TRATAMENTO NÃO OPERATÓRIO DO TRAUMA DE VÍSCERAS ABDOMINAIS PARENQUIMATOSAS

Nonoperative management of the solid organ injuries (liver, spleen and kidneys) in hemodynamically patients has become the standard of care in the last decade. Computed tomography scan is invaluable in determining appropriate patient selection and to exclude other injuries that may necessitate laparotomy. Nonoperative management strategies primarily consist of careful observation with or without the use of adjunctive angiography. The widespread use of angiographic embolization has increased the number and type of patients that can be safety managed without operative intervention. The increasing use of nonoperative management is based on the low failure rates reported in most studies. Success rates of nonoperative treatment have increase to > 90% for these injuries. Practitioners must remain vigilant, however, because failures of nonoperative management may need immediate intervention. This review will discuss current concepts in nonoperative management, including diagnosis, patient selection, nonoperative treatment strategies, benefits, risks, and complications.O tratamento não operatório das lesões de órgãos parenquimatosos abdominais (fígado, baço e rins) em pacientes com estabilidade hemodinâmica tem se tornado o método de escolha na última década. A TC é indispensável para a adequada seleção do paciente e para excluir outras lesões que podem necessitar de laparotomia. As estratégias de tratamento não operatório consistem da observação clínica e monitorização cuidadosa com ou sem o uso adjunto da angiografia. A utilização disseminada de embolização angiográfica tem aumentado o número e o tipo de pacientes que podem ser tratados sem cirurgia. O aumento desta modalidade de tratamento não operatório é baseado nas baixas taxas de falha terapêutica relatado na maioria dos estudos. As taxas de sucesso do tratamento não operatório é maior de 90% para estas lesões. Este artigo de revisão discutirá os conceitos atuais no manuseio não operatório, incluindo o diagnóstico, a seleção dos pacientes, as estratégias utilizadas no tratamento não operatório, os benefícios, os riscos e as complicações

Circulating Senescent T Cells Are Linked to Systemic Inflammation and Lesion Size During Human Cutaneous Leishmaniasis

Leishmania (Viannia) braziliensis induces American tegumentary leishmaniasis that ranges in severity from the milder form, cutaneous (CL) to severe disseminated cutaneous leishmaniasis. Patients with CL develop a cell-mediated Th1 immune response accompanied by production of inflammatory cytokines, which contribute to parasite control and pathogenesis of disease. Here, we describe the accumulation of circulating T cells with multiple features of telomere dependent-senescence including elevated expression of CD57, KLRG-1, and γH2AX that have short telomeres and low hTERT expression during cutaneous L. braziliensis infection. This expanded population of T cells was found within the CD45RA+CD27− (EMRA) subset and produced high levels of inflammatory cytokines, analogous to the senescence-associated secretory profile (SASP) that has been described in senescent non-lymphoid cells. There was a significant correlation between the accumulation of these cells and the extent of systemic inflammation, suggesting that they are involved in the inflammatory response in this disease. Furthermore, these cells expressed high level of the skin homing receptor CLA and there was a highly significant correlation between the number of these cells in the circulation and the size of the Leishmania-induced lesions in the skin. Collectively our results suggest that extensive activation during the early stages of leishmaniasis drives the senescence of T cells with the propensity to home to the skin. The senescence-related inflammatory cytokine secretion by these cells may control the infection but also contribute to the immunopathology in the disease

Passatempo Virus, a Vaccinia Virus Strain, Brazil

Passatempo virus was isolated during a zoonotic outbreak. Biologic features and molecular characterization of hemagglutinin, thymidine kinase, and vaccinia growth factor genes suggested a vaccinia virus infection, which strengthens the idea of the reemergence and circulation of vaccinia virus in Brazil. Molecular polymorphisms indicated that Passatempo virus is a different isolate

Effects of Bone Marrow Mesenchymal Stromal Cell Therapy in Experimental Cutaneous Leishmaniasis in BALB/c Mice Induced by Leishmania amazonensis

Cutaneous leishmaniasis remains both a public health and a therapeutic challenge. To date, no ideal therapy for cutaneous leishmaniasis has been identified, and no universally accepted therapeutic regimen and approved vaccines are available. Due to the mesenchymal stromal cell (MSC) immunomodulatory capacity, they have been applied in a wide variety of disorders, including infectious, inflammatory, and allergic diseases. We evaluated the potential effects of bone marrow MSC therapy in a murine model of cutaneous leishmaniasis. In vitro, coculture of infected macrophages with MSC increased parasite load on macrophages in comparison with controls (macrophages without MSCs). In vivo, BALB/c mice were infected with 2 × 106Leishmania amazonensis (Josefa strain) promastigotes in the footpad. 7 and 37 days after infection, animals were treated with 1 × 105 MSCs, either intralesional (i.l.), i.e., in the same site of infection, or intravenously (i.v.), through the external jugular vein. Control animals received the same volume (50 µL) of phosphate-buffered saline by i.l. or i.v. routes. The lesion progression was assessed by its thickness measured by pachymetry. Forty-two days after infection, animals were euthanized and parasite burden in the footpad and in the draining lymph nodes was quantified by the limiting dilution assay (LDA), and spleen cells were phenotyped by flow cytometry. No significant difference was observed in lesion progression, regardless of the MSC route of administration. However, animals treated with i.v. MSCs presented a significant increase in parasite load in comparison with controls. On the other hand, no harmful effect due to MSCs i.l. administered was observed. The spleen cellular profile analysis showed an increase of IL-10 producing T CD4+ and TCD8+ cells in the spleen only in mice treated with i.v. MSC. The excessive production of IL-10 could be associated with the disease-aggravating effects of MSC therapy when intravenously administered. As a conclusion, in the current murine model of L. amazonensis-induced cutaneous disease, MSCs did not control the damage of cutaneous disease and, depending on the administration route, it could result in deleterious effects

Relato da experiência da realização de pequenos procedimentos em dermatologia em Hospital Universitário

Modelo do estudo: Cohort. Objetivos: Relatar a experiência do setor de Pequenos Procedimentos em Dermatologia do Hospital Universitário Gaffrée e Guinle, determinando os diagnósticos, tipos de tratamentos e resolutividade. Metodologia: Trata-se de estudo prospectivo, observacional, por meio da coleta de dados dos pacientes do Programa de Saúde da Família da Secretaria Municipal de Saúde do Rio de Janeiro encaminhados para a realização de pequenos procedimentos em dermatologia, durante um período de 31 semanas. Resultados: Foram atendidos 884 pacientes. As lesões benignas representaram 77,5% dos diagnósticos clínicos e as malignas 22,5%. Os diagnósticos mais frequentes foram de cisto (133) e carcinoma basocelular (128). Os procedimentos mais realizados foram a excisão e sutura simples (337) e a retirada de lesão por shaving mais eletrocoagulação (161). No total, 98,3% dos procedimentos foram de cirurgia dermatológica básica e 1,7% dos casos necessitaram de procedimentos avançados. Além disso, 90,8% dos pacientes foram operados no dia do primeiro atendimento e 3,7% precisaram ser encaminhados para outras especialidades cirúrgicas. Conclusão: Um serviço de cirurgia dermatológica estruturado para a realização de pequenos procedimentos, em caráter ambulatorial, permite prover atendimento resolutivo à grande maioria dos pacientes com essa necessidade.Study design: Cohort study. Objectives: To report the experience of the Small Procedures Division, Dermatology Department, at Gaffrée and Guinle University Hospital, including a description of diagnoses, types of treatment, and efficacy. Methods: This is a prospective, observational study that consisted of data compilation of patients referred from the primary Family Health Program, Local Health Department, to an University Hospital for the performance of small dermatological procedures, encompassing a period of 31 weeks. Results: Overall, 884 patients underwent procedures. Benign lesions comprised 77.5% of the clinical diagnoses, while malignant lesions constituted 22.5%. The most frequent diagnoses were cyst (133) and basal cell carcinoma (128). The most commonly performed procedures were simple excision and suture (337) and lesion removal through shaving plus electrocoagulation (161). 98.3% of the procedures consisted of basic dermatological surgeries and 1.7% of the cases required advanced procedures. In addition, 90.8% of the patients were operated on the first day of care, on the other hand 3.7% were referred to other surgical specialties. Conclusion: A Dermatologic Surgery Department structured to perform small outpatient procedures provides efficacious care to the vast majority of referred patients

Influence of Ecto-Nucleoside Triphosphate Diphosphohydrolase Activity on Trypanosoma cruzi Infectivity and Virulence

The protozoan Trypanosoma cruzi is the causative agent of Chagas disease, an endemic zoonosis present in some countries of South and Central Americas. The World Health Organization estimates that 100 million people are at risk of acquiring this disease. The infection affects mainly muscle tissues in the heart and digestive tract. There are no vaccines or effective treatment, especially in the chronic phase when most patients are diagnosed, which makes a strong case for the development of new drugs to treat the disease. In this work we evaluate a family of proteins called Ecto-Nucleoside-Triphosphate-Diphosphohydrolase (Ecto-NTPDase) as new chemotherapy target to block T. cruzi infection in mammalian cells and in mice. We have used inhibitors and antibodies against this protein and demonstrated that T. cruzi Ecto-NTPDases act as facilitators of infection in mammalian cells and virulence factors in mice model. Two of the drugs used in this study (Suramin and Gadolinium) are currently used for other diseases in humans, supporting the possibility of their use in the treatment of Chagas disease