Hiperplasia angiolinfoide como causa de eosinofilia

A hiperplasia angiolinfoide (Hale e doença de Kimura são duas entidades que podem se manifestar como nódulos, placas ou pápulas, de localização predominante em face, região retroauricular e cervical. São causas raras de eosinofilia e ainda há muita discussão em torno de suas etiopatogenias. Para alguns autores trata-se de duas patologias distintas enquanto para outros são manifestações diferentes da mesma doença. O presente artigo relata o caso de um paciente asiático que apresentava história de prurido generalizado há um ano, acompanhado de pápulas em membros e nódulo de aproximadamente 5 cm de diâmetro em região retroauricular direita com aumento progressivo. O hemograma apresentava leucocitose às custas de eosinofilia. Os achados sugerem uma superposição entre as duas patologias, pois clinicamente são sugestivos de doença de Kimura, mas a histopatologia e imuno-histoquímica confirmaram a origem endotelial da lesão, sendo compatível com Hale. Os autores destacam a raridade do caso como causa de eosinofilia, assim como alertam para a dificuldade do diagnóstico e da diferenciação entre as duas patologias

Hiperplasia angiolinfoide como causa de eosinofilia Angiolymphoid hyperplasia as the cause of eosinophilia

A hiperplasia angiolinfoide (Hale e doença de Kimura são duas entidades que podem se manifestar como nódulos, placas ou pápulas, de localização predominante em face, região retroauricular e cervical. São causas raras de eosinofilia e ainda há muita discussão em torno de suas etiopatogenias. Para alguns autores trata-se de duas patologias distintas enquanto para outros são manifestações diferentes da mesma doença. O presente artigo relata o caso de um paciente asiático que apresentava história de prurido generalizado há um ano, acompanhado de pápulas em membros e nódulo de aproximadamente 5 cm de diâmetro em região retroauricular direita com aumento progressivo. O hemograma apresentava leucocitose às custas de eosinofilia. Os achados sugerem uma superposição entre as duas patologias, pois clinicamente são sugestivos de doença de Kimura, mas a histopatologia e imuno-histoquímica confirmaram a origem endotelial da lesão, sendo compatível com Hale. Os autores destacam a raridade do caso como causa de eosinofilia, assim como alertam para a dificuldade do diagnóstico e da diferenciação entre as duas patologias.Angiolymphoid hyperplasia (Hale) and Kimura disease are two entities that can manifest as subcutaneous nodules, plaques, or papules, and the predominant localization is face, retroauricular and cervical region. They are rare causes of eosinophilia and there is discussion regarding their etiopathogenesis. Some authors propose that these two diseases are truly individual, but others say that they are separate points on a single spectrum. This article is a case report of an asian patient that showed a one year duration of generalized pruritus, with papules on the limbs and a 5 centimeter nodule on the right retroauricular region with slow progression of the size. The hemogram showed leucocitosis with eosinophilia. These findings suggest an overlap between these two diseases, they are clinically suggestive of Kimura disease diagnosis, but the histopathology with HE and immunohistochemistry confirmed the endothelial origin of the lesion that was compatible with Hale. The authors emphasize the rarity of the case as the cause of eosinophilia, also alert for the challenge of the diagnosis and distinction between these two diseases

Early Childhood Education in Mexico: Expansion, Quality Improvement and Curricular Reform

An accumulation of research across hundreds of studies shows the benefits of quality early childhood care and education for children’s later learning, school success and social development. In recognition of the value of providing early learning opportunities, many nations have expanded early childhood care and education in recent years. Mexico provides an interesting case in which expansion of early childhood care and education has occurred in the past 5 years, as have initiatives to improve quality and revise the national curriculum for preschoolers. This paper examines three policy initiatives that occurred in Mexico between 2000 and 2006 – preschool expansion, quality improvement and curricular reform. The preschool expansion included a mandate for all parents in Mexico to send their preschool-aged children (3, 4 and 5 years old) to preschool, with target dates of 2004, 2005 and 2008 for 100 per cent coverage of 5-year-olds, 4-yeaolds and 3-year-olds, respectively. The quality improvement initiative was part of a larger programme providing supplemental funds to select preschools and schools in Mexico’s public education system. Finally, the curricular reform instituted a new preschool curriculum to be implemented nationwide for all programmes across the 3- to 5-year-old age range. We utilize a combination of national data and synthesis of existing studies to review each policy according to the three dimensions of coverage, quality and equity. We find that the preschool mandate resulted in rapid increases in enrolment. In 2005, 98 per cent of 5-year-olds, 81 per cent of 4-year-olds and 25 per cent of 3-year-olds were enrolled in preschool. The greatest increases occurred among 4- year-olds. A consequence of the rapid increase for 4-year-olds was that coverage for 3-year-olds actually declined in approximately half of the Mexican states. The slow progress in enrolment of 3- year-olds is seen to be affected also by reluctance on the part of parents. We draw attention to the international discussion on how best to respond to the development needs of children around the age of three and suggest alternatives to centre, education-based systems. Although national averages of class size did not increase significantly, the proportion of preschools with average student-adult ratio of 30 or more did rise significantly in the general, CENDI, indigenous and CONAFE systems. In the general system (the largest system), the increase in proportion of preschools with average ratio of 30 or more from 12 per cent in 2001 to 18 per cent in 2005. The average increase in these structural indicators of quality was relatively small due to increases in numbers of preschools, particularly in urban areas. The impact of the mandate on other aspects of quality is unclear. The quality improvement initiative affected a relatively small number of preschools. In addition, the preschools that received quality improvement funds in the first 2 years of the programme were relatively larger and had more resources to begin with than other preschools. The national curricular reform was created after a comprehensive process of obtaining input from teachers, directors and early education officials from across all the Mexican states. This process resulted in the implementation of an open curriculum based on comprehensive notions of the multiple domains of competencies in early childhood development. The curriculum requires high levels of teacher initiative and reflective practice. We provide information regarding how teachers, principals and other educators have responded to this demanding and challenging curriculum. The paper concludes with policy options in each of the areas of preschool expansion, quality improvement and curricular reform. More funding is needed particularly targeted to ECCE services in poor and vulnerable communities, to support teachers achieve their licenciatura, to address the needs of preschools with very large student:teacher ratios and to develop strong systems of monitoring and research for the continuous adaptation of the system, particularly with respect to equity in access to quality services