SUBCUTANEOUS PHEOHYPHOMYCOSIS CAUSED BY Phoma cava: REPORT OF A CASE AND REVIEW OF THE LITERATURE

We report a case of subcutaneous pheohyphomycosis observed in a male patient presenting pulmonary sarcoidosis and submitted to corticosteroid treatment. He presented nodular erythematous-violaceous skin lesions in the dorsum of the right hand. Histopathological examination of the biopsied lesion revealed dematiaceous hyphae and yeast-like cells, with a granulomatous tissual reaction. The isolated fungus was identified as Phoma cava. A review of the literature on fungal infection caused by different Phoma species, is presented. The patient healed after therapy with amphotericin B, followed by itraconazole

Agreement between premortem and postmortem diagnoses in patients with acquired immunodeficiency syndrome observed at a brazilian teaching hospital

Acquired immunodeficiency syndrome (AIDS) is one of the main causes of death in adults worldwide. More commonly than in the general population, in patients with AIDS there is substantial disagreement between causes of death which are clinically suspected and those established by postmortem examination. The findings of 52 postmortem examinations were compared to the premortem (clinical) diagnoses, and there was 46% agreement between them. Fifty two percent of the patients had more than one postmortem diagnosis, and 48% had at least one AIDS-related disease not suspected clinically. Cytomegalovirus infection was the commonest (30.7%) autopsy finding, but not a single case had been suspected premortem. Bacterial infection, tuberculosis, and histoplasmosis were also common, sometimes not previously suspected, postmortem findings. This study shows that multiple infections occur simultaneously in AIDS patients, and that many among them are never suspected before the postmortem examination. These findings suggest that an aggressive investigation of infections and cancers should be done in patients with AIDS, particularly in those who do not respond to therapy of an already recognized condition

Subcutaneous scedosporiosis: Report of two cases and review of the literature

Two cases of subcutaneous scedosporiosis, caused by Scedosporium apiospermum, are reported. Both patients had lesions localized in the forearm: a solitary ulceration in one and a sporotrichoid-like lesion in the other. The literature is reviewed

ECTOPIC CUTANEOUS SCHISTOSOMIASIS: REPORT OF TWO CASES AND A REVIEW OF THE LITERATURE

Two cases of ectopic cutaneous schistosomiasis are described. Both patients presented with abdominal papular skin lesions, which on biopsy were found to contain granulomas with Schistosoma mansoni eggs. Twenty-five other cases were retrieved from the literature. Most patients were female, mean age 24.9 year, with a predominance of the white race. The most common localization was anterior thorax and abdomen. Usually, the lesions were asymptomatic. In few cases, however, severe clinical syndromes due to the parasite coexisted, such as transverse myelitis or the acute-toxemic form of the disease. Intestinal infection was not frequently demonstrated in these patients. The importance of the recognition of these cutaneous lesions may rest on the opportunity to provide an etiological diagnosis in these difficult cases.

EXPERIENCE IN THE EVALUATION OF CHILDREN WITH HEPATOSPLENOMEGALY AT A TEACHING AMBULATORY, SÃO PAULO, BRAZIL

Objectives: Describe cases of children with hepatosplenomegaly (HS) attended at the General Pediatric Teaching Ambulatory (AGER) of Instituto da Criança, São Paulo, identifying the main causes, evolution, necessity for hospitalization and/or referral to specialists. Methodology: Retrospective analysis of the records of children presenting HS on admission at AGER from September 1, 1993 to August 31, 1996. Results: Of the 89 children included (age range, 1 to 148 months; median, 24 months), 64 (72%) were referred from other services for HS investigation. Most common presenting complaints were: fever - 39 (44%); pallor - 26 (29%); weight loss - 21 (24%) and jaundice - 14 (16%). Main alterations noticed on physical examination were: pallor - 47 (53%) and short stature - 17 (19%). Anemia was diagnosed in 70 children (79%); 35 children (39%) had infections; 7 (8%) metabolic disorders and 5 (6%) neoplastic disorders. The most frequent infections were of the urinary tract - 9 (10%) and hepatitis A - 6 (7%).Thirty six children (40%) were referred to specialists, 17 of which were already diagnosed. Conclusions: Most of the children with HS present deficiency anemia associated with infections which the general pediatrician is able to diagnose. Persistence of unexplained HS for more than 2 months, especially when there is substantial volume enlargement or alteration in the organs consistency, is an indication for referral to specialists.

Paracoccidioidomycosis of the male genital tract. Report of eleven cases and a review of Brazilian literature

Eleven cases of involvement of the genital tract in paracoccidioidomycosis were collected in a retrospective study of the clinical records of 683 patients seen in Porto Alegre, Rio Grande do Sul, Brazil. These cases are herein summarily reported. Eighteen similar cases were gathered in review of the Brazilian literature. Obtained data are discussed.

Factors of repatriates’ turnover: literature review

One of the important challenges for multinational organisations is to increase the ability to retain their repatriates. The literature review shows high turnover rates amongst repatriates in the first two years following return from the international assignment. This paper discusses organisation’s (in)ability to retain its repatriates. A diversity of predictable factors of repatriates’ turnover is identified, including factors related to the job, the organisation, qualification, career development, personality, social context and the market. The paper analysis organisational support practices designed to increase the power of retention and decrease the turnover. We concluded that research about retention versus turnover of repatriates is scarce, mainly regarding the role a formal repatriation and retention programme in facilitating the retention of these employees with acquired international knowledge and skills, that is, the role that organisational factors play in voluntary turnover decisions. Further research is suggested at the end of the article.

The role of human resource management practices on repatriates’ retention: a literature review

This investigation reviews literature on human resource management practices that influence the retention of repatriates. The processes of selection and training/preparation before the departure, the role of the mentor and of communication during the international assignment, a program of readjustment to repatriation and a career development plan after return to the home firm are the practices identified in the literature as the main promoters of repatriates’ retention. Evidence suggests that greater responsibility on the part of the firms before, during and after the international assignment allows for more efficiency in the management of their repatriates.

Digital storytelling: student ID in higher education

Identity achievement is related to personality, as well as cognitive and interpersonal development. In tandem with the deep structural changes that have taken place in society, education must also shift towards a teaching approach focused on learning and the overall development of the student. The integration of technology may be the drive to foster the needed changes. We draw on the literature of multiple subject areas as basis for our work, namely: identity construction and self-representation, within a psychological and social standpoint; Higher Education (HE) in Portugal after Bologna, college student development and other intrinsic relationships, namely the role of emotions and interpersonal relationships in the learning process; the technological evolution of storytelling towards Digital Storytelling (DS) – the Californian model – and its connections to identity and education. Ultimately we propose DS as the aggregator capable of humanizing HE while developing essential skills and competences. Grounded on an interpretative/constructivist paradigm, we implemented a qualitative case study to explore DS in HE. In three attempts to collect student data, we gathered detailed observation notes from two Story Circles; twelve student written reflections; fourteen Digital Stories and detailed observation notes from one Story Show. We carried out three focus groups with teachers where we discussed their perceptions of each student prior to and after watching the Digital Stories, in addition to their opinion on DS in HE as a teaching and learning method and its influence on interpersonal relationships. We sought understandings of the integration of DS to analyze student selfperception and self-representation in HE contexts and intersected our findings with teachers’ perceptions of their students. We compared teachers’ and students’ perspectives, through the analysis of data collected throughout the DS process – Story Circle, Story Creation and Story Show – and triangulated that information with the students’ personal reflections and teacher perceptions. Finally we questioned if and how DS may influence teachers’ perceptions of students. We found participants to be the ultimate gatekeepers in our study. Very few students and teachers voluntarily came forth to take part in the study, confirming the challenge remains in getting participants to see the value and understand the academic rigor of DS. Despite this reluctance, DS proved to be an asset for teachers and students directly and indirectly involved in the study. DS challenges HE contexts, namely teacher established perception of students; student’s own expectations regarding learning in HE; the emotional realm, the private vs. public dichotomy and the shift in educational roles.

Matemática na hora do conto

Este artigo procura realçar que, através da conexão entre a literatura e a matemática, se podem criar situações em que as crianças abordem conceitos matemáticos de uma forma significativa permitindo que as habilidades matemáticas e as de linguagem se desenvolvam em conjunto. Uma das formas mais significativas de se construir conhecimento matemático é resolver problemas e desafios, tão comuns nos contos infantis. Apresentamos duas situações, que se enquadram nesta perspetiva pedagógica. Em ambas as situações foi usado um conto como ponto de partida para a construção de atividades matemáticas e tendo presente uma visão construtivista do ensino da matemática.

Tuberculous brain abscess in a patient with AIDS: case report and literature review

Tuberculous brain abscesses in AIDS patients are considered rare with only eight cases reported in the literature. We describe the case of a 34-year-old woman with AIDS and previous toxoplasmic encephalitis who was admitted due to headache and seizures. A brain computed tomography scan disclosed a frontal hypodense lesion with a contrast ring enhancement. Brain abscess was suspected and she underwent a lesion puncture through a trepanation. The material extracted was purulent and the acid-fast smear was markedly positive. Timely medical and surgical approaches allowed a good outcome. Tuberculous abscesses should be considered in the differential diagnosis of focal brain lesions in AIDS patients. Surgical excision or stereotactic aspiration, and antituberculous treatment are the mainstay in the management of these uncommon lesions.

Liver abscess due to Salmonella enteritidis in a returned traveler with HIV infection: case report and review of the literature

Bacteremia due to non-typhi Salmonella is more frequent in patients infected with the human immunodeficiency virus (HIV). However, focal complications have been rarely described. We report a case of liver abscess due to Salmonella enteritidis in an HIV-infected patient who recently returned to Sao Paulo, Brazil, from a trip in the Caribbean. A good clinical and radiological response was seen with both percutaneous catheter drainage and antibiotic treatment. To our knowledge, this is the first culture proven case of non-typhi Salmonellaliver abscess in an HIV-infected patient in Brazil.

Cerebral mass lesion due to cytomegalovirus in a patient with AIDS: case report and literature review

Cytomegalovirus (CMV) disease in acquired immunodeficiency syndrome (AIDS) patients most commonly presents as chorioretinitis and gastro-intestinal infection. Neurological involvement due to CMV may cause several clinical presentations: polyradiculitis, myelitis, encephalitis, ventriculo-encephalitis, and mononeuritis multiplex. Rarely, cerebral mass lesion is described. We report a 39 year-old woman with AIDS and previous cerebral toxoplasmosis. She presented with fever, seizures, and vulval ulcers. Her chest X-ray showed multiple lung nodules, and a large frontal lobe lesion was seen in a brain computed tomography scan. She underwent a brain biopsy through a frontal craniotomy, but her condition deteriorated and she died in the first postoperative day. Histopathological studies and immunohistochemistry disclosed CMV disease, and there was no evidence of cerebral toxoplasmosis, bacterial, mycobacterial or fungal infection. CMV disease should be considered in the differential diagnosis of cerebral mass lesion in AIDS patients. High suspicion index, timely diagnostic procedures (surgical or minimally invasive), and proper utilization of prophylactic and therapeutic medication could improve outcome of these patients.