RESUMO
Background: Many differences exist in postgraduate surgical training programmes worldwide. The aim of this study was to provide an overview of the training requirements in general surgery across 23 different countries. Methods: A collaborator affiliated with each country collected data from the country's official training body website, where possible. The information collected included: management, teaching, academic and operative competencies, mandatory courses, years of postgraduate training (inclusive of intern years), working-hours regulations, selection process into training and formal examination. Results: Countries included were Australia, Belgium, Canada, Colombia, Denmark, Germany, Greece, Guatemala, India, Ireland, Italy, Kuwait, the Netherlands, New Zealand, Russia, Saudi Arabia, South Africa, South Korea, Sweden, Switzerland, UK, USA and Zambia. Frameworks for defining the outcomes of surgical training have been defined nationally in some countries, with some similarities to those in the UK and Ireland. However, some training programmes remain heterogeneous with regional variation, including those in many European countries. Some countries outline minimum operative case requirement (range 60-1600), mandatory courses, or operative, academic or management competencies. The length of postgraduate training ranges from 4 to 10 years. The maximum hours worked per week ranges from 38 to 88 h, but with no limit in some countries. Conclusion: Countries have specific and often differing requirements of their medical profession. Equivalence in training is granted on political agreements, not healthcare need or competencies acquired during training.
Antecedentes: Existen muchas diferencias entre los programas de formación quirúrgica de posgrado del mundo. El objetivo de este estudio fue proporcionar una visión general de los requisitos formativos en cirugía general en 23 países diferentes. Métodos: En cada uno de los países participantes, un colaborador recopiló datos de la página web del organismo oficial encargado de la formación, si era posible. La información incluyó: gestión, formación, competencias académicas y operatorias, cursos obligatorios, años de formación de postgrado (que incluía el período de internado), regulaciones sobre las horas de trabajo, proceso de selección para la formación y existencia de un examen final. Resultados: Se incluyeron los datos de Australia, Bélgica, Canadá, Colombia, Dinamarca, Alemania, Grecia, Guatemala, India, Irlanda, Italia, Kuwait, Países Bajos, Nueva Zelanda, Rusia, Arabia Saudita, Sudáfrica, Corea del Sur, Suecia, Suiza, Reino Unido, Estados Unidos de América y Zambia. En algunos países existen los marcos normativos para definir los resultados del programa de formación, con ciertas semejanzas a los del Reino Unido e Irlanda. Sin embargo, algunos programas de formación, incluso en muchos países europeos, son muy heterogéneos con variaciones regionales. Pocos países describen el número mínimo de procedimientos quirúrgicos (rango 60 a 1.600), los cursos obligatorios o competencias quirúrgicas, académicos o de gestión exigidos. La duración de la formación postgraduada osciló de los 4 a los 10 años. El número de horas trabajadas máximas por semana oscilaron entre 38 y 88, sin límite en algunos países. Conclusión: Cada país tiene unos requisitos específicos, a menudo diferentes, para la formación de sus médicos. La convalidación se otorga por acuerdos políticos, más que por las necesidades médicas o por las competencias adquiridas durante la formación.
Assuntos
Currículo/normas , Educação de Pós-Graduação em Medicina/métodos , Cirurgia Geral/educação , Preceptoria/estatística & dados numéricos , Austrália , Canadá , Colômbia , Currículo/tendências , Europa (Continente) , Guatemala , Humanos , Índia , Kuweit , Nova Zelândia , Preceptoria/tendências , República da Coreia , Federação Russa , Arábia Saudita , Análise de Pequenas Áreas , África do Sul , Reino Unido , Estados Unidos , ZâmbiaRESUMO
Flesh flies (Diptera: Sarcophagidae) are well known cause of myiasis and their gut bacteria have never been studied for antimicrobial activity against bacteria. Antimicrobial studies of Myroides spp. are restricted to nosocomial strains. A Gram-negative bacterium, Myroides sp., was isolated from the gut of adult flesh flies (Sarcophaga sp.) and submitted to evaluation of nutritional parameters using Biolog GN, 16S rRNA gene sequencing, susceptibility to various antimicrobials by disc diffusion method and detection of metallo â-lactamase genes (TUS/MUS). The antagonistic effects were tested on Gram-negative and Gram-positive bacteria isolated from human clinical specimens, environmental samples and insect mid gut. Bacterial species included were Aeromonas hydrophila, A. culicicola, Morganella morganii subsp. sibonii, Ochrobactrum anthropi, Weissella confusa, Escherichia coli, Ochrobactrum sp., Serratia sp., Kestersia sp., Ignatzschineria sp., Bacillus sp. The Myroides sp. strain was resistant to penicillin-G, erythromycin, streptomycin, amikacin, kanamycin, gentamycin, ampicillin, trimethoprim and tobramycin. These strain showed antibacterial action against all bacterial strains except W. confusa, Ignatzschineria sp., A. hydrophila and M. morganii subsp. sibonii. The multidrug resistance of the strain was similar to the resistance of clinical isolates, inhibiting growth of bacteria from clinical, environmental and insect gut samples. The metallo â-lactamase (TUS/MUS) genes were absent, and resistance due to these genes was ruled out, indicating involvement of other secretion machinery.
Moscas varejeiras (Diptera: Sarcophagidae) são causa conhecida de miíase e as bactérias de seus intestinos nunca foram estudadas quanto à atividade antibacteriana. Estudos antimicrobianos de Myroides spp restringem-se à cepas hospitalares. Uma bactéria Gram negativa, Myroides sp, foi isolada do intestino de moscas varejeiras adultas (Sarcophaga sp) e submetida à avaliação de parâmetros nutricionais pelo sistema BIOLOG GN, ao sequenciamento genético 16S rRNA, à sensibilidade a vários antimicrobianos pelo método de difusão de discos e à detecção dos genes de metalo beta lactamases (TUS/MUS). Os efeitos antagonistas foram testados contra bactérias Gram negativas e Gram positivas isoladas de material clínico humano, amostras ambientais e intestino do inseto. As espécies bacterianas incluíram Aeromonas hydrophila, A. culicicola, Morganella morganii subsp sibonii, Ochrobactrum anthropi, Weissella confusa, Escherichia coli, Ochrobactrum sp, Serratia sp, Kestersia sp, Ignatzschineria sp e Bacillus sp. A cepa Myroides sp foi resistente à penicilina G, eritromicina, estreptomicina, amicacina, canamicina, gentamicina, ampicilina, trimetoprim e tobramicina. Esta cepa apresentou atividade antimicrobiana contra todas as cepas exceto W.confusa, Ignatzschineria sp, A. hydrophila e M. morgani subsp sibonii. A resistência múltipla da cepa foi semelhante à de isolados clínicos, inibindo bactérias das amostras clínicas, ambientais e do intestino do inseto. Os genes de metalo beta lactamases (TUS/MUS) estavam ausentes, excluindo-se a resistência mediada por esses genes, o que indica o envolvimento de um mecanismo alternativo de secreção.
Assuntos
Animais , Bactérias Gram-Negativas/genética , Bactérias Gram-Negativas/isolamento & purificação , Dípteros , Resistência Microbiana a Medicamentos , Técnicas In Vitro , beta-Lactamases/análise , Difusão , MétodosRESUMO
FLESH FLIES (DIPTERA: Sarcophagidae) are well known cause of myiasis and their gut bacteria have never been studied for antimicrobial activity against bacteria. Antimicrobial studies of Myroides spp. are restricted to nosocomial strains. A Gram-negative bacterium, Myroides sp., was isolated from the gut of adult flesh flies (Sarcophaga sp.) and submitted to evaluation of nutritional parameters using Biolog GN, 16S rRNA gene sequencing, susceptibility to various antimicrobials by disc diffusion method and detection of metallo ß-lactamase genes (TUS/MUS). The antagonistic effects were tested on Gram-negative and Gram-positive bacteria isolated from human clinical specimens, environmental samples and insect mid gut. Bacterial species included were Aeromonas hydrophila, A. culicicola, Morganella morganii subsp. sibonii, Ochrobactrum anthropi, Weissella confusa, Escherichia coli, Ochrobactrum sp., Serratia sp., Kestersia sp., Ignatzschineria sp., Bacillus sp. The Myroides sp. strain was resistant to penicillin-G, erythromycin, streptomycin, amikacin, kanamycin, gentamycin, ampicillin, trimethoprim and tobramycin. These strain showed antibacterial action against all bacterial strains except W. confusa, Ignatzschineria sp., A. hydrophila and M. morganii subsp. sibonii. The multidrug resistance of the strain was similar to the resistance of clinical isolates, inhibiting growth of bacteria from clinical, environmental and insect gut samples. The metallo ß-lactamase (TUS/MUS) genes were absent, and resistance due to these genes was ruled out, indicating involvement of other secretion machinery.
RESUMO
Flesh flies (Diptera: Sarcophagidae) are well known cause of myiasis and their gut bacteria have never been studied for antimicrobial activity against bacteria. Antimicrobial studies of Myroides spp. are restricted to nosocomial strains. A Gram-negative bacterium, Myroides sp., was isolated from the gut of adult flesh flies (Sarcophaga sp.) and submitted to evaluation of nutritional parameters using Biolog GN, 16S rRNA gene sequencing, susceptibility to various antimicrobials by disc diffusion method and detection of metallo -lactamase genes (TUS/MUS). The antagonistic effects were tested on Gram-negative and Gram-positive bacteria isolated from human clinical specimens, environmental samples and insect mid gut. Bacterial species included were Aeromonas hydrophila, A. culicicola, Morganella morganii subsp. sibonii, Ochrobactrum anthropi, Weissella confusa, Escherichia coli, Ochrobactrum sp., Serratia sp., Kestersia sp., Ignatzschineria sp., Bacillus sp. The Myroides sp. strain was resistant to penicillin-G, erythromycin, streptomycin, amikacin, kanamycin, gentamycin, ampicillin, trimethoprim and tobramycin. These strain showed antibacterial action against all bacterial strains except W. confusa, Ignatzschineria sp., A. hydrophila and M. morganii subsp. sibonii. The multidrug resistance of the strain was similar to the resistance of clinical isolates, inhibiting growth of bacteria from clinical, environmental and insect gut samples. The metallo -lactamase (TUS/MUS) genes were absent, and resistance due to these genes was ruled out, indicating involvement of other secretion machinery.
Moscas varejeiras (Diptera: Sarcophagidae) são causa conhecida de miíase e as bactérias de seus intestinos nunca foram estudadas quanto à atividade antibacteriana. Estudos antimicrobianos de Myroides spp restringem-se à cepas hospitalares. Uma bactéria Gram negativa, Myroides sp, foi isolada do intestino de moscas varejeiras adultas (Sarcophaga sp) e submetida à avaliação de parâmetros nutricionais pelo sistema BIOLOG GN, ao sequenciamento genético 16S rRNA, à sensibilidade a vários antimicrobianos pelo método de difusão de discos e à detecção dos genes de metalo beta lactamases (TUS/MUS). Os efeitos antagonistas foram testados contra bactérias Gram negativas e Gram positivas isoladas de material clínico humano, amostras ambientais e intestino do inseto. As espécies bacterianas incluíram Aeromonas hydrophila, A. culicicola, Morganella morganii subsp sibonii, Ochrobactrum anthropi, Weissella confusa, Escherichia coli, Ochrobactrum sp, Serratia sp, Kestersia sp, Ignatzschineria sp e Bacillus sp. A cepa Myroides sp foi resistente à penicilina G, eritromicina, estreptomicina, amicacina, canamicina, gentamicina, ampicilina, trimetoprim e tobramicina. Esta cepa apresentou atividade antimicrobiana contra todas as cepas exceto W.confusa, Ignatzschineria sp, A. hydrophila e M. morgani subsp sibonii. A resistência múltipla da cepa foi semelhante à de isolados clínicos, inibindo bactérias das amostras clínicas, ambientais e do intestino do inseto. Os genes de metalo beta lactamases (TUS/MUS) estavam ausentes, excluindo-se a resistência mediada por esses genes, o que indica o envolvimento de um mecanismo alternativo de secreção.
RESUMO
The molluscicidal effect of nicotinanilide was evaluated and compared with niclosamide (2',5-dichloro-4'-nitrosalicylanilide, ethanolamide salt) against different stages of the freshwater snail Lymnaea luteola i.e., eggs, immature, young mature, and adults. Calculated values of lethal concentrations (LC50 and LC90) showed that both nicotinanilide and niclosamide as toxic against eggs, immature, and adults. The young mature stage of the snails was comparatively more tolerant to both molluscicides than the other stages. The toxicity of the intermediate compounds of nicotinanilide against the young mature stage of the snails showed them as ineffective. The mortality pattern of the snails exposed to LC90 concentration of these molluscicides showed niclosamide to kill faster (within 8 to 9 h) than nicotinanilide (26 to 28 h). In view of the above studies it may be concluded that both molluscicides are toxic against all the stages of the L. luteola snails.
Assuntos
Vetores de Doenças , Lymnaea/efeitos dos fármacos , Moluscocidas/toxicidade , Niclosamida/toxicidade , Ácidos Nicotínicos/toxicidade , Animais , Água Doce , Testes de Toxicidade/métodosRESUMO
The molluscicidal effect of nicotinanilide was evaluated and compared with niclosamide (2',5-dichloro-4'-nitrosalicylanilide, ethanolamide salt) against different stages of the freshwater snail Lymnaea luteola i.e., eggs, immature, young mature, and adults. Calculated values of lethal concentrations (LC50 and LC90 ) showed that both nicotinanilide and niclosamide as toxic against eggs, immature, and adults. The young mature stage of the snails was comparatively more tolerant to both molluscicides than the other stages. The toxicity of the intermediate compounds of nicotinanilide against the young mature stage of the snails showed them as ineffective. The mortality pattern of the snails exposed to LC90 concentration of these molluscicides showed niclosamide to kill faster (within 8 to 9 h) than nicotinanilide (26 to 28 h). In view of the above studies it may be concluded that both molluscicides are toxic against all the stages of the L. luteola snails.
Assuntos
Animais , Vetores de Doenças , Lymnaea , Moluscocidas , Niclosamida , Água Doce , Testes de ToxicidadeRESUMO
Patients with long-standing chromoblastomycosis may respond poorly to standard treatments such as amphotericin B, oral antifungals, surgical measures or thermotherapy. The objective of this study was to determine the potential of alternate week and combination therapy with itraconazole and terbinafine in the treatment of poorly responsive, or non-responsive, chromoblastomycosis. Four patients with longstanding chromoblastomycosis (8-23 years) caused by Fonsecaea pedrosoi had responded poorly to standard therapies including monotherapy with the oral antifungal agents. In order to try and improve the response to oral itraconazole and terbinafine, alternate week or combination therapy with itraconazole and terbinafine was initiated. Bloodwork including complete blood count and liver function tests were performed every 3-8 weeks to ensure patient safety. Reduction or resolution of lesions of chromoblastomycosis was noted with alternate week or combination treatment using oral itraconazole and terbinafine. Three of four patients experienced no clinical side-effects; the third reported mild, transient gastric discomfort which responded to antacids. Bloodwork generally remained within normal limits throughout the entire course of treatment with no clinically significant changes. The combination therapy was considered effective in treating the poorly responsive chromoblastomycosis of all four patients. Some success with alternative week therapy was also noted in one patient. The favorable response and lack of significant adverse effects suggests that these regimens may be an option for some patients with chromoblastomycosis.
Assuntos
Antifúngicos/administração & dosagem , Cromoblastomicose/tratamento farmacológico , Itraconazol/administração & dosagem , Fungos Mitospóricos/isolamento & purificação , Naftalenos/administração & dosagem , Adulto , Cromoblastomicose/microbiologia , Quimioterapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , TerbinafinaRESUMO
Cardiac tamponade and malignancy are associated with a poor prognosis in Progressive Systemic Sclerosis (PSS). We present the case of a 31-year-old African-Jamaican woman with PSS and a thyroid neoplasm who presented with cardiac tamponade requiring pericardiocentesis. Despite the presence of two poor prognostic markers, she has had a favourable postoperative course.
Assuntos
Carcinoma Papilar/complicações , Tamponamento Cardíaco/complicações , Hipertireoidismo/complicações , Escleroderma Sistêmico/complicações , Neoplasias da Glândula Tireoide/complicações , Adulto , Tamponamento Cardíaco/diagnóstico , Tamponamento Cardíaco/terapia , Feminino , HumanosRESUMO
Cardiac tamponade and malignancy are associated with a poor prognosis in Progressive Systemic Sclerosis (PSS). We present the case of a 31-year-old African-Jamaican woman with PSS and a thyroid neoplasm who presented with cardiac tamponade requiring pericardiocentesis. Despite the presence of two poor prognostic markers, she has had a favourable postoperative course.
Assuntos
Adulto , Feminino , Humanos , Carcinoma Papilar , Hipertireoidismo , Escleroderma Sistêmico/complicações , Neoplasias da Glândula Tireoide/complicações , Tamponamento Cardíaco/complicações , Tamponamento Cardíaco/diagnóstico , Tamponamento Cardíaco/terapiaRESUMO
BACKGROUND: Sporotrichosis is a chronic, granulomatous, deep mycosis caused by the dimorphic fungus Sporothrix schenckii that usually results in indolent cutaneous lesions. OBJECTIVE: To describe four cases of human sporotrichosis transmitted by domestic cats in south-eastern Brazil. METHODS: Confirmation of the diagnosis was performed by histopathology, culture, and/or inoculation of hamsters. RESULTS: In all cases, the clinical findings in both cat and human groups were highly distinctive of the disease. In all human cases, there was a previous history of cat scratching before the development of lymphocutaneous lesions. Histopathology of the human lesions demonstrated the classical granulomatous and exudative pattern with scarce or absent fungal elements. Conversely, in cats, the cutaneous lesions were multiple, extensive, necrotic, exudative, and ulcerated. Histopathology revealed a widespread histiocytic reaction with a large number of fungal organisms. Disseminated lymphatic and visceral mycotic infection was observed in two necropsied cats. CONCLUSIONS: Domestic cats may be an important carrier of agents of sporotrichosis to humans.
Assuntos
Doença da Arranhadura de Gato/transmissão , Sporothrix/isolamento & purificação , Esporotricose/transmissão , Adulto , Idoso , Animais , Biópsia , Doença da Arranhadura de Gato/microbiologia , Gatos , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Patients who are human immunodeficiency virus (HIV) positive are predisposed to the development of infections including tinea pedis and onychomycosis. While smaller studies have been reported, there has been no large study evaluating the prevalence of onychomycosis in HIV-positive individuals, or comparing the development of onychomycosis in a typical temperate area with that in a typical tropical area. METHODS: HIV-positive individuals were evaluated at five clinics: four in Ontario, Canada and one in Sao Paulo, Brazil. The subjects were asked questions to determine the epidemiology of onychomycosis in HIV-positive individuals. The feet were examined and nail material was obtained for mycologic examination to determine the causative organism of onychomycosis. RESULTS: A total of 500 subjects were examined (415 men and 85 women; age (mean +/- SE), 39 +/- 0.4 years; 400 Canadian, 100 Brazilian). The racial origins of the Canadian patients were: Caucasian, 83.8%; Asian, 4.3%; African-American, 8.1%; Hispanic, 3.3%; American Indian, 0.3%. The Brazilian origins were: Caucasian, 68.7%; African, 18.1%; mixed race, 13.3%. Abnormal appearing nails and mycologic evidence of onychomycosis were present in 200 (40.0%) and 116 (23.2%), respectively, of 500 subjects. The prevalence of onychomycosis in the Canadian and Brazilian samples was 24.0% (96 of 400) and 20.0% (20 of 100), respectively. The projected prevalence of onychomycosis in HIV-positive individuals in Canada was 19.9% (95% CI: 16.0-23.9%) after taking into account the age and sex distribution of HIV-positive individuals in the population. When nails appeared clinically abnormal, the prevalence of onychomycosis was 50.5% (Canada, 51.3%; Brazil, 45.5%). For comparison, published data indicate that the prevalence of onychomycosis in immunocompetent individuals living in Canada is 6.9%. The clinical presentation of onychomycosis for the whole sample (n=500) was: distal and lateral subungual onychomycosis (DLSO), 20.0%; white superficial onychomycosis (WSO), 3.6%; proximal subungual onychomycosis (PSO), 1.8% (Canadian and Brazilian samples: DLSO 21.2% vs. 15.0%, WSO 3.3% vs. 5.0%, and PSO 1.5% vs. 3.0%). The distribution of the causative fungal organisms was: dermatophytes: Candida species: nondermatophyte molds, 73:2:2 (Canadian and Brazilian samples: dermatophytes 95.5% vs. 90.9%, Candida species 3.0% vs. 0%, and nondermatophyte molds 1.5% vs. 9.0%). The use of protease inhibitors, reverse transcriptase inhibitors, or oral antifungal agents did not make a significant difference in the prevalence of onychomycosis for both the Canadian and Brazilian groups. Patients with onychomycosis were aware of their abnormal appearing nails (chi2(1)=69.7, P<0.001), embarrassed by the appearance of their nails (chi2(1)=29.7, P<0.001), and took measures to hide their nails from other individuals. A higher proportion of individuals with onychomycosis experienced discomfort compared with those without the disease (chi2(1)=9.0, P=0.003). Also, individuals who experienced pain in the nail unit were more likely to have onychomycosis (risk odds ratio (ROR), 2.2; 95% CI: 1.0-4.7, P=0.05). CONCLUSIONS: The prevalence of onychomycosis in HIV-positive individuals in the sample of 500 patients was 23.2%. In the Canadian (n=400) and Brazilian (n=100) samples, the corresponding figures were 24% and 20%, respectively, with the predominant causative organisms being dermatophytes. The projected prevalence of onychomycosis in HIV-positive Canadians is 19.9%. Predisposing factors include a CD4 count of approximately 370, a positive family history of onychomycosis, a history of tinea pedis, and walking barefoot around pools. Onychomycosis can be symptomatic, a source of embarrassment, and a potential cause of morbidity.
Assuntos
Soropositividade para HIV/complicações , Onicomicose/epidemiologia , Adolescente , Adulto , Idoso , Brasil/epidemiologia , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Unhas/microbiologia , Ontário/epidemiologia , Onicomicose/etiologia , Onicomicose/psicologia , PrevalênciaRESUMO
A autora faz a introduçäo do trabalho uma abordagem sobre o tabagismo como importante fator associado a doenças respiratórias, cardiovasculares e a alguns cânceres. Lembra também sobre as implicaçöes do tabagismo na gravidez e descreve alguns estudos sobre fumante passivo e refere algumas informaçöes epidemiológicas. Propöe-se a: 1- Estudar a prevalência de tabagismo entre estudantes da Universidade de Säo Paulo, campus de Ribeiräo Preto, em 1988. 2- Analisar a tendência desta prevalência no perído de 1980-1988. 3. Analisar a relaçäo entre escolhas das marcas e o custo das mesmas. Foi feito um levantamento em 1988, com questionário padronizado e com a mesma metodologia utilizada em 1980, 1981 e 1986. As principais conclusöes foram: 1- A prevalência do tabagismo nas diferentes unidades da USP, em dezembro de 1988 foi: FMRP, 11,9% EERP, 21,2%, FFRP, 8,7; FORP, 8,9%; e prevalência de extabagista foi respectimente: 6,8%; 9,3%; 7,5% e 6,5%. 2- As mulheres fumam tanto quanto os homens em 1988 entre os alunos inqueridos. 3- Até 1986, há tendência geral de declínio em todas as escolas; em 1988, esta tendência näo tem significado estatístico. 4- A tendência segundo o gênero alterou-se no período estudado, em 1980 e 1981 os homens fumam mais que as mulheres e em 1986 e 1988, homens e mulheres fumam igualmente. Foram levantadas e discutidas várias hipóteses no sentido de tentar explicar esta tendência geral de declínio e as mudanças ocorridas neste período quanto a prevalência nos dois gêneros
Assuntos
Pessoa de Meia-Idade , Humanos , Masculino , Eritema Nodoso/complicações , Glomerulonefrite/etiologia , Hanseníase Virchowiana/complicações , Doença Aguda , Glomerulonefrite/patologiaRESUMO
A middle aged man (48 years) with short duration of illness (7 days) was admitted in the state of acute renal failure with erythema nodosum leprosum. He had repeated episodes of erythema nodosum leprosum in the past. His blood pressure was normal (150/80 mmHg). During his hospital stay he was in the state of progressive anaemia (Hb = 8.8 g/dl to 7.2 g/dl), oliguria (urine out-put = 250-350 ml/day), azotaemia (blood urea = 198 mg/dl to 218 mg/dl) and impaired renal function tests with fatal outcome. Kidneys were smooth, congested and weighing 150 g each with histological features of rapidly progressive (crescentric) glomerulonephritis, a result of immune complex deposition from recurrent erythema nodosum leprosum episodes.
Assuntos
Eritema Nodoso/complicações , Glomerulonefrite/etiologia , Hanseníase Virchowiana/complicações , Doença Aguda , Glomerulonefrite/patologia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Sixty male patients of leprosy (mean age = 27.2 +/- 5.04 years) selected at random, were studied for gonadal involvement and therapeutic efficacy of two indigenous drugs. Of these 34 were married, with the mean duration of illness 4.17 +/- 3.27 years. Only those with lepromatous and dimorphous leprosy developed testicular and epididymal changes. Testicular pain and/or swelling (lepromatous = 62.5%, dimorphous = 30%) was the commonest presenting feature. Altered sexual function was observed in 34 (56.6%) cases, while 11 patients revealed altered sexual hair pattern and nine gynaecomastia. Reduced testicular size associated with soft feel was present in 25% of cases with no testicular sensation in 8 (13.3%) and impaired testicular sensation in 9 (15%) patients. Spermogram revealed azoospermia in 19 (35%) and oligospermia in 16 (26.6%) patients. Histopathological findings of testicle biopsy revealed evidence of leprous pathological irrespective of testicular size, semen picture and clinical manifestations. Histopathological changes had shown marked variation and so did not enable categorising them into vascular, interstitial and obliterative phases. These changes were believed to be due to the altered gonadal state in leprosy. The therapeutic efficacy of the indigenous preparations, Speman and Tentex forte (Himalaya) was evaluated subjectively as well as objectively in 34 patients. 82.3% of cases showed subjective improvement while objective improvement in spermogram was noted in 87.5% cases with oligospermia. The drugs have no side effect and were well tolerated.