Cinara Cássia Brandão de Mattos

Objective: To evaluate and characterize patients with presumed ocular toxoplasmosis using combined clinical and serological approaches in the municipality of Três Lagoas, Mato Grosso do Sul, Brazil. Methods: This cross-sectional quantitative study included 85 patients with presumed Toxoplasma gondii related retinochoroiditis referred from the public healthcare system. Participants underwent ophthalmologic examination and serological testing for anti- T. gondii IgG and IgM antibodies. Patients were classified into control (G1), active lesion (G2), and cicatricial lesion (G3) groups. Results: Overall, 76.5% of patients were positive for anti- T. gondii IgG, while 3.5% were positive for IgM. Most patients with cicatricial lesions (G3) were IgG-positive (31/33). In contrast, IgM positivity was restricted to a small subset of patients (3/13) with active lesions (G2). Ophthalmologic evaluation demonstrated that unilateral disease predominated (78.2%), with lesions mainly located in the posterior pole (52.8%). Morphologically, round-to-ovoid lesions were most frequent (60.0%), followed by amoeboid (16.0%), placoid (8.0%), and wedge-shaped and punctate (4.0% each) patterns. Mean lesion size among evaluable eyes was 16.2 mm ² . Conclusion: The analyses provide data that contribute to the understanding of the clinical characteristics of the disease, ocular behavior, and serological findings. Consequently, preventive measures may be implemented, reducing risk factors and improving patients’ quality of life.

Toxoplasma gondii is a zoonotic parasite widely distributed worldwide responsible for affecting mammals, birds and humans, especially in Brazil, where toxoplasmosis is endemic. Dogs can become infected mostly through the ingestion of tissue cysts and oocysts in contaminated food or environments. This study presents the first serological evidence of anti-T. gondii antibodies in blood donor dogs in the State of Rio de Janeiro. A total of 100 samples were collected, serially, at intervals of 90 days each in a blood bank in the city of Niterói, totaling 300 serological and PCR analyses. The Modified Agglutination Test (MAT) revealed 37% overall seroprevalence with a cutoff point of 1:25, and over the analyzed period dogs seroconverted with respective percentages: 8%, 14% and 15%. In the 529 bp PCR all samples were negative. The results provide serological evidence that dogs, even with all necessary care to become blood donors, are still susceptible to exposure to T. gondii, mainly through Silvafeeding on homemade food/raw chicken meat (p=0.036) when compared to feeding on commercial products. Given the importance of the transmission route and possible parasitemia in healthy dogs in which the disease may be subclinical, these findings highlight the importance of more accurate surveillance for other infectious diseases in which blood transfusion may be a route of infection. We emphasize that blood obtained from donor dogs would be tested using multiple assays, from a One Health perspective, for the prophylactic screening of multiple pathogens in addition to Toxoplasma gondii.

Background: Toxoplasmosis is a zoonotic disease caused by the protozoan Toxoplasma gondii, which can lead to severe disease in humans, particularly during pregnancy or in immunocompromised individuals, although it is typically asymptomatic in immunocompetent hosts. In South America, the prevalence and severity of toxoplasmosis are notably high due to circulation of genetically diverseT. gondii strains. However, genetic characterization of isolates from human infections remains limited.Methods: Seven T. gondii strains were isolated from human clinical samples, including peripheral blood, placenta, and amniotic fluid. Among the seven cases, 6 were congenital toxoplasmosis, 1 was a toxoplasmosis in an immunocompetent male patient. Genotyping was performed by PCR-RFLP using 11 markers and by microsatellite analysis using 15 markers. Virulence-associated genes ROP18 and ROP5 were also genotyped. Clinical data from infected individuals were collected and analyzed, including congenital cases.Findings: Five distinct genotypes were identified: three isolates corresponded to ToxoDB PCR-RFLP genotype #6 (also known as type BrI, South American 1, African 1), and one isolate each to genotypes #11, #19, #41, and #85. Microsatellite analysis revealed a novel variant (South American 1, variant IV.1) circulating in Brazil. ROP18/ROP5 allele combinations (1/3, 4/4, 4/3) correlated with virulence observed in mouse bioassays. Clinically, fever and asthenia were common, while cerebral calcifications and ocular lesions were present in all six congenitally infected newborns.Interpretation: These results expand the understanding of T. gondii genetic diversity in Brazil and support an association between genotypes and severe human toxoplasmosis, emphasizing the need for molecular surveillance to improve clinical management and epidemiological understanding.

Objective To evaluate and characterize patients with presumed ocular toxoplasmosis using combined clinical and serological approaches in the municipality of Três Lagoas, Mato Grosso do Sul, Brazil. Methods This cross-sectional quantitative study included 85 patients with presumed Toxoplasma gondii related retinochoroiditis referred from the public healthcare system. Participants underwent ophthalmologic examination and serological testing for anti- T. gondii IgG and IgM antibodies. Patients were classified into control (G1), active lesion (G2), and cicatricial lesion (G3) groups. Results Eighty percent of patients were seropositive for anti- T. gondii IgG, while IgM positivity was found in 3.5%. Most patients with cicatricial lesions (G3) were IgG-positive (31/33). In contrast, IgM positivity was restricted to a small subset of patients (3/13) with active lesions (G2). Ophthalmologic evaluation demonstrated that unilateral disease predominated (78.2%), with lesions mainly located in the posterior pole (52.8%). Morphologically, round-to-ovoid lesions were most frequent (60.0%), followed by amoeboid (16.0%), placoid (8.0%), and wedge-shaped and punctate (4.0% each) patterns. Mean lesion size among evaluable eyes was 16.2 mm². Conclusion The analyses provide data that contribute to the understanding of the clinical characteristics of the disease, ocular behavior, and serological findings. Consequently, preventive measures may be implemented, reducing risk factors and improving patients’ quality of life.

Purpose: To evaluate the safety and feasibility of repeated subtenon administration of autologous platelet-rich plasma (PRP) in patients with degenerative retinal diseases and to explore preliminary, hypothesis-generating functional observations in retinitis pigmentosa (RP) and extensive macular atrophy with pseudodrusen-like appearance (EMAP). Methods: This prospective, open-label, uncontrolled pilot study included 13 patients (6 RP, 7 EMAP) who received three subtenon PRP injections (1.5 mL each) at baseline, Month 2, and Month 4, with follow-up through Month 6. The study was designed primarily to assess safety and feasibility and was not powered or intended to evaluate efficacy. The primary outcome was safety, including adverse events and intraocular pressure changes. Exploratory secondary outcomes included best-corrected visual acuity (BCVA, logMAR), visual field mean deviation (MD), and structural optical coherence tomography (OCT) parameters. Electrophysiological outcomes were analyzed descriptively due to incomplete paired data. Analyses were conducted within diagnostic groups, and no between-group comparisons were performed. Results: All 13 patients completed the study. No serious adverse events or permanent ocular morbidity were observed. Two transient and self-limited adverse events occurred (anterior uveitis and intraocular pressure elevation), both resolving without sequelae. In the overall cohort, BCVA remained stable without statistically significant change. In the RP subgroup, a small exploratory change in BCVA was observed (mean ΔlogMAR −0.09; nominal p = 0.048), corresponding to approximately 4–5 ETDRS letters; however, this finding was associated with wide confidence intervals and limited statistical power and should be interpreted cautiously. In the EMAP subgroup, functional stability was observed without evidence of consistent improvement. Visual field mean deviation and OCT findings were consistent with absence of short-term deterioration across available paired data. Electrophysiological outcomes showed no consistent directional change. Conclusions: Repeated subtenon PRP administration appeared feasible and well tolerated in this small, uncontrolled pilot cohort. Any observed functional changes are preliminary and hypothesis-generating only and do not establish efficacy. Larger, adequately powered controlled studies with standardized endpoints are required to determine the potential role of PRP in degenerative retinal diseases.

Purpose To evaluate visual function, visual field preservation, and structural retinal stability in patients with Extensive Macular Atrophy with Pseudodrusen-like Appearance (EMAP) treated with intravitreal adalimumab, a tumor necrosis factor–alpha (TNF-α) inhibitor, in a real-world clinical setting. Methods This retrospective, observational cohort study included adult patients with a clinical diagnosis of EMAP who received three intravitreal injections of adalimumab (2 mg/0.05 mL) at baseline, Month 2, and Month 4. Best-corrected visual acuity (BCVA, logMAR) and automated perimetry parameters—Mean Deviation (MD), Pattern Standard Deviation (PSD), and Field Preservation Deviation Index (FPDI)—were analyzed using paired pre–post comparisons over a 6-month follow-up. Structural outcomes assessed ellipsoid zone (EZ) integrity and central macular thickness on optical coherence tomography (OCT). Full-field electroretinography (ERG) with 30-Hz flicker stimulation was used as a surrogate marker of macular cone function. Nonparametric statistics were applied due to non-normal data distribution. Results Nineteen patients (36 eyes) with paired BCVA data were analyzed. Mean BCVA remained stable from baseline (1.05 ± 0.48 logMAR) to follow-up (1.02 ± 0.42 logMAR), with a mean change of − 0.04 ± 0.25 logMAR (p = 0.28). Clinically, 19.4% of eyes showed a ≥ 0.2 logMAR gain, while 5.6% worsened, and 75% remained stable. Visual field analysis demonstrated no significant changes in MD, PSD, or FPDI, with a modest trend toward functional preservation. OCT analysis showed no significant progression of macular atrophy, EZ disruption, or changes in central macular thickness. ERG flicker responses remained stable in eyes with measurable signals. Conclusions In this real-world EMAP cohort, intravitreal adalimumab was associated with overall functional and structural stability over 6 months, without evidence of accelerated deterioration. These findings support the ocular safety and potential stabilizing role of TNF-α inhibition in EMAP and provide preliminary data to inform future controlled trials targeting inflammatory mechanisms in degenerative macular diseases.

This study investigated whether miRNAs and cytokines could be markers of gestational and/or congenital toxoplasmosis (TX). A total of 172 clinical samples collected from women were investigated. For gestational TX, 63 plasmas from pregnant women were analysed: 44 with gestational TX (GT‐PW), 11 with asymptomatic TX (AsT‐PW) and 8 healthy pregnant women (H‐PW). For controls, 68 plasmas: 34 healthy women (HW) and 34 with asymptomatic TX (AsT). For congenital TX, 41 amniotic fluid (AF) samples were tested: 29 with negative qPCR in AF and 12 with positive PCR. Nine miRNAs were assayed by qPCR in plasma and AF samples. IFN‐γ, TNF‐α and IL‐10 detection in plasmas was performed by ELISA. Statistical analyses were determined by F ‐test and ROC curves. Among the 9 hsa‐miRNAs studied, only hsa‐miR‐125b‐5p was significantly expressed in the AsT‐PW group. hsa‐miR‐144‐3p was more expressed in the GT‐PW group. In AF samples, hsa‐miR‐125b‐5p was more expressed in 29 AF samples with Neg‐qPCR and hsa‐miR‐144‐3p in AF samples with Pos‐qPCR. Pregnant women from the GT‐PW group had lower IFN‐γ, TNF‐α, and IL‐10 production than the other groups. The in silico analyses identified pathways for hsa‐miR‐144‐3p and hsa‐miR‐125b‐5p and were related to the pathogenesis and immune response in toxoplasmosis. These findings suggest that hsa‐miR‐125b‐5p could be related to infection regulation and to be characterised as a potential marker for asymptomatic toxoplasmosis. On the other hand, the hsa‐miR‐144‐3p could be related to the exacerbation of the infection since gestational and/or congenital TX groups expressed high expression of hsa‐miR‐144‐3p and low expression of IFN‐γ, TNF‐α and IL‐10.

Recent advances in artificial intelligence (AI) have transformed ophthalmic diagnostics, particularly for retinal diseases. In this prospective, non-randomized study, we evaluated the performance of an AI-based software system against conventional clinical assessment—both quantitative and qualitative—of optical coherence tomography (OCT) images for diagnosing diabetic macular edema (DME). A total of 700 OCT exams were analyzed across 26 features, including demographic data (age, sex), eye laterality, visual acuity, and 21 quantitative OCT parameters (Macula Map A X-Y). We tested two classification scenarios: binary (DME presence vs. absence) and multiclass (six distinct DME phenotypes). To streamline feature selection, we applied paraconsistent feature engineering (PFE), isolating the most diagnostically relevant variables. We then compared the diagnostic accuracies of logistic regression, support vector machines (SVM), K-nearest neighbors (KNN), and decision tree models. In the binary classification using all features, SVM and KNN achieved 92% accuracy, while logistic regression reached 91%. When restricted to the four PFE-selected features, accuracy modestly declined to 84% for both logistic regression and SVM. These findings underscore the potential of AI—and particularly PFE—as an efficient, accurate aid for DME screening and diagnosis.