Corticoides sistémicos en COVID-19 / Systemic corticosteroids in COVID-19

CONTEXTO CLÍNICO: La Enfermedad por el Coronavirus 2019 (COVID­19, por su sigla en inglés Coronavirus Disease 2019) es una enfermedad respiratoria de humanos producida por un nuevo coronavirus identificado con la sigla SARS-CoV-2. El 11 de marzo de 2020 la Organización Mundial de la Salud (OMS) declaro la COVID-19 como una pandemia. Desde ese momento hasta el 15 de junio su circulación se ha reportado en 205 países reportándose más de 7.800.000 casos y la muerte 430.000 personas. El período de incubación de la infección es de 2 a 14 días. La mayor parte de los contagios se producen persona a persona, siendo altamente transmisible.(3) La clínica varía desde casos asintomáticos a cuadros febriles con tos y dificultad respiratoria, neumonía y distrés respiratorio. También puede acompañarse de alteraciones gastrointestinales. En los casos con mal pronóstico, el paciente presenta un importante deterioro respiratorio en 4-8 días. Las imágenes radiológicas muestran generalmente neumonía focal o generalizada semejante al síndrome de distress respiratorio agudo. (3) La mayoría de los casos graves requieren ingreso hospitalario, siendo mayoritariamente casos primarios en pacientes de edad avanzada y con comorbilidades (diabetes, enfermedad crónica renal, hipertensión, enfermedad cardiaca y enfermedad pulmonar crónica). La tasa media de letalidad de los pacientes ingresados a UTI es cercana al 49%, siendo los valores más elevados en pacientes masculinos de más de 50 años con comorbilidades múltiples. Actualmente el tratamiento de la COVID­19 es sintomático y de sostén no existiendo hasta el momento tratamiento farmacológico específico curativo. Debido a la evidencia que sugiere que el daño pulmonar agudo observado en la infección por SARS-CoV-2 estaría asociada a la activación de las células inmunes circulantes, incluyendo células T y las citoquinas que conducen a un síndrome de liberación de citoquinas (similar al síndrome de activación macrofágica y hemofagocítico) por lo que se plantea que el uso de corticoides sistémicos podría disminuir la mortalidad y/o necesidad de soporte ventilatorio invasivo. TECNOLOGÍA: Los glucocorticoides (GCS) son una familia de medicamentos antiinflamatorios e inmunomoduladores que se utilizan en el tratamiento de diversas patologías cuyo principal componente etiopatogénico es la inflamación. Dentro de los mecanismos de acción propuestos se encuentran: inhibición de citoquinas inflamatorias (IL-1 y IL-2), inhibición de la migración de leucocitaria, inhibición de la desgranulación de mastocitos, depleción linfocitaria (principalmente linfocitos T), incremento de citoquinas anti-inflamatorias (IL-10). Dentro de las alternativas para la administración sistémica se pueden mencionar a la hidrocortisona, dexametasona, betametasona, prednisona, prednisolona, metilprednisolona y deflazacort. Todos ellos difieren principalmente en el grado de actividad mineralocorticorticoide y vida media. OBJETIVO: El objetivo del presente informe es evaluar la evidencia disponible acerca de la eficacia, seguridad y aspectos relacionados a las políticas de cobertura del uso de corticoides sistémicos en COVID­19. MÉTODOS: Se realizó una búsqueda en las principales bases de datos bibliográficas, en buscadores genéricos de internet, y financiadores de salud. Se priorizó la inclusión de revisiones sistemáticas (RS), ensayos clínicos controlados aleatorizados (ECAs), evaluaciones de tecnologías sanitarias (ETS), evaluaciones económicas, guías de práctica clínica (GPC) y recomendaciones de diferentes organizaciones de salud. RESULTADOS: Se incluyeron un ECA, una RS, dos estudios observacionales, un documento de evaluación de tecnología sanitaria, 12 guías de práctica clínica, recomendaciones de organismos gubernamentales o sociedades científicas acerca del uso de corticoides sistémicos en pacientes con diagnóstico de COVID­19. CONCLUSIONES: Evidencia de alta calidad proveniente de los resultados de un ensayo clínico aleatorizado aún no publicado sugiere que el uso de corticoides sistémicos se asocia a una disminución en el riesgo de mortalidad principalmente en pacientes con requerimientos de oxigeno suplementario o asistencia mecánica invasiva. Evidencia de muy baja calidad también sugiere que podría tener el mismo beneficio en aquellos pacientes con COVID-19 que presentan síndrome de distrés respiratorio agudo. Múltiples ensayos clínicos aleatorizados en pacientes con cuadros moderados o severos se encuentran en curso. Las guías de práctica clínica de diferentes sociedades internacionales y organismos gubernamentales que lo recomiendan indican su utilización para el tratamiento de pacientes con criterios de síndrome de distrés respiratorio agudo. Si bien no se encontraron estudios de costo-efectividad en Latinoamérica, el costo total del tratamiento al igual que su impacto presupuestario sería muy bajo.

Psoríase com manifestação oral exclusiva / Psorías con manifestación bucal exclusiva / Exclusively oral psoriasis

RESUMO Introdução: a psoríase é uma doença inflamatória crônica e recorrente da pele que raramente ocorre apenas e primariamente na mucosa bucal. Objetivo: A descrever um caso de psoríase primária na mucosa bucal. Apresentação do caso: Um paciente de 16 anos de idade relatou uma "mancha que fez com que se sentisse desconfortável". O paciente apresentava uma placa leucoplásica, exofítica e uma úlcera. Na histopatologia e com as características clínicas, a suspeita de mucosite psoriasiforme foi confirmada. O tratamento escolhido para as lesões da psoríase foi a aplicação tópica de valerato de betametasona 1 mg/g por três semanas. Após duas semanas de tratamento, o paciente retornou para reavaliação clínica e foi observado sucesso na terapêutica. Conclusões: A presença de psoríase exclusiva na cavidade bucal é uma entidade rara. A apresentação clínica variada e a ausência de alterações locais ou sistêmicas associadas foram elementos-chave na suspeição diagnóstica. A abordagem por meio de cirurgia para remoção da lesão exofítica e o uso de betametasona tópica permitiram o controle locorregional(AU)

RESUMEN Introducción: La psoriasis es una enfermedad inflamatoria crónica y recurrente de la piel y que en rara ocasión ocurre única y por primaria vez en mucosa bucal. Objetivo: Describir un caso de psoriasis primaria en mucosa bucal. Presentación de caso: Paciente de 16 años de edad consultada que refirió una "mancha que incomodaba al comer". La paciente presentaba una placa leucoplásica, exofítica y una úlcera. En la histopatología y con las características clínicas, se confirmó la sospechosa de mucositis psoriasiforme. El tratamiento elegido para las lesiones de psoriasis fue la aplicación tópica de valerato de betametasona 1 mg/g durante tres semanas. Después de dos semanas de tratamiento la paciente retornó para reevaluación clínica y se constató éxito en la terapéutica escogida. Conclusiones: la presencia de psoriasis exclusiva en la cavidad bucal es una entidad poco frecuente. La presentación clínica variada y la ausencia de alteraciones locales o sistémicas asociadas fueron elementos clave en la sospecha diagnóstica. El abordaje por medio de cirugía para remoción de la lesión exofítica y utilización de betametasona tópica posibilitó el control locorregional(AU)

ABSTRACT Introduction: Psoriasis is a chronic inflammatory and recurrent skin disease that rarely occurs solely and primarily in the oral mucosa. Objective: Describe a case of primary psoriasis of the oral mucosa. Case presentation: A 16-year-old female patient attends consultation and reports "a spot that hurts when eating." Clinical observation revealed the presence of leukoplastic, exophytic plaque and an ulcer. Histopathological examination confirmed the suspicion of psoriasiform mucositis. The treatment chosen for the psoriatic lesions was topical application of betamethasone valerate 1 mg/g for three weeks. After two weeks of treatment, the patient returned for clinical reassessment and the treatment applied was found to have been successful. Conclusions: Exclusively oral psoriasis is an uncommon condition. Multi-faceted clinical presentation and the absence of local or systemic associated alterations were key elements in the diagnostic suspicion. Surgical removal of the exophytic lesion and application of topical betamethasone led to locoregional control(AU)

Envenomation by an opisthoglyphous snake, Erythrolamprus aesculapii (Dipsadidae), in southeastern Brazil

Abstract Snakebites by aglyphous or opisthoglyphous snakes are common in Brazil. We report a case of snakebite by the opisthoglyphous Erythrolamprus aesculapii. The victim presented with pain, edema, and bleeding at the bite site, along with erythema, similar to a Bothrops envenomation. In this type of snakebite, if the snake is not brought to the hospital, the victim may receive unnecessary serum therapy, with the risk of adverse reactions to the antivenom. The possibility of reducing after-effects with anti-inflammatory drugs and early antibiotic therapy for secondary infection need to be further investigated, preferably in multicenter studies, while observing good clinical practice.

Rotura prematura de membrana: abordagem clínica / Premature membranes rupture: a clinical approach

A rotura prematura de membranas (RPM) é conceituada como corioamniorrexe espontânea que ocorre antes do início do trabalho de parto, independentemente da idade gestacional. Ocorre, aproximadamente, em 10% das gestações. A maioria dos casos incide em pacientes de termo e 2-3% dos casos em gestações pré-termo. Seu diagnóstico, em 90% das vezes, é clínico. Em relação às condutas, a intenção é reduzir ao máximo os prejuízos para o binômio materno-fetal, mas essa é uma tarefa complicada e que ainda suscita muitas discussões. Prioriza-se a interrupção da gestação na presença de corioamnionite ou sofrimento fetal. Na ausência destes, as condutas devem ser individualizadas de acordo com a idade gestacional, levando em conta o uso de corticoterapia e neuroprofilaxia com sulfato de magnésio.(AU)

Premature membranes rupture (PMR) is conceptualized as spontaneous chorioamniorrex that occurs before labor begins, regardless of gestational age. It occurs in approximately 10% of pregnancies. The majority of cases are in term pregnancies patients and 2-3% of cases in preterm pregnancies. The diagnosis is predominantly clinical (about 90%). In relation to the management, the intention is to reduce to the maximum the losses to the maternal-fetal binomial, but this is a complicated task and that still raises many discussions. Discontinuation of gestation is prioritized in the presence of chorioamnionitis or fetal distress. In the absence of these, the management should be individualized according to gestational age, taking into account the use of corticosteroids and neuroprophylaxis with magnesium sulfat.(AU)

Segmental lichen aureus: an uncommon presentation

Abstract: Pigmented purpuric dermatoses are chronic vascular inflammatory conditions characterized by the presence of pigmented macules. Among its different presentations, lichen aureus is distinguished by the lichenoid conformation of its plaques and the predilection for lower limb involvement. Its segmented form is rare and difficult to control, especially in cases of symptomatic lesions. We report a rare case of segmental lichen aureus with six years of evolution associated with light itching. We also discuss the main therapeutic approaches to control the disease.

Periapical injection of betamethasone to control postoperative pain in emergency endodontic care - a randomized double blind clinical trial

Aim: the objective of this study was to evaluate the effect of betamethasone in the control of postoperative pain in patients undergoing endodontic treatment. Methods: patients of both genders (n = 120), after being submitted to emergency endodontic treatment, received a single dose of betamethasone solution (0.05 mg / body weight) or sterile saline solution intramucosally, in the periapical region of the treated tooth. The study evaluated the intensity of pain experienced by the patient and the number of analgesics consumed during periods of 4, 24 and 48 hours after endodontic treatment. To compare the level of pain among the groups and the use of analgesics the Fisher's Exact Test was used, adopting a significance level of 95%. Results: patients who received betamethasone felt less pain in 4 hours (p = 0.0177) and 24 hours (p = 0.0012) compared to those who received the placebo. Conclusions: betamethasone at a dose of 0.05 mg / body weight administered in the periapical region is a advantageous protocol due to its effectiveness, and also because of the comfort it provides to patients in the prevention or control of inflammatory pain in endodontics. (AU)

Improvement of health-related quality of life and adherence to treatment with calcipotriol-betamethasone dipropionate gel in patients with psoriasis vulgaris

Abstract BACKGROUND: Psoriasis is a common, chronic, recurrent, immune-mediated disorder of the skin and joints. It can have a significant negative impact on the physical, emotional and psychosocial wellbeing of affected patients. OBJECTIVES: To measure improvement in health-related QoL (HRQoL) in Greek patients with psoriasis vulgaris after a month of treatment with calcipotriol-betamethasone dipropionate gel; and evaluate adherence to treatment parameters. METHODS: The study included 394 psoriasis vulgaris patients from 16 private dermatological practices in Greece, all treated with calcipotriol-betamethasone dipropionate gel. They were evaluated at the first visit and after 4 weeks. Moreover, they completed the Dermatology Life Quality Index (DLQI), while other data such as disease severity, subjective symptoms and adherence, were collected. RESULTS: At week 4, the DLQI median was reduced by 3.5 points from the baseline (p<0.001; baseline and week 4 median: 4.5 and 1.0 respectively). Pruritus and sleep disorders also improved (p<0.001). Furthermore, 90.1% of the subjects fully adhered to treatment, with a 97.1% mean level of compliance. CONCLUSIONS: The convincing clinical results, with a distinct improvement in HRQoL, plus the high level of adherence due to its advantageous physical properties, make the calcipotriol-betamethasone dipropionate gel formulation an important, effective and well-tolerated topical therapy to treat psoriasis.

Avaliação da ministração de corticosteroides em situações de suspeita de parto pré-termo iminente: um estudo de coorte retrospectivo em um centro terciário / Evaluation of corticosteroid administration in situations of suspected imminent preterm delivery: a retrospective cohort study in a tertiary centre

ResumoOBJETIVOA ministração antenatal de um ciclo único de corticoterapia está recomendada a mulheres grávidas entre a 24 e a 34 semanas com risco de parto prematuro. O efeito máximo é atingido quando os corticosteroides ministrados entre 24 horas e 7 dias antes do parto. O objetivo deste estudo foi avaliar a ocorrência de parto nos sete dias após corticoterapia nas principais situações obstétricas com risco de parto pré-termoMÉTODOSEstudo de coorte retrospectivo incluindo 209 grávidas internadas em risco de parto pré-termo submetidas a tratamento com corticosteroides para maturação pulmonar fetal. O estudo foi realizado entre janeiro de 2012 e março de 2014 e um hospital universitário. O desfecho principal avaliado foi o número de mulheres que tiveram parto no prazo de 7 dias após a ministração antenatal de corticosteroides. Foram definidos dois grupos de acordo com o motivo para iniciar corticosteroides: ameaça de parto pré-termo (Grupo APPT) e outras indicações para corticoterapia (Grupo RPPT). Foi efetuada uma análise de sobrevivência de Kaplan-Meier e um valor p<0,05 foi considerado estatisticamente significativoRESULTADOS46,4% (n=97) das mulheres grávidas tiveram parto nos 7 dias após a ministração de corticosteroides. Parto em 7 dias ocorreu mais frequentemente no grupo RPPT, em comparação com o grupo APPT (57,3 versus 42,4%, p=0,001). Foi detectada uma diferença estatisticamente significativa entre a curva de sobrevivência para os grupos APPT e RPPT, com um hazard ratio para parto até 7 dias 1,71 vezes maior para o grupo RPPT (IC95% 1,23-2,37; p<0,001)CONCLUSÃOPode-se concluir que a probabilidade de um evento (nascimento dentro de 7 dias após corticoterapia) é menor no grupo de grávidas internadas no contexto de ameaça de parto pré-termo do que por outras indicações. A utilização de corticosteroides em grávidas internadas por suspeita de trabalho parto pré-termo deverá ser alvo de uma rigorosa avaliação clínica.

AbstractPURPOSEThe administration of a single-course antenatal corticosteroid treatment is recommended for pregnant women between 24 and 34 weeks with risk of premature birth. The maximum effect is achieved when antenatal corticosteroids are administered between 24h and 7 days before delivery. The objective of this study was to evaluate the occurrence of birth within seven days of corticosteroid therapy in major obstetric situations with risk of preterm birthMETHODSRetrospective cohort study including 209 pregnant women hospitalized in risk of preterm delivery, submitted to corticosteroid therapy for fetal lung maturation. The study was carried out between January 2012 and March 2014 at a university hospital. Main outcome measure was the number of women who delivered within 7 da ys after antenatal corticosteroid administration. Two groups were defined according to the reason for starting corticosteroids: threatened preterm labour (Group APPT) and other indications for corticosteroid therapy (Group RPPT). A Kaplan-Meier survival analysis was performed and a p value <0.05 was considered statistically significant.RESULTS46.4% (n=97) of pregnant women gave birth in the seven days following corticosteroid administration. Delivery within 7 days occurred more frequently on group 2 in comparison to group 1 (57.3 versus42.4%; p=0.001). There is a statistically significant difference between the survival curve for groups 1 and 2, with a hazard ratio for delivery within 7 days 1.71 times higher for group 2 (95%CI 1.23-2.37; p<0.001)CONCLUSIONIt can be concluded that the probability of an event (birth within 7 days after corticosteroids) is smaller in the group of pregnant women admitted in the context of threatened preterm labor than for other indications. The use of corticosteroids in pregnant women admitted for suspected preterm labor should be subject to rigorous clinical evaluation.

Structural analysis of the phimotic prepuce in patients with failed topical treatment compared with untreated phimosis

To evaluate histological alterations in prepuce of patients with phimosis submitted to topic treatment with betamethasone in association with hyaluronidase.

We studied sixty patients (mean age 4.5), presenting true phimosis and treated with a topical treatment with betamethasone cream (0.2%) + hyaluronidase. The parents of seven of these patients opted for circumcision (control group). The other fifty-three patients were submitted to clinical treatment. The samples were stained with Weigert's resorcin-fuchsin (analysis of the elastic fibers) and Picro-Sirius Red, for analysis of the collagen. The volumetric density of the elastic fibers was determined by stereological methods.

Only eight (15%) of the fifty-three patients submitted to topical treatment presented failure, being indicated for circumcision (histological analysis). We observed an increase of the collagen type III of the patients submitted to topical treatment. The quantification showed a reduction of the volumetric density of the prepuce's elastic fibers of the patients submitted to the cream treatment, when compared to the control group (p = 0.056). The volumetric density of the elastic fibers of the prepuce at the group not submitted to topical treatment showed an average of 14.60% (11.06 to 21.64%); in the group submitted to the cream treatment, the volumetric density of the elastic fibers of the prepuce showed an average of 10.34% (3.45 to 17.9%).

The topical treatment of phimosis with betamethasone 0.2% + hyaluronidase had a success rate of 85%. Patients with failure of the topical treatment with steroid had histological alterations in the prepuce. .

The effectiveness of using different pulp-capping agents on the healing response of the pulp.

Background: Some of the disadvantages of calcium hydroxide Ca(OH) 2 as pulp-capping material are related to the inflammatory response, and its poor sealing ability. Cyanoacrylate glue was proposed in this study as pulp-capping agent because of its sealing ability, and diprogenta, on the other hand, was proposed because of its anti-microbial and anti-inflammatory effects. The aim of this study is to evaluate and compare the histopathological response of the pulp toward cyanoacrylate and diprogenta in direct pulp capping (DPC). Materials and Methods: Cyanoacrylate, diprogenta, and calcium hydroxide were applied on 20 permanent teeth of 6 rabbits divided into four groups, each contains five teeth, as follow: G1: Diprogenta and calcium hydroxide. G2: Cyanoacrylate. G3: Diprogenta and cyanoacrylate. G4: Calcium hydroxide (control group). Results: A remarkable dentin bridge formation was found in all groups. No pulp necrosis was found in any tooth of the four groups. Pathological reactions of the pulp were found in 25%, 40%, 20%, and 100% of groups 1, 2, 3, and 4, respectively. Differences between study and control groups were found statistically significant ( P < 0.05). Conclusion: All materials used in this study were biocompatible and suggested to be studied further on human teeth. These materials when used in combination with Ca(OH) 2 , may give better results

Expressão dos genes que codificam as proteínas anexina-1 e galectina-1 nos pólipos rinossinusais e sua modulação pelo glicocorticoide / Expression of genes that encode the annexin-1 and galectin-1 proteins in nasal polyposis and their modulation by glucocorticoid

A fisiopatologia da polipose rinossinusal não é totalmente compreendida, apesar de várias hipóteses em relação ao seu processo inflamatório. OBJETIVOS: Estudo prospectivo da expressão dos genes das proteínas, anexina-1 e a galectina-1, que têm ação anti-inflamatória, e sua modulação pelo glicocorticoide. MATERIAL E MÉTODOS: Onze pacientes portadores de polipose rinossinusal tiveram biopsiados seus pólipos em dois momentos: na ausência de glicocorticoide sistêmico, e na sua presença. Nas duas amostras, foi avaliada a expressão desses genes e comparada com a expressão na mucosa nasal normal do meato médio. RESULTADOS: Verificou-se que a média de expressão dos genes que codifica a anexina-1 e galectina-1 estava predominantemente aumentada, independente do uso do glicocorticoide em relação à mucosa nasal controle. Entretanto, nos pólipos sem uso de corticoide, a média de expressão do gene da anexina-1 foi significativamente maior do que nos pólipos que estavam sob uso de glicocorticoide. Com relação à galectina-1 não houve diferença significativa entre as médias de expressão antes e após o uso de glicocorticoide sistêmico. CONCLUSÃO: Os genes apresentaram um aumento da expressão na mucosa nasal polipoide, independente do uso do glicocorticoide, porém a relação destes dois genes das proteínas anti-inflamatórias com o glicocorticoide não ocorreu da mesma maneira.

Rhinosinusal polyps physiopathology is not fully understand, despite numerous hypotheses regarding its inflammatory process. AIMS: a prospective study regarding the gene expression of proteins: anexin-1 and galectin-1, which has an anti-inflammatory action and is modulated by steroids. MATERIALS AND METHODS: eleven patients with rhinosinusal polyps suffered a biopsy of their polyps at two moments: in the absence of systemic steroids and during its use. In the two samples we assessed the expression of these genes and compared it to the normal nasal mucosa in the middle meatus. RESULTS: We noticed that the mean expression of the genes which code anexin-1 and galectin-1 was predominantly increased, regardless of the use of steroids in relation to the control nasal mucosa. Notwithstanding, in polyps without the use of steroids, the mean gene expression of anexin-1 was significantly higher than in the polyps which were under the use of steroids. Regarding galectin-1, there was no significant difference between the expression mean values before and after the use of systemic steroids. CONCLUSION: The genes present an expression increase in the polyp mucosa, regardless of the use of steroids; nonetheless, the relationship of these two genes of anti-inflammatory proteins with steroids did not happen the same way.

To circ or not to circ: clinical and pharmacoeconomic outcomes of a prospective trial of topical steroid versus primary circumcision

Purpose: To compare the efficacy and costs of circumcision versus topical treatment using a prospective pharmacoeconomic protocol. Materials and methods: We treated 59 patients (3-10 years of age) randomized into two groups: 29 underwent an 8-week course of topical treatment with 0.2 percent betamethasone-hyaluronidase cream twice a day; and 30 underwent circumcision. Topical treatment success was defined as complete exposure of the glans. In cases of treatment failure, circumcision was performed and its cost imputed to that of the initial treatment. The pharmacoeconomic aspects were defined according to the Brazilian National Public Health System database and the Brazilian Community Pharmacies Index. Results: The two groups were statistically similar for all clinical parameters evaluated. Topical treatment resulted in complete exposure of the glans in 52 percent of the patients. Topical treatment was associated with preputial pain and hyperemia. However, treatment suspension was unnecessary. Minor complications were observed in 16.6 percent of the surgical group patients. The mean cost per patient was US$ 53.70 and US$ 125.20, respectively, for topical steroid treatment (including the costs related to treatment failure) and circumcision. The total costs were US$ 2,825.32 and US$ 3,885.73 for topical treatment and circumcision, respectively. Conclusions: Topical treatment of phimosis can reduce costs by 27.3 percent in comparison with circumcision. Therefore, topical treatment of phimosis should be considered prior to the decision to perform surgery.

Betamethasone inhibits tumor development, microvessel density and prolongs survival in mice with a multiresistant adenocarcinoma TA3

Tumor resistance to traditional cancer treatments poses an important challenge to modern science. Thus, angiogenesis inhibition is an important emerging cancer treatment. Many drugs are tested and corticosteroids have shown interesting results. Herein we investigate the effect on microvessel density, survival time and tumoral volume of mice with TA3-MTX-R tumors. Twenty six mice were inoculated with lxlO6 tumor cells, 4-5 days after injection, six mice were injected with PBS (group A) and twenty mice were treated with p-met (group B). All animals from Group A died on day 22. Group B was divided into Bl (treated discontinued) and B2 (treated daily) and observed until day 88. All mice were processed for histo-immunohistochemical analysis and the blood vessels were counted. A decrease in microvessel density and tumoral volume and longer survival times were observed in the treated group. We propose that the antiangiogenic p-met effect explains, at least partially, its tumor inhibitory properties. As an important perspective, we will experimentally combine these strategies with those recently described by us with regard to the important antiangiogenic-antitumor effects of Trypanosoma cruzi calreticulin. Since the molecular targets of these strategies are most likely different, additive or synergic effects are envisaged.

The Remarkable Beneficial Effect of Adding Oral Simvastatin to Topical Betamethasone for Treatment of Psoriasis: A Double-Blind; Randomized; Placebo-Controlled Study

Psoriasis is a common chronic inflammatory disease with unpredictable prognosis. Given the immunomodulatory effects of statins; the present study was conducted to determine whether the addition of orally administered simvastatin to the topical betamethasone; a standard antipsoriatic treatment; can produce a more powerful therapeutic response against this clinical conundrum. In a double-blind study; 30 patients with plaque type psoriasis were randomly divided into two equal treatment groups. Group 1 received oral simvastatin (40 mg/d) plus topical steroid (50betamethasone in petrolatum) for 8 weeks and group 2 received oral placebo plus the same topical steroid for the same time period. Psoriasis Area and Severity Index (PASI) score was checked before and at the end of the treatment period. PASI score decreased significantly in both groups; but the decline of PASI score was more significant in patients who received simvastatin (Mann-Whitney test; P-value=0.001). No side effect or any laboratory abnormality was detected in patients. Our work; which is the first doubleblind; randomized; placebo-controlled study on this subject; shows that oral simvastatin enhances the therapeutic effect of topical steroids against psoriasis. The increased risk of cardiovascular accidents in psoriatic patients and the protective effect of statins against cardiovascular disease further encourages their use in the treatment of this clinical conundrum

Aplicación de farmacopuntura en afecciones dolorosas del hombro / Application pharmacopuncture in painful affections of the shoulder

Se realizó un estudio experimental, tipo ensayo clínico controlado, en el período comprendido entre enero del 2007 hasta enero del 2008, con el fin de comparar la respuesta al tratamiento con farmacopuntura en el hombro doloroso con respecto al bloqueo del nervio supraescapular y proponer un algoritmo de tratamiento. La muestra quedó constituida por 60 pacientes, los cuales fueron aleatorizados y divididos en dos grupos, a uno se le realizó bloqueo del nervio supraescapular con betametasona y lidocaína al 2 por ciento en dosis habituales y al otro grupo se les aplicó farmacopuntura con pequeñas dosis de betametasona diluida con agua para inyección. El tratamiento fue aplicado dos veces por semana y hasta seis sesiones como máximo. Se evaluaron semanalmente por un equipo de trabajo teniendo en cuenta el criterio del paciente según la escala visual análoga, según criterio médico basado en el examen clínico, explorándose el dolor, la limitación de la movilidad articular y el balance funcional . Se observó una evolución satisfactoria más rápida en los pacientes tratados con farmacopuntura. El tratamiento con farmacopuntura en el hombro doloroso es de alta eficacia frente al bloqueo del nervio supraescapular.

We carried out an experimental, longitudinal and prospective study, at the Provincial Centre for the Development of Natural and Traditional Medicine Dr Mario E Dihigo, during the period from January 2007 to January 2008, with the objective of treating the increased incidence of patients with painful affections of the shoulder, requiring in many cases the usage of long, risk treatments, with results not always satisfactory. The sample was formed by 60 patients who were randomized and divided in two groups. A blockade of the supraescapular nerve with betamethasone and lidocain 2 per cent in habitual doses was applied to one group; the second one received pharmacopuncture with low doses of betamethasone diluted in water for injection. The treatment was applied 2 times a week and up to the maximum of 6 sessions. They were evaluated weakly for a working group, taking into account the patient's criteria according to the visual analogous scale, according to the medical criteria based on the clinical examination looking for pain, joint mobility limitation and functional balance. Among the studied patients there was a predominance of the female sex beginning from the third and fourth decades of life. Tendinitis of the rotator cuff was the most frequent diagnosis. There was a faster satisfactory recovery in patients treated with pharmacopuncture. Pharmacopuncture therapy in painful shoulder is of higher efficacy than the blockade of the supraescapular nerve.

Uso de membrana amniótica en el tratamiento de pterigion recidivante, en pacientes intervenidos quirúrgicamente en el Centro Nacional de Oftalmología julio 2007-noviembre 2008 / Use of amniotic membrane in treating recurrent pterygium in patients who underwent surgery at the National Center of Ophthalmology July 2007-November 2008

Se realizó un estudio descriptivo, longitudinal, prospectivo en el Centro Nacional de Oftalmología, durante el período Julio 2007 a Noviembre 2008 con el objetivo de determinar la eficacia de la membrana amniótica en el tratamiento quirúrgico del pterigión recidivante. El Universo lo constituyeron todos los pacientes que asistieron a consulta por pterigión recidivante en el período Julio 2007 – Noviembre 2008 en el Centro Nacional de Oftalmología. La Muestra estuvo conformada por 43 pacientes que tenían historia de pterigión recidivante de 1 año o mas de evolución en el mismo período. Entre los resultados más importantes se destacan que la mayoría de los pacientes tenían entre 36 y 55 años, femeninos, de procedencia urbana, 1 cirugía de pterigión previa y de 1 a 3 años de haber sido operados. El corte evaluativo se realizó cuando todos los pacientes tenían al menos 3 meses de intervención. 4 pacientes presentaron recidiva (9.3%), teniendo estos las características de ser masculinos, del grupo etáreo de 36 a 55 años y 1 cirugía previa. Se concluyó que el uso de membrana amniótica como tratamiento de pterigión recidivante es un método seguro y eficaz en un 90.7%. Se recomendó la implementación del uso de membrana amniótica en pacientes con pterigión recidivante, a fin de reducir el porcentaje de recidivas...