A simple drug-delivery microneedling technique modality successfully improves linear atrophic scars.

BACKGROUND: Atrophic scars are white, dermal depressions, caused by the destruction of collagen fibers and decrease in epidermal cells, following inflammation after different types of trauma. They lead to significant physical, aesthetic and psychological barriers and their treatment remain a therapeutic challenge for dermatologists. Microneedling has been shown to improve scars by stimulating angiogenesis and neocolagenesis and the combination of anti-fibrotic drugs could potentialize the results. METHODS: We present 8 cases of patients with linear scars, successfully treated with two sessions of a new Microneedling technique, using a tattoo machine, associated with drug delivery of 5-FU. RESULTS: A marked improvement in scar pigmentation and texture were noted by patients and doctors, 6 months following the sessions of MMP and drug delivery with 5-FU, in different body sites. We also showed that the assessment scores of at least one of the professionals with those of the patient had significant correlations with each other, which shows consistency between the qualitative assessment instruments. We also showed that the cause of the injury can influence joint assessment scores (physicians plus patient) or those exclusive to professionals trained for the assessments, generating evidence that the cause of the injury can influence the treatment outcome itself. CONCLUSIONS: We present an inexpensive and promising approach that can be easily done as an in-office procedure. Larger, multicenter studies are needed to validate this technique among the first line therapies for acne scar treatment.

Influence of different concentrations of plasticizer diethyl phthalate (DEP) on toxicity of Lactuca sativa seeds, Artemia salina and Zebrafish.

Like other phthalates, diethyl phthalate (DEP) is considered as a contaminant of emerging concern (CEC) due to its ease in migrating from a package to water and food, and hence contaminate consumers, being metabolized and excreted in the urine. Its presence has a negative impact on aquatic ecosystems, especially with respect to disruption of the endocrine system and to reproductive disorders in humans. It mainly enters water bodies via sewage effluents from effluent treatment plants, due to its incomplete or inefficient removal. The objective of this work was to evaluate the toxicity of DEP at different trophic levels and to analyze data on the incidence and concentration of DEP according to its solubility. The concentrations ranged from 12.5 mg L-1 to 500 mg L-1 considering the response for toxicity at each trophic level and to determine the lethal concentration in 50% of the following organisms (LC50) (in mg L-1): Lactuca sativa seeds, Artemia salina Leach nauplii and Zebrafish embryo larval stage (Danio rerio), being 41,057.58 after 120 h; 401.77 after 48 h; and 470 after 96 h of exposure, respectively. As expected, higher organisms were more affected even at low concentrations, which shows the anthropological contribution of CECs to water bodies.

HLA-G alleles and their impacts on placental HSV-1 infection in women from southern Brazil.

The Human Leukocyte Antigen G (HLA-G) is an immunoregulatory molecule with a critical role in pregnancy success. HLA-G alleles are associated with differential susceptibility to multiple conditions, including gestational problems, infectious diseases, and viral persistence. Of note, both herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2) can impair HLA-G expression, interfering with HLA-G-associated immunoregulation. On the other hand, the impacts of HLA-G alleles on susceptibility to Herpesviridae infection is a neglected issue. Therefore, this study evaluated HLA-G allele frequencies and their associations with placental Herpesviridae infection in women from southern Brazil. Placenta samples were collected soon after delivery, and detection of viral DNA of HSV-1, HSV-2 and human cytomegalovirus (HCMV) was performed by polymerase chain reaction (PCR). A fragment of HLA-G (exons 2-4) was amplified by PCR, sequenced, and analyzed to allele determination. One hundred and seventy women had their alleles determined. Overall, 25 HLA-G alleles were found, distributed into 56 different genotypes. The most frequent alleles were G* 01:01:01 and G* 01:01:02, found in 37.9 % and 16.5 % of samples, respectively. Among the 170 women, 89 (52.4 %) tested positive for Herpesviridae DNA in the placenta, 55 (32.3 %) tested negative, 3 (1.8 %) were negative for HSV-1 and HSV-2 (with absent HCMV data), and 23 (13.5 %) were undetermined. The G* 01:01:01 allele was significantly associated with an increased risk of placental HSV-1 infection (p = 0.0151; OR=1.837; IC=1.108-3.045). This study describes new information concerning placental HLA-G alleles in women from southern Brazil and helps explain how genetic background can modify susceptibility to placental infections.

High APOBEC3B mRNA Expression Is Associated with Human Papillomavirus Type 18 Infection in Cervical Cancer.

The APOBEC3 (A3) proteins are cytidine deaminases that exhibit the ability to insert mutations in DNA and/or RNA sequences. APOBEC3B (A3B) has been evidenced as a DNA mutagen with consistent high expression in several cancer types. Data concerning the A3B influence on HPV infection and cervical cancer are limited and controversial. We investigated the role of A3B expression levels in cervical cancer in affected women positive for infection by different HPV types. Tumor biopsies from cancerous uterine cervix were collected from 216 women registered at Hospital do Câncer II of Instituto Nacional de Câncer, and infecting HPV was typed. A3B expression levels were quantified from RNA samples extracted from cervical biopsies using real-time quantitative PCR. Median A3B expression levels were higher among HPV18+ samples when compared to HPV16+ counterparts and were also increased compared to samples positive for other HPV types. In squamous cell carcinoma, HPV18+ samples also showed increased median A3B expression when compared to HPV Alpha-9 species or only to HPV16+ samples. Our findings suggest that A3B expression is differentially upregulated in cervical cancer samples infected with HPV18. A3B could be potentially used as a biomarker for HPV infection and as a prognostic tool for clinical outcomes in the context of cervical cancer.

Repellency and Reduction of Offspring Emergence Potential of Some Botanical Extracts against Sitophilus zeamais (Coleoptera: Curculionidae) in Stored Maize.

Botanical repellents are, usually, considered safe to control Sitophilus zeamais, the main pest of stored maize, as they do not leave toxic residues in food, in addition to having lower costs than chemical insecticides. The aim of this study was to evaluate the repellency potential and the reduction of emerged offspring of botanical extracts, of Schinus terebinthifolius, Ludwigia sericea, L. tomentosa, L. nervosa, L. longifolia, and use them as botanical insecticides for S. zeamais. For the repellency test, arenas were set up, containing 50 g of maize kernels exposed to aqueous extract, besides a control treatment. At the center of each arena, 100 insects were released. After 48 h, the proportion of insects in the treated grains was determined. To test the effects of the extracts on insect mating and egg-laying, free-choice and no-choice tests were performed. Insects in both tests remained for ten days for mating and egg-laying. After this period, insects were removed to evaluate the offspring emergence. Sixty days after grain infestation, the number of emerged insects was counted. All selected botanical extracts demonstrated repellent action against S. zeamais, even after 48 h of application. The L. nervosa aqueous extract significantly reduced the emergence of S. zeamais.

What to expect when AGEP is induced by terbinafine? Case report and critical review of the literature.

BACKGROUND: Acute Generalised Exanthematous Pustulosis (AGEP) is a rash with multiple sterile intraepidermal or subcorneal non-follicular pustules on edematous papules, with a sudden development and rapid evolution, triggered by drugs, vaccination, insect bites, exposure to mercury, and allergens. OBJECTIVES AND METHODS: We describe a female patient who developed extensive and abnormally prolonged AGEP following exposure to terbinafine and SARS-CoV vaccine. A detailed review of terbinafine-induced-AGEP cases was performed, with the aim of evaluating if the AGEP criteria would follow a different pattern when the disease is triggered by this drug. A PubMed search helped retrieve all terbinafine-induced AGEP case reports. AGEP-specific Sideroff criteria were analysed in terbinafine-induced cases and compared to other trigger causes. CONCLUSIONS: When the AGEP causative drug was terbinafine, a delay in recovery was observed, compared to the existing AGEP criteria when other causes are considered. Terbinafine frequently leads to delayed resolution AGEP probably due to the presence of the drug in the skin for several weeks after exposure, even after discontinuation, and the disease severity may be potentialised by additional factors such as concomitant viral infections or vaccination.

Assessment of surface water quality of the bois river (Goiás, Brazil) using an integrated physicochemical, microbiological and ecotoxicological approach.

The data on water pollution is scarce in developing countries, including Brazil. The water quality assessment is important implementing the monitoring and remediation programs to minimize the risk of hazardous substances in freshwaters. Thus, this study evaluated the surface water quality of a stretch of the Bois River (Brazil), based on the physicochemical, microbiological and ecotoxicological analyses conducted in 2017, using Standard Methods and fish embryo acute toxicity (FET) test with zebrafish (Danio rerio). The results indicated that the quality of water samples located close to the discharge of tannery effluents was most impaired. Total phosphorus, BOD, DO, ammoniacal nitrogen, and thermotolerant coliforms parameters in P4 were not in accordance with the standards of current Brazilian legislation. Iron, lead, and copper levels were higher than environmental standards. The physicochemical quality of water samples was lower in the dry season than the rainy season. All samples (P1, P3, and P5) in rainy and dry seasons did not induce significant acute toxicity for zebrafish early-life stage; however other trophic levels (algae and microcrustacean) should be investigated to gain a better understanding of the toxicity during water quality analysis. In conclusion, the physicochemical and microbiological changes in the water of the Bois River can affect aquatic organisms as well as humans when it is used for drinking or in agriculture.

Increased circulating levels of angiotensin-(1-7) in severely ill COVID-19 patients.

This letter reports an unexpected increase of the ACE2 product angiotensin-(1-7) and a parallel decrease of its substrate angiotensin II, suggesting a dysregulation of the renin-angiotensin system towards angiotensin-(1-7) formation in #COVID19 patients https://bit.ly/3xFXuTU.

Implications of Synthetic Modifications of the Cardiotonic Steroid Lactone Ring on Cytotoxicity.

Na,K-ATPase (NKA) and cardiotonic steroids (CTS) have shown potent cytotoxic and anticancer effects. Here, we have synthesized a series of CTS digoxin derivatives (γ-benzylidene) with substitutions in the lactone ring and evaluated the cytotoxicity caused by digoxin derivatives in tumor and non-tumor cells lines, as well as their effects on NKA. The cytotoxicity assay was determined in HeLa, A549, and WI-26 VA4 after they were treated for 48 h with increased concentrations of CTS. The effects of CTS on NKA activity and immunoblotting of α1 and ß1 isoforms were evaluated at IC50 concentrations in A549 cell membrane. NKA activity from mouse brain cortex was also measured. The majority of CTS exhibited low cytotoxicity in tumor and non-tumor cells, presenting IC50 values at micromolar concentrations, while digoxin showed cytotoxicity at nanomolar concentrations. BD-15 presented the lowest IC50 value (8 µM) in A549 and reduced its NKA activity in 28%. In contrast, BD-7 was the compound that most inhibited NKA (56% inhibition) and presented high IC50 value for A549. In mouse cortex, only BD-15 modulated the enzyme activity in a concentration-dependent inhibition curve. These results demonstrate that the cytotoxicity of these compounds is not related to NKA inhibition. The substitutions in the lactone ring of digoxin led to an increase in the cytotoxic concentration in tumor cells, which may not be interesting for cancer, but it has the advantage of increasing the therapeutic margin of these molecules when compared to classic CTS, and can be used safely in research for other diseases.

Intensive care management of patients with COVID-19: a practical approach.

SARS-CoV-2, the causative agent of coronavirus disease 2019 (COVID-19), is responsible for the largest pandemic facing humanity since the Spanish flu pandemic in the early twentieth century. Since there is no specific antiviral treatment, optimized support is the most relevant factor in the patient's prognosis. In the hospital setting, the identification of high-risk patients for clinical deterioration is essential to ensure access to intensive treatment of severe conditions in a timely manner. The initial management of hypoxemia includes conventional oxygen therapy, high-flow nasal canula oxygen, and non-invasive ventilation. For patients requiring invasive mechanical ventilation, lung-protective ventilation with low tidal volumes and plateau pressure is recommended. Cardiovascular complications are frequent and include myocardial injury, thrombotic events, myocarditis, and cardiogenic shock. Acute renal failure is a common complication and is a marker of poor prognosis, with significant impact in costs and resources allocation. Regarding promising therapies for COVID-19, the most promising drugs until now are remdesivir and corticosteroids although further studies may be needed to confirm their effectiveness. Other therapies such as, tocilizumab, anakinra, other anti-cytokine drugs, and heparin are being tested in clinical trials. Thousands of physicians are living a scenario that none of us have ever seen: demand for hospital exceed capacity in most countries. Until now, the certainty we have is that we should try to decrease the number of infected patients and that an optimized critical care support is the best strategy to improve patient's survival.

Dobutamine-sparing versus dobutamine-to-all strategy in cardiac surgery: a randomized noninferiority trial.

BACKGROUND: The detrimental effects of inotropes are well-known, and in many fields they are only used within a goal-directed therapy approach. Nevertheless, standard management in many centers includes administering inotropes to all patients undergoing cardiac surgery to prevent low cardiac output syndrome and its implications. Randomized evidence in favor of a patient-tailored, inotrope-sparing approach is still lacking. We designed a randomized controlled noninferiority trial in patients undergoing cardiac surgery with normal ejection fraction to assess whether an dobutamine-sparing strategy (in which the use of dobutamine was guided by hemodynamic evidence of low cardiac output associated with signs of inadequate tissue perfusion) was noninferior to an inotrope-to-all strategy (in which all patients received dobutamine). RESULTS: A total of 160 patients were randomized to the dobutamine-sparing strategy (80 patients) or to the dobutamine-to-all approach (80 patients). The primary composite endpoint of 30-day mortality or occurrence of major cardiovascular complications (arrhythmias, acute myocardial infarction, low cardiac output syndrome and stroke or transient ischemic attack) occurred in 25/80 (31%) patients of the dobutamine-sparing group (p = 0.74) and 27/80 (34%) of the dobutamine-to-all group. There were no significant differences between groups regarding the incidence of acute kidney injury, prolonged mechanical ventilation, intensive care unit or hospital length of stay. DISCUSSION: Although it is common practice in many centers to administer inotropes to all patients undergoing cardiac surgery, a dobutamine-sparing strategy did not result in an increase of mortality or occurrence of major cardiovascular events when compared to a dobutamine-to-all strategy. Further research is needed to assess if reducing the administration of inotropes can improve outcomes in cardiac surgery. Trial registration ClinicalTrials.gov, NCT02361801. Registered Feb 2nd, 2015. https://clinicaltrials.gov/ct2/show/NCT02361801.

Strategy Combining Nonanimal Methods for Ocular Toxicity Evaluation.

Historically, the ocular toxicity of manufactured consumer materials has been evaluated using the rabbit in vivo Draize rabbit eye test. The animal data obtained were used by the United Nations Globally Harmonized System of Classification and Labelling of Chemicals (UN GHS) to define the classification and labelling (C&L) for eye damage/irritation endpoint. However, the Draize test, a method which was never formally validated, has been widely criticized because of its technical limitations. In addition, ethical and economic issues and advances in scientific knowledge, and political and public pressures have made animal experimentation unsustainable. This scenario has consequently led to the development of nonanimal testing and protocols/approaches with considerable predictive value and relevance for humans. It is widely accepted that one single nonanimal method cannot cover all the criteria of damage/inflammation assessed by regulatory adopted in vivo animal testing. Thus, integrated testing strategies (ITS) have been proposed, including a tiered testing approach combining different nonanimal testing with different endpoints, which have been used for regulatory purposes, on a case-by-case basis and within integrated approaches to testing and assessment (IATA), to identify materials according to their ability to trigger eye damage. In particular, the top-down and bottom-up approaches have been recommended for the C&L of materials, which cause serious eye damage or eye irritation, respectively. This chapter describes detailed protocols for eye irritation testing based on cells (Short Time Exposure-STE, OECD No. 491/2017), a vascularized membrane (the Hen's Egg Test-Chorioallantoic Membrane-HET-CAM) and corneal tissue (Bovine Corneal Opacity and Permeability-BCOP, OECD No. 437/2017), which can be applied using top-down or bottom-up approaches. In addition, it suggests making a corneal histomorphometric evaluation as an additional parameter in the BCOP method to differentiate materials that cause serious eye tissue damage (UN GHS Cat. 1) from materials that have reversible eye irritation effects (UN GHS Cat. 2).

Thymol-Loaded Biogenic Silica Nanoparticles in an Aquatic Environment: The Impact of Particle Aggregation on Ecotoxicity.

Thymol, a monoterpene phenol, is used as a natural biocide. To circumvent its chemical instability, we propose use of thymol-loaded biogenic silica nanoparticles (BSiO2 #THY NPs); however, the toxicity of this system for aquatic organisms is unknown. Thus, the present study aimed to evaluate the toxicogenetic effects induced by thymol, BSiO2 NP, and BSiO2 #THY on Artemia salina and zebrafish (Danio rerio) early life stages. We also investigated the impact of BSiO2 aggregation in different exposure media (saline and freshwater). Based on the median lethal concentration at 48 h (LC5048h ), BSiO2 #THY (LC5048h = 1.06 mg/L) presented similar toxic potential as thymol (LC5048h = 1.03 mg/L) for A. salina, showing that BSiO2 had no influence on BSiO2 #THY toxicity. Because BSiO2 aggregated and sedimented faster in A. salina aqueous medium than in the other medium, this NP had lower interaction with this microcrustacean. Thus, BSiO2 #THY toxicity for A. salina is probably due to the intrinsic toxicity of thymol. For zebrafish early life stages, BSiO2 #THY (LC5096h = 13.13 mg/L) was more toxic than free thymol (LC5096h = 25.60 mg/L); however, BSiO2 NP has no toxicity for zebrafish early life stages. The lower aggregation of BSiO2 in the freshwater medium compared to the saline medium may have enhanced thymol's availability for this aquatic organism. Also, BSiO2 #THY significantly induced sublethal effects as thymol, and both were genotoxic for zebrafish. In conclusion, although BSiO2 #THY still needs improvements to ensure its safety for freshwater ecosystems, BSiO2 NP seems to be a safe nanocarrier for agriculture. Environ Toxicol Chem 2021;40:333-341. © 2020 SETAC.

Hydrocolloid dressings can be used to treat hypertrophic scars: An outpatient dermatology service devoted to treat keloids and challenging scars.

Since we first described the rationale for the use of hydrocolloid dressings to treat keloids and hypertrophic scars, this technique has been used as an occlusive therapy alternative to the use of silicone sheets in our outpatient clinic. In this paper, we describe the use of these dressings on two patients with challenging scars: a large postburn hypertrophic scar on a young patient's hand and arm, with a growing keloid on the wrist, and a progressive scar on the lower eyelid, developing after a complication of a cosmetic blepharoplasty procedure, leading to ectropium. The methods on the proper use of these dressings are reviewed here in detail. Larger clinical trials are needed to further evaluate this technique in the treatment of hypertrophic scars and keloids.

Direct and indirect assessment of functional abilities in patients with Parkinson's disease transitioning to dementia.

Cognitive impairment is common in patients with Parkinson's disease (PD), and evaluation of functional abilities is crucial for diagnosis of dementia. OBJECTIVE: We evaluated differences between direct and indirect functional assessment methods to evaluate functional abilities in PD patients. METHODS: We evaluated 32 patients with PD and suspected mild dementia using direct and indirect assessment methods. RESULTS: There was a significant difference between the scores of direct and indirect methods of assessment. Patients and close informants usually overestimated their abilities in many ADL. However, all functional assessment tools used in this study had a relatively good accuracy to predict abnormal performance in a global cognitive scale. Patients with normal cognition according to scores in a global cognitive scale may have some functional impairment in ADL. Direct Assessment of Functional Ability (DAFA) scores correlated linearly with scores in global cognitive scales, and especially with scores in the domains of memory and concentration. CONCLUSION: Patients and close informants usually overestimate their instrumental abilities in ADL. The direct assessment of daily functioning was more reliable than indirect tools to assess functional losses in patients with PD. Finally, some patients with PD but no dementia may present functional losses in ADL.

O comprometimento cognitivo é comum em pacientes com doença de Parkinson (DP), e a avaliação das habilidades funcionais é crucial para o diagnóstico de demência. OBJETIVO: Avaliamos diferenças entre os métodos de avaliação funcional direta e indireta para avaliar habilidades funcionais em pacientes com DP. MÉTODOS: Foram avaliados 32 pacientes com DP e suspeita de demência inicial usando métodos de avaliação direta e indireta. RESULTADOS: Houve uma diferença significativa entre os escores dos métodos diretos e indiretos de avaliação. Pacientes e informantes geralmente superestimaram suas habilidades em muitas atividades da vida diária (AVD). No entanto, todas as ferramentas de avaliação funcional utilizadas neste estudo tiveram uma precisão relativamente boa para prever desempenho anormal em uma escala cognitiva global. Pacientes com cognição normal, de acordo com os escores em uma escala cognitiva global, podem apresentar algum comprometimento funcional nas AVD. As pontuações do Direct Assessment of Functional Ability (DAFA) correlacionaram-se linearmente com as pontuações nas escalas cognitivas globais e, especialmente, com as pontuações nos domínios da memória e concentração. CONCLUSÃO: Pacientes e informantes próximos geralmente superestimam suas habilidades instrumentais nas AVD. A avaliação direta do funcionamento diário foi mais confiável do que ferramentas indiretas para avaliar perdas funcionais em pacientes com DP. Finalmente, alguns pacientes com DP, mas sem demência, podem apresentar perdas funcionais nas AVD.

Nanoparticle-based thymulin gene therapy therapeutically reverses key pathology of experimental allergic asthma.

Despite long-standing efforts to enhance care for chronic asthma, symptomatic treatments remain the only option to manage this highly prevalent and debilitating disease. We demonstrate that key pathology of allergic asthma can be almost completely resolved in a therapeutic manner by inhaled gene therapy. After the disease was fully and stably established, we treated mice intratracheally with a single dose of thymulin-expressing plasmids delivered via nanoparticles engineered to have a unique ability to penetrate the airway mucus barrier. Twenty days after the treatment, we found that all key pathologic features found in the asthmatic lung, including chronic inflammation, pulmonary fibrosis, and mechanical dysregulation, were normalized. We conducted tissue- and cell-based analyses to confirm that the therapeutic intervention was mediated comprehensively by anti-inflammatory and antifibrotic effects of the therapy. We believe that our findings open a new avenue for clinical development of therapeutically effective gene therapy for chronic asthma.

Silicone sheets and new gels to treat hypertrophic scars and keloids: A short review.

Silicone dressings have been used to treat hypertrophic scars and keloids since 1983. This treatment modality is considered to be safe and efficacious, leading to a progressive improvement in scar color, size, erythema, pliability, pain, and itching. Its mechanism of action is due to the hydration of the skin corneal layer; and modulating the cell signaling between fibroblasts and keratinocytes, mediated by cytokines. Silicone dressings are considered first line treatments for hypertrophic scars and keloids. Silicone gels were developed later, in order to help treating those scars in areas such as the scalp or joints, where fixing the silicone sheets would be a more difficult task, or on the face, where a silicone dressing would be cosmetically undesirable to most. Similar to silicone sheets, silicone gels have also proved to help treating and preventing hypertrophic scars and keloids. A new silicone gel combined with hypochlorous acid has recently been developed to help in treating scars. Hypochlorous acid acts as a biocide and anti-inflammatory agent, therefore, it has also been used in post procedure, on recent traumatic scars or on nonepithelized skin. This manuscript reviews the use of silicone dressings, silicone gels, and combined gels to treat scars.

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