RESUMO
ABSTRACT Purpose: To evaluate the stability and efficacy of the double-flanged 5-0 polypropylene suture to fixate subluxated cataracts at 18 months and the possible complications of this new technique Methods: This technique uses a 5-0 polypropylene monofilament to create two flanges with a thermocautery, for fixation of a capsular tension segment to the sclera to fix the subluxated capsular bag. This technique was implemented in 17 eyes requiring intraocular lens implantation in a setting of zonular dialysis due to trauma, Marfan syndrome, microspherophakia, idiopathic disease, and post-phacoemulsification status. Results: Follow-up of the patients occurred at 18 months. Best-corrected visual acuity improved significantly from 0.85 to 0.39 (logMAR), whereas the spherical and cylindrical refractive errors and intraocular pressure remained stable from preoperation. No suture photodegradation or pseudophacodonesis were detected. Conclusion: The double-flanged 5-0 polypropylene suture transscleral bag fixation technique has shown favorable long-term outcomes in terms of bag intraocular lens/complex fixation and stability. In eyes with zonular weakness or dialysis, this technique appears to be a safe and knotless option for cataract surgery.
RESUMO Objetivo: Avaliar a estabilidade e eficácia da técnica double-flanged com sutura de 5-0 polipropileno para fixação de cataratas subluxadas aos 18 meses e as possíveis complicações desta nova técnica. Métodos: Esta técnica utiliza um monofilamento de polipropileno 5-0 para criar dois flanges com um termocautério para fixar um Segmento de Tensão Capsular na esclera a fim de estabilizar o saco capsular subluxado. Esta técnica foi implementada em 17 olhos que necessitavam do implante de lente intraocular em casos de diálise zonular devido a trauma, síndrome de Marfan, microesferofacia, subluxação idiopática ou pós-facoemulsificação que provocou subulxação do saco capsular intraoperatória. Resultados: O seguimento dos pacientes foi de 18 meses. A acuidade visual corrigida melhorou significativamente de 0,85 para 0,39 (logMAR), enquanto os erros de refração esféricos e cilíndricos e a pressão intraocular permaneceram estáveis. Nenhuma fotodegradação de sutura ou pseudofacodonese foi encontrada. Conclusão: A técnica double-flanged para fixação transescleral de saco capsular com sutura de 5-0 polipropileno mostrou resultados de estabilidade de longo prazo para o complexo lente/saco capsular. Então, aparenta ser uma opção segura para cirurgia de catarata, sem necessidade pontos, em olhos com fraqueza zonular ou diálise.
RESUMO
PURPOSE: To evaluate the stability and efficacy of the double-flanged 5-0 polypropylene suture to fixate subluxated cataracts at 18 months and the possible complications of this new technique. METHODS: This technique uses a 5-0 polypropylene monofilament to create two flanges with a thermocautery, for fixation of a capsular tension segment to the sclera to fix the subluxated capsular bag. This technique was implemented in 17 eyes requiring intraocular lens implantation in a setting of zonular dialysis due to trauma, Marfan syndrome, microspherophakia, idiopathic disease, and post-phacoemulsification status. RESULTS: Follow-up of the patients occurred at 18 months. Best-corrected visual acuity improved significantly from 0.85 to 0.39 (logMAR), whereas the spherical and cylindrical refractive errors and intraocular pressure remained stable from preoperation. No suture photodegradation or pseudophacodonesis were detected. CONCLUSION: The double-flanged 5-0 polypropylene suture transscleral bag fixation technique has shown favorable long-term outcomes in terms of bag intraocular lens/complex fixation and stability. In eyes with zonular weakness or dialysis, this technique appears to be a safe and knotless option for cataract surgery.
Assuntos
Extração de Catarata , Catarata , Cápsula do Cristalino , Lentes Intraoculares , Humanos , Polipropilenos , Cápsula do Cristalino/cirurgia , Extração de Catarata/efeitos adversos , Lentes Intraoculares/efeitos adversos , Esclera/cirurgia , Técnicas de Sutura/efeitos adversos , Estudos RetrospectivosRESUMO
A leishmaniose visceral canina, zoonose de grande importância para a saúde pública, é uma enfermidade crônica que resulta em sinais clínicos variados, dificultando seu diagnóstico. O diagnóstico definitivo da doença em cães baseia-se nos sinais clínicos associados à exames parasitológicos que, além de serem rápidos, possuem alta especificidade. Objetivou-se relatar a detecção de formas amastigotas de Leishmaniaspp. por meio de citologia de nódulos dérmicos de um cão com ausência de formas amastigotas, ao exame parasitológico, em amostras de medula óssea, linfonodos poplíteos e cervicais superficial direito e esquerdo. Uma cadela, poodle, de dez anos, com histórico de problemas dermatológicos e surgimento de nódulos dérmicos nas regiões dorsal e interdigital há cerca de dois anos foi avaliada. Ao exame físico observou-se alopecia discreta e difusa na região dorsal, com descamação. Era possível se observar nódulos com cerca de 3-5 cm de diâmetro, bem delimitados, sólidos e com aspecto inflamado nas regiões dorsal e interdigital; o animal também apresentava onicogrifose. Após avaliação clínica, realizou-se citologia de medula óssea, linfonodos poplíteos e cervicais superficiais, sendo estes negativos para a presença de formas de parasitas. Adicionalmente, amostras citológicas dos nódulos dérmicos foram colhidas tendo sido observadas formas amastigotas de Leishmaniaspp. nesses materiais. Conclui-se que a citologia do nódulo dérmico foi um método complementar de diagnóstico de leishmaniose em um cão negativo ao exame parasitológico de amostras de medula óssea e linfonodos.
Canine visceral leishmaniasis, a zoonosis of great public health importance, is a chronic disease that presents varied clinical signs, making its diagnosis very difficult. The definitive diagnosis of this disease is based on clinical signs associated with parasitological evaluations which, in addition to being quick, show high specificity. The objective of this study was to report the detection of amastigote forms of Leishmaniaspp. by cytology of dermal nodules from a dog negative at parasitological tests of bone marrow, popliteal and right superficial cervical and left lymph node samples. A female dog with a history of dermatological problems and the appearance of dermal nodules in the dorsal and interdigital regions was treated during the past two years. At physical examination, a slight diffuse alopecia was noted on the dorsal region, with desquamation. It was also possible to observe well defined nodules measuring about 3-5 cm of diameter, solid and with an inflammatory aspect on the dorsal and interdigital regions; the dog also presented onychogryphosis. After clinical evaluation, bone marrow, popliteal and superficial cervical lymph node aspiration biopsies were performed, and all of these were negative for the presence of parasites. Additionally, cytological samples of dermal nodules were collected where amastigote forms of Leishmania spp. were observed. We concluded that dermal nodule cytology was a complementary method for diagnosing visceral leishmaniasis in a dog negative at parasitological evaluation of bone marrow and lymph node samples.
Assuntos
Animais , Cães , Cães/parasitologia , Dermatite , Leishmaniose/diagnósticoRESUMO
A leishmaniose visceral canina, zoonose de grande importância para a saúde pública, é uma enfermidade crônica que resulta em sinais clínicos variados, dificultando seu diagnóstico. O diagnóstico definitivo da doença em cães baseia-se nos sinais clínicos associados à exames parasitológicos que, além de serem rápidos, possuem alta especificidade. Objetivou-se relatar a detecção de formas amastigotas de Leishmaniaspp. por meio de citologia de nódulos dérmicos de um cão com ausência de formas amastigotas, ao exame parasitológico, em amostras de medula óssea, linfonodos poplíteos e cervicais superficial direito e esquerdo. Uma cadela, poodle, de dez anos, com histórico de problemas dermatológicos e surgimento de nódulos dérmicos nas regiões dorsal e interdigital há cerca de dois anos foi avaliada. Ao exame físico observou-se alopecia discreta e difusa na região dorsal, com descamação. Era possível se observar nódulos com cerca de 3-5 cm de diâmetro, bem delimitados, sólidos e com aspecto inflamado nas regiões dorsal e interdigital; o animal também apresentava onicogrifose. Após avaliação clínica, realizou-se citologia de medula óssea, linfonodos poplíteos e cervicais superficiais, sendo estes negativos para a presença de formas de parasitas. Adicionalmente, amostras citológicas dos nódulos dérmicos foram colhidas tendo sido observadas formas amastigotas de Leishmaniaspp. nesses materiais. Conclui-se que a citologia do nódulo dérmico foi um método complementar de diagnóstico de leishmaniose em um cão negativo ao exame parasitológico de amostras de medula óssea e linfonodos.(AU)
Canine visceral leishmaniasis, a zoonosis of great public health importance, is a chronic disease that presents varied clinical signs, making its diagnosis very difficult. The definitive diagnosis of this disease is based on clinical signs associated with parasitological evaluations which, in addition to being quick, show high specificity. The objective of this study was to report the detection of amastigote forms of Leishmaniaspp. by cytology of dermal nodules from a dog negative at parasitological tests of bone marrow, popliteal and right superficial cervical and left lymph node samples. A female dog with a history of dermatological problems and the appearance of dermal nodules in the dorsal and interdigital regions was treated during the past two years. At physical examination, a slight diffuse alopecia was noted on the dorsal region, with desquamation. It was also possible to observe well defined nodules measuring about 3-5 cm of diameter, solid and with an inflammatory aspect on the dorsal and interdigital regions; the dog also presented onychogryphosis. After clinical evaluation, bone marrow, popliteal and superficial cervical lymph node aspiration biopsies were performed, and all of these were negative for the presence of parasites. Additionally, cytological samples of dermal nodules were collected where amastigote forms of Leishmania spp. were observed. We concluded that dermal nodule cytology was a complementary method for diagnosing visceral leishmaniasis in a dog negative at parasitological evaluation of bone marrow and lymph node samples.(AU)
Assuntos
Animais , Cães , Cães/parasitologia , Leishmaniose/diagnóstico , DermatiteRESUMO
Tuberculosis treatment has undergone recent changes in Brazil. Objective. To assess whether favorable outcomes on tuberculosis therapy improved in recent years. Methods. Retrospective observational study, based on primary data of tuberculosis patients, followed at INI-FIOCRUZ, from January 2012 to December 2014. Results. The outcomes observed were as follows: cure (80%), default (14%), treatment failure (5%), and death (1%). HIV infection without antiretroviral therapy [OR 0.34 (0.15-0.79)], tuberculosis diagnosis based on sputum smear [OR 0.22 (0.07-0.74)], drug use [OR 0.22 (0.11-0.46)], and/or treatment interruption due to adverse reactions [OR 0.23 (0.08-0.67)] decreased the chance of cure. Predictors of default, that is, use of noninjecting drugs [OR 3.00 (95% CL 1.31-6.88)], treatment interruption due to adverse reactions [OR 6.30 (1.81-21.95)], low schooling [OR 2.59 (2.15-5.82)], higher age [OR 0.44 (0.23-0.82)], and female gender [OR 0.28 (0.11-0.71)], reduced the chance of treatment default. Tuberculosis diagnosis based on sputum smear [OR 7.77 (1.94-31.09)] and/or arterial hypertension [OR 4.07 (1.25-13.18)] was associated with treatment failure. Conclusion. Mortality and default were low considering the prevalence of HIV infection; however cure was not significantly increased.