Comparison of Fundus Biomicroscopy Examination of the Optic Nerve Head with and without Mydriasis.

BACKGROUND: Notwithstanding the significant advances in automated imaging techniques in the past 2 decades, subjective evaluation of the optic disc still remains an important part of glaucoma propaedeutic. In places with limited resources and a high demand for ophthalmic care, anatomical evaluation of glaucoma cases often relies solely on slit-lamp-based fundus biomicroscopic examination, which is frequently performed without mydriasis. OBJECTIVE: The aim of this study was to compare metrics related to fundus biomicroscopy examination of the optic nerve head and peripapillary retinal nerve fiber layer (pRNFL) with and without mydriasis. MATERIAL AND METHODS: Healthy individuals, patients with early glaucoma, and glaucoma suspects were prospectively enrolled. Patients were examined before and after mydriasis by three glaucoma specialists, who estimated patients' vertical cup-to-disc ratio (CDR) and evaluated the presence of glaucomatous signs: laminar dot sign, disc hemorrhage, disc saucering, disc notching, peripapillary atrophy, localized pRNFL defect, and loss of the ISNT pattern. Main outcome measures were the intra-observer comparison, the inter-observer agreement, and the abilities to identify glaucomatous signs before and after mydriasis. RESULTS: Thirty patients (60 eyes) were enrolled (mean age, 62.3 ± 11.6 years). Considering the evaluation of the three examiners, the mean vertical CDR increased from 0.41 to 0.44 (p = 0.02), and the median of the coefficient of variation of the measures was reduced from 0.24 to 0.11 (p = 0.01) after mydriasis. Regarding the inter-observer agreement evaluation, the kappa coefficient values ranged from 0.64 to 0.72 before mydriasis and from 0.71 to 0.77 after mydriasis. Dot sign and disc notching were better identified through fundoscopic examination with mydriasis compared to the nonmydriatic examination (p < 0.01). CONCLUSION: Our results suggest that fundus biomicroscopy should be performed with mydriasis whenever possible, as it yells a better intra- and inter-observer agreement and improves the detection of glaucomatous signs. Moreover, examiners seem to underestimate CDR values without mydriasis. Further investigation is warranted to validate these findings by general ophthalmologists and in different populations.

Preclinical investigations of intravitreal ziv-aflibercept.

BACKGROUND AND OBJECTIVE: To investigate the retinal safety of intravitreal (IVT) ziv-aflibercept in rabbits. MATERIALS AND METHODS: Eighteen rabbits were given an IVT injection of ziv-aflibercept (25 mg/mL) or aflibercept (40 mg/mL) and examined by funduscopy, electroretinography (ERG), optical coherence tomography (OCT), light microscopy, and transmission electron microscopy (TEM). Serum, aqueous, and vitreous were obtained afterward for osmolarity analysis. The effect of ziv-aflibercept on human retinal cultured cells (ARPE-19) was assessed by the MTT cell viability assay. RESULTS: All eyes showed normal funduscopy, OCT, and ERG findings at baseline and 24 hours or 7 days after the procedure. Median baseline serum, vitreous, and aqueous osmolarity remained unchanged. Histology and TEM showed no major anatomic signs of toxicity. No cytotoxic effect was observed in ARPE-19 cells exposed to ziv-aflibercept. CONCLUSION: IVT injection ziv-aflibercept at a concentration of 25 mg/mL proved to be safe for the rabbit retina.

Driving behavior among medical students.

OBJECTIVE: To study the driving behavior of medical students, comparing current patterns with those found in a study previously conducted at the same school of medicine. METHODS: We administered standardized questionnaires to a sample of students enrolled at the medicine major of the Ribeirão Preto School of Medicine, Universidade de São Paulo (USP), in order to collect demographic and socioeconomic data, as well as information on their driving behavior and involvement in traffic accidents. Our findings were compared with those found in a similar study conducted in 1997. RESULTS: We included 354 students in the present study conducted in 2008. The sample of the study conducted in 1997 included 377 students. Of the total number of participants, 431 (59%) had driven after drinking alcohol, and of these, 21.5% had consumed large amounts of alcohol. Participation in illegal street racing was reported by 10.5% of the participants, with significant difference between sexes (12.5% of men and 3.4% of women). Involvement in accidents with fatal or non-fatal casualties was reported by 19.2% of the participants. These percentages reached 31.1% among those who have already driven while being heavily intoxicated and 42.9% among those who participated in illegal street racing. The 2008 study showed higher use of helmets and seat belts in urban areas and reduced use of alcohol before driving. On the other hand, the same study showed an increased disrespect for traffic lights. CONCLUSION: Driving risk behaviors were always highly frequent among the participants, being directly related to involvement in accidents with casualties. Since this sample includes a privileged portion of the population, which is aware of and has direct contact with the consequences of such accidents, we expected lower rates of high-risk behaviors. Our findings may lead the academic community to consider the implementation of educational programs that can effectively change students' behavior.

Comportamento no trânsito entre estudantes de medicina / Traffic behavior of medical students

OBJETIVOS: Estudar o comportamento de estudantes de medicina em relação ao trânsito, comparando os padrões atuais com aqueles observados em estudo realizado anteriormente na mesma instituição. MÉTODOS: Foram aplicados questionários padronizados em uma amostra de estudantes regularmente matriculados no curso médico da Faculdade de Medicina de Ribeirão Preto, objetivando coletar informações demográficas, socioeconômicas e referentes ao comportamento no trânsito e envolvimento em acidentes. Esses resultados foram comparados com os obtidos em investigação semelhante, realizada em 1997. RESULTADOS: Foram estudados 354 alunos em 2008 e 377 em 1997. Do total, 431 (59 por cento) já haviam dirigido logo após a ingestão de álcool, sendo que, desses, 21,5 por cento em condições de intensa alcoolização. Participação em rachas foi referida por 10,5 por cento dos participantes, com diferença marcante entre os sexos (12,5 por cento entre homens e 3,4 por cento em mulheres). Envolvimento em acidentes com vítimas, fatais ou não, foi referido por 19,2 por cento dos participantes. Esses percentuais atingiram 31,1 por cento entre os que já dirigiram intensamente alcoolizados e 42,9 por cento entre os que participaram de rachas. O estudo de 2008 evidenciou maior uso de capacete e de cinto de segurança em meio urbano e redução de uso de bebidas alcoólicas antes de dirigir. Por outro lado, mostrou redução de respeito contínuo à sinalização de semáforos. CONCLUSÃO: Comportamentos de risco no trânsito fazem-se presentes com elevada frequência entre os participantes, estando diretamente relacionados com o envolvimento em acidentes que provocam vítimas. Visto ser essa uma parcela populacional diferenciada, com conhecimento e contato direto com as consequências desses acidentes, esperar-se-ia uma menor presença de comportamentos de elevado risco. As informações oriundas desse trabalho devem conduzir a uma reflexão por parte da comunidade acadêmica com vistas à introdução de programas educativos capazes de produzir mudança efetiva de atitude dos estudantes.

OBJECTIVES: To study the traffic behavior of medical students comparing current patterns with those observed in a study previously carried out in the same institution. METHODS: Standard questionnaires were completed by a sample of regularly registered medical students of the " Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo", Brazil, to collect data regarding demographic and economic information and also traffic behavior and accident involvement. Results were compared to those obtained in a similar investigation done in 1997. RESULTS: In 2008, 354 students were interviewed and 377 in 1997. Of all, 431 (59 percent) had driven right after alcohol ingestion and 21.5 percent of them had driven under severe influence of alcohol. while 10.5 percent referred to participation in "street races", with a large difference between genders (12.5 percent of men and 3.4 percent of women). Involvement in accidents with victims, fatal or not, was reported by 19.2 percent of participants. This percentage reached 31.1 percent among those who had driven under severe influence of alcohol and 42.9 percent among those who participated in "street races". The 2008 study showed increased use of helmets and seat belts in urban areas, as well as reduction of alcohol consumption before driving. On the other hand, it disclosed less continuous compliance with traffic lights. CONCLUSION: Risky traffic behavior was found to be very frequent among these participants directly involved in accidents with victims. Since this is a distinctive segment of the population, that is aware and has direct contact with the consequences of traffic accidents, we would hope to find a lower incidence of such high risk behavior. Information provided by this investigation should lead to a reflection from the academic community intending to introduce educational programs to effectively change student behavior.