An unusual association: polymyositis, myasthenia gravis and thymoma

Based on the inexistence of references in Brazilian and International literature of the association polymyositis, myasthenia gravis and thymoma in a young male adult, the authors propose to describe one case presenting the associated syndrome. The disease began when the patient was 22 years old, being the climax of its clinical expression four years later. It is emphasized the difficulty on the differential diagnosis between polymyositis and myasthenia gravis, once these diseases frequently have their clinical manifestations well individualized. In this study we call attention to the existence of clinical aspects of myasthenia gravis in patients presenting polymyositis and, on the other hand, histopathological alterations typical of polymyositis in myasthenic muscles, what makes the clinical diagnosis uncertain many times.     

Reduction in glucose concentration in the brain of mice inoculated with cerebrospinal fluid from patients with amyotrophic lateral sclerosis

Using chromatographic analysis the authors studied glucose concentration in the brain of Swiss mice inoculated with CSF of four patients with amyotrophic lateral sclerosis. They found reduction in the levels of glucose, suggesting the existence of an exogenous factor transferred by CSF.     

Bilateral cortical necrosis and calcification of the kidneys following snakebite: a case report.

A 16 year-old-boy was admitted to the ICU of university hospital with acute renal failure following snakebite. The clinical evolution of the patient associated with radiological findings of renal calcification suggested bilateral cortical necrosis of the kidneys. The biopsy findings were compatible with this diagnosis. The patient was discharged 86 days after his admission, with chronic renal failure, since a kidney transplantation was not possible.     

Homocysteine and its determinants in nondialyzed chronic kidney disease patients

This cross-sectional study aimed to investigate the prevalence of hyperhomocysteinemia, the determinants of plasma total homocysteine concentrations, and the relationship of total homocysteine with nutritional parameters in a sample of patients with chronic kidney disease (CKD) and not yet on dialysis. The study was done with outpatients from the Nephrology Division of the Federal University of S?o Paulo and Oswaldo Ramos Foundation. Sixty-six patients with CKD (70% male; age 58.6+/-15.6 years [mean+/-standard deviation]) with moderate to severe renal impairment (creatinine clearance=29.8+/-14.3 mL/min [0.5+/-0.24 mL/sec]), clinically stable, and older than 18 years were included. A group of 20 healthy subjects from the clinic staff was also studied for reference values for plasma homocysteine, folate, and vitamin B-12 concentration. Fasting blood samples were collected to determine plasma total homocysteine, folate, vitamin B-12, and creatinine. To calculate creatinine clearance, a 24-hour urine collection sample was obtained. The assessment of nutritional status included anthropometric parameters. Pearson correlation, Mann-Whitney test, and multiple linear regression analysis were used for statistical analyses. The main results showed that the concentration of total homocysteine in the patients was significantly increased compared with the healthy subjects (3.4+/-1.7 vs 1.41+/-0.42 mg/L [25.4+/-12.2 vs 10.4+/-3.1 micromol/L]; P<0.001). Plasma folate and plasma vitamin B-12 were in the normal range and did not differ between patients and healthy individuals. A high prevalence of hyperhomocysteinemia (total homocysteine >1.89 mg/L [14 micromol/L]) was found in the patients (89%). Plasma total homocysteine did not correlate with any of the nutritional parameters studied and did not differ between patients in terms of whether they were using or not using folic acid supplementation (3.07+/-1.09 vs 3.55+/-1.78 mg/L [22.7+/-8.1 vs 26.3+/-13.2 micromol/L]; P=0.47), although plasma folate was significantly higher in the supplemented group (12.6+/-3.0 vs 8.0+/-3.6 ng/mL [28.5+/-6.8 nmol/L vs 18.1+/-8.2 nmol/L]; P<0.001). According to the multiple regression analysis, the determinants of total homocysteine were only plasma folate, plasma vitamin B-12, and creatinine clearance (r2=0.20). In conclusion, a high prevalence of hyperhomocysteinemia was found in our sample of nondialyzed patients with CKD. The determinants of total homocysteine levels were plasma folate, plasma vitamin B-12, and creatinine clearance. No association between nutritional parameters and total homocysteine was observed.     

Superficial thrombophlebitis and anticardiolipin antibodies--report of association

The aim of this study was to determine a possible association between recidivist superficial thrombophlebitis and anticardiolipin antibodies. Forty-five patients with two or more episodes of superficial thrombophlebitis in lower limbs (33 women and 12 men with ages ranging from 17 to 60 years, average: 39.8) were studied. The control group was formed by 100 voluntary donors from the blood bank (83 men and 17 women, age range: 21 to 59 years, average: 35.4). Anticardiolipin antibody concentrations were determined by enzyme-linked immunosorbent assay (ELISA). For semiquantitative detection in human sera with use of QUANTA Lite ACA IgG/IgM--INOVA Diagnostic, Inc., and positive values were considered as 15 GPL units/mL and 12.5 MPL units/mL for immunoglobulin G (IgG) and IgM, respectively, as recommended by the test. The Odds Ratio method was chosen for statistical analysis with a confidence interval (CI) of 95%. In 15 patients (33.3%) anticardiolipin antibody positivity was detected, whereas in 12 patients (26.7%) it occurred as immunoglobulin M (IgM) anticardiolipin and in 3 (6.7%) as immunoglobulin G anticardiolipin. In the control group, positivity was found in 7 patients (7%) for those antibodies. Furthermore, the Odds Ratio = 6.64 with CI = 95% and values ranging from 2.48 to 17.82 (p < 0.05) were significant, as well as for IgM/IgG anticardiolipin proportion with Odds Ratio = 5.09, C = 95% and values varying from 1.33 to 19.54 (p < 0.05). The authors conclude that there is a correlation between the presence of anticardiolipin antibodies and recurrent superficial thrombophlebitis.     

Corneal ulcer caused by the new fungal species Sarcopodium oculorum

We describe a case of keratitis caused by a new species of the hyphomycetous genus Sarcopodium, S. oculorum. The corneal ulcer developed after 5 months of treatment with corticosteroids in a Brazilian boy diagnosed with allergic conjunctivitis. Fungal hyphae and conidia were detected in corneal scrapings, and repeated cultures were positive for this fungus. The infection was resolved with natamycin and ketoconazole. Eleven antifungals were tested against this fungus, and all except flucytosine and fluconazole showed in vitro activity.     

Constructing a new pedagogical proposal in the nursing program of the State University of Londrina

The objective of this article is to outline the history of the Nursing Curriculum of the State University of Londrina. The first curriculum was created in the beginning of the nursing course in 1972 and the last one in January 2000. The results of the bibliographic research show that the curriculum of the nursing course in this university has changed along the years mainly due to professors' academic questions and demands of the labor market. The present study explains and justifies the changes in the curriculum and contributes for a better understanding of the new pedagogical proposal in the current Integrated Curriculum of the Nursing Course of the State University of Londrina.     

Poliomyelitis eradication in areas with armed conflict: the case of Afghanistan

The aim of this study was to describe fieldwork to erradicate poliomyelitis from Afghanistan and particularly from the Mazar Region. From 1997-1999, 365 cases of acute flaccid paralysis were detected. Of these, 216 cases (59.2%) were classified as poliomyelitis. The rate of acute flaccid paralysis improved from 0.1 in 1997 to 0.8 in 1999. Fieldwork in the Mazar region revealed under-notification and the need to improve surveillance methods. However, massive use of the services of traditional healers and extreme transport difficulties reduced the efficacy of the interventions. The case of Afghanistan suggests that epidemiological surveillance systems are feasible in countries with armed conflict, although such systems require considerable resources.