Clinical and epidemiological features of mpox in a Brazilian reference center for HIV and sexually transmitted infections: A cross-sectional study.

Background: The 2022 mpox outbreak has affected disproportionately people living with HIV (PLWH) and pre-exposure prophylaxis (PrEP) users. Methods: We conducted a cross-sectional study to evaluate factors associated with laboratory diagnosis of mpox among suspected cases, and access differences between PrEP users and PLWH with confirmed diagnostic. Results: 394 mpox suspected cases were analyzed, 309 (78.4%) confirmed. Most patients with mpox were PLWH (54.4%) and 99 (32%) PrEP users. Mpox cases were likely to be between 25 and 39 years old (aOR=2.8; p=0.042), men who have sex with men/bisexual or transgender women (aOR=17.2; p< 0.001) and to have fever (aOR=4.7; p< 0.001), adenomegaly (aOR=7.2; p< 0.001) and multiple vesicular lesions (aOR=4.2; p< 0.001). Comparing PrEP users to PLWH with confirmed mpox, PrEP users had lesions predominantly with exclusive genital involvement (p=0.016); while PLWH had higher extragenital involvement (p=0.018). Conclusions: PrEP users and PLWHA were the main epidemiological groups in our cohort. Recognizing the differences between vulnerable populations can contribute to the development public policies to control mpox in settings with reduced access to vaccines.

Three cases of oral mucosal tuberculosis in patients on tumour-necrosis-factor-α blockers.

We present three cases of oral mucosal lesions caused by Mycobacterium tuberculosis in patients treated with anti-tumour necrosis factor-α for psoriasis or rheumatoid arthritis. Diagnosis of oral mucosal tuberculosis was not easily established in any of the cases. A comparison between these cases and other previously described forms of oral mucosal tuberculosis is presented.

Ocorrência de enteroparasitas antes e durante a pandemia da COVID-19 em Nina Rodrigues, Maranhão - Brasil / Occurrence of enteroparasites before and during the COVID-19 pandemic in Nina Rodrigues, Maranhão, Brazil

Parasitoses intestinais são infecções no trato gastrointestinal, por protozoários e/ou helmintos e representam um agravo à saúde pública, mas apesar dessa problemática, foram notificadas menos do que seria esperado devido a pandemia da COVID-19. O objetivo desse estudo foi verificar a ocorrência de enteroparasitas antes e durante a pandemia da COVID-19 em pacientes atendidos no laboratório do hospital de Nina Rodrigues, Maranhão. Foi realizado um estudo tranversal, descritivo e quantitativo, sendo analisados os exames dos anos de 2019 e 2020, coletados do banco de informações do hospital em agosto de 2021. Os dados foram inseridos no programa STATA 14.0 para análise. Em 2019 foram realizados 632 exames, e 2020 um total de 161, as mulheres e os adultos de meia idade (31-59 anos) foram os que mais realizaram exames, em relação aos laudos positivos, 18,51% e 26,09% apresentavam pelo menos um tipo de parasita em 2019 e 2020, respectivamente. O parasita mais ocorrente foi Entamoeba coli e 66,48% dos laudos tinham a presença de mais de um parasita, sendo a associação mais observada E. coli + Entamoeba histolytica. Nota-se que apesar do período pandêmico de 2020 ter sido realizado menos exames parasitológicos de fezes em comparação o período de 2019, é possível constatar que há uma ocorrência razoável de enteroparasitas na população de Nina Rodrigues, com um alto índice de indivíduos com biparasitismo. Assim, torna-se necessário a implementação de medidas que visem o diagnóstico e o tratamento dos infectados, e medidas de prevenção para minimizar a transmissão.

Intestinal parasites are infections in the gastrointestinal tract, by protozoa and/or helminths and represent a public health problem, but despite this problem, less were reported than would be expected due to the COVID-19 pandemic. The objective of this study was to verify the occurrence of enteroparasites before and during the COVID-19 pandemic in patients treated at the laboratory of the Nina Rodrigues hospital, Maranhão. A cross-sectional, descriptive, and quantitative study was carried out, analyzing the exams from the years 2019 and 2020, collected from the hospital's information bank in August 2021. The data were entered into the STATA 14.0 program for analysis. In 2019, 632 exams were performed, and in 2020 a total of 161, women and middle-aged adults (31-59 years old) were the ones who most underwent exams, in relation to positive reports, 18.51% and 26.09% had at least one type of parasite in 2019 and 2020, respectively. The most frequent parasite was Entamoeba coli and 66.48% of the reports had the presence of more than one parasite, the most observed association being E. coli + Entamoeba histolytica. It is noted that despite the 2020 pandemic period, fewer fecal parasitological tests were performed compared to the 2019 period, it is possible to verify that there is a reasonable occurrence of enteroparasites in the population of Nina Rodrigues, with a high rate of individuals with biparasitism. Thus, it is necessary to implement measures aimed at diagnosing and treating those infected, and preventive measures to minimize transmission.

ERRATUM: Severe monkeypox case associated with recent laboratory diagnosis of HIV: case report / ERRATA: Caso grave de monkeypox associado ao diagnóstico laboratorial recente de HIV: relato de caso

Introduction: Monkeypox is a zoonosis caused by the monkeypox virus. The first confirmed human case was in 1970, when the virus was isolated from a child in the Democratic Republic of the Congo. Since the beginning of May 2022, a large and unexpected outbreak has been documented globally, with the first cases initially described in the UK reaching around 70 countries today. The causes of this explosive increase in patients are not well understood, but exceed more than ten thousand10,000 infected by the third week of July 2022. Clinical and epidemiological presentations have been distinct from endemic cases and from small outbreaks previously described in non- endemic areas. Objective: The aim of this study was to describe the evolutionary and epidemiological, clinical characteristics of Monkeypox and human immunodeficiency virus co-infection in a patient treated at an STI/AIDS Reference Service in São Paulo, Brazil. Methods: information contained in this study was obtained through a review of the medical records, interviews with the patient, photographic record of the diagnostic methods, to which the patient was submitted and review of the literature. Results: A Brazilian man, with no epidemiological history of travel who was diagnosed with Monkeypox virus through polymerase chain reaction. At the same time of this diagnosis, he received a laboratory diagnosis of human immunodeficiency virus, Chlamydia Urethritis, and Late Latent Syphilis. Conclusion: To reduce the risk of the dissemination of Monkeypox, strategies at the public health level are necessary, with the dissemination of information and the development of prevention projects with targeted information and recommendations for vulnerable populations, especially men who have sex with men, with great prudence, seeking not to favor the development of stigmas as already experienced at the beginning of the human immunodeficiency virus epidemic.

Introdução: Monkeypox é uma zoonose causada pelo vírus monkeypox. O primeiro caso humano confirmado foi em 1970, quando o vírus foi isolado de uma criança na República Democrática do Congo. Desde o início de maio de 2022, um surto grande e inesperado tem sido documentado globalmente, com os primeiros casos inicialmente descritos no Reino Unido atingindo hoje cerca de 70 países. As causas desse aumento explosivo de pacientes não estão bem esclarecidas, mas ultrapassaram 10 mil infectados até a terceira semana de julho de 2022. As apresentações clínicas e epidemiológicas têm sido distintas dos casos endêmicos e dos pequenos surtos previamente descritos em áreas não endemicas. Objetivo: Neste relato descrevemos as características clínicas evolutivas e epidemiológicas da coinfecção do Monkeypox e do imunodeficiência humana em um paciente atendido em um serviço de referência em infecções sexualmente transmissíveis ­ IST/Aids de São Paulo, Brasil. Métodos: as informações dos métodos contidas neste estudo foram obtidas por meio de revisão dos prontuários, entrevistas com o paciente, prontuário fotográfico dos métodos diagnósticos, aos quais o paciente foi submetido e revisão da literatura. Resultados: Homem brasileiro, sem antecedente epidemiológico de viagem, foi diagnosticado com Monkeypox por meio de reação em cadeia da polimerase. Simultaneamente a esse diagnóstico, recebeu diagnóstico laboratorial de vírus da imunodeficiência humana, uretrite por clamídia e sífilis latente tardia. Conclusão: Para reduzir o risco de disseminação do Monkeypox, são necessárias estratégias no âmbito da saúde pública, com disseminação da informação e elaboração de projetos de prevenção com informações direcionadas e recomendações para populações vulneráveis, especialmente homens que fazem sexo com homens, com bastante prudência, buscando não favorecer o desenvolvimento de estigmas como os já vivenciados no início da epidemia de imunodeficiência humana.

Severe monkeypox case associated with recent laboratory diagnosis of HIV: case report / Caso grave de monkeypox associado ao diagnóstico laboratorial recente de HIV: relato de caso

Monkeypox is a zoonosis caused by the smallpox virus. The first confirmed human case was in 1970, when the virus was isolated from a child in the Democratic Republic of the Congo. Since the beginning of May 2022, a large and unexpected outbreak has been documented globally, with the first cases initially described in the UK reaching around 70 countries today. The causes of this explosive increase in patients are not well understood, but exceed more than ten thousand10,000 infected by the third week of July 2022. Clinical and epidemiological presentations have been distinct from endemic cases and from small outbreaks previously described in non- endemic areas. Objective: The aim of this study was to describe the evolutionary and epidemiological, clinical characteristics of Monkeypox and human immunodeficiency virus co-infection in a patient treated at an STI/AIDS Reference Service in São Paulo, Brazil. Methods: information contained in this study was obtained through a review of the medical records, interviews with the patient, photographic record of the diagnostic methods, to which the patient was submitted and review of the literature. Results: A Brazilian man, with no epidemiological history of travel who was diagnosed with Monkeypox virus through polymerase chain reaction. At the same time of this diagnosis, he received a laboratory diagnosis of human immunodeficiency virus, Chlamydia Urethritis, and Late Latent Syphilis. Conclusion: To reduce the risk of the dissemination of Monkeypox, strategies at the public health level are necessary, with the dissemination of information and the development of prevention projects with targeted information and recommendations for vulnerable populations, especially men who have sex with men, with great prudence, seeking not to favor the development of stigmas as already experienced at the beginning of the human immunodeficiency virus epidemic.

Monkeypox é uma zoonose causada pelo vírus varíola. O primeiro caso humano confirmado foi em 1970, quando o vírus foi isolado de uma criança na República Democrática do Congo. Desde o início de maio de 2022, um surto grande e inesperado tem sido documentado globalmente, com os primeiros casos inicialmente descritos no Reino Unido atingindo hoje cerca de 70 países. As causas desse aumento explosivo de pacientes não estão bem esclarecidas, mas ultrapassaram 10 mil infectados até a terceira semana de julho de 2022. As apresentações clínicas e epidemiológicas têm sido distintas dos casos endêmicos e dos pequenos surtos previamente descritos em áreas não endemicas. Objetivo: Neste relato descrevemos as características clínicas evolutivas e epidemiológicas da coinfecção do Monkeypox e do imunodeficiência humana em um paciente atendido em um serviço de referência em infecções sexualmente transmissíveis ­ IST/Aids de São Paulo, Brasil. Métodos: as informações dos métodos contidas neste estudo foram obtidas por meio de revisão dos prontuários, entrevistas com o paciente, prontuário fotográfico dos métodos diagnósticos, aos quais o paciente foi submetido e revisão da literatura. Resultados: Homem brasileiro, sem antecedente epidemiológico de viagem, foi diagnosticado com Monkeypox por meio de reação em cadeia da polimerase. Simultaneamente a esse diagnóstico, recebeu diagnóstico laboratorial de vírus da imunodeficiência humana, uretrite por clamídia e sífilis latente tardia. Conclusão: Para reduzir o risco de disseminação do Monkeypox, são necessárias estratégias no âmbito da saúde pública, com disseminação da informação e elaboração de projetos de prevenção com informações direcionadas e recomendações para populações vulneráveis, especialmente homens que fazem sexo com homens, com bastante prudência, buscando não favorecer o desenvolvimento de estigmas como os já vivenciados no início da epidemia de imunodeficiência humana

Formação em cuidados paliativos: experiência de alunos de medicina e enfermagem / Formación en cuidados paliativos: la experiencia de los estudiantes de medicina y enfermería / Palliative care training: experience of medical and nursing students

Ganha destaque a importância da formação de profissionais capazes de lidar com a subjetividade necessária aos cuidados paliativos. Este é um estudo exploratório, descritivo, com abordagem qualitativa, que objetiva conhecer a experiência dos alunos de medicina e enfermagem durante atendimento a pacientes em cuidados paliativos, identificando dificuldades e aspectos formadores para esse cuidado. Destacaram-se cinco temas que compõem a experiência: mudança na percepção sobre cuidados paliativos, identificação com o paciente e a família, processo de racionalização e sensibilização, formação em cuidados paliativos e aprendizado com a prática e trabalho em equipe multidisciplinar. O estudo demonstra: a importância das atividades práticas no aprendizado em cuidados paliativos, a valorização do trabalho multidisciplinar, o sofrimento pelo processo de autoidentificação com o paciente em final de vida, e o ciclo de empatia e distanciamento resultante na maturidade emocional necessária ao paliativismo.

En el presente trabajo se destaca la importancia de la formación de profesionales capaces de manejar la subjetividad que es necesaria a los cuidados paliativos. Ese es un estudio cualitativo dirigido a comprender la experiencia de estudiantes de medicina y enfermería durante la atención a pacientes en cuidados paliativos, sus dificultades y aspectos formadores. Se identifican cinco aspectos que componen esa experiencia: cambio en la percepción de los cuidados paliativos, identificación con el paciente y la familia, proceso de racionalización y sensibilización, formación en cuidados paliativos y aprendizaje con la práctica y trabajo en equipos multidisciplinares. El estudio demuestra la importancia de las actividades prácticas de aprendizaje, la valoración del trabajo multidisciplinario, el sufrimiento mediante el proceso de identificación con el paciente al final de la vida y el ciclo de la empatía y alejamiento que resulta en la madurez emocional que es necesaria a los cuidados paliativos.

The research remarks the importance of training professionals capable of handling the subjectivity required to palliative care. This is a qualitative study, with an exploratory and descriptive approach. It aims to explain and analyze the experience of undergraduate medical and nursing students in palliative care, identifying the challenges and understanding the formative requirements for this type of care. It was possible to identify five aspects that make up the experience: change in the perception about palliative care, identification with the patients and their family, rationalization and awareness process, palliative care training and practice learning and multidisciplinary work. The study shows the importance of practice activities in palliative care learning, the valorization of the multidisciplinary teams, the suffering involved in the process of self-identification with the end-of-life patient and the cycle of empathy and estrangement resulting in the emotional maturity needed in palliative care.

Nitric oxide triggers a transient metabolic reprogramming in Arabidopsis.

Nitric oxide (NO) regulates plant growth and development as well as responses to stress that enhanced its endogenous production. Arabidopsis plants exposed to a pulse of exogenous NO gas were used for untargeted global metabolomic analyses thus allowing the identification of metabolic processes affected by NO. At early time points after treatment, NO scavenged superoxide anion and induced the nitration and the S-nitrosylation of proteins. These events preceded an extensive though transient metabolic reprogramming at 6 h after NO treatment, which included enhanced levels of polyamines, lipid catabolism and accumulation of phospholipids, chlorophyll breakdown, protein and nucleic acid turnover and increased content of sugars. Accordingly, lipid-related structures such as root cell membranes and leaf cuticle altered their permeability upon NO treatment. Besides, NO-treated plants displayed degradation of starch granules, which is consistent with the increased sugar content observed in the metabolomic survey. The metabolic profile was restored to baseline levels at 24 h post-treatment, thus pointing up the plasticity of plant metabolism in response to nitroxidative stress conditions.

Decoding the Attentional Demands of Gait through EEG Gamma Band Features.

Rehabilitation techniques are evolving focused on improving their performance in terms of duration and level of recovery. Current studies encourage the patient's involvement in their rehabilitation. Brain-Computer Interfaces are capable of decoding the cognitive state of users to provide feedback to an external device. On this paper, cortical information obtained from the scalp is acquired with the goal of studying the cognitive mechanisms related to the users' attention to the gait. Data from 10 healthy users and 3 incomplete Spinal Cord Injury patients are acquired during treadmill walking. During gait, users are asked to perform 4 attentional tasks. Data obtained are treated to reduce movement artifacts. Features from δ(1 - 4Hz), θ(4 - 8Hz), α(8 - 12Hz), ß(12 - 30Hz), γlow(30 - 50Hz), γhigh(50 - 90Hz) frequency bands are extracted and analyzed to find which ones provide more information related to attention. The selected bands are tested with 5 classifiers to distinguish between tasks. Classification results are also compared with chance levels to evaluate performance. Results show success rates of ∼67% for healthy users and ∼59% for patients. These values are obtained using features from γ band suggesting that the attention mechanisms are related to selective attention mechanisms, meaning that, while the attention on gait decreases the level of attention on the environment and external visual information increases. Linear Discriminant Analysis, K-Nearest Neighbors and Support Vector Machine classifiers provide the best results for all users. Results from patients are slightly lower, but significantly different, than those obtained from healthy users supporting the idea that the patients pay more attention to gait during non-attentional tasks due to the inherent difficulties they have during normal gait. This study provides evidence of the existence of classifiable cortical information related to the attention level on the gait. This fact could allow the development of a real-time system that obtains the attention level during lower limb rehabilitation. This information could be used as feedback to adapt the rehabilitation strategy.

Characterization of Artifacts Produced by Gel Displacement on Non-invasive Brain-Machine Interfaces during Ambulation.

So far, Brain-Machine Interfaces (BMIs) have been mainly used to study brain potentials during movement-free conditions. Recently, due to the emerging concern of improving rehabilitation therapies, these systems are also being used during gait experiments. Under this new condition, the evaluation of motion artifacts has become a critical point to assure the validity of the results obtained. Due to the high signal to noise ratio provided, the use of wet electrodes is a widely accepted technic to acquire electroencephalographic (EEG signals). To perform these recordings it is necessary to apply a conductive gel between the scalp and the electrodes. This work is focused on the study of gel displacements produced during ambulation and how they affect the amplitude of EEG signals. Data recorded during three ambulation conditions (gait training) and one movement-free condition (BMI motor imagery task) are compared to perform this study. Two phenomenons, manifested as unusual increases of the signals' amplitude, have been identified and characterized during this work. Results suggest that they are caused by abrupt changes on the conductivity between the electrode and the scalp due to gel displacement produced during ambulation and head movements. These artifacts significantly increase the Power Spectral Density (PSD) of EEG recordings at all frequencies from 5 to 90 Hz, corresponding to the main bandwidth of electrocortical potentials. They should be taken into consideration before performing EEG recordings in order to asses the correct gel allocation and to avoid the use of electrodes on certain scalp areas depending on the experimental conditions.

Detection of intention of pedaling start cycle through EEG signals.

Recovery from cerebrovascular accident (CVA) is a growing research topic. Exoskeletons are being used for this purpose in combination with a volitional control algorithm. This work studied the intention of pedaling initiation movement, based on previous work, with different types of electrode configuration and different processing time windows. The main characteristic is to find alterations in the mu and beta frequency bands where ERD/ERS is produced. The results show that for the majority of the subjects this event is well detected with 8 or 9 electrodes and using time before and after the movement onset.

A supplementary system for a brain-machine interface based on jaw artifacts for the bidimensional control of a robotic arm.

Non-invasive Brain-Machine Interfaces (BMIs) are being used more and more these days to design systems focused on helping people with motor disabilities. Spontaneous BMIs translate user's brain signals into commands to control devices. On these systems, by and large, 2 different mental tasks can be detected with enough accuracy. However, a large training time is required and the system needs to be adjusted on each session. This paper presents a supplementary system that employs BMI sensors, allowing the use of 2 systems (the BMI system and the supplementary system) with the same data acquisition device. This supplementary system is designed to control a robotic arm in two dimensions using electromyographical (EMG) signals extracted from the electroencephalographical (EEG) recordings. These signals are voluntarily produced by users clenching their jaws. EEG signals (with EMG contributions) were registered and analyzed to obtain the electrodes and the range of frequencies which provide the best classification results for 5 different clenching tasks. A training stage, based on the 2-dimensional control of a cursor, was designed and used by the volunteers to get used to this control. Afterwards, the control was extrapolated to a robotic arm in a 2-dimensional workspace. Although the training performed by volunteers requires 70 minutes, the final results suggest that in a shorter period of time (45 min), users should be able to control the robotic arm in 2 dimensions with their jaws. The designed system is compared with a similar 2-dimensional system based on spontaneous BMIs, and our system shows faster and more accurate performance. This is due to the nature of the control signals. Brain potentials are much more difficult to control than the electromyographical signals produced by jaw clenches. Additionally, the presented system also shows an improvement in the results compared with an electrooculographic system in a similar environment.

Evaluating classifiers to detect arm movement intention from EEG signals.

This paper presents a methodology to detect the intention to make a reaching movement with the arm in healthy subjects before the movement actually starts. This is done by measuring brain activity through electroencephalographic (EEG) signals that are registered by electrodes placed over the scalp. The preparation and performance of an arm movement generate a phenomenon called event-related desynchronization (ERD) in the mu and beta frequency bands. A novel methodology to characterize this cognitive process based on three sums of power spectral frequencies involved in ERD is presented. The main objective of this paper is to set the benchmark for classifiers and to choose the most convenient. The best results are obtained using an SVM classifier with around 72% accuracy. This classifier will be used in further research to generate the control commands to move a robotic exoskeleton that helps people suffering from motor disabilities to perform the movement. The final aim is that this brain-controlled robotic exoskeleton improves the current rehabilitation processes of disabled people.

First report of canine ocular thelaziosis by Thelazia callipaeda in Portugal.

BACKGROUND: Thelazia callipaeda eyeworms are transmitted by the non-biting insect vector Phortica variegata in Europe and infest the conjunctiva(s) of several mammalians, including dogs and humans. Infested hosts might remain asymptomatic or display clinical manifestations characterized by variable degrees of severity. METHODS: From July to November 2011, nine dogs were detected with eyeworms at two veterinary clinics in Chaves and Bragança (North of Portugal). Nematodes collected from dogs were morphologically and molecularly characterized at species level. RESULTS: Nematodes were identified as T. callipaeda. The number of worms collected from each dog ranged from three to 76 (average = 17.9 ± 26.8) and was not associated with the severity of clinical signs. Ocular discharge and conjunctivitis were observed in all dogs and ocular pruritus occurred in six of them. Polymerase chain reaction and sequencing of a portion of target cytochrome c oxidase subunit 1 gene further identified all nematodes as haplotype 1. CONCLUSIONS: This is the first report of T. callipaeda and associated ocular disease in dogs from Portugal, suggesting that thelaziosis should be included in the differential diagnosis of canine ocular affections. The risk of the infestation spreading from Spain and France to Portugal, through domestic dogs or wild mammals, is realistic.

Cardiotoxicidade induzida por quimioterápicos: [revisão] / Chemotherapy induced cardiotoxicity: [review]

A sobrevida dos pacientes com câncer aumentou consideravelmente nos últimos 20 anos e, com ela,o número de eventos adversos associados aos quimioterápicos. A cardiotoxicidade crônica induzida pelos agentes antineoplásicos pode comprometer a sobrevida e a qualidade de vida dos pacientes, independentemente de seu prognóstico oncológico. Inúmeros fármacos foram associados a eventos adversos cardiovasculares, e até o momento não há protocolos bem estabelecidos para se detectar precocemente a toxicidade cardíaca. Alguns métodos auxiliam o diagnóstico, como o ecocardiograma, a dosagem de marcadores bioquímicos como a troponina I e o peptídeo natriurético, e a biópsia endomiocárdica. A cardiotoxicidade induzida por quimioterápicos tem se mostrado irreversível e ,uma vez estabelecida a disfunção miocárdica, seu tratamento independe do agente associado à indução da lesão. Estudos recentes sugerem o papel de agentes específicos como o dexrazoxane, a eritropoietina, a trombopoietina e os inibidores da enzima conversora de angiotensina na prevenção do desenvolvimento de cardiotoxicidade relacionada à quimioterapia.

Life expectancy of cancer patients has considerably increased in the last 20 years, but adverseevents associated to chemotherapy have also been more frequent. Chronic cardiactoxicity of antineoplastic agents can compromise survival and quality of life, independentof the oncological prognosis. A wide range of chemotherapy drugs have been associatedto cardiovascular adverse events, and until nowadays there are no well establishedprotocols for early detection of cardiac toxicity. Some methods help in identifying initialcardiomyopathy, such as the echocardiogram, the biochemical markers troponin I andnatriuretic peptide, and endomiocardial biopsy. Chemotherapy induced cardiotoxicityseems to be irreversible, and once myocardial dysfunction is established, the treatmentis not dependent of the causative drug. Recent studies suggest a role for specific agentssuch as dexrazoxan, eritropoietin, thrombopoietin and angiotensin converting enzymeinhibitors in preventing chemotherapy induced cardiotoxicity.

Choque cardiogênico na miocardiopatia induzida por agentes antineoplásicos: relato de caso / Cardiogenic shock in cardiomyopathy induced by antineoplastic agents: a case report

No Brasil, a principal etiologia da insuficiência cardíaca (IC) é a cardiopatia isquêmica crônica associada à hipertensão arterial. A IC pode se manifestar como doença crônica estável ou descompensada. A IC descompensada pode se apresentar como edema agudo de pulmão ou choque cardiogênico no atendimento de urgência. Este trabalho descreve a evolução de paciente admitida em unidade de pronto-socorro com choque cardiogênico secundário à miocardiopatia induzida por agentes antineoplásicos, manifesta quatro anos após a quimioterapia para câncer de mama.

The main cause of heart failure (HF) in Brazil is ischemic cardiomyopathy associated to arterial hypertension. HF can present as a chronic stable or as a decompensated disease. Decompensated HF can manifest as acute pulmonary edema and cardiogenic shock in the emergency unit. We describe here a patient admitted to an emergency room with cardiogenic shock secondary to cardiomyopathy induced by antineoplastic agents, 4 years after chemotherapy for breast cancer.

Canine babesiosis in northern Portugal and molecular characterization of vector-borne co-infections.

BACKGROUND: Protozoa and bacteria transmitted by arthropods, including ticks and phlebotomine sand flies, may cause a wide range of canine vector-borne diseases. Dogs can be simultaneously or sequentially infected with multiple pathogens. Canine babesiosis caused by Babesia canis canis and Babesia canis vogeli is known to occur in Portugal. This study assessed, by means of blood smear examination, PCR and DNA nucleotide sequencing, the presence of Babesia spp. and co-infecting agents Leishmania, Anaplasma/Ehrlichia and Hepatozoon in 45 dogs from northern Portugal clinically suspected of babesiosis. RESULTS: Forty-four dogs (98%) had infection with B. canis canis and one with B. canis vogeli. Co-infections were detected in nine animals (20%). Eight dogs were found infected with two vector-borne agents: six with B. canis canis and Leishmania infantum; one with B. canis canis and Ehrlichia canis; and one with B. canis canis and Hepatozoon canis. Another dog was infected with three vector-borne pathogens: B. canis vogeli, E. canis and L. infantum. Overall, L. infantum was found in seven (16%), E. canis in two (4%), and H. canis in one (2%) out of the 45 dogs with babesiosis. Almost 90% of the 45 cases of canine babesiosis were diagnosed in the colder months of October (18%), November (27%), December (20%), February (13%) and March (9%). Co-infections were detected in February, March, April, May, October and November. Twenty-two (50%) out of 44 dogs infected with B. canis were found infested by ticks including Dermacentor spp., Ixodes spp. and Rhipicephalus sanguineus. Mortality (9%) included two co-infected dogs that died spontaneously and two with single infections that were euthanized. CONCLUSIONS: Babesia canis canis is the main etiological agent of canine babesiosis in northern Portugal. A higher sensitivity of Babesia spp. detection was obtained with PCR assays, compared to the observation of blood smears. Twenty percent of the dogs were co-infected with L. infantum, E. canis or H. canis. Furthermore, this is the first molecular identification of H. canis in dogs from northern Portugal.

Babesia canis canis and Babesia canis vogeli infections in dogs from northern Portugal.

Canine babesiosis represents an important veterinary medical problem. This study describes the molecular characterization of babesial parasites detected in eight clinically suspected dogs from northern Portugal, affected by lethargy, muscle tremors, weight loss, pale mucous membranes, hyperthermia or red-coloured urine. Microscopic examination of peripheral blood smears showed large intraerythrocytic piroplasms morphologically compatible with Babesia canis in all eight animals. DNA was extracted from blood on filter paper, and a Babesia spp. infection confirmed by polymerase chain reaction (PCR) amplification of a 408bp fragment of the 18S rRNA gene. Analysis of PCR-derived sequences revealed that seven dogs were infected with B. canis canis and one with B. canis vogeli. This is the first molecular identification report of both the species B. canis and the subspecies B. canis canis and B. canis vogeli in dogs from Portugal.

Aspectos epidemiológicos da estimulação cardíaca no Brasil: 12º ano do RBM - Registro Brasileiro de Marcapassos, Desfibriladores e Ressincronizadores Cardíacos / Epidemiological aspects of Brazilian cardiac stimulation - 12th year of RBM - the Brazilian Pacemaker, Defibrillation and Resynchronization Registry / Aspectos epidemiológicos de la estimulación cardíaca en Brasil - 12º año del RBM - Registro Brasileño de Marcapasos, Desfibriladores y Resincronizadores Cardíacos

O Registro Brasileiro de Marcapassos, Desfibriladores e Ressincronizadores Cardíacos (RBM) é uma extensa base de dados nacional que dispõe de informações sobre os procedimentos de estimulação cardíaca em nosso país, tendo completado seu 12º ano em junho de 2006. No 12º observamos praticamente as mesmas tendências observadas nos anos anteriores: aumento da idade média dos pacientes, redução dos casos de doença de Chagas, maior implante de marcapassos atrioventriculares, entre outras. O número e procedimentos voltou a aumentar após uma redução observada no décimo ano do registro. Entretanto, o número de implantes de marcapassos por milhão de habitantes, ainda encontra-se muito aquém do observado em outros países.

The brazilian cardiac pacemaker, defibrillation and resynchronization registry (RBM) is an extensive national database that contains the information about cardiac stimulation procedures in Brazil, which reached its 12th year in June of 2006. During the 12th year we practically observed the same tendencies observed in previous years: an increase in patients average age, reduction in Chagas cases, greater number of atrioventricular pacemaker implants, among others. The number of procedures has increased after a reduction observed during the 10th year of registry. However, the number of pacemaker implants per million inhabitants, is still far from what is observed in other countries.

El Registro Brasileño de Marcapasos, Desfibriladores y Resincronizadores Cardíacos (RBM) es una extensa base de datos nacional que dispone de informaciones sobre los procedimientos de estimulación cardíaca en nuestro país, habiendo cumplido su 12º año en junio de 2006. En el 12º año, observamos prácticamente las mismas tendencias advertidas en los años anteriores: aumento de la edad media de los pacientes, reducción de los casos de enfermedad de Chagas, mayor implante de marcapasos atrioventriculares, entre otras. El número de procedimientos volvió a aumentar tras una reducción observada en el décimo año del registro. Sin embargo, el número de implantes de marcapasos por millón de habitantes todavía se halla muy lejos de lo advertido en otros países.

Tono muscular / Muscle tone

O tono muscular é relativamente fácil de ser examinado e difícil de ser avaliado, pois se trata de matéria de julgamento, e que somente é aprendido por exames repetidos. As alterações do tono podem ocorrer na presença de doenças que envolvam qualquer porção de sistema motor. Nesta revisão o autor faz um apanhado geral sobre a avaliação semiológica do tono muscular e suas diversas formas de apresentação, além de tecer comentários a respeito do mecanismo e modo de atuação do sistema fusimotor.