Vegetative chronic genital herpes with satisfactory response to imiquimod

Abstract Vegetative chronic genital herpes is an atypical presentation of herpes simplex 2 that it is usually seen in patients coinfected with human immunodeficiency virus. Clinically, it is characterized by extensive ulcers that evolve to chronification and hypertrophic pseudotumor forms. Antiviral drugs are recommended for the treatment, and acyclovir is the most used one. Foscarnet is the treatment of choice to resistant cases, although treatment failure has been reported. We report a male patient, previously diagnosed with human immunodeficiency virus who developed vegetative chronic genital herpes resistant to acyclovir and successfully treated with imiquimod.

Hanseníase: o controle dos contatos no município de Londrina-PR em um período de dez anos / Lepra: el control de los contactos en el municipio de Londrina-PR en un periodo de diez años / Leprosy: control of household contacts in the municipality of Londrina-PR for a ten-year period

Estudo descritivo, com o objetivo de analisar variáveis relacionadas aos contatos de pacientes com hanseníase atendidos no município de Londrina, num período de dez anos. Os dados foram obtidos das fichas de comunicantes e do SINAN. Dentre os 1055 casos de hanseníase, foram registrados 3394 contatos, com média de 3,2. Os indivíduos mais expostos possuem até 40 anos de idade (71,5 por cento), sendo filhos/a (40,6 por cento) e esposo/a (17,8 por cento). Foram examinados 1731 (51,0 por cento) contatos, dos quais, 183 apresentavam algum sinal de hanseníase: confirmados 16 casos, descartados 47 e não concluíram a investigação 120 (65,6 por cento). A maioria dos contatos (51,6 por cento) foi exposta às formas multibacilares e 10,1 por cento comprovaram a efetivação de duas doses da BCG. Conclui-se que está havendo falhas no acompanhamento dos contatos.

The purpose of this descriptive study is to analyze variables related to leprosy patients' household contacts who received treatment in Londrina-PR-Brazil for a ten-year period. The data analysis was based on the health service's records and from a system of infectious disease. Out of 1055 leprosy's patients, it was recorded 3394 contacts with an average of 3,2. The most exposed individuals were those aged up to 40 (71,5 percent); son/daughter (40.6 percent) and husband/wife (17.8 percent). Of the1731 contacts (51.0 percent) examined, 183 showed some signs of the disease: there were 16 confirmed cases, 47 were excluded and 120 did not finish the clinical investigation. Most of the contacts (51.6 percent) were exposed to the multibacillary forms and 12.8 percent proved they were vaccinated with two doses of BCG. It is possible to conclude that the follow-up of the contacts was not adequate.

Estudio descriptivo, con el objetivo de analizar variables relacionadas a los contactos de pacientes con Lepra que son atendidos en el município de Londrina, en un período de diez años. Los datos fueron obtenidos en las fichas de los acompañantes y del SINAN (órgano del MInisterio de Salud que registra la ocurrencia de toda enfermedad transmisible). Entre los 1055 casos de hanseníase, fueron registrados 3394 contactos, con una media de 3,2. Los individuos más expuestos tienen hasta 40 años de edad (71,5 por ciento), siendo hijos/as (40,6 por ciento) y esposos/as (17,8 por ciento). Fueron examinados 1731 (51,0 por ciento) contactos, de los cuales, 183 presentaban alguna señal de la lepra: confirmados 16 casos, descartados 47 y sin concluir la investigación 120. La mayoría de los contactos (51,6 por ciento) fue expuesta a las formas multibacilares y 12,8 por ciento comprobó la administración de dos dosis de la BCG. Se concluye que está habiendo fallas en el acompañamiento de los contactos.

Terapia inmunomoduladora en el manejo del paciente con trasplante renal: el papel de los medicamentos antiproliferativos / Immunomodulation therapy in the handling of the patient with renal transplant: the paper of antiproliferation medicines

La terapia de inmunomodulación es un elemento vital en el adecuado manejo de los pacientes con trasplante renal. Grandes logros se ha obtenido con los medicamentos actuales en la disminución de episodios de rechazo agudo del injerto; sin embargo, este beneficio no parece mejorar el pronóstico de la sobrevida del injerto a largo plazo. Se ha postulado como una de las pirncipales causas a la disfunción crónica del injerto, el efecto nefrotóxico de los inhibidores de calcineurina, inmunomoduladores ampliamente utilizados en el manejo de estos pacientes. Por esta razón, emerge una nueva clase de medicamentos inmunomoduladores que se ofrecen como nefrotóxicos, son los medicamentos denomindados como antiproliferativos. Este documento presenta una revisión de las diferentes terapias para la inmunosupresión de los pacientes receptores de un trasplante renal y evaluar el papel de los medicamentos antiproliferativos con base en la evidencia científica disponible. Pablabras clave: trasplante renal, inmunomodulación, inhibidores de calcineurina, medicamentos antiproliferativos.

Survival and quality of life in HIV-positive patients treated with a polyantigenic immunomodulator

A polyantigenic immunomodulator (PAI), previously known as polyantigenic vaccine, which consists of a mixture of antigens of inactivated bacteria with antigens of influenza virus in a peanut-oil-arlacel-A-aluminium monoesterate emulsion, increased tumor resistance and induced tumor regression in tumor bearing mice. This report presents clinical and laboratory data that demonstrate the effect of PAI in long term prolongation of disease free state in HIV positive patients. A total of 40 patients, 35 males and 5 females, with a mean age of 41.1 +/- 10.5 years, ranging from 28 to 68 years, HIV positive by (ELISA and Western Blot), with no restriction on the CD4 + T lymphocytes counts, were included in this open study. The PAI regimen was one subcutaneous injection per week for patients with < 400 CD4 + lymphocytes and one monthly injection for patients with CD4 + count > 400. All patients were monitored at different intervals for lymphocyte counts, clinical condition and treatment toxicity. After a follow up of eight years 81 percent of the patients were alive and 47 percent were free of disease. In patients without AIDS, the weight was 153.9 +/- 28 pounds pre-PAI and 164.6 +/- 27 (P = 1.2 x 10(-4); the CD4 + lymphocyte count was 795 +/- 421 pre-PAI and 585 +/- 279 post PAI (P = 0.08). In patients alive with AIDS, the weight was 159.5 +/- 32 pre-PAI and 163.9 +/- 32 pounds post-PAI (P = 0.8); the CD4 + lymphocyte counts was 491 +/- 255 pre-PAI and 298 +/- 142 post-PAI (P = 0.08); and five AIDS-related infections occurred in five patients. In patients who died the weight was 157.7 +/- 23 pre and 146.8 +/- 30 post (P = 0.10); and the CD4 count was 340.7 +/- 149 pre and 103.4 +/- 88 post (P = 0.0057). All died with infection. No toxicity with the use of PAI was reported. PAI improves disease free survival and quality of life in HIV + patients