Identidade do homem resiliente no contexto de adoecer por câncer de próstata: uma perspectiva cultural / Identity of the resilient man in the context of ill with prostate cancer: a cultural perspective / Identidad del hombre resiliente en el contexto al enfermar por cáncer de próstata: una perspectiva cultural

O estudo objetivou conhecer o contexto do homem resiliente ao adoecer por câncer de próstata. Trata-se de um estudo de caso etnográfico realizado com dois homens sobreviventes ao câncer de próstata, com alto grau de resiliência. Os dados foram coletados no domicílio, no período de abril e maio de 2012, por meio da entrevista semiestruturada em profundidade, de observação participante e do ecomapa. Pela análise dos dados construíram-se duas unidades de sentido: "Identidade do homem resiliente: contextualizando os informantes" e "O homem resiliente descobrindo-se doente". Apreende-se que a identidade de ser homem resiliente, para estes informantes, foi marcada pela diferença histórica e cultural que permeou as suas ações, no processo de adoecimento por câncer de próstata. Considera-se importante que os enfermeiros atentem para os aspectos culturais da saúde do homem, para que este possa sentir-se parte integrante do processo de cura, tornando-se sujeito ativo frente à própria saúde.

The study aimed to understand the context of resilient man when ill with prostate cancer. This is an ethnographic case study conducted with two prostate cancer survival men with a high degree of resilience. The data was collected on their places, in 2012 April and May, using semi-structured in-depth interviews, participant observation and ecomap. For the data analysis, it was built two units of meaning: "Identity of the resilient man: contextualizing the informants" and "The resilient man finding himself ill". It was noticed that the identity of being a resilient man, to these informants, was marked by historical and cultural difference which permeated their actions in the process of being ill with prostate cancer. It is important that nurses pay attention to the cultural aspects of human health, so that they can feel part of the healing process, becoming an active subject facing their own health.

El estudio enfocó conocer el contexto del hombre resiliente al enfermar por cáncer de próstata. Se trata de un estudio de caso etnográfico realizado con dos hombres sobrevivientes al cáncer de próstata con alto grado de resiliencia. Los datos fueron recogidos en el domicilio, en el período de abril y mayo de 2012, por medio de entrevista semiestructurada en profundidad, observación participante y ecomapa. Por el análisis de los datos, se construyeron dos unidades de sentido: "Identidad del hombre resiliente: contextualizando a los informantes" y "El hombre resiliente descubriéndose enfermo". Se comprende que la identidad de ser hombre resiliente, para estos informantes, fue marcada por la diferencia histórica y cultural que hicieron permeables sus acciones en el proceso de enfermar por cáncer de próstata. Se considera importante que los enfermeros estén atentos a los aspectos culturales de la salud del hombre, para que este se pueda sentir parte integrante del proceso de cura, tornándose sujeto activo frente a la propia salud.

Allergic and photoallergic contact dermatitis from ketoprofen: evaluation of cross-reactivities by a combination of photopatch testing and computerized conformational analysis.

Allergic contact dermatitis (ACD) and photo-ACD are cell-mediated delayed hypersensitivity reactions of the skin caused by a wide range of substances. Topical ketoprofen (KP), a nonsteroidal anti-inflammatory drug (NSAID), can induce ACD and photo-ACD. Patients with ACD and/or photo-ACD to KP frequently show concomitant sensitization to other substances. The aim of this study was to identify the substances most frequently associated with sensitization to KP, and to evaluate, by means of computerized conformational analysis, whether this association could be due to cross-allergy. 15 subjects with ACD and photo-ACD to KP were tested with the SIDAPA (Società Italiana di Dermatologia Allergologica Professionale ed Ambientale) patch test standard series, including fragrance mix and its components (eugenol, isoeugenol, oak moss, geraniol, hydroxycitronellal, amylcinnamaldehyde, cinnamyl alcohol and cinnamaldehyde) and with the SIDAPA photopatch test series. Allergic reactions to cinnamyl alcohol were noted in all patients, whereas some patients also showed positive reactions to fenticlor, octocrylene and benzophenone-10. Computerized conformational analysis demonstrated that the structure of cinnamyl alcohol is similar to that of KP, whereas the structures of benzophenone-10, octocrylene and fenticlor are completely different. These results suggest that in patients with contact allergy to KP, concomitant positive reactions to cinnamyl alcohol are due to cross-sensitization, whereas simultaneous allergic reactions to fenticlor, octocrylene and benzophenone-10 should be regarded as co-sensitizations.

Mechanisms of drug-induced allergic contact dermatitis.

Allergic contact dermatitis is induced by a wide variety of drugs that trigger specific immune responses following topical exposure. Identified chemical structures involved in such reactions include the mercuric and thiosalicylic acid groups of thimerosal, the diphenylketone group of the anti-inflammatory drug ketoprofen, the amide or ester structure of local anesthetics, and the side-chain and thiazolidine ring of beta-lactams. The T cell responses to such compounds involve CD4+ and CD8+ alphabeta+ T lymphocytes and also CD4 /CD8 gammadelta+ T cells. Although "T helper 2" cytokine production by drug-specific human T cells from patients with allergic contact dermatitis has been described, T helper 1-like and T cytotoxic 1-like responses clearly play key roles in this cutaneous reaction.

Cross-reactions in patch testing and photopatch testing with ketoprofen, thiaprophenic acid, and cinnamic aldehyde.

In the last 7 years, we have studied 123 patients with allergic reactions to topical arylpropionic anti-inflammatory drugs. We have investigated the rate of sensitization and the irritant potential of one of them, ketoprofen, and its cross-reactivity with such other derivatives as ibuproxam, ibuprofen, naproxen, fenoprofen, flurbiprofen, and thiaprofenic acid. Sensitization was single in most cases, and ketoprofen was the drug most often involved. The combination most frequently found was ketoprofen plus ibuproxam. The most frequent cross-reactions were to fragrance mix, especially cinnamic aldehyde and balsam of Peru, both contact and photocontact sensitizers. Because there is a ketonic group in the molecule of ketoprofen and cinnamic aldehyde and after conversion of thiaprofenic acid, this could be the trigger for this particular allergy and cross-reactivity.

Rat serum albumin modified by diflunisal acyl glucuronide is immunogenic in rats.

Acyl glucuronide metabolites of carboxylic acid drugs such as the salicylate derivative diflunisal (DF) have been shown to react with proteins in vitro and in vivo to produce covalent adducts. Such attachment of foreign compounds to endogenous molecules could be associated with toxic and/or immune consequences. In this study we have injected rats with rat serum albumin (RSA) modified (a) by DF using a carbodiimide reagent (-->DF-RSA-I, 4.9 micrograms DF/mg RSA) and (b) by incubation with DF acyl glucuronide (DAG) and its rearrangement isomers (iso-DAG) (-->DF-RSA-II, 0.34 micrograms DF/mg RSA). All of the six rats injected with DF-RSA-I produced antibodies reactive with DF-modified keyhole limpet hemocyanin (KLH), the coating protein used in the ELISA. Three out of six animals injected with DF-RSA-II generated similar antibodies. Cross-reactivity with other non-steroidal anti-inflammatory drugs (NSAIDs) such as naproxen and ketoprofen (as the free drugs) was not observed. This study shows that a self protein covalently modified by incubation with DAG and iso-DAG is immunogenic in rats. The data thus support the hypothesis that covalent modification of macromolecules by acyl glucuronide metabolites of acidic drugs in vivo can lead to the production of circulating antibodies which may be involved in aberrant immune responses such as drug hypersensitivity.