Phototherapy in the treatment of generalized vitiligo – a case report

Cilj: Cilj rada je prikaz slučaja bolesnika s generaliziranim oblikom vitiliga koji je liječen lokalnim kortikosteroidima i uskospektralnom UVB fototerapijom, kao i pregled novih oblika liječenja vitiliga. Prikaz slučaja: Četrdesetdvogodišnji bolesnik zaprimljen je zbog generalizirane pojave vitiliga. Kliničkim pregledom uočene su depigmentirane mliječnobijele makule simetrično raspoređene po koži lateralnih strana trupa, gornjih i donjih ekstremiteta, kao i vratu te periorbitalno na desnoj strani lica. U terapiju je uvedena kortikosteroidna krema, mometazon furoat, a potom i uskospektralna UVB fototerapija koja se provodila tri puta tjedno uz povećanje doze za 20% prilikom svakog obasjavanja do pojave blagog eritema. Ukupna primljena doza iznosila je 69.213 J/cm2. Liječenje je dovelo do poboljšanja u smislu mjestimične repigmentacije vitiliginoznih lezija, zaustavljena je progresija postojećih, kao i nastajanje novih lezija. Rasprava i zaključak: Iako postoje brojne dostupne metode liječenja, ne postoji univerzalna terapija koja bi bila učinkovita u svih bolesnika s vitiligom. Raznolikost kliničke slike vitiliga posljedica je različitih patogenetskih mehanizama, stoga zahtijeva i različite pristupe u liječenju. Nova istraživanja na polju etiopatogeneze vitiliga omogućit će razvoj novih učinkovitijih modaliteta liječenja koji bi doveli do trajnog izlječenja bolesti.Aim: To present a patient with generalized vitiligo who was treated with topical corticosteroids and narrow band ultraviolet B phototherapy and to give an overview of treatment modalities for vitiligo. Case report: A 42 year-old men was admitted because of generalized vitiligo. Clinical examination revealed depigmented milky-white macules distributed symmetrically on lateral sides of trunk, upper and lower extremities, neck and periorbital region of the right facial side. A topical corticosteroid, mometazon furoat, was prescribed once a day and narrow band UVB phototherapy was initiated. Phototherapy was administered three times a week with the initial dose of 0.3 J/cm2 and dose increment at the rate of 20% of the previous dose until the formation of a mild erythema. Total dose received was 69.213 J/cm2. After received therapy, repigmentation was partially achieved, and the progression, as well as the appearance of the new vitiliginous lesions, were stopped. Discussion and conclusion: Various modalities of treatment are used in therapy of vitiligo, but there is still no universal therapy that could be effective in all vitiligo patients. Different clinical manifestations of vitiligo are the result of different pathogenetic mechanisms and require different treatment approaches. Therefore, future research is needed in order to clarify the etiopathogenetic mechanisms and provide new, more effective therapeutic opportunitie

Phototherapy in the treatment of generalized vitiligo – a case report

Cilj: Cilj rada je prikaz slučaja bolesnika s generaliziranim oblikom vitiliga koji je liječen lokalnim kortikosteroidima i uskospektralnom UVB fototerapijom, kao i pregled novih oblika liječenja vitiliga. Prikaz slučaja: Četrdesetdvogodišnji bolesnik zaprimljen je zbog generalizirane pojave vitiliga. Kliničkim pregledom uočene su depigmentirane mliječnobijele makule simetrično raspoređene po koži lateralnih strana trupa, gornjih i donjih ekstremiteta, kao i vratu te periorbitalno na desnoj strani lica. U terapiju je uvedena kortikosteroidna krema, mometazon furoat, a potom i uskospektralna UVB fototerapija koja se provodila tri puta tjedno uz povećanje doze za 20% prilikom svakog obasjavanja do pojave blagog eritema. Ukupna primljena doza iznosila je 69.213 J/cm2. Liječenje je dovelo do poboljšanja u smislu mjestimične repigmentacije vitiliginoznih lezija, zaustavljena je progresija postojećih, kao i nastajanje novih lezija. Rasprava i zaključak: Iako postoje brojne dostupne metode liječenja, ne postoji univerzalna terapija koja bi bila učinkovita u svih bolesnika s vitiligom. Raznolikost kliničke slike vitiliga posljedica je različitih patogenetskih mehanizama, stoga zahtijeva i različite pristupe u liječenju. Nova istraživanja na polju etiopatogeneze vitiliga omogućit će razvoj novih učinkovitijih modaliteta liječenja koji bi doveli do trajnog izlječenja bolesti.Aim: To present a patient with generalized vitiligo who was treated with topical corticosteroids and narrow band ultraviolet B phototherapy and to give an overview of treatment modalities for vitiligo. Case report: A 42 year-old men was admitted because of generalized vitiligo. Clinical examination revealed depigmented milky-white macules distributed symmetrically on lateral sides of trunk, upper and lower extremities, neck and periorbital region of the right facial side. A topical corticosteroid, mometazon furoat, was prescribed once a day and narrow band UVB phototherapy was initiated. Phototherapy was administered three times a week with the initial dose of 0.3 J/cm2 and dose increment at the rate of 20% of the previous dose until the formation of a mild erythema. Total dose received was 69.213 J/cm2. After received therapy, repigmentation was partially achieved, and the progression, as well as the appearance of the new vitiliginous lesions, were stopped. Discussion and conclusion: Various modalities of treatment are used in therapy of vitiligo, but there is still no universal therapy that could be effective in all vitiligo patients. Different clinical manifestations of vitiligo are the result of different pathogenetic mechanisms and require different treatment approaches. Therefore, future research is needed in order to clarify the etiopathogenetic mechanisms and provide new, more effective therapeutic opportunitie

Applying a transtheoretical model in studying the process of change in obese persons

Cilj je ovoga istraživanja bio provjera transteorijskog modela u ispitivanju procesa promjene u pretilih osoba (Prochaska i DiClemente, 1983). Model pretpostavlja da u procesu promjene osobe prolaze kroz stadije koji idu od predkontemplacije, preko kontemplacije i akcije do održavanja. Provjerene su psihometrijske karakteristike Skale za mjerenje procesa promjene (URICA; McConnaughy, DiClemente, Prochaska i Velicer, 1989), Upitnika donošenja odluke o kontroli tjelesne težine te Upitnika učinkovitosti kontrole težine (prema Rossi, Rossi, Velicer i Prochaska, 1995). U ispitivanju je sudjelovalo 279 prekomjerno teških i pretilih ispitanika, 97 muškarca i 182 žene. Provedene su faktorske analize i provjerene pouzdanosti svih korištenih mjera koje su se pokazale visokima. Radi provjere strukture Skale za mjerenje procesa promjene provedena je konfirmatorna faktorska analiza. Rezultati su pokazali da je četverofaktorska struktura statistički prihvatljiva, bez obzira na visoke međusobne korelacije između stadija kontemplacije, akcije i održavanja. Ovi su rezultati u skladu s nalazima drugih autora i konzistentni s transteorijskim modelom. Rezultati pokazuju da se ova skala može koristiti kao četverofaktorska mjera jednako kao kontinuirana što ovisi o cilju tretmana. Poznavanje stadija u kojemu se nalazi pojedinac može pomoći i u određivanju najpogodnijeg oblika tretmana, voditi kliničara u odlučivanju o prirodi i vremenu potrebnom za terapijsku intervenciju, poboljšati razumijevanje te olakšati istraživanja iz područja motivacije za promjenom kod osoba prekomjerne težine.The main goal of this study was to apply a transtheoretical model in studying the process of change in obese persons. According to the transtheoretical model (Prochaska & DiClemente, 1983), health behavior change involves graduating through stages of readiness: from precontemplation through contemplation and action to maintenance. The psychometric properties of The University of Rhode Island Change Assessment Scale (McConnaughy, DiClemente, Prochaska & Velicer, 1989), the Decisional Balance Inventory and Weight Efficacy Life-Style Questionnaire (Rossi, Rossi, Velicer &Prochaska, 1995) were determined. Two hundred and seventy nine participants took part in the study, 97 male and 182 female persons. Factor and reliability analyses were performed. Using a confirmatory factor analysis, the structure of The University of Rhode Island Change Assessment Scale was examined. A four-factor structure was confirmed despite relatively high correlation coefficients between scores on contemplation, action and maintenance scales. These results are similar to the results of other studies and consistent with the transtheoretical model. The results have shown that this scale could be used as a four factor measure and as a continuous measure of readiness for change depending on the treatment aim. Knowing the stage at which an individual is, could lead a clinician into deciding about the nature and time needed for therapeutic intervention, into a better understanding of the problem and into facilitating research in the field of readiness for change in overweight and obese persons

Effects of Nutritional Support in Patients with Colorectal Cancer during Chemotherapy

Nutritional support, addressing the specific needs of this patient group, is required to help improve prognosis, and reduce the consequences of cancer-associated nutritional decline. Early intervention with nutritional supplementation has been shown to halt malnutrition, and may improve outcome in some patients. In our study we tried to assess the influence of nutritional support (counseling, oral liquids, megestrol acetate) on nutritional status and symptoms prevalence in patients with colorectal cancer during chemotherapy. Group I consisted of 215 (55%) patients with medium age 68 2.6 years who were monitored prospectively and were given nutritional support. Group II included 173 (45%) patients (medium age 67 2.9 years) without the proper nutritional counseling, in whom the data were collected retrospectively during a 6 years period of time. After evaluation Nottingham Screening Tool Score, Appetite Loss Scale and Karnofsky Performance Status) all patients in the group I received nutritional counseling, 153 of them (72%) were taking form of enteral food supplement and 103 (48%) patients were using megestrol acetate. Evaluating the initial risk measurements according to BMI, decrease in weight gain and NST, we did not find any significant difference between the two groups. After chemotherapy completion, patients in group I had a 15.3% drop of those who’s BMI was <20,65% patients increased their body weight, with an average weight gain of 1.5 kg (0.6–2.8 kg). Contrary, in group II we found increase in weight loss ³2 kg/month in 39% of patients. The appetite improvement was detected on Appetite Loss Scale from 3.1 (pre-chemotherapy) to 4.7 (post-chemotherapy) in group I, especially in those receiving megestrol acetate. In both groups Karnofsky Performance Status didn’t change significantly reflecting the impact of the disease itself and chemotherapy procedures to the patient’s condition. Nutritional counseling, supplemental feeding and pharmacological support do temporarily stop weight loss and improve appetite, social life and quality of life in those groups of patients. However, this improvement have no implications on patients KPS and course of their disease

Progressive increase of matrix metalloprotease-9 and interleukin-8 serum levels during carcinogenic process in human colorectal tract

BACKGROUND: Inflammatory reactions, known to promote tumor growth and invasion, have been found associated with colorectal carcinoma (CRC). Macrophages are the chief component of the inflammatory infiltration that occurs early in the progression from non-invasive to malignant tumor, with a switch from the pro-inflammatory phenotype to the tumor-promoting phenotype. Tumor and stroma are additional sources of inflammation-related molecules. The study aimed to evaluate, during colorectal carcinogenesis from benign to malignant phases: i) the trend of serum levels of IL-8, IL-6, TGFβ1, VEGF and MMPs; ii) the parallel trend of CRP serum levels; iii) derangement of the principal TGFβ1 receptors (TGFβ1RI/RII) in tumor tissues. METHODOLOGY/PRINCIPAL FINDINGS: 96 patients with colon adenomas or CRC at different stages of progression, and 17 controls, were recruited. Serum IL-8, IL-6, TGFβ1, VEGF, MMPs and CRP levels were analyzed before endoscopy or surgery. TGFβ1 receptors were evaluated in adenoma biopsies and surgically-removed colorectal adenocarcinomas. Serum levels of IL-8 in adenocarcinoma patients were increased from stage II, when also the enzymatic activity of MMP-9 increased. Of note, the increasing trend of the two serum markers was found significantly correlated. Trend of serum CRP was also very similar to that of IL-8 and MMP-9, but just below statistical significance. TGFβ1 levels were lower at stage III CRC, while IL-6 and VEGF levels had no significant variations. In tissue specimens, TGFβ1 receptors were already absent in about 50% of adenomas, and this percentage of missing receptors markedly increased in CRC stages III and IV. CONCLUSIONS: Combined quantification of serum IL-8, MMP-9 and CRP, appears a reliable and advanced index of inflammation-related processes during malignant phase of colorectal carcinogenesis, since these molecules remain within normal range in colorectal adenoma bearing patients, while consistently increase in the blood of CRC patients, even if from stage II only

Loading into nanoparticles improves quercetin&apos;s efficacy in preventing neuroinflammation induced by oxysterols.

Chronic inflammatory events appear to play a fundamental role in Alzheimer's disease (AD)-related neuropathological changes, and to result in neuronal dysfunction and death. The inflammatory responses observed in the AD brain include activation and proliferation of glial cells, together with up-regulation of inflammatory mediators and of free radicals. Along with glial cells, neurons themselves can also react and contribute to neuroinflammatory changes in the AD brain, by serving as sources of inflammatory mediators. Because excess cholesterol cannot be degraded in the brain, it must be excreted from that organ as cholesterol oxidation products (oxysterols), in order to prevent its accumulation. Among risk factors for this neurodegenerative disease, a mechanistic link between altered cholesterol metabolism and AD has been suggested; oxysterols appear to be the missing linkers between the two, because of their neurotoxic effects. This study shows that 24-hydroxycholesterol, 27-hydroxycholesterol, and 7β-hydroxycholesterol, the three oxysterols potentially implicated in AD pathogenesis, induce some pro-inflammatory mediator expression in human neuroblastoma SH-SY5Y cells, via Toll-like receptor-4/cyclooxygenase-2/membrane bound prostaglandin E synthase (TLR4/COX-2/mPGES-1); this clearly indicates that oxysterols may promote neuroinflammatory changes in AD. To confirm this evidence, cells were incubated with the anti-inflammatory flavonoid quercetin; remarkably, its anti-inflammatory effects in SH-SY5Y cells were enhanced when it was loaded into β-cyclodextrin-dodecylcarbonate nanoparticles, versus cells pretreated with free quercetin. The goal of loading quercetin into nanoparticles was to improve its permeation across the blood-brain barrier into the brain, and its bioavailability to reach target cells. The findings show that this drug delivery system might be a new therapeutic strategy for preventing or reducing AD progression