Ocorrência de carcinoma espinocelular labial não melanocítico em usuários crônicos de hidroclorotiazida / Occurrence of non-melanoma labial squamous cell carcinoma in chronic users of hydrochlorothiazide

Diversos autores desenvolveram estudos acerca da potencial associação entre a etiocarcinogênese do carcinoma espinocelular não melanocítico (CECNM) labial e o uso crônico da hidroclorotiazida (HCTZ). Objetivo: A atual revisão objetivou investigar a relação do diurético HCTZ e o risco de CECNM labial. Métodos: Realizou-se uma revisão de literatura nas bases de dados LILACS, PUBMED/MEDLINE e Periódico CAPES, em que foram incluídos artigos em inglês, português e francês, publicados no período de 2017 a 2022. Foram propostos 60 documentos e, dentre esses, 30 foram selecionados para compor a amostra no estudo. Resultados: Foi evidenciada uma relação entre o uso da HCTZ e a ocorrência de CENM com relação dose cumulativa devido às alterações provocadas pelo fármaco, no entanto, em virtude da heterogeneidade de desenhos metodológicos e concentração dos estudos em populações semelhantes, existem limitações quanto à confiabilidade dessas informações. Conclusão: Identificou-se uma desproporção entre a ocorrência e relevância do CENM e a produção científica vigente, demonstrando a necessidade de estudos com metodologias padronizadas que abranjam diferentes especificidades socioeconômicas e demográficas.(AU)

Several authors have developed studies about a potential association between the etiocarcinogenesis of non-melanocytic lip squamous cell carcinoma (NMSCC) and the chronic use of hydrochlorothiazide (HCTZ). Objective: The current study aimed to investigate the relation between the diuretic HCTZ and the risk of lip NMSCC. Methods: A literature review was carried out in the LILACS, PUBMED/MEDLINE and CAPES Periodical databases, which included articles in English, Portuguese and French, published between 2017 and 2022. Sixty documents were collected and, among these, 30 were selected to compose the sample in the study. Results: There was evidence of a relationship between the use of HCTZ and the occurrence of MSCC with a cumulative dose relationship due to changes caused by the drug, however, because of the heterogeneity of methodological designs and concentration of studies in similar populations, there are limitations regarding the reliability of this information. Conclusion: A disproportion between the occurrence and relevance of the NMSCC and the current scientific production was identified, demonstrating the need for studies with standardized methodologies that cover different demographic socioeconomic specificities.(AU)

Caracterización clínico-epidemiológica de pacientes con daño actínico crónico. Cochabamba, Bolivia / Clinical-epidemiological characterization of patients with chronic actinic damage. Cochabamba, Bolivia

RESUMEN Introducción: el daño actínico crónico es un grupo de alteraciones en la estructura, función y apariencia de la piel como resultado de la exposición no controlada a las radiaciones ultravioletas. Puede provocar el cáncer de piel. Objetivo: caracterizar a los pacientes con daño actínico crónico, atendidos en la consulta de Dermatología del Hospital Comunitario Valle Hermoso, en el departamento de Cochabamba, Bolivia. Materiales y métodos: se realizó un estudio clínico descriptivo, prospectivo, en un universo de 1 833 pacientes diagnosticados con daño actínico crónico, atendidos en la consulta de Dermatología del Hospital Comunitario Valle Hermoso, en Cochabamba, entre septiembre de 2017 y septiembre de 2018. Se evaluaron las variables edad, sexo, color y fototipo de piel, ocupación, uso de medios de protección solar, exposición a otro tipo de radiaciones, manifestaciones clínicas de fotodaño y altitud del lugar de residencia. Resultados: predominaron el grupo de edad de 25 a 59 años, el sexo femenino, el color de piel mestizo (77,08 %), el fototipo de piel IV (76,98 %) y la ocupación comerciante (72,56 %). La mayoría de los pacientes (82,7 %) no utilizaron medios de protección solar, y el 99,8 % no tuvieron exposición a otro tipo de radiaciones. Las lesiones por fotodaño que prevalecieron fueron melasma (83,03 %) y lentigos (12,22 %). El 99,29 % vivían en zonas de gran altitud. Conclusiones: se caracterizaron los pacientes con daño actínico crónico, obteniendo en algunas variables estudiadas resultados similares a los mencionados por otros investigadores (AU).

ABSTRACT Introduction: chronic actinic damage is a group of alterations in the structure, function, and appearance of the skin as a result of uncontrolled exposure to ultraviolet radiation. It can cause skin cancer. Objective: to characterize the patients with chronic actinic damage, treated at the Dermatology consultation of Valle Hermoso Community Hospital, in the department of Cochabamba, Bolivia. Materials and methods: a descriptive, prospective clinical study was conducted in a universe of 1,833 patients diagnosed with chronic actinic damage, treated at the Dermatology clinic of the Valle Hermoso Community Hospital, Cochabamba, between September 2017 and September 2018. The variables age, sex, skin color, skin phototype, occupation, use of sun protectors, exposure to other types of radiation, clinical manifestations of photodamage and altitude of the place of residence were evaluated. Results: the age group from 25 to 59 years, the female sex, mestizo skin color (77.08 %), the IV skin phototype (76.98 %) and merchant occupation (72.56 %) predominated. Most patients (82.7 %) did not use sun protection means, and 99.8 % had no other radiation exposure. The prevailing photodamage lesions were melasma (83.03 %) and lentigo (12.22 %). 99.29 % lived in high altitude areas. Conclusions: the patients with chronic actinic damage were characterized, obtaining in some variables studied results similar to those mentioned by other researchers (AU).

Protodioscin levels in Brachiaria spp. in a sheep production system and a brief review of the literature of Brachiaria spp. poisoning in ruminants / Níveis de protodioscina em Brachiaria spp. em um sistema de produção de ovinos e uma breve revisão da literatura da intoxicação por Brachiaria spp. em ruminantes

Plants of the genus Brachiaria, used in several countries as forage, are poisonous to some livestock species. Their toxic principle is protodioscin, and the main form of clinical presentation of the toxicosis is hepatogenous photosensitization. Here we compare protodioscin levels in B. decumbens and B. brizantha and review the literature on the concentrations and methodologies of collection and analysis of the toxic principle in Brachiaria spp. and the risk of contamination of pastures by more toxic species that may facilitate poisoning by plants of this genus in sheep. The experiment was conducted in pastures originally formed by B. brizantha, with many B. decumbens invasion points. The occurrence of cases of poisoning by Brachiaria spp. was the criterion for confirming pasture toxicity. The forage samples were collected at ten random points every 28 days through manual grazing simulation. The samples were analyzed for protodioscin by high-performance liquid chromatography (HPLC) with light scattering by evaporation (ELSD) after being dried and crushed. In the flock of 69 sheep, five poisoning cases occurred, three sheep died, and two recovered. The protodioscin levels found in the evaluated pastures ranged from 0.70 to 0.45%; higher levels appeared in B. decumbens (7.09%) compared to 1.04% in B. brizantha. We suggest that Brachiaria spp. should be avoided in pastures where sheep are grazing.(AU)

Plantas do gênero Brachiaria, utilizadas em vários países como forragem, são tóxicas para várias espécies pecuárias. Seu princípio tóxico é a protodioscina, e a principal forma de apresentação clínica da toxicose é a fotossensibilização hepatógena. Este estudo teve como objetivo comparar os níveis de protodioscina em B. decumbens e B. brizantha e revisar a literatura sobre as concentrações e metodologias de coleta e análise do princípio tóxico em Brachiaria spp. e o risco de contaminação das pastagens por espécies mais tóxicas que podem facilitar a intoxicação por plantas desse gênero em ovinos. O experimento foi conduzido em pastagens originalmente formadas por B. brizantha, com diversos pontos de invasão por B. decumbens. Ocorrência de casos de intoxicação por Brachiaria spp. foi o critério para confirmação da toxicidade da pastagem. As amostras de forragem foram coletadas a cada 28 dias em dez pontos aleatórios por meio de simulação de pastejo manual. As amostras foram analisadas para protodioscina por cromatografia líquida de alta eficiência (HPLC) com dispersão de luz por evaporação (ELSD) após serem secadas e trituradas. No rebanho de 69 ovelhas, cinco desenvolveram a intoxicação, três morreram e duas se recuperaram. Os níveis de protodioscina encontrados nas pastagens avaliadas variaram de 0,70 a 0,45%; níveis mais elevados apareceram em B. decumbens (7,09%) em comparação com 1,04% em B. brizantha. Sugerimos que Brachiaria spp. deve ser evitada no pasto de ovelhas em pastejo.(AU)

Prurigo actínico en un centro dermatológico de referencia en Colombia: 108 casos / Actinic prurigo in a dermatological reference center in Colombia: 108 cases

Introducción. El prurigo actínico es una fotodermatosis crónica. Afecta con mayor frecuencia a la población latinoamericana, predomina en mujeres y compromete la piel expuesta al sol, las conjuntivas y los labios. Objetivo. Actualizar la información sobre las características clínico-epidemiológicas y el tratamiento de pacientes con prurigo actínico en Colombia. Materiales y métodos. Se hizo un estudio de corte transversal que incluyó los registros clínicos de pacientes con prurigo actínico atendidos en el Servicio de Fotodermatología del Hospital Universitario Centro Dermatológico Federico Lleras Acosta entre el 2011 y el 2016, y se describieron sus características demográficas, clínicas e histopatológicas, así como su tratamiento. Resultados. Se incluyeron 108 pacientes, el 71,3 % de ellos mujeres y el 28,7% hombres, con predominio de los fototipos III-IV (70 %). La enfermedad se había iniciado durante la primera década de vida en el 66,4% de los casos y el 25 % de los pacientes tenía antecedentes familiares de la enfermedad. Las lesiones predominaban en el rostro (93,5 %), los antebrazos (79,6 %) y el dorso de las manos (70,4 %). También, se documentó compromiso ocular (87,9 %) y de los labios (88,8 %). Se hizo la prueba de fotoprovocación con radiación ultravioleta A en el 25 % de los casos y biopsia cutánea en el 19,4 %. Todos los pacientes se trataron con protección solar química y física. En los casos leves a moderados, se formularon corticoides tópicos (91,7 %) e inhibidores de la calcineurina (65,7 %), y en los graves, talidomida (33,3 %) y pentoxifilina (14,8 %). Conclusión. Las características de los pacientes colombianos con prurigo actínico son similares a las reportadas en otros países latinoamericanos: inicio temprano de la enfermedad, predominio en mujeres, compromiso frecuente de conjuntivas y labios, y adecuada respuesta al tratamiento tópico y sistémico.

Introduction: Actinic prurigo is a chronic photodermatosis. It affects the Latin American population more frequently, predominantly women, and involves the sun-exposed areas of the skin, conjunctiva, and lips. Objective: To update the information on the clinical-epidemiological characteristics and treatment of patients with actinic prurigo in Colombia. Materials and methods: We conducted a cross-sectional study including the medical records of patients with actinic prurigo treated in the Photodermatology Service of Hospital Universitario Centro Dermatológico Federico Lleras Acosta between 2011 and 2016. We described the demographic, clinical, histopathological, and treatment characteristics of the patients. Results: We included 108 patients, 77 (71.3%) were women and 31 (28.7%) men, mainly with phototypes III-IV (70%). The disease had begun during the first decade of life in 66.4% of the cases and 25% of the patients had a family history with the condition. The lesions predominated on the face (93.5%), forearms (79.6%), and back of the hands (70.4%). Ocular (87.9%) and lip (88.8%) involvement was also documented. A photo-provocation test with UVA was performed in 25% of the cases and skin biopsies in 19.4%. Physical and chemical photoprotection was indicated in all patients. Mild to moderate cases were treated with topical corticosteroids (91.7%) and calcineurin inhibitors (65.7%) while severe cases received thalidomide (33.3%) and pentoxifylline (14.8%). Conclusion: The characteristics of actinic prurigo patients in Colombia are similar to those reported in other Latin American countries: early onset of the disease, predominance in women, frequent involvement of conjunctiva and lips, and adequate response to topical and systemic treatment.

Poisoning by Enterolobium contortisiliquum pods in calves showing photosensitization and digestive lesions / [Lesões digestivas e fotossensibilização em bezerros intoxicados pelas favas de Enterolobium contortisiliquum]

Este trabalho descreve um surto de rumenite e abomasite decorrente de sobrecarga de carboidratos em um rebanho de 238 bezerros, com idades entre 12 e 15 meses, causada pela ingestão dos frutos de Enterolobium contortisiliquum. As taxas de morbidade, mortalidade e letalidade foram de, respectivamente, 12,7%, 5,2% e 42,1%. Clinicamente, os bovinos apresentaram fotossensibilização, salivação e diarreia. Os achados de necropsia foram semelhantes nos dois bezerros necropsiados e consistiram de fotodermatite e rumenite ulcerativa multifocal, subaguda a crônica, e abomasite. A relevância deste relato é que, pela primeira vez, foi possível associar a ocorrência da rumenite devido à sobrecarga de carboidratos com a intoxicação espontânea por E. contortisiliquum em bovinos, confirmando achados anteriormente descritos em experimentos realizados com ovinos.(AU)

Dermatitis actínica crónica / Chronic actinic dermatitis

RESUMEN La dermatitis actínica crónica (DAC) - dermatitis por fotosensibilidad, reacción solar persistente o su variante extrema el reticuloide actínico- es una fotodermatosis crónica, propia del adulto más frecuente en el sexo masculino provocada por rayos ultravioletas (UVB), (UVA) y luz visible. El diagnóstico es clínico, caracterizado por placas eccematosas y liquenificadas pruriginosas en aéreas expuestas al sol. Se cree que el DAC se debe a la fotosensibilización secundaria de un antígeno endógeno de la piel.

ABSTRACT Chronic actinic dermatitis (ACD) - photosensitivity dermatitis, persistent solar reaction or its extreme variant actinic reticuloid - is a chronic photodermatosis, typical of the adult male caused by ultraviolet (UVB), (UVA) and visible light. The diagnosis suggested by clinical researchers, characterized by eczematous and lichenified pruritic plaques in areas exposed to the sun. It is believed that DAC is due to the secondary photosensitization of an endogenous skin antigen.

Modern aspects of rosacea therapy

This work is aimed at studying the problems of timely diagnostics and therapy of various forms of rosacea, identifying the factors that influence the compliance, prognosis, and quality of life of the patients, as well as the stages of combination therapy. The efficiency of rosacea therapy is determined by the timely identification of patients, as well as the clinical variety of the disease. Complex therapy of rosacea includes identification of the precipitating factors, basic skincare, and the use of systemic and local pathogenetic preparations. The "Gold Standard" of topical rosacea therapy is the antimicrobial and antiprotozoal drug called metronidazole. An important role in disease therapy is played by active cooperation between the doctor and the patient. Comprehensiveness, timeliness, and rationality of rosacea therapy are defined not only by the mechanisms of the disease development but also by aggravating factors, the need for basic care and photosensitivity of the patients

Incapacitating solar urticaria: successful treatment with omalizumab

Abstract: Solar urticaria is a rare form of physical urticaria mediated by immunoglobulin E. The lesions appear immediately after the sun exposure, interfering with the patient's normal daily life. Omalizumab, a monoclonal anti-IgE antibody, has been recently approved for the treatment of chronic spontaneous urticaria, and the latest reports support its role also in the treatment of solar urticaria. Hereby, we report a case of solar urticaria refractory to conventional treatment strategies, with an excellent response to treatment with omalizumab and phototesting normalization.

Fotoprotección y fotodaño en la niñez y la adolescencia / Photoprotection and photodamage in the childhood and adolescence

Durante las últimas décadas se ha incrementado la incidencia del cáncer de piel, debido fundamentalmente a la exposición a las radiaciones solares, por lo cual es importante la protección desde las edades tempranas. Teniendo en cuenta lo anterior, se realizó una revisión bibliográfica con el objetivo de describir los efectos que estas ocasionan en los seres humanos y las formas de protección adecuadas. Se concluyó que el conocimiento y la implementación de las recomendaciones para la fotoprotección, son necesarias para prevenir los efectos causados por dichas radiaciones.

During the last decades the incidence of the skin cancer has been increased, due fundamentally to the exposure to the sun radiations, reason why it is important the protection since early ages. Keeping this in mind, a literature review was carried out with the objective of describing the effects that they cause in the human beings and the appropriate protection forms. It was concluded that the knowledge and the implementation of the recommendations for photoprotection, are necessary to prevent the effects caused by these radiations.

Fotossensibilização primária em bovinos leiteiros causada por Froelichia humboldtiana / Primary photosensitization in dairy cattle caused by Froelichia humboldtiana

O presente trabalho foi conduzido com o objetivo de relatar um surto de fotossensibilização causado por Froelichia humboldtiana em bovinos leiteiros no Estado do Rio Grande do Norte, Brasil. Foram examinados animais de uma propriedade rural que apresentavam sintomatologia compatível com fotodermatite. Procedeu-se a coleta de amostras de sangue periférico de cinco bovinos para análise das atividades das enzimas hepáticas gamaglutamiltransferase e aspartatoaminotransferase, além da concentração de bilirrubina total, direta e indireta. Das áreas de pele com lesões de dois animais foram realizadas biópsias. Constatou-se que 15 animais de um rebanho composto por 40 animais apresentaram fotossemsibilização. Os animais tinham histórico de apresentar lesões de fotodermatite aproximadamente 10 dias após pastarem em áreas invadidas por F. humboldtiana. Ao exame clínico dos bovinos leiteiros notou-se que inicialmente apresentavam prurido e hiperemia nas áreas de pele despigmentadas do dorso e úbere, também havia alterações do comportamento. Posteriormente, as áreas hiperêmicas se apresentavam com edema que evoluíam para dermatite ulcerativa, necrotizante e exudativa, com perda de extensas áreas da epiderme. As úlceras eram mais graves nos quatro bovinos que apresentavam automutilação por lambedura. Esses quatro animais foram retirados do pasto e abrigados em local sombreado. Uma semana após, o prurido regrediu e as fissuras da pele passaram a cicatrizar. Porém, as lesões reapareceram logo após os bovinos serem reintroduzidas no pasto infestado por F. humbolditiana. Percebeu-se ainda queda na produção leiteira (redução de 50-60%) das vacas após a instalação de fotodermatite. Porém, os bezerros que ainda eram lactantes e ingeriam o leite nas vacas acometidas por fotossensibilização, não apresentaram sinais de fotodermatite. A histopatologia de biópsias de pele revelou inflamação na derme superficial constituída por mastócitos, linfócitos, e alguns plasmócitos. Na epiderme haviam extensas úlceras, recobertas por crostas, associada a infiltrado neutrofílico. As atividades séricas de AST, GGT e as concentrações de bilirrubina estavam dentro dos valores de referência normais para a espécie bovina. O diagnóstico de fotossensibilização primária associada à ingestão de F. humboldtiana foi baseado na epidemiologia, sinais clínicos, bioquímica sérica, biópsia de pele e reocorrência das lesões após os animais serem reintroduzidos no pasto invadido pela planta. Conclui-se que a F. humboldtiana é uma importante causa de fotossensibilização primária em bovinos leiteiros no semiárido brasileiro e que sua toxina provavelmente não é excretada pelo leite bovino.(AU)

The present study was conducted with the objective to report an outbreak of photosensitization caused by Froelichia humboldtiana in dairy cattle in the State of Rio Grande do Norte, Brazil. Animals from a rural property with symptoms compatible with photodermatitis were examined. Peripheral blood samples from five cattle were collected for the analysis of the activities of hepatic enzymes gammaglutamyltransferase and aspartate aminotransferase, in addition were also analysed the concentration of total, direct and indirect bilirubin. From the areas of skin with lesions of two animals, biopsies were performed. It was verified that 15 animals from a herd composed by 40 animals presented photosensitization. The animals had a history of photodermatitis lesions approximately 10 days after grazing in areas invaded by F. humboldtiana. Clinical examination of dairy cattle showed that they initially had pruritus and hyperemia in the depigmented areas of the dorsum and udder, and there were also behavioral changes. Subsequently, the hyperemic areas presented edema that evolved to ulcerative, necrotizing and exudative dermatitis, with loss of extensive areas of the epidermis. The ulcers were more severe in four bovines that had self-mutilation by licking. These four animals were removed from the pasture and sheltered in a shady location. A week later, the pruritus regressed and the fissures of the skin began to heal. However, the lesions reappeared after the cattle were reintroduced in the grass infested by F. humbolditiana. There was also a decrease in milk production (reduction of 50-60%) of cows after the installation of photodermatitis. However, calves that were still lactating and ingested the milk in photosensitized cows, showed no signs of photodermatitis. Histopathology of skin biopsies revealed inflammation in the superficial dermis consisting of mast cells, lymphocytes, and some plasma cells. In the epidermis there were extensive ulcers, covered by crusts, associated with neutrophilic infiltrate. Serum activities of AST, GGT and bilirubin concentrations were within normal reference values for the bovine species. The diagnosis of primary photosensitization associated with F. humboldtiana ingestion was based on epidemiology, clinical signs, serum biochemistry, skin biopsy and lesion reoccurrence after the animals were reintroduced in the pasture invaded by the plant. It is concluded that F. humboldtiana is an important cause of primary photosensitization in dairy cattle in the Brazilian semi-arid region and that its toxin is probably not excreted by bovine milk.(AU)

Do you know this syndrome? Ichthyosis associated with neurological condition and alteration of hairs

Abstract: Trichothiodystrophy refers to a heterogeneous group of rare genetic diseases that affects neuroectodermal-derived tissues with multisystem involvement. The hallmark of these syndromes is the deficiency of sulfur in hair matrix proteins, leading to short and brittle hair. Few cases of this rare disorder have been published. The authors report a case of trichothiodystrophy in a male infant with ichthyosis, photosensitivity, spastic paraparesis, short stature, and neurologic and psychomotor retardation. Diagnosis was based on clinical and microscopic features of hair samples.

Intoxicação espontânea por Brachiaria híbrida cv mulato I em ovinos e caprinos e experimental por Brachiaria híbrida cv mulato II em ovinos / Spontaneous poisoning by Brachiaria hybrid cv. mulato I in goats and sheep and experimental poisoning of Brachiaria hybrid cv. mulato II in sheep

Descreve-se a epidemiologia, sinais clínicos e lesões de uma enfermidade em ovinos e caprinos que cursa com fotossensibilização e morte. A doença espontânea ocorreu no município de Abelardo Luz, SC. De um rebanho de 350 ovinos e 278 caprinos, de corte, mantidos em pastagem de Brachiaria híbrida cv mulato I, adoeceram 27 animais, dos quais, 17 morreram e 10 recuperaram-se após terem sido removidos do local. A enfermidade caracterizou-se por lacrimejamento, hiperemia, edema das faces, das orelhas e das pálpebras seguidas de formação de crostas, corrimento nasal seroso, ulcerações na córnea e esclera e conjuntiva levemente amarelada. Seis ovinos e onze caprinos foram necropsiados na propriedade. As lesões macroscópicas observadas foram fígado de coloração castanha, vesícula biliar com conteúdo aumentado e bile grumosa, rins acastanhados com pontos vermelhos na superfície. Na avaliação microscopia foram observadas no fígado, lesões de intensidade leve a moderada caracterizadas principalmente por tumefação e ou, vacuolização de hepatócitos, megalocitose, fibrose periportal, proliferação biliar, pequenos aglomerados de macrófagos, aleatórios e infiltrado de eosinófilos, neutrófilos e macrófagos na periferia do lóbulo. Na luz de ductos biliares encontravam-se imagens negativas de cristais. Nos rins havia dilatação de túbulos variando de leve a acentuada, contração de tufo glomerular e distensão do espaço de Bowman. Quatro ovinos receberam experimentalmente Brachiaria híbrida cv mulato II ad libitum pelo período de 90 dias e não manifestaram alterações clinicas.(AU)

Described is the epidemiology, clinical signs and lesions of a disease that leads to photosensitization and death in sheep and goats. Spontaneous disease occurred in the municipality of Abelardo Luz, SC. From a flock of 350 sheep and 278 goats grazing Brachiaria hybrid cv. mulato I, 27 animals got sick, which 17 died and 10 recovered after being removed from the pasture. The disease was characterized by tearing, hyperemia, swelling of face, ears and eyelid followed by crusting, serous nasal discharge, ulcers on the cornea and sclera, and conjunctiva slightly yellowish. Six sheep and eleven goats were necropsied on the farm. The macroscopic lesions were brownish liver, distended gallbladder and lumpy bile, brownish kidneys with red dots on surface. Through microscopy was observed mild to moderate lesions in liver mainly characterized by swelling and vacuolation of hepatocytes, megalocytosis, periportal fibrosis, biliary hyperplasia; small clusters of macrophages and infiltration of eosinophils, neutrophils and macrophages were present in the periportal area. Crystal negative images were detected within bile ducts. Kidney tubules were dilated ranging from mild to severe with glomerular tuff contraction and distension of Bowman space. Four sheep experimentally fed Brachiaria hybrid cv. mulato II ad libitum for 90 days showed no clinical changes.(AU)

Risk factors associated with actinic prurigo: a case control study

Abstract: Background: Actinic prurigo (AP) is an idiopathic photodermatosis. Although its initial manifestations can appear in 6 to 8-year-old children, cases are diagnosed later, between the second and fourth decades of life, when the injuries are exacerbated. Objective: To identify risk factors associated with clinical manifestations of AP such as skin and mucosal lesions. Methods: Thirty patients with AP and 60 controls were included in the study, the dependent variable was the presence of skin or labial mucosal lesions, the independent variables were age, sex, solar exposure, living with pets or farm animals, exposure to wood smoke, smoking habit, years smoking, and hours spent per day and per week in contact with people who smoke. Results: Of the 30 diagnosed AP patients, 66.7% were female. Patients age ranged from 7 to 71 years and the mean age was 35.77 ± 14.55 years. We found significant differences with the age and cohabitation with farm animals. Those who lived with farm animals presented 14.31 times higher probability of developing AP (95% CI 3-78.06). Study limitations: This is a case-control study; therefore, a causal relationship cannot be proven, and these results cannot be generalized to every population. Conclusions: The identification of factors related to the development of AP increases our knowledge of its physiopathology. Moreover, identifying antigens that possibly trigger the allergic reaction will have preventive and therapeutic applications in populations at risk of AP.

Llega la primavera y florecen los eritemas polimorfos solares / Spring arrives and with it the polymorphous light eruption

El eritema polimorfo solar es la fotodermatosis más frecuente y suele aparecer en primavera con la primera exposición intensa al sol. Sus manifestaciones cutáneas son variadas y el diagnóstico se basa en la clínica junto al antecedente de exposición solar. En los casos leves, la fotoprotección suele ser suficiente para el control de la enfermedad, pero en formas más graves se requieren otras terapéuticas, como corticoides, antihistamínicos, o fototerapia, que genera una "fotoadaptación" de las áreas de piel afectadas. Presentamos un caso típico de erupción polimorfa solar que respondió de forma adecuada a medidas de fotoprotección. (AU)

The polymorphic solar eruption is the most frequent photodermatosis, and usually appears in spring with the first intense exposure to the sun. It has multiple cutaneous manifestations, and its diagnosis is based on the clinic and the antecedent of solar exposition. In mild cases, photoprotection is usually enough to control the disease, but in more severe forms, other therapies are required, such as corticosteroids, antihistamines, or phototherapy to generate a "photo-adaptation" of the affected skin areas. We present a typical case of polymorphic solar eruption that responded adequately to photoprotection measurements. (AU)

Intoxicação por Senecio brasiliensis em bezerros: padrão e evolução de lesões hepáticas / Senecio brasiliensis poisoning in calves: pattern and evolution of hepatic lesions

Poisoning by Senecio spp. plants are an important cause of death in cattle in the State of Rio Grande do Sul, Brazil. It is estimated that over 50% of deaths caused by toxic plants are due to the ingestion of Senecio spp. The epidemiological, clinical and anatomopathological aspects of a spontaneous outbreak of Senecio brasiliensis in calves are described here. Characterization and evolution of liver lesions during the outbreak are also described. Two hundred and six 4-month-old female calves were weaned and placed in a 25-hectare pasture heavily infested by S. brasiliensis at of varying growth stages. The calves remained in this pasture for three months and were later transferred to another area where six calves aged 7-8- month-old developed clinical signs including unthriftiness, diarrhea, and subcutaneous dependent edema in the submandibular region. All these six affected calves died within 15 days from the onset of clinical signs and one of those was necropsied. Grossly the first of three patterns of hepatic lesions described in this report was observed and it was characterized by an enlarged liver, with round borders and an orange hue to the capsular and cut surfaces. Histologically there was marked diffuse vacuolar hepatocellular degeneration, bilestasis, hepatocellular megalocytosis, and mild bile duct proliferation and periportal fibrosis. Two months after the onset of the outbreak, in another visit to the farm, it was observed that an additional 28 calves got sick and 14 died. Affected calves observed in this second on-site visit were 9-10 month-old and their main clinical sign was photosensitization characterized by varying degrees of photophobia, tearing from the eyes, marked drooling, mucopurulent ocular discharge, increased nasal secretion, and ventral diphtheric glossitis. Two of the fourteen calves that died were necropsied and displayed the second pattern of hepatic lesions observed in the outbreak. [...]

Intoxicações por plantas do gênero Senecio representam uma importante causa de morte em bovinos no Rio Grande do Sul e estima-se que mais de 50% das mortes causadas por plantas tóxicas devem-se à intoxicação por Senecio spp. Nesse trabalho, são descritos os aspectos epidemiológicos, clínicos e anatomopatológicos de um surto de intoxicação natural por Senecio brasiliensis em bezerros e a caracterização e evolução das lesões hepáticas durante o surto. Um lote com 206 bovinos, fêmeas, sem raça definida, foi desmamado com aproximadamente quatro meses de idade e soltos em campo nativo com 25 hectares, contendo grande quantidade de Senecio brasiliensis em diferentes estágios. Os bovinos permaneceram nesse campo durante três meses e posteriormente foram transferidos para outra área. Na nova área, seis bezerras, com idades entre sete a oito meses, começaram a apresentar sinais clínicos de emagrecimento, fraqueza, diarreia e edema subcutâneo de declive na região submandibular. Os seis bovinos morreram em um período de 15 dias e um deles foi necropsiado. Macroscopicamente, foi visualizado o primeiro dos três padrões distintos de lesão hepática dos bovinos desse surto, que se caracterizava por um fígado aumentado de tamanho, com os bordos arredondados e com superfície capsular e de corte alaranjada. Histologicamente havia acentuada degeneração vacuolar hepatocelular difusa, bilestase, megalocitose e leve proliferação de ductos biliares e fibrose periportal. Dois meses após o início do surto, constatou-se que em um período de 20 dias adoeceram mais 28 bezerras e, dessas, 14 morreram. Os bovinos acometidos nessa segunda visita tinham idades entre nove a 10 meses. O principal sinal clínico observado foi fotossensibilização, e incluía graus variados de fotofobia, lacrimejamento, salivação excessiva, descarga ocular mucopurulenta, secreção nasal e glossite diftérica ventral.[...]

Intoxicação por Senecio brasiliensis em bezerros: padrão e evolução de lesões hepáticas / Senecio brasiliensis poisoning in calves: pattern and evolution of hepatic lesions

Intoxicações por plantas do gênero Senecio representam uma importante causa de morte em bovinos no Rio Grande do Sul e estima-se que mais de 50% das mortes causadas por plantas tóxicas devem-se à intoxicação por Senecio spp. Nesse trabalho, são descritos os aspectos epidemiológicos, clínicos e anatomopatológicos de um surto de intoxicação natural por Senecio brasiliensis em bezerros e a caracterização e evolução das lesões hepáticas durante o surto. Um lote com 206 bovinos, fêmeas, sem raça definida, foi desmamado com aproximadamente quatro meses de idade e soltos em campo nativo com 25 hectares, contendo grande quantidade de Senecio brasiliensis em diferentes estágios. Os bovinos permaneceram nesse campo durante três meses e posteriormente foram transferidos para outra área. Na nova área, seis bezerras, com idades entre sete a oito meses, começaram a apresentar sinais clínicos de emagrecimento, fraqueza, diarreia e edema subcutâneo de declive na região submandibular. Os seis bovinos morreram em um período de 15 dias e um deles foi necropsiado. Macroscopicamente, foi visualizado o primeiro dos três padrões distintos de lesão hepática dos bovinos desse surto, que se caracterizava por um fígado aumentado de tamanho, com os bordos arredondados e com superfície capsular e de corte alaranjada. Histologicamente havia acentuada degeneração vacuolar hepatocelular difusa, bilestase, megalocitose e leve proliferação de ductos biliares e fibrose periportal. Dois meses após o início do surto, constatou-se que em um período de 20 dias adoeceram mais 28 bezerras e, dessas, 14 morreram. Os bovinos acometidos nessa segunda visita tinham idades entre nove a 10 meses. O principal sinal clínico observado foi fotossensibilização, e incluía graus variados de fotofobia, lacrimejamento, salivação excessiva, descarga ocular mucopurulenta, secreção nasal e glossite diftérica ventral. Das 14 bezerras mortas, realizou-se a necropsia de duas delas, sendo visualizado o segundo padrão de lesão hepática nesse surto (Padrão 2). Os fígados estavam com a superfície capsular lisa e esbranquiçada e moderadamente diminuídos de tamanho. Ao corte observou-se leve irregularidade do parênquima e áreas mais claras intercaladas com áreas avermelhadas. O aspecto histológico incluía acentuada fibrose periportal, marcada proliferação de ductos biliares, megalocitose, áreas multifocais de necrose de hepatócitos, hemorragia e lesões veno-oclusivas. A atividade sérica da GGT foi avaliada em 15 bovinos afetados nessa segunda visita à propriedade. Desses, 13 bezerras testadas apresentaram alterações nos valores, que variaram de 26-175 U/L. Em uma terceira visita à propriedade, sete meses após o início do surto, mais 27 bezerras adoeceram em um período de 40 dias e, dessas, 23 morreram, sendo três submetidas à necropsia. Evidenciou-se o terceiro padrão de lesão hepática. O fígado dos três bovinos estava diminuído de tamanho e acentuadamente firme. A superfície capsular era lisa e esbranquiçada, e a superfície de corte apresentava-se difusamente acastanhada. Lesões histológicas semelhantes ao segundo padrão foram também constatadas no fígado dessas três bezerras. Na quarta visita à propriedade, realizaram-se biópsias hepáticas nos 163 bovinos restantes do lote. Lesões hepáticas características da intoxicação estavam presentes em 103 dos 163 bovinos submetidos à biopsia hepática. Os bovinos afetados foram classificados em grupos de acordo com a severidade e os aspectos morfológicos observados. O diagnóstico de intoxicação nos bovinos desse estudo baseou-se nos achados epidemiológicos, clínicos e anatomopatológicos, associados ao histórico do consumo da planta e evolução das lesões.(AU)

Poisoning by Senecio spp. plants are an important cause of death in cattle in the State of Rio Grande do Sul, Brazil. It is estimated that over 50% of deaths caused by toxic plants are due to the ingestion of Senecio spp. The epidemiological, clinical and anatomopathological aspects of a spontaneous outbreak of Senecio brasiliensis in calves are described here. Characterization and evolution of liver lesions during the outbreak are also described. Two hundred and six 4-month-old female calves were weaned and placed in a 25-hectare pasture heavily infested by S. brasiliensis at of varying growth stages. The calves remained in this pasture for three months and were later transferred to another area where six calves aged 7-8- month-old developed clinical signs including unthriftiness, diarrhea, and subcutaneous dependent edema in the submandibular region. All these six affected calves died within 15 days from the onset of clinical signs and one of those was necropsied. Grossly the first of three patterns of hepatic lesions described in this report was observed and it was characterized by an enlarged liver, with round borders and an orange hue to the capsular and cut surfaces. Histologically there was marked diffuse vacuolar hepatocellular degeneration, bilestasis, hepatocellular megalocytosis, and mild bile duct proliferation and periportal fibrosis. Two months after the onset of the outbreak, in another visit to the farm, it was observed that an additional 28 calves got sick and 14 died. Affected calves observed in this second on-site visit were 9-10 month-old and their main clinical sign was photosensitization characterized by varying degrees of photophobia, tearing from the eyes, marked drooling, mucopurulent ocular discharge, increased nasal secretion, and ventral diphtheric glossitis. Two of the fourteen calves that died were necropsied and displayed the second pattern of hepatic lesions observed in the outbreak. Liver had smooth and whitish capsular surfaces and a moderate decrease in size. There was moderate irregularity to the cut surface of hepatic parenchyma and pale areas intercalated with red ones. Histologically there was marked periportal fibrosis, marked bile duct proliferation, hepatocellular megalocytosis, focal areas of hepatocellular necrosis, and hemorrhage and veno-occlusive changes. In this second on-site visit, GGT serum activity was determined in 15 affected calves and 13 of them had increased values (26-175 U/L). Seven months after the onset of the outbreak, a third visit was made to the farm when was learned that and additional 27 calves have been affected, 23 of which died within a period of 40 days. At the necropsy of three of these calves the third pattern of hepatic lesions were observed. The liver was decreased in size and markedly firm. The capsular surface was smooth and whitish and the capsular surface was diffusely tan. Histological lesions similar to those observed in the second pattern were seen in in the liver of these three calves. A fourth on-site visit to the farm was made and a liver biopsy was performed in each of the 163 calves remaining in the herd and hepatic lesions characteristic of Senecio poisoning were observed in the liver biopsy of 103 of them. Affected calves were classified in groups according to the severity and morphologic aspects of the observed hepatic lesions. The diagnosis of Senecio poisoning in calves of this study was based on epidemiology, clinical and anatomopathological findings associated with the history of consumption of the plant, and on the chronological development of the lesions.(AU)

Experimental poisoning by Enterolobium contortisiliquum in sheep / Intoxicação experimental por Enterolobium contortisiliquum em ovinos

Ingestion of Enterolobium contortisiliquum pods causes digestive disturbances, secondary hepatogenous photosensitization and abortions in ruminants. Pods were administered to sheep via a ruminal cannula to characterize acute poisoning. In Experiment 1, a single dose of 12g/kg of body weight (BW) was administered to three sheep in one experiment. One sheep died, and the other two recovered after presenting clinical signs. In Experiment 2, 10g/kg BW were administered daily to 15 sheep until the onset of clinical signs or for three consecutive days. Fourteen sheep showed mild to severe signs after the ingestion of 1-3 doses. Two sheep died, and the others recovered. Clinical signs in both experiments were diarrhea, anorexia, rumen atony, apathy, dehydration and tachypnea. The main macroscopic findings were an orange, frothy ruminal content witch contained pods fragments. The intestinal content was liquid. Detachment of the mucosa from the submucosa and ballooning degeneration of mucosal cells were observed histologically in the forestomachs. Evaluation of ruminal contents revealed acute lactic ruminal acidosis (ALRA). Bromatological analysis of E. contortisiliquum pods revealed 537.8g/kg DM (dry matter) of non-fibrous carbohydrates, which is sufficient to cause ALRA. Only one sheep in Experiment 2 had liver failure, characterized by jaundice, elevated serum activity of liver enzymes and histological lesions in liver biopsies. It is concluded that the administration of E. contortisiliquum pods in forage-fed sheep at doses of 10g/kg BW or higher may cause ALRA. The induction of liver failure in one sheep suggests that liver damage may occur in those sheep that do not develop acidosis.(AU)

A ingestão das favas de Enterolobium contortisiliquum causa distúrbios digestivos, fotossensibilização hepatógena e abortos em ruminantes. Para caracterizar a intoxicação aguda, favas de E. contortisiliquum foram administradas a ovinos por meio de cânula ruminal. No Experimento 1, uma dose única de 12g/kg de peso corporal (pc) foi administrada a três ovinos. Um dos ovinos morreu e os outros dois se recuperaram após mostrar sinais clínicos. No experimento 2, 10g/kg/pc foram administradas diariamente a 15 ovinos, por três dias consecutivos ou até o parecimento dos sinais clínicos. Catorze ovinos mostraram sinais clínicos leves a acentuados após ingestão de 1-3 doses. Dois ovinos morreram e os outros se recuperaram. Observou-se nos ovinos dos experimentos 1 e 2, diarreia, anorexia, atonia ruminal, apatia, desidratação e taquipneia. Os principais achados macroscópicos incluíram conteúdo ruminal espumoso e alaranjado em meio ao qual se observavam fragmentos das favas de E. contortisiliquum, e conteúdo intestinal líquido. Histologicamente, havia degeneração balonosa e desprendimento do epitélio de revestimento dos pré-estomagos. A avaliação do conteúdo ruminal revelou acidose ruminal láctica aguda (ARLA). Análise bromatológica das favas de E. contortisiliquum revelou 537.8g/kg de matéria seca de carboidratos não fibrosos, quantidade suficiente para causar ARLA. Um ovino do Experimento 2 teve insuficiência hepática aguda, caracterizada por icterícia, elevação da atividade sérica das enzimas hepáticas e alterações histológicas observadas em biópsia hepática. Concluiu-se que a administração de favas de E. contortisiliquum na alimentação de ovinos, nas doses de 10g/kg pc ou maiores, pode causar ARLA. A ocorrência de insuficiência hepática num dos ovinos deste experimento sugere que a lesão hepática pode se desenvolver em ovinos que não apresentam ARLA.(AU)

Queilitis actínica: aspectos histológicos, clínicos y epidemiológicos / Actinic cheilitis: histological, clinical and epidemiological characteristics

Introducción: la destrucción de la capa de ozono ha provocado un aumento en la incidencia de lesiones de la piel, a la que se suma la queilitis actínica. Objetivo: describir los aspectos histológicos, clínicos y epidemiológicos de la queilitis actínica a partir de la literatura reciente. Métodos: se revisaron las bases electrónicas PubMed, SciELO y Google Scholar con los términos claves en inglés y español: queilitis, queratosis, actínica, solar. Se incluyeron artículos originales, de revisión, reportes de casos, tesis y libros de la especialidad publicados preferentemente en el período 2005-2014. Resultados: La queilitis actínica es un trastorno potencialmente maligno inducido por la exposición solar y caracterizado por alteraciones micro y macroestructurales del labio. Factores de riesgo que interaccionan con la exposición solar son el fototipo (piel clara), hábito tabáquico, sexo (hombres), edad y ocupación (aire libre). Entre las alteraciones histológicas se encuentran la displasia epitelial y la elastosis solar; sin embargo, la severidad de estas no correlacionan con la gravedad clínica. Los pacientes con queilitis actínica presentan alteraciones de color, descamación, ulceraciones, difuminación del bermellón, entre otras. En muchas ocasiones la consulta y el diagnóstico son tardíos; se realizan cuando el cuadro ha evolucionado a cáncer. El diagnóstico es principalmente clínico, sumado a la biopsia de las lesiones con presentaciones moderadas y severas. Actualmente la terapia incluye métodos quirúrgicos y farmacológicos, y métodos innovadores como la fototerapia. Sin duda, la estrategia de prevención más importante es aumentar el uso de protectores solares, especialmente en la población de alto riesgo ocupacional. Conclusiones: la queilitis actínica es una patología relevante para los países sudamericanos, debido a que los factores de riesgo están presentes diariamente en las actividades de millones de trabajadores de nuestra región, por eso es necesario potenciar la investigación que permita mejorar la prevención, tratamiento y rehabilitación de esta patología(AU)

Introduction: depletion of the ozone layer has brought about an increase in the incidence of skin lesions, including actinic cheilitis. Objective: describe the histological, clinical and epidemiological characteristics of actinic cheilitis based on a review of recent literature. Methods: a search was conducted in the databases PubMed, SciELO and Google Scholar using the descriptors cheilitis, keratosis, actinic, solar, and their counterparts in Spanish. The search included original papers, review papers, case reports, theses and books about the specialty preferably published from 2005 to 2014. Results: actinic cheilitis is a potentially malignant condition induced by sun exposure and characterized by micro- and macrostructural alterations of the lip. The risk factors interacting with sun exposure are the skin phototype (light skin), smoking, gender (male), age and occupation (outdoor jobs). Histological alterations include epithelial dysplasia and solar elastosis, though their severity does not correlate with the degree of clinical seriousness. Patients with actinic cheilitis present color alterations, desquamation, ulceration and blurring of the vermillion border, among other signs and symptoms. On many occasions patients do not seek care during the early stages of the disease. As a result, diagnosis is made when the condition has already evolved into cancer. The diagnosis is basically clinic, with the support of the biopsy of lesions with moderate to severe characteristics. Current therapy includes surgery and medication, as well as innovative techniques like phototherapy. The most important strategy is no doubt the use of sunscreens, especially by the population at high occupational risk. Conclusions: actinic cheilitis is a condition relevant to South American countries, since its risk factors are present in the daily activities of millions of workers from our region. It is therefore necessary to foster research aimed at improving its prevention, treatment and rehabilitation(AU)

Infections and systemic lupus erythematosus / Infecções e lúpus eritematoso sistêmico

ABSTRACT Objective To determine the incidence of infections in a population of systemic lupus erythematosus individuals and the characteristics of infections regarding original site, as well as to study the possible associations between infections and treatment. Methods An analytical retrospective study using data from medical charts of systemic lupus erythematosus patients from a single university hospital. A total of 144 patients followed up for five years were included. Data collected comprised age of patients and age at onset of lupus, sex and ethnicity, disease duration before the study period, medications, cumulative dose of prednisone, occurrence of infections and their original site. Results The most frequent infections were urinary tract infections (correlated to use of prednisone − p<0.0001 and cyclophosphamide − p=0.045), upper airways infections (correlated to use of prednisone − p=0.0004, mycophenolate mofetil − p=0.0005, and cyclosporine − p=0.025), and pneumonia (associated to prednisone − p=0.017). Conclusion Prednisone was the drug more often associated with presence of infections, pointing to the need for a more judicious management of this drug.

RESUMO Objetivo Determinar a incidência de infecções em uma população com lúpus eritematoso sistêmico e a caracterização das mesmas quanto aos locais de origem, assim como estudar possíveis associações das infecções com a terapêutica utilizada. Métodos Estudo retrospectivo analítico utilizando dados de prontuários de indivíduos com lúpus eritematoso sistêmico de um único hospital universitário. Foram investigados 144 pacientes acompanhados pelo período de 5 anos. Os dados coletados incluíam idade do paciente e idade de início do lúpus, sexo e etnia, tempo de duração da doença antes do período do estudo, medicamentos administrados, dose cumulativa de prednisona, ocorrência de infecções e seu local de origem. Resultados As infecções mais observadas foram as do trato urinário (correlacionadas com o uso de prednisona − p<0,0001, e ciclofosfamida − p=0,045), infecções das vias aéreas superiores (correlacionadas com o uso de prednisona − p=0,0004, micofenolato de mofetila − p=0,0005 e ciclosporina − p=0,025) e pneumonia (correlacionadas ao uso de prednisona − p=0,017). Conclusão A prednisona foi o medicamento mais associado com a presença de infecções, apontando para a necessidade de um manejo mais judicioso desse medicamento.