Assessment of the Benefit of a Deep Cleansing Gel Containing Salicylic Acid 2%, Zinc Gluconate 0.2% and Lipohydroxy Acids 0.05% in Patients with Mild to Moderate Truncal Acne: Results from an Exploratory Study.

Purpose: Acne is a skin condition of the pilosebaceous unit that affects mainly the face, chest and trunk. Approximately 50% of subjects with facial acne also have acne of the trunk. This study investigated the clinical benefit of a cleansing gel containing salicylic acid 2%, zinc gluconate 0.2% and lipohydroxy acid 0.05% in truncal acne after 84 days of daily use. Materials and Methods: A single center, open label, non-randomized study with 51 subjects with mild to moderate truncal acne was conducted. Thirty-five (35) subjects completed the study; mean age was 23 years. Inflammatory and non-inflammatory lesions, Transepidermal water loss (TEWL) and local tolerance were assessed at baseline, Day 42 and Day 84 and total lesion count was calculated. Results: The total lesion count was significantly reduced (p<0.05) after 42 days (-21.5%) and 84 days (-56.3%). Non-inflammatory lesions were significantly decreased after 84 days (-64.0%) only, while inflammatory lesions were decreased at Day 42 (-29.2%), and Day 84 (-48.2%). A statistically significant skin barrier improvement was observed at Day 84 (-21.26%). No adverse events or relevant local intolerance were reported. Conclusion: The use of the cleansing gel studied was effective in improving mild to moderate truncal acne and contributed to the skin barrier improvement. The product was well tolerated. Clintrial Data Base Identifier: NCT05584150.

Benefits of topical hyaluronic acid for skin quality and signs of skin aging: From literature review to clinical evidence.

Skin aging goes beyond a chronological process and also results from extrinsic factors referred to as the exposome. Hyaluronic acid (HA) is an important component of the extracellular matrix, with loss starting at 25 years old. While many studies of HA concern topical use, few literature reviews only address the use of topical HA in dermatology. This review describes the different characteristics of HA-containing cosmeceuticals, with a focus on skin aging and the impact of exposome factors on HA synthesis and degradation. A review was performed using the terms HA, hyaluronan, topical, dermatology, cosmetic, aging treatment, exposome, and cosmeceuticals. Results are also presented from a recent randomized controlled trial (RCT), which investigated the additional benefit of using a HA epidermic filler (HA-filler serum) combined with Botulinum toxin type A (BoNTA) to treat signs of skin aging. Subjects were randomized to two groups: HA-filler serum starting 24 h after the BoNTA injection then twice daily for 24 weeks, or the control group, which received BoNTA. HA is a key ingredient used in cosmeceuticals for its hydration/antiaging properties (hygroscopic, rheological, and viscoelastic). Several clinical studies indicate that HA is both well tolerated and effective, adjuvant to both post-surgical and facial rejuvenation procedures. In the RCT, one of few studies to combine BoNTA and HA with a 6-month follow-up, the HA-filler serum lengthened the duration of BoNTA's effect in reducing wrinkles. Numerous studies support HA-based cosmeceuticals as a noninvasive, effective solution for improving skin hydration and rejuvenation.

Efficacy of a topical serum containing L-ascorbic acid, neohesperidin, pycnogenol, tocopherol, and hyaluronic acid in relation to skin aging signs.

BACKGROUND: Skin aging is a process regulated by chronological aging and amplified by exposome factors including chronic UV exposure and pollution, which both induce reactive oxygen species. Topical antioxidants have the potential to counteract this process and to improve skin aging signs, including wrinkles and hyperpigmentation. OBJECTIVE: To evaluate the efficacy of a topical antioxidant serum containing 15% L-ascorbic acid, neohesperidin, Pinus pinaster bark, tocopherol, and hyaluronic acid (HA) ex vivo on air pollution-induced pigmentation and gene expression, as well as in vivo on skin aging signs in Brazilian volunteers, after 90 days of use. METHODS: Ex vivo human skin samples were repetitively exposed to Diesel Exhaust Particles (DEP) and subsequently analyzed for changes in pigmentation and gene expression. Clinical efficacy was evaluated in 40 healthy adult females with phototype II to IV and visible photoaging signs, including facial hyperpigmentation, through dermatological evaluation and instrumental analysis including Reflectance Confocal Microscopy. RESULTS: Ex vivo, the topical antioxidant serum significantly reduced DEP-induced skin pigmentation and expression of proinflammatory genes. A significant improvement of skin aging signs was observed after 90 days. Local tolerance was good. CONCLUSION: The tested serum is effective in protecting human skin ex vivo against air pollution-induced skin pigmentation/aging and reduced in vivo skin aging signs, with a good safety profile after 90 days of daily use.

Low-dose midazolam for anxiolysis for pregnant women undergoing cesarean delivery: a randomized trial.

INTRODUCTION: Anxiety and fear are common among pregnant women undergoing cesarean delivery. In addition to psychologically unpleasant, they can elicit endocrine and metabolic changes. Administration of benzodiazepines in this patient group is uncommon and investigation focusing on the topic is rare. This study aimed to determine anxiolysis efficacy of low-dose midazolam administered preoperatively, right before cesarean delivery, and to evaluate whether its administration impacts neonatal vitality, maternal consciousness, and recall of the moment the baby was born. METHODS: Fifty pregnant women with indication for cesarean delivery were included in this randomized, double-blind, placebo-controlled clinical study and allocated into two groups of 25 participants each (Midazolam and Control group). Midazolam (0.0125 mg.kg-1) or a placebo solution was administered immediately before spinal anesthesia and the anxiolytic effect was assessed using a visual analogue scale before and after administration. We registered the Apgar score at 1 and 5 minutes, the Ramsay scale and recall of the moment of birth, that was assessed 90 minutes after birth. RESULTS: Pregnant women from the Midazolam group presented a 1.3-point reduction in anxiety on the visual analogue scale, while the Control group showed virtually no change (p = 0.027). We observed no statistically significant changes in Apgar scores, level of maternal consciousness and recall of the moment of delivery. CONCLUSIONS: Low-dose midazolam can provide anxiety management in pregnant women undergoing cesarean delivery with no significant undesirable effects.

Clinical evaluation of the efficacy of a facial serum containing dioic acid, glycolic acid, salicylic acid, LHA, citric acid, and HEPES in treating post-inflammatory hyperchromia and controlling oily skin in patients with acne vulgaris.

BACKGROUND: Acne is a chronic disease that affects the pilosebaceous follicle and is characterized by the presence of non-inflammatory and/or inflammatory lesions, affecting both adolescents and adults. Inflammatory acne lesions are capable to increase their melanin production and promote a post-inflammatory hyperchromia. AIMS: To assess the efficacy of a serum containing dioic acid, glycolic acid, salicylic acid, LHA, citric acid, and HEPES in treating post-inflammatory hyperpigmentation and controlling skin oiliness in Brazilian patients with acne vulgaris. PATIENTS/METHODS: A single-center, prospective, open-label clinical study included 42 subjects, from both genders, presenting acne (grade I or II), oily skin and a clinical diagnosis of acne post-inflammatory hyperpigmentation. The study was conducted for 56 days, with clinical (skin quality and the number of post-inflammatory hyperchromic lesions) and instrumental (Sebumetry) evaluations after 7, 28, and 56 days of treatment. Standardized pictures were obtained using a VISIA-6® device. RESULTS: A significant decrease in the grade of post-inflammatory hyperchromic lesions was observed after 28 and 56 days, while the number of lesions decreases by 29.4% after 56 days (p < 0.001). Sebumetry values showed a significant decrease of 30.7% in the oiliness after 7 days of treatment, and then stable during the study conduction period of 56 days (p < 0.001 for all measurements). CONCLUSIONS: The daily treatment using the investigational product showed an interesting decrease both in the grade and the number of post-inflammatory hyperchromia acne lesions after 56 days, and in the oiliness after 7 days, being stable for all study period.

Águas termais: da balneoterapia à genômica / Thermal spring waters: From balneotherapy to genomics

O presente artigo de revisão relata os dados científicos disponíveis sobre a água termal La Roche-Posay e esclarece seus mecanismos de ação, suas indicações e seus benefícios clínicos. Além disso, estudos clínicos e avaliação genômica do microbioma da pele demonstraram que esta água termal melhora a diversidade do microbioma da pele e reduz a gravidade das lesões cutâneas em dermatoses inflamatórias, tais como dermatite atópica e psoríase. Justifica-se, portanto, o uso de água rica em selênio em formulações tópicas na prevenção ou tratamento de doenças de pele e como coadjuvante para aumentar a qualidade de vida dos pacientes dermatológicos.

This review article reports the scientific data available on La Roche-Posay thermal water and clarifies its mechanisms of action, indications, and clinical benefits. Clinical studies and genomic evaluation of the skin microbiome have shown that La Roche-Posay thermal water improves the skin microbiome's diversity and reduces the severity of skin lesions in inflammatory dermatoses, such as atopic dermatitis and psoriasis. Therefore, it justifies the use of selenium-rich water in topical formulations to prevent or treat skin diseases and as an adjunct to increase dermatological patients' quality of life

Estudo monocêntrico, prospectivo para avaliar a eficácia e a tolerabilidade de formulação cosmecêutica em pacientes com melasma / Monocentric prospective study for assessing the efficacy and tolerability of a cosmeceutical formulation in patients with melasma

Introdução: O melasma é doença pigmentar frequente que acomete áreas expostas, principalmente nas regiões frontal e malar. A hidroquinona se mostra ativo eficaz no tratamento da hiperpigmentação; no entanto, devido a problemas com sua tolerabilidade, diversos estudos são conduzidos para desenvolver alternativas terapêuticas com eficácia equivalente. Objetivo: Avaliar a eficácia e tolerabilidade de formulação cosmecêutica contendo ácido elágico, ácido hidroxifenoxi propiônico, extrato de levedura e ácido salicílico em pacientes brasileiros apresentando melasma leve a moderado. Métodos: 40 pacientes portadores de melasma leve a moderado na face utilizaram o cosmecêutico duas vezes ao dia, associado a filtro solar durante 90 dias. Foram feitas avaliações subjetivas de eficácia e tolerabilidade, medida do grau Masi e questionário MelasQoL-BP. A avaliação da luminosidade da pele e das características colorimétricas foram obtidas por meio de colorimetria. Resultados: Após 90 dias de tratamento, observou-se melhora significativa nos parâmetros clínicos avaliados, nos parâmetros colorimétricos, no questionário de qualidade de vida e no escore Masi em 43%. O tratamento se mostrou eficaz sem causar eventos adversos. Conclusões: A formulação cosmecêutica avaliada demonstrou ser alternativa eficaz à hidroquinona para o tratamento do melasma com excelente perfil de tolerabilidade cutânea.

Introduction: Melasma is a common pigmentary condition that affects exposed body areas, especially in the frontal and malar regions. Hydroquinone is an effective active principle in the treatment of hyperpigmentation, however, due to issues linked to its tolerability, many studies are being conducted aimed at developing alternative therapies with equivalent effectiveness. Objective: To evaluate the efficacy and tolerability of a cosmeceutical formulation containing ellagic acid, hydroxyphenoxy propionic acid, yeast extract and salicylic acid in Brazilian patients with mild to moderate melasma. Methods: Forty patients with mild to moderate melasma on the face used the cosmeceutical twice daily, combined with sunscreen for 90 days. Subjective assessments of efficacy and tolerability were carried out. Measurements of the MASI grade and the application of the MELASQoL-BP questionnaire were also performed. The evaluation of the skin's brightness and the colorimetric characteristics were obtained by colorimetry. Results: After 90 days of treatment, a significant improvement could be observed in the clinical and colorimetric parameters evaluated, and in the quality of life questionnaire. In addition, the MASI score improved by 43%. The treatment was effective without causing adverse events. Conclusions: The evaluated cosmeceutical formulation was proven as an effective alternative to hydroquinone for the treatment of melasma, with excellent cutaneous tolerability profile.

High prevalence of subclinical hypothyroidism and nodular thyroid disease in patients on hemodialysis.

Chronic kidney disease has been known to affect thyroid hormone metabolism. Low serum levels of T3 and T4 are the most remarkable laboratorial findings. A high incidence of goiter and nodules on thyroid ultrasonography has been reported in patients with end-stage renal disease (ESRD). Our objective is to evaluate the prevalence of laboratorial and morphologic alterations in the thyroid gland in a cohort of patients with ESRD on hemodialysis (HD). Sixty-one patients with ESRD on HD were selected and compared with 43 healthy subjects matched by age, gender, and weight. Patients were submitted to thyroid ultrasonography. T3, free T4 (FT4), thyroid-stimulating hormone, antithyroglobulin, and antithyroperoxidase antibodies were measured. The mean age of patients with ESRD was 47.4 ± 12.3 and 61% were women. ESRD was mainly caused by hypertensive nephrosclerosis and diabetic nephropathy. Mean thyroid volume, as determined by ultrasonography, was similar in both groups. Patients with ESRD had more hypoechoic nodules when compared with the control group (24.1% vs. 7.9%, P = 0.056). Mean serum FT4 and T3 levels were significantly lower in patients with ESRD, and subclinical hypothyroidism was more prevalent in patients with ESRD (21.82% vs. 7.14% control group, P = 0.04). Titers of antithyroid antibodies were similar in both groups. ESRD was associated with a higher prevalence of subclinical hypothyroidism and lower levels of T3 and FT4. Almost a quarter of patients showed thyroid nodules >10 mm. Periodic ultrasound evaluation and assessment of thyroid function are recommended in patients with ESRD on HD.

Avaliação da eficácia e tolerabilidade da dapagliflozina quando adicionada à terapia combinada de metformina e sulfoniluréia no tratamento de diabetes mellitus tipo2 / Evaluation of the efficacy and tolerability of dapagliflozin when added to metformin and sulfonylurea combination therapy in the treatment of type 2 diabetes mellitus

O Diabetes Mellitus é uma condição crescente em todo o mundo. Em pacientes DM2, um ótimo controle glicêmico é dificilmente alcançado ou mantido a longo-prazo, independente do tratamento. Apenas 25% dos pacientes estão bem controlados após 9 anos de doença. A fisiopatologia complexa e a natureza progressiva do DM2, muitas vezes, tornam ineficaz o tratamento em monoterapia com os agentes anti-diabéticos disponíveis atualmente. Afim de, evitar a progressão da doença, é fundamental uma intervenção terapêutica precoce para preservar a função das células ß e aumentar a sensibilidade à insulina. A associação medicamentosa mais frequente utilizada no Brasil é metformina com sulfoniuréia. Porém, assim como em monoterapias, um controle glicêmico ideal pode não ser atingido. Em janeiro de 2014, foi liberado pela Food and Drug Administration, o uso e comercialização de um novo medicamento para tratamento do DM2, a dapagliflozina. Um bloqueador do SGLT2, proteína responsável pela reabsorção da glicose no rim, levando a glicosúria com consequente melhora do controle glicêmico. Sua adição a outros hipoglicemiantes orais mostrou redução significativa dos níveis séricos de HbA1c, com resultados promissores em relação a eficácia e segurança, ou seja, uma nova abordagem terapêutica com potencial para o tratamento do DM2. Objetivos: Revisão bibliográfica e apresentação dos resultados iniciais da eficácia e a tolerabilidade da adição da dapagliflozina ao tratamento de pacientes com DM2 em uso de metformina e sulfoniluréia. Métodos: Estudo de coorte prospectivo com a randomização de pacientes com DM2, em uso regular de metformina associada à sulfoniluréia por no mínimo 12 semanas e controle glicêmico inadequado. Os pacientes que preencherem os critérios receberam dapagliflozina na dose de 10mg/dia por 12 semanas, em dose diária única. Variáveis como níveis séricos de HbA1c, glicemia de jejum, insulina, perfil lipídico, creatinina, urina 1, urocultura, índice de massa corpórea (definido com peso/altura²), circunferência abdominal e pressão arterial foram avaliados no início e após a introdução do tratamento. Efeitos colaterais previstos em bula e demais reações adversas durante o uso da medicação foram questionados, tratados com suspensão imediata do fármaco e exclusão do estudo. Resultados: 6 pacientes completaram tratamento. Os níveis de glicemia de jejum apresentaram redução de16,12% em relação aos valores iniciais. HbA1c foi dosada inicialmente nos pacientes, porém devido dificuldades técnicas o exame não foi realizado no controle. Redução de peso ocorreu na maioria dos pacientes, porém em porcentagem menor do que a descrita pelos trabalhos realizados em monoterapia. O efeito-colateral mais temido da medicação, a infecção de trato genito-urinário, não teve repercussão importante em nossa casuística. Conclusão: Não existe um único antidiabético que possa corrigir todos os distúrbios metabólicos. Portanto, uma terapia eficaz exige múltiplas drogas em combinação. Inibidores do SGLT2 podem ser utilizados como monoterapia e em combinação com outros anti-diabéticos. Apesar de se tratar de uma medicação em fase III e os resultados obtidos até o momento revelarem um importante impacto no tratamento de DM2, novos estudos são necessários para avaliar os resultados de segurança, os efeitos a longo prazo e as complicações diabéticas.

Avaliação da eficácia e tolerabilidade da dapagliflozina quando adicionada à terapia combinada de metformina e sulfoniluréia no tratamento do diabetes mellitus tipo 2 / Efficacy and tolerability of dapagliflozin when added to combination therapy of metformin and sulfonylurea in the treatment of type 2 diabetes mellitus

Introdução: O Diabetes Mellitus é uma condição crescente em todo o mundo. Em pacientes DM2, um ótimo controle glicêmico é dificilmente alcançado ou mantido a longo-prazo, independente do tratamento. A fisiopatologia complexa e a natureza progressiva do DM2, muitas vezes, tornam ineficaz o tratamento em monoterapia com os agentes anti-diabéticos disponíveis atualmente. Afim de, evitar a progressão da doença, é fundamental uma intervenção terapêutica precoce para preservar a função das células β e aumentar a sensibilidade à insulina. Objetivos: Revisão bibliográfica e apresentação dos resultados iniciais da eficácia e a tolerabilidade da adição da dapagliflozina ao tratamento de pacientes com DM2 em uso de metformina e sulfoniluréia. Métodos: Estudo de coorte prospectivo com a randomização de pacientes com DM2, em uso regular de metformina associada à sulfoniluréia por no mínimo 12 semanas e controle glicêmico inadequado. Os pacientes que preencherem os critérios receberam dapagliflozina na dose de 10mg/dia por 12 semanas, em dose diária única. Níveis variáveis foram avaliados no início e após a introdução do tratamento. Resultados: 6 pacientes completaram tratamento. Os níveis de glicemia de jejum apresentaram redução de 16,12% em relação aos valores iniciais. Redução de peso ocorreu na maioria dos pacientes e o efeito-colateral mais temido da medicação, a infecção de trato genito-urinário, não teve repercussão importante em nossa casuística. Conclusão: Não existe um único antidiabético que possa corrigir todos os distúrbios metabólicos. Portanto, uma terapia eficaz exige múltiplas drogas em combinação. Inibidores do SGLT2 podem ser utilizados como monoterapia e em combinação com outros anti-diabéticos.(AU)

Torre de Hanói: proposta de utilização do instrumento para sujeitos de 13 a 16 anos / Tower of Hanoi: proposal to use the instrument for subjects 13 to 16 years

Este trabalho propõe padrão de aplicação e estudo normativo da Torre de Hanói (ToH) para população brasileira. Participaram 60 estudantes de 13 a 16 anos. Foram feitos treinos com 3 e 4 peças, 5 vezes cada um. Os resultados sugerem que houve efeito de aprendizagem, com queda do número de movimentos e do tempo. No primeiro treino com 4 peças, houve aumento dos movimentos e do tempo, que foi decrescendo com os treinos, sugerindo que aplicação repetida de ToH automatiza a resposta, requer uso do planejamento, da flexibilidade mental e busca de nova estratégia de sucesso. (AU)

This study proposes a standard application and normative data of Tower of Hanoi (ToH) for Brazilian population. 60 students, age 13 to 16, had participated. They did made trials with 3 and 4 pieces, 5 times each one. The results indicated that it had been learning effect, with the increase of number of movements and time. On the first trial with 4 pieces, it had been a time and movement increase, which was decreasing with the trials, suggesting that repeated application of ToH automatizes the response, and also requires planning, shifting and of new solution searching. (AU)