Intra- and interobserver reliability of a modified distraction test based on digital images to assess lower eyelid horizontal tension / Confiabilidade intra e interobservador do teste de tração modificado para avaliar a tensão da pálpebra inferior baseado em imagens digitais

ABSTRACT Purpose: Inferior eyelid laxity is classically evaluated using "snap-back" and "distraction" tests. This study aimed to assess the reproducibility of the technique used to indirectly quantify the horizontal tension in the lower eyelids using digital image processing. Methods: This longitudinal study was conducted to assess the reproducibility of a new technique that quantifies the horizontal tension in the lower eyelid. The study was conducted at the Hospital das Clínicas of Porto Alegre. The protocol was established by two trained ophthalmologist examiners, allowing intra- and interobserver agreement analyses. Image acquisition was done in two stages: the first image was captured with the eyelid in primary gaze position and the second with the eyelid in traction position. All images and measurements were processed using Image J 1.33m software from the National Institute of Health. The Bland-Altman method, intraclass correlation coefficients, concordance correlation coefficients, and technical measurement error were used to evaluate reproducibility. Results: The study participants comprised healthy individuals with no ophthalmologic pathologies. The measurements obtained in the neutral position showed a slightly higher agreement than those obtained in the traction position. The mean difference between the measurements performed in the traction position was 0.028 ± 0.7 mm and 0.014 ± 0.9 mm in the intra- and interobserver analyses, respectively. The Bland-Altman method demonstrated adequate confidence limits for both measurements. Correlation coefficients for measurements varied between 0.87 [95% confidence interval (CI) 0.68-0.95] and 0.91 (95% CI 0.77-0.97) in the neutral position and between 0.72 (95% CI 0.37-0.89) and 0.76 (95% CI 0.4-0.91) in the traction position. Conclusion: A high intra- and interobserver concordance was observed in the studied method to quantify lower eyelid tension. The proposed method is simple and easily reproducible, and to the best our knowledge, this is the first method that quantifies lower eyelid horizontal tension on the basis of digital image processing. This modified distraction test might be useful in studies quantifying lower eyelid horizontal tension.

RESUMO Objetivo: A frouxidão palpebral inferior é avaliada classicamente por meio de testes de "snap-back" e "distraction test". O objetivo deste estudo foi avaliar a reprodutibilidade da técnica utilizada para quantificar indiretamente a tensão horizontal nas pálpebras inferiores através do processamento digital de imagens. Métodos: Este estudo longitudinal foi realizado para avaliar a reprodutibilidade de uma nova técnica que quantifica a tensão horizontal na pálpebra inferior. O estudo foi realizado no Hospital das Clínicas de Porto Alegre. O protocolo foi estabelecido por dois examinadores oftalmologistas treinados, permitindo análises de concordância intra e interavaliador. A aquisição de imagens foi feita em duas etapas: a primeira imagem foi capturada com a pálpebra na posição primária do olhar e a segunda com pálpebra tracionada. Todas as imagens e medições foram processadas usando o software Image J 1.33m do National Institute of Health. O método de Bland-Altman, os coeficientes de correlação intraclasses, os coeficientes de correlação de concordância e o erro técnico da medida foram utilizados para avaliar a reprodutibilidade. Resultados: Os participantes do estudo foram indivíduos saudáveis e sem patologias oftalmológicas. As medidas obtidas na posição neutra mostraram concordância levemente maior do que as obtidas na posição tracionada. A diferença média entre as medidas realizadas na posição tracionada foi de 0,028 ± 0,7mm e 0,014 ± 0,9mm nas análises intra e interobservadores, respectivamente. O método de Bland-Altman demonstrou limites de confiança adequados para ambas as medidas. Os coeficientes de correlação para as medidas variaram entre 0,87 [intervalo de confiança de 95% (IC) 0,68-0,95) e 0,91 (IC 95% 0,77-0,97) na posição neutra e entre 0,72 (IC 95% 0,37-0,89) e 0,76 (IC 95% 0,46-0,91) na posição tracionada. Conclusão: Observou-se elevada concordância intra e interobservador no método estudado para quantificar a tensão palpebral inferior. O método proposto é simples e facilmente reproduzível, e, do melhor modo possível, este é o primeiro método que quantifica a tensão horizontal da pálpebra inferior com base no processamento digital de imagens. Este teste de distração modificado pode ser útil em estudos que quantifiquem a tensão horizontal da pálpebra inferior.

Intra- and interobserver reliability of a modified distraction test based on digital images to assess lower eyelid horizontal tension.

PURPOSE: Inferior eyelid laxity is classically evaluated using "snap-back" and "distraction" tests. This study aimed to assess the reproducibility of the technique used to indirectly quantify the horizontal tension in the lower eyelids using digital image processing. METHODS: This longitudinal study was conducted to assess the reproducibility of a new technique that quantifies the horizontal tension in the lower eyelid. The study was conducted at the Hospital das Clínicas of Porto Alegre. The protocol was established by two trained ophthalmologist examiners, allowing intra- and interobserver agreement analyses. Image acquisition was done in two stages: the first image was captured with the eyelid in primary gaze position and the second with the eyelid in traction position. All images and measurements were processed using Image J 1.33m software from the National Institute of Health. The Bland-Altman method, intraclass correlation coefficients, concordance correlation coefficients, and technical measurement error were used to evaluate reproducibility. RESULTS: The study participants comprised healthy individuals with no ophthalmologic pathologies. The measurements obtained in the neutral position showed a slightly higher agreement than those obtained in the traction position. The mean difference between the measurements performed in the traction position was 0.028 ± 0.7 mm and 0.014 ± 0.9 mm in the intra- and interobserver analyses, respectively. The Bland-Altman method demonstrated adequate confidence limits for both measurements. Correlation coefficients for measurements varied between 0.87 [95% confidence interval (CI) 0.68-0.95] and 0.91 (95% CI 0.77-0.97) in the neutral position and between 0.72 (95% CI 0.37-0.89) and 0.76 (95% CI 0.4-0.91) in the traction position. CONCLUSION: A high intra- and interobserver concordance was observed in the studied method to quantify lower eyelid tension. The proposed method is simple and easily reproducible, and to the best our knowledge, this is the first method that quantifies lower eyelid horizontal tension on the basis of digital image processing. This modified distraction test might be useful in studies quantifying lower eyelid horizontal tension.

Staphylococcus aureus-induced sepsis in the lobster cockroach Nauphoeta cinerea.

Invertebrates have been instrumental in understanding the mechanisms involved in infectious diseases, considering the idea to replace, reduce and refine the use of mammals as well as to understand the basic principles of immune response in insect. We evaluated the consequences of Staphylococcus aureus-induced sepsis in the last instar nymphs of Nauphoeta cinerea injected with different concentrations of bacteria preserved in two culture media. Infected groups had a decrease in hemolymph metabolites (glucose, amino acids, total proteins, and cholesterol), in contrast to the proteins in the fat body. Higher concentrations of S. aureus caused permanent morphological alterations in adults, decrease in food consumption, increase in isolation, and increase in CFU until death of the cockroaches. Survival and protection of nymphs against a repeated and stronger challenge with the same bacteria varied according to the medium they were conserved. N. cinerea proves to be a suitable and promising model for studies related to bacterial infections.

Antimicrobial susceptibility and pathogenicity of Escherichia coli strains of environmental origin / Suscetibilidade antimicrobiana e patogenicidade de amostras de Escherichia coli de origem ambiental

The study aimed to evaluate the antimicrobial susceptibility of 109 samples of Escherichia coli (E. coli) of environmental origin and to characterize these isolates according to the degree of pathogenicity in vivo, verifying a possible relationship between this variable and susceptibility to the active principles tested. The isolates were subjected to disc diffusion test to 14 antibiotics. From 16.5% to 90% of the samples were sensitive; 1 - 28.5% showed intermediate degree of susceptibility and between 9 to 78% of E. coli analyzed were resistant. The highest resistance percentages were seen in the class of quinolones and tetracyclines (>75%), and for sensitivity in the class of amphenicols (68.8%). By inoculating 1- day - old chicks, the isolates were classified as highly pathogenic (2.7%), intermediate (10.1%), low (42.2%) and apathogenic (45%). It was observed a wide variation in the susceptibility profile of isolates in relation to antimicrobials. It was also found that most of the samples had pathogenic potential (55%), thus being considered as APEC (avian pathogenic E. coli). No relationship between pathogenicity and antimicrobial susceptibility (P≤0.05) was observed.

O estudo teve como objetivo avaliar a suscetibilidade antimicrobiana de 109 amostras de Escherichia coli (E. coli) de origem ambiental frente a antibióticos e caracterizar esses isolados quanto ao grau de patogenicidade in vivo, verificando-se uma possível relação entre esta variável e a suscetibilidade aos princípios ativos testados. Os isolados foram submetidos ao teste de disco-difusão para 14 antibióticos. Entre 16.5% a 90% das amostras foram sensíveis, 1-28.5% apresentaram grau de suscetibilidade intermediário e entre 9-78% das E. coli analisadas foram resistentes. Os maiores percentuais de resistência foram encontrados para a classe das quinolonas e das tetraciclinas (>75%), e de sensibilidade para a classe dos anfenicóis (68.8%). Por meio da inoculação em pintinhos de um dia de idade, os isolados foram classificados como sendo de patogenicidade alta (2.7%), intermediária (10.1%), baixa (42.2%) e apatogênicos (45%). Foi observada uma ampla variação no perfil de suscetibilidade das amostras frente aos antimicrobianos. Verificou-se também que a maioria apresentou potencial patogênico (55%), sendo, portanto, consideradas APEC (E. coli patogênica para aves). Não foi observada relação entre a patogenicidade e a suscetibilidade aos antimicrobianos (P≤0.05).

Characterization of an area of reference for inhalable particulate matter (PM2.5) associated with genetic biomonitoring in children.

Humans are exposed to health-impairing air pollutants, especially children who are more sensitive to cancer-causing toxins. This study described an area of reference for inhalable particulates (PM2.5) by chemical (polycyclic aromatic hydrocarbons) and mutagenic characterization associated with the genetic biomonitoring of children (aged 5-11 years). The area studied was in a small town in Brazil, used as reference in previous studies. Organic matter of PM2.5 (extracted with dichloromethane) was evaluated for mutagenesis in a Salmonella/microsome (microsuspension) assay, in strains measuring frameshift error (TA98, YG1021 and YG1024) and base pair substitution (TA100) of DNA, in the presence and absence of rat liver metabolization fraction (S9). Exposure was studied analyzing a sample of 45 children using comet assay (peripheral blood lymphocytes) and micronucleus (exfoliated buccal mucosa cells). PM2.5 concentration for the period was 9% (25.89-64.71 µg/m3) events above WHO limit value (25 µg/m3). Mutagenesis responses (revertants/m3) varied from negative (spring) to 8.3±0.69 (autumn) (-S9) and 5.4±0.36 (winter) (+S9), in strain TA98, and for TA100, in spring, from negative to 14.8±4.23 (-S9) and 17.5±2.72 (+S9). YG strain results show mononitroarenes and aromatic amines. Mean biomonitoring values were established for MN, 0.3±0.41 (‰) and for other cell types a variation from 0.6±0.73 (‰), nuclear buds to 57.5±24.92 (‰), karyorrhexis. Comet assay means were 23.1±12.44; 7.3±11.66 and 0.9±2.30 for tail length, intensity and moment, respectively. There was no difference for sex and age for the different parameters. A significant difference in confounding factors was observed for passive smoking and MN induction. PAHs and mutagenesis in the air may be related to local vehicular emissions. These results challenge the definition of areas of reference for air pollution associated with human biomonitoring including the region studied.