Características clínico-epidemiológicas da doença Lyme-símile em crianças

OBJETIVO: Determinar a prevalência, distribuição etária, sazonalidade, características clínicas da doença Lyme-símile em menores de 15 anos. MÉTODOS: De julho/1998 a dezembro/2000 foi conduzido um estudo transversal em 333 pacientes, com exantema e febre. Foram coletadas amostras pareadas de sangue para a identificação de patógenos. Somente em 193 amostras, negativas aos outros patógenos (Parvovirus B19, Herpesvírus 6 humano, Sarampo, Rubéola, Dengue, Escarlatina e Enterovírus), foram realizadas a pesquisa da borreliose pelos métodos de Enzyme-Linked Immunosorbent Assay e Western-blotting. Outras variáveis clínicas, socioeconômicas, demográficas e climáticas foram estudadas. RESULTADOS: A prevalência da doença foi de 6,2%(12/193). Das variáveis estudadas, houve predomínio em <6anos(83,2%); sexo feminino (66,7%); procedência da cidade de Franco da Rocha (58,3%); com sazonalidade no outono-verão. O intervalo de atendimento foi de quatro dias. Sinais e sintomas com significância estatística: prurido, ausência da fissura labial e bom estado clínico. Outros dados presentes foram: irritabilidade (80%); febre (?38ºC) (58,3%) com duração de um a três dias. O exantema foi do tipo máculo-papular (33,3%), urticariforme (25%) e escarlatiniforme (16,7%); predominando em tronco (60%). Não houve apresentação clínica característica para diagnóstico da doença de Lyme-símile nestes pacientes. A sensibilidade e especificidade para o diagnóstico clínico contraposta com o diagnóstico laboratorial foi zero. O acompanhamento de 10 casos durante dois anos não evidenciou complicações cardiológicas ou neurológicas. Este é o primeiro estudo desta doença em crianças brasileiras. CONCLUSÃO: A prevalência da doença Lyme-símile foi baixa, não tendo sido lembrada no diagnóstico inicial dos exantemas, mas seu conhecimento é necessário, necessitando maior atenção médica.

Causas mal definidas de morte e óbitos sem assistência

OBJETIVOS: Este trabalho estuda a distribuição dos óbitos por causas mal definidas no Brasil, no ano de 2003, entre as quais identifica a proporção de mortes sem assistência. MÉTODOS: Os dados provieram do Sistema de Informações Sobre Mortalidade, coordenado pelo Ministério da Saúde. As causas mal definidas de morte compreenderam as incluídas no "Capítulo XVIII - Sintomas, sinais e achados anormais de exames clínicos e de laboratório não classificados em outra parte" da Classificação Estatística Internacional de Doenças e Problemas Relacionados à Saúde, décima revisão, capítulo este no qual a categoria R98 identificava a "morte sem assistência". RESULTADOS: No Brasil, em 2003, a causa básica de 13,3% dos óbitos foi identificada como mal definida, sendo que as proporções maiores ocorreram nas Regiões Nordeste e Norte. Do total de causas mal definidas no país, 53,3% corresponderam a mortes sem assistência, proporção esta que superou 70% nos Estados do Maranhão, Piauí, Rio Grande do Norte, Pernambuco, Bahia, Paraíba e Alagoas. CONCLUSÃO: Dada a estrutura descentralizada para o levantamento dos óbitos no país, identifica-se a maior responsabilidade dos municípios e, em seguida, dos Estados para o aprimoramento da qualidade das estatísticas de mortalidade.

Causas múltiplas de morte relacionadas às doenças cerebrovasculares no Estado do Paraná

OBJETIVO: Identificar as causas associadas de morte e o número de causas informadas nas declarações de óbito por doenças cerebrovasculares entre residentes no Estado do Paraná. MATERIAL E MÉTODOS: O banco de dados de mortalidade do ano de 2004 foi obtido do Sistema de Informação de Mortalidade disponível no endereço eletrônico do Datasus. A população escolhida foi separada pelo programa TabWin e as causas múltiplas foram processadas pelo programa Tabulador de Causas Múltiplas de Morte. RESULTADOS: O número médio de causas informadas foi de 2,92 para as mulheres e 2,97 para os homens. A maioria dos óbitos (74,8%) foi de pessoas com 65 anos ou mais de idade. Entre as causas associadas aos óbitos por doenças cerebrovasculares se destacaram as doenças do aparelho respiratório (37,9%), as doenças hipertensivas (37,5%) e os sintomas, sinais e achados anormais de exames clínicos e de laboratório (32,3%). CONSIDERAÇÕES FINAIS: Foi observada relativa melhora na qualidade dos dados de mortalidade em relação ao número de causas citadas. A hipertensão arterial como uma das principais causas associadas sugere a necessidade do seu controle no combate à mortalidade por doenças cerebrovasculares. Incentivos devem ser promovidos para estudos com causas múltiplas, para que se utilizem melhor informações tão importantes, que são desprezadas em estudos de mortalidade feitos somente com a causa básica de morte.

Paralytic rabies in swine

Rabies transmitted by vampire bats was diagnosed in pigs with paralysis of the pelvic limbs. Diffuse nonsuppurative encephalomyelitis, affecting mainly the spinal cord, was observed histologically. Despite the various diagnosis of rabies in pigs this is the first report of clinical signs and pathology of rabies transmitted by vampire bats.

Ornato e despojamento no mundo fabril

O artigo investiga algumas das tendências da arquitetura gerada por fábricas - galpões industriais, moradias, igrejas, escolas, clubes etc. -, erguida no Brasil entre as duas últimas décadas do século XIX e as primeiras do XX. Apoia-se em amplo inventário, como base para um esforço de análise que se propõe a identificar os temas e usos predominantes dos ornatos aplicados a construções geradas por fábricas, as referências historicistas mobilizadas e eventuais rupturas de signos arquitetônicos tipológicos, e, no limite, a abolição de ornatos e dos referidos signos. Assim, de um lado, trata da penetração da linguagem eclética nessas construções, investigando o repertório formal utilizado em diferentes tipologias. De outro, trata da simultânea difusão de uma estética tipicamente fabril, fundamentada em noções de economia, eficiência, utilidade e funcionalidade. Mostra como tais noções se expressam ora em uma simplificação ou ausência de ornatos, ora no uso de ornatos cujos temas remetem ao mundo das máquinas; às vezes, no distanciamento ou abandono de signos arquitetônicos tipológicos consagrados; ou, ainda, no emprego de materiais produzidos industrialmente e que se difundiram a partir, sobretudo, da arquitetura de fábricas.

Menopausa: principais sinais e sintomas à avaliação vestibular computadorizada

Objetivo: Identificar os principais sintomas e sinais ao exame vestibular computadorizado em pacientes na menopausa. Método: Foram examinadas 24 pacientes com idades entre 46 a 66 anos. Analisaram-se os dados relativos à sintomatologia e achados ao exame vestibular computadorizado com vectonistagmografia realizado no ambulatório de otoneurologia da Irmandade Santa Casa de Misericórdia de São Paulo, em 2004 e 2005. Resultados: Entre as pacientes, 54,1 por cento faziam reposição hormonal. Em relação aos sintomas relatados, observamos cefaléia (58,4 por cento), hipersensibilidade a sons intensos (58,4 por cento), tontura (54,2 por cento), zumbido (50 por cento), hipoacusia (50 por cento), ansiedade (50 por cento), distúrbio neurovegetativo (41,7 por cento), vertigem (37,5 por cento) e depressão (37,5 por cento). Ao exame vestibular encontramos alterações do nistagmo de posicionamento (12,5 por cento), e prova calórica (54,2 por cento). Na conclusão do exame tivemos prevalência de síndrome vestibular periférica irritativa (54,2 por cento). Conclusão: Por meio dos resultados desta pesquisa concluiu-se que pacientes no período da menopausa apresentam elevada prevalência de sintoma otoneurológicos e alterações à vectonistagmografia computadorizada, com predomínio de síndrome vestibular periférica do tipo irritativo

Effects of Laser on the Synovial Fluid in the Inflammatory Process of the Knee Joint of the Rabbit

Objective: The purpose of this study was to evaluate the effects of low-level laser (LLL) energy on the clinical signs of inflammation and the cellular composition of synovial fluid (SF) in the inflamed knee of the rabbit. Background Data: There are few findings related to the effects of LLL on SF in inflammatory processes and there is little knowledge about the optimal parameters for reducing joint inflammation. Materials and Methods: Inflammation in the right knee of 36 rabbits was induced by intracapsular injection (0.2 mL) of Terebinthina commun (Tc). The animals were randomly assigned to three groups: acute experimental group (AEG), chronic experimental group (CEG), and control group (CG), which only received Tc. Each group was divided in two subgroups of six animals each. The AEG and CEG groups began to receive laser treatment 2 and 5 d after the induction of inflammation, respectively. Laser irradiation at a wavelength of 830 nm, power output of 77 mW, and power density of 27.5 W/cm(2) was applied daily for 7 d for either 0.12 sec or 0.32 sec, resulting in doses of 3.4 J/cm(2) and 8 J/cm(2), respectively. Body mass, joint perimeter, joint temperature, and the morphology of the SF were analyzed. Results: There was no statistically significant differences between groups in the body mass, joint perimeter, and SF morphology. Conclusion: Laser irradiation with the selected parameters produced only a few subtle differences in the inflammatory signs and the SF. The lack of effects may have been due to the short irradiation time.

The case of thyroid hormones: how to learn physiology by solving a detective case

Lellis-Santos C, Giannocco G, Nunes MT. The case of thyroid hormones: how to learn physiology by solving a detective case. Adv Physiol Educ 35: 219-226, 2011; doi:10.1152/advan.00135.2010.Thyroid diseases are prevalent among endocrine disorders, and careful evaluation of patients' symptoms is a very important part in their diagnosis. Developing new pedagogical strategies, such as problem-based learning (PBL), is extremely important to stimulate and encourage medical and biomedical students to learn thyroid physiology and identify the signs and symptoms of thyroid dysfunction. The present study aimed to create a new pedagogical approach to build deep knowledge about hypo-/hyperthyroidism by proposing a hands-on activity based on a detective case, using alternative materials in place of laboratory animals. After receiving a description of a criminal story involving changes in thyroid hormone economy, students collected data from clues, such as body weight, mesenteric vascularization, visceral fat, heart and thyroid size, heart rate, and thyroid-stimulating hormone serum concentration to solve the case. Nevertheless, there was one missing clue for each panel of data. Four different materials were proposed to perform the same practical lesson. Animals, pictures, small stuffed toy rats, and illustrations were all effective to promote learning, and the detective case context was considered by students as inviting and stimulating. The activity can be easily performed independently of the institution's purchasing power. The practical lesson stimulated the scientific method of data collection and organization, discussion, and review of thyroid hormone actions to solve the case. Hence, this activity provides a new strategy and alternative materials to teach without animal euthanization.

Four cases of equine polysaccharide storage myopathy in the United Kingdom

This paper describes four cases of equine polysaccharide storage myopathy which were confirmed by histological examination of muscle biopsy specimens. The horses were of mixed breeding, with warmblood and thoroughbred dominating. They all had recurrent episodes of rhabdomyolysis, indicated by clinical signs and increased plasma levels of muscle enzymes. They were managed conservatively and have continued athletic careers despite their disease.

Mandibular Function is Severely Impaired in Systemic Sclerosis Patients

Aims: To evaluate the presence of temporomandibular disorders (TMD) in systemic sclerosis (SSc) patients and its possible association with the severity of skin involvement. Methods: The presence of TMD was evaluated in 35 SSc women and 30 age- and sex-matched healthy controls by means of the anamnestic (A(i)) and clinical (D(i)) Helkimo indices; the jaw mobility was further analyzed (M(I)). Skin involvement was scored by the Modified Rodnan Skin Score (MRSS). Results: Signs and symptoms of TMD were more frequent in SSc patients than in controls, the frequency distribution of the different clinical dysfunction indices differing significantly (P < .001) between patients (D(i)0 8.6%, D(i)I 48.6%, D(i)II 22.8%, and D(i)III 20%) and controls (D(i)0 50%, D(i)I 33.3%, and D(i)II 16.7%). Cyclophosphamide for severe and rapidly progressive cutaneous fibrosis was prescribed in six out of seven patients with severe signs (D(i)III), in contrast this treatment was indicated for only two out of 25 patients with mild to moderate signs (D(i)I and D(i)II, P <. 001). Impaired jaw mobility was more frequent in SSc patients than controls (P < .001). It was severe in 77.1% (M(I)II) and mild in 22.9% (M(1)I) of the cases, in contrast to controls (M(I)0 33.4%, M(I)I 53.3%, and M(I)II 13.3%; P < .001). Approximately half of SSc patients with severe (M(I)II) but none of those with mild impairment were on cyclophosphamide treatment for severe cutaneous fibrosis (P = .02). Conclusion: Severe signs of TMD according to the anamnestic and clinical Helkimo indices were very frequent in SSc patients. J OROFAC PAIN 2010;24:197-202

The alcohol withdrawal syndrome

The alcohol withdrawal syndrome (AWS) is a set of signs and symptoms that typically develops in alcohol-dependent people within 6–24 h of their last drink. It may occur unintentionally if abstinence is enforced by illness or injury, or deliberately if the person voluntarily stops drinking because of an alcohol-related illness, or as a prelude to becoming and remaining abstinent. The signs and symptoms of the syndrome (panel) are largely, but not exclusively, those of autonomic hyperactivity, the reverse of the effects of alcohol intoxication. They represent a homoeostatic readjustment of the central nervous system (CNS) to the neuroadaptation that occurs with prolonged alcohol intoxication.1 RC Turner, PR Lichstein and JG Peden et al., Alcohol withdrawal syndromes: a review of pathophysiology, clinical presentation and treatment, J Gen Intern Med 4 (1989), pp. 432–444. Full Text via CrossRef | View Record in Scopus | Cited By in Scopus (39)1 They vary in severity from mild to severe.1

Social anxiety disorder: what are we losing with the current diagnostic criteria?

Objective: To assess the rate of comorbidities and the functional impairment associated with the social anxiety disorder (SAD), with an emphasis on the so-called subthreshold clinical signs and symptoms. Method: Psychiatric comorbidities and psychosocial functioning were evaluated in 355 volunteers (college students) who had been diagnosed as SAD (n = 141), Subthreshold SAD (n = 92) or Controls (n = 122). Results: The rate of comorbidities was 71.6% in the SAD group and 50% in subjects with Subthreshold SAD, both significantly greater than Controls (28.7%). Concerning psychosocial functioning, the SAD group had higher impairment than the other two groups in all domains evaluated, and subjects with Subthreshold SAD presented intermediate values. Conclusion: The rates of psychiatric comorbidities and the impairment of psychosocial functioning increase progressively along the spectrum of social anxiety. The fact that Subthreshold SAD causes considerable disability and suffering in comparison with control subjects justifies a review of the validity of the diagnostic criteria.

Schizophrenia Modifying the Expression of Gender Identity Disorder

According to the Brazilian Federal Medical Association, transsexualism is recognized as a gender identity disorder if a long-term diagnostic therapeutic process has demonstrated that the transposition of gender roles is irreversible, and if only hormonal and surgical procedures are appropriate to relieve the stress associated with the gender identity. Although such treatment will only be initiated with caution and after a long phase of intense diagnostic screening, the differentiation between pure identity disorders and transsexual feelings secondary to an ongoing psychopathologic process, such as schizophrenia, can be arduous for many health professionals. To report a case of a female patient with schizophrenia and transsexualism and the risks of a potential diagnostic confusion. A 19-year-old black woman, with an 8-year history of undifferentiated schizophrenia and intense gender dysphoria, was referred for sex reassignment surgery evaluation in the Ambulatory for the Treatment of Sexual Disorders of the ABC Medical School. After a more adequate antipsychotic treatment, her masculine behavior has persisted, but her desire to change her own genital organs has decreased. A better acceptance of the multiplicity of possible genders should neither contribute to inadequate interpretations of the signs and symptoms of our patients nor facilitate dangerous clinical or surgical recommendations. Baltieri DA, and De Andrade AG. Schizophrenia Modifying the expression of gender identity disorder. J Sex Med **;**:**-**.

Urogenital tuberculosis in immunocompromised patients

Compare the clinicoradiological presentation of urogenital tuberculosis (UGT) between immunocompromised and nonimmunocompromised patients. Eighty patients diagnosed with UGT were divided into two groups: eight immunocompromised patients (four with acquired immunodeficiency syndrome [AIDS], and four renal transplant patients on immunosuppressive therapy) and 72 nonimmunocompromised patients. The groups were compared as for age, signs and symptoms, diagnostic approach, pattern of urogenital organ involvement, and early specific mortality (within 6 months from diagnosis). AIDS patients were younger (median age 26 years, range 16-38 years), and renal transplant patients were older (median age 51.5 years, range 45-57 years), compared with the nonimmunocompromised subjects (median age 35 years, range 12-75 years). Immunocompromised patients had greater frequency of fever (87.5% versus 43.1%, P = 0.024), lower frequency of storage symptoms (37.5% versus 76.4%, P = 0.033), shorter length of disease (< 6 months: 87.5% versus 2.8%, P < 0.001), and larger frequency of disseminated tuberculosis (62.5% versus 18.1%, P = 0.012). Predominantly parenchymatous renal involvement was more frequent in immunocompromised patients (87.5% versus 6.2%, P < 0.001), who also had lower frequency of stenosis of the collecting system (12.5% versus 93.8%, P < 0.001) and contracted bladder (12.5% versus 65.3%, P = 0.001). UGT has a different clinicoradiological presentation in immunocompromised patients, with predominance of systemic symptoms, disseminated tuberculosis, multiple parenchymatous renal foci, and lower frequency of lesions of the collecting system. In the context of immunosuppression, UGT behaves as a severe bacterial infection, with bacteremia and visceral metastatic foci.

USE OF ANTIBIOTIC SPACERS FOR KNEE ENDOPROSTHESIS INFECTIONS TREATMENT

Objective: The aim of this study is to evaluate the use of cement spacers impregnated with antibiotics for the treatment of infections in the nonconventional endoprostheses of the knee. Methodology: We have treated seven patients since 2004 (of which six were submitted to surgery in our service and one patient had been submitted to a primary tumor surgery in another removal service) with deep infection in knee tumor prosthesis. All patients were submitted to endoprosthesis removal and reconstructed with antibiotic cement spacer All patients were monitored both clinically and by lab tests as for monitoring the evolution, being considered able for reviews after 6 (six) months without infections signs. Results: We have noted a small predominance of infectious processes on the prosthesis inserted on proximal tibia as compared with distal femur (57.1% x 42.9%). The mean follow-up time of patients was 68.2 months. During the follow up, one patient died as a result of the root disease. Six patients out of seven were regarded as cured and one persisted with infection signs and symptoms. Conclusion: The results obtained up to date have motivated us to continue using this method of treatment.