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ABSTRACT Purpose: The number of medical schools in Brazil has increased in recent years; however, vacancies for specialization in ophthalmology probably have not kept up with the growing demand. This study wants to estimate the increase in medical schools, the demand for ophthalmology specialization, and evaluate learning opportunities in ophthalmology. Methods: This was a retrospective study with research from the Ministry of Education and Brazilian Council of Ophthalmology database from 2002 to 2021. These data were checked through 120 notices published by the institutions in 2021. Results: The number of medical school vacancies increased by 370%, whereas the number of certified ophthalmology vacancies increased by 64%. There was an 11.4% misalignment between the Brazilian Council of Ophthalmology data in the Ministry of Education. Conclusion: The proportion of medical graduates has increased much more than opportunities for ophthalmology specialization. The effect on the search for unaccredited specialization positions is unknown, and policies for monitoring the specialization of ophthalmology vacancies should be established.
RESUMO Objetivo: Nos últimos 20 anos, o número de escolas médicas no Brasil aumentou, mas as vagas para especialização em Oftalmologia não acompanharam a demanda crescente. Este estudo quer estimar a demanda por especialização e avaliar a oferta de oportunidades de aprendizado em Oftalmologia. Métodos: Estudo epidemiológico com pesquisa em banco de dados provenientes do Ministério da Educação e Conselho Brasileiro de Oftalmologia. Estes dados foram checados através de 120 editais publicados pelos serviços de Residência em 2021. Resultados: De 2002 a 2021, o número de vagas em faculdades de Medicina aumentou 370%, enquanto o número de vagas certificadas de especialização em Oftalmologia aumentou 64%. Houve um desalinhamento de 11.4% entre os dados do Conselho Brasileiro de Oftalmologia e do Ministério da Educação. Conclusão: A proporção de graduados em Medicina aumentou muito mais do que a oferta de oportunidades de especialização em Oftalmologia, o impacto disto na busca por vagas de especialização não acreditadas é desconhecido, políticas de monitoramento das vagas de especialização em Oftalmologia devem ser estabelecidas.
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ABSTRACT Medical specialties have recognized that breaking bad news assists clinical practice by mitigating the impact of difficult conversations. This scenario also encourages various studies on breaking bad news in ophthalmology since certain ocular diagnoses can be considered bad news. Thus, the objective is to review the scientific literature on breaking bad news in ophthalmology. The literature databases like MEDLINE/PUBMED, EMBASE, LILACS, SCOPUS, COCHRANE, and SCIELO, were screened for related research publications. Two independent reviewers read all the articles and short-listed the most relevant ones. Seven articles, in the formats of original article, review, editorial, oral communication, and correspondence, were reviewed. Conclusively it reveals that ophthalmologists are concerned with communicating bad news effectively but lack related studies. Nevertheless, there is a growing realization that training in breaking bad news can increase physicians' confidence during communication, thus, benefiting the therapeutic relationship with the patient and his family. Therefore, it would be valuable to include breaking bad news training in the curriculum of residencies.
RESUMO O reconhecimento sobre a comunicação de más notícias como mitigadora de conversas difíceis por outras especialidades médicas, incentiva o estudo desta temática na oftalmologia. Sendo assim, o objetivo deste estudo é revisar a produção de pesquisas científicas sobre a comunicação de más notícias em oftalmologia. Para isso, foi realizada uma revisão de literatura. As bases de dados utilizadas foram MEDLINE/PUBMED, EMBASE, LILACS, SCOPUS, COCHRANE e SCIELO. Dois revisores independentes leram todos os artigos e selecionaram a amostra final. Sete artigos foram escolhidos nos formatos de artigo original, revisão, editorial, comunicação oral e correspondência. Os oftalmologistas estão preocupados em comunicar as más notícias de forma eficaz, mas faltam estudos sobre o tema. No entanto, há uma crescente percepção de que o treinamento de comunicação de más notícias aumenta a confiança dos médicos na comunicação, beneficiando a relação terapêutica. Portanto, seria valioso incluir este treinamento no currículo das residências.
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ABSTRACT Purpose: Diabetes mellitus is a leading cause of impaired vision. The objective of this study was to evaluate the feasibility of use of portable retinograph and remote analysis of images along with a virtual questionnaire for screening for diabetic retinopathy in basic health units in the city of Ribeirão Preto/SP during the Covid-19 pandemic. Methods: Standard Covid-19 protocol was followed during the screening. Blood pressure and capillary blood glucose were measured. Demographic and social data were collected through a standardized online questionnaire via smartphone. After pupillary dilation, fundal images were obtained with portable retinographs by trained ophthalmology residents. Two standardized 45° images were acquired: one posterior segment and another nasal to the optic nerve. Diabetic retinopathy was classified according to the Early Treatment Diabetic Retinopathy Study. Results: A total of 350 patients (64% female; 45% aged 55-70 years; 55% Caucasian) were evaluated. For 40.5% of patients, the campaign was the first opportunity for retinal evaluation; 47.56% had diabetes mellitus for >10 years. On repeat analysis of images stored in a cloud-based repository by retinal specialist, a 7.8% difference was observed in the Early Treatment Diabetic Retinopathy Study diabetic retinopathy classification, compared to the screening findings. Mild diabetic retinopathy was observed in 12.23%, moderate diabetic retinopathy in 6.31%, and proliferative diabetic retinopathy in 2.58% patients. Macular edema was present in 4.58% patients. Diabetic retinopathy was not detected in 72.78% patients. Conclusion: Use of portable retinographs together with telemedicine can provide efficient alternative to traditional methods for screening and diagnosis of diabetic retinopathy.
RESUMO Objetivo: A diabetes mellitus é considerada uma epidemia global e causa de baixa visual em países em desenvolvimento. Este estudo foi realizado com o objetivo de avaliar a viabilidade do retinógrafo portátil e análise remota de imagens associada a questionário virtual para o rastreio de retinopatia diabética em Unidades Básicas de Saúde da cidade de Ribeirão Preto/SP durante a pandemia de Covid-19. Métodos: Trezentos e sessenta pacientes compareceram a campanha. O acolhimento foi realizado na Unidade Básica de Saúde pela equipe de enfermagem, respeitando medidas de prevenção do Covid-19 Os realizou-se aferição da pressão arterial e glicemia capilar seguida de dilatação. Dados demográficos e sociais foram coletados através de questionário on-line padronizado via smartphone e realizou-se a triagem da retinopatia diabética através da obtenção de imagens com retinógrafos portáteis realizados por residentes de oftalmologia previamente treinados, com a aquisição de 2 imagens padronizadas de 45º: uma do segmento posterior e outra nasal ao nervo óptico. Resultados: Trezentos e sessenta pacientes foram atendidos durante a campanha. Dez pacientes (1,02%) foram excluídos devido à opacidade de meios e impossibilidade de obtenção de imagens de fundo de olho. Foram avaliados 350 pacientes, 64% do sexo feminino, 45% entre 55 e 70 anos e 55% brancos. A Campanha foi a primeira avaliação de retina para 40,5% dos pacientes e 47,56% apresentavam diabetes mellitus há mais de 10 anos. Na análise comparativa da classificação da retinopatia diabética segundo Early Treatment Diabetic Retinopathy Study (triagem X Nuvem) observou-se uma diferença de 7,8% nos resultados. Retinopatia diabética leve foi observada em 12,23%, moderada em 6,31%, proliferativa em 2,58%; edema macular presente em 4,58% e ausência de retinopatia diabética em 72,78% dos pacientes. Conclusão: A utilização de retinógrafos portáteis juntamente a telemedicina, para o rastreamento da retinopatia diabética pode ser considerada uma alternativa eficiente para triagem e diagnóstico da retinopatia diabética dentro ou fora do cenário pandêmico, auxiliando na prevenção de perda visual pelo diabetes.
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La lidocaína es el anestésico local más utilizado a nivel mundial para la cirugía de catarata. También se usa de manera común en otras intervenciones quirúrgicas oftalmológicas del segmento anterior, la superficie del globo ocular, los párpados y vías lagrimales, así como en el segmento posterior del ojo. Esta revisión pretende brindar una actualización sobre las principales características, los efectos y vías de administración de la lidocaína usada en la oftalmología. Se realizó una búsqueda sistemática sobre el tema en publicaciones científicas indexadas en bases de datos, cuya información recopilada se resumió en este trabajo. La lidocaína se presenta en múltiples formas farmacéuticas, con variedad en concentración y formulación. Por lo general, para inyección se usan las concentraciones al 0,5 por ciento, 1 por ciento y 2 por ciento, para anestesia tópica en gel al 2 por ciento y en solución oftálmica al 4 por ciento. Su efecto como anestésico local es bien conocido, a nivel ocular se puede conseguir a través de inyecciones perioculares e intraoculares o mediante su aplicación tópica. Este efecto anestésico de la lidocaína ofrece cierta capacidad de dilatación pupilar, el cual se ha estudiado y aprovechado con frecuencia en los últimos años. Hoy día se encuentran en estudio otros efectos de la lidocaína a nivel local y sistémico. Los usos de la lidocaína en la oftalmología actual, están respaldados fundamentalmente por su eficacia y seguridad comprobadas en el tiempo(AU)
Lidocaine is the most widely used local anesthetic worldwide for cataract surgery. It is also commonly used in other ophthalmic surgical procedures of the anterior segment, surface of the eyeball, eyelids and lacrimal ducts, as well as in the posterior segment of the eye. This review aims to provide an update on the main characteristics, effects and ways of administering lidocaine used in ophthalmology. A systematic search on the subject was carried out in scientific publications indexed in databases, the information collected was summarized in this work. Lidocaine comes in multiple pharmaceutical forms, with a variety of concentrations and formulations. Generally, 0.5 percent, 1 percent and 2 percent concentrations are used for injection, 2 percent for topical anesthesia in gel and 4% in ophthalmic solution. Its effect as a local anesthetic is well known, at ocular level it can be achieved through periocular and intraocular injections or by topical application. This anesthetic effect of lidocaine offers some pupillary dilation capacity, which has been frequently studied and exploited in recent years. Other local and systemic effects of lidocaine are currently under study. The uses of lidocaine in ophthalmology today are supported primarily by its time-tested efficacy and safety(AU)
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Humanos , Catarata/etiología , Anestésicos Locales/uso terapéutico , Lidocaína/administración & dosificación , Literatura de Revisión como AsuntoRESUMEN
Introducción: La oftalmología es la ciencia de la medicina que se encarga del estudio del sistema visual y el órgano de la visión, así como de sus anexos. Para ello es dotada de un conjunto de tecnologías de avanzada que permite describir las múltiples patologías que tienen los pacientes. En la actualidad se nutre del uso de los dispositivos móviles, fundamentalmente en la gestión del conocimiento, pero no se explotan sus otras dimensiones. Objetivo: Identificar los referentes que fundamentan el uso de la telefonía móvil en el proceso de enseñanza aprendizaje del residente de oftalmología. Métodos: Se realizó una investigación de desarrollo tecnológico en el campo de la educación médica superior. Se utilizaron como métodos teóricos el histórico-lógico, el analítico-sintético y el método sistémico estructural funcional. Resultados: La telefonía móvil constituye una nueva tendencia en la educación superior cubana y en la educación médica como alternativa para desarrollar los procesos de enseñanza aprendizaje, a través de su uso para la socialización, la comunicación entre los estudiantes, y la gestión de la información, como medio de enseñanza aprendizaje y herramienta de trabajo. Conclusiones: Existe una contradicción entre la formación que deben tener los residentes en oftalmología en cuanto al uso de las tecnologías, y la preparación que poseen para su utilización en función de su especialidad. A pesar de que existen varios estudios que demuestran la importancia del uso de la telefonía móvil en la formación de los residentes de oftalmología, como objeto de estudio y herramienta de trabajo, no se ha establecido la vía para incluirla como una de las tecnologías dentro de la residencia de oftalmología en Cuba.
Introduction: Ophthalmology is the medical science dealing with the study of the visual system and the organ of vision, as well as its annexes. For this purpose, it is equipped with a set of advanced technologies that allow describing the multiple pathologies presented by patients. Nowadays, it is nourished by the use of mobile devices, mainly in knowledge management, but its other dimensions are not exploited. Objective: To identify the references that support the use of mobile telephony in the teaching-learning process of ophthalmology residents. Methods: A technological development research was carried out in the field of higher medical education. As theoretical methods, the historical-logical, the analytical-synthetic, and the systemic-structural-functional methods were used. Results: Mobile telephony is a new trend in Cuban higher education, as well as in medical education, as an alternative to develop teaching-learning processes, through its use for socialization, communication among students, and information management, as a teaching-learning means and a work tool. Conclusions: There is some contradiction between the training that ophthalmology residents should receive with respect to the use of technologies and the preparation that they have for their usage in accordance with their specialty. Although there are several studies that demonstrate the importance of using mobile telephony in the training of ophthalmology residents, as an object for studying and a work tool, there has not been a way to include it as one of the technologies within the ophthalmology residency in Cuba.
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Antecedentes: Cuando el nervio óptico presenta una superficie mayor a 2.5 mm2 , y sin patologías asociadas, se trata de un macrodisco, cuya excavación es proporcional al tamaño aumentado del mismo. Con base en la distribución bajo la curva de Gauss, se define como "macrodisco" cuando está por encima de 2 desviaciones estándar arriba de la media. Se espera que solo el 2.3% de la población exceda estos límites. Objetivo: Determinar el tamaño promedio del disco óptico y proporción de macrodisco en la población sin glaucoma ni patologías retinianas que acude a dos clínicas oftalmológicas del occidente de Honduras, en el periodo de julio 2021 hasta julio 2022. Métodos: Estudio retrospectivo descriptivo. Se midieron los parámetros morfométricos del disco óptico mediante Tomografía de Coherencia Óptica ZEISS Cirrus HD Model 4000. Se definió macrodisco como: área del disco óptico >2.5 mm 2 y área del disco más 2 o más desviaciones estándar arriba de la media. Resultados: La proporción de macrodisco fue de 31% tomando en cuenta la definición de área de disco >2.5 mm2 , y 3% considerando la definición con base a la distribución bajo la curva de Gauss (>3.17mm2 ). Se obtuvo un promedio de área de disco óptico de 2.28±0.45 mm 2 , ratio copa/disco (C/D) de 0.59±0.13, ratio C/D vertical de 0.56±0.13, área de anillo neuroretiniano de 1.37±0.22 mm 2 , espesor de Capa de Fibras Nerviosas Retinianas (CFNR) de 97.4±10.664µm. Discusión: El área de disco promedio obtenido es mayor que los caucásicos, similar a lo reportado en los hispánicos, y menor que afrodescendientes y asiáticos...(AU)
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Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Disco Óptico , Anomalías del Ojo , Tomografía de Coherencia Óptica/métodosRESUMEN
Introducción: Las tecnologías de la información y las comunicaciones (ICT por sus siglas en inglés) han originado la enseñanza mediante los llamados entornos virtuales de enseñanza-aprendizaje. La Universidad Virtual de la salud (UVS) de Pinar del Río, es una de las instituciones que se destaca en este quehacer, no obstante, son insuficientes las publicaciones relacionadas con la virtualización de contenidos en la especialidad de Oftalmología. Objetivo: desarrollar una aplicación web para la virtualización de los procesos docentes en la especialidad de Oftalmología en la Universidad de Ciencias Médicas de Pinar del Río. Métodos: La investigación se basa en el enfoque dialéctico. Desde este enfoque se utilizaron métodos de investigación teóricos: análisis histórico lógico, análisis y síntesis, inducción y deducción, y empíricos: modelación y análisis documental. Para la modelación y diseño de artefactos de ingeniería se utilizó el Enterprise Architect y para la elaboración de la web el WordPress. Resultados: Se podrán visualizar los contenidos de la especialidad en cada uno de los años de rotación, tanto en pregrado como en el postgrado, a través de interfaz gráfica amigable, sencilla y amena. Conclusiones: Con la elaboración de esta aplicación web se resuelven problemas de masividad, espacio y tiempo, así como de llevar el conocimiento más actualizado y pertinente hasta donde están quienes más lo necesitan, sin que tengan que ausentarse de su entorno laboral y familiar, de forma masiva.
Introduction: ICT have originated training in the so-called virtual teaching-learning environments. The UVS of Pinar del Río is one of the institutions that stands out in this task; however, the publications related to the virtualization of contents in the specialty of Ophthalmology are insufficient. Objective: to develop a web application for the virtualization of teaching processes in the specialty of Ophthalmology at the University of Medical Sciences of Pinar Del Río. Methods: the dialectical approach is the basis of the research. Theoretical methods used were: logical-historical analysis, analysis and synthesis, induction and deduction; empirical methods included modeling and documentary analysis. The Enterprise Architecture was used for the modeling and design of engineering artifacts, and WordPress was used for the development of the Web. Results: the contents of the specialty might be visualized in both undergraduate and postgraduate years of rotation through a friendly, simple and enjoyable graphical interface. Conclusions: the use of this web application can solve problems of massiveness, space and time, bringing the most updated and relevant knowledge to where people need it, without having to be absent from their work and family environment.
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Introducción: La enfermedad COVID-19, declarada como pandemia por la Organización Mundial de la Salud, afecta otros sistemas y órganos ajenos al aparato respiratorio, por ejemplo: los ojos. Objetivo: Caracterizar las manifestaciones oculares de la COVID-19 y sus posibles complicaciones. Método: Se realizó un análisis exhaustivo de bibliografía a través de los motores de búsqueda SciELO, PubMed y Google Académico; se seleccionó un total de 55 artículos. Conclusiones: Clínicamente, la COVID-19 se ha asociado a conjuntivitis leve, que puede ser el primer y único síntoma de la enfermedad, así como a afecciones retinianas, enfermedad de Kawasaki, complicaciones neurooftalmológicas y en el paciente de cuidados intensivos. La pronta detección de estas afecciones puede influir directamente en la posterior evolución del paciente.
Introduction: COVID-19, a pandemic declared by the World Health Organization, affects not only the respiratory system but other systems and organs, for example the eyes. Objective: to characterize ocular manifestations of COVID-19 and their possible complications. Methods: an exhaustive analysis of the bibliography was carried out through SciELO, PubMed and Google Scholar search engines; a total of 55 articles were selected. Conclusions: COVID-19 has been clinically associated with mild conjunctivitis, which may be the first and only symptom of the disease, as well as retinal disorders, Kawasaki disease, neuro-ophthalmological complications, and in intensive care patients. Early detection of these conditions can directly influence the subsequent evolution of the patient.
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Retina , Conjuntivitis , COVID-19RESUMEN
ABSTRACT Purpose: To evaluate the profile of emergency eye-related visits at a reference eye hospital in Sao Paulo during the first months of the quarantine due to the coronavirus disease (COVID-19) pandemic and to compare it with that in the same period of the previous year. Methods: Data were obtained from the emergency department of Ophthal Hospital Especializado, Sao Paulo, Brazil. All the cases registered between March 23 and May 19, 2020, were included in the study as Group 2020. The cases registered between March 23 and May 19, 2019, were included in the study as Group 2019. Frequency tables were used for the descriptive analyses. The chi-square and Fisher exact tests were applied to compare categorical variables between the groups. Results: We observe a decrease of 46.15% in the number of cases during the COVID-19 pandemic in 2020 compared with the same period in 2019. We observed a significant increase in the incidence rates of the following pathologies in 2020 compared with 2019: eyelid disorders (12.3%), corneal disorders (97.1%), retinal pathologies (173.1%), refraction (62.9%), glaucoma (acute and chronic; 43.9%), scleral alterations (68.8%), trauma (39.3%), herpes (54.7%), and cataracts (549.9%). On the other hand, the incidence rates of the following disorders decreased: conjunctivitis (-33.4%), disorders of lacrimal system (-81.0%), iridocyclitis (-39.9%), and postoperative visits (-80.1%). Conclusion: During the early phase of the COVID-19 pandemic, we observed a drastic decrease in the number of patients who visited the emergency eye service. The main reasons for visiting were also changed, with higher frequencies of high-severity cases such as retina disturbances, cornea disturbances, glaucoma, and trauma and lower frequencies of transmittable conditions such as conjunctivitis.
RESUMO Objetivos: Avaliar o perfil das consultas de emergência oftalmológicas durante os primeiros meses de quarentena por pandemia de covid-19 em um hospital oftalmológico de referência em São Paulo e compará-lo com o mesmo período do ano anterior. Métodos: Os dados foram extraídos do serviço de emergência do Hospital Ophthal Especializado, São Paulo, Brasil. Todos os casos registrados entre 23 de março e 19 de maio de 2020 foram incluídos no estudo como Grupo 2020. Os casos registrados entre 23 de março e 19 de maio de 2019 foram incluídos no estudo como Grupo de 2019. Tabelas de frequência foram utilizadas para análises descritivas. Os testes Qui-quadrado e Exato de Fisher foram aplicados para comparar variáveis categóricas entre os grupos. Resultados: Observamos uma diminuição de 46,15% no número de casos durante a pandemia Covid-19 em 2020 quando comparado ao mesmo período sem pandemia em 2019. Foi observado um aumento significativo nos achados de pálpebra (+12,3%), córnea (+97,1%), retina (+173,1%), refração (+62,9%), glaucoma (+43,9%), esclera (+68,8%), trauma (+39,3%), herpes (+54,7%) e catarata (+549,9%) em 2020 quando comparado para 2019. Por outro lado, houve redução nos casos de conjuntivite (-33,4%), transtornos do aparelho lacrimal (-81,0%), iridociclite (-39,9%) e consultas pós-operatórias (-80,1%). Conclusão: durante a fase inicial da pandemia Covid-19, foi observada uma redução drástica no número de pacientes que procuram o serviço de emergência ocular. Houve também uma mudança nos principais motivos para visitas com frequências mais altas de casos de alta gravidade como distúrbios da retina, distúrbios da córnea, glaucoma e trauma, e frequências mais baixas de condições transmissíveis como conjuntivite.
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Resumen Antecedentes: La queratoplastia en población pediátrica ha sido considerada un procedimiento de alto riesgo. Objetivo: Conocer datos demográficos de pacientes menores de 18 años tratados con queratoplastia óptica, indicaciones de la cirugía y sus resultados. Material y métodos: Se realizó un estudio retrospectivo en el Instituto de Oftalmología Conde de Valenciana, en el que se revisaron expedientes de pacientes menores de 18 años tratados con queratoplastia óptica de 2009 a 2019. Resultados: Un total de 53 ojos fueron incluidos. El diagnóstico y el procedimiento más comunes fueron el queratocono y la queratoplastia penetrante. El promedio de agudeza visual inicial fue de 2.05 ± 0.99 logMAR y en la última visita, 0.82 ± 1.33. El tiempo de supervivencia del injerto fue de 130.34 meses. Se registraron cuatro fallas. En cuanto a las cirugías asociadas, antes del trasplante se registró cierre de herida corneal en siete ojos y durante la queratoplastia, vitrectomía anterior en dos ojos y después del trasplante, implante de válvula de Ahmed y resutura. Un total de ocho ojos tuvieron glaucoma, cinco con diagnóstico antes del trasplante. Respecto al rechazo, 15 ojos tuvieron un episodio durante el seguimiento y el tiempo promedio de rechazo al trasplante fue de 10.8 meses. Conclusión: Se puede lograr una supervivencia prolongada del injerto con el mejor conocimiento y manejo de los diferentes factores asociados.
Abstract Background: Keratoplasty in the pediatric population has been considered a high-risk procedure. Objective: To know the demographic data of patients younger than 18 years treated with optical keratoplasty, indications for surgery and its results. Material and methods: A retrospective study was carried out at Conde de Valenciana Ophthalmology Institute, in which the medical records of patients younger than 18 years treated with optical keratoplasty from 2009 to 2019 were analyzed. Results: A total of 53 eyes were included. The most common diagnosis and procedure were keratoconus and penetrating keratoplasty, respectively. Mean initial visual acuity was 2.05 ± 0.99 logMAR, and 0.82 ± 1.33 at last visit. Survival time was 130.34 months. Four failures were recorded. As for associated surgeries, corneal wound closure was recorded in seven eyes prior to transplant; during the keratoplasty procedure, anterior vitrectomy in two eyes, and after the transplant, Ahmed valve implantation and re-suture. A total of eight eyes had glaucoma, five of them diagnosed prior to transplantation. Regarding rejection, 15 eyes had an episode during follow-up, and mean time to transplant rejection was 10.8 months. Conclusion: Prolonged graft survival can be achieved with better knowledge and management of different associated factors.
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Resumen Objetivo: Realizar un análisis descriptivo de los incidentes en oftalmología reportados por médicos oftalmólogos de Argentina. Métodos: Se realizó un estudio basado en una encuesta desarrollada mediante un sistema electrónico, en agosto de 2021, dirigido a médicos oftalmólogos de Argentina. Se solicitó la descripción de incidentes oftalmológicos, clasificándolos en cuatro grupos, acorde a lo descrito por Organización Mundial de la Salud, en A: "Incidentes, casi-accidentes (no alcanzaron a los pacientes)"; B: "Incidentes (que alcanzaron al paciente, pero sin daño)"; C: "Incidentes prevenibles con daño" y D: "Incidentes no prevenibles con daño". El instructivo de la encuesta explicó la terminología y ofreció ejemplos de cada tipo de incidentes, que fueron evaluados mediante un proceso estadístico descriptivo. Resultados: Participaron 264 médicos oftalmólo gos quienes informaron 434 incidentes. A- Incidentes sin alcance al paciente: 125 casos (28.8%). B- Incidentes que alcanzaron al paciente sin daño: 117 casos. (27%). C- Incidentes prevenibles, con daño: 96 casos (22.1%). D- Incidentes no prevenibles con daño: 96 casos (22.1%). Los incidentes vinculados al uso de gotas fueron los más frecuentes en los 4 grupos (68, 75, 13 y 29 incidentes respectivamente). Conclusión: El 77.9% de los incidentes comunicados en este estudio se podrían haber evitado con adecuadas medidas de seguridad, siendo los más frecuentes los asociados a la utilización de gotas oftálmicas.
Abstract Objective: To perform a descriptive analysis of incidents in ophthalmology reported by ophthal mologists of Argentina. Methods: A questionnaire-based study was performed by an electronic survey during August 2021, including ophthalmologists of Argentina, requesting the description of ophthalmological incidents, which were classified in four groups, in accordance with World Health Organization Definition, as follow: A- "Inci dents, almost-accidents (patient no affected)"; B: "Incidents (patient affected without damage)"; C: "Preventable incidents, with damage", and D: "Not Preventable incidents, with damage". An instructive was supported in the survey explaining these definitions with examples of each kind of incidents. Data was processed for descriptive statistics. Results: The survey was performed by 264 ophthalmologists, reporting 434 incidents: A- Incidents, almost-accidents (patient not affected): 125 cases (28.8%). B- Incidents (patient affected without damage): 117 cases (27%). C- Preventable incidents, with damage: 96 cases (22.1%). D- "Not Preventable incidents, with damage: 96 cases (22.1%). In four groups the most frequent incidents were those associated with the use of ophthalmic drops (68, 75, 13, and 29 incidents respectively). Conclusion: Most of the incidents (77.9%) reported in this study could be avoided if appropriate safety measures were taken. Ophthalmic drops related incidents were the most frequent.
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Introducción: La toxoplasmosis es una enfermedad parasitaria, en América Latina la prevalencia es relativamente alta, se sabe que la enfermedad no solo es la causa más frecuente de uveítis posterior, sino también la causa principal de la uveítis en sí misma. En Paraguay no se dispone de datos epidemiológicos publicados sobre la misma. Objetivo: Determinar las características de las lesiones retinianas en pacientes con diagnóstico de Toxoplasmosis ocular. Metodología: El presente estudio es observacional, descriptivo, de corte transversal, temporalmente retrospectivo, con muestreo no probabilístico de casos consecutivos. Se enfocó en pacientes con diagnóstico de Toxoplasmosis que acudieron al servicio de Oftalmología del Hospital de Clínicas, durante el periodo de junio de 2020 a febrero 2022. Resultados: Se observó un 54,3 % de mujeres, una media de 30,62 +/- 12,96 años y un 62,8 % de procedencia urbana. El 88,3 % de los casos fueron unilaterales, la mitad de episodios primarios, el 93,6 % casos agudos, y el 97,9 % tuvo un mecanismo de trasmisión adquirido. La mayoría se presentó como Panuveítis, las localizaciones más frecuentes de las lesiones retinocoroideas fueron el Polo posterior (extramacular) y la periferia. El principal abordaje terapéutico fue el tratamiento con Trimetoprim Sulfametoxazol y corticoides sistémicos, la duración del tratamiento fue de 6,51 +/- 1,52 semanas, y las principales complicaciones fueron la Vitritis residual y la Hipertensión ocular. Discusión: La toxoplasmosis ocular es una causa importante de morbilidad visual. Se hace fundamental la prevención de la infección por este parásito mediante medidas higiénico-sanitarias, así como el diagnóstico y tratamiento precoz de los pacientes infectados, de tal manera a disminuir las complicaciones asociadas a esta patología.
Introduction: Toxoplasmosis is a parasitic disease, in Latin America the prevalence is relatively high, it is known that the disease is not only the most frequent cause of posterior uveitis, but also the main cause of uveitis itself. In Paraguay there are no published epidemiological data on it. Objective: To determine the characteristics of retinal lesions in patients diagnosed with ocular Toxoplasmosis. Methods: This study is observational, descriptive, cross-sectional, temporally retrospective, with non-probabilistic sampling of consecutive cases. It focused on patients diagnosed with Toxoplasmosis who attended the Ophthalmology service of the Hospital de Clínicas, during the period from June 2020 to February 2022. Results: 54.3% of women were observed, an average of 30.62 +/ - 12.96 years old and 62.8% of urban origin. 88.3% of the cases were unilateral, half were primary episodes, 93.6% acute cases, and 97.9% had an acquired transmission mechanism. Most presented as panuveitis, the most frequent locations of retinochoroidal lesions were the posterior pole (extramacular) and the periphery. The main therapeutic approach was treatment with trimethoprim sulfamethoxazole and systemic corticosteroids, the duration of treatment was 6.51 +/- 1.52 weeks, and the main complications were residual vitritis and ocular hypertension. Discussion: Ocular toxoplasmosis is an important cause of visual morbidity. It is essential to prevent infection by this parasite through hygienic-sanitary measures, as well as early diagnosis and treatment of infected patients, in order to reduce the complications associated with this pathology.
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Introducción: La retinopatía asociada a melanoma (RAM) es un desafío para el equipo tratante de pacientes oncológicos debido a la inespecificidad del cuadro clínico y a la dificultad de realizar exámenes que ofrezcan un diagnóstico. Métodos: Paciente 55 años, sexo femenino con diagnóstico de melanoma, consulta por escotoma central asociado a síntomas visuales positivos. Resultados: Examen oftalmológico dentro de rangos normales. Electrorretinograma (ERG) estándar muestra respuesta máxima electronegativa en ambos ojos, sugerente de RAM. Discusión: El reconocimiento temprano de RAM mediante ERG tiene importancia diagnóstica, permitiendo iniciar tratamiento temprano y reducir el riesgo irreversible de daño a la retina.
Introduction: Melanoma-associated retinopathy (MAR) is a challenge for the oncology team due to the non-specific clinical presentation and the associated difficulty of performing indicative tests for diagnosis. Methods: A 55-year-old female patient initially diagnosed with melanoma consults due to vision with central scotoma associated with positive visual symptoms. Results: Ophthalmological examination within normal ranges. Standard electroretinogram (ERG) shows the maximum electronegative response in both eyes, suggesting MAR. Discussion: The early recognition of MAR by ERG has diagnostic importance because it would allow a possible early treatment and could reduce the risk of irreversible retina damage.
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Keratoconjunctivitis sicca (KCS) is a disease commonly seen in dogs that is characterized by the reduction or absence of lacrimal secretions. It can be classified as qualitative or quantitative, and both categories are able to elicit conjunctival and corneal inflammation, ocular pain, progressive corneal disease, and vision impairment. This disease's treatment is based on reestablishing and maintaining ocular surface homeostasis. Patients may benefit from different therapeutic protocols, such as the use of lacrimomimetics, that increase lacrimal stability, helping to retain ocular humidity; lacrimostimulants, that promote lacrimal secretion; fatty acids, which play a role on meibum synthesis and block pro-inflammatory cytokine genic expression; blood products, based on promotion of epithelial growth factors; and stem cells, due to their self-renewing capabilities. Stable cases may benefit from the use of steroidal or non-steroidal anti-inflammatory agents on the control of clinical signs. Refractory cases may eventually benefit from surgical therapies, which include techniques for parotid duct transposition, gland transplants, and lacrimal puncta occlusion.
A ceratoconjuntivite seca (CCS) é uma doença comumente observada em cães caracterizada pela ausência ou redução das secreções lacrimais. Pode ser classificada como qualitativa ou quantitativa, sendo que ambas as categorias são capazes de desencadear inflamação da conjuntiva e da córnea, dor ocular, doença corneana progressiva e redução da visão. O tratamento desta doença é contínuo e se baseia no restabelecimento e manutenção da homeostase do sistema da superfície ocular. Os pacientes podem se beneficiar de diferentes protocolos terapêuticos, tais como o uso de lacrimomiméticos, que aumentam a estabilidade lacrimal ajudando na retenção da umidade ocular; lacrimoestimulantes para a promoção de secreção de lágrimas; ácidos graxos, que desempenham papel na síntese de meibum e bloqueiam a expressão gênica de citocinas pró-inflamatórias; produtos derivados do sangue, baseando-se nos fatores de crescimento de promoção epitelial; e células tronco, devido à sua capacidade de auto renovação. Em casos estáveis, o uso de anti-inflamatórios esteroidais ou não esteroidais pode ser benéfico no controle de sinais clínicos. Casos refratários ao tratamento podem eventualmente se beneficiar de terapias cirúrgicas, que incluem as técnicas de transposição de ducto parotídeo, transplantes glandulares e oclusão da puncta lacrimal.
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Animales , Perros , Lágrimas , Queratoconjuntivitis Seca/veterinaria , Enfermedades de la Córnea/veterinaria , Perros/anomalías , Oftalmopatías/veterinaria , Homeostasis/efectos de los fármacos , Enfermedades del Aparato Lagrimal , Antiinflamatorios/análisisRESUMEN
Fundamento: el sistema de evaluación es un componente importante del proceso enseñanza aprendizaje del Programa de Formación de las Especialidades Médicas. Objetivo: elaborar un sistema de acciones educativas para contribuir a la evaluación integral del residente de Oftalmología. Métodos: se realizó una investigación cualitativa en el Centro Oftalmológico de Villa Clara, en el período septiembre 2019-octubre 2021. Se emplearon métodos teóricos: análisis-síntesis, inductivo-deductivo, histórico-lógico y enfoque sistémico; empíricos: análisis documental, cuestionario y entrevista; matemáticos: frecuencias absolutas y relativas. Resultados: la totalidad de los docentes consideró importante fomentar la formación de valores, principios éticos y morales en los residentes. El 95 % no supieron argumentar las relaciones que se establecen entre el acápite I de aspectos generales de la tarjeta de evaluación y los demás componentes del proceso enseñanza aprendizaje; la mayoría confunden los métodos y medios con las formas de organización de la enseñanza; solo dos residentes tienen dominio de los aspectos que contempla el plan de estudio de la especialidad y todos tienen escasa percepción de la importancia del acápite I de la tarjeta de evaluación, por lo que se elaboró un sistema de acciones educativas teniendo en cuenta los objetivos, contenidos y métodos educativos para solucionar las carencias encontradas. Conclusiones: el diagnóstico realizado logró la identificación de insuficiencias y potencialidades en la evaluación integral del residente y su concreción en el acápite I de la tarjeta de evaluación; las acciones fueron valoradas satisfactoriamente por los especialistas consultados, quienes sugirieron aspectos que fueron adicionados al producto final.
Background: the evaluation system is an important component of the teaching-learning process of the Training Program for Medical Specialties. Objective: to develop a system of educational actions to contribute to the comprehensive evaluation of the Ophthalmology resident. Methods: a qualitative research was carried out at the Villa Clara Ophthalmological Center, from September 2019 to October 2021. Theoretical methods were used: analysis-synthesis, inductive-deductive, historical-logical and systemic approach; empirical ones: documentary analysis, questionnaire and interview; mathematics: absolute and relative values. Results: all the teachers considered it important to promote the formation of values, ethical and moral principles in the residents. 95% did not know how to argue the relationships established between section I of general aspects of the evaluation card and the other components of the teaching-learning process; most confuse the methods and teaching aids with the forms of organization of teaching; only two residents have mastery of the aspects contemplated in the study plan of the specialty and all have little perception of the importance of section I of the evaluation card, for which a system of educational actions was developed taking into account the objectives, content and educational methods to solve the deficiencies found. Conclusions: the diagnosis made achieved the identification of insufficiencies and potentialities in the comprehensive evaluation of the resident and its concretion in section I of the evaluation card; the actions were satisfactorily valued by the specialists consulted, who suggested aspects that were added to the final product.
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Oftalmología , Educación Continua , Educación Médica , Evaluación Educacional , Capacitación en Servicio , Internado y ResidenciaRESUMEN
RESUMO Objetivo Elaborar e validar um curso sobre Ciências Básicas em Oftalmologia. Métodos Foi realizado um estudo metodológico para elaboração e validação de material didático, na modalidade à distância, por meio do desenho instrucional ADDIE. O desenho é composto de três de cinco etapas: análise, desenho e desenvolvimento. Foi utilizada a taxonomia revisada de Bloom para definição dos objetivos de aprendizagem. O curso foi submetido à validação do conteúdo, via remota, por meio de grupo de consenso selecionado pelo modelo de Fehring, segundo as normas da resolução 510/2016. Resultados O curso elaborado e validado tem duração prevista de 15 horas e possui 19 objetivos de aprendizagem distribuído em seis unidades pedagógicas. Contempla o conteúdo programático utilizando diversos recursos tecnológicos interativos e apresenta-se com avaliações formativas de sedimentação do conteúdo ao fim de cada unidade. Conclusão O curso de Ciências Básicas em Oftalmologia na modalidade à distância validado promete democratizar o ensino da Oftalmologia às instituições de ensino credenciadas pelo Conselho Brasileiro de Oftalmologia.
ABSTRACT Objective To develop and validate a course on basic sciences in Ophthalmology. Methods A methodological study for the development and validation of a teaching and instructional material, an online course through the ADDIE instructional design, was prepared at the Faculdade Pernambucana de Saúde (FPS). The design consists of three steps out of five: Analysis, Design, and Development. Bloom's revised Taxonomy was used to define the learning objectives. The course was submitted remotely to content validation, through a consensus group of five specialists selected with a score higher than five in the criteria established by the Fehring model, according to the rules of Resolution 510/2016. Results With expected duration of 15 hours, the course has 19 learning objectives distributed in six pedagogical units. It contemplates the programmatic content using several interactive technological resources, such as storytelling videos, simulation with animated cartoons and clickable interactive actors and screens. In addition to having formative evaluation of content sedimentation at the end of each unit. Conclusions The online course of basic sciences in ophthalmology has been validated by specialists and it is expected to provide democratization of ophthalmology teaching to educational institutions accredited by the CBO.
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RESUMO Objetivo Avaliar e caracterizar a qualidade da assistência oftalmológica ofertada em uma unidade de serviços ambulatoriais da Atenção Secundária do Sistema Único de Saúde na percepção dos usuários e/ou dos responsáveis por esses usuários. Métodos Foi realizado estudo seccional de prevalência analítica entre usuários assistidos no período de setembro de 2019 a março de 2020 em um dos seis serviços de assistência oftalmológica ofertado pelo Sistema Único de Saúde, no município de Vitória da Conquista (BA). Foram avaliadas as condições demográficas e socioeconômicas e a autopercepção da saúde. Também foram avaliadas as características e os níveis de qualidade da assistência à saúde oftalmológica. A coleta das informações ocorreu por meio de entrevista telefônica. Resultados Participaram do estudo 389 usuários e/ou responsáveis. Observaram-se elevados níveis de satisfação, considerando as perguntas que compõem o constructo do instrumento. Identificaram-se níveis de qualidade comprometidos em relação à liberdade de escolher seu prestador de cuidado ocular (154; 39,7%). Menores níveis de satisfação associaram-se com as variáveis sexo masculino (razão de chance de 1,66; IC95% 1,04-2,65; p=0,033) e raça autodeclada branca (razão de chance de 6,89; IC95% 4,00-11,86; p=0,000). Conclusão Os usuários relataram bons níveis de satisfação da assistência à saúde oftalmológica. Observaram-se maiores chances de menores níveis de satisfação entre homens e aqueles com raça autodeclarada branca.
ABSTRACT Objective To evaluate and characterize the quality of ophthalmic care offered in an outpatient service unit of the SUS secondary care according to the perception of users and/or those responsible for these users. Methods A cross-sectional study of analytical prevalence was carried out among users assisted from September 2019 to March 2020, in one of the six ophthalmic care services offered by the SUS, in the municipality of Vitória da Conquista (BA), Brazil. Demographic and socioeconomic conditions, as well as self-perception of health, were evaluated. The characteristics and quality levels of ophthalmic health care were also evaluated. Data collection took place through a telephone interview. Results A total of 389 users and/or guardians participated in the study. Participants reported high levels of satisfaction, considering the questions that make up the instrument's construct. Compromised quality levels were observed in relation to the freedom to choose their eye care provider (n=154; 39.7%). Lower levels of satisfaction were associated with the variables male gender (OR=1.66; 95%CI=1.04-2.65; p=0.033) and self-reported white race (OR=6.89; 95%CI=4, 00-11.86; p=0.000). Conclusion Users reported good levels of satisfaction with eye health care. There were greater chances of lower levels of satisfaction among men and among those with a self-reported white race.
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ABSTRACT Objective To investigate if there is knowledge improvement over the Residency years, as well as students' satisfaction about progress test. Finally, to describe the implementation of the online progress test in some Ophthalmological Residency programs in Brazil. Methods It was an observational cross-section study. The participants were all Ophthalmology residents who accepted to join the study. They did an online test and answered demographic and satisfaction questionnaires. Results Two hundred and fifty-nine residents joined the study. 42,86% of the residents answered the demographic questionnaire and 6,95% answered the satisfaction questionnaire. In general, the residents approved the website as a tool for self-learning and to improve residency programs. Conclusion Over the years, the residents acquired knowledge during the residency program. In general, residents were satisfied with the test. The implementation of the online progress test system in the Ophthalmological Residency schools in Brazil was successful.
RESUMO Objetivo Avaliar se ocorre melhora do desempenho na prova dos residentes ao longo dos anos de curso e o grau de satisfação dos residentes com o teste de progresso. Além disso, descrever a implementação do teste de progresso em alguns serviços de residência em oftalmologia no Brasil. Métodos Estudo observacional prospectivo. Os participantes foram todos os residentes de Oftalmologia que aceitaram participar do estudo. Eles fizeram um teste online e responderam a um questionário pessoal e um de satisfação. Resultados Duzentos e cinquenta e nove residentes participaram do estudo. 42,86% dos residentes responderam o questionário pessoal e 6,95% responderam o questionário de satisfação. Em geral, os residentes aprovaram o site como instrumento de autoaprendizado e como instrumento para melhoria dos programas de residência. Conclusão Houve aquisição de conhecimento dos residentes ao longo do curso. De um modo geral, os residentes ficaram satisfeitos com o teste. A implementação do teste de progresso nos serviços de residência de Oftalmologia foi bem-sucedida.
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Humanos , Masculino , Femenino , Adulto , Oftalmología/educación , Competencia Clínica , Evaluación Educacional/métodos , Internado y Residencia , Satisfacción Personal , Estudios Transversales , Encuestas y Cuestionarios , Educación a Distancia/métodos , Educación MédicaRESUMEN
Fundamento: la evaluación del impacto en el contexto de la educación superior es el proceso mediante el cual se valoran los cambios que ocurren en el egresado por influencia del programa, un tiempo después de aplicadas las acciones formativas. Objetivo: evaluar el impacto de la especialidad Oftalmología en el desarrollo docente de sus egresados en la Facultad de Ciencias Médicas "Mariana Grajales Coello" de Holguín. Métodos: se realizó un estudio de evaluación con enfoque mixto y de corte transversal en el campo del posgrado académico, en el período enero 2021-junio 2022. Se aplicaron métodos teóricos y empírico: cuestionario para obtener información sobre la percepción de los egresados respecto al impacto de la especialidad en su preparación docente. El procesamiento incluyó análisis de frecuencias relativas, índice de posición, la correlación elemento escala y el índice de Cronbach para la confiabilidad. Resultados: las subdimensiones aportes al dominio de las categorías de la didáctica, preparación en el trabajo metodológico, preparación en la organización y dirección del trabajo docente calificaron de Alto el impacto de la especialidad en la preparación docente de los egresados. Además, hubo 47 % de participación en la ejecución de actividades docentes de pregrado y posgrado después de haber cursado la especialidad. Conclusiones: la percepción de los egresados evidenció el alto impacto de la especialidad Oftalmología en su preparación docente, componente esencial en la educación médica para la calidad del proceso docente educativo.
Background: impact evaluation in the context of higher education is the process through which the changes that occur in the graduate due to the influence of the program are assessed, sometime after the training actions have been applied. Objective: to assess the impact of the Ophthalmology specialty on the teaching development of its graduates at "Mariana Grajales Coello" Faculty of Medical Sciences in Holguín. Methods: an evaluation study was carried out with a mixed and cross-sectional approach in the field of academic postgraduate studies, from January 2021 toJune 2022. Theoretical and empirical methods were applied: questionnaire to obtain information on the perception of graduates regarding the impact of the specialty on their teaching preparation. The processing included analysis of relative frequencies, position index, scale element correlation and Cronbach's index for reliability. Results: the sub dimensions contributions to the mastery of the categories of didactics, preparation in methodological work, preparation in the organization and direction of teaching work rated the impact of the specialty on the teaching preparation of graduates as High. In addition, there was 47% participation in the execution of undergraduate and graduate teaching activities after having completed the specialty. Conclusions: the perception of the graduates evidenced the high impact of the Ophthalmology specialty on their teaching preparation, an essential component in medical education for the quality of the educational teaching process.
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Oftalmología , Desarrollo de Personal , Educación Médica , Perfil LaboralRESUMEN
ABSTRACT Objective To evaluate the effects of the Covid-19 pandemic on the profile of emergency eye-related visits and compare the findings with the same period before the pandemic. Methods Cross-sectional study performed during one year at a reference eye hospital. Cases registered at the emergency Municipal Hospital Complex of Santo Andre, Brazil, between March, 2019 and February, 2020 were included in the study as the Pre-pandemic group. Cases registered between March, 2020 and February, 2021 were included as the Pandemic group. Cases were classified according to the International Classification of Diseases ICD-10 and Related Health Problems. Results There was a decrease of 52.1% in the emergency eye care visits during the pandemic period (n=9,198) when compared to the pre-pandemic period (n=19,220), with significant reductions in nonspecific cases (-98.1%), postoperative visits (-67.0%), disorders of the conjunctiva (-54.1%), tear film (-49.4%) and refraction (-85.6%) during the pandemic period. Conditions such as retina disorders (+202.7%), sclera disorders (+76.2%), orbit disorders (+20.2%), glaucoma (+66.6%) and trauma (+19.4%) have shown increased rates, as well as those related to eyelids (+186.9%), cornea (+33.4%), uvea (+40.2%), and herpes (+55.3%). Conclusion A drastic reduction in the number of eye-related emergency visits was observed during the Covid-19 pandemic, outlining a new profile of care, with higher frequency of sight-threatening conditions and lower frequency of contagious and non-specific diagnosis.
RESUMO Objetivo Avaliar os efeitos da pandemia da Covid-19 no perfil dos atendimentos oftalmológicos de emergência e comparar os achados com os do período anterior à pandemia. Métodos Estudo transversal realizado ao longo de 1 ano em um hospital oftalmológico de referência. Casos registrados no Complexo Hospitalar Municipal de Emergências de Santo André (SP, Brasil) entre março de 2019 e fevereiro de 2020 foram incluídos no estudo como Grupo Pré-Pandemia. Os casos registrados entre março de 2020 e fevereiro de 2021 foram incluídos no Grupo Pandemia. Os casos foram classificados de acordo com a Classificação Internacional de Doenças e Problemas Relacionados à Saúde. Resultados Houve redução de 52,1% no número de atendimentos oftalmológicos de emergência durante o período pandêmico (n=9.198) quando comparado ao pré-pandêmico (n=19.220), com reduções significativas em casos inespecíficos (-98,1%), visitas pós-operatórias (-67,0%), distúrbios da conjuntiva (-54,1%), filme lacrimal (-49,4%) e refração (-85,6%) durante o período de pandemia. Condições como distúrbios da retina (+202,7%), distúrbios da esclera (+76,2%), distúrbios da órbita (+20,2%), glaucoma (+66,6%) e trauma (+19,4%) apresentaram taxas aumentadas, bem como aquelas relacionadas a pálpebras (+186,9%), córnea (+33,4%), úvea (+40,2%) e herpes (+55,3%). Conclusão Observou-se drástica redução no número de atendimentos oftalmológicos durante a pandemia da Covid-19, delineando um novo perfil de atendimento, com maior frequência de quadros que levam à baixa de visão e à menor frequência de diagnósticos contagiosos e inespecíficos.