Perfil clínico-epidemiológico de pacientes com hanseníase atendidos em hospital universitário no Rio de Janeiro entre 2008 e 2017 / Clinical and epidemiological profile of leprosy patients admitted to a university hospital in Rio de Janeiro between 2008 and 2017

Modelo do estudo: Estudo observacional, longitudinal, retrospectivo e descritivo de uma coorte de pacientes. Objetivo: Descrever o perfil clínico e epidemiológico dos pacientes com diagnóstico de hanseníase, atendidos em um centro de referência no estado do Rio de Janeiro. Metodologia: Foram incluídos todos os pacientes com diagnóstico de hanseníase atendidos no Hospital Universitário Gaffrée e Guinle entre os anos de 2008 a 2017. Os dados foram coletados através da revisão de prontuários e analisados através de estatística descritiva, utilizando-se o software SPSS 22.0 database. Resultados: Um total de 112 pacientes foi incluído no estudo, sendo que 54,5% eram do sexo masculino. A média de idade foi de 49,9 anos, 62,4% eram moradores do município do Rio de Janeiro e 69,9% apresentaram formas clínicas multibacilares da hanseníase. Foi possível avaliar o grau de incapacidade inicial de 36 (32,1%) dos pacientes incluídos. Desses, 25% apresentaram grau de incapacidade inicial II. Durante o tratamento poliquimioterápico, 21 (18,8%) pacientes apresentaram algum efeito colateral, sendo o mais comum a anemia relacionada à dapsona. Cinquenta e nove (52,7%) pacientes apresentaram algum tipo de estado reacional da hanseníase e 10 (8,9%) apresentaram complicações sistêmicas graves durante o acompanhamento. Conclusões: O presente estudo evidenciou um perfil clínico-epidemiológico diferente do descrito na literatura, com uma grande porcentagem de pacientes com grau de incapacidade inicial II, uma alta frequência de estados reacionais e de complicações advindas do curso clínico da doença ou dos tratamentos implementados.(AU)

Introduction: This was an observational, longitudinal, retrospective and descriptive study of a cohort of patients. Objectives: To describe the clinical and epidemiological profile of the patients diagnosed with leprosy admitted to a reference medical center in the State of Rio de Janeiro. Methods: All leprosy patients admitted to the dermatology clinic from the Hospital Universitário Gaffrée and Guinle between 2008 and 2017 were included. Pertinent patients' data were collected through medical charts review. Data were then analyzed through descriptive statistics using SPSS 22.0 software. Results:a total of 112 patients were included in the study. Among them, 54.5% were male, the median age was 49.9 years old, 62.4% were residents in the city of Rio de Janeiro and 69.9% presented multibacillary leprosy clinical forms. We evaluated the initial disability grade of 36 from the 112 included patients, and out of them, 25% had grade II disability. During multidrug therapy, 21 (18.8%) patients presented an adverse effect, which the most common was anemia related to dapsone. Fifty-nine (52.7%) patients presented leprosy reaction and 10 (8.9%) patients presented severe systemic complications during the follow-up. Conclusions: In the present study, it was observed a distinctive clinical and epidemiological leprosy profile. There was a high frequency of grade II initial disability, leprosy reaction and severe clinical complications due to the progression of the disease or as adverse effects of leprosy treatment. (AU)

Relato da experiência da realização de pequenos procedimentos em dermatologia em Hospital Universitário / Report of the experience of small procedures in dermatology at University Hospital

Modelo do estudo: Cohort. Objetivos: Relatar a experiência do setor de Pequenos Procedimentos em Dermatologia do Hospital Universitário Gaffrée e Guinle, determinando os diagnósticos, tipos de tratamentos e resolutividade. Metodologia: Trata-se de estudo prospectivo, observacional, por meio da coleta de dados dos pacientes do Programa de Saúde da Família da Secretaria Municipal de Saúde do Rio de Janeiro encaminhados para a realização de pequenos procedimentos em dermatologia, durante um período de 31 semanas. Resultados: Foram atendidos 884 pacientes. As lesões benignas representaram 77,5% dos diagnósticos clínicos e as malignas 22,5%. Os diagnósticos mais frequentes foram de cisto (133) e carcinoma basocelular (128). Os procedimentos mais realizados foram a excisão e sutura simples (337) e a retirada de lesão por shaving mais eletrocoagulação (161). No total, 98,3% dos procedimentos foram de cirurgia dermatológica básica e 1,7% dos casos necessitaram de procedimentos avançados. Além disso, 90,8% dos pacientes foram operados no dia do primeiro atendimento e 3,7% precisaram ser encaminhados para outras especialidades cirúrgicas. Conclusão: Um serviço de cirurgia dermatológica estruturado para a realização de pequenos procedimentos, em caráter ambulatorial, permite prover atendimento resolutivo à grande maioria dos pacientes com essa necessidade. (AU)

Study design: Cohort study. Objectives: To report the experience of the Small Procedures Division, Dermatology Department, at Gaffrée and Guinle University Hospital, including a description of diagnoses, types of treatment, and efficacy. Methods: This is a prospective, observational study that consisted of data compilation of patients referred from the primary Family Health Program, Local Health Department, to an University Hospital for the performance of small dermatological procedures, encompassing a period of 31 weeks. Results: Overall, 884 patients underwent procedures. Benign lesions comprised 77.5% of the clinical diagnoses, while malignant lesions constituted 22.5%. The most frequent diagnoses were cyst (133) and basal cell carcinoma (128). The most commonly performed procedures were simple excision and suture (337) and lesion removal through shaving plus electrocoagulation (161). 98.3% of the procedures consisted of basic dermatological surgeries and 1.7% of the cases required advanced procedures. In addition, 90.8% of the patients were operated on the first day of care, on the other hand 3.7% were referred to other surgical specialties. Conclusion: A Dermatologic Surgery Department structured to perform small outpatient procedures provides efficacious care to the vast majority of referred patients (AU)

Nasal-type extranodal T-cell/NK lymphoma in association with hemophagocytic syndrome

Abstract: Extranodal NK/T-cell lymphoma nasal type is a rare disease that mainly affects the nasal cavity and paranasal sinuses of males in the fifth decade of life. It has aggressive and locally destructive behaviour, and can be complicated by the hemophagocytic syndrome, conferring high lethality to the disease. This article describes a case of NK/T-cell lymphoma nasal type in a previously healthy patient, exemplifying its rapid and fulminant course.

Melanomas primários sincrônicos: aspectos dermatoscópicos / Primary synchronic melanomas: dermoscopic aspects

Melanomas sincrônicos são raros e pouco descritos na literatura. São classificados dessa maneira quando um segundo melanoma é observado no primeiro exame ou até três meses após o primeiro diagnóstico. Descrevemos um inusitado caso e o exame dermatoscópico de um paciente com dois melanomas primários sincrônicos. A dermatoscopia é uma ferramenta muito útil no diagnóstico precoce dos melanomas. Alguns padrões dermatoscópicos sugestivos de melanomas na face são aberturas anexiais assimétricas pigmentadas, estruturas romboidais e pontos e glóbulos cinza-azulados. Já na região plantar, o padrão dermatoscópico característico de melanoma é o padrão em cristas paralelas que apresenta alta sensibilidade e especificidade na detecção de melanomas acrais.(AU)

Synchronic melanomas are rare and poorly described in the literature. They are classified in this way when a second melanoma is observed on the first examination or up to three months after the first diagnosis. An unusual case and the dermoscopic examination of a patient with two primary synchronic melanomas is described. The dermatoscopy is a very useful tool in the early diagnosis of melanomas. Some dermatoscopy patterns suggestive of melanomas on the face are asymmetric pigmented anexiais openings, rhomboidal structures and blue-gray globules and dots. The dermatoscopy characteristic pattern of melanoma in the region of plant is the default in parallel ridges that has high sensitivity and specificity in detecting acrais melanomas. (AU)

Acquired perforating dermatosis in a patient with chronic renal failure

Abstract Perforating dermatoses are a group of skin diseases characterized by transepidermal elimination of dermal material. The disease is divided into two groups: the primary group and the secondary group. The classical or primary perforating dermatoses are subdivided into four types according to the eliminated dermal materials: Kyrle disease, perforating reactive collagenosis, elastosis perforans serpiginosa, and perforating folliculitis. The secondary form is known as acquired perforating dermatosis. The term was proposed in 1989 by Rapini to designate the perforating dermatoses affecting adult patients with systemic disease, regardless of the dermal materials eliminated. This report describes a case of the disease with elimination of collagen and elastic fibers in a patient with chronic renal failure.