Prevalence of Aids in the Elderly in Bahia: Ecological Study / Prevalência de Aids em Idosos na Bahia: um Estudo Ecológico

The life expectancy of the Brazilian population has increased and, with this, there is a need to reflect on public policies that address and improve the quality of this population. The objective of the study is to characterize the epidemiological profile of the elderly with AIDS, in Bahia, between the years 2008 to 2018. Ecological time series study, with data obtained from the Information System for Notifiable Diseases (SINAN) provided by the Department of Informatics of the Unified Health System (DATASUS), from 2008 to 2018, with elderly and analyzed from the following variables: sex, race/color, education and hierarchical category (Homosexual, Bisexual, Heterosexual, Ignored). In the period studied, there were 20,931 cases, of which 963 refer to people over 60 years old, representing 4.6% of the total population. It presented a positive linear correlation r 0.794 (p=0.004), when comparing the years of diagnosis with the prevalence of AIDS in the age group of 60-69 years, demonstrating that over the years the number of AIDS cases in this age group increases. The epidemiological profile of the elderly with AIDS in Bahia consists of an individual aged between 60 and 69 years, male, heterosexual and with a low level of education. (AU)

A expectativa de vida da população brasileira tem aumentado e, com isso, surge a necessidade da reflexão acerca de políticas públicas que contemplem e melhorem a qualidade de vida desta população. O objetivo do estudo é caracterizar o perfil epidemiológico dos idosos com AIDS, na Bahia, entre os anos de 2008 a 2018. Estudo ecológico de série temporal, com dados obtidos no Sistema de Informações de Agravos de Notificação (SINAN) disponibilizados pelo Departamento de Informática do Sistema Único de Saúde (DATASUS), no período de 2008 a 2018, com idosos e analisados a partir das seguintes variáveis: sexo, raça/cor, escolaridade e categoria hierárquica (Homossexual, Bissexual, Heterossexual, Ignorado). No período estudado, foram 20.931 casos, dos quais 963 se referem a pessoas acima de 60 anos, representando 4,6% da população total. Apresentou uma correlação linear positiva r 0,794 (p=0,004), quando comparamos os anos de diagnóstico com a prevalência de AIDS na faixa etária de 60-69 anos, demonstrando que com o passar dos anos aumentam o número de casos de AIDS nesta faixa etária. O perfil epidemiológico do idoso com AIDS na Bahia consiste em um indivíduo com idade entre 60 a 69 anos, do sexo masculino, heterossexual e com baixo nível de escolaridade. (AU)

Dry eye in rheumatoid arthritis patients under TNF-inhibitors: conjunctival goblet cell as an early ocular biomarker.

Dry eye disease (DED) is common in Rheumatoid Arthritis (RA) patients. The application of conjunctival goblet cell count as a clinical biomarker to diagnose and respond to treatment can take place in rheumatoid arthritis patients under TNF-inhibitors (TNFi) therapy. This study aimed to investigate the ocular surface parameters and the long-term effects of TNFi therapy on ocular surface features and goblet cell count of rheumatoid arthritis patients. At baseline, rheumatoid arthritis patients eligible to TNFi were compared to healthy controls (similar age/gender), regarding Ocular Surface Disease Index (OSDI) questionnaire, Schirmer I test, tear break-up time test, vital dye staining of the ocular surface, and conjunctival impression cytology. DED severity grade, impression cytology score, and goblet cell count were analyzed. Rheumatoid arthritis patients were followed after three (3 M) and 12 months (12 M), during TNFi treatment. Sixteen rheumatoid arthritis patients and 24 controls were compared: a higher frequency of abnormal OSDI (68.8% vs. 16.7%, p = 0.002), Schirmer's test < 10 mm (37.5% vs. 8.3%, p = 0.042), meibomian gland dysfunction (50% vs. 8.3%, p = 0.007), abnormal impression cytology (75% vs. 8.3%, p < 0.001), and mild to moderate DED (81.3% vs. 4.2%, p < 0.001) were observed in rheumatoid arthritis patients, who also had lower goblet cell count [325 (274-707) cells/mm2 vs. 742 (562-863) cells/mm2, p = 0.004]. The presence of Meibomian gland dysfunction was associated with higher disease activity scores (p < 0.05). The prospective early observation of these patients at 3 M showed an increase improvement in tear production by Schirmer's test [13 (7.5-17.5) vs. 23.5 (16-35); p = 0.001], and an improvement in impression cytology score [1 (0.5-2) vs. 1 (0-1), p = 0.031] and in goblet cell count [325 (274-707) vs. 931 (656-1,244), p < 0.001]. Eight RA responders to TNFi were also re-evaluated at 12 M with further improvement in goblet cell count [393 (275-827) vs. 872 (502-1,185) vs. 1,079 (867-1,244), p = 0.047]. Multifactorial DED is frequent in RA patients, comprising aqueous, lipid, and mucin components. TNFi prompt improves tear production and recovers the goblet cells, which can be a biomarker of the pathological process and response to therapy in this population.

Improvement of conjunctival cytological grade and tear production in Ankylosing Spondylitis patients under TNF inhibitors: a long-term follow-up.

Dry eye disease can compromise the patient's quality of life. Few studies assessed the ocular surface (OS) in Ankylosing Spondylitis (AS) patients. This study aimed to evaluate the clinical and cytological findings of the OS in patients with AS, classify dry eye disease (DED) severity grade and conjunctival impression cytology (IC), and the effects of TNF inhibitors (TNFi) in a one-year follow-up. A baseline (BL) evaluation included 36 AS patients and 39 healthy controls. They fulfilled the Ocular Surface Index Disease questionnaire and underwent the Schirmer I test, break-up time, vital staining, and conjunctival IC. A DED severity grade, as well as IC rating, was applied. Fourteen of these patients received TNFi and analysis of ocular and systemic AS disease parameters occurred at BL and three months (3 M), and 12 months (12 M) after treatment. The AS patients presented a higher frequency of DED (p = 0.01), a worse score of severity (p = 0.001), and a higher frequency of altered IC (p = 0.007) when compared to controls. The 14 patients under TNFi presented an improvement in all the clinical disease activity parameters throughout the one-year treatment (p < 0.05) even as a concomitant increase in the Schirmer test (p = 0.04), and a significant amelioration in the altered IC to a normal IC (p = 0.006). DED is a frequent and under-diagnosed ocular disease in AS patients. The long-term parallel improvement of disease activity and OS parameters in AS patients receiving TNFi suggests that the OS can be an additional target of systemic inflammation in AS.

CD34- Orbital Fibroblasts From Patients With Thyroid-Associated Ophthalmopathy Modulate TNF-α Expression in CD34+ Fibroblasts and Fibrocytes.

Purpose: Orbital fibroblasts from patients with Graves' disease (GD-OF) express many different cytokines when treated with bovine thyrotropin (bTSH). The present study aimed to determine why TNF-α cannot be induced by bTSH in GD-OF. Methods: Fibrocytes and GD-OFs were cultivated from donors who were patients in a busy academic medical center practice. Real-time PCR, Western blot analysis, reporter gene assays, cell transfections, mRNA stability assays, ELISA, and flow cytometry were performed. Results: We found that bTSH induces TNF-α dramatically in fibrocytes but is undetectable in GD-OF. The induction in fibrocytes is a consequence of increased TNF-α gene promoter activity and is independent of ongoing protein synthesis. It could be attenuated by dexamethasone and the IGF-1 receptor inhibiting antibody, teprotumumab. When separated into pure CD34+ OF and CD34- OF subsets, TNF-α mRNA became highly inducible by bTSH in CD34+ OF but remained undetectable in CD34- OF. Conditioned medium from CD34- OF inhibited induction of TNF-α in fibrocytes. Conclusions: Our data indicate that CD34- OF appear to release a soluble(s) factor that downregulates expression and induction by bTSH of TNF-α in fibrocytes and their derivative CD34+ OF. We proffer that CD34- OF produce an unidentified modulatory factor that attenuates TNF-α expression in GD-OF and may do so in the TAO orbit.

The "iatrogenic triad": polypharmacy, drug-drug interactions, and potentially inappropriate medications in older adults.

Background The elderly population is often in continuous use of several medications and is more subject to the "iatrogenic triad" of polypharmacy, potentially inappropriate medication use and drug-drug interactions. However, few studies have investigated these three factors concomitantly. Purpose To assess the prevalence and inter-relationship of potentially inappropriate medication (PIM) use, polypharmacy and drug-drug interactions in older adults, together with their associated factors. Setting city of Juiz de Fora, Brazil. Methods a cross-sectional, observational and door-to-door epidemiologic study in community-dwelling older adults was conducted. Main outcome measure The primary outcomes were polypharmacy, inappropriate medication use (2012 Beers and 2015 STOPP criteria) and drug-drug interactions. Associated factors were also investigated using bivariate and multivariate analyses. Results a total of 368 (92%) older adults were in continuous use of at least one drug. There was a high prevalence of polypharmacy (44.6%), drug-drug interaction (72.3%) and PIMs by Beers (42.1%) and PIMs by STOPP (46.2%). Analysis of the inter-relationship of the criteria (polypharmacy, PIMs STOPP and drug-drug interactions) revealed that 108 (29.3%) of the older adults had all three criteria concomitantly and multivariate analysis showed that frailty and having a caregiver were associated with this "iatrogenic triad". Conclusion A high prevalence of iatrogenic effects from drugs was found in the older adults assessed. One in every three elderly participants of the study had all three iatrogenic criteria concomitantly, highlighting the major public health impact of this problem. The results of this study can serve to inform new preventive and educational strategies for health professionals.

Comparison of four criteria for potentially inappropriate medications in Brazilian community-dwelling older adults.

AIM: To compare four potentially inappropriate medication (PIM) criteria from different regions of the world in terms of their characteristics, concordance, sensitivity, specificity and predictive values in a community-dwelling sample. METHODS: A cross-sectional, observational, epidemiological study was carried out by a door-to-door survey in a Brazilian city. The following PIM criteria were applied: Beers-2015, Screening Tool of Older People's Potentially Inappropriate Prescriptions (STOPP)-2015, The European Union (EU)(7)-PIM list and Taiwan criteria. The associations of criteria with the presence or absence of falls, hospitalizations and cognitive impairment were determined, and their sensitivity, specificity, positive predictive value, negative predictive value and concordance among the criteria were assessed. RESULTS: A total of 368 (92%) older adults were in continuous use of at least one drug. A high prevalence of PIM by Beers (50.0 %), STOPP (46.2%), EU(7)-PIM (59.5%) and Taiwan 31.3%) criteria was found. There was a high concordance among the PIM criteria (66.3-81.8%), and a moderate-to-high intraclass correlation between criteria (0.607-0.851). In general, the Taiwan criterion had lower levels of sensitivity (25.7-34.0%) and higher levels of specificity (67.8-70.3%), The EU(7)-PIM criteria had higher levels of sensitivity (60-75.3%) and lower levels of specificity (41.1-46.9%), whereas the Beers and STOPP had a more balanced sensitivity/specificity ratio (sensitivity: STOPP 50.7-55.3% and Beers 53.0-56.9 %; specificity: STOPP 56-56.6% and Beers 51.6-53.8%). CONCLUSIONS: The present study found moderate-to-high levels of concordance among the four PIM criteria assessed, pointing to a consensus in this field. However, each criterion showed particular characteristics: the EU(7)-PIM criterion had higher sensitivity, the Taiwan criterion higher specificity, and the Beers and STOPP a more balanced profile. These results highlight that each criterion has its own characteristics, and should be used according to health providers' objectives. Geriatr Gerontol Int 2017; 17: 1628-1635.

Update on thyroid-associated Ophthalmopathy with a special emphasis on the ocular surface.

Thyroid-associated ophthalmopathy (TAO) is a condition associated with a wide spectrum of ocular changes, usually in the context of the autoimmune syndrome, Graves' disease. In this topical review, we attempted to provide a roadmap of the recent advances in current understanding the pathogenesis of TAO, important aspects of its clinical presentation, its impact on the ocular surface, describe the tissue abnormalities frequently encountered, and describe how TAO is managed today. We also briefly review how increased understanding of the disease should culminate in improved therapies for patients with this vexing condition.

Speech rate and fluency in children with phonological disorder.

PURPOSE: To identify and describe the speech rate and fluency of children with phonological disorder (PD) with and without speech-language therapy. METHODS: Thirty children, aged 5-8 years old, both genders, were divided into three groups: experimental group 1 (G1) ­ 10 children with PD in intervention; experimental group 2 (G2) ­ 10 children with PD without intervention; and control group (CG) ­ 10 children with typical development. Speech samples were collected and analyzed according to parameters of specific protocol. RESULTS: The children in CG had higher number of words per minute compared to those in G1, which, in turn, performed better in this aspect compared to children in G2. Regarding the number of syllables per minute, the CG showed the best result. In this aspect, the children in G1 showed better results than those in G2. CONCLUSION: Comparing children's performance in the assessed groups regarding the tests, those with PD in intervention had higher time of speech sample and adequate speech rate, which may be indicative of greater auditory monitoring of their own speech as a result of the intervention.

Speech rate and fluency in children with phonological disorder / Velocidade e fluência de fala em crianças com distúrbio fonológico

PURPOSE: To identify and describe the speech rate and fluency of children with phonological disorder (PD) with and without speech-language therapy.METHODS: Thirty children, aged 5-8 years old, both genders, were divided into three groups: experimental group 1 (G1) - 10 children with PD in intervention; experimental group 2 (G2) - 10 children with PD without intervention; and control group (CG) - 10 children with typical development. Speech samples were collected and analyzed according to parameters of specific protocol.RESULTS: The children in CG had higher number of words per minute compared to those in G1, which, in turn, performed better in this aspect compared to children in G2. Regarding the number of syllables per minute, the CG showed the best result. In this aspect, the children in G1 showed better results than those in G2.CONCLUSION: Comparing children's performance in the assessed groups regarding the tests, those with PD in intervention had higher time of speech sample and adequate speech rate, which may be indicative of greater auditory monitoring of their own speech as a result of the intervention.

OBJETIVO: Verificar e descrever a velocidade e fluência de fala de crianças com Distúrbio Fonológico (DF) com e sem intervenção fonoaudiológica.MÉTODOS:30 crianças, 5 a 8 anos de idade, ambos os gêneros, sendo: Grupo experimental 1 (G1) - dez crianças com DF em intervenção; Grupo experimental 2 (G2) - dez crianças com DF sem intervenção; e Grupo controle (GC) - dez crianças com desenvolvimento típico. As amostras de fala foram coletadas e analisadas segundo parâmetros de protocolo específico da área.RESULTADOS: As crianças do GC apresentaram maior quantidade de palavras por minuto em comparação às crianças do G1, que, por sua vez, apresentaram melhor desempenho nesse aspecto em comparação às crianças do G2. Em relação à quantidade de sílabas por minuto, o GC foi o que apresentou melhor resultado. Nesse aspecto, as crianças do G1 apresentaram resultados melhores que os das crianças do G2.CONCLUSÃO: Comparando o desempenho das crianças dos grupos analisados nas provas aplicadas, as crianças com DF em intervenção apresentaram tempo maior de amostra de fala e velocidade de fala adequada, podendo ser indicativo de um maior monitoramento auditivo da própria fala como resultado da intervenção.

Enhancing the cross-cultural adaptation and validation process: linguistic and psychometric testing of the Brazilian-Portuguese version of a self-report measure for dry eye.

OBJECTIVES: To provide a reliable, validated, and culturally adapted instrument that may be used in monitoring dry eye in Brazilian patients and to discuss the strategies for the enhancement of the cross-cultural adaptation and validation process of a self-report measure for dry eye. METHODS: The cross-cultural adaptation process (CCAP) of the original Ocular Surface Disease Index (OSDI) into Brazilian-Portuguese was conducted using a 9-step guideline. The synthesis of translations was tested twice, for face and content validity, by different subjects (focus groups and cognitive interviews). The expert committee contributed on several steps, and back translations were based on the final rather than the prefinal version. For validation, the adapted version was applied in a prospective longitudinal study to 101 patients from the Dry Eye Clinic at the General Hospital of the University of São Paulo, Brazil. Simultaneously to the OSDI, patients answered the short form-36 health survey (SF-36) and the 25-item visual function questionnaire (VFQ-25) and underwent clinical evaluation. Internal consistency, test-retest reliability, and measure validity were assessed. RESULTS: Cronbach's alpha value of the cross-culturally adapted Brazilian-Portuguese version of the OSDI was 0.905, and the intraclass correlation coefficient was 0.801. There was a statistically significant difference between OSDI scores in patients with dry eye (41.15 ± 27.40) and without dry eye (17.88 ± 17.09). There was a negative association between OSDI and VFQ-25 total score (P < 0.01) and between the OSDI and five SF-36 domains. OSDI scores correlated positively with lissamine green and fluorescein staining scores (P < 0.001) and negatively with Schirmer test I and tear break-up time values (P < 0.001). CONCLUSION: Although most of the reviewed guidelines on CCAP involve well-defined steps (translation, synthesis/reconciliation, back translation, expert committee review, pretesting), the proposed methodological steps have not been applied in a uniform way. The translation and adaptation process requires skill, knowledge, experience, and a considerable investment of time to maximize the attainment of semantic, idiomatic, experiential, and conceptual equivalence between the source and target questionnaires. A well-established guideline resulted in a culturally adapted Brazilian-Portuguese version of the OSDI, tested and validated on a sample of Brazilian population, and proved to be a valid and reliable instrument for assessing patients with dry eye syndrome in Brazil.

Is dry eye an environmental disease?

Previous studies have revealed that eye contact with either air pollutants or adverse indoor and/or outdoor environmental conditions can affect tear film composition and ocular surface components. These effects are mediated by selective binding of the environmental agents to ocular surface membrane receptors, leading to activation of pro inflammatory signaling pathways. The aim of the current review was to examine the published evidence associated with environmental factors and ocular surface disease and dry eye. Specifically, the reader will appreciate why it is possible to refer to them as mediators of Environmental Dry Eye Disease (EDED), a singular clinical entity inside DED context, directly caused by pollutants and/ or adverse climatic conditions. The indicators and clinical findings are described along with EDE differential diagnosis in its acute and the chronic phases. Based on strong existing evidence of clinical reports and epidemiological observations regarding DED and environmental factors we conclude that there is a straight cause-and-effect relationship between ambient stresses and DED. International standards and web-based tools are described for monitoring worldwide environmental conditions referring localities and populations susceptible to EDED. This information is beneficial to health providers to pinpoint the individuals and predisposed groups afflicted with DED. Such insights may not only improve the understanding and treatment of DED but also help to identify the contributing factors and lower the frequency and progression of EDED.

O tratamento da dependência química e o ordenamento jurídico brasileiro / Treatment for chemical dependence and the Brazilian legal system / Le traitement de la dépendance chimique et le système juridique brésilien / El tratamiento de la dependencia química y el sistema jurídico brasileño

Este artigo procura relembrar a trajetória de exclusão provocada pelos tratamentos de dependência química no Brasil e apresenta as formas atuais de tratamentos que objetivam a reinserção social do usuário. Ademais, demonstra que o não cumprimento da política pública sobre o assunto, crenças irreais da população sobre uma forma milagrosa de cura e desconhecimento sobre a legislação e formas alternativas de tratamento, retomam, com novas roupagens, a segregação das pessoas que sofrem com a dependência química, permitindo internações desnecessárias, por ordem judicial e sem o devido processo legal.(AU)

This article seeks to re-discuss the process of exclusion caused by drug addiction treatments in Brazil and describes current forms of treatment that focus on the social integration of users. Furthermore, the authors show that failure to comply with public policies in the area, unrealistic beliefs of the population in miraculous cures and their unfamiliarity with alternative forms of treatment and the legislation, are repeating, in new garb, the age-old segregation of persons suffering from such dependence. Among other realities are frequent and unnecessary hospitalization, sometimes by court order and without due process of law.(AU)

Cet article vise à rappeler le cheminement vers l'exclusion provoquée par les types de traitement des toxicomanes au Brésil et présente les traitements actuels qui ont comme but l'intégration sociale de l'utilisateur. En outre, il démontre que la non-conformité avec les réglementations, les croyances irréalistes de la population sur une façon miraculeuse de guérison, la méconnaissance des lois et d'autres formes de traitement, reprennent, sous autre forme, la ségrégation des toxicomanes. Ces phénomènes finissent par légitimer des hospitalisations inutiles par ordonnance du tribunal et sans actions judiciaire correcte.(AU)

Este artículo busca recordar la trayectoria de exclusión causada por los tratamientos de dependencia química en Brasil y presenta las formas actuales de tratamientos que tienen como objetivo la reinserción social del usuario. Además, demuestra que el incumplimiento de la legislación sobre el tema, creencias irreales de la población en una forma milagrosa de cura y desconocimiento sobre la legislación y las formas alternativas de tratamiento, retoman con una nueva apariencia, la segregación de las personas que sufren de dependencia química, permitiendo internaciones desnecesarias, por orden judicial y sin el debido proceso jurídico.(AU)

Is dry eye an environmental disease? / O olho seco é uma doença relacionada a exposição ambiental?

Previous studies have revealed that eye contact with either air pollutants or adverse indoor and/or outdoor environmental conditions can affect tear film composition and ocular surface components. These effects are mediated by selective binding of the environmental agents to ocular surface membrane receptors, leading to activation of pro inflammatory signaling pathways. The aim of the current review was to examine the published evidence associated with environmental factors and ocular surface disease and dry eye. Specifically, the reader will appreciate why it is possible to refer to them as mediators of Environmental Dry Eye Disease (EDED), a singular clinical entity inside DED context, directly caused by pollutants and/ or adverse climatic conditions. The indicators and clinical findings are described along with EDE differential diagnosis in its acute and the chronic phases. Based on strong existing evidence of clinical reports and epidemiological observations regarding DED and environmental factors we conclude that there is a straight cause-and-effect relationship between ambient stresses and DED. International standards and web-based tools are described for monitoring worldwide environmental conditions referring localities and populations susceptible to EDED. This information is beneficial to health providers to pinpoint the individuals and predisposed groups afflicted with DED. Such insights may not only improve the understanding and treatment of DED but also help to identify the contributing factors and lower the frequency and progression of EDED.

Diversos estudos têm demostrado que o contato ocular com poluentes ambientais afeta a composição do filme lacrimal e de estruturas da superfície ocular. Tais efeitos são mediados pela ligação de agentes ambientais com receptores na superfície ocular, levando a ativação de mediadores pró inflamatórios. Esta revisão propõe uma avaliação das evidências publicadas, que associam fatores ambientais as doenças de superfície ocular e ao olho seco. O leitor compreenderá que é possível inferir olho seco ambiental como uma entidade singular dentro do contexto da doença olho seco, diretamente causado pela exposição a poluentes e/ou condições climáticas adversas. Serão descritos os indicadores e achados clínicos, assim como o diagnóstico diferencial das fases aguda e crônica. A avaliação de relatos clínicos e observações epidemiológicas demonstra uma forte associação entre olho seco e fatores ambientais. O conhecimento sobre parâmetros internacionais e ferramentas de monitorização das condições ambientais no mundo, permite identificar localidades e populações mais suceptívies ao olho seco ambiental e pode auxiliar na identificação de indivíduos acometidos e grupos predispostos. E desta forma, melhorar o entendimento e tratamento dessa condição, diminuir os fatores associados, sua frequência e progressão.

O tratamento da dependência química e o ordenamento jurídico brasileiro / Treatment for chemical dependence and the brazilian legal system / Le traitement de la dépendance chimique et le système juridique brésilien / El tratamiento de la dependencia química y el sistema jurídico brasileño

Este artigo procura relembrar a trajetória de exclusão provocada pelos tratamentos de dependência química no Brasil e apresenta as formas atuais de tratamentos que objetivam a reinserção social do usuário. Ademais, demonstra que o não cumprimento da política pública sobre o assunto, crenças irreais da população sobre uma forma milagrosa de cura e desconhecimento sobre a legislação e formas alternativas de tratamento, retomam, com novas roupagens, a segregação das pessoas que sofrem com a dependência química, permitindo internações desnecessárias, por ordem judicial e sem o devido processo legal.

This article seeks to re-discuss the process of exclusion caused by drug addiction treatments in Brazil and describes current forms of treatment that focus on the social integration of users. Furthermore, the authors show that failure to comply with public policies in the area, unrealistic beliefs of the population in miraculous cures and their unfamiliarity with alternative forms of treatment and the legislation, are repeating, in new garb, the age-old segregation of persons suffering from such dependence. Among other realities are frequent and unnecessary hospitalization, sometimes by court order and without due process of law.

Cet article vise à rappeler le cheminement vers l'exclusion provoquée par les types de traitement des toxicomanes au Brésil et présente les traitements actuels qui ont comme but l'intégration sociale de l'utilisateur. En outre, il démontre que la non-conformité avec les réglementations, les croyances irréalistes de la population sur une façon miraculeuse de guérison, la méconnaissance des lois et d'autres formes de traitement, reprennent, sous autre forme, la ségrégation des toxicomanes. Ces phénomènes finissent par légitimer des hospitalisations inutiles par ordonnance du tribunal et sans actions judiciaire correcte.

Este artículo busca recordar la trayectoria de exclusión causada por los tratamientos de dependencia química en Brasil y presenta las formas actuales de tratamientos que tienen como objetivo la reinserción social del usuario. Además, demuestra que el incumplimiento de la legislación sobre el tema, creencias irreales de la población en una forma milagrosa de cura y desconocimiento sobre la legislación y las formas alternativas de tratamiento, retoman con una nueva apariencia, la segregación de las personas que sufren de dependencia química, permitiendo internaciones desnecesarias, por orden judicial y sin el debido proceso jurídico.

Effects of ambient levels of traffic-derived air pollution on the ocular surface: analysis of symptoms, conjunctival goblet cell count and mucin 5AC gene expression.

PURPOSE: To quantify ocular symptoms, goblet cells (GC) and mucin 5AC (MUC5AC) gene expression on the conjunctiva of healthy subjects exposed to ambient levels of traffic-derived air pollution and to estimate its correlation with NO2 and particulate matter smaller than 2.5 µm (PM2.5) levels. METHODS: Twenty-one taxi drivers or traffic controllers were assessed with the Ocular Surface Disease Index (OSDI) questionnaire and conjunctival impression cytology. MUC5AC mRNA levels were determined based on the cytology of the right eye, and GC density was assessed based on the cytology of the left eye. Mean individual levels of 24-h NO2 and PM2.5 exposure were assessed the day before examination. Possible associations between NO2 or PM2.5 levels, OSDI scores, GC densities and MUC5AC mRNA levels were verified. RESULTS: The subjects were exposed to mean PM2.5 levels of 35±12 µg/m(3) and mean NO2 levels of 189±47 µg/m(3). OSDI scores were low (7.4±8) and GC densities were 521±257 and 782±322 cell/mm(2) on the bulbar and tarsal conjunctivas, respectively. The mean GC-derived MUC5AC mRNA expression was 14±7 fM/µg of total RNA. A significant and positive correlation was observed between MUC5AC mRNA levels and tarsal GC density (p=0.018). A trend toward association between PM2.5 levels and tarsal GC cell density (p=0.052) was found. CONCLUSION: Exposure to ambient levels of air pollution impacts conjunctival GC density. An increase in MUC5AC mRNA levels may be part of an adaptive ocular surface response to long-term exposure to air pollution.

Diesel exhaust particles selectively induce both proinflammatory cytokines and mucin production in cornea and conjunctiva human cell lines.

PURPOSE: To evaluate the effect of diesel exhaust particles (DEP) on the viability, proliferation, apoptosis, secretion of cytokines (IL-6, IL-8, and TNF-α), and mucin gene transcription (MUC1, MUC5AC, and MUC16) in human epithelial cells of the cornea (HCLE) and conjunctiva (IOBA-NHC). METHODS: HCLE and IOBA-NHC cells were incubated with DEP (10-500 µg/mL) for 24 hours. Cell proliferation was evaluated by the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay. Apoptotic cells were measured by an annexin V-FITC and propidium iodide kit for flow cytometry. Proinflammatory cytokines were determined by an ELISA kit. Mucin gene transcription was quantified by real-time PCR. RESULTS: DEP significantly decreased the viability, proliferation, and secretion of IL-8, but increased the secretion of IL-6 on both HCLE and IOBA-NHC cell lines in a dose-dependent manner. Neither cornea nor conjunctiva cells incubated with DEP released TNF-α. DEP induced a significant increase in the percentage of apoptotic cells in IOBA-NHC, whereas no changes were observed in HCLE. Finally, DEP significantly decreased the transcription levels of MUC1 and MUC16 in HCLE, but increased the transcription levels of MUC1, MUC5AC, and MUC16 in IOBA-NHC. CONCLUSIONS: These findings suggest that human corneal and conjunctival epithelial cells incubated with DEP showed cytotoxicity and an inflammatory response mediated by IL-6, not by TNF-α or IL-8. Also, the decrease in mucin expression in the cornea cells might leave exposed areas in the cornea for contact with DEP. Finally, the increase in mucin expression in the conjunctiva cells might be involved at least in the clearance of DEP to protect the ocular epithelium.

Correlation between signs and symptoms of ocular surface dysfunction and tear osmolarity with ambient levels of air pollution in a large metropolitan area.

PURPOSE: To evaluate the effect of high levels of environmental air pollution on tear osmolarity and its possible correlation with clinical signs and symptoms. METHODS: This was a panel study involving 71 taxi drivers and traffic controllers from São Paulo, Brazil. Mean individual levels of 24-hour exposure to nitrogen dioxide (NO2) and particulate matter smaller than 2.5 µm (PM2.5) were assessed on 4 different occasions. On the first and third visits, subjects were submitted to clinical evaluations including the administration of the Ocular Surface Disease Index questionnaire, slit-lamp examination, estimation of tear breakup time (BUT), the Schirmer test, and vital staining of the cornea and conjunctiva. On the second and fourth visits, tear samples were collected for osmolarity assays. Statistical analysis was performed using generalized estimating equations. RESULTS: Although the taxi drivers and traffic controllers in our sample were exposed to high levels of NO2 and PM2.5, few symptoms were reported on the Ocular Surface Disease Index questionnaire. BUT values were reduced, whereas vital staining and Schirmer test mean results were within normal limits, despite considerable variability. A significant and negative correlation was found between PM2.5 levels and tear film osmolarity levels (P < 0.05). An increase of 10 µg/m(3) in PM2.5 was associated with a 10.9 mOsm/kg decrease in tear osmolarity. There also was a negative correlation, although not statistically significant, between NO2 and tear osmolarity. CONCLUSIONS: Exposure to air pollution reduces tear film stability and influences tear film osmolarity. Combining clinical examination with the assessment of tear osmolarity may help understand ocular surface response to high levels of air pollution.

Ocular surface adverse effects of ambient levels of air pollution.

It is widely recognized today that outdoor air pollution can affect human health. Various chemical components that are present in ambient pollution may have an irritant effect on the mucous membranes of the body, particularly those of the respiratory tract. Much less attention has been focused on the adverse effect on the ocular surface, despite the fact that this structure is even more exposed to air pollution than the respiratory mucosa since only a very thin tear film separates the corneal and conjunctival epithelia from the air pollutants. So far, clinical data are the more widespread tools used by ophthalmologists for assessing possible aggression to the ocular surface; however, clinical findings alone appears not to correlate properly with the complaints presented by the patients pointing out the need for further clinical and laboratory studies on the subject. The purpose of this study is to review signs and symptoms associated with chronic long-term exposure to environmental air pollutants on the ocular structures currently defined as the ocular surface and to review clinical and laboratory tests used to investigate the adverse effects of air pollutants on such structures. We also review previous studies that investigated the adverse effects of air pollution on the ocular surface and discuss the need for further investigation on the subject.

Ocular surface adverse effects of ambient levels of air pollution / Efeitos adversos na superfície ocular relacionados à poluição ambiental

It is widely recognized today that outdoor air pollution can affect human health. Various chemical components that are present in ambient pollution may have an irritant effect on the mucous membranes of the body, particularly those of the respiratory tract. Much less attention has been focused on the adverse effect on the ocular surface, despite the fact that this structure is even more exposed to air pollution than the respiratory mucosa since only a very thin tear film separates the corneal and conjunctival epithelia from the air pollutants. So far, clinical data are the more widespread tools used by ophthalmologists for assessing possible aggression to the ocular surface; however, clinical findings alone appears not to correlate properly with the complaints presented by the patients pointing out the need for further clinical and laboratory studies on the subject. The purpose of this study is to review signs and symptoms associated with chronic long-term exposure to environmental air pollutants on the ocular structures currently defined as the ocular surface and to review clinical and laboratory tests used to investigate the adverse effects of air pollutants on such structures. We also review previous studies that investigated the adverse effects of air pollution on the ocular surface and discuss the need for further investigation on the subject.

Sabe-se hoje que a poluição ambiental pode afetar a saúde humana. Vários componentes químicos presentes na poluição atmosférica podem acarretar uma irritação nas mucosas, particularmente no trato respiratório. Pouca ênfase tem sido dada à superfície ocular, embora esta estrutura seja até mais exposta à poluição ambiental do que o trato respiratório visto que apenas uma fina camada de filme lacrimal separa a córnea e a conjuntiva dos poluentes presentes no ar. Até o momento, a avaliação clínica é o método mais utilizado pelos oftalmologistas para se detectar uma possível agressão à superfície ocular; entretanto esta avaliação apenas não parece correlacionar-se com as queixas e sinais apresentados pelos pacientes demonstrando a necessidade de mais estudos clínicos e laboratoriais sobre o assunto. O objetivo deste estudo é revisar os sinais e sintomas associados à exposição crônica aos poluentes ambientais no ar nas estruturas oculares definidas atualmente como superfície ocular e revisar os testes clínicos e laboratoriais usados para investigar os efeitos adversos dos poluentes em tais estruturas. Também revisamos estudos prévios que analisaram os efeitos adversos da poluição do ar na superfície ocular e discutimos a necessidade de mais estudos sobre o assunto.