Influence of severity of the cutaneous manifestations and age on the prevalence of several cardiovascular risk factors in patients with psoriasis.

INTRODUCTION: Psoriasis is a disease with proinflammatory state that has been associated with an increased risk of cardiovascular disease. METHOD: This is a cross-sectional, observational study, with analysis of 98 patients being treated for psoriasis. Several variables were analysed: gender, age, weight, height, Psoriasis Area and Severity Index (PASI), blood pressure, blood glucose, blood lipids, obesity, metabolic syndrome (MS) and Framingham score. RESULTS: Ninety-eight patients were analysed (51 men; 52.0%). Age ranged from 12 years to 98 years. About 67% of the patients had dyslipidaemia, 14.3% had type 2 diabetes mellitus and 59.2% had systemic arterial hypertension. Forty-four percentage of patients had the MS and 27.6% had a body mass index >30 kg/m(2). The Psoriasis Area and Severiy Index were equal or over 10 in 27 patients, 18 of whom had dyslipidaemia (P = 0.929) and 14 of whom had the MS (P = 0.327). Seventy-four patients were over the age of 40 years and, of these, 56 had dyslipidaemia (P = 0.002) and 41 had the MS (P < 0.001). For 89 patients, whose cardiovascular risk was calculated according to the Framingham criteria, 71.4% at high or moderate risk had a PASI below 10 (P = 0.945) and 100% at high or moderate risk were over the age of 40 years (P = 0.001). CONCLUSION: There was strong evidence that psoriasis patients have an increased cardiovascular risk, chiefly those over the age of 40 years, probably because of the chronic inflammatory state. It seems that the severity of the cutaneous manifestations was not associated with a higher risk in these patients.

Onychomycosis in inflammatory bowel diseases.

BACKGROUND: As far as we have sought for in Medline and PubMed, not one study until now has evaluated the prevalence of onychomycosis in patients with inflammatory bowel disease (IBD). As there are great evidence of immunological disturbances linked to IBD, a possible relationship of this nail infection in association with those diseases and the possible risk factors might be relevant in IBD patients. METHODS: A case-control prospective study using combined direct smear and cultures for fungus was performed. Sociodemographics, clinical and laboratorial data were recorded at baseline and samples of suspected nails were collected from 141 IBD (61 men and 80 women) and from a group of 100 non-IBD subjects (41 men and 59 women). Direct smear and cultures were performed on each suspected case to exclude other onychodystrophies. RESULTS: The incidence of onychomycosis in IBD patients was highly significant in comparison to non-IBD patients (14.9% vs. 6%, respectively, P < 0.05). The risk factors predisposing IBD patients to onychomycosis were older age (P = 0.02) and leucopoenia in those using azathioprine therapy (P = 0.04) beyond a trend to lymphopenia (P = 0.06). The dermatophytes predominated (76.2%) over yeasts (19%) and moulds (4.8%). CONCLUSION: The prevalence of onychomycosis in IBD patients was expressively high (14.9%) in comparison with non-IBD patients. Considering the sociodemographic factors, any one but two were related to fungal onychomycosis incidence. Therefore, as far as we are concerned, IBD must be included in the high-risk underlying conditions for onychomycosis occurrence.

[Epidemiology, clinical features and clinical course of Crohn's disease: a study of 60 cases]. / Epidemiologia, aspectos clínicos e evolutivos da doença de Crohn: um estudo de 60 casos.

The authors present their experience with the follow-up of 60 cases of Crohn's disease, from 1970 until 1998, in the city of Juiz de Fora, Minas Gerais state, a county of the Southeast region of Brazil, and analyse the epidemiology of disease to improve the understanding of its behaviour in the country. The incidence rates increased greatly in the last 28 years. In the group studied 53.3% were men, 90% white, 71.7% non-smokers, 93.3% non-alcoholics, and all, but two, lived in urban area; 58.3% had their symptoms started at the age between 11 and 30 years and 30% were in the second decade of life. Relatives with Crohn's disease were seen in 6.7%, and the most common symptoms observed at the beginning of disease were: abdominal pain (78.3%), diarrhea (68.3%), weight loss (26.7%) and small bowel obstruction or localized peritonitis (15%). The ileum was involved in 90% and five cases (8.3%) with lesions restricted to the colon were observed. Two patients died because they were non-responders despite any therapy schedule and had sepsis after surgery. The effect of several substances used in the treatment is described, being prednisone the most effective in controlling the active disease. Other drugs as aminosalicilates, metronidazol and immunomodulators are also considered to avoid the side-effects of long-term use of steroides. Comments are made about the clinical evolution, surgeries and response to many treatments adopted. The authors conclude that Crohn's disease is increasing its incidence rate in Brazil and probably in South America formerly considered as a region of low frequency.

[Intestinal parasitosis and hepatic cirrhosis]. / Parasitoses intestinais e cirrose hepática.

The authors describe their experience, in a prospective survey, with the prevalence rates of intestinal parasites in patients with hepatic cirrhosis admitted to the Gastroenterology Unit of University Hospital of Federal University in Juiz de Fora, Brazil, whose fresh stools were examined by Hoffman-Pons-Janner, Baermann-Moraes and Willis methods. They compare the results of stool exams with two control groups and look for a relation with cirrhosis' etiology. A higher prevalence of some parasites was observed in cirrhosis than in people with other digestive diseases (group I). mainly for the Strongyloides stercoralis, found in 40.2%, chiefly in alcoholic cirrhosis. Oddly no one of the group I admitted in the same period had strongyloidiasis. Another group including all the people who had stool samples examined in the same period at the hospital had 1.91% of that helmintic infection (group II). A comparison is also made with the prevalence in schoolchildren between the ages of 7 and 14 studies eight years before (13.16%). Other parasites were also observed in different incidence between those with cirrhosis and the other groups and the results are presented. They conclude that hepatic cirrhosis must be included in the list of conditions which increases the risk of Strongyloides stercoralis infection.

PIP: In a prospective study conducted between July 1995 and June 1996 the prevalence of intestinal parasites is described in 35 (32 male, 3 female) patients with hepatic cirrhosis, aged 13-77 years, who had been admitted to the gastroenterology unit of the Federal University in Juiz de Fora, Brazil. The causes of cirrhosis were: alcohol (19 cases), hepatitis B virus (HBV) (3 cases), hepatitis C virus (HCV) (5 cases), HBV and HCV (2 cases), cryptogenetics (3 cases), Wilson's disease (1 case), biliary cirrhosis (1 case), and Gaucher's disease (1 case). Another 45 patients who were hospitalized during this period served as controls (Group I). Group II was comprised of 1411 persons who underwent parasitological tests during December 1995 and May 1996. Comparison was also made with 7371 tests performed in children aged 7-14 years who had been studied in 1988. Stools were examined by the Hoffman-Pons-Janner, Baermann-Moraes, and Willis methods. The results of stool exams were compared with those of the two control groups. A higher prevalence of some parasites was observed in cirrhosis patients than in patients with other digestive diseases (Group I). Of the 35 cirrhosis patients, 19 presented with positive parasite tests. Strongyloides stercoralis was found in 40.2%, chiefly in alcoholic cirrhosis patients, which was significant when compared to the other two control groups, but not significant when compared to the patients with nonalcoholic cirrhosis (4 cases of strongyloidiasis out of 16 patients). None of the 45 patients in Group I had strongyloidiasis. Group II (including all the people who had stool samples examined during the same period in the hospital) had a 1.91% rate of helminthic infection. A rate of 13.16% was found in the children's group.