Success in the use of oral propranolol in the treatment of infantile hemangioma in nasal tip - Report of two cases

Abstract Infantile hemangioma is the most common pediatric vascular tumor, with the following risk factors: low birth weight, prematurity, white skin, female gender, multiparity and advanced maternal age. The use of oral and topical beta-blockers, although recent, has emerged as the first line of treatment, with superior safety and efficacy to previously used therapies, such as corticosteroids and surgeries. This report describes two cases of nasal tip infantile hemangioma, treated with oral propranolol. Both presented excellent therapeutic responses.

Is there still a place for deep chemical peels in the treatment of perioral wrinkles?

Baker-Gordon formula phenol chemical peel remains the most effective and long-lasting treatment for deep facial lines. However, this treatment is associated with risk of serious complications, such as arrhythmias and dystrophic scars. With the emergence of new and safer technologies for facial rejuvenation, such as fractionated carbon dioxide (CO2) lasers and microneedling, there has been a decrease in the use of deep chemical peels. This raises the question of whether there is still a place for deep phenol chemical peels. In this sense, we present a successful case of using Baker-Gordon formula phenol chemical peel at the perioral region for treating advanced wrinkles. This technique is called "Regional Phenol Peeling" and is safer than the use of the formula applied to the entire face, since it does not need systemic monitoring.

Success in the use of oral propranolol in the treatment of infantile hemangioma in nasal tip - Report of two cases.

Infantile hemangioma is the most common pediatric vascular tumor, with the following risk factors: low birth weight, prematurity, white skin, female gender, multiparity and advanced maternal age. The use of oral and topical beta-blockers, although recent, has emerged as the first line of treatment, with superior safety and efficacy to previously used therapies, such as corticosteroids and surgeries. This report describes two cases of nasal tip infantile hemangioma, treated with oral propranolol. Both presented excellent therapeutic responses.

Escala de Avaliação das Percepções sobre o Programa Mais Médicos / Scale for Assessment of Beliefs about the Program More Doctors / Escala de Evaluación de las Percepciones sobre el Programa Más Médicos

A presente pesquisa objetivou criar um instrumento de avaliação da eficácia do Programa Mais Médicos (PMM), apreendendo as percepções de uma amostra não probabilística nacional estratificada de 643 brasileiros. Foi realizada análise fatorial na escala, e os dados de avaliação do PMM foram analisados por meio de estatística descritiva, bivariada e multivariada. Com indicação de melhores valores psicométricos e explicação teórica, o método Componentes Principais, com rotação varimax, estruturou os 35 itens da escala dicotômica em dois fatores, que explicam conjuntamente 56,92% da variância total: "Aspectos estruturais e organizacionais do Programa Mais Médicos" (α = 0,96) e "A atuação dos médicos no Programa Mais Médicos" (α = 0,74). Contempla-se, ainda, que a eficácia do PMM foi avaliada negativamente. Esses achados revelam que o instrumento é útil para avaliação do PMM, ainda escasso de instrumentos na literatura para sua avaliação, podendo ser adequadamente utilizada em estudos futuros.(AU)

This research aimed to create an instrument for assessing the effectiveness of the Programa Mais Médicos (PMM Program More Doctors), verifying the perceptions of a national non-probabilistic stratified sample of 643 Brazilians. Factor analysis was performed on the scale and the PMM assessment data were analyzed using descriptive, bivariate and multivariate statistics. The Principal Components method, indicating best psychometric values and theoretical explanation, with varimax rotation, structured the 35 items of dichotomous scale into 2 factors, which explain 56.92% of the total variance: "Structural and organizational aspects of the Programa Mais Médicos" (α = 0.96) and "The role of doctors in the Programa Mais Médicos" (α = 0.74). It is also contemplated that the effectiveness of PMM was negatively assessed. These findings reveal that the instrument is useful for evaluation of PMM, still short of instruments in the literature for its evaluation, and can be properly used in future studies.(AU)

Esta investigación tuvo como objetivo crear un instrumento de evaluación de la eficacia del PMM, (Programa Más Médicos) tomando las percepciones de una muestra no probabilística nacional estratificada de 643 brasileños. Fue realizado análisis factorial de la escala y los datos de evaluación del PMM fueron analizados por medio de estadística descriptiva, bivariada y multivariada. Indicando mejores valores psicométricos y explicación teórica, el método Componentes Principales, con rotación varimax, estructuró los 35 ítems de la escala dicotómica en 2 factores, que explican conjuntamente 56,92% de la varianza total: "Aspectos estructurales y organizativos del PMM" (α = 0,96) y "Actuación de los médicos en el PMM" (α = 0,74). Se contempla además que la eficacia del PMM fue evaluada negativamente. Esos resultados revelan que el instrumento es útil para la evaluación del PMM, todavía escaso de instrumentos en la literatura, pudiendo ser utilizado adecuadamente en futuros estudios.(AU)

Monocyte subpopulations study in patients with plaque psoriasis.

Psoriasis is a chronic and systemic, immune-mediated, inflammatory disease, mainly manifested by skin and / or joints lesions, presenting with a wide degree of clinical severity, but generally with great impact on patients' quality of life. Despite advances in the understanding of its pathogenesis, especially regarding the participation of T-lymphocytes and the key role of TNF, the triggering factor of the disease at the molecular level remains unknown, as well as the function of other cell populations. By presenting antigens to T-lymphocytes, monocytes assume an important role in both innate and adaptive immune response. In the last two decades, by using flow cytometry with antibodies against CD14 (receptor for lipopolysaccharide) and CD16 (low affinity receptor for IgG), human blood monocytes were classified into three subpopulations: classical (CD14++CD16-), intermediate (CD14++CD16+), and non-classical (CD14+CD16++). Under normal conditions the population of classical monocytes corresponds to about 85%, while intermediate to 5.4%, and nonclassical to 9.2%. However, intermediate and nonclassical subsets are increased in various inflammatory situations, such as moderate to severe asthma, colorectal cancer, and rheumatoid arthritis. Despite psoriasis being considered a disease of inflammatory nature, scarce studies evaluating the frequency of subpopulations of monocytes in psoriatic patients are found on current medical literature, and they are restricted to peripheral blood analysis. This study aims to identify the frequency of monocyte subpopulations in blood levels as well as lesional skin of plaque psoriasis patients, and to evaluate their association to cytokines, and clinical disease severity.

Review in peeling complications.

Chemical peeling, a procedure wherein a chemical agent is applied to the skin to cause controlled destruction followed by regeneration and remodeling, is a dynamic tool for the treatment of acne, pigmentation issues, and photoaging [Journal of cutaneous and aesthetic surgery vol. 5 (2012) 254-260]. The results and complications are related to the depth of the procedure, with deeper peels producing more marked results and higher rates of complications. Complications are more likely with darker skin types, certain peeling agents, and sun exposure after treatment [Journal of cutaneous and aesthetic surgery vol. 5 (2012) 254-260]. They can range from minor irritations and uneven pigmentation to permanent scarring. In extremely uncommon cases, the complications can be life-threatening. This knowledge is essential to prevent, reduce, and eliminate the occurrence of complications [Cirurgia dermatológica em consultório. São Paulo: Atheneu; 2009]. Swelling, pain, persistent erythema, pruritus, allergic reactions, folliculitis/acne, infection, herpes recurrence, hypopigmentation and hyperpigmentation, demarcation lines, and scarring are some of the complications that will be discussed in this article. The first step in preventing complications is to identify the patients at risk. By doing so, complications can be anticipated, prevented, and, if they still occur, treated as early as possible.

Human T-cell lymphotropic virus-1 infection: three infected generations in the same family.

The human T-cell lymphotropic virus-1 (HTLV-1) affects worldwide population; the estimated number of currently infected individuals is 10-20 million. In this report, we describe the clinical findings of three family members with vertical transmission of HTLV-1. This case report highlights the importance of healthcare providers who have optimal knowledge about HTLV-1 including its transmission and pertinent attributes, and who are able to provide affected individuals with adequate information regarding their condition.

Human T-cell lymphotropic virus-1 infection: three infected generations in the same family

Abstract The human T-cell lymphotropic virus-1 (HTLV-1) affects worldwide population; the estimated number of currently infected individuals is 10-20 million. In this report, we describe the clinical findings of three family members with vertical transmission of HTLV-1. This case report highlights the importance of healthcare providers who have optimal knowledge about HTLV-1 including its transmission and pertinent attributes, and who are able to provide affected individuals with adequate information regarding their condition.

A percepção dos usuários cearenses sobre o Programa Mais Médicos / The perception of Ceará users on Program More Doctors

O presente trabalho tem como objetivo conhecer a percepção que usuários da Estratégia Saúde da Família possuem sobre o programa. Trata-se de uma pesquisa exploratória de abordagem qualitativa. Participaram seis usuários da Estratégia Saúde da Família atendidos por médicos bolsistas do programa, que responderam a um roteiro de entrevista semiestruturado, cujo os resultados foram avaliados por análise de conteúdode Bardin. Os resultados mostraram que existe um desconhecimento por parte dos usuários sobre o programa. Os usuários acreditam que os médicos convencionais têm indisposição para o atendimento, especulam financeiramente a medicina e não realizam atendimento humanitário. Afirmam ainda que, apesar dos médicos bolsistas estrangeiros possuírem uma limitação com o idioma, desenvolvem uma relação de afeto com a população e são considerados capacitados. Apesar das barreiras encontradas, existe uma avaliação positiva do programa por parte dos usuários, que consideram que ele tem ajudado a suprir a quantidade de médicos, ocasionando a melhoria do serviço e do acesso à saúde.

The present study aims to know the perception that users of the Family Health Program have about the program. This is an exploratory research of qualitative approach. Participants were six members of the Family Health Strategy attended by medical program fellows who answered a semi-structured interview guide, whose results were evaluated by analysis of content of Bardin. The results show that part of the interviewees did not know the program or has incorrect information. On the evaluation on the program, users believe that conventional doctors has indisposition to care, speculate financially the medicine and do not carry out humanitarian care. Affirm moreover that foreign medical fellows have the limitation of language and that, however, develop a relationship of affection with the population and are considered trained. Despite the barriers, there is a positive evaluation of the program by the users, who believe that it has helped to supply the amount of doctors, leading to improved service and access to health care...

Um percurso freudiano das depressões / A Freudian path of depressions / Un camino freudiano de las depresiones

Atualmente, as depressões aparecem como diagnóstico recorrente e com a perspectiva de tornar-se, em 20 anos, a doença mais comum do mundo. A abordagem dessa problemática esbarra na dificuldade da falta de uma definição unívoca e de um consenso na diferenciação entre os termos depressão e melancolia, reveladas pela bibliografia existente, incluindo a psicanalítica. Nessa perspectiva, este trabalho se propõe a investigar, na obra freudiana, as definições (ou aproximações) da depressão e da melancolia, traçando um mapeamento dos principais textos que abordam o tema, articulando-os com as reflexões de autores contemporâneos. Com base no percurso empreendido, concluímos que as depressões podem ser concebidas como neuroses de angústia decorrentes de uma inibição sexual; e a melancolia, como uma neurose narcísica, sendo entendida como uma modalidade especial da psicose. Desse modo, esperamos ter contribuído para o avanço dos impasses e das questões advindos da prática psicanalítica e para decorrente direção do tratamento.

Currently, depression appears as recurrent diagnosis and the prospect of becoming, in 20 years, the most common disease in the world. The approach to this problem runs into the difficulty of the lack of a single definition and a consensus on the distinction between the terms depression and melancholy, revealed by the existing literature, including psychotherapy. Thus, this study aims to investigate the Freudian definitions (or approximations) of depression and melancholy, mapping the major texts that address the topic, linking them with the reflections of contemporary authors. Based on the course undertaken, we conclude Depression may be seen as stemming from anxiety neuroses of a sexual inhibition, and melancholia as a narcissistic neurosis, being understood as a special form of psychosis. Thus, we hope to have contributed to the advancement of issues and questions arising from psychoanalytic practice and resulting direction of the treatment.

En la actualidad, las depresiones aparecen como diagnóstico recurrente y con la posibilidad de convertirse, en 20 años, en la enfermedad más común en el mundo. El enfoque de este problema se encuentra con la dificultad de la falta de una definición única y de un consenso sobre la distinción entre los términos depresión y melancolía, revelada por la literatura existente, incluyendo la psicoterapia. Así, este estudio tiene como objetivo investigar en la obra freudiana las definiciones (o aproximaciones) de la depresión y la melancolía, analizando los principales textos que abordan el tema, articulándolos con las reflexiones de autores contemporáneos. Con base en el transcurso emprendido, se concluye que las depresiones pueden ser entendidas como neurosis de angustia derivadas de una inhibición sexual; y la melancolía como una neurosis narcisista, siendo entendida como una modalidad especial de la psicosis. De este modo, esperamos haber contribuido al avance en los dilemas y cuestiones que surgen de la práctica psicoanalítica y a la consecuente dirección del tratamiento.

Um percurso freudiano das depressões / A Freudian path of depressions / Un camino freudiano de las depresiones

Atualmente, as depressões aparecem como diagnóstico recorrente e com a perspectiva de tornar-se, em 20 anos, a doença mais comum do mundo. A abordagem dessa problemática esbarra na dificuldade da falta de uma definição unívoca e de um consenso na diferenciação entre os termos depressão e melancolia, reveladas pela bibliografia existente, incluindo a psicanalítica. Nessa perspectiva, este trabalho se propõe a investigar, na obra freudiana, as definições (ou aproximações) da depressão e da melancolia, traçando um mapeamento dos principais textos que abordam o tema, articulando-os com as reflexões de autores contemporâneos. Com base no percurso empreendido, concluímos que as depressões podem ser concebidas como neuroses de angústia decorrentes de uma inibição sexual; e a melancolia, como uma neurose narcísica, sendo entendida como uma modalidade especial da psicose. Desse modo, esperamos ter contribuído para o avanço dos impasses e das questões advindos da prática psicanalítica e para decorrente direção do tratamento.

Currently, depression appears as recurrent diagnosis and the prospect of becoming, in 20 years, the most common disease in the world. The approach to this problem runs into the difficulty of the lack of a single definition and a consensus on the distinction between the terms depression and melancholy, revealed by the existing literature, including psychotherapy. Thus, this study aims to investigate the Freudian definitions (or approximations) of depression and melancholy, mapping the major texts that address the topic, linking them with the reflections of contemporary authors. Based on the course undertaken, we conclude Depression may be seen as stemming from anxiety neuroses of a sexual inhibition, and melancholia as a narcissistic neurosis, being understood as a special form of psychosis. Thus, we hope to have contributed to the advancement of issues and questions arising from psychoanalytic practice and resulting direction of the treatment.

En la actualidad, las depresiones aparecen como diagnóstico recurrente y con la posibilidad de convertirse, en 20 años, en la enfermedad más común en el mundo. El enfoque de este problema se encuentra con la dificultad de la falta de una definición única y de un consenso sobre la distinción entre los términos depresión y melancolía, revelada por la literatura existente, incluyendo la psicoterapia. Así, este estudio tiene como objetivo investigar en la obra freudiana las definiciones (o aproximaciones) de la depresión y la melancolía, analizando los principales textos que abordan el tema, articulándolos con las reflexiones de autores contemporáneos. Con base en el transcurso emprendido, se concluye que las depresiones pueden ser entendidas como neurosis de angustia derivadas de una inhibición sexual; y la melancolía como una neurosis narcisista, siendo entendida como una modalidad especial de la psicosis. De este modo, esperamos haber contribuido al avance en los dilemas y cuestiones que surgen de la práctica psicoanalítica y a la consecuente dirección del tratamiento.

A representação social dos cearenses sobre o Programa Mais Médicos

Pesquisas apontam que a falta de médicos é um dos principais problemas no Sistema Único de Saúde (SUS). Devido a isso, foi cria do o Programa Mais Médicos (PMM), que visa a melhoria do atendimento aos usuários desse sistema levando mais investimentos em infraestrutura dos hospitais e unidade de saúde, além de direcionar mais médicos a regiões onde há escassez ou ausência de profissionais.O estudo trata-se de uma pesquisa descritiva exploratória que considera os aspectos qualitativos dos discursos dos usuários sobre o PMM. Participaram 6 usuários da Estratégia Saúde da Família atendidos por médicos bolsistas do Programa Mais Médicos, que responderam a um roteiro de entrevista semiestruturado, cujo os resultados foram avaliados por análise de contéudo de Bardin. Após análise dos resultados emergiram duas classes: “Conhecimento sobre o Programa Mais Médicos” e “Avaliação sobre o Programa Mais Médicos”. Os resultados apontam que parte dos entrevistados não conhece o programa ou possui informações incorretas. Em relação a avaliação sobre o Programa Mais Médicos os entrevistados acreditam que os médicos convencionais tem indisposição para o atendimento, especulam financeiramente a medicina e não veem a parte humanitária. Os médicos bolsistas possuem a limitação do idioma, porém desenvolveram uma relação de afeto com a população e são considerados com mais com mais conhecimento. Conclui-se que, de forma geral, os entrevistados fazem uma avaliação positiva do programa e consideram que ele tem ajudado a suprir a quantidade de médicos.

Amelanotic metastatic cutaneous melanoma / Melanoma metastatico amelanotico cutaneo

Dermatoscopy of melanocytic lesions has guided the decision of when or not to biopsy a lesion. The use of this tool has increased clinical examination's sensitivity and specificity in 89% and 96% respectively. However, dermatoscopic evaluation of amelanotic or hypomelanotic melanomas, as well as metastases, can be difficult. There is still no standardization for the analysis of these pathologies, which relies mostly on their vascular pattern. We describe the dermatoscopy of acral metastatic amelanotic melanoma.

A dermatoscopia das lesões melanocíticas tem auxiliado na decisão de biopsiar ou não uma lesão. A utilização desta ferramenta aumentou a sensibilidade e a especificidade do diagnóstico para 89% e 96%, respectivamente. No entanto, a avaliação dermatoscópica de melanomas amelanóticos ou hipomelanóticos, bem como a de metástases cutâneas, pode ser difícil. Ainda falta uma padronização para a análise destas patologias, que se baseia, majoritariamente, no seu padrão vascular. Descreve-se a dermatoscopia de melanoma metastático amelanótico acral.

Amelanotic metastatic cutaneous melanoma.

Dermatoscopy of melanocytic lesions has guided the decision of when or not to biopsy a lesion. The use of this tool has increased clinical examination's sensitivity and specificity in 89% and 96% respectively. However, dermatoscopic evaluation of amelanotic or hypomelanotic melanomas, as well as metastases, can be difficult. There is still no standardization for the analysis of these pathologies, which relies mostly on their vascular pattern. We describe the dermatoscopy of acral metastatic amelanotic melanoma.

In vivo reflectance confocal microscopy in a typical case of melasma.

Melasma is a common disorder of hypermelanosis that affects mainly young and middle-aged women of Fitzpatrick's phototypes III-V. The disease significantly impacts their lives. In vivo reflectance confocal microscopy, a spreading technology for the noninvasive evaluation of the skin up to the papillary dermis, provides real-time en face images with cellular resolution. We present a case of melasma with in vivo reflectance confocal microscopy findings closely correlated to the histopathological features described in the literature.

In vivo reflectance confocal microscopy in a typical case of melasma / Microscopia confocal reflectante in vivo em um caso típico de melasma

Melasma is a common disorder of hypermelanosis that affects mainly young and middle-aged women of Fitzpatrick's phototypes III-V. The disease significantly impacts their lives. In vivo reflectance confocal microscopy, a spreading technology for the noninvasive evaluation of the skin up to the papillary dermis, provides real-time en face images with cellular resolution. We present a case of melasma with in vivo reflectance confocal microscopy findings closely correlated to the histopathological features described in the literature.

O melasma é um distúrbio pigmentar caracterizado por hipermelanose, que afeta principalmente mulheres jovens e de meia-idade com fototipos III-V de Fitzpatrick e acarreta em impacto significativo na qualidade de vida das mesmas. A microscopia confocal reflectante in vivo, uma tecnologia em expansão voltada para análise da pele até a derme superior, proporciona imagens en face em tempo real com resolução celular. Apresentamos um caso de melasma com achados na microscopia confocal reflectante in vivo fortemente correlacionados com as características histopatológicas descritas na literatura.

Acanthosis nigricans and "tripe palm" as paraneoplastic manifestations of metastatic tumor.

Acanthosis nigricans is a common dermatosis and is most often associated with benign conditions, such as insulin resistance. It is rare as a paraneoplastic marker. As such, it is characterized by sudden onset and rapid dissemination of velvety and hyperchromic skin lesions. The term "tripe palm" refers to exaggeration of the palmar ridge pattern, which resembles the internal surface of the bovine intestinal tract. This is a paraneoplastic marker of high specificity, with 90% of the cases being associated with malignancy. We report the case of a patient with stage IV ovarian adenocarcinoma presenting acanthosis nigricans and tripe palm. Both findings are closely correlated to the neoplasm course.