Analgesic and side effects of intravenous recombinant Ph alfa 1 beta

Background: Intrathecal injection of voltage-sensitive calcium channel blocker peptide toxins exerts analgesic effect in several animal models of pain. Upon intrathecal administration, recombinant Phα1β exerts the same analgesic effects as the those of the native toxin. However, from a clinical perspective, the intrathecal administration limits the use of anesthetic drugs in patients. Therefore, this study aimed to investigate the possible antinociceptive effect of intravenous recombinant Phα1β in rat models of neuropathic pain, as well as its side effects on motor, cardiac (heart rate and blood pressure), and biochemical parameters. Methods: Male Wistar rats and male Balb-C mice were used in this study. Giotto Biotech® synthesized the recombinant version of Phα1β using Escherichia coli expression. In rats, neuropathic pain was induced by chronic constriction of the sciatic nerve and paclitaxel-induced acute and chronic pain. Mechanical sensitivity was evaluated using von Frey filaments. A radiotelemeter transmitter (TA11PA-C10; Data Sciences, St. Paul, MN, USA) was placed on the left carotid of mice for investigation of cardiovascular side effects. Locomotor activity data were evaluated using the open-field paradigm, and serum CKMB, TGO, TGP, LDH, lactate, creatinine, and urea levels were examined. Results: Intravenous administration of recombinant Phα1β toxin induced analgesia for up to 4 h, with ED50 of 0.02 (0.01-0.03) mg/kg, and reached the maximal effect (Emax = 100% antinociception) at a dose of 0.2 mg/kg. No significant changes were observed in any of the evaluated motor, cardiac or biochemical parameters. Conclusion: Our data suggest that intravenous administration of recombinant Phα1β may be feasible for drug-induced analgesia, without causing any severe side effects.

Analgesic and side effects of intravenous recombinant Phα1ß

Intrathecal injection of voltage-sensitive calcium channel blocker peptide toxins exerts analgesic effect in several animal models of pain. Upon intrathecal administration, recombinant Phα1ß exerts the same analgesic effects as the those of the native toxin. However, from a clinical perspective, the intrathecal administration limits the use of anesthetic drugs in patients. Therefore, this study aimed to investigate the possible antinociceptive effect of intravenous recombinant Phα1ß in rat models of neuropathic pain, as well as its side effects on motor, cardiac (heart rate and blood pressure), and biochemical parameters. Methods: Male Wistar rats and male Balb-C mice were used in this study. Giotto Biotech® synthesized the recombinant version of Phα1ß using Escherichia coli expression. In rats, neuropathic pain was induced by chronic constriction of the sciatic nerve and paclitaxel-induced acute and chronic pain. Mechanical sensitivity was evaluated using von Frey filaments. A radiotelemeter transmitter (TA11PA-C10; Data Sciences, St. Paul, MN, USA) was placed on the left carotid of mice for investigation of cardiovascular side effects. Locomotor activity data were evaluated using the open-field paradigm, and serum CKMB, TGO, TGP, LDH, lactate, creatinine, and urea levels were examined. Results: Intravenous administration of recombinant Phα1ß toxin induced analgesia for up to 4 h, with ED50 of 0.02 (0.01-0.03) mg/kg, and reached the maximal effect (Emax = 100% antinociception) at a dose of 0.2 mg/kg. No significant changes were observed in any of the evaluated motor, cardiac or biochemical parameters. Conclusion: Our data suggest that intravenous administration of recombinant Phα1ß may be feasible for drug-induced analgesia, without causing any severe side effects.(AU)

Reflectance confocal microscopy of tinea nigra: comparing images with dermoscopy and mycological examination results

Abstract: Tinea nigra is a superficial mycosis whose diagnosis is confirmed by isolating the infectious agent Hortae werneckii through mycological examinations. In vivo reflectance confocal microscopy, initially used in melanocytic dermatosis, has been used with skin infectious diseases to identify the parasite at the cellular level. We report, for the first time in the scientific literature, the use of reflectance confocal microscopy in a case of tinea nigra and compare its findings to dermoscopy and mycological examination results.

Mapping of the continuous epitopes displayed on the Clostridium perfringens type D epsilon-toxin

Abstract The epsilon toxin, produced by Clostridium perfringens, is responsible for enterotoxemia in ruminants and is a potential bioterrorism agent. In the present study, 15 regions of the toxin were recognized by antibodies present in the serum, with different immunodominance scales, and may be antigen determinants that can be used to formulate subunit vaccines.

Análise do perfil dos pacientes e das dermatoses abordadas em mutirão de cirurgia dermatológica: a importância do dermatologista na saúde pública / Analysis of the profile of patients and dermatoses treated in a dermatologic surgery public campaign: the importance of the dermatologist in public health

Introdução: A saúde pública no Brasil apresenta demanda de procedimentos dermatológicos superior à atual oferta, resultando em fila de espera de pacientes com dermatoses a abordar cirurgicamente. Foi realizado mutirão de procedimentos cirúrgicos em serviço terciário de atendimento público para reduzir essa fila, sendo os dados dos pacientes e suas lesões aqui apresentados. Objetivo: Analisar o perfil dos pacientes que aguardam a realização de procedimentos dermatológicos bem como suas dermatoses. Métodos: Realizou-se análise descritiva simples do perfil dos pacientes, de suas dermatoses abordadas e dos procedimentos realizados. Resultados: Foram atendidos 31 pacientes com idade entre 21 e 95 anos (média de 63,7 anos), sendo 17 (54,83%) do sexo feminino e 14 (45,17%) do sexo masculino. Foram abordadas 38 lesões, sendo 21 neoplásicas (carcinomas e melanoma), oito pré-neoplásicas (queratoses actínicas) e nove não neoplásicas (nevos, queloide e neurofibroma). Conclusões: Este artigo torna-se relevante por identificar casos e pacientes que aguardam procedimentos cirúrgicos dermatológicos no serviço público. Com ele, estratégias de saúde pública na área dermatológica podem ser mais bem programadas, além de destacar a importante ação do dermatologista na saúde pública diagnosticando e tratando lesões pré-neoplásicas e neoplásicas.

Introduction: In the Brazilian public health system, the current demand for dermatological procedures is greater than the offer, resulting in a waiting list of patients bearing dermatoses to be treated surgically. Aimed at reducing that waiting list, a collective effort of surgical procedures was carried out in the tertiary public health service. The corresponding data on the patients and lesions is disclosed in the present study. Objective: To assess the profile of the patients ­ and respective skin lesions ­ who are awaiting to undergo dermatological procedures. Methods: A simple descriptive profile analysis of the patients, treated dermatoses and procedures performed was carried out. Results: Thirty-one patients (aged between 21 and 95 years, mean = 63.7 years). Seventeen (54.83%) were women and 14 (45.17%) were men. Thirty-eight lesions were treated: 21 neoplastic (carcinomas and melanomas), 8 pre-neoplastic (actinic keratoses) and 9 non-neoplastic (nevi, keloid and neurofibroma). Conclusions: The present article is relevant due to the fact it identifies cases and patients awaiting dermatological surgical procedures in the public health system. Based on it, a better planning of public health strategies in the dermatological field should be possible. Also, it highlights the importance of the dermatologist physician's action in the public health, diagnosing and treating pre-neoplastic and neoplastic lesions.

White piedra, black piedra, tinea versicolor, and tinea nigra: contribution to the diagnosis of superficial mycosis

Abstract Superficial mycoses are fungal infections restricted to the stratum corneum and to the hair shafts, with no penetration in the epidermis; they are: white piedra, black piedra, tinea versicolor, and tinea nigra. This study presents images of mycological tests performed in the laboratory, as well as exams performed at the authors office, in order to improve the dermatologist's knowledge about the diagnosis of these dermatoses, which are common in many countries.

Supra-acetabular fixation and sacroiliac screws for treating unstable pelvic ring injuries: preliminary results from 20 patients / Tratamento das lesões instáveis do anel pélvico com fixador supra-acetabular e parafusos sacroilíacos: resultados preliminares em 20 pacientes

OBJECTIVE: To analyze the treatment results from 20 patients who underwent an alternative osteosynthesis method as definitive treatment for pelvic ring fractures. METHODS: A retrospective analysis was conducted on a series of 20 patients with pelvic ring fractures (Tile type C) and a high risk of postoperative infection, who were treated at Santa Casa de Misericórdia de São Paulo between August 2004 and December 2012. The patients underwent percutaneous supra-acetabular external fixation in association with cannulated 7.0 mm iliosacral screws. RESULTS: The patients' mean age was 40 years (range 22-77 years) and the mean length of follow-up was 18.5 months (range 3-69 months). At the end of the treatment, ten patients (50%) were classified as having good results, nine patients (45%) had fair results and one patient (5%) did not have any improvement. Six patients presented complications, and paresthesia of the lateral femoral cutaneous nerve was the most frequent of these (two patients). CONCLUSION: Supra-acetabular external fixation in association with iliosacral percutaneous osteosynthesis is a good definitive treatment method for patients with a high risk of postoperative infection.

OBJETIVO: Avaliar os resultados do tratamento de 20 pacientes que usaram como tratamento definitivo um método de osteossíntese opcional para fraturas do anel pélvico. MÉTODOS: Foi feita uma análise retrospectiva da série de 20 casos de pacientes com fratura do anel pélvico tipo C de Tile, portadores de alto risco de infecção pós-operatória, tratados na Santa Casa de Misericórdia de São Paulo entre agosto de 2004 e dezembro de 2012, submetidos a fixação externa supra-acetabular percutânea associada com parafusos canulados iliossacrais de 70 mm. RESULTADOS: A média de idade dos pacientes foi de 40 anos (mínimo de 22; máximo de 77) e o tempo médio de seguimento foi de 18,5 meses (mínimo de três; máximo de 69). Após o término do tratamento dez pacientes (50%) foram classificados com bons resultados, nove (45%) tiveram desfecho regular e um (5%) não apresentou melhoria alguma. Seis apresentaram complicações. A parestesia do nervo cutâneo femoral lateral foi a mais frequente (dois pacientes). CONCLUSÃO: A fixação externa supra-acetabular associada a osteossíntese percutânea iliossacral é um bom método de tratamento definitivo para os pacientes com alto risco de infecção pós-operatória.

Factors contributing to the surgical retreatment of mandibular fractures

The purpose of this retrospective study was to evaluate contributing factors in patients requiring surgical retreatment of mandibular fractures. Of all the patients with mandibular fractures who were treated using internal fixation at a trauma hospital over a seven-year period, 20 patients (4.7%) required a second surgery and thus composed the “reoperated” group. The control group comprised 42 consecutive patients with mandibular fractures who were treated at the same clinic and who healed without complications. Medical charts were reviewed for gender, age, substance abuse history, dental condition, etiology, location of fracture, degree of fragmentation, fracture exposure, teeth in the fracture line, associated facial fractures, polytrauma, time elapsed between trauma and initial treatment, surgical approach and fixation system. Statistical analyses were performed using the Statistical Package for Social Sciences (SPSS) version 20.0; descriptive statistics and the chi-squared test were used to determine differences between groups. Significant differences in substance abuse (p = 0.006), dental condition (p < 0.001), location of fracture (p = 0.010), degree of fragmentation (p = 0.003) and fracture exposure (p < 0.001) were found. With regard to age and time elapsed between trauma and initial treatment, older patients (31.4 years, SD = 11.1) and a delay in fracture repair (19.1 days, SD = 18.7) were more likely to be associated with reoperation. It was concluded that substance abuse, age, dental condition, location of fracture, degree of fragmentation, fracture exposure and the time between trauma and initial treatment should be considered contributing factors to the occurrence of complications that require surgical retreatment of mandibular fractures.

Fratura de mandíbula como complicação pós-operatória da instalação de implantes dentários / Mandibular fracture a postoperative complication after dental implant placement

A fratura espontânea da mandíbula é uma rara complicação pós-operatória da instalação de implantes dentários. O objetivo deste trabalho é relatar um caso de fratura da mandíbula ocorrida uma semana após a instalação de implantes osseointegrados por outra equipe e discutir os possíveis fatores predisponentes ligados à sua ocorrência. Não havia história prévia de trauma na região e o paciente relatava parestesia no lábio inferior e mento no lado esquerdo desde a instalação dos implantes. No exame clínico havia dor à palpação com discreta movimentação óssea na região de corpo mandibular esquerdo e foi observada oclusão dentária apenas na região anterior em decorrência de edentulismo mandibular posterior bilateral. Nos exames de imagens foram visualizados dois implantes longos que invadiam a região do canal mandibular e uma fratura completa da mandíbula na região de corpo esquerdo e associada ao implante mais posterior. O tratamento de escolha foi a remoção dos implantes seguida de redução aberta da fratura e imobilização com placa e parafusos de titânio. Com base nas características clínicas acima mencionadas, pôde-se especular que o padrão oclusal e as alterações proprioceptivas devido a parestesia parecem ser fatores importantes que contribuem para o aumento das tensões na região posterior da mandíbula e consequente fratura após instalação de implante dentário.

Spontaneous mandibular fracture is a rare postoperative complication after dental implant placement. The aim of this study was to report a case of mandibular fracture one week after placement of dental implants by another surgical team, and to discuss possible predisposing factors associated to it. There was no history of previous trauma and the patient reported paresthesia in the lower lip and chin on the left side since implant placement. On clinical examination, there was pain on palpation with discrete bone mobility and dental occlusion only in the anterior region as a result of bilateral, posterior mandibular edentulism. Two long implants impinging the mandibular canal were viewed on radiographs, and a complete mandibular fracture on the left mandibular body associated to the most posterior implant, as well. The treatment of choice was the removal of implants followed by open reduction of fracture and fixation with titanium plate and screws. Based on the aforementioned clinical characteristics, it can be speculated that occlusal patterns and proprioceptive changes due to paresthesia seem to be important factors contributing to the increase of stress in the posterior mandibular region and the accompanying fracture after dental implant placement.

Anemia aplástica: experiencia con 7 casos / Aplastic anemia: a report of 7 cases

La anemia aplástica (AA) es una falla medular caracterizada por pancitopenia en sangre periférica como resultado de una disminución de la producción de células sanguíneas en médula ósea. Tiene diversas etiologías y una incidencia de 2 a 4 casos por 1 000 000 niños menores de 15 años. El tratamiento de elección es el transplante de médula ósea alogénico o en su defecto la inmunosupresión con lingoglobulina o timoglobulina además de ciclosporina, metilprednisolona y factores de crecimiento hematopoyético. Se presenta la experiencia con 7 pacientes del Hospital Roberto del Río diagnosticados entre los años 1995 y 2000, edad 2 meses a 13 años, con biopsia de médula ósea compatible. Dos pacientes presentaban etiología congénita, 3 con antecedentes de hepatitis y 2 fueron considerados idiopáticos. Un paciente fue transplantado de un hermano compatible luego de recibir inmunosupresión, 3 recibieron inmunosupresión con linfo/timoglobulina además de ciclosporina y factor estimulante de colonias de granulocitos y 3 niños sólo recibieron tratamiento de sostén con metilprednisolona o factores de crecimiento. Dos pacientes fallecieron precozmente por cuadro infeccioso. Cinco pacientes están vivos con una mediana de seguimiento de 43 meses, los 4 que recibieron inmunosupresión incluido el paciente transplantado, y la paciente con anemia de Fanconi

Esplenectomía laparoscópica en niños con enfermedades hematológicas (primera serie en México) / Laparoscopic splenectomy in children with hematological disorders

Introducción. Objetivo: mostrar la experiencia inicial con esplenectomía laparoscópica (EL) en enfermedades hematológicas.Material y métodos. Estudio prospectivo, longitudinal, de pacientes con enfermedades hematológicas a quienes se les realizó EL en el período de mayo de 1995 a junio de 1999. Resultados. Se intentó EL en 25 pacientes, con esferocitosis hereditaria (23) o púrpura trombocitopénica (2), con edad promedio de 7 años y peso de 25 kg. Se tuvo éxito en 24 (96 por ciento). Se observó una conversión por hemorragia. En tres pacientes se realizó concomitantemente colecistectomía. El tiempo quirúrgico promedio fue de 175 min. La estancia hospitalaria promedio fue de 3 días. Todos los pacientes incrementaron significativamente su cifra de plaquetas después de la operación y ninguno requirió transfusión o medicación postoperatoria. No hubo fallecimientos y las complicaciones fueron mínimas. Conclusiones. La EL puede realizarse en niños con trastornos hematológicos de manera segura. La morbimortalidad es comparable a la reportada en esplenectomía abierta y conlleva además los beneficios de la cirugía de mínima invasión.

Anomalías del cordón umbilical y su asociación con malformaciones fetales / Anomalies of the umbilical cord and its association with fetal malformations

Se presenta una evolución de 1.500 autopsias perinatales; y se relaciona los hallazgos de anomalías del cordón umbilical con malformaciones fetales mayores y menores. Se destacan la arteria umbilical única y las estenosis del cordón. Como las más frecuentes se señala la importancia de un examen acucioso del cordón umbilical y la placenta