Treatment of Vulvovaginal Candidiasis with A Strategy Based on Phototherapy (M.A.C.® Scar Acceleration Method)

Candidiasis, also known as candidiasis vulvovaginitis, is an infection caused by different types of Candida fungi, the most frequent being Candida albicans. The present study reports an effective strategy, which opens new avenues for the treatment of this public health problem. The MAC® Methodology, conventional laser light-emitting (LLLT)/LED) methods are based on the biphasic response demonstrated many times in LLLT research and as with other forms of drugs, a “drug” (irradiation parameters) and a “dose” (irradiation times) and the “Arndt-Schulz Law” is often cited as a suitable model to describe the dose-dependent effects of LLLT. This method uses photopharmaceuticals, cell markers and the use of correct parameters for each case to induce the acceleration of tissue repair. The present study shows a case of a 32-year-old patient diagnosed with recurrent candidiasis 4 years ago. Eighteen sessions were performed (every other day) using a photoactivated component (Methylene blue 1% + Clotrimazole 1%) and LED phototherapy (red, blue and violet) with emission times of 60 - 260 seconds for each applicator, according to the dose recommendations of the scar acceleration method (MAC®). At the sixth treatment session there was a noticeable decrease in the itching sensation reported by the patient. In session 11 she reported feeling a great improvement, indicating that she no longer felt itching in any area after 18 sessions. The present case demonstrates new methodologies to treat common problems in the population that have a positive impact on the quality of life. This methodology has a promising future because it is non-invasive and requires a great biological transformation for inflammatory, fungal and viral control.

Analysis of the Cicatricial Acceleration Method (MAC®) in Skin Repair in Wistar Rattus norvegicus with Induced Chemical Burns

Introduction: The cicatricial acceleration method (MAC®) promotes photobiological effects of an anti-inflammatory and healing nature. Its therapeutic radiation is emitted, producing photobiostimulant effects that result in rapid tissue repair and better tissue quality. The treatment of burns has always been a challenge, which involves both performing surgery and controlling and guiding scar regeneration, avoiding possible morbidities. Objective: To evaluate the effects of applying the MAC methodology with an AlGa (aluminum, gallium arsenide) laser on the time and quality of tissue repair in the skin of rats after induced chemical burns. Method: 22 adult male rats were subjected to a second-degree chemical burn on the back using 50% trichloroacetic acid. After the burns, the animals were randomly separated into 2 groups: control and experimental. The control group (G1) received placebo laser therapy and the laser group (G2) underwent laser irradiation with an energy density of 100 J/cm2. Histological analysis and macroscopic evaluation were carried out by means of the paper template method. Results: Group G1 showed (53%) of the necrosis area and group G2 showed (11%) necrosis area. Conclusion: The cicatricial acceleration method (MAC®) favored the repair of wounds caused by a 2nd-degree chemical burn, optimizing time and improving quality.

A Study of Laser Effectiveness in Injured Tissues Regeneration

This study aimed to understand the use of low level laser in the regeneration of injured tissues. Also to design our own opinion on the subject, as chemists. Laser is nothing more than a light with very special characteristics that grant it therapeutic properties. We can observe the existence of three different types of laser, being one of them the therapeutic laser, which is used in substitution for medications or along with them. Another type of laser is the surgical one and, in addition to these, there is a diagnostic type. A great advantage is that, instead of taking the medicine, the patient’s own body can be activated by the laser to produce certain substances that can often replace the drugs. This is a literature review emphasizing the use of low level laser. Thus, the reflections from this study can contribute to the amplification of the production of knowledge that aims at the resignification of the use of laser in therapy. Greater attention was given to two types of laser radiation: He-Ne and As-Ga, both presenting a high therapeutic potential in superficial and deep injures. However, the He-Ne laser excels in superficial lesions, whereas the As-Ga laser does so in deep injures, such as articular, muscular, etc.

Early Hepatic Encephalopathy after a Transjugular Intrahepatic Portosystemic Shunt Procedure: Case Report

Patients with decompensated hepatic cirrhosis may present systemic alterations and dysfunction of multiple organs. Ascites, portal hypertension, esophageal varices, and hepatic encephalopathy are common complications arising from cirrhosis. The aim of this paper is to report a case of a patient with liver cirrhosis and the complications of a transjugular intrahepatic portosystemic shunt. Male, elderly, and ex-alcoholic, diagnosed with liver cirrhosis, ascites, and esophageal varices. He underwent transjugular intrahepatic portosystemic shunt due to portal hypertension and returned to the hospital after 24 hours with agitation and mental confusion. He had a bowel movement stop, neurological worsening, loss of renal function, hepatic hydrothorax, hepatic encephalopathy, hypernatremia, hypocalcemia, and hypophosphatemia. He underwent a new procedure to occlude the transjugular intrahepatic portosystemic shunt, showing improvement of the mental status and ascites. However, continued with decompensation and hydro-electrolytic disorders. He evolved with worsening of the ventilatory pattern, and neurological and renal function, with a fatal outcome. Esophageal varices due to portal hypertension can be corrected with the transjugular intrahepatic portosystemic shunt. However, complications such as hypernatremia, hepatic hydrothorax, and hepatic encephalopathy may occur. Therefore, there is a need for reintervention to shunt or reduce its caliber. Thus, for patients with advanced age and decompensated cirrhosis, the potential risks and benefits of this procedure should be carefully evaluated due to the risk of complications and death.

Reversing gastric mucosal alterations during ethanol-induced chronic gastritis in rats by oral administration of Opuntia ficus-indica mucilage

AIM： To study the effect of mucilage obtained from cladodes of Opuntia ficus-indica （Cactaceae） on the healing of ethanol-induced gastritis in rats. METHODS： Chronic gastric mucosa injury was treated with mucilage （5 mg/kg per day） after it was induced by ethanol. Lipid composition, activity of 5＇-nucleotidase （a membrane-associated ectoenzyme） and cytosolic activities of lactate and alcohol dehydrogenases in the plasma membrane of gastric mucosa were determined. Histological studies of gastric samples from the experimental groups were included. RESULTS： Ethanol elicited the histological profile of gastritis characterized by loss of the surface epithelium and infiltration of polymorphonuclear leukocytes. Phosphatidylcholine （PC） decreased and cholesterol content increased in plasma membranes of the gastric mucosa. In addition, cytosolic activity increased while the activity of alcohol dehydrogenases decreased. The administration of mucilage promptly corrected these enzymatic changes. In fact, mucilage readily accelerated restoration of the ethanol-induced histological alterations and the disturbances in plasma membranes of gastric mucosa, showing a univocal anti-inflammatory effect. The activity of 5＇-nucleotidase correlated with the changes in lipid composition and the fluidity of gastric mucosal plasma membranes. CONCLUSION： The beneficial action of mucilage seems correlated with stabilization of plasma membranes of damaged gastric mucosa. Molecular interactions between mucilage monosaccharides and membrane phospholipids, mainly PC and phosphatidylethanolamine （PE）, may be the relevant features responsible for changing activities of membrane-attached proteins during the healing process after chronic gastric mucosal damage.

Approach to Paroxysmal Atrial Fibrillation Type Arrhythmia in a Cardiology Service:A Case Report

Atrial fibrillation is a cardiac arrhythmia of high prevalence in the population, especially in the elderly. Its main electrical characteristics are the interval between two successive irregular R waves, absence of P waves and presence of f waves between QRS complexes. The most common symptoms of atrial fibrillation are irregular palpitations associated with dyspnea, dizziness, feeling tired, fatigue and general malaise, but not all patients have any symptoms. The present report presents the history of an elderly patient who arrived at the hospital’s emergency department with irregular heart rhythm and palpitations. The patient’s symptoms, associated with the electrocardiogram results, indicated paroxysmal atrial fibrillation. Electrical cardioversion was performed, and after, cardiac ablation via the femoral vein at the hospital’s cardiology service. There were no complications during the procedure. As a routine imaging exam after ablation, control esophagogastroduodenoscopy was requested to verify that there was no formation of atrio-esophageal fistula developed by the invasive ablation procedure and electrocardiogram, which showed normal sinus rhythm. The patient remained in the cardiac intensive care unit for observation for 24 hours. After the electrical cardioversion and catheter ablation procedures, the patient improved his clinical picture of atrial fibrillation and was discharged after 24 hours of hospitalization. He received treatment to perform at home, to reduce acid reflux into the esophagus and to prevent thrombosis. He did not present pulmonary thromboembolism after hospital discharge. It is believed, therefore, that this form of treatment and management of paroxysmal atrial fibrillation is effective for the solution of the proposed problem and can also serve as a reference for other professionals within the cardiology service.

The Effect of Plasma Jet on Bacterial Species and Correlation with Physiotherapy

Introduction: As representatives of prokaryotic beings, bacteria were selected in nature for their very high capacity to adapt to the environment. The human body comprises a vast population of bacteria needed for health maintenance;skin lesions represent a major public health problem involving the nutritional, hospital and illness of the patient. Objective: The objective of this study was to verify the effect of the plasma jet on bacterial species and to correlate it with clinical physiotherapy. Method: This is an in vitro experimental study carried out at FSG University Center. Performed through cultures of bacteria Sthaphylococcus aureus, Pseudomonas aeruginosa and Klebsiella pneumoniae under the effect of plasma jet. Results: As observed all strains were resistant to penicillin, creating no inhibition halo in any of them. In the plates of the bacteria Staphylococcus aureus, in the area where the Plasma Jet was applied there was no microbial growth. In Klebsiella pneumoniae strains microbial growth was achieved in 90 and 120 seconds. Finally, Pseudomonas aeruginosa plates in the 90 seconds were microbial growth compared to the 120 and 180 seconds. Conclusion: It can be concluded that the time of application of the plasma jet has an important role in the antimicrobial action, when compared to Physiotherapy, a new method of treatment for skin lesions may be an option, with the aim of reducing infections and accelerating the process of tissue healing.

Photodynamic Therapy in the Healing of the Areolo-Papillary Complex after Mastectomy—Case Report

Some breast reconstruction surgeries after mastectomy, or even reductive mammoplasty, may evolve unexpectedly when the areolopapillary complex heals and develop dehiscences, necrosis and delayed healing. The purpose of this case report was to verify the efficacy of photodynamic therapy in wound healing of the areolopapillary complex. This was a case report of a female patient with diabetes, fibromyalgia and diagnosed with breast cancer, with necrotic areolopapillary complex, after debridement, photodynamic therapy started with clobetasol propionate associated with methylene blue and low power laser application. At the beginning of the treatment with photodynamic therapy, the wound had 6 centimeters of diameter, and after 19 sessions, the wound was closed completely with normalization of the color of the nipple. The photodynamic therapy is advancing a lot in healing of infected wounds and complex wounds. It can be said that in this case report, photodynamic therapy was fundamental for the complete healing, being considered a promising treatment and another alternative for dermatofunctional physiotherapists.

Correlation of Depression with the Functional Profile of Elderly People Living in Homes for the Aged

Introduction: Due to the growth of the elderly population, there is a notable lack of preparation among family members and society to face the challenges of this new reality, resulting in an increasing demand for homes for the aged (HA). It is necessary to understand how the impairment of physical health, mental health and the level of depression can affect the functional capacity of the institutionalized elderly who live in homes for the aged. Objective: To describe the correlation between depression and functionality of elderly people who live in homes for the aged. Method: A cross-sectional, descriptive study with 70 elderly people of both sexes, aged 60 years or older, who live in HA in the state of Rio de Janeiro. Result: It was verified that the female gender was predominant in the HA consulted. The majority of elderly live in HA voluntarily 48.6% and that 41.43% did not complete elementary school. The majority of the elderly 81.43% had the ability to perform basic activities of daily living and the elderly 52.86% had normal psychological pictures. The worsening of the depressive picture is associated with the worse functioning of elderly who live in HA (p < 0.02). Conclusion: Depression is a factor that is associated with the functional capacity of the institutionalized elderly. The worse the functional level of the institutionalized elderly, the greater the chances of presenting a depressive state.

Use of the Scar Acceleration Method/Método de Aceleração Cicatricial—MAC®—in the Treatment of Capsular Contracture: Case Report

Capsular contracture is a frequent complication in the postoperative period of breast implantation. It usually accompanies the appearance of a firm breast that can progress to pain, distortion, and asymmetry of the breasts, requiring surgical revision. The present study is a case report. A 58-year-old woman with a medical diagnosis of capsular contracture of the right breast evidenced by ultrasound. She was referred to the physiotherapy clinic in October 2019 with an initial complaint of pain on palpation, swelling, and stiffness in her right breast. The patient was evaluated and the MACò method was used to treat capsular contracture. For this, 12 sessions of photodynamic therapy were carried out. The treatment included the use of LED by doping: red (300 s), violet (60 s) and blue (120 s), with the use of 1% methylene blue in target areas, three times a week. The patient had the beginning of symptoms’ remission in the fourth visit and total remission in the 12th visit. It was concluded that the use of photodynamic therapy using the MACò method showed improvement in signs and symptoms—the sensation of prosthesis stiffness in the lower and medial region, local temperature, and pain in the right breast. The patient was followed up after treatment and currently, she has no complaints. There was also no need for surgical intervention. In the present case report, the MACò method proved to be effective. Further research is suggested with a cohort of patients with capsular contracture, with randomization and evaluation of a larger number of patients with the referred method.

Scar Acceleration Method—MAC® in the Treatment of Chronic Wounds in Lymphedema: Case Report

Wounds are a serious public health problem in our country. Access to effective, low-cost treatment is still far from the reality for many patients leading to a chronic and serious condition. They interfere in the quality of life of these individuals who isolate themselves socially constrained by the appearance of their wounds. The report shows the case of a patient with type II diabetes mellitus, with chronic wounds in lymphedema in the lower limbs who was treated with the Scar Acceleration Methodology associated with Complex Decongestive Therapy, leading to an improvement in her social participation and quality of life.

The Professional Profile and the Physical Therapy Service in the Emergency Units in the State of São Paulo

The emergency room is the entrance door of hospitals for patients who are in risk of life, and the role of the physiotherapist in this area is recognized as a qualified member of the team, helping to reduce the rate and time of orotracheal intubation, judicious use of invasive mechanical ventilation (MV) and non-invasive ventilation (NIV). The objective was to know the profile and performance of physical therapists in the emergency departments of hospitals in the state of São Paulo. Conducted through a semi-structured questionnaire covering personal and professional aspects, and analyzed and described in percentage form. Thirty-six questionnaires were analyzed, and it was observed that 92% provide emergency care, but only 25% work exclusively. Among the main reasons for admission to this sector are: acute respiratory failure (44%) and decreased level of consciousness (36.1%). Regarding the physiotherapeutic resources used in the emergency department, 97.2% make use of NIV, followed by monitoring of MV parameters (94.4%) and modification of parameters (94.4%). We also found that the average time of MV in this sector is 3 to 21 days (50%), and that 33% believe there is delay between indication and installation of NIV. The physiotherapist has much to contribute in emergency units, however, he must be trained through the search for technical and scientific knowledge, thus contributing to the consolidation of this area of expertise.

Non-Hodgkin’s Lymphoma Associated with Metastatic Lung Cancer: Case Report

Lymphomas are neoplastic transformations that affect lymphoid cells. Diffuse large B-cell non-Hodgkin’s lymphoma has a high degree of cell proliferation, accounting for 30% of all lymphomas. Lung cancer is the leading cause of death worldwide and the recommended treatment is chemotherapy. Among the main complications resulting from non-Hodgkin’s lymphoma, lung cancer and chemotherapy used in their treatment, we can mention sepsis, acute kidney injury and febrile neutropenia. Febrile neutropenia can occur by suppressing the production of neutrophils. Sepsis, a widespread infection, is the main cause of acute kidney injury, which can also be caused by hydroelectrolytic complications or by nephrotoxicity. This is a report of a smoking patient with metastatic lung cancer who sought care due to progressive dysphagia, cough with chest pain, fever, and lower airways critical obstruction due to mediastinal lymphadenopathy, being diagnosed with diffuse large B-cell non-Hodgkin’s lymphoma. The patient evolved to death because of a significant worsening of the ventilatory pattern of multifactorial cause, mainly due to sepsis, acute kidney injury, and febrile neutropenia. The patient had mostly classic characteristics of her comorbidities, however, the overlapping of interrelated comorbidities led to the outcome of death. What is unusual about the present case report is that the patient’s characteristics, such as age, sex, and ethnicity, are opposite to those described as risk factors for diffuse large B-cell non-Hodgkin’s lymphoma.

Neuromuscular Electrical Stimulation in Intensive Care Unit Patients:Integrative Review

Intensive care units’ acquired muscle weakness is present in approximately 50% of the patients. Although active muscle training can attenuate weakness, a large proportion of critical patients cannot participate in any active mobilization. Neuromuscular electrical stimulation may be an alternative strategy to reverse muscle weakness. The objective of the study was to review the scientific publications on the use of neuromuscular electrical stimulation and its parameters and the main results in patients hospitalized in intensive care units. This is an integrative review surveying studies in online databases. The studies were selected from the following descriptors: neuromuscular electrical stimulation AND parameters AND intensive care units AND muscle weakness. The inclusion criteria included articles that addressed the topic of neuromuscular electrical stimulation and the parameters used in patients admitted to intensive care units, aged 18 years or older. Exclusion criteria were studies involving animals, case reports, letters to the editor and book chapters. The search comprised articles in the Portuguese, English and Spanish languages from January 2013 to March 2019. Of the 185 articles identified, nine met the eligibility criteria. The studies were evaluated assessing the level of evidence, and the relevant information was presented in the table and discussed. The parameters of the neuromuscular electrical stimulation employed in the studies showed positive results for the maintenance of strength and muscle mass. There was evidence of benefits in the local and systemic microcirculation, potentially mobilizing endothelial stem cells, to prevent atrophy, to reduce mechanical ventilation time and stay in intensive care unit;and when incorporated into the usual physiotherapy care, proved to be more effective than usual care. Its use is safe and viable in critically ill patients.

Advanced Stage Stuck Gland Adenocarcinoma:Case Report

Parotid gland adenocarcinoma is commonly a tumor of low malignancy and low incidence worldwide. The reported case shows the rapid progression of this tumor in an elderly patient and infrequent effects, such as a presentation of facial edema not commonly described in the medical literature. Patient was admitted to hospital in November 2019 with secretion and partial hearing loss in the right ear and infiltrative and stone lesion with initial skin ulceration in the right cervical region. After 42 days, he returned and was admitted to the intensive care unit with significant swelling of the face, hardened and hyperemic neck, difficulty in speech and inability to open the eye. He presented changes in the mobility of the speech and hearing organs, reduced laryngeal mobility, vocal changes, speech with altered articulation and severe oropharyngeal dysphagia with risk of bronchoaspiration. The patient was diagnosed in September 2019 with a parotid tumor (salivary gland adenocarcinoma T4). The medical team requested computed tomography, computed tomography angiography of the chest and cervical vessels and computed tomography of the neck, in addition to evaluation by the head and neck surgery service and general surgery. After analyzing the results, the medical team suggested a hypothesis of tumor invasion that could result in obstruction of local lymphatic drainage, something unusual in the evolution of this type of tumor. In addition, it was not possible to adhere to radiotherapy treatment due to the extent of the lesion and there was also no confirmation of metastases. The reported case shows us that parotid gland adenocarcinoma, when diagnosed in an advanced stage, can limit the approach to treatment. It was chosen in agreement with the family to proceed with palliative care without invasive measures. Palliative care may be the best option for cases like this, bringing some comfort to the patient and his family.