Anatomopathological findings of Testudines necropsied in the Distrito Federal, Brazil

ABSTRACT: In order to determine the main anatomopathological findings of Testudines necropsied in the Distrito Federal, all necropsy records performed at the “Laboratório de Patologia Veterinária” of the “Universidade de Brasília” (LPV-UnB) on Testudines during the period from January 2008 to July 2020 were reviewed. The 72 cases reviewed were grouped and classified according to species, sex, origin, season of occurrence, and diagnosis. In 69.44% of the cases the species was informed in the necropsy protocols, which included Phrynops geoffroanus (38%), Trachemys dorbigni (36%), Chelonoidis carbonaria (14%), Chelonoidis denticulata (10%) and Podocnemis expansa (2%). In 30.55% of the cases this parameter was not informed and were classified only as Testudines. In 41.66% of the cases the sex was informed, being female 22.22%, male 19.44%, and 58.33% were not informed. Of these animals 79.16% were from environmental agencies and 20.84% from zoos and/or guardians. In 70.83% of the animals analyzed they were directly related to the autumn and winter seasons, with June being the most frequent month (29.17%). The conclusive diagnosis was possible in 68.05% of the cases. The category of disorders caused by injurious agents (48.97%) was the most prevalent, followed by inflammatory disorders (32.65%) and nutritional and metabolic disorders (28.57%). The main diagnoses were carapace and/or plastron fracture with 30.61%, hepatic steatosis (20.40%) and pneumonia (10.22%). Most cases of carapace or plastron fracture and hepatic steatosis occurred in animals from environmental agencies.

Dermoscopy as a diagnostic tool to differentiate between tinea pedis and plantar psoriasis

<p><strong>Background</strong>: Clinical differentiation between tinea pedis and plantar psoriasis may sometimes be challenging, with consequent diagnostic delays and unnecessary therapies; in such cases histopathological analysis helps to differentiate the 2 conditions. In this study we used a dermoscope as a non-invasive tool to investigate the significance of specific dermoscopic features and to improve their non-invasive differentiation.</p><p><strong>Methods:</strong> A clinical diagnosis of plantar psoriasis/tinea pedis was made on basis of accepted literature and proved by histopathology. Image capturing was performed using a dermoscope. Based on combination of history, clinical, and dermoscopic examination conclusive diagnosis with specific dermoscopic features for each disease was achieved.</p><p><strong>Results:</strong> The 15 patients of biopsy proven tinea pedis and 17 patients of biopsy proven plantar psoriasis were selected. We found that the presence of whitish powdery scales located in the furrows with apparently uninvolved skin in between was significant in tinea pedis whereas the presence of silvery white scales on a pinkish red erythematous background with regularly distributed red dots was significant in plantar psoriasis.</p><p><strong>Conclusions:</strong> Dermoscopy showed significant patterns in tinea pedis and plantar psoriasis due to their well-known different histological and physio pathological background, with white diffuse scales reflecting the dry and hyperkeratotic nature of plantar psoriasis and the red dots signifying the pin point blood vessels seen clinically as Auspitz sign. The peculiar scaling in tinea pedis might result from the predilection of dermatophytes to proliferate in moist environment, such as the furrows.</p>

Clinicopathological study of non-granulomatous necrotizing lymphadenopathies

Non-granulomatous necrotizing lymphadenopathy (NGNL) is not a specific entity. It is seen in various conditions like Kikuchi-Fujimoto disease (KFD), Systemic Lupus Erythematosus (SLE), tuberculosis, lymphoma/metastasis and lymph node infarction. These conditions mimic each other histologically but it is necessary to identify the correct pathology as the treatment differs significantly. To highlight the subtle morphological features which lead to the etiological diagnosis in NGNL. The lymphnode biopsies (N=198), reported in our institute as NGNL, over 4½ year study period, were retrieved. Of these, the benign cases were 64 in total, with 40 cases of KFD and 8 cases of SLE. H&E, special stains and immunohistochemistry slides were reviewed by two pathologists. Histomorphological features like amount of necrosis, apoptotic debris, vasculitis, presence of neutrophils, eosinophils, histiocytes, plasma cells, hematoxylin bodies, Azzopardi phenomenon and thrombus formation were studied. Logistic regression analysis was performed to identify the most significant histopathological parameter with each disease. Kendall’s Tau matrix plot analysis was used to measure the correlation between the disease and the histopathologic variables. Features like vasculitis, hematoxylin bodies and Azzopardi phenomenon showed strong correlation with SLE and inverse correlation with KFD. Apoptotic debris, paucity of neutrophils and eosinophils had a strong positive association with KFD. The histological features help in differentiating the various entities associated with NGNL. It is necessary to correlate with clinical details and various laboratory parameters to reach a conclusive diagnosis because these conditions have varied treatment modalities.

Moyamoya disease

Background: Moyamoya disease (MMD) is a rare pathology caused by a progressive unilateral or bilateral stenosis of the terminal portion of the internal carotid artery, leading to the development of collateral vessels. Case Presentation: We report a rare case of a 46-year-old male, born in the city of São Paulo, Brazil, with sudden muscular strength deficit and right hemiparesis, associated with headache and emesis. A priori, the initial diagnosis was arteriovenous malformation (AVM) after performing a series of complementary tests during the patient’s follow-up, also considering the clinical picture similar to that of Moyamoya disease (MMD). The conclusive diagnosis of MMD was finally established when the magnetic resonance imaging (MRI) showed a network of tortuous and dilated collateral vessels, with a hazy “smoke cloud” aspect with stenosis of the M1 segment of the middle cerebral artery (MCA), branch of the artery internal carotid artery (ICA). Conclusion: The recommended treatment was surgical revascularization with extracranial-intracranial bypass, with a favorable prognosis to the patient.

A heuristic model for cephalometric diagnosis of sagittal dysplasia

Objective: To identify the best-suited cephalometric parameter for assessing the sagittal skeletal discrepancy in the Indian population. Design: An in vitro, observational, single-blinded, retrospective study. Setting: Department of Orthodontics and Dentofacial Orthopaedics. Methods: A total of 94 lateral cephalograms were used in this study. The study involved one key person and two examiners. The key person collected the radiographs, coded, analysed and classified them into three groups (skeletal classes I, II and III). Subsequently, the coded radiographs were independently analysed by the two examiners. They classified the cases by matching a minimum of 6 out of 11 parameters. On completion of diagnosis by the examiners, the samples were decoded and matched with the original diagnosis given by the key person. The samples in which identification of a particular cephalometric parameter matched the original evaluation as given by the key person was regarded as correctly diagnosed. The number of correctly assessed cases was used to judge the diagnostic performance of all the parameters in all the cases. Cross-validation of the method was performed, and a diagnostic algorithm was developed for diagnosis. Results: β angle and Pi angle showed a positive predictive value of 1 in both skeletal class I and II cases. ANB angle, W angle and HBN angle showed a positive predictive value of 1 in skeletal class III cases. Conclusion: No single cephalometric parameter can independently be used to diagnose sagittal skeletal discrepancy in all cases. However, a conclusive diagnosis on the type of sagittal skeletal malocclusion can be made by using a simple and easy to use diagnostic algorithmic process having a combination of cephalometric parameters.

A rare cause of postpartum vaginal bleeding

Background Invasive mole is a trophoblastic disease (GTD) caused by trophoblast cells invading the myometrium during pregnancy. The GTD range also includes mole hydatidiform, choriocarcinoma, and placental site trophoblastic tumor (PSTT). Invasive moles are most common following molar pregnancies; however, they can even rarely occur after a full-term birth. Despite the fact that pathology is the only way to make a clear diagnosis, clinic and radiologic evaluation can be helpful. We wanted to highlight a rare incidence of invasive mole following a healthy full-term delivery in this case. Case presentation A 28-year-old female patient presented with intermittent prolonged severe vaginal bleeding for 2 weeks after a term healthy vaginal delivery. In workup, beta human chorionic gonadotropin levels (b-hCG) value was 7540 mIU/ml. After suspicion of gestational trophoblastic neoplasm (GTN), the patient was sent to ultrasonography (US) and magnetic resonance imaging (MRI). GTN was confirmed by radiological and clinical findings, and a conclusive diagnosis of an invasive mole was made histopathologically. Conclusion Invasive mole should be considered in the differential diagnosis in patients with postpartum bleeding and a persistently high b-hCG level after a healthy term delivery.

Paracoccidioidomycosis in an Elderly Simulating Cholangiocarcinoma

Paracoccidioidomycosis, the most prevalent deep mycosis in Latin America, is caused by dimorphic species of the genus Paracoccidioides, affects predominantly male rural workers between 30-50 years of age and is an important cause of morbidity and mortality. It can present in two clinical forms: acute/subacute or chronic. In rare cases paracoccidioidomycosis may simulate neoplasia and must be considered as a differential diagnosis of intra-abdominal tumors in endemic areas. We report an exuberant case of subacute paracoccidioidomycosis in an elderly lady, although it is more frequent in the juvenile form. Multiple facial skin lesions were associated with a wasting syndrome and extensive adenopathy including in the hepatic area, causing bile duct dilatation simulating a cholangiocarcinoma. Skin histopathology was diagnostic and antifungal treatment allowed complete resolution of cutaneous and systemic lesions, thus highlighting the merit of the dermatologist, who was fundamental for the conclusive diagnosis and institution of specific therapy, resulting in a favorable outcome.

Combined use of two rapid tests for the conclusive diagnosis of Chagas disease: a systematic scoping review

ObjectiveThe goal of this systematic scoping review is to collect and summarise scientific evidence regarding the validity of two simultaneous immunochromatographic tests for the conclusive diagnosis of Chagas disease. The research was informed by the following review questions: Will the use of two rapid tests be a valid method for the definitive diagnosis of Chagas disease when compared with conventional serological tests? In what type of population has the operation of two rapid tests been tried for the diagnosis of Chagas disease? What are the biomedical and public health advantages of the diagnostic method resulting from the combination of two rapid tests over the conventional serological method? Will it be a cost–benefit strategy for the diagnosis of Chagas with respect to conventional serological tests?DesignSystematic scoping review.SettingA search of the published and unpublished literature in five databases was carried out, in order to identify, screen and select the studies included in this review.Results468 studies were identified, of which 46 were screened with a full-text reading, and finally, three articles were included in the review. All studies were in endemic countries with adult and paediatric populations (n=1133) and, together, they evaluated four different rapid tests. The rapid tests showed good sensitivity (97.4%–100%) and specificity (96.1%–100%) for the diagnosis of Chagas when used in combination and compared with the reference tests.ConclusionsThe simultaneous use of at least two immunochromatographic rapid tests is a valid option for the definitive diagnosis of chronic Chagas in endemic rural areas, as long as there are studies that previously evaluate their performance on the areas of implementation. Therefore, this could be an alternative to the current diagnostic standard. However, additional studies are still needed in more countries in order to provide further evidence and to investigate the cost–benefit.

Titanium Allergy Caused by Dental Implants: A Systematic Literature Review and Case Report

(1) Background: Hypersensitivity reactions to metals may arise in predisposed patients chronically exposed to metallic materials, including dental implants made of titanium alloys. The purpose of this article was to systematically review titanium allergy manifestations in patients treated with dental implants and report a clinical case; (2) Methods: A systematic electronic search was performed for articles published in the English language until July 2021. The following eligibility criteria were adopted: (1) Population: individuals undergoing titanium and/or titanium alloy implant-supported rehabilitations; (2) Exposure: peri-implant soft tissue reactions attributable to implant insertion; (3) Outcome: evidence of titanium allergy, diagnostic methods, and forms of resolution; (3) Results: The included studies, in summary, presented evidence that titanium should not be considered an inert material, being able to trigger allergic reactions, and may be responsible for implant failure. A 55-year-old male patient received 3 implants in the posterior region of the left mandible and presented an epulis-like lesion developed from the peri-implant mucosa. The immunohistochemical analysis of the biopsy specimen confirmed the initial diagnosis of allergic reaction to titanium; (4) Conclusions: Although the evidence is weak, and titanium allergy has a low incidence, hypersensitivity reactions should not be underestimated. A rapid and conclusive diagnosis is mandatory to prevent further complications.

The diagnostic accuracy and era for improvement for frameless stereotactic brain biopsy: a series of 109 procedures and a systemic review

PurposeTo evaluate the diagnostic accuracy of frameless stereotactic brain biopsy and review the era for improvement.MethodsThis is a prospectively collected cohort study from 2007 to 2020. We reviewed patients who received frameless stereotactic brain biopsy in Prince of Wales Hospital and evaluated the diagnostic accuracy of the frameless stereotactic brain biopsy procedures. The biopsy result was classified into conclusive, inconclusive or negative, based on the pathological, radiological and clinical diagnosis concordance. For inconclusive or negative results, we further evaluated the pre-operative planning and post-operative imaging to review if further improvement could be made. The complication rate of symptomatic hemorrhage and mortality rate was also analyzed.ResultsThere were 106 patients with 109 biopsy procedures performed from 2007 to 2020. The conclusive diagnosis was reached in 103 (94.5%) procedures. The inconclusive diagnosis was noted in four (3.7%) procedures and negative diagnosis was yielded in two (1.9%) procedures. Symptomatic hemorrhage was noted in one patient (0.9%). There was no mortality case (0.0%) in our case series. The registration errors occurred in three cases (2.8%), sampling of the non-representative part of the lesion occurred in two cases (1.8%), and one biopsy (0.9%) for lymphoma was negative after the commencement of steroids. Systemic review showed that the diagnostic accuracy under the structurally defined diagnosis criteria was comparable with published literatures in recent ten years.ConclusionThe stereotactic biopsy is a safe procedure with high diagnostic accuracy only if meticulous pre-operative planning and careful intra-operative registration is performed. The common pitfalls precluding a conclusive diagnosis are errors during registration and non-representative biopsy sites.