Acquired immunodeficiency syndrome (AIDS) is one of the main causes of death in adults worldwide. More commonly than in the general population, in patients with AIDS there is substantial disagreement between causes of death which are clinically suspected and those established by postmortem examination. The findings of 52 postmortem examinations were compared to the premortem (clinical) diagnoses, and there was 46% agreement between them. Fifty two percent of the patients had more than one postmortem diagnosis, and 48% had at least one AIDS-related disease not suspected clinically. Cytomegalovirus infection was the commonest (30.7%) autopsy finding, but not a single case had been suspected premortem. Bacterial infection, tuberculosis, and histoplasmosis were also common, sometimes not previously suspected, postmortem findings. This study shows that multiple infections occur simultaneously in AIDS patients, and that many among them are never suspected before the postmortem examination. These findings suggest that an aggressive investigation of infections and cancers should be done in patients with AIDS, particularly in those who do not respond to therapy of an already recognized condition.
The aim of the present study was to evaluate the effects of changes to the autonomic nervous system in mice during the acute phase of Chagas disease, which is an infection caused by the parasite Trypanosoma cruzi. The following types of mice were inoculated with T. cruzi (CHG): wild-type (WT) and vesicular acetylcholine transporter knockdown (KDVAChT) C57BL/6j mice; wild-type non-treated (NT) FVB mice; FVB mice treated with pyridostigmine bromide (PYR) or salbutamol (SALB); and β 2 -adrenergic receptor knockout (KOβ2) FVB mice. During infection and at 18-21 days after infection (acute phase), the survival curves, parasitaemia, electrocardiograms, heart rate variability, autonomic tonus and histopathology of the animals were evaluated. Negative control groups were matched for age, genetic background and treatment. The KDVAChT-CHG mice exhibited a significant shift in the electrocardiographic, autonomic and histopathological profiles towards a greater inflammatory immune response that was associated with a reduction in blood and tissue parasitism. In contrast, the CHG-PYR mice manifested reduced myocardial inflammation and lower blood and tissue parasitism. Similar results were observed in CHG-SALB animals. Unexpectedly, the KOβ2-CHG mice exhibited less myocardial inflammation and higher blood and tissue parasitism, which were associated with reduced mortality. These findings could have been due to the increase in vagal tone observed in the KOβ2 mice, which rendered them more similar to the CHG-PYR animals. In conclusion, our results indicate a marked immunomodulatory role for the parasympathetic and sympathetic autonomic nervous systems, which inhibit both the inflammatory immune response and parasite clearance during the acute phase of experimental Chagas heart disease in mice.
A síndrome de Down (SD) é um distúrbio cromossômico autossômico causado pela trissomia do cromossomo 21. É a anomalia mental congênita mais frequente e abrange inúmeras alterações mentais e comportamentais incluindo alterações físicas e orais, as quais necessitam atenção por parte dos cirurgiões dentistas. O tratamento odontológico desses pacientes consiste em eliminar ou controlar as dificuldades que eles possuem, adequando-se a conduta e fazendo com que a abordagem precoce seja a melhor opção. O cirurgião dentista, quando ciente de todas essas complicações e características intra e extra orais, poderá realizar um melhor manejo odontológico. O presente trabalho trata-se de uma revisão narrativa qualitativa, realizada nas bases de dados Biblioteca Virtual em Saúde (BVS), Pubmed e Scielo, utilizando as palavras-chave: “Síndrome de Down”, “odontologia” e “manejo comportamental”, bem como seus correspondentes em inglês. O trabalho tem como objetivo caracterizar as técnicas de gerenciamento comportamental utilizadas no atendimento odontopediátrico de crianças portadoras da Síndrome de Down e identificar os principais pontos acerca da conduta do cirurgião dentista durante atendimento odontológicos destes pacientes. Com esse estudo, concluiu-se que ainda há bastante controvérsias entre os autores no que se diz a respeito ao alto ou baixo índice de lesão de cárie desses pacientes. Entende-se também, a importância do acompanhamento familiar durante todo o tratamento odontológico e a necessidade do cirurgião dentista de estar bem preparado e saber lidar com todas as características e particularidades de cada criança.
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