Potential roles of Helicobacter pylori treatment, body mass index and waist circumference in the causation of erosive esophagitis: a randomized clinical trial (HEROES-GERD).

BACKGROUND: In recent decades, the prevalence of gastroesophageal reflux disease (GERD) and obesity has been increasing while Helicobacter pylori infection has been decreasing. OBJECTIVE: To evaluate if H. pylori treatment, excess body weight and other anthropometric measurements are associated with incident erosive esophagitis, as a secondary objective of a trial which tested the efficacy of treatment of H. pylori on the symptoms of functional dyspepsia. SUBJECTS/METHODS: Upper gastrointestinal endoscopy and anthropometric assessments were performed, at baseline and after 12 months, in H. pylori positive patients with functional dyspepsia who had no baseline reflux symptoms or esophagitis. Patients were randomly assigned to receive omeprazole, amoxicillin, and clarithromycin (antibiotic group; n = 201) or omeprazole plus placebo (control group; n = 203). The primary outcome was the incidence of esophagitis 12 months after randomization, according to treatment groups, and the association of BMI and other anthropometric measurements. RESULTS: Four hundred and four patients were included (mean age, 46.1 years; 78.7% women). The 12-month follow-up endoscopic esophagitis rates for the antibiotic and control groups were 10.9% (22/201) and 9.4% (19/203), respectively (p = 0.60). The number needed to harm was 67. Baseline anthropometric measurements were performed in 94% (380/404) of patients. The 12-month follow-up esophagitis rates for overweight and normal body weight patients were 13.6% (29/213) and 6.0% (10/167), respectively (p = 0.015); rates for patients with and without increased baseline waist circumference were 15.4% (24/156) and 6.7% (15/224), respectively (p = 0.006). Following logistic regression, only the combination of increased baseline body mass index and waist, but not H. pylori treatment, was independently associated with new-onset esophagitis (OR 2.88; 95% CI: 1.28-6.45). CONCLUSIONS: Excess body weight and concomitant increased waist circumference, but not H. pylori treatment, predicts new-onset esophagitis.

Criptococose mucocutânea nasal: um relato de caso / Nasal mucocutaneous cryptococcosis: a case report

Paciente feminina, 47 anos, hipertensa e tabagista, em uso crônico de corticoide, apresentou lesões em pele e mucosa nasal, com dor local; tratado empiricamente como sinusite. Houve piora das lesões, com ulceração. Após nove meses do início dos sintomas, foi realizada biópsia da lesão, revelando o anatomopatológico uma micose cutânea sugestiva de criptococose. A paciente foi diagnosticada com infecção pelo vírus da imunodeficiência humana (HIV) e, então, internada em hospital de referência, tendo recebido tratamento com fluconazol 800mg/dia endovenoso, a seguir, fluconazol 800mg/dia oral até completar 12 semanas de tratamento. Houve resolução da lesão ulcerada e posterior fibrose da narina esquerda

A 47-year-old woman, carrier systemic hypertension, tobacco user, and chronic user of corticosteroids, showed skin and nasal mucosa lesions, with local pain; treated empirically as sinusitis. The lesions evolved with increased ulceration. After nine months of symptoms onset, the lesion was biopsied, revealing fungal skin pathology suggestive of cryptococcosis. The patient was diagnosed with an HIV infection. The patient was then hospitalized in a specialized hospital and treated with intravenous fluconazole 800mg/day, followed by fluconazole 800mg daily orally up to 12 weeks of treatment. There was resolution of the ulcerated lesion and subsequent fibrosis of the left nostril