Bone marrow necrosis related to paracoccidioidomycosis: the first eight cases identified at autopsy.

AIMS: To report the first eight bone marrow necrosis (BMN) cases related to paracoccidioidomycosis (PCM) from patient autopsies with well-documented bone marrow (BM) histology and cytology. METHODS AND RESULTS: A retrospective evaluation was performed on BM specimens from eight autopsied patients from Botucatu University Hospital with PCM-related BMN. Relevant BMN literature was searched and analysed. CONCLUSIONS: All eight patients had acute PCM. Six had histological only (biopsies) and two cytological only (smears) specimens. Five biopsy specimens revealed severe and one mild coagulation patterned necrotic areas. Five had osteonecrosis. The cytological specimens also showed typical BMN patterns. Paracoccidioides brasiliensis yeast forms were visible within necrotic areas in all cases.

Dysautonomia and ventricular dysfunction in the indeterminate form of Chagas disease.

BACKGROUND: The associations between autonomic function and biventricular function in patients with the indeterminate form of Chagas disease remains to be elucidated. METHODS: In 42 asymptomatic patients and 19 healthy volunteers, the autonomic function was assessed by time domain indices of heart rate variability (HRV), analyzed for 24 h; the right ventricular function was assessed by fraction area change, right ventricle shortening, and systolic excursion of the tricuspid valve; and the left ventricular function was assessed by ejection fraction and transmitral flow velocities. Data were expressed as mean+/-SD or medians (including the lower quartile and upper quartile). Groups were compared by Student's t or Mann-Whitney U test. Autonomic and ventricular function were correlated by Pearson's or Spearman's correlation coefficient. The level of significance was 5%. RESULTS: Right and left ventricular systolic function indexes were comparable between groups. Transmitral flow velocities were decreased in the Chagas disease group (p<0.05). The patients presented impaired HRV as indicated by the values of SDNN-day (80 (64-99) ms vs. 98 (78-127) ms; p=0.045), SDNNI-24 h (54 (43-71) vs. 65 (54-105) ms; p=0.027), SDNNI-day (49 (42-64) vs. 67 (48-76) ms; p=0.045), pNN50-day (2.2 (0.7-5)% vs. 10 (3-11)%; p=0.033); and pNN50-24 h (3 (1-7)% vs. 12 (8-19)%; p=0.013). There were no correlations between the left ventricular diastolic indices and autonomic dysfunctional indices (p>0.05). CONCLUSION: Patients with the indeterminate form of Chagas disease have both dysautonomia and left ventricular diastolic dysfunction. However, the right ventricular function is preserved. Importantly, ventricular diastolic dysfunction and dysautonomia are independent phenomena.

The malarial impact on the nutritional status of amazonian adult subjects

A avaliacao antropometrica (peso, altura, circunferencia braquial, prega cutanea tricipital, prega cutanea subescapular, indice de Quetelet e circunferencia muscular do braco) e bioquimica (proteinas e lipides) foi realizado em 120 individuos (93 masculinos e 27 do sexo feminino), de 17 a 72 anos de idade, moradores de area endemica de malaria (Humaita - AM). De acordo com a historia da doenca (malaria) eles foram divididos em grupos: G1 - controle (n = 30), sem historia de malaria; G2 - controle (n = 40), com historia de malaria, mas sem manisfetacao de doenca atual; G - doentes com Plasmodium vivax (n = 31). O diagnostico de malaria foi estabelecido por manifestacoes clinicas e confirmado laboratorialmente (gota espessa e esfregaco). No global as medidas antropometricas e bioquimicas discriminaram os grupos diferentemente. As medidas antropometricas do peso, altura, reservas caloricas e estoque proteicos somaticos, apresentaram pouca sensibilidade, discriminado apenas os grupos extremos (G1 > G4). As medidas bioquimicas, no geral diferenciaram dois grandes grupos, os sadios e os doentes (G1+G2) e G3+G4). Os doentes com Plasmodium falciparum (G4) foram os que se apresentaram em pior estado nutricional para a maioria das variaveis, sem entretanto, nenhuma variavel individual que os discriminasse significativamente do G3. Estes dados permitem concluir que a malaria resulta em desnutricao do hospedeiro, cuja gravidade esta relacionada ao tipo e estagio da doenca.