Hipertireoidismo Congenital

Relata-se necropsia de natimorto com hipertireoidismo congênito, filho de mãe portadora de doença de Graves não tratada, que teve como causa de óbito insuficiência cardíaca congestiva. Os achados fundamentais foram vistos no crânio, tireóide coração e placenta. As suturas cranianas encontravam-se fechadas, com acavalgamento dos ossos cranianos. A tireóide apresentava aumento de volume e congestão sangüinea intensa e, histologicamente, os folículos mostravam hiperatividade. O coração estava aumentado de volume, amolecido, com cavidades dilatadas e sufusões hemorrágicas no epicárdio. A placenta apresentava infartos que acometiam menos de 20% da superfície placentária e os vasos do cordão umbilical encontravam-se completamente expostos por diminuição da geléia de Warton. O hipertireoidismo ficou comprovado pelos dados clínicos maternos, os achados fetais de exoftalmia, craniosinostose prematura e bócio com sinais de hiperatividade folicular. A craniosinostose é causada pela ação anabólica dos hormônios tireoidianos na formação óssea, nos estágios iniciais do desenvolvimento. O início tardio do tratamento no presente caso contribuiu para severidade do hipertireoidismo fetal e óbito.We report the autopsy of a stillborn fetus with congenital hyperthyroidism born to a mother with untreated Graves' disease, whose cause of death was congestive heart failure. The major findings concerned the skull, thyroid, heart, and placenta. The cranial sutures were closed, with overlapping skull bones. The thyroid was increased in volume and had intense blood congestion. Histological examination showed hyperactive follicles. The heart was enlarged and softened, with dilated cavities and hemorrhagic suffusions in the epicardium. The placenta had infarctions that involved at least 20% of its surface, and the vessels of the umbilical cord were fully exposed due to a decrease in Wharton 's jelly. Hyperthyroidism was confirmed by the maternal clinical data, the fetal findings of exophthalmia, craniosynostosis, and goiter with signs of follicular hyperactivity. Craniosynostosis is caused by the anabolic action of thyroid hormones in bone formation during the initial stages of development. The delayed initiation of treatment in the present case contributed to the severity of fetal hyperthyroidism and consequent fetal death

Clinicopathological aspects and proviral load of adulthood infective dermatitis associated with HTLV-1: Comparison between juvenile and adulthood forms

Background Infective dermatitis associated with human T-cell lymphotropic virus type-1 (HTLV-1), (IDH), is a chronic eczema occurring in HTLV-1 infected children. Rare cases of adulthood IDH have been reported and no study until now aimed to compare juvenile and adulthood IDH. Methodology/Principal findings Twelve cases of adulthood IDH followed for a mean time of 7.5 years were analyzed according to clinicopathological and molecular aspects, comparing them to juvenile IDH cases. Diagnosis was based on the modified major criteria used for juvenile IDH. Proviral load (PVL) assessment was performed by real-time PCR technique. Adulthood IDH presented similar clinicopathological and molecular aspects compared to juvenile IDH. The morphology of lesions and areas of involvement were similar, except for the involvement of the ankles and inframammary folds in the adulthood form. HTLV-1 associated myelopathy/tropical spastic paraparesis (HAM/TSP) occurred in six adulthood IDH patients, with almost equal frequency. However, at least in two patients, HAM/TSP appeared prior to IDH, differently from what was observed in juvenile IDH. Conclusions/Significance Adulthood IDH is similar to juvenile IDH according to clinicopathological aspects and PVL levels. Therefore, the same modified major diagnostic criteria for juvenile IDH can be applied to both forms.This work was supported by the Conselho Nacional de Desenvolvimento Cientı´fico e Tecnolo´gico (http://www.cnpq.br/), grant number 409985/2016-3, received by AL and by the Fundac¸ão de Amparo a Pesquisa do Estado da Bahia (http://www.fapesb.ba.gov.br), grant number 4345/2012. This project has also received funding from the European Union’s Horizon 2020 research and innovation programme under the Marie Sklodowska Marie Curie grant agreement num 799850 (LF). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

The linkage between psoriasis and non-alcoholic fatty liver disease: a literature review

Psoriasis is a chronic systemic inflammatory disease mainly affecting the skin. Population-based surveys have shown a higher prevalence of non-alcoholic fat liver disease (NAFLD) in patients with psoriasis compared with the general population, especially in those with a greater psoriasis area and severity index (PASI). It is speculated that similar pathogenic bases may play a role in this association, highlighting insulin resistance and the release of inflammatory cytokines as the most likely causes. In the present work, we review basic aspects of the relationship between psoriasis and NAFLD.</p

FRAGILIDADES DO CONHECIMENTO DAS EQUIPES DE UNIDADES DE CRÍTICOS RELACIONADAS AO PROCESSO DE DOAÇÃO DE ÓRGÃOS E TECIDOS

Objetivo: avaliar fragilidades das equipes das unidades críticas relacionadas ao processo de doação.Método: estudo transversal, com 150 profissionais de saúde. Coleta de dados entre 2017 e 2018em dois hospitais públicos de Santa Catarina, com auxílio de instrumento específico sobre as etapasdo processo de doação de órgãos e tecidos. Dados analisados por frequência absoluta e relativa,testes de Kolmogorov-Smirnov e Mann-Whitney.Resultados: índices de acertos: critérios para iniciar o diagnóstico de morte encefálica 137 (91,3%)e sinais clínicos de morte encefálica 126 (84%). Fragilidades: critérios que impedem o diagnósticode morte encefálica 36 (24%) e sequência das etapas do processo de doação 56 (37%). Houvecorrelação entre tempo de atuação na unidade com os critérios que impedem o diagnóstico deMorte p=0,039.Conclusão: os resultados podem embasar ações frente às fragilidades, impactando na melhora doprocesso de doação e transplante de órgãos e tecidos.Objective: To assess the weaknesses of the teams of the critical care units related to thedonation process.Method: A cross-sectional study conducted with 150 health professionals. Data collectiontook place between 2017 and 2018 in two public hospitals in Santa Catarina, with the aid of aspecific instrument on the stages process of organ and tissue donation. Data was analyzed byabsolute and relative frequencies, Kolmogorov-Smirnov and Mann-Whitney tests.Results: Hit rates: criteria for starting the diagnosis of brain death 137 (91.3%) and clinicalsigns of brain death 126 (84%). Weaknesses: criteria that prevent the diagnosis of braindeath 36 (24%) and sequence of the stages of the donation process 56 (37%). There was acorrelation between the length of professional activity in the unit and the criteria that preventthe diagnosis of Death p=0.039.Conclusion: The results can support actions in the face of the weaknesses, impacting on theimprovement of the organ and tissue donation and transplantation process.Objetivo: evaluar las debilidades de los equipos de las unidades de cuidados críticosrelacionadas con el proceso de donación.Método: estudio transversal realizado con 150 profesionales de la salud. Los datos serecolectaron entre 2017 y 2018 en dos hospitales públicos de Santa Catarina, con la ayuda deun instrumento específico sobre las etapas del proceso de donación de órganos y tejidos. Losdatos se analizaron por frecuencia absoluta y relativa, y mediante pruebas de Kolmogorov-Smirnov y de Mann-Whitney.Resultados: índices de respuestas correctas: criterios para iniciar el diagnóstico de muerteencefálica, 137 (91,3%), y señales clínicas de muerte encefálica, 126 (84%). Debilidades:criterios que impiden el diagnóstico de muerte encefálica, 36 (24%), y secuencia de las etapasdel proceso de donación, 56 (37%). Se registró una correlación entre el tiempo de trabajo enla unidad con los criterios que impiden el diagnóstico de muerte: p = 0,039.Conclusión: los resultados pueden servir de base para implementar acciones frente a lasdebilidades, con un buen efecto sobre la mejora del proceso de donación y trasplante deórganos y tejidos