Valsalva Retinopathy Presenting as Subretinal Hemorrhage.

Purpose: To describe a case of subretinal hemorrhage due to the Valsalva maneuver in a patient with no underlying chorioretinal disease. Methods: History and clinical examination, optical coherence tomography (OCT), fluorescein, and indocyanine green angiography. Results: We report a case of a 35-year-old man with a 4-day history of central vision loss in the left eye (OS) after a vomiting episode. His best-corrected visual acuity was 20/200 in OS. Fundus examination revealed a subretinal hemorrhage in the posterior pole, associated with a small preretinal hemorrhage in the superotemporal arcade. OCT confirmed the presence of a thick submacular hemorrhage and a focal hemorrhage beneath the inner limiting membrane along the superotemporal arcade. The patient was submitted to pars plana vitrectomy (PPV), subretinal injection of tissue plasminogen activator (tPA), and air tamponade on the following day. Most of the submacular hemorrhage was displaced, resulting in a satisfactory visual outcome (BCVA = 20/30 after 1 month of surgery). Fluorescein and indocyanine green angiography excluded conditions such as retinal arterial macroaneurysm, polypoidal chorioretinopathy, and choroidal neovascularization. Conclusion: Although rare, Valsalva retinopathy may present with submacular hemorrhage in a patient with no underlying chorioretinal disease. PPV and subretinal tPA injection may provide a good visual outcome.

Doença alérgica ocupacional: aspectos socioepidemiológicos em ambulatório especializado na cidade de São Paulo / Occupational allergic disease: socio-epidemiological aspects from a specialized outpatient clinic at the city of Sao Paulo

Introdução: Doença ocupacional envolvendo o sistema imunológico é considerada doença alérgica ocupacional (DAO). Das doenças ocupacionais, 15% são alérgicas. As consequências sociais do diagnóstico de DAO são importantes para o trabalhador e empregador. Objetivos: Descrever características demográficas e clínicas dos pacientes estudados com DAO e seus desfechos sociais. Métodos: Estudo descritivo, retrospectivo dos prontuários de pacientes do ambulatório de alergia ocupacional de hospital universitário em São Paulo, com diagnóstico de DAO. Resultados: 72 pacientes apresentaram DAO, com idades entre 21 e 89 anos; 52% do sexo masculino. Antecedentes atópicos foram descritos em 35% dos pacientes. A maioria dos pacientes trabalhava nas áreas de indústria química (17%), limpeza (15%), construção civil (11%) e saúde (8%). Rinite ocupacional foi vista em 26% dos pacientes; asma relacionada ao trabalho, em 18%; asma e rinite, em 25%; dermatite de contato alérgica, em 13%. Sobre o desfecho social, 36 (50%) mantiveram-se em seus cargos, 19 (26%) mudaram de função, 7 (10%) mudaram de área, 7 (10%) foram afastados e 3 (4%) se aposentaram. Conclusões: Na casuística estudada, a DAO prevaleceu no sexo masculino, em faixa etária condizente com faixa trabalhadora; com maior número de casos de rinite ocupacional. Metade dos pacientes continuou exercendo a mesma função mesmo após o diagnóstico.

Background: Occupational diseases involving the immune system are considered as occupational allergic diseases (OAD); 15% of occupational diseases are allergic. The social consequences of OAD are significant for both workers and employers. Objectives: To describe demographic and clinical characteristics of patients with OAD and their social outcomes. Methods: Descriptive and retrospective study of the medical records of patients diagnosed with OAD and cared at the occupational allergy clinic of a university hospital in São Paulo, Brazil. Results: A total of 72 patients exhibited OAD, with age from 21 to 89 years old; 52% were male. Atopic antecedents were described for 35% of patients. Most patients worked in the chemical industry (17%), cleaning (15%), construction (11%) and health (8%). Occupational rhinitis was found in 26% of the patients, work-related asthma in 18%, asthma and rhinitis in 25%, and allergic contact dermatitis in 13%. In regard to the social outcomes, 36 (50%) remained in their job, 19 (26%) changed function, 7 (10%) changed work area, 7 (10%) were fired and 3 (4%) retired. Conclusions: In the present study, OAD prevailed in males and the economically active age; cases of occupational rhinitis were the most frequent. Half of the employees remained in the same function even after diagnosis.

Occupational allergic disease: socio-epidemiological aspects from a specialized outpatient clinic in the city of Sao Paulo, Brazil.

BACKGROUND: Occupational diseases involving the immune system are considered to be occupational allergic diseases (OAD); 15% of occupational diseases are allergic. The social consequences of OAD are significant for both workers and employers. OBJECTIVES: To describe demographic and clinical characteristics of patients with OAD and their social outcomes. METHODS: Descriptive and retrospective study of the medical records of patients diagnosed with OAD cared at the occupational allergy clinic of a university hospital in São Paulo, Brazil. RESULTS: A total of 72 patients exhibited OAD, with age 21 to 89 years old; 52% were male. Atopic antecedents were described for 35% of patients. Most patients worked in the chemical industry (17%), cleaning (15%), construction (11%) and health care (8%). Occupational rhinitis was found in 26% of the patients, work-related asthma in 18%, asthma and rhinitis in 25%, and allergic contact dermatitis in 13%. In regard to the social outcomes, 36 (50%) workers remained in their jobs, 19 (26%) changed function, 7 (10%) changed occupation, 7 (10%) were fired and 3 (4%) retired. CONCLUSIONS: In the present study, OAD prevailed among males and within the economically active age; cases of occupational rhinitis were the most frequent. Half of the employees remained in the same job position even after diagnosis.

INTRODUÇÃO: Doença ocupacional envolvendo o sistema imunológico é considerada doença alérgica ocupacional (DAO). Das doenças ocupacionais, 15% são alérgicas. As consequências sociais do diagnóstico de DAO são importantes para o trabalhador e empregador. OBJETIVOS: Descrever características demográficas e clínicas dos pacientes estudados com DAO e seus desfechos sociais. MÉTODOS: Estudo descritivo, retrospectivo dos prontuários de pacientes do ambulatório de alergia ocupacional de hospital universitário em São Paulo, com diagnóstico de DAO. RESULTADOS: 72 pacientes apresentaram DAO, com idades entre 21 e 89 anos; 52% do sexo masculino. Antecedentes atópicos foram descritos em 35% dos pacientes. A maioria dos pacientes trabalhava nas áreas de indústria química (17%), limpeza (15%), construção civil (11%) e saúde (8%). Rinite ocupacional foi vista em 26% dos pacientes; asma relacionada ao trabalho, em 18%; asma e rinite, em 25%; dermatite de contato alérgica, em 13%. Sobre o desfecho social, 36 (50%) mantiveram-se em seus cargos, 19 (26%) mudaram de função, 7 (10%) mudaram de área, 7 (10%) foram afastados e 3 (4%) se aposentaram. CONCLUSÕES: Na casuística estudada, a DAO prevaleceu no sexo masculino, em faixa etária condizente com faixa trabalhadora; com maior número de casos de rinite ocupacional. Metade dos pacientes continuou exercendo a mesma função mesmo após o diagnóstico.