Would Ancylostoma caninum be one of the agents of diffuse unilateral subacute neuroretinitis (D.U.S.N) in Brazil?

The autors present a confirmed case of diffuse unilateral subacute neuroretinitis (D.U.S.N.) with identification of the worm in a 6-year-old child with symptoms of cutaneous larva migrans, as well as analysis of 7 other cases of D.U.S.N. and association with cutaneous larva migrans or positive sorology for Toxocara canis. This is the first described case in the literature of the association between D.U.S.N. and cutaneous larva migrans in its active form.Os autores apresentam um caso de neurorretinite subaguda difusa unilateral (D.U.S.N) confirmada com a identificação da larva em uma criança de 6 anos associada a quadro de larva migrans cutânea, bem como a análise de outros sete casos de D.U.S.N. e sua associação sorológica à toxocaríase e antecedentes de larva migrans cutânea. Este é o primeiro caso descrito na literatura de D.U.S.N. concomitante a larva migrans cutânea na fase ativa.Universidade Estadual de Londrina Setor de OftalmologiaUNIFESP-EPM Departamento de OftalmologiaUNIFESP, EPM, Depto. de OftalmologiaSciEL

Idiopathic Macular Hole: Algorithm for Nonsurgical Closure Based on Literature Review

Our purpose is to review the closure time and optical coherence tomography (OCT) biomarkers that result in the non-surgical repair of idiopathic full-thickness macular holes (IFTMH). Our methodology consisted of a comprehensive literature review of the nonsurgical resolution of IFTMH followed by the calculation of the estimated closure time using the structural equation model. Forty-nine studies were found eligible yielding 181 eyes with IFTMH: 81.1% being small holes (<250 μm) with a median diameter of 166 μm. Final vision (mean 20/41) was related to initial vision (mean 20/65) and mean age (67 years). The hole diameter was correlated with initial vision and closure time (mean 3.9 months). Closure time was related to hole diameter and initial vision in the following algorithm: Closure time (month)= −0.057 + 0.008 diameter (μm) + 0.021 age (year) + 2.153 initial vision (logMAR). Biomarkers by OCT for self-closure included in decreasing frequency: pointed edge, de-turgescence of cystic macular edema (CME) with reversal of bascule bridge, and vitreomacular traction (VMT) release. The crucial function of Muller cell bridging in sealing the hole attests to its exceptional capacity for regeneration. After the hole has begun to close; however in less than 5%, a delayed restoration of the ellipsoid layer or a persistent outer foveal defect may prevent visual recovery and reopening of the hole is possible. In conclusion, eyes with small-size IFTMH and good baseline vision can have the additional option of close OCT monitoring for biomarkers of self-sealing biomarkers. When rehabilitative activity seems to be lacking, surgery is therefore mandatory

Sympathetic ophthalmia - histopathological correlation with fluorescein and indocyanine green angiography: case report Oftalmia simpática - correlação da histopatologia com a angiografia por fluoresceína e indocianina verde: relato de caso

This study correlates fluorescein angiography (FA) and indocyanine green angiography (ICGA) to histopathologic findings in a patient with sympathetic ophtalmia. A male with a perforated trauma in right eye presented after two months a decrease in visual acuity of the left eye. FA and ICGA were performed and the images were correlated with the histopathologic findings of the enucleated eye; FA showed background areas of homogeneous hypofluorescence in the arterial and venous phases, as well as areas of granular progressive hyperfluorescence and leakage from the optic disc. ICGA showed areas of hypofluorescence in the early and intermediate phases of the examination, which persisted until the late phase. During the early phase, there was also diffuse hypofluorescence caused by blockage that allowed observation of areas of partial choroidal circulation. The histopathology of the enucleated right eye showed diffuse choriocapillaris edema and inflammation of the choroids, focal areas of hyperplasia of the retinal pigment epithelium (RPE) as well as foci of epithelioid cells located between the choroid and the RPE. Furthermore, lymphocytic infiltration of the episcleral veins and retinal detachment were present. The hyperfluorescence observed on FA was correlated to retinal detachment and optic nerve inflammation. The hypofluorescence noted on FA and ICGA corresponded to the presence of blocking inflammatory cells (Dalen-Fuchs-like nodules) and to diffuse choriocapillaris edema.<br>O objetivo deste relato de caso foi correlacionar achados da histopatologia com a angiografia por fluoresceína (AF) e por indocianina verde (AIV) em um paciente com oftalmia simpática. Após dois meses de trauma perfurante no olho direito, o paciente apresentou baixa acuidade visual no olho esquerdo (OE). A AF do OE mostrou áreas de hipofluorescência homogênea na fase arterial e venosa, áreas de progressiva hiperfluorescência granular e vazamento do disco. A AIV mostrou áreas de hipofluorescência na fase inicial à tardia. A histopatologia foi realizada após evisceração do olho direito e demonstrou difuso edema da coriocapilar, inflamação da coróide, áreas focais de hiperplasia do epitélio pigmentar da retina, focos de células epitelióides entre a coróide e o epitélio pigmentar da retina, além da infiltração linfocitária das veias episclerais e descolamento de retina. A hiperfluorescência observada na AF foi correlacionada com o descolamento de retina e inflamação do nervo óptico. A hipofluorescência na AF e AIV correspondeu à presença de células inflamatórias (nódulos de Dalen-Fuchs) e edema coriocapilar difuso

Acidúria glutárica tipo 1: variabilidade fenotípica. Estudo de seis pacientes

Estudamos seis pacientes com acidúria glutárica tipo I, em quatro famílias. Observamos variações intensas na apresentação clínica, mesmo entre elementos da mesma família. Três pacientes evoluiram sem alterações até o início das anomalias neurológicas, que se manifestaram como encefalite-símile, no primeiro ano de vida. Uma criança apresentou atraso precoce do desenvolvimento, sem episódios agudos de descompensação. Dois pacientes não têm alteração cognitiva; um deles apresenta leve tremor associado a quadro coreoatetóide desde o primeiro ano de vida, enquanto o outro teve apenas duas crises convulsivas afebris quando lactente. Três crianças apresentam distonia como sequela, não sendo capazes de sentar ou firmar a cabeça. Os seis pacientes apresentam macrocrania e a neles tomografia computatorizada de crânio demonstra aumento dos espaços liquóricos em regiões fronto-temporais. O estudo dos ácidos orgânicos urinários dos pacientes demonstra elevação dos níveis do ácido glutárico

Congenital toxoplasmosis in a reference center of Paraná, Southern Brazil

This study describes the characteristics of 31 children with congenital toxoplasmosis children admitted to the University Hospital of Londrina, Southern Brazil, from 2000 to 2010. In total, 23 (85.2%) of the mothers received prenatal care but only four (13.0%) were treated for toxoplasmosis. Birth weight was <2500 g in 37.9% of the infants. During the first month of life, physical examination was normal in 34.5%, and for those with clinical signs and symptoms, the main manifestations were hepatomegaly and/or splenomegaly (62.1%), jaundice (13.8%), and microcephaly (6.9%). During ophthalmic examination, 74.2% of the children exhibited injuries, 58.1% chorioretinitis, 32.3% strabismus, 19.4% microphthalmia, and 16.2% vitreitis. Anti-Toxoplasma gondii IgM antibodies were detected in 48.3% of the children. Imaging brain evaluation was normal in 44.8%; brain calcifications, hydrocephaly, or both conditions were observed in 27.6%, 10.3%, and 17.2%, respectively, of the patients. Patients with cerebrospinal fluid protein > 200 mg/dL presented more brain calcifications (p = 0.0325). Other sequelae were visual impairment (55.2% of the cases), developmental delay (31.0%), motor deficit (13.8%), convulsion (27.5%), and attention deficit (10.3%). All patients were treated with sulfadiazine, pyrimethamine, and folinic acid, and 55.2% of them exhibited adverse effects. The results demonstrate the significance of the early diagnosis and treatment of toxoplasmosis during pregnancy to reduce congenital toxoplasmosis and its consequences