Scielo RSS http://scielo.isciii.es/rss.php?pid=2695-507520200004&lang=pt vol. 2 num. 4 lang. pt http://scielo.isciii.es/img/en/fbpelogp.gif http://scielo.isciii.es http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S2695-50752020000400001&lng=pt&nrm=iso&tlng=pt http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S2695-50752020000400002&lng=pt&nrm=iso&tlng=pt Abstract Introduction: Diabetes mellitus (DM) is a multifactorial metabolic disorder which is of public health concern. Therapeutic intervention using reliable, affordable and non-toxic natural sources is crucial. Aim of the study: This research was designed to evaluate the α-amylase and α-glucosidase inhibitory activities of ten essential oils from Calophyllum inophyllum Linn. The study is part of our local sourcing for natural promising leads to ameliorating diabetes mellitus globally. Materials and methods: Essential oils from ten parts of C. inophyllum Linn were extracted by hydro-distillation using all-glass Clevenger-type apparatus. The percentage yields (w/v) were between 0.219 and 0.506 %. A plot of percentage inhibition versus concentration (mg/mL) of essential oils gave the IC50 values for each essential oil using non-linear regression analysis in reference to acarbose a standard anti-diabetic drug. Results: The following IC50 values (mg/mL) were obtained in the determination of α-amylase inhibition: [(Leaf, 0.043±0.05); (Leaf-stalk, 0.044±0.02); (Flower, 0.045±0.05); (Seed, 0.042±0.03); (Pod, 0.040±0.05); (Peel, 0.047±0.09); (Stem wood, 0.047±0.02); (Stem bark, 0.049±0.05); (Root wood, 0.048±0.05) and (Root bark, 0.046±0.04)] compared to acarbose (0.034±0.02). While α-glucosidase assay gave the following IC50 values (mg/mL): [(Leaf, 0.044±0.02); (Leaf-stalk, 0.043±0.03); (Flower, 0.044±0.04); (Seed, 0.048±0.02); (Pod, 0.038±0.04); (Peel, 0.048±0.03); (Stem wood, 0.048±0.04); (Stem bark, 0.048±0.02); (Root wood, 0.047±0.04) and (Root bark, 0.045±0.04)] with reference to acarbose (0.032±0.04). The high α-amylase and α-glucosidase inhibitory activity of pod essential oil in comparison with the reference drug must be due to the presence of some impact bioactive phyto-contituents in it. Conclusion: C. inophyllum Linn has been considered a fundamental source of potent anti-diabetic drugs which could be useful in the management of postprandial hyperglycemia. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S2695-50752020000400003&lng=pt&nrm=iso&tlng=pt Abstract Introduction and objective: The study aimed to investigate the prevalence of untreated dental caries in Latin American immigrant children who enter into the child protection system in Aragon, Spain. We analyze if these are related to demographic factors, body mass index, or vulnerability circumstances. Methods: Cross-sectional observational study. We analyze the social and health records of every child between the age of 6 and 17 that required residential care in the period between 2000 and 2019. The Social Services Institute of Aragon who compiled their records and directed the protection measures assessed their vulnerability conditions. A standard anthropometric and oral evaluation by healthcare professionals, together with the recollection of their demographic data, was carried out as these children accessed the welfare system. Results: Two hundred and thirty-one children (55.8% female) with an average age (SD) of 13.6 (3.8) years were evaluated. The prevalence of untreated dental caries was 16.5%. These were associated to the age group 6-13 years-old (p<0.001), the second-generation (p=0.004) and the temporary or permanent parental inability to provide child welfare (p=0.009) due to death, incarceration, physical illness, mental illness, drug addiction, or causes of a similar nature, together with the absence of relatives taking care of the child. The prevalence of overweight and obesity was 32% and do not exhibited association with the presence of untreated dental caries. Conclusion: We observe either that, besides cariogenic dietary habits acquired in their native community or their foster one, socio-family vulnerability and deprivation play an essential role in the high prevalence of untreated dental caries. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S2695-50752020000400004&lng=pt&nrm=iso&tlng=pt Abstract Introduction: Susceptibility to some infectious diseases has been associated with blood group phenotypes. Coronavirus disease 2019 (COVID-19) is a new infectious disease caused by a novel corona virus designated Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) which has spread rapidly around the world. The objective of this study was to determine if the susceptibility or severity to COVID-19 was associated with ABO blood group distribution among the affected countries. Materials and methods: This retrospective study of COVID-19 disease was based on data from 105 countries collected on the 13th of April 2020 and analysed by SPSS software version 16.0. Spearman correlation coefficient and Kruskal Wallis test were used to assess for associations between ABO blood group with COVID-19. Results: The results indicated that individuals of blood group A are at increased risk of infection by SARS-CoV-2 virus and severity of COVID-19 disease. Blood groups B and O were less likely to be infected and the disease evolves less severe. Conclusions: The results are discussed in relation to the host-parasite interactions that might contribute to susceptibility to these infections. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S2695-50752020000400005&lng=pt&nrm=iso&tlng=pt Abstract Introduction: Cicatricial alopecias are a group of disorders characterized by hair follicle destruction with the consequence of permanent hair loss. The current study was conducted to evaluate the epidemiological and clinicopathological characteristics of cicatricial alopecia in Libyan community. Methods: Thirty-one patients with confirmed diagnosis of cicatricial alopecia by biopsy and tricoscopy during Jan 2018 to Dec 2019 were included in this study. Data were collected by filling a pre-designed questionnaire by all included patients. Descriptive statistics were used for analyzing the results. Chi-squared test was performed to test the relationship between different variables using SPSS 22. Results: Out of 31 cases, 16.1% of patients suffered from lichen planopilaris (LPP), 25.8% discoid lupus erythematosus (DLE), 6% Folliculitis decalvans, 6.45% pseudopelade of brocq, and 16.12% Frontal fibrosing alopecia. Conclusions: Cicatricial alopecia was found to affect mainly middle-aged individuals, particularly females. Early diagnosis and treatment can decrease the burden of this concern. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S2695-50752020000400006&lng=pt&nrm=iso&tlng=pt Abstract Introduction: Face masks use among Cameroonians is a new behavior. Many citizens have adopted face masks as a step to prevent the spread of COVID-19. Individuals might use face masks because of their profession, risk perception, and social status. This study aims at evaluating the relation between occupation and face masks use in COVID-19 setting in Cameroon. Our study hypothesizes that face masks use is not associated with occupation in Cameroon. Methods: A survey was conducted from May 13 to June 3, 2020, among Cameroonians ranging from ages 15 to 66+. Participants answered questions regarding face mask use, occupation, perceived susceptibility to COVID-19, and physicians' guidance. A binary logistic regression analysis was used to examine the association between face masks use and occupation. Results: A total of 1,525 persons responded to the survey among 837 males and 688 females. After adjustment, face masks use was not associated with the occupation. Guidance provided by physicians were positively associated with face masks use (OR=2.06, 95%CI:1.48-2.85). Face masks use was also associated with reported answers on whether: face masks protect against COVID-19 (OR=10.48, 95%CI: 7.20-15.25), ability to easily access physician's guidance about COVID-19 on social media (OR=2.70, 95%CI: 1.94-3.75), and the belief that Africans are naturally resistant to COVID-19 (OR=1.73, 95% CI: 1.13-2.65). Conclusions: Our study provides evidence that face masks use in COVID-19 setting in Cameroon is not associated with occupation. However, physicians' role has an impact on people's behavior. The association between face masks use and the belief that Africans are naturally resistant to COVID-19 points to low perceived susceptibility that needs to be addressed by health professionals and competent civil authorities. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S2695-50752020000400007&lng=pt&nrm=iso&tlng=pt Abstract Introduction: This experimental study gauged the value of argyrophilic nucleolar organizer region (AgNOR) staining as a possible technique for the estimation of cell kinetics in conventional histology sections, in benign and malignant breast lesions. Methods: With a silver staining technique and immunohistochemistry, we associated the numbers of AgNORs and Ki67 scores in 30 breast carcinomas and 10 benign breast lesions. Results: The mean values of Ag NORs silver stain dots count for normal, benign, grade II and III were 1.28±0.17, 2.83±0.68, 5.23±0.87 and 7.32±0.92, respectively. There was a statistically significant difference (p≤0.001) was noticed between the all individual groups, among the normal and breast lesion as well as among the GII and GIII. Immunohistochemical Results of Ki-67 protein exhibited homogenous golden-brown color in control case and a positive brown granules or diffuse dark brown color in the nuclei of both benign and malignant cases under the 400X magnify examined under the light microscope. Discussion: AgNOR counts performed on routine formalin-fixed paraffin sections could provide substantial kinetic evidence. Additionally, the difference in AgNOR counts between benign and malignant tumors is such that they may be of diagnostic worth. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S2695-50752020000400008&lng=pt&nrm=iso&tlng=pt Abstract In the 1960s, Jeff Watkins and colleagues discovered N-methyl-d-aspartate (NMDA) receptors, and since then, it has been a pharmacodynamic target for many neurological and psychiatric drugs. NMDA is a glutamate receptor and ion channel protein located in nerve cells. There are many subunits for the NMDA receptor. They are all working together in a harmonic pattern to regulate the calcium permeability and the voltage-dependent sensitivity to magnesium influenced by the binding of glutamate as a neurotransmitter. In this paper, a light will be shed on glutamate ionotropic receptor NMDA subunits. There are several names for the GRIN gene, such as GluN. It is proven that GRIN has a significant influence on memory and learning abilities. Interestingly, part of how GRIN executes its function by interacting with other receptors. For example, GRIN counteracts the role of the cAMP response element-binding protein (CREP) receptor, while its function modulated by dopamine D1 receptors. Therefore, Hypo-functioning and mutation of this gene play a pivotal role in developing neurodevelopmental disorders wither it was with or without hyperkinetic movements and with and without seizures, besides several psychotic disorders such as schizophrenia. Hence, NMDA receptors subunits have been a target for therapeutic development for the last years. With the advancements in the genetic and genomic science, investigators are trying to find the alternative splicing of GRIN, understanding location and the distribution of NMDA subunits with deeper lucidity than it is currently. However, that is faced by some challenges. Modifying the NMDA receptor subunits to treat one condition can lead to potential harm effect in another condition because, sometimes, NMDA works complicatedly inversely with many other receptors and neurotransmitters, which will have an impact on the investigators to find the appropriate way to cause no harm. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S2695-50752020000400009&lng=pt&nrm=iso&tlng=pt Abstract The outbreak of novel Coronavirus disease 2019 (COVID-19) has emerged as a global pandemic and a public health crisis. COVID-19 is the clinical manifestation of infection with Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). Although it is predominantly a respiratory illness, there is growing awareness of the cardiovascular manifestations of COVID-19 disease. Patients with pre-existing cardiovascular co-morbidities appear to be at highest risk for mortality from this disease along with the elderly. COVID-19 also contributes to cardiovascular complications, including myocardtits, acute coronary syndromes, arrhythmias, acute heart failure, and, in the most severe cases, cardiogenic shock and death. Several medications proposed in the treatment of this infection have cardiac-specific adverse effects that warrant cardiac monitoring. This review summarizes the rapidly emerging data on the cardiovascular implications of COVID-19. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S2695-50752020000400010&lng=pt&nrm=iso&tlng=pt Abstract NAD(P)H:quinone oxidoreductase 1 (NQO1) is considered as one of the most significant enzyme in cellular defense due to its ability to detoxify reactive quinones and quinone imines to their less toxic hydroquinones forms. NQO1 is a xenobiotic metabolizing cytosolic enzyme that catalyzes the reduction of two- or four-electron of numerous exogenous and endogenous quinones by utilizing flavin adenine dinucleotide (FAD) as a cofactor. NQO1 enzyme exists as a homodimer enzyme and is biochemically identified by its noticeable ability to utilize either NADH or NADPH as reducing cofactors and by its inhibition by anticoagulant agents such as dicumarol. NQO1 is a distinctly inducible enzyme and known to be controlled by the Nrf2-Keap1 pathway. The importance of the antioxidant activities exhibited by NQO1 enzyme in suppressing the oxidative stress status is provided by demonstration that induction or reduction of NQO1 levels are linked with increased and reduced susceptibilities to oxidative stress, respectively. The gene coding for NQO1 has two well-recognized polymorphisms at nucleotide site 609(C-T) and 465 (C-T) of the human cDNA. C609T causes complete loss of enzymatic activity due to protein instability, whereas the C465T results in reduction of the enzyme activity. In this Review, we deliberate the protecting activates of NQO1 and discussing its possible transcriptional pathways regulating its induction by Nrf2-Keap1/ARE system. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S2695-50752020000400011&lng=pt&nrm=iso&tlng=pt Abstract Introduction: Medicinal plants have been the most productive source of leads for the development of drugs from ancient times. Current research in drug discovery involves a multifaceted approach combining botanical, biological, and molecular techniques. Medicinal plant based drug discovery continues to provide novel and important leads against several diseases. Methods: Relevant articles relating to the concept were identified using a combination of manual library search as well as journal publication on the subject and critically reviewed. Results: Drug discovery from medicinal plants continues to provide an important source of new drug leads however; numerous challenges are encountered including the procurement of plant materials and implementation of appropriate high-throughput screening bioassays. Medicinal plants have great prospect in the ultimate search for the cure against the dreaded coronavirus. Conclusion: It is hoped that the more efficient and effective application of medicinal plants would improve the drug discovery process against the dreaded coronavirus. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S2695-50752020000400012&lng=pt&nrm=iso&tlng=pt Abstract Introduction: Aromatic plants produce diverse chemical constituents with potential to inhibit viral infections. These plants have been utilized for the prevention and treatment of a range of infectious and non-infectious diseases. Essential oils are among the plant-derived antiviral agents that are being employed in phytomedicine, and are considered as prospective drug candidate against the ravaging Coronavirus. Methods: Relevant articles relating to the concept were identified using a combination of manual library search as well as journal publication on the subject and critically reviewed. Results: Essential oils in medicinal plants have extensive applications in medicinal chemistry, aromatherapy and pharmaceuticals. Essential oils have several biological properties such as antibacterial, antifungal, antiviral, antioxidant, anti-inflammatory, wound-healing and anti-cancer effects in vitro and in vivo. Several reports have analyzed and described essential oils as good antiviral agents against Respiratory tract viral infections hence are excellent prospective candidate against Corona virus. Conclusions: It is hoped that efficient and effective exploration and optimization of essential oils from medicinal plants would improve the drug discovery process against the ravaging Coronavirus. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S2695-50752020000400013&lng=pt&nrm=iso&tlng=pt Abstract The objective of this review is to summarize specialty data regarding possible manifestations of diffuse idiopathic skeletal hyperostosis in general otorhinolaryngology practice in order to increase awareness of this entity. Research on the topic was based on consulting specialty books, electronic databases like PubMed, Scopus (Elsevier), Web of Science, Research Gate, Up-to-date and also, on clinical experience. Even though asymptomatic in most patients and many times found during cervical pain investigations or by accident, this overlooked disorder, in rare cases, may cause two of the main complains in practice, dysphagia and dyspnea. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S2695-50752020000400014&lng=pt&nrm=iso&tlng=pt Abstract Introduction: Aspirin has justifiably been called the first miracle drug. In this article, we highlight the history of Aspirin, a novel mechanism of action, and its use in cardiovascular and other diseases. Also included is a brief statement of emerging new applications. Objective: We highlight principal mechanisms by which Aspirin inhibits acute inflammation and alters platelet-biology; therefore, hypothesized that Aspirin might prove highly beneficial as a novel therapeutic drug for combating severe acute inflammation and thrombosis associated with the cytokine storm in COVID -19 patients. The communiqué also suggests possible strategies for maximizing the gain of Aspirin as a wonder-drug of the future. Discussion: Interestingly, some fascinating studies demonstrated Aspirin's superior benefits with dangerous side effects. Aspirin inhibits COX-1 (cyclooxygenase-1). Its impact on COX-2 is more delicate because it “turns off” COX-2's production of prostaglandins but “switches on” the enzymatic ability to produce novel protective lipid mediators. The established mechanism of action of Aspirin is the inhibition of prostaglandin synthesis. However, further evidence showed that aspirin-elicited nitric oxide exerts anti-inflammatory effects in the microcirculation by inhibiting leukocyte–endothelium interactions. Interestingly, aspirin-triggered lipoxin formation may provide a novel mechanism underlying Aspirin's clinical benefits. Interestingly, Aspirin reduces the risk of a cardiovascular event by about 30 percent. Also, Aspirin has been associated with a reduced risk of colorectal cancer, and possibly a few other digestive tract cancers. Conclusion: The current emerging interest is to conduct further study to provide evidence for Aspirin as the novel therapeutic drug for combating severe acute inflammation and thrombosis associated with the cytokine storm in COVID-19 patients. Besides, the most wanted is The RECOVERY II (Randomized Evaluation of COVID-19 Therapy II) trial to be established as a randomized clinical trial to test the effectiveness of low-dose Aspirin as an anti-inflammatory and antithrombotic treatment in COVID-19 patients. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S2695-50752020000400015&lng=pt&nrm=iso&tlng=pt Abstract Assessment in medical education usually gives the evidence that learning was carried out and the learning objectives were achieved. The assessment program is a measurement tool to evaluate the progress in knowledge, skills, behaviors, and the attitude of students. So, the planning for an effective assessment program should be based on instructional objectives, instructional activities, and efficient assessment methods. Thus, a well-designed assessment procedure should be characterized by validity and reliability. There are two methods for interpreting the results of students' performance, norm-referenced and criterion-referenced; the first gives a relative ranking of students while the second describes learning tasks that students can and cannot perform. The information that gets from the assessment results should be used effectively to evaluate and revise the instructional course for more improvement. Therefore, the reporting of the assessment results to stakeholders should be clear, comprehensive, and understandable to prevent misinterpretation that may affect students and other stakeholders adversely. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S2695-50752020000400016&lng=pt&nrm=iso&tlng=pt Abstract After spillover from Wuhan (China) in December, 2019, SARS-CoV-2 related respiratory disease (COVID-19) has rapidly affected all countries. The pandemic has posed a serious threat to world health resources. At present, there is no recommended treatment or vaccine for SARS-CoV-2. However, various drug combinations are under trial. Reversion to general principles of prevention is the preferred strategy under such circumstances. We discuss the importance of wearing a face mask and present a cost-effective approach for long-term management of COVID-19. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S2695-50752020000400017&lng=pt&nrm=iso&tlng=pt Abstract In December 2019 in Wuhan, China, the World Health Organization (WHO) declares that a severe pandemic of Coronavirus disease 2019 (COVID-19) was emerged and was spread rapidly resulted in dramatic global economic and health implications. The novel coronavirus, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is responsible for a severe inflammatory reaction and clinically severe complications, although the majority of the infected individuals had mild symptoms and favorable prognosis after recovery. However, cancer patients are a high-risk group as are already susceptible to COVID-19 infection due to their underlying disease and their immunosuppression. Moreover, cancer patients are at increased risk of developing clinically severe complications in case of COVID-19 infection such as, Intensive Care Unit admission, required mechanical ventilation or even death. Another aggravating factor for oncological patients, during that pandemic crisis is the risk of postponing cancer treatment. The present review presents the clinical characteristics accompanied by the corresponding laboratory findings in COVID-19 infected cancer patients and the possible therapeutic role of some known chemo-therapeutic agents based on the recent observations of the International literature. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S2695-50752020000400018&lng=pt&nrm=iso&tlng=pt Abstract Bladder cancer is one of the most significant genitourinary cancer characterized by a high rate of recurrences, morbidity, and mortality in a large number of patients. Over the years, numerous therapeutic approaches have been developed. For more than 40 years, the most comprehensive method for the treatment of non-invasive and invasive bladder cancer has been the use of Bacillus Calmette-Guerin (BCG), giving a successful effect in a high percentage of patients. However, due to the genetic instability of cancer and the desire to develop personalized therapy, therapeutic approaches are continually evolving and improving. This review will discuss the therapeutic evolution and directions of future research to improve the efficacy of immunotherapy in the treatment of bladder carcinoma. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S2695-50752020000400019&lng=pt&nrm=iso&tlng=pt Abstract The practice of pharmacy in health care societies continues to undergo evolutionary and even radical changes. It has changed to a personal health service charged with assuring pharmaceutic and therapeutic appropriateness of all its functions in the care of patients. The purpose of this study is to review and analysis the historical stages of development of the good pharmaceutical practice (GPP) requirements and to recommend a guideline for the implementation of GPP standards in Libya as a way to improve the pharmaceutical care and profession. The study designates that the development of the GPP standards should be committed at the public professional organizations levels as pharmaceutical syndicates and associations as the national regulation of pharmacy practices in various countries and the local health authorities. This requires basic skills of documentation, professional and communication with all relative professions and it, therefore, is important to establish standards for community, hospital and consultant pharmacists to promote the pharmaceutical mission. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S2695-50752020000400020&lng=pt&nrm=iso&tlng=pt Abstract Hypersensitivity pneumonitis (HP), also called extrinsic allergic alveolitis, is a respiratory syndrome involving the lung parenchyma specifically the alveoli, terminal bronchioles and alveolar interstitium. HP is caused by delayed allergic reaction to variety of antigens like microbes, animal proteins, and low-molecular-weight chemicals. Bagassosis is one such HP caused by repetitive inhalation of bagasse. Though use of bagasse as cause of HP is known, use of bagasse in brick- kiln factory as fuel and its association with HP has not been well documented. We report a case of HP in a brick-kiln worker where bagasse was used as fuel. A twenty-five years old man, working in a brick kiln for five years, presented with complaints of dry cough, low grade fever and weight loss for one month. He had bilateral lower lobe crackles on auscultation. The history of bagasse, clay and coal dust exposure, clinical presentation and imaging were suggestive of HP. However, being endemic in India, pulmonary tuberculosis was ruled out by negative Mantoux test, sputum for acid fast bacilli and Cartridge Based Nucleic Acid Amplification Test. He was managed with corticosteroids and symptomatic treatment with good response and resolution of clinical signs and radiological changes. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S2695-50752020000400021&lng=pt&nrm=iso&tlng=pt Abstract Introduction: Amyand's hernia is an extremely rare and atypical hernia that is difficult to diagnose clinically characterized by the herniation of the appendix into the inguinal sac. The aim of this report is to describe a case of Amyand's hernia and highlights the importance of early CT scanning in reaching the exact and early diagnosis of Amyand's hernia. Case report: We present a rare case of a 69-year-old female patient with a history of intermittent pain in the right inguinal region is see at the emergency surgical clinic. The patient underwent a CT scan of the abdomen and a small pelvis, and an inflamed appendix was diagnosed. The inflamed appendix is herniated in the inguinal hernia sac. Computed tomography was the only modality to diagnose the hernia sac contents preoperatively. Discussion: The reported incidence of Amyand's hernia is less than 1% of all adult inguinal hernia cases. Acute appendicitis in Amyand's hernia is even less common, with 0,1% of all cases of acute appendicitis. This hernia may be present without symptoms until the inflammation of the appendix may lead to incarceration, strangulation, necrosis, perforation, or rupture. Early symptoms include tenderness and inguinal swelling. Conclusions: Computer tomography helps make an accurate and timely diagnosis of Amyand's hernia, thus avoiding complications from delayed surgery. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S2695-50752020000400022&lng=pt&nrm=iso&tlng=pt Abstract Vesiculobullous lesions can be developed by less than 5% of patients with systemic lupus erythematosus (SLE). Among these lesions, bullous systemic lupus erythematosus (BSLE) is one of the rarest and most challenging cutaneous presentations of the disease. Its frequency in the largest series of 5149 patients with cutaneous lupus was 0.19%, and the majority of cases are reported as sporadic observation or small series not exceeding ten cases. We report the original observation of BSLE revealing SLE in 32-year-old Tunisian Woman. This atypical presentation of cutaneous lupus deserves to be known by clinicians and discussed in front of any bullous dermatosis, particularly in young woman. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S2695-50752020000400023&lng=pt&nrm=iso&tlng=pt Abstract Cutis verticis gyrata (CVG) is a rare skin disorder characterised by thick skin folds and grooves, resembling the gyri and sulci of the cerebral cortex. It can be classified as primary essential, primary non-essential and secondary CVG. The rarity of the condition poses a challenge in the diagnosis and ultimately requires good communication between the clinician and the dermatopathologist for diagnosis. Many names have been given to the condition, including Robert-Unna syndrome, cutis verticis plicata, paquidemia verticis gyrata, cutis sulcata, cutis striata or “bulldog” scalp syndrome. To date, the treatment is still limited to plastic surgeons with excision of the folds, scalp reduction and reconstruction. In this article, we are sharing a rare case and the surgical management of a middle age gentleman with cutis verticis gyrata secondary to cerebral intradermal nevus (CIN) over his occipital scalp.