Vitiligo

Vitiligo is a skin disease of unknown etiology that affects 1% of the population. It affects both sexes equally and the mean age at onset is between 10 and 30 years. Some of the factors involved are: emotional or physical stress, mechanical trauma, chemicals such as phenol and certain diseases. Autoimmune diseases, especially of thyroid origin, may be linked to vitiligo. New and emerging therapies have been proposed such as topical immunomodulators, allied to traditional therapies with psoralen and steroids. The most important factor in the therapeutic success depends on the doctor and patient relationship.O vitiligo é doença de pele de causa desconhecida que acomete cerca de 1% da população, comprometendo de modo semelhante homens e mulheres, preferencialmente entre 10 e 30 anos de idade. Alguns fatores precipitantes para essa doença são: estresse físico e emocional, traumas mecânicos e substâncias químicas, como derivados do fenol. Doenças auto-imunes, principalmente as tireoidianas, podem estar associadas ao vitiligo. Novas terapias têm sido propostas, como o uso de imunomoduladores tópicos, aliadas àquelas já consolidadas, como os psoralenos e os corticosteróides; o sucesso terapêutico, entretanto, está estritamente relacionado à qualidade da relação médico/paciente.33535

Vitiligo

Vitiligo is a skin disease of unknown etiology that affects 1% of the population. It affects both sexes equally and the mean age at onset is between 10 and 30 years. Some of the factors involved are: emotional or physical stress, mechanical trauma, chemicals such as phenol and certain diseases. Autoimmune diseases, especially of thyroid origin, may be linked to vitiligo. New and emerging therapies have been proposed such as topical immunomodulators, allied to traditional therapies with psoralen and steroids. The most important factor in the therapeutic success depends on the doctor and patient relationship.O vitiligo é doença de pele de causa desconhecida que acomete cerca de 1% da população, comprometendo de modo semelhante homens e mulheres, preferencialmente entre 10 e 30 anos de idade. Alguns fatores precipitantes para essa doença são: estresse físico e emocional, traumas mecânicos e substâncias químicas, como derivados do fenol. Doenças auto-imunes, principalmente as tireoidianas, podem estar associadas ao vitiligo. Novas terapias têm sido propostas, como o uso de imunomoduladores tópicos, aliadas àquelas já consolidadas, como os psoralenos e os corticosteróides; o sucesso terapêutico, entretanto, está estritamente relacionado à qualidade da relação médico/paciente.Faculdade de Medicina de Jundiaí Serviço de DermatologiaUniversidade Estadual de CampinasClínica StöckliEscola Paulista de Medicina Serviço de DermatologiaFundação ABC Faculdade de MedicinaUNIFESP, EPM, Serviço de DermatologiaSciEL

Minor Structural Alterations of the Vocal Fold Cover: Vocal Quality before and after Treatment

Introduction Minor structural alterations of the vocal fold cover are important causes of dysphonia. The variability in the type of alteration and the grade of vocal deviation affects the definition of the conduit and the results of treatment. Objective To characterize the occurrence, the selected treatments adopted and vocal quality before and after treatment in patients with minor structural alterations of the vocal folds cover. Methods This was a cross-sectional study based on the records of patients treated by an interdisciplinary team at the laryngology outpatient clinic of a public university hospital from 2010 to 2018. Data collection consisted of access to a database of information on otorhinolaryngological diagnostic hypotheses, intervention and perceptual-auditory vocal assessments before and after the treatment. Data from 102 subjects were analyzed. Association tests were applied between the perceptual-auditory vocal results and the different alterations found and between these and the adopted treatments. The results of the degrees of vocal deviation before and after treatment were also compared. Results The degree of roughness was associated with the sulcus vocalis, and in this alteration the highest occurrence was mild degree of roughness. There was an improvement in the breathiness and general grade of vocal deviation after treatment. Conclusion Cysts were the most frequent structural alteration in the population studied. There was an association between the degree of general deviation and that of roughness in sulcus vocalis cases. The breathiness and the general grade of vocal deviation improved after treatment regardless of the type of treatment and alteration

Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies

Background: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings: Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42·4% vs 44·2%; absolute difference -1·69 [-9·58 to 6·11] p=0·67; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5-8] vs 6 [5-8] cm H2O; p=0·0011). ICU mortality was higher in MICs than in HICs (30·5% vs 19·9%; p=0·0004; adjusted effect 16·41% [95% CI 9·52-23·52]; p<0·0001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0·80 [95% CI 0·75-0·86]; p<0·0001). Interpretation: Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status