Lymphangioleiomyomatosis With Atypical Presentation Following Pneumothorax: A Case Report.

Lymphangioleiomyomatosis (LAM) is a rare systemic disease that typically presents like cystic lung disease. High-resolution computed tomography (CT) is the recommended imaging technique, with cysts being the hallmark: typically multiple, well-circumscribed, thin-walled, with a variable diameter (usually <2 cm) and widespread in distribution. The gold standard for diagnosis is a biopsy. LAM should be considered in the differential diagnosis of cystic lung diseases. The authors report a case of LAM presenting with a pneumothorax, which due to its atypical imaging characteristics, mimicked another uncommon cystic disease. A multidisciplinary approach is crucial when dealing with presentations of rare diseases.

Prevalence of Sleep Disturbances in Latin American Populations and Its Association with Their Socioeconomic Status-A Systematic Review and a Meta-Analysis.

BACKGROUND: The worldwide increase in the prevalence and incidence of sleep disturbances represents a major public health issue. Among multiple determinants affecting sleep health, an individual's socioeconomic status (SES) is the most ignored and underestimated throughout the literature. No systematic review on the relation between SES and sleep health has been previously conducted in Latin America. METHODS: PRISMA guidelines were used. RESULTS: Twenty articles were included in the final sample (all cross-sectional studies), and twelve among them were rated as fair or poor quality. Among these studies, 80.0% (n = 16) were performed in Brazil, 10.0% (n = 2) were performed in Peru, 5.0% (n = 1) were performed in Chile, and 5.0% (n = 1) were multicentric (11 countries). The combined total number of participants was N = 128.455, comprising 3.7% (n = 4693) children, 16.0% (n = 20,586) adolescents, and 80.3% (n = 103,176) adults. The results show the following: (1) The sleep outcomes analyzed were sleep duration, sleep quality/sleep disturbance, insomnia, excessive daytime sleepiness (EDS), obstructive sleep apnea (OSA)/sleep-disordered breathing (SDB) symptoms, and bruxism. (2) The most used determinants were income, education level, employment status/occupation, wealth/assets, and composite indices. (3) Higher SES was associated with shorter sleep duration. (4) Lower SES was associated with a decrease in sleep quality, less frequent snoring, more prevalent EDS, and sleep bruxism. (5) Lower education was associated with insomnia. (6) Higher education was associated with more sleep bruxism. (7) The pooled prevalence using a meta-analysis of the random effects model was 24.73% (95%CI, 19.98-30.19), with high heterogeneity (I2 = 100%). (8) The prevalence of sleep disturbances decreased with high education (OR, 0.83; 95%CI, [0.69-0.99]; I2 = 79%), while it increased with low income (OR, 1.26; 95%CI, [1.12-1.42]; I2 = 59%), unemployment (OR, 2.84; 95%CI, [2.14-3.76]; I2 = 0%), and being a housewife (OR, 1.72; 95%CI, [1.19-2.48]; I2 = 55%). DISCUSSION: This meta-analysis shows that lower SES (education, income, and work) was associated with sleep disturbances in Latin America. Therefore, sleep disturbance management should be addressed with a multidimensional approach, and a significant investment in targeted public health programs to reduce sleep disparities and support research should be made by the government before the situation becomes uncontrollable.

Wolfram Syndrome: A Curious Case of Repetitive Loss of Consciousness.

Wolfram syndrome is a rare, multisystemic, progressive, and autosomal-recessive genetic disease, characterized by diabetes mellitus and diabetes insipidus, optic nerve atrophy, deafness, and other neurological signs. The diagnosis is usually based on history and clinical manifestations but genetic tests are necessary for confirmation. Currently, there are no treatments available to cure or delay disease progression. This report describes a case of a 23-year-old male diagnosed with Wolfram syndrome who presented to the emergency department with several episodes of loss of consciousness. This case reinforces the need for an early diagnosis of obstructive and central apneas, respiratory failure, and dysphagia, in order to prevent and treat the complications of this disease and to improve patients' quality of life.

Hypertrophic Osteoarthropathy: A Case of an Undifferentiated Polyarthritis.

Hypertrophic osteoarthropathy is a paraneoplastic syndrome and is considered an important secondary cause of rheumatic disease. It typically manifests as tibial and femoral bone pain, with arthralgia or synovitis of adjacent joints also being common findings. Usually, musculoskeletal symptoms accompany the course of the disease, disappearing with treatment of the neoplasm and recurring coincidentally with the tumor relapse. The authors report a case of a patient with hypertrophic osteoarthropathy, whose etiological study allowed the diagnosis of a lung adenocarcinoma, particularly challenging due to the patient's young age and the absence of associated symptoms.

Diversity of microfungi in the phylloplane of plants growing in a Mediterranean ecosystem.

Mediterranean ecosystems have not been investigated as natural habitats for microorganisms in general, and microfungi in particular. Plants harvested in "Serra da Arrábida" (38 degrees 27' N, 9 degrees 02' W), a Mediterranean ecosystem in Portugal, were analyzed for the filamentous microfungi inhabiting their surface. Two field locations with distinct climatic characteristics were studied: 'Fonte do Veado' (38 degrees 28'50" N, 9 degrees 0'17" W; 300 m elevation) located on the northern slope, and 'Mata do Solitário' (38 degrees 27'55" N, 8 degrees 59'35" W; 50 m elevation), on the southern slope. From Veado zone, leaf samples yielded a total of 3,049 isolates, ranging from 317 to 1,328/sample (mean = 762). The number of species/sample ranged from 12 to 24. From Solitario zone, leaf samples yielded a total of 1,337 isolates, ranging from 189 to 528/sample (mean = 334). The number of species/sample, in this case, ranged from 10 to 17. Veado zone showed a wider range of species. The fungal species more frequently isolated from both zones (Aureobasidium pullulans (De Bary) Arnaud, Cladosporium cladosporioides (Fresen.) De Vries, C. sphaerospermum Penzig and Alternaria alternata (Fr.) Keissler) were found in all plant samples and represents 80% (Veado) and 85% (Solitario) of the total isolates.

Cronologia e sequência de erupçäo de dentes decíduos em crianças nutridas e desnutridas / Chronology and eruptive sequence of decidous teeth among nourished and undernourished children

Objetivamos neste trabalho correlacionar a cronologia e a seqüência de erupçäo decídua entre as crianças nutridas e as desnutridas da grande Joäo Pessoa, na faixa etária dos 6 aos 36 meses inclusive, constantes na delimitaçäo desta pesquisa. Foram utilizadas 510 crianças, sendo 273 do sexo masculino e 237 do sexo feminino, perfazendo um total de 510 crianças. Para isto, foi utilizada a Tabela de Gomez, ou seja, a relaçäo peso-idade, fornecida pelas instituiçöes médicas, onde foi realizada a pesquisa, e onde procedemos à separaçäo entre as crianças nutridas e desnutridas. Com base na amostra e na metodologia utilizada, observamos que a cronologia de erupçäo, em ambos os sexos, é mais precoce nas crianças nutridas, quando comparadas às desnutridas. Especificando-se o sexo, a cronologia de erupçäo da dentiçäo decídua é mais precoce no sexo feminino. Além disto, pode-se verificar que: 1 - A ordem de erupçäo dos dentes decíduos, em crianças de ambos os sexos e ambos os arcos, é a que se segue: incisivos centrais, incisivos laterais, primeiros molares, caninos e segundos molares. 2 - Combinando-se o arco superior com o inferior, a ordem de erupçäo é a que se segue: incisivos centrais inferiores, incisivos centrais superiores, incisivos laterais superiores, incisivos laterais inferiores, primeiros molares decíduos inferiores, primeiros molares decíduos superiores, caninos inferiores, caninos superiores, segundos molares decíduos inferiores e segundos molares superiores