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Purpose of Review In this review, we report on the state of knowledge about human Q fever in Brazil and on the Guiana Shield, an Amazonian region located in northeastern South America. There is a contrast between French Guiana, where the incidence of this disease is the highest in the world, and other countries where this disease is practically non-existent. Recent Findings Recent findings are essentially in French Guiana where a unique strain MST17 has been identified; it is probably more virulent than those usually found with a particularly marked pulmonary tropism, a mysterious animal reservoir, a geographical distribution that raises questions. Summary Q fever is a bacterial zoonosis due to Coxiella burnetii that has been reported worldwide. On the Guiana Shield, a region mostly covered by Amazonian forest, which encompasses the Venezuelan State of Bolivar, Guyana, Suriname, French Guiana, and the Brazilian State of Amapá, the situation is very heterogeneous. While French Guiana is the region reporting the highest incidence of this disease in the world, with a single infecting clone (MST 117) and a unique epidemiological cycle, it has hardly ever been reported in other countries in the region. This absence of cases raises many questions and is probably due to massive under-diagnosis. Studies should estimate comprehensively the true burden of this disease in the region.

Resumen Objetivo Conocer las caracteristicas epidemiologicas, clinicas y terapeuticas de los pacientes con diagnostico de IC atendidos en atencion primaria de 2 zonas de salud de Albacete, Zona 5 A (caracteristicas de centro urbano) y Casas Ibanez (caracteristicas de centro rural), asi como destacar las principales diferencias entre ambos. Metodo Estudio descriptivo y transversal, correspondiente a la primera fase del estudio ALBAPIC. Se han registrado a todos los pacientes de la zona desde el 1 de enero del 2018 hasta el 30 de junio del 2019 que cumplieran el criterio de inclusion: tener diagnostico de IC en el programa TURRIANO (programa de consulta clinica en Atencion Primaria de Castilla-La Mancha). Se registraron las caracteristicas demografico-antropometricas y clinicas, los datos analiticos, las exploraciones diagnosticas complementarias, las pautas terapeuticas y las hospitalizaciones durante 12 meses previos a la inclusion. Se realizaron una exploracion fisica y controles electrocardiograficos y bioquimicos en la visita de inclusion. Resultados Han participado 384 pacientes diagnosticados de IC en ambas zonas de salud (161 en zona urbana y 223 en la rural). Edad media ± desviacion estandar 82,24 ± 10,51 anos (81,24 ± 9,59 anos en zona urbana y 83,37 ± 11 anos en rural, con diferencias significativas, p En relacion con la prevalencia de factores de riesgo cardiovascular, tenemos que la hipertension sobre todo y las dislipidemias son los mas frecuentes, existiendo diferencias segun el medio en el que viven. En el medio rural hay mayores tasas de cardiopatias (principalmente isquemicas y por valvulopatia). Los pacientes con IC tienen numero alto de enfermedades cronicas concomitantes, siendo entre 4 y 6 mas del 60% de los casos en el medio urbano y entre 1 y 4 en el medio rural. Aproximadamente, un 14% tiene tambien una enfermedad oncologica en el medio urbano frente a un 21% en el rural. Segun los datos de exploracion y analitica, las principales variables se encuentran aceptablemente controladas, estando peor controlados los parametros lipidicos en el centro rural. La media de farmacos prescritos por cada paciente fue de 6,3 en rural y 7,2 urbano. En cuanto a los tratamientos que estan tomando se observa que los diureticos y las estatinas son los mas utilizados tanto en el medio rural como urbano. Conclusiones Existe un aceptable control de los factores de riesgo cardiovascular en ambos medios, existiendo diferencias en cuanto a los metodos diagnosticos y tratamientos utilizados.

OBJECTIVE: To assess the effectiveness of corticosteroids on outcomes of patients with COVID-19 pneumonia requiring oxygen without mechanical ventilation. METHODS: We used routine care data from 51 hospitals in France and Luxembourg to assess the effectiveness of corticosteroids at 0.8 mg/kg/day eq. prednisone (CTC group) versus standard of care (no-CTC group) among adults 18 to 80 years old with confirmed COVID-19 pneumonia requiring oxygen without mechanical ventilation. The primary outcome was intubation or death by day 28. In our main analysis, characteristics of patients at baseline (i.e., time when patients met all inclusion criteria) were balanced by using propensity-score inverse probability of treatment weighting. RESULTS: Among the 891 patients included in the analysis, 203 were assigned to the CTC group. Use of corticosteroids was not significantly associated with risk of intubation or death by day 28 (weighted hazard ratio [wHR] 0.92, 95% CI 0.61 to 1.39) or cumulative death rate (wHR 1.03, 95% CI 0.54 to 1.98). However, use of corticosteroids was associated with reduced risk of intubation or death by day 28 in the prespecified subgroups of patients requiring oxygen ≥ 3 L/min (wHR 0.50, 95% CI 0.30 to 0.85) or C-reactive protein level ≥ 100 mg/L (wHR 0.44, 95%CI 0.23 to 0.85). Number of hyperglycaemia events was higher for patients with than without corticosteroids, but number of infections was similar. CONCLUSIONS: We found no association between the use of corticosteroids and intubation or death in the broad population of patients 18 to 80 years old with COVID-19 hospitalized in non-intensive care unit settings. However, the treatment was associated with reduced risk of intubation or death for patients with ≥ 3 L/min oxygen or C-reactive protein level ≥ 100 mg/L at baseline. Further research need to confirm the right timing of corticosteroids for patients with COVID-19 requiring oxygen only.

Electroconvulsive therapy (ECT) involves the induction of seizures for therapeutic purposes in cases of serious psychiatric disorders. Since the early twentieth century, ECT was one of the most important therapeutic alternatives to treat patients suffering from severe psychiatric disorders, and ECT maintained its therapeutic role despite the emergence of psychoactive drugs by mid-century. However, in the 1970's it fell into disuse due to the emergence of a psychiatric paradigm shift that considered it repressive and unsafe. The introduction of anesthesia as a fundamental part of the ECT has significantly improved the safety of the therapy, which, today, continues to be an effective therapy for its precise indications (Lopez Villaescusa et al., 2011; Rodriguez-Jimenez, 2015).

Hypotrichosis with juvenile macular dystrophy is a rare autosomal recessive disorder characterized by sparse scalp hair caused by hair follicle abnormalities as well as progressive retinal degeneration leading to blindness in the second or third decade of life. It is associated with mutations of the cadherin 3 (CDH3) gene, which result in abnormal expression of P-cadherin. Mutations in CDH3 are related to ectodermal dysplasia, ectrodactyly, and macular dystrophy. In this report, we describe an 11-year-old Iranian boy born with a missing left index fingernail and sparse scalp hair who later displayed macular pigmentary changes. Genetic testing of the CDH3 gene revealed a homozygous gene variant at exon 6 (640A>T). This novel in-frame mutation converts a lysine to a premature stop codon, altering synthesis of P-cadherin on chromosome 16q22.