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Previous studies have revealed that eye contact with either air pollutants or adverse indoor and/or outdoor environmental conditions can affect tear film composition and ocular surface components. These effects are mediated by selective binding of the environmental agents to ocular surface membrane receptors, leading to activation of pro inflammatory signaling pathways. The aim of the current review was to examine the published evidence associated with environmental factors and ocular surface disease and dry eye. Specifically, the reader will appreciate why it is possible to refer to them as mediators of Environmental Dry Eye Disease (EDED), a singular clinical entity inside DED context, directly caused by pollutants and/ or adverse climatic conditions. The indicators and clinical findings are described along with EDE differential diagnosis in its acute and the chronic phases. Based on strong existing evidence of clinical reports and epidemiological observations regarding DED and environmental factors we conclude that there is a straight cause-and-effect relationship between ambient stresses and DED. International standards and web-based tools are described for monitoring worldwide environmental conditions referring localities and populations susceptible to EDED. This information is beneficial to health providers to pinpoint the individuals and predisposed groups afflicted with DED. Such insights may not only improve the understanding and treatment of DED but also help to identify the contributing factors and lower the frequency and progression of EDED. of DED has been studied and confirmed in animal models of human DED (13)(14)(15) . KeywordsAs indicated, a healthy and pain-free ocular surface depends on identifying and eliminating factors that cause ambient humidity, airflow and purity, and temperature to intolerable levels. Such an undertaking is needed to preserve tear film qualities commensurate with ocular surface health. This is essential to sustain sufficient corneal refractive power, visual acuity, and ocular comfort (5,16,17) . A desiccating environment can lead to increase in tear film evaporation and/or decline in its turn over and clearance. These initial events lead to exposure of the ocular surface to hazardous environmental elements that trigger or exacerbate EDED symptoms. Clinical findings have shown that increased numbers of people are affected by EDED because of exposure to environmental factors ( Figure 2).Our purpose herein is to provide a critical appraisal of the clinical and epidemiological evidence indicating that DED is influenced by environmental factors. Secondly, we delineate EDED as a single clinical entity with a unique set of symptoms and clinical findings different from that of either DED or other diseases, such as Sjögren's syndrome, diabetes mellitus or drug induced, allergic conjunctivitis, toxic or irritative conjunctivitis, and actinic keratitis. Moreover, we will describe standard tools used to monitor environmental conditions and discuss their relevance in EDED ep...

Dry eye disease and ocular surface disorders may be caused or worsened by viral agents. There are several known and suspected virus associated to ocular surface diseases. The possible pathogenic mechanisms for virus-related dry eye disease are presented herein. This review serves to reinforce the importance of ophthalmologists as one of the healthcare professional able to diagnose a potentially large number of infected patients with high prevalent viral agents. Keywords

CONCLUSIONS:The present work showed that in the last four decades major changes occurred in the guidelines dictating use of research animals occurred and they are being adopted by developing countries. Moreover, animal welfare concern in the scientific community preceded the introduction of journal guidelines for this purpose. Furthermore, in Brazil it was anticipated that laws were needed to protect animal research welfare from being not upheld.

Objetivo: Construir algoritmos de intervenção de enfermagem pré-hospitalar a vítimas de trauma. Metodologia: Revisão Narrativa da Literatura, entre 2008 e 2019, nas principais bases de dados. Dois revisores independentes realizaram a avaliação crítica, extração e síntese dos dados. A construção dos algoritmos resultou do processo interpretativo da revisão narrativa por três peritos na área. Utilizou-se o modelo teórico de Virgínia Henderson. Resultados: Obtiveram-se 17 documentos, seis foram incluídos no desenvolvimento dos metaparadigmas Saúde, Pessoa e Ambiente e 16 para a elaboração e construção de Algoritmos de avaliação, diagnóstico e intervenções de enfermagem às vítimas de trauma. Conclusões: A revisão possibilitou a operacionalização do modelo teórico de Henderson para a assistência pré-hospitalar permitindo a criação de algoritmos orientadores da prática de enfermagem.

Purpose: To assess quality of life in keratoconus patients using the Keratoconus Outcomes Research Questionnaire (KORQ) translated and validated to Portuguese language. KORQ is the only validated keratoconus specific questionnaire and has high rating for psychometric properties.Methods: In this cross-sectional study enrolled 100 patients with keratoconus from a tertiary referral eye hospital, from April 2018 to June 2019. Associations between age, gender, allergic conjunctivitis, keratoconus stage, best-corrected visual acuity (BCVA), maximum simulated keratometry (Kmax), steep keratometry (K2), pachymetry, treatments performed, hydrops and KORQ scores were evaluated with univariate (Wilcoxon test and the Kruskal Wallis test) and multivariate linear regression with stepwise backward modeling. Lower scores of KORQ are associated with better quality of life, as well as higher scores are associated with greater impairment of functional activities and symptoms.Results: Out of the 100 patients, mild, moderate and severe keratoconus, was observed in 15%, 46% and 39% of participants, respectively. Univariate analysis showed lower values for function scores with male gender (p<0.05) and both functional and symptoms scores statistically associated with BCVA<0.3 (LogMAR) (p<0.05). Multivariate analysis indicated significantly lower functional scores in individuals with BCVA<0.3 (p<0.001) and those with history of crosslinking treatment (p=0.022), while symptom scores were only statistically associated with BCVA<0.3 (p<0.001).Conclusions: In patients with keratoconus, BCVA in the better eye and history of crosslinkig are factors were associated with better quality of life scores using KORQ.

The natural aging process accelerate the appearance and the installation of diseases and symptoms characteristic of the age in which the physical and cognitive aspects are compromised progressively. Increasing the necessity of specialized cares and intensive accompaniment. This study aimed to evaluate through the Nursing Activities Score appliance, the nursing team’s working load, destined to elderly people assisted at intensive unit care and subsidize the personal sizing according to what advocate the legislation. It is about a descriptive and documental study of quantitative approach. It was used as data basis 50 patient records of elderly users admitted at a public intensive unit care from João Pessoa, Paraíba, Brazil. It was determined that 56% (28) of the elderly in his first hospitalization day at the Intensive Unit Care, required a nursing high working load while 44% (42) a nursing low working load. Through the sum of the Nursing Activities Score average score, we can achieve the total of hours at the nursing assistance necessaries to the elderly patient care during the hospitalization. The average scores obtained by the total score, corresponded to 59.2 ± 7.8, transforming in hours according to the conducted calculus, correspond to 14.47 hours of nursing assistance turned to the elderly people. It is waited that the results can contribute to quantify the expended assistance time and also evidence the real necessity of the people to ensure safe and quality assistance practices to the elderly people.  Descriptors: Workload. Nursing. Aged. Intensive Care Units.

To report a case of extensive globe enlargement due to secondary glaucoma in a young adult suffering from ocular surface disorders related to hypohidrotic ectodermal dysplasia. To the best of our knowledge, this is the first report of bu phthalmos in the adulthood.