Escorpionismo en pediatría: estudio descriptivo, transversal y retrospectivo de factores predictores de gravedad / Pediatric scorpionism: a descriptive, cross-sectional, and retrospective study of predictors of severity

Introducción. El emponzoñamiento por Tityus carrilloi n. sp. representa una amenaza para la vida. Según las manifestaciones clínicas, se clasifica en leve, moderado y grave. Objetivo. Comparar las características epidemiológicas y bioquímicas en niños con escorpionismo leve, moderado y grave. Población y métodos. Estudio descriptivo, transversal y retrospectivo. Se analizaron las consultas de menores de 15 años picados por Tityus carrilloi n. sp. entre enero de 2017 y diciembre de 2018 en un hospital pediátrico de tercer nivel en Santa Fe (Argentina). Resultados. Se incluyeron 524 niños, el 81 % (421) con dolor local y el 19 % (103) con manifestaciones sistémicas. Los niños con síntomas sistémicos de escorpionismo fueron más pequeños en edad que los que presentaron manifestaciones locales (p <0,001). En el invierno los niños desarrollaron 8 veces más manifestaciones sistémicas de escorpionismo y durante la primavera, 2,4 veces más que durante el verano. De los 103 niños internados, 80 fueron casos moderados y 23, graves. No hubo diferencias entre grupos en edad (p = 0,29) ni en la demora en recibir suero antiescorpiónico (p = 0,81). El tiempo de internación fue mayor en los graves (p <0,001). Los valores de glóbulos blancos o glucemia mayores a 30 000 cel/ml y 300 mg/dl respectivamente estuvieron presentes casi exclusivamente en escorpionismos graves. Conclusión. En niños picados por el escorpión Tityus carrilloi n. sp., el riesgo de desarrollar manifestaciones sistémicas fue mayor cuanto menor fue la edad y durante el invierno y la primavera. Los valores de glóbulos blancos y de glucemia fueron mayores en niños con escorpionismo grave.

Introduction. Scorpion envenomation by Tityus carrilloi n. sp. represents a threat to life. Depending on its clinical manifestations, it is classified as mild, moderate or severe. Objective. To compare the epidemiological and biochemical characteristics among children with mild, moderate, and severe scorpionism. Population and methods. Descriptive, crosssectional, and retrospective study. The consultations at a tertiary care children's hospital in Santa Fe (Argentina) of children under 15 years of age stung by Tityus carrilloi n. sp. between January 2017 and December 2018 were analyzed. Results. In total, 524 children were included, 81% (421) with local pain and 19% (103) with systemic manifestations. Children with systemic symptoms of scorpionism were younger in age than those with local manifestations (p < 0.001). In the winter, children developed 8 times more systemic manifestations of scorpionism; during the spring, 2.4 times more than during the summer. Out of the 103 hospitalized children, 80 were moderate cases and 23 severe cases. There were no differences between age groups (p = 0.29) or in the delay in receiving the anti-scorpion serum (p = 0.81). The length of hospital stay was longer among severe cases (p < 0.001). WBC and blood glucose levels higher than 30 000 cell/mL and 300 mg/dL, respectively, were present almost exclusively in severe scorpionism cases. Conclusion. In children stung by the scorpion Tityus carrilloi n. sp., the younger the age and during winter and spring, the higher the risk for systemic manifestations. WBC and blood glucose levels were higher in children with severe scorpionism.

Co(rpo)memoração: fixação e regressão a traços de memória deixados no corpo / In-body memory: from fixation and regression to memory traces left in the body / Co(rps)mémoration: de la fixation et de la regresssion aux traces de mémoire laissés laissés sur le corps / C(uerp)onmemoración: fijación y regresión a las huellas de memoria que quedan en el cuerpo

O trauma, como co(rpo)memoração, será abordado, neste trabalho, na perspectiva psicanalítica, com base nos desdobramentos que se manifestam em "atos" no corpo que tomam o lugar da elaboração psíquica. Perspectiva na qual a repetição se apresenta sob a modalidade da fixação a um gozo "além" e da regressão como uma espécie de memória que evita o encontro com o novo e retorna a traços de memória deixados no corpo. Para tanto, será tomado como referência o pesadelo vivido e narrado pela ativista Eve Ensler, no relato de cunho testemunhal, em seu livro No corpo do mundo: um livro de memórias (2014). Ensler fala da relação profundamente íntima e dolorosa que tem com seu corpo e como esta mudou ao longo de sua vida, depois de conviver com mulheres que tinham experimentado a violência e o sofrimento da violação de seus corpos.

Resumos This paper discusses trauma as an in-body memory based on ramifications that are manifested as "acts" in the body, and which replace psychic elaborations. In thispsychoanalytic perspective, repetition is manifested as fixation to a joissance "beyond" and as regression as a kind of memory that avoids the new and looks to traces of past memory left in the body. To this end, the nightmare lived and narrated by activist Eve Ensler in her book In the body of the world: A memoir (2014), will be used as reference. Ensler speaks of the deeply intimate and painful relationship she has with her body and how it changed throughout her life, after spending time with women victims of sexual violence.

Cet article traite du traumatisme, comme co(rps)mmémoration basée sur des déroulements qui se manifestent comme des "actes" dans le corps, et qui remplacent les élaborations psychiques. Dans cette perspective psychanalytique, la répétition se manifeste comme une fixation à une jouissance "au-delà" et comme une régression en tant que type de mémoire qui évite la rencontre avec le nouveau et renvoie à des traces de mémoire laissées sur le corps. À cette fin, le cauchemar vécu et raconté par l'activiste Eve Ensler dans son livre Dans le corps du monde: une mémoire (2014), sera utilisé comme référence. Ensler y parle du rapport profondément intime et douloureux qu'elle entretient avec son corps et de la façon dont elle a évolué au cours de sa vie, après avoir vécu avec des femmes victimes des violences sexuelles.

El trauma, como forma de c(uerp)onmemoración, será abordado, en este trabajo, desde la perspectiva psicoanalítica, a partir de los desdoblamientos que se manifiestan en "actos" en el cuerpo que ocupan el lugar de la elaboración psíquica. Una perspectiva en la que la repetición se presenta bajo la modalidad de fijación a un goce "más allá" y de regresión como una especie de memoria que evita el encuentro con lo nuevo y vuelve a las huellas de la memoria dejados en el cuerpo. Para ello, se tomará como referencia la pesadilla vivida y narrada por la activista Eve Ensler, en el relato testimonial de su libro De Pronto, Mi Cuerpo: Una Memoria (2015). Ensler habla de la relación profundamente íntima y dolorosa que mantiene con su cuerpo y de cómo ésta ha cambiado a lo largo de su vida, tras convivir con mujeres que habían experimentado la violencia y el sufrimiento de la violación de sus cuerpos.

Manifestaciones clínicas, diagnóstico y tratamiento del golpe de calor / Clinical Manifestations, Diagnosis and Management of Heat Stroke

Introducción: El golpe de calor es una enfermedad que fue descrita hace más de 2000 años, sin embargo, los cambios climáticos que se han presentado en las últimas décadas han permitido que su prevalencia esté en aumento. Se considera una entidad compleja en la cual existe un compromiso importante de la termorregulación corporal y, en consecuencia, del resto de sistemas. Objetivos: Orientar al abordaje adecuado y óptimo de conceptos clínicos, epidemiológicos, factores el riesgo, presentación clínica y repercusión sobre los diferentes sistemas. Métodos: Se realizó una revisión de la literatura científica de personas con golpe de calor, en quienes se evaluaron sus factores asociados, métodos diagnósticos y manejos terapéuticos. Se realizó una búsqueda de la literatura en las siguientes bases de datos: Pubmed/Medline, Science Direct, Scopus, DOAJ, Embase, Cochrane, Direme, Redalyc y SciELO. Conclusiones: El golpe de calor es una urgencia médica que implica un manejo rápido y óptimo dado su morbilidad y mortalidad, lo cual puede minimizarse si se cumplen los objetivos de tratamiento. El enfriamiento por inmersión en agua helada, por convección o evaporación son las medias más usadas. Evitar la falla multiorgánica es el segundo objetivo terapéutico(AU)

Introduction: Heat stroke is a disease described more than 2000 years ago; however, the climatic changes that have occurred in recent decades have allowed an increase in its prevalence. It is considered a complex entity in which there is an important compromise of body thermoregulation and, consequently, of the rest of the systems. Objectives: To define important concepts concerning heat stroke, risk factors, clinical presentation and repercussions on the different systems, as well as to guide an appropriate and optimal management. Methods: A review of the scientific literature about people with heat stroke was carried out to assess its associated factors, diagnostic methods and therapeutic management. A literature search was performed in the following databases: Pubmed/Medline, Science Direct, Scopus, DOAJ, Embase, Cochrane, Bireme, Redalyc, and SciELO. Conclusions: Heat stroke is a medical emergency that requires rapid and optimal management given its morbidity and mortality, which can be minimized if management goals are met. Cooling by immersion into ice water, convection or evaporation are the most commonly used measures. Avoidance of multiorgan failure is the second therapeutic objective(AU)

Pediatric population with cystic fibrosis in the centre of Portugal: candidates for new therapies

Abstract Objectives: Cystic fibrosis (CF) is a severe autosomal recessive disease that results from mutations in a gene encoding the Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) protein, a chloride channel. This study aims to characterize the clinical and genetic features of a cohort of pediatric people with CF (PwCF) in the center of Portugal and to determine which ones are candidates for the new drugs modulating the CFTR channel. Methods: A review of the demographic, genetic and clinical characteristics of PwCF undergoing follow-up at a CF reference center was carried out. Results: Twenty-three PwCF (12 male), with a median age of 12 years, were followed up. All patients carry the F508del mutation in at least one allele. Fifteen PwCF were F508del-homozygous, median BMI z-score was -0.13, all are pancreatic insufficient and median FEV1 value was 78.1%. These PwCF are eligible for dual therapy (lumacaftor/tezacaftor+ivacaftor) and for triple therapy (tezacaftor+ivacaftor+elexacaftor). PwCF with 711 +1G->T (n = 2), 2184insA (n = 1) mutations and a novel mutation c.3321dup (n = 1) have minimal function mutation and patients with a residual function mutation: R334W (n = 3) and P5L (n = 1) have a less severe phenotype. All these patients, because they also carry F508del mutation, are elegible to triple therapy. Conclusions: Genetic and molecular characterization of PwCF poses an important step not just for CF diagnosis and prognosis which is tightly correlated with the clinical phenotype, but also for the eligibility of CFTR modulator drugs.

Association of FOXO3 polymorphism (rs3800231) and clinical subphenotypes of beta thalassemic individuals

Abstract Introduction Studies have shown that the loss of the FOXO3 transcriptional function is involved in the pathophysiology of some chronic erythroid disorders, including beta-thalassemia (β-thal). Therefore, the single nucleotide polymorphism (SNP) rs3800231 (35-2764A > G) could contribute to alterations in its transcriptional activity, acting as a modifier of β-thal phenotypic manifestations. Objective and method In order to better understand the genotypic and/or allelic distributions among β-thal patients, we evaluated 83 β-thal heterozygous and 20 homozygous, compared to 117 individuals without hemoglobinopathies (control group). Additionally, we verified any influence of the FOXO3 polymorphism on clinical manifestations among β-thal homozygotes. Results We obtained higher frequencies of the wild-type homozygous (AA) and the wild-type allele (A) in the β-thal group (p< 0.0001 and p= 0.00014, respectively). The most common clinical manifestations found among β-thal homozygotes were iron overload (90%), splenomegaly (65%) and bone complications (35%), e.g., osteopenia/osteoporosis. We observed that close to 80% of the patients presenting such manifestations had the genotype AA. However, we did not find any significant involvement of the FOXO3 polymorphism in clinical manifestation occurrences. Conclusion Thus, we concluded that the SNP rs3800231 did not play a significant role as a modifier of the clinical manifestations observed in the β-thal homozygotes studied.

Manifestations cliniques et traitements des diastemes chez les personnes adultes à l'hopital national Donka / Clinical manifestations and treatments of diastemas among people adults at hospital national Donka

Le diastème du grec diastèmà (interstice) se définit comme étant l'existence d'espace entre les dents d'une même arcade. Les objectifs de l'étude étaient de déterminer le profil épidémiologique des diastèmes; décrire les formes cliniques rencontrées, assurer une prise en charge. PATIENTS ET MÉTHODE: Il s'agissait d'une étude prospective de type descriptif effectuée à l'hôpital national Donka, elle avait duré sept mois, allant du 1er Mars au 30 septembre 2019. RÉSULTATS: Le sexe féminin prédominait avec 77,7% contre 22,2 % de sexe masculin, donnant un ratio (f/h) = 3,5. La tranche d'âge de 21-23 ans (tout sexe confondu) était la plus représentée avec un pourcentage de 44,4%. La tonicité du frein labial médian avec 29,62% était l'étiologie principale du diastème inter incisif. Le diastème était plus fréquent au maxillaire avec des valeurs respectives de 33,33% de diastème des dents du bloc incisivo canin et 29,62% de diastème inter incisif soit au total 62,96 %. Le traitement fut chirurgical, orthodontique et prothétique. CONCLUSION:Le diastème reste l'une des anomalies orthodontiques fréquente dans nos pays. Considéré par certains comme un excès de place sur l'arcade dentaire, il est cependant apprécié par d'autres, surtout en Afrique de l'ouest où il est souvent considéré par la population comme signe de chance, de beauté, d'où son impact socio-culturel.

Progress in hemophagocytic lymphohistiocytosis with central nervous system involvement / 国际儿科学杂志

Hemophagocytic lymphohistiocytosis is a systemic inflammatory state caused by abnormal activation and infiltration of lymphocytes and histocytes.Characteristic features include unremitting fever, hepatosplenomegaly, cytopenia, organ damage, and even failure.Patients can develop central nervous system involvement.The most common neurological symptoms of CNS involvement are seizures and mental status changes, which need to be distinguished from various CNS diseases, such as multiple sclerosis, acute disseminated encephalomyelitis, and encephalitis.Early diagnosis and treatment are essential because of the poor prognosis and permanent sequelae of children with CNS involvement.This article aims to review the mechanism, clinical manifestations, accessory examinations, diagnosis, differential diagnosis, and treatment of CNS lesions in hemophagocytic lymphohistiocytosis and find clues for improving the outcome.

Comparison of clinical characteristics of sporotrichosis between children and adults in a third-grade class-A hospital in Jilin province from 2010 to 2019 / 中华皮肤科杂志

Objective:To compare clinical characteristics of sporotrichosis between children and adults in a third-grade class-A hospital in Jilin province during 2010—2019.Methods:Clinical data were collected from 3 124 patients with sporotrichosis in Department of Dermatology, The First Hospital of Jilin University from January 1, 2010 to December 31, 2019, and retrospectively analyzed. There were 911 children aged < 18 years and 2 213 adults aged ≥ 18 years. All the patients were confirmedly diagnosed with sporotrichosis by fungal culture of skin lesions. Chi-square test was used to compare clinical characteristics of sporotrichosis between children and adults.Results:Among the 911 children, the male-to-female ratio was 1.4 ∶1; 720 (79.0%) developed sporotrichosis in cold seasons (January-March and October-December) , 790 (86.7%) were diagnosed with fixed cutaneous sporotrichosis, and 835 (91.7%) presented with skin lesions on the face. Among the 2 213 adult patients, the male-to-female ratio was 1∶2.5; 1 450 (65.5%) developed sporotrichosis in cold seasons, 1 523 (68.8%) were diagnosed with fixed cutaneous sporotrichosis; skin lesions mostly occurred on the extremities (1 090 cases, 49.3%) and face (975 cases, 44.1%) . The proportion of patients developing sporotrichosis in cold seasons was significantly higher in children than in adults ( χ2 = 55.55, P < 0.001) , and the proportion of fixed cutaneous sporotrichosis was also significantly higher in children than in adults ( χ2 = 107.55, P < 0.001) . In addition, the distribution of skin lesions significantly differed between the children and adults ( χ2 = 599.91, P < 0.001) . Conclusion:The epidemiological characteristics and clinical manifestations of sporotrichosis markedly differed between children and adults.

Research progress of pachydrusen / 国际眼科杂志(Guoji Yanke Zazhi)

@#Pachydrusen is found in pachychoroid diseases such as polypoid choroidal vasculopathy disease, central serous chorioretinopathy, pachychoroid pigment epitheliopathy and pachychoroid neovasculopathy. The typical choroidal changes of the spectrum are abnormally dilated pachyvessels, choroidal thickening with overlying retinal pigmentary epithelium changes. In this paper, we summarized the clinical manifestations, epidemiology, genetics, and histopathology of the newly named type of drusen, in order to provide the direction for diagnosis and treatment in clinical ophthalmic diseases.

Clinical features of 71 patients with acute brucellosis in Zaozhuang City of Shandong Province / 中华地方病学杂志

Objective:To analyze the epidemiological characteristics and clinical manifestations of patients with acute brucellosis in Zaozhuang City of Shandong Province, and to improve the understanding of brucellosis.Methods:The demographic characteristics, epidemiological characteristics, clinical manifestations and laboratory examination results of patients with acute brucellosis diagnosed in Zaozhuang Municipal Hospital from January 2019 to December 2020 were retrospectively analyzed.Results:Most of the 71 patients with acute brucellosis were male, with a male-to-female ratio of 2.2 ∶ 1.0 (49 ∶ 22) and an average age of (53.23 ± 14.12) years old, mainly in Yicheng District (32.39%, 23/71); 80.28% (57/71) of patients had a history of epidemiological contact; the disease occurred throughout the year, mainly from April to October (76.06%, 54/71); the main symptoms were fever (100.00%, 71/71), muscle and joint pain (80.28%, 57/71), fatigue (54.93%, 39/71), hyperhidrosis (39.44%, 28/71), hepatosplenomegaly (18.31%, 13/71) and orchitis (4.23%, 3/71), etc. Laboratory examination results showed that decreased white blood cells accounted for 12.68% (9/71), decreased red blood cells accounted for 21.13% (15/71), thrombocytopenia accounted for 8.45% (6/71), decreased lymphocyte percentage accounted for 12.68% (9/71), increased C-reactive protein accounted for 67.61% (48/71), and accelerated erythrocyte sedimentation rate accounted for 50.70% (36/71). Some patients were accompanied by elevated alanine aminotransferase (50.70%, 36/71) and aspartate aminotransferase (42.25%, 30/71), 57 patients (80.28%) with positive blood culture.Conclusions:The clinical manifestations of acute brucellosis are atypical in Zaozhuang City. Brucellosis screening should be carried out for patients with long-term unexplained fever and an epidemiological exposure history, especially those with muscle joint pain, hepatosplenomegaly and orchitis.

Combined oxidative phosphorylation deficiency type 28: a case report and literature review / 中华实用儿科临床杂志

Objective:To summarize the clinical manifestations of a case of combined oxidative phosphorylation deficiency 28 (COXPD-28) caused by the mutations of the SLC25A26 gene, thus providing references for the diagnosis and genetic counseling of the disease. Methods:Clinical data of a case of COXPD-28 treated in the Third Affiliated Hospital of Zhengzhou University in October 2020 were retrospectively analyzed.In addition, The retrieval words " Combined oxidative phosphorylation deficiency 28, SLC25A26 gene" were used to search domestic and foreign databases.The clinical characteristics of combined phosphorylation deficiency 28 and the variation characteristics of SLC25A26 gene were summarized. Results:(1) A female patient full-term delivered after 30 min presented with groaning breath was admitted.Her main manifestations included pale complexion, groaning breathing, metabolic acidosis, and high lactate and pyruvate levels.Symptomatic support treatment like anti-infection and assisted ventilation were given, but her condition gradually worsened and died of respiratory and circulatory failure on the day of admission.The child was compound heterozygous mutation of SLC25A26 gene, the terminating mutation of exon 5 c. 403G>T caused the protein change to p. E135, and the non-synonymous mutation of exon 4 c. 212A>G caused the protein change to p. Y71C.(2) A total of 3 cases of COXPD-28 were searched in online databases, and no cases were reported in China.Through literature review, clinical features of COXPD-28 mainly included respiratory and circulatory fai-lure, elevations of lactate and pyruvate, and reductions of complexes Ⅰ, Ⅲ and Ⅳ in muscle biopsy.Two types of mutations in the SLC25A26 gene were detected, including 3 cases of missense mutations and 1 case of splicing mutation. Conclusions:COXPD-28 is an autosomal recessive genetic disease involving multiple systems and mitochondrial dysfunction.Mutations in the SLC25A26 gene is the pathological cause of COXPD-28.

Progress in diagnosis and treatment of ocular toxocariasis / 国际眼科杂志(Guoji Yanke Zazhi)

@#Ocular toxocariasis(OT)is an ocular parasitic disease involving ocular tissue infection by the ascarid-omatidae nematode. OT is usually caused by toxocara canis or toxocara cati. Susceptible population are more likely to be affected by their own hygiene, the frequency of exposure to dogs and cats, and the consumption of food or water contaminated with toxocariasis larvae. Most cases have been reported worldwide in children, but cases in adults have also been reported in recent years, which may be due to the lack of systematic induction and summary of its diagnosis, treatment and prognosis. In this paper, the four clinical manifestations of OT, advanced noninvasive diagnostic techniques, and laboratory immunological tests were sorted out and supplemented by reviewing domestic and international literature. Meanwhile, this paper introduced the treatment progress of OT in recent years, such as the combination of anthelmintic and hormone, and the application of intravitreal injection and vitreous surgery. It is expected that clinicians should pay more attention to this disease, improve the accuracy of early diagnosis of toxocariasis and protect patients' vision.

Nivel de conocimiento sobre enfermedad renal crónica en pacientes, familiares y personal de enfermería

RESUMEN Introducción: La enfermedad renal crónica es uno de los grandes retos para los profesionales de la salud; constituye un problema que causa discapacidad funcional, disminución de la calidad de vida y elevados costos a los sistemas sanitarios. Objetivo: Determinar el nivel de conocimiento sobre la enfermedad renal crónica de los pacientes atendidos en el Hospital Provincial General Docente de Riobamba, sus familiares y el personal de enfermería. Métodos: Investigación básica, no experimental, descriptiva, de corte transversal y con enfoque mixto. El universo estuvo constituido por 96 pacientes con diagnóstico de enfermedad renal crónica y la muestra quedó conformada por un total de 78 pacientes. Igualmente se investigaron 78 familiares y 40 profesionales de enfermería que atienden pacientes con esta enfermedad. Se aplicaron cuestionarios para identificar características clínicas y nivel de conocimiento sobre el manejo de la enfermedad en las personas participantes en el estudio. Resultados: Existe un porciento elevado de pacientes con enfermedad renal crónica inferior a 40 años (15,38 %). La totalidad de los familiares y del personal de enfermería no han recibido cursos de capacitación sobre el manejo de la enfermedad. Conclusiones: Existe un nivel de conocimiento medio en el personal de enfermería y bajo en los pacientes y sus familiares en relación con el manejo de pacientes con enfermedad renal crónica. Se necesita realizar actividades de capacitación orientadas a cada uno de los grupos de personas incluidas en el estudio.

ABSTRACT Introduction: Chronic kidney disease is one of the great challenges for health professionals; it constitutes a health problem that generates functional disability, decreased quality of life and high costs to health systems. Objective: To determine the level of knowledge about chronic kidney disease in patients treated at the Riobamba Provincial General Teaching Hospital, their families and the nursing staff. Methodology: A basic, non-experimental, descriptive, cross-sectional research with a mixed approach was developed. The universe consisted of 96 patients with a diagnosis of chronic kidney disease and the sample was made up of a total of 78 patients. Likewise, 78 family members and 40 nursing professionals who care for patients with this disease were investigated. Questionnaires were applied to identify clinical characteristics and level of knowledge about the management of the disease in the people participating in the study. Results: There is a high percentage of patients with chronic kidney disease less than 40 years old (15.38%). All the family members and the nursing staff have not received training courses on disease management. Conclusions: There is a medium level of knowledge in the nursing staff and low in the patients and their families in relation to the management of patients with chronic kidney disease. Training activities aimed at each of the groups of people included in the study need to be carried out.

Consideraciones sobre el síndrome de hipermovilidad articular benigna

RESUMEN El síndrome de hipermovilidad articular benigna es la aparición de síntomas musculoesqueléticos en individuos hipermóviles en ausencia de enfermedad reumatológica sistémica. El propósito de este estudio es mostrar los resultados de una revisión bibliográfica sobre hipermovilidad de las articulaciones y sus manifestaciones clínicas. La hipermovilidad puede ocurrir en varios trastornos diferentes del tejido conectivo, incluidos el síndrome de Marfán, el síndrome de Ehlers-Danlos y la osteogénesis imperfecta. También se puede encontrar en ciertos trastornos cromosómicos, genéticos y metabólicos. Identificar de manera habitual la hipermovilidad articular, y el síndrome de hipermovilidad articular no resulta una tarea difícil, siempre que forme parte del pensamiento clínico, lo cual ayudaría a evitar sus complicaciones y las tardanzas diagnósticas, lo que solucionaría en una medida nada despreciable los casos que se atienden regularmente en la práctica médica diaria.

ABSTRACT Benign joint hypermobility syndrome is the appearance of musculoskeletal symptoms in hypermobile individuals in the absence of systemic rheumatologically disease. To show the results of a bibliographic review on joint hypermobility and its clinical manifestations. Hypermobility can occur in several different connective tissue disorders, including Marfan syndrome, Ehlers-Danlos syndrome, and osteogenesis imperfect. It can also be found in certain chromosomal, genetic, and metabolic disorders. Identifying joint hypermobility on a regular basis, and JHS is not a difficult task, as long as it is part of clinical thinking, which would help to avoid its complications and diagnostic delays, which would solve a not inconsiderable measure of cases that they are regularly cared for in daily medical practice.

Dengue en el primer año de la vida / Dengue in the first year of life

Introducción: El dengue es considerada la más importante de todas las arbovirosis por su gran carga de enfermedad e implicaciones sociales. Es una enfermedad infecciosa causada por cualquiera de los cuatro serotipos del complejo dengue, que se trasmite al hombre a través de la picada de un mosquito del género Aedes. Objetivo: Caracterizar las manifestaciones clínicas en lactantes con dengue confirmado. Métodos: Se realizó un estudio observacional, descriptivo y retrospectivo de las manifestaciones clínicas de150 lactantes con diagnóstico de dengue confirmado por serología que fueron hospitalizados en el Hospital Materno Infantil "Dr. Ángel Arturo Aballí" en el período de julio- septiembre del año 2014. Resultados: Los lactantes entre 7 y 12 meses de edad fueron los más afectados (66,8 por ciento), con predominio del sexo femenino (54,0 por ciento). Las principales manifestaciones clínicas fueron: fiebre, manifestaciones respiratorias altas y exantema. La aparición de los signos de alarma coincidió con la defervescencia de la fiebre en 14 niños (9,3 por ciento) y los vómitos frecuentes y la letargia o irritabilidad fueron los síntomas más reiterados. Un solo paciente (0,7 por ciento) presentó cuadro clínico de choque. Conclusiones: Durante el primer año de vida, la enfermedad dengue puede presentarse de modo particular y semejar cualquier otra infección viral. El criterio epidemiológico tiene suma importancia, así como la presencia de fiebre, exantema y las manifestaciones respiratorias que no siempre se asocian al dengue en otras edades(AU)

Introduction: Dengue is considered the most important of all arboviruses because of its high burden of disease and social implications. It is an infectious disease caused by any of the four serotypes of the dengue complex, which is transmitted to the human beings through the bite of a mosquito of Aedes genus. Objective: Characterize the clinical manifestations in infants with confirmed dengue. Methods: An observational, descriptive and retrospective study of the clinical manifestations of 150 infants with a diagnosis of dengue confirmed by serology who were hospitalized at "Dr. Ángel Arturo Aballí" Mother and Child Hospital in the period July-September 2014 was conducted. Results: Infants between 7 and 12 months of age were the most affected (66.8 percent), with a predominance of females (54.0 percent). The main clinical manifestations were: fever, upper respiratory tract manifestations and rash. The appearance of the warning signs coincided with the defervescence of fever in 14 children (9.3 percent) and frequent vomiting and lethargy or irritability were the most repeated symptoms. Just one patient (0.7 percent) presented a clinical picture of shock. Conclusions: During the first year of life, dengue disease can occur in a particular way and resemble any other viral infection. The epidemiological criterion is extremely important, as well as the presence of fever, rash and respiratory manifestations that are not always associated with dengue at other ages(AU)

Ozonoterapia mediante infiltración en pacientes con síndrome del túnel carpiano

RESUMEN Introducción: El síndrome del túnel del carpo de naturaleza idiopática constituye hoy la neuropatía periférica más recurrente. Se reconoce su alta prevalencia y se asocia a condiciones discapacitantes y dolencias desde sus primeras fases. Objetivo: Evaluar los resultados de la ozonoterapia mediante infiltración en pacientes con síndrome del túnel del carpo. Métodos: Se realizó un estudio descriptivo prospectivo en el Hospital Clínico Quirúrgico Lucía Iñiguez Landín de Holguín en el periodo comprendido entre enero del 2018 a enero del 2020. La población del estudio fue de 170 pacientes. La muestra fue de 119 pacientes seleccionadas por muestreo aleatorio simple. Se determinaron las variables clínicas tiempo de evolución de la enfermedad, evolución de los síntomas durante el tratamiento con ozonoterapia y el efecto del tratamiento y uso de analgésicos. Resultados: La mayor proporción de los pacientes fueron mujeres (90,76 %) y predominaron los pacientes en las edades comprendidas entre 50 y 59 años (40,33 %); predominó el antecedente de trabajo manual previo entre 1 y 3 años (48,73 %) y el antecedente de diabetes mellitus y artritis reumatoide (17,64 % en ambas); según el índice de Katz se obtuvo que el 29,41 % presentó caso clásico de la mano derecha, mientras que el 17,64 % solo de la mano izquierda. A los 3 meses de tratamiento, 50 pacientes habían tenido resultados muy buenos (42,01 %), de ellos 31 solo necesitaron analgésicos ocasionalmente y 5 no necesitaron analgésicos, 48 pacientes obtuvieron resultados buenos de los cuales el 17,64 % tomaron analgésicos de forma ocasional. No se presentaron efectos adversos. Conclusiones: El tratamiento con ozonoterapia mediante infiltración fue muy bueno. Se logró reducir el uso de analgésicos, disminuyó la sintomatología de la enfermedad y se mejoró la función de la mano.

ABSTRACT Introduction: The idiopathic carpal tunnel syndrome is today the most recurrent peripheral neuropathy. Its high prevalence is recognized and it is associated with disabling conditions and ailments from its early stages. Objective: To evaluate the results of ozone therapy through infiltration in patients with carpal tunnel syndrome. Methods: A prospective descriptive study was conducted at the Lucía Iñiguez Landín Clinical Surgical Hospital in Holguín in the period from January 2018 to January 2020. The study population was 170 patients. The sample consisted of 119 patients selected by simple random sampling. The clinical variables, time of evolution of the disease, evolution of symptoms during treatment with ozone therapy and the effect of treatment and use of analgesics were determined. Results: The highest proportion of patients were women (90.76%) and patients between 50 and 59 years of age predominated (40.33%); A history of previous manual work between 1 and 3 years prevailed (48.73%) and a history of diabetes mellitus and rheumatoid arthritis (17.64% in both); according to the Katz index, it was obtained that 29.41% presented a classic case of the right hand, while 17.64% only had the left hand. At 3 months of treatment, 50 patients had had very good results (42.01%), of them 31 only needed analgesics occasionally and 5 did not need analgesics, 48 patients obtained good results of which 17.64 % took analgesics from occasional way. There were no adverse effects. Conclusions: Treatment with ozone therapy by infiltration was very good. The use of analgesics was reduced, the symptoms of the disease decreased and the function of the hand improved.

Estreptococos del grupo Streptococcus anginosus Parte IIIb. Infecciones en localizaciones diferentes de las de cabeza y cuello / Streptococcus anginosus group. Part IIIb. Other than head and neck infections

Resumen Las bacterias del grupo Streptococcus anginosus (EGA) son colonizantes habituales de las mucosas orofaríngea, intestinal y genitourinaria, pero, cada vez más frecuentemente, son reconocidas como patógenos humanos. En esta parte III se describen las tendencias de los EGA a la producción de distintas patologías humanas. Por su extensión debió ser desdoblada a su vez en otras dos partes (IIIa y IIIb). Es ampliamente conocida su capacidad de formar abscesos en órganos sólidos, especialmente abscesos cerebrales, pulmonares y hepáticos. También producen sinusitis, empiemas y colecciones en piel y tejidos blandos, huesos, articulaciones, etc. Se han encontrado asociados con infecciones urinarias, vaginitis aeróbica y con exacerbaciones pulmonares en pacientes con fibrosis quística y con enfermedad pulmonar obstructiva crónica. Producen también infecciones posteriores a mordeduras humanas, infecciones diseminadas, bacteriemia sin foco aparente y, en menor medida, endocarditis infecciosas, generalmente complicadas con abscesos perivalvulares. Esta parte IIIb está focalizada en las infecciones que no comprometen la cabeza y el cuello.

Abstract Streptococcus anginosus (SGA) group streptococci are common colonizers of the oropharyngeal, intestinal, and genitourinary mucosa, but they are increasingly recognized as human pathogens. In this part III, tendencies of the EGA to the production of different human pathologies are described. Due to its length, it had to be divided into two other parts (IIIa and IIIb). Its ability to form abscesses in solid organs, especially brain, lung and liver abscesses, is widely known. They also cause sinusitis, empyema and collections in skin and soft tissues, bones, joints, etc. They have been found associated with urinary tract infections, aerobic vaginitis and with pulmonary exacerbations in patients with cystic fibrosis and chronic obstructive pulmonary disease. They also cause infections after human bites, disseminated infections, bacteremia without apparent focus and, to a lesser extent, infective endocarditis, generally complicated by perivalvular abscesses. This part IIIb is focused on other than head and neck infections.

Resumo As bactérias do grupo Streptococcus anginosus (EGA) são colonizadores comuns da mucosa orofaríngea, intestinal e geniturinária, mas são cada vez mais reconhecidos como patógenos humanos. Nesta parte III são descritas as tendências do EGA à produção de diferentes patologias humanas. Devido ao seu comprimento, teve que ser dividido em duas outras partes (IIIa e IIIb). Sua capacidade de formar abcessos em órgãos sólidos, principalmente cérebro, pulmão e fígado, é amplamente conhecida. Eles também causam sinusite, empiema e coleções na pele e tecidos moles, ossos, articulações, etc. Eles foram encontrados associados à infecções urinárias, vaginite aeróbia e às exacerbações pulmonares em pacientes com fibrose cística e doença pulmonar obstrutiva crônica. Também causam infecções após picadas humanas, infecções disseminadas, bacteremia sem origem aparente e, em menor grau, endocardite infecciosa, geralmente complicada por abscessos perivalvulares. Seu papel na faringite é controverso, embora algumas das subespécies possam estar envolvidas em tais infecções. Seu potencial carcinogênico também é postulado pela associação com carcinomas orofaríngeos, gástricos ou esofágicos. Esta parte IIIb enfoca infecções em diferentes locais da cabeça e pescoço.

Citoquinas pro y anti-inflamatorias en la infección por SARS-CoV-2, en población de Colombia / Pro- and anti-inflammatory cytokines associated to SARS-COV-2 infection in the Colombian population

Resumen La infección por SARS-CoV-2 es hoy el principal problema de salud pública en el mundo. No es claro el papel de las citoquinas en la fisiopatología del COVID-19,que en algunos individuos presenta una progresión rápida, severa y mortal asociada con proinflamación sistémicos relacionada con coagulopatías y fallas multiorgánicas. En este estudio, evaluamos los niveles séricos de citoquinas y su correlación con IgM, IgG e IgA, en 24 muestras de individuos positivos y 8 muestras de individuos negativos, para SARS-CoV-2. Hallamos concentraciones significativamente menores de IFN-g, TNF, IL-2 e IL-4 y un aumento significativo de IL-6 en el grupo de infectados hospitalizados respecto a los no infectados, así como una tendencia significativa al aumento, para IgG e IgA en el mismo grupo de individuos, respecto a infectados asintomáticos. Nuestros datos soportan el papel de la IL-6 en la severidad de la enfermedad destacando su potencial papel como biomarcador en la prognosis de esta patología. También, soportan la hipótesis sobre la función de los anticuerpos en el control efectivo del patógeno; se observa una respuesta inmune humoral más débil, frente a la proteína de la nucleocápside viral, en individuos con un mejor curso de la enfermedad.

Abstract The emergency caused by the infection in humans of SARS-COV-2 and the clinical syndrome resulting from the infection (COVID-19) is a major public health crisis with global repercussions. Currently, the role of different cytokine profiles in the infection pathophysiology and its outcome remains unclear despite the coordina ted efforts of the scientific community. COVID-19 shows a rapid progression where the disease severity and mortality are linked to systemic pro-inflammatory pro cesses associated to a dysregulation in the cytokine production balance, resulting in blood clothing disorders and multiorgan failure. Here we evaluate the serum concentration for a cytokine panel as well as the antibody titers of IgM, IgG and IgA from 24 individuals who tested positive for SARS-CoV-2 by RT-PCR (divided into three separate groups according to disease severity) and eight RT-PCR-negative controls. Significantly lower concentrations of IFN-g, TNF, IL-2 and IL-4, and a higher production of IL-6 were observed in hospitalized COVID-19 patients when compared to SARS-CoV-2-negative individuals. Furthermore, a significant and sustained increase in the levels of IgG and IgA was found for the group of hospitalized patients compared to asymptomatic SARS-CoV-2-positive individuals. Our data support previous findings on the role of cytokines like IL-6 in the severity of the disease and highlight their potential use as biomarkers for the prognosis of COVID-19. Finally, we provide evidence supporting the potential function of the antibody response in the effective control of the virus, showing that a somehow weaker humoral immune response can be associated to milder forms of COVID-19.

Nódulo reumatoide benigno en sóleo. Reporte de un caso / Benign rheumatoid nodule in the soleus muscle. Case report

RESUMEN Los nódulos reumatoides benignos son nódulos subcutáneos, idénticos en su morfología e histología a los que ocurren en el transcurso de la artritis reumatoide (AR), que aparecen en personas sin síntomas de artritis y con factor reumatoide (FR) negativo. Se presenta el caso de un varón de 46 arios de raza caucasiana que consultó por tumoración en la pierna derecha. Destacaba negatividad de factor reumatoide, anticuerpos anti péptido citrulinado, anticuerpos antinucleares y anticuerpos anticitoplasma de neutrófilo, así como normalidad de los reactantes de fase aguda. Una ecografía musculoesquelética mostró una tumoración sólida de 3,5 x 1,5 cm, de márgenes bien definidos, en músculo sóleo, con una estructura heterogénea hipoecoica con vascularización intra y perilesional. La resonancia magnética evidenció una tumoración de carácter fibroso sin datos sugestivos de agresividad. Una biopsia guiada por ecografía mostró histología característica de nódulo reumatoide. Se discuten la clínica, el diagnóstico, el diagnóstico diferencial y el tratamiento de los nódulos reumatoides benignos.

ABSTRACT Benign rheumatoid nodules are subcutaneous nodules, identical in morphology and histo logy to those that occur in the course of rheumatoid arthritis. They appear in people without symptoms of arthritis and with negative rheumatoid factor. The case is presented of a 46-year-old Caucasian man who consulted for a tumour inthe right leg. He was negative for rheumatoid factor, anti-citrullinated protein antibodies, antinuclear antibodies, and antineutrophil cytoplasmic antibodies, as well as for acute phase reactants. A musculoskeletal ultrasound showed a solid tumour of 3.5 × 1.5 cm with well-defined margins in the soleus muscle, and with a heterogeneous hypoechoic structure with intra- and peri-lesional vascularisation. The magnetic resonance imaging showed a fibrous tumour with no signs suggestive of aggressive growth. An ultrasound-guided biopsy sho wed the characteristic histology of the rheumatoid nodule. The clinical picture, diagnosis, differential diagnosis, and treatment of benign rheumatoid nodules are discussed.

Expresión clínica del Síndrome de Sjögren primario en pacientes adultos diagnosticados a edad menor o igual a 35 años versus mayores de 35 años / Clinical expression of primary Sjögren's syndrome in adult patients diagnosed at an age less than or equal to 35 years versus those older than 35 years

Objetivo: Describir y comparar las manifestaciones clínicas en pacientes adultos diagnosticados con Síndrome de Sjögren primario (SSp) a edad menor o igual a 35 años versus mayores a 35 años. Materiales y métodos: Se incluyeron pacientes mayores de 18 años de edad, con diagnóstico de SSp de acuerdo a los criterios de clasificación ACR - EULAR 2002/2016, registrados en la base de datos GESSAR (Grupo de Estudio Síndrome de Sjögren Sociedad Argentina de Reumatología). Resultados: Se incluyeron 665 pacientes. Cien (15,04%) con edad al diagnóstico ≤ 35 años, 92% mujeres. El promedio de edad del grupo > 35 años, fue de 54 + 11 años, 96% mujeres. Se encontraron diferencias estadísticamente significativas entre < 35 años vs > 35 años, en xeroftalmia (90,72% vs 95,64%, p: 0,04) y xerodermia (42,35% vs 57,36%, p: 0,03) y en los siguientes dominios del ESSDAI (EULAR Activity Index for primary Sjögren's syndrome): sistema nervioso periférico (4,05 vs 11,32, p: 0,03), respiratorio (6% vs 15,40%, p: 0,01) y renal (6% vs 1,59%, p: 0,02). Conclusión: Nuestro estudio sugiere un menor compromiso glandular en pacientes con SSp diagnosticados a menor edad, sin un patrón diferencial característico en cuanto al compromiso sistémico.

Objective: To describe and compare the clinical manifestations, in adult patients diagnosed with primary Sjögren's Syndrome at age less than or equal to 35 years versus those over 35 years of age. Materials and Methods: We analyzed the data of patients older than 18 years, with diagnosis of primary Sjögren's syndrome (American - European criteria 2002), included in the GESSAR database (Sjögren Syndrome Study Group of the Argentine Society of Rheumatology). Results: 665 patients were included. One hundred of them with an age at diagnosis less than or equal to 35 years and with a mean age at diagnosis of 29 + 4 years, 92% of them women. The average age at diagnosis of the group over 35 years was 54 + 11 years, 96% women. Statistically significant differences were found between less than or equal to 35 years vs over 35 years, in xerophthalmia (90.72% vs 95.64%, p: 0.04) and xeroderma (42.35% vs 57.36% , p: 0.03), and in the following domains of ESSDAI (EULAR Activity Index for primary Sjögren's syndrome): peripheral nervous system (4.05 vs 11.32, p: 0.03), respiratory (6% vs 15.40%, p: 0.01) and renal (6% vs 1.59%, p: 0.02). Conclusion: Our study suggests less glandular involvement in patients with pSS diagnosed at a younger age, without a characteristic differential pattern regarding systemic involvement.