Background: Tacrolimus (FK) and nonsteroidal anti-inflammatory drugs (NSAIDs) can cause acute nephrotoxicity. The expanding use of tacrolimus and the intense consumption of NSAIDS increase the chances of their simultaneous use. Methods: Rats receiving a nonselective COX inhibitor (diclofenac, D) and FK or a selective COX-2 inhibitor (rofecoxib, RO) and FK were treated with FK (2 mg/kg/day), D (10 mg/kg/day), RO (3 mg/kg/day), FK+D, FK+RO and vehicle for 7 days on low-salt diet. Results: Both associations significantly impaired glomerular filtration rate (GFR; 0.63 ± 0.06 ml/min/100 g in FK+D, 0.83 ± 0.06 ml/min/100 g in FK+RO) which did not occur with single drug therapy (0.98 ± 0.03 ml/min/100 g in D, 1.06 ± 0.04 ml/min/100 g in RO, 0.99 ± 0.05 ml/min/ 100 g in FK) or vehicle (1.10 ± 0.05 ml/min/100 g). GFR decrease was significantly higher with FK+D. GFR impairment occurred without RBF or RVR major changes. Mild tubular vacuolization and dilatation and acute degenerative changes were observed in tubular cells. FK+D animals showed a marked weight loss, not observed in the other groups. FK+NSAIDs association decreased FK blood levels (1.73 ± 0.3 ng/ml in FK+D, 1.8 ± 0.3 ng/ml in FK+RO, 3.2 ± 0.4 ng/ml in FK, p < 0.05). Conclusions: The association of FK and nonselective or COX-2 selective NSAIDs in salt-depleted animals caused a significant GFR impairment and decreased FK blood levels.

Criação de banco de dados para sustentação da pós-eliminação em hanseníaseCreation of a data bank for sustainability of leprosy post elimination Resumo São José do Rio Preto atingiu o parâme-tro da Organização Mundial de

Biological agents are widely used for various immune-mediated diseases, with remarkable effectiveness in the treatment of rheumatoid arthritis (RA), psoriasis, psoriatic arthritis, ankylosing spondylitis and Crohn's disease. However, attention needs to be drawn to the adverse effects of these therapies and the risk of reactivating underlying granulomatous infectious diseases such as tuberculosis, leprosy, syphilis, leishmaniasis, among others. The objective of this paper is to describe a case of leprosy in a patient with RA using anti-TNF alfa, demonstrating the need for systematic investigation of skin lesions suggestive of leprosy in patients who require rheumatoid arthritis therapeutic treatment, especially in endemic regions like Brazil.

BACKGROUNDThe incidence of cutaneous melanoma is increasing worldwide. Since it is an aggressive neoplasm, it is difficult to treat in advanced stages; early diagnosis is important to heal the patient. Melanocytic nevi are benign pigmented skin lesions while atypical nevi are associated with the risk of developing melanoma because they have a different histological pattern than common nevi. Thus, the clinical diagnosis of pigmented lesions is of great importance to differentiate benign, atypical and malignant lesions. Dermoscopy appeared as an auxiliary test in vivo, playing an important role in the diagnosis of pigmented lesions, because it allows the visualization of structures located below the stratum corneum. It shows a new morphological dimension of these lesions to the dermatologist and allows greater diagnostic accuracy. However, histopathology is considered the gold standard for the diagnosis. OBJECTIVESTo establish the sensitivity and specificity of dermoscopy in the diagnosis of pigmented lesions suspected of malignancy (atypical nevi), comparing both the dermatoscopic with the histopathological diagnosis, at the Dermatology Service of the outpatient clinic of Hospital de Base, São José do Rio Preto, SP.METHODSAnalysis of melanocytic nevi by dermoscopy and subsequent biopsy on suspicion of atypia or if the patient so desires, for subsequent histopathological diagnosis.RESULTSSensitivity: 93%. Specificity: 42%. CONCLUSIONSDermoscopy is a highly sensitive method for the diagnosis of atypical melanocytic nevi. Despite the low specificity with many false positive diagnoses, the method is effective for scanning lesions with suspected features of malignancy.

Background:Pain is a complex phenomenon that implies pathophysiological processes and psychosocial components. A 56-year-old female patient complaining of pain and presenting with multiple mild physical signs was examined by a multidisciplinary team from the EarNose-Throat, Dermatology, Hematology, General Clinics, and Psychiatry and Psychology Departments. Objective:To present a significant case where pain is primarily caused by psychological conflicts. Method:A multidisciplinary approach, with medical and psychological interventions. Results:The patient was deeply convinced; she had been contaminated by leprosy. Her enrooted personal beliefs, including religion and moral conflicts, seem to be the primary cause for her putative 'disease', a condition that was not confirmed by exhaustive exams. Conclusion:Pain normally is related to several factors, including biological, psychological and cultural. Some complex cases should be investigated by a multidisciplinary team of specialists, in order to identify extra-physiological components.