Increased Home Death Due to Cardiopulmonary Arrest in Times of COVID-19 Pandemic. / Aumento de Óbitos Domiciliares devido a Parada Cardiorrespiratória em Tempos de Pandemia de COVID-19.

BACKGROUND: Cardiovascular diseases constitute an important group of causes of death in the country. Ischemic heart diseases that are the main causes of cardiopulmonary arrest, leading to an impact on the mortality of the cardiovascular diseases in the health system. OBJECTIVE: Assess the number of home deaths by cardiopulmonary arrest notified by the Mobile Emergency Medical Service (SAMU) in March 2018, 2019 and 2020. METHODS: Observational study carried out from the analysis of cardiopulmonary arrest mortality data of citizens assisted by SAMU in Belo Horizonte, Minas Gerais, Brazil. Social and clinical characteristics and occurrence information of the patients were analyzed. The mortality rate due to cardiopulmonary arrest in relation to the total number of attendances was assessed. A significance level of 95% was considered. RESULTS: There was increase of home deaths due to cardiopulmonary arrest in March 2020 compared to March 2018 (p<0.001) and March 2019 (p=0.050). Of the deaths reported in 2020, 63.8% of the patients were aged 60 years or older, 63.7% of the occurrences were performed in the afternoon and approximately 87% of the cardiopulmonary arrest notified had associated clinical comorbidities, with systemic arterial hypertension and heart failure represented by 22.87% and 13.03% of the reported cases, respectively. The majority of the evaluated sample of this study did not have any medical care follow-up (88.7%). CONCLUSION: Considering the increase in the number of the deaths, we suggest reflections and readjustments regarding the monitoring of chronic non-transmissible diseases during a pandemic, as well as improvements in death surveillance. (Arq Bras Cardiol. 2021; 116(2):266-271).

FUNDAMENTO: As doenças cardiovasculares constituem um grupo importante de causas de morte no Brasil. As doenças isquêmicas do coração são as principais causas de parada cardiorrespiratória, levando a um impacto na mortalidade devido às doenças cardiovasculares no sistema de saúde. OBJETIVO: Avaliar o número de óbitos domiciliares por parada cardiorrespiratória notificados pelo Serviço de Atendimento Móvel de Urgência (SAMU) em março de 2018, 2019 e 2020. MÉTODOS: Trata-se de um estudo observacional realizado a partir da análise de dados de mortalidade por parada cardiorrespiratória de cidadãos atendidos pelo SAMU em Belo Horizonte, Minas Gerais, Brasil. Foram analisadas as características sociais e clínicas e as informações de ocorrência. Foi avaliada a taxa de mortalidade por parada cardiorrespiratória em relação ao número total de atendimentos. Foi considerado um nível de significância de 95%. RESULTADOS: Houve um aumento nos óbitos domiciliares por parada cardiorrespiratória em março de 2020, em comparação com março de 2018 (p < 0,001) e março de 2019 (p = 0,050). Dos óbitos relatados em 2020, 63,8% dos pacientes tinham 60 anos ou mais; 63,7% das ocorrências foram à tarde e aproximadamente 87% dos casos de parada cardiorrespiratória notificados apresentavam comorbidades clínicas, com hipertensão arterial sistêmicas e parada cardíaca correspondendo a 22,87% e 13,03% dos casos relatados, respectivamente. A maioria da amostra avaliada deste estudo não teve acompanhamento médico (88,7%). CONCLUSÃO: Considerando o aumento do número de óbitos, sugerimos reflexões e reajustes quanto ao monitoramento das doenças crônicas não transmissíveis durante a pandemia, bem como melhorias na vigilância dos óbitos. (Arq Bras Cardiol. 2021; 116(2):266-271).

Aumento de Óbitos Domiciliares devido a Parada Cardiorrespiratória em Tempos de Pandemia de COVID-19 / Increased Home Death Due to Cardiopulmonary Arrest in Times of COVID-19 Pandemic

Resumo Fundamento As doenças cardiovasculares constituem um grupo importante de causas de morte no Brasil. As doenças isquêmicas do coração são as principais causas de parada cardiorrespiratória, levando a um impacto na mortalidade devido às doenças cardiovasculares no sistema de saúde. Objetivo Avaliar o número de óbitos domiciliares por parada cardiorrespiratória notificados pelo Serviço de Atendimento Móvel de Urgência (SAMU) em março de 2018, 2019 e 2020. Métodos Trata-se de um estudo observacional realizado a partir da análise de dados de mortalidade por parada cardiorrespiratória de cidadãos atendidos pelo SAMU em Belo Horizonte, Minas Gerais, Brasil. Foram analisadas as características sociais e clínicas e as informações de ocorrência. Foi avaliada a taxa de mortalidade por parada cardiorrespiratória em relação ao número total de atendimentos. Foi considerado um nível de significância de 95%. Resultados Houve um aumento nos óbitos domiciliares por parada cardiorrespiratória em março de 2020, em comparação com março de 2018 (p < 0,001) e março de 2019 (p = 0,050). Dos óbitos relatados em 2020, 63,8% dos pacientes tinham 60 anos ou mais; 63,7% das ocorrências foram à tarde e aproximadamente 87% dos casos de parada cardiorrespiratória notificados apresentavam comorbidades clínicas, com hipertensão arterial sistêmicas e parada cardíaca correspondendo a 22,87% e 13,03% dos casos relatados, respectivamente. A maioria da amostra avaliada deste estudo não teve acompanhamento médico (88,7%). Conclusão Considerando o aumento do número de óbitos, sugerimos reflexões e reajustes quanto ao monitoramento das doenças crônicas não transmissíveis durante a pandemia, bem como melhorias na vigilância dos óbitos. (Arq Bras Cardiol. 2021; 116(2):266-271)

Abstract Background Cardiovascular diseases constitute an important group of causes of death in the country. Ischemic heart diseases that are the main causes of cardiopulmonary arrest, leading to an impact on the mortality of the cardiovascular diseases in the health system. Objective Assess the number of home deaths by cardiopulmonary arrest notified by the Mobile Emergency Medical Service (SAMU) in March 2018, 2019 and 2020. Methods Observational study carried out from the analysis of cardiopulmonary arrest mortality data of citizens assisted by SAMU in Belo Horizonte, Minas Gerais, Brazil. Social and clinical characteristics and occurrence information of the patients were analyzed. The mortality rate due to cardiopulmonary arrest in relation to the total number of attendances was assessed. A significance level of 95% was considered. Results There was increase of home deaths due to cardiopulmonary arrest in March 2020 compared to March 2018 (p<0.001) and March 2019 (p=0.050). Of the deaths reported in 2020, 63.8% of the patients were aged 60 years or older, 63.7% of the occurrences were performed in the afternoon and approximately 87% of the cardiopulmonary arrest notified had associated clinical comorbidities, with systemic arterial hypertension and heart failure represented by 22.87% and 13.03% of the reported cases, respectively. The majority of the evaluated sample of this study did not have any medical care follow-up (88.7%). Conclusion Considering the increase in the number of the deaths, we suggest reflections and readjustments regarding the monitoring of chronic non-transmissible diseases during a pandemic, as well as improvements in death surveillance. (Arq Bras Cardiol. 2021; 116(2):266-271)

Assessment of adiposity in psoriatic patients by dual energy X-ray absorptiometry compared to conventional methods.

BACKGROUND: Obesity is considered a chronic low-grade inflammatory disease that shares mediators of inflammation with psoriasis, such as TNF-α and IL-6. The relationship between these two conditions involves factors such as predisposition and response to therapy, in addition to an association with cardiovascular disease. OBJECTIVES: The aim of the present study was to investigate the prevalence of adiposity as determined by body mass index (BMI), waist circumference (WC), and dual energy X-ray absorptiometry (DXA) evaluation in patients with psoriasis. METHODS: BMI, WC and body composition by DXA were measured in 42 psoriatic patients without joint complaints and in 41 control patients using standard procedures. In the comparison between cases and controls, we used Pearson's Χ2 test or Fisher's exact test, and the nonparametric Mann-Whitney test. The difference between the diverse classification methods for obesity was evaluated using McNemar's test. To test the level of agreement between those variables, we used the weighted kappa coefficient. RESULTS: There was no difference in the prevalence of obesity among cases and controls. Both BMI and WC had low agreement with measures of body fat evaluated by DXA. With the use of DXA scanning, prevalence of overweight and obesity in patients with psoriasis was 83.3%, which constitutes a strong evidence of the need for intervention on this metabolic parameter. CONCLUSION: Dual energy X-ray absorptiometry was more capable of identifying obesity compared with BMI and WC both in psoriatic and control patients.

Assessment of adiposity in psoriatic patients by dual energy X-ray absorptiometry compared to conventional methods

Abstract BACKGROUND: Obesity is considered a chronic low-grade inflammatory disease that shares mediators of inflammation with psoriasis, such as TNF-α and IL-6. The relationship between these two conditions involves factors such as predisposition and response to therapy, in addition to an association with cardiovascular disease. OBJECTIVES: The aim of the present study was to investigate the prevalence of adiposity as determined by body mass index (BMI), waist circumference (WC), and dual energy X-ray absorptiometry (DXA) evaluation in patients with psoriasis. METHODS: BMI, WC and body composition by DXA were measured in 42 psoriatic patients without joint complaints and in 41 control patients using standard procedures. In the comparison between cases and controls, we used Pearson’s Χ2 test or Fisher’s exact test, and the nonparametric Mann-Whitney test. The difference between the diverse classification methods for obesity was evaluated using McNemar’s test. To test the level of agreement between those variables, we used the weighted kappa coefficient. RESULTS: There was no difference in the prevalence of obesity among cases and controls. Both BMI and WC had low agreement with measures of body fat evaluated by DXA. With the use of DXA scanning, prevalence of overweight and obesity in patients with psoriasis was 83.3%, which constitutes a strong evidence of the need for intervention on this metabolic parameter. CONCLUSION: Dual energy X-ray absorptiometry was more capable of identifying obesity compared with BMI and WC both in psoriatic and control patients.

Psoriasis: new comorbidities.

Psoriasis is a chronic inflammatory disease associated with several comorbidities. A few decades ago, it was considered an exclusive skin disease but today it is considered a multisystem disease. It is believed that 73% of psoriasis patients have at least one comorbidity. Studies have demonstrated the association of psoriasis with inflammatory bowel disease, uveitis, psychiatric disorders, metabolic syndrome and its components and cardiovascular diseases. The systemic inflammatory state seems to be the common denominator for all these comorbidities. This work aims at presenting a review of the current literature on some new comorbidities that are associated with psoriasis as osteoporosis, obstructive sleep apnea and chronic obstructive pulmonary disease. While there is still controversy, many studies already point to a possible bone involvement in patients with psoriasis, especially in the male group, generally less affected by osteoporosis. Psoriasis and chronic obstructive pulmonary disease present some risk factors in common as obesity, smoking and physical inactivity. Besides, both diseases are associated with the metabolic syndrome. These factors could be potential confounders in the association of the two diseases. Further prospective studies with control of those potential confounders should be developed in an attempt to establish causality. Existing data in the literature suggest that there is an association between obstructive sleep apnea and psoriasis, but studies performed until now have involved few patients and had a short follow-up period. It is, therefore, premature to assert that there is indeed a correlation between these two diseases.

Psoriasis: new comorbidities

Abstract Psoriasis is a chronic inflammatory disease associated with several comorbidities. A few decades ago, it was considered an exclusive skin disease but today it is considered a multisystem disease. It is believed that 73% of psoriasis patients have at least one comorbidity. Studies have demonstrated the association of psoriasis with inflammatory bowel disease, uveitis, psychiatric disorders, metabolic syndrome and its components and cardiovascular diseases. The systemic inflammatory state seems to be the common denominator for all these comorbidities. This work aims at presenting a review of the current literature on some new comorbidities that are associated with psoriasis as osteoporosis, obstructive sleep apnea and chronic obstructive pulmonary disease. While there is still controversy, many studies already point to a possible bone involvement in patients with psoriasis, especially in the male group, generally less affected by osteoporosis. Psoriasis and chronic obstructive pulmonary disease present some risk factors in common as obesity, smoking and physical inactivity. Besides, both diseases are associated with the metabolic syndrome. These factors could be potential confounders in the association of the two diseases. Further prospective studies with control of those potential confounders should be developed in an attempt to establish causality. Existing data in the literature suggest that there is an association between obstructive sleep apnea and psoriasis, but studies performed until now have involved few patients and had a short follow-up period. It is, therefore, premature to assert that there is indeed a correlation between these two diseases.

Comparative study of the prevalence of sepsis in patients admitted to dermatology and internal medicine wards.

BACKGROUND: Sepsis is a common cause of morbidity and mortality among hospitalized patients. The prevalence of this condition has increased significantly in different parts of the world. Patients admitted to dermatology wards often have severe loss of skin barrier and use systemic corticosteroids, which favor the development of sepsis. OBJECTIVES: To evaluate the prevalence of sepsis among patients admitted to a dermatology ward compared to that among patients admitted to an internal medicine ward. METHODS: It is a cross-sectional, observational, comparative study that was conducted at Hospital Santa Casa de Belo Horizonte. Data were collected from all patients admitted to four hospital beds at the dermatology and internal medicine wards between July 2008 and July 2009. Medical records were analyzed for the occurrence of sepsis, dermatologic diagnoses, comorbidities, types of pathogens and most commonly used antibiotics. RESULTS: We analyzed 185 medical records. The prevalence of sepsis was 7.6% among patients admitted to the dermatology ward and 2.2% (p = 0.10) among those admitted to the internal medicine ward. Patients with comorbidities, diabetes mellitus and cancer did not show a higher incidence of sepsis. The main agent found was Staphylococcus aureus, and the most commonly used antibiotics were ciprofloxacin and oxacillin. There was a significant association between sepsis and the use of systemic corticosteroids (p <0.001). CONCLUSION: It becomes clear that epidemiological studies on sepsis should be performed more extensively and accurately in Brazil so that efforts to prevent and treat this serious disease can be made more effectively.

Comparative study of the prevalence of sepsis in patients admitted to dermatology and internal medicine wards / Estudo comparativo da prevalencia de sepse em pacientes internados nas enfermarias de dermatologia e de clinica medica

BACKGROUND: Sepsis is a common cause of morbidity and mortality among hospitalized patients. The prevalence of this condition has increased significantly in different parts of the world. Patients admitted to dermatology wards often have severe loss of skin barrier and use systemic corticosteroids, which favor the development of sepsis. OBJECTIVES: To evaluate the prevalence of sepsis among patients admitted to a dermatology ward compared to that among patients admitted to an internal medicine ward. METHODS: It is a cross-sectional, observational, comparative study that was conducted at Hospital Santa Casa de Belo Horizonte. Data were collected from all patients admitted to four hospital beds at the dermatology and internal medicine wards between July 2008 and July 2009. Medical records were analyzed for the occurrence of sepsis, dermatologic diagnoses, comorbidities, types of pathogens and most commonly used antibiotics. RESULTS: We analyzed 185 medical records. The prevalence of sepsis was 7.6% among patients admitted to the dermatology ward and 2.2% (p = 0.10) among those admitted to the internal medicine ward. Patients with comorbidities, diabetes mellitus and cancer did not show a higher incidence of sepsis. The main agent found was Staphylococcus aureus, and the most commonly used antibiotics were ciprofloxacin and oxacillin. There was a significant association between sepsis and the use of systemic corticosteroids (p <0.001). CONCLUSION: It becomes clear that epidemiological studies on sepsis should be performed more extensively and accurately in Brazil so that efforts to prevent and treat this serious disease can be made more effectively. .

FUNDAMENTOS: A sepse é causa comum de morbimortalidade em pacientes internados. A sua prevalência está aumentando significativamente em diversas partes do mundo. Pacientes internados em enfermarias de dermatologia apresentam extensas áreas de perda da barreira cutânea, além de uso frequente de corticosteróides sistêmicos, condições favoráveis ao desenvolvimento de sepse. OBJETIVOS: Avaliar a prevalência de sepse em pacientes internados em uma enfermaria de dermatologia e compará-la com a prevalência na enfermaria de clínica médica. MÉTODOS: Trata-se de estudo observacional transversal comparativo de análise de prontuários realizado na Santa Casa de Belo Horizonte. Foram coletados os dados de todos os pacientes internados em quatro leitos da clínica médica e da dematologia no período de julho de 2008 e julho de 2009. Foram analisados em busca da ocorrência de sepse, diagnósticos dermatológicas, comorbidades, tipos de patógenos mais associados e perfil de antibióticos mais utilizados. RESULTADOS: Foram analisados 185 prontuários e a prevalência de sepse entre os pacientes internados na enfermaria de dermatologia foi de 7,6% e na enfermaria de clínica médica 2,2% (p=0,10). Pacientes portadores de comorbidades, diabetes mellitus e neoplasias não demostraram maior ocorrência de sepse. O principal agente encontrado foi Staphylococcus aureus e os antibióticos mais utilizados foram ciprofloxacino e oxacilina. Houve significativa associação de sepse com o uso de corticosteróides sistêmicos (p<0,001). CONCLUSÃO: Torna-se claro que devem ser realizados estudos epidemiológicos mais amplos e acurados no Brasil sobre a sepse, para que os esforços na prevenção e no tratamento dessa grave doença possam ser direcionados ...

Nódulos reumatoides: avaliação comparativa da resposta terapêutica com triancinolona e fluoruracil intralesional / Rheumatoid nodules: evaluation of the therapeutic response to intralesional fluorouracil and triamcinolone

Os nódulos reumatoides correspondem à manifestação extra-articular mais comum da artrite reumatoide, ocorrendo em cerca de 20-25 por cento dos pacientes. A etiologia é desconhecida. Apesar de os nódulos poderem apresentar remissão espontânea durante o tratamento, eles, em geral, representam um desafio terapêutico. Apresenta-se um caso no qual se avaliou a resposta dos nódulos reumatoides por meio de ultrassonografia após infiltração de triancinolona e 5-fluoruracil.

Rheumatoid nodules are the most common extra-articular manifestation of rheumatoid arthritis and are present in around 20-25 percent of patients. Their etiology is unknown and although the nodules may undergo spontaneous remission during the treatment of rheumatoid arthritis, they usually constitute a therapeutic challenge. The present paper describes a case in which the response of rheumatoid nodules was evaluated by ultrasound following infiltration of triamcinolone acetonide and 5-fluorouracil.

Rheumatoid nodules: evaluation of the therapeutic response to intralesional fluorouracil and triamcinolone.

Rheumatoid nodules are the most common extra-articular manifestation of rheumatoid arthritis and are present in around 20-25% of patients. Their etiology is unknown and although the nodules may undergo spontaneous remission during the treatment of rheumatoid arthritis, they usually constitute a therapeutic challenge. The present paper describes a case in which the response of rheumatoid nodules was evaluated by ultrasound following infiltration of triamcinolone acetonide and 5-fluorouracil.

Mycetoma caused by Nocardia caviae in the first Brazilian patient.

BACKGROUND: Mycetoma is a chronic subcutaneous mycosis caused by exogenous fungi or actinomycetes. This infection has a progressive course and shows a typical clinical characteristic of tumefaction, draining sinuses, and grains. Infection initiation is related to local trauma and can spread to muscle, underlying bone, and adjacent organs. Nocardia brasiliensis is the most frequent actinomycete isolated, while N. caviae is a rare agent. METHODS: We present a case of mycetoma in a 37-year-old African-American man on the right hand. The infection had been apparent for four years prior to the consultation. When the infection did not respond to antibiotic therapy, the patient was referred to the Dermatology department. Routine laboratory studies were normal. X-ray examination of the hand showed an osteolytic lesion on the hand bones. On skin biopsy culture, on Sabouraud Dextrose Agar at 28 degrees C, a colony was isolated which was further identified as N. caviae by biochemical and hydrolysis testing. RESULTS: The patient was treated with oral trimethoprim/sulfamethoxazole (TMP/SMZ) 160/800 mg twice a day for 10 months. Four months after the beginning of the therapy, the subject exhibited clinical improvement and functional recovery of the hand. Five-year follow-up X-ray examination of the hand showed no osteolytic lesion on the hand bones. CONCLUSION: We report the first mycetoma case caused by N. caviae in our country with an unusual location on the hand. The patient showed clinical improvement with oral TMP/SMZ.

Tropical dermatology: Tropical diseases caused by protozoa.

UNLABELLED: Protozoan infections are very common among tropical countries and have an important impact on public health. Leishmaniasis is the most widely disseminated protozoan infection in the world, while the trypanosomiases are widespread in both Africa and South America. Amebiasis, a less common protozoal infection, is a cause of significant morbidity in some regions. Toxoplasmosis and pneumocystosis (formerly thought to be caused by a protozoan) are worldwide parasitic infections with a very high incidence in immunocompromised patients but are not restricted to them. In the past, most protozoan infections were restricted to specific geographic areas and natural reservoirs. There are cases in which people from other regions may have come in contact with these pathogens. A common situation involves an accidental contamination of a traveler, tourist, soldier, or worker that has contact with a reservoir that contains the infection. Protozoan infections can be transmitted by arthropods, such as sandflies in the case of leishmaniasis or bugs in the case of trypanosomiases. Vertebrates also serve as vectors as in the case of toxoplasmosis and its transmission by domestic cats. The recognition of the clinical symptoms and the dermatologic findings of these diseases, and a knowledge of the geographic distribution of the pathogen, can be critical in making the diagnosis of a protozoan infection. LEARNING OBJECTIVES: After completing this learning activity, participants should be able to recognize the significance of protozoan infections worldwide, identify the dermatologic manifestations of protozoan infections, and select the best treatment for the patient with a protozoan infection.

[Acne induced by amineptine]. / Acne induzida por amineptina.

We report one case of very severe acne-like lesions associated with amineptine (Survector). They were most prominent on the face and back, but were also observed on sites not affected by acne vulgaris, such as perineum, arms and legs. The lesions appeared after long-term self-medication of high doses. Keratoacanthoma-like lesions were also present, and the small ones were successfully treated with topical imiquimod. The case is significant since the disease is quite rare.

Acne induzida por amineptina / Acne induced by amineptine

Relata-se um caso grave de lesões acne-símile associada a amineptina (Survector®), proeminentes na face e dorso, acometendo outros sítios não afetados pela acne vulgar, como períneo, braços e pernas. As lesões apareceram após a auto-administração crônica de altas doses do medicamento. Lesões ceratoacantoma-símile também estavam presentes, tendo as lesões menores resposta satisfatória ao tratamento com imiquimod tópico. O relato é significativo pela raridade da doença.

We report one case of very severe acne-like lesions associated with amineptine (Survector®). They were most prominent on the face and back, but were also observed on sites not affected by acne vulgaris, such as perineum, arms and legs. The lesions appeared after long-term self-medication of high doses. Keratoacanthoma-like lesions were also present, and the small ones were successfully treated with topicalimiquimod. The case is significant since the disease is quite rare.

Hematidrosis: a case report and review of the literature.

The authors report the case of a 9 year-old female who had bleeding episodes around the mouth after strenuous exercise or prolonged exposure to heat. Characteristically, bleeding occurred right after sweat drops started appearing on the surface of the skin around the mouth. The bleeding episodes ceased spontaneously.

Molecular typing and antifungal susceptibility of Trichophyton rubrum isolates from patients with onychomycosis pre- and post-treatment.

Forty sequential isolates of Trichophyton rubrum were obtained from patients suffering from onychomycosis at two time points, before and after antifungal oral therapy. Strain differentiation by specific amplification of the two tandemly repeated elements (TRS-1 and TRS-2) of the ribosomal DNA of T. rubrum was performed. In addition, susceptibility tests were executed by the microdilution method with nine antifungal drugs: ketoconazole, itraconazole, fluconazole, miconazole, clotrimazole, isoconazole, griseofulvin, cyclopiroxolamine and terbinafine. The combination of TRS-1 with TRS-2 PCR amplification patterns configured 11 T. rubrum genotypes and the three most prevalent (genotypes 1-I, 5-I and 2-I) accounted for 67.5% of the isolates. Seven isolates (35%) obtained before antifungal oral therapy exhibited genotype 1-I compared to the 11 (55%) obtained after the treatment. Twelve patients exhibited different strains before and after the antifungal therapy. With respect to in vitro susceptibility testing, terbinafine was the most potent agent, followed by itraconazole, clotrimazole, isoconazole, miconazole, cyclopiroxolamine, ketoconazole, griseofulvin and fluconazole. Furthermore, an increase in the minimum inhibitory concentrations (MIC) were observed for most of the azole agents when testing isolates obtained post-treatment from four patients. This increase in MIC occurred concomitantly with the major occurrence of genotype 1-I for isolates obtained after oral therapy. These data attempt to consider the relevance of in vivo drug resistance for onychomycosis caused by T. rubrum.

Psoriasis and pentoxifylline: a clinical, histopathologic, and immunohistochemical evaluation.

OBJECTIVE: The aim of this study was to examine the clinical and histopathologic effects of pentoxifylline on psoriasis, compared with placebo. METHODS: Sixty-one outpatients with active psoriasis were randomly assigned to either of 2 groups: one was given pentoxifylline 400 mg tid PO, and the other, placebo. Fifty-six patients concluded the study. They were evaluated clinically and by laboratory parameters before and after 8 weeks of treatment. Pretreatment and posttreatment biopsies were taken. Initial sections were stained with hematoxylin-eosin. Further cuts were immunostained for cytokeratins 10, 14, and 16. RESULTS: Clinical and histologic improvement did not show statistically significant differences between the groups. No laboratory abnormalities or serious reactions related to the drug were observed. CONCLUSIONS: No statistical difference was seen when the treatment group was compared with the control group. Pentoxifylline is a well tolerated and safe drug, but its efficacy in psoriasis appears to be limited.

Você conhece esta síndrome? / Do you know this syndrome?

Os autores apresentam caso de criança de dois anos, com história de cabelos negros e lisos ao nascimento que, aos seis meses de idade, desenvolveram alterações da textura e da cor, tornando-se mais claros e impenteáveis. A rara síndrome dos cabelos impenteáveis é caracterizada pelo surgimento de cabelos de crescimento lento, loiro-prateados, desordenados, em indivíduos com cabelos previamente normais. A microscopia óptica é normal e a microscopia eletrônica é diagnóstica. Não há tratamento efetivo.