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Objective: We aimed to determine the prevalence of self-reported swallowing difficulty (dysphagia) among older Colombians and to explore the factors associated with this condition. Methods: This study presents a secondary analysis of the SABE-Colombia survey, a cross-sectional study of community-dwelling older adults. The dependent variable was self-reported swallowing difficulty, assessed through the question: “How often do you have difficulty or discomfort swallowing?” Descriptive and bivariate analyses of the sample were performed, followed by multivariate analysis, adjusting for confounding variables. Results: The final sample included 19 004 older Colombians, whose mean age was 69 years (56% women). The overall prevalence of swallowing difficulty was 12.2%. In the multivariate analysis, significant associations were observed between swallowing difficulty and several factors, including male sex (OR 1.14, 95%CI 1.03 – 1.26), age > 80 years (OR 1.26, 95%CI 1.08 – 1.47), dependence in activities of daily living (OR 1.62, 95%CI 1.23 – 2.13), cognitive impairment (OR 1.49, 95%CI 1.30 – 1.70), depressive symptoms (OR 1.38, 95%CI 1.15 – 1.65), sarcopenia (OR 1.32, 95%CI 1.02 – 1.69), malnutrition (OR 1.35, 95%CI 1.23 – 1.49), and osteoarticular disease (OR 1.18, 95%CI 1.07 – 1.38). Conclusion: There was a high prevalence of swallowing difficulty among older community-dwelling Colombians. Our results showed a strong correlation between swallowing difficulty and risk factors such as cognitive impairment, depressive symptoms, osteoarticular disease, and dependence in activities of daily living, but not with malnutrition or sarcopenia.

El presente artículo es una aproximación reflexiva a lo que supone e implica la destreza escrita en el aula tanto para los profesores como para los estudiantes. Se aborda la distinción entre “expresión escrita” y “composición escrita”, y se defiende la necesidad de equilibrar ambos modos de hacer en el aula para, poco a poco, conseguir de los estudiantes el máximo de eficacia con los textos escritos. Por último, se incide en la importancia de entretejer necesidades, motivación, responsabilidad y “emociones”.

Paracoccidioidomycosis is a systemic fungal disease associated with agricultural activities. Its incidence and prevalence are underestimated because of the lack of reporting in several Brazilian states. If paracoccidiodomycosis is not diagnosed and treated early and adequately, endemic fungal infection may result in serious sequelae. In addition to the Paracoccidioides brasiliensis (P. brasiliensis) complex, the appearance of a new species, Paracoccidioides lutzii (P. lutzii), in Rondônia state, where the disease has reached epidemic levels, and in the country's Midwest region and Pará state, are challenges to diagnosis and to the urgent availability of antigens that are reactive with patients' sera. These guidelines aim to update the first Brazilian consensus on paracoccidioidomycosis by providing evidence-based recommendations for bedside patient management. The guidelines provide data on etiology, epidemiology, immunopathogenesis, diagnosis, treatment and sequelae, with emphasis on diagnosis and treatment, as well as current recommendations and challenges in this field of knowledge.

Competing Interests: Potential Conflict of Interest No potential conflict of interest relevant to this article was reported.

Objective: To evaluate the expression of Glial Fibrillary Acidic Protein (GFAP) after ischemia-reperfusion injury., Methods: twenty four rats were divided into four groups: Control, submitted to anesthesia and liver biopsy; Sham, receiving injection of heparin through the vena cava and hepatic pedicle dissection, with liver biopsy after 24 hours; Ischemia-30, the same as Sham group, plus hepatic pedicle clamping for 30 minutes; and Ischemia-90, the same procedure of Ischemia-30 group, but with clamping period of 90 minutes. After 24 hours of observation, the animals underwent laparotomy and we evaluated their livers macroscopically, microscopically by hematoxylin-eosin (HE) and analyzed the expression of GFAP by Western Blotting., Results: There was no difference in the gross appearance of the livers between the different experimental groups, all having demonstrated normal morphology. HE analysis showed no significant differences with respect to lobule morphology. On the other hand, in the ischemia groups we observed neutrophilic infiltrates and small areas of necrosis. GFAP expression was similar in all groups, either qualitatively and quantitatively., Conclusion: The expression of Glial Fibrillary Acidic Protein did not change in our model of ischemia-reperfusion.

Although many proteins have been described involved in Escherichia coli colonization and infection, only few reports have shown lectins as important components in these processes. Because the mechanisms underlying E. coli colonization process involving lectins are not fully understood, we sought to identify the presence of other non-described lectins in E. coli. Here, we isolated a 75-kDa protein from E. coli on Sepharose column and identified it as ferric aerobactin receptor (IutA). Since IutA is controversially associated with virulence of some E. coli strains, mainly in uropathogenic E. coli (UPEC), we evaluated the presence of iutA gene in UPEC isolated from patients with urinary infection. This gene was present in only 38% of the isolates, suggesting a weak association with virulence. Because there is a redundancy in the siderophore-mediated uptake systems, we suggest that IutA can be advantageous but not essential for UPEC.

Unlabelled: There isn't definitive and consistent data concerning the distribution of bacterial species in patients with Chronic Sinusitis (CS). The variability of the results from studies in CS may be due to the different techniques used as collection method, variations in culture methods, previous antibiotic use, and difficulty in distinguishing bacterial flora from pathogenic agents., Study Design: Clinical prospective., Aim: To identify the incidence of microorganisms in patients with CRS by growing bacteria from the secretion of the maxillary sinus., Patients and Methods: Cross-sectional study in 62 patients that had undergone FESS for treatment of chronic sinusitis; cultures from the maxillary sinus were obtained., Results: 62 samples, 33 (53.2%) had no growth; 29 (45.2%) counts of aerobic bacteria; one case (1.6%) of fungus growth; we did not find anaerobic bacteria. Pseudomonas aeruginosa was the one more frequently found - 8 samples (27.6%), Staphylococcus aureus and Staphylococcus epidermidis in 4 samples each; Streptococcus pneumoniae in 3 samples (10.4%); other Gram negative agents in 17 samples (31%)., Conclusion: In the present study we concluded that Pseudomonas aeruginosa, other Gram negatives bacteria and Staphylococcus spp were the representatives of the bacterial flora found in the paranasal sinuses of patients with CS.

Primary infection with Paracoccidioides brasiliensis has rarely been observed. A 28-year-old male patient presented with a three-month history of fever, respiratory symptoms and malaise. Chest X-rays revealed bilateral apical infiltrates, right pleuritis and hilar lymphadenomegaly. The patient presented with leukocytosis, severe eosinophilia and increasing titers of anti-P. brasiliensis antibodies in serum. To our knowledge, this is the first report of the primary pulmonary lymph node complex of paracoccidioidomycosis accompanied by hypereosinophilia and affecting a previously healthy adult.

Purpose: The effect of a plain 48-wire self-expanding flexible stent (Wallgraft Boston Scientific) on abdominal aortic aneurysms has been studied in a new animal model. We performed this study in order to analyze the mechanical properties of a bare-metal Wallgraft endoprostheses to investigate their responses to hemodynamic forces., Methods: Aneurysms were created by interposing fusiform segments of PTFE into the infrarenal aortas of 12 Large White pigs. The pigs were assessed after 2 weeks by telemetry pressure, ultrasonography and arteriography methods. Endovascular placement of the stents, 2 weeks after aneurysm creation, was performed under arteriographic control in the half of pigs (second group of study). These pigs were assessed by telemetry pressure, ultrasonography and arteriography methods, weekly after stenting; they were then sacrificed for pathological examination., Results: At 6 weeks the aneurysms in the first group were pulsatile with partial endothelialisation and no mural thrombus. Placement of the stent of different sizes in the second group was easily accomplished. Stenting resulted in an immediate reduction in wall pulsatility of all aneurysms and thrombosis of the excluded aneurysm sac occurred in three cases. In the other three cases the pulse pressure in the sac was reduced. In all cases there was a significant reduction in the maximum aneurysm diameter when measured weekly after stenting., Discussion and Conclusions: A pulsatile, non-thrombogenic aortic aneurysm model approaching human dimensions has been successfully developed for the study of endoprostheses prior to their clinical use. Endovascular placement of a plain, multiple-wire Wallgraft was associated with reductions in aneurysm pulsatility, pulse pressure within the sac and maximum aneurysm diameter over the study period. Stenting was associated with thrombosis of the excluded aneurysm sac in 50% of the cases.

Introduction: Spinal cord ischemia is one of the most dreaded complication which may occur after conventional surgery of the thoraco-abdominal aorta, as well as following endoprostheses implantation. A better understanding of its pathogeny and physiopathology may lead to the introduction of means or measures for its prevention. The widespread utilization of the endovascular management of thoraco-abdominal aortic pathology stimulated the search for new alternatives to overcome the problem., Material and Methods: An experimental study was conducted, using Wistar-Lewis rats. Thirty-six animals were employed to assess the spinal cord consequences following the implantation of PTFE endoprosthesis in the thoraco-abdominal aorta. The endoprostheses were introduced through a distal aortotomy and advanced until the limits of the subclavian artery, down to the celiac axis. A similar group of animals underwent the conventional surgical management. To evaluate the neurologic repercussions, a sensor was placed in the spinal cord aimed at the registry of the bioelectric potentials, every two hours, until a limit of eight hours, in subgroups of six animals. Finally, the spinal cord was removed for histological examination., Results and Discussion: The collected data revealed that significant ischemic alterations occurred eight hours after the implantation of the endoprostheses and that 48 hours later some signs of recovery could be observed, probably by means of collateral blood flow arising from the spinal cord itself or from branches of the thoraco-abdominal vasculature. However, it must be stressed that these results were obtained in healthy animals, with normal arteries, and that the resistance of the nervous tissues to the ischemia is certainly lower than in individuals with previous arterial pathology.

Sometimes in clinical practice the spinal cord is subjected to a more or less prolonged period of ischemia, after which cellular lesions may occur, causing paraplegia. The purpose of this paper is to quantify morphologically the damage of the spinal cord after an induced ischemia. Seventy male adult rabbits were used. They were divided into three groups: one group was used for evaluation of spinal cord ischemia at 3 hours, the second at 12 hours and the third at 24 hours. The recovery periods ranged from 3, to 12 and 24 hours. At the end of this period, the animals were anesthetized and killed. A clinical evaluation was made using the Tarlov method and criteria. The spinal cord was subjected to a histological evaluation. The results revealed different changes according to the multiple groups of study. The authors discuss the data of the present study and compare to the reports published in the bibliography on the subject.

We summarize here data regarding the spectrum of action, the pharmacological aspects, the toxicological aspects and the clinical efficacy of liposomal amphotericin B, amphotericin B in colloidal dispersion, amphotericin B lipid complex, voriconazole and caspofungin. We discuss the use of these more recently introduced antifungal agents in terms of their safety, efficiency and cost. We also offer suggestions for the clinical use of these drugs in pulmonary and systemic infections, with an emphasis on the lower toxicity of the lipid formulations of amphotericin B in comparison with conventional medications. In addition, we explore the possibility of using voriconazole as the primary treatment for invasive infections such as aspergillosis, as well as those caused by Scedosporium spp. and Fusarium spp., together with that of using caspofungin to treat disseminated candidiasis and invasive aspergillosis.

Xacriabá Indian Reserve is situated in the north of Minas Gerais State, Brazil, near the municipality of Manga and São Francisco River. The Indian population is miscegenated with caucasian and negroid people and have farming activities. Blood samples were collected from 180 inhabitants of the reserve (85 men and 95 women), 15 to 84 years old. Serum antibodies against antigens of Paracoccidioides brasiliensis, Histoplasma capsulatum, Cryptococcus neoformans, and Candida albicans were tested for by counterimmunoelectrophoresis method. Seropositivity was verified in 5%, 3.9%, 4.2%, and 6.7%, respectively of the 180 samples. Those seropositive for antigens of P. brasiliensis and H. capsulatum were predominantly women and had lower age and more elevated mean titers of antibodies than individuals whose sera reacted with antigens of C. neoformans and C. albicans. The results suggest the occurrence of paracoccidioidomycosis-infection and histoplasmosis-infection in the Xacriabá Indian Reserve, particularly in the first decades of life of the inhabitants.

OBJECTIVE: To describe an unusual case with clinical features of the antiphospholipid syndrome. DESCRIPTION: White child, two years and six months old, with renal failure, renal arterial thrombosis, and diagnosis of antiphospholipid syndrome was hospitalized with a history of abdominal pain, pallor, lethargy, and anuria for 36 hours. On physical examination, the patient showed malnutrition, high blood pressure, moderate edema, and hypochondrial pain. Laboratory findings included: urea=112mg/dl, serum creatinine= 4.5 mg/dl, blood pH= 7.47, blood bicarbonate= 12.8 mmol/L, K=7.2 mEq/L. Peritoneal dialysis was started and maintained for 11 days. After 7 weeks, the patient still needed anti-hypertensive drugs and the renal function was still abnormal. Renal biopsy was performed and revealed renal infarction. The result of Doppler ultrasonography revealed absent renal blood flow on the right side. Renal arteriography showed total occlusion of the right renal artery. Results for collagen diseases were negative. A right nephrectomy was performed and the blood pressure was controlled. The child was hospitalized again at 5 years and 8 months old with episodes of absence seizures and abdominal and precordial pain. Anticardiolipin antibody test was positive. The child is now 7 years old, asymptomatic, with negative anticardiolipin antibody, and has been under regular follow-up. COMMENTS: Children with arterial thrombosis should be investigated for a possible association with the antiphospholipid antibody syndrome even in the absence of collagen disease.

Background: Isolation of a yeast in urine does not necessarily indicate infection, but Candida urinary tract infection is an increasing nosocomial problem. In this study the clinical significance of candiduria was investigated in a Brazilian university hospital., Methods: Between January and December 1998 species of Candida were isolated in the urine of 166 patients admitted to a tertiary-care general hospital at Ribeirão Preto, SP, Brazil. The data of 100 of these patients were retrospectivelly reviewed concerning microbiological, epidemiological, and clinical aspects of candiduria., Results: C. tropicalis was found in 53% of the patients and C. albicans in 36%. Urine cultures yielded more than 20.000 yeast colonies/ml in 76% of cases. Neurological, cardiac and other chronic diseases, cancer, and trauma were frequent underlying illnesses. Diabetes mellitus was present in 25% of patients. The major predisposing factors associated with candiduria were previous antibiotic therapy (93%) indwelling urinary catheter (83%), surgery in the last 60 days (48%), renal failure (32%), concomitant bacterial infections (28%), use of corticosteroids (20%), and use of other immunosuppressive drugs (10%). Therapy for candiduria, fluconazole or amphotericin B with one exception, was given only to 43/100 patients. The overall mortality in the 60 days after the candiduria episode was 40%., Conclusions: The non-albicans species of Candida were the major agents of candiduria and are emergent pathogens of the urinary tract in critically ill patients. The underlying illnesses, risk factors and high mortality commonly associated with Candida urinary tract infection were also observed in a Brazilian university hospital.

Two HIV-seronegative patients with cryptococcal disease refractory to conventional antifungal therapy were submitted to an evaluation of the immune system. Hypogammaglobulinemia was found in both and associated with abnormal function of cell-mediated immunity. Hypogammaglobulinemia is considered as a possible predisposing factor for cryptococcal infection. The importance of the antibodies on the control of Cryptococcus neoformans infection is discussed.

The authors report a case of disseminated cutaneous infection with Sporothrix schenckii in a previously asymptomatic HIV-infected 30 year-old man. Extensive cutaneous involvement was observed with suppurative collections and ulcerations. The agent was isolated in culture. Treatment with liposomal amphotericin B proved to be effective.

In view of the benefits of immunoprophylaxis among newborns of mothers who are seropositive for hepatitis B virus (HBV) surface antigen (HBsAG), these women must be correctly identified so that this measure can be instituted in Brazil. The research reported here studied 7992 women who gave birth in the Hospital das Clínicas of the Ribeirão Preto School of Medicine, University of São Paulo (HCFMRP-USP), Brazil, in order to determine the rate of serum reactivity of HBsAg and other markers of HBV infection among these women, and also to evaluate the risk factors for this infection. Serum reactivity for HBsAg was determined by means of an immunoenzymatic test (ELISA) carried out in two stages: the first with an incubation period of 2 hours (screening), and the second with an incubation period of 18 hours (confirmation) for those samples that were positive in the screening test. The markers anti-HBsAg, HBeAg, anti-HBcAg, and anti-HBeAG were tested in the samples that were confirmed positive. The screening test found 1.05% (95% CI: 0.84 - 1.30) of the samples to be positive for HBsAg. However, only 0.95% (95% CI: 0.75 - 1.19) were confirmed positive, the percentage being significantly higher among patients whose pregnancies had ended in abortion (1.84%) than among those who had given birth (0.84%) (X2, Yates correction = 7.76; P < 0.005). Risk factors for HBV infection could be identified for only 27.6% of the study subjects, based on their recall and reporting. Of the women with confirmed positive samples, 21.3% also were positive for HBeAG, indicating that these patients ran a greater risk of transmitting the virus vertically. These results underline the need for specific serologic studies in the final stage of pregnancy in order to offer the maximum benefit of neonatal immunoprophylaxis.

This study was carried out in order to estimate the frequency of other sexually transmitted diseases (STD) among AIDS patients and to identify their epidemiological association and possible relations to the groups most exposed to the virus. The data were collected from the medical case histories and the STD were identified on the basis of data provided by anamnesis, physical examination and laboratory examinations. Of the total of HIV/AIDS patients assisted at the hospital studied (S. Paulo State, Brazil), between January 1986 and January 1992, 207 were included as sample subjects for this survey. Of the patients studied, 88 (42.5%) had some other STD and 119 (57.5%) had no other STD, equivalent to a proportion of 0.7 STD patients-STD to each non-STD patient. The most prevalent STD identified were hepatitis B (33.3%), syphilis (30.3%) and gonorrhoea (12.9%). Concerning the means of transmission by which the patients had probably been infected with HIV, blood transmission was the most prevalent (44.9%); followed by sexual contact (21.3%); sexual/blood (17.9%); in 25.9% it was undetermined. In a particular comparison of sexual and blood transmission and the presence of other STD a statistical difference in those cases that were exposed to sexual transmission was observed.

The authors report an unusual case of fungal gastric lesion in a patient with the chronic form of paracoccidioidomycosis. For a period of 8 months the major symptoms of the patient were abdominal pain and body weight loss. The endoscopic evaluation of the upper gastrointestinal tract showed a partial gastrectomy made previously, a great and irregular ulcer in the stomach and a granulated aspect of the duodenal mucosa. A granulomatous process and Paracoccidioides brasiliensis were observed in the histopathological examination of the gastric and duodenal biopsy tissue. New endoscopic evaluation 4 months after treatment with sulfadiazine revealed healing of the gastric ulcer. It was suggested that abdominal lymph nodes involvement, duodenal infection and anatomical and atrophic alterations of the stomach were predisposing factors for the gastric paracoccidioidomycosis.

The relationship between alcoholism and paracoccidioidomycosis was evaluated by the case-control method. The alcohol consumption of 4 groups of patients was compared: 50 patients with chronic paracoccidioidomycosis, 20 patients with the acute or subacute form of this mycosis and their respective control groups of hospitalized patients, each case matched by sex and age. Between September 1986 and July 1988 the cases and their controls were interviewed by one and the same investigator using a questionnaire on drinking habits: quantity and type of beverage consumed, time of onset and frequency of use and whether they had manifested symptoms of inebriation or of alcohol dependence previously. As compared with control patients, the mean daily ingestion of alcohol in excess of 60 ml was more frequent in the chronic paracoccidioidomycosis group (50.0% x 30.0%). These patients also preferred to drink sugar cane brandy more frequently (89.4% x 68.3%). When the average daily consumption of ethyl alcohol exceeded 100 ml, most patients presented a recurrence of infection during or after antifungal therapy. In the acute-subacute paracoccidioidomycosis group, 64.3% of the patients reported inebriation on one or more occasions, versus 17.6% in the respective control group. The results suggest that alcoholism can be a predisposing factor to paracoccidioidomycosis and, probably, accounts for a worse prognosis for this infection.

Seventeen consecutive cases of cryptococcal meningitis diagnosed at Hospital das Clínicas of Ribeirão Preto Medical School (São Paulo State Brazil) between 1969 and 1985 were reviewed. For analysis the patients were separated in 3 groups: I. three patients without immunodeficiency; II. six patients with associated disease: cancer (3), diabetes (2) and alcoholism (1); III. Eight renal transplant recipients that developed cryptococcosis after 18 to 67 months of immunosupression with steroids and azathioprine. The median interval between onset of symptoms and diagnosis of infection was greater in Group II (53 days) than in Groups I (25 days) or III (28 days). Neck stiffness, cranial nerve involvement and papilledema were more frequent in Group I than in Group II or III, but fever and focal neurological signs were observed only in patients of two last groups. Cerebrospinal fluid examination showed a mild lymphocytic pleocytosis in most patients, but transplant cases had polymorphonuclear cells more frequently. Late mortality was higher in patients with underlying disease and the prognosis was better for transplant patients that received effective antifungal therapy. Besides cryptococci, autopsy findings in 8 cases revealed granuloma formation in tissues, except in patients of Group II (2 cases). The differences between the groups suggest that clinical characteristics, evolution and postmortem findings of the cryptococcal meningitis are changed according to type of immunodeficiency presented by the patient.

The upper gastrointestinal tract was investigated endoscopically in 30 patients with paracoccidioidomycosis. Esophagus, stomach and duodenum showed, respectivelly, 40%, 53% and 43% of endoscopic alterations. The histopathological examination of biopsy tissue revealed no specific lesions in esophagus and stomach, but P. brasiliensis was observed in three cases of duodenal lesions: two cases with mucosal diffuse erosions and one case of duodenal polyp. It is concluded that duodenal paracoccidioidomycosis is not rare and could be revealed by endoscopic examination in patients with disseminated disease.