Marjolin ulcer: the importance of early diagnosis and excision / Úlcera de Marjolin: a importância do diagnóstico e excisão precoces

Introduction: Marjolin's ulcer is a rare disease characterized by the malignancy of chronic wounds that present healing disorders, often due to chronic irritation and repetitive trauma in this area. The diagnosis is made mainly through clinical history and histopathological examination. The differential diagnoses of other diseases that course with ulcers must always be researched and ruled out. Method: The present work presents a bibliographic review to elucidate the subject's relevance for medical students, physicians and nurses, to assist in early diagnosis. Results: Nine observational studies were selected to compose the discussion. Conclusion: The most effective treatment for this condition is surgery, and lymph node dissection is suggested in some cases. Chemotherapy has not shown satisfactory results, while radiotherapy is used in selected cases. Given the rapid evolution, tissue damage, and worse prognosis, diagnosis, and excision should be performed early for a better clinical outcome.

Introdução: A úlcera de Marjolin é uma doença rara, caracterizada pela malignização de feridas crônicas que apresentaram distúrbios cicatriciais, muitas vezes devido à irritação crônica e a traumas repetitivos nesta área. O diagnóstico é realizado sobretudo através da história clínica e de exame histopatológico. Os diagnósticos diferenciais de outras doenças que cursam com úlceras devem sempre ser pesquisados e afastados. Método: O presente trabalho apresenta uma revisão bibliográfica, a fim de elucidar a relevância do tema para acadêmicos de medicina, médicos e enfermeiros, com o propósito de auxiliar no diagnóstico precoce. Resultados: Foram selecionados 9 estudos observacionais para compor a discussão. Conclusão: O tratamento mais eficaz desta condição é o cirúrgico, e o esvaziamento linfonodal é sugerido em alguns casos. A quimioterapia não demonstrou resultados satisfatórios, enquanto a radioterapia é utilizada em casos selecionados. O diagnóstico e a excisão devem ser feitos precocemente para melhor desfecho clínico, visto a rapidez da evolução, o prejuízo tecidual e pior prognóstico.

Análise da qualidade de vida de idosos com doença de Parkinson vinculados a um programa de atenção à saúde / Analysis of quality of life of elderly people with Parkinson's disease linked to a health care program

Introdução: do ponto de vista clínico, são muitos os elementos para a deterioração da qualidade de vida (QV) na Doença de Parkinson (DP). Objetivo: analisar a QV de idosos com DP vinculados a um programa de atenção à saúde do idoso. Metodologia: estudo transversal com 11 idosos com DP. A QV foi avaliada por meio do Parkinson's Disease Questionary-39, a incapacidade através da Escala de Hoehn e Yahr modificada (HY). As partes I (estado mental), II (atividades da vida diária), III (motricidade) e IV (complicações da terapia) da Escala Unificada de Avaliação da Doença de Parkinson (UPDRS); o tempo de doença e o gênero foram considerados para análise. Resultados: a percepção da QV foi pior no domínio mobilidade e melhor no domínio estigma. Não houve diferença na QV entre os sexos. O tempo de doença influenciou a QV referente à comunicação nos homens (p = 0,02). Houve correlação (moderada a forte) entre a QV domínio cognição com a UPDRS IV (p = 0,04). As mulheres apresentaram correlação entre a QV domínio mobilidade e a HY (p = 0,05) e a III (p = 0,04) e entre a QV domínio atividade de vida diária e a HY (p = 0,02), II (p = 0,01) e III (p = 0,01); os homens entre a QV domínio suporte social e a II (p = 0,01). Conclusão: a percepção da QV de idosos com DP vinculados a um programa de saúde foi similar entre os sexos e permeia as funções corpóreas e atividades do dia-a-dia.

Introduction: from a clinical point of view, there are many elements for the deterioration of quality of life (QoL) in Parkinson's disease (PD). Objective: analyze the QoL of elderly people with PD linked to an elderly health care program. Methodology: cross-sectional study with 11 elderly people with PD. QoL was assessed using the Parkinson's Disease Questionary-39, disability using the Modified Hoehn and Yahr Scale (HY). Parts I (mental status), II (activities of daily living), III (motor skills) and IV (therapy complications) of the Unified Parkinson's Disease Assessment Scale (UPDRS); disease duration and gender were considered for analysis. Results: The perception of QoL was worse in the mobility domain and better in the stigma domain. There was no difference in QoL between genders. The time of illness influenced the Qol regarding communucation in men (p = 0.02). There was correlation (moderate to strong) between QoL cognition domain with UPDRS IV (p = 0.04). Womem showed correlations between QoL mobility domain and HY (p = 0.05) and III (p = 0.04) and between QOL domain activity of daily living and HY (p = 0.02), II (p = 0.01) and III (p = 0.01); men between QoL social support domain and II (p = 0.01). Conclusion: Perception of the QoL of elderly people with PD linked to a health program was similar between genders and permeates bodily functions, day-to-day activities.

Toxicity in vitro and in Zebrafish Embryonic Development of Gold Nanoparticles Biosynthesized Using Cystoseira Macroalgae Extracts.

INTRODUCTION: Research on gold nanoparticles (AuNPs) occupies a prominent place in the field of biomedicine nowadays, being their putative toxicity and bioactivity areas of major concern. The green synthesis of metallic nanoparticles using extracts from marine organisms allows the avoidance of hazardous production steps while maintaining features of interest, thus enabling the exploitation of their promising bioactivity. OBJECTIVE: To synthesize and characterize AuNPs using, for the first time, macroalga Cystoseira tamariscifolia aqueous extract (Au@CT). METHODS: Algal aqueous extracts were used for the synthesis of AuNPs, which were characterized using a wide panel of physicochemical techniques and biological assays. RESULTS: The characterization by UV-Vis spectroscopy, transmission electron microscopy, Z-potential and infrared spectroscopy confirmed that Au@CT were stable, spherical and polycrystalline, with a mean diameter of 7.6 ± 2.2 nm. The antioxidant capacity of the extract, prior to and after synthesis, was analyzed in vitro, showing that the high antioxidant potential was not lost during the synthesis. Subsequently, in vitro and in vivo toxicity was screened, by comparing two species of the genus Cystoseira (C. tamariscifolia and C. baccata) and the corresponding biosynthesized gold nanoparticles (Au@CT and Au@CB). Cytotoxicity was tested in mouse (L929) and human (BJ5ta) fibroblast cell lines. In both cases, only the highest (nominal) test concentration of both extracts (31.25 mg/mL) or Au@CB (12.5 mM) significantly affected cell viability, as measured by the MTT assay. These results were corroborated by a Fish Embryo Acute Toxicity (FET) test. Briefly, it was shown that, at the highest (nominal) tested concentration (31.25 mg/mL), CT extract induced significantly higher cytotoxicity and embryotoxicity than CB extract. However, it was demonstrated that Au@CT, but not Au@CB, were generally non-toxic. At sub-lethal (nominal) test concentrations (1.25 and 2.5 mM), Au@CT affected zebrafish embryonic development to a much lesser extent than Au@CB. In vitro wound healing assays also revealed that, while other experimental conditions did not impact cell migration, CT and Au@CT displayed a moderate positive effect. CONCLUSION: Au@CT and Au@CB display promising features, desirable for biomedical applications, as wound healing.

Novel concept of exosome-like liposomes for the treatment of Alzheimer's disease.

Exosomes are cell-derived vesicles that act as carriers for proteins and nucleic acids, with therapeutic potential and high biocompatibility. We propose a new concept of exosome-like liposomes for controlled delivery. The goal of this work was to develop a new type of liposomes with a unique mixture of phospholipids, similar to naturally occurring exosomes but overcoming their limitations of heterogeneity and low productivity, for therapeutic delivery of bioactive compounds. Curcumin was chosen as model compound, as it is a phytochemical molecule known to have antioxidant and anti-inflammatory properties, which can protect the brain against oxidative stress and reduce ß-amyloid accumulation, major hallmarks of Alzheimer's disease (AD). These new liposomes can efficiently encapsulate hydrophobic curcumin, yielding particles with a size smaller than 200 nm, and a polydispersity index lower than 0.20, which make them ideal for crossing the blood-brain barrier. These particles have a long shelf life, being stable up to 6 months. The curcumin encapsulation efficiency was higher than 85% (up to approximately 94%). Curcumin-loaded liposomes were not cytotoxic (up to 20 µM curcumin, and 200 µM of exo-liposomes), and significantly reduced oxidative stress induced in SH-SY5Y neuronal cells, indicating their potential for neuroprotection. They also do not show any toxicity and are internalized in zebrafish embryos, concentrating in lipid enriched areas, as the brain and the yolk sac. Such innovative carriers are a new effective approach to deliver drugs into the brain, as these are stable, protect the cargo and are uptaken by neuronal cells. Upon internalization, liposomes release the therapeutic biomolecules, resulting in successful neuroprotection, being a positive alternative strategy for AD therapy.

Diagnosis and treatment of mucocele in a pediatric patient: case report / Diagnóstico e tratamento de mucocele em paciente pediátrico: relato de caso

ABSTRACT Mucocele is a benign lesion, originating from disorders of minor salivary glands containing mucus. These lesions are found in children and young adults and usually occur due to local trauma. Clinically, it presents as a circumscribed, asymptomatic, soft and bluish or normocromic blister. The treatment of choice is surgical removal, when the lesion does not rupture naturally. This study aims to report a clinical case of mucocele in a pediatric patient removed through total surgical excision. A 7-year-old patient accompanied by mother sought care at the Dentistry Clinic of the "Tiradentes" University Center (UNIT / AL), with a main complaint of asymptomatic blister in the lower lip for about 15 days. In the anamnesis, the habit of biting in the region was reported. At clinical examination, a blister with clear limits of approximately 10 mm in diameter was observed in the lower lip mucosa, with slightly firm/fibrous consistency, which gave rise to doubts about the possible diagnosis, since it presented characteristics similar to that of a mucocele, although consistency at palpation indicates possible fibroma. Surgical excision of the lesion was performed; the material collected was fixed in 10% formalin and sent to histopathological examination that confirmed the diagnosis of mucocele. The patient was kept on follow-up, and there was no recurrence of the lesion. Surgical excision demonstrated an effective and prognostic therapeutic course, allowing accurate diagnosis through the histopathological evaluation of the lesion.

RESUMO Mucocele é uma lesão benigna, proveniente de desordens de glândulas salivares menores, que contém muco em seu interior. Essas lesões são encontradas em crianças e adultos jovens e ocorrem, geralmente, devido a um traumatismo local. Clinicamente apresenta-se como uma bolha circunscrita, assintomática, de consistência mole e cor azulada ou normocrômica. O tratamento de escolha é a remoção cirúrgica, quando a lesão não rompe naturalmente. Objetivo: Este trabalho tem como objetivo relatar um caso clínico de mucocele em paciente pediátrico removido por meio de excisão cirúrgica total. Relato de caso: Paciente acompanhado da mãe, 7 anos, procurou atendimento na Clínica de Odontologia do Centro Universitário Tiradentes (UNIT/AL), com queixa principal de aparecimento de bolha no lábio inferior, assintomática, cerca de 15 dias, na anamnese foi relatado o hábito de mordedura na região. Ao exame clínico foi observada uma bolha, com limites nítidos, de aproximadamente 10 mm de diâmetro, na mucosa do lábio inferior, de consistência levemente firme/fibrosa o que gerou dúvidas sobre o possível diagnóstico, pois apresentava características semelhantes à de uma mucocele apesar da consistência a palpação indicar um possível fibroma. Foi realizado a excisão cirúrgica da lesão, o material colhido foi fixado em formol a 10% e encaminhado para exame histopatológico que confirmou o diagnóstico de mucocele. O paciente foi mantido em acompanhamento, não havendo recorrência da lesão. Conclusão: A excisão cirúrgica demonstrou-se uma conduta terapêutica eficaz e com bom prognóstico, possibilitando um diagnóstico preciso através da avaliação histopatológica da lesão.

Label-free assay based on immobilized capillary enzyme reactor of Leishmania infantum nucleoside triphosphate diphosphohydrolase (LicNTPDase-2-ICER-LC/UV).

Nucleoside triphosphate diphosphohydrolase (NTPDase) is an enzyme belonging to the apyrase family that participates in the hydrolysis of the nucleosides di- and triphosphate to the corresponding nucleoside monophosphate. This enzyme underlies the virulence of parasites such as Leishmania. Recently, an NTPDase from Leishmania infantum (LicNTPDase-2) was cloned and expressed and has been considered as a new drug target for the treatment of leishmaniasis. With the intent of developing label-free online screening methodologies, LicNTPDase-2 was covalently immobilized onto a fused silica capillary tube in the present study to create an immobilized capillary enzyme reactor (ICER) based on LicNTPDase-2 (LicNTPDase-2-ICER). To perform the activity assays, a multidimensional chromatographic method was developed employing the LicNTPDase-2-ICER in the first dimension, and an analytical Ascentis C8 column was used in the second dimension to provide analytical separation of the substrates and products. The validated LicNTPDase-2-ICER method provided the following kinetic parameters of the immobilized enzyme: KM of 2.2 and 1.8mmolL(-1) for the ADP and ATP substrates, respectively. Suramin (1mmolL(-1)) was also shown to inhibit 32.9% of the enzymatic activity. The developed method is applicable to kinetic studies and enables the recognition of the ligands. Furthermore, a comparison of the values of LicNTPDase-2-ICER with those obtained with an LC method using free enzyme in solution showed that LicNTPDase-2-ICER-LC/UV was an accurate and reproducible method that enabled automated measurements for the rapid screening of ligands.

Razões alegadas por médicos recém-formados em Salvador/BA em 2010 para não prestarem o concurso de residência médica / Reasons alleged by recently graduated physicians at Salvador/BA in 2010 to not attend the residency entrance exam

JUSTIFICATIVA E OBJETIVOS: A residência médica é a mais importante forma de pós-graduação médica, composta de treinamento em serviço de maneira supervisionada. Este estudo teve por objetivo avaliar a frequência de médicos recém-formados de faculdades de Salvador/BA que não se submeteram ao concurso de residência médica no estado, e os motivos pelos quais optaram por não realizá-lo. MÉTODO: Inicialmente, a lista de candidatos do concurso unificado do Sistema Único de Saúde (SUS/BA) de dezembrode 2010 foi confrontada com as listas de formatura das três faculdades de Medicina de Salvador. Os recém-formados que não realizaram o concurso foram contatados e questionados: Qual o principal motivo que o levou a não fazer concurso para a residência do SUS-Bahia no ano passado? As respostas foram abertas, analisadas qualitativamente e categorizadas. RESULTADOS: Duzentos e oitenta e quatro (68,8%) dos recém-formados de Salvador/BA prestaram concurso, além de outros candidatos de outras cidades e estados. Cento e vinte nove (31,2%) recém-formados desta cidade não realizaram o concurso em 2010. Destes, 91 foram contatados e concordaram em participar do estudo. As respostas foram classificadas em cinco categorias distintas: motivo financeiro (41%), desinteresse pela residência local na especialidade de seu interesse (37%), necessidade de deslocamento (10%), despreparo para a prova (4%) e outros (8%). CONCLUSÃO: Percentual significativo de médicos recém-formados optou por não realizar a prova unificada de residência médica na Bahia, sendo o fator financeiro e o desinteresse, na especialidade de seu interesse, pela residência médica local os principais motivos relatados.

BACKGROUND AND OBJECTIVES: The residency program is the most important form of medical post-graduation, composed of in-service training under supervision. This study has the objective to assess the frequency of medical graduates from Salvador / BA who did not apply to medical residency exams, as well as their reasons. METHOD: Initially, we confronted the list of candidates for December 2010 unified residency admission exam with the graduation lists of the three medical schools in Salvador, Bahia. The graduates who did not attend the tests were contacted and asked: What was the main reason to not submit to the SUS-Bahia residency admission exams last year? The responses were discursive, analyzed qualitatively and categorized. RESULTS: Two hundred and eighty-four (68.8%) of graduates in Salvador / BA performed the exam, along with other candidates from other cities and states. One hundred and twenty-nine (31.2%) graduates did not perform the exam in 2010. Ninety-one were contacted and agreed to participate. Responses were classified into five categories: financial motive (41% of respondents), disinterest in local residency in the specialty of interest (37%), necessity to move to a differentcity (10%), feeling of unpreparedness for the test (4%) and others (8%). CONCLUSION: A significant percentage of medical graduates chose not to submit to the unified medical residency admission exam in Bahia, and the financial factor and desinterest in local residency programs in the specialty of interest were the main reasons reported.

Estudo de caso de disfagia: uma reabilitação bio-psíquica / Dysphagic case study: a bio-psychic rehabilitation

O objetivo da pesquisa foi demonstrar a relevância dos aspectos psíquicos na reabilitação fonoaudiológica dos transtornos de deglutição, entendendo porque sintomas disfágicos se tornaram recorrentes mesmo que, do ponto de vista orgânico-funcional, a pacientes não mais possuíssem alteração alimentar. Trata-se de pesquisa descritiva, realizada a partir de estudo de caso clínico de paciente atendida em domicílio acometida por Acidente Vascular Encefálico Isquêmico, que resultou em quadro de disfagia, parestesia e paresia facial à esquerda e alteração na expressão da linguagem e disatrofonia. O AVE fragilizou-a subjetivamente e dificultou as relações cotidianas. A abertura da escuta às angústias inerentes à situação permitiu, a partir da reabilitação orgânica, deslocamento para construção de um novo perfil subjetivo, mais satisfatório em relação às suas condições atuais de vida, o que demonstra a relevância de se considerar, na reabilitação das disfagias, o corpo não apenas por sua face orgânica, mas também nas esferas simbólica e afetiva.

Avaliação de percepção de fala em crianças com deficiência auditiva usuárias de aparelho de amplificação sonora: a questão do instrumento e seus critérios / Evaluation of speech perception in hearing impaired children: the question of instrument and its criteria

OBJETIVO: Comparar diferentes critérios de análise de erros em tarefas de reconhecimento de palavras em crianças com deficiência auditiva usuárias de aparelho de amplificação sonora individual, visando estabelecer seu potencial de utilização na clínica, particularmente nas relações entre percepção de fala e utilização de audição residual. MÉTODOS: Aplicação de listas para reconhecimento de palavras em sujeitos de 6 a 8 anos de idade, com deficiência auditiva e usuários de aparelho de amplificação sonora individual. As respostas foram analisadas por diferentes critérios a partir de dois instrumentos: WASP: acerto de palavras, de fonemas e padrão total de erro; Matriz de Confusão: substituições e omissões de fonemas. RESULTADOS: As relações entre os diferentes critérios de análise permitiram diferentes perspectivas na análise do desempenho das crianças no reconhecimento de palavras, levando a reflexões sobre a utilização do potencial auditivo das crianças e as implicações no processo terapêutico com ênfase na audição residual. CONCLUSÃO: Combinar diferentes critérios de análise dos erros permite ampliar o conhecimento das habilidades de percepção de fala dos sujeitos e, conseqüentemente, contribui para o estabelecimento de metas terapêuticas.

PURPOSE: To compare different error analysis criteria in words recognition tasks, in order to determine its potential for clinical utilization with hearing impaired children, particularly in the relations between speech perception and residual hearing. METHODS: Lists of words were presented to four hearing impaired children, with ages varying from six to eight years, who used hearing aids. The results were analyzed using different criteria, based on two different instruments: WASP: percentage of correct words, phonemes and total error pattern; Confusion Matrix: substitutions and omission of phonemes. RESULTS: The analysis including criteria of both instruments allowed for considerations on use of residual hearing and the influence of intervention on each child's performance. CONCLUSION: The combination of different criteria for error analysis allows greater knowledge about speech perception abilities of the subjects and, consequently, provides greater specificity in clinical techniques in aural rehabilitation.

Avaliação de linguagem e de deglutição de pacientes hospitalizados após acidente vascular cerebral / Language and swallowing evaluation of hospitalized pacients after stroke

Objetiva realizar avaliação clínica de linguagem e de deglutição em idosos hospitalizados após AVC e elaborar propostas terapêuticas para as alterações identificadas. Foram avaliados 14 pacientes, de ambos os sexos, com idade entre 48 e 84 anos