Effect of Topical Losartan in the Treatment of Established Corneal Fibrosis in Rabbits.

Purpose: The purpose of this study was to evaluate the safety and efficacy of topical losartan in the therapeutic treatment of established corneal scaring fibrosis at 1 month after alkali burn in rabbits. Methods: Standardized alkali burns were performed in 1 eye of 24 rabbits with 0.75N NaOH for 15 seconds. Corneas were allowed to heal and develop scaring of the cornea for 1 month. Twelve eyes per group were treated with 50 µL of topical 0.8 mg/mL losartan in balanced salt solution (BSS), pH 7.0, and 12 eyes were treated with vehicle BSS 6 times per day. Six corneas were analyzed at 1 week or 1 month in each group. Standardized slit lamp photographs were obtained at the end point for each cornea and opacity was quantitated using ImageJ. Corneoscleral rims were cryofixed in optimum cutting temperature (OCT) solution and combined duplex immunohistochemistry for myofibroblast marker alpha-smooth muscle actin (α-SMA), mesenchymal cell marker vimentin, and TUNEL assay for apoptosis was performed on all corneas. Results: Topical losartan was effective in the treatment of established stromal fibrosis following alkali burn injury to the rabbit cornea. Stromal myofibroblast density was decreased and stromal cell apoptosis was increased (included both α-SMA-positive myofibroblasts and α-SMA-negative, vimentin-positive cells) at both 1 week and 1 month in the topical losartan-treated compared with vehicle-treated groups. Conclusions: Topical losartan is effective in the treatment of established stromal fibrosis in rabbits. Most myofibroblasts disappear from the stroma within the first month of losartan treatment. Longer treatment with topical losartan is needed to allow time for corneal fibroblast regeneration of the epithelial basement membrane (in coordination with epithelial cells) and the removal of disordered extracellular matrix produced by myofibroblasts.

Corneal stromal localization of TGF beta isoforms in spontaneous persistent epithelial defects after PRK in rabbits.

The purpose of this study was to evaluate transforming growth factor beta (TGFß) isoform localization in rabbit corneas with spontaneous persistent epithelial defects (PEDs) after photorefractive keratectomy (PRK). Four cryofixed corneas from a previously reported series of PEDs in rabbits that had PRK were evaluated with triplex immunohistochemistry (IHC) for TGFß3, myofibroblast marker alpha-smooth muscle actin (α-SMA) and mesenchymal marker vimentin. One cornea had sufficient remaining tissue for triplex IHC for TGFß1, TGFß2, or TGFß3 (each with α-SMA and vimentin) using isoform-specific antibodies. All three TGFß isoforms were detected in the subepithelial stroma at and surrounding the PED. Some of each TGFß isoform co-localized with α-SMA of myofibroblasts, which could be TGFß isoform autocrine production by myofibroblasts or TGFß-1, -2, and -3 binding to these myofibroblasts.

Topical Losartan Inhibition of Myofibroblast Generation in Rabbit Corneas With Acute Incisions.

PURPOSE: The purpose of this study was to study whether deep central corneal incisions close during topical losartan treatment and the effect of topical losartan on myofibroblast generation after incisions in rabbit corneas. METHODS: Rabbits (12) had a 0.35-mm deep radial incision from the center of the cornea into the limbus in 1 eye that was approximated with a single 10-0 nylon suture 1 mm inside the limbus. The incision was treated with 50 µL of topical 0.8 mg/mL losartan or 50 µL of balanced salt solution vehicle 6 times per day for 1 month. Standardized slitlamp photographs of the central incisions were analyzed for opacity with ImageJ before euthanasia. Triplex IHC was performed on cryofixed corneas for myofibroblast marker alpha-smooth muscle actin, mesenchymal cell marker vimentin, and basement membrane marker laminin alpha-5. Stromal α-SMA-positive myofibroblasts surrounding the incisions were quantitated with ImageJ. RESULTS: Topical losartan compared with vehicle did not affect closure of the radial incisions or the opacity that developed surrounding the incisions at 1 month after injury. Topical losartan compared with vehicle did significantly decrease the average density of stromal myofibroblasts surrounding the incisions. CONCLUSIONS: Topical losartan, a known inhibitor of transforming growth factor beta signaling, did not affect closure of deep corneal incisions. Losartan decreased myofibroblast generation surrounding nearly full-thickness radial corneal incisions compared with vehicle. The opacity at the incisions was not significantly affected by losartan-likely because corneal fibroblasts that develop in the stroma adjacent to the incisions were not changed by the losartan compared with the vehicle.

The use of smartphones in ophthalmology: technological development and application / O uso de smartphones na oftalmologia: desenvolvimento tecnológico e aplicação

Objective: Technological development has promoted several advances in society, including the creation of smartphones, which have been increasingly used in medicine, especially in ophthalmology. This study aimed to review the use of smartphones in ophthalmology. Methods: In January of 2020, the MEDLINE and LILACS databases were selected to provide articles containing the terms "Ophthalmology" and "Smartphone", filtering the results between the years of 2015 and 2019. The evaluated outcomes were finally included into the following categories in the discussion: "Visual acuity", "Amblyopia and strabismus", "Anterior segment", "Posterior segment", "Glaucoma", "Community patient education and assistance" and "Neurophthalmology". Results: Smartphones can be useful in several different areas of ophthalmology and can provide the patients better understating and adhesion to their treatment. Conclusion: Applications can be used as tools to facilitate the work of several professionals and improve the understanding of patients about their clinical conditions.

Objetivo: O desenvolvimento tecnológico tem promovido diversos avanços na sociedade, incluindo a criação de smartphones, que têm sido cada vez mais utilizados na medicina, principalmente na oftalmologia. O objetivo deste estudo foi revisar o uso de smartphones na oftalmologia. Métodos: Durante o mês de janeiro de 2020, as bases de dados MEDLINE e LILACS foram selecionadas para buscar artigos contendo os termos "Oftalmologia" e "Smartphone", filtrando os resultados entre os anos de 2015 e 2019. Os dados avaliados foram, finalmente, incluídos nas seguintes categorias na discussão: "Acuidade visual", "Ambliopia e estrabismo", "Segmento anterior", "Segmento posterior", "Glaucoma", "Assistência e educação ao paciente da comunidade" e "Neuroftalmologia". Resultados: Os smartphones podem ser úteis em diversas áreas da oftalmologia e fornecem melhor compreensão e adesão dos pacientes ao tratamento. Conclusão: O uso de aplicativos pode ser utilizado como ferramenta para facilitar o trabalho de diversos profissionais e melhorar o entendimento dos pacientes sobre suas condições clínicas.

Validation of an educational game about first aid for schoolchildren / Validación de un juego educativo sobre primeros auxilios para escolares / Validação de jogo educativo sobre primeiros socorros para crianças escolares

ABSTRACT Objectives: to validate the content and appearance of an educational game about first aid for schoolchildren with experts in education and health. Methods: this is a methodological, quantitative and descriptive research, carried out using the Delphi technique, using an online collection instrument, covering 55 items of the game. Content and appearance assessment was performed by 26 judges. The data were analyzed using Content Validity index. Results: the final prototype is presented in a board format, composed of four buildable pawns and 117 cards between questions, alerts and challenges. Overall Content Validity index of 0.95 and greater than 0.8 was obtained for all items in two Delphi rounds. Conclusions: the educational game validated by experts is a pedagogical tool for teaching first aid to schoolchildren as an option to traditional educational practices.

RESUMEN Objetivos: validar el contenido y apariencia del juego educativo de primeros auxilios para niños en edad escolar con expertos en el campo de la educación y la salud. Métodos: investigación metodológica, cuantitativa y descriptiva, realizada mediante la técnica Delphi utilizando un instrumento de recolección en línea, cubriendo 55 ítems del juego. La evaluación de contenido y apariencia fue realizada por 26 jueces. Los datos se analizaron mediante el índice de validación de contenido. Resultados: el prototipo final del juego se presenta en formato de tablero, compuesto por cuatro peones ensamblables y 117 cartas que incluyen preguntas, alertas y desafíos. Se obtuvo un índice de validación de contenido general de 0,95 y superior a 0,8 para todos los ítems, en dos rondas Delphi. Conclusiones: el juego educativo validado por los expertos es una herramienta pedagógica para la enseñanza de primeros auxilios a escolares como opción a las prácticas educativas tradicionales.

RESUMO Objetivos: validar o conteúdo e a aparência do jogo educativo sobre primeiros socorros para crianças em idade escolar com experts da área da educação e saúde. Métodos: pesquisa metodológica, quantitativa descritiva, realizada por meio da técnica Delphi a partir de instrumento de coleta online, contemplando 55 itens do jogo. A avaliação do conteúdo e aparência foi realizada por 26 juízes. Os dados foram analisados a partir do Índice de Validação de Conteúdo. Resultados: o protótipo final do jogo apresenta-se em formato de tabuleiro, composto por quatro peões montáveis e 117 cartas entre perguntas, alertas e desafios. Obteve-se Índice de Validação de Conteúdo geral de 0,95 e superior a 0,8 em todos os itens, em duas rodadas Delphi. Conclusões: o jogo educativo validado pelos experts é uma ferramenta pedagógica para o ensino de primeiros socorros com crianças escolares como opção às práticas educativas tradicionais.

Pharmacoepidemiology of the antiglaucoma drugs in Brazil from 2012 to 2018 / Farmacoepidemiologia das drogas antiglaucomatosas no Brasil de 2012 a 2018

Abstract Purpose: To outline the epidemiological profile of clinical treatments for glaucoma provided by the Brazilian Unified Health System (SUS, acronym in Portuguese) between January 2012 and December 2018. Methods: A quantitative and descriptive study was conducted using available data based on the outpatient information system from SUS (SIA/SUS, acronym in Portuguese). The variables were monocular treatment with first, second, and third-line drugs; monocular treatment with combinations of two drugs and three drugs from different lines; binocular treatment with first, second, and third-line drugs; and binocular treatment with combinations of two drugs and three drugs from different lines. Results: During the analysis period, the prevalence of clinical therapies for glaucoma increased from 2012 to 2017 and decreased from 2017 to 2018. Of the clinically treated patients, 96% were carriers of binocular glaucoma. Among the regions of Brazil, the Northeast had the highest prevalence of binocular glaucoma (about 60% of the number of cases), and the most common therapy was combinations of two drugs from different lines. The Southeast region had the highest concentration of monocular glaucoma (53% of cases), and the predominant therapy was combinations of three drugs from different lines. The Midwest region had the lowest prevalence of monocular-treatments for glaucoma (less than 6%). Conclusion: In Brazil, the highest number of treatments offered by the public health system was in the Northeast and Southeast regions. There is a high national prevalence and potential for the morbidity of this disease. Therefore, it is necessary to strengthen programs aimed at early diagnosis and appropriate treatment to reduce adverse outcomes.

Resumo Objetivo: Traçar o perfil epidemiológico do tratamento clínico para o glaucoma no Brasil fornecido pelo Sistema Único de Saúde (SUS), no período de janeiro de 2012 a dezembro de 2018. Métodos: Estudo quantitativo e descritivo, utilizando a base de dados disponível no Sistema de Informações Ambulatoriais do SUS (SIA/SUS). As variáveis utilizadas foram: tratamento monocular com drogas de primeira, de segunda e de terceira linha; tratamento monocular com combinações de duas drogas e de três drogas de diferentes linhas; tratamento binocular com drogas de primeira, de segunda e de terceira linha; e tratamento binocular com combinações de duas drogas e de três drogas de diferentes linhas. Resultados: Durante o período analisado, a prevalência de terapias clínicas para o glaucoma aumentou entre 2012 e 2017 e diminuiu entre 2017 e 2018. Dos pacientes tratados clinicamente, 96% eram portadores de glaucoma binocular. Entre as regiões do Brasil, o Nordeste teve a maior prevalência de glaucoma binocular (cerca de 60% do número de casos), e a terapia mais comum foi a combinação de duas drogas de diferentes linhas. A região Sudeste teve a maior concentração de glaucoma monocular (53% dos casos), e a terapia predominante foi a combinação de três drogas de diferentes linhas. A região Centro-Oeste apresentou a menor prevalência de tratamentos monoculares para o glaucoma (menos de 6%). Conclusão: No Brasil, o maior número de tratamentos oferecidos pelo sistema público de saúde foi nas regiões Nordeste e Sudeste. Existe uma alta prevalência nacional e um alto potencial para morbidade desta doença. Portanto, é necessário fortalecer programas voltados para o diagnóstico precoce e para o tratamento adequado a fim de reduzir os resultados adversos.

Impacto do diabetes mellitus na reperfusão miocárdica após intervenção coronariana percutânea primária / Impact of diabetes mellitus on myocardial reperfusion following primary percutaneous coronary intervention

OBJETIVO: Analisar a reperfusão miocárdica após intervenção coronariana percutânea primária em diabéticos e não diabéticos. MÉTODOS: Estudo caso-controle prospectivo, realizado no período de janeiro de 2013 a março de 2014, incluindo pacientes com diagnóstico de infarto agudo do miocárdio com menos de 12 horas do início dos sintomas e submetidos à terapia de reperfusão com intervenção coronariana percutânea primária. Foi realizada avaliação do blush miocárdico, da resolução do supradesnivelamento de segmento ST >50% em 90 e em 180 minutos e do Thrombolysis in Myocardial Infarction (TIMI) frame count corrigido <40 quadros. RESULTADOS: Foram incluídos 201 pacientes no estudo, sendo 32 diabéticos. Levando em consideração os marcadores de reperfusão miocárdica estudados, indivíduos diabéticos tiveram menor resolução do segmento ST, menor blush miocárdico e maior TIMI frame count após angioplastia primária quando comparados aos não diabéticos. CONCLUSÕES: Diabéticos apresentaram piores índices de reperfusão miocárdica pós-angioplastia primária comparados aos não diabéticos. (AU)

OBJECTIVES: To analyze myocardial reperfusion following primary percutaneous coronary intervention in diabetic and non-diabetic patients. METHODS: This is a prospective casecontrol study, conducted from January 2013 to March 2014, including patients diagnosed with acute myocardial infarction less than 12 hours after the onset of symptoms, and undergoing reperfusion therapy with Primary percutaneous coronary intervention. The myocardial blush, ST-segment elevation >50% resolution in 90 and 180 minutes, and corrected Thrombolysis Myocardial Infarction (TIMI) frame count <40 frames were evaluated. RESULTS: A total of 201 patients were included in the study, of which 32 were diabetic. Taking the studied myocardial reperfusion markers into consideration, diabetic patients had lower ST segment resolution, lower myocardial blush, and higher TIMI frame count after primary angioplasty when compared to non-diabetics. CONCLUSIONS: Diabetic patients presented worse myocardial reperfusion rates after primary angioplasty when compared to non-diabetic patients. (AU)