Diabetic retinopathy among Brazilian Xavante Indians.

BACKGROUND: To describe the frequency of diabetic retinopathy (DR) and its associated variables in Brazilian Xavante Indians. METHODS: A population-based survey carried out in two Xavante Reservations between 2008 and 2012, included 948 Indians aged 20 years or more, identified 246 individuals with type 2 diabetes. A non-probabilistic cluster sample of 140 diabetic individuals were submitted to ophthalmologic examination. Due to operational conditions and to optimize the field work, only the larger Xavante villages were included. Ophthalmologic examinations were performed during one trip to each reservation, in their villages and consisted of measurement visual acuity, anterior segment biomicroscopy, applanation tonometry, and direct and indirect ophthalmoscopy. RESULTS: The frequency of DR was 19.3%, distributed as follows: mild non-proliferative retinopathy in nine (33.3%) subjects, moderate in nine (33.3%), severe in six (22.3%), very severe in two (7.4%), and high-risk proliferative DR in one (3.7%). The occurrence of DR was higher among those with a longer duration of diabetes, higher levels of glycated hemoglobin (HbA1c) and fasting glucose, papillary excavation ≥ 0.5, and among individuals in older age group. Using the log-binomial regression model, diabetes duration > 24 months and HbA1c ≥ 6.5% were significantly associated with the occurrence of DR. CONCLUSIONS: The presence of DR (19.3%) in Xavante Indians is an alert for health care providers for this population, since diabetes is a new disease among them. Its association with disease duration, high levels of HbA1c and blood glucose calls attention for the necessity of more actions to improve diabetes control in this recently contacted ethnic group that needs particular attention.

The new WHO decision-making framework on vaccine use in acute humanitarian emergencies: MSF experience in Minkaman, South Sudan.

INTRODUCTION: The main causes of death during population movements can be prevented by addressing the population's basic needs. In 2013, the World Health Organization (WHO) issued a framework for decision making to help prioritize vaccinations in acute humanitarian emergencies. This article describes MSF's experience of applying this framework in addition to addressing key population needs in a displacement setting in Minkaman, South Sudan. CASE DESCRIPTION: Military clashes broke out in South Sudan in December 2013. By May 2014, Minkaman, a village in the Lakes State, hosted some 85,000 displaced people. MSF arrived in Minkaman on 28 December 2013 and immediately provided interventions to address the key humanitarian needs (health care, access to drinking water, measles vaccination). The WHO framework was used to identify priority vaccines: those preventing outbreaks (measles, polio, oral cholera vaccine, and vaccine against meningococcal meningitis A (MenAfrivac®)) and those reducing childhood morbidity and mortality (pentavalent vaccine that combines diphtheria, tetanus, whooping cough, hepatitis B, and Haemophilus influenzae type B; pneumococcal vaccine; and rotavirus vaccine). By mid-March, access to primary and secondary health care was ensured, including community health activities and the provision of safe water. Mass vaccination campaigns against measles, polio, cholera, and meningitis had been organized. Vaccination campaigns against the main deadly childhood diseases, however, were not in place owing to lack of authorization by the Ministry of Health (MoH). CONCLUSIONS: The first field use of the new WHO framework for prioritizing vaccines in acute emergencies is described. Although MSF was unable to implement the full package of priority vaccines because authorization could not be obtained from the MoH, a series of mass vaccination campaigns against key epidemic-prone diseases was successfully implemented within a complex emergency context. Together with covering the population's basic needs, this might have contributed to reducing mortality levels below the emergency threshold and to the absence of epidemics. For the WHO framework to be used to its full potential it must not only be adapted for field use but, most importantly, national decision makers should be briefed on the framework and its practical implementation.

I'm scared to go to School! Capturing the Effects of Chronic Daily Fears on Students' Concept of Self.

Students may experience considerable fear and stress in school settings, and based on Dweck's (2006) notion of "mindset" we hypothesized that fear introduces qualitative changes in students' self-concepts. Hypotheses were tested on 3847 third-grade students from nine Iberoamerican countries (Bolivia, Chile, Colombia, Cuba, Ecuador, Panama, Peru, Spain, and Venezuela), who completed Murillo's (2007) adaptation of Marsh' (1988) SDQ-I. Rasch scaling indicated that the information-content of High-Fear students' ratings was more localized across the latent dimension than was that of Low-Fear students, and their ratings also showed less cognitive variety. The resulting measurement distortions could be captured via logistic regression over the ratings' residuals. Also, using training and validation samples (with respectively 60 and 40% of all cases), it proved possible to predict students' fear levels and their gender. We see the present findings as a first step towards implementing an online warning and detection system for signs of bullying among students.

Inputs, dynamics and potential impacts of silver (Ag) from urban wastewater to a highly turbid estuary (SW France).

Although silver (Ag) has been listed as a priority pollutant for the aquatic environment by the European Union (Directive 2006/11/EC), the use of Ag-based products with antimicrobial effects is increasing in Europe, as well as North America and Asia. This study investigates personal care products (PCP) as a potential source of Ag in wastewater, as well as the dynamics and fate of Ag in the influent and effluent of a major urban wastewater treatment plant (WWTP) located on the fluvial part of the Gironde Estuary. Typical household PCPs marked as using Ag contained concentrations of up to 0.4 mg kg-1 making them likely contributors to urban Ag released into the aquatic environment. Silver concentrations in influent wastewater generally occurred during mid-week working hours and decreased during the night and on weekends clearly indicating the dominance of urban sources. Up to 90% of the total Ag in wastewater was bound to particles and efficiently (>80%) removed by the treatment process, whereas 20% of Ag was released into the fluvial estuary. Silver concentrations in wastewater effluents clearly exceeded estuarine concentrations and may strongly amplify the local Ag concentrations and fluxes, especially during summer rainstorms in low river discharge conditions. Further work should focus on environmental effects and fate of urban Ag release due to immediate localized outfall and/or the adsorption on estuarine particles and subsequent release as dissolved Ag chloro-complexes within the estuarine salinity gradient.

Changes in Health-Seeking Behavior Did Not Result in Increased All-Cause Mortality During the Ebola Outbreak in Western Area, Sierra Leone.

Little is known about the residual effects of the west African Ebola virus disease (Ebola) epidemic on non-Ebola mortality and health-seeking behavior in Sierra Leone. We conducted a retrospective household survey to estimate mortality and describe health-seeking behavior in Western Area, Sierra Leone, between May 25, 2014, and February 16, 2015. We used two-stage cluster sampling, selected 30 geographical sectors with probability proportional to population size, and sampled 30 households per sector. Survey teams conducted face-to-face interviews and collected information on mortality and health-seeking behavior. We calculated all-cause and Ebola-specific mortality rates and compared health-seeking behavior before and during the Ebola epidemic using χ2 and Fisher's exact tests. Ninety-six deaths, 39 due to Ebola, were reported in 898 households. All-cause and Ebola-specific mortality rates were 0.52 (95% confidence interval [CI] = 0.29-0.76) and 0.19 (95% CI = 0.01-0.38) per 10,000 inhabitants per day, respectively. Of those households that reported a sick family member during the month before the survey, 86% (73/85) sought care at a health facility before the epidemic, compared with 58% (50/86) in February 2015 (P = 0.013). Reported self-medication increased from 4% (3/85) before the epidemic to 23% (20/86) during the epidemic (P = 0.013). Underutilization of health services and increased self-medication did not show a demonstrable effect on non-Ebola-related mortality. Nevertheless, the residual effects of outbreaks need to be taken into account for the future. Recovery efforts should focus on rebuilding both the formalized health system and the population's trust in it.

Intravitreal injection of ranibizumab for foveal-macular pattern dystrophy: case report.

In the recent years, anti-angiogenic medications have successfully treated other diseases associated with choroidal neovascularization. The anti-angiogenic therapy alone or combined with LASER and/or steroids has been effective in controlling ocular neovascularization, not only restricted to the treatment of typical membranes due to macular degeneration in the wet form. The discovery and subsequent use of these drugs has revolutionized medicine and ophthalmology. This report illustrates an example of successful treatment in a challenging pathology where it was found important visual and anatomical response after the use of ranibizumab.

Intravitreal injection of ranibizumab for foveal-macular pattern dystrophy: case report / Injeção intravítrea de ranibizumabe para distrofia foveal-macular em padrão: relato de caso

In the recent years, anti-angiogenic medications have successfully treated other diseases associated with choroidal neovascularization. The anti-angiogenic therapy alone or combined with LASER and/or steroids has been effective in controlling ocular neovascularization, not only restricted to the treatment of typical membranes due to macular degeneration in the wet form. The discovery and subsequent use of these drugs has revolutionized medicine and ophthalmology. This report illustrates an example of successful treatment in a challenging pathology where it was found important visual and anatomical response after the use of ranibizumab.

Nos últimos anos, os medicamentos antiangiogênicos têm tratado com sucesso outras doenças relacionadas com a neovascularização da coroide. A terapia antiangiogênica isoladamente ou combinada com LASER e/ou esteroides têm se mostrado eficaz no controle da neovascularização ocular, não se restringindo apenas ao tratamento das membranas típicas da degeneração macular na forma úmida. A descoberta e o posterior uso destas drogas vêm revolucionando a medicina e a oftalmologia. Este relato ilustra um exemplo de tratamento de sucesso numa patologia desafiadora onde se obteve importante resposta visual e anatômica após uso do ranibizumabe.

Scleral thickness following fluocinolone acetonide implant (Retisert).

PURPOSE: To evaluate whether intravitreal fluocinolone acetonide (FA) implantation (Retisert) leads to scleral thinning. METHODS: Scleral thickness was measured at the pars plana region (4 quadrants) with anterior segment OCT (Visante) in FA implanted eyes (18) with noninfectious posterior uveitis in comparison to eyes with prior vitrectomy (8), and normal eyes without prior surgery (30). RESULTS: Mean scleral thickness in normal (nonsurgical) eyes was 0.99/0.93/0.88/0.86, and 0.92 mm in the inferonasal/inferotemporal/superotemporal/superonasal quadrants, and overall, respectively. Sclera was thinner in each quadrant of the FA implanted eyes compared to the fellow or nonsurgical eyes, although none reached statistical significance, as the differences were small. However, a few FA implanted eyes demonstrated more dramatic scleral thinning than others. CONCLUSIONS: FA implant appears to lead to statistically nonsignificant scleral thinning overall with few exceptions. Clinicians should be aware of potential scleral thinning in select cases, important for reimplantation and long-term follow-up.

Intravitreal bevacizumab in pigmented rabbit eyes: histological analysis 90 days after injection.

PURPOSE: To evaluate bevacizumab toxicity in neurosensorial retina and retinal pigment epithelium in pigmented rabbit eyes by means of histological studies. METHODS: Thirty eyes of fifteen rabbits were distributed into three groups: sham group (S), that received a 0.1 ml balanced saline solution (BSS) intravitreal injection (10 eyes); group 1, that received a 1.25 mg (0.1 ml) bevacizumab intravitreal injection (10 eyes); and group 2, that received a 2.5 mg (0.1 ml) bevacizumab intravitreal injection (10 eyes). Rabbits were sacrificed 90 days after the procedure and both eyes of each rabbit were enucleated. A histological examination of neurosensorial retina and retinal pigmented epithelium (RPE) was performed. Its morphological features and layer thickness were also analyzed. RESULTS: No histological differences in neurosensorial retina or in retinal pigmented epithelium were found and layer thickness did not differ significantly between balanced saline solution-injected eyes and bevacizumab-injected eyes. CONCLUSION: After a 90-day follow-up period, a single 1.25 or 2.5 mg bevacizumab intravitreal injection did not lead to toxic damage in the neurosensorial retina and retinal pigment epithelium of pigmented rabbit eyes, and it appears to be a safe procedure for retinal neovascular diseases.

Intravitreal bevacizumab in pigmented rabbit eyes: histological analysis 90 days after injection / Bevacizumabe intravítreo em olhos de coelhos não albinos: análise histológica 90 dias após a injeção

PURPOSE: To evaluate bevacizumab toxicity in neurosensorial retina and retinal pigment epithelium in pigmented rabbit eyes by means of histological studies. METHODS: Thirty eyes of fifteen rabbits were distributed into three groups: sham group (S), that received a 0.1 ml balanced saline solution (BSS) intravitreal injection (10 eyes); group 1, that received a 1.25 mg (0.1 ml) bevacizumab intravitreal injection (10 eyes); and group 2, that received a 2.5 mg (0.1 ml) bevacizumab intravitreal injection (10 eyes). Rabbits were sacrificed 90 days after the procedure and both eyes of each rabbit were enucleated. A histological examination of neurosensorial retina and retinal pigmented epithelium (RPE) was performed. Its morphological features and layer thickness were also analyzed. RESULTS: No histological differences in neurosensorial retina or in retinal pigmented epithelium were found and layer thickness did not differ significantly between balanced saline solution-injected eyes and bevacizumab-injected eyes. CONCLUSION: After a 90-day follow-up period, a single 1.25 or 2.5 mg bevacizumab intravitreal injection did not lead to toxic damage in the neurosensorial retina and retinal pigment epithelium of pigmented rabbit eyes, and it appears to be a safe procedure for retinal neovascular diseases.

OBJETIVOS: Avaliar a toxicidade do bevacizumabe na retina neurossensorial e epitélio pigmentado da retina (EPR) em olhos de coelhos não albinos pelos estudos histológicos. MÉTODOS: Trinta olhos de 15 coelhos foram distribuídos em três grupos: 10 olhos no grupo placebo (P), que recebeu uma injeção intravítrea de 0,1 ml de solução salina balanceada (SSB); 10 olhos no grupo 1, que recebeu uma injeção intravítrea de 1,25 mg (0,1 ml) de bevacizumabe; e 10 olhos no grupo 2, que recebeu uma injeção intravítrea de 2,5 mg (0,1 ml) de bevacizumabe. Os coelhos tiveram seus dois olhos enucleados sob anestesia geral e submetidos à eutanásia 90 dias após a injeção. Foi realizada avaliação histológica na retina neurossensorial e no epitélio pigmentado da retina e seus aspectos morfológicos e espessuras das camadas retinianas foram analisadas. RESULTADOS: Não foi observada diferença significante entre a morfologia histológica e espessura das camadas retinianas entre o grupo P (SSB) e os grupos 1 e 2 (bevacizumabe 1,25 mg e 2,5 mg, respectivamente). CONCLUSÃO: Após um seguimento de 90 dias, uma única injeção intravítrea de bevacizumabe com 1,25 e 2,5 mg não levou a danos histológicos na retina neurossensorial e epitélio pigmentado da retina em olhos de coelhos não albinos e parece ser um procedimento seguro para o tratamento das doenças neovasculares da retina.

Evaluation of injection frequency and visual acuity outcomes for ranibizumab monotherapy in exudative age-related macular degeneration.

OBJECTIVE: To evaluate the visual outcomes for intravitreal ranibizumab administered on an as-needed basis for exudative age-related macular degeneration (AMD) and to investigate the relationship between injection frequency and visual outcome in this setting. DESIGN: Retrospective, interventional case series. PARTICIPANTS: A total of 131 eyes with treatment-naïve, exudative AMD undergoing ranibizumab monotherapy. METHODS: Intravitreal ranibizumab was administered on an as-needed basis guided by clinical examination and optical coherence tomography (OCT). The OCT scans were evaluated by the treating physicians for the presence of intraretinal fluid, subretinal fluid, intraretinal cysts, or increasing pigment epithelial detachment size. Clinical data including visual acuity (VA), choroidal neovascularization lesion morphology, and treatment course were collected retrospectively for analysis. MAIN OUTCOME MEASURES: Mean change in best-corrected Snellen VA. RESULTS: The mean age was 81.3 years, mean follow-up was 12+/-4.3 months (minimum 6 months, median 12 months), and mean number of injections was 5.2+/-2.8. Mean baseline Snellen VA for the entire population was 20/110 and significantly improved at 6 months (20/80; P = 0.0002) and at last follow-up (20/90; P = 0.0066). At 6 months, 31% of eyes had gained at least 3 lines of VA and 90.5% had avoided loss of 3 lines. On average, it took 3.0 injections and 3.5 months to achieve a "dry" or "flat" macula on OCT after initiating treatment. Resolution of intra- and subretinal fluid on OCT did not correlate with the degree of vision improvement. Eyes receiving more frequent injections (defined as <2 months mean inter-injection interval) gained more vision (+2.3 lines at 6 months) than eyes receiving injections less frequently (+0.46 lines at 6 months; P = 0.012). At 6 months, 3.1% of those in the more frequent injection group lost >3 lines of vision compared with 15.9% in the >2 months interval group (P = 0.011). CONCLUSIONS: In a population receiving as-needed injections of ranibizumab for exudative AMD, visual improvement was related to the frequency of injections received but not to the resolution of fluid by OCT. Treatment with ranibizumab on a strictly as-needed basis may result in undertreatment and significantly less visual gain. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.

Evaluation of wound closure in oblique 23-gauge sutureless sclerotomies with visante optical coherence tomography.

PURPOSE: To investigate the in vivo real-time wound morphology of fresh 23-gauge sutureless oblique sclerotomy wounds with anterior segment optical coherence tomography (OCT). DESIGN: Prospective, observational case series. METHODS: Subjects underwent three-port pars plana vitrectomy with a 23-gauge trocar/cannula microincision surgical system at the Cole Eye Institute. All incisions were created in an oblique (aka beveled or angled) fashion. The incisions were imaged with the Visante OCT (Carl Zeiss Meditec, Dublin, California, USA) device on postoperative days 1 and 8. The main outcome measure was wound structure (eg, presence of gaping) as evaluated with OCT. Surgical and ocular parameters were also recorded. RESULTS: Fourteen patients were investigated. Gross clinical examination revealed no evidence of leakage. OCT demonstrated closed wounds in all eyes on postoperative days 1 and 8. The external (entry) site of the incision was occasionally seen as a gape; however the rest of the wound was closed. One patient with closed wounds had transient hypotony along with shallow peripheral choroidals noted on postoperative day 1, which resolved on their own. CONCLUSIONS: Oblique incisions have been proposed for microincision sutureless vitrectomy to prevent wound leakage, hypotony, and the secondary risk of endophthalmitis. This study demonstrates that oblique incisions provide adequate wound apposition as shown by OCT even on postoperative day 1.

Dynamic evaluation of sutureless vitrectomy wounds: an optical coherence tomography and histopathology study.

PURPOSE: To investigate the in vitro dynamic wound morphology of fresh 25- and 23-gauge sutureless sclerotomy wounds. DESIGN: Experimental study; laboratory investigation. PARTICIPANTS: Sixteen eyes of New Zealand white rabbits. METHODS: Eight cadaver heads were obtained, and the eyes were enucleated with their conjunctiva intact to simulate an intact globe. Four eyes were analyzed using 4 different wound types and cannula sizes: 25-gauge straight incision (group a); 25-gauge angled incision (group b); 23-gauge straight incision (group c); and 23-gauge angled incision (group d). Three incisions were created in each eye using either a 25- or 23-gauge trocar/cannula system. Intraocular pressure (IOP) was controlled with intraocular balanced salt solution infused through the infusion cannula. The incisions were imaged with a prototype, anterior segment spectral domain optical coherence tomography device under variable IOP to simulate successive blinks or rubbing of the eye and to evaluate the wounds in a dynamic state. Finally, India ink was applied to the surface of the eye under variable IOP to evaluate for wound leakage and potential ink ingress. The eyes were then analyzed by frozen section. MAIN OUTCOME MEASURES: Wound gaping as evaluated with optical coherence tomography (OCT) and presence of India ink particles in incisions evaluated by histology. RESULTS: Gross examination revealed obvious leakage of intraocular fluid in groups A and C (straight incisions) under variable IOP, with some even developing conjunctival blebs. Groups B and D (angled incisions) demonstrated minimal to no clinical leakage. Spectral domain optical coherence tomography demonstrated open wounds in straight incisions under all IOP conditions, with a slightly larger open wound under high IOP. Angled incisions demonstrated less wound gap overall and better wound apposition under high IOP versus low IOP. Histologic examination revealed India ink particles in all straight incisions with penetration across the whole incision in some wounds, whereas no ink particles were observed in angled incisions. CONCLUSIONS: Angled incisions have been proposed for sutureless vitrectomy to prevent wound leakage, hypotony, and the secondary risk of endophthalmitis. This study demonstrates that angled incisions provide better wound apposition under dynamic IOP conditions immediately after formation that simulate real-world situations: blinking, squeezing, or even rubbing of the eye. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.

Explicações: modos de regulação de uma atividade globalizada / Private tutoring: ways of regulation of a globalized activity

Neste artigo analisamos os modos de regulação de uma atividade - as explicações - que é hoje um caso de sucesso em todo o mundo como oferta educativa privada e que podemos mesmo considerar paralela à do modelo escolar. Num primeiro momento, procedemos à caracterização das políticas de regulação em escala global: a situação nos países que ignoram a atividade das explicações; o caso dos países que escolheram a via da proibição, total ou parcial; o caso dos países que reconheceram a atividade e até formularam políticas educacionais que encontraram nas explicações um aliado para a melhoria dos resultados escolares. Abordaremos depois a situação em Portugal, país onde a atividade existe desde há muito, mas que conhece na atualidade um vigor novo e maior visibilidade social. Quanto às políticas de regulação das explicações em Portugal, podemos falar de uma regulação burocrática sem grande eco na prática dos profissionais, dos estudantes e das famílias. Terminaremos com algumas reflexões sobre a necessidade de se dar dimensão pública à discussão sobre a atividade das explicações, tantas e tão sérias são as suas repercussões sociais e políticas, nomeadamente em matéria de democratização do acesso e do sucesso escolares, questão nuclear que está no cerne da preocupação com a equidade no seio das políticas públicas. (AU)

In this text we analyze the ways of regulation of private tutoring, an activity that is at present a success story as a private educational product with an widespread use across the world that we can even see as parallel to that of the school model. Firstly, we will characterize the regulation policies that are in place worldwide: i) the situation of the countries that ignore the activity of private tutoring; ii) the case of the countries that have chosen to prohibit private tutoring, totally or partially; iii) the case of the countries that have recognized the activity and that have even developed educational policies that have found in private tutoring an ally in the improvement of school results. We will then discuss the situation in Portugal, a country where the activity has a long history, but that knows nowadays a new vigor and greater social visibility. In what concerns the regulation policies of private tutoring in Portugal, we can talk about a bureaucratic regulation without a great impact on the practices of education professionals, students and families. We will conclude our text with some reflections on the need to give public dimension to the discussion on the activity of private tutoring, as it has many and serious social and political repercussions, namely with respect to the democratization of school access and success, a main issue that is at the heart of the concern with equity in public policies. (AU)

Características dos pacientes HIV positivos do estado de Pernambuco nos últimos 20 anos / Characteristics of the positives HIV patients from Pernambuco state in last the 20 years

Objetivos: conhecer o perfil da população HIV positiva do estado de Pernambuco para realizar, desta forma, um melhor acompanhamento deste grupo, assim como instituir novos programas de ajuda e tratamento. Métodos: Foi realizado um estudo ecológico de série histórica, com dados dos anos de 1986 a 2005, utilizando a base de dados do DATASUS. Os dados colhidos foram expostos através de figuras. Resultados: O total de casos de AIDS identificados no estado de Pernambuco entre os anos de 1986 e 2005 foi de: 10994 pacientes. Sendo 69% homens; 77,26% dos pacientes eram provenientes da região metropolitana do grande Recife e grande maioria, 94,12%, se situava entre 15 e 59 anos de idade. Conclusão: O presente estudo mostra que o estado de Pernambuco apresenta características semelhantes aos estados litorâneos do Brasil, e faixa etária acometida e feminização semelhantes aos dados mundiais.

Hipertensão arterial sistêmica: Avaliação de pacientes submetidos a cirurgias oftalmológicas na Fundação Altino Ventura / Systemic arterial hypertension: Evaluation of patients who underwent ophthalmological surgeries at Fundação Altino Ventura (FAV)

Resumo: O objetivo do presente estudo foi estudar a prevalência da Hipertensão Arterial Sistêmica (HAS): ao nível ambulatorial, nos pareceres cardiológicos, e nas pressões arteriais (PA) aferidas antes das cirurgias oftalmológicas em pacientes da Fundação Altino Ventura (FAV), Recife-PE, Brasil. Foram analisados 329 pacientes operados entre agosto e setembro de 2002. O gênero prevalente foi o feminino, 208 (63,2por cento)pacientes. A média de idade foi de 67 anos (mínima de 40 e máxima de 95 anos). Foram submetidos a facectomia 181 (55por cento)pacientes e 96(29,2por cento) a plásticas ou pequenas cirurgias oftalmológicas. Foi utilizado o teste exato de Fisher para avaliação de possível diferença entre frequências. A HAS já tinha, previamente, sido diagnosticada em 129 (39,2por cento) pacientes. No parecer cardiológico esta freqüência aumentou para 141 de 267 (52,8por cento). Evidenciou-se, ainda, um incremento no número de hipertensos, 217 de 329 (66por cento) quando a pressão arterial (PA) foi aferida na admissão no bloco cirúrgico. Observou-se um reconheciemnto maior da freqüência da HAS nos pacientes que se submeteram a cirurgias oftalmológicas quando a PA foi aferida antes dos procedimentos cirúrgicos. Este achado reforça o conceito de se ter, de forma sistemática, o parecer cardiológico e de se dispor de um profissional no ambulatório, para avaliação da PA a fim de proporcionar uma conduta melhor e mais precoce nesses pacientes