Community-acquired Acinetobacter baumannii pneumonia: a rare case in Brazil

ABSTRACT Acinetobacter baumannii, a common pathogen in nosocomial infections, is a rare cause of community-acquired pneumonia. This report highlights the difficulties in its early diagnosis and effective treatment, as it is a multidrug-resistant microorganism with rapid, unfavorable progression. To better understand its clinical outcome, we searched the literature for similar cases but found no community-acquired cases in Brazil.

Placenta: móviles, usos y significaciones en el centro-sur de Chile / Placenta: motivations, uses, and meanings in south central Chile

RESUMEN Se analizan los móviles, usos y significaciones atribuidos a las placentas por mujeres y hombres en el centro-sur de Chile, a partir de la implementación de la Norma Técnica 189 del Ministerio de Salud, que permite a las personas solicitar y disponer de sus placentas con posterioridad al parto en recintos hospitalarios. A través de una mirada etnográfica acerca del tratamiento sociocultural de las placentas, entre julio y noviembre de 2019 se realizaron entrevistas en profundidad con mujeres y sus parejas; se recogieron relatos individuales, así como conversaciones con mujeres y hombres mapuches, habitantes del territorio chileno de la región de La Araucanía, la región Metropolitana y la región de Arica y Parinacota, que habían solicitado la placenta. El artículo se enfoca en cuatro casos que dan cuenta de la presencia de diversas prácticas y conocimientos en torno a la placenta, estableciendo su inscripción en marcos socioculturales, territoriales y políticos, espirituales y religiosos, según la pertenencia sociocultural de los actores. Como conclusión, se contrastan los casos relevando tanto diferencias como similitudes y se proyectan algunos desafíos derivados de los hallazgos.

ABSTRACT Motivations, uses, and meanings given to the placenta by women and men in south central Chile are analyzed, following the implementation of Technical Standard 189 by the Ministry of Health, which allowed people to request their placentas after giving birth on hospital grounds. From an ethnographic approach to the sociocultural uses of placentas, in-depth interviews were carried out with women and their partners between July and November 2019; individual narratives were recorded, as well as conversations between Mapuche women and men who had requested their placenta in three Chilean regions (Araucania, Metropolitan, and Arica and Parinacota). This article focuses on four cases that illustrate the diversity of practices and knowledge surrounding the placenta - inscribed in sociocultural, territorial, political, spiritual, and religious frameworks - according to actors' sociocultural origins. To conclude, the cases are compared in order to highlight both similarities and differences, and some challenges derived from the findings are considered.

Epidemiological survey of hepatitis C in a region considered to have high prevalence: the state of Minas Gerais, Brazil

Abstract INTRODUCTION: The prevalence of hepatitis C virus (HCV) infection is affected by demographic, virological, clinical, and lifestyle-related factors and varies in different regions in Brazil or worldwide. The present study aimed to clarify the epidemiological patterns of HCV infection in the interior region of Brazil. METHODS: This study was conducted in the Southern Triangle Macro-region of the state of Minas Gerais, Brazil, according to the guidelines of the National Program for the Prevention and Control of Viral Hepatitis. The participants answered a structured questionnaire on social and epidemiological factors. Immunochromatographic rapid tests were used for the qualitative detection of antibodies against HCV in whole blood (Alere HCV® Code 02FK10) in adult subjects by a free-standing method. RESULTS: Of 24,085 tested individuals, 184 (0.76%) were anti-HCV positive. The majority of anti-HCV-positive individuals were born between 1951 and 1980 (n=146 [79.3%]), with 68 women and 116 men. Identified risk factors included syringe and/or needle sharing (p = 0.003), being in prison (p = 0.004), and having tattoos or piercings (p = 0.005) and were significantly associated with the decade of birth. CONCLUSIONS: The study shows the importance of testing populations at risk for HCV infection, including incarcerated individuals, those with tattoos or piercings, those who share or have shared syringes or needles, and those in high-risk birth cohorts (1950s, 1960s, and 1970s) in the Southern Triangle Macro-region.

Ulcera de Marjolin, reporte de caso / Marjolin's ulcer: a case report

Se presenta el caso de una mujer de 77 años, sin antecedentes relevantes, con úlcera en tobillo izquierdo de dos años de evolución relacionada a herida previa por quemadura con agua caliente de aproximadamente 60 años de antigüedad, con crecimiento progresivo y mala respuesta a tratamiento inicial con curaciones y luego con antibióticos. Se realiza estudio con biopsia cutánea incisional que confirma cáncer espinocelular moderadamente diferenciado e infiltrante en dermis reticular, lo cual corresponde a una úlcera de Marjolin. Se deriva a cirugía oncológica en donde se realiza el estudio de etapificación con resultado de lesión ósea por contigüidad y una tomografía computada (TC) de tórax, abdomen y pelvis sin diseminación a distancia, por lo que se decide amputación infracondilea de la extremidad afectada. Debido a este caso de interés, se realiza una revisión sobre úlcera de Marjolin, con el fin de lograr un diagnóstico adecuado y un tratamiento precoz.

We present the case of a 77-year-old woman, with no relevant history, with a left ankle ulcer of two years of evolution related to previous burn injury with hot water of approximately 60 years old, with progressive growth and poor response to initial treatment with cures and then with antibiotics. A study was performed with cutaneous incisional biopsy confirming moderately differentiated and infiltrating squamous cell cancer in the reticular dermis, which corresponds to a Marjolin ulcer. It is derived to oncologic surgery where the etapification study is carried out with result of contiguous bone injury and a computed tomography (CT) thorax, abdomen and pelvis without distant dissemination, so infracondile amputation of the affected extremity is decided. Due to this interest case report, a review of Marjolin's ulcer is performed, in order to achieve an adequate diagnosis and early treatment.

Cirrose por HCV genótipo 1a, tratada com 7 semanas de interferon peguilado/ribavirina, transplantada por hepatocarcinoma, em RVS / Cirrhosis by HCV genotype 1a, treated with 7 weeks of pegylated interferon/ribavirin, transplanted for hepatocellular carcinoma, on SVR

A hepatopatia crônica causada pelo vírus da hepatite C (HCV) é a indicação mais comum de transplante hepático no mundo. A recorrência da hepatite C após o transplante hepático é elevada e em grande parte dos pacientes pode evoluir com cirrose e perda do enxerto de forma acelerada. Relatamos caso de portadora de cirrose por hepatite C genótipo 1a, tratada durante sete semanas com Interferon Peguilado e Ribavirina, em Resposta Viral Sustentada (RVS), mesmo após transplante hepático por hepatocarcinoma.

Chronic liver disease caused by hepatitis C virus (HCV) is the most common indication for liver transplantation in the world. The recurrence of hepatitis C after liver transplantation is high and most patients can develop cirrhosis and graft loss in an accelerated manner. A case of a patient with cirrhosis due to hepatitis C genotype 1a, treated for seven weeks with pegylated interferon and Ribavirin in Sustained Viral Response (SVR), even after liver transplantation for hepatocellular carcinoma.

Deixo ela no canto e vou tocar minha vida?: significados de viver com HIV para homens com adesão irregular à terapia antirretroviral / I leave it alone and then I go on with my life?: meanings of living with HIV for men in irregular adherence to antiretroviral therapy / La dejo y voy a seguir con mi vida?: signifcados de vivir con VIH en hombres con adhesión irregular a la terapia antiretroviral

Descrever e analisar os significados de viver com o vírus da imunodeficiência humana (HIV) para homens com adesão irregular à terapia antirretroviral (TARV). Métodos: Pesquisa qualitativa, realizada em um ambulatório de um hospital universitário no interior de Minas Gerais, com participação de 10 homens. Os dados foram coletados entre maio e setembro de 2011 através de entrevista semiestruturada e submetidos à análise de conteúdo, resultando nas categorias temáticas ?Descobrindo a contaminação pelo HIV? e ?(Com)Vivendo com o HIV?. Resultados: Os significados de viver com HIV são marcados pela coexistência de algumas concepções equivocadas sobre HIV/AIDS, consolidadas no início da epidemia, com novas percepções, provenientes dos ganhos advindos da utilização da TARV, associadas à valorização de características que trazem uma percepção de invulnerabilidade pelo homem. Esses aspectos podem ser compreendidos como fatores que se refletem diretamente na formacomo os sujeitos aderem ou não à TARV. Além disso, destacam-se também as limitações impostas pelas condições concretas de vida dos sujeitos, principalmente no que se refere ao âmbito socioeconômico e cultural. Conclusão: O processo de viver com HIV caracteriza-se pela complexidade, o que suscita o planejamento de ações de saúde, numa perspectiva de gênero que atenda às especificidades do universo masculino...

To describe and analyze the meanings of living with the Human Immunodeficiency Virus (HIV) for men with irregular adherence to Antiretroviral Therapy (ART). Methods: Qualitative research conducted at an ambulatory of a school hospital in Minas Gerais, Brazil, with 10 men. Data was collected from May to September 2011 through semi-structured interview and submitted to content analysis, resulting in the categories ?Discovering the HIV infection? and ?Living with HIV?. Results: The meanings of living with HIV are distinguished by the coexistence of some misconceptions about HIV/AIDS, consolidated in the epidemic onset, with new perceptions, derived from the gains resulting from use of ART, associated to the valuation of features that bring a sense of non-vulnerability to the man. These aspects can be understood as factors that are directly reflected in the way that the participant men adhere (or not) to ART. Moreover, the limitations imposed by the real conditions of the individuals? life are highlighted, especially concerning the socioeconomic and cultural context. Conclusion: The process of living with HIV is characterized by complexity, which indicates the planning of health actions from a gender perspective to address the specificities of the masculine universe...

Describir y analizar los significados de vivir com el virus de inmunodeficiencia humana (VIH) en hombres con adhesión irregular a la terapia antiretroviral (TARV). Métodos: Investigación cualitativa realizada en un ambulatório de un hospital universitario en un pueblo de Minas Gerais com participación de 10 hombres. Los datos fueron recogidos entre mayo y septiembre de 2011 a través de entrevista semi-estructurada y sometidos al análisis de contenido resultando en las categorias temáticas ?Descubriendo la contaminación por el VIH? y ?(Con) Viviendo con el VIH?. Resultados: Los significados de vivir com el VIH son marcados por la coexistencia de algunas concepciones equivocadas sobre VIH/SIDA consolidadas en el inicio de La epidemia con nuevas percepciones provenientes de las ganâncias advenidas de la utilización de la TARV asociadas a la valorización de características que traen una percepción de invulnerabilidad del hombre. Eses aspectos pueden ser comprendidos como factores que se reflejan directamente en la forma como los sujetos adhieren o no a la TARV. Además, se destaca también las limitaciones impuestas por las condiciones concretas de vida de los sujetos, principalmente en lo que se refiere al ámbito socioeconómico y cultural. Conclusión: El proceso de vivir con VIH se caracteriza por la complejidad, lo que suscita el planeamiento de acciones en salud en una perspectiva de género que atienda a lãs especificidades del universo masculino...

Aureobasidium pullulans infection in a patient with chronic lymphocytic leukemia

Saprophytic fungi are being increasingly recognized as etiologic agents of mycoses in immunosuppressed patients. We report a case of subcutaneous infiltration by Aureobasidium pullulans, likely due to traumatic inoculation, in a neutropenic patient during chemotherapy for chronic lymphocytic leukemia. The patient was treated with amphotericin B deoxycholate but was subsequently switched to itraconazole, which improved the lesion. This case highlights the importance of considering unusual fungal infections in critically ill patients such as those who are immunosuppressed due to chemotherapy. Diagnostic techniques and effective antifungal therapy have improved the prognosis of these cases.

Hepatitis C and cutaneous alterations / Hepatite C e alterações cutâneas

While most of those infected with hepatitis C virus (HCV) are asymptomatic or only develop liver manifestations, a significant percentage evolves with autoimmune and lymphoproliferative disorders, resulting in a clinical condition called HCV syndrome. This work involving case studies of six patients with hepatitis C and varied skin manifestation aimed to report skin lesions occurring with HCV infection and its treatment. Skin manifestations in hepatitis C have been based on epidemiological studies. This justifies the need for studies that correlate HCV infection and its treatment with skin manifestations.

A maioria dos infectados pelo vírus da hepatite C (VHC) é assintomática ou apresenta somente manifestações hepáticas, porém uma significativa porcentagem evolui com desordens autoimunes e linfoproliferativas resultando na síndrome da hepatite C. Este trabalho envolve seis estudos de casos de pacientes com hepatite C e várias manifestações cutâneas, visando relacionar lesões dermatológicas ao VHC e ao seu tratamento. Manifestações dermatológicas na hepatite C têm sido baseadas em estudos epidemiológicos. Isto justifica a necessidade de estudos que correlacionem infecção pelo VHC e seu tratamento com as manifestações dermatológicas.

Foramen congénito del ligamento ancho con hernia enteral interna y sufrimiento intestinal reversible: presentación de dos casos / Two cases of congenital foramina in the broad ligament of the uterus with small bowel hernias and reversible intestinal distress

Se trata de dos pacientes con un foramen congénito del ligamento ancho que permitió el paso de un asa de intestino delgado y posteriormente causó un cuadro de obstrucción intestinal completa con sufrimiento de asa reversible. Se descartaron antecedentes quirúrgicos, traumáticos e infecciosos que pudieran simular un anillo intraperitoneal congénito.

We report two cases of congenital foramina in the broad ligament through which segments of the small intestine passed producing intestinal obstruction with reversible bowel distress. Surgical, traumatic and infectious causes that could simulate congenital intraperitoneal bands were ruled out.

Dermatitis granulomatosa intersticial en placas con artritis en una adolescente: Informe de un caso / Granulomatous interstitial dermatitis with plaques and arthritis in a teenager: Case report

Se presenta el caso de una adolescente, diabética, con artritis idiopática juvenil indiferenciada a placas y máculas eritemato-violáceas en piel, cuya biopsia mostró cambios incipientes de una dermatitis granulomatosa intersticial. Recibió tratamiento con hidroxicloroquina con respuesta parcial. La dermatitis granulomatosa intersticial en placas asociada a artritis es una dermatosis idiopática rara que afecta usualmente a mujeres adultas, con afección poliarticular relacionada con alguna enfermedad autoinmune. En la patogénesis se ha sugerido un fenómeno de autoinmunidad con formación de complejos inmunes que se depositan en el endotelio. El curso clínico se caracteriza por periodos de exacerbación y remisión o por resolución espontánea de las lesiones.Palabras clave: poliartritis, dermatitis granulomatosa intersticial, síndrome de Ackerman, signo de la cuerda, diagnósticos diferenciales.

The clinical case report of a 14-year-old diabetic teenager with undifferentiated juvenile arthritis and 2- years history of skin-colored maculae and plaques is presented. Biopsy examination of a skin specimen showed findings of early interstitial granulomatous dermatitis. The patient was treated with hydroxicloroquine with partial response. Interstitial granulomatous dermatitis with plaques and arthritis is an idiopathic rare disease that usually affects young women. It is usually related to rheumatoid arthritis or another autoimmune disease. It represents a disorder that involves degeneration of collagen by immune complex-mediated formation and deposition on the endothelial surface. Prognosis is variable with remissions and exacerbations or spontaneous and complete remission of skin lesions.Key words: poliarthritis, granulomatous interstitial dermatitis, Ackerman syndrome, rope sign, differential diagnosis

Xantogranuloma renal: causa poco común de tumoración renal en paciente de edad pediátrica / Xanthogranuloma kidney: cause uncommon renal tumor in a patient of pediatric age

Se reporta el caso de una paciente femenina de 14 años, oriunda de El Ángel, provincia del Carchi, que acude a facultativo con cuadro de decaimiento, fiebre, dolor abdominal, vómito y masa en región lumbar y flanco derecho. Es diagnosticada por ECO de masa renal derecha y referida al Hospital Baca Ortíz de Quito. Mediante nuevo ultrasonido y TAC se evidencia riñón derecho con alteración de su morfología, caracterizado por aumento de tamaño, múltiples quistes y calcificaciones. Se realiza laparotomía exploratoria encontrándose masa dependiente de riñón derecho que produce aumento de tamaño, de características macroscópicas exofiticas, irregulares con áreas quísticas de contenido purulento y áreas induradas de consistencia leñosa, con importantes adherencias a tejidos circundantes. Se realiza resección de aproximadamente el 90% de la masa tumoral, a excepción del polo superior por encontrarse adherido al hilio hepático. La paciente evoluciona de manera favorable. El reporte histopatológico concluye como diagnóstico final: Xantogranuloma renal, siendo esta una forma atípica de infección crónica del parénquima renal, más aun en pacientes de edades tempranas.

Avulsion of permanent teeth: analysis of the efficacy of na informative campaign for professionals from elementary schools

Tooth avulsion is a very common event in children and emergency care procedures are crucial for case prognosis. As anyone at the moment of accident can provide first-aid measures, knowledge of school professionals dealing with children is of paramount importance. An informative campaign about dental trauma was performed in urban schools in the city of Adamantina, São Paulo state, Brazil, in an attempt to educate school professionals about emergency procedures in cases of tooth avulsion. A questionnaire arguing on personal information, tooth avulsion knowledge and personal impressions of the campaign was handed out for evaluation of the informative campaign. Eighty school professionals participated in the survey. Most participants were females (93.75 percent) aged 41-60 years old (53.75 percent) with a college degree (77.5 percent). Time at work ranged from 1-5 years (22.5 percent). The efficacy of the campaign was considered positive, as 100 percent of the interviewees replied to the importance of emergency procedures in case of tooth avulsion. In addition, 81.25 percent of the respondents answered that they would store the avulsed tooth in some storage medium, of which milk was the most frequently mentioned (84.61 percent). The participants considered the campaign as satisfactory and a region-wide campaign will be accomplished at other schools.

Disseminated toxoplasmosis presenting as sepsis in two AIDS patients

This report describes two patients who presented acute disseminated and severe toxoplasmosis as the first opportunistic disease related to acquired immunodeficiency syndrome. At admission, clinical and laboratory findings were similar to sepsis or septic shock and a fast evolutive course to death occurred in both cases. At necropsy, an inflammatory reaction and presence of a great number of Toxoplasma gondii cysts and tachyzoites were observed in most organs examined.

O presente relato descreve dois pacientes que apresentaram toxoplasmose aguda, disseminada e grave como primeira manifestação oportunista da síndrome da imunodeficiência adquirida. Os achados clínicos e laboratoriais foram similares aos de sepse ou choque séptico e, em ambos os casos houve evolução rápida para óbito. A necropsia, foi observada reação inflamatória e presença de taquizoítos e cistos de Toxoplasma gondii na maioria dos órgãos examinados.

Onicrocriptosis en pacientes con infección por VIH / Onychocryptosis in HIV infected patients

Se presenta un caso de onicocriptosis en un hombre de 26 años infectado por el virus de la inmunodeficiencia humana VIH en estadio C3, quien fue remitido al servicio de dermatología por cuadro de dos meses de evolución consistente en dolor y signos de inflamación en ambos hallux. Al examen físico, presentaba onicocriptosis y granulomas telagiectásicos periungueales en ambos rayos. Se realizo manejo inicial con curetaje y aplicación de ácido tricloroacético al 35 por ciento, con moderada respuesta y ante la persistencia de la onicocriptosis y los granulomas se decidió practicar una matricectomía parcial bilateral con resección del lecho ungueal y pliegues laterales de las uñas. La importancia de este caso radica en la posible asociación entre la onicocriptosis, la infección por el VIH y la terapia antirretroviral

Tumor de celulas gigantes de la vaina tendinosa: presentacion de un caso / Giant cell tumor of tendon sheath: a case report

Se presenta el caso de una mujer de 45 años con una masa en el cuarto dedo de la mano derecha. El diagnóstico de tumor de células gigantes de la vaina tendinosa fue hecho por clínica e histopatología. El tratamiento fue cirugía, con buena evolución.

MIB-1 como marcador de proliferación celular del cartílago articular en el cóndilo mandibular, articulación costocondral, extremo esternal de la clavícula y cuarto metatarsiano / MIB-1 as a cell proliferation marker of articular cartilage in the mandibular condyle, costo-chondral articulation, sternal extreme of the clavicle and the fourth metatarsian bone

El objetivo de este estudio fue probar el MIB-1 como método para la evaluación de la proliferación celular del cartílago articular del cóndilo mandibular, el extremo esternal de la clavícula, la unión costocondral y el cuarto metatarsiano y además corroborar y comparar los resultados histológicos de estudios anteriores. El estudio se realizó en 6 cadáveres humanos con menos de 12 horas de fallecidos a los cuales se les extrajo un cóndilo, una clavícula, una quinta costilla y un cuarto metatarsiano. Se encontró que el MIB-1 no es apto para el uso con tejido cartilaginoso ya que la técnica involucra el uso de horno microondas las cuales desprenden los especímenes de las placas utilizadas en inmunohistoquímica. Se corroboran resultados de otros estudios que muestran que macroscópicamente el metatarsiano es más parecido al cóndilo mandibular, pero la clavícula tiene una similitud mayor desde el punto de vista histológico...