Ressecção endoscópica de extensa lesão condilomatosa uretral – relato de caso e revisão da literatura

Introdução: O Condiloma uretral é uma infecção sexualmente transmissível comum associada ao vírus do papiloma humano. O acometimento na uretra é raro, principalmente quando trata-se de um paciente HIV positivo com carga viral indetectável. Objetivo: Tem como objetivo discutir sobre o acometimento uretral do papiloma vírus e as possíveis formas de tratamento, assim como revisar a literatura. Relato de caso: O paciente em questão apresentou suspeita de carcinoma de células de transição, sendo encaminhado para tratamento, porém afastado essa suspeita e fechando diagnóstico para lesão condilomatosa uretral, sendo realizado tratamento por ressecção endoscópica das lesões com energia monopolar. Discussão: O acometimento uretral ocorre em até 5% dos casos, e o mesmo apresenta alta probabilidade de malignização. Não existem diretrizes específicas sobre o manejo do condiloma intra-uretral, pois trata-se de uma patologia rara. O objetivo dos tratamentos é remover as verrugas e induzir períodos livre de lesões, sendo que o conservador com crioterapia e o ácido tricloroacético nem sempre são aplicáveis à uretra devido ao difícil acesso. A ressecção endoscópica das lesões tem se mostrado mais eficaz. Conclusão: Urologistas e patologistas devem estar cientes dessa rara possibilidade, a fim de evitar erros de diagnóstico acerca dessa entidade predominantemente benigna. Desta forma apresentamos um caso de ressecção endoscópica de extensa lesão condilomatosa em uretra peniana de uma paciente masculino hemofílico e HIV positivo.Introduction: Urethral condyloma is a common sexually transmitted infection associated with the human papillomavirus (HPV). Affection in the urethra is rare, especially when dealing with an HIV-positive patient with an undetectable viral load. Objective: It aims to discuss the urethral involvement of the papillomavirus and the possible forms of treatment, as well as to review the literature. Case report: The patient in question presented suspicion of transitional cell carcinoma, being referred for treatment, but this suspicion was removed and the diagnosis of urethral condylomatous lesion was closed, with treatment by endoscopic resection of the lesions with monopolar energy. Discussion: Urethral involvement occurs in up to 5% of cases, and it has a high probability of malignancy. There are no specific guidelines on the management of intra-urethral condyloma, as it is a rare condition. The goal of treatments is to remove warts and induce injury-free periods, the conservative with cryotherapy and trichloroacetic acid not always being applicable to the urethra due to difficult access. Endoscopic resection of the lesions has been shown to be more effective. Conclusion: urologists and pathologists should be aware of this rare possibility to avoid diagnostic errors about this predominantly benign entity. Thus, we present a case of endoscopic resection of an extensive condylomatous lesion in the penile urethra of a male patient with hemophilia and HIV positive

Post-COVID-19 condition: systemic inflammation and low functional exercise capacity

IntroductionPost-COVID-19 condition (PCC) is characterised by a plethora of symptoms, with fatigue appearing as the most frequently reported. The alterations that drive both the persistent and post-acute disease newly acquired symptoms are not yet fully described. Given the lack of robust knowledge regarding the mechanisms of PCC we have examined the impact of inflammation in PCC, by evaluating serum cytokine profile and its potential involvement in inducing the different symptoms reported.MethodsIn this cross-sectional study, we recruited 227 participants who were hospitalised with acute COVID-19 in 2020 and came back for a follow-up assessment 6–12 months after hospital discharge. The participants were enrolled in two symptomatic groups: Self-Reported Symptoms group (SR, n = 96), who did not present major organ lesions, yet reported several debilitating symptoms such as fatigue, muscle weakness, and persistent loss of sense of smell and taste; and the Self-Reported Symptoms and decreased Pulmonary Function group (SRPF, n = 54), composed by individuals with the same symptoms described by SR, plus diagnosed pulmonary lesions. A Control group (n = 77), with participants with minor complaints following acute COVID-19, was also included in the study. Serum cytokine levels, symptom questionnaires, physical performance tests and general clinical data were obtained in the follow-up assessment.ResultsSRPF presented lower IL-4 concentration compared with Control (q = 0.0018) and with SR (q = 0.030), and lower IFN-α2 serum content compared with Control (q = 0.007). In addition, SRPF presented higher MIP-1β serum concentration compared with SR (q = 0.029). SR presented lower CCL11 (q = 0.012 and q = 0.001, respectively) and MCP-1 levels (q = 0.052 for both) compared with Control and SRPF. SRPF presented lower G-CSF compared to Control (q = 0.014). Female participants in SR showed lower handgrip strength in relation to SRPF (q = 0.0082). Male participants in SR and SRPF needed more time to complete the timed up-and-go test, as compared with men in the Control group (q = 0.0302 and q = 0.0078, respectively). Our results indicate that different PCC symptom profiles are accompanied by distinct inflammatory markers in the circulation. Of particular concern are the lower muscle function findings, with likely long-lasting consequences for health and quality of life, found for both PCC phenotypes