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  • OPTICAL NEUROPATHY: ANTIGLAUCOMATOUS TREATMENTS OFFERED BY THE UNIQUE HEALTH SYSTEM IN BRAZIL, AN ANALYSIS OF THE LAST DECADE

    Introduction: Optical neuropathy with progressive loss of visual field, glaucoma represents the main cause of irreversible blindness. Objectives: To analyze the frequency of antiglaucomatous procedures performed by the Unified Health System (SUS), in the last 10 years, requiring hospitalization and outpatient care. Methods: This is a cross-sectional quantitative retrospective study, carried out through consultations and data analysis of antiglaucomatous procedures in the DATASUS system, between January 2010 and December 2019. Results: In Brazil, trabeculectomy was the most performed procedure in the last 10 years. Outpatient care had an average of 10,661 per year, on the other hand, the need for hospitalization increased by 70%. The second procedure that generated the most hospitalizations was the implantation of an anti-glaucomatous prosthesis, which doubled in the corresponding period. Cyclodialysis was the least used procedure in the 10 years of analysis, both on an outpatient and hospital basis, and is reserved for the final stages of glaucoma. Surgical iridectomy, used for acute treatment, showed a reduction, in 2019 it represented less than a third compared to 2010. As for outpatient procedures using lasers, such as phototrabeculoplasty and iridotomy, they showed significant growth. Conclusion: Trabeculectomy is considered the gold standard, justifying its greater frequency, both on an outpatient and hospital basis. Procedures using laser are expanding, trabeculoplasty as an alternative to primary therapy, and iridotomy for greater safety in acute treatment. As the population ages, glaucoma tends to be increasingly prevalent, contributing to the progressive increase in trabeculectomies.

  • Epidemiological Profile Of Congenital Syphilis In Alagoas

    Objective: To analyze the epidemiological profile of congenital syphilis in the state of Alagoas from 2015 to 2019. Methods: Epidemiological study characterized as descriptive, observational, retrospective and cross-sectional, carried out based on data collected from the Information System for Notifiable Diseases (SINAN) and made available by the Department of Chronic Conditions and Sexually Transmitted Infections. Results and Discussions: When observing the cases of congenital syphilis, 2019 saw a significant drop in cases compared to the years 2015 to 2018. Conclusion: It is concluded that the epidemiological profile of DES demonstrates that the number of cases is higher among children under 7 days of age, the mother’s age range between 20 and 29 years, the mother’s education level from 5th to 8th grade incomplete and race / color of the mother, brown. This reflects for health professionals to seek more strategies to eradicate the disease in the state and in Brazil.

  • The Pandemic In Prison: Dissemination Of Covid-19 Infection Among The Population Without Freedom: A Cut In The State Of Pernambuco

    Objectives: To conduct a retrospective analysis on the distribution of cases of COVID-19 in the population deprived of liberty belonging to the state of Pernambuco. Methods: This is a retrospective study conducted on secondary electronic databases in the public domain, exempted from the need for an appreciation by the Ethics Committee. The database consulted was of the Center for Strategic Information on Health Surveillance (CIEVS) in the State of Pernambuco. The reference period for collection was from April 1 to September 28, 2020. Epidemiological bulletins and virtual monitoring reports, available on the CIEVS website, were analyzed. The data were analyzed using descriptive statistical techniques based on obtaining absolute and percentage frequencies. Results: The State of Pernambuco has the sixth largest prison population in the country. There are 25,564 prisoners, 24,657 men and 907 women. Related to the distribution of cases of infection by the new coronavirus, of the 5,926 suspected cases, 1,476 were confirmed, 46 are still under investigation and 37 had inconclusive tests, which represents an infection rate of 5.77% of the prison population. These results reflect that the scenario of COVID-19 infection in Pernambuco is a cause for concern, both for the general population and among the prisioners. Conclusion: The results suggest that although only 5.7% of the prison population has been infected, prison units are spaces with a potential risk for the spread of COVID-19 infection. In addition, many of the prisioners are an effective risk group and, accordingly, they should be monitored with greater intensity.

  • OCULAR TOXOPLASMOSIS: A CASE REPORT

    Introduction: Toxoplasmosis is caused by Toxoplasma gondii, mandatory intracellular protozoan. It’s estimated that one third of the world population is infected with the parasite, a fact that makes it one of the most infectious parasites. Although 80-90% of the immunocompetent infected are asymptomatic, the disease stands out for being one of the main causes of retinochoroiditis, especially among the immunosuppressed. Case report: Patient, 17 years old, white, female, previously healthy, comes to primary care due to a counter-referral with ophthalmology. Patient presented low visual acuity for 6 months, being diagnosed with ocular toxoplasmosis. Standard treatment was started: sulfadiazine, pyrimethamine, folinic acid and oral prednisolone for 6 weeks. Serum antitoxoplasma titers were obtained indicating previous infection: positive IgG and negative IgM. A patient will face another treatment cycle, as the condition doesn’t improve, which includes high doses of systemic corticosteroids. The physical examination showed no changes. The ophthalmologist requested periodic control of patient’s blood pressure and glucose, extending the treatment. Conclusion: In immunocompetent individuals, ocular toxoplasmosis is a consequence of reactivation of a scar that contained a previously inactive cyst, only a minority comes from a new infection. It’s considered the most common cause of posterior uveitis, emphasizing the importance of this report. Ocular reactivation occurs due to a decrease in specific immunity and the peak incidence is at 29 years old. Young patients with ocular toxoplasmosis have higher risk of recurrence when compared to elderly. Antitoxoplasma serology isn’t necessary for treatment, which must be started as clinical diagnosis is established.

  • STABILITY OF CHEMICAL UV FILTERS IN SUNSCREENS EXPOSED TO VEHICLE CABIN TEMPERATURES

    Background: Sunscreen companies recommend replacing your chemical sunscreen every year. Consumer inquiries about product integrity under excessive exposure to heat prompted the FDA to add a requirement statement to sunscreen products indicating a need to protect stored sunscreen from excessive heat and direct sun. If heat exposure indeed affects chemical sunscreen stability, then in some areas, replacement may be warranted earlier than a year. Methods: We examined real-life scenarios related to the storage of sunscreen containers inside vehicles sitting in natural sunlight to provide information about the stability of sunscreen active ingredients under real-life storage conditions. The active ingredients avobenzone, oxybenzone, homosalate, octinoxate, octisalate, and octocrylene in samples of sunscreens were examined after heat exposure over six months using liquid chromatography-tandem mass spectrometry (LC-MS/MS) analysis. The calculated levels of each active ingredient were then compared between the non-heat exposed samples and the heat exposed samples using a paired t-test to look for decreases in active chemicals from heat exposure. Results: No important differences were seen for heat exposure in this study of 378 hours of temperatures above 37.8 °C, with an additional 292 hours of exposure to temperatures of 32.2-37.7 °C, and 3454 hours at 26.7-32.2 °C. Conclusions: This suggests such heat exposure does not result in degradation of the active ingredients of sunscreens with sun protection factors (SPF) of 30 and 50. This is important for individuals attempting to prevent sunburns and skin cancer.

  • COMPARATIVE STUDY ULTRASOUND GUIDED ABDOMINAL FIELD BLOCKS VERSUS PORT INFILTRATION IN LAPAROSCOPIC CHOLECYSTECTOMIES FOR POST-OPERATIVE PAIN RELIEF

    Background and Aims: Effective post‑operative analgesia after laparoscopic cholecystectomy is important because it facilitates early amelioration, ambulation and short hospital stay. Aim: To compare the postoperative analgesic efficacy of ultrasound guided abdominal field blocks with port site infiltration with ropivacaine in laparoscopic cholecystectomy. Methods: An observational study was conducted in the Postgraduate Department of Anaesthesiology and Critical Care Medicine in collaboration with the Department of General Surgery, Government Medical College, Srinagar from October 2017 – December 2018. Patients were randomised into two groups to receive either local anaesthetic infiltration of the laparoscopy port sites (n = 40, Group A/standard group) and USAFBs (n = 40, Group B/study group) using a total dose of 30 ml of ropivacaine 0.2% with sterile technique. Randomisation was done by flipping of coin method. The primary objective was to measure magnitude of pain in first 24 hours using numeric rating scores (NRS). To estimate opioid consumption in first 24 hours postoperatively. To assess the quality of pain relief and patient satisfaction on a four point Patient satisfaction scale. Statistical analysis was done using SPSS version 21. Data were compared using the Chi‑square test and students’ t‑test. Results: Duration of analgesia was significantly longer in Group B than group A. Upon inter group comparison of A vs. B the results were statistically significant (p value

  • Reexamining opioid addiction as a co-occurring disorder: A clinical perspective on the “Chronic Pain Paradox”

    The use of opioids as an anodyne for chronic pain was not prevalent before the 1980s1. Students in medical schools had learnt to avoid prescribing opioids, considered highly addictive for treatment of non-malignant chronic pain1. Yet, from the early 1990s, prescription opioids emerged as a widely accepted method of treating chronic pain and palliative care2. Previously, chronic pain was treated in multidisciplinary clinics with coordinated care which included physical exams, medication management, biopsychosocial evaluation, cognitive behavioral treatment, physical therapy, and occupational therapy2. Starting in the early 1990’s, under dubious antecedence, opioid analgesics were promoted as the proprietary remedy for chronic pain and received endorsement and support from care providers across the United States3. Non-cancerous chronic pain, as a phenomenon, was thus elevated to an ailment or a medical condition by its own right from its erstwhile status as a corollary to another medical condition. This led to an increase in opioid analgesic prescriptions, followed by a wide-ranging abuse by patients, converting opioid use disorder (OUD) to a problem of epidemic proportions4. Apart from the legal course of action initiated against Perdue Pharma, in 2020, the maker and distributor of Oxycontin that resulted in a $3.8 billion lawsuit settlement, in which Perdue Pharma pleaded guilty; since the recognition of this problem, new measures have been adopted to counter the opioid epidemic by clinicians. There has been a significant shift towards circumvention by physicians prescribing opioids for non-cancerous chronic pain. In a few instances, providers have resorted to putting a temporary moratorium on prescribing opioids to all non-cancerous chronic pain cases5. The Center for Disease Control (CDC) and various state agencies have passed protocols, installed prescription monitoring programs (PMPs), and created taskforces to rein in flagrant prescription practices by medical providers. Mental health counseling and alternative, non-prescriptive pain management procedures have been…

  • Epidemiology and Risk Factors for Hepatitis C Infection in Malaysia: A Narrative Review

    Hepatitis C infection is a growing public health issue in Malaysia. A large number of people living with hepatitis C virus (HCV) are unaware of the infection. The treatment complexity warrants a comprehensive understanding of this infectious disease to support planning for strategies to reduce the burden of disease associated with hepatitis C. This study aimed to summarise the epidemiology and risk factors attributable to hepatitis C acquisition in Malaysia based on local published articles. Published articles related to epidemiology and risk factors for hepatitis C infection in Malaysia between 2005 and 2017 were searched through several online databases. Related information from the Ministry of Health official website was also compiled. An increasing trend in the incidence and mortality rate of hepatitis C infection is noted over the last decades. In 2009, the national prevalence of people infected with HCV was approximately 2.5%, with the prevalence rate varying according to different high-risk groups. The most common genotypes reported are genotypes 3 and 1. Frequently reported risk factor for HCV acquisition is injection drug use. Other identified risk factors are being a blood product recipient, haemodialysis patient or participant in high-risk sexual activity. Nevertheless, a considerable number of patients had no known risk factors. The prevalence and burden of HCV-related disease are substantial and can be attributed to many factors. High-quality design studies are needed to provide stronger evidence of the risk factors for hepatitis C infection in local populations for future public health planning.

  • NECROTIZING FASCIITIS AT THE EXTREMITIES AND ITS MANAGEMENT

    We report in the light of a literature review the results of 28 patients treated for Necrotizing Fasciitis (NF) at the extremities between 2012 and 2017 with a view to a prospective study with longer following up and a greater number of patients.

  • Two-year Single-Center Real-Life Data of Tenofovir Disoproxil Fumarate Treatment for Chronic Hepatitis B Patients in Togo

    Objective: to evaluate the treatment efficacy of Tenofovir disoproxil fumarate (TDF) in patients with chronic hepatitis B (CHB) in the Teaching hospital campus of Lome. Patients and method: retrospective cross-sectional study, conducted in the outpatient department of the Hepato-Gastro-Enterology department of the Teaching hospital campus of Lome from January 2018 and December 2020. Patients with HBsAg were included. Outpatient patients having achieved at least HBeAg, anti-HBe antibody, anti-HCV antibody, anti-HBc IgG; viral load hepatic assessment; retroviral serology. Some patients had achieved actitest-fibrotest. Patients with abdominal pain, clinical signs of portal hypertension or hepatocellular insufficiency had achieved alphafetoprotein, protidogram, and abdominal ultrasound. These explorations made it possible to classify patients into different virological profiles. Results: More than sixty-four percent of the patients were male. The patients were asymptomatic at 97.37%. HBeAg was positive in 15.19% of patients. The viral load was detectable in 80.43% of cases with a value of 52000000 IU / ml +/- 280000000UI / ml. Ninety-five point twenty-four patients had an inflammatory activity less than 2 and 52.38% a fibrosis greater than 2 on the Metavir grid. The APRI and Fib-4 scores found a strong predictive value for fibrosis in 16.22% and 11.01% of cases, respectively. HBeAg negative chronic hepatitis was the most common virologic profile (58%). Cirrhosis was the most common complication (9.97%). Tenofovir was the therapeutic molecule used. At 12 months of treatment, HBe seroconversion was noted in 100% of cases, an undetectable viral load in 50% of cases and normalization of the hepatic balance in 84% of cases. No side effects of the treatment were reported Conclusion: TDF treatment shows high rate of complete virologic response in CHB patients. TDF is tolerable and safe during the 96 weeks of treatment period. Monitoring of HBV DNA level and drug adherence is important for achieving complete suppression…