First known case of human bertiellosis in a child in Paraná, Brazil / Primeiro caso conhecido de bertielose humana em uma criança no Paraná, Brasil

ABSTRACT Objective: To describe the first known case of human Bertiellosis in Paraná (Brazil). Case description: A 6-year-old male residing in the Brazilian state of Paraná was suffering from intermittent nonspecific abdominal pain and abdominal distension, associated with expulsion of live tapeworms in his feces for 7 months. He had a history of interaction with monkeys on an island. His first feces analysis was inconclusive, with an initial hypothesis of an atypical Taenia. However, after additional research, the parasitologist identified pregnant proglottids of Bertiella sp. The patient was initially treated with an unknown dosage of albendazole and nitazoxanide, as it was believed he had been infected with Taenia sp. Since the symptoms persisted, praziquantel 10 mg/kg was prescribed without further proglottids elimination. Comments: Human Bertiellosis is a rare zoonosis, with less than one hundred cases reported. However, it is a cause of chronic abdominal pain and should be kept as a differential diagnosis, especially in cases reporting recurrent tapeworm expulsion in feces and refractory treatment with albendazole.

RESUMO Objetivo: Descrever o primeiro caso conhecido de bertielose humana no Paraná, Brasil. Descrição do caso: Criança de seis anos do sexo masculino, residente no Paraná, Brasil, apresentava dor abdominal inespecífica intermitente e distensão abdominal, associadas à expulsão de helmintos vivos em suas fezes havia sete meses. Tinha um histórico de interação com macacos em uma ilha. Sua primeira análise de fezes foi inconclusiva, com hipótese inicial de uma Taenia atípica. No entanto, após pesquisas adicionais, o parasitologista identificou proglótides gravídicas de Bertiella sp. O paciente foi inicialmente tratado com uma dosagem desconhecida de albendazol e nitazoxanida, pois se acreditava que havia sido infectado por Taenia sp. Diante da persistência dos sintomas, foi prescrito praziquantel 10 mg/kg, sem mais eliminação de proglótides. Comentários: A bertielose humana é uma zoonose rara, com menos de cem casos relatados. No entanto, é uma causa de dor abdominal crônica e deve ser mantida como diagnóstico diferencial, principalmente nos casos que relatam expulsão recorrente de helmintos nas fezes e que são refratários ao tratamento com albendazol.

First known case of human bertiellosis in a child in Paraná, Brazil.

OBJECTIVE: To describe the first known case of human Bertiellosis in Paraná (Brazil). CASE DESCRIPTION: A 6-year-old male residing in the Brazilian state of Paraná was suffering from intermittent nonspecific abdominal pain and abdominal distension, associated with expulsion of live tapeworms in his feces for 7 months. He had a history of interaction with monkeys on an island. His first feces analysis was inconclusive, with an initial hypothesis of an atypical Taenia. However, after additional research, the parasitologist identified pregnant proglottids of Bertiella sp. The patient was initially treated with an unknown dosage of albendazole and nitazoxanide, as it was believed he had been infected with Taenia sp. Since the symptoms persisted, praziquantel 10 mg/kg was prescribed without further proglottids elimination. COMMENTS: Human Bertiellosis is a rare zoonosis, with less than one hundred cases reported. However, it is a cause of chronic abdominal pain and should be kept as a differential diagnosis, especially in cases reporting recurrent tapeworm expulsion in feces and refractory treatment with albendazole.

Polymeric Nanoparticles of Enoxaparin as a Delivery System: In Vivo Evaluation in Normal Rats and in a Venous Thrombosis Rat Model.

Enoxaparin is an anticoagulant widely used in the treatment and prophylaxis of deep vein thrombosis (DVT). The subcutaneous route of administration, sometimes in repeated doses during 24 hours, represents a limitation to its use. Thus, the development of a product that can be administered either subcutaneously, in a smaller number of applications becomes a major challenge, with interesting clinical applications. The use of a system for sustained release of drugs can help to meet that goal, by protecting and enabling a gradual released of the agent. This study consisted of the evaluation of in vivo anticoagulant and antithrombotic activity of biodegradable nanoparticles of poly (ε-caprolactone) (PCL) with enoxaparin after subcutaneous injection. The nanoparticles were prepared by the method of double emulsion (w/o/w) and solvent evaporation. Subcutaneous enoxaparin encapsulated in PCL nanoparticles (1000 IU/kg) showed a sustained release in vivo for up to 12 hours (Cmax 0.62 IU/mL) a significantly longer period (P < 0.01) when compared to free enoxaparin (1000 IU/Kg) that disappeared after 9 hours (Cmax 1.50 IU/mL), however with lower anti-Xa activity. The antithrombotic action of enoxaparin-nanoparticles was tested in a DVT model by stasis in rats. There were virtually no formation of venous thrombosis in any of the rats that received enoxaparin encapsulated in nanoparticles (0.03 mg), with a significant difference when compared to groups that received saline (17.2 mg, P < 0.001) and free enoxaparin (2.87 mg, P = 0.001). In summary, enoxaparin-encapsulated in polymeric nanoparticles showed a sustained release for a greater period than that of enoxaparin, and with excellent antithrombotic action. These results corroborate the promising use of pharmacological nanoparticles in clinical practice.

Symptoms of Depression and Risk of New Episodes of Low Back Pain: A Systematic Review and Meta-Analysis.

OBJECTIVE: To investigate the contribution of symptoms of depression to future episodes of low back pain (LBP). METHODS: A search was conducted of AMED, CINAHL, Embase, Health and Society (H&S), LILACS, MEDLINE, PsycINFO, Scopus, and Web of Science databases. We included cohort studies investigating the effect of symptoms of depression on the development of new episodes of LBP, either lifetime incidence or a recurrent episode, in a population free of LBP at baseline. We accepted the original study's definition for a new episode of LBP, and for classifying patients as LBP-free at study entry. Two independent investigators extracted data and assessed methodological quality. Meta-analyses with random effects were used to pool risk estimates. RESULTS: We included 19 studies, with 11 incorporated in the meta-analyses. Overall pooled results showed that symptoms of depression increased the risk of developing LBP (odds ratio [OR] 1.59, 95% confidence interval [95% CI] 1.26-2.01). The risk was similar in studies that used the diagnostic interview method (OR 1.66, 95% CI 1.14-2.42) and in studies using self-report screening questionnaires (OR 1.68, 95% CI 1.05-2.70). No statistically significant relationship was observed when we pooled studies that employed nonspecific screening questionnaires (OR 1.17, 95% CI 0.48-2.87). Three studies provided results in incremental categories of symptoms of depression and the pooled OR for the most severe level of depression (OR 2.51, 95% CI 1.58-3.99) was higher than for the lowest level (OR 1.51, 95% CI 0.89-2.56). CONCLUSION: Individuals with symptoms of depression have an increased risk of developing an episode of LBP in the future, with the risk being higher in patients with more severe levels of depression.

Penile methadone injection in suicidal intent: life-threatening and fatal for erectile function.

We present the case of a 31-year-old man who was admitted to our emergency department after injection of 10 mL of methadone into his penis. He had a history of drug abuse over the last 15 years and a background of 3 attempted suicidal episodes with a combination of at least 2 drugs over the past 12 months. The current suicide attempt had serious consequences: he suffered from acute renal and liver failure. One previously unreported side effect of methadone is erectile dysfunction following injection into the penis. In our case, the patient received vardenafil 10 mg once daily without any signs of functional improvement. Ten months after the event, there still was complete erectile dysfunction.

Delirium / Delirium

Delirium é uma apresentação comum de distúrbios agudos na população geriátrica. Tem sido associado a um pior prognóstico, aumento de permanência hospitalar e dos custos, bem como maiores taxas de morbidade e mortalidade entre os idosos. Os fatores predisponentes e precipitantes são hoje mais conhecidos e estão associados aos cuidados hospitalares.Estudos controlados demonstram que intervenções preventivas podem reduzir de 30% a 40% a incidência de delirium, essas intervenções estão essencialmente ligadas a melhor qualidade no cuidado hospitalar. Este artigo revisa recentes estudos sobre epidemiologia, diagnóstico, fisiopatologia, tratamento e prevenção do delirium na população idosa.

Isoform diversity of giant proteins in relation to passive and active contractile properties of rabbit skeletal muscles.

The active and passive contractile performance of skeletal muscle fibers largely depends on the myosin heavy chain (MHC) isoform and the stiffness of the titin spring, respectively. Open questions concern the relationship between titin-based stiffness and active contractile parameters, and titin's importance for total passive muscle stiffness. Here, a large set of adult rabbit muscles (n = 37) was studied for titin size diversity, passive mechanical properties, and possible correlations with the fiber/MHC composition. Titin isoform analyses showed sizes between approximately 3300 and 3700 kD; 31 muscles contained a single isoform, six muscles coexpressed two isoforms, including the psoas, where individual fibers expressed similar isoform ratios of 30:70 (3.4:3.3 MD). Gel electrophoresis and Western blotting of two other giant muscle proteins, nebulin and obscurin, demonstrated muscle type-dependent size differences of < or =70 kD. Single fiber and single myofibril mechanics performed on a subset of muscles showed inverse relationships between titin size and titin-borne tension. Force measurements on muscle strips suggested that titin-based stiffness is not correlated with total passive stiffness, which is largely determined also by extramyofibrillar structures, particularly collagen. Some muscles have low titin-based stiffness but high total passive stiffness, whereas the opposite is true for other muscles. Plots of titin size versus percentage of fiber type or MHC isoform (I-IIB-IIA-IID) determined by myofibrillar ATPase staining and gel electrophoresis revealed modest correlations with the type I fiber and MHC-I proportions. No relationships were found with the proportions of the different type II fiber/MHC-II subtypes. Titin-based stiffness decreased with the slow fiber/MHC percentage, whereas neither extramyofibrillar nor total passive stiffness depended on the fiber/MHC composition. In conclusion, a low correlation exists between the active and passive mechanical properties of skeletal muscle fibers. Slow muscles usually express long titin(s), predominantly fast muscles can express either short or long titin(s), giving rise to low titin-based stiffness in slow muscles and highly variable stiffness in fast muscles. Titin contributes substantially to total passive stiffness, but this contribution varies greatly among muscles.

Condrocalcinose articular familiar / Familial articular chondrocalcinosis

Condrocalcinose articular familiar é uma condição clínica caracterizada pela deposição de cristais de pirofosfato de cálcio no líquido sinovial e cartilagens articulares levando à artrite. Descrevemos três membros de uma família com condrocalcinose cujo quadro clínico era caracterizado por artrite intermitente em dois e artrite crônica lembrando artrite reumatóide em um. A avaliação radiológica mostrou calcificações em cartilagens de diversas articulações, particularmente de joelhos. A utilização de colchicina foi suficiente para prevenir as crises de artrite em dois pacientes e o paciente com a forma crônica necessitou uso contínuo de antiinflamatórios não-hormonais. Embora aparentemente rara no Brasil, não afastamos a possibilidade desse dado estar subestimado e sugerimos que seja realizada uma avaliação radiológica articular dos familiares de todo paciente com diagnóstico de condrocalcinose esporádica.