ABSTRACT
El objetivo del trabajo fue determinar la prevalencia de cicatrices retinianas por toxoplasmosis en la población adulta en el municipio de San Francisco de Atyra en Paraguay. Se examinó dicha población desde julio del 2013 hasta marzo 2014, con la participaron en forma voluntaria de 61 familias seleccionadas al azar y dentro de cada una de ellas un integrante mayor de 18 años igualmente seleccionado al azar. Se realizó la toma de la agudeza visual utilizando la cartilla de Snellen en cada ojo por separado a 6 metros del paciente, refracción automatizada, prueba refractiva, biomicroscopía en lámpara de hendidura con énfasis en la profundidad de la cámara anterior de forma inmediata se descartaron pacientes con cámaras anteriores pandas o estrechas (utilización de gonioscopio mirrow 4 mini), presión intraocular, instilación de Tropicamida 0,5%/Fenilefrina HCL 5% en cada ojo, evaluación del polo posterior en lámpara de hendidura con lente de 90D Superfield, oftalmoscopia indirecta con lente de 20D y fotografía en la cámara no midriática. El diagnóstico de toxoplasmosis ocular fue basado en criterios clínicos, y aspectos de la cicatriz de la lesión por retinocoroiditis. Recibieron evaluación oftalmológica 61 pacientes de los cuales 6 pacientes fueron excluidos. La prevalencia de cicatrices corioretininanas fue del 9,1%, siendo más frecuente en hombres sin predilección de edad ni de lateralidad ocular, con agudeza visual igual o mejor a 20/40 con su mejor corrección.
The objective of this study was to determine the prevalence of retinal scars caused bytoxoplasmosis in an adult population from the municipality of San Francisco de Atyra inParaguay. The population of this town was examined from July, 2013 to March 2014.Sixty families, randomly selected, participated voluntarily and within each of them amember older than 18 years of age also selected randomly. Visual acuity was measuredusing the Snellen chart in each eye separately at 6 meters from the patient, as well as theautomated refraction, refraction test, biomicroscopy with a slit lamp with emphasis in thedepth of the anterior chamber. Patients with panda or narrow front chambers (use of amini 4 mirror gonioscope) were discarded. Intraocular pressure, instillation of tropicamide0.5%/phenylephrine HCl 5% in each eye, evaluation of the posterior pole in a slit lampwith 90D Superfield lens, indirect ophtalmoscopy with 20D lenses and photography with non-mydriatic camera were also carried out. The diagnosis of ocular toxoplasmosis wasbased in clinical criteria and aspects of the lesion scar by retinochoroiditis. Sixty onepatients were evaluated ophtalmologically and six were excluded. The prevalence ofchorioretinal scars was 9.1% being more frequent in men without age predominance orocular laterality, with visual acuity equal to or better than 20/40 with its best correction.
Subject(s)
Humans , Male , Adolescent , Adult , Female , Middle Aged , Eye Diseases/diagnosis , Eye , Toxoplasma , Cicatrix/diagnosis , PrevalenceABSTRACT
Introduction: Toxoplasmosis is a worldwide disease; it can cause decreased vision or even blindness. The route of transmission in humans may vary according to the habits of the region; probably the ingestion of raw or undercooked meat is the main source of infection. Objective: To determine the seroprevalence of toxoplasmosis in an eye clinic, the frequency of ocular toxoplasmosis (OT) and risk habits for acquiring the infection. Materials and Methods: Adult patients consulting in the Retina Department of the Teaching Hospital of the National University of Asuncion, Paraguay between August and September, 2014 were included. Prior informed consent, socio-demographic and epidemiological data related to T. gondii infection were obtained. In addition a blood sample for the determination of anti T. gondii IgG antibodies by the ELISA method was taken and ophthalmologic evaluation for the diagnosis of OT was made. Results: A total of 80 patients with mean ± SD age of 53 ± 20 years were studied, with slight predominance of women (55%). The seroprevalence of toxoplasmosis was 84% (67/80) and OT was detected in 8.9% of the 67 seropositive persons. The habit of not washing vegetables with sodium hypochlorite and eat meat from wild animals was related to higher risk of infection in this population. Conclusion: It is important to conduct research at the population level to establish the epidemiology of toxoplasmosis in our country. Information on prophylactic measures to prevent infection by T. gondii should be given to the population.
Introducción: La toxoplasmosis es una enfermedad de distribución mundial, que puede ocasionar disminución de la visión hasta ceguera. La vía de transmisión en el hombre puede variar de acuerdo a los hábitos de cada región, siendo probablemente la ingestión de carne cruda o mal cocida la principal vía de contagio. Objetivo: Determinar la seroprevalencia de toxoplasmosis en una clínica oftalmológica, la frecuencia de toxoplasmosis ocular (TO) y los hábitos de riesgo para adquirir la enfermedad. Pacientes y Métodos: Fueron incluidos 80 pacientes adultos que consultaron en el Departamento de Retina de la Cátedra de Oftalmología del Hospital de Clínicas entre agosto y septiembre de 2014. Previo consentimiento informado, se obtuvieron los datos socio-demográficos y epidemiológicos relacionados a la infección por Toxoplasma gondii. Además se tomó una muestra de sangre para la determinación de anticuerpos del tipo IgG anti T. gondii por el método de ELISA y se realizó la evaluación oftalmológica para el diagnóstico de TO. Resultados: La edad promedio ± DE fue de 53 ± 20 años, con leve predominio de mujeres (55%). La seroprevalencia de toxoplasmosis fue de 84% (67/80) y la TO se detectó en 8,9% de los 67 seropositivos. Se observó que el hábito de no lavar las verduras con hipoclorito de sodio y comer carne silvestre presentó mayor riesgo de contraer la infección en esta población. Conclusión: Es importante realizar trabajos de investigación a nivel poblacional para establecer la epidemiología de la toxoplasmosis en nuestro país. Se debe dar a conocer a la población las medidas de profilaxis para evitar la infección por T. gondii.
Subject(s)
Adult , Animals , Female , Humans , Male , Middle Aged , Young Adult , Toxoplasma/immunology , Toxoplasmosis, Ocular/diagnosis , Antibodies, Protozoan/blood , Cross-Sectional Studies , Enzyme-Linked Immunosorbent Assay , Immunoglobulin G/blood , Immunoglobulin M/blood , Paraguay/epidemiology , Risk Factors , Seroepidemiologic Studies , Toxoplasmosis, Ocular/epidemiologyABSTRACT
Purpose: To determine if the cost was the main barrier to undergo cataract surgery in Paraguay. Methods: We conducted a cohort study with patients screened in the 2011 Rapid Assessment of Avoidable Blindness (RAAB) who had reported that the cost was the main barrier to undergo cataract surgery in Paraguay. All patients with operable cataract from the RAAB study and with registered telephone numbers were interviewed by telephone and were offered free surgery services. The patients who did not come for surgery were re-interviewed by telephone to analyze the reasons for not undergoing the operation. Results: Out of 122 patients identified in the RAAB study with barriers for cataract surgery, 69 (56.6%) reported that the surgical fee was the main barrier; 52 (75.4%) of them had their telephone numbers registered. Thirty-six (69.2%) patients did not reside in the metropolitan area of Asunción. Six patients (12%), all from Asunción, agreed to undergo free surgery. Forty-six patients did not agree the free surgery mainly due to the costs associated with their transportation (n=31, 67%) and the travel costs of their companion (n=6, 13%). Conclusion: Surgery fee alone was not the major contributing factor for not undergoing cataract surgery. Place of residence and other indirect out-of-pocket expenses, such as transportation and companion-related costs appear to be more relevant. While further investigation is needed to assess if reducing the cost of transport will improve the uptake, the findings in this study suggest that a surgical package with all costs should be offered to patients of cataract surgical programs to increase cataract surgical coverage in Paraguay. .
Objetivo: Determinar se a taxa de cirurgia é a principal barreira para a adesão à cirurgia de catarata no Paraguai. Métodos: Foi realizado um estudo de coorte com pacientes identificados na Avaliação Rápida da Cegueira Evitável (RAAB) de 2011, que haviam informado ser a taxa para a cirurgia a principal barreira para se submeter à cirurgia de catarata no Paraguai. Todos os pacientes com catarata operável a partir do estudo RAAB, cujos números de telefone foram registrados, foram entrevistados por telefone e foi oferecida a cirurgia gratuitamente. Aqueles pacientes que não compareceram para a cirurgia foram então re-entrevistados por telefone para confirmar as suas razões para não fazer a cirurgia. Resultados: Das 122 pessoas identificadas no estudo RAAB com barreiras para a cirurgia de catarata, 69 (56,6%) relataram a taxa cirúrgica como a principal barreira para a cirurgia; 52 (75,4%) destes indivíduos tiveram seus números de telefone registrados. Trinta e seis (69,2%) pacientes não residiam na área metropolitana de Assunção. Seis pacientes (12%) aceitaram se submeter à cirurgia gratuita, todos eles de Assunção. Dos 46 pacientes que não aceitaram a cirurgia gratuita, as duas principais razões para o não comparecimento foi o custo de transporte (n=31, 67%) e os custos de viagem de seu companheiro (n=6, 13%). Conclusão: A taxa de cirurgia de catarata per se não foi a barreira principal. Local de residência e outras despesas pessoais indiretas, como transporte e custos relacionados à companhia parecem ser mais relevantes. Embora mais estudos sejam necessários para avaliar se a redução do custo do transporte vai melhorar a adesão, os resultados sugerem que um pacote cirúrgico que inclua todos os custos deve ser oferecido aos pacientes dos programas de ...
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Cataract Extraction/economics , Health Services Accessibility/economics , Age Distribution , Cohort Studies , Health Care Costs , Interviews as Topic , Paraguay , Sex Distribution , Socioeconomic Factors , Visual AcuityABSTRACT
PURPOSE: To determine the conjunctival bacterial flora in cataract surgery patients and the effect of presurgical irrigation with 5 percent povidone-iodine solution. METHODS: Three samples from the inferior conjunctival fornix of the eye to be operated were obtained at baseline before washing (T0) with 10 ml 5 percent povidone-iodine solution, immediately after washing (T1), and upon completion of surgery (T2). Bacteria from the samples were inoculated in blood agar, chocolate agar, and thioglycolate broth. RESULTS: A total of 221 patients (n=224 eyes) with a mean age of 67 ± 13 years were included in the study. Bacteria from the (T0) samples were successfully grown in 73.2 percent of the thioglycolate agars, 21.0 percent of the blood agars, and 19.2 percent of the chocolate agars. Compared with T1 samples, the use of povidone-iodine wash translated into a 60.8 percent reduction (from 73.2 percent to 12.5 percent) in colonization of the conjunctiva (p<0.001), while no significant difference was found between the T1 and T2 samples. Conclusion: Conjunctival irrigation with a 5 percent povidone-iodine solution effectively reduces conjunctival flora and is therefore strongly recommended as a means of preventing postsurgical endophthalmitis following cataract surgery.
OBJETIVO: Determinar la flora bacteriana de la conjuntiva en los pacientes a ser sometidos a cirugía de catarata y el efecto del lavado prequirúrgico con yodo povidona al 5 por ciento sobre dichos microorganismos. MÉTODOS: Se tomaron 3 muestras del fondo de saco conjuntival del ojo a ser operado de catarata antes (T0) de la irrigación de la conjuntiva con 10 ml de yodo povidona al 5 por ciento, como control, inmediatamente después (T1) y al término de la cirugía (T2). Se realizaron cultivos en agar sangre, agar chocolate y en caldo de tioglicolato. RESULTADOS: Se incluyeron en el estudio 221 pacientes (n=24 ojos) con un promedio de edad de 67 ± 13 años. El porcentaje de crecimiento bacteriano en (T0) fue de 73,2 por ciento en tioglicolato, 21 por ciento en agar sangre y 19,2 por ciento en agar chocolate. Al compararlo con (T1) el efecto de la yodo povidona se tradujo en una reducción del 60,8 por ciento (de 73,2 por ciento a 12,5 por ciento) en la colonización conjuntival (p<0.001). Entre las muestras de los tiempos T1 y T2 no hubo diferencia significativa en cuanto al crecimiento bacteriano. CONCLUSIÓN: El lavado conjuntival con yodo povidona al 5 por ciento reduce de forma efectiva la flora conjuntival por lo cual se recomienda fuertemente como método preoperatorio, como una de las medidas preventivas de la endoftalmitis posquirúrgica en cirugías de catarata.