Thyroid abnormality in patients with psoriasis: prevalence and association with severity

Abstract Background: Psoriasis is associated with several comorbidities and its association with thyroid abnormality has been hypothesized. Objective: To assess the prevalence of thyroid abnormality in Brazilian patients with psoriasis and to analyze its association with severity, presence of psoriatic arthritis and immunobiological treatment. Additionally, to compare results with literature as a control. Methods: In this observational study, clinical and laboratory data of patients followed from January 2018 to December 2019 were analyzed. Thyroid abnormality was assessed through the current history of thyroid disease and laboratory tests - thyrotropin (TSH), free thyroxine (FT4), antithyroid peroxidase (anti-TPO) and antithyroglobulin (anti-TG) antibodies. Patients were classified according to psoriasis severity - Psoriasis Area and Severity Index (PASI), presence of psoriatic arthritis, and current treatment. Subsequently, the results were compared with a control group selected from the literature review. Results: Of the 250 included patients, 161 were eligible. The prevalence of thyroid abnormality was 28.57% and of hypothyroidism, 14.91%. The mean age was 55 years and the median PASI was 2.2. There was no association between thyroid abnormality and PASI (p = 0.8), presence of psoriatic arthritis (p = 0.87), or use of immunobiological therapy (p = 0.13). The literature control group included 6,227 patients and there was a statistically significant difference for the hypothyroidism variable (p < 0.0001).

Thyroid abnormality in patients with psoriasis: prevalence and association with severity.

BACKGROUND: Psoriasis is associated with several comorbidities and its association with thyroid abnormality has been hypothesized. OBJECTIVE: To assess the prevalence of thyroid abnormality in Brazilian patients with psoriasis and to analyze its association with severity, presence of psoriatic arthritis and immunobiological treatment. Additionally, to compare results with literature as a control. METHODS: In this observational study, clinical and laboratory data of patients followed from January 2018 to December 2019 were analyzed. Thyroid abnormality was assessed through the current history of thyroid disease and laboratory tests - thyrotropin (TSH), free thyroxine (FT4), antithyroid peroxidase (anti-TPO) and antithyroglobulin (anti-TG) antibodies. Patients were classified according to psoriasis severity - Psoriasis Area and Severity Index (PASI), presence of psoriatic arthritis, and current treatment. Subsequently, the results were compared with a control group selected from the literature review. RESULTS: Of the 250 included patients, 161 were eligible. The prevalence of thyroid abnormality was 28.57% and of hypothyroidism, 14.91%. The mean age was 55 years and the median PASI was 2.2. There was no association between thyroid abnormality and PASI (p=0.8), presence of psoriatic arthritis (p=0.87), or use of immunobiological therapy (p=0.13). The literature control group included 6,227 patients and there was a statistically significant difference for the hypothyroidism variable (p<0.0001). STUDY LIMITATIONS: Absence of a control group from the same center. CONCLUSION: This was one of the first Brazilian studies on the prevalence of thyroid abnormality in patients with psoriasis.

Uma proposta histórico-cultural do fazer clínico: relato de experiência em oficinas terapêuticas / Una propuesta histórico-cultural de práctica clínica: informe de experiencia en talleres terapéuticos / A historical-cultural proposal of clinical practice: experience report in therapeutic workshops

Este trabalho trata-se de um registro teórico-prático, descritivo e qualitativo, referente a experiência de Estágio Básico em Psicologia Clínica, da Faculdade Católica Dom Orione. O mesmo ocorreu nas dependências de um Centro de Atenção Psicossocial Infanto-Juvenil (CAPSi). O estágio referido foi realizado através de observações em oficinas terapêuticas, com público alvo de adolescentes, teve como principal intuito favorecer a constituição de vínculos entre estagiários, mediadores das oficinas, adolescentes usuários e familiares, levantando as principais demandas ali expostas, e conseguinte elaborar ações de acordo com os embasamentos teóricos da abordagem histórico-cultural, articulando teoria e prática, aspirando a materialização das emoções e vivências do grupo acompanhado, bem como compreender o processo de subjetividade dos adolescentes a partir de um fazer psicológico para além da clínica. No decorrer das observações foi compreendido que existe um distanciamento entre o serviço ideal e o que é ofertado, tornando factível a correlação entre teoria e prática do psicólogo dentro da instituição, considerando que se faz necessário suscitar reflexões respaldadas em experiências pertinentes às ações desenvolvidas nestes espaços, que tem como projeto um novo modelo de saúde mental, com o propósito de promover um serviço cada vez mais pautado na ética, no respeito e no compromisso social e político, com vistas a reivindicar o direito das pessoas a um serviço cada vez mais preparado para acolher as necessidades individuais de cada um, visando sempre a promoção de saúde.(AU)

Este trabajo es un registro teórico-práctico, descriptivo y cualitativo, que se refiere a la experiencia de la pasantía básica en psicología clínica, en la Facultad Católica Dom Orione. Lo mismo ocurrió en las instalaciones de un Centro de Atención Psicosocial para Niños y Jóvenes (CAPSi). La pasantía referida se realizó a través de observaciones en talleres terapéuticos, con un público objetivo de adolescentes, cuyo objetivo principal era favorecer el establecimiento de vínculos entre pasantes, mediadores de talleres, usuarios adolescentes y miembros de la familia, elevando las principales demandas expuestas allí y, en consecuencia Desarrollar acciones de acuerdo con los fundamentos teóricos del enfoque histórico-cultural, articulando teoría y práctica, aspirando a materializar las emociones y experiencias del grupo acompañado, así como a comprender el proceso de subjetividad de los adolescentes desde un punto de vista psicológico más allá de la clínica. Durante las observaciones, se entendió que existe una brecha entre el servicio ideal y lo que se ofrece, lo que hace posible la correlación entre la teoría y la práctica del psicólogo dentro de la institución, considerando que es necesario plantear reflexiones respaldadas por experiencias pertinentes a las acciones desarrolladas en estos espacios, cuyo proyecto es un nuevo modelo de salud mental, con el objetivo de promover un servicio cada vez más guiado por la ética, el respeto y el compromiso social y político, con el objetivo de reclamar El derecho de las personas a un servicio cada vez más preparado para satisfacer las necesidades individuales de cada uno, siempre con el objetivo de promover la salud.(AU)

This paper is a theoretical-practical, descriptive and qualitative record, referring to the experience of Basic Internship in Clinical Psychology, at Católica Dom Orione College. The same occurred on the premises of a Child and Youth Psychosocial Care Center (CAPSi). The referred internship was carried out through observations in therapeutic workshops, with a target audience of teenagers, whose main purpose was to favor the establishment of bonds between interns, workshop mediators, teenagers users and family members, raising the main demands exposed there, and consequently develop actions according to the theoretical foundations of the historical-cultural approach, articulating theory and practice, aspiring to materialize the emotions and experiences of the accompanied group, as well as understanding the process of subjectivity of teenagers from a psychological way beyond the clinic. During the observations, it was understood that there is a gap between the ideal service and what is offered, making the correlation between theory and practice of the psychologist within the institution feasible, considering that it is necessary to raise reflections supported by experiences pertinent to the actions developed in these spaces, whose project is a new mental health model, with the purpose of promoting a service increasingly guided by ethics, respect and social and political commitment, with a view to claiming the right of people to a service increasingly prepared to accommodate the individual needs of each one, always aiming at health promotion.(AU)

Analysis of cardiovascular risk and carotid intima-media thickness in patients with psoriasis.

BACKGROUND: Psoriasis is associated with atherosclerosis and increased cardiovascular risk. Currently, an automated ultrasound, called quantitative intima media thickness, has proven to be a useful method to evaluate subclinical atherosclerosis. OBJECTIVES: To compare increased cardiovascular risk in psoriasis patients receiving two types of treatments: Methotrexate and tumor necrosis factor inhibitor and to evaluate the correlation between the Framingham score and quantitative intima media thickness. METHODS: Fifty patients with plaque psoriasis were selected from June 2017 to July 2018, divided into two groups, receiving methotrexate and tumor necrosis factor inhibitor. Measurement of abdominal circumference, blood pressure, body mass index and presence of metabolic syndrome were performed. Afterwards, the patients were evaluated for increased cardiovascular risk with the Framingham score and for the quantitative intima media thickness of the carotid arteries. RESULTS: The mean age was 54.8 (±12.5) with a slight male predominance (58%). Overall, 84% of the patients had elevated waist circumference, 82% had a body mass index above ideal, and 50% had a metabolic syndrome. For the correlation between quantitative intima media thickness and Framingham Score, Pearson's linear correlation coefficient was 0.617 (p<0.001), indicating a moderate to strong positive association. STUDY LIMITATIONS: The protective effect of the therapies cited in relation to the increased cardiovascular risk was not evaluated. CONCLUSIONS: A moderate to strong positive association was found correlating the Framingham Score values with the quantitative intima media thickness measurement and it is not possible to state which drug has the highest increased cardiovascular risk.

Analysis of cardiovascular risk and carotid intima-media thickness in patients with psoriasis

Abstract Background: Psoriasis is associated with atherosclerosis and increased cardiovascular risk. Currently, an automated ultrasound, called quantitative intima media thickness, has proven to be a useful method to evaluate subclinical atherosclerosis. Objectives: To compare increased cardiovascular risk in psoriasis patients receiving two types of treatments: Methotrexate and tumor necrosis factor inhibitor and to evaluate the correlation between the Framingham score and quantitative intima media thickness. Methods: Fifty patients with plaque psoriasis were selected from June 2017 to July 2018, divided into two groups, receiving methotrexate and tumor necrosis factor inhibitor. Measurement of abdominal circumference, blood pressure, body mass index and presence of metabolic syndrome were performed. Afterwards, the patients were evaluated for increased cardiovascular risk with the Framingham score and for the quantitative intima media thickness of the carotid arteries. Results: The mean age was 54.8 (±12.5) with a slight male predominance (58%). Overall, 84% of the patients had elevated waist circumference, 82% had a body mass index above ideal, and 50% had a metabolic syndrome. For the correlation between quantitative intima media thickness and Framingham Score, Pearson's linear correlation coefficient was 0.617 (p < 0.001), indicating a moderate to strong positive association. Study limitations: The protective effect of the therapies cited in relation to the increased cardiovascular risk was not evaluated. Conclusions: A moderate to strong positive association was found correlating the Framingham Score values with the quantitative intima media thickness measurement and it is not possible to state which drug has the highest increased cardiovascular risk.

Assessment of psoriasis severity in Brazilian patients with chronic plaque psoriasis attending outpatient clinics: a multicenter, population-based cross-sectional study (APPISOT).

PURPOSE: Data on chronic plaque psoriasis severity and its potential clinical and lifestyle implications in the Brazilian population are limited. The primary aim of this study was to assess the clinical severity of plaque psoriasis in Brazil. Further objectives included evaluating potential associations between disease severity and demographic, lifestyle, and clinical characteristics, health-related quality of life (HRQOL), and work productivity. MATERIALS AND METHODS: This observational (non-interventional) cross-sectional study was conducted in 26 dermatologic clinics across 11 Brazilian states. Psoriasis severity was assessed using investigator judgment and Finlay's Rule of Tens: a Psoriasis Area and Severity Index (PASI) score >10, a Body Surface Area (BSA) > 10%, or a Dermatology Life Quality Index (DLQI) score >10. RESULTS: Among 1125 patients, 205 (18.2%) had moderate-to-severe disease. On multiple regression analyses, psoriasis severity was significantly (directly) associated with the presence of physical inactivity and comorbid pain, anxiety, and depression; and significantly (inversely) associated with HRQOL and work productivity. LIMITATIONS: Cross-sectional studies cannot assess temporal trends, and observational studies cannot conclusively determine causality or exclude biases and confounding due to unmeasured variables. CONCLUSIONS: Among Brazilian patients with moderate-to-severe psoriasis, disease severity had far-reaching adverse impacts on lifestyle, comorbidities, HRQOL, and work productivity.

Evaluation of the effect of tacrolimus on periodontitis induced in rats.

OBJECTIVE: This study was to investigate the effect of tacrolimus (FK506) on periodontitis induced in rats. DESIGN: Periodontal disease was induced in 30 Wistar rats which were then randomly divided into two groups: treatment with a daily injection of 0.9% saline (1mL/day) and treatment with a daily injection of FK506. After periods of 10, 15 and 30days the animals were killed and separate radiographs of the right and left hemimandibles were obtained. One calibrated examiner measured the periodontal bone support (PBS) in the images, after the following treatments: S, saline without ligature; SL, saline with ligature; T, FK506 without ligature; TL, FK506 with ligature. The data were subjected to analysis of variance (ANOVA) and the Tukey test (p<0.01). RESULTS: The radiographic results were similar at all evaluation time points. The S treatment had a higher PBS averaging at 10, 15 and 30days, which was statistically significant different compared with the SL treatment and TL treatment, but not significantly different from the T treatment. The SL and TL treatments showed no statistically significant differences between them. CONCLUSIONS: Tacrolimus used for up to 30days showed no protective or aggravating effects on alveolar bone loss.

Malassezia intra-specific diversity and potentially new species in the skin microbiota from Brazilian healthy subjects and seborrheic dermatitis patients.

Malassezia yeasts are part of the resident cutaneous microbiota, and are also associated with skin diseases such as seborrheic dermatitis (SD). The role these fungi play in skin diseases and why they are pathogenic for only some individuals remain unclear. This study aimed to characterize Malassezia microbiota from different body sites in healthy and SD subjects from Brazil. Scalp and forehead samples from healthy, mild SD and severe SD subjects were collected. Non-scalp lesions from severe SD patients were also sampled. 5.8S rDNA/ITS2 amplicons from Malassezia sp. were analyzed by RFLP and sequencing. Results indicate that Malassezia microbiota did not group according to health condition or body area. Phylogenetic analysis revealed that three groups of sequences did not cluster together with any formally described species, suggesting that they might belong to potential new species. One of them was found in high proportions in scalp samples. A large variety of Malassezia subtypes were detected, indicating intra-specific diversity. Higher M. globosa proportions were found in non-scalp lesions from severe SD subjects compared with other areas, suggesting closer association of this species with SD lesions from areas other than scalp. Our results show the first panorama of Malassezia microbiota in Brazilian subjects using molecular techniques and provide new perspectives for further studies to elucidate the association between Malassezia microbiota and skin diseases.

Avaliação de dermocosmético com retinaldeído, nicotinamida e vitis vinifera no fotoenvelhecimento cutâneo de mulheres entre 25 e 40 anos de idade / Assessment of dermocosmetics contai- ning retinaldehyde, nicotinamide and Vitis vinifera in the cutaneous photoaging of women between 25 and 40 years old

Introdução: A pele está sujeita ao envelhecimento intrínseco e extrínseco. Desse modo, tratar o fotoenvelhecimento cutâneo representa desafio clínico. Objetivo: Avaliar, através de parâmetros objetivos e subjetivos, segurança, tolerabilidade e eficácia clínica de produto cosmético contendo retinaldeído 0,05%, nicotinamina 4% e extrato de Vitis vinifera 1% no tratamento do envelhecimento da pele. Métodos: Estudo monocêntrico, prospectivo, intervencional, aberto que avaliou 40 voluntárias do sexo feminino de 25 a 40 anos, fototipos I a IV de Fitzpatrick, que aplicaram produto dermocosmético durante 60 dias consecutivos. As avaliações foram realizadas de forma subjetiva pelo médico, voluntária e exameultrassonográfico e de forma objetiva por fotografias pelo Visia®, biópsias cutâneas, corneometria, pHmetria e sebumetria. Resultados: 36 voluntárias completaram o estudo. Avaliações subjetivas demonstraram melhora nas rugas, linhas finas, flacidez, viço e aparência geral. Ultrassom e biópsia cutânea evidenciaram aumento de colágeno em 94,4% e 30,6% respectivamente. Fotos do aparelho Visia® demonstraram redução de manchas, rugas, poros e melhora da textura cutânea. Sebumeter revelou diminuição da oleosidade, e houve redução do pH. As medidas do Corneometer mantiveram-se constantes. Conclusões: o produto dermocosmético analisado foi eficaz e seguro para combater o fotoenvelhecimento.

Sistematização da assistência de enfermagem na sala de recuperação pós-anestésica / Systematization of nursing assistance in the post-anesthetic recovery room

O paciente em pós-operatório imediato possui um potencial risco de complicações, necessitando de assistência de enfermagem individualizada. Este estudo objetivou propor a implantação de um protocolo de Sistematização da Assistência de Enfermagem na Sala Recuperação Pós-Anestésica (SRPA) de um hospital público do Agreste Pernambucano...

Psoríase e comorbidades / Psoriasis and comorbidities

A psoríase é uma doença inflamatória crônica associada a comorbidades graves, incluindo artrite psoriásica, depressão, malignidade e complicações cardiovasculares. Esta revisão tem como foco uma série de comorbidades associadas à psoríase. A natureza crônica da psoríase tem sido sugerida como um fator de risco independente para o desenvolvimento destas comorbidades.