Haemophagocytic lymphohistiocytosis secondary to intrauterine cytomegalovirus infection

Congenital cytomegalovirus infection causes lethal diseases with neurological, visual, auditory and systemic injuries, including the hemophagocytic syndrome. Hemophagocytic lymphohistiocytosis (HLH) can be caused by primary hereditary immunological defects, as well as several infectious triggering factors, such as viruses, bacteria and fungus, among them the cytomegalovirus (CMV). Here we present the case report of a male newborn male, delivered by cesarean at term (gestation age of 39 weeks), weighing 3,250 g, with suffusion skin lesions spread throughout the body, anemia, generalized edema, hepatosplenomegaly, thrombocytopenia associated with grunts and difficulty breathing, treated with ganciclovir after receiving the diagnosis of congenital CMV infection. After a few days of hospitalization, the patient presented with high fever, persistent hepatosplenomegaly and pancytopenia, in addition to elevated ferritin and triglycerides, receiving the diagnosis of HLH treated with immunosuppressive therapy, corticosteroids and intravenous human immunoglobulin. The present case report highlights the importance for health professionals to carry out the investigation of congenital diseases, especially in developing countries, as well as their complications, such as HLH

The influence of tobacco exposure in color vision

Cigarette has about four thousand types of substances and its consumption is a risk factor for a variety of diseases, including neuro-ophthalmic disorders. This is a literature survey about the influence of smoking on color vision. Review of literature based in the Google Scholar research platforms, Scielo, Science Direct and the Bank of Dissertations and Theses of CAPES. Smoking articles, smoking, smoking and color vision and color vision in articles titles were adopted for inclusion criteria. Thus, 31 of which were sealed. In addition to cognitive changes, chronic use of tobacco can cause damage to retinal cells, impairing color vision, changes in tear protein patterns, adverse effects on the precorneal tear film and ocular surface. Metabolism is indirectly affected by means of the reduction of plasma levels of antioxidants and increasing the production of free radicals that impair eye health and blood flow in the ocular choroid. The chronic consumption of cigarettes causes changes in color vision / discrimination and such analysis alerts the harmful effects caused by the substances that compose it. In addition, psychophysical vision examination can be used as a screening test for intoxication processes that may be occurring in the subject

Avaliação visual de sujeitos expostos de forma ocupacional a solventes orgânicos através de métodos psicofísicos

Les solvants organiques sont des substances neurotoxiques que peuvent causer des effets préjudiciables dans le système visuel. Lexposition professionnelle de ces types de substances est commune parce quils sont utilisés dans une grande variété dactivités. Ces effets peuvent être quantifiés par des tests spécifiques de psychophysique. Les tests les plus utilisés dans cette évaluation sont, pour la vision des couleurs, le Lanthony Panel D-15 désaturé et le test Farnsworth-Munsell 100-Hue, et pour lévaluation de la sensibilité au contraste, le MCT 8000 Vistech, le VCTS 6500 Vistech et le FACT 101. Généralement, ces tests révèlent une réduction de discrimination des couleurs, des effets dans les axes bleu-jaune et rouge-vert, et une diminution de sensibilité au contraste, spécialement dans les basses fréquences spatiales. Il y a une corrélation positive entre les résultats psychophysiques et les marqueurs biologiques environnementaux, mais cette corrélation dépend du marqueur et du type de solvant auquel le sujet a été exposé. Des facteurs tels que lalcool et le tabac peut nuire à la corrélation des résultats.Los solventes orgánicos son sustancias neurotóxicas que pueden causar efectos dañinos en el sistema visual. La exposición ocupacional a estas sustancias es común, ya que se utilizan en una amplia variedad de actividades. Estos efectos pueden ser cuantificados por las pruebas psicofísicas específicas. Las pruebas más utilizadas para la evaluación de la visión del color son las pruebas de acuerdo, tales como el Panel de Lanthony D-15 desaturado de prueba y la prueba de Farnsworth-Munsell 100-hue, y para evaluar la sensibilidad al contraste, pruebas impresas panel como el MCT 8000 VISTECH, VCTS 6500VISTECH, y el hecho 101 pruebas. En general, estas pruebas demuestran que las pérdidas de color la discriminación en el eje azul-amarillo y rojo-verde, y una disminución de la sensibilidad al contraste, sobre todo a bajas frecuencias espaciales. Hay una correlación positiva entre los resultados de estudios biológicos y psicofísicos marcadores del medio ambiente, pero esta relación depende de la marca y del tipo de disolvente para que los individuos estén expuestos. Factores tales como el alcohol y el tabaco pueden interferir con la correlación de los resultados.Organic solvents are neurotoxic substances that can cause damaging effects in the visual system. Occupational exposure to these substances is common because they are used in a wide variety of activities. These effects can be quantified by specific psychophysical tests. The most commonly used tests for color vision assessment are arrangement tests, such as the Lanthony Panel D-15 desaturated test and the Farnsworth-Munsell 100-hue test, and for contrast sensitivity assessment, printed panel tests such as the MCT 8000 VISTECH, VCTS 6500VISTECH, and FACT 101 tests. Generally, these tests show color discrimination losses in the blue-yellow and red-green axis, and a decrease in contrast sensitivity, mainly at low spatial frequencies. There is a positive correlation between psychophysical results and biological environmental markers, but this correlation depends on the marker and on the kind of solvent to which the individuals are exposed. Factors such as alcohol and tobacco can interfere with the correlation of the results.Os solventes orgânicos são substâncias neurotóxicas que podem causar efeitos danosos sobre as funções visuais. É comum a exposição ocupacional a esses tipos de substâncias, pois elas apresentam grande aplicabilidade em inúmeras atividades. Os efeitos podem ser quantificados por testes psicofísicos. Os testes mais usados nesse tipo de avaliação são de ordenamento de matizes, como o Teste D15 Dessaturado de Lanthony e o Teste dos 100 Matizes de Farnsworth-Munsell, e avaliação de sensibilidade ao contraste espacial de luminância, como MCT 8000 Vistech, VCTS 6500 Vistech e FACT 101. Em geral esses testes descrevem perda de discriminação de cores, afetando tanto o eixo azul-amarelo quanto o eixo verde-vermelho, e diminuição da sensibilidade ao contraste de luminância principalmente para as frequências espaciais mais baixas. Existe correlação positiva entre os resultados da avaliação psicofísica e vários marcadores biológicos e ambientais, mas essa correlação depende do marcador e do tipo de solvente ao qual os indivíduos são expostos. Fatores como alcoolismo crônico e tabagismo inveterado podem interferir no processo de correlacionar esses resultados

ALTERAÇÕES NA MICROBIOTA GASTROINTESTINAL DE CRIANÇAS COM TRANSTORNO DO ESPECTRO AUTISTA: UMA REVISÃO SISTEMÁTICA

Researchs about the causes of Autistic Spectrum Disorder (ASD) has led several scientists to relate many others systems to the patient's brain, linking changes in the gastrointestinal microbiota (GIM) to typical behaviors of people with ASD, suggesting that the brain-intestine axis is an important piece in this 'puzzle'. This work aimed to investigate the microbiota gastrointestinal in children with ASD. Such research was carried out on scientific work platforms, resulting in 293 works, which, after the selection, totaled 28 works analyzed. Almost all of them showed changes in the intestinal microbiota of children with ASD, the reduction of their diversity being the main alteration of these individuals in relation to the control group. The bacterial family Lachnospiraceae, the bacterial gender Lactobacillus, Clostridium, Feacalibacterium, and Bacteroides stood out in these studies; and the fungal genus Candida. Among the symptoms, constipation was quite frequent in children with ASD and some groups of microorganisms were positively or negatively associated with changes in sleep, speech development and behavioral aspects. We conclude that there are several alterations of GIM in children with autism when compared to children with typical neurodevelopment, being also affected by anatomical and metabolic issues as causes or consequences of ASD. There is a need for further studies, especially in the Brazilian population, and more specifically in the states, in view of the great heterogeneity of our people and their culture, the great dietary variations of the last decades, as well as the increase in gene flow among world populations.Investigaciones sobre las causas del TRANSTORNO DEL ESPECTRO AUTISTA (TEA) ha llevado a varios científicos a relacionar otros sistemas del cerebro del paciente, asociando alteraciones en el microbiota gastrointestinal (MGI) a comportamientos típicos de personas con TEA, sugiriendo que el eje cerebro-intestino sea una importante pieza en este rompe cabeza. Este trabajo tiene por objetivo averiguar a microbiota gastrointestinal en niños con TEA. Tal investigación fue realizada en plataformas de trabajos científicos, resultando en 293 que después de la selección, sumaron 28 trabajos analizados. Casi todos evidenciaron modificaciones en la microbiota intestinal de los niños con TEA, siendo la reducción la diversidad de esta la principal alteración de estos individuos en relación al grupo control. Destacándose en estos estudios la familia bacteriana Lactobacillus, Clostridium, Feacalibacterium, y bacteroides, y el género Fúngico Candida. Entre los síntomas, la constipación fue bastante frecuente en los niños con TEA y algunos grupos de microorganismos fueron asociados positiva o negativamente a alteraciones de sueño, en el desenvolvimiento del lenguaje y en los aspectos de comportamiento. Concluimos que hay varias alteraciones de MGI en los niños con autismo cuando lo comparamos en niños con el neurodesenvolvimiento típico, siendo también afectada por cuestiones anatómicas y metabólicas como causas o consecuencias del TEA. Hay necesidad de nuevos estudios, especialmente en la populación peruana, y más específicamente en provincias teniendo en cuenta la grande heterogeneidad de nuestro pueblo y de su cultura, las grandes variaciones alimenticias de las últimas décadas, como el aumento de flujo genético entre las poblaciones mundiales.Pesquisas sobre as causas do Transtorno do Espectro Autista (TEA) têm levado vários cientistas a relacionar diversos outros sistemas ao cérebro do paciente, associando alterações na microbiota gastrointestinal (MGI) a comportamentos típicos de pessoas com TEA, sugerindo que o eixo cérebro-intestino seja uma importante peça neste ‘quebra-cabeças’. Este trabalho teve por objetivo averiguar a microbiota gastrointestinal em crianças com TEA. Tal pesquisa foi realizada em plataformas de trabalhos científicos, resultando em 293 trabalhos, que, após a seleção, somaram 28 trabalhos analisados. Quase todos evidenciaram modificações na microbiota intestinal das crianças com TEA, sendo a redução da diversidade desta a principal alteração destes indivíduos em relação ao grupo controle. Destacaram-se nestes estudos a família bacteriana Lachnospiraceae, os gêneros bacterianos Lactobacillus, Clostridium, Feacalibacterium e Bacteroides; e o gênero fúngico Candida. Dentre os sintomas, a constipação foi bastante frequente nas crianças com TEA e alguns grupos de microrganismos foram associados positiva ou negativamente a alterações no sono, no desenvolvimento da fala e nos aspectos comportamentais. Concluímos que há várias alterações da MGI nas crianças com autismo quando comparado a crianças com o neurodesenvolvimento típico, sendo também afetada por questões anatômicas e metabólicas como causas ou consequências do TEA. Há necessidade de novos estudos, especialmente na população brasileira, e mais especificamente nos estados, tendo em vista a grande heterogeneidade do nosso povo e de sua cultura, as grandes variações alimentares das últimas décadas, bem como o aumento do fluxo gênico entre as populações mundiais

Effects of environmental exposure to tobacco on modulation of color vision

The chronic use of cigarettes causes toxic and oxidative effects on the visual system, which can cause changes in color vision. Although there are studies on the harmful effects of tobacco in active smokers, the literature on secondhand/passive smokers (or environmental tobacco smoke) is still scarce. Therefore, the aim of this study was to investigate the ability of color vision in active and passive smokers. This is a cross-sectional observational study in which 103 individuals were divided pseudorandomly into 3 groups: control group (CG) n = 44 individuals (72 eyes), with a mean age of 28.65 ± 7.90; group of passive smokers (GPS) n = 28 (56 eyes), mean age 28.74 ± 9.42; group of active smokers (GAS) n = 31 (60 eyes), mean age 34.91 ± 11.30. The psychophysical evaluation of color vision was performed using the Ishihara pseudoisochromatic plates, the computer program of the Freiburg Visual Acuity & Contrast Test, version 3.7, and the desaturated Lanthony D15 ordering test. The results indicate that there was no correlation in GAS and GPS with age, time of exposure to tobacco and daily consumption. It was observed that both GAS and GPS showed changes in visual acuity (P <0.05), and only GPS showed changes in color vision (P <0.05); GFP showed a deficit in visual acuity and worse color vision when compared to GAS (P <0.05). These results are discussed in relation to the biochemical and pathophysiological effects that exposure to cigarettes may have on the visual system, which would explain the functional changes observed. We conclude that passive and active smokers have impaired color vision and that the psychophysical methods used in this study are effective for the subclinical tracking of changes in color vision

Psychophysical Evaluation of Achromatic and Chromatic Vision of Workers Chronically Exposed to Organic Solvents

The purpose of this paper was to evaluate achromatic and chromatic vision of workers chronically exposed to organic solvents through psychophysical methods. Thirty-one gas station workers (31.5 ± 8.4 years old) were evaluated. Psychophysical tests were achromatic tests (Snellen chart, spatial and temporal contrast sensitivity, and visual perimetry) and chromatic tests (Ishihara's test, color discrimination ellipses, and Farnsworth-Munsell 100 hue test—FM100). Spatial contrast sensitivities of exposed workers were lower than the control at spatial frequencies of 20 and 30 cpd whilst the temporal contrast sensitivity was preserved. Visual field losses were found in 10–30 degrees of eccentricity in the solvent exposed workers. The exposed workers group had higher error values of FM100 and wider color discrimination ellipses area compared to the controls. Workers occupationally exposed to organic solvents had abnormal visual functions, mainly color vision losses and visual field constriction

Deaths by COVID-19 in a hospital from a city from Legal Amazon region: what lessons could be learned?

Objetivo: Descrever a epidemiologia de mortes por COVID-19 em um hospital na região da Amazônia em um período de 64 dias, que corresponde à curva de crescimento da primeira onda da pandemia de COVID-19 em 2020. Métodos: Os dados foram obtidos de 152 óbitos registrados em prontuários de adultos e idosos hospitalizados. Os dados foram também comparados com o número de óbitos em anos anteriores, no mesmo período estudado, de forma a avaliar o impacto da pandemia neste hospital. O estudo também avalia o impacto das transferências intra-hospitalares, contabilizando o número de vezes que os pacientes que faleceram realizaram transferências entre setores do hospital. Resultados: No período analisado, houve aumento de óbitos em relação aos anos anteriores. A maioria dos pacientes mortos era do sexo masculino, com idade entre 34 e 96 anos. Os óbitos foram associados a comorbidades como hipertensão arterial, diabetes mellitus e doença renal. A infecção por SARS-CoV-2 foi confirmada em 91 casos. Entre eles, 15 indivíduos foram internados sem condições relacionadas à infecção por SARS-CoV-2; eles tiveram um número três vezes maior de transferências hospitalares do que aqueles admitidos com sintomas de infecção por SARS-CoV-2. Dezesseis pacientes com infecção por SARS-CoV-2 desenvolveram sintomas respiratórios logo após a hospitalização. O exame diagnóstico para infecção por SARS-CoV-2 foi realizado em média 4 (± 6) dias após o início dos sintomas e 6 (± 6) dias após a admissão, e o tempo médio do início dos sintomas respiratórios até o óbito foi de 4 ( ± 6) dias. Conclusões: Esses dados sugerem alta presença de infecção hospitalar por SARS-CoV-2 na região amazônica brasileira, o que pode estar relacionado ao número de transferências setoriais, demora na confirmação do diagnóstico e falta de manejo. Relatamos um grave problema de saúde pública, pois demonstra a fragilidade das instituições de saúde no ambiente hospitalar.Objectives: Describe the epidemiology of COVID-19 deaths within a hospital in the Amazon region in a period of 64 days, which corresponds to the growth curve of the COVID-19 first-wave pandemic in 2020. Methods: The data were obtained from medical records of 152 deaths registered for adults and elderly hospitalized. The data were also compared with the number of deaths in previous years during the same period studied to assess the impact of the pandemic on this hospital. The study also assesses the impact of intra-hospital transfers, accounting for the number of times patients who died performed transfers between sectors of the hospital. Results: During the period analyzed, there was an increase in deaths compared to the previous years. The majority of dead patients were male, aged between 34 and 96 years. The deaths were associated comorbidities such as arterial hypertension, diabetes mellitus, and kidney disease. The SARS-CoV-2 infection was confirmed in 91 cases. Among them, 15 individuals were admitted without conditions related to SARS-CoV-2 infection; they had a three-fold higher number of hospital transfers than those admitted with SARS-CoV-2 infection symptoms. Sixteen patients with SARS-CoV-2 infection developed respiratory symptoms just after hospitalization. The diagnostic exam for SARS-CoV-2 infection was performed on average 4 (± 6) days after the onset of symptoms and 6 (± 6) days after admission, and the average time from the onset of respiratory symptoms to death was 4 (± 6) days. Conclusions: These data suggest the high presence of hospital infection by SARS-CoV-2 in the Brazilian Amazon region, which may be related to the number of sectorial transfers, delay in confirming the diagnosis, and lack of management. We report a serious public health problem, as it demonstrates the fragility of healthcare institutions in the hospital environment

Psychophysical Evaluation of Visual Functions of Ex-Alcoholic Subjects After Prolonged Abstinence

Chronic alcohol abuse can lead to a brain damages, and the health status of alcoholics even after a long-term alcohol abstinence is a public health concern. The present study investigated the color vision and spatial luminance contrast sensitivity of a group of 17 ex-alcoholics (46.3 ± 6.7 years old) in long-term alcohol abstinence after having been previously under alcohol dependence for many years. We also investigated the association of impaired psychophysical performance in different tests we applied. The mean time of alcohol consumption was 16.9 ± 5.1 years and the mean abstinence period was 12.4 ± 8.5 years. Achromatic vision of all subjects was evaluated using spatial luminance contrast sensitivity function (CSF) test and color vision was evaluated using Mollon–Reffin color discrimination test (MR) and the Farnsworth–Munsell 100 hue arrangement test (FM100). Relative to controls, the spatial luminance contrast sensitivity was lower in 10/17 of the ex-alcoholic subjects. In the color vision tests, 11/16 ex-alcoholic subjects had impaired results compared to controls in the FM100 test and 13/14 subjects had color vision deficits measured in the MR test. Fourteen subjects performed all visual tests, three subjects had impaired results for all tests, seven subjects had impaired results in two tests, three subjects had visual deficit in one test, and one had normal results for all tests. The results showed the existence of functional deficits in achromatic and chromatic vision of subjects with history of chronic alcoholism after long abstinence. Most subjects had altered result in more than one test, especially in the color vision tests. The present investigation suggests that the damage in visual functions produced by abusive alcohol consumption is not reversed after long term alcohol abstinence

Investigação de danos visuais em pacientes diagnosticados com meningite criptocócica não associada à imunossupressão

Cryptococcal meningitis is a severe infectious disease caused by Cryptococcus spp., which has high lethality and causes sensorial sequels. The most important sequels are visual impairments. The aim of this study was to describe the visual losses suffered by patients without immunosupression history, diagnosed with cryptococcal meningitis in order to indicate a possible mechanism and risk factors for the visual sequels. The work was composed by a case series study with cryptococcal meningitis without immunosupression history (n =7 patients, 14 = eyes) and an epidemiological study of all the cases of cryptococcal meningitis without immunosupression history notified during 14 years in the reference hospital of Para State (n = 113 cases). In the case series study, the visual functions of a sample of patients were studied by ophthalmological, psychophysical, and electrophysiological evaluation. The epidemiological study analyzed the medical records data focusing on visual impairment. It was observed that the studied patients in the case series study had visual acuity impairment. Even in patients without clinical complaints, color discrimination, luminance contrast sensitivity, and visual field were impaired. The results indicated central retina commitment as the principal responsible for a cascade of alterations that prevented the normal upstream image processing, at the visual cortex level. It is suggested that the observed visual dysfunction was due not only to optic nerve damage. The principal risk factors for the visual alterations observed in the epidemiological study were disease time before the beginning of the treatment and patient immunological response.CNPq - Conselho Nacional de Desenvolvimento Científico e TecnológicoFAPESPA - Fundação Amazônia de Amparo a Estudos e PesquisasCAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível SuperiorFINEP - Financiadora de Estudos e ProjetosA meningite criptocócica é uma severa doença infecciosa causada pelo Cryptococcus spp. que apresenta alta letalidade e deixa nos sobreviventes uma série de sequelas sensoriais, entre as quais estão as alterações visuais. O objetivo deste estudo foi descrever as perdas visuais sofridas por pacientes, sem história de imunossupressão, diagnosticados com meningite criptocócica, de forma a indicar um possível mecanismo e fatores de risco para essas sequelas visuais. O trabalho foi composto de um estudo de série de casos de pacientes com meningite criptocócica sem história de imunossupressão (n = 7 pacientes, n = 14 olhos) e um estudo transversal analítico de todos os casos de meningite criptocócica sem história de imunossupressão notificados em 14 anos num hospital de referência do Pará (n = 113 casos). No estudo de série de casos, as funções visuais de uma amostra de pacientes foi cuidadosamente analisada por meio de avaliação oftalmológica, testes psicofísicos e eletrofisiológicos. No estudo transversal analítico, foi realizada análise de dados de prontuário com enfoque nas alterações visuais. Observou-se que os pacientes estudados na série de casos apresentaram grave diminuição da acuidade visual e mesmo em pacientes sem queixa visual houve alteração na percepção de cor, na percepção de contraste de luminância em diferentes frequências espaciais e no campo visual. Os testes indicam comprometimento da retina central como principal desencadeadora de uma cascata de alterações que impedem o normal processamento da imagem no córtex visual. Sugere-se que lesões do nervo óptico não foram as únicas responsáveis pelas alterações visuais observadas. Os principais fatores de risco para as alterações visuais observados pelo estudo transversal analítico foram o tempo de doença antes do início do tratamento e a resposta imunológica do paciente

Avaliação visual de sujeitos expostos de forma ocupacional a solventes orgânicos através de métodos psicofísicos

Os solventes orgânicos são substâncias neurotóxicas que podem causar efeitos danosos sobre as funções visuais. É comum a exposição ocupacional a esses tipos de substâncias, pois elas apresentam grande aplicabilidade em inúmeras atividades. Os efeitos podem ser quantificados por testes psicofísicos. Os testes mais usados nesse tipo de avaliação são de ordenamento de matizes, como o Teste D15 Dessaturado de Lanthony e o Teste dos 100 Matizes de Farnsworth-Munsell, e avaliação de sensibilidade ao contraste espacial de luminância, como MCT 8000 Vistech, VCTS 6500 Vistech e FACT 101. Em geral esses testes descrevem perda de discriminação de cores, afetando tanto o eixo azul-amarelo quanto o eixo verde-vermelho, e diminuição da sensibilidade ao contraste de luminância principalmente para as frequências espaciais mais baixas. Existe correlação positiva entre os resultados da avaliação psicofísica e vários marcadores biológicos e ambientais, mas essa correlação depende do marcador e do tipo de solvente ao qual os indivíduos são expostos. Fatores como alcoolismo crônico e tabagismo inveterado podem interferir no processo de correlacionar esses resultados