Thrombosis after kidney transplantation.

The diagnosis of deep vein thrombosis (DVT) is unusual in patients with sickle cell disease (SCD). Despite the incidence of cerebral thrombosis in SCD patients due to vasooclusion, thrombotic manifestations in peripheral vessels are rare. Patients with homozygous SCD present a variety of renal abnormalities as a result of sickle crisis. In this group of patients, kidney transplantation has been performed in the renal endstage patients; with graft survival rates similar to that of the general transplant population at 1 year. However, patients with SCD experience an augmentation in the frequency of painful crises in the first year after transplantation, which has been attributed to concurrent elevations in hematocrit and plasma viscosity. Despite etiology, renal transplant patients are at increased risk for the development of thromboembolic events such as deep vein thrombosis and renovascular thrombosis after allograft procedure. These events can be due to a prothrombotic state generated by the use of immunosuppressive agents. Although other factors such as acquired or inherited disorders of the clotting system may increase the risk of thrombosis. Here, we report a case of a renal transplant patient with sickle cell disease who presented recurrent episodes of DVT and increase painful sickle episodes after kidney transplantation.

Viral hepatitis: An alternative teaching method.

OBJECTIVES: Our teaching experience has shown that dealing with the immunological aspects of viral hepatitis poses several difficulties. Therefore, we developed a game to verify whether or not this active-learning exercise could enhance students' learning and arouse their interest in subjects that are basically complex. METHODS: Fifteen cards with clinical cases of hepatitis A, B, C, D, and E, and 50 explanatory cards with the description of epidemiological, clinical, and immunological aspects of the hepatitis mentioned above. The objective of the game was to match the explanatory cards with the respective clinical case. Pre- and post-tests were used to assess students' grade improvement. FINDINGS: One-hundred-and-forty students participated in the activity. The overall response of the students to the game was very positive: 129 (92.1%) found the game encouraged clinical thinking, and 105 (75%) regarded the game as an important way of consolidating learning. The students' grades significantly improved (p < 0.05). CONCLUSION: Games allow understanding the subject matter through global knowledge. They also foster the student-professor relationship, simplifying the solution to the questions that may arise from a more comprehensive study.

Epidemiology of sporotrichosis: a study of 304 cases in Brazil.

BACKGROUND: Sporotrichosis is an infection caused by Sporothrix schenckii . It primarily involves the skin and lymphatic channels, but dissemination may occur. OBJECTIVE: We sought to describe clinical and epidemiologic features of cases of sporotrichosis observed in southern Brazil, and to review the literature. Methods We conducted a retrospective analysis of medical records over a 35-year period, from 1967 to 2002. RESULTS: In all, 304 cases of sporotrichosis confirmed by fungal culture, histopathologic examination, and/or remission of lesions with potassium iodide were reviewed. No statistical difference was found between the number of patients with fixed cutaneous sporotrichosis and those with the lymphangitic type. Multifocal and extracutaneous involvement was verified. The upper extremity was the most affected site. Unusual sites, such as the penis and pubic region, were also involved. CONCLUSION: Sporotrichosis is endemic in the study area. There is much to be learned about S schenckii . More studies and therapeutic options are still needed.

Learning from panel boards: T-lymphocyte and B-lymphocyte self-tolerance game.

Immunology is a vast, complex and challenging subject. To facilitate students' understanding, the authors have created a T-lymphocyte and B-lymphocyte self-tolerance game. The T-lymphocyte self-tolerance game consisted of 24 cardboard pieces with illustrations and statements about self-tolerance mechanisms and one large panel board. The B-lymphocyte panel board consisted of 11 cardboard pieces with illustrations and statements about self-tolerance mechanisms, and two large panels. Students had to associate mechanisms of self-tolerance with the corresponding cardboard pieces. In total, 120 students attended the session. Of these, 95.8% considered that the panel board facilitated their understanding; 95% affirmed they understood how T- and B-lymphocyte self-tolerance worked. Students' grades improved significantly. The good results obtained show the value of using a panel board when approaching a subject that is vast and complex.