Search

Sidney Julio Faria-e-Sousa,1 Monike de Paula Gomes Vieira,1 Jailton Vieira Silva21University of São Paulo, São Paulo, Brazil; 2Federal University of Ceará, Ceará, BrazilPurpose: Intermittent entropion may go unnoticed by both patient and physician, in some instances resulting in ocular surface disorders. Unfortunately, the current work-up used to diagnose entropion is not always sufficient to uncover the problem. We present an alternative diagnostic test.Cases: Two case reports are presented showing different situations where the current methods for detection of entropion failed and the diagnosis was only made with an alternative diagnostic test.Results: The common denominator of both cases is an intermittent entropion which could not be detected by the conventional clinical work-up. Diagnosis was easy however using the “TIE test” described in the text.Conclusion: The important clues for suspicion of intermittent entropion are an intermittent foreign-body sensation in the eye accompanied with central punctate keratopathy. The TIE test is a simple and useful test for the diagnosis of intermittent entropion.Keywords: eyelids, lid abnormality, TIE test

Mead is a fermented alcoholic beverage that is made from honey diluted in water and commonly with the addition of other ingredients. The chemical characteristics of mead are closely related to the ingredients and additives that are used in its preparation, especially the type of honey, yeast strain and prefermentation nutrients, as well as herbs, spices and/or fruits. These additives can affect not only the fermentation process, in particular the yeast activity, the formation of metabolites and fermentation time, but also the bioactive potential of the mead, which mainly depends on phenolic compounds. Scientific studies have shown that the mead with added different plant species contains considerable amounts of different classes of polyphenols, which have important biological activities. Within this context, this review study seeks to investigate how different ingredients and additives can affect each of the stages of the preparation of mead, as well as its bioactive potential, in order to understand the effects on its chemical composition, and thus add greater commercial value to this beverage., Competing Interests: CONFLICT OF INTEREST The authors declare that there is no conflict of interest.

Objective: This study aims to analyze the construct and content validity of the Iconographical Falls Efficacy Scale (Icon-FES) in order to measure the fear of falling in community-dwelling older adults., Methods: The Icon-FES was applied to 333 older adults. An exploratory factor analysis was performed to assess internal consistency. Item response theory (IRT) and confirmatory factor analysis (CFA) were used to evaluate the consistency of the questionnaire and whether it corresponded satisfactorily to the construct "concern about falling." Concurrent validity with the Falls Efficacy Scale-International (FES-I) and convergent validity with the Senior Fitness Test (SFT) were also assessed. Receiving operator characteristic (ROC) curves were used to determine the sensitivity and specificity., Results: The structural model of the 30-item and 10-item Icon-FES showed some theoretical fragility. The final model of the new short version of the Icon-FES consisted of 13 items, yielding a theoretically satisfactory structural model. Validity analyses indicated that the 13-item Icon-FES had a moderate relationship with the SFT, a strong relationship with the FES-I, and good sensitivity and specificity for a history of falls., Conclusion: The 13-item Icon-FES has excellent psychometric properties for measuring fear of falling in community-dwelling older adults. It can be recommended as a screening tool for fear of falling for both research and clinical purposes.

Introduction: Brain ischaemic hypoxia can produce severe neurological damage that leads to behavioural disorders. This research analysed the hippocampal and cerebellar histological alterations caused by brain ischaemic hypoxia experimentally induced by sodium nitrite (NaNO 2 ) and possible direct repercussions of this hypoxia on behaviour., Methodology: An experimental study was carried out by administering 60mg/kg NaNO 2 to 10 Wistar rats at 3 months of age for 15 consecutive days. Ten control rats did not receive NaNO 2 . To assess behavioural repercussions, the animals were evaluated in Open Field, Elevated Plus-Maze (EPM), and Forced Swim tests before and after injury to evaluate locomotion, anxiety, and depression, respectively. Markers of stress were evaluated by measuring the blood levels of cortisol, glucose, cholesterol, and lactate. The presence of hippocampal lesions was verified by histologically studying the CA1-CA4 areas. Sections of the cerebellum were also evaluated because Purkinje cells are highly sensitive to ischaemic hypoxia and may serve as markers for this process., Results: The number of neurons with lesions was significantly higher in animals exposed to NaNO 2 in the hippocampus areas CA2, CA3, and CA4. The cerebellum was also very vulnerable to hypoxia, presenting extensive lesion áreas. These results are correlated with the parameters of the anxiety and depression tests., Conclusion: NaNO 2 promoted brain damage due to ischaemic hypoxia in rats. Intoxicated animals showed decreased brain weights; damage in hippocampus and cerebellum; and anxiogenic and depressive behaviour., (Copyright © 2017 Elsevier B.V. All rights reserved.)

This study reports the high-virulence phylogenetic backgrounds of CMY-2- and CTX-M-2-producing avian pathogenic Escherichia coli strains isolated from turkeys sent to slaughter and condemned by airsacculitis in Brazil. Among 300 air sac samples, seven E. coli strains produced plasmid-mediated CMY-2-type AmpC, of which three carried also the bla CTX-M-2 Extended Spectrum Beta-Lactamase encoding gene. Interestingly, the transfer of the bla CMY-2 gene was positive for three E. coli strains, being associated with the presence of IncI1 plasmids. The complete sequence of the representative pJB10 plasmid revealed that the bla CMY-2 gene was within a transposon-like element in the classical genetic environment consisting of tnpA-bla CMY-2 -blc-sugE structure. This plasmid with 94-kb belonged to the sequence type (ST) 12 among IncI1 plasmids, which has been associated with the worldwide spread of bla CMY-2 among Salmonella enterica and E. coli. Furthermore, to the best of our knowledge, this is the first complete sequence of a CMY-2-encoding plasmid derived from an Escherichia coli isolated from food-producing animals in Latin America., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Seabirds may be responsible for the spread of pathogenic/resistant organisms over great distances, playing a relevant role within the context of the One World, One Health concept. Diarrheagenic E. coli strains, known as STEC (shiga toxin-producing E. coli), and the extraintestinal pathogenic E. coli (ExPEC and the subpathotype APEC), are among the E. coli pathotypes with zoonotic potential associated with the birds. In order to identify health threats carried by frigates and to evaluate the anthropic influence on the southern coast of Brazil, the aim of this work was to characterize E. coli isolated from free-ranging frigates in relation to virulence genotypes, serotypes, phylogenetic groups and antimicrobial resistance. Cloacal and choanal swabs were sampled from 38 Fregata magnificens from two oceanic islands and one rescue center. Forty-three E. coli strains were recovered from 33 out of the 38 birds (86.8%); 88.4% of strains showed some of the virulence genes (VGs) searched, 48.8% contained three or more VGs. None of the strains presented VGs related to EPEC/STEC. Some of the isolates showed virulence genotypes, phylogenetic groups and serotypes of classical human ExPEC or APEC (O2:H7, O1:H6, ONT:H7, O25:H4). Regarding antimicrobial susceptibility, 62.8% showed resistance, and 11.6% (5/43) were multidrug-resistant. The E. coli present in the intestines of the frigates may reflect the environmental human impact on southeast coast of Brazil; they may also represent an unexplored threat for seabird species, especially considering the overlap of pathogenic potential and antimicrobial resistance present in these strains.

Purpose: The tilted optic disc is associated with peripapillary choroidal and retinal nerve fiber layer (RNFL) changes as well as visual field defects, often leading to diagnostic difficulties due to similarities with glaucomatous discs. We studied the peripapillary RNFL of the tilted optic disc by comparing values obtained with spectral-domain (SD) and time-domain (TD) optical coherence tomography (OCT) in order to identify characteristic RNFL patterns verified by both OCT devices, and also to determine whether SD-OCT offers any diagnostic advantage over TD-OCT., Methods: Prospective case-control study of 16 individuals with tilted optic discs (27 eyes) and an age-matched control group (10 individuals, 20 eyes). Each case was subjected to ophthalmological examination and automated perimetry. Tilt orientation was classified based on observation of optic disc photographs, and angle of disc torsion was calculated with image processing software. RNFL measurements were obtained with TD-OCT and SD-OCT. Peripapillary choroid thickness was measured with SD-OCT. The findings were related with optic disc morphology and automated perimetry results., Results: Stratus OCT results showed significantly lower superior RNFL (P<0.001) on the tilted group, whereas Spectralis indicated significantly lower superotemporal (P<0.001), superonasal (P=0.001), temporal (P=0.01), and global (P=0.01) RNFL on the tilted disc group. A significant correspondence was found between elevated disc rim and location of RNFL defect on the Spectralis (P=0.004). On the tilted group, peripapillary choroidal thickness was significantly thicker adjacent to the elevated rim (P<0.001). No correspondence was found between tilt orientation, peripapillary RNFL, or choroidal thickness and location of perimetric defects., Conclusions: Our results provide a clinical characterization of the main tilted disc morphologies and are valuable for correctly differentiating a tilted disc from a myopic glaucomatous disc. RNFL assessment by Spectralis OCT seems to be more susceptible to altered disc morphologies. The peripapillary RNFL changes found on titled disc cases could not predict the location of visual field defects.

This study describes an outbreak of necrotic enteritis caused by Clostridium perfringens type A in captive macaws (Ara ararauna). Two psittacine birds presented a history of prostration and died 18 hr after manifestation of clinical signs. The necropsy findings and histopathologic lesions were indicative of necrotic enteritis. Microbiologic assays resulted in the growth of large gram-positive bacilli that were identified as C. perfringens. PCR was used to identify clostridium toxinotypes and confirmed the identification of isolated strains as C pefringens type A, positive to gene codifying beta 2 toxin. The infection source and predisposing factors could not be ascertained.

Purpose: To study the potential association between fundus autofluorescence, spectral-domain optical coherence tomography, and visual acuity in patients undergoing surgery because of epiretinal membranes., Methods: Prospective, interventional case series including 26 patients submitted to vitrectomy because of symptomatic epiretinal membranes. Preoperative evaluation consisted of a complete ophthalmologic examination, autofluorescence, and spectral-domain optical coherence tomography. Studied variables included foveal autofluorescence (fov.AF), photoreceptor inner segment/outer segment (IS/OS) junction line integrity, external limiting membrane integrity, central foveal thickness, and foveal morphology. All examinations were repeated at the first, third, and sixth postoperative months. The main outcome measures were logarithm of minimal angle resolution visual acuity, fov.AF integrity, and IS/OS integrity., Results: All cases showing a continuous IS/OS line had an intact fov.AF, whereas patients with IS/OS disruption could have either an increased area of foveal hypoautofluorescence or an intact fov.AF, with the latter being associated with IS/OS integrity recovery in follow-up spectral-domain optical coherence tomography imaging. The only preoperative variables presenting a significant correlation with final visual acuity were baseline visual acuity (P = 0.047) and fov.AF grade (P = 0.023)., Conclusion: Recovery of IS/OS line integrity after surgery, in patients with preoperative IS/OS disruption and normal fov.AF, can be explained by the presence of a functional retinal pigment epithelium-photoreceptor complex, supporting normal photoreceptor activity. Autofluorescence imaging provides a functional component to the study of epiretinal membranes, complementing the structural information obtained with optical coherence tomography.

Avian Pathogenic Escherichia coli (APEC) has been studied for decades because of its economic impact on the poultry industry. Recently, the zoonotic potential of APEC and multidrug-resistant strains have emerged. The aim of this study was to characterize 225 APEC isolated from turkeys presenting airsacculitis. The results showed that 92% of strains presented a multidrug-resistance (MDR), and the highest levels of resistance were to sulfamethazine (94%) and tetracycline (83%). Half of these strains were classified in phylogenetic group B2, followed by B1 (28.6%), A (17.1%), and D (4.8%). The prevalence of virulence genes was as follows: salmochelin (iroN, 95%), increased serum survival (iss, 93%), colicin V (cvi/cva, 67%), aerobactin (iucD, 67%), temperature-sensitive haemagglutinin (tsh, 56%), iron-repressible protein (irp2, 51%), invasion brain endothelium (ibeA, 31%), vacuolating autotransporter toxin (vat, 24%), K1 antigen (neuS, 19%), enteroaggregative heat-stable cytotoxin (astA, 17%), and pilus associated with pyelonephritis (papC, 15%). These results demonstrate that the majority of the investigated strains belonged to group B2 and were MDR. These data suggest that turkeys may serve as a reservoir of pathogenic and multidrug-resistance strains, reinforcing the idea that poultry plays a role in the epidemiological chain of ExPEC.