O período gestacional não é isento de infecções que comprometam a saúde materno-fetal, de forma especial aquelas que se apresentam assintomáticas ou subclínicas. Nessas situações, o tratamento, em geral, não seria necessário. Entretanto, os riscos da transmissão materno-fetal (vertical)
The diagnosis of American Tegumentary Leishmaniasis is a difficult but essential task
when considering the high toxicity profile of the drugs available. Since the
discovery of its etiologic agent, numerous diagnostic tests have been developed. None
of the tests available today can be considered as the gold standard, since they do
not add enough accuracy for the disease detection. Good epidemiological and clinical
knowledge of the disease are fundamental precepts of the dermatology practice and
precede the rational use of existing diagnostic tests. In this article we aim,
through extensive literature review, to recall fundamental concepts of any diagnostic
test. Subsequently, based on this information, we will weave important comments about
the characteristics of existing diagnostic tests, including immunological tests such
as Montenegro's skin test, serology and detection of parasites by direct examination,
culture or histopathology. Finally we will discuss the new technologies and options
for the diagnosis of Cutaneous Leishmaniasis. The molecular biology technique is
considered a promising tool, promoting the rapid identification of the species
involved. We also aim to educate dermatologists about a disease with high morbidity
and assist in its difficult recognition.
Onychomycosis is a common disease, accounting for up to 50% of all ungual
pathologies. We have been developing a clinical trial (ClinicalTrials.gov:
NCT01528813) using a 2940nm Er:YAG laser to fractionally ablate human nails in vivo,
aiming to increase topical amorolfine lacquer delivery to the nail unit, increasing
the efficacy of topical treatment of distal and lateral subungual onychomycosis.
Partial results have shown an increase in areas of nail plate free of disease. We
believe that ablative lasers can increase the efficacy of topical onychomycosis
treatment.
Leprosy is a disease caused by Mycobacterium leprae that carries a high risk of disability, making early diagnosis mandatory. This study aimed to determine the applicability of anti-PGL-1 IgM antibody detection, using the ML FLOW technique, as an assistant tool for the detection of leprosy infection in asymptomatic household contacts (AHHC) of multibacillary leprosy index cases from Midwest Brazil. Serological changes induced by the prophylaxis of these household contacts with Bacillus Calmette-Guérin (BCG) were also verified. A total of 91 AHHC were assessed, among which, 18.68% (n = 17) presented both positive bacilloscopy and positive anti-PGL-1 IgM serology. Positivity concordance between these two laboratorial exams (Kappa Index = 1; p < 0.001) was indicated, however, one case did not demonstrate concordance between the semiquantitative assessment of anti-PGL-1 IgM and the bacilloscopy index (Kappa Index = 0.96; p< 0.001). Among the 17 AHHC with positive bacilloscopy, eight were reassessed after prophylaxis with BCG and two of them presented negative anti-PGL-1 IgM serology, being these patients who had presented a bacilloscopy index of < 2[+] in the initial assessment. This study shows that anti-PGL-1 IgM detection may be used as a tool to determine the bacillary load in AHHC and to detect immune changes related to prophylaxis by nonspecific vaccination.
We present a case of an 18-year-old male patient who, after two years of inappropriate treatment for cutaneous leishmaniasis, began to show nodules arising at the edges of the former healing scar. He was immune competent and denied any trauma. The diagnosis of recurrent cutaneous leishmaniasis was made following positive culture of aspirate samples. The patient was treated with N-methylglucamine associated with pentoxifylline for 30 days. Similar cases require special attention mainly because of the challenges imposed by treatment.
The incidence of LRC among ACL patients was 1.34%. The analysis included 105 patients; 82 patients (78%) were in the control group, and 23 patients (22%) were in the LRC case group. The data analysis indicated that the standard treatment N-methylglucamine antimoniate (N-MA) reduced the development of LRC in bivariate (odds ratio (OR) = 0.34; 95% CI = 0.13-0.91) and multivariate analyses (OR = 0.16; 95% CI = 0.03-0.86; P = 0.03). However, no differences in LRC incidence were observed when the standard treatment N-MA and alternative drugs, such as pentamidine and amphotericin B, were considered (OR = 0.47; 95% CI = 0.16-1.35) CONCLUSION: We conclude that the standard treatment N-MA, as proposed by the Brazilian Ministry of Health, is effective in the prevention of LRC. Although other drugs have shown promising results in LRC, more scientific evidence is needed to assess their efficacy compared with N-MA.
Melasma represents a pigmentary disorder that is difficult to treat. This study aims
to broadly review the use of ablative lasers (Er:YAG and CO2) in the treatment of
melasma, presenting the level of evidence of studies published to date. A total of 75
patients were enrolled in four case series studies (n=39), one controlled clinical
trial (n=6) and one randomized controlled clinical trial (n=30). Studies on the
Er:YAG laser showed better results with the use of short square-shaped pulses, which
determined low rates of post-inflammatory hyperpigmentation and long-lasting
maintenance of results. Likewise, studies on the CO2 laser proved the benefits of
short pulse duration along with low-density energy. Post-treatment maintenance with
the use of antipigmenting creams was necessary and effective to sustain long-term
results. Ablative lasers may represent another useful and effective tool against
melasma. Postinflammatory hyperpigmentation and difficulty in sustaining long-term
results still represent the main limitations to a broader use of ablative lasers.
Based on actual evidence, the use of this technology should be restricted to patients
with recalcitrant disease. Further studies will help establish optimal laser
parameters and treatment regimens.
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