Luiz Guilherme Cruz Gonçalves

Treatment of severe forms of paracoccidioidomycosis: is there a role for corticosteroids?

Despite their immunosuppressive effects, corticosteroids have long been used as adjunct therapy (aCST) in the treatment of infectious diseases. The rationale is that in certain infections it is necessary to decrease the exacerbated hosts inflammatory response, which can otherwise result in tissue damage and organ dysfunction. In fact, a major concern in treating paracoccidioidomycosis (PCM) is the hosts intense inflammatory response to Paracoccidioides brasiliensis, which can be further intensified by antifungal therapy. Depending on its localization, this immunological phenomenon may be life threatening or result in permanent sequels, as is the case for some patients with cerebral or laryngeal involvement. However, the literature on aCST in paracoccidioidomycosis treatment is scarce and as a result we present our recent experience in the management of four patients with severe PCM manifestations, i.e., cerebral paracoccidioidal granuloma, laryngeal stenosis, compressive abdominal mass, and exacerbated inflammatory response with tissue destruction. In addition to the antifungal therapy, these patients required aCST, which probably promoted their clinical improvement and/or prevented serious complications. We suggest that aCST: (a) can potentially help in the management of selected cases of severe forms of PCM, particularly when there is a risk of acute complications, and (b) that it can be used safely provided that the risk-benefit ratio is carefully weighed. Well-controlled, prospective studies of aCST in the treatment of severe cases of paracoccidioidomycosis are needed to better define its role in the management of PCM.

Periodization Training Focused on Technical-Tactical Ability in Young Soccer Players Positively Affects Biochemical Markers and Game Performance.

Abstract Aquino, RLQT, Cruz Gonçalves, LG, Palucci Vieira, LH, Oliveira, LP, Alves, GF, Pereira Santiago, PR, and Puggina, EF. Periodization training focused on technical-tactical ability in young soccer players positively affects biochemical markers and game performance. J Strength Cond Res 30(10): 2723–2732, 2016—The aim of this study was to investigate the effects of 22 weeks of periodized training, with an emphasis on technical-tactical ability, on indirect markers of muscle damage, and the on-field performance of young soccer players. Fifteen players (age 15.4 ± 0.2 years, height 172.8 ± 3.6 cm; body mass 61.9 ± 2.9 kg; % fat 11.7 ± 1.6; V[Combining Dot Above]O2max 48.67 ± 3.24 ml·kg−1·min−1) underwent 4 stages of evaluation: prepreparatory stage—T0; postpreparatory stage—T1; postcompetitive stage I—T2 and; postcompetitive stage II—T3. The plasmatic activity of creatine kinase (CK) and lactate dehydrogenase (LDH) were evaluated, as well as the on-field performance (movement patterns, tactical variables). Regarding the plasmatic activity of CK and LDH, there was a significant reduction (p ⩽ 0.05) throughout the periodization training (T0: 350 U·L−1; T3: 150 U·L−1). Significant increases were observed (p ⩽ 0.05) in the intensity of the game, high-intensity activities (HIA) (T0: 22%; T3: 27%), maximum speed (T0: 30 km·h−1; T3: 34 km·h−1) and tactical performance, team surface area (T0: 515 m2; T3: 683 m2), and spread (T0: 130 m; T3: 148 m). In addition, we found significant inverse correlations between the percentage variation of T0 to T3 in CK and LDH activities with percentage variation in high-intensity running (r = −0.85; p ⩽ 0.05 and r = −0.84; p < 0.01, respectively) and HIA (r = −0.71 and r = −0.70; p ⩽ 0.05, respectively) during the matches. We concluded that there was reduced activity in biochemical markers related to muscle damage, as well as increases in-game high-intensity performance and the tactical performance of the study participants. Furthermore, players who showed greater reduction in plasma activity of CK and LDH also obtained greater increases in-game high-intensity performance along the periodization. These results may contribute to the expansion and future consolidation of the knowledge of coaches and sport scientists to develop effective methodologies for training in soccer.

Rothia aeria endocarditis in a patient with a bicuspid aortic valve: case report

Rothia aeria is an uncommon pathogen mainly associated with endocarditis in case reports. In previous reports, endocarditis by R. aeria was complicated by central nervous system embolization. In the case we report herein, endocarditis by R. aeria was diagnosed after acute self-limited diarrhea. In addition to the common translocation of R. aeria from the oral cavity, we hypothesize the possibility of intestinal translocation. Matrix-assisted laser desorption ionization-time of flight mass spectrometry and genetic sequencing are important tools that can contribute to early and more accurate etiologic diagnosis of severe infections caused by Gram-positive rods.

Cryptococcal meningitis in HIV-negative patient with liver cirrhosis due to hepatitis C

©2011 Elsevier Editora Ltda. All rights reserved. Dear Editor, Before AIDS, cryptococcal meningitis, a disease caused by the basidiomycete fungus Cryptococcus neoformans, occurred at an incidence rate of one case per one million person-years.1 After AIDS, transplants and the use of immunosuppressive therapies, the incidence rate increased tenfold.1,2 We report a case of a 46-year-old male with a history of headache, confusion, nausea and vomiting for one month. The patient also had type 2 diabetes mellitus, in use of metformin, with good control, and liver cirrhosis due to hepatitis C. Treatment with pegylated interferon and ribavirin had begun two months before clinical presentation. After the second dose of interferon, pancytopenia was observed (hemoglobin: 10.9 g/dL, leukocytes: 3,660 cells/μL, platelets: 36,000/μL), decompensated cirrhosis and diabetes mellitus, characterized by moderate ascites and grade 3 hepatic encephalopathy, which overlapped the clinical symptoms described above, despite treatment with therapeutic doses of furosemide, spironolactone, lactulose, NPH and regular human insulin. Patient was listed for liver transplantation. Model of End-Stage Liver Disease (MELD) score equals 14 points. At presentation, cerebrospinal fluid (CSF) showed 21 cells/mL, total protein = 96 mg/dL, glucose = 34 mg/dL (serum glucose: 290 mg/dL), positive India ink staining and cryptococcal antingen titer greater than 1/1,024. Culture for C. neoformans was positive in the CSF, but negative in blood, bone marrow and ascites. Central nervous system computed tomography and magnetic resonance imaging has showed only mild supratentorial hydrocephalous. Patient evolved with intracranial hypertension (the first opening pressure: 36 cmH2O), without improvement by lumbar puncture. Ventriculoperitoneal shunt was performed after two units of apheresis platelets transfusion. The patient was treated with amphotericin B lipid complex 5 mg/kg/day for 30 days and 5-fluorocytosine 100 mg/kg/day for 14 days until three negative cultures for C. neoformans were obtained. During treatment, he presented elevated creatinine (2.0 mg/dL), but without requiring dialysis. There was no worsening of pancytopenia during treatment. Strict monitoring of renal and liver function and bone marrow was performed. Before starting fluconazole 800 mg/day, the patient has presented bloodstream infection associated with central venous catheter by Enterococcus faecalis, and despite appropriate treatment with vancomycin for 10 days, the patient progressed with septic shock syndrome and multiple organ dysfunction syndrome (MODS) and died 40 days after admission. Cryptococcosis affects the central nervous system in 51.3% of HIV-negative patients, after the introduction of azole agents in the market, and in 39% of patients with cirrhosis, as suggested by the two largest studies in the literature.3,4 The peritoneum is the site most associated with cryptococcal infection in cirrhotic patients (45%).4 In 306 HIV-negative patients, the underlying causes were steroids (28%), organ transplant (18%), chronic shortage of organs (liver, respiratory and renal) (18%), neoplasm (18%), rheumatic diseases (13%), and unknown risk factor (22%).3 Malnutrition, in addition to compromised phagocytosis, immunoglobulins and cellular immunity result in increased risk of cryptococcosis in cirrhotic patients.4 The case fatality rate associated with cryptococcosis in cirrhotic patients is 83%, 92% of which attributed to cryptococcosis. In 53% of cases, death occurs in the second week of diagnosis. Culture positivity is 67% and India ink in around 50% in cirrhotic patients and HIV-negative, respectively.1,2

Relationship between Procedural Tactical Knowledge and Specific Motor Skills in Young Soccer Players

The purpose of this study was to investigate the association between offensive tactical knowledge and the soccer-specific motor skills performance. Fifteen participants were submitted to two evaluation tests, one to assess their technical and tactical analysis. The motor skills performance was measured through four tests of technical soccer skills: ball control, shooting, passing and dribbling. The tactical performance was based on a tactical assessment system called FUT-SAT (Analyses of Procedural Tactical Knowledge in Soccer). Afterwards, technical and tactical evaluation scores were ranked with and without the use of the cluster method. A positive, weak correlation was perceived in both analyses (rho = 0.39, not significant p = 0.14 (with cluster analysis); and rho = 0.35; not significant p = 0.20 (without cluster analysis)). We can conclude that there was a weak association between the technical and the offensive tactical knowledge. This shows the need to reflect on the use of such tests to assess technical skills in team sports since they do not take into account the variability and unpredictability of game actions and disregard the inherent needs to assess such skill performance in the game.

Effects of 22 weeks of training on functional markers and match performance of young soccer players

The aim of this study was to verify the effects of 22 weeks of training on functional markers and match performance through the use of earned points in competition. Twenty male soccer players were submitted to the same group of tests in four moments of the periodization: before the preparatory stage (T0); after the preparatory stage (T1); after the competitive stage I (T2); after the competitive stage II (T3). The functional markers were measured using the vertical and horizontal jump, T-40; Shuttle Run Test and RAST. The match performance was obtained by earned points in competition. An increase were found for all the variables analyzed for functional markers when T0 was compared with T3. In relation to the match performance, the team obtained 83.33% success in competitive stages. It is possible to conclude that training plan was efficient to improve technical-tactical skills and physical fitness of the studied athletes.

Long distance run induced hydration and kidney function changes in marathoners

O objetivo do estudo foi verificar o estado de hidratacao e a funcao renal de maratonistas durante uma temporada preparatoria e apos a competicao. Foram estudados nove maratonistas durante 12 semanas de treinamento. A urina foi coletada em quatro momentos: antes (C1) e durante (C2) o protocolo de treinamento, antes (C3) e apos (C4) a competicao. Foram mensurados o pH a partir de tiras de reagentes, a densidade por meio do refratometro, a proteinuria pelo ensaio de Bradford, concentracao de eritrocitos e de leucocitos por microscopia. Alteracoes foram encontradas quando comparado o C-4 com as coletas anteriores para todas as variaveis estudadas. Pode-se concluir que o exercicio fisico induziu a modificacoes importantes no estado de hidratacao dos corredores e na funcao da membrana glomerular, modificando assim, a funcao renal dos maratonistas no momento pos prova.The aim of the study was to verify the hydration status and the kidney function in marathoners during the training season and after a marathon race. Nine male runners were investigated during 12 weeks of training. Urine was collected in four moments; in the beginning (C1) and during (C2) the training program, before (C3) and after (C4) the competition. Urine pH was measured using reagent tapes, urine density with a refractometer, protein excretion by Bradford assay and erythrocytes and leucocytes by microscopy. Changes were observed when C-4 was compared to the other collection times for all variables investigated. It is possible to conclude that physical exertion induced important changes in the hydration status and glomerular membrane selectivity to macromolecules, modifying the kidney function of the marathoners in C4.

Chronic pulmonary paracoccidioidomycosis in an AIDS patient and Mycobacterium gordonae as confounding factor

Paracoccidioidomycosis is an endemic fungal infection restricted geographically to South and Central America. The incidence in patients with HIV/AIDS was 1.5%, higher than in the general population (0.02%). We report a case of a 47-year-old man pre-sented with fi ve months of cough with yellow sputum, weight loss of 5 kg, daily evening fever, ranging from 38°C to 39°C, malaise, anorexia, dyspnea on exertion and night sweats. He re-ported diagnosis of AIDS four years ago (initial CD4 = 86 cells/mm