Cutaneous manifestations of thrombophilia

O escopo deste artigo é revisar os estados de hipercoagulabilidade sangüínea (trombofilias) mais provavelmente encontrados por dermatologista. Seus sinais cutâneos incluem o livedo reticular, necrose cutânea, ulcerações e isquemia digital, púrpura retiforme, além de úlceras nas pernas. Revisamos seu tratamento adequado, bem como ressaltamos as manifestações cutâneas que impõem pesquisa laboratorial de trombofilias e os exames indicados nessas situações.The aim of this article is to review the hypercoagulable states (thrombophilia) most probably found by dermatologists; their cutaneous signs including livedo racemosa, skin necrosis, digital ischemia and ulcerations, retiform purpura and leg ulcers; their appropriate treatment; to describe the skin manifestations that require laboratory tests for thrombophilias and the tests indicated in these clinical conditions

Overlapping IgG4 Responses to Self- and Environmental Antigens in Endemic Pemphigus Foliaceus

The etiology of human autoimmune diseases in general remains largely unknown, although the genetic and environmental interplay may be relevant. This applies to the autoimmune diseases of the skin such as the pemphigus phenotypes and others. In this group, there is an endemic form of pemphigus foliaceus [also known as Fogo Selvagem (FS)] where the pathogenic IgG4 autoantibody response to the self-antigen, Desmoglein 1 (Dsg1) cross-react with the LJM11 sand fly salivary gland antigen. In this investigation we dissected the IgG4 autoantibody repertoires utilized by FS patients in response to endogenous self Dsg1 and exogenous LJM11 sand fly antigen. Based on analyses of the genetic clonal signatures of these antibodies, our results indicate that there is a significant overlap between these two responses as all identified IgG4 monoclonal antibodies cross-react to both Dsg1 and LJM11 antigens. Germline H and L chain V gene antibodies generated according to mutated cross-reactive monoclonal antibodies preserved their reactivity to both antigens. Our findings suggest that both Dsg1 autoantigen and LJM11 environmental antigen could be the initial antigenic stimulants for the IgG4 autoimmune responses in FS. These results support our hypothesis that LJM11 antigen plays a substantial role in triggering the IgG4 autoantibody development in FS, and provide new insights on how non-infectious environmental antigen(s) may drive the generation of autoantibodies in IgG4-related autoimmune diseases

La extensión universitaria como espacio dialógico de construcción y problematización de saberes y prácticas.

En los últimos cinco años, hemos ido construyendo la idea de acercar las cátedras Problemática Educativa y Política Educativa perteneciente a los Profesorados y a la Licenciatura en Psicopedagogía de la UNPA a la comunidad, haciendo extensivos ciertos contenidos y problemáticas trabajados a distintos actores e instituciones sociales. Intentaremos dar cuenta del recorrido trazado por los equipos de cátedra en estos últimos años, trayectoria que implica un posicionamiento político e ideológico respecto de la educación en general y de la función de la Universidad en particular, tomando cuerpo en un Programa de Extensión de formación e intervención desde una perspectiva crítica, donde se articulan la formación de grado, la extensión y la investigación participativa. Dicho programa implica un gran desafío teórico metodológico dado que -como intentaremos desarrollar- significa rupturas, quiebres en prácticas académicas establecidas, arraigadas en la tradición universitaria y en nuestras propias biografías personales y profesionales. Desde los aportes de las teorías críticas, y fundamentalmente al trabajar la obra de Paulo Freire se decide llevar adelante una serie de acciones de extensión entendida como coproducción, proponiendo experiencias pensadas como acontecimientos, concretadas en jornadas y talleres de educación popular, abiertos a toda la comunidad y otras sólo a los docentes de nuestro sistema educativo provincial, posibilitando diferentes intercambios con los actores sociales participantes. El análisis realizado sobre los emergentes recabados en estos encuentros, la participación en este proceso de reflexión de algunos de los protagonistas externos a la universidad, no sólo posibilita el enriquecimiento teórico-metodológico al interior de las cátedras, sino que permite la reformulación de problemas y desafíos, en base a un diagnóstico más aproximado de las condiciones simbólicas y socio-afectivas de los diferentes colectivos con los que interactuamos, en beneficio de proyectar futuras acciones para alcanzar algunos resultados superadores de la situación inicial. Estas experiencias generaron la necesidad de profundizar los alcances de los resultados obtenidos, a la vez que abrieron nuevos interrogantes y desafíos que dieron origen a un proyecto de investigación participativa: “La educación popular, una alternativa pedagógico-política en los actuales escenarios. Posibles articulaciones con el sistema educativo formal”, integrado por este equipo de trabajo, docentes del sistema educativo provincial y estudiantes. La investigación así concebida irá complejizando teórica y metodológicamente las prácticas llevadas adelante en las acciones de extensión y en los desarrollos de la formación de grado, a la vez que en un proceso espiralado, se retroalimentará en el ejercicio de una praxis crítica

Methicillin-resistant Staphylococcus aureus (MRSA) carriage in a dermatology unit

OBJECTIVE: The aim of this study was to characterize Staphylococcus aureus (MRSA) carriage in a dermatology unit. METHODS: This was a prospective and descriptive study. Over the course of 26 weeks, surveillance cultures were collected weekly from the anterior nares and skin of all patients hospitalized in a 20-bed dermatology unit of a tertiary-care hospital. Samples from healthcare workers (HCWS) were cultured at the beginning and end of the study. Colonized patients were put under contact precautions, and basic infection control measures were enforced. Staphylococcus aureus colonization pressure was determined monthly. Colonized and non-colonized patients were compared, and isolates were evaluated for antimicrobial susceptibility, SCCmec type, virulence factors, and type. RESULTS: Of the 142 patients evaluated, 64 (45%) were colonized by MRSA (39% hospital acquired; 25% community acquired; 36% indeterminate). Despite isolation precautions, hospital-acquired Staphylococcus aureus occurred in addition to the continuous entry of Staphylococcus aureus from the community. Colonization pressure increased from 13% to 59%, and pemphigus and other bullous diseases were associated with MRSA colonization. Eleven out of 71 HCWs (15%) were Staphylococcus aureus carriers, although only one worker carried a persistent clone. Of the hospital-acquired MRSA cases, 14/28 (50%) were SCCmec type IV (3 PFGE types), 13 were SCCmec type III (46%), and one had an indeterminate type. These types were also present among the community-acquired Staphylococcus aureus isolates. SSCmec type IV isolates were shown to be more susceptible than type III isolates. There were two cases of bloodstream infection, and the pvl and tst virulence genes were absent from all isolates. CONCLUSIONS: Dermatology patients were colonized by community- and hospital-acquired Staphylococcus aureus. Half of the nosocomial Staphylococcus aureus isolates were SCCmec type IV. Despite the identification of colonized patients and the subsequent contact precautions and room placement, Staphylococcus aureus colonization continued to occur, and colonization pressure increased. Pemphigus and other bullous diseases were associated with Staphylococcus aureus

Up-regulation of chemokine C-C ligand 2 (CCL2) and C-X-C chemokine 8 (CXCL8) expression by monocytes in chronic idiopathic urticaria

The disturbed cytokinechemokine network could play an important role in the onset of diseases with inflammatory processes such as chronic idiopathic urticaria (CIU). Our main objectives were to evaluate the relation between proinflammatory chemokine serum levels from CIU patients and their response to autologous skin test (ASST) and basophil histamine release (BHR). We also aimed to assess the chemokine secretion by peripheral blood mononuclear cells (PBMC) upon polyclonal stimulus and to evaluate chemokine CC ligand 2/C-X-C chemokine 8 (CCL2/CXCL8) and Toll-like receptor-4 (TLR-4) expression in monocytes. We observed significantly higher serum levels of the CXCL8, CXCL9, CXCL10 and CCL2 in CIU patients compared to the healthy group, regardless of the BHR or ASST response. The basal secretion of CCL2 by PBMC or induced by Staphylococcus aureus enterotoxin A (SEA) was higher in CIU patients than in the control group, as well as for CXCL8 and CCL5 secretions upon phytohaemagglutinin stimulation. Also, up-regulation of CCL2 and CXCL8 mRNA expression was found in monocytes of patients upon SEA stimulation. The findings showed a high responsiveness of monocytes through CCL2/CXCL8 expression, contributing to the creation of a proinflammatory environment in CIU.FAPESP [2007/58485-9]FAPESP[LIM-56/HCFMUSP