Diss. (sammanfattning) Uppsala : Uppsala universitet, 2005. / Härtill 7 uppsatser.

Licentiatavhandling (sammanfattning) Stockholm : Karolinska institutet, 2006. / Härtill 2 uppsatser.

Diss. (sammanfattning) Göteborg : Univ. , 2009. / Härtill 4 uppsatser.

Thèse (M.Sc.)--Université Laval, 2007. / Bibliogr.: f. 82-89. Publié aussi en version électronique dans la Collection Mémoires et thèses électroniques.

Includes bibliographical references.

Background: Psoriasis is a heterogeneous disease with several clinical manifestations; the symptoms are characterized by redness, scaliness and thickness of the skin. There are several treatment options available for psoriasis and patients with moderate to severe psoriasis generally need systemic agents. In 2004 biologics were introduced for patients with moderate to severe psoriasis in Sweden. Methods: The Swedish Health Care Registers and the Swedish registry for systemic treatment of psoriasis PsoReg, were used to; estimate the incidence of psoriasis cases in the Swedish specialist care, to examine the treatment allocation and important factors related to the initiation of especially biologic treatment. Results: On average 9000 new psoriasis patients entered specialist care in Sweden each year under study, corresponding to an incidence of 98 patients per 100,000 person-years. In the treatment allocation analysis of the incident psoriasis cases in the Swedish specialist care Patients living in a Metropolitan Area and with a University degree were more likely to initiate a biologic treatment. By analysing biologic-naïve patients enrolled in PsoReg, PASI (the physician’s assessment of the psoriasis severity) and Psoriasis Arthropathy were shown to be two important factors associated with the initiation of biologic treatment while sex was not. Furthermore, it was also shown that the decision to initiate biological treatment was more strongly associated with PASI than with DLQI (the patients’ assessment of the disease impact Quality of Life). Conclusion: These studies indicate that there are inequalities in the assignments of systemic psoriasis treatments (especially in biologic treatment). Since the allocation of treatments should not depend on sex, education or residency in a Metropolitan Area but rather the need of care, it is important that future studies continue analysing possible factors that could influence the initiation of treatment in clinical practice.

No description available.

Resumo: Psoríase é doença inflamatória da derme e epiderme. Avaliação clínica é parâmetro essencial na indicação e avaliação de resultados terapêuticos. Alteração clínica é tradução macromorfológica de achados micromorfológicos. Investigar a correlação entre índices de gravidade clínica e histopatologia, antes e depois de tratamento sistêmico de pacientes com psoríase em placa. Avaliação clínica padronizada: PASI; "PASI" de região topográfica da lesão alvo; índice de inflamação total e índice de inflamação da região topográfica", expurgados da extensão comprometida e, correlação histopatológica. Nos momentos pré e pós-tratamento sistêmico. Os escores clínicos e histopatológicos foram capazes de detectar melhora significativa entre o pré e pós-tratamento. Não houve correlação, pré-tratamento, entre os escores de gravidades dos índices clínicos utilizados e os escores histopatológicos. No pós-tratamento houve correlação entre índice de "inflamação total" e "inflamação da região topográfica da lesão alvo" e achados histopatológicos nos pacientes com PASI <12. Não houve correlação entre índices clínicos e histopatológicos em nenhum momento nos pacientes com PASI ≥ 12. Os índices clínicos utilizados e a análise histopatológica captaram a intensidade de melhoria clínica dos pacientes. Porém, em pacientes com doença moderada e grave os índices de gravidade clínica não se correlacionaram com as alterações histopatológicas. Palavras-chave: histopatologia, PASI, psoríase, tratamento. / Abstract: Psoriasis is a chronic inflammatory disease of the skin. Clinical appraisal is essential to decide the treatment indication and results evaluation. Clinical aspects are the macro morphologic consequence of the histopathological changes. To investigate the correlation between clinical severity index and histopathological alterations observed before and after systemic treatment plaque psoriasis patients. Structured clinical evaluation of psoriasis area and severity index (PASI), local "PASI", "total inflammatory index" and "inflammatory index of a target lesion", these ones without compromised area, and correlated with histopathological changes, both, before and after treatment. The clinical and histopathological scores were able of detecting significant improvement after treatment. There were no agreement among all clinical indexes and the histopathological appraisal. Considering the post-treatment evaluation, correlation was observed among "total inflammatory index" and "inflammatory index of a target lesion" and histopathological scores from patients with PASI < 12.There was no correlation between clinical indexes and histopathological scores in any moment considering patients with PASI ≥12. The clinical indexes and the histopathological analysis were able to detect the degree of patients' improvement. However, among patients with moderated and severe disease the clinical indexes showed no correlation with the observed histopathological changes. / Orientador: Sílvio Alencar Marques / Coorientador: Mariângela E. A. Marques / Banca: Maria Rita Parise Fortes / Banca: Luciane Donida Bartoli Miot / Banca: Artur Antonio Duarte / Banca: Ricardo Romiti / Doutor

Made available in DSpace on 2014-10-09T12:54:18Z (GMT). No. of bitstreams: 0 / Made available in DSpace on 2014-10-09T14:09:21Z (GMT). No. of bitstreams: 1 12722.pdf: 558008 bytes, checksum: 01284590d84b5a596a55c0b0b7177695 (MD5) / Dissertacao (Mestrado Profissionalizante em Lasers em Odontologia) / IPEN/D-MPLO / Instituto de Pesquisas Energeticas e Nucleares - IPEN/CNEN-SP; Faculdade de Odontologia, Universidade de Sao Paulo, Sao Paulo

Submitted by Fabio Sobreira Campos da Costa (fabio.sobreira@ufpe.br) on 2016-06-29T13:21:09Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Dissertação Pablo Cardoso 2014.pdf: 3350391 bytes, checksum: 407ec26dd181ec31e5ed50bee8e4f25a (MD5) / Made available in DSpace on 2016-06-29T13:21:09Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Dissertação Pablo Cardoso 2014.pdf: 3350391 bytes, checksum: 407ec26dd181ec31e5ed50bee8e4f25a (MD5) Previous issue date: 2014-04-15 / FACEPE / Introdução: A psoríase afeta cerca de 2-3% da população. Esta doença é uma dermatite crônica, recorrente e tem envolvimento inflamatório mediado por células T. A apresentação mais comum da psoríase é o envolvimento da pele com placas eritematosas bem definidas, escamosas, de posição e tamanhos variados. Na placa psoriásica há uma disfunção imunológica que envolve vários tipos celulares e mediadores inflamatórios, como citocinas, tal qual IL -17A. Estuda-se uma atividade imunomoduladora dos derivados tiazolidinadionas (TZD). Esta classe de medicamentos tem uma possível ação anti-inflamatória, e pode ser capaz de reduzir as lesões de psoriásicas. Materiais e Métodos: Portanto, decidiu-se estudar três novos derivados TZD em células mononucleadas do sangue periférico (PBMC) de pacientes com psoríase. Depois da confirmação da estrutura química, os compostos LPSF-SF-33, LPSF-SF-34 e LPSF-SF-35 foram adicionados em cultura de PBMC estimuladas ou não com PMA/Iono. Após 48h os sobrenadantes destas culturas foram utilizados para a avaliação da IL-17A, IL-22 e IL-6. Resultados: O LPSF-SF-33 mostrou uma boa atividade imunomoduladora, reduzindo os níveis de IL - 17A e IL - 22 no sobrenadante de cultura em comparação com a estimulação por PMA/Iono. O LPSF-SF-34 mostrou bons resultados de inibição de IL-17A e IL-22 e ainda em todas as doses foi mais eficaz do que a metilprednisolona, droga padrão, na redução da IL-22. O composto do LPSF-SF-35 diminuiu a produção de IL-17A e IL-22 e também foi capaz de diminuir a produção de IL-6 quando comparado com PMA/Iono. Conclusão: Estes novos derivados tiazolidínicos LPSF-SF-33, LPSF-SF-34 and LPSF-SF-3 são capazes de inibir a produção de IL-17A, IL-22 e IL-6 em doses diferentes e o efeito pode indicar melhoria da inflamação. / Introduction: Psoriasis affects about 2-3% of the population. This is a chronic dermatitis, recurrent and inflammatory disease mediated by T cells. The most common presentation of psoriasis is skin involvement with well-defined and demarcated erythematous plaque, scaly, and random position in the patient's body. In psoriatic plaque, there is an immune dysfunction involving many cell types and inflammatory mediators such as cytokines like IL-17A. There is an immunomodulatory activity of thiazolidinedione derivatives. This class of drugs has a possible anti-inflammatory action, may be able to mitigate the psoriatic lesions. Objectives and Methods: Therefore, we decided to study three new TZD derivatives in PBMC of patients with Pso. After chemical structure confirmation, the thiazolidinedione derivatives LPSF-33, LPSF-34 and LPSF-35 were prepared in culture of PBMC, stimulated or not with PMA / Iono. After that, the supernatant of these cultures were used for IL-17A, IL-22 and IL-6 evaluation. Discussion: The three new TZDs tested were able to reduce the expression of IL-17A and IL-22 at different doses compared to PMA/Iono, but only LPSF-SF-35 was able to reduce a significant IL-6 levels. The compounds differ in their molecular structure that is added by the radical and perhaps the LPSF-SF-35 has been better because in its final structure it features a pyridine. Conclusion: The new thiazolidinedione derivatives LPSF-SF-33, LPSF-SF-34 and LPSF-SF-35 are capable of inhibiting the production of IL-17A, IL-22 and IL-6 at different doses and the effect may indicate improvement in inflammation.