Bronchiolitis obliterans organizing pneumonia (BOOP) is a disease of the small airways characterized by intraluminal polyps of myxoid connective tissue. Although various infectious and non-infectious agents have been implicated as possible precipitants of BOOP, the concomitant occurrence of BOOP with human immunodeficiency virus (HIV) infection has rarely been described. We describe a unique case in which BOOP was a presenting feature in a patient with newly diagnosed AIDS, and we review the literature of BOOP occurring in the setting of HIV infection.

The existence of a cystic mass which walls originated from a metastatic gallbladder adenocarcinoma is infrequent. We present the case of 68-year-old male that present to the emergency department with abdominal distention, hyporexia and jaundice. Upon exploratory laparotomy, a duodeno-colonic cyst with walls formed by metastatic cells derived from a Gallbladder Adenocarcinoma. Metastatic disease from a gallbladder adenocarcinoma to transverse colon and duodenum formed adherences between both organs, leading to the formation of cystic mass. Cancer cells have multiple adaptation mechanisms in order to survive harsh environments. / La existencia de un quiste cuyas paredes se originaron de una metástasis de adenocarcinoma de vesícula biliar es infrecuente. Varón de 68 años con distensión abdominal, hiporexia e ictericia. En la laparotomía exploratoria se evidencia un quiste duodeno-colónico de paredes conformadas por células metastásicas producto de un adenocarcinoma de vesícula biliar. La metástasis del adenocarcinoma de vesícula biliar hacia colon transverso y duodeno formaron adherencias entre ambos órganos, conduciendo a la formación de una masa quística. Las células cancerígenas pueden adaptarse de muchas maneras para sobrevivir en entornos adversos. / Revisión por pares

Objectives: To describe clinical features, demographic characteristics, and treatment outcome in four prepubertal children with severe periodontitis. This is a case report of prepubertal children that have been referred to the Temple University Kornberg School of Dentistry (TUKSD) for the treatment of severe periodontitis. Methods & Materials: Chart review was performed of available paper and electronic records of patients aged ≤ 10 years that have been treated at the Graduate Periodontology Clinic, TUKSD during the past 5 years. Cases were evaluated for periodontal diseases by means of assessing dental plaque, dental calculus, gingivitis, probing depths and clinical attachment level, and radiographic evidence of bone levels. Cases diagnosed with periodontitis were identified and the patients¡¯ demographics, clinical findings, type of treatment provided, treatment outcome, and medical history were noted. Results: Four children with severe periodontitis were identified. All the subjects had deep probing depths around their primary teeth showing significant bone loss on radiographs and were diagnosed with severe periodontitis. These children were treated with scaling and root planing combined with systemic antibiotics and extraction of hopeless primary teeth. The permanent teeth erupted early and there was no radiographic alveolar bone loss. Three subjects had microbiological testing and showed predominance of certain periodontal pathogens such as Prevotella intermedia and Fusobecterium nucleatum. Following treatment all children were inaccessible for follow-up. Conclusion: Periodontitis in prepubertal children causes early loss of primary teeth and early eruption of permanent teeth. Relevant systemic diseases were not detected in any of the children. Compliance with periodontal maintenance is poor among prepubertal children attending the TUKSD clinics for the treatment of periodontitis. / Oral Biology

M.Med.(Internal Medicine), Faculty of Health Sciences, University of the Witwatersrand, 2009. / In Africa, infective endocarditis (IE) is still a disease of young adults with underlying rheumatic heart disease (RHD). As of 2006, almost two-thirds of all persons infected with human immunodeficiency virus (HIV) are living in sub-Saharan Africa. Southern Africa thus remains the epicentre of the global HIV epidemic. The HIV sero-prevalence data reported in Southern Africa are as high as 20% - 30% of the adult population aged between 15 and 49 years. In South Africa, the prevalence of HIV among adults aged 15 - 49 is 18.8%. Based on a simple extrapolation, there is a higher possibility of encountering a significant number of patients infected with HIV and underlying RHD with IE in Southern Africa than in any other part of the world. In Africa because both HIV and valvular heart disease are relatively common, the co-existence of the two conditions in individual patients is not rare. Despite the major advances in diagnosis and management of this classical disease, the overall mortality rates for both native-valve and prosthetic-valve endocarditis remain as high as 20 to 25 percent after 1 year and at 50% after 10 years. However, the mortality rate varies, depending on a number of factors, such as: • the causative microorganism • the presence of complications • the development of perivalvular extension or a myocardial abscess • neurological events • the existence of conditions such as congestive heart failure • renal failure • severe immunosuppression due to HIV infection in intravenous drug abusers • the use of combined medical therapy and surgical therapy in appropriate patients. vi The clinical outcome of infective endocarditis in HIV patients is poor, severe immunodeficiency in IVDAs with IE has been reported to be associated with poor outcome. However, such an association has never been documented in non-IVDAs, particularly in Africa, where the expected majority patients with HIV and IE are non- IVDAs. The clinical profile including bacteriology of infective endocarditis in HIV patients is different from HIV uninfected patients. The clinical impact of the HIV epidemic on infective endocarditis in Africa has not been elucidated in the world literature and there is, moreover, a paucity of literature describing this clinical entity of HIV and IE in Africa. Objective The objective of this study was to highlight the co-existence of infective endocarditis in HIV positive, non-intravenous drug abuse in South Africa and Africa by: reporting three cases admitted at the researcher’s institution within a period of two months; and undertaking a literature review. Methods This was a retrospective case report and literature review study of IE in HIV infected patients. Three HIV positive patients with IE and with or without underlying chronic rheumatic heart disease were reported. The patients were admitted at the researcher’s institution within a period of two months. All three patients did not report intravenous drug abuse. However, all patients died within a short period of admission to the hospital. The systematic review of cases published in the literature was delivered from MEDLINE SEARCH from January 1985 to December 2006. The following key words were used: Human Immunodeficiency Virus, Acquired Immunodeficiency Syndrome, Rheumatic Heart Disease, Infective Endocarditis, and Intravenous Drug Abusers and Non-Intravenous Drug Abusers. Most of the articles were identified in English; where articles were identified in Spanish and French, only abstracts were used. vii Literature emanating from Africa was emphasized. In addition, the references quoted in this study were reviewed for relevance on the topic. Results Three patients with definitive IE and infected with HIV were reported: one patient was without underlying chronic rheumatic valvular heart disease and two showed underlying chronic rheumatic valvular heart disease. There are few reported studies of IE not related to intravenous drug abuse in HIV infected patients in the literature, which is probably attributable to the reported low prevalence of IE in this sub-group of patients. Most of these published studies are limited to a series of case reports and very little data or reports originate from Africa. Conclusion The clinical pattern of IE in HIV positive patients who are not IVDAs is not well described in literature. However, in this anecdotal case report, the three patients studied retrospectively had a poor outcome. Based on this anecdotal report of three cases described, if an extrapolation was done from these numbers and a prospective analysis performed, we would observed a substantial number of non-IVDU cases with infective endocarditis and HIV/AIDS in Africa. The literature review in its current form may shed some light on HIV and IE in non-IVDU patients, but doesn’t specifically address the issue of the potential co-existence of HIV and IE in Africa. Given the high prevalence both HIV/AIDS and rheumatic valvular heart disease in Africa, in future, we are more likely to see a significant proportion of patients with IE and underlying rheumatic valvular heart disease who are coincidentally HIV infected. There is a useful need for prospective studies describing the prevalence and outcome and for subsequently defining the management of this condition in Africa.

Central nervous system (CNS) infection with Morganella morganii is very rare. We describe a 38-year-old female patient with frontal brain abscess caused by M morganii who was unsuccessfully treated. We also review all reported cases of Morganella CNS infections with an emphasis on treatment modalities and outcomes. Aggressive surgical management and appropriate antimicrobial therapy can lead to cure, but the mortality rate for these infections remains high.

Dabbing has been gaining popularity among young people in recent years due to its ability to deliver a high concentration of tetrahydrocannabinol. When produced illegally, it is usually contaminated by toxic substances and associated with multiple health hazards. We present the case of a 66-year-old woman who developed hypersensitivity pneumonitis after dabbing butane hash oil for the first time and was successfully treated with corticosteroids with complete resolution of her symptoms. This case report emphasizes the respiratory complications associated with using a noxious substance like butane hash oil and gives physicians an insight into the diagnosis and management of dabbing-induced hypersensitivity pneumonitis.

Background: Ureteral herniations are a rare occurrence, generally found incidentally on cross sectional imaging or during surgical intervention for unrelated processes. Several locations of ureteral herniations can occur including the inguinal, femoral, sciatic, obturator, and thoracic regions. While few reports of ureteral hernias are reported in the literature overall, the vast majority of those reported are inguinoscrotal herniations found during evaluation and treatment of inguinal hernias. Pelvic outlet ureteral herniations intrinsically are more common secondary to their dependent locations. Intrathoracic ureteral herniations through diaphragmatic defects are an exceptionally rare subset of ureteral herniations and have only been described sparingly. Fewer than ten case reports of diaphramatic ureteral herniations have been reported and none have described both cystoscopic management and open reconstruction. Case presentation: We report the case of a 81 year old female with flank pain who was found to have idiopathic diaphragmatic hernia with incarcerated proximal ureter. She had no prior injury or surgery that explained her clinical presentation. She was initially observed and then managed conservatively with ureteral stent exchanges. Ultimately she underwent open surgical repair of her diaphragmatic hernia, reduction, resection and anastomosis of redundant proximal incarcerated ureteral segment, and nephropexy for a hypermobile right renal unit. This case report illustrates the pre-and post-operative imaging studies of a very rare intrathoracic ureteral herniation as well as surgical approach to repair. Conclusion: A herniated ureter is a potential source of serious renal and ureteral complications. The thoracic herniation of ureter is the rarest of the ureteral herniations. When discovered, they should be managed to preserve renal function and prevent strangulation of the affected segment of ureter. This case report documents the treatment of a thoracic ureteral herniation with observation, conservative endoscopic management, and finally open surgical reconstruction.

Made available in DSpace on 2015-05-14T12:42:42Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 5866309 bytes, checksum: cdb2a3e0fe71cd7431c0f59dec0c1a9a (MD5) Previous issue date: 2011-12-20 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / This research paper has the aim to contribute to the insertion of oral practices in the classroom under an interactive approach. Starting from this language notion, we intend to investigate the child speech in order to better understand the acquisition process by means of little explored genres in the context of linguistic research. We have turned to the genre category as a communication model (Marcuschi, 2008), because we understand that language stands out through use, by means of effective interactive situations experienced by subjects (Bakhtin, 2000). We have investigated children s verbal actions in the case report genre, occurring in spontaneous situations and based on the assumption that word expression is only possible through speaker s co-participation. This means that the child penetrates the language by another s partnership in the interaction (PERRONI,1992) and, through such an action, he/she learns values in addition to reproduce cultural behaviors. According to this focus, language claims the development of a communicative competence on the part of subjects, mostly because it is part of a social demand even more essential in the construction of modern societies. With this purpose, we refer to Bakhtin s (2000), Marcuschi s (2008), and Schneuwly s (2010) theoretical principles, who discuss the understanding of language interconnected to the broadest social-historical contexts, as well as a more specific theory about the case report genre. We also make a link to authors who deal with language acquisition (Perroni, 1992), in order to analyze and describe child s speech with a special view to gestural and verbal movements made by children when they construct the genre in diversified uttering contexts. We have studied the data through a qualitative approach and proven the supposedly raised hypothesis: when children interact, they use different cognitive, discursive strategies to meet their needs of communication , an ability that involves communicative construction supported by different genres dug in natural aspects of similarities which are characteristic among them. By the exposed, we confirm the proposal: Referential for Child Teaching (1998), to recognize oral genres as legitimate instruments of teaching and knowledge acquisition, because, besides being a practice that precedes writing, it is one of the most essential and recurring communication activities for the social practices functioning. / Nosso trabalho tem como objetivo contribuir para a inserção de práticas orais em salas de aula sob uma abordagem interacionista. Ao partir desta noção de linguagem, pretendemos investigar o discurso infantil para melhor compreender o processo de aquisição, através de gêneros pouco explorados no contexto das pesquisas linguísticas. Enveredamos pela categoria do gênero como modelo de comunicação (MARCUSCHI, 2008), por entender que a língua consagra-se pelo uso, por meio das efetivas situações de interação que os sujeitos vivenciam (BAKHTIN, 2000). Investigamos a ação verbal infantil de crianças no gênero relato de experiência, em situações espontâneas, apoiando-se no pressuposto de que a expressão da palavra só é possível pela co-participação do interlocutor. Por entender que é pela parceria da interação que a criança adentra a linguagem, aprende valores e reproduz comportamentos culturais, sobretudo pela consciência de conceber que a competência comunicativa é uma exigência social cada vez mais indispensável no construto das sociedades modernas. Retomamos os postulados teóricos de Bakhtin (2000), Marcuschi (2008), Schneuwly (2010), que trazem uma reflexão sobre a compreensão de linguagem interligada aos mais amplos contextos sócio-históricos, e de uma teoria mais específica sobre o gênero relato de experiência, fazendo uma ponte com autores que tratam da aquisição da linguagem, (PERRONI, 1992) para analisar e descrever a fala infantil com um olhar especial para os movimentos verbais e gestuais que as crianças fazem quando materializam o gênero em diferentes contextos enunciativos. Refletimos sobre os dados através de uma abordagem qualitativa e comprovamos a hipótese supostamente levantada: as crianças quando interagem usam diferentes estratégias cognitivas e discursivas para atingir as suas necessidades de comunicação, habilidade que envolve a construção comunicativa pelos pilares de diferentes gêneros, fincados nos aspectos naturais de similaridade característicos entre eles. Pelas bases expostas, ratificamos a proposta do Referencial para o Ensino Infantil (1998) de reconhecer os gêneros orais como legítimos instrumentos de aquisição de conhecimentos e de ensino, porque, além de ser uma prática que antecede a escrita, é uma das atividades de comunicação mais recorrente e essencial para o funcionamento das práticas sociais.

Bakgrund: Eculizumab (Solirisâ) är en monoklonal antikropp som är riktad mot C5 i komplementsystemet. Bindning av eculizumab till C5 förhindrar proteinets klyvning och därmed också aktivering. Eculizumab är godkänt för behandling av atypiskt hemolytiskt uremiskt syndrom och paroxysmal nokturn hemoglobinuri. Sedan behandlingen blivit godkänd för dessa tillstånd har även ”off-label use” vid andra tillstånd varit betydande. En tidigare studie har visat att uppemot 50 % av behandling med eculizumab är off-label use, det vill säga behandling utanför de idag godkända indikationerna. Ett av dessa tillstånd är katastrofalt antifosfolipidsyndrom (KAPS), ett mycket allvarligt tillstånd som karaktäriseras av multipla tromboser som utvecklas under kort tid i flera organ vid vilket eculizumab visat sig ha en potentiellt positiv effekt. KAPS kan uppstå om man har bakomliggande antifosfolipid syndrom (APS) och kan utlösas vid en så kallad ”second hit”, en inflammatorisk stressreaktion orsakad av exempelvis en infektion eller kirurgiskt ingrepp. Eculizumab är ett särläkemedel och är en av de dyraste läkemedelsbehandlingarna i världen. Syfte: Syftet med denna studie var att analysera fall där KAPS behandlats med eculizumab för att utvärdera om eculizumab bör vara standarbehandling vid detta tillstånd. Likheter och olikheter mellan fallen studerades för att utvärdera när det kan vara lämpligt att behandla med eculizumab. Syftet var också att utvärdera detta utifrån ett ekonomiskt perspektiv. Metod: Detta är en litteraturstudie där sökningar i PubMed gjorts efter rapporter som beskriver fall där patienter med KAPS eller som ansetts haft en risk att utveckla KAPS behandlats med eculizumab. Åtta rapporter med totalt tio fall inkluderades och analyserades. Resultat: De rapporter som analyserades visade övergripande en tydlig effekt av behandling med eculizumab. Eculizumab tolkades också i vissa fall som ett kostnadseffektivt alternativ genom bland annat förkortad intensivvård och dialysbehov. Slutsats: Eculizumab har i de fall som analyserats visat sig ha en avgörande betydelse för att reversera ett livshotande tillstånd och skulle kunna vara standardbehandling vid KAPS och förebyggande av KAPS. För att eculizumab, eller en annan komplementhämmare, ska kunna bli standardbehandling krävs ytterligare forskning på KAPS och dess relation till komplementsystemet. / Catastrophic antiphospholipidsyndrome (CAPS) is a rare but highly fatal condition characterized by thrombosis in multiple organs, often associated with a rapid progression of disease and serious complications for the patient. A rapid diagnosis and treatment is therefore a key to manage this condition. The conventional treatment, which consists of anticoagulation, steroids, plasma exchange and intravenous immunoglobulins, reduces mortality but CAPS is still associated with high mortality. To find the mechanism of how and why this condition evolves is therefore important. There has been progress to find out the pathogenesis and one clue appears to be the complement system. Therefore, a new type of treatment has been used in patients who have been diagnosed with antiphosphlipidsyndrome (APS) and have had a risk of developing CAPS, or have been diagnosed with definitive or probable CAPS. This treatment is aimed at inhibiting parts of the complement system and consists of a monoclonal antibody called eculizumab. Lately eculizumab has been used off label in patients diagnosed with CAPS and in patients that has been at risk of developing CAPS. The results of this treatment have been positive and have therefore been considered as a possible alternative for treating CAPS. The aim of this study was to evaluate if eculizumab can be an alternative to treat patients with CAPS and patients diagnosed with APS who have a risk of developing CAPS. In order to evaluate treatment with eculizumab in patients with CAPS, searches on cases were done in the database PubMed for reports of patients with CAPS or at risk of developing CAPS who have been treated with eculizumab. Eight reports with a total of ten cases were found and used in order to answer the hypothesis of this study. In the ten cases that were analyzed there was a clear connection between the treatment and the recovery. In both patients with CAPS and patients at risk of developing CAPS the treatment with eculizumab was considered of significant importance. Because of the rarity of this condition, every case makes significant impact into the understanding of this potentially fatal condition. For future new cases, the present report will stand as an important source for making decisions about treatment with eculizumab. With time and more cases with positive results eculizumab has the potential to become conventional treatment for CAPS.

No presenta presenta resumen. / Revisión por pares