Paracoccidioides spp. and Histoplasma capsulatum: Current and New Perspectives for Diagnosis and Treatment.

The thermally-dimorphic systemic fungal group includes several important human pathogens: Blastomyces dermatitides, Coccidioides immitis and C. posadasii, Histoplasma capsulatum, Paracoccidioides brasiliensis, P. lutzii, and Talaromyces (Penicillium) marneffei. They usually are geographically restricted and have natural habitats in soil or in plants, and when fungal propagules invade mammalian host by inhalation, they initiate an inflammatory reaction that can result in self-resolution of the infection or cause an acute or chronic disease. In the setting of the AIDS pandemic and the developments in modern medicine, such as immunosuppressive therapy in cancer surgery patients and in transplantation and autoimmune diseases, the incidence of endemic mycoses has progressively increased. Another important factor of the increased incidence of systemic mycoses in certain regions is the progressive devastation of tropical and subtropical forests. In this review, we focus on two of the most important systemic mycoses: paracoccidioidomycosis and histoplasmosis, and their major characteristics in epidemiology, clinical aspects and laboratorial diagnosis.

Estatinas x ácido lipóico na prevenção e tratamento das doenças cardiovasculares / Statins x lipoic acid in the prevention and treatment of cardiovascular diseases

Cardiovascular diseases (CVD) are the leading cause of death worldwide and atherosclerosis is the most important process underlying CVD. Statins are widely used in primary and secondary prevention of CVD, though their adverse side effects, such as myopathy and hepatotoxicity, justify the search for therapeutic alternatives. Alpha lipoic acid is a potent antioxidantand its potential use to combat various conditions, such as diabetic nephropathy, metal poisoning, Alzheimer's disease and CVD has been under intense study. The aim of this review was to gather information on the use of statins and alpha lipoic acid in the prevention and treatment of CVD. The literature suggests that inaddition to the known side effects most associated with the use of statins, they can also cause reduced levels of coenzyme Q10 (CoQ10), an important mitochondrial antioxidant and electron transport chain carrier that has the capacity to antagonize oxidation of plasma lowdensity lipoprotein (LDL). The loss of CoQ10 can reduce adenosine triphosphate (ATP) levels in cardiac cells, further worsening the overall state of the individual. Alpha lipoic acid produces favorable metabolic and endothelial anti-inflammatory effects, without adverse side effects, and thus may be an alternative treatment for the prevention of CVD. However, more controlled clinical studies are needed to establish definitively the prophylactic and therapeutic potential of alpha lipoic acid and to decide whether it might be more effective than statins for the prevention and treatment of CVD...

As doenças cardiovasculares (DCVs) são a principal causa de morte no mundo e tem a aterosclerose como componente mais importante. As estatinas são extensamente utilizadas na prevenção primária e secundária das DCVs, todavia seus efeitos adversos como miopatia e toxicidade hepática justificam a busca por alternativas terapêuticas. O ácido lipóico é um potente antioxidante e vem sendo intensamente investigado no combate de diversas condições tais como nefropatia diabética, intoxicação por metais, doença de Alzheimer e nas DCVs. O objetivo desta revisão foi reunir informações acerca da utilização das estatinas e do ácido lipóico na prevenção e tratamento das DCVs. A literatura aponta que além dos efeitos adversos mais conhecidos associados ao uso das estatinas, elas também podem ocasionar a redução dos níveis de Coenzima Q10 (CoQ10), um importante antioxidante mitocondrial e transportador de elétrons, que possui a capacidade de antagonizar a oxidação da Lipoproteína de Baixa Densidade (LDL) plasmática. Ainda, a deficiência da CoQ10, por sua vez, pode levar a diminuição da adenosina trifosfato (ATP) nas células cardíacas, comprometendo ainda mais o estado global do indivíduo. Enquanto isso, o ácido lipóico apresenta favoráveis efeitos antiinflamatórios, metabólicos e endoteliais, contudo sem a presença de efeitos adversos, podendo ser uma opção terapêutica na prevenção das DCVs. Entretanto, mais estudos clínicos controlados são necessários para estabelecer de maneira definitiva os potenciais terapêuticos e profiláticos do ácido lipóico, avaliando se ele pode ser mais efetivo para a prevenção e tratamento das DCVs do que as estatinas...

Leptospirosis pulmonary haemorrhage syndrome is associated with linear deposition of immunoglobulin and complement on the alveolar surface.

Leptospirosis is a zoonotic infection associated with severe diseases such as leptospirosis pulmonary haemorrhage syndrome (LPHS). The cause of pulmonary haemorrhage is unclear. Understanding which mechanisms and processes are involved in LPHS will be important in treatment regimens under development for this life-threatening syndrome. In the present study, we evaluated 30 lung specimens from LPHS patients and seven controls using histology and immunohistochemistry (detection of IgM, IgG, IgA and C3) in order to describe the pathological features associated with this syndrome. Immunoglobulin deposits were detected on the alveolar surface in 18/30 LPHS patients. Three staining patterns were observed for the immunoglobulins and C3 in the lung tissues of LPHS patients: AS, delicate linear staining adjacent to the alveolar surface, which was indicative of a membrane covering the luminal surface of type I and II pneumocyte cells; S, heterogeneous staining which was sporadically distributed along the alveolar septum; and IA, weak, focal intra-alveolar granular staining. Human LPHS is associated with individual and unique histological patterns that differ from those of other causes of pulmonary haemorrhage. In the present study, it was found that the linear deposition of immunoglobulins (IgA, IgG and IgM) and complement on the alveolar surface may play a role in the pathogenesis of pulmonary haemorrhage in human leptospirosis.

Perforation of Meckel's diverticulum by a chicken bone mimicking acute appendicitis. Case report.

Meckel's diverticulum (MD) is a congenital disorder that results from an incomplete obliteration of the vitelline duct. MD may give rise to bleeding, intestinal obstruction and inflammation; however its perforation by a foreign body is an extremely rare life-threatening complication. We report on a 52 years-old Brazilian Amazon man presenting symptoms and signs of acute abdomen with an initial suspicion of acute appendicitis. However, the right diagnosis was made only during exploratory laparotomy when the appendix was found to be normal, whereas MD was found to be inflamed and perforated by a chicken bone. The patient was treated successfully with resection of a segment of the ileum, including the perforated diverticulum, and had an uncomplicated postoperative course.