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2.
BMC Infect Dis ; 20(1): 829, 2020 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-33176717

RESUMO

BACKGROUND: Mycetoma is a chronic granulomatous subcutaneous infection caused by anaerobic pseudofilamentous bacteria or fungi. It is commonly prevalent in tropical and subtropical countries. Men are more susceptible to the disease due to greater participation in agricultural works. Mycetoma commonly involves lower extremities, wherein untreated cases lead to aggressive therapeutic choices, such as amputation of the affected body organs and consequently lifelong disability. CASE PRESENTATION: In this report, we present the rare case of a 58-year-old man, originally from Algeria with a left foot chronic tumefaction of 5 years. In the initial clinical examination, mycetoma was diagnosed based on tumefaction and the presence of multiple sinuses with the emission of white grains. The latter was observed via direct examination. The histopathological analysis demonstrated an actinomycetoma caused by bacteria, as the etiological agent. Imaging showed a bone involvement with osteolysis at the levels of 2nd to 4th metatarsal diaphysis. The mycological and bacterial cultures were both negative. For an accurate diagnosis, the obtained grains were subjected to molecular analysis, targeting the 16S-rDNA gene. Molecular identification yielded Actinomadura madurae as the causal agent, and 800/160 mg of trimethoprim/sulfamethoxazole was prescribed twice a day for 1 year, as a treatment. CONCLUSION: Considering low information about this disease, especially in non-endemic areas, it is of high importance to enhance the knowledge and awareness of clinicians and healthcare providers, in particular in the countries with immigration issues.


Assuntos
Actinobacteria/genética , Actinobacteria/isolamento & purificação , Antibacterianos/uso terapêutico , Micetoma/diagnóstico , Micetoma/tratamento farmacológico , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Argélia/etnologia , DNA Ribossômico/genética , Emigrantes e Imigrantes , Pé/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Micetoma/etnologia , Micetoma/microbiologia , Paris , Resultado do Tratamento
3.
Anticancer Res ; 40(6): 3411-3415, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32487638

RESUMO

BACKGROUND/AIM: Acral lentiginous melanoma (ALM) is the least common subtype of cutaneous melanoma and typically occurs on the palms, soles, and nails. Tumor characteristics and disease severity in the US population are not well understood. Our aim was to analyze the characteristics of ALM of the extremities. PATIENTS AND METHODS: We queried the National Cancer Database to identify patients with the diagnosis of ALM and common malignant melanoma located in the extremities (CMME). We compared demographic, tumor, and treatment characteristics between patients with ALM and those with CMME. Statistical analysis was performed with chi-squared test and multivariate logistic regression models. RESULTS: We identified 5,203 patients with ALM and 118,485 with CMME. When compared with patients with CMME, those with ALM were more likely to be older than 80. years at diagnosis [odds ratio (OR)=2.85, 95% confidence intervaI (CI)=2.12-3.82; p<0.001], have stage III disease (OR=4.22, 95% CI=1.47-12.16; p=0.01), and have ulceration (OR=1.52, 95% CI=1.33-1.74; p<0.001). Moreover, patients with ALM were less likely to have a mitotic count of 1/mm2 or greater (OR=0.57, 95% CI=0.48-0.67; p<0.001). No statistical difference was found for sex, lymph node involvement, regression, and use of surgery, radiotherapy, and immunotherapy between groups. CONCLUSION: Age, disease stage, ulceration, and mitotic count are independent factors associated with ALM. Knowledge of the disease characteristics may allow for better diagnosis and understanding of disease pathophysiology.


Assuntos
Pé/patologia , Mãos/patologia , Melanoma/diagnóstico , Melanoma/epidemiologia , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada , Bases de Dados Factuais , Feminino , Humanos , Masculino , Melanoma/terapia , Pessoa de Meia-Idade , Metástase Neoplásica , Estadiamento de Neoplasias , Razão de Chances , Estudos Retrospectivos , Neoplasias Cutâneas/terapia , Resultado do Tratamento , Adulto Jovem
6.
Trop Doct ; 50(3): 251-253, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32437296

RESUMO

We present a patient with severe Plasmodium falciparum malaria of seven days' duration who developed an altered sensorium of one day. During hospital admission, peripheral symmetrical gangrene of hands and feet followed, despite normal limb vasculature.


Assuntos
Gangrena/etiologia , Malária Falciparum/complicações , Idoso de 80 Anos ou mais , Feminino , Pé/patologia , Gangrena/parasitologia , Mãos/patologia , Humanos , Malária Falciparum/diagnóstico , Plasmodium falciparum/isolamento & purificação
8.
Chem Biol Interact ; 324: 109095, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-32289289

RESUMO

Rheumatoid Arthritis (RA) affects approximately 1% of the total world population. Despite incessant research and development of new therapeutic agents, management of RA is still a troublesome affair. Histone Deacetylase 1 (HDAC1) is an epigenetic regulator which play important role in pathogenesis of RA. In present study, we hypothesized that Phenethyl isothiocyanate (PEITC), a potent inhibitor of HDAC1, may ameliorate RA. Efficacy of PEITC was evaluated in Complete Freund's Adjuvant (CFA) induced arthritis model in rats. CFA (0.1 ml) was injected subplantarly in the left hind paw on day 0 to all the groups except normal control. The administration of test drug PEITC (10, 24 & 50 mg/kg) and standard drug Ibuprofen started simultaneously and was continued for 21 days. Paw edema, total arthritic index, mobility score, stair climbing ability, behavioral parameters, and bone erosion were evaluated. Further, radiographic studies, TNF-alpha as well as HDAC1 levels in synovial tissue homogenate and histological analysis were performed. Prophylactic treatment of PEITC attenuated paw edema, total arthritic index, mobility score, stair climbing ability, behavioral parameters, and bone erosion in dose dependent manner. Furthermore, there was significant decrease in TNF-alpha as well as HDAC1 levels in synovial tissue homogenate. Histological analysis revealed no cartilage damage, bone erosion, hyperplasia at synovial lining as well as infiltration of inflammatory cells in treatment group. Results of this study suggest potent anti-rheumatoid arthritis activity of Phenethyl isothiocyanate in CFA induced RA model in rats.


Assuntos
Antirreumáticos/uso terapêutico , Artrite Experimental/tratamento farmacológico , Artrite Reumatoide/tratamento farmacológico , Histona Desacetilase 1/metabolismo , Inibidores de Histona Desacetilases/uso terapêutico , Isotiocianatos/uso terapêutico , Analgésicos não Entorpecentes/uso terapêutico , Animais , Artrite Experimental/induzido quimicamente , Edema/tratamento farmacológico , Pé/patologia , Articulações do Pé/patologia , Adjuvante de Freund , Ibuprofeno/uso terapêutico , Locomoção/efeitos dos fármacos , Masculino , Dor/tratamento farmacológico , Ratos Wistar , Fator de Necrose Tumoral alfa/metabolismo
9.
Am J Emerg Med ; 38(7): 1540.e5-1540.e8, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32197716

RESUMO

Capnocytophaga canimorsus, commonly transmitted by dog bites, can cause severe sepsis, and the mortality rate is very high. We experienced a case of hemophagocytic lymphohistiocytosis (HLH) complicated by severe sepsis caused by C. canimorsus. A 58-year-old man with no remarkable medical history was admitted to another hospital with fever and mild consciousness disorder developed 3 days after being bitten by his dog. The next day, the patient developed disseminated intravascular coagulation and shock and was transferred to our emergency medical center. Blood tests showed hyperferritinemia and cytopenia, and bone marrow aspiration was performed. As a result, we diagnosed severe sepsis and HLH. Once antibiotic and steroid therapy was started, the patient's infection and cytopenia improved. Unfortunately, the patient's fingers and toes required amputation, but his life was saved, and he was discharged from hospital. Because HLH may be hidden in such cases, it may be necessary to measure serum ferritin and perform bone marrow aspiration if hyperferritinemia is suspected.


Assuntos
Capnocytophaga , Infecções por Bactérias Gram-Negativas/complicações , Linfo-Histiocitose Hemofagocítica/microbiologia , Sepse/microbiologia , Amputação , Animais , Mordeduras e Picadas/complicações , Coagulação Intravascular Disseminada/etiologia , Cães , Ferritinas/sangue , Pé/patologia , Pé/cirurgia , Infecções por Bactérias Gram-Negativas/diagnóstico , Mãos/patologia , Mãos/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Necrose/etiologia , Necrose/cirurgia
11.
Rev. Asoc. Argent. Ortop. Traumatol ; 85(1): 65-73, mar. 2020.
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-1125539

RESUMO

Los tumores óseos y de partes blandas localizados en el pie son muy poco frecuentes. El lipoblastoma es una neoplasia benigna de partes blandas rara que se presenta exclusivamente en la población pediátrica, con predilección por el sexo masculino. Su asiento preferente son las extremidades, pero raramente afecta el pie. Presentamos un caso de lipoblastoma de pie en un niño de 13 meses de edad y una revisión de la bibliografía. Nivel de Evidencia: IV


Bone and soft tissue tumors of the feet are uncommon. Lipoblastoma is a rare benign soft tissue tumor, exclusive to the pediatric population, with predilection for boys. Lipoblastomas most commonly occur in the extremities, but rarely affect the foot. We present a case of lipoblastoma occurring in the foot of a 13-month-old boy, as well as our literature review. Level of Evidence: IV


Assuntos
Lactente , Neoplasias de Tecidos Moles , Lipoblastoma/cirurgia , Pé/patologia , Doenças do Pé
12.
Clin Exp Dermatol ; 45(6): 719-721, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32049370

RESUMO

Ichthyosis hystrix, Curth-Macklin type (IHCM) is an extremely rare autosomal dominant dermatosis caused by mutations in the keratin genes, KRT1 or KRT10, which often manifests as extensive, dark, spiky or verrucous plaques and severe palmoplantar keratoderma. We report a novel frameshift truncation mutation, c.1596_1597insAT (p.Gly533Metfs*82) in exon 7 (V2 tail domain) of KRT1, which, by replacing the glycine-serine-rich tail of KRT1 with a series of 75 alanine-rich amino acids, produces a mild IHCM phenotype. The patient with the mutation presented with localized ichthyosis and progressive hyperkeratosis of the palms and soles with no history of blistering.


Assuntos
Dermatite Seborreica/genética , Mutação da Fase de Leitura , Ictiose/genética , Queratina-1/genética , Pré-Escolar , Feminino , Pé/patologia , Mãos/patologia , Humanos
13.
BMC Res Notes ; 13(1): 38, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-32005281

RESUMO

OBJECTIVES: Previous studies have shown that diabetic foot ulcers are principally associated with improper foot self-care. Since appropriate foot self-care is essential to prevent diabetic foot-ulcers, any factors which can predict foot self-care behavior should be identified. However, until now, foot self-care behavior data and predictors of foot-care behavior in Indonesia remain unclear since such studies on Indonesian diabetic patients is very limited. Therefore, the purpose of this study was to investigate foot self-care behavior and to identify its predictors in Indonesia. The design of this study was cross-sectional. Cluster sampling was used, involving 546 type 2 diabetes mellitus patients registered in 22 primary healthcare centers. The questionnaires used in this study included the Diabetes Distress Scale, Beck Depression Inventory II, Family APGAR, Foot-Care Knowledge and Modified Diabetic Foot Care Behaviors. RESULTS: Foot self-care behavior and knowledge about foot care were poor. The predictors of foot self-care behavior were age, educational level, diabetes distress, family support, and knowledge. It needs the program to improve foot self-care knowledge and the program to reduce the diabetes distress in Indonesian diabetic patients. In performing of these programs, families should be involved to improve the support toward foot self-care behavior in patients.


Assuntos
Comportamento , Diabetes Mellitus Tipo 2/epidemiologia , Pé/patologia , Autocuidado , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Indonésia/epidemiologia , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Adulto Jovem
14.
BMC Dermatol ; 20(1): 1, 2020 01 10.
Artigo em Inglês | MEDLINE | ID: mdl-31918687

RESUMO

BACKGROUND: Mycetoma is an uncommon chronic granulomatous infection of cutaneous and subcutaneous tissues that can be caused by filamentous bacteria (actinomycetoma) or fungi (eumycetoma). It is the prerogative of young men between the third and fourth decade and is transmitted through any trauma causing an inoculating point. The classic clinical triad associates a painless hard and swelling subcutaneous mass, multiple fistulas, and the pathognomonic discharge of grains. Although endemic in many tropical and subtropical countries, mycetoma can also be found in non-endemic areas as in Morocco, and causes then diagnosis problems leading to long lasting complications. Therefore, we should raise awareness of this neglected disease for an earlier management. Under medical treatment however, mycetoma has a slow healing and surgery is often needed, and relapses are possible. CASE PRESENTATION: Herein we report a case of a 64 years old patient, with a history of eumycetoma occurring ten years ago treated with oral terbinafine coupled with surgery. A complete remission was seen after 2 years. He presented a relapse on the previous scar 6 months ago. There wasn't any bone involvement in the magnetic resonance imaging (MRI). The patient was put under oral terbinafine with a slow but positive outcome. CONCLUSION: Through this case report, we perform a literature review and highlight the importance of increase awareness of mycetoma in clinical practice especially in non-endemic regions.


Assuntos
Doenças do Pé/diagnóstico , Madurella/isolamento & purificação , Micetoma/diagnóstico , Antifúngicos/uso terapêutico , Diagnóstico Diferencial , Pé/diagnóstico por imagem , Pé/microbiologia , Pé/patologia , Doenças do Pé/microbiologia , Doenças do Pé/patologia , Doenças do Pé/terapia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Marrocos , Micetoma/microbiologia , Micetoma/patologia , Micetoma/terapia , Doenças Negligenciadas , Medicina Tropical
15.
J Pak Med Assoc ; 70(1): 174-177, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31954048

RESUMO

Vitamin B12 deficiency results in multisystem manifestations. A 30years-old man presented with progressive weakness of lower limbs along with numbness. Patient had pale colour and noticed progressive pigmentation over dorsal and palmar aspects of both the hands and the feet. Neurological examination revealed absent ankle jerks, sensory impairment until T5 level, loss of joint position sensation and positive Romberg's sign. Workup showed macrocytic anaemia and hypersegmented neutrophils. There was no evidence of hypocortisolism. Magnetic Resonance Imaging of brain and spine was normal; however, Electromyography/Nerve conduction studies were suggestive of demyelinating neuropathy. His clinical and lab findings were suspicious of B12 deficiency, which was found to be very low. Hyperpigmentation is rare in B12 deficiency as presenting symptoms and diagnosis may be overlooked. Therefore, vitamin B12 levels should be checked as any delay in diagnosis and treatment will result in progression of Subacute Combined Degeneration of the spinal cord to the extent that it becomes irreversible.


Assuntos
Doenças da Medula Espinal , Degeneração Combinada Subaguda , Deficiência de Vitamina B 12 , Adulto , Pé/patologia , Mãos/patologia , Humanos , Imagem por Ressonância Magnética , Masculino , Pele/patologia , Pigmentação da Pele
16.
Artigo em Inglês | MEDLINE | ID: mdl-31963718

RESUMO

BACKGROUND: Hallux valgus (HV) has been previously associated with psychological disorders. Thus, the purposes of this study were to associate kinesiophobia and pain intensity with HV deformity degrees, as well as predict kinesiophobia and pain intensity based on HV deformity and demographic features. METHODS: A cross-sectional study was carried out recruiting 100 subjects, who were divided into HV deformity degrees, such as I-no HV (n = 25), II-mild (n = 25), III-moderate (n = 25), and IV-severe (n = 25) HV. Kinesiophobia total and domains (activity avoidance and harm) scores and levels were self-reported by the Tampa Scale of Kinesiophobia (TSK-11). Pain intensity was self-reported by the numeric rating scale (NRS). RESULTS: Statistically significant differences (p < 0.01; η2 = 0.132-0.850) were shown for between-groups comparison of kinesiophobia total and domain scores (activity avoidance and harm) and levels, as well as pain intensity among HV deformity degrees. Post hoc comparisons showed statistically significant differences with a large effect size (p < 0.05; d = 0.85-4.41), showing higher kinesiophobia symptoms and levels and pain intensity associated with greater HV deformity degrees, especially for III-moderate and/or IV-severe HV deformity degrees versus I-no HV and/or II-mild deformity degrees. Both statistically significant prediction models (p < 0.05) for kinesiophobia (R2 = 0.300) and pain intensity (R2 = 0.815) were predicted by greater HV deformity degree and age. CONCLUSIONS: Greater kinesiophobia symptoms and levels and pain were associated with higher HV deformity degrees, especially severe and/or moderate HV with respect to no and/or mild HV. The kinesiophobia and pain intensity were predicted by greater HV deformity degree and age.


Assuntos
Pé/patologia , Hallux Valgus/complicações , Dor/etiologia , Dor/psicologia , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Limitação da Mobilidade , Inquéritos e Questionários , Adulto Jovem
17.
Adv Clin Exp Med ; 29(1): 157-163, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31990461

RESUMO

Palmoplantar pustulosis (PPP) is a chronic inflammatory disease, most often occurring in middle-aged women. In the course of the condition, painful skin lesions appear on the hands and feet, i.e., areas that are extremely important in everyday life. Therefore, the disease significantly reduces quality of life. The pathogenesis of this disease is poorly understood, although it is known that genetic, immunological and environmental factors play a role in its development. Clinical observations confirm the role of nicotine and contact allergens in the development of the lesions. The skin lesions can also occur as a side effect of certain medications. In some cases, PPP coexists with other diseases, i.e., seronegative arthropathies, as well as celiac and thyroid diseases. There is also a connection between the disease and infectious bacterial foci. Exacerbation of the skin lesions is triggered by stress. Therefore, patients require multidirectional tests, since finding the cause of the disease is essential to administering effective treatment.


Assuntos
Psoríase , Doenças da Glândula Tireoide , Doença Crônica , Feminino , Pé/patologia , Mãos/patologia , Humanos , Pessoa de Meia-Idade , Psoríase/complicações , Psoríase/diagnóstico , Psoríase/terapia , Qualidade de Vida , Doenças da Glândula Tireoide/complicações , Doenças da Glândula Tireoide/diagnóstico , Doenças da Glândula Tireoide/terapia
18.
BMC Infect Dis ; 20(1): 23, 2020 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-31914940

RESUMO

BACKGROUND: The prevalence of diabetes mellitus continues to inexorably rise in the United States and throughout the world. Lower limb amputations are a devastating comorbid complication of diabetes mellitus. Osteomyelitis increases the risk of amputation fourfold and commonly presages death. Antimicrobial therapy for diabetic foot osteomyelitis (DFO) varies greatly, indicating that high quality data are needed to inform clinical decision making. Several small trials have indicated that the addition of rifampin to backbone antimicrobial regimens for osteomyelitis outside the setting of the diabetic foot results in 28 to 42% higher cure rates. METHODS/DESIGN: This is a prospective, randomized, double-blind investigation of the addition of 6 weeks of rifampin, 600 mg daily, vs. matched placebo (riboflavin) to standard-of-care, backbone antimicrobial therapy for DFO. The study population are patients enrolled in Veteran Health Administration (VHA), ages ≥18 and ≤ 89 years with diabetes mellitus and definite or probable osteomyelitis of the foot for whom an extended course of oral or intravenous antibiotics is planned. The primary endpoint is amputation-free survival. The primary hypothesis is that using rifampin as adjunctive therapy will lower the hazard rate compared with the group that does not use rifampin as adjunctive therapy. The primary hypothesis will be tested by means of a two-sided log-rank test with a 5% significance level. The test has 90% power to detect a hazard ratio of 0.67 or lower with a total of 880 study participants followed on average for 1.8 years. DISCUSSION: VA INTREPID will test if a rifampin-adjunctive antibiotic regimen increases amputation-free survival in patients seeking care in the VHA with DFO. A positive finding and its adoption by clinicians would reduce lower extremity amputations and their associated physical and emotional impact and reduce mortality for Veterans and for the general population with diabetic foot osteomyelitis. Given that rifampin-adjunctive regimens are currently employed for therapy for the majority of DFO cases in Europe, and only in a small minority of cases in the United States, the trial results will impact therapeutic decisions, even if the null hypothesis is not rejected. TRIAL REGISTRATION: Registered January 6, 2017 at ClinicalTrials.gov, NCT03012529.


Assuntos
Amputação , Pé Diabético/tratamento farmacológico , Osteomielite/tratamento farmacológico , Rifampina/uso terapêutico , Veteranos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Amputação/estatística & dados numéricos , Antibacterianos/uso terapêutico , Antibioticoprofilaxia , Pé Diabético/complicações , Pé Diabético/epidemiologia , Pé Diabético/cirurgia , Método Duplo-Cego , Feminino , Pé/microbiologia , Pé/patologia , Pé/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Osteomielite/complicações , Osteomielite/epidemiologia , Osteomielite/cirurgia , Placebos , Estudos Prospectivos , Prevenção Secundária/métodos , Veteranos/estatística & dados numéricos , Adulto Jovem
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