Determining cut-off scores for simulated tasks in Brazilian Air Force military personnel

INTRODUCTION

Combat readiness assessments through simulated tasks (STs) have been developed for the Brazilian Air Force (BAF) to establish physical employment standards. Previous research has established BAF critical combat tasks with STs developed based on the physical demands of these tasks. Before implementing these STs, the standards required of BAF personnel must be established. The aim of this study was to determine the cut-off scores for five previously established STs.

METHODS

Eighty-eight cadets attended three different testing batteries in order to complete the five STs, being: Battery 1 (foot march), Battery 2 (plane crash on water and water survival skills) and Battery 3 (plane crash on land, obstacle course) with their times recorded. Cut-off scores were set at the 85th percentile of the data distribution with these values and then analysed by four subject matter experts (SMEs) using subjective criteria through criterion analysis.

RESULTS

All 88 cadets were submitted to the five assessments. After analysing the performance results on the STs, the SMEs discussed and agreed on the following cut-off scores: obstacle course (3:21 min:s), foot march (31:00 min:s), plane crash on land (1:25 min:s), plane crash on water (1:12 min:s) and water survival skills (4:03 min:s).

CONCLUSION

The outcomes of this research allow for the five STs to be implemented in BAF cadets and qualified BAF personnel with the established cut-off scores used to monitor the operational capability of these personnel (be it for cadet training outcomes or unit preparedness assessments) and to guide conditioning practices if personnel are below standards.

Seroepidemiological survey to cell culture rabies vaccines (CCRV) in Brazil

Rabies is a contagious viral disease that can be easily transmitted by the saliva and brain/nervous system tissues of the infected animals, causing severe and fatal encephalitis in both animals and humans. Vaccination campaigns are crucial to combat and prevent rabies's spread in dogs and humans. The Modified Fuenzalida & Palicios vaccines have been widely used since the 70s and have proven effective in producing a solid serological response. Since 2008, the Brazilian Ministry of Health has introduced a Cell Culture Rabies Vaccine (CCRV) for all dog mass vaccination campaigns in Brazil. However, to date, there is limited evidence on the immunologic response of dogs to this type of vaccine in field conditions. The present study evaluated the serological response in dogs vaccinated with CCRV from blood samples of 724 dogs using the Simplified Fluorescence Inhibition Microtest - SFIMT. Dogs with a titer equal to 0.5 IU/mL or above were considered seropositive. The results revealed that 59.12% (428/724) of all dogs tested and 48.49% (32/66) of primo-vaccinated animals were seropositive. The percentage of seronegative animals was higher than seropositive for animals that received a single dose during their life (p < 0.05). The opposite was observed in animals with five or more doses. The results of this study demonstrated that the CCRV vaccines elicit a satisfactory immunological response in field conditions and can constitute an essential population-level preventive strategy as part of annual canine rabies vaccination campaigns. Although its effectiveness has been studied, there is limited evidence of its immunological response in dogs under field conditions. This paper evaluates the serological response to CCRV in dogs vaccinated during mass vaccination campaigns from 2012 to 2017.

Cerclage sling technique using temporalis muscle fascia to manage paralytic lagophthalmos: A preliminary study

PURPOSE

Despite various existing surgical techniques, treatment of facial nerve palsy remains difficult. The purpose of this report is to present the cerclage sling technique using temporalis fascia to manage paralytic lagophthalmos.

METHODS

A series of six patients underwent a cerclage sling technique using temporalis muscle fascia to treat paralytic lagophthalmos. The technique is presented in detail. Symptoms, palpebral fissures, and lagophthalmos were assessed pre- and postoperatively. Data were submitted for statistical analysis.

RESULTS

After surgery, all patients achieved a reduction in clinical symptoms. The upper eyelids had lowered, and the inferior eyelids had elevated, reducing ocular exposure even if mild residual lagophthalmos was present.

CONCLUSION

Cerclage using the temporalis muscle fascia sling technique is a safe and effective procedure to treat facial nerve paralytic lagophthalmos. A reduction in ocular exposure and lagophthalmos provides improvement in clinical symptoms and eyelid function.

Myocardial proteome changes in aortic stenosis rats subjected to long-term aerobic exercise

The effects of exercise training (ET) on the heart of aortic stenosis (AS) rats are controversial and the mechanisms involved in alterations induced by ET have been poorly clarified. In this study, we analyzed the myocardial proteome to identify proteins modulated by moderate-intensity aerobic ET in rats with chronic supravalvular AS. Wistar rats were divided into four groups: sedentary control (C-Sed), exercised control (C-Ex), sedentary aortic stenosis (AS-Sed), and exercised AS (AS-Ex). ET consisted of five treadmill running sessions per week for 16 weeks. Statistical analysis was performed by ANOVA or Kruskal-Wallis and Goodman tests. Results were discussed at a significance level of 5%. At the end of the experiment, AS-Ex rats had higher functional capacity, lower blood lactate concentration, and better cardiac structural and left ventricular (LV) functional parameters than the AS-Sed. Myocardial proteome analysis showed that AS-Sed had higher relative protein abundance related to the glycolytic pathway, oxidative stress, and inflammation, and lower relative protein abundance related to beta-oxidation than C-Sed. AS-Ex had higher abundance of one protein related to mitochondrial biogenesis and lower relative protein abundance associated with oxidative stress and inflammation than AS-Sed. Proteomic data were validated for proteins related to lipid and glycolytic metabolism. Chronic pressure overload changes the abundance of myocardial proteins that are mainly involved in lipid and glycolytic energy metabolism in rats. Moderate-intensity aerobic training attenuates changes in proteins related to oxidative stress and inflammation and increases the COX4I1 protein, related to mitochondrial biogenesis. Protein changes are combined with improved functional capacity, cardiac remodeling, and LV function in AS rats.

Trachoma: an underdiagnosed disease revealed by a survey carried out at Jaú, São Paulo

BACKGROUND

Trachoma is a notifiable disease in the state of São Paulo- Brazil. However, in Jaú, a municipality located in this state, in the last 10 years there are no records of cases. This study purpose is to assess if there are cases of inflammatory trachoma in schoolchildren aged 1 to 9 years in the municipality of Jaú as well if it is possible to detect clusters areas of the disease to establish elimination programs.

METHODS

An epidemiological study was performed in 2018, involving a stratified random sample of schoolchildren aged 1- to 9-year-old, from public day care centers and elementary schools in the municipality of Jaú. A trachoma screening following the criteria of the World Health Organization (WHO) and the distribution of cases was assessed using geoprocessing.

RESULTS

Four thousand-six hundred-nineteen children from 44 elementary schools were examined, and 126 children with active trachoma were detected, with an adjusted prevalence rate of 2.65%. The prevalence was higher (3.01%) in children aged 6- to 9-year-old compared to children aged 1-to 5-year-old (2.42%). There were clusters with a higher concentration of positive cases of the disease in three schools located in the neighborhoods with lower socioeconomic conditions.

CONCLUSION

Inflammatory trachoma still present in children aged 1- to 9-year-old in the city of Jaú. The positive cases were located mainly in areas with low socioeconomic conditions. Health promotion with active search and periodical treatment must be planned to fight this important blinding cause, that persists in our municipality.

Morphogeometric Evaluation of the Left Ventricle and Left Atrioventricular Ring in Dogs: A Computerized Anatomical Study

In veterinary, there is scarce availability of morphogeometric studies in normal and remodeled hearts; furthermore, ventricular geometry acts as an indicator of cardiac function. It is a highly necessary field of knowledge for the development of therapeutic protocols, especially surgical ones. The objectives of this study were: to obtain measurements of the left atrioventricular valve ring and left ventricle, to analyze the proportionality between the segments of the left cardiac chamber of normal hearts and to describe reference values for morphogeometric analysis of the left ventricle. For this, 50 hearts from small (Group 1-G1) and medium to large (Group 2-G2) dogs were laminated in the apical, basal and equatorial segments, and submitted to computer analysis to identify the perimeter of each segment and the left atrioventricular ring, wall thickness and distance from the atrioventricular sulcus to the apex. The largest internal perimeter was that of the equatorial. The basal segment had the highest mean for ventral parietal wall thickness, suggesting greater contractile reserve at that location. Considering the proportionality relationships, there was no statistical difference between the intersegmental perimeter indices for the two groups. This suggests that despite the animals' weight variations, the proportions between the left ventricular segments are maintained. Therefore, it is concluded that the data can be used as a standard of comparison for cardiac geometric assessments, as well as a basis for the development of therapeutic measures in the context of adverse cardiac remodeling.

Azadirachtin-based insecticide impairs testis morphology and spermatogenesis of the southern armyworm Spodoptera eridania (Lepidoptera: Noctuidae)

BACKGROUND

In the search for alternative tools for integrated pest management, azadirachtin, a botanical insecticide, has been used with the most promising activity against Spodoptera spp., but the mechanism of cytotoxicity on reproductive organs remains unclear. Spodoptera eridania (Stoll, 1782) is a polyphagous pest with great economic importance that has become an important target to elucidate the action of azadirachtin on the reproductive organs of insect pests, helping to understand the deleterious effects caused by its exposure. This study evaluated the effects of chronic exposure to azadirachtin on the morphology and ultrastructure of S. eridania larval testes as well as larval development.

RESULTS

Azadirachtin exposure (6 or 18 mg a.i. L^-1 ) caused a progressive increase in cumulative mortality and reduced gain in body mass after 5 days. Testicular structure indicated a reduction in their size with internal morphological changes such as spermatogonia, spermatogonial, spermatocytes and spermatid cysts in degeneration. The occurrence of cell death in germ and somatic cells was evidenced by the TUNEL technique. Electron microscopy revealed changes in cystic cells, such as cytoplasmic membrane rupture and cytoplasmic vacuolization. Chromatin compaction, changes in the rough endoplasmic reticulum and Golgi complex cisternae were observed in germ cells. Apoptotic bodies occurred between germ cell cysts.

CONCLUSION

Azadirachtin damaged the testes of S. eridania larvae, and these changes compromised spermatogenesis and consequently the development of the reproductive potential of this specimen, making azadirachtin a promising botanical insecticide for application in integrated pest management programs. © 2022 Society of Chemical Industry.

Hypoxia-Inducible Factor 1-Alpha and Glucose Metabolism during Cardiac Remodeling Progression from Hypertrophy to Heart Failure

In pathological cardiac hypertrophy, the heart is more dependent on glucose than fatty acids. This shift in energy metabolism occurs due to several factors, including the oxygen deficit, which activates hypoxia-inducible factor-1α (HIF-1α), a critical molecule related to glucose metabolism. However, there are gaps regarding the behavior of key proteins in the glycolytic pathway and HIF-1α during the transition from hypertrophy to heart failure (HF). This study assesses the hypothesis that there is an early change and enhancement of HIF-1α and the glycolytic pathway, as well as an association between them during cardiac remodeling. Sham and aortic stenosis Wistar rats were analyzed at 2, 6, and 18 weeks and in HF (n = 10–18). Cardiac structure and function were investigated by echocardiogram. Myocardial glycolysis, the aerobic and anaerobic pathways and glycogen were analyzed by enzymatic assay, Western blot, and enzyme-linked immunosorbent assay (ELISA). The following were observed: increased left ventricular hypertrophy; early diastolic function change and severe systolic and diastolic dysfunction in HF; increased HIF-1α in the 2nd week and in HF; precocious alteration and intensification of glycolysis with a shift to anaerobic metabolism from the 6th week onwards; association between HIF-1α, glycolysis, and the anaerobic pathway. Our hypothesis was confirmed as there was an early change and intensification in glucose metabolism, alteration in HIF-1α, and an association between data during the progression from hypertrophy to heart failure.

Neuroregeneration and immune response after neurorrhaphy are improved with the use of heterologous fibrin biopolymer in addition to suture repair alone

INTRODUCTION/AIMS

Peripheral nerve injuries result in impaired neuromuscular interactions, leading to morphological and functional alterations. Adjuvant suture repair methods have been used to improve nerve regeneration and modulate the immune response. Heterologous fibrin biopolymer (HFB), a scaffold with adhesive properties, plays a critical role in tissue repair. The aim of this study is to evaluate neuroregeneration and immune response focusing on neuromuscular recovery, using suture-associated HFB for sciatic nerve repair.

METHODS

Forty adult male Wistar rats were distributed into four groups (n = 10): C (control), only sciatic nerve location; D (denervated), neurotmesis and 6-mm gap removal and fixation stumps in subcutaneous tissue; S (suture), neurotmesis followed by suture; and SB (suture + HFB), neurotmesis followed by suture and HFB. Analysis of M2 macrophages (CD206⁺ ), as well as the morphology and morphometry of nerves, soleus muscle, and neuromuscular junctions (NMJs), were performed at 7 and 30 days after surgery.

RESULTS

The SB group had the highest M2 macrophage area in both periods. After 7 days, SB was the only group similar to the C group regarding the number of axons; furthermore, after 30 days, the SB group was closer to the C group concerning blood vessel and central myonuclear numbers, NMJ angle, and connective tissue volume. After 7 days, increases in nerve area, as well as the number and area of blood vessels, were also observed in SB.

DISCUSSION

HFB potentiates the immune response, increases axonal regeneration, induces angiogenesis, prevents severe muscle degeneration, and assists in NMJ recovery. In conclusion, suture-associated HFB has major implications for improved peripheral nerve repair.

Acetylcholine receptors of the neuromuscular junctions present normal distribution after peripheral nerve injury and repair through nerve guidance associated with fibrin biopolymer

Peripheral nerve injuries (PNI) lead to alterations in the Agrin-LRP4-MuSK pathway. This results in disaggregation of AChRs and change from epsilon (mature, innervated) to gamma (immature, denervated) subunit. Tubulization technique has been shown to be effective for PNI repair and it also allows the use of adjuvants, such as fibrin biopolymer (FB). This study evaluated the effect of the association of tubulization with FB after PNI on AChRs and associated proteins. Fifty-two adults male Wistar rats were used, distributed in 4 experimental groups: Sham Control (S), Denervated Control (D); Tubulization (TB) and Tubulization + Fibrin Biopolymer (TB+FB). Catwalk was performed every 15 days. Ninety days after surgery the right soleus muscles and ischiatic nerves were submitted to the following analyses: (a) morphological and morphometric analysis of AChRs by confocal microscopy; (b) morphological and morphometric analysis of the ischiatic nerve; (c) protein quantification of AChRs: alpha, gama, and epsilon, of Schwann cells, agrin, LRP4, MuSK, rapsyn, MMP3, MyoD, myogenin, MURF1 and atrogin-1. The main results were about the NMJs that in the TB+FB group presented morphological and morphometric approximation (compactness index; area of the AChRs and motor plate) to the S group. In addition, there were also an increase of S100 and AChRε protein expression and a decrease of MyoD. These positive association resulted in AChRs stabilization that potentiate the neuromuscular regeneration, which strengthens the use of TB for severe injuries repair and the beneficial effect of FB, along with tubulization technique.

Anti-inflammatory effects of α-humulene and β-caryophyllene on pterygium fibroblasts

AIM: To investigate the anti-inflammatory effects of the sesquiterpenes α-humulene and β-caryophyllene on pterygium fibroblasts. METHODS: Primary cultures of pterygium fibroblasts were established. Third passage pterygium fibroblasts were exposed to α-humulene and β-caryophyllene separately and together. The cell viability was assessed by 3- (4,5-dimethylthiazolyl-2) -2,5-diphenyltetrazolium bromide (MTT) assay at 12, 24, 48, and 72h after exposure. The levels of the inflammatory cytokines interleukin (IL)-1β, IL-6, IL-8, tumor necrosis factor (TNF)-α and IL-10 in the conditioned culture medium were assessed by enzyme-linked immunosorbent assay (ELISA) at 12, 24 and 48h after exposure. Data were statistically analyzed using Friedman repeated measures analysis of variances on ranks. RESULTS: The 25 μmol/L β-caryophyllene induced significant decrease in the IL-6 production by pterygium fibroblasts 48h after the exposure (P=0.041). The levels of IL-1β, IL-8, IL-10, and TNF-α were very low and had no statistically significant variations after exposure to α-humulene, β-caryophyllene, or both compounds together. CONCLUSION: The exposure to 25 μmol/L of β-caryophyllene significantly reduce the production of IL-6 by pterygium fibroblasts after 48h. This sesquiterpene may be a potential alternative adjuvant agent for the treatment of pterygium.

Swimming training attenuates the decrease of calcium responsiveness in female infarcted rats

Aim: To evaluate the influence of swimming training on calcium responsiveness of the myocardium of rats with different infarction sizes (MI).

Method: female Wistar rats, sedentary sham (SS = 14), sedentary moderate MI (SMI = 8) and sedentary large MI (SLI = 10) were compared to trained sham (TS = 16), trained moderate MI (TMI = 9) and trained large MI (TLI = 10). After 4 weeks of MI, the animals swam for 60 min/day, 5 days/week, for additional 8 weeks. Papillary muscles of the left ventricle were subjected to different concentrations of extracellular calcium. Inotropism was evaluated through the developed tension (DT), the maximum positive value of the first temporal derivation (+Td/td) and the time to peak tension (TPT). Lusitropism was evaluated by the maximum negative value of the first temporal derivation (−Td/td) and time to 50% relaxation (50%TR). Statistical significance was determined using multivariate analysis of variance and a Hotelling T2 test for the absolute power values of all four extracellular calcium concentrations (p < 0.05).

Results: MI depressed inotropism (from 17% to 51%) and lusitropism (from 22% to 54%) of the sedentary rats, but exercise attenuated the losses, especially regarding + dT/dt, TPT, −dT/dt and 50%TR. Exercise attenuated the decrease in myocardial responsiveness, proportionally to the size of the MI.

Conclusion: Myocardial calcium responsiveness is favorably affected in animals with moderate and large MI after swimming exercise.

Low and high postpubertal ethanol use: damage on adulthood reproduction and offspring

Graphical abstract

Abstract

The relationship between adolescent ethanol uses and its impacts throughout life are not conclusive. Thus, we evaluated if the low and high consumption of ethanol at postpuberty interferes with the reproduction and ethanol-naive offspring and if the effects are dose-related. Female and male rats were divided into three groups: low drinker (L), high drinker (H) and control (C). The L and H groups were exposed to ethanol up to 10 % from 65 to 80 days with withdrawal after this period. The ethanol consumed by low drinkers was 1.41 ± 0.21 g/kg/day and by high drinkers 4.59 ± 0.45 g/kg/day. The study was conducted in two phases. The first phase verified the reproductive capacity in adulthood on generations (litter size and sex ratio). Data were collected over 10 years. The second phase analyzed the parent reproductive parameters (body weight, reproductive organ weight, sperm parameters and estrous cycle) and the pup development. We observed a reduced litter size in both drinker groups. Gestational body weight gain and feed consumption were lower in L and H. We observed an alteration in reproductive organs weight in both sexes of H. Females presented a longer estrous cycle duration. Males presented an increase in abnormal sperm, a decrease in sperm count and accelerated transit time. The ethanol-naive offspring development was also impaired. We conclude that low and high postpubertal alcohol use impairs long-term reproductive parameters, even after alcohol withdrawal. There is also impaired ethanol-naive offspring. Besides, the effects are dose-related.

Lay summary

The effects of alcohol use have been reported in several studies. However, better knowledge about early alcohol use and its impact on reproduction in adulthood, after abstinence and on ethanol-naive offspring could help improve preventive measures and mechanisms of action. One of the methods used was retrospective analysis which allows to evaluate the effects of postpubertal ethanol use on the reproductive capacity of rats over generations. Despite our limitations, we verified that the post-adolescent period acts as a susceptibility window, and lifestyle at this age modulates the long-term reproductive parameters. The early ethanol use impairs reproduction function since sperm parameters and the estrous cycle have been altered. The dose of alcohol also contributes to damage on the drinkers’ reproduction and on the physical development of ethanol-naive offspring. Future studies are necessary to identify the mechanism involved in long-term alcohol use effects, even in withdrawal, as well as ethanol-naive offspring outcomes.

Dual-Scheimpflug-Placido-disc corneal analysis in cats

OBJECTIVE

To evaluate the corneal topography and tomography of cats using a dual Scheimpflug and Placido disc device.

ANIMAL STUDIED

Sixteen mixed-breed cats (32 eyes).

PROCEDURE(S)

Cats were sedated using meperidine (4.3 mg/kg/IM) and xylazine (0.5 mg/kg/IM), and evaluated using the software Galilei™. Values assessed included anterior and posterior corneal curvature, total corneal power, and corneal thickness.

RESULTS

Ten males and six females aged between 18 and 48 months were evaluated. The simulated keratometry (SimK) was 38.37 ± 0.83D, mean posterior keratometry -4.89 ± 0.34D, and mean total corneal power 38.04 ± 0.94D. The mean central corneal thickness (CCT) was 617.34 ± 53.38 μm with a mean thinnest point of 583.74 ± 60.60 μm.

CONCLUSION

The Galilei™ examination was feasible in cats, enabling a detailed study of the cornea. To the best of our knowledge, this is the first study evaluating the corneal topography and tomography of cats using a device that integrates data from a dual Scheimpflug and Placido disc system.

Visual acuity, contrast sensitivity, and quality of life after bilateral implantation of multifocal diffractive intraocular lens

PURPOSE

To evaluate visual outcomes, satisfaction, and quality of life of patients assisted in a Medical School hospital by the Brazilian Public Health System, who underwent bilateral diffractive multifocal intraocular lens implantation.

METHODS

Case series study with intervention, including 20 patients who underwent bilateral implantation of multifocal IOL EyeDiff® (Eyeol UK, Dunstable, UK). Exclusion criteria were corneal astigmatism >1.5 cylindrical diopters, previous ocular surgery or ocular disease, and intra- or postoperative complications. Patients were evaluated one, three, and six months after surgery. Monocular and binocular visual acuity for distance, intermediate and near, under photopic and mesopic conditions, monocular contrast sensitivity under photopic conditions, defocus curve, and quality of life were assessed.

RESULTS

Monocular distance-corrected visual acuity was 0.3 logMAR or better and monocular distance-corrected near visual acuity was J3 or better in all eyes under photopic conditions. Binocular distance-corrected near visual acuity was J1 in all cases. Contrast sensitivity was at the minimum level of normality for low and high spatial frequencies and within normal limits for intermediate spatial frequency. The quality of life questionnaire showed a high level of patient satisfaction.

CONCLUSION

Bilateral implantation of the multifocal intraocular lens EyeDiff® provides patients with good visual acuity and quality of life, besides spectacle independence. The visual acuity and contrast sensitivity progressively improved between one and six postoperative months.

Midgut and fat body: Multisystemic action of pyriproxyfen on non-target organism Ceraeochrysa claveri (Neuroptera: Chrysopidae)

Morphological tools can assist in the evaluation of effects of insecticides on non-target insects. Pyriproxyfen, a juvenile hormone analog, is known to interfere with growth and metamorphosis of insects. However, there are studies showing indirect effects on natural enemies, including green lacewings. Few prior studies describe morphological effects of pyriproxyfen on target insect organs, especially on natural enemies. Through morphological tools, this study aimed to characterize the midgut and fat body, both important organs of digestion and great metabolic activity respectively, of the predator Ceraeochrysa claveri after chronic exposure to pyriproxyfen. Larvae of C. claveri were fed Diatraea saccharalis egg clusters treated with pyriproxyfen in solution of 50 or 100 mg a.i. L^-1 throughout the larval stage. The biological data revealed significant increases in development time, especially in the third instar, and in cumulative mortality from the prepupal into the pupal stage. Morphological analysis of adult midgut (≤24 h old) showed damage including formation of epithelial folds, intercellular spaces, emission of cytoplasmic protrusions. Both fat body regions presented decrease of lipid droplets, vacuolization of trophocytes and mitochondrial injury featuring a multisystemic action. In both organs, pyriproxyfen exposure induced significant oxidative stress by mitochondrial superoxide production. Cytoprotective responses were induced in midgut and fat body cells by augmenting the number of cytoplasmic granules containing calcium and expression of HSP 90. Both organs proved to be efficient in presenting histopathological alterations, showing the sensitivity and applicability of this morphological tool for evaluating other insecticides in non-target organisms.

Upper eyelid blepharoplasty and associated ancillary procedures to improve cosmesis

PURPOSE

To present combined procedures performed for cosmesis in patients with dermatochalasis who underwent upper lid blepharoplasty (ULB).

METHOD

This retrospective cross-sectional study evaluated patients who underwent ULB with associated surgical procedures from 2012 to 2016. Data were collected on patient demographics and types of procedures. The primary outcome measure was ancillary procedures combined with ULB. Data were analyzed for correlation. Statistical significance was defined as P<0.05.

RESULTS

A total of 1,068 ULBs were performed in 825 (86.3%) females and 131 (13.7%) males. The median age was statistically higher in males (P<0.001). Isolated ULB was performed in 296 (31%) patients, and correction of brow ptosis was the most common associated procedure (206/21.5%), followed by repair of eyelid ptosis (183/19.1%).

CONCLUSION

The majority of patients required combined surgical procedures to correct periorbital involutional changes. A detailed preoperative evaluation is fundamental for choosing the appropriate surgical technique for each case, which can determine the final aesthetic result.

Reasons for no-show to referrals at a university eye clinic after eye examination via a mobile ophthalmic unit in a Brazilian region

PURPOSE

This study aimed to identify patient's reason for no-show at a university eye clinic after ophthalmic examination via a mobile ophthalmic unit, which provides comprehensive ophthalmic care to underserved communities in a region of Brazil.

METHODS

In 2017/2018, this prospective observational study searched for no-shows at referrals to a university eye clinic after an outreach program screening via a mobile ophthalmic unit in 10 municipalities in the central-western region of São Paulo, Brazil. A total of 1,928 patients underwent a comprehensive eye examination at no cost, and 37.1% of them needed referral to a university eye clinic for specialized examinations or surgeries. We used the following two main tools: (1) comparative analysis between patients who attended the referral and those who did not; (2) active search using a questionnaire to assess reasons for no-show.

RESULTS

Attendance to referrals was not influenced by age, gender, distance from the university hospital, number of ophthalmologists in the municipality, average family income, and visual acuity. The main cause for referrals was cataract (350 cases). No-show was most common among glaucoma/suspected glaucoma (54.1%) cases, followed by strabismus (45%) and anterior segment disease (33.6%) cases. Many patients who did not attend the referral sought another service.

CONCLUSION

Patient's issues and lack of knowledge regarding their ophthalmic condition are the main reasons for no-show at referrals for free ophthalmic care. Thus, educational campaigns are needed to achieve consistently high attendance to prevent avoidable blindness.

Ophthalmological knowledge of Family Health Network physicians working as first care providers in Brazil

OBJECTIVE

First care providers working in the Brazilian Unified Health System are often physicians from the Family Health Program. Their knowledge on ophthalmology could indicate whether there is a need for training to decrease ophthalmological demands to secondary or tertiary health levels.

METHODS

A cross-sectional observational study based on an electronic questionnaire was conducted to evaluate the ophthalmological knowledge of Family Health Program physicians working at the VI Regional Health Department, Sao Paulo, Brazil. All Family Health Program physicians from this regional health department were invited, and the study included those who responded to the full questionnaire (115 physicians). The data were evaluated using descriptive analysis.

RESULTS

There was no difference in the ophthalmological knowledge between sexes or in relation to undergraduate schools. Only 20% of the interviewees were specialized in Family and Community Medicine, which did not influence the number of correct answers. Only 22 (19.1%) physicians reported having enough knowledge about the main eye disorders, and 82 (71.3%) physicians considered themselves capable of treating ophthalmological emergencies. However, acute glaucoma was recognized by only 51 (44.3%) physicians, and eye perforations could only be handled by 65 (56.5%) of them. In addition, only 47 (40.9%) participants correctly answered that congenital cataracts should be operated right after diagnosis.

CONCLUSIONS

Family Health Program physicians working as first care providers in the Health System in Brazil presented poor ophthalmological knowledge. Providing training on ophthalmology may improve the ophthalmological care at the primary level within SUS and reduce the case demands at other healthcare levels.

Is there a relationship between diet quality and bone health in elderly women? A cross-sectional study

OBJECTIVE

To evaluate whether there is a relationship between diet quality and bone health in a group of elderly Brazilian women.

METHODS

A cross-sectional study was performed with 105 elderly women. Participants were evaluated regarding diet quality (good, needing improvement, and poor) and its relationship with bone mineral density (BMD), bone-specific alkaline phosphatase (BSAP), and C-telopeptide (CTX).

RESULTS

Fifty eight participants (55.2%) presented a poor-quality diet and 47 (44.8%) required dietary improvements, while no subjects presented a good quality diet. The group requiring dietary improvements had lower CTX [0.35 (0.05;1.09) vs. 0.52 (0.10;1.45); p = 0.03)] and BSAP (38.7 ± 12.9 U/L vs. 46.10 ± 15.2 U/L; p < 0.01) levels than the poor-quality diet group. Groups did not differ in terms of BMD.

CONCLUSION

In this group of elderly Brazilian women, there was a relationship between diet quality and bone health, where worse diet quality was associated with higher levels of bone remodelling markers.

Flies as possible vectors of inflammatory trachoma transmission in a Brazilian municipality

Trachoma is a keratoconjunctivitis caused by Chlamydia trachomatis, considered an important leading cause of preventable blindness in the world. This study aimed at verifying if flies can be the vectors for trachoma in our municipality. Flies were assessed in the households of children diagnosed with inflammatory trachoma at the municipality of Botucatu, Sao Paulo State, Brazil. Fly traps were placed in the backyard of the houses during 24 h, in each of the four weather seasons, over a period of one year. The collected dipterans were taxonomically classified and the presence of Chlamydia trachomatis in the flies was evidenced by using the Polymerase Chain Reaction (PCR). During the studied period, 2,188 flies were collected, mainly during the summer and the spring. The most common identified fly was Musca domestica. All fly samples were negative for Chlamydia trachomatis but several other different bacteria were identified in these flies. The authors concluded that flies are probably not the vectors for trachoma in the studied area. Further studies should be conducted to evaluate other possible factors responsible for the maintenance of the disease in our environment.

Diode Green Laser in the Lid Trichiasis Treatment

Purpose

To validate the standard values and evaluate the success rate in the treatment of minor and major trichiasis using thermoablation with a diode green laser.

Methods

In this interventional prospective study, individuals with minor or major trichiasis who were treated with thermoablation using diode green laser were included. The patients' mean age was 72.1 years; the majority were females (54.1%) and Caucasian (98%). The parameters of the diode laser were wavelength of 532 nm, application time of 200 ms, target size of 50 μm, interval between the shots 150 to 200 ms, and power of 600 to 750 mW. The number of shots was defined by the depth of ablation sufficient to reach the pilus hair bulb. The patients were evaluated by slit-lamp every 3 to 4 months, for up to 15 months. The treatment success rate and the association between variables were analyzed.

Results

The study sample was comprised of 98 patients with 135 affected lids and 337 lashes with trichiasis. Minor trichiasis (91.8%), unilateral trichiasis (67.3%), trichiasis affecting the lower eyelid (85.9%), and trichiasis resulting from blepharitis (64.3%) were the most common presentation profiles. The overall cure rate at the end of the study was 85%, with 69% being cured with a single session and 82.8% with two treatment sessions.

Conclusion

Thermoablation using a diode green laser applying the specified parameters to treat minor and major trichiasis is effective and results in high cure rate.

The effects of two types of Western diet on the induction of metabolic syndrome and cardiac remodeling in obese rats

Metabolic syndrome (MetS) include obesity as a critical feature and is strongly associated with risk of cardiovascular disease (CVD). Insights into mechanisms involved in the pathophysiology of these clinical manifestations are essential for the development of therapeutic strategies. Thus, Western diets (WD) have been widely employed in diet-induced obesity (DIO) model. However, there are variations in fat and sugar proportions of such diets, making comparisons challenging. We aimed to assess the impact of two types of the WD on metabolic status and cardiac remodeling, to achieve a DIO model that better mimics the human pathogenesis of MetS-induced CVD. Male Wistar rats were distributed into three groups: control diet, Western diet fat (WDF), and Western diet sugar (WDS) for 41 weeks. Metabolic and inflammatory parameters and cardiac changes were characterized. WDF and WDS feeding promoted higher serum triglycerides, glucose intolerance, and insulin resistance, while just WDF presented inflammation in adipose tissue. WDF-fed rats showed increased catalase activity and malondialdehyde (MDA) and carbonyl protein levels, suggesting cardiac oxidative stress, while WDS-fed rats only raised MDA. Both WD equally elevated protein expressions involved in lipid metabolism, but only WDF downregulated the glycolysis pathway. Furthermore, the mechanical myocardial function was impaired in obese rats, being more relevant in WDF. In conclusion, both WD effectively triggered MetS features, although inflammation was detected just on the WDF-fed animals. Moreover, the WDF promoted a more pronounced functional, metabolic, and oxidative cardiac disorder, suggesting to be an adequate model for studying CVD in the scenario of MetS.