Einstein-Sao Paulo最新文献

Hypersensitivity pneumonitis is an inflammatory lung disease caused by antigen inhalation after sensitization. Here, we report a rare case of the simultaneous diagnosis of hypersensitivity pneumonitis and epithelioid mesothelioma, a subtype of malignant mesothelioma. A 71-year-old man presented with an occasional dry cough and exertional dyspnea that had persisted for about 1 year. He reported walking daily in a park with a considerable number of birds during same period. Functional evaluation revealed a mild restrictive ventilatory disorder. High-resolution computed tomography showed nonspecific peripheral interstitial lung involvement along with signs of bronchopathy and diffuse bronchiolopath without honeycombing or bronchiectasis. Owing to the patient's clinical history and the presence of a restrictive ventilatory disorder, a biopsy was performed for diagnostic clarification. Pathological examination revealed hypersensitive pneumonitis associated with epithelioid mesothelioma. Surgical resection of the mesothelioma and avoidance of occupational exposure resulted in complete regression of symptoms and improvement in radiological findings. A report on this rare concomitant diagnosis of the hypersensitivity pneumonitis and epithelioid mesothelioma is essential for advancements in medicine.

Stress fractures of the sacrum are extremely rare differential diagnoses for persistent low back pain in pregnant and postpartum women. The common occurrence of low back pain due to mechanical overload on the spine, coupled with challenges in obtaining imaging studies during this phase of a woman's life, often delays and compromises the accurate diagnosis of sacral fatigue fractures. We report the rare case of a postpartum patient who underwent surgery for lumbar disc herniation one year and one month earlier and was diagnosed with an atraumatic sacral fracture.

Intestinal worm infections, referred to as helminthiases, represent a significant global health challenge, particularly in low- and middle-income countries. These infections affect millions of people and contribute to malnutrition, anemia, and impaired cognitive development, particularly in children. Nitazoxanide, first described in 1975, was initially developed as a veterinary anthelmintic. It has shown efficacy against various pathogens including Giardia lamblia, Entamoeba histolytica, and Cryptosporidium parvum. Recently, its use has expanded due to its observed in vitro activity against viruses, including coronaviruses. Nitazoxanide, a derivative of salicylamide, combines a nitrothiazole moiety with a salicylic acid moiety. Anaphylaxis, a severe immediate hypersensitivity reaction, may be induced by medications, with nonsteroidal anti-inflammatory drugs being among the most common causes. However, neither immediate hypersensitivity reactio, including anaphylaxis, to nitazoxanide nor cross-reactivity with nonsteroidal anti-inflammatory drugs has been previously reported. This study reports four cases of immediate hypersensitivity reactio to nitazoxanide in patients with non-selective immediate hypersensitivity reactio to nonsteroidal anti-inflammatory drugs. These findings highlight the need for vigilance in monitoring medication reactions and suggest the inclusion of nitazoxanide in the list of medications to be avoided in these patients.

Objective: Organ transplantation improves survival rates and quality of life; however, reintegration into the workforce remains a challenge. Therefore, this study examined the relationship among return-to-work, quality of life, and perceived stigma in Brazilian transplant recipients.

Methods: This cross-sectional study assessed stigma, quality of life (using the Short Form-36), and employment status in 352 transplant recipients. Statistical analyses included Kaplan-Meier survival curves, regression models, and factor analysis to identify key return-to-work and stigma determinants.

Results: The average return-to-work rate was 53.7%, with socioeconomic class, prior employment, and organ transplantation type positively influencing return-to-work. Stigma negatively impacted return-to-work and quality of life, especially Functional Capacity and Mental Health. Older age, racial disparities, and socioeconomic inequities were significant return-to-work barriers.

Conclusion: Return-to-work was observed in 53.7% of transplant recipients, with rates declining over time. Higher return-to-work was associated with pre-transplant employment, higher socioeconomic status, and organ transplant type. Stigma negatively impacted both return-to-work and quality of life. Return-to-work disparities were evident in terms of age, race, and income. Pre-transplant employment has emerged as the strongest return-to-work predictor. Overcoming these structural barriers is essential for optimizing long-term outcomes and ensuring that transplant recipients fully reintegrate into their occupational lives.

T-cell prolymphocytic leukemia is a rare and aggressive mature T-cell malignancy that usually presents with marked lymphocytosis, hepatosplenomegaly, lymphadenopathy, and B symptoms. However, a minority of patients present with an indolent, asymptomatic form. Case Report: A 44-year-old man was diagnosed with asymptomatic T-cell prolymphocytic leukemia after routine blood tests revealed persistent lymphocytosis. Immunophenotyping revealed a mature CD4-/CD8+ T-cell population. Cytogenetic analysis showed 14q11.2 abnormalities with TCRAD rearrangement by fluorescent in situ hybridization. A monoclonal T-cell population was confirmed by flow cytometry and polymerase chain reaction, and a STAT5B mutation was identified by next-generation sequencing. The patient had no cytopenia or organ involvement and a watch-and-wait strategy was adopted. The pathogenesis of T-cell prolymphocytic leukemia involves recurrent genetic alterations, including TCL1A rearrangements and ATM mutations, which promote genomic instability. Despite their aggressive nature, up to 30% of cases initially follow an indolent course, allowing for observation rather than immediate treatment. Standard therapies include alemtuzumab-based regimens and hematopoietic stem cell transplantation, although relapse rates remain high. Conclusion: This case underscores the need to recognize indolent presentations of T-cell prolymphocytic leukemia that may be managed conservatively. Further research is required to identify prognostic markers and optimize therapeutic strategies.

Vulvar cancer, a rare gynecological malignancy, accounts for 3-5% of cases and is most commonly squamous cell carcinoma. Prognosis is poorer in cancers unrelated to human papillomavirus (HPV), often associated with chronic inflammation. We report the case of a 42-year-old woman from São Paulo, Brazil, who presented with a vulvar lesion initially misdiagnosed as an ingrown hair. Despite treatment, the lesion progressed, and subsequent evaluation revealed invasive squamous cell carcinoma. Biopsy confirmed HPV-independent disease, with immunohistochemistry demonstrating aberrant p53 expression. Molecular analysis identified differentiated vulvar intraepithelial neoplasia, underscoring the distinct molecular pathways of HPV-related and HPV-independent carcinogenesis. This case emphasizes the importance of early diagnosis, comprehensive histopathological assessment, and further research to improve management and outcomes in HPV-independent vulvar cancer.

Lower back pain and sciatica account for approximately 40% of work-related absences, with management options ranging from conservative measures, such as rest and analgesia, to surgical intervention. Lumbar epidural steroid injections and facet joint blocks are frequently used for both diagnostic and therapeutic purposes. While most complications are minor (2.4%-9.6%), severe events, including infection, hematoma formation, and spinal cord infarction, have been reported. This case presents a perineural hematoma manifesting as acute radiculopathy, necessitating urgent surgical decompression. The patient was a 55-year-old woman with a 7-month history of low back pain radiating to her right leg, unresponsive to conservative treatments, who subsequently underwent facet and nerve root injections. Magnetic resonance imaging demonstrated lumbar degeneration with Modic changes and multilevel disc bulging. The procedure, performed under fluoroscopic guidance with contrast and therapeutic agents, was initially uneventful. However, on the third day post-injection, she developed acute left leg weakness and sensory impairment. Repeat magnetic resonance imaging showed an abnormal signal in the left L3-L4 foramen compressing the L3 nerve root, raising suspicion for a perineural hematoma. Urgent surgical decompression was performed, and pathological examination confirmed organizing hemorrhage. The patient's neurological symptoms improved rapidly, with complete recovery achieved within a month. The literature indicates that hematomas may arise from increased epidural pressure or direct needle injury, even in the absence of signs of bleeding. Practitioners should remain vigilant for post-injection hematomas, as delayed recognition can result in permanent neurological deficits. Magnetic resonance imaging is essential for timely diagnosis, and urgent decompression may optimize outcomes, given that earlier intervention is associated with better recovery.

Groove pancreatitis is a rare form of chronic pancreatitis that affects the anatomical area between the head of the pancreas, medial wall of the second part of the duodenum, and common bile duct, known as the groove area. We present the case of a 40-year-old female patient with recurrent acute abdominal pain, vomiting, inappetence, and weight loss over several months. Diagnostic imaging revealed obliteration of fat in the pancreaticoduodenal groove and densification of the adjacent adipose planes, along with an infiltrative and stenosing lesion in the duodenum. Despite negative biopsy results, the patient's symptoms persisted, leading to a multidisciplinary decision regarding surgical intervention. Initially, a less-invasive robotic gastroenteric anastomosis was performed; however, this did not yield the desired outcome. Consequently, after further episodes of pancreatic inflammation, a more extensive pancreaticoduodenectomy (Whipple procedure) was performed. The patient showed significant clinical improvement postoperatively, with no recurrence of symptoms. Groove pancreatitis poses a diagnostic challenge owing to its nonspecific clinical presentation and imaging findings. Although management typically involves dietary changes, medication, and endoscopic interventions, surgical intervention may be necessary in cases of recurrent symptoms or complications. This case highlights the importance of a multidisciplinary approach in managing groove pancreatitis and underscores the potential efficacy of surgical intervention in achieving symptomatic relief and improving quality of life, even in atypical patient demographics.

Objective: This study aimed to investigate the effects of sex and time of day on behavioral parameters in healthy rats, focusing on locomotion, cognition, and memory (both spatial and episodic).

Methods: Twenty-four Wistar rats (12 males and 12 females) were divided into morning and afternoon groups. Behavioral tests included actimetry for spontaneous locomotion, novel object recognition test for episodic memory, and the Morris water maze test for spatial memory. Data were analyzed cross-sectionally and longitudinally, considering sex and time of day as variables. The evaluated parameters included fast and slow horizontal and vertical movements, recognition index, average speed, and quadrant preference in the Morris water maze.

Results: Females exhibited higher frequencies of rapid horizontal and vertical movements than males, especially in the morning. Novel object recognition test results showed higher recognition index values in the morning, with females displaying greater exploration of novel objects, while the Morris water maze test results indicated that the time spent in the target quadrant was consistent across groups, but females demonstrated longer latencies in the afternoon.

Conclusion: These results highlight the significant influence of sex and circadian timing on behavioral performance in healthy animals. These factors should be carefully considered when designing and interpreting preclinical behavioral studies to improve experimental consistency and data reproducibility.