Subclinical atherogenesis in patients with mild psoriasis: A role for IL-6? / Aterogênese subclínica em pacientes com psoríase leve: um papel para IL-6?

Summary Introduction: A link of psoriasis with subclinical atherosclerosis has been postulated and cytokine network might intermediate this association. Few data are available in patients with mild psoriasis. We evaluated carotid intima-media thickness (cIMT) in drug-free psoriatic individuals and controls. In parallel, we searched for associations of cIMT with disease activity indexes and serum interleukins (IL) in psoriatic patients. Method: An experienced radiologist performed the cIMT analyses. Cytokine concentrations were assessed by flow cytometry. Disease activity was evaluated based on psoriasis area and severity index (PASI) as well as body surface area (BSA). Results: Sixty-five (65) patients and 64 controls were studied. Mean age of patients (50.9 years) did not differ from controls (p=0.362). A low PASI and BSA (< 10) prevailed (69.2% and 56.9%, respectively). Median levels of IL-12p70, TNF-α, IL-1β and IL-10 were significantly lower in cases than in controls (adjusted p<0.05), while IL-6 and IL-8 medians did not differ between groups (adjusted p>0.05). Smoking habit and diabetes mellitus predominated in cases (p=0.002). An altered cIMT (≥ 0.9 mm) was more frequent in cases than in controls (23.8% versus 8.5%, adjusted p=0.045). Mean cIMT was higher in cases with a borderline significance (p=0.057). cIMT scores did not correlate to PASI (rs=0.066; p=0.250) or BSA (rs=0.175; p=0.185), but did correlate significantly with serum IL-6 (rs=0.26; p=0.005). Conclusion: Subclinical atherosclerosis was more frequent in patients with mild psoriasis than controls. cIMT in psoriatic individuals correlated with serum IL-6, pointing to an eventual proatherogenic role of IL-6 in these patients. Newer studies should clarify the connection of atherogenesis with cytokines in psoriasis.

Resumo Introdução: Foi postulada uma ligação entre psoríase e aterosclerose subclínica. A rede de citocinas pode intermediar essa associação. Poucos dados estão disponíveis em pacientes com psoríase leve. Avaliamos a espessura íntima-média carotídea (cIMT) em psoriáticos e controles livres de medicação. Paralelamente, pesquisamos a associação de cIMT com os índices de atividade de doença e interleucinas séricas (IL) em pacientes com psoríase. Método: Um radiologista experiente procedeu à análise do cIMT. As concentrações de citocinas foram avaliadas por citometria de fluxo. A atividade da doença foi avaliada pelo índice de gravidade (PASI) e pela área de superfície corporal (BSA). Resultados: Sessenta e cinco (65) pacientes e 64 controles foram estudados. A idade média dos pacientes (50,9 anos) não diferiu dos controles (p=0,362). PASI e BSA baixos (< 10) prevaleceram (69,2% e 56,9%, respectivamente). As medianas de IL-12p70, TNF-α, IL-1β e IL-10 foram significativamente menores nos casos do que nos controles (p<0,05 ajustado), enquanto as medianas de IL-6 e IL-8 não diferiram nos grupos (p>0,05 ajustado). Tabagismo e diabetes mellitus predominaram nos casos (p=0,002). Um cIMT alterado (≥ 0,9 mm) foi mais frequente nos casos do que nos controles (23,8% versus 8,5%, p=0,045 ajustado). A média de cIMT foi maior nos casos com significância borderline (p=0,057). Os escores de cIMT não se correlacionaram com o PASI (rs=0,066; p=0,250) ou o BSA (rs=0,175; p=0,185), mas se correlacionaram significativamente com a IL-6 sérica (rs=0,26; p=0,005). Conclusão: A aterosclerose subclínica foi mais frequente em pacientes com psoríase leve do que nos controles. Em psoriáticos, cIMT correlacionou-se com níveis de IL-6 no soro, apontando para um eventual papel pró-aterogênico para a IL-6 nesses pacientes. Novos estudos devem esclarecer a ligação da aterogênese com citocinas na psoríase.

Granulomatosis con poliangeítis de presentación atípica: revisión de la literatura a propósito de un caso de localización ginecológica / Cervicovaginal granuloma as the first manifestation of granulomatosis with polyangiitis

La granulomatosis con poliangeitis (GPA) es una vasculitis sistémica, granulomatosa, con compromiso de pequeños vasos y presencia de anticuerpos c-ANCA. Ocasionalmente es localizada y es rara su manifestación genitourinaria. Se presenta el caso de una mujer de 68 años con sangrado genital causado por una lesión cervicovaginal verrucosa ulcerada, cuya histopatología descartó malignidad, hongos y TBC, con mala respuesta a antibióticos, ácido tricloro acético y crioterapia. Por recidiva al año se practica histerectomía total y colpectomía parcial, pero reincide al mes acompañada de epistaxis, cuyo estudio pornasofibroscopía e imágenes concluye en una lesión de tipo granulomatosa, agregándose anticuerpo anti PR-3 positivo. Se diagnostica GPA y se trata con ciclofosfamida con buena respuesta. La revisión de la literatura permite concluir que la GPA con localización cervicovaginal es muy poco frecuente, especialmente como manifestación inicial, y se debe considerar en el diagnóstico diferencial con cáncer y otras lesiones granulomatosas localizadas.

Granulomatosis with polyangiitis (GPA) is a systemic vasculitis, granulomatous, with commitment of small vessels and the presence of c-ANCA antibodies. Occasionally it is located and its genitourinary manifestation is rare. Presented the case of a 68 year old woman with genital bleeding caused by a lesion cervicovaginal ulcerated verrucosa, whose histopathology ruled out fungal, malignancy and TBC, with poor response to antibiotics, acid trichloro acetic and cryotherapy. By relapse a year is practiced total hysterectomy and partial colpectomia, but repeated a month accompanied by epistaxis, whose study by nasofibroscopia and images concludes in a type granulomatous lesion, adding antibody anti PR-3 positive. GPA is diagnosed and treated with cyclophosphamide with good response. Review of the literature leads to th conclusion that the GPA with cervico-vaginal location is very rare, especially as an initial manifestation, and should be considered in the diagnosis diferenttial with cancer and other localized granulomatous lesions.

An Open, Comparative, Randomized, Parallel, Post Marketing, Multicentric Trial to Compare the Safety and Efficacy of Formula A (Ofloxacin + Ornidazole + Terbinafine Hydrochloride + Clobetasol Propionate) versus Formula B (Clotrimazole + Beclometasone Dipropionate + Neomycin Sulphate), Formula C (Clotrimazole + Beclometasone Dipropionate + Neomycin Sulphate) and Formula D (Clotrimazole + Beclometasone Dipropionate + Neomycin Sulphate) in the Treatment of Patients with Vaginitis.

Vaginitis is among the most common conditions for which women seek medical care, with vaginal discharge accounting for approximately 10 million office visits each year. Since there are no published studies till date that evaluated the Clinical Effectiveness and Safety of Topical Cream of Formula A [Ofloxacin (0.75 % w/w) + Ornidazole (2% w/w) + Terbinafine Hydrochloride (1% w/w) + Clobetasol Propionate (0.05% w/w)] compared to Formula B [Clotrimazole (1%w/w) + Beclometasone Dipropionate (0.025%w/w) + Neomycin Sulphate (0.5% w/w)], Formula C [Clotrimazole (1%w/w) + Beclometasone Dipropionate (0.025%w/w) + Neomycin Sulphate (0.5% w/w)], and Formula D [Clotrimazole (1%w/w) + Beclometasone Dipropionate (0.025%w/w) + Neomycin Sulphate (0.5% w/w)], in mild to moderate vaginitis, hence we undertook this randomized controlled Post Marketing Multicentric trial. Materials and methods: Female subjects diagnosed with mild to moderate symptoms of Vaginitis were eligible and those fulfilling the subject selection criteria were randomized to receive either Formula A, Formula B, Formula C or Formula D for 14 days. The Primary efficacy measures were assessment of symptoms of Vaginitis i.e. vaginal pruritis, vaginal irritation, vaginal soreness or pain, dyspareunia, vaginal erosion and vaginal inflammation and Secondary efficacy measures were assessment of Physical characteristics of vaginal discharge, assessment of pH of vaginal discharge and Microbiological evaluation. Assessment of Safety was done by recording the occurrence of adverse drug reactions. Results: The clinical success rates were comparable and even far better in case of Formula A group (in vaginal pain, Dyspareunia and vaginal erosion it was 100 %, in case of vaginal inflammation it was 92.655 % while in case of vaginal irritation, it was 94.767 % and vaginal pruritus, it was 87.096 %). Adverse events were mild and self limiting while it was totally absent in case of Formula A group. Conclusion: Topical Cream of Formula A is safe and effective for the treatment of mild to moderate vaginitis.

Detección de infección por Mycoplasma en las gestantes con riesgo de parto pretérmino / Detection of Mycoplasma infection in pregnants with a risk of preterm delivery

Introducción: el parto pretérmino es el que se produce antes de las 37 sem de gestación; la sepsis vaginal constituye uno de los factores de riesgo predisponentes para este, de ahí que continúe siendo motivo de preocupación para obstetras y neonatólogos. Objetivo: evaluar el uso del Test Mycoplasma System Plus en gestaciones con riesgo de parto pretérmino, así como algunos de sus aspectos clínicos. Métodos: se realizó un estudio retrospectivo descriptivo de enero a septiembre de 2010 en el Hospital Profesor Eusebio Hernández, la muestra estuvo constituida por 88 pacientes ingresadas en el servicio de cuidados especiales perinatales con gestaciones menores de 34 sem a las que se les realizó el test y tuvieron el parto en este centro, los datos fueron recogidos de las historias clínicas e informes de microbiología agrupados en un formulario y procesados mediante estadísticas descriptivas y de distribución de frecuencia. Resultados: el 67 porciento, de las pacientes presentaban infección moderada o severa a ureaplasma mientras que los exudados vaginales simples fueron negativos en un 71,5 porciento, el antimicrobiano más utilizado fue la eritromicina. Conclusiones: la mayoría de las pacientes después del tratamiento adecuado llegaron al término de la gestación, así como presentaban exudados vaginales simple negativos, pero con un alto índice de infección a ureaplasma urealyticum

Introduction: the pre-term labor is produced before the 37 weeks of pregnancy; the vaginal sepsis is one of the predisposing risk factors to it, being a motive of worry for obstetricians and neonatologists. Objective: to assess the use of Test Mycoplasma System Plus in pregnancies with risk of pre-term labor, as well as of its clinical features. Methods: a descriptive and retrospective study was conducted from January to September, 2010 in the Profesor Eusebio Hernández Hospital; sample included 88 patients admitted in the perinatal special care unit with pregnancies under 34 weeks and performing of test who gave birth in this institution; data were collected from the medical records and microbiology reports grouped in a form and processed by descriptive statistics and of frequency distribution. Results: the 6l7 percent of patients had a moderate or severe infection due to ureaplasma where as the vaginal exudates were negatives in the 71.5 percent, the more used antimicrobial agents was the erythromycin. Conclusions: most of patients after an appropriate treatment arrive to a term pregnancy and also had negative simple vaginal exudate but with a high rate of infection due to ureaplasma urelyticum

Histoplasmosis vaginal en una paciente con síndrome de inmunodeficiencia adquirida / Vaginal histoplasmosis in a patient with acquired immunodeficiency syndrome

El Histoplasma capsulatum es un hongo dimórfico que es endémico en Guatemala. Desde que inició la epidemia de SIDA en Guatemala se han reconocido con mayor frecuencia casos de histoplasmosis crónica en pacientes inmunocomprometidos. Se presenta un caso de una mujer de 30 años con historia de dolor vaginal, fiebre y una lesión vaginal que inició 5 meses antes con un cuadro aparente de papilomatosis. Las lesiones vaginales evolucionaron de tal forma que al ingreso se encontró una paciente en malas condiciones generales y nutricionales con una lesión destructiva en genitales externos y vagina. La biopsia fue compatible con Histoplasmoma. Se inició tratamiento con Anfotericina B, la paciente mejoró parcialmente sin embargo al final falleció. Al revisar la literatura se encontraron solamente 3 casos reportados de Histoplamosis vaginal.

Infecciones vaginales: aspectos prácticos del diagnóstico y tratamiento / Vaginal infections: practice aspects of the diagnosis and treatment

El problema del flujo vaginal y los síntomas asociados de prurito vulvar y mal olor son consultas frecuentes, especialmente en mujeres jóvenes. Estos síntomas son por lo general causados por los síndromes de vaginosis bacteriana (VB), candidosis vaginal y tricomoniasis. La VB es la causa más común de estas infecciones vaginales. Las características de la secreción vaginal no son diagnósticas y no discriminan entre VB y tricomoniasis. En todo los casos, la cervicitis debida a clamidia o gonorrea debería ser excluída. El exámen microscópico, en el momento del examen, es la herramienta diagnóstica más importante. El examen al fresco de la secreción vaginal generalmente es útil asociado con la tinción de gram de muestra cervicales, vaginales o uretrales. Los cultivos vaginales son necesarios sólo para confirmación o en casos en que el diagnóstico no esté claro con el examen de microscopia. Las pautas de tratamiento deben ser específicas, tales como metranidazol para VB y tricomoniasis, y agentes antifúngicos, sistémicos o locales, para candidosis. Las recurrencias son comunes y requieren manejo e investigación cuidadosa. Las parejas sexuales necesitan también investigación y tratamiento

Bacterial vaginosis

Bacterial vaginosis is a common, non-inflammatory infection of the vagina. It is characterised by the presence of a thin, homogenous, greyish-white discharge. The differencial diagnosis includes infection with Trichomonas vaginalis and Candida albicans. A diagnosis of bacterial vaginosis may be made by the detection of three of the following: characteristic discharge, pH of 5 or greater, clue cells and a positive KOH amine test. Culture of vaginal discharge is not necessary to effect a diagnonsis. Bacterial vaginosis respondes readily to treatment with metronidazole at a dosage of 400 mg twce daily for sevem days, although a proportion of patient suffer a recurrence of symptoms. Treatment of sexual partners may be necessary in such cases. Bacterial vaginosis results from the synergistic interaction of Gardnerella vginalis and obligate anerobes, including Bacteroides and Mobiluncus species. The pathogenesis, laboratory diagnosis, treatment, and the mechanisms by which these organisms produce the symptoms of bacterial vaginosis are discussed