Diffusion tensor imaging metrics in diagnosis of HTLV-1-associated myelopathy.

OBJECTIVE: In the diagnosis of HTLV-1-associated myelopathy (HAM), while magnetic resonance imaging (MRI) is essential to exclude other diseases, its power is limited regarding HAM diagnosis, as only 30% of affected patients present with spinal cord atrophy. Diffusion tensor imaging (DTI) may enable the detection of damage in the white matter microstructure. Here, we quantitatively assess spinal cord damage using DTI and evaluate conventional MRI parameters of the spinal cord in HTLV-1-infected individuals. METHODS: This cross-sectional study involved 33 HTLV-1 carriers, 28 patients with definite-HAM, and 11 seronegative healthy subjects (HS). Region-of-interest (ROI)-based fractional anisotropy (FA) and mean diffusivity (MD) measurements were performed in the upper thoracic and lumbar regions of the spinal cord. Thoracic index was defined as 1/ (anteroposterior diameter × transverse diameter) measured at the fifth 5th vertebral level. Receiver operating characteristic (ROC) curve analysis was used to determine optimal cutoff FA, MD, and thoracic index values. RESULTS: Spinal cord atrophy was observed in 15 (53.6%) patients with definite-HAM. The area under the ROC curve in the thoracic spinal cord was 0.824 (95% CI, 0.716-0.932), 0.839 (95% CI: 0.736-0.942), and 0.838 (95% CI: 0.728-0.949) for FA, MD, and the thoracic index, respectively. Lower FA and higher MD values were observed in the definite-HAM group compared to HTLV-1 carriers and HS at the T5 vertebral level (p < 0.01). INTERPRETATION: Complementary to conventional MRI, DTI analysis of the spinal cord and thoracic index determination can offer additional insight that may prove useful in the diagnosis of HAM.

Bladder dysfunction in human T cell lymphotropic virus infection: A prospective cohort study.

BACKGROUND: While bladder dysfunction is observed in the majority of patients with human T cell lymphotropic virus type 1 (HTLV-1)-associated myelopathy (HAM), it is also observed in patients who do not fulfill all diagnostic criteria for HAM. These patients are classified as having possible or probable HAM/TSP. However, it remains unclear whether the severity and progression of bladder dysfunction occurs similarly between these two groups. OBJECTIVE: Compare the severity and evolution of bladder dysfunction in HTLV-1-infected patients with possible and definite HAM/TSP. METHODS: The present prospective cohort study followed 90 HTLV-1 patients with possible HAM/TSP and 84 with definite HAM/TSP between April 2011 and February 2019. Bladder dysfunction was evaluated by bladder diary, overactive bladder symptoms scores (OABSS) and urodynamic studies. Bladder dysfunction progression was defined as the need for clean self-intermittent catheterization (CIC). RESULTS: At baseline, nocturia, urgency and OABSS scores were worse in definite compared to possible HAM/TSP patients. The main urodynamic finding was detrusor overactivity, present in 77.8% of the patients with definite HAM/TSP versus 58.7% of those with possible HAM/TSP (P = 0.05). Upon study conclusion, the cumulative frequency of patients requiring CIC increased in both groups, from 2 to 6 in possible HAM/TSP and from 28 to 44 in definite HAM/TSP patients. The estimated time to need for CIC was 6.7 years (95%CI 6.5-7.0) in the possible HAM/TSP group compared to 5.5 years (95%CI 4.8-6.1) in the definite HAM/TSP group. CONCLUSIONS: Although both groups showed similarities in bladder dysfunction and tended to progress to requiring CIC over time, patients with possible HAM/TSP presented less severe manifestations at baseline and progressed more slowly than those with definite HAM/TSP.

Onabotulinumtoxin type A improves lower urinary tract symptoms and quality of life in patients with human T cell lymphotropic virus type 1 associated overactive bladder

ABSTRACT Aim: To evaluate the efficacy of the onabotulinum toxin type A in the treatment of HTLV-1 associated overactive bladder and its impact on quality of life (QoL). Methods: Case series with 10 patients with overactive bladder refractory to conservative treatment with anticholinergic or physical therapy. They received 200Ui of onabotulinumtoxin type A intravesically and were evaluated by overactive bladder symptoms score (OABSS) and King's Health Questionnaire. Results: The mean (SD) of the age was 52 + 14.5 years and 60% were female. All of them had confirmed detrusor overactivity on urodynamic study. Seven patients had HAM/TSP. The median and range of the OABSS was 13 (12-15) before therapy and decreased to 1.0 (0-12) on day 30 and to 03 (0-14) on day 90 (p < 0.0001). There was a significant improvement in 8 of the 9 domains of the King's Health Questionnaire after the intervention. Hematuria, urinary retention and urinary infection were the complications observed in 3 out of 10 patients. The mean time to request retreatment was 465 days. Conclusion: Onabotulinum toxin type A intravesically reduced the OABSS with last long effect and improved the quality of life of HTLV-1 infected patients with severe overactive bladder.

Onabotulinumtoxin type A improves lower urinary tract symptoms and quality of life in patients with human T cell lymphotropic virus type 1 associated overactive bladder.

AIM: To evaluate the efficacy of the onabotulinum toxin type A in the treatment of HTLV-1 associated overactive bladder and its impact on quality of life (QoL). METHODS: Case series with 10 patients with overactive bladder refractory to conservative treatment with anticholinergic or physical therapy. They received 200Ui of onabotulinumtoxin type A intravesically and were evaluated by overactive bladder symptoms score (OABSS) and King's Health Questionnaire. RESULTS: The mean (SD) of the age was 52+14.5 years and 60% were female. All of them had confirmed detrusor overactivity on urodynamic study. Seven patients had HAM/TSP. The median and range of the OABSS was 13 (12-15) before therapy and decreased to 1.0 (0-12) on day 30 and to 03 (0-14) on day 90 (p<0.0001). There was a significant improvement in 8 of the 9 domains of the King's Health Questionnaire after the intervention. Hematuria, urinary retention and urinary infection were the complications observed in 3 out of 10 patients. The mean time to request retreatment was 465 days. CONCLUSION: Onabotulinum toxin type A intravesically reduced the OABSS with last long effect and improved the quality of life of HTLV-1 infected patients with severe overactive bladder.

Percepción de estudiantes de medicina en Maceió, Alagoas, Brasil, sobre la atención a la mujer en el climaterio / Perception of medical students in Maceió, Alagoas and Brazil on care for women in climateric i: en

Introducción: el climaterio es un periodo especial en la vida de la mujer por lo que debe recibir un trato diferenciado en la Atención en Salud. Para tanto, el proceso de formación de médicos debe ofrecer prácticas que aborden, de manera específica esta situación. Objetivo: analizar prácticas en Unidades de Salud da Familia en relación con las competencias generales a cerca de las mujeres en climaterio. Métodos: fue un estudio cuantitativo, se tuvo como sujetos los alumnos de la escuela de medicina. La fuente de información utilizada en el estudio fue un instrumento de percepción de tipo Likert. Resultados: los resultados mostraron que las prácticas posibilitaron el desarrollo de competencias cognitivas y parte de las competencias técnicas necesarias para la atención a las mujeres en climaterio. Fueron encontradas limitaciones en la oportunidad de los avances para habilidades tales como: la realización del examen físico general, ginecológico y citopatológico; orientación sobre nutrición y factores de riesgo, tales como alcohol y tabaco, así como la discusión de la indicación de la terapia de reemplazo hormonal para esta fase de la mujer. La dimensión integrativa relacional apareció como el área más crítico de la etapa. En esta dimensión es muy visible la limitación de entorno multidisciplinar para el cuidado de las mujeres en el climaterio y la capacidad de integrar los datos epidemiológicos, tendencias y riesgos para la toma de decisiones. Conclusiones: estos resultados demuestran que aunque hay señales de ruptura con los paradigmas tradicionales de la formación médica, las grandes oportunidades de práctica médica en las Unidades de Salud da Familia, junto a la mujer en climaterio, son todavía centradas sobre la cognición(AU)

Introduction: The climacteric is a special period in the life of the woman being that this should receive differential treatment in health care. For both, the process of training doctors should offer practices to address, specifically this situation. Objective: This study has the objective to know any limits on the USF stage in the development of general skills necessary to care for women during the climacteric. Method: This is a quantitative study, with the subjects of the boarding students of medical school. The source of information used in the study was an instrument of perception Likert. Results: The results showed that the stage has enabled the development of cognitive skills and some of the technical skills required to care for women during the climacteric. There were limitations on the opportunity to progress to skills such as conducting general physical examinations, gynecological and pap smear; nutrition guidance and risk factors such as alcohol and tobacco, as well as the discussion of the indication of hormone replacement therapy for this phase of the woman. Finally, the integrative-relational dimension proved to be the most critical area of the stage. This dimension is very visible limiting environment for multidisciplinary care for women in climacteric, and the ability to integrate epidemiological data, trends and risks to decision-making. Conclusion: These results show that although there are signs of a break with the traditional paradigms of medical education, the greatest opportunities for medical practice at Family Health Unit, near the women in climacteric, are still focused on cognition(AU)

Interferon Beta-1a Improves Urinary Symptoms, Reduces Proviral Load, and Modifies the Immune Response in a Patient with HAM/TSP.

The human T-cell lymphotropic virus type 1 (HTLV-1) is the known causative agent of a chronic neurologic condition known as HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). Although several therapies have been evaluated for HAM/TSP, none have been approved for use in humans. In this paper, we describe a 55-year-old female patient with HAM/TSP who was treated with interferon beta-1a. This patient, in comparison to 20 female patients with HAM/TSP who were not treated, showed improvement in urinary symptoms over four years of therapy, as well as a reduction in HTLV-1 proviral load and serum cytokine levels typically observed in HAM/TSP. This improved outcome merits further controlled studies on the use and efficacy of interferon beta-1a as a therapy for HAM/TSP.

Ensino extracurricular em Oftalmologia: grupos de estudos / ligas de alunos de graduação / Extracurricular teaching in Ophthalmology: undergraduate study groups

O objetivo deste estudo é identificar a existência e avaliar o funcionamento de associações de docentes e alunos de graduação (núcleos, ligas, grupos de estudo e ações) dedicadas à complementação extracurricular do ensino de Oftalmologia e à prestação de ser viços comunitários. Realizou-se estudo transversal descritivo e compôs-se amostra de conveniência formada por estudantes de graduação de Medicina e residentes em Oftalmologia das 107 faculdades de Medicina do Brasil. Os dados foram coletados por entrevista, mediante aplicação de questionário, em fevereiro e março de 2002. Encontraram-se 12 ligas de Oftalmologia. O critério de seleção para ingresso inclui, na maior parte, presença em curso introdutório e/ou realização de prova. O número de membros varia de 9 a 30. Metade das ligas aceita alunos a partir do terceiro ano de graduação. Todas as associações apresentam participação de docentes, e 75 por cento, de residentes. As atividades mais comuns incluem participação em aulas teóricas e em projetos comunitários, atendimento em ambulatório e/ou pronto-socorro e realização de pesquisa científica. A maioria das ligas de Oftalmologia preenche os requisitos para suplementar o ensino de Oftalmologia na graduação médica, porém o número de ligas ainda é pequeno.

This study aims at identifying the existence and at evaluating the functioning of undergraduate and facult y associations/study groups dedicated to continued education and community services in Ophthalmology. A cross-section descriptive survey based on a convenience sample was conducted by means of a questionnaire answered by residents and students from 107 Brazilian medical schools during the months February and March 2002. Twelve (11.21 percent) study groups in Ophthalmology were identified among these medical schools. Eleven (91.67 percent) of these 12 associations are controlled by their own by-laws. The admission criteria normally require having followed an introductor y course and / or admission exam. The number of students in the study groups varies between 9 and 30. Half of the groups admit students from the third year on. All study groups count on the participation of faculty members and 75 percent of them admit residents. The most common activities of the groups include attendance to regular classes and participation in communit y projects and scientific research. Though most of the study groups fulfill the requirements for providing primar y undergraduate Ophthalmologic education, the number of study groups is still not significant.

[Simplified intraoperative adjustable suture technique for horizontal strabismus surgery: a study of 153 cases]. / Técnica de sutura ajustável per-operatória simplificada para a correção de desvios horizontais: estudo de 153 casos.

PURPOSE: To evaluate the simplified intraoperative adjustable suture technique for horizontal strabismus surgery. METHODS: Data charts of all patients who underwent horizontal strabismus surgery by the simplified intraoperative adjustable suture technique at the Strabismus Department of the "Hospital das Clínicas" of the University of São Paulo in the period from January 2001 to November 2005 were evaluated retrospectively. Using this technique, the adjustment was calculated based on the corneal light reflection, having considered the difference between the measures in the awake state and with the anesthetized patient. RESULTS: One hundred fifty-three patients were operated on, 73 (47.8%) cases of esotropia (ET) and 80 (52.2%) of exotropia (XT). Under anesthesia, 123 (80.4%) patients had the eye position modified: 69 (56.1%) were less esotropic, 51 (41.5%) were more exotropic and 3 (2.4%) were less exotropic. Surgery was adjusted in 60 (39.2%) patients: 30 were esotropia and 30 were exotropia. Surgical success was defined as an eso- or exodeviation within 10 prism diopters, in a follow-up period of at least 180 days. The overall success rate was 71.6%. CONCLUSIONS: The simplified intraoperative adjustable suture technique, described in 2003 in a study performed on 49 patients operated on by the same surgeon, was shown to be efficient in this larger series of patients operated on by different surgeons. This technique should be considered in patients who do not cooperate in other adjustment techniques, aiming at improved success rates.

Técnica de sutura ajustável per-operatória simplificada para a correção de desvios horizontais: estudo de 153 casos / Simplified intraoperative adjustable suture technique for horizontal strabismus surgery: a study of 153 cases

OBJETIVO: Avaliar a técnica de sutura ajustável per-operatória simplificada para a correção de desvio horizontal. MÉTODOS: Foram avaliados retrospectivamente os prontuários médicos de todos os pacientes que foram submetidos à cirurgia para correção de desvio horizontal utilizando a técnica de sutura ajustável per-operatória simplificada no setor de Motilidade Ocular Extrínseca do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo no período entre janeiro de 2001 e novembro de 2005. Por essa técnica, o ajuste foi calculado com base no reflexo luminoso na córnea, considerando a diferença entre a medida pré-operatória e sob plano anestésico profundo. RESULTADOS: Foram realizadas 153 cirurgias, sendo 73 (47,8 por cento) casos de esotropia (ET) e 80 (52,2 por cento) de exotropia (XT). Após a anestesia, houve alteração do desvio em 123 (80,4 por cento) pacientes, sendo que destes, 69 (56,1 por cento) eram esotropia que diminuíram, 51 (41,5 por cento) eram exotropia que aumentaram e 3 (2,4 por cento) eram exotropia que diminuíram. Foi realizado o ajuste per-operatório em 60 (39,2 por cento) casos, sendo 30 (41,1 por cento) casos de esotropia e 30 (37,5 por cento) de exotropia. Os resultados pós-operatórios foram avaliados após seguimento mínimo de 180 dias, com taxa de sucesso (considerando ortotropia, sub ou supercorreção de até 10 dioptrias prismáticas) de 71,6 por cento. CONCLUSÕES: A técnica de sutura ajustável per-operatória simplificada, que foi apresentada em 2003 em um estudo com 49 pacientes operados pelo mesmo cirurgião, mostrou-se eficiente nessa série maior de casos e realizada por diferentes cirurgiões. É proposta para pacientes que não colaboram para outras técnicas de ajuste, visando aumentar o sucesso cirúrgico.

PURPOSE: To evaluate the simplified intraoperative adjustable suture technique for horizontal strabismus surgery. METHODS: Data charts of all patients who underwent horizontal strabismus surgery by the simplified intraoperative adjustable suture technique at the Strabismus Department of the "Hospital das Clínicas" of the University of São Paulo in the period from January 2001 to November 2005 were evaluated retrospectively. Using this technique, the adjustment was calculated based on the corneal light reflection, having considered the difference between the measures in the awake state and with the anesthetized patient. RESULTS: One hundred fifty-three patients were operated on, 73 (47.8 percent) cases of esotropia (ET) and 80 (52.2 percent) of exotropia (XT). Under anesthesia, 123 (80.4 percent) patients had the eye position modified: 69 (56.1 percent) were less esotropic, 51 (41.5 percent) were more exotropic and 3 (2.4 percent) were less exotropic. Surgery was adjusted in 60 (39.2 percent) patients: 30 were esotropia and 30 were exotropia. Surgical success was defined as an eso- or exodeviation within 10 prism diopters, in a follow-up period of at least 180 days. The overall sucess rate was 71.6 percent. CONCLUSIONS: The simplified intraoperative adjustable suture technique, described in 2003 in a study performed on 49 patients operated on by the same surgeon, was shown to be efficient in this larger series of patients operated on by different surgeons. This technique should be considered in patients who do not cooperate in other adjustment techniques, aiming at improved success rates.

Persistent diplopia and strabismus after cataract surgery under local anesthesia.

BACKGROUND AND PURPOSE: Diplopia is an infrequent complication described for retrobulbar local anesthesia. The objective of this study is to report the clinical characteristics and treatments for this surgical complication. METHODS: Retrospective study of medical records. PERIOD: 5.3 years ending February 2005. During this period, 20453 cataract surgeries were performed. The anesthesia used was retrobulbar block with ropivacaine diluted with hyaluronidase. Nineteen patients reported diplopia due to strabismus after the cataract surgical procedure and were referred for evaluation at the Extrinsic Ocular Motility Department. RESULTS: Persistent diplopia after cataract surgery occurred in 19 (0.093%) of the 20453 cases. The types of deviations found were: exotropia (n=3), esotropia (n=5), hypertropia (n=1), exotropia + hypertropia (n=5) and esotropia + hypertropia (n=5). Small deviations and dysfunction of the lateral rectus muscles were most commonly seen. Prism was applied to 4 patients, eye muscle surgery was the option in 8 patients, orthoptic treatment was performed in 3 patients and for 2 patients the decision was to only observe progress. Overall, binocular vision was restored in eleven of the nineteen patients. CONCLUSIONS: Persistent diplopia due to strabismus is an infrequent complication after cataract surgery with retrobulbar block. Etiology of this disorder of extrinsic ocular motility is variable, including mixed components. We stress the importance of adequate preoperative history of strabismus and evaluation of extrinsic ocular motility. Considering the reported incidence of this problem is as high as one in 25 cataract surgeries, one should advise the patient of the possibility of persistent postoperative diplopia and the possible need for surgical intervention and/or prism to treat the symptoms.

Interesse e conhecimento em cirurgia refrativa entre estudantes de medicina / Interest and knowledge in refractive surgery among medical students

Objetivo: Realizou-se um estudo em estudantes da Faculdade de Medicina do ABC afim de analisar e relacionar a freqüência de usuários de correção óptica, o tipo de vícios de refração, o número de pessoas submetidas à cirurgia refrativa e o conhecimento e interesse por essa operação. Métodos: realizou-se um levantamento entre estudantes de medicina da Faculdade de Medicina do ABC, no período de 19 a 21 de junho de 2000. Foi utilizado um questionário auto-aplicável como instrumento de coleta de dados. Resultados: foi relatado que 62,7 por cento dos estudantes usavam correção óptica, sendo que 53,3 por cento desses apresentavam, como erro de refração, miopia simples ou associada ao astigmatismo. 92,8 por cento do total dos entrevistados já tinham ouvido falar em cirurgia refrativa, contendo apenas 34,2 por cento conhecedores dessa técnica cirúrgica e 17,6 por cento conhecedores dos riscos e complicações pós-operatórios. Entre os 200 estudantes amétropes, 50,5 por cento gostariam de ser submetidos à operação, sendo que 69,0 por cento deles esperavam, através da cirurgia, a cura definitiva. Foi coletado, também, que 51,7 por cento dos entrevistados tiveram a última consulta oftalmológica há menos de 1 ano; 32,0 por cento entre 1 e 3 anos e 15,7 por cento há mais de três anos. Apenas 5 estudantes já tinham sido submetidos à cirurgia refrativa. Conclusão: A maioria dos estudantes de Medicina (62,7 por cento) é portador de vício de refração corrigido, sendo os mais freqüentes a miopia simples e a miopia associada a astigmatismo. Há pouco conhecimento e falsa expectativa em relação à cirurgia, sendo que apenas 34,2 por cento entrevistados conhecem o procedimento cirúrgico, 17,6 por cento sabem dos riscos e das complicações e 69,0 por cento esperam cura total. Diante das condições desse estudo, foi constatado que apesar de muitos se interessarem pela cirurgia refrativa, poucos se submeteram a ela, devido, principalmente, em ordem decrescente, a: contra-indicação médica, falta de oportunidade, falta de conhecimento e problemas financeiros. Os consultórios oftalmológicos são apenas a quarta fonte de informação, precedido, em ordem decrescente, por familiares, amigos e faculdade, o que é evidenciado pelo fato de 81,5 por cento dos entrevistados gostariam de se informar melhor sobre a cirurgia refrativa. Mesmo tendo 83,7 por cento se consultado nos últimos três anos, informações e esclarecimento satisfatório não foram fornecidos.