USE OF AMPHOTERICIN B IN THE SIMULTANEOUS TREATMENT OF CHROMOBLASTOMYCOSIS AND AMERICAN TEGUMENTARY LEISHMANIASIS: A CASE REPORT

ABSTRACT Chromoblastomycosis (CMB) is a polymorphic fungal disease that usually affects the lower limbs and manifests as verrucous nodules or plaques that may ulcerate. American Tegumentary Leishmaniasis (ATL) is an infectious parasitic disease caused by digenetic protozoa of the genus Leishmania sp. which affects the skin and/or mucous membranes of man and various species of wild and domestic animals. Both are part of the World Health Organization (WHO) neglected tropical diseases portfolio, mostly affecting economically vulnerable populations without adequate sanitation and in close contact with infectious vectors. We present the report of a 59-year-old male patient, referred to the Hospital Geral Público de Palmas (HGPP) in December 2017, carrying a positive result from a direct parasitological detection test for Leishmania sp., in addition to multiple previously biopsied lesions caused by CMB. It was observed that the patient had an important improvement of the CMB lesions with the use of amphotericin B in combination with itraconazole, thus demonstrating the role that the former can play in the therapy of this fungal disease.   Keywords: Chromoblastomycosis; American Tegumentary leishmaniasis; Amphotericin B. RESUMO A cromoblastomicose (CBM) é uma doença fúngica polimórfica, que acomete normalmente os membros inferiores e que se manifesta como nódulos ou placas verrucosas que podem ulcerar. A leishmaniose tegumentar (LT) é uma doença infectoparasitária causada por protozoários digenéticos do gênero Leishmania sp. que acomete a pele e/ou mucosas do homem e de várias espécies de animais silvestres e domésticos. Ambas fazem parte do portfólio de doenças negligenciadas da Organização Mundial da Saúde (OMS), afetando em sua maioria pessoas economicamente vulneráveis, sem saneamento adequado e em contato próximo com vetores infecciosos. Apresentamos neste trabalho o relato de um paciente, masculino, 59 anos, encaminhado ao Hospital Geral Público de Palmas (HGPP) em dezembro de 2017, portando exame parasitológico direto positivo para Leishmania sp., além de múltiplas lesões causadas por CBM previamente biopsiadas. Foi observado que o paciente teve importante melhora das lesões de CBM com uso da anfotericina B em associação ao itraconazol, demonstrando o papel que essa droga pode exercer na terapêutica desta doença fúngica. Palavras-chave: Cromoblastomicose; Leishmaniose Tegumentar; Anfotericina B

Perda auditiva associada a manifestações neurológicas do citomegalovírus congênito: relato de caso/ Hearing loss associated with neurological manifestations of congenital cytomegalovirus: case report

A infecção por citomegalovírus (CMV) é a causa mais prevalente de surdez neurossensorial congênita adquirida. A pré-existência de imunidade materna diminui, mas não elimina o risco de infecção fetal. A surdez pode aparecer de forma mais tardia, manifestando-se usualmente até por volta de 5 anos de idade, e ser acompanhada de sequelas neurológicas, acarretando prejuízo tanto auditivo quanto cognitivo. No presente artigo, relatamos um caso de uma criança de 9 anos, sexo masculino, com perda auditiva unilateral, que foi submetida a investigação clínica e resultado de provável infecção por CMV, por achados radiológicos e laboratoriais compatíveis com o quadro

Fixação congênita da platina do estribo: um relato de caso/ Congenital fixation of the stable platinum: a case report

A epidemiologia da fixação congênita do estribo é pouco conhecida. Até o momento não existem testes não invasivos capazes de confirmar o diagnóstico, sendo necessária a realização de timpanotomia exploradora. No entanto, perda condutiva não progressiva com tímpano normal, sem histórico de trauma e infecção, é altamente sugestiva de uma malformação congênita do estribo. O presente trabalho objetivou relatar caso de provável fixação congênita da platina do estribo, discutindo aspectos da investigação diagnóstica e abordagem terapêutica

Statement of Second Brazilian Congress of Mechanical Ventilarion : part I

Resumo não disponíve

Impacts of the Tropical Pacific/Indian Oceans on the Seasonal Cycle of the West African Monsoon

The current consensus is that drought has developed in the Sahel during the second half of the twentieth century as a result of remote effects of oceanic anomalies amplified by local land–atmosphere interactions. This paper focuses on the impacts of oceanic anomalies upon West African climate and specifically aims to identify those from SST anomalies in the Pacific/Indian Oceans during spring and summer seasons, when they were significant. Idealized sensitivity experiments are performed with four atmospheric general circulation models (AGCMs). The prescribed SST patterns used in the AGCMs are based on the leading mode of covariability between SST anomalies over the Pacific/Indian Oceans and summer rainfall over West Africa. The results show that such oceanic anomalies in the Pacific/Indian Ocean lead to a northward shift of an anomalous dry belt from the Gulf of Guinea to the Sahel as the season advances. In the Sahel, the magnitude of rainfall anomalies is comparable to that obtained by other authors using SST anomalies confined to the proximity of the Atlantic Ocean. The mechanism connecting the Pacific/Indian SST anomalies with West African rainfall has a strong seasonal cycle. In spring (May and June), anomalous subsidence develops over both the Maritime Continent and the equatorial Atlantic in response to the enhanced equatorial heating. Precipitation increases over continental West Africa in association with stronger zonal convergence of moisture. In addition, precipitation decreases over the Gulf of Guinea. During the monsoon peak (July and August), the SST anomalies move westward over the equatorial Pacific and the two regions where subsidence occurred earlier in the seasons merge over West Africa. The monsoon weakens and rainfall decreases over the Sahel, especially in August.Peer reviewe

Search for heavy resonances decaying to two Higgs bosons in final states containing four b quarks

A search is presented for narrow heavy resonances X decaying into pairs of Higgs bosons (H) in proton-proton collisions collected by the CMS experiment at the LHC at root s = 8 TeV. The data correspond to an integrated luminosity of 19.7 fb(-1). The search considers HH resonances with masses between 1 and 3 TeV, having final states of two b quark pairs. Each Higgs boson is produced with large momentum, and the hadronization products of the pair of b quarks can usually be reconstructed as single large jets. The background from multijet and t (t) over bar events is significantly reduced by applying requirements related to the flavor of the jet, its mass, and its substructure. The signal would be identified as a peak on top of the dijet invariant mass spectrum of the remaining background events. No evidence is observed for such a signal. Upper limits obtained at 95 confidence level for the product of the production cross section and branching fraction sigma(gg -> X) B(X -> HH -> b (b) over barb (b) over bar) range from 10 to 1.5 fb for the mass of X from 1.15 to 2.0 TeV, significantly extending previous searches. For a warped extra dimension theory with amass scale Lambda(R) = 1 TeV, the data exclude radion scalar masses between 1.15 and 1.55 TeV

Measurement of the top quark mass using charged particles in pp collisions at root s=8 TeV

Peer reviewe

COINFECÇÃO LEISHMANIOSE VISCERAL-HIV

Visceral Leishmaniasis (VL) is the systemic form of the disease caused by the flagellated protozoan of the Leishmania Donovani complex, found in the form of the three subspecies: Leishmania chagasi, Leishmania donovani and Leishmania infantum. VL is an endemic disease in 88 countries, and about 3,400 cases per year are recorded in Brazil. The clinical picture is determined by the immune response of the host, and may vary from asymptomatic, oligossymptomatic, acute to chronic form. In the coinfection of leishmaniasis with HIV, the clinical presentation, response to treatment, evolution and prognosis are directly associated with the immunological condition of the patient, assessed by means of the TCD4 + lymphocyte count. In addition to the clinical history and physical examination, the diagnosis of visceral leishmaniasis is based on laboratory, immunological and parasitological aspects, and the demonstration of the parasite with the culture of the splenic aspirate is the gold standard. When there is coinfection with HIV, as in the clinical case of this report, there is a change in the sensitivity of the diagnostic methods, which can hinder the diagnostic process and delay the initiation of appropriate treatment, being of great clinical relevance the knowledge of these changes. Key-words: Visceral Leishmaniasis; HIV; coinfection; diagnostic methods.A Leishmaniose Visceral (LV) é a forma sistêmica da doença causada pelo protozoário flagelado do complexo Leishmania donovani, encontrado na forma das três subespécies: Leishmania chagasi, Leishmania donovani e Leishmania infantum. A Leishmaniose Visceral é uma doença endêmica em 88 países, sendo registrados no Brasil cerca de 3400 casos por ano. O quadro clínico é determinado pela resposta imunológica do hospedeiro, podendo variar da forma assintomática, oligossintomática, aguda até crônica. Na coinfecção da leishmaniose com o HIV, a apresentação clínica, a resposta ao tratamento, a evolução e o prognóstico são diretamente associados à condição imunológica do paciente, avaliada por meio da contagem de linfócitos TCD4+. Além da história clínica e exame físico, o diagnóstico da Leishmaniose Visceral baseia-se em aspectos laboratoriais, imunológicos e parasitológicos, sendo a demonstração do parasita com cultura do aspirado esplênico o padrão-ouro. Quando há coinfecção com o HIV, como no caso clínico deste relato, há alteração da sensibilidade dos métodos diagnósticos, o que pode dificultar o processo diagnóstico e retardar o início do tratamento adequado, sendo de grande relevância clínica o conhecimento destas alterações. Palavras-chave: Leishmaniose Visceral; HIV; coinfecção; métodos diagnósticos

Topical application of bFGF on acid-conditioned and non-conditioned dentin: effect on cell proliferation and gene expression in cells relevant for periodontal regeneration

Abstract Periodontal regeneration is still a challenge in terms of predictability and magnitude of effect. In this study we assess the biological effects of combining chemical root conditioning and biological mediators on three relevant cell types for periodontal regeneration. Material and Methods: Bovine dentin slices were conditioned with 25% citric acid followed by topical application of basic fibroblast growth factor (bFGF, 10 and 50 ng). We used ELISA to assess the dynamics of bFGF release from the dentin surface and RT-qPCR to study the expression of Runx2, Col1a1, Bglap and fibronectin by periodontal ligament (PDL) fibroblasts, cementoblasts and bone marrow stromal cells (BMSC) grown onto these dentin slices. We also assessed the effects of topical application of bFGF on cell proliferation by quantification of genomic DNA. Results: Acid conditioning significantly increased the release of bFGF from dentin slices. Overall, bFGF application significantly (p<0.05) increased cell proliferation, except for BMSC grown on non-conditioned dentin slices. Dentin substrate discretely increased expression of Col1a1 in all cell types. Expression of Runx2, Col1a1 and Fn was either unaffected or inhibited by bFGF application in all cell types. We could not detect expression of the target genes on BMSC grown onto conditioned dentin. Conclusion: Acid conditioning of dentin improves the release of topically-applied bFGF. Topical application of bFGF had a stimulatory effect on proliferation of PDL fibroblasts, cementoblasts and BMSC, but did not affect expression of Runx2, Col1a1, Bglap and fibronectin by these cells