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El síndrome de Sweet es un tipo de dermatosis neutrofílica infrecuente, caracterizado por un cuadro febril agudo con aparición de lesiones en piel tipo pápulas y placas eritematosas y dolorosas, con neutrofilia periférica acompañante, que mejora con el uso de corticoides. Se presenta el caso de una paciente de 22 años, con vitíligo como enfermedad de base, que acude por un cuadro de 1 semana de evolución de sensación febril no graduada y aparición insidiosa de lesiones en piel foto expuesta. Se realizó estudios laboratoriales e histopatológicos llegando al diagnóstico de síndrome de Sweet. Con los resultados de los estudios paraclínicos se inició tratamiento con corticoides sistémicos y tópicos con excelente respuesta.

Sweet syndrome is a rare type of neutrophilic dermatosis, characterized by an acute febrile picture with the appearance of painful erythematous papules and plaques on the skin, with accompanying peripheral neutrophilia, which improves with the use of corticosteroids. The case of a 22-year-old patient, with vitiligo as the underlying disease, is presented. She attended for a 1-week history of ungraded feverish sensation and insidious appearance of lesions on photo-exposed skin. Laboratory and histopathological studies were carried out, leading to the diagnosis of Sweet syndrome. With the results of the paraclinical studies, treatment with systemic and topical corticosteroids was started with an excellent response.

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La histoplasmosis es una enfermedad causada por el hongo dimorfo Histoplasma capsulatum, que involucra al tejido linfático, pulmones, hígado, bazo, glándulas suprarrenales, riñones y piel. En los últimos años ha emergido como una enfermedad oportunista, principalmente en aquellos individuos con inmunidad celular alterada, como es el caso de los pacientes con SIDA. Cerca de 70% de los pacientes sudamericanos con histoplasmosis y SIDA presenta lesiones cutáneas o mucosas. En Argentina y Paraguay, la histoplasmosis es la micosis sistémica más frecuente en individuos con infección por el VIH. Presentamos el caso de una paciente con diagnóstico de histoplasmosis sistémica cuya única manifestación es la lesión cutánea, confirmado con la anatomía patológica y, fundamentalmente, con el cultivo, constituyendo una presentación clínica inusual.

Histoplasmosis is caused by the dimorphic fungus Histoplasma capsulatum, which involves lymphatic tissue, lungs, liver, spleen, adrenal glands, kidneys, and skin. In recent years, it has emerged as an opportunistic disease, mainly in individuals with altered cellular immunity, as is the case of AIDS patients. About 70% of South American patients with histoplasmosis and AIDS have cutaneous or mucosal lesions. In Argentina and Paraguay, histoplasmosis is the most common systemic mycosis in individuals with HIV infection. We present the case of an patient diagnosed with systemic histoplasmosis whose only manifestation is a single skin lesion, confirmed by pathology and, fundamentally by culture, constituting an unusual clinic presentation.

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RESUMEN La lepra es una enfermedad causada por Mycobacterium leprae. Su evolución crónica a veces se ve interrumpida por cuadros inmunológicos llamados reacción leprosa en pacientes con alta carga bacilar. Estos cuadros inmunológicos incrementan la morbilidad y pueden complicarse, volviéndose potencialmente mortales. En el espectro de estas reacciones, se han descrito algunas caracterizadas por lesiones vasculo necróticas, como el Fenómeno de Lucio y el eritema nodoso lepromatoso necrosante, que son asociadas a la lepra lepromatosa difusa y a la especie de bacilos recién descripta, Mycobacterium lepromatosis. Presentamos un paciente de sexo femenino de 21 años de edad, que duranteel tratamiento específico para lepra multibacilar presentó cuadros recidivantes de eritema nudoso que evolucionó a la forma necrosante. En este paciente se precisó a través de la biología molecular la presencia simultánea de M. leprae y M. lepromatosis como causantes de la enfermedad. Este caso representa la primera comunicación de M. lepromatosis en el Paraguay, y también la primera infección dual como agente causante de lepra, en asociación con el M. leprae.

ABSTRACT Leprosy is a disease caused by Mycobacterium leprae. Its chronic evolution is sometimes interrupted by immunological conditions called leprosy reaction in patients with high bacillary load. These immunological conditions increase morbidity and can be complicated, becoming life threatening. In the spectrum of these reactions, some characterized by vasculonecrotic lesions have been described, such as Lucio's Phenomenon and Necrotizing Lepromatous Nodus Erythem, which are associated with diffuse lepromatous leprosy and the species of bacilli just described, Mycobacterium lepromatosis. We present a 21-year-old female patient, who during specific treatment for multibacillary leprosy presented recurrent pictures of erythema nodosum that evolved to the necrotizing form. In this patient, the simultaneous presence of M. leprae and M. lepromatosis as the cause of the disease was determined through molecular biology. This case represents the first communication of M. lepromatosis in Paraguay, and also the first dual infection as a causative agent of leprosy, in association with M. leprae.

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La lepra es una enfermedad causada por Mycobacterium leprae. Su evolución crónica a veces se ve interrumpida por cuadros inmunológicos llamados reacción leprosa en pacientes con alta carga bacilar. Estos cuadros inmunológicos incrementan la morbilidad y pueden complicarse, volviéndose potencialmente mortales. En el espectro de estas reacciones, se han descrito algunas caracterizadas por lesiones vasculo necróticas, como el Fenómeno de Lucio y el eritema nodoso lepromatoso necrosante, que son asociadas a la lepra lepromatosa difusa y a la especie de bacilos recién descripta, Mycobacterium lepromatosis. Presentamos un paciente de sexo femenino de 21 años de edad, que durante el tratamiento específico para lepra multibacilar presentó cuadros recidivantes de eritema nudoso que evolucionó a la forma necrosante. En este paciente se precisó a través de la biología molecular la presencia simultánea de M. leprae y M. lepromatosis como causantes de la enfermedad. Este caso representa la primera comunicación de M. lepromatosis en el Paraguay, y también la primera infección dual como agente causante de lepra, en asociación con el M. leprae.

Leprosy is a disease caused by Mycobacterium leprae. Its chronic evolution is sometimes interrupted by immunological conditions called leprosy reaction in patients with high bacillary load. These immunological conditions increase morbidity and can be complicated, becoming life threatening. In the spectrum of these reactions, some characterized by vasculonecrotic lesions have been described, such as Lucio's Phenomenon and Necrotizing Lepromatous Nodus Erythem, which are associated with diffuse lepromatous leprosy and the species of bacilli just described, Mycobacterium lepromatosis. We present a 21-year-old female patient, who during specific treatment for multibacillary leprosy presented recurrent pictures of erythema nodosum that evolved to the necrotizing form. In this patient, the simultaneous presence of M. leprae and M. lepromatosis as the cause of the disease was determined through molecular biology. This case represents the first communication of M. lepromatosis in Paraguay, and also the first dual infection as a causative agent of leprosy, in association with M. leprae.

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As liver cirrhosis worsens, sleep pattern impairment and related complaints increase. The objective of this study was to identify the prevalence of poor sleep, excessive daytime sleepiness, and increased risk for obstructive sleep apnea syndrome in adults with Child-Pugh Class A liver cirrhosis; to investigate the association between poor sleep quality, daytime sleepiness, and risk for obstructive sleep apnea syndrome; and to verify the relationship between these 3 variables and clinical, laboratory, and sociodemographic data. A cross-sectional study was conducted with 100 individuals at the outpatient clinic of a university hospital in the interior of Sao Paulo, Brazil. Questionnaires were used in the form of interviews and consultation of medical records. There was a prevalence of 35.0% of poor sleep quality, 29.0% of excessive daytime sleepiness, and 38.0% of high risk for obstructive sleep apnea syndrome, as well as a significant association between high risk for obstructive sleep apnea syndrome and poor sleep quality. There was no significant association between laboratory variables and sleep quality, daytime sleepiness, and high risk for obstructive sleep apnea syndrome. There is a high prevalence of poor sleep, excessive sleepiness, and high risk for obstructive sleep apnea syndrome, and poor sleep quality is related to a high risk for obstructive sleep apnea syndrome among patients with compensated liver cirrhosis.

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Cryptococcal infection results from inhalation of fungal spores and usually is confined to the lungs, but may disseminate systemically. Radiologically, cryptococcal infection has multiple forms of presentation. The diagnosis is usually based on fungal isolation from cultured clinical specimens. Long term antifungal therapy is recommended, but surgical procedures may eventually be necessary when large thoracic symptomatic masses are present. We report a case of a 41-year-old male, immunocompetent, investigating a palpable mass in the left supraclavicular region associated with unintentional weight loss over the last three months. He also reported chest pain in this period. Chest X-ray, ultrasonography, and computed tomography were performed, which diagnosed a mediastinal and left supraclavicular mass, interpreted as lymph node conglomerates of unknown etiology. He also underwent a biopsy of the left supraclavicular mass for etiological determination by histopathology, which confirmed cryptococcosis infection. Although very infrequent, mediastinal cryptococcal infection (simulating masses) is a challenging but important differential diagnosis of benign and malignant lesions, since its treatment is usually clinical.

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AIM AND OBJECTIVE: To analyse the association between napping, functional capacity and satisfaction with life in older adult residing in the community. METHOD: A cross-sectional population-based study using data from a health survey conducted in a city of the state of São Paulo. Information on sociodemographic and clinical variables was collected through a questionnaire, as well as the occurrence or not of napping and satisfaction with life. Functional capacity was assessed using the Katz Index and Lawton-Brody Scale. Statistical analysis was performed using the Rao-Scott chi-square test and a hierarchical analysis using stepwise backward multiple Poisson regression. p-Values <0.05 were considered significant. In this paper, we adhere to STrengthening the Reporting of OBservational studies in Epidemiology guidelines. RESULTS: There was predominance of the 60-69 years age group (51.3%) and of females (60.8%). The majority of the older adults (57.5%), of both sexes, reported napping. A higher prevalence of napping was found in the older subjects, the male sex, the subjects without children, those with health problems and those that were partially dependent in instrumental activities of daily living. CONCLUSIONS: The study showed that naps are prevalent in older adults. The need to identify the issues that permeate napping is emphasised, in order to promote health in individuals of this age group, before classifying the practice as beneficial or harmful. RELEVANCE TO CLINICAL PRACTICE: It is essential that health professionals, in their practices, consider the complaints and reports of naps in the elderly, in an attempt to detect and reduce possible consequences in activities of daily living.

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Broilers are traditionally managed with feeding programs that often consist of three or four phases. In this study we investigated whether a multiphase feeding program (14 phases) of broilers based on the optimal mix of two feeds could replace a traditional four phase system while maintaining broiler performance. To evaluate this prposed program we measured variables of performance, carcass yield, and nitrogen excretion. In addition, we determined if the multiphase feeding program (14 phases) would be equally effective regardless of bird gender. A total of 480 day-old Cobb chicks were used, with an average weight of 44.74 ± 0.16 g (females) and 44.71 ± 0.11 g (males). The birds were distributed in a completely randomized 2 × 2 factorial design. Each treatment consisted of six replicates with 20 animals per experimental unit. Results were analyzed separately in two periods (121 and 2242 days) as determined by slaughter date, as well as for the entire growth period (142 days). The multiphase program led to improvements in final body weight and average daily weight gain, in addition to an increase in breast yield.

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Broilers are traditionally managed with feeding programs that often consist of three or four phases. In this study we investigated whether a multiphase feeding program (14 phases) of broilers based on the optimal mix of two feeds could replace a traditional four phase system while maintaining broiler performance. To evaluate this prposed program we measured variables of performance, carcass yield, and nitrogen excretion. In addition, we determined if the multiphase feeding program (14 phases) would be equally effective regardless of bird gender. A total of 480 day-old Cobb chicks were used, with an average weight of 44.74 ± 0.16 g (females) and 44.71 ± 0.11 g (males). The birds were distributed in a completely randomized 2 × 2 factorial design. Each treatment consisted of six replicates with 20 animals per experimental unit. Results were analyzed separately in two periods (121 and 2242 days) as determined by slaughter date, as well as for the entire growth period (142 days). The multiphase program led to improvements in final body weight and average daily weight gain, in addition to an increase in breast yield.(AU)

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Objetivou-se com este experimento avaliar o efeito da inclusão de torta de mamona destoxificada (TMD) na ração de poedeiras comerciais sobre o desempenho e a qualidade interna e externa dos ovos. Foram utilizadas 200 poedeiras comerciais de 40 a 50 semanas de idade, da linhagem Hy-Line W-36®, com 1543±34g de peso corporal, que foram distribuídas em um delineamento inteiramente casualizado com cinco tratamentos (0, 5, 10, 15 e 20% de torta de mamona destoxificada na ração) com cinco repetições de oito aves cada. Foram avaliados o consumo de ração, a produção, o peso e a massa de ovos e a conversão alimentar. A qualidade interna foi avaliada por meio da unidade de Haugh, percentual de albúmen e de gema. A qualidade da casca foi medida pela espessura, densidade específica e percentual de casca. As variáveis de desempenho foram afetadas pela inclusão da TMD com resposta linear negativa para o consumo de ração e quadrática para produção de ovos, peso do ovo, massa do ovo e conversão alimentar, com os melhores níveis de 10,5, 5,7, 9,2 e 10,3% respectivamente. Não houve efeito significativo da inclusão da TMD para as variáveis de qualidade interna e externa dos ovos. Concluiu-se que a TMD pode ser incluída na ração de poedeiras em até 5,7% para otimizar o desempenho e não alterar a qualidade interna e externa dos ovos.(AU)

This experiment aimed to evaluate the use of detoxified castor cake (DCC) in the diet of laying hens on performance and internal and external quality of eggs. A total of 200 laying hens with 40-50 weeks of age, of Hy-Line W-36® line, with 1543±34g body weight, were distributed in a completely randomized design with five treatments (0, 5, 10, 15 and 20% of DCC in diet) with five replicates of eight birds each. The feed intake, egg production, egg weight, egg mass and feed conversion were evaluated. The egg internal quality was evaluated by Haugh unit, percentage of albumen and yolk. The shell quality was evaluated by the thickness, density and specific percentage of eggshell. The performance variables were affected by the inclusion of DCC with a negative linear response to food intake and quadratic for egg production, egg weight, egg mass and feed conversion, with the best levels of 10.5, 5.7, 9.2 and 10.3% respectively. There was no significant effect of DCC inclusion for the variables of egg quality. It is conclude that the DCC can be included in hens diets up to 5.7% to optimize performance and do not alter the internal and external quality of the eggs.(AU)

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Objetivou-se com este experimento avaliar o efeito da inclusão de torta de mamona destoxificada (TMD) na ração de poedeiras comerciais sobre o desempenho e a qualidade interna e externa dos ovos. Foram utilizadas 200 poedeiras comerciais de 40 a 50 semanas de idade, da linhagem Hy-Line W-36®, com 1543±34g de peso corporal, que foram distribuídas em um delineamento inteiramente casualizado com cinco tratamentos (0, 5, 10, 15 e 20% de torta de mamona destoxificada na ração) com cinco repetições de oito aves cada. Foram avaliados o consumo de ração, a produção, o peso e a massa de ovos e a conversão alimentar. A qualidade interna foi avaliada por meio da unidade de Haugh, percentual de albúmen e de gema. A qualidade da casca foi medida pela espessura, densidade específica e percentual de casca. As variáveis de desempenho foram afetadas pela inclusão da TMD com resposta linear negativa para o consumo de ração e quadrática para produção de ovos, peso do ovo, massa do ovo e conversão alimentar, com os melhores níveis de 10,5, 5,7, 9,2 e 10,3% respectivamente. Não houve efeito significativo da inclusão da TMD para as variáveis de qualidade interna e externa dos ovos. Concluiu-se que a TMD pode ser incluída na ração de poedeiras em até 5,7% para otimizar o desempenho e não alterar a qualidade interna e externa dos ovos.

This experiment aimed to evaluate the use of detoxified castor cake (DCC) in the diet of laying hens on performance and internal and external quality of eggs. A total of 200 laying hens with 40-50 weeks of age, of Hy-Line W-36® line, with 1543±34g body weight, were distributed in a completely randomized design with five treatments (0, 5, 10, 15 and 20% of DCC in diet) with five replicates of eight birds each. The feed intake, egg production, egg weight, egg mass and feed conversion were evaluated. The egg internal quality was evaluated by Haugh unit, percentage of albumen and yolk. The shell quality was evaluated by the thickness, density and specific percentage of eggshell. The performance variables were affected by the inclusion of DCC with a negative linear response to food intake and quadratic for egg production, egg weight, egg mass and feed conversion, with the best levels of 10.5, 5.7, 9.2 and 10.3% respectively. There was no significant effect of DCC inclusion for the variables of egg quality. It is conclude that the DCC can be included in hens diets up to 5.7% to optimize performance and do not alter the internal and external quality of the eggs.

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In the last years, the prevalence of HPV infection in the anal region has increased, especially in some groups like homosexual and HIV-positive people. Since this infection can be associated with the development of squamous anal cancer due to its progression from HPV infection to anal intraepithelial neoplasia (AIN) and finally to cancer, the screening and evaluation of these conditions are important. Anal cytology and high resolution anoscopy are good methods that are available and can be used. Although useful, these methods should be performed correctly and not indiscriminately in all patients. Patients for whom anal cytology screening is recommended are: HIV-infected patients, homosexuals, women who present with high-grade vulvar squamous intraepithelial neoplasia, vulvar cancer or cervical cancer. An abnormal anal cytology should be further evaluated with high resolution anoscopy.

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In the last years, the prevalence of HPV infection in the anal region has increased, especially in some groups like homosexual and HIV-positive people. Since this infection can be associated with the development of squamous anal cancer due to its progression from HPV infection to anal intraepithelial neoplasia (AIN) and finally to cancer, the screening and evaluation of these conditions are important. Anal cytology and high resolution anoscopy are good methods that are available and can be used. Although useful, these methods should be performed correctly and not indiscriminately in all patients. Patients for whom anal cytology screening is recommended are: HIV-infected patients, homosexuals, women who present with high-grade vulvar squamous intraepithelial neoplasia, vulvar cancer or cervical cancer. An abnormal anal cytology should be further evaluated with high resolution anoscopy.

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Este estudo buscou evidenciar o papel das enteroparasitoses como fator adicional de pressão biológica sobre as espécies de aves silvestres locais e migratórias. A ocorrência de endoparasitos pode ser considerada como indicador de alterações indesejáveis das condições higiênicas, acarretando diminuição das áreas naturais com comprometimento dos locais de descanso e da qualidade do hábitat utilizado como ponto de alimentação aviária. Setenta e cinco amostras fecais foram coletadas no câmpus da Universidade Federal Rural do Rio de Janeiro (UFRRJ), Brasil, entre agosto 2007 e maio 2008, e analisadas em lugol e pela técnica de Faust. Das amostras analisadas, 82,66% foram positivas para parasitas entéricos, 44% parasitados por tricomonadídeos, 5,33% com o gênero Chilomastix, 52% com oocistos de coccídeos, 29,33% por formas vegetativas de Entamoeba coli, 37,33% com Iodamoeba butschlii e 10,66% com ovos de helmintos. A elevada prevalência de enteroparasitas indica a necessidade de estudos mais detalhados e avaliações mais frequentes de saneamento deste hábitat, cujo impacto parece estar associado às precárias condições higiênicas locais decorrentes da crescente antropização na região.(AU)

This study aimed to assess the role of endoparasitic infections as another factor of biological pressure on both migratory and local bird species. The occurrence of endoparasites may be considered a sign of undesirable hygienic alterations, causing the shortening of natural fields, compromising the resting area and the habitat nutritional quality. A total of 75 fecal samples were collected at the Campus of the Universidade Federal Rural do Rio de Janeiro (UFRRJ), Brazil, between August 2007 and May 2008, and they were analyzed in a Lugol´s solution by Faust´s technique. Amongst the 82.66% positive samples for enteric parasites, 44% were parasitized by the trichomonads and 5.33% by the Chilomastix enterozoary genera, 52% presented coccidian oocysts, 29.33% showed Entamoeba coli, 37.22% presented Iodamoeba butschlii vegetative forms, and 10.66% were positive for worm eggs. The high prevalence of enteroparasites observed indicates the need of more detailed and frequent evaluations of the environmental sanitary conditions, whose impact seems to be associated to the scarce local hygienic conditions due to the growing anthropization.(AU)

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Este estudo buscou evidenciar o papel das enteroparasitoses como fator adicional de pressão biológica sobre as espécies de aves silvestres locais e migratórias. A ocorrência de endoparasitos pode ser considerada como indicador de alterações indesejáveis das condições higiênicas, acarretando diminuição das áreas naturais com comprometimento dos locais de descanso e da qualidade do hábitat utilizado como ponto de alimentação aviária. Setenta e cinco amostras fecais foram coletadas no câmpus da Universidade Federal Rural do Rio de Janeiro (UFRRJ), Brasil, entre agosto 2007 e maio 2008, e analisadas em lugol e pela técnica de Faust. Das amostras analisadas, 82,66% foram positivas para parasitas entéricos, 44% parasitados por tricomonadídeos, 5,33% com o gênero Chilomastix, 52% com oocistos de coccídeos, 29,33% por formas vegetativas de Entamoeba coli, 37,33% com Iodamoeba butschlii e 10,66% com ovos de helmintos. A elevada prevalência de enteroparasitas indica a necessidade de estudos mais detalhados e avaliações mais frequentes de saneamento deste hábitat, cujo impacto parece estar associado às precárias condições higiênicas locais decorrentes da crescente antropização na região.

This study aimed to assess the role of endoparasitic infections as another factor of biological pressure on both migratory and local bird species. The occurrence of endoparasites may be considered a sign of undesirable hygienic alterations, causing the shortening of natural fields, compromising the resting area and the habitat nutritional quality. A total of 75 fecal samples were collected at the Campus of the Universidade Federal Rural do Rio de Janeiro (UFRRJ), Brazil, between August 2007 and May 2008, and they were analyzed in a Lugol´s solution by Faust´s technique. Amongst the 82.66% positive samples for enteric parasites, 44% were parasitized by the trichomonads and 5.33% by the Chilomastix enterozoary genera, 52% presented coccidian oocysts, 29.33% showed Entamoeba coli, 37.22% presented Iodamoeba butschlii vegetative forms, and 10.66% were positive for worm eggs. The high prevalence of enteroparasites observed indicates the need of more detailed and frequent evaluations of the environmental sanitary conditions, whose impact seems to be associated to the scarce local hygienic conditions due to the growing anthropization.

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The occurrence of Campylobacter and Listeria monocytogenes was studied in 645 samples from surfaces, water, and poultry products (chicken carcasses, chicken parts, viscera, and spoils) in a poultry processing plant in southern Brazil. The automated mini-VIDAS system was used to detect the presence of Campylobacter and L. monocytogenes on the samples. The positive samples were confirmed by conventional methods. Campylobacter and L. monocytogenes were found in 16.6 and 35.6% of the analyzed samples, respectively. The sampling points with the highest Campylobacter incidence were intestine (63.3%, 19 of 30 samples), gallbladder (46.7%, 14 of 30), carcasses before evisceration (33.33%, 10 of 30), and carcasses after plucking (30%, 9 of 30). For L. monocytogenes, the majority of positive samples were from frozen breast (100%, 15 of 15 samples), frozen wing (93.3%, 14 of 15), fresh breast (83.3%, 25 of 30), fresh wing (80%, 24 of 30), skin of breast and leg (76.7%, 23 of 30), frozen leg (60%, 9 of 15), and fresh leg (50%, 15 of 30).

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Nos primeiros anos de vida a crianca passa pelo periodo mais critico do desenvolvimento do sistema nervoso central (SNC) e varios fatores podem interferir nesse processo, dentre eles a prematuridade. O bebe pre-termo apresenta caracteristicas que o ...

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