Treatment of Human Sporotrichosis Caused by Sporothrix brasiliensis

We describe the successful treatment of a series of 30 zoonotic sporotrichosis cases from southern Brazil. Sporothrix brasiliensis was the species genotypically identified in all 25 confirmed cases. Five other cases were classified as probable, without laboratory confirmation, but with clinical and epidemiological data of cat-transmitted sporotrichosis. Two isolates were sequenced by translation elongation factor-1 alpha (EF1α) loci in order to compare their sequences, and both of them showed distinct genotypes from S. brasiliensis strains from other Brazilian states. Itraconazole (ITZ) or potassium iodide (KI) were the first choice treatment in 28 and 2 cases, respectively. Microdilution assay showed a wild-type profile of S. brasiliensis isolates to ITZ. However, a lack of clinical response occurred in 42% of cases, especially those treated with ITZ 100 mg/day, and treatment needed modifications, by either increased doses or antifungal combinations. Clinical cure required a mean of 187 days of treatment, which was dependent on the clinical form of the disease and age of patients. Therapy, including dosages and durations, for cutaneous forms of sporotrichosis requires re-evaluation, since cases caused by S. brasiliensis may influence treatment efficacy.

A Case of Transient Neonatal Diabetes Mellitus Attributable to a Nonspecific Mutation in the ABCC8 Gene

Neonatal diabetes mellitus (NDM) is defined as hyperglycemia that persists for more than 2 weeks and requires insulin therapy. NDM principally occurs before 6 months of age. Transient NDM (TNDM) is a clinical form of NDM that persists for a median of 12 weeks and resolves completely by 18 months. However, it may relapse as type 2 DM during early adulthood. The major causes of TNDM are mutations in chromosome 6q24 or the KCNJ11 or ABCC8 genes; the latter encode the two subunits of the pancreatic adenosine triphosphate (ATP)-sensitive potassium channel (KATP-channel). This condition responds well to oral sulfonylurea therapy. Herein, we report a neonate who was small for gestational age and exhibited TNDM symptoms. Genetic analysis revealed a nonspecific mutation in ABCC8; he was successfully treated with oral sulfonylurea.

Computer tomography in diagnostics and treatment of inflammatory complications of diverticular disease of the colon

AIM: to evaluate the role of computed tomography (CT) in the treatment and diagnostic algorithm in patients with complicated diverticular disease (CDD).PATIENTS AND METHODS: during the period from 2014 to 2020, 165 hospitalized patients with complications of CDD included in the study. Fifteen (9.1%) patients were hospitalized for elective indications and 150 (90.9%) as emergencies. The indications for hospitalization were inflammatory complications of CDD. Computed tomography with intravenous contrast was performed in 89 (53.9%) patients. The study was performed on a 64-slice CT “Philips Brilliance 64” with intravenous bolus injection of a low-osmolar iodine-containing contrast agent. The absence of the CT in the remaining patients is due to the presence of classical symptoms of acute diverticulitis with a previously verified diagnosis of CDD, the presence of an informative transabdominal ultrasound, as well as the refusal of patients from CT.RESULTS: the CT allowed to verify the presence of diverticula in the patients, to reveal the distinctive CT signs and pathognomonic symptoms of inflammatory complications of CDD, as well as to establish the severity of the complications that occurred. The specific signs of the destruction of the diverticulum and the complications developed were abdominal mass, abscess, peritonitis, and fistula. Besides the diagnostic value, CT scan permitted to choose the treatment approach and to clarify indications for surgery. Besides that, some CDD complications revealed by CT were considered as a predictor of ineffectiveness of conservative treatment, which requires surgery.CONCLUSION: CT is a valuable diagnostic method for CDD which allows to determine timely the clinical form of inflammatory complication, to find out indications for surgery and to predict high risk of recurrence.

Side Effects After Vaccination Using the Pfizer-Biontech (Bnt162b2) Against Sars-Cov-2 in the Young Adults

Background: In order to limit the spread of the SARS-CoV-2 virus, national immunization programs have started in many countries. Vaccinations are effective in preventing infection and severe clinical form of COVID-19, which affects 15% of patients. Despite the high efficacy of The Pfizer-BioNTech (BNT162b2) vaccine, the characterization of side effects in age-stratified populations is still not exhaustive in the literature.Aim: The aim of our study is to determine what side effects affect the population of young adults following vaccination with the Pfizer-BioNTech vaccine (BNT162b2).Material and methods: An anonymous survey was conducted. People vaccinated with two doses of the SARS-CoV-2 vaccine (BNT162b2) were qualified for the study. The Paired Wilcoxon and Fisher's exact tests were used for statistical analysis.Results: The main side effects after the first dose were increased pain, pain and swelling at the injection site. After the 2nd dose, the dominant side effects were weakness, fever and headache. In the case of the 2nd dose, no difference in side effects was observed between those who suffered of COVID-19 and those who had no symptoms of COVID-19 in their past medical history.

Physical Disabilities and Individual Vulnerability: Perspectives in Hyperendemic Municipalities for Leprosy

Introduction: Epidemiological, operational and socio-demographic data on leprosy, as well as its direct and indirect impact on the affected person, his/her family, and community, are included in the group of neglected diseases. Objective: To analyze the association between the occurrence of physical disabilities in leprosy cases and individual vulnerability in hyperendemic municipalities. Methodology: population-based cross-sectional study of leprosy cases reported from 2001 to 2014 in two municipalities of Piauí/Brazil. Interviews and descriptive, bivariate and multivariate analyses were conducted to study eventual associations. Results: Of the 603 cases evaluated, the most frequent were female (52%), brown (46%), with low schooling, married/united (50%) and retired (28%). A significant proportion of cases was multibacillary (46%), Virchowian clinical form (14%), reactional episodes (20%), disability degree I or II (70%). The explanatory variables for the presence of some degree of physical disability were gender, age group, perceived health, operational classification, clinical form, and hypertension (p<0.05). Conclusion: The physical disabilities caused by leprosy involve, in addition to dermatoneurological damage, psychological damage resulting from the strong stigma they produce. This result reinforces the need for differentiated care and nursing in disability prevention, physical rehabilitation and psychological follow-up to ensure comprehensive care.

Orofacial myofunctional disorder characteristics in cerebral palsy and their treatment methods

Relevance. The variety of clinical manifestations of orofacial myofunctional disorders in cerebral palsy determines the need to improve diagnosis and treatment approaches. According to the authors, the planning of rehabilitation measures for children with cerebral palsy and orofacial pathology should be individual.Materials and methods. 120 children (mean age 8.7 years) with cerebral palsy and orofacial myofunctional disorders participated in the study with subsequent assessment of dental and neurological statuses during treatment, prevention and rehabilitation.Results. The study established correlations between general motor pathology, malocclusion and changes in the speech organs depending on the clinical form of cerebral palsy. Spastic dysarthria and anarthria were detected in 82 cases, age-appropriate speech and language development - in 38. Occlusion assessment revealed malocclusion in 88 subjects, neutral occlusion – in 32.Conclusions. Modern approaches to the treatment of malocclusion and orofacial myofunctional disorders in children with cerebral palsy allow increasing the effectiveness and quality of rehabilitation, organizing the sequence and continuity of specialist actions in a multidisciplinary rehabilitation team.

Main metabolic and toxic polyneuropathies in clinical practice

Polyneuropathies are diseases of the peripheral nervous system with lesions of motor, sensory or autonomic fibers which are encountered by attending physicians of almost all specialties in outpatient and clinical settings. To date, more than 100 different causes of polyneuropathies have been identified. Metabolic and toxic polyneuropathies are the most common in the group of secondary polyneuropathies. Diabetic, alcoholic, uremic, and drug-induced polyneuropathies take the leading place among these diseases. The main forms of diabetic polyneuropathy are presented. The main clinical form is distal symmetrical polyneuropathy. Clinical symptoms depend on the type of fibers involved in the pathological process - thin or thick. There is an assessment scale in points to determine the severity of diabetic polyneuropathy, which helps in clarifying the diagnosis and prognosis of the disease. The next most frequent among metabolic polyneuropathies is uremic polyneuropathy as the most frequent complication in patients suffering from chronic renal insufficiency. Risk factors of uremic polyneuropathy development, clinical picture, the course of the disease are described. Within the framework of toxic polyneuropathies, the main place is given to alcoholic polyneuropathies, chemotherapy-induced, and drug-induced. For each of these categories, clinical forms and pathophysiology of development are described. For all polyneuropathies, the main diagnostic aspects are presented. The main therapeutic approaches are shown. A separate place is given to the use of alpha-lipoic acid.

Molecular epidemiology of Paracoccidiodes spp. recovered from patients with paracoccidioidomycosis in a teaching hospital from Minas Gerais State of Brazil

Introduction Paracoccidioidomycosis (PCM) is caused by several species of the Paracoccidioides genus which can be differentiated by interspecific genetic variations, morphology and geographic distribution. Intraspecific variability correlation with clinical and epidemiological aspects of these species still remains unclear. This study aimed to sequence the loci GP43, exon 2 and ARF of 23 clinical isolates of Paracoccidioides spp. from patients in the Southeast Region of Brazil. Methodology and main findings GenBank was used to compare the present (23) with previous described sequences (151) that included ARF and GP43. It was identified a high polymorphism rate among the 23 isolates in comparison to the other 151. Among the isolates, 22 (95,66%) were S1/P. brasiliensis and 1 (4,34%) was identified as PS2/P. americana. A total of 45 haplotypes were found as follows: 19 from S1/P. brasiliensis (13 from the present study), 15 from P. lutzii, 6 from PS2/P. americana (1 from the present study), 3 from PS3/P. restrepiensis and 2 from PS4/P. venezuelensis. Moreover, exclusive haplotypes according to clinical origin and geographical area were found. S1/P. brasiliensis (HD = 0,655 and K = 4,613) and P. lutzii (HD = 0,649 and K = 2,906) presented the highest rate of polymorphism among all species, from which 12 isolates of the present study were clustered within S1b/P. brasiliensis. The GP43 locus showed a higher variability and was found to be the main reason for the species differentiation. Conclusions The results herein decribed show a high intraspecific genetic variability among S1/P. brasiliensis isolates and confirm the predominance of this species in the Southeast region of Brazil. The finding of exclusive haplotypes according to clinical origin and geographical area would suggest correlation between the molecular profile with the clinical form and geographic origin of patients with PCM.

Clinical Spectrum of Schistosomiasis: An Update

Schistosomiasis is a helminthic infection and one of the neglected tropical diseases (NTDs). It is caused by blood flukes of the genus Schistosoma. It is an important public health problem, particularly in poverty-stricken areas, especially those within the tropics and subtropics. It is estimated that at least 236 million people worldwide are infected, 90% of them in sub-Saharan Africa, and that this disease causes approximately 300,000 deaths annually. The clinical manifestations are varied and affect practically all organs. There are substantial differences in the clinical presentation, depending on the phase and clinical form of schistosomiasis in which it occurs. Schistosomiasis can remain undiagnosed for a long period of time, with secondary clinical lesion. Here, we review the clinical profile of schistosomiasis. This information may aid in the development of more efficacious treatments and improved disease prognosis.

Expression of CD80 and HLA-DR molecules on blood monocytes in patients with pulmonary tuberculosis

We examined expression pattern of CD80 and HLA-DR pro-inflammatory molecules on the monocytes in patients with pulmonary tuberculosis (TB), depending on the clinical form of the disease and susceptibility of the pathogen to anti-tuberculosis drugs. The study involved forty-five patients with newly diagnosed pulmonary TB (25 men and 20 women aged 18 to 55 years, average age — 44.0±12.4 years). The control group included 15 healthy donors with similar socio-demographic characteristics as in TB patients. Venous blood was used as biomaterial for assays. Studies of the monocyte immunophenotype were carried out by flow cytometry of whole blood cells using Cytoflex flow cytometer (Beckman Coulter, USA) with specific monoclonal antibodies (eBioscience, USA). We determined the content of cells expressing surface markers of monocytes, i.e., CD14, CD45, CD80, and HLA-DR. The results of this study were evaluated using SPSS Statistics 17.0 standard software package and Microsoft Excel. In the course of the study, we have suggested a working hypothesis that the monocytes in TB patients, still being in circulation, can express activation markers during their migration to inflammation focus, especially CD80 and HLA-DR molecules. Analysis of the total CD14+ monocyte number showed its decrease in all forms and variants of clinical course of pulmonary tuberculosis compared with the control group. Assessment of pro-inflammatory markers expressed on CD14 positive monocytes, i.e., HLA-DR activation marker and CD80 co-stimulatory molecule, showed that the number of monocytes with HLA-DR expression in all TB patients was higher than in healthy donors. HLA- DR expression on CD14+ monocytes in the group of patients with infiltrative TB proved to be 15% higher than in patients with disseminated TB. The expression of CD80 on CD14+ monocytes in TB patients showed no differences between the groups and varied within the normal range. Hence, an imbalance within monocyte population in patients with pulmonary tuberculosis, regardless of its clinical form and drug sensitivity of the pathogen is developed, due to decrease in total number of CD14+ cells, along with increased relative number of monocytes expressing HLA-DR activation marker (pro-inflammatory phenotype). Meanwhile, expression of the CD80 co-stimulatory molecule on monocytes was within normal values.