Evolución clínica en pacientes con síndrome del túnel carpiano tratados con ultrasonido o infiltración con corticoesteroides / Clinical Evolution in Patients with Carpal Tunnel Syndrome Treated with Ultrasound or Corticosteroid Infiltration

Introducción. El Síndrome del túnel carpiano es la neuropatía periférica compresiva más común de la extremidad superior, que se produce por la compresión del nervio mediano. Los casos leves y moderados pueden tratarse con métodos conservadores como ultrasonido terapéutico o infiltración con corticoesteroides. Objetivo. Describir la evolución clínica de pacientes con síndrome de túnel carpiano tratados con terapia por ultrasonido e infiltración de corticoesteroides. Metodología. Ensayo clínico abierto, en pacientes con síndrome del túnel carpiano leve y moderado, que consultaron del 1 de octubre 2021 al 30 de mayo 2022. Se formaron dos grupos; el que recibió tratamiento con ultrasonido con 12 casos y el grupo tratado con infiltración con corticoesteroides con seis casos. Ambos grupos fueron intervenidos en la consulta inicial, y luego, en las cuatro y ocho semanas posteriores al inicio del tratamiento. Resultados. Se muestran los resultados descriptivos relacionados con la intensidad de dolor, valorada con la Escala Visual Numérica, la infiltración obtuvo dos casos sin dolor y cuatro con dolor moderado, contrario a ultrasonido que se mantuvo con cuatro casos leves, tres moderados y cinco intensos. En los síntomas, la infiltración redujo el número de casos en cuatro de los síntomas estudiados, en cambio el ultrasonido únicamente en dos. En severidad, valorada con el cuestionario de Boston para túnel carpal, con infiltración se obtuvieron dos casos asintomáticos y ninguno con ultrasonido. Respecto a los signos clínicos, el signo de Tinel desapareció en cuatro casos en ambos grupos, mientras que signo de Phalen desapareció en cuatro casos en ultrasonido y dos en infiltración. Conclusión. En intensidad de dolor y grado de severidad, la infiltración generó casos asintomáticos y redujo mayor cantidad de síntomas que el ultrasonido. Ambos tratamientos disminuyeron la presencia de signos clínicos

Introduction. Carpal tunnel syndrome is the most common compressive peripheral neuropathy of the upper extremity, which is caused by compression of the median nerve. Mild and moderate cases can be treated with conservative methods such as therapeutic ultrasound or corticosteroid infiltration. Objective. To describe the clinical evolution of patients with carpal tunnel syndrome treated with ultrasound therapy and corticosteroid infiltration. Methodology. A prospective open clinical trial was conducted in patients with mild and moderate carpal tunnel syndrome who consulted from October 1, 2021 to May 30, 2022. Two groups were formed: the group that received ultrasound treatment with 12 cases and the group treated with corticosteroid infiltration with six cases. Both groups were treated at the initial consultation and then at four and eight weeks after the start of treatment. Results. The descriptive results related to the intensity of pain, evaluated with the Visual Numeric Scale, are shown. Infiltration obtained two cases without pain and four with moderate pain, contrary to ultrasound which was maintained with four mild, three moderate and five intense cases. In symptoms, infiltration reduced the number of cases in four of the symptoms studied, while ultrasound reduced the number of cases in only two. In severity, assessed with the Boston carpal tunnel questionnaire, with infiltration, there were two asymptomatic cases and none with ultrasound. Regarding clinical signs, Tinel's sign disappeared in four cases in both groups, while Phalen's sign disappeared in four cases in ultrasound and two in infiltration. Conclusion. Infiltration produced asymptomatic patients and reduced more symptoms than ultrasonography in terms of pain intensity and severity. Clinical symptoms were less common with both treatments.

Hipoacusia en el síndrome de Vogt-Koyanagi-Harada: reporte de caso y revisión de la literatura / Hearing loss in Vogt-Koyanagi-Harada syndrome: case report and literature review

El síndrome de Vogt-Koyanagi-Harada (VKH) es una rara enfermedad granulomatosa multisistémica caracterizada por aparición de panuveítis grave bilateral y desprendimiento seroso de retina; puede acompañarse de un amplio espectro de síntomas extraoculares como los auditivos, y la afección más frecuente es la hipoacusia neurosensorial. Su etiología se reconoce como respuesta autoinmune mediada por células T contra antígenos de melanocitos presentes en coroides, meninges, cóclea y piel. Asimismo, factores genéticos del huésped se han identificado como predisponentes para su aparición, y es la presencia del alelo HLA-DR4, en particular el subtipo HLA-DRB1 0405, el más estudiado hasta la fecha. El tratamiento se basa en administración de corticosteroides sistémicos en dosis altas, sin embargo, es escasa la evidencia que evalúa específicamente la eficacia de estos medicamentos sobre sus manifestaciones audiovestibulares. Este artículo expone un caso de síndrome de VKH con compromiso auditivo concomitante y realiza una breve revisión narrativa de la literatura.

Vogt-Koyanagi-Harada syndrome (VKHS) is a rare multisystemic granulomatous disease, characterized by severe bilateral panuveitis and serous retinal detachment; it can be associated with a wide spectrum of extraocular symptoms, such as auditory symptoms, and the most common condition is sensorineural hearing loss. Its etio-logy is recognized as a T-cell-mediated autoimmune response against melanocyte antigens present in the choroid, meninges, cochlea, and skin. Likewise, host genetic factors have been identified as predisposing for its development, specifically the pre-sence of the HLA-DR4 allele, the HLA-DRB1 0405 subtype is the most studied up to date. Treatment is based on the administration of high doses of systemic corticos-teroids, however, there is not much evidence that specifically evaluates the efficacy of these medications on their audiovestibular manifestations. This article presents a clinical case of VKH syndrome with concomitant hearing impairment and carries out a short narrative review of the literature.

Actualización del consenso chileno SOCHINEP-SER para el manejo de las sibilancias recurrentes del preescolar / Update of the chilean consensus SOCHINEP-SER for the management of recurrent wheezing in preschool children

Las sibilancias recurrentes del preescolar son un problema prevalente. 50% de todos los niños tiene al menos un episodio de sibilancias en los primeros 6 años. Sin embargo, solo 4 % de los menores de 4 años tiene diagnóstico de asma. Por este motivo es fundamental realizar una adecuada anamnesis y examen físico tendientes a descartar causas secundarias, lo que debe ser complementado con exámenes de laboratorio de acuerdo con la orientación clínica. En la actualidad se recomienda indicar tratamiento de mantención con corticoides inhalados en aquellos niños que tengan episodios repetidos de obstrucción bronquial y que tengan una alta probabilidad de respuesta favorable a esta terapia. Se ha demostrado que aquellos pacientes que tienen un recuento de eosinófilos en sangre > 300 células por mm3 o aquellos que presentan una prueba cutánea positiva o IgE específicas positivas para alérgenos inhalados, responderán adecuadamente al tratamiento con esteroides inhalados.

Recurrent wheezing in preschoolers has a high prevalence. 50% of all children have at least one wheezing episode in the first six years of life. However, only 4% of children under four years of age are diagnosed with asthma. Therefore, it is essential to carry out an adequate medical history and physical examination to rule out secondary causes, which must be complemented with laboratory tests in accordance with clinical guidance. It is recommended to indicate maintenance treatment with inhaled corticosteroids to those children who have repeated episodes of wheezing and who have a high probability of a good response to this therapy. It has been demonstrated that those patients who have blood eosinophil count > 300 cells per mm3 or those who have a positive skin test or positive specific IgE for inhaled allergens will have a good response to inhaled corticosteroids.

Actualización del consenso chileno SOCHINEP-SER para el manejo de las sibilancias recurrentes del preescolar / Update of the chilean consensus SOCHINEP-SER for the management of recurrent wheezing in preschool children

Las sibilancias recurrentes del preescolar son un problema prevalente. 50% de todos los niños tiene al menos un episodio de sibilancias en los primeros 6 años. Sin embargo, solo 4% de los menores de 4 años tiene diagnóstico de asma. Por este motivo es fundamental realizar una adecuada anamnesis y examen físico tendientes a descartar causas secundarias, lo que debe ser complementado con exámenes de laboratorio de acuerdo con la orientación clínica. En la actualidad se recomienda indicar tratamiento de mantención con corticoides inhalados en aquellos niños que tengan episodios repetidos de obstrucción bronquial y que tengan una alta probabilidad de respuesta favorable a esta terapia. Se ha demostrado que aquellos pacientes que tienen un recuento de eosinófilos en sangre > 300 células por mm3 o aquellos que presentan una prueba cutánea positiva o IgE específicas positivas para alergenos inhalados responderán adecuadamente al tratamiento con esteroides inhalados.

Recurrent wheezing in preschoolers has a high prevalence. 50% of all children have at least one wheezing episode in the first six years of life. However, only 4% of children under four years of age are diagnosed with asthma. Therefore it is essential to carry out an adequate medical history and physical examination to rule out secondary causes, which must be complemented with laboratory tests in accordance with clinical guidance. It is recommended to indicate maintenance treatment with inhaled corticosteroids to those children who have repeated episodes of wheezing and who have a high probability of a good response to this therapy. It has been demonstrated that those patients who have blood eosinophil count > 300 cells per mm3 or those who have a positive skin test or positive specific IgE for inhaled allergens will have a good response to inhaled corticosteroids.

Systemic lupus erythematosus: Pharmacological differences between women and men and among age groups and geographical regions

Systemic lupus erythematosus (SLE) is a chronic and potentially fatal autoimmune disease. There are clinical differences between women and men and among age groups. Its treatment involves a heterogeneous group of drugs. The objective was to determine the pharmacological treatment patterns in a group of patients with SLE and compare them according to sex, age group and geographic region. This was a cross-sectional study that identified outpatient drugs used in patients with SLE from a population database of Colombians affiliated with the Colombian Health System. Sociodemographic and pharmacological variables were considered. Descriptive and bivariate analyses were performed. A total of 4307 patients with SLE were identified (median age, 44.2 years; 89.4% women). Disease-modifying antirheumatics were the most prescribed drugs (90.5%), especially chloroquine (54.4%), which predominated in all age groups and geographical regions. Hydroxychloroquine and methotrexate were the predominant prescribed drugs for women, while corticosteroids, chloroquine, azathioprine, and mycophenolate were the predominant prescribed drugs for men. The use of corticosteroids (prednisolone and prednisone) decreased with increasing age. Differences were found in the prescription of drugs for patients with SLE between women and men and among geographic regions and age groups. The use of chloroquine predominated over hydroxychloroquine, contrasting with clinical practice guidelines.

El lupus eritematoso sistémico (LES) es una enfermedad autoinmune crónica y potencialmente mortal. Existen diferencias clínicas entre mujeres y hombres, y entre grupos de edad. Su tratamiento involucra un grupo heterogeneo de medicamentos. El objetivo fue determinar los patrones de tratamiento farmacológico de un grupo de pacientes con LES y compararlos según el sexo, los grupos de edad y las regiones geograficas. Estudio de corte transversal que identifico los medicamentos de uso ambulatorio empleados en pacientes con LES, a partir de una base de datos poblacional de colombianos afiliados al Sistema de Salud de Colombia. Se consideraron variables sociodemográficas y farmacologicas. Se realizo un análisis descriptivo y bivariado. Se identificó a 4.307 pacientes con LES, con una mediana de edad 44,2 an˜ os y un 89,4% mujeres. Los medicamentos modificadores de enfermedad reumatica fueron los mas prescritos (90,5%), en especial cloroquina (54,4%), el cual predomino en todos los grupos de edad y las regiones geográficas. La hidroxicloroquina y el metotrexato predominaron en mujeres, mientras que los corticosteroides, la cloroquina, la azatioprina y el micofenolato, en hombres. Con el aumento de la edad disminuyo el uso de corticoides (prednisolona y prednisona). Se encontraron diferencias en la prescripción de los medicamentos empleados en los pacientes con LES entre mujeres y hombres, regiones geográficas y grupos etarios. El uso de cloroquina predomino sobre la hidroxicloroquina, en contraste con lo recomendado por las guías de practica clínica.

O que mudou entre os períodos de pico e de platô durante a primeira onda do SARS-CoV-2? Estudo multicêntrico português em unidades de cuidados intensivos / What changed between the peak and plateau periods of the first COVID-19 pandemic wave? A multicentric Portuguese cohort study in intensive care

RESUMO Objetivo: Analisar e comparar as características de pacientes críticos com a COVID-19, a abordagem clínica e os resultados entre os períodos de pico e de platô na primeira onda pandêmica em Portugal. Métodos: Este foi um estudo de coorte multicêntrico ambispectivo, que incluiu pacientes consecutivos com a forma grave da COVID-19 entre março e agosto de 2020 de 16 unidades de terapia intensiva portuguesas. Definiram-se as semanas 10 - 16 e 17 - 34 como os períodos de pico e platô. Resultados: Incluíram-se 541 pacientes adultos com mediana de idade de 65 [57 - 74] anos, a maioria do sexo masculino (71,2%). Não houve diferenças significativas na mediana de idade (p = 0,3), no Simplified Acute Physiology Score II (40 versus 39; p = 0,8), na pressão parcial de oxigênio/fração inspirada de oxigênio (139 versus 136; p = 0,6), na terapia com antibióticos na admissão (57% versus 64%; p = 0,2) ou na mortalidade aos 28 dias (24,4% versus 22,8%; p = 0,7) entre o período de pico e platô. Durante o período de pico, os pacientes tiveram menos comorbidades (1 [0 - 3] versus 2 [0 - 5]; p = 0,002); fizeram mais uso de vasopressores (47% versus 36%; p < 0,001) e ventilação mecânica invasiva na admissão (58,1% versus 49,2%; p < 0,001), e tiveram mais prescrição de hidroxicloroquina (59% versus 10%; p < 0,001), lopinavir/ritonavir (41% versus 10%; p < 0,001) e posição prona (45% versus 36%; p = 0,04). Entretanto, durante o platô, observou-se maior uso de cânulas nasais de alto fluxo (5% versus 16%; p < 0,001) na admissão, remdesivir (0,3% versus 15%; p < 0,001) e corticosteroides (29% versus 52%; p < 0,001), além de menor tempo de internação na unidade de terapia intensiva (12 versus 8 dias; p < 0,001). Conclusão: Houve mudanças significativas nas comorbidades dos pacientes, nos tratamentos da unidade de terapia intensiva e no tempo de internação entre os períodos de pico e platô na primeira onda da COVID-19.

ABSTRACT Objective: To analyze and compare COVID-19 patient characteristics, clinical management and outcomes between the peak and plateau periods of the first pandemic wave in Portugal. Methods: This was a multicentric ambispective cohort study including consecutive severe COVID-19 patients between March and August 2020 from 16 Portuguese intensive care units. The peak and plateau periods, respectively, weeks 10 - 16 and 17 - 34, were defined. Results: Five hundred forty-one adult patients with a median age of 65 [57 - 74] years, mostly male (71.2%), were included. There were no significant differences in median age (p = 0.3), Simplified Acute Physiology Score II (40 versus 39; p = 0.8), partial arterial oxygen pressure/fraction of inspired oxygen ratio (139 versus 136; p = 0.6), antibiotic therapy (57% versus 64%; p = 0.2) at admission, or 28-day mortality (24.4% versus 22.8%; p = 0.7) between the peak and plateau periods. During the peak period, patients had fewer comorbidities (1 [0 - 3] versus 2 [0 - 5]; p = 0.002) and presented a higher use of vasopressors (47% versus 36%; p < 0.001) and invasive mechanical ventilation (58.1 versus 49.2%; p < 0.001) at admission, prone positioning (45% versus 36%; p = 0.04), and hydroxychloroquine (59% versus 10%; p < 0.001) and lopinavir/ritonavir (41% versus 10%; p < 0.001) prescriptions. However, a greater use of high-flow nasal cannulas (5% versus 16%, p < 0.001) on admission, remdesivir (0.3% versus 15%; p < 0.001) and corticosteroid (29% versus 52%, p < 0.001) therapy, and a shorter ICU length of stay (12 days versus 8, p < 0.001) were observed during the plateau. Conclusion: There were significant changes in patient comorbidities, intensive care unit therapies and length of stay between the peak and plateau periods of the first COVID-19 wave.

Evaluation of the impact of subepithelial corneal infiltrates on corneal biomechanics after epidemic keratoconjunctivitis / Avaliação do impacto de infiltrados sub-epiteliais corneanos na biomecânica corneana após ceratoconjuntivite epidêmica

ABSTRACT Purpose: To examine the effect of subepithelial corneal infiltrates on corneal biomechanical properties after epidemic keratoconjunctivitis compared to that in healthy controls. Methods: The cross-sectional study included consecutive patients with bilateral subepithelial corneal infiltrates after epidemic keratoconjunctivitis and healthy controls. Best corrected visual acuity corneal subepithelial infiltrate scoring Fantes grading scale, and central corneal thickness were measured. Corneal hysteresis corneal resistance factor Goldmann correlated intraocular pressure and corneal compensated intraocular pressure were assessed using an ocular response analyzer. Results: This study included 66 eyes of 33 patients with subepithelial corneal infiltrates following epidemic keratoconjunctivitis and randomly selected 37 eyes of 37 healthy volunteers. The mean Fantes and CSIS scores were 1.8 ± 0.8 and 2.9 ± 1.3, respectively, in the first involved eyes and 1.3 ± 1.1 and 1.9 ± 1.7, respectively, in the fellow eyes (p=0.009 and p=0.002, respectively). The first (526.1 ± 28.1 µm; p=0.005) and second involved eyes (523.4 ± 38.1 µm; p=0.044) had significantly thinner corneas compared to that in healthy controls (557.0 ± 38.1 µm). While best-corrected visual acuity showed a positive correlation with corneal resistance factor (r=0.363, p=0.045) and corneal hysteresis (r=0.414, p=0.021), corneal subepithelial infiltrate scoring showed a negative correlation with Goldmann correlated intraocular pressure (r=-0.479, p=0.006) and corneal compensated intraocular pressure (r=-0.413, p=0.021). Conclusion: Eyes with subepithelial corneal infiltrates had significantly thinner corneas compared to that in healthy controls. A positive correlation of the corneal resistance factor and corneal hysteresis with best-corrected visual acuity and a negative correlation of the Goldmann correlated intraocular pressure and corneal compensated intraocular pressure with corneal subepithelial infiltrate scoring should be taken into account when measuring intraocular pressure values in patients with subepithelial corneal infiltrates.

RESUMO Objetivo: Examinar o efeito de infiltrados sub-epiteliais corneanos nas propriedades biomecânicas da córnea após ceratoconjuntivite epidêmica, em comparação com controles saudáveis. Métodos: Este estudo transversal incluiu pacientes consecutivos com infiltrados sub-epiteliais corneanos bilaterais após ceratoconjuntivite epidêmica e controles saudáveis. Foram medidas a melhor acuidade visual corrigida, uma pontuação do infiltrado sub-epitelial da córnea, a escala de graduação de Fantes e a espessura central da córnea. A histerese da córnea, o fator de resistência da córnea, a pressão intraocular correlacionada à tonometria de Goldmann e a pressão intraocular compensada da córnea foram avaliados com o Ocular Response Analyzer. Resultados: Este estudo incluiu 66 olhos de 33 pacientes com infiltrados corneanos sub-epiteliais após ceratoconjuntivite epidêmica e selecionou aleatoriamente 37 olhos de 37 voluntários saudáveis. As pontuações médias da escala de Fantes e dos infiltrados sub-epiteliais corneanos nos primeiros olhos acometidos foram respectivamente de 1,8 ± 0,8 e 2,9 ± 1,3. Nos olhos contralaterais, foram respectivamente de 1,3 ± 1,1 e 1,9 ± 1,7 (p=0,009 e p=0,002, respectivamente). O primeiro e o segundo olhos envolvidos tinham córneas significativamente mais finas (respectivamente 526,1 ± 28,1 µm; p=0,005 e 523,4 ± 38,1 µm; p=0,044) em comparação com os controles saudáveis (557,0 ± 38,1 µm). Embora a acuidade visual melhor corrigida tenha mostrado uma correlação positiva com o fator de resistência da córnea (r=0,363, p=0,045) e com a histerese da córnea (r=0,414, p=0,021), a pontuação dos infiltrados sub-epiteliais corneanos mostrou uma correlação negativa com a pressão intraocular correlacionada à tonometria de Goldmann (r=-0,479, p=0,006) e com a pressão intraocular compensada da córnea (r=-0,413, p=0,021). Conclusão: Os olhos com infiltrados corneanos sub-epiteliais tinham córneas significativamente mais finas em comparação com os controles saudáveis. Ao se medirem os valores de pressão intraocular em pacientes com infiltrados sub-epiteliais corneanos, deve-se levar em consideração tanto as correlações positivas do fator de resistência da córnea e da histerese da córnea com a melhor acuidade visual corrigida quanto as correlações negativas da pressão intraocular correlacionada à tonometria de Goldmann e da pressão intraocular compensada da córnea com a pontuação do infiltrado sub-epitelial da córnea.

Persistence of behavioral abnormalities following corticosteroid therapy in children with initial episode of idiopathic nephrotic syndrome: a prospective longitudinal observation / Persistência de anormalidades comportamentais após corticoterapia em crianças com episódio inicial de síndrome nefrótica idiopática: uma observação longitudinal prospectiva

Abstract Introduction: Treatment of nephrotic syndrome with corticosteroid can cause several side- effects including behavioral abnormalities. The objectives of the study were to observe the proportion of non-relapsers having persistence of behavioral abnormalities after completion of treatment of initial episode and compare the abnormalities with relapsers, and to determine risk factors for persistence. Methods: Seventy-five children with a first episode of idiopathic nephrotic syndrome and 60 normal children were rated by parents for behavioral problems using the Child Behavior Checklist. The Parenting Stress Index was also evaluated. The children were rated before treatment and 12 and 36 weeks after. Results: Both relapsers and non-relapsers showed abnormalities in internalizing and externalizing domains at 12 weeks of steroid therapy. Non-relapsers had abnormal scores in the internalizing domain in 63.5 % and externalizing domain in 48.1% of cases at 36 weeks. Relapsers had abnormal scores in all the three behavior domains, but a significantly higher proportion of relapsers had abnormal scores regarding total behavior (65.2% vs 28.8%, p<0.01) and child domains (100% vs 57.7%, p<0.001) of Parenting Stress Index in comparison to non-relapsers at 36 weeks. Occurrence of relapse increased the risk (odds ratio 5.76, 95% CI 1.35-10.76, p< 0.001) for persistence of abnormal total behavior at 36 weeks follow-up. Conclusion: Persistence of abnormalities was observed not only in relapsers but also in non-relapsers. Relapse was found to be a significant risk factor for persistence of abnormal behaviors in these patients.

Resumo Introdução: O tratamento da síndrome nefrótica com corticosteroide pode causar vários efeitos colaterais, incluindo anormalidades comportamentais. Os objetivos do estudo foram observar a proporção de não-recidivos com persistência de anormalidades comportamentais após conclusão do tratamento do episódio inicial, comparar as anormalidades com os recidivos, e determinar fatores de risco para persistência. Métodos: 75 crianças com primeiro episódio de síndrome nefrótica idiopática e 60 crianças normais foram avaliadas pelos pais por problemas comportamentais usando o Checklist de Comportamento Infantil. O Índice de Estresse Parental também foi avaliado. As crianças foram avaliadas antes do tratamento, 12 e 36 semanas após. Resultados: Tanto recidivos quanto não recidivos mostraram anormalidades nos domínios de internalização e externalização às 12 semanas de terapia com esteroides. Não-recidivos apresentaram pontuações anormais no domínio de internalização em 63,5%, e no domínio de externalização, em 48,1% dos casos em 36 semanas. Recidivos tiveram pontuações anormais em todos os três domínios de comportamento, mas uma proporção significativamente maior de recidivos apresentou pontuações anormais em relação ao comportamento total (65,2% vs 28,8%, p<0,01) e domínios infantis (100% vs 57,7%, p<0,001) do Índice de Estresse Parental em comparação com não recidivos às 36 semanas. A ocorrência de recidiva aumentou o risco (odds ratio 5,76, 95% IC 1,35-10,76, p< 0,001) de persistência de comportamento total anormal em 36 semanas de acompanhamento. Conclusão: A persistência de anormalidades foi observada não apenas em recidivos, mas também em não recidivos. A recidiva foi um fator de risco significativo para a persistência de comportamentos anormais nesses pacientes.

Gastritis eosinofílica: a propósito de un caso

Introducción: La gastritis eosinofílica es una enfermedad infrecuente caracterizada por la presencia de eosinofilia hística, que afecta las diferentes capas de la pared intestinal. Este tipo de gastritis se caracteriza por una infiltración eosinofílica intensa que puede afectar solo la mucosa gástrica o todas sus capas hasta la serosa. La presentación clínica difiere de la posición y la extensión de la infiltración del eosinófilo, así como también su profundidad a través de la pared del intestino. Objetivo: Presentar el caso de un paciente diagnosticado y tratado como una gastritis eosinofílica. Caso clínico: Paciente masculino, raza blanca, de 47 años de edad, que acudió al Servicio de Gastroenterología del Hospital Universitario Manuel Ascunce Domenech, de la provincia Camagüey; en octubre de 2019. Refirió que durante los dos últimos meses había consultado en atención primaria de forma esporádica por molestias epigástricas, estos episodios cedían con pautas cortas de antiácidos. Los síntomas comenzaron agudizarse y se hicieron más resistentes al tratamiento, apareciendo náuseas, vómitos y pérdida de peso marcada. Se decidió comenzar la realización de estudios analíticos al paciente. Conclusiones: El resultado del estudio histológico fue infiltrado inflamatorio crónico severo con presencia de eosinófilos más del 50 % que se extiende a todas las capas con epitelio glandular reactivo, concluyó como una gastritis eosinofílica.

Introduction: Eosinophilic gastroenteritis is a rare disease characterized by the presence of tissue eosinophilia, which affects the different layers of the intestinal wall.This type of gastritis is characterized by an intense eosinophilic infiltration that can affect only the gastric mucosa or all its layers up to the serosa. The clinical presentation differs on the position and extent of the eosinophil infiltration, as well as its depth through the bowel wall. Objective: To present the case of a patient diagnosed and treated as eosinophilic gastritis. Case report: A 47-year-old white male patient from Camagüey province, who attends the Gastroenterology Service of the Manuel Ascunce Domenech University Hospital, Camagüey province; in October 2019. He reported that during the last two months he had consulted primary care sporadically due to epigastric discomfort, these episodes subsided with short courses of antacids. The symptoms began to worsen and became more resistant to treatment, with nausea, vomiting and marked weight loss appearing. It was decided to start performing analytical studies on the patient. Conclusions: The result of the histological study was a severe chronic inflammatory infiltrate with the presence of eosinophils more than 50% that extends to all layers with reactive glandular epithelium, concluding it as eosinophilic gastritis.

Progress on pathogenesis and treatment of ocular cicatricial pemphigoid / 国际眼科杂志(Guoji Yanke Zazhi)

@#Ocular cicatricial pemphigoid(OCP)is a special manifestation of mucosal pemphigoid(mucous membrane pemphigoid, MMP), and the pathogenesis is not clear at present. It can be caused by variety factors such as antigen-antibody reaction, inflammation cell infiltration, the action of various cytokines, elevated calcium ion levels and susceptibility genes. In the early period of diseases, conjunctival present chronic progressive fibrotic inflammation, later the corneal opacity and the neovascularization will eventually lose vision. Therefore, it is particularly important to carry out clinical standardized treatment for OCP patients in a timely manner. To use medicine to control the inflammation and delay the progression of the disease, for example, dapsone, intravenous immunoglobulin(IVIG), rituximab(RTX), tumor necrosis factor antagonists and adrenocorticoids. Surgical treatment can be considered appropriately when OCP patients are complicated by severe trichiasis, corneal disease and cataract.

Brain lesions associated with eosinophilia. A useful clue for neurotoxocariasis. Report of one case

ABSTRACT Neurotoxocariasis is uncommon. Its manifestations include events of meningitis, encephalitis and less frequently vasculitis, which manifest as headache, seizures, focalization, confusion, cognitive alterations and /or fever. Peripheral eosinophilia with clinical and neurological imaging elements, allow its early suspicion. We report a 48-year-old agricultural worker, admitted in our hospital for one week of gastrointestinal complaints, headache, progressive left hemiparesis and impaired consciousness. He had leukocytosis (13,530/μL) with peripheral eosinophilia (25%, absolute count 3,400 /μL). CSF analysis revealed no abnormalities and brain CT showed poorly defined hypodense lesions on subcortical areas and semioval centers. Magnetic resonance imaging showed multiple foci with increased signals predominantly in the white matter in both hemispheres, especially at frontal and occipital regions and at semioval centers. Lesions reinforced after paramagnetic contrast. Serological studies found specific IgG antibodies by ELISA against antigens of the genus Toxocara, which were confirmed by a positive IgG Western Blot. The patient was treated with albendazole (800 mg/d) for 14 days associated with parenteral and then oral corticosteroids with a favorable response and gradual complete recovery.

La neurotoxocariasis es infrecuente. Sus manifestaciones incluyen eventos de meningitis, encefalitis y con menor frecuencia vasculitis, que se manifiestan como cefalea, convulsiones, focalización, confusión, alteraciones cognitivas o fiebre. La eosinofilia periférica, junto a elementos clínicos e imágenes compatibles, permiten su sospecha. Informamos el caso de un trabajador agrícola de 48 años que ingresó por una semana de molestias gastrointestinales, cefalea, hemiparesia izquierda progresiva y deterioro de conciencia. Los exámenes revelaron leucocitosis (13.530/μL) con eosinofilia periférica (25%, recuento absoluto 3.400/μL). El análisis del LCR sin anomalías y la tomografía computada cerebral mostró lesiones hipodensas mal definidas en áreas subcorticales y centros semiovales. La resonancia magnética mostró múltiples focos con aumento de la señal predominantemente en la sustancia blanca en ambos hemisferios. Las lesiones presentaron refuerzo tras contraste paramagnético. Los estudios serológicos indicaron anticuerpos IgG específicos por ELISA contra antígenos del género Toxocara. El paciente fue tratado con albendazol (800 mg /día) durante 14 días asociado a corticoides con respuesta favorable y una recuperación gradual completa.

Immunosuppressors and immunomodulators in Neurology - Part I: a guide for management of patients underimmunotherapy / Imunossupressores e imunomoduladores em Neurologia - Parte I: um guia para o manejo de pacientes em imunoterapia

ABSTRACT For patients with autoimmune diseases, the risks and benefits of immunosuppressive or immunomodulatory treatment are a matter of continual concern. Knowledge of the follow-up routine for each drug is crucial, in order to attain better outcomes and avoid new disease activity or occurrence of adverse effects. To achieve control of autoimmune diseases, immunosuppressive and immunomodulatory drugs act on different pathways of the immune response. Knowledge of the mechanisms of action of these drugs and their recommended doses, adverse reactions and risks of infection and malignancy is essential for safe treatment. Each drug has a specific safety profile, and management should be adapted for different circumstances during the treatment. Primary prophylaxis for opportunistic infections and vaccination are indispensable steps during the treatment plan, given that these prevent potential severe infectious complications. General neurologists frequently prescribe immunosuppressive and immunomodulatory drugs, and awareness of the characteristics of each drug is crucial for treatment success. Implementation of a routine before, during and after use of these drugs avoids treatment-related complications and enables superior disease control.

RESUMO Pacientes com doenças autoimunes exigem uma constante preocupação com os riscos e benefícios do tratamento imunossupressor ou imunomodulador. O conhecimento das rotinas no uso de cada uma dessas drogas é fundamental para o bom desfecho clínico, evitando a piora da doença ou efeitos colaterais. As drogas imunossupressoras e imunomoduladoras agem em diferentes pontos da resposta imunológica a fim de controlar a doença para qual são indicadas. O conhecimento do mecanismo de ação, principais posologias, efeitos adversos e os riscos de infecções e neoplasias relacionadas ao uso dessas medicações são fundamentais para um tratamento seguro. Cada uma delas apresenta um perfil específico de complicações e o manejo deve ser individualizado em diferentes cenários ao longo do seguimento do paciente. O uso de medicações para profilaxia primária de infecções e a vacinação são pontos essenciais no planejamento do tratamento, prevenindo potenciais complicações infecciosas ao longo do acompanhamento. O uso de imunossupressores e imunomoduladores é uma frequente realidade no dia-a-dia do neurologista, e o conhecimento das características de cada droga é crucial para o sucesso do tratamento. A realização de uma rotina antes, durante e depois do uso dessas medicações evita complicações relacionadas com o tratamento e alcança um melhor controle da doença.

Toxoplasmosis ocular activa: consideraciones actuales sobre el tratamiento / Active ocular toxoplasmosis: current management considerations

RESUMEN Introducción: la toxoplasmosis ocular constituye la principal causa de uveítis posterior en el mundo; representa un trastorno recurrente con fatales consecuencias para la visión. Objetivo: exponer las diferentes alternativas actuales de tratamiento en la toxoplasmosis ocular Métodos: se llevó a cabo una búsqueda bibliográfica con el empleo de literatura nacional e internacional, en formato electrónico e impreso en el buscador de acceso libre Google académico y las bases de datos de Medline/Pubmed y Scielo. Desarrollo: en la actualidad aún no existe un consenso en cuanto a la mejor pauta de tratamiento, por lo que el objetivo de esta revisión es exponer las diferentes alternativas según la bibliografía consultada nacional e internacional. Sus indicaciones están determinadas por las condiciones clínicas del paciente: la edad pediátrica, el embarazo, el estado inmune del individuo enfermo, la intensidad del cuadro inflamatorio ocular y el número de recurrencias. Las opciones terapéuticas de modo general se realizan con inhibidores de dihidrofolato, sulfonamidas y esteroides. Conclusiones: la finalidad del tratamiento está enfocada en disminuir la replicación del parásito durante la etapa activa y minimizar el daño retinal, fundamentalmente en las lesiones que afecten la mácula. Por lo que resulta de interés el conocimiento de las distintas alternativas, a fin de lograr un buen resultado visual del paciente afecto por toxoplasmosis ocular y evitar la discapacidad visual o ceguera por esta parasitosis.

ABSTRACT Introduction: ocular toxoplasmosis is the leading cause of posterior uveitis in the world; it represents a recurrent disorder with fatal consequences for vision. Objective: to present the different current treatment alternatives in ocular toxoplasmosis. Methods: a bibliographic search was carried out using national and international medical literature, in electronic and printed format in the open access search engine Google Scholar and the Medline/Pubmed and SciELO databases. Development: at present there is still no consensus as to the best treatment guideline, therefore the aim of this review is to present the different alternatives according to the national and international medical literature consulted. Its indications are determined by the clinical conditions of the patient: pediatric age, pregnancy, the immune status of the patient, the intensity of the ocular inflammatory condition and the number of recurrences. The therapeutic options are generally carried out with dihydrofolate inhibitors, sulfonamides and steroids. Conclusions: the purpose of treatment is focused on reducing parasite replication during the active stage and minimizing retinal damage, mainly in lesions affecting the macula. Therefore, it is of interest to know the different alternatives in order to achieve a good visual outcome in patients affected by ocular toxoplasmosis and avoid visual disability or blindness due to this parasitic disease.

Evaluación Comparativa de la Inflamación de Tejidos Blandos en Pacientes Sometidos a Exodoncias de Terceros Molares con y sin Uso de PRF

RESUMEN: La exodoncia de los terceros molares, es uno de los procedimientos ambulatorios más frecuente en la cirugía oral, donde habitualmente requiere de osteotomías y odontosección. Es por el cual, el manejo de la inflamación postoperatoria ha ido variando, con el fin de obtener mejores resultados con el menor riesgo posible. Comparar la eficacia de Dexametasona versus L- PRF en el control de la inflamación, dolor y trismus, en pacientes sin patologías basales sometidos a exodoncias de terceros molares inferiores incluidos y semi incluidos. Se realizó un estudio experimental clínico controlado aleatorizado, autorizado por el comité de ética de la Universidad Andrés Bello, con el código PROPRGFO 54- 2019. El tamaño muestral fue de 31 pacientes, dividido en 2 grupos, Grupo A Dexametasona (15) y Grupo B PRF (16). Ambos grupos fueron medicados de manera IV con Cefazolina 1 gr y Ketoprofeno 100 mg. Excepcionalmente al grupo A se le administró Dexametasona 4 mg. Una vez realizada la extracción del tercer molar, se aplicó L-PRF en el alvéolo de los pacientes del grupo B. Se indicaron los mismos cuidados y medicación postquirúrgica para ambos grupos. Cada paciente se controló en 4 ocasiones: Antes de la cirugía, inmediatamente después, a las 72 horas y a los 7 días de realizada la intervención, donde se consignaron las medidas faciales según el método de Neupert. Además, se registró la intensidad de dolor según escala EVA y longitud de apertura bucal. No existen diferencias estadísticamente significativas en cuanto a inflamación entre ambos grupos analizados, ni en cuanto al control de la inflamación entre cada instante de tiempo, cuando se analizó cada método por separado. Se puede considerar al L-PRF como una alternativa a la medicación preoperatoria clásica para disminuir la inflamación y complicaciones postoperatorias en pacientes en los cuales está contraindicado el uso de corticoides.

ABSTRACT: Third molar extraction is one of the most frequent outpatient procedures in oral surgery, usually requiring osteotomies and odontosection. For this reason, the management of post operative inflammation has been varying in order to obtain better results with the lowest posible risk. The aim was to compare the efficacy of Dexamethasone versus L-PRF in the control of inflammation, pain and trismus in patients without basal pathologies who underwent exodontia of included and semi-included lower third molars. A randomised controlled clinical experimental study was carried out, authorised by the ethics committee of the Universidad Andrés Bello, with code PROPRGFO 54- 2019. The simple size was 31 patients, divided into 2 groups, Group A Dexamethasone (15) and Group B PRF (16). Both groups were medicated IV with Cefazolin 1 g and Ketoprofen 100 mg. Exceptionally, group A was given Dexamethasone 4 mg. After the extraction of the third molar, L-PRF was applied to the alveolus of group B patients. The same post- surgical care and medication was indicated for both groups. Each patient was monitored on 4 occasions: Before surgery, immediately after, 72 hours and 7 days after surgery, where facial measurements were recorded according to Neupert's method. In addition, pain intensity was recorded according to the VAS scale and buccal opening length. There are no statistically significant differences in terms of inflammation between the two groups analysed, nor in L-PRF can be considered as an alternative to classic preoperative medication to reduce inflammation and post operative complications in patients in who use of corticosteroids is contraindicated.

Opinião de médicos brasileiros sobre o tratamento da COVID-19 / Opinion of Brazilian physicians on the treatment of COVID-19 / Opinión de médicos brasileños sobre el tratamiento de la COVID-19

Objetivo: Investigar a opinião de médicos brasileiros sobre o tratamento precoce da COVID-19 com hidroxicloroquina/ cloroquina e azitromicina em pacientes com suspeita clínica e sobre o tratamento com corticoterapia na fase inflamatória da doença. Métodos: Trata-se de uma pesquisa de opinião, com amostragem por conveniência, com médicos atuantes no Brasil. A coleta dos dados ocorreu no período de 26 de maio a 8 de junho de 2020 (13 dias), por meio de um formulário Google, disponibilizado publicamente nas redes sociais e aplicativos de comunicação. Realizou-se uma análise descritiva dos dados, teste de independência, teste T Student e modelo de regressão logística com análise multivariada. Resultados: A pesquisa contou com 1.020 médicos participantes, com média de 21,9 anos de formado. 72,4% dos participantes apresentaram-se a favor do tratamento precoce com hidroxicloroquina/cloroquina e azitromicina e 89,7% dos médicos apresentaram-se favoráveis ao uso da corticoterapia para o tratamento da fase inflamatória da COVID-19. Constatou-se também que participantes com maior idade, com residência médica, atuantes nas regiões Nordeste e Norte possuíam mais chances de serem favoráveis aos tratamentos. Por outro lado, profissionais especialistas em medicina intensiva, infectologia e pneumologia, além de atuantes nas unidades de terapia intensiva, mostraram-se mais desfavoráveis. Conclusão: A maioria dos médicos investigados nesta pesquisa de opinião mostrou-se a favor do tratamento precoce apresentado e do uso da corticoterapia no tratamento da COVID-19. Já os especialistas em medicina intensiva, infectologia e pneumologia e profissionais atuantes nas Unidades de Terapia Intensiva mostraram-se mais desfavoráveis.

Objective: To investigate the opinion of Brazilian physicians on the early treatment of COVID-19 with hydroxychloroquine/ chloroquine and azithromycin in patients with clinical suspicion and on the treatment with corticosteroid therapy in the inflammatory stage of the disease. Methods: This is an opinion survey conducted with a convenient sample of physicians working in Brazil. Data were collected from May 26 to June 8, 2020 (13 days) through Google forms made publicly available on social media and chat applications. Data underwent descriptive analysis, independence test, Student t-test, and a logistic regression model using multivariate analysis. Results: The survey included 1020 physicians with a mean of 21.9 years since graduation. 72.4% of the participants were in favor of early treatment with hydroxychloroquine/chloroquine and azithromycin and 89.7% of the physicians were in favor of using corticosteroid therapy to treat the inflammatory stage of COVID-19. We also observed that older participants, those who completed medical residency, and those working in the Northeast and North regions were more likely to be in favor of the treatments. On the other hand, professionals specialized in intensive care medicine, infectious diseases and pneumology and working in intensive care units were more opposed. Conclusion: Most physicians in this opinion survey were in favor of the early treatment presented and the use of corticosteroid therapy in the treatment of COVID-19. But specialists in intensive care medicine, infectious diseases and pulmonology, and professionals working in Intensive Care Units were more opposed to them.

Objetivo: Investigar la opinión de médicos brasileños sobre el tratamiento precoz de la COVID-19 con la hidroxicloroquina/ cloroquina y la azitromicina en pacientes con sospecha clínica y bajo el tratamiento de corticoterapia en la fase inflamatoria de la enfermedad. Métodos: Se trata de una investigación de opinión con la muestra de conveniencia realizada con médicos de Brasil. La recogida de datos se dio en el periodo entre 26 de mayo y 8 de junio de 2020 (13 días) a través de un formulario Google que ha estado disponible públicamente en las redes sociales y los aplicativos de comunicación. Se realizó un análisis descriptivo de los datos, la prueba de independencia, la prueba T Student y el modelo de regresión logística con el análisis multivariado. Resultados: La investigación tuvo 1.020 médicos participantes, con la media de 21,9 años de término del grado. El 72,4% de los participantes se presentaron a favor del tratamiento precoz con la hidroxicloroquina/cloroquina y la azitromicina y el 89,7% de los médicos se presentaron favorables a la utilización de la corticoterapia para el tratamiento de la fase inflamatoria de la COVID-19. Se constató también que los participantes de más edad, con el curso de residencia medica y que eran de las regiones Noreste y Norte del país eran más favorables a los tratamientos. Los profesionales especialistas de la medicina intensiva, la infectologia y la neumología, además de actuaren en las unidades de cuidados intensivos parecieron más desfavorables. Conclusión: La mayoría de los médicos investigados de esa investigación de opinión se mostró favorable al tratamiento precoz presentado y a la utilización de la corticoterapia para el tratamiento de la COVID-19. Los especialistas de la medicina intensiva, la infectología y la neumología y los profesionales de las Unidades de Cuidados Intensivos se presentaron más desfavorables a los tratamientos.

Comparison between concentrated bone marrow aspirate and corticoid in gluteal tendinopathy / Comparação entre o aspirado de medula óssea concentrado e o corticóide na tendinopatia glútea

ABSTRACT Objective: To compare bone marrow aspirate concentrate (BMAC) with the standard treatment for gluteal tendinopathies. Methods: 48 patients diagnosed with gluteal tendinopathy at a university hospital were selected by a randomized clinical trial and divided into two groups: (G1) bone marrow aspirate concentrate and (G2) corticosteroid injections. Results: 40 of the 48 selected patients were monitored for six months and both groups showed better scores. Visual analog scale (VAS) scores and Lequesne index were statistically significant higher in patients submitted to BMAC treatment when compared to standard treatment. Both groups improved their quality of life, without statistically significant difference. Conclusion: BMAC constitutes an alternative to gluteal tendinopathy standard treatment, proving to be a safe technique with promising results when combined with multidisciplinary team behavioral therapy. Level of Evidence II, Randomized Clinical Trial.

RESUMO Objetivo: Estudo comparativo entre tratamento com corticóide e aspirado de medula óssea concentrado (BMAC) para o tratamento de tendinopatias glúteas. Métodos: O ensaio clínico randomizado selecionou pacientes diagnosticados com tendinopatia glútea e os dividiu em dois grupos: (G1) aspirado de medula óssea concentrada e (G2) injeção de corticosteróide. Resultados: Foram selecionados 48 pacientes, dos quais 40 foram monitorados por 6 meses, com melhora nos escores nos dois grupos. Os pacientes que foram submetidos ao tratamento com BMAC tiveram uma melhora estatisticamente significativa nos escores de EVA e nos escores de Lequesne em comparação ao tratamento padrão. Houve uma melhora na avaliação da qualidade de vida em ambos os grupos, sem diferença estatisticamente significativa. Conclusão: O aspirado de medula óssea concentrada surge como uma alternativa ao tratamento padrão da tendinopatia glútea, provando ser uma técnica segura e com resultados promissores quando combinada à terapia comportamental de equipe multidisciplinar. Nível de Evidência II, O ensaio clínico randomizado.

Esquemas terapéuticos y factores asociados a mortalidad en pacientes con cuadro severo de COVID-19 atendidos en Hospital Nacional Alberto Sabogal Sologuren 2020 / Therapeutic regimens and factors associated with mortality in patients with severe COVID-19 infection treated at the Hospital Nacional Alberto Sabogal Sologuren, 2020

RESUMEN Objetivo: Explorar el esquema terapéutico y factores asociados a mortalidad en pacientes con un cuadro severo de COVID-19 atendidos en el Hospital Nacional Alberto Sabogal Sologuren en 2020. Materiales y métodos: Estudio observacional, analítico de caso-control y prospectivo. Fueron incluidos los pacientes que ingresaron al hospital con un cuadro severo de COVID-19 entre junio a septiembre de 2020 y fueron clasificados en dos grupos: el grupo caso (61 pacientes fallecidos) y el grupo control (60 sobrevivientes que recibieron el alta hospitalaria). Los datos fueron analizados en el software estadístico Stata(R) y se realizó análisis bivariado y multivariado con regresión logística, nivel de confianza del 95 %. Resultados: En pacientes con cuadro severo de COVID-19, la edad mayor de 60 años está asociada a la mortalidad (p=0,035; OR=2,21 IC: [1,05-4,63]). Los esquemas terapéuticos fueron variados, los participantes que recibieron metilprednisolona a dosis altas tuvieron mayor probabilidad de morir en comparación a los que recibieron otros corticoides (p=0,001; OR ajustado=5,18 IC: [1,94-13,83]). El tratamiento con azitromicina por más de cinco días incrementa la probabilidad de fallecer en comparación a los que la tomaron por menos días (p=0,000; OR ajustado=7,14 IC: [2,22-22,99]). El modelo multivariado tenía una probabilidad predictiva de mortalidad de 73,06 % para los pacientes con cuadro severo de COVID-19. Conclusiones: Los esquemas terapéuticos que incluyen administración de metilprednisolona a dosis altas y azitromicina por más de 5 días incrementan la probabilidad de fallecer en los pacientes con una presentación severa de COVID-19. Además, la edad mayor a 60 años estuvo asociada a la mortalidad en los pacientes analizados en el estudio.

ABSTRACT Objective: To explore the therapeutic regimen and factors associated with mortality in patients with severe COVID-19 infection treated at the Hospital Nacional Alberto Sabogal Sologuren in 2020. Materials and methods: An observational, case-control, analytical and prospective study conducted in patients with severe COVID-19 infection at hospital admission between June and September 2020. The study population was classified into two groups: case group (61 deceased patients) and control group (60 discharged patients). Data were analyzed using Stata statistical software. Bivariate and multivariate logistic regression analyses were performed with a 95 % confidence level. Results: As for patients with severe COVID-19 infection, ages older than 60 years are associated with mortality (p = 0.035; OR = 2.21; CI: [1.05 - 4.63]). Different therapeutic regimens were included in the research: patients who received high-dose methylprednisolone had more probability of dying compared to those who received other corticosteroids (p = 0.001; adjusted OR = 5.18; CI: [1.94 - 13.83]). Patients who were treated with azithromycin for more than five days had more probability of dying compared to those that took it for fewer days (p = 0.000; adjusted OR = 7.14; CI: [2.22 - 22.99]). The multivariate model showed a 73.06 % predictive probability of mortality for patients with severe COVID-19 infection. Conclusions: The therapeutic regimens that include the administration of high-dose methylprednisolone and azithromycin for more than five days increase the probability of dying in patients with severe COVID-19 infection. Furthermore, ages over 60 years were associated with mortality in the patients who participated in the study.

Use of hyaluronic acid associated with triamcinolone acetonide or ozone gas in the treatment of induced osteoarthritis in rabbits

Purpose: To evaluate the effects of the intra-articular application of hyaluronic acid associated with triamcinolone acetonide, and ozone gas in the treatment of induced osteoarthritis in rabbit’s stifles.Methods: Twenty-one Norfolk rabbits were submitted to cranial cruciate ligament transection of the left stifle. After six weeks of the surgery, the rabbits were randomized assigned into three groups: G1 (control) – saline solution (0.9%); G2 – hyaluronic acid associated with triamcinolone; G3 – ozone gas, submitted to three intra-articular applications every seven days. Results: Significant differences occurred: osteophytes at medial femoral condyle (G2 > G1, G2 > G3) on radiography exam; thickening of the medial condyle (G1 > G3, G2 > G3) on ultrasound exam; osteophytes at lateral tibial condyle (G2 > G1, G2 > G3), and medial femoral condyle (G1 > G2, G3 > G1) on computed tomography. Histologically, mean values of chondrocytes in the femur and tibia in G3 and G2 were statistically lower. Conclusions: The intra-articular injection of hyaluronic acid associated with triamcinolone accentuated degenerative joint disease by imaging and macroscopic evaluations, and by histological findings, this treatment and the ozone gas treatment showed similar effects and were inferior to the saline solution (0.9%).

Uso de corticosteroides no tratamento da lesão hepática aguda grave decorrente de anabolizante estanazolol / Use of corticosteroids in the treatment of stanazolol-induce severe acute liver injury

A busca pelo corpo perfeito pode gerar graves consequências para a população que faz uso indiscriminado de substâncias visando a resultados rápidos. O caso relatado se refere a um pa- ciente de 21 anos, do sexo masculino, na cidade de São Paulo (SP), que apresentou quadro de síndrome colestática 15 dias após uso do anabolizante estanazolol para fins estéticos na ativi- dade física, evoluindo com hepatite medicamentosa grave, com aumento de transaminases, hiperrubilinemia às custas de bilirrubina direta e fatores de coagulação, sem resposta satis- fatória ao tratamento de suporte convencional, com melhora significativa após introdução de corticoterapia.

Searching for the perfect body image can cause severe conse- quences to the population using substances indiscriminately to reach results fast. The case reported refers to a male patient, 21 years old, from the city of São Paulo (SP), who developed choles- tatic syndrome 15 days after the use of the steroid Stanazol for aesthetic purposes during physical activity, progressing with se- vere drug-induced hepatitis, transaminases, bilirubin, and coagu- lation factors increase with no satisfactory response to the con- ventional support treatment, and significant improvement after the introduction of corticotherapy.

Frequência da Covid-19 em pacientes com diagnóstico de lúpus eritematoso sistêmico / Frequency of Covid-19 in followed patients diagnosed with systemic erythematous lupus

Objetivos: Determinar a frequência da Covid-19 em indivíduos com lúpus eritematoso sistêmico, bem como descrever aspectos relacionados a esse adoecimento. Métodos: Estudo observacional longitudinal, com 418 indivíduos, divididos em um grupo caso, composto de 224 portadores de doenças reumáticas imunomediadas, e grupo controle, composto de 194 contactantes domiciliares sem essas doenças. Resultados: A ocorrência de Covid-19 entre indivíduos com lúpus foi de 5,8% (n=13), por outro lado, 41,1% (n=92) relataram sintomas gripais. Dentre os casos da Covid-19 em indivíduos com lúpus, 15,4% (n=2) necessitaram da internação hospitalar e 7,7% (n=1) tiveram necessidade de ventilação mecânica. Nenhum paciente evoluiu a óbito. Foram 11 (84,6%) as pessoas que relataram não ter havido piora dos sintomas do lúpus com a infecção da Covid-19. Conclusão: As mani- festações da Covid-19 nos indivíduos com lúpus foram compatíveis com aquelas demonstradas para a população geral. O uso de hidroxicloroquina e de corticoides não demonstrou associação protetora ou de risco para a ocorrência da Covid-19, sendo necessários estudos adicionais, também para determinar se indivíduos com lúpus estão mais suscetíveis a formas graves da Covid-19.

Objectives: To determine the frequency of Covid-19 in people with systemic lupus erythematosus, as well as to describe aspects related to this illness. Methods: A longitudinal observational study was conducted with 418 individuals, who were divided in one case group, consisting of 224 people with immune-mediated rheumatic diseases, and a control group, composed of 194 home contacts with none of these illnesses. Results: The occurrence of Covid-19 among people with lupus was 5,8% (n=13). On the other hand, 41,1% (n=92) reported flu-like symptoms. Among the cases of Covid-19 in people with lupus, 15,4% (n=2) needed hospitalization and 7,7% (n=1) needed mechanical ventilation. No patient progressed to death. Eleven individuals (84,6%) reported no worsening of the manifestations of lupus while with Covid-19. Conclusion: The manifestations of Covid-19 among the people with lupus were consistent with those reported for the general population. The use of hydroxychloroquine and corticoids did not show risky or protective association to the occurrence of Covid-19, with additional studies therefore being required also to determine if individuals with lupus are more susceptible to severe presentations of Covid-19.