Paracoccidioidomicosis juvenil diseminada y tuberculosis miliar: Reporte de un caso

Paracoccidioidomycosis (PMC) is a chronic, systemic, granulomatous disease, limited to the American continent, endemic in Venezuela, with a very varied clinical presentation, it is prevalent in the adult population, for which there are few reports in children. Co-infection of tuberculosis with deep mycoses can occur simultaneously or sequentially. The data in the literature indicate that the frequency of this combination ranges between 5.5 and 19%, with the deficiency of cellular immunity being the main factor in both entities. A clinical case of a 13-year-old male adolescent is presented, who presents with adenomegalic syndrome with a predominance in the cervical region, associated with fever, diffuse abdominal pain and malnutrition, antibiotic treatment with clindamycin is indicated without improvement, which is why lymph node excision is performed cervical, the pathological study reports Paracoccidiodes brasiliensis, initiating treatment with amphotericin B. Abdominal pain reappears, acute appendicitis is diagnosed, undergoing surgery, performing an appendectomy and excision of the mesenteric ganglion. The pathological results of the cecal appendix report periapendicular peritonitis, presence of isolated alcohol-resistant bacilli compatible with tuberculosis and of the mesenteric ganglion. Chronic granulomatous inflammatory infiltrate by Paracoccidiodes brasiliensis and alcohol-resistant bacilli. Given these findings, the diagnosis of paracoccidiodomycosis and miliary tuberculosis coinfection was concluded. Treatment with itraconazole, trimethoprim / sulfamethoxazole, and antifungal treatment based on isoniazid, rifampin, pyrazinamide, and ethambutol are indicated, presenting a favorable evolution. Conclusion The coinfection of PCM with tuberculosis has been recognized, which is why it should be ruled out in all patients with a diagnosis of PMCLa paracoccidioidomicosis (PMC) es una enfermedad crónica, sistémica, granulomatosa, limitada al continente americano, endémica en Venezuela, de presentación clínica muy variada, es prevalente en la población adulta,  existen pocos reportes en la edad pediátrica. La coinfección de tuberculosis con micosis profundas puede ocurrir de forma simultánea o secuencialmente. Los datos en la literatura indican que la frecuencia de esta combinación oscila entre 5,5 y 19%, siendo la deficiencia de la inmunidad celular el principal factor de ambas entidades. Se presenta caso clínico de adolescente masculino de 13 años, quien cursa con un síndrome adenomegálico,  predominio en  región cervical, asociado a fiebre, dolor abdominal difuso y desnutrición, se indica tratamiento con clindamicina sin mejoría, motivo por el que se realiza exéresis de ganglio cervical,  el estudio anatomopatologico reporta Paracoccidiodes brasiliensis, se inicia tratamiento con anfotericina B. Posteriormente reaparece el dolor abdominal diagnosticándose apendicitis aguda, siendo intervenido quirúrgicamente, se realiza apendicectomía y exéresis de ganglio mesentérico.  Los resultados anatomopatológicos del apéndice cecal reporta peritonitis periapendicular, presencia de bacilos alcohol resistente aislados compatible con tuberculosis y  del ganglio mesentérico Infiltrado inflamatorio crónico granulomatoso por Paracoccidiodes brasiliensis y bacilos alcohol resistente. Ante estos hallazgos se concluye diagnóstico de coinfección paracoccidiodomicosis y tuberculosis  miliar. Se indica tratamiento con itraconazol,  trimetoprima/sulfametoxazol, y tratamiento antifímico a base de isoniazida, rifampicina  pirazinamida y etambutol presentando una evolución favorable. Conclusión: la coinfección de PCM con tuberculosis ha sido reconocida en el 5 a 19% de los casos por lo que debe descartarse tuberculosis en todo paciente con diagnóstico de PMC

Microbiological analysis of bacterial plaque of periodontal disease on dogs and effects of antibioticotherapy on it

Objetivou-se determinar a microbiota da placa bacteriana subgengival de cães com doença periodontal (DP) e estabelecer o efeito da antibioticoterapia. Avaliaram-se 20 cães com graus variados de DP e coletaram-se amostras da placa bacteriana subgengival antes e após antibioticoterapia. Preconizou-se antibioticoterapia distinta em dois grupos, com 10 animais cada: clindamicina (G1) e metronidazol + espiramicina (G2). Observou-se crescimento bacteriano subgengival na maioria dos cães com DP e correlação entre a severidade da DP e a idade dos animais. Houve redução significativa no crescimento bacteriano após a antibioticoterapia e o antibiograma demonstrou maior sensibilidade à clindamicina, seguido da espiramicina; todos os microrganismos foram resistentes ao metronidazol. ___________________________________________________________________________________________________ ABSTRACTThe objective was to determine microbiote of the subgingival bacterial plaque of dogs with periodontal disease (PD) and establish the effect of antibioticotherapy on its reduction. Twenty dogs with varied stages of PD were evaluated and samples of their subgingival bacterial plaque were collected. Distinct antibiotic protocols were used in two groups with ten animals each: clindamycin (G1) and metronidazole + espiramycin (G2). New subgingival samples were collected 15 days after antibiotic therapy started. There were observed subgingival bacterial culture on most dogs with PD and correlation between severity of PD and age. There was reduction of bacterial growth in 20% of the samples after treatment and antibiogram showed higher sensibility to clindamycin, followed by espiramycin - all microorganisms were resistant to metronidazole

ACOLHIMENTO PRESTADO PELOS PROFISSIONAIS DE ENFERMAGEM ÀS GESTANTES/PARTURIENTES PORTADORAS DO VÍRUS HIV EM UMA MATERNIDADE DE SÃO LUÍS - MARANHÃO

AIDS (Acquired Immunodeficiency Syndrome) is one of the biggest health problems today. One of the priorities of National Program on STIs and AIDS is to reduce the vertical transmission (VT) of HIV. Accordingly, it is believed that maternity nursing professionals offer adequate reception, and they are aware of all prophylactic measures, to ensure that parturientes, to HIV – positive, have a lower risk delivery to the newborn babies (RN) and a postpartum satisfactory operation. This study aims to describe the reception given by nursing professionals to HIV - positive pregnant/parturient in a maternity hospital in São Luís - MA. This is a quantitative, descriptive research carried out in a maternity hospital of high complexity in Maranhão. The sample consisted of 22 Nurses and 38 Nursing Technicians from June to August of 2018. After approval by the Research Ethics Committee, the data collection was done through a questionnaire containing 20 questions. When questioned about how they performed reception, 57.14% of the nurses emphasized equity, 28.57% referral to social services and orientations, 62% of nursing technicians’ orientations, 37.5% equity and referral to social service. The results obtained allowed the tracing of Nursing and Nursing Technicians to pregnant/parturient in the Maternity of High Complexity of Maranhão, from hospitalization to discharge, revealing important points for a total and humanized care not only to the pregnant/parturient, but also to her family. Some gaps were observed for totaled care.El SIDA (Síndrome de Inmunodeficiencia Adquirida) es uno de los mayores problemas de salud en la actualidad. Una de las prioridades del Programa Nacional sobre ITS y SIDA es reducir la transmisión vertical (VT) del VIH. En consecuencia, se cree que los profesionales de enfermería de maternidad ofrecen una recepción adecuada, y son conscientes de todas las medidas profilácticas, para garantizar que los parturientes, al VIH positivo, tengan un menor riesgo de parto a los recién nacidos (RN) y una operación postparto satisfactoria. Este estudio tiene como objetivo describir la recepción dada por los profesionales de enfermería a las embarazadas/parturientas VIH positivas en un hospital de maternidad en São Luís - MA. Se trata de una investigación cuantitativa y descriptiva realizada en una maternidad de alta complejidad en Maranhão. La muestra estuvo constituida por 22 Enfermeras y 38 Técnicos de Enfermería de junio a agosto de 2018. Tras la aprobación por parte del Comité de Ética en Investigación, la recolección de datos se realizó a través de un cuestionario que contenía 20 preguntas. Cuando se les preguntó sobre cómo realizaron la recepción, el 57,14% de las enfermeras enfatizó la equidad, el 28,57% la derivación a servicios sociales y orientaciones, el 62% de las orientaciones de los técnicos de enfermería, el 37,5% la equidad y la derivación al servicio social. Los resultados obtenidos permitieron el rastreo de Técnicos de Enfermería y Enfermería a embarazadas/parturientas en la Maternidad de Alta Complejidad de Maranhão, desde la hospitalización hasta el alta, revelando puntos importantes para una atención total y humanizada no solo a la embarazada/parturienta, sino también a su familia. Se observaron algunas brechas para la atención total.A AIDS (Acquired Immunodeficiency Syndrome) representa um dos maiores problemas de saúde da atualidade. Uma das prioridades do Programa Nacional de IST e AIDS é a redução da transmissão vertical (TV) do HIV. Diante disso, acredita-se que os profissionais de enfermagem da maternidade ofereçam um acolhimento adequado, e que tenham o conhecimento de todas as medidas profiláticas, para assegurar que as parturientes portadoras de HIV, tenham um parto de menor risco para o recém-nascido (RN) e um puerpério satisfatório. Este estudo tem como objetivo descrever o acolhimento prestado pelos profissionais de enfermagem às gestantes/parturientes portadoras de HIV em uma maternidade de São Luís – MA. Trata-se de uma pesquisa quantitativa, descritiva, realizada em uma maternidade de alta complexidade do Maranhão. A amostra foi composta por 22 Enfermeiros e 38 Técnicos de Enfermagem, no período de junho a agosto de 2018. Após aprovação pelo Comitê de Ética em Pesquisa, a coleta de dados se deu através de questionário contendo 20 questões. Quando questionados sobre como realizavam o acolhimento, 57,14% dos enfermeiros destacaram a equidade, 28,57% encaminhamento ao serviço social e orientações, 62% dos técnicos de enfermagem as orientações, 37,5% a equidade e encaminhamento ao serviço social. Os resultados obtidos permitiram traçar o acolhimento prestado pelos Enfermeiros e Técnicos de Enfermagem às gestantes/parturientes na Maternidade de Alta Complexidade do Maranhão, desde a internação até a sua alta, revelando pontos importantes para uma assistência total e humanizada não só à gestante/parturiente, mas também à sua família. Algumas lacunas foram observadas para realização de uma assistência totalizada

A (DES)NECESSIDADE DE REGULAMENTAÇÃO DA DISPENSA COLETIVA NO BRASIL: UMA ANÁLISE SOB A ÓTICA DO VALOR SOCIAL DO TRABALHO E DA DIGNIDADE DA PESSOA HUMANA

In the current Brazilian scenario, it is not uncommon to report the occurrence of collective dismissals involving a large number of workers. The justifications are based on factors linked to the economic situation of the country. In this context, this paper aims to examine the arbitrary collective dismissal, under the perspective of preservation of jobs inserted in the Federal Constitution of 1988, as well as the principles of social value of work and human dignity. As a method of procedure, we adopted the data collection through the technique of literature research. As a method of approach, the deductive method was used. It stands out, nowadays, the imperative need to modernize and upgrade the labor laws in face of the economic reality, in a way to face the great challenges typical to this area of law, among which the employment crisis appears to be the most complex.No cenário brasileiro atual, não é raro se noticiar a ocorrência de dispensas coletivas envolvendo um grande número de trabalhadores. As justificativas têm se baseado em fatores vinculados à situação econômica do país. Nesse contexto, o presente trabalho tem por objetivo examinar a dispensa coletiva arbitrária, sob o viés dos ditames da preservação de empregos insculpido na Constituição Federal de 1988 e dos princípios do valor social do trabalho e da dignidade humana. Como método de procedimento, adotou-se o levantamento de dados por meio da técnica de pesquisa bibliográfica. E, como método de abordagem, adotou-se o método dedutivo. Destaca-se, na atualidade, a imperativa necessidade de modernizar e atualizar o Direito do Trabalho face à realidade econômica, no sentido de enfrentar os grandes desafios próprios desse ramo do direito, dentre os quais a crise do emprego se afigura o mais complexo

Dengue Virus Type 4 Phylogenetics in Brazil 2011: Looking beyond the Veil

Dengue Fever and Dengue Hemorrhagic Fever are diseases affecting approximately 100 million people/year and are a major concern in developing countries. In the present study, the phylogenetic relationship of six strains of the first autochthonous cases of DENV-4 infection occurred in Sao Paulo State, Parana State and Rio Grande do Sul State, Brazil, 2011 were studied. Nucleotide sequences of the envelope gene were determined and compared with sequences representative of the genotypes I, II, III and Sylvatic for DEN4 retrieved from GenBank. We employed a Bayesian phylogenetic approach to reconstruct the phylogenetic relationships of Brazilian DENV-4 and we estimated evolutionary rates and dates of divergence for DENV-4 found in Brazil in 2011. All samples sequenced in this study were located in Genotype II. The studied strains are monophyletic and our data suggest that they have been evolving separately for at least 4 to 6 years. Our data suggest that the virus might have been present in the region for some time, without being noticed by Health Surveillance Services due to a low level of circulation and a higher prevalence of DENV-1 and DENV- 2

Phylogeographic pattern and extensive mitochondrial DNA divergence disclose a species complex within the Chagas disease vector Triatoma dimidiata.

ABSTARCT: Previous studies have shown that "bioequivalent" generic products of vancomycin are less effective in vivo against Staphylococcus aureus than the innovator compound. Considering that suboptimal bactericidal effect has been associated with emergence of resistance, we aimed to assess in vivo the impact of exposure to innovator and generic products of vancomycin on S. aureus susceptibility. A clinical methicillin-resistant S. aureus (MRSA) strain from a liver transplant patient with persistent bacteremia was used for which MIC, minimum bactericidal concentration (MBC), and autolytic properties were determined. Susceptibility was also assessed by determining a population analysis profile (PAP) with vancomycin concentrations from 0 to 5 mg/liter. ICR neutropenic mice were inoculated in each thigh with ∼7.0 log(10) CFU. Treatment with the different vancomycin products (innovator and three generics; 1,200 mg/kg of body weight/day every 3 h) started 2 h later while the control group received sterile saline. After 24 h, mice were euthanized, and the thigh homogenates were plated. Recovered colonies were reinoculated to new groups of animals, and the exposure-recovery process was repeated until 12 cycles were completed. The evolution of resistance was assessed by PAP after cycles 5, 10, 11, and 12. The initial isolate displayed reduced autolysis and higher resistance frequencies than S. aureus ATCC 29213 but without vancomycin-intermediate S. aureus (VISA) subpopulations. After 12 cycles, innovator vancomycin had significantly reduced resistant subpopulations at 1, 2, and 3 mg/liter, while the generic products had enriched them progressively by orders of magnitude. The great capacity of generic vancomycin to select for less susceptible organisms raises concerns about the role of therapeutic inequivalence of any antimicrobial on the epidemiology of resistance worldwide

Diagnóstico brasileiro sobre biodiversidade e serviços ecossistêmicos : sumário para tomadores de decisão

A biodiversidade e os ecossistemas são elementos importantes para enfrentar as crises socioeconômicas e ambientais nacionais e globais, uma vez que proporcionam novas oportunidades de desenvolvimento. Incorporar a biodiversidade na vida cotidiana é uma oportunidade de ouro para promover o uso sustentável da biodiversidade e dos serviços ecossistêmicos. A conservação e a restauração da biodiversidade, dos ecossistemas e de seus serviços associados mostram potencial para um novo desenvolvimento social e econômico, como fonte de geração de emprego e renda, redução da pobreza e da desigualdade socioeconômica. A diversidade biológica brasileira também se expressa em sua imensa diversidade cultural, com uma grande variedade de detentores de conhecimento indígenas e tradicionais. Esses povos possuem vasto conhecimento sobre agrobiodiversidade, pesca, manejo do fogo, medicina natural, entre outros de valor comercial, cultural e espiritual. As principais conclusões deste Sumário para Tomadores de Decisão é que as mudanças no uso da terra e as mudanças climáticas tenham sido - e continuarão sendo ao longo deste século - os principais vetores da perda de biodiversidade e serviços ecossistêmicos no país. Intervenções políticas em diferentes níveis (do local ao nacional, do público ao privado) e a aplicação das leis existentes (mecanismos regulatórios e incentivos) são necessárias para promover a mitigação dos impactos negativos sobre a biodiversidade e a perda de serviços ecossistêmicos. O Brasil já possui uma ampla variedade de instrumentos de política e opções de governança socioambiental, bem como compromissos globais (ODS, Metas de Aichi, Acordo de Paris) relacionados à possibilidade de um futuro sustentável. Entretanto, o controle ineficiente da gestão ou a falta de incentivo para cumprir as regras traz riscos para a consolidação do caminho para esse futuro. O país tem instituições fortes e capazes, mas problemas de infraestrutura, processos lentos, medidas ineficazes e conflitos judiciais, sociais e ecológicos impedem a realização de um desempenho eficiente. Há uma falta de comunicação entre a ciência e a sociedade que precisa ser melhorada por meio do estabelecimento de um fluxo efetivo que torne a comunicação inclusiva e representativa, alcançando os tomadores de decisão públicos e privados. Esforços permanentes para integrar essas duas esferas de conhecimento na sociedade são desejáveis para criar confiança entre os formuladores de políticas e os pesquisadores.Biodiversity and ecosystems are important elements for addressing national and global socioeconomic and environmental crises, since they provide new development opportunities, for example, as source of job and income creation, and reduction in poverty and socioeconomic inequity. Brazilian biological diversity is also expressed in its immense cultural diversity, with a great variety of knowledge holders. These peoples possess vast knowledge on agrobiodiversity, fishing, fire management, natural medicine, among others of commercial, cultural and spiritual value. The main conclusions of this Summary for Police Makers is that land use changes and climate changes have been - and will continue to be throughout this century - the main drivers that result in the loss of biodiversity and ecosystem services in the country. Political interventions at different levels (from local to national, from public to private) and the enforcement of existing laws (regulatory mechanisms and incentives) are required to cope with the mitigation of the negative impacts of biodiversity and ecosystem services loss. Brazil has already a wide variety of policy instruments and socioenvironmental governance options, as well as global commitments (ODS, Aich Targets, Paris Agreement) related to the objective of a sustainable future. However, inefficient management control or lack of incentive to comply with the rules pose risks to consolidating the path to this future. The country has strong and capable institutions, but infrastructural problems, slow processes, inefficient measurements and judicial, social and ecological conflicts obstruct a proficient performance. There is a lack of communication between science and society which needs to be improved by establishing an effective flow that makes communication inclusive and representative, reaching public and private decision makers. Permanent efforts to integrate Science and policy knowledges are desirable to build confidence between policy makers and researchers

Social economic costs of type 1 diabetes mellitus in pediatric patients in Spain: CHRYSTAL observational study

AIMS: To estimate the social-economic costs of Type 1 Diabetes Mellitus (T1DM) in patients aged 0-17 years in Spain from a social perspective. METHODS: We conducted a cross-sectional observational study in 2014 of 275 T1DM pediatric outpatients distributed across 12 public health centers in Spain. Data on demographic and clinical characteristics, healthcare utilization and informal care were collected from medical records and questionnaires completed by clinicians and patients' caregivers. RESULTS: A valid sample of 249 individuals was analyzed. The average annual cost for a T1DM patient was €27,274. Direct healthcare costs were €4070 and direct non-healthcare cost were €23,204. Informal (familial) care represented 83% of total cost, followed by medical material (8%), outpatient and primary care visits (3.1%) and insulin (2.1%). Direct healthcare cost per patient statistically differed by glycated haemoglobin (HbA1c) level [mean cost €4704 in HbA1c ?7.5% (?58mmol/mol) group vs. €3616 in HbA1c<7.5% (<58mmol/mol) group)]; and by the presence or absence of complications and comorbidities (mean cost €5713 in group with complications or comorbidities vs. €3636 in group without complications or comorbidities). CONCLUSIONS: T1DM amongst pediatric patients incurs in considerable societal costs. Informal care represents the largest cost category