Practical management of acne for clinicians: An international consensus from the Global Alliance to Improve Outcomes in Acne.

Scientific advances are continually improving the knowledge of acne and contributing to the refinement of treatment options; it is important for clinicians to regularly update their practice patterns to reflect current standards. The Global Alliance to Improve Outcomes in Acne is an international group of dermatologists with an interest in acne research and education that has been meeting regularly since 2001. As a group, we have continuously evaluated the literature on acne. This supplement focuses on providing relevant clinical guidance to health care practitioners managing patients with acne, with an emphasis on areas where the evidence base may be sparse or need interpretation for daily practice.

Aflatoxins Contamination in Maize Products from Rural Communities in San Luis Potosi, Mexico.

BACKGROUND: Aflatoxins are a group of mycotoxins that have been associated with hepatic damage and cancer. Aflatoxins B1 and B2 are secondary metabolites produced by fungi Aspergillus. These toxins can be found in a variety of commodities, especially in maize, and have been studied around the world due to their effects in human health. The Latin American population is especially exposed to aflatoxins given that maize products can be found in traditional diets all over the continent. Interestingly, in Mexico, chronic hepatic diseases and cirrhosis are leading causes of death in adult population. METHODS: In order to observe the effect of physical variables like temperature and humidity, this study was conducted collecting samples in four different seasons, in two communities in the State of San Luis Potosi, in Mexico. The content of aflatoxins in tortillas was measured using immunoaffinity columns prior to HPLC-FLD analysis. FINDINGS: Results showed that 18% of samples exceeded the Mexican limits for AFB1; whereas, 26% of the samples exceeded the limits of the European Union for AFB1. The AFB1 was detected in 80% of samples in one site and higher concentrations were found in samples collected during fall and winter seasons. CONCLUSIONS: Lack of control in storing practices is the principal cause for the contamination of maize. Considering that maize products are part of the staple diet of Mexican population, our results show that AFB1 detection has to be declared a public health priority. Detection and prevention of aflatoxins through a surveillance program, may avoid chronic health effects.

Epidemiology of rosacea in Colombia.

BACKGROUND: Prevalence of rosacea has been estimated around the world in the range of 0-22%. In Colombia, the prevalence of rosacea remains unknown. The aim of this study was to determine the prevalence of rosacea and the frequencies of its subtypes in Colombia. METHODS: This cross-sectional, multicenter study was conducted in six outpatient dermatology clinics across Colombia. A total of 33 dermatologists conducted a comprehensive medical history and physical examination for all rosacea patients seen at their offices over the course of 2 months. All patients who accepted to participate were encouraged to answer a survey about the history of their illness. RESULTS: Of 10,204 outpatients evaluated for rosacea between July and August 2014, 291 rosacea patients were included in this study. The prevalence of rosacea subtypes in this cohort was: 45.3% erythematotelangiectatic (ETR) (n = 132), 48.7% papulopustular (PPR) (n = 142), 4.8% phymatous (n = 14), and 1% ocular (n = 3). CONCLUSIONS: Overall, the prevalence in Colombia was 2.85%. Our data represent an important first step to understanding the current state of rosacea in Colombia. The prevalence of rosacea in Colombia is the highest in Latin America among a few reports published, which might be explained by geographic features. However, contrary to our expectations, the prevalence is lower than that in some European countries. We postulate that this finding may be due to methodological differences.

Stage progression and need for renal replacement therapy in a renal protection programme in Colombia. A cohort study. / Progreso de estadio y requerimiento de terapia de reemplazo renal en un programa de protección renal en Colombia. Estudio de cohorte.

BACKGROUND: Due to the global burden represented by chronic kidney disease (CKD), the World Health Organization encouraged the implementation of renal protection programmes (RPP) to affect its incidence through prevention and control measures. OBJECTIVES: To assess the effectiveness of a Colombian RPP in terms of its effect on the stage progression of CKD and the need for renal replacement therapy (RRT). METHODS: An analytical study that monitored 2cohorts of patients diagnosed with CKD. The study compares the behaviour of clinical and renal impairment indicators from patients exposed to a RPP with that of patients following conventional treatment (CT). The population of both intervention groups was considered when determining the sample size. The incidence rate was calculated as well as patient survival (Kaplan Meier). In addition, a multivariate analysis (Cox) was used to calculate the influence that exposure to the RPP had on the outcomes of the patients following the RPP and those following CT. RESULTS: The patients exposed to the RPP took longer to advance to the next CKD stage and require RRT. The incidence rate for progression is higher for the patients following CT (0.050, IC 95%: 0.040-0.064) compared to those in the RPP (0.034, IC 95%: 0.030-0.039). The ratio of incidence rates was 1.480 (IC 95% 1.21-1.90). The hazard of progression was lower for the RPP (HR: 0.855, IC 95%: 0.74- 0.98), as was the hazard of requiring RRT (HR: 0.797, IC 95%: 0.606-1.049). CONCLUSIONS: The RPP is a secondary prevention strategy against CKD which has an effect on the stage progression of CKD and the need for RRT. Early patient detection has a positive effect on the outcomes studied.

Acute effects of tianeptine on circulating neurotransmitters and cardiovascular parameters.

Tianeptine is a serotonin-uptake enhancer drug whose antidepressant effectiveness is based on its ability to reduce rather than increase serotonin availability at the synaptic cleft. This paradoxical neuropharmacological mechanism has raised doubt among neuropharmacologists and psychiatrists as to the role of tianeptine as a trusty-reliable antidepressant drug. This controversial issue led us to investigate the acute effects of a single, oral dose (12.5 mg) of this drug on circulating neurotransmitters and cardiovascular parameters in 50 healthy subjects. The drug provoked a striking and significant reduction of plasma noradrenaline (NA) and plasma serotonin (f-5-HT) while it increased plasma dopamine (DA) and platelet serotonin (p-5-HT) concentrations within the 4-h study period. No adrenaline (Ad) changes were registered. The NA/Ad ratio and the f-5-HT/p-5-HT ratio showed significant reduction throughout the test. Finally, although diastolic blood pressure (DBP) showed significant decrease, neither systolic blood pressure (SBP) nor heart rate (HR) showed significant change. These findings are consistent with the postulation that tianeptine reduces both neural sympathetic activity and parasympathetic activity without affecting adrenal sympathetic activity, enabling us to discuss the possible mechanisms involved in the antidepressant effects of tianeptine. The well-known fact that major depressed patients always show raised NA plus lower than normal p-5-HT levels, both disorders which are normalized by tianeptine, gives neurochemical support to the clinical improvement triggered by the drug in these patients. Summarizing, the results presented in this study demonstrate that tianeptine triggers significant reduction of circulating noradrenaline and plasma serotonin while increasing circulating dopamine and platelet serotonin. Other possible neuropharmacological effects are also discussed.

Neurochemical, neuroautonomic and neuropharmacological acute effects of sibutramine in healthy subjects.

Sibutramine is a neuropharmacological drug that exerts central (CNS) and peripheral effects including noradrenaline (NA), and serotonin (5-HT) uptake inhibition. In addition, the drug is able to induce release from DA axons. We measured levels of circulating neurotransmitters in 20 healthy subjects during supine-resting (fasting) state before and after 15 mg of oral sibutramine. Systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) were also monitored. Sibutramine triggered sustained and progressive increase of NA, NA/Ad ratio and DBP. Slight increases of DA were also registered between the 60 and 240 min periods. The rise in DA tended to fade progressively, reaching basal level at 360 min period. Diastolic blood pressure, but neither SBP nor HR, showed significant increases that correlated positively with NA/Ad ratios. Slight but significant negative correlation was also found between DBP and DA. This correlation tended to fade throughout the trial to show no significance at the 360 min period. Although neither plasma serotonin (f-5HT) nor platelet serotonin (p-5HT) values showed significant variation throughout the trial, the f-5HT/p-5HT ratio showed significant decrease throughout. Significant negative correlation was found between f-5HT/p-5HT ratio and NA/Ad ratio. Our results indicate that sibutramine stimulates neural sympathetic activity but not adrenal sympathetic activity in healthy individuals. Further, sibutramine lowers parasympathetic activity. The moderate rise in diastolic blood pressure triggered by sibutramine would be associated with CNS-NA enhancement plus parasympathetic inhibition.

Circulating neurotransmitters during the different wake-sleep stages in normal subjects.

We investigated the changes of circulating neurotransmitters during the wake-sleep cycle in order to find possible correlations with the activity of central neurocircuitry functioning. Noradrenaline (NA), adrenaline (Ad), dopamine (DA), platelet serotonin (p-5HT), plasma serotonin (f-5HT) and plasma tryptophan (TRP) were assessed during the morning (supine resting + 1-min orthostasis + 5-min exercise) and at night (supine resting + slow wave sleep (SWS) + REM sleep). Only NA increased in the plasma during short-lasting (1-min) orthostasis morning waking period. Both NA and Ad rose during moderate exercise. The nocturnal results demonstrated that whereas Ad dropped during the supine resting, NA did not fall until SWS period. Although DA did not show significant changes during the nocturnal test, the NA/DA ratio showed significant reduction. The analysis of correlations supports the postulation that this finding reflects the DA modulatory role on neural sympathetic activity. Both f-5HT and p-5HT values were lower during sleep cycle than wake periods. However, they showed progressive rises during sleep stages. Conversely, the f-5HT/p-5HT ratio showed significantly greater values during the SWS period than during supine resting and REM periods. These findings are consistent with the postulation that f-5HT/p-5HT ratio is positively associated with parasympathetic activity during the sleep-cycle. We concluded that the profile of sleep-cycle circulating neurotransmitters differs from that obtained during waking periods. According to the above, we attempted to correlate the profile of circulating neurotransmitters with the very well-known central neurocircuitry functioning during wake-sleep cycle, in experimental mammals.

Clasificación y distribución de las enfermedades autoinmunes en un hospital de referencia en el nororiente colombiano / Classification and distribution of autoimmune diseases in a hospital of reference in the Northeast Colombian

Introducción y Objetivo:Las enfermedades autoinmunes pertenecen a un complejo de enfermedades que usualmente son de difícil diagnóstico, en ocasiones son poco conocidas por el cuerpo médico y que denotan un reto diagnóstico, no existen datos sobre la distribución y clasificación en Colombia. El objetivo es realizar una clasificación de las enfermedades autoinmunes basadas en la literatura y conocer la distribución de estas enfermedades en nuestro hospital. Métodos: Estudio observacional, descriptivo de corte transversal retrospectivo, la población de estudio fue pacientes con enfermedades autoinmune en el Hospital Universitario de Santander entre el 2012 y el 2016, posteriormente se realizó la distribución de los pacientes por subgrupos basados en su clasificación. Resultados: Se analizó una muestra de 1.463 pacientes con enfermedades autoinmunes, la edad promedio fue de 46,6 años, con mayor prevalencia en las mujeres 1.043 (71%). De 37 enfermedades seleccionadas se encontraron 31. Las enfermedades autoinmunes se clasificaron en Enfermedades sistémicas y Órgano-Específicas, con un total de 637 (43%) y 826 (57%) respectivamente, las enfermedades autoinmunes sistémicas se subclasificarón en enfermedades del tejido conectivo con 616 (97%) pacientes y enfermedades del tejido mixto conectivo con 21 (3%) pacientes

Manifestaciones dermatológicas de las enfermedades autoinmunes en un hospital universitario / Dermatologic Manifestations of autoimmune diseases at a university hospital

Introducción y objetivo: Las manifestaciones dermatológicas son frecuentes en las enfer-medades autoinmunes, sin embargo la proporción de presentación varía dependiendo de la enfermedad y de factores genéticos, epigenéticos y ambientales. En algunas enfermedades autoinmunes se ha estudiado ampliamente el compromiso cutáneo como un órgano afec-tado secundariamente por la enfermedad, mientras que en otras el órgano blanco, afectado primariamente, es la piel. No hay evidencia conocida de las manifestaciones dermatológicas agrupadas en un solo estudio. Por lo tanto, en este estudio se describen y clasifican las ma-nifestaciones dermatológicas de las enfermedades autoinmunes. Métodos: Estudio observa-cional, descriptivo de corte transversal retrospectivo. La población estudio fueron pacientes con enfermedades autoinmunes con manifestaciones dermatológicas en un hospital universi-tario de Colombia entre los años 2012-2016 en pacientes mayores de 13 años.

Perfil clínico y sociodemográfico de pacientes con diabetes mellitus tipo 1 en un hospital universitario en Colombia / Clinical profile and socio-demographic of patients with diabetes mellitus type 1 in a university hospital in Colombia

Introducción y objetivo: La diabetes mellitus tipo 1 (T1D) es una enfermedad autoinmu-ne causada por múltiples factores ambientales y genéticos que conducen a la destrucción autoinmune de células ß pancreáticas productoras de insulina. Presenta un trío clásico de síntomas, tales como, polidipsia, polifagia, poliuria que se manifiesta junto con la hiperglu-cemia. En el presente estudio se describen los casos de T1D atendidos en un hospital univer-sitario. Metodos: Estudio observacional, descriptivo de corte transversal retrospectivo. La población estudio fueron pacientes con T1D que ingresaron a un hospital universitario de Colombia, período comprendido entre los años 2012-2016 en pacientes mayores de 13 años.

Progreso de estadio y requerimiento de terapia de reemplazo renal en un programa de protección renal en Colombia. Estudio de cohorte / Stage progression and need for renal replacement therapy in a renal protection programme in Colombia. A cohort study

Antecedentes: Debido a la carga global de la enfermedad renal crónica (ERC), la Organización Mundial de la Salud fomentó programas de protección renal (PPR) para impactar en su incidencia con medidas de prevención y control. Objetivos: Evaluar la efectividad de un PPR en Colombia sobre el progreso de estadio en ERC y el requerimiento de terapia de reemplazo renal (TRR). Métodos: Estudio analítico de seguimiento a 2cohortes de pacientes con diagnóstico de ERC, que compara el comportamiento de indicadores clínicos y de deterioro renal entre pacientes expuestos a un PPR versus el tratamiento convencional (TC). Como tamaño de muestra se tuvo en cuenta el censo de la población de ambas aseguradoras. Se calculó la tasa de incidencia, la supervivencia (Kaplan Meier) y la influencia de la exposición al PPR sobre los desenlaces entre PPR y TC mediante un análisis multivariado (Cox). Resultados: Los pacientes expuestos al PPR se demoraron más en hacer el primer progreso de estadio y en requerir TRR. La tasa de incidencia para progreso es mayor en TC (0,050; IC 95%: 0,040-0,064) que en PPR (0,034: IC 95%: 0,030-0,039). Razón de tasas de incidencia: 1,480 (IC 95%: 1,21-1,90). El riesgo instantáneo de progreso fue menor en PPR (HR: 0,855; IC 95%: 0,74-0,98), al igual que el riesgo de requerir TRR (HR: 0,797; IC 95%: 0,606-1,049). Conclusiones: El PPR representa una estrategia de prevención secundaria en ERC que impacta en el progreso de estadio y requerimiento de TRR. La captación temprana de pacientes mejora dichos desenlaces (AU)

Background: Due to the global burden represented by chronic kidney disease (CKD), the World Health Organization encouraged the implementation of renal protection programmes (RPP) to affect its incidence through prevention and control measures. Objectives: To assess the effectiveness of a Colombian RPP in terms of its effect on the stage progression of CKD and the need for renal replacement therapy (RRT). Methods: An analytical study that monitored 2cohorts of patients diagnosed with CKD. The study compares the behaviour of clinical and renal impairment indicators from patients exposed to a RPP with that of patients following conventional treatment (CT). The population of both intervention groups was considered when determining the sample size. The incidence rate was calculated as well as patient survival (Kaplan Meier). In addition, a multivariate analysis (Cox) was used to calculate the influence that exposure to the RPP had on the outcomes of the patients following the RPP and those following CT. Results: The patients exposed to the RPP took longer to advance to the next CKD stage and require RRT. The incidence rate for progression is higher for the patients following CT (0.050, IC 95%: 0.040-0.064) compared to those in the RPP (0.034, IC 95%: 0.030-0.039). The ratio of incidence rates was 1.480 (IC 95% 1.21-1.90). The hazard of progression was lower for the RPP (HR: 0.855, IC 95%: 0.74- 0.98), as was the hazard of requiring RRT (HR: 0.797, IC 95%: 0.606-1.049). Conclusions: The RPP is a secondary prevention strategy against CKD which has an effect on the stage progression of CKD and the need for RRT. Early patient detection has a positive effect on the outcomes studied (AU)

A qualitative study of patient's perceptions of a preventive renal programme in Colombia 2008.

OBJECTIVE: The aim of this study was to describe how users perceive the preventive renal programme in Colombia and cope with their chronic kidney disease (CKD) from its early stages of development. METHODS: Some techniques from the grounded theory approach were used. The sampling strategy was selective. RESULTS: For medical knowledge, CKD is an irreversible condition that, during its earlier stages does not represent an obstacle for living an apparently normal life, which may lead patients to get late diagnosis and identify their condition as a 'dormant disease'. Therefore, patients have learned to 'live with their disease' by developing various coping strategies. In the case of predialysis patients, these strategies include 'fear of dialysis and transplant', 'living a normal life' and 'considering CKD a deadly disease'. On the other hand, for dialysis patients, strategies include 'resignation', 'seeing dialysis as a lifesaver' and a 'feeling of loss'. CONCLUSION: Patients recognizing their participation in the Renal Protection Programme may lead them to live longer and improve their quality of life. Also, due to the asymptomatic nature of CKD, late diagnoses are not uncommon, hence opportunities for prevention are usually scarce, which in turn becomes a challenge for public health.

Guías colombianas para el manejo del acné: una revisión basada en la evidencia por el Grupo Colombiano de Estudio en Acné

El acné es una enfermedad inflamatoria crónica que afecta, principalmente, adolescentes y adultos jóvenes. Se calcula que antes de los 21 años entre el 80 y el 90% de esta población ha estado expuesta a la enfermedad. Sin embargo, el acné puede persistir después de los 21 años y se sabe que 12% de las mujeres mayores de 25 años aún sufren de acné facial. El arsenal terapéutico para el acné consta de medicamentos tópicos y sistémicos que han demostrado su eficacia en la reducción de las lesiones. El mecanismo de acción de estos medicamentos está orientado, al menos, a uno de los cuatro factores fisiopatológicos reconocidos como responsables de la formación de las lesiones del acné, a saber: trastornos de la queratinización, hipersecreción sebácea, proliferación de Propionibacterium acnes o actividad inflamatoria in situ. La elección del tratamiento apropiado depende de varios factores, como la forma clínica de la enfermedad (de retención o inflamatoria), la gravedad de la misma y la respuesta del paciente a tratamientos previos. Asimismo, y entendiendo al acné como una enfermedad de carácter crónico, el tratamiento debe incluir una fase inicial con el objetivo de lograr una mayor reducción de la extensión y gravedad de las lesiones, y una fase de mantenimiento orientada a la prevención de las recaídas o exacerbaciones. Además, el resultado del tratamiento depende del cumplimiento del mismo y para lograrlo, es fundamental una adecuada relación médico-paciente. Este documento presenta el resultado de una revisión actualizada de la literatura, que incluye guías nacionales e internacionales para el manejo del acné y formula recomendaciones terapéuticas basadas en el mejor nivel de “evidencia” que se encontró. Su implementación permitirá la unificación de criterios con el objetivo de ofrecer un mejor manejo a los pacientes con la enfermedad, evitando así sus secuelas físicas y emocionales. Por otro lado, las guías presentan un marco científico y conceptual con la suficiente validez para su inclusión en los protocolos del plan obligatorio de salud.

Sífilis atípica: presentación de un caso / Non typical syphilis: resentation of a case

La sífilis es una infección de transmisión sexual que debe ser considerada en el diagnóstico diferencial de lesiones cutáneas en pacientes con infección por el virus de inmunodeficiencia humana (VIH). Se presenta el caso de un paciente positivo para VIH con una placa eritematosa que simuló ser un linfoma cutáneo, una infección por micobacterias, una histoplasmosis o una esporotricosis. El diagnóstico de sífilis secundaria se retardó debido al fenómeno de prozona. Los hallazgos clínicos e histopatológicos hicieron el diagnóstico de sífilis secundaria atípica.

Syphilis is a sexually transmitted disease that should be considered in the differential diagnosis of cutaneous lesions in HIV patients. We report the case of a patient who presented to the dermatology clinic with an erythematous plaque, appearing to be a cutaneous lymphoma, mycobacteria infection, histoplasmosis or esporotricosis. The real diagnosisof secondary syphilis was delayed because of a prozone phenomenon. The clinical findings, epidemiology and histologic findings establish the diagnosis of atypical secondary syphilis.

Lepra dimorfa en estado reaccional tipo 1 y 2 / Multibacillary borderline leprosy with leprosy reaction type 1 and 2

El enfoque de los pacientes con lepra se ha modificado de forma positiva en los últimos años; sin embargo, las reacciones lepróticas siguen siendo un problema clínico importante. Se reporta el caso de un paciente con lepra dimorfa multibacilar que presentó reacción leprótica tipo 1 y 2. Se discute la dificultad de su manejo.

Infección labial por citomegalovirus en un paciente infectado con VIH-1 / Labial cytomegalovirus infection in a patient infected with HIV-1

En pacientes infectados con el virus de la inmunodeficiencia humana tipo 1 (VIH-1), la infección por citomegalovirus (CMV) ocurre principalmente en estadios avanzados de la enfermedad, especialmente cuando el recuento de células T CD4+ en sangre periférica se encuentra por debajo de 100 células/mm3, lo cual favorece la progresión al sida y aumenta la probabilidad de muerte. El compromiso de la retina es la manifestación más común de esta coinfección, pero existen otras manifestaciones, como la radiculopatía periférica, la encefalopatía y el compromiso gastrointestinal; en raras ocasiones se observa neumonitis. Esta coinfección también puede presentarse como un cuadro fatal, asociado con una viremia alta y persistente, y con un compromiso grave de varios órganos. La infección cutánea por CMV es una manifestación muy rara en los pacientes positivos para VIH-1, la cual se observa cuando el recuento de células T CD4+ es menor de 50/mm3 y cursa con úlceras crónicas en la piel o las mucosas.Se presentan las características clínicas e inmunológicas de un caso de infección cutánea por CMV en un paciente positivo para VIH-1, y se revisa la literatura.

In patients infected with the type 1-human immunodeficiency virus (HIV-1), the cytomegalovirus (CMV) infection occurs mainly in advanced stages of the disease, especially when the CD4+ T-cell count in under 100 cells/millilitre, which accelerates the progression to AIDS and increases the risk of death. The retina compromise is the most frequent manifestation of the CMV infection associated to HIV-1. Other manifestations include peripheralpolyradiculopathy, encephalopathy, andgastrointestinal compromise. Pneumonitis is rarely observed. In addition, this coinfection can be presented as a fatal disease associated with high and persistent viremia and severe compromise of several organs. The cutaneous CMV infection is a very rare manifestation in HIV-1-infected patients, which is observed when the CD4+ T-cell count is under 50 cells/millilitre, and course with chronicskin and mucosal ulcers. We present the clinic and immunological characteristicsof an HIV-1-infected individual with aCMV cutaneous infection, making a comprehensive review of literature published.

Relación entre el virus humano herpes 8 y el sarcoma de Kaposi en pacientes positivos y negativos para el VIH / Relationship between human herpes virus 8 and Kaposi sarcoma in HIV positive and negative patients

Es un estudio descriptivo, de cohorte, prospectivo, del suero de 98 pacientes de diferentes instituciones de salud de Medellín, los cuales se dividieron en cuatro grupos para determinar por inmunofluorescencia su seropositividad frente a HHV-8 y poder asociar en forma univariada y bivariada con diferentes variables. Resultados. Se estudiaron 98 sueros. En el grupo de pacientes con sarcoma de Kaposi y VIH, 83,3 por ciento fueron positivos para HHV- 8, en el grupo sin sarcoma de Kaposi pero con sífilis, 20,8 por ciento fueron positivos para HHV-8, en el grupo sin sarcoma de Kaposi pero VIH positivos, 8 por ciento fueron positivos para HHV-8 y en el grupo de sueros de banco de sangre, 4 por ciento fueron positivos para HHV-8. La presencia de sarcoma de Kaposi no tuvo relación con la evolución de la enfermedad por VIH ni con el recuento de CD4/ml. Conclusiones. El HHV-8 circula en nuestro medio y existe una relación entre la infección por este virus y el desarrollo de sarcoma de Kaposi, especialmente en pacientes con enfermedades de transmisión sexual y VIH positivos.