RESUMO
BACKGROUND: In cutaneous melanomas in general, tumor inflammatory infiltrate (TII) can protect against distant metastases, but there is no consensus when only thin primary cutaneous melanomas (TPCM) are considered. OBJECTIVE: To investigate the presence of TII in TPCM and the relationship between TII and the occurrence of metastases. METHODS: Case-control study including 50 patients with TPCM, 22 metastatic (MC group) and 28 non-metastatic (NMC group). The presence of TII was evaluated and, if present, qualified as mild, moderate or marked. RESULTS: The mean age was 50.7 years in the MC and 56.2 years in the NMC group (pâ¯=â¯0.234), and the male sex predominated in the MC group (63.6%). The average Breslow thickness was higher in the MC when compared to that observed in the NMC (respectively 0.8 vs. 0.6â¯mm, pâ¯=â¯0.012). The presence of ulceration occurred in 22.7% of the MC and 17.9% of the NMC (pâ¯=â¯0.732). TII was present in all 50 TPCM, being marked or moderate in 67.9% of the NMC and 54.5% in the MC group (pâ¯=â¯0.503). In the multivariate analysis, the presence of moderate and marked TII had an Odds Ratio (OR) of 0.57 (95% Confidence Interval [CI]: 0.18â1.8) and adjusted OR of 0.68 (95% CI 0.13â3.99). STUDY LIMITATIONS: Small sample size. CONCLUSIONS: TII was present in all TPCM (with and without metastases), and it was not possible to demonstrate a protective effect of TII against the appearance of metastases.
Assuntos
Melanoma , Neoplasias Cutâneas , Humanos , Masculino , Pessoa de Meia-Idade , Melanoma/patologia , Neoplasias Cutâneas/patologia , Estudos de Casos e Controles , Prognóstico , Melanoma Maligno CutâneoRESUMO
Abstract Background In cutaneous melanomas in general, tumor inflammatory infiltrate (TII) can protect against distant metastases, but there is no consensus when only thin primary cutaneous melanomas (TPCM) are considered. Objective To investigate the presence of TII in TPCM and the relationship between TII and the occurrence of metastases. Methods Case-control study including 50 patients with TPCM, 22 metastatic (MC group) and 28 non-metastatic (NMC group). The presence of TII was evaluated and, if present, qualified as mild, moderate or marked. Results The mean age was 50.7 years in the MC and 56.2 years in the NMC group (p = 0.234), and the male sex predominated in the MC group (63.6%). The average Breslow thickness was higher in the MC when compared to that observed in the NMC (respectively 0.8 vs. 0.6 mm, p = 0.012). The presence of ulceration occurred in 22.7% of the MC and 17.9% of the NMC (p = 0.732). TII was present in all 50 TPCM, being marked or moderate in 67.9% of the NMC and 54.5% in the MC group (p = 0.503). In the multivariate analysis, the presence of moderate and marked TII had an Odds Ratio (OR) of 0.57 (95% Confidence Interval [CI]: 0.18‒1.8) and adjusted OR of 0.68 (95% CI 0.13‒3.99). Study limitations Small sample size. Conclusions TII was present in all TPCM (with and without metastases), and it was not possible to demonstrate a protective effect of TII against the appearance of metastases.
RESUMO
OBJECTIVE: To describe the results from the hearing screening protocol adopted in a Hospital in Colombia emphasizing the importance of performing screening on an outpatient basis, when the newborn is more than 24â¯h old. METHODS: A prospective study at Hospital Universitario San Ignacio in Bogota, Colombia was carried out, from May 1st, 2016 to Nov 30th, 2017, the study sample included 2.088 newborns examined using transient otoacoustic emissions. RESULTS: We obtained written consent from the parents of 1.523 newborns and 24 individuals (1.6%) failed the first stage of the screening, nine cases unilateral and 15 bilateral. A total of nine neonates (0,6%) failed the second screening test, six cases unilateral and three bilateral. Four (0,3%) did not return to the second test. Our false altered screening rate was 0.7%. CONCLUSIONS: In a developing country with limited human and economic resources, in which newborn early discharge is the norm, a newborn hearing screening program linked to infants' check-ups, that uses otoacoustic emissions after 48â¯h of life, seems a feasible option compare to the standard US protocol aiming to conduct hearing screening prior to discharge.
Assuntos
Países em Desenvolvimento , Perda Auditiva Bilateral/diagnóstico , Perda Auditiva Unilateral/diagnóstico , Triagem Neonatal/métodos , Assistência Ambulatorial , Colômbia , Feminino , Testes Auditivos , Hospitais , Humanos , Recém-Nascido , Masculino , Emissões Otoacústicas Espontâneas , Estudos ProspectivosRESUMO
BACKGROUND: In the last years, Antimicrobial Peptides (AMPs) and lipopeptides have received attention as promising candidates to treat infections caused by resistant microorganisms. OBJECTIVE: The main objective of this study was to investigate the effect of repetitive KLFK motifs and the attachment of aliphatic acids to the N-terminus of (KLFK)n peptides on therapeutic properties. METHODS: Minimal inhibitory concentration against Gram (+) and (-) bacteria and yeast of synthetic compounds were determined by broth microtiter dilution method, and the toxicity was evaluated by hemolysis assay. Membrane-peptide interaction studies were performed with model phospholipid membranes mimicking those of bacterial and mammalian cells by Fluorescence Spectroscopy. The secondary structure in solution and membranes was determined by Circular Dichroism. RESULTS: Our results showed that the resulting compounds have inhibitory activity against bacteria and fungi. The (KLFK)3 peptide showed the highest therapeutic index against bacterial and yeast strains, and the (KLFK)2 peptide conjugated with octanoic acid was the most active against yeasts. All the lipopeptides containing long-chain fatty acids (C14 or longer) were highly hemolytic at low concentrations. The antimicrobial activity of (KLFK)2 and (KLFK)3 lipopeptides was mainly associated with improved stability of the amphipathic secondary structure, which showed high contributions of α-helix in dipalmitoylphosphatidylglycerol (DPPG) vesicles. CONCLUSION: The repetition of the KLFK sequence and the conjugation with lipid tails allowed obtained compounds with high antimicrobial activity and low toxicity, becoming good candidates for treating infectious diseases.
Assuntos
Peptídeos Catiônicos Antimicrobianos , Bactérias Gram-Negativas/crescimento & desenvolvimento , Bactérias Gram-Positivas/crescimento & desenvolvimento , Lipopeptídeos , Motivos de Aminoácidos , Peptídeos Catiônicos Antimicrobianos/síntese química , Peptídeos Catiônicos Antimicrobianos/química , Peptídeos Catiônicos Antimicrobianos/farmacologia , Lipopeptídeos/síntese química , Lipopeptídeos/química , Lipopeptídeos/farmacologiaRESUMO
The increasing bacterial resistance against conventional antibiotics has led to the search for new antimicrobial drugs with different modes of action. Cationic antimicrobial peptides (AMPs) and lipopeptides are promising candidates to treat infections because they act on bacterial membranes causing rapid destruction of sensitive bacteria. In this study, a decapeptide named A2 (IKQVKKLFKK) was conjugated at the N-terminus with saturated, unsaturated, methoxylated and methyl -branched fatty acids of different chain lengths (C8 - C20), the antimicrobial and structural properties of the lipopeptides being then investigated. The attachment of the fatty acid chain significantly improved the antimicrobial activity of A2 against bacteria, and so, endowed it with moderated antifungal activity against yeast strains belonging to genus Candida. Lipopeptides containing hydrocarbon chain lengths between C8 and C14 were the best antibacterial compounds (MIC = 0.7 to 5.8 µM), while the most active compounds against yeast were A2 conjugated with methoxylated and enoic fatty acids (11.1 to 83.3 µM). The improvement in antimicrobial activity was mainly related to the amphipathic secondary structure adopted by A2 lipopeptides in the presence of vesicles that mimic bacterial membranes. Peptide conjugation with long hydrocarbon chains (C12 or more), regardless of their structure, significantly increased toxicity towards eukaryotic cells, resulting in a loss of selectivity. These findings suggest that A2-derived lipopeptides are potential good candidates for the treatment of infectious diseases caused by bacteria and opportunistic pathogenic yeast belonging to genus Candida. Copyright © 2016 European Peptide Society and John Wiley & Sons, Ltd.
Assuntos
Antibacterianos/química , Antifúngicos/química , Peptídeos Catiônicos Antimicrobianos/química , Ácidos Graxos/química , Lipopeptídeos/química , Sequência de Aminoácidos , Antibacterianos/farmacologia , Antifúngicos/farmacologia , Peptídeos Catiônicos Antimicrobianos/farmacologia , Candida/efeitos dos fármacos , Candida/crescimento & desenvolvimento , Eritrócitos/citologia , Eritrócitos/efeitos dos fármacos , Bactérias Gram-Negativas/efeitos dos fármacos , Bactérias Gram-Negativas/crescimento & desenvolvimento , Bactérias Gram-Positivas/efeitos dos fármacos , Bactérias Gram-Positivas/crescimento & desenvolvimento , Hemólise/efeitos dos fármacos , Humanos , Lipopeptídeos/farmacologia , Testes de Sensibilidade Microbiana , Estrutura Secundária de Proteína , Especificidade da Espécie , Relação Estrutura-AtividadeRESUMO
Agminated nevus is a cluster group of melanocytic nevi confined to a localized area of the body. There are many pigmented lesions described in the literature as agminated, such as blue nevi, multiple lentigines and Spitz nevi, but only a few cases of congenital agminated melanocytic nevi have been described. We report a case of a male child who presented with congenital agminated nevi, emphasizing the importance of physical examination, dermoscopy, histopathological evaluation, differential diagnosis and follow up to rule out the possibility of dysplastic or malignant changes.
Assuntos
Nevo Pigmentado/congênito , Neoplasias Cutâneas/congênito , Biópsia , Criança , Dermoscopia , Diagnóstico Diferencial , Humanos , Masculino , Nevo Pigmentado/patologia , Transtornos da Pigmentação/congênito , Transtornos da Pigmentação/patologia , Pele/patologia , Neoplasias Cutâneas/patologiaRESUMO
Agminated nevus is a cluster group of melanocytic nevi confined to a localized area of the body. There are many pigmented lesions described in the literature as agminated, such as blue nevi, multiple lentigines and Spitz nevi, but only a few cases of congenital agminated melanocytic nevi have been described. We report a case of a male child who presented with congenital agminated nevi, emphasizing the importance of physical examination, dermoscopy, histopathological evaluation, differential diagnosis and follow up to rule out the possibility of dysplastic or malignant changes.
Nevo agminado é um conjunto de lesões melanocíticas confinadas a uma área do corpo. Existem muitas lesões descritas na literatura como agminada s, como nevos azuis, lentigos múltiplos, nevo de Spitz, mas existem poucos casos de nevos melanocíticos agminados congênitos descritos. Relatamos o caso de um paciente do sexo masculino que se apresentou com um nevo agminado congênito, enfatizando a importância do exame físico, dermatoscopia, avaliação histológica, diagnóstico diferencial e seguimento para descartar a possibilidade de alterações displásicas ou malignas.
Assuntos
Criança , Humanos , Masculino , Nevo Pigmentado/congênito , Neoplasias Cutâneas/congênito , Biópsia , Dermoscopia , Diagnóstico Diferencial , Nevo Pigmentado/patologia , Transtornos da Pigmentação/congênito , Transtornos da Pigmentação/patologia , Neoplasias Cutâneas/patologia , Pele/patologiaRESUMO
OBJECTIVE: The purpose of this study was to establish a new approach to improve detection of deafness due to rubella. METHODS: Colombian institutes for the deaf were visited by a medical team to perform in all enrolled individuals an ophthalmological examination with emphasis in fundus eye by a retina specialist. In cases where ocular alterations compatible with CRS were found, a medical interview by a clinical geneticist analyzing pre-and postnatal history and a thorough medical examination was done. RESULTS: A total of 1383 deaf institutionalized individuals were evaluated in 9 Colombian cities in the period of 2005 to 2006, finding a total of 463 positive cases for salt-and-pepper retinopathy (33.5%), in which rubella could be the etiology of deafness. Medellin, Cartagena, Bucaramanga and Barranquilla were the cities with the highest percentage of Congenital rubella, corresponding to 22.8% of analyzed population. The analysis performed on cases in which reliable prenatal history was obtained in a second appointment (n=88) showed association between positive viral symptoms during pregnancy and salt-and-pepper retinopathy in 62.5% of cases, while both (retinopathy and viral symptoms) were absent in 29.5% of cases; showing a correlation in 92% of cases. CONCLUSIONS: The frequency of deafness by rubella obtained by this study is significantly high compared with previous Colombian studies and with international reports. It was possible to correlate the antecedent of symptoms during pregnancy with the presence of salt-and-pepper retinopathy in this deaf population when reliable prenatal history was available, therefore eye testing with emphasis in fundus examination is a good indicator of rubella induced deafness. We propose a new approach in the search of deafness causes, based on a thorough ophthalmologic examination in all deaf people.
Assuntos
Surdez/etiologia , Complicações Infecciosas na Gravidez/diagnóstico , Doenças Retinianas/diagnóstico , Doenças Retinianas/epidemiologia , Síndrome da Rubéola Congênita/complicações , Colômbia/epidemiologia , Estudos Transversais , Surdez/congênito , Surdez/epidemiologia , Países em Desenvolvimento , Diagnóstico Precoce , Feminino , Fundo de Olho , Humanos , Incidência , Masculino , Oftalmoscopia/métodos , Valor Preditivo dos Testes , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Medição de Risco , Síndrome da Rubéola Congênita/diagnóstico , Síndrome da Rubéola Congênita/epidemiologiaRESUMO
Fundamentos: A regra do ABCD é utilizada para orientar médicos, profissionais da saúde e pacientes quanto ao reconhecimento das principais características de lesões cutâneas suspeitas de melanoma. Não há, no Brasil,estudos que validem a utilização da regra do ABCD pelos pacientes após orientações realizadas por dermatologistas. Objetivos: Avaliar o aprendizado da regra do ABCD por pacientes atendidos em centro dermatológico de referência no sul do Brasil. Métodos: Estudo randomizado com 80 pacientes ambulatoriais de ambos os sexos, com 12 anos ou mais. Foram avaliados: grau de escolaridade, renda mensal e acesso aos meios de comunicação. O grupo de intervenção recebeu orientações sobre o emprego da regra do ABCD, ao passo que o grupo-controle não recebeu. Ambos os grupos foram avaliados quanto às suas respostas em três momentos (basal, fora do consultório e no consultório, 15 dias após) em painel de fotografias. O nível de significância utilizado foi o p < 0,05 e o poder de 0,80. Resultados: O grupo que recebeu as informações respondeu de forma correta, com mais frequência, quanto ao diagnóstico dos melanomas, quando comparado ao grupo-controle (p < 0,01). Excetuando-se o acesso ao rádio, que influenciou positivamente os resultados (p < 0,05), as outras variáveis avaliadas não os afetaram. Conclusões: A regra do ABCD pode ser usada para capacitar pacientes acima de 17 anos a identificar alterações sugestivas de melanoma. Esse aprendizado independe de sexo, nível de escolaridade, renda mensal e acesso aos meios de comunicação, exceto rádio.
Background: the ABCD rule is used to guide physicians, health care professionals and patients to recognize the main characteristics of suspicious skin lesions for melanoma. In Brazil there are no studies to validate the use of the ABCD rule by patients after instructions given by dermatologists. Objectives: to evaluate the learning of the ABCD rule by patients at a dermatology center of reference in the Southern region of Brazil. Methods: a randomized study, with 80 outpatients. The following were evaluated: sex, age, level of schooling, monthly income and access to means of communication. The intervention group received instructions regarding the use of the ABCD rule and the control group did not. Both groups were evaluated at three points in time (baseline; outside the office; and in the doctor's office, 15 days later) regarding their answers about a panel of photographs. The level of significance used was p < 0.05 and a power of 0.80. Results: the group that received information answered correctly regarding the diagnosis of melanomas more often compared to the control group (p < 0.01).Except access to radio broadcasting, which had a positive influence of the results (p < 0.05), the other variables evaluated did not influence the results. Conclusions: the ABCD rule can be used to train patients, above the age of 17 years, to identify changes that suggest melanoma. This learning is independent of sex, level of schooling, monthly income and access to means of communication, except the radio.
Assuntos
Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Melanoma/diagnóstico , Educação de Pacientes como Assunto , Neoplasias Cutâneas/diagnóstico , Brasil , Estudos Prospectivos , Adulto JovemRESUMO
BACKGROUND: the ABCD rule is used to guide physicians, health care professionals and patients to recognize the main characteristics of suspicious skin lesions for melanoma. In Brazil there are no studies to validate the use of the ABCD rule by patients after instructions given by dermatologists. OBJECTIVES: to evaluate the learning of the ABCD rule by patients at a dermatology center of reference in the Southern region of Brazil. METHODS: a randomized study, with 80 outpatients. The following were evaluated: sex, age, level of schooling, monthly income and access to means of communication. The intervention group received instructions regarding the use of the ABCD rule and the control group did not. Both groups were evaluated at three points in time (baseline; outside the office; and in the doctor's office, 15 days later) regarding their answers about a panel of photographs. The level of significance used was p < 0.05 and a power of 0.80. RESULTS: the group that received information answered correctly regarding the diagnosis of melanomas more often compared to the control group (p < 0.01). Except access to radio broadcasting, which had a positive influence of the results (p < 0.05), the other variables evaluated did not influence the results. CONCLUSIONS: the ABCD rule can be used to train patients, above the age of 17 years, to identify changes that suggest melanoma. This learning is independent of sex, level of schooling, monthly income and access to means of communication, except the radio.
Assuntos
Melanoma/diagnóstico , Educação de Pacientes como Assunto , Neoplasias Cutâneas/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto JovemRESUMO
Objetivo: Avaliar os dados com os quais trabalham os residentes dos Serviços de Pediatria de Porto Alegre RS sobre fotoproteção e câncer da pele, comparados com os especializandos de dermatologia da mesma cidade. Materias e métodos: Estudo descritivo transversal; incluindo 58 residentes de pediatria (RP) e 34 especializandos de dermatologia (ED) que responderam a questionário estruturado sobre fotoproteção e câncer da pele. Resultados: Dos RP 38% e dos ED 97% obtiveram informações sobre fotoproteção na pós-graduação. Quando perguntado aos RP se indicam protetor solar, 15% indicam sempre, 36,20% freqüentemente, 36,20% algumas vezes, 11,9% raramente. Quando realizado o mesmo questionamento aos ED, 67,64% indicam sempre, 29,41% freqüentemente e 2,95% algumas vezes (p= 0,0002). Quanto à capacidade de avaliar sinais em crianças, dentre os RP ,17,24% afirmam sentirem-se muito capazes, 70,68% pouco capazes e 12,06% incapazes. Já dentre os ED, 44,11% sentem-se muito capazes, 52,94% pouco capazes e 2,94% incapazes (p= 0,015). Conclusão: Os dados sugerem que os residentes de pediatria provavelmente devam aprimorar seus estudos em fotoproteção. É importante ressaltar o papel dos programas de pós-graduação em Pediatria em enfatizar a necessidade de estudos sobre fotoproteção e em capacitar adequadamente os futuros profissionais para avaliações de lesões cutâneas em crianças (AU)
Objective: To evaluate information concerning photoprotection and skin cancer as used by pediatrics residents in comparison to dermatology residents in Porto Alegre RS. Material and Methods: This is a transversal descriptive study including 58 pediatrics residents (PRs) and 34 dermatology residents (DRs) who answered a questionnaire about their knowledge and practices as regards photoprotection and skin cancer. Results: Thirty eight percent of the PRs and 97% of the DRs had received information about photoprotection in postgraduate courses. When asked if they prescribe sunscreens, 15% of the PRs said they always do, 36.20% often do, 36.20% sometimes, and 11.9% rarely. On the other hand, 67.64% of the DRs said they always prescribe sunscreens, 29.41% often do and 2.95% sometimes (p=0.0002). Concerning the ability to evaluate signs in children, 17.24% of the PR said they feel very capable, 70.68% little capable and 12.06% incapable. Among the DRs, 44.11% felt very capable, 52.94% little capable and 2.94% incapable (p=0,015). Conclusion: The data suggest that the pediatrics residents should improve their knowledge on photoprotection. It is important to highlight the role of the pediatrics graduate programs in emphasizing the need for studies into photoprotection and in adequately qualifying the future professionals to evaluate skin lesions in children (AU)
Assuntos
Humanos , Masculino , Feminino , Pediatria/educação , Neoplasias Cutâneas/prevenção & controle , Luz Solar/efeitos adversos , Protetores Solares/uso terapêutico , Conhecimentos, Atitudes e Prática em Saúde , Internato e Residência , Estudantes de Medicina/estatística & dados numéricos , Brasil , Estudos Transversais , Dermatologia/educaçãoRESUMO
O Cryptococcus neoformans é um fungo oportunista responsável por infecções em humanos. O trabalho revisa a literatura sobre os aspectos epidemiológico, microbiológico, clínico e terapêutico da criptococose em nosso meio