Ophthalmic adverse drug reactions:A nationwide detection using hospital databases

AIM: To detect ophthalmic adverse drug reactions(ADRs), that occurred in Portugal from 2000 to 2009, through the utilization of administrative hospital databases. We also intended to compare the results of this methodology with spontaneous reporting.METHODS: We conducted a retrospective nationwide study using hospital administrative databases, which included all inpatients and outpatients in all public hospitals in Portugal, from 2000 to 2009. We used International Classification of Diseases- 9th Revision- Clinical Modification(ICD-9-CM) coding data that allowed the detection of ADRs. We used WHO's definition for ADR. We searched all of ICD-9-CM terms in Ophthalmology for codes that included "drug-induced", "iatrogenic", "toxic" and all other that could signal an ADR, such as "362.55- toxic maculopathy" or "365.03- steroid responders", and also "E" codes(codes from E930 to E949.9, that exclude intoxications and errors).RESULTS: From 11944725 hospitalizations or ambulatory episodes within that period of time, we identified 1524 probable ophthalmic ADRs(corresponding to a frequency of 1.28 per 10000 episodes) and an additional 100 possible ophthalmic ADRs. We used only 4 person-hours in the application of this methodology. A total of 113 spontaneous reports arose from ophthalmic ADRs from 2000 to 2009 in Portugal(frequency of 0.095 per 10000 episodes).To our knowledge, this was the first estimate of the frequency of ophthalmic ADRs through the use of databases, and the first nationwide estimate of ophthalmic ADRs, in Portugal. We identified 1524 probable ADRs and 100 possible ADRs. CONCLUSION: This database methodology adapted for Ophthalmology may represent a new approach for the detection of ophthalmic ADRs, since these codes exist in the ICD-9-CM classification. Its performance was clearly superior to spontaneous reporting.

Assessment of the Risk of Violence in Portuguese Psychiatric Settings Using the Broset Violence Checklist

The risk of violence in psychiatric settings implies the assessment of dynamic predictors to adjust nursing interventions. So as to identify the pattern of aggressive behaviors, assess the dynamic predictors of violence in hospitalized patients, and analyze the predictive qualities of the Brcset Violence Checklist （BVC）, an exploratory/descriptive study was conducted in psychiatric wards in Coimbra, Portugal. The instruments used were： the staff observation aggression scale-revised （SOAS-R）, visual analogue scale （VAS）, and the BVC. For the period of a month, 64 patients with a mean age of 29 years, unemployed, and with psychotic disorders were observed. In this group, 13 people displayed 15 aggressive behaviors of moderate severity, which had consequences for nurses; they were triggered by the denial of something through verbal aggression and controlled by non-restrictive measures. The most common predictors of violence were irritability and boisterousness. It was also concluded that the BVC shows good predictive characteristics （sensitivity and specificity） of violence, thus, it may be considered as a useful and effective instrument to assess the risk of violence and, consequently, to adjust nursing interventions to prevent this phenomenon.

Congenital Coronary Variants and Anomalies: Prevalence in Cardiovascular Multislice Computed Tomography Studies in a Single Center

In the era of Multislice Computed Tomography (MSCT), few studies have been dedicated to the evaluation of coronary anomalies and variants. We aim to present, describe and assess the prevalence of congenital coronary variants and anomalies (CVA) in the MSCT coronary angiographic studies performed in our department. All the MSCT coronary angiographies performed in our department, between April 1, 2007 and May 31, 2012 were reviewed. Coronary anomalies and variants were characterized and grouped according to their type: origin, course (including myocardial bridging) and distal ending. A total of 663 patients underwent a MSCT coronary evaluation during this period. A total of 84 anomalies and variants were identified in 80 individuals: 12.1% of the population (80/663). The most frequent variant was the myocardial bridging of the anterior descending artery. Four (4.7%) of the anomalies were considered malignant, corresponding to a prevalence of 0.6% (4/663) in the population. Congenital coronary anomalies and variants are relatively common. In our study, the prevalence was 12.1%, myocardial bridging being the most common. This fact may explain the higher prevalence compared to some series based on the cardiac catheterization studies. Few of these anomalies were considered malignant, with prevalence rates similar to those found in the cardiac catheterization studies.

Fluorescent probes for the detection of reactive oxygen species in human spermatozoa

Reactive oxygen species(ROS)production is a by-product of mitochondrial activity and is necessary for the acquisition of the capacitated state,a requirement for functional spermatozoa.However,an increase in oxidative stress,due to an abnormal production of ROS,has been shown to be related to loss of sperm function,highlighting the importance of an accurate detection of sperm ROS,given the specific nature of this cell.In this work,we tested a variety of commercially available fluorescent probes to detect ROS and reactive nitrogen species(RNS)in human sperm,to define their specificity.Using both flow cytometry(FC)and fluorescence microscopy(FM),we confirmed that MitoSOX™Red and dihydroethidium(DHE)detect superoxide anion(as determined using antimycin A as a positive control),while DAF-2A detects reactive nitrogen species(namely,nitric oxide).For the first time,we also report that RedoxSensor™Red CC-1,CellROX®Orange Reagent,and MitoPYl seem to be mostly sensitive to hydrogen peroxide,but not superoxide.Furthermore,mean fluorescence intensity(and not percentage of labeled cells)is the main parameter that can be reproducibly monitored using this type of methodology.

Diagnosis and Objective Pain Assessment of Traditional Chinese Medicine May Be Useful to Demonstrate Specific Effects of Acupuncture in Low Back Pain: A Prospective, Randomized, Controlled and Single Blinded Pre-study

Objective: To prove specific effects of acupuncture on chronic pain. It was speculated that the potential specific effectiveness of acupuncture could be better shown in more properly designed studies. Therefore, diagnoses of both Western medicine and traditional Chinese medicine (TCM) were used as inclusion criteria to allocate acupoints more precisely to the complaints of the patients. Secondly, objectively measurable parameters of pain relief in addition to usual Visual Analogue Scale (VAS) were chosen to quantify the effects of acupuncture. Methods: The study was prospective, randomized, controlled and single-blinded. Eighteen patients with chronic back pain and TCM diagnosis of a Taiyang/Yangming syndrome received one single session of acupuncture chosen according to TCM diagnosis or acupuncture on points outside the meridian system (controls). We evaluated pain via VAS and increased mobility via inclinometry of the back. Results: Although the sample size was small, there was a statistically significant improvement in pain and mobility in the intervention group (n=13), but not in the control group (n=5). The calculated sample size adequate power was lower for inclinometry than for VAS, indicating that VAS is less probable to discriminate acupuncture effects. Conclusion: Objectively measurable physical parameters such as the angle of flexion before and after acupuncture (inclinometry) may be more suitable to measure pain relief than subjective assessment by VAS in acupuncture studies. TCM diagnosis may be a helpful inclusion criterion in studies on acupuncture, so as to potentially allocate interventions better to the complaints of patients.