Currently, the Milwaukee protocol presents healing results in human beings affected by the rabies virus. However, there are many points to clarify on the action of drugs and the immune mechanism involved in the evolution of the disease. One of the drugs used is biopterin, which is an important cofactor for nitric oxide, important for preventing vasospasm. Thus, we describe the effect of biopterin on some inflammatory factors in a rabies virus infection developed in an animal model. The immunological mediators studied in animals infected with rabies virus submitted to doses of sapropterin were Anti-RABV, IL-6, IL-2, IL-17a, INF-gamma and Anti-iNOS. It is suggested that the medication in the context of a RABV infection already installed, had the effect of modulating the inflammatory mechanisms mainly linked to the permeability of the blood-brain barrier and the migration of cytotoxic cells.

Introduction: Psoriasis is a chronic inflammatory multisystemic disease with several comorbidities, namely anxiety and depression disorders. Methods: In this study, the prevalence of these psychiatric entities was investigated by the PHQ-9 and GAD-7 questionnaries and related to the socio-demographic variables and to the forms of clinical treatment. Results: A total of 90 patients (56 females) were analyzed. Of these, 41 patients (45.56%) used topical treatment only, 28 patients (31.11%) used oral methotrexate and 21 patients (23.33%) used immunobiological agents (anti-TNF-alfa agents). It was observed that 47 patients (52.23%) presented some degree of depression (mild, moderate or severe) and 53 patients (58.89%) presented some degree of anxiety disorder (mild, moderate or severe). There was no statistical relationship between the anxiety and depression scores and the PASI score, as well as age, employability or schooling. There was a statistical association between psychiatric comorbidities and the female gender (p <0.0001). It was also observed a lower prevalence of depression (p = 0.0336) on patients using immunobiological treatments. Conclusion: The findings confirm published data, showing association of psychiatric conditions with psoriasis, especially in relation to TNF-alpha, so that anti-TNF therapies may become an alternative for the treatment of depression or anxiety disorders associated with psoriasis.

Objetivo: Averiguar a efetividade da utilização da cirurgia de MOHS no manejo de tumores cutâneos tipo não melanoma em comparação a outros métodos de terapia. Métodos: O estudo consiste em uma revisão sistemática, cuja coleta de artigos ocorreu nas bases de dados MEDLINE, PubMed Central (PMC), LILACS e SciELO, utilizando os termos “Cirurgia de MOHS”, “Câncer de pele”, “Ensaio clínico”, excluindo “melanoma”. Resultados: Do total de 132 artigos identificados, foram considerados elegíveis 11. A análise dos artigos demonstrou que a CMM, comparada a outros métodos, apresentou resultados estéticos melhores, além de menor grau de complicações em tumores recorrentes e um custo/benefício variável com o país onde foi feita operação. A CMM também apresentou menores índices de recorrência em todos os estudos. Conclusão: No geral, a cirurgia de MOHS se mostrou um método terapêutico promissor. No entanto, existem ainda poucos estudos comparativos sobre a eficácia da CMM e os que existem se concentram em poucas regiões do mundo.

INTRODUÇÃO: Micose fungoide (MF) é um tipo de linfoma cutâneo de células T com incidência aproximada de 0,41/100.000 indivíduos anualmente. O presente relato ressalta os impactos do atraso diagnóstico na evolução da doença. RELATO DO CASO: Paciente do sexo feminino buscou assistência médica no serviço de dermatologia da Universidade do Estado do Pará (UEPA), em novembro de 2017, apresentando três placas eritemato-hipercrômicas infiltradas, duas no abdômen e uma descamativa no membro inferior esquerdo, e linfonodo palpável na região inguinal esquerda com crescimento progressivo que iniciou em 2011. A paciente relatou que havia sido submetida a vários exames e tratamentos, assistida por seis profissionais médicos de diferentes especialidades e realizado quatro exames histopatológicos. O caso foi investigado no serviço de dermatologia, tendo sido realizado estudo imunohistoquímico e concluído o diagnóstico de MF. A paciente iniciou tratamento com metotrexato 15 mg e ácido fólico 5 mg, em dose única semanal, e fototerapia com PUVA, tendo apresentado melhora significativa, porém, com extensa área de atrofia e infecções secundárias. CONCLUSÃO: O presente caso é um problema de saúde pública que reforça a necessidade de capacitação adequada de médicos para identificação e tratamento precoce de MF.

Background Brazil remains endemic for infection by the human immunodeficiency virus (HIV) and leprosy, having a major impact on public health and the life quality of affected patients. Although the relevance of this co-infection is recognized, several aspects, such as the immune response, are not yet fully understood. The objective of this study was to investigate the expression of FOXP3+ Treg cells in leprosy skin lesions and to correlate their clinical forms, laboratory characteristics (CD4, CD8, and CV), and the immune reconstitution syndrome in HIV-leprosy co-infection. Methodology/Principal findings An observational, cross-sectional, and analytical study was carried out comparing four groups of patients: those with concomitant diagnosis of leprosy and HIV infection without a leprosy reaction, those with leprosy and HIV co-infection patients with a reverse reaction (RR), those with leprosy without HIV and without reaction, and those with leprosywithout HIV and with RR. The patients were diagnosed at a dermatology outpatient clinic located in Belém, Pará, Brazil, from 2003 to 2017. In the sample studied, there was a positive correlation between FOXP3+ cell density and viral load, negative correlation with blood CD4+ (not statistically significant), significant positive correlation in CD8 count in patients with leprosy reaction, and positive relationship in patients with IRIS. The density of cells expressing FOXP3 was higher in the BL/LL forms in patients without HIV, although the difference was not statistically significant. However, the cell mean was higher in the TT/BT forms in patients co-infected with leprosy and HIV, showing contradictory results. Conclusions/Significance These findings support that higher activity of the HIV may stimulate or result in a higher expression of FOXP3-Tregs and that they may be involved in active immunosuppression observed at the infection site at the tissue level. This supports the need to expand studies on FOXP3+ Treg cells in co-infected patients.