RESUMO
Geographic tongue (GT) is a chronic condition of unknown aetiology, with no defined parameters to establish the protocol for evidence-based management. Validation of a newly developed and proposed clinical index to assess the severity of GT could assist in its diagnosis, especially in cases associated with systemic dermatological diseases in the form of psoriasis. OBJECTIVE: To verify the applicability of the geographic tongue area and severity index (GTASI). This involved healthcare professionals from different specialties to evaluate the usefulness of the GTASI in supporting GT classification, as well as the follow-up process. METHODS: One hundred cases of previously diagnosed GT were initially evaluated by three independent, experienced researchers/clinicians to obtain a standardised classification baseline. Subsequently, nine cases of GT were selected, three cases for each category-mild, moderate and severe. These stages were professionally evaluated by 51 healthcare professionals from three groups: 17 dentists (33%), 22 oral medicine specialists (43%) and 12 specialist dermatologists (24%) during a cross-sectional survey. RESULTS: The quantitative and qualitative assessment based on experts' opinions in the cross-sectional survey demonstrated an acceptable, similar level of GT clinical diagnosis (p > 0.05), with coherence between the various groups of professionals critically appraising the GTASI. An apparent divergence was observed for the moderate GT category, as well as in the group of less experienced evaluators. CONCLUSION: Whilst the validation of GTASI applicability was successfully executed, the general dental practitioners, specialists in oral medicine and dermatologists were equally capable of correct GT diagnosis and appropriately rating its severity. These coherent results were especially replicated among the experienced clinicians. The validation of the newly proposed index confirmed its reliability as a feasible instrument in oral medicine, with the prospect of its wider implementation in clinical practice.
RESUMO
INTRODUCTION: In general, chronic wounds are colonized by bacteria; however, when microorganisms start to multiply at higher levels, wounds can become infected, causing prolongation of the inflammatory phase and retardation of collagen synthesis and epithelialization. OBJECTIVE: The objective of this study was to evaluate the presence of infection in venous ulcers after 12 weeks of treatment with autologous platelet-rich plasma (PRP) and determine global white blood cell counts. MATERIALS AND METHODS: This case series study involved a sequential sample of 17 patients with venous ulcers treated with PRP for 12 weeks. Descriptive and inferential statistical analysis was performed using the McNemar test and χ² test. RESULTS: At baseline, 10 patients (58.8%) had wound infection. During the sixth week of treatment with PRP, only 3 patients (17.6%) continued to exhibit wound infection. After 12 weeks of PRP treatment, only 1 patient (5.9%) continued to exhibit wound infection. McNemar and χ² tests used to assess the presence of infection in the intervention group produced a P value of .0039 for a comparison of baseline and week 6 and a P value of .0078 for a comparison of baseline and week 12. These results demonstrated significant differences from baseline at both 6 weeks and 12 weeks of treatment, with greater significance at 12 weeks. There was no relationship between global white blood cell count and the presence of infection. CONCLUSION: After intervention with PRP, 94% of patients experienced improvement concerning the infection of ulcers.
Assuntos
Plasma Rico em Plaquetas , Úlcera Varicosa , Infecção dos Ferimentos , Contagem de Células Sanguíneas , Humanos , Úlcera , Úlcera Varicosa/terapiaRESUMO
Interest has increased in comorbidities associated with psoriasis and their effects on health-related quality of life (HRQoL). This study aimed to evaluate the prevalence of metabolic syndrome (MetS) and psoriatic arthritis (PsA) and to investigate HRQoL and the prevalence of hypertension, type 2 diabetes mellitus (T2DM), obesity and dyslipidemia. In a cross-sectional design, patients diagnosed with plaque psoriasis answered an interview and standardized questionnaires (Dermatology Life Quality Index questionnaire [DLQI], 36-Item Short Form Health Survey [SF-36] and EuroQol Five-Dimension Questionnaire Three-Level version [EQ-5D-3L]). Physical examination and several tests to assess desired outcomes were performed by a dermatologist and a rheumatologist during three visits. The prevalence of MetS and PsA was 50.0% and 41.8%, respectively. Dyslipidemia was the most prevalent (74.5%) secondary comorbidity, followed by hypertension (61.8%), obesity (52.5%) and T2DM (30.9%). The mean (standard deviation) DLQI score was 6.5 (6.9), and mean physical and mental SF-36 measures were 45.2 (10.4) and 45.5 (12.3), respectively, and for EQ-5D-3L, mean utility index and EQ-VAS scores were 0.68 (0.27) and 72.7 (19.7), respectively. PsA and MetS are important comorbidities; a reduced HRQoL is noted among plaque psoriasis patients with these comorbidities, emphasizing the relevance of diagnosis and treatment beyond the care of skin lesions.
Assuntos
Artrite Psoriásica/epidemiologia , Síndrome Metabólica/epidemiologia , Psoríase/epidemiologia , Qualidade de Vida , Adulto , Brasil/epidemiologia , Comorbidade , Estudos Transversais , Diabetes Mellitus Tipo 2/epidemiologia , Dislipidemias/epidemiologia , Feminino , Humanos , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Prevalência , Índice de Gravidade de Doença , Inquéritos e QuestionáriosRESUMO
OBJETIVO: Avaliar a viabilidade do tratamento de úlceras venosas com o Plasma Rico em Plaquetas (PRP). MÉTODO: Estudo descritivo do tipo série de casos, realizado como piloto de um ensaio clínico, com amostra de três pacientes, alocados após a randomização, dois para intervenção e um para o controle. O custo direto foi coletado por meio de observação direta. RESULTADOS: Nos pacientes que receberam a intervenção (PRP), das duas úlceras venosas acompanhadas, uma apresentou cicatrização total, com um custo de US$550,35 e a outra obteve taxa de redução de área de 33,33%, com o custo de US$1.070,32. No paciente controle, a taxa de redução da úlcera venosa foi de 83,33%, com o custo de US$361,53. DISCUSSÃO: A partir do teste piloto, foi possível adequar os protocolos e determinar os insumos para realização do estudo. CONCLUSÃO: A avaliação de protocolos clínicos é de suma importância para o desenvolvimento de ensaios clínicos controlados
OBJECTIVE: To assess the viability of the treatment of venous ulcers with platelet-rich plasma (PRP). METHOD: A descriptive case series study conducted as a pilot study for a clinical trial. With a sample of three patients, allocated after randomization, two for intervention and one for control. The cost was collected by means of direct observation. RESULTS: In patients who received the intervention (PRP), two venous ulcers were followed-up, one presented complete healing, with a cost of US$ 550.35, and the other exhibited a rate of area reduction of 33.33%, with a cost of US$ 1,070.32. In the control patient, there was an 83.33% reduction in the venous ulcer area, with a cost of US$ 361,53. DISCUSSION: The pilot test made it possible to adequate the protocols and to determine the supplies required for the completion of the study. CONCLUSION: The assessment of the clinical protocols is pivotal for the development of controlled clinical trials
OBJETIVO: Evaluar la viabilidad del tratamiento de úlceras venosas con el plasma rico en plaquetas (PRP). MÉTODO: Estudio descriptivo de serie de casos, realizado como piloto de un ensayo clínico, con una muestra de tres pacientes, asignados mediante aleatorización, dos para la intervención y uno para el control. El costo directo se estimó mediante observación directa. RESULTADOS: En los pacientes que recibieron la intervención (PRP), de las dos úlceras venosas monitoreadas, una cuales presentó cicatrización total, con un costo de US$ 550,35, y la otra tuvo una tasa de reducción de área del 33,33%, con un costo de US$ 1070,32. En el paciente control, la tasa de reducción de la úlcera venosa fue del 83,33%, con un costo de US$ 361,53. DISCUSIÓN: A partir de la prueba piloto, fue posible adecuar los protocolos y determinar los insumos necesarios para realizar el estudio. CONCLUSIÓN: La evaluación de protocolos clínicos es de suma importancia para el desarrollo de ensayos clínicos controlados
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Avaliação da Tecnologia Biomédica , Úlcera Varicosa , Custos e Análise de Custo , Análise de Custo-Efetividade , Plasma Rico em Plaquetas , Insuficiência Venosa , Cicatrização , Ferimentos e Lesões , Hospitais UniversitáriosRESUMO
BACKGROUND: Few studies have examined the clinical features of geographic tongue (GT), an inflammatory lesion, making diagnosis and the investigation of oral psoriasis difficult. PURPOSE: To investigate the clinical features of GT to facilitate its identification and understand its relationship with psoriasis. METHODS: A total of 96 participants diagnosed with GT underwent stomatological and dermatological examinations. The parameters assessed were burning sensation; number, classification, and location of lesions; loss of papillae; severity of GT lesions; and association with fissured tongue (FT). Psoriatic patients (PS) and those without psoriasis (NPS) were compared. RESULTS: Burning sensation was reported by 45 (47%) patients, 67 (70%) patients showed active GT, 68 (71%) presented with typical lesions, and 59 (61%) exhibited moderate lesions. GT was associated with FT in 75% of the cases and exhibited a diffused pattern associated with severe lesions. It was also more frequent in the PS group. The comparative analysis between the PS and NPS groups showed significant differences between the groups with regard to gender, presence of burning sensation, and GT severity. CONCLUSION: GT is a symptomatic lesion with a thick halo. In contrast, psoriatic patients are frequently asymptomatic and exhibit severe lesions with greater loss of papillae that are associated with severe FT. The present study is the first to demonstrate clinical differences in the GT of patients with and without psoriasis, suggesting that some GT cases may represent true oral psoriasis and some cases may represent only GT.
Assuntos
Glossite Migratória Benigna/epidemiologia , Psoríase/epidemiologia , Língua Fissurada/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Adulto JovemRESUMO
Geographic tongue (GT) and fissured tongue (FT) are the more frequent oral lesions in patients with psoriasis. The aims of this study were to compare the prevalence of GT/FT between psoriasis group (PG) and healthy controls (HC) and investigate the correlation between GT/FT and psoriasis severity using the PASI and age of psoriasis onset. Three hundred and forty-eight PG and 348 HC were selected. According to the age of psoriasis onset, the individuals were classified as having early psoriasis and late psoriasis. The severity of vulgaris psoriasis was determined according to PASI. A follow-up was conducted in patients with psoriasis vulgaris (PV) with GT to evaluate the progression of oral and cutaneous lesions. The FT and GT were more frequent in PG than in HC. The incidence of GT was higher in patients with early psoriasis and that of FT in late-psoriasis. There is association between psoriasis intensity and GT; and a higher monthly decrease of PASI score in patients without GT. The presence of GT and FT is higher in PG than in the HC. GT is associated with disease severity and may be a marker of the psoriasis severity.
Assuntos
Glossite Migratória Benigna/etiologia , Psoríase/complicações , Língua Fissurada/etiologia , Adolescente , Adulto , Idade de Início , Idoso , Idoso de 80 Anos ou mais , Feminino , Glossite Migratória Benigna/epidemiologia , Glossite Migratória Benigna/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Psoríase/patologia , Índice de Gravidade de Doença , Língua/patologia , Língua Fissurada/epidemiologia , Língua Fissurada/patologia , Adulto JovemRESUMO
The platelet-rich plasma (PRP) has proved promising regarding its applicability in dermatology, especially in the healing of chronic ulcers. The autologous platelet-rich plasma is obtained by centrifuging the blood, so that the components are separated by density gradient. The final product is a gel rich in growth factors that act in tissue repair by activating fibroblasts and inducing extracellular matrix remodeling.
Assuntos
Plasma Rico em Plaquetas , Úlcera Cutânea/terapia , Cicatrização , Idoso , Transfusão de Sangue Autóloga/métodos , Doença Crônica , Feminino , Géis/uso terapêutico , Humanos , Transfusão de Plaquetas/métodos , Úlcera Cutânea/patologia , Resultado do TratamentoRESUMO
The platelet-rich plasma (PRP) has proved promising regarding its applicability in dermatology, especially in the healing of chronic ulcers. The autologous platelet-rich plasma is obtained by centrifuging the blood, so that the components are separated by density gradient. The final product is a gel rich in growth factors that act in tissue repair by activating fibroblasts and inducing extracellular matrix remodeling.
Assuntos
Idoso , Feminino , Humanos , Plasma Rico em Plaquetas , Úlcera Cutânea/terapia , Cicatrização , Transfusão de Sangue Autóloga/métodos , Doença Crônica , Géis/uso terapêutico , Transfusão de Plaquetas/métodos , Úlcera Cutânea/patologia , Resultado do TratamentoRESUMO
BACKGROUND: Infections are known to trigger and exacerbate psoriasis. Although oral candidiasis is often clinically diagnosed, it is not always confirmed by laboratory tests such as oral cytopathology. OBJECTIVES: The aims of this study were to determine the prevalence of oral candidiasis in patients with psoriasis through clinical and cytopathological diagnosis and to investigate the association between oral candidiasis and psoriasis with regards to the severity of the clinical presentation and the type of treatment for psoriasis. METHODS: A total of 140 patients with psoriasis and 140 healthy control subjects received an oral examination. Scrapings of the tongue were also obtained for a cytopathological examination. RESULTS: The oral examination and the results of the cytopathological smear revealed 37 (26%) cases of candidiasis in the patients with psoriasis and no cases of candidiasis in the healthy control subjects. There was no correlation between the type of psoriasis treatment and the presence of oral candidiasis (P = .616). There was a statistically significant association (P = .033) between the clinical severity of psoriasis and the presence of Candida. LIMITATIONS: This study was limited by the small number of subjects and the lack of follow-up to determine the development of psoriasis after treatment for oral candidiasis. CONCLUSIONS: The presence of oral candidiasis is higher in patients with psoriasis and it is associated with disease severity. This increased presence of oral candidiasis was apparent despite any type of treatment for the psoriasis. Cytopathology to rule out oral candidiasis should be used in the routine medical workup of patients with psoriasis.
Assuntos
Candidíase Bucal/epidemiologia , Psoríase/epidemiologia , Adulto , Idoso , Candidíase Bucal/tratamento farmacológico , Candidíase Bucal/patologia , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Psoríase/patologia , Psoríase/terapia , Índice de Gravidade de DoençaRESUMO
Recently, the world is facing an escalate in the incidence of chronic kidney disease (CKD). Databases containing information about patients in end stage renal disease (ESRD), especially in the United States, were the sources of initial information about it. Brazil has the third largest population on dialysis in the world, and there are about 680 dialysis centers, spread across all units of the federation in the present, providing treatment to an estimated population of almost 90,000 patients. Cutaneous involvement in the chronic renal failure is characterized by a number of manifestations, which may be related to three processes: the primary renal disease, the uremic state, or the therapeutic measures used in their handling. The skin changes in these two classes of patients, dialysis and transplant recipients, have been the subject of several studies. n recent years, however, great progress has been achieved in these two therapeutic modalities, which may have changed not only the type of the dermatologic disorders associated with these two conditions, but also their intensity or frequency. This article aims to yield an update as to the topic skin diseases in hemodialysis and kidney transplant patients.
Assuntos
Transplante de Rim/efeitos adversos , Diálise Renal/efeitos adversos , Dermatopatias/etiologia , HumanosRESUMO
Na atualidade, o mundo está enfrentando uma epidemia de doença renal crônica (DRC). Bases de dados contendo informações sobre os pacientes no estágio terminal da doença renal (DRCt), especialmente nos Estados Unidos, foram as fontes das primeiras informações a respeito deste assunto. O Brasil possui a terceira maior população em diálise no mundo, e atualmente existem cerca de 680 centros de diálise, distribuídos por todas as unidades da federação, atendendo uma população estimada em quase 90.000 pacientes. O envolvimento cutâneo na insuficiência renal crônica é caracterizado por uma diversidade de manifestações, as quais podem ser relacionadas a três processos: à doença renal primária; ao estado urêmico ou a medidas terapêuticas empregadas no seu manuseio. As alterações dermatológicas nessas duas classes de pacientes, dialisados e transplantados, já foram motivo de diversos estudos. Nos últimos anos, entretanto, grandes progressos foram alcançados nestas duas modalidades terapêuticas, os quais podem ter modificado tanto o tipo de alteração dermatológica associada a estas duas condições, quanto a sua intensidade ou frequência. Este artigo tem como objetivo oferecer uma atualização sobre o tema dermatoses em hemodialisados e transplantados.
Recently, the world is facing an escalate in the incidence of chronic kidney dis>ease (CKD). Databases containing information about patients in end stage renal disease (ESRD), especially in the United States, were the sources of initial information about it. Brazil has the third largest population on dialysis in the world, and there are about 680 dialysis centers, spread across all units of the federation in the present, providing treatment to an estimated population of almost 90,000 patients. Cutaneous involvement in the chronic renal failure is characterized by a number of manifestations, which may be related to three processes: the primary renal disease, the uremic state, or the therapeutic measures used in their handling. The skin changes in these two classes of patients, dialysis and transplant recipients, have been the subject of several studies. n recent years, however, great progress has been achieved in these two therapeutic modalities, which may have changed not only the type of the dermatologic disorders associated with these two conditions, but also their intensity or frequency. This article aims to yield an update as to the topic skin diseases in hemodialysis and kidney transplant patients.
Assuntos
Humanos , Diálise Renal , Falência Renal Crônica/epidemiologia , Dermatopatias , Transplante de RimRESUMO
A 55-year-old man with progressive loss of vision was referred for dermatology consultation for the evaluation of his skin lesions. The cutaneous examination of the patient revealed multiple small yellow papules, coalescing into plaques, on his neck, axillae and periumbilical regions. He also had redundant skin folds on the axillae. His peripheral pulses and blood pressure were normal. Angioid streaks were found in the ocular fundi. A skin biopsy specimen of the papule showed fragmentation of elastic fibers as well as calcification in the dermis. Given the clinical manifestations and the histopathologic findings, the patient's illness was diagnosed as pseudoxanthoma elasticum. The patient was then sent to undergo a thorough cardiovascular evaluation.
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Pseudoxantoma Elástico , Humanos , Masculino , Pessoa de Meia-Idade , Pseudoxantoma Elástico/patologiaRESUMO
There are different types of skin changes associated with internal malignancy. One type is the skin involvement as a result of cutaneous metastasis from an internal tumor. The skin is an uncommon site for distant metastasis; when it is present the most common sources are breast, lung, and colon. Metastasis generally occurs after an internal malignancy had been discovered and signifies disseminated disease with a poor prognosis. We report an exuberant and rare case of cutaneous metastasis from gastric adenocarcinoma as the first sign of this serious visceral cancer.
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Carcinoma de Células em Anel de Sinete/secundário , Neoplasias Cutâneas/secundário , Neoplasias Gástricas/diagnóstico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Caquexia/etiologia , Carcinoma de Células em Anel de Sinete/diagnóstico , Carcinoma de Células em Anel de Sinete/tratamento farmacológico , Carcinoma de Células em Anel de Sinete/ultraestrutura , Etoposídeo/administração & dosagem , Fluoruracila/administração & dosagem , Humanos , Leucovorina/administração & dosagem , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/secundário , Masculino , Pessoa de Meia-Idade , Neoplasias Cutâneas/tratamento farmacológico , Neoplasias Cutâneas/ultraestrutura , Neoplasias da Coluna Vertebral/tratamento farmacológico , Neoplasias da Coluna Vertebral/secundário , Neoplasias Gástricas/tratamento farmacológico , Neoplasias Gástricas/patologia , Falha de TratamentoRESUMO
Sporotrichosis is the most common of the deep mycoses. In most cases the transmission occurs secondary to recent penetrating trauma with plant thorns, wood splinters or contaminated organic material. We report a case of a 68-year-old Brazilian female with a small ulcer on her right forefinger and palpable erythematous nodules on her right forearm. These occurred after the bite of a domestic cat that had a lesion on its hind-foot. Since the 1980s, the role of felines in the transmission of this mycosis to humans has gained attention among animal owners, veterinarians, and caretakers. Humans can be contaminated by a cat scratch or bite and even by contact with contaminated solutions.
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Dermatomicoses/patologia , Sporothrix/patogenicidade , Esporotricose/transmissão , Esporotricose/veterinária , Idoso , Animais , Biópsia por Agulha , Brasil , Doenças do Gato/patologia , Doenças do Gato/transmissão , Gatos , Dermatomicoses/tratamento farmacológico , Dermatomicoses/veterinária , Feminino , Seguimentos , Humanos , Imuno-Histoquímica , Vasos Linfáticos/patologia , Iodeto de Potássio/uso terapêutico , Medição de Risco , Índice de Gravidade de Doença , Esporotricose/patologia , Resultado do Tratamento , Extremidade SuperiorRESUMO
Säo analisadas, no material disponível, as principaiscondiçöes clínicas decorrentes de deficiências nutricionais em criança, adulto e idoso, visando as estratégias a serem empregadas em sua profilaxia e tratamento. Säo relacionadas as deficiências nutricionais específicas pelo uso de determinadas drogas no adulto e na criança, e discutidos os problemas da administraçäo de suplementos vitamínicos, nutricionais e, sobretudo, das formulaçöes ortomoleculares, que o grupo considera necessário ser objeto de debate para o próximo Congresso Brasileiro de Dermatologia. É abordada ainda a necessidade do uso da mídia para informaçäo à populaçäo de baixa renda sobre o assunto e da ênfase de sua induçäo como tema para investigaçöes nos cursos de graduaçäo da área médica.