Hanseníase no curso de Terapia Imunobiológica na Artrite Reumatoide: Relato de Caso Leprosy in the course of immunobiological therapy in patients with rheumatoid arthritis: Case Report

Objetivo: Relatar um caso de hanseníase no curso de terapia imunobiológica em paciente com artrite reumatoide. Relato do caso: Paciente do sexo feminino, 59 anos, portadora de artrite reumatóide, em uso de etanercepte, apresentando erupção cutânea eritematosa disseminada, associada a nodulações em MMSS e MMII. Exame físico: Placas eritemato-infiltrativas em face, nódulos e placas eritematosas nos MMII e cotovelos. Biópsia de pele: infiltrado linfoplasmocitário perivascular e perineural com formação de granuloma. Conclui-se por Hanseníase, iniciado corticoterapia e terapia antimicrobiana, com melhora do quadro cutâneo. Comentários: O uso de anti-TNF exige cautela com outras infecções por micobactérias, além da tuberculose. Deve-se estar atento a manifestações potencialmente associadas à hanseníase

Discrete cutaneous lesions in a critically ill patient treated only for AIDS and miliary tuberculosis: a case report of disseminated histoplasmosis

Histoplasmosis is a systemic mycosis caused by the dimorphic fungus Histoplasma capsulatum, with disseminated histoplasmosis (HD) being one of its clinical forms. As a consequence of the HIV-AIDS pandemic, HD has become prevalent not only in regions that are recognized as endemic but also in areas not considered endemic, such as Europe and Asia. Its clinical manifestations are varied and mimic several infectious diseases, mainly tuberculosis. In endemic areas, it is the first manifestation of AIDS in 50 to 70% of patients. The diagnosis of histoplasmosis is difficult and HD can lead to death if not diagnosed early and if proper treatment is not instituted. The present report presents a patient with a recent diagnosis of HIV-AIDS, in treatment for miliary tuberculosis, who was diagnosed with disseminated histoplasmosis because of his dermatological manifestations

Case Report Herpetic Esophagitis in Immunocompetent Medical Student

Esophagitis caused by herpes simplex virus (HSV) is often documented during periods of immunosuppression in patients infected with human immunodeficiency virus (HIV); it is rare in immunocompetent diagnosed patients. Case reports of herpetic esophagitis in students of health sciences are extremely rare. The disease presents with a clinical picture characterized by acute odynophagia and retrosternal pain without obvious causes and ulcers, evidenced endoscopically in the middistal esophagus. Diagnosis depends on endoscopy, biopsies for pathology studies, and immunohistochemistry techniques. The disease course is often benign; however, treatment with acyclovir speeds the disappearance of symptoms and limits the severity of infection. In this report, we present a case of herpetic esophagitis in an immunocompetent medical student, with reference to its clinical features, diagnosis, and treatment. The disease may have manifested as a result of emotional stress experienced by the patient

Síndrome de superposição e associação de paniculite e amiloidose – Relato de Caso - Overlap syndrome and association of panniculitis and amyloidosis - case report

ResumoObjetivo: Descrever um caso clínico de uma mulher de 46 anos, com superposição de esclerose sistêmica e artrite reumatoide, que desenvolve paniculite septal e amiloidose. Relato do caso: Paciente do gênero feminino, 46 anos, com diagnóstico de síndrome de superposição (esclerose sistêmica e artrite reumatóide) há oito anos, evolui com dor e aumento de volume das pernas. Aventada a hipótese de paniculite, a paciente foi medicada com anti-inflamatórios, não obtendo melhora. Submetida à biópsia de pele da perna direita, o quadro histopatológico foi compatível com amiloidose e discreta paniculite septal.  Considerações finais: A presença de paniculite, de difícil resposta ao tratamento antiinflamatório, deve suscitar a pesquisa de doenças infiltrativas, tais como a amiloidose. A presença de depósito amiloide na derme implica na investigação de doença sistêmica.Palavras-chave:Esclerose sistêmica. Artrite reumatoide. Paniculite. Amiloidose.AbstractObjective: To describe a clinical case of a 46-year-old woman, with overlap of systemic sclerosis and rheumatoid arthritis who develop panniculitis septal and amyloidosis. Case report: A 46-year-old female patient with a diagnosis of overlap syndrome (systemic sclerosis and rheumatoid arthritis) eight years ago evolves with pain and enlargement of the legs . After the hypothesis of panniculitis, the patient was medicated with antiinflammatory drugs and did not obtain improvement. Subjected to skin biopsy of the right leg, histopathological findings were compatible with amyloidosis and discrete panniculitis septal. Final considerations: The presence of panniculitis, which is difficult to respond to antiinflammatory treatment, should lead to the investigation of infiltrative diseases, such as amyloidosis. The presence of amyloid deposits in the dermis implies the investigation of systemic disease.Keyword:Systemic sclerosis. Rheumatoid arthritis. Panniculitis. Amyloidosis

Em movimento:: relato de uma experiência coletiva de resistência à violência no Ceará

This article proposes to share the history of the Movement Every Life Matters: The University in Preventing and Coping with Violence in Ceará (Movimento Cada Vida Importa: A Universidade na Prevenção e no Enfrentamento da Violência no Ceará – MCVI) in its first year of activities. Initially, the emergence conditions and the primary principles of the MCVI are addressed. Next, the scenario of violence in the State of Ceará is contextualized in 2018, with critical data and questions about its new manifestations – such as the vertiginous increase in the number of girl homicides. The auscultation of contexts and the listening to various social players have been constantly considered in the actions of this group and they are exposed through axial dimensions: a) awareness-raising; b) mobilization; c) education; d) articulation; and e) incidence. In the end, this study presents some challenges for the MCVI in 2019, by considering the political scenario changes and the state’s public security crisis in January. It is noticed that the MCVI recognizes the need to obtain greater capillarity in Higher Education institutions (HEIs), both in terms of its expansion to a greater number of teaching units and fields of knowledge and the inclusion of other social players from HEIs – like technical-administrative civil servants and support workers. This is the MCVI on the move.Este artículo se propone socializar la historia del Movimiento Cada Vida Importa: La Universidad en la Prevención y en el Enfrentamiento de la Violencia en Ceará (Movimento Cada Vida Importa: A Universidade na Prevenção e no Enfrentamento da Violência no Ceará – MCVI) en su primer año de actividades. Inicialmente, se abordan las condiciones de surgimiento y los principios básicos del MCVI. En seguida, se contextualiza el escenario de violencia en el Estado de Ceará en 2018, con datos críticos e interrogaciones sobre sus nuevas manifestaciones – como el aumento vertiginoso de homicidios de niñas. La auscultación de contextos y la escucha de diversificados actores sociales vienen siendo consideradas constantemente en las acciones de este colectivo y se exponen a partir de dimensiones axiales: a) sensibilización; b) movilización; c) formación; d) articulación; y e) incidencia. Al final, este estudio presenta algunos desafíos planteados para el MCVI en 2019, considerando los cambios del escenario político y la crisis de la seguridad pública del estado en el mes de enero. Se constata que el MCVI reconoce la necesidad de obtener mayor capilaridad en las instituciones de Enseñanza Superior (IES), tanto en términos de su ampliación a un número mayor de unidades de enseñanza y de campos del saber cómo de la inclusión de otros actores sociales de las IES – como los servidores técnico-administrativos y los trabajadores de apoyo. Esto es el MCVI en movimiento.Este artigo se propõe a socializar a história do Movimento Cada Vida Importa: A Universidade na Prevenção e no Enfrentamento da Violência no Ceará (MCVI) em seu primeiro ano de atividades. Inicialmente, abordam-se as condições de surgimento e os princípios básicos do MCVI. Em seguida, contextualiza-se o cenário de violência no Estado do Ceará em 2018, com dados críticos e interrogações sobre suas novas manifestações – como o aumento vertiginoso de homicídios de meninas. A ausculta de contextos e a escuta de diversificados atores sociais vêm sendo consideradas constantemente nas ações desse coletivo e são expostas a partir de dimensões axiais: a) sensibilização; b) mobilização; c) formação; d) articulação; e e) incidência. Ao final, este estudo apresenta alguns desafios postos para o MCVI em 2019, considerando as mudanças do cenário político e a crise da segurança pública do estado no mês de janeiro. Constata-se que o MCVI reconhece a necessidade de obter maior capilaridade nas instituições de Ensino Superior (IES), tanto em termos de sua ampliação para um número maior de unidades de ensino e campos do saber quanto da inclusão de outros atores sociais das IES – como os servidores técnico-administrativos e os trabalhadores de apoio. É o MCVI em movimento

Microcephaly in Pernambuco State, Brazil: epidemiological characteristics and evaluation of the diagnostic accuracy of cutoff points for reporting suspected cases.

The increase in the number of reported cases of microcephaly in Pernambuco State, and Northeast Brazil, characterized an epidemic that led the Brazilian Ministry of Health to declare a national public health emergency. The Brazilian Ministry of Health initially defined suspected cases as newborns with gestational age (GA) ≥ 37 weeks and head circumference (HC) ≤ 33cm, but in December 2015 this cutoff was lowered to 32cm. The current study aimed to estimate the accuracy, sensitivity, and specificity of different cutoff points for HC, using ROC curves, with the Fenton and Intergrowth (2014) curves as the gold standard. The study described cases reported in Pernambuco from August 8 to November 28, 2015, according to sex and GA categories. The Fenton and Intergrowth methods provide HC growth curves according to GA and sex, and microcephaly is defined as a newborn with HC below the 3rd percentile in these distributions. Of the 684 reported cases, 599 were term or post-term neonates. For these, the analyses with ROC curves show that according to the Fenton criterion the cutoff point with the largest area under the ROC curve, with sensitivity greater than specificity, is 32cm for both sexes. Using the Intergrowth method and following the same criteria, the cutoff points are 32cm and 31.5cm for males and females, respectively. The cutoff point identified by the Fenton method (32cm) coincided with the Brazilian Ministry of Health recommendation. Adopting Intergrowth as the standard, the choice would be 32cm for males and 31.5cm for females. The study identified the need to conduct critical and on-going analyses to evaluate cutoff points, including other characteristics for microcephaly case definition

Benefícios do cuidado fisioterapêutico em idosos com demência de Alzheimer: uma revisão integrativa / Benefits of physiotherapeutic care in elderly with Alzheimer's dementia: an integrative review

Introdução: A Demência de Alzheimer é uma doença neurodegenerativa, progressiva, de origem idiopática, que provoca alterações cognitivas e, posteriormente, compromete a realização das atividades básicas de vida diária. A intervenção fisioterapêutica atuará conforme a necessidade de cada paciente, conservando o paciente mais ativo e independente de acordo com as suas possibilidades. Objetivo: Diante do exposto, o presente trabalho teve como objetivo analisar os benefícios do cuidado fisioterapêutico direcionado a idosos com Demência de Alzheimer apresentados pelas produções científicas atuais. Metodologia: Trata-se, portanto, de um estudo de revisão bibliográfica de abordagem integrativa. As buscas foram realizadas nas bases de dados SCIELO e LILACS. Resultados: Foram selecionados 10 artigos para análise e discussão dos resultados. Essa revisão permitiu identificar que com a realização da fisioterapia é possível conseguir melhora na locomoção e redução dos distúrbios neuropsiquiátricos na fase inicial da demência, melhora da ADM, força muscular, equilíbrio e prevenção do declínio da mobilidade na fase intermediária e prevenção de úlceras de decúbito na fase final. Conclusão: A atualização do conhecimento de profissionais da área de saúde, cuidadores e familiares, promove a construção de linhas de cuidado aos idosos com Demência de Alzheimer, de forma a controlar os agravos associados e possibilitar um envelhecimento digno e com qualidade

ELABORAÇÃO DE SORVETES FUNCIONAIS ADICIONADOS DE FRUTA EXÓTICA

Atualmente, os consumidores têm mostrado grande preocupação em adquirir produtos mais nutritivos e saudáveis, com sabores diferenciados e, acima de tudo, seguro para o consumo. Isso é uma tendência de mercado e, sendo o sorvete muito apreciado no Brasil, o objetivo deste estudo foi desenvolver e otimizar sorvetes funcionais adicionados de kinkan. Para este efeito, foram usadas três fibras dietéticas (amido modificado, polidextrose e inulina) isoladas e em diferentes combinações, a fim de se obter um produto rico em fibras e em compostos bioativos. Verificou-se que o kinkan tem boas propriedades físico-químicas, tanto em sua forma in natura e quanto processado, além de possuir elevados teores de antioxidantes. Estas características fazem com que o kinkan seja uma boa escolha para ser adicionado aos sorvetes rico em fibras. O sorvete funcional adicionado com kinkan demonstrou boa aceitabilidade, alta atividade antioxidante e alto teor de compostos fenólicos, o que o torna uma alternativa saudável e interessante para o mercado de alimentos funcionais. No que diz respeito as fibras utilizadas, pode-se concluir que, para uma melhor aceitabilidade do consumidor, deve ser adicionado inulina (0,25% a 0,75%) e polidextrose (0,25% a 0,75%) na formulação dos sorvete

Association between Zika virus infection and microcephaly in Brazil, January to May, 2016: preliminary report of a case-control study.

BACKGROUND: The microcephaly epidemic, which started in Brazil in 2015, was declared a Public Health Emergency of International Concern by WHO in 2016. We report the preliminary results of a case-control study investigating the association between microcephaly and Zika virus infection during pregnancy. METHODS: We did this case-control study in eight public hospitals in Recife, Brazil. Cases were neonates with microcephaly. Two controls (neonates without microcephaly), matched by expected date of delivery and area of residence, were selected for each case. Serum samples of cases and controls and cerebrospinal fluid samples of cases were tested for Zika virus-specific IgM and by quantitative RT-PCR. Laboratory-confirmed Zika virus infection during pregnancy was defined as detection of Zika virus-specific IgM or a positive RT-PCR result in neonates. Maternal serum samples were tested by plaque reduction neutralisation assay for Zika virus and dengue virus. We estimated crude odds ratios (ORs) and 95% CIs using a median unbiased estimator for binary data in an unconditional logistic regression model. We estimated ORs separately for cases with and without radiological evidence of brain abnormalities. FINDINGS: Between Jan 15, 2016, and May 2, 2016, we prospectively recruited 32 cases and 62 controls. 24 (80%) of 30 mothers of cases had Zika virus infection compared with 39 (64%) of 61 mothers of controls (p=0·12). 13 (41%) of 32 cases and none of 62 controls had laboratory-confirmed Zika virus infection; crude overall OR 55·5 (95% CI 8·6-∞); OR 113·3 (95% CI 14·5-∞) for seven cases with brain abnormalities; and OR 24·7 (95% CI 2·9-∞) for four cases without brain abnormalities. INTERPRETATION: Our data suggest that the microcephaly epidemic is a result of congenital Zika virus infection. We await further data from this ongoing study to assess other potential risk factors and to confirm the strength of association in a larger sample size. FUNDING: Brazilian Ministry of Health, Pan American Health Organization, and Enhancing Research Activity in Epidemic Situations

Microcephaly epidemic related to the Zika virus and living conditions in Recife, Northeast Brazil.

BACKGROUND: Starting in August 2015, there was an increase in the number of cases of neonatal microcephaly in Northeast Brazil. These findings were identified as being an epidemic of microcephaly related to Zika virus (ZIKV) infection. The present study aims to analyse the spatial distribution of microcephaly cases in Recife (2015-2016), which is in Northeast Brazil, and its association with the living conditions in this city. METHODS: This was an ecological study that used data from reported cases of microcephaly from the State Health Department of Pernambuco (August 2015 to July 2016). The basic spatial unit of analysis was the 94 districts of Recife. The case definition of microcephaly was: neonates with a head circumference of less than the cut-off point of -2 standard deviations below the mean value from the established Fenton growth curve. As an indicator of the living conditions of the 94 districts, the percentage of heads of households with an income of less than twice the minimum wage was calculated. The districts were classified into four homogeneous strata using the K-means clustering algorithm. We plotted the locations of each microcephaly case over a layer of living conditions. RESULTS: During the study period, 347 microcephaly cases were reported, of which 142 (40.9%) fulfilled the definition of a microcephaly case. Stratification of the 94 districts resulted in the identification of four strata. The highest stratum in relation to the living conditions presented the lowest prevalence rate of microcephaly, and the overall difference between this rate and the rates of the other strata was statistically significant. The results of the Kruskal-Wallis test demonstrated that there was a strong association between a higher prevalence of microcephaly and poor living conditions. After the first 6 months of the study period, there were no microcephaly cases recorded within the population living in the richest socio-economic strata. CONCLUSION: This study showed that those residing in areas with precarious living conditions had a higher prevalence of microcephaly compared with populations with better living conditions