Herniated superficial lipomas in gluteal and thigh support areas: a special clinical ultrasound presentation.

BACKGROUND: Lipomas are the most frequent benign tumor. They have been described as soft, well-defined, slow-growing palpable masses, and classified as deep or superficial. PURPOSE: To present the clinical and ultrasound findings of herniated superficial subcutaneous lipoma (HSL), located in pressure/support areas, not previously described. MATERIAL AND METHODS: A seven-year retrospective review was performed. Patients with a preoperative high-resolution ultrasound (HRUS) diagnosis of HSL archived in the computational system and histological study information were selected. RESULTS: A total of 37 patients (mean age = 46 years) were recruited. The clinical diagnoses were "lipoma" or "suspected lipoma" in just 46% of the cases. This was three times more frequent in women. Tumors were located mainly in the gluteal (38%) and proximal thigh areas (35%). Clinically, all patients showed small, soft, rounded skin nodules. On HRUS, they appear as lipomatous tumors that protruded, compressed, and thinned the covering dermal layer. The subcutaneous portion was bigger than the herniated part, with an iceberg image. CONCLUSION: HSL in support areas have a special clinical ultrasound presentation, not previously described. It is important to recognize them for a proper diagnosis and treatment, especially because they clinically may present as small superficial lesions; however, they are associated with a larger subcutaneous portion (iceberg image). It is probable that an estrogen influence on the adipose tissue can be suspected because of the female predominance.

Time-restricted eating and exercise training improve HbA1c and body composition in women with overweight/obesity: A randomized controlled trial.

Diet modification and exercise training are primary lifestyle strategies for obesity management, but poor adherence rates limit their effectiveness. Time-restricted eating (TRE) and high-intensity interval training (HIIT) improve cardiometabolic health in at-risk individuals, but whether these two interventions combined induce superior improvements in glycemic control than each individual intervention is not known. In this four-armed randomized controlled trial (ClinicalTrials.gov NCT04019860), we determined the isolated and combined effects of 7 weeks of TRE (≤10-h daily eating window, with ad libitum energy intake) and HIIT (three exercise sessions per week), compared with a non-intervention control group, on glycemic control and secondary cardiometabolic outcomes in 131 women (36.2 ± 6.2 years) with overweight/obesity. There were no statistically significant effects after isolated TRE, HIIT, or a combination (TREHIIT) on glucose area under the curve during an oral glucose tolerance test (the primary outcome) compared with the control group (TRE, -26.3 mmol/L; 95% confidence interval [CI], -82.3 to 29.7, p = 0.36; HIIT, -53.8 mmol/L; 95% CI, -109.2 to 1.6, p = 0.057; TREHIIT, -41.3 mmol/L; 95% CI, -96.4 to 13.8, p = 0.14). However, TREHIIT improved HbA1c and induced superior reductions in total and visceral fat mass compared with TRE and HIIT alone. High participant adherence rates suggest that TRE, HIIT, and a combination thereof may be realistic diet-exercise strategies for improving markers of metabolic health in women at risk of cardiometabolic disease.

Isolated and combined effects of high-intensity interval training and time-restricted eating on glycaemic control in reproductive-aged women with overweight or obesity: study protocol for a four-armed randomised controlled trial.

INTRODUCTION: Overweight and obesity in reproductive-aged women is a global problem due to the increased risk of subfertility, pregnancy complications and cardiometabolic diseases. High-intensity interval training and time-restricted eating are two primary lifestyle interventions that, independently, have positive effects on a range of health outcomes. Whether these two strategies have synergistic effects is currently unknown. Our primary aim is to determine the isolated and combined effect of high-intensity interval training and time-restricted eating on glycaemic control in reproductive-aged women with overweight/obesity. METHODS AND ANALYSIS: The study is a randomised controlled trial with four parallel groups. Women (N=120) aged 18-45 years with body mass index ≥27 kg/m2 will be randomly allocated (1:1:1:1) to either: (1) high-intensity interval training, (2) time-restricted eating, (3) a combination of high-intensity interval training and of time-restricted eating, or (4) a control group. The duration of each intervention will be 7 weeks. The primary outcome measure will be glycaemic control, determined by the total area under the plasma glucose curve over 2 hours after a 75-gram oral glucose tolerance test. Secondary outcome measurements will include markers of cardiovascular and metabolic health (peak oxygen uptake, blood pressure, blood lipids, body composition, insulin sensitivity), sleep quality, physical activity, diet and adherence rates to the intervention. ETHICS AND DISSEMINATION: The Regional Committee Medical Research Ethics, Norway has approved the trial protocol. This study will provide important new knowledge to both the scientific community and the general population about the isolated and combined effects of two novel diet-exercise strategies on cardiovascular and metabolic health among women with overweight/obesity. TRIAL REGISTRATION NUMBER: NCT04019860.

Comparison of Supraglottic Activity and Spectral Slope Between Theater Actors and Vocally Untrained Subjects.

PURPOSE: The present study aimed to assess supraglottic activity in theater actors and to observe whether they present differences compared with subjects with no voice training. Acoustic and perceptual analyses were also performed. METHODS: A total of 20 participants were divided into two groups: an experimental group of trained theater actors, and a comparative group of subjects with no voice training. Absence of laryngeal pathology was confirmed by rigid videostroboscopy. Flexible laryngoscopy was performed to assess supraglottic activity during speaking phonatory tasks. Voice recording was also carried out. Four blinded judges were asked to assess laryngoscopic and perceptual variables using a visual analog scale. A comparison between groups, phonatory tasks, and loudness levels was performed. RESULTS: Multivariate linear regression showed that trained participants had a higher degree of both laryngeal and pharyngeal activities compared with untrained participants. Moreover, phonatory tasks at high intensity showed higher activity than those at medium and low intensities for most phonatory tasks and laryngoscopic parameters. Vocally trained participants evidenced higher values for all spectral variables compared with untrained participants. CONCLUSION: Actors have a greater degree of both laryngeal and pharyngeal activities than vocally untrained subjects. Apparently, this higher activity is associated to speaking voice training and not to a hyperfunctional vocal behavior. Anterior-posterior laryngeal compression is greater than medial compression. Intensity and phonatory tasks have an effect on all laryngoscopic variables. Supraglottic activity during professional speaking voice may be not necessarily a hyperfunctional behavior, but a strategy to avoid vocal fold damage while producing the desired voice quality.

Úlceras por hidroxiurea en paciente con policitemia vera / Ulcers to hydroxyurea in a patient with polycythemia vera

La hidroxiurea es un agente citostático que inhibe la síntesis de ADN. Se considera el tratamiento de primera línea para algunos trastornos mieloproliferativos, enfermedad de células falciformes, casos severos de psoriasis refractaria y como adyuvante en la terapia de VIH. Se ha informado de que algunos pacientes tratados con hidroxiurea pueden tener úlceras en las extremidades inferiores. Paciente femenino de 67 años de edad con antecedentes de policitemia vera tratada con hidroxiurea durante un año, se deriva a dermatología por presentar úlceras bilaterales en extremidades inferiores. Al examen físico se evidencian dos lesiones ulceradas en la región calcánea. Se realiza una biopsia de piel, y muestra signos no específicos de inflamación. Se decide la interrupción de la hidroxiurea y se inicia la terapia adyuvante con pentoxifilina. Las lesiones se resolvieron en dos meses, dejando una pequeña cicatriz residual. Es importante recordar esta rara complicación inducida por el uso prolongado de la hidroxiurea y, de esta manera, realizar un diagnóstico precoz y tratamiento adecuado, que hasta el momento es básicamente la suspensión de la hidroxiurea.

Hydroxyurea is a cytostatic agent that inhibits DNA synthesis. It is considered the first line treatment for some myeloproliferative disorders, sickle cell disease, severe cases of refractory psoriasis and as adjuvant in VIH therapy. It has been reported that some patients treated with hydroxyurea may have leg ulcers. A 67 year old female patient with a history of polycythemia vera treated with hydroxyurea for a year, is derived to dermatology for presenting bilateral lower extremity ulcers. Physical examination demonstrated two ulcerated lesions in the calcaneal region. A skin biopsy is performed, and it shows non-specific signs of inflammation. Discontinuation of hydroxyurea is decided and initiate adjuvant therapy with pentoxifylline. These ulcerative lesions were resolved within two months, leaving a small residual scar. It is important to remember this rare complication induced by prolonged use of hydroxyurea and thus, early diagnosis and appropriate treatment can be made, which so far is basically the suspension of hydroxyurea.

Rendu Osler Weber syndrome, a case report and review

La telangiectasia hemorrágica hereditaria (THH) o síndrome Rendu Osler Weber es un trastorno autosómico dominante que lleva a la formación anormal de vasos sanguíneos y se manifiesta como telangiectasias y malformaciones arteriovenosas en piel y órganos internos. Mujer de 72 años con antecedentes de hipertensión arterial, anemia ferropénica e hipertensión pulmonar en tratamiento. Es derivada a dermatología por la presencia durante años de lesiones asintomáticas en cara y manos. Refiere 4 episodios de epistaxis durante su vida y no tiene historia familiar de patologías dermatológicas. Al examen se observan múltiples máculas eritemato-violáceas, con vitropresión positiva, algunas conformadas por telangiectasias, localizadas en la región malar, frente, lengua y ambas palmas. Se excluyó compromiso hepático, pero se encontraron lesiones vasculares en estómago y duodeno. Con estos antecedentes, se confirmó el diagnóstico de THH. La THH es un diagnóstico clínico basado en los criterios de Curaçao: epistaxis, telangiectasias, lesiones viscerales e historia familiar. Desde el punto de vista dermatológico, se presenta con telangiectasias en palmas, dedos, labios y lengua. Aunque la epistaxis u otras presentaciones pueden ser las manifestaciones más incapacitantes o peligrosas, las telangiectasias extranasales pueden ser más importantes para el paciente, llevándolo a consultar a dermatología. Los dermatólogos deben considerar este síndrome, a pesar de su baja incidencia reportada, debido a sus posibles complicaciones. El tratamiento es sólo paliativo, sin consenso sobre la mejor opción de manejo. Es esencial promover un control a largo plazo de la enfermedad.

Hereditary hemorrhagic telangiectasia (HHT) or Rendu Osler Weber syndrome is an autosomal dominant disorder that leads to abnormal blood vessels formation. It manifests as telangiectasias and arteriovenous malformations in the skin and internal organs. A 72-year-old female patient with previous medical history of hypertension, iron deficiency anemia, and pulmonary hypertension in treatment was referred to our clinic due to the presence of asymptomatic acral lesions. She reported only four epistaxis events throughout her life, and had no family history bleeding. Examination showed multiple, blanching, erythematous-violaceous macules. On the malar region, forehead, tongue and palms, some telangiectasias were grouped. No hepatic lesions were found, however, stomach and duodenum vascular malformations were found after workup; prompting the diagnosis of HHT . HHT diagnosis is made clinically based on the Curaçao criteria: epistaxis, telangiectasias, visceral lesions and family history. From a dermatological point of view, it is presented with telangiectases in palms, fingers, lips and tongue. However, epistaxis or other vascular malformations may be life-threatening. Dermatologists should be aware of the existence of HHT, despite its low reported incidence, due to its frequent cutaneous manifestations and potential complications. Treatment is only palliative, with no consensus on the best management option. It is essential to promote long-term control of the disease.

Dermatosis purpúrica pigmentaria, variante granulomatosa, a propósito de un caso / Granulomatous variant of chronic pigmented purpuric dermatosis: case report

La dermatosis purpúrica pigmentaria (DPP) corresponde a un grupo de enfermedades caracterizadas clínicamente por petequias y coloración bronce de la piel. Generalmente se localiza en las extremidades inferiores y se describen varios tipos, dentro de los cuales se encuentra la variante granulomatosa. Se trata de una dermatopatía benigna, poco frecuente, de etiología aún no precisada y de difícil manejo. Se presenta el caso de una paciente de 48 años, sexo femenino, sin antecedentes mórbidos, que es derivada a dermatología desde reumatología, con el diagnóstico clínico de vasculitis, por la aparición de lesiones maculares y papulares eritematovioláceas, confluentes y pruriginosas en extremidades. Presenta todos sus exámenes normales. Se planteó, entonces, una acroangiodermatitis o liquen plano. Sin embargo, fue necesario llegar al estudio histopatológico para llegar al diagnóstico de dermatosis purpúrica pigmentaria, variante granulomatosa. Si bien se considera que la DPP granulomatosa es una entidad poco frecuente, la literatura sugiere que es una entidad subdiagnosticada. Se debe plantear como diagnóstico diferencial de lesiones cutáneas en extremidades inferiores, lo que determina la importancia de realizar el estudio histopatológico. De esta forma, la DPP granulomatosa será cada vez más común y se plantearán alternativas de tratamiento mejores a las actuales.

The pigmented purpuric dermatoses are a group of diseases characterized clinically by petechiae and bronze skin color, usually affecting the lower extremities. Several types are described and one of them is the granulomatous variant. This is a still rare and benign skin disease of unknown etiology. We present the case of a 48 years old female, previously healthy, derived from rheumatology to dermatology, with the clinical diagnosis of vasculitis due to the presence of confluent erythematous macular and papular lesions, mildly pruritic in lower extremities. Her tests were all in normal ranges. Therefore, an acroangiodermatitis or lichen planus were considered. However, it was necessary to perform a histopathology study to reach the final diagnosis of granulomatous pigmented purpuric dermatosis. It is considered that Granulomatous DPP is a rare entity, but the literature suggests that it is underdiagnosed. It should always be considered as a differential diagnosis of cutaneous lesions located in lower extremities, which determines the importance of histopathology. Thus, the granulomatous DPP will become more common and will be posible to propose better treatment alternatives.

Especies del género malassezia aisladas en pacientes con psoriasis y sujetos controles sanos / Species of the genus Malassezia isolated in patients with psoriasis and healthy control subjects

La Psoriasis es una enfermedad crónica de la piel, de etiología y patogenia aún desconocida. Se ha propuesto una posible asociación entre la levadura Malassezia y la exacerbación de lesiones cutáneas en pacientes con psoriasis. OBJETIVO: Determinar frecuencia y distribución de especies de Malassezia en pacientes con psoriasis y en un grupo control sano. MATERIAL Y MÉTODO: Se evaluaron 25 pacientes con psoriasis y 55 sanos como grupo control. Se recolectó muestras de piel de 4 sitios anatómicos y se realizó un examen microscópico directo (EMD) con recuento de levaduras y cultivo en medio de Dixon modificado. Las levaduras aisladas se identificaron según características macro y micromorfológicas y pruebas bioquímicas. RESULTADOS: Un total de 396 muestras de escamas de piel de 4 sitios anatómicos obtenidas de 80 pacientes (55 sanos y 25 con psoriasis). Un 67,5% (54/80) de los pacientes presentaron un EMD positivo y la tasa de recuperación por cultivo fue 58,7% (47/80). De las 396 muestras analizadas, un 28 % (111/396) fueron positivas al EMD y un 25,2% (100/396) al cultivo. Las especies aisladas fueron: M. furfur, M. globosa, M. slooffiae y M. sympodialis. CONCLUSIONES: La presencia de Malassezia en la muestra global fue 77,5 %. El sitio anatómico más afectado fue espalda y pecho y las especies identificadas corresponden a las descritas en la literatura internacional, en sujetos sanos y con psoriasis, pero con diferente frecuencia. Se requerirán estudios adicionales para ayudar a dilucidar el posible rol de Malassezia en la exacerbación de lesiones en los pacientes con psoriasis.

Psoriasis is a chronic skin disease of unknown etiology. A possible association between psoriasis exacerbation and Malassezia species has been proposed. AIM: To determine the frequency and distribution of Malassezia species in psoriasis patients and a healthy control group. MATERIAL AND METHODS: 25 psoriatic patients and 55 healthy controls were studied. In each one of them skin scrapings samples were collected, from 4 anatomical sites. KOH yeast count and culture in modified Dixon agar were done. The isolated yeasts were identified according to macroscopic, microscopic and physiologic features. RESULTS: In 80 patients (55 healthy and 25 psoriatic), a total of 396 skin scrapings samples from 4 different anatomical sites were obtained. A total of 67.5% of the patients presented a positive KOH, and the recovery rate per culture was 58.7%. Out of the 396 analyzed samples, 28% (111/396) resulted positive to microscopic examination and 25,2% (100/396) positive on culture. The isolated species were: M. furfur, M globosa, M. slooffiae y M. sympodialis. CONCLUSIONS: The global frequency of Malassezia in the studied sample was 77.5%. It was more frequently detected on the posterior trunk and chest. We found the same species reported worldwide, in healthy and psoriatic patients, but in different frequency. Further research will be needed to clarify a possible role of this yeast on the exacerbation of skin lesions in psoriatic patients.

Citotoxicidad in vitro de extractos laticiferos de Calotropis procera (Aiton) W.T. Aiton y Pedilanthus tithymaloides (L.) Poit / In vitro cytotoxicity of laticifers extracts from Calotropis procera (Aiton) WT and Pedilanthus tithymaloides (L) Poit

In order to assess the anticancer action of extracts obtained by latex from Calotropis procera and Pedilanthus tithymaloides, samples were collected from adult plants. Soluble proteins were extracted with 16 uL of 50 mM sodium acetate pH 5/ug integral latex and centrifugation at 16,000 x g for 15 min, the supernatant was named "latex crude extract" (LCE). The "latex methanolic extract" (LME) was obtained on dried latex. Both extracts were tested in vitro by cytotoxic and cytostatic activity in Jurkat cell cultures. Cellular viability, proliferation, necrosis and apoptosis were evaluated. LCE and LME of C. procera were found with cytotoxic and cytostatic activity after 24 incubation hours (p < 0,05) with doses from 1ug/mL. The LCE and LME of P. tithymaloides presented cytotoxic effect (p < 0,05) from 50 ug/mL and from 1ug/mL, respectively.

Con el objetivo de evaluar el potencial anticanceroso de extractos de látex de Calotropis procera y Pedilanthus tithymaloides se colectaron muestras de plantas adultas. Las proteínas solubles fueron extraídas con 16 uL de acetato de sodio 50 mM pH 5/ug de látex integral y centrifugación a 16.000 x g durante 15 min, denominándose al sobrenadante “extracto crudo de látex” (ECL). El “extracto metanólico de látex” (EML) se obtuvo sobre látex deshidratado. Ambos extractos fueron probados en su actividad citotóxica y citostática in vitro sobre cultivos de células Jurkat. Se realizaron estudios de viabilidad, proliferación, necrosis y apoptosis celular. El ECL y el EML de C. procera presentaron actividad citotóxica y citostática después de 24 y 48 horas de incubación (p < 0,05) con dosis desde 1 ug/mL. Los ECL y EML de P. tithymaloides presentaron efectos citotóxicos (p < 0,05) a partir de 50 ug/mL y desde 1 ug/mL respectivamente.