Fernanda Mansano Carbinatto

A Promising Strategy for the Treatment of Onychomycosis with Curcumin and Photodynamic Therapy

Onychomycosis is a disease of high incidence in the nail plate and responsible for approximately half of the cases of nail infections. Conventionally, dermatologists prescribe antibiotics and antifungals for long periods for its treatment. The high incidence of this type of infection and the increase of microbial strains resistant to the available drugs have justified the importance of the development of new technologies and treatments. This paper presents the photodynamic therapy as an alternative treatment of onychomycosis. New strategies for the use of curcumin as a photosensitizer and its therapeutic response were investigated in different formulations (gel and emulsion). Photodynamic therapy is a promising technique by which microorganisms are eliminated by a photosensitizing compound , light and oxygen. It was evaluated in two patients who had developed lesions in the fingernails caused by onychomycosis for approximately 10 years. The lesions were treated by photodynamic therapy with curcumin. The therapeutic efficacy was observed after a maximum of six photodynamic therapy sessions without any other adjuvant therapy. Curcumin has become more promising than the therapeutic standard as it is a natural and versatible drug for incorporation in different formulations, at low cost and low probability of side effects.

Evaluation of PpIX formation in Cervical Intraepithelial Neoplasia I (CIN) using widefield fluorescence images

Optical techniques has been described as auxiliary technology for screening of neoplasia because shows the potential for tissues differentiation in real-time and it is a noninvasive detection and safe. However, only endogenous fluorophores presents the lesion may be insufficient and needed of the administration of the fluorophores synthesized, such as, precursor molecule of protoporphyrin IX (PpIX) induced by 5- aminolevulinic acid and your derivatives. Topical application of methylaminolevulinate (MAL), induces formation of the endogenous photosensitizer, PpIX in tissues where carcinogenesis has begun. The PpIX tend to accumulate in premalignant and malignant tissues and the illumination with light with appropriate wavelength beginning to excitation of PpIX fluorescence, which helps to localize PpIX-rich areas and identify potentially malignant tissues. The aim of the study is to evaluate the production of PpIX in the cervix with CIN I through of the fluorescence images captured after 1 hour of cream application. It was possible to visualize PpIX fluorescence in cervix and it was possible to observe the selectivity in fluorescence in squamous-columnar junction, which a pre-cancerous condition (CIN) and usually is localized. Through the image processing it was possible to quantify the increase of red fluorescence. For the CIN I the increase of red fluorescence was approximately of 4 times indicating a good PpIX formation.

Adapting smartphones for low-cost optical medical imaging

Optical images have been used in several medical situations to improve diagnosis of lesions or to monitor treatments. However, most systems employ expensive scientific (CCD or CMOS) cameras and need computers to display and save the images, usually resulting in a high final cost for the system. Additionally, this sort of apparatus operation usually becomes more complex, requiring more and more specialized technical knowledge from the operator. Currently, the number of people using smartphone-like devices with built-in high quality cameras is increasing, which might allow using such devices as an efficient, lower cost, portable imaging system for medical applications. Thus, we aim to develop methods of adaptation of those devices to optical medical imaging techniques, such as fluorescence. Particularly, smartphones covers were adapted to connect a smartphone-like device to widefield fluorescence imaging systems. These systems were used to detect lesions in different tissues, such as cervix and mouth/throat mucosa, and to monitor ALA-induced protoporphyrin-IX formation for photodynamic treatment of Cervical Intraepithelial Neoplasia. This approach may contribute significantly to low-cost, portable and simple clinical optical imaging collection.

Photonic technology for the treatments of the venous and arterial ulcers: Case report

In this report, we report a case study on a 50-year-old male patient with different chronic wounds, such as venous ulcer and arterial ulcer in both legs. These wounds have persisted for more than 10 years, despite the different treatments applied, including, different dressings, hyperbaric camera, as well as the used of several medicines of oral and topical application. The case is addressed with the aim to evaluate if treatment that uses combined techniques such as low level laser therapy (LLLT), photodynamic therapy and cellulose membrane is able to improve healing and reduction of time of treatment in those types of chronic wounds. The results show the clinical protocol is effective for the healing of arterial and venous ulcers and can be considered as a promising possibility.

Optical techniques for the diagnosis and treatment of lesions induced by the human papillomavirus — A resource letter

Human papillomaviruses (HPV) are the most common sexually-transmitted virus, and carcinogenic HPV strains are reported to be responsible for virtually all cases of cervical cancer and its precursor, the cervical intraepithelial neoplasia (CIN). About 30% of the sexually active population are considered to be affected by HPV. Around 600 million people are estimated to be infected worldwide. Diseases related to HPV cause significant impact from both the personal welfare point of view and public healthcare perspective. This resource letter collects relevant information regarding HPV-induced lesions and discusses both diagnosis and treatment, with particular attention to optical techniques and the challenges involved to the implementation of those approaches.

PDT and emerging therapies for Actinic Keratosis—A resource letter

Aktinic Keratosis is common and if left untreated may develop into life threatening squamous cell carcinoma. Therefore early intervention is the standard of care. While many treatments are available PDT continues to move to the for - front for this indication (Brito et al., 2016 [31]). Topical PS is commercially available that are able to reliably ablate these lesions. Innovative protocols including sunlight, large volume LED arrays and maneuvers to improve treatment parameters and cosmesis continue to make this a worldwide treatment of choice for AK.

Regression of Non-Alcoholic Fatty Liver by Metabolic Reduction: Phototherapy in Association with Aerobic Plus Resistance Training In Obese Man - A Pilot Study

The excessive body fat, one of the results of obesity, brings with it comorbidities such as lipid changes, insulin resistance, diabetes mellitus type 2 and non-alcoholic fatty liver disease. In this controlled and randomized pilot study, as a non-pharmacological and non-invasive strategy, we consider two groups during 8 weeks: the use of moderate intensity physical exercise and nutritional education, as control group (n=10) and moderate intensity physical exercise, nutritional education and phototherapy (n=10), as phototherapy group. The used phototherapy parameters were: laser Ga-Al-As, wavelength 808 nm, continuous mode, output power 100 mW, and total energy delivery 92.16 J. Selected patients were men with age between 20 and 40 years old, primary obesity, body mass index (BMI) between 30 and 34.9 kg/ m2. The special device as described in the text was applied, allocated in the anterior region and posterior region of body during 5 minutes each side, totalizing 10 minutes of application of light, always at the end after session of exercise. Comparing the control group in relation to the phototherapy group, the better results were obtained for the phototherapy group, with statistical difference in all anthropometric variables, such as the increase of 3.54% (p<0.007) in total skeletal muscle mass; as well as, 2.77% (p<0.005) in the basal metabolic rate body; 5.47% (p<0.04) for metabolic progress; reduction of 4.67% (p<0.007) for body mass and reduction was also observed for total body fat, total trunk fat and visceral fat of which the phototherapy group showed the following reduction percentages: 14.3% (p<0.01), 14.7% (p<0.005) and 16.4% (p<0.03), respectively. A significant improvement was also observed in all the biochemical parameters and enzymatic analyzed, such as total cholesterol, triglyceride, the basal insulin, glutamic oxaloacetic transaminase, glutamic pyruvic transaminase, and gamma-glutamyl-transpeptidase. Therefore the proposed treatment in this work suggests that the association of physical exercise, the nutritional education and phototherapy applied in obese men for two months caused great improvement in all anthropometric parameters, as well as, in all biochemistry and enzymatic parameters indicating that phototherapy is a potential instrument in the treatment of non-alcoholic fatty liver disease, being able to reverse the degree of steatosis in 8 weeks, besides it can be a new non-invasive treatment to obesity and its comorbidities.

Antimicrobial Efficacy of Curcumin Formulations by Photodynamic Therapy

URTI (upper respiratory tract infections) are caused by acute, chronic or recurrent infections including pharyngitis and tonsillitis. The etiologic agents involved are bacteria, virus, and fungi. The standard treatment for bacterial infections is the use of antibiotics. The antibiotic resistance, side effects of drugs and URTI complications indicate the importance of new therapies. PDT (photodynamic therapy) is a treatment option with a fast onset of action, low side effects, and easy administration of PS (photosensitizer) based on this study. The main aim of this study was to develop a new modality for the treatment of infectious pharyngotonsillitis by photodynamic therapy. In addition, this study aims to evaluate components of the therapy as the PS, curcumin, in two formulations and irradiation conditions in the effectiveness of treatment. The procedure consists of two steps: oral administration of CFs (curcumin formulations) containing a PS and illumination (450 nm and 0-60 J/cm). Bacterial isolates were obtained from patients in a routine clinical pratice. The new methodology has been developed from the principle of PI (photodynamic inactivation). The strain identification number of colony forming units determined the efficacy of PI using each component, lighting and PS. The use of curcumin formulations in PI presented microbial reduction of 5 log.

Photodynamic therapy of Cervical Intraepithelial Neoplasia (CIN) high grade

Cervical intraepithelial neoplasia (CIN) is the precursor of invasive cervical cancer and associated with human papillomavirus (HPV) infection. Photodynamic therapy (PDT) is a technique that has been used for the treatment of tumors. PDT is based on the accumulation of a photosensitizer in target cells that will generate cytotoxic reactive oxygen species upon illumination, inducing the death of abnormal tissue and PDT with less damaging to normal tissues than surgery, radiation, or chemotherapy and seems to be a promising alternative procedure for CIN treatment. The CIN high grades (II and III) presents potential indications for PDT due the success of PDT for CIN low grade treatment. The patients with CIN high grade that were treated with new clinic protocol shows lesion regression to CIN low grade 60 days after the treatment. The new clinical protocol using for treatment of CIN high grade shows great potential to become a public health technique.

Clinical use of a portable dual microscope system for smartphone (Conference Presentation)

Cervical cancer is still one of the most relevant women cancer types, since the 5-year survival rate is of only around 68%. Prevention and early diagnosis are the best strategies to improve cervical cancer prognosis. Conventional diagnosis procedure in Gynecology is mainly based on the macroscopic clinical evaluation, Pap smear cytology, and biopsy, if needed. A portable microscope with dual configuration and its use for diagnosis in Gynecology is investigated. The microscope has interchangeable parts that allow its use for cytopathology smear samples or in situ endoscopic tissue interrogation, both using acriflavine as a nuclei marker. Patients of the Women Ambulatory of the School of Medicine (UNIARA, Araraquara, Brazil) were interrogated during the colposcopy examination. The cervix was initially cleaned using an acetic acid solution, and a 0.05% (wt/vol) acriflavine in saline solution was topically applied at the tissue surface using a cotton swab. Microendoscopy images were taken from clinically normal cervix mucosa and from detected lesions. An image processing is performed to evaluate the cell nuclei morphology and the cytoplasm/nuclei ratio. The Pap smear results and the histology analyses are taken as gold standard for the diagnosis. Preliminary results in 5 patients demonstrated the potential use of our microscope at the clinical setting.