Catastrophic Kawasaki disease unresponsive to IVIG in a 3-month-old infant : a diagnostic and therapeutic challenge

The present report describes the severe evolution of Kawasaki disease in a three-month-old infant. The ailment was initially atypical in its presentation, with the patient exhibiting only persistent fever in association with a progressive lethargy and maculopapular rash on the face, trunk and limbs erroneously diagnosed as roseola infantum. On the 10th day of the condition, mainly due to the unexplained persistence of fever, the infant was admitted to a local hospital. The typical features of KD appeared only on the 14th day of illness with the relapse of the maculopapular rash in association with non-purulent conjunctivitis; dry, reddish and fissured lips; tongue with reddish and hypertrophic papillae; erythema and edema of the palms and soles. During the following days, the ailment rapidly evolved to a catastrophic clinical picture characterized by generalized vasculitis, splenic infarction, pulmonary thrombosis, giant right and left coronary aneurysms, dilatation of common and internal iliac arteries and progressive ischemia of the distal third of the feet resulting in necrotic lesions of both halluces. Appropriate therapy was initiated, but repeated administration of intravenous immunoglobulin G (IVIG) followed by three days of administration of methylprednisolone did not abate the intense inflammatory activity. The remission of inflammation and regression of vascular lesions were only achieved during the following five weeks after the introduction of methotrexate associated with etanercept. The report of this case aims to draw attention to severe forms of KD that exhibit an unfavorable evolution and can be extremely refractory to the conventional therapy

A extensão universitária frente ao isolamento social imposto pela COVID-19 / University extension front of the social isolation imposed by COVID-19

A emergência de uma nova pandemia não é uma questão de “se”, mas de “quando” irá acontecer. Atualmente, estamos diante da mais importante crise de saúde pública mundial, a pandemia do novo coronavírus. A Universidade é uma instituição criada para atender às necessidades sociais e uma das estratégias para realizar esse dever é através de ações de extensão universitária. Mas como realizar extensão universitária frente ao isolamento social imposto pelo COVID-19? Durante a pandemia a Universidade ganhou destaque em ações extensionistas, especialmente na disseminação e construção correta do conhecimento sobre SARS-CoV-2 e COVID-19, em ações que objetivam o desenvolvimento e confecção de insumos para proteção individual e coletiva, distribuídos para hospitais, profissionais de saúde e em comunidades carentes, e atividades de educação e cultura explorando novos recursos em plataformas digitais. Acreditamos no poder transformador da Universidade e no seu compromisso em reduzir impactos sociais através da extensão e que no futuro próximo a extensão deve ser enquadrada no mundo pós-pandemia

ATLANTIC-PRIMATES: a dataset of communities and occurrences of primates in the Atlantic Forests of South America

Primates play an important role in ecosystem functioning and offer critical insights into human evolution, biology, behavior, and emerging infectious diseases. There are 26 primate species in the Atlantic Forests of South America, 19 of them endemic. We compiled a dataset of 5,472 georeferenced locations of 26 native and 1 introduced primate species, as hybrids in the genera Callithrix and Alouatta. The dataset includes 700 primate communities, 8,121 single species occurrences and 714 estimates of primate population sizes, covering most natural forest types of the tropical and subtropical Atlantic Forest of Brazil, Paraguay and Argentina and some other biomes. On average, primate communities of the Atlantic Forest harbor 2 ± 1 species (range = 1–6). However, about 40% of primate communities contain only one species. Alouatta guariba (N = 2,188 records) and Sapajus nigritus (N = 1,127) were the species with the most records. Callicebus barbarabrownae (N = 35), Leontopithecus caissara (N = 38), and Sapajus libidinosus (N = 41) were the species with the least records. Recorded primate densities varied from 0.004 individuals/km 2 (Alouatta guariba at Fragmento do Bugre, Paraná, Brazil) to 400 individuals/km 2 (Alouatta caraya in Santiago, Rio Grande do Sul, Brazil). Our dataset reflects disparity between the numerous primate census conducted in the Atlantic Forest, in contrast to the scarcity of estimates of population sizes and densities. With these data, researchers can develop different macroecological and regional level studies, focusing on communities, populations, species co-occurrence and distribution patterns. Moreover, the data can also be used to assess the consequences of fragmentation, defaunation, and disease outbreaks on different ecological processes, such as trophic cascades, species invasion or extinction, and community dynamics. There are no copyright restrictions. Please cite this Data Paper when the data are used in publications. We also request that researchers and teachers inform us of how they are using the data. © 2018 by the The Authors. Ecology © 2018 The Ecological Society of Americ

Efficacy of a specific model for cognitive-behavioral therapy among panic disorder patients with agoraphobia: a randomized clinical trial

CONTEXT AND OBJECTIVE: Cognitive-behavioral therapy is frequently indicated for panic disorder. The aim here was to evaluate the efficacy of a model for cognitive-behavioral therapy for treating panic disorder with agoraphobia. DESIGN AND SETTING: Randomized clinical trial at Instituto de Psiquiatria da Universidade Federal do Rio de Janeiro. METHODS: A group of 50 patients with a diagnosis of panic disorder with agoraphobia was randomized into two groups to receive: a) cognitive-behavioral therapy with medication; or b) medication (tricyclic antidepressants or selective serotonin reuptake inhibitors). RESULTS: Although there was no difference between the groups after the treatment in relation to almost all variables with the exception of some items of the Sheehan disability scale and the psychosocial and environmental problems scale, the patients who received the specific therapy presented significant reductions in panic attacks, anticipatory anxiety, agoraphobia avoidance and fear of body sensations at the end of the study, in relation to the group without the therapy. On the overall functioning assessment scale, overall wellbeing increased from 60.8% to 72.5% among the patients in the group with therapy, thus differing from the group without therapy. CONCLUSION: Although both groups responded to the treatment and improved, we only observed significant differences between the interventions on some scales. The association between specific cognitive-behavioral therapy focusing on somatic complaints and pharmacological treatment was effective among this sample of patients with panic disorder and the response was similar in the group with pharmacological treatment alone

IMUNOPATOLOGIA INDUZIDAS POR Trichomonas vaginalis DURANTE A GESTAÇÃO E O RISCO DE ABORTO E PARTO PREMATURO

A Organização Mundial de Saúde estima em 276.4 milhões de casos de tricomoníase todos os anos, dos quais 70-90% são registrados em mulheres em idade reprodutiva e destas, 25 milhões são gestantes. Pouco se conhece sobre os fatores fisiopatológicos e imunológicos na tricomoníase associados ao aborto e/ou parto prematuro. Assim, objetivamos investigar as alterações imunopatológicas decorrentes da tricomoníase durante a gestação e sua associação com aborto e/ou parto prematuro. Através da busca bibliográfica nas bases do Scielo, Pubmed, Medline e Lilacs com o cruzamento dos descritores: Trichomonas vaginalis, tricomoníase, gestação, aborto e parto prematuro (inglês/português), sem limitar ano de publicação. Só na década de 80 iniciaram estudos da possível associação da tricomoníase com aborto e/ou parto prematuro. T. vaginalis estimula macrófagos na síntese de citocinas pró-inflamatórias (IL-6, TNF-α, IL-8, IL-6 e IL-1β) e aumento de células T e B, plasmócitos e polimorfonucleares no endométrio, resultando na inflamação intrauterina e interrompendo a circulação uteroplacentária. IL-8 no líquido amniótico pode provocar rompimento da placenta. Na gravidez a síntese de citocinas Th1/Th2 e polimorfonucleares encontram-se reduzida, uma vez que supressão imunológica é essencial para acomodar e proteger o feto. Em gestações saudáveis há níveis elevados de IgG anti-lipofosfoglicano-T. vaginalis quando comparamos grávidas infectadas. Proteína C reativa e fator estimulador de granulócitos estão elevados no soro de grávidas portadoras de tricomoníase. Parto prematuro associado a tricomoníase é atribuído as prostaglandinas que estimulam a contratilidade uterina, síntese e liberação de metaloproteinases, comprometendo membranas corioamnióticas, levando a remodelação da matriz extracelular e colapso do colo uterino. Alterações imunopatógicas decorrentes da tricomoníase alteram homeostase gestacional e podem ter associação com abordo e nascimento precoce. No entanto, pesquisadores apontam a necessidade de mais estudos que possam esclarecer essa associação, incluindo estudos que correlacionem questões culturais, sociais, econômicas, geográficas e patogenicidade das cepas de T. vaginalis