ABSTRACT
Lawsonella clevelandensis es un bacilo anaerobio Gram positivo, parcialmente ácido-alcohol resistente, perteneciente al orden Corynebacteriales y considerado comensal de la piel y la cavidad bucal. En los últimos años se han reportado escasos casos de infección por este microorganismo, generalmente en pacientes inmunosuprimidos, siendo la presentación clínica más común la generación de abscesos. El aislamiento de esta bacteria es difícil ya que no crece en los medios de cultivo tradicionales, por lo que su identificación requiere habitualmente del uso de biología molecular. Presentamos el caso de una paciente de 29 años con trasplante renal y empeoramiento progresivo de la función renal en contexto de una vasculitis pauciinmune con requerimiento de mayor inmunosupresión. En el laboratorio destacaba leucocituria asintomática, con urocultivo negativo, por lo que se realizaron 7 baciloscopias en orina, con resultados positivos en 3, pero con PCR de M. tuberculosis y cultivo de micobacterias negativo. Se realizó secuenciación del gen que codifica para el ARN 16s del ribosoma bacteriano a partir de una muestra de orina, obteniéndose una secuencia compatible con Lawsonella clevelandensis. Tras el resultado, se indicó terapia con amoxicilina-ácido clavulánico por 7 meses. A conocimiento de los autores, este es el duodécimo caso de infección por Lawsonella clevelandensis descrito en la literatura médica y el primero que reporta el aislamiento del patógeno en la orina.
Lawsonella clevelandensis is a gram-positive anaerobic bacillus, partially acid-fast, belonging to the order Corynebacteriales and is considered commensal of the skin and oral cavity. In recent years, few cases of infection by this microorganism have been reported, generally in immunosuppressed patients, with the most reported clinical presentation being the generation of abscesses. The isolation of this bacterium is difficult since it does not grow in traditional cultures, so its identification usually requires the use of molecular biology. We present the case of a 29-year-old patient with a kidney transplant and progressive worsening of kidney function in the context of a pauci-immune vasculitis which required greater immunosuppression. During the investigation, it was identified an asymptomatic leukocyturia, with a negative urine culture, for which six urine smear microscopy tests were performed of which 3 were positive, but with a negative Koch culture. Sequencing of the gene that codes for the 16s RNA of the bacterial ribosome was performed from a urine sample, obtaining a sequence compatible with Lawsonella clevelandensis. After the result, therapy with amoxicillin-clavulanic acid was indicated with resolution of the leukocyturia and negative smear microscopy, and immunosuppression could be indicated without inconvenience. To the authors' knowledge, this is the twelfth case of Lawsonella clevelandensis infection described in the medical literature in the world and the first to report the isolation of the pathogen in urine.
Subject(s)
Humans , Male , Adult , Kidney Transplantation/adverse effects , Latin America , Anti-Bacterial Agents/therapeutic useABSTRACT
La intoxicación humana por rodenticidas anticoagulantes de acción prolongada, conocidos como superwarfarinas, provoca coagulopatía de prolongado manejo. Presentamos el caso de un hombre de 42 años que ingirió una dosis tóxica de rodenticida en un intento suicida, evolucionando con epistaxis, INR de 11,6 y necesidad de hospitalización. Durante 7 días se realizaron controles seriados de pruebas de coagulación, con optimización de diferentes dosis de suplementación de Vitamina K. El caso destaca la potencia y vida media prolongada (aproximadamente 6 semanas) de este tipo de anticoagulantes, hecho que requiere un control clínico regular y una adherencia al tratamiento satisfactoria.
Human intoxication by long-acting anticoagulant rodenticides, known as superwarfarins, causes coagulopathy that is difficult to manage. We present the case of a 42-year-old man who ingested a toxic dose of rodenticide in a suicide attempt, evolving with epistaxis, INR of 11.6, and needing hospitalization. For seven days, serial controls of coagulation tests were carried out, with optimization of different doses of Vitamin K supplementation. The case highlights this type of anticoagulant's potency and prolonged half-life (approximately six weeks), which requires regular clinical control and satisfactory treatment adherence.
Subject(s)
Humans , Male , Adult , Rodenticides/poisoning , Suicide, Attempted , Anticoagulants/poisoning , Vitamin K/therapeutic use , 4-Hydroxycoumarins/poisoningABSTRACT
Resumo A premissa de que todo ser humano é vulnerável por natureza advém da noção de vulnerabilidade enquanto suscetibilidade ao dano, assim como da inter-relação e interdependência intrínseca do ser humano com seu contexto socioambiental, cabendo à sociedade estabelecer instituições capazes de promover tanto a proteção quanto a autonomia das pessoas, em equidade de condições. Para além do dever profissional de informar benefícios e malefícios das intervenções possíveis, incluindo as consequências de negar qualquer intervenção, o cuidado centrado no paciente integra uma abordagem colaborativa que considera fundamental a tomada de decisão compartilhada. A partir de uma revisão teórica, neste artigo analisa-se o conceito de vulnerabilidade e sua relação com o respeito e a promoção dos direitos humanos dos pacientes, propondo e justificando a tomada de decisão compartilhada no que se refere a uma boa estratégia de mitigação de vulnerabilidades acrescidas.
Abstract The premise that every human being is vulnerable by nature stems from the notion of vulnerability as susceptibility to harm, as well as the interrelations and intrinsic interdependence of human beings with their socio-environmental context. It is up to society to establish institutions capable of promoting both the protection and autonomy, under equal conditions. Besides the professional duty to inform patients of the benefits and harms from possible interventions, including the consequences of denying any intervention, patient-centered care integrates a collaborative approach that considers shared decision-making essential. This theoretical review analyzes the concept of vulnerability and its relations with respect for and promotion of patient rights, proposing and justifying shared decision-making as a good strategy for mitigating increased vulnerabilities.
Resumen La premisa de que todo ser humano es vulnerable por naturaleza parte de la noción de vulnerabilidad como susceptibilidad al daño, así como de la interrelación e interdependencia intrínseca del ser humano con su contexto socioambiental, y a la sociedad le corresponde establecer instituciones capaces de promover tanto la protección como la autonomía de las personas en igualdad de condiciones. Además del deber profesional de informar de los beneficios y perjuicios de las posibles intervenciones, incluyendo las consecuencias de negar cualquier intervención, la atención centrada en el paciente integra un enfoque colaborativo que considera fundamental la toma de decisiones compartida. A partir de una revisión teórica, este artículo analiza el concepto de vulnerabilidad y su relación con el respeto y la promoción de los derechos humanos de los pacientes, proponiendo y justificando la toma de decisiones compartida como una buena estrategia para mitigar el aumento de las vulnerabilidades.
Subject(s)
BioethicsABSTRACT
To measure the prevalence of Molar Incisor Hypomineralization (MIH), its severity and association with dental caries among public school children from Belém/PA, Brazil.Material and Methods:This is a cross-sectional study conducted with children enrolled in three public schools of Belém, which were selected by simple random sampling. MIH diagnosis was carried out according tocriteria of the European Academy of Pediatric Dentistry.Results:Among the 260 students that met the inclusion criteria, 56.92% were male and 43.07% female. The average age was 10.22 years. Of these, 8.84% (n = 23) had MIH, but there was no statistically significant difference in this prevalence between sexes (p = 0.6244). The most affected teeth were the upper first permanent molars, followed by lower first permanent molars and upper permanent central incisors. About 43.48% of students had at least one tooth with severe defect in enamel and 30.43% of students with MIH presented dental caries in the affected teeth. Conclusion:Severe MIH was not the most prevalent among schoolchildren, but the relationship with dental caries found demonstrates the importance of knowledge about diagnosis and treatment of enamel defects, which should be part of promotion and prevention actions in oral health due to its epidemiological impact in the demographic change of dental caries...
Subject(s)
Humans , Male , Female , Child , Child , Dental Caries/prevention & control , Molar/anatomy & histology , Tooth Demineralization/etiology , Dental Enamel , Incisor , Oral Health/education , Brazil , Cross-Sectional Studies , PrevalenceABSTRACT
Leveduras do gênero Candida são comuns na cavidade bucal e podem causar candidose na presença de fatores predisponentes, especialmente em paciente diabético, o qual é caracterizado por um aumento anormal da glicose no sangue. A manifestação da doença está relacionada a este conjunto de fatores locais, tais como a presença de próteses dentárias, pH salivar, fluxo salivar e tabaco. A redução da saliva é um dos principais fatores de risco para o aparecimento de infecção e o controle glicêmico inadequado causado por diabetes, em associação com todos estes fatores, pode aumentar a incidência de infecções. Os objetivos deste estudo foram: 1) isolar e identificar cepas de Candida albicans da mucosa bucal de pacientes diabéticos 2) avaliar os fatores de virulência: proteinase e fosfolipase. Amostras microbiológicas foram coletadas a partir de locais da mucosa bucal e semeadas em CHROMagar para posterior identificação de C. albicans por PCR. Foram realizados testes da atividade de proteinase e fosfolipase para todos os isolados de C. albicans. Neste estudo, 22 isolados foram identificados como C. albicans. Em relação às atividades de proteinases, todas as cepas de C. albicans foram capazes de produzir proteinase, enquanto que para fosfolipase, apenas 4,5% dos isolados não produziram esta exoenzima. Portanto, C. albicans presente na cavidade bucal de pacientes diabéticos tem potencial patogênico e pode participar de processos infecciosos e inflamatórios, causando lesões e invadindo os tecidos orais.
Candida yeasts are common in the oral cavity and can cause candidosis in the presence of predisposing factors, especially diabetes, which is characterized by an abnormal increasing in blood glucose concentration. The manifestation of the disease is related to a set of local factors such as the presence of dental prostheses, salivary pH, salivary flow and tobacco. The reduction in saliva is a major risk factor for the onset of infection and poor glycemic control caused by diabetes in association with all these factors further increases the incidence of candidosis. The objectives of this study were: 1) to isolate and identify Candida albicans strains from oral mucosa sites of diabetic patients 2) to evaluate the virulence factors: proteinase and phospholipase. Thus, microbial samples were collected from oral mucosa sites and seeded in CHROMagar for subsequent identification of C. albicans by PCR. For the phenotypic tests, all strains of C. albicans were evaluated for their proteinase and phospholipase productions. In this study, 22 isolates were identified as C. albicans. In regard to the proteinase activities, all strains of C. albicans were able to produce proteinase, while only 4.5% from those isolates were not able to produce phospholipase activity. In conclusion, C. albicans present in the oral cavity of diabetic patients is potentially pathogenic and can participate in infectious and inflammatory processes, causing injury and invading oral tissues.