Accuracy of mucocutaneous leishmaniasis diagnosis using polymerase chain reaction: systematic literature review and meta-analysis

The diagnosis of mucocutaneous leishmaniasis (MCL) is hampered by the absence of a gold standard. An accurate diagnosis is essential because of the high toxicity of the medications for the disease. This study aimed to assess the ability of polymerase chain reaction (PCR) to identify MCL and to compare these results with clinical research recently published by the authors. A systematic literature review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA Statement was performed using comprehensive search criteria and communication with the authors. A meta-analysis considering the estimates of the univariate and bivariate models was performed. Specificity near 100% was common among the papers. The primary reason for accuracy differences was sensitivity. The meta-analysis, which was only possible for PCR samples of lesion fragments, revealed a sensitivity of 71% [95% confidence interval (CI) = 0.59; 0.81] and a specificity of 93% (95% CI = 0.83; 0.98) in the bivariate model. The search for measures that could increase the sensitivity of PCR should be encouraged. The quality of the collected material and the optimisation of the amplification of genetic material should be prioritised.

Recurrent cutaneous leishmaniasis / Leishmaniose recidiva cútis

We present a case of an 18-year-old male patient who, after two years of inappropriate treatment for cutaneous leishmaniasis, began to show nodules arising at the edges of the former healing scar. He was immune competent and denied any trauma. The diagnosis of recurrent cutaneous leishmaniasis was made following positive culture of aspirate samples. The patient was treated with N-methylglucamine associated with pentoxifylline for 30 days. Similar cases require special attention mainly because of the challenges imposed by treatment.

Paciente do sexo masculino, 18 anos. Dois anos após tratamento insuficiente para leishmaniose tegumentar americana, apresentou, na mesma localização, lesão formada por cicatriz atrófica central e nódulos verrucosos na periferia. Era imunocompetente, hígido e negava qualquer trauma local. O diagnóstico de leishmaniose recidiva cutis foi feito através de cultura do aspirado da lesão. Realizou tratamento com N-metilglucamina (20mgSbV/kg/dia) associado à pentoxifilina (1200mg/dia) durante 30 dias alcançando cura clínica. Os casos semelhantes requerem atenção diferenciada pela dificuldade ao tratamento.

Stage II Chronic Maxillary Atelectasis Associated with Subclinical Visual Field Defect

Chronic maxillary atelectasis (CMA) is characterized by a persistent decrease in the maxillary sinus volume due to inward bowing of its walls. According to its severity, it may be classified into three clinical-radiological stages. Objective: To report a case of stage II CMA associated with subclinical visual field defect. Case Report: A 34-year-old woman presented with a 15-year history of recurrent episodes of sinusitis and intermittent right facial discomfort for the past 5 years. She denied visual complaints, and no facial deformities were observed on physical examination. Paranasal sinus computed tomography (CT) demonstrated a completely opacified right maxillary sinus with inward bowing of its walls, suggesting the diagnosis of stage II CMA. A computerized campimetry (CC) disclosed a scotoma adjacent to the blind spot of the right eye, indicating a possible damage to the optic nerve. The patient was submitted to functional endoscopic sinus surgery, with drainage of a thick mucous fluid from the sinus. She did well after surgery and has been asymptomatic since then. Postoperative CT was satisfactory and CC was normal. Discussion: CMA occurs because of a persistent ostiomeatal obstruction, which creates negative pressure inside the sinus. It is associated with nasosinusal symptoms but had never been described in association with any visual field defect. It can be divided into stage I (membranous deformity), stage II (bony deformity), and stage III (clinical deformity). The silent sinus syndrome is a special form of CMA. This term should only be used to describe those cases with spontaneous enophthalmos, hypoglobus, and/or midfacial deformity in the absence of nasosinusal symptoms...

Comparação dos fatores de risco e complicações da síndrome coronariana aguda entre pacientes com idade superior ou igual a 65 anos e aqueles com menor idade / Comparison of risk factors and complications of the acute coronary syndrome in patients aged over or equal to 65 years and those with younger age

Objetivo. Analisar os principais fatores de risco de síndrome coronariana aguda e as complicações mais frequentes em pacientes com idade igual ou superior a 65 anos hospitalizados em unidade de terapia intensiva, inclusos os casos de óbito após o evento coronariano. Método. Estudo retrospectivo, de revisão de prontuários de 740 pacientes admitidos com síndrome coronariana aguda na unidade de terapia intensiva do Hospital Santa Lúcia, Brasília, DF, no período de outubro de 2003 a fevereirode 2009. Compararam-se os dados dos 377 (51%) pacientes com idade igual ou superior a 65 anos com aqueles dos 363 (49%) pacientes com menos de 65 anos, com os testes qui ao quadrado ou exato de Fisher e Mann-Whitney. Considerou-se estatisticamente significante o valor de p ? 0,05. Resultados. Os portadores de síndrome coronariana aguda com idade igual ou superior a 65 anos, em relação àqueles com idade inferior a 65 anos, apresentam, com mais frequência, infarto agudo do miocárdio sem supradesnivelamento do segmento ST (p = 0,001), hipertensão arterial sistêmica (p = 0,009), diabetes melito tipo 2 (p < 0,0001), insuficiência renal crônica (p = 0,04), antecedente de acidente vascular encefálico (p = 0,01), arritmias (p = 0,01), insuficiênciacardíaca congestiva (0,01) e óbito (p < 0,0001). Conclusões. Houve diferença entre os fatores de risco com relação à idade. A hipertensão arterial sistêmica e o diabetes foram prevalentes na faixa etária igual ou acima dos 65 anos. Esses doentes têm seu curso hospitalar frequentemente acompanhado de complicações, principalmente arritmias e insuficiência cardíaca congestiva. O índice de mortalidadefoi maior nos pacientes com 65 anos de idade ou acima.

Objective. To analyze the risk factors for acute coronary syndrome and the complications in patients aged over or equal to 65 years hospitalized in an intensive care unit, including the mortality after coronary event.Method. Retrospective data collection with 740 patients admitted with acute coronary syndrome in an intensive care unit of Hospital Santa Lucia (Brasilia-DF, Brazil), from October 2003 to February 2009. Comparative analysis between the group of 377 (51%) patients aged over or equal to 65 years, and 363 (49%) patients younger than 65 yearswere performed. Data collection was based on the records, exams and interviews with patients or family members. Results. Patients aged over or equal to 65 years with acute coronary syndrome often have acute myocardial infarction without ST-segment elevation (p = 0.001), hypertension (p = 0.009), type 2 diabetes mellitus (p <0.0001), chronicrenal failure (p = 0.04), previous stroke (p = 0.01), arrhythmias (p = 0.01), congestive heart failure (0.01) and death (p <0.0001). Conclusions. There were differences of risk factors with age. High blood pressure and diabetes mellitus were prevalent in patients aged over or equal to 65 years. These patients have their hospital course frequently accompaniedby complications, especially arrhythmias, congestive heart failure. The mortality rate was higher in patients aged over or equal to 65 years.