ABSTRACT Paracoccidioidomycosis (PCM) is a systemic fungal infection caused by Paracoccidioides species. Chylothorax is a rare complication of PCM. A 16-year-old adolescent presented daily fever, lymphadenomegaly, sweating, weight loss, ventilatory-dependent pain, and dysphagia, which confirmed PCM. During treatment, the patient developed chylothorax and chylous ascites. Chronic inflammatory and fibrotic lymphadenopathy may obstruct lymphatic vessels, resulting in the extravasation of lymph into the abdomen or pleural cavities. Chylothorax is one of several complications of PCM and can lead to respiratory insufficiency, even in patients undergoing antifungal therapy.

ABSTRACT Paracoccidioidomycosis caused by Paracoccidioides lutzii is endemic in the Midwest of Brazil and its clinical spectrum is still little known due to the recent identification of this fungal species. A patient resident in Southeast Brazil, but who had lived for many years in the Midwest region, presented with skin injuries, chronic cough and bilateral adrenal involvement. Paracoccidioides spp. was isolated in culture from a skin lesion biopsy. This isolate was later identified as P. lutzii using gene sequencing. A favorable initial response to treatment with itraconazole was observed, but a few weeks later, the patient developed respiratory failure and worsening of lung lesions. Evaluation by computed tomography and echocardiography were suggestive of pulmonary arterial hypertension, and a bronchoscopic biopsy showed peribronchial remodeling. The patient completed the antifungal treatment but maintained the respiratory dysfunction. The reported case shows that P. lutzii can be isolated from patients in a geographic area far from the place of infection acquisition and that, as P. brasiliensis , it can cause adrenal injury and cardio-respiratory complications as a consequence of excessive necrosis and fibrosis.

Abstract Dirofilariasis is a little-known zoonosis, with dogs and cats as definitive hosts. It is caused by nematodes and transmitted by mosquito bites. We report the case of a 67-year-old man with a consumptive syndrome with two subpleural pulmonary opacities. A transthoracic lung biopsy revealed a Dirofilaria worm. Myocardial nuclear magnetic resonance (NMR) demonstrated dilated cardiomyopathy after myocarditis related to dirofilariasis. Human infection is rare and occurs accidentally. The most common radiological alteration is a mainly subpleural coin lesion. Dirofilariasis is a neglected emergent disease and knowledge about it is important for differential diagnoses from neoplastic pulmonary nodules.

SUMMARY The aim of this retrospective study was to review all the notified cases of multidrug-resistant tuberculosis (MDR-TB) in São Paulo State (Brazil), as well as to describe and discuss the clinical, microbiological and radiologic aspects in a single reference center, within the same state, from 2000 to 2012. There were 1,097 notifications of MDR-TB in São Paulo State over this period, 70% affecting men aged on average 38 years (10-77). There was a significant fall in the MDR-TB mortality rate from 30% to 8% (2000-2003 versus 2009-2012). The same trend was observed in the cases studied at the reference center. The number of notified cases increased and death rate reduced from 37.5% (2000-2005) to 3.4% (2006-2012). Among the 48 drug-resistant TB cases, 17 non-tuberculous Mycobacteria were isolated in the sputum culture of nine patients, without any clinical significance. TB and fungus co-infection was diagnosed in 15% (7/48) of these cases: three with confirmed chronic pulmonary aspergillosis and four with positive serological markers for paracoccidioidomycosis. Overall, the reports show that MDR-TB diagnosis and cure rates have increased, while the mortality rate has decreased significantly in São Paulo State including in the studied reference center.

O EEG tem sido amplamente empregado na avaliação de mudanças eletrofisiológicas induzidas por medicações distintas.A sensibilidade desta técnica em detectar alterações produzidas por uma substância pode ser aprimorada por métodos de análise quantitativa (EEGq). O presente estudo teve por objetivo investigar os efeitos modulatórios do bromazepam na dinâmica cerebral. Os efeitos de 3mg de bromazepam na distribuição de potência cortical foram observados em 10 indivíduos sadios, em um desenho duplo-cego. A medida eletrofisiológica foi analisada nas diferentes condições experimentais, momentos e eletrodos, em delta, teta, alfa e beta separadamente. Uma diminuição significativa de potência relativa foi observada em delta e teta (efeito principal para condição). Não foram observadas interações. Embora o perfil ansiolítico do EEG (aumento de beta e diminuição de alfa) não tenha sido observado, esteresultado específico pode estar relacionado a outros fatores, tais como dose utilizada e estado fisiológico dos sujeitos, e não necessariamente à droga propriamente dita.

The EEG has been widely employed in the assessment of electrophysiological changes induced by distinct medications. Its sensibility in detecting alterations produced by a specific substance may be enhanced by methods of quantitative analyses (qEEG). The present study aimed at investigating the modulatory effects of bromazepam on brain dynamics. The effects of bromazepam (3mg) on EEG power distribution were tested in 10 healthy individuals, in a double-blind experiment. The electrophysiological measure was analyzed across experimental conditions, moments, and electrodes, in the delta, theta, alpha and beta frequency bands separately. A significant decrease of relative power was observed in delta and theta (main effect of condition). No interactions were observed. Although the expected anxiolytic EEG profile was not observed (increased beta and decreased alpha activity), this specific result may be related to other factors such as dosage used and the subjects' general physiological state, and not necessarily to the drug itself.

Os estágios iniciais do processamento da informação visual, envolvendo a percepção e detecção de um estímulo visual simples, tem demonstrado serem sensíveis a agentes psicotrópicos. O presente estudo investigou os efeitos de uma dose aguda de bromazepam (3 mg), comparado com placebo, no componente P100 do potencial evocado visual e no tempo de reação. A mostra consistiu de 14 sujeitos sadios (6 homens e 8 mulheres), submetidos a uma tarefa de discriminação visual, a qual empregou o paradigma "oddball". Os resultados sugerem que o bromazepam (3 mg) prejudica o estágio inicial do processamento da informação visual, como observado pelo aumento da latência do P100.

The early stages of visual information processing, involving the detection and perception of simple visual stimuli, have been demonstrated to be sensitive to psychotropic agents. The present study investigated the effects of an acute dose of bromazepam (3 mg), compared with placebo, on the P100 component of the visual evoked potential and reaction time. The sample, consisting of 14 healthy subjects (6 male and 8 female), was submitted to a visual discrimination task, which employed the "oddball" paradigm. Results suggest that bromazepam (3 mg) impairs the initial stage of visual information processing, as observed by an increase in P100 latency.

Benzodiazepínicos estão entre as medicações mais comumente prescritas devido à sua eficácia terapêutica para reduzir ansiedade e induzir sono. Conseqüentemente, eles têm sido amplamente empregados no tratamento de diversas desordens. No entanto, poucos estudos têm analisado os efeitos do bromazepam na atividade eletrencefalográfica (EEG). Assim, o presente estudo teve por objetivo investigar os efeitos modulatórios desta droga na dinâmica cerebral. Especificamente, os efeitos de 3 mg de bromazepam na coerência eletrocortical foram analisados em um experimento duplo-cego. A amostra consistiu de 10 sujeitos sadios (5 homens e 5 mulheres), submetidos a dez minutos de captação do sinal de EEG. A medida eletrofisiológica (coerência) foi analisada em três condições experimentais: bromazepam, placebo 1 e placebo 2. Os resultados sugerem que o bromazepam aumenta significativamente a coerência cortical inter-hemisférica.

Benzodiazepines are among the most commonly prescribed medications due to their therapeutic efficacy in reducing anxiety and inducing sleep. Consequently, they have been widely employed in the pharmacological treatment of several disorders. Nevertheless, few studies have analyzed the effects of bromazepam in electroencephalographic activity (EEG). The present study aimed at investigating the modulatory effects of this drug on brain dynamics. Specifically, the effects of bromazepam (3mg) on EEG coherence were tested in a double-blind experiment. The sample, consisting of 10 healthy subjects (5 male and 5 female), was submitted to ten minutes of EEG recording. The electrophysiological measure (coherence) was analyzed across three experimental conditions: bromazepam, placebo 1, and placebo 2. Results indicate that bromazepam significantly increases cortical interhemispheric coherence.

Benzodiazepínicos têm sido utilizados no tratamento farmacológico da ansiedade há mais de quatro décadas. No entanto, poucos estudos têm combinado bromazepam e potencial evocado relacionado a evento (PRE). O presente estudo teve por objetivo investigar os efeitos modulatórios desta droga na dinâmica cerebral. Especificamente, os efeitos de 3mg de bromazepam no componente P300 do PRE foram analisados em um experimento duplo-cego. A amostra consistiu de 15 sujeitos sadios (7 homens e 8 mulheres), submetidos a uma tarefa de discriminação visual utilizando o paradigma "oddball". Medidas eletrofisiológicas (P300) e comportamentais (stroop, digit span, e tempo de reação) foram analisadas em três condições experimentais: placebo 1, placebo 2 e bromazepam. Os resultados sugerem que os efeitos de 3mg de bromazepam em processos cognitivos não são aparentes. Apesar do que parece irrefutável na literatura, o bromazepam não produziu efeitos evidentes nas variáveis comportamentais e eletrofisiológicas analisadas.

Benzodiazepines have been used in the pharmacological treatment of anxiety for over four decades. However, very few studies have combined bromazepam and event-related potentials (ERP). The present study aimed at investigating the modulatory effects of this drug on brain dynamics. Specifically, the effects of bromazepam (3mg) on the P300 component of the ERP were tested in a double-blind experiment. The sample, consisting of 15 healthy subjects (7 male and 8 female), was submitted to a visual discrimination task, which employed the "oddball" paradigm. Electrophysiological (P300) and behavioral measures (stroop, digit span, and reaction time) were analyzed across three experimental conditions: placebo 1, placebo 2, and bromazepam. Results suggest that the effects of bromazepam (3mg) on cognitive processes are not apparent. In spite of what seems irrefutable in current literature, bromazepam did not produce evident effects on the behavioral and electrophysiological variables analyzed.