Lipid Subhyaloid Maculopathy and Exposure to High Altitude.

BACKGROUND: High altitude retinopathy (HAR) includes a number of diseases related to high altitude such as acute mountain sickness (AMS), high altitude pulmonary edema (HAPE) and high altitude cerebral edema (HACE). High altitude retinopathy is mainly characterized by retinal hemorrhages, usually sparing the macular region, a condition specifically known as high altitude retinal hemorrhages (HARH). The pathogenesis of HARH is unclear. Many studies show that lack of oxygen causes an inadequate autoregulation of retinal circulation, causing vascular incompetence. Other retinal changes described in HAR have been reported, such as optical disk edema, optic disc hyperemia, cotton wool exudates, venous occlusions, and macular edema. CASE REPORT: In this paper we present a case of an aviator who developed a unilateral maculopathy through subhyaloid lipid accumulation on a climb to the top of Mt. Everest. The clinical findings are suggestive of an apparent case of temporary altitude-induced visual disruption maybe by the same presumable pathogenesis of HARH. Right eye visual loss was perceived at 5150 m when he was trying to take a photograph 40 d into the expedition. DISCUSSION: The maculopathy developed by this patient adds to the discussion on the pathogenesis of HARH, especially the aspect of this maculopathy and its complete resolution. It seems that autoregulation failure could lead to exudation and lipid deposits in the foveal area. Although macular damage is not a common signal in HARH, checking visual acuity during high altitude expeditions remains an important procedure to avoid late diagnosis as unilateral blindness may not be detected early. Rosas Petrocinio R, Gomes ED. Lipid subhyaloid maculopathy and exposure to high altitude. Aerosp Med Hum Perform. 2016; 87(10):898-900.

Perfil da microbiota conjuntival em pacientes HIV positivos / Profile of conjunctival microbiota in HIV positive patients

Objetivos: Determinar o perfil da microbiota conjuntival bacteriana e fúngica dos pacientes HIV positivos do Hospital Universitário Gaffrée e Guinle (HUGG). Métodos: Foram coletadas amostras de 45 pacientes HIV positivos, sem queixas oculares, de ambos os sexos, com idade mínima de 18 anos. Foram colhidas 2 (duas) amostras desecreções conjuntivais de cada olho, que foram submetidos à cultura e coloração pelo método de Gram. Os olhos foram anestesiados com colírio anestésico (cloridrato de proximetacaína 0.5%). O material foi semeado nos meios ágar sangue, ágar chocolate, ágar Sabouraud dextrose e caldo tioglicolato com indicador. Quanto à identificação dos microorganismos isolados foi utilizado o sistema de automação Vitek (BioMérieux), seguindo as orientações do fabricante. Resultados: Dos 90 olhos estudados, 69% apresentaram culturas positivas em pelo menos um dos meios utilizados. Dez pacientes apresentaram culturas negativas nos 2 olhos e 10 tiveram mais de 1 microorganismoisolado em um ou ambos os olhos. A bactéria isolada com mais frequência foi o Staphylococcus epidermidis. Em ordem decrescente de frequência, observou-se o crescimento de outros tipos deSCN, Staphylococcus aureus,Serratia marcescens ,Streptococcus haemoliticus (grupo viridans), Corynebacterium xerosis, Bacillus spp, Aspergillus spp,Pseudomonas aeruginosa e Penicillium spp. Conclusão: Os microorganismos isolados na conjuntiva de pacientes HIV positivos são em geral os mesmos encontrados na microbiota normal dos indivíduos imunocompetentes, com exceção do Bacillus spp e Aspergillus spp, que podem fazer parte da microbiota transitiva desses pacientes.

Objectives: To detect the profile of conjunctival bacterial and fungical of HIV positive patients of the GaffréeGuinle University Hospital (HUGG), University of Rio de Janeiro (UNIRIO). Methods: Samples were collectedfrom 45 HIVpositive patients of both genders, with a minimum age of 18 years and without ocular complaints.Swabs from each eye were taken and microbiologically investigated with Gram stain and culture. The sampleswere inoculated onto blood agar, chocolate agar, Sabouraud dextrose agar and tioglicolate broth.Topicalanesthetic was used (proparacaine hydrochloride 0,5 %). In relation to the identification of the isolated microorganisms, Vitek system of automation (BioMérieux) was used, following the orientations of themanufacturer. Results: Of the 90 studied eyes, 69% had positive cultures in, at least, one of the used ways. Ten patients had presented negative cultures in both eyes and, ten had more than one isolated microorganism in one or of both eyes. The most frequently isolated bacteria was Staphylococcus epidermidis. It was also observed, in decreasing order of frequency, the growth of other kinds of coagulase-negative staphylococci, Staphylococcus aureus, Serratia marcescens, Streptococcus a haemoliticus (group viridans), Corynebacterium xerosis, Bacillus spp , Aspergillus sp, Pseudomonas aeruginosas, and Penicillium spp. Conclusion: Isolated microorganisms are part of the normalconjunctival microbiota, excepted by the Bacillus spp and Aspergilus spp, those may be part of transitory microbiota of these patients.