Topical treatment of oral lichen planus with anthocyanins.

BACKGROUND: Oxidative stress is involved in oral lichen planus (OLP) pathogenesis; meanwhile anthocyanins are natural antioxidants present in grapes skin. OBJECTIVES: The aim of this research was to verify the utility of anthocyanins, extracted from grapes skin, for the local treatment of oral lichen planus and to compare it with clobetasol propionate- neomycin -nystatin cream (CP-NN). STUDY DESIGN: Prospective, non-randomized study, with control group. Fifty-two patients with OLP were included. We divided patients into two categories: erosive oral lichen planus (EOLP) and non erosive oral lichen planus (NEOLP). 38 had EOLP (17 cases and 21 controls) and 14 presented NEOLP types (9 cases and 5 controls).Cases received local treatment with anthocyanins from grapes and controls, were treated with CP-NN. The clinical evolution of patients was followed up during six months. RESULTS: The patients had a therapeutic response with anthocyanins. This was better than CP-NN treatment for patients with EOLP, in improving the involvement score of the oral mucosa and in the morphometric study of the affected areas. In EOLP there were no statistically significant differences in: therapeutic response time, the evolution of pain, or the relapse rate between the two groups. With respect to the treatment of NEOLP there was improved pain relief in the group treated with anthocyanins. This was not observed with CP-NN. The resting analized variables showed no significant difference with both treatments. CONCLUSIONS: OLP has a favorable response to local treatment with anthocyanins from grapes. We found an equal to or better response than with CP-NN treatment. Many of our patients have systemic diseases, which may contraindicate the use of steroids. With regard to this particular group, the use of this natural antioxidant present in the diet is considered advantageous.

Determination of cytokeratins 1, 13 and 14 in oral lichen planus.

UNLABELLED: INTRODUCCION: Cytokeratins (CK) are molecules of the cytoskeleton that contribute to the cellular differenciation. We studied the expression of CK1, CK13 and CK14 in thirty-three patients with OLP. The biopsied lesions were located in the dorsal surface of the tongue, the palatal keratinized mucosa and the nonkeratinized buccal mucosa. OBJECTIVES: This study aimed to determine the expression of CK1, CK13 and CK14 in oral lichen planus (OLP) and its relations with: clinical patterns, prognosis, drugs and tobacco intake and histopathological features. STUDY DESIGN: Immunohistochemical analysis, retrospective, descriptive, observational and no randomized study. RESULTS: No significant difference was observed in the expression of CK1 in patients with or without drug treatment. No association was found with the amount of drugs intake or smoking nor with the histopathological features examined. Samples immunostained with CK13 were all positive in the suprabasal layers, and 13 of them in the basal layer. In these last ones, statistical analysis showed significance in the grade of vacuolization of the basal layer (p=0.023) and in the degree of exocytosis (p=0.0025), this, making the degree of affection higher for both parameters. Thirty-two tissue sections were immunostained with CK14. CK14 was expressed in the basal layer in 97% of samples and in the suprabasal layer in 94% of samples. CONCLUSIONS: The three CK were altered in OLP. CK1 does not have a direct connection with the presence of orthokeratosis. The finding of the CK13 in the basal layer is related to the agression of the lymphocytic infiltration in the epithelium, due to the basal stratum vacuolization and the increase in lymphocytic exocitosis. The presence of CK14 in the suprabasal stratums is not a parameter to predict malignancy. The CK in OLP do not follow the normal pattern of keratinized or non-keratinized mucosa.

Manifestaciones cutáneas de la diabetes mellitus y su importancia clínica / Cutaneous manifestations of diabetes mellitus: clinical meaning

Antecedentes. La diabetes mellitus como enfermedad crónica se asocia a múltiples complicaciones. Varios órganos se ven afectados; entre ellos, con diversas manifestaciones, la piel. Objetivo. Determinar el tipo de lesiones cutáneas presentes en pacientes diabéticos, analizar su frecuencia de presentación y su correlato con otras complicaciones sistemáticas y realizar un análisis estadístico comparativo entre pacientes con y sin dermopatía diabética (DD). Métodos. Se incluyeron 125 pacientes internados en el Servicio de Clínica Médica de nuestro hospital en un período de 6 meses. Diseño. Estudio protocolizado, descriptivo, transversal y observacional. Medidas de tendencia central, x2, test de Student. Criterio de significación: error alfa menor de 5%. Resultados. El 88% presentó DM tipo 2.Sexo femenino: 57%.Edad media: 58,9 años. En 88 pacientes existió alguna complicación crónica de esta enfermedad: 35% DD, 32% nefropatía, 26% retinopatía, 41% neuropatía y el 15% macroangiopatía. El número de patologías cutáneas promedio por paciente fue de 4,4. Tuvieron lesiones cutáneas el 90,4% de los pacientes y las más frecuentes fueron xerodermia (69%), dermatofitosis (52,8%), hipotriquia periférica (39%), DD (35%). Mediante el análisis comparativo entre pacientes con y sin DD se detectó como más frecuente en los primeros (p<0,05): sexo masculino, edad mayor de 50 años, presencia de retinopatía diabética, neuropatía sensitiva, macroangiopatía, pie diabético y tiña pedis. Conclusiones. Las lesiones cutáneas más encontradas en pacientes diabéticos fueron xerodermia, tiña pedis, onicomicosis, hipotriquia periférica y DD. Al detectar asociación estadísticamente significativa entre DD y otras complicaciones sistémicas de la enfermedad, proponemos utilizar esta manifestación cutánea como marcador de complicaciones internas.

Background. Diabetes mellitus as a chronic disease it is associated tomultiple complications. As other organs, skin is aff ected showing diff erentmanifestations.Objetive. The aim of this study was to determinate the diff erent types ofskin lesions in diabetes mellitus and to analyze their prevalence and theirclinical correlation with other systemic complications of this disease. Finally,to make a comparative statistical study between patients with andwithout diabetic dermopathy (DD).Methods. We included 125 diabetics in a six month period. They wereonly Internal Medicine Department’s in-patients.Design. We made a protocoled, transversal, descriptive and observablestudy.Results. The 88% had type 2 diabetes mellitus. 57% were female andthe mean age was 58.9 years.Eighty-eight patients had DM chronic complications: 35% DD, 32%nephropathy, 26% retinopathy, 41% neuropathy and 15% macroangiopathy.The average of cutaneous lesions per patient was 4,4. The90.4% had cutaneous manifestations, being the most frequent: xeroderma(69%), dermatophytosis (52.8%), peripheral hypotrichia (39%),DD (35%).After doing a comparative analyze between patients with and withoutDD, we found, in the fi rst group more frequently (p<0,05) the followingsvariants: male sex, over 50 years old, retinopathy, sensitive neuropathy,macroangiopathy, diabetic foot and tinea pedis.Conclusions. The cutaneous lesions more frequently found in diabeticpatients were xeroderma, tinea pedis, onychomycosis, peripheral hypotrichiaand DD.As we found a statistic signifi cant association between DD and some systemiccomplications of DM, we propose to use this cutaneous sign as amarker of internal complications (Dermatol Argent 2010;16(2):117-121).

[Clinical significance of persistent or recurrent fever during the treatment of infective endocarditis]. / Significado de la fiebre persistente o recurrente durante el tratamiento de la endocarditis infecciosa.

Patients with infective endocarditis (IE) were studied to assess incidence, clinical features and mortality in a population with either persistent (PF) or recurrent fever (RF) during treatment. A sample of 81 patients was evaluated. Of these, 46 patients (56.8%) had fever during treatment: 35 had PF and 16 had RF (Group 1). This group was compared with 35 patients with IE without fever (Group 2). Age, sex, in-hospital days, nosocomial acquisition, delay in diagnosis, and co-morbidities were similar among each group. The aortic and tricuspid valve compromise, and Staphylococcus aureus as etiologic agent were more frequent in Group 1 (although not significantly). However, the development of complications (95.6 vs. 65.7%), renal dysfunction (58.6 vs. 31.4%), major vessel embolization (60.8 vs. 34%), microvascular phenomena (43.4 vs. 17.1%), infections with MRSA (22.2 vs. 4%) and valvular surgery (34.7 vs. 11.4%) were significantly higher in Group 1 (p<0.05). The most common causes of PF were microvascular phenomena (14/32 patients), systemic and pulmonary embolization (10), valvular abscesses (5), persistent bacteremia (4) and mycotic aneurysm (2). On the other hand, phlebitis (6/16), drug hypersensitivity (3) and nosocomial infections (3) were related with RF. The overall mortality was 39.5%, distributed as follows: 52.2% of Group 1 and in 22.9% of Group 2 (p=0.007). The presence of comorbidities, major vessel embolization, heart failure, MRSA infection and inappropriate initial antibiotic therapy were significantly associated with the increased mortality in Group 1 (p<0.05). We propose an evaluation method during the treatment of patients affected by this type of fever.

Significado de la fiebre persistente o recurrente durante el tratamiento de la endocarditis infecciosa / Clinical significance of persistent or recurrent fever during the treatment of infective endocarditis

Se evaluaron 81 pacientes con endocarditis infecciosa con el objeto de establecer la significación clínica de la presencia de fiebre persistente (FP) y/o fiebre ecurrente (FR) durante el tratamiento. Un total de 46 pacientes (56.8%) (Grupo 1) tuvieron FP y/o FR durante el tratamiento: 35 FP y 16 FR, que se compararon con 35 sin FP/FR (Grupo 2). No hubo diferencias en la edad, sexo, permanencia hospitalaria, origen nosocomial, demora diagnóstica y comorbilidad asociada. El compromiso aórtico (47.8 vs 34.2%) y tricuspídeo (21.7 vs 11.4%) y la infección por Staphylococcus aureus (55.5 vs 28%) fueron más frecuentes en el Grupo 1, aunque no significativamente. El S. aureus meticilino resistente (SAMR) (22.2 vs 4%), las complicaciones (95.6 vs 65.7%), la disfunción renal (58.6 vs 31.4%), el embolismo mayor (60.8 vs 34%), los fenómenos microvasculares (43.4 vs 17.1%) y la cirugía valvular (34.7 vs 11.4%) ocurrieron significativamente en el Grupo 1 (p<0.05). Se estableció una causa de FP en 32/35 pacientes: fenómenos microvasculares (14 pacientes), embolismo mayor (10), abscesos valvulares (5), bacteriemia persistente (4) y aneurismas micóticos (2). La flebitis de infusión (6/16pacientes), fiebre medicamentosa (3) e infección nosocomial (3) fueron las causas más comunes de FR. La mortalidad global fue del 39.5% y ocurrió en 52.2% del Grupo 1 y 22.9% del Grupo 2 (p=0.007) y en el grupo 1 seasoció a comorbilidad, embolismo mayor, sepsis severa, encefalopatía, insuficiencia cardíaca, infección por SAMRy antibioticoterapia inicial inapropiada (p<0.05). Se propone una metodología de evaluación en pacientes con esta problemática.

Rabdomiolisis asociada a infeccion gonococcica diseminada en una anciana / Rhabdomyolisis associated to disseminated gonococcal infection in an elderly woman

El síndrome de infección Gonocóccica Diseminada (IGD) es muy infrecuente en pacientes de edad avanzada y su asociación a Rabdomiólisis (RML) no ha sido publicada, por lo cual presentamos un caso de RML secundario a IGD en una mujer geronte. Se presume que el daño muscular en este caso estuvo relacionado directamente con la infección gonocóccica a través de la liberación de endotoxinas y mediadores celulares del sistema mononuclear-fagocítico y/o con la injuria isquémica secundaria al cuadro de severa hipoperfusión tisular. Sugerimos que la infección gonocóccica se agregue a las causas infecciosas de RML y que se incluya en el diagnóstico diferencial inicial de todo paciente que se presente con poliartritis y RML.