Neurotoxoplasmosis diagnosis for HIV-1 patients by real-time PCR of cerebrospinal fluid

Encephalitis caused by Toxoplasma gondii is the most common cause of central nervous system damage in patients with acquired immunodeficiency syndrome (AIDS). Toxoplasma may infect any of the brain cells, thus leading to non-specific neurotoxoplasmosis clinical manifestations including focused or non-focused signs and symptoms of central nervous system malfunction. Clinical development ranges from insidious display during weeks to experiencing acute general confusion or ultimately fatal onset. Cerebral toxoplasmosis occurs in advanced stages of immunodeficiency, and the absence of anti-toxoplasmosis antibodies by the immunofluorescence method does not allow us to rule out its diagnosis. As specific therapy begins, diagnosis confirmation is sought through clinical and radiological response. There are few accurate diagnosis methods to confirm such cases. We present a method for T. gondii DNA detection by real time PCR-Multiplex. Fifty-one patients were evaluated; 16 patients had AIDS and a presumptive diagnosis for toxoplasmosis, 23 patients were HIV-positive with further morbidities except neurotoxoplasmosis, and 12 subjects were HIV-negative control patients. Real time PCR-Multiplex was applied to these patients' cephalorachidian liquid with a specific T. gondii genome sequence from the 529bp fragment. This test is usually carried out within four hours. Test sensitivity, specificity, positive predictive value, and negative predictive value were calculated according to applicable tables. Toxoplasma gondii assay by real time Multiplex of cephalorachidian fluid was positive for 11 out of 16 patients with AIDS and a presumptive diagnosis for cerebral toxoplasmosis, while none of the 35 control patients displayed such a result. Therefore, this method allowed us to achieve 68.8 percent sensitivity, 100 percent specificity, 100 percent positive predictive value, and 87.8 percent negative predictive value. Real time PCR on CSF allowed high specificity...

Estudo da variabilidade da freqüência cardíaca em repouso de pacientes hemiparéticos por acidente vascular encefálico praticantes de natação / Study of the variability of cardiac frequency in hemiparethical patients that are training swimming

O estudo teve como objetivo de analisar a variabilidade da freqüência cardíaca em repouso dos pacientes hemiparéticos praticantes de natação. Compara-se 72 voluntários de ambos os sexos divididos em quatro grupos. No primeiro grupo, 18 pessoas, denominado NATAVE estão pessoas que praticam natação e que são portadores de AVE (acidente vascular encefálico), hemiparéticas em virtude do acidente vascular encefálico. No segundo grupo 18 pessoas, que praticavam natação não haviam sofrido AVE, grupo denominado NAT. No terceiro grupo 18 pessoas sedentárias, AVE (SEDAVE). O último grupo de 18 pessoas sedentárias sem AVE, denominado de SED. No desempenho desses voluntários se compara a Variação da Freqüência Cardíaca (VFC) entre pessoas sedentárias e as praticantes de natação. A análise se justifica porque a literatura pesquisada demonstra que não há artigos relacionando a freqüência cardíaca (FC) de repouso e a variabilidade da FC em pessoas hemiparéticas praticantes de natação. Verifica-se a braquicardia de repouso e o aumento da VFC no domínio do tempo nas pessoas com seqüela de AVE. Como método de VFC é não-invasivo ele propicia os meios mais adequados para avaliar as condições do sistema nervoso autômato. Foi detectada uma freqüência cardíaca menor naqueles indivíduos que praticam natação. A bradicardia em repouso, induzida pelos exercícios aeróbicos, ocorre pelos estímulos parassimpáticos que diminuem a freqüência cardíaca. No caso dos nadadores hemiparéticos também acontece adaptações fisiológicas importantes. Isso permite ao paciente maior segurança, possibilitando maior variabilidade de freqüência cardíaca com efetiva melhora em sua qualidade de vida.

This study has the objective of analyzing the variability of cardiac frequency in hemiparethical patients that swim. Seventy-two volunteers of both sexes were compared and divided into four groups. In the first group, with eighteen people, called NATAVE, are the swimmers that have CVA (Cerebrovascular accident), which cause them to be hemiparethical. In the second group, with another eighteen people, the swimmers have not suffered from CVA, and this group was called NAT. The third group has eighteen sedentary people without CVA. The last group with eighteen sedentary people was called SED. In the performance od these volunteers was compared the Cardiac Frequency Variation (CFV) between sedentary people and swimmers. The analysis is justified because the researched literature shows that there are no articles comparing the cardiac frequency (CF) of ease and the CF variability in hehemiparethical swimmers. It was noticed the ease bradycardia and the CFV increase in the people that have CVA. As the CFV method in non-invasive, it provides the most adequate paths to evaluate the conditions of automaton nervous system. It was detected a decreased cardiac frequency in those who practice swimming. The ease bradycardia, induced by aerobic exercises, happens through the parasympathetic stimulus that reduce the cardiac frequency. In the case of hemiparethical swimmers, important physiological adaptatios also happen. It allows the patient more safety, providing more cardiac frequency variability with effective improvement in his/her quality of life.

Agnosia auditiva surdez pura para palavras afasia de Wernicke sem alexia: aspectos clínicos e conceituais / Auditory agnosia, pure word deafness, Wernicke's aphasia without alexia: clinical and concepetial aspects

A agnosia auditiva e sindromes correlatas podem ter seu diagnóstico confundido com o das afasias. Descrevemos o caso de uma mulher de 32 anos que subitamente perdeu a capacidade de compreender a palavra falada e sons näo verbais,, embora a leitura e a escrita estivessem intactas e a fala espontânea fosse apenas muito discretamente disfásica. A investigaçäo mostrou isquemia extensa e bilateral do córtex temporal, secundária a anticoagulaçäo inadequada, após colocaçäo de prótese aórtica. O segundo paciente é um homem de 43 anos com súbita dificuldade para compreender a palavra falada, estando preservadas a compreensäo de sons näo verbais, leitura e escrita. A nosso ver, o primeiro caso corresponde à agnosia auditiva e o segundo à afasia de Wernicke sem alexia. Säo discutidos aspectos do diagnóstico diferencial e prognóstico das diferentes síndromes