Absceso subpectoral como diagnóstico diferencial de hombro doloroso: reporte de un caso / Subpectoral abscess as a differential diagnosis of painful shoulder: a case report

Los síndromes dolorosos del hombro son relativamente comunes en la práctica clínica. Habitualmente son causados por un número limitado de patologías. Dentro de los diagnósticos diferenciales, el pinzamiento subacromial, las lesiones aisladas del manguito rotador, capsulitis adhesiva, tendinitis cálcica, patología degenerativa de las articulaciones glenohumeral y acromioclavicular, y la inestabilidad crónica del hombro, son causas comunes. Causas infrecuentes son la rotura del tendón del bíceps, neuralgias, patología infecciosa articular y tumores del hombro. Un absceso subpectoral sin sintomatología infecciosa clara es una causa extremadamente rara de hombro doloroso en el adulto. Presentamos el caso de un paciente de 60 años, que inicia con un cuadro de hombro doloroso cuya causa se identifica como un absceso subpectoral por staphylococcus aureus que se maneja con drenaje quirúrgico y tratamiento antibiótico endovenoso con buenos resultados.

Painful shoulder syndromes are commonly caused by a limited assortment of pathologies. Differential diagnosis include rotator cuff impingement syndrome, rotator cuff tears, adhesive capsulitis, calcific tendonitis, degenerative disease of the joint including acromio-clavicular and gleno-humeral joints and chronic instability. Less common causes are labral tears, biceps tendon rupture, soft tissue infection, neurologic disease, joint infection and shoulder tumors. A subpectoral abscess without infectious clinical features is a very rare cause of shoulder pain in adults. We present the case of a 52 years old male who develops a painful shoulder syndrome caused by a staphylococcus aureus subpectoral abscess, treated by surgical drainage and intravenous antibiotic therapy with good results.

Prevalence of and risk factors associated with the presence of Staphylococcus aureus in the chronic wounds of patients treated in primary health care settings in Brazil

Abstract INTRODUCTION: Wounds can be colonized by methicillin-resistant Staphylococcus aureus (MRSA). METHODS: We evaluated the prevalence of S. aureus and MRSA in the wounds of patients treated at Basic Health Units in Brazil and identified risk factors associated with their presence. RESULTS: The prevalence rates of S. aureus and MRSA were 51.5% and 8.7%, respectively. There was a correlation between the presence of S. aureus in wounds and nostrils (p<0.01). A positive association was detected between S. aureus infection and previous benzylpenicillin use (p=0.02). No associations were observed for MRSA. CONCLUSIONS: Multidrug-resistant pathogens are present in primary healthcare settings in Brazil.

Absceso renal neonatal: un desafío diagnóstico y terapéutico. Caso clínico / Neonatal renal abscess: a diagnostic and therapeutic challenge. A clinical case

El absceso renal representa una patología infrecuente en el recién nacido. Puede presentar consecuencias graves: sepsis con alta mortalidad, cicatrices renales y riesgo de enfermedad renal crónica. Se reporta sobre un recién nacido con absceso renal unilateral a Staphylococcus aureus, con cuadro de septicemia, sin otro foco supurativo ni malformación urinaria, que evolucionó adecuadamente con antibióticos endovenosos, sin tratamiento quirúrgico, aunque con cicatrices renales como secuela. A partir de este caso, se analizan las estrategias de diagnóstico, tratamiento y seguimiento del absceso renal en un neonato y se destaca el diagnóstico precoz para evitar cicatrices renales.

Renal abscess is a rare disease in newborn, but severe consequences can occur: sepsis with high mortality, renal scar formation and risk of chronic renal failure. A neonate with unilateral renal abscess due to Staphylococcus aureus is reported, with septicemia, with no other suppurative focus, nor with urinary malformation, with good clinical evolution with intravenous antibiotics and without surgical treatment, but with renal scars sequel. From this case, the strategies of diagnosis, treatment and followup of the renal abscess in a neonate are analyzed, emphasizing the early diagnosis to avoid renal scars.

Silibinin improves palmitate-induced insulin resistance in C2C12 myotubes by attenuating IRS-1/PI3K/Akt pathway inhibition

The present study investigated the effect of silibinin, the principal potential anti-inflammatory flavonoid contained in silymarin, a mixture of flavonolignans extracted from Silybum marianum seeds, on palmitate-induced insulin resistance in C2C12 myotubes and its potential molecular mechanisms. Silibinin prevented the decrease of insulin-stimulated 2-NBDG (2-[N-(7-nitrobenz-2-oxa-1,3-diazol-4-yl)amino]-2-deoxy-D-glucose) uptake and the downregulation of glutamate transporter type 4 (GLUT4) translocation in C2C12 myotubes induced by palmitate. Meanwhile, silibinin suppressed the palmitate-induced decrease of insulin-stimulated Akt Ser473 phosphorylation, which was reversed by wortmannin, a specific inhibitor of phosphatidylinositol-3-kinase (PI3K). We also found that palmitate downregulated insulin-stimulated Tyr632 phosphorylation of insulin receptor substrate 1 (IRS-1) and up-regulated IRS-1 Ser307 phosphorylation. These effects were rebalanced by silibinin. Considering several serine/threonine kinases reported to phosphorylate IRS-1 at Ser307, treatment with silibinin downregulated the phosphorylation of both c-Jun N-terminal kinase (JNK) and nuclear factor-κB kinase β (IKKβ), which was increased by palmitate in C2C12 myotubes mediating inflammatory status, whereas the phosphorylation of PKC-θ was not significantly modulated by silibinin. Collectively, the results indicated that silibinin prevented inhibition of the IRS-1/PI3K/Akt pathway, thus ameliorating palmitate-induced insulin resistance in C2C12 myotubes.

Quercetin protects the retina by reducing apoptosis due to ischemia-reperfusion injury in a rat model / Quercetina protege a retina reduzindo a apoptose consequente à lesão por isquemia e reperfusão em um modelo de rato

Purpose: This study aimed to investigate the effect of quercetin on apoptotic cell death induced by ischemia-reperfusion (I/R) injury in the rat retina. Methods: Twenty-four rats were divided into four equal groups: control, ischemic, solvent, and quercetin. I/R injury was achieved by elevating the intraocular pressure above the perfusion pressure. Intraperitoneal injections of 20 mg/kg of quercetin and dimethyl sulfoxide (DMSO) were performed in the quercetin and solvent groups, respectively, immediately prior to I/R injury, and the researchers allowed for the retinas to be reperfused. Forty-eight hours after injury, the thicknesses of the retinal ganglion cell layer (RGCL), inner nuclear layer (INL), inner plexiform layer (IPL), outer plexiform layer (OPL), and outer nuclear layer (ONL) were measured in all groups. Moreover, the numbers of terminal deoxynucleotidyl transferase dUTP nick-end-labeled [TUNEL (+)] cells and caspase-3 (+) cells in both INL and ONL were evaluated in all groups. Results: The administration of quercetin was found to reduce the thinning of all retinal layers. The mean thickness of INL in the quercetin and ischemic groups was 21 ± 5.6 µm and 16 ± 6.4 µm, respectively (P<0.05). Similarly, the mean thickness of ONL in the quercetin and ischemic groups was 50 ± 12.8 µm and 40 ± 8.7 µm, respectively (P<0.05). The antiapoptotic effect of quercetin in terms of reducing the numbers of both TUNEL (+) cells and caspase-3 (+) cells was significant in INL. The mean number of TUNEL (+) cells in INL in the ischemic and quercetin groups was 476.8 ± 45.6/mm2 and 238.72 ± 251/mm2, respectively (P<0.005). The mean number of caspase-3 (+) cells in INL of ischemic and quercetin groups was 633.6 ± 38.7/mm2 and 342.4 ± 36.1/mm2, respectively (P<0.001). Conclusion: The use of quercetin may be beneficial in the treatment of retinal I/R injury because of its antiapoptotic effect on the retinal layers, particularly in INL. .

Objetivo: O objetivo deste estudo é investigar o efeito da quercetina, contra a morte celular por apoptose induzida por lesão consequente à isquemia-reperfusão (I/R) na retina de ratos. Método: Vinte e quatro ratos foram divididos em quatro grupos iguais: controle, isquêmico, solvente e quercetina. O modelo lesão por I/R foi realizado por meio da elevação da pressão intraocular acima da pressão de perfusão, em todos os grupos. Injecções intraperitoneais de 20 mg/kg de quercetina ou sulfóxido de dimetilo (DMSO) foram realizadas nos grupos quercetina e solvente, respectivamente, imediatamente antes da lesão por I/R, permitindo que as retinas fossem reperfundidas. Quarenta e oito horas após a lesão, as espessuras de camada de células ganglionares da retina (RGCL), camada nuclear interna (INL), camada plexiforme interna (IPL), camada plexiforme externa (OPL), e a camada nuclear externa (ONL) foram medidas em todos os grupos. Além disso, o número de células TUNEL (+) e caspase-3 (+) tanto na camada nuclear interna quanto na camada nuclear externa foi avaliada em todos os grupos. Resultados: A administração de quercetina diminuiu o afinamento de todas as camadas da retina em comparação com o grupo isquêmico. A espessura média da camada nuclear interna nos grupos quercetina e isquêmico foi de 21 ± 5,6 µm e 16 ± 6,4 µm, respectivamente (p<0,05). A espessura média da camada nuclear externa no grupo quercetina e isquêmico foi 50 ± 12,8 µm e 40 ± 8,7 µm, respectivamente (p<0,05). O efeito anti-apoptótico de quercetina em termos de redução do número de células TUNEL (+) e caspase-3 (+) foi significativa na INL. O número médio de células TUNEL (+) da camada nuclear interna no grupo isquêmico e quercetina foi 476,8 ± 45,6/mm2 e 238,72 ± 251/mm2, respectivamente (p<0,005). O médio número de células de caspase-3 (+) na INL do grupo isquêmico e quercetina foi 633,6 ± 38,7/mm2 e 342,4 ± 36,1/mm2, respectivamente (p<0,001). Conclusão: A utilização ...

Macular dystrophy associated with Kjellin’s syndrome: a case report / Distrofia macular associada à síndrome de Kjellin: um relato de caso

Hereditary spastic paraplegia (HSP) is characterized by weakness and spasticity of the lower extremities. Kjellin’s syndrome is a rare syndrome associated with HSP. The syndrome is characterized by the presence of bilateral retinal flecks, similar to the findings in Stargardt disease and fundus flavimaculatus. We report the case of a 34-year-old male who presented with complete features of Kjellin’s syndrome, with typical retinal findings observed on multimodal imaging (spectral domain optical coherence tomography [SD-OCT], near-infrared reflectance and autofluorescence imaging). The ophthalmological changes at early stages of the disease may not impair visual acuity. Therefore, the detection of central retinal degeneration requires thorough fundus examination.

A paralisia espástica hereditária (HSP) é caracterizada por fraqueza e espasticidade das extremidades inferiores. A síndrome de Kjellin é uma rara associação de HSP com a presença de flecks retinianos similares aos encontrados em pacientes com doença de Stargardt ou fundus flavimaculatus. Descrevemos os achados em imagens multimodais da retina (tomografia de coerência óptica de domínio espectral [SD-OCT], reflectância próxima ao infravermelho e autofluorescência) em um paciente de 34 anos que apresenta conjunto completo de sinais e sintomas da síndrome de Kjellin. As alterações retinianas em estágios iniciais da doença podem aparecer, mesmo sem redução da acuidade visual, e por isso, para detecção da degeneração central da retina, é necessário exame minucioso do fundo de olho.

Endocardite infecciosa em câmaras direitas: discrepância entre evolução clínica e ecocardiográfica: relato de caso / Right-side infective endocarditis: discrepancy between clinical and echocardiographic evolution: case report

A endocardite infecciosa é uma patologia relativamente rara na prática clínica, e, apesar dos avanços em seu diagnóstico e tratamento, sua morbi-mortalidade ainda é significativa. Muitas vezes é difícil a identificação de suas complicações e a conduta frente a elas, ocorrendo com freqüência a dissociação entre a evolução clínica e os achados de exames complementares - principalmente ecocardiográficos. A decisão clínica torna-se ainda mais difícil frente às manifestações atípicas da doença, como a endocardite de câmaras direitas. Este é o relato de um caso raro de endocardite de câmaras direitas em uma paciente renal crônica, cuja piora dos achados ecocardiográficos se opunha à evolução clínica favorável. Esta situação pode suscitar dificuldade quanto aos critérios para indicação cirúrgica e a segurança do tratamento conservador.

Infective endocarditis is a relatively rare disease in clinical practice, with significant morbidity and mortality despite the improvements on its diagnosis and treatment. It is often difficult to identify its complications and define strategies for them. Dissociation between the clinical evolution and the findings from complementary tests (especially echocardiographic tests) is common. Clinical decisions become even more difficult when there are atypical manifestations of the disease, such as right-side endocarditis. This report is about a rare case of right-side endocarditis in a patient with chronic renal disease, in which there was a contradiction between worsening of the echocardiographic findings and clinical improvement. This situation may lead to difficulties regarding the criteria for indicating surgery and the safety of conservative clinical treatment.

Vascular access-related infections in HIV patients undergoing hemodialysis: case description and literature review

Poor immune status, the use of a vascular access different from an AV fistula, and intravenous drug use (IDU) may favor increased rates of vascular access infections among HIV infected patients on hemodialysis. Staphylococcus spp. and Streptococcus spp. are the main cause of these infections, but Gram-negative rods and fungi have been found as well. Using an AV fistula when possible, and eliciting a history of IVDU on every visit may prevent this type of infection. When infections are present, coverage for both Gram-positive and negative organisms is recommended. Additional studies specifically addressing the issue of vascular access infection in HIV infected patients are required.

Febre crônica associada a abscesso esplênico causado por Staphylococcus epidermidis / Chronic fever associated with splenic abscess due to Staphylococcus epidermidis

Abscessos ocultos são causa freqüente de febre crônica. Os abscessos esplênicos são entidades raras, usualmente associadas a quadros subjacentes de cirurgia abdominal, endocardite ou imunodepressão. Apresenta-se um caso de paciente com febre prolongada causada por um abscesso esplênico, cujo principal diagnóstico diferencial era leishmaniose visceral, que provavelmente esteve associado a traumatismo abdominal. O tratamento consistiu em antibioticoterapia seguida de esplenectomia.

Occult abscesses are frequent causes of chronic fever. Splenic abscesses are rare entities that are usually associated with underlying conditions such as abdominal surgery, endocarditis or immunodepression. We report on the case of a patient with prolonged fever caused by a splenic abscess, whose main differential diagnosis was visceral leishmaniasis. However, this condition was probably related to abdominal trauma. The treatment consisted of antibiotics followed by splenectomy.

Guias para el manejo de las infecciones osteoarticulares por Staphylococcus meticilino-resistente / [Guidelines for the management of bone and joint infections due to methicillin resistant staphylococci]

Bone and joint infections are a group of complicated diseases with high morbidity. Emerging resistant microorganisms and the use of prosthetic devices have increased the difficulty in the medical treatment of patients. The purpose of these guidelines is to offer information on the management of bone and joint infections (post-invasive septic arthritis, chronic osteomyelitis and infected arthroplasty) produced by methicillin resistant staphylococci. They are oriented to physicians dedicated to internal medicine, infectious diseases, trauma and orthopedist surgeons as well as to everybody interested in this issue. The guidelines mainly point to the rational use of diagnostic methods and describe the new treatment modalities. A group of experts analyzed the different strategies for diagnosing and treating bone and joint infections due to methicillin resistant staphylococci and attempted at setting a level of evidence level and the strength of each recommendation.

Staphylococcus aureus: incidência em pacientes hospitalizados e profissionais de saúde vinculados ao hospital das clínicas de Goiânia/UFG - Caracterizaçäo das amostras isoladas pela fagotipagem e antibiograma / Staphylococcus aureus: incidence in hospitalized patients and health professionals from the Hospital das Clínicas de Goiânia-UFG - Caracterization of isolated samples by the phage typing and antibiogram

Com a finalidade de detectar portadores de Staphylococcus aureus relacionados a ambiente hospitalar, foram amostrados, em duas ou três áreas corporais diferentes, 112 indivíduos ligados ao Hospital das Clínicas de Goiânia/UFG, sendo 92 pacientes hospitalizados e 20 profissionais, internados e lotados nas enfermarias de Obstetrícia, Ginecologia, Pediatria e Dermatologia. O percentual de portadores foi 39,1 pôr cento entre os pacientes internados e de 20,0 pôr cento entre os profissionais. Os pacientes internados forneceram um percentual de 20,9 pôr cento de amostras positivas para Staphylococcus aureus e os profissionais 12,5 pôr cento. A área anatômica que apresentou o maior frequencial de colonizaçäo foram as fossas nasais, para as quais encontrou-se um índice de 54,7 pôr cento entre os pacientes internados e 80,0 pôr cento entre os profissionais. A identificaçäo das amostras de Staphylococcus aureus pela fagotipagem revelou que 69,9 pôr cento das amostras isoladas dos pacientes internados foram tipáveis, havendo maior percentual (35,1 pôr cento) de cepas pertencentes ao grupo fágico III, além dos experimentais (32,5 pôr cento). Entre os profissionais, 60,0 pôr cento das amostras tipáveis, todas pertencentes ao grupo fágico III. O antibiograma demonstrou que, tanto as amostras provenientes dos pacientes internados como a dos profissionais, apresentaram resistência mais acentuada à Penicilina G cristalina, à Ampicilina e à Tetraciclina como também, maior sensibilidade à Amicacina, Cefalotina e Associaçäo Trimetoprim-sulfatoxazol (Bactrim)