Cutaneous lupus erythematosus can occur as a manifestation of systemic lupus erythematosus (SLE) or independently of SLE.Erythema multiform-like (Rowell's syndrome) is one of the less common variants of subacute cutaneous lupus.Less than 5% of patients have bullous lesions. CASE REPORTFemale, 26 years old, with polyarthritis that evolved with periods of spontaneous improvement and worsening for 2 years, alopecia, oral ulcers, rash and photosensitivity.Antinuclear antibody 1:320 nucleolar and dense fine speckled cytoplasm.Five months after the first symptoms and signs, she had oliguria, and was evaluated by a nephrologist who detected proteinuria 1,836 mg/24 h, creatinine clearance 18.72 mg/dL, and hypochromic and microcytic anemia.Before performing the renal biopsy, the patient showed erythematous-violaceous lesions that evolved with clear, pruritic blisters, initially on the face, spreading to the trunk, abdomen and limbs within 7 days.Prednisone 50 mg/day was prescribed and hydroxychloroquine was withdrawn due to suspected toxidermia.The patient was hospitalized, and the dermatologist raised the clinical hypothesis of Rowell's syndrome, disseminated herpes and toxidermia.A skin biopsy was performed on July 28, 2021 and the anatomopathological result was compatible with erythema multiform.Corticosteroid therapy with 0.5 mg/kg/day prednisone was maintained and antibiotic therapy and acyclovir were started for 10 days.The patient evolved with improvement of the pruritus and lesions, presenting epidermolysis on the face, trunk, abdomen and limbs, followed by rash on the trunk and abdomen that disappeared with digital pressure.Due to the improvement of the skin at the puncture site, a renal biopsy was performed on October 10, 2021 confirming proliferative lupus nephritis.The patient received IV methylprednisolone for 3 days and cyclophosphamide 750 mg/month. CONCLUSIONCutaneous lupus erythematosus may have several forms of clinical presentation, and could be a manifestation of SLE.In this case of a patient with Rowell's syndrome and erythema multiform, the lesions had a good response to both corticosteroids and immunomodulators when associated with SLE therapy.
OBJECTIVES: Define the prevalence of exclusive breastfeeding among patients that received discharge in breastfeeding, exclusive or complementing with formula, 15 days after discharge from the neonatal unit and the related factors. METHODS: Observational, descriptive, prospective study, including newborns hospitalized in the Neonatal Unit who were discharged in breastfeeding, exclusive or mixed with formula, during the period from May to July, 2019. Fifteen days after hospital discharge, it was made a phone contact to the mother asking about the type of feeding in that moment. RESULTS: The prevalence of exclusive breastfeeding 15 days after hospital discharge was 62.3%. Birthweight and gestational age were significantly higher and the length of stay was smaller in the group being exclusively breastfed 15 days after discharge (p<0.05). There was a positive correlation between exclusive breastfeeding by hospital discharge and exclusive breastfeeding 15 days after discharge (p<0.05). CONCLUSION: Initiating and maintaining breastfeeding for newborns who need hospitalization for healthcare is a challenge and requires all the efforts in terms of structure and process. Factors such as birthweight, gestational age and length of hospital stay have influence on the prevalence of breastfeeding after discharge. Exclusive breastfeeding by the hospital discharge has favored breastfeeding 15 days after discharge.
PurposeTo analyze the action of strontium ranelate (SR) and melatonin in isolation or in association in knees, liver and kidneys of rats Wistar with induced osteoarthritis (OA).MethodsThirty male rats were induced to OA through an anterior cruciate ligament transection (ACLT), and treated with melatonin and SR in isolation or in association. Morphological, histopathological, histochemical and morphometric analysis were realized of the structure of the articular capsule, as well as histopathological analysis of liver and kidneys from the animals.ResultsThe experimental model was successful. The association of the drugs presented chondroprotective pharmacodynamics. However, more successful results were identified from analysis of animals in which received melatonin in isolation, regarding biochemical parameters of glutamic oxalacetic transaminase. The prepared slide samples of liver and kidneys from groups submitted to the isolated use of SR and melatonin or the association of these drugs presented no differences, when compared to the control group.DiscussionThe administration of the drugs presented chondroprotective effect and prevented from the aggravation of articulate damages, and was not capable of modifying the histology of liver or kidneys. This finding suggests a safe association for the treatment of OA, however it requires further investigation in order to expand therapeutic perspectives regarding improvements of the quality of life of individuals in our society.
Charcot's arthropathy is a degenerative, progressive and painless joint disease that occurs in patients with sensory neuropathies. It mainly affects weight bearing joints, such as knees and ankles, but can also affect upper limbs. The main causes are diabetes mellitus, leprosy, alcoholism and tertiary syphilis, but may occur less frequently due to multiple sclerosis, amyloidosis, tumors, spinal cord trauma, among others. Its pathogenesis is controversial, although decreased sensitivity, excessive joint use and repetitive trauma are considered predisposing factors.
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