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INTRODUCTION AND OBJECTIVES: Surrogate biomarkers of liver fibrosis developed in tertiary care are increasingly used in general populations. We evaluated the association between liver stiffness (LS) and five continuous (AST/ALT, APRI, Forns Index, FIB-4, GGT) and two discrete biomarkers (BARD, BAAT) in a general population. PATIENTS AND METHODS: 636 (29%) of the 2159 citizens of the Bagnacavallo Study had LS measured by transient elastography. Using linear regression with univariate multiple imputation, we evaluated the association of LS with the above biomarkers in the total sample of 2159 citizens. RESULTS: The mean change of LS between the 5th and 95th internal percentile of any continuous biomarker was ≤1kPa. The mean change of LS between scores 0 and 3 of BARD and scores 0 and ≥3 of BAAT was >1kPa but of doubtful clinical relevance. CONCLUSION: We found a modest association between LS and seven biomarkers of liver fibrosis in a general population.
Assuntos
Fígado Gorduroso Alcoólico/sangue , Cirrose Hepática/sangue , Hepatopatia Gordurosa não Alcoólica/sangue , Adulto , Alanina Transaminase/sangue , Aspartato Aminotransferases/sangue , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Técnicas de Imagem por Elasticidade , Fígado Gorduroso Alcoólico/diagnóstico por imagem , Feminino , Humanos , Cirrose Hepática/diagnóstico por imagem , Masculino , Síndrome Metabólica , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/diagnóstico por imagem , Obesidade , Sobrepeso , Contagem de Plaquetas , gama-Glutamiltransferase/sangueRESUMO
BACKGROUND: Reflectance confocal microscopy (RCM) has been used for the evaluation of several inflammatory skin conditions, including skin discoid lupus erythematosus (DLE), and has been correlated with conventional histopathology (HP). However, RCM is not being widely used in trichology. Few reports and just preliminary data suggest the use of RCM as a complementary tool in alopecias. OBJECTIVES: To correlate the major RCM features of scalp DLE with trichoscopy and HP findings of biopsy specimens obtained from the same lesions. METHODS: This is an observational, analytical, and cross-sectional study involving 12 patients with a clinically established diagnosis of scalp DLE. Patients underwent global clinical photograph, trichoscopy, and RCM examination in the same site followed by two 4-mm punch biopsy specimens for HP analysis. Inter-methods agreement among RCM imaging, trichoscopy, and horizontal histopathology sections (HHS) were calculated using Cohen Kappa (k) statistics. RESULTS: Statistical analysis of the agreement between RCM and HP features disclosed an overall agreement similar to skin DLE. Seven of the eleven features evaluated had agreement superior to 75%. We also evaluated RCM features associated with three of their corresponding trichoscopic findings for further investigation of their agreement with HP. Statistical analysis showed an enhancement with agreement of 86% when the non-invasive techniques are used together. CONCLUSION: Consistent correlation between RCM and HP observed in our study supports the reliability of RCM in the diagnosis of scalp DLE. RCM may be considered a promising tool for scalp DLE microscopic evaluation and presents similar RCM features to DLE in other body sites. By associating clinical, trichoscopic and RCM evaluation, dermatologists will have a non-invasive arsenal for the assessment of hair and scalp disorders, benefiting patients.
Assuntos
Lúpus Eritematoso Discoide , Microscopia Confocal , Couro Cabeludo , Estudos Transversais , Humanos , Lúpus Eritematoso Discoide/diagnóstico por imagem , Reprodutibilidade dos Testes , Couro Cabeludo/diagnóstico por imagemRESUMO
Este trabalho tem como objetivo mostrar a aplicabilidade da técnica de imagens com colagens, pictodrama, no setting clínico, buscando compreendê-la como recurso psicoterápico. A pesquisa qualitativa teve como base a investigação de um estudo de caso clínico. O uso do pictodrama permitiu à paciente experienciar a distância entre a narrativa individual e seus conteúdos internos. Os resultados encontrados no estudo de caso com a paciente possibilitaram seu autoconhecimento sobre como ela ordena suas experiências e dinâmicas emocionais, permitindo uma reorganização interna.
This work aims to show the technical applicability of the image technique collage, pictodrama, in the clinical setting configuration, seeking to understand it as a psychotherapeutic resource. This qualitative research was based on the investigation of a clinical case study. The use of pictodrama let the patient experience the distance between an individual narrative and its internal contents. The results found in the case study with the patient enabled the self-knowledge of how he orders his experiences and emotional dynamics, allowing an internal reorganization.
La técnica tiene como objetivo mostrar la aplicabilidad técnica de collage de imágenes, pictodrama, sin configuración clínica, buscando entender como un recurso psicoterapéutico. Una cualitativa investigación se basó en la investigación de un estudio de caso clínico. El uso de pictodrama permitió al paciente experimentar la distancia entre una narración individual y sus contenidos internos. Los resultados encontrados en el estudio de caso con la paciente permitieron el autoconocimiento de su forma de ordenar sus experiencias y dinámicas emocionales, permitiendo una reorganización interna.
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PURPOSE: We present a case of a patient with progressive open angle glaucoma who presented changes suggestive of improvement in the Heidelberg retinal tomography 3 (HRT3) analysis after a cardiac catheterization. OBSERVATION: A 69-year-old woman presented with progressive open angle glaucoma despite maximum tolerable antiglaucomatous topical treatment. A filtering surgery (trabeculectomy) was performed and successfully achieved intraocular pressure (IOP) levels of 10 mm Hg on average. Despite this, changes were evidenced in the HRT3 protocols (trend analysis and topographic change analysis) suggesting marked progression. Brimonidine 0.2% twice a day was initiated, and a cardiovascular examination was requested. A cardiac catheterism was performed in the following weeks, and afterward, all structural parameters improved until the last control. Medication was not discontinued, and no signs of apparent progression on the HRT3 parameters have been evidenced up until the time of writing this case report. CONCLUSIONS AND IMPORTANCE: There was a marked improvement in the HRT3 parameters (trend and topographic change analysis), suggesting that the progression stopped after a cardiac catheterism in a patient with progressive glaucoma despite having the IOP controlled. To our knowledge, this is the first case of a patient with progressive glaucoma that was medically and surgically managed, and despite achieving low IOP levels, the progression detected by the HRT3 analysis could not be stopped until a cardiac catheterization was performed.
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BACKGROUND: The spasticity could lead to decreased functional capacity and changes in musculoskeletal tissue. OBJECTIVE: To compare the Achilles tendon properties between the affected and contralateral limbs of participants with spasticity due to stroke and the healthy subjects. METHODS: Fifteen individuals with ankle spasticity due to stroke and 15 healthy subjects were recruited. Maximal isometric ankle joint torque was obtained with an isokinetic dynamometer, and an ultrasound was used to determine tendon length, tendon cross-sectional area, and the medial gastrocnemius myotendinous junction displacement. The Achilles tendon strength, displacement, stress, strain, stiffness, and Young's modulus were obtained during a maximum voluntary isometric plantarflexion contraction. RESULTS: There were no differences between Achilles tendon length among participants. Both limbs of participants with stroke showed reduced tendon cross-sectional area (~18%) compared to healthy limb. The affected limb showed decreased tendon strength (686 ± 293.3 N), displacement (10.6 ± 1.7 mm), Young's modulus values (849 ± 235.6 MPa), and lower stiffness (196.6 ± 67.6 N/mm) compared to the contralateral limb (strength, 1357.1 ± 294.8 N; displacement, 15.2 ± 5.5 mm; Young's modulus, 1431.8 ± 301.9 MPa; stiffness, 337.5 ± 98.1 N/mm) and to the healthy limb. The contralateral limb also showed decreased tendon strength (~26.2%) and stiffness (~21.5%) compared to the healthy group. CONCLUSION: There is a decrement in Achilles tendon morphological and mechanical properties of the affected limb in individuals with spasticity due to stroke. The contralateral limb had a thinner tendon more compliant likely to physical activity reduction.