Mucosal leishmaniasis: description of case management approaches and analysis of risk factors for treatment failure in a cohort of 140 patients in Brazil

Background Mucosal leishmaniasis is caused mainly by Leishmania braziliensis and it occurs months or years after cutaneous lesions. This progressive disease destroys cartilages and osseous structures from face, pharynx and larynx. Objective and methods The aim of this study was to analyse the significance of clinical and epidemiological findings, diagnosis and treatment with the outcome and recurrence of mucosal leishmaniasis through binary logistic regression model from 140 patients with mucosal leishmaniasis from a Brazilian centre. Results The median age of patients was 57.5 and systemic arterial hypertension was the most prevalent secondary disease found in patients with mucosal leishmaniasis (43%). Diabetes, chronic nephropathy and viral hepatitis, allergy and coagulopathy were found in less than 10% of patients. Human immunodeficiency virus (HIV) infection was found in 7 of 140 patients (5%). Rhinorrhea (47%) and epistaxis (75%) were the most common symptoms. N-methyl-glucamine showed a cure rate of 91% and recurrence of 22%. Pentamidine showed a similar rate of cure (91%) and recurrence (25%). Fifteen patients received itraconazole with a cure rate of 73% and recurrence of 18%. Amphotericin B was the drug used in 30 patients with 82% of response with a recurrence rate of 7%. The binary logistic regression analysis demonstrated that systemic arterial hypertension and HIV infection were associated with failure of the treatment (P < 0.05). Conclusion The current first-line mucosal leishmaniasis therapy shows an adequate cure but later recurrence. HIV infection and systemic arterial hypertension should be investigated before start the treatment of mucosal leishmaniasis. Conflicts of interest The authors are not part of any associations or commercial relationships that might represent conflicts of interest in the writing of this study (e.g. pharmaceutical stock ownership, consultancy, advisory board membership, relevant patents, or research funding).

Lei n?? 8.140, de 28 de dezembro de 1990: altera a denomina????o da Funda????o Centro de Forma????o do Servidor P??blico - FUNCEP e d?? outras provid??ncias

A lei n?? 8.140, de 28 de dezembro de 1990 altera a denomina????o da Funda????o Centro de Forma????o do Servidor P??blico - FUNCEP e d?? outras provid??ncias.

Friday Facts, May 4, 2012, Vol. 140

Bureau of Nutrition and Health Promotion part of the Iowa Department of Public Health produces of weekly newsletter about the Iowa WIC Program for the State of Iowa citizen.

[Collection de cartes postales classées méthodiquement pour l'enseignement de la géographie, Paris, F. Nathan, s.d. (1928), offert par l'éditeur. 353 cartes postales en 15 paquets. 1. Généralités, définitions principales (1-25) 2. Ports de commerce, de pêche, militaires, fluviaux (26-50) 3. Pêches et industries diverses (51-75) 4. Relief du sol (76-95) 5. Communications en montagne (96-119) 6. Histoire d'un fleuve (120-139) 7. Phénomènes dus à l'érosion (140-159) 8. Voies de communication (160-179) 9. Paris (180-204) 10. Algérie (205-228) 11. Tunisie (229-253) 12. Maroc (254-278) 13. A.O.F. et A.E.F. (279-303) 14. Madagascar (304-328) 15. Indochine (329-353)]

Donateur : Nathan, Fernand (1858-1947)

Flood of May 19, 1990, Along Perry Creek in Plymouth and Woodbury Counties, Iowa, HR-140, 1996

A water-surface-elevation profile and peak discharges for the flood of May 19, 1990, along Perry Creek in Plymouth and Woodbury Counties, Iowa, are presented in this report. The peak discharge for the May 19, 1990, flood on Perry Creek at 38th Street, Sioux City (06600000) is the second largest flood-peak discharge recorded at the streamflow-gaging station for the period 1939-95. The peak discharge for May 19, 1990, of 8,670 cubic feet per second, is approximately equal to the 35-year recurrence-interval discharge. The report provides information on flood stages and discharges and floodflow frequencies for streamflow- gaging stations in the Perry Creek Basin using flood information collected during 1939-95. Information on temporary bench marks and reference points established in the Perry Creek Basin during 1990-93 is also included in the report. A flood history describes rainfall conditions for the three largest floods that occurred during 1939-95 (July 1944, September 1949, and May 1990).

Floods of 1986 and 1990 in the Raccoon River Basin, West-Central Iowa, HR-140, 1992

Water-surface-elevation profiles and peak discharges for the floods of 1973 and 1979 are compared to those of 1986 and 1990 in the Raccoon River basin, west-central Iowa. The profiles illustrate the 1979 and 1986 floods on the Raccoon, South Raccoon, and Middle Raccoon Rivers, the 1973 and 1986 floods on Walnut Creek, and the 1986 flood on Willow Creek and Mosquito Creek. The 1986 flood is the largest on record at U.S. Geological Survey streamflowgaging stations on the Middle Raccoon River tributary at Carroll, Middle Raccoon River near Bayard, Middle Raccoon River at Panora, and Walnut Creek at Des Moines. The 1990 flood discharge is the largest on record at U.S. Geological Survey crest-stage gaging stations on Hardin Creek near Farlin and on East Fork Hardin Creek near Churdan. The flood history given in this report describes rainfall conditions for floods that occurred during 1986 and 1990. Discharge for the 1990 flood on East Fork Hardin Creek near Churdan was 1.01 times larger than the 100-year recurrence-interval discharge.

Floods of July 19-25, 1999, in the Wapsipinicon and Cedar River Basins, Northeast Iowa, HR-140

Severe flooding occurred during July 19-25, 1999, in the Wapsipinicon and Cedar River Basins following two thunderstorms over northeast Iowa. During July 18-19, as much as 6 inches ofrainfall was centered over Cerro Gordo, Floyd, Mitchell, and Worth Counties. During July 20-21, a second storm occurred in which an additional rainfall of as much as 8 inches was centered over Chickasaw and Floyd Counties. The cumulative effect of the storms produced floods with new maximum peak discharges at the following streamflow-gaging stations: Wapsipinicon River near Tripoli, 19,400 cubic feet per second; Cedar River at Charles City, 31,200 cubic feet per second (recurrence interval about 90 years); Cedar River at Janesville, 42,200 cubic feet per second (recurrence interval about 80 years); and Flood Creek near Powersville, 19,000 cubic feet per second. Profiles of flood elevations for the July 1999 flood are presented in this report for selected reaches along the Wapsipinicon, Cedar, and Shell Rock Rivers and along Flood Creek. Information about the river basins, rain storms, and flooding are presented along with information on temporary bench marks and reference points in the Wapsipinicon and Cedar River Basins.

Floods of May 17-20, 1999, in the Volga and Wapsipinicon River Basins, Northeast Iowa, HR-140

Record flooding occurred May 17-20, 1999, in the Volga and Wapsipinicon River Basins following thunderstorm activity over northeast Iowa. On Sunday, May 16, between 6 and 8 inches of rain fell during a 24- hour period over portions of Bremer, Butler, and Fayette Counties. Highest rainfall during this 24-hour period was 8.3 inches recorded north of Oelwein in southwest Fayette County. A peak discharge of 29,800 cubic feet per second in the Volga River at Mederville, 53,900 cubic feet per second in the Turkey River at Garber, and 31, 100 cubic feet per second in the Wapsipinicon River at Independence set new peak discharge records. The peak discharge at Garber was greater than a theoretical 500-year flood, and the peak discharge at Independence was the equivalent of a 90- year flood. Information about the basins, rain storms, flooding, and a profile of high water marks are presented for selected intervals along the Volga River, Wapsipinicon River, Crane Creek, Little Wapsipinicon River, and Otter Creek.