Epidemiological Survey of Equine Pythiosis in the Brazilian Pantanal and Nearby Areas: Results of 76 Cases

A clinical epidemiological study was conducted among 34 rural properties located within the Brazilian Pantanal region and nearby areas between 2007 and 2010. The diagnosis of equine pythiosis was based on antibody detection (by enzyme-linked immunosorbent assay), polymerase chain reaction, histopathological analysis, and cultures positive for Pythium insidiosum. The majority of the affected animals (85%) were in the Pantanal biome, which had a higher disease prevalence (0.9%-66.7%) than that of the Cerrado (2.7%-33.3%). The disease was more prevalent in the rainy season (January-March), with an abrupt fall in the number of cases during the drought period (April-September; correlation of R 2 = 0.77; P < .01). Generally, the average prevalence of equine pythiosis in both regions was 5%, with mortality and lethality rates of 1.3% and 23.1%, respectively, in the Pantanal and 2.3% and 45.5%, respectively, in the Cerrado. However, the treatment with immunotherapy may have underestimated these numbers, especially in the Pantanal. Animals older than 1 year were 8.09 times more affected by the disease than younger animals in the same environment (P < .05). A correlation between the anatomical area of the lesion and the type of skin color was also observed. Approximately 73% of the lesions were found in dark-pigmented areas, and animals with a dark coat color were affected more frequently. These findings highlight the importance of hematophagous insects in the epidemiology of pythiosis because these areas are preferred for blood feeding. © 2013 Elsevier Inc. All rights reserved.

Intraoral schwannomas: Presentation of a series of 12 cases

Introduction: Schwannomas are benign and not very frequent tumors of the peripheral nerves, derived from the nerve supporting Schwann cells. Study Design: Data were collected on the clinical manifestations (sex, age), location, size and symptonts of the lesions as well as the evolution time and the initial (presumption) diagnosis. Results: Twelve patients were documented, with a mean age of 29,5 ± 12,1 years (range 16-50) and a balanced gender distribution. The mean duration of the lesions was 42,17± 45,3 months. The lesion located in the floor of the mouth was the largest tumor, measuring about 4 cm in maximum diameter, while the average size of the 12 schwannomas was 2.04± 1.1 cm. Conclusion: We present 12 oral schwannomas diagnosed and treated over a period of 10 years. © Medicina Oral S. L. C.I.F. B 96689336 - eISSN: 1989-5488.

Conditioning factors of the success of population policies: the cases of El Salvador and Costa Rica

Includes bibliography

Women's participation in economic activity as a strategic factor of change in fertility: the cases of Mexico and Costa Rica

Includes bibliography

HTLV-I associated myelopathy in the northern region of Brazil (Belém-Pará): serological and clinical features of three cases

Três pacientes (masculinos, negros, idades 37, 40 e 57) foram atendidos em uma clínica universitária com uma paraparesia progressiva de origem obscura. Um paciente que referiu a duração da doença por mais de 16 anos, mostrou hiporreflexia, sinal de Babinski bilateral, uma sensibilidade vibratória diminuída, disfunção urinária e dor lombar. Os outros dois pacientes (com um e seis anos de duração da doença) queixavam-se de fraqueza em uma das pernas, hiperreflexia e lombalgia. Sinal de Babinski e distúrbio urinário estavam também presentes no paciente com seis anos de doença. Amostras de sangue testadas por ELISA e Western blot foram positivos para HTLV-I. A análise familiar de um dos pacientes, mostrou um possível padrão de transmissão sexual e vertical do vírus. Ao nosso conhecimento, estes são os primeiros casos comprovados de uma provável associação entre o HTLV-I e PET/MAH em Belém, Pará, e enfatiza a necessidade de uma busca ativa de casos de doenças neurológicas associadas ao vírus na região.

Evaluation of the therapeutic response of hepatitis C in coinfected patients (HIV/HCV): a study of cases from a hospital for chronic liver diseases in the Eastern Brazilian Amazon

INTRODUCTION: The aim of this study was to evaluate the therapeutic response of hepatitis C in patients coinfected with human immunodeficiency virus (HIV-1). METHODS: A retrospective study of 20 patients coinfected with HIV-1/HCV who were treated in the outpatient liver clinic at the Sacred House of Mercy Foundation Hospital of Pará (Fundação Santa Casa de Misericórdia do Pará - FSCMPA) from April 2004 to June 2009. Patients were treated with 180µg PEG interferon-α2a in combination with ribavirin (1,000 to 1,250mg/day) for 48 weeks. The end point was the sustained virological response (SVR) rate (HCV RNA negative 24 weeks after completing treatment). RESULTS: The mean age of the patients was 40±9.5 years, of which 89% (n=17) were male, and the HCV genotypes were genotype 1 (55%, n=11/20), genotype 2 (10%, n=2/20) and genotype 3 (35%, n=7/20). The mean CD4+ lymphocyte count was 507.8, and the liver fibrosis stages were (METAVIR) F1 (25%), F2 (55%), F3 (10%) and F4 (10%). The early virological response (EVR) was 60%, the end-of-treatment virological response (EOTVR) was 45% and the SVR was 45%. CONCLUSIONS: The median HCV viral load was high, and in 85% of cases in which highly active antiretroviral therapy (HAART) was used, none of the patients with F3-F4 fibrosis responded to treatment. Of the twenty patients treated, 45% achieved SVR and 45% achieved EOTVR. Studies that include cases from a wider region are needed to better evaluate these findings.

Evaluation of cases of pemphigus vulgaris and pemphigus foliaceus from a reference service in Pará state, Brazil

BACKGROUND: Pemphigusis a bullous, rare and chronic autoimmune disease. There are two major forms of pemphigus: vulgaris and foliaceus. Epidemiological data and clinical outcome in patients diagnosed in the Brazilian Amazon states are still rare. OBJECTIVES: To study the occurrence of the disease during the study period and analyze the epidemiological profile of patients, the most common subtype of pemphigus, and the clinical evolution of patients. METHODS: Retrospective analysis of medical records of hospitalized patients with pemphigus foliaceus and pemphigus vulgaris in the period from 2003 to 2010 in Dermatology Service of Hospital Fundação Santa Casa de Misericórdia do Pará, Belém, Northern Brazil. RESULTS: We found a total of 20 cases of pemphigus during the study period, 8 of which were of foliaceus pemphigus and 12 of vulgaris pemphigus. Pemphigus foliaceus had the predominance of male patients (75%), showed satisfactory clinical evolution, and was characterized by absence of pediatric cases. Pemphigus vulgaris affected more women (66.7%), showed mean hospital stay of 1 to 3 months (50%), and there were three cases of death (25%). The prescribed immunosuppressive drugs included prednisone with or without combination of azathioprine and/or dapsone. Sepsis was associated with 100% of the deaths. CONCLUSIONS: The occurrence of the disease is rare, there are no familiar/endemic outbreaks in the sample. Evolution is usually favorable, but secondary infection is associated with worse prognosis. The choice of best drugs to treat pemphigus remains controversial.

Peritoneal Dialysis-Related Peritonitis due to Coagulase-Negative Staphylococcus: A Review of 115 Cases in a Brazilian Center

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Spontaneous healing responses detected by cone-beam computed tomography of horizontal root fractures: a report of two cases

Horizontal root fractures (HRF) usually affect the anterior teeth as a result of trauma, and generally heal spontaneously, depending on the vitality of the pulp. Diagnosis based on clinical findings, sensitivity tests, and radiographic examination is important to determine the presence of a root fracture and to prevent a root fracture from passing unnoticed. Cone-beam computed tomography (CBCT) has been used successfully for diagnosis and prognosis imaging of root fractures and has proved to be superior to other radiographic methods. This study reports two cases of dental trauma caused by a collision and a sports accident. The patients suffered horizontal root fractures in the maxillary left central incisor and in the mandibular left central incisor. The diagnosis of root fracture was confirmed by cone-beam computed tomography (CBCT) images, which also demonstrated spontaneous healing of the fracture line. The repair occurred by interposition of connective tissue in the former case and by interposition of bone and connective tissue in the latter case. The final diagnoses of both cases were based on CBCT images, indicating the importance of a CBCT examination to reach a firm diagnosis and to follow the healing process of root fracture cases, avoiding unnecessary radical endodontic treatment.

Ultrasound examination in gastric diseases in dogs: description of cases

Ultrasound is considered the method of choice for evaluation of the gastrintestinal wall. Thickening of the wall is the most common ultrasonographic finding in gastric disorders. Inflammatory and neoplastic disorders are the most frequent causes of wall thickening. Case report 1: Boxer, with abdominal distension, ultrasound examination detected marked diffuse thickening of the gastric wall with loss of definition of wall layers. Fine needle aspiration guided by ultrasound diagnosed gastric carcinoma. Case report 2: mixed breed dog presenting oliguria, emesis and melena, the ultrasound examination showed diffuse thickening of the gastric wall, but with preserved layers and presence of calcification areas. An inflammatory process of the gastric wall was diagnosed using cytology. The distinction between inflammatory and neoplastic processes is performed based on several factors such as distribution, symmetry, size and architecture of the parietal layer in the lesions, and ultrasonography is a valuable tool to direct diagnosis and treatment.

Prevalence of the germline TP53 p.R337H mutation in families with multiple cases of cancer

Germline mutations in TP53 gene are associated with Li-Fraumeni syndrome (LFS) and its variants Li-Fraumeni-like (LFL). They predispose carriers to a wide variety of early onset tumors. In Brazil, there is a high frequency of a germline mutation in this gene (NC_000017.9: c.1010G>A; p.R337H) in Southern and Southeastern regions, due to a founder effect. It is estimated to be present in 0,3% ofthe local population, but only few families have been detected. Due to this significant divergence, the purpose of this study was to verify the effectiveness of wider criteria for detection of these individuals. Herein, clinical criteria were established, DNA samples were collected, analyzed by Restriction Fragment Length Polymorphism (RFLP) and sequenced. Thus, assessing the prevalence of this mutation in families with multiple cases of cancer. Based on our proposed criteria, one out of 31 patients (3,22%) was found to carry p.R337H mutation. The patient developed ductal invasive breast cancer at age 47, invasive adenocarcinoma of the lung at age 48 and soft-tissue sarcoma at age 49. In addition, an extensive cancer family history was referred, atypical for LFS, including a case of Ewing’s sarcoma. These outcomes indicate that the proposed criteria may detect probable carriers who did not fit previous LFS criteria. Nevertheless, additional studies, which might include a larger number of families and more stringent parameters, will be useful to improve screening sensibility

Frontal sinus obliteration with iliac crest bone grafts: review of 8 cases

This study evaluated postoperative results of 8 cases of frontal sinus fractures treated by frontal sinus obliteration with autogenous bone from the anterior iliac crest. Patients and methods: The medical charts of patients sequentially treated for frontal sinus fractures by obliteration with autogenous cancellous iliac crest bone in the Oral and Maxillofacial Surgery Division of this institution were reviewed. From those, eight had complete records and adequately described long-term follow-up. All were operated by the same surgical team. Those patients were recalled and independently evaluated by 2 examiners. Radiographs and/or CT scans were available for this evaluation. Associated fractures and complications were noted. The average postoperative follow-up was 7 years, ranging from 3 to 16 years. The main complication was infection. Four patients (50%) had uneventful long-term follow-ups and four (50%) experienced complications requiring reoperation. Based on the studied sample studied the authors conclude that the obliteration with autogenous bone presented a high percentage of complications in this series.