RESUMO
Non-FDA approved foreign substances injected in areas such as the hips and buttocks for aesthetic purposes have resulted in significant complications including secondary lymphedema. We sought to demonstrate lymphoscintigraphic abnormalities in a group of patients with lower extremity edema following infiltration of foreign substances in but-tocks and hips to confirm secondary lymphedema. This retrospective and observational study examined 10 lower extremities for lymphoscintigraphic abnormalities from patients with history of infiltration of foreign substances and subsequent complaints about lower extremity edema. Clinical evaluation, lymphedema index, lymphoscintigraphy, and Transport Index (TI) were evaluated. The average lymphedema index documented in each limb was 236.45 categorizing most of our patients in a lower limb lymphedema stage I. The average TI was 15.7 points (8.6 - 22.8 points) demonstrating that all patients show abnormal lymphoscintigraphy (LSG) patterns. LSG findings confirm the diagnosis of lower extremity lymphedema secondary to injection of foreign substances in the buttocks and hips in the group of patients studied.
Assuntos
Linfedema , Humanos , Extremidade Inferior , Linfedema/diagnóstico por imagem , Linfedema/etiologia , Linfocintigrafia , Estudos RetrospectivosRESUMO
The COVID-19 pandemic has forced the establishment of preventive measures against contagion during the performance of diagnostic and therapeutic tests in gastroenterology. Digestive tract motility tests involve an intermediate and elevated risk for the transmission of COVID-19 infection. Given their elective or non-urgent indication in the majority of cases, we recommend postponing those tests until significant control of the infection rate in each Latin American country has been achieved during the pandemic. When the health authorities allow the return to normality, and in the absence of an effective treatment for or preventive vaccine against COVID-19 infection, we recommend a strict protocol for classifying patients according to their infectious-contagious status through the appropriate use of tests for the detection of the virus and the immune response to it, and the following of protective measures by the healthcare personnel to prevent contagion during the performance of a gastrointestinal motility test.
Assuntos
Infecções por Coronavirus/prevenção & controle , Gastroenterologia/normas , Gastroenteropatias/diagnóstico , Controle de Infecções/normas , Neurologia/normas , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Testes Respiratórios , COVID-19 , Teste para COVID-19 , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/transmissão , Monitoramento do pH Esofágico/normas , Gastroenteropatias/terapia , Motilidade Gastrointestinal , Humanos , Controle de Infecções/métodos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , América Latina , Manometria/normas , Seleção de Pacientes , Pneumonia Viral/diagnóstico , Pneumonia Viral/transmissão , Sociedades MédicasRESUMO
AIM: Full-thickness local excision after neoadjuvant chemoradiotherapy (CRT) for patients with rectal cancer and incomplete clinical response has been a treatment strategy for organ preservation. Follow-up of these patients is challenging since anatomic distortion and postoperative changes may be clinically indistinguishable from tumour recurrence. MRI may have a role in detecting recurrence. The aim of this study was to describe the MRI findings during follow-up in patients having local excision following CRT with and without local recurrence. METHOD: The data were collected retrospectively from a single centre. Fifty-three patients with rectal cancer who had full-thickness local excision after neoadjuvant CRT and near-complete response were eligible for the study. Patients with local recurrence were treated by radical salvage surgery. The main outcome was local MRI assessment findings during follow-up. RESULTS: Fifteen patients (five who developed local recurrence and 10 with no evidence of local recurrence) had MR images available for review and were included in the study. High signal intensity and thickening of the rectal wall were present in all patients with recurrent disease within the rectal wall. Overall, 80% of the patients with recurrence showed diffusion restriction. MRI mesorectal fascia status and circumferential resection margin showed agreement in all cases. A low signal intensity scar was seen in all patients without recurrent disease. CONCLUSION: MRI shows high signal intensity and thickening of the rectal wall in recurrent disease in comparison to a low signal intensity fibrotic scar in non-recurrent disease. These findings may be useful in surveillance of these patients.
Assuntos
Quimiorradioterapia Adjuvante/métodos , Imageamento por Ressonância Magnética , Recidiva Local de Neoplasia/diagnóstico por imagem , Neoplasias Retais/diagnóstico por imagem , Microcirurgia Endoscópica Transanal/métodos , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante/métodos , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/cirurgia , Estadiamento de Neoplasias , Período Pós-Operatório , Neoplasias Retais/patologia , Neoplasias Retais/terapia , Reto/diagnóstico por imagem , Reto/cirurgia , Estudos Retrospectivos , Terapia de Salvação , Resultado do TratamentoRESUMO
Los anticuerpos anticitoplasma de neutrófilos (ANCA) han cobrado relevancia en distintas patologías. Recientemente se ha reportado un elevado porcentaje (79%) de ANCAp en pacientes con Artropatía Psoriática (APs). Los objetivos de este estudio fueron evaluar la prevalencia ANCAp en pacientes con APs y compararlo con pacientes con artritis reumatoidea (AR), espondilitis anquilosante (EA), psoriasis cutánea (Ps) y controles sanos (CS). Material y métodos: Se incluyeron pacientes consecutivos con APs según criterios CASPAR, AR (criterios ACR 87), EA (criterios de NY modificados); los CS fueron personas de la población general sin antecedentes o evidencias de enfermedades inmunológicas. Se excluyeron pacientes con antecedentes oncológicos, infecciosos, sarcoidosis u otras enfermedades del tejido conectivo y/o vasculitis. Se consignaron datos demográficos, clínicos, radiológicos, antecedentes familiares y terapéutica actual. Se realizaron cuestionarios de actividad de enfermedad y capacidad funcional: BASDAI, BASFI, PASI y HAQ. Se extrajeron muestras de sangre para determinación de ANCA por IFI en etanol que posteriormente fueron confirmadas por IFI en formol. Se realizó además laboratorio general de rutina. Análisis estadístico: Las variables continuas fueron comparadas por ANOVA o test Student y las variables categóricas por Chi-cuadrado o test de Fisher. Resultados: Se incluyeron 148 pacientes (APs = 43, EA = 22, AR = 41, Controles = 38, Psoriasis cutánea = 4). La mediana de edad fue de 52 años (RIQ: 39,5-59), 66% eran mujeres. En el análisis intergrupo, las EA eran más jóvenes y más frecuentemente (87%) de sexo masculino. El resto de los grupos eran comparables para todas las variables demográficas. 57 pacientes mostraron fluorescencia positiva en etanol: AR: 25 (61%), APs: 14 (32,6%), EA: 11 (50%), CS: 6 (15,8%) y Ps: 1 (25%).
Antibodies ANCA are important diagnostic tools in different diseases. Recently it has been shown that these antibodies can be observed in 79% of patients with Psoriatic Arthritis (PsA). The purpose of our study was to determine the prevalence of ANCA in patients with PsA and compared to patients with Rheumatoid Arthritis (RA), Ankylosing Spondylitis (AS), Psoriasis (Ps) and healthy controls (HC). Material and methods: Consecutive patients with PsA (CASPAR criteria), RA (ACR 87) and AS (New York criteria) were included. HC were people of the general population without evidence of immunological diseases. Patients with a previous history of oncologic, infectious diseases and sarcoidosis were excluded. Demographic, clinical, radiological and therapeutic data were collected. Disease activity and functional capacity were evaluated using validated and specific questionnaires (BASDAI, BASFI, PASI, and HAQ). ANCAs were determined by indirect immunofluorescence (IIF) on ethanol. Then, the positive ones were confirmed by IIF on formol. Student test, ANOVA, Chi square and Fisher exact test were used for Statistical analysis. Results: 148 patients were included (PsA = 43, AS = 22, RA = 41, Ps = 4 y HC = 38). Median age was 52 years (IQR: 39.5 59), 66% were women. AS patients were younger and more frequently men. Other variables were comparable between groups. 57 patients exhibited positive ethanol fluorescence: RA: 25 (61%), PsA: 14 (32.6%), AS: 11 (50%), HC: 6 (15.8%) and Ps: 1 (25%). However only 5 patients showed formol fluorescence: AS: 4/22 (ANCAp = 2, ANCAc = 2) y RA: 1/41 (ANCAp). The frequency of positive ANCA was significantly greater in AS vs. RA (p = 0.046).
Assuntos
Artrite Psoriásica , Artrite Reumatoide , Anticorpos Anticitoplasma de Neutrófilos , Psoríase , Espondilite AnquilosanteRESUMO
Los anticuerpos anticitoplasma de neutrófilos (ANCA) han cobrado relevancia en distintas patologías. Recientemente se ha reportado un elevado porcentaje (79%) de ANCAp en pacientes con Artropatía Psoriática (APs). Los objetivos de este estudio fueron evaluar la prevalencia ANCAp en pacientes con APs y compararlo con pacientes con artritis reumatoidea (AR), espondilitis anquilosante (EA), psoriasis cutánea (Ps) y controles sanos (CS). Material y métodos: Se incluyeron pacientes consecutivos con APs según criterios CASPAR, AR (criterios ACR 87), EA (criterios de NY modificados); los CS fueron personas de la población general sin antecedentes o evidencias de enfermedades inmunológicas. Se excluyeron pacientes con antecedentes oncológicos, infecciosos, sarcoidosis u otras enfermedades del tejido conectivo y/o vasculitis. Se consignaron datos demográficos, clínicos, radiológicos, antecedentes familiares y terapéutica actual. Se realizaron cuestionarios de actividad de enfermedad y capacidad funcional: BASDAI, BASFI, PASI y HAQ. Se extrajeron muestras de sangre para determinación de ANCA por IFI en etanol que posteriormente fueron confirmadas por IFI en formol. Se realizó además laboratorio general de rutina. Análisis estadístico: Las variables continuas fueron comparadas por ANOVA o test Student y las variables categóricas por Chi-cuadrado o test de Fisher. Resultados: Se incluyeron 148 pacientes (APs = 43, EA = 22, AR = 41, Controles = 38, Psoriasis cutánea = 4). La mediana de edad fue de 52 años (RIQ: 39,5-59), 66% eran mujeres. En el análisis intergrupo, las EA eran más jóvenes y más frecuentemente (87%) de sexo masculino. El resto de los grupos eran comparables para todas las variables demográficas. 57 pacientes mostraron fluorescencia positiva en etanol: AR: 25 (61%), APs: 14 (32,6%), EA: 11 (50%), CS: 6 (15,8%) y Ps: 1 (25%).(AU)
Antibodies ANCA are important diagnostic tools in different diseases. Recently it has been shown that these antibodies can be observed in 79% of patients with Psoriatic Arthritis (PsA). The purpose of our study was to determine the prevalence of ANCA in patients with PsA and compared to patients with Rheumatoid Arthritis (RA), Ankylosing Spondylitis (AS), Psoriasis (Ps) and healthy controls (HC). Material and methods: Consecutive patients with PsA (CASPAR criteria), RA (ACR 87) and AS (New York criteria) were included. HC were people of the general population without evidence of immunological diseases. Patients with a previous history of oncologic, infectious diseases and sarcoidosis were excluded. Demographic, clinical, radiological and therapeutic data were collected. Disease activity and functional capacity were evaluated using validated and specific questionnaires (BASDAI, BASFI, PASI, and HAQ). ANCAs were determined by indirect immunofluorescence (IIF) on ethanol. Then, the positive ones were confirmed by IIF on formol. Student test, ANOVA, Chi square and Fisher exact test were used for Statistical analysis. Results: 148 patients were included (PsA = 43, AS = 22, RA = 41, Ps = 4 y HC = 38). Median age was 52 years (IQR: 39.5 ¹ 59), 66% were women. AS patients were younger and more frequently men. Other variables were comparable between groups. 57 patients exhibited positive ethanol fluorescence: RA: 25 (61%), PsA: 14 (32.6%), AS: 11 (50%), HC: 6 (15.8%) and Ps: 1 (25%). However only 5 patients showed formol fluorescence: AS: 4/22 (ANCAp = 2, ANCAc = 2) y RA: 1/41 (ANCAp). The frequency of positive ANCA was significantly greater in AS vs. RA (p = 0.046).(AU)
Assuntos
Artrite Psoriásica , Artrite Reumatoide , Anticorpos Anticitoplasma de Neutrófilos , Espondilite Anquilosante , PsoríaseRESUMO
BACKGROUND: Irritable Bowel Syndrome (IBS) is characterized by the worsening of symptoms with a high fiber diet. This intolerance could be related to an increase in colonic bacterial fermentation. The hydrogen breath test (HBT) is a marker of the intestinal micro flora fermentative capacity. AIM: To assess if there is an association between hydrogen (H2) levels and clinical changes between diets with and without bran. PATIENTS AND METHODS: 10 women with predominantly constipated irritable bowel syndrome (Rome II criteria) received a lowfiber diet during one week. This phase was followed by a second 7 day period with the same diet but supplemented with 12 g of crude dietary fiber. At the end of both periods, patients completed a symptom scale (Lickert type) and performed a HBT. RESULTS: Comparing both periods with a different diet the median difference in the clinical scale score (-2.5) shows a tendency favorable to the diet without bran, p = 0.048. In the fiber period the median increase of 2 ppm in H2 values was not significant deferent. Neither was possible to establish an association between breath H2 and the clinical response to a fiber diet. CONCLUSIONS: In this pilot study we could not detect ary association between breath H2 levels and the clinical response to dietary fiber.
Introducción: Los pacientes con síndrome del intestino irritable (SII) frecuentemente agravan sus síntomas cuando incorporan fibra insoluble en su dieta. Esta intolerancia podría estar relacionada con una incrementada fermentación colónica. El nivel de hidrógeno en el aire espirado es una variable dependiente de la capacidad fermentativa del contenido bacteriano del intestino por lo que podría representar un recurso capaz de predecir el grado de intolerancia a la fibra dietética. Objetivo: El objetivo de este estudio piloto fue investigar si existe una asociación entre los niveles de hidrógeno (H2) en el aire espirado y la respuesta clínica a las dietas con y sin fibra. Pacientes y métodos: En este estudio piloto se incluyeron diez mujeres afectadas de síndrome de intestino irritable con constipación (Criterios Roma II). Siguieron una dieta poco fermentable durante 14 días. En la primera semana las pacientes se sujetaron a la dieta sin ningún agregado, en la segunda semana incorporaron 12 gr diarios de fibra dietaria cruda. Al finalizar ambos períodos las pacientes completaron una escala de Lickert de 7 ítems donde se valoró la respuesta clínica a la dieta administrada y se midió la excreción de H2 en el aire espirado. Resultados: Comparando ambas dietas, se observó que la mediana de las diferencias de los puntajes clínicos (-2,5) indicaba una tendencia favorable a la dieta poco fermentable sin fibra, p=0,048. El incremento de la mediana de la concentración de H2 en el aire espirado fue de 2 ppm para la dieta con fibra, pero el mismo no fue significativo. Tampoco se pudo demostrar una tendencia que permitiera relacionar los valores de H2 con la respuesta clínica a la fibra dietética. Conclusión: Los resultados de este estudio no lograron demostrar una asociación entre los niveles de hidrógeno en el aire espirado y la respuesta clínica a la dieta con fibra.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Constipação Intestinal/dietoterapia , Fermentação/fisiologia , Fibras na Dieta/efeitos adversos , Hidrogênio/análise , Síndrome do Intestino Irritável/fisiopatologia , Estudos Prospectivos , Projetos Piloto , Testes Respiratórios/métodos , Valor Preditivo dos TestesRESUMO
BACKGROUND: Irritable Bowel Syndrome (IBS) is characterized by the worsening of symptoms with a high fiber diet. This intolerance could be related to an increase in colonic bacterial fermentation. The hydrogen breath test (HBT) is a marker of the intestinal micro flora fermentative capacity. AIM: To assess if there is an association between hydrogen (H2) levels and clinical changes between diets with and without bran. PATIENTS AND METHODS: 10 women with predominantly constipated irritable bowel syndrome (Rome II criteria) received a lowfiber diet during one week. This phase was followed by a second 7 day period with the same diet but supplemented with 12 g of crude dietary fiber. At the end of both periods, patients completed a symptom scale (Lickert type) and performed a HBT. RESULTS: Comparing both periods with a different diet the median difference in the clinical scale score (-2.5) shows a tendency favorable to the diet without bran, p = 0.048. In the fiber period the median increase of 2 ppm in H2 values was not significant deferent. Neither was possible to establish an association between breath H2 and the clinical response to a fiber diet. CONCLUSIONS: In this pilot study we could not detect ary association between breath H2 levels and the clinical response to dietary fiber.(AU)
Introducción: Los pacientes con síndrome del intestino irritable (SII) frecuentemente agravan sus síntomas cuando incorporan fibra insoluble en su dieta. Esta intolerancia podría estar relacionada con una incrementada fermentación colónica. El nivel de hidrógeno en el aire espirado es una variable dependiente de la capacidad fermentativa del contenido bacteriano del intestino por lo que podría representar un recurso capaz de predecir el grado de intolerancia a la fibra dietética. Objetivo: El objetivo de este estudio piloto fue investigar si existe una asociación entre los niveles de hidrógeno (H2) en el aire espirado y la respuesta clínica a las dietas con y sin fibra. Pacientes y métodos: En este estudio piloto se incluyeron diez mujeres afectadas de síndrome de intestino irritable con constipación (Criterios Roma II). Siguieron una dieta poco fermentable durante 14 días. En la primera semana las pacientes se sujetaron a la dieta sin ningún agregado, en la segunda semana incorporaron 12 gr diarios de fibra dietaria cruda. Al finalizar ambos períodos las pacientes completaron una escala de Lickert de 7 ítems donde se valoró la respuesta clínica a la dieta administrada y se midió la excreción de H2 en el aire espirado. Resultados: Comparando ambas dietas, se observó que la mediana de las diferencias de los puntajes clínicos (-2,5) indicaba una tendencia favorable a la dieta poco fermentable sin fibra, p=0,048. El incremento de la mediana de la concentración de H2 en el aire espirado fue de 2 ppm para la dieta con fibra, pero el mismo no fue significativo. Tampoco se pudo demostrar una tendencia que permitiera relacionar los valores de H2 con la respuesta clínica a la fibra dietética. Conclusión: Los resultados de este estudio no lograron demostrar una asociación entre los niveles de hidrógeno en el aire espirado y la respuesta clínica a la dieta con fibra.(AU)
Assuntos
Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Constipação Intestinal/dietoterapia , Fibras na Dieta/efeitos adversos , Fermentação/fisiologia , Hidrogênio/análise , Síndrome do Intestino Irritável/fisiopatologia , Testes Respiratórios/métodos , Projetos Piloto , Valor Preditivo dos Testes , Estudos ProspectivosRESUMO
Solitary gastric plasmacitomas are infrequent tumors. They account for 5% of the extramedullary plasmacitomas. We report an unusual case in a 14 years old boy. The patient has had gastric symptoms for 2 years prior to an endoscopic examination. A fungating, ulcerated lesion was observed in the antrum. The biopsies showed a monoclonal, Lambda positive, diffuse, plasmocitic proliferation infiltrating the mucosa. Also a moderate number of Helicobacter pylori were identified in the gastric pits and numerous lymphoid follicules were observed in the deep portion of the mucosa. In view of the presence of HP infection the patient was treated with Orneprazole and Clarithromycin. Endoscopic examination and biopsies performed 3 and 5 months later showed a complete remission of the gastric lesion. At the time of this report the patient is in good physical condition, has recovered his weight and has grown 5 cm. Differential diagnosis with plasmo limpho in chronic gastritis and with lympheicitic lymphoma with plasmocitoid features had to be done. The macroscopic appearance of the gastric lesion, the absence of other inflammatory cells and monoclonality of the plasmocitic infiltration ruled out chronic gastritis. The negative staining for CD 20 as well as the abscence of lymphoid cells in the mucosal infiltrate give support: to the diagnosis of plasmocitoma. The close association between gastric MALT lymphoma and HP infection has been reported as well as its regression after antibiotic treatment for its erradication. In our review of the literature we failed to find any references to the association of HP with gastric plasmocitoma nor to its regression after antibiotic therapy.
Assuntos
Infecções por Helicobacter/complicações , Helicobacter pylori , Plasmocitoma/microbiologia , Neoplasias Gástricas/microbiologia , Adolescente , Antibacterianos/uso terapêutico , Antiulcerosos/uso terapêutico , Claritromicina/uso terapêutico , Mucosa Gástrica/microbiologia , Infecções por Helicobacter/tratamento farmacológico , Infecções por Helicobacter/patologia , Humanos , Masculino , Omeprazol/uso terapêutico , Plasmocitoma/tratamento farmacológico , Plasmocitoma/patologia , Neoplasias Gástricas/tratamento farmacológico , Neoplasias Gástricas/patologiaRESUMO
We describe a case of hypertrophic pulmonary osteoarthropathy (HPOA) in an adult patient with acquired immunodeficiency syndrome (AIDS). This is the ninth case of HPOA associated with AIDS in adults, reported in the literature. The presence of pulmonary tuberculosis was also suspected, based on clinical grounds. Cases of clubbing associated with AIDS infection are reviewed.
Assuntos
Síndrome da Imunodeficiência Adquirida/complicações , Osteoartropatia Hipertrófica Secundária/complicações , Tuberculose Pulmonar/complicações , Adulto , Humanos , MasculinoRESUMO
In Cuba, the illness that produces most deaths among 1-64-year-olds is cancer. Over 65, it is the second cause of death after heart diseases. A National Cancer Registry was created 1964. Its main goals are to register all malignant neoplasms diagnosed in the country, to study this disease from the statistical and epidemiological point of view and to aid in the health control and planning of cancer fighting resources. This paper presents the results based on cases registered from 1986 to 1990. More than 50% of incidence and mortality caused by cancer is confined to the five major primary sites: lung, prostate, colon, breast and cervix. World population standardised rates by 100,000 inhabitants for the period 1986-1990 were 218.2 in males and 183.7 in females for incidence and 138.4 in males and 95.1 in females for mortality. Cancer incidence distribution by provinces shows two major regions: western-central, where higher risks of lung, breast, prostate and colon cancers are found, and eastern where very high risk of cervix cancer is observed. Although an improvement of the information quality indexes has been reported by the National Cancer registry in the studied period of time, quality of the data remained very poor according to the international standards. However, the results obtained by the National Cancer Registry seem to be a valuable tool to evaluate the cancer burden and, in particular, to control and eventually modify the tasks of the National Cancer Control Program in Cuba.
Assuntos
Neoplasias/epidemiologia , Sistema de Registros/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Idoso , Causas de Morte , Criança , Pré-Escolar , Cuba/epidemiologia , Feminino , Humanos , Incidência , Lactente , Masculino , Pessoa de Meia-Idade , Neoplasias/mortalidade , Razão de Chances , Sistema de Registros/normas , Distribuição por SexoRESUMO
This paper reports metabolic data of 24 women and two men, 44-66 years old, ex-residents in an area of endemic fluorosis close to Bahía Blanca city. Fasting fluoremias of these subjects (0.5 to 9.2 microM) and daily urinary fluoride excretion (> 60 mumoles/day) are characteristics of zones with endemic fluorosis. Bone mineral density (BMD) at the lumbar spine (L2-4 1330 +/- 41 mg/cm2) and femoral neck (1045 +/- 10 mg/cm2) were significantly above average of normal subjects of the same age and sex. A significant correlation was observed between the daily excretion of fluoride and BMD L2-4 (r = 0.43, P < 0.05). The Area Under the Curve of insulin during a standard glucose tolerance test showed an inverse relationship with fluoremia. This observation coincides with experiments published elsewhere indicating that fluoride intake at concentrations 5 microM or greater, inhibits the secretion of insulin.
Assuntos
Glicemia/efeitos dos fármacos , Densidade Óssea/efeitos dos fármacos , Fluoretos/farmacologia , Adulto , Idoso , Feminino , Homeostase , Humanos , Masculino , Pessoa de Meia-IdadeAssuntos
Bloqueio Cardíaco/congênito , Síndrome de Sjogren/imunologia , Adulto , Autoanticorpos , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , PrognósticoRESUMO
BACKGROUND: Onychomycoses are among the most frequent nail diseases. The principal agents are dermatophytes. Itraconazole and terbinafine are two effective and systemic antimycotics. Previous trials have shown, that treatment schedules with effective concentrations for 3 months cause drug deposits in nail plates that persist 6 months after the end of the treatment. METHODS: A comparative, open, prospective study was carried out with random assignment of patients. The first group included 27 patients under treatment with 200 mg of itraconazole once daily for 3 months. The second group included 26 patients treated with 250 mg of terbinafine for 3 months. Both series of patients were followed for 6 additional months. RESULTS: Both groups were similar in age, sex, and history of onychomycosis. Trichophyton rubrum was the main isolated agent in all patients. The percentage of diseased nails was similar in both groups affecting predominantly the first toenail. Treatment was highly effective and differences between groups were not significant. The rate of adverse events was 21% in the itraconazole group and 47% in the terbinafine group. CONCLUSIONS: Itraconazole and terbinafine are two drugs of choice in dermatophytic onychomycosis.
Assuntos
Antifúngicos/uso terapêutico , Itraconazol/uso terapêutico , Naftalenos/uso terapêutico , Onicomicose/tratamento farmacológico , Adulto , Antifúngicos/administração & dosagem , Esquema de Medicação , Feminino , Dermatoses do Pé/tratamento farmacológico , Dermatoses do Pé/fisiopatologia , Humanos , Itraconazol/administração & dosagem , Masculino , Pessoa de Meia-Idade , Naftalenos/administração & dosagem , Onicomicose/fisiopatologia , Estudos Prospectivos , Terbinafina , Resultado do TratamentoAssuntos
Ácidos Aminossalicílicos/uso terapêutico , Psoríase/tratamento farmacológico , Administração Oral , Adolescente , Adulto , Ácidos Aminossalicílicos/administração & dosagem , Esquema de Medicação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Psoríase/fisiopatologia , Resultado do TratamentoRESUMO
In order to know the agents and foods related more frequently with food-borne disease outbreaks, we reviewed all the outbreaks studied between 1980 and 1989 by the National Laboratory of Public Health. A total of 79 outbreaks of food-borne diseases of microbial origin were reviewed. The causative agent was identified in 50 (73%) outbreaks. Twenty-four per cent of the outbreaks occurred in parties, 10.3 per cent in school or nurseries, 8.6 per cent in restaurants and 8.6 per cent in hospitals. Staphylococcus aureus was the most common agent, causing 48.2 per cent of the outbreaks. Salmonella enterica was involved in 34 per cent of them. The most frequent serovar was typhimurium. Foods involved were: cheese in 29.3 per cent of the cases; cakes in 15.5 per cent; cooked meat in 15.1 per cent; milk in 13.8 per cent; and fish and seafood in 7.0 per cent of the cases. Since the number of studied incidents represents only a small proportion of all the outbreaks occurring in the country, the constant exchange of information among the laboratories which work on the problem and the promotion of the health care team are necessary in order to improve the epidemiologic surveillance systems and the study and prevention of food-borne disease and food poisoning outbreaks.
Assuntos
Infecções Bacterianas/epidemiologia , Infecções Bacterianas/etiologia , Surtos de Doenças , Doenças Transmitidas por Alimentos/epidemiologia , Doenças Transmitidas por Alimentos/etiologia , Doenças Parasitárias/complicações , Doenças Parasitárias/epidemiologia , Infecções Bacterianas/microbiologia , Infecções Bacterianas/parasitologia , Surtos de Doenças/estatística & dados numéricos , Microbiologia de Alimentos , Parasitologia de Alimentos , Doenças Transmitidas por Alimentos/microbiologia , Doenças Transmitidas por Alimentos/parasitologia , Humanos , Incidência , México/epidemiologia , Doenças Parasitárias/microbiologia , Doenças Parasitárias/parasitologiaRESUMO
Treatment with 1,25-dihydroxy-vitamin D3 (1,25(OH)2D3) (1-12 h, 10(-10) M) stimulates DNA synthesis in proliferating myoblasts, with an early response at 2-4 h of treatment followed by a maximal effect at 10 h. To investigate the mechanism involved in the mitogenic action of the hormone we studied the possible activation of intracellular messengers by 1,25(OH)2D3. The initial phase of stimulation of [3H]thymidine incorporation into DNA by the sterol was mimicked by the protein kinase C activator tetradecanoylphorbol acetate (TPA) in a manner which was dose dependent and specific as the inactive analog 4 alpha-phorbol was without effect. Maximal responses to TPA (100 nM) were obtained at 4 h. Staurosporine, a protein kinase C inhibitor, blocked the effect of 1,25(OH)2D3 on myoblast proliferation at 4 h. In addition, a fast (1-5 min) elevation of diacylglycerol levels and membrane-associated protein kinase C activity was observed in response to 1,25(OH)2D3. The adenylate cyclase activator forskolin (20 microM) and dibutyryl-cAMP (50 microM) increased DNA synthesis reproducing the second 1,25(OH)2D3-dependent stimulatory phase at 10 h. Inhibitors of protein kinase A blocked the increase in muscle cell DNA synthesis induced by 1,25(OH)2D3 at 10 h. Significant increases in cyclic AMP levels were detected in myoblasts treated with the sterol for 1-10 h. The calcium channel antagonist nifedipine (5-10 microM) abolished both the effects of 4-h treatment with 1,25(OH)2D3 or TPA and 10-h treatment with 1,25(OH)2D3 or dibutyryl-cAMP. Similar to the calcium channel agonist Bay K8644, 1,25(OH)2D3 stimulated myoblast 45Ca uptake and its effects were blocked by nifedipine.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Calcitriol/farmacologia , Músculos/citologia , Proteína Quinase C/fisiologia , Proteínas Quinases/fisiologia , Éster Metílico do Ácido 3-Piridinacarboxílico, 1,4-Di-Hidro-2,6-Dimetil-5-Nitro-4-(2-(Trifluormetil)fenil)/farmacologia , Alcaloides/farmacologia , Animais , Bucladesina/farmacologia , Cálcio/fisiologia , Canais de Cálcio/fisiologia , Divisão Celular/efeitos dos fármacos , Células Cultivadas , Embrião de Galinha , Colforsina/farmacologia , DNA/biossíntese , Diglicerídeos/biossíntese , Relação Dose-Resposta a Droga , Músculos/efeitos dos fármacos , Músculos/enzimologia , Músculos/metabolismo , Nifedipino/farmacologia , Proteína Quinase C/antagonistas & inibidores , Estaurosporina , Acetato de Tetradecanoilforbol/farmacologia , Fatores de TempoRESUMO
Experiments were carried out to obtain information about the mechanism underlying the fast action of 1,25-dihydroxyvitamin D3 (1,25(OH)2D3) in skeletal muscle. N-2'-o-dibutyryladenosine-3',5'-cyclic monophosphate (dbcAMP), similarly as 1,25(OH)2D3 (5 x 10(-10) M), rapidly increased 45Ca uptake by soleus muscle from vitamin D-deficient chicks (+25% and +98% at 3 min and 10 min, respectively) in a dose-dependent manner. The effects of the cAMP analog (10 microM) and 1,25(OH)2D3 could be abolished by the Ca(2+)-channel blocker nifedipine and the calmodulin antagonist flufenazine. Calmodulin binding by two muscle microsomal proteins of 28 kDa and 30 kDa was stimulated within 1 min of exposure of the tissue to 1,25(OH)2D3. Direct effects of the sterol on membrane calmodulin binding were shown with isolated microsomes. The 1,25(OH)2D3-mediated rise of [125I]calmodulin binding to microsomal membranes was dependent on the presence of medium ATP. Forskolin (10 microM) and cAMP (10 microM) also increased [125I]calmodulin binding (+75% and +64%, respectively, with respect to controls). Pretreatment of microsomal membranes with cAMP-dependent protein kinase inhibitor (1 microgram/ml) or addition of alkaline phosphates (1 U/ml) after hormonal treatment caused complete inhibition of 1,25(OH)2D3-induced [125I]calmodulin binding to microsomal membrane proteins. These results imply modifications of membrane protein phosphorylation through the cAMP signal pathway and in turn of calmodulin binding in the mechanism by which 1,25(OH)2D3 rapidly stimulates skeletal muscle Ca2+ uptake.