Aspects épidémiologique et clinique des uvéites au Niger: analyse rétrospective d'une série de 127 cas colligés sur 5 ans / Epidemiological and clinical aspects of uveitis in Niger: A retrospective analysis of a series of 127 cases collected during 5 years

Contexte & objectif L'uvéite est peu très peu documentée en Niamey. L'objectif de la présente étude était de décrire les aspects épidémiologique et clinique des uvéites. Méthodes. Il s'agissait d'une étude rétrospective et descriptive portant sur 127 dossiers des patients suivis pour uvéites à la clinique lumière de Niamey sur une période de 5 ans (2015 ­ 2020). Les paramètres sociodémographiques, cliniques et thérapeutiques ont été recueillis. Résultats. La fréquence hospitalière des uvéites était de 0,21 %. Le sex-ratio était de 1,01. L'âge moyen des patients était de 40,76 ans. La douleur oculaire représentait le motif de consultation le plus fréquent avec 51 ,97 %. La majorité des patients avait présenté 2 épisodes d'uvéites soit 57,48 %. L'atteinte était unilatérale dans 70,97 % et les uvéites antérieures étaient les plus fréquentes 66,93 %. Les étiologies étaient identifiées chez seulement 7,87 % des patients dont près de la moitié était la tuberculose. 33,07 % des patients avaient présenté des complications. Conclusion. Il ressort de cette étude que l'uvéite touche plus des jeunes adultes, ses étiologies sont indéterminées dans la majorité de cas. Les formes antérieures sont plus fréquentes.

Context and objective Little is known about Uveitis in Niamey. This study aimed to analyze the epidemiological and clinical aspects of uveitis. Methods. This was a retrospective, descriptive study of 127 records of patients followed up for uveitis at the Niamey Lumière Clinic over a 5-year period (2015 ­ 2020). Sociodemographic, clinical and therapeutic parameters were collected. Results. The hospital frequency of uveitis was 0.21%. The sex ratio was 1.01. The mean age of patients was 40.76 years. Ocular pain was the most frequent reason for consultation, accounting for 51.97 %. The majority of patients (57.48%) had presented with 2 episodes of uveitis. Involvement was unilateral in 70.97 %, and anterior uveitis was the most frequent, at 66.93 %. Etiologies were identified in only 7.87 % of patients, of which tuberculosis accounted for almost half. Complications occurred in 33.07 % of patients. Conclusion. This study shows that uveitis affects mainly young adults, and its etiologies are undetermined in most cases. Anterior forms are more frequent.

Acidentes com animais peçonhentos no Brasil: uma revisão integrativa / Accidents with venomous animals in Brazil: an integrative review

Considerados como doenças negligenciadas pela Organização Mundial de Saúde, os acidentes com animais peçonhentos são de grande relevância média por apresentarem altos índices de mortalidade e morbidade. Objetivo - O objetivo desta revisão é apresentar os aspectos epidemiológicos e clínicos dos acidentes com animais peçonhentos no Brasil nos últimos dez anos. Métodos - Foram utilizadas publicações que compreendessem os aspectos clínicos e epidemiológicos de estados, regiões ou municípios brasileiros. Para a revisão foram os artigos foram selecionados em maio de 2020, compreendendo os anos de 2010 a 2020. Resultados e Discussão - Os principais acidentes foram relacionados às serpentes peçonhentas e escorpiões. Nas regiões Sudeste, Norte, Centro-Oeste os acidentes ofídicos foram os mais recorrentes, enquanto que, na região Nordeste, os acidentes com escorpiões e um estudo da região Sul um estudo destacou o araneísmo como principal acidente. Os sinais e sintomas do ofidismo variaram de acordo com o gênero das serpentes, sendo os acidentes com o gênero Bothrops predominante. Os sintomas recorrentes foram: dor, edema, equimose, hemorragia local e sistêmica e alterações na coagulação. O escorpionismo foi causado principalmente pelo gênero Tityus, sendo os casos graves relacionados ao comprometimento pulmonar. Conclusão - Os tipos de acidentes, bem como os sinais e sintomas do envenenamento apresentam muitas variáveis, como região geográfica, gênero e espécie dos animais. A melhoria da qualidade dos dados epidemiológicos e ampliação da assistência em saúde são fatores essenciais para a redução no número de casos de mortalidade e morbidades decorrentes do envenenamento por animais peçonhentos.

Considered as neglected by the World Health Organization, accidents with venomous animals are of great relevance because they have high mortality and morbidity rates. Purpose - This review has the purpose to present the epidemiological and clinical aspects of accidents with venomous animals in Brazil in the past ten years. Methods - Publications were used that understood the clinical and epidemiological aspects of Brazilian states, regions or municipalities. For the review, articles were selected in May 2020, covering the years 2010 to 2020. Results and Discussion - The main accidents were related to venomous snakes and scorpions. In the Southeast, North, and Center-West regions, snakebite accidents were the most recurrent, while in the Northeast region, accidents involving scorpions and a study in the Southern region highlighted accidents with arachnids as the most frequent type of incident. Signs and symptoms of snakebite varied according to the gender of the snakes, with predominance for accidents with the Bothrops genus. Recurring symptoms included pain, edema, ecchymosis, local and systemic hemorrhage, and changes in coagulation. Scorpionism was mainly caused by the Tityus genus, with severe cases presenting pulmonary involvement. Conclusion - The types of accidents, as well as the signs and symptoms of envenomation, present many variables which included geographic region, gender and species of animals. Improving the quality of epidemiological data and expanding health care are essential factors for reducing the number of mortality and morbidity cases resulting from envenomation by venomous animals.

Natural infection of Trypanosoma sp. in domestic sheep from Ecuador / Infecção natural do Trypanosoma sp. em ovelhas domésticas do Equador

Trypanosomosis in sheep is a hemoparasitic disease of worldwide interest due to its effects on the health of animals and the economic impact on producers, is caused by the protozoan Trypanosoma sp. In the present study, the occurrence of Trypanosoma sp. in sheep from the urban-rural area of the canton Salitre was determined, through an applied study with a qualitative descriptive prospective cross-sectional approach, carried out between October 1, 2019, and February 19, 2020. Blood samples were extracted from the jugular vein and analyzed by the blood smear method using the Giemsa and Diff-Quick staining techniques. Previously, in a first study realized between 2018 and 2019, 2 cases (2%) of Trypanosoma sp., 1 case of Babesia sp. (1%), and 4 cases of Anaplasma marginale (4%) were identified, but without the presence of symptoms of the disease. However, in this new research study, of 170 animals sampled from 5 herds and aged between 3 and 8 years, 34 (20%) were positive for Trypanosoma sp., 6 for Babesia sp. (3.52%) and 6 for A. marginale (3.52%) with coinfection between them. In this research, deteriorated clinical aspects and low hematological values were also determined in positive animals; besides of the total of positive cases, 25 presented symptoms of hemoparasitic disease, 3 sheep had abortions and 8 died. The results of this study showed that Trypanosoma sp. could already become an endemic parasitosis in sheep in the country, representing a serious problem of animal health.

A tripanossomose em ovinos é uma doença hemoparasitária de interesse mundial devido a seus efeitos sobre a saúde dos animais e o impacto econômico sobre os produtores, Esta doença é causada pelo protozoário Trypanosoma sp. No presente estudo, foi determinada a ocorrência de Trypanosoma sp. em ovelhas da área urbano-rural do Cantão Salitre, através de um estudo aplicado com uma abordagem transversal descritiva qualitativa prospectiva, realizado entre dia primeiro de outubro de 2019, à 19 de fevereiro de 2020. Amostras de sangue foram extraídas da veia jugular e analisadas pelo método de esfregaço de sangue usando as técnicas de coloração Giemsa e Diff-Quick. Anteriormente, em um primeiro estudo realizado entre 2018 e 2019, dois casos (2%) de Trypanosoma sp., foram identificados um caso de Babesia sp. (1%), e quatro casos de Anaplasma marginale (4%), mas sem a presença de sintomas da doença. Entretanto, neste novo estudo de pesquisa, de 170 animais amostrados de cinco rebanhos e com idades entre três e oito anos, 34 (20%) foram positivos para Trypanosoma sp., seis para Babesia sp. (3,52%) e seis para A. marginale (3,52%) com coinfecção entre eles. Nesta pesquisa, aspectos clínicos deteriorados e baixos valores hematológicos também foram determinados em animais positivos; além do total de casos positivos, 25 apresentaram sintomas de doença hemoparasítica, três ovelhas tiveram abortos e oito morreram. Os resultados deste estudo mostram que o Trypanosoma sp. já poderia se tornar uma parasitose endêmica em ovinos no país, representando um grave problema de saúde animal.

Clinical findings of equine leukoencephalomalacia

ABSTRACT: Equine leukoencephalomalacia (LEM) is a disease caused by the ingestion of food, especially corn, contaminated by fumonisin, a Fusarium verticillioides (synonymous with F. moniliforme) metabolite. The clinical signs of brain injuries have an acute onset and rapid evolution. This study aimed to describe the clinical findings in 11 animals diagnosed with LEM, including cerebrospinal fluid (CSF) analysis. Of these animals, 91% (10/11) were horses, and only 9% (1/11) were asinine. The clinical localization of the lesions was 64% (7/10) cerebral, manifested mainly by altered mental state and behavioral disturbance, and 36% (4/11) were brainstem lesions, manifested by incoordination, head tilt, nystagmus, facial hypoalgesia, difficulty in apprehension, chewing, and swallowing food. Postmortem findings revealed that 82% (9/11) of the lesions were in the cerebrum and 18% (2/11) in the brainstem. CSF findings, such as xanthochromia (43%, 3/7), hyperproteinorrachia (50%, 3/6), and pleocytosis (43%, 3/7) were observed. The affected animals showed neurological signs that were compatible with cerebral and/or brainstem injuries. The CSF from animals with LEM may present with xanthochromia, hyperproteinorrachia, and pleocytosis, reinforcing the fact that this disease should be included in the differential diagnosis of encephalomyelopathies.

RESUMO: A leucoencefalomalácia (LEM) é uma enfermidade que acomete equídeos causada pela ingestão de milho e seus derivados e feno contaminados pela micotoxina fumonisina, um metabólito do fungo Fusarium verticillioides (sinônimo para F. moniliforme). Os sinais clínicos apresentam início agudo e evolução rápida e são decorrentes de lesões encefálicas. O objetivo deste estudo é descrever os achados clínicos de 11 equídeos diagnosticados com LEM, incluindo a análise do líquido cefalorraquidiano (LCR). 91% dos animais afetados eram equinos e somente 9% (1/11) era asinino. A localização clínica das lesões era 64% (7/10) cerebrais, manifestadas por alterações no estado mental e comportamento e 36% (4/10) no tronco encefálico, manifestadas por incoordenação, desvio lateral de cabeça, nistagmo, hipoalgesia da face e dificuldade de apreensão, mastigação e deglutição de alimentos. Comparativamente, os achados post mortem revelaram que 82% (9/11) das lesões eram no cérebro e 18% (2/11) no tronco encefálico. Alterações no LCR, tais como xantocromia (43%, 3/7), hiperproteinorraquia (50%, 3/6) e pleocitose (43%, 3/7), foram observadas. Os animais afetados apresentaram sinais clínicos compatíveis com lesões encefálicas e/ou de tronco cerebral. O LCR de animais com LEM pode apresentar xantocromia, hiperproteinorraquia, e pleocitose, reforçando que esta doença deve ser incluída como diagnóstico diferencial de encefalomielites.

Clinical findings of equine leukoencephalomalacia / Achados clínicos de leucoencefalomalácia equina

Equine leukoencephalomalacia (LEM) is a disease caused by the ingestion of food, especially corn, contaminated by fumonisin, a Fusarium verticillioides (synonymous with F. moniliforme) metabolite. The clinical signs of brain injuries have an acute onset and rapid evolution. This study aimed to describe the clinical findings in 11 animals diagnosed with LEM, including cerebrospinal fluid (CSF) analysis. Of these animals, 91% (10/11) were horses, and only 9% (1/11) were asinine. The clinical localization of the lesions was 64% (7/10) cerebral, manifested mainly by altered mental state and behavioral disturbance, and 36% (4/11) were brainstem lesions, manifested by incoordination, head tilt, nystagmus, facial hypoalgesia, difficulty in apprehension, chewing, and swallowing food. Postmortem findings revealed that 82% (9/11) of the lesions were in the cerebrum and 18% (2/11) in the brainstem. CSF findings, such as xanthochromia (43%, 3/7), hyperproteinorrachia (50%, 3/6), and pleocytosis (43%, 3/7) were observed. The affected animals showed neurological signs that were compatible with cerebral and/or brainstem injuries. The CSF from animals with LEM may present with xanthochromia, hyperproteinorrachia, and pleocytosis, reinforcing the fact that this disease should be included in the differential diagnosis of encephalomyelopathies.(AU)

A leucoencefalomalácia (LEM) é uma enfermidade que acomete equídeos causada pela ingestão de milho e seus derivados e feno contaminados pela micotoxina fumonisina, um metabólito do fungo Fusarium verticillioides (sinônimo para F. moniliforme). Os sinais clínicos apresentam início agudo e evolução rápida e são decorrentes de lesões encefálicas. O objetivo deste estudo é descrever os achados clínicos de 11 equídeos diagnosticados com LEM, incluindo a análise do líquido cefalorraquidiano (LCR). 91% dos animais afetados eram equinos e somente 9% (1/11) era asinino. A localização clínica das lesões era 64% (7/10) cerebrais, manifestadas por alterações no estado mental e comportamento e 36% (4/10) no tronco encefálico, manifestadas por incoordenação, desvio lateral de cabeça, nistagmo, hipoalgesia da face e dificuldade de apreensão, mastigação e deglutição de alimentos. Comparativamente, os achados post mortem revelaram que 82% (9/11) das lesões eram no cérebro e 18% (2/11) no tronco encefálico. Alterações no LCR, tais como xantocromia (43%, 3/7), hiperproteinorraquia (50%, 3/6) e pleocitose (43%, 3/7), foram observadas. Os animais afetados apresentaram sinais clínicos compatíveis com lesões encefálicas e/ou de tronco cerebral. O LCR de animais com LEM pode apresentar xantocromia, hiperproteinorraquia, e pleocitose, reforçando que esta doença deve ser incluída como diagnóstico diferencial de encefalomielites.(AU)

Testicular tumors in 190 dogs: clinical, macroscopic and histopathological aspects / Neoplasmas testiculares em 190 cães: aspectos clínicos, macroscópicos e histopatológicos

This study aimed to characterize the prevalence and clinical, macroscopic and histopathological aspects of dogs affected by testicular tumors based on biopsy specimens from the Laboratório de Patologia Veterinária of the Universidade Federal de Santa Maria (LPV-UFSM) over 19 years. Parameters regarding the age, size, and breed of the affected dogs were also established. Of all dogs with some type of neoplasm submitted to histopathological analysis at the LPV over these 19 years (n=1,900), 213 (11.2%) had at least one testicular neoplasm. The tissues of 190 dogs (with 220 neoplasms) were available for histological reassessment. The dogs in this study had different types of testicular tumors with relatively similar frequencies. In descending order, the most frequent testicular neoplasms were seminomas (88/220), Leydig (interstitial) cell tumor (LCT; 64/220), Sertoli cell tumor (SCT; 61/220), and mixed germ cell-sex cord stromal tumor (MGSCT) (07/220). Among the dogs of defined breed (119 cases), large breeds had the largest number of cases (50/119), followed by small (47/119) and medium-sized (22/119) breeds. The ages of dogs affected by testicular tumors ranged from 10 months to 18 years. Increased testicular volume was the most common clinical manifestation. Eleven dogs presented information about clinical signs suggestive of hyperestrogenism syndrome (feminization). In seminomas, the diffuse pattern predominated over the intratubular pattern. Two sites (luminal and basal compartments) suggestive of the onset of neoplastic transformations in germ cells were observed in intratubular seminomas. They corroborate the hypothesis that canine seminomas possibly have pathogenesis similar to that observed in human spermatocytic seminomas. The SCTs and LCTs presented high cell morphology variation. SCTs had neoplastic cells organized in five different histological arrangements. As for LCT, solid-diffuse and cystic-vascular histological patterns were the most commonly observed. Through this study, it was possible to establish some of the leading clinical, macroscopic, and histopathological aspects of testicular neoplasms diagnosed over 19 years in the area covered by the LPV-UFSM.(AU)

Este estudo teve por objetivo caracterizar a prevalência, aspectos clínicos, macroscópicos e histopatológicos dos cães acometidos por neoplasmas testiculares, a partir dos espécimes de biópsias do Laboratório de Patologia Veterinária da Universidade Federal de Santa Maria (LPV-UFSM) em 19 anos. Parâmetros quanto à idade, porte, raça dos cães acometidos também foram estabelecidos. De todos os cães com algum tipo de neoplasma submetido à análise histopatológica no LPV nesses 19 anos (n=1.900), 213 (11,2%) tinham ao menos um neoplasma testicular. Os tecidos de 190 cães (com 220 neoplasmas) estavam disponíveis para reavaliação histológica. Os cães deste estudo apresentaram diferentes tipos de neoplasmas testiculares com frequências relativamente semelhantes. Em ordem decrescente, os neoplasmas testiculares mais frequentes foram: seminomas (88/220), leydigomas (64/220), sertoliomas (61/220) e o tumor misto de células germinativas e do estroma do cordão sexual (MGSCT; 07/220). Dentre os cães com raça definida (119 casos), as raças de grande porte tiveram o maior número de casos (50/119), seguido das raças de pequeno (47/119) e médio porte (22/119). As idades dos cães acometidos por neoplasmas testiculares variaram de 10 meses a 18 anos. Aumento de volume testicular foi a manifestação clínica mais comum. Onze cães tinham informações sobre sinais clínicos sugestivos da síndrome da feminilização. Nos seminomas, houve o predomínio do padrão difuso sobre o intratubular. Dois locais (compartimentos luminal e basal) sugestivos de início das transformações neoplásicas nas células germinativas foram observados nos seminomas intratubulares, corroborando com a hipótese de que os seminomas caninos possivelmente tem patogênese semelhante à observada nos seminomas espermatocíticos humanos. Sertoliomas e leydigomas foram neoplasmas com alta variação na morfologia celular. Os sertoliomas tinham células neoplásicas dispostas em cinco arranjos histológicos distintos. Quanto aos leydigomas, os padrões histológicos sólido-difuso e cístico-vascular foram os mais comumente observados. Através deste estudo foi possível estabelecer alguns dos principais aspectos clínicos, macroscópicos e histopatológicos dos neoplasmas testiculares diagnosticados em 19 anos na área de abrangência do LPV-UFSM.(AU)

Miastenia gravis: Registro de 190 casos en un centro único / Myasthenia gravis. Register of 190 cases in a single center

La miastenia gravis (MG) es una enfermedad autoinmune mediada por anticuerpos dirigidos contra proteínas post sinápticas de la unión neuromuscular. El objetivo de este estudio fue describir los aspectos clínicos, epidemiológicos y serológicos de pacientes con MG en un Hospital Público de la Ciudad de Buenos Aires. Se realizó un análisis retrospectivo sobre 190 enfermos con diagnóstico de MG. La edad media de inicio de la enfermedad fue de 38 años; 57 (30%) fueron MG de inicio tardío (inicio de síntomas > 50 años). La relación mujer/hombre fue 1.7/1. La enfermedad se inició más tempranamente en las mujeres que en los hombres, media 32 vs. 48 años (p < 0.0001). La MG familiar autoinmune representó el 3.2 % (6 casos). La forma más común de presentación fue con manifestaciones oculares puras (52%). El 12.1% (23/190) fue considerada MG ocular en el seguimiento. La MG asociada a timoma se presentó en 22 casos (11.6%). El 27.1% presentó otra enfermedad autoinmune asociada, siendo las tiroideas las más frecuentes. El 81.4% tuvo anticuerpos anti-receptores de acetilcolina (ACRA) positivos y 22.7% de los ACRA negativos fueron positivos para anticuerpos anti-tirosina quinasa musculo especifica (anti-MusK). La evolución clínica fue favorable, hallándose más de la mitad de los casos en remisión o manifestaciones mínimas en la última visita. La mayoría requirió inmunosupresión para control de la sintomatología, el 78% recibió corticoides y el 48% un inmunosupresor no esteroideo.

Myasthenia gravis (MG) is an antibody-mediated autoimmune disease of the neuromuscular junction. The aim of this study was to evaluate clinical, epidemiological and serological features of patients with MG in a Public Hospital of Buenos Aires City. A retrospective analysis of 190 patients diagnosed with MG was performed. The mean age of MG onset was 38 years, 30% had late-onset MG (onset age > 50 years). The female/male ratio was 1.7 / 1. Disease started earlier in women than in men, mean 32 vs. 48 years (p < 0.0001). Familial autoimmune MG represented 3.2% of the cases. Most of the patients initiated their disease with a pure ocular form (52%). 12.1% (23/190) were considered ocular MG at follow-up. Thymoma-associated MG represented 11.6% of cases. 27.1% had other associated autoimmune disease, thyroid disorders were the most frequent. 81.4% were anti-acetylcholine receptor antibody (AChR-ab) positive MG; 22.7% of AChR-ab negatives were positive for anti-muscle specific kinase (MusK) antibodies. Clinical outcome was relatively good; more than half of cases were in remission or minimal manifestations at the last visit. The majority of patients required immunosuppression to control the symptoms, 78% received corticosteroids and 48%, a non-steroidal immunosuppressant.

Epidemiology and clinical aspects of hematological malignancies at the military hospital of Antananarivo

Background: Malignant hemopathies constitute a group of pathologies having in common the anomalies of the bone marrow or of the lymphatic system cells. In developed countries, the number and actual distribution of cancers is provided by cancer registries. In Madagascar there is no effective cancer registry and only two studies on malignant hemopathies have been carried out to date, but neither has described their epidemiology and clinical aspects. Thus, we aimed to describe the epidemiology and clinical aspects of malignant hemopathies managed in the Medical Oncology Unit of the Military Hospital of Antananarivo.Methods: It was a cross-sectional and descriptive study carried out at this unit from 1st December 2012 to 31st August 2015 (33 months). Authors included all patients followed, then excluded those without pathologic evidence, cases of monoclonal gammapathy of unknown significance and cases of solid cancers.Results: We followed up 57 cases of malignant hemopathies. The mean age was 49.39±15.46 years and the sex ratio was 1.71. Superficial lymphadenopathy was the most frequent warning signs (31.58%) and lymphomas were most represented (52.63%). There was a significant association between warning signs and diagnosis (p value <0.001).Conclusions: Present results are grossly similar to those of other African authors. Present results are distinguished by a low proportion of chronic myeloid leukemia and a very low proportion of chronic lymphocytic leukemia compared to literature data. The effectiveness of the cancer registry will allow us to improve the knowledge about frequency and current distribution of cancer in Madagascar.

Eosinophilic Granulomatosis with Polyangiitis: Experiences in Korean Patients

Eosinophilic granulomatosis with polyangiitis (EGPA) is one form of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis. Identical to what has been called Churg-Strauss syndrome, EGPA exhibits both allergic and vasculitis features. EGPA was first described as a syndrome consisting of asthma, fever, eosinophilia, and organ involvement including heart failure, neuropathy, and kidney damage, by Churg and Strauss in 1951. On the basis of the 2012 Chapel Hill Consensus Conferences Nomenclature of Vasculitis, EGPA comprises three typical allergic components, including asthma, peripheral eosinophilia, and eosinophil-rich granuloma of the respiratory tracts. EGPA has three clinical and histological stages. The first is an allergic stage composed of asthma and sinusitis, and the second is an eosinophilic stage characterised by peripheral hypereosinophilia and intra-organ infiltration of eosinophils. The last is a vasculitic stage, including necrotising inflammation of small vessels and end-organ damage. In this review, we describe the classification criteria for EGPA and recommendations for the evaluation and management of EGPA with conventional and newly suggested drugs for EGPA. Also, we discuss a variety of clinical aspects such as predictive values for prognosis and associations with other Th2-mediated diseases and hepatitis B virus.

Yellow fever

Summary The yellow fever (YF) virus is a Flavivirus, transmitted by Haemagogus, Sabethes or Aedes aegypti mosquitoes. The disease is endemic in forest areas in Africa and Latin America leading to epizootics in monkeys that constitute the reservoir of the disease. There are two forms of YF: sylvatic, transmitted accidentally when approaching the forests, and urban, which can be perpetuated by Aedes aegypti. In Brazil, the last case of urban YF occurred in 1942. Since then, there has been an expansion of transmission areas from the North and Midwest regions to the South and Southeast. In 2017, the country faced an important outbreak of the disease mainly in the states of Minas Gerais, Espírito Santo and Rio de Janeiro. In 2018, its reach extended from Minas Gerais toward São Paulo. Yellow fever has an incubation period of 3 to 6 days and sudden onset of symptoms with high fever, myalgia, headache, nausea/vomiting and increased transaminases. The disease ranges from asymptomatic to severe forms. The most serious forms occur in around 15% of those infected, with high lethality rates. These forms lead to renal, hepatic and neurological impairment, and bleeding episodes. Treatment of mild and moderate forms is symptomatic, while severe and malignant forms depend on intensive care. Prevention is achieved by administering the vaccine, which is an effective (immunogenicity at 90-98%) and safe (0.4 severe events per 100,000 doses) measure. In 2018, the first transplants in the world due to YF were performed. There is also an attempt to evaluate the use of active drugs against the virus in order to reduce disease severity.

Aspectos clínicos e radiográficos das lesões endo-periodontais: uma revisão de literatura / Clinical and radiographic aspects of endo-periodontal lesion: a literature review

O objetivo dessa revisão de literatura é apresentar aspectos clínicos e radiográficos das lesões endo-periodontais. Por meio de busca na plataforma PUBMED, foi selecionando artigos de 2008 até 12/2017, em língua inglesa, com os termos: "clinical aspect endo-periodontal" E/OU "lesion endo-periodontal" E/OU "radiology". Características de cada tipo de lesão: 1. Lesão endodôntica primária: polpa necrótica, abcesso periapical, drenagem pelo ligamento periodontal, destruição óssea é geralmente estreita e sem amplitude. 2. Lesão endodôntica primária com envolvimento periodontal secundário: endodôntica primeiramente se não tratada leva um envolvimento secundário periodontal; bactérias na região gengival, cálculo, progressão de periodontites, presença de pinos soltos ou perfurações, dor, pus e inchaço; aspecto radiográfico é radiolucência periapical e lateral. 3. Lesão periodontal primária: não se restringe à um dente, é generalizada, vitalidade pulpar, lesão progressiva no sentido do apical, mais larga na margem gengival do que apical, trauma oclusal ou não, progressão de periodontites em direção apical; radiologicamente, apresenta anomalias periodontais podendo chegar até o ápice. 4. Havendo retro-infecção do tecido pulpar, com forte dor que será uma lesão periodontal primária com envolvimento endodôntico secundário: envolvimento pulpar, periodontites, bactérias específicas associada à lesão periodontal; radiograficamente pode haver a presença de calculo nos canais lateriais/ forame apical. 5. Lesões combinadas verdadeiras: lesões periodontais e endodônticas que se comunicam, presença de biofilme; radiograficamente presença de lesão periapical e defeito ósseo regular na superfície radicular, aspecto de fratura vertical. Portanto, lesões endo-periodontais necessitam de conhecimento clínico e radiográfico para se estabelecer um adequado diagnóstico e tratamento (AU)

The objective of this literature review is to present clinical and radiographic aspects of the endo-periodontal lesions. By means of means of search in the PUBMED platform, articles from 2008 to 12/2017, in english, were selected with the terms: "clinical aspect endo-periodontal" AND/OR "endoperiodontal lesion" AND/OR "radiology". Characteristics of each type of lesion: 1. Primary endodontic lesion: necrotic pulp, periapical abscess, drainage by periodontal ligament, bone destruction and generally narrow and without amplitude. 2. Primary endodontic lesion with secondary periodontal involvement: first untreated endodontic leads to secondary periodontal involvement; bacteria in the gingival region, calculus, progression of periodontitis, presence of loose pins or perforations, pain, pus and swelling; radiographic appearance and periapical and lateral radiolucency. 3. Primary periodontal lesion: it is not restricted to a tooth, it is generalized, pulp vitality, progressive lesion towards the apical, wider at the gingival margin than apical, occlusal trauma or not, progression of periodontites towards the apical; radiologically, it presents periodontal anomalies and can reach the apex. 4. There being retro-infection of the pulp tissue, with severe pain that will be a primary periodontal disease with secondary endodontic involvement: pulp involvement, periodontitis, specific bacteria associated with periodontal lesion; radiographically there mays be a presence of calculus in the lateral channels/ apical foramen. 5. True combined lesions: periodontal and endodontic lesions that communicate, presence of biofilm; radiographically presence of periapical lesion and regular bone defect on the root surface, aspect of vertical fracture. Thus, endo-periodontals require clinical and radiographic knowledge to establish a diagnosis and treatment. (AU)

Aspects cliniques de la maladie de Stargardt: cas d'une atteinte familiale / NA

La maladie de Stargardt est la plus connue des dystrophies maculaires juvéniles. Encore appelé fundus flavimaculatus, elle est une dystrophie maculaire héréditaire qui se transmet souvent sur un mode autosomique récessif et rarement sur un mode autosomique dominant. Elle est typiquement caractérisée par une déficience de la vision centrale, qui se manifeste autour de la première et ou de la deuxième décennie de la vie. Nous présentons les cas de deux frères et une soeur atteints de la maladie. La présentation, le diagnostic et les modalités thérapeutiques sont discutés.

Stargardt's disease is the best known of juvenile macular dystrophies. Also called fundus flavimaculatus, it is an inherited macular dystrophy that is often transmitted in an autosomal recessive fashion and rarely in an autosomal dominant mode. It is typically characterized by a deficiency of central vision, which manifests itself around the first and / or second decade of life. We present the cases of two brothers and one sister with the disease. Presentation, diagnosis and therapeutic modalities are discussed.

Chikungunya virus: clinical aspects and treatment: a review

Chikungunya is a severe and debilitating disease. Currently, Brazil is experiencing an epidemic caused by three arboviruses, which has changed the way health professionals have diagnosed and treated infected patients. The difficulty of diagnosis and the lack of a protocol for patient treatment, which fits Brazilian health system models, have made it difficult to manage this disease. It is necessary to implement a multidisciplinary network of patient care, in which primary care units play the main role. This review aims to present current information regarding the clinical aspects and treatment of Chikungunya virus infection.

Sobre os aspectos clínicos e a complexidade do trabalho: as clínicas do trabalho compreendidas pela perspectiva da Psicossociologia / On the clinical aspects and the complexity of the work: the clinics of work understood by psychosociologycal perspective

O surgimento das denominadas "Clínicas do Trabalho" como um agrupamento de campos metodológicos ­ evidenciados por uma perspectiva clínica de análise da complexidade das relações de trabalho e de compreensão da interação entre questões subjetivas e organizacionais do trabalho ­ aponta também para a leitura "ampliada" e multifacetada inerente à psicologia do trabalho atual. Embora não constituam uma escola única de pensamento, as Clínicas do Trabalho compartilham posicionamentos críticos frente às problemáticas que envolvem a intricada relação entre subjetividade e trabalho, tendo como principais interesses suas dimensões simbólicas e culturais, inerentes às vinculações interpessoais, e a questão da atividade no trabalho (i.e., ação e poder de ação do sujeito na situação de trabalho). A pesquisa, que atrela os recortes social e clínico, extrapola a definição mais técnica ou formal de trabalho, emprestando a ela a ideia de implicação subjetiva bem como de construção de significados e sentidos protagonizados pelo sujeito em situação, considerado essencialmente em sua dimensão histórica e como ator social; suas propostas de intervenção vêm conjuntamente, nesta mesma perspectiva, e buscam a construção de um saber inerente à realidade do trabalho, inseparável da experiência de onde emerge e dos sujeitos que a constroem ­ pautando tal compreensão justamente pela complexidade da situação, junto de seus conflitos, dificuldades e questionamentos. Neste artigo, buscamos discutir algumas características fundamentais desta perspectiva metodológica voltada às questões do trabalho a partir das contribuições da Psicossociologia francesa

The appearing of so-called "Clinics of Work" as a grouping of methodological fields ­ evidenced by a clinical perspective to analyze the complexity of labor relations and understanding the interaction between subjective and organizational labor issues ­ also points to this "enlarged" and multifaceted understanding inherent in the actual Work psychology. Although they do not constitute a single school of thought, those Clinics of Work share critical positions regarding the problems that involve the intricate relationship between subjectivity and work, having as main interests their symbolic and cultural dimensions, inherent in interpersonal connections, and the question of the activity in the work (ie, action and power of action of the subject in the work situation). The research, which links the social and clinical aspects, goes beyond the more technical or formal definition of work, lending it the idea of subjective implication, as well as the construction of meanings carried out by the subject in situation, considered essentially in its historical dimension and as a social actor; their proposals for intervention come together in this same perspective and seek to construct a knowledge inherent in the reality of work, inseparable from the experience from which it emerges and from the subjects who construct it ­ setting out its understanding precisely in the complexity of the situation, with its conflicts, difficulties and questions. In this article, we intend to discuss some fundamental characteristics of this methodological perspective focused on the issues of work, from the contributions of the french Psychosociology

Glycogen storage disease type I: clinical and laboratory profile / Doença de depósito de glicogênio tipo I: perfil clínico e laboratorial

OBJECTIVES: To characterize the clinical, laboratory, and anthropometric profile of a sample of Brazilian patients with glycogen storage disease type I managed at an outpatient referral clinic for inborn errors of metabolism. METHODS: This was a cross-sectional outpatient study based on a convenience sampling strategy. Data on diagnosis, management, anthropometric parameters, and follow-up were assessed. RESULTS: Twenty-one patients were included (median age 10 years, range 1-25 years), all using uncooked cornstarch therapy. Median age at diagnosis was 7 months (range, 1-132 months), and 19 patients underwent liver biopsy for diagnostic confirmation. Overweight, short stature, hepatomegaly, and liver nodules were present in 16 of 21, four of 21, nine of 14, and three of 14 patients, respectively. A correlation was found between height-for-age and BMI-for-age Z-scores (r = 0.561; p = 0.008). CONCLUSIONS: Diagnosis of glycogen storage disease type I is delayed in Brazil. Most patients undergo liver biopsy for diagnostic confirmation, even though the combination of a characteristic clinical presentation and molecular methods can provide a definitive diagnosis in a less invasive manner. Obesity is a side effect of cornstarch therapy, and appears to be associated with growth in these patients. .

OBJETIVOS: Caracterizar o perfil clínico, laboratorial e antropométrico de uma amostra de pacientes brasileiros com doença de depósito de glicogênio tipo I tratados em um ambulatório de referência para erros inatos do metabolismo. MÉTODOS: Este foi um estudo ambulatorial transversal com base em uma estratégia de amostragem de conveniência. Foram avaliados os dados com relação ao diagnóstico, tratamento, parâmetros antropométricos e acompanhamento. RESULTADOS: Foram incluídos 21 pacientes (idade média de 10 anos, faixa 1-25 anos de idade), e todos se encontravam em terapia de amido de milho cru. A idade média na época do diagnóstico foi de sete meses (faixa, 1-32 meses), e 19 pacientes foram submetidos a biópsia hepática para confirmação do diagnóstico. Sobrepeso, baixa estatura, hepatomegalia e nódulos hepáticos foram fatores presentes em 16 de 21, quatro de 21, nove de 14 e três de 14 pacientes, respectivamente. Foi encontrada uma correlação entre os escores z para peso para idade e IMC para idade (r = 0,561; p = 0,008). CONCLUSÕES: O diagnóstico da doença de depósito de glicogênio tipo I tem sido tardio no Brasil. A maioria dos pacientes foi submetida a confirmação do diagnóstico, apesar de o quadro clínico característico e os métodos moleculares poderem fornecer um diagnóstico definitivo de forma menos invasiva. Obesidade é um efeito colateral da terapia com amido de milho e parece estar associada a crescimento nesses pacientes. .

Morphology of the cement-enamel junction (CEJ), clinical correlations / Morfología de la unión amelo-cementaria (UAC), correlaciones clínicas

The following study describes the mineralized tissue distribution which composes the cement-enamel junction, in a simple of Chilean people, comparing several teeth surfaces. Cervical area was observed (M-V, D-V, M-L/P, D-L/P sites) from 136 (n=68) longitudinal sections on premolars and incisors, with orthodontic or prosthetic reasons for exodontia, which were analyzed by optical microscope in order to identify the type of cement-enamel junction. For that measurement it was Choquet's criteria, founding four types: 1) cement over enamel, 2) enamel over cement, 3) vis a vis, 4) Gap presence between enamel, cement and exposed dentin. The objective of this study was to determine the prevalence of these. As result, it was observed that there was no association between tooth surface and Choquet's classification; however that association was observed while comparing the type of tooth and the relationship with mineralized tissues at the CEJ. So, incisors were associated with class 1 and premolars with class 3 of Choquet. Class 3 prevalence is the most frequently observed in the sample size (51.9 percent), following class 1 (42.4 percent), class 4 (4.4 percent), and class 2 with the lower prevalence on the sample (1.5 percent). Because this region is fragile and highly susceptible to pathological changes and from the external environment, it must be carefully handled during clinical procedures such as teeth whitening, orthodontics, restorations, root scaling and clamp placement.

Se describe la distribución de los tejidos mineralizados que componen la unión amelocementaria de una muestra de la población chilena, con respecto a distintos dientes y distintas caras de éste. Se observó la región cervical (zona M-V, D-V, M-L/P, D- L/P) de 136 (n=68) secciones longitudinales de premolares e incisivos, con indicación de extracción por razones ortodónticas o protésica, los cuales fueron analizadas mediante lupa estereoscópica para identificar el tipo de relación cemento-esmalte. Fue utilizada para dicha observación los criterios de Choquet; así se observaron cuatro tipos: 1) Cemento sobre esmalte; 2) Esmalte sobre cemento; 3) Bis a bis y 4) Presencia de brecha entre el esmalte y cemento con la dentina expuesta. Se observó que no existía asociación entre caras del diente y la clasificación de Choquet, en cambio sí existió dicha asociación entre el tipo de diente y la relación de los tejidos mineralizados en la UAC. De esta manera, los incisivos se asocian con la clase 1 y los premolares con la clase 3 de Choquet. En cuanto a la prevalencia, la clase 3 era la más frecuente en el total de la muestra (51,9 por ciento) seguido de la clase 1 (42,2 por ciento), de la clase 4 (4,4 por ciento) y la clase 2 fue observada en una pequeña proporción de la muestra (1,5 por ciento). Debido a que esta región es frágil y altamente susceptible a cambios patológicos y del medio externo debe ser manejada cuidadosamente durante procedimientos clínicos como el blanqueamiento dental, tratamiento de ortodoncia, restauración, destartraje o colocación de clamps.

HbA1c: A Review of Analytical and Clinical Aspects

After the relationship between glycemic control and the HbA1c concentration was demonstrated, many tests have been developed to determine the HbA1c concentration. The test results are standardized to the International Federation of Clinical Chemistry (IFCC) Reference Measurement Procedure (RMP) in harmony with the efforts of the National Glycohemoglobin Standardization Program (NGSP). The longitudinal use of the test requires strict quality management including accreditation of the laboratory, a dedicated internal control design, participation in an external quality assessment (EQA) program (proficiency test), and careful consideration of pre- and post-analytical aspects of the test. Performance goals for optimizing determination of the HbA1c concentration have been described. As an index of long-term glycemic control and a risk predictor, the HbA1c concentration is an indispensable part of routine management of diabetes. Because of the improving quality of the test, the HbA1c concentration is being increasingly applied in the diagnosis of diabetes. There are, however, concerns of this application in point-of-care settings. The HbA1c concentration is also used to achieve stringent control in pregnant diabetic patients. Strict standardization enables the definition of universal reference values and clinical decision limits. This review describes the present status of analytical and clinical aspects of determining the HbA1c concentration and highlights the challenges involved.

Infecções pelo vírus linfotrópico humano (HTLV) / Infections by human lymphotropic virus (HTLV)

No presente artigo são revistos os aspectos clínicos das infecções pelo HTLV-I e HTLV-II.

In the present paper the clinical aspects of HTLV-I and HTLV-II infections are reviewed.

Histoplasmosis diseminada progresiva en una cohorte de pacientes coinfectados con el VIH / Progressive disseminated histoplasmosis in a cohort of patients with HIV coinfection

Objetivo: identificar manifestaciones clínicas y métodos de laboratorio conducentes al diagnóstico de histoplasmosis diseminada progresiva (HDP), en una cohorte de pacientes coinfectados con el VIH. Diseño: análisis retrospectivo de historias clínicas. No intervención adicional. Pacientes: cuarenta pacientes con HDP e infección por VIH del Hospital La María, enero de 1992 a diciembre de 2008. Mediciones: datos demográficos, signos, síntomas y exámenes de laboratorio que permitieron el diagnóstico de HDP. Resultados: cuarenta pacientes, 34 hombres (85%), y seis mujeres (15%), con edades promedio de 33.4 y 27 años, respectivamente. En éstos predominaron: tos (77.5%), fiebre (90%) y anorexia con pérdida de peso en 92.5% y 77.4%, respectivamente. Lesiones en piel en 55% y en mucosa en 50%, crecimiento ganglionar en 62.5% y hepatomegalia en 52.5%. Menos frecuentes fueron disnea, esplenomegalia, vómito, diarrea y cefalea. Presentaron anemia el 85%, leucopenia el 52.5% y trombocitopenia el 30% de los pacientes. Exámenes micológicos: directo positivo en 21 muestras, de lavado broncoalveolar siete, piel seis, ganglio 12, biopsia transbronquial una y lesión de mucosa una. Se aisló H. capsulatum en todos los pacientes a partir de muestras de piel 10, ganglio 18, sangre tres, médula ósea una, lavado broncoalveolar (LBA) 10, y mucosa tres. Además, en siete pacientes, el hongo se aisló de más de un sitio anatómico. La serología realizada en 13 pacientes, se mostró reactiva en la inmunodifusión en gel de agar (IDGA) en 11 y en la fijación del complemento (FC) en 10. Conclusión: ante un cuadro clínico compatible con HDP en paciente con infección por VIH que presenta fiebre, pérdida del estado general, crecimiento ganglionar, compromiso medular y piel y mucosas, el laboratorio permitirá confirmar fácilmente el diagnóstico de la sospecha clínica de la entidad (Acta Med Colomb 2011; 36: 63-67).

Objective: to identify the clinical manifestations and laboratory methods leading to the diagnosis of progressive disseminated histoplasmosis (PDH) in a cohort of patients co-infected with HIV. Design: retrospective analysis of case histories. No further intervention. Patients: forty patients with PDH and HIV infection from Hospital La María. January 1992 to December 2008. Measurements: demographic data, signs and symptoms, and laboratory tests leading to the diagnosis of PDH. Results: 40 patients, 34 males (85%) and 6 females (15%), with mean ages of 33.4 and 27 years, respectively. The dominant symptoms were: cough (77.5%), fever (90%), and anorexia with weight loss in 92.5% and 77.4%, respectively. Skin lesions in 55% and mucosal lesions in 50%, enlargement of lymph nodes in 62.5%, and hepatomegaly in 52.5%. Less frequent manifestations were dyspnea, splenomegaly, vomiting, diarrhea, and headache. Anemia was found in 85%, leucopenia in 52.5%, and thrombocytopenia in 30% of the patients. Mycological tests: directly positive in 21 samples: bronchoalveolar lavage (7), skin (6), lymph node (12), transbronchial biopsy (1), and mucosal lesion (1). H. capsulatum was isolated in all patients from samples of: skin (10), lymph node (18), blood (3), bone marrow (1), bronchoalveolar lavage fluid (10), and mucosa (3). Moreover, the fungus was isolated in more than one anatomical site in 7 patients. Serology carried out in 13 patients was reactive on agar gel immunodifusion test in 11 cases and on complement fixation in 10 cases. Conclusion: in the face of a clinical picture consistent with PDH in a patient with HIV who presents with fever, constitutional symptoms, enlargement of lymph nodes, and involvement of the bone marrow, skin, and mucous membranes, laboratory testing allows easy confirmation of the clinically suspected condition (Acta Med Colomb 2011; 36: 63-67).