Physical, Mechanical and Radiological Characteristics of a Fly Ash Geopolymer Incorporating Titanium Dioxide Waste as Passive Fire Insulating Material in Steel Structures.

This research analyzes whether a titanium dioxide waste (TiO2 waste) can be used as a source material for geopolymers with good fire resistance properties. Samples with different proportions were prepared, replacing fly ashes with titanium dioxide waste on geopolymers (0, 20, 30, 40 and 100% w/w). The activating solution has a Na2O/SiO2 molar ratio of 0.98. Physical (bulk density, moisture content and water absorption) and mechanical (superficial hardness and compressive strength) characteristics have been evaluated. In addition, their thermal behavior at high temperatures (fire resistance, compressive strength at elevated temperature and absorbed energy) has also been evaluated to see if they can be used as fire insulating materials. This work also studies the radiological activity of geopolymer materials. The replacement of FA with WTiO2 increases the bulk density due to its higher specific bulk density. The highest compressive strength values were obtained with a TiO2 waste content between 30 and 40% w/w. The compressive strength decreases at high temperatures, especially when more TiO2 waste is added. When the amount of TiO2 waste is increased, so is the plateau of evaporation, and this, in turn, increases the resistance to fire. Geopolymers containing FA and TiO2 waste do not present radiological problems, although, when the TiO2 waste is increased, the activity index of the geopolymer also rises.

Knowledge about healthcare-associated infections in medical, bioanalysis and nursing students from a Venezuelan university / Conocimiento sobre infecciones asociadas a la atención de la salud en estudiantes de Medicina, Licenciatura en Bioanálisis y Licenciatura en Enfermería de una universidad venezolana

Abstract Introduction: Knowledge about healthcare-associated infections (HAIs) among health professionals is fundamental to reduce morbidity and mortality rates attributable to these infections. Objective: To assess the level of knowledge on HAIs in final-year students enrolled in the School of Health Sciences of Universidad de Oriente, Venezuela. Materials and methods: A descriptive study was conducted in a stratified random sample (n=98). A survey was administered to all participants in order to determine their knowledge about 3 specific areas: basics of HAIs, universal precautions and hand hygiene. Students who obtained an average score of 17.5 were considered as having an adequate level of knowledge about HAIs. Results: Participants' average age was 24.9 years, and 74.9% were female. The average scores of nursing, medical and bioanalysis students were 18, 18.04 and 17.25, respectively; the total average score was 17.87. 59.2% of the respondents obtained a passing score. In terms of the 3 areas of knowledge assessed in the survey, most of the students obtained a failing score in basics of HAIs (n=78) and the Hand hygiene (n=76) components, while the majority (n=91) had a passing score in the Universal precautions area. Conclusions: In general, all respondents have adequate knowledge about HAIs and their prevention. However, regardless of the academic program they were enrolled in, students showed a lack of knowledge regarding specific aspects of HAIs, such as the source of the microorganisms that cause these infections or the proper use of gloves, thus it is necessary that more attention is paid to these issues in their curricula.

Resumen Introducción. El conocimiento acerca de las infecciones asociadas a la atención de la salud (IAAS) en profesionales en salud es fundamental para disminuir las tasas de morbimortalidad causadas por estas infecciones. Objetivo. Evaluar el nivel de conocimiento sobre las IAAS en estudiantes del último año de la Escuela de Ciencias de la Salud de la Universidad de Oriente, Venezuela. Materiales y métodos. Estudio descriptivo realizado en una muestra aleatoria estratificada (n=98). Se aplicó una encuesta para determinar los conocimientos de los participantes sobre 3 áreas específicas: generalidades sobre IAAS, precauciones universales e higiene de las manos. Se consideró que los estudiantes tenían un conocimiento adecuado si obtenían un puntaje promedio de 17.5. Resultados. La edad promedio de los encuestados fue 24.9 años y el 74.9% fueron mujeres. En promedio, los estudiantes de Licenciatura en Enfermería, los de Medicina y los de Licenciatura en Bioanálisis obtuvieron 18, 18.04 y 17.25 puntos, respectivamente; el 59.2% de los respondientes aprobó la encuesta y el puntaje promedio total fue 17.87 puntos. En cuanto a las tres áreas de conocimiento evaluadas, la mayoría de estudiantes reprobó Generalidades sobre IAAS (n=78) e Higiene de las manos (n=76), mientras que la mayoría (n=91) aprobó Precauciones universales. Conclusiones. En general, los estudiantes encuestados tienen un conocimiento adecuado de las IAAS y su prevención; sin embargo, independiente del programa académico, se evidenciaron deficiencias en aspectos puntuales del tema, tales como la fuente de los microorganismos causantes de las IAAS y el uso adecuado de guantes, por lo que es necesario que los currículos de estos programas profundicen más al respecto.

Pseudomonas aeruginosa Ethanol Oxidation by AdhA in Low-Oxygen Environments.

Pseudomonas aeruginosa has a broad metabolic repertoire that facilitates its coexistence with different microbes. Many microbes secrete products that P. aeruginosa can then catabolize, including ethanol, a common fermentation product. Here, we show that under oxygen-limiting conditions P. aeruginosa utilizes AdhA, an NAD-linked alcohol dehydrogenase, as a previously undescribed means for ethanol catabolism. In a rich medium containing ethanol, AdhA, but not the previously described PQQ-linked alcohol dehydrogenase, ExaA, oxidizes ethanol and leads to the accumulation of acetate in culture supernatants. AdhA-dependent acetate accumulation and the accompanying decrease in pH promote P. aeruginosa survival in LB-grown stationary-phase cultures. The transcription of adhA is elevated by hypoxia and under anoxic conditions, and we show that it is regulated by the Anr transcription factor. We have shown that lasR mutants, which lack an important quorum sensing regulator, have higher levels of Anr-regulated transcripts under low-oxygen conditions than their wild-type counterparts. Here, we show that a lasR mutant, when grown with ethanol, has an even larger decrease in pH than the wild type (WT) that is dependent on both anr and adhA The large increase in AdhA activity is similar to that of a strain expressing a hyperactive Anr-D149A variant. Ethanol catabolism in P. aeruginosa by AdhA supports growth on ethanol as a sole carbon source and electron donor in oxygen-limited settings and in cells growing by denitrification under anoxic conditions. This is the first demonstration of a physiological role for AdhA in ethanol oxidation in P. aeruginosaIMPORTANCE Ethanol is a common product of microbial fermentation, and the Pseudomonas aeruginosa response to and utilization of ethanol are relevant to our understanding of its role in microbial communities. Here, we report that the putative alcohol dehydrogenase AdhA is responsible for ethanol catabolism and acetate accumulation under low-oxygen conditions and that it is regulated by Anr.

Primary health care quality assessment according to the level of satisfaction of elderly users. / Avaliação da qualidade da atenção primária à saúde segundo o nível de satisfação dos idosos.

OBJECTIVE: To evaluate the quality of Primary Health Care according to the level of satisfaction of elderly users. METHOD: An exploratory-descriptive study, with a quantitative approach, performed with 381 elderly users of Primary Health Care. For data collection, the Service Quality scale (SERVQUAL) was adapted to the context of the Primary Health Units (UBS) of Family Health Strategy (ESF) and a questionnaire with 44 questions was elaborated. Data was treated using SSPS® and analyzed using descriptive and inferential statistical techniques. RESULTS: the SERVQUAL subscales "expectations" and "perceptions" exhibited excellent reliability and internal consistency, with Cronbach's Alpha 0.948 and 0.932, respectively. The evaluated dimensions presented negative Gaps results: tangible aspects -0.65, reliability -1.19, responsiveness -0.56, guarantee -0.91, and empathy -0.52. CONCLUSION: negative Gaps in all dimensions show gaps in the quality of services and demonstrates the low satisfaction of the elderly users of UBS/ESF/APS.

Avaliação da qualidade da atenção primária à saúde segundo o nível de satisfação dos idosos / Evaluación de la calidad de la atención primaria de la salud según el nivel de satisfacción de los ancianos / Primary health care quality assessment according to the level of satisfaction of elderly users

Resumo OBJETIVO Avaliar a qualidade da Atenção Primária à Saúde segundo o nível de satisfação dos usuários idosos. MÉTODO Estudo exploratório, descritivo, com abordagem quantitativa, realizado com 381 idosos usuários dos serviços da Atenção Primária à Saúde. Para a coleta de dados, o Service Quality (SERVQUAL) foi adaptado ao contexto das Unidades Básicas de Saúde (UBS) da Estratégia Saúde da Família (ESF) e foi elaborado um questionário com 44 questões. Os dados foram tratados utilizando o SSPS® e analisados por meio de técnicas estatísticas descritivas e inferenciais. RESULTADOS O SERVQUAL exibiu excelente confiabilidade e consistência interna das subescalas expectativas e percepções, com Alpha Cronbach 0,948 e 0,932, respectivamente. As dimensões avaliadas apresentaram Gaps negativos: aspectos tangíveis -0,65; confiabilidade -1,19; capacidade de resposta -0,56; garantia -0,91 e empatia -0.52. CONCLUSÃO Os Gaps negativos, em todas as dimensões, evidenciam lacunas na qualidade dos serviços e demonstram a baixa satisfação dos idosos usuários das UBS/ESF/APS.

Resumen OBJETIVO Evaluar la calidad de la Atención Primaria a la Salud según el nivel de satisfacción de los usuarios ancianos. MÉTODO Estudio exploratorio, descriptivo, con abordaje cuantitativo, realizado con 381 ancianos usuarios de los servicios de Atención Primaria Salud. Para la recolección de los datos, el Service Quality (SERVQUAL) fue adaptado al contexto de las Unidades Básicas de Salud (UBS) Estrategia Salud de la Familia (ESF) y elaboró ​​un cuestionario con 44 preguntas. Los datos fueron tratados utilizando SSPS® y analizados a través de las técnicas estadísticas descriptivas e inferenciales. RESULTADOS El SERVQUAL exhibió excelente confiabilidad y consistencia interna de las sub-escalas expectativas y percepciones con Alpha de Cronbach 0,948 y 0,932, respectivamente. Las dimensiones evaluadas presentaron Gaps negativos: aspectos tangibles -0,65, confiabilidad -1,19, capacidad de respuesta -0,56, garantía -0,91 y empatía -0.52. CONCLUSIÓN Los Gaps negativos evidencian lagunas en la calidad de los servicios y demuestran la satisfacción baja de los ancianos usuarios de las UBS/ESF/APS.

Abstract OBJECTIVE To evaluate the quality of Primary Health Care according to the level of satisfaction of elderly users. METHOD An exploratory-descriptive study, with a quantitative approach, performed with 381 elderly users of Primary Health Care. For data collection, the Service Quality scale (SERVQUAL) was adapted to the context of the Primary Health Units (UBS) of Family Health Strategy (ESF) and a questionnaire with 44 questions was elaborated. Data was treated using SSPS® and analyzed using descriptive and inferential statistical techniques. RESULTS the SERVQUAL subscales "expectations" and "perceptions" exhibited excellent reliability and internal consistency, with Cronbach's Alpha 0.948 and 0.932, respectively. The evaluated dimensions presented negative Gaps results: tangible aspects -0.65, reliability -1.19, responsiveness -0.56, guarantee -0.91, and empathy -0.52. CONCLUSION negative Gaps in all dimensions show gaps in the quality of services and demonstrates the low satisfaction of the elderly users of UBS/ESF/APS.

The Frequency and Type of K-RAS Mutations in Mexican Patients With Colorectal Cancer: A National Study.

BACKGROUND: Current metastatic colorectal cancer (mCRC) therapy uses monoclonal antibodies against the epidermal growth factor receptor. This treatment is only useful in the absence of K-RAS gene mutations; therefore the study of such mutations is part of a personalized treatment. The aim of this work is to determine the frequency and type of the most common K-RAS mutations in Mexican patients with metastatic disease by nucleotide sequencing. PATIENTS AND METHODS: We studied 888 patients with mCRC from different regions of Mexico. The presence of mutations in exon 2, codons 12 and 13, of the K-RAS gene was determined by nucleotide sequencing. RESULTS: Patients exhibited K-RAS gene mutations in 35% (310/888) of cases. Mutation frequency of codons 12 and 13 was 71% (221/310) and 29% (89/310), respectively. The most common mutation (45.7%) in codon 12 was c.35G>A (p.G12D), whereas the one in codon 13 was c.38G>A (p.G13D) (78.7%). DISCUSSION: Given the frequency of K-RAS mutations in Mexicans, making a genetic study before deciding to treat mCRC patients with monoclonal antibodies is indispensable.

Application of Prussian Blue electrodes for amperometric detection of free chlorine in water samples using Flow Injection Analysis.

The performance for free chlorine detection of surfactant-modified Prussian Blue screen printed carbon electrodes (SPCEs/PB-BZT) have been assessed by cyclic voltammetry and constant potential amperometry. The characterization of SPCEs/PB-BZT by X-ray photoemission, Raman and infrared spectroscopies confirmed the correct electrodeposition of the surfactant-modified PB film. These electrodes were incorporated in a Flow Injection device and the optimal working conditions determined as a function of experimental variables such as detection potential, electrolyte concentration or flow-rate. The sensor presented a linear response in the range 0-3 ppm free chlorine, with a sensitivity of 16.2 µA ppm(-1) cm(-2). The limit of detection (LOD) (S/N=3.3) and the limit of quantification (S/N=10) amounted to 8.25 and 24.6 ppb, respectively, adequate for controlling tap and drinking waters. To demonstrate the feasibility of using this free chlorine sensor for real applications possible interferences such as nitrate, nitrite and sulfate ions were successfully tested and discarded. Real free chlorine analysis was carried out in spiked tap water samples and commercial bleaches.

Rapid Legionella pneumophila determination based on a disposable core-shell Fe3O4@poly(dopamine) magnetic nanoparticles immunoplatform.

A novel amperometric magnetoimmunoassay, based on the use of core-shell magnetic nanoparticles and screen-printed carbon electrodes, was developed for the selective determination of Legionella pneumophila SG1. A specific capture antibody (Ab) was linked to the poly(dopamine)-modified magnetic nanoparticles (MNPs@pDA-Ab) and incubated with bacteria. The captured bacteria were sandwiched using the antibody labeled with horseradish peroxidase (Ab-HRP), and the resulting MNPs@pDA-Ab-Legionella neumophila-Ab-HRP were captured by a magnetic field on the electrode surface. The amperometric response measured at -0.15 V vs. Ag pseudo-reference electrode of the SPCE after the addition of H2O2 in the presence of hydroquinone (HQ) was used as transduction signal. The achieved limit of detection, without pre-concentration or pre-enrichment steps, was 10(4) Colony Forming Units (CFUs) mL(-1). The method showed a good selectivity and the MNPs@pDA-Ab exhibited a good stability during 30 days. The possibility of detecting L. pneumophila at 10 CFU mL(-1) level in less than 3 h, after performing a membrane-based preconcentration step, was also demonstrated.

Core-shell polydopamine magnetic nanoparticles as sorbent in micro-dispersive solid-phase extraction for the determination of estrogenic compounds in water samples prior to high-performance liquid chromatography-mass spectrometry analysis.

In this work, core-shell Fe3O4@poly(dopamine) magnetic nanoparticles (m-NPs) were prepared and characterized in our laboratory and applied as sorbents for the magnetic-micro solid phase extraction (m-µSPE) of twelve estrogenic compounds of interest (i.e. 17α-estradiol, 17ß-estradiol, estrone, hexestrol, 17α-ethynylestradiol, diethylstibestrol, dienestrol, zearalenone, α-zearalanol, ß-zearalanol, α-zearalenol and ß-zearalenol) from different water samples. Separation, determination and quantification were achieved by high-performance liquid chromatography coupled to ion trap mass spectrometry with electrospray ionization. NPs@poly(dopamine) were synthesized by a chemical coprecipitation procedure and characterized by different surface characterization techniques (X-ray diffraction, X-ray photoelectron spectroscopy, thermogravimetric analysis, transmission and scanning electron microscopy, infrared and Raman spectroscopy, vibrating sample magnetometry, microelectrophoresis and adsorption/desorption isotherms). Parameters affecting the extraction efficiency of m-µSPE (i.e. polymerization time, pH of the sample, extraction and elution conditions) were studied and optimized. The methodology was validated for Milli-Q, mineral, tap and wastewater using 2-methoxyestradiol as internal standard, obtaining recoveries ranging from 70 to 119% with relative standard deviation values lower than 20% and limits of quantification in the range 0.02-1.1 µg/L.

Tratamiento de hemangiomas coroideos con terapia fotodinámica / Choroidal hemangiomas treatment with photodynamic therapy

Objetivo: reportar tres casos de pacientes con hemangioma de coroides tratados con terapia fotodinámica (TFD) y realizar una revisión de la literatura sobre el tema. Diseño del estudio: estudio retrospectivo intervencionista, tipo serie de casos. Pacientes y metodología: revisión de historias clínicas y de exámenes complementarios de 3 pacientes con diagnóstico de hemangioma de coroides pre y post tratamiento con TFD en la Fundación Oftalmológica Nacional. Resultados: de los 3 casos presentados, dos se presentaron como hemangiomas de coroides circunscritos y uno difuso en un paciente con síndrome de Sturge ­ Weber. En todos los casos se observó mejoría de la agudeza visual, resolución del desprendimiento seroso de retina y regresión del tumor, sin efectos secundarios a la TFD. Conclusiones: el hemangioma coroideo es una patología con una baja incidencia, de evolución variable y difícil de predecir. La terapia fotodinámica es una alternativa no invasiva, de elección para hemangiomas coroideos sintomáticos, ya que no produce daño a las estructuras vecinas y presenta pocos efectos colaterales.

Objective: to report three cases of patients with choroidal hemangioma treated with photodynamic therapy (PDT) and review of the literature. Study design: retrospective interventional study, cases reports. Patients and methods: review of medical records and ancillary tests were performed in 3 patients with choroidal hemangioma pre and post PDT treatment. Results: of the 3 cases reported, two had a circumscribed choroidal hemangioma and one a diffuse hemangioma associated with Sturge ­ Weber syndrome. All cases had improvement in visual acuity, resolution of serous retinal detachment and tumor regression without PDT side eff ects after follow-up. Conclusions: choroidal hemangiomas have a low incidence and an uncertain prognosis. Photodynamic therapy remains as a noninvasive alternative for symptomatic choroidal hemangiomas, without damage to surrounding structures and few side effects.

Relaciones entre Actividad Física y Salud Mental en la Población Adulta de Madrid / Relationships between physical activity and mental health inthe adult population of Madrid / Relações entre actividade física e saúde mental na população adulta de Madrid

El objetivo de este trabajo fue analizar las relaciones entre la actividad física, los niveles de salud mental y la vulnerabilidad a los trastornos mentales. Participaron 1.422 personas residentes en la Comunidad de Madrid (edad: 15-74 años), evaluándose sus niveles de actividad física y salud mental mediante los cuestionarios GPAQv2 (Global Physical Activity Questionnaire Version 2) y GHQ-12 (General Health Questionnaire), respectivamente. Los resultados evidencian que los sujetos con niveles altos o moderados de actividad física total y en el tiempo libre presentaron niveles de salud mental superiores a aquellos que realizaban un nivel bajo de actividad física. Además, el nivel de la actividad física realizada en el tiempo libre mostró una relación inversa con la vulnerabilidad a los trastornos mentales

The aim of this study was to analyze the relationships between physical activity, levels of mental health, and vulnerability to mental disorders. We performed a cross-sectional study with a sample of 1422 people from the Region of Madrid, aged between 15 and 74, assessing levels of physical activity and mental health through questionnaires GPAQv2 (Global Physical Activity Questionnaire Version 2) and GHQ-12 (General Health Questionnaire), respectively. The results reveal that individuals with high or moderate total and recreational physical activity had higher levels of mental health than those who had a low level of physical activity. Furthermore, the level of physical activity during leisure time showed an inverse relationship with vulnerability to mental disorders

objectivo deste trabalho foi analisar as relações entre a actividade física, os níveis de saúde mental e a vulnerabilidade aos transtornosmentais. Participaram 1.422 pessoas residentes na Comunidade de Madrid (idade: 15-74 anos), avaliando-se os seus níveis de actividade física e saúdemental através dos questionários GPAQv2 (Global Physical Activity Questionnaire Version 2) e GHQ-12 (General Health Questionnaire),respectivamente. Os resultados evidenciam que os sujeitos com níveis elevados ou moderados de actividade física total apresentaram níveis de saúdemental superiores comparativamente com aqueles que realizavam um nível baixo de actividade física. Adicionalmente, o nível de actividade físicarealizada no tempo livre relacionou-se inversamente com a vulnerabilidade aos transtornos mentais

Quinone-rich poly(dopamine) magnetic nanoparticles for biosensor applications.

Novel core-shell quinone-rich poly(dopamine)-magnetic nanoparticles (MNPs) were prepared by using an in situ polymerization method. Catechol groups were oxidized to quinone by using a thermal treatment. MNPs were characterized by using X-ray diffraction, X-ray photoelectron spectroscopy, atomic force microscopy, magnetic force microscopy, UV/Vis, Fourier-transform infrared spectroscopy, and electrochemical techniques. The hybrid nanomaterial showed an average core diameter of 17 nm and a polymer-film thickness of 2 nm. The core-shell nanoparticles showed high reactivity and were used as solid supports for the covalent immobilization of glucose oxidase (Gox) through Schiff base formation and Michael addition. The amount of Gox immobilized onto the nanoparticle surface was almost twice that of the nonoxidized film. The resulting biofunctionalized MNPs were used to construct an amperometric biosensor for glucose. The enzyme biosensor has a sensitivity of 8.7 mA M(-1) cm(-2) , a low limit of detection (0.02 mM), and high stability for 45 days. Finally, the biosensor was used to determine glucose in blood samples and was checked against a commercial glucometer.

Preparation of core-shell Fe3O4@poly(dopamine) magnetic nanoparticles for biosensor construction.

Novel core-shell Fe3O4@poly(dopamine) magnetic nanoparticles were prepared through an in situ self-polymerization method. The hybrid nanomaterial showed an average core diameter of 11 ± 3 nm and a polymer thin film thickness of 1.8 ± 0.2 nm. The core-shell nanoparticles were employed as solid supports for the covalent immobilization of horseradish peroxidase (HRP), and the resulting biofunctionalized magnetic nanoparticles were employed to construct an amperometric biosensor for H2O2. The enzyme biosensor showed a high sensitivity of 442.14 mA M-1 cm-2, a low limit of detection of 182 nM, a wide linear range from 6.0 × 10-7 to 8.0 × 10-4 M and high stability for 1 month.

Validez de la citología de impresión para neoplasias de la superficie ocular: resultados preliminares / Validation of impression cytology for ocular surface neoplasia: preliminary results

Objetivo: determinar la validez de la citología de impresión en lesiones conjuntivales clínicamente sospechosas de neoplasia comparada con la histopatología. Diseño: estudio de prueba diagnóstica. Métodos: pacientes que ingresaron a la Fundación Oftalmológica Nacional de Colombia con diagnóstico clínico de neoplasia de superficie ocular o lesión sospechosa de neoplasia quienes fueron sometidos a citología de impresión y posterior resección quirúrgica completa más estudio patológico de la lesión. Resultados: se examinaron 54 pacientes de los cuales 27 fueron mujeres y 27 hombres correspondiendo a 50% en cada grupo. La media de edad fue 52.3 años. La lesión más frecuente fue la neoplasia conjuntival escamosa intraepitelial (NIC) en los diagnósticos clínico, citológico y patológico. Se encontró que la sensibilidad de la citología de impresión fue de 92.86% y la especifi cidad de 50%. Con respecto al diagnóstico clínico relacionado con la patología se obtuvo una sensibilidad de 92.86% y una especificidad de 80.77%. Conclusiones: Se encontró que la citología de impresión es una prueba sensible mas no específica para el tamizaje de neoplasias de superficie ocular, sin embargo no muestra una superioridad frente a un buen diagnóstico clínico. Se debe aclarar que son observaciones preliminares de un estudio que se encuentra en curso.

Objective: to determine impression cytology validity for conjunctival malignant lesions compared to pathology. Design: diagnostic test study. Methods: patients admitted to Fundación Oftalmológica Nacional of Colombia with clinical diagnosis of ocular surface neoplasia or suspicious ocular surface neoplasia who underwent impression cytology before excisional surgery of the lesion and pathologic study. Results: fifty four patients were obtained for this initial analysis, 27 were of female sex and 27 males, each group corresponded to 50%. Mean age obtained was 52.3 years. The most frequent lesion found was ocular surface squamous cell neoplasia in the clinical diagnosis, impression cytology and pathology. Impression cytology sensitivity found is 92.86% and 50% of specificity. Clinical diagnosis was found to have 92.68% sensitivity and 80.77% Conclusions: impression cytology was found to be a sensitive test but not specific, which is adequate for a screening test, however it does not demonstrate to be superior to a clinical diagnosis made by a trained specialist. It must be clear that these are preliminary observations and calculations of a study that is still in course and the sample is incomplete.

Bilateralidad en agujeros maculares. Reporte de serie de casos / Bilateral macular holes. A case series

Propósito. Reportar la bilateralidad de los agujeros maculares, su patogenia, manejo e implicaciones. Método. Retrospectivo, observacional en Institución Oftalmológica en Colombia con reporte de seis pacientes bilateralmente afectados, en quienes se realizó examen ocular completo utilizando técnicas diagnósticas vitreo-retinianas como fluoroangiografía y tomografía óptica coherente de dominio en tiempo y espectral. Resultados. En ausencia de cirugías vitreo-retinianas, los resultados fueron de tipo observacional en el seguimiento que se detalla en las historias clínicas. Conclusiones. El agujero macular lamelar puede ser bilateral, siendo importante reconocer su incidencia, patogénesis, manejo e implicaciones.

Purpose. To report bilaterality of macular holes, pathogenesis, management and implications. Method. Retrospective, observational, case series design in a Colombian Ophthalmological Institution, reporting five patients bilaterally affected. Th ey underwent to complete ocular examination and vítreo-retinal imaging diagnostic techniques as fluorescein angiography, time domain and spectral domain optical coherence tomography. Results. In absence of ocular surgeries, results were mainly observed on long time follow-up of five cases of bilateral lamellar macular holes. Conclusions. Macular holes can be bilateral and it is important the recognition of their incidence, pathogenesis, management and future implications.

Avaliação da qualidade do gerenciamento hospitalar na percepção dos profissionais / Assessment of the quality of hospital manegement according to profesisonals' perception

OBJETIVO avaliar a qualidade do gerenciamento hospitalar na percepção dos profissionais de saúde. Metodologia: o estudo é de natureza exploratória que envolve 185 profissionais, em exercício no cargo de gerência/supervisão de sete hospitais credenciados pelo SUS, na cidade de Campina Grande-PB. As respostas dos profissionais foram analisadas por meio de um modelo analítico facilitado, e discutidas à luz da literatura pertinente. RESULTADOS: Os dados revelaram que na percepção dos profissionais a qualidade do gerenciamento do serviço de saúde é diretamente afetado pela análise de processo/informação, desenvolvimento da força de trabalho e liderança tecnológica. CONCLUSÃO: Os gerentes/supervisores hospitalares não executam avaliação dos serviços, por isso, os gestores hospitalares necessitam implementar a liderança da gerência hospitalar, a cooperação organizacional, o investimento em tecnologia e análise de processo/informação e o desenvolvimento da força de trabalho e da performance da qualidade de serviço.

OBJECTIVE: To evaluate the quality of hospital management according to professionals' perception. Methods: This was an exploratory study which involved 185 professionals, working as managers/supervisors in seven hospitals accredited by the Brazilian Unified Health System in the city of Campina Grande-PB. Professionals' responses were analyzed by means of a simplified analytical model and were discussed in the light of pertinent literature. RESULTS: Data revealed that, according to professionals' perceptions, the quality of health care management is directly affected by the process/information analysis, workforce development and technological leadership. CONCLUSIONS: Hospital managers/supervisors do not execute service assessment. Consequentely, hospital managers need to implement a hospital management leadership, organizational cooperation, investment in technology and process/information analysis, development of the workforce and of the service quality performance.

Abnormal position of lymph nodes in a freemartin sheep.

In this freemartin case report the authors present the clinical and morphological findings of a freemartin ewe with an abnormal position of two lymph nodes. Freemartins, infertile females from mixed-sex twin pregnancies, are chimeras, having two cell populations: one of their own (XX DNA) and one from their male twin (XY DNA). Freemartins can have varying degrees of phenotypic masculinization, including, in some cases, having active male gonads and exhibiting male behaviors such as heat detection and aggressiveness. During the clinical examination of the freemartin ewe, a morphological abnormality of the vulva, the presence of scrotal sacs, and a lack of mammary tissue development were noted. On inspection of the vaginal channel, an extremely enlarged clitoris, resembling a penis, was found. The clinical evidence suggested freemartinism. After the karyotyping diagnosis confirmation, a necropsy was performed and samples were taken for histology and immunohistochemistry. There were two structures found in the scrotal sacs; however, these were found to be lymph nodes, not testicles, and this was confirmed by CD3 lymph protein coloration. On histological study, the phallic structure showed corpus cavernosum and tunica albuginea. The testicles were found retained inside the abdominal cavity, with the presence of atrophic seminiferous tubules. Although the position of the testicles in freemartins has been reported as highly variable, this is the first time, to the best of the authors' knowledge, that a case has been reported where lymph nodes have been found inside the scrotal sacs. It is possible that these were the inguinal lymph nodes, trapped inside the scrotum during fetal growth and development.

Periocular triamcinolone for prevention of macular edema after plaque radiotherapy of uveal melanoma: a randomized controlled trial.

OBJECTIVE: To determine the efficacy and safety of periocular triamcinolone acetonide (40 mg) for the prevention of macular edema in patients undergoing plaque radiotherapy for uveal melanoma. DESIGN: Prospective, randomized, controlled clinical trial. PARTICIPANTS AND CONTROLS: One-hundred sixty-three patients with newly diagnosed uveal melanoma undergoing iodine 125 plaque radiotherapy were entered into the study. Fifty-five patients were randomized to the control group and 108 to the triamcinolone group. Eighteen-month data were available for 143 (88%) of the 163 patients. INTERVENTION: Periocular injection of triamcinolone acetonide (40 mg in 1 ml) at the time of plaque radiotherapy and 4 months and 8 months later. Optical coherence tomography was performed at each patient evaluation. MAIN OUTCOME MEASURES: Optical coherence tomography-evident macular edema, moderate vision loss, and poor final visual acuity. RESULTS: Optical coherence tomography-evident macular edema occurred significantly less often in the triamcinolone group compared with the control group up to 18 months after plaque radiotherapy (hazard estimate, 0.45; 95% confidence interval, 0.19-0.70; P = 0.001). At the 18-month follow-up, moderate vision loss (loss of 3 lines or more of best-corrected visual acuity [BCVA]) and severe vision loss (BCVA <5/200 Snellen) occurred significantly less frequently in the triamcinolone group than in the control group (31% vs. 48% [P = 0.039] and 5% vs. 15% [P = 0.048], respectively). Rates of elevated intraocular pressure and cataract progression were similar in both groups. CONCLUSIONS: Periocular triamcinolone is beneficial in reducing the risk of macular edema up to 18 months after plaque radiotherapy for uveal melanoma and significantly reduces the risk of moderate vision loss and poor visual acuity in these patients.

Peripheral exudative hemorrhagic chorioretinopathy simulating choroidal melanoma in 173 eyes.

PURPOSE: To evaluate the clinical features and outcomes of eyes with peripheral exudative hemorrhagic chorioretinopathy (PEHCR) simulating choroidal melanoma. DESIGN: Noncomparative case series. PARTICIPANTS: A total of 173 eyes in 146 patients. METHODS: Retrospective chart review. MAIN OUTCOME MEASURES: Clinical features and outcome. RESULTS: All cases were referred for possible choroidal melanoma. The mean patient age was 80 years, 145 (99%) were Caucasian, and 98 (67%) were female. The main lesion had a mean diameter of 10 mm and mean thickness of 3 mm. The lesion was located temporally in 103 eyes (77%), involved 1 or 2 quadrants in 123 eyes (92%), and was located between the equator and the ora serrata in 119 eyes (89%). Features included subretinal hemorrhage in 134 eyes (78%), retinal exudation in 37 eyes (21%), retinal pigment epithelial (RPE) detachment in 48 eyes (28%), and sub-RPE hemorrhage in 45 eyes (26%). Peripheral RPE alterations or drusen were found in 120 ipsilateral eyes (69%) and 73 contralateral eyes (42%). Macular RPE alterations, drusen, or choroidal neovascularization was found in 83 ipsilateral eyes (48%) and 97 contralateral eyes (56%). After observation (mean 15 months), lesion regression or stability was found in 80 eyes (89%) and progression was found in 10 eyes (11%). CONCLUSIONS: PEHCR is a hemorrhagic retinal degenerative process that simulates choroidal melanoma.

Globe salvage using chemoreduction for advanced retinoblastoma in a glaucomatous eye with buphthalmos.

PURPOSE: To report globe salvage using chemoreduction (CRD) for advanced retinoblastoma in a glaucomatous eye with buphthalmos. METHODS: Case report. RESULTS: A 7-month-old girl presented with epiphora and buphthalmos in the right eye. She was found to have bilateral retinoblastoma. Classified as group E, the right eye exhibited a total retinal detachment and buphthalmos from secondary glaucoma. The left eye was classified as group B. Systemic workup revealed no metastatic disease. CRD was employed with future planned enucleation of the right eye. After six cycles of CRD and focal consolidating treatments, complete regression of retinoblastoma in both eyes was achieved. The right eye showed complete resolution of the retinal detachment and no active tumor or seeds at 18 months follow-up, allowing for salvage of the eye. CONCLUSION: In this child with secondary glaucoma and buphthalmos from retinoblastoma, CRD provided complete tumor control and globe salvage.