<p>Fifty children with hematologic malignancies have been treated with autologous BMT in Uppsala. The aim was to describe late effects in this group with special reference to cataracts, reduced final height, and to hepatic, renal, and pulmonary late effects. </p><p>Cataracts: All patients who received TBI in their conditioning developed posterior subcapsular cataract after BMT. A few patients with visual impairment affecting daily life needed cataract surgery, whereas the visual acuity was well preserved in most of the other patients.</p><p>Final height: There was a decrease in final height relative both to height at BMT and to target height. This decrease was significant both in those who had received TBI only and in those who had been given cranial irradiation. Cranial irradiation, young age at BMT, and short duration of GH treatment were predictors of height loss. </p><p>Hepatic function: Hepatic function was well preserved over a period of 10 years after BMT. TBI did not appear to be a risk factor for hepatic impairment. </p><p>Renal function: Six months after BMT there was a decrease in renal function in patients who had received TBI. It then recovered, albeit incompletely, and stabilized. After the first year there was little change over a period of 10 years after BMT. TBI appeared to be the most important risk factor for the development of chronic renal impairment in a number of patients. Nephrotoxic antibiotics may have contributed.</p><p>Pulmonary function: Six months after BMT there was a decrease in pulmonary function in those who received TBI. It then recovered and stabilized at the pretransplant level. After the first year there was little change over a period of 10 years after BMT. TBI appeared to be the most important risk factor for restrictive pulmonary disease in a number of patients whereas chemotherapy might also have been of importance for impaired gas exchange.</p>

Fifty children with hematologic malignancies have been treated with autologous BMT in Uppsala. The aim was to describe late effects in this group with special reference to cataracts, reduced final height, and to hepatic, renal, and pulmonary late effects. Cataracts: All patients who received TBI in their conditioning developed posterior subcapsular cataract after BMT. A few patients with visual impairment affecting daily life needed cataract surgery, whereas the visual acuity was well preserved in most of the other patients. Final height: There was a decrease in final height relative both to height at BMT and to target height. This decrease was significant both in those who had received TBI only and in those who had been given cranial irradiation. Cranial irradiation, young age at BMT, and short duration of GH treatment were predictors of height loss. Hepatic function: Hepatic function was well preserved over a period of 10 years after BMT. TBI did not appear to be a risk factor for hepatic impairment. Renal function: Six months after BMT there was a decrease in renal function in patients who had received TBI. It then recovered, albeit incompletely, and stabilized. After the first year there was little change over a period of 10 years after BMT. TBI appeared to be the most important risk factor for the development of chronic renal impairment in a number of patients. Nephrotoxic antibiotics may have contributed. Pulmonary function: Six months after BMT there was a decrease in pulmonary function in those who received TBI. It then recovered and stabilized at the pretransplant level. After the first year there was little change over a period of 10 years after BMT. TBI appeared to be the most important risk factor for restrictive pulmonary disease in a number of patients whereas chemotherapy might also have been of importance for impaired gas exchange.

Se ha estudiado la calidad óptica del ojo en función de la edad para entender mejor el envejecimiento del sistema visual humano. Se ha construido un sistema experimental de registro de imágenes, adaptado a un entorno clínico, para medir la función de transferencia (MTF) ocular, y se ha desarrollado un procedimiento computacional para obtener las aberraciones ópticas de la córnea. Se han realizado medidas en una población de 60 sujetos distribuidos en tres grupos de edad (20-30 años, 40-50 años y 60-70 años), y en un grupo de pacientes implantados con lente intraocular. La MTF media ocular empeora de cada grupo de edad al siguiente, y las aberraciones corneales tienden a aumentar. La calidad óptica del ojo humano se reduce progresivamente con la edad; la córnea es parcialmente responsable de esa reducción. La calidad óptica en pacientes con lente intraocular es similar a la media de los sujetos mayores normales. / The optical quality of the eye was studied as a function of age to better understand the aging process in the human visual system. An experimental imaging system, adapted to a clinical environment, was constructed to measure the ocular modulation transfer function (MTF). A computational procedure was developed to obtain the optical aberrations of the cornea. Measurements were performed in a population of 60 subjects within three age groups (20-30 years, 40-50 years, and 60-70 years), and in a group of 20 patients implanted with intraocular lenses. The average MTF declines as age increases from young to middle and older groups. Corneal aberrations tends to increase with age. Optical quality of the human eye progressively deteriorates with age. The cornea may partially explain the reduction of optical performance of the complete eye. The average image quality in patients with intraocular lenses was similar to the average of normal older subjects.

O vírus da diarreia viral bovina (BVDV) é responsável por diferentes síndromes que afetam principalmente bovinos em todo o mundo, causando grandes perdas econômicas. A principal medida de controle desta infecção é a detecção e retirada dos animais persistentemente infectados (PI) do rebanho. O presente trabalho analisou a infecção persistente por este vírus em um rebanho bovino de gado de corte, vacinado com vacina inativada contra BVDV tipo 1 e localizado no Município de Viamão, Rio Grande do Sul, de novembro de 2007 a maio de 2009. Para a triagem de animais PI, amostras de soro, sangue com EDTA e fragmentos de orelhas foram coletadas principalmente de animais com idade entre 2-3 meses. Os testes utilizados compreenderam o isolamento viral, a transcrição reversa seguida da reação em cadeia da polimerase (RT-PCR), a imuno-histoquímica (IHQ) e a sorologia pelo ensaio imunoenzimático (ELISA). De 1300 animais da propriedade, coletou-se 179 amostras e em 6 se identificou a infecção persistente pelo BVDV tipo 2 não citopático (ncp). Os principais sinais clínicos verificados na propriedade englobavam nascimento de bezerros fracos, grande número de animais com retardo no crescimento e catarata congênita uni e bilateral. As principais lesões observadas em 5 animais necropsiados consistiam de aumento dos linfonodos mesentéricos, evidenciação das placas de Peyer e em um animal verificou-se pododermatite com lesões crostosas no plano nasal e na região periocular. Os achados microscópicos caracterizavam-se principalmente por infiltrado mononuclear na lâmina própria do intestino delgado e rarefação linfoide com infiltrado histiocitário nos centrofoliculares de linfonodos e nas placas de Peyer. A demonstração do antígeno viral nos 5 animais avaliados ocorreu principalmente em: queratinócitos da epiderme , no epitélio de folículos pilosos e células dendríticas da derme de orelhas e pele; histiócitos e em linfócitos dos linfonodos; células foliculares da tireoide; no citoplasma de neurônios e em menor escala, em células da micróglia no córtex cerebral e no hipocampo. A análise de pools de soro de animais suspeitos pelo RT-PCR em conjunto com a avaliação imuno-histoquímica de biópsia de orelhas mostraram bons resultados e podem ser úteis como método de triagem de infecções persistentes em rebanhos, inclusive em animais menores de 6 meses de idade por não sofrerem interferência de anticorpos maternos. A retirada e eliminação dos animais PI surtiram efeitos positivos na propriedade, entretanto novas coletas devem ser realizadas em 2010. / Bovine viral diarrhea virus (BVDV) is responsible for different syndromes that affect mainly cattle worldwide, causing important economic losses. The main control measure for this infection is the detection and removal of all persistently animals infected (PI) from the herd. This study examined the persistent infection for this virus in a beef cattle herd, vaccinated with killed vaccine against BVDV type 1, located in the county of Viamão, Rio Grande do Sul, southern Brazil, from november 2007 to may 2009. For the screening of PI animals, serum, blood with EDTA and fragments of ears were collected mainly from animals aged between 2-3 months. Tests used were viral isolation, reverse transcription polymerase chain reaction (RT-PCR), immunohistochemistry (IHC) and serology by enzyme linked immunosorbent assay (ELISA). From 1300 animals, 179 samples were collected and 6 were identified as persistent infected for BVDV type 2 non-cytopathic (ncp). The most important clinical signs observed on the farm were birth of weak calves, many animals with growth retardation and unilateral or bilateral cataract. The main gross lesions observed at the necropsy of 5 animals were enlargement of mesenteric lymph nodes and Peyer's patches, and in one case, pododermatitis with crusted lesions on nasal planum and periocular region. The microscopic findings were characterized mostly by mononuclear infiltrate in the lamina propria primarily in small intestine and lymphoid depletion with histiocytic infiltrate in follicular centers of lymph nodes and Peyer's patches. In 5 animals evaluated the viral antigen was more frequently demonstrated in epidermal keratinocytes, epithelium of hair follicles and dendritic cells of the dermis of the ears and skin, histiocytes and lymphocytes in lymph nodes, thyroid follicular cells, in the cytoplasm of neurons and to a lesser extent, in glial cells in the cerebral cortex and hippocampus. The analysis of pools of serum from animals suspected by RT-PCR together with immunohistochemical analysis of ears biopsy showed good results and can be useful as screening method for persistent infections in cattle, including animals under 6 months age, because they not suffer interference from maternal antibodies. The removal and elimination of PI animals had positive effects on the property, however new collection should be carried out in 2010.

O vírus da diarreia viral bovina (BVDV) é responsável por diferentes síndromes que afetam principalmente bovinos em todo o mundo, causando grandes perdas econômicas. A principal medida de controle desta infecção é a detecção e retirada dos animais persistentemente infectados (PI) do rebanho. O presente trabalho analisou a infecção persistente por este vírus em um rebanho bovino de gado de corte, vacinado com vacina inativada contra BVDV tipo 1 e localizado no Município de Viamão, Rio Grande do Sul, de novembro de 2007 a maio de 2009. Para a triagem de animais PI, amostras de soro, sangue com EDTA e fragmentos de orelhas foram coletadas principalmente de animais com idade entre 2-3 meses. Os testes utilizados compreenderam o isolamento viral, a transcrição reversa seguida da reação em cadeia da polimerase (RT-PCR), a imuno-histoquímica (IHQ) e a sorologia pelo ensaio imunoenzimático (ELISA). De 1300 animais da propriedade, coletou-se 179 amostras e em 6 se identificou a infecção persistente pelo BVDV tipo 2 não citopático (ncp). Os principais sinais clínicos verificados na propriedade englobavam nascimento de bezerros fracos, grande número de animais com retardo no crescimento e catarata congênita uni e bilateral. As principais lesões observadas em 5 animais necropsiados consistiam de aumento dos linfonodos mesentéricos, evidenciação das placas de Peyer e em um animal verificou-se pododermatite com lesões crostosas no plano nasal e na região periocular. Os achados microscópicos caracterizavam-se principalmente por infiltrado mononuclear na lâmina própria do intestino delgado e rarefação linfoide com infiltrado histiocitário nos centrofoliculares de linfonodos e nas placas de Peyer. A demonstração do antígeno viral nos 5 animais avaliados ocorreu principalmente em: queratinócitos da epiderme , no epitélio de folículos pilosos e células dendríticas da derme de orelhas e pele; histiócitos e em linfócitos dos linfonodos; células foliculares da tireoide; no citoplasma de neurônios e em menor escala, em células da micróglia no córtex cerebral e no hipocampo. A análise de pools de soro de animais suspeitos pelo RT-PCR em conjunto com a avaliação imuno-histoquímica de biópsia de orelhas mostraram bons resultados e podem ser úteis como método de triagem de infecções persistentes em rebanhos, inclusive em animais menores de 6 meses de idade por não sofrerem interferência de anticorpos maternos. A retirada e eliminação dos animais PI surtiram efeitos positivos na propriedade, entretanto novas coletas devem ser realizadas em 2010. / Bovine viral diarrhea virus (BVDV) is responsible for different syndromes that affect mainly cattle worldwide, causing important economic losses. The main control measure for this infection is the detection and removal of all persistently animals infected (PI) from the herd. This study examined the persistent infection for this virus in a beef cattle herd, vaccinated with killed vaccine against BVDV type 1, located in the county of Viamão, Rio Grande do Sul, southern Brazil, from november 2007 to may 2009. For the screening of PI animals, serum, blood with EDTA and fragments of ears were collected mainly from animals aged between 2-3 months. Tests used were viral isolation, reverse transcription polymerase chain reaction (RT-PCR), immunohistochemistry (IHC) and serology by enzyme linked immunosorbent assay (ELISA). From 1300 animals, 179 samples were collected and 6 were identified as persistent infected for BVDV type 2 non-cytopathic (ncp). The most important clinical signs observed on the farm were birth of weak calves, many animals with growth retardation and unilateral or bilateral cataract. The main gross lesions observed at the necropsy of 5 animals were enlargement of mesenteric lymph nodes and Peyer's patches, and in one case, pododermatitis with crusted lesions on nasal planum and periocular region. The microscopic findings were characterized mostly by mononuclear infiltrate in the lamina propria primarily in small intestine and lymphoid depletion with histiocytic infiltrate in follicular centers of lymph nodes and Peyer's patches. In 5 animals evaluated the viral antigen was more frequently demonstrated in epidermal keratinocytes, epithelium of hair follicles and dendritic cells of the dermis of the ears and skin, histiocytes and lymphocytes in lymph nodes, thyroid follicular cells, in the cytoplasm of neurons and to a lesser extent, in glial cells in the cerebral cortex and hippocampus. The analysis of pools of serum from animals suspected by RT-PCR together with immunohistochemical analysis of ears biopsy showed good results and can be useful as screening method for persistent infections in cattle, including animals under 6 months age, because they not suffer interference from maternal antibodies. The removal and elimination of PI animals had positive effects on the property, however new collection should be carried out in 2010.

O vírus da diarreia viral bovina (BVDV) é responsável por diferentes síndromes que afetam principalmente bovinos em todo o mundo, causando grandes perdas econômicas. A principal medida de controle desta infecção é a detecção e retirada dos animais persistentemente infectados (PI) do rebanho. O presente trabalho analisou a infecção persistente por este vírus em um rebanho bovino de gado de corte, vacinado com vacina inativada contra BVDV tipo 1 e localizado no Município de Viamão, Rio Grande do Sul, de novembro de 2007 a maio de 2009. Para a triagem de animais PI, amostras de soro, sangue com EDTA e fragmentos de orelhas foram coletadas principalmente de animais com idade entre 2-3 meses. Os testes utilizados compreenderam o isolamento viral, a transcrição reversa seguida da reação em cadeia da polimerase (RT-PCR), a imuno-histoquímica (IHQ) e a sorologia pelo ensaio imunoenzimático (ELISA). De 1300 animais da propriedade, coletou-se 179 amostras e em 6 se identificou a infecção persistente pelo BVDV tipo 2 não citopático (ncp). Os principais sinais clínicos verificados na propriedade englobavam nascimento de bezerros fracos, grande número de animais com retardo no crescimento e catarata congênita uni e bilateral. As principais lesões observadas em 5 animais necropsiados consistiam de aumento dos linfonodos mesentéricos, evidenciação das placas de Peyer e em um animal verificou-se pododermatite com lesões crostosas no plano nasal e na região periocular. Os achados microscópicos caracterizavam-se principalmente por infiltrado mononuclear na lâmina própria do intestino delgado e rarefação linfoide com infiltrado histiocitário nos centrofoliculares de linfonodos e nas placas de Peyer. A demonstração do antígeno viral nos 5 animais avaliados ocorreu principalmente em: queratinócitos da epiderme , no epitélio de folículos pilosos e células dendríticas da derme de orelhas e pele; histiócitos e em linfócitos dos linfonodos; células foliculares da tireoide; no citoplasma de neurônios e em menor escala, em células da micróglia no córtex cerebral e no hipocampo. A análise de pools de soro de animais suspeitos pelo RT-PCR em conjunto com a avaliação imuno-histoquímica de biópsia de orelhas mostraram bons resultados e podem ser úteis como método de triagem de infecções persistentes em rebanhos, inclusive em animais menores de 6 meses de idade por não sofrerem interferência de anticorpos maternos. A retirada e eliminação dos animais PI surtiram efeitos positivos na propriedade, entretanto novas coletas devem ser realizadas em 2010. / Bovine viral diarrhea virus (BVDV) is responsible for different syndromes that affect mainly cattle worldwide, causing important economic losses. The main control measure for this infection is the detection and removal of all persistently animals infected (PI) from the herd. This study examined the persistent infection for this virus in a beef cattle herd, vaccinated with killed vaccine against BVDV type 1, located in the county of Viamão, Rio Grande do Sul, southern Brazil, from november 2007 to may 2009. For the screening of PI animals, serum, blood with EDTA and fragments of ears were collected mainly from animals aged between 2-3 months. Tests used were viral isolation, reverse transcription polymerase chain reaction (RT-PCR), immunohistochemistry (IHC) and serology by enzyme linked immunosorbent assay (ELISA). From 1300 animals, 179 samples were collected and 6 were identified as persistent infected for BVDV type 2 non-cytopathic (ncp). The most important clinical signs observed on the farm were birth of weak calves, many animals with growth retardation and unilateral or bilateral cataract. The main gross lesions observed at the necropsy of 5 animals were enlargement of mesenteric lymph nodes and Peyer's patches, and in one case, pododermatitis with crusted lesions on nasal planum and periocular region. The microscopic findings were characterized mostly by mononuclear infiltrate in the lamina propria primarily in small intestine and lymphoid depletion with histiocytic infiltrate in follicular centers of lymph nodes and Peyer's patches. In 5 animals evaluated the viral antigen was more frequently demonstrated in epidermal keratinocytes, epithelium of hair follicles and dendritic cells of the dermis of the ears and skin, histiocytes and lymphocytes in lymph nodes, thyroid follicular cells, in the cytoplasm of neurons and to a lesser extent, in glial cells in the cerebral cortex and hippocampus. The analysis of pools of serum from animals suspected by RT-PCR together with immunohistochemical analysis of ears biopsy showed good results and can be useful as screening method for persistent infections in cattle, including animals under 6 months age, because they not suffer interference from maternal antibodies. The removal and elimination of PI animals had positive effects on the property, however new collection should be carried out in 2010.

The objective of this work is the evaluation of the impact on health care of the systematic use of health related quality of life (HRQL) measures. A systematic review and a meta-analysis of randomized clinical trials were performed. A novel method was developed for the interpretation of scores that was based on Item Response Theory and it was applied to Visual Function Index VF-14, a perceived visual function measure for cataract patients. In a before-after trial, the visual function of 833 consecutive cataract patients attending 19 ophthalmologists in hospital and primary care based practices was routinely assessed. The results suggest that the feed back on HRQL and perceived health to health professionals might improve some aspects of medical care process, but not its outcome. / El objetivo del presente trabajo es evaluar el impacto en la atención médica del uso sistemático de instrumentos de medida de la calidad de vida relacionada con la salud (CVRS). Para ello se realizó una revisión sistemática y meta-análisis de ensayos clínicos. Se desarrolló un método para la interpretación de las puntuaciones basado en Teoría de Respuesta al Ítem y se aplicó al Índice de Función Visual VF-14, una medida de función visual percibida para pacientes con cataratas. Se diseñó un estudio de intervención antes-después en el que se midió de forma sistemática la función visual de 833 pacientes con cataratas que acudieron de forma consecutiva a las consultas de 19 oftalmólogos en centros hospitalarios y de atención primaria. Los resultados indican que la administración de información sobre CVRS y salud percibida a los profesionales de la salud podría modificar algunos componentes del proceso de la atención sanitaria, pero no su resultado. / L' objectiu del present treball és l'avaluació de l'impacto a l' atenció mèdica de l'us sistemàtic dels instruments de mesura de la qualitat de vida relacionada amb la salut (QVRS). Es realitzà una revisió sistemàtica i meta-anàlisi d'assaijos clínics. Es va desenvolupar un mètode per a la interpretació de les puntuacions basat en la Teoria de Resposta a l'Ítem que es va aplicar a l'Índex de Funció Visual VF-14, una mesura de funció visual percebuda per a pacients amb cataractes. Es va dissenyar un estudi d'intervenció abans-després en el que es mesurà de forma sistemàtica la funció visual de 833 pacients amb cataractes atesos de forma consecutiva a les consultas de 19 oftalmòlegs de centres hospitalaris i d'atenció primària. Els resultats indiquen que l'administració d'información sobre QVRS i salut percebuda als professionals de la salut pot modificar alguns components del procés de l' atenció sanitària, pero no el seu resultat.