Sex dimorphism of weight and length at birth: evidence based on disorders of sex development.

BACKGROUND: Males have higher weight and length at birth than females. AIM: To verify the influence of the Y chromosome and the action of intrauterine androgens on weight and length at birth of children with Disorders of Sex Development (DSD). SUBJECTS AND METHODS: A cross-sectional and retrospective study. Patients with Turner syndrome (TS), complete (XX and XY), mixed (45,X/46,XY) and partial (XY) gonadal dysgenesis (GD), complete (CAIS) and partial (PAIS) androgen insensitivity syndromes and XX and XY congenital adrenal hyperplasia (CAH) were included. Weight and length at birth were evaluated. RESULTS: Weight and length at birth were lower in TS and mixed GD when compared to XY and XX DSD cases. In turn, patients with increased androgen action (117 cases) had higher weight and length at birth when compared to those with absent (108 cases) and decreased (68 cases) production/action. In birthweight, there was a negative influence of the 45,X/46,XY karyotype and a positive influence of increased androgen and gestational age. In birth length, there was a negative influence of the 45,X and 45,X/46,XY karyotypes and also a positive influence of increased androgen and gestational age. CONCLUSIONS: The sex dimorphism of weight and length at birth could possibly be influenced by intrauterine androgenic action.

The 2020 Canadian Cardiovascular Society/Canadian Heart Rhythm Society Comprehensive guidelines for the management of Atrial Fibrillation

The Canadian Cardiovascular Society (CCS) atrial fibrillation (AF) guidelines program was developed to aid clinicians in the management of these complex patients, as well as to provide direction to policy makers and health care systems regarding related issues. The most recent comprehensive CCS AF guidelines update was published in 2010. Since then, periodic updates were published dealing with rapidly changing areas. However, since 2010 a large number of developments had accumulated in a wide range of areas, motivating the committee to complete a thorough guideline review. The 2020 iteration of the CCS AF guidelines represents a comprehensive renewal that integrates, updates, and replaces the past decade of guidelines, recommendations, and practical tips. It is intended to be used by practicing clinicians across all disciplines who care for patients with AF. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system was used to evaluate recommendation strength and the quality of evidence. Areas of focus include: AF classification and definitions, epidemiology, pathophysiology, clinical evaluation, screening and opportunistic AF detection, detection and management of modifiable risk factors, integrated approach to AF management, stroke prevention, arrhythmia management, sex differences, and AF in special populations. Extensive use is made of tables and figures to synthesize important material and present key concepts. This document should be an important aid for knowledge translation and a tool to help improve clinical management of this important and challenging arrhythmia.

Le programme de lignes directrices de la Société canadienne de cardiologie (SCC) en matière de fibrillation auriculaire (FA) a été élaboré pour aider les cliniciens à prendre en charge ces patients complexes, ainsi que pour orienter les décideurs politiques et les systèmes de soins de santé sur des questions connexes. La dernière édition complète des lignes directrices de la SCC en matière de FA a été publiée en 2010. Depuis lors, des mises à jour périodiques ont été publiées, traitant de domaines en évolution rapide. Cependant, en 2020, un grand nombre de développements s'y étaient ajoutés, couvrant un large éventail de domaines, ce qui a motivé le comité à créer une refonte complète des lignes directrices. L'édition 2020 des lignes directrices de la SCC en matière de FA représente un renouvellement complet qui intègre, met à jour et remplace les lignes directrices, les recommandations et les conseils pratiques des dix dernières années. Elle est destinée à être utilisée par les cliniciens praticiens de toutes les disciplines qui s'occupent de patients souffrant de FA. L'approche GRADE (Gradation des Recommandations, de l'Appréciation, du Développement et des Évaluations) a été utilisée pour évaluer la pertinence des recommandations et la qualité des résultats. Les domaines d'intérêt incluent : la classification et les définitions de la FA, son épidémiologie, sa physiopathologie, l'évaluation clinique, le dépistage de la FA, la détection et la gestion des facteurs de risque modifiables, l'approche intégrée de la gestion de la FA, la prévention des accidents vasculaires cérébraux, la gestion de l'arythmie, les différences entre les sexes et la FA dans des populations particulières. Des tableaux et figures ont été largement utilisés pour synthétiser les éléments importants et présenter les concepts clés. Ce document devrait représenter une aide importante pour l'intégration des connaissances et un outil pour aider à améliorer la gestion clinique de cette arythmie importante et difficile à traiter.

Histopathological findings in lungs of hawksbill turtles collected on the coasts of the states of Espírito Santo and Rio de Janeiro, Brazil / Achados histopatológicos em pulmões de tartarugas-de-pente procedentes dos litorais dos estados do Espírito Santo e do Rio de Janeiro, Brasil

The present work aimed to report the histopathological findings verified in lungs of hawksbill turtles (Eretmochelys imbricata) retrieved from the coasts of the states of Espírito Santo and Rio de Janeiro, Brazil. Between the years 2010 and 2014, 29 E. imbricata individuals were found stranded on the coasts, already dead or dying during treatment. Lung samples of all specimens were collected during necropsies, fixed in 10% neutral buffered formalin, subjected to routine histological processing and classified histomorphologically. The findings revealed that 37.93% of the specimens presented lung lesions. Of these, 90.91% were rescued alive and 9.09% were found dead; 63.63% were females and 36.37% were males. The mean weight was 5.44 Kg and the mean length 39 cm, characterizing young individuals. The animals originated from São Francisco de Itabapoana - RJ, Aracruz - ES, São Mateus - ES, Guarapari - ES, Linhares - ES, Itapemirim - ES, and Anchieta - ES. Macroscopic analysis revealed presence of foam, hyperemia, nodules in the parenchyma, cyst and caseous material. Microscopic examination evidenced heterophilic bronchopneumonia, parasitic granulomatous pneumonia caused by spirorchiids, bacterial granulomatous pneumonia, fungal granulomatous pneumonia, and congestion. It was concluded that juvenile specimens of Eretmochelys imbricata, females and males, originated from the states of Espírito Santo and Rio de Janeiro and found stranded both alive or dead, have significant lung lesions, mainly inflammatory ones, associated or not with infectious agents.(AU)

Objetivou-se com este trabalho relatar os achados histopatológicos em pulmões de Eretmochelys imbricata provenientes dos litorais dos estados do Espírito Santo e do Rio de Janeiro, Brasil. Amostras de pulmões de 29 E. imbricata foram coletadas, durante os anos de 2010 a 2014, em necropsias de espécimes encalhadas mortas ou que vieram a óbito durante o tratamento, nos litorais dos estados do Espírito Santo e do Rio de Janeiro, fixadas em formalina tamponada neutra a 10%, submetidas ao processamento histológico de rotina e classificadas histomorfologicamente. Os dados dos animais mostraram que 37,93% dos animais apresentaram lesões pulmonares. Destes, 90,91% foram encontrados vivos e 9,09% morto, 63,63% eram fêmeas e 36,37% machos. O peso médio foi de 5,44kg, e o comprimento médio de 39cm, o que caracterizou animais juvenis. Os animais eram provenientes de São Francisco de Itabapoana - RJ, Aracruz - ES, São Mateus - ES, Guarapari - ES, Linhares - ES, Itapemirim - ES e Anchieta - ES. Á macroscopia, observou-se: presença de espuma, hiperemia, nódulos no parênquima, cisto e cáseo. Ao exame microscópico, foram encontrados broncopneumonia heterofílica, pneumonia granulomatosa parasitária, causadas por espirorquídeos, pneumonia granulomatosa bacteriana, pneumonia granulomatosa fúngica e congestão. Conclui-se que exemplares juvenis de Eretmochelys imbricata, fêmeas e machos, provenientes dos estados do Espírito Santo e do Rio de Janeiro e encalhados tanto vivos quanto mortos, apresentam lesões pulmonares importantes, principalmente as de origem inflamatória, associadas ou não a agentes infecciosos.(AU)

Influence of vascular endothelial growth factor and alpha-fetoprotein on hepatocellular carcinoma.

We evaluated the influence of the vascular endothelial growth factor (VEGF) -C936T polymorphism on prognosis of hepatocellular carcinoma (HCC), cirrhosis, and hepatitis C virus (HCV) infection. Serum VEGF and alpha-fetoprotein (AFP) levels were determined and used to characterize sensitivity and specificity. A total of 285 subjects were studied: 68 HCC, 118 cirrhosis, 43 HCV, and 56 healthy controls. Prevalence of the VEGF -C936T polymorphism and serum levels of VEGF and AFP were analyzed by polymerase chain reaction-restriction fragment length polymorphism and enzyme-linked immunosorbent assay, respectively. The genotype CC (frequencies between 63.24 and 76.79%; P > 0.05) and the C allele (absolute frequencies from 0.816 to 0.884, P > 0.05) were prevalent in all groups. Higher VEGF levels in HCC patients (588.0 ± 501.0 pg/mL) were observed, particularly in patients with the T allele in VEGF -C936T (764.4 ± 571.7 pg/mL) compared to those in the other groups (P < 0.05). The same trend occurred with AFP levels (HCC = 8.522 ± 23.830; cirrhosis = 12.7 ± 59.3; HCV = 4.6 ± 4.7; control = 2.7 ± 1.8 ng/mL; P = 0.005). Levels of VEGF and AFP showed sensitivity of 65 and 28% and specificity of 85 and 99%, respectively, for HCC patients. In conclusion, the VEGF -C936T polymorphism is not associated with HCC but the mutant allele (T) increases VEGF levels in HCC patients. VEGF could be a potential biomarker for HCC, while AFP could be used to distinguish between patients with HCC and cirrhosis or HCV.

OCT4 immunohistochemistry may be necessary to identify the real risk of gonadal tumors in patients with Turner syndrome and Y chromosome sequences.

BACKGROUND: The aim of this study was to investigate the frequency of gonadal tumors among patients with Turner syndrome (TS) carrying Y-derivative sequences in their chromosomal constitution. METHODS: Six out of 260 patients with TS were selected based on mosaicism of the entire Y chromosome; 10 were included because Y-derivative sequences have been detected by PCR with specific oligonucleotides (sex-determining region on the Y, testis specific-protein, Y and DYZ3) and further confirmed by FISH. The 16 patients were subjected to bilateral gonadectomy at ages varying from 8.7 to 18.2 years. Both histopathological investigation with hematoxylin and eosin (H&E) and immunohistochemical analysis with anti-octamer-binding transcription factor 4 (OCT4) antibody were performed. RESULTS: Gonadal neoplasia was not detected in any of the 32 gonads evaluated by H&E; however, four gonads (12%) from three patients (19%) had positive OCT4 staining in 50-80% of nuclei, suggesting the existence of germ cell tumors (gonadoblastoma or in situ carcinoma). CONCLUSIONS: Evaluation of the real risk of development of gonadal tumors in TS patients with Y-derivative sequences in their chromosomal constitution may require a specific histopathological study, such as immunohistochemistry with OCT4.

Serotypes of carriage and invasive isolates of Streptococcus pneumoniae in Brazilian children in the era of pneumococcal vaccines.

Nasopharyngeal carriage of Streptococcus pneumoniae is a key factor in the development of invasive disease and the spread of resistant strains within the community. A single nasopharyngeal swab was obtained from 648 unvaccinated children aged <5 years, either healthy or with acute respiratory tract infection or meningitis, during the winters of 2000 and 2001. The overall pneumococcal carriage rate was 35.8% (95% CI 32.1-39.6). The pneumococcal serotypes found most frequently in the nasopharynx were 14, 6B, 6A, 19F, 10A, 23F and 18C, which included five of the seven serotypes in the currently licensed seven-valent conjugate vaccine (PCV7); serotypes 4 and 9V were less common. Serotypes 1 and 5 were isolated rarely from the nasopharynx. A comparison of 222 nasopharyngeal isolates with 125 invasive isolates, matched for age and time to the carrier isolates, showed a similar prevalence of penicillin non-susceptible pneumococci (PNSp) (19.8% and 19.2%, respectively). PNSp serotypes were similar (6B, 14, 19F, 19 A, 23B and 23F) for carriage and invasive disease isolates. The coverage of PCV7 for carriage isolates (52.2%) and invasive isolates (62.4%) did not differ significantly (p 0.06); similarly, there was no significant difference in PCV7 coverage for carriage isolates (34.5%) and invasive isolates (28.2%) of PNSp. These data suggest that PCV7 has the potential to reduce pneumococcal carriage and the number of carriers of PNSp belonging to vaccine serotypes.

Randomised trial of efficacy of benznidazole in treatment of early Trypanosoma cruzi infection.

BACKGROUND: Benznidazole, a nitroimidazole derivative, has been recommended for the treatment of acute and congenital Trypanosoma cruzi infection (Chagas' disease). We have examined the safety and efficacy of this drug in the treatment of the early chronic phase of T cruzi infection. METHODS: Between 1991 and 1995, we carried out a randomised, double-blind, placebo-controlled trial in a rural area of Brazil with endemic Chagas' disease. 82% of 2434 schoolchildren (aged 7-12 years) identified in a census were screened for antibodies to T cruzi by indirect immunofluorescence, indirect haemagglutination, and ELISA. 130 were positive in all tests and were randomly assigned benznidazole (7.5 mg/kg daily for 60 days by mouth) or placebo. The primary endpoint for efficacy was the disappearance of specific antibodies (negative seroconversion) by the end of 3-year follow-up. The secondary endpoint was the reduction of antibody titres on repeated serological tests. One child moved away from the area just after randomisation and was excluded from the analyses. Insecticidal measures were taken throughout the trial to reduce the risk of reinfection. FINDINGS: Minor side-effects requiring no specific medication were recorded in a small proportion of individuals. On a chemiluminescent ELISA with purified trypomastigote glycoconjugate, serum from all participants was positive at the beginning of the trial. At the end of follow-up, 37 (58%) of the 64 benznidazole-treated participants and 3 (5%) of those who received placebo were negative for T cruzi antibodies. The efficacy of benznidazole treatment estimated by intention to treat was 55.8% (95% CI 40.8-67.0). At the end of follow-up, children who received benznidazole had five-fold lower geometric mean titres by indirect immunofluorescence than placebo-treated children (196[147-256] vs 1068[809-1408], p < 0.00001). INTERPRETATION: The trial showed that a 60-day course of benznidazole treatment of early chronic T cruzi infection was safe and 55.8% effective in producing negative seroconversion of specific antibodies. The results are very encouraging and justify the recommendation of treatment for seropositive children as public health policy.

A randomized clinical trial with high dose of chloroquine for treatment of Plasmodium falciparum malaria in Brazil.

This clinical trial compared parasitological efficacy, levels of in vivo resistance and side effects of oral chloroquine 25 mg/Kg and 50 mg/Kg in 3 days treatment in Plasmodium falciparum malaria with an extended followed-up of 30 days. The study enrolled 58 patients in the 25 mg/Kg group and 66 in the 50 mg/Kg group. All eligible subjects were over 14 years of age and came from Amazon Basin and Central Brazil during the period of August 1989 to April 1991. The cure rate in the 50 mg/Kg group was 89.4% on day 7 and 71.2% on day 14 compared to 44.8% and 24.1% in the 25 mg/Kg group. 74.1% of the patients in the 25 mg/Kg group and 48.4% of the patients in the 50 mg/Kg group had detectable parasitaemia at the day 30. However, there was a decrease of the geometric mean parasite density in both groups specially in the 50 mg/Kg group. There was 24.1% of RIII and 13.8% of RII in the 25 mg/Kg group. Side effects were found to be minimum in both groups. The present data support that there was a high level resistance to chloroquine in both groups, and the high dose regimen only delayed the development of resistance and its administration should not be recommended as first choice in malaria P. falciparum therapy in Brazil.

[Bacteriologic study of abscesses caused by bites of snakes of the genus Bothrops]. / Estudo bacteriológico de abscessos causados por picada de serpentes do genero Bothrops.

The bacterial flora of 99 cases of abscesses following Bothrops snakebite were analysed. They corresponded to 61.1% of all snakebite abscesses observed in 1030 patients attending the Hospital de Doenças Tropicais de Goiánia in Goiás, Brazil, from January 1984 to April 1988. An exsudate sample of each abscess was examined by Gram stain, culture and susceptibility tests. The Gram negative bacillis, Morganella morganii, Escherichia coli and Providencia sp were the most frequent bacterias isolated. They were identified in 44.4%, 20.2% and 13.1% of the samples respectively. This flora was similar to those described in snake mouth and venom by other researchers. Based on the results of the susceptibility tests the authors suggested the use of chloramphenicol for the treatment of those abscesses which do not respond to simple drainage.

Feohifomicose disseminada por Exophiala spinifera. / Disseminated phaeohyphomycosis caused by Exophiala spinifera

Os autores descrevem caso de feohifomicose em paciente do sexo feminino, com cinco anos natural de Goiania (Estado de Goias Brasil), portadora de lesoes cutaneas generalizadas, de aspectos dermatologicos diversos, acompanhadas por tumoracao cerebral, detectada por radiografia computadorizada. Diagnosticadas micologicamente as lesoes cutaneas, com o isolamento de um fungo demacio, identificado como Exophiala spinifera, foi instituido tratamento com anfotericina B, havendo aparente melhoria das mesmas. No decurso do tratamento, apareceu hemiparesia a direita.A tumoracao,ao nivel do talamo e nucleos de base, comprimindo a capsula interna, revelada pela tomografia axial computadorizada, nao foi examinada histopatologicamente, pela relutancia da familia na pratica de uma intervencao neurocirurgica. Exophiala spinifera e um fungo demacio, oportunista por excelencia, raramente encontrado como agente de feohifomicose. Os autores, ao registrarem o presente caso, fazem revisao da literatura sobre o assunto, com comentarios sobre esta micose (aspectos micologicos, clinicos, histopatologicos e terapeutico)

Criterios diagnosticos e terapeuticos da sifilis. / Diagnostic and therapeutic criteria of syphilis

Nesta revisao foi feita uma abordagem dos aspectos epidemiologicos da sifilis, realcando-se o seu grau de infectividade; fezse uma correlacao clinico-sorologica dos diversos estagios da doenca, evidenciandose os varios perfis sorologicos que ocorrem na sua historia natural. Procurou-se destacar a metodologia para o diagnostico clinico e sorologico, dando-se enfase aos aspectos da sifilis congenita e neurologica; discutiram-se os criterios terapeuticos e de cura, particularizando-se as situacoes da sifilis na gravidez, congenita e neurologica

Ribavirina no tratamento da hepatite aguda por virus. / Rebavirin in the treatment of acute hepatitis due to virus

A ribavirina, um nucleosidio sintetico, foi administrada, em estudo duplo-cego, a 20 pacientes acometidos de tipica hepatite aguda por virus, tendo outros 20 pacientes recebido placebo,como grupo de controle.O tempo de duracao da doenca, definido como o necessario para alcancar cifras de transaminasemia maior igual 2 mg/dl, mostrou-se equiparavel nos dois grupos. A depuracao de antigenemia AgsHB ocorreu em sete de oito pacientes do grupo ribavirina e em todos os cinco do grupo placebo. Conclui-se por ineficacia da ribavirina em vantajosamente influenciar a evolucao da hepatite aguda por virus