Tratamento de carcinoma basocelular com associação de terapia fotodinâmica e cirurgia micrográfica de Mohs / Treatment of basocellular carcinoma with the association of photodynamic therapy and Mohs micrographic surgery

O tratamento de carcinomas basocelulares mal delimitados, recidivados, extensos, localizados em áreas de risco, em pacientes com várias comorbidades representa sempre um desafio para o cirurgião dermatológico.A cirurgia micrográfica de Mohs, geralmente utilizada nesses casos, apresenta riscos inerentes a uma cirurgia extensa, além da dificuldade no fechamento da ferida operatória, que muitas vezes se estende além dos limites clínicos da lesão. Demonstra-se, em paciente com 90 anos, diabética e hipertensa, a utilização da terapia fotodinâmica anterior à cirurgia micrográfica de Mohs, visando à diminuição e melhor delimitação da lesão para posterior exérese.

The treatment of extensive, recurrent and poorly delimited basocellular carcinomas, located in highrisk areas of the body in patients with several comorbidities, is a challenge for the dermatologic surgeon. Mohs micrographic surgery is usually employed in such cases, presenting the risks inherent to large surgeries, in addition to the difficulties of closing the operative wound ­ which very frequently extends beyond the clinical limits of the lesion. In this paper, we report the use of photodynamic therapy prior to Mohs micrographic surgery in a 90-year-old diabetic and hypertensive female patient, with the objective of reducing and better delimiting the lesion for the subsequent exeresis.

Dried blood spots as a practical and inexpensive source for human immunodeficiency virus and hepatitis C virus surveillance.

Passive surveillance of infectious diseases with a high percentage of asymptomatic cases or long incubation periods, such as acquired immunodeficiency syndrome (AIDS), does not reflect the current transmission dynamics. Thus, a multi-strategic surveillance, such as the human immunodeficiency virus (HIV) sentinel surveillance proposed by the World Health Organization (WHO), is necessary. The Brazilian HIV sentinel surveillance was started in May 1992 with this purpose. The objectives of this study were to evaluate the feasibility and costs of HIV and hepatitis C virus (HCV) surveillance using dried blood spots (DBS) collected for neonatal screening of metabolic diseases in the state of Minas Gerais, Brazil. This was accomplished through the comparison of HIV and HCV seroprevalence with previous Brazilian studies. From December 2001 to June 2002, 24,905 newborns were tested for HIV and 4211 for HCV. HIV seroprevalence was 0.25% and the 95% confidence interval (CI) was 0.18, 0.31%; and HCV seroprevalence was 0.71% and the 95% CI was 0.46, 0.97%. These numbers are similar to previous Brazilian studies. Cost in this study was approximately USD 3.10 per sample, which was roughly one third of the cost of the same exam at the Brazilian HIV sentinel surveillance. We conclude that it is possible and more cost-effective to use DBS for infectious diseases surveillance, albeit it is still necessary to compare these results with the usual sentinel methodology in a concomitant trial.

Dried blood spots as a practical and inexpensive source for human immunodeficiency virus and hepatitis C virus surveillance

Passive surveillance of infectious diseases with a high percentage of asymptomatic cases or long incubation periods, such as acquired immunodeficiency syndrome (AIDS), does not reflect the current transmission dynamics. Thus, a multi-strategic surveillance, such as the human immunodeficiency virus (HIV) sentinel surveillance proposed by the World Health Organization (WHO), is necessary. The Brazilian HIV sentinel surveillance was started in May 1992 with this purpose. The objectives of this study were to evaluate the feasibility and costs of HIV and hepatitis C virus (HCV) surveillance using dried blood spots (DBS) collected for neonatal screening of metabolic diseases in the state of Minas Gerais, Brazil. This was accomplished through the comparison of HIV and HCV seroprevalence with previous Brazilian studies. From December 2001 to June 2002, 24,905 newborns were tested for HIV and 4211 for HCV. HIV seroprevalence was 0.25 percent and the 95 percent confidence interval (CI) was 0.18, 0.31 percent; and HCV seroprevalence was 0.71 percent and the 95 percent CI was 0.46, 0.97 percent. These numbers are similar to previous Brazilian studies. Cost in this study was approximately US$ 3.10 per sample, which was roughly one third of the cost of the same exam at the Brazilian HIV sentinel surveillance. We conclude that it is possible and more cost-effective to use DBS for infectious diseases surveillance, albeit it is still necessary to compare these results with the usual sentinel methodology in a concomitant trial.