Safety and tolerability of a natural supplement containing glucosinolates, phytosterols and citrus flavonoids in adult women: a randomized phase I, placebo-controlled, multi-arm, double-blinded clinical trial.

OBJECTIVE: To evaluate the safety and tolerability of an oral herbal supplement containing glucosinolates, phytosterols, and citrus flavonoids (Warmi®, Lima Perú;) in otherwise healthy adult women. METHODS: This was a phase-I, randomized parallel three arms, double-blinded, and a placebo-controlled clinical trial. A total of 55 participants aged 18-40 were randomly assigned to one of three groups to receive for three months: (1) an oral herbal supplement of 1650 mg/day; (2) an oral herbal supplement of 3300 mg/day; or (3) an oral placebo 3300 mg/day. The primary endpoints were oral safety and tolerability of the supplement. The secondary endpoint was its effect on vital functions, anthropometrics, and laboratory tests. We used an exploratory approach by covariance analysis (ANCOVA) adjusted for the variables' baseline value for the secondary outcomes. RESULTS: All women completed three months of follow-up, reporting no side effects. Our exploratory analysis revealed that treatment with the herbal supplement of 1650 mg/day was associated with increased glucose and uric acid levels. In comparison, the herbal supplement 3300 mg/day was associated with reduced breathing rate, increased basal temperature, and systolic blood pressure, both compared to the placebo group. However, despite significant differences, none of these was clinically significant. CONCLUSION: The oral herbal supplement had a favorable safety and tolerability profile in studied women. There is a need to study its potential as an option to treat menopausal symptoms.

Effect of a natural supplement containing glucosinolates, phytosterols and citrus flavonoids on body weight and metabolic parameters in a menopausal murine model induced by bilateral ovariectomy.

OBJECTIVE: To evaluate the effect of a herbal preparation containing glucosinolates, phytosterols and citrus flavonoids (supplement) on body weight and metabolic parameters usually impaired by menopause. METHODS: A pre-clinical experimental study carried out in twenty-five Swiss strain mice (Mus musculus) randomly distributed (1:1:1:1:1 ratio) to five groups to receive for ten weeks: (1) oral gelatinized maca extract 0.5625 mg/kg/day + bilateral ovariectomy (Maca + OVX); (2) oral supplement 0.5625 mg/kg/day + bilateral ovariectomy (S1 + OVX); (3) oral supplement 1.6875 mg/kg/day + bilateral ovariectomy (S2 + OVX); (4) oral saline 100 µl/kg/day + bilateral ovariectomy (OVX); and (5) oral saline 100 µl/kg/day + sham surgery (sham). The primary endpoint was change in body weight gain from baseline to final. Secondary endpoints were uterine weight and cholesterol, triglyceride, glucose, and glucose/triglycerides index values at the end of the study. A modified intention-to-treat analysis was performed through linear regression models and using the Bonferroni method to penalized p-values by multiple comparisons. RESULTS: Twenty-three animals completed the study. There was a significant average difference in weight gain, with a greater reduction in the S2 + OVX group compared to the OVX group (difference= -3.5; 95% CI (-5.27; -1.74); p < .001). S2 + OVX group also displayed a significant average reduction of total blood cholesterol (difference: -16.94; 95% CI (-33.73; -0.15); p = .037). No significant effects of the supplement were found on other secondary endpoints. CONCLUSION: In this murine menopausal model, triple oral supplement dose resulted in an average reduction of weight gain and total cholesterol levels, suggesting that the compound could have a potential effect at regulating menopausal altered metabolism.

Short-term effects and safety of a natural oral supplement containing glucosinolates, phytosterols, and citrus flavonoids compared with hormone treatment for the management of postmenopausal symptomatic women: a pilot single-center randomized phase 2 clinical trial.

OBJECTIVE: This study aimed to evaluate the short-term efficacy and safety of an oral herbal supplement containing glucosinolates, phytosterols, and citrus flavonoids for menopausal symptoms in comparison with estrogen plus progestogen therapy (EPT) among postmenopausal women. METHODS: This was a pilot single-blinded, three-armed phase II randomized clinical trial, controlled with EPT. Sixty participants were randomly assigned to receive treatment for 3 months: (1) an oral herbal supplement of 1,500 mg/d (G1, n = 20), (2) an oral herbal supplement of 3,000 mg/d (G2, n = 20), or (3) conjugated equine estrogens 0.625 mg/d plus medroxyprogesterone acetate of 5 mg/d (EPT group, n = 20). The primary endpoint was the intensity of menopausal symptoms as measured using the Menopause-Specific Quality of Life Questionnaire (global and domain scores). The Menopause-Specific Quality of Life Questionnaire uses a 7-point scale to rate the symptom intensity, with higher scores indicating severity. The secondary endpoints were hormonal, lipid, and safety profiles. RESULTS: Fifty-four participants (n = 54) completed the study. The mean, model-estimated, and global menopausal symptom scores at 3 months were 85.8 in the EPT group, 61.3 in G1, and 62.5 in G2. Participants treated with the herbal compound had lower global (13.7 [6.9-20.4], P < 0.001) and physical symptom scores (6.6 [1.6-11.5], P = 0.002) on the second month and lower psychosocial symptom scores (3.8 [1.3 to 6.3], P < 0.001) on the third month of follow-up, compared with EPT. Conversely, participants receiving EPT showed better outcomes on vasomotor symptoms since the first month of treatment (-6.1 [-8.3 to -4.0], P < 0.001). The EPT group exhibited higher values of estradiol and lower follicle-stimulating hormone and luteinizing hormone since the first month of follow-up. Also, total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol were significantly higher in this group than in G2. CONCLUSIONS: In this small single-blind exploratory trial, the oral herbal supplement was more efficacious in reducing global, physical, and psychosocial menopausal symptoms in the short term than EPT. However, further studies are needed to adequately assess the efficacy and safety of this herbal supplement in the treatment of menopausal symptoms.

Relationship between extrinsic factors and non-carious cervical lesions in patients of the National Hospital "Hipólito Unánue"

Non-carious cervical lesions cause destructive dental disorders that actively contribute to the progressive loss of dental structure and the immediate need for dental treatment, due to their multiple symptoms and factors that produce them. Aim: The purpose of the study was to determine the relationship between extrinsic factors and non-carious cervical lesions in patients of the National Hospital Hipólito Unánue. Methods: The research was of a descriptive correlative type. The sample consisted of male and female patients between 18 and 65 years old, who attended the carielogy service of this hospital. For data collection, 2 questionnaires were used to estimate the values of the extrinsic factors that allowed us to obtain the necessary information on the variables to be studied. Spearman's Rho was applied to determine the relationship between the variable's study. Results: According to Spearman's Rho of 0.622, compared to p-0.000 <0.01. Between the variables studied; extrinsic factors and noncarious cervical lesions there is a moderate and significant positive correlation. Conclusion: Through this section it was possible to demonstrate the existing relationship between extrinsic variable factors and non-carious cervical lesions, therefore it was concluded that there is a moderate and significant positive correlation in the sample comprised by the patients of the Hospital in mention

[Lessons learned in the control of Aedes aegypti to address dengue and the emergency of chikungunya in Iquitos, Peru]. / Lecciones aprendidas en el control de Aedes aegypti para afrontar el dengue y la emergencia de chikungunya en Iquitos, Perú.

Dengue has affected Iquitos since 1990 causing outbreaks of major impact on public health and for this reason great efforts have been made for its temporal control. Currently, with the expansion of the chikungunya virus in the Americas and the threat of the emergence of the virus in Iquitos, we reflect on lessons learned by way of the activities undertaken in the area of vector control; epidemiological surveillance, diagnosis and clinical management during periods of outbreaks of dengue, in a way that will allow us to better face the threat of an outbreak of chikungunya virus in the largest city in the Peruvian Amazon.

Anti-inflammatory activity of two different extracts of Uncaria tomentosa (Rubiaceae).

We assessed in vivo the anti-inflammatory activity of two Cat's claw bark extracts, by comparing a spray-dried hydroalcoholic extract against an aqueous freeze-dried extract, to determine which extract was more effective. We used the carrageenan-induced paw edema model in mice. In addition, to assess the molecular mechanism of action, we determined the inhibition of NF-kappa B through the Electrophoretic Mobility Shift Assay (EMSA) and the effects on cycloxygenase-1 and -2. Results showed that the anti-inflammatory activity was significantly higher using the hydroalcoholic compared with the aqueous extract (P<0.05). The extracts also showed little inhibitory activity on cyclooxygenase-1 and -2. It cannot be excluded that the slight inhibitory activity on DNA binding of NF-kappa B is due to cytotoxic effects.

Lecciones aprendidas en el control de Aedes aegypti para afrontar el dengue y la emergencia de chikungunya en Iquitos, Perú / Lessons learned in the control of Aedes aegypti to address dengue and the emergency of chikungunya in Iquitos, Peru

El dengue ha afectado a Iquitos desde 1990 causando varios brotes de gran impacto en la salud pública y por el que se desplegaron grandes esfuerzos para su control temporal. Actualmente, ante la expansión del virus chikungunya en las Américas y la amenaza de la emergencia del virus en Iquitos, reflexionamos a modo de lecciones aprendidas las actividades emprendidas en el área del control vectorial; la vigilancia epidemiológica; el diagnóstico y el manejo clínico durante los periodos de brotes de dengue, de modo que nos permita enfrentar mejor la amenaza de un brote del virus chikunguña en la ciudad más grande de la Amazonía peruana.

Dengue has affected Iquitos since 1990 causing outbreaks of major impact on public health and for this reason great efforts have been made for its temporal control. Currently, with the expansion of the chikungunya virus in the Americas and the threat of the emergence of the virus in Iquitos, we reflect on lessons learned by way of the activities undertaken in the area of vector control; epidemiological surveillance, diagnosis and clinical management during periods of outbreaks of dengue, in a way that will allow us to better face the threat of an outbreak of chikungunya virus in the largest city in the Peruvian Amazon.

Síndrome metabólico como factor de riesgo en adultos con psoriasis / Metabolic syndrome as risk factor for psoriasis in adults

Determinar si el síndrome metabólico constituye un factor asociado a psoriasis en adultos. Material y métodos: estudio analítico, observacional, de casos y controles que incluyó a 24 pacientes con diagnóstico clínico nuevo de psoriasis y 48 controles atendidos en el Servicio de Dermatología del Hospital Regional Docente de Trujillo entre febrero 2010 y enero 2011. El diagnóstico de síndrome metabólico se realizó tomando en cuenta los criterios del Programa Nacional de Educación del Colesterol de los Estados Unidos. Para determinar la asociación entre las variables se empleó la prueba de chi cuadrado o la prueba exacta de Fisher según correspondiera, con un nivel de significancia del 0.05; igualmente se calculó la fuerza de asociación mediante el odds ratio (OR) con intervalos de confianza al 95% (IC 95%). Resultados: el síndrome metabólico fue identificado en el 45.8% de los casos frente a 29.2% de los controles, diferencia que no fue estadísticamente significativa (OR: 2.05, IC 95%: 0.74-5.68, p=0.161). Todos los componentes del síndrome metabólico se presentaron en mayor frecuencia en el grupo con psoriasis, con excepción de niveles bajos de colesterol HDL sérico que fueron más frecuentes en los controles. La obesidad abdominal fue el único factor asociado a psoriasis (OR: 5.00; IC 95%: 1.49-16.83, p=0.013). Conclusión: no se observó asociación entre el síndrome metabólico y la psoriasis a pesar de presentarse con mayor frecuencia en los pacientes con la enfermedad cutánea. Sin embargo, el componente obsesos abdominal, si tuvo asociado con la psoriasis...

To determine the association between metabolic syndrome and psoriasis in adults. Methods: We carried out an analytic, observational, case-control study that included 24 newly diagnosed patients with psoriasis and 48 control seen at the Dermatology Service of the Hospital Regional Docente de Trujillo, between Frebruary 2010 and January 2010 and January 2011. Metabolic syndrome diagnosis was made taking into account the criteria from the National Cholesterol Education Program of the United States. Association between variables was determined from a chi-square test or FisherÆs exact test as appropriate, with a significance level of 0.05; odds ratio (OR) with 95% confidence interval was used as measure of strength of association. Results: Metabolic syndrome was identified in 45.8% of cases versus 29.2% of control, difference that was not statistically significant (OR: 2.05, 95% CI: 0.74-5.68, p=0.161). All components of the metabolic syndrome occurred more frequently in the group with psoriasis but low levels of serum HDL cholesterol, which were more common in controls. Abdominal obesity was the only factor associated with psoriasis (OR: 5.00, 95% CI: 1.49-16.83, p=0.013). Conclusion: No association between metabolic syndrome and psoriasis was observed, despite it occurred frequently in patients with the cutaneous disease. However, one of its components, central obesity, was assosciated with psoriasis...

Dermatosis paraneoplásica liquenoide / Lichenoid paraneoplastic dermatoses

Las dermatosis paraneoplásicas son alteraciones cutáneas debidas a la presencia de una neoplasia maligna interna. Son marcadores o signos dermatológicos de malignidad a distancia que en ocasiones preceden a las manifestaciones directas de la neoplasia, contribuyendo a un diagnóstico temprano. Presentamos el caso de una paciente mujer de 58 años de edad, hospitalizada en el servicio de Medicina Interna del Hospital Regional Docente de Trujillo por trombosis venosa profunda, celulitis de pierna izquierda y lesiones cutáneas diseminadas muy pruriginosas; así como erosiones dolorosas en mucosa oral, estas últimas de dos meses de evolución. En los exámenes de laboratorio se encontró anemia y leucopenia; en la radiografía de huesos largos se evidenció metástasis osteoblásticas y en la tomografía toraco-abdominal: metástasis pleurales, hepáticas y óseas y adenomegalias retroperitoneales. El estudio histopatológico cutáneo informó dermatitis de interfase liquenoide. La biopsia del ganglio linfático supraclavicular evidenció adenocarcinoma papilar metastásico. Debido al precoz fallecimiento de la paciente no se llegó a determinar la neoplasia primaria. Se presenta el caso debido a la gran extensión y severidad de esta dermopatía liquenoide, en el contexto de una neoplasia metastásica.

Paraneoplastic dermatoses are cutaneous alterations related with the presence of an internal malignant neoplasm. They are dermatologic markers of a distant malignancy that in some cases preceded direct neoplastic manifestations, contributing an early diagnosis. We report the case of a 58 years old female patient hospitalized at the Internal Medicine department at the Hospital Regional Docente de Trujillo, because of deep vein thrombosis, left leg cellulitis, and spread and extremely pruritic skin lesions; as well as painful erosions in the oral mucosa, these last two months. In laboratory tests we found anemia and leucopenia; large bone X-rays showed osteoblastic metastasis and thoracic-abdominal tomography evidenced pleural, hepatic and bone metastasis and retroperitoneal lymphadenopathy. Cutaneous histopathology study described a lichenoid interface dermatitis and the supraclavicular node biopsy was informed as a papilar metastasic adenocarcinoma. Because of her early death we didnÆt find the primary neoplasm. We present this case due to its severity and extension related to a metastasic neoplasm.

Eritrodermia adquirida en un adulto / Acquired erythroderma in an adult

La eritrodermia o dermatitis exfoliativa, es un raro desorden cutáneo inflamatorio, en el cual, la presencia de eritema y descamación comprometen más del 90% de la superficie corporal. Puede originarse a partir de múltiples dermopatías congénitas o adquiridas y ha mostrado ser potencialmente fatal. El presente caso corresponde al de un paciente varón de 53 años de edad, sin antecedentes patológicos de importancia, con tiempo de enfermedad de 6 meses presentando placas eritemato escamosas en cara y cuero cabelludo, las cuales paulatinamente se distribuyen de manera generalizada en piel y se asocian a prurito y pérdida progresiva de peso. Tras su hospitalización, se evidencia además, linfadenopatía generalizada, anemia, hipoalbuminemia y eosinofilia moderada. Se le realizó biopsias de piel y ganglio linfático inguinal, habiendo sido informadas como compatibles con Psoriasis y Linfadenopatía dermopática, respectivamente.

Erythroderma or exfoliative dermatitis is a rare cutaneous inflammatory disorder in which erythema and scaling involve more than 90% of the body surface. It can be originated by several congenital or acquired skin conditions and showsa fatal potential. This case belongs to a male of 53 years old, with erythematous scale plaques initiated in the face and scalp that then turned into a generalized distribution during 6 months, associated to a progressive weight loss and itch. During his hospitalization, we found generalized lymphadenopathy, anemia, hypoalbuminemia and moderated eosinophylia. Skin and lymphatic biopsies informed Psoriasis and Dermopathic Lymphadenopathy respectively.

Antecedente familiar, obesidad y tabaquismo como factores de riesgo en personas adultas con diagnóstico de psoriasis / Family history, obesity and smoking as risk factors in adult people with psoriasis

Se realizo un estudio de casos y controles que incluyo a 35 pacientes con diagnostico nuevo de psoriasis y 105 controles atendidos en el Servicio de Dermatología del Hospital Regional Docente de Trujillo-Perú entre abril 2009 y febrero 2010, con el objetivo de determinar si el antecedente familiar, la obesidad y el tabaquismo eran factores de riesgo en personas adultas con diagnostico de psoriasis. Se encontró asociación estadísticamente significativa entre el antecedente familiar de psoriasis (11.4 por ciento vs 1.9 por ciento; OR 6.65 IC95 por ciento 1.16-38.02), y la obesidad (25.7 por ciento vs 10.5 por ciento; OR 2.96 IC95 por ciento 1.11-7.90). Sin embargo el tabaquismo, a pesar de haber sido referido de manera frecuente por los pacientes con psoriasis, no mostro asociación estadísticamente significativa (20 por ciento vs 14.3 por ciento; OR 1.50 IC95 por ciento 0.56-4.05). El análisis de regresión logística mostro que el antecedente familiar de psoriasis fue la variable de riesgo más relevante. Se concluyo que el antecedente familiar y la obesidad constituyen factores de riesgo en personas adultas con diagnostico de psoriasis.

We conducted a case-control study that included 35 newly diagnosed patients with psoriasis and 105 controls seen at the Dermatology Department of Hospital Regional Docente de Trujillo-Peru, between April 2009 and February 2010, in order to assess the role of heritage, obesity and smoking as risk factors in adults with psoriasis. Family history of psoriasis was associated with psoriasis (11.43 percent vs 1.90 percent; OR 6.65 95 percentCI 1.16-38.02), likewise obesity (25.71 percent vs 10.48 percent; OR 2.96 95 percentCI 1.11-7.90). While smoking, despite having been often referred by patients with psoriasis, showed no significant association with the disease (20 percent vs 14.29 percent OR 1.50 95 percentCI 0.56-4.05). Logistic regression analysis showed that family history of psoriasis was the most important risk factor. We concluded that family history and obesity are risk factors in adults with psoriasis.