Microbiota bacteriana aeróbica conjuntival em pacientes diabéticos com hemoglobina glicada normal e alterada em duas regiões brasileiras

Purpose:To study the aerobic bacterial microbiota of the conjunctiva in diabetic patient with regard to the management of diabetes, assessed using glycated hemoglobin levels.Methods:A cross-sectional study was conducted using conjunctival smears of diabetic patients from both sexes and with different ages, residing in two different Brazilian cities (Sorocaba and Rio Branco). A control group of non-diabetic patients was also included. The diabetic patients were considered to have controlled diabetes when their glycated hemoglobin level was ≤7% and blood glucose level was ≤126 mg/dL. Patients with non-controlled diabetes were those with glycated hemoglobin levels >7% and blood glucose levels >126 mg/dL. The samples obtained were inoculated in Brain-Heart Infusion broth and in culture media for aerobic bacteria (blood and chocolate agars); bacterial growth wa evaluated in a microbiology laboratory.Results:A total of 120 eyes of 120 patients were included in the present study. The percentage of cultures in which bacterial growth was observed was greater in diabetic patients, although the difference was not statistically significant (p=0.103). There was a greater trend toward bacterial growth in the conjunctiva of diabetic patients with altered fasting blood glucose. There was no difference in the frequency of bacterial growth on the conjunctiva between diabetic patient with normal or altered glycated hemoglobin levels. In Sorocaba, conjunctival bacterial growth was similar to that observed in Rio Branco. The microorganism most frequently detected in the present study was Staphylococcuepidermidis, followed by Staphylococcus aureus,Proteus mirabilis, and Escherichia coli.Conclusion:There was no difference between diabetic patients with normal or altered glycated hemoglobin levels. The microorganisms found were similar to those found in studie investigating the conjunctival bacterial flora of diabetic and non-diabetic patients.Objetivo:Estudar a microbiota conjuntival bacteriana aeróbica dos pacientes diabéticos em relação ao controle glicêmico, verificado através da hemoglobina glicada, em dua cidades distintas.Métodos:Foi realizado um estudo transversal utilizando raspados de conjuntiva de indivíduos diabéticos de ambos os sexos e idades variáveis de duas cidades: Sorocaba e Rio Branco. O grupo controle foi constituído de pacientes não diabéticos. A amostra foi constituída de pacientes diabéticos que foram considerados controlados com hemoglobina glicada ≤7% e glicemia de jejum ≤126 mg/dl e não controlados com hemoglobina glicada >7% e glicemia de jejum >126 mg/dl. O material obtido foi semeado em meio líquido Brain Heart Infusion (BHI) e em meios de cultivo para bactérias aeróbicas (ágar sangue e ágar chocolate). O crescimento bacteriano foi avaliado em laboratório de microbiologia.Resultados:Foram incluídos 120 olhos de 120 pacientes. A porcentagem de culturas nas quai houve crescimento bacteriano foi maior em pacientes diabéticos, sendo a diferença não estatisticamente significante (p=0,103). Não houve diferença entre o crescimento bacteriano em pacientes com hemoglobina glicada normal e alterada. Houve uma tendência maior de crescimento bacteriano em conjuntivas de paciente diabéticos com glicemias de jejum elevada. Em Sorocaba houve crescimento bacteriano conjuntival semelhante a Rio Branco. O microrganismo mais frequente encontrado neste estudo foi Staphylococcus epidermidis, seguido de Staphylococcus aureus, Proteus mirabilis e Escherichiacoli.Conclusões:Não ocorreu diferença entre pacientes diabéticos com hemoglobina glicada normal e alterada. Os microrganismos encontrados foram semelhantes aos estudos da flora bacteriana de conjuntivas normais e de diabéticos.Federal University of São Paulo Department of Ophthalmology and Visual SciencesFederal University of Acre Department of OphthalmologyFederal University of São Paulo Department of Ophthalmology and Visual Sciences Cornea and External Diseases SectionUNIFESP, Department of Ophthalmology and Visual SciencesUNIFESP, Department of Ophthalmology and Visual Sciences Cornea and External Diseases SectionSciEL

O processamento da leitura na aquisição da morfologia derivacional em português brasileiro (PB) por disléxicos

This study investigates the acquisition of derivational morphology in Brazilian Portuguese (BP) by children with preliminary dyslexia diagnosis. Many studies have pointed out that dyslexic people have difficult in processing morphologically complex words (CAPLAN, 1998), thus suggesting a possible disorder concerning the way derived words are processed and stored in the mental lexicon. Another possible explanation could be that dyslexic people show many problems during the word graphical form recognition and in the relationship between the graphical form and its corresponding phonetical one. In both of these cases, this difficult is reflected on the reading competence as well as on the acquisition of rules underlying the derivational processes of word formation in BP. In order to gain more evidences about this question, an experimental task was conducted, using the Morphosemantical Decision Paradigm (BESSE; VIDIGAL DE PAULA; GOMBERT, 2005), which represents an adaptation of the experimental task used by Mota (2008). It were tested 25 non-dyslexic children divided in 2 aged groups, thus forming two control groups; and 10 children with preliminary dyslexia diagnosis, divided in two aged groups. Results suggest that dyslexic children acquiring BP have showed more difficult to read and to process morphologically complex words compared with nondyslexic children who are still acquiring this language.Este estudo investiga a aquisição da morfologia derivacional do português brasileiro (PB) por crianças com diagnóstico preliminar de dislexia. A literatura tem sugerido uma dificuldade dos disléxicos em processar palavras morfologicamente complexas (CAPLAN, 1998), o que remete a um possível distúrbio no modo como palavras derivadas são representadas no léxico mental dos portadores de dislexia e por eles processadas. Outra explicação cabível seria a de que o disléxico apresenta problemas na passagem do reconhecimento da forma gráfica da palavra para a forma fônica correspondente. Em qualquer dos casos, essa dificuldade se reflete tanto nas habilidades de leitura quanto na aquisição das regras subjacentes aos processos derivacionais de formação de palavras em PB. A fim de prover mais evidências sobre essa questão, realizou-se um experimento, valendo-se da Técnica de Decisão Morfossemântica (BESSE; VIDIGAL DE PAULA; GOMBERT, 2005), numa adaptação da que foi usada por Mota (2008). Foram testadas 25 crianças sem queixa de dislexia, divididas em dois grupos etários, as quais serviram como controle, e 16 crianças com diagnóstico preliminar desse distúrbio, também divididas em dois grupos etários. Os resultados indicam que as crianças disléxicas que adquirem PB têm maior dificuldade em ler e processar as palavras morfologicamente complexas, em relação às crianças não disléxicas que adquirem essa mesma língua

Deep anterior lamellar keratoplasty evaluation in patients with keratoconus

PURPOSE: To evaluate the efficacy, complications and confocal microscopy corneal features of deep anterior lamellar keratoplasty using the air dissection technique in keratoconus. METHODS: Seventeen eyes with advanced keratoconus were submitted to this technique. Postoperative visual acuity and complication rate were analyzed. The thicknesses of full cornea tissue, host bed and donor button were measured, donor-host interface was also evaluated using confocal microscopy. RESULTS: Best-spectacle corrected visual acuity was 0.5 or better in 50% of the eyes. Complications occurred in five of seventeen patients (29.41%). Confocal microscopy demonstrated in four eyes the presence of hiperreflective structures at the interface, suggesting deposits and striae. Average corneal pachymetry, donor button and host bed thicknesses were respectively 609.00 ± 77.55 µm, 516.55 ± 43.65 µm and 92.50 ± 60.10 µm. CONCLUSIONS: Although technically challenging with the risk of intraoperative Descemet's membrane perforation, deep anterior lamellar keratoplasty with air dissection technique presents as an option for keratoconus treatment. Confocal microscopy demonstrated to be a useful method not only for the pachymetry measurement but also for the evaluation of interface by observing the absence of opacities in most of the cases.OBJETIVO: Avaliar a eficácia e as complicações da técnica de ceratoplastia lamelar anterior profunda com dissecção a ar no ceratocone, além dos achados da microscopia confocal. MÉTODOS: Dezessete olhos com ceratocone avançado foram submetidos à técnica supracitada. Após o procedimento cirúrgico, foram avaliadas a acuidade visual e as complicações tanto intraoperatórias quanto pós-operatórias. As espessuras corneana total, da córnea receptora, do botão doado e a interface doador-receptora foram avaliadas pela microscopia confocal. RESULTADOS: Obteve-se acuidade visual corrigida com óculos maior ou igual a 0,5 em 50% dos olhos. Foram observadas complicações intraoperatórias, como perfuração de membrana de Descemet, quanto pós-operatórias, como hipertensão ocular, crescimento epitelial e rejeição estromal, que atingiram 5 dos 17 pacientes (29,41%). Em 4 pacientes foi observada, pela microscopia confocal, a presença de estruturas hiperrefletivas na interface, sugestivas de depósitos e estrias. A média dos valores encontrados das paquimetrias corneana total, do botão doado e da córnea receptora foram de 609,00 ± 77,55 µm de 516,55 ± 43,65 µm e de 92,50 ± 60,10 µm respectivamente. CONCLUSÃO: Apesar de tecnicamente mais complexa, com risco de perfuração intraoperatória da membrana de Descemet, a técnica de ceratoplastia lamelar anterior profunda com dissecção a ar apresenta-se como opção de tratamento em casos de ceratocone. A microscopia confocal mostrou-se um método útil tanto na medida da paquimetria pós-operatória quanto na avaliação da interface, ao evidenciar ausência de opacidades na maioria dos casos.Universidade Federal de São Paulo (UNIFESP) Departamento de OftalmologiaEye Clinic Day HospitalUNIFESPHospital Oftalmológico de SorocabaUNIFESP, Depto. de OftalmologiaUNIFESPSciEL

Femtosecond laser-assisted deep anterior lamellar keratoplasty in phototherapeutic keratectomy versus the big-bubble technique in keratoconus

AIM: To compare the functional and anatomic results of femtosecond laser (FSL)-assisted deep anterior lamellar keratoplasty (DALK) associated with phototherapeutic keratectomy (PTK) and FSL-assisted DALK performed using the big-bubble technique in keratoconus. METHODS: During the first phase of the study, an electron microscopy histopathology pilot study was conducted that included four unsuitable donor corneas divided into two groups: in FSL group, FSL lamellar cuts were performed on two corneas and in FSL+ PTK group, PTK was performed at the stromal beds of two corneas after FSL lamellar cuts were made. During the second phase of the study, a randomized clinical trial was conducted that included two treatment groups of patients with keratoconus: group 1 (n= 14 eyes) underwent FSL-assisted DALK associated with PTK and group 2 (n= 12 eyes) underwent FSL-assisted DALK associated with the big-bubble technique. The main outcome measures were the postoperative visual acuity (VA) and optical coherence tomography (OCT) measurements, confocal microscopic findings, and contrast sensitivity. RESULTS: In the pilot study, histopathology showed a more regular stromal bed in the FSL+ PTK group. In the clinical trial, group 1 had significantly worse best spectacle-corrected VA and contrast sensitivity (P< 0.05 for both comparisons). The residual stromal bed measured by OCT was significantly (P< 0.05) thicker in group 1. Confocal microscopy detected opacities only at the donor-receptor interface in group 1. CONCLUSION: Patients with keratoconus treated with FSL-assisted DALK performed using the big-bubble technique fare better than treated with FSL-assisted DALK associated with PTK.Univ Fed Sao Paulo, Escola Paulista Med, Dept Ophthalmol & Visual Sci, BR-04039032 Sao Paulo, BrazilUniv Fed Sao Paulo, Escola Paulista Med, Dept Ophthalmol & Visual Sci, BR-04039032 Sao Paulo, BrazilWeb of Scienc