Comparison of Nonablative Fractional Erbium Laser 1,340 nm and Microneedling for the Treatment of Atrophic Acne Scars: A Randomized Clinical Trial.

BACKGROUND: The efficacy and safety of nonablative fractional laser for acne scars treatment has been described in several studies. Recently, microneedling treatment has been showing promising results with lower costs, quick healing time, and low risk of postinflammatory hyperpigmentation (PIH). OBJECTIVE: To compare the effectiveness and safety of nonablative fractional erbium laser 1,340 nm and microneedling for the treatment of facial atrophic acne scars. METHODS: Forty-six patients with atrophic facial acne scars were randomized to microneedling and laser groups, receiving 3 sessions performed monthly. Two blinded dermatologists applied the validated "Quantitative Global Grading System for Postacne Scarring" scale, before, 2 months, and 6 months after the treatment. Side effects were recorded at each follow-up visit and patient's satisfaction was evaluated. RESULTS: Both groups showed a significant improvement, and there was no statistically significant difference between results of both therapies (p = .264). The erythema after each session was longer in the laser group and 13.6% subjects experienced PIH. No PIH was observed in the microneedling group. CONCLUSION: This study shows that both nonablative fractional laser 1,340 nm and microneedling are comparable and effective in the treatment of atrophic acne scars. Microneedling is well tolerated, with fewer side effects and lower down time.

Polymorphisms in the genes related to angiogenesis are associated with uterine cervical cancer.

INTRODUCTION: The expression of plasminogen activator inhibitor type 1 (PAI-1), vascular endothelial growth factor (VEGF), and transforming growth factor ß1 (TGF-ß1) participates in the angiogenesis of several cancer types. The goal of this study was to investigate polymorphisms in genes related to angiogenesis (PAI-1-675 4G/5G, VEGF C936T, and TGF-ß1 G-800A) to evaluate the risk for developing uterine cervical cancer (UCC). METHODS: In a case-control study, 100 healthy subjects and 100 patients with UCC from Mexico were included. We determined the genetic profile of the polymorphic markers, which were evaluated by polymerase chain reaction using a sequence-specific primer. RESULTS: There was no statistical difference in the allele distribution from the intergroup comparisons of PAI-1 675 4G/5G and VEGF C936T data; however, a significant difference was observed within TGF-ß1 G-800A. The linkage disequilibrium analysis revealed that PAI-1 -675 4G and TGF-ß1 -800A pair-haplotype was in strong linkage disequilibrium with a significantly increased risk (odds ratio, 3.44; 95% confidence interval, 1.66-7.25) to UCC. CONCLUSIONS: The polymorphisms in the genes related to angiogenesis -675 4G/5G PAI-1 and G-800A TGF-ß1, segregated solely or combined, might contribute to the increased susceptibility to UCC in a Mexican population.

Alcohol Use Disorder in Older Adults.

As the number of older adults worldwide continues to grow, we observe a proportional growth of substance use. Despite the myriad of complications alcohol use disorder (AUD) has on the body with regards to organ systems and mental health, the topic has been underresearched in the older adult population. Thus, it is important to create awareness about the growing problem of AUD among older adults. In this way, we can mitigate the long-term complications and side effects observed with alcohol abuse in this vulnerable population.

Nail psoriasis treated with pulsed dye laser.

Nail changes are present in about 50% of psoriasis patients and tend to be refractory to conventional treatments. Pulsed dye laser has emerged as an alternative therapy. Our aim is to evaluate the efficacy of pulsed dye laser in nail psoriasis and the impact of treatment on quality of life. Fourteen patients were treated in monthly sessions for three months. The outcome assesment was made by the Nail Psoriasis Severity Index (NAPSI). The median improvement in the scores of the overall NAPSI, nail bed NAPSI, and nail matrix NAPSI were 44.2% (P = 0.002), 50% (P = 0.033) and 65.1% (P = 0.024), respectively.

Syndrome in question. A case of Cowden´s syndrome.

The authors describe a case of Cowden's syndrome in a female patient with classic cutaneous lesions, plus papillomatous lesions in the gastrointestinal tract and a previous history of thyroid carcinoma. Mucocutaneous lesions occur in 90% of Cowden's syndrome cases and are characterized by facial trichilemmomas, oral mucosal papillomas and benign acral keratoses. Sites of extracutaneous involvement include: the thyroid, gastrointestinal tract, breast and endometrial tissue. There is risk of malignancies in these organs and they need to be monitored with imaging tests. The early diagnosis of the syndrome by a dermatologist through mucocutaneous lesions enables the investigation and diagnosis of extracutaneous involvement.

Development and application of the mania rating guide (MRG).

In this article we present the development and application of the Mania Rating Guide (MRG), a semi-structured interview. This guide was created in order to assist the filling of three mania Scales: Mania Rating Scale, Bech-Rafaelsen Mania Scale and Clinician-Administered Rating Scale for Mania. The MRG consists of twenty-one Psychopathological Dimensions, that correspond to the Items of the original Scales, and are structured in Questions. The guide was applied to fifteen manic patients admitted in the Psychiatric Unit of the Clinical Hospital of Porto Alegre. A psychiatrist interviewed them using the MRG, and the interviews were videotaped. Afterwards, three independent raters scored the Mania scales based on the films. The impression of the raters was that the MRG allows not only to easily score all the Items of the Scales but also to cover the wide spectrum of the symptomatological presentation of a manic syndrome.

[Most frequent causes of constipación in our environment]. / Causas más frecuentes de constipación en nuestro medio.

At the Digestive Motility Department on gastroenterology floor of the "Hospital de Clinicas Jose de San Martin", 165 patients were evaluated due to chronic constipation, underlying the most frequent causes in our environment. The use of the present diagnostic methods is suggested following a suitable clinical orientation. The most frequent causes of constipation after this test were: chronic idiopathic constipation in 112 cases (67.87%) and with megarectum, megasigma and megacolon 32 cases (19.09%), rectocele in 9 cases (5.45%), rectal prolapse in 5 cases (3.03%), enf. De Hirschprung 5 cases (3.03%) and anal estenosis 2 cases (1.21%).

Translation into Brazilian Portuguese and validation of the "Quantitative Global Scarring Grading System for Post-acne Scarring".

The "Quantitative Global Scarring Grading System for Postacne Scarring" was developed in English for acne scar grading, based on the number and severity of each type of scar. The aims of this study were to translate this scale into Brazilian Portuguese and verify its reliability and validity. The study followed five steps: Translation, Expert Panel, Back Translation, Approval of authors and Validation. The translated scale showed high internal consistency and high test-retest reliability, confirming its reproducibility. Therefore, it has been validated for our population and can be recommended as a reliable instrument to assess acne scarring.

Livedoid vasculopathy associated with peripheral neuropathy: a report of two cases.

Livedoid vasculopathy (LV) is a chronic and recurrent disease consisting of livedo reticularis and symmetric ulcerations, primarily located on the lower extremities, which heal slowly and leave an atrophic white scar ("atrophie blanche"). Neurological involvment is rare and presumed to be secondary to the ischemia from vascular thrombosis of the vasa nervorum. Laboratory evaluation is needed to exclude secondary causes such as hyper-coagulable states, autoimmune disorders and neoplasms. We present two patients with a rare association of peripheral neuropathy and LV, thereby highlighting the importance of a multidisciplinary approach to reach the correct diagnosis.

Nail psoriasis treated with pulsed dye laser

Abstract: Nail changes are present in about 50% of psoriasis patients and tend to be refractory to conventional treatments. Pulsed dye laser has emerged as an alternative therapy. Our aim is to evaluate the efficacy of pulsed dye laser in nail psoriasis and the impact of treatment on quality of life. Fourteen patients were treated in monthly sessions for three months. The outcome assesment was made by the Nail Psoriasis Severity Index (NAPSI). The median improvement in the scores of the overall NAPSI, nail bed NAPSI, and nail matrix NAPSI were 44.2% (P = 0.002), 50% (P = 0.033) and 65.1% (P = 0.024), respectively.

Syndrome In Question

The authors describe a case of Cowden´s syndrome in a female patient with classic cutaneous lesions, plus papillomatous lesions in the gastrointestinal tract and a previous history of thyroid carcinoma. Mucocutaneous lesions occur in 90% of Cowden's syndrome cases and are characterized by facial trichilemmomas, oral mucosal papillomas and benign acral keratoses. Sites of extracutaneous involvement include: the thyroid, gastrointestinal tract, breast and endometrial tissue. There is risk of malignancies in these organs and they need to be monitored with imaging tests. The early diagnosis of the syndrome by a dermatologist through mucocutaneous lesions enables the investigation and diagnosis of extracutaneous involvement. .

An atypical presentation of erythema elevatum diutinum

Erythema elevatum diutinum is a rare chronic leukocytoclastic vasculitis of unknown etiology. Lesions are usually asymptomatic, although burning and itchiness can occur. The typical clinical presentation is characterized by persistent, symmetrical,papules and nodules that may coalesce to form larger nodules or plaques. It may be associated with various pathologies and the diagnosis is based on clinical and histopathological findings. Treatment is based on the use of dapsone and sulfonamides, first-line therapies, and other options such as niacinamide, tetracycline,colchicine, chloroquine and corticosteroids. We describe the case of a 65-year-oldmale patient that presented a single lesion on the dorsum of the hand, an unusual clinical presentation.

Livedoid vasculopathy associated with peripheral neuropathy: a report of two cases / Vasculopatia livedoide associada a neuropatia periferica: relato de dois casos

Livedoid vasculopathy (LV) is a chronic and recurrent disease consisting of livedo reticularis and symmetric ulcerations, primarily located on the lower extremities, which heal slowly and leave an atrophic white scar ("atrophie blanche"). Neurological involvment is rare and presumed to be secondary to the ischemia from vascular thrombosis of the vasa nervorum. Laboratory evaluation is needed to exclude secondary causes such as hyper-coagulable states, autoimmune disorders and neoplasms. We present two patients with a rare association of peripheral neuropathy and LV, thereby highlighting the importance of a multidisciplinary approach to reach the correct diagnosis. .

Vasculopatia livedoide é uma doença crônica e recorrente caracterizada por livedo reticular e úlceras simétricas nos membros inferiores, que cicatrizam e deixam uma cicatriz branca atrófica ("atrophie blanche"). Envolvimento neurológico é raro e está provavelmente associado a isquemia pela trombose dos vasa nervorum. Avaliação laboratorial é indicada com o intuito de excluir causas secundárias como estados de hipercoagulabilidade, doenças autoimunes e neoplasias. Apresentamos dois pacientes com uma rara associação de vasculopatia livedoide com neuropatia periférica, enfatizando a importância de uma abordagem multidisciplinar na busca do diagnóstico correto.

O trauma psíquico e o paradoxo das narrativas impossíveis, mas necessárias / The psychical trauma and the paradox of the impossible but necessary narrations

Considerando-se, à luz das contribuições freudianas mais tardias, que o traumático, entendido como excesso pulsional, estaria situado além da capacidade de representação psíquica, exploramos neste artigo a estreita articulação entre trauma e "indizível". Para tal, são retomados alguns aspectos centrais da teorização psicanalítica sobre o trauma, aspectos relacionados com a sua dimensão "intransmissível". Segundo esta visada, o trauma constitui um vivido que ultrapassa a capacidade psíquica de apropriação e de recalcamento. Nosso objetivo é mostrar como a ideia de uma narrativa impossível, mas absolutamente necessária - eixo central do presente artigo - parece aplicar-se perfeitamente ao sofrimento indizível posto em cena a partir da experiência traumática, e que torna tão fundamental a paradoxal tarefa de narrá-la.

In this paper we examine the strict articulation between trauma and the "unsayable", taking into account that in the light of the latest Freudian contributions, the traumatic, understood as drive excess, would be situated beyond the capacity of psychical representation. For that, we analyze some central features of psychoanalytical theorizing on trauma, related to its "untransmissible" dimension. From that perspective, trauma constitutes an experience that exceeds the psychical capacity to appropriate and to repress. Our aim is to point out that the idea of an impossible, though absolutely necessary, narration - central axis of this paper - appears to fit the unsayable pain introduced by the traumatic experience, and makes essential the paradoxical task of narrating it.

Anoscopia de alta resolución en la identificación de lesiones anales inaparentes / High resolution anoscopy for the identification of non-apparent anal lesions

Introducción: En los últimos años, la aplicación de métodos de diagnóstico tales como el PAP anal y la Anoscopia de Alta Resolución (AAR) en población de alto riesgo permite una pesquisa diagnóstica temprana del cáncer invasor del conducto anal abriendo las puertas a la posibilidad curativa. El objetivo del siguiente estudio es presentar dos casos clínicos con neoplasia intraepitelial anal (NIA) hallados en la pieza de anatomía patología poshemorroidectomía en los que se utilizó la AAR para dirigir la conducta a seguir. Material y método: En el “H.I.G.A. Prof. Dr. Luis Güemes”, Haedo, provincia de Buenos Aires, en el período comprendido entre el 01/01/08 al 06/06/09, fueron halladas en la pieza de hemorroidectomía dos NIA. Ninguno de estos dos pacientes presentaba factores de riesgo para carcinoma de ano previo a la cirugía hemorroidal. A ambos pacientes se les realizó AAR con el objetivo de reconocer la extensión de las lesiones para su completa resección. Resultados: La visualización de la localización y extensión de la lesión a través de la AAR, permitió la correcta elección del área de resección y márgenes de seguridad oncológicos adecuados. Conclusiones: La AAR tiene la ventaja de ser utilizada como localizador de lesiones no visibles por otro método, luego del hallazgo de atipias o lesiones premalignas mucosas; es por ello que el entrenamiento en el método resulta indispensable como complemento diagnóstico.

Introduction: Recently, the use of diagnostic methods such us anal cytolgy and high resolution anoscopy (HRA) in high risk population allows an early diagnosis of invasive anal cancer which increases chances of cure. The objective of the following study is to present two cases with anal intraepithelial neoplasia found in pathologie specimen where high resolution anoscopy was used to guide the next course of action. Patients and methods: In H.I.G.A. Prof. Dr. L. Güemes, Haedo Bs. As. Province, between 01/01/08 and 06/06/09, one anal intraepithelial neoplasia and one invasive anal cancer were found in the hemorrhoidectomy piece. Neither of these two patients showed risk factors for anal cancer previous to hemorrhoid surgery. Both patients were treated with HRA with the purpose of recognizing the extent of the injuries to be fully resected. Result: Spotting the localization and extension of the injuries through HRA enabled the physician to choose margins. Conclusions: The HRA has the advantage to be used as a localizer of lesions that can't be seen otherwise, as from the finding of atypia or premalignant mucosal lesion. That is the reason why the training in these methods is essential as a complementary test.

Síndrome de reconstitución inmune en pacientes VIH positivo / Immune reconstitution syndrome in HIV-positive patients

El síndrome de reconstitución inmune (SR) en pacientes VIH positivo es una consecuencia adversa de la restauración de la respuesta inmune específica, durante los primeros 6 meses de tratamiento antirretroviral de gran actividad (TARGA). Objetivo. Cuantificar la prevalencia de SRI y caracterizar demográfica, clínica, inmunológica y virológicamente a pacientes VIH positivo con SRI que iniciaron TARGA en la Clínica de Enfermedades Infecciosas del Hospital Roosevelt, ciudad capital, Guatemala, 2006-2008...

Desenvolvimento da versão em português da Escala Administrada pelo Clínico para Avaliação de Mania (EACA-M): Escala de Mania de Altman / Development of the Portuguese-language versión of the Clinician-Administered Rating Scale for Mania (CARS-M): Altman Scale for Mania

OBJETIVOS: No presente artigo é apresentado o desenvolvimento da versão em português da "Clinician-Administered Rating Scale for Mania" (CARS-M) de Altman e colaboradores intitulada: Escala Administrada pelo Clínico para Avaliação de Mania (EACA-M) ou "Escala de Mania de Altman". Os objetivos desse artigo são: (1) descrever a metodologia de elaboração da versão em português da CARS-M, (2) transmitir as impressões dos profissionais que a utilizaram e (3) disponibilizar a escala na íntegra em língua portuguesa. MÉTODOS: Os métodos utilizados foram: a) painel bilíngüe de tradução e discussão de todos os itens; b) retrotradução por pessoa habilitada; c) envio ao próprio autor da escala da nova versão em inglês originada a partir da sua tradução para o português; d) discussão com o autor dos pontos pendentes, bem como nova discussão entre os participantes do grupo de pesquisadores brasileiros até se chegar a um consenso. CONCLUSÕES: A impressão dos autores é a de que a EACA-M permite não apenas a fácil pontuação de todos os escores, mas também cobre o largo espectro de apresentação de uma síndrome maníaca. Com este artigo, a comunidade científica de Língua Portuguesa passa a dispor de um importante instrumento para avaliação do estado maníaco.

Desenvolvimento da versão em português da Escala de Avaliação de Mania de Bech-Rafaelsen (EAM-BR) / Development of the Portuguese version of the Bech-Rafaelsen Mania Rating Scale (BRMaS)

No presente artigo, é apresentado o desenvolvimento da versão em português da Bech-Rafaelsen Mania Rating Scale (BRMaS) de Bech e colaboradores intitulada: Escala de Avaliação de Mania de Bech-Rafaelsen (EAM-BR). A EAM-BR foi desenvolvida para ser aplicada na forma de uma entrevista semi-estruturada breve conduzida pelo clínico. Ela investiga a presença versus a ausência de sintomas maníacos, sua severidade e sua mudança em resposta ao tratamento. São descritas as qualidades psicométricas da escala original. Com este artigo, a comunidade científica passa a dispor em português de mais um importante instrumento para avaliação do estado maníaco.