Our objective was to compare the diagnostic accuracies of and to determine the correlations between the disc damage likelihood scale (DDLS) and anatomical and functional tests used for glaucoma ...detection. A total of 54 healthy subjects (54 eyes) and 47 primary open-angle glaucoma patients (47 eyes) were included in this cross-sectional observational study. DDLS scores and cup-to-disc (C/D) ratios were evaluated. Subjects underwent standard automated perimetry (SAP), optic disc and retinal nerve fiber layer (RNFL) imaging with time and spectral-domain optical coherence tomography (TD and SD-OCT), Heidelberg Retina Tomograph (HRT II), and scanning laser polarimetry (GDx-VCC). Areas under the receiver operating characteristic curves (AROCs) for DDLS and diagnostic tests parameters were calculated. DDLS correlations (Spearman's rank) among these parameters were analyzed. Fifty-four eyes were healthy and 47 had glaucoma, including 16 preperimetric glaucoma. DDLS, vertical and horizontal C/D ratios had the largest AROCs (0.92, 0.94 and 0.91, respectively). DDLS diagnostic accuracy was better than the accuracies of HRT II parameters, TD and SD-OCT RNFL thicknesses, and SAP mean deviation (MD) index. There were no significant differences between the accuracies of the DDLS and the C/D ratios, TD-OCT vertical (0.89) and horizontal (0.86) C/D ratios, TD-OCT C/D area ratio (0.89), and GDx-VCC NFI (0.81). DDLS showed significant strong correlations with vertical (r = 0.79) and horizontal (0.74) C/D ratios, and with the parameters vertical C/D ratio and C/D area ratio from HRT II (both 0.77) and TD-OCT (0.75 and 0.72, respectively). DDLS had significant moderate correlations with most of the other structural measurements and SAP MD. The optic disc clinical evaluation with DDLS system and C/D ratio demonstrated excellent accuracy in distinguishing glaucomatous from healthy eyes. DDLS had moderate to strong correlations with most structural and functional parameters. These findings stress the importance of optic disc clinical examination to detect glaucoma in a clinical scenario.
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Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Abstract Objective We sought to compare the glaucoma discrimination ability of macular inner retinal layer (MIRL) thickness with that of conventional peripapillary retinal nerve fiber layer (pRNFL) ...thickness as measured by spectral-domain optical coherence tomography (SD-OCT) in patients with early glaucoma. Design Cross-sectional study. Participants We studied 67 patients with early glaucoma (visual field mean deviation index ≥-6 dB), and 56 healthy subjects were prospectively enrolled. Methods All patients underwent MIRL thickness measurement (ganglion cell complex GCC scan) and pRNFL thickness measurement (3.45 mm scan) by SD-OCT. Whenever both eyes were eligible, one was randomly selected. Receiver operating characteristic curves and sensitivities at fixed specificities were generated for different parameters. The areas under the receiver operating characteristic curves (AUCs) of each parameter were compared. Results The average mean deviation for the glaucomatous eyes was −2.5 ± 1.6 dB. The AUCs for average (0.815); superior (0.807); and inferior (0.788) MIRL thicknesses were not significantly different ( p ≥ 0.18). The AUCs for average (0.735); superior (0.728); and inferior (0.697) pRNFL thicknesses were also similar ( p ≥ 0.15). Average MIRL thickness had a significantly larger AUC compared to average pRNFL thickness analysis (0.815 vs 0.735; p = 0.03). Sensitivities at 80% specificity for average MIRL and pRNFL thicknesses were 66.7% (cutoff, 89.9 μm) and 62.9% (cutoff, 111.8 μm), respectively. Conclusions The GCC scan showed a similar or even a slightly better ability to discriminate between healthy and early glaucomatous eyes compared to the pRNFL scan. Different from previous analyses considering total macular thickness, the GCC macular scan seems to be a useful tool for identification of early structural damage in patients with glaucoma.
Purpose To establish a reference range for normal fetal eye volume (FEV) by three-dimensional ultrasound using Virtual Organ Computer-aided AnaLysis (VOCAL) method and compare the reproducibility ...between the two trace modes (manual and sphere). Methods This prospective, longitudinal observational study was performed at a single center and involved 71 eyes of 37 fetuses between 17 and 40 weeks of gestational age. Only pregnancies without fetal growth restriction, diabetes mellitus, hypertension, or major fetal malformation were included. Fetuses' eye measurements were obtained by a single observer during routine ultrasonographic examination. Results Mean FEV manual mode ranged from 309.5 ± 80.1 mm3 at 17-18 weeks to 2552.1 ± 384.9 mm3 at 39-40 weeks. Mean FEV sphere mode ranged from 394.8 ± 71.8 mm3 at 17-18 weeks to 2682.1 ± 343.4 mm3 at 39-40 weeks. Correlations ranged from R ² = 0.85 (transversal diameter and gestational age) to R ² = 0.91 (FEV sphere mode and gestational age). All correlations were statistically significant ( P < 0.001). Although highly correlated ( R ² = 0.97, P < 0.001), there was a fixed bias between manual and sphere measurements. The agreement between these measurements showed no proportional bias ( P = 0.89). Conclusions The present study establishes reference values for FEV using the VOCAL method manual mode. These normal growth parameters can be used in routine ultrasound assessment of the fetal eye, especially in families at risk of genetic diseases that affect ocular growth, such as congenital glaucoma.
In plastic surgery, a causal relationship between heavy smoking and flap necrosis has been shown. The deleterious effect of nicotine in random skin flaps in rats has also been proven, being related ...to vasoconstriction and possibly reactive oxygen species. This study aimed to verify the capacity of dimethyl sulfoxide, an antioxidant, to block the deleterious effect of nicotine in a random skin flap.
Fourteen adult male Wistar-EPM rats were distributed at random into two groups of seven animals. The nicotine group received this drug subcutaneously (1.2 mg/kg/day), for 1 week before flap elevation. The nicotine plus dimethyl sulfoxide group followed the same routine. Five minutes before the surgical procedure, rats in the nicotine group received distilled water orally and rats in the nicotine plus dimethyl sulfoxide group received dimethyl sulfoxide orally (2 ml/kg). Blood and skin tissue samples were collected to allow determination of malondialdehyde levels.
The nicotine group had a mean value of 40.2 percent and the nicotine plus dimethyl sulfoxide group had a mean value of 20.6 percent necrosis (p = 0.009). Malondialdehyde levels in both serum and skin samples were lower in the animals that received dimethyl sulfoxide.
The deleterious effect of nicotine was effectively blocked by dimethyl sulfoxide.
Os profissionais da área de saúde estão expostos a vários tipos de riscos ocupacionais, sendo o de maior impacto o risco biológico, devido ao contato direto com material orgânico potencialmente ...contaminado. A manutenção da situação vacinal atualizada é uma das ferramentas que devem ser empregadas neste contexto, além da adoção de medidas universais de biossegurança, sendo a educação fundamental neste processo. Avaliamos a situação vacinal e a percepção sobre risco biológico dos discentes da Faculdade de Medicina da UFJF em estudo observacional transversal (n = 136 alunos). Oitenta e nove alunos (65,4%) referiram estar com o cartão vacinal atualizado. Noventa e sete alunos (71,3%) receberam o esquema da hepatite B, e 99 (72,8%) o do tétano. Oitenta e seis 86 alunos (63,2%) declararam ter recebido orientação sobre imunização durante o curso. Setenta e três alunos (53,7%) já foram expostos a material potencialmente contaminado em suas atividades acadêmicas, e 97 deles (71,3%) usam equipamentos de proteção individual (EPI) nestas. Identificamos falhas na imunização (hepatite B e tétano), expondo os discentes a riscos desnecessários. A orientação relativa à imunização se mostrou insuficiente. A significativa taxa de exposição a risco biológico e o insatisfatório uso de EPIs verificados demandam maior atenção, a fim de prevenir acidentes.
Os profissionais da área de saúde estão expostos a vários tipos de riscos ocupacionais, sendo o de maior impacto o risco biológico, devido ao contato direto com material orgânico potencialmente ...contaminado. A manutenção da situação vacinal atualizada é uma das ferramentas que devem ser empregadas neste contexto, além da adoção de medidas universais de biossegurança, sendo a educação fundamental neste processo. Avaliamos a situação vacinal e a percepção sobre risco biológico dos discentes da Faculdade de Medicina da UFJF em estudo observacional transversal (n = 136 alunos). Oitenta e nove alunos (65,4%) referiram estar com o cartão vacinal atualizado. Noventa e sete alunos (71,3%) receberam o esquema da hepatite B, e 99 (72,8%) o do tétano. Oitenta e seis 86 alunos (63,2%) declararam ter recebido orientação sobre imunização durante o curso. Setenta e três alunos (53,7%) já foram expostos a material potencialmente contaminado em suas atividades acadêmicas, e 97 deles (71,3%) usam equipamentos de proteção individual (EPI) nestas. Identificamos falhas na imunização (hepatite B e tétano), expondo os discentes a riscos desnecessários. A orientação relativa à imunização se mostrou insuficiente. A significativa taxa de exposição a risco biológico e o insatisfatório uso de EPIs verificados demandam maior atenção, a fim de prevenir acidentes.
Health professionals are exposed to various occupational risks, with the greatest impact from biological hazards due to direct contact with potentially contaminated organic materials. Besides adopting universal biosafety measures, adequate immunization coverage must be achieved in this context, with educational initiatives playing a crucial role in the process. This was a cross-sectional observational study of undergraduates (n = 136) at the Medical School of the Federal University in Juiz de Fora to assess their immunization status and biological risk perceptions. Eighty-nine students (65.4%) reported a complete vaccination schedule. Ninety-seven (71.3%) had received full immunization against hepatitis B and 99 (72.8%) against tetanus. Eighty-six (63.2%) reported having received immunization advice during the course. Seventy-three (53.7%) had already been exposed to potentially contaminated material during their academic activities, and 97 (71.3%) used personal protective equipment (PPE) in these contexts. We identified missed immunization doses against hepatitis B and tetanus, a situation that exposes medical students to unnecessary risks. Immunization advice was insufficient. The significant rate of exposure to biological hazards and the unsatisfactory use of PPE call for greater attention to accident prevention.
Sustainable cropping systems can enhance the development of young coffee plants under drought conditions. The objective of this study was to evaluate the behavior of coffee plants grown under ...different cover crops, soil conditioners, and fertilizers to reduce the effects of water scarcity. The treatments were the association of soil cover management (Urochloa decumbens, polyethylene film, and bare soil), fertilizers (conventional and controlled release), and soil conditioners (coffee husk, agricultural gypsum, water-retaining polymer, organic compost, and control). The assessments carried out were the growth, physiology, and anatomy of coffee plants and soil moisture and resistance to penetration. A multivariate analysis of the results was performed. The coffee plants grown with soil cover (Urochloa decumbens) and organic conditioners (coffee husk and organic compost) had better agronomic performance and higher soil moisture.
The aim of this manuscript is to describe the first year of our experience using extracorporeal membrane oxygenation support.
Ten patients with severe refractory hypoxemia, two with associated severe ...cardiovascular failure, were supported using venous-venous extracorporeal membrane oxygenation (eight patients) or veno-arterial extracorporeal membrane oxygenation (two patients).
The median age of the patients was 31 yr (range 14–71 yr). Their median simplified acute physiological score three (SAPS3) was 94 (range 84–118), and they had a median expected mortality of 95% (range 87–99%). Community-acquired pneumonia was the most common diagnosis (50%), followed by P. jiroveci pneumonia in two patients with AIDS (20%). Six patients were transferred from other ICUs during extracorporeal membrane oxygenation support, three of whom were transferred between ICUs within the hospital (30%), two by ambulance (20%) and one by helicopter (10%). Only one patient (10%) was anticoagulated with heparin throughout extracorporeal membrane oxygenation support. Eighty percent of patients required continuous venous-venous hemofiltration. Three patients (30%) developed persistent hypoxemia, which was corrected using higher positive end-expiratory pressure, higher inspired oxygen fractions, recruitment maneuvers, and nitric oxide. The median time on extracorporeal membrane oxygenation support was five (range 3–32) days. The median length of the hospital stay was 31 (range 3-97) days. Four patients (40%) survived to 60 days, and they were free from renal replacement therapy and oxygen support.
The use of extracorporeal membrane oxygenation support in severely ill patients is possible in the presence of a structured team. Efforts must be made to recognize the necessity of extracorporeal respiratory support at an early stage and to prompt activation of the extracorporeal membrane oxygenation team.
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