Prevalence of Metabolic Syndrome Among Patients with Psoriasis Treated with TNF Inhibitors and the Effects of Anti-TNF Therapy on Their Lipid Profile: A Prospective Cohort Study.

Background: Tumor necrosis factor (TNF) is an important inflammatory cytokine in the pathogenesis of psoriasis and metabolic syndrome (MS). Patients with psoriasis have higher rates of MS; therefore, some authors suggest an MS screening within this population. In addition, TNF inhibitor treatment often modifies the metabolic profiles of these patients. This study describes the epidemiological, clinical, and laboratory characteristics of patients with psoriasis undergoing anti-TNF treatment and evaluates whether anti-TNF treatments influence changes in their metabolic parameters. Methods: A prospective 6-month cohort study followed patients who underwent three consecutive consultations at 0, 3, and 6 months. The sample composed of 83 patients with psoriasis using anti-TNF. Results: The mean age and disease duration of the patients were 48 ± 11 and 16 ± 9 years, respectively. Most patients were men (61.5%). The prevalence of MS was 36%, and high rates of abdominal obesity (59%) and overweight (82%) were observed. Anti-TNF treatment significantly altered total cholesterol levels (195.5 ± 36.17 vs. 183.5 ± 41.23, P = 0.04) and low-density lipoprotein (LDL) cholesterol levels (128.5 ± 31.26 vs. 113 ± 36.31, P = 0.04). This study has some limitations, such as small sample size, brief follow-up period (6 months), patient recruitment from a tertiary-level referral center, and no control group. Conclusions: Patients with psoriasis have high rates of MS, overweight, and obesity, but anti-TNF treatment seems to improve the metabolic profile of these patients by decreasing their total and LDL cholesterol levels.

Figurate erythematous lesion by Microsporum canis in immunosuppressed patient.

Dermatophytes are fungi capable of invading keratinized tissues. Isolation of the fungus with the culture is essential to guide the treatment, because there are more resistant species like Microsporum canis. The chronic use of corticosteroids leads to the deregulation of immunity, promoting atypical manifestations of infections. Topical antifungal therapy is often insufficient, requiring systemic medications. We describe the case of a patient undergoing systemic corticosteroid therapy with a large figurate lesion who presented complete response to exclusively topical treatment.

Figurate erythematous lesion by Microsporum canis in immunosuppressed patient

Abstract: Dermatophytes are fungi capable of invading keratinized tissues. Isolation of the fungus with the culture is essential to guide the treatment, because there are more resistant species like Microsporum canis. The chronic use of corticosteroids leads to the deregulation of immunity, promoting atypical manifestations of infections. Topical antifungal therapy is often insufficient, requiring systemic medications. We describe the case of a patient undergoing systemic corticosteroid therapy with a large figurate lesion who presented complete response to exclusively topical treatment.

Daylight photodynamic therapy - Experience and safety in treatment of actinic keratoses of the face and scalp in low latitude and high brightness region.

Daylight photodynamic therapy has been used in countries with high latitudes during the summer for actinic keratoses treatment with reports of similar efficacy to conventional photodynamic therapy. We evaluate its safety in 20 patients in the city of Fortaleza, a local with low latitude and high brightness. Sixteen patients did not report any discomfort due to the procedure. Daylight photodynamic therapy is an easy application method with great tolerability by the patient and has the possibility of being performed throughout the year in these regions. It can mean a promising tool in the control of skin cancer.

Daylight photodynamic therapy - Experience and safety in treatment of actinic keratoses of the face and scalp in low latitude and high brightness region

ABSTRACT Daylight photodynamic therapy has been used in countries with high latitudes during the summer for actinic keratoses treatment with reports of similar efficacy to conventional photodynamic therapy. We evaluate its safety in 20 patients in the city of Fortaleza, a local with low latitude and high brightness. Sixteen patients did not report any discomfort due to the procedure. Daylight photodynamic therapy is an easy application method with great tolerability by the patient and has the possibility of being performed throughout the year in these regions. It can mean a promising tool in the control of skin cancer.

Serum levels of interleukin-6 in contacts of active pulmonary tuberculosis / Níveis séricos de interleucina-6 em contatos de tuberculose pulmonar ativa

INTRODUCTION: It is estimated that over two billion individuals are infected by Mycobacterium tuberculosis worldwide. Interleukin-6 (IL-6) is an important cytokine whose serum levels are commonly high in active pulmonary tuberculosis (TB). IL-6 screening in contacts of patients with TB may be useful to monitor the progress of the infectious process and to infer the risk of progression to active disease. OBJECTIVE: To evaluate the serum levels of interleukin-6 in contacts of patients with active pulmonary tuberculosis and to compare them with two other groups: a) patients affected by active pulmonary tuberculosis; b) non-contacts of tuberculosis. METHODS: Cross-sectional study with 15 contacts of patients with active pulmonary tuberculosis, selected according to the protocol recommended by the Ministry of Health. The serum levels of interleukin-6 were measured by Enzyme-linked immunosorbent assay (ELISA). The same test was also applied in the two comparison groups: 38 patients with active pulmonary tuberculosis (confirmed by clinical examination, X-rays of the chest and baciloscopy) and 63 non-contacts (healthy blood donors). RESULTS: In the contact group, the median IL-6 concentration was 1.7 pg/ml (0.96-4.8 pg/ml). For those affected by active pulmonary tuberculosis and non-contact individuals, these values corresponded to 4.3 pg/ml (0.5-24 pg/ml) and 0.5 pg/ml (0-2.8 pg/ml), respectively (p < 0.0001). CONCLUSION: Contacts of patients with active pulmonary tuberculosis had significantly higher IL-6 serum levels (3.4 times higher) in relation to non-contact individuals, but on a lower level (2.5 times lower) when compared to those affected by active disease.

INTRODUÇÃO: Estima-se em mais de dois bilhões o número de infectados pelo Mycobacterium tuberculosis no mundo. A interleucina-6 (IL-6) é uma importante citocina, cujos níveis séricos estão comumente elevados na tuberculose pulmonar ativa. A dosagem dessa citocina em contatos de pacientes com tuberculose pode ser útil para se acompanhar a evolução do processo infeccioso, bem como para inferir o risco de progressão da doença ativa. OBJETIVO: Avaliar os níveis séricos de IL-6 em contatos de pacientes com tuberculose pulmonar ativa e compará-los com os de dois outros grupos: a) pacientes acometidos por tuberculose pulmonar ativa; b) não contatos de tuberculose. MÉTODOS: Estudo transversal com 15 contatos de pacientes com tuberculose pulmonar ativa, selecionados de acordo com protocolo preconizado pelo Ministério da Saúde. Os níveis séricos de IL-6 foram mensurados por meio de ensaio imunoenzimático (ELISA). O mesmo ensaio também foi empregado nos dois grupos de comparação: 38 pacientes com tuberculose pulmonar ativa (confirmada por exame clínico, raios X de tórax e baciloscopia) e 63 não contatos, doadores saudáveis de sangue. RESULTADOS: Para o grupo de contatos, a mediana de concentração de IL-6 foi de 1,7 pg/ml (0,96-4,8 pg/ml); para os acometidos por tuberculose pulmonar ativa e indivíduos não contatos, esses valores foram 4,3 pg/ml (0-12 pg/ml) e 0,5 pg/ml (0-2,8 pg/ml), respectivamente (p < 0,0001). CONCLUSÃO: Contatos de pacientes com tuberculose pulmonar ativa apresentaram níveis séricos de IL-6 significativamente aumentados (3,4 vezes mais), em relação aos indivíduos não contatos, mas em um patamar inferior (2,5 vezes menos), quando comparados com os acometidos pela doença ativa.