Diagnostic challenges and disease management in patients with a mild Zellweger spectrum disorder phenotype.

Peroxisome Biogenesis Disorders-Zellweger spectrum disorder (PBD-ZSD) is a rare, autosomal recessive peroxisome biogenesis disorder that presents with variable symptoms. In patients with PBD-ZSD, pathogenic variants in the PEX family of genes disrupt normal peroxisomal function, impairing α- and ß-oxidation of very-long-chain fatty acids and synthesis of bile acids, resulting in increased levels of toxic bile acid intermediates and multisystem organ damage. The spectrum of severity in PBD-ZSD is variable, with some patients dying in the first year of life, while others live into adulthood. Symptoms of mild PBD-ZSD include various combinations of developmental delay, craniofacial dysmorphic features, visual impairment, sensorineural hearing loss, liver disease, and adrenal insufficiency. Disease progression in mild PBD-ZSD is generally slow, and may include extended periods of stability in some cases. The presence and extent to which symptoms occur in mild PBD-ZSD represents a diagnostic challenge that can cause delays in diagnosis with potential significant implications related to disease monitoring and treatment. There is some support for the pharmacologic therapies of Lorenzo's oil, docosohexanoic acid, and batyl alcohol in altering symptoms; however, systematic long-term studies are lacking. Cholic acid (CA) therapy has demonstrated treatment efficacy in patients with PBD-ZSD, including decreased toxic bile acid intermediates, transaminase levels, and liver inflammation, with improvement in growth parameters. However, these responses are most apparent in patients diagnosed and treated at a young age. Advanced liver disease may limit the efficacy of CA, underscoring the need to diagnose and treat these patients before significant liver damage and other related complications occur. Here we discuss the signs and symptoms of PBD-ZSD in patients with mild disease, standard diagnostic tools, factors affecting disease management, and available pharmacological interventions.

Analysis of current SARS-CoV-2 infection in a large population of blood donors evidenced that RNAemia is rare in plasma.

BACKGROUND: Transmission of SARS-CoV-2 by asymptomatic individuals and by blood transfusion are important issues to understand to control the viral spread. In this work, we estimated the current SARS-CoV-2 infection rate in blood donors from Belo Horizonte, Brazil. STUDY DESIGN AND METHODS: Saliva and blood samples were collected from 4103 blood donors from June 15 to September 30, 2020. Saliva samples were tested by real-time RT-PCR for SARS-CoV-2 in mini-pools of four samples. Individual samples were tested for positive or inconclusive pools, and positive donors had their plasma tested. RESULTS: Twenty-seven (0.66%) blood donors were positive for SARS-CoV-2 in their saliva, but their plasma was negative, except for one, who presented a high viral load in saliva and nasopharyngeal samples and RNAemia in the plasma close to the limit of detection. Fourteen (56%) positive blood donors reported mild symptoms related to COVID-19 after donation, but the viral load levels were not statistically different between symptomatic and asymptomatic individuals. DISCUSSION: Despite the measures taken by Blood Centers to avoid blood donors with SARS-CoV-2 infection, asymptomatic or presymptomatic carriers are able to donate. The risk of the virus transmission by transfusion seems to be negligible since plasma RNAemia was seen at a very low level in only one (3.7%) of the positive donors, but other studies must be performed to confirm this finding.

Telehealth distance education course in Latin America: analysis of an experience involving 15 countries.

BACKGROUND: Telehealth activities are already going on in many Latin American countries. This article aims to present and evaluate a distance learning telehealth training course in the region. MATERIALS AND METHODS: This was a cross-sectional descriptive study. A coordinating committee was formed, composed of medical school faculty from 15 countries, which defined the course's syllabus, teaching model, and mentoring structure. A questionnaire was prepared, using a Likert scale, in order to verify if the parameters of gender, age, professional category, postgraduate degree, and experience in distance education indicated any difference in relation to the course evaluation. The responses were analyzed by chi-squared test, considering as significant a value of p<0.05. RESULTS: Of the 353 enrolled participants, 251 (71.10%) did the basic modules, and 96 (43.91%) completed the full training. In relation to the overall course assessment, it was considered excellent or good by 80.92% of participants, the mentors received positive evaluations by 72.83% of students, the course content was evaluated as excellent or good by 87.4% of students, and 94.40% of participants would recommend it. As for the parameters assessed, only experience in distance education was statistically significant for the evaluation of the tutors. CONCLUSIONS: The results presented indicate an important concern on the part of the Latin American countries participating on the course in relation to telehealth training activities. Regarding course assessment, high approval rates in relation to tutoring, educational model, course content, and goals were noted, corroborating literature data. The experience of conducting a Latin American shared telehealth training course was indeed positive, contributing to the development of telehealth actions.

Rituximab therapy for severe refractory chronic Henoch-Schönlein purpura.

To report on the efficacy of rituximab (RTX) therapy in standard treatment-refractory, chronic Henoch-Schönlein purpura, a retrospective chart review of 3 pediatric patients treated with RTX for severe refractory chronic Henoch-Schönlein purpura was performed. All 3 patients responded to 1 or 2 courses of RTX without serious adverse events.

Bile Acid Synthesis Disorder Masquerading as Intractable Vitamin D-Deficiency Rickets.

Vitamin D-deficiency rickets, not responding to large treatment doses of oral vitamin D, suggest rare receptor mutations, malabsorption, or hepatobiliary dysfunction. We present a set of twins of Hispanic origin who presented with refractory vitamin D-deficiency rickets and failure to thrive (FTT) at 6 months of age. On follow-up, mild elevations in serum alanine transaminases and normal aspartate aminotransferase were noted. Subsequently, patients manifested fat-soluble vitamin deficiencies. More targeted evaluations revealed a diagnosis of 3ß-hydroxy-Δ 5-C27-steroid oxidoreductase deficiency. Treatment with oral bile acid replacement with cholic acid resolved rickets and promoted weight gain. Bile acid synthesis disorders should be suspected in refractory rickets in infancy, particularly in a clinical setting of FTT, even in the absence of substantial abnormalities in liver-function tests.

In vitro antimicrobial activity of plants in Acute Otitis Externa.

UNLABELLED: Acute Otitis Externa is an inflammation of the outer auditory meatus, and according to popular saying, medicinal plant extracts can be used in its treatment. AIM: to assess the in vitro antimicrobial activity of the following plants: Aleolanthus suaveolens; Caryophyllus aromaticus; Cymbopogon citratus; Matricaria chamomila; Pithecellobium avaremotemo; Plectranthus amboinicus and Ruta graveolens on the germs that cause otitis externa. MATERIALS AND METHODS: the minimum inhibitory concentration of extracts and oils from these plants was obtained from otitis externa samples. RESULTS: Staphylococcus aureus in 10 cultures, Pseudomonas aeruginosa in 8, Pseudomonas aeruginosa and Staphylococcus aureus together in 5 cultures and Candida albicans and Candida krusei in 4 cultures. P. aeruginosa was resistant to all oils and extracts tested; extracts from A. suaveolens, P. avaremotemo and R. graveolens were inactive; the essential oil from C. aromaticus and M. chamomila were active against 3 strains of S. aureus and the Candida strains; seven of the S. aureus strains were sensitive to the P. amboinicus extract; however, the oil was inactive against 4 S. aureus strains and the Candida strains were sensitive to the R. graveolens essential oil. CONCLUSION: depending on the etiological agent, some plants presented satisfactory results, however we still need more detailed studies in order to better use these plants.

Identification and antimicrobial susceptibility of acute external otitis microorganisms.

UNLABELLED: Acute external otitis is a polymicrobial infectious disease. AIM: The purpose of this study was to isolate, identify and determine the Antimicrobial susceptibility of organisms causing otitis externa (OE). METHODS: Twenty-seven swabs were taken from the ears of 27 patients with OE for culture and 22 microorganisms were isolate to evaluate sensitivity. In vitro susceptibility tests were performed by agar diffusion disk and results were interpreted according to Clinical Laboratory Standards. RESULTS: 10 Ear cultures were positive for S. aureus , 8 for P. aeruginosa, 5 for P. aeruginosa and S. aureus and 4 for fungal organisms (Candida albicans e C. Krusei). Gentamicin and quinolones were active against all bacteria tested and significant resistance to amoxicillin/clavulanate was observed. The tested species of Candida had been sensitive to amphothericin B, nystatin, fluconazole and clotrimazole and resistant to miconazole. CONCLUSION: Acute external otitis is a polymicrobial infection and proper knowledge regarding microorganism etiology and susceptibility will contribute to rational antibiotic usage and treatment success.

Small intestine polypoid arteriovenous malformation: a stepwise approach to diagnosis in a paediatric case.

We report a case of acute gastrointestinal haemorrhage due to a small intestine polypoid arteriovenous malformation (AVM) in a patient with a remote history of obscure gastrointestinal bleeding (OGIB) 8 years earlier. The diagnosis of a small intestine AVM was made using video capsule endoscopy (VCE) and confirmed using single-balloon push enteroscopy. The lesion was marked with submucosal tattoo to aid in subsequent surgical resection of the lesion with primary duodenoduodenostomy. Since our patient's initial bleeding episode, a variety of advanced tools have become widely available to aid in the localisation of OGIB. This case illustrates the use of a stepwise approach using new medical technology to identify and manage OGIB in children. VCE and push enteroscopy proved to be important diagnostic modalities in this paediatric case.

Obtaining monokaryotic and dikaryotic mycelial cultures of two Amazonian strains of Geastrum (Geastraceae, Basidiomycota)

The high diversity of the genus Geastrum and the difficulty of obtaining mycelial cultures impairs the study of the ecophysiology and the exploration of the biotechnological potential of the taxon. In this study, different culture media were tested to obtain mycelial cultures for G. lloydianum and G. subiculosum collected in the Brazilian Amazon. Data on spore germination, and isolation of monokaryotic cultures and in vitro sexual reproduction are presented, as well as a brief morphological description of the cultures obtained. For both species, Potato Dextrose Agar (PDA) was the most promising of the tested culture media. The highest growth in agar culture ever recorded for this genus is reported (4.9 mm per week for G. lloydianum and 7.5 mm for G. subiculosum). In the PDA culture medium, spores germinated after 35-40 days of incubation and the isolation of monokaryotic cultures of the two species, as well as in vitro sexual crosses, were successfully performed. (AU)

Mycophenolate mofetil-related enterocolitis and weight loss: a pediatric case series.

Mycophenolate mofetil (MMF) is an immunosuppressive medication utilized in the management of both autoimmune and solid organ transplant patients. Diarrhea is a common gastrointestinal side effect of MMF, but more severe forms of GI symptoms are described in renal transplant patients with a distinct pattern of histopathologic change, similar to graft-versus-host disease or Crohn's disease. This rare entity, commonly referred to as "MMF-related enterocolitis," has been described in adult patients, mostly in renal transplant patients, and in only two pediatric renal transplant patients. In previously reported cases, symptoms and abnormal histopathology improve with dose reduction of MMF. We describe a series of three pediatric patients with varied underlying disease process who presented with severe diarrhea and histopathologic findings characteristic of MMF-related enterocolitis, who share a novel finding of weight loss as a complication of MMF-related enterocolitis in pediatric patients.

[Probiotics in allergic rhinitis]. / Uso de probióticos na rinite alérgica.

UNLABELLED: Probiotics are live microorganisms used as supplementary food, usually lactic acid bacteria that can change either the composition and/or the metabolic activities of the gut microbiota modulating the immune system in a way that benefits the person's health. AIM: To review the use of Probiotics (Lactobacillus and Bifidobacterium) in allergic rhinitis patients. MATERIALS AND METHODS: Pubmed original articles were used as data source. RESULTS: Results indicate that probiotics, Lactobacillus and Bifidobacterium appear to prevent allergy recurrences, alleviate the severity of symptoms and improve the quality of life of patients with allergic rhinitis. This happens because of the immune system modulation through the induction of cytokine production which cause a dominant TH1 response in allergic patients by modulating the TH1/TH2 balance effect. CONCLUSION: The use of probiotic bacteria could be an effective and safe way to prevent and/or treat allergic rhinitis, but its underlying mechanisms remain unclear. Therefore, clinical studies using probiotics and dietary intervention should be the focus of future research to enable a more widespread use.

Assessment of hearing in a municipal public school student population.

UNLABELLED: Children need good hearing for adequate learning. Hearing screening in students is important because it allows cases that go unnoticed by the family may be detected. AIM: To evaluate hearing in children aged 4-15 years--public school students from pre-first to the fifth grade in the city of Cabedelo, Paraíba state. MATERIAL AND METHODS: A prospective study of 98 students referred by teachers of 18 public schools in Cabedelo, from June 2007 to June 2010. Students were examined by an otolaryngologist and underwent audiometric testing. RESULTS: Eighteen schools were enrolled in this study. The student's age ranged from 4 to 15 years; 62% were male and 38% were female. Otolaryngological tests were normal in 85% of cases, and abnormal in 15% of cases. The most frequent findings were ear wax and tympanic membrane retraction. Audiometry demonstrated normal hearing in 66% of children and impaired hearing in 34%. CONCLUSION: Hearing Screening in school children is an important method for diagnosing hearing loss, especially in low-income populations.

Avaliação auditiva em uma população de estudantes da rede pública municipal / Assessment of hearing in a municipal public school student population

Para que haja um aprendizado adequado, a criança necessita ter audição satisfatória. A triagem auditiva escolar é importante, pois permite a detecção de casos que passaram despercebidos pela família. OBJETIVO: Avaliar audição de crianças na faixa etária de 4 a 15 anos, estudantes do pré-1 ao quinto ano, do ensino público do município de Cabedelo/PB. MATERIAL E MÉTODO: Foi realizado um estudo prospectivo com 98 alunos, encaminhados pelos professores, de 18 escolas rede pública do município de Cabedelo, no período de junho de 2007 a junho de 2010. Estes alunos foram examinados pelo otorrinolaringologista e submetidos a exame audiométrico. RESULTADOS: Dezoito escolas participaram do estudo, a idade dos alunos variou de 4 a 15 anos, sendo 62 por cento do sexo masculino e 38 por cento do sexo feminino. Exame otorrinolaringológico foi normal em 85 por cento dos casos, com 15 por cento de alteração, sendo mais frequente cerume e retração de membrana timpânica. O exame audiométrico demonstrou audição normal bilateral em 66 por cento das crianças, com perda auditiva em 34 por cento. CONCLUSÃO: A triagem escolar torna-se um meio importante para diagnóstico de perda auditiva, sobretudo em populações de baixa renda.

Children need good hearing for adequate learning. Hearing screening in students is important because it allows cases that go unnoticed by the family may be detected. AIM: To evaluate hearing in children aged 4-15 years - public school students from pre-first to the fifth grade in the city of Cabedelo, Paraíba state. MATERIAL AND METHODS: A prospective study of 98 students referred by teachers of 18 public schools in Cabedelo, from June 2007 to June 2010. Students were examined by an otolaryngologist and underwent audiometric testing. RESULTS: Eighteen schools were enrolled in this study. The student's age ranged from 4 to 15 years; 62 percent were male and 38 percent were female. Otolaryngological tests were normal in 85 percent of cases, and abnormal in 15 percent of cases. The most frequent findings were ear wax and tympanic membrane retraction. Audiometry demonstrated normal hearing in 66 percent of children and impaired hearing in 34 percent. CONCLUSION: Hearing Screening in school children is an important method for diagnosing hearing loss, especially in low-income populations.

Uso de probióticos na rinite alérgica / Probiotics in allergic rhinitis

Probióticos são microrganismos viáveis, usados como suplemento alimentar, normalmente bactérias ácidas lácticas, que podem modificar a composição e/ou a atividade metabólica da microbiota intestinal, modulando o sistema imune de forma que beneficie a saúde do indivíduo. OBJETIVO: Fazer uma revisão sobre o uso de Probióticos (Lactobacillus e Bifidobacterium) na rinite alérgica. MATERIAL E MÉTODO: Foram pesquisados artigos originais no Pubmed. RESULTADOS: Os resultados encontrados indicam que os probióticos, Lactobacillus e Bifidobacterium parecem prevenir as recorrências alérgicas, aliviar a severidade dos sintomas e promover melhora da qualidade de vida dos pacientes com rinite alérgica. Estes efeitos ocorrem devido à modulação do sistema imunológico através da indução da produção de citocinas que promovem uma resposta TH1 dominante em alérgicos, através do efeito da modulação no balanço TH1/TH2. CONCLUSÃO: O uso de bactérias probióticas pode ser uma forma efetiva e segura de prevenção e/ou tratamento de rinite alérgica, mas seu mecanismo exato de ação permanece desconhecido. No entanto, estudos clínicos usando probióticos e intervenção dietética deverão ser o foco de futuras investigações, para permitir um uso mais amplo.

Probiotics are live microorganisms used as supplementary food, usually lactic acid bacteria that can change either the composition and/or the metabolic activities of the gut microbiota modulating the immune system in a way that benefits the person's health. AIM: To review the use of Probiotics (Lactobacillus and Bifidobacterium) in allergic rhinitis patients. MATERIALS AND METHODS: Pubmed original articles were used as data source. RESULTS: Results indicate that probiotics, Lactobacillus and Bifidobacterium appear to prevent allergy recurrences, alleviate the severity of symptoms and improve the quality of life of patients with allergic rhinitis. This happens because of the immune system modulation through the induction of cytokine production which cause a dominant TH1 response in allergic patients by modulating the TH1/TH2 balance effect. CONCLUSION: The use of probiotic bacteria could be an effective and safe way to prevent and/or treat allergic rhinitis, but its underlying mechanisms remain unclear. Therefore, clinical studies using probiotics and dietary intervention should be the focus of future research to enable a more widespread use.

Probióticos - Revisão da Literatura / Probiotics - Literature Review

Realizar revisão sobre uso de Probióticos emartigos originais no Pubmed. Resultados: Foram selecionadosartigos que abordavam as características gerais dosprobióticos, bem como seu uso na imunomodulação. Osprobióticos estão indicados na prevenção de diarréias,causadas por antibióticos e rotavírus, mas também emdoenças atópicas, auto-imunes e câncer. O efeito terapêutico,na literatura, foi observado com doses variáveis de 106 a109 UFC e embora seu mecanismo de ação não estejatotalmente estabelecido, o probiótico deve estar viável quandoconsumido, permanecer vivo após contato com suco gástricoe bile, aderir-se à mucosa intestinal e competir commicrorganismos patogênicos, promovendo ação satisfatóriana modulação de inflamação e imunidade. Conclusão: Asbactérias ácidas lácticas promovem melhoria nofuncionamento do organismo, devendo-se realizar maioresestudos, para que sua utilização seja mais ampla em Medicina...

To perform a literature review on probiotics usefrom articles published in Pubmed. Results: Were selectedarticles that addressed general characteristics of probioticsand their use in immunomodulation. Probiotics have beenindicated for the prevention of diarrhea caused by rotavirusand antibiotics, and also atopic diseases, autoimmunediseases and cancer. Therapeutic effect, in literature, wasobserved at doses varying from 106 to 109 CFU, and althoughits mechanism of action has not been fully established, to bebeneficial probiotics must be viable when consumed, remainalive after contact with gastric and bile juice, adhere to theintestinal mucosa and compete with pathogenicmicroorganisms, promoting a satisfactory action in themodulation of inflammation and immunity. Conclusion: Lacticacid bacteria promote improvement in the body’s function.Further studies must be carried out so that probiotics usemay be broadened in medicine...

Prática dos Professores da Rede Pública de Ensino em Relação à Avaliação Auditiva em Crianças / Practice of Public School Teachers Regarding Hearing Evaluation in Children

Avaliar se os professores do ensino infantil darede pública de Cabedelo/PB têm conhecimento sobre atriagem auditiva escolar, como realizam esta triagem e se amesma está baseada em achados na literatura. Material eMétodos: Estudo descritivo transversal, realizado por meiode entrevista estruturada com 31 professores do EnsinoPúblico do Município de Cabedelo/ Paraíba - Brasil. Asentrevistas foram transcritas e posteriormente submetidas àanálise. Resultados: A grande maioria dos sujeitosentrevistados tinha conhecimento sobre a triagem auditivaescolar, mas sem haver critérios claros e científicos paraencaminhamento de crianças ao exame auditivo. Conclusão:A triagem auditiva escolar é importante, para detecção deperdas auditivas, mas para ser efetiva, necessita daparticipação consciente e orientada dos professores...

To assess whether the infant school teachersfrom public school in Cabedelo / PB are knowledgeable aboutthe hearing screening at school, how they carry out thisscreening and whether it is based on findings in the literaturecriteria. Material and Methods: This is a cross-sectional study,conducted through structured interviews with 31 teachersof Public Education of the City of Cabedelo / Paraíba. Theinterviews were transcribed and then analyzed. Results:The majority of interviewees have knowledge about hearingscreening at school but without clear and scientific criteria forreferral to the hearing test. Conclusion: The school hearingscreening is important to detect hearing loss, but to beeffective it needs oriented and conscious participation ofteachers...

Atividade antimicrobiana in vitro de produtos vegetais em otite externa aguda / In vitro antimicrobial activity of plants in Acute Otitis Externa

Otite externa aguda é a inflamação do conduto auditivo externo, e plantas medicinais podem ser utilizadas, na cultura popular, para seu tratamento. OBJETIVO: Avaliar atividade antimicrobiana in vitro de Aleolanthus suaveolens, Caryophyllus aromaticus, Cymbopogon citratus, Matricaria chamomila, Pithecellobium avaremotemo, Plectranthus amboinicus e Ruta graveolens sobre agentes etiológicos de otite externa. CASUÍSTICA E MÉTODOS: A concentração inibitória mínima de extratos e óleos destas plantas foi obtida em amostras de otite externa. RESULTADOS: Staphylococcus aureus em 10 culturas, Pseudomonas aeruginosa em 8, Pseudomonas aeruginosa e Staphylococcus aureus, em associação, em 5 culturas e Candida albicans e Candida krusei em 4 culturas. P. aeruginosa foi resistente a todos os extratos e óleos essenciais testados; os extratos de A. suaveolens, P. avaremotemo e de R. graveolens foram inativos, o óleo essencial de C. aromaticus e M. chamomila foram ativos contra 3 cepas de S. aureus e as cepas de Candida; Sete das cepas de S. aureus foram sensíveis ao extrato de P. amboinicus, mas o óleo não mostrou atividade, 4 cepas de S.aureus e as cepas de Candida foram sensíveis ao óleo essencial de R. graveolens. CONCLUSÃO: Algumas plantas apresentaram resultados satisfatórios, dependendo do agente etiológico, porém se faz necessário estudos mais detalhados, para melhorar o aproveitamento destas plantas.

Acute Otitis Externa is an inflammation of the outer auditory meatus, and according to popular saying, medicinal plant extracts can be used in its treatment. AIM: to assess the in vitro antimicrobial activity of the following plants: Aleolanthus suaveolens; Caryophyllus aromaticus; Cymbopogon citratus; Matricaria chamomila; Pithecellobium avaremotemo; Plectranthus amboinicus and Ruta graveolens on the germs that cause otitis externa. MATERIALS AND METHODS: the minimum inhibitory concentration of extracts and oils from these plants was obtained from otitis externa samples. RESULTS: Staphylococcus aureus in 10 cultures, Pseudomonas aeruginosa in 8, Pseudomonas aeruginosa and Staphylococcus aureus together in 5 cultures and Candida albicans and Candida krusei in 4 cultures. P. aeruginosa was resistant to all oils and extracts tested; extracts from A. suaveolens, P. avaremotemo and R. graveolens were inactive; the essential oil from C. aromaticus and M. chamomila were active against 3 strains of S. aureus and the Candida strains; seven of the S. aureus strains were sensitive to the P. amboinicus extract; however, the oil was inactive against 4 S. aureus strains and the Candida strains were sensitive to the R. graveolens essential oil. CONCLUSION: depending on the etiological agent, some plants presented satisfactory results, however we still need more detailed studies in order to better use these plants.

Identificação e susceptibilidade antimicrobiana de microrganismos obtidos de otite externa aguda / Identification and antimicrobial susceptibility of acute external otitis microorganisms

Otite externa aguda é a infecção do conduto auditivo externo, geralmente causada por flora polimicrobiana. OBJETIVO: Isolar, identificar e determinar a susceptibilidade antimicrobiana dos organismos causadores da otite externa (OE). MÉTODO: 27 swabs foram obtidos de 27 orelhas de pacientes portadores de OE para cultura e 22 microrganismos foram isolados para avaliação de susceptibilidade. A susceptibilidade in vitro foi obtida através do método de ágar difusão em disco e os resultados, interpretados de acordo com critérios clínico-laboratoriais padrão. RESULTADOS: 10 culturas positivas para S. aureus, 8 culturas para P.aeruginosa, 5 para P.aeruginosa e S.aureus e 4 para fungos (Candida albicans e C. krusei). Gentamicina e as quinolonas foram ativas contra todas as cepas testadas, havendo resistência significativa contra amoxicilina/clavulanato. As espécies de Candida testadas foram sensíveis à Anfotericina B, nistatina, fluconazol e clotrimazol e resistentes à miconazol. CONCLUSÃO: A otite externa aguda é uma infecção polimicrobiana, e o conhecimento apropriado da etiologia e susceptibilidade dos microrganismos irá contribuir para o uso racional de antibióticos e o sucesso do tratamento.

Acute external otitis is a polymicrobial infectious disease. AIM: The purpose of this study was to isolate, identify and determine the Antimicrobial susceptibility of organisms causing otitis externa (OE). METHODS: twenty-seven swabs were taken from the ears of 27 patients with OE for culture and 22 microorganisms were isolate to evaluate sensitivity. In vitro susceptibility tests were performed by agar diffusion disk and results were interpreted according to Clinical Laboratory Standards. RESULTS: 10 Ear cultures were positive for S. aureus , 8 for P. aeruginosa, 5 for P. aeruginosa and S. aureus and 4 for fungal organisms (Candida albicans e C. Krusei). Gentamicin and quinolones were active against all bacteria tested and significant resistance to amoxicillin/clavulanate was observed. The tested species of Candida had been sensitive to amphothericin B, nystatin, fluconazole and clotrimazole and resistant to miconazole. CONCLUSION: Acute external otitis is a polymicrobial infection and proper knowledge regarding microorganism etiology and susceptibility will contribute to rational antibiotic usage and treatment success.

Esquistossomose hepato-esplênica em crianças: avaliação morfológica e funcional após esplenectomia e auto-implante esplênico / Hepatosplenic schistosomiasis in children: morphologic and functional evaluation after splenectomy and autologous splenic implantation

A esquistossomose mansônica hepato-esplênica com varizes sangrantes do esôfago é infrequente em crianças, entretanto, determina morbidade atingindo a produtividade desses futuros adultos. Uma das opções para o tratamento cirúrgico é a esplenectomia associada à ligadura da veia gástrica esquerda e esclerose endoscópica das varizes, nos casos de recidiva hemorrágica. Auto-implante esplênico tem sido adicionado em crianças. Há evidências de que a esplenose pós-esplenectomia por trauma mantém, de forma parcial, as funções imunológica e de filtração esplênicas. Todavia, estudos semelhantes não foram realizados em pacientes esquistossomóticos. Foram analisados 23 pacientes, de 9 a 18 anos, com esquistossomose hepato-esplênica submetidos à esplenectomia, ligadura de veia gástrica esquerda e auto-implante esplênico no omento maior. Avaliou-se a função de filtração através da pesquisa de corpúsculos de Howell-Jolly em esfregaços de sangue periférico, cuja presença indica ausência ou insuficiência de função de filtração esplênica. Foi realizada análise morfológica da esplenose através de exame cintilográfico, usando enxofre coloidal, marcado com Tecnécio 99m. Observou-se captação dos implantes esplênicos em todos os pacientes, entretanto, em dois (8,7 por cento), o número de nódulos esplênicos observados foi inferior a cinco, sendo considerado insuficiente. Em correspondência, esses dois pacientes foram os únicos que apresentaram positividade para corpúsculos de Howell-Jolly. Os dados confirmam o auto-implante esplênico no omento maior como método eficaz de produção de esplenose e manutenção da função de filtração esplênica em mais de 90 por cento dos pacientes

Esquistossomose hepato-esplênica em crianças: corpúsculo de Howell-Jolly após esplenectomia e esplenose / Hepatosplenic schistosomiais mansoni in children: Howell-Jolly bodies after splenectomy and splenosis

A esquistossomose mansônica hepato-esplênica com varizes esofágicas é infrequente em crianças, entretanto, determina morbidade atingindo a produtividade desses futuros adultos. Há evidências de que a esplenose pós-esplenectomia, por trauma, mantém, de forma parcial, as funçSes imunológica e hemocaterética esplênicas. Estudos semelhantes, entretanto, nÝo foram realizados em esquistossomóticos submetidos a esplenectomia. Foram analisados, para avaliaçÝo da funçÝo de esplenose, 15 pacientes, de 7 a 18 anos, com esquistossomose hepato-esplênica submetidos a esplenectomia, ligadura de veia gástrica esquerda e auto-implante esplênico (Grupo A). A esplenose foi comprovada por cintilografia ou por Dopplerfluxometria. Também foram analisados cinco pacientes similares antes da cirurgia (grupo B) e três crianças, nÝo esquistossomóticas submetidas a esplenectomia sem auto-implante esplênico (grupo C). Os esfregaços de sangue periférico foram examinados para pesquisa de corpúsculos de Howell-Jolly, que indicam ausência ou insuficiência de funçÝo hemocaterética esplênica. Dos pacientes do grupo A, um (7por cento) apresentou corpúsculosde Howell-Jolly. Os demais nÝo apresentaram estes corpúsculos (93por cento). Nenhum paciente do grupo B os apresentou, enquanto que todos os esfregaços dos pacientes do Grupo C apresentaram estes corpúsculos. Os dados confirmam o auto-implante esplênico como método edicaz na manutençÝo da funçÝo hemocaterética esplênica