Reading of the Mitsuda test: comparison between diameter and total area by means of a computerized method.

The Mitsuda test is a skin test based on the individual's immune response through late and highly specific hypersensitivity reaction to the Mycobacterium leprae bacillus. A negative reaction identifies individuals who present a higher risk of becoming ill if exposed to M. leprae and, if they become ill, to develop the virchowian form of disease. The Mitsuda test reading is performed by means of a millimeter ruler. The dermatoscopy is a method that has not been used in the evaluation of cutaneous tests, although its use has increased in several areas. The study aimed to compare the results between the standardized reading and the total area of the Mitsuda test obtained by a computerized method which was structured by the association of digital dermatoscopy, the Dermatology Web system and the Image Tool 3.0 software. Data collection was performed at the Dermatology Outpatient Clinic of the Eduardo de Menezes Hospital, in Belo Horizonte, from November 2015 to August 2016. The sample consisted of 100 leprosy domiciliary contacts. There was an excellent agreement between the Mitsuda test (diameter and area), with a coefficient greater than 80%, and an excellent correlation with the Spearman's correlation coefficient (0.936). The intraclass correlation coefficient indicated a low (0.219) but significant agreement between the two measurements. In conclusion, there is a significant correlation between the standardized reading and the total area of the Mitsuda test. Digital dermoscopy can be an alternative instrument of evaluation, allowing the computerization and recording of the Mitsuda test.

Deep Venous Thrombosis in Patients with Erythema Nodosum Leprosum in the Use of Thalidomide and Systemic Corticosteroid in Reference Service in Belo Horizonte, Minas Gerais.

INTRODUCTION: Erythema nodosum leprosum (ENL) is a type of lepra reaction treated with corticosteroids and thalidomide, but this association increases the risk of deep venous thrombosis (DVT). OBJECTIVE: To report cases of ENL with DVT in the use of thalidomide/corticosteroid associated. METHODOLOGY: The study was conducted between December 2015 and December 2016 at the Eduardo de Menezes Hospital (HEM-FHEMIG). RESULTS: A clinical case series of 16 patients, eight from HEM-FHEMIG and eight from the literature. DVT occurred on 4 continents, mainly in adults and men. All patients were multibacillary; four people had pulmonary embolism (PE); there were 11 unilateral and five bilateral DVT cases; 12 cases were proximal, two distal, and two unspecified. Pharmacological thromboprophylaxis was used on two individuals. Outcome after DVT, 14 patients improved, one had sequelae, and one died. DISCUSSION: DVT increased in association with thalidomide/corticosteroid in multiple myeloma, but this complication is poorly described in ENL. In proximal DVT, there was a greater risk of PE and sequelae venous insufficiency. After DVT, start anticoagulation. ASA 100mg/day as prophylaxis for DVT in case of this drug association in ENL is recommended. CONCLUSION: The article illustrates the incidence increase of DVT because of the thalidomide/corticosteroid combination in ENL. When this association is necessary, use ASA 100mg/day as prophylaxis.

Ischemia-reperfusion histopathology alterations of the rabbit intestinal wall with and without exclusion of the collateral mesenteric circulation supply.

PURPOSE: To evaluate the histopathology alterations of the intestinal mucosa of rabbits submitted to different times of mesenteric artery ischemia and reperfusion with and without celiac artery collateral circulation supply. METHODS: Two groups of eight male New Zealand white rabbits (weight 2.2-3.5 kg) were used in this study. In the Group 1 animals, the proximal mesenteric artery was occluded for 60 min with an atraumatic vascular clamp, followed by reperfusion for 60 min. In the Group 2 animals the small bowel and mesentery were cut 30cm and 60cm far from the gastroduodenal pyloric transition before the proximal mesenteric artery occlusion. Small bowel biopsies were obtained before ischemia (control), after 30 min and 60 min of mesenteric ischemia and at 30 and 60 min. of mesenteric artery reperfusion. RESULTS: In the Group I animals, the followings histopathology grade results were observed: t1, mean 0.4 + 0.29; t2, mean 1.9 +/- 0.38; t3, 1.9 +/- 0.33; t4, 1.2 +/- 0.36 and t5, 1.2 +/- 0.32. Differences between t0 and t2 and between t3 and t4 were statistically significant (p<0.05). Differences between t2 and t3 and t4 and t5 were not significant (p>0.5). In the Group II animals, it was observed: t1, mean 1.6 +/- 0.33; t2, 2.4 +/- 0.36; t3, 3.0 +/- 0.35; t4 3.4 +/- 0.31; t5, 3 +/- 031. Differences between t0 and t1, t1 and t2, and t2 and t3 were significant (p<0.05). Differences between histopathology grades results of samples t1 to t5 in Group 1 and 2 were statistically significant (p<0.5). CONCLUSION: Microscopic examination of the biopsies revealed significant evidence of worse small bowel wall ischemia-reperfusion lesions by exclusion of the celiac artery collateral circulation supply.

Epidemiologia dos pacientes tratados no Hospital Risoleta Tolentino Neves de acordo com o tipo de atendimento pré-hospitalar / Epidemiology of patients treated at the Risoleta Tolentino Neves Hospital according to the type of pre-hospital care

O Hospital Risoleta Tolentino Neves (HRTN) é considerado uma referência em trauma em Belo Horizonte. Em 2010, 102.098 pacientes foram admitidos no Pronto-Socorro do HRTN e alocados em três grupos distintos (G1, G2 e G3), considerando-se o tipo de cuidado pré-hospitalar. Os dados foram estudados de acordo com os capítulos do CID-10. Objetivos: realizar análise epidemiológica do Pronto-Socorro do HRTN em 2010. Comparar características epidemiológicas de pacientes transportados por serviçosespecializados feitos por ambulâncias e por outras formas de transporte feitas por leigos, a fim de implementar um serviço de teleurgência para a integração do serviço pré-hospitalar com a assistência médica hospitalar. Material e métodos: este trabalho é o resultado de um estudo epidemiológico descritivo, individual, observacional e retrospectivo. Resultados: pacientes transportados por ambulância (G1) foram 7.191(7,4% do total). Os pacientes transportados informalmente por leigos da polícia (G2) foram 1.603 (1,57 % do total). Os demais pacientes transportados por leigos ou por conta própria (G3) totalizaram 93.304 indivíduos (91,38%). Casos de trauma representaram 72,22% do grupo G1, 60,06% do grupo G2 e 22,7% do grupo G3. Conclusão: este estudo reuniu dados epidemiológicos detalhados do Pronto-Socorro do HRTN em 2010 e associou com o atendimento pré-hospitalar. O conhecimento desses dados pode ser usado para melhorar o atendimento pré-hospitalar especializado e o transporte pré-hospitalar informal, além de integrar o atendimento pré-hospitalar ao hospitalar. A implantação de um serviço de teleurgência é fundamental para melhorar essa integração e para reduzir a mortalidade no trauma.

The Risoleta Tolentino Neves Hospital (RTNH) is considered a trauma reference hospital in Belo Horizonte. In 2010, 102,098 patients were admitted to the Emergency Room of the RTNH and allocated in three distinct groups (G1, G2, and G3) considering the type of pre-hospital care received. The data were studied according to the ICD-10 chapters. Objectives: to perform an epidemiological analysis of RTNH Emergency Room in 2010 and compare epidemiological characteristics of patients transported by specialized services provided by ambulances and by other forms of transportation, such as by laymen, to implement the tele-urgent service to integrate the prehospital service with hospital medical assistance. Material and methods: this study is the result of an epidemiological, descriptive, individual, observational, and retrospective study. Results: a total of 7,191 patients were transported by ambulance (G1) (7.4%). A total of 1,603 patients were transported informally by lay people from the police (G2) (1.57%). The remaining patients were transported by laymen or self (G3) and totaled 93,304 individuals (91.38%). Trauma cases accounted for 72.22% in G1, 60.06% in G2, and 22.7% in G3. Conclusion: this study gathered detailed epidemiological datain the RTNH Emergency Room in 2010 and analyzed its association with the pre-hospital care received. This knowledge can be used to improve specialized prehospital care and pre-hospital informal transportation, and integrate the pre-hospital with hospital care. The implementation of a tele urgent service is fundamental to improve this integration and reduce mortality in trauma.

Ischemia-reperfusion histopathology alterations of the rabbit intestinal wall with and without exclusion of the collateral mesenteric circulation supply / Alterações histopatológicas da parede intestinal de coelhos na isquemia-reperfusão com e sem exclusão da circulação mesentérica colateral

PURPOSE: To evaluate the histopathology alterations of the intestinal mucosa of rabbits submitted to different times of mesenteric artery ischemia and reperfusion with and without celiac artery collateral circulation supply. METHODS: Two groups of eight male New Zealand white rabbits (weight 2.2-3.5 kg) were used in this study. In the Group 1 animals, the proximal mesenteric artery was occluded for 60 min with an atraumatic vascular clamp, followed by reperfusion for 60 min. In the Group 2 animals the small bowel and mesentery were cut 30cm and 60cm far from the gastroduodenal pyloric transition before the proximal mesenteric artery occlusion. Small bowel biopsies were obtained before ischemia (control), after 30 min and 60 min of mesenteric ischemia and at 30 and 60 min. of mesenteric artery reperfusion. RESULTS: In the Group I animals, the followings histopathology grade results were observed: t1, mean 0.4 + 0.29; t2, mean 1.9 ± 0.38; t3, 1.9 ± 0.33; t4, 1.2 ± 0.36 and t5, 1.2 ± 0.32. Differences between t0 and t2 and between t3 and t4 were statistically significant (p<0.05). Differences between t2 and t3 and t4 and t5 were not significant (p>0.5). In the Group II animals, it was observed: t1, mean 1.6 ± 0.33; t2, 2.4 ± 0.36; t3, 3.0 ± 0.35; t4 3.4 ± 0.31; t5, 3 ± 031. Differences between t0 and t1, t1 and t2, and t2 and t3 were significant (p<0.05). Differences between histopathology grades results of samples t1 to t5 in Group 1 and 2 were statistically significant (p<0.5). CONCLUSION: Microscopic examination of the biopsies revealed significant evidence of worse small bowel wall ischemia-reperfusion lesions by exclusion of the celiac artery collateral circulation supply.

OBJETIVO: Avaliar as alterações histopatológicas da mucosa intestinal de coelhos submetidos à isquemia-reperfusão com e sem exclusão da circulação mesentérica colateral. MÉTODOS: Foram estudados dois grupos de oito coelhos Nova Zelândia machos com pesos variáveis entre 2,2 e 3,5 kg de peso corpóreo. Nos animais do Grupo 1, a artéria mesentérica proximal foi ocluida por pinçamento atraumático durante 60 min, seguido de reperfusão por 60 min. No Grupo 2 o intestino delgado e o mesentério foram seccionados 30 cm e 60 após a transição pilórica gastroduodenal antes da oclusão da artéria mesentérica cranial. Biópsias da parede intestinal foram obtidas antes da isquemia (controle), após 30 e 60 min. de isquemia. RESULTADOS: No Grupo I foram observados os seguintes graus de lesões: t1,média de 0.4 + 0.29; t2, média 1.9 ± 0.38; t3, 1.9 ± 0.33; t4, 1.2 ± 0.36 e t5, 1.2 ± 0.32. As diferenças entre t0 e t2 e entre t3 e t4 foram significantes (p<0.05). As diferenças entre t2 e t3 e t4 e t5 não foram significantes (p>0.5). No Group II observou-se: t1, média de 1.6 ± 0.33; t2, 2.4 ± 0.36; t3, 3.0 ± 0.35; t4 3.4 ± 0.31; t5, 3 ± 031. As diferenças entre t0 e t1, t1 e t2, e t2 e t3 foram significantes (p<0.05). As diferenças entre os resultados histopatológicos das biopsies de t1 a t5 dos Grupos 1 e 2 foram significantes (p<0.5). CONCLUSÃO: A exclusão da circulação mesentérica colateral agravou significantemente a degeneração histopatológica na isquemia-reperfusão da parede intestinal.

Coagulação intravascular disseminada na gravidez - considerações, diagnóstico e manejo / Disseminated intravascular coagulation in pregnancy - considerations, diagnosis and manegement

A Síndrome de Coagulação Intravascular Disseminada (CIVD) é caracterizada por alteração das vias de ativação e controle da coagulação sanguínea gerando acúmulos de fibrina na micro-vasculatura, com consumo de plaquetas e fatores de coagulação. Pode resultar em falência orgânica múltipla e sangramento anormal. A gravidez caracterizase por estado de hipercoagulabilidade e por complicações como descolamento prematuro de placenta, pré-eclâmpsia e síndrome HELLP que representam algumas das condições associadas à CIVD. Seu diagnóstico é feito baseado na suspeita clínica, conhecendo-se os fatores de risco associados e apoiando-se na propedêutica sugestiva de coagulopatia. A abordagem terapêutica consiste principalmente em tratar a anormalidade obstétrica de base. Mas podem ser necessárias as medidas de suporte e de reposição de elementos sanguíneos para a normalização da função hemostática. A CIVD, apesar de rara, figura como complicação obstétrica grave, que pode cursar com hemorragia intensa e levar a paciente ao óbito. Esta revisão propõe-se a sistematizar o conhecimento da CIVD para ajudar em seu manejo eficiente e estratégico.

Disseminated Intravascular Coagulation (DIC) is a syndrome characterized by altered activation and control of blood coagulation pathways causing accumulation of fibrin in the micro-vasculature, consumption of platelets and coagulation factors, which may result in organ failure and abnormal bleeding. Pregnancy is known to be a hypercoagulable state and complications such as placental abruption, pre-eclampsia and HELLP syndrome are some of the conditions associated to the onset of DIC. The diagnosis is based on clinical suspicion and investigation of associated risk factors and supported by lab tests results suggestive of coagulopathy. Primary therapeutic management includes addressing the underlying obstetric disorder. However, additional supportive treatment and blood transfusion may be necessary to repair haemostatic function. Therefore, despite its rare incidence, DIC figures as a very serious obstetric complication that can cause massive bleeding and lead to patient´s death. This review aims to systematize the knowledge of this entity to allow an efficient and strategic management.

Leucemia linfoblástica aguda diagnosticada na vigência de parto, simulando síndrome Hellp / Acute lymphoblastic leukemia diagnosed in delivery force, simulating Hellp syndrome

Este artigo relata a necessidade de realização de cesariana de emergência em paciente de 15 anos de idade, com 29 semanas de gestação, portadora de Leucemia linfoblástica aguda (LLA), pré-eclampsia e suspeita de síndrome HELLP. Possui a LLA baixa incidência durante a gravidez sendo, em geral, sua possibilidade diagnóstica pouco aventada. Neste relato, o diagnóstico de LLA não foi realizado de forma precoce no pré-natal, só tardiamente no pré-operatório da cesariana. A paciente evoluiu com instabilidade hemodinâmica, necessitando de terapia intensiva.

The ALL (acute lymphoblastic leukemia) is a disease with low incidence during pregnancy. This case report an emergency caesarean section in a patient of 15 years with 29 weeks of gestation, ALL, pré-eclâmpsia and suspect of HELLP Syndrome. It was difficult to diagnose ALL during prenatal and pre-operative period, which may be associated with low incidence of this disease during pregnancy. The patient developed hemodynamic instability, had to stay in the ICU and the ALL was diagnosed in the postoperative period. This study shows the differential diagnosis in ALL, the difficulties to the diagnosis, clinical reasoning and the therapeutic.