Uso da micropigmentação como método de camuflagem para cicatriz de estrias / Use of micropigmentation as a camouflage method for stretch mark scarring

As estrias são atrofias cutâneas lineares derivadas de um processo cicatricial. Elas se formam quando a tensão do tecido provoca uma lesão do conectivo dérmico, ocasionando uma dilaceração das malhas, gerando a perda da elasticidade e da compactação. A micropigmentação, também conhecida como dermopigmentação, dermografia, dermatografia ou tatuagem é uma técnica que consiste em um procedimento minimamente invasivo, utilizado para implantar pigmento na camada subepidérmica, para corrigir pequenas anormalidades ou para fins estéticos. O objetivo deste trabalho foi verificar a eficácia da camuflagem de cicatrizes de estrias por meio da micropigmentação. Após aplicação da sessão de micropigmentação foi verificado melhora da aparência das estrias na voluntária que seguiu corretamente as orientações. (AU)

Striae are linear cutaneous atrophies derived from a cicatricial process, they are formed when the tissue tension causes a lesion of the dermal connective, causing a tear of the meshes, generating the loss of elasticity and compression causing an injury. Micropigmentation, or also known as dermopigmentation, dermography, dermatography, or tattooing is a technique that consists of a minimally invasive procedure, used to implant pigment in the subepidermal layer, to correct small abnormalities or for aesthetic purposes. The objective of this case study was to verify the efficacy of the camouflage of scars by micropigmentation. After application of the micropigmentation session, it was verified an improvement in the appearance of the striae in the volunteer who followed the guidelines correctly. (AU)

Epidemiological and laboratorial profile of patients with isolation of nontuberculous mycobacteria.

BACKGROUND: An increase in NTM diseases in the international scenario has been observed in recent years. AIMS: To analyze the epidemiological and laboratory profiles of patients with isolation of nontuberculous mycobacteria (NTM) over one decade. A retrospective analysis of records of a mycobacterial reference laboratory found 135 cases with isolation of NTM. METHODS: Clinical and epidemiological data were collected from the records of government health clinics and from the State notification system (TBWEB). The cases were geocoded by location based on the street address in the Mercator Transverse Universal projection, Datum SAD/69 and MapInfo software. RESULTS: Most patients were male (66.7%), older than 50 years (40%) and had only completed elementary schooling (38.5%). Associated health problems were found in 71.8% of the subjects, with 43.7% being HIV positive and 25.9% having had tuberculosis in the past. Hospitals were the most able institutions to diagnose cases (45.2%). Sputum was the most common material tested (63.0%) with the bacilloscopy being positive in 33.3% of cases. The most common mycobacteria species in the region were Mycobacterium avium and M. abscessus/M. massiliense/M. bolletii. When the regional reference municipality was analyzed, M. avium and M. fortuitum were the most common species isolated in the urban area. CONCLUSIONS: In the study region, mycobacteriosis most affected adult males with low schooling. Most patients presented comorbidities in particular co-infection with the HIV virus. M. avium is the most prevalent species in the region with the M. abscessus/M. massiliense/M. bolletii species being the main cause of nosocomial infections.

Clinical and epidemiological profiles of individuals with drug-resistant tuberculosis.

Drug-resistant tuberculosis (TB) is a growing global threat. Approximately 450,000 people developed multidrug-resistant TB worldwide in 2012 and an estimated 170,000 people died from the disease. This paper describes the sociodemographic, clinical-epidemiological and bacteriological aspects of TB and correlates these features with the distribution of anti-TB drug resistance. Mycobacterium tuberculosis (MT) cultures and drug susceptibility testing were performed according to the BACTEC MGIT 960 method. The results demonstrated that MT strains from individuals who received treatment for TB and people who were infected with human immunodeficiency virus were more resistant to TB drugs compared to other individuals (p < 0.05). Approximately half of the individuals received supervised treatment, but most drug-resistant cases were positive for pulmonary TB and exhibited positive acid-fast bacilli smears, which are complicating factors for TB control programs. Primary healthcare is the ideal level for early disease detection, but tertiary healthcare is the most common entry point for patients into the system. These factors require special attention from healthcare managers and professionals to effectively control and monitor the spread of TB drug-resistant cases.

Clinical and epidemiological profiles of individuals with drug-resistant tuberculosis

Drug-resistant tuberculosis (TB) is a growing global threat. Approximately 450,000 people developed multidrug-resistant TB worldwide in 2012 and an estimated 170,000 people died from the disease. This paper describes the sociodemographic, clinical-epidemiological and bacteriological aspects of TB and correlates these features with the distribution of anti-TB drug resistance. Mycobacterium tuberculosis (MT) cultures and drug susceptibility testing were performed according to the BACTEC MGIT 960 method. The results demonstrated that MT strains from individuals who received treatment for TB and people who were infected with human immunodeficiency virus were more resistant to TB drugs compared to other individuals (p < 0.05). Approximately half of the individuals received supervised treatment, but most drug-resistant cases were positive for pulmonary TB and exhibited positive acid-fast bacilli smears, which are complicating factors for TB control programs. Primary healthcare is the ideal level for early disease detection, but tertiary healthcare is the most common entry point for patients into the system. These factors require special attention from healthcare managers and professionals to effectively control and monitor the spread of TB drug-resistant cases.

Cenário atual da tuberculose / Current scenario of tuberculosis

Mesmo após 133 anos desde a descoberta do Mycobacterium tuberculosis, a tuberculose continua ser uma das principais causas de morte por doenças infecciosas no mundo, principalmente em países em desenvolvimento.O objetivo deste estudo foi mostrar aspectos relevantes da doença visando uma atualização literária e a busca de um olhar mais atento à problemática da tuberculose no contexto atual. Foram utilizados 130 artigos advindos das bases LILACS, MEDLINE/PUBMED, SCielo, Paho, Biblioteca Cochrane, WHOLIS, IBECS e Scopus, com as principais palavras-chaves selecionadas em terminologia em saúde encontradas no DECS. As espécies pertencentes ao Complexo M. tuberculosis compartilham cerca de 99% de identidade do DNA,com sequências altamente conservadas, mas diferem na distribuição geográfica, patogenicidade e hospedeiros. O mecanismo de resistência clinicamente significativo para rifampicina é uma mutação do gene rpoB, que codifica o alvo desse antibiótico. Há grandes avanços no diagnóstico da TB, com novos instrumentos de biologia molecular e testes rápidos, mas ainda não substituem os métodos clássicos bacteriológicos, apesar de suas conhecidas limitações. Atualmente, a associação de métodos moleculares, principalmente aqueles baseados em reações da PCR tem proporcionado grande impulso nos estudos da epidemiologia molecular do MT. Embora haja uma diminuição do número de casos no mundo, dentre os desafios da doença estão a necessidade de pesquisas na área, envolvimento político para solucionar as questões sociais atribuídas à TB, treinamento permanente dos profissionais e monitoramento de vigilância dos casos para eliminar a doença no cenário mundial.

Even 133 years after the discovery of Mycobacterium tuberculosis, tuberculosis continues to be one of the main causes of death due to infectious diseases worldwide, especially in developing countries. The objective of this study was, after a survey of recent publications, to show issues relevant to the disease and to takea closer look at the tuberculosis problem in the current context. A total of 130 articles were found in the LILACS, MEDLINE/PubMed, SciELO, Paho, Cochrane Library, WHOLIS, IBECS and Scopus databases using the main keywords selected from health terminology of MeSH. Species belonging to the M. tuberculosis complex have highly conserved sequences and share about 99% DNA identity, but differ in their geographic distribution, pathogenicityand host. The clinically significant mechanismof rifampicin resistance is due to a mutation of the rpoB gene which encodes the target of the antibiotic. Great advances in the diagnosis of tuberculosis have occurred, with new molecular biology tools and rapid tests, but without replacing classical bacteriological methods, despite their known limitations. Recently, the association of molecular methods, especially based on PCR, has provided great impetus in molecular epidemiology studies of M. tuberculosis. Although the number of cases in the world has decreased, among the challenges are the need for further research, political involvement to solve social issues linked to tuberculosis, permanent training and the surveillance of cases in order to eliminate the disease on the world stage.

Mycobacterium tuberculosis detection in the penitentiary system

Descrevemos retrospectivamente a detecção de Mycobacterium tuberculosis (MT) e o seu perfil de suscetibilidade entre detentos de três presídios da região de São José do Rio Preto, São Paulo, Brazil. Entre 2003 e 2006 foram avaliados 1.070 detentos com suspeita de tuberculose (TB). A positividadedo Mycobacterium sp. foi avaliada pela baciloscopia e cultura. A análise estatística foi realizada utilizando o Epi Info e BioEstat. Não houve diferença significante nos resultados positivos entre as três unidades penitenciárias. Foi encontrado um percentual de 6,9por cento de positividade para MT e operfil de sensibilidade mostrou que 4,2por cento dos detentos apresentaram isolados resistentes a isoniazida,enquanto 6,2por cento foram resistentes à rifampicina. Todos os isolados resistentes foram obtidos de presos bacilíferos, apontando para a possibilidade de transmissão intra-institucional. Nossos dados abrem portas para o entendimento da magnitude da tuberculose e o perfil de resistência às drogas do MT no sistema penitenciário do Estado de São Paulo.

Chemical structure and selected biological properties of a glucomannan from the lichenized fungus Heterodermia obscurata.

Successive aqueous and alkaline extraction of the thallus of the lichenized fungus Heterodermia obscurata provided a highly branched glucomannan fraction (GM), whose chemical structure was determined. This was based on monosaccharide composition, methylation, partial acid hydrolysis, and NMR spectroscopic analysis. It consisted of a main chain of (1→6)-linked α-D-mannopyranosyl units, almost all being substituted at O-2 with α-D-glucopyranosyl, α-D-mannopyranosyl, and 4-O-substituted α-D-mannopyranosyl groups. Intra-peritoneal administration of this GM induced a marked and dose-dependent inhibition of acetic acid-induced visceral pain with an ID(50) of 0.6 (0.2-2.0) mg/kg and inhibition of 88±4%. It also reduced leukocyte migration by 58±4%, but did not alter plasmatic extravasation to the peritoneal cavity. The results suggest that the glucomannan from the H. obscurata might have potential for antinociceptive and anti-inflammatory utilization.

Risco ocupacional para trabalhadores expostos ao temefós no programa de controle do vetor da dengue no Distrito Federal / Occupational risk for wor kers exposed to temephos on Distrito Federal Dengue`s Vector Control Program

Objetivo. Conhecer os aspectos epidemiológicos, clínicos e laboratoriais da exposição ocupacional ao agrotóxico organofosforado temefós. Método. Trata-se de estudo descritivo, retrospectivo, transverso, cujos dados foram colhidos dos registros de trabalhadores do Programa de Controle do Vetor da Dengue no Distrito Federal com suspeita de intoxicação pelo organofosforado temefós. O diagnóstico de intoxicação foi feito pela dosagem sérica de acetilcolinesterase e por meio das manifestações clínicas. Usou-se o teste de Fisher para análise estatística. O valor p < 0,05 foi considerado significante. Resultados. A média de idade dos 108 trabalhadores avaliados com intoxicação pelo temefós foi 42 anos, e 61,1% foram masculinos. Cinquenta e dois (48,1%) encontraram-se afastados do serviço por um a dois anos. A maioria das exposições (86,1%) foi pelas vias cutânea e respiratória. Sintomas e sinais de intoxicação estiveram presentes em29,6% dos trabalhadores, e 45% deles tiveram alterações no sistema nervoso central, como cefaleia, tontura, amnésia. A adesão ao uso completo ou incompleto de equipamentos de proteção individual foi significativamente maior entre homens (56,1%) do que entre mulheres (14,3%). Conclusão. O uso de temefós para controle do vetor da dengue associa-se a intoxicação dos trabalhadores envolvidos no serviço. É possível que a baixa utilização de equipamentos de proteção possa contribuir para isso.

Objective. To know the epidemiologic, clinic and laboratorial aspects of occupational exposure to the organophosphorus insecticide temephos. Method. This is a descriptive, retrospective and cross-sectional study. Data were obtained from outpatient service records of the Distrito Federal dengue's vector control program with suspect of organophosphate temephos poison. Poison diagnosis by temephos was made using acetilcolinesterase activity in the hematias and clinical manifestations. The Fisher test was used for statistical analysis. P less than 0.05 was considered significant. Results. The age average of workers was 42 years-old, being 61.1% men, 48.1% were licensed, with prevailing of 1 or 2 years of occupational license. The majority of expositions were through skin and aerial way. Only 29.6% of workers presented some kind of symptoms and signs. Central nervous system changes were prevalent on 45%, as cephalalgia, dizzyness, amnesia. The individual protection equipment used in adhesion was bigger between men (56.1%) than between women (14.3%). Conclusion. The use of temephos to control the dengue vector is associated with the poisoning of workers involved in the service. It is possible that the low use of protective equipment can contribute to it.

Nontuberculous mycobacteria isolated in São José do Rio Preto, Brazil between 1996 and 2005.

OBJECTIVE: To study the incidence of nontuberculous mycobacteria and the range of species isolated between 1996 and 2005 at a regional branch of the Adolfo Lutz Institute-located in the city of São José do Rio Preto, Brazil-and to show the importance of laboratory testing. METHODS: Mycobacteria were isolated from pulmonary and extrapulmonary specimens and identified through phenotyping and molecular methods (polymerase chain reaction-restriction enzyme analysis). RESULTS: We isolated 317 nontuberculous mycobacterium strains: Mycobacterium avium complex, 182 (57.4%); M. gordonae, 33 (10.4%); M. fortuitum, 25 (7.9%); M. chelonae, 8 (2.5%); M. terrae complex, 8(2.5%); M.kansasii, 7 (2.2%); and less frequent species, 54 (17%). During this period, 72 cases (33.3%) were characterized as mycobacteriosis, according to bacteriological criteria established by the American Thoracic Society in 2007. Of those 72 cases, 56 were attributed to M.avium complex. Of those 56, 29 (51.8%) were characterized as disseminated disease. Six cases were attributed to M. fortuitum, 3 to M. gordonae, 2 to M. chelonae, 1 to M. abscessus, 1 to M. kansasii, 1 to M. intracellulare, 1 to M. malmoense and 1 to Mycobacterium ssp. CONCLUSIONS: These results show the importance of the bacteriological diagnosis, since identification of the species enables early and appropriate treatment.

Isolamento de micobactérias não-tuberculosas em São José do Rio Preto entre 1996 e 2005 / Nontuberculous mycobacteria isolated in São José do Rio Preto, Brazil between 1996 and 2005

OBJETIVO: Estudar a ocorrência de micobactérias não-tuberculosas e a variabilidade das espécies isoladas na região atendida pelo Instituto Adolfo Lutz-Regional de São José do Rio Preto-no período entre 1996 e 2005, assim como mostrar a importância do diagnóstico laboratorial. MÉTODOS: A partir de amostras pulmonares e extrapulmonares, foi realizado o isolamento de micobactérias, e estas foram identificadas por métodos fenotípicos e pelo método molecular polymerase chain reaction-restriction enzyme analysis. RESULTADOS: Foram isoladas 317 cepas de micobactérias não-tuberculosas: complexo Mycobacterium avium, 182 (57,4%); M. gordonae, 33 (10,4%); M. fortuitum, 25(7,9%); M. chelonae, 8 (2,5%); complexo M. terrae, 8 (2,5%); M. kansasii, 7 (2,2%); e espécies menos freqüentes, 54 (17%). No período, foram caracterizados 72 casos (33,3%) de micobacterioses, de acordo com os critérios bacteriológicos estabelecidos pela American Thoracic Society (2007).Desses, complexo M. avium foi responsável por 56 casos, sendo que 29 (51,8%) foram caracterizados como doença disseminada. M. fortuitum foi responsável por 6 casos; M. gordonae, 3; M. chelonae, 2; M. abscessus, 1; M. kansasii, 1; M. intracellulare, 1; M. malmoense, 1; e Mycobacterium ssp., 1. CONCLUSÕES: Os resultados obtidos mostraram a importância do diagnóstico bacteriológico das micobacterioses, pois a identificação das espécies possibilita a introdução de um tratamento adequado precocemente.

OBJECTIVE: To study the incidence of nontuberculous mycobacteria and the range of species isolated between 1996 and 2005 at a regional branch of the Adolfo Lutz Institute-located in the city of São José do Rio Preto, Brazil-and to show the importance of laboratory testing. METHODS: Mycobacteria were isolated from pulmonary and extrapulmonary specimens and identified through phenotyping and molecular methods (polymerase chain reaction-restriction enzyme analysis). RESULTS: We isolated 317 nontuberculous mycobacterium strains: Mycobacterium avium complex, 182 (57.4%); M. gordonae, 33 (10.4%); M. fortuitum, 25 (7.9%); M. chelonae, 8 (2.5%); M. terrae complex, 8(2.5%); M.kansasii, 7 (2.2%); and less frequent species, 54 (17%). During this period, 72 cases (33.3%) were characterized as mycobacteriosis, according to bacteriological criteria established by the American Thoracic Society in 2007. Of those 72 cases, 56 were attributed to M.avium complex. Of those 56, 29 (51.8%) were characterized as disseminated disease. Six cases were attributed to M. fortuitum, 3 to M. gordonae, 2 to M. chelonae, 1 to M. abscessus, 1 to M. kansasii, 1 to M. intracellulare, 1 to M. malmoense and 1 to Mycobacterium ssp. CONCLUSIONS: These results show the importance of the bacteriological diagnosis, since identification of the species enables early and appropriate treatment.

A gel-forming beta-glucan isolated from the fruit bodies of the edible mushroom Pleurotus florida.

Glucans of basidiomycetes are considered to be an important class of polysaccharides, as they can act as biological response modifiers. We now isolate a gel-forming, water-soluble beta-glucan, with a molecular mass of 1.2 x 10(6)g/mol (HPSEC), from the fruit bodies of the edible mushroom Pleurotus florida, via alkaline extraction, followed by fractionation by freeze-thawing. Structural assignments were carried out using mono- and bi-dimensional nuclear magnetic resonance spectroscopy, monosaccharide composition, methylation analyses, and a controlled Smith degradation. It was a branched beta-glucan, with a main chain of (1-->3)-linked-Glcp residues, substituted at O-6 by single-unit Glcp side chains, on average to every fourth residue of the backbone.

Ovo desidratado para substituir ovo in natura na preparaçäo do meio Löwenstein-Jensen para cultivo de micobactérias / Dehydrated egg to replace in natura egg in the preparation of Löwenstein-Jensen medium for mycobacteria culture

Os métodos bacteriológicos säo extremamente importantes para diagnosticar tuberculose pulmonar. O meio de cultura mais comumente usado para isolar micobactérias é o Löwenstein-Jensen (LJ), meio sólido à base de ovos. Os ovos precisam sofrer uma limpeza prévia que consiste em escová-los com água e sabäo, com posterior descontaminaçäo por 30 minutos em álcool 70 por cento. O ovo "in natura" apresenta dois inconvenientes: esta limpeza, que é demorada e o sistema de compras e armazenamento, pois os ovos devem ser frescos. Com o propósito de simplificar este procedimento, este estudo comparou o meio preparado com ovos frescos e com ovos desidratados. Amostras clínicas foram precessadas para cultura e o inoculo foi semeado nos dois tipos de meios. Os resultados das culturas mostraram que das 150 amostras positivas pela baciloscopia 123 foram positivas no meio convencional e 24 foram negativas, enquanto que no meio teste, foram 121 positivas e 26 negativas, mostrando uma diferença que näo foi significativa. Contaminaçöes ocorreram igualmente nos dois meios (3 amostras). Ao comparar-se os dois meios a sensibilidade foi de 98 por cento e a especificidade de 100 por cento. Conclui-se que o ovo desidratado pode ser uma forma alternativa e vantajosa, no preparo do meio de Löwenstein-Jensen. (AU)

Bacteriological methods are the most important to diagnose pulmonary tuberculosis. The culture medium most used to isolate mycobacteria is Löwenstein-Jensen (LJ), which is a solid medium containing eggs, glycerol and asparagine as carbon and nitrogen source. The eggs used to prepare the medium need a previous cleaning, consisting of brushing with water and soap, and decontamination with 70% alcohol during 30 minutes. This procedure takes time; besides it is not so simple to organize the acquisition of fresch eggs. With the purpose of simplifying the whole procedure of making medium, we propose the replacement of "in natura" by dehydrated eggs. This study compares the performance of conventional LJ and LJ made with dehydrated eggs. Clinical specimens sent to the laboratory for tuberculosis diagnosis were decontaminated by Petroff method and inoculated in tubes of conventional LJ and the test LJ. It was used 200 clinical specimens, 150 were smear positive and 50 smear negative. Among the 150 samples smear positive 123 were positive in traditional LJ and 24 were culture negative, while in the test LJ 121 were positive and 26 were negative. The difference was not significant. Three cultures were contaminated in both media. Comparison of the two media showed a sensibility of 98% and specificity of 100% The conclusion is that the dehydrated egg could be na alternative way to make LJ medium, propitiating a simpler and more practical medium preparation. (AU)