Malignant otitis externa in a 21-year-old male patient with Prader-Willi syndrome.

Malignant otitis externa is an invasive infection of the external auditory canal and temporal bone with potentially life-threatening complications. Elderly patients with type 2 diabetes mellitus are the population most commonly affected by malignant otitis externa, but any type of immunosuppression predisposes to the disease. Prader-Willi syndrome is a genetic cause of obesity, often associated with insulin resistance and type 2 diabetes mellitus. This report describes a case of a 21-year-old male patient with Prader-Willi syndrome who had malignant otitis externa that progressed to sepsis during hospitalization. To the best of the authors' knowledge, this is the first description of malignant otitis externa in a young patient with Prader-Willi syndrome.

Improvement of blood inflammatory marker levels in patients with hypothyroidism under levothyroxine treatment.

BACKGROUND: There are several specific inflammatory and oxidative correlates among patients with hypothyroidism, but most studies are cross-sectional and do not evaluate the change in parameters during the treatment. The aim of this study was to investigate the effect of levothyroxine replacement therapy on biomarkers of oxidative stress (OS) and systemic inflammation in patients with hypothyroidism. METHODS: In this prospective open-label study, 17 patients with recently diagnosed primary hypothyroidism due to Hashimoto's thyroiditis who were not taking levothyroxine were included. The following parameters were measured before and at 6 and 12 months of levothyroxine treatment with an average dose of 1.5 to 1.7 µg/kg/day: thyroid-stimulating hormone (TSH), free thyroxine (FT4), high-sensitivity C-reactive protein (hs-CRP), interleukin 1 (IL-1), IL-6, IL-10, interferon gamma (INF-γ), tumor necrosis factor alpha (TNF-α), thiobarbituric acid-reactive substances (TBARS), activity of aminolevulinic acid dehydratase (δ-ALA-D), nonprotein and total thiol (NP-SH and T-SH) groups, total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and triglycerides (TG). Generalized estimating equation (GEE) modeling was used to analyze the effects of LRT (at pre-treatment, 6 months and 12 months) on those variables. The hypothyroidism status (i.e., overt or subclinical hypothyroidism) was included as a confounder in all analyses. An additional GEE post hoc analysis was made to compare time points. RESULTS: There was a significant decrease in TSH over time (P < 0.0001), (initial levels were on average 32.4 µIU/mL and 10.5 µIU/mL at 12 months). There was a significant increase in FT4 (P < 0.0001) (initial levels were on average 0,8 ng/dL and 2.7 ng/dL at 12 months). There were significant changes in interleukin levels over time, with a significant increase in IL-10 (P < 0.0001) and significant decreases in IL-1 (P < 0.0001), IL-6 (P < 0.0001), INF-γ (P < 0.0001) and TNF-α (P < 0.0001). No significant difference in hs-CRP over time was observed (P < 0.284). There was a significant reduction in NP-SH (P < 0.0001). CONCLUSIONS: This study observed significant changes in the inflammatory profile in hypothyroid patients under treatment, with reduction of pro-inflammatory cytokines and elevation of anti-inflammatory cytokine. In these patients, a decrease in low-grade chronic inflammation may have clinical relevance due to the known connection between chronic inflammation, atherosclerosis and cardiovascular events.

Prevalence of benign diseases mimicking lung cancer: experience from a university hospital of southern Brazil.

BACKGROUND: Lung cancer is the most lethal type of cancer in the world. Several benign lung diseases may mimic lung carcinoma in its clinical and radiological presentation, which makes the differential diagnosis for granulomatous diseases more relevant in endemic regions like Brazil. This study was designed to describe the prevalence and the diagnostic work-up of benign diseases that mimic primary lung cancer in patients hospitalized at a university hospital from south of Brazil. METHODS: This was a transversal study, which evaluated the medical records of 1,056 patients hospitalized for lung cancer treatment from September 2003 to September 2013 at University Hospital of Santa Maria. RESULTS: Eight hundred and four patients underwent invasive procedures for suspected primary lung carcinoma. Primary lung cancer was confirmed in 77.4% of the patients. Benign disease was confirmed in 8% of all patients. Tuberculosis (n=14) and paracoccidioidomycosis (n=9) were the most frequent infectious diseases. The diagnosis of benign diseases was obtained by flexible bronchoscopy in 55.6% of the cases and by thoracotomy in 33.4%. CONCLUSION: Infectious diseases are the most frequent benign diseases mimicking lung cancer at their initial presentation. Many of these cases could be diagnosed by minimally invasive procedures such as flexible bronchoscopy. Benign diseases should be included in the differential diagnosis during the investigation for primary lung cancer in order to avoid higher cost procedures and mortality.

Diagnóstico e tratamento da DPOC exacerbada na emergência / Diagnosis and treatment of exacerbated COPD in emergency care

A doença pulmonar obstrutiva crônica (DPOC) é uma doença respiratória prevenível e tratável que se caracteriza pela obstrução crônica e não totalmente reversível do fluxo aéreo. A exacerbação da DPOC é um evento agudo que ocorre no curso natural da doença caracterizado por uma mudança na dispneia basal do paciente, tosse e/ou expectoração e mudança na coloração do escarro que está além das variações normais do dia a dia e que possa justificar uma mudança na medicação habitual do paciente, com alta morbidade e mortalidade. Este trabalho tem como objetivo auxiliar profissionais de saúde no atendimento de pacientes com exacerbação da DPOC na emergência, garantindo o atendimento correto e completo desses pacientes

Chronic Obstructive Pulmonary Disease (COPD) is a preventable and treatable respiratory disease characterized by chronic and not fully reversible obstruction of the airflow. COPD exacerbation is an acute event that occurs in the natural course of the disease characterized by a change in the patient’s baseline dyspnea, cough and/or sputum and change in color of sputum that is beyond normal day-to-day variations and that can justify a change in the patient’s usual medication, with high morbidity and mortality. This work aims to help health professionals in caring for patients with COPD exacerbation, so as to ensure that these patients receive proper and complete care in emergency care situations

Avaliação pré-operatória de pacientes com doença coronariana conhecida ou suspeitada / Preoperative evaluation of patients with coronary disease known or suspected

A doença cardiovascular, em especial a isquêmica é a principal causa de morbimortalidade peroperatória, sendo por isso responsabilidade médica a sua identificação, manejo e estratificação de risco adequados para os pacientes candidatos a procedimentos cirúrgicos não-cardíacos. Os autores fazem uma revisão da literatura sobre avaliação pré-operatória de pacientes com doença arterial coronariana conhecida ou suspeitada, evidenciando uma correta estratificação e quantificação do risco das complicações peroperatórias de cirurgias não cardíacas.

Cardiovascular disease, especially ischemic heart disease, are the principal case of perioperative morbidity and mortality. It's a medical's responsability to identify, to make appropriate preoperative evaluation and to stratify his patients for electives noncardiac surgery. This article is a literature review on preoperative assessment of patients with known or suspected coronary arterial disease.

Importåncia da determinaçåo da enzima adenosina deaminase (ADA) no diagnóstico da tuberculose / The importance of adenosine deaminase (ADA) determination in tuberculosis diagnosis

Os autores enfatizam a importância da utilizaçåo da atividade de adenosina deaminase como um critério útil no diagnóstico do derrame pleural, peritonite e meningite de etiologia tuberculosa. As características destas enzima e os principais estudos evidenciando sua utilidade no diagnóstico das diferentes formas de tuberculose såo também abordados. Os autores ainda apresentam as metodologias disponíveis para sua determinaçåo, ressaltando que a simplicidade de execuçåo técnica é vantajosa na rotinizaçåo laboratorial