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BACKGROUND: To verify the correlation between retinal sensitivity (RS) assessed by the microperimetry (MP) and optical coherence tomography (OCT) parameters measured in eyes submitted to pars-plana vitrectomy (PPV) for idiopathic epiretinal membrane (ERM) treatment. METHODS: 43 patients underwent PPV. Best-corrected visual acuity (BCVA) and OCT imaging were acquired preoperatively and 6 months after surgery. The RS values were recorded 6 months after the surgery. Total macular thickness (TMT) measurements and OCT-evaluated structural findings were also analyzed. The MP examination tested 44 points, with direct topographic correspondence with the OCT-ETDRS map. Correlations between BCVA, RS, and OCT parameters were assessed. RESULTS: TMT measurements in patients were significantly thicker preoperatively and reduced after surgery. All patients demonstrated BCVA improvements after surgery. The RS parameters after surgery were significantly lower in patients. For OCT structural analyses, patients with lower RS at the fovea correlated with the preexisting disorganization of retinal inner layers (DRIL). In addition, lower RS values were associated with DRIL, outer retinal changes (ORC), and intraretinal microcysts after surgery. CONCLUSIONS: The RS values after surgery were significantly lower when compared to controls. The DRIL presence before and after surgery, and microcysts and ORC after surgery were related to worse visual outcomes.
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ABSTRACT We describe a case of a 33-years-old woman who presents with severe acute bilateral visual loss secondary to massive exudative hypertensive maculopathy as the first sign of immunoglobulin A nephropathy. The patient's ophthalmic examination showed bilateral cotton-wool spots, flame-shaped retinal hemorrhages, diffuse narrow arterioles, optic disk edema, and exudative maculopathy. Systemic workup demonstrated a systolic and diastolic blood pressure of 240 mmHg and 160 mmHg, respectively, proteinuria, and hematuria, suggesting kidney disease as the causative condition. A kidney biopsy confirmed immunoglobulin A nephropathy. She was treated with systemic corticosteroids, antihypertensive drugs, and a single bilateral intravitreal injection of aflibercept. There was a prompt resolution of macular edema and vision improvement. Our case draws attention to the fact that severe bilateral visual loss can be the first sign of severe hypertension. Secondary causes, such as immunoglobulin A nephropathy, should be ruled out.
RESUMO Nosso objetivo é descrever uma paciente de 33 anos de idade, com perda visual bilateral grave por maculopatia hipertensiva exsudativa como o primeiro sinal da nefropatia por imunoglobulina A. A fundoscopia revelou a presença de manchas algodonosas, hemorragias em chama-de-vela, estreitamento arteriolar difuso, edema de disco óptico e maculopatia exsudativa bilateral. A pressão arterial sistólica foi de 240mmHg e a diastólica de 160 mmHg associado a proteinúria e hematúria, sugerindo a presença de doença renal. A biópsia renal confirmou a nefropatia por imunoglobulina A. A paciente foi tratada como corticoide sistêmico, drogas anti-hipertensivas e uma única dose intravítrea de Aflibercept em ambos os olhos. Houve rápida melhora do edema macular e da acuidade visual. Nosso caso chama a atenção para o fato de que a perda visual bilateral grave pode ser a primeira apresentação de uma doença hipertensiva sistêmica. Causas secundárias como a nefropatia por imunoglobulina A devem ser afastadas.
RESUMO
We describe a case of a 33-years-old woman who presents with severe acute bilateral visual loss secondary to massive exudative hypertensive maculopathy as the first sign of immunoglobulin A nephropathy. The patient's ophthalmic examination showed bilateral cotton-wool spots, flame-shaped retinal hemorrhages, diffuse narrow arterioles, optic disk edema, and exudative maculopathy. Systemic workup demonstrated a systolic and diastolic blood pressure of 240 mmHg and 160 mmHg, respectively, proteinuria, and hematuria, suggesting kidney disease as the causative condition. A kidney biopsy confirmed immunoglobulin A nephropathy. She was treated with systemic corticosteroids, antihypertensive drugs, and a single bilateral intravitreal injection of aflibercept. There was a prompt resolution of macular edema and vision improvement. Our case draws attention to the fact that severe bilateral visual loss can be the first sign of severe hypertension. Secondary causes, such as immunoglobulin A nephropathy, should be ruled out.
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Societal influences, such as beliefs and behaviors, and their increasing complexity add to the challenges of interactivity promoted by globalization. This study was developed during a virtual global educational exchange experience and designed for research and educational purposes to assess personal social and cultural risk factors for students' COVID-19 personal prevention behavior and perceptions about life during the pandemic, and to inform future educational efforts in intercultural learning for healthcare students. We designed and implemented a cross-sectional anonymous online survey intended to assess social and cultural risk factors for COVID-19 personal prevention behavior and students' perceptions about life during the pandemic in public health and healthcare students in two public universities (United States n = 53; Brazil n = 55). Statistically significant differences existed between the United States and Brazil students in degree type, employment, risk behavior, personal prevention procedures, sanitization perceptions, and views of governmental policies. Cultural and social differences, risk messaging, and lifestyle factors may contribute to disparities in perceptions and behaviors of students around the novel infectious disease, with implications for future global infectious disease control.
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COVID-19 , Pandemias , Brasil/epidemiologia , Estudos Transversais , Atenção à Saúde , Humanos , Percepção , SARS-CoV-2 , Estudantes , Inquéritos e Questionários , Estados Unidos/epidemiologiaRESUMO
Human epidermal growth factor receptor-2 (HER2) is an important biomarker in the diagnosis and prognosis of breast cancer. This work aimed to develop an aptasensor to detect HER2 in human serum. HER2 aptamer was immobilized by electrostatic adsorption on the surface of a homemade screen-printed electrode modified with poly-L-lysine. Measurements were made by differential pulse voltammetry using methylene blue as a redox indicator. A calibration curve was constructed (R2 = 0.997) using different concentrations of HER2 protein (10-60 ng/mL) in PBS buffer (pH 7.4), with a detection limit of 3.0 ng/mL. The aptasensor showed good reproducibility with relative standard deviations (RSDs) of 3% and remained stable for 3 days with an RSD around 2%. When the tests were performed with serum from a healthy woman, a peak of 6.72 µA was found without the addition of the protein. When we tested the serum of a woman with HER2+ breast cancer, we obtained a signal of 2.65 µA; the same pattern was found when adding to protein in serum control, i.e., the higher the concentration of protein, the lower the signal. The aptasensor was characterized by scanning electron microscopy and isothermal titration calorimetry (ITC), showing excellent interaction between aptamer and target protein. The results revealed a promising and sensitive tool capable of detecting HER2 protein in human serum with albumin depletion, aiding in the molecular diagnosis of breast cancer. Graphical abstract.
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Aptâmeros de Nucleotídeos/química , Neoplasias da Mama/sangue , Receptor ErbB-2/sangue , Técnicas Biossensoriais/instrumentação , Técnicas Biossensoriais/métodos , Neoplasias da Mama/diagnóstico , Detecção Precoce de Câncer , Técnicas Eletroquímicas/instrumentação , Técnicas Eletroquímicas/métodos , Eletrodos , Desenho de Equipamento , Feminino , Humanos , Limite de Detecção , Receptor ErbB-2/análise , Reprodutibilidade dos TestesRESUMO
Hipernatremia é um distúrbio hidro-eletrolítico frequente em pessoas nas quais o mecanismo da sede ou o acesso à água está comprometido podendo causar desde morbidades mínimas até coma. Entre as morbidades causadas pela hipernatremia, a hemorragia do sistema nervoso central é infreqüente e pouco estudada. Relatamos um caso de paciente admitido na unidade de terapia intensiva com redução do nível de consciência, hipernatremia e tomografia computadorizada de crânio evidenciando hemorragia intraparenquimatosa bilateral. Foi realizada revisão de literatura de encefalopatia hemorrágica hipernatrêmica.
Hypernatremia is a common electrolyte disorder in people with impaired thirst control mechanism or access to water, and may lead from minimal disorders until coma. Among the hypernatremia morbidities, central nervous system hemorrhage is uncommon and poorly studied. We report a case involving a patient admitted to the intensive care unit with reduced consciousness level, hypernatremia and head computed tomography scan showing bilateral parenchyma hemorrhage. A literature review of hypernatremia hemorrhagic encephalopathy was conducted.
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Hypernatremia is a common electrolyte disorder in people with impaired thirst control mechanism or access to water, and may lead from minimal disorders until coma. Among the hypernatremia morbidities, central nervous system hemorrhage is uncommon and poorly studied. We report a case involving a patient admitted to the intensive care unit with reduced consciousness level, hypernatremia and head computed tomography scan showing bilateral parenchyma hemorrhage. A literature review of hypernatremia hemorrhagic encephalopathy was conducted.
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OBJECTIVE: To study any possible relation between hyponatremia following brain injury and the presence of cerebral salt-wasting syndrome (CSWS) or the syndrome of inappropriate secretion of antidiuretic hormone (SIADH), and if vasopressin, brain natriuretic peptide (BNP) and aldosterone have a role in its mechanism. METHOD: Patients with brain injury admitted to the intensive care unit were included and had their BNP, aldosterone and vasopressin levels dosed on day 7. RESULTS: Twenty six adult patients were included in the study. Nine (34.6 percent) had hyponatremia and presented with a negative water balance and higher values of urinary sodium, serum potassium and diuresis than patients with normonatremia. The serum levels of BNP, aldosterone, and vasopressin were normal and no relation was observed between plasma sodium and BNP, aldosterone or vasopressin. CONCLUSION: The most likely cause of hyponatremia was CSWS and there was no correlation between BNP, aldosterone and vasopressin with serum sodium level.
OBJETIVO: Estudar a possível relação entre a hiponatremia seguindo traumatismo cranioencefálico e a presença da síndrome cerebral perdedora de sal (SCPS) ou a síndrome da secreção inapropriada do hormônio antidiurético (SSIHAD), e se a vasopressina, peptídeo natriurético cerebral (BNP) e aldosterona têm um papel nesse mecanismo. MÉTODO: Foram incluídos pacientes com traumatismo cranioencefálico admitidos na unidade de terapia intensiva e foram dosados no sétimo dia seguindo o trauma, BNP, aldosterona e vasopressina. RESULTADOS: Vinte e seis pacientes foram incluídos no estudo. Nove (34,6 por cento) tiveram hiponatremia e apresentaram um balanço hídrico mais negativo e altos valores de sódio urinário, potássio sérico e diurese quando comparados com o grupo que apresentou normonatremia. Os níveis séricos de BNP, aldosterona e vasopressina foram normais e não foi observada relação entre o sódio sérico e BNP, aldosterona e vasopressina. CONCLUSÃO: A causa mais provável da hiponatremia foi a SCPS e não houve correlação entre BNP, aldosterona e vasopressina com o nível sérico de sódio.
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Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Aldosterona/sangue , Lesões Encefálicas/sangue , Hiponatremia/sangue , Peptídeo Natriurético Encefálico/sangue , Vasopressinas/sangue , Encefalopatias Metabólicas/sangue , Encefalopatias Metabólicas/complicações , Encefalopatias Metabólicas/diagnóstico , Lesões Encefálicas/complicações , Hiponatremia/diagnóstico , Hiponatremia/etiologia , Síndrome de Secreção Inadequada de HAD/sangue , Síndrome de Secreção Inadequada de HAD/complicações , Síndrome de Secreção Inadequada de HAD/diagnóstico , Adulto JovemRESUMO
Estudo que teve como objetivo quantificar a coexistência da tireoidite de Hashimoto no carcinoma papilífero da tireoide, correlacionando-a com os dados demográficos, informações clínicas e diagnósticos anatomopatológicos prévios. Realizou-se um estudo de série de 347 casos de pacientes com diagnóstico anatomopatológico de carcinoma papilífero da tireoide no serviço de Anatomia Patológica e Citopatologia do Hospital São Rafael, de janeiro de 2000 a dezembro de 2007. Foram feitas aplicações de formulários aos casos, visando a coletar os dados demográficos e as informações clínicas; os exames anatomopatológicos foram diagnosticados pelos dois patologistas deste estudo.O estudo apresentou uma coexistência de 31,4 por cento de tireoidite de Hashimoto em pacientes com carcinoma papilífero da tireoide. No sexo feminino houve um total de 96 casos (88,1 por cento), o que demonstra maior frequência quando comparado com os casos sem a coexistência. A série de casos apresentada mostrou uma frequência de 31,4 por cento de tireoidite de Hashimoto nos casos de carcinoma papilífero da tireoide, sugerindo uma associação não apenas casual, mas que levanta a possibilidade de uma relação de causa e efeito entre a tireoidite e o desenvolvimento do carcinoma. No entanto, necessita-se de mais estudos, seccionais ou de coorte, para essa comprovação.
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Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Carcinoma Papilar/diagnóstico , Carcinoma Papilar/epidemiologia , Carcinoma Papilar/patologia , Doença de Hashimoto/complicações , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/epidemiologia , Neoplasias da Glândula Tireoide/patologiaRESUMO
OBJECTIVE: To study any possible relation between hyponatremia following brain injury and the presence of cerebral salt-wasting syndrome (CSWS) or the syndrome of inappropriate secretion of antidiuretic hormone (SIADH), and if vasopressin, brain natriuretic peptide (BNP) and aldosterone have a role in its mechanism. METHOD: Patients with brain injury admitted to the intensive care unit were included and had their BNP, aldosterone and vasopressin levels dosed on day 7. RESULTS: Twenty six adult patients were included in the study. Nine (34.6%) had hyponatremia and presented with a negative water balance and higher values of urinary sodium, serum potassium and diuresis than patients with normonatremia. The serum levels of BNP, aldosterone, and vasopressin were normal and no relation was observed between plasma sodium and BNP, aldosterone or vasopressin. CONCLUSION: The most likely cause of hyponatremia was CSWS and there was no correlation between BNP, aldosterone and vasopressin with serum sodium level.