RESUMEN
PURPOSE: This study aimed to verify the association between dental pain and severity of dental caries (caries morbidity stages) and the impact on oral health-related quality of life (OHRQoL) in preschool children. METHODS: A cross-sectional study with 199 children (2-5 years old) enrolled at preschools in Capão do Leão-RS, Brazil. The self-report of mothers of children with a history of dental pain in the last 6 months and perception of their child's OHRQoL (ECOHIS) were obtained through a structured questionnaire. This questionnaire also collected independent variables. Children's oral examination was performed using the CAST instrument to determine caries morbidity stage. Crude and adjusted Poisson regression analysis was performed. RESULTS: The prevalence of dental pain was 14.57%. The chance of the occurrence of dental pain was higher among children diagnosed in morbidity [Prevalence ratio-PR: 5.29 (95% confidence interval-95% CI 1.91-14.61); p = 0.001] and severe morbidity [RP = 6.12 (95 CI% 2.25-16.64); p < 0.001] stages. Children with dental pain presented higher scores in the total ECOHIS [rate ratio = 7.11 (95% CI 4.55-11.09); p < 0.001] and in all of the domains of this instrument. Furthermore, children with a history of dental trauma [PR = 2.41 (95% CI 1.15-5.04); p < 0.001] and those whose reason for last visit to the dental office was for restorative/endodontic/extraction treatment [PR = 1.29 (95% CI 1.01-6.19); p = 0.049] had a higher prevalence of dental pain. CONCLUSION: A substantial prevalence of dental pain in the last 6 months and negative impact on children's OHRQoL was identified in this sample. Children diagnosed with carious dentin lesions and abscess and fistula were more likely to have dental pain.
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Caries Dental , Salud Bucal , Calidad de Vida , Odontalgia , Humanos , Caries Dental/epidemiología , Caries Dental/complicaciones , Brasil/epidemiología , Preescolar , Estudios Transversales , Femenino , Masculino , Odontalgia/epidemiología , Prevalencia , Encuestas y Cuestionarios , Índice de Severidad de la EnfermedadRESUMEN
PURPOSE: This is the first study to adopt a multilevel approach to assess the impact of the order of dental visits on child's behaviour. The aim was to investigate which factors directly interfere with child's behaviour regardless of the order of sequential dental visits. METHODS: In this prospective longitudinal study, children aged 7-12 years were invited to participate. Child behaviour was assessed using the Frankl Scale during four sequential dental visits. Chi-square test was used to analyse the effect of dental fear on children's non-cooperative behaviour according to the presence of dental fear. Multilevel mixed logistic regression model was used to assess the association between predictor variables and the outcome (child behaviour) during the sequential dental visits. RESULTS: Overall, 111 children participated in this study. Maternal dental anxiety, dental pain and complexity of the treatment were associated with the non-cooperative behaviour in children aged 7-12 years. When stratified by dental fear, the complexity of the treatment remained associated with non-cooperative behaviour. CONCLUSIONS: The results provide evidence that, even with the familiarization of child with the dental environment, maternal dental anxiety, dental pain in the last month, and the complexity of dental treatment negatively affect the children's behaviour aged 7-12 years.
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Atención Dental para Niños , Niño , Conducta Infantil , Ansiedad al Tratamiento Odontológico , Humanos , Estudios Prospectivos , OdontalgiaRESUMEN
AIM: This retrospective study aimed to analyse demographic data and the severity of traumatic dental injuries (TDIs) to the primary dentition based on children's dental records at a university clinic. STUDY DESIGN: A cross-sectional retrospective study. METHODS: The records of all patients were analysed according to gender, age, aetiology, teeth involved, number of affected teeth, place of occurrence, witness to the trauma, time elapsed between trauma occurrence and care-seeking, type of trauma and severity of injury. RESULTS: A total of 576 children aged 8-89 months suffered injuries to 1,043 teeth. Severe injuries were the most prevalent (45.5%). These occurred at all ages, but their frequency was higher in children aged between 13 and 24 months. The prevalence of mild injury was higher when the cause was a fall from one's own height. No differences were detected in severity according to the place of occurrence and witnesses of the accident. The prevalence of severe injury was higher in cases where three or more teeth were involved. CONCLUSIONS: In this specialist treatment centre, severe injuries were the most common TDIs, which occurred in children aged 13-24 months, mainly due to falls and most occurred at home. Professionals must be prepared to deliver the best and most efficient care to this population.
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Diente Primario/lesiones , Accidentes por Caídas/estadística & datos numéricos , Accidentes Domésticos/estadística & datos numéricos , Accidentes de Tránsito/estadística & datos numéricos , Factores de Edad , Brasil/epidemiología , Niño , Preescolar , Estudios Transversales , Atención Odontológica/estadística & datos numéricos , Femenino , Humanos , Incisivo/lesiones , Lactante , Masculino , Prevalencia , Estudios Retrospectivos , Avulsión de Diente/epidemiología , Corona del Diente/lesiones , Fracturas de los Dientes/epidemiología , Raíz del Diente/lesionesRESUMEN
The spittlebug Mahanarva fimbriolata (Stål) (Hemiptera: Cercopidae) is one of the most important pests of the sugarcane crop in Brazil. Despite of its importance, there is currently a lack of information regarding sugarcane cultivars' resistance to the spittlebug. Therefore, our objective was to evaluate the response of sugarcane genotypes to this species. Two experiments were carried out under laboratory conditions using a random block design with treatments in a factorial arrangement of 2 × 13 (experiment 1) and 2 × 12 (experiment 2), with six replicates. The first factor included two levels of infestation (infested and noninfested plants with spittlebugs), while the second consisted of the cultivars. Nymph survival varied from 47.9 to 84.5%, indicating that there are different levels of antibiosis to M. fimbriolata among the tested cultivars. The highest degree of antibiosis was found in cultivars IACSP96-7586 and IACSP96-2008, in which nymph survival was close to 48%. IACSP96-7586 also presented some degree of tolerance, but IACSP96-7569 and IACSP97-6682 stood out as the most tolerant cultivars to the pest, showing the lowest reduction in weight of aboveground biomass. On average, spittlebug infestations caused a significant reduction in relative leaf chlorophyll content and aboveground biomass weight.
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Hemípteros , Saccharum , Animales , Antibiosis , Biomasa , Brasil , Clorofila , Genotipo , Ninfa , Saccharum/genética , Saccharum/fisiologíaRESUMEN
Este trabalho teve como objetivo verificar junto à comunidade do bairro dos Tenentes (Extrema, MG) como é feito o tratamento de doenças a partir do uso de plantas medicinais, bem como identificar e relacionar as plantas utilizadas com a literatura científica. Para tanto, foram realizadas entrevistas e coletas de plantas utilizadas na medicina popular local as quais, após processo de herborização e identificação, foram comparadas com informações disponíveis em literatura especializada. Foram identificadas 71 espécies, pertencentes a 33 famílias botânicas, sendo Asteraceae e Lamiaceae as mais expressivas. As folhas e ramos (88 por cento) foram as partes mais utilizadas e a forma de preparo mais freqüente foi a infusão (67 por cento). As plantas foram indicadas principalmente para o tratamento de males associados ao aparelho digestório (23 espécies), respiratório (16), excretor (10), nervoso (6), circulatório (5), endócrino (4), reprodutor feminino (2), e ainda como cicatrizante (7), antiinflamatório (4) e para dores no corpo (5).
This study aimed to verify with the community of Tenentes District (Extrema Municipality, Minas Gerais State, Brazil) how diseases are treated by using medicinal plants, as well as to identify and relate the used plants to the scientific literature. Thus, interviews were done and plants used in the local folk medicine were collected; after the herborization process and identification, the obtained data were compared with information available in the literature. Seventy-one species were identified; they belonged to 33 botanical families, of which Asteraceae and Lamiaceae were most expressive. Leaves and branches (88 percent) were the most used part and the most frequent form of preparation was infusion (67 percent). The plants were indicated especially for the treatment of illness associated with digestive (23 species), respiratory (16), excretory (10), nervous (6), circulatory (5), endocrine (4) and woman reproductive systems (2), as healing (7), anti-inflammatory (4), and for general body aches (5).
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Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Brasil/etnología , Plantas Medicinales , Etnobotánica/clasificación , Etnobotánica/estadística & datos numéricos , Encuestas y Cuestionarios , Población RuralRESUMEN
PURPOSE: To evaluate the influence of pupil dilation on retinal nerve fibre layer (RNFL) measurements with spectral domain optical coherence tomography (OCT). PATIENTS AND METHODS: In total, 29 healthy individuals and 26 glaucoma patients underwent RNFL measurements with the Cirrus HD-OCT Model 4000 (Carl Zeiss Meditec Inc.) before and 30-40 min after pupil dilation with one drop of tropicamide 1%. Average thickness, quadrant thickness, and clock-hour thickness measurements were compared with the paired Student's t-test. We also compared the quality scores of the images obtained pre- and post-pupil dilation. RESULTS: Mean ages in the glaucoma and control groups were 58.3+/-13.4 and 41.6+/-16.4 years respectively (P<0.001). Mean deviation values were -6.96+6.31 dB in the glaucoma group and -1.26+0.79 dB in the control group (P<0.001). Mean RNFL measurements obtained in the glaucoma group were significantly lower than those obtained in the control group (P<0.001). There were no statistically significant differences between mean quality scores obtained before and after dilation neither in the glaucoma group (7.73+/-0.92 vs 7.54+/-1.10, P=0.232) nor in the control group (8.14+/-0.88 vs 8.00+/-0.71, P=0.380). There was no statistically significant difference between mean RNFL measurements obtained pre- and post-pupil dilation neither among normal individuals (P>0.05), nor among glaucoma patients (P>0.05). CONCLUSION: The results of this study indicate that RNFL measurements obtained with spectral domain OCT are not influenced by pupil size.
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Fibras Nerviosas/patología , Disco Óptico/patología , Pupila/fisiología , Tomografía de Coherencia Óptica/métodos , Adulto , Anciano , Estudios de Casos y Controles , Femenino , Glaucoma/patología , Humanos , Masculino , Persona de Mediana Edad , Disco Óptico/anatomía & histologíaRESUMEN
Although intraocular pressure (IOP) is considered the main risk factor for the development of glaucoma and the only parameter subject to treatment, there is sufficient evidence to suggest that glaucoma may continue to progress despite lowering patients' IOP to targeted levels. Several studies have implicated vascular risk factors in the pathogenesis of glaucoma. Among them, blood pressure (BP) and ocular perfusion pressure have become increasingly important. Although clinicians cannot currently visualise ocular blood flow directly, they can easily measure glaucoma patients' BP and IOP to calculate their ocular perfusion pressure and quantify the vascular changes. The purpose of this review article is to discuss the relationship between BP and IOP, BP and glaucoma, and perfusion pressure and glaucoma. We discuss the importance of autoregulation to maintain the adequate perfusion of the optic nerve head, and suggest that ocular perfusion pressure and its fluctuation may be parameters that need to be measured in glaucoma patients.
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Presión Sanguínea/fisiología , Glaucoma/fisiopatología , Glaucoma/etiología , Humanos , Hipertensión/complicaciones , Hipotensión/complicaciones , Presión Intraocular/fisiologíaRESUMEN
AIMS: To compare the IOP measurements obtained with dynamic contour tonometry (DCT) and Goldmann applanation tonometry (GAT), and to analyse the influence of central corneal thickness (CCT) and age on both measurements, and the influence of the quality score on DCT readings. METHODS: A total of 500 healthy subjects with no prior history of glaucoma or ocular hypertension (age: 7-86 years) were consecutively recruited. GAT, DCT, and CCT measurements were obtained from both eyes of each individual, in this order, by three observers. The mean of five CCT measurements was used for analysis. DCT measurements were accepted when quality scores varied between 1 (higher quality) and 3 (lower quality). RESULTS: Mean DCT measurements were 3.2 mmHg higher than GAT readings. CCT values varied between 449 and 653 microm. IOP measured by GAT correlated strongly with CCT (r(2)=0.28, P=<0.001), whereas DCT readings correlated poorly with CCT (r(2)=0.01, P=0.017). Both DCT (r(2)=<0.01, P=0.044) and GAT (r(2)=0.01, P=<0.001) measurements correlated poorly with age. Bland-Altmann analysis revealed disagreement between DCT and GAT readings, with 95% confidence intervals of +/-6.7 mmHg. Quality scores for DCT measurements were 1 (n=369, 36.9%), 2 (n=340, 34.0%), and 3 (n=291, 29.1%). DCT readings with quality score of 3 (18.8+/-3.4 mmHg) were significantly higher than those with quality scores of 1 (16.7+/-2.9 mmHg) and 2 (17.4+/-2.9 mmHg; P=<0.001). CONCLUSIONS: DCT is not influenced by CCT, unlike GAT. Both DCT and GAT measurements are not influenced by age. DCT measurements with lower quality scores are associated with higher readings.
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Córnea/patología , Presión Intraocular/fisiología , Tonometría Ocular/métodos , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Niño , Estudios Transversales , Femenino , Glaucoma/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Hipertensión Ocular/fisiopatología , Estudios Prospectivos , Tonometría Ocular/normas , Adulto JovenRESUMEN
AIM: To measure the central corneal thickness (CCT) of children with congenital cataract and surgical aphakia. METHODS: Children with congenital cataract or surgical aphakia were prospectively recruited and divided into four groups: unilateral cataract (group 1, n = 14), bilateral cataract (group 2, n = 17), unilateral aphakia (group 3, n = 32) and bilateral aphakia (group 4, n = 44). An age-, sex-, and race-matched control group of normal individuals was selected. Ultrasonic pachymetry was performed by the same observer. RESULTS: The mean CCT of the control group was not significantly different from the normal (p = 0.747) and cataractous eyes of group 1 (p = 0.252). The mean CCTs of both eyes of group 2 were significantly higher than the control group (p<0.01). The mean CCT of the aphakic eyes in group 3 was significantly higher than the contralateral healthy eyes and control eyes (p<0.001). The mean CCTs of both eyes of group 4 were significantly higher than the control group (p<0.001). The mean CCT was significantly higher in aphakic eyes of groups 3 and 4 than in cataractous eyes of groups 1 and 2 (p<0.001). CONCLUSIONS: Aphakic eyes due to congenital cataract show thicker corneas than normal phakic eyes. Aphakic eyes after congenital cataract extraction show thicker corneas than eyes with congenital cataracts, suggesting that the increase in CCT occurs postoperatively.
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Afaquia/diagnóstico por imagen , Catarata/congénito , Catarata/diagnóstico por imagen , Córnea/diagnóstico por imagen , Adolescente , Estudios de Casos y Controles , Extracción de Catarata , Distribución de Chi-Cuadrado , Niño , Preescolar , Estudios Transversales , Femenino , Humanos , Lactante , Masculino , Periodo Posoperatorio , Estudios Prospectivos , UltrasonografíaRESUMEN
PURPOSE: To evaluate the effects of topical latanoprost, travoprost, and bimatoprost on the blood-aqueous barrier and central corneal thickness (CCT) of patients with primary open-angle glaucoma (POAG) and ocular hypertension (OHT). DESIGN: Prospective, randomized, masked-observer, crossover clinical trial. METHODS: A total of 34 phakic patients with POAG or OHT with no previous history of intraocular surgery or uveitis completed the study. Patients were randomized to use latanoprost 0.005%, travoprost 0.004%, or bimatoprost 0.03% once daily (2000 hours) for 1 month, followed by a washout period of 4 weeks between each drug. Aqueous flare was measured with a laser flare metre. CCT was calculated as the average of five measurements using ultrasound pachymetry. All measurements were performed by a masked observer (1000 h). RESULTS: There were no statistically significant differences between baseline mean IOP, mean CCT, and mean flare values among the groups. There was no statistically significant increase in mean flare values from baseline in all groups (P>0.05). There were no statistically significant differences between mean flare values among the groups (P>0.05). All medications significantly reduced the mean IOP from baseline (P<0.0001). IOP reduction obtained with travoprost (7.3+/-3.8 mmHg) was significantly higher than that obtained with latanoprost (4.7+/-4.2 mmHg) (P=0.01). A statistically significant reduction in mean CCT (0.6+/-1.3%) from baseline was observed when patients instilled bimatoprost (P=0.01). CONCLUSIONS: Latanoprost, travoprost, and bimatoprost had no statistically significant effect on the blood-aqueous barrier of phakic patients with POAG or OHT. Bimatoprost may be associated with a clinically irrelevant reduction in mean CCT.
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Antihipertensivos/farmacología , Barrera Hematoacuosa/efectos de los fármacos , Hipertensión Ocular/fisiopatología , Prostaglandinas F Sintéticas/farmacología , Adulto , Anciano , Amidas/efectos adversos , Amidas/farmacología , Antihipertensivos/efectos adversos , Humor Acuoso/efectos de los fármacos , Bimatoprost , Cloprostenol/efectos adversos , Cloprostenol/análogos & derivados , Cloprostenol/farmacología , Métodos Epidemiológicos , Femenino , Glaucoma de Ángulo Abierto/tratamiento farmacológico , Glaucoma de Ángulo Abierto/patología , Glaucoma de Ángulo Abierto/fisiopatología , Humanos , Presión Intraocular/efectos de los fármacos , Latanoprost , Masculino , Persona de Mediana Edad , Hipertensión Ocular/tratamiento farmacológico , Hipertensión Ocular/patología , Prostaglandinas F Sintéticas/efectos adversos , TravoprostRESUMEN
PURPOSE: To evaluate the long-term intraocular pressure (IOP) control of eyes that developed an encapsulated bleb (EB) following trabeculectomy. METHODS: Between 1994 and 1995, 25 eyes developed EBs and were randomized to medical treatment or needling without adjunct antimetabolites. Among the 25 patients who developed an EB, 21 were followed for at least 6 months. A control group of 21 consecutive eyes, which underwent trabeculectomy during the same period and that did not develop EBs was retrospectively selected. Success was defined as IOP <21 mmHg with or without medications. Kaplan-Meier survival analysis was performed to compare the groups. RESULTS: Among the 21 eyes that developed EBs, 12 (57%) had undergone transconjunctival needling and nine (43%) had received medical treatment. Mean follow-ups were 30.0 +/- 14.0 months, 33.3 +/- 18.5 months, and 37.4 +/- 2.6 months for the needling, medical treatment, and control groups, respectively (P = 0.19). Kaplan-Meier survival curves demonstrated that the control group showed a significantly lower chance of failure than both the needling and the medical treatment groups (P < 0.0001). CONCLUSION: Encapsulated blebs may be associated with an increased risk for surgical failure.
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Vesícula/etiología , Vesícula/terapia , Presión Intraocular , Trabeculectomía/efectos adversos , Anciano , Anciano de 80 o más Años , Antimetabolitos/uso terapéutico , Vesícula/fisiopatología , Métodos Epidemiológicos , Femenino , Glaucoma/cirugía , Humanos , Masculino , Persona de Mediana Edad , Agujas , Insuficiencia del Tratamiento , Resultado del TratamientoRESUMEN
PURPOSE: To test the ability of structural parameters (as measured by scanning laser polarimetry (SLP) software 1.0.12 and confocal scanning laser ophthalmoscopy (CSLO) to discriminate between normal and glaucomatous eyes. METHODS: A total of 112 patients with primary open-angle glaucoma and 88 normal individuals were enrolled in the study. All individuals underwent a thorough ophthalmic evaluation, a 24-2 full threshold Humphrey visual field, SLP with the GDx, and CSLO with the TOPSS. Patients with marked cataract or low vision were excluded from the study. Cut-off points were selected and receiver operator characteristic (ROC) curves were created for each individual CSLO and SLP parameter. Finally, multivariate dicriminant formulas were developed in order to achieve a better sensitivity (Se)/specificity (Sp) ratio for the diagnosis of glaucoma, initially separately for each device, and then combining parameters from CSLO and SLP. RESULTS: The mean deviation for the glaucoma group was -10.63 +/- 7.58 dB. Multivariate discriminant formulas resulted in better sensitivity/specificity ratios than any individual parameter, either for CSLO (Se: 90%; Sp: 81%; accuracy: 86%) or SLP (Se: 87%; Sp: 86%; accuracy: 86%). The multivariate formula combining parameters from both devices resulted in an improvement in the ability to diagnose glaucoma. An area under the ROC curve of 0.97 was obtained, with a sensitivity of 93%, a specificity of 91%, and an accuracy of 92%. CONCLUSIONS: The combination of structural parameters derived from CSLO and SLP in a multivariate discriminant formula may enhance the ability to diagnose glaucoma. Further studies investigating a random population are needed in order to test the validity of this formula.
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Glaucoma de Ángulo Abierto/diagnóstico , Oftalmoscopía/métodos , Disco Óptico/patología , Enfermedades del Nervio Óptico/diagnóstico , Análisis Discriminante , Femenino , Humanos , Masculino , Microscopía Confocal , Persona de Mediana Edad , Análisis Multivariante , Curva ROC , Reproducibilidad de los Resultados , Campos VisualesRESUMEN
OBJECTIVE: To verify whether intraoperative mitomycin C (MMC) without conjunctival and Tenon's touch is effective in inhibiting the development of thin, avascular blebs in eyes undergoing primary trabeculectomy. DESIGN: Noncomparative, interventional study. PARTICIPANTS: Fifteen eyes of 15 consecutive patients undergoing primary trabeculectomy. INTERVENTION: All eyes underwent trabeculectomy with intraoperative MMC (0.25 mg/ml for 3 minutes) without either conjunctival or Tenon's touch. Patients were examined 1 month, 3 months, 6 months, and 12 months after surgery. Intraocular pressure (IOP) and number of medications were evaluated at each examination. The appearance of the bleb was classified at the last examination into one of three groups: flat and vascularized; elevated but not avascular; or elevated, thin, and avascular. MAIN OUTCOME MEASURES: Intraocular pressure, number of antiglaucoma medications, and appearance of the bleb. RESULTS: Preoperative mean IOP was 30.57 +/- 10.92 mmHG: Statistically significant IOP reductions were observed 1 month, 3 months, 6 months, and 1 year after surgery (P < 0.01). Twelve months after surgery, the mean IOP was 14.92 +/- 6.53 mmHG: Five eyes (33.3%) showed an IOP less than 15 mmHg without antiglaucoma medication at the 12-month examination. The bleb was considered elevated, thin, and avascular in 12 of 15 eyes (80%) at the end of follow-up. CONCLUSIONS: Intraoperative MMC at 0.25 mg/ml for 3 minutes without either conjunctival or Tenon's touch was not effective in eliminating the development of thin, avascular blebs in eyes undergoing primary trabeculectomy.
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Conjuntiva , Tejido Conectivo , Glaucoma de Ángulo Cerrado/cirugía , Glaucoma de Ángulo Abierto/cirugía , Mitomicina/uso terapéutico , Complicaciones Posoperatorias/prevención & control , Trabeculectomía/métodos , Conjuntiva/anatomía & histología , Tejido Conectivo/anatomía & histología , Femenino , Humanos , Presión Intraocular , Cuidados Intraoperatorios/métodos , Masculino , Persona de Mediana Edad , Soluciones Oftálmicas , Colgajos Quirúrgicos , Resultado del Tratamiento , Agudeza Visual , Cicatrización de Heridas/efectos de los fármacosRESUMEN
AIM: To evaluate the ability of structural parameters (as determined by retinal nerve fibre layer (RNFL) measurements obtained with the scanning laser polarimeter (SLP-NFA/GDx)) and functional parameters (as determined by automated perimetry) to discriminate between normal and glaucomatous eyes. METHODS: In a case-control study, a total of 91 normal subjects and 94 patients with glaucoma underwent automated perimetry and RNFL measurements obtained with the SLP. Three independent scans of each eye were obtained and a mean image was created and used for further analysis. Only one eye per individual was randomly included in the study. The sensitivity (Se) and specificity (Sp) of 12 RNFL parameters were calculated according to the SLP internal normative database. The Se and Sp of the visual field (VF) global indices and the glaucoma hemifield test (GHT) were also calculated according to the instrument's normative database. Receiver operator characteristic (ROC) curves were built for each SLP parameter and VF index. Fisher's linear discriminant formulas (LDFs) were developed for VF indices (VF LDF), SLP measurements (SLP LDF), and both examinations (combined LDF). RESULTS: According to the SLP internal database, the parameters with better Se and Sp were: superior/nasal ratio (Se = 58.5%; Sp = 86.8%), and GDx the number (Se = 43.3%; Sp = 96.7%). The construction of an ROC curve for the number resulted in Se = 84% and Sp = 79%. The creation of LDFs improved both the sensitivities and specificities when compared with isolated parameters SLP LDF (Se = 90.4%; Sp = 82.4%), VF LDF (Se = 89.4%; Sp = 89.0%), and combined LDF (Se = 93.0%; Sp = 90.1%). The sensitivity to diagnose early and moderate glaucomatous damage observed with the GHT was lower than that obtained with the number (p < 0.01). CONCLUSIONS: Creation of LDFs enhanced the Se and Sp for both VF and SLP. Integration of SLP and VF in a combined LDF reached the highest Se/Sp relation, suggesting that these examinations may be additive concerning the diagnosis of glaucoma. The SLP parameter the number may be more sensitive than the GHT in diagnosing early and moderate glaucomatous damage.
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Glaucoma de Ángulo Abierto/diagnóstico , Retina/patología , Pruebas del Campo Visual/métodos , Adulto , Anciano , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Microscopía Confocal , Persona de Mediana Edad , Curva ROC , Valores de Referencia , Sensibilidad y EspecificidadRESUMEN
OBJECTIVE: To analyze the effects of carotid endarterectomy on the retrobulbar circulation of patients with severe occlusive carotid artery disease (OCAD) by means of color Doppler imaging (CDI). DESIGN: Prospective. PARTICIPANTS: A total of 17 consecutive patients with severe OCAD and neurologic symptoms (with a history of transitory ischemic attack or cerebral vascular accident) participated. INTERVENTION: All 17 patients underwent carotid endarterectomy. The CDI of both orbits was performed by one masked investigator before surgery and at 1 week and 1 month after surgery. MAIN OUTCOME MEASURES: Peak systolic velocity, end diastolic velocity, and resistive index of the ophthalmic, central retinal, and temporal short posterior ciliary arteries were measured. The authors compared the hemodynamic parameters at all intervals. RESULTS: Peak systolic and end diastolic velocities in the ophthalmic, central retinal, and temporal short posterior ciliary arteries increased significantly 1 week and 1 month after carotid endarterectomy (P < 0.05). After surgery, the resistive indices in the central retinal and temporal short posterior ciliary arteries decreased significantly at both intervals (P < 0.05). The six patients who had reversed ophthalmic artery flow before surgery showed forward ophthalmic artery flow after carotid endarterectomy. The contralateral orbits showed no significant hemodynamic change after endarterectomy (P < 0.05). CONCLUSIONS: Hemodynamic changes in patients with severe OCAD undergoing carotid endarterectomy suggest improvement in the ipsilateral retrobulbar blood flow.
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Arteriopatías Oclusivas/fisiopatología , Enfermedades de las Arterias Carótidas/fisiopatología , Endarterectomía Carotidea , Ojo/irrigación sanguínea , Ultrasonografía Doppler en Color , Anciano , Anciano de 80 o más Años , Arteriopatías Oclusivas/cirugía , Circulación Sanguínea , Velocidad del Flujo Sanguíneo , Enfermedades de las Arterias Carótidas/cirugía , Arteria Carótida Interna/fisiopatología , Arteria Carótida Interna/cirugía , Arterias Ciliares/diagnóstico por imagen , Arterias Ciliares/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Arteria Oftálmica/diagnóstico por imagen , Arteria Oftálmica/fisiopatología , Estudios Prospectivos , Arteria Retiniana/diagnóstico por imagen , Arteria Retiniana/fisiopatologíaRESUMEN
PURPOSE: To analyze the results of an educational program applied to glaucoma patients; to serve as a guideline for a definitive educational program to be developed at the Glaucoma Service of the University of Campinas. METHODS: Fifty glaucoma patients were given information about the disease and its treatment by an experienced nurse and answered the same questionnaire before and 2.7 months after the initial explanation. The technique of eyedrop instillation was compared before and after the educational program. RESULTS: There was no significant improvement concerning the knowledge of the identification of the ocular disease, the side effects, the meaning of glaucoma, the importance of treatment, the purpose of medications and the normal value of intraocular pressure. There was a significant improvement in all steps of eyedrop instillation (p < 0.01) and in knowledge regarding the importance of heredity (p < 0.001) and the purpose of perimetry (p=0.033). CONCLUSION: Although a significant improvement was observed in the technique of eyedrop instillation, the authors conclude that this plan was not complete enough for its contents fully to be understood. These findings may be secondary to the vertical teaching-learning process, which is inappropriate for the patient, and to the difficulty in comprehending the information, which is associated with low cultural and instruction levels, and to psychosocial factors related to their disease.
Asunto(s)
Glaucoma , Educación en Salud , Evaluación de Programas y Proyectos de Salud , Adolescente , Adulto , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
OBJECTIVE: This study aimed to evaluate the retrobulbar circulatory effects of reversed ophthalmic artery flow (ROAF) on the ophthalmic artery branches by means of color Doppler imaging. DESIGN: The design was a case-controlled study. PARTICIPANTS: Among 56 consecutive patients with severe (>70% stenosis) occlusive carotid artery disease, 15 patients (26.8%) with ROAF were identified. The control group consisted of 15 patients with similar degrees of carotid artery stenosis and forward ophthalmic artery flow. INTERVENTION: Arteriography and measurement of the retrobulbar hemodynamic parameters with color Doppler imaging were performed. MAIN OUTCOME MEASURES: Blood flow velocities and resistive index in the ophthalmic, central retinal, and temporal short posterior ciliary arteries were measured. RESULTS: Arteriography confirmed the diagnosis of ROAF in all 15 patients. There was no patient with ROAF diagnosed by arteriography and not diagnosed by color Doppler imaging. The frequency of bilateral severe occlusive carotid artery disease was significantly higher in the ROAF group (40%) compared to the control group (6.6%) (P = 0.04). Patients with ROAF showed significantly reduced vascular resistance in the ophthalmic artery (P = 0.03), higher vascular resistance, and lower blood flow velocities in the central retinal and temporal short posterior ciliary arteries (P < 0.05). CONCLUSION: This study suggests that patients with ROAF show a steal phenomenon, characterized by a shunt to the low-resistance intracranial circuit and reduction of retrobulbar blood flow.
Asunto(s)
Arteria Carótida Interna/fisiopatología , Estenosis Carotídea/fisiopatología , Circulación Colateral , Arteria Oftálmica/fisiopatología , Ultrasonografía Doppler en Color , Anciano , Velocidad del Flujo Sanguíneo , Estudios de Casos y Controles , Arterias Ciliares/diagnóstico por imagen , Arterias Ciliares/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Arteria Oftálmica/diagnóstico por imagen , Arteria Retiniana/diagnóstico por imagen , Arteria Retiniana/fisiopatologíaRESUMEN
Since dengue fever has only recently appeared in the city of Marília, São Paulo, State, Brazil, and no fatal cases of the disease have yet to occur, dengue prevention is not a local priority. A dengue prevention program in one neighborhood made the tires, cans and bottles where mosquitoes breed its focus, and conducted an ethnography of refuse, including local classification of materials as useful or disposable in preparation for and educational intervention. The initial assumption was that patterns of refuse disposal are and individual choice, influenced by relatively static cultural definitions of what constitutes refuse. This gave way over the course of the project to a new, more dynamic and contextualized view, allowing for the influence of a system of selective refuse collection with participation of both householders and informal refuse collectors. The implications of the findings for programs to control other emerging infectious diseases are discussed.
Asunto(s)
Masculino , Femenino , Humanos , Dengue Grave/epidemiología , Dengue Grave/inmunología , Dengue Grave/microbiología , Dengue Grave/sangre , Dengue Grave/transmisión , Dengue Grave/virologíaRESUMEN
OBJECTIVE: The purpose of the study was to evaluate the ophthalmologic findings and to analyze the retrobulbar hemodynamics of patients with severe (greater than 70% stenosis) occlusive carotid artery disease (OCAD) by means of color Doppler imaging (CDI). DESIGN: A case-controlled study. PARTICIPANTS: Fifty-six consecutive patients with severe OCAD and an age- and sex-matched control group consisting of 56 healthy patients without OCAD were studied. INTERVENTION: All 112 patients underwent a complete ophthalmologic examination. Color Doppler imaging of both orbits was performed by one masked investigator. MAIN OUTCOME MEASURES: Peak systolic velocity, end diastolic velocity, and the resistive index of the ophthalmic, central retinal, and temporal short posterior ciliary arteries were measured. The authors compared the hemodynamic parameters measured in patients with severe OCAD with those obtained in the control group. The hemodynamic parameters of patients with asymmetric OCAD (stenosis > 70% in one internal carotid artery and stenosis < 50% in the contralateral artery) were also compared. In an attempt to determine risk factors associated with the ocular ischemic syndrome (OIS), the authors compared patients with severe OCAD and OIS with patients with severe OCAD without OIS. RESULTS: Peak systolic and end diastolic velocities in the ophthalmic, central retinal, and temporal short posterior ciliary arteries were significantly lower in patients with severe OCAD (P < 0.01). The mean resistive indices in the central retinal and temporal short posterior ciliary arteries were higher in the group with severe OCAD (P < 0.01). Similar results were obtained in the analysis of 25 patients with asymmetric carotid stenosis. Younger age (P = 0.012), severe bilateral OCAD (P = 0.01), high-grade carotid stenosis (P = 0.013), and reversed ophthalmic artery flow (P = 0.038) were significant risk factors for OIS. CONCLUSIONS: Patients with severe OCAD show hemodynamic changes that suggest reduced retrobulbar blood flow. Patients with severe bilateral OCAD, high-grade carotid stenosis, and reversed ophthalmic artery flow may have a greater risk of developing OIS.
Asunto(s)
Arteriopatías Oclusivas/fisiopatología , Enfermedades de las Arterias Carótidas/fisiopatología , Arterias Ciliares/fisiología , Arteria Oftálmica/fisiología , Arteria Retiniana/fisiología , Anciano , Arteriopatías Oclusivas/diagnóstico por imagen , Velocidad del Flujo Sanguíneo/fisiología , Enfermedades de las Arterias Carótidas/diagnóstico por imagen , Estudios de Casos y Controles , Arterias Ciliares/diagnóstico por imagen , Femenino , Humanos , Isquemia/diagnóstico por imagen , Isquemia/fisiopatología , Masculino , Persona de Mediana Edad , Arteria Oftálmica/diagnóstico por imagen , Estudios Prospectivos , Flujo Sanguíneo Regional , Arteria Retiniana/diagnóstico por imagen , Síndrome , Ultrasonografía Doppler en ColorRESUMEN
Color Doppler imaging allows simultaneous bidimensional imaging and Doppler evaluation of blood flow in orbital vessels. We report 4 cases in which color Doppler imaging was used to diagnose and monitor carotid cavernous fistulas. In all cases, color Doppler imaging demonstrated dilated, arterialized superior ophthalmic veins; these findings were confirmed by angiography. Two patients underwent embolization with complete regression of the clinical findings. After embolization, color Doppler imaging revealed normal, laminar flow in the superior ophthalmic vein. This noninvasive technique represents a safe and fast method that is useful in the diagnosis and post-treatment follow-up of carotid cavernous fistulas.