Assessment of quality of life, psychosocial, and epidemiological aspects in patients diagnosed with tuberculous uveitis.

PURPOSE: To assess the quality of life in patients diagnosed as having tuberculous uveitis and its association with sociodemographic, clinical, and psychosocial aspects. METHOD: By conducting standardized interviews, clinical and demographic data were collected using a measure developed in this study. This measure was applied in addition to other measures, namely SF-12, Hospital Anxiety and Depression Scale, and NEI-VFQ-39, which were used to assess health-related quality of life, anxiety and depression symptoms, and visual functioning. RESULTS: The study included 34 patients [mean age: 46.5 ± 15.1 years, female patients: 21 (61.8%)]. The mean of the VFQ-39 score was 74.5 ± 16.6 and that of SF-12 physical and mental component scores were 45.8 ± 10.1 and 51.6 ± 7.5, respectively, for the health-related quality of life. Anxiety symptoms were the most prevalent compared with depression symptoms and were found in 35.3% of the participants. CONCLUSION: Tuberculous uveitis affects several scales of quality of life, thereby affecting a population economically active with a social, psychological, and economic burden.

Description of a new species of Aegla (Decapoda, Anomura) from the Paran 3 hydrographic basin, Brazil.

Freshwater crustaceans of the genus Aegla are endemic to southern South America, and present greater richness in the river basins of the state of Rio Grande do Sul, Brazil. However, recent studies have shown the enormous potential for discovering new species of Aegla in the state of Paran. In the last six year the number of species recorded has almost doubled, increasing from 9 to 16. In the present work, we expand the current knowledge about the diversity of Aegla in a set of poorly explored drainage basins in the western region of the state and describe a new species, Aegla urussanga n. sp., based on morphological and molecular evidence. A combination of morphological characters supports the new species: orbital spine absent, non-elevated epigastric prominences, robust protogastric lobes with scales, anterior dorsal margin of epimeron 2 armed and with pronounced concavity, sub-rectangular palmar crest of chelipeds, internal margin of the ventral face of the ischium of the cheliped with a proximal stout spine, a distal stout spine, and up to three tubercles with spiniform scales. The molecular data, based on partial COI sequences, also support the distinction of the new species from others that occur in adjacent river basins. The species with the smallest genetic distance from A. urussanga n. sp. is Aegla castro Schmitt, 1942 which occurs in the Iguau River basin. The new species occurs in distinct streams, probably interconnected in the past and currently isolated by the Itaipu reservoir and is the second species of Aegla described from the complex of drainage basins called Paran 3 basin.

Vision-related quality of life in patients treated for ocular syphilis.

Multiple studies have showed negative impact of non-infectious uveitis on quality of life (QoL). Less is understood regarding life experiences in patients with infectious uveitis. We investigated vision-related QoL in individuals who had recovered from ocular syphilis. 32 adults treated for ocular syphilis at a uveitis service in Brazil completed the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25), and a comprehensive ophthalmic examination was performed. Medical records were reviewed to confirm resolution of ocular inflammation for 3 months pre-enrolment, and collect clinical data. The NEI VFQ-25 composite score was low overall (75.5 ± 19.8, mean ± standard deviation), and subscale scores varied from relative lows of 59.1 ± 39.6 (driving) and 60.9 ± 24.5 (mental health), to relative highs of 84.8 ± 21.8 (ocular) and 89.1 ± 21.0 (color vision). Adults aged over 40 years and those with a final visual acuity of 20/50 or worse had significantly lower mean composite and subscale scores. Other clinical characteristics-including gender, HIV co-infection, and type of uveitis-did not significantly influence scores. Our findings, taken in context with previous observations that prompt recognition achieves better vision outcomes, suggest early treatment may improve QoL after recovery from ocular syphilis.

Trends in Inpatient Antibiotic Use Among Adults Hospitalized During the Coronavirus Disease 2019 Pandemic in Argentina, Brazil, and Chile, 2018-2021.

BACKGROUND: High rates of antibiotic use (AU) among inpatients with coronavirus disease 2019 (COVID-19) despite low rates of bacterial coinfection and secondary infection have been reported. We evaluated the impact of the COVID-19 pandemic on AU in healthcare facilities (HCFs) in South America. METHODS: We conducted an ecologic evaluation of AU in inpatient adult acute care wards in 2 HCFs each in Argentina, Brazil, and Chile. The AU rates for intravenous antibiotics were calculated as the defined daily dose per 1000 patient-days, using pharmacy dispensing records and hospitalization data from March 2018-February 2020 (prepandemic) and March 2020-February 2021 (pandemic). Differences in median AU were compared between the prepandemic and pandemic periods, using the Wilcoxon rank sum test to determine significance. Interrupted time series analysis was used to analyze changes in AU during the COVID-19 pandemic. RESULTS: Compared with the prepandemic period, the median difference in AU rates for all antibiotics combined increased in 4 of 6 HCFs (percentage change, 6.7%-35.1%; P < .05). In the interrupted time series models, 5 of 6 HCFs had significant increases in use of all antibiotics combined immediately at the onset of the pandemic (immediate effect estimate range, 15.4-268), but only 1 of these 5 HCFs experienced a sustained increase over time (change in slope, +8.13; P < .01). The effect of the pandemic onset varied by antibiotic group and HCF. CONCLUSIONS: Substantial increases in AU were observed at the beginning of the COVID-19 pandemic, suggesting the need to maintain or strengthen antibiotic stewardship activities as part of pandemic or emergency HCF responses.

Impact of gender on clinical features and outcomes of ocular toxoplasmosis.

AIM: To investigate the effect of gender on the clinical features and outcomes of ocular toxoplasmosis. METHODS: 262 patients (139 women and 123 men) presenting to a tertiary referral uveitis service in Ribeirão Preto, Brazil, with serological and clinical evidence of ocular toxoplasmosis were prospectively enrolled in an observational study. Predefined data items including demographics, descriptors of uveitis and ocular toxoplasmosis, best-corrected visual acuity and ocular complications were disaggregated by gender and compared statistically. RESULTS: Approximately equal numbers of women and men had active versus inactive ocular toxoplasmosis. In both women and men, most infections were remotely acquired. Men were significantly more likely to present with primary active disease than women (24.4% vs 12.9%); conversely, women were significantly more likely to present with recurrent active disease than men (36.0% vs 28.5%). One toxoplasmic retinal lesion was observed in more eyes of men than eyes of women (50.4% vs 35.3%), while women's eyes were more likely to have multiple lesions than men's eyes (54.7% vs 39.8%). Lesions in women's eyes were significantly more likely to occur at the posterior pole compared with those in men's eyes (56.1% vs 39.8%). Measures of vision were similar for women and men. There were no significant differences in measures of visual acuity, ocular complications, and occurrence and timing of reactivations between the genders. CONCLUSION: Ocular toxoplasmosis has equivalent outcomes in women and men, with clinical differences in the form and type of disease, as well as characteristics of the retinal lesion.

Comparison of Retinal Structure Using Optical Coherence Tomography Angiography between Persons with and without HIV Infection.

HIV retinal microangiopathy is an important predictor for increased risk of mortality. Optical coherence tomography angiography (OCTA) can investigate microvascular changes resulting from retinal diseases. Study included 25 persons with HIV and 25 healthy persons. OCTA evaluated the vascularization of retinal layers, choriocapillary, and optic disk. HIV group had lower vessel flow density (VFD) in superficial plexus. No difference was observed in the deep plexus. VFD of the optic disk and peripapillary region showed no difference between the groups. HIV group showed a thinner retinal nerve fiber layer and smaller area of the optic disk rim. HIV infection is associated with VFD reduction in superficial retinal plexus, neural rim area reduction, and retinal nerve fiber layer thinning in individuals without microangiopathic alterations on fundus examination. Therefore, OCTA can find retinal changes before clinical evidence of retinopathy.

Análise das solicitações de medicamentos não padronizados de um hospital universitário terciário / Analysis of requests for non-standard medicines from a tertiary university hospital

Introdução: O uso extensivo de medicamentos não padronizados causa aumento de custos em saúde, além de potencial redução de segurança e uso racional de medicamentos. A Comissão de Farmácia e Terapêutica orienta a prescrição de medicamentos, por meio da avaliação e seleção de medicamentos a serem incluídos no formulário de medicamentos padronizados, com base nas melhores evidências científicas disponíveis e no perfil dos pacientes locais, promovendo o uso racional de medicamentos. O objetivo deste trabalho foi analisar as solicitações de fornecimento de medicamentos não padronizados na instituição. Métodos: Trata-se de um estudo observacional e descritivo onde foram analisadas as solicitações de medicamentos não padronizados realizadas entre fevereiro de 2016 e dezembro de 2021, identificando os medicamentos envolvidos e seus respectivos custos. Resultados: Foram realizadas 203 solicitações no período, sendo 174 incluídas no estudo. Os medicamentos que tiveram mais solicitações foram o rituximabe (41), a imunoglobulina humana (31), o sucralfato (23), a nitazoxanida (12) e o eltrombopague (7). As solicitações com maior custo foram as de imunoglobulina humana (US$ 799,702.38), rituximabe (US$ 717,320.26), eltrombopague (US$ 281,062.50), ruxolitinibe (US$ 167,867.46) e bortezomibe (US$ 149,033.52). As principais clínicas que solicitaram medicamentos não padronizado foram a neurologia (47), a hematologia (30), as moléstias infecciosas e parasitárias (17), e a anestesiologia (12). As solicitações de maior custo foram realizadas pela neurologia (US$ 145,519.08), hematologia (US$ 120,980.25), transplante de medula óssea (US$ 51,635.11) e dermatologia (US$ 44,813.40). Conclusão: O estudo demonstrou que há um fluxo estruturado de solicitação de medicamentos não padronizados na instituição, sendo uma importante ferramenta de gerenciamento dessas solicitações, evitando a aquisição desnecessária de itens que não compõem o elenco terapêutico do hospital.

Introduction: Widespread use of non-formulary drugs (NFD) increases cost and may reduce safety and rational use of medicines. The Pharmacy and Therapeutics Committee provides guidance on drug prescription by evaluating and selecting medications to be included in a hospital's formulary based on best scientific evidence available and local patients' profile, promoting rational use of medicines. The objective of this study was to assess non-formulary drugs prescriptions at a tertiary hospital. Methods: This was a retrospective study. NFD prescribed and its associated costs were assessed through NFD request forms received from February 2016 to December 2021. Results: A total of 203 NFD request forms were received, from which 174 were included in this study. The most frequently prescribed NFD included rituximab (n = 41), immunoglobulin (31), sucralfate (23), nitazoxanide (12), and eltrombopag (7), with the highest costs being with immunoglobulin (US$ 799,702.38), rituximab (US$ 717,320.26), eltrombopag (US$ 281,062.50), ruxolitinib (US$ 167,867.46), and bortezomib (US$ 149,033.52). The most frequent requesting specialties were neurology (n = 47), hematology (30), infectious disease (17) and anesthesiology (12), and highest costs requests were from neurology (US$ 145,519.08), hematology (US$ 120,980.25), bone marrow transplant unit (US$ 51,635.11), and dermatology (US$ 44,813.40). Conclusion: This study showed that a structured request flow for NFD prescription is a critical procedure in order to better manage drug prescription within the hospital, promoting rational use of medicines and preventing unnecessary spending with drugs for which the clinical indication may be covered by a drug already in the hospital's formulary.

COVID-19: como informações baseadas em evidências auxiliaram um hospital terciário durante o primeiro ano pandêmico / COVID-19: how evidence-based information supported a tertiary hospital during the first pandemic year

Introdução: Durante a pandemia de COVID-19, a necessidade por uma informação confiável, rápida e precisa desafiou os profissionais de saúde de todo o mundo. O objetivo deste trabalho foi avaliar e comparar as solicitações dos profissionais da saúde realizadas a um Centro de Informação Sobre Medicamentos (CIM) em um ano pré-pandêmico e durante o primeiro ano pandêmico. Métodos: Trata-se de um estudo quantitativo e retrospectivo, que analisou as perguntas realizadas ao CIM do Instituto Central do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (ICHCFMUSP) quanto ao seu assunto, classificação ATC dos medicamentos envolvidos e profissionais solicitantes. Resultados: Os resultados demonstram que, de maneira geral, durante o primeiro ano pandêmico houve um aumento de 454 perguntas (66,13%; p < 0,01). As dúvidas se referiam principalmente a questões de administração, estabilidade/compatibilidade e padronização do medicamento na instituição, sendo o farmacêutico o profissional que realizou maior número de questionamentos. Ao seccionar as perguntas, verificou-se que a maioria das informações solicitadas se referiram a agentes infecciosos, agentes que atuam no sangue/órgãos hematopoiéticos e sistema nervoso. Conclusão: Considerando o cenário pandêmico, com sobrecarga dos serviços de saúde, contratação em massa de novos profissionais e pouca disponibilidade de informações com embasamento científico, as evidências fornecidas pelo CIM, aliadas ao entendimento do quadro clínico de cada paciente, com certeza auxiliaram em um melhor desfecho clínico, bem como foram essenciais no uso racional de medicamentos no combate a pandemia de COVID-19.

Introduction: During the COVID-19 pandemic the need for reliable, fast and accurate information challenged healthcare professionals around the world. The aim of this study was to evaluate and compare the requests made by health professionals to a Drug Information Center (DIC) in a pre-pandemic year and during the first year of the pandemic. Methods: This is a quantitative and retrospective study that analyzed the solicitations made to the DIC of the Instituto Central do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (ICHCFMUSP) regarding its subject, ATC classification of drugs involved and requesting professionals. Results: The results show that, in general, during the first pandemic year there was an increase of 454 questions (66.13%; p < 0.01). The questions referred mainly to issues of administration, stability/compatibility and standardization of the medicines in the institution, being the pharmacist the professional who asked the most number of questions. When sectioning the questions, it was found that most of the information requested referred to infectious agents, agents that act on the blood/hematopoietic organs and the nervous system. Conclusion: Considering the pandemic scenario, with an overload of health services, large number of hires of new professionals and lack of availability of scientifically based information, the evidence provided by the DIC, combined with the understanding of clinical condition of each patient, certainly helped in a better outcome for each patient, as well as being essential in the rational use of medicines in the fight against the COVID-19 pandemic.

Brazilian perspective: antimicrobial stewardship in solid organ transplant.

BACKGROUND: The incidence of multidrug resistant organisms (MDROs) infections among solid organ transplant (SOT) patients is very high in Brazil. METHODS: This review will discuss antimicrobial use and resistance in SOT in Brazil, highlighting the main barriers and facilitators for implementation of an antimicrobial stewardship programme (ASP). RESULTS: The most common group of MDROs is carbapenem-resistant Gram-negative bacteria and vancomycin-resistant Enterococcus. Carbapenem-resistant Enterobacterales (CREs) are the most frequent MDROs and have been reported as donor-derived as well. Although ASPs are mandatory in the country, there is a lack of information regarding ASPs in SOT recipients. The main barriers for the implementation of ASPs in Brazilian hospitals are lack of electronic medical records, absence of national guidelines specific to SOT recipients, lack of recommendations on surveillance culture to evaluate colonization and transmission of donor-derived MDROs, limited availability of rapid diagnostic tests, and insufficient pharmacist and clinician time allocated to ASP activities in some SOT centers. CONCLUSIONS: The incidence of MDRO infections caused mainly by VREs and CREs is very high in the country. There is limited data regarding antimicrobial use among SOT recipients in Brazil. The absence of antimicrobial stewardship national guidelines specific to SOT recipients is one of the main barriers for the implementation of ASPs in Brazilian hospitals.

Impact of an Antimicrobial Stewardship Program Intervention Associated with the Rapid Identification of Microorganisms by MALDI-TOF and Detection of Resistance Genes in ICU Patients with Gram-Negative Bacteremia.

Combination of strategies for rapid diagnostics tests (RDT) with real-time intervention could improve patient outcomes. We aimed to assess the impact on clinical outcomes, antimicrobial consumption, and costs in patients with gram-negative bacteremia. We designed a quasi-experimental study among 216 episodes of gram-negative bacteremia using RDT (MALDI-TOF and detection of resistance genes) directly from blood culture bottles combined with real-time communication of results. Our study did not demonstrate impact on 30-day mortality (25% vs. 35%; p = 0.115). Hospital and ICU length of stay were significantly lower in the intervention period ((44 days vs. 39 days; p = 0.005) and (17 days vs. 13 days; p = 0.033)), respectively. The antimicrobial consumption was 1381 DOT/1000 days in the pre-intervention period compared to 1262 DOT/1000 days in the intervention period (p = 0.032). Antimicrobials against gram-positive and carbapenems had a significantly reduced consumption in the intervention period. Our intervention showed no impact on 30 days-mortality, but demonstrated an impact on hospital and ICU length of stay, as well as antimicrobials consumption and costs. Knowledge of resistance genes adds value and information for safe decision making that can result in direct and indirect benefits related to the economic burden of antibiotic overuse and bacterial resistance.

Optical Coherence Tomography Findings in Ocular Syphilis Involving the Posterior Segment of the Eye.

PURPOSE: To analyse posterior segment optical coherence tomography (OCT) findings in ocular syphilis. METHODS: Medical records of 54 patients presenting consecutively with syphilitic uveitis were reviewed. Vitreous, retina and choroid (one eye/patient) were assessed by spectral-domain OCT on presentation (54 eyes) and after treatment (31 eyes). Improvement in signs and associations between presenting signs and final best corrected visual acuity (BCVA) were determined by McNemar's and Fisher's exact tests. RESULTS: Early inner retinal OCT findings included hyperreflective dots (n = 49, 91%), tongue-like projections (n = 44, 81%) and large rounded spots (n = 41, 76%). Common outer retinal findings included thickening, irregularity, elevations and/or detachment of retinal pigment epithelium (n = 46, 85%), and disruption or loss of the ellipsoid zone (n = 33, 61%). Most outer retinal changes resolved with treatment (p < .05), and common presenting signs were not associated with poor final BCVA (p > .05). CONCLUSION: OCT findings have diagnostic value in ocular syphilis, but do not predict prognosis.

Humanistic and Economic Burden of Blindness Associated with Retinal Disorders in a Brazilian Sample: A Cross-Sectional Study.

INTRODUCTION: Vision impairment and blindness have been significantly associated with high medical care expenditures, decrease in health utility, and loss or reduction of productivity. The objective of this study was to assess the humanistic and economic burden of blindness in a Brazilian sample from a societal perspective. METHODS: Cross-sectional, observational, and multicenter study enrolling individuals with blindness (defined as the best corrected visual acuity less than 6/60 in the better-seeing eye) caused by retinal disorders. Data collection was performed between December 2012 and December 2014 through face-to-face interview using a structured questionnaire and three standardized patient-reported outcomes instruments. Direct costs were estimated by multiplying the amount of resources used (12-month recall period) by the corresponding unit cost. Productivity losses were measured using the human capital method. All data were collected in Brazilian real (BRL) and converted to United States dollar (USD), using the exchange rate of 1 USD = 3.0415 BRL (May 7, 2015). RESULTS: A total of 146 subjects from 17 research sites were included with a mean age of 68 (SD = 14.8) years and equal gender distribution. Blindness negatively affected both general and vision-specific health-related quality of life. One-half of patients presented some level of anxiety and depression; of these, about 50% with moderate or severe symptoms. Around one-third of subjects (34.2%) reported at least one fall in the previous 12 months due to vision impairment; of these subjects, 14% reported fractures. Emergency room visits and hospitalization were reported by around 25% and 5% of subjects, respectively. The short-term costs (annual costs) of severe vision impairment or blindness for the studied subjects was USD 128,389.09 (USD 879.37 per person). Total medical direct costs summed USD 116,182.00 (USD 795.77 per person), 61.7% of which was due to outpatient visits (with physicians and other healthcare professionals). The long-term costs (lifetime productivity loss) totalized USD 1,962,599.50 (USD 13,442.47 per person). CONCLUSION: This study demonstrated that blindness imposes both humanistic and economic burden for individuals and for Brazilian society. It also pointed out that there is room to improve blindness management, especially for the poorest people, including health education for individuals, availability of services, and reduction of barriers to patients' access to healthcare assistance. This was a good starting point; however, further research is needed.

PRESUMED TUBERCULOUS MULTIFOCAL RETINITIS IN PATIENTS UNDER TREATMENT WITH BIOLOGIC AGENTS.

PURPOSE: To report unique retinal fundus lesions and treatment outcomes of intraocular tuberculosis in patients under anti-tumor necrosis factor treatment. METHODS: Retrospective review of two patients with laboratorial evidence of tuberculosis who had bilateral ocular signs and symptoms not attributable to other diseases. Multimodal imaging was analyzed at the time of presentation and after the treatment initiation. The study patients underwent standard treatment for tuberculosis. RESULTS: Clinical and laboratory findings were consistent with the diagnosis of presumed tuberculosis. Color fundus photograph revealed the presence of multifocal yellowish retinal spots in the study eyes. On fluorescein angiography, the retinal lesions seen on color fundus photograph showed early hypofluorescence with progressive staining of its edges. Occlusive vasculitis with peripheral nonperfusion was also observed in both cases. Spectral domain optical coherence tomography demonstrated increased reflectivity and thickness on the topography of retinitis lesions. After specific antibiotic treatment for tuberculosis, there was complete disappearance of the retinal lesions in all study eyes. CONCLUSION: We report two unique cases of bilateral presumed intraocular tuberculosis presenting as multifocal retinitis in patients under biologic agent treatment. Anti-tumor necrosis factor agents may be related to unusual fundus manifestations of tuberculosis.

Distribuição temporal dos casos e da mortalidade infantil por sífilis congênita nas cinco regiões geográficas do Brasil entre 2009 e 2018 / Temporal distribution of cases and of infant mortality from congenital syphilis in the five geographical regions of Brazil between 2009 and 2018

Introdução: No mundo, estima-se que cerca de 1,8 milhões de gestantes estejam infectadas por sífilis, apesar de apenas 10% desse valor sejam diagnosticados e devidamente tratados. Nesse sentido, o presente estudo tem por objetivo descrever a evolução temporal da incidência dos casos e das taxas de mortalidade por sífilis congênita (SC) em menores de 1 ano, bem como comparar o impacto dessa mortalidade por regiões do Brasil, entre 2009 e 2018. Métodos: Trata-se de um estudo ecológico, retrospectivo, com dados do Sistema de Informação e Agravos de Notificação (SINAN), Sistema de Informações sobre Mortalidade (SIM) e do Sistema de Informação sobre Nascidos Vivos (SINASC). Resultados: A incidência de SC em indivíduos menores de 1 ano apresentou um acréscimo de 328,57% nas taxas notificadas entre 2009 (2,1/1.000) e 2018 (9/1.000). A média anual de incidência (ß 1 ) por SC foi de 0,80 (IC95% 0,75­0,86; p=00006), com um coeficiente de determinação (R 2 ) igual a 0,99%. A variação média da taxa de mortalidade por SC (ß 1 ) foi 0,006/1.000 (IC95% 0,005­0,008; p=0,00004, R 2 = 0,93%). A região Sudeste apresentou a maior proporção de mortalidade pela doença entre menores de 1 ano por SC, com 43,14% dos óbitos. Conclusão: Foi observada uma correlação positiva da incidência e da mortalidade por SC entre menores de 1 ano no Brasil ao longo dos anos analisados, sendo perceptível elevadas taxas entre as cincos regiões geográficas, sugerindo a necessidade de maior atenção à triagem no pré-natal e melhorias na capacitação dos serviços de saúde. (AU)

Introduction: Worldwide, it is estimated that about 1.8 million pregnant women are infected with syphilis, although only 10% of them are diagnosed and treated appropriately. Therefore, the present study aims to describe the temporal evolution of the incidence of cases of and mortality rates from congenital syphilis (CS) in children younger than 1 year, as well as to compare the impact of this mortality by regions of Brazil between 2009 and 2018. Methods: This is an ecological, retrospective study, with data from the Information System and Notifiable Diseases (SINAN), Mortality Information System (SIM) and the Information System on Live Births (SINASC). Results: The incidence of CS in individuals younger than 1 year showed an increase of 328.57% in the rates recorded between 2009 (2.1/1,000) and 2018 (9/1,000). The mean annual incidence (ß1) per CS was 0.80 (95% confidence interval [95%CI] 0.75-0.86; p = 00006), with a coefficient of determination (R2) equal to 0.99%. The mean variation in mortality rate from SC (ß1) was 0.006/1,000 (95%CI 0.005- 0.008; p = 0.00004, R2 = 0.93%). The southeast region had the highest proportion of mortality from the disease among children younger than 1 year due to CS, with 43.14% of deaths. Conclusion: There was a positive correlation between incidence of and mortality from CS among children younger than 1 year in Brazil over the years analyzed, with high rates in the five geographic regions, suggesting the need for greater attention to prenatal screening and improvements in the training of health service professionals. (AU)

Evaluation of the retinal vasculature of patients with branch retinal vein occlusion using optical coherence tomography angiography / Avaliação da vasculatura da retina em pacientes com oclusão de ramo da veia central da retina utilizando a angiografia por tomografia de coerência óptica

ABSTRACT Purpose: To evaluate vascular density in super­ficial and deep capillary plexuses of the retina, measured using optical coherence tomography angiography in patients with branch retinal vein occlusion. Affected eyes were compared with the contralateral eye of the same patient and both were compared with normal eyes. Methods: A cross-sectional study including 16 previously untreated patients with branch retinal vein occlusion. Patients with poor quality examinations, bilateral disease, high refractive error, or any other retinal or choroidal disease were excluded. A total of 31 patients without eye disease were also selected as a comparison group. All participants underwent five optical coherence tomography angiographies, and only those with at least two good quality examinations were selected. The Kruskal-Wallis, Wilcoxon signed-rank, and Mann-Whitney U tests were used for the statistical analysis. Results: Vascular density was lower in affected eyes compared with contralateral eyes: whole density (p=0.020 for capillary plexuses superficial; p=0.049 for deep capillary plexuses) and parafoveal density (p=0.020 for capillary plexuses superficial; p=0.011 for deep capillary plexuses). Vascular density was also lower in affected eyes compared with normal eyes: whole density (p<0.001 for capillary plexuses superficial and deep) and parafoveal density (p<0.001 for capillary plexuses superficial and deep). Whole density (p=0.001 for capillary plexuses superficial and deep) and parafoveal density (p=0.001 for capillary plexuses superficial; p<0.001 for deep capillary plexuses) were both lower in the contralateral eyes compared with normal eyes. Following adjustment for arterial hypertension, this difference was no longer observed. Conclusions: Vascular density in capillary plexuses and deep capillary plexuses was lower in the eyes affected by branch retinal vein occlusion. Furthermore, the lower vascular density noted in the contralateral eyes indicates that changes most likely occurred in these eyes prior to the appearance of any clinically detectable alterations, reflecting the early signs of hypertensive retinopathy.

RESUMO Objetivo: Avaliar a densidade vascular do plexo capilar superficial e profundo da retina, usando angiografia por tomografia de coerência óptica em pacientes com oclusão de ramo da veia central da retina, comparando o olho afetado com o contralateral do mesmo paciente e ambos com olhos normais. Métodos: Estudo transversal. Incluídos dezesseis pacientes com oclusão de ramo da veia central da retina sem tratamento prévio. Pacientes com exames de baixa qualidade, altas ametropias, outras patologias de retina ou coróide foram excluídos. Para comparação, trinta e um pacientes sem doença ocular foram selecionados. Todos foram submetidos a cinco exames angiografia por tomografia de coerência óptica, apenas aqueles com pelo menos dois exames de boa qualidade permaneceram no estudo. Os testes Kruskal-Wallis, Wilcoxon, e Mann-Whitney foram utilizados. Resultados: Densidades vasculares mais baixas do plexo capilar superficial e plexo capilar profundo foram observadas quando olhos com oclusão de ramo da veia central da retina foram comparados com os contralaterais: densidade total (p=0,02 para plexo capilar superficial, p=0,049 para plexo capilar profundo), densidade parafoveal (p=0,02 para plexo capilar superficial, p=0,011 para plexo capilar profundo). Comparando olhos acometidos com olhos normais, também foram observadas densidades vasculares mais baixas de plexo capilar superficial e plexo capilar profundo: densidade total (ambos com p<0,001) e densidade parafoveal (ambos com p<0,001). Quando os olhos contralaterais foram comparados aos normais, tanto a densidade total do plexo capilar superficial e plexo capilar profundo (ambos com p=0,001) quanto a densidade parafoveal (plexo capilar superficial com p=0,001, plexo capilar profundo com p<0,001) foram menores. Ao se realizar uma subanálise, minimizando o fator hipertensão arterial, esta diferença não se manteve. Conclusões: Densidades vasculares mais baixas do plexo capilar superficial e do plexo capilar profundo foram observadas em olhos com oclusão de ramo da veia central da retina. Além disso, a presença de densidades vasculares mais baixas nos olhos contralaterais mostra que já existem altera­ções nesses olhos antes das alterações clínicas, devido a al­terações inicias da retinopatia hipertensiva.

Evaluation of the retinal vasculature of patients with branch retinal vein occlusion using optical coherence tomography angiography.

PURPOSE: To evaluate vascular density in super-ficial and deep capillary plexuses of the retina, measured using optical coherence tomography angiography in patients with branch retinal vein occlusion. Affected eyes were compared with the contralateral eye of the same patient and both were compared with normal eyes. METHODS: A cross-sectional study including 16 previously untreated patients with branch retinal vein occlusion. Patients with poor quality examinations, bilateral disease, high refractive error, or any other retinal or choroidal disease were excluded. A total of 31 patients without eye disease were also selected as a comparison group. All participants underwent five optical coherence tomography angiographies, and only those with at least two good quality examinations were selected. The Kruskal-Wallis, Wilcoxon signed-rank, and Mann-Whitney U tests were used for the statistical analysis. RESULTS: Vascular density was lower in affected eyes compared with contralateral eyes: whole density (p=0.020 for capillary plexuses superficial; p=0.049 for deep capillary plexuses) and parafoveal density (p=0.020 for capillary plexuses superficial; p=0.011 for deep capillary plexuses). Vascular density was also lower in affected eyes compared with normal eyes: whole density (p<0.001 for capillary plexuses superficial and deep) and parafoveal density (p<0.001 for capillary plexuses superficial and deep). Whole density (p=0.001 for capillary plexuses superficial and deep) and parafoveal density (p=0.001 for capillary plexuses superficial; p<0.001 for deep capillary plexuses) were both lower in the contralateral eyes compared with normal eyes. Following adjustment for arterial hypertension, this difference was no longer observed. CONCLUSIONS: Vascular density in capillary plexuses and deep capillary plexuses was lower in the eyes affected by branch retinal vein occlusion. Furthermore, the lower vascular density noted in the contralateral eyes indicates that changes most likely occurred in these eyes prior to the appearance of any clinically detectable alterations, reflecting the early signs of hypertensive retinopathy.

Avaliação da economia gerada por meio das intervenções farmacêuticas realizadas em um hospital universitário terciário de grande porte / Evaluation of cost savings generated through pharmaceutical inverventions performed in a large tertiary university hospital

Introdução: A farmácia clínica tem como objetivo garantir uma farmacoterapia adequada ao paciente. A avaliação de prescrição é uma das principais atividades do farmacêutico clínico, o que pode resultar em intervenções e economia para a instituição, além de promover o uso racional e seguro de medicamentos. O objetivo deste estudo foi avaliar a economia gerada por meio das intervenções realizadas pelos farmacêuticos clínicos durante o processo de avaliação farmacêutica de prescrição. Métodos: Estudo transversal, observacional e analítico, onde foi analisada a economia gerada através das intervenções realizadas pelos farmacêuticos no período entre janeiro e julho de 2017. Resultados: Foram realizadas 3.033 intervenções no período do estudo e 943 foram incluídas. O valor da economia gerada foi de R$ 72.648,39 (US$ 23.134,95), sendo as intervenções mais frequentes relacionadas à adequação de apresentação (847) e forma farmacêutica (44). Dentre os medicamentos cujas intervenções farmacêuticas resultaram em maior economia, estão a anfotericina B lipossomal (R$ 18.919,75), a daptomicina (R$ 8.575,00), o valganciclovir (R$ 7.452,00) e a anidulafungina (R$ 7.422,35). Algumas intervenções não resultaram em economia direta do tratamento medicamentoso, como ocorreu com a risperidona comprimido (− R$ 264,04) e o sulfametoxazol+trimetoprima comprimido (− R$ 208,62), que foram substituídos por solução oral para administração por sondas. Conclusão: O estudo demonstrou que a atuação do farmacêutico clínico resultou na efetivação de intervenções relacionadas à adequação de dose, correção de diluição, alteração de apresentação, substituição de forma farmacêutica, adequação de tempo de tratamento e a adesão aos protocolos institucionais. Essas intervenções refletiram diretamente na redução de custo dos tratamentos, otimizando recursos e gerando economia ao serviço de saúde. (AU)

Introduction: Clinical pharmacy aims to ensure appropriate pharmacotherapy for patients. Prescription evaluation is one of the main activities of the clinical pharmacist and can result in interventions and cost savings for the institution, in addition to promoting the rational and safe use of medications. The objective of this study was to evaluate cost savings generated through interventions performed by clinical pharmacists during the process of prescription evaluation. Methods: This cross-sectional, observational, analytical study analyzed cost savings generated through interventions performed by pharmacists from January to July 2017. Results: A total of 3,033 interventions were performed during the study period, of which 943 were included. Cost savings amounted to R$ 72,648.39 (US$ 23,134.95), and the most frequent interventions were related to the adequacy of presentation (847) and dosage form (44). The medications whose pharmaceutical interventions resulted in the greatest cost savings are liposomal amphotericin B (R$ 18,919.75), daptomycin (R$ 8,575.00), valganciclovir (R$ 7,452.00), and anidulafungin (R$ 7,422.35). Some interventions did not result in direct cost savings, such as treatment with risperidone tablet (− R$ 264.04) and trimethoprim-sulfamethoxazole tablet (− R$ 208.62), which were replaced by oral solution for tube administration. Conclusion: The study demonstrated that the performance of clinical pharmacists resulted in the implementation of interventions related to dose adjustment, dilution correction, change of presentation, replacement of dosage form, adjustment of treatment duration, and adherence to institutional protocols. These interventions directly resulted in the reduction of treatment costs, optimizing resources and generating cost savings for the health system. (AU)

Levels of Evidence: What Should Ophthalmologists Know? / Níveis de evidência: O que os Oftalmologistas devem saber?

Abstract Facing an enormous influx of information from medical research, clinicians need to differentiate robust study findings from spurious ones. The levels of evidence are an important component of Evidence-Based Medicine. Understanding the levels helps the Ophthalmologist to prioritize information and make right clinical decisions. The aim of this article is to describe the hierarchy of studies regarding their scientific evidence focusing on ophthalmology.

Resumo Em face a um enorme influxo de informações de pesquisa médica, os clínicos precisam diferenciar os achados de estudos robusto dos espúrios. Os níveis de evidência são um componente importante da Medicina Baseada em Evidências. Compreender os níveis ajuda ooftalmologista a priorizar as informações e tomar decisões clínicas corretas. O objetivo deste artigo é descrever a hierarquia dosestudos em relação à evidência científica com enfoque na oftalmologia.

Ultrasonographic characteristics of active ocular toxoplasmosis / Achados ultrassonográficos em toxoplasmose ocular ativa

ABSTRACT Purpose: To evaluate ophthalmic ultrasonographic findings associated with active ocular toxoplasmosis. Methods: Forty-seven eyes with active ocular toxoplasmosis in 47 patients were subjected to ocular ultrasonography using the transpalpebral technique (10-MHz transducer) and fundus photography. Patient medical records were retrospectively reviewed. Results: Ocular ultrasonography revealed vitritis, posterior vitreous detachment, retinal wall thickening, and non-rhegmatogenous retinal detachment in 47 (100%), 36 [76.6%; partial in 12 (25.5%) and total in 23 (48.9%)], 12 (25.5%), and 5 eyes (10.6%). Thirty-five of the 36 eyes with posterior vitreous detachment (97.2%) exhibited posterior hyaloid thickening; moreover, adhesion to the exudative lesion and vitreoschisis were observed in 4 (11.1%) and 12 eyes (25.5%), respectively. Ultrasonography detected the location of the exudative focus in 12 eyes (25.5%). Conclusion: Ultrasonography is helpful for detecting important intraocular findings of acute ocular toxoplasmosis that can be hindered by medial opacity or posterior synechiae.

RESUMO Objetivo: Avaliar os achados da ultrassonografia na toxoplasmose ocular ativa. Métodos: Quarenta e sete olhos com toxoplasmose ocular ativa em 47 pacientes foram submetidos à ultrassonografia ocular pela técnica transpalpebral (transdutor de 10 MHz) e fundo de olho. Os prontuários médicos foram revistos retrospectivamente. Resultados: A ultrassonografia ocular revelou vitreíte, descolamento vítreo posterior, espessamento da parede da retina e descolamento de retina não regmatogênico em 47 (100%), 36 [76,6%; parcial em 12 (25,5%) e total em 23 (48,9%)], 12 (25,5%) e 5 olhos (10,6%). Trinta e cinco dos 36 olhos com descolamento vítreo posterior (97,2%) exibiram espessamento hialoide posterior; além disso, a adesão à lesão exsudativa e vitreosquise foi observada em 4 (11,1%) e 12 (25,5%), respectivamente. A ultrassonografia detectou a localização do foco exsudativo em 12 olhos (25,5%). Conclusão: A ultrassonografia é útil na detecção de importantes achados intra-oculares de toxoplasmose ocular aguda que podem ser prejudicados pela opacidade medial ou sinéquia posterior.