UTILIZAÇÃO DE CORTICOSTEROIDE TÓPICO OCLUSIVO NO TRATAMENTO DO PENFIGOIDE CICATRICIAL DAS MEMBRANAS MUCOSAS EM PACIENTE APRESENTANDO GENGIVITE DESCAMATIVA

Pemphigoid of the mucous membranes is an autoimmune, vesiculobullous, chronic disease characterized by the presence of suprabasal or subepithelial blisters on mucous membranes. It predominantly affects a fixed older age, generally from the fourth decade of life. Ocular involvement is common, with the formation of scars characteristic of this type of pemphigoid, and when the conjunctiva is affected, it can lead the patient to blindness. Those with this alteration may have involvement of the oral mucous membranes, with the inserted gingiva being the most affected site, triggering a condition of desquamative gingivitis, as well as painful and bleeding bullous lesions with deep cleavage. The etiology is unknown, but some authors associate pemphigoid with the use of certain drugs such as Captopril, Furosemide and Amoxicillin. Diagnosis is based on clinical history, perilesional biopsy and direct immunofluorescence. Histopathological examinations show the separation of the basal epithelial layer from the connective tissue itself, vacuolation in the basal lamina under an intact epithelium, and deposits of IgG and C3 in the basal membrane, which can be identified through direct immunofluorescence. The treatment is done in a multidisciplinary way, through topical or systemic corticosteroid therapy, depending on the severity of the disease, in addition to laser therapy and drug associations. The present work aims to present a case of pemphigoid of the mucous membranes, where the patient presented lesions in the eyes and in the oral mucosa, with a diagnosis confirmed through histopathology, in concomitant treatment of stomatology with other medical specialties, such as ophthalmology, presenting satisfactory evolution of the mouth injuries.Penfigoide das membranas mucosas, é uma doença autoimune, vesiculobolhosa, de caráter crônico, que se caracteriza pela presença de bolhas suprabasais, ou subepiteliais, em membranas mucosas. Acomete predominantemente fixa etária mais elevada, geralmente, a partir da quarta década de vida. O envolvimento ocular é costumaz, ocorrendo a formação de cicatrizes característica desse tipo de penfigoide, e quando afetada a conjuntiva, pode levar o paciente à cegueira. Os portadores desta alteração podem apresentar envolvimento das mucosas orais, sendo a gengiva inserida o sítio mais afetado, desencadeando um quadro de gengivite descamativa, além de lesões bolhosas de clivagem profunda, doloridas e sangrantes. A etiologia é desconhecida, mas alguns autores associam o penfigoide ao uso de certos fármacos como Captopril, Furosemida e Amoxicilina. O diagnóstico é baseado na história clínica, biópsia perilesional e imunofluorescência direta. Nos exames histopatológicos, observa-se a separação da camada basal epitelial do tecido conjuntivo propriamente dito, vacuolização na lâmina basal sob um epitélio íntegro, e, depósitos de IgG e C3 na membrana basal, que podem ser identificados através de imunofluorescência direta. O tratamento é feito de forma multiprofissional, através de corticosteroideterapia, tópica ou de forma sistêmica, a depender da gravidade da doença, além de laserterapia e associações medicamentosas. O presente trabalho tem por objetivo apresentar um caso de penfigoide das membranas mucosas, onde o paciente apresentava lesões oculares e em mucosa oral, tendo diagnóstico confirmado através de histopatologia, em tratamento concomitante da estomatologia com outras especialidades médicas, como oftalmologia, apresentando evolução satisfatória das lesões bucais

Skin thickness as a potential marker of gestational age at birth despite different fetal growth profiles: A feasibility study.

New methodologies to estimate gestational age (GA) at birth are demanded to face the limited access to obstetric ultrasonography and imprecision of postnatal scores. The study analyzed the correlation between neonatal skin thickness and pregnancy duration. Secondarily, it investigated the influence of fetal growth profiles on tissue layer dimensions.In a feasibility study, 222 infants selected at a term-to-preterm ratio of 1:1 were assessed. Reliable information on GA was based on the early ultrasonography-based reference. The thicknesses of the epidermal and dermal skin layers were examined using high-frequency ultrasonography. We scanned the skin over the forearm and foot plantar surface of the newborns. A multivariate regression model was adjusted to determine the correlation of GA with skin layer dimensions. The best model to correlate skin thickness with GA was fitted using the epidermal layer on the forearm site, adjusted to cofactors, as follows: Gestational age (weeks) = -28.0 + 12.8 Ln (Thickness) - 4.4 Incubator staying; R2 = 0.604 (P<0.001). In this model, the constant value for the standard of fetal growth was statistically null. The dermal layer thickness on the forearm and plantar surfaces had a negative moderate linear correlation with GA (R = -0.370, P<0.001 and R = -0.421, P<0.001, respectively). The univariate statistical analyses revealed the influence of underweight and overweight profiles on neonatal skin thickness at birth. Of the 222 infants, 53 (23.9%) had inappropriate fetal growths expected for their GA. Epidermal thickness was not fetal growth standard dependent as follows: 172.2 (19.8) μm for adequate for GA, 171.4 (20.6) μm for SGA, and 177.7 (15.2) μm for LGA (P = 0.525, mean [SD] on the forearm).The analysis highlights a new opportunity to relate GA at birth to neonatal skin layer thickness. As this parameter was not influenced by the standard of fetal growth, skin maturity can contribute to clinical applications

Magnitudes of the skin layer thicknesses of 222 newborns on the first day of life.

<p>(A) Distribution corresponds to the epidermal skin over the forearm. Values: n = 217; mean (SD), 172.4 (19.6) μm and 95% CI of the mean, 169.8–175.1. (B) Distribution corresponds to the dermal skin over the forearm. Values: n = 217; mean (SD), 974.0 (290.0) μm; 95% CI of the mean, 994.9–1061.8; and median (IQR), 974.0 (290.0) μm. (C) Distribution corresponds to the epidermal skin over the plantar surface. Values: n = 219; mean (SD), 174.6 (17.5) μm; 95% CI of the mean, 172.2–176.9. (D) Distribution corresponds to the dermal skin over the plantar surface. Values: n = 219; mean (SD), 1244.5 (869.0) μm; 95% CI of the mean, 1125.2–1263.9); and median (IQR), 1244.5 (869.0) μm.</p

Variation of skin thickness at birth according to birthweight patterns and examination site in newborns.

<p>Variation of skin thickness at birth according to birthweight patterns and examination site in newborns.</p

Histogram of residual value for the skin thickness vs. gestational age.

<p>Histogram of residual value for the skin thickness vs. gestational age.</p

Environmental conditions and neonatal oximetry during the newborn assessment.

<p>Environmental conditions and neonatal oximetry during the newborn assessment.</p

High-frequency ultrasonography image of the skin over the forearm with automated epidermal thickness estimation.

<p>(A) Skin ultrasonography image. (B) The red lines and the grid in between indicate the area over which dermal thickness is calculated using the DermaLab^® software. (C) The red color corresponds to the automated epidermal boundary detection by our dedicated software. (D) The white and black limits of the epidermis correspond to the automated mean thickness estimation by our dedicated software.</p

Gestational age estimated using the epidermal skin thickness of the forearm in comparison with GA at birth by early obstetric ultrasonography.

<p>Equation: Gestational age (weeks) = −28.0 + 12.8 <i>Ln</i> (Thickness) − 4.4 Incubator stay + 0.015 standard fetal growth; <i>R</i> = 0.777, <i>R</i>² = 0.604, P < 0.001.</p

Clinical characteristics of the studied gestation and newborns, considering birth weight patterns.

<p>Clinical characteristics of the studied gestation and newborns, considering birth weight patterns.</p

Competências do Enfermeiro para atuar sobre as desigualdades sociais: Aprendizagem experiencial e diferentes estratégias de ensino.

This Scoping Review protocol was developed following the international guide PRISMA-ScR and in the method proposed by the Joanna Briggs Institute. The research question is: Which skills to act in the face of social inequalities are developed in professional training / Professional education of nurses