A Brazilian male with typical oral and pulmonary paracoccidioidomycosis.

An autochthonous case of paracoccidioidomycosis was reported in a city of north Iran. This condition is a well-known endemic fungal infection highly prevalent in Latin American countries, with an incidence of 1 to 3.7 cases per 100.000 annually in Brazil. The classical features are cutaneous lesions, lymph node, and pulmonary involvements, while typical oral changes are superficial ulcers with hemorrhage and moriform aspect. Herein is reported an adult male patient with characteristic oral and pulmonary lesions. Rural environment, male gender, cigarette smoking, and alcohol abuse were risk factors; and clinical history, imaging studies, and histopathologic data established the diagnosis. The patient improved well by administration of sulfamethoxazole plus trimethoprim. The aim of this case study is to enhance the awareness of generalists about this mycosis.

Effectiveness of a resistance exercise program for lower limbs in chronic renal patients on hemodialysis: A randomized controlled trial.

INTRODUCTION: Physical inactivity in hemodialysis patients is associated with increased mortality. The objective of this study was evaluated the effect of an intradialytic resistance exercise program on chronic kidney disease (CKD) patients on hemodialysis. METHODS: One hundred seven patients were included in the study. They were aged 18-60 years, of both sexes, had undergone hemodialysis treatment for at least 1 year, sedentary. Patients were randomly divided into two groups: stretching (STG) and resistance exercise (REG). Intervention programs were performed for 8 weeks, three times a week. The evaluations were performed before and after the training programs. The primary outcome was functional capacity using the 6-minute walk test (6MWT). Secondary outcomes were peripheral muscle strength, respiratory muscle strength, spirometric respiratory function, and laboratory data. FINDINGS: Comparisons between groups revealed the following clinically relevant results in favor of REG: lower limb muscle strength (mean difference [MD] = -1.99, 95% confidence interval [CI] = -2.77 to -1.21; d = -0.53), distance walked in the 6MWT (MD = -26.27, 95% CI = -45.40 to -7.14; d = -0.46), creatinine (MD = -1.52, 95% CI = -2.49 to -0.54; d = -0.66), and calcium (MD = -0.44, 95% CI = -0.78 to -0.10; d = -0.49). DISCUSSION: CKD patients on hemodialysis have reduced functional capacity compared to healthy sedentary individuals. In turn, this reduction appears to be associated with a lower survival rate and affects the performance of their daily living activities. Thus, resistance exercise performed in the intradialytic phase is an effective therapeutic strategy for CKD patients, mainly because it increases functional capacity and lower limb muscle strength.

Mycobacterium abscessus urinary tract infection: case report.

Urinary tract infection is a serious public health issue that predominantly affects women. In men, it is more often associated with prostatic hyperplasia and bladder catheterization. Urogenital tuberculosis presents with nonspecific with nonspecific symptoms and the diagnosis can be made in the presence of sterile leukocyturia and recurrent infection with acid urine. Non-tuberculous mycobacteria or other non-tuberculosis mycobacteria are opportunistic pathogens that inhabit the soil, water or environment surfaces, and usually cause diseases in immunocompromised individuals. Mycobacterium abscessus is an agent that causes lung, skin and soft tissue hospital infections. Urinary tract infections by this pathogen are rare.

Acute kidney injury diagnosis in Intensive Care Units: biomarkers or Information?

In recent years, the diagnosis of acute kidney injury (AKI) has been based on classifications such as RIFLE, AKIN and KDIGO, which has the goal of world standardization and timely recognition of the disease. It is essential that intensivists be aware about these classifications, because most of the time, they will have the first opportunity to diagnose AKI. However, it is still very common that the nephrologist consultation be performed in advanced stages of the AKI, when the interventions to halt the progression are very limited. We recently assessed intensivist on AKI diagnostic criteria, with emphasis on RIFLE, and observed a very low level of knowledge and lack of use in daily practice. Faced with the constant search for new biomarkers of kidney injury, these and other evidences, highlights the urgency of simple actions, such as the beginning of educational interventions in order to familiarize the intensivist with the latest clinical tools for AKI diagnosis.

Mycobacterium abscessus urinary tract infection: case report / Infecção urinária por Mycobacterium abscessus: relato de caso

Abstract Urinary tract infection is a serious public health issue that predominantly affects women. In men, it is more often associated with prostatic hyperplasia and bladder catheterization. Urogenital tuberculosis presents with nonspecific with nonspecific symptoms and the diagnosis can be made in the presence of sterile leukocyturia and recurrent infection with acid urine. Non-tuberculous mycobacteria or other non-tuberculosis mycobacteria are opportunistic pathogens that inhabit the soil, water or environment surfaces, and usually cause diseases in immunocompromised individuals. Mycobacterium abscessus is an agent that causes lung, skin and soft tissue hospital infections. Urinary tract infections by this pathogen are rare.

Resumo Infecção do trato urinário é um sério problema de saúde pública que acomete predominantemente as mulheres. Em homens, está mais relacionada com hiperplasia prostática e cateterismo vesical. A tuberculose urogenital cursa com sintomas inespecíficos e o diagnóstico pode ser aventado na presença de leucocitúria estéril, e infecção recorrente com urina ácida. Micobactérias não tuberculosas ou mycobacteria other than tuberculosis são patógenos oportunistas que habitam o solo, a água ou superfícies do meio ambiente, e geralmente causam doenças em imunodeprimidos. Mycobacterium abscessus é um agente que causa infecções nosocomiais, pulmonares, de pele e de tecidos moles. Infecção urinária decorrente desse patógeno é considerada rara.

Acute kidney injury diagnosis in Intensive Care Units: biomarkers or Information? / Diagnóstico da injúria renal aguda em terapia intensiva: biomarcadores ou informação?

Abstract In recent years, the diagnosis of acute kidney injury (AKI) has been based on classifications such as RIFLE, AKIN and KDIGO, which has the goal of world standardization and timely recognition of the disease. It is essential that intensivists be aware about these classifications, because most of the time, they will have the first opportunity to diagnose AKI. However, it is still very common that the nephrologist consultation be performed in advanced stages of the AKI, when the interventions to halt the progression are very limited. We recently assessed intensivist on AKI diagnostic criteria, with emphasis on RIFLE, and observed a very low level of knowledge and lack of use in daily practice. Faced with the constant search for new biomarkers of kidney injury, these and other evidences, highlights the urgency of simple actions, such as the beginning of educational interventions in order to familiarize the intensivist with the latest clinical tools for AKI diagnosis.

Resumo Nos últimos anos, o diagnóstico da injúria renal aguda (IRA) vem sendo baseado em classificações como as de RIFLE, AKIN E KDIGO, que têm o objetivo de uma padronização mundial e maior agilidade no reconhecimento da doença. É essencial que os intensivistas estejam familiarizados com estas classificações, porque, na maioria das vezes, eles terão a primeira oportunidade de diagnosticar a IRA no paciente crítico. No entanto, ainda é muito comum que a chamada do nefrologista para avaliar pacientes em UTIs seja feita em estágios muito avançados da IRA, quando as medidas para evitar a progressão da doença são bastante limitadas. Recentemente, avaliamos intensivistas sobre os critérios diagnósticos de IRA, com ênfase no RIFLE, e observamos um baixíssimo grau de conhecimento, além de pouco uso dessas classificações na prática diária. Diante da busca constante por novos biomarcadores de lesão renal, estas e outras evidências indicam a necessidade urgente de ações simples, como o início de medidas educativas, no intuito de familiarizar os intensivistas com os instrumentos clínicos mais recentes para o diagnóstico da IRA.

Necrose cortical renal em placa secundária e choque séptico por colangite / Cortical necrosis secondary to cholangitis and septic shock

Atualmente, a necrose cortical é uma causa rara de insuficiência renal aguda. Sua freqüência tem sido cada vez menor, principalmente nos países desenvolvidos, em decorrência do menor número de casos de insuficiência renal aguda associados à gestação. Neste artigo, é descrito um caso de necrose cortical em placas, secundária a choque séptico por colangite e feita uma revisão da literatura pertinente.