The importance of superficial basal cell carcinoma in a retrospective study of 139 patients who underwent Mohs micrographic surgery in a Brazilian university hospital

OBJECTIVE: Mohs micrographic surgery is a specialized surgical procedure used to treat skin cancer. The purpose of this study was to better understand the profile of the patients who underwent the procedure and to determine how histology might be related to complications and the number of stages required for complete removal. METHODS: The records of patients who underwent Mohs micrographic surgery from October 2008 to November 2013 at the Dermatology Division of the Hospital of the Campinas University were assessed. The variables included were gender, age, anatomical location, histology, number of stages required and complications. RESULTS: Contingency tables were used to compare the number of stages with the histological diagnosis. The analysis showed that patients with superficial basal cell carcinoma were 9.03 times more likely to require more than one stage. A comparison between complications and histological diagnosis showed that patients with superficial basal cell carcinoma were 6.5 times more likely to experience complications. CONCLUSION: Although superficial basal cell carcinoma is typically thought to represent a less-aggressive variant of these tumors, its propensity for demonstrating “skip areas” and clinically indistinct borders make it a challenge to treat. Its particular nature may result in the higher number of surgery stages required, which may, as a consequence, result in more complications, including recurrence. Recurrence likely occurs due to the inadequate excision of the tumors despite their clear margins. Further research on this subtype of basal cell carcinoma is needed to optimize treatments and decrease morbidity

Diagnosis and follow-up of keratoacanthoma-like lesions: Clinical-histologic study of 43 cases

Background. Keratoacanthorna (KA) is easily confused with squamous cell carcinoma (SCC) on a clinical or a histopathologic basis. However, KA undergoes spontaneous regression, whereas SCC does not. Objective: Our objective was to study the histopathologic features associated with clinical regression in KA-like lesions to support the therapeutic option. Methods: Forty-three biopsies of KA-like lesions were taken at patient admission. One month later, surgical excision was performed in 18 growing lesions. Regressing lesions were left untreated. Classic histopathologic features and diagnosis were blindly recorded in both biopsies and surgical specimens. Results: On a clinical and a histologic basis, 32 lesions were assessed as KA and 11 as SCC. Features that indicated malignancy were observed in both groups, but the probability of SCC was 31 times higher in tumors with five or more of such features. Several of the histologically atypical lesions were found to regress. Conclusion: SCCs and KAs have more pathologic similarities than differences, especially in the proliferative phase. The combination of the most useful features did not allow the nosologic diagnosis in difficult cases but helped. Differential diagnosis was easier to determine after the 1-month follow up. Complete surgical excision should be indicated in nonregressing and growing lesions.12416317

Blood Cell Findings Resembling Bartonella spp.

Some Bartonella species are able to invade red blood cells (RBC) and may cause persistent infection in the susceptible host. Use of transmission electron microscopy (TEM) demonstrates, inside erythrocytes, the typical triple-walled agents. However, when examining ultrathin sections of blood cells, the authors have, on several occasions, detected intraerythrocytic abnormalities that mimic but are not typical of Bartonella spp. Small endovesicles, pseudoinclusions, cavities, and irregular hemoglobin granules distribution, resulting in regions of increased or decreased electron density, may be observed in the erythrocytes and platelets, which may be confused with bartonellas. So far, detailed ultrastructural findings of Bartonella spp. in blood cells have not yet been described. Aiming to improve TEM interpretation of blood cells changes, in routine examination of blood sections of patients with suspected bartonellosis, the authors studied the morphological findings they have observed, and present their putative nature, according to information in the literature.</.3412

CORTICOSTERONE INCREASES FGF-2 (BFGF) IMMUNOREACTIVITY IN THE SUBSTANTIA-NIGRA OF THE RAT

THE effects of acute and subchronic (7 days) administrations of the adrenocortical hormone corticosterone on basic fibroblast growth factor (bFGF, FGF-2) immunoreactivity were studied in the substantia nigra of the rat by semiquantitative immunocytochemistry coupled with image analysis. Corticosterone was able to increase FGF-2 immunoreactivity in different nigral subregions and cell types (astrocytes and neurones) depending on the duration of the treatment. These results open up the possibility that stress hormones can modulate the trophic state of the substantia nigra through an action on FGF-2

Lime and fertilizer recommendation system for coconut trees

Fertilizer recommendation to most agricultural crops is based on response curves. Such curves are constructed from field experimental data, obtained for a particular condition and may not be reliable to be applied to other regions. The aim of this study was to develop a Lime and Fertilizer Recommendation System for Coconut Crop based on the nutritional balance. The System considers the expected productivity and plant nutrient use efficiency to estimate nutrient demand, and effective rooting layer, soil nutrient availability, as well as any other nutrient input to estimate the nutrient supply. Comparing the nutrient demand with the nutrient supply the System defines the nutrient balance. If the balance for a given nutrient is negative, lime and, or, fertilization is recommended. On the other hand, if the balance is positive, no lime or fertilizer is needed. For coconut trees, the fertilization regime is divided in three stages: fertilization at the planting spot, band fertilization and fertilization at the production phase. The data set for the development of the System for coconut trees was obtained from the literature. The recommendations generated by the System were compared to those derived from recommendation tables used for coconut crop in Brazil. The main differences between the two procedures were for the P rate applied in the planting hole, which was higher in the proposed System because the tables do not pay heed to the pit volume, whereas the N and K rates were lower. The crop demand for K is very high, and the rates recommended by the System are superior to the table recommendations for the formation and initial production stage. The fertilizer recommendations by the System are higher for the phase of coconut tree growth as compared to the production phase, because greater amount of biomass is produced in the first phase

Requirements for Brazilian Outpatient Centers of Excellence in Hidradenitis Suppurativa: Consensus Co-Creative Study

Ericles Andrei Bellei,1 Miriam Emi Makinodan Shirozaki,1 Ana Lia Pradella Puglia,2,3 André Vicente Esteves de Carvalho,4 Barbara Riquena,2,5 Camilla Carlini Vallilo,2,3 Danilo de Barros,6 Erika Yumi Tamashiro,2 Gabriela Cintra,2 Gleison Vieira Duarte,7 Maria Cecília da Matta Rivitti-Machado,8 Renata Ferreira Magalhães,9 Ricardo Figueiredo do Nascimento,2 Roberto Tunala,5 Roberto da Silva,10 Wagner Guimarães Galvão Cesar,11 Felipe Garutti Thies2 1Department of Data, Digital, and Innovation, Novartis, São Paulo, Brazil; 2Immunology Franchise, Novartis, São Paulo, Brazil; 3Department of Scientific Operations, Novartis, São Paulo, Brazil; 4Dermatology, Hospital Moinhos de Ventos de Porto Alegre, Porto Alegre, Brazil; 5Department of Medical Affairs, Novartis, São Paulo, Brazil; 6Dermatology Service, Hospital Irmandade Santa Casa de Curitiba, Curitiba, Brazil; 7Dermatology, Instituto Bahiano de Imunoterapia (IBIS), Salvador, Brazil; 8Hospital das Clínicas da Faculdade de Medicina, University of São Paulo (USP), São Paulo, Brazil; 9School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil; 10Department of Dermatology, Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil; 11Dermatology, Hospital Alemão Oswaldo Cruz, São Paulo, BrazilCorrespondence: Ericles Andrei Bellei, Novartis Biociências S.A, 90 Av Prof Vicente Rao, São Paulo, 04706-900, Brazil, Tel +55 1155327122, Email [email protected]: Hidradenitis suppurativa (HS) is a chronic skin condition. Its complexity and impact on patients highlight the need for multidisciplinary care that can address the physical, psychological, and social aspects. Centers of excellence can ideally provide the necessary infrastructure, resources, and expertise to effectively treat HS. However, there are still no consolidated models of centers of excellence in HS, and establishing their foundations is an intricate research challenge. Purposely, design and co-creation as innovation techniques are helpful approaches to this type of research.Methods: In this study, we conducted a co-creation with consensus among HS specialists to propose the criteria and requirements to establish outpatient centers of excellence of HS in Brazil. We followed a linear process with mixed methods in 6 stages.Results: The process resulted in 10 categories for establishing outpatient centers, including their respective requirements, rationale, and classification. The categories include onboarding and welcoming; infrastructure and procedures; infusion therapy; flows and referrals; staffing; disease management; metrics during diagnosis; metrics during treatment; awareness and advocacy; research and education.Discussion: The idealized outpatient centers can play a role in the complete multidisciplinary treatment for HS and advancing the science of healthcare services by providing a focus for research, training, and translation of findings into practice.Keywords: hidradenitis suppurativa, centers of excellence, co-design, consensus, health services research, patient-centered care, community-based participatory research, healthcare innovatio