Epidemiologia e previsibilidade no diagnóstico clínico de ceratite microbiana no sudeste do Brasil

PURPOSE: The goals of the study were the following: 1) to show the epidemiology of microbial keratitis (MK) in the southeast Brazil, 2) to compare the epidemiological differences between fungal (FK) and bacterial keratitis (BK), and 3) to evaluate the frequency which ophthalmologists accurately differentiate bacterial keratitis from fungal keratitis based on clinical diagnosis. METHODS: A retrospective chart analysis of all clinically diagnosed microbial keratitis patients presenting between October, 2003 and September, 2006 was performed. Demographic features, ocular and laboratory findings, and information regarding the risk factors and clinical evolution were recorded. RESULTS: Among 118 consecutive patients with a clinical diagnosis of microbial keratitis, the positive culture rate was 61%. The predominant bacterial and fungal pathogens isolated were S. epidermidis and Fusarium spp. Prior corneal injury was more frequent among fungal keratitis than bacterial keratitis cases (p<0.0001). Coexisting systemic diseases, ocular diseases, and previous ocular surgery were more frequent among BK cases (p=0.001; p=0.001; p=0.004; respectively). The following clinical findings were more frequent in bacterial keratitis: hypopion, corneal peripheral superficial vascularisation, and ulceration area &gt;20 mm² (p<0.05). The diagnosis was predicted correctly in 81.6% of bacterial keratitis cases and in 48.1% of fungal keratitis cases. CONCLUSION: Medical judgment of microbial keratitis agent is possible based on clinical and epidemiological data, but it is more difficult for fungal infection. Thus, such data cannot be the only basis for the diagnosis of suspected microbial keratitis, but oriented clinical suspicion based on these data may be beneficial for guiding antimicrobial treatment and earlier therapy.OBJETIVO: Os objetivos deste estudo foram os seguintes: 1) mostrar epidemiologia da ceratite microbiana (CM) no sudeste do Brasil, 2) para comparar as diferenças epidemiológicas entre ceratites fúngicas (CF) e bacterianas (CB) e 3) avaliar a frequência com que os oftalmologistas distinguem com precisão ceratite fúngica de ceratite bacteriana baseado no diagnóstico clínico. MÉTODOS: Uma análise retrospectiva de todas as ceratites microbianas diagnosticadas clinicamente apresentando entre outubro de 2003 e setembro de 2006 foi realizada. As características demográficas, relativas ocular e de laboratório, e informações aos fatores de risco e evolução clínica foram registrados. RESULTADOS: Dentre 118 pacientes consecutivos com diagnóstico clínico de ceratite microbiana, a taxa de cultura positiva foi de 61%. Os patógenos predominantes de bactérias e fungos isolados foram S. epidermidis e Fusarium spp. O trauma de córnea foi mais frequente entre os casos de ceratite fúngica do que ceratite bacteriana (p<0,0001). A coexistência de doenças sistêmicas, doenças oculares e cirurgia ocular prévia foram mais frequentes entre os casos de ceratite bacteriana (p=0,001, p=0,001, p=0,004, respectivamente). Os seguintes achados clínicos foram mais frequentes em ceratite bacteriana: hipópio, vascularização periférica da córnea superficial e área de ulceração &gt;20 mm² (p<0,05). O diagnóstico foi corretamente estimado em 81,6% dos casos de CB e em 48,1% dos casos de CF. CONCLUSÃO: A presunção clínica do agente da ceratite microbiana é possível baseada em dados clínicos e epidemiológicos, mas é mais difícil para infecção fúngica. Assim, esses dados não podem ser a única base para o diagnóstico de suspeita de ceratite microbiana, mas a suspeita clínica orientada com base nesses dados pode ser benéfica para orientar o tratamento antimicrobiano e terapia precoce.CNP

Epidemiologia e previsibilidade no diagnóstico clínico de ceratite microbiana no sudeste do Brasil

The goals of the study were the following: 1) to show the epidemiology of microbial keratitis (MK) in the southeast Brazil, 2) to compare the epidemiological differences between fungal (FK) and bacterial keratitis (BK), and 3) to evaluate the frequency which ophthalmologists accurately differentiate bacterial keratitis from fungal keratitis based on clinical diagnosis. A retrospective chart analysis of all clinically diagnosed microbial keratitis patients presenting between October, 2003 and September, 2006 was performed. Demographic features, ocular and laboratory findings, and information regarding the risk factors and clinical evolution were recorded. Among 118 consecutive patients with a clinical diagnosis of microbial keratitis, the positive culture rate was 61%. The predominant bacterial and fungal pathogens isolated were S. epidermidis and Fusarium spp. Prior corneal injury was more frequent among fungal keratitis than bacterial keratitis cases (p20 mm2 (p20 mm2 (p<0,05). O diagnóstico foi corretamente estimado em 81,6% dos casos de CB e em 48,1% dos casos de CF. A presunção clínica do agente da ceratite microbiana é possível baseada em dados clínicos e epidemiológicos, mas é mais difícil para infecção fúngica. Assim, esses dados não podem ser a única base para o diagnóstico de suspeita de ceratite microbiana, mas a suspeita clínica orientada com base nesses dados pode ser benéfica para orientar o tratamento antimicrobiano e terapia precoc

Alterações nos vícios refracionais em crianças com exotropia intermitente submetidas ao tratamento por meio da hipercorreção com lentes negativas

PURPOSE: Intermittent exotropia may be decreased by stimulation of accommodative convergence. Once excessive accommodation has been related to myopia, our objective was to evaluate refractive errors changes in children under overcorrecting minus lens therapy. METHODS: A retrospective chart review of 21 children with intermittent exotropia was performed. All patients were treated with occlusion, and a 13-patient subset of them received overminus lens therapy (group A). Eight children received spectacles as necessary (group B). Initial age, age interval, initial spherical equivalent (SE), and magnitude of overcorrection were considered as co-variables of the mean variation in refractive error (SE of each eye) between groups, through a multivariate analysis. RESULTS: Overcorrection used in group A ranged from 0.5 D to 3.5 D (2.46 ± 0.87 D). Although initial SE of each eye was significant different between group A and B (OD - p=0.02; OS - p=0.01), initial age (p=0.69), age interval (p=0.90), and mean variation in refractive errors (p=0.36) did not differ between groups. Multivariate analysis with linear regression showed no significantly difference regarding all co-variables enrolled. CONCLUSIONS: Treatment of intermittent exotropia with overcorrecting minus lens did not induce refractive errors changes, even considering age, treatment period, initial spherical equivalent and overcorrection magnitude used.OBJETIVO: A exotropia intermitente pode ser diminuída pela estimulação da convergência acomodativa. Uma vez que uma acomodação excessiva tem sido relacionada à miopização, o objetivo deste trabalho foi o de avaliar alterações nos vícios de refração de crianças submetidas à hipercorreção com lentes negativas. MÉTODOS: Foi realizada revisão dos prontuários de 21 crianças com exotropia intermitente. Todos os pacientes foram tratados com oclusão, sendo que 13 deles foram submetidos à hipercorreção com lentes negativas (grupo A). As 8 crianças restantes receberam prescrições ópticas conforme necessário pelas suas ametropias (grupo B). A idade inicial, tempo de tratamento, equivalente esférico (EE) inicial e magnitude da hipercorreção foram considerados como covariáveis na análise das diferenças das médias de erro refrativo (EE de cada olho) entre os grupos, pela análise multivariada. RESULTADOS: A hipercorreção utilizada no grupo A variou entre 0,5 D e 3,5 D (2,46 ± 0,87 D). Embora o EE inicial de cada olho ter sido significativamente diferente entre os grupo A e B (olho direito - p=0,02; olho esquerdo - p=0,01), a idade inicial (p=0,69), o tempo de tratamento (p=0,90) e a variação média nos erros refrativos (p=0,36) não diferiram entre os grupos. A análise multivariada com regressão linear não mostrou diferença significativa, considerando as covariáveis em questão. CONCLUSÕES: O tratamento de crianças com exotropia intermitente por meio de hipercorreção óptica com lentes negativas não induziu alterações nos vícios de refração, mesmo considerando fatores como idade inicial, o tempo de tratamento, equivalente esférico inicial e a magnitude da hipercorreção utilizada

O pensamento da CEPAL de 2010 a 2018: o enfoque na Mudança Estrutural Produtiva para Igualdade (MEPI)

O artigo tem como unidade de análise a Comissão Econômica para América Latina e Caribe das Nações Unidas (CEPAL/ONU). O objetivo é de investigar a atual fase de seu pensamento com expressivo enfoque na igualdade. A pesquisa categoriza o pensamento cepalino em duas fases distintas: 1º Estado-empreendedor e método histórico-estruturalista (1948 – 1990) e 2º Estado-gerencial e método histórico-neoestruturalista (1990 – atualidade). A hipótese elencada é de que o pensamento cepalino desde 2010 se afastou da proposta de Transformação Produtiva com Equidade (TPE) – defendido, inicialmente, pelo neoestruturalismo – e está estabelecendo uma nova concepção: Mudança Estrutural Produtiva para Igualdade (MEPI) A pesquisa optou em priorizar como procedimentos técnicos uma abordagem sistemática por meio da avaliação crítica dos dados bibliográficos e documentais sobre a temática, sobretudo os próprios documentos produzidos pela CEPAL

Role of T. cruzi exposure in the pattern of T cell cytokines among chronically infected HIV and Chagas disease patients

OBJECTIVES: The impact of Chagas disease (CD) in HIV-infected patients is relevant throughout the world. In fact, the characterization of the adaptive immune response in the context of co-infection is important for predicting the need for interventions in areas in which HIV and Chagas disease co-exist. METHODS: We described and compared the frequency of cytokine-producing T cells stimulated with soluble antigen of Trypanosoma cruzi (T. cruzi) using a cytometric assay for the following groups: individuals with chronic Chagas disease (CHR, n=10), those with Chagas disease and HIV infection (CO, n=11), those with only HIV (HIV, n=14) and healthy individuals (C, n=15). RESULTS: We found 1) a constitutively lower frequency of IL-2+ and IFN-γ+ T cells in the CHR group compared with the HIV, CO and healthy groups; 2) a suppressive activity of soluble T. cruzi antigen, which down-regulated IL-2+CD4+ and IFN-γ+CD4+ phenotypes, notably in the healthy group; 3) a down-regulation of inflammatory cytokines on CD8+ T cells in the indeterminate form of Chagas disease; and 4) a significant increase in IL-10+CD8+ cells distinguishing the indeterminate form from the cardiac/digestive form of Chagas disease, even in the presence of HIV infection. CONCLUSIONS: Taken together, our data suggest the presence of an immunoregulatory response in chronic Chagas disease, which seems to be driven by T. cruzi antigens. Our findings provide new insights into immunotherapeutic strategies for people living with HIV/AIDS and Chagas disease

A New Method to Predict the Epidemiology of Fungal Keratitis by Monitoring the Sales Distribution of Antifungal Eye Drops in Brazil

Purpose: Fungi are a major cause of keratitis, although few medications are licensed for their treatment. The aim of this study is to observe the variation in commercialisation of antifungal eye drops, and to predict the seasonal distribution of fungal keratitis in Brazil. Methods: Data from a retrospective study of antifungal eye drops sales from the only pharmaceutical ophthalmologic laboratory, authorized to dispense them in Brazil (Opthalmos) were gathered. These data were correlated with geographic and seasonal distribution of fungal keratitis in Brazil between July 2002 and June 2008. Results: A total of 26,087 antifungal eye drop units were sold, with a mean of 2.3 per patient. There was significant variation in antifungal sales during the year (p &lt; 0.01). A linear regression model displayed a significant association between reduced relative humidity and antifungal drug sales (R-2 = 0.17, p &lt; 0.01). Conclusions: Antifungal eye drops sales suggest that there is a seasonal distribution of fungal keratitis. A possible interpretation is that the third quarter of the year (a period when the climate is drier), when agricultural activity is more intense in Brazil, suggests a correlation with a higher incidence of fungal keratitis. A similar model could be applied to other diseases, that are managed with unique, or few, and monitorable medications to predict epidemiological aspects.Conselho Nacional de Desenvolvimento Cientifico e TecnologicoConselho Nacional de Desenvolvimento Cientifico e Tecnologico [302005/2009-9]Fundacao de Apoio ao Ensino, Pesquisa e Assistencia do Hospital das Clinicas da Faculdade de Medicina de Ribeirao Preto da Universidade de Sao PauloFundacao de Apoio ao Ensino, Pesquisa e Assistencia do Hospital das Clinicas da Faculdade de Medicina de Ribeirao Preto da Universidade de Sao Paul

Fabrication and characterisation of electrospun silk fibroin/gelatin scaffolds crosslinked with glutaraldehyde vapour

Bombyx mori silk fibroin (SF) /gelatin nanofibre mats with different blend ratios of 100/0, 90/10 and 70/30 were prepared by electrospinning and crosslinked with glutaraldehyde (GTA) vapour at room temperature. GTA was shown to induce the conformational transition of SFs from random coils to β-sheets along with increasing nanofibre diameters with the addition of gelatin into SFs. It was found that by increasing the gelatin content, crosslinking degree was enhanced from 34% for pure SF nanofibre mats to 43% for SF/gelatin counterparts at the blend ratio of 70/30, which directly affected mechanical properties, porosity, and water uptake capacity (WUC) of prepared nanofibre mats. The addition of 10 and 30 wt% gelatin into SFs improved tensile strengths of SF/gelatin nanofibre mats by 10 and 27% along with significant increases in Young’s modulus by 1.1 and 1.3 times, respectively, as opposed to plain SF counterparts. However, both porosity and WUC were found to decrease from 62 and 405% for pristine SF nanofibre mats to 47% and 232% for SF/gelatin counterparts at the blend ratio of 70/30 accordingly. To further evaluate the combined effect of GTA crosslinking and gelatin content on biological response of SF/gelatin scaffolds, the proliferation assay using 3T3 mouse fibroblast was conducted. In comparison with pure SFs, cell proliferation rate was lower for SF/gelatin constructs, which declined when the gelatin content increased. These results indicated that the adverse effect of GTA crosslinking on cell response may be ascribed to imposed changes in morphology and physiochemical properties of SF/gelatin nanofibre mats. Although crosslinking could be used to improve mechanical properties of nanofibre mats, it reduced their capacity to support the cell activity. GTA optimisation is required to further modulate the physico-chemical properties of SF/gelatin nanofibre mats in order to obtain stable materials with favourable bioactive properties and promote cellular responses for tissue engineering applications