Urgencias dermatológicas. Estudio prospectivo y multicéntrico en Argentina / Dermatological emergencies. Prospective and multicentric study in Argentina

Resumen Las urgencias dermatológicas constituyen un motivo de consulta frecuente en los departamentos de urgencias. Con el objetivo de determinar la prevalencia de las consultas por urgencias dermato lógicas, describir las mismas, analizar la coincidencia entre los diagnósticos recibidos por los pacientes, en los casos que realizaron dos consultas por el mismo cuadro, y analizar el comportamiento de las variables de acuerdo al subsector del sistema de salud en el cual fueron atendidos: subsector público, y subsector privado, se realizó un estudio prospectivo, observacional, analítico, de corte transversal y multicéntrico. Se incluyeron 2801 pacientes. La prevalencia de las consultas por urgencias dermatológicas en adultos fue de 15% en el mismo período horario (subsector público: 10.6% y subsector privado: 22.5%, p < 0.05). Motivó la consulta una enfermedad infecciosa en el 35.5%, alérgica en el 29.6% y neoplásica en el 8.6%. Se hospitalizó el 0.7% de los pacientes. El 31.7% de los pacientes había realizado consultas previas. En estos casos se encontró coincidencia entre los diagnósticos realizados en el 80.7% de los atendidos de forma precedente por un médico dermatólogo, y el 52.6% de los evaluados por médicos no dermatólogos. La alta prevalencia de las consultas por urgencias dermatológicas y las diferencias existentes en la probabilidad de recibir un diagnóstico apropiado de acuerdo con la especialización del profesional interviniente, muestran la importancia de la presencia de un médico con formación en dermatología en el área de urgencias.

Abstract Dermatological emergencies are a frequent reason for emergency departments consultation. In order to determine the prevalence of dermatological emergencies, to describe the kind of dermatological diseases that present as emergencies, to analyze the coincidence between the diagnoses received by the patients in those cases with a previous consultations for the same cutaneous manifestation, and to analyze the behavior according to the health system segment in which they were attended: public segment and private segment; a prospective, ob servational, analytical, cross-sectional and multi-center study was carried out. Two thousand eight hundred one patients were included. The prevalence of consultations for dermatological emergencies in adults was 15% in the same time period (public segment: 10.6 and private segment: 22.5%, p < 0.05). The consultation was due to an infectious disease in 35.5%, allergic in 29.6% and neoplastic in 8.6%; 0.7% of patients were hospitalized. In 31.7% of patients who had a previous consultation, a coincidence was found between the diagnoses made in 80.7% of those attended by a dermatologist, and 52.6% evaluated by non-dermatologist physician. The high prevalence of dermatological consultations and the existing differences in the probability of receiving an appropri ate diagnosis according to the specialization of the intervening professional, show the importance of the presence of dermatology-trained physicians in the emergency area.

Piodermitis. Comportamiento en el Servicio Provincial de Dermatología del Hospital Universitario “Faustino Pérez Hernández”. Matanzas / Pyodermitis. Behavior in the Provincial Service of Dermatology of the Teaching Hospital “Faustino Pérez Hernández”. Matanzas

Introducción: las piodermitis son enfermedades infecciosas cutáneas producidas por microorganismos aerobios grampositivos (estreptococos y los estafilococos). En las consultas de Dermatología se ha incrementado el número de pacientes diagnosticados, presentándose un manejo inadecuado de la enfermedad. Objetivo: valorar el comportamiento de las piodermitis en los pacientes atendidos en el servicio provincial de Dermatología. Diseño metodológico: estudio longitudinal, prospectivo y descriptivo, en el Hospital “Faustino Pérez Hernández” de Matanzas. Universo: 121 pacientes con diagnóstico de piodermitis. Variables: edad, sexo, factores predisponentes, diagnóstico dermatológico. Resultados: hubo predominio en el sexo masculino, con un 57.9%. La edad de 18-30 años fue la frecuente para los casos ambulatorios con el 26.4%, siendo la de 61 a 70 años de un 12,4% para los ingresos. Entre los factores predisponentes estuvieron las micosis superficiales, la obesidad y la higiene inadecuada. El comportamiento de las micosis fue similar en ambos grupos para un 48,8% Y 62,2% en ambulatorios e ingresados respectivamente. En las piodermitis primarias diagnosticadas prevalecieron los forúnculos con un 36,4% para pacientes ambulatorios y un 20% para ingresados. Las micosis superficiales, las dermatitis de contacto y la escabiosis fueron las de mayor representación en las piodermitis secundarias. Conclusiones: en el estudio hubo un predominio del sexo masculino y las edades más jóvenes. Entre los principales factores predisponentes estuvieron las micosis superficiales, la obesidad y la higiene inadecuada. Dentro de las piodermitis primarias diagnosticadas predominaron los forúnculos y en las secundarias se observó un aumento de las piodermitis asociadas a micosis superficiales.

Introduction: pyodermitis are cutaneous infectious diseases caused by aerobic gram-positive microorganisms (streptococcus and staphylococcus). There has been an increase in the number of pyodermitis diagnosed patients in the dermatological consultation, showing an inadequate management of this disease. Objective: to assess the behavior of pyodermitis in patients treated at the provincial service of Dermatology. Methodological design:a longitudinal, prospective and descriptive study was carried out at “Faustino Pérez Hernández” Hospital of Matanzas, on a universe of 121 patients diagnosed with pyodermitis. The variables included were: age, sex, predisposing factors and dermatological diagnosis. Results: male sex was predominant with a 57,9 %. The group formed by people aged 18-30 years old was the most frequent one for ambulatory cases with the 26,4 %, being the group of patients aged 61-70 years old representative of 12,4 % for the in-patients. Superficial mycosis, obesity and inadequate hygiene were identified among other predisposing facts. Mycosis behavior was similar in both groups accounting for 48.8 % and 62.2 % of the ambulatory and in cases respectively. In the diagnosed primary pyodermitis furuncles prevailed with 36.4 % for ambulatory patients and 20 % for in-patients. Superficial mycosis, contact dermatitis and scabies were those of major representation in secondary pyodermitis. Conclusions: male sex and early age were predominant in the study. Among the main predisposing factors were superficial mycosis, obesity and inadequate hygiene. In the diagnosed primary pyodermitis,furuncles prevailed and we observed an increase of the pyodemitis associated to superficial mycosis among the secondary pyodermitis.

Histological study on acute inflammatory reaction to polyurethane-coated silicone implants in rats

PURPOSE: Evaluating histologically the silicone peri-implant coated by polyurethane inflammation associated to the use of anti-microbial and bacterial contamination. METHODS: It was used 35 Wistar rats. The animals were divided in seven groups: I - Control; II - implant cavity contamination with10 bacteria/ml; III - implant cavity contamination with 10 bacteria/ml; IV - implant cavity contamination with 10 bacteria/ml; V - identical contamination to group II and implant immersions in anti-microbial solution; VI - identical contamination in group III and implant immersions in the anti-microbial solution; VII - identical contamination of group IV and implant immersions in anti-microbial solution. It was evaluated morphometrically the peri-implant capsules after 30 days of introduction. RESULTS: The factors with more discriminating power were the giants cells of a strange body and the mononuclear. There was no correlation between the bacterial concentrations and the histological alterations. CONCLUSION: 1) The histological standard of the inflammatory reaction around the silicone implant coated with polyurethan is chronic granulomatosis type of a strange body; 2) There isn´t correlation between concentration of Staphylococcus epidermidis and histological changes; 3) The use of anti-microbial solution decreased the mononuclear cell reactions, with the increase of giant cells in a strange body.

OBJETIVO: Avaliar, histologicamente, a reação inflamatória aos implantes de silicone revestidos por poliuretano, com contaminação bacteriana, associada ou não ao uso de antimicrobianos. MÉTODOS: Utilizou-se 35 ratos Wistar. Os animais foram divididos em 7 grupos: I- Controle, II- contaminação da cavidade do implante com 10¹ bactérias/ml, III- contaminação da cavidade do implante com 10³ bactérias/ml, IV- contaminação da cavidade do implante com 10(5) bactérias/ml, V- contaminação idêntica ao grupo II e imersão dos implantes em solução antimicrobiana, VI- contaminação idêntica do grupo III e imersão dos implantes em solução antimicrobiana, VII- contaminação idêntica do grupo IV e imersão dos implantes em solução antimicrobiana. Avaliou-se morfometricamente as cápsulas peri-implantes após 30 dias da introdução. RESULTADOS: Os fatores com maior poder discriminante foram as células gigantes de corpo estranho e os mononucleares. Não houve correlação entre as concentrações bacterianas e as alterações histológicas. CONCLUSÕES: 1) O padrão histológico da reação inflamatória ao redor dos implantes de silicone revestidos com poliuretano é do tipo crônica granulomatosa de corpo estranho; 2) Não há correlação entre a concentração de bactérias Staphylococcus epidermidis e as alterações morfométricas; 3) O uso de solução antimicrobiana diminui a reação de células mononucleares, com aumento de células gigantes de corpo estranho.