Background Zika virus (ZIKV) was first detected in Brazil in May 2015 and the country experienced an explosive epidemic. However, recent studies indicate that the introduction of ZIKV occurred in late 2013. Cases of microcephaly and deaths associated with ZIKV infection were identified in Brazil in November, 2015. Objectives To determine the etiology of three fatal adult cases. Study design Here we report three fatal adult cases of ZIKV disease. ZIKV infection in these patients was confirmed by cells culture and/or real-time reverse transcriptase polymerase chain reaction (RT-qPCR) and by antigen detection using immunohistochemical assay. Samples of brain and other selected organs taken at autopsy from three patients were also analyzed by histopathological and immunohistological examination. Results The first patient, a 36-year-old man with lupus and receiving prednisone therapy, developed a fulminant ZIKV infection. At autopsy, RT-qPCR of blood and tissues was positive for ZIKV RNA, and the virus was cultured from an organ homogenate. The second patient, a previously healthy female, 16 years of age, presented classic symptoms of Zika fever, but later developed severe thrombocytopenia, anemia and hemorrhagic manifestations and died. A blood sample taken on the seventh day of her illness was positive RT-PCR for ZIKV RNA and research in the serum was positive for antinuclear factor fine speckled (1/640), suggesting Evans syndrome (hemolytic anemia an autoimmune disorder with immune thrombocytopenic purpura) secondary to ZIKV infection. The third patient was a 20-year-old woman hospitalized with fever, pneumonia and hemorrhages, who died on 13 days after admission. Histopathological changes were observed in all viscera examined. ZIKV antigens were detected by immunohistochemistry in viscera specimens of patients 1 and 3. These three cases demonstrate other potential complications of ZIKV infection, in addition to microcephaly and Guillain-Barre syndrome (GBS), and they suggest that individuals with immune suppression and/or autoimmune disorders may be at higher risk of developing severe disease, if infected with ZIKV.

PWV is more useful than carotid ultrasound in detecting structural and functional vascular damage in BD and emphasizes the role of the disease itself in promoting these alterations. Our findings also reinforce the need for rigorous control of all risk factors in BD, particularly lipoproteins.

Objetivou-se identificar as especialidades mais desejadas pelos alunos de Medicina do Centro Universitário do Estado do Pará (Cesupa) e fatores determinantes dessa escolha. Trata-se de um estudo transversal, descritivo e analítico, realizado mediante aplicação de questionários a alunos do primeiro, quarto e sexto anos, no período de novembro de 2012 a março de 2013. A maioria dos alunos era do sexo masculino (59,2%), com média de idade de 22 ± 2 anos, possuindo renda familiar acima de dez salários mínimos e apresentando pelo menos um parente médico. As principais especialidades escolhidas foram: Cirurgia Plástica (10,4%), Endocrinologia (15,7%), e Oftalmologia (14,0%) no primeiro, quarto e sexto anos, respectivamente. O principal fator influenciador na escolha no primeiro ano foi a influência dos pais (17,2%), e no quarto e sexto anos o fator financeiro, com 15,8% e 22,8%, respectivamente. Conclui-se que muitos fatores influenciam a escolha de especialidades, sendo necessário buscar formas de atrair alunos para áreas de caráter mais generalista.

To describe clinical and epidemiological data of Behçet's disease (BD) in Brazil, we retrospectively reviewed records of all patients seen between 2006 and 2007 at the BD outpatient clinic of University of Sao Paulo. One hundred and six patients fulfilled the International Study Group for Behçet's Disease diagnostic criteria and they were included in this study. There was a female/male ratio of 2.2:1 and mean age at diagnosis was 31.9 +/- 9.2 years. In order of frequency, oral (100%) and genital ulcerations (92.5%), pseudofolliculitis (59.4%), erythema nodosum (49.1%), ocular lesions (47.2%), and musculoskeletal complaints (35.8%) were the most common manifestations. Blindness and major vessel involvement (18.2% vs. 5.5%, p = 0.038 and 27.3% vs. 9.6%, p = 0.019) were more frequent among male than female patients. We concluded that in Brazil, a South American country faraway from the Silk Route, BD follows the same pattern exhibited on its usual endemic area.

MedicinaCopyright Rego et al. Este é um artigo publicado em acesso aberto (Open Access) sob a licença Creative Commons Attribution, que permite uso, distribuição e reprodução em qualquer meio, sem restrições desde que o trabalho original seja corretamente citado.Resumo Objetivo: Descrever o perfil do estudante de Medicina e a sua repercussão na trajetória acadêmica. Método: Foi realizado um estudo transversal e descritivo através da aplicação de questionário a estudantes do curso de Medicina do segundo ao quinto semestre do curso, com coleta de dados no período de outubro de 2017 a fevereiro de 2018. Resultados: Participaram 154 alunos, sendo 50,6% do sexo masculino e com média de idade de 21,5±3,0 anos, observando-se que 30% considera seu desempenho regular e 37,5% moram em casa alugada ou cedida por terceiros, ao passo que a grande maioria mora distante da Universidade (61%), utiliza transporte público coletivo (70,1%) e relatam queixas relacionadas à má qualidade do sono (74,7%), bem como dificuldade em frequentar as aulas (39%). Destaca-se que 30,9% possui renda familiar de 1 a 3 salários mínimos, sendo que a maioria não exerce trabalho remunerado (94,2%). Conclusão: Conclui-se que as condições socioeconômicas já não são, universalmente, aquelas das classes mais altas da sociedade, o que pode ajudar a compreender as dificuldades enfrentadas por vários estudantes.Descritores: educação médica; classe social; fatores socioeconômicos; desempenho acadêmico. Summary Purpose: To describe the medical student profile and its repercussion in the academic trajectory. Methods: A cross-sectional descriptive study was done, using a survey that medical students from the second to the fifth semester answered it. The data was collected from October 2017 to February 2018. Results: 154 students with the average age of 21.5±3.0 years old participated on the survey; 50.6% of them were men, 30% consider their achievement regular, 37.5% live in rented houses or lent by third parties, most of them live far from the university (61%) and use public transportation (74%), 39% report difficulties to attend the classes. We highlight that 30.9% are from families that their monthly revenue is 1 to 3 minimum salaries. Conclusion: We conclude that the socio-economic conditions today are not those of the highest classes of the society, what may help us to understand the difficulties faced by several students. IntroduçãoEm geral, os cursos de Medicina apresentaram por muitos anos um perfil predominante de estudantes: sexo masculino, de classes sociais mais elevadas, provenientes de grandes centros urbanos 1 . Entretanto, atualmente percebe-se uma mudança neste perfil, em especial nas instituições públicas, relacionadas a mudanças nos processos de admissão, como ações afirmativas e sistemas de cotas, visando ampliar o acesso às instituições públicas de ensino superior. Estas mudanças trazem consigo a necessidade de conhecimento sobre possíveis novas variáveis, a fim de moldar o ensino médico a novos modelos educacionais mais adequados à situação...

This study identified a need for greater control of risk factors for cardiovascular diseases and a better understanding of the pathogenesis of atherosclerosis in SLE. Infectious causes are still frequent, and management should be improved, especially in the early stages of the disease.

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