Clinical diagnosis of bacterial vaginosis.

OBJECTIVE: To evaluate the accuracy of Amsel's criteria individually or in combinations of two for the clinical diagnosis of bacterial vaginosis. METHODS: This cross-sectional study enrolled 135 women at UNICAMP, and evaluated Amsel's four clinical criteria. Sensitivity, specificity, positive and negative predictive values were calculated for each criterion individually, in combinations of two, and for the classic test with at least three criteria present. The Nugent method was used as gold standard. RESULTS: The most sensitive individual criteria were pH and vaginal discharge (97%), the latter having lowest specificity (26%). The criterion with highest specificity was the presence of clue cells (86%). The combination of two criteria showed sensitivity of 83% to 93%, and specificity of 82% to 94%. CONCLUSION: The accuracy of Amsel's clinical criteria individually or in combinations of two was as accurate as the presence of at least three criteria for the diagnosis of bacterial vaginosis.

Ipsilateral limbal translocation for treatment of partial limbal deficiency secondary to ocular alkali burn.

BACKGROUND/AIM: Chemical ocular burn, especially by alkali, may result in damage to the limbal stem cells, fundamental in maintaining the integrity of ocular surface. Clinically, patients manifest abnormal conjunctival-corneal healing with peripheral neovessels, chronic epithelial defect, severe stromal inflammation, and conjunctivalisation of the corneal, which is characteristic of limbal deficiency. Penetrating keratoplasty has a poor prognosis in these cases. Available therapeutic options included limbal autograft and allograft transplantation associated or not with human amniotic membrane transplant. The authors propose an alternative treatment with ipsilateral autologous limbal transplantation, transferring the healthy portion of the limbus from the partially burned eye to the deficient area in patients with partial limbal deficiency secondary to alkali burn. METHODS: Ipsilateral limbal autografts were performed in five patients with partial limbal deficiency secondary to alkali burn, transferring the healthy portion of the limbus to the burned area of the same eye, without intervening in the contralateral eye. RESULTS: All cases had regression of the limbal deficiency with improvement of visual acuity to a minimum of 20/60-20/20 (partial), without complications during the follow up period (range 7-11 months). CONCLUSION: Ipsilateral autologous limbal autograft is a therapeutic option for partial limbal deficient eyes.

Bilateral corneal involvement in epidermolysis bullosa acquisita.

PURPOSE: To report clinical and laboratory findings of bilateral corneal involvement in a patient with epidermolysis bullosa acquisita. METHODS: A 25-year-old man with a history of progressive and painless loss of vision in both eyes presented to our service with bilateral corneal involvement: peripheral corneal perforation in one eye and advanced corneal thinning in the other eye. There was concomitant dermatologic bullous disease. Clinical and laboratory exams were analyzed. RESULTS: The patient was diagnosed as having epidermolysis bullosa acquisita. Therapeutic corneal patch graft and conjunctival resection with cryotherapy were done, with satisfactory results. CONCLUSION: Bilateral corneal involvement in epidermolysis bullosa acquisita is described. To the best of our knowledge, this is the first description of such a case. Surgical management of the ocular findings associated with systemic therapy with colchicine seems to be a good therapeutic option in the management of this defying disease.

Antibacterial activity of anesthetic solutions and preservatives: an in vitro comparative study.

PURPOSE: To investigate the antibacterial activity of topical anesthetic solutions and their preservatives individually in vitro, to determine involvement with bacterial growth inhibition. MATERIAL AND METHODS: Proparacaine and tetracaine (in concentrations of 0.125%, 0.25%, and 0.50%), edetate disodium (EDTA), benzalkonium chloride, EDTA + benzalkonium chloride, and sterile saline solution were used. Five microliters of each solution were applied to standard filter paper disks and placed in Mueller-Hinton agar previously inoculated with known strains of Pseudomonas aeruginosa and Staphylococcus aureus. Zones of growth inhibition were measured 24 hours later and analyzed. RESULTS: There were no zones of inhibition in the agar inoculated with P. aeruginosa to all tested solutions. Benzalkonium chloride alone and associated with EDTA inhibited growth of S. aureus. All other solutions did not inhibit S. aureus. CONCLUSION: Preservative-free anesthetic solutions seemed not to interfere with bacterial development in culture media. Benzalkonium chloride alone and associated with EDTA inhibited development of gram positive bacteria, S. aureus, but did not inhibit P. aeruginosa.

Central nervous system effects of the crude extract of Erythrina velutina on rodents.

The aqueous extract (AE) of Erythrina velutina prolonged the sleep duration induced by sodium pentobarbital (control: 6.4 +/- 1.2 min; extract 10 mg/kg, 47.1 +/- 3.9 min; extract 100 mg/kg, 109.4 +/- 7.2 min; F = 243, P < 0.001). In the open field, the extract at the doses of 10 and 50 mg/kg did not changed the number of crossings, rearings nor groomings. On the other hand, at the dose of 200 mg/kg it reduced the number of crossings (q = 6.25, P < 0.05) and groomings (q = 3.91, P < 0.05). When exposed during three consecutive days to the open field, the control animals showed habituation for crossings (F = 17.56, P < 0.001) and rearings (F = 14.01, P < 0.001). The same was not true for animals treated with 10 mg/kg of the extract (crossings: F = 3.59, P > 0.05; rearings: F = 3.62, P > 0.05). At the same dose, the extract blocked the acquisition of foot shock memory (P = 0.9219) when compared to the control values (P = 0.0078). Our data showed that the crude extract of Erythrina velutina at lower doses interferes with mnemonic process for different tasks, while at higher doses, the sedative and neuromuscular blocking actions are the main effects.

Retrobulbar anesthesia with a flexible catheter.

BACKGROUND AND OBJECTIVES: The authors describe a method that seeks to improve the administration of local anesthesia for intraocular surgery, avoiding the risk of potential complications associated with retrobulbar and peribulbar techniques and eliminating the inconveniences of the new methods such as subconjunctival and limbal infiltration. PATIENTS AND METHODS: The authors demonstrate the safety and effectiveness of this technique in 50 consecutive cases. This technique consists of a small, blunt dissection of the conjunctiva, Tenon's capsule, and intermuscular septum in the inferior nasal quadrant, followed by the insertion of a flexible catheter that is guided to the retrobulbar space, where 3.0 ml of anesthetic solution is injected. RESULTS: All of the patients (100%) felt that this procedure was comfortable and painless. No complications were observed. Ultrasonography demonstrated the exact catheter position in the retrobulbar space; therefore, the authors could be sure that this anesthetic infiltration was done in the appropriate and safe place. CONCLUSIONS: This is a direct sub-Tenon's technique that is simple, effective, and safe and that avoids introducing a sharp or metallic instrument into the orbit.

Surgical resection of giant papillae and autologous conjunctival graft in patients with severe vernal keratoconjunctivitis and giant papillae.

PURPOSE: Giant papillae (GP) in patients with vernal keratoconjunctivitis (VKC) refractory to clinical treatment may cause serious corneal complications, such as shield ulcer. We propose a surgical treatment--resection of GP--in conjunction with free autologous conjunctival graft to treat severe cases of VKC with GP. METHODS: Six eyes of five patients with VKC, characterized by GP and shield ulcer refractory to clinical treatment, underwent surgical resection of GP associated with free autologous conjunctival graft. RESULTS: No recurrence of GP over the graft was observed during follow-up intervals ranging from 9 months to 27 months. Corneal shield ulcers healed during the first week after treatment and did not recur. CONCLUSIONS: Patients with refractory VKC and GP associated with corneal shield ulcer may benefit from resection of GP and autologous conjunctival graft.

Microbiological study of disposable soft contact lenses after photorefractive keratectomy.

PURPOSE: To evaluate the bacterial contamination of bandage disposable soft contact lenses used in patients following photorefractive keratectomy (PRK) and to correlate our findings with clinical data. METHODS: Forty-six patients (81 eyes) underwent PRK. Immediately after each procedure, disposable soft contact lenses were positioned with sterile forceps. After 3 days, the lenses were removed in a sterile manner, placed in sterile Eppendorf pipettes containing 8 mL of enriched brain heart infusion broth, and analyzed for microbial contamination. RESULTS: Seven positive cultures were found: six gram positive cocci (7.4%) and one gram negative bacillus (1.2%). There was no clinical correlation with these findings. CONCLUSION: Isolated microorganisms were similar to those described in the literature as agents of bacterial keratitis and are components of the normal ocular flora. Klebsiela pneumoniae--considered an occasional or transient flora--was the exception. All isolated microorganisms but K. pneumoniae were sensitive to most of the antibiotics tested. Our findings suggest that the risk of infectious keratitis after PRK related to soft contact lens wear for 3 days seems to be low, which may be because lenses were not manipulated by the patient during the wearing period, and the postoperative antibiotic regimen was strictly followed by patients. However, care should be taken to instruct patients in proper lens care practices to reduce the risk of bacterial keratitis in contact lens wear following PRK.

Seroprevalência da infecçäo pelo HIV-1 em gestantes atendidas no IMIP, Recife - Brasil / Seroprevalence of HIV infection among pregnant women attending in the IMIP, Recife-Brasil

The number of HIV infected heterosexual has been steadily increasing in Brazil. This fact was followed by a decline on the ratio of male/female HIV infection every year. We have examined the seroprevalence of HIV infection among pregnant women attending an antenatal clinic in the Instituto Materno Infantil de Pernambuco (IMIP) at Recife, North-eastern Brazil. This study was performae as an anonymous sentinel surveillance. The collected blood samples were tested for HIV infection by two different types of ELISA, and if positive, further analysis by IIA was submitted. The subjects were arranged in four age groups with the respective proportion: group l (<15 years)-0.9 per cent, group II (15 to 20 years)-31.6 per cent, group III (21 to 34 years)-61.7 per cent and group IV (>35 years)- 5,8 per cent. It was found an HIV-1 seroprevalence of 0.1 per cent (95 per cent confidence interval, -0.l to + 0,3) This percentage represents one single HIV positive woman included in age group III. his low HIV infection seroprevalence is suitable with a low risk population (pregnant women) in a low prevalence area. However, we became concerned with the great propottion of pregnant woman under 21 years (32,5 per cent) and with the implications of how to reinforce effectively HIV preventions of how to reinforce effectively HIV prevention strategies to this population