Toxoplasmosis hemorrágica en paciente VIH / Hemorrhagic toxoplasmosis in hiv patient

La Toxoplasmosis Cerebral es una neuroinfección oportunista frecuente en el paciente VIH, sin embargo, hay escasos reportes en el mundo en relación con la presentación hemorrágica de esta entidad por lo que se presenta el caso de un paciente varón de 44 años, cuya evolución clínica llevó a sospechar Toxoplasmosis Cerebral Hemorrágica precozmente, pero, pese al tratamiento oportuno finalmente fallece.

Cerebral toxoplasmosis is a frequent opportunistic neuro-infection in HIV patients. However, there are few reports worldwide of its hemorrhagic presentation, so we present the case of a 44 year old male patient whose clinical progress led to early suspicion of cerebral hemorrhagic toxoplasmosis. Despite timely treatment the case resulted in death.

Adenoma pleomorfo del septum nasal, dos casos clínicos y revisión del tema / Pleomorphic adenoma of the nasal septum: two clinical cases

El tumor benigno más frecuente de las glándulas salivales mayores es el adenoma pleomorfo. Además de las glándulas salivales mayores, también puede ocurrir en las glándulas salivales del paladar duro y blando. Raros casos se han reportado en la nasofaringe, orofaringe, hipofaringe y laringe. Adenomas pleomorfos intranasales son muy infrecuentes y pueden ser mal diagnosticados debido a que tienen mayor celularidad mioepitelial y poco estroma mixoide, en comparación con los que se localizan en otros lugares. Presentamos dos raros casos de adenomas pleomorfos del septum nasal y analizamos los hallazgos patológicos y el manejo clínico. Se revisa la literatura en relación al tema.

The most common benign tumor of major salivary glands is the pleomorphic adenoma. In addition to the major salivary glands may also occur in the salivary glands of hard and soft palate. Rare cases have been reported in the nasopharynx, oropharynx, hypopharynx and larynx. Intranasal pleomorphic adenomas are very rare and can be misdiagnosed because they have greater myoepithelial cellularity and little myxoid stroma, compared with those located elsewhere. We report two rare cases of pleomorphic adenomas of the nasal septum and analyze the pathological findings and clinical management. We review the literature on the subject.

Caracterización epidemiológica de los lipomas subcutáneos / Epidemiological characterization of subcutaneous lipomas

Introducción: Los lipomas son los tumores subcutáneos de tejido blando más comunes, con una incidencia de 1 por cada 1.000 personas. Se presentan generalmente entre los 40 y 60 años de edad. El objetivo de este trabajo fue realizar una caracterización epidemiológica de los lipomas subcutáneos. Metodología: Se realizó una búsqueda computacional sobre la base de datos del Servicio de Cirugía del Hospital Dipreca para localizar los pacientes operados con diagnóstico clínico de lipoma y luego se revisó el informe diferido de Anatomía Patológica. Resultados: La muestra estuvo conducida a 110 pacientes, correspondiendo 52% a sexo femenino. La edad de la muestra se concentró en un 65% entre los 40 y los 69 años. El 54% de los lipomas se localizaron en el tronco; de éstos destaca un 62% de localización en dorso, siendo la localización inguinal la menos frecuente. La biopsia diferida correspondió en un 72% de los casos a lipoma.

Introduction: Lipomas are the most common subcutaneous tumors of tender tissue, with an incidence of 1 in 1000 people. The greater incidence is between the ages of 40 and 60. The objective of this trial is to establish an epidemiologic description of subcutaneous lipomas. Methodology: A computational search of the Dipreca Hospital Surgery Department data base was carried out in order to locate patients diagnosed with lipomas that underwent surgery, and the correlation with pathology exams was reviewed. Results: 110 patients were studied, 52% women. 65% were between the ages of 40 and 69. 54% of the lipomas were located in the trunk, of which 62% were located in the back, being the groin the less affected area. Histopathology exams were conclusive of lipoma in 72% of cases.

Genetic determinants of Venezuelan equine encephalitis emergence.

Following a period of inactivity from 1973-1991, Venezuelan equine encephalitis (VEE) reemerged during the past decade in South America and Mexico. Experimental studies of VEE virus (VEEV) infection of horses with virus strains isolated during these outbreaks have revealed considerable variation in the ability of equine-virulent, epizootic strains to exploit horses as efficient amplification hosts. Subtype IC strains from recent outbreaks in Venezuela and Colombia amplify efficiently in equines, with a correlation between maximum viremia titers and the extent of the outbreak from which the virus strain was isolated. Studies of enzootic VEEV strains that are believed to represent progenitors of the epizootic subtypes support the hypothesis that adaptation to efficient replication in equines is a major determinant of emergence and the ability of VEEV to spread geographically. Correlations between the ability of enzootic and epizootic VEEV strains to infect abundant, equiphilic mosquitoes, and the location and extent of these outbreaks, also suggest that specific adaptation to Ochlerotatus taeniorhynchus mosquitoes is a determinant of some but not all emergence events. Genetic studies imply that mutations in the E2 envelope glycoprotein gene are major determinants of adaptation to both equines and mosquito vectors.

Vector competence of rural and urban strains of Aedes (Stegomyia) albopictus (Diptera: Culicidae) from São Paulo State, Brazil for IC, ID, and IF subtypes of Venezuelan equine encephalitis virus.

Aedes albopictus (Skuse) is an Asiatic mosquito species that has spread and colonized all continents except Antarctica. It has major public health importance because it is a potential vector of several pathogens. The objectives of our study were to analyze the vector competence of urban and rural strains of Ae. albopictus from São Paulo State (Brazil) for Venezuelan equine encephalitis virus (VEE) subtypes IC, ID, and IF, and to evaluate the effect of infection with subtype IC of VEE on mosquito longevity. Both mosquito strains were susceptible to subtypes IC and ID, but the infection rate for subtype IF was low. Infection and transmission rates of Ae. albopictus for subtype IC were similar to those reported for Ochlerotatus taeniorhynchus (Wiedemann). The high infection, dissemination, and transmission rates for subtype ID reported for Oc. fulvus (Wiedemann) and Culex (Melanoconion) spp. are comparable with those found in this study. We found significant differences in the susceptibility to subtype IC between rural and urban populations of São Paulo. Significant survival rate differences were observed between uninfected and infected mosquitoes, but there were no differences in survival between rural and urban mosquito strains.

Relación entre el síndrome de apnea obstructiva del sueño y el trastorno de déficit atencional con hiperactividad: estudio en una población de escolares chilenos / The relationship between obstructive sleep apnea syndrome and attention deficit hyperactivity disorder: a study in Chilean schoolchildren

Introducción: el síndrome de apnea obstructiva del sueño (SAOS) uqe afecta a 1-2 porciento de los niños, puede ser causa de importante morbilidad, como problemas conductuales y de rendimiento escolar. Objetivo: evaluar la asociación entre SAOS y trastorno de déficit atencional con hiperactividad (TDAH) en escolares en una comuna de Santiago. Métodos: se envió una encuesta a 50 padres de niños con diagnóstico de TDAH y a 100 niños controles, de edad y sexo similares, obtenidos de las mismas escuelas de los niños con TDAH. La encuesta incluyó información sobre datos generales, edad, sexo, peso, talla, promedio de notas; y un cuestionario de 12 preguntas para diagnóstico de SAOS, validado previamente en una población extranjera. Resultados: la respuesta de la encuesta fue de 84,6 porciento. No hubo diferencias significativas entre el grupo con TDAH y el grupo control de edad, peso, talla; si las hubo en sexo y promedio de notas (p < 0,01). El promedio del puntaje del cuestionario en niños con TDAH fue de 9 ñ 1,26, y en el grupo control de 6 ñ 0,66, (p < 0,05). Se encontraron preguntas del cuestionario que permitieron diferenciar, en forma significativa, niños con SAOS de otros sin esta patológia. Conclusiones: la presencia de SAOS es más frecuente en niños con TDAH que en controles, lo que podría tener una influencia en el déficit atencional de estos pacientes. Sugerimos buscar activamente problemas del sueño en niños con TDAH, con el objeto de proporcionar un tratamiento integral

Ecological studies of enzootic Venezuelan equine encephalitis in north-central Venezuela, 1997-1998.

From 1997-1998, we investigated the possible continuous circulation of epizootic Venezuelan equine encephalitis (VEE) virus suggested by a 1983 subtype IC interepizootic mosquito isolate made in Panaquire, Miranda State, Venezuela. The study area was originally covered by lowland tropical rainforest but has been converted into cacao plantations. Sentinel hamsters, small mammal trapping, mosquito collections, and human serosurveys were used to detect active or recent virus circulation. Six strains of subtype ID VEE virus were isolated from hamsters that displayed no apparent disease. Four other arboviruses belonging to group A (Togaviridae: Alphavirus), two Bunyamwera group (Bunyaviridae), and three Gamboa group (Bunyaviridae) arboviruses were also isolated from hamsters, as well as 8 unidentified viruses. Venezuelan equine encephalitis-specific antibodies were detected in 5 small mammal species: Proechimys guairae, Marmosa spp., and Didelphis marsupialis. Mosquito collections comprised of 38 different species, including 8 members of the subgenus Culex (Melanoconion), did not yield any virus isolates. Sera from 195 humans, either workers in the cacao plantation or nearby residents, were all negative for VEE virus antibodies. Sequences of 1,677 nucleotides from the P62 gene of 2 virus isolates indicated that they represent a subtype ID lineage that is distinct from all others characterized previously, and are unrelated to epizootic VEE emergence.

[Adult Aedes albopictus and Ae. scapularis behavior (Diptera: Culicidae in Southeastern Brazil]. / Comportamento de Aedes albopictus e de Ae. scapularis adultos (Diptera: Culicidae) no Sudeste do Brasil.

OBJECTIVE: Aedes albopictus and Ae. scapularis were found living together in the Pedrinhas Village, Southeastern of São Paulo State, Brazil. This finding was a good opportunity to make observations about the mosquitoes' behavior. METHODS: From October 1996 to January 2000 observations were carried out through systematic collections with human bait, environment aspirations and Shannon trap utilization. Synanthropy was estimated by the Nuorteva index and synanthropic ratios. RESULTS: The 87 collections with human bait yield 872 females adults. Williams' means, multiplied by 100, were 118 and 21 for Ae. albopictus at the 7 AM-6PM and 6PM-8PM hours, respectively, 100 and 106 for Ae. scapularis at the same timetable but there was an evening peak. Through environmental aspirations, a total of 1,124 adults samples was collected, 226 Ae. albopictus samples and 898 Ae. scapularis samples. The period between the months of January-May was the one with higher yield for both mosquitoes. There was no Ae. albopictus in the Shannon trap operated inside the adjacent forest. Regarding the sinanthropy, that culicid showed the higher index values, while Ae. scapularis was ubiquitous. CONCLUSIONS: The data obtained allows to form the hypothesis that Ae. scapularis females may have a diapause phase in the resting places and after that period they will retake the hematophagy habit. That might explain the higher activity at the human bait during the dry months, corresponding to the period of July-October.

[Identification of the encephalitis equine virus, Parana, Brazil]. / Identificação do vírus causador de encefalomielite eqüina, Paraná, Brasil.

INTRODUCTION: In the period of 1996-1999 some virus associated with encephalitis have been reported in horses from different regions of Paraná State, Brazil. To identify the etiologic agent associated with this illness, mosquitoes and serum samples were collected in the endemic area. METHODS: The study area corresponded to four municipalities of Paraná State, Brazil. Mosquitoes were captured in Shannon trap and human bait. After identification, they were processed for virus isolation. Blood of equines were collected in the municipalities of Querência do Norte and Colorado. Antibodies to different Alphavirus and Flavivirus were analyzed by hemagglutination inhibition test. Specific seroneutralization reactions were performed in those sera with a positive reaction in the hemagglutination test. RESULTS: The mosquitoes genus collected were: Culex, Aedes, Mansonia, Coquillettidia, Psorophora, Sabethes, Wyeomyia, and Limatus. Even thought no virus was isolated, serologic analyses showed hemagglutinazing antibodies to Eastern equine encephalitis, Mucambo, Pixuna, Maguari, and St Luis encephalitis viruses. The neutralization test showed specific reaction to Eastern equine encephalitis virus in 12 tested sera. CONCLUSIONS: Species of mosquitoes that could be potential vectors of encephalitis, buniavirus, and other arboviruses of epidemiological importance were collected. It is believed that Eastern equine encephalitis virus affected the equines populations in the study regions because of the symptoms and antibodies for the virus in the sera detected in these equines.

[The synanthropic potential of Kerteszia and Culex mosquitoes (Diptera:Culicidae) in Southeastern Brazil]. / Potencial sinantrópico de mosquitos Kerteszia e Culex (Diptera: Culicidae) no Sudeste do Brasil.

OBJECTIVE: To determine the synanthropic potential of Anopheles bellator and An. cruzii in a village close to a wild environment. For comparative purposes, Culex quinquefasciatus and Cx. sacchettae populations were also investigated. METHODS: From October 1996 to January 2000, vectors investigations were carried out in Pedrinhas village, Southeastern of S. Paulo State, Brazil, through systematic collections with human bait, air aspirations and Shannon traps. The synanthropic index was estimated using Nuorteva's indices plus the Mihályi's endophylic factor. RESULTS: Attraction principle was s=35.7 for both Kerteszia species at the peridomiciliary environment through human bait. Cx. sacchettae showed a sr ratio of 12.8 with a degree of synanthropy. However active search through the aspiration method yielded negative s values, such as -43.1 for An. bellator and -48.2 for An. cruzii. For Cx. sacchettae that value was -3.0. These values were calculated when +100.00 was given to Cx. quinquefasciatus, which showed the highest synanthropic habits, corresponding to s =+93.8. CONCLUSIONS: The present data allow to conclude that what was observed until now for isolated rural dwellings is valid for small villages at the same conditions. This means that female Kerteszia adults tend to be in anthropic environment for blood seeking. After that, they return to the surrounding natural environment of the village. Regarding Cx. Sacchettae, they seem to have an anthropic adaptation tendency.

[Development of a milk beverage based on pumpkin flakes]. / Desenvolvimento de bebida láctea a base de flocos de abóbora.

Vitamin A deficiency is one of the majors public health problems in Brazilian Northeast, and among other causes may be concerned to precocious weaning. Aiming at reducing this problem, a dehydrated product based on powdered milk and pumpkin flakes was developed to act as a carotene source at weaning period. Pumpkin flakes were obtained by drum drying at a 6 atm steam pressure, 0.75 m2 contact surface and 1 rpm, and had their content of carotenoids, beta carotene, centesimal composition molds and yeast and faecal coliforms evaluated. The flakes were added to sugar and whole powdered milk according to FAO/WHO nutritional recommendation to 6-12 months old children and submitted to acceptability test by a 6 judges' panel. The results showed that the drying process had a 7% efficiency score and the flakes composition presented 4.84% moisture; 4.0% protein; 5.5% ash; 1.30% fat; 6.22% fiber; 78.14% carbohydrates; 115.08 micrograms/g total carotenois and 80.64 micrograms/g beta-carotene content. No coliforms were detected and molds and yeast content was 4.0 x 10(2) CFU/g. The powdered formulation properly diluted in water supports 45% of the RDA for children (calories, protein, carbohydrates and lipids) and 100% vitamin A and protein considering a 400 ml/day ingestion.

[Results of preoperative preparation with mannitol in colorectal surgery. January-December 1995]. / Resultados de la preparación preoperatoria con manitol en cirugía colorrectal. Enero-diciembre, 1995.

A study on the results obtained in 20 patients selected by the simple randomized method, who were preoperatively prepared for colorectal surgery with the oral administration of manitol and complementary antimicrobial therapeutics at the ASaturnino Lora@ Provincial Teaching Hospital, in Santiago de Cuba, from January to December, 1995, was conducted aimed at evaluating the results attained with the use of manitol in the preoperative preparation for colorectal surgery, determining its complications, analyzing its advantages, and assessing the patient, nurse and surgeon's opinion about the new procedure. The following variables were taken into account: age, preoperative diagnosis and previous operations. The percentage statistical method was used. Most of the patients were elderly, who were able to undergo surgery. There were no complications in connection with the preoperative preparation, which has the following advantages: it is simpler and more efficient that the traditional use of enemas, it is easy to apply, it saves time and resources on reducing the preoperative stay, it is considered as more comfortable for patients and nurses, and it is much more economic and effective, which was proved by surgeons during the operation.

Incidencia de la infección por virus pirital en roedores de la especie sigmodón alstoni: efectos de la infección sobre la especie / Incidence of the pirital virus infection in rodents of the sigmodon alstony species: effects of the infection on the specie

El virus Pirital es un nuevo arenavirus descubierto en Venezuela, sin embargo no existen evidencias de que pueda ser un virus patógeno para el humano. Sus efectos en el roedor que le sirve de reservorio natural: sigmodón alstoni se analiza en el presente estudio. Un total de 478 roedores: S. alstoni fueron capturados entre junio de 1994 a diciembre de 1995 en el Municipio Papelón, estado Portuguesa. Se recolectaron muestras de sangre y bazo para el aislamineto e identificación de virus en cultivo de células Vero E6. La densidad de la población de roedores S. alstoni mostró un patrón estacional con un máximo éxito de trampeo al final de la estación de sequía (Marzo-Abril). Esta variación temporal no estuvo correlacionada con variaciones en la prevalencia de infección por virus Pirital. El promedio de infección en la especie fue de 33,8 por ciento con un incremento no significativo en la prevalencia de infección entre animales juveniles y adultos. El efecto de la infección por el virus Pirital en el peso y tamaño del cuerpo de los roedores así como en la fertilidad, número de animales por camada, etc. no fue significativamente diferente cuando se compararon los animales infectados con los no infectados

[Carpal tunnel syndrome as initial manifestation of polymyalgia rheumatica]. / Síndrome del túnel carpiano como manifestación inicial de polimalgia reumática.

A case of polymyalgia rheumatica with atypical manifestations, including carpal tunnel syndrome, distal myalgias and a low eritro sedimentation is reported. The association of polymyalgia rheumatica and carpal tunnel syndrome is controversial. Although it has been reported previously in a recent and large review of carpal tunnel syndrome in Rochester, USA, there was not any more cases of polymyalgia rheumatica associated with carpal tunnel syndrome than in the general population. In our patient, the symptoms of polymyalgia rheumatica and of carpal tunnel syndrome were present at the beginning, and both responded satisfactorally to the treatment with methylprednisone. This form of presentation and its response to treatment suggest that the symptoms of carpal tunnel syndrome are caused by the inflammation of the carpal synovial, which is an unfrequent manifestation of polymyalgia rheumatica. We report this case for the purpose of altering to an unusual form of presentation of polymyalgia rheumatica in order to avoid unnecessary surgery for the carpal tunnel syndrome.

Morbimortalidad en cirugía general. Estudio durante un año / Morbimortality in general surgery. Oner year study

Se realiza un estudio en el servicio de Cirugía General del hospital provincial docente clinicoquirúrgico "Dr. Ambrosio Grillo", de Santiago de Cuba, donde se analizan 2 326 historias clínicas de los pacientes egresados vivos y fallecidos durante el año 1978. Las enfermedades de mayor prevalencia fueron la hernia inguinal, afecciones ginecológicas y de las glándulas mamarias. La enfermedad que más operaciones electivas requirió fue la hernia inguinal y, entre las urgentes, la apendicitis aguda. La mayor tasa de complicaciones se observó en las intervenciones intestinales. Las complicaciones posoperatorias más frecuentes fueron la sepsis de la herida y respiratorias. El promedio de estadía fue de 11,8 porciento; la mortalidad bruta de 1,4 porciento y la neta de 1,2 porciento (AU)