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BACKGROUND: Fungal keratitis is a severe eye infection that can result in blindness and visual impairment, particularly in developing countries. Fusarium spp. are the primary causative agents of this condition. Diagnosis of Fusarium keratitis (FK) is challenging, and delayed treatment can lead to serious complications. However, there is limited epidemiological data on FK, especially in tropical areas. OBJECTIVES: This study aimed to describe the clinical, laboratorial and epidemiological characteristics of FK in a tropical semi-arid region of Brazil. PATIENTS/METHODS: Adult patients with laboratory-confirmed FK diagnosed between October 2019 and March 2022 were evaluated. Fusarium isolates were characterized at molecular level and evaluated regarding antifungal susceptibility. RESULTS: A total of 226 clinical samples from patients suspected of keratitis were evaluated; fungal growth was detected in 50 samples (22.12%); out of which 42 were suggestive of Fusarium spp. (84%). Molecular analysis of a randomly selected set of 27 isolates identified F. solani species complex (n = 14); F. fujikuroi sensu lato (n = 6) and F. dimerum sensu lato (n = 7); a total of 10 haplotypes were identified among the strains. All but one Fusarium strains were inhibited by amphotericin B, natamycin and fluconazole. Most patients were male (71.42%; 30 out of 42), aged from 27 to 73 years old. Trauma was the most important risk factor for FK (40.47%; 17 out of 42). Patients were treated with antifungals, corticoids and antibiotics; keratoplasty and eye enucleation were also performed. CONCLUSIONS: The study provided insights into the characteristics of FK in tropical regions and emphasized the importance of enhanced surveillance and management strategies.
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Antifúngicos , Infecciones Fúngicas del Ojo , Fusariosis , Fusarium , Queratitis , Pruebas de Sensibilidad Microbiana , Humanos , Brasil/epidemiología , Fusarium/genética , Fusarium/efectos de los fármacos , Fusarium/aislamiento & purificación , Fusarium/clasificación , Masculino , Femenino , Antifúngicos/farmacología , Antifúngicos/uso terapéutico , Adulto , Queratitis/microbiología , Queratitis/epidemiología , Queratitis/tratamiento farmacológico , Persona de Mediana Edad , Fusariosis/microbiología , Fusariosis/epidemiología , Fusariosis/tratamiento farmacológico , Infecciones Fúngicas del Ojo/microbiología , Infecciones Fúngicas del Ojo/epidemiología , Infecciones Fúngicas del Ojo/tratamiento farmacológico , Anciano , Adulto Joven , Adolescente , Clima Tropical , Anciano de 80 o más Años , Anfotericina B/farmacología , Anfotericina B/uso terapéuticoRESUMEN
Abstract Introduction: Methylene Blue (MB) has been shown to attenuate oxidative, inflammatory, myocardial, and neurological lesions during ischemia-reperfusion and has great potential during cardiac arrest. This study aimed to determine the effects of MB combined with epinephrine during cardiac arrest on myocardial and cerebral lesions. Method: Thirty-eight male Wistar rats were randomly assigned to four groups: the sham group (SH, n = 5), and three groups subjected to cardiac arrest (n = 11 /group) and treated with EPI 20 μg.kg−1 (EPI), EPI 20 μg.kg−1 + MB 2 mg.kg−1 (EPI + MB), or saline 0.9% 0.2 ml (CTL). Ventricular fibrillation was induced by direct electrical stimulation in the right ventricle for 3 minutes, and anoxia was maintained for 5 minutes. Cardiopulmonary Resuscitation (CPR) consisted of medications, ventilation, chest compressions, and defibrillation. After returning to spontaneous circulation, animals were observed for four hours. Blood gas, troponin, oxidative stress, histology, and TUNEL staining measurements were analyzed. Groups were compared using generalized estimating equations. Results: No differences in the Returning of Spontaneous Circulation (ROSC) rate were observed among the groups (EPI: 63%, EPI + MB: 45%, CTL: 40%, p = 0.672). The mean arterial pressure immediately after ROSC was higher in the EPI+MB group than in the CTRL group (CTL: 30.5 [5.8], EPI: 63 [25.5], EPI+MB: 123 [31] mmHg, p = 0.007). Serum troponin levels were high in the CTL group (CTL: 130.1 [333.8], EPI: 3.70 [36.0], EPI +MB: 43.7 [116.31] ng/mL, p < 0.05). Conclusion: The coadministration of MB and epinephrine failed to yield enhancements in cardiac or brain lesions in a rodent model of cardiac arrest.
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Abstract Background Sepsis and septic shock still represent great challenges in critical care medicine. Sildenafil has been largely used in the treatment of pulmonary arterial hypertension, but its effects in sepsis are unknown. The aim of this study was to investigate the hypothesis that sildenafil can attenuate endotoxin-induced pulmonary hypertension in a porcine model of endotoxemia. Methods Twenty pigs were randomly assigned to Control group (n = 10), which received saline solution; or to Sildenafil group (n = 10), which received sildenafil orally (100 mg). After 30 minutes, both groups were submitted to endotoxemia with intravenous bacterial lipopolysaccharide endotoxin (LPS) infusion (4 µg.kg-1.h-1) for 180 minutes. We evaluated hemodynamic and oxygenation functions, and also lung histology and plasma cytokine (TNFα, IL-1β, IL6, and IL10) and troponin I response. Results Significant hemodynamic alterations were observed after 30 minutes of LPS continuous infusion, mainly in pulmonary arterial pressure (from Baseline 19 ± 2 mmHg to LPS30 52 ± 4 mmHg, p< 0.05). There was also a significant decrease in PaO2/FiO2 (from Baseline 411 ± 29 to LPS180 334 ± 49, p< 0.05). Pulmonary arterial pressure was significantly lower in the Sildenafil group (35 ± 4 mmHg at LPS30, p< 0.05). The Sildenafil group also presented lower values of systemic arterial pressure. Sildenafil maintained oxygenation with higher PaO2/FiO2 and lower oxygen extraction rate than Control group but had no effect on intrapulmonary shunt. All cytokines and troponin increased after LPS infusion in both groups similarly. Conclusion Sildenafil attenuated endotoxin-induced pulmonary hypertension preserving the correct heart function without improving lung lesions or inflammation.
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Animales , Endotoxemia , Hipertensión Pulmonar/tratamiento farmacológico , Porcinos , Lipopolisacáridos/farmacología , Endotoxinas/farmacología , Citrato de Sildenafil/farmacología , Hemodinámica , Hipertensión Pulmonar/inducido químicamenteRESUMEN
ABSTRACT The treatment of Parkinson's disease (PD) is challenging, especially since it is considered highly individualized. The Brazilian Academy of Neurology has recognized the need to disseminate knowledge about the management of PD treatment, adapting the best evidence to the Brazilian reality. Thus, the main published treatment guidelines were reviewed based on the recommendations of group from the Movement Disorders Scientific Department of the Brazilian Academy of Neurology.
Resumo O tratamento da doença de Parkinson (DP) constitui um desafio, especialmente por ser considerado muito individualizado. A Academia Brasileira de Neurologia (ABN) identificou a necessidade de disseminar o conhecimento sobre o manejo do tratamento da DP, adaptando as melhores evidências à realidade brasileira. Assim, foi realizada uma revisão sobre as principais orientações de tratamento publicadas, baseada nas recomendações elaboradas por um grupo de especialistas em transtornos do movimento do departamento científico da ABN.
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ABSTRACT Cannabinoids comprehend endocannabinoids, phytocannabinoids, and synthetic cannabinoids, with actions both in the central and peripherical nervous systems. A considerable amount of publications have been made in recent years, although cannabis has been known for over a thousand years. Scientific Departments from the Brazilian Academy of Neurology described evidence for medical use in their areas. Literature is constantly changing, and possible new evidence can emerge in the next days or months. Prescription of these substances must be discussed with patients and their families, with knowledge about adverse events and their efficacy.
RESUMO Os canabinoides compreendem os endocanabinoides, fitocanabinoides e os canabinoides sintéticos e desempenham ações no sistema nervoso central e periférico. Uma quantidade enorme de publicações tem sido lançada nos últimos anos, embora a cannabis seja conhecida por milênios. Os Departamentos Científicos da Academia Brasileira de Neurologia descreveram as evidências do uso médico em suas áreas. A literatura está em constantes mudanças e possíveis novas evidências podem surgir nos próximos dias ou meses. A prescrição dessas substâncias deve ser discutida com os pacientes e suas famílias, com conhecimento sobre eventos adversos e sua eficácia.
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Humanos , Cannabinoides , Cannabis , Neurología , Brasil , EndocannabinoidesRESUMEN
É relatado aqui o caso de uma mulher de 38 anos com AIDS que desenvolveu a síndrome de opsoclonia-mioclonia-ataxia em um período diferente dos outros casos já relatados na literatura. A síndrome de opsoclonia-mioclonia-ataxia já tinha sido relatada como manifestação inicial de AIDS, assim como no momento da soroconversão de HIV e na síndrome de reconstituição imune. Este caso é único, uma vez que a paciente tinha contagem elevada de CD4 e carga viral negativa no momento em que a síndrome de opsoclonia-mioclonia-ataxia ocorreu.
We report the case of a 38-year-old woman with AIDS who developed opsoclonus-myoclonus-ataxia syndrome during a period different from other cases reported in literature. Opsoclonus-myoclonus-ataxia syndrome had already been reported as the initial neurological presentation of AIDS, as well as at the time of HIV-seroconversion and immune reconstitution syndrome. Our case is unique since the patient had an elevated CD4 count and negative viral load in the period when the opsoclonus-myoclonus-ataxia syndrome occurred.
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Adulto , Femenino , Humanos , Terapia Antirretroviral Altamente Activa/efectos adversos , Ataxia/inducido químicamente , Infecciones por VIH/complicaciones , Síndrome de Opsoclonía-Mioclonía/inducido químicamente , Trastornos Parkinsonianos/inducido químicamente , Ataxia/patología , Encéfalo/patología , Infecciones por VIH/tratamiento farmacológico , Síndrome Inflamatorio de Reconstitución Inmune/complicaciones , Síndrome Inflamatorio de Reconstitución Inmune/diagnóstico , Imagen por Resonancia Magnética , Síndrome de Opsoclonía-Mioclonía/diagnóstico , Trastornos Parkinsonianos/diagnóstico , Carga ViralRESUMEN
There are few studies of language and speech in patients with Sydenham's chorea (SC). We have done an acoustic analysis of fundamental frequency (F0), duration and intensity of declarative and interrogative sentences made by 20 SC patients, 20 patients with rheumatic fever (RF) without chorea, and compared them with 20 healthy age-matched controls (CO). Each group included 12 females. We found that there is no difference between the RF and CO groups in all studied parameters. Patients with SC, however, presented with a speech characterized by decreased F0 range (difference between minimum and maximum F0), shorter duration of sentences, and higher intensity of the first syllable of sentences. The findings were not influenced by the nature of the sentences (i.e. , declarative or interrogative), but for all variables they were significantly more severe in males than females. In conclusion, we have demonstrated that patients with acute SC have an impairment of modulation of F0 and longer duration of emission of sentences, resulting in a monotone and slow speech. This pattern is similar to what has been described in other basal ganglia illnesses, such as Parkinson's disease, Huntington's disease and Wilson's disease.
Há poucos estudos sobre linguagem e fala em pacientes com coréia de Sydenham (CS). Fizemos uma análise acústica da freqüência fundamental (F0), duração e intensidade de sentenças declarativas e interrogativas feitas por 20 pacientes com CS, 20 pacientes com febre reumática (FR) sem coréia, comparando-os com 20 controles saudáveis e pareados por idade (CO). Cada grupo incluiu 12 mulheres. Foi encontrado que não há diferença entre os grupos FR e CO quanto a todos parâmetros estudados. Pacientes com CS, contudo, apresentaram-se com fala caracterizada pela redução da variação de F0 (diferença entre F0 mínima e máxima), duração mais curta das sentenças e maior intensidade da primeira sílaba das sentenças. Os achados não foram influenciados pela natureza das sentenças (i.e. , declarativas ou interrogativas), mas os achados foram mais evidentes em todas as variáveis em homens em contraste com mulheres. Em conclusão, demonstramos que pacientes com CS aguda têm prejuízo da modulação da F0 e duração mais longa da emissão de sentenças, resultando em fala mais lenta e monótona. Esse padrão é semelhante ao que tem sido descrito em outras fecções dos núcleos da base, tais como doença de Parkinson, doença de Huntington e doença de Wilson.
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Niño , Femenino , Humanos , Masculino , Corea/fisiopatología , Fiebre Reumática/fisiopatología , Acústica del Lenguaje , Percepción del Habla/fisiología , Conducta Verbal/fisiología , Enfermedad Aguda , Estudios de Casos y ControlesRESUMEN
We report a 67-year-old man with Parkinson's disease for 9 years who developed compulsive use of levodopa. This phenomenon is the main feature of the dopamine dysregulation syndrome. Other related symptoms presented by our patient were mood fluctuation and increased writing activity suggestive of punding.
Relatamos sobre um homem de 67 anos de idade com doença de Parkinson por 9 anos e que desenvolveu uso compulsivo de levodopa. Esse fenômeno é a principal característica da síndrome de desregulação dopaminérgica. Outros sintomas apresentados pelo paciente foram flutuações do humor e atividade de escrita aumentada, comportamento este sugestivo de punding.
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Anciano , Humanos , Masculino , Antiparkinsonianos/efectos adversos , Dopamina/metabolismo , Levodopa/efectos adversos , Trastornos del Humor/inducido químicamente , Enfermedad de Parkinson/metabolismo , Trastornos Relacionados con Sustancias/diagnóstico , Antiparkinsonianos/uso terapéutico , Levodopa/uso terapéutico , Enfermedad de Parkinson/tratamiento farmacológico , Síndrome , Trastornos Relacionados con Sustancias/complicacionesRESUMEN
Tourette syndrome (TS) is a neuropsychiatric disorder characterized by a combination of multiple motor tics and at least one phonic tic. TS patients often have associated behavioral abnormalities such as obsessive compulsive disorder, attention deficit and hyperactive disorder. Coprolalia, defined as emission of obscenities or swearing, is one type of complex vocal tic, present in 8 percent to 26 percent of patients. The pathophysiology of coprolalia and other complex phonic tics remains ill-defined. We report a patient whose complex phonic tic was characterized by repetitively saying "breast cancer" on seeing the son of aunt who suffered from this condition. The patient was unable to suppress the tic and did not meet criteria for obsessive compulsive disorder. The phenomenology herein described supports the theory that complex phonic tics result from disinhibition of the loop connecting the basal ganglia with the limbic cortex
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Humanos , Masculino , Adulto , Trastornos del Habla/fisiopatología , Síndrome de Tourette/fisiopatología , Ganglios Basales/fisiopatologíaRESUMEN
Síndrome de Tourette (ST) é uma doença neuropsiquiátrica caracterizada pela combinação de múltiplos tiques motores e ao menos um tique vocal. Está comumente associada a alterações comportamentais. A ST inicia-se nas primeiras duas décadas de vida, dura mais de 1 ano e causa impacto significativo na vida social e ocupacional do paciente. Embora sua fisiopatologia seja controversa, há evidências de disfunção dos núcleos da base. O objetivo deste texto é fazer uma breve revisão da ST
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Síndrome de TouretteRESUMEN
Após consentimento livre esclarecido, foram coletadas e analisadas, bacteriologicamente, 116 amostras (líquor, escarro, lavado brônquico, biópsia/punçäo de gänglio, urina, sangue, biópsia hepática, aspirado da medula óssea e líquido pleural), provenientes de 87 portadores de aids internados ou em acompanhamento no Hospital de Doenças Tropicais do Estado de Goiás (HDT). O material foi submetido à baciloscopia pela técnica de Ziehl-Neelsen e à cultura em dois meios: Lowenstein-Jensen, L-J, (sólidoO e sistema bifásico, BI, (sólido/líquido). A descontaminaçäo foi processada pelos métodos de Petroff e lauril-sulfato de sódio9 (SDS). A identificaçäo das micobactérias foi realizada através de provas de crescimento em presença de inibidores, produçäo de pigmento, tempo de crescimento e provas bioquímicas...
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Humanos , Mycobacterium tuberculosis , Micobacterias no Tuberculosas/aislamiento & purificación , Síndrome de Inmunodeficiencia Adquirida/microbiología , Brasil , Micobacterias no TuberculosasRESUMEN
O objetivo principal deste estudo piloto foi investigar as relações de parentesco em pacientes esquizofrênicos, maníacos e com psicose reativa breve. Baseados em cinco questões, que avaliam as dimensões clássicas das relações de parentesco, buscouðse averiguar os tipos de erros que ocorrem, relacionandoðos com as psicoses estudadas. Os resultados demonstram uma maior incidência de erros nas questões relacionadas à dimensão geracional. A pesquisa vem corroborar estudos anteriores que verificaram a dificuldade de elaboração da diferença de gerações por parte de pacientes psicóticos
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Humanos , Relaciones Familiares , Esquizofrenia , Trastornos Psicóticos/diagnóstico , Escala del Estado MentalRESUMEN
As amostras de Candida, previamente isoladas e identificadas da mucosa vaginal de mulheres portadoras de candidíase, foram submetidas ao teste de concentrçåo inibitória mínima (CIM), frente às drogas anfotericina B, nistatina, cetoconazol e fluconazol; utilizando-se a técnica de diluiçåo em ágar (TDA), a partir da diluiçåo de 0,05 mg/ml até 100 mg/ml. As 12 amostras de Canddida albicans isoladas foram inibidas pela nistatina em concentraçåo ó 6,25 mg/ml e pela anfotericina B numa concentraçåo ó 0,78 mg/ml. Todas as amostras mostraram-se resistentes aos derivados azólicos. Candida krusei, que foi identificada em 2 amostras, mostrou-se também resistente aos derivados azólicos e com CIM de 6,25 mg/ml para nistatina e de 0,78 mg/ml para anfotericina B