Detrusor Arreflexia as an End Stage of Neurogenic Bladder in HAM/TSP?

The HTLV-1 virus is a known agent involved in the development of HAM/TSP. Past studies have typically observed patients with autonomic dysfunction consisting of detrusor overactivity and detrusor-sphincter dyssynergia, with the occasional observation of underactive detrusor or detrusor arreflexia. However, studies have not yet evaluated the progression of neurogenic bladder over time. In this paper, we describe a HAM/TSP patient with the initial development of overactive detrusor, and subsequent development of detrusor arreflexia. Given a paucity of studies characterizing the effects of HTLV-1 on the autonomic nervous system, particularly aspects controlling continence, this patient's clinical course may represent one type of end point for patients with HAM/TSP and neurogenic bladder. Further cohort or case-series studies, with particular emphasis on the progression of neurogenic bladder, are needed to evaluate the significance of this described case in relation to typical disease progression patterns

Inquérito soroepidemiológico de dengue em dois municípios do estado do Acre, fronteira Brasil - Bolívia

Serum samples from 320 inhabitants from the cities of Brasiléia and Epitaciolândia in Acre State (on the Brazil - Bolívia border) have been tested, using the ELISA method for IgM and IgG. These samples have been tested in the period after an epidemic of dengue in 2000 by serotypes DEN-1 and DEN-2. The prevalence of seropositivity for IgM was of 60.3% and 67.2% for IgG, and only 15% presented seronegativity. The positivity was most frequent among individuals of the male sex (70% IgM; 78.2% IgG), and also in the older ages (p < 0.0005). Among the individuals with no history of dengue, 62.2% and 66.7% presented IgM and IgG antibodies, respectively. The estimative of subnotification of such infection is on the order of 65% in Brasiléia and 9.9% in Epitaciolândia. In conclusion, the high prevalence of infection and the regional characteristics provide conditions for the introduction of new serotypes of dengue, which expose the population of such cities to the risk for the occurrence of dengue hemorrhagic fever.Amostras séricas de 320 pessoas das cidades de Brasiléia e Epitaciolândia, fronteira Brasil (Acre)-Bolívia, foram testadas, pelos métodos de IgM-ELISA e IgG-ELISA, em período posterior as epidemias de dengue ocorridas em 2000 pelos sorotipos DEN-1 e DEN-2. A prevalência de portadores de anticorpos IgM foi de 60,3% e 67,2% de IgG e somente 15,0% foram co-soronegativos. A soropositividade foi mais freqüente entre indivíduos do sexo masculino (70% IgM; 78,2% IgG) e nas faixas etárias mais avançadas (p < 0,0005). Entre as pessoas sem história de dengue anterior, 62,2% e 66,7%, respectivamente, foram IgM e IgG positivos. A estimativa de subnotificação da infecção foi de 65% em Brasiléia, e 69,9% em Epitaciolândia. Em conclusão, a elevada prevalência de infecção prévia e as características regionais facilitam a introdução de novos sorotipos do vírus da dengue, o que coloca a população daquelas cidades sob risco de ocorrência de casos de dengue hemorrágico

Características epidemiológicas das vítimas de Escorpionismo na Bahia

Objetivo: Investigar o perfil epidemiológico dos casos de escorpionismo na Bahia. Métodos: Esta pesquisa consistiu em uma revisão integrativa da literatura utilizando as bases de dados MEDLINE e LILACS, através do Portal Biblioteca Virtual em Saúde (BVS) e PubMed. O período da análise compreendeu os anos 2013 a 2023. Foram escolhidos 10 estudos, distribuídos da seguinte forma: 40% pesquisas retrospectivas, 30%&nbsp; estudos observacionais descritivos, 10% clínico-epidemiológico, 10% estudos transversais e 10% estudos ecológicos. Discussão: Há uma associação direta e proporcional entre a incidência de casos de escorpionismo no Brasil e territórios com fragilidades sanitárias. Considerações finais: A maioria dos estudos analisados concorda que, o sexo feminino é o mais acometido por acidentes escorpiônicos. A faixa etária de acometimentos variou entre os estudos, entretanto, predominou vítimas com idade entre 20 a 59 anos. Os maiores registros ocorreram em ambiente domiciliar, em populações autodeclaradas pardas

Neurological aspects of HTLV-1 infection in Bahia: results from an 8-year cohort

HTLV-1 is the causal agent of HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP), a disease observed in up to 5% of individuals infected with HTLV-1. However, infected individuals without the disease can present neurological complaints relating to sensory, motor or urinary manifestations. The aim of this study was to investigate the incidence of neurological manifestations among patients with HTLV-1. Method HTLV-1 patients in Salvador, Bahia, Brazil, were enrolled into a cohort study. Results Among 414 subjects, 76 had definite and 87 had possible or probable HAM/TSP at the baseline, whereas 251 subjects had no neurological signs or symptoms. Definite HAM/TSP developed in 5 patients (1.74%). The asymptomatic subjects were selected for analysis. The incidence rate expressed per 1,000 persons-year was calculated. It was 206 for hand numbness, 129 for nocturia and 126 for urinary urgency. In the neurological examination, leg hyperreflexia presented an average incidence rate of 76; leg paraparesis, 52; and Babinski sign, 36. Kaplan-Meyer curves categorized according to gender and proviral load showed that females and patients with proviral load of more than 100,000 copies per 106 peripheral blood mononuclear cells (PBMCs) presented higher risk. Conclusion Development of neurological symptoms or signs occurred in up to 30% of asymptomatic subjects during 8 years of follow-up. Female gender and high proviral load were risk factors for neurological disease

CLINICAL AND ENDOSCOPIC EVALUATION IN PATIENTS WITH GASTROESOPHAGEAL SYMPTOMS

ABSTRACT BACKGROUND: The gastroesophageal reflux disease (GERD) is the most common esophageal disease in medical practice, and it is suspected according to patients’ symptoms. GERD can be classified in erosive esophagitis (EE) according to the presence of upper gastrointestinal endoscopy findings. OBJECTIVE: To evaluate endoscopic findings in patients with symptoms suggestive of GERD comparing epicemiological and risk factors. METHODS: Upper endoscopy reports were examined retrospectively from patients with symptoms of GERD such as heartburn, regurgitation, cough, throat clearing, globus and chest pain. EE was determined based on Los Angeles classification. Comparisons between risk factors in EE and non-EE groups were done with statistical analysis. RESULTS: A total of 984 endoscopic reports were examined and 676 selected for analysis (281 with EE and 395 with non-EE form). Most were female 381 (56.36%) with a mean age of 44.01±15.40 years. Hiatal hernia was present in 47(6.96%) and smoking in 41(6.07%). Univariate logistic regression showed that male (OR=2.24, CI 95%, 1.63-3.06) and hiatal hernia (OR=4.52, CI 95%, 2.30-8.89) were independent predictors of erosions in the EE group. The presence of hiatal hernia (OR=12.04, CI 95%, 3.57-40.62), smoking (OR=8.46, CI 95%, 3.28-31.32) and aged patients (OR=8.01, CI 95%, 2.42-26.49) were also indicated as a risk factor for severe EE (grades C and D of Los Angeles). CONCLUSION Male gender and hiatal hernia were associated with EE. Aged patients, smoking and hiatal hernia were related to severe EE. It is suggested that the risk factors for EE and non-EE types are different. Cohort studies are necessary to identify the exact mechanisms involved in each disease form