Acute paraplegia in a patient with eosinophilic granulomatosis and polyangiitis with 20 years of evolution: case report.

Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare and necrotizing vasculitis of small and medium vessels with a heterogeneous presentation, multiorgan involvement, characterized by the presence of chronic rhinosinusitis, asthma, and peripheral eosinophilia. Nervous system involvement is frequent, especially in the peripheral nervous system (PNS), in the form of mononeuritis multiplex. However, subarachnoid and cerebral hemorrhage, cerebral infarction, cranial nerve palsies, and cortical blindness have also been reported in the literature. Initial therapy involves systemic GC, which are not free of complications. We present the case of a patient with EGPA of more than 20 years duration who suddenly developed bilateral paresthesia of the lower limbs and urinary retention. The neurological exam revealed paraplegia with a sensorial level in D4; the MRI showed spinal cord compression in the D2-D7 level, and the patient was emergently submitted to surgical decompression. The histopathology of the surgical specimen demonstrated the presence of epidural adipose tissue with multiple vasculitic lesions. The effects of systemic corticosteroid therapy may contribute to abnormal fat deposition in various body segments, including the neuroaxis, leading to the development of epidural lipomatosis. However, the intra-lesional vasculitic character is a unique manifestation of myelopathy that has shown us to have a more aggressive attitude.

Biological therapy in systemic lupus erythematosus, antiphospholipid syndrome, and Sjögren's syndrome: evidence- and practice-based guidance.

Systemic lupus erythematosus (SLE), antiphospholipid syndrome (APS), and Sjögren's syndrome (SS) are heterogeneous autoimmune diseases. Severe manifestations and refractory/intolerance to conventional immunosuppressants demand other options, namely biological drugs, and small molecules. We aimed to define evidence and practice-based guidance for the off-label use of biologics in SLE, APS, and SS. Recommendations were made by an independent expert panel, following a comprehensive literature review and two consensus rounds. The panel included 17 internal medicine experts with recognized practice in autoimmune disease management. The literature review was systematic from 2014 until 2019 and later updated by cross-reference checking and experts' input until 2021. Preliminary recommendations were drafted by working groups for each disease. A revision meeting with all experts anticipated the consensus meeting held in June 2021. All experts voted (agree, disagree, neither agree nor disagree) during two rounds, and recommendations with at least 75% agreement were approved. A total of 32 final recommendations (20 for SLE treatment, 5 for APS, and 7 for SS) were approved by the experts. These recommendations consider organ involvement, manifestations, severity, and response to previous treatments. In these three autoimmune diseases, most recommendations refer to rituximab, which aligns with the higher number of studies and clinical experience with this biological agent. Belimumab sequential treatment after rituximab may also be used in severe cases of SLE and SS. Second-line therapy with baricitinib, bortezomib, eculizumab, secukinumab, or tocilizumab can be considered in SLE-specific manifestations. These evidence and practice-based recommendations may support treatment decision and, ultimately, improve the outcome of patients living with SLE, APS, or SS.

Biologic therapy in large and small vessels vasculitis, and Behçet's disease: Evidence- and practice-based guidance.

OBJECTIVE: Vasculitis are a very heterogenous group of systemic autoimmune diseases, affecting large vessels (LVV), small vessels or presenting as a multisystemic variable vessel vasculitis. We aimed to define evidence and practice-based recommendations for the use of biologics in large and small vessels vasculitis, and Behçet's disease (BD). METHODS: Recommendations were made by an independent expert panel, following a comprehensive literature review and two consensus rounds. The panel included 17 internal medicine experts with recognized practice on autoimmune diseases management. The literature review was systematic from 2014 until 2019 and later updated by cross-reference checking and experts' input until 2022. Preliminary recommendations were drafted by working groups for each disease and voted in two rounds, in June and September 2021. Recommendations with at least 75% agreement were approved. RESULTS: A total of 32 final recommendations (10 for LVV treatment, 7 for small vessels vasculitis and 15 for BD) were approved by the experts and several biologic drugs were considered with different supporting evidence. Among LVV treatment options, tocilizumab presents the higher level of supporting evidence. Rituximab is recommended for treatment of severe/refractory cryoglobulinemic vasculitis. Infliximab and adalimumab are most recommended in treatment of severe/refractory BD manifestations. Other biologic drugs can be considered is specific presentations. CONCLUSION: These evidence and practice-based recommendations are a contribute to treatment decision and may, ultimately, improve the outcome of patients living with these conditions.

Sinusitis and Late-Onset Asthma: A Red Flag of Eosinophilic Granulomatosis With Polyangiitis.

Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare systemic disease that develops with necrotizing granulomatous inflammation and is characterized by eosinophilia, asthma, and small vessel vasculitis. We report the case of a 74-year-old woman with a history of asthma, admitted to the Emergency Room with fever, headache, general malaise, weight loss and night sweats with one-month evolution, previously medicated with antibiotics without improvement. She presented with sinus palpation tenderness and lower leg bilateral sensitivity impairment. Laboratory tests showed neutrophilia and eosinophilia, normocytic anemia and elevated erythrocyte sedimentation rate and C-reactive protein. A computed tomography revealed sphenoid and maxillary sinusitis. Blood cultures and lumbar puncture were innocent. An extended autoimmune panel exposed a strong positive perinuclear anti-neutrophil cytoplasmic antibody - myeloperoxidase (pANCA-MPO). Sinus biopsy showed tissue infiltration by eosinophils, confirming EGPA. Corticosteroid (1 mg/kg/day) treatment was started with gradual improvement. Six months later there were no signs of active disease under prednisolone 10 mg and azathioprine 50 mg/day. This case highlights that refractory sinusitis in the presence of constitutional syndrome and peripheral eosinophilia should alert clinicians to the possibility of EGPA, particularly in patients with late-onset asthma.

Gallstone Ileus: A Rare Cause of Mechanical Bowel Obstruction.

A gallstone ileus is a rare cause of mechanical bowel obstruction, accounting for 1% to 4% of all cases. Twenty-five percent of the patients are 65 years of age or older and often present previous significant medical conditions. The authors report the case of an 87-year-old male patient, admitted with the diagnosis of community-acquired pneumonia, who later developed frequent episodes of biliary vomiting, intermittent constipation, and abdominal distension. Abdominal imaging (ultrasound and computed tomography (CT)) showed evidence of a localized inflammatory process in a small bowel loop but excluded vesicular lithiasis. After a failure in the medical approach with antibiotics, an exploratory laparotomy was performed, identifying the intestinal occlusion area, followed by an enterolithotomy at the specific area, and extraction of a 4 cm stone of acellular material. Posteriorly, the patient was treated for three weeks with a carbapenem and physical rehabilitation was promptly initiated with full recovery of his previous status. Gallstone ileus is a very challenging diagnosis and surgery is the treatment of choice. In elderly patients, it is important to promote prompt physical rehabilitation to prevent prolonged bed rest.

Acute meningitis complicated with ventriculitis caused by Streptococcus dysgalactiae subsp. dysgalactiae.

Streptococcus dysgalactiae subspecies dysgalactiae (SDSD), also known as Lancefield group C streptococcus, is a pathogen found in animals. It is known to cause pyogenic infections in animals and is one of the most common pathogens that can cause mastitis in cattle. Very few reports of SDSD causing human diseases to have been reported in the literature, but we report a case of community-acquired meningitis and pyogenic ventriculitis caused by SDSD. This report is the first case of SDSD causing a central nervous system (CNS) infection in humans and aims to raise awareness about the role of SDSD in CNS infections. It also seeks to promote the recognition of this bacteria as a potential cause of invasive diseases.

Hypovolemic shock due to rectus sheath hematoma secondary to subcutaneous low molecular weight heparin: a case report.

Rectus sheath hematoma (RSH) is a rare clinical entity caused by the rupture of the epigastric arteries or the rectus abdominal muscle itself, leading to the accumulation of blood in this location. It is a potentially fatal condition that mimics an acute belly condition. It is crucial to identify and treat it early to avoid unfavourable outcomes. We present the case of an 85-year-old woman hospitalized for pneumonia and respiratory failure who developed refractory hypovolemic shock associated with an abdominal mass. Computed tomography with angiography was performed, which detected the presence of a large hematoma of the wall of both rectus abdominal. (www.actabiomedica.it).

Spontaneous Tumor Lysis Syndrome in Prostate Cancer.

Tumor lysis syndrome (TLS) is an oncological emergency that most frequently occurs in hematological and high-turnover solid neoplasia. Its incidence in solid, slowly proliferating neoplasia is unclear, primarily because of few published case reports. TLS may be triggered by chemotherapy or infection, or may spontaneously arise. Here, we present a review of the literature and a case of a 58-year-old male patient with prostate cancer who developed spontaneous TLS.

Incidence of Antibiotic Treatment Failure in Patients with Nursing Home-Acquired Pneumonia and Community Acquired Pneumonia.

PURPOSE: Nursing home-acquired pneumonia (NHAP) patients are at higher risk of multi-drug resistant infection (MDR) than those with community-acquired pneumonia (CAP). Recent evidence suggests a single risk factor for MDR does not accurately predict the need for broad-spectrum antibiotics. The goal of this study was to compare the rate antibiotic failure between NHAP and CAP patients. METHODS: Demographic characteristics, co-morbidities, clinical and laboratory variables, antibiotic therapy, and mortality data were collected retrospectively for all patients with pneumonia admitted to an Internal Medicine Service between April 2017 and April 2018. RESULTS: In total, 313 of 556 patients had CAP and 243 had NHAP. NHAP patients were older, and were more likely to be dependent, to have recent antibiotic use, and to experience treatment failure (odds ratio (OR) 1.583; 95% CI 1.102-2.276; p = 0.013). In multivariate analysis, patient's origin did not predict treatment failure (OR 1.083; 95% CI 0.726-1.616; p = 0.696). DISCUSSION: Higher rates of antibiotic failure and mortality in NHAP patients were explained by the presence of other risk factors such as comorbidities, more severe presentation, and age. Admission from a nursing home is not a sufficient condition to start broader-spectrum antibiotics.

Whipple's Disease: A Rare Cause of Malabsorption Syndrome.

INTRODUCTION: Whipple's disease is a rare, chronic, systemic disease caused by the actinomycete Tropheryma whipplei. Clinical manifestations vary widely depending on the affected system, the most common being the digestive tract. CASE PRESENTATION: The authors report the case of a 52-year-old man with malabsorption syndrome, diarrhea, marked weight loss, melanoderma, and visual and proprioception disorders. Periodic acid-Schiff staining of a proximal small bowel biopsy and peripheral-blood PCR identification of T. whipplei confirmed the disease. The patient was initially treated with intravenous ceftriaxone, followed by oral trimethoprim/sulfamethoxazole with significant clinical improvement. CONCLUSIONS: This case is reported due to its rarity and the diagnostic challenge it presents. Although uncommon, Whipple's disease should be considered as a differential diagnosis of malabsorption syndrome due to its systemic impact and possible treatment with targeted antibiotic therapy.

INTRODUÇÃO: A doença de Whipple é uma doença rara, crónica, sistémica, causada pelo actinomicete Tropheryma whipplei. As manifestações clínicas variam de acordo com o órgão envolvido, sendo a sua apresentação típica predominantemente associada ao sistema digestivo. CASO CLÍNICO: Os autores descrevem um caso de um homem de 52 anos com síndrome de má absorção, diarreia, perda de peso marcada, melanodermia, bem como alterações visuais e a nível da propriocepção. A coloração com PAS na biopsia de intestino delgado proximal e a identificação por PCR no sangue periférico confirmou a doença. Iniciou antibioterapia com ceftriaxone EV, seguida de trimetropim/sulfametoxazol oral com recuperação clínica significativa. CONCLUSÃO: Este caso é descrito pela sua raridade e pelo desafio diagnóstico. Apesar de incomum deve ser considerada como diagnóstico diferencial do síndrome de má absorção atendendo ao seu impacto sistémico e ao possível tratamento com antibioterapia dirigida.

First record of Geoglossum fallax (Geoglossaceae, Ascomycota) in the southernmost region of the state of Bahia, northeastern Brazil / Primeiro registro de Geoglossum fallax (Geoglossaceae, Ascomycota) na região do extremo sul da Bahia, Nordeste do Brasil

Informally known as black earth tongue, Geoglossum fallax has a large terrestrial dark brown or black ascoma. The species belongs to the Geoglossomycetes class of fungi, which includes the genera Geoglossum, Sarcoleotia, Thuemenidium and Trichoglossum. This study describes the first record of G. fallaxin Bahia, northeastern Brazil, and presents the species' main identification features. The specimens were found growing on a lawn, in Campus X, Bahia State University (UNEB), municipality of Teixeira de Freitas, southernmost region of Bahia state. After gross inspection and microscopy, all specimens were identified based on the specialized literature. Slides and exsiccata of specimens were deposited in the Fungi Collection, Fungal Biology Laboratory, Campus X, UNEB. This is the first record of G. fallax in northeastern Brazil.

Conhecido como "língua-da-terra", o fungo Geoglossum fallax pertence à classe Geoglossomycetes e é tipicamente caracterizado por ascocarpo terrestre grande, escuro, variando de cor entre marrom-escuro a preto. Atualmente encontram-se incluídos na classe Geoglossomycetes os gêneros Geoglossum, Sarcoleotia, Thuemenidium e Trichoglossum. Os objetivos deste trabalho foram apresentar o primeiro registro da espécie G. fallax no extremo sul da Bahia, nordeste brasileiro, e descrever as principais características que permitiram sua identificação. Os espécimes foram encontrados em um gramado no CampusX da Universidade do Estado da Bahia (UNEB), município de Teixeira de Freitas. Todo o material foi analisado macro e microscopicamente e identificado com base na literatura especializada. Lâminas e exsicatas dos espécimes foram depositadas na Micoteca do Laboratório de Biologia dos Fungos, Campus X da UNEB. A identificação de G. fallax confirma o primeiro registro desta espécie no extremo sul da Bahia e no nordeste do Brasil.

Hyperglycaemic Hemichorea and Hyperglycaemic Hyperosmolar Syndrome in a Patient with HbA1c levels of 19.9%: A Rare and Potentially Reversible Case.

Hemichorea is a rare clinical manifestation of type 2 diabetes mellitus. The patient presents with non-ketotic hyperglycaemia, hemichorea (characterized by rapid and involuntary movements of a specific part of the body) and the CT imaging reveals the presence of alterations involving the ganglia of the base[1-3]. LEARNING POINTS: Hemichorea is a rare clinical manifestation of type 2 diabetes mellitus associated with an uncontrolled disease.Hyperglycaemic hemichorea has a good prognosis.All diabetics need to maintain good metabolic control and control cardiovascular risk factors.

Dumping Syndrome: A Rare Complication Following Nissen Fundoplication.

Dumping syndrome (DS) is a debilitating entity with gastrointestinal and vasomotor symptoms due to rapid gastric emptying. It is a rare complication of Nissen fundoplication in adults. We report the case of a patient with oesophageal compressive symptoms (dysphagia, oesophageal food impaction and regurgitation) and frequent episodes of sweating and hypoglycaemia after a Nissen fundoplication to treat gastroesophageal reflux disease. Investigation revealed severe oesophagogastric stenosis and excluded insulinoma and other causes of hypoglycaemia. An oral glucose tolerance test and gastric emptying scintigraphy were performed, supporting the diagnosis of DS. LEARNING POINTS: Dumping syndrome following Nissen fundoplication is a rare condition in adults.Diagnosis requires exclusion of other causes of hypoglycaemia.First-line treatment is based on dietary modifications, although some patients may require pharmacological therapy.

Carvedilol-Induced Liver Injury, a Rare Cause of Mixed Hepatitis: A Clinical Case.

INTRODUCTION: Drug-induced liver injury is an increasingly prevalent consequence of the diversification of available therapeutic weapons, mostly idiosyncratic and with several possible mechanisms and patterns of specific damage for each drug. Carvedilol, a widely used non-selective alpha and beta blocker leads, in very rare cases, to injury of the bile ducts by toxic metabolites, resulting in a mixed-pattern hepatitis with possible progression to chronic cholestatic syndrome and cirrhosis. The authors report the second known case of this important toxicity. CLINICAL CASE: An 83-year-old woman was admitted to the Internal Medicine ward for etiological clarification of a mixed-pattern hepatitis. Clinical history was unremarkable and structural, infectious, and autoimmune causes were excluded by blood tests and imaging exams, ultimately leading to the diagnosis of toxic hepatitis that was further confirmed by liver biopsy with morphologic findings of mixed-pattern liver injury. Carvedilol, started 6 months before, was deemed the causal agent since it was the only drug with a clinically, temporally, analytically, and histologically compatible pattern. The withdrawal of the drug resulted in slow reversal of the referred abnormalities. CONCLUSION: In very rare cases, carvedilol can cause important liver toxicity as a chronic cholestatic syndrome which can evolve to cirrhosis. It should be taken in consideration as causal agent in similar cases and stopped immediately upon suspicion, as the timely withdrawal results in reversion of the pathological findings.

INTRODUÇÃO: A lesão hepática induzida por drogas é uma consequáncia cada vez mais prevalente da diversificação de armas terapáuticas disponíveis. São principalmente reacções idiossincráticas, com vários mecanismos possíveis e padrões de danos específicos de cada droga. O carvedilol, bloqueador alfa e beta não seletivo amplamente utilizado, leva, em casos muito raros, a lesão dos canalículos biliares por metabólitos tóxicos, resultando numa hepatite padrão misto com possível progressão a síndrome colestática crónica e potencialmente cirrose. Os autores relatam o segundo caso conhecido desta importante toxicidade. CASO CLÍNICO: Uma mulher idosa foi admitida na enfermaria de Medicina Interna para esclarecimento etiológico de uma hepatite de padrão misto. Esta investigação que incluiu uma extensa pesquisa de antecedentes, exclusão de causas estruturais, infecciosas e auto-imunes por análises sanguíneas e exames de imagem, levou ao diagnóstico de uma hepatite tóxica, confirmada por biópsia hepática com achados morfológicos de um padrão misto de lesão hepática. O carvedilol, introduzido 6 meses antes, foi considerado o agente causal dado ser a única substância com padrão clínico, temporal, analítico e histológico compatível. A retirada do medicamento resultou na reversão lenta das referidas anormalidades. DISCUSSÃO: Em casos muito raros, o carvedilol pode causar toxicidade hepática importante sob a forma de síndrome colestástica crónica que pode evoluir até uma cirrose hepática. Deve ser tomado em consideração como potencial agente causal em casos semelhantes e retirado imediatamente após suspeita, sendo que a suspensão atempada resulta na reversão completa dos achados patológicos.

Pesquisa de coliformes na água de consumo das creches da rede municipal de ensino de Teixeira de Freitas, BA / Research of coliforms in drinking water of the municipal nursery school of Teixeira de Freitas, BA

A falta de estruturas adequadas para o fornecimento de água potável é uma das principais causas de contaminação por micro-organismos patogênicos. Uma vez que nas instituições de ensino, esta água é utilizada para o preparo de alimentos e consumo das crianças, sua contaminação torna-se um perigo para a saúde humana constituindo assim uma ameaça à saúde pública. Este trabalho teve como objetivo pesquisar a presença de coliformes totais e termotolerantes na água das cozinhas e bebedouros em creches da rede municipal de ensino de Teixeira de Freitas, BA. Foram realizadas 32 amostras de água, coletadas diretamente da torneira da cozinha e do bebedouro das creches. A pesquisa foi realizada, através da técnica do Número Mais Provável (NMP), de coliformes totais e termotolerantes, além de testes bioquímicos para isolamento e identificação de Escherichia coli. Das amostras de água analisadas 11 (34,4%) estavam contaminadas por coliformes totais e uma (3,1%) com presença de coliformes termotolerantes, sendo esta uma amostra de água do bebedouro.(AU)

The lack of proper structures to supply drinking water is one of the main causes of contamination with pathogenic microorganisms. Since this water is used to prepare food for students in schools, such contamination represents a health hazards, becoming a threat to public health. This study investigated the presence of total and thermotolerant coliforms in the water used in kitchens and dispensed in water coolers in day care units in the municipal education network of Teixeira de Freitas, Bahia, Brazil. In total, 32 water samples were collected directly from the kitchen tap and water coolers. Thermotolerant and total coliforms counts were obtained using the Most Probable Number method, in addition to biochemical assays to isolate and identify Escherichia coli. Eleven (33.4%) samples were contaminated with total coliforms, while one (3.1%) sample collected from a water cooler had thermotolerant coliforms.

Non-Obstructive Middle Lobe Syndrome: An Unusual Cause of Recurrent Pneumonia in an Elderly Woman.

An 84-year-old woman had five episodes of pneumonia in 4 months. Despite extensive comorbidities and advanced age, her health status was good and the recurrence seemed unjustified. Exhaustive background investigation revealed 14 episodes of right-sided pneumonias during the 3 previous years and an inconclusive investigation with CT of the thorax and bronchofibroscopy, despite some fibrotic and atelectasic alterations in the right middle lobe. A new right-sided x-ray showed a wedge-shaped density extending anteriorly and inferiorly from the hilum, and CT of the thorax revealed aggravated middle lobe abnormalities with thickening of the bronchial wall and segment atelectasis, without any visible airway obstruction. After extensive work-up had excluded other causes of recurrent pneumonia and immunodeficiency, a non-obstructive middle lobe syndrome (MLS) was deemed responsible for the repeated episodes of pneumonia. MLS is characterised by chronic hypoventilation and atelectasis of the middle lobe, facilitating secretion accumulation, chronic inflammation and repeated infection. After treatment with bronchodilators and immunostimulants was initiated, the patient experienced no recurrences for several months. LEARNING POINTS: Recurrent pneumonia is common and has several possible causes. Investigation should be directed by whether or not the location of the episodes varies, suggesting a systemic condition or a local abnormality, respectively.Middle lobe syndrome (MLS) is characterised by chronic hypoventilation of the right middle lobe resulting in atelectasis and secretion accumulation, sometimes causing recurrent pneumonia, and should therefore be considered in the differential diagnosis.MLS is not unusual in children with asthma but is quite uncommon in the elderly despite age-related changes in the characteristics of airways with reduced elastic recoil and mucociliary clearance.

CARACTERÍSTICAS CLÍNICO-EPIDEMIOLÓGICAS DE CÂNCER DE MAMA EM PACIENTES DE UNIDADE DE ALTA COMPLEXIDADE EM ONCOLOGIA / CLINICAL AND EPIDEMIOLOGICAL CHARACTERISTICS OF BREAST CANCER IN HIGH-COMPLEXITY ONCOLOGY PATIENTS / CARACTERÍSTICAS CLÍNICAS Y EPIDEMIOLÓGICAS DE CÁNCER DE MAMA EN PACIENTES ONCOLÓGICOS DE ALTA COMPLEJIDAD

O câncer de mama figura como uma das patologias que mais atinge a população feminina no mundo. Este trabalho objetivou identificar as características clínico-epidemiológicas e subtipos do câncer de mama mais frequente em pacientes atendidas pela Unidade de Alta Complexidade em Oncologia de Teixeira de Freitas, Bahia, Brasil, no período de 2010 a 2012. Realizou-se estudo transversal do tipo descritivo-quantitativo e os dados obtidos foram verificados pelo teste de Análise de Variância e o teste de Tukey (p<0,05). Foram analisados 122 prontuários de mulheres diagnosticadas e submetidas a tratamento de câncer de mama. Os resultados apontaram que o tipo histológico mais frequente foi ductal (71,31%) e a gradação histológica II a mais recorrente (47,54%). Em 55,75% dos casos, os tumores foram classificados como ≥IIB e em 41,80% das pacientes havia comprometimento linfonodal. O subtipo de câncer mamário predominante foi Luminal A (36,07%) e os subtipos triplo-negativos foram mais frequentes em pacientes com idade inferior a 43 anos. O intervalo temporal entre o diagnóstico e o início de tratamento foi de 3,7 meses em 52,24%. Concluiu-se que os resultados são compatíveis com a literatura, no que se refere às características clinico-epidemiológicas e ao subtipo de carcinoma mamário mais frequente (Luminal A), que apresenta o melhor prognóstico, quando comparado com os demais. Entretanto, o diagnóstico e o início do tratamento das pacientes pesquisadas não ocorreram precocemente.

Breast cancer stands as one of the most frequent diseases affecting women worldwide. This study evaluated the clinical and epidemiological characteristics of as well as identified the most common breast cancer types in patients treated in the High-complexity Oncology Unit in the municipality of Teixeira de Freitas, state of Bahia, Brazil, between 2010 and 2012. For the descriptive and quantitative method adopted, the medical records of 122 women with confirmed breast cancer in treatment were analyzed, and the results were compared using an Analysis of Variance and the Tukey test (p<0.05). Ductal breast cancer was the most common histological manifestation (71.31%), and stage II was the grade most frequently observed (47.54%). Also, 55.75% of cases were ≥IIB, and lymph nodes were affected in 41.80%. Luminal A was the most common cancer subtype diagnosed (36.07%), and the triple negative subtypes were more often observed in patients under 43 years of age. Mean time elapsed between diagnosis and beginning of treatment was 3.7 months in 52.24% of patients. The results obtained are in accordance with the literature about the clinical and epidemiological characteristics and the most common breast cancer subtype (luminal A), which has the best prognosis amongst breast cancers. However, neither early screening nor the beginning of treatment happened within the period conventionally considered appropriate to breast cancer cases.

El cáncer de mama representa una de las patologías que más afectan a la población femenina en el mundo. Este trabajo objetivó identificar las características clínico-epidemiológicas y subtipos del cáncer de mama más frecuente en pacientes atendidos por la Unidad de Alta Complejidad en Oncología de Teixeira de Freitas, Bahia, Brasil, en el período de 2010 a 2012. Se realizó un estudio transversal de tipo descriptivo-cuantitativo y los datos obtenidos fueron verificados por la prueba de Análisis de Varianza y la prueba de Tukey (p<0,05). Se analizaron 122 prontuarios de mujeres diagnosticadas y sometidas a tratamiento de cáncer de mama. El tipo histológico más frecuente fue ductal (71,31%) y la gradación histológica II la más recurrente (47,54%). En el 55,75% de los casos, los tumores fueron clasificados como ≥IIB y en el 41,80% de las pacientes había un compromiso linfonodal. El subtipo de cáncer mamario predominante fue Luminal A (36,07%) y los subtipos triple-negativos fueron más frecuentes en pacientes menores de 43 años. El intervalo temporal entre el diagnóstico y el inicio de tratamiento fue de 3,7 meses en el 52,24% de los pacientes. Los resultados son compatibles con la literatura, en lo que se refiere a las características clínico-epidemiológicas y al subtipo de carcinoma mamario más frecuente (Luminal A), que presenta el mejor pronóstico, en comparación con los demás. Sin embargo, el diagnóstico y el inicio del tratamiento de las pacientes investigadas no ocurrieron precozmente.

Fungos potencialmente toxigênicos em amostras de amendoim disponível para o consumo humano / Potentially toxigenic fungi in peanut samples available for human consumption

Avaliou-se a contaminação por fungos potencialmente toxigênicos em amendoim in natura disponível para consumo humano e comercializado em supermercados de Juiz de Fora, MG. Foram adquiridas 31 amostras de sete diferentes marcas de amendoim em grãos cru; amendoim torrado em grãos e amendoim torrado e triturado (moído), em embalagens originais e invioladas, em cinco estabelecimentos comerciais. A análise da presença de fungos potencialmente toxigênicos nos grãos de amendoim foi realizada por meio da técnica de plaqueamento direto em placas de Petri, contendo os meios de cultura Ágar Batata Dextrose (ABD) e Ágar Dicloran Rosa de Bengala Cloranfenicol (ADRBC). Das 31 amostras analisadas, 17 (54,84%) estavam contaminadas por fungos potencialmente toxigênicos (Aspergillus niger, Aspergillus flavus e/ou Aspergillus parasiticus, Aspergillus fumigatus e Penicillium spp) além de outros não toxigênicos (Rhizopus spp. e leveduras). O índice de contaminação nas diferentes amostras de amendoim avaliadas foi expressivo, sendo que as espécies encontradas foram de fungos potencialmente toxigênicos produtores de micotoxinas importantes como as aflatoxinas.