Recomendaciones de expertos para el tratamiento biológico en pacientes con psoriasis / Expert recommendations for biological treatment in patients with psoriasis

Resumen En los últimos años, la introducción de diversos medicamentos biológicos para el tratamiento de la psoriasis ha aumentado considerablemente el arsenal terapéutico del médico, con lo cual se ha logrado un fuerte impacto positivo en el control de la enfermedad. Con el fin de proveer de las mejores recomendaciones para el uso de estos biológicos en los pacientes afectados de psoriasis, el grupo mexicano de expertos en psoriasis PSOMEX ha formulado recomendaciones para mejorar la comprensión y el posicionamiento terapéutico de este tipo de medicamentos.

Abstract In recent years, the introduction of a series of biological drugs for the treatment of psoriasis has considerably increased the therapeutic armamentarium of doctors, and thus a strongly positive impact on the control of this condition has been achieved. With the purpose to provide the best recommendations for the use of these biological agents in patients with psoriasis, the Mexican group of psoriasis experts, PSOMEX, has developed recommendations in order to improve the understanding and therapeutic positioning of this type of medications.

Consenso mexicano en el manejo clínico de la hidradenitis supurativa / Mexican consensus on the clinical management of hidradenitis suppurativa

Resumen ANTECEDENTES: La hidradenitis supurativa es una enfermedad inflamatoria, crónica y recurrente con gran repercusión en la calidad de vida de los pacientes, específicamente en los aspectos psicológicos y sexuales, así como también en la productividad laboral. OBJETIVO: Generar un documento de consenso sobre el manejo clínico de los pacientes con hidradenitis supurativa en México que sirva para homologar el diagnóstico y tratamiento de estos pacientes. MÉTODO: Se convocó a un grupo multidisciplinario (dermatólogos, ginecólogos, cirujanos, infectólogos, proctólogos) para analizar la evidencia en el tratamiento integral de la hidradenitis supurativa (calidad de vida, clinimetría, diagnóstico y tratamiento), localizada mediante una revisión sistemática de la bibliografía. El grupo discutió sobre los temas y se generaron las recomendaciones por acuerdo unánime de los participantes. RESULTADOS: Con frecuencia los pacientes con hidradenitis supurativa pueden tardar mucho tiempo en obtener el diagnóstico y manejo correctos, principalmente debido a la falta de evidencia sobre la enfermedad, así como a la falta de criterios para referir al paciente con un especialista. Se emitieron 22 recomendaciones para el tratamiento de pacientes con hidradenitis supurativa, que comprenden el diagnóstico, estadificación y clinimetría, así como el manejo clínico en el primer, segundo y tercer nivel de atención. CONCLUSIONES: Se emitieron las recomendaciones con base en la mejor evidencia disponible, así como la experiencia del grupo multidisciplinario de expertos en el tratamiento de hidradenitis supurativa.

Abstract BACKGROUND: Hidradenitis suppurativa is an inflammatory, chronic and recurrent disease with a high impact on patients quality of life, specifically in psychological and sexual aspects, as well as in labor productivity. OBJECTIVE: To generate a consensus document on the clinical management of patients with hidradenitis suppurativa in Mexico, that serves to standardize the diagnosis and treatment of these patients. METHOD: A multidisciplinary group was convened (dermatologists, gynecologists, surgeons, infectologists, proctologists) to analyze the evidence on the integral treatment of hidradenitis suppurativa (quality of life, clinimetry, diagnosis and treatment), located through a systematic review of the literature. The group discussed the issues and the recommendations were generated by unanimous agreement of the participants. RESULTS: Frequently, patients with hidradenitis suppurativa can take a long time to obtain the correct diagnosis and management, mainly due to the lack of evidence about the disease, as well as the lack of criteria to refer the patient to a specialist. Twenty-two recommendations were issued for the treatment of patients with hidradenitis suppurativa, which include diagnosis, staging and clinimetry, as well as clinical management in the first, second and third levels of care. CONCLUSIONS: The recommendations were issued based on the best available evidence, as well as the experience of the multidisciplinary group of experts in the treatment of hidradenitis suppurativa.

Deterioro cognitivo e hiperparatiroidismo primario: resultado favorable después de cirugía: Caso clínico / Cognitive impairment associated to primary hyperparathyroidism: Report of one case

We report a 79-year-old male patient presenting with progressive memory loss associated with anxiety and muscularpain. An extensive biochemical control revealed high serum calcium and parathormone levels, and normal thyroid hormones. Cognitive assessment prior to surgery was compatible with mild cognitive impairment, showing significant improvement two months after parathyroidectomy. Our case suggests that, although rare, primary hyperparathyroidism should be considered as a possible cause of cognitive decline in the elderly.

Comparative in vivo antiangiogenic effects of calreticulin from Trypanosoma cruzi and Homo sapiens sapiens

Angiogenesis is a complex multi-step process of neovascularization arising from preexisting blood vessels whose generation is regulated by pro- and anti-angiogenic factors. Both Trypanosoma cruzi calreticulin (TcCRT) and its human counterpart (HuCRT) are antiangiogenic. This is the first report where the TcCRT and HuCRT anti-angiogenic properties are compared in vivo. In the chick embryonic chorioallantoid membrane assay (CAM) and at equimolar concentrations, TcCRT displayed significantly higher antiangiogenic activities than its human counterpart. LPS had marginal effects at the concentrations present in the recombinant protein preparations and the TcCRT antiangiogenic effects were largely inhibited by specific polyclonal antibodies, thus, reinforcing the fact that the observed TcCRT effects can be attributed to the parasite-derived molecule and not to the endotoxin. The antiangiogenic TcCRT effects correlate with its anti-tumor in vivo effects, as recently shown in our laboratory.

F(ab')2 antibody fragments against Trypanosoma cruzi calreticulin inhibit its interaction with the first component of human complement

Trypanosoma cruzi calreticulin (TcCRT), described in our laboratory, retains several important functional features from its vertebrate homologues. We have shown that recombinant TcCRT inhibits the human complement system when it binds to the collagenous portion of C1q. The generation of classical pathway convertases and membrane attack complexes is thus strongly inhibited. In most T. cruzi-infected individuals, TcCRT is immunogenic and mediates the generation of specific antibodies. By reverting the C1q / TcCRT interaction, a parasite immune evasion strategy, these antibodies contribute to the host / parasite equilibrium. In an in vitro correlate of this situation, we show that the C1q / TcCRT interaction is inhibited by F(ab')2 polyclonal anti-TcCRT IgG fragments. It is therefore feasible that in infected humans anti-TcCRT antibodies participate in reverting an important parasite strategy aimed at inhibiting the classical complement pathway. Thus, membrane-bound TcCRT interacts with the collagenous portion C1q, and this C1q is recognized by the CD91-bound host cell CRT, thus facilitating parasite internalization. Based on our in vitro results, it could be proposed that the in vivo interaction between TcCRT and vertebrate C1q could be inhibited by F(ab')2 fragments anti-rTcCRT or against its S functional domain, thus interfering with the internalization process.

Molusco contagioso con halo hipocrómico. Presentación de un caso / Molluscum contagiosum with hypochromic halo. Presentation of a case

Se presenta el caso de un hombre de 57 años con múltiples neoformaciones perladas de 1 a 3 mm, umbilicadas, asintomáticas, rodeadas de un halo de hipopigmentación. El estudio histopatológico mostró inclusiones intracitoplasmáticas en las células epidérmicas y ausencia del pigmento melánico en la periferia