Angiomatose bacilar: descrição de 13 casos relatados em cinco centros de referência para tratamento de AIDS no Rio de Janeiro, Brasil

The aim of this case series was to describe the clinical, laboratory and epidemiological characteristics and the presentation of bacillary angiomatosis cases (and/or parenchymal bacillary peliosis) that were identified in five public hospitals of Rio de Janeiro state between 1990 and 1997; these cases were compared with those previously described in the medical literature. Thirteen case-patients were enrolled in the study; the median age was 39 years and all patients were male. All patients were human immunodeficiency virus type 1 (HIV-1) infected and they had previous or concomitant HIV-associated opportunistic infections or malignancies diagnosed at the time bacillary angiomatosis was diagnosed. Median T4 helper lymphocyte counts of patients was 96 cells per mm³. Cutaneous involvement was the most common clinical manifestation of bacillary angiomatosis in this study. Clinical remission following appropriate treatment was more common in our case series than that reported in the medical literature, while the incidence of relapse was similar. The frequency of bacillary angiomatosis in HIV patients calculated from two of the hospitals included in our study was 1.42 cases per 1000 patients, similar to the frequencies reported in the medical literature. Bacillary angiomatosis is an unusual opportunistic pathogen in our setting.Esta série de casos foi conduzida com o objetivo de descrever a apresentação clínica, as características epidemiológicas, os exames laboratoriais e a evolução dos casos de angiomatose bacilar (e/ou peliose parenquimatosa bacilar) ocorridos em cinco hospitais públicos do Rio de Janeiro, no período de 1990 a 1997, comparando a casuística encontrada com a relatada na literatura médica. Foram incluídos 13 pacientes com mediana de idade de 39 anos, sendo todos pertencentes ao sexo masculino. Todos os pacientes apresentaram infecções oportunistas e/ou neoplasias associadas ao vírus da imunodeficiência humana (HIV-1) anteriores (ou concomitantes) ao diagnóstico de angiomatose bacilar. A mediana da contagem de linfócitos T Helper encontrada foi de 96 células por mm³. O acometimento cutâneo foi a apresentação clínica de angiomatose bacilar mais freqüente deste estudo. A freqüência de remissão após tratamento específico foi discretamente maior do que a relatada na literatura médica, enquanto a de recidiva foi semelhante. A freqüência de angiomatose bacilar entre indivíduos infectados pelo HIV de dois hospitais do Rio de Janeiro foi de 1,42 casos por 1.000 pacientes, semelhante ao relatado na literatura médica e sugestivo de que a angiomatose bacilar é relativamente incomum em nosso meio

Bioinspired Magneto-optical Bacteria

“Two-in-one” magneto-optical bacteria have been produced using the probiotic Lactobacillus fermentum for the first time. We took advantage of two features of bacteria to synthesize this novel and bifunctional nanostructure: their metal-reducing properties, to produce gold nanoparticles, and their capacity to incorporate iron oxide nanoparticles at their external surface. The magneto-optical bacteria survive the process and behave as a magnet at room temperature.This work was funded by Biosearch S.A. (POSTBIO project-Agency for Innovation and Development of Andalucia IDEA) and by MINECO and FEDER (project CTQ2012-32236)

Modificaciones de la función ventricular izquierda con dosis crecientes de dobutamina en individuos sanos

E1 objetivo fue valorar los cambios de la función ventricular con dosis crecientes de dobutamina en jóvenes sanos. Se realizó ventriculografía isotópica en situación basal, con dosis baja (10 µg/Kg/min) y alta (40 µg/Kg/min) del fármaco. Se estudiaron la fracción de eyección global, segmentaria y del primer tercio de la sístole, la velocidad máxima de llenado diastólico y el tiempo hasta la velocidad máxima de llenado. Se observó un aumento progresivo de la fracción de eyección global con las dosis sucesivas del fármaco. La fracción de eyección segmentaria, fracción de eyección del primer tercio de la sístole y la velocidad máxima de llenado aumentaron con la dosis baja sin mostrar diferencias con la alta. Se concluye que la dobutamina en jóvenes sanos y en estas dosis induce un aumento significativo de todos los parámetros sistólicos y de la velocidad máxima de llenado, sin modificar el tiempo hasta la velocidad máxima de llenado

How early can myocardial iron overload occur in Beta thalassemia major?

BACKGROUND: Myocardial siderosis is the most common cause of death in patients with beta thalassemia major(TM). This study aimed at investigating the occurrence, prevalence and severity of cardiac iron overload in a young Chinese population with beta TM. METHODS AND RESULTS: We analyzed T2* cardiac magnetic resonance (CMR), left ventricular ejection fraction (LVEF) and serum ferritin (SF) in 201 beta TM patients. The median age was 9 years old. Patients received an average of 13 units of blood per year. The median SF level was 4536 ng/ml and 165 patients (82.1%) had SF>2500 ng/ml. Myocardial iron overload was detected in 68 patients (33.8%) and severe myocardial iron overload was detected in 26 patients (12.6%). Twenty-two patients ≤10 years old had myocardial iron overload, three of whom were only 6 years old. No myocardial iron overload was detected under the age of 6 years. Median LVEF was 64% (measured by CMR in 175 patients). Five of 6 patients with a LVEF<56% and 8 of 10 patients with cardiac disease had myocardial iron overload. CONCLUSIONS: The TM patients under follow-up at this regional centre in China patients are younger than other reported cohorts, more poorly-chelated, and have a high burden of iron overload. Myocardial siderosis occurred in patients younger than previously reported, and was strongly associated with impaired LVEF and cardiac disease. For such poorly-chelated TM patients, our data shows that the first assessment of cardiac T2* should be performed as early as 6 years old

Cardiovascular magnetic resonance in systemic hypertension

Systemic hypertension is a highly prevalent potentially modifiable cardiovascular risk factor. Imaging plays an important role in the diagnosis of underlying causes for hypertension, in assessing cardiovascular complications of hypertension, and in understanding the pathophysiology of the disease process. Cardiovascular magnetic resonance (CMR) provides accurate and reproducible measures of ventricular volumes, mass, function and haemodynamics as well as uniquely allowing tissue characterization of diffuse and focal fibrosis. In addition, CMR is well suited for exclusion of common secondary causes for hypertension. We review the current and emerging clinical and research applications of CMR in hypertension

Captación de Talio-201 en pulmón y corazón con diferentes tipos de estrés. Estudio en voluntarios sanos

Para comprobar si existen diferencias en la captación pulmonar y miocárdica de Talio-201 entre distintos tipos de estrés se estudiaron 40 voluntarios varones de edad 21,7 ± 0,9 años. A todos se les practicó una gammagrafía de perfusión miocárdica con Talio-201 mediante SPECT. Los 40 individuos fueron aleatorizados en 4 grupos de 10 sujetos cada uno, siendo cada grupo sometido a un tipo de estrés: ejercicio físico, dobutamina, dipiridamol y adenosina trifosfato (ATP). Se observaron diferencias significativas en la captación pulmonar y cardíaca del isótopo, siendo ambas menores con ejercicio físico que con los tres tipos de estrés farmacológico; el índice pulmón/corazón fue equivalente en los cuatro grupos. Se concluye que, aunque el ejercicio físico induce una menor captación pulmonar y cardíaca de Talio-201 que el estrés farmacológico, el índice pulmón/corazón es equivalente para los cuatro grupos y de un valor de 0,28 ± 0,03 en individuos jóvenes sano

Feasibility of perfusion cardiovascular magnetic resonance in paediatric patients

AIMS: As coronary artery disease may also occur during childhood in some specific conditions, we sought to assess the feasibility and accuracy of perfusion cardiovascular magnetic resonance (CMR) in paediatric patients. METHODS AND RESULTS: First-pass perfusion CMR studies were performed under pharmacological stress with adenosine and by using a hybrid echo-planar pulse sequence with slice-selective saturation recovery preparation. Fifty-six perfusion CMR examinations were performed in 47 patients. The median age was 12 years (1 month-18 years), and weight 42.8 kg (2.6-82 kg). General anaesthesia was required in 18 patients. Mean examination time was 67 +/- 19 min. Diagnostic image quality was obtained in 54/56 examinations. In 23 cases the acquisition parameters were adapted to patient's size. Perfusion CMR was abnormal in 16 examinations. The perfusion defects affected the territory of the left anterior descending coronary artery in 11, of the right coronary artery in 3, and of the circumflex coronary artery in 2 cases. Compared to coronary angiography, perfusion CMR showed a sensitivity of 87% (CI 52-97%) and a specificity of 95% (CI 79-99%). CONCLUSION: In children, perfusion CMR is feasible and accurate. In very young children (less than 1 year old), diagnostic image quality may be limited