Fatores associados ao homicídio de mulheres no Brasil, segundo raça/cor, 2016-2020 / Factors associated with homicides of women in Brazil, by race or colour, 2016-2020

Resumo O objetivo deste estudo é avaliar as taxas de homicídios contra mulheres residentes no Brasil, segundo unidades da federação e raça/cor, no período de 2016 a 2020. Trata-se de um estudo ecológico de tendência temporal. Foi realizada análise múltipla adotando-se modelo de regressão para dados longitudinais. No período, ocorreram no Brasil 20.405 homicídios de mulheres e as taxas padronizadas mostraram que as mulheres negras (6,1/100.000) apresentaram as maiores taxas, em comparação às brancas (3,4/100.000). O Brasil apresentou queda de 25,2% de 2016 a 2020. A taxa de homicídio variou de 4,7 mortes por 100 mil mulheres em 2016 para 3,5 em 2020, mas a tendência decrescente e estatisticamente significante foi observada nas taxas de mulheres negras e brancas. As variáveis IDH, taxa de analfabetismo e proporção de causas mal definidas apresentaram uma relação inversa e estatisticamente significante com as taxas de homicídio de mulheres. Nos anos de 2019 e 2020 houve uma diminuição da taxa média de homicídio em relação ao ano de 2016. Apesar do decrescimento na evolução temporal das taxas para negras e brancas, houve diferenças raciais importantes nos homicídios de mulheres, com piores resultados para as mulheres negras.

Abstract This ecological, time-trend study examined rates of homicide against women residing in Brazil, by state and race/colour, from 2016 to 2020, by performing. Multiple analysis by regression model on longitudinal data. During the study period, 20,405 homicides of women were recorded in Brazil. Standardised homicides rates were higher among black women (6.1/100,000) than among white women (3.4/100,000). From 2016 to 2020, rates decreased 25.2%, from 4.7 deaths per 100,000 women in 2016 to 3.5 in 2020, with a statistically significant downward trend among both black and white women. Statistically significant inverse relationships were found between female homicide rates and HDI, illiteracy rate and proportion of ill-defined causes. The average homicide rate decreased in 2019 and 2020, as compared with 2016. Despite the decreasing time trend in homicide rates for both black and white women, they differed substantially by race, with worse outcomes for black women.

Autocuidado e hábitos de vida de acadêmicos de enfermagem durante a pandemia de Sars-Cov-2 / Self-care and lifestyle habits of nursing students during the Sars-Cov-2 pandemic / Hábitos de autocuidado y estilo de vida de estudiantes de enfermería durante la pandemia Sars-Cov-2

Objective: to understand how the Covid-19 pandemic has interfered with the self-care and lifestyle of university students. Method: exploratory descriptive research carried out with nursing students from four higher education institutions in the state of Paraná. Data were collected using an electronic form available on Google Forms; those of a quantitative nature were subjected to descriptive and inferential analysis, and the answers to open questions analyzed using the Iramuteq Software. Results: 58 nursing students participated in the study, the majority of whom were female (82.76%), with an average age of 22 years, the majority lived with their family. Statistically significant association was observed between Age and "Made friends during remote classes"; Sex and "substance use"; and Year of graduation with eating habits and "Made friends during remote classes". Conclusion: the pandemic especially influenced eating habits, self-care, sleep quality and alcohol and tobacco use among nursing students.

Objetivos:comprender cómo la pandemia de Covid-19 ha interferido en el autocuidado y estilo de vida de los estudiantes universitarios. Método: investigación descriptiva exploratoria realizada con estudiantes de enfermería de cuatro instituciones de educación superior del estado de Paraná. Los datos fueron recopilados mediante un formulario electrónico disponible en Google Forms; los de carácter cuantitativo fueron sometidos a análisis descriptivo e inferencial, y las respuestas a preguntas abiertas analizadas mediante el Software Iramuteq. Resultados: Participaron del estudio 58 estudiantes de enfermería, la mayoría del sexo femenino (82,76%), con una edad promedio de 22 años, la mayoría vivía con su familia. Se observó asociación estadísticamente significativa entre Edad y "Hizo amigos durante las clases remotas"; Sexo y "consumo de sustancias"; y Año de graduación con hábitos alimentarios y "Hice amigos durante clases remotas". Conclusión: la pandemia influyó especialmente en los hábitos alimentarios, el autocuidado, la calidad del sueño y el consumo de alcohol y tabaco entre los estudiantes de enfermería.

Concepções e práticas dos profissionais da atenção primária à saúde acerca dos cuidados paliativos / Conceptions and practices of primary health care professionals regarding palliative care / Concepciones y prácticas de los profesionales de la atención primaria de salud sobre los cuidados paliativos

Objetivo: compreender as concepções e práticas dos profissionais da Atenção Primária à Saúde acerca dos cuidados paliativos. Método: estudo descritivo-exploratório, de abordagem qualitativa realizado com profissionais atuantes em três Unidades Básicas em município no sul do Brasil. Os dados foram coletados em junho de 2021, mediante entrevistas presenciais, audiogravadas junto a 36 profissionais de saúde selecionados por conveniência e submetidos à análise de conteúdo, modalidade temática. Resultados: muitos profissionais da Atenção Primária, sobretudo os agentes comunitários, técnicos e auxiliares de enfermagem, possuem pouco conhecimento ou uma visão distorcida a respeito de cuidados paliativos, mas em seu cotidiano assistem pacientes e familiares. Considerações finais: embora não suficientemente preparados, os profissionais de saúde precisam estar junto, orientar e assistir usuários e familiares que necessitam de cuidados paliativos, necessitam portanto serem sensibilizados quanto a importância e benefícios dos cuidados paliativos e serem devidamente intrumentalizados para prestar essa assistência que valorize seus princípios.

Objective: to understand the conceptions and practices of Primary Health Care professionals regarding palliative care. Method: descriptive-exploratory study, with a qualitative approach carried out with professionals working in three Basic Units in a city in southern Brazil. Data were collected in June 2021, through face-to-face, audio-recorded interviews with 36 health professionals selected for convenience and subjected to content analysis, thematic modality. Results: many Primary Care professionals, especially community workers, technicians and nursing assistants, have little knowledge or a distorted view of palliative care, but in their daily lives they assist patients and families. Final considerations: although not sufficiently prepared, health professionals need to be together, guide and assist users and families who need palliative care, they therefore need to be made aware of the importance and benefits of palliative care and be properly equipped to provide this assistance that values its principles.

Objetivos: comprender las concepciones y prácticas de los profesionales de la Atención Primaria de Salud sobre los cuidados paliativos. Método: estudio descriptivo-exploratorio, con enfoque cualitativo, realizado con profesionales de tres Unidades Básicas de una ciudad de Brasil. Los datos fueron recolectados en junio de 2021, mediante entrevistas presenciales, audio grabadas, a 36 profesionales seleccionados por conveniencia y sometidos a análisis de contenido, modalidad temática. Resultados: muchos profesionales, especialmente trabajadores comunitarios, técnicos y auxiliares de enfermería, tienen pocos conocimientos o una visión distorsionada de los cuidados paliativos, pero en su vida diaria asisten a pacientes y familiares. Consideraciones finales: aunque no están suficientemente preparados, los profesionales de la salud necesitan estar juntos, orientar y asistir a los usuarios y familias que necesitan cuidados paliativos, por lo que deben ser conscientes de la importancia y los beneficios de estes Cuidados y estar adecuadamente equipados para brindar esta asistencia que valora sus principios.

Agreement between corneal diameter measurements obtained with an optical biometer and a Placido-based topographer / Acordo de medições do diâmetro da córnea obtidas por um biômetro óptico e um topógrafo com base em Plácido

ABSTRACT Purpose: The purpose of this study was to compare the white-to-white distance measurements of two devices (IOL Master 500 and Atlas corneal topographer) commonly used in clinical practice to determine if they were interchangeable. Providing information on instrument interchangeability could eliminate several unnecessary tests and consequently reduce the economic burden for the patient and society. Methods: In this prospective, comparative case series, the white-to-white distance was measured by independent examiners using the Atlas topographer (Carl Zeiss Meditec) and the IOL Master 500 (Carl Zeiss Meditec). One eye each of 184 patients was tested. Statistical analyses were performed using a paired t-test, Pearson correlation analysis, and Bland-Altman analysis to compare the measurement methods. Results: The mean white-to-white distance measurements with the Atlas topographer and the IOL Master 500 were 12.20 ± 0.44 mm and 12.12 ± 0.41 mm, respectively (p<0.001). The mean white-to-white difference between the two devices was 0.07 mm (95% confidence interval of mean difference: 0.04-0.11 mm). The Pearson correlation coefficient between the two devices was 0.85 (p<0.0001). The 95% limits of agreement between the two devices were -0.38 mm to 0.53 mm. Conclusions: The Atlas topographer and IOL Master 500 can be used interchangeably with respect to white-to-white distance measurements, as the range of differences is unlikely to affect clinical practice and decision making.

RESUMO Objetivo: O objetivo deste estudo é comparar as medições de diâmetro corneano de dois dispositivos normalmente utilizados na prática clínica (IOL Master 500 e Atlas topógrafo corneal) para ver se são permutáveis. O fornecimento de informações sobre a permutabilidade de instrumentos poderia eliminar vários testes desnecessários e, consequentemente, reduzir a carga econômica para o paciente e para a sociedade. Métodos: Nesta série de casos prospectivos e comparativos, a distância do diâmetro corneano foi medida por examinadores independentes utilizando o Topógrafo Atlas (Carl Zeiss Meditec) e o IOL Master 500 (Carl Zeiss Meditec), em um olho de 184 pacientes. A análise estatística foi realizada utilizando o teste t pareado, a correlação Pearson e a análise Bland-Altman para comparar os métodos de medição. Resultados: As medições médias da distância do diâmetro corneano com o topógrafo Atlas e o IOL Master 500 foram de 12,20 ± 0,44 mm e 12,12 ± 0,41 mm, respectivamente (p<0,001). A diferença média de WTW entre os dois dispositivos foi de 0,07 mm (intervalo de confiança de 95% da diferença média: 0,04 - 0,11 mm). O coeficiente de correlação Pearson entre os dois dispositivos foi de 0,85, p<0,0001. Os limites de concordância de 95% entre os dois dispositivos foram de -0,38 mm a 0,53 mm. Conclusões: O Atlas topographer e o IOL Master 500 podem ser utilizados permutavelmente em relação à medição do diâmetro corneano, uma vez que a gama de diferenças encontradas é pouco susceptível de afetar a prática clínica e a tomada de decisões.

Morphologic and molecular study on the lens anterior capsule in systemic sclerosis / Relato sobre estudo morfológico e molecular da cápsula anterior do cristalino na esclerose sistêmica

ABSTRACT This study aimed to analyze the anterior lens capsule specimens from both eyes of a patient with systemic sclerosis and compare them to the eyes of a control patient. No significant differences between systemic sclerosis and control eyes were observed in the results from the hematoxylin-eosin and picrosirius staining. In the samples obtained from both systemic sclerosis and control eyes, there were expressions of caspase, a molecule expressed in cell death by apoptosis. Heparanase was overexpressed in the systemic sclerosis sample compared to the control sample. Therefore, the anterior lens capsule of the patient with systemic sclerosis is probably affected by the disease since it showed marked expression of heparanase 1.(AU)

RESUMO Analisamos as amostras das cápsulas anteriores do cristalino de uma paciente com esclerose sistêmica e comparamos com as de um paciente controle. Não foram observadas diferenças significativas entre esclerose sistêmica e controle nos resultados da coloração com hematoxilina-eosina e picrosirius. Nas amostras obtidas da esclerose sistêmica e do controle, obtivemos expressão de caspase, uma molécula expressa na morte celular por apoptose. A heparinase foi expressa de forma mais marcante na amostra de esclerose sistêmica quando comparada ao controle. Portanto, a cápsula anterior do cristalino da paciente com esclerose sistêmica provavelmente foi afetada pela doença, uma vez que mostrou expressão aumentada de heparinase 1.(AU)

Um estudo de correlação entre a contagem endotelial da córnea em pacientes com diferentes estágios de ceratocone usando a microscopia especular / A correlation study between a corneal endothelial count in patients with different stages of keratoconus using specular microscopy

RESUMO Objetivo: Avaliar a contagem endotelial da córnea em pacientes com ceratocone (KCN) por microscopia especular e correlacionar com o estágio do ceratocone. Métodos: Noventa e três olhos de 61 pacientes com KCN foram incluídos neste estudo transversal. Os olhos foram classificados nos estágios 1 a 4 de KCN de acordo com a classificação de Amsler-Krumeich utilizando ceratometria obtida pela topografia de córnea e leituras de paquimetria obtidas pela microscopia especular. Resultados: A idade variou de 12 a 43 anos, média ± (desvio padrão) 22,1 ± 6,7 anos. A ceratometria média variou de 42,25 a 71,4 D (53,0 ± 6,1 D). A paquimetria variou de 350 a 606 µm, (461,7 ± 47,1 µm). Em relação a classificação, 23 pacientes (24,7%) apresentavam estágio 1, 24 (25,8%) estágio 2, 5 (6,5%) estágio 3 e 41 pacientes (44,1%) estágio 4. Não foi observada correlação linear entre ceratometria média e contagem de células endoteliais (Coeficiente de correlação de Pearson = -0,05). Nos estágios iniciais a moderados de KCN, a média da contagem de células endoteliais foi 2738,3 ± 285,4 cel/mm2, enquanto no grupo de KCN avançado (estágios 3 e 4) foi 2670,6 ± 262,7 cel/mm2, p= 0,24. Conclusões: Não há correlação entre a contagem de células endoteliais e o estágio do KCN.

ABSTRACT Objective: To evaluate the corneal endothelial count in patients with keratoconus (KCN) by specular microscopy and correlate with the stage of keratoconus. Methods: Ninety-three eyes from 61 patients with KCN were included in this cross-sectional study. The eyes were classified into KCN stages 1 to 4 according to the Amsler-Krumeich classification using keratometry obtained by corneal topography and pachymetry readings obtained by specular microscopy. Results: Age ranged from 12 to 43 years, mean ± (standard deviation) 22.1 ± 6.7 years. The average keratometry ranged from 42.25 to 71.4 D, (53.0 ± 6.1 D). Pachymetry ranged from 350 to 606 µm, (461.7 ± 47.1 µm). Regarding the Amsler classification, 23 patients (24.7%) had stage 1, 24 (25.8%) stage 2, 5 (6.5%) stage 3 and 41 patients (44.1%) stage 4. No linear correlation was observed between mean keratometry and endothelial cell count (Pearson's correlation coefficient = -0.05). In the early to moderate stages of KCN, the mean endothelial cell count was 2738.3 ± 285.4 cell / mm2, while in the advanced KCN group (stages 3 and 4) it was 2670.6 ± 262.7 cell / mm2 , p = 0.24. Conclusions: No correlation was found between the endothelial cell count and the KCN stage.

Prevalence of corneal astigmatism in cataract surgery candidates at a public hospital in Brazil / Prevalência de astigmatismo corneano em candidatos a facectomia em hospital público no Brasil

ABSTRACT Purpose: To assess the frequency of corneal astigmatism before cataract surgery in a Brazilian sample. Methods: This clinic-based cross-sectional study was conducted at the Bonsucesso Federal Hospital, Rio de Janeiro, Brazil. Charts of patients who underwent cataract surgery over a two-year period were retrospectively reviewed, and preoperative keratometric measurements were collected and analyzed. Results: A total of 1707 eyes of 1045 patients were enrolled. The corneal astigmatism was less than 1.0 D in 971 eyes (56.9%), 1.0-1.99 D in 496 eyes (29.1%), 2.0-2.99 D in 157 eyes (9.2%), and more than 3.0 D in 83 eyes (4.9%). The mean corneal astigmatism was 0.92 ± (SD) 0.96 D (range 0 - 10.25 D). Conclusion: Over 40% of the patients undergoing cataract surgery enrolled in this study had more than 1.0 D of corneal astigmatism and may benefit from the use of toric intraocular lenses. These data can be useful for planning to make this technology available for patients.

RESUMO Objetivo: Avaliar a prevalência do astigmatismo corneano antes da cirurgia de catarata em pacientes brasileiros. Métodos: Este estudo transversal de base clínica foi realizado no Hospital Federal de Bonsucesso, Rio de Janeiro, Brasil. Os prontuários de pacientes submetidos à cirurgia de catarata durante um período de dois anos foram revisados retrospectivamente, e as medidas ceratométricas pré-operatórias foram coletadas e analisadas. Resultados: Um total de 1.707 olhos de 1045 pacientes foram incluídos. O astigmatismo corneano foi menor que 1,0 D em 971 olhos (56,9%), 1,0-1,99 D em 496 olhos (29,1%), 2,0-2,99 D em 157 olhos (9,2%) e mais de 3,0 D em 83 olhos (4,9%). A média do astigmatismo corneano foi de 0,92 ± (SD) 0,96 D (intervalo 0-10,25 D). Conclusão: Mais de 40% dos pacientes estudados submetidos à cirurgia de catarata incluídos neste estudo tinham mais de 1,0 D de astigmatismo corneano e podem se beneficiar do uso de lentes intraoculares tóricas. Esses dados podem ser úteis no planejar a disponibilização dessa tecnologia para os pacientes.

Effect of 16-week blood flow restriction exercise on functional fitness in sarcopenic women: a randomized controlled trial / Efecto del ejercicio de restricción del flujo sanguíneo de 16 semanas sobre la aptitud funcional en mujeres sarcopénicas: un ensayo controlado aleatorio

SUMMARY: We investigated the effect of the intervention using the BFR method on functional capacity after 16 weeks in elderly women. In a controlled clinical trial, 23 women were randomly allocated into two groups, low-intensity exercise with blood flow restriction (LI + BFR, N = 11, Age: 69.40 ± 5.73) and control group (CG, N = 12, Age: 69.00 ± 6.39). The LI + BFR group had a volume of 75 repetitions at 20-30 % of 1RM and 3-4 sets per exercise (30, 15, 15 and repetitions with 30" rest between sets). The CG did not undergo any type of exercise. Functional capacity, anthropometry and sarcopenia were verified through a battery of tests before and after 16 weeks. The LI + BFR group had significant improvement in performance in Handgrip strength, Chair Stand, Arm curl, 2.44 Up-and-Go and 6 min walk, Sit-andreach and Back Scratch (p<0.05) after the intervention. The elderly women were still classified as sarcopenic, despite the improvement in the Muscle Mass Index (p<0.01). CG did not present significant changes. The BFR method can be an effective in the intervention process using physical exercise as an auxiliary strategy in the control of sarcopenia, providing a physical profile during the aging process.

RESUMEN: Investigamos en mujeres ancianas el efecto de la intervención utilizando el método de restricción del flujo sanguíneo en la capacidad funcional, después de 16 semanas. En un ensayo clínico controlado, 23 mujeres fueron asignadas aleatoriamente en dos grupos; ejercicio de baja intensidad con restricción de flujo sanguíneo (BI + RFS, N = 11, edad: 69,40 ± 5,73) y grupo control (GC, N = 12, Edad: 69,00 ± 6,39). El grupo BI + RFS tuvo un volumen de 75 repeticiones al 20-30 % de 1RM y 3-4 series por ejercicio (30, 15, 15 y repeticiones con 30 " de descanso entre series). El GC no fue sometido a ningún tipo de ejercicio. La capacidad funcional, la antropometría y la sarcopenia se verificaron mediante una batería de pruebas antes y después de 16 semanas. El grupo BI + RFS tuvo una mejora significativa en el rendimiento de la fuerza de la empuñadura, soporte de la silla, curvatura del brazo, 2,44 up-and-go y 6 min, 'sit-and-reach' 'Back Scratch' (p<0,05) después de la intervención. Las mujeres de edad avanzada seguían clasificadas como sarcopénicas, a pesar de la mejora en el índice de masa muscular (p<0,01). El GC no presentó cambios significativos. El método de restricción del flujo sanguíneo puede ser efectivo en el proceso de intervención utilizando ejercicio físico como estrategia auxiliar en el control de la sarcopenia, proporcionando un perfil físico durante el proceso de envejecimiento.

Assessment of eye drop instillation technique in glaucoma patients / Técnica de instilação de colírio em pacientes com glaucoma

ABSTRACT Purpose: To study the technique of eye drop instillation in glaucoma patients and identify independent factors that may influence their performance. Methods: In this cross-sectional study, 71 consecutive patients with glaucoma or ocular hypertension, self-administering topical anti-glaucoma medications for ≥6 months were evaluated. All patients instilled a tear substitute into the eye with the worst eyesight using the technique normally used at home. The following parameters were evaluated: age, number of years receiving treatment with ocular hypotensive eye drops, time spent to instill the first drop, number of drops instilled, correct location of the eye drops, contact of the bottle with the eye, closing of the eyelids or occlusion of the tear punctum, and asepsis of the hands. Results: The mean age of the patients was 66 ± 10.8 years, and patients were on ocular hypotensive drugs for 11.3 ± 7.3 (range, 2-35) years. Only 28% of the patients were able to correctly instill the eye drops (squeeze out 1 drop and instill it into the conjunctival sac without bottle tip contact). Touching the tip of the bottle to the globe or periocular tissue occurred in 62% of the patients. In 49% of the patients, the eye drops fell on the eyelids or cheek. Two or more drops were squeezed by 27% of the patients. Conclusions: The majority of glaucoma patients were unable to correctly instill eye drops. Age was an independent factor associated with eye drop instillation performance.

RESUMO Objetivo: Avaliar a técnica de instilação de colírio em portadores de glaucoma e identificar fatores independentes que pode influenciar o desempenho. Métodos: Neste estudo transversal 71 pacientes consecutivos com glaucoma ou hipertensão ocular que auto instilam seus colírios há pelo menos 6 meses, foram avaliados. Todos os pacientes instilaram um colírio lubrificante no olho de pior visão utilizando a mesma técnica de instilação de colírio que utilizam rotineiramente em casa. Foram avaliados parâmetros como: idade, número de anos em tratamento com colírios hipotensores oculares, tempo gasto para instilação da primeira gota, número de gotas instiladas, localização correta do colírio, contato do frasco com o olho, fechamento de pálpebras ou oclusão do ponto lacrimal e assepsia das mãos. Resultados: A idade média dos pacientes foi de 66 ± 10,8 anos. Os pacientes esta vam em tratamento com colírios hipotensores oculares por, em média, 11,3 ± 7,3 anos (variando de 2 a 35 anos). Apenas 28% dos pacientes foram capazes de instilar corretamente o colírio (instilação de 1 gota em saco conjuntival sem contato com a ponta do frasco). Contato da ponta do frasco com o olho ou tecido periocular ocorreu em 62% dos pacientes. Em 49% dos casos, o colírio caiu nas pálpebras ou fora do saco lacrimal na primeira tentativa. Duas ou mais gotas foram instiladas por 27% dos pacientes. Conclusão: A maioria dos pacientes com glaucoma é incapaz de instilar o colírio corretamente. A idade é um fator independente que influencia o desempenho da instilação de colírio.

Sinais e sintomas de doença da superfície ocular em usuários de hipotensores oculares tópicos / Signs and symptoms of ocular surface disease in patients on topical intraocular pressure-lowering therapy

OBJETIVO: determinar a prevalência de sinais e sintomas de doença da superfície ocular (OSD) em pacientes em uso crônico de hipotensores oculares tópicos. MÉTODOS: Neste estudo transversal, foram recrutados 40 pacientes consecutivos, provenientes do ambulatório de glaucoma de um hospital público localizado no Rio de Janeiro, Brasil. Os mesmos deveriam apresentar: idade maior ou igual a 18 anos, diagnóstico de hipertensão ocular ou glaucoma primário de ângulo aberto e deveriam estar em uso da mesma terapia hipotensora ocular há pelo menos seis meses. Foram considerados: sexo, idade, medicação utilizada e duração do tratamento. Todos os pacientes foram submetidos à avaliação da superfície ocular que incluiu: entrevista por meio do questionário Ocular Surface Disease Index® (OSDI®), tempo de rotura do filme lacrimal, biomicroscopia, avaliação da superfície ocular com fluoresceína e com rosa Bengala. RESULTADOS: A média de pontuação do OSDI® foi 24,6 ± 20,7. A maioria dos pacientes (67,5%) apresentou uma pontuação anormal no questionário do OSDI®. Em 25% dos pacientes, a pontuação foi compatível com sintomas leves, em 12,5% com sintomas moderados e em 30% com sintomas graves. Blefarite e ceratite ponteada foram diagnosticadas em 42,5% e 20% dos pacientes respectivamente. Instabilidade do filme lacrimal foi observada em 75% dos pacientes, enquanto que alteração da superfície ocular foi evidenciada pelo teste de rosa bengala em 35% dos pacientes. Foi encontrada correlação positiva (r=0,4) estatisticamente significativa (p=0,01) entre a pontuação do OSDI® e o tempo de duração do tratamento com hipotensores oculares tópicos. CONCLUSÃO: Pacientes em uso crônico de hipotensores oculares tópicos apresentam alta prevalência de sinais e sintomas de OSD. Existe correlação significativa entre a duração do tratamento e a gravidade dos sintomas de OSD.

PURPOSE: To determine the prevalence of signs and symptoms of ocular surface disease (OSD) in patients using topical intraocular pressure-lowering therapy. METHODS: In this cross-sectional study, 40 patients were consecutively recruited from the glaucoma clinic of a public hospital located in Rio de Janeiro, Brazil. Eligible patients were 18 years of age or older, with primary open-angle glaucoma or ocular hypertension and on the same topical ocular therapy for at least 6 months. The following data were considered: sex, age, medication history and number of years on topical intraocular pressure-lowering therapy. All patients underwent an evaluation of the ocular surface which included: an interview using the Ocular Surface Disease Index® (OSDI®) questionnaire, break-up time, biomicroscopy, fluorescein corneal staining and rose Bengal ocular surface staining. RESULTS: The mean OSDI® score was 24.6 ± 20.7. Most patients (67.5%) had an abnormal score on the OSDI® questionnaire. In 25% of patients, the score was consistent with mild symptoms, 12.5% ​​with moderate symptoms and 30% with severe symptoms. Blepharitis and punctate keratitis were diagnosed in 42.5% and 20% of patients respectively. Tear film instability was observed in 75% of patients and ocular surface staining with rose Bengal in 35%. A positive statistically significant correlation (r=0.4; p=0.01) was found between OSDI® scores and the duration of topical intraocular pressure-lowering therapy. CONCLUSION: Patients with primary open-angle glaucoma or ocular hypertension on topical intraocular pressure-lowering therapy have high prevalence of OSD. Longer duration since diagnosis is significantly correlated with worsening of OSD symptoms.

Prevalence of eye disease in Brazilian patients with psoriatic arthritis

OBJECTIVES: The aim of this study was to report the type and frequency of ocular manifestations in Brazilian psoriatic arthritis patients. METHODS: We conducted a cross-sectional study in a Brazilian tertiary hospital. The test group included 40 patients who had psoriatic arthritis according to the Classification Criteria for Psoriatic Arthritis. A control group of 40 individuals was matched for age and gender. All of the patients underwent ophthalmic evaluation, which included best-corrected visual acuity, slit lamp and fundus examinations, and dry eye diagnostic tests (Schirmer I, tear breakup time and rose bengal). Demographic parameters were also evaluated. RESULTS: The mean age of the patients was 53.9±13.1 years; the mean disease duration was 8±10.5 years. Most of the patients were women (60%), and the majority had polyarticular disease (57.5%). Several ocular abnormalities were found, including punctate keratitis, pinguecula, blepharitis, pterygium, cataract, glaucoma, uveitis, and retinal microvascular abnormalities. There were no significant differences in the rates of these abnormalities compared with the control group, however. The Keratoconjunctivitis sicca and dry eye diagnostic tests were more often positive in the patients with psoriatic arthritis than in the control group. CONCLUSIONS: In this study, keratoconjunctivitis sicca was the most common ocular finding related to psoriatic arthritis. Therefore, we recommend early ophthalmologic evaluations for all psoriatic arthritis patients who complain of eye symptoms.

Metallo-β-lactamase and genetic diversity of Pseudomonas aeruginosa in intensive care units in Campo Grande, MS, Brazil

Infection by Pseudomonas aeruginosa has spread worldwide, with limited options for treatment. The purpose of this study was to investigate metallo-β-lactamase-producing P. aeruginosa strains and compare their genetic profile using samples collected from patients in intensive care units. Forty P. aeruginosa strains were isolated from two public hospitals in Campo Grande, Mato Grosso do Sul State, from January 1st, 2007 to June 31st, 2008. Profiles of antimicrobial susceptibility were determined using the agar diffusion method. Metallo-β-lactamase was investigated using the double-disk diffusion test and PCR. Molecular typing was performed by pulsed-field gel electrophoresis (PFGE). Respiratory and urinary tracts were the most common isolation sites. Of the 40 samples tested, 72.5 percent (29/40) were resistant to ceftazidime and 92.5 percent (37/40) to imipenem, whereas 65 percent (26/40) were resistant to both antimicrobials. Fifteen pan-resistant samples were found. Five percent (2/40) of samples were positive for metallo-β-lactamase on the phenotype test. No metallo-β-lactamase subtype was detected by PCR. Macrorestriction analysis revealed 14 distinct genetic patterns. Based on the superior accuracy of PCR, it can be inferred that P. aeruginosa isolates from the investigated hospitals have alternative mechanisms of carbapenem resistance. The results also suggest clonal spread of P. aeruginosa between the studied hospitals.

Ocular findings in patients with systemic sclerosis

OBJECTIVE: To evaluate the frequency and characteristics of ocular manifestations in outpatients with systemic sclerosis. METHODS: In this cross-sectional study, 45 patients with systemic sclerosis were enrolled. Data regarding demographics, disease duration and subtype, age at diagnosis, nailfold capillaroscopic pattern and autoantibody profile were collected, and a full ophthalmic examination was conducted. Parametric (Student's t-test) and nonparametric (Mann-Whitney U test) tests were used to compare continuous variables. Fisher's exact test was used to compare categorical data. P values < 0.05 were considered significant. RESULTS: Twenty-three subjects (51.1 percent) had eyelid skin changes; 22 (48.9 percent) had keratoconjunctivitis sicca, 19 (42.2 percent) had cataracts, 13 (28.9 percent) had retinal microvascular abnormalities and 6 (13.3 percent) had glaucoma. Eyelid skin changes were more frequent in patients with the diffuse subtype of systemic sclerosis and were associated with a younger age and an earlier age at diagnosis. Cataracts were presumed to be age-related and secondary to corticosteroid treatment. There was no association between demographic, clinical or serological data and keratoconjunctivitis sicca. The retinal microvascular abnormalities were indistinguishable from those related to systemic hypertension and were associated with an older age and a severe capillaroscopic pattern. CONCLUSIONS: Eyelid skin abnormalities and keratoconjunctivitis sicca were the most common ocular findings related to systemic sclerosis. Some demographic and clinical data were associated with some ophthalmic features and not with others, showing that the ocular manifestations of systemic sclerosis are characterized by heterogeneity and reflect the differences in the implicated pathophysiological mechanisms.

Wavefront analysis and modulation transfer function of three multifocal intraocular lenses.

Purpose: To evaluate wavefront performance and modulation transfer function (MTF) in the human eye after the implantation of diffractive or refractive multifocal intraocular lenses (IOLs). Materials and Methods: This was a prospective, interventional, comparative, nonrandomized clinical study. Uncorrected distance and near visual acuity, and wavefront analysis including MTF curves (iTrace aberrometer, Tracey Technologies, Houston, TX, USA) were measured in 60 patients after bilateral IOL implantation with 6 months of follow-up. Forty eyes received the diffractive ReSTOR (Alcon), 40 eyes received the refractive ReZoom (Advanced Medical Optics) and 40 eyes, the Tecnis ZM900 (Advanced Medical Optics). The comparison of MTF and aberration between the intraocular lenses was performed using analysis of variance (ANOVA), followed by the Dunn test when necessary. Results: The mean uncorrected distance visual acuity was similar in all three groups of multifocal IOLs. The ReSTOR group provided better uncorrected near visual acuity than the ReZoom group (P < 0.001), but similar to the Tecnis group. Spherical aberration was significantly higher in the ReZoom group (P = 0.007). Similar MTF curves were found for the aspheric multifocal IOL Tecnis and the spheric multifocal IOL ReSTOR, and both performed better than the multifocal IOL ReZoom in a 5 mm pupil (P < 0.001 at all spatial frequencies). Conclusions: Diffractive IOLs studied presented similar MTF curves for a 5 mm pupil diameter. Both diffractive IOLs showed similar spherical aberration, which was significantly better with the full-diffractive IOL Tecnis than with the refractive IOL ReZoom.

Perfil do paciente com ceratopatia bolhosa pós-facectomia atendidos em hospital público / Profile of patient with aphakic/pseudopfakic bullous keratopaty attended at public hospital

Objetivo: Identificar e analisar criticamente o perfil dos pacientes com ceratopatia bolhosa atendidos em um hospital municipal. Métodos: Foi realizada análise retrospectiva de 35 olhos de 35 pacientes em acompanhamento no setor de córnea e doenças externas do Hospital da Piedade, que apresentavam ceratopatia bolhosa pós-facectomia. Foram excluídos aqueles onde não se conseguiu determinar características pré e per-operatórias fundamentais em nossa pesquisa. Esta seleção de pacientes foi realizada durante o período de janeiro de 2007 a junho de 2007. Resultados: Como principais resultados observou-se que a ceratopatia bolhosa ocorreu em 22.86% (8 olhos) dos casos pós-facectomia extracapsular (FEC) e 74.28% (26 olhos) pós- facoemulsificação. Em 25.71% (9 olhos) foi documentado rotura de cápsula posterior (RCP) com perda vítrea. Em 94.29% (33 olhos) a lente intraocular se localizava na câmara posterior, e dois pacientes estavam afácicos. A acuidade visual de todos os pacientes era pior que 20/200. O tempo médio de evolução entre a facectomia e o diagnostico de ceratopatia bolhosa foi 11,93 meses (1 - 44 meses). Conclusão: A análise adequada do endotélio corneano é condição essencial para o sucesso da cirurgia de catarata com transparência corneal, e que a ceratopatia bolhosa parece estar mais associada à facoemulsificação. Esta informação deve ser interpretada com cautela, já que esta relação pode vir do maior numero de facoemulsificações realizadas no Hospital onde foi realizado o estudo e muitas destas por cirurgiões em treinamento.

Objective: Analyze and identify critically the profile of patients with aphakic/pseudophakic bullous keratopathy attended at a public hospital. Methods: Retrospective analysis of 35 eyes of 35 patients with diagnosis of bullous keratopathy, which has been followed in the department of cornea and external diseases of Hospital da Piedade. The one whose pre and per operative data we did not find were excluded. This selection of patients was done from January to June of 2007. Results: As main results we found that bullous keratopathy occurred in 22.86% (8 eyes) of cases after extracapsular phakectomy and 74.28% (26 eyes) after phacoemulsification. Rupture of posterior capsule and vitreous loss was documented in 25.71% (9 eyes). In 94.29% (33eyes) the intraocular lenses was in posterior chamber, and two patients were aphakic. The visual acuity of all patients was worse than 20/200. The mean time from phakectomy to diagnosis of bullous keratopathy was 11.93 months (1-44 months). Conclusion: Adequate analysis of corneal endothelium is an essential condition to obtain success of cataract surgery with corneal transparency, and bullous keratopathy seems to be more related to phacoemulsification. That should be read with caution since this relation may occur because of the higher number of phacoemulsifications that are practiced in that Hospital where the study was conducted and many of them was performed by training surgeons.

Facectomia na infância: quem são nossos pacientes? / Phakectomy in childhood: who are our patients?

OBJETIVO: Analisar o perfil dos pacientes até 10 anos de idade, submetidos à facectomia no setor de catarata do Hospital da Piedade, determinando as principais indicações, perfil sócioeconômico e características pré-natais nos casos relevantes. MÉTODOS: Foram analisados retrospectivamente, os dados de 60 pacientes com até 10 anos de idade, submetidos à lensectomia, dentro do período de janeiro de 2006 a dezembro de 2007. Todas as cirurgias foram realizadas no setor de catarata do Hospital da Piedade, pelo mesmo cirurgião. Os responsáveis pelas crianças foram submetidos a questionário. RESULTADOS: Dos 60 pacientes, 25 eram do sexo feminino (42 por cento) e 35 do sexo masculino (58 por cento). 42 pacientes (70 por cento) apresentavam o diagnóstico de catarata congênita, 8 (13 por cento) tinham subluxação de cristalino e 10 (17 por cento) foram submetidos à lensectomia devido à baixa da acuidade visual associada à catarata traumática. Entre as mães dos pacientes com catarata congênita, 40 (95 por cento) realizaram pré natal com mais de 5 consultas, destas 9 mães (22,5 por cento) foram infectadas pelo vírus da rubéola durante a gestação. Nos casos referentes à subluxação todos os 8 apresentavam síndrome de Marfan. Os 10 casos de trauma foram em meninos. CONCLUSÕES: Foi possível verificar que a grande maioria de nossos pacientes submetidos à facectomia apresentava catarata congênita e um número relevante dos casos encontrava-se ainda relacionado à rubéola. É fundamental diminuir o tempo entre a suspeita diagnóstica e o atendimento especializado, favorecendo o prognóstico visual dessas crianças.

OBJECTIVE: To analyze the profile of the patients who were submitted to phakectomy at the cataract service of the Hospital da Piedade, under the age of 10 years old, evaluating the main indications, the socioeconomic and gestational profiles in the relevant cases. METHODS: Data of 60 patients under the age of 10 years old submitted to lensectomy, were retrospectively analyzed, during the period between January of 2006 and December of 2007. All the surgeries were performed at the cataract service of the Hospital da Piedade, by the same surgeon. RESULTS: Of the 60 patients, 25 were female (42 percent) and 35 were male (58 percent). 42 patients (70 percent) had the diagnostic of congenital cataract, 8 (13 percent) had subluxated lens and 10 (17 percent) had lensectomy for traumatic cataract. Considering congenital cataract patient's mothers, 40 (95 percent) underwent prenatal exams with more than 5 appointments, 9 (22.5 percent) of them were infected by rubella virus during the pregnancy. In subluxation cases, 8 had Marfan's syndrome. 10 cases of trauma occurred in boys. CONCLUSION: It was possible to verify that the majority of our patients submitted to phakectomy had congenital cataract and there is an important number of cases that still associated to rubella. Decreasing time since the suspect until the specialized consultation, will improve the visual prognosis of the children.

Tendências evolutivas dos cirurgiões de catarata presentes no IV Congresso Brasileiro de Catarata e Cirurgia Refrativa / Evolutionary trends of cataract surgeons who attended the IV Brazilian Congress of Cataract and Refractive Surgery

OBJETIVO:Dar continuidade ao processo de atualização e aperfeiçoamento da cirurgia de catarata no Brasil, além de obter dados para uma análise comparativa das atuais tendências cirúrgicas nacionais e internacionais. MÉTODOS:Em maio de 2007, foram obtidos dados de 188 participantes de um congresso de Catarata e Cirurgia Refrativa através questionários autoaplicáveis, contendo perguntas objetivas a respeito da cirurgia de catarata. Análise estatística foi feita através teste T e Qui-quadrado. RESULTADOS: Observou-se que 95,8 por cento dos participantes praticam a facoemulsificação, enquanto somente 4,2 por cento preferem usar a técnica extracapsular convencional. Para 73,4 por cento dos participantes, o bloqueio peribulbar é preferido em relação ao uso de anestésico tópico (20,2 por cento). A técnica de facoemulsificação mais realizada é a de dividir e conquistar (32,0 por cento). A hidroximetilcelulose foi o viscoelástico de escolha para 60,8 por cento dos colaboradores. O aparelho de facoemulsificação mais usado pelos participantes foi o Infiniti® (24,0 por cento), seguido pelo Legacy® (19,8 por cento). CONCLUSÃO:Os resultados deste estudo foram consistentes com o que era esperado, tendo como base pesquisas semelhantes. Destaca-se um aumento considerável do número cirurgiões adeptos à facoemulsificação e tendências no sentido de maior utilização de incisões corneanas temporais e anestesia tópica.

Purpose: To continue the updating and improving process of the cataract surgery in Brazil, through recently pulled out and documented registries. In addition, we want to obtain data for a comparative analysis of the current national and international surgical trends. METHODS:In May 2007, data were obtained from 188 participants of a Congress of Cataract and Refrative Surgery who answered simple and multiple-response questions about cataract surgery. Data were analyzed by statistic means of Chi-square test and T test. RESULTS:95.8 percent of respondents practice phacoemulsification, while only 4.2 percent perform the conventional planned extracapsular cataract extraction. For 73.4 percent of respondents, the periocular block is preferred instead of topical anesthesia (20.2 percent). The most practiced phacoemulsification technique is the 4-section divide and conquer (32.0 percent). The hidroximetilcelulosis is the ophthalmic viscosurgical device chosen by 60.8 percent of respondents. The most used phaco machine is Infiniti® (24.0 percent), followed by Legacy® (19.8 percent). CONCLUSION: According to this paper is possible to suggest a tendency to high the surgeons who practice clear corneal incision and topical anesthesia. Besides that it was possible to suggest that in ten years the phacoemulsification seems to be consolidated as the surgeons's procedure of choice.

A contralateral eye study comparing apodized diffrative and full diffrative lenses: wavefront analysis and distance and near uncorrected visual acuity

PURPOSE: To evaluate intraindividual visual acuity, wavefront errors and modulation transfer functions in patients implanted with two diffractive multifocal intraocular lenses. METHODS: This prospective study examined 40 eyes of 20 cataract patients who underwent phacoemulsification and implantation of a spherical multifocal ReSTOR intraocular lens in one eye and an aspheric Tecnis ZM900 multifocal intraocular lens in the other eye. The main outcome measures, over a 3-month follow-up period, were the uncorrected photopic distance and near visual acuity and the defocus curve. The visual acuity was converted to logMAR for statistical analysis and is presented in decimal scale. The wavefront error and modulation transfer function were also evaluated in both groups. RESULTS: At the 3-month postoperative visit, the mean photopic distance uncorrected visual acuity (UCVA) was 0.74 ± 0.20 in the ReSTOR group and 0.76 ± 0.22 in the Tecnis group (p=0.286). The mean near UCVA was 0.96 ± 0.10 in the ReSTOR group and 0.93 ± 0.14 in the Tecnis group (p=0.963). The binocular defocus curve showed measurements between the peaks better than 0.2 logMAR. The total aberration, higher-order aberration and coma aberration were not significantly different between the groups. The spherical aberration was significantly lower in the Tecnis group than in the ReSTOR group. (p=0.004). Both groups performed similarly for the modulation transfer function. CONCLUSION: The ReSTOR SN60D3 and Tecnis ZM 900 intraocular lenses provided similar photopic visual acuity at distance and near. The diffractive intraocular lenses studied provided a low value of coma and spherical aberrations, with the Tecnis intraocular lens having a statistically lower spherical aberration compared to the ReSTOR intraocular lens. In the 5 mm pupil diameter analyses, both intraocular lens groups showed similar modulation transfer functions.

Contribuição da tomografia de coerência óptica de 820 nm na distrofia granular corneana: relato de caso / Contribution of 820 nm optical coherence tomography in granular corneal dystrophy: case report

O objetivo deste trabalho é correlacionar os dados clínicos de um caso de distrofia granular com o exame de tomografia de coerência óptica (OCT) de 820 nm de modo a determinar o nível intra-estromal dos depósitos corneanos. É relatado um caso de distrofia granular em paciente de 38 anos do sexo masculino. Foi realizado exame oftalmológico completo e OCT para documentação do caso. O aparelho utilizado foi o Stratus OCT III, originalmente desenvolvido para avaliação do segmento posterior. A acuidade visual corrigida foi de 20/50 em ambos os olhos. À biomicroscopia, foram observadas opacidades em "floco de neve" em diferentes níveis do estroma corneano bilateral e de forma simétrica. A avaliação pelo OCT revelou múltiplos pontos hiperreflectivos nas camadas superficiais e profundas do estroma. Foi possível acessar a anatomia morfológica da córnea através de cortes seriados realizados pelo Stratus OCT III e confirmar a profundidade dos depósitos corneanos.

The purpose of this case report is to correlate clinical features of granular dystrophy using 820 nm optical coherence tomography (OCT) in order to determine the depth of intrastromal corneal deposits. We report a case of a 38-year-old man with granular dystrophy. After complete ophthalmologic examination the patient was submitted to OCT, using the Stratus OCT III, originally proposed for studying disorders of the posterior segment. Best-corrected visual acuity was 20/50 in both eyes. Biomicroscopy revealed bilateral "snowflake"opacities in different levels of the stromal layer. OCT disclosed multiple hiperreflective dots in anterior and deeper stromal layers. It was possible to assess the morphology of the cornea and to determine the depth of the corneal deposits with serial cross-sectional OCT scans using the Stratus OCT III.

Perfil socioeconômico e epidemiológico dos pacientes submetidos à cirurgia de catarata em um hospital universitário / Socioeconomic and epidemiologic profile of patients submitted to cataract surgery at a university hospital

OBJETIVO: Determinar as características sócioeconômicas dos pacientes operados de catarata em hospital universitário, avaliar o acesso à unidade terciária e determinar o tempo de espera até o tratamento cirúrgico. MÉTODOS: Estudo transversal, realizado através da revisão de prontuários de 148 pacientes operados de catarata escolhidos aleatoriamente durante o primeiro semestre de 2007. RESULTADOS: Os pacientes apresentaram idade mediana de 70,5 anos, com maior prevalência de mulheres (60,1 por cento), da raça branca (48,0 por cento), com baixo grau de instrução (ensino fundamental incompleto, 50,7 por cento), acuidade visual igual ou pior a 20/200 (57,4 por cento) e diagnóstico realizado em consulta regular no hospital universitário (47,8 por cento). Apenas 9,4 por cento dos pacientes operados foram diagnosticados na campanha de catarata. O tempo médio entre o diagnóstico e a cirurgia foi 3,5 meses e relacionou-se principalmente à realização dos exames oftalmológicos e clínicos pré-operatórios. CONCLUSÃO: Os pacientes com baixa renda familiar são os principais usuários do Sistema Único de Saúde (SUS) e o acesso ao tratamento cirúrgico é demorado, resultando em visão subnormal incapacitante. Ressalta-se a importância da campanha de catarata no ingresso de pacientes carentes ao hospital de alta complexidade.

PURPOSE: To determine the socio-economic characteristics of the patients who were submitted to cataract surgery in a university hospital, to evaluate the accessibility to the tertiary health service and to determine the waiting time for cataract surgery. METHODS: A cross-sectional study of medical charts from 148 random patients who underwent cataract surgery during the first semester of 2007. RESULTS: The patients in this study had median of age of 70.5 years, and the major prevalence was of female (60.1 percent), caucasian (48.0 percent), with low educational level (incomplete fundamental study, 50.7 percent), best corrected visual acuity 20/200 or worst; the diagnosis of cataract was done at the University Hospital in a routine appointment (47.8 percent). Only 9.4 percent of patients submitted to the surgery had his diagnosis done in a cataract campaign. The average time between the diagnosis and the surgery was 3.5 months and the delay was mainly due to pre operative exams. CONCLUSION: The majority of patients in the Brazilian Public Health System have low family income. The system takes a long time to access surgical procedures that need to be addressed in a proper time manner. The result of the long wait is subnormal vision. It is important to highlight the cataract campaign in order to enroll patients with low income in a hospital of high complexity.