Cardiovascular risk profile in patients with myelopathy associated with HTLV-1

ABSTRACT HAM/TSP (HTLV-1-associated myelopathy/tropical spastic paraparesis) is a slowly progressive disease, characterized by a chronic spastic paraparesis. It is not known if the disease carries an independent risk for cardiovascular disease. The objective of this study was to evaluate the cardiovascular risk profile related to HAM/TSP and compare it with the general population. Methods: This was a cross-sectional study, with a control group. HAM/TSP patients were evaluated using cardiovascular risk scores (ASCVD RISK, SCORE and Framingham) and inflammatory markers (ultrasensitive CRP and IL-6), and compared with a control group of healthy individuals. We also evaluated the correlation between cardiovascular risk and the functional status of patients with HAM/TSP evaluated by the FIM scale. Results: Eighty percent of patients in this study were females, mean age of 51 years (11.3). The control group showed an increased cardiovascular event risk in 10 years when ASCVD was analyzed (cardiovascular risk ≥7.5% in 10 years seen in 43% of patients in the control group vs. 23% of patients with HAM/TSP; p = 0.037). There was no difference in ultrasensitive CRP or IL-6 values between the groups, even when groups were stratified into low and high risk. There was no correlation between the functional status of HAM/TSP patients and the cardiovascular risk. Conclusions: In this study, the cardiovascular risk profile of patients with HAM/TSP was better than the risk of the control group.

Cardiovascular risk profile in patients with myelopathy associated with HTLV-1.

HAM/TSP (HTLV-1-associated myelopathy/tropical spastic paraparesis) is a slowly progressive disease, characterized by a chronic spastic paraparesis. It is not known if the disease carries an independent risk for cardiovascular disease. The objective of this study was to evaluate the cardiovascular risk profile related to HAM/TSP and compare it with the general population. METHODS: This was a cross-sectional study, with a control group. HAM/TSP patients were evaluated using cardiovascular risk scores (ASCVD RISK, SCORE and Framingham) and inflammatory markers (ultrasensitive CRP and IL-6), and compared with a control group of healthy individuals. We also evaluated the correlation between cardiovascular risk and the functional status of patients with HAM/TSP evaluated by the FIM scale. RESULTS: Eighty percent of patients in this study were females, mean age of 51 years (11.3). The control group showed an increased cardiovascular event risk in 10 years when ASCVD was analyzed (cardiovascular risk ≥7.5% in 10 years seen in 43% of patients in the control group vs. 23% of patients with HAM/TSP; p=0.037). There was no difference in ultrasensitive CRP or IL-6 values between the groups, even when groups were stratified into low and high risk. There was no correlation between the functional status of HAM/TSP patients and the cardiovascular risk. CONCLUSIONS: In this study, the cardiovascular risk profile of patients with HAM/TSP was better than the risk of the control group.

Pulmonary paracoccidioidomycosis: radiology and clinical-epidemiological evaluation.

INTRODUCTION: The purpose of this study was to compare respiratory signs and symptoms between patients with and without chest X-ray abnormalities in order to establish the meaning of radiographic findings in pulmonary PCM diagnosis. METHODS: The epidemiological, clinical and radiological lung findings of 44 patients with paracoccidioidomycosis (PCM) were evaluated. Patients were divided into two groups of 23 and 21 individuals according to the presence (group 1) or absence (group 2) of chest X-ray abnormalities, respectively, and their clinical data was analyzed with the aid of statistical tools. RESULTS: As a general rule, patients were rural workers, young adult males and smokers - group 1 and 2, respectively: males (91.3% and 66.7%); mean age (44.4 and 27.9 year-old); smoking (34.7% and 71.4 %); acute/subacute presentation (38.1% and 21.7%); chronic presentation (61.9% and 78.3%). The most frequent respiratory manifestations were - group 1 and 2, respectively: cough (25% and 11.4%) and dyspnea (22.7% and 6.8%). No statistical difference was observed in pulmonary signs and symptoms between patients with or without radiographic abnormalities. The most frequent radiological finding was nodular (23.8%) or nodular-fibrous (19%), bilateral (90.5%) and diffuse infiltrates (85.7%). CONCLUSIONS: Absence of statistical difference in pulmonary signs and symptoms between these two groups of patients with PCM indicates clinical-radiological dissociation. A simplified classification of radiological lung PCM findings is suggested, based on correlation of these data and current literature review.

Pulmonary paracoccidoidomycosis: radiology and clinical-epidemiological evaluation / Paracoccidioidomicose pulmonar: radiologia e avaliação clínico-epidemiológica

INTRODUCTION: The purpose of this study was to compare respiratory signs and symptoms between patients with and without chest X-ray abnormalities in order to establish the meaning of radiographic findings in pulmonary PCM diagnosis. METHODS: The epidemiological, clinical and radiological lung findings of 44 patients with paracoccidiodomycosis (PCM) were evaluated. Patients were divided into two groups of 23 and 21 individuals according to the presence (group 1) or absence (group 2) of chest X-ray abnormalities, respectively, and their clinical data was analyzed with the aid of statistical tools. RESULTS: As a general rule, patients were rural workers, young adult males and smokers - group 1 and 2, respectively: males (91.3 percent and 66.7 percent); mean age (44.4 and 27.9 year-old); smoking (34.7 percent and 71.4 percent); acute/subacute presentation (38.1 percent and 21.7 percent); chronic presentation (61.9 percent and 78.3 percent). The most frequent respiratory manifestations were - group 1 and 2, respectively: cough (25 percent and 11.4 percent) and dyspnea (22.7 percent and 6.8 percent). No statistical difference was observed in pulmonary signs and symptoms between patients with or without radiographic abnormalities. The most frequent radiological finding was nodular (23.8 percent) or nodular-fibrous (19 percent), bilateral (90.5 percent) and diffuse infiltrates (85.7 percent). CONCLUSIONS: Absence of statistical difference in pulmonary signs and symptoms between these two groups of patients with PCM indicates clinical-radiological dissociation. A simplified classification of radiological lung PCM findings is suggested, based on correlation of these data and current literature review.

INTRODUÇÃO: Comparar sinais e sintomas respiratórios entre pacientes com e sem alterações à radiografia de tórax para se estabelecer o significado dos achados radiográficos no diagnóstico da paracoccidioidomicose pulmonar. MÉTODOS: Os achados epidemiológicos, clínicos e radiológicos de 44 pacientes com paracoccidioidomicose (PCM) foram avaliados. Os pacientes foram divididos em dois grupos de 23 e 21 indivíduos de acordo com a presença (grupo 1) ou ausência (grupo 2) de anormalidades à radiografia de tórax, respectivamente, e seus dados clínicos foram analisados com auxílio de ferramentas estatísticas. RESULTADOS: Como regra geral, os pacientes eram trabalhadores rurais do sexo masculino, tabagistas e em idade adulta jovem - grupo 1 e 2, respectivamente: homens (91,3 por cento e 66,7 por cento); média de idade (44,4 e 27,9 anos); tabagismo (34,7 por cento e 71,4 por cento); forma aguda/subaguda (38,1 por cento e 21,7 por cento); forma crônica (61,9 por cento e 78,3 por cento). As manifestações respiratórias mais frequentes foram - grupo 1 e 2, respectivamente: tosse (25 por cento e 11,4 por cento) e dispnéia (22,7 por cento e 6,8 por cento). Nenhuma diferença estatística foi observada nos sinais e sintomas respiratórios entre pacientes com ou sem anormalidades radiográficas. Os achados radiológicos mais frequentes foram o padrão nodular (23,8 por cento) ou nodular-fibrótico (19 por cento), bilateral (90,5 por cento) e infiltrado difuso (85,7 por cento). CONCLUSÕES: A ausência de diferença estatística nos sinais e sintomas pulmonares entre estes dois grupos de pacientes com PCM sugere dissociação clínico-radiológica. Uma classificação simplificada dos achados radiológicos pulmonares da PCM é sugerida, com base na correlação destes dados e revisão da literatura atual.

Lymphoabdominal paracoccidioidomycosis simulating primary neoplasia of the biliary tract.

The lymphoabdominal involvement in the sub-acute form of paracoccidioidomycosis shows a wide variety of clinical manifestations, ranging from fever and lymph node enlargement to infiltration of all abdominal organs, which can lead to a situation of abdominal surgical emergency. This case report presents paracoccidioidomycosis mimicking carcinoma of the biliary tract, The purpose of this paper is to call the general physician's attention for this important differential diagnosis of abdominal masses. Although paracoccidioidomycosis is rarely encountered in the United States and Europe, it should be considered in patients who are suspected of having a fungal infection and have had previous exposure in an endemic area for this disease.