Marcos Antonio Custódio Neto da Silva

INTERFERON BETA-1A TREATMENT IN HTLV-1-ASSOCIATED MYELOPATHY/TROPICAL SPASTIC PARAPARESIS: A CASE REPORT

Here a young patient (< 21 years of age) with a history of infective dermatitis is described. The patient was diagnosed with myelopathy associated with HTLV-1/tropical spastic paraparesis and treated with interferon beta-1a. The disease was clinically established as HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP), and laboratory tests confirmed the presence of antibodies to HTLV-1 in the cerebrospinal fluid (CSF). Mumps, cytomegalovirus, Epstein-Barr virus, schistosomiasis, herpes virus 1 and 2, rubella, measles, varicella-zoster toxoplasmosis, hepatitis, HIV, and syphilis were excluded by serology. The patient was diagnosed with neurogenic bladder and presented with nocturia, urinary urgency, paresthesia of the lower left limb, a marked reduction of muscle strength in the lower limbs, and a slight reduction in upper limb strength. During the fourth week of treatment with interferon beta-1a, urinary urgency and paresthesia disappeared and clinical motor skills improved.

Diversity and dynamics of airborne fungi in São Luis, State of Maranhão, Brazil

INTRODUCTION This study aimed to identify airborne fungi in São Luis, Maranhão, Brazil, to determine the prevalent genera and to correlate these genera with the area and season. METHODS In total, 1,510 colony-forming units (CFUs) of airborne fungi were isolated from the north, south, east and west sides and from the center of the city from January to December 2007. The samples were collected on Petri dishes that were exposed to the fungi by the gravitational method. RESULTS Twenty genera of fungi were isolated; the most common were Aspergillus (33.5%), Penicillium (18.8%), Cladosporium (14.2%), Curvularia (10.6%) and Fusarium (7.6%). The CFUs of the fungi were statistically significant (p < 0.0001). Fungal biological diversity was present all year, without any large seasonal variations but with slight increases in May, August and September. CONCLUSIONS The fungal genera identified in this study were correlated with natural systems and could be useful when evaluating the impact of environmental changes on the region.

Osteoporosis in primary care: an opportunity to approach risk factors

INTRODUCTION Climacteric women are susceptible to a number of changes, among them osteoporosis. Osteoporosis is a disease characterized by low bone mass and susceptibility to fracture. Currently, this disease is a public health issue, being necessary to recognize its risk factors. OBJECTIVES Identify risk factors related to osteoporosis in women attending PROPIS/PROEX/UFMA, tracing a socio-demographic characterization and considering community lifestyles. MATERIAL AND METHODS This is a transversal retrospective clinical with a quantitative approach study conducted between March and June 2013 in São Luís-MA with 107 women treated at the Programa de Práticas de Integralidade em Saúde (PROPIS - Integrality Health Practice Program). The study was approved by the University Hospital Ethics Committee of UFMA under opinion no. 362/07. Data were tabulated and analyzed in the epidemiological Epi-Info(®) software, version 3.4.1. RESULTS The brown color was predominant, consensual relationships proved to be a protective factor and low education was a risk factor. The average age of the group with menopause was 54.1 years and without menopause was 31.3 years (p<0.0001). The average age of menopause was 43.7 years. The irregular menstrual cycle was a protective factor. The average number of pregnancies was 4.56 for the group with menopause and 2.45 for the group without menopause, with most births occurring normally (p<0.0001). Smoking, physical inactivity and caffeine intake were risk factors, while the absence of alcoholism and of soda intake were protective factors for the disease. CONCLUSION The patients followed the socioeconomic and demographic profile of Maranhão. Most had menarche and menopause in appropriate periods, showed no positive family history of osteoporosis, did not usually drink alcohol, were sedentary and the caffeine intake was high.

Eco-epidemiologic study of emerging fungi related to the work of babaçu coconut breakers in the State of Maranhão, Brazil

INTRODUCTION There are more than 300,000 extractors using the babaçu coconut as a source of income in the States of Maranhão, Pará, Tocantins and Piauí, and this activity is associated with fungal infections. The objective of this study was to examine the occurrence of emergent fungi in the conjunctiva, nails and surface and subcutaneous injuries of female coconut breakers in Esperantinópolis, Maranhão. Additionally, soil samples and palm structures were collected. METHODS The obtained samples were cultured in Petri dishes containing potato-dextrose-agar and chloramphenicol. The etiological agent was confirmed by a direct mycological exam and growth in culture. RESULTS In total, 150 domiciles were visited, and samples were collected from 80 patients. From the ground, the most frequently isolated fungus was Aspergillus niger (53. 8%). the most frequently detected fungus in babaçu coconut was Aspergillus niger (66.7%). Conjunctival fungal growth occurred in 76.3% of the women. The ocular fungal microbiota consisted of filamentous fungi (80.6%), and yeasts were present in 19.4% of cases. Onychomycosis was diagnosed in 44% (11/25) of the women. CONCLUSIONS The identification of the genera Neosartorya, Rhizopus and Curvularia in onychomycoses shows that emergent filamentous fungi can be isolated. Aspergillus sp., Penicillium sp. and Scedosporium sp. were the predominant genera found in the babaçu coconut. From ocular conjunctiva, Candida spp. were the most prevalent species isolated, and Fusarium sp. was present only in one woman. The nearly permanent exposure of coconut breakers to the external environment and to the soil is most likely the reason for the existence of a mycotic flora and fungal infections, varying according to the individuals practices and occupation.

Gaucher disease in a family from Maranhão

Background Gaucher disease is an inborn, autosomal recessive error of the metabolism which belongs to the group of lysosomal storage disorders. Objective This work reports on the treatment of Gaucher disease in several members of the same family from the countryside of Maranhão. Methods This was an observational, retrospective and prospective, descriptive case study about the efficacy of enzyme replacement therapy. Results The results showed that women were more affected (80% of patients) by the disease, age at diagnosis ranged from 24 to 33 years, the predominant ethnicity was mulatto (80%) and all cases were classified as type 1. The diagnosis of these patients was performed by measuring the levels of glucocerebrosidase and chitotriosidase enzymes and confirmed by genotyping. All patients suffering from Gaucher disease had low glucocerebrosidase levels. Before replacement therapy, hepatosplenomegaly was the most common clinical manifestation (100%) and osteopenia was seen in 80% of the cases. Regarding hematological manifestations, anemia and leukopenia were found in 40% of patients at diagnosis; however the hemoglobin and leukocyte levels were normalized after four years of therapy. Thrombocytopenia, observed in 20% of cases, was normalized after the second year of treatment. Conclusion In these cases, despite gaps in the treatment as the family resides in the rural region of the state, the patients with Gaucher disease showed satisfactory therapeutic response over time.

Resistant tuberculosis in Maranhão, Brazil: a case series

BackgroundMycobacterium tuberculosis multidrug resistance, especially against rifampicin and isoniazid, places pulmonary tuberculosis in the list of emerging diseases. The misuse of therapeutic regimens is one of its main predisposing factors.Case presentationFour clinical cases (three were brown and one black) with multidrug-resistant tuberculosis, treated in a reference hospital in the state of Maranhão, Brazil, were reported to evaluate the importance of radiological framework on disease evolution.ConclusionThe clinical framework showed a bad evolution and drug resistance, while radiology showed lung lesions, ranging from exudative infiltrates to lung parenchyma disintegration.

Respiratory allergy to airborne fungi in São Luís – MA: clinical aspects and levels of IgE in a structured asthma program

Abstract Introduction: Respiratory allergies are becoming increasingly frequent, especially based on studies of asthma and rhinitis. It is estimated that 20–30% of the world’s population is affected. Allergic reactions are caused by the production of IgE antibodies specific to inhaled allergens, such as fungi in the air. This study aimed to analyze the level of specific IgE against airborne fungi in patients with a clinical diagnosis of asthma and rhinitis/sinusitis. Methods: In total, 158 patients enrolled in the Program of Support for Asthmatic Patient, and 20 controls were studied. Clinical data from the period of 2007–2008 were surveyed using a protocol form. ELISAs were performed to quantify the levels of total and specific IgE. Results: Of the 158 patients diagnosed with asthma, 71 had rhinitis and 32 had sinusitis. There was a predominance of females and residents of urban areas. The main symptoms reported were dyspnea, cough, wheezing and nasal obstruction. There was a statistically significant relationship between dyspnea and seropositivity for Fusarium (p = 0.01) and Penicillium (p = 0.005) and between cough and seropositivity for Aspergillus (p = 0.007). Conclusions: Anti-Penicillium (79.7%) and anti-Fusarium IgE (77.8%) were found to have the highest prevalence of seropositivity in individuals with asthma and rhinitis/sinusitis. Sensitivity to fungi was higher in symptomatic individuals. The identification of environmental fungi is essential for the diagnosis of respiratory allergy.

Effect of urinary incontinence on the quality of life of asthmatic women.

Abstract Objectives: Urinary incontinence (UI) has been associated with chronic respiratory symptoms, and it affects quality of life. This study evaluated the quality of life of asthmatic patients from the Assistance Program for Asthmatic Patients (PAPA) with and without UI. Methods: This is an analytical descriptive cross-sectional study using a sample of 358 women with asthma. Data were collected via the International Consultation Incontinence Questionnaire-Simplified Form (ICIQ-SF), Quality of Life in Asthma Questionnaire (QLAQ-ASTHMA) and Short Form 36 Health Survey (SF-36). Results: We found a general prevalence of UI of 55.3%. Overall quality of life scores in the SF-36 and QLAQ-ASTHMA were not related to the presence of UI. However, the amount of urine lost was significantly correlated with the subdomains physical aspects, general health, social functioning and mental health of the SF-36 and with socioeconomic and psychosocial domains of the QLAQ-ASTHMA. Conclusions: Urinary incontinence may affect a large proportion of older women with asthma. This study demonstrates the importance of routinely evaluating the occurrence of UI in order to improve the quality of life of asthmatic patients.

DIVERSITY AND INFECTIVITY POTENTIAL OF EMERGING FUNGI IN AN AREA OF BABAÇU TREES IN THE STATE OF MARANHÃO, BRAZIL

We studied human mycoses in conjunctiva, nails (onycholytic lesions) and skin lesions in 100 babaçu coconut breakers of Esperantinópolis, Maranhão (Fig. 1), and studied the ground near the babaçu palms, coconut shells and palm leaves (Fig. 2), for taxonomic classification of fungi by direct mycological and microscopic examination. We also performed direct examination with KOH for human mycoses. After the growth of colonies, these were analyzed by light microscopy using blue lactophenol dye. Colonies of interest were subcultured in tubes of 16 x 150, containing Sabouraud agar medium and subsequently was prepared microcultivation for taxonomic identification. The study was approved by the Ethics Committee in Research of the University Hospital of UFMA. Of the 20 samples taken from the soil, we obtained 13 isolates of fungi, whose macro and micromorphological characteristics of the colonies allowed the diagnosis of Aspergillus niger, Penicillium sp., and Scedosporium sp., besides others, Fusarium sp. not being found. In coconut shells Aspergillus niger and Penicillium sp. were found; in almond coconut, Aspergillus niger, A. versicolor, A. flavus, and Penicillium sp. were obtained. On palm leaves we identified Aspergillus niger and Penicillium sp. (Table 1). Twenty-five nail samples that showed suggestive alterations of onycholytic lesions (Fig. 3) were harvested; eleven positive cultures for yeast, Neosartorya spinosa, and Trichophyton sp. Rhizopus sp. and Curvularia sp. (Fig. 4) were isolated. Seventy-two fungal isolates were obtained from the conjunctiva, the most common were filamentous fungi from 58 (80.57%) breakers and 14 samples (19.43%) were found corresponding to Candida sp., and the Fusarium spp. occurred in only one sample (Fig. 5 and Table 2).

Endemic transmission of HTLV-2 in blood donors from São Luís do Maranhão, northeastern Brazil: report of two asymptomatic individuals

Human T-cell lymphotropic virus 1 and 2 (HTLV-1, HTLV-2) belong to the Retroviridae family, genus Deltaretrovirus1,2 and have similar biological properties, with tropism of T lymphocytes. They are associated with rare lymphoproliferative diseases.3,4 Brazil has a high seroprevalence of HTLV-1/2 among blood donors. The mean prevalence ranges from 0.4/1000 in Florianopolis to 10.0/1000 in Sao Luis do Maranhao.5 The first case of HTLV-2 was described in 1982 in a patient with hairy cell leukemia.6 The virus is acquired through unprotected sexual intercourse, by vertical transmission and, in Europe and North America, infection is associated with intravenous drug users. HTLV-2 is endemic in some Indian villages and urban populations in northern Brazil,7 in the state of Sao Paulo and in the central western region of the country.8 HTLV-2 can be classified into four major subtypes: HTLV-2a, HTLV-2b, HTLV-2c and HTLV-2d by molecular