ABSTRACT
Abstract Cutaneous leishmaniasis is characterized by ulcers with raised edges and a granular bottom, mainly on the lower limbs. This is a case report of a male patient with an ulcer on the left plantar region. The diagnosis was confirmed by positive PCR for L. braziliensis and the presence of amastigotes of Leishmania sp. in the histopathological examination. After treatment with Glucantime, the patient showed full healing of the ulcer. The unusual location of the ulceration calls attention to atypical presentations of leishmaniasis, and the importance of histopathological examination and PCR, leading to the appropriate diagnosis and treatment.
Subject(s)
Humans , Male , Leishmania braziliensis , Leishmaniasis, Cutaneous/diagnosis , Leishmaniasis, Cutaneous/drug therapy , Foot Ulcer , Leishmania , Ulcer , Meglumine AntimoniateABSTRACT
Cutaneous leishmaniasis is characterized by ulcers with raised edges and a granular bottom, mainly on the lower limbs. This is a case report of a male patient with an ulcer on the left plantar region. The diagnosis was confirmed by positive PCR for L. braziliensis and the presence of amastigotes of Leishmania sp. in the histopathological examination. After treatment with Glucantime, the patient showed full healing of the ulcer. The unusual location of the ulceration calls attention to atypical presentations of leishmaniasis, and the importance of histopathological examination and PCR, leading to the appropriate diagnosis and treatment.
Subject(s)
Foot Ulcer , Leishmania braziliensis , Leishmania , Leishmaniasis, Cutaneous , Humans , Leishmaniasis, Cutaneous/diagnosis , Leishmaniasis, Cutaneous/drug therapy , Male , Meglumine Antimoniate , UlcerABSTRACT
Hemoglobinopathies are the most common genetic disorders in the world and include sickle cell anemia (SCA), which is a public health problem in Brazil. Nevertheless, the disease is highly unknown among health professionals, and delayed diagnosis constitutes an important cause of concern for caretakers of SCA patients. The purpose of this study was to compare the clinical and laboratory history of SCA patients whose diagnosis was established during the first year of life to those of other SCA patients who had delayed SCA diagnosis. Demographic, clinical, and laboratory data were all reviewed from 99 steady-state SCA patients who were followed in a public hematology and hemotherapy clinic in Salvador, Brazil. The patients were aged > or = 12 years and attended the outpatient unit at least once from November 2008 to June 2009. The data were analyzed in 2010. For all patients, the mean age (+/- SD) at diagnosis was 12.7(+/- 12.1) years, ranging from 0 to 47 years. Mean age was higher in patients whose SCA diagnosis was established after age 5 (32.9 +/- 11.9 years, P = .005). Increased unconjugated bilirubin, stroke and splenic sequestration were more prevalent in patients who were diagnosed in the first year of life (P = .043, .024 and .026 respectively). The data suggest that stroke, splenic sequestration and unconjugated bilirubin level may be influenced by age at SCA diagnosis.
Subject(s)
Anemia, Sickle Cell/diagnosis , Anemia, Sickle Cell/ethnology , Black People , Delayed Diagnosis , Adolescent , Adult , Age Factors , Anemia, Sickle Cell/complications , Brazil , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Middle Aged , Neonatal Screening , Outcome Assessment, Health Care , Retrospective Studies , Young AdultABSTRACT
JUSTIFICATIVA E OBJETIVOS: Apesar do alto valor preditivo positivo da anemia ferropriva para o câncer colorretal na população acima de 50 anos, há um atraso no diagnóstico da neoplasia, prejudicando o seu prognóstico. O objetivo deste estudo foi identificar a capacidade de investigação de residentes em clínica médica em relação ao câncer colorretal nesses pacientes, em alguns hospitais gerais. MÉTODO: Trata-se de estudo descritivo e analítico. Um questionário ilustrado por um caso clínico, trazendo perguntas sobre o diagnóstico mais importante para este tipo de anemia e da maneira mais precisa para o diagnóstico precoce da sua causa, foi aplicado a 103 médicos residentes em clínica médica. A resposta correta foi suspeitar de câncer colorretal entre as três principais causas para a anemia e investigar com colonoscopia em primeiro lugar em ordem de importância diagnóstica. RESULTADOS: Oitenta profissionais (77,7%) relataram câncer colorretal entre as três principais causas de anemia, com 15 (18,8%) indicando a colonoscopia em primeiro lugar, 25 (31,3%) no segundo, 18 (22,5%) no terceiro, e 14 (17,5%) em quarto na ordem de investigação diagnóstica. Quatro (5,0%) não mencionaram ordem de prioridade para a colonoscopia, e 4 (5%) não indicaram esse exame. Não houve diferença estatisticamente significativa entre as formas de investigação no que diz respeito aos residentes formados pelas duas principais escolas de Medicina em Salvador. CONCLUSÃO: Demonstrou-se que a investigação de câncer colorretal não segue um algoritmo uniforme para a avaliação da anemia ferropriva em pacientes nessa faixa etária, o que tende a retardar o diagnóstico da doença.
BACKGROUND AND OBJECTIVES: Although the high predictive positive value of iron deficiency anemia for colorectal cancer in the population with 50 years or older, there is a delay in the neoplasia diagnosis, damaging prognosis. This study aimed at identifies resident?s ability to investigate colorectal cancer in these patients, at some general hospitals. METHOD: The study was descriptive and analytical. A questionnaire, illustrated by a clinical case, about the most important diagnosis for this type of anemia and the more precise way to the early diagnosis of its cause, was applied to a sample of 103 medical residents in internal medicine. The correct answer was to suspect of colorectal cancer among the three main causes for the anemia and to investigate it with colonoscopy in first line of choice. RESULTS: Eighty professionals (77.7%) reported colorectal cancer among the three main diagnosis, with 15 (18.8%) indicating colonoscopy in first line of choice, 25 (31.3%) in second, 18 (22.5%) in third, and 14 (17.5%) in fourth. Four (5%) didn?t mention the order of choice for colonoscopy, and 4 (5%) didn?t indicated it. No statistical significant difference was shown in the attitudes among the residents graduated by the two main medical schools at Salvador. CONCLUSION: It was shown that investigation of colorectal cancer did not follow a uniform algorithm for the assessment of iron deficiency anemia in patients at this age, what tend to delay diagnosis of the condition.
Subject(s)
Humans , Male , Female , Adult , Anemia, Iron-Deficiency , Medical Staff, Hospital , Middle Aged , Colorectal Neoplasms/complications , Colorectal Neoplasms/diagnosis , Physicians, FamilyABSTRACT
OBJECTIVE: To determine the prevalence of allergic bronchopulmonary aspergillosis (ABPA) in patients with cystic fibrosis treated at a referral center in the state of Bahia, Brazil. METHODS: A cross-sectional study, with prospective data collection, carried out at the Cystic Fibrosis Referral Center of Bahia of the Octavio Mangabeira Specialized Hospital. We evaluated 74 patients diagnosed with cystic fibrosis, older than six years of age, treated between December 9, 2003 and March 7, 2005. We analyzed the following variables: gender, age, forced vital capacity, forced expiratory volume in one second, pharmacodynamic response, chest X-ray findings, facial sinus X-ray findings, wheezing, cultures for Aspergillus spp., total immunoglobulin E (IgE), specific IgE for Aspergillus fumigatus and immediate skin test reactivity to A.fumigatus antigen. RESULTS: Of the 74 patients, 2 were diagnosed with ABPA. We found total IgE levels > 1,000 IU/mL in 17 (23%), positive immediate skin reactivity to A. fumigatus antigen in 19 (25.7%) and wheezing in 60 (81.1%). CONCLUSIONS: The prevalence of ABPA was 2.7%. The high levels of total IgE, high incidence of wheezing and high rate of immediate skin test reactivity to A. fumigatus antigen suggest that these patients should be carefully monitored due to their propensity to develop ABPA.
Subject(s)
Aspergillosis, Allergic Bronchopulmonary/epidemiology , Cystic Fibrosis/complications , Adolescent , Adult , Aged , Aspergillosis, Allergic Bronchopulmonary/immunology , Aspergillus fumigatus/immunology , Brazil/epidemiology , Child , Cross-Sectional Studies , Cystic Fibrosis/microbiology , Female , Humans , Hypersensitivity, Immediate/immunology , Immunoglobulin E/blood , Immunoglobulin E/immunology , Male , Middle Aged , Prevalence , Prospective Studies , Skin Tests , Young AdultABSTRACT
OBJETIVO: Determinar a prevalência de aspergilose broncopulmonar alérgica (ABPA) em pacientes com fibrose cística acompanhados em um centro de referência da Bahia. MÉTODOS: Estudo transversal, com coleta prospectiva de dados, realizado no Centro de Referência de Fibrose Cística da Bahia do Hospital Especializado Octavio Mangabeira. Foram incluídos no estudo 74 pacientes que tinham diagnóstico de fibrose cística, com idade acima de 6 anos e tratados entre 9 de dezembro de 2003 e 7 de março de 2005. Foram analisadas as seguintes variáveis: gênero, idade, capacidade vital forçada, volume expiratório forçado no primeiro segundo, resposta a prova farmacodinâmica, achados em radiografia torácica e de seios de face, presença de sibilância, culturas para Aspergillus spp., imunoglobulina E (IgE) total, IgE específica para Aspergillus fumigatus e teste cutâneo de leitura imediata para aspergilina. RESULTADOS: Dos 74 pacientes, 2 foram diagnosticados com ABPA. Níveis de IgE total > 1.000 UI/mL foram observados em 17 pacientes (23%), teste cutâneo de leitura imediata para A. fumigatus positivos em 19 (25,7%) e sibilância em 60 (81,1%). CONCLUSÕES: A taxa de prevalência de ABPA foi de 2,7%. As altas taxas de IgE total, de teste cutâneo imediato para A. fumigatus positivos e de sibilância sugerem que estes pacientes devam ser acompanhados cuidadosamente por haver a possibilidade do desenvolvimento de ABPA.
OBJECTIVE: To determine the prevalence of allergic bronchopulmonary aspergillosis (ABPA) in patients with cystic fibrosis treated at a referral center in the state of Bahia, Brazil. METHODS: A cross-sectional study, with prospective data collection, carried out at the Cystic Fibrosis Referral Center of Bahia of the Octavio Mangabeira Specialized Hospital. We evaluated 74 patients diagnosed with cystic fibrosis, older than six years of age, treated between December 9, 2003 and March 7, 2005. We analyzed the following variables: gender, age, forced vital capacity, forced expiratory volume in one second, pharmacodynamic response, chest X-ray findings, facial sinus X-ray findings, wheezing, cultures for Aspergillus spp., total immunoglobulin E (IgE), specific IgE for Aspergillus fumigatus and immediate skin test reactivity to A.fumigatus antigen. RESULTS: Of the 74 patients, 2 were diagnosed with ABPA. We found total IgE levels > 1,000 IU/mL in 17 (23%), positive immediate skin reactivity to A. fumigatus antigen in 19 (25.7%) and wheezing in 60 (81.1%). CONCLUSIONS: The prevalence of ABPA was 2.7%. The high levels of total IgE, high incidence of wheezing and high rate of immediate skin test reactivity to A. fumigatus antigen suggest that these patients should be carefully monitored due to their propensity to develop ABPA.
Subject(s)
Adolescent , Adult , Aged , Child , Female , Humans , Male , Middle Aged , Young Adult , Aspergillosis, Allergic Bronchopulmonary/epidemiology , Cystic Fibrosis/complications , Aspergillosis, Allergic Bronchopulmonary/immunology , Aspergillus fumigatus/immunology , Brazil/epidemiology , Cross-Sectional Studies , Cystic Fibrosis/microbiology , Hypersensitivity, Immediate/immunology , Immunoglobulin E/blood , Immunoglobulin E/immunology , Prevalence , Prospective Studies , Skin TestsABSTRACT
A tuberculose pleural (tbp) é uma das formas extra-pulmonares da tuberculose humana de melhor prognóstico. A presença de derrame pleural rico em células de origem imune que se forma na cavidade pleural pode estar relacionada com a cura espontânea observada em pacientes com tbp. A partir dessas observações, o presente estudo teve por objetivo investigar a imunidade celular de pacientes com pleurite crônica tuberculosa através da análise comparativa do perfil das células mononucleares do sangue e do derrame pleural por FACS e comparar a proliferação celular, resposta citotóxica e produção de citocinas induzidas pelo antígeno do M. tuberculosís e antígenos recombinantes de micobactérias. Avaliamos também o papel de citocinas sobre a resposta citotóxica das células mononucleares do derrame pleural contra células alvos K562. Doze pacientes incluídos neste estudo tiveram diagnóstico de pleurite tuberculosa confirmado pela presença de granulomas nas biópsias pleurais. Pacientes HIV e HTLV positivos ou com outras doenças associadas foram excluídos desta avaliação. O perfil das células mononucleares foi analisado por citometria de fluxo para identificar os subtipos de linfócitos presentes no sangue e no derrame pleural. A proliferação das células mononucleares foi obtida pela incorporação de [3H] timidina. Os níveis de IFN-y, TNF-a e IL-10 foram analisados nos sobrenadantes das células mononucleares estimuladas com antígeno do M. tuberculosís e antígenos recombinantes de micobactérias. O papel da IL-12, IFN-y, TNF-a, IL-10 e TGF-~ na resposta citotóxica induzida pelo antígeno do M. tuberculosís nas células mononucleares foi avaliado através de ensaios de liberação de [51Cr]. A análise do perfil de células por FACS demonstrou um enriquecimento de linfócitos CD4+ que co-expressam CD45RO+ entre as células do derrame comparado ao perfil das células mononucleares do sangue. Linfócitos B, CD8+ e células NK são menos frequentes no compartimento pleural. Mononucleares...
