Tinea nigra: Report of three pediatrics cases. / Tiña negra: reporte de tres casos pediátricos.

INTRODUCTION: Tinea nigra is a superficial mycosis caused by Hortaea werneckii. Its clinical characte ristic is the appearance of a blackish brown macula of rapid growth, caused by the pigment produced by the fungus itself. The presence of a dark, fast growing, acral pigmentary lesion causes concern among patients and their treating physician about the possibility of a malignant pigmentary lesion. OBJECTIVE: To present a series of three clinical cases in pediatric patients with this pathology and to show the tools that help to make a differential diagnosis. CLINICAL CASES: Three patients between three and five years of age, which present a macular pigmented lesion on palms or soles, whose parents reported a rapid growth over a short period of time. Two of the patients reported previous trips to the Caribbean. Clinical and dermatoscopy suspicion of tinea nigra lead to a direct mycological exa mination, which confirmed the diagnosis. In all three cases, treatment with topical antifungals led to complete healing of the lesions. CONCLUSIONS: Although tinea nigra is rare in a dry climate, increasing travel of patients to tropical countries will increase the number of cases. Dermatoscopy and direct mycological examination are the tools that allow performing a correct diagnosis and avoiding unne cessary biopsies and/or surgeries.

Tiña negra: reporte de tres casos pediátricos / Tinea nigra: report of three pediatrics cases

Resumen: Introducción: La tiña negra es una micosis superficial causada por Hortaea werneckii. Su caracte rística clínica es la aparición de una mácula café negruzca de rápido crecimiento, producto del pig mento sintetizado por el mismo hongo. Sus características pigmentarias y de rápido crecimiento, de localización preferentemente acral, genera preocupación en los pacientes y en sus médicos tratantes por la sospecha de una lesion névica en evolución. Objetivos: Presentar 3 casos clínicos de pacientes pediátricos con esta patología y dar a conocer las herramientas para su diagnóstico diferencial. Casos clínicos: Tres pacientes, edades 3 y 5 años, con lesión macular pigmentada en palmas o plantas, cuyos padres referían habían crecido en forma rápida en poco tiempo. Dos de los casos tenían antecedentes de viajes previos al Caribe. Ante la sospecha clínica y dermatoscópica de una tiña negra, se realizó exámen micológico que confirmó el diagnóstico. En todos los casos, el tratamiento con antimicóticos tópicos llevó a la resolución completa de las lesiones. Conclusión: Aunque la tiña negra es rara en un clima seco, los viajes cada vez más frecuentes de los pacientes a países tropicales, probablemente aumentarán el número de casos. La dermatoscopía y el examen micológico son las herramientas que permiten realizar un correcto diagnóstico, evitando biopsias y/o cirugías innecesarias.

Abstract: Introduction: Tinea nigra is a superficial mycosis caused by Hortaea werneckii. Its clinical characte ristic is the appearance of a blackish brown macula of rapid growth, caused by the pigment produced by the fungus itself. The presence of a dark, fast growing, acral pigmentary lesion causes concern among patients and their treating physician about the possibility of a malignant pigmentary lesion. Objective: To present a series of three clinical cases in pediatric patients with this pathology and to show the tools that help to make a differential diagnosis. Clinical cases: Three patients between three and five years of age, which present a macular pigmented lesion on palms or soles, whose parents reported a rapid growth over a short period of time. Two of the patients reported previous trips to the Caribbean. Clinical and dermatoscopy suspicion of tinea nigra lead to a direct mycological exa mination, which confirmed the diagnosis. In all three cases, treatment with topical antifungals led to complete healing of the lesions. Conclusions: Although tinea nigra is rare in a dry climate, increasing travel of patients to tropical countries will increase the number of cases. Dermatoscopy and direct mycological examination are the tools that allow performing a correct diagnosis and avoiding unne cessary biopsies and/or surgeries.

[Onychomadesis secondary to hand-foot-mouth disease: a frequent manifestation and cause of concern for parents]. / Onicomadesis secundaria a enfermedad pie-mano-boca: una manifestación frecuente y motivo de preocupación de los padres.

INTRODUCTION: Nail alterations in children are an important cause of parent anxiety and derive in multiple and unnecessary consultations. The onychomadesis corresponds to the complete and pain less detachment of the nail plate from the proximal fold. This self-resolving nail finding has been described as a late complication of hand-foot-mouth disease, a frequent viral exanthema in the pedia tric age. OBJECTIVE: To describe a classic pediatric case of hand-foot-mouth disease with subsequent onychomadesis. CLINICAL CASE: A 3-years-old male patient with an acute presentation of acute erythe matous perioral papulovesicles, which extend to upper extremities and hands, buttocks, thighs and feet, asymptomatic, and without compromising general condition. Skin lesions resolve completely, but after one month, he develops detachment of the nails, with subsequent complete recovery. Con clusions: The recognition of this association will allow primary care physicians to guide the parents about a benign and self-resolving process that may occur as part of the evolution of hand-foot-mouth disease, thus avoiding unnecessary anxiety, referral and treatments.

Onicomadesis secundaria a enfermedad pie-mano-boca: una manifestación frecuente y motivo de preocupación de los padres / Onychomadesis secondary to hand-foot-mouth disease: a frequent manifestation and cause of concern for parents

INTRODUCCIÓN: Las alteraciones ungueales en niños provocan gran ansiedad en los padres y múltiples consultas en su mayoría innecesarias. La onicomadesis corresponde al despegamiento completo e indoloro de la lámina ungueal desde el pliegue proximal. Este hallazgo ungueal autoresolutivo se ha descrito como una complicación tardía de la enfermedad pie-mano-boca, exantema viral frecuente en la edad pediátrica. OBJETIVO: Reportar un caso pediátrico clásico de enfermedad pie-mano-boca que evolucionó con onicomadesis y revisión de la literatura. CASO CLÍNICO: Paciente masculino de 3 años de edad, con cuadro agudo de microampollas eritematosas, peribucales en un comienzo, luego brazos y manos, glúteos, muslo y pies, asintomático y sin compromiso del estado general. Se reali za diagnóstico clínico de enfermedad pie-mano-boca. Evoluciona con resolución total de lesiones cutáneas , pero al mes, desprendimiento completo de uñas, las que se recuperan con posterioridad. CONCLUSIÓN: El reconocimiento de la asociación entre enfermedad pie-mano-boca con onicomadesis nos permite orientar a los padres sobre un fenómeno benigno y transitorio que puede ocurrir como parte de la evolución de esta virosis, evitando así la ansiedad, derivación y tratamientos innecesarios.

INTRODUCTION: Nail alterations in children are an important cause of parent anxiety and derive in multiple and unnecessary consultations. The onychomadesis corresponds to the complete and pain less detachment of the nail plate from the proximal fold. This self-resolving nail finding has been described as a late complication of hand-foot-mouth disease, a frequent viral exanthema in the pedia tric age. OBJECTIVE: To describe a classic pediatric case of hand-foot-mouth disease with subsequent onychomadesis. CLINICAL CASE: A 3-years-old male patient with an acute presentation of acute erythe matous perioral papulovesicles, which extend to upper extremities and hands, buttocks, thighs and feet, asymptomatic, and without compromising general condition. Skin lesions resolve completely, but after one month, he develops detachment of the nails, with subsequent complete recovery. CONCLUSIONS: The recognition of this association will allow primary care physicians to guide the parents about a benign and self-resolving process that may occur as part of the evolution of hand-foot-mouth disease, thus avoiding unnecessary anxiety, referral and treatments.

Pneumonia due to Talaromyces marneffei in a Dog from Southern Brazil with Concomitant Canine Distemper Virus Infection.

The pathological and molecular findings associated with Talaromyces marneffei-induced pneumonia with concomitant infection by canine distemper virus (CDV) are described in a dog. The principal pathological alteration occurred in the lungs. Histopathology confirmed multifocal granulomatous pneumonia associated with numerous intralesional and intracellular septate fission cells consistent with T. marneffei. A molecular assay designed to amplify a partial fragment of the 18S rRNA gene of T. marneffei provided positive results from two fungal cultures derived from the lung. Sequencing and phylogenetic analyses confirmed the results of polymerase chain reaction (PCR). Furthermore, antigens of the CDV N protein were identified within the bronchial epithelium by immunohistochemistry and a PCR assay amplified the CDV N gene from hepatic and pulmonary fragments. Collectively, the pathological and molecular techniques confirmed a diagnosis of T. marneffei-induced pneumonia with concomitant infection by CDV. These findings represent the first description of pulmonary penicilliosis in the dog and extend the geographical niche of this emerging infectious pathogen. In this case, infection by CDV may have induced immunosuppression, which facilitated the development of pulmonary penicilliosis.

Prognostic markers of canine pyometra / Marcadores prognósticos na piometra canina

The pyometra is a disease that affects middle age and elderly female dogs during diestrus. Hormonal, microbiological, biochemical and hematological aspects are well described. However, few studies have evaluated the role of each in the prognosis of canine pyometra. The aim of this study was to identify markers associated with clinical worsening of dogs with pyometra. We prospectively evaluated 80 dogs with pyometra treated surgically. Group 1 consisted of dogs that were discharged within 48 hours after surgery and Group 2 consisted of those who required prolonged hospitalization or died. The findings of hematological, biochemical and blood lactate levels were compared between groups and variables such as bacterial multidrug resistance, systemic inflammatory response syndrome (SIRS), hyperlactatemia and increased creatinine were analyzed through the dispersion of frequencies between groups. Among the variables studied, the presence of SIRS and elevated serum creatinine >2.5mg/mL were effective in predicting the worsening of the disease and can be used as prognostic markers of canine pyometra.(AU)

A piometra é doença que acomete as fêmeas da espécie canina de meia-idade a idosa durante o diestro. Aspectos hormonais, microbiológicos, hematológicos e bioquímicos são bem descritos. Entretanto, são poucos os estudos que avaliam o papel de cada um desses no prognóstico da piometra canina. O objetivo deste estudo foi identificar marcadores associados ao agravamento clínico de cadelas com piometra. Foram avaliadas prospectivamente 80 cadelas com piometra tratadas cirurgicamente. O grupo 1 foi composto por cadelas que receberam alta até 48 horas de pós-operatório, e o grupo 2 por aquelas que necessitaram de internamento prolongado ou morreram. Os achados hematológicos, bioquímicos e os níveis do lactato sanguíneo foram comparados entre os grupos, e variáveis como multirresistência bacteriana, síndrome da resposta inflamatória sistêmica (SIRS), hiperlactatemia e aumento da creatinina foram analisadas por meio da dispersão de frequências entre os grupos. Entre as variáveis estudadas, a presença de SIRS e a elevação da creatinina sérica >2,5mg/mL foram eficazes em predizer o agravamento da doença e podem ser utilizadas como marcadores prognósticos da piometra canina.(AU)

Prognostic markers of canine pyometra / Marcadores prognósticos na piometra canina

The pyometra is a disease that affects middle age and elderly female dogs during diestrus. Hormonal, microbiological, biochemical and hematological aspects are well described. However, few studies have evaluated the role of each in the prognosis of canine pyometra. The aim of this study was to identify markers associated with clinical worsening of dogs with pyometra. We prospectively evaluated 80 dogs with pyometra treated surgically. Group 1 consisted of dogs that were discharged within 48 hours after surgery and Group 2 consisted of those who required prolonged hospitalization or died. The findings of hematological, biochemical and blood lactate levels were compared between groups and variables such as bacterial multidrug resistance, systemic inflammatory response syndrome (SIRS), hyperlactatemia and increased creatinine were analyzed through the dispersion of frequencies between groups. Among the variables studied, the presence of SIRS and elevated serum creatinine >2.5mg/mL were effective in predicting the worsening of the disease and can be used as prognostic markers of canine pyometra...

A piometra é doença que acomete as fêmeas da espécie canina de meia-idade a idosa durante o diestro. Aspectos hormonais, microbiológicos, hematológicos e bioquímicos são bem descritos. Entretanto, são poucos os estudos que avaliam o papel de cada um desses no prognóstico da piometra canina. O objetivo deste estudo foi identificar marcadores associados ao agravamento clínico de cadelas com piometra. Foram avaliadas prospectivamente 80 cadelas com piometra tratadas cirurgicamente. O grupo 1 foi composto por cadelas que receberam alta até 48 horas de pós-operatório, e o grupo 2 por aquelas que necessitaram de internamento prolongado ou morreram. Os achados hematológicos, bioquímicos e os níveis do lactato sanguíneo foram comparados entre os grupos, e variáveis como multirresistência bacteriana, síndrome da resposta inflamatória sistêmica (SIRS), hiperlactatemia e aumento da creatinina foram analisadas por meio da dispersão de frequências entre os grupos. Entre as variáveis estudadas, a presença de SIRS e a elevação da creatinina sérica >2,5mg/mL foram eficazes em predizer o agravamento da doença e podem ser utilizadas como marcadores prognósticos da piometra canina...

Vitamina D y fotoprotección / Vitamin D and photoprotection

La radiación ultravioleta produce fotodaño, por lo que tratamos de evitar su acumulación en nuestra piel. Al mismo tiempo, es esta misma, en su espectro UV-B, la responsable de iniciar la única vía metabólica para la síntesis de vitamina D en el organismo humano. La vitamina D tiene un impacto benéfico en nuestro sistema óseo, inmune, y cardiovascular, entre otros. Es por esto que se genera controversia sobre el uso de fotoprotección, en cuanto a sus beneficios versus su interferencia en la síntesis de esta vitamina liposoluble. No hemos encontrado suficiente evidencia que demuestre que el uso de fotoprotección disminuya significativamente los niveles de vitamina D, como si existe para la protección contra fotodaño que los fotoprotectores proveen. Planteamos mantener la recomendación de uso de fotoprotectores, añadiendo vitamina D como suplemento oral a la dieta encaso de deficiencia.

Ultraviolet radiation generates photodamage. Therefore, we try to avoid its accumulation in our skin. At the same time, this radiation, in its UV-B wavelength, is the only catalyst of the endogenous metabolic pathway of vitamin D synthesis. This vitamin has beneficial impact in our bones, immune and cardiovascular system, among others. This is why controversy arises regarding photoprotection, its benefits versus its interference in this lipid vitamin. We have not found concrete evidence that proves that the use of photoprotection significantly lowers vitamin D levels, though we have found vast evidence of its beneficial effects concerning photodamage prevention. We suggest following the current sunscreen recommendations, and adding vitamin D oral supplements to our diet in case of deficiency.

Progression of the renal graft: treatment of acute rejection based on a biopsy against a presumptive diagnosis.

The aim of this study was to compare the progression of renal grafts following treatment of an acute rejection event based on the histological diagnosis of a graft biopsy compared to a presumptive (clinical and laboratory) diagnosis. A historical cohort was used to study 44 patients undergoing a living haploidentical related donor renal transplant, using a similar immunosuppressive treatment: cyclosporine, azathioprine, and prednisone. Acute rejection events were treated with methylprednisolone (250 mg for 3 to 5 days) based on a histological diagnosis (biopsy group = 14) or on a clinical and laboratory diagnosis (presumptive group = 30), which consisted of an elevation over 20% in plasma creatinine in 24 hours and renal ultrasound or scintigraphy findings. The study demonstrated no significant difference in renal function (plasma creatinine) and other outcomes 2 years following transplantation in both groups. The results show that treatment of acute rejection based on a presumptive diagnosis is not a risk factor for unfavorable outcomes following 2 years of renal transplantation monitoring.

Empirical diversity indices applied to forest communities in different successional stages

Neste trabalho, examinamos a precisão de seis índices de diversidade, quatro deles empíricos, ao incorporarmos em suas fórmulas os números de adaptação climáxica, que definem a posição da espécie na sucessão vegetal em cinco áreas florestais no Estado de São Paulo. Foram realizadas simulações em florestas hipotéticas, comparando seus resultados com listagem de espécies das cinco áreas florestais analisadas. Há baixa concordância entre os índices no meio da sucessão ecológica. Conclui-se, portanto, que para alguns índices os números de adaptação climáxica aumentam sua precisão, já para outros não.

Empirical diversity indices applied to forest communities in different successional stages.

In this paper we examine the precision of six diversity indices, four of them empirical when including in their formulae climax adaptation numbers. These numbers define the succession position of the plant species in five forest areas in Sao Paulo State. We simulated hypothetical forests and compared the results with a list of species in the five areas. Low agreement was found among the indices in succession stages. Including the climax adaptation numbers increased precision for only some indices.

Empirical diversity indices applied to forest communities in different successional stages

In this paper we examine the precision of six diversity indices, four of them empirical when including in their formulae climax adaptation numbers. These numbers define the succession position of the plant species in five forest areas in São Paulo State. We simulated hypothetical forests and compared the results with a list of species in the five areas. Low agreement was found among the indices in succession stages. Including the climax adaptation numbers increased precision for only some indices.

Neste trabalho, examinamos a precisão de seis índices de diversidade, quatro deles empíricos, ao incorporarmos em suas fórmulas os números de adaptação climáxica, que definem a posição da espécie na sucessão vegetal em cinco áreas florestais no Estado de São Paulo. Foram realizadas simulações em florestas hipotéticas, comparando seus resultados com listagem de espécies das cinco áreas florestais analisadas. Há baixa concordância entre os índices no meio da sucessão ecológica. Conclui-se, portanto, que para alguns índices os números de adaptação climáxica aumentam sua precisão, já para outros não.

Interleukin-1beta regulates CFTR expression in human intestinal T84 cells.

Cystic fibrosis is an autosomal recessive genetic disease, produced by a mutation in the CFTR gene that impairs its function as a chloride channel. In this work, we have examined the effects of interleukin-1beta (IL-1beta) on the expression of CFTR in human colonic T84 cells. Treatment of T84 cells with IL-1beta (0.25 ng/ml) for 4 h resulted in an increased CFTR expression (mRNA and protein). However, higher doses of IL-1beta (1 ng/ml and over) produced inhibition of CFTR mRNA and protein expression. The protein kinase C (PKC) inhibitors H7 (50 microM) and GF109203X (1 microM) inhibited the stimulatory effect of IL-1beta. Similar effects were seen in the presence of the protein tyrosine kinase (PTK) inhibitors genistein (60 microM) and herbymicin A (2 microM). These results suggest that some PKC isoform(s) and at least a PTK might be involved in the CFTR up-regulation induced by IL-1beta. The repression of CFTR up-regulation by cycloheximide (35.5 microM) suggests the participation of a de novo synthesized protein. Results obtained by using the RNA polymerase II inhibitor DRB (78 microM), suggest that the increased mRNA levels seen after IL-1beta treatment are not due to an increased stability of the message. We conclude that the CFTR mRNA and protein levels are modulated by IL-1beta, this cytokine being the first extracellular protein known to up-regulate CFTR gene expression.