Enfermedad de Paget extramamaria tratada con imiquimod 5% crema / Extramammary Paget Disease Treated With 5% Imiquimod Cream

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[Ankle-brachial index testing is particularly indicated in patients with metabolic syndrome but without known arterial disease]. / La medida del índice tobillo-brazo: particularmente indicada en pacientes con síndrome metabólico sin enfermedad arterial conocida.

INTRODUCTION: The objective was to investigate the prevalence of metabolic syndrome (MetS), its cardiovascular disease (CVD) risk and its association with peripheral arterial disease, defined by a low ankle-brachial index (ABI) (< 0.90), in primary prevention. MATERIAL AND METHODS: Cross-sectional study performed in the primary care general population, aged 50-79 years. CVD risk and ABI were measured in persons without known arterial disease with MetS and in a control group. MetS was defined by Adult Treatment Panel III. CVD risk was estimated using the Systematic Coronary Risk Evaluation (SCORE). RESULTS: A total of 581 subjects were recruited. The prevalence of the metabolic syndrome was 30.8% (95% confidence interval [CI], 27.0-34.5). For the CVD risk and ABI studies 217 individuals were included (138 with MetS and 49 with diabetes). Average CVD risk was high (5%) on patients with MetS and twice as much as those without MetS. ABI was low (< 0.90) on 15 subjects [6.9% (95% CI), 3.5-10.2], with higher frequency in the MetS group: 14 patients (10.1%) vs 1 patient (1.3%). The frequency of low ABI in patients with and without diabetes was 18.3% and 3.6% respectively. Low ABI was associated to MetS, diabetes, inactivity, high risk of SCORE and less alcohol habit. In the multivariate analysis, the odds ratio for the association MetS/low ABI was 14.7 (95% CI, 1.7-123.6). CONCLUSION: MetS is related to asymptomatic peripheral arterial disease. Thus, the measure of ABI in those patients with this syndrome is recommended.

La medida del índice tobillo-brazo: particularmente indicada en pacientes con síndrome metabólico sin enfermedad arterial conocida / Ankle-brachial index testing is particularly indicated in patients with metabolic syndrome but without known arterial disease

Introducción. El objetivo fue investigar la prevalencia del síndrome metabólico (SM), su riesgo cardiovascular (RCV) y su asociación con la enfermedad arterial periférica (EAP), definida por un índice tobillo-brazo (ITB) bajo (< 0,90), en prevención primaria. Material y métodos. Estudio transversal, realizado en población general de Atención Primaria, de 50-79 años. EL RCV y el ITB se midieron en los casos de SM sin enfermedad arterial conocida y en un grupo control sin SM. El SM se definió según el Adult Treatment Panel III. El RCV fue estimado mediante el Systematic Coronary Risk Evaluation (SCORE). Resultados. Se incluyeron 581 sujetos. La prevalencia de SM fue del 30,8% (intervalo de confianza [IC] del 95%: 27,0-34,5). Para el estudio del RCV y el ITB se incluyeron 217 sujetos (138 con SM y 49 con diabetes). En los pacientes con SM el RCV medio resultó alto (5%) y dos veces mayor al de los pacientes sin SM. El ITB fue bajo (< 0,90) en 15 sujetos (6,9% [IC del 95%]: 3,5-10,2), con mayor frecuencia en el grupo SM: 14 casos (10,1%) frente a un caso (1,3%). La frecuencia de ITB bajo en pacientes con y sin diabetes fue del 18,3% y del 3,6% respectivamente. El ITB bajo se asoció con SM, diabetes, sedentarismo, alto riesgo SCORE y con un menor consumo de alcohol. En el análisis multivariante la asociación SM/ITB bajo presentó odds ratio = 14,7 (IC del 95%: 1,7-123,6). Conclusión. El SM se asocia a EAP asintomática, por lo que se aconseja medir el ITB en los pacientes que padecen este síndrome

Introduction. The objective was to investigate the prevalence of metabolic syndrome (MetS), its cardiovascular disease (CVD) risk and its association with peripheral arterial disease, defined by a low ankle-brachial index (ABI) (< 0.90), in primary prevention. Material and methods. Cross-sectional study performed in the primary care general population, aged 50-79 years. CVD risk and ABI were measured in persons without known arterial disease with MetS and in a control group. MetS was defined by Adult Treatment Panel III. CVD risk was estimated using the Systematic Coronary Risk Evaluation (SCORE). Results. A total of 581 subjects were recruited. The prevalence of the metabolic syndrome was 30.8% (95% confidence interval [CI], 27.0-34.5). For the CVD risk and ABI studies 217 individuals were included (138 with MetS and 49 with diabetes). Average CVD risk was high (5%) on patients with MetS and twice as much as those without MetS. ABI was low (< 0.90) on 15 subjects [6.9% (95% CI), 3.5-10.2], with higher frequency in the MetS group: 14 patients (10.1%) vs 1 patient (1.3%). The frequency of low ABI in patients with and without diabetes was 18.3% and 3.6% respectively. Low ABI was associated to MetS, diabetes, inactivity, high risk of SCORE and less alcohol habit. In the multivariate analysis, the odds ratio for the association MetS/low ABI was 14.7 (95% CI, 1.7-123.6). Conclusion. MetS is related to asymptomatic peripheral arterial disease. Thus, the measure of ABI in those patients with this syndrome is recommended

Efecto del estrés sobre el movimiento dental / Effect of stress on dental movement

Introducción. Es bien conocido que la actividad remodeladora del hueso alveolar en los tejidos periodontales ocurre bajo ciertas circunstancias. Factores sistémicos pueden estar involucrados en la regulación de la actividad degradadora tisular. La reabsorción ósea es regulada por las citoquinas, que se encuentran dentro de las células medulares, que median la activación y formación de osteoclastos. Material y método. Veinticuatro ratas fueron asignadas al azar en cuatro grupos de seis ratas cada uno: grupo control, grupo estrés, grupo con movimiento dental y grupo de movimiento dental y estrés. Para ejercer la fuerza ortodóncica se utilizó un método modificado por Kohno et al. Las ratas fueron sometidas a una banda ancha de ruidos de 100 dB diarios por 5 segundos cada minuto durante períodos de 1 a 3 horas alrededor de la medianoche, en el pico de la actividad diurna. Se midió el movimiento dentario por un método modificado que fue descrito previamente por King et al (1991).Resultados. A los siete y catorce días se observó un aumento estadísticamente significativo del movimiento dental en animales sujetos a estrés comparados con aquellos no estresados. Discusión. Estudios recientes han sugerido que la regulación de la remodelación ósea puede estar influenciada por el sistema inmune a través de la producción de citoquinas por las células inflamatorias presentes tras la aplicación de fuerzas ortodóncicas. Numerosos estudios interdisciplinarios psicoinmunológicos han evidenciado que estímulos externos que generan repuestas de estrés emocional pueden influir y modular al sistema inmune por la vía del sistema nervioso y neuroendocrino (AU)

Introduction. The active remodeling of alveolar bone in periodontal tissues is well known to occur in various kinds of conditions. Systemic factors may be involved in the regulation of the tissue-degrading activity. Bone resorption is regulated by the cytokines within marrow cells that mediate osteoclast formation and activation. Psychological responses to stressors have been shown to modulate the immune system though the neural and endocrine system in at least three different pathways. Material and method. Twenty-four rats, were randomly assigned into four groups of six rats each, control, stress, dental movement, stress and dental movement. To exert orthodontic force we used a modified method described by Kohno et al. The rats were subjected to a broad band noise at 100 dB daily for 5 seconds every minute during a 1 or 3-h period around midnight, at the height of the diurnal activity cycle. Unstimulated rats were exposed only to the normal activity of the animal room. Tooth movement assessed by extra-oral cephalometric radiographic view from the superior, by a modified method that was previously described by King et al (1991).Results. At seven and fourteen days we observed a statistically significant increase of dental movement in the animals subject to stress compared to those not stressed. Discussion. Recent studies have suggested that the regulation of bone remodeling can be influenced by the immune system though cytokine production from inflammatory cells present after the application of orthodontic forces. Numerous interdisciplinary psychoimmunological studies have provided evidence that external stimuli generating emotional stress responses may influence and modulate the immune system via nervous and neuroendochrine system (AU)

Alfafeto proteina en suero materno elevada: relación con el bajo peso al nacer: estudio comparativo / Elevated alpha-fetoprotein in maternal serum: its relationship to low birth weight. A

Se realiza estudio de serie cronológica de los nacidos vivos con bajo peso durante 1990–1993 y 2000–2003, comparándose entre ambos períodos la sensibilidad y valor predictivo positivo de la Alfafeto proteína en suero materno elevada, con el objetivo de comprobar su utilidad como indicador de riesgo de bajo peso al nacer en ausencia de defectos de cierre del tubo neural en el Policlínico Docente Rampa del municipio Plaza de Ciudad de La Habana. Se determinó una sensibilidad de 15,68por ciento y 11,94por ciento y un valor predictivo positivo de 30,76por ciento y 24por ciento, respectivamente, independiente de la natalidad e índice de bajo peso de ambos períodos(AU)

Malassezia globosa as the causative agent of pityriasis versicolor.

BACKGROUND: The taxonomic revision carried out in 1996 on the genus Malassezia, which now comprises seven different species, made necessary a re-evaluation of the data concerning the ecology and pathogenicity of these lipophilic yeasts. Very little has been published since then. OBJECTIVES: The aim of this work was to contribute to the knowledge of the aetiology of pityriasis versicolor (PV) with a mycological study made according to the new species. METHODS: Ninety-six patients with PV completed the study. In all of them, samples were taken from the lesions for direct microscopy with KOH+ Parker ink and culture. Samples were also taken from normal skin of the trunk and the forehead of the same patients for culture. Cultures were made in modified Dixon medium in Petri dishes, incubated at 31 degrees C and the isolates were identified by morphological and physiological characteristics. RESULTS: In the PV lesions, direct microscopy always showed the typical mixture of globose blastoconidia and pseudomycelium. Only one patient, having received previous topical antimycotic treatment, was negative. The spherical yeasts observed in vivo were morphologically identical to the globose yeasts characteristic of M. globosa. In culture, M. globosa was found in 97% of cases, alone in 60% of them and associated with M. sympodialis in 29% and M. slooffiae in 7%. These two species were also found in similar percentages on the clinically uninvolved skin of the trunk, whereas M. globosa was not isolated at these sites. However, on the forehead, a small number of colonies of M. globosa was recovered in 12% of cases. CONCLUSIONS: These results support the data previously reported and strongly suggest that M. globosa in its mycelial phase is the causative agent of PV.

[Isolation and identification of Malassezia spp. In pytiriasis versicolor, seborrheic dermatitis and healthy skin.]. / Aislamiento e identificación de Malassezia spp. en pitiriasis versicolor, dermatitis seborreica y piel sana.

The taxonomy of the genus Malassezia has been recently revised and enlarged to include seven distinct species. The aim of the study was to analyse the prevalence of these species in the cutaneous lesions of pityriasis versicolor and dermatitis seborrhoeica, as well as in the normal skin. Seventy-five patients with pityriasis versicolor, 75 of dermatitis seborrhoeica, and 150 samples of normal skin (75 from the forehead and 75 from the shoulders) were studied. A direct microscopy with KOH + Parker ink was carried out in the pityriasis versicolor and dermatitis seborrhoeica samples. All the samples were inoculated in plates containing modified Dixon medium and incubated at 31 degrees C. The yeasts isolated were identified by its morphological and physiological characteristics, upon the scheme published by Guillot et al. In pityriasis versicolor, Malassezia globosa was found in 84% of cases, alone or associated with Malassezia sympodialis, which was by far the commonest species in normal skin (91.7% of isolates, predominating in the trunk skin). In dermatitis seborrhoeica, Malassezia restricta was the commonest species (63.9%), often associated with M. globosa and/or Malassezia sympodialis. M. globosa was also very common in this disease (54.4%), where Malassezia slooffiae and Malassezia furfur could be detected in less than 5% of the samples. These results support that M. globosa, in its mycelial phase, plays a predominant role in the aetiology of pityriasis versicolor. In dermatitis seborrhoeica, the significance of the presence of different species, mainly M. restricta and M. globosa in its yeast phase, remains unclear. Further studies are needed to establish appropriately the pathogenicity of the lipophilic skin mycoflora.

Physician and dietitian prescribing of a commercially available oral nutritional supplement.

We examined whether a policy change transferring prescribing privileges for oral nutritional supplements to dietitians resulted in fewer inappropriate outpatient prescriptions. This was a pre/post study design using a retrospective review of physician and dietitian prescribing for ambulatory patients during two separate time periods: physician prescribing, October to December, 1994; dietitian prescribing, April to June, 1995. Inappropriate prescriptions during each period were defined as those given to patients with normal nutritional status or with a contraindication to a high-energy, electrolyte-containing solution. The study was conducted in outpatient clinics at a Veterans Affairs teaching hospital. We found that dietitians gave fewer prescriptions to outpatients who were not malnourished or to outpatients who had a contraindication to receiving a supplement (11% vs 34%; P = 0.002). In addition, dietitians more often completed relevant laboratory assessments (75% vs 43%; P = 0.001) and more frequently arranged follow-up dietetic evaluations (84% vs 30%, P < 0.001) for ambulatory patients receiving supplements. We conclude that transferring nutritional supplement prescribing privileges to dietitians led to fewer inappropriate outpatient prescriptions and to more comprehensive nutritional assessments, as measured by relevant laboratory use and dietetic follow-up. Physicians more frequently prescribed supplements to outpatients who were not malnourished or who had contraindications to receiving supplements. Our results suggest that physicians would benefit from assistance with and/or education concerning oral nutritional supplements.

Postoperative decline in plasma aspirin-esterase and cholinesterase activity in surgical patients.

We studied preoperative and postoperative plasma hydrolysis of aspirin and plasma cholinesterase activity in surgical patients. Postoperative aspirin esterase and cholinesterase activities fell sharply (119 +/- 32 micrograms ml h-1 and 3746 +/- 1068 U l-1 respectively; P < 0.01) in comparison to basal preoperative values (157 +/- 33 micrograms ml h-1 and 4620 +/- 940 U l-1 respectively, P < 0.01). We suggest that alterations in plasma esterase during the postoperative period may be related to the metabolic response to anesthesia- and surgery-induced stress.

Once-daily use of glyburide.

Ideally, metabolic control with sulfonylureas should be maintained for 24 hours. To determine an optimal glyburide dosage schedule, the effects of glyburide once (every morning) or twice daily and chlorpropamide once daily (every morning) were compared in 18 men with non-insulin-dependent diabetes mellitus in a randomized, double-blind fashion. After discontinuation of previous hypoglycemic agents for 10 days, patients were admitted to a metabolic ward for two weeks (Study A). Glycemic measurements were performed on Day 14. Subjects were readmitted after 12 weeks of outpatient therapy for another two weeks (Study B), and glycemic determinations were repeated. Weight was kept constant during and between Studies A and B. Effective hypoglycemic action of each drug regimen was demonstrated. When six glycemic parameters were compared, there was no significant difference between groups. Thus, over a 14-week period, both glyburide regimens were similar and as effective as chlorpropamide once daily.

[Post-phlebitis cutaneous calcinosis. Histochemical study]. / Calcinosis cutis postflebitis. Estudio histoquímico.

A case of cutaneous localized calcinosis of the left upper limb is reported and classified as dystrophic calcinosis because the antecedent of superficial phlebitis. This kind of manifestation is rare in relationship with the frequence of superficial inflammatory processus of veins.

[Sclerodermiform porphyria cutanea tarda. Ultrastructural study]. / Porfiria cutánea tarda esclerodermiforme. Estudio ultraestructural.

Approximately 30% of patients affected of PCT present scleroderma-like lesion of the skin. Two cases of PCT, presenting scleroderma-like lesions are reported. The patients were diabetic but not alcoholic and tolerate relatively well sunshine. Porphyrin elimination diminished with urine alkalinization and phlebotomies, and the scleroderma-like lesions improved with N-acetyl-hydroxy-proline administration.