Broncopneumopatias a vírus: análise crítica de alterações histológicas encontradas no estudo de afecções respiratórias não bacterianas na infância

Os autores apresentam 69 casos de afecções respiratórias em crianças que atribuem a agentes não bacterianos, provavelmente virais. Usam para isto um critério clínico, outro morfológico, em uma revisão de 372 pneumopatias infecciosas em casos de autópsias. Caracterizaram morfologicamente a resposta à agressão viral pela presença de: infiltrado mononuclear intersticial, predominantemente peribronquilar; alterações degenerativas ou mesmo necrose e hiperplasia do epitélio respiratório; membrana hialina; descamação epitelial; células gigantes sinciciais alveolares e bronquiolares; inclusões nucleares e citoplasmáticas; edema proteináceo alveolar e septal, proliferação intersticial conjuntiva incipiente. Criticam o erro por excesso de diagnósticos de "pneumonia mononuclear intesticial" e o erro por falta quando o acometimento bacteriano dificulta o diagnóstico de lesão atribuível a vírus. Além disso realçam a importância de achado de bonquiolite aguda como fundamental para o diagnóstico. Estas lesões - ao lado de achados clínicos-radiológicos e epidemiológicos - cosntituem o que a experiência adquirida julga como reação do pulmão a vários vírus conhecidos (Adenovírus, Influenza, Parainfluenza, Vírus Sincicial Respiratório e Sarampo).<br>69 cases of respiratory diseases in children are presented and atributed to non-bacterial agents, probably viral. Using clinical and morphological criteria, a review of 372 cases of infections lung diseases was performed in autopsy material. The reaction due to the viral injury is characterized morphologically by interstitial mononuclear infiltration, mainly peribronchiolar; degenerative changes, necrosis and hyperplasia of the respiratory epithelium; hyaline membrane; epithelial desquamation; syncytial giant-cells, alveolar or bronquiolar; nuclear and cytoplasmic inclusions; proteinaceous edema, alveolar and septal; mild intersticial conective tissue proliferation. The overdiagnosis of "mononuclear intesticial pneumonia' is criticized; on the other hand, attention is called to the underdiagnosis of viral pneumonia when bacterial complication difficults its bronchiolitis for morphological diagnosis of viral disease of the lung is stressed. Those lesions - correlated the clinico-radiological and epidemiological findings - constitute which the acquired experience judge as the reaction of the lung to several known viruses (adenovirus, influenza, parainfluenza, sysncytial respiratory virus and measles)

The hemorrhagic syndrome of leptospirosis: an experimental study in guinea pigs

The hemorrhagic syndrome of leptospirosis was studied in guinea pigs. The study correlates hematological, histopathological and immunohistochemical alterations in sixty animals inoculated by the intraperitoneal route with lml of the culture of virulent strain of Leptospira interrogans serovar copenhageni. Leptospirae antigens were detected by immunoperoxidase, chiefly in liver, kidney and heart muscle capillaries. Possible pathogenic mechanisms responsible for hemorrhagic syndrome are discussed with emphasis on toxic and anoxic attacks causing damage to endothelia, platelet depletion and alterations to hemostasia rates: prothrombin time [FT], partial thromboplastin time [PIT] and fibrinogen concentrations. Tide clinical-laboratoiy picture is compatible with the histopathological observation of disseminated intravascular coagulation [D1C] in most of the guinea pigs from day 4 of infection

Screening for decreased glomerular filtration rate and associated risk factors in a cohort of HIV-infected patients in a middle-income country

Submitted by Rodrigo Senorans ([email protected]) on 2015-05-08T17:14:14Z No. of bitstreams: 1 Screening for decreased glomerular filtration rate and associated risk factors in a cohort of HIV-infected patients in a middle-income country.pdf: 183300 bytes, checksum: c4e1fabfd912ba83a08f4407a34c0900 (MD5)Approved for entry into archive by Anderson Silva ([email protected]) on 2015-05-11T12:42:53Z (GMT) No. of bitstreams: 1 Screening for decreased glomerular filtration rate and associated risk factors in a cohort of HIV-infected patients in a middle-income country.pdf: 183300 bytes, checksum: c4e1fabfd912ba83a08f4407a34c0900 (MD5)Approved for entry into archive by Anderson Silva ([email protected]) on 2015-05-11T12:44:28Z (GMT) No. of bitstreams: 1 Screening for decreased glomerular filtration rate and associated risk factors in a cohort of HIV-infected patients in a middle-income country.pdf: 183300 bytes, checksum: c4e1fabfd912ba83a08f4407a34c0900 (MD5)Made available in DSpace on 2015-05-11T18:07:25Z (GMT). No. of bitstreams: 1 Screening for decreased glomerular filtration rate and associated risk factors in a cohort of HIV-infected patients in a middle-income country.pdf: 183300 bytes, checksum: c4e1fabfd912ba83a08f4407a34c0900 (MD5) Previous issue date: 2014Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST e AIDS. Rio de Janeiro, RJ, Brasil / Universidade do Estado do Rio de Janeiro. Faculdade de Ciências Médicas. Hospital Universitário Pedro Ernesto. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST e AIDS. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST e AIDS. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST e AIDS. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST e AIDS. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST e AIDS. Rio de Janeiro, RJ, Brasil.Universidade do Estado do Rio de Janeiro. Faculdade de Ciências Médicas. Departamento de Patologia. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST e AIDS. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST e AIDS. Rio de Janeiro, RJ, BrasiFundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST e AIDS. Rio de Janeiro, RJ, Brasil.Universidade do Estado do Rio de Janeiro. Faculdade de Ciências Médicas. Hospital Universitário Pedro Ernesto. Rio de Janeiro, RJ, Brasil.With the introduction of combined active antiretroviral therapy and the improved survival of HIV-infected patients, degenerative diseases and drug toxicity have emerged as long-term concerns. We studied the prevalence of decreased glomerular filtration rate (GFR) and associated risk factors in a cohort of HIV-infected patients from a middle-income country. Our cross-sectional study included all adult patients who attended an urban outpatient clinic in 2008. GFR was estimated using the CKD-EPI equation. The prevalence ratio (PR) of decreased GFR (defined as ,60 mL/min/1.73 m2) was estimated using generalizing linear models assuming a Poisson distribution. We analyzed data from 1,970 patients, of which 82.9% had been exposed to ART. A total of 249 patients (12.6%) had a GFR between 60 and 89 mL/min/1.73 m2, 3.1% had a GFR between 30 and 59, 0.3% had a GFR between 15 and 29, and 0.4% had a GFR ,15. Decreased GFR was found in only 74 patients (3.8%). In the multivariate regression model, the factors that were independently associated with a GFR below 60 mL/min/1.73 m2 were as follows: age $50 years (PR = 3.4; 95% CI: 1.7–6.8), diabetes (PR = 2.0; 95% CI: 1.2–3.4), hypertension (PR = 2.0; 95% CI: 1.3–3.2), current CD4+ cell count ,350 cells/mm3 (PR = 2.1; 95% CI: 1.3–3.3), past exposure to tenofovir (PR = 4.7; 95% CI: 2.3–9.4) and past exposure to indinavir (PR = 1.7; 95% CI: 1.0–2.8). As in high-income countries, CKD was the predominant form of kidney involvement among HIV-infected individuals in our setting. The risk factors associated with decreased glomerular filtration were broad and included virus-related factors as well as degenerative and nephrotoxic factors. Despite the potential for nephrotoxicity associated with some antiretroviral drugs, in the short-term, advanced chronic renal disease remains very rare

Factors associated with decreased GFR (<60 mL/min per 1.73 m²) in HIV-infected patients of the IPEC/FIOCRUZ Cohort.

<p>Factors associated with decreased GFR (<60 mL/min per 1.73 m²) in HIV-infected patients of the IPEC/FIOCRUZ Cohort.</p

Prevalence of estimated GFR (eGFR) categories in the IPEC/FIOCRUZ cohort of HIV-infected patients.

<p>*Estimated by the CKD-EPI equation.</p