Pontos amarelados na retina: um achado da sífilis ocular?

Here we report the occurrence of pale yellowish perivascular preretinal dots in 12 patients with ocular syphilis. A case series of these patients was examined between March and October 2012 at the Uveitis Sector of Universidade Federal de São Paulo. After diagnostic confirmation of syphilis, fundus photographs and optical coherence tomography (OCT) were performed to verify the localization of the dots, and patients were treated with IV crystalline penicillin for 14 days. The study comprised 11 men (91.6%), 19 eyes, median presentation age of 38.1 years, and panuveitis as the main clinical manifestation (seven patients, 58.3%), being bilateral in four. Ten patients were taking oral prednisone (83.3%). Serum panels performed by the Venereal Disease Research Laboratory (VDRL) showed positive results in eight patients (66.7%), whereas VDRL cerebrospinal fluid (CSF) tests were negative in seven of nine collected (77.8%). However, serum FTA-Abs was positive in 100% of patients, and eight patients (66.7%) had HIV infection. The best corrected visual acuity (BCVA) presented after treatment improved in 10 eyes (55.6%), did not change in seven eyes (38.9%), and worsened in one eye (5.6%). Although not yet acknowledged in the literature as a typical manifestation of ocular syphilis, these are very common findings in clinical practice. We believe that preretinal dots are due to perivasculitis secondary to treponema infection. It is important recognize them and remember that syphilis can present in several forms, including the one presented in this study.Relatar a ocorrência de pontos amarelo-esbranquiçados perivasculares pré-retinianos em 12 pacientes com sífilis ocular. Série de casos de 12 pacientes examinados entre março e outubro de 2012 no setor de uveítes da UNIFESP. Após confirmação diagnóstica de sífilis ocular, retinografias e OCT (optical coherence tomography) foram realizados para verificar a localização dos pontos e os pacientes foram tratados com penicilina cristalina IV por 14 dias. Dados demográficos incluíram 11 homens (91,6%), 19 olhos, mediana de idade de 38,1 anos, e a manifestação clínica principal foi panuveíte (7 pacientes, 58,3%), sendo bilateral em 4. Dez fizeram uso de prednisona oral (83,3%). VDRL (Venereal Disease Research Laboratory) sanguíneo foi positivo em 8 pacientes (66.7%), VDRL no líquor foi negativo em 7 de 9 coletados (77,8%), FTA-Abs sanguíneo foi positivo em 100% e 8 pacientes (66,7%) eram HIV positivos, AV após tratamento melhorou em 10 olhos (55,6%), não se alterou em 7 (38,9%) e piorou em 1 olho (5,6%). Embora ainda não reconhecida na literatura como uma manifestação típica da sífilis ocular, este achado é muito comum na prática clínica. Acreditamos que esses pontos são devidos a perivasculite secundária à infecção pelo treponema. É importante os reconhecer e lembrar que a sífilis pode se apresentar de várias formas, incluindo essa apresentada aqui.Universidade Federal de São Paulo (UNIFESP) Department of Ophthalmology and Visual SciencesUniversidade Federal de São Paulo (UNIFESP) Department of Ophthalmology and Visual Sciences Uveitis SectorUNIFESP, Department of Ophthalmology and Visual SciencesUNIFESP, Department of Ophthalmology and Visual Sciences Uveitis SectorSciEL

PROPOSTA CURRICULAR DO ENSINO DE FÍSICA EM SANTA CATARINA: REFLEXÕES A PARTIR DA PEDAGOGIA DO IMAGINÁRIO

Resumo: Este artigo visa analisar a proposta curricular do Estado de Santa Catarina para o ensino de Física a partir da pedagogia do imaginário. Buscar visualizar o contexto de escola e currículo escolar, segundo a perspectiva histórico-cultural, que é o aporte teórico-epistemológico da proposta catarinense. Para se alcançar o objetivo geral, delimitou-se um estudo bibliográfico, como método a abordagem qualitativa, cuja natureza é descritiva e o tipo de análise é de conteúdo. Dentre os trabalhos referentes à pedagogia do imaginário foram selecionados os estudos de Durand (1993, 2004 e 2012), Almeida (2005), Ferreira Santos e Almeida (2019), Santa Catarina (2014). Diante dos resultados obtidos, verificou-se similitude em relação à importância da linguagem para o ser humano, e a essencialidade enquanto algo inerente às áreas de conhecimento, significância da questão cultural em ambas as abordagens.   Palavras-chave: Educação. Física. Pedagogia. Imaginário.    Abstract: This article aims to analyze the curricular proposal of the State of Santa Catarina for teaching Physics from the pedagogy of the imaginary. Seek to visualize the school context and school curriculum, according to the historical-cultural perspective, which is the theoretical-epistemological contribution of the Santa Catarina proposal. To achieve the general objective, a bibliographic study was delimited, as a method with a qualitative approach, whose nature is descriptive and the type of analysis is content. Among the works related to the pedagogy of the imaginary, the studies of Durand (1993, 2004 and 2012), Almeida (2005), Ferreira Santos and Almeida (2019), Santa Catarina (2014) were selected. In view of the results obtained, there was similarity in relation to the importance of language for human beings, and the essentiality as something inherent in the areas of knowledge, the significance of the cultural issue in both approaches.   Keywords: Education. Physical. Pedagogy. Imaginary

Tricomegalia essencial: relato de caso

The present study reports two cases of symptomatic essential trichomegaly. Trichomegaly may develop in various diseases, including anorexia nervosa, hypothyroidism, pregnancy, pretibial myxedema, systemic lupus erythematosus, vernal keratoconjunctivitis, and uveitis. The exact incidence trichomegaly is unknown, and the condition remains sporadically reported. Two cases of symptomatic trichomegaly without any associated systemic disorder are presented in this paper.O presente estudo tem por objetivo relatar dois casos de tricomegalia essencial com diminuição da acuidade visual. A tricomegalia pode se desenvolver em várias doenças, incluindo anorexia nervosa, hipotireoidismo, gravidez, mixedema pré-tibial, lúpus eritematoso sistêmico, ceratoconjuntivite primaveril, e uveíte. A incidência da tricomegalia essencial é desconhecida e a condição permanece esporadicamente relatada. São apresentados dois casos de tricomegalia sintomática em pacientes sem distúrbios sistêmicos associados.Universidade Federal de São Paulo (UNIFESP) Department of OphthalmologyUNIFESP, Department of OphthalmologySciEL

LASIK retreatment with customized versus conventional photo-ablation using LADAR - Alcon

Objective: To evaluate the results of conventional (Ladar, Alcon) and customized (LADARWave, Alcon) retreatment in eyes undergoing conventional primary LASIK. Methods: Retrospective revision of consecutive clinical report forms of 38 eyes of 38 patients who underwent LASIK retreatment for myopia and astigmatism. The operated eyes were divided into two equal groups. In the first was performed customized retreatment and, in the other, conventional retreatment. The following variables were compared: high contrast visual acuity and manifest refraction. The visual quality was estimated and compared using subjective survey offered to patients. Results: There was no statistical difference between the groups when comparing the variables studied. The spherical equivalent after retreatment was 0.36 in the conventional group and 0.47 in the custom (p = 0.079). Snelen visual acuity was 0.91 and 0.87, respectively (p = 0.07). The preoperative total aberrations was higher than the postoperative period in custom group (p < 0.001). In the conventional group there was no difference for any aberration evaluated. Complaints of glare (p = 0.117), photophobia (p = 0.987) and vision fluctuation (p = 0.545) were statistically similar between the two groups. Conclusion: Comparing the custom and conventional surgery for primary LASIK retreatment with LADAR, Alcon, there was no statistical difference in the quantity and quality of vision. Nevertheless, there was a higher percentage of patients with complaints in relation to the visual quality in the group undergoing conventional surgery. Custom surgery seems to have greater capacity to reduce the total aberrations than conventional.Univ Fed Sao Paulo UNIFESP, Escola Paulista Med, Setor Cirurgia Refrat, Sao Paulo, BrazilUniv Fed Sao Paulo UNIFESP, Escola Paulista Med, Setor Cirurgia Refrat, Sao Paulo, BrazilWeb of Scienc

Acute iris depigmentation following systemic moxifloxacin

Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM) HospitalUNIFESP, EPM, HospitalSciEL

Técnicas De Biologia Molecular Para Ceratites Infecciosas

Objectives: To study the conjunctival microbiota and etiologic diagnosis in patients with infectious keratitis due to alpha Herpes virus and Mycobacteria with molecular biology techniques. Methods: Conjunctival microbiota analysis was performed in ocular surface samples in eyes previously submitted to Boston Type I keratoprosthesis surgery with PCR assay with amplicon analysis using electrospray ionization mass spectroscopy (PCR/ESI-MS). To study corneal viral infections real-time PCR was used for Herpes Virus Type 1 and 2 (HSV 1 and 2) and Varicella Zoster Virus in corneal scrapings from typical herpes dendritic keratitis and from the corneal stroma of patients with unspecific infectious keratitis. Polymerase chain reaction–restriction enzyme analysis of the hsp65 gene (PRA-hsp65), DNA sequencing and pulsed-field gel electrophoresis were used to identify Mycobacteria strains isolated in corneal samples of a post-refractive surgery infection outbreak. The same methodology was used to study samples of tap and distilled water, water from the reservoir of the distilling equipment, steamer, and autoclave cassette; antiseptic and anesthetic solutions and surgical instruments. Results: The molecular diagnostic approach using serial polymerase chain reaction and mass spectrometry was comparable with standard microbiologic techniques as a surveillance tool in patients previously submitted to Boston type I keratoprosthesis implantation. Of the 25 patients in the dendritic keratitis group, 21 tested positive for HSV-1 by qPCR analysis. From the unspecific keratitis group (65), nine patients had negative smears, cultures, and qPCR findings. Fifty-six patients had positive cultures: 51 for bacteria, 4 for fungi, and 1 for amoebae. From those, qPCR identified 10 patients who were also positive for virus: one for VZV and nine for HSV-1. Polymerase chain reaction–restriction enzyme analysis of the hsp65 gene (PRA-hsp65), DNA sequencing and pulsed-field gel electrophoresis were used to identify Mycobacteria in eyes with clinical signs of infection. The same strain isolated from the patient’s eyes was obtained in tap distilled water samples, which suggests that the contamination source could have been the distilled water used to rinse the instruments. Conclusion: PCR/ESI-MS is comparable to cultures to study conjunctival microbiota and is a possibility of post-operative follow-up. Real-time PCR was able to demonstrate Herpes Virus in typical cases of Herpes keratitis and in unspecific keratitis initially suspicious of bacteria, suggesting mist infection. Polymerase chain reaction–restriction enzyme analysis of the hsp65 gene (PRA-hsp65), DNA sequencing and pulsed-field gel electrophoresis were important to identify Mycobacteria in a post-refractive surgery Mycobacterium chelonae outbreak. Molecular Biology can be used to investigate ocular infections bringing new insights that contribute to comprehension and correlation of infectious processes.Objetivo: Avaliar a aplicação de técnicas de biologia molecular para estudo da microbiota conjuntival e diagnóstico etiológico em portadores de ceratites infecciosas por alpha Herpes vírus e por Mycobacteria. Métodos: A análise da microbiota conjuntival foi feita pela colheita de amostras da superfície ocular em olhos submetidos previamente a implante de ceratoprótese Boston tipo 1 pela PCR com análise de amplicon acoplada a espectrometria de massas com fonte de ionização electrospray (PCR/ESI-MS). Para estudo de infecção viral da córnea utilizou-se a PCR em tempo real para vírus Herpes Simplex tipo 1 e 2 (HSV 1 e 2) e Vírus Varicella Zoster (VZV) em amostras obtidas de lesões dendríticas típicas de infecção viral e do estroma corneano de pacientes com suspeita diagnóstica de ceratite infecciosa inespecífica. A PCR de restrição enzimática do gene hsp65, o sequenciamento por DNA, genotipagem e eletroforese em gel de campo pulsado foram usados para identificação das cepas que foram isoladas de amostras da córnea em um surto de infecção por Mycobactéria após cirurgia refrativa. A mesma metodologia foi utilizada para estudo das cepas isoladas do ambiente cirúrgico em que ocorreu o surto. Resultados: O diagnóstico molecular pela PCR/ESI-MS foi comparável às técnicas microbiológicas tradicionais para avaliação pós-operatória de vigilância da microbiota ocular em pacientes submetidos previamente a implante de ceratoprótese Boston tipo I. O qPCR foi positivo em 84% dos pacientes com ceratites dendríticas típicas de infecção viral e em dez dos sessenta e cinco pacientes suspeitos de etiologia infecciosa não específica com cultura positiva para bactéria. Nove foram positivos para HSV-1 e um para VZV. Nenhum paciente teve resultado positivo para a pesquisa de HSV-2. A PCR de análise de restrição enzimática do gene hsp65, sequenciamento por DNA e eletroforese em gel de campo pulsado foram aplicadas de forma a complementar os testes de cultivo no diagnóstico de Mycobactéria nos olhos com sinais clínicos de infecção. Foi isolada a mesma cepa de M. chelonae dos olhos dos pacientes nas amostras de água corrente submetidas a processo de destilação, o que sugere que a fonte de contaminação do surto possa ter sido a água destilada usada para lavagem dos instrumentos cirúrgicos. Conclusões: O uso da PCR/ESI-MS foi eficaz para avaliação da microbiota conjuntival e é uma possibilidade de acompanhamento pós-operatório. Com PCR em tempo real foi possível demonstrar a presença de Herpes vírus em casos típicos de ceratites dendríticas herpéticas e infecciosas inicialmente diagnosticadas como de etiologia bacteriana, sugerindo infecção mista. A PCR de análise de restrição enzimática do gene hsp65, o sequenciamento de DNA e a eletroforese em gel de campo pulsado foram importantes na identificação de Mycobacterium chelonae em um surto após cirurgia refrativa. A biologia molecular pode ser aplicada a investigação de situações de infecção do olho trazendo informações que contribuem para a compreensão da origem e correlação dos processos infecciosos.Dados abertos - Sucupira - Teses e dissertações (2017

Infectious keratitis in patients undergoing Boston Type 1 keratoprosthesis (Boston KPro) procedure: case series

Description of two cases of infectious keratitis in patients after Boston Type 1 keratoprosthesis (Boston KPro) implantation. The first case refers to a patient that had the device indicated due to limbal deficiency secondary to severe dry eye who presented a fungal infection by Aerobasidium pullulans that was successfully treated with amphotericin B eye drops. The second case reports a patient with Boston KPro implantation due to previous corneal transplant rejection showing bacterial keratitis in the fourth postoperative month. The etiologic agent was identified asStreptococcus sp and topical treatment with vancomycin was effective. The importance of postoperative surveillance in Boston KPro eyes is discussed