Cross-sectional study of the microbiological safety profile of reusing hyaluronic acid fillers.

INTRODUCTION: Facial filling with hyaluronic acid (HA) is a dermatological procedure that has been emerging today. There are not many references regarding safety of reusing the remaining product for later touch-up in the same patient. OBJECTIVE: To determine the microbiological safety of reusing hyaluronic acid that is remnant from syringes used for facial filling, stored at room temperature or cooled in a refrigerator at 4°C. MATERIALS AND METHODS: In culture medium, small aliquots of leftovers from 31 hyaluronic acid fillers, previously used for facial filling, were inoculated. The fillers were stored in their original syringes at room temperature or cooled in a standard refrigerator at 4°C for a period ranging from 1 week to 12 months after initial use. LIMITATIONS: The small number of samples limits extrapolation of the results obtained. RESULTS: After 42 days of inoculation in culture medium, none of the samples showed any aerobic or anaerobic bacterial or fungal growth. CONCLUSION: Hyaluronic acid fillers did not show any fungal or bacterial contamination after being opened and stored at room temperature in nonaseptic conditions. The possibility of reusing the remaining portion of the material in the syringe can be safe and economically viable.

Case for diagnosis. Subcutaneous phaeohyphomycosis.

Subcutaneous phaeohyphomycosis is an infection caused by dematiaceous fungi which mainly affects immunosuppressed patients. We report a case of subcutaneous phaeohyphomycosis on the back of the left hand in a kidney transplant patient who had been taking prednisone, tacrolimus, and azathioprine daily for 3 years.

Drug-induced acne and rose pearl: similarities.

Drug-induced acne is a common skin condition whose classic symptoms can be similar to a rose pearl, as in the case of a male patient presenting with this condition after excessive use of a cream containing corticosteroids.

Analysis of the CC chemokine receptor 5 delta32 polymorphism in a Brazilian population with cutaneous leishmaniasis.

Patients with mucocutaneous leishmaniasis (MCL) show a vigorous T-cell immune response against Leishmania braziliensis. Because the Th response is associated with inflammation, the non-functional CC chemokine receptor 5 (CCR5) may rely in a less severe inflammatory state. The aim of this study was to investigate the CCR5 gene in a Brazilian population with leishmaniasis compared with healthy control subjects and to determine the progression from cutaneous to MCL in the Delta32 allele carriers. Among 100 patients with Montenegro skin test and indirect immunofluorescence assay (IIF) values positive for leishmaniasis, there were 32% women and 68% men. The patients were 89% CCR5/CCR5, 10% CCR5/Delta32, and 1% Delta32/Delta32, while healthy subjects showed a 91% incidence of CCR5/CCR5, 8% of CCR5/Delta32, and 1% of Delta32/Delta32. The CCR5/CCR5 patients (89%) showed a large spectrum of clinical manifestations, where 22.47% had active mucous lesions and 77.53% had cutaneous lesions. In this work, the Delta32 allele carriers (10%) showed only cutaneous manifestations when compared with wild-type individuals. Finally, with regard to the Delta32 allele carriers, a less severe spectrum of clinical manifestations was observed in comparison with wild-type individuals. Although a lack of mucocutaneous lesions was evident among Delta32 allele carriers, the number of individuals studied was small. Therefore, further investigations are needed to elucidate the role of CCR5 in the clinical aspects of leishmaniasis.

Dermatite esfoliativa: estudo clínico-etiológico de 58 casos / Exfoliative dermatitis: clinical and etiologic study of 58 cases

FUNDAMENTO: Dermatite esfoliativa é síndrome cutânea caracterizada por eritema e descamação generalizados, que pode ser conseqüente ou estar associada a várias doenças dermatológicas prévias, doenças sistêmicas ou reações medicamentosas. OBJETIVOS: Relatar a freqüência das diferentes causas e características clínicas associadas à dermatite esfoliativa nos pacientes atendidos no Setor de Dermatologia do Hospital Universitário Regional do Norte do Paraná, da Universidade Estadual de Londrina. MÉTODOS: Foram revisados os registros de pacientes com diagnóstico de dermatite esfoliativa diagnosticados no Hospital Universitário Regional do Norte do Paraná no período de 10 anos. RESULTADOS: Foi encontrado o total de 58 pacientes com diagnóstico de dermatite esfoliativa, com idade média de 56,89 anos. Em 33 pacientes, foi definida uma dermatose como causa (psoríase, 11 casos; dermatite de contato, nove casos; eritrodermia ictiosiforme congênita, três casos; dermatite seborréica, cinco casos; dermatite atópica, três casos; pitiríase rubra pilar, dois casos). Reações a drogas foram observadas em 11 pacientes. Em 14 casos (24 por cento) não foi possível determinar a causa básica. CONCLUSÕES: Numa amostra de pacientes atendidos num serviço de referência em dermatologia, a dermatite esfoliativa foi ocorrência pouco comum, e a maior parte dos casos estava relacionada a doenças dermatológicas.

Eritrodermia esfoliativa / Exfokiative erythroderma

Os autores realizam uma breve revisão sobre eritrodermia esfoliativa, que constitui uma síndrome que pode resultar de muitas causas diferentes. Doenças cutâneas prévias, doenças sistêmicas e reações às drogas tópicas ou sistêmicas podem ser causas de eritrodermia esfoliativa. Sintomas e sinais podem incluir prurido, fraqueza, hipotermia, perda de peso e descamação generalizada. A importância deste achado clínico são as complicações (debilidade e desidratação) e a possibilidade de ser manifestação de uma doença grave, como o linfoma cutâneo de células T

Intradermal vaccination of adults with three low doses (2 µg) of recombinant hepatitis B vaccine. I: seroconversion rate and adverse effects

A total of 250 dentists (53.6 percent men and 46.4 percent women), with a mean age of 35.1 ± 9.8 years, were submitted to serological tests for the diagnosis of hepatitis B (HB) - HBsAg, anti-HBs, anti-HBc, HBeAg, and anti-HBe - using a radioimmunoassay. One or more of these markers were detected in 78 individuals (31.2 percent) who were excluded from the group to be vaccinated. Of the 172 HB-susceptible individuals, 135 (78.5 percent) responded to the call and were intradermally injected with three 2 µg doses of the Belgian HB recombinant vaccine, applied at an interval of one month between the 1st and 2nd dose and of five months between the 2nd and 3rd dose. A new determination of HB markers carried out 50 days after the 3rd dose showed that 110 (81.5 percent) individuals had become anti-HBs positive (65.5 percent good responders and 34.5 percent poor responders). Mean serum anti-HBs titer of these 110 dentists was 42.4 U S/N, similar in both sexes. The adverse effects analyzed in 106 dentists were: (a) local: pain (12.3 percent), burning sensation (14.1 percent), pruritus (25.5 percent), erythema (28.3 percent), local heat (18.9 percent), and a hypochromic spot (32.1 percent); (b) systemic (4.7 percent): discomfort in two patients, and fever, anorexia, and asthenia in one patient each. Intradermal administration of a fourth 2 µg vaccine dose to 39 dentists (poor or non-responders) increased the total number of anti-HBs-positive individuals from 110 (81.5 percent) to 114 (84.4 percent), with the number of good responders increasing from 72 (65.5 percent) to 85 (74.6 percent). We conclude that the Belgian recombinant vaccine applied in the scheme used here induces a high rate of seroconversion and causes only mild and transitory adverse effects.

Intradermal vaccination of adults with three low doses (2 µg) of recombinant hepatitis B vaccine. II: persistence of immunity and induction of immunologic memory

Of the 110 dentists who had presented seroconversion 50 days after the intradermal application of three 2 µg doses of the Belgian recombinant vaccine against hepatitis B (HB), administered eight years before at an interval of one month between the 1st and 2nd doses and of five months between the 2nd and 3rd doses, 51 were included for the assessment of the persistence of immunity. None of the dentists had hepatitis or had received HB vaccine during this period. All subjects were submitted to serological tests for the detection of the following markers of hepatitis B virus (HBV) infection: HBsAg, anti-HBc, HBeAg, anti-HBe, and anti-HBs, with no HBsAg, anti-HBc, HBeAg or anti-HBe being detected. A microparticle enzyme immunoassay (MEIA) revealed the presence of anti-HBs at protective titers (> 10 mIU/ml) in 42 dentists (82.4 percent), with the anti-HBs titer being higher than 100 mIU/ml in 36 of them (70.6 percent) (good responders), between 10 and 100 mIU/ml in 6 (11.8 percent) (poor responders), and lower than 10 mIU/ml in 9 (17.6 percent) (non-responders). According to clinical data and serological tests, none of the dentists had presented disease or latent HBV infection during the eight years following the first vaccination. A 2 µg booster dose was administered intradermally to eight dentists with anti-HBs titers lower than 10 mIU/ml (non-responders) and to six dentists with titers ranging from 10 to 100 mIU/ml (poor responders); the determination of anti-HBs one month later demonstrated the occurrence of seroconversion in the eight non-responders and an increase in anti-HBs titer in the six poor responders. In summary, the present results demonstrated the prolonged persistence of protection against HBV infection and the development of immunologic memory provided by vaccination against HB - with intra-dermal application of three 2 µg doses of the Belgian recombinant vaccine at 0, 1, and 6 months - carried out eight years before in 51 dentists.

Intradermal vaccination of adults with three low doses (2 micrograms) of recombinant hepatitis B vaccine. I. Seroconversion rate and adverse effects.

A total of 250 dentists (53.6% men and 46.4% women), with a mean age of 35.1 +/- 9.8 years, were submitted to serological tests for the diagnosis of hepatitis B (HB)--HBsAg, anti-HBs, anti-HBc, HBeAg, and anti-HBe--using a radioimmunoassay. One or more of these markers were detected in 78 individuals (31.2%) who were excluded from the group to be vaccinated. Of the 172 HB-susceptible individuals, 135 (78.5%) responded to the call and were intradermally injected with three 2 micrograms doses of the Belgian HB recombinant vaccine, applied at an interval of one month between the 1st and 2nd dose and of five months between the 2nd and 3rd dose. A new determination of HB markers carried out 50 days after the 3rd dose showed that 110 (81.5%) individuals had become anti-HBs positive (65.5% good responders and 34.5% poor responders). Mean serum anti-HBs titer of these 110 dentists was 42.4 U S/N, similar in both sexes. The adverse effects analyzed in 106 dentists were: (a) local: pain (12.3%), burning sensation (14.1%), pruritus (25.5%), erythema (28.3%), local heat (18.9%), and a hypochromic spot (32.1%); (b) systemic (4.7%): discomfort in two patients, and fever, anorexia, and asthenia in one patient each. Intradermal administration of a fourth 2 micrograms vaccine dose to 39 dentists (poor or non-responders) increased the total number of anti-HBs-positive individuals from 110 (81.5%) to 114 (84.4%), with the number of good responders increasing from 72 (65.5%) to 85 (74.6%). We conclude that the Belgian recombinant vaccine applied in the scheme used here induces a high rate of seroconversion and causes only mild and transitory adverse effects.

Intradermal vaccination of adults with three low doses (2 micrograms) of recombinant hepatitis B vaccine. II. Persistence of immunity and induction of immunologic memory.

Of the 110 dentists who had presented seroconversion 50 days after the intradermal application of three 2 micrograms doses of the Belgian recombinant vaccine against hepatitis B (HB), administered eight years before at an interval of one month between the 1st and 2nd doses and of five months between the 2nd and 3rd doses, 51 were included for the assessment of the persistence of immunity. None of the dentists had hepatitis or had received HB vaccine during this period. All subjects were submitted to serological tests for the detection of the following markers of hepatitis B virus (HBV) infection: HBsAg, anti-HBc, HBeAg, anti-HBe, and anti-HBs, with no HBsAg, anti-HBc, HBeAg or anti-HBe being detected. A microparticle enzyme immunoassay (MEIA) revealed the presence of anti-HBs at protective titers (> or = 10 mIU/ml) in 42 dentists (82.4%), with the anti-HBs titer being higher than 100 mIU/ml in 36 of them (70.6%) (good responders), between 10 and 100 mIU/ml in 6 (11.8%) (poor responders), and lower than 10 mIU/ml in 9 (17.6%) (non-responders). According to clinical data and serological tests, none of the dentists had presented disease or latent HBV infection during the eight years following the first vaccination. A 2 micrograms booster dose was administered intradermally to eight dentists with anti-HBs titers lower than 10 mIU/ml (non-responders) and to six dentists with titers ranging from 10 to 100 mIU/ml (poor responders); the determination of anti-HBs one month later demonstrated the occurrence of seroconversion in the eight non-responders and an increase in anti-HBs titer in the six poor responders. In summary, the present results demonstrated the prolonged persistence of protection against HBV infection and the development of immunologic memory provided by vaccination against HB--with intradermal application of three 2 micrograms doses of the Belgian recombinant vaccine at 0, 1, and 6 months--carried out eight years before in 51 dentists.

Eritema nodoso / Etythema nodosum

Os autores realizam uma breve revisão sobre eritema nodoso, uma manifestação clínica a uma ampla variedade de agentes agressores. A importância deste achado clínico e histopatológico é a possibilidade de associarse às doenças graves como o linfoma. Na maioria das vezes a história e exame físico sugerem a etiologia. A terapia consiste em sintomáticos e no tratamento da doença de base. As lesões desaparecem em 3-6 semanas, mas podem recorrer

Leishmaniose tegumentar americana (LTA) difusa em paciente infectado pelo vírus da imunodeficiência humana (HIV): relato de caso / American cutaneous leishmaniasis (LTA) in an hiv-positive patient: a case report

Paciente acompanhado pelo Setor de Doenças Infecciosas e Parasitárias do Hospital Universitário Regional do Norte do Paraná (HURNP), desde janeiro de 1991, com o diagnóstico de infecçäo pelo vírus da imunodeficiência humana (HIV), feito na ocasiäo por teste imunoenzimático (Elisa) e Western Blot. Manteve-se assintomático até 1994, quando passou a apresentar lesäo papuloeritematosa ulcerada no punho direito, cuja biópsia permitiu estabelecer o diagnóstico de leishmaniose tegumentar americana. Foi, entäo, submetido a tratamento com N-metilglucamina, sem resposta clínica. A terapêutica com anfotericina B, iniciada em seguida, teve bom resultado, mas foi interrompida pelo paciente, que näo mais compareceu ao ambulatório. Em março de 1995, retornou ao Serviço, com quadro de monilíase oral, diarréia e lesöes maculares, melanodérmicas e polimórficas generalizadas, predominantemente localizadas nos membros superiores e inferiores. A biópsia dessas lesöes confirmou, mais uma vez, o diagnóstico de LTA, tendo sido positiva (1:640) a pesquisa no soro, por imunofluorescência indireta, de IgG anti-Leishmania braziliensis. Foi, entäo reintroduzido o tratamento com anfotericina B

Dermatite herpetiforme / Dermatitis herpetiformis

A dermatite herpetiforme é uma doença bolhosa crônica, sensível ao glúten, relacionada a us risco aumentado para o desenvolvimento de linfoma. Através deste artigo, foi realizada uma revisão bibliográfica sobre seus aspectos epidemiológicos clínicos e terapêuticos.

Dermatitis herpetiformis is a lifelong, gluten sensitive skin disease, that is associated with an increased risk for lymphoma. It was made a bibliographic review about its epidemiological, clinical and therapeutical features.

Eritema nodoso / Erythema nodosum

Eritema nodoso é uma síndrome de hipersensibilidade do grupo das paniculites, caracterizada por nódulos eritematosos dolorosos que aparecem mais freqüentemente na superfície extensora das pernas. A doença pode ser associada a vários agentes infecciosos, não-infecciosos e a drogas. Neste artigo revisamos os principais aspectos relacionados ao eritema nodoso, destacando os agentes etiológicos, achados clínicos e laboratoriais, diagnósticos diferenciais e tratamento.

Erythema nodosum is a hypersensitivity syndrome of panniculitis group, characterized by painfull erythematous nodules thar appear most commonly on the extensor surfaces of the legs. The disease may be associated with many infeccious of not infeccious agents and drugs. In the article, we rewiew the mainly aspects related to the erythema nodosum, such as clinical and laboratory findings, differential diagnosis and treatment.

Melanoma maligno / Malignant melanoma

O melanoma maligno é um tumor potencialmente letal, com incidência crescente nas últimas décadas. O quadro clínico é variado e a cura só é alcançada nos estágios mais precoces da doença, sendo assim a prevençäo de suma importância.

Pelegra / Pellagra

A pelagra (do italiano pelle agra ou pele áspera) é uma doença decorrente de múltiplas deficiências vitamínicas (B). Suas manifestaçoes clínicas incluem dermatite, diarréia e demência (doença dos três Ds), podendo, em alguns casos, até levar a óbito (quarto D, de death).

Seropositivity for anti-trypanosoma cruzi antibodies among blood donors of the "Hospital Universitário Regional do Norte do Paraná", Londrina, Brazil

The most frequent form of acquisition of Chagas' disease in endemic areas was the transmission through the feces of contaminated triatominae. However, special attention should be paid in urban areas to transmission by blood transfusion, justifying the compulsory screening of blood donors. Early investigations at blood banks in the town of Londrina, Brazil, demonstrated that the seroprevalence of anti-Trypanosoma cruzi antibodies among blood donors was approximately 7.0 in the fifties. Further studies demonstrated practically the same seroprevalence until the eighties. In an attempt to obtain data about the real dimension of the seropositivity for anti-Trypanosoma cruzi antibodies in the region, the authors carried out a large-scale study on 45,774 serum samples from blood donors of the Hemocentro of Hospital Univesitário Regional do Norte do Paraná (HURNP), Universidade Estadual de Londrina. The immunological tests were done at the Division of Clinical Immunology of HURNP from May 1990 to December 1994. The serum samples were studied by the indirect hemagglutination assay (IHA, using kits commercially obtained from EBRAM) and by indirect immunofluorescence (IFI, using kits from LIO SERUM) with anti-human IgG conjugate (LABORCLIN). The results demonstrated that 643 serum samples were positive in both assay corresponding to a seroprevalence of 1.4, i.e., a significant decrease in anti-Trypanosoma cruzi antibodies in the region in comparison with the previously mentioned rates. Data correlating sex and age of seropositive blood donors are presented, as well as the possible factors that may have contributed to the results observed.

Reavaliação e proposta de um protocolo de sorologia para paracoccidioidomicose / Serodiagnostic protocol for PCM

A necessidade de implantação de uma nova conduta sorodiagnóstica para Paracoccidiomicose (PCM), na região Norte do Paraná, surgiu pela falta de correlação entre as condições clínicas dos pacientes com exame ou anatomopatológico positivo para P. brasiliensis, com os resultados de reação de fixação de complemento utilizando antígeno polissacarídico comercial Pimenta Abreu (AgPA). A reavaliação foi realizada utilizando-se 43 soros com requisição de sorologia para PCM, negativos por fixação de complemento com AgPA. Os testes utilizados foram imunodifusão radial, Fixação de Complemento, Elisa e Western Blotting, utilizando exoantígeno de 7 dias (Ag7d de P. brasiliensis e glicoproteína de 43KDa de P. Brasiliensis. Não foi observada nenhuma reação positiva com AgPA mesmo em pacientes diagnosticados por exames anatomopatológicos e ou micológicos AgPA, enquanto que a positividade pós-reação de fixação de complemento utilizando Ag7d foi de 37,2% e por imunodifusão radial dupla de 25,5%. Foi realizada também análise desses soros pelo ensaio: ELISA clássico com o Ag7D, ELISA captura com a glicoproteína de 43KDa (Gp43) de P. brasiliensis e “Western blotting” com Ag7d, obtendo-se 81,4%. Os resultados aqui obtidos mostram claramente a necessidade de controle de qualidade na produção e padronização de antígeno como reagente para imunodiagnóstico.

A reaçäo imunoenzimática para neurocisticercose no líquido cefalorraquidiano: correlaçäo com a reaçäo de Weinberg e imunofluorescência indireta / The immunoenzimatic assay to neurocysticercosis in the cerebrospinal fluid: correlation with Weinberg's reaction and indirect immunofluorescence

Com o objetivo de correlacionar as metodologias empregadas no imunodiagnóstico de neurocisticercose (NNC), os autores realizaram as reaçöes de Fixaçäo de Complemento (FC), imunofluorescência indireta (IFI), e enzimaimunoensaio (ELISA) em 1547 amostras de líquido cefalorraquidiano (LCR provenientes de pacientes com suspeita de NCC atendidos no Hospital Universitário Regional do Norte do Paraná (HURNP), no período de fevereiro de 1991 a fevereiro de 1993. As reaçöes imunológicas no LCR foram realizadas no Setor de Imunologia Clínica do HURNP, empregando para a reaçäo de FC a técnica quantitativa de Kolmer com extrato alcóolico de Cysticercus cellulosae como antígeno (Lio Serum); IFI com lâminas contendo fragmentos de parasitas fixados (Lio Serum), conjugado fluorescente anti-IgG humano (Biolab Merieux) e a reaçäo de ELISA, empregando extrato salino do antígeno de Cysticercus cellulosae, segundo padronizaçäo descrita na literatura, e demais reagentes (conjugado enzimático peroxidase, substrato OPD, H2SO4 1 N) da Abbott Laboratories. Como grupo controle utilizou-se de 50 amostras de LCR normais, provenientes de pacientes atendidos em outros serviços do HURNP. Os resultados permitiram classificar as amostras em 2 grupos I - 1281 (82,81 porcento) näo apresentaram nenhuma reaçäo reagente para NCC e II - 263 (17,0 porcento) apresentaram, pelo menos, uma reaçäo imunológica reagente para NCC...