Bacterial incidence and drug resistance from pathogens recovered from blood, cerebrospinal and pleural fluids in 2019-2020. Results of the Invifar network.

Background: Antimicrobial resistance is a global concern. Analysis of sterile fluids is essential because microorganisms are defined as significant in most cases. Blood, cerebrospinal, and pleural fluids are frequently received in the microbiology lab because they are associated with considerable rates of morbi-mortality. Knowledge of epidemiology in these samples is needed to choose proper empirical treatments due to the importance of reducing selection pressure. Methods: We used retrospective laboratory data of blood, CSF, and pleural fluid collected from patients in Mexico between 2019 and 2020. Each laboratory identified the strains and tested susceptibility using its routine methods. For Streptococcus pneumoniae, a comparative analysis was performed with data from the broth microdilution method. Results: Forty-five centers participated in the study, with 30,746 clinical isolates from blood, 2,429 from pleural fluid, and 2,275 from CSF. For blood and CSF, Staphylococcus epidermidis was the most frequent. For blood, among gram negatives, the most frequent was Escherichia coli. Among Enterobacterales, 9.8% of K. pneumoniae were carbapenem-resistant. For S. pneumoniae, similar resistance percentages were observed for levofloxacin, cefotaxime, and vancomycin. For CSF, the most frequent gram-negative was E. coli. In Acinetobacter baumannii, carbapenem resistance was 71.4%. The most frequent species detected for pleural fluid was E. coli; in A. baumannii, carbapenem resistance was 96.3%. Conclusion: Gram-negative bacteria, with E. coli most prevalent, are frequently recovered from CSF, blood, and pleural fluid. In S. pneumoniae, the routine, conventional methods showed good agreement in detecting resistance percentages for erythromycin, levofloxacin, and vancomycin.

The applicability of the Tinnitus and Hearing Survey (THS) in the differentiation of tinnitus and hearing complaints. / Aplicabilidade do Tinnitus and Hearing Survey (THS) na diferenciação de queixas auditivas.

PURPOSE: To verify the applicability of the Tinnitus and Hearing Survey (THS) to measure the different complaints of tinnitus, hearing loss and sound tolerance. METHODS: THS was performed, composed of 4 questions about tinnitus, 4 about hearing loss and one about sound tolerance. Previously, all participants performed a battery of audiological diagnostic tests and were then divided into 4 groups: Bilateral normal audiometry with mean up to 25dB, with and without tinnitus complaint (Groups 1 and 3); diagnosis of mild to moderate neural sensory hearing loss (26dB to 60dB), no previous use of individual hearing aids, complaining of chronic tinnitus (≥6 months) and individuals without tinnitus complaints (Groups 2 and 4); and age ≥18 years old. RESULTS: Seventy subjects were included in the present study. Regarding the analysis of the total between the groups by the Kruskal-Wallis test, significant differences were found in the sections about tinnitus and hearing loss, but there was no significance in the section regarding sound tolerance. Regarding the questions in Section A of the THS, only Groups 3 and 4 scored the highest. Regarding the questions related to Section B about hearing loss, the groups without hearing loss (Groups 1 and 3) scored the lowest. In relation to the question of the THS in Section C, Group 3 scored the highest. CONCLUSIONS: The THS questionnaire proved to be a useful, quick and simple tool to assist the audiologist in the understanding and differentiation of the audiologic complaints.

OBJETIVO: verificar a aplicabilidade do THS em mensurar e diferenciar as queixas de zumbido, perda auditiva e tolerância ao som. MÉTODO: Foi aplicado o questionário THS, composto por 4 questões sobre zumbido, 4 sobre perda auditiva e 1 sobre tolerância ao som. Previamente, todos os participantes realizaram uma bateria de exames de diagnóstico audiológico e foram divididos em grupos: audição normal bilateral com média até 25dB, com e sem queixa de zumbido (Grupos 1 e 3); diagnóstico de perda auditiva sensório neural de grau leve a moderado (26dB a 60dB), sem uso prévio de aparelho de amplificação sonora Individual (AASI), com queixa de zumbido crônico (≥6 meses) e também indivíduos sem queixa de zumbido (Grupos 2 e 4); idade igual ou superior a 18 anos. RESULTADOS: Foram incluídos no presente estudo 70 indivíduos. Em relação a análise do total entre os grupos pelo teste Kruskal-Wallis foram encontradas diferenças significativas nas seções sobre zumbido e perda auditiva, mas não houve significância da seção sobre tolerância ao som. Em relação às questões sobre zumbido apenas os grupos 3 e 4 pontuaram. Quanto às questões referentes à perda auditiva, os grupos sem perda (grupos 1 e 3) foram os que menos pontuaram. Em relação a questão do THS sobre tolerância ao som, o grupo 3 foi o que mais pontuou. CONCLUSÃO: o questionário THS se mostrou como uma possível ferramenta para auxiliar na compreensão e diferenciação das queixas auditivas.

Sound Generator: Analysis of the Effectiveness of Noise in the Habituation of Tinnitus.

Introduction Tinnitus is a disorder that affects 10 to 15% of de world's population. Sound therapy performed through hearing aids (HAs) with integrated sound generator (SG) is one of the forms of tinnitus treatment. Objective To analyze the effectiveness of four masking noises in relieving tinnitus in individuals with mild and moderate bilateral sensorineural hearing loss and their influence in speech perception. Methods The participants were 35 individuals with tinnitus and mild and moderate bilateral sensorineural hearing loss, divided into four groups. All groups underwent HA and SG adaptation, being regulated in the combined mode (HA and SG). In group 1 (G1), the white noise stimulus was applied, in group 2 (G2), pink noise was applied, in group 3 (G3), speech noise, and in group 4 (G4), the high tone was applied. All patients were subjected to the following procedures: audiological diagnosis, acuphenometry, tinnitus handicap inventory (THI), visual analogue scale (VAS), and hearing in noise test (HINT). The procedures were performed prior to and after hearing intervention, and after 3 months of use of HA and SG. Results All groups presented a statistically significant difference for the THI, VAS, and HINT pre and postintervention. In the case of the HINT, only pink noise presented a significant difference. However, in the comparation among groups there was no significant difference. Conclusion The present study made it possible to conclude that the four noises were equally effective in relieving tinnitus, with no statistically significant differences between the analyzed groups.

Development and Evaluation of Portal do Zumbido : A Novel Telehealth Approach to Tinnitus.

Introduction Tinnitus is a prevalent symptom in audiological clinics, and the speech therapist participates in the assessment, diagnosis, and intervention of tinnitus. A range of studies have been developed with the aim to promote auditory health, and telehealth is an option for this purpose. Objective The aim of the present study was to develop and assess a virtual platform for tinnitus management for speech therapists. Methods The present study provided a distance-learning-course, with the aid of Portal do Zumbido , available in the following electronic address: zumbido.fob.usp.br. Infographics were available for download, and modules were made to comprise the introduction to the symptoms, assessment, and intervention for tinnitus. Results Speech therapists of different regions of Brazil received an e-mail invitation to participate and to assess the platform, 46 of whom registered. From the 46 speech therapists registered, 38 assessed the virtual platform with the aid of a questionnaire about the theoretical content and then answered a motivational research sheet (MRS). The speech therapists correctly answered 90% and 100% of the questions in the questionnaire and in the MRS, respectively, which may indicate that the professionals positively absorbed the content; thus, the content was considered to be impressive when the MRS was analyzed. Conclusion Portal do Zumbido was developed and is available for access in the following electronic address: zumbido.fob.usp.br. Furthermore, the platform received a positive assessment by the speech therapists who participated in the present study.

Sound Generator: Analysis of the Effectiveness of Noise in the Habituation of Tinnitus

Abstract Introduction Tinnitus is a disorder that affects 10 to 15% of de world's population. Sound therapy performed through hearing aids (HAs) with integrated sound generator (SG) is one of the forms of tinnitus treatment. Objective To analyze the effectiveness of four masking noises in relieving tinnitus in individuals with mild and moderate bilateral sensorineural hearing loss and their influence in speech perception. Methods The participants were 35 individuals with tinnitus and mild and moderate bilateral sensorineural hearing loss, divided into four groups. All groups underwent HA and SG adaptation, being regulated in the combined mode (HA and SG). In group 1 (G1), the white noise stimulus was applied, in group 2 (G2), pink noise was applied, in group 3 (G3), speech noise, and in group 4 (G4), the high tone was applied. All patients were subjected to the following procedures: audiological diagnosis, acuphenometry, tinnitus handicap inventory (THI), visual analogue scale (VAS), and hearing in noise test (HINT). The procedures were performed prior to and after hearing intervention, and after 3 months of use of HA and SG. Results All groups presented a statistically significant difference for the THI, VAS, and HINT pre and postintervention. In the case of the HINT, only pink noise presented a significant difference. However, in the comparation among groups there was no significant difference. Conclusion The present study made it possible to conclude that the four noises were equally effective in relieving tinnitus, with no statistically significant differences between the analyzed groups.

Effects of Low-Level Laser Therapy as a Therapeutic Strategy for Patients With Tinnitus: A Systematic Review.

Purpose This systematic review aimed to analyze the effects of low-level laser therapy (LLLT) on the severity of tinnitus when compared to no therapy or other modalities of therapies. Method A systematic review protocol was registered at the International Prospective Register of Systematic Reviews (PROSPERO) under the Registration Number CRD42019119376. A search was performed in each of the following databases: EMBASE, LILACS, PubMed, Science Direct, Scopus, Web of Science, Google Scholar, and ProQuest. The inclusion criteria consisted of studies in adults over 16 years of age, randomized clinical trials in which subjects presented chronic (≥ 6 months) and subjective tinnitus (unilateral or bilateral) as well as with or without bilateral sensorineural hearing loss, and studies that used only LLLT for treatment of tinnitus compared to no-therapy group or other modalities of therapy. No language or time restrictions were stipulated. The references were managed by Endnote Web and Rayyan QCRI. Results After the screening process, seven studies remained that attained the eligibility criteria. Regarding the risk of bias, only one study was categorized as low risk of bias; the six remaining studies were classified as moderate risk of bias. The seven included studies mainly assessed the LLLT effects on tinnitus by Visual Analogue Scale, Tinnitus Handicap Inventory, pitch and loudness matching, minimum masking level, and pure-tone audiometry. All the seven selected studies found different degrees of significant results regarding tinnitus severity; however, there was no consensus among the results. Conclusion Even though the LLLT showed positive effects in the tinnitus severity in some studies, it is not possible yet to make any recommendation over its uses for the treatment of tinnitus severity.

Post-transplant lymphoproliferative disorder with cutaneous involvement: A series of four cases.

BACKGROUND: Post-transplant lymphoproliferative disorders (PTLD) are lymphoid proliferations associated with post-transplant immunosuppression. Most originate from B cells and are associated with Epstein-Barr virus (EBV) infection. Although extranodal involvement is common, cutaneous presentation is rare. OBJECTIVE: To report and characterize cutaneous manifestations of PTLD from clinical, histopathologic, and immunohistochemistry standpoints. METHODS: Patients' information was obtained retrospectively by reviewing medical records. Skin biopsies were submitted to histological and immunohistochemistry analysis, and EBV detection was performed by in situ hybridization and polymerase chain reaction (PCR) analysis. Staging examinations were included. A literature review of reported cutaneous PTLD cases was performed. RESULTS: We describe two cases of primary cutaneous and 2 cases of systemic PTLD with secondary cutaneous manifestations. All had late onset disease, which presented at least 6 years after transplantation. Histopathologic findings were compatible with monomorphic PTLD in three cases and plasmacytic hyperplasia in one case. EBV was detected in two patients. Both patients with systemic disease had fatal outcome, and those with primary cutaneous involvement responded to treatment. LIMITATIONS: Due to the rare incidence of cutaneous manifestation of PTLD, the analysis of a large number of cases was not possible. CONCLUSION: Although rare, PTLD should be considered in the differential diagnosis of late onset cutaneous complications post-renal transplant.

Audiological findings in the Vogt-Koyanagi-Harada Syndrome. / Achados audiológicos na Síndrome de Vogt-Koyanagi-Harada.

The Vogt-Koyanagi-Harada syndrome (VKHS) is a rare, multisystemic and autoimmune disease. The syndrome mainly affects the eyes, followed by bilateral chronic panuveitis, however, the syndrome may also affect the melanocytes tissues, for example, the eyes, inner ear, meninges and skin. The syndrome origin mechanism is not yet completely known. Commonly, the specific ethnic groups that are affected by the VKHS are as follows: Hispanics, Asians, Indians, Native Americans and ethnic groups from the Middle East. The audiological characteristics of the syndrome and the possible audiologist interventions for a specific case will be reported. The patient was attended at the Clinic of Speech Therapy, Faculdade de Odontologia de Bauru (FOB). She is 53 years old and presented audiological complaints. She was diagnosed with VKHS by a specialist doctor. Throughout the audiologist assessment, she presented bilateral sensorineural hearing loss, absent otoacoustic evoked emissions, complaints about postural vertigo and acute tinnitus. The specific case reported presented sudden sensorineural hearing loss, vertigo, tinnitus and bilateral ocular disease. Even though drug treatment was performed, the hearing loss remained. Therefore, before the hearing aid (HA) fitting, the audiologist should perform the hearing management, investigate if the patient takes the drug treatment and the occurrence of suggestive symptoms of the syndrome. These are some points that help in the reference to the specialist doctor and the audiologist strongly participates in what concerns the hearing.

A síndrome de Vogt-Koyanagi-Harada (SVKH) é rara, multissistêmica e autoimune. Atinge principalmente os olhos, provocando uma panuveíte crônica bilateral, porém traz afecções em outras áreas e tecidos que são ricos em melanócitos, como olhos, orelha interna, meninges e a pele. Sua origem ainda não é totalmente conhecida. Geralmente, a SVKH atinge indivíduos de origem hispânica, do Oriente Médio, indianos, nativos americanos e asiáticos. Descrição dos aspectos audiológicos acometidos pela síndrome e as possíveis intervenções fonoaudiológicas para um caso específico. Paciente de 53 anos, sexo feminino, compareceu à Clínica de Fonoaudiologia, Faculdade de Odontologia de Bauru (FOB) com queixas audiológicas e diagnóstico médico da SVKH. A paciente apresentou perda auditiva sensório-neural bilateralmente, emissões otoacústicas evocadas ausentes e queixas vestibulares de vertigem postural e desequilíbrio ao andar, bem como queixa de zumbido agudo contínuo. O caso apresentado mostrou perda auditiva sensório-neural, vertigem, zumbido e acometimento ocular bilateral. Apesar do tratamento com corticoesteroide, a perda auditiva se manteve. Desta forma, precedente à indicação do AASI, o fonoaudiólogo deve atentar-se para o acompanhamento audiológico do caso, realização ou não de tratamento medicamentoso e ocorrência de sintomas sugestivos da síndrome, favorecendo o encaminhamento para o médico e participando ativamente do processo terapêutico envolvendo a audição.

Analysis of speech perception with amplification devices in subjects with ear malformation and unilateral hearing loss. / Análise da percepção da fala com uso de dispositivos de amplificação em indivíduos com malformação de orelha e perda auditiva unilateral.

PURPOSE: To verify the speech perception in subjects with ear malformation and unilateral hearing loss, fitted with two types of amplification as follows: conventional hearing aids and softband (band with vibrator bone). METHOD: The study included fifteen subjects of both sexes who presented congenital malformation of the middle or outer ear, diagnosed with unilateral conductive or mixed hearing loss, moderate to severe hearing loss, age range between 15 to 25 years and, prescription from a specialist doctor for hearing device fitting. We performed the speech perception assessment without amplification after the hearing aid and softband fitting, with the hearing aid linked to the bone vibrator (conventional) and the softband (band with the bone vibrator). The subjects were evaluated using the Hearing in Noise Test (HINT), in silence and in noise. RESULTS: Seven subjects with unilateral ear malformation were evaluated, 57.1 % had impairment in the right ear and 42.9 % in the left ear. Regarding the type and the level of hearing loss, 71 % of all subjects included in the sample presented moderate conductive hearing loss. The assessment of speech perception was performed during silence, frontal noise, lateral noise and, during three specifics situations: no amplification, with conventional hearing aid and with the softband. The results with the amplification devices were positive in all evaluated conditions. CONCLUSION: Evaluated subjects presented improvement in speech perception, in silence, frontal noise and lateral noise situations, regardless of the type of amplification; however, the difference was not statistically significant.

Polymeric films containing pomegranate peel extract based on PVA/starch/PAA blends for use as wound dressing: In vitro analysis and physicochemical evaluation.

Chronic wounds constitute a serious public health problem, and developing pharmaceutical dosage forms to ensure patient comfort and safety, as well as optimizing treatment effectiveness, are of great interest in the pharmaceutical, medical and biomaterial fields. In this work, the preparation of films based on blends of poly(vinyl alcohol), starch and poly(acrylic acid), polymers widely used as pharmaceutical excipients, and pomegranate peel extract (PPE), a bioactive compound with antimicrobial and healing activities relevant to the use as a bioactive wound dressing, was proposed. Initially, the minimum inhibitory concentration (MIC) of the PPE was investigated by an in vitro method. Then, the best concentration of the PPE to be used to prepare the films was researched using an antimicrobial susceptibility test with the disc diffusion method. The microbiological assay was performed in films prepared by the solvent casting method in the presence of two concentrations of PPE: 1.25% w/v and 2.5% w/v. Films containing the lower PPE concentration showed antimicrobial activity against Staphylococcus aureus and Staphylococcus epidermidis, with a difference that was not considered statistically significant when compared to the higher concentration of the extract. Therefore, the films prepared with the lower proportion of PPE (1.25% w/v) were considered for the other studies. The miscibility and stability of the extract in the films were investigated by thermal analysis. Parameters that determine the barrier properties of the films were also investigated by complementary techniques. Finally, in vitro biological tests were performed for safety evaluation and activity research. Analysis of the results showed that the incorporation of the higher proportion of starch in the blend (15% v/v) (PVA:S:PAA:PPE4) yielded smooth, transparent, and domain-free films without phase separation. Additionally, the PVA:S:PAA:PPE4 film presented barrier properties suitable for use as a cover. These films, when subjected to the in vitro hemolytic activity assay, were nonhemolytic and biocompatible. No toxicity from the extract was observed at the concentrations studied. The results of the wound healing in vitro test showed that films containing 1.25% PPE are efficient in reducing the scratch open area, provoking almost total closure of the scratches within 48 h without cytotoxicity.

Análise da percepção da fala com uso de dispositivos de amplificação em indivíduos com malformação de orelha e perda auditiva unilateral / Analysis of speech perception with amplification devices in subjects with ear malformation and unilateral hearing loss

RESUMO Objetivo: Verificar a percepção da fala de indivíduos com malformação de orelha e perda auditiva unilateral utilizando dois tipos de amplificação: amplificação sonora individual (AASI) convencional e softband (faixa com vibrador ósseo). Método: Foram selecionados 15 indivíduos, de ambos os sexos, com malformação congênita de orelha externa e/ou orelha média, diagnóstico de perda auditiva unilateral do tipo condutiva ou mista de grau moderado a severo, idade entre 15 e 25 anos, e encaminhamento para amplificação realizado pelo médico otorrinolaringologista. Após a adaptação com AASI e softband, foi realizada avaliação da percepção da fala sem uso da amplificação, com AASI acoplado ao arco e vibrador ósseo (convencional) e com uso do softband (faixa com vibrador). Os indivíduos foram avaliados por meio do Hearing in Noise Test (HINT) nas condições de silêncio e de ruído. Resultados: Foram avaliados sete indivíduos com malformação de orelha unilateral, sendo 57,1% na orelha direita e 42,9% na orelha esquerda. Quanto ao tipo e grau da perda, 71, 4% da amostra possuía perda auditiva condutiva moderada. No teste de percepção de fala na condição de silêncio, ruído frontal e ruído lateral, em três situações: sem amplificação, com o uso do AASI convencional e com o uso do softband, os resultados com uso de dispositivos de amplificação apresentaram-se melhores em todas as condições. Conclusão: Os indivíduos apresentaram melhora sutil, porém não significativa, na percepção de fala tanto em situações de silêncio, ruído frontal e lateral independentemente do tipo de amplificação.

ABSTRACT Purpose: To verify the speech perception in subjects with ear malformation and unilateral hearing loss, fitted with two types of amplification as follows: conventional hearing aids and softband (band with vibrator bone). Method: The study included fifteen subjects of both sexes who presented congenital malformation of the middle or outer ear, diagnosed with unilateral conductive or mixed hearing loss, moderate to severe hearing loss, age range between 15 to 25 years and, prescription from a specialist doctor for hearing device fitting. We performed the speech perception assessment without amplification after the hearing aid and softband fitting, with the hearing aid linked to the bone vibrator (conventional) and the softband (band with the bone vibrator). The subjects were evaluated using the Hearing in Noise Test (HINT), in silence and in noise. Results: Seven subjects with unilateral ear malformation were evaluated, 57.1 % had impairment in the right ear and 42.9 % in the left ear. Regarding the type and the level of hearing loss, 71 % of all subjects included in the sample presented moderate conductive hearing loss. The assessment of speech perception was performed during silence, frontal noise, lateral noise and, during three specifics situations: no amplification, with conventional hearing aid and with the softband. The results with the amplification devices were positive in all evaluated conditions. Conclusion: Evaluated subjects presented improvement in speech perception, in silence, frontal noise and lateral noise situations, regardless of the type of amplification; however, the difference was not statistically significant.

Achados audiológicos na Síndrome de Vogt-Koyanagi-Harada / Audiological findings in the Vogt-Koyanagi-Harada Syndrome

RESUMO A síndrome de Vogt-Koyanagi-Harada (SVKH) é rara, multissistêmica e autoimune. Atinge principalmente os olhos, provocando uma panuveíte crônica bilateral, porém traz afecções em outras áreas e tecidos que são ricos em melanócitos, como olhos, orelha interna, meninges e a pele. Sua origem ainda não é totalmente conhecida. Geralmente, a SVKH atinge indivíduos de origem hispânica, do Oriente Médio, indianos, nativos americanos e asiáticos. Descrição dos aspectos audiológicos acometidos pela síndrome e as possíveis intervenções fonoaudiológicas para um caso específico. Paciente de 53 anos, sexo feminino, compareceu à Clínica de Fonoaudiologia, Faculdade de Odontologia de Bauru (FOB) com queixas audiológicas e diagnóstico médico da SVKH. A paciente apresentou perda auditiva sensório-neural bilateralmente, emissões otoacústicas evocadas ausentes e queixas vestibulares de vertigem postural e desequilíbrio ao andar, bem como queixa de zumbido agudo contínuo. O caso apresentado mostrou perda auditiva sensório-neural, vertigem, zumbido e acometimento ocular bilateral. Apesar do tratamento com corticoesteroide, a perda auditiva se manteve. Desta forma, precedente à indicação do AASI, o fonoaudiólogo deve atentar-se para o acompanhamento audiológico do caso, realização ou não de tratamento medicamentoso e ocorrência de sintomas sugestivos da síndrome, favorecendo o encaminhamento para o médico e participando ativamente do processo terapêutico envolvendo a audição.

ABSTRACT The Vogt-Koyanagi-Harada syndrome (VKHS) is a rare, multisystemic and autoimmune disease. The syndrome mainly affects the eyes, followed by bilateral chronic panuveitis, however, the syndrome may also affect the melanocytes tissues, for example, the eyes, inner ear, meninges and skin. The syndrome origin mechanism is not yet completely known. Commonly, the specific ethnic groups that are affected by the VKHS are as follows: Hispanics, Asians, Indians, Native Americans and ethnic groups from the Middle East. The audiological characteristics of the syndrome and the possible audiologist interventions for a specific case will be reported. The patient was attended at the Clinic of Speech Therapy, Faculdade de Odontologia de Bauru (FOB). She is 53 years old and presented audiological complaints. She was diagnosed with VKHS by a specialist doctor. Throughout the audiologist assessment, she presented bilateral sensorineural hearing loss, absent otoacoustic evoked emissions, complaints about postural vertigo and acute tinnitus. The specific case reported presented sudden sensorineural hearing loss, vertigo, tinnitus and bilateral ocular disease. Even though drug treatment was performed, the hearing loss remained. Therefore, before the hearing aid (HA) fitting, the audiologist should perform the hearing management, investigate if the patient takes the drug treatment and the occurrence of suggestive symptoms of the syndrome. These are some points that help in the reference to the specialist doctor and the audiologist strongly participates in what concerns the hearing.

Pemphigus vulgaris.

Pemphigus vulgaris is a chronic autoimmune bullous dermatosis that results from the production of autoantibodies against desmogleins 1 and 3. It is the most frequent and most severe form of pemphigus, occurring universally, usually between 40 and 60 years of age. It usually begins with blisters and erosions on the oral mucosa, followed by lesions on other mucous membranes and flaccid blisters on the skin, which can be disseminated. There is a clinical variant, pemphigus vegetans, which is characterized by the presence of vegetating lesions in the large folds of the skin. Clinical suspicion can be confirmed by cytological examination, histopathological examination, and direct and indirect immunofluorescence tests. The treatment is performed with systemic corticosteroids, and immunosuppressive drugs may be associated, among them azathioprine and mycophenolate mofetil. More severe cases may benefit from corticosteroids in the form of intravenous pulse therapy, and recent studies have shown a beneficial effect of rituximab, an anti-CD20 immunobiological drug. It is a chronic disease with mortality around 10%, and septicemia is the main cause of death. Patients need long-term and multidisciplinary follow-up.

Pemphigus vulgaris

Abstract: Pemphigus vulgaris is a chronic autoimmune bullous dermatosis that results from the production of autoantibodies against desmogleins 1 and 3. It is the most frequent and most severe form of pemphigus, occurring universally, usually between 40 and 60 years of age. It usually begins with blisters and erosions on the oral mucosa, followed by lesions on other mucous membranes and flaccid blisters on the skin, which can be disseminated. There is a clinical variant, pemphigus vegetans, which is characterized by the presence of vegetating lesions in the large folds of the skin. Clinical suspicion can be confirmed by cytological examination, histopathological examination, and direct and indirect immunofluorescence tests. The treatment is performed with systemic corticosteroids, and immunosuppressive drugs may be associated, among them azathioprine and mycophenolate mofetil. More severe cases may benefit from corticosteroids in the form of intravenous pulse therapy, and recent studies have shown a beneficial effect of rituximab, an anti-CD20 immunobiological drug. It is a chronic disease with mortality around 10%, and septicemia is the main cause of death. Patients need long-term and multidisciplinary follow-up.

Structural brain abnormalities are related to retinal nerve fiber layer thinning and disease duration in neuromyelitis optica spectrum disorders.

BACKGROUND: Although aquaporin-4 (AQP4) is widely expressed in the human brain cortex, lesions are rare in neuromyelitis optica (NMO) spectrum disorders (NMOSD). Recently, however, several studies have demonstrated occult structural brain atrophy in NMO. OBJECTIVE: This study aims to investigate magnetic resonance imaging (MRI) patterns of gray matter (GM) and white matter (WM) abnormalities in patients with NMOSD and to assess the visual pathway integrity during disease duration correlation of the retinal nerve fiber layer (RNFL) and pericalcarine cortex thickness. METHODS: Twenty-one patients with NMOSD and 34 matched healthy controls underwent both high-field MRI (3T) high-resolution T1-weighted and diffusion-tensor MRI. Voxel-based morphometry, cortical analyses (Freesurfer) and diffusion-tensor imaging (DTI) analyses (TBSS-FSL) were used to investigate brain abnormalities. In addition, RNFL measurement by optic-coherence tomography (OCT) was performed. RESULTS: We demonstrate that NMOSD is associated with GM and WM atrophy, encompassing more frequently the motor, sensory and visual pathways, and that the extent of GM atrophy correlates with disease duration. Furthermore, we demonstrate for the first time a correlation between RNFL and pericalcarine cortical thickness, with cortical atrophy evolving over the course of disease. CONCLUSIONS: Our findings indicate a role for retrograde and anterograde neurodegeneration in GM atrophy in NMOSD. However, the presence atrophy encompassing almost all lobes suggests that additional pathomechanisms might also be involved.

Interleukin-17-induced protein lipocalin 2 is dispensable for immunity to oral candidiasis.

Oropharyngeal candidiasis (OPC; thrush) is an opportunistic fungal infection caused by the commensal microbe Candida albicans. Immunity to OPC is strongly dependent on CD4+ T cells, particularly those of the Th17 subset. Interleukin-17 (IL-17) deficiency in mice or humans leads to chronic mucocutaneous candidiasis, but the specific downstream mechanisms of IL-17-mediated host defense remain unclear. Lipocalin 2 (Lcn2; 24p3; neutrophil gelatinase-associated lipocalin [NGAL]) is an antimicrobial host defense factor produced in response to inflammatory cytokines, particularly IL-17. Lcn2 plays a key role in preventing iron acquisition by bacteria that use catecholate-type siderophores, and lipocalin 2(-/-) mice are highly susceptible to infection by Escherichia coli and Klebsiella pneumoniae. The role of Lcn2 in mediating immunity to fungi is poorly defined. Accordingly, in this study, we evaluated the role of Lcn2 in immunity to oral infection with C. albicans. Lcn2 is strongly upregulated following oral infection with C. albicans, and its expression is almost entirely abrogated in mice with defective IL-17 signaling (IL-17RA(-/-) or Act1(-/-) mice). However, Lcn2(-/-) mice were completely resistant to OPC, comparably to wild-type (WT) mice. Moreover, Lcn2 deficiency mediated protection from OPC induced by steroid immunosuppression. Therefore, despite its potent regulation during C. albicans infection, Lcn2 is not required for immunity to mucosal candidiasis.

Influence of English language in the number of citations of articles published in Brazilian journals of ophthalmology.

PURPOSE: To determine the association between language and number of citations of ophthalmology articles published in Brazilian journals. METHODS: This study was a systematic review. Original articles were identified by review of documents published at the two Brazilian ophthalmology journals indexed at Science Citation Index Expanded - SCIE ["Arquivos Brasileiros de Oftalmologia (ABO)" and "Revista Brasileira de Oftalmologia (RBO)"]. All document types ("articles" and "reviews") listed at SCIE in English (English Group) or in Portuguese (Portuguese Group) from January 1, 2008 to December 31, 2009 were included, except: "editorial materials"; "corrections"; "letters"; and "biographical items". The primary outcome was the number of citations through the end of second year after publication date. Subgroup analysis included likelihood of citation (cited at least once versus no citation), journal, and year of publication. RESULTS: The search at the web of science revealed 382 articles [107 (28%) in the English Group and 275 (72%) in the Portuguese Group]. Of those, 297 (77.7%) were published at the ABO and 85 (23.3%) at the RBO. The citation counts were statistically significantly higher (P<0.001) in the English Group (1.51 - SD 1.98 - range 0 to 11) compared with the Portuguese Group (0.57 - SD 1.06 - range 0 to 7). The likelihood citation was statistically significant higher (P<0.001) in the English Group (70/107 - 65.4%) compared with the Portuguese Group (89/275 - 32.7%). There were more articles published in English at the ABO (98/297 - 32.9%) than at the RBO (9/85 - 10.6%) [P<0.001]. There were no significant difference (P=0.967) at the proportion of articles published in English at the years 2008 (48/172 - 27.9%) and 2009 (59/210 - 28.1%). CONCLUSION: The number of citations of articles published in Portuguese at Brazilian ophthalmology journals is lower than the published in English. The results of this study suggest that the editorial boards should strongly encourage the authors to adopt English as the main language in their future articles.

Characterization of the immune response in human paracoccidioidomycosis.

OBJECTIVES: Paracoccidioidomycosis (PCM) is a systemic mycosis caused by the dimorphic fungus Paracoccidioides brasiliensis that presents two main clinical forms: the adult form (AF) and the juvenile form (JF); and an asymptomatic form denominated PCM-infection (PI). These forms of PCM are related to the immune response developed after infection, which has been associated with Th1 and Th2 responses. However, some PCM characteristics cannot be explained by this balance. In this study we aimed to complement the characterization of the immune response in PCM, including the newly described T cells subpopulations (Th17, Th9 and Th22). METHODS: We analyzed the expression of cytokines and transcription factors characteristics of these different subpopulations of CD4(+) T cells in PBMCs from PCM patients and a PI group. RESULTS: The results showed that the PI group presented a predominant Th1 response; that JF patients were characterized by a mixed Th2/Th9 response; and AF patients were characterized by a predominant Th17/Th22 response, as well as substantial participation of Th1 cells. CONCLUSIONS: These results contribute to the existing knowledge on the immune responses associated with resistance or susceptibility to the P. brasiliensis infection, and thus could lead to the development of new strategies for patient management.

Detection of TCD4+ subsets in human carotid atheroma.

Activated TCD4(+) cells are detected in human atherosclerotic plaques which indicate their participation in disease progression and destabilization. Among these cells, IFN-γ-producing T cells (TH1) are recognized as having a pro-atherogenic role. Recently, the IL-17-producing T helper lineage of cells (TH17) has been identified in atherosclerotic lesions. They have been linked to atheroma development through the production of pro-inflammatory mediators present in these lesions. Furthermore, IL-22 producing TCD4(+) cells (TH22) have been identified in the atheromatous environment, but their presence and function has not been investigated. The aim of this study was to analyze the immune response mediated by pro-inflammatory subtypes of TCD4(+) cells in atheromatous lesions. Atherosclerotic plaques of 57 patients with critical stenosis of carotid submitted to endarterectomy were evaluated. Three carotid fragments from organ donors were used as control. mRNA analysis showed expression of TH1 (IFN-γ, T-bet, IL-2, IL-12p35, TNF-α and IL-18); TH2 (GATA-3); TH17 (IL-17A, IL-17RA, Rorγt, TGF-ß, IL-6, IL-1ß, IL-23p19, CCL20, CCR4 and CCR6) and TH22 (IL-22 and Ahr) related markers. Asymptomatic patients showed higher expression of mRNA of IL-10, TGF-ß, CCR4 and GATA-3 when compared to symptomatic ones. Immunohistochemistry analysis showed higher levels of IL-23, TGF-ß, IL-1ß and IL-18 in macrophages and foam cells in unstable lesions compared to stable and control ones. In vitro stimulation of atheroma cells induced IL-17 and IFN-γ production. Finally we were able to detect, the following subpopulations of TCD3(+) cells: TCD4(+) IFN-γ(+), TCD4(+)IL-17(+), TCD4(+)IL-4(+), TCD4(+)IL-22(+) and double positive cells (IFN-γ/IL-17(+), IFN-γ/IL-22(+) or IL-17/IL-22(+)). Our results showed the presence of distinct TCD4(+) cells subsets in human carotid lesions and suggest that interactions among them may contribute to the atheroma progression and destabilization.