Structural brain abnormalities are related to retinal nerve fiber layer thinning and disease duration in neuromyelitis optica spectrum disorders.

BACKGROUND: Although aquaporin-4 (AQP4) is widely expressed in the human brain cortex, lesions are rare in neuromyelitis optica (NMO) spectrum disorders (NMOSD). Recently, however, several studies have demonstrated occult structural brain atrophy in NMO. OBJECTIVE: This study aims to investigate magnetic resonance imaging (MRI) patterns of gray matter (GM) and white matter (WM) abnormalities in patients with NMOSD and to assess the visual pathway integrity during disease duration correlation of the retinal nerve fiber layer (RNFL) and pericalcarine cortex thickness. METHODS: Twenty-one patients with NMOSD and 34 matched healthy controls underwent both high-field MRI (3T) high-resolution T1-weighted and diffusion-tensor MRI. Voxel-based morphometry, cortical analyses (Freesurfer) and diffusion-tensor imaging (DTI) analyses (TBSS-FSL) were used to investigate brain abnormalities. In addition, RNFL measurement by optic-coherence tomography (OCT) was performed. RESULTS: We demonstrate that NMOSD is associated with GM and WM atrophy, encompassing more frequently the motor, sensory and visual pathways, and that the extent of GM atrophy correlates with disease duration. Furthermore, we demonstrate for the first time a correlation between RNFL and pericalcarine cortical thickness, with cortical atrophy evolving over the course of disease. CONCLUSIONS: Our findings indicate a role for retrograde and anterograde neurodegeneration in GM atrophy in NMOSD. However, the presence atrophy encompassing almost all lobes suggests that additional pathomechanisms might also be involved.

Visual pathway abnormalities were found in most multiple sclerosis patients despite history of previous optic neuritis.

OBJECTIVE: It was to investigate visual field (VF) abnormalities in a group of multiple sclerosis (MS) patients in the remission phase and the presence of magnetic resonance imaging (MRI) lesions in the optic radiations. METHODS: VF was assessed in 60 participants (age range 20-51 years): 35 relapsing-remitting MS patients [20 optic neuritis (+), 15 optic neuritis (-)] and 25 controls. MRI (3-Tesla) was obtained in all patients. RESULTS: Visual parameters were abnormal in MS patients as compared to controls. The majority of VF defects were diffuse. All patients except one had posterior visual pathways lesions. No significant difference in lesion number, length and distribution was noted between patients with and without history of optic neuritis. One patient presented homonymous hemianopsia. CONCLUSION: Posterior visual pathway abnormalities were found in most MS patients despite history of previous optic neuritis.

Visual pathway abnormalities were found in most multiple sclerosis patients despite history of previous optic neuritis / Anormalidades nas vias visuais foram encontradas na maior parte dos pacientes com esclerose multipla independentemente da historia de neurite optica

Objective It was to investigate visual field (VF) abnormalities in a group of multiple sclerosis (MS) patients in the remission phase and the presence of magnetic resonance imaging (MRI) lesions in the optic radiations. Methods VF was assessed in 60 participants (age range 20-51 years): 35 relapsing-remitting MS patients [20 optic neuritis (+), 15 optic neuritis (-)] and 25 controls. MRI (3-Tesla) was obtained in all patients. Results Visual parameters were abnormal in MS patients as compared to controls. The majority of VF defects were diffuse. All patients except one had posterior visual pathways lesions. No significant difference in lesion number, length and distribution was noted between patients with and without history of optic neuritis. One patient presented homonymous hemianopsia. Conclusion Posterior visual pathway abnormalities were found in most MS patients despite history of previous optic neuritis. .

Objetivo Foi analisar o campo visual (CV) de um grupo de pacientes com esclerose múltipla (EM) na fase remissiva e a presença de lesões nas imagens de ressonância magnética (MRI) na radiação óptica. Método O CV foi estudado em 60 participantes (faixa etária de 20-51 anos): 35 pacientes EM remitente-recorrente: [20 neurite óptica (+), 15 neurite óptica (-)] e 25 controles. Foram obtidas MRI (3-Tesla) de todos os pacientes. Resultados Havia alterações visuais nos pacientes com EM quando comparados aos controles. A maioria apresentava defeitos difusos de CV. Todos os pacientes, à exceção de um, apresentaram lesões nas vias visuais posteriores. Não foi observada diferença significativa quanto a número, extensão e distribuição das lesões entre os pacientes com e sem história de neurite óptica. Um paciente apresentou hemianopsia homônima. Conclusão Anormalidades nas via visuais posteriores foram encontradas na maior parte dos pacientes com EM independentemente da história de neurite óptica. .

The development and evaluation of a distance learning system in ophthalmology / A elaboração e avaliação de um sistema de ensino a distância em oftalmologia

INTRODUÇÃO: O ensino a distância pela Internet é uma ferramenta de educação cada vez mais utilizada em muitas faculdades de medicina e áreas de medicina especializadas, inclusive a oftalmologia. OBJETIVOS: Este estudo piloto teve como objetivo elaborar casos clínicos baseados no curso online e avaliar a eficácia deste método num grupo de estudantes de pós-graduação de medicina. MÉTODOS: foi um estudo de intervenção randomizado. Em primeiro lugar, um website foi construído usando uma plataforma de ensino à distância. Dezesseis residentes de oftalmologia do primeiro ano então foram divididos em dois grupos aleatórios: um grupo experimental, o qual foi submetido à intervenção (uso do site de ensino a distância) e outro grupo de controle, que não foi submetido à intervenção. Os alunos responderam a um caso clínico impresso e seus resultados foram comparados. RESULTADOS: não houve diferença estatisticamente significativa entre os grupos. CONCLUSÃO: Conseguimos desenvolver com sucesso o website de ensino a distância e os respectivos casos clínicos. Apesar do fato de que não houve diferença estatisticamente significativa entre o grupo com acesso e o grupo sem acesso, o estudo foi pioneiro no nosso departamento, uma vez que nunca havia sido desenvolvido anteriormente um programa online de casos clínicos.

INTRODUCTION: Web-based e-learning is a teaching tool increasingly used in many medical schools and specialist fields, including ophthalmology. AIMS: this pilot study aimed to develop internet-based course-based clinical cases and to evaluate the effectiveness of this method within a graduate medical education group. METHODS: this was an interventional randomized study. First, a website was built using a distance learning platform. Sixteen first-year ophthalmology residents were then divided into two randomized groups: one experimental group, which was submitted to the intervention (use of the e-learning site) and another control group, which was not submitted to the intervention. The students answered a printed clinical case and their scores were compared. RESULTS: there was no statistically significant difference between the groups. CONCLUSION: We were able to successfully develop the e-learning site and the respective clinical cases. Despite the fact that there was no statistically significant difference between the access and the non access group, the study was a pioneer in our department, since a clinical case online program had never previously been developed.

Experience with an internet-based course for ophthalmology residents / Curso por internet para residentes em oftalmologia: uma experiência

OBJECTIVE: To describe the first experience of an Internet-based course for ophthalmology residents. METHOD: Twenty-three residents were invited to participate in the study; however, only 13 (56.52%) took part, performing the proposed activities and answering a questionnaire. RESULTS: Of the 13 participants, only five (38.46%) completed 100% of the tasks, three (23.07%) completed between 70 and 90%, two (15.38%) completed between 50 and 60% and three (23.07%) completed less than 10% of the tasks. Regarding the use of computers and the Internet in general, all the participants reported using the Internet daily. All of them also affirmed they use the internet to study or to conduct research. CONCLUSION: Despite the advantages of the Internet, medical residents are still very reluctant to its use. Considering the context of information and communication technologies, there is a pressing need to reformulate continuing medical education in order to meet the demand of this new developing world.

OBJETIVO: Descrever a primeira experiência com um curso à distância para médicos residentes de Oftalmologia. MÉTODO: Vinte e três residentes foram convidados a participar do estudo, porém somente 13 (56,52%) aderiram, realizando as atividades propostas e respondendo o questionário. RESULTADOS: Dentre os 13 participantes, apenas 5 (38,46%) completaram 100% das tarefas, 3 (23,07%) completaram entre 70% e 90%, 2 (15,38%) completaram entre 50% e 60%, e 3 (23,07%) completaram menos de 10% das tarefas. Em relação ao uso do computador e da internet em geral, todos os participantes afirmaram que usam a internet diariamente. Todos também responderam que usam a internet para estudar ou fazer pesquisas. CONCLUSÃO: Apesar das vantagens da internet, os médicos residentes ainda são muito relutantes quanto ao seu uso. Considerando-se o contexto atual das tecnologias de informação e comunicação, é mandatório que se faça uma reformulação na educação médica continuada para atender à demanda deste novo mundo.

Visual control in children with developmental dyslexia / Controle visual em crianças com dislexia do desenvolvimento

PURPOSE: To assess binocular control in children with dyslexia. METHODS: Cross-sectional study with 26 children who were submitted to a set of ophthalmologic and visual tests. RESULTS: In the dyslexic children less eye movement control in voluntary convergence and unstable binocular fixation was observed. CONCLUSION: The results support the hypothesis that developmental dyslexia might present deficits which involve the magnocellular pathway and a part of the posterior cortical attentional network.

OBJETIVO: Avaliar o controle binocular em crianças com dislexia. MÉTODOS: Estudo transversal do qual participaram 26 crianças, nas quais foram aplicadas uma série de exames oftalmológicos e visuais. RESULTADOS: Nas crianças com dislexia observou-se controle menor na convergência voluntária e na estabilidade da fixação binocular. CONCLUSÃO: Os resultados apóiam a hipótese de que na dislexia do desenvolvimento podem ocorrer déficits que envolvem a via visual magnocelular e uma parte da rede cortical posterior da atenção.

Visual control in children with developmental dyslexia.

PURPOSE: To assess binocular control in children with dyslexia. METHODS: Cross-sectional study with 26 children who were submitted to a set of ophthalmologic and visual tests. RESULTS: In the dyslexic children less eye movement control in voluntary convergence and unstable binocular fixation was observed. CONCLUSION: The results support the hypothesis that developmental dyslexia might present deficits which involve the magnocellular pathway and a part of the posterior cortical attentional network.

Atención odontopediátrica integral de alta complejidad en pacientes de riesgo

Palabras preliminares, Dra. Lidia Pinola. Marco general. Bioseguridad. Pacientes discapacitados físico mentales. Pacientes inmuno comprometidos. Pacientes sistémicos. Pacientes con malformaciones cráneo máxilo faciales y fisurados. Unidad de Internación. Traumatología

Atención odontopediátrica integral de alta complejidad en pacientes de riesgo

Palabras preliminares, Dra. Lidia Pinola. Marco general. Bioseguridad. Pacientes discapacitados físico mentales. Pacientes inmuno comprometidos. Pacientes sistémicos. Pacientes con malformaciones cráneo máxilo faciales y fisurados. Unidad de Internación. Traumatología