RESUMO
BACKGROUND: Psoriasis is a chronic inflammatory disease associated with increased cardiovascular risk. Metabolic syndrome (MS) is a significant predictor of cardiovascular events. OBJECTIVE: To assess the prevalence of MS in a Mexican population with psoriasis. METHODS: A descriptive, case control study was performed, involving a series of 209 patients. Relevant demographic, clinical, anthropometric, and analytic information was obtained from all participants. Metabolic syndrome was diagnosed according to the NCEP-ATPIII criteria. RESULTS: The study included 103 patients with psoriasis and 106 controls. The mean age of the case patients was 48.37 years; 55% were women and 46% were men. Metabolic syndrome was significantly more common in psoriatic patients than in controls (41.7 vs. 20%, odds ratio: 1.738; 95% CI: 1.194-2.531; p < 0.001). We also found a higher frequency of diabetes mellitus (17.3 vs. 6.6%; p = 0.001), alcoholic habits (8.7 vs. 0.9%; p = 0.009), and higher levels of blood pressure (p = 0.002), BMI (p = 0.016), waist circumference (p = 0.008), and triglycerides (p = 0.002). CONCLUSIONS: Psoriatic patients have a higher prevalence of metabolic syndrome, which can favor cardiovascular events.
Assuntos
Síndrome Metabólica/complicações , Síndrome Metabólica/epidemiologia , Psoríase/complicações , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , PrevalênciaRESUMO
The healing process in diabetic foot ulcer (DFU) is hindered by factors such as chronic inflammation, defects in fibroblast function, poor angiogenesis, and lack of cell migration. Recombinant human epidermal growth factor (rhEGF) has been shown to enhance extracellular matrix formation, cellular proliferation, and angiogenesis. Therefore, intralesional application of rhEGF in DFU could accelerate wound healing. Our objective was to determine the efficacy and safety of rhEGF in patients with DFU. A randomized, double-blinded, placebo-controlled study was conducted comparing a thrice-per-week intralesional application of rhEGF (75 µg) or placebo in patients with DFU for 8 weeks. The number of completely healed ulcers, size, and wound bed characteristics were evaluated to determine the efficacy of rhEGF. Adverse events were recorded and analyzed to establish its safety. A total of 34 patients were recruited for the study. After three dropouts, we were able to follow and analyze 16 patients in the placebo group and 15 patients in the rhEGF study to the end of the trial. Baseline testing showed that both groups were similar. Compared to the placebo group, more ulcers achieved complete healing in the rhEGF group (rhEGF, n = 4; placebo, n = 0; p = 0.033); ulcers in the rhEGF group decreased in area size (12.5 cm2 [rhEGF] vs. 5.2 cm2 [placebo]; p = 0.049); and more epithelial islands in the wound bed were present (28% vs. 3%; p = 0.025). Mild transitory dizziness was the only side effect that was more frequently noted in the rhEGF group. Our results showed that in patients with DFU who received standard care, intralesional rhEGF application resulted in complete healing in more patients, promoted the epithelialization of the wound bed, and significantly reduced the area of the DFU treated. Therefore, rhEGF resulted in better outcomes for patients suffering from DFU.
Assuntos
Indutores da Angiogênese/uso terapêutico , Pé Diabético/tratamento farmacológico , Fator de Crescimento Epidérmico/uso terapêutico , Cicatrização/efeitos dos fármacos , Adulto , Amputação Cirúrgica , Proliferação de Células/efeitos dos fármacos , Pé Diabético/patologia , Pé Diabético/fisiopatologia , Relação Dose-Resposta a Droga , Método Duplo-Cego , Feminino , Tecido de Granulação/efeitos dos fármacos , Humanos , Injeções Intralesionais , Masculino , México/epidemiologia , Proteínas Recombinantes/uso terapêutico , Resultado do TratamentoRESUMO
Mycetoma is the most frequently diagnosed deep mycosis in Mexico and is caused, in 86% of cases, by Nocardia brasiliensis. Worldwide, Nocardia harenae has not been previously reported as a causative agent of human mycetoma. Herein we report, to our knowledge, the first two human cases of mycetoma due to N. harenae in a clinical setting. The strains were identified by phenotypic and molecular techniques. Both cases were characterized by long-lasting mycetoma that had previously been failed to be cured and had shown resistance to therapy. However, in our hospital, a multidrug therapy proved to be effective in these cases.
Assuntos
Micetoma/diagnóstico , Micetoma/microbiologia , Nocardiose/diagnóstico , Nocardiose/microbiologia , Nocardia/classificação , Nocardia/isolamento & purificação , Adulto , Antibacterianos/administração & dosagem , DNA Bacteriano/química , DNA Bacteriano/genética , Feminino , Humanos , Masculino , México , Pessoa de Meia-Idade , Dados de Sequência Molecular , Micetoma/patologia , Nocardia/genética , Nocardiose/patologia , Análise de Sequência de DNA , Pele/patologia , Resultado do TratamentoRESUMO
Pyoderma gangrenosum (PD) is a rare, chronic, relapsing, ulcerative, neutrophilic cutaneous disease and may be difficult to recognize. It is not uncommon for PD to be mistakenly diagnosed as vascular occlusive or venous disease, vasculitis, cancer, infection, exogenous tissue injury, or other inflammatory disorders. A 55-year-old woman with a 5-year history of a very painful and enlarging ulcer presented at the authors' clinic. Previously, based on an original diagnosis of venous ulcer, the wound had been surgically debrided and managed with saline-soaked gauze and compression therapy. After the authors secured a complete history (which included rheumatoid arthritis) and assessment, PD was suspected. A biopsy was performed for histological confirmation. Pyoderma gangrenosum treatment, including oral corticosteroids and topical 0.01% tacrolimus twice daily covered with nonadhesive gauze and compression wrapping, was started. After 4 weeks, the wound had improved noticeably and pain medications to manage wound pain were discontinued. The wound was completely healed after 4 months. The presence or absence of PD must be ascertained in all patients who present with a history of painful lower leg ulcers and PD risk factors, such as rheumatoid arthritis.