Long-term eutrophication and contamination of the central area of Sepetiba Bay (SW Brazil).

This work sheds light on the recent evolution (≈1915-2015 AD) of Sepetiba Bay (SB; SE Brazil), a subtropical coastal lagoon on the southwestern Brazilian coast, based on a multiproxy approach. Variations in geochemical proxies as well as textural, mineralogical and geochronological data allow us to reconstruct temporally constrained changes in the depositional environments along the SP3 sediment core collected from the central area of SB. At the beginning of the twentieth century, the substrate of the study site was composed of coarse-grained sediments, largely sourced from felsic rocks of proximal areas and deposited under moderate to strong shallow marine hydrodynamics. Since the 1930s, the study area has undergone silting and received high contributions of materials from mafic rocks sourced by river basins. The SP3 core reveals a shallowing-upward sequence due to human-induced silting with significant eutrophication since the middle of 1970, which was caused by significant enrichment of organic matter that was provided by not only marine productivity but also continental and human waste. In addition, the sediments deposited after 1980 exhibit significant enrichment and are moderately to strongly polluted by Cd and Zn. Metals were dispersed by hydrodynamics from the source areas, but diagenetic processes promoted their retention in the sediments. The potential ecological risk index (PERI) indicates that the level of high (considerable) ecological risk is in sediments deposited in ≈1995 (30-32 cm; subsurface). The applied methodology allowed us to understand the thickness of the bottom sediment affected by eutrophication processes and contaminants. Identical methodologies can be applied in other coastal zones, and can provide useful information to decision makers and stakeholders that manage those areas.

Ultrastructural changes detected using swept-source optical coherence tomography in severe vitreopapillary traction: a case report / Alterações ultraestruturais detectadas pela tomografia de coerência óptica de fonte de varredura em tração vitreopapilar grave: relato de caso

ABSTRACT Vitreopapillary traction is an uncommon condition characterized by strong adhesion and the traction of the posterior hyaloid onto the optic disc and peripapillary retina, leading to optic disc elevation and visual loss. An 85-year-old man presented with a 6-month history of slow, progressive visual loss in the left eye along with optic disc edema. Swept-source optical coherence tomography B-scans revealed circumpapillary anterior-posterior persistent traction of dense vitreous strands onto the optic disc. Visual field examination demonstrated mild, generalized, diffuse sensitivity loss and blind-spot enlargement. A 25-gauge posterior vitrectomy was performed with posterior hyaloid separation from the optic disc, resulting in significant anatomical and visual improvement. In conclusion, swept-source optical coherence tomography aids in understanding the mechanism underlying visual loss in vitreopapillary traction. Moreover, posterior vitrectomy can effectively promote anatomical and visual improvements in these cases.

RESUMO A tração vitreopapilar é uma condição incomum caracterizada por forte adesão e tração da hialoide posterior no disco óptico e retina peripapilar, levando à elevação do disco óptico e à perda visual. Um homem de 85 anos apresentou uma história de 6 meses de perda visual lenta e progressiva no olho esquerdo, juntamente com edema do disco óptico. A tomografia de coerência óptica por fonte de varredura revelou tração persistente ântero-posterior peripapilar com traves vítreas densas sobre o disco óptico. Exame de campo visual demonstrou perda de sensibilidade difusa, generalizada, leve e aumento do ponto cego. Uma vitrectomia posterior de calibre 25 foi realizada com separação hialóide posterior do disco óptico, resultando em melhora anatômica e visual significativa. Em conclusão, a tomografia de coerência óptica por fonte de varredura auxilia na compreensão do mecanismo subjacente à perda visual na síndrome de tração vitreopapilar. Além disso, a vitrectomia posterior pode efetivamente promover melhorias visuais e anatômicas nesses casos.

Ultrastructural changes detected using swept-source optical coherence tomography in severe vitreopapillary traction: a case report.

Vitreopapillary traction is an uncommon condition characterized by strong adhesion and the traction of the posterior hyaloid onto the optic disc and peripapillary retina, leading to optic disc elevation and visual loss. An 85-year-old man presented with a 6-month history of slow, progressive visual loss in the left eye along with optic disc edema. Swept-source optical coherence tomography B-scans revealed circumpapillary anterior-posterior persistent traction of dense vitreous strands onto the optic disc. Visual field examination demonstrated mild, generalized, diffuse sensitivity loss and blind-spot enlargement. A 25-gauge posterior vitrectomy was performed with posterior hyaloid separation from the optic disc, resulting in significant anatomical and visual improvement. In conclusion, swept-source optical coherence tomography aids in understanding the mechanism underlying visual loss in vitreopapillary traction. Moreover, posterior vitrectomy can effectively promote anatomical and visual improvements in these cases.

Non-Mydriatic Fundus Retinography in Screening for Diabetic Retinopathy: Agreement Between Family Physicians, General Ophthalmologists, and a Retinal Specialist.

PURPOSE: To determine the level of agreement between trained family physicians (FPs), general ophthalmologists (GOs), and a retinal specialist (RS) in the assessment of non-mydriatic fundus retinography in screening for diabetic retinopathy (DR) in the primary health-care setting. METHODS: 200 Diabetic patients were submitted to two-field non-mydriatic digital fundus camera. The images were examined by four trained FPs, two GOs, and one RS with regard to the diagnosis and severity of DR and the diagnosis of macular edema. The RS served as gold standard. Reliability and accuracy were determined with the kappa test and diagnostic measures. RESULTS: A total of 397 eyes of 200 patients were included. The mean age was 55.1 (±11.7) years, and 182 (91%) had type 2 diabetes. The mean levels of serum glucose and glycosylated hemoglobin A1c were 195.6 (±87.3) mg/dL and 8.9% (±2.1), respectively. DR was diagnosed in 166 eyes by the RS and in 114 and 182 eyes by GO1 and GO2, respectively. For severity, DR was graded as proliferative in 8 eyes by the RS vs. 15 and 9 eyes by GO1 and GO2, respectively. The agreement between the RS and the GOs was substantial for both DR diagnosis (GO1k = 0.65; GO2k = 0.74) and severity (GO1k = 0.60; GO2k = 0.71), and fair or moderate for macular edema (GO1k = 0.27; GO2k = 0.43). FP1, FP2, FP3, and FP4 diagnosed DR in 108, 119, 163, and 117 eyes, respectively. The agreement between the RS and the FPs with regard to DR diagnosis was substantial (FP2k = 0.69; FP3k = 0.73; FP4k = 0.71) or moderate (FP1k = 0.56). As for DR severity, the agreement between the FPs and the RS was substantial (FP2k = 0.66; FP3k = 069; FP4k = 0.64) or moderate (FP1k = 0.51). Agreement between the FPs and the RS with regard to macular edema was fair (FP1k = 0.33; FP2k = 0.39; FP3k = 0.37) or moderate (FP4k = 0.51). CONCLUSION: Non-mydriatic fundus retinography was shown to be useful in DR screening in the primary health-care setting. FPs made assessments with good levels of agreement with an RS. Non-mydriatic fundus retinography associated with appropriate general physicians training is essential for the DR screening.

Nonarteritic anterior ischemic optic neuropathy following pars plana vitrectomy for macular hole treatment: case report.

Herein, we report a case of nonarteritic anterior ischemic optic neuropathy (NAION) following uneventful pars plana vitrectomy for macular hole treatment. A 56-year-old previously healthy woman presented with a full-thickness macular hole in right eye (OD) and small cup-to-disc ratios in both eyes. Five days after surgery, she noticed sudden painless loss of vision in OD and was found to have an afferent pupillary defect and intraocular pressure of 29 mmHg. Fundus examination showed right optic disc edema and the resolution of a macular hole with an inferior altitudinal visual field defect. Erythrocyte sedimentation rate, C-reactive protein levels, and general physical examination findings were normal. She was treated with hypotensive eyedrops and oral prednisone, resulting in mild visual improvement and a pale optic disc. A combination of face-down position and increased intraocular pressure due to a small optic disc cup were considered as potential mechanisms underlying NAION in the present case. Vitreoretinal surgeons should be aware of NAION as a potentially serious complication and be able to recognize associated risk factors and clinical findings.

Nonarteritic anterior ischemic optic neuropathy following pars plana vitrectomy for macular hole treatment: case report / Neuropatia óptica isquêmica anterior não arterítica pós vitrectomia pars plana para tratamento do buraco macular: relato de caso

ABSTRACT Herein, we report a case of nonarteritic anterior ischemic optic neuropathy (NAION) following uneventful pars plana vitrectomy for macular hole treatment. A 56-year-old previously healthy woman presented with a full-thickness macular hole in right eye (OD) and small cup-to-disc ratios in both eyes. Five days after surgery, she noticed sudden painless loss of vision in OD and was found to have an afferent pupillary defect and intraocular pressure of 29 mmHg. Fundus examination showed right optic disc edema and the resolution of a macular hole with an inferior altitudinal visual field defect. Erythrocyte sedimentation rate, C-reactive protein levels, and general physical examination findings were normal. She was treated with hypotensive eyedrops and oral prednisone, resulting in mild visual improvement and a pale optic disc. A combination of face-down position and increased intraocular pressure due to a small optic disc cup were considered as potential mechanisms underlying NAION in the present case. Vitreoretinal surgeons should be aware of NAION as a potentially serious complication and be able to recognize associated risk factors and clinical findings.

RESUMO Nosso objetivo é descrever a ocorrência de neuropatia óptica isquêmica anterior não-arterítica (NOIA-NA) após vitrectomia posterior para tratamento do buraco macular. Uma mulher de 56 anos de idade previamente hígida apresentou buraco macular de espessura total no olho direito (OD) e uma relação escavação disco pequena em ambos os olhos. No quinto dia de pós-operatório ela notou uma perda visual súbita e indolor OD associado a presença de um defeito pupilar aferente relativo e pressão intraocular de 29 mmHg neste mesmo olho. A avaliação do fundo de olho revelou a presença de edema de disco óptico e buraco macular fechado OD associado a presença de defeito de campo visual altitudinal inferior. A velocidade de hemossedimentação e a dosagem da proteína C reativa foram normais, assim como o exame físico geral. A paciente foi tratada com colírios hipotensores e prednisona oral e evoluiu com discreta melhora visual e palidez de disco óptico. Acreditamos que a combinação de posição de cabeça virada para baixo associado a um aumento da pressão intraocular em um paciente com relação escavação disco pequena são os possíveis mecanismos para a ocorrência de NOIA-NA neste presente caso. Os cirurgiões de retina e vítreo devem estar atentos a esta possível grave complicação e reconhecer os seus fatores de risco relacionados assim como sua apresentação clinica.

Macular Thickness Measurements with Frequency Domain-OCT for Quantification of Retinal Neural Loss and its Correlation with Cognitive Impairment in Alzheimer's Disease.

PURPOSE: To evaluate the ability of frequency domain optical coherence tomography (fd-OCT) to estimate retinal neural loss in eyes with Alzheimer's disease (AD). We also verified the existence of a correlation between AD-related cognitive impairment and macular and peripapillary retinal nerve fiber layer (RNFL) thickness measurements. METHODS: fd-OCT scans were obtained from 45 eyes of 24 patients with AD and 48 control eyes. Peripapillary RNFL, macular full-thickness and segmented inner macular thickness parameters were calculated. The inner macular parameters included macular retinal nerve fiber layer (mRNFL) thickness, ganglion cell layer (GCL) plus inner plexiform layer thickness (GCL+), and RNFL plus GCL+ thickness (GCL++). The Mini-Mental State Examination (MMSE) was used to assess cognition in all subjects. The two groups were compared and the relationship between MMSE scores and fd-OCT measurements was verified. RESULTS: Average, superior and inferior quadrant RNFL thickness parameters and all but one of the nine full-thickness macular measurements were significantly reduced in AD patients compared to controls. The segmented layers, GCL+ and GCL++ were significantly reduced in AD eyes. A significant correlation was found between most fd-OCT parameters (especially macular thickness measurements) and MMSE scores. CONCLUSIONS: Most fd-OCT peripapillary RNFL and macular full-thickness and segmented inner retinal layers parameters were reduced in AD eyes compared to controls. Moreover, neuronal loss, especially as reflected in macular parameters, correlated well with cognitive impairment in AD. Our results suggest that fd-OCT could be a potentially useful diagnostic tool in the evaluation and follow-up of AD patients.

Anatomic and functional outcome of eyes with massive submacular hemorrhage secondary to retinal macroaneurysm submitted to vitrectomy

Purpose: To report the anatomic and functional outcome in patients with severe visual loss after acute massive submacular hemorrhage secondary to retinal arterial macroaneurysm submitted to vitrectomy and subretinal recombinant tissue plasminogen activator injection. Methods: Retrospective, observational, case-series of 4 eyes of 4 patients submitted to pars plana posterior vitrectomy (ppV) combined with internal limiting membrane (ILM) removal and subretinal recombinant tissue plasminogen activator (rtPA-12.5 mg/0.1 ml) injection with dilute (20%) sulfur hexafluoride (SF6) gas in the vitreous cavity of eyes with recent onset (≤7 days) massive macular hemorrhage due to retinal arterial macroaneurysm (RAMA). Optical coherence tomography (OCT) was obtained both at presentation and during follow up. Results: Patients ranged in age from 63 to 78 years and all had systemic arterial hypertension. Visual acuity at presentation ranged from hand motions to count fingers at 50 cm. All eyes showed extensive retinal hemorrhage involving more than two-thirds of macular area. The time between the onset of symptoms and the surgery ranged from 3 to 7 days. After a mean postoperative follow-up of 15.5 ± 5.19 months (range, 10-22 months), all eyes showed visual acuity improvement and final visual acuity ranged from 20/30 to 20/80. All had complete displacement of the subretinal hemorrhage from the fovea after the surgery. OCT images showed neurosensory retina thinning and disruption of the reflective line that represents the junction between inner and outer photoreceptors segments (IS/OS line) beneath the macular area and absence of the external limiting membrane (ELM). Conclusions: ppV associated with subretinal rtPA injection with intravitreal gas seems to be a safe and effective technique to promote visual improvement in patients with multilevel macular hemorrhage secondary to RAMA. Despite functional improvement, OCT images demonstrate that...

Objetivo: Relatar os resultados anatômicos e funcionais em uma série de pacientes com perda visual grave por hemorragia submacular maciça aguda secundária a macroaneurisma arterial de retina (MAR) e descrever a técnica cirúrgica utilizada. Métodos: Este é um estudo retrospectivo, observacional, série de casos, incluindo 4 olhos de 4 pacientes que foram submetidos à cirurgia de vitrectomia posterior (VP), associada a peeling da membrane limitante interna (MLI) e injeção sub-retiniana de ativador do plasminogênio tecidual recombinante (rtPA-12,5 mg/0.1 ml) por hemorragia submacular maciça recente (≤7 dias) secundária MAR. Em todos os casos, o exame de tomografia de coerência óptica (OCT) foi obtido na consulta inicial e nas subsequentes para avaliação das alterações estruturais da retina. Resultados: A idade dos pacientes variou entre 63 a 78 anos e todos apresentavam hipertensão arterial sistêmica. A acuidade visual inicial nos olhos afetados variou de movimento de mãos a conta dedos a 50 cm. Todos os olhos apresentaram hemorragia retiniana extensa ocupando mais do que dois terços da região macular. O tempo decorrido entre a perda visual e a cirurgia variou entre 3 a 7 dias. Após um seguimento médio de 15.5 ± 5.19 meses (variando entre 10 a 22 meses), a acuidade visual pós-operatória variou entre 20/30 e 20/80. Todos os olhos apresentaram um deslocamento completo da hemorragia subretiniana da região macular central no pós operatório. As imagens seccionais da retina obtidas pela OCT revelaram um afilamento da retina neurossensorial e interrupções na linha refletiva que representa a junção entre os segmentos internos e externos dos fotorreceptores na região macular, além de falhas na membrane limitante externa em todos os casos. Conclusão: De acordo com os resultados do presente estudo, a VP associada à injeção sub-retiniana de rtPA parece ser uma técnica segura e eficaz em promover melhora visual em pacientes com hemorragia submacular...

Predictive factors for anterior chamber fibrin formation after vitreoretinal surgery / Fatores preditivos para formação de fibrina na câmara anterior após cirurgia vitreorretiniana

Purpose: The aim of this study was to investigate possible predictive factors related to anterior chamber fibrin formation after vitreoretinal surgery in a large series of patients. Methods: The data of 185 eyes of 185 patients submitted to vitreoretinal surgery was reviewed. The following variables were evaluated: the postoperatively presence of fibrin, age, diabetes mellitus, the vitrectomy system gauge (20, 23 or 25 gauge), the type of vitreous substitute, the influence of prior surgical procedures and the combination with cataract extraction. To evaluate predictive factors for anterior chamber fibrin formation, univariate analysis was performed. A multivariate stepwise logistic regression model was adjusted to investigate factors associated with fibrin formation (p<0.05). Results: Fibrinoid anterior chamber reaction was found in 12 (6.4%) patients. For multivariate logistic regression analysis, balanced salt solution (BSS), the chance of fibrin occurrence was 5 times greater (odds ratio 4.83, CI 95% 1.302 - 17.892; p=0.019), while combination with phacoemulsification increased the chance of fibrin formation by 20 times (odds ratio 20, CI 95% 2.480 - 161.347; p=0.005). No significant difference was found regarding other variables. Conclusion: Anterior chamber fibrin formation is an unwanted complication after vitreoretinal surgery. Factors such as combined performance of phacoemulsification and the use of balanced salt solution as a vitreous substitute may predispose the occurrence of this complication. .

Objetivo: Avaliar os possíveis fatores relacionados à formação de fibrina na câmara anterior após cirurgia vitreorretiniana em uma grande série de casos. Métodos: Foi realizado um estudo retrospectivo, observacional, caso-controle, onde os dados de 185 olhos de 185 pacientes submetidos à cirurgia vitreorretiniana foram avaliados. Os seguintes dados foram analisados: presença ou não de fibrina na câmara anterior na primeira semana de pós-operatório, idade, presença ou não de diabetes mellitus, calibre do sistema de vitrectomia utilizado (20,23 ou 25 gauge), substituto vítreo, a influência de cirurgias oftalmológicas prévias e a realização de cirurgia de catarata combinada. Para avaliação dos fatores preditivos para formação de fibrina, a análise univariada foi realizada. O modelo de regressão logística multivariada foi utilizado para investigar os fatores associados com a formação de fibrina (p<0,05). Resultados: A presença de fibrina na câmara anterior foi encontrada em 12 (6,4%) pacientes. Pela análise de regressão logística multivariada, o uso de solução salina balanceada (BSS) como substituto vítreo, a chance da presença de fibrina foi 5 vezes maior (odds ratio 4,83, IC 95% 1,302 - 17,892; p=0,019), enquanto que a realização de cirurgia facoemulsificação combinada aumentou a chance de formação de fibrina 20 vezes (odds ratio 20, IC 95% 2,480 - 161,347; p=0,005). Nenhuma diferença estatisticamente significativa foi encontrada para as outras variáveis. Conclusão: A formação de fibrina na câmara é uma complicação indesejada após cirurgia vitreorretiniana. Fatores como realização de cirurgia de facoemulsificação combinada e ...

Cessação tabágica em paciente com tremor essencial / Smoking cessation in a patient with essential tremor

Existem pacientes que, apesar dos esforços da equipe do programa de cessação tabágica, mostram-se refratários à redução do tabagismo. Entre os motivos mais citados para isso, estão abuso de álcool, ansiedade e depressão. Além desses, o tremor essencial, frequentemente negligenciado pelos pacientes e médicos, tem implicações clínicas diretas e indiretas para aqueles que desejam parar de fumar. Antes entendida como uma doença benigna, o tremor essencial tem fortes associações com transtornos psiquiátricos, além de piorar com a abstinência de nicotina e com o uso de determinados medicamentos para a cessação. Descrevemos um caso de tremor essencial e comorbidades psiquiátricas no seu percurso para a abstinência tabágica. Com relação à associação entre nicotina e o curso do tremor essencial, maiores estudos são necessários. Mas diagnosticar sua presença apresenta relevância clínica, podendo ser um marcador de pior prognóstico para a cessação.

There are patients that are resistant to reducing tobacco use, despite the effort of the professionals helping them to quit. Among the most cited motives, there are alcohol abuse, anxiety and depression. Furthermore, frequently neglected by patients and doctors, essential tremor has direct and indirect clinical implications for those who want to stop smoking. Once known as a benign condition, essential tremor has strong association with psychiatric disorders and can get worse because of nicotine abstinence and certain medications used in smoking cessation. We report a case of essential tremor and psychiatric comorbidities on the path towards tobacco abstinence. Regarding the link between nicotine and the course of essential tremor, further studies are necessary. However, diagnosing its presence is clinically relevant and should be considered a marker of worse prognosis in smoking cessation.