Investigação de marcadores moleculares sanguíneos durante a infecção pelo vírus Chikungunya / Investigation of blood molecular markers during Chikungunya virus infection

A febre Chikungunya (CHIKF) é uma infecção viral causada pelo vírus Chikungunya (CHIKV). Os sintomas agudos incluem febre alta de início súbito, erupção cutânea, poliartrite e poliartralgia. Embora a infecção geralmente seja resolvida em menos de duas semanas, muitos pacientes experenciam recorrente dor e inflamação nas articulações, que podem persistir por anos. Esse estudo buscou marcadores moleculares no sangue de infectados pelo CHIKV que estejam associados a dor articular e cronicidade da CHIKF. O sequenciamento de receptores de células B (BCR) e T (TCR) demonstrou que a infecção por CHIKV diminui a diversidade desses receptores. Essa diversidade é ainda menor, durante a fase aguda da infecção, naqueles pacientes que irão desenvolver cronicidade. A menor diversidade de BCR em infectados está associada a um aumento na expressão de genes envolvidos na diferenciação e ativação de osteoclastos pela sinalização RANK/RANKL. Em adição, a cronicidade pode estar relacionada um aumento na expressão do gene ZBTB7A cuja expressão confere maior resistência a apoptose em precursores de osteoclastos naqueles pacientes que vão se tornar crônicos. Caso o envolvimento dos osteoclastos durante a patogênese de CHIKF seja confirmado, os pacientes poderão se beneficiar de abordagens terapêuticas já existentes como alternativas adicionais ao tratamento de CHIKF

Chikungunya fever (CHIKF) is a viral infection caused by the Chikungunya virus (CHIKV). Acute symptoms include sudden-onset high fever, rash, polyarthritis, and polyarthralgia. Although the infection usually resolves within two weeks, many patients experience recurrent joint pain and inflammation, which can persist for years. This study sought molecular markers in the blood of CHIKV-infected individuals that are associated with joint pain and chronicity of CHIKF. Sequencing of B (BCR) and T (TCR) cell receptors demonstrated that CHIKV infection decreases the diversity of these receptors. The diversity is even lower, during the acute phase of the infection, in those patients who will develop chronicity. The lower diversity of BCR in infected individuals is associated with an increase in the expression of genes involved in the differentiation and activation of osteoclasts by RANK/RANKL signaling. In addition, chronicity may be related to an increase in the expression of the ZBTB7A gene whose expression confers greater resistance to apoptosis in osteoclast precursors in those patients who will become chronic. If osteoclast role during CHIKF pathogenesis is confirmed, patients may benefit from existing therapeutic approaches as additional alternatives to CHIKF treatment

Cáncer de próstata de bajo riesgo e intermedio: opciones de tratamiento / Low and intermediate risk prostate cancer: Treatment options

Los pacientes con cáncer de próstata de bajo riesgo e intermedio constituyen el grupo más frecuentemente diagnosticado en la actualidad. En aquellos con una esperanza de vida inferior a 10 años es muy probable que cualquier tratamiento sea innecesario por lo que la observación debe ser la aproximación más apropiada. En los pacientes en los que esté indicada alguna forma de terapia activa es necesario llevar a cabo un balance entre los riesgos de morir o desarrollar metástasis por la enfermedad y los efectos adversos de los tratamientos radicales comúnmente aceptados, como la prostatectomía radical y la radioterapia externa o intersticial. La significativa incidencia de morbilidad asociada, fundamentalmente disfunción eréctil e incontinencia urinaria, de alto impacto en la calidad de vida, exige esta aproximación en el ámbito de decisiones compartidas con los pacientes. El riesgo de sobretratamiento en este grupo de pacientes ha dado lugar a la introducción de abordajes más conservadores como el seguimiento activo y la terapia focal. El primero, trata de demorar los tratamientos radicales en tanto no existan criterios de agresividad suficiente por parte del tumor o el paciente los solicite. El segundo, que está llamado a ocupar un lugar entre el seguimiento activo y los tratamientos radicales, consiste en llevar a cabo una ablación parcial de la próstata para evitar los efectos adversos de los tratamientos radicales, tratando de lograr un control oncológico lo más similar posible al obtenido con estos

Patients with low and intermediate risk prostate cancer are the most frequently diagnosed group currently. In those with a life expectancy inferior to 10 years it is highly likely that treatment is not necessary so that observation must be the most appropriate approach. In patients in whom active therapy, in any of its forms, is indicated, it is necessary to balance between risk of dying or developing metastases from the disease and adverse effects of commonly accepted radical treatments, such as radical prostatectomy and external beam or interstitial radiotherapy. The significant incidence of associated morbidity, mainly erectile dysfunction and urinary incontinence, with high impact on quality of life, demands this approach in the field of decisions shared with patients. The risk of overtreatment in this group of patients has generated the introduction of more conservative approaches such as active surveillance and focal therapy. The first one tries to differ radical treatments as far as there are not enough aggressiveness criteria on the tumor or the patient requests them. The second, called to have a place between active surveillance and radical treatments, involves the performance of a partial ablation of the prostate to avoid the adverse effects of radical treatments, trying to achieve the closest oncological control to the radical options. We perform a review of the therapeutic options and their results in this type of patients

Modalidades de imágen en Terapia Focal: Ecografía Multiparamétrica / Imaging diagnosis in Focal Therapy for prostate cancer: Multiparametric Magnetic Resonance Imaging

El uso de la imagen por Resonancia magnética multiparamétrica (RMmp) de próstata ha aumentado de forma significativa en los últimos años, y ha emergido como una prueba crucial en el diagnóstico, estadiaje y tratamiento del cáncer de próstata (CaP). El empleo de las distintas secuencias disponibles (T2W, T1W, difusión, perfusión y espectroscopia), así como de los diferentes parámetros que asocian, permiten no sólo determinar el grupo de pacientes subsidiarios de terapias ablativas focales, sino realizar una correcta determinación de las áreas a tratar, así como monitorizar el desarrollo de la terapia, y evaluar tanto los resultados oncológicos como los posibles fallos terapeúticos. A pesar de los excelentes resultados mostrados en los distintos estudios, es preciso alcanzar un consenso sobre su utilización en los distintos aspectos asociados al tratamiento focal, dado que es una técnica que requiere no sólo amplia experiencia en su manejo sino que precisa de una estandarización, que en el momento actual la convierten en una técnica compleja y no exenta de dificultad en su interpretación

The use of prostatic multiparametric MRI (mpMRI) has increased significantly over the last years, and has emerged as a crucial test for diagnosis, staging and treatment of prostate cancer (PCa). The use of the various available sequences (T2W, T1W, diffusion, perfusion and spectroscopy), as well as the different parameters they associate, not only enables to determine the group of patients subsidiary of focal ablative therapy, but also to perform a proper determination of the áreas to treat, as well as to monitor the development of therapy and to evaluate both oncological results and possible therapeutic failures. Despite the excellent results showed in the different studies, it is necessary to reach a consensus about its use on the different features associated with focal therapy, since it is a technique that requires not only large experience in its operation but also standardization. All this make it a complex technique and not free of difficulties in its interpretation

Ablación Focal con Láser y Terapia Vascular Fotodinámica con TOOKAD® soluble, en el tratamiento del cáncer de próstata de bajo riesgo / Focal Laser Ablation and Photodynamic Vascular Therapy with soluble TOOKAD® in the treatment of low risk prostate cancer

El incremento en el diagnóstico de Cáncer de Próstata (CaP) de bajo riesgo se traducen una nueva entidad clínica, para la cual, la vigilancia activa puede no ser siempre suficiente y para la que las terapias convencionales suponen un claro sobre-tratamiento. Ante la necesidad de dar una respuesta terapéutica a estos pacientes, y facilitado por los avances tecnológicos en el campo de la imagen y nuevas fuentes de energía, el interés se centra ahora en el desarrollo clínico de las terapias focales, como una alternativa de mínima comorbilidad y oncológicamente segura. Como parte de la revisión llevada a cabo por este monográfico, este artículo se centrará en aspectos referentes al desarrollo pre-clínico y clínico de la terapia ablativa con láser y de la novedosa terapia vascular fotodinámica con TOOKAD® Soluble. Con esta finalidad, se realizó una exhaustiva búsqueda bibliográfica, actualizada en Febrero de 2016, de las mayores bases reprográficas, incluyendo publicaciones originales y revisiones referentes al objeto de esta revisión, sin restricciones por año de publicación. Este artículo revisa el desarrollo pre- y clínico de estas novedosas técnicas ablativas en el campo de la terapia focal del CaP de bajo riesgo

The increase of the diagnosis of low risk prostate cancer translates into a new clinical entity, for which active surveillance may not be always enough and conventional therapies are clearly overtreatment. Faced with the necessity of giving a therapeutic answer to these patients, and facilitated by the technological advances in the imaging field and new energy sources, the interest is centered in the clinical development of focal therapies as an alternative with minimal morbidity and oncologically safe. As a part of the review carried out in this monographic issue, this article focus on the features relative to the preclinical and clinical development of laser ablative therapy and the innovative photodynamic vascular therapy with soluble TOOKAD®. With this aim we performed an exhaustive bibliographic search, updated to February 2016, in the greater databases, including original articles and reviews in reference to the object of this review, without restrictions for year of publication. This article reviews the preclinical and clinical development of these innovative ablative techniques in the field of focal therapy for low risk prostate cáncer

Cementoblastoma: oito novos casos, revisão da literatura e considerações sobre melhor manejo clínico / Cementoblastoma: report of eight cases, literature review and considerations of best approach

Cementoblastoma é um tumor odontogênico benigno incomum de origem mesenquimalque usualmente afeta ossos gnáticos de indivíduos jovens, produzindo dor ou desconforto. Pode ser erroneamente diagnosticado como outras lesões, devido sua variada apresentação clínica era diográfica. Frequentemente o tratamento sugerido é a ressecção tumoral em conjunto como dente associado. Entretanto, abordagem mais conservadora pode ser uma opção em alguns casos assintomáticos e estáveis, como observado neste estudo. Apresentamos oito novos casos e uma breve revisão da literatura a fim de melhor caracterizar o comportamento biológico desta relativamente rara lesão.

Cementoblastoma is an uncommon benign odontogenic tumour of mesenchymal originthat affects the jaws of generally young persons, producing pain or discomfort. It may be mistakenfor several other lesions, due to its varied clinical and radiographic features. The suggestedtreatment is often tumour resection in conjunction with the associated tooth. However, a moreconservative approach could be an option in asymptomatic and stable lesions as seen in thepresent study. Eight new cases and a brief review of the literature are presented here to bettercharacterize the biological behavior of this relatively rare lesion.

Fiabilidad en la evaluación radiológica de la calcificación aórtica abdominal mediante la escala de 24 puntos / Reliability of radiologic evaluation of abdominal aortic calcification using the 24-point scale

Objetivo. La calcificación de la aorta abdominal se asocia a un incremento en el riesgo de morbilidad cardiovascular, y disponer de un método de cuantificación de la misma es clínicamente trascendente. La escala de 24 puntos (AAC-24) es el método estándar para su evaluación en la radiología simple lateral de columna lumbar. El objetivo del estudio ha sido conocer el nivel de acuerdo intra e interobservador que aporta esta escala, teniendo en cuenta la heterogeneidad de la distribución de las calcificaciones en el diseño del análisis estadístico. Material y métodos. Se analizó la concordancia intraobservador (sobre radiografías de 81 pacientes, con una separación de 4 años) y la concordancia interobservador (sobre radiografías de 100 pacientes, con tres evaluadores), utilizando simultáneamente la correlación intraclase y el método gráfico de Bland-Altman. Resultados. El coeficiente de correlación intraclase fue de 0,93 (intervalo de confianza al 95% [IC95%]: 0,6-0,9) y 0,91 (IC95%: 0,8-0,9), intra e interobservador, respectivamente, con un incremento del coeficiente en el tercil de mayor discrepancia. La diferencia de medias osciló entre 0,3 y-1,2 puntos. La amplitud entre los límites de acuerdo, entre 4,7 y 9,4 puntos. Se observó un aumento significativo de las diferencias en relación con el aumento progresivo de la calcificación. Conclusiones. La valoración de la calcificación de la aorta abdominal en radiología simple lateral de columna lumbar mediante la escala AAC-24 es un método fiable y reproducible, observándose un mayor grado de concordancia intra e interobservador en las fases iniciales de la calcificación (AU)

Objective. Calcification of the abdominal aorta is associated with increased cardiovascular morbidity, so a reliable method to quantify it is clinically transcendent. The 24-point scale (AAC-24) is the standard method for assessing abdominal aortic calcification on lateral plain films of the lumbar spine. The aim of this study was to determine the intraobserver and interobserver agreements for the AAC-24, taking into account the heterogeneity of the distribution of the calcifications in the design of the statistical analysis. Material and methods. We analyzed the intraobserver agreement (in plain films from 81 patients, with a four-year separation between observations) and the interobserver agreement (in plain films from 100 patients, with three observers), using both intraclass correlation and Bland-Altman plots. Results. The intraobserver intraclass correlation coefficient was 0.93 (95% confidence interval [CI95%]: 0.6-0.9), and the interobserver intraclass correlation coefficient was 0.91 (CI95%: 0.8-0.9) with an increase in the coefficient in the tercile with the greatest discrepancy. The difference in means ranged from 0.3 to 1.2 points, and the distance between the limits of agreement ranged from 4.7 to 9.4 points. These differences increased significantly as the calcification progressed. Conclusions. Using the AAC-24 on lateral plain films of the lumbar spine is a reliable and reproducible method of assessing calcification of the abdominal aorta; both intraobserver and interobserver agreement are higher during the initial phases of calcification (AU)

68Ga-DOTANOC PET/CT detection of multiple extracranial localizations in a patient with anaplastic meningioma / Uso de 68Ga-DOTANOC PET/TC en la detección de localizaciones extracraneales múltiples en un paciente con meningioma anaplásico

We report herein a case of a 65-year-old male with intracranial recurrence of atypical meningioma initially treated with a combination of surgical resection and gamma knife radiotherapy. Afterwards, he underwent a 68Ga-DOTANOC PET/CT scan in order to evaluate the feasibility of peptide receptor radionuclide therapy (PRRT). The scan identified multiple pulmonary, pleural and lymph node localizations. Histological diagnosis was consistent with intracranial atypical meningioma with diffuse metastatic spread. In our case, we have shown that meningioma with extracranial locations may present high uptake of somatostatin receptor analogues. Among other radionuclides, we believe that 68Ga-DOTANOC PET/CT may be particularly useful for staging, detection of recurrence, evaluation of disease extension and alternative therapeutic approaches (AU)

Presentamos el caso de un varón de 65 años de edad, con recurrencia intracraneal de meningioma atípico tratada inicialmente con una combinación de resección quirúrgica y radioterapia bisturí de rayos gamma. Después se sometió a una exploración 68Ga-DOTANOC PET/TC con el fin de evaluar la viabilidad de la terapia metabólica con el receptor del péptido (PRRT). Se identificaron múltiples localizaciones en pulmón, pleura y ganglios linfáticos. El diagnóstico histológico fue compatible con meningioma atípico intracraneal y diseminación metastásica difusa. Se ha demostrado con nuestro caso que meningioma con localizaciones extracraneales puede presentar alta captación de análogos de los receptores de somatostatina. Entre otros radiotrazadores creemos que 68Ga-DOTANOC PET/TC puede ser particularmente útil en la estadificación, detección de la recurrencia, la evaluación de la extensión de la enfermedad y los enfoques terapéuticos alternativos (AU)

Efeitos da ginástica laboral sobre a força de preensão palmar e queixas de dores musculares em auxiliares de produção de uma indústria alimentícia / Effects of stretching-break in the hand grip force and muscles pain in workers of a food industry production department

A ginástica laboral (GL) consiste em exercícios específicos de alongamento e relaxamento, atuando de forma preventiva e terapêutica entre os trabalhadores. Uma das classes mais acometidas pela dor muscular é o auxiliar de produção, com o principal movimento de preensão palmar. O objetivo deste estudo consistiu em verificar registros de queixas musculares no serviço de saúde da fábrica, e avaliar a força de preensão palmar após a realização da GL, nos auxiliares de produção. A amostra foi constituída por 55 trabalhadores, divididos aleatoriamente em 2 grupos: grupo teste (GT) com n = 28, submetidos a 45 sessões de GL, e um grupo controle (GC), n = 27, não realizando nenhuma intervenção. Na coleta de dados utilizou-se a dinamometria de preensão palmar, e o número de registros de queixas musculares em ambos os grupos. Verificou-se, uma redução de 26,25 por cento no número de queixas de dores musculares no GT em relação ao GC. Na dinamometria, foi observado um aumento significativo de 4,78 Kgf (p = 0,0042) na mão direita, e 4,84 (p = 0,0077) na mão esquerda após a GL realizada pelo GT, quando comparada com o GC. A GL, quando aplicada de forma adequada, regularmente e associada à ergonomia, pode ser eficaz na prevenção das doenças e dores musculares ocupacionais.

The stretching-break (SB) consists in specific stretching and relaxing exercises, acting as a preventive and therapeutic measure among workers. The auxiliary workers of the production department are frequently reporting muscle pain, with the main movement of hand grip. The aim of this study was to verify muscle complains registration at the factory health service and to evaluate the hand grip force after stretching-break of auxiliary workers of production. The sample was composed by 55 workers, randomly divided into 2 groups: test group (TG) with n = 28 took 45 sessions of stretching-break and the control group (CG), n = 27, did not have any intervention. During data collection, it was used the dynamometer for hand grip and the number of muscles complains records in both groups. It was noticed a reduction of 26.25 percent in the muscles pain complains in the TG compared to the CG. In the dynamometer it was observed a significant increase of 4.78 Kgf (p = 0.0042) in the right hand and 4.84 (p = 0.0077) in the left hand after the stretching-break of the TG, when compared to the CC. The SB when performed correctly and regularly associated to ergonomics can be efficient to prevent occupational diseases and muscles pain.