Characterization of central-involved diabetic macular edema using OCT and OCTA.

PURPOSE: To characterize the occurrence of diabetic macular edema and the presence of abnormal retinal fluid accumulation in nonproliferative diabetic retinopathy (NPDR). METHODS: In this two-year prospective study, a total of 122 eyes with diabetes type 2 underwent optical coherence tomography (OCT) and OCT-Angiography in association with OCT-Fluid imaging, a novel algorithm of OCT analysis allowing quantification of abnormal accumulation of fluid in the retina through low optical reflectivity ratios (LOR). Early Treatment Diabetic Retinopathy Study (ETDRS) grading for diabetic retinopathy (DR) severity assessment was performed using 7-field color fundus photography. Best corrected visual acuity was also recorded. RESULTS: During the 2-year follow-up, 23 eyes (19%) developed central-involved diabetic macular edema (CI-DME) and 2 eyes (2%) developed clinically significant macular edema (CSME). In the two-year period of the study, eyes that developed CI-DME showed a progressive increase in central retinal thickness (CRT) (ß = 7.7 ± 2.1 µm/year, p < 0.001) and in LOR values (ß = 0.009 ± 0.004 ratio/year, p = 0.027). The increase in CRT and abnormal retinal fluid, represented by increased LOR ratios, are associated with increased retinal perfusion in the deep capillary plexus (DCP) (skeletonized vessel density, p = 0.039). In contrast, the eyes with CSME showed decreased retinal perfusion and abnormal fluid located in the outer layers of the retina. CONCLUSIONS: CI-DME and CSME appear to represent different entities. Eyes with CI-DME show increases in abnormal retinal fluid associated with increased retinal vascular perfusion in the DCP. Eyes with CSME are apparently associated with decreased retinal vascular perfusion in the DCP and abnormal fluid in the outer retina.

Retinal neurodegeneration in eyes with NPDR risk phenotypes: A two-year longitudinal study.

INTRODUCTION: Diabetic retinopathy (DR) is both a microangiopathy and a neurodegenerative disease. However, the connections between both changes are not well known. PURPOSE: To characterise the longitudinal retinal ganglion cell layer + inner plexiform layer (GCL + IPL) changes and their association with microvascular changes in type-2 diabetes (T2D) patients with nonproliferative diabetic retinopathy (NPDR). METHODS: This two-year prospective study (CORDIS, NCT03696810) included 122 T2D individuals with NPDR identified as risk phenotypes B and C, which present a more rapid progression. Phenotype C was identified by decreased VD ≥ 2SD in healthy controls, and phenotype B, identified by subclinical macular oedema with only minimal vascular closure. The GCL + IPL thickness, vessel density, perfusion density and area of intercapillary spaces (AIS) were assessed by optical coherence tomography (OCT) and OCT angiography (OCTA). Linear mixed effects models were employed to evaluate the retinal GCL + IPL progression and its associations. RESULTS: Regarding GCL + IPL thickness, T2D individuals presented on average 80.1 ± 7.49 µm, statistically significantly lower than the healthy control group, 82.5 ± 5.71 (p = 0.022), with only phenotype C differing significantly from controls (p = 0.006). GCL + IPL thickness steadily decreased during the two-year period in both risk phenotypes, with an annual decline rate of -0.372 µm/year (p < 0.001). Indeed, phenotype C showed a higher rate of progression (-0.459 µm/year, p < 0.001) when compared to phenotype B (-0.296 µm/year, p = 0.036). Eyes with ETDRS grade 20 showed GCL + IPL thickness values comparable to those of healthy control group (83.3 ± 5.80 and 82.7 ± 5.50 µm, respectively, p = 0.880), whereas there was a progressive decrease in GCL + IPL thickness in ETDRS grades 35 and 43-47 associated with the increase in severity of the retinopathy (-0.276 µm/year, p = 0.004; -0.585 µm/year, p = 0.013, respectively). Furthermore, the study showed statistically significant associations between the progressive thinning of GCL + IPL and the progressive increase in retinal capillary non-perfusion, with particular relevance for AIS (p < 0.001). CONCLUSIONS: Our findings showed that, in eyes with NPDR and at risk for progression, retinal neurodegeneration occurs at different rates in different risk phenotypes, and it is associated with retinal microvascular non-perfusion.

Atualizações na terapêutica farmacológica para infertilidade na mulher diagnosticada com síndrome de ovários policísticos: revisão de literatura / Updates on pharmacological treatments for infertility in women diagnosed with polycystic ovary syndrome: a literature review

Objetivo: Abordar atualizações referentes à terapia medicamentosa para indução da ovulação nas mulheres diagnosticadas com síndrome dos ovários policísticos (SOP). Métodos: Revisão de literatura por meio de levantamento bibliográfico do período de 1975 a 2021, nas bases eletrônicas PubMed, SciELO e MedLine, complementado pela Diretriz Internacional Baseada em Evidências para a Avaliação e Manejo da SOP de 2018 e pelo manual da Febrasgo para SOP. Sete descritores que atendessem à finalidade da pesquisa foram utilizados. Resultados: A literatura aponta atualmente algumas drogas como opção na terapêutica para a indução de ovulação, como metformina, letrozol e citrato de clomifeno, evidenciando que o uso de letrozol isolado e em associação com a metformina apresentaram melhores taxas de ovulação, 71,5% e 75,4%, respectivamente. Conclusão: O uso do letrozol isolado ou combinado com a metformina apresentou os melhores resultados nas taxas de gravidez e ovulação, todavia o tratamento para indução ovulatória deve ser individualizado.(AU)

Objective: To address updates of medicinal therapy for ovulation induction in women diagnosed with polycystic ovary syndrome (PCOS). Methods: Reviewing Literature through a bibliographic survey from 1975 to 2021, on the electronic databases PubMed, SciELO and MedLine, complemented by the International Evidence-Based Guideline for the Evaluation and Management of PCOS 2018 and the Febrasgo guide for PCOS. Seven descriptors that matched to the purpose of the research were applied. Results: Some drugs are currently indicated in the literature as an option for ovulation induction therapy, such as: metformin, letrozole and clomiphene citrate, showing that the use of letrozole alone and in association with metformin had better ovulation rates, 71.5% and 75.4%, respectively. Conclusion: The use of letrozole alone or combined with metformin showed the best results in pregnancy and ovulation rates, however, treatment for ovulatory induction must be individualized.(AU)

Lesão de tecido mole em pacientes vítimas de trauma buco-maxilo-facial / Soft tissue injury in victims of bucco-maxillo-facial trauma

Objetivo: este artigo teve como objetivo avaliar a prevalência e o perfil de lesões de tecido mole na face de pacientes atendidos no Hospital da Restauração- HR, no período de setembro/2011 - julho/2012. Metodologia: Para compor a amostra, foram selecionados 160 pacientes, tendo os dados sido obtidos com base em questionário, referentes aos dados pessoais e às circunstâncias do trauma. a outra parte da coleta de dados aconteceu por meio do exame físico para se verificar a presença das lesões nos tecidos moles faciais, sendo sua localização e aspecto registrados e documentados. Resultado: Os traumatismos faciais ocorreram, preferencialmente, em homem (81,9%) na fase adulto jovem (34,4%), sendo a maioria decorrente de acidente automobilístico (46,2%) e violência interpessoal (22,5%). Os locais anatômicos mais comuns foram a região frontal (43,8%) e os lábios superior e inferior (20,6%). O tamanho das lesões em tecido mole variaram em 58,6% dos pacientes que apresentaram lesão de 1,01- 5cm, 31,7% de 0,01- 1 cm. Conclusão: Neste estudo, verificou-se que as lesões de tecido mole acometem, principalmente, homens em decorrência de acidentes de trânsito, sendo essas lesões variáveis de 0,2 cm a 10 cm de tamanho, com predominância de uma lesão por paciente. verificou-se, ainda, que a região mais acometida foi a frontal.

Object: This paper set out to evaluate the prevalence and components of facial soft tissue injuries in patients treated at Hospital da Restauração - HR from September 2011 to July 2012. Method: The sample comprised 160 patients, who were interviewed using a questionnaire to obtain data on their personal particulars, time and location of the trauma event, use of safety devices, driver's license and alcoholic beverage intake. Result: Facial trauma occurred mainly in men (81.9%), 34.4% of whom were young adults. Most of facial traumas were due to a motor vehicle accident (46.2%) and interpersonal violence (22.5%). The most common anatomical locations of the injuries were the frontal region (43.8%) and the upper and lower lips (20.6%). The size of the lesion ranged from 0.2 to 24 cm, with 58.6% of patients having injuries ranging from 1.01 to 5 cm and 31.7% with injuries from 0.01 to 1 cm. Conclusion: Facial soft tissue injuries occur mainly in men and are due mostly to motor vehicle accidents. The injuries ranged from 0.2 to 10 cm, with an average occurrence of one injury per case, the frontal region being the most affected.

Microaneurysm turnover at the macula predicts risk of development of clinically significant macular edema in persons with mild nonproliferative diabetic retinopathy.

OBJECTIVE: To examine the relationship between microaneurysm (MA) turnover using automated analysis of fundus photographs (RetmarkerDR; Critical Health SA) and development of clinically significant macular edema (CSME) in nonproliferative diabetic retinopathy (NPDR). RESEARCH DESIGN AND METHODS: A prospective, monocenter, observational study was designed to follow eyes/patients with type 2 diabetes and NPDR (Early Treatment Diabetic Retinopathy Study levels 20 and 35) with no prior laser treatment for 2 years or until development of CSME. A total of 410 patients, one eye per patient, fulfilled the inclusion/exclusion criteria and were included in the study. Ophthalmologic examinations including best corrected visual acuity, fundus photography, and optical coherence tomography were performed at baseline, 6 months, and at the last study visit (24 months or before laser treatment). RESULTS: A total of 348 eyes/patients performed the 24-month visit or developed CSME. Of these 348 eyes/patients, 26 developed CSME. HbA1c levels at baseline and MA turnover (i.e., the sum of the MA formation and disappearance rates) computed during the first 6 months of follow-up were found to be independently predictive factors for development of CSME. MA turnover was 11.2 ± 11.2 in the 26 eyes/patients that developed CSME and 5.0 ± 5.2 in the remaining 322 (P < 0.001). Higher MA turnover values correlated with earlier development of CSME. MA turnover predictive values for CSME development were, for the positive predictive value, 20% and for the negative predictive value, 96%. CONCLUSIONS: MA turnover calculated with the RetmarkerDR predicts development of CSME in eyes with NPDR. Low MA turnover values identify well the eyes that are less likely to develop CSME in a 2-year period.

Improved automated screening of diabetic retinopathy.

AIM: To assess a two-step automated system (RetmarkerSR) that analyzes retinal photographs to detect diabetic retinopathy for the purpose of reducing the burden of manual grading. METHODS: Anonymous images from 5,386 patients screened in 2007 were obtained from a nonmydriatic diabetic retinopathy screening program in Portugal and graded by an experienced ophthalmologist. RetmarkerSR earmarked microaneurysms, generating two outputs: 'disease' or 'no disease'. A second-step analysis, based on coregistration, combining two visits, was subsequently performed in 289 patients who underwent repeated examinations in 2008. The study was extended by analyzing all referrals considered urgent by the ophthalmologist from 2001 to 2007. Results were compared with those obtained by manual grading. RESULTS: The RetmarkerSR classified in a first-step analysis 2,560 patients (47.5%) as having 'no disease' and 2,826 patients (52.5%) as having 'disease', thus requiring manual grading. RetmarkerSR detected all eyes considered urgent referrals. The two-step analysis further reduced the number of false-positive results by 26.3%, indicating an overall sensitivity of 95.8% and a specificity of 63.2%. CONCLUSION: Automated grading of diabetic retinopathy may safely reduce the burden of grading patients in diabetic retinopathy screening programs. The novel two-step automated analysis system offers improved sensitivity and specificity over published automated analysis systems.

Cisto do ducto tireoglosso associado a cisto branquial: relato de caso e revisäo da literatura / Thyroglossal duct cyst and branchial cyst: case report and literature review

O cisto do ducto tireoglosso é uma das mais freqüentes anomalias congênitas do pescoço. As afecções branquiais são um terço menos freqüentes que os cistos do ducto tireoglosso. Este relato de caso descreve um paciente com um cisto do ducto tireoglosso concomitante com restos branquiais. Foi submetido à cirurgia com sucesso e o diagnóstico definido pelo exame histopatológico. O possível desenvolvimento embiológico de cada patologia é discutido, e a revisão da literatura mostra que este é um caso raro. O achado de variações de apresentação de afecções comuns pode ser maior do que supõe.

Gravidez na adolescência: o papel da equipe de Saúde da Família na prevenção

Este estudo de revisão bibliográfica sistemática, teve por objetivo aprofundar o entendimento cultural e do quadro biopsicossocial relacionados à gravidez na adolescência, seus determinantes históricos e métodos contraceptivos adequados para esta faixa etária. Nesta fase da vida, em um contexto de competição de necessidades, vêm ganhando destaque para o setor saúde a incidência de gravidez. A prevenção da gestação não planejada é fundamental para adolescentes e jovens sexualmente ativos. O ideal é que os adolescentes recebam a maior quantidade possível de informação, em vista que podem se tornar vítimas do uso inadequado de métodos contraceptivos. Torna-se, portanto, imprescindível esse tipo de orientação antes mesmo que se tornem sexualmente ativos. A Atenção à Saúde do Adolescente pela equipe de saúde da família, integrada às escolas de ensino fundamental e médio constitui um desafio que deve orientar-se, principalmente, na prevenção de agravos, utilizando todos os recursos necessários para atender os grupos mais vulneráveis, seja por agravos biológicos, psicológicos ou sociais. Quando se trata de prestar assistência ao adolescente, deve-se ter em mente a importância do envolvimento multidisciplinar e intersetorial com estes jovens, frente à apresentação de necessidades que estão relacionadas a aspectos biológicos, psicológicos, sociais, jurídicos entre outros, bem como a peculiaridades de cada um.