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1.
Article in English | MEDLINE | ID: mdl-38055375

ABSTRACT

Paracoccidioidomycosis (PCM) is a systemic fungal infection caused by Paracoccidioides spp. It can occur as an acute/subacute form (A/SAF), a chronic form (CF) and rarely as a mixed form combining the features of the two aforementioned forms in an immunocompromised patient. Here, we report a 56-year-old male patient with CF-PCM who presented with atypical manifestations, including the development of an initial esophageal ulcer, followed by central nervous system (CNS) lesions and cervical and abdominal lymphatic involvement concomitant with severe SARS-CoV-2 infection. He was HIV-negative and had no other signs of previous immunodeficiency. Biopsy of the ulcer confirmed its mycotic etiology. He was hospitalized for treatment of COVID-19 and required supplemental oxygen in the intensive unit. The patient recovered without the need for invasive ventilatory support. Investigation of the extent of disease during hospitalization revealed severe lymphatic involvement typical of A/SAF, although the patient`s long history of high-risk exposure to PCM, and lung involvement typical of the CF. Esophageal involvement is rare in non-immunosuppressed PCM patients. CNS involvement is also rare. We suggest that the immunological imbalance caused by the severe COVID-19 infection may have contributed to the patient developing atypical severe CF, which resembles the PCM mixed form of immunosuppressed patients. Severe COVID-19 infection is known to impair the cell-mediated immune response, including the antiviral response, through T-lymphopenia, decreased NK cell counts and T-cell exhaustion. We hypothesize that these alterations would also impair antifungal defenses. Our case highlights the potential influence of COVID-19 on the course of PCM. Fortunately, the patient was timely treated for both diseases, evolving favorably.


Subject(s)
COVID-19 , Paracoccidioides , Paracoccidioidomycosis , Male , Humans , Middle Aged , Paracoccidioidomycosis/complications , Paracoccidioidomycosis/diagnosis , Ulcer , COVID-19/complications , SARS-CoV-2 , Antifungal Agents/therapeutic use
2.
Cureus ; 15(7): e42039, 2023 Jul.
Article in English | MEDLINE | ID: mdl-37593320

ABSTRACT

Kaposi sarcoma (KS) is a vascular tumor of low malignancy. Lesions may vary in shape, color, and size. Angiogenesis, spindle-shaped cells, and inflammatory infiltration are the main histologic features of the condition. Human herpesvirus-8 (HHV-8) infection and immune dysfunction play a key role in the development of KS. We report a case of a 40-year-old man with disseminated KS (DKS) who underwent an endoscopic examination. Colonoscopy revealed an ulcer in the anal canal. Biopsy and immunohistochemistry (IHC) confirmed the diagnosis of cytomegalovirus (CMV) proctitis, a rare and underreported pathology.

3.
Article in English | MEDLINE | ID: mdl-37075335

ABSTRACT

AIDS-related disseminated histoplasmosis (DH) can cause septic shock and multiorgan dysfunction with mortality rates of up to 80%. A 41-year-old male presented with fever, fatigue, weight loss, disseminated skin lesions, low urine output, and mental confusion. Three weeks before admission, the patient was diagnosed with HIV infection, but antiretroviral therapy (ART) was not initiated. On day 1 of admission, sepsis with multiorgan dysfunction (acute renal failure, metabolic acidosis, hepatic failure, and coagulopathy) was identified. A chest computed tomography showed unspecific findings. Yeasts suggestive of Histoplasma spp. were observed in a routine peripheral blood smear. On day 2, the patient was transferred to the ICU, where his clinical condition progressed with reduced level of consciousness, hyperferritinemia, and refractory septic shock, requiring high doses of vasopressors, corticosteroids, mechanical ventilation, and hemodialysis. Amphotericin B deoxycholate was initiated. On day 3, yeasts suggestive of Histoplasma spp. were observed in the bone marrow. On day 10, ART was initiated. On day 28, samples of peripheral blood and bone marrow cultures revealed Histoplasma spp. The patient stayed in the ICU for 32 days, completing three weeks of intravenous antifungal therapy. After progressive clinical and laboratory improvement, the patient was discharged from the hospital on oral itraconazole, trimethoprim-sulfamethoxazole, and ART. This case highlights the inclusion of DH in the differential diagnosis of patients with advanced HIV disease, septic shock and multiorgan dysfunction but without respiratory failure. In addition, it provides early in-hospital diagnosis and treatment and comprehensive management in the ICU as determining factors for a good outcome.


Subject(s)
HIV Infections , Histoplasmosis , Respiratory Insufficiency , Shock, Septic , Male , Humans , Adult , Histoplasmosis/complications , Histoplasmosis/diagnosis , Histoplasmosis/drug therapy , HIV Infections/complications , Multiple Organ Failure/etiology , Histoplasma , Respiratory Insufficiency/etiology
4.
Article in English | LILACS-Express | LILACS | ID: biblio-1431363

ABSTRACT

ABSTRACT AIDS-related disseminated histoplasmosis (DH) can cause septic shock and multiorgan dysfunction with mortality rates of up to 80%. A 41-year-old male presented with fever, fatigue, weight loss, disseminated skin lesions, low urine output, and mental confusion. Three weeks before admission, the patient was diagnosed with HIV infection, but antiretroviral therapy (ART) was not initiated. On day 1 of admission, sepsis with multiorgan dysfunction (acute renal failure, metabolic acidosis, hepatic failure, and coagulopathy) was identified. A chest computed tomography showed unspecific findings. Yeasts suggestive of Histoplasma spp. were observed in a routine peripheral blood smear. On day 2, the patient was transferred to the ICU, where his clinical condition progressed with reduced level of consciousness, hyperferritinemia, and refractory septic shock, requiring high doses of vasopressors, corticosteroids, mechanical ventilation, and hemodialysis. Amphotericin B deoxycholate was initiated. On day 3, yeasts suggestive of Histoplasma spp. were observed in the bone marrow. On day 10, ART was initiated. On day 28, samples of peripheral blood and bone marrow cultures revealed Histoplasma spp. The patient stayed in the ICU for 32 days, completing three weeks of intravenous antifungal therapy. After progressive clinical and laboratory improvement, the patient was discharged from the hospital on oral itraconazole, trimethoprim-sulfamethoxazole, and ART. This case highlights the inclusion of DH in the differential diagnosis of patients with advanced HIV disease, septic shock and multiorgan dysfunction but without respiratory failure. In addition, it provides early in-hospital diagnosis and treatment and comprehensive management in the ICU as determining factors for a good outcome.

5.
Article in English | LILACS-Express | LILACS | ID: biblio-1529448

ABSTRACT

ABSTRACT Paracoccidioidomycosis (PCM) is a systemic fungal infection caused by Paracoccidioides spp. It can occur as an acute/subacute form (A/SAF), a chronic form (CF) and rarely as a mixed form combining the features of the two aforementioned forms in an immunocompromised patient. Here, we report a 56-year-old male patient with CF-PCM who presented with atypical manifestations, including the development of an initial esophageal ulcer, followed by central nervous system (CNS) lesions and cervical and abdominal lymphatic involvement concomitant with severe SARS-CoV-2 infection. He was HIV-negative and had no other signs of previous immunodeficiency. Biopsy of the ulcer confirmed its mycotic etiology. He was hospitalized for treatment of COVID-19 and required supplemental oxygen in the intensive unit. The patient recovered without the need for invasive ventilatory support. Investigation of the extent of disease during hospitalization revealed severe lymphatic involvement typical of A/SAF, although the patient`s long history of high-risk exposure to PCM, and lung involvement typical of the CF. Esophageal involvement is rare in non-immunosuppressed PCM patients. CNS involvement is also rare. We suggest that the immunological imbalance caused by the severe COVID-19 infection may have contributed to the patient developing atypical severe CF, which resembles the PCM mixed form of immunosuppressed patients. Severe COVID-19 infection is known to impair the cell-mediated immune response, including the antiviral response, through T-lymphopenia, decreased NK cell counts and T-cell exhaustion. We hypothesize that these alterations would also impair antifungal defenses. Our case highlights the potential influence of COVID-19 on the course of PCM. Fortunately, the patient was timely treated for both diseases, evolving favorably.

6.
Braz J Microbiol ; 53(3): 1305-1312, 2022 Sep.
Article in English | MEDLINE | ID: mdl-35779208

ABSTRACT

Dengue infection is the most prevalent arthropod-borne viral disease in subtropical and tropical regions, whose primary vector is Aedes aegypti mosquitoes. The mechanisms of dengue virus (DENV) pathogenesis are little understood because we have no good disease models. Only humans develop symptoms (dengue fever, DF, or dengue hemorrhagic fever, DHF) and research has been limited to studies involving patients. Samples from serum, brain, cerebellum, heart, lungs, liver, and kidneys from a 13-year-old male patient that died with hemorrhagic manifestations were sent for differential diagnosis at Adolfo Lutz, using both classical virological methods (RT-qPCR, virus isolation, ELISA, and hemagglutination inhibition test) and immunohistochemistry (IHQ). A DENV serotype 4 was detected by a DENV multiplex RT-qPCR, and the C6/36 cell supernatant was used for NGS using Minion. Lesions were described in the heart, liver, lung, and kidney with positive IHQ in endothelial cells of the brain, cerebellum, heart, and kidney, and also in hepatocytes and Kuppfer cells. A whole genome was obtained, revealing a DENV-4 genotype II, with no evidence of secondary dengue infection.


Subject(s)
Dengue Virus , Dengue , Severe Dengue , Adolescent , Animals , Brazil , Dengue/diagnosis , Dengue Virus/physiology , Endothelial Cells , Genomics , Humans , Male , Mosquito Vectors , Phylogeny
7.
Article in English, Portuguese | LILACS-Express | LILACS | ID: biblio-1437463

ABSTRACT

A feared fungal disease surprised and became a warning to severe cases of COVID-19, especially to health professionals involved with the pandemic. Designated as black fungus for public health services in India, where reported data reflects an increase of more than eighty times the expected increase for Rhizopus among the communities. The disease has become even more worrisome due to the high mortality already established as an opportunistic infection, coupled with the reserved prognosis for all those infected and hospitalised by the SARS-CoV-2 severity criteria. This patient, who was submitted to corticosteroid therapy, in an excessive dose, therefore immunosuppressive, developed a severe, disseminated clinical form. It was verified the progression of the lesions and thus the high risk of trans- surgical lethality, or, also, by the insufficiency of conduct in removing the lesions to their satisfaction. Thus, the therapeutic option is the associated use of micafungin, liposomal amphotericin B and isavuconazole for the regressive phase. The patient remains hospitalised with progressive and discrete improvement. Until the opportunity of reevaluation of the surgery by the interspecialty collaboration.


Uma temida doença fúngica surpreendeu e se tornou um alerta para casos graves de COVID-19, principalmente aos profissionais de saúde envolvidos com a pandemia. Designado como fungo preto para serviços de saúde pública na Índia, onde os dados relatados refletem um aumento de mais de oitenta vezes o aumento esperado para Rhizopus entre as comunidades. A doença tornou-se ainda mais preocupante devido à alta mortalidade já estabelecida como infecção oportunista, aliada ao prognóstico reservado para todos os infectados e internados pelos critérios de gravidade do SARS-CoV-2. Esse paciente, que foi submetido à corticoterapia, em dose excessiva, portanto imunossupressora, desenvolveu uma forma clínica grave e disseminada. Verificou-se a progressão das lesões e, portanto, o alto risco de letalidade transcirúrgica, ou, ainda, pela insuficiência de conduta na remoção das lesões a contento. Assim, a opção terapêutica é o uso associado de micafungina, anfotericina B lipossomal e isavuconazol para a fase regressiva. O paciente permanece internado com melhora progressiva e discreta. Até a oportunidade de reavaliação da cirurgia pela colaboração interespecialista.

8.
Rev. Eugenio Espejo ; 16(2): 16-24, 20220504.
Article in Spanish | LILACS | ID: biblio-1369899

ABSTRACT

El estudio realizado fue no experimental correlacional de corte transversal con enfoque cuantitativo, en una población de 100 trabajadores de seguridad de una empresa en la ciudad de Quito, que desempeñaban funciones de guardias de seguridad. Los datos se recolectaron mediante dos instrumentos validados: cuestionario factorial de personalidad 16PF-V y el test AUDIT (por sus siglas en inglés: Alcohol Use Disorders Identification Test). Los rasgos de riesgo más observa-dos fueron: imperturbable-con poca ansiedad (52%) e introvertido-socialmente inhibido (49%), el 79% de los participantes no mostró dificultades con el consumo de alcohol. El nivel de consumo de alcohol se correlacionó positiva y estadísticamente significativa con la dimensión de personalidad ansiedad. Se destaca la necesidad de dar seguimiento constante a esta problemática y generar estrategias preventivas y de afrontamiento al respecto.


The research was non-experimental, correlational and cross-sectional with a quantitative approach. The population consisted of 100 security workers of a company who performed func-tions of security guards in the city of Quito. Data were collected using two validated instruments: the 16PF-V factorial personality questionnaire and the AUDIT test (for its acronym in English: Alcohol Use Disorders Identification Test). The most observed risk traits were: unper-turbed, with little anxiety (52%) and introverted, socially inhibited (49%), 79% of the partici-pants did not show difficulties with alcohol consumption. The level of alcohol consumption was positively correlated and statistically significant with the anxiety personality dimension. Moni-toring this problem and generating preventive and coping strategies in this regard is highlighted


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Anxiety , Personality , Alcoholism , Safety , Alcohol Drinking , Occupational Groups
9.
Rev. Eugenio Espejo ; 16(2): 81-90, 20220504.
Article in Spanish | LILACS | ID: biblio-1370058

ABSTRACT

Introducción: la selección de pareja es un proceso complejo donde se involucran factores biológicos, psicológicos, personales, sociales y emocionales. Objetivo: determinar los criterios para la selección de pareja según el tiempo de relación en los padres de estudiantes de la Unidad Educativa Vigotsky en la ciudad de Riobamba. Metodología: se hizo un estudio con enfoque cuantitativo, de tipo observacional descriptivo. La población estuvo integrada por padres de familia mayores de 20 años, cuyos hijos estudiaban en la institución mencionada, a partir de cual se seleccionó una muestra de 170 individuos mediante la técnica del tipo bola de nieve. los datos se recolectaron mediante la Escala de Selección de Pareja de Romero. Resultados: según los involucrados, los criterios más relevantes para la selección de pareja fueron los rasgos de personalidad (61,8%) y satisfacción de necesidades (65,3%); mientras que, los menos considerados fueron el atractivo (80,0%) y la similitud de intereses personales (48,2%). Conclusiones: la comparación del nivel de importancia de los criterios de selección de pareja según al tiempo de relación posibilitó determinar que el nivel bajo predominó en los aspectos no verbales en aquellas con menos de 10 años de unión. Además, el tiempo de relación se asoció significativa-mente con las dimensiones: aspectos no verbales, rasgos de personalidad y satisfacción de necesidades


Introduction: mate selection is a complex process involving biological, psychological, personal, social and emotional factors. Objective: to determine the criteria for mate selection according to the relationship time in the parents of students of the Vigotsky Educational Unit in the city of Riobamba. Methodology: a study was carried out with a quantitative approach, of a descriptive observational type. The population was made up of parents over 20 years of age, whose children studied at the aforementioned institution. A sample of 170 individuals was selected using the snowball-type technique. Data were collected using the Romero Mate Selection Scale. Results: The most relevant criteria for partner selection were personality traits (61.8%) and satisfaction of needs (65.3%. On the other hand, attractiveness (80.0%) and the similarity of personal interests (48.2%) were the least considered. Conclusions: It was determined that the low level prevailed in the non-verbal aspects in those ones with less than 10 years of union based on the comparison of the level of importance of the mate selection criteria according to the time of the relationship. In addition, the relationship time was significantly associated with the dimensions: non-verbal aspects, personality traits and needs satisfaction.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Parents , Family , Marriage , Time , Emotions , Interpersonal Relations
10.
Dis Aquat Organ ; 148: 13-18, 2022 Feb 10.
Article in English | MEDLINE | ID: mdl-35142294

ABSTRACT

Histopathological and immunohistochemical methods were used to diagnose round cell tumors in 2 subantarctic fur seals Arctocephalus tropicalis with marked anemia. Although wild-born, both individuals were placed under human care while juveniles in a Brazilian aquarium. Both pinnipeds were PCR tested for herpesvirus, and 1 was infected with otariid gammaherpesvirus 5 (OtHV-5), previously described in a subantarctic fur seal stranded in Brazil. Although some gammaherpesviruses can cause sarcomas and other neoplasms, it was not possible to definitively associate OtHV-5 with the neoplasm. To our knowledge, these are the first neoplasm records in subantarctic fur seals.


Subject(s)
Caniformia , Fur Seals , Herpesviridae , Histiocytic Sarcoma , Animals , Brazil/epidemiology , Histiocytic Sarcoma/veterinary
11.
Rev. Eugenio Espejo ; 15(3): 81-89, 20210830.
Article in Spanish | LILACS | ID: biblio-1337967

ABSTRACT

La presente investigación se desarrolló con el objetivo de describir el nivel de ansiedad-rasgo en estudiantes de la carrera de Odontología de la Universidad Central del Ecuador, mediante un estudio descriptivo transversal que involucró a 293 estudiantes universitarios de séptimo a noveno semestre. Los datos se recopilaron mediante el Inventario de Ansiedad Rasgo Estado (IDARE), los que mostraron un predominio del nivel medio (58,02%), seguido del alto (39,6%). El 42,38% de las mujeres se catalogó con un alto nivel de ansiedad-rasgo. Entre esa variable y la edad se estableció una dependencia estadísticamente significativa. Los menores de 23 años resultaron más afectados por esa entidad psicológica. La frecuencia del nivel medio se manifestó mayoritariamente en los tres semestres estudiados, aunque el nivel alto estuvo más presente en los alumnos de octavo semestre


This research was developed in order to describe the level of trait anxiety in students of the school of dentistry of the Central University of Ecuador. A cross-sectional descriptive study was carried out, which involved 293 university students from seventh to ninth semester. The data were collected using the State Trait Anxiety Inventory, which showed a predominance of the medium level (58.02%), followed by the high level (39.6%). 42.38% of the women were classi-fied as having a high level of trait anxiety. A statistically significant dependence was established between this variable and age. Those ones under 23 years of age were more affected by this psychological entity. The frequency of the medium level was manifested mainly in the three semesters studied; however, the high level was more present in the eighth semester students.


Subject(s)
Humans , Male , Female , Adult , Anxiety , Students , Universities , Schools , Stress, Psychological , Dentistry
12.
J Int Acad Periodontol ; 23(1): 11-16, 2021 01 01.
Article in English | MEDLINE | ID: mdl-33512338

ABSTRACT

AIMS: This study aimed to determine the possible clinical and histological periodontal effects of long-term coca leaf chewing habit in habitants of the highland region of Peru. MATERIALS AND METHODS: A total of 100 residents, were recruited for the study. Fifty individuals were habitual coca leaf chewers and 50 were non-users. Eligibility criteria were: 60-80 years old, ≥20 teeth present (excluding third molars), systemically healthy (controlled systemic disease), not using medication affecting the gingiva. Chronic tobacco smokers were excluded. All participants completed questionnaires, received clinical periodontal examination, and had gingival biopsies harvested for histopathological assessment. RESULTS: Most coca leaf chewers reported several oral changes resulting from the habit, such as bitterness, numbness and mouth dryness, while none of the non-chewers reported experiencing such changes. Within the clinical periodontal parameters, it was found that there was a significant difference in terms of clinical attachment level loss, with a p value of 0.014 in those who chewed coca leaves, who appeared to have less clinical attachment loss. CONCLUSIONS: Chewing coca leaf produce bitterness, numbness and mouth dryness, and clinical attachment loss. Histologically higher number of inflammatory cells in the stratum spinosum, with more acanthosis, clear cell, and higher number of blood vessels.


Subject(s)
Coca , Cocaine , Aged , Aged, 80 and over , Cross-Sectional Studies , Humans , Mastication , Middle Aged , Peru
13.
Rev Peru Med Exp Salud Publica ; 37(2): 312-319, 2020.
Article in Spanish | MEDLINE | ID: mdl-32876223

ABSTRACT

Disease caused by the new coronavirus (COVID-19) is characterized by fever, cough, and affection of the lower respiratory tract. It is associated with age, comorbidities and a weakened immune system. Typically, lymphopenias have been evidenced in severe cases and an excessive production of inflammatory cytokines (cytokine storm), which would explain the role of the hyperinflammatory response in the pathogenesis of COVID-19. Secondary inflammatory responses from virus reinfections may induce antibody-dependent enhancement (ADE), a viremic phenomenon that may be an alternative mechanism of cellular infection and should be considered when designing vaccines or immunotherapies involving the stimulation of neutralizing antibodies or the use of monoclonal antibodies. Currently, no vaccines or treatments demonstrate safety and efficacy in patients with COVID-19. However, the results from phase III clinical trials which involve the application of an mRNA (messenger ribonucleic acid) nucleic acid vaccine and an antiviral drug (remdisivir), are yet to be concluded. For the time being, the best measure to prevent the spread of COVID-19 is by implementing social isolation, this measure has been adopted by several countries as recommended by the World Health Organization (WHO).


La enfermedad causada por el nuevo coronavirus (COVID-19) se caracteriza por presentar fiebre y tos, afectar el tracto respiratorio inferior y estar asociada con la edad, comorbilidades y un sistema inmune debilitado. Típicamente se ha evidenciado linfopenias en los casos graves y una desmedida producción de citocinas inflamatorias (tormenta de citocinas), lo que explicaría el rol de la respuesta hiperinflamatoria en la patogénesis de la COVID-19. Las respuestas inflamatorias secundarias por reinfecciones del virus podrían inducir el aumento o la mejora dependiente de anticuerpos (ADE, por sus siglas en inglés), un fenómeno virémico que podría ser un mecanismo alternativo de infección celular y que se deberá tener en cuenta cuando se diseñen vacunas o inmunoterapias que involucren el estímulo de anticuerpos neutralizantes o el uso de anticuerpos monoclonales. Actualmente no existen vacunas ni tratamientos que demuestren seguridad y eficacia en pacientes con COVID-19; sin embargo, se espera la conclusión de los resultados de la aplicación de una vacuna de ácidos nucleicos ARNm (mensajero del ácido ribonucleico) y de un fármaco antiviral (remdisivir) que se encuentran en ensayos clínicos fase III. Por el momento la mejor medida para evitar la propagación de la infección es el aislamiento social exhaustivo y viene siendo adoptado por varios países según recomendación de la Organización Mundial de la Salud (OMS).


Subject(s)
Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Social Isolation , Antiviral Agents/administration & dosage , COVID-19 , Coronavirus Infections/drug therapy , Coronavirus Infections/immunology , Coronavirus Infections/prevention & control , Cytokines/immunology , Humans , Pandemics/prevention & control , Pneumonia, Viral/immunology , Pneumonia, Viral/prevention & control , Risk Factors , Viral Vaccines/administration & dosage , COVID-19 Drug Treatment
14.
Rev. peru. med. exp. salud publica ; 37(2): 312-319, abr.-jun. 2020. graf
Article in Spanish | LILACS | ID: biblio-1127151

ABSTRACT

RESUMEN La enfermedad causada por el nuevo coronavirus (COVID-19) se caracteriza por presentar fiebre y tos, afectar el tracto respiratorio inferior y estar asociada con la edad, comorbilidades y un sistema inmune debilitado. Típicamente se ha evidenciado linfopenias en los casos graves y una desmedida producción de citocinas inflamatorias (tormenta de citocinas), lo que explicaría el rol de la respuesta hiperinflamatoria en la patogénesis de la COVID-19. Las respuestas inflamatorias secundarias por reinfecciones del virus podrían inducir el aumento o la mejora dependiente de anticuerpos (ADE, por sus siglas en inglés), un fenómeno virémico que podría ser un mecanismo alternativo de infección celular y que se deberá tener en cuenta cuando se diseñen vacunas o inmunoterapias que involucren el estímulo de anticuerpos neutralizantes o el uso de anticuerpos monoclonales. Actualmente no existen vacunas ni tratamientos que demuestren seguridad y eficacia en pacientes con COVID-19; sin embargo, se espera la conclusión de los resultados de la aplicación de una vacuna de ácidos nucleicos ARNm (mensajero del ácido ribonucleico) y de un fármaco antiviral (remdisivir) que se encuentran en ensayos clínicos fase III. Por el momento la mejor medida para evitar la propagación de la infección es el aislamiento social exhaustivo y viene siendo adoptado por varios países según recomendación de la Organización Mundial de la Salud (OMS).


ABSTRACT Disease caused by the new coronavirus (COVID-19) is characterized by fever, cough, and affection of the lower respiratory tract. It is associated with age, comorbidities and a weakened immune system. Typically, lymphopenias have been evidenced in severe cases and an excessive production of inflammatory cytokines (cytokine storm), which would explain the role of the hyperinflammatory response in the pathogenesis of COVID-19. Secondary inflammatory responses from virus reinfections may induce antibody-dependent enhancement (ADE), a viremic phenomenon that may be an alternative mechanism of cellular infection and should be considered when designing vaccines or immunotherapies involving the stimulation of neutralizing antibodies or the use of monoclonal antibodies. Currently, no vaccines or treatments demonstrate safety and efficacy in patients with COVID-19. However, the results from phase III clinical trials which involve the application of an mRNA (messenger ribonucleic acid) nucleic acid vaccine and an antiviral drug (remdisivir), are yet to be concluded. For the time being, the best measure to prevent the spread of COVID-19 is by implementing social isolation, this measure has been adopted by several countries as recommended by the World Health Organization (WHO).


Subject(s)
Humans , Pneumonia, Viral/epidemiology , Social Isolation , Coronavirus Infections/epidemiology , Antiviral Agents/administration & dosage , Pneumonia, Viral/immunology , Pneumonia, Viral/prevention & control , Viral Vaccines/administration & dosage , Risk Factors , Cytokines/immunology , Coronavirus Infections/immunology , Coronavirus Infections/prevention & control , Coronavirus Infections/drug therapy , Pandemics/prevention & control , COVID-19
16.
Autops. Case Rep ; 9(3): e2019104, July-Sept. 2019. ilus
Article in English | LILACS | ID: biblio-1017386

ABSTRACT

Rhabdomyosarcoma (RMS) is a rare solid tumor in childhood and adolescence. The higher incidence is predominant during the first two decades of life. According to the Intergroup RMS Study Group, the embryonal RMS (ERMS), botryoidal variant, constitutes a histological subtype characterized as a "grape-like" lesion of 2.0 cm to 9.5 cm. The treatment involves chemotherapy, surgery, and/or radiotherapy. We present the case of a 14-year-old female patient diagnosed with ERMS, botryoidal variant, which originated in the uterine cervix with vaginal externalization. The initial therapeutic approach comprised an initial prolapsed mass excision followed by Wertheim­Meigs surgery due to the tumor extension. No consensual protocol to ERMS treatment is found in the medical literature; however, a combined approach seems to offer a better result. The postoperative time period was uneventful and the patient followed an adjuvant therapy with vincristine, d-actinomycin, and cyclophosphamide. A comprehensive evaluation of the therapeutic options preserving the reproductive function­unfortunately not always possible­is part of a multi-disciplined care team concerning the pediatric patients.


Subject(s)
Humans , Female , Adolescent , Uterine Cervical Neoplasms/pathology , Rhabdomyosarcoma, Embryonal/pathology , Cervix Uteri/abnormalities
17.
Autops Case Rep ; 9(3): e2019104, 2019.
Article in English | MEDLINE | ID: mdl-31372362

ABSTRACT

Rhabdomyosarcoma (RMS) is a rare solid tumor in childhood and adolescence. The higher incidence is predominant during the first two decades of life. According to the Intergroup RMS Study Group, the embryonal RMS (ERMS), botryoidal variant, constitutes a histological subtype characterized as a "grape-like" lesion of 2.0 cm to 9.5 cm. The treatment involves chemotherapy, surgery, and/or radiotherapy. We present the case of a 14-year-old female patient diagnosed with ERMS, botryoidal variant, which originated in the uterine cervix with vaginal externalization. The initial therapeutic approach comprised an initial prolapsed mass excision followed by Wertheim-Meigs surgery due to the tumor extension. No consensual protocol to ERMS treatment is found in the medical literature; however, a combined approach seems to offer a better result. The postoperative time period was uneventful and the patient followed an adjuvant therapy with vincristine, d-actinomycin, and cyclophosphamide. A comprehensive evaluation of the therapeutic options preserving the reproductive function-unfortunately not always possible-is part of a multi-disciplined care team concerning the pediatric patients.

18.
Autops. Case Rep ; 8(2): e2018022, Apr.-May 2018. ilus
Article in English | LILACS | ID: biblio-905523

ABSTRACT

Congenital pulmonary airway malformation (CPAM) is a developmental malformation of the lower respiratory tract. We report the case of a male newborn diagnosed with cystic lung disease during prenatal ultrasound. A cesarean section was performed at the 32nd gestational week because of premature rupture of the membranes, and soon after the delivery the newborn developed respiratory failure and died. The aim of this study is to report an autopsy case because of its rarity, and to briefly discuss the CPAM subtypes and differential diagnosis of cystic lung diseases of childhood.


Subject(s)
Humans , Female , Pregnancy , Infant, Newborn , Cystic Adenomatoid Malformation of Lung, Congenital/diagnosis , Prenatal Diagnosis/statistics & numerical data , Abortion , Autopsy , Cystic Adenomatoid Malformation of Lung, Congenital/pathology , Diagnosis, Differential , Fatal Outcome , Infant, Premature , Respiratory Distress Syndrome, Newborn/etiology
19.
Autops Case Rep ; 8(2): e2018022, 2018.
Article in English | MEDLINE | ID: mdl-29780758

ABSTRACT

Congenital pulmonary airway malformation (CPAM) is a developmental malformation of the lower respiratory tract. We report the case of a male newborn diagnosed with cystic lung disease during prenatal ultrasound. A cesarean section was performed at the 32nd gestational week because of premature rupture of the membranes, and soon after the delivery the newborn developed respiratory failure and died. The aim of this study is to report an autopsy case because of its rarity, and to briefly discuss the CPAM subtypes and differential diagnosis of cystic lung diseases of childhood.

20.
Autops Case Rep ; 8(1): e2018006, 2018.
Article in English | MEDLINE | ID: mdl-29515981

ABSTRACT

Gastric Dieulafoy's lesion (DL) is a potentially fatal entity that causes upper digestive hemorrhage as a consequence of the erosion of an abnormal large-caliber artery in the submucosa of the gastrointestinal tract. We report the case of a 59-year-old female patient admitted to the emergency facility due to melena without any active sign of bleeding during the esophagogastroduodenoscopy. Unexpectedly, she progressed presenting a massive hematemesis followed by an irreversible cardiorespiratory arrest. The aim of this study is to draw attention to DL as a possible cause of massive and fatal digestive hemorrhage, and to describe the anatomical autopsy findings.

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