Retinografia como forma de rastreio de retinopatia diabética em hospital terciário do Sistema Único de Saúde / Color retinography as a means of screening for diabetic retinopathy in the tertiary hospital of Unified Health System

RESUMO Objetivo Avaliar o impacto da triagem de retinopatia diabética de paciente diabéticos realizada com retinografia colorida. Métodos Estudo retrospectivo, de caráter descritivo, avaliando laudos de retinografias realizadas desde a implementação do protocolo da triagem de retinopatia diabética de paciente diabéticos acompanhados no Ambulatório de Endocrinologia de um hospital terciário do Sistema Único de Saúde, de maio de 2018 até maio de 2020. Resultados Realizaram retinografia 727 pacientes diabéticos, que tinham entre 14 e 91 anos, sendo a maioria com 60 anos ou mais (53,2%), do sexo feminino (68%) e brancos (87,6%). Não apresentavam retinopatia diabética 467 (64,2%) pacientes, 125 (17,2%) tinham retinopatia diabética não proliferativa, 37 (5,1%) retinopatia diabética não proliferativa grave e/ou suspeita de edema macular, 65 (8,9%) retinopatia diabética proliferativa, 21 (2,9%) suspeita de outras patologias, e as imagens de 12 (1,7%) pacientes eram insatisfatórias. Foram considerados de alto risco (aqueles com retinopatia diabética não proliferativa grave e/ou edema macular, retinopatia diabética proliferativa ou imagem insatisfatória) 114 (15,68%) pacientes. Conclusão O rastreio de retinopatia diabética com retinografia colorida possibilitou a detecção de pacientes diabéticos de alto risco que necessitavam atendimento com brevidade, permitindo o acesso deles à consulta oftalmológica e diminuindo a morbidade da doença relacionada ao tratamento tardio. Os demais foram encaminhados à Atenção Primária para regulamentação, por meio do Sistema de Regulação.

ABSTRACT Objective To evaluate the impact of diabetic retinopathy (DR) screening using color retinography in diabetic patients. Methods Retrospective descriptive study, evaluating reports of all retinographs performed since the implementation of the protocol for screening for diabetic retinopathy in diabetic patients followed up at the endocrinology outpatient clinic of a tertiary hospital of the Unified Health System, from May 2018 to May 2020. Results 727 diabetic with age range from 14 to 91 years old, the majority being 60 years old or older (53.2%), female (68%) and white (87.6%), patients underwent retinography. Of the patients, 467 (64.2%) did not have DR, 125 (17.2%) had non-proliferative DR, 37 (5.1%) had severe non-proliferative DR and/or suspected macular edema, 65 (8.9%) had proliferative DR, 21 (2.9%) had suspicion signs of other pathologies and 12 (1.7%) had unsatisfactory images. A total of 114 (15.68%) patients were considered at high risk (those with severe non-proliferative NP and/or EM, proliferative DR or poor image) and were referred for comprehensive ophthalmic evaluation. Conclusion The screening of RD with color retinography enabled the detection of high-risk diabetic patients who needed assistance sooner and enabled their access to ophthalmologic consultation, which decreased disease morbidity. The others were referred to primary care for regulation through the Regulation System (SISREG).

Retinal exams requested at Primary Care Unit: indications, results and alternative strategies of evaluation / Exames de retina solicitados em Unidades Básicas de Saúde: indicações, resultados e estratégias alternativas de avaliação

ABSTRACT Objective To evaluate indications, results and strategy of retinal exams requested at Primary Care Units. Methods A retrospective study that analyzed the indications and results of retinal exams, in the modalities clinical dilated fundus exams and color fundus photographs. In the following situations, patients were considered eligible for color fundus photographs if visual acuity was normal and ocular symptoms were absent: diabetes mellitus and/or hypertension, in use of drugs with potential retinal toxicity, diagnosis or suspicion of glaucoma, stable and asymptomatic retinopathies, except myopia greater than -3.00 diopters. Results A total of 1,729 patients were evaluated (66% female, age 63.5±15.5 years), and 1,190 underwent clinical dilated fundus exam and 539 underwent color fundus photographs. Diabetes was present in 32.2%. The main indications were diabetes (23.7%) and glaucoma evaluation (23.5%). In 3.4% of patients there was no apparent indication. The main results were a large cup/disc ratio (30.7%) and diabetic retinopathy (13.2%). Exam was normal in 9.6%, detected peripheral changes in 7% and could not be performed in 1%. Considering patients eligible for fundus photographs (22.4%), more than half underwent clinical dilated fundus exams. Conclusion Regarding exam modality, there were no important differences in the distribution of indications or diagnosis. Color fundus photograph is compatible with telemedicine and more cost-effective, and could be considered the strategy of choice in some scenarios. Since there are no clear guidelines for retinal exams indications or the modality of choice, this study may contribute to such standardization, in order to optimize public health resources.

RESUMO Objetivo Avaliar as indicações, os resultados e a estratégia de exames de retina solicitados em Unidades Básicas de Saúde. Métodos Estudo retrospectivo no qual foram analisados as indicações e os resultados de exames de retina, nas modalidades mapeamento de retina e retinografia. Em casos de boa acuidade visual e sintomas oculares ausentes, foram considerados elegíveis para avaliação por retinografia: pacientes com diabetes mellitus e/ou hipertensão arterial sistêmica, em uso de medicação com potencial toxicidade retiniana, diagnóstico ou suspeita de glaucoma, e retinopatias estáveis e assintomáticas, exceto miopia maior que -3,00 dioptrias. Resultados Foram avaliados 1.729 pacientes (66% do sexo feminino, idade 63,5±15,5 anos). Destes, 1.190 realizaram mapeamento de retina e 539 realizaram retinografia. Diabetes estava presente em 32,2%. As principais indicações para solicitação do exame foram diabetes (23,7%) e investigação de glaucoma (23,5%). Em 3,4%, não havia indicação aparente. Os principais resultados foram aumento da escavação papilar (30,7%) e retinopatia diabética (13,2%). O exame foi normal em 9,6%; detectou alterações periféricas em 7%; e sua realização foi impossível em 1%. Dos pacientes elegíveis para retinografia (22,4%), mais da metade foi submetida ao mapeamento de retina. Conclusão Não houve diferenças importantes nas distribuições de indicações ou diagnósticos em relação à modalidade de exame. A retinografia, compatível com telemedicina e mais custo-efetiva, pode ser considerada a modalidade de escolha em determinadas situações. Na ausência de consenso quanto às indicações para a solicitação de exames da retina ou sua modalidade, este estudo pode contribuir para tal padronização, de modo a otimizar recursos do sistema público de saúde.

A educação médica nos cenários de práticas em anos iniciais da formação: sentidos tecidos pelo photovoice / La educación médica en los escenarios de prácticas en años iniciales de la formación: sentidos tejidos por el photovoice / Medical education applied to practical settings in the first college years: meanings given by photovoice

Como estratégia para formação de profissionais aptos a promoverem assistência integral à saúde, na contemporaneidade, o ensino médico prevê inserção do acadêmico no campo de atenção, desde os anos iniciais da graduação. Objetivou-se analisar a dimensão formativa desta imersão em cenários da saúde mental a partir de imagens captadas pelo photovoice e reflexões em grupo focal. Participaram seis estudantes de uma disciplina de graduação que promove a integração desses nos equipamentos de saúde do município, no período de 2017 a 2018. Pela interpretação dos sentidos do material produzido, duas categorias temáticas se sobressaíram: a inserção nos cenários de práticas e a educação médica em ação. Esses núcleos de sentido foram descritos, estabelecendo-se um diálogo com a literatura pertinente. A experiência fotografada, relatada e discutida no grupo trouxe vitalidade à formação, aproximando-os do humano que há neles e nos outros, favorecendo a integralidade do cuidado.(AU)

Como estrategia para la formación de profesionales aptos para promover asistencia integral a la salud, en la contemporaneidad, la enseñanza médica prevé la inserción del académico en el campo de atención desde los años iniciales de la graduación. El objetivo fue analizar la dimensión formativa de esta inmersión en escenarios de la salud mental a partir de imágenes captadas por el photovoice y reflexiones en grupo focal. Participaron seis alumnos de una disciplina de graduación que promueve la integración de ellos en los equipos de salud del municipio, en el período de 2017 a 2018. Por la interpretación de los sentidos del material producido, se destacaron dos categorías temáticas: La inserción en los Escenarios de Prácticas y la Educación Médica en Acción. Se describieron estableciéndose un diálogo con la literatura pertinente. La experiencia fotografiada, relatada y discutida en el grupo brindó vitalidad a la formación, aproximándolos del humano que hay en ellos y en los otros, favoreciendo la integralidad del cuidado.(AU)

Nowadays, medical education aims at introducing students to their study field since the first college years in order to prepare professionals for a comprehensive health care. The aim of the present study is to assess educational potential through immersion in mental health studies based on focus-group discussions and photovoice images. Six undergraduate students were encouraged to work with local medical equipment from 2017 to 2018. Two themes in accordance to relevant literature and to meanings given to the pictures were chosen, namely: Introduction to Health Care Practice and Medical Education in Action. The picture-taking experience, which was shared and discussed by the group, gave life to education; it took students closer to their humanity and to the humanity of others. Therefore, it ensured comprehensive healthcare.(AU)

Improving skin picking diagnosis among Brazilians: validation of the Skin Picking Impact Scale and development of a photographic instrument

Abstract Background Skin picking disorder is a prevalent disorder frequently comorbid with depression and anxiety, which is underdiagnosed mainly by dermatologists. Assessment of skin picking disorder is based on instruments influenced by the awareness about skin picking disorder and comorbid symptoms. To date, there is no validated instrument for Brazilian individuals nor an instrument to evaluate the severity of skin lesions in an objective way. Objectives Validate the Skin Picking Impact Scale for Brazilian Portuguese and create a photographic measurement to assess skin lesions. Methods The sample was assessed through the Skin Picking Impact Scale translated into Brazilian Portuguese, the Hamilton Anxiety Scale, the Beck Depression Inventory, and the Clinical Global Impression Scale. The patients' skin lesions were photographed. Photos were evaluated regarding active excoriation, crust/bleeding, exulceration, and linear lesions. Results There were 63 patients included. The Skin Picking Impact Scale translated into Brazilian Portuguese had good internal consistency (Cronbach's alpha = 0.88), which tests of goodness-of-fit, showing a suitable model. The reliability of photographic measurement was 0.66, with a high internal consistency (Cronbach's alpha = 0.87). Photographic measurement was not correlated with the Skin Picking Impact Scale, the Clinical Global Impression Scale, or comorbid symptoms. Study limitations Lack of a previously validated instrument to evaluate dermatillomania in the Brazilian population for comparison. Conclusion The Skin Picking Impact Scale validated in Brazilian Portuguese is a good instrument to evaluate skin picking disorder. Photographic measurement is a consistent way of assessing skin lesions, but it does not reflect the impact of skin picking disorder on the individual's life.

Photography in the planning of health interventions for the elderly / La fotografía en la planificación de intervenciones de salud dirigidas a ancianos / A fotografia no planejamento de intervenções de saúde dirigidas a idosos

ABSTRACT Objective: To analyze potentialities of the use of photo-elicitation technique as a tool of access to the real needs of the beneficiaries of the intervention of health professionals. For this purpose, the aspects of their quality of life that they considered more relevant were identified with an elderly group. Method: It is a qualitative investigation in which the discourse of the elderly on the changes to their quality of life is encouraged through the use of photographic images. Results: Based on the data obtained, it was possible to identify the aspects of quality of life considered more relevant by the elderly, allowing, therefore, to sustain a later intervention adjusted to the needs and expectations of the elderly. Final considerations: The use of photo-elicitation allowed verifying its potentialities as a strategy to collect significant and relevant information for the planning of interventions in the Health area.

RESUMEN Objetivo: Analizar las potencialidades de la utilización de la técnica de la foto-elección como instrumento de acceso a las reales necesidades de los beneficiarios de la intervención de los profesionales de salud. Con ese propósito, se identificaron, junto a un grupo de ancianos, los aspectos de su calidad de vida que consideran más relevantes. Método: Se trata de una investigación cualitativa en la que el discurso de los ancianos sobre las alteraciones a su calidad de vida es estimulado mediante el uso de imágenes fotográficas. Resultados: Con base en los datos obtenidos, fue posible identificar los aspectos de la calidad de vida considerados más relevantes por los ancianos, permitiendo así sostener una posterior intervención ajustada a las necesidades y expectativas del anciano. Consideraciones finales: La experiencia de utilización de la foto-elicitación permitió constatar sus potencialidades como estrategia de recogida de información significativa y relevante para la planificación de intervenciones en el área de la Salud.

RESUMO Objetivo: Analisar as potencialidades da utilização da técnica da foto-elicitação enquanto instrumento de acesso às reais necessidades dos beneficiários da intervenção dos profissionais de saúde. Com esse propósito, foram identificados, junto a um grupo de idosos, os aspetos da sua qualidade de vida que consideram mais relevantes. Método: Trata-se de uma investigação qualitativa em que o discurso dos idosos sobre as alterações à sua qualidade de vida é estimulado através do recurso a imagens fotográficas. Resultados: Com base nos dados obtidos, foi possível identificar os aspetos da qualidade de vida considerados mais relevantes pelos idosos, permitindo, assim, sustentar uma posterior intervenção ajustada às necessidades e expectativas do idoso. Considerações finais: A experiência de utilização da foto-elicitação permitiu constatar as suas potencialidades enquanto estratégia de recolha de informação significativa e relevante para o planejamento de intervenções na área da Saúde.

Reclassification and treatment of odontogenic keratocysts: A cohort study

Abstract: The odontogenic keratocyst (OKC) is a recurrent cyst that has been recently reclassified from an odontogenic tumor to an odontogenic cyst. The aim of the present study was to investigate its treatment and address issues related to its association with nevoid basal cell carcinoma syndrome (NBCCS). Lesions from the cohort of patients included in the present study consisted of 40 OKCs, of which 27 lesions were treated by enucleation (GE) and 13 underwent decompression (GD). Complementary treatment occurred in 38 (95%) lesions, of which 10 underwent isolated peripheral ostectomy (GO) and 28 underwent peripheral ostectomy combined with Carnoy's solution (GC). Thirteen lesions were associated with NBCCS (GS), while the others (n=27) were non-syndromic lesions (GnS). The recurrence-free periods (RFP) in the sample groups were compared using the Kaplan-Meier function and log-rank test at a significance level of 5% (p < 0.05) and were used to calculate the cumulative risk of recurrence (CRR) in each postoperative year. During the follow-up period, which had a mean of 43.5 months (range: 12-102 months), six (15%) recurrences were diagnosed. There was no significant difference among the RFP for the compared groups (p > 0.05) or increased CRR for the decompression (15.4%) over five years. Application of Carnoy's solution did not increase the efficacy of the peripheral ostectomy, but was related to a CRR of 0% for the syndromic lesions over five years. Therefore, 1) decompression did not increase the recurrence risk; 2) peripheral ostectomy demonstrated a similar efficacy as the combination with Carnoy's solution; 3) the association of NBCCS did not seem to significantly influence OKC recurrence; and 4) syndromic lesions seem to behave in the same manner as non-syndromic lesions when submitted to complementary treatments.

Significados construídos acerca das instituições socioeducativas: entre o Imaginado e o Vivido / Constructed meanings about socio-educational institutions: between what is imagined and what is lived / Significados de las instituciones socioeducativas construídas sobre: entre el imaginario y la duración

Este trabalho teve por objetivo compreender como adolescentes autores de ato infracional, cumprindo medida socioeducativa de internação, significam a internação. Utilizou-se, como aporte teórico, a Psicologia Histórico-Cultural, que concebe a construção social da pessoa em uma relação dialética. A fotovoz foi o instrumento utilizado para a coleta de dados, tendo sido solicitado que fotografassem o que percebiam como significativo. Após a revelação das fotos, foram realizados encontros nos quais os adolescentes puderam falar sobre as imagens. Os resultados destacam a visão dos adolescentes sobre o julgamento social a respeito das unidades de internação e dos adolescentes que dela fazem parte. A análise permitiu perceber que existe uma tentativa, por parte desses sujeitos, de modificar os significados construídos acerca dessas instituições e, consequentemente, minimizar o preconceito imposto pela sociedade. Essa mudança pode ser um dos caminhos possíveis para que o adolescente venha a estabelecer um convívio social distanciado da vivência infracional.

This study had the purpose to understand how felon adolescents serving some socio-educational measure, understand the internment and the deprivation of freedom. The theoretical approach of Cultural-Historical Psychology was used, which conceives the person's social construction in a dialectical relationship. The photo-voice technique was the instrument used for data collection, in which they were requested to photograph what they perceive as significant. After developing those photos, there were some meetings where the adolescents could talk about the photos. The results highlight the adolescents' perception of the social judgment of the internment units and the adolescents who are part of those units. The analysis allowed us to realize that there is an attempt by these adolescents to modify the constructed meanings about these institutions and, therefore, minimize the prejudice imposed by society. This change can be one of the possible ways for the adolescent to establish a social life distant from the infraction experience.

Este estudio tuvo como objetivo entender cómo los adolescentes delincuentes cumpliendo medidas socioeducativas de internación, viven y sienten la internación. Se utilizó como aporte teórico la Psicología Histórico-Cultural, que concibe la construcción social de la persona en una relación dialéctica. Fotovoz fue el instrumento utilizado para la recolección de datos y se les pidió que fotografiasen lo que percibían significativo. Después de la revelación de las fotos fueron realizados encuentros en los cuales los adolescentes pudieron hablar sobre las imágenes. Los resultados destacan la visión de los adolescentes de cómo las personas juzgan las unidades de internación y a los adolescentes que forman parte de ellas. El análisis permitió percibir que existe un intento por parte de estos adolescentes, de modificar los significados construídos sobre esas instituciones y minimizar el prejuicio impuesto por la sociedade. Este cambio puede ser uno de los caminos posibles para que el adolescente establezca una vida social distanciada de la experiencia delictiva.

Extraperitoneal versus transperitoneal laparoscopic radical cystectomy for selected elderly bladder cancer patients: a single center experience

ABSTRACT Objective: This study reports the initial experience of extraperitoneal laparoscopic radical cystectomy (ELRC) and compared with transperitoneal laparoscopic radical cystectomy (TLRC) in the treatment of selected elderly bladder cancer patients. Patients and Methods: A total of forty male bladder cancer patients who underwent ELRC (n=19) or TLRC (n=21) with ureterocutaneostomy were investigated. Demographic parameters, perioperative variables, oncological outcomes and follow-up data were retrospectively analyzed. Results: A significantly shorter time to exsufflation (1.5±0.7 vs 2.1±1.1 d; p=0.026) and liquid intake (1.8±0.9 vs 2.8±1.9 d; p=0.035) were observed in the ELRC group compared with the TLRC group. The incidence of postoperative ileus in the ELRC group was lower than the TLRC group (0 vs 9.5%). However, the difference had no statistical significance (p>0.05). The removed lymph node number in the ELRC group was significantly lower than the TLRC group (p<0.001). No significant differences were observed between the two groups in the overall and cancer-free survival rates (p>0.05). Conclusions: ELRC seems to be a safe and feasible surgical strategy for the selected elderly bladder cancer patients with ≤ T2 disease. The surgical and oncological efficacy of the ELRC is similar to that of the TLRC, but with faster intestinal function recovery. Further studies with a large series including different urinary diversions are needed to confirm our results and to better evaluate the benefit of ELRC in bladder cancer patients.

Vasculite reumatoide - Relato de caso / Rheumatoid Vasculitis - Case Report

Resumo A artrite reumatoide (AR) é uma doença crônica autoimune inflamatória sistêmica e sua principal manifestação é a sinovite persistente, que compromete articulações periféricas de forma simétrica. Apesar do seu potencial destrutivo, a evolução da AR é muito variável. Alguns pacientes podem ter apenas um processo de curta duração oligoarticular com lesão mínima, enquanto outros sofrem uma poliartrite progressiva e contínua e evoluem com acometimento de outros órgãos e sistemas, como pele, coração, pulmões, músculos e mais raramente vasos sanguíneos, que leva à vasculite reumatoide. O objetivo deste estudo foi descrever um caso de vasculite reumatoide, uma condição rara e grave.

Abstract Rheumatoid arthritis (RA) is a chronic systemic inflammatory autoimmune disease and its main manifestation is persistent synovitis affecting peripheral joints symmetrically, In spite of its destructive potential, the evolution of RA is highly variable. Some patients may have only a short-term process oligoarticular with minimum lesion, while others suffer a polyarthritis evolving with progressive and continuous involvement of other organ systems such as skin, heart, lungs, muscles and blood vessels rarely leading to rheumatoid vasculitis. The aim of this study was to describe a case of rheumatoid vasculitis a rare and severe condition.

Fotografia e imagem corporal na maturidade / Photography and body image in maturity

A Imagem Corporal de Idosos tem se tornado objeto de vários estudos nosúltimos anos, devido à influência que esta exerce sobre a qualidade de vida desses idosos. Oobjetivo desta pesquisa foi avaliar a percepção da imagem corporal de idosos através derelatos pessoais e preenchimento de uma escala de Imagem Corporal para Idosos. Por meio deuma sessão de fotos e a aplicação de uma escala de avaliação de imagem corporal foramavaliados níveis de satisfação corporal.

The Elder's Body Image have become the object of several studies in recentyears due to the influence that this has on the quality of life for theirselves. The objective ofthis research was to evaluate the perception of body image of elderly people through personalaccounts and completion of a range of Body Image for Seniors. Through a photoshoot andapplication of a rating scale for body image levels of body satisfaction were evaluated.

Demandas de cuidado domiciliar da criança nascida exposta ao HIV na ótica da teoria ambientalista / Demandas de cuidados en casa del niño nacido expuesto al VIH en la óptica de la teoría ambientalista / Demands of home care of children born exposed to HIV in the perspective of the environmental theory

Objetivou-se identificar as demandas de cuidado domiciliar da criança nascida exposta ao HIV, sob a perspectiva da teoria ambientalista. Trata-se de estudo qualitativo exploratório-descritivo realizado de janeiro a abril de 2011. Participaram dez mães infectadas pelo HIV, com crianças nascidas expostas ao vírus, em Fortaleza, Ceará. Constituíram-se como instrumentos de coleta de dados: câmera fotográfica descartável e digital e formulários para captação de informações em saúde associadas ao ambiente domiciliar. Os resultados foram contextualizados de acordo com a teoria e organizados em categorias: "vulnerabilidades associadas à estrutura física da moradia"; "ar intradomiciliar e peridomiciliar impuro"; "água utilizada para consumo"; "rede de esgoto e saneamento"; "iluminação e ventilação da residência". Conclui-se que o ambiente domiciliar oferece condições ambientais desfavoráveis para a criança. Urge a realização de intervenções focalizadas no ambiente domiciliar, para promover a saúde da criança nascida exposta ao HIV.

Se objetivó identificar las demandas de atención en el hogar de los niños nacidos expuestos al VIH en la perspectiva de la teoría ambientalista. Estudio cualitativo exploratorio-descriptivo realizado entre enero y abril de 2011. Participaron diez madres VIH-positivas con bebés expuestos al virus, en Fortaleza, Ceará. Fueron instrumentos de recolección de datos: cámara desechable y digital y formularios para capturar información sobre la salud asociada con el ambiente del hogar. Los resultados fueron contextualizados de acuerdo a la teoría y organizado en categorías: vulnerabilidades asociadas con la estructura física de la casa; aire intra y peridoméstico impuro; agua utilizada para el consumo; saneamiento y alcantarillado; iluminación y ventilación de la residencia. Se concluye que el hogar ofrece condiciones ambientales desfavorables para el niño. Hay necesidad de intervenciones específicas en el entorno del hogar para promover la salud de los niños nacidos expuestos al VIH.

The purpose of this study was to identify the demands of home care of children born exposed to HIV in the perspective of the environmental theory. It consists of an exploratory descriptive qualitative study, developed between January and April of 2011. Study participants were ten HIV-infected mothers with infants exposed to the virus, living in Fortaleza, Ceará. The data collection instruments included: a disposable digital camera and forms to obtain information on health associated with the home environment. Results were contextualized according to the theory and organized into the following categories: vulnerabilities associated with the physical structure of the house; contaminated intra and peridomestic air; unclean water used for drinking; sanitation and sewerage system; lighting and ventilation of the house. In conclusion, the home environment offers unfavorable environmental conditions for the child. Targeted interventions in the home environment are necessary so as to promote the health of children born exposed to HIV.

Prevalence of diabetic retinopathy in Peruvian patients with type 2 diabetes: results of a hospital-based retinal telescreening program / Prevalencia de retinopatía diabética en pacientes con diabetes tipo 2 en el Perú: resultados de un programa hospitalario de detección sistemßtica mediante telemedicina

OBJECTIVE: To estimate the prevalence of diabetic retinopathy (DR) in patients with type 2 diabetes and to determine any association with clinical factors. METHODS: This hospital-based screening project was designed to prospectively detect the presence of DR in patients with type 2 diabetes by grading images acquired with a digital retinal camera. RESULTS: Of 1 311 patients screened, appropriate retinal images were obtained in 1 222 subjects (93.2 percent). DR was detected in 282 patients (23.1 percent) [95 percent confidence interval (CI): 20.71-25.44]; 249 patients (20.4 percent) (95 percent CI: 18.1-22.6) had nonproliferative DR and 33 (2.7 percent) (95 percent CI: 1.8-3.6) had proliferative DR. In 32 patients (11.3 percent), DR was unilateral. The frequency of DR was the same in both sexes. Prevalence of blindness was twice as frequent in patients with DR as in those without it (9.4 percent and 4.6 percent, respectively) (P = 0.001). The frequency of DR at diagnosis was 3.5 percent and it increased with the duration of diabetes. DR was more frequent in patients with arterial hypertension, macrovascular or microvascular complications, and hemoglobin A1c (HbA1c) > 7.0 percent and in those treated with insulin or sulfonylureas. It was less prevalent in those with HbA1c < 7.0 percent, with greater body mass index, and who had been treated with metformin. CONCLUSIONS: The prevalence of DR in these patients with type 2 diabetes was 23.1 percent. Nonproliferative retinopathy accounted for 77.0 percent of cases. Although less prevalent than in a previous report, it doubled the frequency of blindness in the people affected. A national screening DR program should be considered in order to detect this prevalent condition early and treat it in a timely fashion.

OBJETIVO: Calcular la prevalencia de la retinopatía diabética en pacientes con diabetes tipo 2 y determinar su asociación con factores clínicos. MÉTODOS: Este proyecto de detección sistemßtica hospitalaria se dise±ó para detectar de manera prospectiva la presencia de retinopatía diabética en pacientes con diabetes tipo 2 mediante la valoración de imßgenes obtenidas con una cßmara digital para fotografía retiniana. RESULTADOS: Se evaluó a 1 311 pacientes y se obtuvieron imßgenes retinianas apropiadas en 1 222 de ellos (93,2 por ciento). Se detectó retinopatía diabética en 282 pacientes (23,1 por ciento) (intervalo de confianza [IC] de 95 por ciento: 20,71-25,44): 249 pacientes (20,4 por ciento) (IC de 95 por ciento: 18,1-22,6) tenían retinopatía diabética no proliferativa y 33 (2,7 por ciento) (IC 95 por ciento: 1,8-3,6) presentaban retinopatía diabética proliferativa. En 32 pacientes (11,3 por ciento), la retinopatía diabética era unilateral. La frecuencia de retinopatía diabética fue la misma en ambos sexos. La prevalencia de ceguera fue del doble en los pacientes con retinopatía diabética que en aquellos sin ella (9,4 por ciento y 4,6 por ciento, respectivamente) (P = 0,001). La frecuencia de retinopatía diabética en el momento del diagnóstico fue de 3,5 por ciento y aumentó con la duración de la diabetes. La retinopatía diabética fue mßs frecuente en los pacientes con hipertensión arterial, complicaciones macrovasculares o microvasculares y hemoglobina A1c (HbA1c) > 7,0 por ciento, y en aquellos tratados con insulina o sulfonilureas. Fue menos prevalente en los pacientes con HbA1c < 7,0 por ciento, en aquellos con mayor índice de masa corporal y en los tratados con metformina. CONCLUSIONES: La prevalencia de retinopatía diabética en estos pacientes con diabetes tipo 2 fue de 23,1 por ciento. La retinopatía no proliferativa representó 77,0 por ciento de los casos. Aunque la prevalencia de la ceguera fue menor que en un informe anterior...

Cribado de retinopatía diabética mediante retinografía midriática en atención primaria / Coverage and results of a screening program for diabetic retinopathy using mydriatic retinography in primary health care

OBJETIVOS: Conocer la cobertura de un programa de cribado de retinopatía diabética en atención primaria y la concordancia entre médicos de familia (MF) y oftalmólogos. MATERIAL Y MÉTODOS: Estudio observacional transversal. Revisión de retinografías midriáticas de pacientes con diabetes mellitus tipo 2 (2007-2008) solicitadas por MF de tres centros de salud urbanos en Jaén,España. RESULTADOS: En total 296 retinografías (2007) y 380 (2008) (cobertura=26 por ciento±2.4).Retinografías patológicas: 181 MF (27 por ciento±1.3) y 59 (9 por ciento±0.3) oftalmólogos. Concordancia global moderada (kappa=0.408±0.039), que mejora del primer al segundo año (0.34 y 0.45; p<0.001, prueba χ2). La interpretación de los MF tiene sensibilidad, 97 por ciento, especificidad, 80 por ciento, VPP, 33 por ciento, VPN, 100 por ciento, cociente de probabilidad positivo, 4.88 y negativo, 0.04. Hay variabilidad en cobertura y concordancia entre centros de salud. CONCLUSIONES: La retinografía midriática realizada e interpretada por MF es útil como cribado de retinopatía en diabéticos. En el segundo año se mejora cobertura, valores predictivos y cocientes de probabilidad, aunque se debe homogeneizar la interpretación.

OBJECTIVE: To identify the coverage of a diabetic retinopathy screening program in primary health care and to assess agreement between ophthalmologists and family physicians (FP) regarding retinography evaluations of diabetic patients. MATERIALS AND METHODS: Cross-sectional observational study,with a review of diabetic patients' mydriatic retinographies (2007-2008) from three urban primary health centers (PHC)(Jaén-Spain). RESULTS: A total of 296 retinographies in 2007 and 380 in 2008 (coverage=26 percent±2,4) were reviewed. Pathological retinographies were identified by 181 FPs (27 percent±1,3) and 59 (9 percent±0,3) ophthalmologists.Total agreement was moderate (kappa=0,408±0,039).Agreement was better in the latter year (0,45 vs 0,34; p<0,001 test χ2). FP evaluations showed 97 percent sensitivity,80 percent specificity,33 percent positive predictive value, 100 percent negative predictive value, 4, 88 positive likelihood ratio and 0,04 negative likelihood ratio. We find variability in coverage and agreement between PHC. CONCLUSIONS: Mydriatic retinographies performed and evaluated by FPs are useful to retinopathy screening of diabetic patients. Coverage, predictive values and likelihood ratio were better in the latter year, although the interpretation should be homogenized.

Concordância entre diagnósticos dermatológicos obtidos por consulta presencial e por análise de imagens digitais / Agreement between dermatological diagnoses made by live examination compared to analysis of digital images

FUNDAMENTOS: A teledermatologia, pouco utilizada no Brasil e com iniciativas incipientes no Amazonas, necessita de estudos para demonstrar sua factibilidade e eficácia. OBJETIVOS: Avaliar a eficácia de um método assíncrono de teledermatologia, utilizando recursos tecnológicos simples e de baixo custo. MÉTODOS: Cento e setenta e quatro pacientes foram examinados por quatro dermatologistas; dois efetuaram diagnóstico presencial (A1 e A2) e dois por meio de imagens das lesões e história clínica (B1 e B2). Foi investigada a concordância entre as avaliações presenciais e por imagens. RESULTADOS: A concordância do diagnóstico principal entre os examinadores presenciais (A1 e A2) foi de 83,3 por cento e entre os de imagens (B1 e B2), de 81 por cento. A concordância entre o diagnóstico principal estabelecido pelo método presencial e o obtido por meio de imagens variou de 78,2 por cento a 83,9 por cento. CONCLUSÃO: O diagnóstico de doenças dermatológicas realizado por imagens digitais demonstrou concordância ótima quando comparado àquele realizado com a presença física do paciente.

BACKGROUND: Teledermatology is seldom used in Brazil, although some incipient initiatives have been implemented in the state of Amazonas. Further studies are still required to confirm the feasibility and efficacy of this diagnostic tool. OBJECTIVES: To evaluate the efficacy of an asynchronous method of teledermatology using simple, inexpensive technological resources. METHODS: One hundred and seventy-four patients were examined by four dermatologists, two clinic-based dermatologists, who diagnosed the patients following live examination (A1 and A2), and two consultant specialists in image dermatology, who reached diagnoses by examining images of the lesions and the patients' clinical histories (B1 and B2). The agreement between live examination and examination of images was evaluated. RESULTS: Agreement between the two live examiners (A1 and A2) with respect to the principal diagnosis was 83.3 percent compared to 81.0 percent between the physicians who diagnosed by examining images (B1 and B2). Agreement between the principal diagnosis established by live examination and that obtained from examining images ranged from 78.2 percent to 83.9 percent, CONCLUSION: Agreement between diagnoses of dermatological diseases reached following examination of digital images and those reached following live examination of the patient was excellent.

Validación del uso de modelos fotográficos para cuantificar el tamaño de las porciones de alimentos / Validation of food photographs as a tool to quantify portion size

The aim of this research was to validate the usefulness of a food photograph atlas for the estimation of food portion sizes. The instrument was tested in 76 adults, of whom 34 were professionals and 42 had only primary school education. Selected foods were weighed before its intake and later on a questionnaire was made about food portion sizes using the food photograph atlas. Total corrected answers were 60.9 percent in the university group and 52.7 percent in the primary school group (p=0.07). Correlation between real weight and the estimated weight for the total observations was good [r =0.722 (p=0.003)] and percentage of variation between both weights had a range of - 29 percent to + 256 percent. Food photograph models give an approximation to food portion sizes, so they are useful instruments to be use in nutritional surveys.

La finalidad de esta investigación fue validar la utilidad de un atlas fotográfico para estimar el peso de las porciones de alimentos. El instrumento se probó en 76 adultos; de los cuales 34 eran profesionales y 42 eran personas con estudios primarios. Los alimentos seleccionados se pesaron previo a su consumo y posteriormente se indagó sobre la cantidad recibida, utilizando para la estimación las fotografías del atlas. El porcentaje de observaciones acertadas fue del 60.9 por ciento en el grupo con estudios universitarios y del 52.7 por ciento en el grupo con estudios primarios (p= 0.07). La correlación hallada para el total de estimaciones entre el peso estimado y el peso real fue elevada y significativa r =0.722 (p=0.003) y el porcentaje de variación entre ambos pesos tuvo un rango de - 29 por ciento a + 256 por ciento. Los modelos fotográficos de alimentos ofrecen una aproximación a las porciones consumidas, por lo que resultan un instrumento de utilidad para la realización de encuestas alimentarias.

Vacinas e campanhas: as imagens de uma história a ser contada / Vaccines and campaigns: images with a story to tell

Seleciona duas coleçöes de imagens consideradas importantes para a compreensäo da história das políticas de imunizaçäo no Brasil. Refere-se ao material reunido pela exposiçäo A Revolta da Vacina: da varíola às campanhas de imunizaçäo, e ao trabalho de Angela Porto sobre a erradicaçäo da poliomielite no Brasil, onde säo analisadas as mudanças ocorridas nas campanhas publicitárias convocando a populaçäo a vacinar seus filhos.