Recidiva Neural em hanseníase multibacilar após 6 anos de tratamento

This article presents a case of relapse, with isolated neural manifestation, in a multibacillary patient previously treated with multidrug therapy for multibacillary leprosy (24 doses). The patient returned to the service six years after the end of treatment, with pain in hands and legs. He was investigated, and the serological monitoring showed an important increase in anti-phenolic glycolipid serum levels. A neural recurrence was suspected, since the patient had no new skin lesions. A new biopsy in the right ulnar nerve showed a bacilloscopy of 2 +, compatible with relapse. This is a literature review of the etiological, clinical, propedeutical and diagnostic aspects of this situation so poorly understood. © 2012 by Anais Brasileiros de Dermatologia.

Aparecimento de psoríase durante o tratamento das doenças inflamatórias intestinais com infliximabe: A terapia biológica deve ser suspensa?

Context - Several paradoxical cases of infliximab-induced or-exacerbated psoriatic lesions have been described in the recent years. There is disagreement regarding the need to discontinue infliximab in order to achieve the resolution of these adverse cutaneous reactions specifically in inflammatory bowel disease (IBD) patients. Objective - To systematically review the literature to collect information on IBD patients that showed this adverse cutaneous reaction, focusing mainly on the therapeutic approach. Methods - A systematic literature review was performed utilizing Medline, Embase, SciELO and Lilacs databases. Published studies were identified, reviewed and the data were extracted. Results - Thirty-four studies (69 IBD patients) met inclusion criteria for review. There was inconsistency in reporting of some clinical and therapeutic aspects. Most patients included had Crohn's disease (89.86%), was female (47.83%), had an average age of 27.11 years, and no reported history of psoriasis (84.05%). The patients developed primarily plaque-type psoriasis (40.58%). There was complete remission of psoriatic lesions in 86.96% of IBD patients, existing differences in the therapeutic approaches; cessation of infliximab therapy led to resolution in 47.83% of cases and 43.48% of patients were able to continue infliximab therapy. Conclusion - As increasing numbers of IBD patients with psoriasis induced or exacerbated by infliximab, physicians should be aware of its clinical manifestations so that appropriate diagnosis and treatment are properly established. The decision whether to continue or discontinue infliximab should be individualized.

Fondaparinux em intervenção coronária percutânea no tratamento da síndrome coronária aguda

Background: Fondaparinux is considered an agent with a well-established safety and efficacy profile in the treatment of non-ST segment elevation acute coronary syndromes, but when used alone, is associated to a higher incidence of thrombotic complications during invasive coronary procedures, requiring the supplementation of an anti-IIa agent. This study aimed to evaluate the efficacy and safety of percutaneous coronary intervention (PCI) in patients with non-ST segment elevation acute coronary syndromes previously treated with fondaparinux. Methods: Prospective, controlled registry enrolling 127 consecutive patients submitted to an early invasive stratification during treatment with fondaparinux, with supplementation of intravenous unfractionated heparin at a dose of 85 U/kg at the time of PCI. Results: The rate of the composite primary endpoint including death, acute myocardial infarction, stroke, stent thrombosis or emergency myocardial revascularization was 3.2%. The cumulative incidence of major bleeding and vascular complications was 3.2%. There were no cases of guidecatheter thrombosis or abrupt vessel closure. Conclusions: PCI in patients with acute coronary syndromes receiving fondaparinux is associated with a low rate of major adverse cardiovascular ischemic events and severe hemorrhagic complications. Supplementation of unfractionated heparin during the invasive procedures eliminates the risk of catheter-related thrombosis.

Resposta de cultivares de trigo ao nitrogênio com e sem tratamento fúngico

The fungicide can enhance response of nitrogen fertilization on wheat crop, since the application of higher N rates can provide better conditions for the development of some diseases. The present study investigated the effects of different nitrogen doses and fungicide application in preventive character on the yield of two cultivars of wheat irrigated, in Savannah conditions. The experiment was conducted in Selvíria - MS, in a Distrophic Red Latosol (Typic Haplustox). Treatments were arranged in a randomized block design, in a 4x2x2 factorial scheme: four N rates (0, 60, 120 and 180 kg ha-1), topdressing at the early boot stage as urea, two wheat cultivars (IAC 24 and IAC 370), and with and without fungicide application (Tebuconazole and Triciclazol), with four replications. The cultivars IAC 24 and IAC 370 present similar grain yield. The increase of N doses influences the mass hectoliter negatively and the leaf N content and number of ears per m2 positively. The increment of N doses increase the grain yield up to dose of 116 kg ha -1 of N, regardless of cultivar and of the fungicide application in preventive character, due to non occurrence of diseases in the experiment.

Estudo duplo cego com Isoconazol e Terbinafina tópicos no tratamento de um paciente com Tinea nigra plantaris bilateral e sugestões para novos diagnósticos diferenciais

The authors report a case of bilateral Tinea nigra plantaris treated through a double-blind study with the topical antifungal agents Isoconazole and Terbinafine. The objective of the study was to clinically compare the efficacy of these two topical antifungal agents on days 10, 20 and 30 of the treatment. No significant clinical differences were found, as all the plantar lesions regressed completely by the end of the treatment. Our conclusion was that in the case reported, the topical antifungal agents Isoconazole and Terbinafine demonstrated identical efficacy as a clinical cure. We also suggest the inclusion of injuries caused by arthropods of the Diplopoda Class in the differential diagnosis of Tinea nigra plantaris, due to the persistent acral hyperpigmentation.

Controle em pós-colheita de Penicillium digitatum em laranja-pera com microrganismos e tratamento térmico

The consumer market demands food without pesticide residues. Therefore, this study focused on evaluating the control of green mold in Pera orange trees with biocontrol agents (Bacillus subtilis, Bacillus licheniformis and Bacillus subtilis (QST 713)), associated or not with heat treatment. The fruit was obtained in packinghouse before processing, being washed and disinfected with the use of Sodium Hypochlorite. Fruits submitted to these treatments were stored from 11 to 28 days at temperature of 10 °C and RH 90%±5 or for eight days at 20 °C and 90%±5. In general, the heat treatment reduced the disease severity determine by the area under the disease progress curve in the fruit and the incidence of natural postharvest disease in Pera oranges. On the other hand, biocontrol agents did not control the disease, showing that the organisms tested did not present curative activity against the green mold.

Ultrassonografia Doppler na avaliação renal de cadelas diagnosticadas com piometra antes e após tratamento com ovariosalpingohisterectomia

The aim of this study was evaluate the renal hemodynamics of bitches with pyometra by means of laboratory tests, ultrasound B mode and Doppler, before and after treatment with ovariohysterectomy (OSH). This study evaluated 30 bitches with pyometra, all were subjected to OSH (moment 1) and 20 were evaluated after 7 days (moment 2). The renal perfusion, the resistivity index (RI) of the main renal artery and the interlobar arteries (cranial, middle and caudal) were statistically different between times 1 and 2 (p<0,05). There was no statistical difference for renal perfusion between the left and the right kidney at the time 1 and 2. The correlations between the IR of the main artery and the variables used to determine renal function were stablished at the time 1. For the correlated variables: urea, creatinine, proteinuria, ratio GGT/creatinine and protein/creatinine were curvilinear and positive associations with the resistivity index of the main renal artery (p<0,05), however these correlations were considered medium and weak. Comparing the RI of the main renal artery with different scores of dehydration and renal perfusion, there was statistical difference, and show increased of resistance renal in bitches with moderate reduction in renal perfusion as well as in dehydrated bitches. Were evaluated several features of renal morphology in ultrasound B mode, however, only the presence of pelvic dilatation, medullary signal and other changes as infarcts areas and diffuse hyperechoic spots in the renal cortical and medullary were statistically different from one moment to the other, most frequently at the time 2. The results of this study show that the Doppler ultrasound can identify changes of reduction in renal perfusion by color Doppler and the increasing of the resistivity index of the renal arteries in some bitches with pyometra. As well as, the ultrasound B mode, although has non-specific changes, can detect progressive renal disorders in bitches with pyometra.

Aspectos clínicos do enxerto conjuntival 360° e do implante da membrana amniótica criopreservada no tratamento de úlceras de córnea em cães

To evaluate the clinical application of implant of the canine cryopreserved amniotic membrane (DMEM plus DMSO 1:1) and 360° conjunctival flap in the treatment of progressive corneal ulceration. 10 dogs of the different breeds, males and females, aging four months to four years old with deep corneal ulceration and different clinical progression were divided in two groups: G1=360° conjunctival graft (n=5) and G2=implant of amniotic membrane, sutured at the edge of the ulcer with epithelial side facing up, associated with the third eyelid flap (n=5). The comparative analysis between groups was: complications, blepharospasm, ocular secretion, corneal vascularization, epithelial defect and corneal opacification in six moments (first emergency care, surgery and 3, 7, 15 and 30 days of postoperative). Without epithelial defect was evaluated quality of the scar. It was used score scale for subjective to qualify of the ocular signs. In G1, it was observed the non-adherence of the conjunctival graft to the ulcer (n=2), dehiscence of the suture (n=2), anterior synechia (n=2) and intense chemosis (n=1). In G2, it was not observed these complications. It was not significant difference between the groups to others ocular parameters, but it was different among the start and end moments of the same groups (ocular secretion, corneal vascularization, epithelial defect). The corneal opacity was more intense in G1. According to the clinical results, the cryopreserved amniotic membrane implant proved to be as effective in the corneal ulceration in comparison to the 360° conjunctival flap, because probably, the membrane promoted a trophic support for epithelialization, anti-inflamatory effect associated with important to the end result phenotype.

Caracterização do tratamento medicamentoso com estatinas em unidade básica de saúde

Study Model: Retrospective study. Study Objective: To characterize statin treatment management due to lipid alterations and side effects throughout statin treatment in basic healthcare unit. Methods: Medical reports of women from a basic healthcare unit were analyzed, obtaining: disease presence, regular medication prescription, statin type and dosage, biochemical exams results, musculoskeletal complaints, and statin use cessation, going back the information until the medical consultation of first prescription. Results: Prescribed statins were Simvastatin and Atorvastatin at low doses (10-20 mg). Dose (48,4%) and/or type (25,4%) alterations occurred for lipid profile adequacy. Lipid levels were reduced without creatine kinase elevation. Treatment withdrawn (30,6%) was mainly due to their own decision (74%), which was strongly associated with records of musculoskeletal complaints (Odds Ratio: 6,40[1,53-26,78]). Conclusion: Statin treatment was effective in reducing serum lipid levels and self-reported pain was underestimated, characterizing the major limiting factor for treatment adherence.

Efeitos do tratamento com formalina e sulfato de cobre sobre os parâmetros hematológicos e parasitos monogenéticos em juvenis de Hemigrammus sp. (Osteichthyes: Characidae)

The objective of this study was to evaluate the effectiveness of formalin and copper sulphate to control monogeneans in juvenile Hemigrammus sp and its effect on leukocyte count. We used a completely randomized design with five treatments and three replications. All treatments lasted for three days and consisted of: T1, control; T2 and T3 immersion bath for one hour in formalin, an of two concentrations of 0.25 ml formalin and the other 0.1 ml L-1; the T4 bath for 24 hours with 0,025 ml of formalin-L-1; and T5, bath 24 hours with copper sulphate (0.3 mg L-1). After the experimental period was observed that T2, 100% mortality. The T3 and T5 provided 100% efficiency, however, fish presented mortalities and intoxication of the 66 and 80% respectively. T4 showed an efficacy of 77.7% and decrease in parasitological indices: total number of parasites of11, 3 ± 9, mean infection intensity of 3.2 ± 2 and a prevalence of 47.1%. As the leukocytes was observed that at T3, T4 and T5 occurred differences in the proportion of lymphocytes, monocytes and neutrophils as compared to control. The CuSO4 and formalin reduce the parasite load, but presented to be toxic at higher concentrations.

Ocorrência de cristais em plantas medicinais utilizadas no tratamento da nefrolitíase: Paradoxo?

Nephrolithiasis (kidney stones) can be seen as a common clinical condition responsible for substantial economic, social and psychological costs, due to its high morbidity, especially since it affects adults in their productive phase. Its development in the urinary tract is a complex and multifactorial process. The majority of kidney stones are made of calcium oxalate. A lot of plants are used to treat nephrolithiasis and they often exhibit calcium oxalate crystals in the parts that are employed for this medicinal purpose, representing a possible risk. In this light, we performed a literature review via the databases Scielo, PubMed and Medline and found 28 articles reporting the traditional use of plants in the treatment of nephrolithiasis. The occurrence of calcium oxalate crystals was indicated in 19 species. We argue that the use of these plants could give rise to adverse effects in people who are prone to form calcium oxalate stones in the kidney.

Evolução de pacientes com AIDS pós cART: Evolução clínica e laboratorial de pacientes com AIDS após 48 semanas de tratamento antirretroviral

Combination Antiretroviral Therapy (cART) aims to inhibit viral replication, delay immunodeficiency progression and improve survival in AIDS patients. The objective of this study was to compare two different schemes of cART, based on plasma viral load (VL) and CD4+ T lymphocyte count, during 48 weeks of treatment. For this purpose, 472 medical charts of a Specialized Outpatient Service were reviewed from 1998 to 2005. Out of these, 58 AIDS patients who had received a triple drug scheme as the initial treatment were included in the study and two groups were formed: Group 1 (G1): 47 individuals treated with two nucleoside reverse-transcriptase inhibitors (NRTI) and one non-nucleoside reverse-transcriptase inhibitor; Group 2 (G2): 11 patients treated with two NRTI and one protease inhibitor. In G1 and G2, 53.2% and 81.8% respectively were patients with an AIDS-defining disease. The T CD4+ lymphocyte count increased progressively up until the 24th week of treatment in all patients, while VL became undetectable in 68.1% of G1 and in 63.6% of G2. The study concluded that the evolutions of laboratory tests were similar in the two treatment groups and that both presented a favorable clinical evolution.

Tratamento cirúrgico de condroma extradural lombar em cão - relato de caso

Neoplasms originating in the spinal canal are uncommon in small animal veterinary clinic, but when present can cause significant neurological signs. Anatomically, these neoplasms can be classified as extradural, intradural-extramedullary and medullary. Extradural neoplasms are located outside the dura mater, but they can cause compression of the spinal cord. The chondromas are benign neoplasms characterized by the formation of cartilage and is rarely located in the spinal canal in both human and veterinary medicine. We describe a case of lumbar extradural chondroma in a dog that surgical decompression and removal of the mass allowed the resolution of clinical signs of paralysis with return of function of the hind limbs of the patient.

Contaminação das águas subterrâneas por nitrogênio devido à irrigação com efluente do tratamento de esgoto

Agriculture is an activity in which there is the possibility of using lower quality water and reuse appears as an alternative for irrigation. However, the negative environmental effects of reuse must be understood. The objective of the present work was to verify the potential of groundwater contamination by nitrogen duo to drip irrigation with effluent from domestic wastewater treatment. Three crop cycles of lettuce cv. Raider were conducted, the first between October and November 2009, the second in April and May 2010 and the third one in June and July 2010. The use of effluents was compared with potable water at accumulated water depths of 98.8 mm for the first, 98.4 mm for the second and 119 mm for the third cycle. Soil percolate concentrations of nitrate, nitrite and ammonia were studied at 0.25 m and 0.50 m depths in a completely randomized design. Percolate concentrations of nitrite and ammonia in soil irrigated with effluents showed no groundwater contamination risk. Nitrate however, caused concern, albeit with similar concentrations for both effluent and potable water.