Murilo Barreto Souza

E-learning program for medical students in dermatology

INTRODUCTION: Dermatological disorders are common in medical practice. In medical school, however, the time devoted to teaching dermatology is usually very limited. Therefore, online educational systems have increasingly been used in medical education settings to enhance exposure to dermatology. OBJECTIVE: The present study was designed to develop an e-learning program for medical students in dermatology and evaluate the impact of this program on learning. METHODS: This prospective study included second year medical students at the University of Technology and Science, Salvador, Brazil. All students attended discussion seminars and practical activities, and half of the students had adjunct online seminars (blended learning). Tests were given to all students before and after the courses, and test scores were evaluated. RESULTS: Students who participated in online discussions associated with face-to-face activities (blended learning) had significantly higher posttest scores (9.0±0.8) than those who only participated in classes (7.75±1.8, p <0.01). CONCLUSIONS: The results indicate that an associated online course might improve the learning of medical students in dermatology.

Evaluation of machine learning classifiers in keratoconus detection from orbscan II examinations

PURPOSE: To evaluate the performance of support vector machine, multi‐layer perceptron and radial basis function neural network as auxiliary tools to identify keratoconus from Orbscan II maps. METHODS: A total of 318 maps were selected and classified into four categories: normal (n = 172), astigmatism (n = 89), keratoconus (n = 46) and photorefractive keratectomy (n = 11). For each map, 11 attributes were obtained or calculated from data provided by the Orbscan II. Ten‐fold cross‐validation was used to train and test the classifiers. Besides accuracy, sensitivity and specificity, receiver operating characteristic (ROC) curves for each classifier were generated, and the areas under the curves were calculated. RESULTS: The three selected classifiers provided a good performance, and there were no differences between their performances. The area under the ROC curve of the support vector machine, multi‐layer perceptron and radial basis function neural network were significantly larger than those for all individual Orbscan II attributes evaluated (p<0.05). CONCLUSION: Overall, the results suggest that using a support vector machine, multi‐layer perceptron classifiers and radial basis function neural network, these classifiers, trained on Orbscan II data, could represent useful techniques for keratoconus detection.

Chlorambucil and cyclosporine A in Brazilian patients with Behçet's disease uveitis: a retrospective study

PURPOSE To assess the efficacy and side effects of immunosuppressive therapy in patients with Behçets disease uveitis. METHODS A nonrandomized retrospective case-series study analyzed data from 22 patients with Behçets disease uveitis, from a single Uveitis Service, São Paulo, Brazil (period 1978-2007), under systemic chlorambucil and/or cyclosporine A, for at least 6 months with a minimum one-year follow-up. Drug efficacy was measured by reduction in relapse rate and reduction of prednisone dose. RESULTS Patients (10M/12F) mean age was 29 (range 10-43) years-old at the onset of uveitis. The median duration of followup was 11 (range 1-29) years-old. Chlorambucil (2-6 mg/day) was used in 13 patients and cyclosporine A (3-5 mg/kg/day) in 9 patients at initiation. Drugs were switched because of no effectiveness or side-effects. Chlorambucil was effective in 78.5% (11/14) and induced disease remission in 43% (6/14) of patients, whereas cyclosporine A was effective in 57% (8/14) of patients. Chlorambucil and cyclosporine A were discontinued due to side effects in 21% (leucopenia) and in 57% of patients (nephrotoxicity, 36% and gastrointestinal complications, 21%), respectively. No case of late malignancy was observed. 36% (16/44) of eyes had final visual acuity < or =0.1, among which 69% (11/16) had already this visual acuity at the first visit. CONCLUSION This study reiterates previous data that chlorambucil can induce long-term remission of Behçets disease uveitis, whereas cyclosporine is effective but side effects limit its use. Chlorambucil therapy may still be a reasonable option in patients with intractable, sight-threatening Behçets disease uveitis.

Teledermatologia: correlação diagnóstica em serviço primário de saúde

BACKGROUND: Telemedicine can be defined as the use of telecommunication technologies for the transmission of health data. It has been described in different medical specialties, especially those in which interpretation of images represents a fundamental key in formulating diagnosis. OBJECTIVE: To evaluate the role of teledermatology in primary care system. METHODS: A prospective analysis included 60 patients seen in a primary care unit. All patients were seen by a dermatologist as regular outpatient dermatology consultation. A medical student obtained digital images and a brief clinical history of all patients. Using a Telemedicine system these data were reviewed by two dermatologists for distance diagnosis. Agreement between the diagnoses was assessed. RESULTS: Good agreement, ranging from 86.6% to 91.6%, was achieved between direct observation and teleconsultation. Good agreement was also achieved between two telemedicine diagnosis (Kappa = 0.62). CONCLUSION: Teledermatology is a form of care with great potential for use in dermatology, and could represent a useful tool in cases of low complexity from primary health units.

Oculometric parameters of hyperopia in children with esotropic amblyopia.

Citation information: Debert I, de Alencar LM, Polati M, Souza MB & Alves MR. Oculometric parameters of hyperopia in children with esotropic amblyopia. Ophthalmic Physiol Opt 2011, 31, 389–397. doi: 10.1111/j.1475‐1313.2011.00850.x

Estrabismo sensorial: estudo de 191 casos

PURPOSE: To evaluate the charts of patients with sensorial strabismus regarding range of different aspects, such as etiology, the type and the amount of deviation, relationship between the type of deviation and the patients age when the disease occurred and the surgical outcome. METHODS: A retrospective analysis of data charts of 191 patients seen at the section of Ophthalmology at the University of Sao Paulo, from September 1990 to July 2002. RESULTS: There were 84 male and 107 female patients. The most frequent diagnosis responsible for low vision in the squinted eye was atrophic chorioretinitis in 49 patients. Eighty-seven were exotropes and 97 were esotropes. Fifty patients were operated on, but 8 of them were lost to follow-up. In 90.5% the surgical outcome was successful: less than 15 prismatic diopters of hyper or undercorrection after surgery. CONCLUSIONS: The good surgical outcome seen in this and other studies enhances and justifies the need for surgical correction of this type of strabismus.

Criptococose palpebral: relato de caso

Relata-se o caso de uma paciente portadora de sindrome da imunodeficiencia adquirida empiricamente tratada com esquema triplice para tuberculose miliar. Durante a evolucao clinica a paciente cursou com lesoes comprometendo a palpebra e conjuntiva tarsal a direita. A hipotese diagnostica inicial foi de tuberculose ocular com comprometimento conjuntival e palpebral. A biopsia da lesao conjuntival mostrou presenca do Criptococcus neoformans. Apos o inicio do tratamento especifico com anfotericina B, a paciente apresentou melhora das lesoes cutâneas.

Relationship between the biomechanical properties of the cornea and anterior segment measurements

OBJECTIVE: To evaluate the relationship of biomechanical properties, corneal hysteresis and corneal resistance factor with age, sex and various corneal parameters measured with a Pentacam in normal subjects. METHODS: A total of 226 eyes from 113 patients were enrolled in this study. The subjects underwent Ocular Response Analyzer and Pentacam evaluations. A varying-intercept multilevel regression was implemented using Bayesian inference. The predictor variables were age, sex, central corneal thickness, corneal volume at a 7-mm diameter, anterior chamber angle and volume, anterior chamber depth, mean radius of the corneal curvature and corneal astigmatism. RESULTS: Corneal hysteresis ranged from 5.5 to 14.8舁mmHg (mean 10.42±1.74舁mmHg), and the corneal resistance factor ranged from 5.7 to 15.5舁mmHg (mean 10.23±1.88舁mmHg). No predictor variable other than gender and central corneal thickness had a significant correlation with either corneal hysteresis or corneal resistance factor. Corneal hysteresis was positively associated with female sex and with central corneal thickness, and corneal resistance factor was positively associated with central corneal thickness. CONCLUSION: Despite the associations found, only a small fraction of the variance in biomechanical measurements could be explained by the descriptors that were evaluated, indicating the influence of other corneal aspects on the biomechanical characteristics.

Diagnóstico do ceratocone baseado no Orbscan com o auxílio de uma rede neural

PURPOSE: To evaluate an artificial neural network in order to correctly identify Orbscan IITM tests of patients with normal and keratoconus corneas. METHODS: A retrospective analysis included 98 Orbscan IITM tests of 59 subjects and an artificial neural network was created and trained based on the Java Neural Network 1.1 software. Seventy-three tests (59 normal tests and 14 keratoconus examinations) were applied to train the neural network and 25 eyes were used to test the method (19 normal eyes and 6 cases of keratoconus corneas). RESULTS: Backpropagation method was performed to train the neural network to 5% error and 0.2 learning rate. The trained neural network presented sensibility and specificity of 83 and 100% respectively. CONCLUSION: Artificial neural network can accurately help clinicians to classify keratoconus in Orbscan IITM tests.

Doenças do segmento anterior ocular associadas a lentes de contato

Nowadays, contact lenses have shown a larger variety of options in order to meet the needs of different patients. They have become more frequent in the clinical practice and, consequently, the complications related to contact lenses have been more common. This review attempted to describe the main alterations and diseases of the cornea and anterior segment associated with contact lens wearers.