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Rev. Soc. Bras. Med. Trop ; 53: e20190516, 2020. graf
Article in English | LILACS, ColecionaSUS, SES-SP | ID: biblio-1136894


Abstract The differential diagnosis of optic neuritis is broad and varied. We report the case of a 24-year-old Brazilian man who presented with five-week history of fever, malaise, myalgia, severe fatigue, tender right preauricular lymphadenopathy, and acute vision blurring associated with right optic disc swelling and exudates in a macular star pattern. His illness developed soon after an infestation of fleas broke out among his cats. Diagnosis of ocular bartonellosis was confirmed by serological and molecular analyses targeting amplification of Bartonella spp. htrA gene. Signs and symptoms only improved after initiation of antimicrobial therapy.

Humans , Animals , Male , Cats , Young Adult , Retinitis/microbiology , Bartonella henselae/isolation & purification , Retinitis/diagnosis , Retinitis/drug therapy , Doxycycline/therapeutic use , Anti-Bacterial Agents/therapeutic use
Rev. Soc. Bras. Med. Trop ; 50(2): 277-279, Mar.-Apr. 2017. graf
Article in English | LILACS | ID: biblio-842840


Abstract Botryomycosis is an uncommon, chronic, suppurative, bacterial infection that primarily affects the skin and subcutaneous tissues. It has long been associated with defects of cellular immunity. We report a 28-year-old woman who presented with a chronic, ulcerated lesion with draining sinuses in the right malar region. Predisposing factors were HIV infection with poor immunological control, alcoholism, and a previous trauma to the right cheek. Several courses of antimicrobial therapy provided only partial and temporary remission. Complete clinical remission was only achieved 5 years later when a novel antiretroviral regimen composed of darunavir and raltegravir was initiated.

Humans , Female , Adult , Pyoderma/drug therapy , AIDS-Related Opportunistic Infections/drug therapy , Botrytis/isolation & purification , Dermatomycoses/drug therapy , Facial Dermatoses/drug therapy , Pyoderma/diagnosis , AIDS-Related Opportunistic Infections/diagnosis , Anti-HIV Agents/therapeutic use , Dermatomycoses/diagnosis , Facial Dermatoses/diagnosis , Darunavir/therapeutic use , Raltegravir Potassium/therapeutic use
Rev. Soc. Bras. Med. Trop ; 49(6): 790-792, Dec. 2016. graf
Article in English | LILACS | ID: biblio-829661


Abstract: Chikungunya virus (CHIKV) is a mosquito-borne arthritogenic alphavirus that has recently been introduced to Brazil. We report the case of a 36-year-old male patient from the City of Rio de Janeiro who developed molecularly-confirmed CHIKV disease and whose clinical picture was remarkable because of acute arthritis of an interphalangeal joint that had been damaged by trauma 8 years previously. This case illustrates that acute CHIKV disease may preferentially target previously damaged joints. Careful study of individual cases may provide valuable information on the presentation and management of this emerging zoonosis in Brazil.

Humans , Male , Adult , Arthritis/diagnosis , Finger Injuries/virology , Finger Joint/virology , Chikungunya Fever/diagnosis , Arthritis/virology , Time Factors , Acute Disease , Chikungunya Fever/complications
Arch. endocrinol. metab. (Online) ; 59(2): 116-122, 04/2015. tab
Article in English | LILACS | ID: lil-746470


Objective This study aims to estimate the prevalence of thyroid diseases and anti-TPO status. We searched for an association among presence of immune reconstitution and use of stavudine, didanosine and protease inhibitors with thyroid diseases. Materials and methods A cross-sectional study was performed to analyze the records of 117 HIV-infected patients who had their CD4+ cell count, viral load, anti-TPO, TSH and free T4 levels collected on the same day. Immune reconstitution was considered in those whose T CD4+ count was below 200 cells/mm3, but these values increased above 200 cells/mm3 after the use of antiretrovirals. The odds ratio obtained by a 2x2 contingency table and a chi-square test were used to measure the association between categorical variables. Results The prevalence of thyroid disease was 34.18%; of these, 4.34% were positive for anti-TPO. There was an association of risk between stavudine use and subclinical hypothyroidism (OR = 4.19, 95% CI: 1.29 to 13.59, X2 = 6.37, p = 0.01). Immune reconstitution achieved protection associated with thyroid disease that was near statistical significance OR = 0.45, 95% CI: 0.19 to 1.04, X2 = 3.55, p = 0.059. Conclusion The prevalence of thyroid disease in the sample studied was higher than what had been found in the literature, with a low positive anti-TPO frequency. The historical use of stavudine has an association of risk for the presence of subclinical hypothyroidism, and immune reconstitution has trends towards protection for the presence of thyroid diseases. .

Adult , Female , Humans , Male , Acquired Immunodeficiency Syndrome/drug therapy , Autoantibodies/isolation & purification , Hypothyroidism/epidemiology , Iodide Peroxidase/immunology , Reverse Transcriptase Inhibitors/therapeutic use , Stavudine/therapeutic use , Thyroid Diseases/epidemiology , Acquired Immunodeficiency Syndrome/blood , Acquired Immunodeficiency Syndrome/complications , Anti-Retroviral Agents/therapeutic use , Asymptomatic Diseases/epidemiology , Asymptomatic Diseases/therapy , Cross-Sectional Studies , Didanosine/therapeutic use , Hypothyroidism/chemically induced , Hypothyroidism/immunology , Prevalence , Reverse Transcriptase Inhibitors/adverse effects , Stavudine/adverse effects , Thyroid Diseases/drug therapy
Rev. Inst. Med. Trop. Säo Paulo ; 56(1): 81-84, Jan-Feb/2014. tab, graf
Article in English | LILACS | ID: lil-702062


Visceral leishmaniasis is an anthropozoonosis that is caused by protozoa of the genus Leishmania, especially Leishmania (Leishmania) infantum, and is transmitted to humans by the bite of sandflies of the genus Lutzomyia, such as Lutzomyia longipalpis. There are many reservoirs, including Canis familiaris. It is a chronic infectious disease with systemic involvement that is characterized by three phases: the initial period, the state period and the final period. The main symptoms are fever, malnutrition, hepatosplenomegaly, and pancytopenia. This article reports a case of a patient diagnosed with visceral leishmaniasis in the final period following autochthonous transmission in the urban area of Rio de Janeiro. The case reported here is considered by the Municipal Civil Defense and Health Surveillance of Rio de Janeiro to be the first instance of autochthonous visceral leishmaniasis in humans in the urban area of this city. The patient was discharged and is undergoing a follow-up at the outpatient clinic, demonstrating clinical improvement.

A leishmaniose visceral é uma antropozoonose causada por protozoários do gênero Leishmania, principalmente Leishmania (Leishmania) infantum e transmitida ao homem pela picada do flebotomíneo do gênero Lutzomyia, destacando-se no Brasil a Lutzomyia longipalpis. Os animais reservatórios são muitos, tendo o cão doméstico (Canis familiaris) como principal reservatório. Trata-se de uma doença infecciosa crônica, de envolvimento sistêmico e caracterizado por três fases: período inicial, período de estado e período final. As principais manifestações são febre, hepatoesplenomegalia, desnutrição e pancitopenia. Este artigo tem como objetivo relatar o caso de paciente diagnosticada com leishmaniose visceral em período final, de transmissão autóctone na área urbana da cidade do Rio de Janeiro. O caso relatado neste artigo é considerado, após investigação, pela Secretaria Municipal de Saúde e Defesa Civil do Rio de Janeiro como o primeiro caso autóctone de leishmaniose visceral em humanos na área urbana da cidade do Rio de Janeiro. O tratamento oferecido foi eficaz e a paciente encontra-se em acompanhamento ambulatorial.

Adult , Humans , Male , Leishmaniasis, Visceral/diagnosis , Brazil/epidemiology , Cities/epidemiology , Leishmaniasis, Visceral/epidemiology , Urban Population
Rio de Janeiro; s.n; 2014. xvii,74 p. ilus, tab, graf.
Thesis in Portuguese | LILACS | ID: lil-751004


A deficiência de vitamina D é uma condição subdiagnosticada e geralmente não aventada como alvo de investigação laboratorial por parte dos clínicos. Estima-se que em torno de 36 por cento dos adultos saudáveis e 57 por cento dos pacientes internados apresentem algum grau de deficiência de vitamina D. A prevalência elevada desta deficiência deve-se aos polimorfismos dos genes implicados na resposta à vitamina D, baixa exposição solar, interações medicamentosas e aspectos nutricionais. A aplicação das pesquisas relacionadas à vitamina D e AIDS se baseia em possíveis usos na redução da transmissibilidade, redução da progressão clínica, interações medicamentosas, redução na incidência de infecções, neoplasias, doenças autoimunes e queda da mortalidade geral. Este estudo visa obter a prevalência da deficiência de vitamina D entre em pacientes com diagnóstico de infecção pelo HIV acompanhados em um grande ambulatório de referência no município do Rio de Janeiro, avaliar a associação do uso de antirretrovirais e deficiência de vitamina D, associação entre a contagem de linfócitos TCD4+ e a deficiência de vitamina D, associação entre a carga viral plasmática do HIV e a deficiência de vitamina D e realizar a análise estatística dos dados utilizando técnicas descritivas e exploratórias. Dos pacientes estudados, um total de 91 (72,8 por cento) apresentou deficiência de vitamina D, definida por concentração plasmática inferior a 32 ng/dLO grupo foi classificado categoricamente em deficiência grave, com valores inferiores a 10 ng/dL (5 indivíduos), deficiência moderada, entre 10-19 ± (36 indivíduos), deficiência leve, 20-31 ng/dL (50 indivíduos) e suficiência, maiores ou iguais a 32 ng/dL (34 indivíduos). Não foi encontrada associação entre as concentrações plasmáticas de vitamina D e as variáveis idade, sexo, tempo de diagnóstico, tempo de uso de terapia antirretroviral, carga viral plasmática do HIV e esquema antirretroviral atual...

The vitamin D deficiency is an underdiagnosed condition and generally not investigated by the clinical laboratory. It is estimated that around 36 percent of healthy adults and 57 percent of hospitalized patients in the U.S. have some degree of vitamin D defiency. The high prevalence of this condition is due to polymorphisms of genes involved in the response to vitamin D, low sunexposure, drug interactions, and nutritional aspects. The application of research related to vitamin D and AIDS is based on possible uses: reduction intransmission, reduction in clinical progression, drug interactions, reducedincidence of infections, malignancies, autoimmune diseases, and decreasedoverall mortality. This study aims to determine the prevalence of vitamin Ddeficiency among patients diagnosed with HIV infection followed at a greatreference outpatient clinic in the city of Rio de Janeiro, assess the associationbetween use of antiretroviral drugs and vitamin D deficiency, associationbetween CD4 + lymphocyte count and vitamin D, between plasma HIV viralload and vitamin D deficiency, and perform statistical analysis of the data using descriptive and exploratory techniques. Of the patients studied, a total of 91 (72.8 percent) had vitamin D defiency, defined as plasma concentration below 32 ng /dL. The group was rated categorically in severe defiency with less than 10 ng /dL (5 subjects), moderate defiency , between 10-19 ± (36 subjects) , milddefiency, 20-31 ng / dL (50 individuals), and sufficiency, greater than or equal to 32 ng / dL (34 individuals) . No association was found between plasma concentrations of vitamin D and the variables age, sex, time since diagnosis, duration of use of antiretroviral therapy, plasma HIV viral load, and current antiretroviral regimen...

Acquired Immunodeficiency Syndrome , Anti-Retroviral Agents , Vitamin D/physiology , Cardiovascular Diseases , Neoplasms
Rev. Soc. Bras. Clín. Méd ; 11(3)jul.-set. 2013.
Article in Portuguese | LILACS | ID: lil-686978


O hipotireoidismo subclínico é uma alteração frequente, definida como condição oligossintomática ou assintomática, com níveis séricos elevados do hormônio estimulador da tireoidee níveis normais de tiroxina livre. Pode representar o estágio inicial de uma deterioração progressiva da função tireoidiana, sendo que, em alguns casos, esta função pode permanecer inalterada ou mesmo normal. O objetivo deste estudo foi revisara literatura para os aspectos epidemiológicos, diagnósticos, indicações do tratamento e o procedimento terapêutico aplicado ao hipotireoidismo subclínico. Os clínicos generalistas devem ser capazes de diagnosticar, indicar a terapia em situações adequadas e dar seguimento aos casos. Será discutido o conceito de hipotireoidismo subclínico, rastreio e epidemiologia.Serão abordadas evidências presentes em relação às alterações provocadas pelo hipotireoidismo subclínico: na dislipidemia,na resposta cardiovascular ao esforço físico e recuperação, no risco cardiovascular, em distúrbios psiquiátricos e em grupos especiais de idosos e gestantes, descrevendo-se o tratamento. Oh ipotireoidismo subclínico é uma condição frequente nos ambulatórios de clínica médica e por muitas vezes é assintomático ou apresentado por sintomas sutis e inespecíficos tais como: a disfunção sexual, parestesias, fadiga crônica, mialgia, sintomas psiquiátricos e disfunção cognitiva leve. É papel de o médico generalista estar capacitado para diagnosticar, analisar as variáveis que se impõem para decisão quanto ao início do tratamento e realizar acompanhamento periódico destes pacientes.

Subclinical hypothyroidism is a frequent pathology defined as an oligosymptomatic or asymptomatic condition with high serum levels of thyroid stimulating hormone, and normal free thyroxine levels. It can represent the initial stage of a progressive deterioration of thyroid function, and in some cases this function may remain unchanged or even become normal. The objective of this study is to review the literature for the epidemiological aspects, diagnosis, treatment indications and treatment procedure applied to subclinical hypothyroidism. Generalist physicians should be able to diagnose, indicate the therapy in appropriate situations and follow the cases. The concept, screening and epidemiology of subclinical hypothyroidism will be discussed. We will approach the current evidence regarding changes caused by the subclinical hypothyroidism in dyslipidemia, cardiovascular response to physical exercise and recovery, cardiovascular risk, psychiatric disorders, and in the special groups: elderly and pregnant women. The treatment will also be described. The subclinical hypothyroidism is a common condition in the outpatient clinica nd is often asymptomatic or presented with subtle and nonspecific symptoms such as sexual dysfunction, paresthesias, chronic fatigue, myalgia, psychiatric symptoms and mild cognitive impairment. The generalist physician must be able to diagnose, analyze the variables that are needed for decision on the initiation of treatment, and regularly monitor the thyroid function of these patients.

Humans , Hashimoto Disease , Hypothyroidism/complications , Hypothyroidism/diagnosis , Hypothyroidism/epidemiology , Hypothyroidism/drug therapy , Thyroxine
Rev. Inst. Med. Trop. Säo Paulo ; 55(1): 61-64, Jan.-Feb. 2013. ilus, tab
Article in English | LILACS | ID: lil-661104


Envenoming syndrome from Africanized bee stings is a toxic syndrome caused by the inoculation of large amounts of venom from multiple bee stings, generally more than five hundred. The incidence of severe toxicity from Africanized bee stings is rare but deadly. This report reveals that because of the small volume of distribution, having fewer stings does not exempt a patient from experiencing an unfavorable outcome, particularly in children, elderly people or underweight people.

A síndrome de envenenamento por ferroadas de abelhas africanizadas é causada pela inoculação de uma grande quantidade de peçonha por múltiplas ferroadas de abelhas, geralmente acima de quinhentas. A incidência de uma intoxicação severa por ferroadas de abelhas africanizadas é rara, porém letal. Este relato de caso aponta que, devido a um menor volume de distribuição do veneno, um número menor de ferroadas por abelhas africanizadas não exime o paciente de apresentar envenenamentos com desfecho desfavorável, principalmente em crianças, idosos e pessoas com baixo peso.

Aged , Animals , Humans , Male , Bees , Bee Venoms/poisoning , Insect Bites and Stings/complications , Insect Bites and Stings/therapy , Syndrome
Rev. Soc. Bras. Clín. Méd ; 11(1)jan.-mar. 2013.
Article in Portuguese | LILACS | ID: lil-668517


JUSTIFICATIVA E OBJETIVOS: Tomar uma decisão constitui um processo pelo qual se escolhe uma ou algumas ações dentre várias possíveis. A escolha é baseada em um conjunto de informações que levam ao intelecto a processar probabilidades de desfecho optando pela mais aprazível ou de maior chance de sucesso. A propedêutica médica está reforçada no século XXI pelos instrumentos de apoio às decisões informatizadas que visam reduzir a incerteza diagnóstica e terapêutica. Apesar dos esforços, ainda não foi totalmente decifrado a forma como o médico exerce suas decisões. CONTEÚDO: Serão discutidos os aspectos da prática da medicina com abordagem sobre como as decisões são tomadas no ambiente médico. A discussão será baseada no conceito das heurísticas, sistemas epidemiológicos, sistemas informatizados de apoio às decisões, Medicina Baseada em Evidências, Medicina Baseada em Experiência e Medicina Baseada em Preferências. CONCLUSÃO: O processo de tomada de decisão na pratica clínica e o pensamento médico vem sendo pouco discutidos e valorizados. A visualização da tomada de decisão como meramente intuitiva desvaloriza um processo tão nobre e apaixonante. É de extrema importância para a classe médica adquirir uma autoconsciência de sua prática a fim de detectar os erros que a leva ser alvo de processos pelos pacientes e para que haja redução das incertezas.

BACKGROUND AND OBJECTIVES: Making a decision is a process by which one chooses one or a few of several possible actions. The choice is based on a set of information that leads the individual to process outcome probabilities, opting for the more pleasant or that with greater chance of success. In the twenty-first century, medical propedeutics, consisting of medical history, physical examination and laboratory tests, is supported by computed decision instruments aimed at reducing uncertainty about the diagnosis and treatment. Despite of our best efforts, we cannot fully decipher how a doctor takes his decisions. CONTENTS: We will discuss aspects of the practice of medicine approaching how decisions are made in the medical environment. The discussion will be based on the concept of heuristics, epidemiological systems, and computed-supported decision making, Evidence-Based Medicine, Experience-Based Medicine and Preference-Based Medicine. CONCLUSION: Decision making process in clinical practice, and medical thinking, have been little discussed and valued. The view of decision making as merely intuitive devalues such a noble and passionate process. It is extremely important for physicians to have self-awareness of their practice in order to detect errors that lead the patients to sue them, and to reduce the degree of uncertainty.

Humans , Decision Making , Evidence-Based Medicine