Tuberculose cutânea forma escrofuloderma: relato de caso / Scrofuloderma-shaped cutaneous tuberculosis: case report

Introdução: A tuberculose (TB) é uma doença infecciosa causada pela bactéria Mycobacterium tuberculosis, transmitida a partir da via aérea de pacientes com a forma pulmonar ou laríngea, que atinge cerca de 10 milhões de pessoas no mundo por ano. A forma pulmonar é a mais comum, sendo a TB cutânea responsável por 1,5% dos casos. Descrição do caso: Paciente 58 anos, masculino, apresentando síndrome consumptiva e abscessos em flanco direito, região pré-esternal e hemitórax direito há 60 dias, sem febre ou outros sintomas associados. Ao exame, apresentava lesão fibroelástica com aspecto similar a escrofuloderma. Análise histopatológica evidenciou processo inflamatório inespecífico sem sinais de malignidade. Cultura para fungos negativa e houve positivação da cultura para M. tuberculosis. Discussão: A TB cutânea é uma forma de apresentação rara de TB. Sua forma escrofuloderma é a mais observada em países em desenvolvimento. A lesão do escrofuloderma pode ser única ou múltipla. Todo paciente deve ser submetido a pesquisa de foco de TB subjacente, sendo a coexistência com um processo pulmonar ativo relativamente comum. O tratamento da TB cutânea inclui medidas gerais e terapia farmacológica por seis meses. Conclusão: A tuberculose continua sendo uma doença prevalente em todo mundo. O Brasil está entre os 30 países de alta carga de TB, considerados como prioritários no mundo para controle da doença pela OMS. Nesse contexto, reconhecer as formas de apresentação da doença se torna cada vez mais importante. Devemos sempre nos lembrar da TB como um diagnóstico diferencial em nosso meio.

Introduction: Tuberculosis (TB) is an infectious disease caused by the bacterium Mycobacterium tuberculosis, transmitted from the airways of patients with pulmonary or laryngeal forms, which affects around 10 million people worldwide each year. The pulmonary form is the most common, with cutaneous TB responsible for 1.5% of cases. Case description: A 58-year-old male patient, with consumptive syndrome and abscesses on the right flank, pre-sternal region and right hemithorax for 60 days, without fever or other associated symptoms. Upon physical examination, he presented fibroelastic lesion with an aspect similar to scrofuloderma. Histopathological analysis showed a nonspecific inflammatory process with no signs of malignancy. Culture for bacteria and fungi were negatives, while the culture for M. tuberculosis was positive. Discussion: Cutaneous TB is a rare form of TB. Its scrofuloderma form is the most observed in developing countries. The scrofuloderma lesion can be single or multiple. In every single patient, the underlying TB focus survey should be performed, coexistence with an active pulmonary process being relatively common. The cutaneous TB treatment includes general measures and pharmacological therapy for six months. Conclusion: Tuberculosis remains a prevalent disease worldwide. Brazil is among the 30 countries with a high TB load, considered as priorities in the world for the control of the disease by WHO. In this context, recognizing the forms of presentation of the disease becomes increasingly important. We must always remember TB as a differential diagnosis in our environment.

Synthesis and characterization of a molecularly imprinted polymer (MIP) for solid-phase extraction of the antidiabetic gliclazide from human plasma.

Gliclazide is a sulfonylurea frequently prescribed for the management of type 2 diabetes mellitus in elderly patients and for patients with chronic renal or hepatic diseases. Even though it is considered a safer alternative, the drug can provoke side effects in some patients, especially hypoglycemia, due to the high interindividual variability. Therefore, the quantification of gliclazide in biological samples is usually recommended in order to assure efficacy and safety of the pharmacotherapy. However, due to the complexity of biological matrices, therapeutic monitoring can be very challenging, especially in the sample preparation step. For that reason, the synthesis and characterization of a novel and selective molecularly imprinted polymer (MIP) was proposed to be employed as sorbent for the extraction of gliclazide from human plasma samples by a molecularly imprinted solid-phase extraction (MISPE) procedure. Synthesis conditions were optimized (monomer, crosslinker and porogen) and the polymer was characterized for its morphological, physicochemical and stability properties. The influence of drug concentration, solvent composition and pH on the coefficient of distribution (Kd) and imprinting factor (IF) were studied, as well as repeatability between batches and selectivity. A bioanalytical method was developed applying the developed MIP as sorbent in solid phase extraction and liquid chromatography using a Poroshell 120 C18 (100 × 4.6 mm, 4 µm) column, acetonitrile and 10 mM potassium phosphate buffer pH 3.0 (50:50) at a flow-rate of 1.2 mL/min as mobile phase, temperature of 30 °C, injection volume of 40 µL and detection at 230 nm. The best reaction yield, extraction capacity, and selectivity was obtained using 2-hydroxyethyl methacrylate (2-HEMA), ethyleneglycol dimethacrylate (EGDMA) and acetonitrile. The optimized MIP showed coefficient of distribution (Kd) of 59.85 µg/g, imprinting factor (IF) of 1.60, and selectivity for gliclazide and other sulfonylureas compared to possible concurrent drugs. The developed method by MISPE-HPLC-UV showed to be appropriate to determine gliclazide in human plasma samples.

Structural signature in SCA1: clinical correlates, determinants and natural history.

Spinocerebellar ataxia type 1 is an autosomal dominant disorder caused by a CAG repeat expansion in ATXN1, characterized by progressive cerebellar and extracerebellar symptoms. MRI-based studies in SCA1 focused in the cerebellum and connections, but there are few data about supratentorial/spinal damage and its clinical relevance. We have thus designed this multimodal MRI study to uncover the structural signature of SCA1. To accomplish that, a group of 33 patients and 33 age-and gender-matched healthy controls underwent MRI on a 3T scanner. All patients underwent a comprehensive neurological and neuropsychological evaluation. We correlated the structural findings with the clinical features of the disease. In addition, we evaluated the disease progression looking at differences in SCA1 subgroups defined by disease duration. Ataxia and pyramidal signs were the main symptoms. Neuropsychological evaluation disclosed cognitive impairment in 53% with predominant frontotemporal dysfunction. Gray matter analysis unfolded cortical thinning of primary and associative motor areas with more restricted impairment of deep structures. Deep gray matter atrophy was associated with motor handicap and poor cognition skills. White matter integrity loss was diffuse in the brainstem but restricted in supratentorial structures. Cerebellar cortical thinning was found in multiple areas and correlated not only with motor disability but also with verbal fluency. Spinal cord atrophy correlated with motor handicap. Comparison of MRI findings in disease duration-defined subgroups identified a peculiar pattern of progressive degeneration.

Magnetic solid-phase extraction based on mesoporous silica-coated magnetic nanoparticles for analysis of oral antidiabetic drugs in human plasma.

In the present work, magnetic nanoparticles embedded into mesoporous silica were prepared in two steps: first, magnetite was synthesized by oxidation-precipitation method, and next, the magnetic nanoparticles were coated with mesoporous silica by using nonionic block copolymer surfactants as structure-directing agents. The mesoporous SiO2-coated Fe3O4 samples were functionalized using octadecyltrimethoxysilane as silanizing agent. The pure and functionalized silica nanoparticles were physicochemically and morphologically characterized by X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FTIR), N2 adsorption, scanning electron microscopy (SEM) and transmission electron microscopy (TEM). The resultant magnetic silica nanoparticles were applied as sorbents for magnetic solid-phase extraction (MSPE) of oral antidiabetic drugs in human plasma. Our results revealed that the magnetite nanoparticles were completely coated by well-ordered mesoporous silica with free pores and stable pore walls, and that the structural and magnetic properties of the Fe3O4 nanoparticles were preserved in the applied synthesis route. Indeed, the sorbent material was capable of extracting the antidiabetic drugs from human plasma, being useful for the sample preparation in biological matrices.