Psoriasis in obesity: comparison of serum levels of leptin and adiponectin in obese subjects - cases and controls

Abstract BACKGROUND: Psoriasis and obesity are somewhat related to a low-grade systemic inflammatory response. OBJECTIVES: To determine leptin and adiponectin levels in psoriasis patients compared to control patients matched for weight. METHODS: A case-control study was performed, evaluating 113 psoriasis patients and 41 controls with other dermatologic diseases. RESULTS: The prevalence of obesity was 33% in cases and 21.9% in controls. All evaluated comorbidities were more prevalent among cases. When stratified by weight, the comorbidities were more frequent in overweight patients. We found no correlation between being overweight (p=0.25), leptin (p=0.18) or adiponectin (p=0.762) levels and psoriasis severity. When overweight cases and controls were compared, we found differences in the adiponectin values (p= 0.04). The overweight cases had lower adiponectin levels than the overweight controls. We found no differences in the leptin dosage between cases and controls. The overweight cases had higher leptin values than the normal weight cases (p<0.001). STUDY LIMITATIONS: Several patients used systemic anti-inflammatory medication. CONCLUSIONS: The prevalence of obesity among psoriasis cases (33%) was higher than in the general population (17.4%). We did not find any correlation between severity of psoriasis and inflammatory cytokines and the condition of being overweight. The overweight cases had lower values of adiponectin than the overweight controls. It seems, therefore, that there is a relationship between adiponectin and psoriasis, but this relationship depends on the presence of obesity.

Assessment of adiposity in psoriatic patients by dual energy X-ray absorptiometry compared to conventional methods

Abstract BACKGROUND: Obesity is considered a chronic low-grade inflammatory disease that shares mediators of inflammation with psoriasis, such as TNF-α and IL-6. The relationship between these two conditions involves factors such as predisposition and response to therapy, in addition to an association with cardiovascular disease. OBJECTIVES: The aim of the present study was to investigate the prevalence of adiposity as determined by body mass index (BMI), waist circumference (WC), and dual energy X-ray absorptiometry (DXA) evaluation in patients with psoriasis. METHODS: BMI, WC and body composition by DXA were measured in 42 psoriatic patients without joint complaints and in 41 control patients using standard procedures. In the comparison between cases and controls, we used Pearson’s Χ2 test or Fisher’s exact test, and the nonparametric Mann-Whitney test. The difference between the diverse classification methods for obesity was evaluated using McNemar’s test. To test the level of agreement between those variables, we used the weighted kappa coefficient. RESULTS: There was no difference in the prevalence of obesity among cases and controls. Both BMI and WC had low agreement with measures of body fat evaluated by DXA. With the use of DXA scanning, prevalence of overweight and obesity in patients with psoriasis was 83.3%, which constitutes a strong evidence of the need for intervention on this metabolic parameter. CONCLUSION: Dual energy X-ray absorptiometry was more capable of identifying obesity compared with BMI and WC both in psoriatic and control patients.

Psoriasis: new comorbidities

Abstract Psoriasis is a chronic inflammatory disease associated with several comorbidities. A few decades ago, it was considered an exclusive skin disease but today it is considered a multisystem disease. It is believed that 73% of psoriasis patients have at least one comorbidity. Studies have demonstrated the association of psoriasis with inflammatory bowel disease, uveitis, psychiatric disorders, metabolic syndrome and its components and cardiovascular diseases. The systemic inflammatory state seems to be the common denominator for all these comorbidities. This work aims at presenting a review of the current literature on some new comorbidities that are associated with psoriasis as osteoporosis, obstructive sleep apnea and chronic obstructive pulmonary disease. While there is still controversy, many studies already point to a possible bone involvement in patients with psoriasis, especially in the male group, generally less affected by osteoporosis. Psoriasis and chronic obstructive pulmonary disease present some risk factors in common as obesity, smoking and physical inactivity. Besides, both diseases are associated with the metabolic syndrome. These factors could be potential confounders in the association of the two diseases. Further prospective studies with control of those potential confounders should be developed in an attempt to establish causality. Existing data in the literature suggest that there is an association between obstructive sleep apnea and psoriasis, but studies performed until now have involved few patients and had a short follow-up period. It is, therefore, premature to assert that there is indeed a correlation between these two diseases.

Comparative study of the prevalence of sepsis in patients admitted to dermatology and internal medicine wards / Estudo comparativo da prevalencia de sepse em pacientes internados nas enfermarias de dermatologia e de clinica medica

BACKGROUND: Sepsis is a common cause of morbidity and mortality among hospitalized patients. The prevalence of this condition has increased significantly in different parts of the world. Patients admitted to dermatology wards often have severe loss of skin barrier and use systemic corticosteroids, which favor the development of sepsis. OBJECTIVES: To evaluate the prevalence of sepsis among patients admitted to a dermatology ward compared to that among patients admitted to an internal medicine ward. METHODS: It is a cross-sectional, observational, comparative study that was conducted at Hospital Santa Casa de Belo Horizonte. Data were collected from all patients admitted to four hospital beds at the dermatology and internal medicine wards between July 2008 and July 2009. Medical records were analyzed for the occurrence of sepsis, dermatologic diagnoses, comorbidities, types of pathogens and most commonly used antibiotics. RESULTS: We analyzed 185 medical records. The prevalence of sepsis was 7.6% among patients admitted to the dermatology ward and 2.2% (p = 0.10) among those admitted to the internal medicine ward. Patients with comorbidities, diabetes mellitus and cancer did not show a higher incidence of sepsis. The main agent found was Staphylococcus aureus, and the most commonly used antibiotics were ciprofloxacin and oxacillin. There was a significant association between sepsis and the use of systemic corticosteroids (p <0.001). CONCLUSION: It becomes clear that epidemiological studies on sepsis should be performed more extensively and accurately in Brazil so that efforts to prevent and treat this serious disease can be made more effectively. .

FUNDAMENTOS: A sepse é causa comum de morbimortalidade em pacientes internados. A sua prevalência está aumentando significativamente em diversas partes do mundo. Pacientes internados em enfermarias de dermatologia apresentam extensas áreas de perda da barreira cutânea, além de uso frequente de corticosteróides sistêmicos, condições favoráveis ao desenvolvimento de sepse. OBJETIVOS: Avaliar a prevalência de sepse em pacientes internados em uma enfermaria de dermatologia e compará-la com a prevalência na enfermaria de clínica médica. MÉTODOS: Trata-se de estudo observacional transversal comparativo de análise de prontuários realizado na Santa Casa de Belo Horizonte. Foram coletados os dados de todos os pacientes internados em quatro leitos da clínica médica e da dematologia no período de julho de 2008 e julho de 2009. Foram analisados em busca da ocorrência de sepse, diagnósticos dermatológicas, comorbidades, tipos de patógenos mais associados e perfil de antibióticos mais utilizados. RESULTADOS: Foram analisados 185 prontuários e a prevalência de sepse entre os pacientes internados na enfermaria de dermatologia foi de 7,6% e na enfermaria de clínica médica 2,2% (p=0,10). Pacientes portadores de comorbidades, diabetes mellitus e neoplasias não demostraram maior ocorrência de sepse. O principal agente encontrado foi Staphylococcus aureus e os antibióticos mais utilizados foram ciprofloxacino e oxacilina. Houve significativa associação de sepse com o uso de corticosteróides sistêmicos (p<0,001). CONCLUSÃO: Torna-se claro que devem ser realizados estudos epidemiológicos mais amplos e acurados no Brasil sobre a sepse, para que os esforços na prevenção e no tratamento dessa grave doença possam ser direcionados ...

Case for diagnosis / Caso para diagnóstico

Granular cell tumor (Abrikossoff's tumor) is a rare benign disease that preferentially affects the cervicofacial segment. It is usually a solitary nodule that may ulcerate and present pearly infiltration on the borders, while keeping a clean background and a hyperchromic halo. This paper describes the case of an ulcerated granular cell tumor on an unusual location, which reinforces the necessity of including this tumor in the differential diagnosis of nodular-ulcerative skin lesions.

O tumor de células granulares (tumor de Abrikossoff) é uma doença rara, benigna, que acomete preferencialmente o segmento cérvico facial. Geralmente é uma lesão única, nodular, que pode ulcerar e apresentar bordas infiltradas e peroláceas, com fundo limpo e halo hipercrômico. Esse trabalho descreve um caso de tumor de células granulares ulcerado e de localização pouco usual reforçando a necessidade de se incluir esse tumor no diagnóstico diferencial das lesões nódulo-ulceradas da pele.

Dermatofibrossarcoma protuberans: localização não usual e a importância da cirurgia micrográfica de Mohs / Dermatofibrosarcoma protuberans: atypical location and the importance of Mohs micrographic surgery

O dermatofibrossarcoma protuberans é neoplasia de células fusiformes de malignidade intermediária, mas que apresenta alto risco de recidivas locais. Acomete principalmente tronco e membros, sendo raro na face. O tratamento do tumor pode ser feito com cirurgia convencional com amplas margens cirúrgicas ou cirurgia micrográfica de Mohs. Em casos selecionados pode-se indicar radioterapia e quimioterapia. Relata-se o caso de paciente do sexo masculino, de 39 anos, apresentando na fronte pápula amarelada de 0,7 cm, cujas biópsia e imuno-histoquímica confirmaram o diagnóstico desse tumor. A lesão foi tratada através da cirurgia micrográfica de Mohs com bom resultado estético.

Dermatofibrosarcoma protuberans is a spindle cell neoplasm of intermediate malignancy, nonetheless it presents a high risk of local recurrence. It mainly affects the trunk and limbs, and is rare on the face. The treatment of the tumor can be carried out using conventional surgery with wide surgical margins or Mohs micrographic surgery. Radiation and chemotherapy can be indicated in selected cases. The present article reports the case of a 39-year-old male patient with a 0.7cm yellowish papule on the forehead, whose biopsy and immunohistochemistry confirmed the tumor's diagnosis. The lesion was treated through Mohs micrographic surgery with good aesthetic results.

Do you know this syndrome? / Você conhece esta síndrome?

Goldenhar syndrome is a sporadic or inherited genetic syndrome characterized by limbal dermoids, preauricular skin tags and mandibular hypoplasia. Vertebral abnormalities may occur. The incidence of this syndrome ranges from 1 in 5,600 to 1 in >20,000 live births. It consists of abnormalities involving the first and second branchial arches. The etiology of the syndrome is heterogeneous. Diagnosis should be based principally on clinical aspects, which should be associated with the patient's systemic conditions and radiologic findings. Treatment depends on the patient's age and systemic manifestations, with a multidisciplinary approach often being required.

A síndrome de Goldenhar é uma síndrome genética esporádica ou hereditária caracterizada por dermóides epibulbares, apêndices auriculares e hipoplasia mandibular. Anormalidades vertebrais podem ocorrer. A sua incidência varia de 1 para 5600 a 20000 nascidos vivos e consiste em anormalidades que envolvem o primeiro e segundo arcos faríngeos. A etiologia da síndrome é heterogênea. O diagnóstico deve ser feito baseado principalmente nos aspectos clínicos e associado tanto com as condições sistêmicas quanto com os achados radiológicos. O tratamento depende da idade e das manifestações sistêmicas geralmente necessitando de acompanhamento multidisciplinar.

Nódulos reumatoides: avaliação comparativa da resposta terapêutica com triancinolona e fluoruracil intralesional / Rheumatoid nodules: evaluation of the therapeutic response to intralesional fluorouracil and triamcinolone

Os nódulos reumatoides correspondem à manifestação extra-articular mais comum da artrite reumatoide, ocorrendo em cerca de 20-25 por cento dos pacientes. A etiologia é desconhecida. Apesar de os nódulos poderem apresentar remissão espontânea durante o tratamento, eles, em geral, representam um desafio terapêutico. Apresenta-se um caso no qual se avaliou a resposta dos nódulos reumatoides por meio de ultrassonografia após infiltração de triancinolona e 5-fluoruracil.

Rheumatoid nodules are the most common extra-articular manifestation of rheumatoid arthritis and are present in around 20-25 percent of patients. Their etiology is unknown and although the nodules may undergo spontaneous remission during the treatment of rheumatoid arthritis, they usually constitute a therapeutic challenge. The present paper describes a case in which the response of rheumatoid nodules was evaluated by ultrasound following infiltration of triamcinolone acetonide and 5-fluorouracil.

Estudo duplo-cego e randomizado do peeling de ácido retinoico a 5% e 10% no tratamento do melasma: avaliação clínica e impacto na qualidade de vida / Double-blind randomized study of 5% and 10% retinoic acid peels in the treatment of melasma: clinical evaluation and impact on the quality of life

Introdução: o melasma é dermatose de alta prevalência que provoca grande impacto na qualidade de vida dos pacientes. Seu tratamento é um desafio. O índice de área e gravidade do melasma - Masi, e o Melasma Quality of Life Scale - MelasQoL são instrumentos úteis na avaliação clínica e do impacto na qualidade de vida, respectivamente. Objetivo: estudar, através do Masi e MelasQoL, o efeito do peeling de ácido retinoico em pacientes portadoras de melasma, comparando as concentrações de 5 e 10%. Métodos: 30 pacientes foram randomizados e submetidos a peelings de ácido retinoico a 5% ou 10% nas semanas 0, 2, 4 e 6.As pacientes foram submetidas à avaliação clínica, através do Masi e à avaliação da qualidade de vida, através do MelasQoL, nas semanas 0 e 8. Resultados: na avaliação global dos dois grupos houve redução estatisticamente significativa de ambos os índices após os tratamentos. Quando se compararam os peelings de ácido retinoico a 5 e 10% não se observou diferença estatisticamente significativa entre as variáveis Masi e MelasQoL. Conclusões: o peeling de ácido retinóico é eficaz e seguro no tratamento do melasma, como tratamento isolado, e não há diferença da melhora quando se comparam as concentrações de 5% e 10%.

Leucemias agudas na infância / Childhood acute leukemias

As leucemias constituem a neoplasia mais freqüente na infância. São responsáveis por cerca de um terço dos cânceres pediátricos. A leucemia linfocítica aguda (LLA) representa cerca de 75% dos casos de leucemias infantis. As leucemias mielóides agudas (LMA) representam 15% a 20% das leucemias em pacientes com idade inferior a 15 anos. As manifestações clínicas das leucemias agudas são decorrentes da inibição da hematopoiese pelas células leucêmicas e dos efeitos da infiltração leucêmica em diversos órgãos e sistemas. Observa-se anemia devido à diminuição dos eritrócitos, sangramentos decorrentes da trombocitopenia e infecções conseqüentes à neutropenia. A infiltração dos diferentes tecidos resulta em hepatomegalia, esplenomegalia e linfadenomegalia. O diagnóstico das leucemias é firmado pela presença de mais de 25% de células leucêmicas na punção aspirativa de medula óssea (mielograma). O tratamento da LLA é feito com regimes quimioterápicos de longa duração. A indicação do trans- plante de medula óssea durante uma primeira remissão permanece controversa. A probabilidade de cura da LLA pode chegar a 80%. Na LMA, com o uso exclusivo de quimioterapia, a probabi- lidade de sobrevida livre de doença (SLD) por períodos prolonga- dos é de 30% a 40%. Quando se emprega o transplante de medula óssea alogênico, a probabilidade estimada de SLD a longo prazo é de 50% a 60%...(AU)

The leukemias are the most common malignant neoplasm in child- represents 15% to 20% of cases in patients less than 15 years old. The clinical manifestations of acute leukemias are secondary to inhibition of hematopoiesis by leukemic cells and to the effects of leukemic infiltration in different organs and systems. Anemia is caused by reduction of erythrocytes, bleeding is secondary to thrombocytopenia, and infections are related to neutropenie. The infiltration of tissues results in hepatomegaly, splenomegaly and lymphadenopathy Acute leukemias are diagnosed by abone mar- row aspirate that demonstrates more than 25% of the bone mar- row cells as a relatively homogeneous population of blasts. The treatment of ALL consists of prolonged chemotherapy regimens. The role of allogeneic bone marrow transplantation during first remission remains controversiet. The probability of cure in ALL reaches 80%, In AML, with chemotherapy alone, the probability of long term disease free survival is from 30% to 40%. When bone marrow transplantation is used the estimated probability of prolonged disease free survival is 50% to 60%...