Epidemiology and fungal species distribution of superficial mycoses in Northeast Brazil.

OBJECTIVE: Dermatomycoses are superficial fungal infections which affect the skin, hair and nails of humans and animals. Male and female patients of all ages are affected by this condition. The main etiological agents of dermatomycoses are the dermatophytes fungi of the genera Trichophyton, Microsporum and Epidermophyton, while the main yeasts belong to the genera Candida, Malassezia and Trichosporon. The variation in the distribution of dermatomycoses worldwide justify the conduction of epidemiological studies in order to contribute for the better understanding of patterns of mycological cutaneous infections. This study was conducted from April 2013 to December 2014. MATERIAL AND METHODS: A total of 205 patients were evaluated, while 235 clinical specimens were obtained. From our positive cases of mycological examination, 73 (64.6%) patients were female, while 40 (35.4%) were male. Scales from the skin and nails were collected and observed at optical microscopy after potassium hydroxide clarification. Cultures were performed on Sabouraud Dextrose Agar added chloramphenicol. Identification was performed by classic methodology. RESULTS: We found that the glabrous skin was the largest source of dermatomycoses (30.11%), followed by toenails (27.4%) and fingernails (17.7%). Regarding onychomycosis, the most affected population was over 50 years old. Trichophyton rubrum was the dermatophyte fungal species more commonly found. Most of the patients with pityriasis versicolor were adults and female. Another important fact observed is that Candida parapsilosis was the most prevalent species. Finally, a high incidence of T. tonsurans in cases of superficial mycoses was observed. CONCLUSION: Our results clearly demonstrate peculiarities in terms of etiological agents of dermatophytoses distribution in a specific region of Brazil.

Falls in patients with HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP).

STUDY DESIGN: Cross-sectional study. OBJECTIVES: To determine the prevalence of falls in human T-cell lymphotropic virus type I (HTLV-I)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) patients and possible factors associated to their occurrence. SETTING: Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz (FIOCRUZ) - Brazil. METHODS: Thirty-six HAM/TSP patients able to walk at least 20 m were assessed by a questionnaire. Data regarding gender, age, duration of disease (DD), HTLV-I proviral load (HPL), frequency of physical activity (FCA), use of walking aids, functional ambulation level, the number of falls and associated injuries in the last year were reviewed. Multiple correspondence analysis was used to group characteristics of this sample according to the fall occurrence. RESULTS: The prevalence of falls was 63.9% and we observed injuries in 47.8% of the cases. Four groups were identified in the descriptive analysis. One group was formed by faller individuals, men <60 years, independent ambulation, FCA≥3 times per week and HPL <6.6 copies per 100 cells (group B). The other one comprised non-faller patients, women ≥60 years, restricted ambulation, DD ≥7 years, use of orthosis, FCA 0-1 time per week and HPL ≥6.6 copies per 100 cells (group D). The others two groups comprised individuals that did not use orthosis (group A) and those that FCA was two times per week and DD <7 years (group C). CONCLUSION: Falls occur in roughly two-thirds of ambulatory HAM/TSP patients and are associated with significant morbidity. Further studies with a larger number of patients are necessarily to identify risk factors in order to elaborate specific programs to prevent falls in this population.

Temporomandibular joint and mandibular growth alterations in patients with juvenile rheumatoid arthritis.

OBJECTIVE: To determine the frequency and type of lesions of the temporomandibular joints (TMJ) as well as orthodontic alterations present in patients with juvenile rheumatoid arthritis (JRA). METHODS: Twenty-six patients had their TMJ evaluated clinically and by high resolution computer tomography. The patients were also submitted to orthodontic evaluation. Children with isolated malocclusion were used as a control group. RESULTS: Computer tomography detected TMJ alterations in 13 (50%) patients with JRA. Bilateral mild lesions were the most frequent. TMJ alterations were especially observed in young patients with JRA with the systemic and polyarticular type of onset. Worse functional class and corticosteroid therapy were also related to TMJ involvement. We observed orthodontic alterations in 18 patients with JRA (69%): midline deviation, convex facial profile. Class II molar relation, crowded lower anterior teeth, anterior open bite, and reduction in the maximum opening of the mouth. Severe TMJ lesions were correlated to cephalometric alterations, suggesting decreased mandibular growth.