Síndrome metabólico en pacientes psoriáticos en el Hospital Clínico de la Universidad de Chile / Metabolic syndrome in psoriasis patients

Introducción: La psoriasis ha sido relacionada al aumento en el riesgo cardiovascular (CV). El Síndrome metabólico sería más prevalente en psoriáticos; sin embargo, se desconoce la realidad local. Objetivo: Determinar la presencia de Síndrome metabólico en pacientes con psoriasis leve a moderada en el Hospital Clínico de la Universidad de Chile. Pacientes y Métodos: Se realizó un estudio prospectivo en 214 psoriáticos adultos. Se definió Síndrome metabólico según criterios A TP III. Los resultados se compararon con estadísticas nacionales de prevalencia de Síndrome metabólico de lo OMS y publicaciones afines. Resultados: El Síndrome metabólico fue encontrado en el 71% de los psoriáticos examinados versus el 22,6% de población general. Los psoriáticos tuvieron una alta prevalencia de obesidad (70,6% vs 21,9%), hipercolesterolemia (239 mg/dL vs 186 mg/dL), hipertrigliceridemia (197 mg/dL) y aumento de la circunferencia abdominal (92 cm), además de alzas moderadas de la presión arterial y glicemia. Tabaquismo (40,2%) más prevalente que en la población general y sedentarismo (90,2%) con cifra similar a la población general. Conclusión: Los pacientes psoriáticos tienen una alta frecuencia de Síndrome metabólico. Este trabajo coincide con los datos publicados a nivel internacional.

Introduction: Psoriasis has been linked to on increase in cardiovascular risk (CV). Metabolic syndrome is more prevalent in psoriatic, however data on Chilean psoriasis patients hove not been reported. Objective: Study the prevalence of metabolic syndrome in patients with mild to moderate psoriasis attendees at Hospital Clínico of Universidad de Chile. Patients and methods: Descriptive study in 2 I 4 consecutive psoriasis patients. Metabolic syndrome was determined according to A TP III criteria. Data was compared with WHO notional statistics on prevalence of metabolic syndrome and related articles. Results: 71% of psoriasis patients had metabolic syndrome in comparison with 22.6% of general population. 70.6% were obese in contrast to 21,9% of the general population. The mean cholesterol level was 239 mg/dL vs. 186 mg/dL patients had elevated triglycerides (197 mg/dL) and increase of abdominal circumference (92 cm). Blood pressure, fasting blood sugar were moderately elevated. Smoking present in 40.2% was more frequent than in general population, and sedentarism (90.2%) was equally frequent. Conclusions: Psoriasis patients have a high prevalence of metabolic syndrome. This data is concurrent with results in international trials.

Síndrome de Cornelia de Lange / Cornelia de Lange syndrome

El Síndrome de Cornelia de Lange (SCL) es un cuadro malformativo poco frecuente, caracterizado por la presencia de retraso del crecimiento, microcefalia, retardo mental, hirsutismo, dismorfias faciales características y defectos en las extremidades. Se estima una incidencia de 1:10.000 a 1:40.000 recién nacidos vivos, siendo la mayoría casos esporádicos, aunque algunos pocos se han publicado con una herencia de tipo autosómico dominante. Existen dos genes responsables del SCL: el NIPBL, que ha sido recientemente identificado y mapeado en 5p13.1, y el SMC1L1 en Xp11.22 –p11.21, descubierto también recientemente en varios sujetos afectados y con herencia ligada al X. Mutaciones en el gen NIPBL se han encontrado en el 40 por ciento a 50 por ciento de los pacientes afectados clínicamente por el cuadro. En esta revisión presentamos el caso de una paciente de seis años de edad, con diagnóstico clínico de SCL, con el objetivo de dar a conocer esta patología malformativa, que forma parte del diagnóstico diferencial de los cuadros clínicos con retardo mental.

Cornelia de Lange Syndrome (CdLS) is a rare malformative disease. It is characterized by the presence of growth retardation, microcephaly, mental retardation, hirsutism, facial alterations and defects in the extremities. Incidence is 1:10,000 to 1:40,000 in newborns. Most cases are sporadic, although some cases have been published with autosomal dominant inheritance. Two recently identified genes are responsible for CdLS: NIPBL, located on 5p13.1, and SMC1L1, located on Xp11.22 –p11.21 and present in several affected subjects, and with X-linked inheritance. Mutations of NIPBL genes are described in 40 to 50 percent of patients. We present the case of a six year old patient, with clinical diagnosis of CdLS, with the purpose of presenting this malformative disease, which is part of the differential diagnosis of clinical manifestations associated to mental retardation.

Neoplasias genitales intraepiteliales: a propósito de dos pacientes inmunosuprimidos / Penile intraepithelial neoplasia: two case report

Las neoplasias genitales intraepiteliales constituyen lesiones que afectan a todo el espesor de la epidermis e incluyen entidades específicas, como la eritroplasia de Queyrat, la enfermedad de Bowen y papulosis bowenoide. Actualmente se describe aumento de la frecuencia de neoplasias intraepiteliales, pero la real incidencia de los carcinomas in situ genitales es desconocida. Se describen factores predisponentes, tanto para las neoplasias in situ como para los carcinomas invasores, dentro de los que se encuentran los pacientes no circuncidados, deficiente higiene genital, balanitis recurrente, liquen escleroso, fimosis, inmunosupresión, infección por virus papiloma humano, etc. Existen distintas terapias descritas para estas lesiones; sin embargo, aún no hay consenso en su manejo. Las opciones de tratamiento dependen de la localización, de la extensión de la enfermedad, costo de la terapia, etc. En general se ha descrito recidiva de las lesiones, con todos los tratamientos mencionados; no obstante, la cirugía micrográfica de Mohs es considerada por algunos autores la terapia de elección en estos casos. En este artículo se presentan dos casos de neoplasias genitales intraepiteliales tratadas con Imiquimod 5 por ciento y 5-Fluoracilo con buenos resultados.

The intraepithelial neoplasias of genitals are lesions that affect all the thickness of the epidermis and include specific carcinomas such as erythroplasia of Queyrat, Bowen’s disease and bowenoid papulosis. Presently, there is an increase in the frequency of intraepithelial neoplasias, but the real incidence of in situ genital carcinoma is unknown. Many predisposing factors are described for both in situ and invasive carcinomas, for example, the lack of circumcision, poor genital hygiene, recurrent balanitis, penile lichen sclerosus, phimosis, immune suppression, HPV infections, etc. Different therapies are described for these illnesses, but there is no uniform guideline assessment. Treatment depends on location, extension of the illness, cost of the therapy, etc. In general, recurrence of carcinomas has been described with all treatments, although Mohs micrographic surgery is considered by some authors as the therapy of choice in these cases. We present two cases of intraepithelial neoplasias of genitals that were treated with Imiquimod 5 percent and 5-Fluoracilo with positive results.

Función sexual en mujeres usuarias de terapia de reemplazo hormonal / Sexual function in postmenopausal women using hormone replacement therapy

The loss of sexuality observed in the climacteric period is difficult to evaluate. An important advance has been the development of the Female Sexual Function Index (FSFI), a test based on the norms of the International Consensus Development Conference on Sexual Female Dysfunctions. Aim: To study the effects of hormone replacement therapy (HRT) on sexuality, applying the FSFI. Material and methods: The FSFI was applied to 300 healthy women between 45-64 years, sexually active, beneficiaries of the Southern Metropolitan Health Service. Results: The mean age of the sample studied was 51±5 years, 27% were HRT users, 21% had had an hysterectomy and 98% had a stable couple. The total score of the FSFI decreased from 27.3±5.8 in women between 45 and 49 years of age to 19.3±7.0 in women between 60 and 64 years (p <0.01). A significantly better sexuality was observed in HRT users, with FSFI scores of 28.1±5.5 and 24.6±6.8 in HRT users and non users, respectively (p <0.01). Women on HRT obtained a higher score in all of the test domains, especially in lubrication, orgasm and sexual satisfaction. Conclusions: Female sexuality decreases with aging. HRT users have a better sexual function than non users (Rev Méd Chile 2003; 131: 1251-55 ).