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Em casos de psoríase moderada e grave, imunobiológicos são uma opção de tratamento eficaz. Nesses pacientes, imunizações e outros tratamentos podem ser necessários por diversas razões. Vacinas com micro-organismos inativados são, em geral, seguras para pacientes imunossuprimidos. Todavia, vacinas com micro-organismos vivos atenuados, como febre amarela, sarampo, rubéola, herpes zoster e cólera podem levar a sérias reações em pacientes imunocomprometidos. Como o Brasil enfrenta um dos mais expressivos surtos da última de Febre Amarela, intensificou-se a campanha de vacinação para doença. Com isso, aumenta o risco de vacinação inadvertida e ocorrência de efeitos adversos severos. É fundamental destacar os grupos que possuem contraindicação relativa e absoluta da doença, com objetivo de identificá-los facilmente e evitar qualquer dano pela vacinação

In moderate and severe cases, immunobiological medications can be used successfully in psoriasis. In these patients, immunizations and other treatments can be necessary for different reasons. Inactivated vaccines are generally safe in subjects with underlying immunosuppression. In contrast, live vaccines such as yellow fever, measles, rubella, herpes zoster and cholera may lead to severe reactions in immunocompromised patients. Brazil is been threatened by the worst outbreak of Yellow Fever in the last decades. For this reason, a national vaccination campaign has been started. It is important to recognize the groups that have vaccines contraindication or precaution to avoid any severe side effect

RESUMEN

Em casos de psoríase moderada e grave, imunobiológicos são uma opção de tratamento eficaz. Nesses pacientes, imunizações e outros tratamentos podem ser necessários por diversas razões. Vacinas com micro-organismos inativados são, em geral, seguras para pacientes imunossuprimidos. Todavia, vacinas com micro-organismos vivos atenuados, como febre amarela, sarampo, rubéola, herpes zoster e cólera podem levar a sérias reações em pacientes imunocomprometidos. Como o Brasil enfrenta um dos mais expressivos surtos da última de Febre Amarela, intensificou-se a campanha de vacinação para doença. Com isso, aumenta o risco de vacinação inadvertida e ocorrência de efeitos adversos severos. É fundamental destacar os grupos que possuem contraindicação relativa e absoluta da doença, com objetivo de identificá-los facilmente e evitar qualquer dano pela vacinação

In moderate and severe cases, immunobiological medications can be used successfully in psoriasis. In these patients, immunizations and other treatments can be necessary for different reasons. Inactivated vaccines are generally safe in subjects with underlying immunosuppression. In contrast, live vaccines such as yellow fever, measles, rubella, herpes zoster and cholera may lead to severe reactions in immunocompromised patients. Brazil is been threatened by the worst outbreak of Yellow Fever in the last decades. For this reason, a national vaccination campaign has been started. It is important to recognize the groups that have vaccines contraindication or precaution to avoid any severe side effect

RESUMEN

BACKGROUND: Defective adhesion seems to be involved in the chronic loss of melanocytes observed in vitiligo. Recent findings showed an association of genetic variants of an adhesion gene with vitiligo and reduced immunohistochemical expression of some adhesion molecules in vitiligo skin. AIMS: To compare CCN3 immunohistochemical expression in lesional and non-lesional epidermis of individuals with vitiligo. METHODS: A total of 66 skin specimens from 33 volunteers with vitiligo were analyzed by immunohistochemistry using anti-CCN3 antibodies. Absence of topical or systemic treatment for vitiligo over the previous 30 days and availability of an area of non-lesional skin for biopsy at least 15 cm away from any vitiliginous macules were the main inclusion criteria. RESULTS: A significant reduction of CCN3 expression was observed in lesional skin as compared to non-lesional skin (P = 0.001). LIMITATIONS: Paraffin embedded skin samples do not allow investigation by molecular biology methods. Not all samples allowed analysis due to the lamina preparation technique. Complete clinical data was not available for all patients. CONCLUSION: Our results support the hypothesis of impaired cell adhesion in vitiligo suggested by genetic studies. The pattern of immunohistochemical expression suggests that vitiligo might be an epithelial disease and not just a melanocyte disorder.

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In an unprecedented effort in the field of vitiligo, a global consensus resulted on a suggested new classification protocol for the disease. The main histopathological finding in vitiligo is the total absence of functioning melanocytes in the lesions, while the inflammatory cells most commonly found on the edges of the lesions are CD4+ and CD8+ T lymphocytes. Physical and pharmacological treatment strategies aim to control the autoimmune damage and stimulate melanocyte migration from the unaffected edges of lesions and the outer hair follicle root sheath to the affected skin; moreover, surgical treatments can be combined with topical and physical treatments.

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In an unprecedented effort in the field of vitiligo, a global consensus resulted on a suggested new classification protocol for the disease. The main histopathological finding in vitiligo is the total absence of functioning melanocytes in the lesions, while the inflammatory cells most commonly found on the edges of the lesions are CD4+ and CD8+ T lymphocytes. Physical and pharmacological treatment strategies aim to control the autoimmune damage and stimulate melanocyte migration from the unaffected edges of lesions and the outer hair follicle root sheath to the affected skin; moreover, surgical treatments can be combined with topical and physical treatments.

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O uso de agentes biológicos vem se mostrando uma boa opção no tratamento da psoríase de difícil controle. Os inibidores do fator de necrose tumoral alfa (TNF-alfa) demonstraram resultados positivos tanto em índices de resposta terapêutica quanto em velocidade de início de ação. No entanto, pelo fato de o TNF-alfa ter uma importante participação na formação do granuloma e, consequentemente na defesa contra o Mycobacterium tuberculosis, tal tratamento pode resultar na reativação de doença latente. Assim sendo, o screening para tuberculose é necessário antes e durante o uso destas drogas na prática clínica.

The use of biologics agents has been a good option in the trteatment of resistant psoriasis. The tumor necrosis factor-alpha (TNF-alpha) blockers demonstrated positives results, both in efficacy and onset of action. However TNF-alpha plays an important role in host defense against tuberculosis, this treatment can result in reactivation of latent disease. Thus, screening for tuberculosis is necessary before and during the use of these drugs in clinical practice.

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OBJETIVO: Avaliar casos confirmados de câncer de pulmão, revisando suas variáveis epidemiológicas, clínicas, estadiamento e tratamento. MÉTODOS: Foram estudados 263 casos provenientes do Hospital de Clínicas da Universidade Federal do Paraná e do Hospital Erasto Gaertner, instituições responsáveis por parcela significativa do atendimento a pacientes na cidade de Curitiba (PR). Realizou-se um estudo retrospectivo através de preenchimento de questionário e os dados obtidos foram analisados de forma descritiva, utilizando-se o software EPI-INFO. RESULTADOS: Houve predomínio de pacientes do sexo masculino (76 por cento), sendo que a maioria dos pacientes era fumante ou ex-fumante por ocasião do diagnóstico (90 por cento). Não havia referência a doença pulmonar prévia em 87 por cento dos casos. Tosse (142 casos) e dor torácica (92 casos) foram os sintomas iniciais mais freqüentes. O câncer de pulmão tipo não pequenas células foi encontrado em 87 por cento dos pacientes e o tipo histológico mais freqüente foi o carcinoma espinocelular, representando 49 por cento dos casos. O tabagismo foi considerado o fator predisponente mais importante. CONCLUSÃO: As características evolutivas do câncer de pulmão, como a inespecificidade dos sintomas iniciais e o tempo e evolução do tumor, somadas à ausência de programas de rastreamento efetivos, constituem os principais fatores que contribuem para a não detecção da neoplasia pulmonar de forma precoce, o que torna difícil o tratamento e dificulta o aumento da sobrevida.

OBJECTIVE: To evaluate confirmed cases of lung cancer, reviewing epidemiological variables, clinical variables, staging and treatment. METHODS: The cases of 263 patients were studied. All of the patients had been treated at the Universidade Federal do Paraná (Federal University of Paraná) Hospital de Clínicas or at the Hospital Erasto Gaertner, two institutions that, together, serve a significant portion of the patients seeking treatment in the city of Curitiba, located in the state of Paraná. This was a retrospective study, involving the administration of questionnaires. The descriptive analysis of the data obtained was performed using the Epi-Info program. RESULTS: There was a predominance of male patients (76 percent). At the time of diagnosis, the majority of patients (90 percent) were smokers or former smokers. In 87 percent of the cases, there was no history of lung disease. The most common initial symptoms were cough (142 cases) and chest pain (92 cases). Non-small cell lung cancer was found in 87 percent of the patients, and the most common histological type was spinocellular carcinoma, which was found in 49 percent of all of the patients. Smoking was found to be the most significant predisposing factor. CONCLUSION: The characteristics of lung cancer progression, such as the nonspecificity of the initial symptoms, the duration of tumor growth and the course of the tumor, together with the lack of tracking programs, are the principal factors that hinder the early detection of lung cancer, making it difficult to treat lung cancer patients and to increase their survival.

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OBJECTIVE: To evaluate confirmed cases of lung cancer, reviewing epidemiological variables, clinical variables, staging and treatment. METHODS: The cases of 263 patients were studied. All of the patients had been treated at the Universidade Federal do Paraná (Federal University of Paraná) Hospital de Clínicas or at the Hospital Erasto Gaertner, two institutions that, together, serve a significant portion of the patients seeking treatment in the city of Curitiba, located in the state of Paraná. This was a retrospective study, involving the administration of questionnaires. The descriptive analysis of the data obtained was performed using the Epi-Info program. RESULTS: There was a predominance of male patients (76%). At the time of diagnosis, the majority of patients (90%) were smokers or former smokers. In 87% of the cases, there was no history of lung disease. The most common initial symptoms were cough (142 cases) and chest pain (92 cases). Non-small cell lung cancer was found in 87% of the patients, and the most common histological type was spinocellular carcinoma, which was found in 49% of all of the patients. Smoking was found to be the most significant predisposing factor. CONCLUSION: The characteristics of lung cancer progression, such as the nonspecificity of the initial symptoms, the duration of tumor growth and the course of the tumor, together with the lack of tracking programs, are the principal factors that hinder the early detection of lung cancer, making it difficult to treat lung cancer patients and to increase their survival.

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