O tratamento das cicatrizes de esternotomia mediana com injeções de triancinolona, placas de silicone e terapia combinada: um estudo prospectivo randomizado / Treatment of median sternotomy scars using Triamcinolone injections, Silicone Dressings and a combination group: a prospective randomized comparative study

Introdução: Placas de silicone e injeções de triancinolona melhoram o tamanho dos queloides e das cicatrizes hipertróficas, além do eritema, da elasticidade e de sintomas como dor e prurido. Esses tratamentos não são invasivos, têm um bom custo-beneficio e são amplamente utilizados como terapia inicial para queloides e cicatrizes hipertróficas; entretanto, faltam estudos comparativos dos dois tratamentos. Objetivo: Comparar o uso de placas de silicone, triancinolona intralesional, e a combinação de ambas as modalidades terapêuticas, no tratamento de cicatrizes hipertróficas na mesma área anatômica e causadas pelo mesmo mecanismo de lesão. Métodos e Materiais: Em um estudo prospectivo, 12 pacientes com cicatrizes de esternotomia mediana foram randomizados em 3 grupos (4 pacientes em cada grupo): Grupo 1. injeções mensais de triancinolona; Grupo 2. uma combinação de placas de silicone e injeções de triancinolona e Grupo 3. placas de silicone. Os pacientes foram avaliados em consultas clínicas mensais com o uso da Escala de Vancouver e durômetro. Foram realizadas imunohistoquímica e microscopia confocal para os colágenos de tipos I e VI em amostras de cicatriz. Os grupos foram comparados com os testes de Kruskall-Wallis e Friedman com significância de p< 0.05. Resultados: Os três tratamentos mostraram-se eficazes na melhora das cicatrizes, conforme demonstrado pela redução nos parâmetros da Escala de Vancouver. Foi observada uma diferença entre os três grupos no tempo 2, quando a triancinolona mostrou-se menos eficaz. O grupo 2 apresentou melhora na pigmentação (p = 0,042). Os colágenos de tipos I e VI apresentaram aumento de fluorescência em toda a derme superficial e profunda nas lesões não-tratadas, que diminuiu após do tratamento. Apesar do número pequeno de pacientes, este foi o primeiro estudo prospectivo que comparou estas modalidades de tratamento de cicatrizes, evitando vieses frequentemente vistos em publicações sobre tratamentos de cicatrizes

Introduction: Silicone dressings and Triamcinolone injections are known to improve keloids and hypertrophic scars size, erythema, flexibility, and symptoms such as pain and itching. These treatments are non-invasive, inexpensive, and widely used as first or second-line therapy; however, studies comparing them are still lacking. Objective: To compare silicone dressings, triamcinolone injections, and a combination group, to treat hypertrophic scars, at the same anatomical area, caused by the same mechanism of injury. Materials and methods: In a prospective study, 12 patients with median-sternotomy scars were randomized into 3 groups (n=4 patients each): group 1, monthly triamcinolone injections; group 2, a combination of silicone dressings and triamcinolone injections; and group 3, silicone dressings. Patients were evaluated in monthly clinical appointments using the Vancouver Scale and the durometer. Immunohistochemistry and confocal microscopy for collagen types I and VI were performed in scar samples. The groups were compared using Kruskal-Wallis and Friedman tests, with p<0,05 indicating significance. Results: The three treatments were effective in reducing the Vancouver scores. A difference between the three groups was observed at time 2 when triamcinolone was less effective. Group 2 showed an improvement on pigmentation (p = 0,042). Collagens types I and VI presented increased fluorescence throughout the superficial and deep dermis in untreated lesions, which decreased after the treatment. Although the number of patients is limited, this is the first prospective study addressing some of the major bias in scars treatment

Human papillomavirus type distribution and HPV16 intratype diversity in southern Brazil in women with and without cervical lesions

BACKGROUND Increasing evidence suggests that human papillomavirus (HPV) intratype variants (specific lineages and sublineages) are associated with pathogenesis and progression from HPV infection to persistence and the development of cervical cancer. OBJECTIVES This study aimed to verify the prevalence of HPV infection and distribution of HPV types and HPV16 variants in southern Brazil in women with normal cytology or intraepithelial lesions. METHODS HPV typing was determined by L1 gene sequencing. To identify HPV16 variants, the LCR and E6 regions were sequenced, and characteristic single nucleotide variants were identified. FINDINGS A total of 445 samples were studied, with 355 from cervical scrapes and 90 from cervical biopsies. HPV was detected in 24% and 91% of these samples, respectively. The most prevalent HPV types observed were 16 (cervical, 24%; biopsies, 57%) and 58 (cervical, 12%; biopsies, 12%). Seventy-five percent of the HPV16-positive samples were classified into lineages, with 88% defined as lineage A, 10% as lineage D, and 2% as lineage B. MAIN CONCLUSIONS This study identified a high frequency of European and North American HPV16 lineages, consistent with the genetic background of the human population in southern Brazil.

Risk factors ofhhiv-1 vertical transmission (vt and the influence of antiretrooviral therapy (art) in pregnancy outcmme / Fatores de risco para a transmissao vertical do HIV-1 e a influencia da terapia antirretroviral (ARV) no desfecho gestacional

In the absence of intervention, the rate of vertical transmission of HIV can range from 15-45%. With the inclusion of antiretroviral drugs during pregnancy and the choice of delivery route this amounts to less than 2%. However ARV use during pregnancy has generated several questions regarding the adverse effects of the gestational and neonatal outcome. This study aims to analyze the risk factors for vertical transmission of HIV-1 seropositive pregnant women living in Rio Grande and the influence of the use of ARVs in pregnancy outcome. Among the 262 pregnant women studied the rate of vertical transmission of HIV was found to be 3.8%. Regarding the VT, there was a lower risk of transmission when antiretroviral drugs were used and prenatal care was conducted at the referral service. However, the use of ART did not influence the outcome of pregnancy. However, initiation of prenatal care after the first trimester had an influence on low birth weight, as well as performance of less than six visits increased the risk of prematurity. Therefore, the risk factors analyzed in this study appear to be related to the realization of inadequate pre-natal and maternal behavior.

Na ausência de intervenção, as taxas de transmissão vertical do HIV podem variar de 15-45%. Com a inserção dos antirretrovirais durante a gestação e a escolha da via de parto estas taxas chegam a menos de 2%. No entanto o uso de ARV na gestação tem gerado várias duvidas quanto aos efeitos adversos causados ao desfecho gestacional e ao neonato. Este estudo objetiva analisar os fatores de risco da transmissão vertical do HIV-1 em gestantes soropositivas atendidas na cidade do Rio Grande e a influência do uso do ARV no desfecho gestacional. Entre as 262 gestantes estudadas a taxa de transmissão vertical do HIV encontrada foi de 3,8%. Em relação à TV, foi observado menor risco de transmissão quando esta havia feito uso de antirretrovirais e o pré-natal era realizado no serviço de referência. Entretanto, o uso de ARV não influenciou negativamente o desfecho gestacional. No entanto, o inicio do pré-natal após o primeiro trimestre teve influencia sobre o baixo peso ao nascer, assim como a realização de menos de seis consultas aumentou o risco de prematuridade. Portanto, os fatores de risco analisados neste estudo parecem estar relacionados à realização não adequada do pré-natal e ao comportamento materno.