Da pálpebra à retina : relato de caso de paciente com “doença de Vogt-Koyanagi-Harada-like” secundária à terapia adjuvante para melanoma palpebral com dabrafenibe + trametinibe

Relatamos o caso de paciente com melanoma palpebral submetida à ressecção cirúrgica e terapia adjuvante sistêmica com associação de Trametinibe (inibidor de MEK) + Dabrafenibe (inibidor de BRAF) que apresentou grave efeito adverso ocular. O desenvolvimento de terapias alvo tem modificado significativamente o prognóstico de pacientes portadores de melanomas, incluindo palpebrais. Entretanto, tais medicações podem acarretar efeitos adversos significativos com eventuais repercussões oculares irreversíveis

Complete revascularization versus treatment of the culprit artery only in ST elevation myocardial infarction : a multicenter registry

Fundamento: São restritos os dados sobre o manejo e o prognóstico dos pacientes com infarto agudo do miocárdio com supradesnivelamento do segmento ST (IAMCSST) com acometimento multiarterial no Brasil, o que mostra a necessidade de investigar as estratégias de revascularização disponíveis. Objetivo: Avaliar os desfechos relacionados à revascularização completa em comparação com o tratamento da artéria culpada em pacientes multiarteriais com IAMCSST. Métodos: Foi realizada um estudo de coorte prospectiva em dois centros de hemodinâmica do Sul do Brasil, com seguimento de 1 ano após a intervenção índice. O desfecho primário foi composto de óbito cardiovascular, reinfarto ou angina recorrente e secundários acidente vascular encefálico, parada cardiorrespiratória não fatal, sangramento maior ou necessidade de reintervenção. A probabilidade de ocorrência de desfechos foi comparada entre os grupos através de regressão logística binária. Considerou-se como estatisticamente significativo o valor de probabilidade < 0,05. Resultados: Participaram 85 pacientes, com média de idade de 62±12 anos, sendo 61 (71,8%) do sexo masculino. Cinquenta e oito (68,2%) pacientes receberam a estratégia de revascularização completa e 27 (31,8%), a de revascularização incompleta. A chance de ocorrência tanto do desfecho primário quanto do secundário foi significativamente maior entre os indivíduos tratados com revascularização incompleta quando comparados com os tratados com estratégia completa [razão de chances (OR) 5,1, intervalo de confiança de 95% (IC95%) 1,6-16,1 vs. OR 5,2, IC95% 1,2-22,9, respectivamente], assim como os óbitos cardiovasculares (OR 6,4, IC95% 1,2-35,3). Conclusão: Dados deste registro regional, de dois centros do Sul do Brasil, demonstram que a estratégia de revascularização completa esteve associada à redução significativa dos desfechos primário e secundário no seguimento de 1 ano quando comparada à estratégia de revascularização incompleta.Background: Data on the management and prognosis of patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease are limited in Brazil, showing that the available revascularization strategies should be investigated. Objective: To assess the outcomes of complete revascularization versus treatment of the culprit artery only in patients with STEMI and multivessel disease. Methods: A prospective cohort study was conducted at two medical centers in southern Brazil with a 1-year follow-up after the index procedure. The primary outcome was a composite of cardiac death, reinfarction, or recurrent angina, while the secondary outcome was stroke, nonfatal cardiac arrest, major bleeding, or need for reintervention. The probability of outcomes occurring was compared between the groups using binary logistic regression. A p-value < 0.05 was considered statistically significant. Results: Eighty-five patients were included. Their mean age was 62±12 years, and 61 (71.8%) were male. Fifty-eight (68.2%) were treated with complete revascularization and 27 (31.8%) with incomplete revascularization. The chance of both the primary and secondary outcomes occurring was significantly greater among patients treated with incomplete revascularization when compared to those treated with complete revascularization (odds ratio [OR] 5.1, 95% confidence interval [CI] 1.6-16.1 vs. OR 5.2, 95% CI 1.2-22.9, respectively), as well as cardiac death (OR 6.4, 95% CI 1.2-35.3). Conclusion: Registry data from two centers in southern Brazil demonstrate that the complete revascularization strategy is associated with a significant reduction in primary and secondary outcomes in a 1-year follow-up when compared to the incomplete revascularization strategy

Electron-responsive molecular materials and organized assemblies based on Pi-radicals as building blocks.

Le but de cette proposition est d'explorer un nouveau concept de matériaux moléculaires sensibles à l'oxydoréduction. Les architectures commutables électron-sensibles ont longtemps été reconnues comme le choix le plus simple et le plus viable pour produire des dispositifs pratiques, mais la conception efficace de tels systèmes à l'échelle moléculaire reste un défi. L'approche développée dans ce projet repose sur la production électrochimiquement déclenchée de radicaux pi à partir de dérivés de viologène, l'objectif étant d'induire la formation d'une liaison non-covalente et réversible entre ces radicaux pi pour contrôler la conformation des échafaudages supramoléculaires. Les nanomatériaux comprendront des fils moléculaires provenant de polymères de coordination et des fils moléculaires produits par des interactions π le long de l'axe du fil, mis en œuvre par des interactions faibles périphériques telles que l'agrégation des chaînes latérales lipophiles ou la liaison H. Les efforts initiaux se concentreront sur l'optimisation de la formation de π-dimères et de pimer, avec ou sans assistance d'interactions secondaires. Après avoir déterminé les paramètres qui produisent l'auto-assemblage dirigé π le plus efficace, des motifs basés sur les viologènes appropriés seront introduits dans des blocs de construction plus sophistiqués. Tout au long de la synthèse des assemblages, la π-dimérisation utilisée comme force motrice principale pour l'auto-assemblage des nanomatériaux peut être consolidée par un blocage covalent des structures. En fin de compte, l'électrostimulation des systèmes π fournira des assemblages moléculaires dynamiques dans lesquels la morphologie sera sensible aux stimuli redox.The aim of this proposal is to explore a new concept of redox-responsive molecular materials. Electron-responsive switchable architectures have long been recognized as the most straightforward and viable choice to produce practical devices but efficiently designing such systems on the molecular scale still remains a challenge. The approach developed in this project relies on the electrochemically triggered production of pi-radicals from viologen derivatives, the objective being to induce the formation of non-covalent and reversible binding between these pi-radicals to control the conformation of supramolecular scaffolds. The nanomaterials will comprise molecular wires arising from coordination polymers and molecular wires produced by π-interactions along the wire's axis implemented by peripheral weak interactions such as lipophilic side chain aggregation or H-bonding. The initial efforts will focus on the optimization of π-dimer and pimer formation, with or without assistance of secondary interactions. After determining the parameters that yield the most efficient π directed self-assembly, suitable viologen based motifs will be introduced in more sophisticated building blocks. Throughout the synthesis of the assemblies, π-dimerization that is used as the primary driving force for the self-assembly of nanomaterials may be consolidated by covalent locking of the structures. In the end, the electro-stimulation of π systems will provide dynamic molecular assemblies in which the morphology will be responsive to redox stimuli