Prevalence of trachoma in indigenous and non-indigenous areas, Northeastern Brazil, 2019-2021 / Prevalencia del tracoma en zonas de población indígena y no indígena del nordeste de Brasil, 2019-2021 / Prevalência de tracoma em áreas indígenas e não indígenas, Nordeste do Brasil, 2019-2021

ABSTRACT Objective. To estimate the prevalence of trachoma in indigenous and non-indigenous populations in selected areas of the state of Maranhão, in northeastern Brazil. Methods. This was a population-based survey with probabilistic sampling. For the diagnosis of trachoma, external ocular examination was performed using head magnifying loupes, at 2.5X magnification. The prevalence of trachomatous inflammation - follicular (TF) in children aged 1-9 years and the prevalence of trachomatous trichiasis (TT) in the population aged ≥15 years were estimated. Relative frequencies of sociodemographic and environmental characteristics were obtained. Results. The study included 7 971 individuals, 3 429 from non-indigenous populations and 4 542 from indigenous populations. The prevalence of TF in non-indigenous and indigenous populations was 0.1% and 2.9%, respectively, and the prevalence of TT among indigenous populations was 0.1%. Conclusions. The prevalence of TF and TT in the two evaluation units in the state of Maranhão were within the limits recommended for the elimination of trachoma as a public health problem. However, the prevalence of TF was higher in the indigenous evaluation unit, indicating a greater vulnerability of this population to the disease. The prevalence of TF of below 5.0% implies a reduction in transmission, which may have resulted from improved socioeconomic conditions and/or the implementation of the World Health Organization SAFE strategy.

RESUMEN Objetivo. Estimar la prevalencia del tracoma en poblaciones indígenas y no indígenas en determinadas zonas del estado de Maranhão, en el nordeste de Brasil. Métodos. Se trató de una encuesta de ámbito poblacional con muestreo probabilístico. Para el diagnóstico del tracoma, se realizó un examen ocular externo con una lupa frontal de 2,5X aumentos. Se estimó la prevalencia de la inflamación tracomatosa folicular (TF) en la población infantil de 1 a 9 años y la prevalencia de la triquiasis tracomatosa (TT) en la población de 15 años o más. Se obtuvieron las frecuencias relativas de las características sociodemográficas y ambientales. Resultados. En el estudio participaron 7 971 personas, 3 429 de poblaciones no indígenas y 4 542 de poblaciones indígenas. La prevalencia de la TF en las poblaciones no indígenas e indígenas fue de 0,1% y 2,9%, respectivamente, en tanto que la de la TT en las poblaciones indígenas fue de 0,1%. Conclusiones. La prevalencia de la TF y la TT en las dos unidades de evaluación del estado de Maranhão estuvo dentro de los límites recomendados para la eliminación del tracoma como problema de salud pública. Sin embargo, la prevalencia de la TF fue mayor en la unidad de evaluación indígena, lo que indica una mayor vulnerabilidad de esta población a la enfermedad. La prevalencia de la TF inferior al 5,0% implica una reducción de la transmisión, que puede haber sido consecuencia tanto de la mejora de las condiciones socioeconómicas como de la aplicación de la estrategia SAFE de la Organización Mundial de la Salud.

RESUMO Objetivo. Estimar a prevalência do tracoma em populações indígenas e não indígenas em áreas selecionadas do estado do Maranhão, na região Nordeste do Brasil. Métodos. Inquérito de base populacional com amostragem probabilística. Para o diagnóstico de tracoma, foi realizado exame ocular externo com o auxílio de lupas binoculares com ampliação de 2,5×. Foram estimadas a prevalência de inflamação tracomatosa folicular (TF) em crianças de 1 a 9 anos de idade e a prevalência de triquíase tracomatosa (TT) na população com idade ≥15 anos. Foram obtidas as frequências relativas das características sociodemográficas e ambientais. Resultados. O estudo incluiu 7 971 indivíduos (3 429 de populações não indígenas e 4 542 de populações indígenas). A prevalência de TF nas populações não indígenas e indígenas foi de 0,1% e 2,9%, respectivamente, e a prevalência de TT entre as populações indígenas foi de 0,1%. Conclusões. A prevalência de TF e TT nas duas unidades de avaliação no estado do Maranhão ficou dentro dos limites recomendados para a eliminação do tracoma como problema de saúde pública. No entanto, a prevalência de TF foi maior na unidade de avaliação indígena, indicando uma maior vulnerabilidade dessa população à doença. A prevalência de TF abaixo de 5,0% implica uma redução na transmissão, que pode ter sido resultado de melhores condições socioeconômicas e da implementação da estratégia SAFE da Organização Mundial da Saúde.

Epidemiology and control of trachoma in the state of Ceará, Northeast Brazil, 2007-2021

ABSTRACT Background: To analyze the epidemiology, surveillance, and control strategies for trachoma in the state of Ceará, northeast Brazil, from 2007 to 2021. Methods: This ecological study was based on secondary data from the Information System on Notifiable Diseases of the Secretary of Health of the state of Ceará. Data from school and home surveys for trachoma detection obtained during the study period were analyzed, the percentage of positivity was estimated, and sociodemographic and clinico-epidemiological factors were investigated. Results: The coverage of trachoma surveillance and control actions in Ceará municipalities increased from 12.5% in 2007 to 55.9% in 2019, but with an average restriction of 8.0% during the COVID-19 pandemic. The estimated trachoma positivity (mean overall positivity) was less than 5.0% (2.76%, 95% CI 1.2-5.2), with a higher proportion of cases in the 5-9-year age group (45.0%, 95% CI 44.6-45.4), in females (53.2%, 95% CI 52.8-53.6), and rural areas (52.6%, 95% CI 52.2-53.0). Positivity above 10.0% was observed in the Litoral Leste/Jaguaribe and Sertão Central regions, with a higher occurrence of the follicular inflammatory clinical form (98.1%, 95% CI 98.0-98.2). Conclusions: Trachoma remains in the state of Ceará and is likely underreported. Despite recent advances, the fragility of health surveillance activities compromises the recognition of the actual magnitude and distribution of trachoma in the state. Accurate information is fundamental for planning, monitoring, and evaluating surveillance and disease control.

Current status of trachoma in India: Results from the National Trachoma Prevalence Survey

Purpose: In the mid?twentieth century, trachoma was endemic in the northwestern states of India. We aimed to generate recent estimates of prevalence of trachomatous inflammation, follicular (TF) and trachomatous trichiasis (TT) in ten suspected?endemic districts across seven previously hyper?endemic states and union territories for trachoma in India including Delhi, Rajasthan, Haryana, Punjab, Gujarat, Uttarakhand and the Andaman and Nicobar Islands. Methods: Population?based prevalence surveys were undertaken in 10 districts. In each of those districts, two?stage cluster sampling was used to select a sample of 2000 children aged 1–9 years and all adults aged ?15 years in the enumerated households from a total of 20 clusters per district. Consenting eligible participants were examined for trachoma by trained ophthalmologists using the World Health Organization’s simplified grading system. Data were analyzed at the district level. Results: A total of 13,802 households were surveyed in which 19,662 children were examined for TF and 44,135 adults aged ?15 years were examined for TT. District?level TF prevalence in 1–9?year?olds ranged from 0.1% in Bikaner (95% CI: 0.01–0.3) to 2.1% in Dholpur (95% CI: 1.6–2.8) and that of trichiasis ranged from 0.7 per 1000 in Pauri Garhwal (95% CI: 0.01–1.4) to 22.1 per 1000 (95% CI: 15.8–28.4) in Car Nicobar. In four districts (Car Nicobar, Dholpur, Hoshiarpur, Tonk), trichiasis prevalence in adults aged ?15 years was ?0.2%. Conclusion: TF was not a public health problem in any of the districts surveyed; thus, antibiotic mass drug administration is not needed. However, TT among adults was found to be above 0.2% in four districts; thus, further trichiasis surgery interventions at the public health level are warranted to achieve elimination. These findings will facilitate planning for elimination of trachoma as a public health problem in India.

Scientometric analysis of research on trachoma in Brazil, 2000-2020 / Análise cienciométrica da pesquisa sobre tracoma no Brasil, 2000-2020

ABSTRACT OBJECTIVE To analyze the scientometric profile of research on trachoma in Brazil. METHODS Bibliographic research of publications on trachoma in Brazil indexed by the Scopus database from 2000 to 2020, based on specific criteria. Data on authorship, country of origin, institutions, and keywords were collected and analyzed with analysis of time trends. Bibliographic networks were constructed via a scientometric visualization software—VOSviewer® 1.6.16. RESULTS We analyzed 42 publications on trachoma in Brazil. The annual average was two articles, with an increase of about 50% during the period. The average number of authors was three per document and school surveys were the most common subject category. Most published articles came from Brazilian institutions (95.2%), mainly those based in Southeast and North Brazil. Of the most productive authors, 10 were mentioned as first author in 26.2% of publications (11/42) and the predominant institutions are based in the state of São Paulo. The term "trachoma" (n = 18) was the most recurrent keyword. CONCLUSION This first scientometric analysis of research on trachoma in Brazil showed a limited number of studies on this disease. The scientific production slightly increased, although the origin of many studies is geographical areas with lower endemicity of this disease. Greater investments are needed for a better understanding and control of this neglected tropical disease. The analysis of bibliographic production on this topic is important to strengthen the development of research and strategic planning of programs for the control of trachoma and neglected tropical diseases in general.

RESUMO OBJETIVO Analisar o perfil cienciométrico das pesquisas sobre tracoma no Brasil. MÉTODOS Pesquisa bibliográfica de publicações sobre tracoma no Brasil indexadas pela base de dados da Scopus, a partir de critérios específicos no período de 2000 a 2020. Foram extraídos e analisados dados sobre autoria, país de origem, instituições e descritores, com análises de tendências temporais. As redes bibliográficas foram construídas via software de visualização cienciométrica VOSviewer® 1.6.16. RESULTADOS Do total de 42 publicações analisadas sobre tracoma no Brasil, observou-se média anual de dois artigos, com incremento de aproximadamente 50% no período. Verificou-se média de três autores por documento e os inquéritos escolares foram a categoria de assunto mais comum. Os artigos publicados provêm majoritariamente de instituições brasileiras (95,2%), principalmente das sediadas nas regiões Sudeste e Norte. Dez autores mais produtivos estão mencionados nas primeiras autorias em 26,2% (11/42) das publicações e as instituições predominantes estão afiliadas ao estado de São Paulo. O termo Trachoma (n = 18) apresenta maior recorrência como descritor. CONCLUSÃO Esta primeira análise cienciométrica sobre tracoma no Brasil evidencia limitado número de pesquisas sobre essa doença. Há discreto incremento da produção científica, apesar da concentração da origem em áreas geográficas com menor endemicidade da doença. Maiores investimentos são necessários para o melhor entendimento e controle dessa doença tropical negligenciada. A análise da produção bibliográfica tem papel relevante para fortalecimento do desenvolvimento de pesquisas e planejamento estratégico de programas para o controle de tracoma e doenças tropicais negligenciadas em geral.

Advancing towards the elimination of trachoma as a cause of blindness in two cities in Sao Paulo State, Southeastern Brazil

ABSTRACT The World Health Organization recommends conducting prevalence surveys to validate the elimination of trachoma as a public health problem by the year 2030. The recommendation specifies that the surveys should be directed to previous endemic poor rural areas. Brazil is an endemic country for trachoma and has experienced a large internal migration from the rural areas to the outskirts of the major cities. This study aimed to determine the prevalence of trachoma in children aged 1 to 9 years old in two of the poorest municipalities on the outskirts of Sao Paulo to test the hypothesis of whether internal migration brought trachoma with it. A household survey was conducted between 2013 and 2014. The field teams went door-to-door to collect data on households with children of the selected age group and their members. The trachoma prevalence in this group was 1.5% (79/5,393). In the 10 to 19 years old group, the trachoma prevalence was significantly higher among girls 3.2% (47/1,448) than among boys 1.5% (20/1,361). This result adds evidence to the elimination of trachoma as a public health problem and will be included in the supporting material to validate its elimination in Brazil.

Exploring the elements of educational intervention for sustainable trachoma prevention programs / 国際保健医療

Objective  To explore and extract the elements of educational intervention from sustainable trachoma prevention programs in developing countries particularly in Africa.Methods  Literature review was conducted with the search engine, PubMed, with extracting keywords as “Trachoma, intervention, education, SAFE, hygiene, WASH, sustainable, sustainability, and elimination”. After carefully reading the extracted literature and assessing the sustainability of the interventions conducted in Sub-Saharan Africa, using analytical standpoint determined by the JICA evaluation items on sustainability, the elements of educational interventions were categorized.Result  Twenty-two articles were extracted and 10 articles that specifically state effectiveness and contents of intervention were selected for analysis. Five categories with elements of educational intervention were classified as follows: [Education in school age and community], [Intangible and tangible support], [Guidance of constructing latrines], [Guidance on how to use equipment and resources], and [Continuation of knowledge and skill transfer activities].Discussion  The results of this study suggested the significance of conducting educational intervention, not only the construction but also the management and maintenance of latrines, and the effectiveness of habituation of hygiene behavior to school children by implementing hygiene education at schools which behavior may also diffuse at home. Challenges remained in trachoma prevention effort who are left out of the support, such as unenrolled children who are unable to receive school hygiene education, and/or those who are inaccessible to clean water.Conclusion  Elements for educational intervention in sustainable trachoma prevention were examined in this study. It was shown that continuous holistic efforts should be made for the educational interventions as well as for the improvement of accessibility of clean water and hygiene without leaving people and the least developed countries behind.

Efficacy of two surgical approaches in correction of severe upper eyelid cicatricial entropion / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To compare the efficacy of two surgical approaches that microscopical Hotz combined with eyelid margin incision and flap translocation and pure Hotz method in correction of severe upper eyelid cicatricial entropion. <p>METHODS: Totally 84 eyes of 60 patients who underwent corrective surgery for upper eyelid trichiasis between July 2017 to July 2019 were retrospectively assessed. The patients in trial group(32 cases, 42 eyes)underwent the surgical procedure of combining Hotz with eyelid margin incision and skin flap transposition under microscope, the other group(28 cases, 42 eyes)were treated with Hotz method. The follow-up time was 12mo. Subjective symptoms, eyelid marginal position, eyelash eversion and patient satisfaction were recorded.<p>RESULTS: The surgery time of one eye in trial group was longer than that in control group(40.8±2.57min <i>vs</i> 28.5±2.64min, <i>P</i><0.01). The cure rates of 1 and 12mo in trial group were 100% and 95%, respectively. And those in control group were 95% and 76%, respectively. The cure rate of 12mo in trial group was higher than that of the control group(<i>P</i>=0.013). There was no significant difference in patient satisfaction between the two groups at 1mo after surgery(<i>Z</i>=1.1825, <i>P</i>=0.2371). 12mo after surgery, patient satisfaction in the trial group was higher than that in the control group(<i>Z</i>=3.7346, <i>P</i><0.01).<p>CONCLUSION: While it spents longer time, the procedure of combining Hotz with eyelid margin incision and skin flap transposition under microscope is reasonably successful and satisfactory in rectifying severe upper eyelid cicatricial entropion. It offers more higher cure rate than Hotz alone at long time after operation.

Elaboração e análise de validade e confiabilidade de um questionário para avaliar o conhecimento de médicos e enfermeiros da atenção primária sobre o tracoma / Elaboration and validity and reliability analysis of a questionnaire to assess the knowledge of primary care physicians and nurses about trachoma

Resumo Objetivo: Elaborar e analisar a validade e confiabilidade de um questionário para avaliar o conhecimento de médicos e enfermeiros da atenção primária sobre o tracoma. Métodos: Trata-se de um estudo metodológico de elaboração e análise de validade e confiabilidade de instrumento (questionário). Foram desenvolvidas as seguintes etapas: 1) identificação da literatura fonte atualizada sobre o tema; 2) elaboração dos itens do questionário pelos pesquisadores; 3) validação de conteúdo por experts; 4) validação de construto com aplicação do instrumento e análise de teste de hipóteses; 5) análise de consistência interna e; 6) análise de estabilidade temporal (teste-reteste). Resultados: Participaram da pesquisa 205 médicos e enfermeiros da atenção primária e 10 especialistas em oftalmologia e infectologia. O instrumento, inicialmente com 52 itens, ficou com 34 itens após todas as etapas. O instrumento mostrou-se capaz de discriminar adequadamente profissionais com maior e menor conhecimento, segundo o teste de hipóteses (p<0,001). O alfa de Cronbach foi de 0,86 e o teste-reteste registrou uma concordância superior a 60% para a maioria dos itens. Conclusões: O instrumento final apresentou validade e confiabilidade satisfatórios. Poderá ser um instrumento útil para aferir conhecimentos de profissionais da atenção primária sobre o tracoma e auxiliar na elaboração de estratégias educacionais para estes profissionais.

Abstract Objective: To develop and analyze the validity and reliability of a questionnaire to assess the knowledge of primary care physicians and nurses about trachoma. Methods: This is a methodological study of elaboration and analysis of validity and reliability of an instrument (questionnaire). The following steps were developed: 1) identification of updated source literature on the subject; 2) elaboration of the questionnaire items by the researchers; 3) content validation by experts; 4) construct validation with instrument application and hypothesis test analysis; 5) internal consistency analysis and; 6) temporal stability analysis (test-retest). Results: The study included 205 primary health care physicians and nurses and 10 specialists in ophthalmology and infectology. The instrument, initially with 52 items, was left with 41 items after all stages. The instrument was able to adequately discriminate professionals with greater and lesser knowledge, according to the hypothesis test (p <0.001). Cronbach's alpha was 0.86 and the test-retest recorded an agreement greater than 60% for most items. Conclusions: The final instrument presented satisfactory validity and reliability. It may be a useful tool to assess knowledge of primary health care professionals about trachoma and assisting in the development of educational strategies for these professionals.

A profilaxia e o tratamento das enfermidades do oeste paulista: o Serviço Sanitário e o tracoma no princípio do século XX / Prophylaxis and treatment of diseases in western São Paulo state: the Sanitation Service and trachoma in the early twentieth century

Resumo Em 1906, Emílio Ribas reorganizou o Serviço Sanitário e centralizou na capital os serviços de saúde pública do estado de São Paulo. Nesse projeto, a campanha de combate ao tracoma, uma enfermidade oftálmica, foi implantada. Este artigo analisa essa campanha que atendeu os enfermos das propriedades rurais em um processo que antecedeu ao Código Sanitário Rural de 1917. O material empírico foi composto por relatórios governamentais, decretos, periódicos médicos e jornais. Concluímos que Ribas, ao criar uma estrutura que unificou os esforços dos distritos sanitários com as equipes de atendimento das Comissões do Tracoma, buscou formar um complexo aparato para combater as enfermidades presentes tanto nas áreas urbanas quanto na zona rural.

Abstract In 1906, Emílio Ribas reorganized the Sanitation Service and centralized São Paulo state public health services in the state capital. A campaign to combat trachoma, an ophthalmic disease, was implemented as part of this project. This article analyzes this campaign, which provided care for the sick living on rural properties in a process that predated the 1917 Rural Sanitary Code. The empirical data was obtained from government reports, decrees, medical journals and newspapers. We conclude that Ribas, by creating an organization that integrated the efforts of the sanitary districts and the Trachoma Commission medical teams, sought to form a complex apparatus to combat the diseases present in both urban areas and the countryside.

Fatores associados ao tratamento e ao controle do tratamento do tracoma em escolares de município da Região Nordeste, Brasil / Factors associated with trachoma treatment and control treatment in schools of municipality of the Northeast Region, Brazil

RESUMO: Introdução: O tracoma mantém-se como problema de saúde pública e importante causa de morbidade, deficiência visual e cegueira evitável no Brasil. Objetivo: Analisar fatores associados ao tratamento e ao controle do tratamento do tracoma em escolares diagnosticados durante Campanha Nacional de Hanseníase, Verminoses, Tracoma e Esquistossomose, em 2014, no município de Russas, Ceará. Metodologia: Estudo transversal desenvolvido de janeiro a abril de 2016. Foram coletados dados sociais, demográficos, econômicos e de acompanhamento pela atenção básica de 390 escolares de 5 a 14 anos de idade diagnosticados com tracoma, na campanha em 2014. Definiram-se as variáveis dependentes: tratamento do tracoma e controle do tratamento do tracoma, categorizadas em adequado e inadequado, realizando-se análises bi e multivariada. Resultados: O tratamento foi considerado adequado em 56,7% dos escolares, e em apenas 5,9% o controle do tratamento foi classificado como adequado. Na análise multivariada, mantiveram associação com o desfecho tratamento do tracoma as variáveis zona de residência rural e destino dos dejetos em rede não pública. O desfecho controle do tratamento do tracoma permaneceu associado às variáveis: zona de residência rural, renda familiar menor que um salário mínimo e escolar não examinado pelo médico. Conclusão: O tratamento e controle do tratamento inadequados do tracoma mostraram associação com variáveis socioeconômicas e de acompanhamento pela atenção básica. As atividades de educação em saúde não foram acessíveis a toda a comunidade, indicando a necessidade de maior envolvimento dos profissionais da atenção básica.

ABSTRACT: Introduction: Trachoma maintains itself as a public health problem and an important cause of morbidity, visual impairment and preventable blindness in Brazil. Objective: To analyze factors associated with treatment and control of trachoma treatment in schoolchildren diagnosed during the national campaign in 2014, in the town of Russas, Ceará. Methodology: A cross-sectional study was brought out from January to April 2016. Social, demographic, economic and follow-up data were collected for 390 schoolchildren aged five to 14 years old, diagnosed with trachoma in the campaign in 2014. They were defined dependent variables: trachoma treatment and control of trachoma disease, categorized as adequate and inadequate, and multivariate analyzes were performed. Results: Treatment was considered adequate in 56.7% of schoolchildren and in only 5.9% treatment control was classified as adequate. In the multivariate analysis, they have got an association with the trachoma treatment result: rural residence zone and waste destination in a non-public space. The last control of the treatment of trachoma remained associated to the variables: rural residence zone; family income less than a minimum wage and school not examined by the physician. Conclusion: Inadequate treatment and control of trachoma treatment showed an association with socioeconomic variables and follow-up of primary care. Health education activities were not accessible to the entire community, indicating the need for more involvement by primary care professionals.

Anterior tarsal flap rotation combined with anterior lamellar reposition in the repair of cicatricial upper eyelid entropion / Rotação anterior de retalho tarsal combinada com reposição laminar anterior no reparo do entrópio cicatricial das pálpebras superiores

ABSTRACT Purpose: This study aimed to share the results of patients who underwent anterior tarsal flap rotation combined with anterior lamellar reposition because of cicatricial upper eyelid entropion, and to determine the effectiveness and reliability of this surgical technique. Methods: Fifteen eyes of 11 patients (2 right eyes; 5 left eyes; and 4 bilateral eyes) on whom we performed anterior tarsal flap rotation surgery combined with anterior lamellar reposition because of cicatricial entropion were included in this study. The medical records of the patients were analyzed retrospectively, and the causes of cicatricial entropion as well as the preoperative and postoperative ophthalmic examination findings were recorded. Normal anatomical appearance and function of eyelid were considered to have been achieved. Results: The mean age was 59.81 ± 18 years. The mean follow-up period was 21.72 ± 14 months (range, 5-43 months). The causes of cicatricial entropion were postoperative cicatrices development due to multiple electrolyzes for trichiasis and/or distichiasis in 7 eyes, trachoma in 6 eyes, and trauma in 2 eyes. Irritation and watering were detected in all patients preoperatively, whereas corneal opacity and erosion were detected in 10 patients and epithelial erosion was detected in one patient. Full anatomical and functional success was achieved for all patients. Conclusion: Anterior tarsal flap rotation combined with anterior lamellar reposition in the repair of cicatricial entropion was found to be an effective and reliable alternative surgical procedure.

RESUMO Objetivo: Compartilhar os resultados dos pacientes submetidos à rotação de retalho tarsal anterior, combinados com a reposição lamelar anterior devido à entrópio cicatricial da pálpebra superior e determinar a eficácia e a confiabilidade desta técnica cirúrgica. Métodos: Foram incluídos neste estudo quinze olhos de 11 pacientes em quem realizamos cirurgia de rotação de retalho tarsal anterior combinada com reposição lamelar anterior devido ao entrópio cicatricial. Os registros médicos dos pacientes foram analisados retrospectivamente e as causas da entrópio cicatricial, bem como os achados do exame oftalmológico pré-operatório e pós-operatório foram registrados. A integridade anatômica e funcional da pálpebra foi considerada como sucesso cirúrgico. Resultados: A idade média foi de 59,81 ± 18 anos. O período médio de seguimento foi de 21,72 ± 14 meses (intervalo 5-43 meses). As causas da entrópio cicatricial foram o desenvolvimento de cicatrizes pós-operatórias devido a eletrólises múltiplas para triquíase e/ou distiquiase em 7 olhos, tracoma em 6 olhos e trauma em 2 olhos. Todos os pacientes foram tiveram irritação e lacrimejamento pré-operatório, enquanto que 10 pacientes apresentavam opacidade e erosão da córnea e 1 paciente apresentava apenas erosão epitelial. O sucesso total anatômico e funcional foi alcançado em todos os casos. Conclusão: A rotação do retalho tarsal anterior combinada com a reposição lamelar anterior no reparo da entrópio cicatricial é um procedimento cirúrgico alternativo efetivo e confiável.

"Era urgente e indispensável agir": o tracoma em São Paulo no início do século XX / "It was urgent and indispensable to act": the trachoma in São Paulo in the early twentieth century

Resumo No início do século XX o tracoma, enfermidade oftálmica contagiosa, tornou-se endêmica no interior do estado de São Paulo. Em 1906, mediante a infecção de quase 40% da população rural examinada, o governo estadual implantou 25 postos de tratamento em diversos municípios. Foi uma campanha audaciosa, dispendendo recursos com equipes médicas, transporte e medicação. O objetivo desta pesquisa é analisar por que o Serviço Sanitário interviu sobre o tracoma, num período em que as ações profiláticas estavam restritas às áreas urbanas. O recorte temporal se inicia em 1898, quando o primeiro artigo médico foi publicado, e termina em 1906, com a formação dos postos tracomatosos. Como fontes, foram utilizados relatórios governamentais, revistas médicas, teses e jornais. Concluímos que a pressão exercida por médicos e imprensa, concomitante à proteção do setor agroexportador, influenciaram a implantação das comissões.

Abstract At the beginning of the 20th century, trachoma, a contagious ophthalmic disease, became endemic in the interior of the state of São Paulo. In 1906, through the infection of almost 40% of the rural population examined, the state government implemented 25 treatment stations in several municipalities. It was an audacious campaign, spending resources with medical staff, transportation and medication. This research aimed to analyze why the Health Service intervened on trachoma in a period in which prophylactic actions were restricted to urban areas. The temporal cut begins in 1898, when the first medical article was published, and ends in 1906, with the formation of trachomatous posts. As sources, government reports, medical journals, theses and journals were used. We conclude that the pressure exerted by doctors and the press, concomitant to the protection of the agroexport sector, influenced the implementation of the commissions.

Tracoma: de lo básico a lo clínico / Trachoma: from basics to clinic / Tracoma: do básico ao clínico

RESUMEN El tracoma es una de las Enfermedades Tropicales Desatendidas; lo producen los serotipos A, B, Ba y C de la bacteria intracelular Chlamydia trachomatis, adquirida a partir de la diseminación directa por contacto ocular, propagación indirecta por fómites, transmisión por moscas que buscan los ojos y contacto con los dedos contaminados con secreciones oculares y nasales. En la actualidad es la principal causa de ceguera prevenible en el mundo, representa el 1,4 % de los casos totales y genera el deterioro visual de 1,8 millones de personas, de las cuales 500 000 tienen ceguera. Se calcula que hay 51 países endémicos distribuidos en África, Asia, Latinoamérica y Oceanía. En América hay focos activos en Brasil, México, Guatemala y Colombia. Las manifestaciones oculares iniciales son epífora, inyección conjuntival y secreción mucopurulenta; con el curso crónico se producen queratitis, entropión, triquiasis y opacidades corneales. El diagnóstico es básicamente clínico. Para eliminar esta enfermedad, la Organización Mundial de la Salud formuló el Programa Global para la Eliminación del Tracoma para 2020, basado en la implementación de la estrategia SAFE, consistente en cirugía para evitar complicaciones, tratamiento antibiótico, higiene facial y corporal y mejoramiento de las condiciones ambientales.

SUMMARY Trachoma is one of the Neglected Tropical Diseases. It is caused by the serotypes A, B, Ba and C o the intracellular bacteria Chlamydia trachomatis, acquired directly by ocular contact, and indirectly by fomites; also, transmitted by eye-seeking flies, and fingers contaminated with ocular and nasal secretions. Currently, trachoma is the leading cause of preventable blindness in the world, it represents 1.4 % of the total cases and generates visual deterioration in 1.8 million people, of which 500 000 are blind. It is estimated that 51 countries are endemic, distributed in Africa, Asia, Latin America and Oceania. Outbreaks in America take place in Brazil, Mexico, Guatemala, and Colombia. Initial ocular manifestations are epiphora, conjunctival injection and mucopurulent discharge; in the course of chronicity keratitis, entropion, trichiasis and corneal opacities are produced. Diagnosis is basically clinical. In order to eliminate this disease, the World Health Organization formulated the Global Program for the Elimination of Trachoma for 2020, based on the implementation of the SAFE strategy, which consists of surgery to avoid complications, antibiotic therapy, facial and body hygiene and the improvement of environmental conditions.

RESUMO O tracoma é uma das Doenças Tropicais Desatendidas; o produz os serótipos A, B, Ba e C da bactéria intracelular Chlamydia trachomatis, adquirida a partir da disseminação direta por contato ocular, propagação indireta por fómites, transmissão por moscas que buscam os olhos e contato com os dedos contaminados com secreções oculares e nasais. Na atualidade é a principal causa de cegueira evitável no mundo, representa 1,4 % dos casos totais e gera o deterioro visual de 1,8 milhões de pessoas, das quais 500 000 têm cegueira. Se calcula que há 51 países endêmicos distribuídos na África, na Ásia, na América Latina e na Oceania. Na América há focos ativos no Brasil, no México, na Guatemala e na Colômbia. As manifestações oculares iniciais são epífora, injeção conjuntival e secreção mucopurulenta; com o curso crônico se produz ceratiti, entropio, triquíase e opacidades corneais. O diagnóstico é basicamente clínico. Para eliminar esta doença, a Organização Mundial da Saúde formulou o Programa Global para a Eliminação do Tracoma para 2020, baseado na implementação da estratégia SAFE, consistente na cirurgia para evitar complicações, tratamento antibiótico, higiene facial e corporal e melhoramento das condições ambientais.

Situação epidemiológica do tracoma no Piauí, nordeste brasileiro / Epidemiological situation of trachoma in the northeastern state of Piauí, Brazil

Este estudo objetivou apresentar a epidemiologia do tracoma no Piauí com enfoque no número de casos positivos, formas clínicas e locais de ocorrência. Tratou-se de um estudo exploratório de abordagem quantitativa, realizado a partir da análise de dados de acesso restrito sobre a situação epidemiológica do tracoma no Piauí. Casos positivos de tracoma foram notificados em 34 municípios piauienses nos últimos nove anos, a maioria localizada na região Sudoeste do Estado e apresentando baixo índice de desenvolvimento humano. O município de Uruçuí apresentou o maior número de casos. foram notificados 593 casos de tracoma, sendo o tracoma folicular a forma clínica mais frequente, além de casos raros de tracoma inflamatório intenso e um caso de tracoma cicatricial. Considerando dados do último inquérito nacional do tracoma no Piauí, houve redução de municípios afetados, corroborando com a meta da Organização Mundial de Saúde de eliminação de tracoma até 2020.

Trachoma epidemiology in the Brazilian state of Piauí is provided, with special emphasis on the number of positive cases, clinical types and sites of occurrence. Current exploratory and quantitative analysis has been undertaken by analyzing restricted data on the epidemiological situation of trachoma in Piauí. Positive trachoma cases were notified in 34 municipalities during the last nine years, most of which from the southeastern region of the state with low human development rates. The municipality of Uruçuí had the highest number of cases. Further, 593 cases of trachoma, particularly follicle mode, were notified, even though there were rare cases of intense inflammatory trachoma and one case of cicatricial trachoma. When data on the latest national survey on trachoma in Piauí are investigated, one may note a decrease in the municipalities affected, corroborating with the aim of WHO for its elimination by 2020.

Rapid assessment of children's active trachoma in rural area of Naxi district and Jiangyang district of Luzhou in China during 10 years / 中华实验眼科杂志

Background Trachoma is a serious blinding eye disease.At present,the incidence rate of trachoma in China has been greatly reduced with the unremitting efforts of World Health Orgnization (WHO) and Chinese government.However,in some economically underdeveloped areas,there is still active trachoma.Ohjective This study aimed to survey the prevalence of children's active trachoma in rural area of Naxi district and Jiangyang district of Luzhou city and assess the prevention and treatment outcome of trachoma during 10 years.Methods A cross-sectional study was performed in Naxi district and Jiangyang district of Luzhou city,the economic underdeveloping and water-starved regions in the year 2000.The active trachoma was screened in 214 school-age children with the male 113 and female 101 based on simplified trachoma grading system and trachoma rapid assessment survey standards and requirements of WHO.The symptoms of active trachoma were divided into trachomatous follicular (TF),trachomatous inflammation intense (TI),trachomatous scarring (TS),trachoma trichiasis (TT) and corneal opacities (CO).The epidemiological survey was re-assessed in 100 school-age children (with the male 58 and female 42) in these regions in the year 2013 to evaluate the prevalence change of children active trachoma during 10 years.Results In the year 2000,214 children were screened in 4 villages of Naxi district and Jiangyang district,and the prevalence rate of TF was 49.07％ (105/214) in the year 2000.The prevalence rate of TF was 49.05％ (52/106) in the Naxi district and 49.07％ (53/108) in the Jiangyang district,showing no significant difference between them (x2 =0.01,P =0.99).In the 100 school-age children who received survey in Naxi district and Jiangyang district in the year 2013,no TF,TF,TI,TS,TT and CO was found,showing no active trachoma.Conclusions The active trachoma has been controlled in rural areas of Luzhou city following the prevention and treatment of trachoma and the improvement of economic status in past decade.

Trachoma rapid assessment of children aged 1 to 9 years in Hainan Province of China / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the incidence of trachoma in children aged 1 to 9y in Hainan Province and determine high-risk trachoma endemic and non-endemic areas in Hainan, and thus provide evidence for developing trachoma control and prevention therapy.METHODS:The areas of investigation were chosen on the basis of past literatures, expert interviews and survey on the spot.In 2013, Hainan Provincial Office of Blindness Prevention carried out the survey in 7 counties including Dongfang City, Wuzhishan City, Ledong County, Baisha County, Baoting County, Lingao County and Changjiang County.In these districts, 356 pupils including 192 boys and 164 girls were examined, their age ranging from 1 to 9 and their average age being 7 years old.The targeted students received the trachoma rapid assessment by the adoption of simplified trachoma classification system which was recommended by the World Health Organization.RESULTS: No case of active trachoma was found among the 356 students.CONCLUSION:The prevalence rate of trachoma in children under 9 years is less than 5% in Hainan Province.Active trachoma is not a public health issue in Hainan Province.

Biological Effects of Chlamydiaphage phiCPG1 Capsid Protein Vp1 on Chlamydia Trachomatis In Vitro and In Vivo / 华中科技大学学报（医学）（英德文版）

The researches on chlamydia in recent years show that chlamydia bacteriophage may be a potential and effective means to solve the clinical infection of chlamydia trachomatis (Ct).We investigated the biological effect of chlamydiaphage phiCPG1 capsid protein Vp1 on Ct both in McCoy cells and genital tract of mice.Different concentrations of Vp1 were co-incubated with Ct E serotype strain in McCoy cells.Female BALB/c mice were used to establish Ct E strain-induced urogenital infection model.They were randomly divided into five groups and given different treatments on the fifth day after Ct inoculation.Animals in groups 1 and 2 were given 30 μL different concentrations of Vp1 in the genital tract respectively,those in group 3 were intramuscularly injected with 30 μL Vp1,those in the infected group did not receive any intervention,and those in the control group received 30 μL PBS in the genital tract.The vaginal discharge was collected to identify the live chlamydia by cell culture and gene fragment by real time PCR different days after infection.Inhibition rate of 100 μg/mL and 50 μg/mL Vpl proteins against Ct E strain in the McCoy cell cultures was 91％ and 79％ respectively,The number of intracellular Ct inclusion in the McCoy cells co-cultured with vaginal discharge of group 1 and group 2 was less than in the infected group,and that in group 1 was less than in group 2,on the 7th day after Ct inoculation.Real-time PCR showed that chlamydia concentration of the vaginal discharge in group 2 was lower than in the infected group,and that in group 1 was lower than in group 2 on the 10th day.It was suggested that Vp1 capsid proteins had inhibitory effect on the proliferation of Ct serovar E strain in cell culture and mouse genital tract.

Rapid assessment study of active trachoma in Shaanxi Province / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To evaluate the prevalence of trachoma in Shaanxi Province and provide basic data for the prevention and treatment of trachoma.<p>METHODS: Four suspected areas with high prevalence of trachoma including Kengzhen in Jiaxian Yulin, Luochuan of Yan'an, Nanzheng county of Hanzhong, Shangzhou distract in Shangluo, were selected by Blindness Prevention Office of Shaanxi Province. A random sample of 200 pupils aged 6 to 8 was examined by ophthalmic officers using the World Health Organization(WHO)simplified clinical grading system.<p>RESULTS: No infection of active trachoma was detected in 200 pupils.<p>CONCLUSION: No epidemic areas of active trachoma were found. Based on the data of this study,trachoma is no longer considered as a public health problem in Shaanxi Province.

Novel progress on the prevention and treatment of trachoma / 眼科新进展

Trachoma is a type of contagious keratoconjunctivitis,with Chlamydia trachomatis as the main source of infection,which is one of the major causes of infectious blindness.Compared with the developed countries such as Europe and the United States,the incidence of trachoma in other developing countries is even higher.The World Health Organization (WHO) established a simplified grading system (TF,TI,TS,TT,CO) for trachoma identification and naming in order to prevention and control of trachoma.Meanwhile,according to the clinical characteristics of trachoma," SAFE" strategy has been put forward.And this article will give a brief review for the prevention and treatment of trachoma in recent years based on the " SAFE" strategy of WHO.

Análise das intervenções e dos fatores socioambientais associados à ocorrência de tracoma em Pernambuco a partir de dois inquéritos em escolares realizados em 2006 e 2012 / Analysis of interventions and socio environmental factors associated with the occurrence of trachoma in Pernambuco in two surveys on schoolchildren conducted in 2006 and 2012

Resumo O tracoma é a principal causa de cegueira prevenível nos países em desenvolvimento. O objetivo foi descrever o panorama do tracoma entre escolares no Estado de Pernambuco, identificando as estratégias norteadoras do programa de controle e analisando a existência de associação entre variáveis socioeconômicas, demográficas e de saúde, em âmbito ecológico, com as taxas de prevalência da doença obtidas nos inquéritos realizados em 2006 e 2012. Realizou-se um estudo ecológico descritivo, com dados secundários de inquéritos realizados em escolas públicas de 79 municípios de Pernambuco, em 2006, e de 22 municípios, em 2012. O pequeno número de examinados em 2006 resultou em estimativas imprecisas de prevalência, fragilizando metodologicamente a escolha dos 22 municípios considerados prioritários pelo Programa SANAR em 2012. Só foi possível comprovar a diminuição da prevalência do tracoma apenas em 5 dos 22 prioritários investigados. Investigações de base populacional deverão ser executadas no Estado e as ações de controle deverão ser repensadas, pois o formato das investigações ainda é baseado em campanhas com ações pontuais, sem o desenvolvimento de outras contínuas e efetivas que reduzam as formas ativas da doença, alcançando, assim, a meta de eliminação do tracoma com causa de cegueira no Brasil.

Abstract Trachoma is the main cause of preventable blindness in developing countries. This paper aims to describe the trachoma situation in the schools of Pernambuco, Brazil, noting guidelines for the control program and analyzing a possible association of the prevalence rates obtained by research in 2006 and 2012 with socioeconomic, demographic and ecological health factors. A descriptive ecological study was performed, using secondary data from investigations within Pernambuco public schools (investigating 79 cities in 2006 and 22 in 2012). Due to the small number of patients examined in 2006, the prevalence numbers estimative was rather inaccurate, methodologically impairing the choice of the 22 cities considered priorities for the SANAR programme in 2012. However, it was only possible to confirm the reduction of Trachoma prevalence in 5 among the 22 priority cities investigated. Demographic studies shall be done and the containing measures shall be reviewed in the state, since the investigation layout is still based in punctual actions campaigns, without the development of other continuous and effective measures that reduce the active types of the disease in order to eliminate Trachoma as a cause of blindness in Brazil.