Hydroxyurea as an alternative therapy for psoriasis

Background: Methotrexate is the drug of choice in extensive psoriasis in developing countries. In patients who can not take methotrexate either due to intolerance or concomitant liver disease, there is an urgent need for an alternative affordable and accessible drug. Aims: To evaluate the therapeutic efficacy and safety of hydroxyurea as an alternative in the management of patients with extensive psoriasis. Methods: A prospective study was carried out over 16 months on 34 patients with chronic plaque psoriasis (>20% body surface area involvement), erythrodermic or generalized pustular psoriasis who were partially responsive or non-responsive to the conventional topical and systemic modalities of therapy. Besides doing a baseline hemogram, liver and renal function tests, and urine analysis, these tests were frequently repeated during the course of therapy. Hydroxyurea was started at 1 g daily and increased to 1.5 g, if required. The therapeutic response was evaluated by a global assessment made by the patient and physician and regular PASI scoring. Results: Good to excellent response was observed in 25 (73.5%) patients, less than 50% response in 7 (20.6%) patients, while 2 (5.9%) patients were lost to follow up. The mean PASI score was reduced by 76% at 10-12 weeks. Therapy was discontinued in 3 patients due to leukopenia that recovered on discontinuation of hydroxyurea. Patients were followed up to 1 year and relapse was observed in 5 patients. The duration of remission varied from 6 months to 1 year. Conclusion: Hydroxyurea is an effective and reasonably safe second line agent for psoriasis

Resistência à punção de ligações laje-pilar interno com conectores de cisalhamento

A punção é uma forma de ruptura por cisalhamento que pode ocorrer em ligações laje-pilar que pode ser evitada utilizando-se armaduras de cisalhamento na ligação. Este artigo apresenta comparações entre resultados experimentais de 36 ensaios realizados em ligações laje-pilar interno, armadas com conectores de cisalhamento do tipo pino de duas cabeças, populares na América do Norte, Europa e Ásia, com resultados teóricos utilizando as recomendações do ACI 318, NBR 6118, Eurocode 2, além da Teoria da Fissura Crítica de Cisalhamento (TFCC). Para o banco de dados utilizado, o ACI 318 mostrou tendências conservadoras, enquanto que a NBR 6118 mostrou baixo coeficiente de variação, mas um grande número de resultados contra a segurança. Tanto o Eurocode 2, quanto a TFCC apresentaram resultados satisfatórios, com o Eurocode 2 apresentando desempenho ligeiramente superior.Punching shear is a brittle failure mode that may occur in slab-column connections, which may be prevented by using shear reinforcement in the slab-column connection. This paper presents comparisons between experimental results of 36 tests in internal slab-column connections with double- headed shear studs, which are largely used in North America, Europe and Asia, with theoretical results using recommendations presented by ACI 318, NBR6118, Eurocode 2 and also the Critical Shear Crack Theory (CSCT).Considering the database used it is possible to observe that ACI 318 presents conservative trends, whereas NBR 6118 showed a low coefficient of variation, but with a large number of unsafe results. Both Eurocode 2 and CSCT showed satisfactory results with Eurocode 2 presenting slightly higher performance

Response by Dr. Ramam

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