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RESUMEN El síndrome de Cushing iatrogénico es común por el uso de corticoides por vía oral, tópica o inhalada, pero es extremadamente raro por la vía intranasal. El riesgo de desarrollar insuficiencia suprarrenal secundaria al uso tópico de corticoides es raro, pero siempre está presente. Presentamos el caso de una paciente con síntomas de Cushing y laboratorio compatible con insuficiencia suprarrenal secundaria al uso de corticoides por vía intranasal.
ABSTRACT Iatrogenic Cushing syndrome is commonly caused by the use of corticosteroids orally, topically, or inhaled, but by intranasal use is extremely rare. The risk of developing adrenal insufficiency secondary to topical corticosteroid use is rare, but always present. We present the case of a patient with Cushing's symptoms and a laboratory compatible with adrenal insufficiency secondary to the intranasal use of corticosteroids.
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INTRODUCCIÓN: La enfermedad celíaca puede estar asociada de forma silente a varias enfermedades de la piel y las mucosas. OBJETIVO: Determinar la frecuencia de enfermedad celíaca en portadores de urticaria crónica, vitíligo, alopecia areata, psoriasis y estomatitis aftosa, en el Hospital Nacional de Itauguá, Paraguay, en los años 2017 y 2018. MATERIAL Y MÉTODOS: Diseño observacional de corte transversal, prospectivo. Se determinaron los anticuerpos IgA antitransglutaminasa tisular e IgA sérica en pacientes adolescentes y adultos que otorgaron su consentimiento informado. En los casos positivos se realizó la confirmación histológica con biopsias duodenales. RESULTADOS: Se incluyeron 79 pacientes, con predominio del sexo femenino (75%). La mediana de edad fue de 33 años y el índice de masa corporal medio fue de 24.7 kg/m2. La enfermedad celíaca se demostró histológicamente en 4 de 32 portadores de estomatitis aftosa, en 2 de 24 con vitíligo y en 1 de 17 con alopecia areata. No se detectó en pacientes con urticaria crónica ni psoriasis. CONCLUSIÓN: La frecuencia de enfermedad celíaca confirmada histológicamente en pacientes con estomatitis aftosa, vitíligo o alopecia areata fue del 8.8%. BACKGROUND: Silent celiac disease may be associated to various skin and mucous membranes diseases. OBJECTIVE: Determine the frequency of celiac disease in carriers of chronic urticaria, vitiligo, alopecia areata, psoriasis and aphthous stomatitis treated in the National Hospital of Itauguá, Paraguay, in years 2017 and 2018. MATERIAL AND METHODS: An observational cross-sectional, prospective design was used. IgA tissue antitransglutaminase antibody and serum IgA was determined in adolescents and adult patients who gave their informed consent. In positive cases, histological confirmation was performed with duodenal biopsies. RESULTS: 79 patients were included, with a predominance of females (75%). Median age was 33 years, and the average body mass index 24.7 kg/m2. Celiac disease was demonstrated histologically in 4/32 carriers of aphthous stomatitis, in 2/24 with vitiligo, and in 1/17 with alopecia areata. It was not detected in patients with chronic urticaria or psoriasis. CONCLUSION: Frequency of celiac disease histologically confirmed in patients with aphthous stomatitis, vitiligo or alopecia areata was 8.8%.
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La Insuficiencia Suprarrenal es un cuadro grave que presenta numerosas manifestaciones clínicas secundarias a la depresión de la producción hormonal de dicha glándula. Las causas son varias e incluso depende de las regiones y épocas. En América Latina se debe considerar al Paracoccidioides como probable causa. Presentamos el caso de un hombre campesino, ingresado al Hospital por Insuficiencia Suprarrenal, con dificultad respiratoria y lesiones ulcerosas en piernas debidas a paracoccidioidomicosis, que también fue la causa del trastorno respiratorio y posiblemente suprarrenal.
Adrenal insufficiency is a serious condition that presents numerous clinical manifestations secondary to the depression of the hormonal production of said gland. The causes are several and even depends on the regions and times. In Latin America, Paracoccidioides must be considered as a probable cause. We present the case of a peasant man, admitted to the Hospital for Adrenal Insufficiency, with respiratory distress and ulcerous leg injuries due to paracoccidioidomycosis, which was also the cause of the respiratory and possibly adrenal disorder.
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La enfermedad celiaca altera el estado emocional, las relaciones sociales, la autonomía y la percepción de la salud, afectando la calidad de vida relacionada a la salud. Los objetivos de esta investigación fueron determinar la calidad de vida relacionada a la salud en adolescentes y adultos con enfermedad celiaca e investigar las condiciones que la afectan. Se realizó un estudio observacional, prospectivo en adolescentes y adultos de Paraguay portadores de enfermedad celiaca con al menos seis meses en dieta sin gluten. Se aplicó el cuestionario CD-QOL (Celiac Disease Quality of Life Measure). Fueron incluidos 114 sujetos, con edad media 30±10 años, siendo 58% del sexo femenino. La calidad de vida fue buena en 25%, regular en 49% y mala en 26%. Las condiciones asociadas significativamente a mejor calidad de vida fueron el sexo femenino, el grupo etario >30 años y que efectúan actividades fuera del hogar. Se concluye que la calidad de vida de los celiacos adolescentes y adultos es regular en 49% de los encuestados.
Celiac disease alters emotional state, social relations, autonomy and health perception, affecting the health related quality of life. The objectives of this research were to determine the health related quality of life in adolescents and adults with celiac disease and to investigate the factors that affect it. We included 114 subjects. The mean age was 30 ± 10 years and 58% of subjects were female. The quality of life was good in 25% of the cases, regular in 49% and bad in 26%. The factors significantly associated with a better quality of life were the female sex, the age group >30 years and carrying out activities outside home. In conclusion, the quality of life of celiac adolescents and adults is regular in 49% of respondents.
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Doença Celíaca , Qualidade de VidaRESUMO
The effect of preventive human papillomavirus (HPV) vaccination on the reduction of the cervical cancer (CC) burden will not be known for 30 years. Therefore, it's still necessary to improve the procedures for CC screening and treatment. The objective of this study was to identify and characterize cellular targets that could be considered potential markers for screening or therapeutic targets. A pyramidal strategy was used. Initially the expression of 8,638 genes was compared between 43 HPV16-positive CCs and 12 healthy cervical epitheliums using microarrays. A total of 997 genes were deregulated, and 21 genes that showed the greatest deregulation were validated using qRT-PCR. The 6 most upregulated genes (CCNB2, CDC20, PRC1, SYCP2, NUSAP1, CDKN3) belong to the mitosis pathway. They were further explored in 29 low-grade cervical intraepithelial neoplasias (CIN1) and 21 high-grade CIN (CIN2/3) to investigate whether they could differentiate CC and CIN2/3 (CIN2+) from CIN1 and controls. CCNB2, PRC1, and SYCP2 were mostly associated with CC and CDC20, NUSAP1, and CDKN3 were also associated with CIN2/3. The sensitivity and specificity of CDKN3 and NUSAP1 to detect CIN2+ was approximately 90%. The proteins encoded by all 6 genes were shown upregulated in CC by immunohistochemistry. The association of these markers with survival was investigated in 42 CC patients followed up for at least 42 months. Only CDKN3 was associated with poor survival and it was independent from clinical stage (HRâ=â5.9, 95%CIâ=â1.4-23.8, pâ=â0.01). CDKN3 and NUSAP1 may be potential targets for the development of screening methods. Nevertheless, further studies with larger samples are needed to define the optimal sensitivity and specificity. Inhibition of mitosis is a well-known strategy to combat cancers. Therefore, CDKN3 may be not only a screening and survival marker but a potential therapeutic target in CC. However, whether it's indispensable for tumor growth remains to be demonstrated.