Einstein-Sao Paulo最新文献

Dengue, a vector-borne acute febrile illness caused by members of the Flavivirus genus, has dramatically increased its occurrence worldwide. Neurological complications of dengue range from 2.63 to 40%, and subarachnoid hemorrhage is a rare, but significant manifestation. Hemophagocytic lymphohistiocytosis is a life-threatening hyperinflammatory syndrome, sometimes secondary to infections such as dengue. This report presents a rare case of severe dengue with subarachnoid hemorrhage and hemophagocytic lymphohistiocytosis. A 19-year-old male presented with a 7-day history of fever and myalgia, followed by severe headache and vomiting. Initial examination revealed high fever, hepatosplenomegaly, and pancytopenia. Lumbar puncture confirmed via computed tomography showed a Fisher Grade 2 subarachnoid hemorrhage with a small aneurysm at the junction of the left anterior coronary and anterior communicating arteries. Secondary hemophagocytic lymphohistiocytosis was diagnosed based on the criteria from 2004, with elevated inflammatory markers, hypertriglyceridemia, and hyperferritinemia. The patient was treated conservatively with intravenous fluids, osmotic diuretics, antiepileptics, steroids, and nimodipine. The patient showed clinical improvement and was discharged on the 11th day. Isolated subarachnoid hemorrhage is rare in dengue. The hyperinflammatory state in hemophagocytic lymphohistiocytosis, which is often overlooked due to nonspecific symptoms, can lead to aneurysm formation and rupture. Persistent fever, cytopenia, and hyperferritinemia should raise suspicion of hemophagocytic lymphohistiocytosis in cases of severe dengue with neurological complications. In patients with severe dengue and intracranial hemorrhage, clinicians should remain cautious for hemophagocytic lymphohistiocytosis to reduce the associated morbidity and mortality.

Background: Participants had limited exposure to prior diabetes education but improved their understanding of key components of diabetes management, including glucose monitoring, medication, diet, and exercise. Misconceptions regarding insulin use, lipodystrophy prevention, hypoglycemia correction, and appropriate consumption of snacks and carbohydrates were effectively addressed.

Objective: We aimed to implement a comprehensive and accessible diabetes education program for patients and their families based on the AADE7 framework to enhance diabetes self-management and clinical outcomes.

Methods: An observational, descriptive, mixed-methods study was conducted using weekly online webinars to deliver AADE7 educational content to participant groups. Data collection involved pre and postintervention assessments of knowledge and participant feedback.

Results: A total of 123 participants (72 with diabetes, 5 with prediabetes, and 46 family members) from various Brazilian regions participated in the study. The majority of family members were female and from low-income backgrounds. Most participants had limited prior diabetes education. The educational sessions improved participants' understanding of diabetes management, including the importance of monitoring blood glucose, administering medication, managing diet, and maintaining physical activity. The program also addressed common misconceptions, including managing insulin types, preventing lipodystrophy, adequately correcting hypoglycemia, and incorporating sweets and other carbohydrate-rich foods into the diet when appropriate.

Conclusion: Diabetes education enhances glycemic management; therefore, it should be an integral part of treatment. The AADE7 framework proved highly effective, offering a holistic perspective on diabetes care.

Background: This cross-sectional study describes the adequacy of nutritional status and food intake in patients with American Tegumentary Leishmaniasis and its relationship with the form of the disease: cutaneous or mucosal. Patients with mucosal have greater nutritional impairment associated with older age and symptoms such as odynophagia, dysphagia, and oropharyngeal lesions, which lead to reduced dietary intake and inadequate intake of micronutrients.

Objective: Patients with American Tegumentary Leishmaniasis often experience malnutrition, weight loss, and dehydration; however, their eating profile and the degree of interference of disease manifestations on food intake is not well understood. Therefore, this study aimed to evaluate the nutritional profile and food intake of patients with American Tegumentary Leishmaniasis before treatment initiation.

Methods: This was a cross-sectional study of adult and older patients with cutaneous and mucosal leishmaniasis treated at a reference center between 2011 and 2017. A nutritional consultation was conducted to collect anthropometric, biochemical, and dietary intake data (24-h dietary recalls), which were assessed for adequacy.

Results: Sixty-two patients were included, with a median age of 47.5 (35.0-60.5) years, 82.3% being men, and 59.7% presenting the cutaneous form of the disease. Approximately half of the participants (51.6%) were overweight; however, most had an inadequate intake of selenium (93.5%), calcium (91.9%), magnesium (83.9%), and fiber (66.1%). Patients with mucosal leishmaniasis showed greater nutritional impairment (lower body weight, arm muscle circumference, and serum albumin levels), which was associated with older age and symptoms such as odynophagia, dysphagia, and nasal obstruction, and insufficient zinc intake than those with cutaneous leishmaniasis (p<0.05).

Conclusion: Patients with mucosal leishmaniasis had greater nutritional impairment leading to reduced dietary intake and inadequate intake of micronutrients, which can negatively interfere with disease prognosis and prolong the healing process. Consequently, nutrient supplementation, a nutritional intervention, could increase the effectiveness of American Tegumentary Leishmaniasis treatment, by ensuring a good nutritional status, which is essential for tissue recovery.

Schizophrenia diagnostics have evolved to adapt to clinical needs and scientific advances, and the current denominations emerged at the beginning of the twentieth century. Most problems arise while integrating clinical experiences, based on historical psychopathological descriptions, with emerging translational neuroscience research. This study aimed to evaluate the state-of-the-art critics of the current schizophrenia concept and their recommendations for new concepts. We performed a narrative review of the literature and searched for studies published in English in PubMed in the last 2 years which discussed the diagnosis of schizophrenia. Two authors independently selected the studies after analyzing the abstracts. Subsequently, studies were selected for this review by consensus. Twenty-six studies were selected, and all authors, except two, had restrictions on the current categorical model for the diagnosis of schizophrenia owing to the heterogeneity of symptomatology and high frequency of comorbidity. Eight studies proposed changes to the concept of schizophrenia. The central proposition was to adopt psychotic syndrome as a core feature instead of the current concept of schizophrenia. We synthesize these proposals using psychosis as a spectrum that includes schizophrenia as a more severe case at the end of the spectrum.

Food allergies are the leading cause of anaphylaxis in children. Cofactors, such as exercise and non-steroidal anti-inflammatory drugs, may influence the occurrence and severity of allergic reactions to food. However, despite their relevance, the underlying mechanisms of cofactor-enhanced food allergies remain poorly understood. We report the case of a 12-year-old girl with mitochondrial DNA depletion syndrome who was referred to an allergy appointment due to suspected ibuprofen hypersensitivity. Detailed anamnesis, laboratory assessment, and negative drug challenge results excluded this diagnosis; however, continued follow-up revealed a crucial pattern on patient reactions that led to the diagnosis of a cofactor-enhanced food allergy with the presumed involvement of soy storage proteins and non-steroidal anti-inflammatory drugs. Our purpose was to highlight the non-negligible role of cofactors in food allergies and the importance of early identification. Moreover, to underscore the relevance of maintaining patient follow-up, as new information may arise and redirect the diagnosis.

Kabuki syndrome is a rare congenital malformation with typical facial features, skeletal anomalies, delayed neuropsychomotor development and growth, and cardiac, genitourinary, gastrointestinal, endocrine, and dental anomalies. One of the main differential diagnoses is CHARGE syndrome, standing for and characterized by Coloboma of the eye, Heart defects, Atresia of the nasal choanae, Restricted intellectual development, Genitourinary malformations, and Ear anomalies. Because these syndromes have similar characteristics, distinguishing them may be challenging. A 24-year-old male patient admitted with reduced renal function had a previous phenotype-based diagnosis of CHARGE syndrome based on many characteristic clinical features. The unveiling of a hypocalcemic crisis diagnosed as primary hypoparathyroidism at the age of 15 years, which did not fit into that diagnosis, led the nephrologist to request a genetic test, which evidenced a missense variant of uncertain significance in exon 38 of the KMT2D gene. This phenotype further suggested Kabuki syndrome, ruling out CHARGE. The present report highlights the importance of genetic testing and discusses phenotype-genotype correlations, which ultimately showed that specific variants in exon 38 rendered a form of Kabuki syndrome distinct from the typical one.