Botucatu - FMB - Faculdade de Medicina

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https://hdl.handle.net/11449/253819

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Nerves injuries during rhytidoplasty: How to avoid and surgical reparation
(2021-04-07) Viterbo, Fausto ; Universidade Estadual Paulista (UNESP)
Nerve injury in facial aesthetic surgery is not rare. Specially in facial lifting, the injuries may occur in the sensory and motor nerves. In this chapter, we describe the most injured nerves during face-lifting and our approach in terms of clinical and surgical treatment.
Peritoneal Dialysis in Acute Kidney Injury: Prescribing Acute PD
(2021-01-01) Ponce, Daniela ; Balbi, André Luís ; Universidade de São Paulo (USP) ; Universidade Estadual Paulista (UNESP)
Decades ago, peritoneal dialysis was widely accepted as treatment for acute kidney injury (AKI); however, its usage declined in favor of other types of extracorporeal therapies. The interest in PD to manage AKI patients has been reignited, and PD now frequently is used in developing countries because of its lower cost and minimal requirements for infrastructure. Studies from Brazil, India, and Africa have shown that with careful thought and planning, critically ill patients can be successfully treated with PD. To overcome some of the classic limitations in the use of PD for AKI, such as increased risk of infectious and mechanical complications and poorer control of urea, potassium, and bicarbonate levels, the use of cyclers, flexible catheters, and a high volume of dialysis fluid has been proposed. However, in developing countries, the setup for quality research is often lacking, thereby resulting in limited evidence regarding standardized treatment regimens including indications, dosing, technical failure, and mortality. The recent publication of the International Society for Peritoneal Dialysis (ISPD) guidelines for PD in AKI has tried to address these issues and provide an evidence-based standard by which to provide therapy. In this chapter, the advances in technical aspects, advantages, and limitations of PD and the key prescriptions and strategies for PD use in AKI are discussed, and we will review recent literature on clinical experience with PD for the treatment of AKI.
Gluteal augmentation in post-massive weight loss patients
(2021-04-29) Mendes, Flavio Henrique ; Viterbo, Fausto ; Universidade Estadual Paulista (UNESP)
Surgical treatment of obesity and its comorbidities has not only been recognized as one of the greatest achievements of modern medicine, but it also has created new body contour deformities for which our specialty has been devoted to correct in the last decades. Massive weight loss patients usually present with body contour deformities that often affect gluteal aesthetics. The lack of volume and projection is related to a severe disarrangement of the buttocks' frame, which requires specific measures to restore anatomical landmarks and to enhance shape and contour of the gluteal region. In most cases, circumferential body lift will be the first step to readjust the gluteal frame. Augmentation techniques such as fat grafting, autologous flaps, and alloplastic implants can be associated to enhance buttocks projection. Fat grafting helps restore volume and projection to the massive weight loss (MWL) buttocks, targeting different aesthetic units and globally promoting a true refill of the deflated subcutaneous spaces. Besides volume restoration, other regenerative and angiogenic properties of adipose tissue may be responsible for metabolic turnover and improvement in skin quality. Dermal flaps and silicone implants also contribute to increase buttock projection in specific gluteal units. As we continue to advance in our understanding of the MWL deformities, surgical techniques for gluteal contour will certainly be refined toward improving aesthetic outcomes and fewer complications.
Paracoccidioidomycosis: An Update from the Environment to Clinics
(2022-01-01) de Oliveira, Haroldo Cesar ; de Paula e Silva, Ana Carolina Alves ; Marcos, Caroline Maria ; de Fátima da Silva, Julhiany ; Scorzoni, Liliana ; Assato, Patricia Akemi ; Rossi, Suélen Andreia ; Fundação Oswaldo Cruz (Fiocruz-PR) ; Universidade Estadual Paulista (UNESP) ; Guarulhos University (UNG) ; Universidade de São Paulo (USP)
Paracoccidioidomycosis is an endemic mycosis of great importance in Latin America caused by dimorphic fungi of the genus Paracoccidioides. Recent advances in the study of this mycosis reveal the Paracoccidioides genus as fungi that are difficult to treat and diagnose, with a great capacity to adapt and evade the environment of host cells, causing an invasive disease that is neglected in areas where it is endemic. This chapter aims to provide an overview of the fungi of this genus and the disease, bringing historical aspects and also the most recent advances in the study of this important mycosis, which has a great impact on public health in many countries in Latin America. This chapter will address issues such as the diversity of species of the Paracoccidioides genus, the thermal dimorphism, that allows the fungus to survive in the environment and the host, and its impact on the infectious process, virulence factors, and their relationship with the evasion capacity of the host immune system, as well as aspects associated with the disease such as clinical forms, pathogenesis, epidemiology, diagnosis and treatment.
Oral Signs of Tropical, Fungal, and Parasitic Diseases
(2019-01-01) Pérez-Alfonzo, Ricardo ; Alencar-Marques, Silvio ; Giansante, Elda ; Guzmán-Fawcett, Antonio ; Central University of Venezuela ; Universidade Estadual Paulista (UNESP) ; Autonomous University of Paraguay
More than 50% of the world population live in the tropics mostly in developing countries, with great poverty and poor essential goods, services, and access. These conditions and environmental factors make the population high risk for a group of fungal, bacterial, and parasitic diseases, many of which affect the oral mucosa.
Tuberculosis
(2014-01-01) Pereira, Paulo Camara Marques ; Corrêa, Camila Renata ; Calvi, Sueli Aparecida ; Universidade Estadual Paulista (UNESP)
Tuberculosis (TB) has been present in man since pre-historic times. More than 100 yr after Robert Koch identified its causative agent in 1882, TB is still a chronic infection with one of the highest morbidity and mortality rates (Brasil-Ministerio da Saude 2002).
Congestive Heart Failure
(2014-01-01) Azevedo, Paula Schmidt ; Santos, Priscila Portugal dos ; Fernandes, Ana Angélica Henrique ; Minicucci, Marcos Ferreira ; Zornoff, Leonardo Antonio Mamede ; de Paiva, Sergio Alberto Rupp ; Universidade Estadual Paulista (UNESP)
Heart failure (HF) is an emerging epidemic disorder. As one of the most prevalent diseases in the world, HF has a significant impact on mortality. Before the 1990s, HF mortality rate in 5 yr was about 60-70 percent. Despite the improvements in treatment, heart disease-related mortality rate has decreased 20-30 percent, but is still considered high (Mc Murray 2010). Furthermore, decompensated HF is one of the most frequent causes of hospitalization (Mc Murray 2010). Therefore, it is necessary to elucidate the mechanisms involved in HF that could be potential sites of intervention.
Ethics of Research Involving Human Subjects: The Brazilian Experience
(2010-01-01) Hossne, William Saad ; de Freitas, Corina Bontempo Duca ; Universidade Estadual Paulista (UNESP) ; Fundação de Ensino e Pesquisa em Ciências da Saúde-FEPECS
Human experimentation cannot be analyzed in isolation because many forces shape social interaction - man’s quest for knowledge and mastery, his willingness to risk human life, and his readiness to delegate authority and to rely on professional judgment (Katz 1972). It was man’s capacity for seeking justice that made ethics committees possible, while at the same time it was man’s capacity for deceiving people that made ethics committees necessary (Ramsey 1982, p. 533). As Raul Hilberg wrote in The Destruction of the European Jews, “If the world was so shocked at what it discovered to be the extremes to which experimental medicine would go, it has yet to condemn the method or find the means to control it” (Hilberg 2003). From our point of view, the right choice is to control experimentation on human beings.
MRSA among burn patients: Relevance, epidemiology and control
(2021-04-08) Fortaleza, Carlos Magno Castelo Branco ; de Lourdes Ribeiro de Souza da Cunha, Maria ; Universidade Estadual Paulista (UNESP)
Burn wounds provide ideal conditions for colonization and infection with several bacteria. This, alongside with the extensive use of antimicrobials in burn units, facilitates the spread of multidrug-resistant organisms (MDROs). Methicillin-resistant Staphylococcus aureus (MRSA) stands out as one of the most threatening MDROs. The burn wound site, degree and extension are associated with greater risk for the acquisition of MRSA. Other factors, such as invasive procedures, prolonged hospitalization and antimicrobial therapy have been associated with MRSA colonization or infection. MRSA-infected patients are at greater risk of death, and may transmit the pathogen to others. The recognition of the clinical importance of MRSA in burn patients highlights the need of appropriate infection control measures that aim to minimize transmission among vulnerable patients. In that setting, the ever changing epidemiology of this microorganism makes it necessary to apply molecular epidemiology methods, in order to identify the circulation of specific clones, the spread of resistance phenotypes and the virulence of strains. Active surveillance of MRSA colonization and infection is an essential part of any strategy aimed at preventing or controlling that agent. In this chapter we will discuss aspects of MRSA epidemiology, antimicrobial resistance and virulence, and their implications for burn patients. We will also address the current recommendations for surveillance and control of MRSA among that population.
Aquatic animals inducing mechanical injuries
(2016-01-01) Haddad, Vidal ; Universidade Estadual Paulista (UNESP)
Injuries and envenomation are caused by poisonous, venomous, and traumatogenic aquatic animals. In this chapter we discuss the main aquatic animals that can cause trauma in humans, which are included in the Phyla Cnidaria (corals), Echinodermata (sea urchins), Crustacea (crabs and mantis shrimp) and Chordata (fish and reptiles), emphasizing the clinical aspects of the wounds and the therapeutical measures used to control the manifestations.
Contemporary overview of metallo-Β-lactamases in pseudomonas aeruginosa: Epidemiology, detection methods and treatment challenges
(2012-11-01) Camargo, Carlos Henrique ; Bruder-Nascimento, Ariane ; Mondelli, Alessandro Lia ; Montelli, Augusto Cezar ; Sadatsune, Terue ; Universidade Estadual Paulista (UNESP)
Antimicrobial resistance poses a daunting challenge to treating bacterial infections. In Pseudomonas aeruginosa, an important opportunistic agent of nosocomial infection, antimicrobial resistance is well-pronounced and can be due to several intrinsic or acquired mechanisms. The therapeutic options to treat P. aeruginosa infection vary according to antimicrobial resistant patterns. Carbapenems, which had been longstanding last-line agents for treating P. aeruginosa infections, have become almost ineffective against this agent, mainly due to the emergence of carbapenemases. Metallo-ß-lactamases (MBL), enzymes from Bush and Jacoby's Group 3, are able to hydrolyze several substrates, such as carbapenems and cephalosporins. The genes encoding these enzymes are essentially located on mobile genetic elements that may be transferable to other strains or even distinct species. Considering their ubiquitous nature and potential to survive in hospital environments, early detection and implementation of contention barriers are desirable to prevent this bacterium from spreading throughout hospital settings and to prescribe a rational antibiotic regimen. Thus, fast and specific tests to detect MBL-producing P. aeruginosa are important both for bedside clinicians and hospital infection control committees. The purpose of this text is to provide an overview on the current status of the epidemiology, detection methods and treatment options for MBL-producing P. aeruginosa infections. © 2012 by Nova Science Publishers, Inc. All rights reserved.
Candida parapsilosis complex
(2013-12-01) Moris, D. V. ; Melhem, M. S.C. ; Martins, M. A. ; Mendes, R. P. ; Universidade Estadual Paulista (UNESP) ; Instituto Adolfo Lutz ; São Paulo State
History. C. parapsilosis complex was first isolated by Ashford (1928) from the feces of a Puerto Rican patient with diarrhea, as a species of Monilia parapsilosis that was incapable of fermenting maltose and therefore reclassified as Candida parapsilosis by Langeron and Talice (1932). Ecology and Epidemiology. C. parapsilosis complex has an extensive distribution in nature, having been isolated from domestic animals, insects, soil, and marine environments. Known as a normal human commensal, it is also one of the most frequently isolated fungi from the subungual space of human hands. Its transient colonization of human integument is the basis of much debate as to whether or not C. parapsilosis is a pathogen or bystander in certain infections. C. parapsilosis complex has been reported as a contaminant of high concentration in glucose solutions and prosthetic material. Several nosocomial infections have been associated with its presence in contaminated hospital equipment via external sources such as medical devices or fluids, hands of health care workers, prosthetic devices, and can occur without prior colonization. C. parapsilosis complex is highly associated with the biofilms formation on various surfaces. Biofilms display a very complex threedimensional architecture, affecting the nutrient fluxes and waste products as well as the sensitivity of cells to antifungal drugs. Biofilms are already formed when C. parapsilosiscells grow in means containing high glucose and lipid concentrations, which is associated with the increased prevalence of bloodstream infections in patients receiving parenteral nutrition. C. parapsilosis complex is the second most common Candida species isolated from normally sterile body sites of hospitalized patients. It accounts for 15.5% of Candida isolates in North America, 16.3% in Europe, and 23.4% in Latin America, outranked only by C. albicans (51.5%, 47.8%, and 36.5%, respectively) and by C. glabrata (21.3%) in North America. Virulence factors. The pathogenesis of invasive candidiasis is facilitated by a number of virulence factors, mainly by adherence to host cells, biofilm formation, and secretion of hydrolytic enzymes - proteases, phospholipases, and lipases. Mycology. C. parapsilosis complex is formed by white and creamy colonies with variable morphology. It grows as oval cells or pseudohyphal filaments, but in contrast to C. albicans, it does not form true hyphae. Prior to 2005, C. parapsilosis complex was separated into groups I to III. Further genetic studies revealed sufficient differences that have led to the separation of the groups into closely related, distinct species: C. parapsilosis, C. orthopsilosis, and C. metapsilosis. The identification of C. parapsilosis complex is performed by conventional morphological and physiological methods and by molecular typing for identification of C. parapsilosis sensu stricto, C. orthopsilosis and C. metapsilosis species. Antifungal susceptibility. C. parapsilosis complex is usually susceptible to most antifungal compounds but decreased responsiveness to fluconazole and caspofungin was reported. It has also been suggested that C. orthopsilosis and C. metapsilosis could be more susceptible to amphotericin B and echinocandins than C. parapsilosis sensu stricto, which could affect therapeutic choices. Clinical manifestation. C. parapsilosis complex can cause several infections such as bloodstream infections, endocarditis, meningitis, onychomycosis, endophthalmitis, peritonitis, arthritis, otomycosis, vulvovaginitis and urinary tract infections.© 2013 Nova Science Publishers, Inc. All rights reserved.
Palliative care of colorectal cancer
(2011-01-01) Paiva, Carlos Eduardo ; dos Santos, Renata ; Fukushima, Fernanda Bono ; de Oliveira Vidal, Edison Iglesias ; de Angelis Nascimento, Maria Salete ; Palliative Care Unit from Barretos Cancer Hospital ; Universidade Estadual Paulista (UNESP) ; Albert Einstein Hospital
Colorectal cancer (CRC) is the third most common cancer in the world. The symptoms and syndromes that are most commonly observed in CRC patients are pain, nausea/vomiting, weight loss, fatigue, constipation/diarrhoea, gastrointestinal bleeding, ascites, bowel obstruction and confusion. Both locally advanced tumors and its distant metastasis can lead to extreme discomfort. Palliative care (PC) in oncology focuses on prevention and the relief of suffering in order to to optimize quality of life (QoL) for patients with advanced cancers. It is intended to address medical problems as a whole (physical, psychosocial and spiritual necessit).PC may be provided at any time during a patient's illness, even from the time of diagnosis. Moreover, it may also be given concurrent with treatments designed to prolong life. Palliative chemotherapy significantly reduces mortality in patients with stage IV CRC. Without any treatment, advanced CRC patients lives for approximately 6 months. Treating patients with a fluoropyrimidine compound can prolong overall survival for up to a median of ~12 months. Adding oxaliplatin and/or irinotecan to a fluoropyrimidine-based regimen enhances survival for up to 20 months and even more (>20-24 months) when using novel monoclonal antibodies like bevacizumab and cetuximab. Sometimes, addition of months of life does not justify excessive treatment toxicity. Studies addressing QoL issues are of upmost interest in this context. When symptoms are well-managed, CRC patients can be more likely to sustain a full anti-cancer therapy with a longer and more fulfilling life. PC becomes the main focus of care in the case that curative treatments fail or patients are unable to tolerate it. This chapter presents general approaches of some specific symptoms and syndromes commonly diagnosed in advanced CRC, including: malignant bowel obstruction, anorexia/cachexia, malignant ascites and cancer pain. The pathophysiology, underlying causes, assessment and management will be updated by the authors. General basis of palliative anti-cancer therapy will be presented by the authors. The last hours of life will also be discussed in this chapter, as well its associated management dilemmas, especially regarding feeding and hydration, changes in consciousness, delirium, breathlessness and respiratory secretions.© 2011 Nova Science Publishers,Inc. All rights reserved.
Paracoccidioidomycosis associated with immunosuppression, AIDS, and Cancer
(2018-01-01) Marques, Silvio Alencar ; Shikanai-Yasuda, Maria Aparecida ; Universidade Estadual Paulista (Unesp) ; Universidade de São Paulo (USP)
This chapter presents clinical, diagnostic, and therapeutic aspects of the mycosis when associated to immunosuppressive conditions. Antifungal therapy proved unsuccessful in patients with severe forms of paracoccidioidomycosis indicating that in addition to treatment of the underlying disease, these patients should also receive a long course of antifungal therapy. Most of the neoplasias associated to paracoccidioidomycosis were carcinomas. The association paracoccidioidomycosis and cancer is an important one which should be approached from a multidisciplinary point of view in order to further contribute to the knowledge of the host-parasite relationship in paracoccidioidomycosis. An interpretation of the low antibody titers detect in AIDS-associated paracoccidioidomycosis may be given by the immunopathogenesis of HIV infection. In AIDS patients, although B cells proliferate and show polyclonal activation, they have a defect in their ability to secrete antigen-specific immunoglobulins. AIDS-associated paracoccidioidomycosis should be considered a real and serious complications which presents new challenges to clinicians and investigators living in endemic countries.
Bone and joint lesions
(2018-01-01) Mendes, Rinaldo Poncio ; Universidade Estadual Paulista (Unesp)
Bone and joint involvement in paracoccidioidomycosis was first reported in 1911. Bone lesions occur at all age groups but younger patients are more frequently affected. The distribution of patients with bone lesions according to sex seems to be the same observed in cases with other involved organs. Isolated lesions are characterized by granulomatous reaction with great numbers of epithelioid and giant cells, which enclose the fungus. Disseminated lesions begin with necrosis and intense osteolysis, easily visible on radiological examination. The bone lesions are more frequent in the superior limbs and chest: clavicles, humeri, acromions, ribs, and radii. However, any bone may be affected. The etiological diagnosis of bone and joint involvement in paracoccidioidomycosis can be done by a surgical or percutaneous needle biopsy or by fine needly aspiration. Bone involvement by tuberculosis, an endemic disease in Latin America, is one of the most important differential diagnosis.
Treatment and control of cure
(2018-01-01) Mendes, Rinaldo Poncio ; Negroni, Ricardo ; Arechavala, Alicia ; Universidade Estadual Paulista (Unesp) ; FJ Muniz Infectious Diseases Hospital ; University del Salvador ; FJ Muñiz Infectious Diseases Hospital
The treatment of paracoccidioidomycosis should include general measures and a fight against the malnutrition-immunologic depression-infection triad, since malnutrition impairs the immune response and favors the installation of infectious diseases, including mycoses. The association of a sulfonamide derivative with trimethoprim has proved to be very effective in the initial treatment of paracoccidioidomycosis. The general measures include rest, treatment of associated diseases, among which verminosis is the most frequent, and control of aggravating conditions. A marked advance in the treatment of paracoccidioidomycosis has been made with the use of azole compounds. The criteria for cure of paracoccidioidomycosis are based on clinical, mycological, radiological and immunological data. Patients who are to receive the initial treatment should be submitted to close surveillance. A patient’s course during treatment depends on the severity of the clinical picture as well as on the therapeutic procedures.
The gamut of clinical manifestations
(2018-01-01) Mendes, Rinaldo Poncio ; Universidade Estadual Paulista (Unesp)
Paracoccidioidomycosis is a systemic disease that presents marked tendency toward dissemination with involvement of any organ or system. In order to illustrate the most frequent and also some of the uncommon clinical presentations, case histories of patients withparacoccidioidomycosis are reported. The importance of cutaneous involvement in paracoccidioidomycosis is related to its frequency, the possibility it provides for an easy diagnosis and often, to the exuberance of the lesions. The skin is reached by the fungus either by hematogenic dissemintion or by contiguity from mucosal or lymph node lesions. The high incidence of adrenal lesions in paracoccidioidomycosis was then characterized; these glands occupy the third place among the viscera involved. Information about the participation of bones and joints in paracoccidioidomycosis has been obtained from reports of isolated cases or of small series. Urogenital involvement in paracoccidioidomycosis usually occurs in patients with lesions of other organs, the lungs in particular; it is almost exclusively encountered in males.
Cutaneous lesions
(2018-01-01) Marques, Silvio Alencar ; Universidade Estadual Paulista (Unesp)
In paracoccidioidomycosis the cutaneous lesions are important not only because of their high frequency but also because they carry especial diagnostic value and clinical significance. The clinical significance of cutaneous lesions depends on their number, pattern, and location. Multiple lesions of the papulo-acneiform type point toward hematogenous dissemination of P. brasiliensis and reflect the severity of the disease. Cutaneous lesions may originate from preexisting contigous lesions, from the hematogenous dissemination of the fungus or from the direct inoculation of P. brasiliensis into the skin. Cutaneous lesions originating by contiguity arise from lesions in the neighboring mucosa, from fistulization of a lymph node or from osteomyelitis. Paracoccidioidomycosis is a systemic, chronic, and progressive disease which is acquired by the inhalation of P. brasiliensis propagules and later disseminates to the skin where it produces lesions that are one of the major clinical manifestation of this disorder. The predominant cutaneous lesions are those resulting from the cutaneous implantation of the blood-borne fungus.
Impact of molecular interactions with phenolic compounds on food polysaccharides functionality
(2019-01-01) Dobson, Corrine C. ; Mottawea, Walid ; Rodrigue, Alexane ; Buzati Pereira, Bruna L. ; Hammami, Riadh ; Power, Krista A. ; Bordenave, Nicolas ; University of Ottawa ; Universidade Estadual Paulista (Unesp)
Commercial trends based of the emergence of plant-based functional foods lead to investigate the structure-function relationship of their main bioactive constituents and their interactions in the food matrix and throughout the gastro-intestinal tract. Among these bioactive constituents, dietary polysaccharides and polyphenols have shown to interact at the molecular level and these interactions may have consequences on the polysaccharides physical and nutritional properties. The methods of investigation and mechanisms of interactions between polysaccharides and polyphenols are reviewed in light of their respective technological and nutritional functionalities. Finally, the potential impact of the co-occurrence or co-ingestion of polyphenols and polysaccharides on the technological and nutritional functionality of the polysaccharides are investigated.
Systemic Fungal Infections
(2016-12-16) Francesconi, Fabio ; Vilasboas, Virgínia ; Mendes, Luciana ; Francesconi, Valeska A. ; Smith, Michael B. ; Patel, Seema ; Meixner, Jeffrey A. ; McGinnis, Michael R. ; Marques, Silvio Alencar ; Amazon Tropical Medicine Foundation ; Amazon Federal University ; Brazilian Dermatology Society ; Tropical Medicine Foundation Dr. Heitor Vieira Dourado ; Amazonas State University ; University of Texas Medical Branch ; Winston Salem State University ; Universidade Estadual Paulista (Unesp)

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