RESUMO Descreve-se um caso de sífilis recente, num doente com infeção VIH e história prévia de sífilis, caracterizado por balanite e sifílides papulares, e um resultado falso negativo para o teste VDRL devido ao fenómeno de prozona. Este resultado falso negativo decorre de títulos muito elevados de anticorpos, que interferem na formação de complexos antigénio-anticorpo, necessários para visualizar um teste de floculação positivo.

ABSTRACT We report a case of early syphilis, presenting as balanitis and papular syphilides in an HIV-infected patient, with a previous history of syphilis infection, which demonstrated a false negative VDRL testing due to a prozone phenomenon. This false negative response results from overwhelming antibody titers, which interfere with the proper formation of the antigen-antibody lattice network, necessary to visualize a positive flocculation test.

Abstract: The approach to children with anogenital warts in the context of sexual abuse is a challenge in clinical practice. This study aims to review the current knowledge of anogenital warts in children, the forms of transmission, and the association with sexual abuse and to propose a cross-sectional approach involving all medical specialties. A systematic review of the literature was conducted in Portuguese and English from January 2000 to June 2016 using the ISI Web of Knowledge and PubMed databases. Children aged 12 years or younger were included. The ethical and legal aspects were consulted in the Declaration and Convention on the Rights of Children and in the World Health Organization. Non-sexual and sexual transmission events of human papillomavirus in children have been well documented. The possibility of sexual transmission appears to be greater in children older than 4 years. In the case of anogenital warts in children younger than 4 years of age, the possibility of non-sexual transmission should be strongly considered in the absence of another sexually transmitted infection, clinical indicators, or history of sexual abuse. The importance of human papillomavirus genotyping in the evaluation of sexual abuse is controversial. A detailed medical history and physical examination of both the child and caregivers are critical during the course of the investigation. The likelihood of an association between human papillomavirus infection and sexual abuse increases directly with age. A multidisciplinary clinical approach improves the ability to identify sexual abuse in children with anogenital warts.

A doença de Riga-Fede caracteriza-se por ulceração reativa da mucosa oral associada ao traumatismo dentário repetitivo. Foi inicialmente descrita em crianças com déficit neurológico, sendo muito rara em adultos. O presente caso descreve o aparecimento de uma úlcera grande, semelhante ao carcinoma espinocelular, na língua de um adulto com hemiparesia. A lesão teve resolução completa após a recuperação neurológica. O caso salienta a importância de considerar esta doença no diagnóstico diferencial das úlceras da mucosa oral.

Riga-Fede disease is a rare, benign disorder characterized by reactive ulceration of the oral mucosa associated with repetitive dental traumatism. It was first described in children with neurologic disorders and is very rare in adults. This case report describes the occurrence of a large ulcer of the tongue, resembling squamous cell carcinoma, in an adult with hemiparesis. The lesion cleared after neurologic recovery. This case highlights the importance of considering this disorder in the differential diagnosis of oral mucosal ulcerations.

Background: Patients with chronic obstructive pulmonary disease (COPD) have elevated serum levels of ultrasensitive C reactive protein (CRPus). This raise may be related directly to COPD and its associated systemic inflammation or secondary to other factors such as smoking status, disease severity, acute exacerbations, or associated complications. Aim: To evaluate the potential causes of raised levels of CRPus in stable COPD patients. Patients and Methods: Cohorts of 133 mild-to-very severe COPD patients (41 current smokers), 31 never-smokers, and 33 current smoker controls were compared. Clinical assessments included body mass index (BMI), fat (FM) and fat-free mass (FFM) measurement by DEXA, forced expiratory volume in one second (FEV1), arterial oxygen tension (PaO2), six-minute walking test (SMWT), emphysema (EMPH) and right thigh muscle cross-sectional area (TMCSA), both quantified by high resolution computed tomography. Results: Serum CRPus levels were significantly higher in COPD patients than in controls (7 ± 4.2 and 3.7 ± 2.7 mg/L respectively; p < 0.0001). Being smoker did not influence CRPus levels. These levels were significantly correlated with FM (r = 0.30), BMI (r = 0.21), FEV1 (r = -0.21), number of acute exacerbations of the disease in the last year (r = 0.28), and PaO2 (r = -0.27). Using multivariate analysis FM, PaO2, and number of acute exacerbations of the disease in the last year had the strongest association with CRPus levels. Conclusions: CRPus is elevated in COPD patients, independent of smoking status. It is weakly associated with fat mass, arterial oxygen tension and frequency of exacerbations.

Background: Patients with chronic obstructive pulmonary disease (COPD) decrease their physical activity. However, it is unknown at which stage of the disease the reduction occurs and whether dyspnea is a limiting factor. Aim: To compare physical activity between patients with COPD and controls of similar age and to assess its association with disease severity. Material and Methods: We studied 112 patients with mild to very severe COPD and 55 controls. Lung function, six-minutes walking test (SMWT), and physical activity through the International Physical Activity Questionnaire (IPAQ) were measured. Results: Compared to controls, physical activity was significantly reduced in COPD patients (1823 ± 2598 vs. 2920 ± 3040 METs min/week; p = 0.001). Patients were more frequently sedentary (38 vs. 11%), while controls were more often very active (31 vs. 19%) or moderately active (58 vs. 43%). Physical activity was reduced from Global Initiative for Obstructive Chronic Lung Disease (GOLD) stage 2 and from Modified Medical Research Council (MMRC) dyspnea grade 1. Weak relationships were observed between lung function, SMWT and physical activity. Conclusions: Physical activity decreases early in the course of the disease and when dyspnea is still mild, among patients with COPD. (Rev Med Chile 2011; 139:1562-1572).

As manifestações neurológicas de sífilis tornaram-se raras após a introdução da penicilinoterapia. No entanto, a partir da década de 70, verificou-se um aumentou do número de casos, particularmente em associação com a infecção pelo vírus da imunodeficiência humana. Este aumento da incidência de sífilis, observável também na Europa e nos Estados Unidos da América, poderá traduzir-se num acréscimo do número de casos de neurossífilis observados na prática clínica. É importante conhecer o carácter polimórfico da neurossífilis, a qual pode mimetizar múltiplas afecções do sistema nervoso central. Importa ainda conhecer os diferentes perfis das reacções serológicas da sífilis, a bioquímica e os padrões electroforéticos de Imunoglobulina G no líquido cefalorraquidiano que, em conjugação com os achados clínicos, possibilitam um diagnóstico correcto. Nos doentes infectados com o vírus da imunodeficiência humana, o diagnóstico de neurossífilis assume algumas particularidades, nomeadamente a possibilidade de confusão das suas manifestações clínicas com outras infecções do sistema nervoso central como a infecção pelo próprio vírus da imunodeficiência humana ou infecções oportunistas, e a maior taxa de falsos negativos das reacções serológicas da sífilis. Pelas razões acima mencionadas, os autores fazem uma revisão dos aspectos clínicos e laboratoriais da doença e das recomendações terapêuticas mais recentes.

Neurosyphilis became very rare since the introduction of penicillin. However, in the mid-1970s, it was reported an increasing number of cases in individuals likely to have concurrent human immunodeficiency virus infection. The rising in syphilis in recent years in Europe and United States of America, can also lead to an increase in the number of cases of neurosyphilis seen by practitioners. It is importante to know the polymorphic character of neurosyphilis, which can easily mimic many other neurologic and psychiatric diseases. Besides, one must know the range of the possible serologic reactions, biochemistry and Immunoglobulin G electrophoretic patterns in blood and cerebrospinal fluid. In human immunodeficiency virus infected patients clinical manifestations may be confused with other central nervous system diseases such as infection by human immunodeficiency virus or by other opportunistic agents and these patients also have a higher rate of negative serologic reactions in cerebrospinal fluid, which makes diagnosis more difficult. For the above mentioned reasons, the authors make a review of the clinical and laboratorial findings and of the more recent therapeutic guidelines of the disease.