Discrete cutaneous lesions in a critically ill patient treated only for AIDS and miliary tuberculosis: a case report of disseminated histoplasmosis

Histoplasmosis is a systemic mycosis caused by the dimorphic fungus Histoplasma capsulatum, with disseminated histoplasmosis (HD) being one of its clinical forms. As a consequence of the HIV-AIDS pandemic, HD has become prevalent not only in regions that are recognized as endemic but also in areas not considered endemic, such as Europe and Asia. Its clinical manifestations are varied and mimic several infectious diseases, mainly tuberculosis. In endemic areas, it is the first manifestation of AIDS in 50 to 70% of patients. The diagnosis of histoplasmosis is difficult and HD can lead to death if not diagnosed early and if proper treatment is not instituted. The present report presents a patient with a recent diagnosis of HIV-AIDS, in treatment for miliary tuberculosis, who was diagnosed with disseminated histoplasmosis because of his dermatological manifestations

Síndrome de Sweet e Infecção pelo VIH: O que Podemos Interpretar?

Sweet's syndrome is a neutrophilic dermatosis whose etiopathogenesis is not yet fully known. Histopathology of cutaneous lesions shows an infiltrate with mature neutrophils diffusely distributed in the papillary dermis. The diagnosis is made through clinical, laboratory and histopathological criteria. Association of Sweet syndrome and HIV infection is scarcely related in the literature, having been reported with the use of abacavir, opportunistic infections and vaccination. The explicit evidence for the association is considering Sweet's syndrome as a manifestation of immune reconstitution syndrome, which occurs in 10% to 45% of HIV-infected individuals at the start of antiretroviral therapy. The present report describes the case of a patient HIV-positive for 4 years, who maintained antiretroviral therapy irregularity and, after regularizing the use of antiretrovirals, developed Sweet syndrome.A síndrome de Sweet é uma dermatose neutrofílica cuja etiopatogenia ainda não é totalmente conhecida. A análise histopatológica das lesões cutâneas evidencia infiltrado com predominância de neutrófilos maduros que são distribuídos de forma difusa na derme papilar. O diagnóstico é realizado através de critérios clínicos, laboratoriais e histopatológicos. A relação entre síndrome de Sweet e infecção VIH está escassamente relatada na literatura, sendo geralmente relacionada ao uso de abacavir, infecções oportunistas e vacinação. Uma das possíveis explicações descritas para a associação entre o VIH e a síndrome de Sweet consiste na síndrome de Sweet como manifestação clínica da síndrome da reconstituição imune , a qual afeta 10% a 45% de indivíduos infectados pelo VIH após o início da terapêutica anti-retroviral. O presente relato descreve o caso de uma paciente, VIH positivo há 4 anos, que manteve terapêutica anti-retroviral irregular e após regularizar o uso dos antirretrovirais, evoluiu com síndrome de Sweet

Pioderma Gangrenoso Associado a Hemoglobinúria Paroxística Noturna

Pyoderma gangrenosum is a chronic neutrophilic dermatosis with no established etiology. It is often associated with systemic diseases such as inflammatory rheumatic diseases, inflammatory bowel diseases, malignant neoplasms and haematological diseases including nocturnal paroxysmal hemoglobinuria. It presents as ulcerated and painful skin lesions with rapid and progressive evolution, mainly in the lower limbs. Ulcerations may arise spontaneously or induced by trauma (pathergy phenomenon). The period between the onset of the lesions and the diagnosis is usually prolonged. The diagnosis is based on clinical data and confirmed after the exclusion of other causes of cutaneous ulcerations. We report a case of Pyoderma gangrenosum in the left upper limb with onset after a traumatic event in a patient with nocturnal paroxysmal hemoglobinuria.O pioderma gangrenoso é uma dermatose neutrofílica crônica sem etiologia estabelecida. Sabe-se que se associa a doenças sistémicas como doenças reumatológicas, doenças inflamatórias intestinais, neoplasias malignas, doenças hematológicas, dentre elas a hemoglobinúria paroxística noturna. Manifesta-se através de lesões cutâneas ulceradas e dolorosas com evolução rápida e progressiva, sendo mais comum nos membros inferiores. As ulcerações podem surgir espontaneamente ou induzidas por traumas, sendo característico do pioderma gangrenoso o fenômeno de patergia. O período entre o início das lesões e o diagnóstico costuma ser prolongado. O diagnóstico é baseado em evidências clínicas e confirmado com a exclusão das outras etiologias de lesões ulceradas cutâneas. Relatamos um caso de pioderma gangrenoso em membro superior esquerdo com início após evento traumático em paciente com diagnóstico de hemoglobinúria paroxística noturna

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

Prevalência de doenças autorreferidas por minorias étnicas na Região Metropolitana de Manaus

Introdução: Minorias étnicas são grupos cujas características históricas, étnicas, linguísticas, religiosas e culturais diferem daquelas existentes na maior parte da população. Muitas pesquisas relataram associações entre doenças autorreferidas e minorias étnicas em várias partes do mundo, incluindo o Brasil. Estudos como esse poderão nortear políticas públicas para a diminuição e prevenção de doenças autorreferidas por minorias étnicas na região metropolitana de Manaus. Objetivo: O objetivo deste estudo é determinar a prevalência de doenças autorreferidas por minorias étnicas na região metropolitana de Manaus e identificar as etnias mais proprensas a desenvolver doenças crônicas. Métodos: Trata-se de um estudo transversal de base populacional. O estudo será realizado na Região Metropolitana de Manaus, composta pelos municípios de Manaus, Careiro da Várzea, Iranduba, Itacoatiara, Manacapuru, Novo Airão, Presidente Figueiredo e Rio Preto da Eva. Será realizada uma amostragem probabilística, por conglomerados em dois estágios. As variáveis serão aferidas por meio de um questionário respondido pelo próprio participante por meio de entrevista face a face, previamente validado, semiestruturado e pré-codificado. Calculou-se o tamanho da amostra a partir de uma estimativa de 50% de prevalência de doenças autorreferidas. Chegou-se a uma amostra de 3.598 indivíduos a serem entrevistados, considerando o nível de confiança 95%, precisão de 2% e efeito do desenho 1,5. A esse número será adicionado 10% para compensar eventuais perdas, totalizando 4.000 pessoas a serem entrevistadas. Para analisar todas as variáveis de caracterização da amostra, será utilizada estatística descritiva. A razão de prevalência ajustada através da Regressão de Poisson com variância robusta será calculada para identificar os fatores relacionados à prevalência de doenças autorreferidas por minorias étnicas na região metropolitana de Manaus. Será considerado o delineamento amostral complexo nas análises. O projeto foi aprovado pelo Comitê de Ética em Pesquisa da Universidade Federal do Amazonas (parecer 974.428/2015, CAAE 42203615.4.0000.5020) e recebeu financiamento do Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq).Voluntári

Discrete cutaneous lesions in a critically ill patient treated only for AIDS and miliary tuberculosis: a case report of disseminated histoplasmosis

Histoplasmosis is a systemic mycosis caused by the dimorphic fungus Histoplasma capsulatum, with disseminated histoplasmosis (HD) being one of its clinical forms. As a consequence of the HIV-AIDS pandemic, HD has become prevalent not only in regions that are recognized as endemic but also in areas not considered endemic, such as Europe and Asia. Its clinical manifestations are varied and mimic several infectious diseases, mainly tuberculosis. In endemic areas, it is the first manifestation of AIDS in 50 to 70% of patients. The diagnosis of histoplasmosis is difficult and HD can lead to death if not diagnosed early and if proper treatment is not instituted. The present report presents a patient with a recent diagnosis of HIV-AIDS, in treatment for miliary tuberculosis, who was diagnosed with disseminated histoplasmosis because of his dermatological manifestations

Analisando as pesquisas em educação especial no Brasil Analysing research in special education in Brazil

Nosso objetivo foi examinar a articulação lógica entre o problema e a proposição teórico-metodológica das produções na área da Educação Especial, focando os seus pressupostos epistemológicos. Nos fundamentamos nos pressupostos das tendências empírico-analítica, fenomenológica-hermenêutica, crítico-dialética e do paradigma da complexidade. O procedimento adotado foi interpretar todas as dissertações/teses produzidas nos Programas de Pós-Graduação em Educação e Educação Especial do Brasil, que versam sobre Educação Especial, produzidas nos anos de 2001, 2002 e 2003, disponíveis no banco de teses da CAPES. Encontramos as tendências empírica, fenomenológica e dialética. Os equívocos encontrados foram a não inserção da pesquisa entre as produções na área; ausência de criticidade; não posicionamento numa determinada concepção de educação; construção teórica fundamentada em concepções diferentes; falta de coerência nos pressupostos teórico-metodológicos; não explicitação metodológica; não descrição dos procedimentos éticos; e má elaboração dos resumos. Concluímos pela necessidade da melhoria das dissertações/teses para que possamos avançar na produção de conhecimento na área da Educação Especial.<br>Our objective was to analyze the logical articulation between the problem and the theoretical-methodological proposal of studies in the field of Special Education, focusing on the epistemological issues. We based our study on the empiric-analytical tendencies, phenomenology-hermeneutic, critical-dialectical and the complexity paradigm. The procedure that was adopted was interpreting all dissertations/thesis produced in Post-Graduate programs in Education and Special Education in Brazil, which focus on Special Education, produced in 2001, 2002 and 2003, available online at CAPES' thesis database. We found empirical, phenomenological and dialectic tendencies. The errors encountered included the failure to include the research among the productions in the field; lack of critical approach; lack of making explicit what educational conception the study was based on; theoretical construction based on different conceptions; lack of coherence in the theoretical-methodological proposals; lack of methodological specification; absence of ethical procedural descriptions; and poorly written abstracts. We came to the conclusion that improvements in theses /dissertations are necessary so as to continually move forward in the production of knowledge in the field of Special Education

NEOTROPICAL ALIEN MAMMALS: a data set of occurrence and abundance of alien mammals in the Neotropics

Biological invasion is one of the main threats to native biodiversity. For a species to become invasive, it must be voluntarily or involuntarily introduced by humans into a nonnative habitat. Mammals were among first taxa to be introduced worldwide for game, meat, and labor, yet the number of species introduced in the Neotropics remains unknown. In this data set, we make available occurrence and abundance data on mammal species that (1) transposed a geographical barrier and (2) were voluntarily or involuntarily introduced by humans into the Neotropics. Our data set is composed of 73,738 historical and current georeferenced records on alien mammal species of which around 96% correspond to occurrence data on 77 species belonging to eight orders and 26 families. Data cover 26 continental countries in the Neotropics, ranging from Mexico and its frontier regions (southern Florida and coastal-central Florida in the southeast United States) to Argentina, Paraguay, Chile, and Uruguay, and the 13 countries of Caribbean islands. Our data set also includes neotropical species (e.g., Callithrix sp., Myocastor coypus, Nasua nasua) considered alien in particular areas of Neotropics. The most numerous species in terms of records are from Bos sp. (n = 37,782), Sus scrofa (n = 6,730), and Canis familiaris (n = 10,084); 17 species were represented by only one record (e.g., Syncerus caffer, Cervus timorensis, Cervus unicolor, Canis latrans). Primates have the highest number of species in the data set (n = 20 species), partly because of uncertainties regarding taxonomic identification of the genera Callithrix, which includes the species Callithrix aurita, Callithrix flaviceps, Callithrix geoffroyi, Callithrix jacchus, Callithrix kuhlii, Callithrix penicillata, and their hybrids. This unique data set will be a valuable source of information on invasion risk assessments, biodiversity redistribution and conservation-related research. There are no copyright restrictions. Please cite this data paper when using the data in publications. We also request that researchers and teachers inform us on how they are using the data