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A detailed review was conducted of the literature on models evaluating the effectiveness of integrated and coordinated care networks for the older population. The search made use of the following bibliographic databases: Pubmed, The Cochrane Library, LILACS, Web of Science, Scopus and SciELO. Twelve articles on five different models were included for discussion. Analysis of the literature showed that the services provided were based on primary care, including services within the home. Service users relied on the integration of primary and hospital care, day centers and in-home and social services. Care plans and case management were key elements in care continuity. This approach was shown to be effective in the studies, reducing the need for hospital care, which resulted in savings for the system. There was reduced prevalence of functional loss and improved satisfaction and quality of life on the part of service users and their families. The analysis reinforced the need for change in the approach to health care for older adults and the integration and coordination of services is an efficient way of initiating this change.

This review presents current considerations for renal transplantation in HIV patients. In the last decade, with the advent of highly active antiretroviral therapy (HAART), life expectancy of patients infected with human immunodeficiency virus (HIV) has significantly improved, showing a marked decrease in the rates of morbidity and mortality in this population. In this setting, the number of HIV-positive patients with end stage chronic kidney disease requiring dialysis is progressively growing. Kidney transplantation, previously considered as absolute contraindication for HIV-infected patients is currently, in the HAART era, considered a possible treatment alternative. Concerns for the effects of immunosuppressive drugs in these patients and the possible effects on progression of HIV disease, in addition to the risk of opportunistic infections and cancer development are widely discussed. Clinical experience in the HAART era shows that use of immunosuppressive drugs does not adversely affect HIV-seropositive patients. Furthermore, several transplant centers have reported improved patient and graft outcomes for kidney transplant recipients infected with HIV. In summary, results obtained so far are encouraging, supporting that renal transplantation, following specific selection criteria, can be considered an alternative of renal replacement therapy in HIV-infected patients.

Retinal pigment epithelial dysfunction is believed to be the main cause of many debilitating retinal diseases of which age-related macular degeneration is the most common. In this disease, the retinal pigment epithelial dysfunction leads to photoreceptors damage causing severe vision loss. The retinal pigment epithelium and Bruch's membrane suffer cumulative damage over lifetime, which is thought to induce age-related macular degeneration in susceptible individuals. In the past 20 years, a huge amount of research has been conducted in the area of transplantation of RPE. This technique aims to restore the subretinal anatomy and reestablish the critical interaction between the retinal pigment epithelium and the photoreceptor, which is fundamental to sight. Retinal pigment epithelial transplantation has been performed with two different techniques: retinal pigment epithelial suspension and autologous full-thickness retinal pigment epithelial-choroid transplantation in some cases of the age-related macular degeneration (AMD). Despite the feasibility of this technique, search for a cell source to replace autologous retinal pigment epithelium such as embryonic stem cells, marrow-derived stem cells and umbilical cord-derived cells continues. The combination of cell transplantation with other modalities of treatment such as gene transfer remains an exciting future prospect.

We report a case of choroidal metastasis simulating uveal effusion syndrome. This patient with uveal metastasis from lung carcinoma presented with decreased vision in the left eye. Fundoscopic examination revealed pigmentary clumping, multiple choroidal nodules and serous retinal detachment. Fluorescein angioraphy revealed a leopard spots pattern similar to uveal effusion syndrome. Ultrasound revealed the presence of choroidal nodules with moderate internal reflectivity, choroidal thickening and serous retinal detachment. Optical coherence tomography showed retinal pigment epithelium tear and hyper-reflective nodules within the choroid and areas of serous retinal detachment. Image investigation demonstrated the presence of a solitary pulmonary nodule at the left apical lung. Choroidal metastasis can lead to a scenario that simulates uveal effusion syndrome. This possibility must be considered when having an atypical uveal effusion symptomatoloy and a systemic screening for systemic cancer should be performed.