Interventions to improve adherence to tuberculosis treatment: systematic review and meta-analysis.

SETTING: One of the most serious problems in tuberculosis (TB) control is non-adherence to treatment. Several strategies have been developed to improve adherence and increase the cure rate. OBJECTIVE: To systematically review interventions to improve adherence to anti-tuberculosis treatment. DESIGN: We performed a systematic review and meta-analysis of 22 randomised clinical trials (RCTs) to ascertain whether providing directly observed treatment, short-course (DOTS), financial incentives, food incentives and/or patient education/counselling improved adherence to anti-tuberculosis treatment. The primary outcome was cure rate; secondary outcomes were default and mortality rates. Sources used were Medline (accessed via PubMed), Cochrane Central, LILACS (Literatura Latino Americana em Ciências da Saúde, Latin American and Caribbean Health Sciences Literature) and Embase from inception to October 2015. RESULTS: A significant increase in cure rates, by 18% with DOTS and by 16% with patient education and counselling, was observed. In addition, the default rate decreased by 49% with DOTS, by 26% with financial incentives and by 13% with patient education and counselling. There was no statistically significant reduction in mortality rates with these interventions. CONCLUSION: Use of DOTS and patient education/counselling significantly improved cure rates; DOTS, patient education/counselling and financial incentives led to a reduction in the default rate.

Adult blindness secondary to vitamin A deficiency associated with an eating disorder.

OBJECTIVE: We examined an adult patient who lost one eye due to severe keratomalacia secondary to self-induced vitamin A deficiency. METHODS: This case report provides a clinical, ophthalmologic, and laboratory description in addition to a review of the medical literature. RESULTS: A 33-y-old woman with a 17-y history of an eating disorder presented with bilateral conjunctival xerosis, an infected corneal ulcer in the right eye and a large descemetocele in the left eye. Laboratory and clinical findings were consistent with vitamin A deficiency. Despite a tectonic penetrating keratoplasty, her left eye perforated and had to be eviscerated. In parallel, vitamin A replacement improved her clinical status and the ocular findings in her right eye. CONCLUSIONS: The present report indicates that vitamin A deficiency secondary to eating disorders should be considered in the differential diagnosis of patients with severe dry eye and corneal ulceration.

Conjunctival keratoacanthoma.

Keratoacanthoma generally occurs on the skin; it is rarely found in the conjunctiva. A case of a 34-year-old woman with a rapidly growing conjunctival mass is reported. The tumor was excised with a safety margin to exclude squamous cell carcinoma. Histopathologically it was crateriform and consistent with atypical keratoacanthoma. There has been no recurrence in 2 years of follow-up. Conjunctival keratoacanthoma is rare; differential diagnosis of conventional squamous cell carcinoma and keratoacanthoma can be difficult. We recommend complete surgical excision and careful follow-up of crateriform squamous proliferations.

Septo-optic dysplasia: case report

The clinical triad of septo-optic dysplasia (SOD) comprises the abscence of the septum pellucidum, congenital optic nerve dysplasia, and multiple endocrine disorders. When any two of these factors are present, the condition is defined as an imcomplete form of SOD. The authors report the case of an imcomplete form of SOD in a 9-year old boy with low vision and nystagmus present from birth. The bilateral ophthalmoscopic examination revealed small papillae with double countour images. Magnetic resonance imaging showed hypoplasia of the optic nerve bilaterally, chiasm and absence of the septum pellucidum.

Upper eyelid oedema in Melkersson-Rosenthal syndrome.

Melkersson-Rosenthal syndrome is an uncommon disorder of uncertain aetiology characterized by orofacial oedema, facial nerve palsy and lingua plicata. The triad is seldom seen in its complete form, and oligo-symptomatic or mono-symptomatic forms are more common. An unusual case of Melkersson-Rosenthal syndrome involving the left upper eyelid is presented. The pathology, clinical features and management of this disorder are discussed.

Conjunctival keratoacanthoma

Ceratoacantoma geralmente ocorre na pele e raramente é encontrado na conjuntiva. Relatamos um caso de uma mulher de 34 anos que apresentou uma massa conjuntival de rápido crescimento. O tumor foi retirado com margem de segurança para excluir carcinoma de células escamosas. Ao exame histopatológico, o tumor apresentou configuração crateriforme, sendo consistente com ceratoacantoma atípico. Não houve recorrência após dois anos de seguimento. Ceratoacantoma conjuntival é uma doença rara. Um diagnóstico diferencial entre carcinoma de células escamosas e ceratoacantoma pode ser difícil. Recomendamos total remoção e seguimento cuidadoso de pacientes com lesões escamosas crateriformes.

Morning glory syndrome associated with posterior pituitary ectopia and hypopituitarism.

PURPOSE: To report a patient with morning glory syndrome in combination with posterior pituitary ectopia and to emphasize the need for early recognition of this syndrome as an important step towards the diagnosis and treatment of the systemic anomalies that may be associated with it. METHODS: We present a 7-year-old boy who showed short stature, nystagmus, inward deviation and low vision. Ophthalmological and general physical examinations, further endocrine evaluation and magnetic resonance imaging (MRI) of the brain and sella turcica were performed. RESULTS: Both fundi showed symptoms of morning glory syndrome. The discs were pink and deeply excavated, and were surrounded by a ring of chorioretinal pigmentary disturbance. Magnetic resonance imaging revealed the absence of the infundibulum and posterior pituitary ectopia. Growth hormone studies confirmed the diagnosis of growth hormone deficiency. Therapy with recombinant human growth hormone was initiated. CONCLUSIONS: Although most cases of morning glory syndrome occur as isolated ocular abnormalities, it may occur in association with systemic anomalies, including posterior pituitary ectopia and hypopituitarism. A complete general physical examination and growth evaluation is important for early detection and treatment, resulting in benefit for these patients.

Endophthalmitis caused by Agrobacterium radiobacter.

Infections due to Agrobacterium radiobacter are rare. This study reports 2 cases of A. radiobacter endophthalmitis. To the authors' knowledge, these are only the second and third reported cases of endophthalmitis caused by this Gram-negative rod.

Tratamento cirúrgico da fratura-luxaçäo de Lisfranc / Surgical treatment of Lisfranc fracture dislocation

Os autores apresentam o estudo crítico de 16 pacientes (16 pTs) com fratura-luxaçäo da articulaçäo de Lisfranc tratados pelo método cruento através de incisöes longitudinais e fixaçäo com fios de Kirschner. Os deslocamentos da junta de Lisfranc säo ferimentos que apresentam grande potencial para incapacidade crônica quando näo diagnosticados e tratados de maneira correta. Discutem neste trabalho os aspectos clínicos, anatômicos e radiográficos para avaliaçäo do diagnóstico e detalhes da técnica cirúrgica, evoluçäo e complicaçöes. Obtiveram 80 por cento de bons resultados com o tratamento cruento. Os casos considerados como maus geralmente se associam a cominuiçäo da fratura, lesöes de partes moles ou reduçäo anatômica inadequada. Concluem que o melhor tratamento para as lesöes de Lisfranc é a reduçäo aberta com fixaçäo das fraturas por meios de fios de Kirschner ou parafusos.