Caracterização do fibro edema gelóide e respectivos tratamentos nos estudantes de fisioterapia

Mestrado em Fisioterapia

Dermatophytosis caused by Trichophyton raubitschekii. Report of the first case in São Paulo, Brazil

The authors report the first case of dermatophytosis caused by Trichophyton raubitschekii in a patient from the State of São Paulo with Tinea corporis lesions localized on the buttocks. Culture on Sabouraud-agar with cycloheximide permitted the isolation and identification of the fungus, and the diagnosis was confirmed by Dr. Lynne Sigler, University of Alberta, Canada. Systemic treatment with fluconazole, 150 mg/week for 4 weeks, in combination with topical treatment with isoconazole initially yielded favorable results, with recurrence of the lesions after the medication was discontinued. This is the fifth case of this dermatophytosis published in the Brazilian medical literature.

Moxibustión en la malposición fetal

Introducción: La incidencia de la presentación fetal podálica en España es del 3,8%. La moxibustión es parte integral de la milenaria medicina tradicional china. La técnica consiste en la colocación de un palillo incandescente de Artemisia vulgaris a unos pocos centímetros del punto de acupuntura Zhiyin (punto 67 del meridiano de vejiga, ubicado en la base externa de la uña del quinto dedo del pie). Los objetivos son: 1. Conocer el porcentaje de fetos que han rotado a cefálica mediante la moxibustión en gestantes que presenten una malposición fetal a partir de las 32 semanas de embarazo; 2. Identificar las complicaciones materno-fetales en la aplicación de la técnica. Sujetos: Se estudiaron 18 gestantes de más de 32 semanas de embarazo. Material y métodos: Mediante un estudio descriptivo de intervención, analizamos el porcentaje de fetos que rotaron a presentación cefálica. Resultados: Quince gestantes (83,9%) realizaron el tratamiento adecuadamente y las 3 restantes (16,7%) lo realizaron de manera ocasional y terminaron con una cesárea electiva por nalgas. Conclusiones: Parece razonable concluir que el cumplimiento del tratamiento influye en el tipo de parto (χ2= 12,600; gl= 1; p= 0,000), aunque no modifica el Apgar del recién nacido. Esta técnica se presenta como una alternativa económica, segura, sencilla y práctica para la versión fetal de la presentación podálica.

Bariatric and Post-Bariatric Surgery: from Metabolic Surgery to Plastic Surgery Indications

Background: Controversy exists concerning indications and outcomes of major bariatric surgery procedures. Massive weight loss after bariatric surgery leads to excess skin with functional and aesthetic impairments. The aim of this study was to investigate the major bariatric surgery procedures and their outcomes in two specific subgroups of morbidly obese patients, ≥55-year-olds and the superobese. Further aims were to evaluate whether the preoperative weight loss correlates with laparoscopic gastric bypass complications. The prevalence and impact of excess skin and the desire for body contouring after bariatric surgery were also studied. Patients and Methods: Data from patients who underwent Laparoscopic Adjustable Gastric Banding (LAGB) and Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) at Vaasa Central Hospital were collected and postoperative outcomes were evaluated according to the BMI, age and preoperative weight loss. Patients who had undergone bariatric surgery procedures were asked to complete a questionnaire to estimate any impairment due to redundant skin and to analyse each patient’s desire for body contouring by area. Results: No significant difference was found in operative time, hospital stay, or overall early postoperative morbidity between LAGB and LRYGB. Mean excess weight loss percents (EWL%) at 6 and 12 months after LRYGB were significantly higher. A significant difference was found in operative time favouring patients <55 years. Intraoperative complications were significantly more frequent in the group aged >55 years. No significant difference was detected in overall postoperative morbidity rates. A significant difference was found in operative time and hospital stay favouring all patients who lost weight preoperatively. Most patients reported problems with redundant skin, especially on the abdomen, upper arms and rear/buttocks, which impaired daily physical activity in half of them. Excess skin was significantly associated with female gender, weight loss and ΔBMI. Patients with a WL >20 kg, ΔBMI ≥10 kg/m2 and an EWL % > 50 showed a significantly surplus skin discomfort (p < 0.001). Most patients desired body contouring surgery, with high or very high desire for waist/abdomen (62.2%), upper arm (37.6%), chest/breast (28.3%), and rear/buttock (35.6%) contouring. Conclusions: LRYGB is effective and safe in superobese (BMI >50) and elderly (>55 years) patients. A preoperative weight loss >5% is recommended to improve the outcomes and reduce complications. A WL >20 kg, ΔBMI ≥10 kg/m2 and an EWL % > 50 are associated with a higher functional discomfort due to redundant skin and to a stronger desire for body contouring plastic surgery.

Escala fotográfica para la clasificación clínica de la severidad de la Paniculopatía Edematofibroesclerosa (celulitis) en glúteos en un grupo de mujeres colombianas

Introducción: La Paniculopatía Edematofibroesclerosa (PEFE) es una de las mayores causas de consulta estética. Presentándose 85% en mujeres, careciendo de un método de medición de la severidad reproducible y confiable. El objetivo del estudio es evaluar la confiabilidad y la reproducibilidad de una escala fotográfica que permita clasificar los grados de severidad de la PEFE en glúteos en un grupo de mujeres colombianas. Materiales y Métodos: Se tomaron 182 fotografías estandarizadas de los glúteos en reposo y contracción muscular. Se establecieron por consenso de expertos los criterios para la calificación de las fotografías. Se realizaron dos sesiones con seis evaluadores ciegos a datos clínicos. Se utilizó la siguiente escala 0= Ningún, 1= Leve, 2= Moderado, 3= Severo. Se tomaron para el álbum las fotografías en las que los seis evaluadores concordaron. Resultados: La concordancia entre los evaluadores en reposo y contracción se dio en 23 (25.27%) de las 182 fotografías. Los evaluadores concordaron en 5/91 (5.49%) de las fotografías en reposo y en 18/91 (19.78%) de las fotografías en contracción. No hubo concordancia para los grados 0 y 3 en contracción. La concordancia intraevaluador en reposo como en contracción fue 0.443(p<0.0001). La concordancia Interevaluador en reposo y contracción fue 0.398 (p<0.0001) Discusión: En la construcción de la escala fotográfica, no se encontró concordancia en la calificación de todos los grados de severidad, en los grados en los que si hubo concordancia intra e interevaluador, esta fue aceptable. Se hace necesario continuar con el estudio hasta obtener datos completos.

Determinação da dose eritematosa mínima como marcador de risco e sensibilidade à radiação ultravioleta

Objetivos: Determinar a dose eritematosa mínima (DEM) medida por exposição controlada à radiação ultravioleta-B (RUV-B), como limiar para dano solar agudo nos diversos fototipos, e medir a cor da pele constitucional pelo sistema colorimétrico CIELAB. Pacientes e Métodos: Um total de 194 voluntários, sadios, com idades acima de 18 anos, distribuídos em um mínimo de 30 participantes por fototipo. Todos foram classificados por fototipos segundo os critérios de Fitzpatrick. As regiões infra-axilar torácica e nádega foram irradiadas em 4 áreas de 1 cm2, assim como foi registrada a cor da pele desses locais pelo sistema CIELAB. Delineamento: Estudo transversal. Resultados: A média de idade dos participantes foi de 38 anos, sendo 68% do sexo feminino. A avaliação da associação entre as medidas das DEMs e dos valores colorimétricos da coordenada L*, mostrou uma correlação de Pearson negativa com r = -0,91 para um valor p<0,05. Para os valores das DEMs e os escores da classificação dos voluntários por fototipos, obteve-se correlação de Spearman (rs) de +0,95 para p<0,05 e, correlacionando os valores colorimétricos com os escores dos fototipos, encontrou-se em tórax um rs de -0,93 e em nádega -0,92 para um p < 0,05. Conclusões – Concluiu-se que: 1)- a mensuração dos valores colorimétricos da coordenada L* nas regiões infra-axilar torácica e nádega mostraram uma forte correlação com os valores das DEMs, sendo de menor poder invasivo e de maior praticidade para mensuração de sensibilidade à radiação ultravioleta; 2)- apesar de os escores de Fitzpatrick terem alta correlação com os valores das DEMs, mostraram superposição de valores nos fototipos adjacentes; 3)- o grau de associação das classes dos fototipos com a cor da pele permite dizer que a categoria numérica do fototipo aumenta à medida que a pele fica mais escura.

Anthropometric aspects of body seated in school

This study aimed to assess the student-furniture interface from anthropometric parameters of the sitting posture. The sample was composed of 887 students from two public schools in the State of Parana - Brazil, which attended children from 7 to 17 years of age. The data collection used anthropometric measures of the sitting position, a questionnaire containing a human body diagram for indication of discomfort areas and photographic records to verify postural and ergonomic inadequacies in classroom. The following anthropometric variables were measured: popliteal height, sacro-popliteal length, hip width, lumbar support height, and elbow and thigh height. Percentiles 5 and 95 of anthropometric variables showed differences statistically significant, with variation coefficient greater than 30%. In relation to body discomfort, the highest occurrences were recorded for ankle, knees and shoulder joints as well as for spine and buttocks. It was concluded that children use school furniture that does not meet their anthropometric standards, which favored the adoption of incorrect postures and contributed to the emergence of musculoskeletal problems that can interfere with their educational process.

Site-specific concentrations of carotenoids in adipose tissue: relations with dietary and serum carotenoid concentrations in healthy adults

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Metáforas do universo lexical português e italiano das zonas erógenas: ânus, nádegas, pênis, seios, testículos e vulva

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Associação fitoterápica no tratamento de feridas cutâneas induzidas em equinos

The efficiency of the topical use of a commercial product constituted by a herbal combination on the healing evolution of equine induced wounds was studied. A skin lesion in the shape of a square with 5cm sides was surgically produced on both sides of the buttocks of eight adult horses. One side was considered control and another one treated. Both control and treated sides were rinsed with water and neutral soap. Additionally, the wound on the treated side received the topical treatment with the herbal combination. Macroscopic and microscopic healing evolution of the wounds was evaluated and their areas were determined during the experimental period. There was statistical difference between wound areas. At the last evaluation, the average area of the control side was 0.70cm² and of the treated side was 1.23cm². The contraction of scar observed at 77 days was 97.57% for the control side and 95.59% for the treated side.

Long-wave infrared radiation reflected by compression stockings in the treatment of cellulite: a clinical double-blind, randomized and controlled study

SynopsisBackgroundCellulite refers to changes in skin relief on the thighs and buttocks of women, with a prevalence of 80-90%, causing dissatisfaction and search for treatment. Etiopathogenesis is multifactorial, as follows: herniation of the hypodermis towards the dermis, facilitated by perpendicular fibrous septa, changes in the dermal extracellular matrix, decreased adiponectin, genetic polymorphism, microcirculation alterations and inflammatory process. There are numerous therapeutic approaches, with little evidence of effectiveness. The long-wave infrared (LWIR) radiation interacts with water, improves microcirculation and stimulates metabolic processes. To date, the use of tissues with potential reflection of LWIR radiation has not been systematically investigated as adjuvant treatment for cellulite.ObjectiveTo investigate the efficacy and safety of the treatment of cellulite through the use of compression stockings made with thread reflecting LWIR radiation.Patients and methodsClinical study of therapeutic intervention, controlled and double-blind, including 30 women, aging from 25 to 40years, with cellulite of grades II and III on the thighs and buttocks who used compression stockings, pantyhose model, made with reflector thread of LWIR radiation, on only one randomized side. Women under other treatments for cellulite and with venous and/or blood insufficiencies were excluded. Evaluation of efficacy by clinical parameters, photographs, Dermatology Life Quality Index (DLQI), cutometry and high frequency ultrasonography and security by observation of adverse events and venous EcoDoppler recordings.ResultsDLQI scores showed significant reduction; the two-dimensional high-frequency ultrasonography showed an insignificant increase in dermal echogenicity as well as other efficacy parameters demonstrated no or slight improvement, with no differences between the sides exposed or not to LWIR; and there were no severe adverse events.ConclusionCompression stockings, with or without thread reflector of LWIR, showed slight effects in the appearance of cellulite, but the treatment determined a positive impact on women quality of life.

Cellulite: poor correlation between instrumental methods and photograph evaluation for severity classification

SynopsisBackgroundCellulite refers to skin relief alterations in womens thighs and buttocks, causing dissatisfaction and search for treatment. Its physiopathology is complex and not completely understood. Many therapeutic options have been reported with no scientific evidence about benefits. The majority of the studies are not controlled nor randomized; most efficacy endpoints are subjective, like not well-standardized photographs and investigator opinion. Objective measures could improve severity assessment. Our purpose was to correlate non-invasive instrumental measures and standardized clinical evaluation.MethodsTwenty six women presenting cellulite on buttocks, aged from 25 to 41, were evaluated by: body mass index; standardized photography analysis (10-point severity and 5-point photonumeric scales) by five dermatologists; cutometry and high-frequency ultrasonography (dermal density and dermis/hypodermis interface length). Quality of life impact was assessed. Correlations between clinical and instrumental parameters were performed.ResultsGood agreement among dermatologists and main investigator perceptions was detected. Positive correlations: body mass index and clinical scores; ultrasonographic measures. Negative correlation: cutometry and clinical scores. Quality of life score was correlated to dermal collagen density.ConclusionCellulite caused impact in quality of life. Poor correlation between objective measures and clinical evaluation was detected. Cellulite severity assessment is a challenge, and objective parameters should be optimized for clinical trials.

The use of thermal manikin to evaluate interface pressure distribution

The use of a thermal buttocks manikin(1) was explored as a tool to standardize the evaluation of seat comfort. Thermal manikin buttocks were developed and calibrated thermally and anatomically to simulate the sensible heat transfer of a seated person and used to evaluate interface pressure distribution. In essence, the pressure maps of manikin buttocks with and without heating were compared to those of a seated person. The results of average pressure demonstrated that the thermal manikins have a better response in interface pressure measurement than manikins without heating.

Forme atipiche di malattia mani-piedi-bocca: La nostra esperienza

Introduzione: La malattia mani-piedi-bocca è una patologia infettiva tipica della prima infanzia causata dagli enterovirus, in particolare i sierotipi Coxsackievirus A16 ed Enterovirus 71. A partire dal 2008, ne è stata descritta un’epidemia da Coxsackievirus A6, in genere accompagnata da febbre elevata e che si distingue per lo sviluppo di piccole vescicole che progrediscono a lesioni vescicolo-bollose e a bolle vere e proprie. Inoltre, nei pazienti affetti da dermatite atopica, le lesioni tendono a localizzarsi sulle aree eczematose. Abbiamo quindi svolto uno studio osservazionale prospettico per descrivere le caratteristiche cliniche delle forme atipiche di malattia mani-piedi-bocca. Metodi: Sono stati arruolati i pazienti affetti da una forma atipica di malattia mani-piedi-bocca giunti consecutivamente presso l’Ambulatorio di Dermatologia Pediatrica del Policlinico S.Orsola-Malpighi di Bologna tra gennaio 2012 e febbraio 2014. Abbiamo valutato distribuzione, tipologia ed estensione delle lesioni. In un gruppo di pazienti è stata inoltre eseguita l’identificazione virale sul fluido vescicolare. Risultati: Abbiamo arruolato 47 pazienti (68% maschi) con un’età mediana di 22 mesi. Sono stati individuati 3 aspetti clinici principali: 1) forma acrale (distribuzione delle lesioni prevalentemente acrale), nel 62% dei soggetti; 2) eczema coxsackium (lesioni localizzate su aree eczematose), nel 23% dei soggetti; 3) forma diffusa (estensione delle lesioni al tronco), nel 15% dei soggetti. Inoltre, nell’80% circa dei pazienti si riscontravano macule purpuriche acrali, circa la metà dei pazienti aveva lesioni con aspetto purpurico e il 72% un interessamento dei glutei. In 9 su 11 soggetti genotipizzati è stato isolato il Coxsackievirus A6. Conclusioni: Questo studio ha permesso di descrivere tre fenotipi di malattia mani-piedi-bocca atipica, che deve essere correttamente identificata al fine di non porre diagnosi errate quali varicella, eczema herpeticum, vasculiti, impetigine, e di potere così procedere ad una gestione appropriata della patologia.