Radiotherapy resources in Brazil (RT2030): a comprehensive analysis and projections for 2030.

BACKGROUND: The demand for radiotherapy in Brazil is unfulfilled, and the scarcity of data on the national network hampers the development of effective policies. We aimed to evaluate the current situation, estimate demands and requirements, and provide an action plan to ensure access to radiotherapy for those in need by 2030. METHODS: The Brazilian Society for Radiation Oncology created a task force (RT2030) including physicians, medical physicists, policy makers, patient advocates, and suppliers, all of whom were major stakeholders involved in Brazilian radiotherapy care. The group was further divided into seven working groups to address themes associated with radiotherapy care in Brazil. From March 1, 2019, to Aug 3, 2020, there were monthly meetings between the group's leaders and the Central Committee and six general meetings. First, a comprehensive search of all different national databases was done to identify all radiotherapy centres. Questionnaires evaluating radiotherapy infrastructure and human resources and assing the availability, distribution, capacity, and workload of resources were created and sent to the radioprotection supervisor of each centre. Results were analysed nationally and across the country's regions and health-care systems. A pre-planned review of available databases was done to gather data on active radiation oncology centres and the distribution of radiotherapy machines (linear accelerators [LINACs]) across Brazil. We used national population and cancer incidence projections, recommended radiotherapy usage from the medical literature, and national working patterns to project radiotherapy demands in 2030. An action plan was established with suggestions to address the gaps and meet the demands. FINDINGS: The database search yielded 279 centres with an active radiotherapy registry. After applying predefined exclusion criteria, 263 centres were identified that provided external beam radiotherapy machines with or without brachytherapy. All 263 operational centres answered the questionnaires sent on Dec 9, 2019, which were then returned between Jan 1 and June 30, 2020. There were 409 therapy machines, 646 radiation oncologists, 533 physicists, and 230 989 patients undergoing radiotherapy (150 628 [65·2%] in the public health-care system and 80 937 [35·0%] in private). The mean annual occupation rate was 566 patients per treatment machine (SD 250). The number of residents per treatment machine ranged from 258 333 to 1 800 000. Technology availability varied considerably among regions and systems. In 2030, 639 994 new cancer cases are expected, which will require 332 797 radiotherapy courses. Therefore, 530 LINACs, 1079 radiation oncologists, and 1060 medical physicists will be needed. INTERPRETATION: The expected increase in cancer incidence in the coming years will probably increase the disparities in cancer care and the burden for Brazilian patients. We provide a roadmap of the current situation and the particularities of the Brazilian radiotherapy network, which can serve as a starting point for cancer policy planning to improve this scenario. FUNDING: Accuray, BRAINLAB, Elekta, IBA, ONE medical solution, SUN NUCLEAR corporation, VARIAN, and ZIGMA.

Hypofractionated radiotherapy recommendations for localized prostate cancer in Brasil.

OBJECTIVE: Several prospective randomized trials have shown that hypofractionation has the same efficacy and safety as the conventional fractionation in the treatment of localized prostate cancer. There are many benefits of hypofractionation, including a more convenient schedule for the patients and better use of resources, which is especially important in low- and middle-income countries like Brasil. Based on these data, the Brazilian Society of Radiotherapy (Sociedade Brasileira de Radioterapia) organized this consensus to guide and support the use of hypofractionated radiotherapy for localized prostate cancer in Brasil. METHODS: The relevant literature regarding moderate hypofractionation (mHypo) and ultra-hypofractionation (uHypo) was reviewed and discussed by a group of experts from public and private centers of different parts of Brasil. Several key questions concerning clinical indications, outcomes and technological requirements for hypofractionation were discussed and voted. For each question, consensus was reached if there was an agreement of at least 75% of the panel members. RESULTS: The recommendations are described in this article. CONCLUSION: This initiative will assist Brazilian radiation oncologists and medical physicists to safely treat localized prostate cancer patients with hypofractionation.

Hypofractionated radiotherapy recommendations for localized prostate cancer in Brasil

SUMMARY OBJECTIVE: Several prospective randomized trials have shown that hypofractionation has the same efficacy and safety as the conventional fractionation in the treatment of localized prostate cancer. There are many benefits of hypofractionation, including a more convenient schedule for the patients and better use of resources, which is especially important in low- and middle-income countries like Brasil. Based on these data, the Brazilian Society of Radiotherapy (Sociedade Brasileira de Radioterapia) organized this consensus to guide and support the use of hypofractionated radiotherapy for localized prostate cancer in Brasil. METHODS: The relevant literature regarding moderate hypofractionation (mHypo) and ultra-hypofractionation (uHypo) was reviewed and discussed by a group of experts from public and private centers of different parts of Brasil. Several key questions concerning clinical indications, outcomes and technological requirements for hypofractionation were discussed and voted. For each question, consensus was reached if there was an agreement of at least 75% of the panel members. RESULTS: The recommendations are described in this article. CONCLUSION: This initiative will assist Brazilian radiation oncologists and medical physicists to safely treat localized prostate cancer patients with hypofractionation.

A força assertórica dos valores sexuais / The assertive force of sexual values

A psicanálise trouxe significantes questões relacionadas à diferença sexual e às posições sexuadas ao longo de sua história. Em 1933, Freud chega à incrível conclusão de que é impossível conceder significados novos e acabados para os termos “homem” e “mulher”. E nos anos 70, Lacan aprofunda esta posição de-finindo-os como valores, valores sexuais. Esta caracterização não é óbvia, indo além do mero sentido de “possibilidades”, porque está diretamente ligada à ideia de Gottlob Frege a respeito dos valores veritativos. Portanto, o autor propõe uma discussão sobre a ideia lógica de valor em comparação à ideia lacaniana de valor sexual; e para tanto, assenta seu argumento no conceito de semblante.(AU)

Psychoanalysis has brought significant issues pertaining sexual difference and sexual positions throughout its history. In 1933, Freud comes to the astounding conclusion that it is impossible to give new and thorough meanings to the terms “man” and “woman”. And in the 70s, Lacan will further this position by defining them as values, sexual values. This characterization is not obvious, going beyond the meaning of “possibilities”, because it is directly linked to Gottlob Frege’s idea of truth value. Therefore, the author proposes a discussion about the logic idea of value in comparison to the lacanian idea of sexual value; and to do so, he bases his argument on the concept of semblant.(AU)

[Davidenkow syndrome. A rare peripheral neuropathy]. / Síndrome de Davidenkow. Una neuropatía periférica rara.

A different and rare type of atrophy with a predominant pattern in scapulo-peroneal distribution was described by Davidenkow in 1939. The syndrome was characterized by some researchers as a variant of Charcot-Marie-Tooth disease, however Davidenkow noticed that clinical and laboratorial manifestations did not corroborate exactly with this hypothesis. We describe a case of a female patient, 39 years-old, clinical picture similar to the syndrome described by Davidenkow, presenting scapulo-peroneal atrophy. Her first symptoms had appeared when she was 24, initially with proximal motor weakness in the upper limbs. This patient did not have family history of myopathy or neuropathy. Several tests were performed to exclude other syndromes that could be included in the differential diagnosis, by testing gene mutation, in addition to the physical examination and electromyography. The large spectrum of neuromuscular diseases makes difficult the diagnosis of Davidenkow's syndrome which always should be considered in the differential diagnosis.

Síndrome de Davidenkow: Una neuropatía periférica rara / Davidenkow syndrome. A rare peripheral neuropathy

En 1939 Davidenkow describió un tipo de atrofia diferente y rara con un patrón predominante en distribución escápulo-peroneal. Algunos investigadores caracterizaron el síndrome como una variante de la enfermedad de Charcot-Marie-Tooth; sin embargo, Davidenkow percibió que las manifestaciones clínicas y de laboratorio no corroboraban exactamente esta hipótesis. Describimos el caso de una mujer de 39 años, con cuadro clínico semejante al síndrome descrito por Davidenkow, presentando atrofia escápulo-peroneal. Sus primeros síntomas comenzaron cuando tenía 24 años, inicialmente con debilidad motora proximal en los miembros superiores. No tenía historia familiar de miopatía o neuropatía y se excluyeron otros síndromes que se podrían incluir entre los diagnósticos diferenciales mediante la realización de pruebas de mutación genética, además del examen físico y electromiografía. El amplio espectro de enfermedades neuromusculares a veces dificulta su diagnóstico y debe ser siempre considerado en el diagnóstico diferencial.

A different and rare type of atrophy with a predominant pattern in scapulo-peroneal distribution was described by Davidenkow in 1939. The syndrome was characterized by some researchers as a variant of Charcot-Marie-Tooth disease, however Davidenkow noticed that clinical and laboratorial manifestations did not corroborate exactly with this hypothesis. We describe a case of a female patient, 39 years-old, clinical picture similar to the syndrome described by Davidenkow, presenting scapulo-peroneal atrophy. Her first symptoms had appeared when she was 24, initially with proximal motor weakness in the upper limbs. This patient did not have family history of myopathy or neuropathy. Several tests were performed to exclude other syndromes that could be included in the differential diagnosis, by testing gene mutation, in addition to the physical examination and electromyography. The large spectrum of neuromuscular diseases makes difficult the diagnosis of Davidenkow’s syndrome which always should be considered in the differential diagnosis.

Resenha de Eu, mamãe e o espelho / Me, my mom and the mirror

Guillaume Galliene, em seu filme intitulado Les garçons et Guillaume, à table (França, 2013), reflete sobre a complicada relação que teve com sua mãe, figura que sempre tentou imitar. Ela havia determinado, como o título diz, que ele não faria parte do conjunto dos meninos. A sua aventura ao escapar dessa determinação simbólica é o motor do enredo, expresso através de uma comédia com traços pungentes e muitas cenas burlescas. O tratamento freudiano dos temas da identificação, escolha objetal e fobia mostra as marcas deixadas pela análise do autor/ator; tais referências são claras, porém não excluem o interesse que o filme desperta por seu viés peculiar e bem figurativo dessa relação primordial com o outro materno(AU)

Gullaume Galliene, in his movie Les garçons et Guillaume, à table (France, 2013), reflects on the complicated relationship he had with his mother, who he always tried to mimic. She had determined, as the title states, that he wouldn't be a part of the boys' group. His adventure in escaping this symbolic determination is what drives the plotline, expressed in a comedy with pungent traces and a lot of burlesque scenes. The freudian treatment of the subjects of identification, object choice and phobia shows the traces left from the analysis of the writer/actor; such references are obvious, but they don't exclude the interest awoken by the movie in its peculiar and quite figurative view of this primordial relation to the maternal other(AU)

Effects of botulinum toxin type A for spastic foot in post-stroke patients enrolled in a rehabilitation program.

UNLABELLED: The objective of this study was to evaluate the effects of botulinum toxin type A (BTX-A) on spastic foot in stroke patients in a rehabilitation program. METHOD: Hemiparetic stroke patients (n=21) enrolled in a rehabilitation program were divided into two groups. The first group (n=11) received a total of 300 UI BTX-A, and the second group (n=10) received 100 UI BTX-A. All patients were assessed at baseline and 2, 4, 8 and 12 weeks after injection for Modified Ashworth Score, time walking 10 meters, and the Functional Independence Measure (mFIM) motor score. RESULTS: The higher-dose group exhibited a significant improvement in spasticity, and both groups showed an improvement in time walking 10 meters and mFIM, with no significant differences between them. CONCLUSIONS: Our findings suggest that gains in gait velocity and functional independence were not correlated to BTX-A dose.

Effects of botulinum toxin type A for spastic foot in post-stroke patients enrolled in a rehabilitation program / Efeitos da toxina botulinica tipo A no pe espastico em pacientes pos-acidente vascular encefalico inseridos em programa de reabilitacao

The objective of this study was to evaluate the effects of botulinum toxin type A (BTX-A) on spastic foot in stroke patients in a rehabilitation program. Method: Hemiparetic stroke patients (n=21) enrolled in a rehabilitation program were divided into two groups. The first group (n=11) received a total of 300UI BTX-A, and the second group (n=10) received 100 UI BTX-A. All patients were assessed at baseline and 2, 4, 8 and 12 weeks after injection for Modified Ashworth Score, time walking 10 meters, and the Functional Independence Measure (mFIM) motor score. Results: The higher-dose group exhibited a significant improvement in spasticity, and both groups showed an improvement in time walking 10 meters and mFIM, with no significant differences between them. Conclusions: Our findings suggest that gains in gait velocity and functional independence were not correlated to BTX-A dose. .

O objetivo deste estudo foi avaliar os efeitos da toxina botulínica tipo A (TXB-A) sobre a espasticidade de membro inferior em pacientes pós-AVE em reabilitação. Método: 21 pacientes hemiparéticos foram divididos em dois grupos que receberam doses de TXB-A de 300UI (Grupo 1) e 100UI (Grupo 2) e foram avaliados antes da injeção e 2, 4, 8 e 12 semanas após, quanto à escala de Ashworth modificada, tempo para andar 10 metros e escore motor da Medida de Independência Funcional (MIFm). Resultados: O grupo que utilizou dose mais alta teve melhora significativa da espasticidade. Ambos os grupos tiveram melhora do tempo para andar 10 metros e da MIFm sem diferença significativa entre eles. Conclusões: A melhora da velocidade de marcha e da independência funcional não foram correlacionadas com a dose de TXB-A na amostra analisada. .

Correlações entre a densitometria do cristalino através da imagem de Scheimplufg, tempo e gasto de energia na cirurgia de facoemulsificação / Correlations between densitometry of the lens by Scheimplufg imaging, time factor and energy (power US) in phacoemulsification

OBJETIVO:Correlacionar a densitometria do cristalino(PNS - patient nuclear score)por meio da imagem de Scheimplufgcom o tempo de facoemulsificação e o gasto de energia. MÉTODOS: Estudo observacional prospectivo, envolvendo 22 olhos de 22 pacientes que se submeteram à cirurgia de catarata por facoemulsificação com implante de lente intraocular. A densitometria do cristalino (PNS) foi medida através da tomografia de segmento anterior e córnea (Pentacam) no pré-operatório com a imagem de Scheimplufg. O tempo de facoemulsificação e o gasto de energia foram verificados e anotados ao término de cada cirurgia. O teste de correlação de Pearson foi utilizado para análise estatística através do programa Bioestat 5.0. Foi considerado como estatisticamente significante p < 0,05 por cento. RESULTADOS: As correlações entre PNS x Tempo de Facoemulsificação (s) e PNS x Gasto de Energia obtiveram respectivamente um p < 0,0050 e RP (Coeficiente de Pearson) de 0,5757 e p < 0,0029 e RP (Coeficiente de Pearson) de 0,6034. CONCLUSÃO: Observamos uma forte associação entre o método objetivo de classificação da catarata através da imagem de Scheimplufg (PNS), tempo e gasto de energia. Assim há possibilidade de realizarmos um planejamento cirúrgico pré-operatório baseado em métodos objetivos da classificação da catarata, reduzindo a fluídica, energia e tempo na cirurgia de facoemulsificação.

PURPOSE: To evaluate and to correlate the PNS (patient nuclear score) and time and energy (power US) in patients priorto and following phacoemulsification with intraocular lens implantation. METHODS: This is a prospective study. Twenty two consecutive patients (22 eyes) that underwent phacoemulsification surgery and intraocular lens implantation were enrolled. Full ophthalmologic clinical assessment including Pentacam (Oculus, Pentacam) measurements were performed in all cases prior to surgery (Pre). Excluison criteria were corneal disease or scars. RESULTS: There are statistically significant difference between PNS and Time with p < 0,0050 and PNS x Energy with p < 0,0029. CONCLUSION: Preoperatively adjusting phaco parameters based on cataract grade helped improve overall efficiency by reducing the amount of energy and fluid used in the eye and reducing overall phaco time.

Ceratoplastia em crianças: indicações e resultados / Pediatric keratoplasty: indications and outcomes

OBJETIVO: Avaliar as indicações e os resultados do transplante de córnea em crianças na Fundação Altino Ventura (FAV). MÉTODOS: Foi realizado estudo retrospectivo em 33 pacientes (34 olhos), com idades igual ou inferior a 12 anos, que haviam sido submetidos a transplante penetrante de córnea entre 2000 e 2009 na FAV. A média dos tempos de seguimento pós-operatório foi de 32,5±23,2 meses (variando de 4 meses a 7 anos). Os dados analisados foram: indicação cirúrgica; acuidade visual para longe com melhor correção óptica (AVLc/c) no pré-operatório e na última consulta de seguimento, equivalente esférico refracional (EE) pós-cirurgia e complicações. Os resultados qualitativos foram expressos por suas frequências e os quantitativos por suas médias e desvios padrão. Utilizou-se o teste de t-Student para verificar possível diferença entre médias, aceitando-se o nível de significância de 95,0 por cento (p<0,05). RESULTADOS: A média das idades dos pacientes na cirurgia foi de 7,5 ± 3,3 anos (variando de 2 a 12 anos). Vinte e sete transplantes (79,4 por cento) tiveram indicação óptica e sete (20,6 por cento) tectônica ou terapêutica. A principal indicação entre os ópticos foi leucoma pós-trauma em dezoito (52,9 por cento). A acuidade visual melhorou em 21 (61,7 por cento) olhos e piorou em oito (23,5 por cento). Entre os transplantes ópticos, a rejeição esteve presente em quatro (14,8, por cento) olhos. Em quatro (11,8 por cento) olhos houve desenvolvimento de glaucoma. CONCLUSÃO: Na FAV, o leucoma pós-trauma foi a causa mais frequente de indicação do transplante de córnea em crianças, isto pode ser o resultado da baixa condição sócioeconômica e violência entre a população estudada. Uma proporção significativa de crianças cegas por problemas corneanos obteve melhora funcional da visão através do tratamento cirúrgico apropriado e bom acompanhamento no pós -operatório.

PURPOSE: To evaluate the indications and results after penetrating keratoplasty in children at Altino Ventura Foundation (FAV). METHODS: A retrospective study was performed in 33 patients (34 eyes), with ages equal or less than 12 years, they underwent a penetrating keratoplasty at FAV, from 2000 to 2009. The mean follow up time was 32.5 ± 23.1 months. Surgery indication, best corrected visual acuity (BCVA) before and after surgery, spherical equivalent (SE) pos surgical and complications were analyzed. The qualitative results were expressed by their frequencies and the quantitative by their means and standard deviations. The t-Student test was used to verify possible differences between means. The level of significance was 95.0 percent (p<0.05). RESULTS: Mean age at surgery was 7.5 ± 3.3 years. Twenty seven (79.4 percent) grafts had optical indication and seven (20.6 percent) therapeutic or tectonic. Among the optical transplants, the most frequent indication was cornea opacity after ocular trauma in 18 (52.9 percent) eyes. The visual acuity was better in 21 (61.7 percent) eyes and worse in eight (23.5 percent). In the optical transplants, rejection was present in four (14.8 percent) eyes, and four (11.8 percent) developed glaucoma. CONCLUSION: In FAV opacity after ocular trauma was the most common indication for pediatric keratoplasty. This may be the result of the low income and violent society, among the citizens from the studied population. Many blind children due to cornea disease may achieve improvement in visual acuity if an appropriate surgical and good postoperative management is performed.

Impacto da análise do 'wavefront' na refratometria de pacientes com ceratocone / Impact of the wavefront analysis in refraction of keratoconus patients

OBJETIVO: Verificar se a aberrometria ocular total (análise da frente de onda ou 'wavefront') possibilita melhora na acuidade visual corrigida (AVc) com lentes esfero-cilíndricas, obtida com a refratometria manifesta em casos de ceratocone com algum grau de intolerância ao uso de lentes de contato. MÉTODOS: Os prontuários de 46 pacientes (89 olhos), referidos com diagnóstico de ceratocone e intolerantes ao uso de lentes de contato, submetidos ao exame de aberrometria ocular total seguido de refração manifesta, foram estudados de forma retrospectiva. A AVc (logMAR) com a correção existente antes do exame foi comparada com a obtida com a nova refração manifesta, realizada considerando-se os dados objetivos da aberrometria. O teste não-paramétrico de Wilcoxon para amostras pareadas foi utilizado para verificação de diferenças estatisticamente significantes na AVc. RESULTADOS: Houve uma melhora estatisticamente significante na AVc com a nova refração manifesta (p<0,0001). A AVc média passou de 0,37 ou 20/47 (variando entre 1,3 e 0; desvio padrão[DP]=0,25) com a refração prévia para 0,23 ou 20/34 (variando entre 1 e 0,1; DP=0,21). Cinquenta e dois olhos (58,4 por cento) de 28 pacientes apresentaram melhora na AVc com a nova refração. A melhora média foi de 0,13 logMAR (1,3 linhas na tabela de Snellen), variando entre nula e 0,6 (6 linhas), com desvio padrão de 0,16. Oito pacientes apresentaram anisometropia significativa que limitou a prescrição de óculos em um dos olhos. CONCLUSÃO: A aberrometria facilitou a refratometria, determinando melhora significativa na acuidade visual corrigida com as lentes esfero-cilíndricas de pacientes com ceratocone intolerantes ao uso de lentes de contato. A anisometropia foi um fator limitante na prescrição de óculos.

OBJECTIVE: To verify if the total ocular aberrometry (wavefront analysis) facilitates manifest refraction and improvement in best spectacle distance corrected visual acuity (BSCDVA) with sphero-cylindrical lenses, in keratoconus cases with some degree of contact lenses intolerance. METHODS: Retrospective chart review of 46 patients (89 eyes) referred with keratoconus and contact lenses intolerance was performed. Ocular aberrometry with ray tracing was followed by manifest refraction. BSCDVA (logMAR) with the previous correction was compared with the one obtained based on the wavefront autorefraction. The nonparametric test of Wilcoxon for paired samples was used to test statistically significant differences in BSCDVA. RESULTS: There was a statistically significant improvement in BSCDVA with the new manifest refraction (p <0,0001). The average BSCDVA changed from 0,37 or 20/47 (varying between 1,3 and 0; standard deviation [SD] = 0,25) with previous refraction to 0,23 or 20/34 (varying between 1 and 0,1; SD = 0,21). 52 eyes (58,4 percent) of 28 patients showed improvement in BSCDVA with the new refraction. The average improvement was 0,13 logMAR (1,3 lines on Snellen chart), varying between zero and 0,6 (6 lines), with standard deviation of 0,16. Eight patients had significant anisometropia that limited the prescription of glasses. CONCLUSION: Aberrometry facilitated the refraction, determining significant improvement in visual acuity with sphero-cylindrical lenses in keratoconus patients intolerant to contact lenses. The anisometropia was a limiting factor in the prescription of glasses.

Repetibilidade em características biométricas do fruto de macaúba / Repeatability in biometric characteristics of macaw palm fruit

Estimativas do coeficiente de repetibilidade têm sido utilizadas no estudo de caracteres de várias espécies de palmeiras, auxiliando na definição do número e período adequado de avaliações dos genótipos para maior eficiência dos programas de melhoramento. Para macaúba, não há relatos de estudos dessa natureza. Nesse contexto, faz-se importante a determinação do coeficiente de repetibilidade das seguintes características biométricas dos frutos: peso do fruto, volume do fruto, diâmetro equatorial do fruto, peso da amêndoa, volume da amêndoa, diâmetro da amêndoa e espessura do endocarpo; e a determinação do número mínimo de avaliações para um eficiente processo de seleção e avaliação de subamostras de macaúba. O trabalho foi desenvolvido no Departamento de Fitotecnia da Universidade Federal de Viçosa, analisando-se 145 subamostras de macaúba, provenientes de coletas realizadas nos estados de Minas Gerais, São Paulo, Mato Grosso do Sul, Pará, Maranhão e Pernambuco. Houve diferença significativa para todas as características analisadas e observou-se concordância nas magnitudes dos coeficientes de repetibilidade de cada característica, obtidos pelos diferentes métodos. No entanto, os coeficientes de repetibilidade variam entre as oito características, de 0,68 a 0,99, observados para a característica espessura do endocarpo e volume da amêndoa, respectivamente. As estimativas dos coeficientes de determinação obtidas a partir das 10 repetições para as oito características e pelos quatro métodos foram superiores a 95 por cento. A avaliação de quatro frutos é suficiente para compreensão das características estudadas das subamostras de macaúba com 90 por cento de acurácia.

Estimates of repeatability coefficient have been used in character study of several species of palms, helping to define the number and appropriate period of assessment of genotypes to increase the efficiency of breeding programs. For macaw palm there are no reports of such studies. In this context it is important to determine the repeatability coefficient of the following biometric characteristics of fruits: fruit weight, fruit volume, equatorial diameter of the fruit, kernel weight, kernel volume, equatorial diameter of de kernel, and thickness of the endocarp, and the determination of the minimum number of ratings for an efficient selection process and evaluation of macaw palm subsamples. The study was conducted at the Department of Plant Science, Federal University of Viçosa, and 145 macaw palm subsamples were analyzed, from collections made in the states of Minas Gerais, São Paulo, Mato Grosso do Sul, Pará, Maranhão and Pernambuco. There were significant differences for all traits analyzed, and there was agreement on the magnitude of repeatability coefficients of each feature obtained by different methods. However, the repeatability coefficients ranging between eight characteristics, from 0.68 to 0.99, and were observed for feature endocarp thickness and volume of kernel, respectively. The coefficient of determination obtained from 10 repetitions for the eight features and the four methods were superior to 95 percent. The evaluation of four fruits is sufficient to assess the traits of macaw palm subsamples with 90 percent accuracy.

Impacto da análise do "wavefront" na refratometria de pacientes com ceratocone / Impact of the wavefront analysis in refraction of keratoconus patients

OBJETIVO: Verificar se a aberrometria ocular total (análise da frente de onda ou wavefront) possibilita a melhora na acuidade visual corrigida (AVc) com lentes esfero-cilíndricas, obtida com a refratometria manifesta em casos de ceratocone com algum grau de intolerância ao uso de lentes de contato. MÉTODOS: Os prontuários de 46 pacientes (89 olhos) referidos com diagnóstico de ceratocone e intolerantes ao uso de lentes de contato, submetidos ao exame de aberrometria ocular total seguido de refração manifesta, foram estudados de forma retrospectiva. A AVc (logMAR) com a correção existente antes do exame foi comparada com a obtida com a nova refração manifesta, realizada, considerando-se os dados objetivos da aberrometria. O teste não-paramétrico de Wilcoxon para amostras pareadas foi utilizado para verificação de diferenças estatisticamente significantes na AVc. RESULTADOS: Houve uma melhora estatisticamente significante na AVc com a nova refração manifesta (p<0,0001). A AVc média passou de 0,37 ou 20/47 (variando entre 1,3 e 0; desvio padrão[DP]=0,25) com a refração prévia para 0,23 ou 20/34 (variando entre 1 e 0,1; DP=0,21). 52 olhos (58,4 por cento) de 28 pacientes apresentaram melhora na AVc com a nova refração. A melhora média foi de 0,13 logMAR (1,3 linhas na tabela de Snellen), variando entre nula e 0,6 (6 linhas), com desvio padrão de 0,16. Oito pacientes apresentaram anisometropia significativa que limitou a prescrição de óculos em um dos olhos. CONCLUSÃO: A aberrometria facilitou a refratometria, determinando melhora significativa na acuidade visual corrigida com as lentes esfero-cilíndricas de pacientes com ceratocone intolerantes ao uso de lentes de contato. A anisometropia foi um fator limitante na prescrição de óculos.

OBJECTIVE: To verify if the total ocular aberrometry (wavefront analysis) facilitates manifest refraction and improvement in best spectacle distance corrected visual acuity (BSCDVA) with sphero-cylindrical lenses, in keratoconus cases with some degree of contact lenses intolerance. METHODS: Retrospective chart review of 46 patients (89 eyes) referred with keratoconus and contact lenses intolerance was performed. Ocular aberrometry with ray tracing was followed by manifest refraction. BSCDVA (logMAR) with the previous correction was compared with the one obtained based on the wavefront auto-refraction. The nonparametric test of Wilcoxon for paired samples was used to test statistically significant differences in BSCDVA. RESULTS: There was a statistically significant improvement in BSCDVA with the new manifest refraction (p <0,0001). The average BSCDVA changed from 0,37 or 20/47 (varying between 1,3 and 0; standard deviation [SD] = 0,25) with previous refraction to 0,23 or 20/34 (varying between 1 and 0,1; SD = 0,21). 52 eyes (58,4 percent) of 28 patients showed improvement in BSCDVA with the new refraction. The average improvement was 0,13 logMAR (1,3 lines on Snellen chart), varying between zero and 0,6 (6 lines), with standard deviation of 0,16. Eight patients had significant anisometropia that limited the prescription of glasses. CONCLUSION: Aberrometry facilitated the refraction, determining significant improvement in visual acuity with sphero-cylindrical lenses in keratoconus patients intolerant to contact lenses. The anisometropia was a limiting factor in the prescription of glasses.

On the spectrum of leprosy neuropathies: multifocal inflammatory neuropathy heralding leprosy relapse.

We report a 52 year-old woman with a past history of lepromatous leprosy (14 years prior to our first evaluation) who presented with progressive weakness and severe arm/leg pain. CSF analysis revealed elevated protein level with normal cell count. Skin and sural nerve biopsy showed no bacilli. Immunomodulatory treatment led to major improvement on clinical, CSF and electrodiagnostic grounds, but after one year of treatment, skin test revealed leprosy relapse. To our knowledge, this is the first report of a multifocal inflammatory neuropathy heralding leprosy relapse. Extended neurological work-up may be important in unexplained neuropathy progression after leprosy treatment.