Alterations promoted by acid straightening and/or bleaching in hair microstructures.

Human hair is a biopolymer constituted mainly of keratin intermediate filaments, lipids, pigments and water. Cosmetic treatments usually interact with the hair at the molecular level, inducing changes in its components and modifying the physicochemical and mechanical properties of the fibers. Here, the effect of acid straightening on the morphology and ultrastructure of Caucasian hair was investigated by a group of complementary experimental methods: wide-, small- and ultra-small-angle X-ray scattering; high-resolution 3D X-ray microscopy; quasi-elastic neutron scattering and inelastic neutron scattering; thermogravimetry-mass spectrometry; and differential scanning calorimetry (DSC). X-ray diffraction patterns showed that acid straightening associated with a flat iron (∼180°C) changed the cortex of the fiber, shown by denaturation of the intermediate filaments (measured by DSC). The increase in the spacing of the lipid layers and the observation of the dehydration behavior of the fiber provided indications that water may be confined between these layers, while neutron spectroscopy showed alterations in the vibration mode of the CH2 groups of the lipids and an increase of the proton (H+) mobility in the hair structure. The latter may be associated with the extremely low pH of the formulation (pH ≃ 1). Additionally, this investigation showed that bleached hair (one-time bleached) is more damaged by the action of acid straightening than virgin hair, which was shown by a threefold increase in the percentage of total porosity of the tresses. The obtained results demonstrate that the investigation approach proposed here can provide very important thermodynamic and structural information on induced changes of hair structure, and certainly can be applied for the evaluation of the action mode and efficiency of cosmetic treatments.

Pediatric perianal Crohn's disease behavior in the era of biologic therapy. / Comportamiento de la afectación perianal en pacientes pediátricos con enfermedad de Crohn en la era de la terapia biológica.

AIM OF THE STUDY: To describe perianal Crohn's disease behavior and the role of biological therapy in a sample of pediatric patients. METHODS: A retrospective study of pediatric patients with Crohn's disease (CD) treated in our institution from 2017 to 2021, with a minimum follow up period of 6 months, was conducted. Patients were divided whether they had perianal disease (PD) or not. Baseline characteristics, extension of disease, growth failure rate, aggressive pattern rate, use of biological therapy and need for surgery, among other variables, were compared between both groups. Clinical and/or radiological improvement in the last 6 months of follow up was considered good control of PD. RESULTS: Seventy eight pediatric patients with CD were included. Median age at diagnosis was 10.5 years, and median follow up time was 3.8 years. 64.1% patients were male. Of all, 15 (19.2%) had perianal disease, of which 10 had fistulizing findings and 5 had non fistulizing findings. PD was presented at diagnosis in 8 patients, and the rest developed it in a median time of 1 year from diagnosis. PD was associated with growth failure (p = 0.003), use of biological therapies (p = 0.005), and need for second line of biologics (p = 0.005). Most patients (12/15, 80%) had good control of PD with the treatment received. CONCLUSIONS: CD patients with PD seem to need a more aggressive treatment, with biological therapies playing a key role for its handling nowadays. These patients require close nutritional evaluation that ensures proper development and growth.

OBJETIVO DEL ESTUDIO: Describir el comportamiento de la enfermedad de Crohn perianal y el papel de la terapia biológica en una muestra de pacientes pediátricos. METODOS: Estudio retrospectivo de pacientes pediátricos con enfermedad de Crohn (EC) tratados en nuestro centro entre 2017 y 2021, con un seguimiento mínimo de seis meses. Los pacientes se dividieron en función de si tenían enfermedad perianal (EP) o no. Se compararon entre ambos grupos las características iniciales, la extensión de la enfermedad, el índice de retraso en el crecimiento, el índice de patrón agresivo, el empleo de terapia biológica y la necesidad de cirugía, entre otras variables. Se consideró un buen control de la EP una mejoría clínica o radiológica en los 6 últimos meses de seguimiento. RESULTADOS: Se incluyeron 78 pacientes pediátricos con EC. La edad mediana en el momento del diagnóstico fue de 10,5 años, y el tiempo mediano de seguimiento fue de 3,8 años. El 64,1% de los pacientes eran varones. Del total, 15 (19,2%) tenían enfermedad perianal, de los cuales 10 presentaban hallazgos fistulizantes y 5 no fistulizantes. La EP estaba presente en el momento del diagnóstico en 8 pacientes, y el resto la desarrolló en una mediana de 1 año desde el diagnóstico. La EP se asoció con retraso en el crecimiento (p = 0,003), empleo de terapias biológicas (p = 0,005) y necesidad de una segunda línea de terapia biológica (p = 0,005). La mayoría de los pacientes (12/15, 80%) tuvieron un buen control de la EP con el tratamiento recibido. CONCLUSIONES: Los pacientes de EC con EP parecen necesitar un tratamiento más agresivo, en el que las terapias biológicas desempeñan hoy en día un papel fundamental. Estos pacientes precisan de una estrecha evaluación nutricional que garantice su correcto crecimiento y desarrollo.

Nanoemulsions containing plant oils: How do they influence hair treatment?

OBJECTIVE: Cosmetic and dermatological products, mainly the hair treatments, are projected to have remarkable growing in coming years. Nanotechnology, specifically nanoemulsions, has potential to be used in several hair products, owing to their beneficial properties. Concurrently, plant-derived cosmetics have become more popular over the years to consumers who prefer a safer, natural and sustainable approach. There is a lack of studies combining plant oils and nanotechnology for haircare formulations. In this work, different plant oil-loaded nanoemulsions were prepared to investigate the influence of their particle size, zeta potential and composition on hair treatment efficacy. METHODS: Coconut, olive and Abyssinian oils, alone or in combination, were loaded into nanoemulsions by high-pressure homogenization method (HPH). The mean particle size, polydispersity index and zeta potential were measured by the dynamic light scattering (DLS) method, and a stability test was performed for five months. A sensorial screening evaluation performed by the analyst and the combing test using Dia-Stron® instrumentation were applied on hair tresses treated by these nanoemulsions. RESULTS: The use of different plant oils for nanoemulsion resulted in distinct final particle sizes and zeta potential. However, results suggested no significant difference between them in hair tresses combing efficacy compared by Dia-Stron® instrument testing. Moreover, the plant-loaded nanoemulsions with increased concentration of cationic surfactant indicated a 50% reduction in combing force using this device when compared to control, in addition to better sensory results by screening test compared to other nanoemulsions and control. CONCLUSION: The composition of plant oils, particle size or zeta potential of the prepared nanoemulsions does not seem to significantly influence hair performance. Thus, we suggest that finding the right balance between cationic surfactant and plant oils may be the most appropriate path to develop effective nanoemulsions in hair treatment.

OBJECTIF: Les produits cosmétiques et dermatologiques, principalement les traitements capillaires, devraient connaître une croissance remarquable dans les années à venir. La nanotechnologie, en particulier les nanoémulsions, a le potentiel d'être utilisée dans plusieurs produits capillaires, en raison de leurs propriétés bénéfiques. Parallèlement, les cosmétiques d'origine végétale sont devenus plus populaires au fil des ans auprès des consommateurs qui préfèrent une approche plus sûre, naturelle et durable. Il existe un manque d'études combinant les huiles végétales et la nanotechnologie pour les formulations de traitement capillaire. Dans ce travail, différentes nanoémulsions contenant de l'huile végétale ont été préparées pour étudier l'influence de leur taille de particule, de leur potentiel zêta et de leur composition sur l'efficacité du traitement capillaire. MÉTHODES: Les huiles de noix de coco, d'olive et d'Abyssinie, seules ou en combinaison, ont été chargées dans des nanoémulsions par méthode d'homogénéisation à haute pression (HPH). La taille moyenne des particules, l'indice de polydispersité et le potentiel zêta ont été mesurés par la méthode de diffusion dynamique de la lumière (DLS), et un test de stabilité a été effectué pendant cinq mois. Une évaluation sensoriel réalisée par l'analyste et le test de peignage à l'aide de l'instrumentation Dia - Stron® ont été appliqués sur les cheveux traités par ces nanoémulsions. RÉSULTATS: L'utilisation de différentes huiles végétales pour la nanoémulsion a donné des tailles de particules finales et un potentiel zêta distinct. Cependant, les résultats n'ont suggéré aucune différence significative entre eux dans l'efficacité du peignage des cheveux par rapport aux tests d'instruments Dia-Stron®. De plus, la nanoémulsion chargée avec une concentration plus élevée de tensioactif cationique a indiqué une réduction de 50% de la force de peignage en utilisant ce dispositif par rapport au contrôle, et, le screening a montré de meilleurs résultats sensoriels par rapport aux autres nanoémulsions et contrôle. CONCLUSION: La composition des huiles végétales, la taille des particules ou le potentiel zêta des nanoémulsions préparées ne semblent pas influencer significativement les performances capillaires. Ainsi, nous suggérons que trouver le bon équilibre entre un tensioactif cationique et des huiles végétales peut être la voie la plus appropriée pour développer des nanoémulsions efficaces dans le traitement des cheveux.

[Sacral nerve stimulation for the treatment of severe fecal incontinence: long-term quality of life and functional outcomes].

BACKGROUND: The aim is to determine whether good functional and quality of life results of sacral nerve stimulation (SNS) in patients with severe fecal incontinence are maintained in the long-term. MATERIAL AND METHODS: Consecutive cohort of patients with severe fecal incontinence not responding to conservative (drugs and/or biofeedback) or surgical (sphincteroplasty) treatment, undergoing SNS between 2002 and 2013. Patients with a definitive implant were individually assessed in consultation throughout the follow-up, until January 2016. Defeca-tory function was assessed by Wexner score and stool diary, and perceived quality of life by FIQL and EQ-5D question-naires. RESULTS: Acute percutaneous nerve evaluation (PNE) was performed on 93 patients; a temporary electrode was implanted in 91 (79.1% women, mean age 62.5 years), obtaining a good functional response in 64. A permanent implant was per-formed in 61 patients, with a mean follow-up of 78.1 months (SD: 35.4; range 1-161); at the end of the study 42 patients remained in follow-up. A significant decrease was observed in the number of days per week with an incontinent episode, from 4.98 (SD 2.1) to 1.25 (SD 1.7), and in Wexner score from 16.88 (SD 2.74) to 6.95 (SD 3.54). Specific FIQL and generic EQ-5D questionnaires showed a significant improvement in quality of life. CONCLUSION: Long-term functional and quality of life outcomes of SNS for the treatment of severe faecal incontinence is maintained, with individual follow-ups that reach 10 years.

[The perception of care received by patients with actinic keratosis]. / La percepción del proceso asistencial de pacientes con queratosis actínica.

OBJECTIVE: To analyse barriers limiting an integral approach in the care process of patients with actinic keratosis, and to validate a questionnaire of their perception in order to assess this approach. METHOD: A qualitative study (Focus Group) was conducted to assess the perception of the healthcare process of professionals (dermatologists, family doctors, nurses, pharmacists and managers), and patients. A validation study of a new tool was conducted, defining the scope and contents of a questionnaire of perceived quality. Reliability, consistency and validity were analysed after inviting a convenience sample of 225 patients to respond. RESULTS: Underdiagnosis in primary care, a higher variability in resources, and access to the health care circuit, together with gaps in patient information about actinic keratosis, are relevant barriers to achieve comprehensive care in this disease condition. The result of the focus groups advised to elaborate 14 reactive items. A total of 224 patients responded (mean age 71.6, SD 11.1), of which 153 (68%) were men. Two factors were isolated including 12 items (explained variance of 58%). The consistency of this factorial solution was .87, the split-half reliability being .76, with the scores in the factors showing an adequate predictive capacity. CONCLUSIONS: The coordination between levels and to reduce to variability in equipment and clinical decision making in Primary Care are the most prominent barriers. The questionnaire has appropriate metric properties and it explores the information and care by the medical staff and the information and advice provided by the pharmacist.

Manejo de los tratamientos biológicos en pacientes con psoriasis moderada-grave sometidos a intervenciones quirúrgicas en el registro español Biobadaderm / Management of biologic therapy in moderate to severe psoriasis in surgical patients: data from the Spanish Biobadaderm registry

INTRODUCCIÓN Y OBJETIVO: Disponemos de una gran experiencia en el uso de los fármacos biológicos para el tratamiento de los pacientes con psoriasis, sin embargo, existen situaciones concretas, como la cirugía, en las que pueden surgir dudas sobre su manejo. Aunque las guías de tratamiento aconsejan su suspensión programada previamente a los procedimientos de cirugía mayor, no existe evidencia de cuál es la actitud habitual en la práctica clínica y su asociación a complicaciones. Nuestro objetivo fue analizar el manejo actual de esta situación en la práctica clínica habitual. MÉTODOS: A través de un estudio retrospectivo de la base de datos Biobadaderm se analizó el manejo práctico de pacientes con psoriasis en tratamiento biológico que fueron intervenidos mediante algún procedimiento quirúrgico. RESULTADOS: De los 2.113 pacientes incluidos en Biobadaderm, 48 fueron tratados con una intervención quirúrgica, de las que fueron mayoritarias las de tipo cutáneo (31%). El tratamiento biológico se suspendió en el 42% de los casos. No se observaron asociaciones estadísticamente significativas entre la aparición de complicaciones posquirúrgicas y la interrupción del fármaco. Tampoco se detectó asociación entre la interrupción del tratamiento con otras variables como el sexo, la edad, la duración de la enfermedad y la gravedad de la psoriasis. CONCLUSIÓN: No se ha encontrado asociación entre la continuidad del tratamiento biológico y el riesgo de complicaciones posquirúrgicas, aunque el estudio presenta la limitación de tener un tamaño muestral escaso

BACKGROUND AND OBJECTIVE: We now have considerable experience in the use of biologic agents to treat psoriasis, but doubts about management arise in certain clinical settings. Surgery is one of them. Although treatment guidelines advise that biologics be suspended before major surgery, data about actual clinical practices and associated complications are lacking. We aimed to analyze current practice in the clinical management of these cases. METHODS: Retrospective study of cases in the Biobadaderm database. We analyzed the management of biologic therapy in patients with psoriasis who underwent surgical procedures. RESULTS: Forty-eight of the 2113 patients registered in Biobadaderm underwent surgery. Thelargest percentage of procedures (31%) involved skin lesions. Biologic treatment was interrupted in 42% of the cases. No postsurgical complications were significantly related to treatment interruption. Likewise we detected no associations between treatment interruption and other variables, such as sex, age, or duration or severity of psoriasis. CONCLUSION: Continuity of biologic treatment and the risk of postsurgical complications were not associated in this study, although conclusions are limited by the small sample size

Lesión tuberosa parietal secundaria a Sirsasana, una postura de yoga invertida / Tuberous Parietal Lesion Secondary to Sirsasana, the Yoga Headstand Posture

No disponible

Informe de expertos en psoriasis: opinión de los dermatólogos españoles sobre el manejo de la psoriasis moderada-grave con agentes biológicos en pacientes adultos / Expert Report on Psoriasis: Spanish Dermatologists’ Opinions on the Use of Biologic Agents to Manage Moderate to Severe Psoriasis in Adults

Introducción: Aunque se dispone de directrices nacionales sobre el tratamiento de la psoriasis moderada-grave del adulto con biológicos, es esencial ampliar el conocimiento sobre aspectos prácticos en el uso de estos agentes. Objetivo: El objetivo de este estudio fue recoger la opinión de los dermatólogos españoles expertos en el manejo de la psoriasis sobre aspectos prácticos de su tratamiento con biológicos. Material y métodos: Encuesta on-line remitida a 309 dermatólogos pertenecientes al Grupo Español de Psoriasis o miembros de la Academia Española de Dermatología. La encuesta diseñada específicamente para el estudio incluía preguntas sobre diferentes aspectos del tratamiento de la psoriasis en su práctica clínica. Seis coordinadores, representativos de las diferentes zonas geográficas, elaboraron el informe final de expertos. Resultados: La tasa de respuesta fue del 97% (n = 300). Los biológicos considerados como opción preferida o más favorable por los encuestados (opción 4 de 4) fueron: infliximab por su eficacia a corto plazo (74%) y rapidez de acción (78%); ustekinumab por su conveniencia en la administración (73%) y etanercept por la posibilidad de administrarlo en ciclos (71%), seguridad a largo plazo (72%) y posibilidad de discontinuar en situaciones especiales (76%). En cuanto a la percepción clínica de seguridad y «supervivencia» otorgaron la máxima valoración (opción 5 de 5) a etanercept un 49 y 33% de los encuestados. Un 30% de los encuestados considera muy relevantes las guías de manejo terapéutico con biológicos. Conclusiones: Los resultados de este estudio proporcionan una perspectiva inédita sobre la opinión de una amplia muestra de dermatólogos españoles en España, respecto al uso actual de biológicos en el tratamiento de la psoriasis (AU)

Background: Although national guidelines on biologic agents for treating moderate to severe psoriasis in adults have been published in several countries, increased knowledge on the practical aspects of their implementation is required. Objective: The objective of this study was to survey Spanish dermatologists to determine their expert opinions on practical aspects of psoriasis treatment with biologics. Materials and methods: An online survey was sent to 309 dermatologists who belong to the Spanish Psoriasis Group and/or the Spanish Academy of Dermatology and Venereology (AEDV). The questionnaire was designed specifically for the study and included items on various aspects of the treatment of psoriasis in clinical practice. Six coordinators in different geographic areas worked together to write the final expert report. Results: The response rate was 97% (300 returned questionnaires). The biologics preferred, or considered to be the best option (median score 4 out of 4 points) by respondents, were infliximab for its short-term efficacy (74% of the respondents) and rapid onset of action (78%); ustekinumab for convenience of administration (73%); and etanercept because of its suitability for cyclic treatment (71%), safety in long-term use (72%), and the possibility of temporary interruption of treatment under certain circumstances (76%). Etanercept was assigned the highest evaluations for safety and expected survival time (scored 5 on each item by 49% and 33% of the respondents, respectively). Thirty percent of the respondents considered that clinical guidelines contain important information for therapeutic management of psoriasis. Conclusions: This study provides a unique perspective on the opinions of a large sample of dermatologists as regards current treatment of psoriasis with biologics in Spain (AU)

Obtención y evaluación de etanol a partir de los subproductos del beneficio de café / Production and evaluation of ethanol from coffee processing by-products

En la actualidad se desarrollan numerosas investigaciones para la producción de alcohol a partir de biomasa lignocelulósica. En este estudio, se evaluó el etanol producido a partir de pulpa y mucílago de café, levadura comercial y panela (jugo de caña solidificado y deshidratado). La pulpa y el mucílago del café se hidrolizaron vía acida y el mosto (jugo de pulpa y mucilago) se fermentó con un inóculo de Saccharomyces cerevisiae en fase exponencial, elaborado con panela entera comercial. El producto fermentado se destiló y su análisis mediante cromatografía de gases arrojó un resultado de 25,44 kg/m3de etanol a partir de 64,40 kg/m3de azúcares totales, lo que equivale a un rendimiento del 77,29% respecto al teórico; mostrando que es posible su obtención en pequeñas fincas cafeteras con materias primas de fácil acceso. Se analizaron las vinazas resultantes del proceso, reportando valores de 0,40 ppm (Hierro), 0,97 ppm (Magnesio), 1,54 ppm (Calcio), y 4,40 ppm (Fósforo), lo que las hace particularmente útiles como complemento en el desarrollo de biofertilizantes para la lombricultura.

Disfagia en el anciano / Dysphagia in elderly patients

La disfagia es un síntoma muy prevalente en la población anciana. En enfermos neurológicos, ancianos o personas institucionalizadas su prevalencia puede oscilar entre un 30-60%, con grados de gravedad variables que pueden llegar a hacer necesaria una nutrición artificial. Además, la disfagia está relacionada con mayor discapacidad, estancias hospitalarias prolongadas y mayor mortalidad. Las complicaciones de la disfagia derivan por un lado de una deglución ineficaz, motivo por el que el anciano puede presentar desnutrición y deshidratación y por otro lado de una deglución no segura, que conlleva la presencia de penetraciones, aspiraciones y en el 50% de los casos la aparición de neumonía por aspiración, ésta última con una mortalidad del 50%. Por todo ello es imprescindible un diagnóstico precoz de la misma, mediante métodos clínicos y/o instrumentales y que este diagnóstico lleve siempre implícito un tratamiento y una rehabilitación (AU)

Dysphagia is a prevalent symptom in the older people. The prevalence may range from 30-60% in neurological, elderly or institutionalized patients, with different degrees of gravity that can reach artificial nutritional support. Also, dysphagia is related to greater disability, longer hospital stay and higher mortality. Dysphagia may cause two types of complications in these patients: (a) a decrease in the efficacy of deglutition leading to malnutrition and dehydration, (b) a decrease in deglutition safety, leading to aspiration which results in pneumonia in the 50% of cases with an associated mortality of up to 50%. Therefore, it is essential an early diagnosis of it, using clinical and / or instrumental methods that always carry an implicit diagnosis treatment and rehabilitation (AU)

Evolución y factores de pronóstico en cáncer diferenciado de tiroides / Evolution and prognosis of differentiated thyroid carcinoma

Differentiated thyroid carcinoma has a good prognosis with a 90 percent survival at 10 years. Follicular carcinoma is more aggressive than papillary carcinoma Aim: To study the clinical presentation, evolution and prognosis of differentiated thyroid carcinoma. Material and Methods: The pathological registries of differentiated thyroid cancer processed in a pathology service of a general hospital, between 1984 and 2007, were searched. The clinical records of patients were reviewed. Results: One hundred six pathology registries were identified but only 89 patients had complete medical records. Seventy six patients aged 44 +/- 16 years had a papillary carcinoma and 13 patients aged 42 +/- 15 years had a follicular carcinoma. After a mean follow up of 53 months, 65 patients with papillary and 12 patients with follicular thyroid cancer were alive. Five patients with papillary carcinoma and one with follicular carcinoma had a local or distant relapse. Calculated actuarial survival at 10 years was 84 and 100 percent for papillary and follicular carcinoma, respectively. Ten year survival for stage I, II, III and IV tumors was 100, 92, 68 and 0 percent, respectively. Mortality was associated with the presence of distant metastases, a stage IV tumor, vascular or lymphatic tumor infiltration, tumor size, lymph node involvement, extra capsular invasion and a multi focal lesions. The relative risk for mortality increases between 2.7 and 9 times with the presence of lymph node infiltration and distant metastases. Conclusions: The prognosis of differentiated thyroid cancer is related to lymph node infiltration and the presence of distant metastases.

Los objetivos del presente estudio son identificar la forma de presentación clínica y evolución del cáncer diferenciado de tiroides (CDT); definir la curva de sobrevivencia para ambos tipos histológicos e identificar los factores clínicos e histológicos de mal pronóstico. Se presentan 89 pacientes portadores de cáncer diferenciado (papilar y folicular) de tiroides (75 CP Y 13 CF) tratados en los Hospitales de Coquimbo y La Serena, entre 1984 y 2007. La forma de presentación de ambos tumores fue similar. La mediana de seguimiento fue 53 meses. El 75 por ciento de los pacientes tuvo un seguimiento mínimo de 7 años y el 86,4 por ciento de los pacientes (64 cáncer papilar y 12 cáncer folicular) se encuentran vivos y libres de enfermedad; el intervalo libre de enfermedad fue de 52,7 meses con rango entre 3 meses y 16 años. La sobrevida actuarial a 10 a±os para cáncer papilar es 84 por ciento y, para cáncer folicular 100 por ciento. Por estadios, a los 10 años la sobrevida es de 100 por ciento en estadio I, 92 por ciento en estadio II, 68 por ciento en estadio III y 0 por ciento en estadio IV. El riesgo de muerte se asoció a la presencia de metástasis distantes, T4 e infiltración histológica vascular y/o linfática, p = 0,02. Otros factores no mostraron asociación: tamaño del tumor < T4, compromiso de linfonodos, invasión extracapsular y multifocalidad histológica. Sin embargo, el RR se incrementa 2,7 y 9 veces con invasión linfática o con presencia de metástasis, 1,6 veces con el aumento del tamaño tumoral, y 1,33 con multifocalidad neoplásica en la glándula. La presencia de metástasis linfáticas en cáncer papilar representa un RR de 1,22. Aunque el seguimiento de esta casuística es reducido (mediana 5 años), los resultados sugieren que el mal pronóstico se asocia fundamentalmente a compromiso linfático y metástasis a distancia y, por otra parte, a que el planteamiento terapéutico ha resultado efectivo para el control de la enfermedad en estadio I y II.

Double-blind, randomized, placebo-controlled trial of a cream containing the Stryphnodendron adstringens (Martius) Coville bark extract for suppressing terminal hair growth.

BACKGROUND: Excess of terminal hair can be defined as excessive hair that appears in male-like pattern in women. Some experts consider this condition as a result of an atypical relationship between levels of circulating androgens and sensitivity of androgen receptors in hair follicles to circulating androgens. AIMS: The aim of this research work was to evaluate the efficacy of a topical treatment for suppressing terminal hair growth of a cream containing 6.0% of the Stryphnodendron adstringens bark extract. STUDY DESIGN AND SUBJECTS: Study was randomized, double-blind and placebo-controlled. Subjects with excess of terminal hair were randomized to placebo and to the active treatment (cream with 6.0% of the extract). Evaluation was performed before and after 6 months, and subjects were photographed in each time. Clinical examination was carried out with the same physicians and in accordance with the Ferriman-Gallwey (FG) score. RESULTS: Benefits of the cream containing S. adstringens bark extract was observed in 60.98% (P < 0.001) of the subjects. FG score changed from 4 to 3 in the placebo group compared to 4-2 in the active. The cream suppressed the terminal hair growth and diminished the number of terminal hair. Subjects also described the reduction of skin hyperpigmentation, folliculitis and acne. Adverse events were not verified by physicians or patients. CONCLUSIONS: The cream with 6.0% of the S. adstringens bark extract was effective on the reduction and on the reversion of the terminal hair excess, being considered a new promissory product for such finality.

[Central nervous system neuromodulation for the treatment of epilepsy]. / Neuromodulation du système nerveux central dans le traitement des épilepsies I-Efficacité et sécurité de la méthode.

We present here a review of the work on neuromodulation - defined as application of an inhibitory or excitatory current - on intracranial structures for the treatment of drug-resistant epilepsy. Near 250 patients were treated using a neuromodulation technique of the cerebellum (paravermian cortex), the CM-pf nucleus of the thalamus, the hippocampus, epileptogenic foci, and anterior ventral nucleus of the thalamus, with a one- to 15-year follow-up. Four contact strips were used for cerebellar and functional region neuromodulation, and DBS-type depth electrodes were stereotactically implanted for CM-pf and anterior nuclei of the thalamus and hippocampal neuromodulation. Electric stimulation was cyclic in almost all trials, using low frequency (10-40 Hz) for excitation and high frequency (60-185 Hz) for inhibition. Seizure frequency reduction was variable, depending on the neuromodulation site and patient selection, although seizure duration decreased in most patients. Cerebellar neuromodulation was followed by a 78% reduction in tonic and tonic-clonic seizures, CM-pf neuromodulation by an 83% reduction in tonic-clonic seizures and atypical absence of Lennox-Gastaut syndrome, with a 17.2% seizure-free and drug-free patient rate. Hippocampal neuromodulation was followed by a 73% reduction in partial complex seizures, with a 33% seizure-free patient rate. Anterior ventral nucleus of the thalamus was followed by a 63% reduction in tonic-clonic, tonic and atonic seizures. Several prognostic factors were identified in order to improve future results. There was no mortality and morbidity was limited to skin erosion at the neurostimulator site. Seizure reduction was associated with improved neuropsychological performance and better quality of life. Neuromodulation is safe and effective for the treatment of epileptic seizures of various origins. Several targets may be associated in a single patient, especially when bilateral hippocampal seizure foci are present.

Neuromodulation of prelemniscal radiations in the treatment of Parkinson's disease.

In patients with Parkinson's disease (PD), tetrapolar electrodes were implanted in the prelemniscal radiations (RAPRL) to treat tremor, rigidity and bradykinesia. Fifteen patients were implanted unilaterally and five patients bilaterally and followed-up for one year. The selection criteria included the presence of unilateral pronounced tremor and rigidity in patients implanted unilaterally or bilateral symptoms including severe bradykinesia in patients implanted bilaterally. In the operating room, the tremor decreased significantly or was abolished following the insertion of the electrode in the RAPRL. This effect was temporary and subsided when the stimulation was off. However, when the stimulator was turned on, the severity of the symptoms and signs decreased significantly. The post-implantation MRI confirmed that the electrode contacts used for stimulation were inserted in RAPRL, a group of fibers located between the red nucleus and subthalamic nucleus, above the substantia nigra, medially to the zona incerta and below the thalamus. The patients were evaluated using the UPDRS part III, before implantation and every 3 months during the first year. Global scores decreased significantly. The pre- and postoperative median values (range in round brackets) were as follows: tremor improved from 3 (2-16) to 1 (2-3) (p<0.001); rigidity was either abolished or decreased markedly from 2 (1-16) to 0 (0-4) (p< 0.001); bradykinesia improved from 2 (0-4) to 1 (0-2) (p<0.001). We conclude that RAPRL, an area anatomically different from STN, is a good target for electrical stimulation in order to treat effectively all the main symptoms of PD.

Neuromodulation of the inferior thalamic peduncle for major depression and obsessive compulsive disorder.

Neuromodulation of the inferior thalamic peduncle is a new surgical treatment for major depression and obsessive-compulsive disorder. The inferior thalamic peduncle is a bundle of fibers connecting the orbito-frontal cortex with the non-specific thalamic system in a small area behind the fornix and anterior to the polar reticular thalamic nucleus. Electrical stimulation elicits characteristic frontal cortical responses (recruiting responses and direct current (DC)-shift) that confirm correct localization of this anatomical structure. A female with depression for 23 years and a male with obsessive-compulsive disorder for 9 years had stereotactic implantation of electrodes in the inferior thalamic peduncle and were evaluated over a long-term period. Initial OFF stimulation period (1 month) showed no consistent changes in the Hamilton Depression Scale (HAM-D), Yale Brown Obsessive Compulsive Scale (YBOCS), or Global Assessment of Functioning scale (GAF). The ON stimulation period (3-5 V, 130-Hz frequency, 450-msec pulse width in a continuous program) showed significant decrease in depression, obsession, and compulsion symptoms. GAF improved significantly in both cases. The neuropsychological tests battery showed no significant changes except from a reduction in the perseverative response of the obsessive-compulsive patient and better performance in manual praxias of the female depressive patient. Moderate increase in weight (5 kg on average) was observed in both cases.

[Theoretical model of a cost-effectiveness analysis of combined enalapril-nitrendipine therapy for treating hypertension]. / Modelo teórico de análisis coste-efectividad de la terapia combinada de enalapril-nitrendipino en el tratamiento de la hipertensión arterial.

OBJECTIVE: Cost-effectiveness analysis of combined enalapril-nitrendipine therapy (E/N), as second-line therapy for light or moderate hypertension. DESIGN: Theoretical model of cost-effectiveness, based on the norms of hypertension treatment in primary care, the considered view of a panel of experts and the direct costs of health resources and purchase of medication. SETTING: Spanish National Health system. PARTICIPANTS: Simulation of 1000 patients with hypertension, with a time horizon of one year. INTERVENTIONS: After a prior failure of the first-line treatment with either enalapril or nitrendipine, an evaluation was made of the possibilities of increasing dosage of the first-line treatment, changing the drug or administering the E/N combination. MAIN MEASUREMENT: The likelihoods, in the primary care context, of controlling diastolic pressure, of abandonment and of using the two strategies or not were measured, as were the use of health resources in each situation, and costs of resource use and of medication. RESULTS: The cost-effectiveness quotient of the combined E/N treatment was consistently more efficient than the increase in dose or change to another drug. This was so, whether the treatment was started with enalapril (301.06 euros vs 337.97 euros and 588.42 euros) or with nitrendipine (331.5 euros vs 469.88 euros and 579.76 euros). CONCLUSIONS: Combined therapy (E/N) is, on the basis of the assumptions made in the model, an efficient therapy option. Therefore, it can be recommended for prescription.

Electrical stimulation of the prelemniscal radiation in the treatment of Parkinson's disease: an old target revised with new techniques.

OBJECTIVE: In the treatment of tremor and rigidity in patients with Parkinson's disease (PD), the prelemniscal radiation (RAPRL), a subthalamic bundle of fibers, is an exquisite target that can be visualized easily on ventriculograms. We sought to evaluate the effect of electrical stimulation of the RAPRL on symptoms and signs of PD in a long-term trial and to determine the localization of the stimulated area by means of stereotactic magnetic resonance imaging studies. METHODS: Ten patients with PD predominantly on one side had tetrapolar electrodes stereotactically oriented through a frontal parasagittal approach to the RAPRL contralateral to the most prominent symptoms. Preoperative and postoperative evaluations at 3, 6, 9, and 12 months after surgery were performed using conventional PD scales and quantitative evaluations of tremor amplitude and reaction time. Stereotactic high-resolution magnetic resonance imaging studies with the electrodes in place were used for anatomic localization. RESULTS: In all patients, temporary suppression of tremor occurred when the electrodes reached the target. The most effective stimulation was obtained when the pair of contacts was placed in the RAPRL. Long-term stimulation at 130 Hz, 0.09 to 0.450 milliseconds, and 1.5 to 3.0 V produced significant improvement in tremor and rigidity and mild improvement in bradykinesia. CONCLUSION: The RAPRL is an effective target for the alleviation of tremor and rigidity in patients with PD by either lesioning or neuromodulation; however, neuromodulation has the advantage of not inducing an increase in bradykinesia. The stimulated area seems to be independent of the subthalamic nucleus.

Semipersonalized psychological evaluation of quality of life in hypertensive patients during a trial with two calcium antagonists: a multicenter Latin-American Study (LASTLHY).

OBJECTIVE: The main objective of this study was to evaluate well-being and physical activity of 248 hypertensive patients, including 177 females, who had previously been included in the Latin-American Study on Lacidipine in Hypertension (LASTLHY). SUBJECTS, MATERIALS AND METHODS: This open study was carried out in 12 clinical centers in Argentina, Brazil, Colombia, Mexico and Venezuela, to compare, over a period of 16 weeks, the antihypertensive action of a fixed-dose, once daily of 4 mg lacidipine administered orally to 120 patients and 30 mg nifedipine GITS (Gastro-Intestinal Therapeutic System) administered to 128 patients, aged between 40 and 65 years. All patients had mild to moderate hypertension and treatment was begun at the end of a one-week placebo run-in period (end of week -1). Well-being and physical activity were assessed by means of single questionnaire, which reflected the physical and cultural diversities amongst the clinical centers and patients. The questionnaire included 13 multiple-choice and 8 contingent open questions. The score of each question was multiplied by a coefficient related to the importance of each question to the patient (semipersonalization); the coefficient was obtained from cultural and socioeconomic data collected at the time of enrollment. The semipersonalization was carried out by a blind psychological study with respect to the medication and had a high repeatability in the assignment of personalized coefficients to the score of each question. The scores of each question were added to obtain an overall well-being and activity scoring. The possible theoretical range for the overall scoring in this study was 10 - 124. RESULTS: See Table 1. CONCLUSION: The study revealed that the administration of calcium channel blockers such as lacidipine and nifedipine GITS, and lacidipine in particular, produced low incidence of side effects, and lacidipine in particular induced significant improvement in the quality of life.