Protoporphyrin IX Associated with Visible Light for the Treatment of Trichophyton rubrum Causing Onychomycosis - An Updated Review

Systemic medications used during the treatment of onychomycosis caused by Trichophyton rubrum may have relapse, making them costly and insignificant for the patient. Photodynamic therapy (PDT) is an advantageous therapeutic option for disease control, mainly due to the absence of risk of microbial resistance. The action of PDT is combined by three elements: photosensitizer (PS), visible light (VL) and molecular oxygen, leading to the formation of reactive oxygen species (ROS) or singlet oxygen formation (1O2), both ROS (type I mechanism) as 1O2 (type II mechanism) induce damage and death to microbial cells. This research was proposed as a study through a non-systematic review, to investigate the action of PS "Protoporphyrin IX" (Pp IX) associated with visible light on T. rubrum, contemplating clinical and relevant data regarding the treatment of onychomycosis by PDT. PubMed survey was conducted from June 2021 to April 2022. The research strategy included clinical trials, randomized trials, systematic reviews, meta-analyses and reviews in English. Pp IX has affinity for T. rubrum, which is justified by the incorporation of Pp IX into the cell membrane, which led to inhibition by LV irradiation. Thus, the photodynamic process of Pp IX may lead to cell death by type I and II mechanisms. The data found are promising, however, new studies in vitro and in vivo are suggested, since few studies have been found related to the theme

Anatomical characteristics of the accessory hepatic lobe and its clinical-functional particularities

Riedel's lobe (ectopic lobe), also known as the accessory hepatic lobe, consists of an anatomical variation characterized by a tongue-shaped protrusion on the visceral surface of the liver right lobe, fixed by a pedicle. This variant draws attention in the clinical practice, as it can be mistaken for a tumor due to its elongated aspect. The aim of this research was to conduct a study on the anatomical characteristics and clinical and functional peculiarities of the accessory hepatic lobe. The paper is based on a integrative review and observational study on a cadaveric specimen. A cadaver with anatomical variation was used. Data were collected in PubMed, Scielo, and VHL. 257 articles were found in the databases, but only 13 were used for research. In careful review, two rare cases of the accessory lobe in the left lobe of the liver, hypoplastic left lobes, and agenesis of the right hepatic lobe, and often the clinical picture without changes in signs and symptoms were found. These morphological abnormalities' clinical impact is limited in the absence of underlying liver disease, cirrhosis, or known cancer. In case of complications or after the diagnosis of pedunculated tumors in the liver, laparoscopy is well indicated for removing these lobes or tumors