Strongyloides stercoralis hyperinfection: a dreaded but still missed diagnosis

Strongyloides stercoralis (S. stercoralis), an intestinal nematode, is endemic in tropical and subtropical regions, being less prevalent in temperate climates. The number of infected persons worldwide ranges between 10 million and 100 million people. In Brazil the reported prevalence is 13%. Chronic infection may be asymptomatic or accompanied by gastrointestinal and respiratory symptoms. Under immunosuppressive conditions, the infection assumes serious proportions frequently accompanied by septic shock, disseminated intravascular coagulopathy and respiratory distress syndrome. The authors report a case of a 50-year-old female patient who was a chronic user of glucocorticoids and had been seeking medical attention for two months because of continuous gastrointestinal symptoms. She was admitted to the emergency room with clinical signs of septic shock and died after four days despite an adequate antibiotic regimen, vasopressor drugs, and ventilatory support. The autopsy revealed the unsuspected finding of  S. stercoralishyperinfection and septicemia

Transforming the invisible into the visible: disparities in the access to health in LGBT+ older people

Objectives: To compare variables of access to healthcare between the LGBT+ population aged 50 and over and those non-LGBT+. Methods: A cross-sectional study was carried out in Brazil through a confidential online questionnaire. The use of the health system was characterized by the number of preventive tests performed and measured by the PCATool-Brasil scale (a 10-point scale in which higher scores were associated with better assistance in healthcare). The association between being LGBT+ and access to health was analyzed in Poisson regression models. Results: 6693 participants (1332 LGBT+ and 5361 non-LGBT+) with a median age of 60 years were included. In the univariate analysis, it was observed not only lower scores on the PCATool scale (5.13 against 5.82, p < 0.001), but a greater proportion of individuals among those classified with the worst quintile of access to healthcare (< 4 points), 31% against 18% (p < 0.001). Being LGBT+ was an independent factor associated with worse access to health (PR = 2.5, 95% CI 2.04‒3.06). The rate of screening cancer, for breast, colon, and cervical cancer was also found to be lower in the LGBT+ population. Conclusion: Healthcare access and health service experiences were worse in the LGBT+ group than in their non-LGBT peers. Inclusive and effective healthcare public policies are essential to promote healthy aging for all

Cardiac angiosarcoma: an unexpected diagnosis

Cardiac angiosarcoma is a rare entity. The incidence through autopsy findings ranges between 0.001% and 0.03%. The disease usually presents with non-specific symptoms, although asymptomatic cases are frequent; therefore, diagnosis iis unexpected and consequently delayed. The authors report the case of a middle-aged man with a recent onset cough and dyspnea. He sought medical care several times without receiving a definite diagnosis until a plain chest radiography was taken showing a mediastinal enlargement, which was the reason why he was hospitalized for clinical investigation. During the diagnostic workup, an echodopplercardiogram and a thoracic computed tomography were performed, showing a heterogeneous soft-tissue mass infiltrating the pericardium and the anterior atrial wall. Multiple and scattered\ud pulmonary nodules were also present. A pulmonary nodule was biopsied, which revealed an angiosarcoma. The clinical features added to the radiological and histological findings permitted the diagnosis of right atrial angiosarcoma. The authors highlight the unexpected pattern in the presentation of cardiac tumors

Mucinous adenocarcinona of the appendix

Diagnosis of malignancy in the vermiform appendix is quite rare. The most common histological malignant neoplasia found in this tiny portion of the gastrointestinal tract is represented by the mucinous adenocarcinoma. This entity predominates in males around 50 years of age, and clinical presentation usually mimics or occurs along with an acute appendicitis. Early diagnosis is outside the rule since most cases at this stage are symptomless. The authors present the case of a 59-year-old female patient who looked for medical attention complaining of abdominal pain. Physical examination and laboratory workup were poor in diagnostic findings. The computed tomography images were compatible with the diagnosis of appendicitis and/or appendiceal neoplasia. The patient underwent a laparotomy and right hemicolectomy. The histological examination disclosed a moderately differentiated mucinous adenocarcinoma of the appendix stage T4a, N0, M0. The patient outcome was uneventful and was referred to an oncological center

Prognostic factors associated to a worse healthcare access in Brazilian aging adults: the impact of gender and sexual orientation

INTRODUÇÃO: Fatores como pobreza, opressão sexual, racismo e exclusão social podem estar associados com maior vulnerabilidade em saúde. Sabe-se ainda que acesso a saúde é um aspecto central desta vulnerabilidade. O entendimento dos fatores determinantes de uma pior atenção à saúde é particularmente importante entre idosos, já que estes compõem a população que mais frequentemente necessita de cuidados. No entanto, pouco se sabe se características individuais básicas, como gênero e orientação sexual, interferem no acesso à saúde no Brasil, e, consequentemente, conferem uma maior vulnerabilidade em saúde àqueles que envelhecem. OBJETIVOS: (1) Descrever o perfil de saúde de adultos brasileiros com 50 anos ou mais, comparando suas características conforme gênero e orientação sexual. (2) Investigar a associação entre gênero, orientação sexual e acesso à saúde nessa população. MÉTODOS: Estudo de corte transversal realizado através da divulgação de um questionário online sigiloso, distribuído em diferentes plataformas digitais e estimulando o recrutamento em bola de neve (snowball sampling). Foram incluídas as respostas de todos os brasileiros com 50 anos ou mais que aceitaram participar da pesquisa após a leitura de Termo de Consentimento Livre e Esclarecido, entre agosto de 2019 e janeiro de 2020. Foi solicitado que os participantes respondessem questões detalhadas sobre suas características sociodemográficas, sobre sua saúde e experiências no sistema de saúde, e sobre sua sexualidade. O 15 desfecho primário foi acesso à saúde, avaliado através da pontuação na escala Primary Care Assessment Tool (PCATool-Brasil). Como desfecho secundário, foi caracterizada a utilização do sistema de saúde conforme o número de exames preventivos realizados pelos participantes. A variável independente primária foi definida como pertencimento ou não à comunidade de Lésbicas, Gays, Bissexuais e Transgêneros (LGBT). Foram definidos como não-LGBT participantes que se identificaram como homens ou mulheres heterossexuais cisgênero, e como LGBT aqueles que se identificaram como transgênero, gênero não-binário, travestis, homossexuais, bissexuais e pansexuais. A associação entre ser LGBT e acesso à saúde foi analisada em modelos de regressão de Poisson. RESULTADOS: Foram incluídos 6693 participantes, sendo 1332 LGBT e 5361 não-LGBT, com mediana de idade de 60 anos. Na amostra geral, 77% das respostas tiveram origem na região Sudeste e 79% tinham escolaridade com nível superior completo. Pessoas LGBT relataram uma frequência semelhante de doenças como Diabetes Mellitus (p=0,76), Hipertensão Arterial Sistêmica (p=0,2), Insuficiência Cardíaca (p=0,37) e Fragilidade (p=0,068) quando comparadas às não-LGBT. No entanto, depressão foi mais comum no grupo LGBT, atingindo 37% da amostra, contra 28% (p<0,001) no grupo nãoLGBT. A mediana de pontuação na PCATool-Brasil foi 5,68, mas com diferença significativa entre pessoas LGBT e não-LGBT (5,13 contra 5,82; p<0,001). Além disso, enquanto 31% dos participantes LGBT estavam no pior quintil de acesso à saúde nessa população, o mesmo foi verificado em apenas 18% dos não-LGBT (p<0,001). As frequências de realização de exames de rastreio para câncer de mama, câncer de cólon e câncer de colo uterino também foram menores no grupo LGBT. Por fim, após análise multivariada, foi confirmada a associação independente entre ser LGBT e ter pior acesso à saúde, com razão de prevalências de 2,5 (IC95%=2,04- 16 3,06). CONCLUSÕES: Em uma população de brasileiros com 50 anos ou mais, pessoas LGBT relataram sinais sugestivos de depressão com uma frequência maior que as não-LGBT. Além disso, ser LGBT associou-se com pior acesso à saúde, sugerindo que a elaboração de políticas públicas promovendo a inclusão dessas pessoas nos serviços de saúde seja necessária para melhorar seus cuidados durante o processo de envelhecimentoBACKGROUND: Factors such as poverty, sexual oppression, racism, and social exclusion may be associated with greater health vulnerability. It is also known that healthcare access is a central aspect of this vulnerability. Understanding the determinants of healthcare access inequities is particularly important in older adults, as they make up the population that most often needs care. However, little is known whether basic individual characteristics, such as gender and sexual orientation, interfere with healthcare access in Brazil and, consequently, confer greater vulnerability on those who age. OBJECTIVES: (1) To describe the health profile of Brazilian adults aged 50 years and over, comparing their characteristics according to gender and sexual orientation. (2) To investigate the association between gender, sexual orientation, and healthcare access in this population. METHODS: Crosssectional study carried out by disseminating a confidential online questionnaire, distributed on different digital platforms and encouraging recruitment in snowball sampling. We included responses from all eligible individuals who agreed to participate after reading the Free and Informed Consent Form, between August 2019 and January 2020. Participants were asked to answer detailed questions about their sociodemographic characteristics, their health and experiences in the health system, and their sexuality. Our primary outcome was healthcare access as measured by the Primary Care Assessment Tool scale (PCATool-Brasil). Our secondary outcome was 18 healthcare utilization as measured by the number of preventive tests performed by the participants. Our primary independent variable was defined as belonging or not to the Lesbian, Gay, Bisexual, and Transgender (LGBT) community. Heterosexual cisgender men and women were defined as Non-LGBT, and those who identified as transgender, non-binary gender, travestis, homosexuals, bisexuals, or pansexuals were defined as LGBT participants. The association between being LGBT and healthcare access was analyzed in Poisson regression models. RESULTS: We included 6693 participants, 1332 LGBT and 5361 non-LGBT, with a median age of 60. Overall, 77% of the answers came from the Brazilian Southeast, and 79% had completed higher education. LGBT participants reported a similar frequency of diseases such as Diabetes Mellitus (p=0.76), Hypertension (p=0.2), Heart Failure (p=0.37) and Frailty (p = 0.068) when compared to non-LGBT participants. However, depression was more common in the LGBT group, reaching 37% of the sample, against 28% (p<0.001) in the non-LGBT group. The median PCATool-Brasil score was 5.68, but with a significant difference between the LGBT and non-LGBT groups (5.13 versus 5.82; p<0.001). In addition, while 31% of LGBT participants were in the worst quintile of healthcare access, the same was found in only 18% of non-LGBT participants (p<0.001). The frequencies of screening tests for breast cancer, colon cancer and cervical cancer were also lower in the LGBT group. Finally, after multivariable analysis, we confirmed the independent association between being LGBT and having worse healthcare access, with a prevalence ratio of 2.5 (95% CI = 2.04-3.06). CONCLUSIONS: In a population of Brazilian adults aged 50 or over, LGBT persons reported signs suggestive of depression more frequently than non-LGBT persons. In addition, being LGBT was associated with worse healthcare access, suggesting that 19 the elaboration of public policies promoting their inclusion in health services is necessary to improve care as they ag

An approach to the peculiarities of lesbian, gay, bisexual, and transgender aging

The invisibility of lesbian, gay, bisexual, and transgender people (LGBT) aging is a reality. These individuals suffer from ageism, from various forms of discrimination, and from the assumption that all are heterosexual and cisgender. They are also at higher risk of living alone, being childless, and having no one to call in an emergency. Few studies have addressed the subject, especially in the Brazilian medical literature. Additionally, geriatricians and gerontologists may encounter challenging situations when caring for LGBT older adults who are healthy, or have dementia, or are even at the end of life. Thus, this review article aimed to investigate the aging process of the LGBT population; to reinforce appropriate terminology; and to discuss the discrimination that they face in health care services, measures for health promotion, and the specific care of the LGBT older person with dementia, at the end of life, or living in a long-term care facility.</p

Palliative care over the rainbow: perspectives of middle-age and older LGBT+ adults regarding their end-of-life

OBJECTIVE: Reports show that LGBT+ people may face several struggles during their end-of-life (EOF) preparations, reporting higher rates, for example, of harassment and fear of feeling pain during these moments. We thus aimed to investigate variables related to EOF preparations among LGBT+ people and compare them with heterosexual cisgender individuals. METHODS: This is a cross-sectional study in which Brazilians aged 50 or older were invited to answer an anonymous online survey between August 2019 and January 2020. The survey was widely distributed in neighbourhood associations, nongovernmental organizations, and social media. Those who identified as homosexual, bisexual, pansexual, non-heterosexual, transgender, travesti, or non-binary were grouped as LGBT+; cisgender and heterosexual participants were grouped as non-LGBT+. RESULTS: The questionnaire was answered by 6693 participants with a median age of 60 years. Out of all respondents, 1332 were LGBT+ (19.90%) and 5361 were non-LGBT+ (80.10%). Compared to their non-LGBT+ peers, LGBT+ people reported higher rates of loneliness (25.30% vs 16.32%, p &lt; 0.001), fear of dying alone (15.69% vs 9.79%, p &lt; 0.001) or in pain (35.21% vs 25.74%, p &lt; 0.001), and less social support (19.44% vs 13.48%, p &lt; 0.001). CONCLUSIONS: Being LGBT+ was associated with challenges and inequalities regarding EOF preparations and discussions. Sexuality and diversity should be addressed in palliative training programs to address the needs of the LGBT+ population and to provide them with a dignified death.</p

Emprego da exsangüineotransfusão em acidente loxoscélico humano, grave

Foi utilizada a exsangüineotransfusão, associada à soroterapia heteróloga específica e alcalinização urinaria, em um caso de acidente loxoscélico humano na cidade de São Paulo. A indicação da exsangüineotransfusão foi a intensa hemólise associada à gravidade e o iminente risco de morte