ABSTRACT
BACKGROUND: Skin field cancerization (SFC) is a process that occurs in areas of the skin that have undergone genomic alterations induced by ultraviolet radiation. Actinic keratosis (AK) is a sign of its activity. OBJECTIVES: To evaluate the effectiveness and safety of 0·5% colchicine (COL) cream vs. methyl aminolaevulinate photodynamic therapy (MAL-PDT) in the treatment of AK and SFC. METHODS: We conducted a randomized, open, intrasubject controlled trial. A total of 36 participants with 3-10 AKs on each forearm were treated with either COL cream (twice daily for 10 days) or a single session of MAL-PDT and were reassessed after 60 days. The clinical evaluation was performed using AK count, forearm photoageing scale (PAS) and AK degree (AKD). Patients underwent central forearm biopsies and histopathological evaluation by keratinocyte intraepithelial neoplasia (KIN) assessment, epithelial atrophy and immunohistochemistry (p53/Ki67). RESULTS: Overall, 50% of patients were male. The mean age was 70·9 years (SD 8·6) and phototypes I and II were predominant (89%). Total clearance was observed in six (17%) forearms treated with COL and seven (19%) forearms treated with MAL-PDT (P = 0·76); partial clearance was observed in 44% of forearms in the COL group and 67% of forearms in the MAL-PDT group (P = 0·07). In both COL and MAL-PDT groups, reductions in PAS (-6% vs. -6%) and AKD (-45% vs. -40%) were observed. KIN normalized in 28% of patients treated with MAL-PDT and 20% of those treated with COL. Epithelial atrophy reduced after treatment (P < 0·01). Expression levels of Ki67 and p53 were also assessed. Mild or moderate adverse effects were similar for both groups. CONCLUSIONS: COL 0·5% cream and MAL-PDT are safe and effective for treating SFC.
Subject(s)
Aminolevulinic Acid/analogs & derivatives , Colchicine/administration & dosage , Keratosis, Actinic/drug therapy , Photochemotherapy/methods , Photosensitizing Agents/administration & dosage , Skin/pathology , Aged , Aminolevulinic Acid/administration & dosage , Aminolevulinic Acid/adverse effects , Atrophy/drug therapy , Atrophy/pathology , Biopsy , Carcinoma, Squamous Cell/pathology , Carcinoma, Squamous Cell/prevention & control , Colchicine/adverse effects , Disease Progression , Female , Forearm , Humans , Keratosis, Actinic/pathology , Male , Middle Aged , Patient Preference/statistics & numerical data , Photochemotherapy/adverse effects , Photosensitizing Agents/adverse effects , Skin/drug effects , Skin/radiation effects , Skin Cream/administration & dosage , Skin Cream/adverse effects , Skin Neoplasms/pathology , Skin Neoplasms/prevention & control , Treatment Outcome , Ultraviolet Rays/adverse effectsABSTRACT
The literature has identified complex aspects of intracellular host-parasite relationships, which require systematic, nonreductionist approaches and spatial/temporal information. Increasing and integrating temporal and spatial dimensions in host cell imaging have contributed to elucidating several conceptual gaps in the biology of intracellular parasites. To access and investigate complex and emergent dynamic events, it is mandatory to follow them in the context of living cells and organs, constructing scientific images with integrated high quality spatiotemporal data. This review discusses examples of how advances in microscopy have challenged established conceptual models of the intracellular life cycles of Leishmania spp. and Trypanosoma cruzi protozoan parasites.
Subject(s)
Chagas Disease/pathology , Host-Parasite Interactions/physiology , Leishmania/physiology , Leishmaniasis/pathology , Trypanosoma cruzi/physiology , Animals , Humans , MicroscopyABSTRACT
A doença meningocócica (DM) é uma moléstia infecciosa aguda de expressiva relevância em saúde pública, devido ao seu potencial epidêmico, a elevada morbi-mortalidade e ao percentual significativo de seqüelas. Em setembro de 2006, o Município de Estrela DOeste/São Paulo confirmou a ocorrência de 3 casos de DM e letalidade de 66,7%. Os casos foram sorogrupados e todos identificados como meningococo do sorogrupo C. O objetivo da investigação foi caracterizar e confirmar a ocorrência do surto da doença na região. A investigação dos casos foi realizada a partir da análise de bancos de dados, de fichas epidemiológicas de notificação/investigação, de fichas de atendimento hospitalar e dos exames processados e de entrevistas com os médicos, casos suspeitos, contatos e familiares. Para inclusão no presente surto foram utilizadas as seguintes definições de casos: caso suspeito: todo paciente com sinais e/ou sintomas de meningite aguda, isto é, febre alta, vômitos, cefaléia intensa, rigidez de nuca ou abaulamento de fontanela; com ou sem toxemia (sonolência e/ou torpor e/ou irritação) e lesões cutâneas (petéquias ou púrpuras) residente ou que se deslocou para o Município de Estrela DOeste, no mês de setembro de 2006. Caso confirmado: caso suspeito com critério de confirmação laboratorial e/ou necropsia. Na ocasião, foi confirmado um surto de DM no Município de Estrela DOeste, com três casos e dois óbitos, desenvolvido em curso rápido e progressivo e com identificação do meningococo sorogrupo C nos três casos, o que está de acordo com a atual prevalência do sorogrupo C no Estado de São Paulo. As medidas de controle, quimioprofilaxia e vacinação, foram realizadas de forma criteriosa e oportuna. A investigação permitiu a descrição clínica e epidemiológica dos casos, com a confirmação de surto e a efetivação oportuna das ações de prevenção e controle.
