Profile of total IgG, IgG1, IgG2, IgG3 and IgG4 levels in sera of patients with paracoccidioidomycosis: treatment follow-up using Mexo and rPb27 as antigens in an ELISA.

The levels of total of IgG, IgG1, IgG2, IgG3 and IgG4 were evaluated in 54 patients with chronic paracoccidioidomycosis (PCM) before, during and after treatment using an enzyme-linked immunosorbent assay with Mexo and recombinant Pb27 (rPb27) as the antigens. Mexo was effective in distinguishing PCM patients from individuals in the negative control group (NC) based on total IgG and rPb27 performed worse than Mexo when these two groups were compared. IgG1, IgG2, IgG3 and IgG4 could not be used to clearly distinguish PCM patients from those in the NC group using either antigen. There was no clear relationship between antibody levels and the period of treatment. The majority of patients presented with decreased antibody levels during treatment, with no statistically significant differences among the different periods of treatment. Only IgG4 presented a negative correlation between its levels and clinical improvement during treatment. In total, 65% of untreated PCM patients showed reactivity against IgG4 when the Mexo antigen was used and this reactivity decreased over the course of treatment. There was a tendency towards decreasing antibody levels during treatment, but these antibody levels did not necessarily clear after the treatment was stopped. Mexo was useful for PCM diagnosis using total IgG; however, more studies are necessary before this antigen can be used in measuring the levels of total IgG and its subclasses for monitoring patients during treatment.

Prostatic paracoccidioidomycosis: differential diagnosis of prostate cancer.

Symptomatic prostatic paracoccidioidomycosis (PCM) is a very rare condition; however, it may express as a typical benign prostatic hyperplasia or a simulating prostatic adenocarcinoma. This case report presents PCM mimicking prostatic adenocarcinoma. The purpose of this paper is to call the general physician's attention to this important differential diagnosis.

SARS-CoV-2-2019: emergência de uma pandemia / SARS-CoV-2-2019: emergence of a pandemic

A pandemia associada à emergência do vírus corona-2-2019 associado à síndrome respiratória aguda grave (SARS-CoV-2) representa um desafio imposto ao ser humano e sua sociedade, de forma planetária, com repercussões ainda por serem determinadas em todos os níveis da relação biopsicossocial cultural-espiritual. Constitui-se em um dos desafios mais graves já vividos pela humanidade, e sinaliza para a ocorrência de outras emergências e reemergências de doenças, em situações similares e episódicas, e que expressam a vulnerabilidade e imponderabilidade humanas, e requer reflexão sobre o autoconhecimento e o respeito aos limites da sua dignidade e da natureza. Esta revisão constitui-se em esforço para resumir de forma simples e prática a quantidade de aspectos significativos ao conhecimento que se apresenta de forma avassaladora que acompanha a virologia, epidemiologia, clínica, diagnóstico, terapêutica e prevenção da doença pelo SARS-CoV-2, para que possa ser entendida e facilitada sua abordagem.

The pandemic associated with the emergence of the SARS-CoV-2 represents a challenge imposed on human beings and their society, on a planetary basis, with repercussions yet to be determined at all levels of the biopsychosocial cultural-spiritual relationship. It represents one of the most serious challenges humankind has ever experienced, and signals the occurrence of other emergencies and reemergence's of diseases, in similar and episodic situations, which express human vulnerability and weightlessness, and requires reflection on self-knowledge and respect for limits of their dignity. This review is an effort to summarize in a simple and practical way the amount of significant aspects to the knowledge that is presented in an overwhelming way that accompanies the virology, epidemiology, clinic, diagnosis, therapy, and prevention of the disease by the SARS-CoV-2, so that its approach can be understood and facilitated.

A medicina contemporânea pode fazer mal para os pacientes? / Can contemporary medicine damage patients?

O equilíbrio que o senso comum permite pode ser a resposta para que a interferência da ciência não incorra em transformação da ação médica, processo semelhante ao que ocorre em uma linha de montagem de uma fábrica. É preciso combinar ciência e arte, objetividade e subjetividade, em que a compaixão constitua a essência de toda a relação humana, princípio da medicina e necessária para que a prática médica conspire em busca do bem-estar que todos almejam e merecem.

The balance that the common sense allows can be the answer so that the necessary interference of science does not incur in the transformation of the medical action in the same process that occurs in an assembly line of a factory. It is necessary to combine science and art, objectivity and subjectivity, in which compassion constitutes the essence of the whole human relationship, the principle of medicine and necessary for medical practice to conspire in search of the well-being that everyone desires and desires.

[Nutritional status and related factors among elderly Brazilians]. / Estado nutricional e fatores associados em idosos.

OBJECTIVE: This study describes the nutritional status and associated factors among elderly Brazilians. METHODS: Data from "Pesquisa sobre Padrões de Vida" (PPV- Life Pattern Research), conducted by the "Brazilian Geographic and Statistics Institute" in 1996/1997 were used. Body Mass Index (BMI) was applied to classify nutritional status and is the response variable of this study. Multivariate analysis with polytomous logistic regression was used. RESULTS: Prevalence of underweight was 5.7%, eutrophy 50.4%, overweight 32.3% and obesity 11.6%. Women have a 1.32 greater chance of overweight (CI 95% 0.99-1.74; p=0.05) and 4.11 of obesity (CI 95% 2.57-6.57; p<0.01). Higher age increased risk of underweight and diminished that of overweight and obesity. Elderly with a lower income have a higher risk of underweight and those with a greater income have higher risk of overweight and obesity. Elderly with a chronic disease have a higher risk of changes in the nutritional status. CONCLUSION: Results show a higher prevalence of overweight and eutrophy and a lower prevalence of obesity and underweight. Characteristics associated with nutritional status other than eutrophy are: gender, schooling, income, chronic health problem and age.

Acidose láctica associada à hipopotassemia grave em paciente sob uso de abacavir, atazanavir, lamivudina, lopinavir/ritonavir e tenofovir: Relato de caso / Lactic acidosis associated with severe hypopotasemia in patients under the use of abacavir, atazanavir, lamivudine, lopinavir / ritonavir and tenofovir: Case report

Os antirretrovirais (ARV) modificaram a evolução natural da síndrome da imunodeficiência adquirida de um quadro inicialmente com perspectiva fatal para doença de convivência crônica, com sobrevida que pode ser próxima daquela esperada para a pessoa hígida. A administração dos ARV, entretanto, requer vigilância médica, não só do especialista, mas de todos os envolvidos na Atenção Básica, na Unidade de Pronto Atendimento e na Terapia Intensiva, para que seus efeitos adversos sejam reconhecidos e abordados convenientemente, o que significará melhores condições de vida para os portadores do vírus da imunodeficiência humana (VIH). Este relato mostra os riscos de associação de ARV, e alerta para situações limites em que alterações metabólicas graves, como acidemia e hipopotassemia, podem colocar em risco a vida do paciente sob terapia ARV

Antirretrovirals (ARV) are medications that have modified the natural evolution of acquired immunodeficiency syndrome from a disease initially with fatal perspective to a chronic coexisting desease, with survival that may be close to that expected for the healthy person. Its administration, however, requires medical supervision, not only of the specialist, but of all those involved in basic care, in the emergency care unit and in the intensive care unit, so that its adverse effects are recognizeed and approached conveniently, which will mean better living conditions for human immunodeficiency vírus (HIV) carriers. This report shows the risk of ARV association, and alerts to limiting situations in whick serious metabolic changes, such as acidemia and hypokalemia, may endanger the lives of patients on ARV therapy.

[Cerebral Aspergillus abscess in immunocompetent patient]. / Aspergilose cerebral em paciente imunocompetente.

We report an unusual case of brain aspergillosis with multiple recurrent abscess in a 40 year-old immunocompetent woman, with good therapeutical outcome. The patient presented a subarachnoid hemorrhage caused by a ruptured pericallosal artery aneurysm and was submitted to a craniotomy for aneurysm surgery. Five months later, she developed multiple Aspergillus cerebral abscess. Two craniotomies and amphotericin B became necessary during treatment. Fourteen years later, she is asymptomatic. Treatment of brain aspergillosis abscess implied the combination of both surgical and drug therapy with amphotericin B.

sTREM-1 predicts intensive care unit and 28-day mortality in cancer patients with severe sepsis and septic shock.

INTRODUCTION: The innate immune response molecules and their use as a predictor of mortality in cancer patients with severe sepsis and septic shock are poorly investigated. OBJECTIVE: To analyze the value of interleukin (IL)-1ß, IL-6, IL-8, IL-10, IL-12, tumor necrosis factor α (TNF-α), soluble triggering receptor expressed on myeloid cells 1 (sTREM-1), and high-mobility group box 1 (HMGB-1) as predictors of mortality in cancer patients with severe sepsis and septic shock compared with septic patients without malignancies. DESIGN: Prospective, observational cohort study. SETTING: Tertiary level adult intensive care unit (ICU). SUBJECTS: Seventy-five patients with severe sepsis or septic shock, 40 with cancer and 35 without. INTERVENTIONS AND MEASUREMENTS: Laboratory data were collected at ICU admission, 24 and 48 hours after. Plasma concentrations of HMGB-1 and sTREM-1 were measured by enzyme-linked immunosorbent assay, whereas cytokines were measured by cytometric bead array. RESULTS: Intensive care unit mortality in cancer and noncancer patients was 40% and 28.6% (P = .29), and 28-day mortality was 45% and 34.3% (P = .34). Proinflammatory cytokines IL-1ß, IL-6, IL-8, IL-12, and TNF-α showed significantly higher values in the cancer group. Interleukin-10 at 48 hours (P = .01), sTREM-1 in all measurements (P < .01) and HMGB-1 at 24 hours (P < .01) showed significantly lower values in the cancer group. In addition, for the cancer group, sTREM-1 at 24 hours (P = .02) and 48 hours (P = .01) showed higher levels in nonsurvivors patients. The area under the receiver operating characteristic curve for predicting ICU mortality for sTREM-1 was 0.73 (95% confidence interval, 0.57-0.89; P = .01). Multivariate logistic analysis showed that the days spent in mechanical ventilation and levels of sTREM-1 and IL-1ß at 48 hours were independent predictors of ICU mortality; corticosteroids requirement and levels of sTREM-1 and TNF-α at 24 hours were independent predictors of 28-day mortality. CONCLUSIONS: Patients with cancer have different immune profile in sepsis when compared with patients without cancer, as demonstrated for levels of cytokines, sTREM-1 and HMGB-1. sTREM-1 and days spent in mechanical ventilation proved to be good predictors of ICU and 28-day mortality in cancer patients.

Training-related accidents during teacher-student-assistance activities of medical students.

A survey was done to determine the most common hospital accidents with biologically contaminated material among students at the Medical College of the Federal University of Minas Gerais. Six hundred and ninety-four students (between fifth and twelfth semesters of the college course) answered the questionnaire individually. Three-hundred and forty-nine accidents were reported. The accident rate was found to be 33.9% in the third semester of the course, and increased over time, reaching 52.3% in the last semester. Sixty-three percent of the accidents were needlestick or sharp object injuries; 18.3% mucous membrane exposure; 16.6% were on the skin, and 1.7% were simultaneously on the skin and mucous membrane exposure. The contaminating substances were: blood (88.3%), vaginal secretion (1.7%), and others (9.1%). The parts of the body most frequently affected were: hands (67%), eyes (18.9%), mouth (1.7%), and others (6.3%). The procedures being performed when the accidents occurred were: suture (34.1%), applying anesthesia (16.6%), assisting surgery (8.9%), disposing of needles (8.6%), assisting delivery (6.3%), and others (25.9%). Forty-nine percent of those involved reported the accident to the accident control department. Of these 29.2% did not receive adequate medical assistance. Eight percent of those involved used antiretroviral drugs and of these 86% discontinued the treatment on receiving the Elisa method applied to the patient (HIV-negative); 6.4% discontinued the treatment due to its side-effects; and 16% completed the treatment.

A oportunidade de discussão sobre a formação de médicos no Brasil. Os Ministérios envolvidos, o Sistema de Saúde, as Organizações e Associações Médicas, as Escolas de Medicina, a Sociedade em geral, estão envolvidos na definição de como quer ter atenção médica, e como situar a formação médica para que suas necessidades para a obtenção de bem-estar sejam atendidas? / The opportunity to discuss the training of physicians in Brazil. The Ministries involved, the Health System, the Medical Organizations and Associations, the Medical Schools, the Society in general, are involved in defining how they want to have medical attention, and how to situate medical training so that their needs for obtaining well-being are met?

Várias das questões que sempre desafiaram os educadores médicos tornaram-se de extrema agudeza na atualidade interagindo, potencializando seus efeitos de forma a tornar a formação médica complexa quando o automatismo, automação, tecnocracia, tecnicismo suplantam o humanismo e o humanitarismo nas relações humanas. O desafio continua sendo como tornar o sistema de saúde realmente nacional, equânime, democrático, referenciado, único?; como organizar o sistema de saúde de forma a que a comunidade a quem é destinado e quem o financia seja capaz de o controlar, gerenciar e determinar como evoluir? Como inserir as Escolas Médicas nesse propósito, especialmente diante da abertura em grande escala de Escolas, especialmente, privadas? Como distribuir médicos pelo Brasil de forma equânime? Como garantir a formação adequada de médicos para a real necessidade de atenção médica no Brasil e garantir a carreira de forma a fixar o médico de forma digna em todo o Brasil? Essas particularidades próprias do Brasil são simultâneas ao que ocorre no resto do mundo o que inclui países desenvolvidos, mas especialmente naqueles em que o respeito às pessoas, à família, às instituições ainda espera por cidadania acurada, independente, reflexiva e construtora de seu destino, diante da necessidade de que seja garantida às pessoas o bem estar que todos procuram e merecem. (AU)

Several of the issues that have always challenged medical educators have become extremely acute in today's interacting, potentializing their effects in ways that make medical training complex when automatism, automation, technocracy, and technicalism supplant humanism and humanitarism in human relationships. The challenge remains how to make the health system truly national, equitable, democratic, referenced, unique? how to organize the health system so that the community to whom it is destined and who finances it is able to control, manage and determine how to evolve? How to insert Medical Schools in this purpose, especially in view of the large-scale opening of Schools, especially private schools? How to distribute doctors in Brazil in an equitable way? How to guarantee the adequate training of physicians for the real need of medical attention in Brazil and guarantee the career in order to fix the doctor in a dignified manner throughout Brazil? These particularities of Brazil are simultaneous to what occurs in the rest of the world, which includes developed countries, but especially in those in which respect for people, families and institutions still awaits accurate, independent, reflective and constructive citizenship. their destiny, in the face of the need to guarantee people the well-being that everyone seeks and deserves. (AU)

Antimicrobial susceptibility of Neisseria gonorrhoeae isolates from patients attending a public referral center for sexually transmitted diseases in Belo Horizonte, State of Minas Gerais, Brazil.

INTRODUCTION: The aim of this study was to determine the antimicrobial susceptibility of Neisseria gonorrhoeae isolates obtained from patients attending a public referral center for sexually transmitted diseases and specialized care services (STD/SCS) in Belo Horizonte, Brazil. METHODS: Between March 2011 and February 2012, 201 specimens of Neisseria gonorrhoeae were consecutively obtained from men with symptoms of urethritis and women with symptons of cervicitis or were obtained during their initial consultation. The strains were tested using the disk diffusion method, and the minimum inhibitory concentrations of azithromycin, cefixime, ceftriaxone, ciprofloxacin, chloramphenicol, penicillin, tetracycline and spectinomycin were determined using the E-test. RESULTS: The specimens were 100% sensitive to cefixime, ceftriaxone and spectinomycin and exhibited resistances of 4.5% (9/201), 21.4% (43/201), 11.9% (24/201), 22.4% (45/201) and 32.3% (65/201) to azithromycin, ciprofloxacin, chloramphenicol, penicillin and tetracycline, respectively. Intermediate sensitivities of 17.9% (36/201), 4% (8/201), 16.9% (34/201), 71.1% (143/201) and 22.9% (46/201) were observed for azithromycin, ciprofloxacin, chloramphenicol, penicillin and tetracycline, respectively. The specimens had plasmid-mediated resistance to penicillin PPNG 14.5% (29/201) and tetracycline TRNG 11.5% (23/201). CONCLUSIONS: The high percentage of detected resistance to penicillin, tetracycline, chloramphenicol and ciprofloxacin indicates that these antibiotics are not appropriate for gonorrhea treatment at the Health Clinic and possibly in Belo Horizonte. The resistance and intermediate sensitivity of these isolates indicates that caution is recommended in the use of azithromycin and emphasizes the need to establish mechanisms for the surveillance of antimicrobial resistance for the effective control of gonorrhea.

Características Clínicolaboratoriais da Criptococose em Pacientes Admitidos em Pronto Socorro Hospital das Clínicas, Universidade Federal de Minas Gerais, Referência Terciária do Sistema Único de Saúde: Análise Retrospectiva desde 2000 a 2013 / Clinical Laboratory Characteristics of Cryptococcosis in Patients Admitted to the Emergency Room Hospital das Clínicas, Federal University of Minas Gerais, Tertiary Reference of the Unified Health System: Retrospective Analysis from 2000 to 2013

A criptococose é uma micose sistêmica, de ocorrência relativamente rara, potencialmente grave, geralmente oportunista e de elevada frequência em pacientes imunossuprimidos, com amplo espectro de acometimento de órgãos, tropismo especial para o sistema nervoso central (SNC), evolução subaguda ou crônica, e manifestações clínicas variadas. Este estudo descritivo, retrospectivo, observacional, transversal, objetivou descrever os dados demográficos, clínicos, comorbidades, sintomas ou sinais, e o prognóstico de pacientes com neurocriptococose, atendidos e internados no Hospital das Clínicas (HC) da Universidade Federal de Minas Gerais desde 2000 até 2013. O HC é unidade universitária, pública e geral, de nível terciário e quaternário, com 450 leitos de internação, integrado ao Sistema Único de Saúde (SUS), com clientela universalizada, cerca de 40% do total proveniente do interior do estado de Minas Gerais, predominando da região Metropolitana de Belo Horizonte, aberto à transferência de pacientes de todo o território mineiro, com área de abrangência de população de mais de cinco milhões de pessoas, de todas as faixas etárias e todas as especialidades médicas, encaminhados pela intensidade de sua expressão clínica, especialmente em situação crítica, o que torna sua casuísticade máxima gravidade. Os pacientes foram internados a partir do Pronto Socorro do HC que admite, em média, 80 pacientes com urgência clínicas por dia, incluindo obstétricas, e excluídas aquelas devido à acidente ou violência de qualquer natureza. Foram analisados 40 pacientes com neurocriptococose o que significou 0,13% de toda demanda de admissão de urgência para o período estudado, cerca de 603.000 pessoas, isto é 12% da população referida, e associou-se à letalidade de 25%; com frequência da distribuição de acordo com o gênero em 2:1, entre homens e mulheres, respectivamente; e nas faixas etárias entre 20-40, 40-60 e mais de 60 anos de idade, de 36%, 42%, e 22%, respectivamente, sendo a proporção entre 20 a 60 e mais de 60 de aproximadamente, 2:1. A neurocriptococose associou-se em mais de 50% dos pacientes com a: SIDA (57,5%); internação prévia (52,5%) relacionada à quimio e corticoterapia, transplante, cirurgias para ressecção de neoplasias; e, em menos de 20% com doença cardiovascular hipertensiva sistêmica (17,5%), cirurgia prévia (15%) e tuberculose (5%). A sintomatologia isolada presente em pelo menos 40% dos pacientes foi: cefaleia (70%), astenia (50%), febre (45%), vômitos (40%); entretanto, em até um terço deles constituiu-se de: emagrecimento (30%), tontura (30%), dor abdominal (27,5%), convulsão (22,5%). As anormalidades mais e menos especificamente indicadoras de acometimento do SNC foram cefaleia; e, vômito, tontura e convulsão,respectivamente. As alterações do exame neurológico foram relacionadas aos distúrbios da consciência (35%), lesão focal (30%), alteração da marcha (25%) e distúrbio do comportamento (15%). A concomitância de cefaléia, convulsão e vômitos foi anotada em 5% dos pacientes; enquanto de cefaléia e convulsão em 22,5%. Foi observada, à admissão hospitalar, em 40%, dos pacientes a associação de cefaléia e vômito; mas todos os pacientes com vômito e também os com lesão focal apresentavam cefaleia. A presença de cefaleia não foi descrita em 35% dos pacientes com alteração da consciência à admissão hospitalar. O diagnóstico presuntivo de neurocriptococose deve ser realizado, independentemente da sintomatologia clínica neurológica, o que realça a percepção geral do paciente, incluindo epidemiologia, história familiar, história prévia, manifestações clínicas, presença de imunossupressão, para surpreender a criptococose, e iniciar a terapêutica o mais apidamente possível para que possa ser reduzida sua letalidade. A limitação deste estudo relaciona-se ao fato de ter sido retrospectivo, em que o controle dos dados registrados é muito limitada, sendo impossível corrigir a ausência de dados registrados. (AU)

Cryptococcosis is a systemic, relatively rare, potentially severe, often opportunistic and systemic mycosis in immunosuppressed patients with a broad spectrum of organ involvement, a special central nervous system (CNS) tropism, subacute or chronic clinical manifestations. This descriptive, retrospective, observational, cross-sectional study aimed to describe the demographic, clinical, comorbidities, symptoms or signs, and the prognosis of patients with neurocryptococcosis, attended and hospitalized at the Hospital das Clínicas (HC) of the Universidade Federal de Minas Gerais since 2000 until 2013. The HC is a university unit, public and general, tertiary and quaternary level, with 450 beds of hospitalization, integrated into the Unified Health System (SUS), with a universalized clientele, about 40% of the total coming from the interior of the state of Minas Gerais, predominating in the metropolitan region of Belo Horizonte, which is open to the transfer of patients from all over Minas Gerais, with an area of population of more than five million people, of all age groups and all medical specialties. intensity of its clinical expression, especially in a critical situation, which makes its series of age.The patients were hospitalized from the HC Emergency Room, which admitted, on average, 80 urgently needed clinics per day, including obstetrics, and excluded due to accidents or violence of any kind. We analyzed 40 patients with neurocryptococcosis, which represented 0.13% of all urgent admission demands for the period studied, about 603,000 people, ie 12% of the referred population, and was associated with a 25% lethality; with frequency of distribution according to gender in 2: 1, between men and women, respectively; and in the age groups between 20-40, 40-60 and over 60 years of age, of 36%, 42%, and 22% respectively, the ratio being between 20 to 60 and more than 60 of approximately 2: 1. Neurocryptococcosis was associated in more than 50% of patients with: AIDS (57.5%); previous hospitalization (52.5%) related to chemo and corticoid therapy, transplantation, surgeries for resection of neoplasias; and in less than 20% with systemic hypertensive cardiovascular disease (17.5%), previous surgery (15%) and tuberculosis (5%). The isolated symptoms present in at least 40% of the patients were: headache (70%), asthenia (50%), fever (45%), vomiting (40%); (30%), dizziness (30%), abdominal pain (27.5%), and seizure (22.5%). The most and least specific abnormalities of CNS involvement were headache; and, vomiting, dizziness and convulsion, respectively. Changes in neurological examination were related to disturbances of consciousness (35%), focal lesion (30%), gait alteration (25%) and behavior disorder (15%). The concomitance of headache, convulsion and vomiting was noted in 5% of the patients; while headache and seizure in 22.5%. The association of headache and vomiting was observed in 40% of patients; but all patients with vomiting and those with focal lesion also had headache. The presence of headache was not described in 35% of patients with altered consciousness at hospital admission. The presumptive diagnosis of neurocryptococcosis should be performed independently of the clinical neurological symptomatology, which highlights the general perception of the patient, including epidemiology, family history, previous history, clinical manifestations, presence of immunosuppression, to start cryptococcosis, and initiate therapy. as soon as possible so that their lethality can be reduced. The limitation of this study is the fact that it was retrospective, in which the control of the recorded data is very limited, and it is impossible to correct the absence of recorded data. (AU)

Paracoccidioidomycosis case series with and without central nervous system involvement.

INTRODUCTION: Paracoccidioidomycosis (PCM) is the most important systemic mycosis in South America. Central nervous system involvement is potentially fatal and can occur in 12.5% of cases. This paper aims to contribute to the literature describing eight cases of neuroparacoccidioidomycosis (NPMC) and compare their characteristics with patients without neurological involvement, to identify unique characteristics of NPCM. METHODS: A cohort of 213 PCM cases was evaluated at the Infectious Diseases Clinic of the University Hospital, Federal University of Minas Gerais, Brazil, from October 1976 to August 2008. Epidemiological, clinical, laboratory, therapeutic and follow-up data were registered. RESULTS: Eight patients presented NPCM. The observed NPCM prevalence was 3.8%. One patient presented the subacute form of PCM and the other seven presented the chronic form of the disease. The parenchymatous form of NPCM occurred in all patients. 60% of the patients who proceeded from the north/ northeast region of Minas Gerais State developed NPCM. The neurological involvement of a mother and her son was observed. NPCM patients exhibited demographical and clinical profiles similar to what is described in the literature. When NPCM cases were compared to PCM patients, there were differences in relation to origin and positive PCM family history. CONCLUSIONS: The results corroborate the clinical view that the neurological findings are extremely important in the evaluation of PCM patients. Despite the limitations of this study, the differences in relation to patient's origins and family history point to the need of further studies to determine the susceptibility factors involved in the neurological compromise.

Bilateral paracoccidioidomycotic iliopsoas abscess associated with ileo-colonic lesion.

This case report shows the clinical development of a patient with systemic paracoccidioidomycosis presenting with lymphatic-intestinalmanifestation. The patient initially had a substantial clinical improvement but had a recrudescence after six months of sulfamethoxazoletrimethoprim oral treatment, with the emergence of feverish syndrome, lumbar pain, and intermittent claudication, characterizing a bilateral iliopsoas muscle abscess, necessitating clinicosurgical therapeutics.

Assessment of the effectiveness of a home-based care program for patients coinfected with tuberculosis and human immunodeficiency virus after discharge from a reference hospital in South-Eastern Brazil.

The effectiveness of tuberculosis treatment delivered by a home-based care program to patients coinfected with HIV was compared with that of a service provided by outpatient departments. A retrospective study was made of a cohort of coinfected patients discharged from hospital between January 1998 and December 2002 who had been followed-up for one year within one of these programs. Two-hundred-and-forty-three patients who met the inclusion criteria were grouped according to their treatment program (group 1 received home-based care; group 2 attended outpatient departments) and then paired one-to-one across the groups by gender, age and level of education. Only 48 patients from each group could be paired. Apart from the duration of HIV infection, there were no statistically significant differences (P < 0.05) between patients in the two groups with respect to social-demographic status and clinical or laboratory characteristics. In group 1, 75.0% of patients attained successful tuberculosis treatment compared with 72.9% of those in group 2 (P = 0.816). Treatment was abandoned by 22.9% of patients in group 1 and by 54.2% of those in group 2 (P = 0.008). The death rate within one year after discharge was 20.8% for group 1 compared with 6.3% for group 2 (P = 0.334). Although both programs achieved a similar success rate in the treatment of tuberculosis, patients receiving outpatient care were three to eight-times more likely to abandon the program. The importance of assigning patients at-risk of abandoning treatment to a home-based care program after discharge from hospital is emphasized.

Scintigraphy for the detection of myocardial damage in the indeterminate form of Chagas disease.

BACKGROUND: Non-invasive cardiological methods have been used for the identification of myocardial damage in Chagas disease. OBJECTIVE: To verify whether the rest/stress myocardial perfusion scintigraphy is able to identify early myocardial damage in the indeterminate form of Chagas disease. METHODS: Eighteen patients with the indeterminate form of Chagas Disease and the same number of normal controls, paired by sex and age, underwent rest/stress myocardial scintigraphy using sestamibi-99mTc, aiming at detecting early cardiac damage. RESULTS: The results did not show perfusion or ventricular function defects in patients at the indeterminate phase of Chagas disease and in the normal controls, except for a patient who presented signs of ventricular dysfunction in the myocardial perfusion scintigraphy with electrocardiographic gating. CONCLUSION: The results of this study, considering the small sample size, showed that the rest/stress myocardial scintigraphy using sestamibi-99mTc is not an effective method to detect early myocardial alterations in the indeterminate form of Chagas disease.

Pulmonary paracoccidioidomycosis: radiology and clinical-epidemiological evaluation.

INTRODUCTION: The purpose of this study was to compare respiratory signs and symptoms between patients with and without chest X-ray abnormalities in order to establish the meaning of radiographic findings in pulmonary PCM diagnosis. METHODS: The epidemiological, clinical and radiological lung findings of 44 patients with paracoccidioidomycosis (PCM) were evaluated. Patients were divided into two groups of 23 and 21 individuals according to the presence (group 1) or absence (group 2) of chest X-ray abnormalities, respectively, and their clinical data was analyzed with the aid of statistical tools. RESULTS: As a general rule, patients were rural workers, young adult males and smokers - group 1 and 2, respectively: males (91.3% and 66.7%); mean age (44.4 and 27.9 year-old); smoking (34.7% and 71.4 %); acute/subacute presentation (38.1% and 21.7%); chronic presentation (61.9% and 78.3%). The most frequent respiratory manifestations were - group 1 and 2, respectively: cough (25% and 11.4%) and dyspnea (22.7% and 6.8%). No statistical difference was observed in pulmonary signs and symptoms between patients with or without radiographic abnormalities. The most frequent radiological finding was nodular (23.8%) or nodular-fibrous (19%), bilateral (90.5%) and diffuse infiltrates (85.7%). CONCLUSIONS: Absence of statistical difference in pulmonary signs and symptoms between these two groups of patients with PCM indicates clinical-radiological dissociation. A simplified classification of radiological lung PCM findings is suggested, based on correlation of these data and current literature review.

Paracoccidioidomicose (doença de Lutz-Splendore-Almeida) [Editorial] / Paracoccidioidomycosis (Lutz-Splendore-Almeida Disease)

A paracoccidioidomicose (PCM), doença provocada pelo Paracoccidioidis brasiliensis, é a mais importante micose profunda existente na América Latina. Foi descrita inicialmente no Brasil em 1908 por Adolfo Lutz, comcontribuições posteriores de relevância, para seu entendimento, de Splendore e Almeida. Pode acometer pessoas de todas as faixas etárias, evoluindo de forma aguda-subaguda ou crônica, respectivamente, em crianças-adolescentes e adultos após os 30 anos de idade. Possui desde manifestações benignas até formas graves com risco de morte. Apresenta anatomopatologicamente caráter granulomatoso e supurativo, acometendo principalmente os pulmões, mucosas das vias aéreas superiores e boca, pele e linfonodos, podendo afetar todos os órgãos e sistemas.