron entre julio de 2018 y febrero de 2019 en dos hospitales de alta complejidad y la muestra estuvo compuesta por 304 participantes. El análisis de validez del Work Limitations Questionnaire se realizó mediante Análisis Factorial Confirmatorio. Resultados: la mayoría de los participantes era mujer (88,5%), con una edad media de 40,9 años. La validez del constructo factorial, convergente y discriminante, y la confiabilidad de la versión completa y de la versión de 16 ítems del instrumento fueron adecuadas luego de ajustar los modelos. Hubo una correlación estadísticamente significativa y negativa (p <0,001) entre carga horaria de trabajo, tiempo de trabajo y las dimensiones Gestión del Tiempo y Demandas Físicas; correlación estadísticamente significativa (p <0,001) entre el tiempo de trabajo y las dimensiones Demandas Mentales Interpersonales y Demandas de Producción. El sexo y la categoría profesional no influyeron en el presentismo. La tasa de pérdida de productividad en el trabajo fue del 19,51%. Conclusión: el Work Limitations Questionnaire presentó adecuada validez y confiabilidad y puede ser considerado un instrumento válido y confiable para evaluar el presentismo en el equipo de enfermería.

Association of salivary alpha-amylase with anxiety and stress in nursing professionals / Associação da alfa amilase salivar com a ansiedade e o estresse de profissionais de enfermagem / Asociación de la alfa amilasa salival con la ansiedad y el estrés en profesionales de enfermería

Objective: to assess if changes in salivary alpha-amylase activity are associated with anxiety and stress among hospital nursing professionals and whether anxiety and stress are associated with sociodemographic, epidemiological, and occupational factors. Method: cross-sectional, quantitative study, carried out with 210 nursing professionals from a hospital. For data collection, we used a questionnaire to characterize workers, Beck's Anxiety Inventory, Lipp's Stress Symptoms Inventory for Adults and samples and saliva samples collected in work shifts. The data were analyzed descriptively and inferentially using the software Statistical Package for the Social Science and GraphPad Prism. Results: most professionals experienced stress and anxiety. The variables age group, number of children, use of medication and workload were associated with anxiety; age group, smoking and medication use were associated with stress. An increase in the salivary alpha-amylase activity was observed in the middle of the work shift. Professionals who had stress and anxiety had significant changes in alpha-amylase in the night shift. Conclusion: changes in salivary alpha-amylase were associated with anxiety and stress among nursing professionals, indicating that this enzyme can be a possible biomarker of anxiety and stress in workers.

Objetivo: avaliar se a alteração na atividade da alfa amilase salivar está associada à ansiedade e ao estresse dos profissionais de enfermagem hospitalar e, se a ansiedade e o estresse estão associados aos fatores sociodemográficos, epidemiológicos e laborais. Método: estudo transversal, quantitativo, desenvolvido com 210 profissionais de enfermagem de uma instituição hospitalar. Para a coleta de dados, utilizouse um questionário de caracterização dos trabalhadores, o Inventário de Ansiedade de Beck, o Inventário de Sintomas de Stress para Adultos de Lipp e as amostras de saliva coletadas durante os turnos de trabalho. Os dados foram analisados de forma descritiva e inferencial utilizando os softwares Statistical Package for the Social Science e GraphPad Prism. Resultados: a maioria dos profissionais apresentou estresse e ansiedade. As variáveis faixa etária, quantidade de filhos, uso de medicamentos e carga horária de trabalho estavam associadas à ansiedade; faixa etária, tabagismo e uso de medicamentos estavam associadas ao estresse. Observouse um aumento da atividade da alfa amilase salivar no meio do turno de trabalho. Os profissionais que tinham estresse e ansiedade apresentaram alteração significativa da alfa amilase no turno da noite. Conclusão: as alterações na atividade da alfa amilase estavam associadas à ansiedade e ao estresse dos profissionais de enfermagem, demonstrando que essa enzima pode ser um possível biomarcador de ansiedade e estresse em trabalhadores.

Objetivo: evaluar si la alteración en la actividad de la alfa amilasa salival está asociada a la ansiedad y al estrés de los profesionales de enfermería hospitalaria y, si la ansiedad y el estrés están asociados a factores sociodemográficos, epidemiológicos y laborales. Método: estudio transversal, cuantitativo, desarrollado en 210 profesionales de enfermería, en una institución hospitalaria. Para la recogida de datos, se utilizó un cuestionario de caracterización de los trabajadores, el Inventario de Ansiedad de Beck, el Inventario de Síntomas de Stress para Adultos de Lipp y las muestras de saliva recogidas durante los turnos de trabajo. Los datos fueron analizados de forma descriptiva e inferencial utilizando los softwares Statistical Package for the Social Science y GraphPad Prism. Resultados: la mayoría de los profesionales presentó estrés y ansiedad. Las variables intervalo etario, cantidad de hijos, uso de medicamentos y carga horaria de trabajo estaban asociadas a la ansiedad; el intervalo etario, el tabaquismo y el uso de medicamentos estaban asociados al estrés. Se observó un aumento de la actividad de la alfa amilasa salival en los ambientes de los turnos de trabajo. Los profesionales que tenían estrés y ansiedad presentaron alteración significativa de la alfa amilasa en el turno de la noche. Conclusión: las alteraciones en la actividad de la alfa amilasa estaban asociadas a la ansiedad y al estrés de los profesionales de enfermería, demostrando que esa enzima puede ser un posible biomarcador de ansiedad y estrés en trabajadores.

Follow-up care for premature children: the repercussions of the COVID-19 pandemic / Seguimento da saúde da criança e prematuridade: as repercussões da pandemia da COVID-19 / Seguimiento de la salud del niño y prematuridad: las repercusiones de la pandemia de COVID-19

Objective: to analyze elements of the follow-up care provided to premature children amidst the COVID-19 pandemic. Method: qualitative study from the perspective of philosophical hermeneutics, interpreting experiences with childcare provided at home. Twelve mothers and 14 children aged two years old were interviewed online via a text messaging application. Data were analyzed by interpreting meanings. Results: weaknesses stood out in the follow-up care provided to children such as gaps of communication, lack of guidance and delayed immunizations, while care intended to meet health demands was interrupted. Vulnerability aspects affecting child development included: social isolation measures that impeded the children from socializing with their peers, increased screen time, the manifestation of demanding behaviors and irritation and the mothers experiencing an overload of responsibilities. The elements that strengthened maternal care included the mothers being attentive to contagion, enjoying greater experience and satisfaction with the maternal role, spending more time with their children, and recognizing respiratory signs and symptoms, especially fever. Conclusion: follow-up care provided to children in stressful situations implies implementing practices that support the wellbeing of children and families, decreasing the likelihood of children being exposed to development deficits, and detecting signs and symptoms timely. The use of nursing call centers can break the invisibility of longitudinal needs and promote health education actions at home.

Objetivo: analisar os elementos relacionados ao seguimento da saúde da criança com histórico de prematuridade em meio à pandemia da COVID-19. Método: estudo qualitativo na perspectiva da hermenêutica filosófica, conduzido pelo movimento interpretativo das experiências de cuidado da criança em casa. Participaram 12 mães e 14 crianças de dois anos de idade, com entrevistas on-line por mensagem de texto instantânea e análise de dados por interpretação de sentidos. Resultados: destacaram-se elementos frágeis ao seguimento da saúde da criança: lacunas na comunicação, ausência de orientações, atraso vacinal, demandas de cuidados interrompidas; elementos vulneráveis ao desenvolvimento infantil: distanciamento social impeditivo ao convívio entre pares, aumento do uso de telas, comportamentos de irritação e reivindicações, sobrecarga das atribuições maternas; e elementos fortalecedores dos cuidados maternos: atenção ao contágio, experiência e satisfação no papel materno, ampliação do tempo de convívio com a criança, reconhecimento de sinais e sintomas respiratórios, principalmente febris. Conclusão: o seguimento da saúde das crianças em situações estressoras implica ampliar práticas sustentadoras ao bem-estar infantil e familiar, reduzir chances de expor crianças aos prejuízos no desenvolvimento e detectar oportunamente sinais e sintomas. O teleatendimento de enfermagem pode quebrar a invisibilidade das necessidades longitudinais e alavancar as ações de educação em saúde em domicílio.

Objetivo: analizar elementos del seguimiento de la salud del niño con historial de prematuridad en medio de la pandemia de la COVID-19. Método: estudio cualitativo en la perspectiva de la hermenéutica filosófica, conducido por el movimiento interpretativo de las experiencias de cuidado del niño en el hogar. Participaron 12 madres y 14 niños de 2 años de edad, con entrevistas online por mensaje de texto instantáneo y análisis de datos por interpretación de sentidos. Resultados: se destacaron elementos frágiles al seguimiento de la salud del niño: lagunas en la comunicación, ausencia de orientaciones, atraso de vacunación, demandas de cuidados interrumpidas; elementos vulnerables al desarrollo infantil: distanciamiento social impeditivo a la convivencia entre pares, aumento del uso de pantallas, comportamientos de irritación y reivindicaciones, sobrecarga de las atribuciones maternas; y elementos fortalecedores de los cuidados maternos: atención al contagio, experiencia y satisfacción en el papel materno, ampliación del tiempo de convivencia con el niño, reconocimiento de señales y síntomas respiratorios, principalmente febriles. Conclusión: el seguimiento de la salud de los niños en situaciones estresantes implica ampliar prácticas sustentadoras al bienestar infantil y familiar, reducir posibilidades de exponer niños a los perjuicios en el desarrollo y detectar oportunamente señales y síntomas. Los servicios remotos de enfermería pueden quebrar la invisibilidad de las necesidades longitudinales y apalancar las acciones de educación en salud a domicilio.

The use of antimicrobial-impregnated fabrics in health services: an integrative review / Utilização de têxteis impregnados com antimicrobianos nos serviços de saúde: revisão integrativa / Utilización de textiles impregnados con antimicrobianos en los servicios sanitarios: revisión integradora

Objective: to analyze evidence concerning the feasibility of antimicrobial-impregnated fabrics in preventing and controlling microbial transmission in health services. Method: an integrative review using the following databases: MEDLINE (via PubMed), Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, and Latin American and Caribbean Health Sciences Literature (LILACS), regardless of language and date of publication. Seven studies were included in the analysis to verify the types of fabrics and substances used to impregnate the fabrics, applicability in health services, and decrease in microbial load. Results: silver nanoparticles and copper oxide are the main antimicrobial substances used to impregnate the fabrics. The patients' use of these fabrics, such as in bed and bath linens and clothing, was more effective in reducing antimicrobial load than in health workers' uniforms. Conclusion: the use of these antimicrobial-impregnated textiles, especially by patients, is a viable alternative to prevent and control microbial transmission in health services. Implementing these fabrics in health workers' uniforms requires further studies, however, to verify its effectiveness in decreasing microbial load in clinical practice.

Objetivo: analisar as evidências existentes sobre a viabilidade de utilizar têxteis impregnados com substâncias antimicrobianas na prevenção e no controle da transmissão microbiana em serviços de saúde. Método: revisão integrativa, utilizando as bases de dados MEDLINE (via PubMed), Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus e Literatura Latino-Americana em Ciências da Saúde (LILACS), sem restrição de idioma e período de publicação. Após a busca na literatura científica, foram selecionados sete estudos para análise quanto ao tipo de têxtil e substância utilizada para a impregnação, a aplicabilidade no serviço de saúde e a redução da carga microbiana. Resultados: nanopartículas de prata e óxido de cobre foram as principais substâncias antimicrobianas utilizadas para a impregnação de têxteis. A utilização desses têxteis pelos pacientes, como roupas de hotelaria e vestuário, mostrou maior eficácia na redução da carga microbiana em comparação ao uso como uniforme por profissionais de saúde. Conclusão: a utilização de têxteis impregnados com substâncias antimicrobianas, sobretudo pelos pacientes, pode ser considerada uma alternativa viável na prevenção e no controle da transmissão microbiana nos serviços de saúde. Todavia, a implementação destes têxteis, como uniforme para profissionais de saúde, ainda necessita de maiores investigações quanto à redução da carga microbiana na prática clínica.

Objetivo: analizar las evidencias existentes sobre la viabilidad de utilizar textiles impregnados con sustancias antimicrobianas en la prevención y control de la transmisión microbiana en servicios sanitarios. Método: revisión integradora, utilizando las bases de dados MEDLINE (vía PubMed), Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus y Literatura Latino-Americana em Ciências da Saúde (LILACS), sin restricción de idioma y período de publicación. Después de la búsqueda en la literatura científica, fueron seleccionados siete estudios para análisis en cuanto al tipo de textil y sustancia utilizada para impregnación, aplicabilidad en el servicio sanitario y reducción de la carga microbiana. Resultados: nanopartículas de plata y óxido de cobre fueron las principales sustancias antimicrobianas utilizadas para la impregnación de textiles. La utilización de esos textiles por los pacientes, como ropa de hotel y ropa, demostró mayor eficacia en la reducción de la carga microbiana en comparación al uso como uniforme por profesionales sanitarios. Conclusión: la utilización de textiles impregnados con sustancias antimicrobianas, sobre todo por los pacientes, puede ser considerada una alternativa viable en la prevención y control de la transmisión microbiana en los servicios sanitarios. Sin embargo, la implementación de estos textiles como uniforme para profesionales de la salud todavía necesita de mayores investigaciones en cuanto a la reducción de la carga microbiana en la práctica clínica.

Management of cardiopulmonary arrest in an educational video: contributions to education in pediatric nursing / Manejo da parada cardiorrespiratória em vídeo educativo: contribuições para o ensino na enfermagem pediátrica / Manejo del paro cardiorrespiratorio en un video educativo: contribuciones a la enseñanza en enfermería pediátrica

Objective: to make and validate an educational video about the management of pediatric cardiopulmonary arrest caused by respiratory failure. Method: methodological study developed in three stages: preparation and validation of a clinical case; production; and validation of educational video. To build the educational video, the Fleming, Reynolds and Wallace methodological framework was used. Results: the clinical case was validated by ten expert referees, who worked as nurses in different regions in Brazil, by completing an online form, with one round of evaluation and calculation of the content validity index. The educational video was validated by three expert judges and 25 nursing students in an evaluation round and contains six scenes, with duration of nine minutes and 56 seconds. An agreement over 80% was reached for most of the items in both the clinical case and the educational video. Conclusion: the educational video proved valid regarding face and content. This educational technology has the potential to meet the demands of students, who are digital natives, related to teaching of management of pediatric cardiopulmonary arrest caused by respiratory failure.

Objetivo: construir e validar um vídeo educativo sobre o manejo da parada cardiorrespiratória pediátrica por insuficiência respiratória. Método: estudo metodológico desenvolvido em três etapas: elaboração e validação de um caso clínico; produção; e validação de vídeo educativo. Para construção do vídeo educativo foi utilizado o referencial metodológico de Fleming, Reynolds e Wallace. Resultados: o caso clínico foi validado por 10 juízes expertises e enfermeiros de diferentes regiões do Brasil, por meio de formulário on-line, com uma rodada de avaliação e cálculo do Índice de Validação de Conteúdo. O vídeo educativo foi validado por três juízes expertises e 25 acadêmicos de Enfermagem em uma rodada de avaliação e contém seis cenas e duração de nove minutos e cinquenta e seis segundos. Tanto o caso clínico quanto o vídeo educativo obteve-se para a maior parte dos itens, 80% ou mais de concordância. Conclusão: vídeo educativo mostrou-se válido quanto à aparência e ao conteúdo. Essa tecnologia educacional tem potencial para atender às demandas de alunos, nativos digitais, tanto quanto ao ensino do manejo da parada cardiorrespiratória pediátrica ocasionada por insuficiência respiratória.

Objetivo: construir y validar un video educativo sobre manejo del paro cardiorrespiratorio pediátrico por insuficiencia respiratoria. Método: estudio metodológico desarrollado en tres etapas: elaboración y validación de un caso clínico; producción; y validación de video educativo. Para la construcción del video educativo se utilizó el marco metodológico de Fleming, Reynolds y Wallace. Resultados: el caso clínico fue validado por 10 jurados expertos, enfermeros de diferentes regiones de Brasil, mediante formulario online, en una ronda de evaluación y calculándose Índice de Validación de Contenido. El video educativo fue validado por tres jueces expertos y 25 estudiantes de enfermería en una ronda de evaluación y contiene seis escenas, de nueve minutos cincuenta y seis segundos. Se obtuvo concordancia de 80% o superior para la mayoría de los ítems del caso clínico y del video educativo. Conclusión: el video educativo demostró validez en cuanto a apariencia y contenido. Esta tecnología educacional tiene potencial para satisfacer la demanda de alumnos nativos digitales en la enseñanza del manejo del paro cardiorrespiratorio pediátrico ocasionado por insuficiencia respiratoria.

Contribution of an instructional module for lymph node evaluation: An experiment / Contribuição de um módulo instrucional para avaliação de linfonodos: um experimento / Contribución de un módulo instruccional para la evaluación de ganglios linfáticos: experimento

Objective: to evaluate the contribution of an instructional module identifying the number and characteristics of lymph nodes by undergraduate nursing students. Method: an experimental, randomized, controlled and masked study using an instructional module for intervention. The 68 students who made up the control group or the experimental group performed the prototype lymph node palpation in the initial and final phases, following the free registration of the characteristics and number of these structures. Between the phases, the instructional module (palpation prototype and a registration guide instrument) was applied to the experimental group. Descriptive statistics and mixed linear regression were used for analysis. Results: the experimental group showed greater accuracy (p<0.05) in the evaluation of the size, consistency, mobility and coalescence of the lymph nodes in the final phase when compared to the control; it also showed more chances to correctly evaluate the consistency ( OR 45,26; 95% CI<7,74>‡<264.54> p<0.0001), mobility (OR 55.95; CI 95% 12.45 - 251.60; p<0.0001) and size (OR 25.64; CI 95% 3.92 - 160.2; p=0.0002) of the lymph nodes. Conclusion: the results reinforce the contribution of the instructional module to increase the knowledge of nursing students about the evaluation of lymph nodes.

Objetivo: avaliar a contribuição de um módulo instrucional para a identificação do número e das características de linfonodos por estudantes de graduação em enfermagem. Método: estudo experimental, aleatorizado, controlado e mascarado utilizando para intervenção um módulo instrucional. Os 68 estudantes que compuseram o grupo controle ou o grupo experimento realizaram nas fases inicial e final a palpação dos linfonodos em protótipo, seguindo-se o registro livre das características e número dessas estruturas. Ao grupo experimento foi aplicado, entre as fases, o módulo instrucional (protótipo de palpação e um instrumento-guia de registro). Para análise empregou-se estatística descritiva e regressão linear mista. Resultados: o grupo experimento apresentou maior acerto (p<0,05) na avaliação do tamanho, consistência, mobilidade e coalescência dos linfonodos na fase final quando comparado ao controle; ainda, apresentou mais chances de avaliar corretamente a consistência (OR 45,26; IC 95% 7,74 - 264,54; p<0,0001), mobilidade (OR 55,95; IC 95% 12,45 - 251,60; p<0,0001) e tamanho (OR 25,64; IC 95% 3,92 - 160,62; p=0,0002) dos linfonodos. Conclusão: os resultados reforçam a contribuição do módulo instrucional para o aumento do conhecimento de estudantes de enfermagem sobre a avaliação de linfonodos.

Objetivo: evaluar la contribución de un módulo instruccional a la identificación del número y características de ganglios linfáticos por estudiantes de pregrado de enfermería. Método: estudio experimental, aleatorizado, controlado y enmascarado mediante intervención de un módulo instruccional. Los 68 estudiantes que integraron el grupo control o el grupo experimental realizaron en las fases inicial y final la palpación de los ganglios linfáticos en prototipo, tras el registro libre de las características y número de estas estructuras. El módulo instruccional (prototipo de palpación y un instrumento-guía de registro) se aplicó al grupo de Experimental. Para el análisis, se utilizó estadística descriptiva y regresión lineal mixta. Resultados: el grupo Experimental mostró mayor acierto (p<0,05) en la evaluación del tamaño, consistencia, movilidad y coalescencia de los ganglios linfáticos en la fase final en comparación con el control; aun así, presentó más probabilidad de evaluar correctamente la consistencia (OR 45,26; IC del 95% 7,74 - 264,54; p<0,0001), la movilidad (OR 55,95; IC del 95% 12,45 - 251, 60; p<0,0001) y tamaño (OR 25,64; IC 95% 3,92 - 160,62; p=0,0002) de los ganglios linfáticos. Conclusión: los resultados refuerzan el aporte del módulo instruccional para el incremento del conocimiento de los estudiantes de enfermería sobre la evaluación de ganglios linfáticos.

The use of indicators for the management of Mental Health Services / O uso de indicadores para a gestão dos Serviços de Saúde Mental / El uso de indicadores para la gestión de Servicios de Salud Mental

Objective: to identify indicators that can be used in the management of Mental Health Services. Method: an integrative review in which we adopted the Population, Concept, and Context strategy to formulate the following Guiding Question: "Which indicators can be used for the management of mental health services?". Results: a total of 22 articles were included and divided into two main groups: countries with initial high income (54%) as well as low- and middle-income countries (46%). We identified 5 studies that had experienced the use of indicators, 5 studies that had reported partial implementation, 9 studies that did not report use or implementation, 1 study on the indicator selection process, 1 as an implementation pilot, and a final study with a discussion for implementation. High-income countries also find it difficult to implement mental health indicators. The main difficulties in adopting the use of indicators are lack of basic mental health services, financial resources, legislation, political interest, and guidelines for its management. Conclusion: it is unusual to find a descriptive comparison of quality monitoring programs at the system level in the technical-scientific literature related to mental health indicators.

Objetivo: identificar indicadores que possam ser utilizados na gestão dos Serviços de Saúde Mental. Método: revisão integrativa em que adotou-se a estratégia População, Conceito e Contexto para formular a seguinte questão norteadora: "Quais indicadores podem ser usados para a gestão dos serviços de saúde mental?". Resultados: um total de 22 artigos foram incluídos e divididos em dois grupos principais: países com renda inicial alta (54%), bem como países de baixa e média renda (46%). Identificamos 5 estudos que experimentaram o uso de indicadores, 5 estudos que relataram implementação parcial, 9 estudos que não relataram uso ou implementação, 1 estudo sobre o processo de seleção de indicadores, 1 como piloto de implementação e um estudo final com uma discussão para implementação. Os países de alta renda também têm dificuldade para implementar indicadores de saúde mental. As principais dificuldades na adoção do uso de indicadores são a falta de serviços básicos de saúde mental, recursos financeiros, legislação, interesse político e diretrizes para sua gestão. Conclusão: é incomum encontrar uma comparação descritiva de programas de monitoramento de qualidade no nível de sistema na literatura técnico-científica relacionada a indicadores de saúde mental.

Objetivo: identificar indicadores que se puedan utilizar en la gestión de Servicios de Salud Mental. Método: revisión integradora en la que adoptamos la estrategia Población, Concepto y Contexto para formular la siguiente Pregunta Orientadora: "¿Qué indicadores se pueden utilizar para la gestión de servicios de salud mental?". Resultados: se incluyó un total de 22 artículos y se los dividió en dos grupos principales: países con ingresos altos iniciales (54%) y países con ingresos bajos y medios (46%). Identificamos 5 estudios que habían experimentado el uso de indicadores, 5 estudios que habían reportado implementación parcial, 9 estudios que no reportaron uso o implementación, 1 estudio sobre el proceso de selección de indicadores, 1 como piloto de implementación y un estudio final con una discusión para la implementación. Los países de ingresos altos también tienen dificultades para implementar indicadores de salud mental. Las principales dificultades para adoptar el uso de indicadores son la falta de servicios básicos de salud mental, recursos económicos, legislación, interés político y directrices para su gestión. Conclusión: es inusual encontrar una comparación descriptiva de los programas de monitoreo de la calidad a nivel de sistema en la literatura técnico-científica relacionada con indicadores de salud mental.

Atypical Retinal Hemorrhages after Vitrectomy for Idiopathic Macular Hole: Possible Toxicity of Brilliant Blue G

Purpose@#To describe the development of multiple retinal hemorrhages after uncomplicated macular hole (MH) surgery, and to determine the associated factors. @*Methods@#The medical records of 163 patients (167 eyes) diagnosed with idiopathic MHs and who underwent surgery at Pusan National University Hospital between March 2016 and July 2018 were retrospectively reviewed. The development of retinal hemorrhages was evaluated using ultra-widefield fundus photographs. Multiple retinal hemorrhages were defined as three or more dot or blot hemorrhages that had not been observed before and during the surgery. The patients were divided into two groups according to the presence of multiple retinal hemorrhages. The variable parameters were compared between the two groups to find the risk factors. The associated factors were evaluated further for the independent factor using multiple logistic regression analysis. @*Results@#Multiple retinal hemorrhages were observed in 31 eyes (18.6%) after MH surgery. The associated factors were the surgical induction of posterior vitreous detachment (PVD) (p = 0.003), use of the internal limiting membrane flap technique (p = 0.028), and staining with Brilliant Blue G (BBG) (p = 0.003). Retinal hemorrhages were exclusively observed in eyes in which BBG was used. Surgical PVD induction was the only independent risk factor (odds ratio, 13.099; p = 0.013). No statistically significant differences were observed between the two groups in the postoperative visual outcomes and MH closure rate. Additionally, patients who underwent surgery for idiopathic epiretinal membrane during the study period were reviewed to validate the above findings. Multiple retinal hemorrhages were noted in only one case (0.4%) in which BBG was used after surgical induction of PVD. @*Conclusions@#Multiple retinal hemorrhages after MH surgery appear to be related to the intravitreal use of BBG in eyes that sustained mechanical damage because of surgical induction of PVD; however, they did not affect surgical outcomes.

Primary Synovial Chondromatosis Presented as Non-Calcified Loose Bodies in the Popliteal Cyst / 대한정형외과학회잡지

A magnetic resonance imaging test was performed on a 56-year-old male patient, who visited with a one-month history of painless swelling at the popliteal area of the left knee. A popliteal cyst and non-calcified loose body in the cyst were identified. Synovial chondromatosis was diagnosed from a histology examination by excision and biopsy. This paper reports this case of extra-articular synovial chondromatosis of the knee with a review of the relevant literature.

Streptococcus infantarius Endophthalmitis after XEN Gel Stent Implantation

Purpose@#To report a case of Streptococcus infantarius endophthalmitis related to the use of a XEN® Gel Stent.Case summary: A 75-year-old male was referred to our practice with a diagnosis of endophthalmitis 55 days after XEN® Gel Stent implantation. He had primary open-angle glaucoma. Visual acuity was 20/50. Slit-lamp examination revealed conjunctival injection and anterior chamber inflammation with hypopyon. Fundus examination showed inflammatory cells with exudative materials in the vitreous. The aqueous sampling for culture of causative micro-organisms was followed by removal of the XEN® Gel Stent, along with anterior chamber irrigation and intracameral and intravitreal injection of antibiotics. Streptococcus infantarius was isolated after 5 days. Vitrectomy, anterior chamber lavage, and intravitreal injection of antibiotics were additionally performed to control the intraocular inflammation. Sixteen days after vitrectomy, the intraocular inflammation disappeared. The choroidal detachment was resolved 34 days after vitrectomy. Visual improvement was limited to 20/100 at 6 months. @*Conclusions@#XEN® Gel Stent-related bacterial endophthalmitis was successfully treated by implant removal, vitrectomy, and proper intraocular antibiotic treatment.

Acute Noninfectious Endophthalmitis after Removal of Silicone Oil and Posterior Capsulectomy in Proliferative Diabetic Retinopathy

Purpose@#Here, we report a case of acute noninfectious endophthalmitis after removal of silicone oil (SO) and posterior capsulectomy in a patient with proliferative diabetic retinopathy.Case summary: SO removal and posterior capsulectomy were performed in a 61-year-old man who had undergone vitrectomy with combined cataract surgery, membrane peeling, laser photocoagulation, and SO injection to treat vitreous hemorrhage and tractional retinal detachment three months previously. The patient’s best-corrected visual acuity on the day after surgery was 20/50; it decreased to hand motion at five days after SO removal. Exudative membrane with hypopyon, anterior chamber cell (trace), and mild conjunctival injection were observed. The patient did not complain of ocular pain. Topical steroid was applied following a diagnosis of postoperative noninfectious endophthalmitis. The exudative membrane and hypopyon decreased after three days of treatment and had resolved completely after one month of treatment. The patient’s visual acuity improved to 20/50. @*Conclusions@#Noninfectious endophthalmitis can develop after removal of SO and posterior capsulectomy. Topical steroid treatment is effective in such cases.

Exhibiting Residual Subretinal Fluid after High Myopic Macular Hole Retinal Detachment Surgery

Purpose@#To report a case of poor visual prognosis complicated by residual subretinal fluid after use of the internal limiting membrane flap technique to treat macular hole retinal detachment in a patient with high myopia.Case summary: A 55-year-old male stated that he had experienced a transparent circle in the central visual field of the right eye for 1 month. His best-corrected visual acuity (BCVA) was 0.32 and the axial length of the right eye was 32.57 mm. Fundus examination revealed a macular hole with retinal detachment localized to the posterior pole. We performed vitrectomy, membrane peeling, internal limiting membrane peeling with inverted internal limiting membrane flap, and silicone oil injection. On day 1 after surgery, the macular hole was closed, but subretinal fluid was noticed in the macula. At 3 months after surgery, the BCVA was 0.16 and the silicone oil was removed. At 14 months after the first surgery, the subretinal fluid was completely absorbed, but leopard-pattern pigment degeneration became prominent and the macula exhibited ellipsoid zone disruption. The BCVA decreased to 0.1. @*Conclusions@#In patients exhibiting macular hole retinal detachment in the context of high myopia, an inverted internal limiting membrane flap may increase the macular hole closure rate but disturb subretinal fluid drainage. As persistent subretinal fluid may cause permanent retinal damage with a poor visual prognosis, the surgical method must be carefully chosen.