Is the 2015 eye care service delivery profile in Southeast Asia closer to universal eye health need!

PURPOSE: The year 2015 status of eye care service profile in Southeast Asia countries was compared with year 2010 data to determine the state of preparedness to achieve the World Health Organization global action plan 2019. METHODS: Information was collected from the International Agency for Prevention of Blindness country chairs and from the recent PubMed referenced articles. The data included the following: blindness and low vision prevalence, national eye health policy, eye health expenses, presence of international non-governmental organizations, density of eye health personnel, and the cataract surgical rate and coverage. The last two key parameters were compared with year 2010 data. RESULTS: Ten of 11 country chairs shared the information, and 28 PubMed referenced publications were assessed. The prevalence of blindness was lowest in Bhutan and highest in Timor-Leste. Cataract surgical rate was high in India and Sri Lanka. Cataract surgical coverage was high in Thailand and Sri Lanka. Despite increase in number of ophthalmologists in all countries (except Timor-Leste), the ratio of the population was adequate (1:100,000) only in 4 of 10 countries (Bhutan, India, Maldives and Thailand), but this did not benefit much due to unequal urban-rural divide. CONCLUSION: The midterm assessment suggests that all countries must design the current programs to effectively address both current and emerging causes of blindness. Capacity building and proportionate distribution of human resources for adequate rural reach along with poverty alleviation could be the keys to achieve the universal eye health by 2019.

Safety and immunogenicity of the anti-cocaine vaccine UFMG-VAC-V4N2 in a non-human primate model.

A promising strategy for cocaine addiction treatment is the anti-drug vaccine. These vaccines induce the production of anticocaine antibodies, capable of linking to cocaine, and decrease the passage of cocaine throughout the blood-brain barrier, decreasing drug activity in the brain. Our research group developed a new vaccine candidate, the UFMG-V4N2, to treat cocaine use disorders (CUD) using an innovative carrier based on calixarenes. This study assessed the safety and immunogenicity of the anti-cocaine vaccine UFMG-VAC-V4N2 in a non-human primate toxicity study using single and multiple vaccine doses. The UFMG-VAC-V4N2 yielded only mild effects in the injection site and did not influence the general health, feeding behavior, or hematological, renal, hepatic, or metabolic parameters in the vaccinated marmosets. The anti-cocaine vaccine UFMG-VAC-V4N2 presented a favorable safety profile and induced the expected immune response in a non-human primate model of Callithrix penicillata. This preclinical UFMG-VAC-V4N2 study responds to the criteria required by international regulatory agencies contributing to future anticocaine clinical trials of this anti-cocaine vaccine.

Cultural and technology elucidation of the Tupi-Guarani tradition through analysis of potsherds from Travessão do Rio Vermelho site (Santa Catarina - Brazil) by spectroscopy, SEM-EDS and chemometrics.

Ceramic fragments can provide an insight into the ancient culture and practices of groups of humans and their way of life (technology, cultural identity, social organization, habitation and economy). Scientific analysis can be used to obtain information on the ceramic production process, as well as the specificities of the material employed. In this research, all samples of archaeological potsherd from the Tupi-Guarani tradition were analyzed in order to identify and to characterize the structures, morphologies and the elemental composition by using by scanning electron microscopy (SEM-EDS) and multivariate statistical methods (PCA and HCA). FTIR spectroscopy revealed the presence of an organic residue in three samples along with carbonates, clay minerals, quartz and hematite. In addition, the presence of the stretching attributed to water molecules in crystalline systems was observed. Also, the presence of TiO2 in the anatase polymorphic form was detected using µ-Raman spectroscopy. These results indicate a firing temperature of between 800 and 1000 °C. In relation to the morphology, all samples revealed amorphous structures presenting isolated and heterogenic particles of different forms and sizes, and the EDS spectrum confirmed the elements present in the molecular structures elucidated by vibrational spectroscopy. The multivariate analysis has confirmed the correlation between the elemental compositions of ceramics collected from two different sites: a mountain region and a coastal area in Santa Catarina State, Brazil.

Vitamin A nutrition among East Timor refugee children.

BACKGROUND AND OBJECTIVES: Children age 6 to 72 months, living in refugee camps are at increased risk of developing vitamin A deficiency (VAD), resulting in increased morbidity and mortality. Due to poverty, often this population group has limited access to foods containing vitamin A from animal-based food sources and do not commonly consume available foods containing beta-carotene. To date, there is a paucity of data on vitamin A intake in young refugee children. To determine vitamin A intake in children ages 6 to 72 months at refugee camps in East Timor. METHODS AND STUDY DESIGN: A cross sectional study was carried out among children ages 6 to 72 months at refugee camps near Dili, East Timor. A detailed vitamin A intake questionnaire was ascertained from the primary caretaker, and the criteria and indicator cut off values suggested by World Health Organization (WHO) were used to classify the populations' vitamin A risk. RESULTS: Although animal sources of vitamin A were limited due to costs, all 89 children commonly consumed fruit containing vitamin A sources more than 3 times a week. Most children (69.7%) had been breast fed regularly, while 30.3% combined with bottle milk. 80.9% of children received vitamin A supplementation. CONCLUSION: Children in East Timor refugee camps have adequate vitamin A intake.

A search for trachoma in Timor-Leste: no evidence to justify undertaking population-based prevalence surveys.

PURPOSE: We sought evidence to justify undertaking population-based trachoma surveys in Timor-Leste, believing that in the absence of such evidence, the country could be categorized as not needing interventions to eliminate trachoma. METHODS: We undertook a systematic review of published literature on trachoma in Timor-Leste, with results updated to 28 April 2018. We also undertook a series of clinic- and field-based screening exercises, consisting of: (1) in October 2015, conjunctival examination of all children attending a school in Vila, Atauro Island; (2) from 1 November 2016 to 30 April 2017, examination for trichiasis, by specifically-trained frontline eye workers, of all individuals presenting to the ophthalmic clinics of six referral hospitals and five district eye clinics; and (3) house-to-house case searches in a total of 110 households, drawn from three communities that were reported by investigators from the 2016 Rapid Assessment of Avoidable Blindness (RAAB) to include residents with trachoma. RESULTS: Three RAABs (2005, 2009-2010, 2016) and two relevant published papers were identified. The 2016 RAAB reported one female subject to have been diagnosed with trachomatous corneal opacity. Re-examination of that individual revealed that she had ankyloblepharon, without evidence of trichiasis or entropion. No children on Atauro Island, no clinic attendees, and no individuals examined in the targeted house-to-house searches had any sign of trachoma. CONCLUSION: Trachoma is very unlikely to be a public health problem in Timor-Leste. It would not be appropriate to incur the costs of conducting formal population-based trachoma prevalence surveys here.

Prevalence and causes of blindness, visual impairment, and cataract surgery in Timor-Leste.

PURPOSE: To estimate the prevalence and causes of blindness and visual impairment, cataract surgical coverage (CSC), visual outcome of cataract surgery, and barriers to uptake cataract surgery in Timor-Leste. METHOD: In a nationwide rapid assessment of avoidable blindness (RAAB), the latest population (1,066,409) and household data were used to create a sampling frame which consists of 2,227 population units (study clusters) from all 13 districts, with populations of 450-900 per unit. The sample size of 3,350 was calculated with the assumed prevalence of blindness at 4.5% among people aged ≥50 years with a 20% tolerable error, 95% CI, and a 90% response rate. The team was trained in the survey methodology, and inter-observer variation was measured. Door-to-door visits, led by an ophthalmologist, were made in preselected study clusters, and data were collected in line with the RAAB5 survey protocol. An Android smart phone installed with mRAAB software was used for data collection. RESULT: The age-gender standardized prevalence of blindness, severe visual impairment, and visual impairment were 2.8%, (1.8-3.8), 1.7% (1.7-2.3), and 8.1% (6.6-9.6), respectively. Cataract was the leading cause of blindness (79.4%). Blindness was more prevalent in the older age group and in women. CSC was 41.5% in cataract blind eyes and 48.6% in cataract blind people. Good visual outcome in the cataract-operated eyes was 62% (presenting) and 75.2% (best corrected). Two important barriers to not using available cataract surgical services were accessibility (45.5%) and lack of attendants to accompany (24.8%). CONCLUSION: The prevalence of blindness and visual impairment in Timor-Leste remains high. CSC is unacceptably low; gender inequity in blindness and CSC exists. Lack of access is the prominent barrier to cataract surgery.

Prospective Study of Eye Disease in Timor-Leste: The East Timor Eye Program.

PURPOSE: This study aimed to present the methodology of the East Timor Eye Program and report the prevalence of eye disease seen at the National Eye Centre during a 3-month sample period between June and August 2012. DESIGN: Two hundred ninety-three new patients aged 17 years or older were assessed at the National Eye Centre in Dili, Timor-Leste. METHODS: All participants received a comprehensive dilated eye examination that included distance visual acuity measurements, indirect fundoscopy, and a complete slit lamp assessment including gonioscopy and intraocular pressure measurement. Each patient completed an interview-administered general questionnaire, and information on general health, ocular history, and medication was obtained. Anthropometric measurements were also taken and recorded. RESULTS: A total of 293 patients, 183 males (62.5%) and 110 females (37.5%), aged between 17 and 88 years (mean, 47.66 years) were recruited and examined. The 3 most common clinical eye presentations were conjunctival disorders (60.41%), followed by lens disorders (48.12%) and scleral, corneal, iris, and ciliary body disorders (46.42%). The 3 most common conditions causing blindness (visual acuity less than 3/60 as defined by the World Health Organization) were lens disorders (45.9%), choroidal and retinal disorders (18.9%), and other disorders of the eye and adnexa (13.5%). CONCLUSIONS: The East Timor Eye Program is an effective program that has enabled the management and treatment of various eye conditions in residents of Timor-Leste. The program set high standards for stringent and accurate data collection and ophthalmic diagnoses in a low-resource setting. Lens disorders and choroidal and retinal disorders were the most common conditions causing blindness.

Congenital malformations and other reproductive losses in goats due to poisoning by Poincianella pyramidalis (Tul.) L.P. Queiroz (=Caesalpinia pyramidalis Tul.).

In the semiarid region of Brazil, in areas with vegetation composed mainly of Poincianella pyramidalis, several cases of congenital malformation and reproductive losses were observed in goats and sheep from 2012 to 2014. To determine the teratogenic effect of P. pyramidalis, two groups of eight goats each were used. Goats from Group 1 received fresh P. pyramidalis, harvested daily, as the only roughage during the whole breeding and pregnancy period. Goats in Group 2 (control) received Cynodon dactylon (tifton) hay free choice. Ultrasound examination for pregnancy diagnosis was performed every 28 days. Four goats from Group 1 were pregnant on day 28 but not on day 56, suggesting embryonic death or abortion. Another goat from Group 1 died at day 70 of pregnancy, and the fetuses exhibited micrognathia. The other three goats bore six kids, three of which showed bone malformations in the limbs, spine, ribs, sternum, and head, including arthrogryposis, scoliosis and micrognathia. One kid also showed hypoplasia of the left pulmonary lobes. In the control group, all goats bore a total of 13 kids and none of them exhibited malformations. These results demonstrated that P. pyramidalis causes congenital malformations and other reproductive losses in goats.

Functional and visual acuity outcomes of cataract surgery in Timor-Leste (East Timor).

PURPOSE: To report functional outcomes following cataract surgery in Timor-Leste. METHODS: Pre- and post-intervention study measuring visual function improvement following cataract surgery. Presenting visual acuity (VA) was measured and visual function documented using the Indian vision function questionnaire (IND-VFQ). RESULTS: All 174 persons undergoing cataract surgery from November 2009 to January 2011 in Timor-Leste were included. Mean age was 65.4 years; 113 (64.9%) were male, 143 (82.1%) were from a rural background and 151 (86.8%) were illiterate. Pre-operatively, 77 of 174 patients (44.3%, 95% confidence interval, CI, 37.0-51.7%) were blind (VA ≤3/60), 77 (44.3%, 95% CI 37.0-51.7%) were visually impaired (VA <6/18->3/60), while 20 (11.5%, 95% CI 7.4-16.9%) had presenting acuity ≥6/18 in the better eye. Following surgery, significant improvement in visual function was demonstrated by an effect size of 2.8, 3.7 and 3.9 in the domains of general functioning, psychosocial impact and visual symptoms, respectively. Four weeks following surgery, 85 patients (48.9%, 95% CI 41.5-66.3%) had a presenting VA ≥6/18, 74 (42.5%, 95% CI 35.3-45.9%) were visually impaired and 15 (8.6%, 95% CI 5.0-13.6%) were blind. IND-VFQ improvement occurred even in patients remaining visually impaired or blind following surgery. CONCLUSION: In this setting, cataract surgery led to a significant improvement in visual function but the VA results did not meet World Health Organization quality criteria. IND-VFQ results, although complementary to clinical VA outcomes did not, in isolation, reflect the need to improve program quality.