Abstract Introduction: Fundus autofluorescence (FAF) has shown sensitivity in the detection of macular edema. Objectives: To evaluate indices formed with FAF and retinal anatomical-functional variables in patients with diabetic macular edema (DME) treated with Ziv-aflibercept (Ziv-AFL). Methods: Twenty-nine eyes of 15 DME patients who received Ziv-AFL intravitreal injections were included. Best-corrected visual acuity (BCVA), contrast sensitivity (CS), optical coherence tomography (OCT), and FAF were evaluated before treatment and at one and two months. OCT variables were central subfield thickness (CST), macular volume (MV), and macular cube average thickness (MCAT). FAF/BCVA, FAF/CS, FAF/CST, FAF/MV and AF/MCAT indices baseline values were obtained. Analysis was performed with Spearman's rank correlation coefficient and linear regression analysis. Results: There was a significant correlation between baseline FAF/BCVA index and BCVA at second month (rs = -0.78, p = 0.000), between baseline FAF/CS index and BCVA at second month (rs = -0.68, p = 0.0009), and between baseline FAF/CS index and MV at first month of follow-up (rs = 0.64, p = 0.002). Conclusions: In DME, composite indices with baseline FAF predict variables such as BCVA in the follow-up of patients receiving ziv-AFL.

Resumen Introducción: La autofluorescencia retiniana (AF) ha mostrado sensibilidad en la detección del edema macular. Objetivos: Evaluar índices formados con la AF y variables anatomofuncionales retinianas en pacientes con edema macular diabético (EMD) tratados con ziv-aflibercept (ziv-AFL). Métodos: Fueron incluidos 29 ojos de 15 pacientes con EMD que recibieron inyecciones intravítreas de ziv-AFL. Se evaluó agudeza visual mejor corregida (AVMC), sensibilidad al contraste (SC), tomografía de coherencia óptica (TCO) y AF, antes del tratamiento, así como al primer y segundo mes de iniciado este. Las variables de la TCO fueron grosor foveal central (GFC), volumen macular (VM) y grosor promedio macular (GPM). Se obtuvieron los valores basales de AF/AVMC, AF/SC, AF/GFC, AF/VM y AF/GPM. Se realizó análisis con el coeficiente de correlación de rangos de Spearman y análisis de regresión lineal. Resultados: Hubo una correlación significativa entre el índice AF/AVMC basal y la AVMC en el segundo mes (rs = −0.78, p = 0.000), entre el índice AF/SC basal y la AVMC en el segundo mes (rs = −0.68, p = 0.0009) y entre AF/SC basal y el VM en el primer mes de seguimiento (rs = 0.64, p = 0.002). Conclusiones: En el EMD, los índices compuestos con AF basales predicen variables como AVMC en el seguimiento de pacientes que reciben ziv-AFL.

Introduction: Patients with diabetic macular edema can develop fundus autofluorescence alterations; thus far, these alterations have been more widely studied with scanning or confocal laser systems. Objective: To describe and classify fundus autofluorescence abnormal patterns in patients with diabetic macular edema using the fundus autofluorescence system with a flash camera. Method: Observational, retrospective, cross-sectional, descriptive study. Fundus autofluorescence digital images of non-comparative cases with untreated diabetic macular edema, obtained and stored with a flash camera system, were assessed. Inter-observer variability was evaluated. Results: 37 eyes of 20 patients were included. Lens opacity was the most common cause of inadequate image quality. Five different fundus autofluorescence patterns were observed: decreased (13%), normal (40%), single-spot hyper-autofluorescent (17 %), multiple-spot hyper-autofluorescent (22 %) and plaque-like hyper-autofluorescent (8 %). The kappa coefficient was 0.906 (p = 0.000). Conclusions: Different fundus autofluorescence phenotypic patterns are observed with flash camera systems in patients with diabetic macular edema. A more accurate phenotypic classification could help establish prognostic factors for visual loss or for the design of clinical trials for diabetic macular edema.

A degradação ou ausência de reboco nas paredes e as condições higiênicas deficientes são os fatores de risco mais importantes para a infestação intradomiciliar por Triatoma dimidiata na Guatemala. Realizamos um estudo transdisciplinar sobre infestação por T. dimidiata, higiene intradomiciliar e condições de construção. O estudo destacou as questões de materiais locais e aspectos culturais (inclusive papéis de gênero) que poderiam levar a melhorias nas condições das paredes no longo prazo. Formulou-se uma nova mistura de gesso para paredes, após estudos de laboratório sobre materiais de construção com base em recomendações dos residentes locais. Foram estudados quatro vilarejos com infestação por T. dimidiata que havia persistido mesmo após aplicação de inseticida. Em duas comunidades, foi implementada uma abordagem ecossistêmica, e os residentes implementaram melhorias nas paredes e no saneamento domiciliar, com o apoio da equipe interdisciplinar (intervenção ecossistêmica). Nas duas outras comunidades, adotou-se uma estratégia de controle com base na aplicação de inseticida (intervenção tradicional). Ambas as intervenções levaram a uma redução na infestação por T. dimidiata, mas apenas a abordagem ecossistêmica produziu melhorias importantes nas condições de moradia (saneamento e revestimento das paredes) capazes de prevenir a re-infestação por T. dimidiata no longo prazo.

The deterioration or absence of plaster walls in houses and poor hygienic conditions are the most important risk factors for indoor Triatoma dimidiata infestation in Guatemala. A cross-disciplinary study was conducted addressing T. dimidiata infestation, household hygiene, and housing construction. The study focused on local materials and cultural aspects (including gender roles) that could lead to long-term improvements in wall construction. A new plaster mix for walls was developed on the basis of laboratory studies on construction materials recommended by local villagers. Four villages with persistent (post-spraying) T. dimidiata infestation were studied. In two villages, an ecosystem approach was implemented, and the homeowners conducted wall improvements and household sanitation with the support of the interdisciplinary team (the ecosystem intervention). In the other two villages, a vector control approach based on insecticide spraying was adopted (traditional intervention). Both interventions were associated with a reduction in T. dimidiata infestation, but only the ecosystem approach produced important housing improvements (sanitation and wall construction) capable of preventing T. dimidiata re-infestation in the long term.

Seventeen variables were evaluated as possible risk factors for the intradomiciliary infestation with Triatoma dimidiata in 644 houses in Jutiapa, Guatemala. During 2004 the houses were assessed for vector presence and evaluated for hygiene, cluttering, material comfort, construction conditions and number of inhabitants, among other factors. Chi-square analysis detected significant associations between vector presence and eight variables related to domestic sanitary and construction conditions. Log-linear models showed that regardless of the age of the house, the odds of vector presence were 4.3 and 10 times lower in houses with a good socioeconomic status compared with poor and very poor houses respectively. Log-linear models also pointed to a greater chance of vector presence when walls lacked plastering (3.85 times) or walls had low quality-incomplete plastering (4.56 times), compared with walls that were completely plastered. Control strategies against T. dimidiata should include the introduction of better-quality but inexpensive plastering formulations and better sanitation practices should also be promoted among the population. Such control strategies should not only reduce or eliminate infestation, but also prevent vector reinfestation.

Seiscientas cuarenta y cuatro casas en Jutiapa, Guatemala fueron encuestadas en el año 2004 para buscar el vector de la enfermedad de Chagas Triatoma dimidiata. Diecisiete variables relacionadas con las condiciones estructurales y de higiene de las casas fueron registradas y evaluadas como factores de riesgo para la infestación intradomiciliar con T. dimidiata. Análisis chi-cuadrado detectaron asociaciones significativas entre la presencia del vector y 8 de estas variables. En modelos log-lineares se detectó, que sin importar la antigüedad de la casa, las posibilidades de presencia del vector fueron 4,3 y 10 veces más bajas en casas con un buen estado socioeconómico que en casas pobres o muy pobres, respectivamente. Además, las posibilidades de infestación fueron mayores en casas con paredes sin repello (3,85 veces) o con repellado incompleto o de mala calidad (4,56 veces), que con repellado completo. Las estrategias para el control de T. dimidiata deberían incluir la introducción de repellos baratos y de buena calidad y la promoción de mejores prácticas sanitarias. Estas estrategias no solo reducirían o eliminaría la infestación, sino también ayudaría a prevenir la reinfestación.

A degradação ou ausência de reboco nas paredes e as condições higiênicas deficientes são os fatores de risco mais importantes para a infestação intradomiciliar por Triatoma dimidiata na Guatemala. Realizamos um estudo transdisciplinar sobre infestação por T. dimidiata, higiene intradomiciliar e condições de construção. O estudo destacou as questões de materiais locais e aspectos culturais (inclusive papéis de gênero) que poderiam levar a melhorias nas condições das paredes no longo prazo. Formulou-se uma nova mistura de gesso para paredes, após estudos de laboratório sobre materiais de construção com base em recomendações dos residentes locais. Foram estudados quatro vilarejos com infestação por T. dimidiata que havia persistido mesmo após aplicação de inseticida. Em duas comunidades, foi implementada uma abordagem ecossistêmica, e os residentes implementaram melhorias nas paredes e no saneamento domiciliar, com o apoio da equipe interdisciplinar (intervenção ecossistêmica). Nas duas outras comunidades, adotou-se uma estratégia de controle com base na aplicação de inseticida (intervenção tradicional). Ambas as intervenções levaram a uma redução na infestação por T. dimidiata, mas apenas a abordagem ecossistêmica produziu melhorias importantes nas condições de moradia (saneamento e revestimento das paredes) capazes de prevenir a re-infestação por T. dimidiata no longo prazo.

The deterioration or absence of plaster walls in houses and poor hygienic conditions are the most important risk factors for indoor Triatoma dimidiata infestation in Guatemala. A cross-disciplinary study was conducted addressing T. dimidiata infestation, household hygiene, and housing construction. The study focused on local materials and cultural aspects (including gender roles) that could lead to long-term improvements in wall construction. A new plaster mix for walls was developed on the basis of laboratory studies on construction materials recommended by local villagers. Four villages with persistent (post-spraying) T. dimidiata infestation were studied. In two villages, an ecosystem approach was implemented, and the homeowners conducted wall improvements and household sanitation with the support of the interdisciplinary team (the ecosystem intervention). In the other two villages, a vector control approach based on insecticide spraying was adopted (traditional intervention). Both interventions were associated with a reduction in T. dimidiata infestation, but only the ecosystem approach produced important housing improvements (sanitation and wall construction) capable of preventing T. dimidiata re-infestation in the long term.

Seventeen variables were evaluated as possible risk factors for the intradomiciliary infestation with Triatoma dimidiata in 644 houses in Jutiapa, Guatemala. During 2004 the houses were assessed for vector presence and evaluated for hygiene, cluttering, material comfort, construction conditions and number of inhabitants, among other factors. Chi-square analysis detected significant associations between vector presence and eight variables related to domestic sanitary and construction conditions. Log-linear models showed that regardless of the age of the house, the odds of vector presence were 4.3 and 10 times lower in houses with a good socioeconomic status compared with poor and very poor houses respectively. Log-linear models also pointed to a greater chance of vector presence when walls lacked plastering (3.85 times) or walls had low quality-incomplete plastering (4.56 times), compared with walls that were completely plastered. Control strategies against T. dimidiata should include the introduction of better-quality but inexpensive plastering formulations and better sanitation practices should also be promoted among the population. Such control strategies should not only reduce or eliminate infestation, but also prevent vector reinfestation.

Seiscientas cuarenta y cuatro casas en Jutiapa, Guatemala fueron encuestadas en el año 2004 para buscar el vector de la enfermedad de Chagas Triatoma dimidiata. Diecisiete variables relacionadas con las condiciones estructurales y de higiene de las casas fueron registradas y evaluadas como factores de riesgo para la infestación intradomiciliar con T. dimidiata. Análisis chi-cuadrado detectaron asociaciones significativas entre la presencia del vector y 8 de estas variables. En modelos log-lineares se detectó, que sin importar la antigüedad de la casa, las posibilidades de presencia del vector fueron 4,3 y 10 veces más bajas en casas con un buen estado socioeconómico que en casas pobres o muy pobres, respectivamente. Además, las posibilidades de infestación fueron mayores en casas con paredes sin repello (3,85 veces) o con repellado incompleto o de mala calidad (4,56 veces), que con repellado completo. Las estrategias para el control de T. dimidiata deberían incluir la introducción de repellos baratos y de buena calidad y la promoción de mejores prácticas sanitarias. Estas estrategias no solo reducirían o eliminaría la infestación, sino también ayudaría a prevenir la reinfestación.