Quilopericárdio idiopático primário: relato de caso

O acúmulo de quilo no espaço pericárdico ou quilopericárdio é uma condição que, com maior frequência, ocorre após trauma, cirurgia cardíaca e torácica ou associado a tumores, tuberculose ou linfoangiomatose. Quando não é possível a identificação precisa da etiologia, o quilopericárdio é denominado primário ou idiopático. Essa é uma situação clínica rara. Descrevemos um caso em paciente do sexo feminino, com 20 anos de idade, tratada cirurgicamente. A propósito do caso, apresentamos breve revisão da literatura e comentários sobre quadro clínico, etiopatogenia, exames diagnósticos complementares e opções de tratamento.

Histopathological placental lesions in mild gestational hyperglycemic and diabetic women

Objective: To investigate and compare the incidence of histopathological placental lesions in mild gestational hyperglycemia, gestational diabetes and overt diabetes at term and preterm gestation.Research design and methods: One-hundred-and-thirty-one placental samples were collected from Diabetes mellitus (DM) positive screened patients. Two diagnostic tests, glycemic profile and 100 g oral glucose tolerance test (OGTT) in parallel identified 4 groups normoglycemic, mild gestational hyperglycemia (MGH), gestational DM (GDM) or overt DM (DM). Placental tissue specimens and sections from 4 groups were obtained by uniform random sampling and stained with hematoxylin-eosin.Results: Placentas from MGH group presented 17 types of histopathological change and higher rates of syncytial nodes and endarteritis. GDM placentas presented only nine types of histopathological change, high rates of dysmaturity, low rates of calcification and no syncytial nodes. Overt DM placentas showed 22 types of histopathological change, 21 of which were present in the preterm period. There were histopathological similarities between MGH and DM placentas, but the former exhibited a higher incidence of endarteritis, which has been described as a post-mortem phenomenon.Conclusion: Our results confirmed that the distinct placental changes associated with DM and MGH depend on gestational period during which the diabetic insult occurs. It may reasonably be inferred that subclinical maternal hyperglycemia during pregnancy, as showed in MGH group, is responsible for increased placental endarteritis, a postmortem lesion in the live fetus.

Discrepancies between clinical diagnoses and autopsy findings

Autopsy examination is considered to be an essential element for medical auditing and teaching. Despite the significant progress in diagnostic procedures, autopsy has not always confirmed the clinical diagnosis. In the present study, we compared the diagnosis recorded on medical charts with reports of 96 autopsies performed at the University Teaching Hospital of the Faculdade de Medicina de Botucatu, Botucatu, SP, Brazil, between 1975 and 1982, and of 156 autopsies performed at the same institution between 1992 and 1996. The clinical diagnosis of the basic cause of death was confirmed at autopsy in 77% of cases. The percent confirmation fell to 60% when the immediate terminal cause of death was considered, and in 25% of cases, the terminal cause was only diagnosed at autopsy. The discrepancies between clinical and autopsy diagnosis were even larger for secondary diagnoses: 50% of them were not suspected upon clinical diagnosis. Among them, we emphasize the diagnosis of venous thromboses (83%), pulmonary embolisms (80%), bronchopneumonias (46%) and neoplasias (38%). Iatrogenic injuries were very frequent, and approximately 90% of them were not described in clinical reports. Our results suggest that highly sensitive and specific diagnostic tests are necessary but cannot substitute the clinical practice for the elaboration of correct diagnoses.

Facial paralysis associated to hypothyroidism in a dog

The hypothyroidism is the most commonly endocrinopathy in dogs, that occurs preferentially in middle-aged pure breed. The clinical signs associated with hypothyroidism are variable, many times non-specific, including metabolical, dermatological or cardiovascular. The main laboratorial findings are non-regenerative anemia and hypercholesterolemia. Hyponatremia, increase on alanine transferase and alkaline phosphatase activity also can be observed in a lower frequency. There are some reports of peripheral neuropathies caused by hypothyroidism, but the pathophysiology of this process is still unknown. There are specific diagnostic tests that can be used to help diagnose hypothyroidism, and those should be aligned together with the animal's clinical symptoms. The thyroxine stimulating hormone, and free and total thyroxine concentrations are the most used tests. A Pit Bull dog, female, over weighted, was treated presenting left facial paralysis. Thyroid function tests confirmed hypothyroidism. The animal was treated with hormonal replacement and there was improvement in clinical signs in 40 days, confirming that hypothyroidism was facial paralysis' cause.

Detecção do Grapevine virus A e Grapevine virus B por hibridização dot-blot com sondas moleculares não radioativas

O vírus A da videira (Grapevine virus A, GVA) e o vírus B da videira (Grapevirus virus B, GVB) estão associados à acanaladura do lenho de Kober (Kober stem grooving) e ao fendilhamento cortical da videira (grapevine corky bark), respectivamente. Este trabalho descreve o uso de sondas moleculares de cDNA na detecção de isolados do GVA (GVA-SP) e do GVB (GVB-C-SP e GVB-I-SP) em videiras (Vitis spp.) e fumo (Nicotiana occidentalis). As sondas marcadas com digoxigenina foram produzidas por RT-PCR utilizando oligonucleotídeos específicos para os genes da proteína capsidial. Os RNA totais foram extraídos de 45 plantas de diversas variedades de videira e de 13 plantas de fumo inoculadas mecanicamente com o GVB. Os RNA extraídos das plantas infetadas, indexadas biologicamente, hibridizaram com as sondas, não se verificando reação com plantas sadias. Para confirmar os resultados de hibridização, foram também feitos testes de RT-PCR. A utilização de hibridização dot-blot com sondas de cDNA mostrou-se eficaz na detecção dos vírus com especificidade e sensibilidade, ressaltando-se que, preferencialmente, folhas maduras e ramos dormentes devem ser utilizados nos testes diagnósticos para o GVB e GVA, respectivamente.

Development of a rapid one-step immunochromatographic assay for HCV core antigen detection

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Síndrome dolorosa complexa regional: epidemiologia, fisiopatologia, manifestações clínicas, testes diagnósticos e propostas terapêuticas

JUSTIFICATIVA E OBJETIVOS: A Síndrome Dolorosa Complexa Regional (SDCR), assim denominada a partir de 1994 pelo Consenso da Associação Internacional para o Estudo da Dor (AIED) e anteriormente denominada de várias formas, tais como Distrofia Simpático Reflexa, Causalgia, Algodistrofia ou Atrofia de Sudeck, é uma doença cuja compreensão dos limites clínicos, fisiopatologia e implicações de patogenia ainda é pobre. Disto resulta a enorme insatisfação não só para os pacientes como para os profissionais da saúde quanto aos métodos terapêuticos atualmente disponíveis. O objetivo deste trabalho é rever a literatura e atualizar um conjunto de informações com o intuito da melhor compreensão desta importante síndrome dolorosa. CONTEÚDO: Este é um trabalho de revisão da literatura nos diversos aspectos da SDCR, com ênfase em suas causas, definição e taxonomia, fisiopatologia, características clínicas, testes diagnósticos e propostas de tratamentos mais recentes. CONCLUSÕES: Poucos são os estudos controlados adequadamente, encobertos e aleatórios, publicados com grandes amostras, havendo muitas dúvidas sobre esta doença. Desta forma, ainda há enorme empirismo na sua terapêutica, e os resultados obtidos são insatisfatórios.

Relevância de exames de rotina em pacientes de baixo risco submetidos a cirurgias de pequeno e médio porte

JUSTIFICATIVA E OBJETIVOS: A avaliação pré-operatória tem como objetivos diminuir a morbimortalidade do paciente cirúrgico, o custo do atendimento perioperatório e a ansiedade pré-operatória. A partir da avaliação clínica deve-se definir a necessidade de exames complementares e estratégias para reduzir o risco anestésico-cirúrgico. O objetivo deste trabalho foi avaliar o benefício de exames de rotina pré-operatório de pacientes de baixo risco em cirurgias de pequeno e médio porte. MÉTODOS: Trata-se de um estudo descritivo, transversal, com 800 pacientes atendidos no consultório de avaliação pré-anestésica do Hospital Santo Antonio, Salvador, BA. Foram incluídos pacientes de 1 a 45 anos, estado físico ASA I, que seriam submetidos a cirurgias eletivas de pequeno e médio porte. Avaliaram-se alterações no hemograma, coagulograma, eletrocardiograma, RX de tórax, glicemia, função renal e dosagem de sódio e potássio e as eventuais mudanças de conduta que ocorreram decorrentes dessas alterações. RESULTADOS: Dos 800 pacientes avaliados, 97,5% fizeram hemograma, 89% coagulograma, 74,1% eletrocardiograma, 62% RX de tórax, 68% glicemia de jejum, 55,7% dosagens séricas de ureia e creatinina e 10,1% dosagens de sódio e potássio séricos. Desses 700 pacientes, 68 (9,71%) apresentaram alteração nos exames pré-operatórios de rotina e apenas 10 (14,7%) dos considerados alterados tiveram conduta pré-operatória modificada, ou seja, solicitação de novos exames, interconsulta ou adiamento do procedimento. Nenhuma das cirurgias foi suspensa. CONCLUSÃO: Observou-se que excessivos exames complementares são solicitados no pré-operatório, mesmo em pacientes jovens, de baixo risco cirúrgico, com pouca ou nenhuma interferência na conduta perioperatória. Exames aboratoriais padronizados não são bons instrumentos de screening de doenças, além de gerar gastos elevados e desnecessários.

Coffee leaf scorch caused by a strain of Xylella fastidiosa from citrus

Citrus variegated chlorosis (CVC) and coffee leaf scorch (CLS) are two economically important diseases in Brazil caused by the bacterium Xylella fastidiosa. Strains of the bacterium isolated from the two plant hosts are very closely related, and the two diseases share sharpshooter insect vectors. In order to determine if citrus strains of X. fastidiosa could infect coffee and induce CLS disease, plant inoculations were performed. Plants of coffee, Coffea arabica 'Mundo Novo', grafted on Coffea canephora var, robusta 'Apuatao 2258' were mechanically inoculated with triply cloned strains of X. fastidiosa isolated from diseased coffee and citrus. Three months postinoculation, 5 of the 10 plants inoculated with CLS-X. fastidiosa and 1 of the 10 plants inoculated with CVC-X. fastidiosa gave positive enzyme-linked immunosorbent assay (ELISA) and/or polymerase chain reaction (PCR). Eight months postinoculation, another six plants inoculated with CVC-X. fastidiosa gave positive PCR results. The two X. fastidiosa strains were isolated from the inoculated plants and showed the same characteristics as the original clones by microscopy, ELISA, and PCR. None of the plants inoculated with sterile periwinkle wilt (PW) medium as controls gave positive reactions in diagnostic tests, and none developed disease symptoms. Six months postinoculation, seven plants inoculated with CLS-X. fastidiosn and eight inoculated with CVC-X. fastidiosa began to develop characteristic CLS symptoms, including apical and marginal leaf scorch, defoliation, and reductions of internode length, leaf size, and plant height, terminal clusters of small chlorotic and deformed leaves, and lateral shoot dieback. We have demonstrated that X, fastidiosa from citrus plants is pathogenic for coffee plants. This has important consequences for the management of CLS disease and has implications for the origin of citrus variegated chlorosis disease.

Late-onset sepsis: Epidemiology, evaluation, and outcome

Late-onset neonatal sepsis is a common serious problem in preterm infants in neonatal intensive care units. Diagnosis can be difficult because clinical manifestations are not specific and none of the available laboratory tests can be considered an ideal marker. For this reason, a combination of markers has been proposed. Complete blood count and acute-phase reactants evaluated together help in diagnosis. C-reactive protein is a specific but late marker, and procalcitonin has proven accurate, although it is little studied in newborns. Blood, cerebrospinal fluid, and urine cultures always should be obtained when late-onset sepsis is suspected. Blood culture, the gold standard in diagnosis, is highly sensitive but needs up to 48 hours to detect microbial growth. Various cytokines have been investigated as early markers of infection, but results are not uniform. Other diagnostic tests that offer promise include: neutrophil surface markers, granulocyte colony-stimulating factor, toll-like receptors, and nuclear factor kappa B. The greatest hope for quick and accurate diagnosis lies in molecular biology, using real time polymerase chain reaction combined withDNAmicroarray. Sepsis and meningitis may affect both the short- and long-term prognosis for newborns. Mortality in neonatal meningitis has been reduced in recent years, but short-term complications and later neurocognitive sequelae remain. Late-onset sepsis significantly increases preterm infant mortality and the risk of cerebral lesions and neurosensory sequelae, including developmental difficulties and cerebral palsy. Early diagnosis of late-onset sepsis contributes to improved neonatal prognosis, but the outcome remains far from satisfactory. © 2010 by the American Academy of Pediatrics.

Utilização de teste sorológico ELISA para a detecção de bovinos naturalmente infectados por Taenia saginata

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Conjunctival flora, Schirmer's tear test, intraocular pressure, and conjunctival cytology in neotropical primates from Salvador, Brazil

Background: This study aimed to establish reference values for selected ophthalmic diagnostic tests in healthy neotropical primates from Salvador, Brazil. Methods: A total of 73 intact adults, including Callithrix jacchus (n = 31), Callithrix penicillata (n = 8), Cebus sp. (n = 22), and Cebus xanthosternos (n = 9) were used to evaluate the normal conjunctival bacterial flora. Cebus xanthosternos (n = 12) were used to evaluate tear production with Schirmer's tear test (STT), intraocular pressure (IOP), and conjunctival cytology. Results: For all animals evaluated, Gram-positive bacteria were predominant. Results of the diagnostic tests in Cebus xanthosternos were as follows: STT: 14.92 ± 5.46 mm/minutes, IOP: 19.62 ± 4.57 mmHg, and conjunctival cytology revealed intermediate squamous epithelial cells in great quantities. Conclusions: These ophthalmic reference values will be particularly useful to diagnose discrete or unusual pathological changes in the neotropical primates eye. © 2013 John Wiley & Sons A/S.

Quantificação da resoluçao do sistema SPECT-CZT através do uso da função de transferência modulada (MTF)

Pós-graduação em Biologia Geral e Aplicada - IBB

Leishmaniose visceral canina-LVC, em Campina Grande-PB/Brasil: avalição epidemiológica e diagnóstica

Pós-graduação em Doenças Tropicais - FMB