Ehlers-Danlos Syndrome associated with cardiomyopathy hypertrophic obstructive.

Ehlers-Danlos syndrome is a rare clinical condition caused by a genetic change that results in the formation of structurally or functionally altered collagen. The clinical manifestations are varied, being the most obvious skin hypermotility and increased joint flexibility, although other systems - such as cardiovascular, respiratory and neurological - may also be affected. This paper presents the report of a patient who sought medical attention with complaints of atypical chest pain. Clinical evaluation enabled hypothetical diagnosis of hypertrophic obstructive cardiomyopathy and Ehlers-Danlos syndrome. Initial electrocardiogram, echocardiogram and 24 hours holter allowed the confirmation of the first hypothesis. A skin biopsy performed later associated clinical data and confirmed the second hypothesis.

A Severe Accident Caused by an Ocellate River Stingray (Potamotrygon motoro) in Central Brazil: How Well Do We Really Understand Stingray Venom Chemistry, Envenomation, and Therapeutics?

Freshwater stingrays cause many serious human injuries, but identification of the offending species is uncommon. The present case involved a large freshwater stingray, Potamotrygon motoro (Chondrichthyes: Potamotrygonidae), in the Araguaia River in Tocantins, Brazil. Appropriate first aid was administered within ~15 min, except that an ice pack was applied. Analgesics provided no pain relief, although hot compresses did. Ciprofloxacin therapy commenced after ~18 h and continued seven days. Then antibiotic was suspended; however, after two more days and additional tests, cephalosporin therapy was initiated, and proved successful. Pain worsened despite increasingly powerful analgesics, until debridement of the wound was performed after one month. The wound finally closed ~70 days after the accident, but the patient continued to have problems wearing shoes even eight months later. Chemistry and pharmacology of Potamotrygon venom and mucus, and clinical management of freshwater stingray envenomations are reviewed in light of the present case. Bacterial infections of stingray puncture wounds may account for more long-term morbidity than stingray venom. Simultaneous prophylactic use of multiple antibiotics is recommended for all but the most superficial stingray wounds. Distinguishing relative contributions of venom, mucus, and bacteria will require careful genomic and transcriptomic investigations of stingray tissues and contaminating bacteria.

Ehlers-Danlos Syndrome associated with cardiomyopathy hypertrophic obstructive

Ehlers-Danlos syndrome is a rare clinical condition caused by a genetic change that results in the formation of structurally or functionally altered collagen. The clinical manifestations are varied, being the most obvious skin hypermotility and increased joint flexibility, although other systems - such as cardiovascular, respiratory and neurological - may also be affected. This paper presents the report of a patient who sought medical attention with complaints of atypical chest pain. Clinical evaluation enabled hypothetical diagnosis of hypertrophic obstructive cardiomyopathy and Ehlers-Danlos syndrome. Initial electrocardiogram, echocardiogram and 24 hours holter allowed the confirmation of the first hypothesis. A skin biopsy performed later associated clinical data and confirmed the second hypothesis.

Chronic renal failure in Kuwaiti children: an eight-year experience.

Over an 8-year period (January 1996 to December 2003), a total of 171 patients below the age of 15 years were diagnosed with chronic renal failure. The mean incidence rate of CRF in Kuwaiti children was found to be 38.2 per million children per year, with a peak incidence of 55 per million children per year. While the mean age at diagnosis was 33+/-12 months (range: 1 month to 15 years), the male:female ratio was 2.7:1. Etiological factors for chronic renal failure included congenital urological malformation (61.9%), chronic glomerulopathies (5.2%), hereditary nephropathies (21%), multi-system disease (0.5%), chronic pyelonephritis (without VUR) (4.6%), tumors (0.6%), ischemic renal disease (1.1%) and unknown etiology (1.7%). Thirty percent of patients reached end-stage renal disease within a mean of 18 months following diagnosis. The overall mortality before reaching ESRD was reported to be 4%. Kuwait has one of the highest incidence and prevalence rates of CRF in children. It is likely that genetic and hereditary factors are the cause of these high rates.

Estudo bacteriológico de abscessos causados por picada de serpentes do genero Bothrops / Bacteriological study of abscesses caused by Bothrops snake bites

Foi analisada a flora bacteriana de 99 abscessos causados por picadas de serpentes do gênero Bothrops, correspondendo a 61,1% dos casos que ocorreram em 1030 acidentes ofídicos atendidos no Hospital de Doenças Tropicais (HDT) de Goiânia, no período de janeiro de 1984 a abril de 1988. O exsudato dos abscessos foi estudado através de bacterioscopia, cultura e testes de sensibilidade para aeróbios. Os bacilos Gram negativos foram isolados em maior frequência, destacando-se a Morganella morganii, Escherichia coli e Providencia sp presentes respectivamente em 44,4%, 20,2% e 13,1% das amostras. Esta flora aeróbica foi semelhante a encontrada na cavidade oral e no veneno das serpentes em outros estudos, nos quais predominaram Morganella morganii. Foi sugerido o uso do cloranfenicol no tratamento dos abscessos que näo respondam a simples drenagem, face a grande sensibilidade destes microorganismos demonstrada nos testes "in vitro"

Infecçäo hospitalar em hospital de doenças transmissíveis: análise do Hospital de Doenças Tropicais; Goiânia, 1985-1988 / Hospitalar infection in hospital of communicable diseases: analysis of the Hospital de Doenças Tropicais; Goiânia, 1985-1988

Foi analisada a tendência de infecçäo hospitalar em um hospital de doenças infecciosas (Hospital de Doenças de maior risco. Verificaram-se taxas de infecçäo hospitalar de 6,3% e 4,5% nos primeiros anos de funcionamento da Comissäo de Controle de Infecçäo Hospitalar. Após a introduçäo do sistema de busca ativa houve elevaçäo dessas taxas para 11%. Embora a malária, os acidentes ofídicos e as meningites de todas as entiologias tenham correspondido a 46,7% das internaçöes no período de estudo, o tétano e o pênfigo foram as doenças que contribuiram para maior risco de infecçäo hospitalar, com média de 24% e 20% nos últimos anos. Discutiu-se a importância do registro sistemático de taxas de infecçäo hospitalar para a mensuraçäo dos níveis endêmicos. O cálculo de risco de infecçäo por doença e risco atributáveis säo sugeridos como forma de monitoraçäo da eficiência hospitalar em hospitais de doenças transmissíveis

Notas parasitológicas sobre Lagochilascaríase humana em Goiás / Parasitological notes about human lagochilascariasis from Goiás

Temos , até o presente momento, 10 casos de lagochilascaríase humana diagnosticados em Goiás. Os autores chamam atençäo para a freqüência e distribuiçäo geográfica do parasito na área compreendida entr o norte do Estado e a regiäo sul do Pará (Amazônia Legal). Foram realizadas tentativas de reproduçäo experimental do ciclo evolutivo do verme com resultados infrutíferos