Both small volume hypertonic saline and large volume lactated Ringer's blunts calcium influx in early stages of TBI associated to hemorrhagic shock. No fluid resuscitation strategy promotes calcium influx and further neural damage.

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Resumo: Este trabalho trata do desenvolvimento sustentável da comunidade de remanescentes de quilombolas de Monte Alegre, em Cachoeiro de Itapemirim, Espírito Santo. Revela como a intervenção da universidade, por meio da pesquisa, do ensino e da extensão, tem contribuído para o desenvolvimento da região, com especial ênfase para as atividades turísticas que despontam como uma das principais vocações do lugar. Apresenta os resultados de uma pesquisa cujo objetivo é diagnosticar a sociedade local e possibilitar o conhecimento do perfil sócio-econômico da comunidade, visando subsidiar ações de planejamento estratégico, entre outras. Apresenta os resultados do planejamento estratégico desenvolvido com base no diagnóstico pelos próprios moradores. Este planejamento servirá para orientar o futuro da localidade sendo uma peça que respeita as características dos moradores, uma vez que foi desenvolvida por eles. Conclui apresentando as novas etapas do projeto, com o objetivo de congregar teoria e prática no ensino do Turismo e de outras áreas afins. Palavras-chave: Desenvolvimento sustentável. Turismo. Quilombolas.

Purpose: Late hypotony is an undesirable and challenging complication of glaucoma surgery. We describe our use of the Ologen Collagen Matrix to treat late hypotony developing after trabeculectomy. Study design: A retrospective study performed at three eye surgery centers in Brazil. Participants: Eighteen patients who underwent 19 eye surgeries. Intervention: Subconjunctival Ologen was implanted at the trabeculectomy sites to treat over-filtering or leaking blebs in patients experiencing late hypotony after trabeculectomy (obtained 6 months after glaucoma surgery). The primary outcome was the intraocular pressure (IOP); we gathered preoperative data records from 19 Ologen treated eyes and days 1, 7, 30, 60, and 180 postoperatively. The secondary outcomes included visual acuity and macular thickness measured via optical coherence tomography; we compared preoperative data to subsequent ones up to sixth-month-evolution. Results: Over the 6-month period, the IOP rose from 2.89 ± 1.59 mmHg preoperatively to 8.21 ± 3.46 mmHg ( p = 0.0001). Visual acuity improved from 0.33 ± 0.29 to 0.21 ± 0.31 LogMar ( p = 0.0013). Macular thickness fell from 325.62 ± 58.7 to 283.08 ± 47.35 µm ( p = 0.0097). We encountered two complications: one related to suture dehiscence following an ocular trauma and one instance of transitory choroidal detachment. Conclusion: Subconjunctival Ologen implants preserved bleb function and successfully treated post-trabeculectomy hypotony as revealed by data collected at the 6-month follow-up. Longer follow-up is necessary to confirm long-term efficacy and safety. There are no financial conflicts of interest to disclose.

Fluorescein is associated with minor adverse effects during retinal angiography, and most of these effects are not severe and not related to immunological mechanism. However, on rare occasions, anaphylatoid reaction can occur, and fatalities involving fluorescein have been described. Life threatening complications after intravenous injection of sodium fluorescein require immediate intervention. Trainings for professionals are needed to standardize treatment for this event.Keywords: Anaphylaxis; Seizures/chemically induced; Fluorescein angiography/adverse effects; Fluoresceins/administration & dosage; Retinal diseases; Injections, intravenous; Case reports RESUMO A fluoresceína endovenosa é associada a pequenos efeitos adversos durante a angiografia da retina, a maioria deles sem gravidade e não relacionada a mecanismos imunológicos. Entretanto, em raras ocasiões, pode ocorrer reação anafilactoide; fatalidades envolvendo o uso de fluoresceína têm sido descritas. Complicações graves após injeção endovenosa de fluoresceína requerem ação imediata da equipe envolvida, assim como treinamento regular para padronizar o tratamento.

Purpose To study the effects of Ologen collagen matrix on the outcomes of the Ahmed glaucoma valve implant. Study Design Retrospective case-control multicenter study, conducted at four centers, comparing the 6-month outcomes of Ahmed valve implants with or without Ologen. Participants The study included 125 eyes in a 4:1 pairing (25 patients with Ologen matched to 100 patients without Ologen). Intervention Ologen was placed over the Ahmed plate in the study group. Success was defined as an intraocular pressure (IOP) ≤ 21 mmHg either with no medication (complete success) or regardless of medications (qualified success). Other outcomes included IOP variation, eye drop use, and surgical complications. Results Overall, the IOP decreased from 30.72 ± 9.08 to 16.14 ± 4.79 mmHg (p=0.0001). Of the 125 eyes, 26 achieved complete success and 94 achieved qualified success. There was no difference in complete success between the groups (p=0.12); however, there was a difference in qualified success (p=0.01), with better results in the no-Ologen group (80% vs 56%). There were no differences in the decrease in medications (p=0.06), as well as the incidence of complications (p=0.69). Although the need for postoperative surgical reintervention was higher in the no-Ologen group (13% vs 4%), the difference was not significant (p=0.2). Conclusion The reductions in IOP and number of medications were similar in both groups after 6 months, with similar complication rates. The qualified success rate was lower in the Ologen group, but further studies are needed to clarify the role of Ologen in Ahmed valve implants.

Background and Goal of Study: The definition of the EffectSize in clinical research is imperative because the required sample size to detect an effect of an intervention may vary.The sample size is dependent on the expected outcome that is assumed previously, and the variability of the sample.Therefore, compelling research must describe the Effect Size accurately. Materials and Methods: We performed a search in the European Journal of Anaesthesiology (EJA), backward from December 2017 to August 2012, and we included 100 human randomized clinical trials. We searched

Background and Aim: The role of vitamin D plus calcium to protect against hip fracture in postmenopausal women remains controversial. Two major studies on this subject presented diverse outcomes; they implemented different doses of Vitamin D and Calcium, and they studied different populations. One study found evidence that Calcium plus Vitamin D do protect against fractures; the second study failed to demonstrate such protection. The aim of the present study is to test the hypothesis that a higher dose of vitamin D plus calcium is effective in reducing hip fractures in non-osteoporotic elderly women when compared to placebo. Methods: This will be a randomized, double-blinded superiority, multicenter trial involving three centers in São Paulo, Lima and Mexico City. After a three-month run-in period, 7176 participants will receive Calcium + Vitamin D or Placebo. The primary outcome is the occurrence of hip fractures assessed by the pelvic radiographic image; secondary outcomes include other fractures, the variation of Bone Mass Density, and the adverse effects rate. Conclusion: There is an increase in morbidity, mortality, and costs resulting from hip fractures since it is an important risk fact following accidents. A possible lack of benefit inside the active group drives more attention to an eventual over-prescription of those substances. Therefore, further studies including a phase II trial with different exclusion criteria could be desirable to confirm these findings and help to reduce the incidence of hip fractures..