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.

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.

Resumo: FUNDAMENTOS: O termo telemedicina faz referência ao uso de tecnologias de comunicação para a transmissão a distância de informações relacionadas à saúde. Esse recurso é utilizado em várias especialidades médicas, principalmente naquelas em que a interpretação de imagens representa uma etapa fundamental na formulação diagnóstica. OBJETIVO: Avaliar a concordância entre o diagnóstico presencial e o diagnóstico a distância de lesões cutâneas, utilizando a teledermatologia, em pacientes atendidos em uma unidade básica de saúde. MÉTODOS: Foi realizado um estudo prospectivo envolvendo pacientes atendidos no serviço de dermatologia da clínica FTC em Salvador -BA. Participaram do estudo um dermatologista responsável pela consulta presencial e dois dermatologistas responsáveis pela consulta a distância. Os diagnósticos obtidos através da teleconsulta foram avaliados quanto à concordância e comparados com os diagnósticos da consulta presencial. RESULTADOS: Foram incluídos neste estudo 60 pacientes. Observou-se um grau de concordância total variando de 86,6% a 91,6% com índice Kappa de 0,62. CONCLUSÃO: A teledermatologia é uma forma de assistência com um grande potencial de uso na dermatologia, podendo representar uma ferramenta útil principalmente em casos clínicos de baixa complexidade, oriundos de unidades básicas de saúde. Palavras-chave: Consulta remota; Diagnóstico; Telemedicina Abstract: 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.

We observed that the correlation among the major oculometric parameters and their individual contribution to hyperopia in esotropic children were similar in amblyopic and non-amblyopic eyes. This finding suggests that the counterbalancing effect of greater corneal and lens power associated with shorter axial length is similar in both eyes of patients with esotropic amblyopia.

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INTRODUÇÃOUma das questões mais difíceis no tratamento do estrabismo consiste no planejamento da estratégia cirúrgica. Além do conhecimento científico, a experiência do cirurgião tem participação fundamental na decisão desta etapa, devido, em parte, à grande variabilidade observada em situações clínicas aparentemente semelhantes (1) .Recentemente, a inteligência artificial vem sendo utilizada como uma ferramenta de auxílio diagnóstico na área médica. Como exemplo podemos citar os programas para interpretação de eletrocardiogramas, que atualmente apresentam performance comparável à de um cardiologista (2) . A rede neural artificial (RNA), uma forma de inteligência artificial, consiste na simulação, através de "software" ou "hardware", de alguns aspectos do sistema nervoso biológico, na tentativa de permitir a realização de tarefas Uso da rede neural artificial no planejamento cirúrgico da correção do estrabismo Objetivo: Desenvolver uma rede neural artificial para planejar a estratégia cirúrgica em pacientes portadores de estrabismo sensorial, com desvio horizontal. Métodos: Foi realizado estudo retrospectivo envolvendo 95 pacientes portadores de estrabismo sensorial, atendidos no Ambulatório de Motilidade Ocular Extrínseca do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Foi construída uma rede neural artificial utilizando-se o Java Neural Network 1.1. Foram utilizados 68 pacientes para treinamento e validação da rede e 27 para testar o seu funcionamento. Resultados: Dos 68 pacientes utilizados no treinamento da rede, 37 apresentavam exotropia e 31 esotropia. O método utilizado para treinamento da rede foi o "backpropagation". A taxa de aprendizado utilizada foi de 0,6, e a taxa de tolerância de erro 0,05. Dos 27 pacientes utilizados para avaliação da eficácia da rede, 18 apresentavam exotropia, e 9 esotropia. A eficácia da rede foi avaliada pela média da diferença entre os resultados fornecidos pela rede, e as indicações originais. Nos pacientes com exotropia o erro médio foi de 0,4 mm (±0,4), para o retrocesso do músculo reto lateral, e de 0,3 mm (±0,3), para a ressecção do músculo reto medial. Nas esotropias, o erro médio foi de 0,2 mm (±0,2), para o retrocesso do músculo reto medial e de 0,5 mm (±0,3), para ressecção do músculo reto lateral. Conclusão: A rede neural artificial, por sua característica de simular o sistema nervoso central biológico, e sua capacidade de realizar tarefas cognitivas, é opção viável para auxiliar no planejamento cirúrgico da correção do estrabismo.

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.

This paper is about a patient with acquired immunodeficiency syndrome empirically treated for miliary tuberculosis. During the clinical evolution the patient presented lesions compromising the right eyelid and tarsal conjunctiva. The initial diagnostic hypothesis was ocular tuberculosis with conjunctival and eyelid involvement. The biopsy of the conjunctival lesion identified an encapsulated yeast-like fungus: Criptococcus neoformans. After starting treatment with B anfotericin, the cutaneus lesions cleared.