Os desafios na conduta terapêutica em pacientes acometidos com feridas crônicas / Challenges in the therapeutic conduct in patients affected with chronic wounds / Retos en la conducta terapéutica en pacientes afectados de heridas crónicas

Considerado um grave problema em saúde pública, as feridas crônicas são patologias que desafiam o manejo terapêutico e infelizmente acometem milhares de pessoas em todo o mundo. Essa doença apresenta altos índices de morbidade impactando negativamente na qualidade de vida dos seus portadores, além de influenciar negativamente no domínio "bem-estar", principalmente quando associado aos fatores clínicos podendo estar relacionado há anos de tratamento sem cura da ferida. As feridas crônicas são caracterizadas por demora ou dificuldade nos processos de cicatrização e reparação ordenada da integridade anatômica e funcional da pele durante um período de no mínimo três meses. Porém, algumas lesões permanecem por anos e até décadas sem cicatrizar. Objetivo: O escopo dessa revisão é mostrar o limitado arsenal terapêutico bem como a dificuldade no manejo clínico e dessa forma proporcionar uma reflexão sobre sua fisiopatologia e a urgente necessidade de novas opções e condutas terapêuticas que possam auxiliar no tratamento desses pacientes. Metodologia: Trata-se de uma revisão integrativa da literatura sobre feridas crônicas, cujo critérios de inclusão foram artigos publicados no período de janeiro de 2005 a fevereiro de 2023. Conclusão: A problemática acerca dessa patologia é vasta, tratando de uma doença de difícil cura, com uma gama de fatores associados que dificultam a cura da lesão, estendendo essa doença a altos índices de morbidade. Novas condutas terapêuticas e novos fármacos, precisam ser desenvolvidos urgentemente. Destaca-se que o uso de probióticos e o emprego da nanotecnologia tem mostrado um grande potencial inovador no tratamento de pacientes portadores de feridas crônicas.

Considered a serious public health problem, chronic wounds are pathologies that defy therapeutic management and unfortunately affect thousands of people around the world. This disease has high morbidity rates, negatively impacting the quality of life of its patients, in addition to negatively influencing the "well-being" domain, especially when associated with clinical factors, which may be related to years of treatment without healing of the wound. Chronic wounds are characterized by delay or difficulty in healing processes and orderly repair of the anatomical and functional integrity of the skin over a period of at least three months. However, some injuries remain for years and even decades without healing. Objective: The scope of this review is to show the limited therapeutic arsenal as well as the difficulty in clinical management and thus provide a reflection on its pathophysiology and the urgent need for new options and therapeutic approaches that can help in the treatment of these patients. Methodology: This is an integrative review of the literature on chronic wounds, whose inclusion criteria were articles published from January 2005 to February 2023. Conclusion: The problem surrounding this pathology is vast, dealing with a difficult-to-cure disease, with a range of associated factors that make healing of the lesion difficult, extending this disease to high morbidity rates. New therapeutic approaches and new drugs need to be developed urgently. It is noteworthy that the use of probiotics and the use of nanotechnology have shown great innovative potential in the treatment of patients with chronic wounds.

Consideradas un grave problema de salud pública, las heridas crónicas son patologías que desafían el manejo terapéutico y que, lamentablemente, afectan a miles de personas en todo el mundo. Esta enfermedad presenta altas tasas de morbilidad, impactando negativamente en la calidad de vida de sus pacientes, además de influir negativamente en el dominio "bienestar", especialmente cuando se asocia a factores clínicos, que pueden estar relacionados con años de tratamiento sin curación de la herida. Las heridas crónicas se caracterizan por un retraso o dificultad en los procesos de cicatrización y reparación ordenada de la integridad anatómica y funcional de la piel durante un periodo de al menos tres meses. Sin embargo, algunas heridas permanecen durante años e incluso décadas sin cicatrizar. Objetivo: El alcance de esta revisión es mostrar el limitado arsenal terapéutico así como la dificultad en el manejo clínico y así aportar una reflexión sobre su fisiopatología y la urgente necesidad de nuevas opciones y enfoques terapéuticos que puedan ayudar en el tratamiento de estos pacientes. Metodología: Se trata de una revisión integradora de la literatura sobre heridas crónicas, cuyos criterios de inclusión fueron artículos publicados desde enero de 2005 hasta febrero de 2023. Conclusiones: La problemática que rodea a esta patología es amplia, tratándose de una enfermedad de difícil curación, con una serie de factores asociados que dificultan la cicatrización de la lesión, extendiendo esta enfermedad a altas tasas de morbilidad. Es urgente desarrollar nuevos enfoques terapéuticos y nuevos fármacos. Cabe destacar que el uso de probióticos y el empleo de nanotecnología han mostrado un gran potencial innovador en el tratamiento de pacientes con heridas crónicas.

Oral and nasal vaccination: current prospects, challenges, and impact of nanotechnology-based delivery systems

Abstract Currently, mucosal vaccine administration has stood out as an easier and non-invasive application method. It can also be used to induce local and systemic immune responses. In the COVID-19 pandemic context, nasal and oral vaccines have been developed based on different technological platforms. This review addressed relevant aspects of mucosal vaccine administration, with emphasis on oral and nasal vaccinations, in addition to the importance of using nanotechnology-based delivery systems to enable these strategies.

Improved antimutagenic effect of Pyrostegia venusta (Ker Gawl. ) Miers nanostructured extract in liposome and polymeric nanoparticle

Abstract Pyrostegia venusta (Ker Gawl.) Miers, popularly known as "Cipó-de São-João", has been used in traditional medicine for its therapeutic properties. Nanotechnology is able to enhance the pharmacological activity of plant extracts. In this context, liposomes and polymeric nanoparticles containing P. venusta ethanolic extract were developed and then physico-chemically characterized to evaluate the mutagenic/antimutagenic effects of P. venusta. In addition, transaminases and serum creatinine were biochemically analyzed for liver and renal damage, respectively. The micronucleus test was performed with male Swiss mice treated orally for 15 consecutive days with free extracts and nanostructured with P. venusta, and then intraperitoneally with N-ethyl-N-nitrosurea (50 mg/kg) on the 15th day of treatment. Micronucleated polychromatic erythrocytes (MNPCE) were evaluated in bone marrow. There was a significant reduction in the frequency of MNPCE (LPEPV = 183% and NPEPV = 114%, p < 0.001), indicating antimutagenic potential of the nanostructured extracts with P. venusta. The groups treated with only nanostructured extract did not show an increase in MNPCE frequency, and biochemical analyzes showed no significant difference between treatments. The liposomes and polymeric nanoparticles containing Pyrostegia venusta ethanolic extract showed biological potential in preventing the first step of carcinogenesis under the experimental conditions

Limitations and advances in new treatments and future perspectives of corneal blindness / Limitações e avanços em novos tratamentos e perspectivas futuras na cegueira corneal

ABSTRACT This review is intended to describe the therapeutic approaches for corneal blindness, detailing the steps and elements involved in corneal wound healing. It also presents the limitations of the actual surgical and pharmacological strategies used to restore and maintain corneal transparency in terms of long-term survival and geographic coverage. In addition, we critically review the perspectives of anabolic agents, including vitamin A, hormones, growth factors, and novel promitotic and anti-inflammatory modulators, to assist corneal wound healing. We discuss the studies involving nanotechnology, gene therapy, and tissue reengineering as potential future strategies to work solely or in combination with corneal surgery to prevent or revert corneal blindness.(AU)

RESUMO O presente trabalho traz uma revisão das abordagens terapêuticas para a cegueira da córnea. O estudo detalha as etapas e os elementos envolvidos na cicatrização da córnea. Ele mostra as limitações das estratégias cirúrgicas e farmacológicas usadas para restaurar e manter a transparência da córnea em termos de sobrevida a longo prazo e alcance geográfico. As perspectivas dos agentes anabólicos, incluindo vitamina A, hormônios, fatores de crescimento e novos moduladores pró-mitóticos e anti-inflamatórios para auxiliar a cicatrização da ferida na córnea, são revisadas criticamente. Aqui, apresentamos estudos envolvendo nanotecnologia, terapia gênica e reengenharia de tecidos como possíveis estratégias futuras para atuar de maneira isolada ou combinada com a cirurgia da córnea para prevenir ou reverter a cegueira corneana.(AU)

Gás ozônio como agente esterilizante de nanofibras eletrofiadas para engenharia tecidual: avaliação da segurança e da eficácia / Ozone gas as sterilant for electrospun nanofibers for tissue engineering: safety and efficacy evaluation

Com o aumento da expectativa de vida e o envelhecimento da população, a medicina regenerativa vem ocupando um importante espaço visando manter a qualidade de vida da população. A engenharia de tecidos, apoiada nos avanços da biotecnologia e da nanotecnologia, vem se configurando como alternativa mais versátil e menos custosa ao reparo e transplante de tecidos e órgãos. Os arcabouços para engenharia tecidual constituídos de nanofibras têm o potencial para mimetizar a arquitetura nanométrica dos tecidos humanos, especialmente devido à grande área superficial e elevada porosidade. Para a fabricação de arcabouços de nanofibras, a técnica mais utilizada é a de eletrofiação, devido à sua alta versatilidade, e os materiais mais estudados são os polímeros biodegradáveis e biocompatíveis, que são os mais desejados para fins biomédicos. A esterilização é uma etapa crítica no processo de fabricação de produto médico implantável e pode ter impacto no desempenho dos arcabouços poliméricos. Desta forma, o objetivo deste estudo foi avaliar o impacto da esterilização por gás ozônio em arcabouços de nanofibras poliméricas eletrofiadas para engenharia de tecidos. A esterilização por ozônio foi eficaz na inativação do indicador biológico G. stearothermophilus, caracterizando eficácia na letalidade microbiana; igualmente, não se detectou crescimento microbiano no teste de esterilidade. Os arcabouços de nanofibras de poli(ácido láctico-co-ácido glicólico) tiveram suas propriedades físico-químicas, mecânicas e biológicas preservadas, mantendo o mesmo desempenho como suporte para o crescimento de fibroblastos NIH3T3 após a esterilização. Já os arcabouços de poli-caprolactona, tiveram suas propriedades alteradas e apresentaram um melhor desempenho na proliferação celular de fibroblastos L929 após a esterilização. Assim, o gás ozônio se mostrou como um método alternativo para a esterilização de nanofibras poliméricas para engenharia tecidual

Since world population is ageing, regenerative medicine has become a growing area in the medical field in order to maintain the life quality of population. With the advance of biotechnology and nanotechnology, tissue engineering has emerged as a more versatile and less costly alternative to tissue repair and transplantation. Nanofibers have the potential to mimic the human tissue architecture at the nanometer scale, especially due to their large surface area and high porosity. Electrospinning is the most applied technique to fabricate nanofibers scaffolds mainly because of its powerful and high versatility. Many polymers can be used on the fabrication of nanofibers scaffolds; however, the biodegradable and biocompatible polymers are the most desired ones for biomedical purposes. Sterilization is a critical step in the fabrication process and might impact the performance of polymeric scaffolds. Therefore, the aim of this study was to evaluate the impact of sterilization by ozone gas on polymeric electrospun nanofibers scaffolds for tissue engineering. Ozone gas sterilization was efficient in killing the G. stearothermophilus spores, a common biological indicator used for validation of sterilization processes. The sterilization method preserved the physico-chemical, mechanical, and biological properties of poly(lactic-co-glycolic) acid nanofibers, keeping the performance of NIH3T3 proliferation on the scaffolds. On the other hand, the same sterilization method altered some properties of poly-caprolactone electrospun scaffolds, what improved L929 fibroblasts proliferation on the scaffolds after sterilization. Therefore, ozone gas was found to be a benign sterilization method for polymeric electrospun scaffolds for tissue engineering

Completeness of tuberculosis reporting forms for disease control in individuals with HIV/AIDS in priority cities of Bahia state / Completude das fichas de notificação de Tuberculose nos municípios prioritários da Bahia para controle da doença em indivíduos com HIV/AIDS

The control of HIV / Tuberculosis (TB) co -infection remains a challenge for public health. Notification is mandatory for both diseases and the National Case Registry Database (Sinan) is responsible for the collection and processing of individual forms of reporting and monitoring. The adequate fulfillment of these fields chips (completeness) is essential to follow the dynamics of the disease and set priorities for intervention. The aim of this study was to evaluate the completeness of the notification forms of tuberculosis in the priority municipalities of Bahia (Camaçari , Feira de Santana , Ilhéus , Itabuna, Jequié, Lauro de Freitas , Porto Seguro , Teixeira de Freitas , Paulo Afonso, Barreiras and Salvador) to control the disease in individuals with HIV/AIDS using tabulations obtained from the Sinan in the period from 2001 to 2010. The results showed that despite the completeness of the field HIV be above 50 %, more than half the cases were met as "undone" or "being processed" in all municipalities assessed in the period. The low completeness of reporting forms may compromise the quality of surveillance of TB cases. The results suggest the need for greater availability of HIV testing in these individuals.

O controle da coinfecção HIV/Tuberculose (TB) ainda representa um desafio para a saúde pública. Ambas as doenças são de notificação obrigatória e o Sistema Nacional de Agravos de Notificação (SINAN) é o órgão responsável pela coleta e processamento das fichas individuais de notificação e acompanhamento. O preenchimento adequado dos campos destas fichas (completude) é essencial para acompanhar a dinâmica da doença e definir prioridades de intervenção. O objetivo deste estudo foi avaliar a completude das fichas de notificações de tuberculose nos municípios prioritários da Bahia (Camaçari, Feira de Santana, Ilhéus, Itabuna, Jequié, Lauro de Freitas, Porto Seguro, Teixeira de Freitas, Paulo Afonso, Barreiras e Salvador), para controle da doença em indivíduos com HIV/AIDS, através dos relatórios de tabulação do Sinan, no período de 2001 a 2010. Os resultados demonstraram que, apesar da completude do campo HIV estar acima de 50%, mais da metade das fichas estavam preenchidas como "não realizado" ou "em andamento", em todos os municípios avaliados no período. A baixa completude das fichas de notificação pode comprometer a qualidade de vigilância dos casos de TB. Os resultados sugerem a necessidade de maior disponibilidade de teste para HIV nesses indivíduos.

Robótica, nanotecnología y singularidad / Robotics, nanotechnology and uniqueness

Los avances en la tecnología nos han llevado a descubrimientos científicos importantes, a descubrir causas y tratamientos de enfermedades que antiguamente solo eran mitos y suposiciones y en las últimas décadas hemos tenido en el campo de la otorrinolaringología nuevos elementos que nos llevan a mejores desempeños en el campo laboral, no es futurista hablar de robots, de cirugía de telepresencia, y cibernética es lo que actualmente estamos viviendo, es el hoy y el mañana de la medicina. Es por ello que en el presente artículo hemos querido plasmar un campo desconocido aun por muchos y por otros realmente exaltado es el campo de la robótica, la nanotecnología y la singularidad, su aplicaciones en la otorrinolaringología, algunas de sus ventajas y desventajas. Puede que para nosotros sea el comienzo pero para nuestros hijos y futuros colegas sea la base fundamental de su vida profesional...

Advances in technology have led to important scientific discoveries, to discover causes and treatments of diseases that formerly were only myths and assumptions and in recent decades we have had in the field of otolaryngology new elements that lead to better performances in the workforce, not to mention futuristic robots, telepresence surgery, and cybernetics is what we are currently experiencing, is the present and the future of medicine. That is why in this article we want to express an unknown field and even by many others really excited is the field of robotics, nanotechnology and the singularity, its applications in otolaryngology, some of the advantages and disadvantages. It may be the start for us but for our children and future colleagues is the foundation of his professional life...

Nanotechnology: a new frontier in virus detection in clinical practice.

Researchers are expanding the applications of nanotechnology in the field of medicine since mid-2000. These technologies include nanoarrays, protein arrays, nanopore technology, nanoparticles as a contrivance in immunoassays and nanosensors, among others. Nanobiotechnologies are clinically applicable and possess the potential to be useful in laboratory diagnosis of infections in general and viral infections in particular. Nanotechnology is a significant advance in molecular diagnostics. The technology strengthens and expands the DNA and protein microarray methods. In particular, the waveguide technology is an emergent area with many diagnostic applications. Nanosensors are the new contrivance for detection of bioterrorism agents. All these new technologies would have to be evaluated in clinical settings before their full import is appreciated and accepted.

Uso da nanotecnologia no reparo das lesões traumáticas de nervos / Nanotechnology and repair of peripheral nerve injuries

A nanotecnologia tem permitido avanços revolucionários nos últimos anos em diversas áreas da Ciência, incluindo a medicina, onde o impacto de novas aquisições se faz presente também na neurocirurgia.Trabalhos experimentais têm demonstrado diversas possibilidades do uso de artefatos obtidos a partir da nanotecnologia no tratamento das lesões traumáticas de nervos periféricos. Isto inclui desde a construção de dispositivos semi-sintéticos que substituem a estrutura de um nervo até a manipulação direta dos axônios. O objetivo deste estudo é apresentar ao neurocirurgião uma revisão sobre as principais técnicas de manufatura de nanomateriais e suas aplicações atuais e futuras no manejo das patologias traumáticas dos nervos periféricos.

Over the last several years, nanotechnology has made possible revolutionary advances in several áreas of Science, including medicine, where the impact of new acquisitions also has occurred in neurosurgery.Experimental researchs have demonstrated several possibilities for the treatment of peripheral nerve traumatic lesions with artefacts obtained from nanotechnology. This have included the construction of semi-synthetic devices that replace the structure of the nerve and the direct manipulation of axons. The goal of this study is to present a review to the neurosurgeon about nanomaterials manufacture techniques and its current and future applications in peripheral nerve injury.

La frontera entre la Biología molecular y la Nanotecnología: impacto en la Medicina / Limits between molecular biology and nanotechnology: impact on Medicine

Con el advenimiento de la Nanobiotecnología, han mejorado rápidamente las perspectivas para usar nanomateriales en Imaginología médica, diagnóstico de enfermedades, liberación de fármacos, tratamiento del cáncer, terapia génica y otras áreas. Se entiende por Nanomedicina la aplicación de nanotecnologías en Medicina para el mantenimiento y mejoramiento de la vida humana. Este artículo revisa el vasto potencial de los nanosistemas (nanoliposomas, gotas cuánticas, nanopartículas, dendrímeros) en estas áreas, con aplicaciones novedosas que constantemente están siendo exploradas.

With the advent of Nanotechnology, the prospects have rapidly improved for using nanomaterials in medical imaging, disease diagnoses, drug delivery, cancer treatment, gene therapy, and other areas. Nanomedicine is the application of nanotechnologies to the maintenance and improvement of human life. Nanosystems (nanoliposomes, quantum dots, nanoparticles, dendrimers) have a vast potential in these areas, and novel applications are being actively explored.

Application of nanotechnology in biomedicine.

Nanotechnology is the development of engineered devices at the atomic, molecular and macromolecular level in nanometer range. Nanoparticles have potential application in medical field including diagnostics and therapeutics. Nanotechnology devices are being developed for diagnosis of cancer and infectious diseases which can help in early detection of the disease. Advances in nanotechnology also proved beneficial in therapeutic field such as drug discovery, drug delivery and gene/protein delivery. Nanoparticles can be constructed by various methodology so that effect can be targeted at desired site. In this review, some of the applications of nanoparticles in medicine as diagnostics and therapeutics which can be employed safely at the clinical level have been described. On other hand, as the particles become generally smaller their likehood of causing harm to the lung increases. Therefore, there is a need to study safety of nanoparticles.

Development of Micro/Nano Devices for Cancer Diagnosis / 대한소화기학회지

In order to rapidly detect and analyze the presence of a target ligand of interests in environmental or industrial fluids as well as biological samples, numerous test systems have been designed and developed, which have been based on the combination of a test reagent and absorbing paper or membrane. The main limitations of these conventional devices are the difficulty of quantitative or semi-quantitative detection and poor detection limit (around nanogram/ml range detection capability). In this paper, new approaches and research trends which use nano/MEMS (micro electro mechanical systems) technology is introduced, which has a concept of fast, precise, and massive diagnosis and analysis of target molecules using very small amount of samples.

Medical applications of nanotechnology.

In the true spirit of interdisciplinary expansion of scientific knowledge, results from the applicability of nanotechnology in the fields of physical sciences and chemistry have now matured enough to extend into biology and medicine. The advances in nanotechnology in the past decade have offered novel opportunities for sensing clinically relevant markers, molecular dsease imaging and tools for therapeutic intervention, which have a potential to transform the field of medicine. We describe the currently available components of the nano-toolbox, which are likely to be incorporated in clinical practice in the forseeable future. These include nanowires, cantilevers and nanopores for sensing, naoparticles and quantum dots for molecular imaging and nanoparticles for therapy. We also discuss the issue of toxicity of these nanomaterials and other limitations in the application of nanotechnology to medicine.