An Evaluation of clinical, serologic, anatomopathologic and immunohistochemical findings for fifteen patients with mucosal leishmaniasis before and after treatment

Treatment of mucosal leishmaniasis (ML) can be controlled by clinical examination and by serologic titers by the indirect immunofluorescence serologic reaction (IISR). We studied the correlation between the presence of antigen in tissue determined by immunohistochemistry, the IISR titers and the anatomopathologic findings in fifteen patients with ML before and after healing of the lesions as determined by otorhinolaryngologic evaluation, and evaluated these parameters to determine which of them could be useful during follow-up. Tissue antigens became negative in four patients (group A) after treatment, with a statistically significant reduction or negativity of IISR titers (p<0.05). This did not occur in patients in whom the antigen persisted after treatment (group B), suggesting that serologic follow-up should be performed together with the search for tissue antigen, a combination which, to our knowledge, has not been used in previous studies. The negativity of tissue antigens and the behavior of IIRS titers in group A patients probably indicate a lower possibility of recurrence. Upon anatomopathologic examination the inflammatory process was found to persist after treatment even in group A, suggesting that the permanence of inflammatory activity even in clinically healed lesions is possibly correlated with the presence of the antigen or of some unknown factor.

A DCAP for the social and solidarity economy

This article presents a work-in-progress version of a Dublin Core Application Profile (DCAP) developed to serve the Social and Solidarity Economy (SSE). Studies revealed that this community is interested in implementing both internal interoperability between their Web platforms to build a global SSE e-marketplace, and external interoperability among their Web platforms and external ones. The Dublin Core Application Profile for Social and Solidarity Economy (DCAP-SSE) serves this purpose. SSE organisations are submerged in the market economy but they have specificities not taken into account in this economy. The DCAP-SSE integrates terms from well-known metadata schemas, Resource Description Framework (RDF) vocabularies or ontologies, in order to enhance interoperability and take advantage of the benefits of the Linked Open Data ecosystem. It also integrates terms from the new essglobal RDF vocabulary which was created with the goal to respond to the SSE-specific needs. The DCAP-SSE also integrates five new Vocabulary Encoding Schemes to be used with DCAP-SSE properties. The DCAP development was based on a method for the development of application profiles (Me4MAP). We believe that this article has an educational value since it presents the idea that it is important to base DCAP developments on a method. This article shows the main results of applying such a method.

Subcutaneoous phaeohyphomycosis by Exophiala jeanselmei in a cardiac transplant recipient

We report a case of phaeohyphomycosis caused by Exophiala jeanselmei in a cardiac transplant recipient maintained on immunosuppressive therapy with mycophenolate mofetil tacrolimus and prednisone. The lesion began after trauma on the right leg that evolved to multiple lesions with nodules and ulcers. Diagnosis was performed by histological examination and culture of pus from skin lesions. Treatment consisted of itraconazole (200 mg/day) for three months with no improvement and subsequently with amphotericin B (0.5 mg/Kg per day to a total of 3.8 g intravenously). After four months of treatment, the lesions showed marked improvement with reduction in the swelling and healing of sinuses and residual scaring.

A Rat Model of Diabetic Wound Infection for the Evaluation of Topical Antimicrobial Therapies

Diabetes mellitus is an epidemic multisystemic chronic disease that frequently is complicated by complex wound infections. Innovative topical antimicrobial therapy agents are potentially useful for multimodal treatment of these infections. However, an appropriately standardized in vivo model is currently not available to facilitate the screening of these emerging products and their effect on wound healing. To develop such a model, we analyzed, tested, and modified published models of wound healing. We optimized various aspects of the model, including animal species, diabetes induction method, hair removal technique, splint and dressing methods, the control of unintentional bacterial infection, sampling methods for the evaluation of bacterial burden, and aspects of the microscopic and macroscopic assessment of wound healing, all while taking into consideration animal welfare and the '3Rs' principle. We thus developed a new wound infection model in rats that is optimized for testing topical antimicrobial therapy agents. This model accurately reproduces the pathophysiology of infected diabetic wound healing and includes the current standard treatment (that is, debridement). The numerous benefits of this model include the ready availability of necessary materials, simple techniques, high reproducibility, and practicality for experiments with large sample sizes. Furthermore, given its similarities to infected-wound healing and treatment in humans, our new model can serve as a valid alternative for applied research.

Projeto de uma ETAR para a freguesia de Canelas, Penafiel

O tratamento das águas residuais domésticas surge com o intuito de degradar os poluentes presentes, para que as águas residuais tratadas não prejudiquem o ambiente nem a saúde pública. O presente trabalho teve como objetivo a conceção e o dimensionamento de uma Estação de Tratamento de Águas Residuais (ETAR) na freguesia de Canelas com a finalidade de substituir a já existente e permitir a ampliação da área da rede de saneamento da freguesia. Foram considerados dois tipos de ETAR’s, compacta e convencional, para tratar águas residuais domésticas de aproxidamente 2000 habitantes, com um caudal médio de 400 m3/dia e um caudal de ponta de 1136,7 m3/dia. Das duas opções optou-se pela convencional uma vez que acarreta um menor investimento, no valor de 187 232 €, e se considera também mais adequada às características do efluente a tratar. O tratamento escolhido inclui inicialmente uma gradagem, com uma grade constituída por sete barras com um espaçamento de 20 mm entre elas, seguida de um tamisador rotativo com uma abertura de malha de 3 mm. Depois do tamisador, optou-se por um sistema de desarenação/desengorduramento com um volume do tanque de 3,95 m3 e um fluxo de ar de 17,9 m3/h. Na fase seguinte considerou-se um tratamento biológico por lamas ativadas em regime de arejamento prolongado num tanque de arejamento de volume igual a 245,8 m3 com um arejador submerso, seguindo-se um decantador secundário de volume 33,3 m3. Por último, escolheu-se um sistema de desinfeção por ultravioleta e, a montante do mesmo, um filtro rápido para eliminar pequenas partículas que o efluente ainda possa conter. Para a desinfeção foram consideradas duas secções com cinco módulos de duas lâmpadas cada, ou seja, vinte lâmpadas ultravioleta. Dos resíduos produzidos pelo tratamento da água residual, os gradados e as areias serão encaminhados para aterro, enquanto que as lamas serão enviadas para a ETAR das Termas de S.Vicente, para que sofram o tratamento adequado e sejam encaminhadas para o destinal final adequado (aplicação em solos agrícolas, compostagem ou em alternativa para aterro). No caso da ETAR covencional foi ainda avaliada a possível reutilização de um decantador da ETAR de Milhundos uma vez que esta se encontrava em fase de desativação. Desta avaliação, concluiu-se que não seria economicamente viável o seu reaproveitamento. Mestrado em Engenharia Química – Tecnologias de Proteção Ambiental Para além disso realizou-se também um levantamento dos principais problemas que ocorrem na maioria das ETAR’s e foram apresentadas as respetivas sugestões de resolução. A realização de um inquérito permititu concluir que os odores são o problema que mais causa incómodo à população.

Cicatrização de Feridas Crónicas. Algumas Opções Terapêuticas

As feridas crónicas representam um problema grave de saúde pública e uma das causas de grande consumo de recursos em saúde. Recentes avanços no conhecimento do mecanismo de cicatrização levaram ao desenvolvimento de novos tratamentos. Definir o papel e eficácia destes novos tratamentos é o próximo passo. Os autores procuraram neste trabalho abordar algumas terapêuticas, que não terapia compressiva e material de penso, na cicatrização de feridas crónicas.

Cicatrização de Feridas

A cicatrização de feridas constitui um processo complexo e coordenado, envolvendo a interacção entre células e vários sistemas mensageiros. Este processo pode dividir-se em 3 fases: inflamatória, proliferativa e de remodelação. O mecanismo exacto das feridas crónicas permanece ainda por esclarecer. Os avanços recentes da biologia molecular permitiram identificar moléculas que evidenciaram novos mecanismos fisiopatológicos das feridas crónicas, assim como possíveis alvos terapêuticos. Este artigo tem como objectivo uma revisão dos mecanismos envolvidos na cicatrização, pilar fundamental para a compreensão e abordagem de doentes com feridas crónicas, prática corrente em Dermatologia.

Cicatrização por Segunda Intenção. A Propósito de um Caso Clínico

Na abordagem da cicatrização de uma ferida cirúrgica deve equacionar-se a cicatrização por segunda intenção como uma alternativa válida, revelando excelentes resultados e claras vantagens após selecção adequada dos doentes. Os autores descrevem o caso de um doente do sexo masculino com 66 anos de idade, submetido a excisão de um carcinoma espinocelular da concha do pavilhão auricular direito e subsequente cicatrização por segunda intenção. Discutem-se algumas particularidades desta técnica revendo a literatura relevante.

MONTENEGRO SKIN TEST AND AGE OF SKIN LESION AS PREDICTORS OF TREATMENT FAILURE IN CUTANEOUS LEISHMANIASIS

A case-control study was conducted to examine the association among the Montenegro skin test (MST), age of skin lesion and therapeutic response in patients with cutaneous leishmaniasis (CL) treated at Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil. For each treatment failure (case), two controls showing skin lesion healing following treatment, paired by sex and age, were randomly selected. All patients were treated with 5 mg Sb5+/kg/day of intramuscular meglumine antimoniate (Sb5+) for 30 successive days. Patients with CL were approximately five times more likely to fail when lesions were less than two months old at the first appointment. Patients with treatment failure showed less intense MST reactions than patients progressing to clinical cure. For each 10 mm of increase in MST response, there was a 26% reduction in the chance of treatment failure. An early treatment - defined as a treatment applied for skin lesions, which starts when they are less than two months old at the first appointment -, as well as a poor cellular immune response, reflected by lower reactivity in MST, were associated with treatment failure in cutaneous leishmaniasis.

Efecto de la temperatura de la piel en la leishmaniasis cutanea experimental

The literature on the thermosensitive properties of strains or species of Leishmania and of other miercorganisms is revised. Cutaneous or mucocutaneous strains that infect animais in the coldest areas of the skin or mucosa in general can not grow in tissue culture at 37°C or higher temperatures and their respiratory metabolism decreases at these temperatures. These facts suggest a thermosensitive event in some important metabolism phase of the organisme. The strains or species that are able to produce visceral leishmaniasis were probably originated from cutaneous strains after genetioally determined physiological adaptation, to warmer temperatures. These strains can not only visceralize in animais and man but will also grow in tissue culture at 36-37°C and the respiratory metabolism will be higher at such temperatures. There are reasons to believe that intermediate strains, i. e., with properties of both groupsí do exist. A thermosensitive physiological event is a more general phenomenon and examples of it can also be found in the fields of virology, bacteriology and mycology. It has practical applications since some of the diseases produced by these agents can be cured by treatments with heat or artificial fever. Experiments along these line were performed on hamsters with a Costa Rican strain of L. braziliensis as an experimental model. Even after intraperitoneal inoculation lesions appear in the nose, ears, paws and tail with a subcutaneous temperature bellow 33°C at 22-24°C. Healing of the lesión is accomplished by increasing room temperature. A good lesión is produced in the rump of the animal if the area is depilated (comercial cream depilatory) previously and the naked skin cooled artificially. Elevated temperature, or the growing back of the hair will tend to diminish or cure the lesion.

Diabetes Mellitus as a Risk Factor in Glaucoma's Physiopathology and Surgical Survival Time: A Literature Review

Glaucoma is a multifactorial condition under serious influence of many risk factors. The role of diabetes mellitus (DM) in glaucoma etiology or progression remains inconclusive. Although, the diabetic patients have different healing mechanism comparing to the general population and it has a possible-negative role on surgical outcomes. This review article attempts to analyze the association of both diseases, glaucoma and DM, before and after the surgery. The epidemiological studies, based mainly in population prevalence analyzes, have shown opposite outcomes in time and even in the most recent articles also the association remains inconclusive. On the contrary, the experimental models based on animal induced chronic hyperglycemia have shown an important association of both diseases, explained by common neurodegenerative mechanisms. Diabetic patients have a different wound healing process in the eye viz-a-viz other organs. The healing process is more and it results in lower surgical survival time, higher intraocular pressure (IOP) levels and, therefore, these patients usually need more medication to lower the IOP. Both randomized and nonrandomized retrospective and experimental molecular studies have shown the association between DM and glaucoma. Further studies are needed to get better explanations about outcomes on more recent surgical procedures and with the exponential use of antifibrotics. How to cite this article: Costa L, Cunha JP, Amado D, Pinto LA, Ferreira J. Diabetes Mellitus as a Risk Factor in Glaucoma's Physiopathology and Surgical Survival Time: A Literature Review.

Human mucocutaneous leishmaniasis in Três Braços, Bahia - Brazil: an area of Leishmania braziliensis braziliensis transmission. II. Cutaneous disease. Presentation and evolution

The clinical records of 182 patients with cutaneous leishmaniasis probably due to Leishmania braziliensis braziliensis are analysed. 68% had a single lesion which was usually an ulceron the lower anterior tibial third. Many had short histories of one to two months and all age groups were represented 13% had closed lesions of a verrucose or plaque like nature. Evolution of these skin lesions after treatment was related to the regularity of antimony therapy. Although healing usually occurred in three months, the time to scarring after commencing treatment was variable and related to the size ofthe lesion (p < 0.01). Usually if sufficient antimony treatment was given the lesion closed. Seven of the ten patients with initially negative leishmanin skin tests converted to positive after treatment. A significant decline of indirect fluorescent antibody titres occurred in patients followed, during and after therapy.

Spontaneous regional heading of extensive skin lesions in diffuse cutaneous leishmaniasis (DCL)

The authors report a case of diffuse cutaneous leishmaniasis, with longstanding evolution and presenting with diffuse infiltrated lesions rich in amastigotes in the absence of mucosal involvement. In situ characterization with monoclonal antibodies revealed Leishmania amazonensis. Large regional lesions have presented spontaneous healing without specific therapy. Considering that DCL presents with a defect in the cellular immune response, thisfact demonstrate that this patient may develop a regional cellular immune response enough to destroy the parasites and to produce clearing of some lesions.

Evaluation of IFN-gamma and TNF-alpha as immunological markers of clinical outcome in cutaneous leishmaniasis

To evaluate if IFN-gamma and TNF-alpha levels could be used as markers of therapeutic response in cutaneous leishmaniasis, 54 patients with history of one ulcerated cutaneous lesion, with up to 30 days onset, were enrolled in the study. IFN-gammaand TNF-alpha were measured by ELISA in lymphocyte cultures supernatant before and 60 days after initiating therapy. Cure was considered to be a complete healing of lesion 60 days after treatment. IFN-gamma and TNF-alpha levels were similar in both groups of patients before therapy. There was a tendency to increase IFN-gamma levels in patients that were cured in 60 days, however the values did not reach statistical significance. In both groups of patients, TNF-alpha levels were similar before therapy and fell significantly after treatment, irrespective of cure or maintenance of active lesion.

Development of a "green process" for the isolation of natural functional extracts with anti-cancer activity - Application of high-pressure technology

Dissertação para obtenção do Grau de Mestre em Engenharia Química e Bioquímica