Infective dermatitis associated with human T-cell lymphotropic virus type-1, an underdiagnosed disease.

Infective dermatitis associated with human T-cell lymphotropic virus type-1 (HTLV-1) (IDH) is a severe form of chronically infected eczema occurring in early childhood, although very rarely cases have been reported in adults. Most of the cases are from Jamaica and Brazil and occur in individuals with low socioeconomic status. IDH is always associated with refractory Staphylococcus aureus or beta-hemolytic Streptococcus infection of the skin and nasal vestibules. Patients with IDH may develop other even more severe HTLV-1-associated diseases, such as HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) of early or late appearance and adult T-cell leukemia/lymphoma. In the context of the Brazilian experience, it has been observed that 54% of IDH patients exhibit the juvenile form of HAM/TSP while the estimated incidence of adult HAM/TSP is 3%. As there are no curative treatments for HTLV-1 infection (or vaccines) or most of its associated diseases, prevention of infection is fundamental, mainly by vertical transmission, as it is responsible for the development of IDH, infantojuvenile HAM/TSP, and ATL. Public measures to reduce this transmission must be implemented urgently. Furthermore, it is recommended, mainly in HTLV-1 endemic areas, to search for HTLV-1 infection in all patients with infected eczema, even in adults.

Low viscosity silicone with less shrinkage for brain slices.

Plastination consists of replacing lipid and water with a curable polymer. This technique has numerous advantages, of which the production of non-toxic, inert, highly durable, dry, and easy maintenance and storage specimens stand out. Like all anatomical techniques, plastination also has disadvantages, and one of them is tissue shrinkage. The feasibility of using low viscosity domestic silicone (0,1Pa.s at 20°C) to plastinate brain slices was examined. Twenty humans, 10 millimeters (mm) brain slices were impregnated, ten slices each with two polymers [10 with domestic low viscosity polymer - P1 and 10 slices with Biodur® (0,45-0,6Pa.s at 20°C) S10]. Shrinkage was accessed by volume and area measurements. Volume shrinkage was significantly less in the slices impregnated with low viscosity domestic polymer, demonstrating the feasibility to plastinate brain slices with domestic low viscosity silicone polymer.

Is domestic polyester suitable for plastination of thin brain slices?

Plastination is a technique used to preserve biological tissues while retaining most of their original appearance. In the technique, developed by Dr. Gunther von Hagens in 1977, specimens were impregnated with a polymer, such as silicone, epoxy, or polyester. Considered the most suitable material for brain plastination, polyester has a wide application in teaching and research compared with imaging techniques. The materials for plastination are usually imported from Germany and more expensive than domestic products. If domestic polymers were to enter the market it would favor the expansion of plastination in Brazil. Hence, this study evaluated the feasibility of using domestic polyesters to replace the usual Biodur® (P40) in plastination of brain slices. For this evaluation, 2-mm-thick sections of bovine brains were prepared and plastinated with domestic polyester. Slices were compared before impregnation and after curing using standardized photographs taken after dehydration and after curing. Plastination followed the standard protocol: fixation, dehydration, forced impregnation, and curing. Fifteen brain slices were plastinated with each polyester (P40, P18, and C1-3). There was no significant difference in the percent shrinkage between groups after plastination of P18 and P40, but the curing time of Cristalan© polymer was too short for impregnation. Therefore, no initiator was used for C polymers impregnation. Thus, domestic polyester P18 was a viable option for the process.

Survival of osseointegrated implants: a 10-year retrospective study.

Introduction: New techniques, surgical protocols, dental implant designs, and prosthetic rehabilitation have been used in dentistry, most of which have yielded good results in the literature. This retrospective survey assessed the clinical results of patients rehabilitated with dental implants between January 2011 and December 2021. Load protocols (immediate and conventional), types of connections of the installed implants, external hexagon (EH), and cone morse (MC) were evaluated. Material and methods: Two evaluators were selected and calibrated to perform the analyses. The inclusion criteria were records with complete and legible information of patients rehabilitated with dental implants who were followed for at least 1 year after rehabilita-tion. The medical records were divided into two groups, G1 (implants with conventional load) and G2 (implants with immediate load), and further subdivided according to implant type. Information about the rehabilitation failures was noted and descriptive statistics of the results were obtained. Results: Among the 432 evaluated medical records of patients rehabilitated with implants, the study included 319 records: 223 from women and 96 from men, aged 20-79 years. In total, data were available on 1,227 implants with dimensions of 10-13 mm and diameters of 3.75-4 mm. The G1 (n=1.188) survival rates were 94.95% for EH implants and 99.5% for MC implants. In G2 (n=39), the survival rates were 93.75% for EH implants and 91.3% for MC implants. The implant survival rates were relatively high among all groups evaluated; however, the discrepancy between the number of implants in the groups may compromise the comparison between them. Understanding and respecting the biomechanical and technical principles of each protocol was the main factor influencing the success of rehabilitation. Conclusion: The results of this study showed that, according to medical records, rehabilitation with dental implants showed excellent results regardless of the connection type (EH or MC) or loading protocol (conventional or immediate). The two loading protocols and two connection types had excellent results and scientific support. Therefore, the choice should be based on the clinical needs of each patient.

Is domestic polyester suitable for plastination of thin brain slices?

Plastination is a technique used to preserve biological tissues while retaining most of their original appearance. In the technique, developed by Dr. Gunther von Hagens in 1977, specimens were impregnated with a polymer, such as silicone, epoxy, or polyester. Considered the most suitable material for brain plastination, polyester has a wide application in teaching and research compared with imaging techniques. The materials for plastination are usually imported from Germany and more expensive than domestic products. If domestic polymers were to enter the market it would favor the expansion of plastination in Brazil. Hence, this study evaluated the feasibility of using domestic polyesters to replace the usual Biodur® (P40) in plastination of brain slices. For this evaluation, 2-mm-thick sections of bovine brains were prepared and plastinated with domestic polyester. Slices were compared before impregnation and after curing using standardized photographs taken after dehydration and after curing. Plastination followed the standard protocol: fixation, dehydration, forced impregnation, and curing. Fifteen brain slices were plastinated with each polyester (P40, P18, and C1-3). There was no significant difference in the percent shrinkage between groups after plastination of P18 and P40, but the curing time of Cristalan© polymer was too short for impregnation. Therefore, no initiator was used for C polymers impregnation. Thus, domestic polyester P18 was a viable option for the process.

Plastination with low viscosity silicone: strategy for less tissue shrinkage.

Plastination is an anatomical technique for preserving biological tissues based on the principle of replacing body fluids with a curable polymer. An inconvenient aspect of this technique is the tissue shrinkage it causes; several studies seek ways to reduce or avoid this shrinkage. Additionally, there are no studies in the literature that quantitatively evaluate the use of low viscosity silicones in plastination having shrinkage of tissue as a parameter. Therefore, this study aimed to evaluate the use of Silicones S10 (Biodur) and P1 (Polisil) in the plastination of different types of biological tissues of a sliced human body, having as a parameter the tissue shrinkage caused in the forced impregnation stage. Human cardiac, pulmonary, splenic, renal, hepatic, muscular, and bone tissues were analyzed. For such purpose, a male human body was used, sliced in 13-15-mm-thick pieces, having as a parameter the before and the after plastination with the different silicones. The standard protocol of the plastination of the slices was followed: dehydration, forced impregnation, and curation. Half of the pieces obtained were plastinated with silicone P1 (group P1) and the other half with S10 (group S10). All tissues and anatomical segments analyzed in this study showed less or equal shrinkage when plastination of the control group (S10) was compared with that of the P1 group. Therefore, we concluded that the lower viscosity silicone promoted less tissue shrinkage, making it a viable alternative to the reference.

Success rate of short unitary implants installed in atrophic mandible: Integrative Review.

Introduction: In the rehabilitation of total edentulous patients, lack of bone availability in posterior maxillary regions is common due to pneumatization of the maxillary sinus and posterior mandible due to the presence of the lower alveolar nerve. And to rehabilitate this type of patient, one of them is the use of short implants. Methods: The work aims to evaluate the success rate of treatment of short implants through a literature review. The search was carried out in august 2020 in the Pubmed (MedLine), Scopus and Embase databases, using the keywords: extra short implants, short implants, survival rate, single implant, atrophic mandible. The keywords followed the AND or OR criteria previously elaborated by the PICO question. The inclu-sion criteria were: implants with a length of 4 to 8 mm, which were single and in the posterior region of atrophic mandible and which had 5 years of follow-up. Articles were excluded from the review where the implants were splinted, had a follow-up of less than 5 years and considered short implants larger than 8 mm. Results: After the search, 4 articles were separated, which totaled an n = 172 short implants obtaining a success rate of 93.47% in 5 years. After the search, 4 articles were separated, which totaled an n = 172 short implants obtaining a success rate of 93.47% in 5 years. Conclusion: We can conclude that the use of short implants, even in single prostheses, has a high success rate, which can provide the edentulous patient with little bone bioavailability for rehabilitation.

Plastination with low viscosity silicone: strategy for less tissue shrinkage

Plastination is an anatomical technique for preserving biological tissues based on the principle of replacing body fluids with a curable polymer. An inconvenient aspect of this technique is the tissue shrinkage it causes; several studies seek ways to reduce or avoid this shrinkage. Additionally, there are no studies in the literature that quantitatively evaluate the use of low viscosity silicones in plastination having shrinkage of tissue as a parameter. Therefore, this study aimed to evaluate the use of Silicones S10 (Biodur) and P1 (Polisil) in the plastination of different types of biological tissues of a sliced human body, having as a parameter the tissue shrinkage caused in the forced impregnation stage. Human cardiac, pulmonary, splenic, renal, hepatic, muscular, and bone tissues were analyzed. For such purpose, a male human body was used, sliced in 13-15-mm-thick pieces, having as a parameter the before and the after plastination with the different silicones. The standard protocol of the plastination of the slices was followed: dehydration, forced impregnation, and curation. Half of the pieces obtained were plastinated with silicone P1 (group P1) and the other half with S10 (group S10). All tissues and anatomical segments analyzed in this study showed less or equal shrinkage when plastination of the control group (S10) was compared with that of the P1 group. Therefore, we concluded that the lower viscosity silicone promoted less tissue shrinkage, making it a viable alternative to the reference.

Galanin subtype 1 and subtype 2 receptors mediate opposite anxiety-like effects in the rat dorsal raphe nucleus.

About 40% of the dorsal raphe nucleus (DRN) neurons co-express serotonin (5-HT) and galanin. Serotonergic pathways from the DRN to the amygdala facilitate learned anxiety, while those from the DRN to the dorsal periaqueductal grey matter (DPAG) impair innate anxiety. Previously, we showed that galanin infusion in the DRN of rats induces anxiolytic effect by impairing inhibitory avoidance without changing escape behaviour in the elevated T-maze (ETM). Here, we evaluated: (1) which galanin receptors would be involved in the anxiolytic effect of galanin in the DRN of rats tested in the ETM; (2) the effects of galanin intra-DRN on panic-like behaviours evoked by electrical stimulation of the DPAG. The activation of DRN GAL1 receptors by M617 (1.0 and 3.0nmol) facilitated inhibitory avoidance, whereas the activation of GAL2 receptors by AR-M1896 (3.0nmol) impaired the inhibitory avoidance in the ETM, suggesting an anxiogenic and an anxiolytic-like effect respectively. Both agonists did not change escape behaviour in the ETM or locomotor activity in the open field. The anxiolytic effect of AR-M1896 was attenuated by the prior administration of WAY100635 (0.18nmol), a 5-HT1A antagonist. Galanin (0.3nmol) administered in the DRN increased discreetly flight behaviours induced by electrical stimulation of the DPAG, suggesting a panicolytic effect. Together, our results showed that galanin mediates opposite anxiety responses in the DRN by activation of GAL1 and GAL2 receptors. The anxiolytic effect induced by activation of Gal2 receptors may depend on serotonergic tone. Finally, the role of galanin in panic related behaviours remains uncertain.

Cochleovestibular nerve involvement in multifocal fibrosclerosis.

OBJECTIVES: To report a case of multifocal fibrosclerosis with a nine-year follow up, and to discuss this disease's radiological appearance and management. The disease is a rare systemic disorder of unknown cause characterised by fibrous proliferation involving multiple anatomical sites. CASE REPORT: A 50-year-old woman presented with histological findings characterised by similar inflammatory processes involving the meninges, pituitary gland, peritoneum, retroperitoneum and orbits, prompting a search for a common pathophysiology. A diagnosis of multifocal fibrosclerosis was postulated. Symptom improvement was noted after treatment with prednisone and azathioprine. CONCLUSION: This is the first documented case of involvement of the cochleovestibular nerve in a patient with multifocal fibrosclerosis. The rare association between fibrotic diseases and masses showing various clinical patterns should be kept in mind by otolaryngologists, and imaging performed to investigate for multifocal fibrosclerosis. However, diagnosis can only be confirmed with tissue biopsy and histopathological examination.

Caracterização genotípica de amostras Escherichia coli isoladas de mastite bovina / Genotypic characterization of Escherichia coli isolated from cows with mastitis

Escherichia coli samples isolated from cases of dairy mastitis in municipalities of Rio de Janeiro State, Brazil, were genotypically compared and Shiga-toxin genes were detected and their prevalence evaluated. Genetically related samples were verified and the referred genes were detected in 14.28% of the cases.

Enterobacterial microbiota on Stomoxys calcitrans external surface.

The current study evaluated the prevalence of enterobacterial agents on the external surface of the stable fly, Stomoxys calcitrans. In addition, this study investigated the presence of virulence genes of enterobacteria. Twenty different species were isolated and identified, Escherichia coli was the most frequent species isolated. The genes stx1, stx2 and/or eae for production of Shiga toxin were present in 13.04% of the E. coli samples.

High HTLV-1 proviral load, a marker for HTLV-1 associated myelopathy/tropical spastic paraparesis, is also detected in patients with infective dermatitis associated with HTLV-1

Salvador (BA, Brazil) is an endemic area for human T-cell lymphotrophic virus type 1 (HTLV-1). The overall prevalence of HTLV-1 infection in the general population has been estimated to be 1.76%. HTLV-1 carriers may develop a variety of diseases such as adult T-cell leukemia/lymphoma, HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) and infective dermatitis associated with HTLV-1 (IDH). IDH is a chronic and severe form of childhood exudative and infective dermatitis involving mainly the scalp, neck and ears. It has recently been observed that 30% of patients with IDH develop juvenile HAM/TSP. The replication of HTLV-1 has been reported to be greater in adult HAM/TSP patients than in asymptomatic HTLV-1 carriers. In the current study, the proviral load of 28 children and adolescents with IDH not associated with HAM/TSP was determined and the results were compared to those obtained in 28 HTLV-1 adult carriers and 28 adult patients with HAM/TSP. The proviral load in IDH patients was similar to that of patients with HAM/TSP and much higher than that found in HTLV-1 carriers. The high levels of proviral load in IDH patients were not associated with age, duration of illness, duration of breast-feeding, or activity status of the skin disease. Since proviral load is associated with neurological disability, these data support the view that IDH patients are at high risk of developing HAM/TSP.

High HTLV-1 proviral load, a marker for HTLV-1 associated myelopathy/tropical spastic paraparesis, is also detected in patients with infective dermatitis associated with HTLV-1.

Salvador (BA, Brazil) is an endemic area for human T-cell lymphotrophic virus type 1 (HTLV-1). The overall prevalence of HTLV-1 infection in the general population has been estimated to be 1.76%. HTLV-1 carriers may develop a variety of diseases such as adult T-cell leukemia/lymphoma, HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) and infective dermatitis associated with HTLV-1 (IDH). IDH is a chronic and severe form of childhood exudative and infective dermatitis involving mainly the scalp, neck and ears. It has recently been observed that 30% of patients with IDH develop juvenile HAM/TSP. The replication of HTLV-1 has been reported to be greater in adult HAM/TSP patients than in asymptomatic HTLV-1 carriers. In the current study, the proviral load of 28 children and adolescents with IDH not associated with HAM/TSP was determined and the results were compared to those obtained in 28 HTLV-1 adult carriers and 28 adult patients with HAM/TSP. The proviral load in IDH patients was similar to that of patients with HAM/TSP and much higher than that found in HTLV-1 carriers. The high levels of proviral load in IDH patients were not associated with age, duration of illness, duration of breast-feeding, or activity status of the skin disease. Since proviral load is associated with neurological disability, these data support the view that IDH patients are at high risk of developing HAM/TSP.

Infective dermatitis has similar immunological features to human T lymphotropic virus-type 1-associated myelopathy/tropical spastic paraparesis.

Human T lymphotropic virus-type 1 (HTLV-1) is the causal agent of the HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP), adult T cell leukaemia/lymphoma and infective dermatitis associated with HTLV-1 (IDH). Over-production of proinflammatory cytokines and an increase in HTLV-1 proviral load are features of HAM/TSP, but the immunological basis of IDH has not been established. In addition to severe cutaneous manifestations, the importance of IDH relies on the observation that up to 30% of children with IDH develop HAM/TSP in childhood and adolescence. In this study we determined the immune response in patients with IDH measuring interleukin (IL)-4, IL-5, IL-10, interferon (IFN)-gamma and tumour necrosis factor (TNF)-alpha levels as well as the HTLV-1 proviral load. Additionally, regulatory cytokines and anti-cytokines were added to cultures to evaluate the ability of these molecules to down-modulate TNF-alpha and IFN-gamma synthesis. HTLV-1 carriers and patients with HAM/TSP served as controls. TNF-alpha and IFN-gamma levels were higher in IDH than in HTLV-1 carriers. There was no difference in IFN-gamma and TNF-alpha concentrations in IDH and HAM/TSP patients. There was a tendency for higher IL-4 mRNA expression and immunoglobulin E (IgE) levels in IDH than in HTLV-1 carriers, but the difference did not reach statistical significance. The HTLV-1 proviral load was significantly higher in IDH patients than in HTLV-1 carriers. IDH is characterized by an exaggerated Th1 immune response and high HTLV-1 proviral load. The similarities between the immunological response in patients with IDH and HAM/TSP and the high proviral load observed in IDH provide support that IDH is a risk factor for development of HAM/TSP.

Microbiota bacteriana em segmentos de mosca do estábulo Stomoxys calcitrans no Brasil: primeiro relato de espécies / Microbiota in Stomoxys calcitrans segments in Brazil: first description of species

This study report the first description of bacterial species recovered from body segments of Stomoxys calcitrans collected in dairy farms from Rio de Janeiro State, Brazil. Eighteen out of 33 isolated and identified species were unknown in stable flies by the worldwide literature. Some of these species have the potential to develop diseases in man and other animals and some others have not been described yet as pathogenic agents.

Fas 670 promoter polymorphism is associated to susceptibility, clinical presentation, and survival in adult T cell leukemia.

Fas (TNFRSF6/Apo-1/CD95) is a type I transmembrane receptor, which mediates apoptosis. Fas gene mutations, aberrant transcripts, and abundant expression of Fas have been reported in adult T cell leukemia (ATL). To further elucidate the role of Fas in ATL pathogenesis, we investigated whether the -670 FAS promoter A/G polymorphism (STAT1-binding site) might contribute to susceptibility and clinical outcome in ATL. Thirty-one patients with ATL, 33 healthy, human T lymphotropic virus type 1-infected individuals, and 70 healthy, uninfected controls were genotyped for the FAS -670 polymorphism by PCR-restriction fragment-length polymorphism. The AA genotype was significantly over-represented in ATL patients in comparison with healthy controls (P=0.006), as well as asymptomatics (P=0.037), corresponding to an odds ratio (OR) of 3.79 [95% confidence intervals (CI; 1.28-11.41)] and 4.58 [95% CI (1.13-20.03)], respectively. The AA group also comprised significantly more aggressive (acute and lymphoma) clinical subtypes [P=0.012; OR=8.40; 95% CI (1.60-44.12)]. In addition, we observed a statistically significant association between GG genotype and survival (log rank test, P=0.032). Finally, IFN-gamma-induced but not basal FAS mRNA levels were increased significantly (P=0.049) in PBMCs from AA versus GG individuals, demonstrating the IFN-dependent functionality of the -670 polymorphism. In conclusion, our results demonstrate that a functional Fas promoter polymorphism is significantly associated to susceptibility, clinical manifestation, and survival in ATL.

Health care-related infections in solid organ transplants

The health care-related infections are well-known in a critical care setting, but reports of those infections in solid organ transplanted patients are scarce. We developed a study of retrospective cohort in a tertiary teaching hospital for 14 months. Eighty-one patients underwent solid organ transplants. The global incidence of health care-related infection was 42.0 percent. Fifteen percent of the cases were occurrences of surgical site infections, 14.0 percent pneumonias, 9.0 percent primary blood stream infections, 4.0 percent urinary tract infections and 2.0 percent skin infection. The most prevalent etiologic agents were K. pneumoniae (8.6 percent), P. aeruginosa (7.4 percent); A. baumannii (5.0 percent) and S. aureus (2.5 percent). Mortality was 18.0 percent, none of then related to health care infections. The high rate of those infections, mainly surgical site infections, suggests a demand for stricter measures to prevent and control health care-related infections.

Infiltrating giant cellular blue naevus.

INTRODUCTION: Cellular blue naevi (CBN) measure 1-2 cm in diameter and affect the dermis, occasionally extending into the subcutaneous fat. The case of a 14-year-old boy with a giant CBN (GCBN) involving the right half of the face, the jugal mucosa and the lower eyelid with a tumour that had infiltrated the bone and the maxillary and ethmoidal sinuses is reported. METHODS: Biopsies were taken from the skin, jugal mucosa and maxillary sinus. The following markers were used in the immunohistochemical evaluation: CD34, CD56, HMB-45, anti-S100, A-103, Melan A and MIB-1. RESULTS: The biopsy specimens showed a biphasic pattern affecting the lower dermis, subcutaneous fat, skeletal muscle, bone, jugal mucosa and maxillary sinus, but there was no histological evidence of malignancy. The tumour cells were CD34-, CD56-, HMB45+, anti-S100+ and A-103+. Melan A was focally expressed. No positive MIB-1 cells were identified. DISCUSSION: The present case shows that GCBN may infiltrate deeply, with no evidence of malignancy.