[Guideline for the Treatment and Prevention of Infections Associated with Immunosuppressive Therapy for Autoimmune Diseases]. / Protocolo de Prevenção e Tratamento de Infeções Associadas à Terapêutica Imunossupressora de Doenças Autoimunes.

We propose a guideline about the risk, prevention and treatment of infection in the patient under immunomodulatory or immunosuppressive therapy in the context of autoimmune or autoinflammatory disease. It is divided into three sections: drugs and associated risk of infection; immunizations; risk, prevention, and treatment of specific infections. The treatment of autoimmune diseases involves the use of immunosuppressive or immunomodulatory therapies, with an increasing number of new drugs being used. It is associated with an increased risk of infection, which may be present globally or only for specific agents, varying widely depending on the pharmacological class and even within the same class. The prevention strategy and clinical management need to be individually tailored and there are several key factors: characterization of the disease that prompts the immunosuppression, understanding of the mechanism of action of the immunosuppressive drug, knowledge of previous infections, recognition of risk factors, laboratory test results, vaccine administration, monitoring of clinical signs and symptoms and patient education.

O presente protocolo aborda o risco, prevenção e tratamento da infeção no doente sob terapêutica imunomoduladora ou imunossupressoraem contexto de doença autoimune ou autoinflamatória. Subdivide-se nas seguintes secções: fármacos e risco associado de infeção; imunizações; risco, prevenção e tratamento de infeções específicas. Com um número crescente de novos fármacos em utilização nos últimos anos, o tratamento de doenças autoimunes envolve a utilização de terapêuticas imunossupressoras ou imunomoduladoras e associa-se a aumento do risco de infeção, que pode estar presente de uma forma global ou apenas para infeções por agentes específicos, variando amplamente consoante a classe farmacológica e mesmo dentro desta. Na estruturação da estratégia preventiva são fundamentais a caracterização da patologia que motiva a imunossupressão, a compreensão do mecanismo de ação do imunossupressor, a aferição de infeções prévias, o reconhecimento de fatores de risco, a realização de rastreios laboratoriais, a administração de vacinas, a educação do doente e a monitorização de sintomas e sinais clínicos, na dependência de uma gestão clínica necessariamente individualizada.

Abdominoplasty with Scarpa fascia preservation - comparative study in a bariatric population.

BACKGROUND: Abdominoplasty techniques using a more superficial plane of dissection with Scarpa fascia preservation have been shown to improve recovery and reduce complications in nonbariatric patients. Patients who have experienced massive weight loss frequently need body contour procedures and represent a high-risk group. OBJECTIVE: To evaluate the effect of this technique in patients with massive weight loss after bariatric surgery. SETTING: University hospital, Portugal. METHODS: This was a single-center retrospective study of 51 postbariatric patients who had been undergone either a classic full abdominoplasty (group A) or a similar procedure except for the preservation of Scarpa fascia below the umbilicus (group B). General characteristics of both groups were analyzed, and recorded outcomes were total and daily volume of drain output, time until drain removal, time until hospital discharge, and local and systemic complications. RESULTS: There were no statistically significant differences between groups regarding general characteristics or complications. The Scarpa fascia preservation group had a highly significant reduction of 79% on the total drain output, 7 days until drain removal, and 5 days' hospital stay. Long drainers (7 days or more with drains) were eliminated (reduction from 52% in group A to 3% in group B) and seroma had a 65% reduction. CONCLUSION: Preserving Scarpa fascia during a full abdominoplasty in postbariatric patients improves recovery by reducing total drain output and hospital stay, allowing earlier drain removal, eliminating long periods with suction drains, and reducing seroma incidence. Clear benefits for the patient were obtained.