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Food supplements consist of various substances, which can be used orally or enterally and are assigned for food supplementation. Research with dietary supplements pointed to substances not declared on the labels, such as prohormones or anabolic androgenic steroids (AAS). Objective: Conduct chemical and chromatographic tests with a sample of protein food supplements to detect possible anabolic androgenic steroids. Materials and Method: This is an analytical study of a quali-quantitative nature. Conclusion: Analyzes indicate the presence of steroids in all evaluations of dietary protein supplement samples. [ABSTRACT FROM AUTHOR]

BACKGROUND: Eosinophilic fasciitis is a rare sclerodermiform syndrome of unknown etiology, characterized by thickening of the muscle fascia and subcutaneous tissue and clinically presents with arthralgia, functional limitation, and thickening of deep tissues that conditions flexion contractures, with variable infiltration by eosinophils and peripheral eosinophilia; the diagnosis requires an adequate approach and, if possible, a skin, muscle and fascia block biopsy. Treatment is discussed and steroids and immunosuppressants are prescribed. Rituximab has currently shown good results in some cases and series. CLINICAL CASE: A 19-year-old female patient who began acutely with skin hardening that lead to functional limitation associated with peripheral eosinophilia; eosinophilic fasciitis was concluded and she had a lack of response to usual treatment, which is why management with rituximab was started, with a good response. CONCLUSIONS: The diagnosis of eosinophilic fasciitis is complex, it requires a high index of suspicion and extensive studies such as magnetic resonance imaging or biopsy; the latter is important but should not delay treatment, which is currently based on steroids and immunosuppressants, with good response; Rituximab may be a therapeutic option in refractory cases. [ABSTRACT FROM AUTHOR]

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Introducción: la enfermedad asociada a la glicoproteína oligodendrocitaria de mielina (MOGAD) comprende un espectro amplio de manifestaciones clínicas y hallazgos imagenológicos, donde la evidencia reciente indica que la encefalitis de tallo es una posible manifestación de MOGAD. Presentación de caso: se presenta el caso de una paciente femenina de 32 años con curso de enfermedad fluctuante y buena respuesta a esteroides, con afectación predominante del tallo cerebral de nueve años de evolución y posterior compromiso del nervio óptico. La paciente no cumplía criterios para esclerosis múltiple o neuromielitis óptica y otros diagnósticos diferenciales fueron excluidos. Finalmente, el diagnóstico de MOGAD fue confirmado mediante la detección de anticuerpos IgG contra la proteína MOG. Discusión: las lesiones de tallo cerebral en MOGAD se han descrito en el 30?% de los casos de una cohorte española de pacientes positivos para MOG-IgG. Las lesiones tienden a ser bilaterales, mal definidas y de gran tamaño. A pesar de que los bajos títulos del examen pueden generar dudas sobre el diagnóstico, Banwell et al. recientemente propusieron unos nuevos criterios diagnósticos que incluyen bajos títulos de MOG-IgG y, ante ello, los criterios clínicos de soporte apoyan el diagnóstico. Conclusiones: los pacientes con signos de encefalitis de tallo sin clara etiología deben ser evaluados con anticuerpos asociados a la proteína MOG, para confirmar o descartar el diagnóstico.

La sordera súbita fue descrita por primera vez en 1860 por Bing, la cual relacionó con la parotiditis. En 1944 De Kleyn hizo sus aportes, así como McCabe en 1979, y muchos desde entonces han tratado de definir, y manejar correctamente esta entidad, pero no fue hasta 1986, que Wilson la describe como un trastorno de instalación súbita donde existe una pérdida auditiva unilateral o bilateral de tipo sensorineural mayor a 30 dB que afecta por lo menos a tres frecuencias audiométricas consecutivas y se desarrolla en un periodo menor o igual a 72 horas.

Introduction. Anxiety, mood- and stress-related behaviors are regulated by sex hormones in pregnant and non-pregnant women. Very scarce information exists about the role of sex steroids in pregnant women displaying high levels of anxiety. Objective. To determine sex hormones serum levels in pregnant women exhibiting high levels of anxiety symptoms. Method. The Hamilton Anxiety Rating Scale (HARS/ HAM-A) was used to assess the intensity of anxiety symptoms in third-trimester pregnant women. Two groups were included in the study, pregnant women exhibiting severe anxiety (ANX; HARS scores ≥ 25; n = 101) and healthy control subjects (CTRL; n = 40) displaying lower scores for anxiety (HARS scores ≤ 7). Estradiol (E2), progesterone (P4), and testosterone (T) serum levels were measured using a standard chemiluminescent immunoassay. Bivariate and partial correlations were performed to detect significant associations between groups, clinical measures, biochemical data, and HARS scores. Results. The anxiety group (ANX) showed an increase in E2 and T serum levels (p < .001) compared to CTRL. Conversely, significantly lower P4 levels were found in the symptomatic group (p < .001) as compared to the CTRL hormone values. The P4:E2 index was significantly reduced in pregnant women with high levels of anxiety (p < .001). Negative correlations between anxiety (HARS) scores, P4 serum levels (p = .02), and P4:E2 ratio (p = .04) were found in the symptomatic group. Conversely, T serum levels displayed a positive association (p = .001) with high levels of anxiety symptoms in the same group, after adjusting our data by clinical confounders. Discussion and conclusion. Serum levels of sex-steroid hormones are altered in pregnant women exhibiting severe anxiety. [ABSTRACT FROM AUTHOR]

Copyright of Tesla Revista Científica is the property of Puerto Madero Editorial Academica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

BACKGROUND: Systemic lupus erythematosus is a systemic inflammatory disease characterized by multiple autoantibodies, some of the pathogenic as anti-Ro/La (neonatal blockade), antiphospholipid (thrombosis) and anti-ADN (nephritis). CLINICAL CASES: This study includes a series of cases from our systemic lupus erythematosus cohort that presented to the emergency room without a previously established diagnosis. Seven cases were identified as the initial manifestation of the disease, 5 women and 2 men with a median age of 17 years. For the diagnosis, the new 2019 ACR/EULAR classification criteria were used, which include seven clinical manifestations (skin, arthritis, fever, neurological, serositis, hematological and kidney) and three immunological criteria. Systemic lupus erythematosus is classified with a score of 10 or more. The manifestations were serositis, arterial thrombosis with associated antiphospholipid antibodies, psychosis, transverse myelitis, and probable cerebral vasculitis. All patients received immunosuppressants with high doses of steroids with subsequent reduction. CONCLUSIONS: Several forms of initial manifestation of systemic lupus erythematosus have been described. A high index of suspicion for autoimmune disease is necessary in young subjects, particularly systemic lupus erythematosus. [ABSTRACT FROM AUTHOR]

BACKGROUND: Food allergies are on the raise, with a wide suite of clinical presentations that include affectation to the skin, respiratory and gastrointestinal systems. CLINICAL CASE: A 63-year-old male patient, without any relevant clinical background that went to evaluation for secondary hemiglossitis after eating mamey ice cream, being a rare manifestation of a food allergy/food poisoning. CONCLUSIONS: Timely management of hemiglossitis with antihistamines in association with steroids is very useful to limit the extent of damage. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To identify the risk factors associated with mortality in patients with rhinoorbito-cerebral mucormycosis and COVID-19 infection. MATERIALS AND METHODS: Observational, analytical, cross-sectional and retrospective study of patients with rhino-orbito-cerebral mucormycosis was made from January 2020 to October 2022. Descriptive statistics were applied, for the inferential analysis Mann-Whitney U and Pearson's X² were used, as well as odds ratio (OR) to determine the risk, a value of p ≤ 0.05 was considered significant. RESULTS: Fifteen patients were included, with an average age of 60.87, 9 males. No differences were found between the living and the dead for sex, location of the mucormycosis, or the severity of COVID-19. Differences were found between the number of comorbidities (p = 0.035) and the type of surgical treatment (p = 0.039). When evaluating the risk of death and sex OR was of 0.125 (CI95% 0.009-1.723), location of the disease: OR 0.30 (CI95% 0.014-6.382), degree of disease by COVID-19: OR 10 (CI95% 0.584-171.202), stage by tomography: OR 4.500 (CI95% 0.374-54.155), type of surgical treatment: OR 13.500 (CI95% 0.878-207.624). CONCLUSIONS: The factors associated with mortality in patients with rhino-orbitocerebral mucormycosis and COVID-19 were having two or more comorbidities and the type of surgical treatment. [ABSTRACT FROM AUTHOR]

Resumo Esta pesquisa analisa os processos críticos para a redução de danos entre consumidores de esteroides, no contexto de academias de ginástica da região Metropolitana de Goiânia, Goiás, e os sujeitos do estudo foram selecionados por meio da técnica de Bola de Neve. Foi realizada análise de conteúdo a partir da transcrição de quinze entrevistas, e a exploração do material produzido levou à construção de quatro categorias a posteriori. Foram observadas ações - como o gerenciamento individual de riscos, a exemplo da autoexperimentação para avaliar a qualidade do produto e da automedicação na forma de terapias pós-ciclo - e, ao mesmo tempo, processos que conferem proteção à saúde, especialmente relativos às redes de apoio e à posição socioeconômica favorável dos participantes deste estudo. Considera-se importante estruturar ações proativas, contínuas e integradas de redução de danos que respondam às necessidades de saúde de quem consome esteroides, assim como implementar estratégias que superem tanto a abordagem de guerra às drogas quanto a abordagem apenas pragmática e individual do gerenciamento de riscos.

Given the public health problem posed by anabolic steroids, the consumption of ergogenic aids is increasing worldwide, not indifferently in Bolivia. In addition, there is an excessive consumption of nutritional and pharmaceutical supplements, as well as reversible and irreversible effects of anabolic steroids. Objectives: to describe how nutritional and pharmaceutical ergogenic aids are consumed and how gym-goers in the Cercado municipality of Cochabamba perceive their effects on their health. Methods: a crosssectional observational study was conducted with 378 participants over 18 years of age, (stratified) divided into four groups; Amateur, Fitness, Athlete and in 9 gyms and 2 groups (NABBA-IFFB) and athletes in general in the metropolitan area of Cercado Cochabamba. Results: it was found that 74.6% consumed some performance-enhancing substance; the consumption of nutritional ergogenic aids was 57.1% (n=216) and pharmacological aids 17.4% (n=66). Time dedicated to training and diet for the amateur group is statistically significant with a value of (p<0.05). The perceived and reported effects of the consumption of pharmacological ergogenic aids (anabolic androgenic steroids) are mainly mood changes, libido alteration and acne. Among the irreversible side effects 2 cases of men developed gynecomastia and 2 women developed clitoromegaly. Conclusions: exercise users in the gym consume large amounts of nutritional and/or pharmacological performance enhancing substances. [ABSTRACT FROM AUTHOR]

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Objetivo: caracterizar clínica y epidemiológicamente a los pacientes con enfermedad pulmonar obstructiva crónica. Métodos: estudio descriptivo retrospectivo trasversal, que incluyó pacientes adultos con diagnóstico de enfermedad pulmonar obstructiva crónica en un hospital universitario de Medellín. La fuente de información fue secundaria a través de historias clínicas, el análisis se realizó en el programa Jamovi, empleando un análisis univariado. Resultados: se incluyeron 552 pacientes, la edad mediana fue 76 años con predominio del sexo femenino (56.7%). Respecto a la exposición a sustancias tóxicas respiratorias importantes en el desarrollo de la enfermedad, 24.1% consumían cigarrillo y 23% exposición a biomasa. Al momento del ingreso hospitalario 17.9% fueron clasificados con disnea grado IV; 74.1% recibió beta-agonistas de corta acción y antimuscarínicos de corta acción 60%; 11.6% requirió ingreso a las unidades de cuidados intensivos o especiales y 7.8% fallecieron durante la hospitalización. Conclusión: se evidencia subdiagnóstico espirométrico de la enfermedad que puede estar relacionado con las limitaciones económicas, tecnológicas y de recurso humano capacitado, lo cual afecta el adecuado diagnóstico y manejo de la enfermedad, así como impacta la calidad de vida de los pacientes.

Contexto: el uso del monitoreo de glucosa flash (MCG) intrahospitalario puede facilitar la toma de decisiones médicas. Objetivo: describir el comportamiento glucémico en pacientes hospitalizados con COVID-19, evaluados mediante MCG, y explorar la asociación entre el control glucémico intrahospitalario y los desenlaces adversos. Adicionalmente, describir la seguridad del esquema de corrección resistente. Metodología: cohorte prospectiva. Resultados: en el estudio se incluyó a 27 pacientes, de los cuales 25 presentaron al menos un desenlace adverso (25,9?% UCI, 11,1?% choque séptico, 40,7?% SDRA, 25,9?% lesión renal aguda y 22,2?% lesión cardiaca aguda). La glucosa capilar promedio fue de 245 mg/dl, el promedio de glucosa intersticial fue de 180 mg/dl, el tiempo en rango (TIR) fue de 70-180 mg/dl 52,9?%, el tiempo por encima del tiempo en rango fue de (TAR) > 180 mg/dl 43,7?%, por debajo del tiempo en rango estuvo en (TBR) < 70 mg/dl 4,8?% y el coeficiente de variación (CV) fue de 35,2?%. La mejor capacidad discriminativa fue para CV con un AUC de 0,70 (IC95?% 0,45-0,94). En 11 pacientes se realizó al menos una corrección mediante el esquema resistente de la guía internacional del 2012 sin inducir hipoglucemia y el 69?% logró una medición en metas cinco horas después. Conclusiones: el MCG puede facilitar el entendimiento de la relación entre el control glucémico durante la hospitalización y los desenlaces clínicos adversos. El coeficiente de variación mostró el mejor rendimiento para predecir las complicaciones clínicas en comparación con el resto de las métricas, además que el control glucémico de los pacientes que reciben dexametasona es retador y exige un abordaje que incluya, no solo la insulina basal y prandial, sino también un esquema de corrección apropiado.

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Pneumonia continues to be one of the most frequent infectious syndromes and a relevant cause of death and health resources utilization. The OPENIN ("Optimización de procesos clínicos para el diagnóstico y tratamiento de infecciones") Group is composed of Infectious Diseases specialists and Microbiologists and aims at generating recommendations that can contribute to improve the approach to processes with high impact on the health system. Such task relies on a critical review of the available scientific evidence. The first Group meeting (held in October 2023) aimed at answering the following questions: Can we optimize the syndromic and microbiological diagnosis of pneumonia? Is it feasible to safely shorten the length of antibiotic therapy? And, is there any role for the immunomodulatory strategies based on the adjuvant use of steroids, macrolides or immunoglobulins? The present review summarizes the literature reviewed for that meeting and offers a series of expert recommendations., (Copyright © 2024 The Authors. Published by Elsevier España, S.L.U. All rights reserved.)

We present the case of a 68-year-old female who presented with a substantial cyclodialysis after phacoemulsification identified by anterior segment optical coherence tomography and ultrasound biomicroscopy. Gonioscopy is challenging because of its shallow anterior chamber. Due to lack of response to topical steroids and refusal by the patient for surgical treatment, topical steroids were tapered, and cycloplegic was initiated. After two weeks, the cyclodialysis cleft was closed on optical coherence tomography persisting residual subchoroidal fluid, topical treatment was mantained. Despite of this, visual acuity and hypotony were restored. Finally at 2 months visit subchoroidal fluid was reabsorbed and patient was discharged. Clinics should consider the possibility of cyclodialysis in cases of unjustified hypotony during postoperative period. In addition, we recommend performing anterior segment imaging which includes ultrasound biomicroscopy and optical coherence tomography, when the evaluation of angular structures is unfeasible. Finally, we propose medical management for severe cyclodialysis as the first option considering anti-inflammatory drugs could perpetrate the separation between scleral spur and ciliary muscle., (Copyright © 2024 Sociedad Española de Oftalmología. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction: In recent years, there have been changes in the management of patients with primary immune thrombocytopenia. In this study, a review is presented of the characteristics and outcomes of children with primary immune thrombocytopenia in a children’s hospital (Hospital Infantil Niño Jesús). Moreover, an analysis is made of the changes in the care of these patients diagnosed before and after 2011, when new guidelines were published by the Spanish Society of Paediatric Haematology Oncology (SEHOP). Material and methods: Data from a cohort of primary immune thrombocytopenia patients followed up in this hospital have been retrospectively reviewed. The statistical package used for the analysis was SPSS Statistics 22.0 (IBM Corp., Chicago, IL, USA). Results: A review is presented on the clinical data from 235 paediatric patients diagnosed with primary immune thrombocytopenia. It was observed that some features at diagnosis, such as age younger than five years and a previous history of infection, influenced the probability of cure. Regarding the changes in the management of patients since 2011, the steroid doses received during the first month and the first year, and the number of days corresponding to the patient’s first admission have both significantly decreased. Splenectomies were also significantly reduced. Conclusions: Since 2011, there have been changes in the medical care of our primary immune thrombocytopenia patients: they receive lower doses of steroids, they stay fewer days in the hospital, and the number of splenectomies has decreased without increasing bleeding or worsening the clinical evolution. Furthermore, it was observed that age younger than 5 years and a history of infection prior to diagnosis were related to higher chances of recovery. Resumen: Introducción: En los últimos años se han experimentado cambios en el manejo de los pacientes con trombocitopenia inmune primaria. En este estudio se revisan las características de los pacientes con trombocitopenia inmune primaria del Hospital Infantil Universitario Niño Jesús y su evolución. Además, analizamos los cambios en el abordaje de los pacientes diagnosticados antes y después del 2011, año en el que se publicó la guía de la Sociedad Española de Pediatría. Material y métodos: Se han revisado retrospectivamente los datos de pacientes con trombocitopenia inmune primaria en seguimiento en nuestro hospital desde el año 2000. El paquete estadístico utilizado para el análisis fue SPSS Statistics 22.0 (IBM Corp, Chicago, IL, EE.UU.). Resultados: Se han revisado 235 pacientes pediátricos con trombocitopenia inmune primaria observando que algunas características al diagnóstico, como la edad menor de 5 años y los antecedentes previos de infección, pueden influir en la probabilidad de recuperación. Con respecto al cambio de manejo de los pacientes, a partir de 2011 las dosis de esteroides recibidas durante el primer mes y el primer año se han reducido de forma significativa, así como el número de días del primer ingreso pasando de 5 a 3 días. Las esplenectomías también se han reducido significativamente. Conclusiones: Desde el año 2011 se han producido cambios en el abordaje de nuestros pacientes: reciben una menor dosis de esteroides, permanecen menos días ingresados y se ha reducido el número de esplenectomías sin aumentar los sangrados y sin disminuir la tasa de respuestas. Además, observamos que la edad menor de 5 años y el antecedente de infección previa al diagnóstico están relacionados con una mayor tasa de recuperación.

Introduction: Regardless corticosteroids are recommended for the treatment of organizing pneumonia there is limited evidence supporting this practice. Thus, we performed a systematic review of the literature on systemic corticosteroid treatment for organizing pneumonia. Methods: A search was implemented in the PubMed database (Medline) for articles published in the last 20 years. Those studies with incomplete or insufficient data and case reports were excluded. We collected data including: demographics, clinical data, diagnostic procedures, aetiology, treatment regimen (drug, posology, duration, response) and evolution. Results: A total of 135 publications were selected and finally 13 studies with 849 patients were included in the review: 12 retrospective observational studies and a single prospective observational study. Most of the patients were started on treatment with systemic corticosteroids – a total of 627 (30–100% depending on the series), but there was a great heterogeneity regarding drug, doses and duration. On those that started treatment, 226 (36%) presented a relapse of the disease during follow-up. Only one study provided information regarding treatment side-effects. Conclusion: The findings of this systematic review show the low quality data supporting the use of corticosteroids for the treatment of organizing pneumonia. This highlights a need to undertake appropriately designed studies to investigate which is the most appropriate treatment regimen that trades off benefits and risks of prolonged corticosteroid administration. Resumen: Introducción: Aunque los corticosteroides están recomendados para tratar la neumonía organizada, hay pocos datos que respalden esta práctica, por lo cual efectuamos una revisión sistemática de la bibliografía sobre el tratamiento con corticosteroides sistémicos para la neumonía organizada. Métodos: Se hizo una búsqueda en la base de datos PubMed (Medline) de artículos publicados en los últimos 20 años. Se descartaron los estudios con datos y casos clínicos incompletos o insuficientes. Los datos que recabamos abarcaron: datos demográficos, datos clínicos, técnicas diagnósticas, etiología, pauta terapéutica (fármaco, posología, duración, respuesta) y evolución. Resultados: Se eligieron 135 publicaciones en total y se incorporaron finalmente a la revisión 13 estudios con 849 pacientes: 12 estudios observacionales retrospectivos y un solo estudio observacional prospectivo. La mayor parte de los pacientes habían comenzado el tratamiento con corticosteroides sistémicos, un total de 627 (30%-100% en función de la serie), pero la duración, las dosis y el fármaco manifestaron una gran heterogeneidad. Entre los que habían empezado el tratamiento, 226 (36%) presentaron una recidiva de la enfermedad durante el seguimiento. Solo en un estudio se ofreció información sobre los efectos adversos del tratamiento. Conclusión: Los resultados de esta revisión ponen de manifiesto la escasa calidad de los datos sobre el tratamiento de la neumonía organizada con corticosteroides. Este hecho destaca la necesidad de emprender estudios diseñados correctamente para investigar la pauta terapéutica más adecuada que compense los riesgos y beneficios de la administración prolongada de corticosteroides.

Cataracts are the leading cause of reversible blindness in developing countries, their causes are varied, some are secondary to medications (such as the steroids), or eye diseases like uveitis, which might be associated in some cases with rheumatic conditions. The precise mechanism by which steroids promote cataracts development is not yet known, although it is relevant to be aware of this adverse effect in patients receiving these treatments. The relationship between cataracts and uveitis is important, as it is a common complication in this setting. Surgical management in these cases is more complex compared to those in which concomitant uveitis is not present. The aim of this review is to highlight the relationship and importance of a multidisciplinary approach between ophthalmologists and rheumatologists for providing an adequate management, and achievement of a good visual prognosis. [ABSTRACT FROM AUTHOR]

Introduction: chickenpox is a common and highly contagious rash disease caused by the varicella-zoster virus. In general, its presentation is benign, but serious complications may occur. In this article we present an adolescent who developed thrombocytopenic purpura as a complication of chickenpox. Clinical case: previously healthy 12-year-old female patient. Before admission, she had fever for six days, varicelloid rash, and epistaxis. On physical examination, in addition to the characteristic varicella rash, petechiae and ecchymosis were observed. Thrombocytopenia of 2,000/mm3 was documented. Acyclovir, immunoglobulin, and systemic corticosteroids were administered, as well as platelet transfusions, remaining hospitalized for more than two weeks, until recovery was achieved. Conclusion: serious complications of chickenpox such as thrombocytopenic purpura can occur in previously healthy and non-immunosuppressed patients. [ABSTRACT FROM AUTHOR]

Introdução: O CrossFit trabalha todas as capacidades fí­sicas em equilí­brio, aperfeiçoando as funções humanas básicas sem focar apenas na especialização de uma determinada habilidade, como acontece nos treinos tradicionais. Todavia, o culto ao corpo imposto pela sociedade e busca pela melhoria do desempenho, estimulada pela comunidade, faz com que o atleta além de praticar CrossFit, procure também fórmulas mágicas para alcançar seus objetivos. Objetivo: Investigar a prevalência e fatores associados ao uso de suplementos alimentares e esteroides anabólicos androgênicos em praticantes de CrossFit. Materiais e Métodos: Trata-se de um estudo quantitativo com delineamento transversal. Avaliou-se o perfil socioeconômico, antropométrico, hábitos de vida, prática de exercí­cio fí­sico, o consumo de suplementos e esteróides anabólicos androgênicos. Resultados: Evidenciou-se que 71,0% dos praticantes fazem uso de suplementos alimentares e 20,9% usam esteroides anabolizantes. Observou associação entre o uso de suplementos com o gênero, tempo de Crossfit, número de dias na semana que prática o esporte, duração do treino e participação em competições. Houve também associação entre o uso de esteroides anabolizantes e gênero, faixa etária e renda familiar. Conclusão: Conclui-se que o uso de suplementos alimentares e esteroides anabolizantes é cada vez mais crescente na população que prática atividade fí­sica, inclusive entre os praticantes de CrossFit.

Among the cutaneous lichen planus, the linear zosteriform subtype is included in those with a lower frequency of appearance; therefore, the report of its clinical form confirmed by the result of pathology of this inflammatory entity should be taken into account as a differential diagnosis of other pathological conditions that can adopt this pattern of distribution. We present the case of a female patient in the fourth decade of life with a 5-week history of appearance of highly pruritic, lichenoid-looking skin lesions, who underwent histopathological confirmation of the suspected clinical diagnosis, and we also observed significant clinical improvement to high potency steroid treatment. [ABSTRACT FROM AUTHOR]

El mecanismo específico por el cual los esteroides actuarían sobre la inflamación pulmonar sostenida, así como la definición del mejor fármaco a utilizar e incluso la duración adecuada del tratamiento, siguen siendo objetivos de los ensayos clínicos en curso. Como médicos clínicos, creemos que las potentes propiedades antiinflamatorias de los esteroides sintéticos están bien definidas y aún falta evidencia definitiva de que otras estrategias antiinflamatorias proporcionen una mejor eficacia, al menos en el COVID-19. Aunque los esteroides sintéticos comparten una marcada acción antiinflamatoria y escasos efectos mineralocorticoides, su bioequivalencia y diferentes cinéticas deben considerarse cuidadosamente, debido a la elevada variabilidad de la farmacocinética individual, el uso y prescripción adecuada de estos fármacos, pueden desencadenar efectos adversos diversos que podrían impactar negativamente en el curso clínico del paciente con COVID-19, además, muchos de los fármacos actualmente considerados en el manejo del paciente con coronavirus pueden potenciar la vida media y la aparición de efectos adversos de los corticosteroides, o algunos efectos adversos de estos otros fármacos pueden simular complicaciones asociadas al uso de corticosteroides lo que podría conllevar a una suspensión precoz e inoportuna de los mismos. Números estudios clínicos y artículos basados en revisiones narrativas han servido de guías para los médicos clínicos en medio de esta pandemia, sin embargo, los resultados de estos estudios deben interpretarse con cautela. Por esta razón, hemos realizado un análisis con base en el sistema GRADE de estos estudios para contrastar la información incluida en los estudios clínicos y minimizar el error de análisis.

Copyright of Ginecología y Obstetricia de México is the property of Federacion Mexicana de Ginecologia y Obstetricia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Alcoholic hepatitis is a frequent condition in the Mexican population. It is characterized by acute-on-chronic liver failure, important systemic inflammatory response, and multiple organ failure. The severe variant of the disease implies elevated mortality. Therefore, the Asociación Mexicana de Gastroenterología and the Asociación Mexicana de Hepatología brought together a multidisciplinary team of health professionals to formulate the first Mexican consensus on alcoholic hepatitis, carried out utilizing the Delphi method and resulting in 37 recommendations. Alcohol-related liver disease covers a broad spectrum of pathologies that includes steatosis, steatohepatitis, different grades of fibrosis, and cirrhosis and its complications. Severe alcoholic hepatitis is defined by a modified Maddrey’s discriminant function score ≥ 32 or by a Model for End-Stage Liver Disease (MELD) score equal to or above 21. There is currently no specific biomarker for its diagnosis. Leukocytosis with neutrophilia, hyperbilirubinemia (>3 mg/dl), AST > 50 U/l (< 400 U/l), and an AST/ALT ratio > 1.5-2 can guide the diagnosis. Abstinence from alcohol, together with nutritional support, is the cornerstone of treatment. Steroids are indicated for severe disease and have been effective in reducing the 28-day mortality rate. At present, liver transplantation is the only life-saving option for patients that are nonresponders to steroids. Certain drugs, such as N-acetylcysteine, granulocyte-colony stimulating factor, and metadoxine, can be adjuvant therapies with a positive impact on patient survival. Resumen: La hepatitis alcohólica es una condición frecuente en población mexicana, se caracteriza por insuficiencia hepática aguda sobre crónica, importante reacción inflamatoria sistémica y fallo multiorgánico, que en la variante grave de la enfermedad implica una elevada mortalidad. Por lo anterior, la Asociación Mexicana de Gastroenterología y la Asociación Mexicana de Hepatología conjuntaron un equipo multidisciplinario de profesionales de la salud para elaborar el primer consenso mexicano de hepatitis alcohólica. El consenso fue elaborado con la metodología Delphi, emitiendo 37 recomendaciones. La enfermedad hepática relacionada al consumo de alcohol comprende un amplio espectro, que incluye esteatosis, esteatohepatitis, fibrosis en diferentes grados, cirrosis y sus complicaciones. La hepatitis alcohólica grave se define por una función modificada de Maddrey ≥32 o por un puntaje de MELD (Model for End-Stage Liver Disease) igual o mayor a 21. Actualmente no existe un biomarcador específico para el diagnóstico. La presencia de leucocitosis con neutrofilia, hiperbilirrubinemia (>3 mg/dL), AST > 50 U/L ( 1.5-2 pueden orientar al diagnóstico. La piedra angular del tratamiento es la abstiencia junto con el soporte nutricional. Los esteroides estan indicados en la forma grave, en donde han resultado efectivos para reducir la mortalidad a 28 días. El trasplante hepático es en la actualidad la única opción con que se cuenta para salvar la vida de pacientes no respondedores a esteroides. Ciertos fármacos, como la N-acetilcisteína, el factor estimulante de colonias de granulocitos, y la metadoxina pueden ser una terapia adyuvante que puede impactar en la sobrevida de los pacientes.

A busca dos jovens pelo corpo perfeito influi para o consumo de esteroides anabólicos androgênicos (EAA), entretanto o consumo desses sem prescrição médica pode acarretar efeitos colaterais graves. O objetivo do estudo foi averiguar o conhecimento de adolescentes do Ensino Médio de uma escola pública sobre os EAA. Selecionou-se 31 alunos entre 15 e 17 anos (17 homens e 14 mulheres). O instrumento utilizado se tratou de um questionário. A maioria dos alunos não havia utilizado EAA e sabiam dos possíveis efeitos colaterais (90,3%), dos que usaram os meios foram: injetáveis (3,2%), ingestão (3,2%) e ambas (3,2%). Acerca da tratativa do assunto em casa 60% responderam de forma negativa. Todos os alunos disseram conhecer sobre os EAA. Sobre a indicação dos EAA a outra pessoa, 3% responderam de forma afirmativa, enquanto 97% não indicariam o uso. Diante do uso por motivos estéticos 16% relataram o interesse e 84% responderam que não usariam. Em relação à abordagem em sala de aula 58% afirmaram terem tido aulas a esse respeito e 90% julgam necessário à presença do assunto na grade curricular. Conclui-se então a relevância da atuação docente na abordagem sobre os EAA em sala de aula.

O risco infecioso associado a terapêutica biológica é cada vez mais estudado e conhecido, existindo estratégias de rastreio e profilaxia bem estabelecidas. O mesmo não se verifica na utilização de corticoide sistémico nem dos tradicionais modificadores de doença autoimune, de que são exemplo o metotrexato e a ciclosporina, apesar de usados há largos anos. A dose e tempo de terapêutica com corticoide sistémico relacionam-se com a ocorrência de infeção oportunista. Doses superiores a 5 mg/dia associam-se a infeção bacteriana, superiores a 10 mg/dia a reativação de infeção por vírus herpes zoster (VHZ), e superiores a 15 mg/dia ou por mais de 2 a 4 semanas a reativação de tuberculose latente, o que implica rastreio e aplicação de quimioprofilaxia de forma adequada. O corticoide sistémico surge ainda como dos principais fatores de risco para o desenvolvimento de pneumocistose no doente não-VIH e doses prolongadas (por mais de 4 semanas) podem levar a reativação de infeção por vírus da hepatite B (VHB) e justificar a profilaxia com tenofovir disoproxil fumarato ou entecavir. Foram ainda descritos casos de estrongiloidíase complicada de síndrome de hiperinfeção em doentes sob corticoide. O grau de imunossupressão conferido pode contraindicar a realização de vacinas vivas atenuadas. O metotrexato e ciclosporina comportam baixo risco infecioso quando utilizados em monoterapia, sendo a vigilância de sintomas a principal estratégia preventiva. Não obstante, ambos são imunomoduladores, contraindicam a realização de vacinas vivas atenuadas e associam-se a risco de infeção bacteriana e reativação de infeção por VHZ, no caso da ciclosporina, ou reativação de infeção por VHZ e VHB no caso do metotrexato, sobretudo se administrado em dose >0,4 mg/kg/semana. Ambos se associam a evolução para tuberculose ativa quando em associação terapêutica com outros imunossupressores. Compreender e estudar o risco de infeção na utilização de terapêutica imunossupressora permite a sua aplicação de forma mais informada e segura.

Vogt-Koyanagi-Harada (VKH) syndrome is an inflammatory condition of unknown etiology that can affect the eye. The most common ocular manifestation related to VKH is bilateral diffuse uveitis associated to exudative retinal detachment. Although these patients respond well to steroid pulse therapy, we report a case of a 44-year-old female patient presenting bilateral exudative retinal detachment and clinical diagnosis of VKH, who did not respond to the first cycle of 3-day pulse therapy with methylprednisolone. The exudation was reabsorbed only after a second cycle of steroid therapy. [ABSTRACT FROM AUTHOR]

Idiopathic nephrotic syndrome (ns) is one of the most frequent syndromes in childhood. It usually appears in children between 2-8 years with an overall incidence of 2-7 cases per 100,000 inhabitants. most respond to steroid treatment and more than 80% of the cases have minimal Glomerular lesion as the hystolopathological lesion. It is considered as a long-lasting process, with unpredictable periods of relapses and remissions. the objective of these national guidelines is to unify criteria regarding the management and treatment of patients with ns. An updated documentary research was carried out at local and international levels to suggest a consensus regarding the treatment of patients with ns and thus guarantee an early diagnosis, unified criteria to perform a renal biopsy when necessary, and an adequate therapy with the association of other immunosuppressants in order to minimize adverse effects. [ABSTRACT FROM AUTHOR]

Introdução: O uso de esteroides anabólicos andrógenos (EAA) tem sido relatado como presente em diversas modalidades esportivas, associado ao uso deles está a ocorrência de distúrbios de autoimagem. A vigorexia é um desses distúrbios mais comumente verificados. Objetivos: Relacionar a vigorexia com o uso de esteroides anabolizantes em praticantes de treinamento de força (TF) dentro de Centros de Treinamento Esportivo (CTE). Materiais e Métodos: pesquisa tipo transversal, quantitativa com abordagem descritiva, realizada no período de outubro de 2017 a junho de 2018 em dois CTE, localizada na zona periférica da cidade e na zona nobre. Composta por 40 voluntários, 20 da zona periférica (ZP) e 20 da zona nobre (ZN), classificados como vigoréxicos, de acordo com o Questionário de Complexo de Adônis. Os voluntários também preencheram um questionário com perguntas relacionadas ao uso de esteroides anabolizantes. Para a comparação dos dados foi utilizado o teste T de Student para amostras independentes, já para associação entre os dados qualitativos foi utilizado o teste de Qui-Quadrado. Resultados: Os participantes de ZN e ZP a tinham idade de (28,7 ± 4,77 anos) e (32,42 ± 6,03 anos) respectivamente (p=0,03). Foi verificado um maior percentual de uso de EAAs em ZN (80%), quando comparado com ZP (45%) (p=0,08). Os EAAs mais utilizados percentualmente foram, Durateston®(84%), Winstrol® (80%) e Deca Durabolin(44%). Em ambos grupos o fator principal para o uso de esteroides foi a estética (p

Background: Inflammation caused by chronic diseases and the constant use of systemic corticosteroids could be linked to the increased incidence of venous thromboembolic disease. Clinical case: A 47 year-old man with severe asthma of difficult control and allergic bronchopulmonary aspergillosis who, although the treatment was optimal, continued to have recurrent exacerbations and the need for systemic corticosteroids. He had edema in his left leg. Through venous Doppler ultrasound, deep vein thrombosis was confirmed; because of the images of the pulmonary V/Q gammagram, the presence of chronic pulmonary thromboembolism was suspected. 5 mg of apixaban were prescribed every 12 hours; in less than two months, symptom control was achieved without hospitalization, systemic corticosteroids or short-acting B2 agonists. Gradual withdrawal of omalizumab was started with good tolerance. Conclusions: The important decrease of bronchial symptoms with the blood thinner confirmed the suspicion that the exacerbations were caused by chronic pulmonary thromboembolism.

El cultivo del camarón genera un gran interés por su alto valor co- mercial y su creciente demanda en el mercado internacional. Alcan- zar elevados parámetros reproductivos en condiciones de cautiverio continúa siendo un reto en la mayoría de los países involucrados. En este sentido, la hormona inhibidora de las gónadas, un neuropépti- do tipo II secretado en el complejo endocrino Órgano X/glándula si- nusal perteneciente a la Familia de las hormonas hiperglucemiantes de crustáceos, ha sido identificado como el principal responsable de la regulación de la maduración ovárica mediante un control negativo de la expresión génica de la vitelogenina/vitelina. Por otro lado, se han descrito toda una serie de factores hormonales estimuladores de las gónadas que intervienen en los diferentes pasos de este proceso, cuyas rutas de acción están muchas veces interconectadas y sus actividades se encuentran altamente reguladas. Sin embargo, aún se requieren estudios más profundos de sus mecanismos de acción para una mejor comprensión del complejo esquema global de control endocrino de la reproducción en crustáceos. En este trabajo se realiza una revisión de las principales técnicas actualmente implementadas en los centros de desove para inducir la maduración de las hembras reproductoras y se hace un resumen de los hallazgos científicos más prominentes en el campo de la endocrinología de crustáceos a fin de desarrollar un mé- todo alternativo o en conjunto con la ablación unilateral del pedúnculo ocular para la inducción de la maduración ovárica bajo condiciones de cautiverio. ABSTRACT Shrimp culture has generate great interest worldwide for its growing demand in the in- ternational market and its high commercial value. Achieving higher reproductive param- eters under hatchery conditions continues to be a challenge for most of the countries in- volved. In this sense, gonad inhibiting hor- mone (GIH), an XO-SG complex eyestalk type II neuropeptide included in the CHH family, has been identified as the main regulator of ovarian maturation by controlling negatively vitellogenin/vitellin gene expression. In the other hand, there has been described several gonad stimulatory hormone factors that inter- vene among the different stages of this process, which routes of action are interconnected and their activities are highly regulated. However, further studies of their action mechanisms are required for a better understanding of the complex global scheme of endocrine control of reproduction in crustaceans. In this work cur- rently implemented techniques for induction of gonad maturation of reproductive females in hatchery facilities are reviewed; and most prominent scientific findings in the field of crustacean endocrinology are summarize aim- ing for the development of an alternative or in conjunction method to unilateral eyestalk ab- lation for the induction of ovarian maturation under captivity conditions.

El mecanismo específico por el cual los esteroides actuarían sobre la inflamación pulmonar sostenida, así como la definición del mejor fármaco a utilizar e incluso la duración adecuada del tratamiento, siguen siendo objetivo de estudio de los ensayos clínicos en curso. Como médicos clínicos, creemos que las potentes propiedades antiinflamatorias de los esteroides sintéticos están bien definidas, y aún falta evidencia definitiva de que otras estrategias antiinflamatorias proporcionen una mejor eficacia, al menos en el COVID-19. Aunque los esteroides sintéticos comparten una marcada acción antiinflamatoria y escasos efectos mineralocorticoides, su bioequivalencia y diferentes cinéticas deben considerarse cuidadosamente, debido a la elevada variabilidad de la farmacocinética individual, uso y prescripción adecuada de estos fármacos, ya que pueden desencadenar efectos adversos diversos que podrían impactar negativamente el curso clínico del paciente con COVID-19. Además, muchos de los fármacos actualmente considerados en el manejo del paciente con esta patología pueden potenciar la vida media y la aparición de efectos adversos de los corticoesteroides, o algunos efectos adversos de estos otros fármacos pueden simular complicaciones asociadas al uso de corticoesteroides, lo que podría conllevar a una suspensión precoz e inoportuna de los mismos. Números estudios clínicos y artículos basados en revisiones narrativas han servido de guías para los médicos clínicos en medio de esta pandemia, sin embargo, sus resultados deben interpretarse con cautela. Por estas razones, hemos realizado un análisis con base en el sistema GRADE de estos estudios para contrastar la información incluida en los estudios clínicos y minimizar el error de análisis.

The infectious risk associated with biological therapy is well studied today and screening and prophylaxis strategies have been stablished. However, this may not be true for systemic steroids or DMARDs (disease-modifying anti-rheumatic drugs) such as methotrexate and cyclosporine, even after long term use. The dose and duration of therapy with systemic steroids are related to the occurrence of opportunistic infection. Doses above 5 mg/day are associated with bacterial infection, above 10 mg/day with herpes zoster virus (HZV) reactivation, and above 15 mg/day or for more than 2 to 4 weeks with tuberculosis reactivation, which implies proper screening and chemoprophylaxis. Systemic steroids also appear as one of the main risk factors for the development of pneumocystosis in non-HIV patients and prolonged doses, for more than 4 weeks, can lead to hepatitis B virus (HBV) infection reactivation, and justify the beginning of prophylaxis with tenofovir disoproxil fumarate or entecavir. Cases of strongyloidiasis with hyperinfection syndrome have also been reported in patients on steroids. The degree of immunosuppression conferred may contraindicate live attenuated vaccines. Methotrexate and cyclosporine have a low infectious risk when used as monotherapy. Symptom surveillance is the main preventive strategy. However, both are immunomodulators, contraindicate live attenuated vaccines administration and are associated with infectious risk. Cyclosporine can lead to bacterial infection and HZV reactivation, and methotrexate is associated with HZV and HBV reactivation, especially if administered at a dose >0.4 mg/kg/week. Both are linked with active tuberculosis when in therapeutic combination with other immunosuppressants. Understanding and studying the risk of infection when using immunosuppressive therapy allows its use in a more informed and safe manner. [ABSTRACT FROM AUTHOR]

A clinical scenario is presented, from which a structured clinical question arises: In asthmatic children or adolescents with exacerbation symptoms, does the use of inhaled corticosteroids (newly instituted or base dose increased) reduce the risk of exacerbations that require systemic steroids and/or hospitalization? To answer it, we carried out a bibliographic search, with selection, evaluation and graduation of the evidence, following GRADE criteria. We did not find sufficient evidence to consider intermittent inhaled steroids as an alternative to maintenance inhaled steroids to avoid exacerbations that require the use of systemic steroids. The use of a combination of inhaled steroids with formoterol, as a rescue treatment at the onset of symptoms, is only effective when used by patients with this maintenance treatment, compared to those who only have inhaled steroids and rescue with beta2-agonists of short action; when patients already take maintenance combined therapy, combined rescue does not reduce the risk. In patients with asthma attacks attended in the emergency department, inhaled steroids compared to placebo reduce the risk of admission, but not when compared to systemic corticosteroids. Resumen: Se presenta un escenario clínico, del que surge una pregunta clínica estructurada: ¿En niños o adolescentes asmáticos con síntomas de exacerbación, el uso de corticoides inhalados (de nueva instauración o aumento de dosis habitual) reduce el riesgo de exacerbaciones que requieran corticoides sistémicos y/o ingreso? Para contestarla realizamos una búsqueda bibliográfica, con selección, valoración y jerarquización de la evidencia, siguiendo criterios GRADE. No encontramos evidencia suficiente como para considerar los corticoides inhalados intermitentes una alternativa a los corticoides inhalados de mantenimiento para evitar exacerbaciones que requieran el uso de corticoides sistémicos. El uso de una combinación de corticoides inhalados con formoterol, como tratamiento de rescate al inicio de síntomas, sólo es eficaz cuando la usan los pacientes con dicho tratamiento de base, en comparación con los que sólo tienen corticoides inhalados y hacen rescate con beta2-agonistas de acción corta; cuando los pacientes ya toman tratamiento combinado de base, el rescate combinado no mejora el riesgo. En pacientes con crisis asmáticas atendidas en urgencias, los corticoides inhalados en comparación con placebo reducen el riesgo de ingreso, pero no si se compara con corticoides sistémicos.

Tolosa-Hunt syndrome is an uncommon disease, described as an idiopathic granulomatous inflammation of the cavernous sinus or the superior orbital fissure. Its diagnosis is based on the presence of unilateral ophtalmoplegia associated with the enlargement and the enhanced contrast of the affected cavernus sinus. We present a case of a 71-year-old woman with trigeminal first branch pain. After performing extensive diagnostic studies, Tolosa-Hunt syndrome was considered as the cause of symptoms. [ABSTRACT FROM AUTHOR]

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Copyright of Gaceta Médica de Caracas is the property of Academia Nacional de Medicina and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)