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BACKGROUND: The subjective global assessment (SGA) is a powerful tool for nutrition status assessment. Our aim was to compare vitamin C serum levels among patients classified as A, B, or C in the SGA. METHODS: One hundred-and-fifty adults in the wards of the University Hospital participated in this study. Besides SGA, all cases were submitted to anthropometry, bioelectrical impedance analysis (BIA), and 24-hour dietary recall. Laboratory data included blood hemoglobin, serum ferritin, serum albumin, transferrin, C-reactive protein (CRP), and vitamin C. Acute phase response was defined by serum CRP > 0.5 mg/dL; low serum vitamin C was defined by serum levels < 0.4 mg/dL. Analysis of variance and χ2 tests were used to compare groups; P < 0.05 was considered significant. RESULTS: Patients were diagnosed as SGA A (n = 76), B (n = 38), or C (n = 36) and showed different anthropometry and BIA. The same occurred, respectively, with vitamin C (median; range, in mg/day) intake (55.0; 4.7-140.6 vs 34.0; 10.3-244.2 vs 15.8; 2.3-124.0) and high (%) CRP (88.3 vs 65.8 vs 48.7) and low (%) vitamin C serum levels (21.1 vs 34.2 vs 63.9). CONCLUSION: Patients with worst nutrition parameters (SGA C) showed lower ascorbic acid serum levels than those classified as SGA A or B. These results are in accordance with reduced vitamin C intake and the presence of acute phase response.

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BACKGROUND The current common practice when using urine as a biomarker for vitamin excretion is to use a 24-hour sample for analysis. Due to the difficulty involved in this process, we attempted to find an alternative solution through the use of a single first morning void. The aim of our study was to investigate if there is a correlation between the first morning single void and the 24-hour collections of urines for the urine metabolite of niacin, N-1-methylnicotinamide (N1MN), and to test the reliability of utilizing a method using first morning single void collections corrected with the concentration of urine creatinine. MATERIAL AND METHODS All urine samples were collected from 30 healthy adult volunteers over the age of 18 years: 20 females and 10 males. Samples were collected after discarding the first morning urine and collecting every other urine voided during the next 24 hours including the first morning urine of the day after in 2 separate vessels. We analyzed the concentration of N1MN by high performance liquid chromatography and the concentration of creatinine by a commercial kit by spectrophotometry. The B3 excretion was expressed as the ratio of N1MN to creatinine. RESULTS We found a significant correlation between the ratios of first morning single void and 24-hour urines. When comparing males and females, the ratio demonstrated a significant correlation as well. CONCLUSIONS Our results demonstrated that it is possible to substitute a 24-hour collection with a first morning single void urine for the estimation of N1MN excretion.

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Up to now, over 200 patients with paracoccidioidomycosis (PCM) associated to HIV infection have already been reported; however, the central nervous system involvement in this coinfection was rarely reported. This paper presents a 35-year-old Brazilian male AIDS patient who developed pulmonary PCM successfully treated with itraconazole. At the antiretroviral therapy starting, he had 32 CD4(+) T cells baseline count and high viral load levels. After 9 months, he presented severe fungal meningoencephalitis diagnosed by sublenticular enhanced nodular lesion at computerized tomography and magnetic resonance brain imaging and a positive Paracoccidiodes brasiliensis smear and culture from cerebrospinal fluid. At the time, a sixfold increase in CD4(+) T cell count and undetectable viral load level were evidenced. The patient received amphotericin B during 1 year presenting slow but progressive clinical improvement, and he is currently asymptomatic and without neurological disabilities. To our knowledge, this is the second case report of a patient with neuroparacoccidioidomycosis associated to HIV infection.

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OBJECTIVE: To investigate the influence of the reprocessing technique of enzymatic bath with ultrasonic cleaning and ethylene oxide sterilization on the chemical properties and morphological structure of polymeric coatings of guide wire for regular guiding catheter. METHODS: These techniques simulated the routine of guide wire reprocessing in many hemodynamic services in Brazil and other countries. Samples from three different manufacturers were verified by scanning electron microscopy and X-ray photoelectron spectroscopy. RESULTS: A single or double sterilization of the catheters with ethylene oxide was not associated with morphological or chemical changes. However, scanning electron microscopy images showed that the washing method was associated with rough morphological changes, including superficial holes and bubbles, in addition to chemical changes of external atomic layers of polymeric coating surfaces, as detected by the X-ray photoelectron spectroscopy method, which is compatible with extended chemical changes on catheter surfaces. CONCLUSION: The reprocessing of the catheters with ethylene oxide was not associated with morphological or chemical changes, and it seemed appropriate to maintain guide wire coating integrity. However, the method combining chemical cleaning with mechanical vibration resulted in rough anatomical and chemical surface deterioration, suggesting that this reprocessing method should be discouraged.

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Saprophytic fungi are being increasingly recognized as etiologic agents of mycoses in immunosuppressed patients. We report a case of subcutaneous infiltration by Aureobasidium pullulans, likely due to traumatic inoculation, in a neutropenic patient during chemotherapy for chronic lymphocytic leukemia. The patient was treated with amphotericin B deoxycholate but was subsequently switched to itraconazole, which improved the lesion. This case highlights the importance of considering unusual fungal infections in critically ill patients such as those who are immunosuppressed due to chemotherapy. Diagnostic techniques and effective antifungal therapy have improved the prognosis of these cases.

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Saprophytic fungi are being increasingly recognized as etiologic agents of mycoses in immunosuppressed patients. We report a case of subcutaneous infiltration by Aureobasidium pullulans, likely due to traumatic inoculation, in a neutropenic patient during chemotherapy for chronic lymphocytic leukemia. The patient was treated with amphotericin B deoxycholate but was subsequently switched to itraconazole, which improved the lesion. This case highlights the importance of considering unusual fungal infections in critically ill patients such as those who are immunosuppressed due to chemotherapy. Diagnostic techniques and effective antifungal therapy have improved the prognosis of these cases.

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OBJECTIVE: To investigate the influence of the reprocessing technique of enzymatic bath with ultrasonic cleaning and ethylene oxide sterilization on the chemical properties and morphological structure of polymeric coatings of guide wire for regular guiding catheter. METHODS: These techniques simulated the routine of guide wire reprocessing in many hemodynamic services in Brazil and other countries. Samples from three different manufacturers were verified by scanning electron microscopy and X-ray photoelectron spectroscopy. RESULTS: A single or double sterilization of the catheters with ethylene oxide was not associated with morphological or chemical changes. However, scanning electron microscopy images showed that the washing method was associated with rough morphological changes, including superficial holes and bubbles, in addition to chemical changes of external atomic layers of polymeric coating surfaces, as detected by the X-ray photoelectron spectroscopy method, which is compatible with extended chemical changes on catheter surfaces. CONCLUSION: The reprocessing of the catheters with ethylene oxide was not associated with morphological or chemical changes, and it seemed appropriate to maintain guide wire coating integrity. However, the method combining chemical cleaning with mechanical vibration resulted in rough anatomical and chemical surface deterioration, suggesting that this reprocessing method should be discouraged.

OBJETIVO: Investigar a influência das técnicas de reprocessamento de banho enzimático com limpeza ultrassônica e a esterilização com óxido de etileno nas propriedades químicas e estruturas morfológicas de revestimentos poliméricos de fios-guia usados como guias em cateteres regulares. MÉTODOS: Estas técnicas simulam a rotina de processamento de fios-guia em muitos serviços de hemodinâmica do Brasil e de outros países. Amostras de três diferentes fabricantes foram verificadas por microscopia eletrônica de varredura e espectroscopia de fotoelétrons de raios-X. RESULTADOS: Uma única ou dupla esterilização dos cateteres com óxido de etileno não foi associada a mudanças químicas ou morfológicas. Contudo, imagens de microscopia eletrônica de varredura mostraram que o método de lavagem foi associado a intensas modificações morfológicas, incluindo bolhas e buracos superficiais, assim como mudanças nas ligações químicas das camadas atômicas externas do revestimento polimérico, conforme demonstrado por resultados de espectroscopia de fotoelétrons de raios-X, compatível com extensas modificações químicas induzidas por esse processo de lavagem. CONCLUSÃO: O reprocessamento dos fios-guia de cateteres com óxido de etileno não está associado a mudanças químicas e morfológicas dos mesmos e pode ser considerado adequado para manter a integridade destes materiais. Entretanto, o método que combina lavagem química com vibração mecânica resulta em intensas deteriorações anatômicas e químicas, sugerindo que esse método de processamento deve ser desencorajado.

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We report the case of a 35-year-old homeless alcoholic and illicit drug user, with AIDS, who was admitted to the emergency unit complaining of asthenia and a weight loss of 30 kg over the preceding three months. Clinical and laboratory data confirmed a diagnosis of marasmus, bacterial pneumonia, chorioretinitis caused by Toxoplasma gondii and oral Candida infection. The patient also presented loss of tongue papillae, gingival hypertrophy, perifollicular hyperkeratosis and hemorrhage, coiled, corkscrew-like hair, anemia, hypoalbuminemia, increased C-reactive protein levels and low serum vitamin C levels. The patient developed severe gastric hemorrhage, with hemodynamic instability and terminal disseminated intravascular coagulopathy.

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We report the case of a 35-year-old homeless alcoholic and illicit drug user, with AIDS, who was admitted to the emergency unit complaining of asthenia and a weight loss of 30kg over the preceding three months. Clinical and laboratory data confirmed a diagnosis of marasmus, bacterial pneumonia, chorioretinitis caused by Toxoplasma gondii and oral Candida infection. The patient also presented loss of tongue papillae, gingival hypertrophy, perifollicular hyperkeratosis and hemorrhage, coiled, corkscrew-like hair, anemia, hypoalbuminemia, increased C-reactive protein levels and low serum vitamin C levels. The patient developed severe gastric hemorrhage, with hemodynamic instability and terminal disseminated intravascular coagulopathy.

Relatamos o caso de um paciente alcoólatra e usuário de drogas ilícitas com 35 anos de idade, morador de rua com AIDS, admitido na Unidade de Emergência referindo astenia e perda ponderal de trinta quilos nos últimos três meses. Dados clínicos e laboratoriais confirmaram o diagnóstico de marasmo, pneumonia, corioretinite por Toxoplasma gondii e candidíase oral. Apresentava ainda: língua despapilada com hipertrofia gengival, hiperqueratose e hemorragia folicular associada a pêlos tipo saca-rolhas, anemia, hipoalbuminemia, aumento dos níveis de proteína C reativa com baixos níveis séricos de vitamina C. O paciente desenvolveu hemorragia gástrica grave, com instabilidade hemodinâmica e coagulação intravascular disseminada terminal.

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Estados de imunossupressão têm provocado mudanças na história natural da doença de Chagas com descrição de reativação da doença em pacientes com a Síndrome de Imunodeficiência Adquirida (AIDS), durante transplantes de órgãos e em quimioterapia de malignidades hematológicas. É relatado caso de reativação de doença de Chagas com meningoencefalite durante quimioterapia de linfoma não Hodgkin não relacionado a transplante de células-tronco hematopoéticas com tardia detecção de Trypanosoma cruzi em sangue e líquido cefalorraquidiano. Apesar de tratamento específico com benzonidazol, paciente morreu após oito dias. Alta suspeição clínica com abordagens diagnósticas sensíveis é fundamental para diagnóstico precoce e início de tratamento com objetivo de diminuir mortalidade.

Immunosuppression has caused changes in the natural history of Chagas' disease with reports of reactivation of the disease in acquired immune deficiency syndrome (AIDS) and organ transplant patients and during chemotherapy treatment in patients with hematological malignances. We report on a case of reactivation of Chagas' disease in a patient with meningoencephalitis during chemotherapy for non-Hodgkin's lymphoma without any relation to hematopoietic stem-cell transplantation and with late detection of Trypanosoma cruzi in blood and cerebrospinal fluid. Despite specific treatment with benznidazole, the patient died 8 days later. High clinical suspicion and sensitive diagnostic methods are fundamental for early diagnosis and initiation of treatment in order to minimize mortality.

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