Periodontal pathogen Aggregatibacter actinomycetemcomitans JP2 correlates with colonic leukocytes decrease and gut microbiome imbalance in mice.

AIM: Evidence suggests that translocation of oral pathogens through the oral-gut axis may induce intestinal dysbiosis. This study aimed to evaluate the impact of a highly leukotoxic Aggregatibacter actinomycetemcomitans (Aa) strain on the gut microbiota, intestinal mucosal integrity and immune system in healthy mice. METHODS: Eight-week-old male C57BL6 mice were divided into control (n = 16) and JP2 groups (n = 19), which received intragastric gavage with PBS and with a suspension of Aa JP2 (HK921), respectively, twice a week for 4 weeks. Colonic lamina propria, fecal material, serum, gingival tissues, and mandibles were obtained for analyses of leukocyte populations, inflammatory mediators, mucosal integrity, alveolar bone loss, and gut microbiota. Differences between groups for these parameters were examined by non-parametric tests. RESULTS: The gut microbial richness and the number of colonic macrophages, neutrophils, and monocytes were significantly lower in Aa JP2-infected mice than in controls (p < .05). In contrast, infected animals showed higher abundance of Clostridiaceae, Lactobacillus taiwanensis, Helicobacter rodentium, higher levels of IL-6 expression in colonic tissues, and higher splenic MPO activity than controls (p < .05). No differences in tight junction expression, serum endotoxin levels, and colonic inflammatory cytokines were observed between groups. Infected animals presented also slightly more alveolar bone loss and gingival IL-6 levels than controls (p < .05). CONCLUSION: Based on this model, intragastric administration of Aa JP2 is associated with changes in the gut ecosystem of healthy hosts, characterized by less live/recruited myeloid cells, enrichment of the gut microbiota with pathobionts and decrease in commensals. Negligible levels of colonic pro-inflammatory cytokines, and no signs of mucosal barrier disruption were related to these changes.

Curcuma longa L. Extract and Photodynamic Therapy are Effective against Candida spp. and Do Not Show Toxicity In Vivo.

Radiotherapy induces a higher level of Candida spp. colonization, resulting in oral candidiasis. This study aimed to evaluate the phototransformation potential of the glycolic extract of Curcuma longa (C. longa); the antifungal activity of C. longa, curcumin, and antifungal photodynamic therapy (aPDT) with blue light-emitting diodes "LED" on Candida albicans and Candida tropicalis in vitro; and the toxicity of C. longa and curcumin in Galleria mellonella model. In order to confirm the light absorption capacity of the C. longa extract, its phototransformation potential was evaluated. The antifungal effect of C. longa, curcumin, and aPDT was evaluated over Candida spp. Finally, the toxicity of C. longa and curcumin was evaluated on the Galleria mellonella model. The data were analyzed using the GraphPad Prism 5.0 software considering α = 5%. It was found that C. longa, curcumin, and aPDT using blue LED have an antifungal effect over C. albicans and C. tropicalis. The extract of C. longa 100 mg/mL and curcumin 200 µg/mL do not show toxicity on Galleria mellonella model.

Thiazolidine-2,4-dione derivative exhibits antitumoral effect and reverts behavioral and metabolic changes in a model of glioblastoma.

The aim of the present study was to evaluate the anti-glioma activity of 3-(4-fluorobenzyl)-5-(4-methoxybenzylidene)thiazolidine-2,4-dione (AV23) in a preclinical model of glioblastoma, as well as behavioral parameters and toxicological profile. The implantation of C6 cells in the left striatum of male Wistar rats was performed by stereotaxic surgery. After recovery, animals were treated with vehicle (canola oil) or AV23 (10 mg/kg/day) intragastrically for 15 days. It was found that AV23 reduced tumor volume by 90%. Serum biochemical parameters such as triglycerides, cholesterol, HDL-cholesterol, LDL-cholesterol, albumin, aspartate aminotransferase, urea, creatinine and total proteins were not changed; however, there was a slight increase in alanine aminotransferase. The compound AV23 reverted the hypoglycemia and the reduction in body weight caused by glioblastoma. Additionally, AV23 was able to revert the reduction of locomotion caused by the tumor implantation. Therefore, the compound AV23 can be considered a promising candidate in the treatment of glioblastoma.

Cost-effectiveness analysis of Oncotype DX from a Brazilian private medicine perspective: a GBECAM multicenter retrospective study.

Background: Oncotype DX (ODX) is a validated assay for the prediction of risk of recurrence and benefit of chemotherapy (CT) in both node negative (N0) and 1-3 positive nodes (N1), hormone receptor positive (HR+), human epidermal growth factor receptor 2-negative (HER2-) early breast cancer (eBC). Due to limited access to genomic assays in Brazil, treatment decisions remain largely driven by traditional clinicopathologic risk factors. ODX has been reported to be cost-effective in different health system, but limited data are available considering the reality of middle-income countries such as Brazil. We aim to evaluate the cost-effectiveness of ODX across strata of clinical risk groups using data from a dataset of patients from Brazilian institutions. Methods: Clinicopathologic and ODX information were analyzed for patients with T1-T3, N0-N1, HR+/HER2- eBC who had an ODX performed between 2005 and 2020. Projections of CT indication by clinicopathologic criteria were based on binary clinical risk categorization based on the Adjuvant! Algorithm. The ODX score was correlated with the indication of CT according to TAILORx and RxPONDER data. Two decision-tree models were developed. In the first model, low and high clinical risk patients were included while in the second, only high clinical risk patients were included. The cost for ODX and CT was based on the Brazilian private medicine perspective. Results: In all, 645 patients were analyzed; 411 patients (63.7%) had low clinical risk and 234 patients (36.3%) had high clinical risk disease. The ODX indicated low (<11), intermediate (11-25), and high (>25) risk in 119 (18.4%), 415 (64.3%), and 111 (17.2%) patients, respectively. Among 645 patients analyzed in the first model, ODX was effective (5.6% reduction in CT indication) though with an incremental cost of United States Dollar (US$) 2288.87 per patient. Among 234 patients analyzed in the second model (high clinical risk only), ODX led to a 57.7% reduction in CT indication and reduced costs by US$ 4350.66 per patient. Conclusions: Our study suggests that ODX is cost-saving for patients with high clinical risk HR+/HER2- eBC and cost-attractive for the overall population in the Brazilian private medicine perspective. Its incorporation into routine practice should be strongly considered by healthcare providers.

Moderately hypofractionated radiation therapy for breast cancer: A Brazilian cohort study.

Background: Results from numerous clinical trials have led to a consensus that moderately hypofractionated radiation therapy is the ideal postoperative irradiation treatment plan in patients with breast cancer (BC). However, there are specific situations such as chest wall (with or without breast reconstruction) and regional node irradiation that still face obstacles in its widespread use. There is a lack of evidence supporting the use of moderately hypofractionated irradiation from the Latin American context. This study aims to describe the profile and clinical outcomes of patients treated with moderate hypofractionation for both early-stage (Stage I and II) and locally advanced BC (Stage III) regardless of the type of surgery in a Brazilian Oncology Center. Methods: All patients with non-metastatic BC who were treated with moderately hypofractionated schedules of 40Gy in 15 fractions or 42.4Gy in 16 fractions between 2010 to 2019 at Hospital Sírio-Libanês, Brazil were retrospectively analyzed. The rates of local recurrence-free survival (LRFS), regional recurrence-free survival (RRFS), distance recurrence-free survival (DRFS) and overall survival (OS) were estimated. Acute and late toxicity profiles were accessed for the entire cohort. Findings: A total of 670 patients were included. The median age was 57 years and the median follow-up time was 31 months. Most of the patients had stage I and II breast cancer, and 81.6% underwent breast-conserving surgery. Of the 123 women who underwent mastectomy treatment, 29% (n = 37) had immediate reconstruction with implants and 28% (n = 35) with autologous tissue. Seventy-one per cent of the patients presented luminal subtype tumour and 84.3% received adjuvant hormonal therapy. Chemotherapy was administered to almost half of the patients and all 80 patients with Her-2 positive disease received trastuzumab-based systemic therapy. One-third of patients received regional node irradiation; boost was performed in 41.1% of treatments. The 5-year LRFS, RRFS, DRFS and OS was 95.6%, 97.6%,92.2% and 95.9%, respectively. Acute and late side effects profile were mild and only 2.9% of patients developed grade 3 dermatitis. Among patients with breast implants, 11.4% had capsular contracture. Interpretation: In this Brazilian institution experience, moderately hypofractionated irradiation to the breast, chest wall (with or without breast reconstruction), and regional lymph nodes was safe and with an acceptable toxicity profile. Funding: None.

Identification of docosahexaenoic and eicosapentaenoic acids multiple targets facing periodontopathogens.

The eicosapentaenoic (EPA) and docosahexaenoic acid (DHA) play a substantial role in Periodontal Disease (PD) due to their antimicrobial and immunomodulatory actions. However, their antimicrobial mechanism of action against bacteria involved in PD remains unclear. We aimed to estimate the probable targets of EPA and DHA against the seven periodontopathogens. Through in silico analyses, the protein-acids interactions, protein characterization, and molecular docking were performed. We identified 165 proteins from periodontopathogens that may interact with EPA and DHA. Fusobacterium nucleatum has the highest number of predicted proteins among analyzed bacteria (n = 43, 26.06%). The EPA shows more interactions than DHA. The EPA and DHA interact mainly with proteins involved in the metabolism (n = 69, 41.81%). Also, the EPA and DHA interact with proteins located in any subcellular location. The affinities between acids and pathogenic proteins were moderate (binding energy was lower than -4.0 kcal/mol). The interactions between EPA and DHA and periodontopathogens occur in multiples proteins. There is not a predilection about the functional class of pathogenic proteins targeting EPA and DHA. However, there are moderate binding affinities between EPA or DHA and essential pathogenic proteins (TolC, CRISPR, FusA).

Stressors in Indoor and Field Brazilian Soccer: Are They Perceived as a Distress or Eustress?

Soccer players inescapably live under stress during the sportive career, and many real-life aspects of soccer situations operate in the ongoing performance. This study's main objective was to elaborate the List of Stressors in Professional Indoor and Field Soccer, a self-report instrument designed to measure the impact of 77 soccer situations upon the sport performance. Participants were 138 indoor and field soccer players from the Brazilian Premier League. Each situation was evaluated on a 7-point scale, ranging from the most negative (-3) to the most positive (+3). Data were analyzed according to the players' perception of the items: distress or eustress and its intensity, and after that, situations perceived as plus -1 and +1 were compared by time in which they were experienced and distributed among five categories established by the literature: Expectations about the Performance, Personal Factors, Competition Aspects, Training Demands, and Relationship with Significant People. Narratives of athletes' experiences were also used to discuss the results. An Exploratory Structural Equation Modeling using Bi-factorial (BI-ESEM) was employed to assess the factor structure. For the total participants, 49 situations were perceived as distress and 28 as eustress. Using the criteria established a priori, the distribution was among the five categories in the remaining 32 situations. Differences in perception between less and more experienced players were found in 11 situations. The results revealed that Brazilian professional soccer players experience various stressful situations. These events are important representations of environmental demands and could predict the performance as they are perceived as eustress or distress. Some of these stressful situations are inherent in sport and others adjacent to the sports system or environment. Coach pressure to win and conflicts with teammates are examples of stressors in-sport, family problems and disputes with press or fans are examples of stressors external to the team, also called peripheral opponents, and showed the relative social influence of significant others in soccer performance. We can conclude that the knowledge of the direction of a given stress situation has important practical implications in preparing athletes and helping them face the performance stressors that are part of soccer daily life.

Lateral septum microglial changes and behavioral abnormalities of mice exposed to valproic acid during the prenatal period.

Most animal model studies of autism spectrum disorder (ASD) have been performed in males, which may be a reflex of the 3-times higher prevalence in boys than in girls. For this reason, little is known about the mechanisms underlying disease progression in females, and nothing is known about potential associations between microglial changes in the lateral septum (LS) and adult female cognition. Prenatal exposure to valproic acid (VPA) in mice has been widely used as an experimental model of autism-like behaviors associated with cellular changes. However, no study has reported the influence of VPA exposure in utero and its consequences on limbic system-dependent tasks or the microglial response in the LS in adult female mice. We compared the exploratory activity and risk assessment in novel environments of BALB/c control mice to mice exposed in utero to VPA and estimated the total number of microglia in the LS using an optical fractionator. On day 12.5 of pregnancy, females received diluted VPA or saline by gavage. After weaning, VPA exposed or control pups were separately housed in standard laboratory cages. At 5 months of age, all mice underwent behavioral testing and their brain sections were immunolabelled using IBA-1 antibody. In the open field test, VPA group showed a greater distance traveled, which was accompanied by less immobility, less time spent on the periphery and a greater number, crossed lines. Similar findings were found in the elevated plus maze test, where VPA mice traveled greater distances, immobility was significantly higher than that of control and VPA group spent less time on the closed arms of apparatus. Stereological analysis demonstrated higher microglial total number and density in the LS of VPA mice, as the cell count was greater, but the volume was similar. Therefore, we suggest that an increase in microglia in the LS may be part of the cellular changes associated with behavioral dysfunction in the VPA model of ASD.

Estresse gerencial: análise de conceito na perspectiva evolucionária de Rodgers / Managerial stress according to rodgers' evolutionary concept analysis / Estrés gerencial: análisis de concepto en la perspectiva evolutiva de Rodgers

Objetivo: analisar o conceito estresse gerencial na perspectiva evolucionária de Rodgers. Método: estudo descritivo de abordagem mista, cuja fonte da coleta de dados foi o Banco de Teses e Dissertações da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES). A busca foi realizada em maio de 2017, através do descritor "Estresse Ocupacional". Foram incluídas produções brasileiras disponíveis na íntegra. Os dados quantitativos foram analisados a partir de estatística descritiva simples, e a variável qualitativa através da análise de similitude com suporte do IRAMUTEQ. Resultados: a amostra final contou com 12 estudos. Na análise conceitual foram encontrados os seguintes vocábulos: estresse ocupacional, indivíduo, ambiente, saúde e físico. Conclusão: conceituou-se estresse gerencial como um conjunto de fatores organizacionais e interpessoaisno local de trabalho, que causam o desgaste fisiológico e psicológico do trabalhador, o que afeta a saúde doindivíduo, assim como reflete diretamente na instituição

Objective: to analyze the concept of managerial stress in Rodgers' evolutionary perspective. Method: descriptive study of mixed approach, whose source of data collection was the Bank of Theses and Dissertations of the Coordination of Improvement of Higher Education Personnel (CAPES). The search was carried out in May of 2017, through the descriptor "Occupational Stress". Brazilian productions available in full were included. The quantitative data were analyzed from simple descriptive statistics, and the qualitative variable through the similarity analysis with IRAMUTEQ support. Results: the final sample had 12 studies. In the conceptual analysis were found the following words: occupational stress, individual, environment, health and physical. Conclusion: management stress was defined as a set of organizational and interpersonal factors in the workplace, which cause the physiological and psychological erosion of the worker, which affects the health of the individual, as well as reflects directly in the institution

Objetivo: analizar el concepto de estrés gerencial en la perspectiva evolutiva de Rodgers. Método: estudio descriptivo de enfoque mixto, cuya fuente de recolección de datos fue el Banco de Tesis y Disertaciones de la Coordinación de Perfeccionamiento de Personal de Nivel Superior (CAPES). La investigación se realizó en mayo de 2017, a través del descriptor "estrés ocupacional". Las producciones brasileñas disponibles en su totalidad se incluyeron. Los datos cuantitativos se analizaron a partir de estadística descriptiva simples y la variable cualitativa a través del análisis de la similitud con soporte del IRAMUTEQ. Resultados: la muestra final contó con 12 estudios. En el análisis conceptual se encontraron los siguientes vocablos: estrés ocupacional, individuo, ambiente, salud y físico. Conclusión: estrés gerencial fue concebido como un conjunto de factores organizacional e interpersonales en el lugar de trabajo, que causan el desgaste fisiológico y psicológico del trabajador

A curriculum for behaviour and oral healthcare management for dentally anxious children-Recommendations from the Children Experiencing Dental Anxiety: Collaboration on Research and Education (CEDACORE).

BACKGROUND: Dentists need training in the management of children's anxiety (DA), fear (DF) and behaviour management problems (DBMP) but little is known of their competence on this topic. AIM: To report dentists' opinions and attitudes about protective stabilisation and pharmacological techniques for the management of children with DA/DF/DBMP; to propose a postgraduate curriculum focussing on DA/DF/DBMP. DESIGN: A survey of 301 Brazilian dentists and later a modified Delphi process to outline the curriculum in two phases: (a) face-to-face discussions with 33 early career researchers mentored by six researchers, both from UK and Brazil; (b) online discussions by eight early and senior researchers on the knowledge, experience, and competencies necessary for a specialist in paediatric dentistry in Brazil that should be included in the core curriculum of postgraduate courses. RESULTS: Almost all (99.0%) of the survey respondents provide treatment to children with DA/DF/DBMP, and 91.2% do not systematically diagnose these conditions; 94.3% use protective stabilisation, and 20.0%-30.0% have training in pharmacological techniques. The four-domain framework supporting the proposed curriculum is as follows: DA/DF/DBMP assessment, non-pharmacological and pharmacological approaches, and decision-making. CONCLUSION: Dental curricula should be customised to solve the misconceptions and promote a comprehensive and positive attitude to DA/DF/DBMP by paediatric oral healthcare practitioners.

Percepções de gestores de um hospital universitário sobre a qualidade em saúde / Percepciones de los gerentes de un hospital universitario sobre la calidad de la salud / Perceptions of the managers of a university hospital about quality in health

Objetivo: descrever as percepções de gestores de um hospital universitário sobre a qualidade em saúde. Método: trata-se de estudo do tipo descritivo, com abordagem qualitativa, realizado em hospital universitário do Nordeste do Brasil. A população de estudo foi composta por 60 gestores. Os dados foram coletados entre 2017 e 2018, a partir de entrevista semiestruturada. Realizou-se análise textual lexicográfica com suporte do software IRaMuTeQ. Resultados: foram analisados 593 segmentos de texto com elucidação das classes: "Influência do modelo de gestão", "Ferramentas de gestão da qualidade", "Concepções de qualidade em saúde" e "Ações de promoção em saúde". Os gestores compreendiam que o modelo de gestão adotado influencia na assistência e, consequentemente, na qualidade do atendimento. Conclusão: verificou-se que os gestores relacionaram a qualidade à resolutividade do atendimento aos usuários, bem como a um bom relacionamento entre profissionais e à consequente melhoria no processo de trabalho.

Objective: to describe the perceptions of managers of a university hospital about quality in health. Method: this is a descriptive study, with a qualitative approach, carried out in a university hospital in Northeast Brazil. The study population was composed of 60 managers. Data were collected between 2017 and 2018, based on a semi-structured interview. Lexicographic textual analysis was performed with the support of the IRaMuTeQ software. Results: 593 text segments were analyzed and classified in the following categories: "Influence of the management model", "Quality management tools", "Conceptions of quality in health" and "Health promotion actions". The managers understood that the management model adopted influences care, and, consequently, its quality. Conclusion: it was found that managers related quality to the problem-solving service provided to users, as well as to a good relationship between professionals and the consequent improvement in the work process.

Objetivo: describir las percepciones de los gerentes de un hospital universitario sobre la calidad de la salud. Método: estudio descriptivo, con enfoque cualitativo, realizado en un hospital universitario en el noreste de Brasil. La población del estudio consistió en 60 gerentes. Los datos se recopilaron entre 2017 y 2018, a partir de entrevistas semiestructuradas. El análisis textual lexicográfico se realizó con el apoyo del software IRaMuTeQ. Resultados: se analizaron 593 segmentos de texto con las clases: "Influencia del modelo de gestión", "Herramientas de gestión de calidad", "Concepciones de calidad en salud" y "Acciones de promoción de la salud". Los gerentes entendieron que el modelo de gestión adoptado influye en la atención y, en consecuencia, en la calidad de la atención. Conclusión: se encontró que los gerentes relacionan la calidad con la capacidad de resolución de problemas de atención a los usuarios, así como con una buena relación entre los profesionales y la consiguiente mejora en el proceso de trabajo.

How Do Observational Scales Correlate the Ratings of Children's Behavior during Pediatric Procedural Sedation?

Background. There is little information regarding the ability of observational scales to properly assess children's behavior during procedural sedation. Aim. To evaluate the characteristics of the Houpt scales, the Ohio State University Behavioral Rating Scale (OSUBRS) and the Venham Behavior Rating Scale when applied to preschool children undergoing conscious dental sedation. Design. This study included 27 children, 4-6 years old with early childhood caries that participated in a clinical trial (NCT02284204) that investigated two sedative regimes using oral midazolam/ketamine. Dental appointments were video-recorded; five calibrated observers assessed 1,209 minutes of video recording to score the children's behavior, following the instructions of the investigated scales. Data were analyzed by descriptive analysis and Spearman correlation tests (P < 0.05). Results. The Houpt overall behavior and the Venham scale were highly correlated (rho = -0.87; P < 0.001). OSUBRS scores were better correlated with Houpt overall behavior and Venham ratings, when compared to Houpt scores in the categories for movement and crying. Conclusions. The Houpt overall behavior and the Venham scores are global scales that properly measure children's behavior during dental sedation. Continuous assessment with OSUBRS through videos has a chance to give more precise data, while the Houpt categories can easily demonstrate children's behavior during procedures.

Tratamentos estéticos e cuidados dos cabelos: uma visão médica (parte 2) / Hair care: a medical overview (part 2)

Neste artigo, os autores complementam o primeiro trabalho sobre a pesquisa dermatológica dos tratamentos estéticos capilares. O alisamento capilar defi nitivo com os principais alisantes legalizados ­ hidróxidos de sódio e lítio, hidróxido de guanidina e tioglicolato de amônio ­, suas diferenças, mecanismos de ação, indicações e segurança para a saúde são aqui abordados. O artigo ainda discute sobre o uso ilegal e indiscriminado de produtos do grupo dos aldeídos (formaldeído e glutaraldeído) nos salões de cabeleireiro no Brasil, suas implicações legais e em saúde pública, sua carcinogenicidade e a identifi cação dos referidos registros junto à ANVISA. Também são estudados os xampus e agentes condicionadores indicados para tratamento da haste capilar. Ao fi nal, são discutidas as implicações dos tratamentos capilares em geral, para a saúde do fi o e do couro cabeludo.

The authors complement the fi rst article on the approach of dermatological aesthetic hair treatments. This article addresses the ultimate hair straightening with major straightening legalized ­ sodium, lithium and guanidine hydroxides and ammonium thioglycolate ­, their differences, mechanisms of action, indications and safety to human health. Besides these straighteners, we discuss the illegal and indiscriminate use of hairdressers salons in Brazil in the group of aldehydes (formaldehyde and glutaraldehyde) for smoothing hair. This study focuses its legal implications and public health, carcinogenic potencial and the identifi cation of such fi lings with ANVISA. Also studied the shampoos and conditioning agents indicated for treatment of the hair shaft. Finally, we discuss the implications of hair care in general health of the hair shaft and the scalp.

Tratamentos estéticos e cuidados dos cabelos: uma visão médica (parte 1) / Hair care: a medical overview (part 1)

Dúvidas sobre a ação dos cosméticos capilares sobre a saúde do corpo e dos cabelos são cada vez mais frequentes nas consultas dermatológicas. Os médicos dermatologistas necessitam enriquecer o conhecimento a respeito, não somente, das doenças do couro cabeludo, como também das interações moleculares dos cosméticos usados na fibra capilar, incluindo a influência de tais produtos quando absorvidos pelo epitélio do couro cabeludo. A cada dia, aumentam as consultas médicas para esclarecimento de quais técnicas e produtos químicos são mais indicados para permitir que os cabelos sofram as alterações desejadas de seu aspecto natural e, ao mesmo tempo, mantenhamse saudáveis e belos. Neste artigo, dividido em duas partes, abordamos a fisiologia dos cabelos, sua estrutura e natureza química, os agentes usados para seu alisamento, sua coloração, higiene e seu tratamento estético e as consequências que tais procedimentos podem ter na saúde em geral, incluindo sua segurança no uso durante a gravidez e lactação.

Doubts concerning the action of hair cosmetics and the health of both body and hair are very frequent in the dermatological visits. Dermatologists need no only to enrich the knowledge of scalp diseases but also of molecular interactions of cosmetics used in hair fi ber, including the infl uence of such products when absorbed by the epithelium of the scalp. The amount of medical visits increases every day to fi nd out which techniques and chemical products are best indicated to enable the desired changes in hair from its natural appearance and, at the same time, to keep the hair healthy and beautiful. In this article, divided in two parts, we discuss the hair physiology, structure and chemical nature, as well as the agents used for its smoothing, coloring, hygiene and cosmetic treatment, and the consequences that such procedures can have on overall health, including their use safety during pregnancy and lactation.

Dermoscopy findings of alopecia areata in an African-American patient.

BACKGROUND: Dermoscopy has been established as an indispensable tool in the diagnosis and follow up of hair disorders. In alopecia areata, dermoscopy of active disease shows yellow dots, dystrophic hairs, as well as cadaverized (black dots) and exclamation mark hairs. Alopecia areata has been reported to occur equally among races, however, until date, there are no published data regarding dermoscopic findings in African-American patient. MAIN OBSERVATION: We report a case of scalp dermoscopy of alopecia areata in an African-American patient that shows a diffuse honeycomb-like pigmented network, few yellow dots and white dots. CONCLUSION: This case shows that skin color may affect dermoscopic findings in alopecia areata. In our African-American patient with alopecia areata dermoscopy showed a diffuse honeycomb-like pigmented network, which was previously considered characteristic for androgenic alopecia and white dots, which were considered characteristic for cicatricial alopecia. Further studies are needed to elucidate the presence of white dots in alopecia areata.

The use of monoclonal antibody (rituximab) in the treatment of type II mixed cryoglobulinemia.

Anti-CD20 monoclonal antibody has been successfully used to treat several self-immune diseases. The authors report the case of a 71 year-old female patient under the use of pegylated form of interferon á associated with ribavirin for the treatment of hepatitis C, who, after concluding the therapeutic program - negative Polymerase Chain Reaction (PCR) - developed a severe cutaneous vasculitis, receiving the diagnostic of type II mixed cryoglobulinemia. Four sessions of plasmapheresis were prescribed along the period of 11 days, with no result. The choice made was to administer anti-CD 20 monoclonal antibody (rituximab), 375 mg/m(2), per week, during four consecutive weeks. One could observe fast recovery from the purpura, as well as total remission of urticaria.

The use of monoclonal antibody (Rituximab) in the treatment of type II mixed cryoglobulinemia

Anti-CD20 monoclonal antibody has been successfully used to treat several self-immune diseases. The authors report the case of a 71 year-old female patient under the use of pegylated form of interferon á associated with ribavirin for the treatment of hepatitis C, who, after concluding the therapeutic program - negative Polymerase Chain Reaction (PCR) - developed a severe cutaneous vasculitis, receiving the diagnostic of type II mixed cryoglobulinemia. Four sessions of plasmapheresis were prescribed along the period of 11 days, with no result. The choice made was to administer anti-CD 20 monoclonal antibody (rituximab), 375 mg/m², per week, during four consecutive weeks. One could observe fast recovery from the purpura, as well as total remission of urticaria.