Topical and Oral Roflumilast in Dermatology: A Narrative Review

Oral roflumilast is a phosphodiesterase-4 inhibitor approved for the prevention of exacerbations of chronic obstructive pulmonary disease and chronic bronchitis. In dermatology, topical roflumilast is authorized by the US Food and Drug Administration for the treatment of plaque psoriasis and mild to moderate seborrheic dermatitis. Several studies have described the off-label use of roflumilast in dermatology, including a randomized controlled trial showing its usefulness in the treatment of psoriasis; case reports and small series have also reported successful outcomes in hidradenitis suppurativa, recurrent oral aphthosis, nummular eczema, lichen planus, and Behçet disease. Roflumilast has a favorable safety profile, similar to that of apremilast, and it is considerably cheaper than new generation drugs and even some conventional immunosuppressants. We review the pharmacokinetics and pharmacodynamics of topical and oral roflumilast and discuss potential adverse effects and both approved and off-label uses in dermatology. Roflumilast is a promising agent to consider.

[Translated aticle] Topical and Oral Roflumilast in Dermatology: A Narrative Review

Oral roflumilast is a phosphodiesterase-4 inhibitor approved for the prevention of exacerbations of chronic obstructive pulmonary disease and chronic bronchitis. In dermatology, topical roflumilast is authorized by the US Food and Drug Administration for the treatment of plaque psoriasis and mild to moderate seborrheic dermatitis. Several studies have described the off-label use of roflumilast in dermatology, including a randomized controlled trial showing its usefulness in the treatment of psoriasis; case reports and small series have also reported successful outcomes in hidradenitis suppurativa, recurrent oral aphthosis, nummular eczema, lichen planus, and Behçet disease. Roflumilast has a favorable safety profile, similar to that of apremilast, and it is considerably cheaper than new generation drugs and even some conventional immunosuppressants. We review the pharmacokinetics and pharmacodynamics of topical and oral roflumilast and discuss potential adverse effects and both approved and off-label uses in dermatology. Roflumilast is a promising agent to consider.

Cognitive Analytic Therapy and Mentalizing Function

Introduction

Cognitive-Analytic Therapy (CAT) has settled as an integrative approach from Ryle and Kerr's model in the 70's widely accepted in England and Australia, although increasingly European countries have decided to include this model in their public mental health services. Even though its formulation allows the treatment of almost any pathology ensuring good results, it has been traditionally applied to the treatment of personality and eating disorders. Some authors seem to link this efficacy with training in mental states and reciprocal role procedures identification, justifying the improvement through the increase of the reflexive function.

Aim and objectives

The aim of this study is to determine the effect of CAT in mentalizing ability and social functioning in patients attending consultation.

Methods

For this purpose a CAT intervention was performed in 6 adults, administering the Inventory of Interpersonal Problems (IIP-64) and the Mindful Awareness Assessment Scale (MAAS) before and after treatment.

Results

The results show a statistically significant reduction in interpersonal problems, as well as a non-significant increase in the mentalizing ability.

Conclusions

Cognitive Analytic Therapy has shown being effective in increasing social functioning, however we have not been able to demonstrate significantly its efficacy in the reflexive function.

Discussion

Implications in the clinical setting are discussed.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Designing an instrument to assess the competence of cognitive analytic therapists in training

Introduction

Since its origins, cognitive analytic therapy (CAT) has become a focused and more effective alternative that can be approached from the first line of action by mental health teams. However, since CAT incorporates in its intervention aspects of other currents, it is possible that its limits and specificity may have blurred. Furthermore, therapists in training use to report difficulties related to this. For that reason, assessing the competence of CAT therapists in training becomes so important, as it promote the reflection of the therapist in its training and provides professionals necessary skills to ensure a better quality care for their patients.

Aim and objectives

The aim of this study was to design an instrument to identify the main training problems in CAT therapists which allows therapist's competence evaluation.

Methods

For this purpose, a specific tool to detect the main problems in the implementation of the psychotherapy by self-report was administered and evaluated by two therapists in training during its clinical practice.

Results

The main implementation problems detected had to do with collusions and the temporary adjustment of the sessions. The therapists reported a high satisfaction with the instrument, which was valued as useful to be aware of the problems in CAT training and with clearly explained contents.

Conclusions

The tool has been shown to be useful to assess therapist's competence and to take awareness of collusions allowing the therapist to avoid them.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Borderline Personality Disorder in Adolescence. Prevention and Early Intervention From a Cognitive Analytic Approach

Introduction

Borderline personality disorder begins in adolescence, however, its diagnosis is subject to some controversy and tends to be underdiagnosed. Stigma associated with its diagnosis, comorbidity with other axis I disorders or the changeable sense of identity during adolescence are some of the elements that obscure the diagnosis. Increasingly, recent studies have shown the utility of prevention programs as well as instituting early intervention in adolescents, with very hopeful outcomes.

Objectives

The aim of this study is to review the benefits derived from early prevention and intervention programs in adolescents with borderline symptoms from a cognitive analytic approach.

Methods

A systematic review for scientific articles extracted from research databases including Dialnet, EBSCO, Pubmed, Unika and Scholar Google was conducted. Other high-impact studies in the field were also included.

Results

Evidence reported by reviewed articles supports Cognitive analytical therapy as one of the most successful approaches, the same as Mentalization based therapy, in the treatment of Borderline personality disorder. From this approach, prevention and early intervention have shown their effectiveness in reducing borderline symptoms and risk factors besides they contribute to interpersonal functioning improvement.

Conclusions

Prevention and early intervention constitute the main pillars to prevent the potential development of Borderline personality disorder or its evolution in more complex and irreversible forms. But this intervention must be carried not only in young already diagnosed, but also in those who are on the diagnostic threshold, presenting risk factors for further development.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Histological and histochemical study of the uropygial gland of chimango caracara (Milvago chimango vieillot, 1816)

The uropygial glands of birds are sebaceous organs that contribute to the water-repellent properties of the feather coat. We studied the histological and histochemical characteristics of the uropygial gland of chimango caracara using hematoxylin and eosin (H & E), Gomori´s trichrome, orcein, Gomori´s reticulin, periodic acid-Schiff (PAS), Alcian blue (AB) and a variety of lectins. The gland is composed of two lobes and a papilla with 20 downy feathers. It is surrounded by a capsule of dense connective tissue that contains elastic, reticular and smooth muscle fibers. The papilla is delicate and has two excretory ducts. The gland mass relative to body mass was 0.143%. Both adenomer cells and their secretions were stained with Sudan IV, PAS and AB, and were positive for numerous lectins that indicated the presence of lipids and carbohydrates. Immunohistochemical techniques to detect PCNA confirmed cell proliferation in the basal stratum of the adenomer cells. The lipids and glycoconjugates secreted by the uropygial gland serve numerous functions including protection against microorganisms.

NT-ProBNP prediction of major chemotherapy-related toxicity and death in lymphoma patients

9569

Background: NT-Pro BNP provides diagnostic and prognostic information in many heart syndromes, but its role in oncologic patients is not established. Methods: We studied the association between NT-ProBNP levels and the risk of major toxicity associated with chemotherapy and death from all causes in 116 consecutive patients with lymphoma treated with curative intent. High resolution ultrasound echocardiography and serum NT-ProBNP levels were prospectively done previous the start of chemotherapy. Charlson Comorbidity Index was retrospectively calculated. A major toxicity event was defined as: when chemotherapy had to be discontinued, when chemotherapy had to be changed to a less intensive regimen, and treatment-related death. Results: High blood levels of NT-proBNP were associated with previous cardiologic history but not with left ventricular ejection fraction. With a median follow-up of 16 moths (0–49 months), 25 patients had a major toxic event with first line chemotherapy and 16 had died at last follow-up. The threshold of NT-ProBNP with better predictive accuracy for major toxicity-free and overall survival was 900 pg/mL. Patients with levels of NT-proBNP greater of 900 pg/mL had an adjusted hazard ratio (HR) for major toxicity after first-line chemotherapy for lymphoma of 6.4 (95%CI, 2.7–15.1). Two additional independent factors predicting higher major toxicity associated with chemotherapy were albumin < 3.5 g/mL (HR 3.5, P=0.008) and number of extranodal sites ≥ 2 (HR 3.1, P<0.007). For prediction of death from all causes, patients with a NT-ProBNP greater of 900 pg/mL had an HR of death of 15.3 (95%CI, 4.8–48.8; P<0.001). ECOG ≥ 2 was also significant for predicting death (HR 3.6; 95%CI, 1.1–11.6; P=0.03). The NT-Pro BNP added prognostic information beyond that provided by conventional risk factors, including IPI, left ventricular ejection fraction and Charlson comorbidity index. Conclusions: NT-ProBNP is the stronger marker for predicting major toxicity after first-line chemotherapy and death from all causes in patients with lymphoma and provides prognostic information beyond that provided by conventional lymphoma risk factors and comorbidity indexes.

No significant financial relationships to disclose.

[The organisation and future development of Veterinary Services in Latin America]

Latin America undoubtedly has comparative advantages in the fields of animal production, animal health and the production of food of animal origin. However, countries in Latin America must build on these strengths if the continent is to become more competitive and be able to deal with the complexities of world markets. To do this, Veterinary Services must define their objectives and establish quality standards on which to base their work. For this to occur, the State must create well-defined regulations, establish systems of audit and find ways of working which allow for a high degree of coordination and collaboration between the public and private sectors. This should be done within a framework of a quality assurance system, which allows for responsible accreditation and independent audit and evaluation. The author discusses the approaches of the different countries in the region to animal health, zoonosis, food safety, veterinary drugs control, animal welfare and export-import control. All programmes relating to these issues must be based on technical information gained through epidemiological surveillance, the network of diagnostic laboratories, quarantine systems, risk analysis, identification and traceability of animals and animal products, registration and control of veterinary drugs, and food safety research. In some countries these systems are already being developed. Maintaining good international relations and cooperating with neighbouring countries is always a challenge for official Veterinary Services and international organisations such as the OIE (World organisation for animal health) have a key role to play in facilitating these relationships.

Bioavailability of tyrosol, an antioxidant phenolic compound present in wine and olive oil, in humans

Tyrosol is a phenolic compound present in two of the traditional components of the Mediterranean diet: wine and virgin olive oil. The presence of tyrosol has been described in red and white wines. Tyrosol is also present in vermouth and beer. Tyrosol has been shown to be able to exert antioxidant activity in in vitro studies. Oxidation of low-density lipoprotein (LDL) appears to occur predominantly in arterial intima in microdomains sequestered from antioxidants of plasma. The antioxidant content of the LDL particle is critical for its protection. Thus, phenolics, which are able to bind LDL, could be effective in preventing lipid peroxidation and atherosclerotic processes. The ability of tyrosol to bind human LDL has been reported. We have demonstrated the bioavailability of tyrosol in humans from virgin olive oil in its natural form. Urinary tyrosol increased, reaching a peak at 0-4 h after virgin olive oil administration. Men and women showed a different pattern of urinary excretion of tyrosol. Moreover, tyrosol is absorbed in a dose-dependent manner after sustained and moderate doses of virgin olive oil. In summary, our results suggest that tyrosol from wine or virgin olive oil could exert beneficial effects on human health in vivo if its biological properties are confirmed in in vivo studies.

Effect of ingestion of virgin olive oil on human low-density lipoprotein composition

OBJECTIVE

To measure the incorporation of oleic acid and antioxidants (phenols and vitamin E) to low density lipoprotein (LDL) after acute and short-term ingestion of virgin olive oil. To study whether this incorporation contributes to an increase in LDL resistance to oxidation.

SETTING

Department of Food and Nutrition, University of Barcelona, Spain and Department of Lipids and Cardiovascular Epidemiology, IMIM, Barcelona, Spain.

SUBJECTS

Sixteen healthy volunteers aged 25-65 y.

DESIGN AND INTERVENTIONS

To observe the change in the fatty acid profile, vitamin E, phenolic compounds and LDL oxidation-related variables after the postprandial phase and after daily ingestion of olive oil for one week.

RESULTS

Few changes were observed in the postprandial phase. However, after a week of olive oil consumption there was an increase in oleic acid (P=0.015), vitamin E (P=0.047), phenolics (P=0.021) and lag time (P=0.000), and a decrease in the maximum amount of dienes (P=0.045) and oxidation rate (P=0.05).

CONCLUSION

After ingestion of virgin olive oil, an increase in antioxidants and oleic acid in LDL was observed as well as an improvement of LDL resistance to oxidation. Our results support the idea that daily ingestion of virgin olive oil could protect LDL from oxidation.

SPONSORSHIP

This study was supported by a research grant from Spain (ALI 97-1607-C02-02).

[Coronary disease protective factors: antioxidant effect of olive oil]

Alongside the French paradox, the REGICOR Study (Girona, Spain) has shown another paradox in the Mediterranean area: a high prevalence of cardiovascular risk factors with low incidence of myocardial infarction in the population of Girona, Spain. The antioxidant effects associated with olive oil consumption could explain part of this 'Mediterranean Paradox'. Virgin olive oils processed by two centrifugation phases and with low fruit ripeness have the highest levels of antioxidant content. The total content of phenolic compounds (PC) from virgin olive oil could delay LDL oxidation. The content and nature of olive oil PC have a high influence in the antioxidant capacity of an olive oil. PC from diet could bind human LDL in non-supplemented volunteers. PC from virgin olive oil could bind LDL and tyrosol is bioavailable in humans from ingestion of virgin olive oil in its natural form.

Rapid high-performance liquid chromatographic method for the simultaneous determination of retinol, alpha-tocopherol and beta-carotene in human plasma and low-density lipoproteins

A reversed-phase HPLC method with diode-array detection was used to simultaneously determine retinol, alpha-tocopherol and beta-carotene in human plasma and low-density lipoproteins. An aliquot of sample was de-proteinized with ethanol containing beta-tocopherol acetate as internal standard, and the analytes were extracted twice with hexane. The solvent was evaporated to dryness under a stream of nitrogen and the residue was redissolved in methanol to be injected directly into the HPLC system. A multiple solvent system based on methanol, butanol and water at a flow-rate of 2 ml/min and held at 45 degrees C provided clear separation of these compounds in only 8 min. The method showed good linearity, precision and accuracy for all compounds. Owing to its simplicity, this method may be useful in routine clinical and epidemiological work.

A study on the experimental envenomation in mice with the venom of Tityus trivitattus Kraepelin 1898 (Scorpiones, Buthidae) captured in Argentina

Although Tityus trivitattus is the only scorpion species reported to cause severe human envenomation in Argentina, no previous studies on its venom have been done. Telson homogenates from T. trivitattus specimens collected in Santiago del Estero, Cordoba, and Buenos Aires were employed to study their protein composition and toxicity to mice. Regardless of the site of collection, electrophoretic analysis showed bands at 205, 150, 100, 40, 32, and 13 kDa or smaller. FPLC gel filtration showed three major peaks and 6-8 minor peaks with similar elution volumes. One of the minor peaks from FPLC containing a component of approximately 8 kDa was lethal to mice. Mice injected intravenously with different doses of homogenates presented severe autonomic signs like tachypnea, tachycardia, sialorrhea, lacrimation, profuse sweating, diarrhea, dyspnea, and death. Pathology studies of lungs showed severe congestion of alveolar capillaries, pulmonary edema, and hemorrhagic areas. The kidneys showed glomerular as well as tubular lesions and exocrine glands showed areas of necrosis. The calculated LD50 was 0.38 +/- 0.08 telsons per 20 g mouse, which suggests a lethal potency similar to that of T. serrulatus venom. The lethal potency of 5.0 LD50 of T. trivitattus telson homogenate was neutralized by both an anti-T. trivitattus and a heterologous anti Tityus with ED50 values of 41 +/- 19 and 170 +/- 42 microl, respectively.

Rapid determination of vitamin E in vegetable oils by reversed-phase high-performance liquid chromatography

A quick and direct method for measuring tocopherols (alpha, beta+gamma and delta) in vegetable oils has been developed using RP-HPLC with UV detection. Previous extraction of tocopherols is not required. The oil is diluted in hexane and an aliquot is mixed with ethanol containing an internal standard (alpha-tocopherol acetate). The chromatographic system consists of an ODS-2 column with a methanol-water mobile phase. Tocopherols are detected at 292 nm in less than 5 min after injection. The method is precise (RSD=2.69%) and has a high mean recovery (98.14%).

Simultaneous determination of alpha-tocopherol and beta-carotene in olive oil by reversed-phase high-performance liquid chromatography

A reversed-phase high-performance liquid chromatographic method was developed for the determination, in one run, of alpha-tocopherol and beta-carotene in virgin olive oil. The method involved a rapid saponification and a later extraction with a mixture of hexane-ethyl acetate. The chromatographic system consists of an ODS-2 column with a mobile phase of methanol-water-butanol and a diode-array detector. Linearity, precision, recovery and sensitivity were satisfactory. The main advantage of the proposed method is the speed and simultaneous determination of both compounds at the same time.

Skin lesions and cattle hide damage from Haematobia irritans infestations

The horn fly Haematobia irritans L. (Diptera: Muscidae) has recently spread to Argentina and Uruguay and is believed to cause damage to cattle hides. Four groups of ten Holstein steers each were maintained for 58 weeks under different infestation levels with H. irritans to determine if it was the cause of this problem. Hides (chrome tanned) from steers maintained under minimum infestation level had 4.7 +/- 3.8% of the area damaged. Maintaining the steers under low H. irritans level for the last 44 days of the trial using insecticidal ear-tags, resulted in 29.5 +/- 15.8% of hide area being damaged. Steers that were treated with 5% cypermethrin pour-on, when the H. irritans population was close to 50 flies, showed that 31.3 +/- 16.6% of hide area was injured, and 46.6 +/- 12.8% of damaged hide area was found in hides from non-treated steers. Significant differences were found between mean hide damage from steers maintained continuously under low H. irritans infestation levels and all other groups. Hyperaemia was significantly lower in the skin of steers under low H. irritans infestation level than in the skins of non-treated steers and steers maintained under low-level infestations for the final 44 days. Eosinophil and mononuclear cell infiltration was significantly lower when the population of H. irritans was less than six per steer than when the population was more than 100 flies per steer. Low numbers of Stomoxys calcitrans were found in all groups, but most hide damage was presumed due to H. irritans.

Wastewater from the manufacture of rubber vulcanization accelerators: characterization, downstream monitoring and chemical treatment

The content of wastewater resulting from the manufacture of rubber antioxidants and accelerators by a factory situated in the Ebro basin (Spain) has been determined using gas chromatography-mass spectrometry (GC-MS) and gas chromatography-flame ionization detection (GC-FID). The change in the pollutants was studied in the riverbed via two modules which continuously gathered pollutants on various solid supports (activated carbon and XAD-2 resins). These modules were located in Bocal Station, lying a further 100 km downstream from the factory, and from the Zaragoza water supply. Forty-six different compounds were identified at Bocal Station, the majority resulting from the production of rubber additives. Due to the immunity of different waste substances, and to the toxic nature of some, we studied their reaction when subjected to techniques of chemical oxidation using ozone.

[Tuberculous splenic abscess in an immunocompetent patient]

Splenic tuberculosis is a rare entity. The case of an 18-year old patient admitted for fever and general malice is described. Echography and abdominal CT showed a hypodense image localized in the spleen. Splenic tuberculosis was diagnosed upon observation of alcohol acid resistant bacilli (AARB) in the biopsy obtained by punction of the abscess. Correct tuberculostatic treatment led to disappearance of the splenic abscess with no further therapeutic measures being required.

A bovine viral diarrhoea/mucosal disease-like syndrome in moose (Alces alces): investigations on the central nervous system

A disease of unknown aetiology has been observed in moose. The animals showed signs of a bovine viral diarrhoea/mucosal disease-like syndrome, and central nervous disturbances. Brains from adult female moose were investigated by means of histology, immunohistochemistry, electron microscopy, virology, and bacteriology. The results indicate that the nervous signs were not associated with a spongiform encephalopathy. The lesions suggest a viral aetiology, although all the virological investigations have so far proved negative.

Bowenoid papulosis: clinical and histological study of eight cases

Eight cases of bowenoid papulosis are reported. The clinical diagnoses were confirmed by histology. In one case an immunoperoxidase method showed the presence of papillomavirus antigen in the nucleus of the most superficial epidermal cells. We consider bowenoid papulosis to be a condition with specific features that distinguish it clinically and histologically from carcinoma in situ and condylomata acuminata.

Primary liposarcoma of bone: light and electron microscopic study

The case history of a patient with primary liposarcoma of the humerus associated with a schwannoma of the radial nerve in the arm is described. Ultrastructurally, the neoplasm showed multiple and varied lipid droplets, dilated RER, mitochondria with electron-dense matrix, and microfilaments as the most prominent features. It is concluded, based on these ultrastructural observations, that liposarcoma of the bone is similar to pleomorphic liposarcoma arising in the soft tissues. This is the first ultrastructural study of a primary liposarcoma of the bone and the first reported association of this tumor with a schwannoma. The possible pathogenetic relationship between both tumors remains unknown.

Cephalexin concentration in the human ejaculate following oral and parenteral administration

Cephalexin levels in the ejaculates of 31 infection-free volunteers have been determined following the administration of 1 g of antibiotic. In 16 subjects the cephalexin was administered by intramuscular injection and in 15 by mouth. In each case the volunteers were divided into groups of five each of which received the drug, 1, 2 or 4 hours before the collection of semen. Antibiotic concentrations were determined microbiologically on agar plates using Sarcina lutea ATCC 9341. For selection purposes healthy subjects were considered to be those showing a normal anamnesis and physical exploration, an absence of leucocytes demonstrable by a cytomorphological evaluation of the semen, semen citric acid and fructose levels within normal limits and a qualitatively and quantitatively similar saprophytic flora to that seen in a culture of urine taken immediately before the collection of semen. Maximum concentrations were obtained 2 hours after the administration of the antibiotic and the concentration following intramuscular injection (6.9 microgram/ml) was significantly greater than that following oral administration (4.7 microgram/ml).