Síndrome del bebe bronceado, una complicación impredecible de la fototerapia / Bronze baby syndrome, an unpredictable complication of phototherapy: A case report

Resumen El síndrome del bebe bronceado es una rara discromía que se presenta como una complicación de la fototerapia en recién nacidos con ictericia neonatal. Aunque el fenotipo común se ha descrito en pacientes con hiperbilirrubinemia directa secundaria a colestasis, también se conocen casos con hiperbilirrubinemia indirecta en quienes se invierte el patrón de hiperbilirrubinemia e, incluso, otros con hiperbilirrubinemia indirecta aislada. La fisiopatología de la enfermedad sigue siendo motivo de controversia, por lo que no se ha establecido claramente cuál es la mejor aproximación diagnóstica y terapéutica. En general, el síndrome se considera leve y se resuelve con la suspensión de la fototerapia; no suele prolongarse más allá del periodo neonatal y no tiene secuelas a largo plazo. Sin embargo, su aparición constituye una contraindicación absoluta para continuar la fototerapia. En caso de persistir, se recomienda disminuir los niveles de bilirrubina y recurrir a la exanguinotransfusión, pero dado que esta implica riesgos para el neonato, una conducta adecuada sería suspender la fototerapia y reiniciarla si la bilirrubina directa disminuye y se ha descartado el compromiso colestásico, aunque siempre evaluando en forma seriada posibles manifestaciones de encefalopatía aguda por bilirrubina. El objetivo de este estudio fue presentar el caso de un recién nacido con incompatibilidad de grupo sanguíneo ABO que presentó el síndrome del bebé bronceado. El bebé respondió satisfactoriamente a la suspensión de la fototerapia y a su posterior reanudación, sin necesidad de recurrir a la exanguinotransfusión.

Abstract The bronze baby syndrome is an infrequent dyschromia resulting from phototherapy in newborn babies with neonatal jaundice. Even though the common phenotype has been described in patients with direct neonatal hyperbilirubinemia secondary to cholestasis, several cases of patients with indirect neonatal hyperbilirubinemia who have managed to reverse it have been reported, as well as patients with isolated hyperbilirubinemia. Currently, the physiopathology of this condition is still a subject of controversy and, therefore, there is a lack of clear conducts for its correct diagnosis and treatment. Generally, this syndrome has been considered as a mild condition that is resolved with the suspension of phototherapy. Its duration is usually not greater than the neonatal period, and it has no long-term sequelae. However, its occurrence is considered an absolute contraindication for the continuation of phototherapy. In case of persistence, the recommendation is to decrease bilirrubin levels and proceed with exchange transfusion; this procedure, however, represents risks for the newborn, so our recommendation is to suspend phototherapy and reinitiate it if the direct bilirrubin value decreases, and cholestasis compromise has been discarded. Serial evaluations of acute encephalopathy caused by bilirrubin are absolutely recommended. The objective of this paper was to describe the case of a newborn with ABO incompatibility who developed the bronze baby syndrome. This patient responded satisfactorily to the suspension and resumption of phototherapy without exchange transfusion.

Recién nacido pretérmino con quilotórax congénito bilateral, una entidad infrecuente que amenaza la vida / Preterm newborn with bilateral congenital chylothorax, a rare life-threatening entity

RESUMEN El quilotórax corresponde a la acumulación de linfa en el espacio pleural. El diagnóstico se confirma por la presencia de quilomicrones en el líquido pleural, sin embargo en la práctica clínica se utilizan los criterios de Büttiker, para establecer el diagnóstico. El objetivo de esta publicación es presentar el caso de un recién nacido con quilotórax congénito bilateral, realizando una revisión actualizada del tema, que incentive la recolección de datos y la generación de guías nacionales para su abordaje estandarizado. Se trató de un recién nacido pretérmino, quien tras parto por cesárea presentó síndrome de distrés respiratorio, ameritó terapia temprana de surfactante logrando retiro de ventilación mecánica al día de vida, con posterior presentación de signos de dificultad respiratoria y hallazgo radiológico y ecográfico de derrame pleural bilateral. Se realizó toracentesis con citoquímico compatible con quilotórax. Nuevamente ameritó soporte ventilatorio invasivo, toracostomía cerrada bilateral y nutrición parenteral, con posterior evolución clínica satisfactoria. MÉD.UIS. 2017;30(1):87-92.

ABSTRACT Chylothorax refers to the accumulation of lymphatic fluid in the pleural space. Diagnosis is confirmed by the presence of chylomicrons in the pleural fluid, however in clinical practice Büttiker criteria are widely used. The aim of this publication is to present the case of a newborn with bilateral congenital chylothorax with an updated review of the literature that encourages data collection and generation of national guidelines for standardized approach. This was a newborn preterm, who after a cesarean delivery presented respiratory distress syndrome who required early surfactant therapy achieving withdrawal of mechanical ventilation on his first day, with subsequent presentation of signs of respiratory distress, and a radiological and ultrasound finding of bilateral pleural effusion. Thoracentesis was performed obtaining cytochemical compatible with chylothorax. Again required invasive ventilatory support, closed bilateral thoracostomy and parenteral nutrition, with a satisfactory clinical course. MÉD.UIS. 2017;30(1):87-92.

Personality Style in Patients Looking for Tooth Bleaching and Its Correlation with Treatment Satisfaction

Abstract In the last years the focus in dentistry has shifted to an "esthetic dentistry" approach, where patients are concerned about reaching a better look of their teeth. Vital tooth bleaching is a technique with immediate results, which improves the appearance and patient's self-esteem. The aim of this study was to recognize personality characteristics determined by the Millon Index of Personality Styles of participants looking for tooth bleaching and to correlate them to satisfaction with the treatment. Forty participants were included and filled out the Millon Index of Personality Styles form before treatment. Expectation about tooth bleaching was quantified from 1 to 5. Patients were treated with bleaching agent according to manufacturer's directions. One week after treatment, the patient's satisfaction was quantified from 1 to 5. Prevailing personality characteristics were determined. Expectations and satisfaction values of all patients were correlated with each of the presented personality scales by Spearman Rho test. Ten scales prevailed over their counterpart. Median of patient's expectation was 2 and satisfaction 4. Only the score of a single characteristic (extraversing) showed statistically significant correlation with patient satisfaction. Patients looking for tooth bleaching treatment seem to have common personality characteristics. Almost all of them wanted to achieve a moderate change in teeth color and the result of the treatment was usually satisfactory.

Resumo Ultimamente, o foco da Odontologia deslocou-se para uma "odontologia estética", em que os pacientes se preocupam em conseguir uma aparência melhor para seus dentes. O branqueamento vital é uma técnica com resultados imediatos que melhora aparência e auto-estima do paciente. O objetivo deste estudo foi detectar características de personalidade definidas pelo Índice Millon de Estilos de Personalidade de pessoas que buscaram branqueamento dental e correlacioná-las com a satisfação com o tratamento. Foram incluídos 40 participantes que preencheram o formulário do Índice Millon de Estilos de Personalidade antes do tratamento. A expectative sobre o branqueamento dental foi quantificada com valores de 1 a 5. Os pacientes foram tratados com agente branqueador de acordo com as instruções do fabricante. Uma semana depois o tratamento, a satisfação do paciente foi quantificada com valores de 1 a 5. Foram determinados as características predominantes. Os valores da expectativa e da satisfação foram correlacionados com cada escala de personalidade apresentada através do teste de Spearman Rho. Dez escalas prevaleceram sobre a sua contrapartida. A mediana das expectativas foi 2 e das satisfações foi 4. O valor de uma característica apenas (extraversão) apresentou correlação estatisticamente significante com a satisfação do paciente. Os pacientes que buscam o branqueamento dental parecem ter características comuns de personalidade. Quase todos queriam conseguir uma mudança moderada na cor dos dentes e o resultado do tratamento foi geralmente satisfatório.