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ABSTRACT Objective: To characterize approach methods for intradomiciliary contacts (IdC) of leprosy cases resident in Northern Brazil, during 2001-2012. Method: A cross-sectional and descriptive study in the state of Rondônia. Included IdC of leprosy cases diagnosed/reported in SINAN-Ministry of Health (MS), 2001-2012. A semi-structured instrument was applied to the IdCs, with six interventions: complete dermatological examination; complete neurological examination; BCG vaccination; instructions for return to the health unit; BCG guidance; and guidance to mobilize other contacts. Results: From a total of 459 IdCs included, failure to perform the dermatological examination was reported by 191 people (41.6%) and the neurological examination, by 252 (54.9%); 138 (30.1%) did not have BCG indicated and 122 (26.6%) did not receive guidelines; 257 (56.0%) were not advised to return for a new evaluation/follow-up and 186 (40.5%) were not asked to mobilize other contacts. Conclusion: Despite the favorable indicators of IdC examination coverage in the state, the evaluation process presents patterns that indicate operational quality failures. RESUMEN Objetivo: Caracterizar normas de abordaje de contactos intradomiciliarias(CId) de casos de lepra residentes en el Norte de Brasil, de 2001-2012. Método: Estudio transversal y descriptivo en el estado de Rondônia. Incluidos CId de casos de lepra diagnosticados/notificados en SINAN-Ministerio de Salud (MS), 2001-2012. Se aplicó instrumento semi estructurado a los CId verificándose 6 intervenciones: examen dermatológico completo; examen neurológico completo; vacunación BCG; orientación para retorno a la unidad de salud; orientación sobre BCG y orientación para movilizar otros contactos. Resultados: Fueron incluidos 459 CId. La no realización del examen dermatológico fue referida por 191 personas (41,6%) y el neurológico, por 252 (54,9%), 138(30,1%) no tuvieron la BCG indicada y 122 (26,6%) no recibieron orientaciones, 257 (56,0%) no fueron orientados a retornar para nueva evaluación/seguimiento y 186 (40,5%) no fueron orientados para movilización de otros contactos. Conclusión: A pesar de los indicadores favorables de cobertura de examen de CId en el estado, el proceso de evaluación presenta normas que indican fallos operacionales de cualidad. RESUMO Objetivo: Caracterizar padrões de abordagem de contatos intradomiciliares (CId) de casos de hanseníase residentes no Norte do Brasil, de 2001-2012. Método: Estudo transversal e descritivo no estado de Rondônia. Incluídos CId de casos de hanseníase diagnosticados/notificados no SINAN-Ministério da Saúde (MS), 2001-2012. Aplicou-se instrumento semiestruturado aos CId verificando-se seis intervenções: exame dermatológico completo; exame neurológico completo; vacinação BCG; orientação para retorno à unidade de saúde; orientação sobre BCG e orientação para mobilizar outros contatos. Resultados: Foram incluídos 459 CId. A não realização do exame dermatológico foi referida por 191 pessoas (41,6%) e o neurológico, por 252 (54,9%); 138 (30,1%) não tiveram a BCG indicada e 122 (26,6%) não receberam orientações; 257 (56,0%) não foram orientados a retornar para nova avaliação/seguimento e 186 (40,5%) não foram orientados para mobilização de outros contatos. Conclusão: Apesar dos indicadores favoráveis de cobertura de exame de CId no estado, o processo de avaliação apresenta padrões que indicam falhas operacionais de qualidade.

There are few studies on the role of innate immune response in dermatophytosis. An investigation was conducted to define the involvement of Toll-Like Receptors (TLRs) 2 and 4 in localized (LD) and disseminated (DD) dermatophytosis due to T. rubrum. Fifteen newly diagnosed patients, eight patients with LD and seven with DD, defined by involvement of at least three body segments were used in this study. Controls comprised twenty skin samples from healthy individuals undergoing plastic surgery. TLR2 and TLR4 were quantified in skin lesions by immunohistochemistry. A reduced expression of TLR4 in the lower and upper epidermis of both LD and DD patients was found compared to controls; TLR2 expression was preserved in the upper and lower epidermis of all three groups. As TLR4 signaling induces the production of inflammatory cytokines and neutrophils recruitment, its reduced expression likely contributed to the lack of resolution of the infection and the consequent chronic nature of the dermatophytosis. As TLR2 expression acts to limit the inflammatory process and preserves the epidermal structure, its preserved expression may also contribute to the persistent infection and limited inflammation that are characteristic of dermatophytic infections. A literatura sobre o papel da resposta imune inata em dermatofitose é escassa. Este estudo se propôs a investigar a participação dos receptores do tipo Toll 2 e 4 (TLRs) 2 e 4 em pacientes com dermatofitose localizada (LD) e disseminada (DD, definida como lesões em pelo menos três segmentos corpóreos distintos), causadas por Trichophyton rubrum. Foram analisados cortes histológicos de 15 pacientes recém-diagnosticados, oito com LD e sete com DD. O grupo controle foi composto por 20 amostras de pele de indivíduos saudáveis submetidos a cirurgia plástica. TLR-2 e TLR-4 foram quantificados em lesões cutâneas por imunohistoquímica. Encontramos uma expressão reduzida de TLR-4 na epiderme superior e inferior nos dois grupos, LD e DD, quando comparados com o grupo controle; a expressão de TLR-2 foi preservada na epiderme superior e inferior de todos os três grupos. Como a sinalização por TLR-4 induz produção de citocinas inflamatórias e recrutamento de neutrófilos, a menor expressão desta molécula provavelmente contribui para a não resolução da infecção e conseqüente natureza persistente da dermatofitose. Como a sinalização via TLR-2 tem sido descrita como fator de regulação do processo inflamatório e de preservação da estrutura epidérmica, a sua expressão inalterada nas lesões dos pacientes com DD e DL pode contribuir também para a persistência da infecção e do reduzido processo inflamatório que são característicos das infecções por dermatófitos.

Novel internet-based applications and associated technologies have influenced all aspects of society, ranging from commerce and business to entertainment and health care, and education is no exception. In this context, this study was designed to evaluate the impact of a dermatology e-learning program on the academic performance of medical students in dermatology. The aim of this study is to develop a dermatology blended-learning course for undergraduate medical students, evaluate the knowledge gained by students exposed to this course, and compare the results to those of traditional teaching methods. In this prospective study, we evaluated the performance of fourth-semester medical students at the Federal University of Bahia, Brazil. Students who had been in their second year of the medical course in 2019 were considered the control group, while students in their second year in 2020 were considered the blended or hybrid group. The first group attended traditional classes, using printed material (books and handouts), while the second group used our web-based course and e-book as a supplement in a hybrid web-plus-traditional fashion. Neither participants nor evaluators were blinded. The students in both groups were subjected to the same pre- and postcourse face-to-face, multiple-choice, paper-based evaluations, and we compared their performances. The content of the classes was the same for both groups. All didactic activities were developed by a team of certified dermatologists and professors from the university. A total of 129 students were selected and divided into 2 groups: the control group (n=57) and the hybrid group (n=72). The precourse tests did not indicate any difference between the control group (mean score 2.74, SD 1.25) and the hybrid group (mean score 3.2, SD 1.22 SD; P>.05). The hybrid group had better final-term grades (mean 8.18, SD 1.26) than the traditional group (mean 7.11, SD 1.04). This difference was statistically significant (P<.05). This study explores pedagogical possibilities in the field of dermatology teaching for medical school students. The results suggest that the performance of undergraduate students who attended the course with additional e-learning material was superior when compared to the performance of those who participated in the traditional course alone.

Leprosy is a hyperendemic chronic condition in the Rondônia State . Despite the significant impact of oral health on the quality of life and clinical evolution of leprosy patients, systematic evaluation of oral health status has been neglected. To analyze the dental-clinical profile, self-perceived oral health and dental health service access of leprosy cases in the municipality of Cacoal in Rondônia State , North Brazil, from 2001 to 2012. A descriptive, cross-sectional study design was performed based on dental evaluation and standardized structured instruments. We investigated clinically assessed and self-perceived oral health status, as well as dental health service access. A total of 303 leprosy cases were included; 41.6% rated their oral health as good, and 42.6% reported being satisfied with their oral health. Self-reported loss of upper teeth was 45.5%. The clinical evaluation revealed that 54.5% had active caries. Most (97.7%) cases reported having been to the dentist at least once in their life and 23.1% used public health services. The poor standard of oral health in this population may increase the risk for leprosy reactions, consequently reducing quality of life. Low access to public health dental services and poor self-perceived oral health reinforce the need to achieve comprehensive health care in this population.

Background Multiple lymphomatous polyposis is a rare type of gastrointestinal lymphoma that extensively infiltrates the intestine. Multiple lymphomatous polyposis originates from the mantle zone of the lymphoma follicle and is considered to be a mantle cell lymphoma, which is a relatively aggressive type of B-cell non-Hodgkin’s lymphoma. We report an unusual case of a patient with multiple lymphomatous polyposis with extensive colorectal involvement and acute intestinal obstruction, an atypical complication of this rare disease. On the basis of this case study, the pitfalls in gastrointestinal tract lymphomatous polyposis diagnosis and prognosis, as well as the treatment options, are discussed. Case presentation Our patient was a 76-year-old white woman with asthenia, cramps, and swelling in the lower left quadrant of the abdomen, as well as weight loss within the previous 5 months. A colonoscopy revealed polyps in the rectum, sigmoid colon, descending colon, and right and left colic flexures. A biopsy revealed lymphomatous infiltration of the intestinal wall. Because of the large size of the polypoid masses, which narrowed the colonic lumen in multiple locations, the patient developed acute intestinal obstruction and was referred for laparotomy. She underwent a total proctocolectomy with a permanent ileostomy and a left salpingo-oophorectomy. Microscopic examination showed the presence of a multicentric, low-grade, small lymphocytic lymphoma. Immunohistochemical analysis revealed positive immunostaining for CD79a, CD20, and CD45. These results were consistent with the diagnosis of mantle cell lymphoma. Two weeks after surgery and prior to discharge, but before the beginning of chemotherapy, the patient’s general condition worsened as she experienced a severe and progressive respiratory tract infection, advanced respiratory insufficiency, and septic shock, and she ultimately died. Conclusions Mantle cell lymphoma develops as a progressive and aggressive disease with widespread polyposis of the gastrointestinal tract. The intensive chemotherapeutic regimens usually result in the regression of macroscopic and microscopic lesions; however, remissions are short in duration, and the median length of patient survival is 3–4 years. Mantle cell lymphoma is a rare disease that should be part of the differential diagnosis of polypoid diseases of the large intestine.

Background. Acne is a dermatosis that involves an altered sebum pattern. Objectives. (1) To evaluate if a treatment based on antibiotics (lymecycline) can alter fatty acids contents of the sebum of patients with acne; (2) to evaluate if oral supplementation of fatty acids can interfere with fatty acids contents of the sebum of patients with acne; (3) to evaluate if there is any interaction in fatty acids contents of the sebum of patients with acne when they use both antibiotics and oral supplementation of fatty acids. Methods. Forty-five male volunteers with inflammatory acne vulgaris were treated with 300 mg of lymecycline per day, with 540 mg of γ-linolenic acid, 1,200 mg of linoleic acid, and 510 mg of oleic acid per day, or with both regimens for 90 days. Every 30 days, a sample of sebum from the forehead was collected for fatty acids’ chromatographic analysis. Results. Twelve fatty acids studied exhibited some kind of pattern changes during the study: C12:0, C14:0, C15:0, C16:1, C18:0, C18:1n9c+C18:1n9t, C18:2n6t, C18:3n6, C18:3n3, C20:1, C22:0, and C24:0. Conclusions. The daily administration of lymecycline and/or specific fatty acids may slightly influence some fatty acids levels present in the sebum of patients with inflammatory acne vulgaris.

Background Despite of the advances in plastic surgery, the approach to inferior eyelid is still considered a potential area for complications. Inferior transcutaneous blepharoplasty, without a canthal support, can lead to malposition of the inferior eyelid in 15 to 20 % of the individuals. The purpose of the study was to evaluate orbicularis oculi muscle function through electroneuromyographic studies of the face and inferior eyelid after inferior transcutaneous blepharoplasty with musculocutaneous flap. Methods Fifteen individuals, 30 eyelids, were submitted to inferior blepharoplasty with musculocutaneous flap and lateral canthopexy. Electroneuromyography with standard needles and facial nerve conductive studies were performed before and after surgery on both sides of the face. Statistical analysis was used. Results All the operated eyelids showed electroneuromyographic activity during voluntary contraction of orbicularis oculi muscle. Blink reflexes and facial nerve studies revealed no signs of denervation in both sides ( p  > 0.01). Functional and aesthetical results were considered satisfactory. Conclusions Electroneuromyographic studies after inferior transcutaneous blepharoplasty showed a viable muscle, functional and electrically active to inferior eyelid. Denervation was not evidenced. Level of Evidence: Level IV, prognostic study.