RESUMO
Children and youth with special health care needs (CYSHCN) present an intensive use of health services resources and demand a high level of coordination between these services, communities, and families. SOCHIPE, along with other experts, generated a Complexity Classification Guideline to allocate resources according to the need of the cases through the Health Care Network. OBJECTIVE: To perform a construct validation of the Complexity Classification Guideline. SUBJECTS AND METHOD: With a sample of 488 CYSHNC to whom the Classification Guideline was applied, an instrument reliability analysis was performed, in addition to an exploratory and confirmatory factor analysis. RESULTS: The Classification Guideline obtained a standardized Cronbach's Alpha of 0.87; however, the RMSEA, TLI, and CFI model fit statistics were lower than expected. The MI coefficient suggested the elimination of 9 items, from which a summary Guideline of 11 items and three dimensions was generated that presented an RMSEA of 0.60; TLI of 0.970, and CFI of 0.977. CONCLUSION: The study allows us to have a Summarized Complexity Classification Guideline for CYSHNC, with good psychometric properties, quick application, and easy interpretation, for application in the public health network.
Assuntos
Atenção à Saúde , Humanos , Adolescente , Criança , Psicometria/métodos , Reprodutibilidade dos Testes , Inquéritos e Questionários , Análise FatorialRESUMO
Laccases are ligninolytic enzymes produced by different microorganisms, especially by fungi such as the white-rot fungus Pleurotus ostreatus. Chemical inductors have been used to promote laccase secretion due to the application of these enzymes in lignocellulosic biomass pretreatment. Cordyceps nidus ANDES-F1080 was previously described as a source of bioactive compounds that could influence the enzymatic production system of other fungi. For that reason, this study evaluates the effect of C. nidus' ANDES-F1080 extracts on the laccase activity of P. ostreatus ANDES-F515. To achieve this objective, C. nidus ANDES-F1080 was grown in four different substrates: two artificial-based and two natural-based culture media. Metabolites were extracted from C. nidus ANDES-F1080 using water and methanol as solvents. Biochemical characterization of these extracts was performed to complement the analysis of their effect on laccase activity. Our results revealed an enhancement on the laccase activity of P. ostreatus ANDES-F515â¯grown in natural-based cultures when C. nidus' ANDES-F1080 extracts were supplemented. The best laccase activities registered values around 10,575⯱â¯813 U·L-1.
RESUMO
BACKGROUND: Rheumatic fever (RF) and rheumatic heart disease (RHD) are still major medical and public health problems mainly in developing countries. Pilot studies conducted during the last five decades in developed and developing countries indicated that the prevention and control of RF/RHD is possible. During the 1970s and 1980s, epidemiological studies were carried out in selected areas of Cuba in order to determine the prevalence and characteristics of RF/RHD, and to test several long-term strategies for prevention of the diseases. METHODS: Between 1986 and 1996 we carried out a comprehensive 10-year prevention programme in the Cuban province of Pinar del Rio and evaluated its efficacy five years later. The project included primary and secondary prevention of RF/RHD, training of personnel, health education, dissemination of information, community involvement and epidemiological surveillance. Permanent local and provincial RF/RHD registers were established at all hospitals, policlinics and family physicians in the province. Educational activities and training workshops were organised at provincial, local and health facility level. Thousands of pamphlets and hundreds of posters were distributed, and special programmes were broadcast on the public media to advertise the project. RESULTS: There was a progressive decline in the occurrence and severity of acute RF and RHD, with a marked decrease in the prevalence of RHD in school children from 2.27 patients per 1,000 children in 1986 to 0.24 per 1,000 in 1996. A marked and progressive decline was also seen in the incidence and severity of acute RF in five- to 25-year-olds, from 18.6 patients per 100,000 in 1986 to 2.5 per 100,000 in 1996. There was an even more marked reduction in recurrent attacks of RF from 6.4 to 0.4 patients per 100,000, as well as in the number and severity of patients requiring hospitalisation and surgical care. Regular compliance with secondary prophylaxis increased progressively and the direct costs related to treatment of RF/RHD decreased with time. The implementation of the programme did not incur much additional cost for healthcare. Five years after the project ended, most of the measures initiated at the start of the programme were still in place and occurrence of RF/RHD was low.
Assuntos
Serviços de Saúde Comunitária , Países em Desenvolvimento , Atenção Primária à Saúde , Prevenção Primária , Febre Reumática/prevenção & controle , Cardiopatia Reumática/prevenção & controle , Prevenção Secundária , Adolescente , Adulto , Atitude do Pessoal de Saúde , Criança , Pré-Escolar , Serviços de Saúde Comunitária/economia , Análise Custo-Benefício , Estudos Transversais , Cuba/epidemiologia , Custos de Cuidados de Saúde , Educação em Saúde , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/educação , Humanos , Incidência , Meios de Comunicação de Massa , Prevalência , Atenção Primária à Saúde/economia , Prevenção Primária/economia , Prevenção Primária/educação , Avaliação de Programas e Projetos de Saúde , Recidiva , Sistema de Registros , Febre Reumática/complicações , Febre Reumática/economia , Febre Reumática/mortalidade , Cardiopatia Reumática/economia , Cardiopatia Reumática/etiologia , Cardiopatia Reumática/mortalidade , Prevenção Secundária/economia , Prevenção Secundária/educação , Fatores de Tempo , Adulto JovemRESUMO
In order to asses the role of the soluble mediators of serum from patients with SLE in the apoptotic cell clearance, we measured the in vitro phagocytosis of apoptotic Jurkat cells by normal healthy donor macrophages in the presence of SLE patients' sera. A significant increase of the phagocytic index (NHD = 1.0 +/- 0.3; SLE = 1.9 +/- 0.6; p < 0.01) was to be observed in the presence of serum from patients with SLE. The increased phagocytic index correlated to the anti-dsDNA antibodies titers. We conclude that anti-dsDNA antibodies present in sera of patients with SLE favor the apoptotic cell phagocytosis by opsonization of the target cells. This may represent a deviation of the clearance process towards inflammation and a new pathologic feature of these autoantibodies in SLE.
Assuntos
Anticorpos Antinucleares/imunologia , Apoptose/imunologia , Lúpus Eritematoso Sistêmico/imunologia , Macrófagos/imunologia , Fagocitose/imunologia , Anticorpos Antinucleares/sangue , Humanos , Células Jurkat , Lúpus Eritematoso Sistêmico/sangueRESUMO
AIMS/HYPOTHESIS: To determine whether the emergent infection by echovirus 16 that occurred in Cuba during the year 2000 was related to the presence of Type 1 diabetes associated autoantibodies. METHODS: The presence of ICA, IAA, GADA, IA2 antibodies and neutralizing antibodies (NtAb) to echovirus 16 were determined in sera from 38 infected children and adolescents and 80 control subjects, matched in sex, age, local residence and time of sample collection. RESULTS: The occurrence of a large-scale echovirus 16 epidemic was associated with the appearance of humoral autoimmune markers of Type 1 diabetes, especially for ICA, IAA and GADA. In the convalescent stage, ICA, IAA and GADA seroconversion was shown in 92.1%, 44.7% and 28.9% of echovirus 16 infected subjects. None of the 80 uninfected subjects had ICA or IAA, while one was GADA positive. ICA, IAA and GADA frequency was higher in the convalescent than in the acute stage (p<0.0005). A strong positive correlation was found between the NtAb to echovirus 16 and ICA titres in both acute and convalescent stage (r=0.91; p<0.0001, r=0.55; p=0.0003 respectively). CONCLUSION/INTERPRETATION: This work provides evidence of an association between echovirus 16 infection and the presence of Type 1 diabetes related antibodies (ICA, IAA and GADA). Our data show that the echovirus 16 infection might be capable of inducing a process of autoimmune beta-cell damage and support the hypothesis that enterovirus infections are important risk factors for the development of Type 1 diabetes.
Assuntos
Autoanticorpos/análise , Diabetes Mellitus Tipo 1/imunologia , Infecções por Echovirus/imunologia , Adolescente , Estudos de Casos e Controles , Criança , Pré-Escolar , Glutamato Descarboxilase/imunologia , Humanos , Lactente , Insulina/imunologia , Isoenzimas/imunologiaRESUMO
From April to September 2000, an epidemic of aseptic meningitis spread throughout Cuba, with 16,943 reported cases. Virologic studies identified echovirus 16 as the cause of this epidemic. This is the first reported isolate of echovirus 16 from patients with viral meningitis in Cuba.
Assuntos
Surtos de Doenças , Infecções por Echovirus/epidemiologia , Enterovirus Humano B/isolamento & purificação , Meningite Asséptica/epidemiologia , Meningite Viral/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Líquido Cefalorraquidiano/virologia , Criança , Pré-Escolar , Cuba/epidemiologia , Infecções por Echovirus/diagnóstico , Infecções por Echovirus/virologia , Enterovirus Humano B/classificação , Enterovirus Humano B/genética , Fezes/virologia , Humanos , Incidência , Lactente , Meningite Asséptica/diagnóstico , Meningite Asséptica/virologia , Meningite Viral/diagnóstico , Meningite Viral/virologia , Pessoa de Meia-Idade , RNA Viral/análise , Reação em Cadeia da Polimerase Via Transcriptase ReversaRESUMO
BACKGROUND: With substantial progress made toward polio eradication, developing the appropriate strategy for discontinuing global oral poliovirus vaccine (OPV) after global eradication becomes increasingly important. At issue is the theoretical risk of independent circulation of potentially virulent OPV-derived strains. Because Cuba uses OPV only in mass campaigns, it represents an ideal site to assess vaccine-derived poliovirus persistence. METHODS: Infants born after the 1997 biannual mass campaigns were evaluated for past (neutralizing antibody) or current (virus excretion) evidence of vaccine-derived poliovirus exposure. We obtained sera and/or stool specimens from 861 infants; a second serum from 218 infants. RESULTS: All stool specimens were poliovirus negative. Of 762 infants, 113 (14.8%) had initially detectable poliovirus type 1 antibody, 193 (25.3%) type 2, and 94 (12.3%) type 3. A precipitous antibody decline occurred in initially positive sera. CONCLUSIONS: Our results suggest that in a country with high population immunity, vaccine-derived virus is unlikely to establish ongoing circulation.
Assuntos
Programas de Imunização , Poliomielite/prevenção & controle , Vacina Antipólio Oral , Cuba/epidemiologia , Saúde Global , Humanos , Lactente , Recém-Nascido , Poliomielite/epidemiologiaRESUMO
During the epidemic of optic and peripheral neuropathy which occurred in Cuba in 1992-1993, viruses antigenically related to the Coxsackie viruses were isolated from cerebrospinal fluid of patients. Concurrently with the virologic studies, epidemiologic, toxicologic, nutritional, immunologic, and histopathologic investigations were also carried out. Although it was demonstrated that the illness was associated with toxic and nutritional risk factors, it has not been possible to identify a specific etiology for the symptoms observed. Taking into consideration the results obtained in all of the various investigations, we have formulated an integral, multifactorial hypothesis which attempts to explain a pathophysiologic mechanism by which the viruses isolated could participate in the pathogenesis of the illness. We propose that the viral agents produce a persistent infection, and the possibility that they may act as mediator of an autoimmune pathogenic process.
Assuntos
Infecções por Coxsackievirus/epidemiologia , Infecções por Coxsackievirus/fisiopatologia , Enterovirus/isolamento & purificação , Doenças do Nervo Óptico/epidemiologia , Doenças do Sistema Nervoso Periférico/epidemiologia , Infecções por Coxsackievirus/imunologia , Cuba/epidemiologia , Humanos , Modelos Biológicos , Modelos Neurológicos , Doenças do Nervo Óptico/fisiopatologia , Doenças do Nervo Óptico/virologia , Doenças do Sistema Nervoso Periférico/fisiopatologia , Doenças do Sistema Nervoso Periférico/virologiaRESUMO
The erradication of poliomyelitis in the world is a goal that requires the adoption of effective and safe strategies for its attainment. Knowing how long the strains of poliovirus derived from the oral attenuated virus vaccine may circulate and remain in the environment was essential to define the measures to be taken and was also the objective of our paper. Specimens of stools and sewage water, which were weekly obtained at the end of the National Polio Vaccination Campaign, in 1998, were analyzed. Viruses were isolated and identified by culture and neutralization tests for the identification of poliovirus. In the particular case of the sewage water, it was also used the polymerase chain reaction. The curves of elimination in both media were drawn and it was concluded that the permanence of viruses in the environment did not exceed the 12 weeks after the immunization with the oral attenuated virus vaccine.
Assuntos
Fezes/virologia , Vacinas contra Poliovirus , Esgotos/virologia , Pré-Escolar , Humanos , Lactente , Fatores de TempoRESUMO
The epidemiological features of rotavirus infection may be quite relevant for evaluation of the performance of a rotavirus vaccine in different settings, as well as for monitoring its impact during vaccination under routine conditions. This article describes some important issues regarding rotavirus epidemiology in Venezuela, where major field trials of rotavirus vaccine have been carried out. Rotaviruses was significantly more frequently observed in inpatient (43%) than in outpatient (21%) consultations for diarrhea in infants and young children. There was a high prevalence of rotavirus illness, regardless of socioeconomic conditions, but the risk of dehydration was greater among the lower socioeconomic groups. Rotavirus disease occurs year-round, with a slight seasonal pattern. Eighty-five percent of rotavirus-positive diarrheal episodes, as well as 86% of cases of dehydration due to rotavirus, occurred during the first year of life. However, rotavirus illnesses occur less commonly during the first months of life (0-2 months), which may be a result of protection by transplacental antibodies. The pattern of acquisition of rotavirus antibody was consistent with this age distribution of disease and with optimal age for vaccination. Thus, regional epidemiological characteristics of rotavirus infection may affect optimal performance of rotavirus vaccine.
Assuntos
Diarreia Infantil/epidemiologia , Infecções por Rotavirus/epidemiologia , Distribuição por Idade , Pré-Escolar , Diarreia Infantil/induzido quimicamente , Fezes/virologia , Humanos , Programas de Imunização , Lactente , Recém-Nascido , Rotavirus/classificação , Rotavirus/isolamento & purificação , Infecções por Rotavirus/imunologia , Estações do Ano , Sorotipagem , Distribuição por Sexo , Classe Social , Venezuela/epidemiologiaRESUMO
Some believe that asteroid bodies (AB) in sporotrichosis are nonspecific and are equivalent to the AB of sarcoidosis and other granulomatous diseases. We studied 25 skin biopsy specimens of sporotrichosis in which AB were demonstrated, ten of them with Sporothrix-positive culture. Immunohistochemistry was performed in paraffin-embedded biopsy specimens using an anti-Sporothrix antibody. The same procedures were done with seven biopsy specimens of lobomycosis, which contained AB within giant cells. These did not react with the anti-Sporothrix antibody, and by electron microscopy they displayed filamentous and myelin figures similar to the AB of sarcoidosis. In sporotrichosis, the AB are extracellular eosinophilic structures, 15-35 microm in diameter, and located within abscesses. One to three are found in a section. They consist of a central yeast, surrounded by eosinophilic spicules. The yeast stains with the anti-Sporothrix antibody, while the spicules do not. Therefore, AB in sporotrichosis are specific for disease. Visualization of the spicules alone can lead to the demonstration of the AB in adjacent sections, and thus is a useful clue in the diagnosis of sporotrichosis. Sporotrichotic AB must not be confused with the intracellular AB seen in giant cells of granulomatous reactions, which are filamentous and myelin figures that contain lipid.
Assuntos
Pele/microbiologia , Pele/patologia , Esporotricose/microbiologia , Esporotricose/patologia , Biópsia , Células Epitelioides/citologia , Células Epitelioides/microbiologia , Células Epitelioides/patologia , Células Gigantes/citologia , Células Gigantes/microbiologia , Células Gigantes/patologia , Humanos , Imuno-Histoquímica , Corpos de Inclusão/microbiologia , Corpos de Inclusão/patologia , Corpos de Inclusão/ultraestrutura , Microscopia Eletrônica , Pele/ultraestrutura , Sporothrix/citologia , Sporothrix/imunologia , Sporothrix/isolamento & purificaçãoRESUMO
Se describen los resultados del estudio de enterovirus como agentes causanes de meningoencefalitis viral (MEV) en Cuba, desde 1990 hasta 1995. En este período fueron estudiados 586 muestras de heces, 108 líquidos cefalorraquídeos y 1095 sueros pareados para un total de 1789 muestras, procedentes de 1458 pacientes diagnosticados clínicamente con esta patología. Las muestras para el aislamiento viral se inocularon en dos sistemas celulares diferentes, encontrándose 225 muestras positivas a enterovirus que representan el 32,42 o/o del total; el mayor número de aislamientos (217) fue a partir de heces, en células diploides de fibroblastos de pulmón humano (PHuE-1). Las determinaciones de anticuerpos se realizaron por prueba de neutralizacion en micrométodo, enfrentándolos con 10 antígenos de enterovirus (Echovirus 4, 6, 9, 11 y Coxsackievirus B1-6) y, en períodos epidémicos, además con el virus aislado. En los años estudiados se produjeron tres brotes epidémicos por Coxsackievirus A9 (1990-91), Echovirus 30 (1994) y Coxsackievirus B5 (1995). Es de señalar que desde 1970 los Coxsackievirus A9 y Echovirus 30 se vincularon en nuestro país, por primera vez, con epidemias de MEV. En los sueros pareados se obtuvo 66,84 o/o de positivos, siendo la mayor positividad a los Echovirus 6 y 11. Al considerar en conjunto la positividad por aislamiento y serología, más del 80 o/o de los casos estudiados pudieran tener ua explicación por algún enterovirus, lo uqe demuestra la importancia de estos agentes como causantes de MEV en Cuba
Assuntos
Humanos , Enterovirus Humano B/isolamento & purificação , Enterovirus/isolamento & purificação , Meningoencefalite/epidemiologia , Meningoencefalite/etiologia , Cuba/epidemiologiaRESUMO
Se describen los resultados del estudio de enterovirus como agentes causanes de meningoencefalitis viral (MEV) en Cuba, desde 1990 hasta 1995. En este período fueron estudiados 586 muestras de heces, 108 líquidos cefalorraquídeos y 1095 sueros pareados para un total de 1789 muestras, procedentes de 1458 pacientes diagnosticados clínicamente con esta patología. Las muestras para el aislamiento viral se inocularon en dos sistemas celulares diferentes, encontrándose 225 muestras positivas a enterovirus que representan el 32,42 o/o del total; el mayor número de aislamientos (217) fue a partir de heces, en células diploides de fibroblastos de pulmón humano (PHuE-1). Las determinaciones de anticuerpos se realizaron por prueba de neutralizacion en micrométodo, enfrentándolos con 10 antígenos de enterovirus (Echovirus 4, 6, 9, 11 y Coxsackievirus B1-6) y, en períodos epidémicos, además con el virus aislado. En los años estudiados se produjeron tres brotes epidémicos por Coxsackievirus A9 (1990-91), Echovirus 30 (1994) y Coxsackievirus B5 (1995). Es de señalar que desde 1970 los Coxsackievirus A9 y Echovirus 30 se vincularon en nuestro país, por primera vez, con epidemias de MEV. En los sueros pareados se obtuvo 66,84 o/o de positivos, siendo la mayor positividad a los Echovirus 6 y 11. Al considerar en conjunto la positividad por aislamiento y serología, más del 80 o/o de los casos estudiados pudieran tener ua explicación por algún enterovirus, lo uqe demuestra la importancia de estos agentes como causantes de MEV en Cuba (AU)
Assuntos
Humanos , Meningoencefalite/etiologia , Meningoencefalite/epidemiologia , Enterovirus Humano B/isolamento & purificação , Enterovirus/isolamento & purificação , Enterovirus/isolamento & purificação , Cuba/epidemiologiaRESUMO
Twenty-one respiratory syncytial virus (RSV) strains isolated from one outbreak in Havana, Cuba (1994 to 1995), were analyzed to determine their relatedness. All isolated strains were classified as subgroup A by monoclonal antibodies. Of 21 RSV strains examined, 20 were classified as having restriction pattern NP4 and only 1 was classified as having restriction pattern NP5.
Assuntos
Antígenos Virais/imunologia , RNA Viral/isolamento & purificação , Infecções por Vírus Respiratório Sincicial/epidemiologia , Vírus Sincicial Respiratório Humano/genética , Anticorpos Monoclonais , Cuba/epidemiologia , Surtos de Doenças , Humanos , Lactente , Epidemiologia Molecular , Reação em Cadeia da Polimerase , Infecções por Vírus Respiratório Sincicial/imunologia , Vírus Sincicial Respiratório Humano/isolamento & purificação , Mapeamento por RestriçãoRESUMO
The aim of this study was to develop a polymerase chain reaction (PCR) for the detection of respiratory syncytial virus (RSV) genomes. The primers were designed from published sequences and selected from conserved regions of the genome encoding for the N protein of subgroups A and B of RSV. PCR was applied to 20 specimens from children admitted to the respiratory ward of "William Soler" Pediatric Hospital in Havana City with a clinical diagnosis of bronchiolitis. The PCR was compared with viral isolation and with an indirect immunofluorescence technique that employs monoclonal antibodies of subgroups A and B. Of 20 nasopharyngeal exudates, 10 were found positive by the three assayed methods. In only two cases, samples that yielded positive RNA-PCR were found negative by indirect immunofluorescence and cell culture. Considering viral isolation as the "gold standard" technique, RNA-PCR had 100% sensitivity and 80% specificity. RNA-PCR is a specific and sensitive technique for the detection of the RSV genome. Technical advantages are discussed.
Assuntos
Reação em Cadeia da Polimerase , Infecções por Vírus Respiratório Sincicial/diagnóstico , Vírus Sincicial Respiratório Humano/genética , Humanos , DNA Polimerase Dirigida por RNA , Mapeamento por RestriçãoRESUMO
The polymerase chain reaction (PCR) was developed in order to identify the respiratory syncytial virus by using the reference strain. The high sensitivity and specificity obtained show the PCR utility for detecting the RSV genoma and its application on the diagnosis.
Assuntos
Reação em Cadeia da Polimerase , RNA Viral/análise , Vírus Sinciciais Respiratórios/isolamento & purificação , Estudos de Avaliação como Assunto , Humanos , Vírus Sinciciais Respiratórios/genética , Sensibilidade e Especificidade , Fatores de TempoRESUMO
During the epidemic neuropathy occurred in Cuba from 1992 to 1993, viral isolations antigenically connected with Coxsackie viruses were obtained from the cerebrospinal fluid of patients. Virological, epidemiological, toxicologic, nutritional, immunological and histopathological investigations were made. Though the disease was related to toxic and nutritional factors, it has been impossible to identify the cause of the epidemic. Taking into consideration the results of the different investigations, we have formulated a comprehensive and multifactorial hypothesis to explain the physiopathological mechanism of the participation of the isolated viruses as mediators in a process of autoimmunity of the pathogeny of the disease.
Assuntos
Doenças Autoimunes/etiologia , Infecções por Coxsackievirus/complicações , Surtos de Doenças , Enterovirus/patogenicidade , Doenças do Nervo Óptico/etiologia , Doenças do Sistema Nervoso Periférico/etiologia , Animais , Doenças Autoimunes/líquido cefalorraquidiano , Doenças Autoimunes/epidemiologia , Doenças Autoimunes/imunologia , Doenças Autoimunes/virologia , Líquido Cefalorraquidiano/virologia , Infecções por Coxsackievirus/epidemiologia , Infecções por Coxsackievirus/imunologia , Cuba/epidemiologia , Efeito Citopatogênico Viral , Enterovirus/imunologia , Enterovirus/isolamento & purificação , Enterovirus/fisiologia , Humanos , Interleucina-2/biossíntese , Camundongos , Modelos Biológicos , Mimetismo Molecular , Proteínas do Tecido Nervoso/imunologia , Distúrbios Nutricionais/complicações , Doenças do Nervo Óptico/líquido cefalorraquidiano , Doenças do Nervo Óptico/epidemiologia , Doenças do Nervo Óptico/imunologia , Doenças do Nervo Óptico/virologia , Doenças do Sistema Nervoso Periférico/líquido cefalorraquidiano , Doenças do Sistema Nervoso Periférico/epidemiologia , Doenças do Sistema Nervoso Periférico/imunologia , Doenças do Sistema Nervoso Periférico/virologia , Fumar/efeitos adversos , Subpopulações de Linfócitos T/imunologia , Proteínas Virais/imunologia , Latência ViralRESUMO
Varias enfermedades producen lesiones del área centrofacial. Una de las más frecuentes en nuestro medio es la leishmaniasis destructivas mucosa. Como el INS es un centro de estudio de leishmaniasis, se atendieron pacientes o sus biopsias con afecciones del macizo centrofacial, primariamente remitidas con el diagnóstico clínico de leishmaniasis mucosa. En un período de 7 años (1987-1993), se estudiaron 134 biopsias de estos pacientes. El diagnóstico de leishmaniasis mucosa fue definitivo en 26 casos, por demostración del amastigote con la coloración de hematoxilina eosina y el mismo diagnóstico se estableció por patrón histopatológico solamente, en 27 casos. Una técnica inmunoenzimática para demostrar los amastigotes no fue satisfactoria. La perforación banal del tabique nasal (52 biopsias) es la entidad que el clínico y el patólogo confunden con mayor frecuencia con la leishmaniasis mucosa. Otras entidades demostradas fueron la paracoccidioidomicosis (3), histoplasmosis (2), rinosporidiosis (2), esporotricosis (1), tuberculosis bucal (3), lepra lepromatosa(1), escleroma nasal (2), granulomatosis de Wegener (2), linfomas angiocéntricos (4), aspiración crónica de cocaína (1), y carcinoma escamocelular palatino (1). La biopsia, luego de la historia clínica, es el pilar esencial para identificar y manejar adecuadamente estas lesiones, que pueden originar destrucción facial grave, a veces letal, si no se dispone del diagnóstico preciso y del tratamiento oportuno
Assuntos
Humanos , Traumatismos Faciais/patologia , Leishmaniose Mucocutânea/diagnóstico , BiópsiaRESUMO
The genus Espeletia (Asteraceae) underwent an accelerated adaptive radiation in the new habitats of the high tropical Andes after the retreat of the glaciers. From the ancestral rainforest species, with tree-like forms, the genus diversified at high altitude, developing morphological and physiological adaptations to the peculiar combination of low-temperature, energy and nutrient stresses of the tropical periglacial environments. Espeletia offers an exceptional example of a taxon undergoing a rapid evolutionary process through the colonization of a totally original environment: the cold tropics. Here we review recent research on the ecological, biogeographical, taxonomic, morphological and physiological traits that have led to the adaptive radiation of Espeletia in this extreme habitat.