Exploring Symptom Responses to Upper Limb Neural Test Variations of the Radial Nerve in Patients With Lateral Epicondylalgia: An Observational Study.

OBJECTIVE: Clinical practice guidelines recommend the radial nerve mechanosensitivity evaluation in patients with lateral epicondylalgia. Despite different positions and sequences having been described, no research analyzed how each variation triggers symptoms associated with lateral epicondylalgia. The aim of this study was to explore the effects of different positions and sequences in the upper limb neural tension test 2b (ULNT2b) in symptom responses in patients with lateral epicondylalgia. METHODS: In this observational study, 66 patients underwent 4 test conditions: standard ULNT2b, ULNT2b proximal to distal, ULNT2B with resisted supination, and resisted supination isolated. Paresthesia sensations, symptom reproduction, pain intensity (measured using a visual analog scale), and distribution of painful symptoms data were collected. RESULTS: Significant differences in paresthesia sensations were observed between groups, with significant differences between the standard ULNT2B and other ULNT variations or resisted supination maneuvers. Symptom reproduction also differed significantly across groups, with significant differences between the standard ULNT2B and other ULNT or resisted supination tests. The positive/negative test and percentage of distribution of painful symptoms scores varied significantly across 4 conditions in both lateral and frontal views. Although pain intensity scores during tests were comparable among the tests, distribution of painful symptoms differed significantly. CONCLUSION: Variations in the ULNT2b test can affect symptom responses in patients with lateral epicondylalgia. The standard ULNT2b test appears more effective at reproducing symptoms, intensity of paresthesia, and distribution of painful symptoms compared to other ULNT variations and the resisted supination test. IMPACT: ULNT2b sequences have been shown to elicit varying responses concerning paresthesia, replication of familiar symptoms, positive/negative test results, and distribution of painful symptoms. Clinicians should consider specific test variations during the patients' radial nerve mechanosensitivity assessment to identify aggravating factors reproducing recognizable symptoms. A control group of asymptomatic participants and the role of presence of other comorbidities, psychological factors, or the duration of symptoms were not considered in this study and might play an important role influencing the results of the tests.

Congenital herpes simplex with ophthalmic and multisystem features: a case report.

BACKGROUND: Neonatal herpes simplex virus (HSV) infection is rare and has significant morbimortality rates. Approximately 85% of newborns are infected intrapartum, and risk factors for mother-to-child transmission include vaginal delivery, primary maternal infection, and prolonged rupture of membranes. Neonatal HSV can manifest with isolated mucocutaneous lesions, neurological involvement, or disseminated disease. In general, herpetic infection can cause blepharoconjunctivitis or keratitis. We report a rare case of congenital herpes with ophthalmologic manifestations and multisystemic involvement. CASE PRESENTATION: A preterm infant, born at 32 weeks and 2 days, with presumed neonatal infection developed intestinal and respiratory complications, as well as hyperemic lesions on the left nostril and oral mucosa. An ophthalmological assessment was requested and brought up the suspicion of HSV infection, indicating empirical treatment with endovenous acyclovir. Later, a new ocular examination was suggestive of panuveitis. Afterward, serum IgM antibodies to HSV-1 and HSV-2 were positive. Proper antiviral therapy led to an improvement in the condition. DISCUSSION: Neonatal herpes is associated with a high risk of persistent skin lesions, long-term neurological disability and other lasting sequelae. It is essential to consider HSV infection in cases of neonatal conjunctivitis, especially in patients with an epithelial defect and no improvement after initial treatment with topical or systemic antibiotics. CONCLUSIONS: In the management of neonatal HSV, early diagnosis is essential for the timely initiation of antiviral therapy. Our report highlights that ocular assessment can be crucial in the correct diagnostic investigation of this condition.

Immediate effects of percutaneous electrical nerve stimulation in patients with lateral elbow pain.

INTRODUCTION: Ultrasound guided-percutaneous electrical nerve stimulation appears to be effective in the treatment of chronic musculoskeletal pain. OBJECTIVE: To investigate the immediate effects of one session of percutaneous electrical nerve stimulation on the radial nerve in patients with lateral elbow pain. METHODS: A randomized clinical trial was conducted. Sixty patients with chronic lateral elbow pain were allocated into real-percutaneous electrical nerve stimulation (n = 30) or sham-percutaneous electrical nerve stimulation (n = 30) where the patients received one-single session of the real or sham percutaneous stimulation on the radial nerve, respectively. Pressure pain thresholds, pain intensity, pain-free grip strength, and the self-perceived improvement were evaluated after the intervention. RESULTS: Significant differences between groups for pain intensity (-11.55, 95% CI -21.79 to -1.30, p < .028), but not for pressure pain threshold or pain-free grip strength, were found. Patients receiving real-percutaneous stimulation had significant improvement in pain-free grip strength on the treated side. The proportion of individuals reporting moderate to large self-perceived improvement (≥4) was significantly higher (p = .026) after real-percutaneous stimulation than after sham-percutaneous stimulation. CONCLUSION: A single session of real-percutaneous electrical nerve stimulation targeting the radial nerve in subjects with lateral elbow pain decreased pain intensity between groups and increased pain-free grip strength on the treated side but not between groups.

Birdshot retinochoroiditis in Brazil: a multicenter review of 40 patients.

BACKGROUND: Birdshot retinochoroiditis (BRC) is a rare and chronic bilateral uveitis mostly found in Caucasians. As few data are available about the clinical course of BRC in Hispanic patients, we aimed to report the clinical findings and the evolution of BRC in Brazilian patients. METHODS: This retrospective cohort multicenter nationwide study was performed by analyzing the records of patients with BRC diagnoses from Brazilian ophthalmological centers from April 1995 to May 2020. RESULTS: Forty patients (80 eyes) with a diagnosis of BRC were evaluated. The mean age was 53 years, and there was no sex predominance. All tested patients (34/40) were positive for HLA-A29. The diagnosis of BRC was made following the Levinson et al. criteria, and all ancillary tests were performed to exclude differential diagnoses. Clinical signs and symptoms, such as complications and treatment, were described. CONCLUSIONS: BRC evolution in Brazilian patients seems to have some peculiarities that diverge from the published literature available about Caucasians, as AS inflammation is higher in this population.

Effects of two exercise programmes on joint position sense, dynamic balance and countermovement jump in male amateur football players. A randomised controlled trial.

Introduction: The injury prevention and warm-up exercises programmes improve physical performance and injury ratio, but it is poorly investigated in amateur football. Objectives: To assess the effects of two warm-up multi-station programmes (IAI-Programme and FIFA11+) through JPS, LSDT and CMJ. Study design: Randomised controlled trial. Methods: 36 football players were randomised into 2 groups: IAI-Programme (n = 18) and FIFA11+ (n = 18) and performed the intervention protocol for 6 weeks. JPS, LSDT and CMJ were measured at baseline, after 6, 10 and 18 weeks (from baseline). The inter-group and intra-group differences were assessed by repeated-measures analysis of variance test (ANOVA). Results: Significant differences between groups were found after 18 weeks in the absolute angular error (-2.18[-4.33,-0.047], d = 0.69, p < 0.05) of the JPS and in the CMJ (p = 0.001, ŋ2p=,0.298) in favour of IAI-Programme when compared to FIFA11 +. No significant differences between groups were found in the LSDT. There were also intra-group differences observed in the LSDT in both groups. Conclusions: IAI-Programme can provide sensitive benefits with respect to the proprioceptive ability of knee flexion and CMJ than FIFA11 +. Both IAI-Programme and FIFA11+ present improvements in the dynamic postural control measured by the LSDT.

Pressure pain sensitivity over nerve trunk areas and physical performance in amateur male soccer players with and without chronic ankle instability.

OBJECTIVE: Chronic ankle instability (CAI) is reported after ankle sprain. Our aim was to assess differences in mechanical pain sensitivity of lower extremity nerve trunks and physical performance between amateur soccer players with and without CAI. DESIGN: A cross-sectional case-control study. SETTING: Amateur soccer teams. PARTICIPANTS: Fifty-five male soccer players, 28 with and 27 without CAI participated. MAIN OUTCOME MEASURES: The perceived instability was assessed with the Cumberland Ankle Instability Tool (CAIT). Pressure pain thresholds (PPTs) on the common peroneal and tibialis nerve trunks, vertical jump, lateral step-down test and joint position sense of the knee were assessed by a blinded assessor. RESULTS: Soccer players with CAI showed lower PPTs over the common peroneal nerve than those without CAI (between-groups mean difference: 1.0 ±â€¯0.8 kg/cm2, P < 0.001). No differences for PPT over the tibialis posterior (P = 0.078) or any physical performance outcome (knee joint positioning sense [P = 0.798], lateral step-down test [P = 0.580] and vertical jump variables [all, P > 0.310]) were found. PPT over the common peroneal nerve exhibited a significant moderate correlation with the CAIT score (r = 0.528, P < 0.001). CONCLUSION: Amateur soccer players with CAI have higher pressure pain sensitivity over the common peroneal nerve but exhibit similar physical performance to amateur soccer players without CAI.

Klebsiella oxytoca enterotoxins tilimycin and tilivalline have distinct host DNA-damaging and microtubule-stabilizing activities.

Establishing causal links between bacterial metabolites and human intestinal disease is a significant challenge. This study reveals the molecular basis of antibiotic-associated hemorrhagic colitis (AAHC) caused by intestinal resident Klebsiella oxytoca Colitogenic strains produce the nonribosomal peptides tilivalline and tilimycin. Here, we verify that these enterotoxins are present in the human intestine during active colitis and determine their concentrations in a murine disease model. Although both toxins share a pyrrolobenzodiazepine structure, they have distinct molecular targets. Tilimycin acts as a genotoxin. Its interaction with DNA activates damage repair mechanisms in cultured cells and causes DNA strand breakage and an increased lesion burden in cecal enterocytes of colonized mice. In contrast, tilivalline binds tubulin and stabilizes microtubules leading to mitotic arrest. To our knowledge, this activity is unique for microbiota-derived metabolites of the human intestine. The capacity of both toxins to induce apoptosis in intestinal epithelial cells-a hallmark feature of AAHC-by independent modes of action, strengthens our proposal that these metabolites act collectively in the pathogenicity of colitis.

Six weeks of multistation program on the knee proprioception and performance of futsal players.

BACKGROUND: Proprioception and vertical jump are important parameters in the performance and prevention of injuries in futsal. However, very few studies have analyzed the role of multistation exercises to improve these variables. The purpose of this study was to assess the effects of a six-week multistation exercise program on knee joint position sense (JPS) and countermovement jump (CMJ) of futsal players. METHODS: Thirty-four male futsal players randomly classified into experimental (N.=17) or control group (N.=17). The experimental group included a multistation exercise protocol to their training routines (2 times/week - 6 weeks); the control group continued their training routines. All the players completed similar training routines outside of the multistation exercises. Before (baseline), just after the intervention (Post6Wk) and four weeks later (Post10Wk), CMJ and knee JPS (absolute, relative and variable angular error: AAE, RAE and VAE, respectively) were evaluated. RESULTS: ANOVA showed that the experimental group significantly decreased VAE at Post10Wk compared to baseline, suggestive of greater proprioceptive precision, while the control group significantly increased AAE, RAE and VAE at Post10Wk compared to baseline. The experimental group exhibited lower and thus, better AAE and VAE than the control group at Post10Wk, although no significant differences were found at Post6Wk. No significant differences was found in the CMJ. CONCLUSIONS: A six weeks of multistation program may help improve proprioceptive precision of futsal players, even one month after finishing the 6-wk multistation training program. However, this is not long enough to improve proprioceptive acuity and maximum vertical jump. Therefore, the meaningful of these results in term of performance are unclear.

Ângulos visuais: Artigo sobre a importância para o Implante de Lentes Intraoculares Multifocais / Visual angles: Article on the importance of Multifocal Intraocular Lenses Implantation

Resumo Objetivos: Medir o ângulo lâmbda (AL) em indivíduos no pré-operatório de facectomias, correlacionando a sua presença com o comprimento axial e o esférico dos olhos. Sugerir condutas para o implante de LIO multifocal de acordo com a presença do ângulo lâmbda. Métodos: Estudo transversal em 128 olhos de 74 indivíduos candidatos à cirurgia de catarata para registrar a equivalente presença do ângulo lâmbda. Resultados: Avaliando o ângulo lâmbda observou-se uma correlação positiva (r= 0,559 / p= 0,000) para o tamanho desse ângulo comparando-se os dois olhos. Não houve correlação entre o tamanho do ângulo lâmbda e o equivalente esférico no olho direito (r= -0,027 / p= 0,840), mas foi verificada correlação positiva para o olho esquerdo (r= 0,313 / p= 0,013). A presença da hipermetropia correlacionou com os comprimentos axiais pequenos, assim como a miopia com os grandes. Observou-se correlação negativa entre o tamanho do ângulo lâmbda e o comprimento axial para os dois olhos, sendo de r= -0,249 para o olho direito (p= 0,042) e r= -0,281 para o olho esquerdo (p= 0,018) Conclusões: Houve correlação entre a presença de ângulo lâmbda maior e comprimentos axiais menores para os dois olhos. Para o equivalente esférico hipermétrope houve correlação com a presença de um ângulo lâmbda maior apenas para o olho esquerdo. Esse trabalho sugere parcimônia nos implantes de LIO multifocal na presença de ângulo lâmbda significativo, baseado na teoria que a presença desse ângulo é reguladora do equilíbrio entre as aberrações da superfície corneana versus cristalineanas.

Abstract Objectives: To measure the labral angle (LA) in individuals in the preoperative period of facectomies, correlating their presence with axial length and spherical equivalent of the eyes. Suggest conduits for the implantation of multifocal IOL according to the presence of the lambda angle. Methods: A cross-sectional study of 128 eyes of 74 individuals who were candidates for cataract surgery to record the presence of the lambda angle. Results: A positive correlation (r = 0.559 / p = 0.000) was observed for the angle of this angle by comparing the two eyes. There was no correlation between the size of the lambda angle and the spherical equivalent in the right eye (r = -0.027 / p = 0.840), but a positive correlation was observed for the left eye (r = 0.313 / p = 0.013). The presence of hyperopia correlated with small axial lengths, as did myopia with large ones. There was a negative correlation between the angle of the tongue and the axial length of the two eyes, with r = -0.249 for the right eye (p = 0.042) and = 0.281 for the left eye (p = 0.018). Conclusions: There was a correlation between the presence of a larger lambda angle and smaller axial lengths for both eyes. For the spherical hypermétrope equivalent, there was a correlation with the presence of a larger blunt angle only for the left eye. This work suggests parsimony in multifocal IOL implants in the presence of a significant lamella angle, based on the theory that the presence of this angle regulates the balance between corneal versus crystaline surface aberrations.

Estudo do coeficiente de asfericidade e aberração esférica longitudinal da superfície corneana / Study of asphericity coefficient and longitudinal spherical aberration surface corneal

Resumo Objetivo: Correlacionar o coeficiente de asfericidade com a aberração esférica longitudinal na superfície corneana, correlacionando também cada uma dessas variáveis com a ceratometria média Métodos: Realizou-se um estudo observacional através da coleta de dados pré-operatórios nos prontuários de indivíduos candidatos a facectomia. Os dados coletados se referiam ao sexo e idade, além do Q, LSA da superfície corneana e ceratometria média (Km). Foram excluídos do estudo os pacientes que realizaram qualquer procedimento cirúrgico corneano, por alterar as medidas da Q, LSA e Km. O topógrafo selecionou, de maneira fixa, uma área 4,5mm da superfície anterior da córnea para medida do Q e da LSA, tendo como ponto central o eixo pupilar. A ocorrência da LSA é relevante em ambientes de penumbra, em indivíduos com pupila maior que 3mm. Resultados: A amostra foi composta por 70 olhos de 35 indivíduos: 24 (68,6%) mulheres e 11 (31,4%) homens. A idade variou de 48 a 89 anos (média de 69,97 ± 8,29). A Km variou de 41,00D a 46,50D com média de 43,94 ± 1,48D. Na avaliação do Q da superfície corneana se observou uma média de -0,15 ± 0,15. Seis (8,57%) córneas apresentaram desenho esférico com Q= 0 e apenas uma córnea apresentou desenho asférico com Q= -0,50, gerando LSA= 0,0µm. Em relação a LSA da superfície corneana se observou média de +0,33 ± 0,14 µm. Quarenta e dois olhos (60,0%) apresentaram LSA entre +0,31 a +0,64µm e 19 (27,15%) entre +0,16 a +0,30µm. Não houve correção entre a Km e o Q (r= -0,005 / p= 0,965), assim como entre Km e a LSA (r= 0,167 / p= 0,170). Observou-se correlação (r= 0,962 / p= 0,000) entre as variáveis Q x LSA. Conclusão: Foi observada correlação entre o Q e a LSA da superfície corneana. Não foi observado correlações entre o coeficiente de asfericidade ou aberração esférica longitudinal com a ceratometria média.

Abstract Objective: To correlate the asphericity coefficient (Q) with longitudinal spherical aberration (LSA) of the corneal surface, also correlating each of these variables with the average keratometry Methods: An observational study was conducted by collecting preoperative data from the medical records of individuals candidate cataract surgery, i.e., patient sex and age, as well as Q, LSA of the corneal surface and mean keratometry (Km). Patients who had been subjected to any corneal surgical procedure who would alter Q, LSA and Km measuements were excluded. The corneanl topograph selected, fixedly, a 4.5 mm area of the anterior surface of the cornea for the measurement of Q and LSA, having the pupillary axis as the central point, since the occurrence of LSA is relevant in dim environments in individuals with a pupil wider than 3 mm Results: The sample consisted of 70 eyes of 35 individuals, 24 of them women (68.6%) and 11 men (31.4%) ranging in age from 48 to 89 years (mean: 69.97 ± 8.29). Km ranged from 41.00 to 46.50 D, with a mean of 43.94 ± 1.48D, and mean Q of the corneal surface was -0.15 ± 0.15. Six corneas showed a spherical design (Q= 0.0) and only one showed an aspheric design with Q = -0.50, generating an LSA of 0.0. Mean LSA of the corneal surface was +0.33 ± 0.14 µm. Only one eye showed an LSA equal to 0.0µm, and five showed an LSA of +0.10 to +0.30µm. No eye showed a negative LSA of the corneal surface. There was no correlation between Km and Q (r = -0.005 / p = 0.965) or between Km and LSA (r = 0.167 / p = 0.170). A correlation (r = 0.962 / p = 0.000) was observed between Q and LSA Conclusion: There was a correlation between Q and LSA of the corneal surface. There was no correlation between the sphericity coefficient or longitudinal spherical aberration with the average keratometry.

Correlation between cup-to-disc ratio and cup/retrobulbar optic nerve diameter proportion assessed by high-resolution ultrasound in glaucomatous eyes.

PURPOSE: To investigate the correlation between the measurements of the cup/retrobulbar optic nerve diameter (C/OND) proportion obtained by high-resolution 20-MHz B-mode ultrasound (US) and those of the cup/disc ratio (C/D) obtained by fundus biomicroscopy (BIO) and optical coherence tomography (OCT). METHODS: Thirty eyes of 15 glaucomatous patients with any C/D proportion were studied. All patients underwent examination of the vertical C/D by BIO with a 78D lens and time-domain OCT analysis, as well as the vertical C/OND proportion using 20-MHz US measurements. All data were analyzed by correlation and agreement tests. RESULTS: The Spearman test showed a strong correlation between C/D results obtained by BIO and the measurements of C/OND (US) (r=0.788, p<0.0001), and with C/D obtained by OCT (r=0.8529, p<0.0001). However, comparison of C/D results obtained with OCT to those obtained by with C/OND (US) showed only a moderate correlation (r=0.6727, p<0.0001). Bland-Altman analysis did not show good agreement between C/D (BIO) and C/OND (US). CONCLUSIONS: The results demonstrate that B-mode ultrasound examination with a 20 MHz probe can be a good additional method for the evaluation of the C/D ratio in glaucomatous patients, and may be considered as an alternative gross tool in glaucomatous patients with optic media opacities.

Correlation between cup-to-disc ratio and cup/retrobulbar optic nerve diameter proportion assessed by high-resolution ultrasound in glaucomatous eyes / Correlação entre relação escavação/disco e proporção escavação/diâmetro do nervo óptico retrobulbar obtida pela ultrassonografia de alta resolução em olhos com glaucoma

PURPOSE: To investigate the correlation between the measurements of the cup/retrobulbar optic nerve diameter (C/OND) proportion obtained by high-resolution 20-MHz B-mode ultrasound (US) and those of the cup/disc ratio (C/D) obtained by fundus biomicroscopy (BIO) and optical coherence tomography (OCT). METHODS: Thirty eyes of 15 glaucomatous patients with any C/D proportion were studied. All patients underwent examination of the vertical C/D by BIO with a 78D lens and time-domain OCT analysis, as well as the vertical C/OND proportion using 20-MHz US measurements. All data were analyzed by correlation and agreement tests. RESULTS: The Spearman test showed a strong correlation between C/D results obtained by BIO and the measurements of C/OND (US) (r=0.788, p<0.0001), and with C/D obtained by OCT (r=0.8529, p<0.0001). However, comparison of C/D results obtained with OCT to those obtained by with C/OND (US) showed only a moderate correlation (r=0.6727, p<0.0001). Bland-Altman analysis did not show good agreement between C/D (BIO) and C/OND (US). CONCLUSIONS: The results demonstrate that B-mode ultrasound examination with a 20 MHz probe can be a good additional method for the evaluation of the C/D ratio in glaucomatous patients, and may be considered as an alternative gross tool in glaucomatous patients with optic media opacities.

OBJETIVOS: Verificar a correlação entre os achados da relação escavação/diâmetro do nervo óptico retrobulbar (E/DNO) obtidos pelo exame de ultrassom (US) modo B de alta resolução com sonda de 20 MHz e a relação escavação/disco (E/D) obtidos pela biomicroscopia de fundo de olho (BIO) e pela tomografia de coerência óptica (OCT). MÉTODOS: Foram analisados 30 olhos de 15 pacientes com diagnóstico de glaucoma com qualquer proporção da relação E/D. Todos os pacientes foram submetidos ao exame de BIO, com lente 78D, e de OCT, com tecnologia de domínio temporal, para a análise da relação E/D vertical e exame de US modo B, com sonda de 20 MHz, para determinação da proporção E/DNO vertical. Todos os resultados foram analisados por métodos de correlação e concordância. RESULTADOS: Observou-se forte correlação entre as medidas E/D obtidas pela BIO, e as medidas E/DNO (US) (r=0,788; p<0,0001), e com as medidas E/D obtidas pelo OCT (r=0,8529; p<0,0001). Porém, a análise entre as medidas E/DNO (US) e E/D (OCT) mostrou apenas níveis moderados de correlação (r=0,6727, p<0,0001). O teste de Bland-Altman não mostrou bons níveis de concordância entre E/D (BIO) e E/DNO (US). CONCLUSÕES: Os resultados demonstraram que o exame de US modo B com sonda de 20 MHz pode ser um bom método adicional para avaliar a relação E/D de pacientes com glaucoma, a ser considerado como uma ferramenta alternativa na avaliação de pacientes glaucomatosos com opacidades dos meios ópticos.

Impacto de multimorbidade sobre mortalidade em idosos: estudo de coorte pós-hospitalização / Impact of multimorbidity on mortality in elderly: a post-hospitalization cohort study

OBJETIVOS: Avaliar a associação entre comorbidades e risco de morte e reinternação em idosos após alta de enfermarias de clínica médica de um hospital universitário. MÉTODOS: Estudo de coorte de idosos que receberam alta do Hospital Universitário Lauro Wanderley. Foram utilizados o Índice de Comorbidade de Charlson (ICC) e o ICC associado à idade (ICIC). O desfecho primário foi mortalidade pós-hospitalização e o secundário, ocorrência de reinternações. RESULTADOS: Foram acompanhados 104 pacientes por 40,9±27,6 semanas; 31 (29,8%) morreram e 38 (36,5%) foram reinternados. A curva de sobrevida foi descendente com proporção acumulada de 50%. Óbito relacionou-se com idade (p=0,04), número de prescrições hospitalares (p=0,01), ICC (p=0,001) e ICIC (p=0,001). Não houve associação de ICC com reinternação. CONCLUSÕES: A gravidade das comorbidades em idosos relacionou-se com maior risco de morte pós-hospitalização. Salienta-se a necessidade de se disporem de dados de comorbidade para avaliar cuidados a essa clientela.

OBJECTIVES: To evaluate the association between comorbidities and risk of death and readmission after discharge of elderly after discharge from medical wards in a university hospital. METHODS: A cohort study of elderly patients discharged from University Hospital Lauro Wanderley. We used the Charlson Comorbidity Index (CCI) and the ICC associated with age (ICIC). The primary outcome was post-hospitalization mortality ; the secondary, readmissions. RESULTS: 104 patients were followed for 40.9±27.6 weeks; 31 (29.8%) died and 38 (36.5%) were readmitted. The survival curve was descending with cumulative proportion of 50%. Death was related to age (p = 0.04), number of hospital prescriptions (p=0.01), CHF (p=0.001) and ICIC (p=0.001). There was no association of ICC with rehospitalization. CONCLUSIONS: The severity of comorbidities in the elderly was related to increased risk of death after hospitalization. This emphasizes the need to dispose of comorbidity data to evaluate care for these patients.

Intravitreal injection versus subtenon infusion of triamcinolone acetonide during cataract surgery in patients with refractory diabetic macular edema.

PURPOSE: The purpose of this study was to compare the effectiveness of intravitreal injection (IVT) versus posterior subtenon infusion (STI) of triamcinolone acetonide performed during phacoemulsification cataract surgery in eyes with refractory diffuse diabetic macular edema. METHODS: Twenty-four eyes of 24 patients with refractory diffuse diabetic macular edema scheduled to undergo phacoemulsification cataract surgery were randomly assigned to receive either a 4-mg IVT (n = 12) or a 40-mg STI (n = 12) of triamcinolone acetonide during cataract surgery. Comprehensive ophthalmic evaluation, including best-corrected visual acuity, intraocular pressure, and central macular thickness measured with optical coherence tomography, was performed at baseline and at 1, 4, 8 +/- 1, 12 +/- 2, and 24 +/- 2 weeks postoperatively. RESULTS: Ten patients from the IVT group and 9 patients from the STI group completed the 24-week study visit. Mean baseline best-corrected visual acuity (logarithm of the minimum angle of resolution) was 20/259 and 20/222 in the IVT and STI groups, respectively (t = 0.41; P = 0.3407). A significant improvement in best-corrected visual acuity was observed only in the IVT group at 4 weeks (mean difference +/- standard error, improved to 20/116; P = 0.0437), 8 weeks (20/110; P = 0.0355), and 12 weeks (20/121; P = 0.0471) postoperatively. There was no significant change from baseline in mean intraocular pressure in either group. Mean +/- standard error baseline central macular thickness was 474.1 +/- 42.4 microm and 490.8 +/- 70.8 microm in the IVT and STI groups, respectively (t = 0.21; P = 0.5807). The central macular thickness reductions after surgery at all study follow-up visits were significantly greater in the IVT group than in the STI group (P < 0.05). CONCLUSION: These data suggest that IVT is more effective than STI of triamcinolone acetonide for the management of refractory diffuse diabetic macular edema in eyes undergoing phacoemulsification. Further investigation of a larger number of patients with longer follow-up is necessary to confirm these findings.

Roturas retinianas em retinocoroidite por toxoplasmose: série de casos / Retinal tears in toxoplasmic retinochoroiditis: case series

Trata-se de série retrospectiva de 10 pacientes com rotura retiniana e retinocoroidite por toxoplasmose atendidos no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, de janeiro de 2007 a abril de 2008, com objetivo de avaliar a relação entre lesões de retinocoroidite e a ocorrência de rotura retiniana. Foram utilizados teste de Fisher e qui-quadrado com nível de significância p<0,05. Oito casos (80 por cento) apresentaram descolamento de retina. Doze roturas foram identificadas, localizando-se principalmente na periferia temporal superior (6 casos, 50 por cento). Não foi observada relação estatisticamente significativa entre localização da rotura e da cicatriz coriorretiniana considerando a distribuição em cinco quadrantes (p=0,0828) ou em três zonas (p=0,2507). A ocorrência de roturas retinianas em pacientes com uveíte posterior pode estar relacionada ao descolamento precoce do vítreo posterior causado pelo processo inflamatório intraocular. Não foi observado neste estudo correlação entre a localização das roturas retinianas e as cicatrizes de coriorretinite, o que sugere um mecanismo não relacionado diretamente à cicatriz.

This study is a retrospective case series aiming to evaluate the relation between toxoplasmic retinochoroiditis scars and the occurrence of retinal tears. Ten patients with retinal tear and toxoplasmic retinochoroiditis examined at the School of Medicine of Ribeirão Preto Clinics Hospital, between January 2007 and April 2008, were included. Fisher test and qui-square test with significance level of p<0.05 were used. Eight cases (80 percent) had retinal detachment. Twelve tears were found and localized mostly in the temporal superior periphery (6 cases, 50 percent). No statistically significant association between retinal tear and chorioretinal scar localization was observed considering five retinal quadrants (p=0.0828) or three zones (p=0.2507). The occurrence of retinal tears in patients with uveitis may be related to early posterior vitreous detachment caused by the intraocular inflammatory process. No correlation was observed between the localization of retinal tears and chorioretinal scars in this study, which suggests a causative factor not directly related to the presence of a scar.

Proliferative sickle cell retinopathy associated with sickle cell trait and gestational diabetes: case report.

Proliferative sickle cell retinopathy is an uncommon complication in individuals with sickle cell trait (AS). However, the risk for proliferative retinopathy development is increased in patients with AS hemoglobinopathy associated with systemic conditions or ocular trauma. A case of a patient with AS hemoglobinopathy who developed proliferative sickle cell retinopathy after the occurrence of gestational diabetes and pregnancy-induced hypertension is reported. Hemoglobin electrophoresis revealed presence of A2 5.0%, S 35.0% and A 53.2%. The present case emphasizes the importance of evaluating systemic comorbidities in patients with sickle cell trait during pregnancy since sickle cell retinopathy can progress rapidly, as well as the importance of regular eye fundus examination in these patients.

Proliferative sickle cell retinopathy associated with sickle cell trait and gestational diabetes: case report / Retinopatia falciforme proliferativa associada a traço falciforme e diabetes gestacional: relato de caso

Proliferative sickle cell retinopathy is an uncommon complication in individuals with sickle cell trait (AS). However, the risk for proliferative retinopathy development is increased in patients with AS hemoglobinopathy associated with systemic conditions or ocular trauma. A case of a patient with AS hemoglobinopathy who developed proliferative sickle cell retinopathy after the occurrence of gestational diabetes and pregnancy-induced hypertension is reported. Hemoglobin electrophoresis revealed presence of A2 5.0 percent, S 35.0 percent and A 53.2 percent. The present case emphasizes the importance of evaluating systemic comorbidities in patients with sickle cell trait during pregnancy since sickle cell retinopathy can progress rapidly, as well as the importance of regular eye fundus examination in these patients.

Retinopatia falciforme proliferativa é uma complicação incomum em indivíduos com traço falciforme, havendo, porém, risco aumentado de desenvolver retinopatia proliferativa em pacientes com hemoglobinopatia AS associada a condições sistêmicas ou trauma ocular. Neste artigo será apresentado um caso de paciente com diabetes gestacional, hipertensão arterial sistêmica associada à gravidez e traço falciforme. Eletroforese de hemoglobinas revelou a presença de A2 5,0 por cento, S 35,0 por cento e A 53,2 por cento. Este caso ressalta a importância da avaliação de comorbidades sistêmicas em pacientes com traço falciforme no período gestacional, uma vez que pode ocorrer rápida progressão da retinopatia falciforme, devendo-se realizar também exames regulares do fundo de olho nestes pacientes.

Ultrasonography-guided scleral buckle retinopexy and cryotherapy: case report.

If the ocular media are clear, indirect binocular ophthalmoscopy allows retinal detachment and retinal tear identification and treatment under direct visualization. However, if opacities are present preventing direct fundus examination, ultrasonography becomes the most important tool for evaluating the posterior segment. In addition, ultrasonography can be useful in retinal tear treatment by guiding cryotherapy. In this article we describe a rhegmatogenous retinal detachment treatment technique applied to a patient with corneal opacity. Cryopexy and circumferential and radial buckle positioning were guided by ultrasonography, resulting in retinal attachment during the 6-month follow-up period.

Ultrasonography-guided scleral buckle retinopexy and cryotherapy: case report / Retinopexia com "buckle" escleral e crioterapia guiada por ultrassom: relato de caso

If the ocular media are clear, indirect binocular ophthalmoscopy allows retinal detachment and retinal tear identification and treatment under direct visualization. However, if opacities are present preventing direct fundus examination, ultrasonography becomes the most important tool for evaluating the posterior segment. In addition, ultrasonography can be useful in retinal tear treatment by guiding cryotherapy. In this article we describe a rhegmatogenous retinal detachment treatment technique applied to a patient with corneal opacity. Cryopexy and circumferential and radial buckle positioning were guided by ultrasonography, resulting in retinal attachment during the 6-month follow-up period.

Quando os meios oculares são transparentes, oftalmoscopia binocular indireta permite a identificação de descolamento de retina e roturas, bem como seu tratamento sob visibilização direta. Porém, em olhos que apresentam opacidades de meios impedindo o exame oftalmoscópico, a ultrassonografia constitui o exame mais importante do segmento posterior do olho. Além disso, o tratamento de roturas retinianas também pode ser auxiliado pelo uso desse equipamento, orientando a crioterapia. Neste trabalho será apresentada técnica de tratamento de descolamento de retina regmatogênico, no qual a criopexia e o posicionamento dos "buckles" episclerais circunferencial e radial foram guiados pelo ultrassom em paciente com leucoma corneano. O tratamento resultou em aplicação retiniana durante o seguimento em seis meses.

[Retinal tears in toxoplasmic retinochoroiditis: case series]. / Roturas retinianas em retinocoroidite por toxoplasmose: série de casos.

This study is a retrospective case series aiming to evaluate the relation between toxoplasmic retinochoroiditis scars and the occurrence of retinal tears. Ten patients with retinal tear and toxoplasmic retinochoroiditis examined at the School of Medicine of Ribeirão Preto Clinics Hospital, between January 2007 and April 2008, were included. Fisher test and qui-square test with significance level of p<0.05 were used. Eight cases (80%) had retinal detachment. Twelve tears were found and localized mostly in the temporal superior periphery (6 cases, 50%). No statistically significant association between retinal tear and chorioretinal scar localization was observed considering five retinal quadrants (p=0.0828) or three zones (p=0.2507). The occurrence of retinal tears in patients with uveitis may be related to early posterior vitreous detachment caused by the intraocular inflammatory process. No correlation was observed between the localization of retinal tears and chorioretinal scars in this study, which suggests a causative factor not directly related to the presence of a scar.