Abstract Background: The increase in the zoonotic epidemic of sporotrichosis caused by Sporothrix brasiliensis, which started in the late 1990s in Rio de Janeiro and is now found in almost all Brazilian states, has been equally advancing in neighboring countries of Brazil. Changes in the clinical-epidemiological profile, advances in the laboratory diagnosis of the disease, and therapeutic difficulties have been observed throughout these almost 25 years of the epidemic, although there is no national consensus. The last international guideline dates from 2007. Objectives: Update the clinical classification, diagnostic methods and recommendations on the therapeutic management of patients with sporotrichosis. Methods: Twelve experts in human sporotrichosis were selected from different Brazilian regions, and divided into three work groups: clinical, diagnosis and treatment. The bibliographic research was carried out on the EBSCOHost platform. Meetings took place via electronic mail and remote/face-to-face and hybrid settings, resulting in a questionnaire which pointed out 13 divergences, resolved based on the opinion of the majority of the participants. Results: The clinical classification and laboratory diagnosis were updated. Therapeutic recommendations were made for the different clinical forms. Conclusions: Publication of the first national recommendation, carried out by the Brazilian Society of Dermatology, aimed at the Brazilian scientific community, especially dermatologists, infectologists, pediatricians, family medicine personnel, and laboratory professionals who work in the management of human sporotrichosis.

Abstract Aiming at disclosing the semiotic method used in the diagnosis of pityriasis versicolor, the authors go through the history of the creation of Zirelí sign, describing the method, its usefulness and practicality in dermatological clinical practice, whether public or private, and to give credit to the author of this semiological maneuver, in memoriam.

Abstract Fungal infections by dermatophytes can present with unusual clinical manifestations, which can cause diagnostic difficulties. The authors present the case of a patient with cutaneous infection by Nanizzia gypsea, initially treated erroneously with topical corticosteroids due to a wrong diagnosis. It was cured after antifungal treatment.

Abstract: In the late 90's there was a change in both the route of transmission and the people at risk for sporotrichosis. This zoonotic cat-man alternative transmission route elicited changes in strategies to control the epidemic. There was a progressive increase in the number of cases involving especially children and the elderly. In addition to becoming hyperendemic, uncommon clinical pictures like immunoreactive clinical presentations or severe systemic cases have emerged. New species were identified and classified through molecular tools using more virulent clinical isolates, like S. brasiliensis, compared to the environmental isolates. Likewise, different species of Sporothrix have been associated with different geographic regions. The serological and molecular techniques are used as an auxiliary tool for the diagnosis and/or for species identification, although the isolation and the identification of Sporothrix spp. in clinical specimen is still the gold standard. Currently sporotrichosis epidemics requires the knowledge of the epidemiological-molecular profile to control the disease and the specific treatment. Itraconazole, potassium iodide, terfinafine, and amphotericin B are the available drugs in Brazil to treat sporotrichosis. The drug of choice, its posology, and treatment duration vary according to the clinical presentation, the Sporothrix species, and host immune status. New treatment choices, including a vaccine, are being developed; nevertheless, more clinical trials are required to confirm its efficacy.

RESUMO O diagnóstico de lesões melanocíticas pode ser desafiador, e o estudo imuno-histoquímico é uma ferramenta valiosa para os dermatopatologistas. Relatamos dois casos inicialmente diagnosticados como melanoma in situ, avaliando os achados histopatológicos e imuno-histoquímicos e os casos publicados na literatura com resultados semelhantes. Ressaltamos a importância da correlação clinicopatológica na avaliação das lesões com danos na interface e nos "ninhos pseudomelanocíticos", que podem simular melanoma in situ. Destacamos também a importância da utilização de um painel de imuno-histoquímica, além do Melan-A, no estudo dessas lesões.

ABSTRACT The diagnosis of melanocytic lesions can be challenging and immunohistochemical study is a valuable tool for dermatopathologists. We report two cases initially simulating melanoma in situ, reviewing the histopathological and immunohistochemical findings and the cases published in the literature with similar findings/results. We emphasize the importance of clinicopathological correlation in the evaluation of lesions with interface changes and in the "pseudomelanocytic nests", which may simulate melanoma in situ. We also highlight the importance of using a immunohistochemistry panel in addition to Melan-A, in the study of these lesions.

A reforma curricular implantada em 2005 no curso de graduação em Medicina do Centro Universitário Serra dos Órgãos (Unifeso) com a utilização das metodologias ativas de ensino-aprendizagem, no caso a aprendizagem baseada em problemas (ABP), e com a passagem pela Unidade Básica de Saúde da Família (UBSF) desde os primeiros períodos pode influenciar a trajetória de formação profissional de seu estudante? Para responder a esta questão - objetivo deste estudo -, procedeu-se a uma pesquisa qualitativa com os discentes matriculados no quinto período do curso, por meio de entrevistas, as quais foram categorizadas e analisadas. Os resultados evidenciaram significativa receptividade ao novo modelo curricular, pelo entendimento de que este é capaz de suscitar novas reflexões dirigidas à futura prática do estudante, e, igualmente, ao conceito de saúde e ao processo de adoecimento. Verificou-se, ainda, que a opção precoce por uma especialidade, expressa pela maior parte dos entrevistados, não foi alterada sob o novo currículo e que a formação do médico como generalista ou médico de família é ainda pouco valorizada.

This paper asks whether the curriculum change implemented in 2005 to the Centro Universitário Serra dos Órgãos (Unifeso) Undergraduate Medical Course may influence the course of its students' vocational training, through its active teaching and learning methodologies, such as problem-based learning (PBL) and the students' passage through the Primary Care Unit (PCU) in the early years of the course. To answer this objective question, qualitative research was carried out on medical students in the fifth semester, by means of interviews which were categorized and later analyzed. The results showed significant receptivity to the new curriculum model, due to the understanding that such a model is able to inspire new reflections on future student practice and also on the concept of health and the process taken by illnesses. The study also showed that the early option to choose a particular specialization - taken up by the majority of respondents - had not changed under the new curriculum and that the training of medical practitioners or family physicians is still poorly regarded.

Leprosy is an infectious and contagious spectral disease accompanied by a series of immunological events triggered by the host response to the aetiologic agent, Mycobacterium leprae . The induction and maintenance of the immune/inflammatory response in leprosy are linked to multiple cell interactions and soluble factors, primarily through the action of cytokines. The purpose of the present study was to evaluate the serum levels of tumour necrosis factor (TNF)-α and its soluble receptors (sTNF-R1 and sTNF-R2) in leprosy patients at different stages of multidrug treatment (MDT) in comparison with non-infected individuals and to determine their role as putative biomarkers of the severity of leprosy or the treatment response. ELISA was used to measure the levels of these molecules in 30 healthy controls and 37 leprosy patients at the time of diagnosis and during and after MDT. Our results showed increases in the serum levels of TNF-α and sTNF-R2 in infected individuals in comparison with controls. The levels of TNF-α, but not sTNF-R2, decreased with treatment. The current results corroborate previous reports of elevated serum levels of TNF-α in leprosy and suggest a role for sTNF-R2 in the control of this cytokine during MDT.

Iodeto de potássio, sob a forma de solução saturada, é um valioso medicamento no arsenal terapêutico do dermatologista. É usado há mais de um século e útil para doenças de fisiopatologias diversas em virtude de seu caráter imunomodulador. Prescrevê-lo, entretanto, tem se tornado cada vez menos frequente na prática dermatológica. O pouco conhecimento sobre seu exato mecanismo de ação, o desinteresse da indústria farmacêutica com o advento de novos fármacos, além da toxicidade do medicamento pelas altas doses utilizadas são algumas das possíveis justificativas. Dessa forma, os estudos científicos envolvendo seus aspectos farmacológicos, posológicos e de eficácia são relativamente raros. Consequentemente, não se convencionou uma padronização na forma de manipular e prescrever a solução saturada de iodeto de potássio, o que causa um verdadeiro desconhecimento da dose exata em gramas do sal que está sendo fornecida aos pacientes. Ao considerar que a dose está diretamente relacionada toxicidade e o conhecimento da característica imunomoduladora dessa droga, é importante definir a quantidade a ser fornecida, reduzindo-a até a dose mínima eficaz, de forma a diminuir a intolerância e melhorar a adesão ao tratamento. A relevância do tema se deve ao fato da solução saturada de iodeto de potássio ser, muitas vezes, a única escolha na terapêutica disponível para o tratamento de algumas dermatoses de origem infecciosa, inflamatória ou imunomediada, quer por indicação específica, por falha de outro medicamento ou por seu custo acessível.

Potassium iodide, as a saturated solution, is a valuable drug in the dermatologist's therapeutic arsenal and is useful for the treatment of different diseases due to its immunomodulatory features. However, its prescription has become increasingly less frequent in dermatology practice. Little knowledge about its exact mechanism of action, lack of interest from the pharmaceutical industry, the advent of new drugs, and the toxicity caused by the use of high doses of the drug are some possible explanations for that. Consequently, there are few scientific studies on the pharmacological aspects, dosage and efficacy of this drug. Also, there is no conventional standard on how to manipulate and prescribe the saturated solution of potassium iodide, which leads to unawareness of the exact amount of the salt being delivered in grams to patients. Considering that dosage is directly related to toxicity and the immunomodulatory features of this drug, it is essential to define the amount to be prescribed and to reduce it to a minimum effective dose in order to minimize the risks of intolerance and thus improve treatment adherence. This review is relevant due to the fact that the saturated solution of potassium iodide is often the only therapeutic choice available for the treatment of some infectious, inflammatory and immune-mediated dermatoses, no matter whether the reason is specific indication, failure of a previous therapy or cost-effectiveness.

Diante das atuais demandas sociais, tornou-se imprescindível para a educação médica a transição do modelo tradicional de formação reducionista e hospitalocêntrica para uma vertente de educação mais ampla e integralizada. A construção de novas práticas de formação em saúde - com a utilização de cenários externos -, em coparticipação com o SUS, tem assumido um papel fundamental na formação médica. Em 2005, o Centro Universitário Serra dos Órgãos (Unifeso) incorporou em seu currículo a Aprendizagem Baseada em Problemas e a inserção dos graduandos de Medicina em Unidades Básicas de Saúde da Família. Este artigo apresenta a percepção dos discentes de Medicina neste cenário. Para isto, realizou-se uma pesquisa qualitativa, utilizando-se entrevistas e análise temática das respostas, com a criação de categorias. Os resultados demonstram a combinação de impressões positivas - integração entre teoria e prática - e negativas - problemas na organização das atividades e necessidade de identificação de um preceptor local. Propõe-se um planejamento orientado pelas novas diretrizes para o ensino na Atenção Primária à Saúde, contextualizada à condição da integralidade.

Given current social demands, it has become essential for medical education to break from the traditional model of biological reductionist and training based only at hospitals and redefine itself towards a holistic care (integrality). The construction of new training practices in health with the use of new outdoor scenarios, in partnership with (Unified National Health System - SUS), assumed a key role. In 2005 the Centro Universitário Serra dos Órgãos (Unifeso) incorporated into its curriculum the Problem-Based Learning and the insertion of medical undergraduates into Basic Health Units Family. This paper describes the perception of medical students in this scenario. We conducted a qualitative research working from the application of interviews and the utilization of thematic analysis of responses with the creation of categories. The results show the combination of positive impressions - integration between theory and practice - and negative - problems in the organization of activities, as well as the necessity to identify a local preceptor. A plan is proposed, guided by the new Directives, for teaching in the primary health care in the context of the condition of integrality.

FUNDAMENTOS: As incapacidades e deformidades decorrentes dos surtos reacionais de hanseníase podem acarretar inúmeros problemas aos pacientes, interferindo na qualidade de vida. OBJETIVOS: Avaliar a qualidade de vida de pacientes portadores de hanseníase em estado reacional identificados em centro de referência de Belo Horizonte, MG. MÉTODOS: Trata-se de um estudo epidemiológico transversal, descritivo e analítico, envolvendo 120 pacientes em tratamento de surto reacional de hanseníase, no período de dezembro de 2007 a março de 2008, realizado no ambulatório de dermatologia do Hospital Eduardo de Menezes da Fhemig. Foram utilizados dois instrumentos referentes às variáveis sociodemográficas, econômicas e clínicas e o instrumento genérico WHOQOL-bref da OMS. Os dados foram tabulados no SPSS e analisados por meio do escore médio com aplicação de testes estatísticos (p < 0,05). RESULTADOS: Constatou-se que a mediana da idade dos pacientes estudados foi de 48 anos, sendo a maioria deles do sexo masculino, casada, de cidades circunvizinhas a BH, com primeiro grau incompleto, aposentada ou gozando de licença saúde e com renda familiar de um a dois salários mínimos vigentes. A maioria deles relatou que a doença interferiu muito nas atividades profissionais e de lazer. Na avaliação da QV, o índice mais baixo foi observado no domínio físico e os mais altos foram observados nos domínios psicológico e das relações sociais. A consistência interna do WHOQOL-bref foi aceitável para as facetas e domínios. CONCLUSÕES: A hanseníase causa sofrimento que ultrapassa a dor e o mal-estar estritamente vinculados ao prejuízo físico, com grande impacto social e psicológico.

BACKGROUND: Disabilities and deformities resulting from reactive outbreaks of leprosy can cause many problems for the patients, interfering with their quality of life. OBJECTIVES: To assess the quality of life of patients with leprosy reactional states identified at the Reference Center in Belo Horizonte - MG. METHODS: This was an epidemiological cross-sectional descriptive and analytical study, involving 120 patients in treatment for leprosy reactional states, from December 2007 to March 2008, held at the Dermatology outpatients clinic of the Hospital Eduardo de Menezes from FHEMIG, BH. We used two instruments for the socio-demographic, economic and clinical variables and a generic instrument WHOQOL WHO. The data were tabulated in SPSS and analyzed using the mean score with the application of statistical tests (p <0.05). RESULTS: We found that the median age of the patients was 48 years, most were males, married, from cities around BH, with incomplete elementary school, retired or pensioner, and with a family income of two minimum wages. Most of them reported that the disease interfered a great deal with their professional activities and leisure. In the assessment of QoL, the lowest rating was observed in the physical domain and the highest was observed in the psychological and social relations. The internal consistency of WHO-QOL-bref was acceptable to the facets and domains. CONCLUSIONS: Leprosy causes suffering that goes beyond the pain and discomfort strictly related to the physical damage, with great social and psychological impact.

Os autores apresentam cinco casos de esporotricose em gestantes numa epidemia zoonótica no Rio de Janeiro. São discutidos principalmente os aspectos clínicos e as dificuldades na escolha terapêutica desse grupo específico de pacientes.

Five cases of sporotrichosis occurring in pregnant women in a zoonotic epidemic in Rio de Janeiro, Brazil, are described. The main clinical features, as well as the challenging therapeutic choices for this specific group of patients, are discussed.

A formação oferecida em boa parte das escolas médicas perpetua, ainda hoje, o distanciamento do profissional das necessidades da sociedade. Estratégias têm sido pensadas em resposta a tal contexto, destacando-se a publicação das Diretrizes Curriculares Nacionais do Curso de Graduação em Medicina e a implementação do Programa de Incentivos a Mudanças Curriculares em Medicina (PROMED) e do Programa Nacional de Reorientação da Formação Profissional em Saúde (PRÓ-SAÚDE). Inscrito neste novo movimento, o Centro Universitário Serra dos Órgãos (UNIFESO) realizou uma profunda transformação curricular, em 2005, baseada no uso das metodologias ativas de ensino-aprendizagem (MAEA), especialmente a Aprendizagem Baseada em Problemas. Para aferir a visão dos estudantes partícipes deste processo de mudança foi desenhada a presente investigação, realizada através da consecução de entrevistas semi-estruturadas com estudantes do quinto período do Curso de Graduação em Medicina. Ato contínuo, os dados obtidos foram apreciados a partir dos princípios da analise temática. Os resultados apontam para uma boa aceitação das MAEA, as quais foram definidas como estimulantes e integradoras da teoria/prática no ensino médico.

The prevailing undergraduate medical training process still favors disconnection and professional distancing from social needs. The Brazilian Ministries of Education and Health, through the National Curriculum Guidelines, the Incentives Program for Changes in the Medical Curriculum (PROMED), and the National Program for Reorientation of Professional Training in Health (PRO-SAÚDE), promoted the stimulus for an effective connection between medical institutions and the Unified National Health System (SUS). In accordance to the new paradigm for medical training, the Centro Universitário Serra dos Órgãos (UNIFESO) established a teaching plan in 2005 using active methodologies, specifically problem-based learning (PBL). Research was conducted through semi-structured interviews with third-year undergraduate students at the UNIFESO Medical School. The results were categorized as proposed by Bardin's thematic analysis, with the purpose of verifying the students' impressions of the new curriculum. Active methodologies proved to be well-accepted by students, who defined them as exciting and inclusive of theory and practice in medical education.

O fator neurotrófico derivado do cérebro (BDNF) é uma neurotrofina envolvida na sobrevivência neuronal e no crescimento e diferenciação dos dendritos e axônios. O objetivo do presente estudo foi avaliar os níveis plasmáticos do BDNF de pacientes com hanseníase em diferentes fases da poliquimioterapia (PQT), em comparação com indivíduos não-infectados. Os níveis plasmáticos do BDNF foram mensurados pelo teste ELISA em 30 controles sadios e 37 pacientes com hanseníase no momento do diagnóstico, durante e após PQT. Os níveis plasmáticos do BDNF mostraram-se maiores nos indivíduos controles em comparação com os pacientes com hanseníase, mas não houve diferença estatisticamente significante. Curiosamente, os níveis de BDNF modificaram-se com o tratamento, mostrando diferença estatística apenas na segunda dose de PQT. Esses resultados indicam que o BDNF pode não ser um marcador de infecção na hanseníase e/ou neuropatias relacionadas. Novas pesquisas são necessárias para investigar o significado das alterações nos níveis de BDNF ao longo do tratamento da hanseníase.

Brain-derived neurotrophic factor (BDNF) is a neurotrophin involved in the survival of neurons and growth and differentiation of dendrites and axons. The purpose of the present study was to evaluate plasma levels of BDNF of leprosy patients at different stages of multidrug therapy (MDT) in comparison with non-infected individuals. Plasma levels of BDNF were measured by ELISA in 30 healthy controls and 37 leprosy patients at diagnosis, during and after MDT. Plasma levels of BDNF tended to be higher in control subjects in comparison with leprosy patients, but this difference does not reach statistical significance. Interestingly, BDNF levels changed following MDT, achieving statistical difference only at the 2nd dose of MDT. These results indicate that BDNF may not be a surrogate marker of leprosy infection and/or related neuropathy. Further research is needed to investigate the meaning of BDNF level changes following leprosy treatment.

São apresentadas imagens ilustrativas de um caso de feoifomicose subcutânea causada pela Exophiala jeanselmei num paciente transplantado renal. Breves comentários sobre a doença encontram-se no texto. Ressalta-se a necessidade de essa micose entrar no diagnóstico diferencial de outras dermatoses, inclusive as não infecciosas.

This report shows images of a case of subcutaneous phaeohyphomycosis caused by Exophiala jeanselmei in a patient who has undergone renal transplantation. The paper comments briefly on the disease and emphasizes the need to take this mycosis into account in the differential diagnosis of other dermatoses, including non-infectious dermatoses.