Achados histopatológicos de atividade inflamatória em pacientes com cardite subclínica

Nos pacientes com Cardite Reumática Crônica, a cardite em atividade é uma condição frequentemente subdiagnosticada. Os surtos reumáticos promovem o agravamento das lesões já existentes, levando a uma deterioração da condição clínica do paciente. Dessa forma a redução da morbimortalidade da doença depende, em parte, do controle de recidivas a partir da profilaxia secundária. O subdiagnóstico deve-se em parte a ocorrência de surtos reumáticos subclínicos. Este estudo foi realizado com dados dos pacientes que tiveram o diagnóstico de Cardite Reumática Crônica e foram submetidos à cirurgia cardíaca para troca ou plastia valvar, sem evidência clínica ou laboratorial desurto reumático. Um fragmento de miocárdio foi enviado para análise histopatológica. Foram analisados os dados de frequência de alterações histopatológicas compatíveis com surto reumático. Após análises, 80% dos pacientes apresentaram alterações compatíveis com atividade inflamatória. Desses, 87,5% apresentavam infiltrado linfocitário;25% apresentavam nódulos de Aschoff. Os achados histopatológicos de doença crônica mais frequentes foram hipertrofia miocárdica em 56,7% pacientes e fibrose em 53,3%.In patients with Chronic Rheumatic Carditis, active carditis is an often underdiagnosed condition. Rheumatic attacks promote the aggravation of existing lesions, leading to a deterioration of the patient’s clinical condition. Thus, reducing the morbidity and mortality of the disease depends, in part, on controlling relapses through secondary prophylaxis. Underdiagnosis is due in part to the occurrence of subclinical rheumatic attacks. This study was carried out with data from patients who were diagnosed with Chronic Rheumatic Carditis and who underwent cardiac surgery for valve replacement or repair, without clinical or laboratory evidence of rheumatic outbreak. A fragment of myocardium was sent for histopathological analysis. Data on the frequency of histopathological alterations compatible with a rheumatic outbreak were analyzed. After analysis, 80% of patients showed changes compatible with inflammatory activity. Of these, 87.5% had lymphocytic infiltrate; 25% had Aschoff’s nodules. The most frequent histopathological findings of chronic disease were myocardial hypertrophy in 56.7% of patients and fibrosis in 53.3%

Fatores Associados à Desnutrição Crônica de Crianças e Adolescentes Admitidas em um Hospital de Referência do Nordeste / Factors Associated with Chronic Malnutrition in Children and Adolescents Admitted to a Northeast Referral Hospital

Objetivo: Identificar os fatores associados à desnutrição crônica de crianças e adolescentes admitidas na enfermaria da clínica pediátrica. Métodos: Estudo transversal ambispectivo, originado de um banco de dados, que teve sua coleta retomada com foco no estado nutricional de crianças e adolescentes, realizado na clínica médica pediátrica de um hospital de referência do Nordeste brasileiro. Foram incluídos pacientes que apresentaram os critérios de elegibilidade, admitidos entre agosto de 2016 e outubro de 2019. A entrevista foi realizada com um questionário estruturado e avaliação nutricional a partir do peso e da estatura aferidos até 48 horas após a internação. Foram utilizados os índices propostos pela Organização Mundial de Saúde para avaliação e classificação do estado nutricional. O estudo foi aprovado pelo Comitê de Ética e Pesquisa. Resultados: A amostra total foi de 550 crianças e adolescentes, sendo a maioria, do sexo masculino e 11,3% dos pacientes apresentaram baixa estatura para idade. Os principais fatores associados à desnutrição crônica foram: idade, altura e peso da mãe, altura do pai, número de pessoas na residência, renda da família e valor do auxílio do governo com p<0,05. Conclusão: A taxa de desnutrição crônica expressa pela baixa estatura para idade foi maior do que o preconizado pela Organização Mundial de Saúde e o estado nutricional materno foi o fator que mais se associou com essa condição de crianças e adolescentes

Clinical and laboratory characteristics, staging, and outcomes of individuals with AIDS-associated Kaposi's sarcoma at an university hospital

Submitted by Adagilson Silva ([email protected]) on 2017-06-19T19:20:13Z No. of bitstreams: 1 28538874 2017 lim-clin.oa.pdf: 287529 bytes, checksum: c9afa11ebf83a86fc4e42c532ae83f6d (MD5)Approved for entry into archive by Adagilson Silva ([email protected]) on 2017-06-19T19:21:51Z (GMT) No. of bitstreams: 1 28538874 2017 lim-clin.oa.pdf: 287529 bytes, checksum: c9afa11ebf83a86fc4e42c532ae83f6d (MD5)Made available in DSpace on 2017-06-19T19:21:51Z (GMT). No. of bitstreams: 1 28538874 2017 lim-clin.oa.pdf: 287529 bytes, checksum: c9afa11ebf83a86fc4e42c532ae83f6d (MD5) Previous issue date: 2017Commission and Hospital Infection Control Service of the Hospital Barão de Lucena. Recife, PE, Brazil.Universidade Federal de Pernambuco. Department of Tropical Medicine. Recife, PE, Brazil / Fundação Oswaldo Cruz. Instituto Aggeu Magalhães. Recife, PE, Brasil.Real Hospital Português de Beneficência de Pernambuco. Department of Clinical Oncology. Recife, PE, Brazil / Hospital Barão de Lucena. Department of Clinical Oncology. Recife, PE, Brazil.Universidade Federal de Pernambuco. Department of Tropical Medicine. Recife, PE, Brazil / Dermatology Service of the Hospital das Clínicas of the Universidade Federal de Pernambuco (HC-UFPE). Recife, PE, Brazil.Universidade Federal de Pernambuco. Department of Tropical Medicine. Recife, PE, Brazil.Background: Kaposi's sarcoma continues to be the most common human immunodeficiency virus - associated neoplasm with considerable morbidity and mortality. Objective: To describe the clinical and laboratory characteristics, initial staging, and outcomes of aids patients with Kaposi's sarcoma at an university hospital of Recife, Pernambuco. Methods: This is a descriptive study with analytic character, retrospective, of a case series between 2004 and 2014. Results: Of the 22 patients included in the study, 20 were aged <40 years (72.7%). The majority had CD4+ T lymphocyte counts of <200 cells/mm3 (77.3%) and human immunodeficiency virus loads of <100,000 copies/mL (78.9%). Lesions were most commonly observed on the skin (90%), and internal organs were affected in 11 of the 22 patients. Only 7 (31.8%) of the 22 patients were undergoing antiretroviral therapy (ART) at the time of Kaposis sarcoma diagnosis, and the initial disease staging classification was high risk (Aids Clinical Trials Group Oncology Committee) in 19 of the 22 patients (86.4%). Regarding Kaposi's sarcoma treatment, 17 of 22 patients (77.3%) underwent systemic chemotherapy + ART and 5 were treated exclusively with ART. Eight of the 22 patients died (36.5%); of these, 87.5% had died within one year of Kaposi's sarcoma diagnosis. Limitation of the study: Without a control group, this study cannot be used to generate hypotheses. Conclusions: Despite the association between aids and late Kaposi's sarcoma diagnosis in the study population, including an unfavorable risk at the time of staging, a lower mortality rate was observed relative to other studies; this might be related to access to a specialized health service

Epidemiological risk factors associated with primary infection by Epstein-Barr virus in HIV-1-positive subjects in the Brazilian Amazon region

Health Surveillance Department of the Brazilian Ministry of Health and Conselho Nacional de Desenvolvimento Científco e Tecnológico–CNPQ (#301869/2017-0). Coordination for the Improvement of Higher Education Personnel (CAPES) (process number: 88882.183970/2018-01).Federal University of Pará. Institute of Biological Sciences. Laboratory of Virology. Belém, PA, Brazil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Laboratório de Vírus Epstein-Barr. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Laboratório de Vírus Epstein-Barr. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Laboratório de Vírus Epstein-Barr. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Departamento de Epidemiologia e Vigilância. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Departamento de Epidemiologia e Vigilância. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Laboratório de Vírus Epstein-Barr. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Laboratório de Retrovírus. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Laboratório de Vírus Epstein-Barr. Ananindeua, PA, Brasil / Federal University of Pará. School of Medicine. Belém, PA, Brazil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Laboratório de Retrovírus. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Laboratório de Vírus Epstein-Barr. Ananindeua, PA, Brasil / Federal University of Pará. Institute of Biological Sciences. Graduate Program in Biology of Infectious and Parasitic Agents. Belém, PA, Brazil.Federal University of Pará. Institute of Biological Sciences. Laboratory of Virology. Belém, PA, Brazil /Federal University of Pará. Institute of Biological Sciences. Graduate Program in Biology of Infectious and Parasitic Agents. Belém, PA, Brazil.To identify the prevalence and risk factors for primary Epstein–Barr virus (EBV) infection in human immunodeficiency virus (HIV)-1-positive adult treatment-naïve patients between January 2018 and December 2019 in a state of the Brazilian Amazon region. A total of 268 HIV-1 positive patients and 65 blood donors participated in the study. Epidemiological data were obtained from medical records and through a designed questionnaire. EBV infection was screened by the semiquantitative detection of anti-viral capsid antigen (VCA) EBV IgM and IgG, followed by molecular detection of the EBNA-3C gene. The plasma viral loads of HIV-1 and EBV were quantified using a commercial kit. The prevalence of primary coinfection was 7.12%. The associated risk factors were education level, family income, history of illicit drug use and sexually transmitted infections, homosexual contact and condom nonuse. Approximately 58.5% had late initiation of highly active antiretroviral therapy, which influenced the risk of HIV-EBV 1/2 multiple infection (odds ratio (OR): 4.76; 95% CI 1.51–15.04) and symptom development (p = 0.004). HIV viral load was associated with patient age (OR: 2.04; 95% CI 2.01–2.07; p = 0.026) and duration of illicit drug use (OR: 1.57; 95% CI 1.12–2.22; p = 0.0548). EBV viral load was associated with younger age (OR: 0.82; 95% CI 0.79–1.03; p = 0.0579). The replication of both viruses was associated with symptom development (HIV = OR: 2.06; 95% CI 1.22–3.50; p = 0.0073; EBV = OR: 8.81; 95% CI 1–10; p = 0.0447). The prevalence of HIV/EBV coinfection was lower than that observed in other studies, and social vulnerability and promiscuous sexual behavior were associated risk factors. A long time of HIV-1 infection, without therapy, influenced the risk of coinfection and disease progression. The viral loads of both viruses may be associated with some epidemiological aspects of the population

Epstein&ndash;Barr Virus (EBV) Genotypes Associated with the Immunopathological Profile of People Living with HIV-1: Immunological Aspects of Primary EBV Infection

Background: The aim of the present study was to evaluate the immunological profile of adult HIV-1+ patients coinfected with primary Epstein&ndash;Barr virus (EBV) infection who were free of antiretroviral drugs and inhabitants of the Brazilian Amazon region. Materials and methods: Primary EBV infection was screened by the semiquantitative detection of IgM and IgG anti-VCA. Genotypes were determined by conventional PCR. EBV and HIV viral load (VL) were quantified by real-time PCR. Cytokine dosage and cell quantification were performed by cytometry. Results: Only HIV-1+ individuals had primary EBV infection (7.12%). The EBV-1 genotype was the most prevalent (47.37%). The VL of HIV-1 was lower in the HIV/EBV-2 group. CD4+ T lymphocytes were inversely proportional to the VL of EBV in HIV/EBV-1/2 multi-infected patients. The HIV/EBV-2 group had the lowest cytokine levels, especially IFN-&gamma; and IL-4. Different correlations were proposed for each coinfection. The late search for specific care related to HIV infection directly affected the cytokine profile and the number of CD8+ T lymphocytes. Symptoms were associated with the increase in VL of both viruses and cytokine profile. Conclusions: Different immunological profiles were associated with EBV genotypes in primary infection, with EBV-2 being more frequent in patients with low levels of HIV viral load. With late infection monitoring and consequent delay in the initiation of HAART, clinical changes and effects on the maintenance of the immune response were observed