Níveis inatos de C3 e C4 em pacientes curados para a leishmaniose visceral e associação com os aspectos clínico-laboratoriais / Innate levels of C3 and C4 in patients cured for visceral leishmaniasis and association with clinical and laboratory aspects

Introdução: assim que inoculada pelo flebotomíneo, a Leishmania entra em contato com o sistema complemento, sendo que poucos estudos têm avaliado os níveis inatos dos componentes iniciais C3 e C4. Objetivo: avaliar os níveis inatos dos componentes C3 e C4 do sistema complemento em pacientes curados de leishmaniose visceral (LV) e sua associação com aspectos clínico-laboratoriais no momento de diagnóstico da doença. Metodologia: foram estudados 29 pacientes com LV curada. Os níveis de C3 e C4 séricos foram dosados pela técnica de imunodifusão radial simples, após um tempo médio de 59,48 meses pós-tratamento, formados os grupos: C3: baixo (< 84 mg/dl; n=10), normal (84 a 193 mg/dl; n=14) e elevado (> 193 mg/dl; n=5); C4: muito baixo (< 20 mg/dl; n=10), baixo (20 a 40 mg/dl; n=15) e normal (> 40 mg/dl; n=4). Os dados clínicos e laboratoriais empregados para as análises foram coletados por levantamento dos prontuários, considerando o período de diagnóstico da doença de cada paciente. Resultados: foi observada uma correlação positiva fraca entre os níveis de C3 e C4 (rho=0,46; p=0,01). Verificou-se que a maioria dos pacientes sintomáticos no momento do diagnóstico apresentavam níveis inatos normais de C3 e baixos de C4. Pacientes com C3 baixo apresentaram maiores níveis do hematócrito em relação ao grupo C3 normal (p=0,0406). Conclusão: conclui-se que o componente C3 do sistema complemento está associado às alterações do hematócrito, sugerindo o acompanhamento dos seus níveis em pacientes com LV.

Introduction: once inoculated by the sand fly, Leishmania comes into contact with the complement system, and few studies have evaluated the innate levels of the initial components C3 and C4. Objective: to evaluate the innate levels of the C3 and C4 components of the complement system in patients cured of visceral leishmaniasis (VL) and its association with clinical and laboratory aspects at the time of diagnosis of the disease. Methodology: twenty-nine patients with cured VL were studied. Serum C3 and C4 levels were measured by simple radial immunodiffusion technique, after an average time of 59.48 months post-treatment, forming the groups: C3: low (< 84 mg/dl; n=10), normal (84 to 193 mg/dl; n=14) and high (> 193 mg/dl; n=5); C4: very low (< 20 mg/dl; n=10), low (20 to 40 mg/dl; n=15) and normal (> 40 mg/dl; n=4). The clinical and laboratory data used for the analyzes were collected by surveying the medical records, considering the period of diagnosis of the disease of each patient. Results: a weak positive correlation was observed between C3 and C4 levels (rho=0.46; p=0.01). Most symptomatic patients at the time of diagnosis were found to have normal C3 and low C4 levels. Low C3 patients had higher levels of hematocrit compared to the normal C3 group (p=0.0406). Conclusion: in conclusion, the C3 component of the complement system is associated with changes in the hematocrit, suggesting the monitoring of its levels in patients with VL.

Disseminated cryptococcosis manifested as a single tumor in an immunocompetent patient, similar to the cutaneous primary forms

Abstract Cryptococcosis is a fungal infection caused by Cryptococcus neoformans that tends to affect immunocompromised individuals. The fungi are mostly acquired by inhalation, which leads to an initial pulmonary infection. Later, other organs - such as the central nervous system and the skin - can be affected by hematogenous spread. In addition, cutaneous contamination can occur by primary inoculation after injuries (primary cutaneous cryptococcosis), whose diagnosis is defined based on the absence of systemic involvement. The clinical presentation of cutaneous forms typically vary according to the infection mode. We report an unusual case of disseminated cryptococcosis in an immunocompetent patient with cutaneous lesions similar to those caused by primary inoculation. This clinical picture leads us to question the definition of primary cutaneous cryptococcosis established in the literature.

Disseminated cryptococcosis manifested as a single tumor in an immunocompetent patient, similar to the cutaneous primary forms.

Cryptococcosis is a fungal infection caused by Cryptococcus neoformans that tends to affect immunocompromised individuals. The fungi are mostly acquired by inhalation, which leads to an initial pulmonary infection. Later, other organs - such as the central nervous system and the skin - can be affected by hematogenous spread. In addition, cutaneous contamination can occur by primary inoculation after injuries (primary cutaneous cryptococcosis), whose diagnosis is defined based on the absence of systemic involvement. The clinical presentation of cutaneous forms typically vary according to the infection mode. We report an unusual case of disseminated cryptococcosis in an immunocompetent patient with cutaneous lesions similar to those caused by primary inoculation. This clinical picture leads us to question the definition of primary cutaneous cryptococcosis established in the literature.

Efeito da adenotonsilectomia sobre a qualidade de vida de crianças com hiperplasia adenotonsilar / Adenotonsillectomy effect on the life quality of children with adenotonsillar hyperplasia

Introdução: A hiperplasia adenotonsilar é a causa mais comum de obstrução respiratória em crianças originando um grupo variado de anormalidades como ronco e síndrome da apneia obstrutiva do sono, com elevada reincidência de infecções das vias aéreas superiores e uso frequente de antibióticos. Em certos casos, a adenotonsilectomia é o melhor tratamento. Objetivo: Analisar o efeito da adenotonsilectomia na qualidade de vida de crianças com hiperplasia adenotonsilar. Método: Cinquenta e um pais ou responsáveis de crianças submetidas a adenotonsilectomia foram entrevistados 12 a 18 meses após a cirurgia através do questionário sobre qualidade de vida desenvolvido por De Serres et al., que inclui os domínios: sofrimento físico, distúrbios do sono, problemas de fala e deglutição, desconforto emocional, limitação das atividades e preocupação do responsável. Foram incluídos os domínios: prevalência de rinite, episódios de infecções de vias aéreas superiores e uso de antibioticoterapia antes e após o procedimento cirúrgico. Resultados e Conclusão: Correlacionando-se os domínios entre si, observamos que a adenotonsilectomia melhorou a qualidade de vida das crianças, a longo prazo, em especial entre distúrbios do sono, como diminuição do ronco (4,16±1,47 vs 0,43±0,96; *p< 0,001), significativa queda do número de tonsilites (4,43±1,14 vs 0,61±0,94 *p< 0,001) e menor uso de antibióticos (4,43±1,14 vs 0,59±0,90; p< 0,001), quando comparado antes e após a cirurgia. No entanto, a melhora foi menos significativa em crianças com sintomas de rinite (8,82±1,81 vs 9,71±0,68 *p= 0,007), comparado as crianças sem rinite e em meninos que meninas (9,13±1,48 vs 9,85±0,49; *p= 0,02).

Introduction: The adenotonsillar hyperplasia is the most common cause of breathing obstruction in children and leads to a variable group of abnormalities such as snoring and sleep obstructive apnea syndrome, with a high recurrence of infection in the upper airways and frequent use of antibiotics. In certain cases, the adenotonsillectomy is the best treatment. Objective: To analyze the effects of adenotonsillectomy onto the life quality of children with adenotonsillar hyperplasia. Method: Fifty-one parents of children submitted to adenotonsillectomy were interviewed 12 to 18 months after the surgery, by means of the questionnaire about life quality, developed by De Serres et al., which includes the following domains: physical suffering, sleep disorders, problems of lack of deglutition, emotional discomfort, limitation of activities and parents concerns. The following domains were included: prevalence of rhinitis, episodes of infections of the upper airways and use of antibiotic therapy before and after surgical procedure. Results and Conclusion: By relating the domains, we observed that the adenotonsillectomy improved the children's life quality on a long term basis, 1.47 vs.±specially sleep disorders such as diminishing of snore (4.16 0.96; *p±0.43< 0.001), significant fall on the number of tonsillitis (4.43±1.14 vs. 0.61±0.94 *p< 0,001) and lower use of antibiotics (4.43±1.14 vs. 0.59±0.90; p< 0.001), when compared before and after the surgery. However, the improvement was less significant in children with symptoms of rhinitis ((8.82±1.81 vs. 9.71±0.68 *p= 0.007), compared to children without rhinitis and between boys and girls (9.13±1.48 vs. 9.85±0.49; *p= 0.02).