Systemic corticosteroids in dermatological practice. Part I: Main adverse effects

Systemic corticosteroids have been used in dermatological practice for approximately 60 years due to their anti-inflammatory and immunosuppressive effects. The challenge of corticosteroid therapy is to counterbalance the desirable actions and undesirable pharmacological effects. Unfortunately, advanced understanding of the mechanisms of action of corticosteroids has not resulted in the development of minimal toxicity regimens. In this article, we report the main pharmacological properties of systemic corticosteroids, their major indications in clinical practice and the adverse effects of high doses and/or prolonged administration.Há quase 60 anos os corticosteróides sistêmicos têm sido amplamente utilizados na área de dermatologia, trazendo benefícios para muitas doenças em decorrência de suas ações antiinflamatórias e imunossupressoras. O desafio de seu uso consiste em contrabalançar os efeitos benéficos e as atividades farmacológicas indesejáveis. Infelizmente, os avanços no conhecimento sobre os mecanismos de ação dos corticosteróides não resultaram no desenvolvimento de regimes com mínima toxicidade. Dessa maneira, este artigo de revisão discorre sobre os aspectos farmacológicos dos corticosteróides sistêmicos, bem como suas principais indicações de uso e efeitos colaterais da administração em altas doses e/ou por longos períodos de tempo.UNIFESPHospital Central da Santa Casa de São Paulo Departamento de Clínica Médica Serviço de DermatologiaHospital Central da Santa Casa de São Paulo Clínica de DermatologiaUNIFESPSciEL

Desafios para a participação da sociedade civil na estruturação da política municipal de cultura em Lavras - MG

Este artigo pretende investigar o processo de participação da sociedade civil na estruturação da política cultural no município de Lavras (MG), e identificar os principais desafios encontrados para a implementação do Sistema Municipal de Cultura (SMC) e seus elementos estruturantes essenciais: o Conselho, o Plano, e o Fundo de Cultura. Metodologicamente, realizou-se revisão teórica e pesquisa documental sobre o tema, seguida de abordagem qualitativa, sendo os dados primários coletados através de entrevistas realizadas com os atores sociais da área. Concluímos apontando os desafios e os relacionando à participação da sociedade civil como forma de sua superação

Influence Of English Language In The Number Of Citations Of Articles Published In Brazilian Journals Of Ophthalmology.

To determine the association between language and number of citations of ophthalmology articles published in Brazilian journals. This study was a systematic review. Original articles were identified by review of documents published at the two Brazilian ophthalmology journals indexed at Science Citation Index Expanded - SCIE [Arquivos Brasileiros de Oftalmologia (ABO) and Revista Brasileira de Oftalmologia (RBO)]. All document types (articles and reviews) listed at SCIE in English (English Group) or in Portuguese (Portuguese Group) from January 1, 2008 to December 31, 2009 were included, except: editorial materials; corrections; letters; and biographical items. The primary outcome was the number of citations through the end of second year after publication date. Subgroup analysis included likelihood of citation (cited at least once versus no citation), journal, and year of publication. The search at the web of science revealed 382 articles [107 (28%) in the English Group and 275 (72%) in the Portuguese Group]. Of those, 297 (77.7%) were published at the ABO and 85 (23.3%) at the RBO. The citation counts were statistically significantly higher (P<0.001) in the English Group (1.51 - SD 1.98 - range 0 to 11) compared with the Portuguese Group (0.57 - SD 1.06 - range 0 to 7). The likelihood citation was statistically significant higher (P<0.001) in the English Group (70/107 - 65.4%) compared with the Portuguese Group (89/275 - 32.7%). There were more articles published in English at the ABO (98/297 - 32.9%) than at the RBO (9/85 - 10.6%) [P<0.001]. There were no significant difference (P=0.967) at the proportion of articles published in English at the years 2008 (48/172 - 27.9%) and 2009 (59/210 - 28.1%). The number of citations of articles published in Portuguese at Brazilian ophthalmology journals is lower than the published in English. The results of this study suggest that the editorial boards should strongly encourage the authors to adopt English as the main language in their future articles.7626-

Influência do idioma inglês no número de citações de artigos publicados em periódicos brasileiros de Oftalmologia

PURPOSE: To determine the association between language and number of citations of ophthalmology articles published in Brazilian journals. METHODS: This study was a systematic review. Original articles were identified by review of documents published at the two Brazilian ophthalmology journals indexed at Science Citation Index Expanded - SCIE [Arquivos Brasileiros de Oftalmologia (ABO) and Revista Brasileira de Oftalmologia (RBO)]. All document types (articles and reviews) listed at SCIE in English (English Group) or in Portuguese (Portuguese Group) from January 1, 2008 to December 31, 2009 were included, except: editorial materials; corrections; letters; and biographical items. The primary outcome was the number of citations through the end of second year after publication date. Subgroup analysis included likelihood of citation (cited at least once versus no citation), journal, and year of publication. RESULTS: The search at the web of science revealed 382 articles [107 (28%) in the English Group and 275 (72%) in the Portuguese Group]. Of those, 297 (77.7%) were published at the ABO and 85 (23.3%) at the RBO. The citation counts were statistically significantly higher (P<0.001) in the English Group (1.51 - SD 1.98 - range 0 to 11) compared with the Portuguese Group (0.57 - SD 1.06 - range 0 to 7). The likelihood citation was statistically significant higher (P<0.001) in the English Group (70/107 - 65.4%) compared with the Portuguese Group (89/275 - 32.7%). There were more articles published in English at the ABO (98/297 - 32.9%) than at the RBO (9/85 - 10.6%) [P<0.001]. There were no significant difference (P=0.967) at the proportion of articles published in English at the years 2008 (48/172 - 27.9%) and 2009 (59/210 - 28.1%). CONCLUSION: The number of citations of articles published in Portuguese at Brazilian ophthalmology journals is lower than the published in English. The results of this study suggest that the editorial boards should strongly encourage the authors to adopt English as the main language in their future articles.OBJETIVO: Determinar a associação entre a língua e o número de citações de artigos publicados em periódicos de oftalmologia brasileiros. MÉTODOS: Este estudo foi uma revisão sistemática. Artigos originais foram identificados a partir da revisão dos documentos publicados nos dois periódicos de oftalmologia brasileiros indexados no Science Citation Index Expanded - SCIE [Arquivos Brasileiros de Oftalmologia (ABO) e Revista Brasileira de Oftalmologia (RBO)]. Todos os tipos de documentos (artigos e revisões) listados no SCIE em inglês (Grupo Inglês) ou em português (Grupo Português), de 1º de janeiro de 2008 a 31 de dezembro de 2009, foram incluídos, exceto: editoriais; correções; cartas; e biografias. O desfecho primário foi o número de citações até o segundo ano após a data de publicação. Análise de subgrupo incluiu probabilidade de citação (citado pelo menos uma vez contra nenhuma citação), periódico e ano da publicação. RESULTADOS: A pesquisa na Web of Science revelou 382 artigos [107 (28%) no Grupo Inglês e 275 (72%) no Grupo Português]. Destes, 297 (77,7%) foram publicados na ABO e 85 (23,3%) na RBO. O número de citações foi significativamente maior (P<0,001) no Grupo de Inglês (1,51 - DP 1,98 - faixa 0 to 11) em comparação com o Grupo Português (0,57 - DP 1,06 - faixa 0 to 7). A probabilidade de citação foi estatisticamente superior (P<0,001) no Grupo de Inglês (70/107 - 65,4%) comparado com o Grupo Português (89/275 - 32,7%). Havia mais artigos publicados em Inglês na ABO (98/297 - 32,9%) do que no RBO (9/85 - 10,6%) [P<0,001]. Não houve diferença significativa (P=0,967) na proporção de artigos publicados em Inglês nos anos de 2008 (48/172 - 27,9%) e 2009 (59/210 - 28,1%). CONCLUSÃO: O número de citações de artigos publicados em Português em periódicos brasileiros de oftalmologia é menor do que o publicado em Inglês. Os resultados deste estudo sugerem que os conselhos editoriais devem incentivar fortemente os autores a adotar o Inglês como língua principal em seus artigos futuros.262

Intervening factors in language therapy with autistic children

Estudos recentes mencionam que a incidência dos distúrbios do espectro autístico chega a 1%. Isso implica na necessidade de identificação urgente de modelos de intervenção eficazes, bem como dos fatores que podem interferir nesses processos. O objetivo deste artigo é descrever três anos de processos de terapia de linguagem de três crianças com diagnósticos incluídos no espectro do autismo com diferentes características de desenvolvimento e diferentes respostas ao processo terapêutico. Todas as crianças são atendidas em sistema ambulatorial, uma vez por semana, num serviço especializado, por fonoaudiólogas pós-graduandas na área há aproximadamente seis meses antes dos primeiros relatos apresentados. Os casos apresentados evidenciam a diversidade do fenótipo do autismo. Embora não fosse o objetivo deste estudo, fica aparente a referencia a três diferentes quadros incluídos no espectro do autismo. Desta forma, os processos de intervenção foram objeto de sutis ajustes às necessidades e possibilidades de cada uma das crianças. Todas as crianças tiveram progressos importantes em suas manifestações. A análise longitudinal individualizada de processos de intervenção terapêutica permite a abordagem de aspectos associados que podem ser determinantes nos resultados e que exigem abordagem consistente.Recent studies state that the incidence of autism spectrum disorders is 1% of the infantile population. It implies the need of urgent identification of efficient intervention proposals as well as of the factors that may intervene in these processes. The aim of this study is to describe three years of language therapy processes of three children diagnosed within the autism spectrum with different developmental characteristics and different responses to the therapeutic process. All the children were attending a specialized ambulatory program once a week. The language therapists were post-graduate students in the field and the therapeutic intervention started approximately six months prior to the beginning of the study. The children presented evidence of the diversity of the autism phenotype. Although it was not the purpose of this study, the reference to the three different features of the autism spectrum is clear. This way, the intervention processes received subtle adjustments to each child's specific needs and possibilities. All children had significant progress in their manifestations. The longitudinal individual analysis of therapeutic intervention processes allows the identification of associate process that might be determinant to the results and that demand consistent approaches

Treatment interruption of biological drugs and tofacitinib in rheumatoid arthritis: A systematic review of case reports

The aim of this study was to evaluate interruption of treatment with biological drugs and tofacitinib due to adverse events in patients with rheumatoid arthritis. A systematic review was performed in the electronic databases MEDLINE, Cochrane, Scopus, CRD, IPA, Lilacs and Scielo. Case reports addressing interruption of treatment due to any adverse event related to abatacept (ABA), adalimumab (ADA), anakinra (ANA), certolizumab pegol (CER), etanercept (ETA), golimumab (GOL), infliximab (IFX), rituximab (RTX), secukinumab (SEC), tocilizumab (TCZ), tofacitinib (TOF) or ustekinumab (UST) in rheumatoid arthritis patients were evaluated. Baseline data, patient profile, previous and current treatments, cause of discontinuation and information on reintroduction of treatment were extracted from the case reports. One hundred and fifty-four studies (154 patients) reported 162 discontinuations of rheumatoid arthritis treatment due to adverse events (ETA = 57; IFX = 46; ADA = 32; TCZ = 13; RTX = 5; ANA = 3; GOL = 2; ABA = 2; TOF = 1; CER = 1; SEC = 0 and UST = 0). The mean age of patients was 56 (± 12.1) years and 82% were female. Seventy-four adverse events were confirmed (related to used drug), and 138 were observed in patients using anti-TNF. The most common adverse events were infections (21%), skin disease (15%), autoimmune disease (13%) and hematological disorders (9%). Case reports are important in the detection of rare adverse events and should be considered in the choice of appropriate therapy for patients

Molecular epidemiology of Listeria monocytogenes isolated from different sources in Brazil

Listeria monocytogenes is an important foodborne pathogen that primarily affects pregnant women, neonates, the elderly and immune-compromised individuals, and it may cause abortion, septicemia, and meningitis. From the 13 capsular groups described, serotypes 4b, 1/2b and 1/2a are most closely related to human infection. For this reason, serotyping has limited value as an epidemiological tool; thus, improved discriminatory typing methods are required to enhance knowledge of L. monocytogenes contamination and infection. The aim of this study was to characterize the genetic diversity of L. monocytogenes isolates in the pork processing industry in Sao Paulo, Brazil and human infection isolates by ERICPCR and single enzyme AFLP. Serotypes 1/2c and 4b were frequent among isolates from pork and slaughterhouse/market environments, whereas serotypes 4b and 1/2a were observed among human isolates. ERIC-PCR and AFLP revealed 34 and 31 distinct profiles, respectively, which had tendencies of separation according to serogroup and isolate origin. The genetic profiles from slaughterhouse and market environments suggest the possibility of different sources of Listeria contamination in the environment, although in certain cases, continuous contamination caused by the persistence of clonal strains is also a possibility.Listeria monocytogenes é um importante patógeno de origem alimentar que afeta principalmente grávidas, neonatos, idosos e indivíduos imunocomprometidos, e pode causar abortamento, septicemia e meningite. Dos 13 grupos capsulares descritos, os sorotipos 4b, 1/2b e 1/2a são os mais relacionados à infecção humana. Por esta razão, a sorotipagem possui valor limitado como ferramenta epidemiológica e, dessa forma, métodos mais discriminatórios são necessários para melhorar o conhecimento sobre a contaminação e a infecção por L. monocytogenes. O objetivo deste estudo foi caracterizar a diversidade genética de isolados de L. monocytogenes da indústria de processamento de carne suína no Estado de São Paulo, Brasil, e compará-los a isolados de casos de infecção humana através do ERIC-PCR e AFLP com uma única enzima. Os sorotipos 1/2c e 4b foram frequentes em carne suína e ambientes de abatedouros e mercados, enquanto os sorotipos 4b e 1/2a foram observados nos isolados de humanos. ERIC-PCR e AFLP resultaram em 34 e 31 perfis distintos, respectivamente, com uma tendência a separar de acordo com o sorogrupo e a origem do isolado. Os perfis genéticos de ambiente dos abatedouros e mercados sugerem a possibilidade de diferentes origens de contaminação por Listeria nos ambientes estudados, porém, em alguns casos, é possível que ocorra a persistência de cepas clonais causando contaminação contínua

What is the response profile of deciduous pulp fibroblasts stimulated with E. coli LPS and E. faecalis LTA?

BACKGROUND: Oral fibroblast immunological responses to bacterial stimuli are well known. However, there are few studies about pulp fibroblasts from deciduous teeth (HDPF) responses, which are important for the treatment of pulp infections in children. The aim of this study was to evaluate expression and production of inflammatory cytokines and chemokines by HDPF when challenged with bacterial antigens normally present in advanced caries lesions. METHODS: Triplicate HDPF from 4 children (n = 4; 2 boys and 2 girls) were cultured by explant technique and challenged or not with Escherichia coli lipopolysaccharide/1 μg/mL (EcLPS) or Enterococcus faecalis lipoteichoic acid/1 μg/mL (EfLTA) for 6 and 24 h. Most of published studies employed immortalized cells, i.e., without checking possible gender and genetic variables. mRNA expression and protein production were evaluated by RT-qPCR and ELISA MILLIPLEX®, respectively, for Interleukin (IL)-1α, IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12, IL-17, Chemokine C-C motif ligand 2/monocyte chemoattractant protein 1 (CCL2/MCP-1), Chemokine C-C motif ligand 3/macrophage inflammatory protein 1-alpha (CCL3/MIP1-α), Chemokine C-C motif ligand 5/ regulated on activation, normal T cell expressed and secreted (CCL5/RANTES), C-X-C motif chemokine 12/ stromal cell-derived factor 1 (CXCL12/SDF-1), Tumor Necrosis Factor-alpha (TNF-α), Interferon-gamma (IFN γ), Vascular Endothelial Growth Factor (VEGF), Colony stimulating factor 1 (CSF-1) and Macrophage colony-stimulating factor (M-CSF). RESULTS: EcLPS increased IL-1α, IL-1β, IL-8, CCL2, CCL5, TNF-α and CSF-1 mRNA and protein levels while EfLTA was only able to positively regulate gene expression and protein production of IL-8. CONCLUSION: The results of the present study confirmed our hypothesis, since pulp fibroblasts from deciduous teeth are capable of increasing gene expression and protein production after being stimulated with EcLPS and EfLTA