Cutaneous Leiomyomatosis in a Mother and Daughter

A 34-year-old woman with no known medical history was evaluated for multiple painful brown nodules and papules on the anterior aspect of the trunk. She mentioned a history of similar cutaneous findings on her mother. Biopsies of three lesions revealed piloleiomyomata. Renal and adrenal ultrasound revealed an isolated simple cortical cyst, and pelvic and endovaginal ultrasound revealed two uterine myomata. The clinical diagnosis of hereditary leiomyomatosis and renal cell cancer was corroborated by the identification of a heterozygous variant on exon 5 of the fumarate hydratase gene (c.578C>T p.T193I). Identification of the tumor piloleiomyoma should alert the dermatologist to this rare genodermatosis, which is associated with an increased risk of renal cell tumors, demanding multidisciplinary follow-up, and personal and family counseling.

Influence of Compound 16.842 on hookworm infections

Compound 16.842 was tried with three different groups of patients in order to evaluate its tolerancy, and efficacy as well, with a view of using the drug in mass campaigns against hookworm. Group I, used for a preliminary trial, consisted of 38 patients attending an out-patient clinic, and living either in the out-skirts or in the various urban areas of the city of Rio de Janeiro, including some inmates of an orphanage. Group II, a field trial, was carried out in two farms, where the drug was administered both to the positive cases (124) and to the rest of the population (nearly 90%). Group III, a field trial was also carried out in a small town where nearly 40% of the total population was treated with the Compound. Tolerability was considered rather satisfactory, mainly among the patients receiving two single doses (50-150mg), according to the age, 4 - 6 weeks apart). These results suggest that 2-4 courses of therapy within a shorter span of time should be the ideal for a mass treatment campaign. Efficacy varied from 26.6% to 76.2% parasitological cure in the various groups, with a wide range of variation also in the percent of mean reduction of eggs for hookworm. The drug showed also some effect against Ascaris lumbricoides giving cure rates between 10,5% and 35.7% in the various groups, with a percentage reduction in mean egg counts of 27% to 83.3% according to the various groups. It was concluded that Compound 16.842 possesses a marked effect on hookworm and a mild effect on A. lumbricoides. The findings indicate the need for more accurate studies to determine the most efficient schedules of treatment and the real value of the drug, as compared to other antihelminthics against the two parasites under study.

Acidentes em Crianças e Jovens, Que Contexto e Que Abordagem? Experiência de Nove Meses no Serviço de Urgência num Hospital de Nível II

Introdução: Os acidentes constituem uma importante causa de morbimortalidade infantil e de recurso ao serviço de urgência pediátrica. A nível nacional conhecem-se apenas alguns dados epidemiológicos. Métodos: Estudo observacional transversal com análise da coorte das crianças observadas no serviço de urgência pediátrica de um hospital nível II por motivo de acidente, durante um período de nove meses, com dados obtidos através de um inquérito e submetidos a análise estatística. Resultados: Das 22502 admissões de crianças até aos 14 anos registadas, 1746 (7,8%) foram por acidentes. A maioria era do sexo masculino e tinha mais de 5 anos. Os acidentes ocorreram maioritariamente no exterior da escola (29,1%) e interior de casa (25%), predominando a queda como tipo de acidente (55,5%) e a contusão como mecanismo de lesão (54,2%). A maioria das crianças (77,3%) foi submetida a exames complementares de diagnóstico destacando-se os radiológicos. Os diagnósticos mais frequentes foram os traumatismos superficiais (47,9%) e os ferimentos (24,8%). Em 6,6% (115) dos casos os acidentes foram considerados graves. Estas admissões por acidentes associaram-se a uma despesa imediata estimada de 124 mil euros. Discussão: A frequência elevada e o local de ocorrência dos acidentes coincidiram com a literatura. Apesar do predomínio das lesões minor superficiais (47,9%) verificou-se um número significativo de crianças com necessidade de cuidados hospitalares. Não foram registados óbitos. Os autores concluem que os acidentes em crianças foram um motivo frequente de ida ao serviço de urgência pediátrica com importante consumo de recursos. A sensibilização dos cuidadores é essencial na prevenção dos acidentes.

Exame parasitológico quantitativo das fezes: estudo comparativo entre os métodos de McMaster, Stoll-Hausheer e Kato-Katz

Foram comparados 300 exames parasitológicos quantitativos das fezes, pelos métodos de Kato-Katz, Stoll-Hausheer e McMaster, após análise prévia e rotineira. Os resultados evidenciaram as porcentagens de positividades a seguir especificadas, levando em conta, por ordem, espécie de helminto, número de situações nas quais os ovos respectivos apareceram e as participações dos processos de Kato-Katz, Stoll- Hausheer e McMaster: ancilostomídeos- 117(89,7%, 76,0% e80,3%); Trichocephalus trichiurus-124 (91,1 %, 70,9% e 70,9%); Ascaris lumbricoides- 59 (94,9%, 84,7% e 49,1%); Schistosoma mansoni- 58 (96,5%, 48,2% e 0,0%); Hymenolepis nana -15 (46,6%, 73,3% e 86,6%). Quanto à sensibilidade dos métodos, a avaliação estatística demonstrou, na maioria das situações, vantagem do de Kato-Katz sobre os demais. O estudo efetuado comprovou superioridade da técnica de Kato-Katz, em virtude de verificações relacionadas com especificidade, sensibilidade e facilidade para execução. O procedimento de McMaster não merece recomendação para uso habitual, uma vez que não é eficiente no que concerne à demonstração de ovos pesados e propicia preparações dificilmente examináveis.

International News Reporting in the Multidimensional Network: The socio-demographics, professional culture and newswork of foreign correspondents working across Sub-Saharan Africa

Tese apresentada para cumprimento dos requisitos necessários à obtenção do grau de Doutor em Media Digitais

Comportamento da parasitemia pelo Trypanosoma cruzi em chagásicos crônicos durante 13 anos

Foi estudada a parasitemia de 202 chagásicos crônicos por um período médio de 13 anos, através de repetidos xenodiagnósticos convencionais. Os pacientes tinham média de idade de 41,4 anos, residiam em área endêmica, sendo 124 do sexo feminino e 78 do sexo masculino. Foi observado que o nível de parasitemia aumentou em 14 indivíduos, diminuiu em 42 e permaneceu inalterado em 146. Porém, no geral, a parasitemia declinou. Os percentuais de chagásicos xenopositivos que foram 37,6%, 48,5%, 51% no primeiro, segundo e terceiro xenodiagnósticos, respectivamente, em 1976/78, passaram a ser 30,2% em 1988/91 (p = 0,00003). Os percentuais de pools positivos que foram 15,2%, 20,9%, 20,8% no primeiro, segundo e terceiro xenodiagnósticos, respectivamente, em 1976/78, passaram a ser 10,4% em 1988/91, (p = 0.00000001). Houve 62 pacientes que tiveram todos os xenodiagnósticos negativos e 23 que apresentaram todos os exames positivos. Os percentuais de chagásicos com alta, média e baixa parasitemias que, em 1976/78, foram, respectivamente, 9,4%; 20,8% e 69,8% passaram a ser, em 1988/91, respectivamente, 4,4%, 12,9% e 82,7%.

Seguimiento serológico de infección por Trypanosoma cruzi en individuos estudiados de 50 municipios del Estado de Jalisco, México de 1987 a 1994

La Universidad de Guadalajara decidió realizar en 1987 un estudio seroepidemiológico para conocer la prevalencia de la infección por Trypanosoma cruzi en los 124 municipios del Estado de Jalisco, México, en el cual se obtuvieron tasas de 21,6 por 100 habitantes. De diciembre de 1993 a junio de 1994 se realizó un seguimiento de algunos de esos individuos, estudiándose sólo 2669 de ellos, de 50 municipios de áreas rurales del estado. Las causas de no encuesta de los faltantes fueron diversas, estando entre las más importantes la emigración (27,6) y la renuencia (14,8). Encontramos a 476 positivos (17,8%) y 2193 negativos (82,2%). Este segundo estudio nos permitió detectar 80 infectados nuevos (2,9%) lo que representa una tasa de incidencia de 30 por 1000 habitantes. Sin embargo, encontramos una seroconversión en los individuos estudiados, ya que de 1007 individuos que estaban positivos en 1987, 943 de ellos continúan así, mientras, que 64 individuos se negativizaron (2,3%), no siendo esto imputable a fallas de laboratorio, la prevalencia de positividad detectada en ambos estudios fue casi idéntica 18,1 y 17,8 % respectivamente, por lo que nosotros pensamos que las condiciones en que viven los individuos de las localidades rurales del Estado de Jalisco favorecen a que las infecciones continúen.

Relationship between protein-energy malnutrition, vitamin A, and parasitoses in children living in Brasília

It is still controversial whether intestinal parasitic infections can influence the nutritional status of children. The relationship between protein-energy malnutrition, vitamin A and parasitic infections was evaluated in 124 children. The food intake estimated by recall method was generally low and poor. Seventy five percent of the children were infected with intestinal parasites. The mean±SD weight-for-age and height-for-age Z-score were skewed one standard deviation to the left, when compared to normal standards. An association was found between protein-energy malnutrition and Giardia lamblia, but not with Ascaris lumbricoides or Hymenolepis nana infection. Only Giardia-infected children had a decreased weight-for-age and weight-for-height Z-score. Hypovitaminosis A was a major nutritional problem, but no relationship between this deficiency and parasitic infection was found. Our data indicate that low and poor food intake were the major cause of protein-energy malnutrition among the children, and except for Giardia, this was not influenced by parasitic infections.

Diagnosing human asymptomatic visceral leishmaniasis in an urban area of the State of Minas Gerais, using serological and molecular biology techniques

A population-based cross-sectional study was set up in Sabará country, Southeastern Brazil, to identify asymptomatic human visceral leishmaniasis in an urban area of low disease prevalence. Blood was collected on filter paper (n=1,604 inhabitants) and examined by indirect immunofluorescent test, enzyme-linked immunosorbent assay and immunochromatographic strip test. The prevalence rates of infection ranged from 2.4 to 5.6% depending on the test used. One year later, venous blood was collected in a subset of 226 participants (102 seropositive and 124 seronegative). The tests performed were IFAT, ELISA, rk39-ELISA, polymerase chain reaction and hybridization with Leishmania donovani complex probe. No clinical signs or symptoms of leishmaniasis were observed. Using hybridization as a reference test, the sensitivity and specificity of serology were respectively: 24.8 and 71% (ELISA); 26.3 and 76.3% (rk-39); 30.1 and 63.4% (IFAT). Due to disagreements, different criteria were tested to define the infection and hybridization should be considered in epidemiological studies.

Clinical and epidemiological study of leprosy cases in the University Hospital of Brasília: 20 years - 1985 to 2005

Hansen's disease, also known as leprosy, is an infectious disease still prevalent in Brazil. It is a chronic illness with acute immunological phenomena known as leprosy reactions. In the Federal District of Brazil, the University Hospital of Brasília is the reference centre for leprosy care. The study aimed to characterize the clinical and epidemiological profile of Hansen's disease patients at the University Hospital of Brasília, by descriptive, retrospective analysis of 1,124 patients over the period from 1985 to 2005. The pattern of leprosy in this study demonstrated that type 2 leprosy reactions were common, especially in the lepromatous form and presented a direct correlation with the bacilloscopic index. The prevalence and frequency of severe complications, such as leprosy reactions, emphasize the importance of the ongoing study of leprosy and the need for continual improvement in the scope of knowledge concerning its treatment.

Epidemiological factors related to the transmission risk of Trypanosoma cruzi in a Quilombola community, State of Mato Grosso do Sul, Brazil

INTRODUCTION: This work was an epidemiological investigation of the risk of Trypanosoma cruzi transmission in the rural Quilombola community of Furnas do Dionízio, State of Mato Grosso do Sul, Brazil. METHODS: Of the 71 animals examined, seven were captured (two opossums, Didelphis albiventris; four rats, Rattus rattus; and one nine-banded armadillo, Dasypus novemcinctus) and 64 were domestic (one canine, Canis familiaris; five pigs, Sus scrofa; two bovines, Bos taurus; five caprines, Capra sp.; and 51 ovines, Ovis aries). Parasitological tests were performed to detect parasites in the blood and to identify the morphology of flagellates. These methods included fresh examinations, buffy coat tests and blood cultures. Molecular analysis of DNA for identification of trypanosomatids was performed by polymerase chain reaction (PCR) with primers S35 and S36. RESULTS: The parasitological tests showed flagellates in an opossum and two cattle. The molecular tests showed DNA from T. cruzi in an opossum and a pig. Triatoma sordida was the only triatomine species found in the community, and it colonized households (four specimens) and the surrounding areas (124 specimens). Twenty-three specimens tested positive for flagellates, which were subsequently identified as T. cruzi by PCR. CONCLUSIONS: Data analysis demonstrated that T. cruzi has a peridomestic life cycle that involves both domestic and wild mammals.

Detection of Dientamoeba fragilis in patients with HIV/AIDS by using a simplified iron hematoxylin technique

INTRODUCTION: Studies strongly indicate Dientamoeba fragilis as one of the causes of diarrhea in human immunodeficiency virus (HIV) patients. METHODS: The objective of the present study was to evaluate the prevalence of D. fragilis associated with the causes of diarrhea in 82 HIV/ AIDS patients hospitalized at the Instituto de Infectologia Emílio Ribas from September 2006 to November 2008. RESULTS: In total, 105 samples were collected from 82 patients. Unprotected sex was the most frequent cause of HIV infection (46.3%), followed by the use of injectable or non-injectable drugs (14.6%). Patients presented with viral loads of 49-750,000 copies/ mL (average: 73,849 ± 124,850 copies/mL) and CD4 counts ranging of 2-1,306 cells/mm³ (average: 159 ± 250 cells/mm³). On an average, the odds of obtaining a positive result by using the other techniques (Hoffman, Pons and Janer or Lutz; Ritchie) were 2.7 times higher than the chance of obtaining a positive result by using the simplified iron hematoxylin method. Significant differences were found between the methods (p = 0.003). CONCLUSIONS: The other techniques can detect a significantly greater amount of parasites than the simplified iron hematoxylin method, especially with respect to Isospora belli, Cryptosporidium sp., Schistosoma mansoni, and Strongyloides stercoralis, which were not detected using hematoxylin. Endolimax nana and D. fragilis were detected more frequently on using hematoxylin, and the only parasite not found by the other methods was D. fragilis.

Consensualismo fiscal: notas para reflexão

In, revista "Fisco", Ano XVII, Nº 122/123-124/125, 2007

Human immunodeficiency virus/Leishmania infantum in the first foci of urban American visceral leishmaniasis: clinical presentation from 1994 to 2010

INTRODUCTION:Human immunodeficiency virus (HIV) coinfection with Leishmania infantum or Leishmania donovani, the agents of visceral leishmaniasis (or kala-azar), has become a fatal public health problem in the tropics where kala-azar is endemic.METHODS:The clinical presentation of patients with HIV and L. infantum coinfection is described using two unique databases that together produce the largest case series of patients with kala-azar infected with HIV in South America. First, a retrospective study paired the list of all patients with kala-azar from 1994 to 2004 with another of all patients with HIV/AIDS from the reference hospital for both diseases in the City of Teresina, State of Piauí, Brazil. Beginning in 2005 through to 2010 this information was prospectively collected at the moment of hospitalization.RESULTS:During the study, 256 admissions related to 224 patients with HIV/L. infantum coinfection were registered and most of them were males between 20-40 years of age. Most of the 224 patients were males between 20-40 years of age. HIV contraction was principally sexual. The most common symptoms and signs were pallor, fever, asthenia and hepatosplenomegaly. 16.8% of the cohort died. The primary risk factors associated to death were kidney or respiratory failure, somnolence, hemorrhagic manifestations and a syndrome of systemic inflammation. The diagnosis of HIV and kala-azar was made simultaneously in 124 patients.CONCLUSIONS:The urban association between HIV and kala-azar coinfection in South America is worrisome due to difficulty in establishing the diagnosis and higher mortality among the coinfected then those with either disease independently. HIV/L. infantum coinfection exhibits some singular characteristics and due to its higher mortality it requires immediate assistance to patients and greater research on appropriate combination therapy.

Prevalence and risk factors for Toxoplasma gondii infection among pregnant and postpartum women attended at public healthcare facilities in the City of Niterói, State of Rio de Janeiro, Brazil

IntroductionTo determine the prevalence of immunoglobulin G (IgG) and immunoglobulin M (IgM) anti-Toxoplasma gondii antibodies among pregnant and postpartum women attended within the public healthcare system in Niterói, State of Rio de Janeiro, and to detect possible exposure factors associated with T. gondii infection in this population.MethodsIgM and IgG anti-T. gondii antibodies were investigated in 276 pregnant and 124 postpartum women by using the indirect immunofluorescence (IFAT) and immunoenzymatic assay (ELISA) techniques. The participants were selected by convenience sampling. All these 400 patients filled out a free and informed consent statement, answered an epidemiological questionnaire and were informed about the disease.ResultsAmong the 400 samples analyzed, 234 (58.5%) were reactive to IgG anti-T. gondii antibodies, according to the IFAT and/or ELISA assay. One pregnant woman was found to be reactive to IgM anti-T. gondii antibodies, with an intermediate IgG avidity test. Risk factor analysis showed that seropositivity was significantly associated (p<0.05) with age, contact with cats and presence of rodents at home. Through a logistic regression model, these associations were confirmed for age and contact with cats, while education at least of the high school level was found to be a protective factor.ConclusionsThe prevalence rate of IgG anti-T. gondii antibodies in the City of Niterói was high and the risk factors for infection detected after multivariate analysis were: age over 30 years, contact with cats and education levels lower than university graduate level.