[American cutaneous leishmaniasis in a military training center located in Zona da Mata, Pernambuco, Brazil]

An outbreak of American cutaneous leishmaniasis has been occurred in military training unit localized in 'Zona da Mata' of Pernambuco State, Brazil, where were registered 26 human cases. An epidemiological survey was carried out by entomological investigation and Montenegro skin test (MST). Lutzomyia choti presents predominance (89.9%) in sandflies identified. Out of 545 men who realized training activities were 24.12% positive to MST.

Older men from global settings more vulnerable to clinical changes associated with food insecurity

Background

Studies of the food security status of older adults are rare outside of the United States, especially in low- and middle-income settings. Food insecurity may contribute to disease and disability. Using a diverse sample of older adults, we examine the association of food insecurity with clinical and self-reported measures that are related to disease and impairment.

Methods

Cross sectional analysis of 1482 older adults from Kingston and St. Hyacinthe (Canada), Tirana (Albania), Manizales (Colombia), and Natal (Brazil). Outcome measures were Body Mass Index (BMI), waist circumference, and self-reported unintentional weight loss. Food insecurity was assessed with the 9-item Latin American and Caribbean Household Food Security Scale. Covariates were age, sex, study site, and education. Statistical analyses included Student's T-test, Chi-square test, and linear regression.

Results

83% of participants were food secure; 12% experienced mild food insecurity and 5%, moderate/severe food insecurity. Among men, BMI and waist circumference varied significantly by food security status (p < 0.05). Mean BMI among men with moderate/severe food insecurity was 25.5 compared to 27.0 for mild and 27.5 for no food insecurity. The pattern for waist circumference was similar (93.9cm for moderate/severe, 96.7cm for mild, and 98.9cm for no food insecurity). More food insecure men reported unintentional weight loss (13%) than food secure men (10%). This pattern was not observed among women. Statistical adjustment for study site, education, and age did not change the findings.

Conclusions

Significant differences in clinical indicators of disease were observed by food security status in men. At the extreme, low BMI and waist circumference are linked to increased risk of malnutrition, compromised immune function, and respiratory and digestive diseases. Differences in these measures by food security status emphasize the need for gender and age specific food security interventions.

Key messages

Food insecure men experience clinical indicators of disease significantly more than food insecure women. Successful food security interventions may require sex specific focus across global settings. Little research has been done on food insecurity in elderly outside of North America and study findings contribute to significant gap in sex specific research in this population across global settings.

[Urolithiasis and renal colic. Therapeutic approach in urology]

Renal colic is one of the most common pathologies found in our emergency services. Although a source of great pain and apprehension, most of the episodes do not need a specialised approach. The authors present a general overview in the proposed management of kidney lithiasis, including both recommendations for a conservative, expectant or prophylactic treatment, and recommendations and different techniques for urological intervention.

First account on the larval biology of a Litomosoides filaria, from a bat

Litomosoides filariae are parasites of unrelated groups of hosts, including bats, marsupials, ancient and modern rodents. The four life cycles to-date elucidated, develop in terrestrial mammals and, at least experimentally, in the mite Ornithonyssus bacoti. A batch of mites was fed on an infected bat, Artibeus jamaicensis captured in Costa Rica, and 18 days later one infective larva was recovered. Its morphology was similar to that of other Litomosoides species, with the characteristic long buccal capsule. These first accounts on the larval biology of Litomosoides from Microchiroptera confirm the unity of the genus which supports the view that it has passed from one group of hosts to another by means of captures.

Primary cutaneous actinomycosis caused by Actinomyces meyeri as first manifestation of HIV infection

Primary cutaneous actinomycosis is very uncommon. We report a patient with cutaneous actinomycosis with multiple lesions without any detectable extra-cutaneous lesions. In our patient the actinomycosis was the presenting manifestation of HIV infection.

Portuguese recommendations for the prevention, diagnosis and management of primary osteoporosis - 2018 update

BACKGROUND

Advances in osteoporosis (OP)case definition, treatment options, optimal therapy duration and pharmacoeconomic evidence in the national context motivated the Portuguese Society of Rheumatology (SPR) to update the Portuguese recommendations for the diagnosis and management of osteoporosis published in 2007.

METHODS

SPR bone diseases' working group organized meetings involving 55 participants (rheumatologists, rheumatology fellows and one OP specialist nurse) to debate and develop the document. First, the working group selected 11 pertinent clinical questions for the diagnosis and management of osteoporosis in standard clinical practice. Then, each question was investigated through literature review and draft recommendations were built through consensus. When insufficient evidence was available, recommendations were based on experts' opinion and on good clinical practice. At two national meetings, the recommendations were discussed and updated. A draft of the recommendations full text was submitted to critical review among the working group and suggestions were incorporated. A final version was circulated among all Portuguese rheumatologists before publication and the level of agreement was anonymously assessed using an online survey.

RESULTS

The 2018 SPR recommendations provide comprehensive guidance on osteoporosis prevention, diagnosis, fracture risk assessment, pharmacological treatment initiation, therapy options and duration of treatment, based on the best available evidence. They attained desirable agreement among Portuguese rheumatologists. As more evidence becomes available, periodic revisions will be performed. Target audience and patient population: The target audience for these guidelines includes all clinicians. The target patient population includes adult Portuguese people. Intended use: These recommendations provide general guidance for typical cases. They may not be appropriate in all situations - clinicians are encouraged to consider this information together with updated evidence and their best clinical judgment in individual cases.

Cycloid psychosis: From Kleist until our days

Introduction

After Emil Kraepelin's division of psychoses into a group of dementia praecox and manic-depressive insanity, the classification of psychoses with atypical symptoms, which could not be assigned in this dichotomy created a debate, that lasts until our days. These “atypical psychoses” had been described under many terms and concepts in different countries.

In 1926, Kleist coined the term “cycloid psychosis” to describe cases which did not meet the typical presentation shown in Kraepelian's dichotomy. Three decades later, Karl Leonhard established the concept of cycloid psychosis as a nosologically independent group of endogenous psychosis.

Objectives/Aims

Make an historical review of the concept of cycloid psychosis. Discuss the clinical features and debate the classification of this clinical entity.

Methods

A bibliographical review is made of the cycloid psychosis, based on the data published in Pubmed.

Results

According to Leonhard, cycloid psychosis generally present with bipolar, polymorphous clinical symptomatology, and run a phasic course with complete remissions after each episode. Furthermore, Leonhard delineated three subtypes: anxiety-happiness psychosis, confusion psychosis and motility psychosis presenting with different symptoms. In 1981, Perris and Brockington formulated the first set of operational criteria for cycloid psychoses. In recent years, new data about this entity have been acknowledged due to information displayed by different clinical studies and imaging techniques.

Conclusion

The phenomenology and classification of cycloid psychosis still needs more evidence for a greater use in clinical practice. However, this clinical entity can solve the void for the diagnosis of many of the so-called “atypical psychoses”.

Disclosure of interest

The authors have not supplied their declaration of competing interest.