Efecto de la dieta en psoriasis moderada a severa, en pacientes con sobrepeso y obesos con tratamiento tópico y sistémico con metotrexato / Effect of diet on moderate or severe psoriasis in patients with obese and overweight under treatment with topical and systemic methotrexate

INTRODUCTION: Psoriasis is a chronic inflammatory disease with significant impact on quality of life. There are environmental factors that can change the course of the disease. OBJECTIVE: To investigate whether moderate weight loss, improves response to methotrexate in obese or overweight patients who suffer from the disease. METHODOLOGY: A controlled pilot project of 8 weeks was performed in 15 patients with moderate to severe psoriasis under treatment with Methotrexate and topical therapy. The intervention corresponded to a nutritional assessment, a strict diet and physical activity suggestion. Patients were evaluated using PASI, at 0, 4 and 8 weeks. RESULTS: After 8 weeks, mean PASI decreased by 13% and a decrease in weight, BMI and waist circumference was achieved, but without statistical significance. CONCLUSION: Further studies are required to demonstrate the importance of weight loss in obese or overweight psoriatic patients under methotrexate treatment.

INTRODUCCIÓN: La Psoriasis es una enfermedad inflamatoria crónica con importante impacto en la calidad de vida.Existen factores ambientalesque pueden modificar el curso de la enfermedad. OBJETIVO: Investigar si una pérdida moderada de peso, aumenta la respuesta a Metotrexato en pacientes obesos o con sobrepeso que padecen la enfermedad. METODOLOGÍA: Proyecto Piloto, controlado, de 8 semanas en 15 pacientes con psoriasis moderada a severa,en tratamiento con Metotrexato y terapia tópica, atendidos en Santiago de Chile. La intervención correspondió a una evaluación nutricional, una dieta estricta y sugerencia de actividad física. Los pacientes fueron evaluadas con PASI, a las 0, 4 y 8 semanas. RESULTADOS: Después de 8 semanas, se logró una disminución del PASI promedio en un 13% y una disminución del peso, IMC y circunferencia abdominal, pero sin significancia estadística. CONCLUSIÓN: Se requieren realizar estudios con un mayor número de pacientes para demostrar la importancia de una disminución de peso en el tratamiento con metotrexato en pacientes psoriáticos obesos o con sobrepeso.

[The role of endothelial lipase in atherogenesis]. / Lipasa endotelial y su relación con la enfermedad cardiovascular y diabetes mellitus tipo 2.

Endothelial lipase (EL) is synthetized by endothelial cells and its main substrates are lipoprotein phospholipids. Over expression of EL reduces high density lipoprotein (HDL) cholesterol and phospholipids, in vivo and in vitro. Inhibition of the enzyme achieves the opposite effects. The synthesis of the enzyme is regulated by interleukin 1 and tumor necrosis factor a. These inflammatory cytokines play a role in diabetes and vascular disease. An increase in vascular mechanical forces, that play a role in atherogenesis, also increase the synthesis of EL. There is expression of EL in endothelial cells, macrophages and muscle cells of atherosclerotic lesions of coronary arteries of humans. This evidence leads to the suspicion that EL plays a role in atherogenesis. There are also higher plasma levels of EL in subjects with type 2 diabetes, who are especially susceptible to the development of vascular lesions. Therefore the inhibition of EL could play an important role in HDL metabolism and could be a new therapeutic strategy for the prevention of atherosclerosis.

Lipasa endotelial y su relación con la enfermedad cardiovascular y diabetes mellitus tipo 2 / The role of endothelial lipase in atherogenesis

Endothelial lipase (EL) is synthetized by endothelial cells and its main substrates are lipoprotein phospholipids. Over expression of EL reduces high density lipoprotein (HDL) cholesterol and phospholipids, in vivo and in vitro. Inhibition of the enzyme achieves the opposite effects. The synthesis of the enzyme is regulated by interleukin 1 and tumor necrosis factor a. These inflammatory cytokines play a role in diabetes and vascular disease. An increase in vascular mechanical forces, that play a role in atherogenesis, also increase the synthesis of EL. There is expression of EL in endothelial cells, macrophages and muscle cells of atherosclerotic lesions of coronary arteries of humans. This evidence leads to the suspicion that EL plays a role in atherogenesis. There are also higher plasma levels of EL in subjects with type 2 diabetes, who are especially susceptible to the development of vascular lesions. Therefore the inhibition of EL could play an important role in HDL metabolism and could be a new therapeutic strategy for the prevention of atherosclerosis.

Estudio transversal: evaluación de prevalencia de comorbilidades metabólicas y factores de riesgo cardiovascular, y su correlación con la severidad clínica, en 106 pacientes con psoriasis / Prevalence of metabolic comorbidities and cardiovascular risk factors in patients with psoriasis: cross-sectional study

Introducción: Diversos estudios epidemiológicos han demostrado que los pacientes con psoriasis presentan mayor mortalidad general, mortalidad cardiovascular (CV) e incidencia de infarto al miocardio que la población general. Esto se explican o sólo por la mayor prevalencia de factores de riesgo CV clásicos (obesidad, diabetes, hipertensión arterial, entre otros) en estos pacientes, sino que también la psoriasis constituye un factor de riesgo CV independiente en directa relación con su severidad, con mayor impacto en pacientes jóvenes. Objetivos: Evaluar la prevalencia de comorbilidades metabólicas y factores de riesgo CV en 106 pacientes con psoriasis, y su correlación su severidad clínica. Además de comparar dichas prevalencias con las reportadas por la Encuesta Nacional de Salud (ENS) 2010 para la población chilena. Material y método: Se realizó una evaluación antropométrica y una encuesta sobre antecedentes mórbidos y de la psoriasis a 106 pacientes. Se definieron dos grupos de severidad. Se compararon prevalencias entre los grupos de severidad, así como entre la muestra total y la población chilena. Posteriormente se realizó la comparación considerando exclusivamente al grupo etario de 25 a 64 años (84,8 por ciento, tanto para hombres y mujeres. También se compararon prevalencias entre el grupo de pacientes jóvenes con psoriasis severa y la ENS, siendo éste el grupo de mayor riesgo CV asociado a la psoriasis. Resultados: La muestra correspondió a 106 pacientes, 47 mujeres y 59 hombres, con edad media de 43,5 +/- 14 años. La mitad presentó sobrepeso, un 26 por ciento peso normal y un 34 por ciento obesidad, con IMC promedio de 27,8 kg/m2 y gran prevalencia de comorbilidades metabólicas y factores de riesgo CV, siendo los más frecuentes el tabaquismo (41 por ciento) y la hipertensión arterial...

Background: Epidemiologic studies have demonstrated that patients with psoriasis have an increased risk of mortality, cardiovascular (CV) mortality and myocardial infarction, than general population. Some explanation for this is related to an increased incidence of classical CV risk factors (e.g: obesity, diabetes, blood hypertension) on psoriasis patients. Additionally, psoriasis itself is considered as an independent CV risk factor, directly related to its severity and with higher impact on young patients. Objective: To determinate the prevalence of metabolic comorbidities and CV risk factors in patients with psoriasis, and its correlation with the severity of the psoriasis. To compare such prevalence with those reported by the national health database for Chilean population developed in 2010. Materials and Methods: An observational and analytic study was conduced at the Dermatology Department of the Pontificia Universidad Católica de Chile. Patients with psoriasis were evaluated and classified as having as severity in two groups. The prevalence of metabolic comorbidities was determined, comparing outcomes among patients with mild and severe psoriasis and between all psoriasis patients and Chilean population. Results: One hundred and six patients with psoriasis were included in the study. The mean (SD) age was 43.5 (14) years and 55.6 percent were male. Overweight was present on half of the patients, normal weight was present on 26 percent, and obesity was present on 34 percent. Mean body mass index (IMC) was 27.8kg/m2. The most frequent CV risk factor was tabaquism (41 percent), followed by blood hypertension (22.6 percent). The group with severe psoriasis presented higher prevalence of obesity (31.6 vs.13 percent, p=0.02) and abdominal obesity (86.7 vs. 76 percent, p=0.04),that the group with mild psoriasis...

Hipertrigliceridemias de origen genético / Hypertriglyceridemias of genetic origen

Hypertriglyceridemia (HTG) is defined as plasma triglycerides (TG) > 150 mg/dL, and it is a frequent disease in the general population. When plasma TG reach concentrations > 500 mg/dL (severe HTG), there is usually a genetic defect involved. This defect can involve a single gene or be of polygenic inheritance. In polygenic HTG, the phenotypic expression of the disease is usually associated to the presence of certain diseases such as diabetes, obesity or insulin resistance. The most common known genes associated with monogenic hypertriglyceridemia are LPL and APOC2, but in recent years a few cases caused by mutant APOA5, GPIHBP1 and LMF1, have been identified. Furthermore, genome wide association studies (GWA) have brought up new genes that are related to discrete changes in triglyceride plasma levels of the general population. Among them, it is worth mentioning GCKR, TRIB1, MLXIPL, GALNT2, APOB, APOC2, APOA5, APOE, LPL, ANGPTL3 and NCAN. It is remarkable that most severe hypertriglyceridemias are of polygenic origin, and they could involve a major susceptibility gene. Only in a few cases of severe or very severe HTG (TG > 2.000 mg/dL) the genetic cause is known.

Diabetes mellitus y piel: lesiones cutáneas y su significado clínico / Skin lesions associated with diabetes mellitus

Approximately 30 to 70 percent of patients with diabetes will suffer a skin disorder during the course of their disease. The vast majority of these cases arise during the course of the disease. However, the skin disorder occasionally precedes the diagnosis of diabetes. Many of these lesions are highly associated with diabetes. Moreover, some of them are considered as markers of the disease. The most common skin lesion is diabetic dermopathy that presents as red or purple papules that last one to three weeks. Necrobiosis lipoidica diabeticorum is seen in 0.3 percent of diabetic patients, may precede the development of the disease and appears as oval or irregularly shaped, indurated plaques with central atrophy and yellow pigmentation. Granuloma annulare is seen in 10 to 24 percent of diabetic patients and appears as a skin-colored or erythematous, annular or arciform plaque with a moderately firm, rope-like border and central clearing. Physicians should be able to recognize these and other lesions associated with diabetes mellitus.