Endomiocardite de Löffler – a propósito de um caso clínico

Loeffler's endocarditis is an acute form of primary restrictive cardiomyopathy. We report the case of a young woman with pleuritic chest pain associated with fever and hypereosinophilia. She was hospitalized with suspected acute myopericarditis and was treated with aspirin, leading to clinical improvement. Ten days after discharge, she was rehospitalized due to recurrence of chest pain. The echocardiogram showed what appeared to be a mass filling the apex of the right ventricle (RV). She was referred for magnetic resonance imaging, which revealed marked myocardial thickening in the apex of the RV. The patient underwent an endomyocardial biopsy, resulting in a diagnosis of eosinophilic endocarditis. After treatment with prednisolone, all symptoms and the eosinophilia disappeared, and there was complete remission of the RV abnormalities. After three years of follow-up, the patient remains asymptomatic. This case shows that, even without an etiologic diagnosis of eosinophilia, the prognosis for Loeffler's endocarditis can be favorable if treatment is initiated early.     

Lyme disease in the state of Tocantins,Brazil: report of the first cases

Lyme disease is an underdiagnosed zoonosis in Brazil. There are no cases registered in the state of Tocantins, the newest Brazilian state. The cases of three patients in contact with rural areas in three Tocantins’ districts are herein described, and the Brazilian literature is reviewed.     

Salud,deporte y vulnerabilidad socioeconómica en una comunidad urbana

ObjectiveTo analyse the association between perceived and diagnosed health, sport practice, and the belonging to a vulnerable socioeconomic group.DesignObservational study. Questionnaire.SettingCasablanca neighbourhood. Primary Health Care Area in the city of Zaragoza (Spain).Participants1032 residents aged over 15 years.Main measurementsa) Perceived health using the Health Perception Questionnaire of Davis and Ware; b) diagnosed morbidity; c) sport practice using the Healthy Lifestyles questionnaire-94 of Herrero, Musitu and Gracia, and d) socioeconomic vulnerability based on the occupational, educational and economic conditions of the family unit.ResultsSocioeconomic vulnerability had a statistically significant association with diagnosed health, self-perceived health, and sport practice. Vulnerability and exercise showed a higher influence over self-perceived health than over diagnosed health. In the analysis stratified by gender, the association could only be observed in men.ConclusionsThe impact of health social factors is modulated by gender. Social stratification and lifestyles, such as sport practice, are predictors of self-perceived health and, thus, of the relationship between the population and the use of health services.     

Internet como fuente de información sobre salud en pacientes de atención primaria y su influencia en la relación médico-paciente

ObjectiveTo describe the use of the Internet by primary care patients to seek health related information, understand how they are influenced by this information, and evaluate its impact on the doctor-patient relationship.DesignCross sectional study, through self-administered survey.SettingOne urban health center in Madrid.ParticipantsA total of 323 questionnaires were collected from patients between 14 and 75 years old who attended a physician's office for any reason, excluding illiterate patients and those with neurological or psychiatric problems preventing them from completing the survey.MeasurementsInternet usage, ability of the internet to clarify doubts regarding health issues, patient lifestyle changes, socio-demographic variables, and physician's receptivity to the use of internet by patients.Results61% (CI 95%: 56%-67%) of patients used the Internet as a source of health information: Internet queries were able to address health doubts in 92.4% of users, 53.5% reported that the Internet changed their thinking about their health in at least one instance, 30% made behavioral changes (of which 60.1% discussed these changes with their physician), 44.3% had more questions at the physician's office, and 80.8% believe that the doctor would be willing to talk about the information found on the internet.ConclusionsUsing the Internet to find information about health is very common, with positive influence on physician-patient relationship. This may be useful for achieving behavioral changes in patients and can be used as a tool in medical practice.     

Molecular Variations Linked to the Grouping of β- and α-Globin Genes in Neonatal Patients with Sickle Cell Disease in the State of Pernambuco,Brazil

Various factors have been described as phenotypic modulators of sickle cell disease, such as levels of fetal hemoglobin (Hb F), presence of α-thalassemia (thal), and haplotypes of the β-globin genes. In order to characterize and determine the frequency of the β^S and β^C mutations and the prevalence of ?α^3.7-thal, 74 patients with sickle cell disease detected during neonatal screening in the State of Pernambuco, Brazil, were studied. The haplotypes of the β gene and ?α^3.7-thal were determined using polymerase chain reaction (PCR), and specific restriction endonucleases were used to establish the polymorphic sites of the haplotypes. The results showed the high frequency of the Central African Republic (CAR) or Bantu haplotype in the State of Pernambuco, Brazil. The low frequency of the Benin haplotype recorded in this study, in comparison with other states in northeast Brazil, suggests the diversity of origins of Afro-Brazilians in this region.