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1.
An Bras Dermatol ; 2021 Oct 04.
Artigo em Inglês | MEDLINE | ID: mdl-34620526

RESUMO

BACKGROUND: There are conflicting data regarding the prognostic value of the lymphatic basin drainage pattern in melanoma patients and the evidence is scant in the setting of negative sentinel lymph node biopsy. OBJECTIVE: To investigate whether the pattern of lymphatic basin drainage influences the risk of nodal disease in patients with melanoma of the trunk and negative sentinel lymph node biopsy. METHODS: A case series of patients with trunk melanomas and negative sentinel lymph node biopsy was retrospectively evaluated. Clinicopathological features, the pattern of lymphatic drainage and nodal, metastatic, and overall recurrence-free survival were reviewed. RESULTS: Of the 135 patients included, multiple lymphatic basin drainage was identified in 61 (45.2%). Ten of the 74 (13.5%) patients with single drainage developed nodal recurrence, compared with 2 of the 61 (3.6%) patients with multiple drainages (p = 0.04). Nodal recurrence-free survival was significantly longer in the group with multiple drainages than in the group with single drainage (175.6 vs. 138.7 months; p = 0.04). In multivariate analysis, single drainage was associated with a higher risk of nodal recurrence (HR = 4.54; p = 0.05). No significant differences in metastatic and overall recurrence-free survival were found between groups. STUDY LIMITATIONS: Retrospective analysis, single-center study, small sample, detailed histopathologic information not always present. CONCLUSIONS: In patients with trunk melanoma and negative sentinel lymph node biopsy, multiple lymphatic basin drainage may be an independent risk factor for nodal disease recurrence. This factor may help to identify patients with negative sentinel lymph node biopsy with a higher risk of nodal recurrence.

2.
Vector Borne Zoonotic Dis ; 21(10): 785-795, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34661486

RESUMO

This study focused on the epidemiological characterization and spatial distribution of bat shelters concerning livestock animal rabies in Paraná State, southern Brazil. A spatiotemporal cluster analysis was performed based on rabies-positive cases and the Desmodus rotundus shelters. A total of 1742 suspect rabies cases submitted for diagnosis from 2011 to 2017 were analyzed; 481 (27.61%) were positive, and 1261 (72.39%) were negative by direct immunofluorescence and biological testing in mice. Out of the positive samples, 413/481 (85.8%) was bovine, 44/481 (9.1%) equine, 6/481 (1.2%) sheep, 5/481 (1.0%) bubaline, and 14/481 (2.9%) were bats. From 22 Regional Units of Agricultural Health, the northeast 129 (26.82%) and central 86 (17.88%) units had the highest recurrence rates of positive cases. Paraná State was continuously endemic for livestock rabies, with the highest caseload seen in the southern-central regions, which was associated with the highest number of vampire bat shelters and natural geographical characteristics favoring bat housing. There was a decrease in the number of rabies cases in livestock in 2013 and 2014. Spatiotemporal analyses of point process mapping and control of D. rotundus shelters and suspected livestock rabies cases in the study area were steady and statistically correlated. However, as bats may travel up to 35-40 km to prey on cattle clusters, bat shelter locations may not be the most sensitive measure of exposure. Furthermore, future studies should consider landscape features such as altitude as potential associated risk factors. Rabies vaccination of livestock and bat hematophagous shelters identification combined with bat control is recommended to increase the efficacy of preventive measures, particularly in natural geographic characteristics favoring local bat housing.

3.
Sci Rep ; 11(1): 16430, 2021 08 12.
Artigo em Inglês | MEDLINE | ID: mdl-34385527

RESUMO

Until there is an effective implementation of COVID-19 vaccination program, a robust testing strategy, along with prevention measures, will continue to be the most viable way to control disease spread. Such a strategy should rely on disparate diagnostic tests to prevent a slowdown in testing due to lack of materials and reagents imposed by supply chain problems, which happened at the beginning of the pandemic. In this study, we have established a single-tube test based on RT-LAMP that enables the visual detection of less than 100 viral genome copies of SARS-CoV-2 within 30 min. We benchmarked the assay against the gold standard test for COVID-19 diagnosis, RT-PCR, using 177 nasopharyngeal RNA samples. For viral loads above 100 copies, the RT-LAMP assay had a sensitivity of 100% and a specificity of 96.1%. Additionally, we set up a RNA extraction-free RT-LAMP test capable of detecting SARS-CoV-2 directly from saliva samples, albeit with lower sensitivity. The saliva was self-collected and the collection tube remained closed until inactivation, thereby ensuring the protection of the testing personnel. As expected, RNA extraction from saliva samples increased the sensitivity of the test. To lower the costs associated with RNA extraction, we performed this step using an alternative protocol that uses plasmid DNA extraction columns. We also produced the enzymes needed for the assay and established an in-house-made RT-LAMP test independent of specific distribution channels. Finally, we developed a new colorimetric method that allowed the detection of LAMP products by the visualization of an evident color shift, regardless of the reaction pH.


Assuntos
Teste para COVID-19/métodos , COVID-19/virologia , Colorimetria/métodos , Técnicas de Diagnóstico Molecular/métodos , Técnicas de Amplificação de Ácido Nucleico/métodos , SARS-CoV-2/isolamento & purificação , COVID-19/diagnóstico , Humanos , Pandemias , Portugal/epidemiologia , RNA Viral/genética , SARS-CoV-2/genética , Saliva/química , Saliva/virologia , Sensibilidade e Especificidade
4.
Dermatol Surg ; 2021 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-34313635

RESUMO

BACKGROUND: The viability of random skin flaps (RSFs) depends on an adequate perfusion pressure to avoid necrosis. Laser speckle contrast imaging is a new method to monitor skin flap microcirculation. OBJECTIVE: The authors aimed to use laser speckle contrast imaging in evaluating the correlation between the perfusion pressure and the length-to-width ratio (LTWR) of RSFs. MATERIALS AND METHODS: Sixty patients submitted to flaps were included: 20 advancement, 20 rotation, and 20 transposition flaps. Laser speckle contrast imaging measurements of perfusion were obtained-after the flaps were planned, dissected, and sutured-from the base to the tip of the flaps, allowing the creation of plot charts and calculation of linear regression equations. RESULTS: Perfusion consistently and significantly decreased with the dissection of all flaps. A significant correlation between LTWR and perfusion was observed in undermined and sutured stages; a mathematical model was then delineated, explaining objectively the drop of perfusion along LTWR, with statistical significance, in all flaps. CONCLUSION: Laser speckle contrast imaging allows accurate, rapid, reproducible, and noncontact measurements of skin blood perfusion over RSF, ultimately leading to an optimization of skin flap planning. This study proves that variation of perfusion pressure along the flap is dependent on the LTWR in a linear decreasing function.

6.
Sci Rep ; 11(1): 11374, 2021 05 31.
Artigo em Inglês | MEDLINE | ID: mdl-34059735

RESUMO

Cell culture models are important tools to study epileptogenesis mechanisms. The aim of this work was to characterize the spontaneous and synchronized rhythmic activity developed by cultured hippocampal neurons after transient incubation in zero Mg2+ to model Status Epilepticus. Cultured hippocampal neurons were transiently incubated with a Mg2+-free solution and the activity of neuronal networks was evaluated using single cell calcium imaging and whole-cell current clamp recordings. Here we report the development of synchronized and spontaneous [Ca2+]i transients in cultured hippocampal neurons immediately after transient incubation in a Mg2+-free solution. Spontaneous and synchronous [Ca2+]i oscillations were observed when the cells were then incubated in the presence of Mg2+. Functional studies also showed that transient incubation in Mg2+-free medium induces neuronal rhythmic burst activity that was prevented by antagonists of glutamate receptors. In conclusion, we report the development of epileptiform-like activity, characterized by spontaneous and synchronized discharges, in cultured hippocampal neurons transiently incubated in the absence of Mg2+. This model will allow studying synaptic alterations contributing to the hyperexcitability that underlies the development of seizures and will be useful in pharmacological studies for testing new drugs for the treatment of epilepsy.

7.
Am. heart j ; (231): 128-136, Jan. 2021. tab
Artigo em Inglês | Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: biblio-1145450

RESUMO

Background The efficacy and safety of rivaroxaban in patients with bioprosthetic mitral valves and atrial fibrillation or flutter remain uncertain. Design RIVER was an academic-led, multicenter, open-label, randomized, non-inferiority trial with blinded outcome adjudication that enrolled 1005 patients from 49 sites in Brazil. Patients with a bioprosthetic mitral valve and atrial fibrillation or flutter were randomly assigned (1:1) to rivaroxaban 20 mg once daily (15 mg in those with creatinine clearance <50 mL/min) or dose-adjusted warfarin (target international normalized ratio 2.0-30.); the follow-up period was 12 months. The primary outcome was a composite of all-cause mortality, stroke, transient ischemic attack, major bleeding, valve thrombosis, systemic embolism, or hospitalization for heart failure. Secondary outcomes included individual components of the primary composite outcome, bleeding events, and venous thromboembolism. Summary RIVER represents the largest trial specifically designed to assess the efficacy and safety of a direct oral anticoagulant in patients with bioprosthetic mitral valves and atrial fibrillation or flutter. The results of this trial can inform clinical practice and international guidelines.


Assuntos
Fibrilação Atrial , Rivaroxabana , Bioprótese , Valva Mitral , Anticoagulantes
9.
Ann Bot ; 127(3): 347-360, 2021 02 09.
Artigo em Inglês | MEDLINE | ID: mdl-33038225

RESUMO

BACKGROUND AND AIMS: The aroid vine Rhodospatha oblongata is characterized by a habitat change from terrestrial to canopy, relying on aerial roots at maturity to obtain water and nutrients from the forest soil. We hypothesize that morphophysiological acclimation occurs in roots as they grow under atmospheric conditions. These changes would guarantee the whole-plant survival of aroid vines in the new and potentially stressful habitat of the canopy. METHODS: Terrestrial and aerial roots were compared on a morphophysiological basis. Root anatomy, water balance, water absorption capacity via fluorescent tracer, and photochemical activity via chlorophyll fluorescence were measured. KEY RESULTS: While thin fasciculate roots occur on terrestrial crawling individuals, two clearly distinct aerial roots (anchor and feeder) are produced on canopy individuals, which both adhere to the host trunk. The colour of both aerial roots changes during development from red and brownish to striped and green at maturity. Colour changes are induced by the replacement of epidermis, exodermis and outer cortex by an inner layer of lignified cork on the root region exposed to the atmosphere. In the root region that is in contact with the host, covering substitutions do not occur and both exodermis and lignified cork, along with several epidermal hairs, appear. Water retention capacity was higher in green roots than in other root types. Rehydration capacity via water absorption by hairs of aerial roots was confirmed by fluorescence. Chlorophyll fluorescence data indicated low levels of photosynthetic capacity in aerial roots. CONCLUSIONS: Plants should evolve strategies to survive stress situations. The transition from soil to canopy imposes abiotic changes and potentially stressful situations on R. oblongata. We conclude that the morphophysiological changes observed represent an important strategy that permits the maintenance of aroid roots and the survival of R. oblongata in the canopy.


Assuntos
Araceae , Solo , Clima , Ecossistema , Fotossíntese , Raízes de Plantas
10.
Am Heart J ; 231: 128-136, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33045224

RESUMO

The efficacy and safety of rivaroxaban in patients with bioprosthetic mitral valves and atrial fibrillation or flutter remain uncertain. DESIGN: RIVER was an academic-led, multicenter, open-label, randomized, non-inferiority trial with blinded outcome adjudication that enrolled 1005 patients from 49 sites in Brazil. Patients with a bioprosthetic mitral valve and atrial fibrillation or flutter were randomly assigned (1:1) to rivaroxaban 20 mg once daily (15 mg in those with creatinine clearance <50 mL/min) or dose-adjusted warfarin (target international normalized ratio 2.0-30.); the follow-up period was 12 months. The primary outcome was a composite of all-cause mortality, stroke, transient ischemic attack, major bleeding, valve thrombosis, systemic embolism, or hospitalization for heart failure. Secondary outcomes included individual components of the primary composite outcome, bleeding events, and venous thromboembolism. SUMMARY: RIVER represents the largest trial specifically designed to assess the efficacy and safety of a direct oral anticoagulant in patients with bioprosthetic mitral valves and atrial fibrillation or flutter. The results of this trial can inform clinical practice and international guidelines.


Assuntos
Fibrilação Atrial/complicações , Flutter Atrial/complicações , Bioprótese , Inibidores do Fator Xa/uso terapêutico , Próteses Valvulares Cardíacas , Valva Mitral , Rivaroxabana/uso terapêutico , Trombose/prevenção & controle , Administração Oral , Aspirina/administração & dosagem , Bioprótese/efeitos adversos , Brasil , Causas de Morte , Creatinina/metabolismo , Embolia , Inibidores do Fator Xa/administração & dosagem , Inibidores do Fator Xa/efeitos adversos , Próteses Valvulares Cardíacas/efeitos adversos , Hemorragia/induzido quimicamente , Hospitalização , Humanos , Ataque Isquêmico Transitório , Rivaroxabana/administração & dosagem , Rivaroxabana/efeitos adversos , Tamanho da Amostra , Acidente Vascular Cerebral , Procedimentos Cirúrgicos Operatórios , Trombose/etiologia , Resultado do Tratamento , Varfarina/administração & dosagem , Varfarina/efeitos adversos , Varfarina/uso terapêutico
11.
Gen Dent ; 69(1): 70-76, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33350959

RESUMO

This study compared the impact of conventional oral health education with that of combined conventional and digital education on the oral hygiene outcomes and habits of children and adolescents. A double-blind, parallel, randomized controlled prevention clinical trial with 2 arms involved 80 students aged 10 to 17 years old. Students were randomly allocated to the control group (n = 40), which received conventional oral health education, or the experimental group (n = 40), which received both conventional oral health education and digital educational content through WhatsApp Messenger. Before the randomization of the groups and after the conclusion of the educational interventions, 2 examiners (κ > 0.7) who were blinded as to the groups evaluated the students and recorded the Plaque Index (PI); Gingival Bleeding Index (GBI); number of decayed, missing, and filled permanent teeth (DMFT); and number of decayed, missing, and filled primary teeth (dmft). The toothbrushing and flossing habits of the students were evaluated through questionnaires. The Fisher exact test, chi-square test, Mann-Whitney U test, Wilcoxon test for paired samples, and sign test were applied to the data (α = 0.05). After 3 students in the control group were excluded because they received fixed orthodontic appliances, 37 students participated in the control group and 40 in the experimental group. Both groups presented a 30% reduction in PI (P < 0.001) after the interventions. The experimental group flossed significantly more frequently (P = 0.003) than the control group. The interventions had no statistically significant effect on GBI, and there were no significant differences in toothbrushing frequency after interventions or between groups. Both approaches to oral health education-conventional and digital-had a positive impact on the reduction of the PI, and the use of a smartphone app seemed to be an effective resource for providing oral health education to students. Trial registration: Registro Brasileiro de Ensaios Clinicos (ReBEC) No. U1111-1216-4770.


Assuntos
Cárie Dentária , Mídias Sociais , Adolescente , Criança , Método Duplo-Cego , Hábitos , Humanos , Higiene Bucal , Escovação Dentária
12.
Hist. enferm., Rev. eletronica ; 11(1): 22-33, 20200000.
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1284413

RESUMO

Estudo epistemológico delineado à luz do modelo evolucionário de análise/exploração de conceito de Beth Rodgers, que explorou a reverberação dos fenômenos do conceito principal - História da Enfermagem, na perspectiva de evidenciar novos conceitos (unidades de conhecimento) dele derivados e agrupados segundo os cinco componentes do processo de trabalho da Enfermagem. Tem como objetivo propor uma taxonomia do conhecimento sobre História da Enfermagem, a partir da análise da produção científica brasileira, disponível nos Catálogos de Teses e Dissertações do CEPEn/ABEn desde 1963. Foram classificados 204 produtos sobre História da Enfermagem datados de 1988-2015, segundo as variáveis: objeto de estudo, fontes, descritores, método, titulação, ano de defesa, orientador, localização geográfica e programa de procedência, possibilitando delinear essa produção, e propor a Taxonomia do Conhecimento sobre História da Enfermagem derivada de sua análise. A maior parte da produção se dedicou à História do Ensino, da Participação Política e da Administração em Enfermagem. A proposta buscou inovar na apresentação dos achados, dando perspectiva epistemológica ao saber científico tratado no conceito geral de História da Enfermagem, resultando em um modelo de taxonomia do conhecimento que integra 30 unidades de conhecimento do saber científico derivado do conceito geral de História da Enfermagem, segundo cinco componentes do processo de trabalho da Enfermagem. O produto apresentado é uma primeira proposta que deverá ser validada e aperfeiçoada pelas críticas emanadas pela comunidade científica da Enfermagem.


Assuntos
História do Século XX , Classificação , Conhecimento , História da Enfermagem , Ensino , Atividades Científicas e Tecnológicas
14.
J Immunol ; 204(12): 3149-3159, 2020 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-32376646

RESUMO

Decidual NK cells (dNK) are the main lymphocyte population in early pregnancy decidual mucosa. Although dNK decrease during pregnancy, they remain present in decidual tissues at term. First trimester dNK facilitate trophoblast invasion, provide protection against infections, and were shown to have many differences in their expression of NKRs, cytokines, and cytolytic capacity compared with peripheral blood NK cells (pNK). However, only limited data are available on the phenotype and function of term pregnancy dNK. In this study, dNK from human term pregnancy decidua basalis and decidua parietalis tissues were compared with pNK and first trimester dNK. Profound differences were found, including: 1) term pregnancy dNK have an increased degranulation response to K562 and PMA/ionomycin but lower capacity to respond to human CMV-infected cells; 2) term pregnancy dNK are not skewed toward recognition of HLA-C, as was previously shown for first trimester dNK; and 3) protein and gene expression profiles identified multiple differences between pNK, first trimester, and term pregnancy dNK, suggesting term pregnancy dNK are a distinct type of NK cells. Understanding the role of dNK throughout pregnancy is of high clinical relevance for studies aiming to prevent placental inflammatory disorders as well as maternal-to-fetal transmission of pathogens.


Assuntos
Decídua/imunologia , Células Matadoras Naturais/imunologia , Linhagem Celular Tumoral , Movimento Celular/imunologia , Células Cultivadas , Feminino , Expressão Gênica/imunologia , Antígenos HLA-C/imunologia , Humanos , Células K562 , Gravidez , Trofoblastos/imunologia
15.
J Anim Sci ; 98(5)2020 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-32386223

RESUMO

Methods have been developed to measure the effectiveness of many roughages, but few evaluations have been conducted with tropical feeds. The objectives of this research were to determine the effectiveness of roughage sources based on bioassay and laboratory methods and identify the biological attributes of the diets that correlate with these methods. Six ruminally cannulated Nellore steers (408 ± 12 kg of BW) were randomly assigned to a 6 × 6 Latin square design within six diets: negative control diet (NC) with aNDF as 10% from corn silage (CS); positive control diet (PC) with aNDF as 20% from CS; and four diets containing 10% aNDF from CS and 10% aNDF from each of the following sources: sugarcane (SC), sugarcane bagasse (SCB), soybean hulls (SH), or low oil cottonseed hulls (LOCH). Physical effectiveness factor (pef, related to the physical characteristics of aNDF) and effectiveness factor (ef, related to the ruminal pH) were determined based on a linear model approach that uses a bioassay method in which CS aNDF was assumed to be the standard fiber source. Laboratory methods to estimate pef of roughage sources were based on the proportion of DM of roughage retained on a 1.18-mm sieve pef(>1.18 mm) or retained on the 8.0-mm Penn State Particle Separator screen pef(>8.0 mm). The pef calculated by the bioassay method (total chewing time and ruminal mat resistance) for CS, SCB, and SC were higher values (P < 0.05) compared with SH and LOCH. The pef(rumen mat) of SC and SCB were higher (P < 0.05) than that of CS, SH, and LOCH. The pef(rumen mat) of LOCH was 61% higher than SH. The ef(rumen pH) of SC and LOCH was higher (P < 0.05) than CS and SH. The pef(chewing, min/d), pef(chewing, min/kg of DM), pef(rumen mat), and ef(rumen pH) positively correlated with rumination time, total chewing time, and ruminal mat resistance (values from transit time in seconds). No correlation was observed (P > 0.05) between pef(>8.0 mm) and rumination time, chewing time, and ruminal pH. The pef calculated using the bioassay method as well as pef (>8.0 mm) were negatively correlated with rumen pH (P > 0.05). The values of the effectiveness of fiber sources obtained in this research can be used as a guideline for nutritionists aiming to replace roughage sources from tropical regions in beef cattle finishing diets. Under our conditions, the pef using the bioassay method or laboratory methods were not adequate in predicting ruminal pH.


Assuntos
Bovinos/fisiologia , Fibras na Dieta/análise , Silagem/análise , Animais , Bioensaio/veterinária , Celulose , Óleo de Sementes de Algodão , Dieta/veterinária , Ingestão de Alimentos , Comportamento Alimentar , Concentração de Íons de Hidrogênio , Masculino , Rúmen/metabolismo , Saccharum , Soja , Zea mays
16.
J Anim Sci ; 98(5)2020 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-32386225

RESUMO

The objectives of this research were to evaluate the effects of source and concentration of α-amylase-treated neutral detergent fiber (aNDF) from roughage on feed intake, ingestive behavior, and ruminal kinetics in beef cattle receiving high-concentrate diets. Six ruminally cannulated Nellore steers (408 ± 12 kg of body weight) were randomly assigned to a 6 × 6 Latin square design with six diets: 10% aNDF from corn silage (10CS); 20% aNDF from corn silage (20CS); or four diets containing 10% aNDF from corn silage and 10% aNDF from one of the following sources: sugarcane (SC), sugarcane bagasse (SCB), soybean hulls (SH), or low oil cottonseed hulls (LOCH). The parameters of passage and degradation kinetics were estimated based on a two-compartmental model with gamma- and exponential-distributed residence times. The nonlinear models were fitted by nonlinear least squares, and a linear mixed-effects model was fitted to all variables measured from the Latin square design that were related to intake, digestibility, digestion kinetic parameters, and residence times. Mean particle size (MPS) between roughage sources (CS, SCB, and SC) and coproducts (SH and LOCH) was affected (P < 0.05). Dry matter intake (DMI) was not affected (P > 0.05) by 20CS, SC, SH, or LOCH. Steers fed 20CS or LOCH diets had 16% and 20% greater DMI, respectively, (P < 0.05) than steers fed 10CS diet. Steers fed SCB consumed the least dry matter (DM). The SH and LOCH diets had lower MPS values (about 8.77 mm) in comparison to 20CS, SCB, and SC diets (about 13.08 mm) and, consequently, affected (P < 0.05) rumen content, ruminal in situ disappearance, nutrient digestibility, and solid fractional passage rate. Chewing time was affected (P < 0.05) by roughage sources and concentration. Lower values of distance travel inside the rumen (min/cm) were observed (P < 0.05) for the SCB and SC diets in comparison with any other diet. Except for SCB, there was no difference (P > 0.05) in rumen fill, among other treatments. Mean daily ruminal pH was not affected (P > 0.05) by 20CS, SCB, SC, and LOCH diets, and it ranged from 6.1 to 6.23. Total short-chain fatty acids concentration was affected (P < 0.05) by roughage source and concentration. Based on our results, we recommend that under Brazilian finishing diets, replacing roughage sources, except for SCB, based on aNDF concentration of the roughage in high-concentrate diets containing finely ground flint corn does not affect DMI.


Assuntos
Bovinos/fisiologia , Fibras na Dieta/análise , Ácidos Graxos Voláteis/análise , Comportamento Alimentar , Silagem/análise , Animais , Celulose , Óleo de Sementes de Algodão , Dieta/veterinária , Ingestão de Alimentos , Cinética , Masculino , Rúmen/metabolismo , Saccharum , Soja , Zea mays
17.
J Clin Aesthet Dermatol ; 13(3): 17-19, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32308791

RESUMO

Hailey-Hailey disease (HHD), or chronic benign familial pemphigus, is a rare inherited acantholytic dermatosis, characterized by chronic, recurrent vesicles, erosions, and maceration in intertriginous sites. We present a case of a male patient with longstanding HHD who presented with an acute exacerbation characterized by the worsening of pre-existing lesions but also with the appearance of new large, tense bullae on an erythematous base in the areas of the groin (i.e., inguinal region), trunk, and arms, associated with intense pruritus. Blood work revealed eosinophilia. Histopathology and direct immunofluorescence were compatible with the diagnosis of bullous pemphigoid (BP). Indirect immunofluorescence showed positivity for autoantibodies to BP antigen 180. We started oral methylprednisolone, oral antihistamines, and local care with potassium permanganate baths, a potent corticosteroid, and fusidic acid, with resulting improvement of the lesions. The case was further complicated by the occurrence of eczema herpeticum, which was successfully treated with acyclovir. At the time of discharge from the hospital, the patient was medicated with a low dose of oral steroid and oral doxycycline. During a later examination, the lesions had totally disappeared, but the skin had some residual hyperpigmented patches and excoriated papules. This case was a diagnostic challenge due to the simultaneous occurrence of three distinct bullous diseases with different etiopathogeneses. To our knowledge, there are no other reports of the coexistence of HHD and BP in the literature.

18.
Eur J Cancer ; 128: 60-82, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32113941

RESUMO

Invasive cutaneous squamous cell carcinoma (cSCC) is one of the most common cancers in the white populations, accounting for 20% of all cutaneous malignancies. Factors implicated in cSCC etiopathogenesis include ultraviolet radiation exposure and chronic photoaging, age, male sex, immunosuppression, smoking and genetic factors. A collaboration of multidisciplinary experts from the European Dermatology Forum (EDF), the European Association of Dermato-Oncology (EADO) and the European Organisation of Research and Treatment of Cancer (EORTC) was formed to update recommendations on cSCC classification, diagnosis, risk stratification, staging and prevention, based on current literature, staging systems and expert consensus. Common cSCCs are typically indolent tumors, and most have a good prognosis with 5-year cure rates of greater than 90%, and a low rate of metastases (<4%). Further risk stratification into low-risk or high-risk common primary cSCC is recommended based on proposed high-risk factors. Advanced cSCC is classified as locally advanced (lacSCC), and metastatic (mcSCC) including locoregional metastatic or distant metastatic cSCC. Current systems used for staging include the American Joint Committee on Cancer (AJCC) 8th edition, the Union for International Cancer Control (UICC) 8th edition, and Brigham and Women's Hospital (BWH) system. Physical examination for all cSCCs should include total body skin examination and clinical palpation of lymph nodes, especially of the draining basins. Radiologic imaging such as ultrasound of the regional lymph nodes, magnetic resonance imaging (MRI), computed tomography (CT), positron emission tomography-computed tomography (PET-CT) scans are recommended for staging of high-risk cSCC. Sentinel lymph node biopsy is currently not recommended. Nicotinamide, oral retinoids, and topical 5-FU have been used for the chemoprevention of subsequent cSCCs in high-risk patients but are not routinely recommended. Education about sun protection measures including reducing sun exposure, use of protective clothing, regular use of sunscreens and avoidance of artificial tanning, is recommended.


Assuntos
Carcinoma de Células Escamosas/diagnóstico , Consenso , Dermatologia/normas , Oncologia/normas , Neoplasias Cutâneas/diagnóstico , Carcinoma de Células Escamosas/etiologia , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/prevenção & controle , Humanos , Linfonodos/diagnóstico por imagem , Imageamento por Ressonância Magnética/normas , Estadiamento de Neoplasias/normas , Educação de Pacientes como Assunto/normas , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/normas , Roupa de Proteção/normas , Medição de Risco/normas , Pele/diagnóstico por imagem , Pele/patologia , Neoplasias Cutâneas/etiologia , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/prevenção & controle , Sociedades Médicas/normas , Luz Solar/efeitos adversos , Protetores Solares/administração & dosagem , Ultrassonografia/normas
19.
Eur J Cancer ; 128: 83-102, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32113942

RESUMO

In order to update recommendations on treatment, supportive care, education and follow-up of patients with invasive cutaneous squamous cell carcinoma (cSCC), a multidisciplinary panel of experts from the European Dermatology Forum, the European Association of Dermato-Oncology and the European Organization of Research and Treatment of Cancer was formed. Recommendations were based on evidence-based literature review, guidelines and expert consensus. Treatment recommendations are presented for common primary cSCC (low risk, high risk), locally advanced cSCC, regional metastatic cSCC (operable or inoperable) and distant metastatic cSCC. For common primary cSCC (the most frequent cSCC type), first-line treatment is surgical excision with postoperative margin assessment or microscopically controlled sugery. Safety margins containing clinical normal-appearing tissue around the tumour during surgical excision and negative margins as reported in the pathology report are necessary to minimise the risk of local recurrence and metastasis. In case of positive margins, a re-excision shall be done, for operable cases. Lymph node dissection is recommended for cSCC with cytologically or histologically confirmed regional nodal involvement. Radiotherapy should be considered as curative treatment for inoperable cSCC, or for non-surgical candidates. Anti-PD-1 antibodies are the first-line systemic treatment for patients with metastatic or locally advanced cSCC who are not candidates for curative surgery or radiation, with cemiplimab being the first approved systemic agent for advanced cSCC by the Food and Drug Administration/European Medicines Agency. Second-line systemic treatments for advanced cSCC include epidermal growth factor receptor inhibitors (cetuximab) combined with chemotherapy or radiation therapy. Multidisciplinary board decisions are mandatory for all patients with advanced disease who require more than surgery. Patients should be engaged with informed decisions on management and be provided with best supportive care to optimise symptom management and improve quality of life. Frequency of follow-up visits and investigations for subsequent new cSCC depend on underlying risk characteristics.


Assuntos
Carcinoma de Células Escamosas/terapia , Procedimentos Cirúrgicos Dermatológicos/normas , Dermatologia/normas , Oncologia/normas , Neoplasias Cutâneas/terapia , Assistência ao Convalescente/normas , Anticorpos Monoclonais Humanizados/uso terapêutico , Antineoplásicos Imunológicos/uso terapêutico , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/etiologia , Carcinoma de Células Escamosas/patologia , Quimiorradioterapia/métodos , Quimiorradioterapia/normas , Tomada de Decisão Clínica , Consenso , Humanos , Excisão de Linfonodo , Linfonodos/diagnóstico por imagem , Linfonodos/patologia , Linfonodos/cirurgia , Margens de Excisão , Estadiamento de Neoplasias/normas , Cuidados Paliativos/normas , Equipe de Assistência ao Paciente/normas , Educação de Pacientes como Assunto/normas , Pele/diagnóstico por imagem , Pele/patologia , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/etiologia , Neoplasias Cutâneas/patologia , Sociedades Médicas/normas , Luz Solar/efeitos adversos
20.
Eur J Cancer ; 126: 141-158, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31928887

RESUMO

Cutaneous melanoma (CM) is potentially the most dangerous form of skin tumor and causes 90% of skin cancer mortality. A unique collaboration of multidisciplinary experts from the European Dermatology Forum (EDF), the European Association of Dermato-Oncology (EADO), and the European Organization of Research and Treatment of Cancer (EORTC) was formed to make recommendations on CM diagnosis and treatment, based on systematic literature reviews and the experts' experience. The diagnosis of melanoma can be made clinically and shall always be confirmed through dermatoscopy. If a melanoma is suspected, a histopathological examination is required. Sequential digital dermatoscopy and full-body photography can be used in risk persons to detect the development of melanomas at an earlier stage. Where available, confocal reflectance microscopy can improve clinical diagnosis in special cases. Melanoma shall be classified according to the 8th version of the AJCC classification. Thin melanomas up to 0.8 mm tumor thickness does not require further imaging diagnostics. From stage IB onwards, examinations with lymph node sonography are recommended, but no further imaging examinations. From stage IIC whole-body examinations with CT or PET-CT in combination with brain MRI are recommended. From stage III and higher, mutation testing is recommended, particularly for BRAF V600 mutation. It is important to provide a structured follow-up to detect relapses and secondary primary melanomas as early as possible. There is no evidence to support the frequency and extent of examinations. A stage-based follow-up scheme is proposed, which, according to the experience of the guideline group, covers the minimum requirements; further studies may be considered. This guideline is valid until the end of 2021.


Assuntos
Diagnóstico por Imagem/normas , Comunicação Interdisciplinar , Melanoma/diagnóstico , Melanoma/terapia , Guias de Prática Clínica como Assunto/normas , Terapia Combinada , Consenso , União Europeia , Humanos , Melanoma/classificação , Estadiamento de Neoplasias
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