Uso de modelo de olho não biológico na simulação de cirurgia de estrabismo: relato de experiência / Use of non-biological eye model in strabismus surgery simulation: experience report

Resumo: Introdução: Estrabismo é uma doença ocular caracterizada pelo desvio dos olhos cujo tratamento pode ser clínico ou cirúrgico. O ensino da cirurgia de estrabismo faz parte do programa de residência médica de oftalmologia, e seu treinamento é realizado mais frequentemente em sala de cirurgia, em situações reais. A aprendizagem ativa por experimentação ou simulação é cada vez mais utilizada na educação em saúde. Relato de experiência: O objetivo deste trabalho é descrever o relato de experiência da utilização de simulação como método de ensino de cirurgia de estrabismo para os médicos residentes do programa de residência de oftalmologia de um hospital universitário. Discussão: A simulação é um tipo de metodologia ativa que permite ao residente conquistar habilidades cirúrgicas por meio da repetição em ambiente seguro, de modo a diminuir as taxas de complicações cirúrgicas. Diferentemente de outros simuladores com tecnologia avançada para treinamento de cirurgia intraocular, nosso modelo de olho é uma ferramenta simples, de baixo custo e de fácil acesso e manuseio. A portabilidade e facilidade no manuseio permitem que o residente pratique as etapas com mais frequência desenvolvendo a memória com as etapas cirúrgicas. Conclusão: O ensino da cirurgia oftalmológica é uma tarefa desafiadora, e a utilização de métodos de aprendizagem ativa, como a simulação, é uma alternativa para o treinamento de habilidades cirúrgicas, com o propósito de diminuir as taxas de complicações.

Abstract: Introduction: Strabismus is an ocular condition characterized by eye misalignment. Its treatment can be clinical or surgical. The teaching of strabismus surgery is part of the medical residency program in ophthalmology. Its training is most often carried out in the operating theatre, in real situations. However, active learning through experimentation or simulation has been increasingly applied in health education. Experience Report: This study describes the use of simulation as a teaching method of strabismus surgery to ophthalmology residents. Discussion: Simulation is a type of active methodology that allows the resident to gain surgical skills through repetition in a safe environment. This can help reduce the risk of surgical complications. Unlike other simulators with advanced technology for intraocular surgery training, our model eye is a simple low-cost tool. It is easy to access and handle. The portability and ease of use allow the residents to practice the steps more frequently. Conclusion: The teaching of ophthalmic surgery is a challenging task and the use of active learning methods such as simulation is an alternative for training surgical skills.

Ultrasound-Assisted "Green" Extraction (UAE) of Antioxidant Compounds (Betalains and Phenolics) from Opuntia stricta var. Dilenii's Fruits: Optimization and Biological Activities.

Opuntia stricta var. Dillenii's prickly pears are an underutilized fruit with a high content of betalains and phenolic compounds that could bring potential health benefits for humans. The aim of this study is the optimization of the "green" extraction of betalains and phenolic compounds from Opuntia stricta var. Dillenii's whole fruits by ultrasound-assisted extraction (UAE), using a response surface methodology (RSM) by a central composite design (CCD) in order to obtain extracts rich in betalains and phenolic compounds with proven biological activities. For UAE optimization, the extraction temperature (20-50 °C), the amplitude (20-50%) and the ethanol volume in extraction solvent (15-80%, v/v) were selected as independent variables. All combinations were conducted at 2, 5, 10, 20 and 30 min to determinate the time effect. The betalain and phenolic compound content in Opuntia stricta var. Dillenii's whole fruits and UAE extracts were identified by HPLC-DAD-ESI/MS and HPLC-DAD-MS/QTOF and the antioxidant (ORAC method) and the anti-inflammatory (hyaluronidase inhibition method) in vitro biological activities also were determined. The most efficient extraction time was 5 min and the best UAE parameter combination was 50% amplitude, 15% ethanol in solvent (ethanol/water, 15/85, v/v) and 20 °C temperature, obtaining 10.06 ± 0.10 mg of total major betalains/g dry weight, 2.32 ± 0.08 mg of piscidic acid/g dry weight and 0.38 ± 0.00 mg of total major flavonoids/g dry weight. All applied UAE combinations significantly improved the in vitro bioactive activities (antioxidant and anti-inflammatory) of the Opuntia stricta var. Dillenii's extracts compared to the bioactivities of the extracts obtained by standard homogenization processes.

Characterization, Stability, and Bioaccessibility of Betalain and Phenolic Compounds from Opuntia stricta var. Dillenii Fruits and Products of Their Industrialization.

The aim of the present study was the full characterization, quantification, and determination of the digestive stability and bioaccessibility of individual betalain and phenolic compounds of Opuntia stricta, var. Dillenii fresh fruits (peel, pulp, and whole fruit) and of the products of the industrialization to obtain jam (raw pressed juice (product used for jam formulation), by-product (bagasse), and frozen whole fruit (starting material for jam production)). Opuntia stricta var. Dillenii fruits and products profile showed 60 betalain and phenolic compounds that were identified and quantified by HPLC-DAD-ESI/MS and HPLC-DAD-MS/QTOF, being 25 phenolic acids (including isomers and derivatives), 12 flavonoids (including glycosides), 3 ellagic acids (including glycosides and derivative), and 20 betanins (including degradation compounds). In vitro gastrointestinal digestion was performed by INFOGEST® protocol. Fruit pulp showed the greater content of total betalains (444.77 mg/100 g f.w.), and jam only showed very low amounts of two betanin degradation compounds, Cyclo-dopa-5-O-ß-glucoside (and its isomer) (0.63 mg/100 f.w.), and two Phyllocactin derivatives (1.04 mg/100 g f.w.). Meanwhile, fruit peel was the richer tissue in total phenolic acids (273.42 mg/100 g f.w.), mainly in piscidic acid content and total flavonoids (7.39 mg/100 g f.w.), isorhamnetin glucoxyl-rhamnosyl-pentoside (IG2) being the most abundant of these compounds. The stability of betalains and phenolic compounds during in vitro gastrointestinal digestion is reported in the present study. In Opuntia stricta var. Dillenii pulp (the edible fraction of the fresh fruit), the betanin bioaccessibility was only 22.9%, and the flavonoid bioaccessibility ranged from 53.7% to 30.6%, depending on the compound. In non-edible samples, such as peel sample (PE), the betanin bioaccessibility was 42.5% and the greater bioaccessibility in flavonoids was observed for quercetin glycoside (QG1) 53.7%, the fruit peel being the most interesting material to obtain antioxidant extracts, attending to its composition on antioxidant compounds and their bioaccessibilities.

Carotenoid and Carotenoid Ester Profile and Their Deposition in Plastids in Fruits of New Papaya (Carica papaya L.) Varieties from the Canary Islands.

The carotenoid profile of non-saponified and saponified extracts of different tissues (pulp and peel) of fruits of three new papaya varieties, Sweet Mary, Alicia, and Eksotika, was characterized for the first time, and almost all carotenoid compounds were quantified. Carotenoids and carotenoid esters were analyzed and characterized using HPLC-photo diode array (PDA-MS with atmospheric pressure chemical ionization with positive ion mode (APCI+) with a C30 reversed-phase column. The carotenoid deposition in collenchyma and chlorenchyma cells of papaya pulp and peel tissues was assessed by optical microscopy, confocal laser scanning microscopy, and transmission electron microscopy. The most abundant carotenoids in the fruit of the three papaya varieties (pulp and peel) were (all-E)-lycopene (230.0-421.2 µg/100 g fresh weight), (all-E)-ß-carotene (120.3-233.2 µg/100 g fresh weight), and (all-E)-ß-cryptoxanthin laurate (74.4-223.2 µg/100 g fresh weight. Moreover, high concentrations of (all-E)-lutein (922.5-1381.1 µg/100 g fresh weight) and its esters, such as (all-E)-lutein-3-O-myristate and (all-E)-lutein dimyristate, were found in peel extracts. The optical microscopy study of papaya pulps showed that carotenoid deposition in all papaya varieties, including Maradol, was mainly localized close to the cell walls, showing the presence of some crystalloids and round-shaped structures, with different sizes and distribution due to the different carotenoid content among varieties. No crystalloids or globular depositions were found in any of the peel sections, and no remarkable differences were found in the papaya peel microstructure of the different papaya varieties.

Symptoms in healthcare professionals infected with SARS-CoV-2 at a university hospital.

Introduction: Healthcare professionals are among the main risk groups for novel coronavirus disease (COVID 19). The identification of respiratory symptoms is important in the clinical assumption of infection, but it may be asymptomatic or paucisymptomatic. Objectives: To compare the proportion of professionals with symptoms suggestive of COVID-19 who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with the proportion of positive asymptomatic professionals with high-risk contact; and to identify respiratory and non-respiratory symptoms of professionals with suspected COVID-19 and the proportion of those who tested positive for SARS CoV-2. Methods: This is a cross-sectional study that retrospectively analyzed clinical records of health professionals who spontaneously sought the occupational health service of a university hospital center from March to August 2020 for presenting with symptoms and/or for having had high risk contact with a confirmed case of COVID-19 and who, in this context, underwent the reverse transcription polymerase chain reaction test for SARS-CoV-2. Results: COVID-19 was confirmed in 27 of the 420 symptomatic professionals vs. three of the 193 asymptomatic professionals (p = 0.009). Of the 371 professionals with respiratory symptoms, 19 were positive for COVID-19 vs. 11 among the 242 with no respiratory symptoms (p = 0.750). Nasal congestion and rhinorrhea were the respiratory symptoms with the highest proportion of positive cases (11.43 and 8.97%, respectively). Conclusions: Although COVID-19 is typically associated with respiratory symptoms, not all these symptoms were predictive of disease. It becomes crucial to value mild symptoms among healthcare professionals.

Low-Volume High-Intensity Aerobic Interval Training Is an Efficient Method to Improve Cardiorespiratory Fitness After Myocardial Infarction: PILOT STUDY FROM THE INTERFARCT PROJECT.

PURPOSE: To analyze the changes in cardiorespiratory fitness (CRF) and body composition following 2 different (low-volume vs high-volume) high-intensity aerobic interval training (HIIT) programs with Mediterranean diet (Mediet) recommendations in individuals after myocardial infarction (MI) and compared with an attention control group (AC). METHODS: Body composition and CRF were assessed before and after a 16-wk intervention in 70 participants (58.4 ± 8.5 yr) diagnosed with MI. All participants received Mediet recommendations and were randomly assigned to the AC group (physical activity recommendations, n = 14) or one of the 2 supervised aerobic exercise groups (2 d/wk training): high-volume (40 min) HIIT (n = 28) and low-volume (20 min) HIIT (n = 28). RESULTS: Following the intervention, no significant changes were seen in the AC group and no differences between HIIT groups were found in any of the studied variables. Only HIIT groups showed reductions in waist circumference (low-volume HIIT, Δ = -4%, P < .05; high-volume HIIT, Δ = -2%, P < .001) and improvements in CRF (low-volume HIIT, Δ = 15%, P < .01; high-volume HIIT, Δ = 22%; P < .001) with significant between-group differences (attention control vs HIIT groups). CONCLUSIONS: Results suggest that a 16-wk intervention (2 d/wk) of different HIIT volumes with Mediet recommendations could equally improve CRF and waist circumference after MI. Low-volume HIIT may be a potent and time-efficient exercise training strategy to improve functional capacity.

Ablation of Arrhythmias in Patients with Adult Congenital Heart Disease.

Arrhythmias in adults with congenital heart disease, most commonly related to previous surgical procedures, are a frequent comorbidity in this growing population thanks to the improved outcome of surgical techniques. Re-entrant circuits around areas of scarring and natural barriers, combined with abnormal haemodynamics and the underlying anatomy, are the most common cause for these arrhythmias. They are often poorly tolerated and medical treatment is frequently inadequate. In recent years, catheter ablation has emerged as a successful therapeutic option. New advanced techniques such as the use of modern three-dimensional (3D) navigation systems have contributed to better understanding of the arrhythmia mechanisms and higher success rates of the ablation procedures. In this article we briefly summarise the characteristics of the most common arrhythmias in this patient population and some key aspects in their treatment by catheter ablation.

Trombosis protésica mitral tratada con dos fibrinolisis consecutivas / Prosthetic mitral valve thrombosis treated with two consecutive courses of fibrinolysis

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Correlation between water-drinking test outcomes and body mass index in primary open-angle glaucoma patients under clinical treatment.

AIMS: The aim of this study was to evaluate the correlation between water-drinking test (WDT) outcomes and body mass index (BMI) in primary open-angle glaucoma (POAG) patients. METHODS: This study enrolled 41 POAG patients (41 eyes) under glaucoma treatment. POAG was defined as any typical signs of glaucomatous optic neuropathy and/or visual-field finding, with open angle on gonioscopy. After inclusion, patients underwent weight and height measurements. The WDT was performed, consisting of a baseline intraocular pressure (IOP) measurement, followed by the ingestion of 1 L of tap water within 5 min. Then, IOP was measured four times, at 15-min intervals. IOP peak was considered the maximum value of the four measurements, and IOP fluctuation was defined as the difference between the peak and the baseline IOP. RESULTS: The analysis of the IOP profile during the WDT revealed significant differences between groups with different BMIs. Patients with a higher BMI presented lower IOP peaks and fluctuation (P < 0.043; P < 0.001). There was also a significant correlation between the IOP fluctuation (both absolute [P < 0.024] and percentage [P < 0.021] values) and the following baseline parameters: BMI, weight, height, and cup-to-disc ratio. CONCLUSIONS: These data suggest that patients' individual characteristics, including BMI and weight, may influence the results of the WDT. In addition, patients with a higher BMI presented lower IOP fluctuation in the WDT.

Hígo graso agudo del embarazo: caso clínico

Se describen un caso clínico de hígado graso agudo del embarazo con sobrevida para madre e hijo. Se comenta sobre la clínica, patogenia, anatomía patológica y frecuencia de la enfermedad. Se destaca la disminución de la mortalidad en los últimos años