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Crohn's disease (CD) represents a subtype of inflammatory bowel disease and can affect any portion of the gastrointestinal tract, from the mouth to the anus, with the capacity to affect extraintestinal organs. Salpingo-oophoritis is an uncommon manifestation of CD. There is only a limited number of documented case reports. We present the case of a patient with ileocolonic CD and secondary granulomatous salpingo-oophoritis. We emphasize the significance of clinical suspicion and an interdisciplinary approach as crucial factors in ensuring the effective management of the case.
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OBJECTIVES: To assess the prevalence and pattern of behavioral problems in children and adolescents with atopic dermatitis (AD) and to study their associations with clinical data and severity. METHODS: This was a single-center, cross-sectional study of patients (6-17 years) with AD. Assessment of competencies and syndrome scale scores of behavioral problems was performed by applying the Child Behavior Checklist 6-18 (CBCL 6-18) and AD severity using the Eczema Area Severity Index (EASI) score. RESULTS: Of the 100 patients with AD, 56% were male, with a mean age of 11±3 years, and 43% had moderate/severe AD. Borderline or abnormal values were found in 75% of the patients for total social competence, 57% for internalization, 27% for externalization, and 18% for aggressive behavior. A higher prevalence of aggressive behavior (27.9% vs. 10.5%; p = 0.02) and sleep disorders (32.6% vs. 15.8%; p = 0.04) was observed in patients with moderate/severe AD than in those with mild AD. Children with current or previous use of immunosuppressants/immunobiological tests had a lower frequency of normal social competence (53% vs. 83%, p = 0.012). Regarding the critical questions, 8% responded affirmatively to suicidal ideation. CONCLUSION: A high prevalence of behavioral problems was observed among children and adolescents with AD, with a predominance of internalizing profiles, mainly anxiety and depression. Children with moderate/severe AD have a higher prevalence of aggressive behaviors and sleep disorders. These findings highlight the importance of multidisciplinary teams, including mental health professionals, in caring for patients with AD.
Subject(s)
Dermatitis, Atopic , Problem Behavior , Sleep Wake Disorders , Child , Humans , Male , Adolescent , Female , Dermatitis, Atopic/epidemiology , Cross-Sectional Studies , Anxiety/epidemiology , Sleep Wake Disorders/etiology , Sleep Wake Disorders/complications , Severity of Illness IndexABSTRACT
Abstract Objectives To assess the prevalence and pattern of behavioral problems in children and adolescents with atopic dermatitis (AD) and to study their associations with clinical data and severity. Methods This was a single-center, cross-sectional study of patients (6-17 years) with AD. Assessment of competencies and syndrome scale scores of behavioral problems was performed by applying the Child Behavior Checklist 6-18 (CBCL 6-18) and AD severity using the Eczema Area Severity Index (EASI) score. Results Of the 100 patients with AD, 56% were male, with a mean age of 11±3 years, and 43% had moderate/severe AD. Borderline or abnormal values were found in 75% of the patients for total social competence, 57% for internalization, 27% for externalization, and 18% for aggressive behavior. A higher prevalence of aggressive behavior (27.9% vs. 10.5%; p= 0.02) and sleep disorders (32.6% vs. 15.8%; p= 0.04) was observed in patients with moderate/severe AD than in those with mild AD. Children with current or previous use of immunosuppressants/immunobiological tests had a lower frequency of normal social competence (53% vs. 83%, p= 0.012). Regarding the critical questions, 8% responded affirmatively to suicidal ideation. Conclusion A high prevalence of behavioral problems was observed among children and adolescents with AD, with a predominance of internalizing profiles, mainly anxiety and depression. Children with moderate/severe AD have a higher prevalence of aggressive behaviors and sleep disorders. These findings highlight the importance of multidisciplinary teams, including mental health professionals, in caring for patients with AD.
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ABSTRACT Objective: Age-related macular degeneration (AMD) is the most prevalent cause of irreversible visual loss in the developed world. In late stages, it may lead to extremely low visual acuities, especially when associated with geographic atrophy or choroidal neovascularization. According to recent literature, Charles Bonnet syndrome (CBS) may be a rather common feature of late AMD. Methods: One hundred patients with late-stage age-related macular degeneration were actively asked whether they had symptoms of Charles Bonnet syndrome. Those that answered positively underwent a comprehensive questionnaire about the details of the visual hallucinations. Results: The following factors were significantly associated with Charles Bonnet syndrome: older age (+6.3 years; p=0.003), lower visual acuity in the better eye (Charles Bonnet Syndrome Group: 0.11; Non-Charles Bonnet Syndrome Group: 0.42; p=0.005) and female sex (Charles Bonnet Syndrome Group: 88%; Non-Charles Bonnet Syndrome Group: 43%; p=0.02). The visual hallucinations occurred mainly straight ahead (n=5), once per day (n=4), at no particular time (n=6), lasted some minutes (n=5), and disappeared after blinking (n=3) or looking away (n=3). The majority of patients lived alone (n=7), had not told anyone about the hallucinations (n=6), and associated the episodes with severe distress (n=5). Conclusion: Charles Bonnet syndrome was fairly prevalent in this late-stage age-related macular degeneration population. Our sample shows the importance of directly asking subjects about Charles Bonnet syndrome since they are often reluctant to admit to having visual hallucinations. Reassurance about its benignity is crucial to improve their quality of life.
RESUMO Objetivo: A doença macular ligada à idade (DMI) é a causa mais prevalente de perda visual irreversível nos países desenvolvidos. Em estadios avançados, esta doença pode levar a acuidades visuais extremamente baixas. De acordo com literatura recente, a Síndrome de Charles Bonnet (SCB) pode acontecer de forma relativamente comum na DMI tardia. Métodos: Cem doentes com degeneração macular da idade avançada foram interrogados ativamente sobre terem sintomas da síndrome de Charles Bonnet. Os que responderam de forma positiva foram submetidos a um questionário oral detalhado sobre os pormenores das alucinações visuais. Resultados: Os seguintes fatores foram significativamente associados à síndrome de Charles Bonnet: idade avançada (+6,3 anos; p=0,003), menor melhor acuidade visual corrigida no melhor olho (Grupo com Síndrome de Charles Bonnet: 0,11; Grupo sem Síndrome de Charles Bonnet: 0,42; p=0,005) e sexo feminino (Grupo com Síndrome de Charles Bonnet: 88%; Grupo sem Síndrome de Charles Bonnet: 43%; p=0,02). As alucinações visuais ocorriam principalmente em frente (n=5), uma vez por dia (n=4), em qualquer altura do dia (n=6), duravam alguns minutos (n=5) e desapareciam após pestanejo (n=3) ou desvio do olhar (n=3). A maioria dos doentes vivia sozinha (n=7), não tinha partilhado sua condição com ninguém (n=6) e associava os episódios a uma sensação angustiante (n=5). Conclusão: A síndrome de Charles Bonnet teve prevalência relativamente alta nessa população de degeneração macular da idade. Nossa amostra sublinha a importância de questionar diretamente sobre síndrome de Charles Bonnet, uma vez que os doentes se sentem muitas vezes relutantes em admitir alucinações visuais. A reafirmação da benignidade da situação é crucial para aumentar a qualidade de vida desses indivíduos.
Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Charles Bonnet Syndrome/etiology , Charles Bonnet Syndrome/epidemiology , Hallucinations/etiology , Hallucinations/epidemiology , Macular Degeneration/complications , Portugal/epidemiology , Visual Acuity , Vision, Low , Prevalence , Surveys and QuestionnairesABSTRACT
OBJECTIVE: To analyze the quantity of cervical smears, also designated Papanicolaou tests, between 2006 and 2015 in all the Federal units of Brazil, as well as to verify the quantity of exams collected outside the recommended age range and the economic impact of such excess. METHODS: The data was collected from the Ministry of Health's database called Sistema de Informação do Câncer do Colo de Útero (SISCOLO), which contains all the test results collected nationwide by the Unified Health System (SUS, in the Portuguese acronym). From that, the number of exams and the age range of the women who underwent them were analyzed; besides, these numbers were stratified according to the state of where the exam was performed. The quantity of exams collected outside the recommended age range was verified, and, so, the economic impact generated was noted. RESULTS: Between 2006 and 2015, 87,425,549 Papanicolaou tests were collected in Brazil. Of these, 20,215,052 tests were collected outside the age range recommended by the Brazilian Ministry of Health; this number corresponded to 23.12% of all exams. From such data, considering that each Pap smear collected by SUS generates a cost of BRL 7.30 to the government, according to the information in the Tabela SUS dated September 2018, there was a total charge of BRL 147,569,880 for tests collected outside the protocol. CONCLUSION: In Brazil, according to the Ministry of Health's protocol about the recommended practices on collecting Pap smears, whose newest edition dates of 2016, it is recommended that Pap smears are collected in women from a specific age range, in whom the potential diagnosing advantages overcome the onus of overdiagnosis or of a lesion with great regression potential. However, such protocols have not been correctly followed, promoting more than 20 million tests in excess, and an exorbitant cost for the Brazilian public health system. It is relevant to take measures to correctly use the official protocol, reducing the patients risks, as well as the economic impact for SUS.
OBJETIVO: Analisar a quantidade de exames cérvico-vaginais, também chamados de Teste de Papanicolau, entre os anos de 2006 e 2015 em todos os estados brasileiros, bem como verificar o número de exames realizados fora da faixa etária indicada, e o impacto econômico desse excesso. MéTODOS: Os dados foram coletados a partir da base de dados do Ministério da Saúde chamada Sistema de Informação do Câncer do Colo de Útero (SISCOLO), que reúne os resultados de exames realizados em todo o Brasil pelo sistema único de saúde (SUS). A partir disso, foi analisado o número de exames e a faixa-etária de realização dos mesmos; além disso, esses números foram estratificados de acordo com o estado brasileiro de origem do exame. Foi verificada a quantidade de exames fora da idade recomendada, e, assim, foi observado o impacto econômico gerado. RESULTADO: Entre 2006 e 2015, 87.425.549 exames de Papanicolau foram realizados no Brasil. Deste montante, 20.215.052 testes foram realizados fora da faixa-etária preconizada pelo Ministério da Saúde do Brasil, o que equivale a 23,12% do total. A partir desse número, considerando que cada exame cérvico -vaginal realizado pelo SUS gera um custo de R$ 7,30 para o governo, de acordo com informações na Tabela SUS datada de setembro de 2018, foram gastos R$ 147.569.880 em exames realizados sem indicação. CONCLUSãO: No Brasil, no protocolo do Ministério da Saúde sobre as práticas adequadas em coleta de exames cérvico-vaginais, sendo sua edição mais recente de 2016, a recomendação é realizar o teste de Papanicolau em mulheres dentro de uma faixa-etária específica, na qual a chance de se diagnosticar uma lesão supera o ônus de um sobrediagnóstico ou uma lesão com grande potencial de regressão. Entretanto, essa recomendação não tem sido seguida corretamente, gerando mais de 20 milhões de exames excedentes e um custo monetário exorbitante para o sistema público de saúde. É importante que medidas sejam tomadas para que o protocolo seja empregado corretamente a fim de reduzir riscos para a paciente, bem como a redução de gastos desnecessários para o SUS.
Subject(s)
Papanicolaou Test , Uterine Cervical Neoplasms , Brazil , Female , Humans , Overdiagnosis , Uterine Cervical Neoplasms/diagnosis , Vaginal SmearsABSTRACT
Abstract Objective To analyze the quantity of cervical smears, also designated Papanicolaou tests, between 2006 and 2015 in all the Federal units of Brazil, as well as to verify the quantity of exams collected outside the recommended age range and the economic impact of such excess. Methods The data was collected from the Ministry of Health's database called Sistema de Informação do Câncer do Colo de Útero (SISCOLO), which contains all the test results collected nationwide by the Unified Health System (SUS, in the Portuguese acronym). From that, the number of exams and the age range of thewomen who underwent them were analyzed; besides, these numbers were stratified according to the state of where the exam was performed. The quantity of exams collected outside the recommended age range was verified, and, so, the economic impact generated was noted. Results Between 2006and2015, 87,425,549Papanicolaoutestswere collected in Brazil. Of these, 20,215,052 testswere collected outside the age range recommended by the Brazilian Ministry of Health; this number corresponded to 23.12% of all exams. From such data, considering that each Pap smear collected by SUS generates a cost of BRL 7.30 to the government, according to the information in the Tabela SUS dated September 2018, there was a total charge of BRL 147,569,880 for tests collected outside the protocol. Conclusion In Brazil, according to the Ministry of Health's protocol about the recommended practices on collecting Pap smears, whose newest edition dates of 2016, it is recommended that Pap smears are collected inwomen from a specific age range, inwhom the potential diagnosing advantages overcome the onus of overdiagnosis or of a lesion with great regression potential. However, such protocols have not been correctly followed, promoting more than 20 million tests in excess, and an exorbitant cost for the Brazilian public health system. It is relevant to take measures to correctly use the official protocol, reducing the patients risks, as well as the economic impact for SUS.
Resumo Objetivo Analisar a quantidade de exames cérvico-vaginais, também chamados de Teste de Papanicolau, entre os anos de 2006 e 2015 em todos os estados brasileiros, bem como verificar o número de exames realizados fora da faixa etária indicada, e o impacto econômico desse excesso. Métodos Os dados foram coletados a partir da base de dados do Ministério da Saúde chamada Sistema de Informação do Câncer do Colo de Útero (SISCOLO), que reúne os resultados de exames realizados em todo o Brasil pelo sistema único de saúde (SUS). A partir disso, foi analisado o número de exames e a faixa-etária de realização dos mesmos; além disso, esses números foram estratificados de acordo com o estado brasileiro de origem do exame. Foi verificada a quantidade de exames fora da idade recomendada, e, assim, foi observado o impacto econômico gerado. Resultado Entre 2006 e 2015, 87.425.549 exames de Papanicolau foram realizados no Brasil. Deste montante, 20.215.052 testes foram realizados fora da faixa-etária preconizada pelo Ministério da Saúde do Brasil, o que equivale a 23,12% do total. A partir desse número, considerando que cada exame cérvico -vaginal realizado pelo SUS gera um custo de R$ 7,30 para o governo, de acordo com informações na Tabela SUS datada de setembro de 2018, foram gastos R$ 147.569.880 em exames realizados sem indicação. Conclusão No Brasil, no protocolo do Ministério da Saúde sobre as práticas adequadas em coleta de exames cérvico-vaginais, sendo sua edição mais recente de 2016, a recomendação é realizar o teste de Papanicolau em mulheres dentro de uma faixaetária específica, na qual a chance de se diagnosticar uma lesão supera o ônus de um sobrediagnóstico ou uma lesão com grande potencial de regressão. Entretanto, essa recomendação não tem sido seguida corretamente, gerando mais de 20 milhões de exames excedentes e umcusto monetário exorbitante para o sistema público de saúde. É importante que medidas sejam tomadas para que o protocolo seja empregado corretamente a fim de reduzir riscos para a paciente, bem como a redução de gastos desnecessários para o SUS.
Subject(s)
Humans , Female , Brazil/epidemiology , Uterine Cervical Dysplasia/diagnosis , Cervix Uteri/pathologyABSTRACT
O câncer de ovário é considerado a neoplasia ginecológica mais letal e ocupa a sétima posição entre as causas de óbito em mulheres. Tem como dificuldade para seu tratamento o fato de o diagnóstico ser tardio, por apresentar sintomas inespecíficos e ainda não possuirmos um método de rastreamento abrangente e eficaz. O presente artigo traz como objetivo estimar o perfil epidemiológico das neoplasias de ovário diagnosticadas em um laboratório de anatomia patológica no sul do estado de Santa Catarina no período de julho de 2008 a julho de 2011. Se trata de estudo transversal, documental, descritivo e de abordagem predominantemente quantitativa. Foram encontrados 268 casos de neoplasias de ovário com idade média no momento do diagnóstico de 43,20 anos. O tamanho médio do ovário foi de 8,27cm havendo significância entre o tamanho do ovário e a malignidade do tumor. Os tipos histológicos mais encontrados foram o mucinoso benigno 22,0%, o teratoma maduro (cisto dermóide) 28,6% e o seroso benigno 36,3%. O câncer de ovário participa, a cada cinco anos, com cerca de meio milhão de mulheres afetadas. A literatura mostra os tumores epiteliais como os mais prevalentes, seguidos pelos tumores das células germinativas e do cordão sexual-estroma, coincidindo nossos dados, 68%, 29% e 3% respectivamente. A região de Criciúma mantém os padrões encontrados na literatura no que se refere às neoplasias ovarianas e os parâmetros avaliados neste estudo. Destacamos características locais que poderão contribuir para futuros estudos, a fim de desenvolver ações preventivas e diagnósticas.
Ovarian cancer is considered the most lethal gynecologic cancer and ranks seventh among the most common causes of death in women. One thing that complicate its treatment is the fact that the diagnosis is usually late, since the symptoms are nonspecific and still not having a screening method comprehensive and effective of tracking it. To estimate the epidemiological profile of ovarian cancer diagnosed in a pathology laboratory in southern Santa Catarina between July 2008 and July 2011. A transversal, documental, descriptive and addressing predominantly quantitative study. We found 268 cases of ovarian cancer with an average age at diagnosis of 43.20 years old. The average size of the ovary was 8.27 cm with a significant association between the ovarian size and the malignancy of the tumor. The prevalent histological types found were benign mucinous 22.0%, mature teratoma (dermoid cyst) 28.6% and benign serous 36.3%. The ovarian cancer affects about half a million women every five years. The literature shows epithelial tumors as the most prevalent, followed by germ cell tumors and sex cord-stromal, coinciding with our survey, which were 68%, 29% and 3% respectively. The region of Criciúma maintains the standards found in the literature referring to ovarian tumors and the parameters evaluated in this study. We emphasize local characteristics that may contribute to future studies, in order to develop preventive and diagnostic strategies.
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Abstract Objectives: to identify spatial pattern on hospitalization rates of children with diarrhea in the counties in São Paulo State. Methods: ecological and exploratory study on hospitalized data of children with diarrhea under the age of four in 2008 and 2012, the IDH mothers with low schooling level and children living with a low income less than half minimum wage were obtained from Datasus and inserted into digital map of the counties in São Paulo State. Moran's global index (I) and Pearson's coefficients correlation and thematic maps of hospitalization rates of 1,000 children, Moran maps and kernel map were calculated. Results: there were 34, 802 hospital admissions, with an average rate of 4.7 hospitalizations / 1,000 children (SD=7.2). Hospitalization rates were correlated only with schooling (r= 0.09, p<0.05). Moran's index for hospitalization rate was I=0.31(p<0.01). The thematic map of the hospital admission rates showed a cluster of counties in the west of the State; the kernel map showed a higher density of hospitalization in this region and the Moran map identified 57 counties which deserve attention. Conclusions: the results provide subsidies for the counties and regional managers to implement measurements aiming to reduce these rates.
Resumo Objetivos: identificar padrão espacial para taxas de internação por diarreia em crianças nos municípios do estado de São Paulo. Métodos: estudo ecológico e exploratório, com dados de internação por diarréia em crianças com até quatro anos de idade, de 2008 e 2012, IDH, proporções de mães com baixa escolaridade, e crianças que vivem em famílias com renda menor que meio salário mínimo obtidos do Datasus e inseridos em malha digital dos municípios de São Paulo. Foram calculados índices de Moran global (I) e coeficientes de correlação de Pearson e construídos mapas temáticos das taxas de internação por 1000 crianças, mapas de Moran e mapa de kernel. Resultados: houve 34802 internações, média no período de 4,7 internações/1000 crianças (dp = 7,2). As taxas de internação estiveram correlacionadas com a escolaridade (r=0,09; p<0,05). O índice de Moran para a taxa de internação foi I = 0,31 (p<0,01). O mapa temático das taxas de internação mostrou aglomerado de municípios no oeste do estado; o mapa de kernel mostra uma maior densidade de internação nesta região e o mapa de Moran identificou 57 municípios que merecem atenção. Conclusões: os resultados fornecem subsídios para os gestores municipais e regionais na implantação de medidas visando a redução dessas taxas.
Subject(s)
Humans , Child, Preschool , Diarrhea, Infantile , Dysentery , Spatial Analysis , Hospitalization/statistics & numerical data , Poverty , Unified Health System , Brazil , Infant Mortality , Morbidity , Educational Status , Health Information SystemsABSTRACT
Objectives To identifying spatial patterns in the distribution of perinatal mortality in the state of São Paulo from 2003 to 2012. Methods An ecological and exploratory study with data on perinatal mortality rates of every thousand live births, which were registered on the digital database containing 645 municipalities in the state of São Paulo within the periods of 2003 to 2007 and 2008 to 2012. The spatial analysis provided Moran's index (MI) and thematic maps of rates, and the Moran maps of both periods were drawn. The average rates were compared by Student's t test. The TerraView 4.2.2 software (INPE, S. José dos Campos, Brazil) was also used. Results There were 49,485 perinatal deaths during the first period, at a rate of 17.90 deaths/1,000 live births (standard deviation [SD] = 7.0; MI = 0.14; p = 0.01), and 44,582 perinatal deaths during the second period, at a rate of 16.40 deaths/1,000 live births (SD = 11.14; MI = 0.04; p = 0.03). These rates are statistically different (p < 0.01). There was a decrease in these rates in 413 municipalities when comparing the two periods. The Moran map has identified 35 municipalities that require special attention, which are located in the Eastern, Southwestern, Western and Northwestern regions of São Paulo state. Conclusion The study provides municipal managers with subsidies so they can minimize these rates by implementing public policies and taking better care of pregnant women and newborns.
Subject(s)
Perinatal Mortality , Brazil , Humans , Infant, Newborn , Spatial Analysis , Time FactorsABSTRACT
Abstract Objectives To identifying spatial patterns in the distribution of perinatal mortality in the state of São Paulo from 2003 to 2012. Methods An ecological and exploratory study with data on perinatal mortality rates of every thousand live births, which were registered on the digital database containing 645 municipalities in the state of São Paulo within the periods of 2003 to 2007 and 2008 to 2012. The spatial analysis provided Moran’s index (MI) and thematic maps of rates, and the Moran maps of both periods were drawn. The average rates were compared by Student’s t test. The TerraView 4.2.2 software (INPE, S. José dos Campos, Brazil) was also used. Results There were 49,485 perinatal deaths during the first period, at a rate of 17.90 deaths/1,000 live births (standard deviation [SD] = 7.0; MI = 0.14; p = 0.01), and 44,582 perinatal deaths during the second period, at a rate of 16.40 deaths/1,000 live births (SD = 11.14; MI = 0.04; p = 0.03). These rates are statistically different (p < 0.01). There was a decrease in these rates in 413 municipalities when comparing the two periods. The Moran map has identified 35 municipalities that require special attention, which are located in the Eastern, Southwestern, Western and Northwestern regions of São Paulo state. Conclusion The study provides municipal managers with subsidies so they can minimize these rates by implementing public policies and taking better care of pregnant women and newborns.
Resumo Objetivo Identificar padrões espaciais na distribuição de mortalidade perinatal no Estado de São Paulo no período de 2003 a 2012. Métodos Estudo ecológico e exploratório, com dados sobre as taxas de mortalidade perinatal por mil nascidos vivos e inseridos em malha digital dos 645 municípios do estado de São Paulo entre 2003 e 2007 e 2008 e 2012. A análise espacial forneceu o índice de Moran (IM), e foram construídos mapas temáticos das taxas e o mapa de Moran de ambos os períodos. As taxas médias foram comparadas utilizando o teste t de Student. Utilizou-se o programa Terra View 4.2.2. Resultados Foram 49.485 óbitos perinatais no primeiro período, taxa de 17,90 óbitos/1.000 nascidos vivos (desvio-padrão [DP] = 7,0; IM = 0,14; p = 0,01), e 44.582 óbitos perinatais no segundo período, taxa de 16,40 óbitos/1.000 nascidos vivos (DP = 11,14; IM = 0,04; p = 0,03). Estas taxas são diferentes (p < 0,01). Houve diminuição destas taxas em 413 municípios quando comparados os dois períodos. O mapa de Moran identificou 35 municípios localizados nas regiões Leste, Sudoeste, Oeste e Noroeste, que merecem uma atenção especial. Conclusão O estudo fornece subsídios para que os gestores municipais possam minimizar estas taxas, implantando políticas públicas e melhor atendimento às gestantes e recém-nascidos.
Subject(s)
Humans , Infant, Newborn , Perinatal Mortality , Brazil , Spatial Analysis , Time FactorsABSTRACT
AIM: Evaluate the real-life experience with ocriplasmin on vitreomacular traction (VMT) release and full-thickness macular hole (FTMH) closure in Portugal. METHODS: Multicentric, retrospective study of 83 eyes of 78 patients who were treated with intravitreal ocriplasmin for VMT with and without FTMH. Primary outcomes were VMT release and FTMH closure. Secondary outcomes included visual acuity changes and structural features on spectral-domain ocular coherence tomography. RESULTS: VMT resolved in 47 of the 83 eyes (56.6%) and 6 of the 12 FTMH were closed (50.0%). Mean best-corrected visual acuity (BCVA) improved from 65.1 at baseline to 70.8 ETDRS letters at the end of follow-up (p < 0.0001) with a mean follow-up of 138.8 days. Improvement in BCVA was significantly better in eyes with VMT release (p = 0.021). Approximately 73% of patients had normal ellipsoid zone integrity at the end of follow-up, 87% had no neurosensorial detachment and 40% had no intra- or subretinal fluid. CONCLUSION: VMT release and FTMH closure were achieved in more than half of the treated eyes and were correlated with significant BCVA improvements and favorable baseline characteristics. In fact, if a careful patient selection is carried out, VMT resolution with ocriplasmin can be optimized, tailoring the best approach to each patient.
Subject(s)
Fibrinolysin/administration & dosage , Peptide Fragments/administration & dosage , Tomography, Optical Coherence/methods , Vitreous Detachment/drug therapy , Aged , Female , Follow-Up Studies , Humans , Intravitreal Injections , Male , Retrospective Studies , Time Factors , Treatment Outcome , Visual Acuity , Vitreous Detachment/diagnosis , Vitreous Detachment/physiopathologyABSTRACT
Objetivo: Avaliar o impacto da degeneração macular relacionada à idade (DMRI) na qualidade de vida relacionada com a visão (QVRV) numa amostra de pacientes portugueses. Métodos: Estudo observacional em corte transversal, não comparativo no qual foram incluídos 68 pacientes seguidos no departamento de Retina Médica do Serviço de Oftalmologia do Centro Hospitalar de Lisboa Ocidental, entre janeiro e abril de 2011. A QVRV foi avaliada por meio do questionário National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25), traduzido para o português. Os scores obtidos foram analisados e correlacionados com os seguintes parâmetros idade, sexo, lateralidade da doença, tempo de follow-up, acuidade visual (AV) e EFC iniciais e finais do melhor (MO) e pior olho (PO). Resultados: A AV do PO apresentou valor preditivo nos scores global, atividade para longe, visão cromática, visão periférica, desempenho, função social e saúde mental (p<0,05). Num modelo de multivariáveis com inclusão de todos os parâmetros clínicos analisados, as variáveis estudadas explicaram 60% da variância do score global (SG) com um valor preditivo de 0,08 (R2 0,57, p=0,088). Conclusões: A DMRI NV está associada a uma diminuição da QVRV. A AV do PO tem valor preditivo nos scores do NEI-VFQ-25.
Purpose: To describe the impact of aged-related macular degeneration (AMD) on vision-related quality of life (QOL) on a sample of portuguese patients and explore the association with vision, Central Foveal Thickness (CFT) and demographic variables in a Portuguese population. Methods: Observational, interview study of 68 patients with clinical diagnosis of NV AMD seen between January and April 2011 at the Ophthalmology Department of Centro Hospitalar de Lisboa Ocidental. Health-related quality of life (HRQL) was measured with a Portuguese version of the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25). Scores were analysed and correlated with age, gender, laterality of the disease, initial and final visual acuity (VA), CFT and duration of follow-up. Results: Worst eye VA had predictive value in the following scores: global, distance activities, color vision, peripheral vision, role difficulties, social functioning and mental health (p<0.05). In a multivariable model with inclusion of all the parameters studied, the analysed variables explained 60% of the variability of the Global Score, with a predictive value of 0.08 (R2 0.57, p=0.088). Conclusion: NV AMD is associated with impairment in reported vision related QOL in our group of patients. The VA of the worst eye has a predictive value in NEI VFQ-25 scores.
Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Chronic Disease , Macular Degeneration , Quality of Life , Surveys and Questionnaires , Visual Acuity , Cross-Sectional Studies , Observational Study , PortugalABSTRACT
Objetivo: Determinar se existe variação da PIO em doentes com glaucoma submetidos à cirurgia de catarata. Métodos: Estudo retrospectivo de 101 olhos, de 75 doentes com média de idade de 78,91 ± 7,9 anos submetidos à cirurgia de catarata por facoemulsificação por dois cirurgiões, sem complicações associadas e com follow-up superior a 6 meses. Os olhos foram subdivididos em dois grupos: olhos com glaucoma (G) e olhos sem glaucoma (SG). A PIO foi avaliada por tonometria de Goldmann. Resultados: Analisaram-se 51 olhos do grupo (SG) e 50 olhos do grupo (G). A PIO média nos dois grupos era no pré-operatório 16,08 ± 3,04, sendo aos 12 meses 14,69 ± 2,7 e aos 24 meses 14,21 ± 3,56. A diminuição média de PIO do pré-operatório para os 12 meses foi de 1,49 ± 2,98. A PIO pré-operatória apresentou uma diferença com significado estatístico da PIO aos 12 e 24 meses (p<0,001 e p=0,001, respectivamente T. t pares) na amostra global. Não se detectou uma diferença com significado estatístico na variação de PIO entre estes 2 grupos de olhos (p>0,05, teste T Student). Determinou-se um modelo de regressão linear stepwise para a variação de PIO do pré-operatório para os 12m. As variáveis com valor preditivo eram a PIO pré-operatória (R2=0,249, p=0,03), e a idade (R2=0,18, p=0,01). Conclusão: O nosso estudo revela que a cirurgia de catarata por facoemulsificação leva a uma diminuição significativa da PIO, que se mantém aos 12 e 24m. .
Objective: To describe the variation of intraocular pressure (IOP) in patients with glaucoma submitted to cataract surgery. Methods: Retrospective study of 101 eyes of 75 patients with medium age of 78.91 ± 7.9 submitted to cataract surgery by facoemulsification by two surgeons, without complications and with at least 6 months of follow-up. The eyes were divided in two groups: eyes with glaucoma (G) and eyes without glaucoma (NG). The IOP was evaluated with Goldmann tonometry. Results: 51 eyes without glaucoma and 50 eyes with glaucoma. The medium IOP was 16.08 ± 3.04 before surgery, 14.69 ± 2.7 at 12 months and 14.21 ± 3.56 at 24 months. The medium value of IOP reduction before surgery to 12 months was 1.49 ± 2.98. IOP measured before surgery differed statistically from IOP at 12 and 24 months (p<0.001 e p=0.001 respectively, T. Student). Between the two groups of eyes there wasn’t a statistically significant difference in the variation of IOP (p>0.05, T Student). A model of linear regression stepwise was calculated for the variation of the IOP from before surgery to 12 months. The variables with more predictive value were IOP before surgery (R2=0.249, p=0.03) and age (R2=0.18, p=0.01). Conclusion: In our study cataract surgery results in IOP reduction, that is maintained at 12 months. .
Subject(s)
Humans , Male , Female , Aged , Cataract Extraction/methods , Phacoemulsification/methods , Intraocular Pressure/physiology , Tonometry, Ocular , Visual Acuity , Glaucoma/physiopathology , Predictive Value of Tests , Retrospective Studies , Follow-Up Studies , Lens Implantation, Intraocular , Axial Length, EyeABSTRACT
Oncocitoma e carcinoma de células renais representam2 a 3% dos tumores no adulto. O oncocitoma é benigno,do córtex renal, normalmente unilateral, sendo 3,1-6,6%de todas as neoplasias renais. Os carcinomas são tumoresde células epiteliais, malignos, com tendência à invasãotecidual, podendo originar metástases. Os carcinomas representam85% dos cânceres renais, sendo prevalente o decélulas claras. No relato de caso os autores evidenciam,através do estudo histopatológico, a presença de oncocitomae carcinoma de células claras em um único rim.
Oncocytoma and renal cell carcinoma correspond to 2-3% of all tumors in adults. Oncocytomas are benign, usuallyin the kidney cortex and unilateral, correspondingto 3,1 to 6,6 % of all renal neoplasm. Carcinomas aremalignant tumors of epithelial cells which tend to tissueinvasion and can result in metastasis. Carcinoma represents85% of kidney neoplasm, with the clear cell carcinomabeing the most prevalent type. In the case reportthe authors demonstrate, through the histopathologicalstudies, the presence of oncocytoma and clear-cell carcinomain the same kidney.
ABSTRACT
This report describes the first case of Aspergillus endophthalmitis after heart transplantation which was successfully treated with intravitreal voriconazole. A 62-year-old man receiving immunosuppressive agents after a heart transplant presented with pain, reduced visual acuity and redness of the left eye. The patient had been diagnosed with invasive pulmonary aspergillosis and was being treated with intravenous voriconazole. Endogenous endophthalmitis was diagnosed. Aspergillus fumigatus was isolated in a vitreous sample. After five intravitreal voriconazole injections (50 µg/0.1 ml), pars plana vitrectomy, intravenous and topical voriconazole treatment, there was no ocular inflammation and the visual acuity improved from counting fingers at 50 cm to 20/20. This case report shows that intravitreal voriconazole, in addition to topical and systemic treatment, was safe and very effective in treating Aspergillus endophthalmitis. More clinical studies are needed to determine the optimal treatment for this condition.
ABSTRACT
PURPOSE: To assess the two year outcome following macular translocation (MT) with scleral infolding in the management of myopic subfoveal choroidal neovascularisation (CNV). DESIGN: Prospective, clinical interventional noncomparative consecutive case series. PARTICIPANTS: 79 eyes of 79 patients with myopic subfoveal CNV and less than 6 months of duration of the symptoms. INTERVENTION: MT with scleral infolding. MAIN OUTCOME MEASURES: Visual Acuity (VA), reading ability of 12 point Arial letter sentences at a reading distance without magnifying systems and foveal displacement. RESULTS: Mean preoperative VA was 20/125, after two years the mean VA was 20/80. Reading ability of 12 point Arial letter sentences at a reading distance (33 cm) was obtained in 59% of the eyes at one year, descending to 43% at two years. Mean foveal displacement after surgery was 942 microns. Intraoperative complications have been: retinal breaks (21.5%) and choroidal haemorrhage not affecting the posterior pole (3.7%). Main postoperative complications have been: Insufficient foveal displacement: 20%; Retinal detachment: 8.8%; Subfoveal recurrence: 28%; macular fold: 2.5% and macular hole: 1.2%. CONCLUSION: MT with scleral infolding offers the opportunity to recover central vision and reading ability in patients with myopic CNV but it remains unpredictable.