Beneficios de la reparación artroscópica del manguito rotador en octogenarios. Análisis de resultados funcionales y complicaciones / Benefits of arthroscopic rotator cuff repair in octogenar ians. Analysis of functional results and complications

Resumen Introducción: Existe falta de información en la litera tura sobre los resultados de la reparación artroscópica del manguito rotador en pacientes mayores de 80 años. El objetivo de este estudio fue evaluar una serie conse cutiva de pacientes con rupturas del manguito rotador a los que se les realizó la reparación artroscópica del mismo. Métodos: Análisis retrospectivo de pacientes mayores de 80 años a quienes se les realizó reparación artroscó pica de manguito rotador entre junio de 2004 y enero de 2016. El seguimiento mínimo fue de 2 años. Para la evaluación funcional y del dolor se utilizaron las escalas Constant, Dash, UCLA y Escala Visual Análoga (EVA). Resultados: El seguimiento promedio fue de 8.4 años. Se obtuvieron mejoras significativas en la valoración del rango de movilidad y la evaluación de las escalas de Constant, Dash y UCLA, y EVA. No se registraron complicaciones mayores y solo 4 pacientes requirieron una re-operación. Conclusión: Los principales hallazgos obtenidos fue ron la mejoría funcional y del dolor en los pacientes mayores de 80 años operados por una ruptura completa del manguito rotador en forma artroscópica.

Abstract Introduction: There is a lack of information in the literature on the results of arthroscopic rotator cuff re pair in patients older than 80 years. The purpose of this study was to evaluate a consecutive series of patients with rotator cuff tears who underwent arthroscopic rotator cuff repair. Methods: Retrospective analysis of patients older than 80 years who underwent arthroscopic rotator cuff repair between June 2004 and January 2016. The mini mum follow-up was 2 years. For functional and pain assessment, the Constant, Dash, UCLA scale and Visual Analogue Scale (VAS) for pain were used. Results: The average follow-up was 8.4 years. Signifi cant improvements were obtained in the assessment of the range of motion and the evaluation of the Constant, Dash and UCLA scales, as well as in the VAS. No major complications were recorded and only 4 patients re quired a reoperation. Conclusion: The main findings obtained were func tional and pain improvement in patients over 80 years of age operated on for a complete arthroscopic rotator cuff tear.

Neurosífilis con neuropatía óptica y auditiva simultáneas en un paciente VIH positivo / Neurosyphilis with simultaneous optic and auditive involvement in an HIV-positive patient

Introducción: a partir del año 2000, los médicos han asistido a un retorno de la sífilis vinculado a prácticas sexuales no protegidas y con parejas múltiples, en especial entre hombres que tienen sexo con hombres. La coinfección Treponema pallidum/virus de la inmunodeficiencia humana (VIH) modifica tanto la historia natural de la sífilis, incrementando la incidencia de neurosífilis temprana, como la respuesta al tratamiento con penicilina. Métodos: un paciente varón, peruano, de 36 años, seropositivo para VIH, consulta por dis-minución de la agudeza visual en ojo derecho, pérdida de la audición, tinnitus, mareos y vértigo. Refería antecedentes de sífilis en los 2 años previos. Resultados: el examen oftalmológico efectuado al paciente mostró células en el segmento anterior del ojo derecho. El fondo de ojo reveló la existencia de inflamación del nervio óptico asociada con panuveítis. En base a los hallazgos clínicos, los valores de VDRL en suero y líquido cefalorraquídeo (LCR) se diagnosticó neurosífilis (NS) con neuritis óptica, panuveítis y otosífilis en un paciente coinfectado por VIH. El paciente fue tratado con penicilina G sódica intravenosa, 4 millones de UI cada 4 horas, durante 2 semanas con buena respuesta clínica. Discusión: el compromiso de los pares craneales óptico y auditivo puede representar la manifestación de una NS temprana, en especial, en el contexto de un paciente VIH positivo. De acuerdo con nuestro conocimiento, este sería el segundo caso publicado de compromiso simultáneo del nervio óptico y del aparato vestíbulo-coclear en un paciente con NS.

Introduction: from the 2000s, the physicians experienced a return of syphilis, which may be related to unrestricted sexual behaviour with unprotected contact between multiple partners, especially in men who have sex with men. Concurrent infection with human immunodeficiency virus (HIV) alters the natural history of syphilis by increasing the frequency of early neurosyphilis and the response to penicillin. Methods: a 36-year-old Peruvian man, seropositive for HIV infection, was admitted to the hospital with decreased visual acuity in his right eye, hearing loss, tinnitus, buzzing, and vertigo. He referred history of syphilis in the previous two years. Results: oph-thalmological examination was performed. Ocular anterior segment examination of the right eye showed cells. Fundoscopy revealed swelling of the right optic disc with panuveitis. Diagnosis of neurosyphilis (NS) with optic and ear neuritis, and concurrent HIV infection was made, based on the clinical manifestations and serum and cerebrospinal VDRL titers. The patient was treated with intravenous penicillin (four million units every four hours for two weeks) with an excellent clinical response. Discussion: simultaneous optic and auditive cranial nerve involvement can manifest early neurosyphilis (NS) and HIV coinfection. This is the second report to describe the simultaneous occurrence of syphilitic optic neuritis with vestibulocochlear nerve involvement.

Proposal of an obesity classification based on weight history: an official document by the Brazilian Society of Endocrinology and Metabolism (SBEM) and the Brazilian Society for the Study of Obesity and Metabolic Syndrome (ABESO)

ABSTRACT Obesity is a chronic disease associated with impaired physical and mental health. A widespread view in the treatment of obesity is that the goal is to normalize the individual's body mass index (BMI). However, a modest weight loss (usually above 5%) is already associated with clinical improvement, while weight losses of 10%-15% bring even further benefits, independent from the final BMI. The percentage of weight reduction is accepted as a treatment goal since a greater decrease in weight is frequently difficult to achieve due to metabolic adaptation along with environmental and lifestyle factors. In this document, the Brazilian Society of Endocrinology and Metabolism (SBEM) and the Brazilian Society for the Study of Obesity and Metabolic Syndrome (ABESO) propose a new obesity classification based on the maximum weight attained in life (MWAL). In this classification, individuals losing a specific proportion of weight are classified as having "reduced" or "controlled" obesity. This simple classification - which is not intended to replace others but to serve as an adjuvant tool - could help disseminate the concept of clinical benefits derived from modest weight loss, allowing individuals with obesity and their health care professionals to focus on strategies for weight maintenance instead of further weight reduction. In future studies, this proposed classification can also be an important tool to evaluate possible differences in therapeutic outcomes between individuals with similar BMIs but different weight trajectories.

Diferenciación de la patología tumoral musculoesquelética benigna y maligna utilizando la técnica de difusión con resonancia magnética / Differentiation of benign and malignant musculoskeletal tumor pathology using the diffusion technique with magnetic resonance imaging

Resumen Introducción: La imagen ponderada en difusión es una técnica de imagen funcional que aporta información complementaria a las secuencias convencionales de resonancia magnética. El coeficiente de difusión aparente (CDA) se valora junto con la secuencia de difusión, calculando el logaritmo negativo de la proporción de intensidades de dos conjuntos de imágenes, lo que permite el análisis cuantitativo de la restricción a la difusión. Objetivo: Determinar si existe una diferencia significativa entre los valores de CDA de las lesiones musculoesqueléticas benignas y malignas, correlacionando los resultados con los hallazgos histológicos. Método: Estudio prospectivo, observacional y descriptivo. Se incluyeron en el trabajo pacientes con sospecha de lesiones tumorales del sistema musculoesquelético de cualquier edad y sexo, sin antecedentes de radioterapia previa o cirugía, evaluados con resonancia magnética y con posterior biopsia o cirugía. Resultados: Se incluyeron 170 pacientes, de los cuales 80 (44 benignos) eran hombres y 90 (43 benignos) eran mujeres. El total fue de 87 lesiones benignas y 83 lesiones malignas, con una media de CDA de 1,44 ± 0,55 × 10−3 mm2/s y de 0,96 ± 0,4 × 10−3 mm2/s, respectivamente, con una diferencia estadísticamente significativa (p < 0,001; 6,335; 168). Conclusiones: Los valores de difusión, y particularmente el CDA, han aportado información adicional en la caracterización de los tumores benignos y malignos, con diferencia significativa, estableciendo valores altos de CDA para los tumores benignos.

Abstract Introduction: Diffusion-weighted imaging is a functional imaging technique that provides complementary information to conventional magnetic resonance imaging sequences. The apparent diffusion coefficient (ADC) is evaluated together with the diffusion sequence, calculating the negative logarithm of the intensity ratio of two image sets, allowing the quantitative analysis of the diffusion. Objective: To determine if there is a statistical significance between the ADC values of benign and malignant musculoskeletal lesions, correlating the results with the histological findings. Method: Prospective, observational and descriptive study. Patients with suspected tumoral lesions of the musculoskeletal system of any age and sex, with no history of prior radiation therapy or surgery, evaluated with resonance with subsequent biopsy or surgery. Results: This study included 170 patients. Male patients were 80 (44 benign), and female patients were 90 (43 benign). The total was 87 benign lesions and 83 malignant lesions, with a mean ADC of 1.44 ± 0.55 × 10−3 mm2/s and 0.96 ± 0.4 × 10−3 mm2/s respectively, with a statistical significance (p < 0.001; 6.335; 168). Conclusions: Diffusion and, in particular, ADC values have provided additional information in the characterization of benign and malignant tumors, with a statistical significance, establishing high ADC values for benign tumors.

Metástasis infecciosas en pacientes pediátricos con bacteriemia por Staphylococcus aureus asistidos en el Hospital de Niños de La Plata, Argentina / Metastatic infections in pediatric patients with Staphylococcus aureus bacteremia assisted at a children's hospital in La Plata, Argentina

Introducción. Staphylococcus aureus es uno de los agentes infecciosos más prevalentes en niños y puede causar un variado espectro de presentaciones clínicas. La bacteriemia por S. aureus se asocia frecuentemente con complicaciones y metástasis infecciosas. Los datos epidemiológicos y clínicos sobre esta entidad, y sus complicaciones en pediatría son escasos. Objetivos. Describir la epidemiología, frecuencia, distribución y tipo de metástasis infecciosas en una serie de pacientes pediátricos con bacteriemia por S. aureus y evaluar posibles factores de riesgo para su aparición. Población y métodos. Estudio de corte transversal de pacientes pediátricos internados con bacteriemia por S. aureus en un hospital pediátrico de La Plata entre enero de 201 y junio de 2019. Resultados. Se analizaron 112 episodios de bacteriemia por S. aureus. La tasa de infección metastásica fue del 34,8 %; el pulmón fue la localización más frecuente. Los factores de riesgo principales para el desarrollo de metástasis infecciosas fueron la bacteriemia por S. aureus meticilino resistente (OR : 2,95; IC95 %: 1,19-7,83; p = 0,015) y la persistencia de hemocultivos de control positivos a las 48 horas (OR: 3,17; IC95 %: 1,22-8,46; p = 0,012). Conclusión. La tasa de metástasis infecciosas en pacientes con bacteriemia por S. aureus fue del 34,8 %. Los factores de riesgo asociados fueron la bacteriemia por S. aureus meticilino resistente y la persistencia de hemocultivos de control positivos a las 48 horas. Los órganos más afectados fueron el pulmón, el sistema osteoarticular, la piel y partes blandas.

Introduction. Staphylococcus aureus is one of the most prevalent infectious agents in children and may cause a wide variety of clinical presentations. S. aureus bacteremia is frequently associated with complications and metastatic infections. The epidemiological and clinical data about S. aureus bacteremia and its complications in pediatrics are scarce. Objectives. To describe the epidemiology, frequency, distribution, and type of metastatic infections in a series of pediatric patients with S. aureus bacteremia and assess possible risk factors for its development. Population and methods. Cross-sectional study of pediatric patients with S. aureus bacteremia admitted to a children's hospital of La Plata between January 2016 and June 2019. Results. A total of 112 S. aureus bacteremia events were analyzed. The rate of metastatic infection was 34.8 %; the lung was the most common infection site. The main risk factors for the development of metastatic infections were bacteremia due to methicillin-resistant S. aureus (odds ratio: 2.95; 95% confidence interval: 1.19-7.83; p = 0.015) and persistent positive control blood cultures at 48 hours (odds ratio: 3.17; 95 % confidence interval: 1.22-8.46; p = 0.012). Conclusion. The rate of metastatic infections among patients with S. aureus bacteremia was 34.8 %. Associated risk factors were bacteremia due to methicillin-resistant S. aureus and persistent positive control blood cultures at 48 hours. The most common organs affected included the lungs, the osteoarticular system, and the skin and soft tissue.

Ulnar two-point discrimination following endoscopic carpal tunnel release / La liberación endoscópica del túnel carpiano y la prueba de discriminación de dos puntos del nervio cubital

Abstract Carpal tunnel syndrome is median nerve symptomatic compression at the level of the wrist, characterized by increased pressure within the carpal tunnel and decreased nerve function at the level. Carpal tunnel release decreases pressure in Guyon's canal, via open techniques, with symptom and two-point discrimination improvement in the ulnar nerve distribution. We hypothesize that endoscopic carpal tunnel release improves two-point discrimination in the ulnar nerve distribution as well. This study includes 143 patients who underwent endoscopic carpal tunnel release between April 2016 to June 2019 in a single, community-based teaching hospital. A comprehensive retrospective chart review was performed on patient demographics, preand post-operative two-point discrimination test results, and complications. The effects of sex, age, and diabetes mellitus in the ulnar and median nerve territories with two-point discrimination tests were analyzed. As well as the differences in two-point discrimination among patient's based on their smoking status. There were significant post operative improvements in both the median (7.7 vs 4.4 mm, p < 0.001) and ulnar (5.7 vs 4.1 mm, p < 0.001) nerve territories. Smoking status, sex, age and diabetes did not significantly affect two-point discrimination outcomes. In conclusion the endoscopic release of the transverse carpal ligament decompresses the carpal tunnel and Guyon's canal, demonstrating improvement in two-point discrimination in both the ulnar and median nerve distributions.

Resumen El síndrome de túnel carpiano es la compresión sintomática del nervio mediano al nivel de la muñeca. Se caracteriza por un aumento de presión dentro del túnel y una disminución de la función del nervio a ese nivel. La liberación del túnel carpiano descomprime el canal de Guyon, con mejoría sintomática y en la prueba de discriminación de dos puntos en la distribución del nervio cubital. Hipotetizamos que la liberación endoscópica mejora de la misma manera en la distribución del nervio cubital. Este trabajo incluye 143 pacientes que tuvieron liberación endoscópica del túnel carpiano entre abril del 2016 y junio del 2019 en un hospital Universitario de la comunidad. Se evaluaron retrospectivamente las historias clínicas para los datos demográficos, los resultados pre y post quirúrgicos en la prueba de discriminación de dos puntos y complicaciones. Se analizaron los efectos del sexo, edad, tabaco y diabetes en los resultados de la prueba de discriminación de dos puntos para los nervios cubital y mediano. Hubo mejoría significativa post quirúrgica en la prueba de discriminación de dos puntos para los nervios mediano (7.7 vs 4.4 mm, p < 0.001) y cubital (5.7 vs 4.1 mm, p < 0.001). Fumadores, sexo, edad, y diabetes no afectaron de forma significativa. Concluimos que la liberación endoscópica del ligamento transverso del carpo descomprime el túnel carpiano y el canal de Guyon con mejoría en la prueba de discriminación de dos puntos para los nervios cubital y mediano.

Tuberculosis en húmero proximal. Un diagnóstico infrecuente en infecciones articulares / Tuberculosis in the proximal humerus. A rare diagnosis in joint infections

Resumen La incidencia de Tb osteoarticular es mucho menor que la pulmonar, representando 1-2% de los casos de Tuberculosis (Tb) y el 10% de los casos de Tb extrapulmonar, por lo que usualmente no es considerada para el diagnóstico diferencial de pacientes con enfermedad articular. Su diagnóstico es difícil y se basa en hallazgos clínicos, radiológicos, bacteriológicos e histológicos. Las lesiones extrapulmonares son paucibacilares y las muestras, en la mayoría de los casos, difíciles de obtener, por lo que el diagnóstico a menudo es simplemente presuntivo. La tuberculosis articular en etapas tempranas, presenta manifestaciones clínicas e imagenológicas inespecíficas. Esto puede facilitar la progresión de la enfermedad local, generando lesiones osteoarticulares graves y, finalmente, la destrucción articular. Se presenta el caso de una paciente de 60 años, intervenida quirúrgicamente por presentar manifestaciones clínicas e imagenológicas compatibles con una ruptura del manguito rotador, y cuya evolución tórpida posoperatoria, llevó al diagnóstico bacteriológico de tuberculosis de húmero proximal.

Abstract The incidence of osteoarticular TB is much lower than that of the lung, representing 1-2% of TB cases and 10% of extrapulmonary TB cases, so it is often not considered for the differential diagnosis of patients with joint disease. Its diagnosis is difficult and is based on clinical, radiological, bacteriological and histological findings. Extrapulmonary lesions are paucibacillary and specimens, in most cases, difficult to obtain, so the diagnosis is often simply presumptive. Joint tuberculosis in early stages presents nonspecific clinical and imaging manifestations. This can lead to the progression of the local disease, generating severe osteoarticular lesions and, finally, joint destruction. We present the case of a 60-year-old patient who underwent surgery due to clinical and imaging manifestations compatible with a rotator cuff tear, and whose torpid postoperative evolution led to the bacteriological diagnosis of proximal humerus tuberculosis.

Bovine tuberculosis in safari park in Brazil / Tuberculose bovina em parque safári no Brasil

Bovine tuberculosis (bTB) is an infectious disease caused by Mycobacterium bovis, affecting domestic animals, wild animals and humans. In captivity, for wild animals, bTB represents a risk to animal keepers and zoo visitors, in addition to the possibility of spreading the infection to domestic animals or through the trade of infected wild animals. Sambar (Cervus unicolor), red deer (Cervus elaphus) and fallow deer (Dama dama) from a safari park in the State of Rio Grande do Sul, Brazil, showed a clinical condition of dyspnea and weight loss. Some animals died and showed lesions suggestive of tuberculosis (LST), which were confirmed by histopathology. After the interdiction of the safari park by the state veterinary authorities, 281 deer were euthanized with the authorization of the "Instituto Brasileiro do Meio Ambiente e dos Recursos Naturais Renováveis" (IBAMA). Retropharyngeal and submandibular lymph nodes and viscera were collected from 21 animals, which were grown in Stonebrink medium for up to 90 days. After DNA extraction from the bacterial colonies, PCR was performed for targets flanking the region of differentiation 4 (RD4). Of the 21 samples, 14 (66.7%) presented LST with a granulomatous appearance, a whitish coloration, and caseous or calcified consistency, and seven samples (33.3%), showed no lesions. In the culture of 14 samples with LST, 13 (92.8%) presented bacterial growth compatible with M. bovis. In the cultivation of the seven samples without LST, four (57.1%) presented colonies compatible with M. bovis. PCR and DNA sequencing of the PCR amplicons detected as positive all the 17 (100%) bacteriological cultures suggestive of M. bovis, thus confirming the outbreak of bTB in deer. Decisions about positive tested and suspicious animals should be taken based on the evaluation of the risk of transmission to the rest of the zoological animals, animal welfare, conservation considerations and, the zoonotic potential of this pathogen.(AU)

A tuberculose bovina (bTB) é uma doença infecciosa causada por Mycobacterium bovis, afetando animais domésticos, animais selvagens e humanos. Para animais selvagens em cativeiro, a bTB representa um risco para os tratadores de animais e visitantes do zoológico, além da possibilidade de espalhar a infecção para animais domésticos ou por meio do comércio de animais silvestres infectados. Cervídeos sambar (Cervus unicolor), veado-vermelho (Cervus elaphus) e gamo (Dama dama) de um parque safári no Estado do Rio Grande do Sul, Brasil, mostraram uma condição clínica de dispneia e perda de peso. Alguns animais morreram e apresentaram lesões sugestivas de tuberculose (LST), as quais foram confirmadas por histopatologia. Após a interdição do parque safári pelas autoridades veterinárias estaduais, 281 veados sofreram eutanásia com a autorização do Instituto Brasileiro do Meio Ambiente e dos Recursos Naturais Renováveis (IBAMA). Os linfonodos retrofaríngeos e submandibulares e vísceras foram coletados de 21 animais, que foram cultivados em meio Stonebrink por até 90 dias. Após extração de DNA das colônias bacterianas, foi realizada PCR para alvos que flanqueavam a região de diferenciação 4 (RD4). Das 21 amostras, 14 (66,7%) apresentaram LST com aspecto granulomatoso, coloração esbranquiçada e consistência caseosa ou calcificada, e sete amostras (33,3%) não apresentaram lesões. Na cultura de 14 amostras com LST, 13 (92,8%) apresentaram crescimento bacteriano compatível com M. bovis. No cultivo das sete amostras sem LST, quatro (57,1%) apresentaram colônias compatíveis com M. bovis. A PCR e o sequenciamento de DNA dos fragmentos de PCR detectaram como positivo todas as 17 (100%) culturas bacteriológicas sugestivas de M. bovis, confirmando assim o surto de bTB em cervídeos. As decisões sobre animais positivos testados e suspeitos devem ser tomadas com base na avaliação do risco de transmissão para o restante dos animais zoológicos, bem-estar animal, considerações de conservação e no potencial zoonótico desse patógeno.(AU)

Bovine tuberculosis in safari park in Brazil

ABSTRACT: Bovine tuberculosis (bTB) is an infectious disease caused by Mycobacterium bovis, affecting domestic animals, wild animals and humans. In captivity, for wild animals, bTB represents a risk to animal keepers and zoo visitors, in addition to the possibility of spreading the infection to domestic animals or through the trade of infected wild animals. Sambar (Cervus unicolor), red deer (Cervus elaphus) and fallow deer (Dama dama) from a safari park in the State of Rio Grande do Sul, Brazil, showed a clinical condition of dyspnea and weight loss. Some animals died and showed lesions suggestive of tuberculosis (LST), which were confirmed by histopathology. After the interdiction of the safari park by the state veterinary authorities, 281 deer were euthanized with the authorization of the Instituto Brasileiro do Meio Ambiente e dos Recursos Naturais Renováveis (IBAMA). Retropharyngeal and submandibular lymph nodes and viscera were collected from 21 animals, which were grown in Stonebrink medium for up to 90 days. After DNA extraction from the bacterial colonies, PCR was performed for targets flanking the region of differentiation 4 (RD4). Of the 21 samples, 14 (66.7%) presented LST with a granulomatous appearance, a whitish coloration, and caseous or calcified consistency, and seven samples (33.3%), showed no lesions. In the culture of 14 samples with LST, 13 (92.8%) presented bacterial growth compatible with M. bovis. In the cultivation of the seven samples without LST, four (57.1%) presented colonies compatible with M. bovis. PCR and DNA sequencing of the PCR amplicons detected as positive all the 17 (100%) bacteriological cultures suggestive of M. bovis, thus confirming the outbreak of bTB in deer. Decisions about positive tested and suspicious animals should be taken based on the evaluation of the risk of transmission to the rest of the zoological animals, animal welfare, conservation considerations and, the zoonotic potential of this pathogen.

RESUMO: A tuberculose bovina (bTB) é uma doença infecciosa causada por Mycobacterium bovis, afetando animais domésticos, animais selvagens e humanos. Para animais selvagens em cativeiro, a bTB representa um risco para os tratadores de animais e visitantes do zoológico, além da possibilidade de espalhar a infecção para animais domésticos ou por meio do comércio de animais silvestres infectados. Cervídeos sambar (Cervus unicolor), veado-vermelho (Cervus elaphus) e gamo (Dama dama) de um parque safári no Estado do Rio Grande do Sul, Brasil, mostraram uma condição clínica de dispneia e perda de peso. Alguns animais morreram e apresentaram lesões sugestivas de tuberculose (LST), as quais foram confirmadas por histopatologia. Após a interdição do parque safári pelas autoridades veterinárias estaduais, 281 veados sofreram eutanásia com a autorização do Instituto Brasileiro do Meio Ambiente e dos Recursos Naturais Renováveis (IBAMA). Os linfonodos retrofaríngeos e submandibulares e vísceras foram coletados de 21 animais, que foram cultivados em meio Stonebrink por até 90 dias. Após extração de DNA das colônias bacterianas, foi realizada PCR para alvos que flanqueavam a região de diferenciação 4 (RD4). Das 21 amostras, 14 (66,7%) apresentaram LST com aspecto granulomatoso, coloração esbranquiçada e consistência caseosa ou calcificada, e sete amostras (33,3%) não apresentaram lesões. Na cultura de 14 amostras com LST, 13 (92,8%) apresentaram crescimento bacteriano compatível com M. bovis. No cultivo das sete amostras sem LST, quatro (57,1%) apresentaram colônias compatíveis com M. bovis. A PCR e o sequenciamento de DNA dos fragmentos de PCR detectaram como positivo todas as 17 (100%) culturas bacteriológicas sugestivas de M. bovis, confirmando assim o surto de bTB em cervídeos. As decisões sobre animais positivos testados e suspeitos devem ser tomadas com base na avaliação do risco de transmissão para o restante dos animais zoológicos, bem-estar animal, considerações de conservação e no potencial zoonótico desse patógeno.

Gingival carcinoma cuniculatum mimicking a reactive/inflammatory process / Carcinoma cuniculado gengival mimetizando um processo inflamatório/reativo

ABSTRACT Carcinoma cuniculatum (CC), a rare variant of oral squamous cell carcinoma, presents well-differentiated neoplastic epithelial cells infiltrating the underlying submucosal or bone tissues, forming the so-called "rabbit burrows" filled with keratin. A 67-year-old female patient was referred complaining of a painless tumoral mass in the left mandibular body, with several months of evolution. Previous history indicated extraction of the teeth #37 and #38 and diagnosis of chronic suppurative osteomyelitis. A deep incisional biopsy revealed CC. Due to its microscopic features, suggesting an inflammatory or reactive process, strict clinicopathological correlation is necessary for the correct diagnosis of CC.

RESUMEN El carcinoma cuniculatum (CC), una variante del carcinoma de células escamosas oral, presenta células epiteliales neoplásicas bien diferenciadas que se infiltran en la submucosa o en el tejido óseo subyacente, formando la llamada "madriguera de conejo", rellenada con queratina. Reportamos el caso de una paciente de 67 años con quejas de una masa tumoral asintomática en el cuerpo mandibular izquierdo con varios meses de evolución. La historia previa apuntó exodoncia de los dientes 37 y 38 y diagnóstico de osteomielitis supurativa crónica. Una biopsia incisional profunda reveló CC. Debido a las características microscópicas, que sugirieron un proceso inflamatorio o reactivo, es necesaria una estrecha correlación clinicopatológica para el diagnóstico correcto del CC.

RESUMO O carcinoma cuniculado (CC), uma rara variante do carcinoma espinocelular oral, apresenta células epiteliais neoplásicas bem diferenciadas que se infiltram na submucosa ou no tecido ósseo subjacente, formando a chamada "toca de coelho", preenchida por queratina. Relatamos o caso de uma paciente de 67 anos que foi encaminhada apresentando uma massa tumoral assintomática no corpo mandibular esquerdo com vários meses de evolução. A história prévia indicou exodontia dos dentes 37 e 38 e diagnóstico de osteomielite supurativa crônica. Uma biópsia incisional profunda revelou CC. Devido às características microscópicas, as quais sugeriram um processo inflamatório ou reativo, é necessário estrita correlação clinicopatológica para o correto diagnóstico do CC.

False-negative reactions to the comparative intradermal tuberculin test for bovine tuberculosis / Reações falso-negativas ao teste cervical comparativo para tuberculose bovina

According to the Brazilian National Program for the Control and Eradication of Animal Brucellosis and Tuberculosis (PNCEBT), the routine tests for the diagnosis of bovine tuberculosis in the country are the simple intradermal tuberculin test (SITT) of the Ministry of Agriculture, Livestock and Food Supply (MAPA), the caudal fold test and the comparative intradermal tuberculin test (CITT). The latter is also used as a confirmatory test. A group of 53 animals from three dairy herds in a focal area for bovine tuberculosis, that were submitted to depopulation in the state of Rio Grande do Sul, were submitted to the CITT. Tissues were cultured and the resulting colonies were confirmed by PCR and DNA sequencing. Among the 53 animals analyzed using the CITT, 32 (60.4%) were negative, 14 (26.4%) were positive and seven (13.2%) results were inconclusive. The CITT detected 11 of the 39 animals with culture-confirmed M. bovis infection as positive. Among the total of 14 uninfected animals based on cultures, the CBT detected eight as negative. Thus, the CITT demonstrated sensitivity of 28.2% and specificity of 57.1% for the population sampled. A total of 24/32 (75.0%) of the animals with negative CITT results were culture positive (confirmed by PCR) and were considered false negatives based on the CITT. The maintenance of these false-negative animals in herds has serious implications for the control of the disease, since they can be a source of infection. The addition of complementary tests could help identify such animals and increase the odds of diagnostic success.(AU)

No Brasil, segundo o Programa Nacional de Controle e Erradicação da Brucelose e Tuberculose Animal (PNCEBT), do Ministério da Agricultura, Pecuária e Abastecimento (MAPA), os testes de rotina para o diagnóstico de tuberculose bovina são o teste cervical simples (TCC), o teste da prega caudal (TPC) e o teste cervical comparativo (TCC), sendo que o último também é utilizado como teste confirmatório. Um grupo de 53 animais oriundos de três rebanhos leiteiros de área de foco para tuberculose bovina que foram submetidos a vazio sanitário no Rio Grande do Sul foi submetido ao TCC. Os tecidos destes animais foram cultivados e as colônias resultantes confirmadas por PCR e sequenciamento de DNA. Dos 53 animais analisados no TCC, 32 (60,4%) foram negativos, 14 (26,4%) positivos e sete (13,2%) inconclusivos, com base no PNCEBT. O TCC detectou como positivos 11 dos 39 animais com infecção por M. bovis confirmada por cultivo. Do total de 14 animais não infectados, baseado na cultura, o TCC detectou oito como negativos. Assim, o TCC apresentou, para a população amostrada, sensibilidade de 28,2% e especificidade de 57,1%. Um total de 24/32 (75,0%) dos animais negativos ao TCC foi positivo no cultivo (confirmado por PCR), sendo considerados falso-negativos ao TCC. A manutenção destes animais falso-negativos nos rebanhos tem sérias implicações para o controle da enfermidade, já que os mesmos podem ser fonte de infecção. A adição de testes complementares poderia auxiliar na identificação destes animais, aumentando a cobertura diagnóstica.(AU)

Effect of Erosion/Abrasion Challenge on the Dentin Tubule Occlusion Using Different Desensitizing Agents

The aim of the study was to evaluate dentinal tubule occlusion, measuring the dentin permeability (Lp) and using different desensitizing agents before and after abrasive/erosive challenge. Dentin discs from 42 healthy human third molars were obtained. Minimum Lp was measured after a smear layer simulation using #600 SiC paper and maximum Lp after an immersion in 0.5 M EDTA. The specimens were treated with different desensitizers: two varnishes (Clinpro XT Varnish-CV, Fluor Protector-FP), a paste (Desensibilize Nano P-NP) and a gel (Oxa Gel-OG). The Lp of each specimen was measured immediately after the desensitizers’ application. The discs were subjected to erosion/abrasion cycles for 7 days, with 0.5% citric acid solution (6x/day) and tooth brushing (3x/day). Lp was measured after the first, fourth and seventh day of the challenge. The data were analyzed by 3-way ANOVA with repeated measurements and by a Games-Howell test (α=5%). FP and CV did not show significant differences in Lp immediately after application until the 7th day (p<0.05). OG showed a significant increase in Lp after the 4th and 7th days. NP resulted in a significantly higher permeability compared to the other materials immediately after the application and after the 1st day of challenge. All the desensitizers reduced the dentin permeability immediately after application. However, only the varnishes were able to maintain the occlusive effect after the erosion/abrasion challenge.

Resumo O objetivo do estudo foi avaliar a permeabilidade da dentina (Lp) usando diferentes agentes dessensibilizantes antes e depois de um desafio abrasivo/erosivo. Discos de dentina foram obtidos a partir 42 terceiros molares humanos. Lp mínima foi medida após uma simulação de smear layer usando lixa de SiC # 600 e a Lp máxima foi medida após imersão em EDTA 0,5 M. As amostras foram tratadas com diferentes dessensibilizantes: dois vernizes (Fluor Protector-FP, Clinpro XT Varnish-CV), uma pasta (Desensibilize Nano P-NP) e um gel (Oxa Gel-OG). A Lp de cada amostra foi medida imediatamente após a aplicação dos dessensibilizantes. Os discos foram submetidos a um ciclo de erosão/abrasão durante 7 dias, com uma solução de 0,5% de ácido cítrico (6x/dia) e escovação (3x/dia). Lp foi medida do primeiro ao sétimo dia do desafio. Os dados foram analisados por ANOVA a 3 critérios com medidas repetidas e teste de Games-Howell (α=5%). FP e CV demonstraram Lp semelhante imediatamente depois da aplicação até 7 dias (p<0,05). OG apresentou um aumento significativo na Lp depois do 4º e 7º dias. NP resultou numa permeabilidade significativamente mais elevada comparada com a dos outros materiais imediatamente após a aplicação e após o primeiro dia de desafio. Todos os dessensibilizantes reduziram a permeabilidade da dentina imediatamente após a aplicação. No entanto, apenas os vernizes foram capazes de manter o efeito oclusivo após o desafio da erosão/abrasão.

Estado atual do tratamento dos defeitos do septo atrial / Current status of the treatment of atrial septal defects

A comunicação interatrial tipo ostium secundum (CIA OS) é uma cardiopatia congênita relativamente frequente, que causa repercussão hemodinâmica para o ventrículo direito, com sobrecarga volumétrica e dilatação da câmara. A maioria dos pacientes é assintomática, porém sintomas podem aparecer depois da segunda década de vida. O tratamento eletivo é usualmente realizado próximo ao quinto ano de vida, podendo ser indicado mais precocemente quando houver sintomatologia exuberante. O fechamento transcateter usando uma prótese de duplo disco é bem estabelecido como a primeira escolha de tratamento para a maioria dos pacientes de anatomia favorável. Foi comprovado que o forame oval patente (FOP) está associado à acidente vascular cerebral isquêmico (AVCI) em pacientes com poucos ou nenhum fator de risco de doença cardiovascular. Recentemente, foi demonstrado que a oclusão transcateter do FOP é superior ao tratamento clínico para prevenir recorrências de AVCI nessa população, em um estudo randomizado com acompanhamento clínico de longo prazo. Este manuscrito revisa as atuais indicações, critérios de seleção do paciente e o seguimento clínico dos pacientes com CIA OS e FOP submetidos ao tratamento transcateter

Ostium secundum atrial septal defect (OS-ASD) is a relatively frequent congenital heart defect that causes hemodynamic burden on the right ventricle with volume overload and chamber dilatation. Most patients are asymptomatic, however symptoms can appear after the second decade of life. Elective treatment is usually performed around the fifth year of life, and may be occasionally indicated earlier if there are exuberant symptoms. Transcatheter closure using a double disc device is well established as the first choice of treatment for most patients with suitable anatomy. Patent foramen ovale (PFO) has been shown to be associated with ischemic stroke in patients with no or limited risk factors for cardiovascular disease. It was recently demonstrated in a randomized trial with long-term follow-up that transcatheter closure of PFO is superior to medical treatment for preventing recurrences of stroke in this patient population. This manuscript reviews the current indications, patient selection criteria, and long-term follow-up in patients with OS-ASD and PFO submitted to transcatheter closure

Experiência Inicial com o Implante Percutâneo da Válvula Melody® no Brasil / Initial Experience with Percutaneous Implantation of the MelodyTM Valve in Brazil

Introdução: Stress is associated with cardiovascular diseases.O implante percutâneo da válvula pulmonar é uma alternativa para condutos com disfunção. Descrevemos aqui a primeira experiência com o implante da válvula Melody® no Brasil. Métodos: Foram selecionados pacientes com estenose ou insuficiência pulmonar significativa em condutos de 16 a 22 mm. Foram empregadas técnicas padronizadas. Factibilidade, segurança e eficácia desse procedimento foram avaliadas. Resultados: Desde dezembro de 2013, dez pacientes (média de idade e peso de 16,5 anos e 49 kg, respectivamente) foram submetidos ao procedimento com intervalo médio de 11,9 ± 8,6 anos desde a última cirurgia. Insuficiência pulmonar foi indicação para o tratamento em três pacientes, estenose em dois e lesão mista em cinco. A válvula Melody® foi implantada com sucesso em todos os casos. A média da pressão sistólica do ventrículo direito e a relação ventrículo direito/ventrículo esquerdo diminuíram de 49,2 ± 15,9 para 35,8 ± 5,7 mmHg e de 0,55 ± 0,18 para 0,39 ± 0,08 mmHg (p < 0,01 para ambos). Não observamos estenose e nem insuficiência pulmonar residual significativa. Um paciente teve extravasamento contido requerendo um stent coberto e um segundo implante valvular. Todos os pacientes receberam alta do hospital em 72 horas. As válvulas funcionaram adequadamente ...

Background: Transcatheter pulmonary valve implantation is an alternative for dysfunctional conduits. We report the first experience with the MelodyTM valve implantation in Brazil. Methods: Patients with significant pulmonary stenosis or significant pulmonary insufficiency in conduits measuring 16 to 22 mm were enrolled. Standardized techniques were employed. The feasibility, safety and efficacy of this procedure were assessed. Results: From December 2013, ten patients (mean age and weight of 16.5 years and 49 kg, respectively) have undergone the procedure with a mean interval of 11.9 ± 8.6 years since the last surgery. Pulmonary insufficiency was an indication for treatment in three patients, pulmonary stenosis in two, and mixed lesion in five. The MelodyTM valve was successfully implanted in all cases. Mean right ventricular systolic pressure and right ventricle/left ventricle ratio decreased from 49.2 ± 15.9 to 35.8 ± 5.7 mmHg and from 0.55 ± 0.18 to 0.39 ± 0.08 mmHg (p < 0.01 for both). Significant residual pulmonary stenosis or pulmonary insufficiency was not observed. One patient had a contained conduit tear requiring a covered stent and a second valve implantation. All patients were discharged within 72 hours. The valves were properly functioning in a mean follow-up of 4.1 ± 2.2 months with no complications. Conclusions: Transcatheter MelodyTM valve implantation was feasible, safe and effective ...

Autoimmune features caused by dengue fever: a case report

Dengue virus is the most important mosquito-borne viral disease in the world. Co-circulation of the four types of dengue viruses and expansion of dengue epidemic gave rise to infection enhancement and a big expansion of clinical aspects of the disease. Herein we report a case of a 25-year-old white woman with dengue fever and numerous associated autoimmune features. Our patient had proteinuria, an extensive right pleural effusion, a thin pericardial effusion and ascites. She had a low C3 level and positive antinuclear antibody; cryoglobulins were also positive. The numerous autoimmune features of this patient were a diagnostic challenge, since she was a young woman and could be easily mistaken for a rheumatologic patient in a newly open disease. Dengue infection probably was a triggering event causing an abnormal immune response. Therefore, dengue should be suspected in patients with hematological disorders and autoimmune features in endemic regions or those who have travelled to those regions.

Oclusão percutânea de defeitos cardíacos congênitos e estruturais com Amplatzer Duct oOccluder II TM / Percutaneous closure of congenital and structural heart defects with the Amplatzer Duct Occluder II TM

INTRODUÇÃO: Uma nova geração de próteses Amplatzer com menor perfil e maior flexibilidade foi desenvolvida recentemente para o tratamento percutâneo da persistência do canal arterial (PCA). Neste artigo é relatado o uso desse novo dispositivo, Amplatzer Duct Occludder IITM (ADO II), para o tratamento tanto de PCA como de outros defeitos congênitos e estruturais, avaliando sua eficácia e segurança. Métodos: Estudo longitudinal observacional de um coorte de pacientes portadores de cardiopatias congênitas e estruturais tratados com ADO II entre outubro de 2009 e agosto de 2011. Pacientes com menos de 5 kg e canais > 5,5 mm e/ou do tipo B foram excluídos do estudo. A prótese foi implantada por vias anterógrada ou retrógrada. A cintura foi cerca de 2 mm maior que o defeito e o comprimento da prótese foi de 4 mm para lesões mais curtas ( até 6-8 mm). Resultados: Foram incluídos no estudo 28 pacientes, com mediana de idade e de peso de 2 anos e 11,7 kg, respectivamente, dos quais 23 eram portadores de PCA com diâmetro mínimo de 2,3 +- 0,8 mm. Os demais apresentavam...

BACKGROUND: A new generation of Amplatzer devices with lower profile and greater flexibility has been recently developed for percutaneous occlusion of the patent ductus arteriosus (PDA). In this paper, the use of this new device, the Amplatzer Duct Occludder II TM (ADO II) for percutaneous closure of the PDA as well as for the treatment of other congenital and structural heart defects is reported, assessing its safety and efficacy. METHODS: Longitudinal and observational study of a cohort of patients with congenital and structural heart defects treated with ADO II between October 2009 and August 2011. Patients weighing less than 5 kg and PDAs > 5.5 mm and/or type B were excluded. The device was implanted using the antegrade or retrograde approach. The waist was 2 mm larger than the defect and the length of the prosthesis was 4 mm for shorter lesions (less than 6-8 mm). RESULTS: Twenty-eight patients with a median age and weight of 2 years and 11.7 kg, respectively, were included. Twenty-three had a PDA with a mean minimal diameter of 2.3 + 0.8 mm. The remainder had muscular ventricular septal defect (1), pulmonary arteriovenous fistula (1), ruptured aneurysm of the sinus of Valsalva (1), and univentricular heart in the early postoperative period of bidirectional cavopulmonary anastomosis with residual antegrade pulmonary flow (2). The device was successfully implanted in all patients, except for an infant weighing 8 kg with a long, tortuous and oblique PDA with a diameter of 2.8 mm and a shallow ampulla. There was total occlusion of the defects in all patients. One patient with univentricular heart and right isomerism died due to complications not related to the procedure. CONCLUSIONS: ADO II proved to be a flexible, safe and effective device for the percutaneous treatment of infants, children and selected adults with PDA and other congenital and structural heart defects. Its use may have limitations for some anatomical PDA configurations in smaller infants.

Avaliação do quadro clínico e perfil bioquímico de bovinos durante indução e tratamento de hipocalcemia / Assessment of clinical and biochemical profile of cattle during induction and treatment of hypocalcemia

O presente trabalho objetivou estudar o quadro sintomatológico, algumas variáveis bioquímicas e a resposta ao tratamento com cálcio de bovinos com hipocalcemia induzida experimentalmente. Foram utilizadas 12 novilhas distribuídas nos grupos controle (n = 5) e tratado (n = 7). Foi infundida solução de EDTA a 5% até o animal apresentar sinais clínicos de hipocalcemia, quando então era iniciado o tratamento com solução contendo cálcio, fósforo, magnésio e glicose, na dose de 1 mL/kg/PV, em 30 minutos, enquanto que o grupo controle recebia apenas solução fisiológica na mesma dose. Exame clínico e coleta de amostras sanguíneas foram realizados nos tempos T0 (basal), T1 (Fase I, caracterizada por tremores musculares), T2 (ao final da infusão com EDTA), T3 (ao final do tratamento) e T4 (24 horas após o término do experimento). Todas as novilhas mostraram diminuição temporária da concentração de cálcio total e livre, fósforo, e apresentaram quadro clássico de hipocalcemia. A taquicardia, a hipofonese e a atonia ruminal desapareceram no decorrer do tratamento, sendo observado aumento no cálcio livre e total e fósforo. O medicamento usado no tratamento dos animais foi eficaz na recuperação do quadro clínico de hipocalcemia dentro de 30 minutos, promovendo retorno das principais variáveis do perfil bioquímico aos valores basais

The present work aims to study the clinical picture, biochemical profile and treatment response in cattle with induced hypocalcaemia. Were utilized 12 heifers randomly distributed in treated (n = 7) and control (n = 5) groups. The induction model was carried on by continuous EDTA infusion into jugular vein until the animals present clinical signs of hypocalcaemia. After that, the treated group received a calcium (Ca) solution enriched with phosphorus, magnesium and glucose with a dose of 1 mL/kg/BW in 30 minutes, meanwhile, the control group was treated with the same dose of physiologic solution. Clinical examination were performed and blood samples were obtained in times T0 (basal time), T1 (beginning of hypocalcaemia); T2 (end of EDTA infusion); T3 (end of treatment) and T4 (24 hours after the induction). All the heifers present temporary blood calcium and phosphorus reduction and demonstrated classical clinical picture of hypocalcaemia. The treated group present full clinical recovery and blood calcium and phosphorus increase. Most evident clinical signs were increasing heart beat, hypophonesis and rumenal atony. Those symptoms were reversed after calcium treatment. The solution used for treatment was efficient on clinical recovery within thirty minutes, promoting the return to basal levels of the most of biochemical's variables