Can COVID-19 impact the natural history of paracoccidioidomycosis? Insights from an atypical chronic form of the mycosis

Paracoccidioidomycosis (PCM) is a systemic fungal infection caused by Paracoccidioides spp. It can occur as an acute/subacute form (A/SAF), a chronic form (CF) and rarely as a mixed form combining the features of the two aforementioned forms in an immunocompromised patient. Here, we report a 56-year-old male patient with CF-PCM who presented with atypical manifestations, including the development of an initial esophageal ulcer, followed by central nervous system (CNS) lesions and cervical and abdominal lymphatic involvement concomitant with severe SARS-CoV-2 infection. He was HIV-negative and had no other signs of previous immunodeficiency. Biopsy of the ulcer confirmed its mycotic etiology. He was hospitalized for treatment of COVID-19 and required supplemental oxygen in the intensive unit. The patient recovered without the need for invasive ventilatory support. Investigation of the extent of disease during hospitalization revealed severe lymphatic involvement typical of A/SAF, although the patient`s long history of high-risk exposure to PCM, and lung involvement typical of the CF. Esophageal involvement is rare in non-immunosuppressed PCM patients. CNS involvement is also rare. We suggest that the immunological imbalance caused by the severe COVID-19 infection may have contributed to the patient developing atypical severe CF, which resembles the PCM mixed form of immunosuppressed patients. Severe COVID-19 infection is known to impair the cell-mediated immune response, including the antiviral response, through T-lymphopenia, decreased NK cell counts and T-cell exhaustion. We hypothesize that these alterations would also impair antifungal defenses. Our case highlights the potential influence of COVID-19 on the course of PCM. Fortunately, the patient was timely treated for both diseases, evolving favorably

INCONTINÊNCIA URINÁRIA DE ESFORÇOS EM MULHERES: UMA REVISÃO LITERÁRIA

Introduction:  Stress urinary incontinence (SUI) significantly impacts the quality of life of many women, especially postpartum and during menopause. It is characterized by the involuntary loss of urine during activities that increase intra-abdominal pressure. Objective:  This study systematically reviews the literature on SUI in women from 2019 to 2024 to analyze prevalence, risk factors, pathophysiology, psychosocial impact, diagnosis, and treatment. Methodology: Research was conducted in databases such as PubMed, Scopus, and Cochrane Library, using specific terms. Studies published between 2019 and 2024, addressing SUI in women were included. Results and Discussion: SUI prevalence ranges from 10% to 40%, influenced by age, parity, BMI, and menopause. Diagnosis involves clinical history, physical examination, and specific tests. Treatments include Kegel exercises, behavioral therapies, pharmacological, and surgical interventions. Conclusion: SUI is common and negatively affects women's lives. A multimodal treatment approach and education are essential to improve patients' quality of life.Introdução: A incontinência urinária por esforços (IUE) afeta significativamente a qualidade de vida de muitas mulheres, especialmente no pós-parto e na menopausa. Caracteriza-se pela perda involuntária de urina durante atividades que aumentam a pressão intra-abdominal. Objetivo: Este estudo revisa sistematicamente a literatura sobre IUE em mulheres, de 2019 a 2024, para analisar prevalência, fatores de risco, fisiopatologia, impacto psicossocial, diagnóstico e tratamento. Metodologia:  A pesquisa foi realizada em bases de dados como PubMed, Scopus e Cochrane Library, utilizando termos específicos. Foram incluídos estudos publicados entre 2019 e 2024, abordando a IUE em mulheres. Resultados e Discussão A prevalência de IUE varia entre 10% e 40%, influenciada por idade, paridade, IMC e menopausa. O diagnóstico envolve história clínica, exame físico e testes específicos. Tratamentos incluem exercícios de Kegel, terapias comportamentais, farmacológicas e cirúrgicas. Conclusão: A IUE é comum e afeta negativamente a vida das mulheres. A abordagem multimodal de tratamento e a educação são essenciais para melhorar a qualidade de vida das pacientes

O PROCESSO PRODUTIVO DO SORO ANTIOFÍDICO: DA CRISE À SUPERAÇÃO?

Made available in DSpace on 2016-08-10T10:54:07Z (GMT). No. of bitstreams: 1 Wladimir Jacome de Queiroz.pdf: 1180747 bytes, checksum: 888d9ebe6ee9cf7d0b0df6dc4c2c7244 (MD5) Previous issue date: 2005-04-18In the present work we focused the theme of the production of the Brazilian snakebite serum, emphasizing the political-social character and describing the current politics of public health in this field, with the objective of showing the reality that involves environment, health and education. We studied the current environmental variables of the crisis of the Brazilian snakebite serum, happened in 1985, as well as the social problems generated by this process and the invested resources. We tried to observe the several aspects of the process of production of the snakebite serum in Brazil, related to the used technology, to the opportunities and the threats (analysis of SWOT) of the productive process in Brazil and also to the benefits generated for the population. Finally, after the analysis of the statistical data and factualists, we suggested, starting from a vision generalist, multidisciplinary and global of this subject, viable options for the production of the snakebite serum in Brazil, which would involve technology, government, society and administration of resources.No presente trabalho, focamos o tema da produção do soro antiofídico brasileiro, enfatizando o caráter político-social e descrevendo a atual política de saúde pública neste campo, com o objetivo de mostrar a realidade que envolve meio ambiente, saúde e educação. Estudamos as variáveis ambientais decorrentes da crise do soro antiofídico brasileiro, ocorrida em 1985, assim como os problemas sociais gerados por este processo e os recursos investidos. Procuramos observar os vários aspectos do processo de produção do soro antiofídico no Brasil, relacionados à tecnologia utilizada, às oportunidades e às ameaças (análise de SWOT) do processo produtivo no Brasil e também aos benefícios gerados para a população. Finalmente, depois da análise dos dados estatísticos e factuais, sugerimos, a partir de uma visão generalista, multidisciplinar e global desta questão, opções mais viáveis para a produção do soro antiofídico no Brasil, as quais envolveriam tecnologia, governo, sociedade e administração de recursos

COINFECÇÃO MPOX/HIV-1 EM PACIENTE GRAVEMENTE IMUNOSSUPRIMIDO: UMA EVOLUÇÃO CATASTRÓFICA

A Monkeypox (MPOX) é uma doença causada pelo vírus monkeypox (MPXV), endêmico desde 1970 na África Central e Ocidental, com poucos surtos relatados fora desse continente. Em maio de 2022 observou-se um aumento no número de casos da doença mundialmente, com maior prevalência em homens que fazem sexo com homens (HSH) e com transmissão através de contato direto, incluindo exposição sexual. Nesse contexto, evidenciou-se a associação da MPOX com infecções sexualmente transmissíveis, tal como a infecção pelo HIV. Relatamos o caso de um homem de 26 anos, HSH, com febre alta, mialgia e cefaleia iniciados em julho de 2022, evoluindo após 1 semana com erupção de pápulas umbilicadas dolorosas em nuca e punho, com progressão para membros superiores e região anal e surgimento de vesículas e pústulas disseminadas. O paciente foi atendido no Instituto de Infectologia Emílio Ribas, em São Paulo, cidade brasileira com maior número de casos confirmados da MPOX, tendo procurado atenção médica devido à dor perianal intensa, com lesões pleomórficas. Diagnosticado com MPOX por técnica de reação em cadeia da polimerase das lesões. Apresentava infecção prévia pelo HIV-1, em uso irregular de terapia antirretroviral (TARV), com contagem de LT-CD4+ de 4 células/µL e carga viral de HIV-1 de 1.428.516 cópias/mL. Após um mês apresentou piora das lesões, complicadas com proctite, celulite perianal, necrose de área glútea e edema peniano com obstrução uretral. Observou-se evolução desfavorável, com surgimento de novas lesões diariamente durante toda a internação. Reintroduzida TARV e iniciada terapia com Tecovirimat na dose de 600 mg de 12/12h, com realização de 2 ciclos de 14 dias do antiviral sem estabilização ou remissão do quadro, mantendo resposta isomórfica em locais de manipulação, simulando um fenômeno de Koebner. Posteriormente, apresentou piora do padrão respiratório, sendo submetido a broncoscopia, na qual se observaram lesões mucosas brônquicas secundárias ao MPXV de acordo com achados histopatológicos. Paciente evoluiu ao longo da internação com múltiplas disfunções orgânicas e síndrome de reconstituição imune, com desfecho de óbito em 3 meses. O caso apresentado retrata coinfecção HIV-1 e MPXV em paciente gravemente imunossuprimido, resultando em evolução desfavorável e refratariedade à terapia antirretroviral e antiviral. Chama-se atenção, portanto, para a importância da interação de ambas as infecções no prognóstico clínico

UTILIZAÇÃO DE Spirulina platensis COMO SUPLEMENTO ALIMENTAR DURANTE A REVERSÃO SEXUAL DE TILÁPIA DO NILO

This study aimed to evaluate the influence of S. platensis as a food supplement for Nile tilapia post-larvae. Two trials was running. In the first, was used two treatments, one offered freshwater microalgae (green water) and other offered microalga S. platensis. In the second trial, were evaluated the effect of without copepods, administration of copepods alone and copepods enriched with S. platensis. Throughout the study, all animals were fed diets with masculinizing hormone 17-K-methyl-testosterone. It was evaluated the growth in weight and length, the survival rate and the rate of sex reversal of tilapia (mean +,- SD). In the first trial, the fish that received the S. platensis and receiving freshwater microalgae showed as result, 0.21 +,- 0.042 g; 2.50 +,- 0.091 cm; 97.5 ± 1,00% and 0.11 +,- 0.022 g; 1.91 +,- 0.419 cm; 98.33 +,- 0.70%, respectively. In the second trial, when the copepods were utilized, with and without S. platensis, the post-larvae as result, 0.221 ± 0.008 g; 2.70 ± 0.070 cm; 86.67 +,- 1.03% and 0.211 +,- 0.014 g; 2.56 ± 0.121 cm; 77.50 +,- 1.33%, respectively. The animals that received only commercial had as result, 0.190 +,- 0.008 g; 2.22 +,- 0.215 cm and 79.17 +,-0.21%. Using S. platensis resulted in better growth in weight and length, but did not affect survival and rates of sex reversal Nile tilapia post-larvae of exposed to natural food

Chronic skull osteomyelitis due to Cryptococcus neoformans: first case report in an HIV-infected patient

ABSTRACT Osteomyelitis due to Cryptococcus neoformans are described in mostly 10% of patients with disseminated cryptococcosis, being direct inoculation even more uncommon. We report the case of an HIV-infected patient with history of recurring itching on his scalp and repetitive local trauma. For eighteen months, he noticed a painful and slow growing lump on his scalp. He was submitted to an excisional biopsy of the lesion but no etiological diagnosis was identified. After this procedure, the post-surgical wound never completely healed. At admission, the patient presented nausea and headache for three days and an open orifice into his skull. Investigations confirmed meningitis and skull osteomyelitis caused by Cryptococcus neoformans. He was treated with bone debridement and combined systemic antifungals, showing good clinical and laboratorial outcome. Cryptococcal disease should be included in the differential diagnoses of chronic osteomyelitis in HIV-infected patients and trauma is a possible source of infection

Both human immunodeficiency virus-infected and human immunodeficiency virus-exposed, uninfected children living in Brazil, Argentina, and Mexico have similar rates of low concentrations of retinol, beta-carotene, and vitamin E

Our objective was to describe the prevalence of low concentrations of retinol, beta-carotene, and vitamin E in a group of human immunodeficiency virus (HIV)-infected Latin American children and a comparison group of HIV-exposed, uninfected children. Our hypothesis was that the rates of low concentrations of these micronutrients would be higher in the HIV-infected group than those in the HIV-exposed, uninfected group. This was a cross-sectional substudy of a larger cohort study at clinical pediatric HIV centers in Latin America. Serum levels of micronutrients were measured in the first stored sample obtained after each child`s first birthday by high-performance liquid chromatography. Low concentrations of retinol, beta-carotene, and vitamin E were defined as serum levels below 0.70, 0.35, and 18.0 mu mol/L, respectively. The Population for this analysis was 336 children (124 HIV-infected, 212 HIV-exposed, uninfected) aged I year or older to younger than 4 years. Rates of low concentrations were 74% for retinol, 27% for beta-carotene, and 89% for vitamin E. These rates were not affected by HIV status. Among the HIV-infected children, those treated with anti retrovirals were less likely to have retinol deficiency, but no other HIV-related factors correlated with micronutrient low serum levels. Low concentrations of retinol, beta-carotene, and vitamin E are very common in children exposed to HIV living in Brazil, Argentina, and Mexico, regardless of HIV-infection status. Published by Elsevier Inc.NICHD[N01-HD-3-3345]NICHD[N01-DK-8-0001