Introduction: Cryptosporidiosis is a protozoal infection caused mainly by Cryptosporidium parvum and C. hominis [1]. In immunocompetent individuals, it causes self-limiting diarrhea, but in people living with HIV/AIDS, it may progress to severe disseminated forms [2], including rare pulmonary involvement. Transmission occurs primarily via the fecal-oral route, but in advanced immunosuppression, inhalation of oocysts is also possible. Specific treatment has limited efficacy, making antiretroviral therapy (ART) essential [3]. Case Report: A 36-year-old previously healthy man was hospitalized with postprandial nausea, vomiting, and yellowish diarrhea for three weeks, with decreasing frequency over time. He developed persistent dry cough, hiccups, heartburn, epigastric pain, and a 12-kg weight loss in 22 days. On examination, he was pale, with mild hepatomegaly, pulmonary crackles, and epigastric tenderness. Abdominal CT revealed retroperitoneal and mesenteric lymphadenopathy. HIV serology was positive. Initial stool tests for Cryptosporidium sp. and Isospora were negative. Sputum smear microscopy revealed acid-fast bacilli, leading to the initiation of tuberculosis treatment (RHZE). During hospitalization, he developed daily afternoon fever, anal incontinence, progressive respiratory distress, and required non-invasive ventilation. After 15 days of RHZE, a new sputum smear revealed Cryptosporidium sp. cysts, which were also detected in a new stool sample. Nitazoxanide and ART were initiated. Despite treatment, he maintained severe diarrhea and respiratory discomfort, progressing to orotracheal intubation and vasopressor support. He died 17 days after treatment initiation. Discussion: The pulmonary form of cryptosporidiosis is rare and underdiagnosed, with nonspecific symptoms often attributed to tuberculosis or other opportunistic infections. Inhalation of oocysts and hematogenous spread are possible mechanisms [2]. Antiparasitic therapy alone has low efficacy, and early ART is crucial for control [3]. Conclusion: Disseminated cryptosporidiosis should be investigated in PLHIV with persistent diarrhea and respiratory symptoms, especially in cases unresponsive to antibiotics and antiparasitics. Simultaneous testing of stool and sputum samples contributes to the diagnosis and better management of the case.
Abstract Background and aims ICH is the second most common type of stroke and is associated with high prevalence and mortality. Ischemic lesions have been described in patients with ICH; however, their prevalence and predictive factors in multi-ethnic populations are not well established, and studies in the Brazilian population are lacking Methods This transversal study included patients consecutively admitted with a diagnosis of ICH between January 2009 and December 2018 at a tertiary hospital. Multivariable logistic regression analysis was performed to identify independent predictors Results Eighty-nine patients were evaluated (mean age 61 ± 16.6 years), and 47 (52.8%) were female. The prevalence of ischemic lesions was 27%. Hypertension (39.8%) and Amyloid Angiopathy (AA) (29.5%) were the most frequent etiologies. Independent predictors of ischemia on MRI were AA (OR 12.8, 95%CI 2.6–91.6), intraventricular hemorrhage (OR 19.5, 95%CI 3.9–136), superficial cortical siderosis (OR 15.8, 95%CI 2.0–194), SBP 48 hours after ICH (OR 1.04, 95%CI 1.01–1.07), and ICH volume at admission (OR 0.98, 95%CI 0.95–1.0). Predictors of poor outcome included antithrombotic therapy, hematoma expansion, and ICH volume at admission. Glasgow Coma Scale score was the only predictor of in-hospital mortality. Patients with ischemic lesions had longer hospital and ICU stays Conclusions Ischemic lesions were frequent in patients with ICH. No association was found between ischemic lesions and clinical outcomes or in-hospital mortality Conflict of interest Luiz Dalfior Junior : nothing to disclose; Eva Rocha : nothing to disclose; Maramelia Miranda: nothing to disclose; Feres Chaddad Neto: nothing to disclose; Gisele Sampaio: nothing to disclose
Objective Traditional analyses of subthalamic nucleus local field potentials (STN-LFPs) may obscure relevant dynamics by conflating periodic and aperiodic activity. We investigated whether spectral parameterization reveals phenotype- and movement-dependent neural signatures in Parkinson’s disease (PD). Methods Intraoperative STN-LFPs (35 STN: 20 PIGD, 15 TD) were recorded across rest and movement conditions during deep brain stimulation surgery in twenty-two PD patients (10 tremor-dominant [TD], 12 postural instability and gait disorder [PIGD]). Power spectral densities were parameterized into aperiodic-adjusted and non-adjusted bandpowers (alpha, low-beta, and high-beta), and aperiodic features (offset, knee frequency, and exponent). Linear Mixed-Effects models assessed interactions between phenotype and condition. Multivariate logistic regression classified phenotypes, and Spearman’s rank correlations evaluated pairwise relationships between each UPDRS subscores (rigidity, tremor, and bradykinesia) and each spectral feature. Results TD patients exhibited significant suppression in aperiodic-adjusted low-beta power during movement. Aperiodic features revealed significant phenotype-dependent modulation, marked by significant knee frequency enhancement in PIGD during movement (p = 0.002) and significant phenotype differences in movement-related exponent modulation (p < 0.01). Combining periodic and aperiodic movement-related features in logistic regression yielded the highest classification performance. Furthermore, aperiodic spectral features did not significantly correlate with the severity of PD symptoms. Conclusions Decomposing STN-LFPs into periodic and aperiodic components reveals distinct phenotype- and movement-specific neural dynamics in patients with PD. The differential modulation of the aperiodic exponent and knee frequency suggests that TD and PIGD may engage distinct circuit-level responses during movement, potentially involving differences in excitation/inhibition-related dynamics and intrinsic neural timescales.
