RESUMEN
One of the key aspects of photodynamic therapy is the light source that is used to irradiate the lesion to be treated. The devices used must ensure that their emission spectrum matches the absorption spectrum of the photosensitizer, so that treatment radiation is delivered only on the target area, without irradiating healthy tissue at superficial or deep levels. Irradiance values must be adequate in order to avoid thermal damage, exceed the oxygen replenishment rate and avoid long treatment times. Furthermore, the device should be user-friendly, inexpensive, and able to be adapted to different photosensitizers. We have developed an easy-to-use and highly customizable device based on LED technology. Its innovative geometric design allows radiation to be delivered to a small treatment surface, since the LEDs are arranged in three arms, the configuration of which directs their radiation on the treatment point. Different high-power color LEDs are disposed on the arms, and can be independently selected based on the most effective wavelengths for exciting the different photodynamic therapy photosensitizers. We have tested the prototype in 5 different patients (1 actinic keratose, 1 actinic cheilitis, 1 superficial basal cell carcinoma and 2 Bowen's disease) and after 1-2 sessions of total cumulative dose of 25-50 J / cm2, 100% clearance of lesions were obtained. Our device can be used by any professional in the field, whether for medical or research purposes. It facilitates the development of treatment protocols and trials with different photosensitizers.
Asunto(s)
Enfermedad de Bowen , Carcinoma Basocelular , Fotoquimioterapia , Neoplasias Cutáneas , Enfermedad de Bowen/tratamiento farmacológico , Carcinoma Basocelular/tratamiento farmacológico , Humanos , Fotoquimioterapia/métodos , Fármacos Fotosensibilizantes/uso terapéutico , Neoplasias Cutáneas/tratamiento farmacológicoRESUMEN
Mammalian nervous systems depend crucially on myelin sheaths covering the axons. In the central nervous system, myelin sheaths consist of lipid structures that are generated from the membrane of oligodendrocytes (OL). These sheaths allow fast nerve transmission, protect axons and provide them metabolic support. In response to specific traumas or pathologies, these lipid structures can be destabilized and generate demyelinating lesions. Multiple sclerosis (MS) is an example of a demyelinating disease in which the myelin sheaths surrounding the nerve fibers of the brain and spinal cord are damaged. MS is the leading cause of neurological disability in young adults in many countries, and its incidence has been increasing in recent decades. Related to its etiology, it is known that MS is an autoimmune and inflammatory CNS disease. However, there are no effective treatments for this disease and the immunomodulatory therapies that currently exist have proven limited success since they only delay the progress of the disease. Nowadays, one of the main goals in MS research is to find treatments which allow the recovery of neurological disabilities due to demyelination. To this end, different approaches, such as modulating intracellular signaling or regulating the lipid metabolism of OLs, are being considered. Here, in addition to immunosuppressive or immunomodulatory drugs that reduce the immune response against myelin sheaths, we review a diverse group of drugs that promotes endogenous remyelination in MS patients and their use may be interesting as potential therapeutic agents in MS disease. To this end, we compile specific treatments against MS that are currently in the market with remyelination strategies that have entered into human clinical trials for future reparative MS therapies. The method used in this study is a systematic literature review on PubMed, Web of Science and Science Direct databases up to May 31, 2020. To narrow down the search results in databases, more specific keywords, such as "myelin sheath", "remyelination", "demyelination", "oligodendrocyte" and "lipid synthesis" were used to focus the search. We preferred papers published after January 2015, but did not exclude earlier seminal papers.
Asunto(s)
Esclerosis Múltiple , Preparaciones Farmacéuticas , Remielinización , Animales , Humanos , Esclerosis Múltiple/tratamiento farmacológico , Vaina de Mielina , OligodendroglíaRESUMEN
No disponible
Asunto(s)
Humanos , Masculino , Anciano , Síndrome de Sézary/complicaciones , Neoplasias Cutáneas/complicaciones , Síndromes Paraneoplásicos , Pénfigo/diagnóstico , Pénfigo/etiología , Prednisona/uso terapéutico , Inmunoglobulinas Intravenosas/uso terapéutico , Diagnóstico Diferencial , Pénfigo/tratamiento farmacológico , Resultado FatalRESUMEN
Photodynamic therapy is taking importance as a nonintrusive treatment for nail onychomycosis. Knowledge of true transmittance values across nails could lead to qualitative and quantitative improvements in light-based treatments. We have characterized the spectral transmittance of healthy and fungally infected human fingernails and toenails according to nail thickness, and we propose a surface transmittance model for the small-scale optimization of light-based treatments. Transmittance of fingernails and toenails was analyzed by means of spectroradiometric measurements under solar-simulated visible light radiation (400 nm to 750 nm). The nail thickness was measured by means of microscope measurement. Transmittance was highest at longer wavelengths and decreased gradually as the wavelengths became shorter but with a significant nail transmittance of around 20% in the blue region of the spectrum. In the case of nails affected by onychomycosis, transmittance fell to under 10% because of the thickness of the nails, with no changes in spectral characteristics of transmitted light. Nail thickness is the main variable controlling exponentially light transmission in the visible spectrum and not only red radiation is effective for nail onychomycosis PDT. Blue light, the spectral band more effective for PPIX absorption is also effectively transmitted.
Asunto(s)
Uñas/efectos de los fármacos , Onicomicosis/tratamiento farmacológico , Fotoquimioterapia , HumanosAsunto(s)
Alopecia/epidemiología , Andrógenos/metabolismo , Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/diagnóstico , Neumonía Viral/diagnóstico , Índice de Severidad de la Enfermedad , Adulto , Anciano , Anciano de 80 o más Años , Alopecia/complicaciones , Alopecia/metabolismo , Antagonistas de Andrógenos/uso terapéutico , COVID-19 , Infecciones por Coronavirus/tratamiento farmacológico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/metabolismo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/tratamiento farmacológico , Neumonía Viral/epidemiología , Neumonía Viral/metabolismo , Prevalencia , Receptores Androgénicos/metabolismo , SARS-CoV-2 , España/epidemiología , Adulto Joven , Tratamiento Farmacológico de COVID-19Asunto(s)
Infecciones por Coronavirus/patología , Eritema/virología , Dermatosis del Pie/virología , Dermatosis de la Mano/virología , Neumonía Viral/patología , Adolescente , Adulto , Anciano de 80 o más Años , Betacoronavirus/aislamiento & purificación , COVID-19 , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/virología , Femenino , Dermatosis del Pie/patología , Dermatosis de la Mano/patología , Humanos , Masculino , Pandemias , Neumonía Viral/epidemiología , Neumonía Viral/virología , SARS-CoV-2 , Dedos del Pie/patología , Adulto JovenAsunto(s)
Ácido Aminolevulínico/análogos & derivados , Fotoquimioterapia/métodos , Fármacos Fotosensibilizantes/uso terapéutico , Sarcoma de Kaposi/tratamiento farmacológico , Neoplasias Cutáneas/tratamiento farmacológico , Adulto , Anciano de 80 o más Años , Ácido Aminolevulínico/uso terapéutico , Humanos , MasculinoRESUMEN
Multiple sclerosis is a high-frequency neurological disorder in young adults. Although there are some genetic and environmental factors that have been related to the onset of the disease, these are still not completely understood and nowadays multiple sclerosis can neither be prevented, nor its symptom effectively treated due to disease heterogeneity. For this reason, the search of prognostic factors and new therapeutic compounds for MS has long aroused among clinicians and researchers. Among these therapeutic compounds, GEMSP, which consists of a mixture of functional constituents as fatty acids, antioxidants, free radical scavengers and amino acids linked individually to poly-L-Lysine (PL), is emerging as a promising drug for MS treatment. Pre-clinical studies using GEMSP have demonstrated that this drug strongly inhibits brain leukocyte infiltration and completely abolishes experimental autoimmune encephalomyelitis. In addition, in an open clinical trial in humans treated with GEMSP, in 72% of the cases, a positive evolution of the state of the MS patients treated with GMSP was observed. In this review a biochemical characterization of main constituents of GEMSP, which include fatty acids as oleic acid, linoleic acid or azelaic acid and the antioxidants alpha-tocopherol or ascorbic acid, will be provided in order to understand their proved therapeutic effects in MS.
Asunto(s)
Antioxidantes/uso terapéutico , Ácidos Grasos/uso terapéutico , Esclerosis Múltiple/tratamiento farmacológico , Aminoácidos , Ensayos Clínicos como Asunto , Depuradores de Radicales Libres , Humanos , PolilisinaRESUMEN
BACKGROUND: Daylight photodynamic therapy (dlPDT) is a painless and increasingly cost-effective treatment for actinic keratosis (AK). New protocols avoid incubation, minimizing pain and adverse events. However, it is time-consuming and dependent on specific weather conditions. In patients with AK of the scalp, we evaluated the efficacy of indoor photodynamic therapy (PDT) using a wearable low-level light therapy (LLLT) device, without pre-incubation with a photosensitizing agent. METHODS: In this pilot study, 27 patients with thin and moderately thick AK (Olsen Grades I-II) underwent a single 15-minute session of LLLT using a wearable cap-like device immediately after application of methyl-aminolevulinate (MAL) cream, with no prior preparation of the affected area. Treatment efficacy was quantified by measuring the reduction in AK lesion number and the AK quality of life (AKQoL) score. All AK lesions were mapped at baseline for follow-up 2 months later. Paired pre/post scalp biopsies from 5 patients were analysed using histological and immunohistochemical techniques (p53, p27, cyclin D1, p63, and Ki67 expression). Data were analysed using the Wilcoxon signed-rank test. RESULTS: In all patients we observed a global reduction in the number of AK lesions (71%; p < 0.0001) and AKQoL score (from 5.6 to 4.4; p = 0.034) 2 months after treatment. Histology and immunohistochemistry of skin biopsies from 5 patients also revealed marked improvements after LLLT. No patients reported any pain during treatment. CONCLUSION: PDT using LLLT is a rapid, painless, and efficacious modality for the treatment of AK.
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Ácido Aminolevulínico/análogos & derivados , Queratosis Actínica/tratamiento farmacológico , Terapia por Luz de Baja Intensidad/métodos , Fotoquimioterapia/métodos , Fármacos Fotosensibilizantes/uso terapéutico , Dermatosis del Cuero Cabelludo/tratamiento farmacológico , Anciano , Anciano de 80 o más Años , Ácido Aminolevulínico/uso terapéutico , Terapia Combinada , Femenino , Humanos , Queratosis Actínica/patología , Masculino , Persona de Mediana Edad , Proyectos Piloto , Estudios Prospectivos , Índice de Severidad de la EnfermedadRESUMEN
INTRODUCTION: Frontal fibrosing alopecia (FFA) is a condition that likely involves an interplay of autoimmune, hormonal, and environmental factors in its pathogenesis. There is a lack of comparative studies demonstrating the presence of hormonal background differences in FFA patients compared to the general population. MATERIALS AND METHODS: A single-center case-control study was designed, including 104 female FFA patients and 208 controls. Patients and controls were interviewed, and extensive data regarding their gynecological and hormonal background were recorded. RESULTS: One hundred four cases and 208 age-matched controls were included in the study. A significant difference of 2 years in the age of menopause was detected with a consistent mean increase in fertile life for the control group of 1.7 years. After the multivariate analysis, we found previous intake of tamoxifen to be a risk factor for the development of FFA (OR 14.89). The only protective factor identified was the previous use of an intrauterine device (IUD) (OR 0.22). CONCLUSIONS: An earlier menopause and tamoxifen intake might promote or maintain FFA, while the use of an IUD might protect from developing FFA. Our results support the previously proposed hypothesis of an underlying hormonal mechanism in the etiopathogenesis of FFA and point out low-estrogen environments as an ideal condition for FFA development.
Asunto(s)
Corticoesteroides/efectos adversos , Alopecia/tratamiento farmacológico , Alopecia/patología , Cabello/efectos de los fármacos , Administración Tópica , Corticoesteroides/uso terapéutico , Estudios de Cohortes , Dermoscopía/métodos , Relación Dosis-Respuesta a Droga , Esquema de Medicación , Femenino , Fibrosis/patología , Estudios de Seguimiento , Frente , Cabello/crecimiento & desarrollo , Humanos , Masculino , Estudios Retrospectivos , Medición de Riesgo , Dermatosis del Cuero Cabelludo/tratamiento farmacológico , Dermatosis del Cuero Cabelludo/patología , EspañaRESUMEN
Objetivo: Evaluar la efectividad de un programa de mindfulness y autocompasión sobre los niveles de estrés y burnout en profesionales sanitarios de atención primaria. Diseño: Ensayo clínico controlado aleatorizado. Participantes y emplazamiento: Se ofertó entrenamiento en mindfulness a los 1.281 profesionales sanitarios de atención primaria de Navarra y aceptaron 48. Se asignaron por sorteo 25 participantes al grupo intervención, quedando los 23 restantes en el grupo control. Intervención: El programa de entrenamiento en mindfulness y autocompasión consistía en sesiones de 2,5 h/semana durante 8 semanas, a las que había que asistir al menos al 75% de las sesiones y realizar una práctica diaria de 45 min. Mediciones principales: Antes-después de la intervención se midieron mediante cuatro cuestionarios los niveles de mindfulness, autocompasión, estrés percibido y burnout. Resultados: Tras la intervención, las puntuaciones del grupo intervención mejoran significativamente en mindfulness (p < 0,001); estrés percibido (p < 0,001); autocompasión: auto-amabilidad p < 0,001, humanidad compartida p=0,004, mindfulness p=0,001; y burnout: cansancio emocional (p = 0,046). La comparación respecto al grupo control muestra diferencias significativas en mindfulness (p < 0,001), estrés percibido (p < 0,001), auto-amabilidad (p < 0,001) y cansancio emocional (p < 0,032). Conclusiones: Este trabajo sugiere que puede ser beneficioso impulsar las prácticas de mindfulness y autocompasión en el ámbito sanitario (AU)
Objective: To evaluate the effectiveness of a Mindfulness and Self-Compassion Program on the levels of stress and burnout in Primary Care health professionals. Design: Randomised, controlled clinical trial. Participants and setting: Training in Mindfulness was offered to 1,281 health professionals in Navarra (Spain) Primary Care, and 48 of them accepted. The participants were randomly assigned to groups: 25 to the intervention group, and the remaining 23 to the control group. Intervention: The Mindfulness and Self-Compassion training program consisted of sessions of 2.5 chours/week for 8 weeks. The participants had to attend at least 75% of the sessions and perform a daily practical of 45 minutes. Main measurements: The levels of mindfulness, self-compassion, perceived stress, and burnout were measured using four questionnaires before and after the intervention. Results: After the intervention, the scores of the intervention group improved significantly in mindfulness (P < .001); perceived stress (P < .001); self-compassion: self-kindness P < .001, shared humanity P = .004, mindfulness P = .001; and burnout: emotional fatigue (P = .046). The comparison with the control group showed significant differences in mindfulness (P < .001), perceived stress (P < .001), self-kindness (P < .001) and emotional fatigue (P = .032). Conclusions: This work suggests that it may be beneficial to encourage mindfulness and self-compassion practices in the health environment (AU)
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Humanos , Masculino , Femenino , Persona de Mediana Edad , Personal de Salud/psicología , Evaluación de Eficacia-Efectividad de Intervenciones , Atención Plena/métodos , Agotamiento Profesional/prevención & control , Agotamiento Profesional/psicología , Personal de Salud/estadística & datos numéricos , Estrés Psicológico/prevención & control , Estrés Psicológico/psicología , Atención Primaria de Salud , Atención Primaria de Salud/estadística & datos numéricos , Encuestas y CuestionariosAsunto(s)
Alopecia/epidemiología , Frente/patología , Rosácea/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Alopecia/complicaciones , Alopecia/patología , Cicatriz/etiología , Comorbilidad , Estudios Transversales , Femenino , Fibrosis , Humanos , Lupus Eritematoso Discoide/epidemiología , Persona de Mediana Edad , Prevalencia , Índice de Severidad de la Enfermedad , Vitíligo/epidemiologíaAsunto(s)
Complejo Mycobacterium avium/aislamiento & purificación , Infección por Mycobacterium avium-intracellulare/diagnóstico , Pene/patología , Neoplasias Cutáneas/diagnóstico , Diagnóstico Diferencial , Humanos , Masculino , Persona de Mediana Edad , Infección por Mycobacterium avium-intracellulare/complicaciones , Pene/microbiología , Neoplasias Cutáneas/etiologíaAsunto(s)
Melanoma/diagnóstico , Neoplasias Cutáneas/diagnóstico , Biopsia , Análisis Mutacional de ADN , Femenino , Humanos , Neoplasias Hepáticas/genética , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/secundario , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/secundario , Metástasis Linfática/genética , Metástasis Linfática/patología , Melanoma/genética , Melanoma/patología , Persona de Mediana Edad , Metástasis de la Neoplasia , Tomografía Computarizada por Tomografía de Emisión de Positrones , Proteínas Proto-Oncogénicas B-raf/genética , Escápula , Piel/patología , Neoplasias Cutáneas/genética , Neoplasias Cutáneas/patología , Melanoma Cutáneo MalignoRESUMEN
Folliculitis decalvans (FD) is a primary neutrophilic scarring alopecia characterized by perifollicular papules, crusts, and pustules frequently located on the vertex. FD may affect young men and women. Since it may lead to hair loss, it can have a negative impact on patients' quality of life. Nevertheless, studies have focused on clinical, prognostic, and therapeutic aspects without considering the psychological impact of FD. In our study, we found that FD patients experienced a considerable impact on their quality of life. Interestingly, almost half of the patients considered that their alopecia was related to a poor medical care in their past. To our knowledge, this is the first description of the impact of FD on patients' quality of life, and it highlights the importance of psychological support for these patients.