Aplastic anemia associated to systemic lupus erythematosus in an AIDS patient: a case report.

Aplastic anemia is a bone marrow failure syndrome characterized by peripheral cytopenias and hypocellular bone marrow. Although aplastic anemia is idiopathic in most cases, rheumatic diseases such as systemic lupus erythematosus are recognized as causes of aplastic anemia, with their possible etiological mechanisms being T and B lymphocyte dysfunction and pro-inflammatory cytokines and autoantibody production directed against bone marrow components. In the course of the human immunodeficiency virus infection/acquired immunodeficiency syndrome, the identification of autoantibodies and the occurrence of rheumatic events, in addition to the natural course of systemic lupus erythematosus which is modified by immune changes that are characteristic of human immunodeficiency virus infection/acquired immunodeficiency syndrome, make the diagnosis of systemic lupus erythematosus challenging. This study reports the case of a woman with acquired immunodeficiency syndrome treated with a highly active antiretroviral therapy, who had prolonged cytopenias and hypocellular bone marrow consistent with aplastic anemia. The clinical picture, high autoantibodies titers, and sustained remission of the patient's hematological status through immunosuppression supported the diagnosis of systemic lupus erythematosus-associated aplastic anemia. This is the first report of aplastic anemia concurrent with systemic lupus erythematosus and acquired immunodeficiency syndrome, providing additional evidence that immune dysfunction is a key part of the pathophysiological mechanism of aplastic anemia.

Influência dos tipos de câncer pediátrico e das fases do tratamento na qualidade de vida dos cuidadores / Influence of types of pediatric cancer treatment and phases of the quality of life of caregivers

O objetivo deste trabalho foi descrever a qualidade de vida relacionada à saúde dos cuidadores de crianças e adolescentes com câncer e comparar seus escores com controles saudáveis, com os tipos de tumor e a fase de tratamento. Entre setembro de 2005 a janeiro de 2007, 73 cuidadores de crianças e adolescentes com câncer (idade média= 34,8; DP=8,5) e 125 cuidadores de crianças e adolescentes saudáveis (idade média= 37,2; DP=9,1) participaram de um estudo transversal e responderam a um questionário de qualidade de vida relacionada à saúde (SF-36). Os resultados demonstraram que os escores de todos domínios do SF-36 dos cuidadores de crianças e adolescentes com câncer foram menores que os dos controles. Não se observou diferença significativa dos escores segundo o tipo de tumor (leucemias, do sistema nervoso central e sólidos) e a fase de tratamento (quimioterapia/radioterapia versus fora de tratamento). Conclui-se que os cuidadores de crianças e adolescentes com câncer apresentam prejuízo multidimensional na qualidade de vida relacionada à saúde, independentemente do tipo de câncer e da fase do tratamento. Esses resultados indicam que o tratamento de crianças e adolescentes com câncer deve incluir estratégias específicas para o acompanhamento da saúde física, mental e social dos seus cuidadores.

To describe the health-related quality of life of caregivers of children and adolescents with cancer and to compare their scores with healthy children´s caregivers as a control group, the tumor types and treatment phase. Between September 2005 and January 2007, 73 caregivers of children and adolescents with cancer (average age = 34.8; SD = 8.5) and 125 caregivers of healthy children and adolescents (average age = 37.2; SD = 9.1) participated in a crosssectional study and completed a health-related quality of life questionnaire (SF-36). The results showed scores in all domains of the SF-36 of the caregivers of children and adolescents with cancer were lower than those of the control group. There was no significant difference in scores according to tumor type (leukemia, of the central nervous system and solid tumors) and phase of treatment (chemotherapy / radiotherapy versus off-treatment). It follows that caregivers of children and adolescents with cancer have a disadvantage in multidimensional health-related quality of life, regardless of cancer type and stage of treatment. These results indicate that treatment of children and adolescents with cancer should include specific strategies for monitoring the physical, mental and social health of their caregivers.

Aplastic anemia associated to systemic lupus erythematosus in an AIDS patient: a case report

Aplastic anemia is a bone marrow failure syndrome characterized by peripheral cytopenias and hypocellular bone marrow. Although aplastic anemia is idiopathic in most cases, rheumatic diseases such as systemic lupus erythematosus are recognized as causes of aplastic anemia, with their possible etiological mechanisms being T and B lymphocyte dysfunction and pro-inflammatory cytokines and autoantibody production directed against bone marrow components. In the course of the human immunodeficiency virus infection/acquired immunodeficiency syndrome, the identification of autoantibodies and the occurrence of rheumatic events, in addition to the natural course of systemic lupus erythematosus which is modified by immune changes that are characteristic of human immunodeficiency virus infection/acquired immunodeficiency syndrome, make the diagnosis of systemic lupus erythematosus challenging. This study reports the case of a woman with acquired immunodeficiency syndrome treated with a highly active antiretroviral therapy, who had prolonged cytopenias and hypocellular bone marrow consistent with aplastic anemia. The clinical picture, high autoantibodies titers, and sustained remission of the patient's hematological status through immunosuppression supported the diagnosis of systemic lupus erythematosus-associated aplastic anemia. This is the first report of aplastic anemia concurrent with systemic lupus erythematosus and acquired immunodeficiency syndrome, providing additional evidence that immune dysfunction is a key part of the pathophysiological mechanism of aplastic anemia.

Cutaneous horn: a retrospective histopathological study of 222 cases.

BACKGROUND: Cutaneous horn is a keratotic, conical and circumscribed lesion that can hide both benign or malignant lesions. OBJECTIVE: To identify,from a histopathological point of view, the main clinical dermatoses that are presented ,from a clinical point of view, as cutaneous horn. METHODS: RETROSPECTIVE HISTOPATHOLOGICAL STUDY OF 222 CASES OF CUTANEOUS HORNS THAT WERE CLASSIFIED AS SUCH BY ANATOMICAL-PATHOLOGICAL REPORTS OF THE UNIVERSITY HOSPITAL (HOSPITAL DE CLINICAS DE UBERLANDIA) FROM 1990 TO 2006. RESULTS: The average age of patients was 67,42. The female sex was more affected (64,86%). The average time of clinical evolution was 16,92 months. Lesions were mostly frequent located on the head (35,14%) and upper limbs (31,08%). Histopathological analysis considered 41,44 % of the lesions as benign and 58,56% as pre-malignant or malignant among the 222 cases of cutaneous horns studied. Within the group of pre-malignant lesions, actinic keratosis was found in 83,84% of the cases; within the group of malignant lesions, squamous cell carcinoma was found in 93,75% of the cases. CONCLUSIONS: This study showed that the majority of cutaneosus horns occured in areas of the body that are exposed to the sun, predominantly head and upper limbs. Considering the high frequency of pre-malignant lesions and also the presence of malignant lesions it is suggested surgical exeresis followed by histopathological study of the cutaneous horns for confirmation of specific diagnosis.

Corno cutâneo: estudo histopatológico retrospectivo de 222 casos / Cutaneous horn: a retrospective histopathological study of 222 cases

FUNDAMENTOS: O corno cutâneo é lesão acentuadamente hiperqueratótica, cônica e circunscrita, que pode ocultar tanto lesões benignas como malignas. OBJETIVO: Identificar histopatologicamente as principais dermatoses que se apresentam clinicamente como corno cutâneo. MÉTODOS: Estudo histopatológico retrospectivo de 222 cornos cutâneos, a partir de laudos anatomopatológicos do Hospital de Clínicas de Uberlândia entre os anos de 1990 e 2006. RESULTADOS: A média de idade dos pacientes foi de 67,42 anos. O sexo feminino foi mais acometido (64,86 por cento). O tempo médio de evolução foi de 16,92 meses. As localizações mais frequentes das lesões foram: cabeça (35,14 por cento) e membros superiores (31,08 por cento). Observaram-se lesões histopatologicamente benignas em 41,44 por cento e lesões prémalignas ou malignas em 58,56 por cento dos cornos cutâneos estudados. Entre as lesões pré-malignas, a queratose actínica foi encontrada em 83,84 por cento dos casos; entre as malignas, o carcinoma espinocelular correspondeu a 93,75 por cento dos casos. CONCLUSÕES: Este estudo mostrou que a maioria dos cornos cutâneos surgiu sobre áreas do corpo expostas à luz solar, predominantemente, cabeça e membros superiores. Considerando-se a elevada frequência de lesões prémalignas e também a presença de lesões malignas, sugere-se exérese cirúrgica seguida de estudo histopatológico dos cornos cutâneos, para confirmação de diagnóstico específico.

BACKGROUND: Cutaneous horn is a keratotic, conical and circumscribed lesion that can hide both benign or malignant lesions. OBJECTIVE: To identify,from a histopathological point of view, the main clinical dermatoses that are presented ,from a clinical point of view, as cutaneous horn. METHODS: RETROSPECTIVE HISTOPATHOLOGICAL STUDY OF 222 CASES OF CUTANEOUS HORNS THAT WERE CLASSIFIED AS SUCH BY ANATOMICAL-PATHOLOGICAL REPORTS OF THE UNIVERSITY HOSPITAL (HOSPITAL DE CLÍNICAS DE UBERLÂNDIA) FROM 1990 TO 2006. RESULTS: The average age of patients was 67,42. The female sex was more affected (64,86 percent). The average time of clinical evolution was 16,92 months. Lesions were mostly frequent located on the head (35,14 percent) and upper limbs (31,08 percent). Histopathological analysis considered 41,44 percent of the lesions as benign and 58,56 percent as pre-malignant or malignant among the 222 cases of cutaneous horns studied. Within the group of pre-malignant lesions, actinic keratosis was found in 83,84 percent of the cases; within the group of malignant lesions, squamous cell carcinoma was found in 93,75 percent of the cases. CONCLUSIONS: This study showed that the majority of cutaneosus horns occured in areas of the body that are exposed to the sun, predominantly head and upper limbs. Considering the high frequency of pre-malignant lesions and also the presence of malignant lesions it is suggested surgical exeresis followed by histopathological study of the cutaneous horns for confirmation of specific diagnosis.