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BACKGROUND: Snakebite is a neglected global health problem with high morbidity. We describe compartment syndrome (CS) cases related to snakebites by Bothrops spp. METHODS: The medical records of patients admitted with snakebites envenomation were reviewed. RESULTS: Of 47 patients with Bothrops spp. envenomation (4 male; mean age: 42 years), 7 (15%) developed CS. The mean time to antivenom administration was 9.5 hours. The time to fasciotomy was variable. Seven patients developed infection and four had acute kidney injury. CONCLUSIONS: The incidence of CS is higher than that reported previously. This may be due to the clinical severity and long delay before administering antivenom.

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ABSTRACT Background: Snakebite is a neglected global health problem with high morbidity. We describe compartment syndrome (CS) cases related to snakebites by Bothrops spp. Methods: The medical records of patients admitted with snakebites envenomation were reviewed. Results: Of 47 patients with Bothrops spp. envenomation (4 male; mean age: 42 years), 7 (15%) developed CS. The mean time to antivenom administration was 9.5 hours. The time to fasciotomy was variable. Seven patients developed infection and four had acute kidney injury. Conclusions: The incidence of CS is higher than that reported previously. This may be due to the clinical severity and long delay before administering antivenom.

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The purpose of this study is to analyse the effect of 12 weeks of non-linear resistance training (NLRT) on anthropometry, muscle strength and inflammatory biomarkers in persons infected with human immunodeficiency virus (PIHIV). Thirty previously sedentary PIHIVs were randomized into the NLRT (n = 15) and control (CON, n = 15) groups. NLRT group were submitted to 12 weeks of training, whereas the CON group maintained their daily habits. At baseline and after 12 weeks, both groups underwent anthropometric evaluations and blood sampling for the analysis of inflammatory biomarkers. Analysis of covariance using preintervention values as covariate was performed to determine the effects of exercise on anthropometry, muscle strength, cytokines levels and T cells. Significance was set at p < 0.05. After 12 weeks of intervention, there was a decrease in subcutaneous body fat (p < .0001), neck, abdomen and waist circumferences (p < .05), waist-to-hip ratio (p = .009), blood levels of interleukin (IL)-1ß (p = .029), IL-6 (p = .005), IL-8 (p = .010), and tumour necrosis factor (TNF)-α (p = .001) and an increase in muscle strength (p < .0001), IL-10 levels (p = .030) and CD4(+) (p = .004) and CD8(+) (p < .0001) counts in the NLRT compared to CON group. Twelve weeks of NLRT promoted positive changes in the body fat, body circumferences, muscular strength and inflammatory profile in PIHIV.

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O objetivo do estudo foi verificar o efeito de 12 semanas de treinamento físico resistido periodizado sobre os perfis glicêmico, lipídico, imunitário, antropométrico e força muscular em um paciente vivendo com HIV e lipodistrófico. O indivíduo do estudo era do sexo masculino, 46 anos, etnia branca, diagnosticado há 17 anos com HIV e há 3 anos com lipodistrofia; o mesmo foi submetido a 12 semanas de treinamento físico resistido periodizado de forma ondulatória diária (TRPO), três vezes por semana. Antes e após este período foram realizadas avaliações antropométrica, bioquímica, imunitárias e de força muscular. Após TRPO, houve diminuição das circunferências de pescoço, peito, abdômen, percentual de gordura, massa gorda, bem como de gorduras subcutânea total, central e periférica. Concomitantemente houve aumento das circunferências de quadril, braços, coxas e panturrilhas, além do aumento de massa muscular. Houve diminuição nos níveis de glicemia de jejum, triglicerídeos, colesterol total, LDL-colesterol, HB1AC, monócitos e aumento do HDL-colesterol, leucócitos, linfócitos, neutrófilos, monócitos e plaquetas. Como conclusão demonstramos que 12 semanas de TRPO foi benéfico e seguro no tratamento das desordens metabólicas e antropométricas em um paciente vivendo com HIV lipodistrófico.(AU)

The purpose of the study was to evaluate the effect of 12 weeks of resistance exercise training periodization on the glycemic, lipid, immune, muscular strength and anthropometric profiles in a patient living with HIV and lipodystrophy. The subject of the study was male, 46 years old, white ethnicity, diagnosed 17 years ago with HIV and 3 years with lipodystrophy; the same was submitted to 12 weeks of daily undulating resistance training (DUPRT) three times per week. Before and after this period were conducted anthropometric, biochemical, immune and muscle strength. After DUPRT, there was reduction in neck, chest and abdomen circumferences, fat percentage, fat mass and total, central and peripheral subcutaneous fat. Concurrently there was an increase of hip, arms, thighs and calves circumferences, and increased muscle mass. There was a decrease in fasting glucose levels, triglycerides, total cholesterol, LDL-cholesterol, Hb1Ac, monocytes and increased HDL-cholesterol, white blood cells, lymphocytes, neutrophils, monocytes and platelets. In conclusion we demonstrated that 12 weeks of TRPO was beneficial and safe in the treatment of metabolic and anthropometric disorders in a patient living with HIV and lipodystrophy.(AU)

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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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Aplastic anemia is a bone marrow failure syndrome characterized by peripheral cytopenias and hypocellular bone marrow. Although aplastic anemia is idiopathic in most cases, rheumatic diseases such as systemic lupus erythematosus are recognized as causes of aplastic anemia, with their possible etiological mechanisms being T and B lymphocyte dysfunction and pro-inflammatory cytokines and autoantibody production directed against bone marrow components. In the course of the human immunodeficiency virus infection/acquired immunodeficiency syndrome, the identification of autoantibodies and the occurrence of rheumatic events, in addition to the natural course of systemic lupus erythematosus which is modified by immune changes that are characteristic of human immunodeficiency virus infection/acquired immunodeficiency syndrome, make the diagnosis of systemic lupus erythematosus challenging. This study reports the case of a woman with acquired immunodeficiency syndrome treated with a highly active antiretroviral therapy, who had prolonged cytopenias and hypocellular bone marrow consistent with aplastic anemia. The clinical picture, high autoantibodies titers, and sustained remission of the patient's hematological status through immunosuppression supported the diagnosis of systemic lupus erythematosus-associated aplastic anemia. This is the first report of aplastic anemia concurrent with systemic lupus erythematosus and acquired immunodeficiency syndrome, providing additional evidence that immune dysfunction is a key part of the pathophysiological mechanism of aplastic anemia.

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Aplastic anemia is a bone marrow failure syndrome characterized by peripheral cytopenias and hypocellular bone marrow. Although aplastic anemia is idiopathic in most cases, rheumatic diseases such as systemic lupus erythematosus are recognized as causes of aplastic anemia, with their possible etiological mechanisms being T and B lymphocyte dysfunction and pro-inflammatory cytokines and autoantibody production directed against bone marrow components. In the course of the human immunodeficiency virus infection/acquired immunodeficiency syndrome, the identification of autoantibodies and the occurrence of rheumatic events, in addition to the natural course of systemic lupus erythematosus which is modified by immune changes that are characteristic of human immunodeficiency virus infection/acquired immunodeficiency syndrome, make the diagnosis of systemic lupus erythematosus challenging. This study reports the case of a woman with acquired immunodeficiency syndrome treated with a highly active antiretroviral therapy, who had prolonged cytopenias and hypocellular bone marrow consistent with aplastic anemia. The clinical picture, high autoantibodies titers, and sustained remission of the patient's hematological status through immunosuppression supported the diagnosis of systemic lupus erythematosus-associated aplastic anemia. This is the first report of aplastic anemia concurrent with systemic lupus erythematosus and acquired immunodeficiency syndrome, providing additional evidence that immune dysfunction is a key part of the pathophysiological mechanism of aplastic anemia.

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