RESUMEN
Wolff-Parkinson-White (WPW) syndrome is a conduction disturbance in which atrial impulses are transmitted to the ventricles by an accessory pathway instead of the normal atrioventricular conduction. The WPW syndrome may either simulate myocardial infarction or mask the electrocardiographic abnormalities of an acute MI. However, concealed WPW revealed after an acute coronary syndrome is rare with few cases reported in the literature. This article reports a case of coronary artery disease with ST-segment elevation in a 57-year-old man, previously asymptomatic, with an initial electrocardiogram showing no conduction abnormalities that subsequently presented with an ECG compatible with WPW.
Asunto(s)
Síndrome Coronario Agudo/etiología , Electrocardiografía/métodos , Síndrome de Wolff-Parkinson-White/complicaciones , Síndrome de Wolff-Parkinson-White/diagnóstico , Síndrome Coronario Agudo/terapia , Analgésicos Opioides/uso terapéutico , Aspirina/uso terapéutico , Clopidogrel/uso terapéutico , Stents Liberadores de Fármacos , Fibrinolíticos/uso terapéutico , Humanos , Masculino , Persona de Mediana Edad , Morfina/uso terapéutico , Inhibidores de Agregación Plaquetaria/uso terapéutico , Infarto del Miocardio con Elevación del ST/etiología , Infarto del Miocardio con Elevación del ST/terapia , Síndrome de Wolff-Parkinson-White/terapiaRESUMEN
Falls are a prevalent problem in actual society. Some falls result in injuries and the cost associated with their treatment is high. This is a complex problem that requires several steps in order to be tackled. Firstly, it is crucial to develop strategies that recognize the locomotion mode, indicating the state of the subject in various situations. This article aims to develop a strategy capable of identifying normal gait, the pre-fall condition, and the fall situation, based on a wearable system (IMUs-based). This system was used to collect data from healthy subjects that mimicked falls. The strategy consists, essentially, in the construction and use of classifiers as tools for recognizing the locomotion modes. Two approaches were explored. Associative Skill Memories (ASMs) based classifier and a Convolutional Neural Network (CNN) classifier based on deep learning. Finally, these classifiers were compared, providing for a tool with a good accuracy in recognizing the locomotion modes. Results have shown that the accuracy of the classifiers was quite acceptable. The CNN presented the best results with 92.71% of accuracy considering the pre-fall step different from normal steps, and 100% when not considering.
Asunto(s)
Accidentes por Caídas/prevención & control , Marcha/fisiología , Redes Neurales de la Computación , Dispositivos Electrónicos Vestibles , Adulto , Algoritmos , Femenino , Humanos , Locomoción/fisiología , Masculino , Análisis de Componente Principal , Curva ROC , Adulto JovenRESUMEN
Left ventricular involvement in the advanced stage of arrhythmogenic cardiomyopathy (AC) is an evolution of this desmosomopathy. Mutation in intercalated discs explains the phenotypic variability. Abnormal trafficking of the intercalated discs at the site of end-to-end contacts between cardiomyocytes and the canonical Wnt/ß-catenin and Hippo signaling pathways have been implicated. In AC, T-wave inversion in lateral leads is the hallmark of left ventricular (LV) involvement. We herein report a case of isolated LV AC in which the initial ECG has typical features: fragmented QRS (fQRS), Twave inversion (TWI) in lateral leads, and ventricular tachycardia from inferobasal LV wall.
Asunto(s)
Cardiomiopatías/complicaciones , Cardiomiopatías/diagnóstico , Electrocardiografía/métodos , Taquicardia Ventricular/complicaciones , Taquicardia Ventricular/diagnóstico , Disfunción Ventricular Izquierda/complicaciones , Disfunción Ventricular Izquierda/diagnóstico , Diagnóstico Diferencial , Humanos , Masculino , Persona de Mediana EdadRESUMEN
The major goal of this study was to create easy-to-use, reusable substrates capable of storing any peptides or bioactive molecules for a desired period of time until cells uptake them without the need for bioactive molecule or peptide-specific techniques. Nanopore arrays of uniform size and distribution were machined into fused silica substrates using femtosecond laser ablation and loaded with peptides by simple adsorption. The nanopore substrates were validated by examining the effect of N-acetyl-seryl-aspartyl-lysyl-proline (Ac-SDKP) loaded nanopores on macrophage phagocytosis and intracellular production of reactive oxygen species (ROS) with and without the pro-inflammatory lipopolysaccharide (LPS). Our results demonstrated that nanopores were generated in a uniform array fashion. Ac-SDKP peptides were stably stored in nanopores and internalized by macrophages. Significant reductions in ROS production and phagocytosis in macrophages were observed over control substrates, even in combination with LPS stimulation, indicating that loading Ac-SDKP peptides in pores significantly improved the anti-inflammatory effects. FROM THE CLINICAL EDITOR: This team of scientists intended to create easy-to-use, reusable substrates for storing peptides or bioactive molecules for a desired period of time before cellular uptake occurs, and without the need for bioactive molecule or peptide-specific techniques. They demonstrate the successful generation of nanopores in a uniform array that stably stores Ac-SDKP peptides in the nanopores. When peptides were internalized by macrophages, significant reductions in ROS production and phagocytosis were observed, indicating improved anti-inflammatory effects.
Asunto(s)
Antiinflamatorios/química , Macrófagos/metabolismo , Nanoporos , Péptidos/química , Adsorción , Humanos , Inflamación/metabolismo , Inflamación/patología , Terapia por Láser , Macrófagos/química , Nanotecnología , Fagocitosis , Especies Reactivas de Oxígeno/metabolismo , Propiedades de SuperficieRESUMEN
A microcompressor is a precision mechanical device that flattens and immobilizes living cells and small organisms for optical microscopy, allowing enhanced visualization of sub-cellular structures and organelles. We have developed an easily fabricated device, which can be equipped with microfluidics, permitting the addition of media or chemicals during observation. This device can be used on both upright and inverted microscopes. The apparatus permits micrometer precision flattening for nondestructive immobilization of specimens as small as a bacterium, while also accommodating larger specimens, such as Caenorhabditis elegans, for long-term observations. The compressor mount is removable and allows easy specimen addition and recovery for later observation. Several customized specimen beds can be incorporated into the base. To demonstrate the capabilities of the device, we have imaged numerous cellular events in several protozoan species, in yeast cells, and in Drosophila melanogaster embryos. We have been able to document previously unreported events, and also perform photobleaching experiments, in conjugating Tetrahymena thermophila.
Asunto(s)
Técnicas Citológicas/instrumentación , Técnicas Analíticas Microfluídicas/instrumentación , Animales , Técnicas Citológicas/métodos , Drosophila melanogaster/citología , Diseño de Equipo , Técnicas Analíticas Microfluídicas/métodos , Paramecium tetraurelia/citología , Análisis de la Célula Individual , Tetrahymena thermophila/citología , Levaduras/citologíaRESUMEN
In this paper we report on the fabrication of regular arrays of silica nanoneedles by deposition of a thin layer of silica on patterned arrays of polymer nanowires (or polymer nanohair). An array of high-aspect-ratio nanoscale diameter holes of depths greater than 10 µm was produced at the surface of a fused silica wafer by an amplified femtosecond laser system operated in single-pulse mode. Cellulose acetate (CA) film was imprinted into the nanoholes and peeled off to form a patterned array of standing CA nanowires, a negative replica of the laser machined nanoholes. The cellulose acetate replica was then coated with silica in a chemical vapor deposition process using silicon tetrachloride vapor at 65 °C. Field emission scanning electron microscopy, focused ion beam sectioning, energy dispersive x-ray analysis and Fourier-transform infrared spectroscopy were used to characterize the silica nanoneedles. Precisely patterned, functionalized arrays of standing silica nanoneedles are useful for a number of applications.
Asunto(s)
Nanotecnología/instrumentación , Nanotecnología/métodos , Nanocables/química , Dióxido de Silicio/química , Celulosa/análogos & derivados , Celulosa/química , Nanocables/ultraestructura , Espectrometría por Rayos X , Espectroscopía Infrarroja por Transformada de FourierRESUMEN
Microfluidic devices can provide unique control over both the chemoattractant gradient and the migration environment of the cells. Our work incorporates laser-machined micro and nanofluidic channels into bulk fused silica and cover slip-sized silica wafers. We have designed "open" chemotaxis devices that produce passive chemoattractant gradients without an external micropipette system. Since the migration area is unobstructed, cells can be easily loaded and strategically placed into the devices with a standard micropipette. The reusable monolithic glass devices have integral ports that can generate multiple gradients in a single experiment. We also used cover slip microfluidics for chemotaxis assays. Passive gradients elicited from these cover slips could be readily adapted for high throughput chemotaxis assays.We have also demonstrated for the first time that cells can be recruited into cover slip ports eliciting passive chemoattractant gradients. This proves, in principle, that intravital cover slip configurations could deliver controlled amounts of drugs, chemicals, or pathogens as well as recruit cells for proteomic or histological analysis in living animals while under microscopic observation. Intravital cover slip fluidics will create a new paradigm for in vivo observation of biological processes.
Asunto(s)
Quimiotaxis , Dictyostelium/citología , Técnicas Analíticas Microfluídicas/métodos , Movimiento Celular , AMP Cíclico/metabolismo , Dictyostelium/metabolismo , Microscopía por VideoRESUMEN
INTRODUCTION: Xenotransplantation and multivisceral transplantation are advanced therapeutic methods that still require a scientific basis. There are no experimental models of multivisceral transplantation available, particularly not the monitoring by endoscopy. Here, we describe the endoscopic features in a model of multivisceral xenotransplantation. METHODS: The distal esophagus, stomach, intestine, colon, liver, pancreas, and the kidneys with a common vascular pedicle were harvested from rabbits and implanted in swine (group I, n = 9) or in rabbits (group II, n = 4). Endoscopy was performed in the stomach, jejunum, and ascending colon at four consecutive time points (immediate after surgery and 10, 90, and 180 min after reperfusion). Lesions were macroscopically graded as mild, moderate, and severe. Biopsies were taken following sacrifice at 180 min after reperfusion. RESULTS: In group I, the stomach, jejunum, and colon manifested a progression of lesions with predominance of mild lesions after 10 min, mild to moderate lesions after 90 min, and moderate to severe lesions after 180 min. In animals from group II, endoscopy showed normal features at all time points after reperfusion. Histopathologic analysis confirmed the diagnosis of hyperacute rejection in group I. Grafts from group II animals presented normal or mild ischemic/reperfusion injury. CONCLUSION: All animals subjected to multivisceral xenotransplantation showed a progression of endoscopic lesions with time after transplantation, while animals subjected to allotransplantation showed no aberrations in endoscopy. We conclude that endoscopy is a useful tool in the assessment of hyperacute rejection of a xenograft.
Asunto(s)
Trasplante Heterólogo/métodos , Vísceras/trasplante , Animales , Endoscopía Gastrointestinal , Rechazo de Injerto/patología , Humanos , Conejos , Porcinos , Trasplante Heterólogo/patología , Vísceras/patologíaRESUMEN
BACKGROUND: Organ shortage impairs the proposition of multivisceral transplantation to treat multiple organ failure. Interspecies (xeno) transplantation is a valid solution for organ shortage; however, suitable models of this advance are lacking. We describe an effective model of multivisceral xenotransplantation to study hyperacute rejection. METHODS: Under general anesthesia, we in block recovered the distal esophagus, stomach, small bowel, colon, liver, pancreas, spleen, and kidneys from donors and implanted heterotopically in the lower abdomen of recipients. Animals were divided into four groups: I-canine donor, swine recipient (n = 6); II - swine donor, canine recipient (n = 5); III-canine donor, canine recipient (n = 4); and IV-swine donor, swine recipient (n = 5). Groups I and II comprised experimental (xenotransplantation) and III and IV control groups (allotransplantation). During the experiment, we appraised recipient evolution and graft modification by sequential biopsy up to 3 h. At this time, we killed animals for autopsy (experimental end point). RESULTS: We accomplished all experiments successfully. Every grafts attained customary appearance and convenient urine output immediately after unclamp. Around 15 min after reperfusion, xenografts achieved signs of progressive hyperacute rejection and absence of urine output. At the end of experiments we observed moderate to severe hyperacute rejection at small bowel, colon, mesenteric lymph node, liver, spleen, pancreas, and kidney, while stomach and esophagus achieved mild lesions. In contrast, allograft achieved normal or minimum ischemia/reperfusion injury and constant urine output. CONCLUSION: The present procedure assembles a simple and effective model to study multivisceral xenotransplantation and may ultimately spread researches toward hyperacute rejection.
Asunto(s)
Trasplante de Órganos , Trasplante Heterólogo , Anestesia General , Animales , Perros , Estudios de Seguimiento , Rechazo de Injerto/patología , Supervivencia de Injerto , Masculino , PorcinosRESUMEN
Extracerebral toxoplasmosis, with pulmonary involvement and shock, is a rare form of toxoplasmosis in patients with advanced AIDS. It can mimic pneumocystosis, histoplasmosis, and disseminated tuberculosis, and should be considered in the differential diagnosis of causes of respiratory failure and fulminant disease in this group of individuals, especially in areas where the Toxoplasma gondii infection is highly prevalent and in those without proper use of antimicrobial prophylaxis. We report the case of a 46-year-old male patient who presented to the emergency department with uremia, requiring urgent dialysis. During the laboratorial investigation, the patient had confirmed HIV infection, with a low CD4+ peripheral T-cell count (74 cells/µL). During hospitalization, the patient presented drug-induced hepatitis due to trimethoprim/sulfamethoxazole in a prophylactic dose, requiring interruption of this medication. On the 55th day of hospitalization, the patient developed refractory shock and died. At the autopsy, disseminated toxoplasmosis with encephalitis and severe necrotizing pneumonia were diagnosed, with numerous tachyzoites in the areas of pulmonary necrosis.
RESUMEN
Basal cell carcinoma is the most frequent skin cancer, generally located in hair-bearing, sunlight-exposed areas. Basal cell carcinoma usually occurs on the head and neck, but very rarely on extra-facial locations. We report a case of a 65-year-old woman presenting with a solitary non-healing ulcer on the sole of the right foot for two years. Histopathological examination showed a typical nodular basal cell carcinoma, confirmed by positivity to Ber-EP4 on immunohistochemistry. There was no history of trauma, exposure to noxious agents, basal cell nevus syndrome, or xeroderma pigmentosum.
Asunto(s)
Carcinoma Basocelular/patología , Úlcera del Pie/patología , Neoplasias Cutáneas/patología , Anciano , Femenino , Humanos , InmunohistoquímicaRESUMEN
Total knee arthroplasty (TKA) is a surgical procedure used in patients with Osteoarthritis to improve their state. An understanding about how gait patterns differ from patient to patient and are influenced by the assistive device (AD) that is prescribed is still missing. This article focuses on such purpose. Standard walker, crutches and rollator were tested. Symmetric indexes of spatiotemporal and postural control features were calculated. In order to select the important features which can discriminate the differences among the ADs, different techniques for feature selection are investigated. Classification is handled by Multi-class Support Vector Machine. Results showed that rollator provides a more symmetrical gait and crutches demonstrated to be the worst. Relatively to postural control parameters, standard walker is the most stable and crutches are the worst AD. This means that, depending on the patient's problem and the recovery goal, different ADs should be used. After selecting a set of 16 important features, through correlation, it was demonstrated that they provide important quantitative information about the functional capacity, which is not represented by velocity, cadence and clinical scales. Also, they were capable of distinguishing the gait patterns influenced by each AD, showing that each patient has different needs during recovery. Implications of Rehabilitation An understanding about how gait patterns of post-surgical patients differ from person to person and how they are influenced by the type of device that is prescribed during their recovery might help in physical therapy. Research specifically addressing these issues is still missing. Inter-limb asymmetry and postural control features can be evaluated in an outpatient setting, supplying important additional information about individual gait pattern, which is not represented by gait velocity, cadence and scales usually used. The features calculated in this study are able to provide complementary information to gait velocity, cadence and clinical scales to assess the functional capacity of patients that passed through TKA. The selected parameters make a new clinical tool useful for tracking the evolution of patients' recovery after TKA.
Asunto(s)
Artroplastia de Reemplazo de Rodilla/rehabilitación , Marcha , Equipo Ortopédico , Osteoartritis de la Rodilla/cirugía , Caminata , Adulto , Fenómenos Biomecánicos , Bastones , Muletas , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador , Masculino , Persona de Mediana Edad , Equilibrio Postural , Análisis Espacio-Temporal , AndadoresRESUMEN
The basal lamina or basement membrane (BM) is a key physiological system that participates in physicochemical signaling between tissue types. Its formation and function are essential in tissue maintenance, growth, angiogenesis, disease progression, and immunology. In vitro models of the BM (e.g., Boyden and transwell chambers) are common in cell biology and lab-on-a-chip devices where cells require apical and basolateral polarization. Extravasation, intravasation, membrane transport of chemokines, cytokines, chemotaxis of cells, and other key functions are routinely studied in these models. The goal of the present study was to integrate a semipermeable ultrathin polymer membrane with precisely positioned pores of 2 µm diameter in a microfluidic device with apical and basolateral chambers. We selected poly(l-lactic acid) (PLLA), a transparent biocompatible polymer, to prepare the semipermeable ultrathin membranes. The pores were generated by pattern transfer using a three-step method coupling femtosecond laser machining, polymer replication, and spin coating. Each step of the fabrication process was characterized by scanning electron microscopy to investigate reliability of the process and fidelity of pattern transfer. In order to evaluate the compatibility of the fabrication method with organs-on-a-chip technology, porous PLLA membranes were embedded in polydimethylsiloxane (PDMS) microfluidic devices and used to grow human umbilical vein endothelial cells (HUVECS) on top of the membrane with perfusion through the basolateral chamber. Viability of cells, optical transparency of membranes and strong adhesion of PLLA to PDMS were observed, thus confirming the suitability of the prepared membranes for use in organs-on-a-chip devices.
RESUMEN
BACKGROUND: The interaction of stem cells with their culture substrates is critical in controlling their fate and function. Declining stemness of adult-derived human mesenchymal stem cells (hMSCs) during in vitro expansion on tissue culture polystyrene (TCPS) severely limits their therapeutic efficacy prior to cell transplantation into damaged tissues. Thus, various formats of natural and synthetic materials have been manipulated in attempts to reproduce in vivo matrix environments in which hMSCs reside. RESULTS: We developed a series of patterned polymer matrices for cell culture by hot-pressing poly(ε-caprolactone) (PCL) films in femtosecond laser-ablated nanopore molds, forming nanofibers on flat PCL substrates. hMSCs cultured on these PCL fiber matrices significantly increased expression of critical self-renewal factors, Nanog and OCT4A, as well as markers of cell-cell interaction PECAM and ITGA2. The results suggest the patterned polymer fiber matrix is a promising model to maintain the stemness of adult hMSCs. CONCLUSION: This approach meets the need for scalable, highly repeatable, and tuneable models that mimic extracellular matrix features that signal for maintenance of hMSC stemness.
RESUMEN
Walker devices are often prescribed incorrectly to patients, leading to the increase of dissatisfaction and occurrence of several problems, such as, discomfort and pain. Thus, it is necessary to objectively evaluate the effects that assisted gait can have on the gait patterns of walker users, comparatively to a non-assisted gait. A gait analysis, focusing on spatiotemporal and kinematics parameters, will be issued for this purpose. However, gait analysis yields redundant information that often is difficult to interpret. This study addresses the problem of selecting the most relevant gait features required to differentiate between assisted and non-assisted gait. For that purpose, it is presented an efficient approach that combines evolutionary techniques, based on genetic algorithms, and support vector machine algorithms, to discriminate differences between assisted and non-assisted gait with a walker with forearm supports. For comparison purposes, other classification algorithms are verified. Results with healthy subjects show that the main differences are characterized by balance and joints excursion in the sagittal plane. These results, confirmed by clinical evidence, allow concluding that this technique is an efficient feature selection approach.
Asunto(s)
Algoritmos , Deambulación Dependiente/fisiología , Marcha/fisiología , Máquina de Vectores de Soporte , Andadores , Adulto , Fenómenos Biomecánicos , Biología Computacional , Deambulación Dependiente/estadística & datos numéricos , Humanos , Modelos Biológicos , Rehabilitación/instrumentación , Rehabilitación/estadística & datos numéricos , Grabación en Video , Adulto JovenRESUMEN
Stromal cells in the tumor microenvironment play a key role in the metastatic properties of a tumor. It is recognized that cancer-associated fibroblasts (CAFs) and endothelial cells secrete factors capable of influencing tumor cell migration into the blood or lymphatic vessels. We developed a microfluidic device that can be used to image the interactions between stromal cells and tumor cell spheroids in a three dimensional (3D) microenvironment while enabling external control of interstitial flow at an interface, which supports endothelial cells. The apparatus couples a 200-µm channel with a semicircular well to mimic the interface of a blood vessel with the stroma, and the design allows for visualization of the interactions of interstitial flow, endothelial cells, leukocytes, and fibroblasts with the tumor cells. We observed that normal tissue-associated fibroblasts (NAFs) contribute to the "single file" pattern of migration of tumor cells from the spheroid in the 3D microenvironment. In contrast, CAFs induce a rapid dispersion of tumor cells out of the spheroid with migration into the 3D matrix. Moreover, treatment of tumor spheroid cultures with the chemokine CXCL12 mimics the effect of the CAFs, resulting in similar patterns of dispersal of the tumor cells from the spheroid. Conversely, addition of CXCL12 to co-cultures of NAFs with tumor spheroids did not mimic the effects observed with CAF co-cultures, suggesting that NAFs produce factors that stabilize the tumor spheroids to reduce their migration in response to CXCL12.
RESUMEN
There is controversy concerning the effect of pilocarpine in the reversal of radio-induced xerostomia; however, the tests are usually performed at the end of radiotherapy. The present study evaluated the radioprotective effects of pilocarpine when ingested during radiation treatment. Eleven patients (recently diagnosed with head and neck cancer who were not undergoing radiotherapy) were divided into two groups: the control group (saline solution intake n=6) and the pilocarpine-treated (5 mg pilocarpine three times daily, n=5) group, in a prospective and double-blinded study. For five weeks, oral conditions, unstimulated salivary flow and stimulated saliva flow were collected weekly, with the first collection occurring prior to radiation therapy. As early as the second week, the control group exhibited oral complications and greater reduction in salivary flow rate. At the end of the study, the pilocarpine-treated group presented mean values of salivary flow greater than those of the control group. Pilocarpine intake applied simultaneously with radiotherapy demonstrated encouraging results with regard to lowering salivary flow reduction and incidence of xerostomia, as well as of oral complications.
Asunto(s)
Pilocarpina/administración & dosificación , Protectores contra Radiación/administración & dosificación , Radioterapia/efectos adversos , Glándulas Salivales/efectos de los fármacos , Glándulas Salivales/efectos de la radiación , Administración Oral , Neoplasias de Cabeza y Cuello/complicaciones , Neoplasias de Cabeza y Cuello/radioterapia , Humanos , Pilocarpina/uso terapéutico , Protectores contra Radiación/uso terapéutico , Resultado del Tratamiento , Xerostomía/etiologíaRESUMEN
Understanding cellular interactions with culture substrate features is important to advance cell biology and regenerative medicine. When surface topographical features are considerably larger in vertical dimension and are spaced at least one cell dimension apart, the features act as 3D physical barriers that can guide cell adhesion, thereby altering cell behavior. In the present study, we investigated competitive interactions of cells with neighboring cells and matrix using a novel nanoneedle gradient array. A gradient array of nanoholes was patterned at the surface of fused silica by single-pulse femtosecond laser machining. A negative replica of the pattern was extracted by nanoimprinting with a thin film of polymer. Silica was deposited on top of the polymer replica to form silica nanoneedles. NIH 3T3 fibroblasts were cultured on silica nanoneedles and their behavior was studied and compared with those cultured on a flat silica surface. The presence of silica nanoneedles was found to enhance the adhesion of fibroblasts while maintaining cell viability. The anisotropy in the arrangement of silica nanoneedles was found to affect the morphology and spreading of fibroblasts. Additionally, variations in nanoneedle spacing regulated cell-matrix and cell-cell interactions, effectively preventing cell aggregation in areas of tightly-packed nanoneedles. This proof-of-concept study provides a reproducible means for controlling competitive cell adhesion events and offers a novel system whose properties can be manipulated to intimately control cell behavior.
Asunto(s)
Nanoestructuras/química , Dióxido de Silicio/química , Animales , Adhesión Celular/fisiología , Comunicación Celular/fisiología , Ratones , Células 3T3 NIHRESUMEN
Extracerebral toxoplasmosis, with pulmonary involvement and shock, is a rare form of toxoplasmosis in patients with advanced AIDS. It can mimic pneumocystosis, histoplasmosis, and disseminated tuberculosis, and should be considered in the differential diagnosis of causes of respiratory failure and fulminant disease in this group of individuals, especially in areas where the Toxoplasma gondii infection is highly prevalent and in those without proper use of antimicrobial prophylaxis. We report the case of a 46-year-old male patient who presented to the emergency department with uremia, requiring urgent dialysis. During the laboratorial investigation, the patient had confirmed HIV infection, with a low CD4+ peripheral T-cell count (74 cells/µL). During hospitalization, the patient presented drug-induced hepatitis due to trimethoprim/sulfamethoxazole in a prophylactic dose, requiring interruption of this medication. On the 55th day of hospitalization, the patient developed refractory shock and died. At the autopsy, disseminated toxoplasmosis with encephalitis and severe necrotizing pneumonia were diagnosed, with numerous tachyzoites in the areas of pulmonary necrosis.
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Infecciones Oportunistas Relacionadas con el SIDA/complicaciones , Encefalitis Infecciosa/complicaciones , Neumonía/complicaciones , Choque/complicaciones , Toxoplasmosis Cerebral/complicaciones , Autopsia , Diagnóstico Diferencial , Resultado Fatal , Toxoplasma , Toxoplasmosis/patologíaRESUMEN
Abstract: Basal cell carcinoma is the most frequent skin cancer, generally located in hair-bearing, sunlight-exposed areas. Basal cell carcinoma usually occurs on the head and neck, but very rarely on extra-facial locations. We report a case of a 65-year-old woman presenting with a solitary non-healing ulcer on the sole of the right foot for two years. Histopathological examination showed a typical nodular basal cell carcinoma, confirmed by positivity to Ber-EP4 on immunohistochemistry. There was no history of trauma, exposure to noxious agents, basal cell nevus syndrome, or xeroderma pigmentosum.