Enteric viruses in HIV-1 seropositive and HIV-1 seronegative children with diarrheal diseases in Brazil.

Diarrheal diseases (DD) have distinct etiological profiles in immune-deficient and immune-competent patients. This study compares detection rates, genotype distribution and viral loads of different enteric viral agents in HIV-1 seropositive (n = 200) and HIV-1 seronegative (n = 125) children hospitalized with DD in Rio de Janeiro, Brazil. Except for group A rotavirus (RVA), which were detected through enzyme immunoassay, the other enteric viruses (norovirus [NoV], astrovirus [HAstV], adenovirus [HAdV] and bocavirus [HBoV]) were detected through PCR or RT-PCR. A quantitative PCR was performed for RVA, NoV, HAstV, HAdV and HBoV. Infections with NoV (19% vs. 9.6%; p<0.001), HBoV (14% vs. 7.2%; p = 0.042) and HAdV (30.5% vs. 14.4%; p<0.001) were significantly more frequent among HIV-1 seropositive children. RVA was significantly less frequent among HIV-1 seropositive patients (6.5% vs. 20%; p<0.001). Similarly, frequency of infection with HAstV was lower among HIV-1 seropositive children (5.5% vs. 12.8%; p = 0.018). Among HIV-1 seropositive children 33 (16.5%) had co-infections, including three enteric viruses, such as NoV, HBoV and HAdV (n = 2) and NoV, HAstV and HAdV (n = 2). The frequency of infection with more than one virus was 17 (13.6%) in the HIV-1 negative group, triple infection (NoV + HAstV + HBoV) being observed in only one patient. The median viral load of HAstV in feces was significantly higher among HIV-1 positive children compared to HIV-1 negative children. Concerning children infected with RVA, NoV, HBoV and HAdV, no statistically significant differences were observed in the medians of viral loads in feces, comparing HIV-1 seropositive and HIV-1 seronegative children. Similar detection rates were observed for RVA, HAstV and HAdV, whilst NoV and HBoV were significantly more prevalent among children with CD4+ T lymphocyte count below 200 cells/mm3. Enteric viruses should be considered an important cause of DD in HIV-1 seropositive children, along with pathogens more classically associated with intestinal infections in immunocompromised hosts.

Aichi Virus Positivity in HIV-1 Seropositive Children Hospitalized with Diarrheal Disease.

Aichi viruses (AiV) have been detected in patients with diarrheal diseases (DD). The aim of this study was to assess AiV infection rates in hospitalized children with DD, including 123 HIV-1 seropositive and 125 HIV-1 seronegative patients, in two public pediatric hospitals in Rio de Janeiro, Brazil. AiV was investigated by nested RT-PCR. The AiV-positive samples were also tested for specie A rotavirus, norovirus, astrovirus, enteric adenovirus and bocavirus in order to assess co-infections. AiV parcial genome sequencing and phylogenetic analyses were performed. AiV were detected in 9/123 (7.32%) of the HIV-1 seropositive subjects and 1/125 (0.8%) of the HIV seronegative patients with DD (p = 0.019). The phylogenetic analysis of positive samples disclosed that: i) 13 samples were characterized as genotype A, with one of them being from the HIV-1 seronegative patient; ii) one sample from a HIV-1 seropositive patient was characterized as genotype B. AiV genotype A was grouped into 3 genetic clusters. Data suggest that AiV may be an opportunistic pathogen infecting children with AIDS and DD.

Acurácia da tomografia computadorizada de múltiplos detectores no diagnóstico da doença arterial coronariana: revisão sistemática / Accuracy of multi-detector computed tomography for diagnosing coronary artery disease: systematic review

A doença arterial coronariana (DAC) é uma das condições mais prevalentes entre as doenças cardiovasculares. A angiografia coronariana invasiva (ACI) é o padrão de referência para o diagnóstico da DAC, sendo indicada quando há suspeita de estenose coronariana em pacientes com alta probabilidade de DAC. A angiocoronariografia com tomografia computadorizada de múltiplos detectores (TCMD) surgiu como nava técnica de diagnóstico, não invasiva, que permite a visão direta da artéria coronária. Sua indicação no diagnóstico de DAC, em pacientes sintomáticos com probabilidade pré-teste intermediária para essa condição, tem sido reportada. entretanto, os estudos apresentados até 2008 foram pequenos, de um único centro, envolvendo pacientes selecionados e, frequentemente, os segmentos com baixa nitidez de imagem eram excluídos da análise. O objetivo desta revisão sistemática foi avaliar a acurácia da TCMD no diagnóstico da DAC em pacientes que apresentavam probabilidade intermediária para essa condição. Dos 414 artigos encontrados, 13 estudos foram selecionados, os quais incluíam pacientes com probabilidade intermediária par DAC e que foram submetidos à angiocoronariografia invasica (ACI) e angiotomografia coronariana (ATC) de 64 detectores. Foram estudados 1992 pacientes em 12 dos 13 estudos selecionados, e somente oito estudos apresentaram dados disponíveis para a análise de 14725 segmentos coronarianas. Não houve diferença estatisticamente significativa...

Left colon stenosis caused by tuberculosis.

The authors present a case of intestinal tuberculosis affecting exclusively the left colon causing severe undernourishment, abdominal pain, and bowel obstruction with a sealed colonic fistula in a 10-year-old child. These clinical characteristics and difficulties led to a diagnosis of intestinal tuberculosis in childhood. Intestinal tuberculosis affecting exclusively the colon is very rare, and differential diagnosis with Crohn's disease is difficult. Surgical complications are frequent, especially intestinal obstruction, and can be treated in most cases by resection of the affected segment and primary anastomosis.