Onychomycosis in Psoriatic Patients with Nail Disorders: Aetiological Agents and Immunosuppressive Therapy.

Psoriasis and psoriatic arthritis are chronic, relapsing, immune-based diseases. Psoriatic patients may have nail involvement in 50 to 80% of cases, and this may reach 85% in patients with joint disease, in spite of the fact that the relationship between psoriasis and onychomycosis is not well established. The aim of this study was to investigate the occurrence of onychomycosis in patients with nail disorders and diagnosis of psoriasis and psoriatic arthritis. This was a cross-sectional study in which 38 patients diagnosed with psoriasis and/or psoriatic arthritis were interviewed and had altered nail samples analysed by mycological and histopathological exams. Twenty-two (57.89%) patients had a confirmed diagnosis for onychomycosis. Seventeen (44.8%) had a positive direct mycological examination, 16 (42.1%) had positive cultures, and 12 (31.6%) were positive for fungi by histopathological examination. Dermatophytes were identified in nine (56.3%) cultures, and of these, eight were Trichophyton rubrum and one T. tonsurans. Yeasts were isolated in seven patients (43.75%), which included four Candida parapsilosis and three C. albicans. Six patients (15.78%) were not using immunosuppressive therapy, and the others were using methotrexate, etanercept, adalimumab, infliximab, secukinumab, or golimumab, in monotherapy or in combination with other drugs. The confirmed onychomycosis rate in patients using methotrexate alone was 92.8% (n = 13). We concluded that it is possible that there is a positive relationship between psoriatic disease and onychomycosis. And we highlight that it is also worth investigating in the future the possible role of immunosuppressive therapy (mainly methotrexate) as a predisposing factor for the development of fungal infections in psoriatic patients.

Semantic and psychometric validation of the Brazilian Portuguese version (PASE-P) of the Psoriatic Arthritis Screening and Evaluation questionnaire.

PASE (Psoriatic Arthritis Screening and Evaluation) was developed in the English language to screen for inflammatory arthritis among patients with psoriasis. It is 15 item self administered questionnaire with a score from 15 to 75. A higher score indicates a greater risk for inflammatory joint disease. The purpose of this study was to translate, adapt and validate this questionnaire into Brazilian Portuguese (PASE-P). METHODS: 465 patients diagnosed with psoriasis (158 with psoriatic arthritis confirmed by a rheumatologist according to the CASPAR criteria and 307 without) were evaluated in dermatology clinics. We performed the analysis of semantic equivalence in eight steps. For psychometric equivalence, we evaluated the data quality, reliability, construct validity, well-known groups and discriminant characteristics of the items, as well as a ROC curve to determine optimal PASE-P cutoff points in case identification and their sensitivity / specificity. The final version presented excellent reproducibility (CCI = 0.97) and reliability (Cronbach's alpha> 0.9). A cut-off point of 25 distinguished between patients with and without psoriatic arthritis, with sensitivity of 69.5 and specificity of 86.8. PASE-P proved to be culturally valid and reliable to screen for psoriatic arthritis in Brazilian patients with psoriasis.

Relationship of Helicobacter pylori seroprevalence with the occurrence and severity of psoriasis.

BACKGROUND:: Psoriasis is a chronic inflammatory disease that affects the skin and joints and has a multifactorial etiology. Recently, it has been suggested that Helicobacter pylori infection may contribute as a trigger for the development of the disease. OBJECTIVES:: To determine the prevalence of H. pylori seropositivity in patients with psoriasis and to evaluate the relation between disease severity and H. pylori infection. METHODS:: H. pylori infection was assessed in psoriatic patients and controls by using H. pylori IgG quantitative enzyme immunoassay (ELISA test). The patients were classified according to the severity of the disease (PASI score). RESULTS:: One hundred and twenty six patients with psoriasis (73 females and 53 males); mean age 50.48 years; 65 patients (51.59%) had severe psoriasis, 40 (31.75%) moderate psoriasis and 21 (16.67%) mild psoriasis. Twenty one healthy volunteers included as a control group, mean age of 41.05 years, 13 females and 8 males. One hundred and eleven patients with psoriasis tested serologically, 80 (72.07%) were seropositive compared with 7 positive volunteers (33.33%; P=0.002). Forty-nine (75.38%) patients with severe psoriasis were positive, 25 (62.50%) with moderate psoriasis were positive and 6 (28.57%) with mild psoriasis were positive (P=0.045). Study limitations: none. CONCLUSIONS:: H. pylori infection influences the development of psoriasis and severity of the disease.

Relationship of Helicobacter pylori seroprevalence with the occurrence and severity of psoriasis

Abstract: BACKGROUND: Psoriasis is a chronic inflammatory disease that affects the skin and joints and has a multifactorial etiology. Recently, it has been suggested that Helicobacter pylori infection may contribute as a trigger for the development of the disease. OBJECTIVES: To determine the prevalence of H. pylori seropositivity in patients with psoriasis and to evaluate the relation between disease severity and H. pylori infection. METHODS: H. pylori infection was assessed in psoriatic patients and controls by using H. pylori IgG quantitative enzyme immunoassay (ELISA test). The patients were classified according to the severity of the disease (PASI score). RESULTS: One hundred and twenty six patients with psoriasis (73 females and 53 males); mean age 50.48 years; 65 patients (51.59%) had severe psoriasis, 40 (31.75%) moderate psoriasis and 21 (16.67%) mild psoriasis. Twenty one healthy volunteers included as a control group, mean age of 41.05 years, 13 females and 8 males. One hundred and eleven patients with psoriasis tested serologically, 80 (72.07%) were seropositive compared with 7 positive volunteers (33.33%; P=0.002). Forty-nine (75.38%) patients with severe psoriasis were positive, 25 (62.50%) with moderate psoriasis were positive and 6 (28.57%) with mild psoriasis were positive (P=0.045). Study limitations: none. CONCLUSIONS: H. pylori infection influences the development of psoriasis and severity of the disease.

Prevalence of psoriatic arthritis in a large cohort of Brazilian patients with psoriasis.

OBJECTIVE: To determine the prevalence of psoriatic arthritis (PsA) in a large cohort of Brazilian patients with psoriasis (PsO) being seen at dermatology centers. METHODS: A multicenter study was conducted in 4 university dermatology clinics. In each center, consecutive patients with confirmed diagnoses of PsO were evaluated by a rheumatologist. Individuals were classified as having PsA according to the ClASsification criteria for Psoriatic ARthritis (CASPAR). Laboratory tests and radiographs were performed, as needed, based on the clinical judgment of the rheumatologist. RESULTS: A total of 524 patients with PsO were evaluated. The mean age was 48.5 ± 14.5 years, 50% were women, and the mean PsO duration was 15.4 ± 11.7 years. A diagnosis of PsA was documented in 175 patients (33%), of whom 49% were newly identified by the rheumatologist. Most individuals with PsA (72%) had peripheral involvement, 11% had isolated axial involvement, and 17% had both peripheral and axial involvement. Dactylitis occurred in 20% and clinical enthesitis in 30% of the patients. Laboratory and/or radiograph tests were necessary for a definitive diagnosis of PsA in 42 of 175 individuals (24%). CONCLUSION: In our study, one-third of Brazilian patients with PsO, followed in dermatology settings, were diagnosed with PsA by a rheumatologist. Almost half of subjects with PsA had no previous diagnosis. A collaboration between dermatologists and rheumatologists is greatly needed to establish earlier PsA diagnoses and adequate multidisciplinary management.

Perfil estomatológico de pacientes psoriátricos: análise de 50 casos / Stomatologic feactures in psoriatric patients: analysis of 50 cases

Introdução: a psoríase é uma doença dermatológica crônica que acomete cerca de 3% da população mundial e pode representar um fator importante de exclusão social. A manifestação bucal ainda é um assunto controverso na literatura sendo descrita como lesões brancas, eritematosas, úlceras e papuloescamosa. Objetivos - Avaliar a presença de manifestações bucais da psoríase, considerando-se a localização e as características clínicas das lesões encontradas, o sexo, a idade e a raça dos acometidos. Métodos - Estudo observacional, do tipo transversal, com pacientes que procuraram atendimento no ambulatório de dermatologiado Hospital de Clínicas da Universidade Federal de Uberlândia (HCUFU) entre dezembro de 2006 a novembro de 2007 (n=50). Resultados - A idade variou entre 7 e 78 anos com media de idade de 43,58 anos e mediana de 45 anos. Não houve predileção por sexo, sendo que 26 pacientes eram do sexo masculino e 24 feminino. No exame bucal foram encontradas lesões em 44% dos pacientes, sendo 16 lesões em língua (53,3%) na forma de fissuras ou áreas despapiladas, 2 em mucosa jugal (6,7%) na forma de placas brancas, 5 em lábio (16,7%) na forma de queilites e ressecamento e 7 lesões eritematosa sem palato (23,3%). Conclusões - Não foi possível identificar alteração que pudesse estar associada à psoríase, visto que nenhuma lesão acompanhou o quadro da doença cutâneaou teve diagnóstico histológico confirmado. Com relação às alterações em língua, tais como língua fissurada e língua geográfica, a incidência encontrada foi muito próxima a outros estudos em pacientes sem uma doença de base importante.

Introduction: psoriasis is a chronic dermatologic disease that affects at least 3% of the world population. Oral manifestation is still a controversy in the literature. It has been described by some authors in clinical case reports as white or erythematous lesions, ulcers and descamative papules. Objectives - To evaluate the presence of oral manifestations associated with psoriasis, considering location and clinical characteristics of the lesions and also gender, age and race of patients. Method - It was an observational,cross-sectional study of patients who sought for treatment at the Dermatology Service ofthe University Hospital (Uberlândia Federal University); between December 2006 and November 2007 (n=50) . Results - Age varied from 7 to 78 years, mean age of 43,58years and median of 45 years. There was no predominance of male (n=26) or female(n=24) patients. Lesions were found in 44% of patients, 16 (53,3%) of these lesions werein tongue, 2 (6,7%) white plaques in the cheeks, 5 (16,7%) lesion in lips as cheilitis anddryness and 7 (23,3%) erythematous areas in the hard palate. Conclusions - After all,it was not possible to make any specific association between oral lesions and psoriasis because the lesions did not follow the cutaneous disease stage nor was histologically confirmed. Also the tongue alterations incidence identified in this study was similar tothat found in population without other diseases.

Câncer gástrico precoce: complicações e mortalidade após gastrectomia e linfadenectomia regrada: experiência com 178 casos em uma instituição / Early onset gastric cancer: complications and mortality rates subsequent to gastrectomy and lymphadenectomy: a single institution experience on 178 cases

O tratamento cirúrgico é a primeira opção para os pacientes com câncer gástrico precoce. Entretanto, a gastrectomia com linfadenectomia está associada a níveis significativos de morbimortalidade. Torna-se oportuno, em população ocidental, estudar estes fatores...

Surgical treatment is the first option for patients wich early gastric cancer. Nevertheless, gastrectomy with lymphadenectomy is associated with significant levels of morbimortality. It is therefore very appropriate to study these factors in the western population...