Paracoccidioidomycosis is a fungal infection endemic to South America. The infection is usually asymptomatic and mostly affects the upper and lower respiratory tracts with clinical-radiological dissociation. Joint involvement is rare with no specific pattern or radiological injury. We report a case of paracoccidioidomycosis in which the patient's initial symptoms were hoarseness and arthritis. After an ultrasound examination, we performed the differential diagnosis of other noninfectious arthropathies and analysis of the material collected, which revealed infection with the fungus Paracoccidioides brasiliensis.
Paracoccidioidomycosis is a fungal infection endemic to South America. The infection is usually asymptomatic and mostly affects the upper and lower respiratory tracts with clinical-radiological dissociation. Joint involvement is rare with no specific pattern or radiological injury. We report a case of paracoccidioidomycosis in which the patient's initial symptoms were hoarseness and arthritis. After an ultrasound examination, we performed the differential diagnosis of other noninfectious arthropathies and analysis of the material collected, which revealed infection with the fungus Paracoccidioides brasiliensis.
BackgroundHigh frequency linear probe ultrasound (US), besides allowing a better resolution in the gray scale (GS), is able to characterize colored images standards through a RGB image histogram1. These images develop through the information of additive primary colors, such as Red (R), Green (G) and Blue (B). On the other hand, the 3D US2 can better define the anatomical cuts, with more details, yielding more precise measures, together with the 2D US. These two methods are able to define echotextural damages, thus enhancing the detection of such changes in rheumatic diseases.ObjectivesTo detect echotextural damages through 2D and 3D US correlating these area and volumes measures.MethodsA total of 16 patients have been assessed (37.5% males and 62.5% females); 75% were affected by synovitis in their wrists, knees, metacarpophalangeal joint, distal interphalangeal joint, hips, ankle, metatarsophalangeal joint; 6.3% exhibited tenossynovitis, 6.3% tophus, 6.3% synovial cyst, 6.3% femoral-condyle cartilage, including 2 rheumatoid arthritis, 5 juvenile idiopathic arthritis, 4 gouts, 1 psoriatic arthritis, 2 osteoarthritis, 1 non-differentiated spondiloarthritis and 1 reactive arthropathy. A MyLab 50 -Esaote equipment was used with frequency transducer that ranged between 6.0 and 18.0 MHz for 2D, and with frequency that ranged from 10.0 to 12.0 MHz for 3D. A total of 630 images was obtained, 470 were in 2 D and 160 images in 3D. For each GS measurement there were 10 measures of 2D standard colored images as well as 3D correlation images of the original GS image, taken at different times in order not to remind prior measurements.ResultsAverage age 39.93±25.98 years of age; average measurement of 2D image area: (GS) 159.23±174.98 cm2, (Indigo) 126.86±156.98 cm2, (RGB) 117.78±142.71 cm2 and average measurement of 3D images 0.588±0.812 cm3. Correlations 2D: (GS) with (Indigo): r=0.948; p<0. 001; (GS) with (RGB) r=0.979; p<0. 001; (Indigo) with (RGB) r=0.987; p<0.001. Correlations 3D and 2D: (GS) r=0.757; p=0.001; (Indigo) r=0.758; p=0.002 and (RGB) r=0.764; p=0.001.ConclusionsThe 2D colored image standards, together with 3D images, may improve the precision of the echotextural damage boundaries in rheumatologic diseases.ReferencesMarques Filho, O; Vieira Neto, H. Processamento Digital de Imagens, Rio de Janeiro: Brasport, 1999. ISBN8574520098.Mendonça JA. O US Tridimensional (3D US). Ultrassonografia em Reumatologia: Uma Extensão do Exame Físico. Rio de Janeiro: Revinter, 2014. p. 70-76.Disclosure of InterestNone declared
Ao meu orientador, Prof. Dr. Gilberto de Nucci, que abriu todas as portas e ofereceu todo o apoio técnico nesta pós-graduação; ao Prof. Dr. Ronilson Moreno, pela incansável disponibilidade em orientação; O presente trabalho foi realizado com apoio do Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), bolsa processo nº 130717/2016-9 RESUMOA testosterona é indicada à terapia de disfunção sexual feminina em mulheres na menopausa.Entretanto, até o momento, somente há uma formulação de testosterona aprovado pelo FDA no tratamento de disfunção sexual feminina na pós menopausa. Esse trabalho teve como objetivo avaliar, de forma comparativa, a farmacodinâmica após a administração tópica de tres concentrações diferentes de testosterona gel em mulheres menopausadas com disfunção sexual.Todas as voluntárias foram avaliadas clinicamente e através de exames laboratoriais antes do início e ao final do estudo para confirmar higidez. O estudo foi realizado com aplicação do produto teste em forma escalonada em sua dosagem. Amostras de sangue foram coletadas antes e após a administração de cada medicamento para determinação dos níveis plasmáticos de testosterona livre e total. Realizou-se o, questionário FSFI de resposta sexual feminina antes do estudo e após a aplicação de testosterona gel em cada regime de dosagem. Os dados do FSFI foram analisados pelo teste estatístico de Friedman com o pós-teste de Dunn. A partir dos dados obtidos pudemos concluir que a administração de testosterona em gel, mostrou-se segura; as doses de 4,4mg e 8,8mg melhoraram os índices na função sexual global, desejo, excitação, lubrificação, orgasmo e satisfação; a dose de 8,8mg também melhorou o quesito dor; e a baixa frequência de testosterona plasmática acima do valor de referência (8,3%). Desta forma novas formulações de testerona em gel podem ser avaliadas futuramente em ensaios clínicos para o tratamento de disfunção sexual feminina pois apresentarem perfil de segurança e melhorar os índices nas função sexual.
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