Photoletter to the editor: Atypical primary cutaneous mucormycosis of the scalp.

Mucormycosis of the scalp is a rare cutaneous presentation of the disease. It is also an unusual infection in children. We present the case of a 4-year-old girl with acute lymphoblastic leukemia, who presented with atypical cutaneous mucormycosis simulating an ecthyma gangrenosum lesion. Risk factors for the infection are diabetes, neoplastic diseases, immunosuppression in organ transplant recipients, and neutropenia. The cutaneos forms have been associated with trauma, burns and surgical wounds. First line treatment is amphotericin B. Posaconazole was recently approved to treat invasive mucormycosis. Surgical removal of the infected tissue is indicated.

[Comparison of the effectiveness of hematopoietic cell mobilization with chemotherapy and filgrastim versus filgrastim alone for autologous transplant in patients with lymphoma.] / Comparación de la efectividad de la movilización de células hematopoyéticas con quimioterapia y filgrastim, o con filgrastim solo, para autotrasplante en pacientes con linfoma.

INTRODUCTION: Autologous hematopoietic stem cell transplantation is the treatment of choice for high-risk Hodgkin's lymphoma and non-Hodgkin's lymphoma. OBJECTIVE: Compare the capacity to mobilize CD34+ cells for autologous hematopoietic stem cell transplantation using schemes with chemotherapy and without chemotherapy plus filgrastim in patients diagnosed with Hodgkin's lymphoma or non-Hodgkin's lymphoma. MATERIAL AND METHODS: The clinical records of patients with Hodgkin's lymphoma or non-Hodgkin's lymphoma who received an autologous hematopoietic stem cell transplant were analyzed retrospectively. Filgrastim alone or in combination with chemotherapy was used as mobilization scheme. Cell harvesting was classified as adequate when > 2 × 106 cells/kg were collected. RESULTS: Forty-seven patients (Hodgkin's lymphoma, 24; non-Hodgkin's lymphoma, 23) were included. Comparing groups of Hodgkin's lymphoma mobilized with chemotherapy (15 patients) and without chemotherapy (nine patients), one apheresis procedure was sufficient in 73 and 44% of patients, respectively (p = 0.04), the average of CD34 + cells/kg collected was 11 x 106 and 3 x 106, respectively (p = 0.017), and the collection was adequate in 100 and 55.6% of cases, respectively (p = 0.014). Comparing the groups of non-Hodgkin's lymphoma mobilized with chemotherapy (six patients) and without chemotherapy (17 patients), one apheresis procedure was sufficient in 33 and 65% of patients, respectively (p = 0.26), the average of CD34+ cells/kg was 3.56 x 106 and 3.41 x 106, respectively (p = 0.47), and collection was adequate in 66.6 and 59% of cases, respectively (p = 0.37). CONCLUSION: In Hodgkin's lymphoma patients, mobilization schemes with chemotherapy were more effective considering the number of cells collected, the number of apheresis required, and the percentage of successful cell collections. In non-Hodgkin's lymphoma patients, there were no significant differences between the two groups.

Acute pulmonary thromboembolism: risk stratification, treatment modalities, mortality and adherence to clinical guidelines / Tromboembolismo pulmonar agudo: estratificación del riesgo, modalidades de tratamiento, mortalidad y apego a guías clínicas

Abstract: Introduction: Pulmonary thromboembolism (PTE) is a cardiovascular emergency threatening life. It is classified at low, intermediate and high risk of mortality. By the above, it allows to establishing conservative treatment for low-intermediate risk PTE and more intense treatment for high risk PTE. Objective: To report the number of cases of acute PTE, risk stratification and prognosis in those treated with adherence to clinical guidelines. Material and methods: Review of clinical records with a diagnosis of acute PTE by confirmatory diagnostic test. The type of treatment was determined by: oral anticoagulation (OAC) or parenteral anticoagulation (PAC), percutaneous thrombectomy, supraselective thrombolysis, systemic thrombolysis, surgical thrombectomy or combinations. The type of initial anticoagulation and maintenance therapy. Hard results: TIMI major bleeding, re-thrombosis, death and brain stroke (BS). Normality was verified by Kolmogorov-Smirnov test. Then was compared with Student t or U Mann-Whitney. Results: A sample of 36 patients was obtained, the mean age was 67.24 ± 18.83 years, 62.2% were females. The 29.7% were low-risk PTE, 51.4% were intermediate risk and 18.9% were high risk. The 70.3% received OAC, 8.1% percutaneous trombectomy, 8.1% systemic thrombolysis, 10.8% systemic thrombolysis + percutaneous thrombolysis, 2.7% percutaneous trombectomy + supraselective thrombolysis. There is increased risk of death in this group OR = 2.63 (95% CI 0.45-16.08) but not significant (p = 0.255). Conclusions: Lack of adherence to clinical guidelines confers increased risk of death in patients with acute PTE, this difference is not statistically significant.

Resumen: Introducción: La tromboembolia pulmonar (TEP) es una urgencia cardiovascular que pone en riesgo la vida. Se cataloga en riesgo bajo de mortalidad, intermedio y alto. Lo anterior permite establecer estrategias terapéuticas conservadoras para la TEP de riesgo bajo-intermedio y más intensas para alto riesgo. Objetivo: Reportar el número de casos de TEP aguda, la estratificación de riesgo y el pronóstico en quienes recibieron tratamiento con apego a guías clínicas. Material y métodos: Revisión de expedientes clínicos con diagnóstico de TEP aguda, mediante prueba diagnóstica confirmatoria. Se determinó el tipo de tratamiento: anticoagulación (ACO), oral o parenteral (ACP), trombectomía percutánea(TBTP), trombolisis supraselectiva (TBLSU), trombolisis sistémica (TBLSIS), trombectomía quirúrgica (TBTQ) o sus combinaciones. El tipo de anticoagulación inicial y de mantenimiento. Los resultados duros: sangrado TIMI mayor, retrombosis, muerte y evento vascular cerebral (EVC). Se verificó la normalidad mediante prueba de Kolmogorov-Smirnov. Posteriormente se comparó con t Student o U de Mann-Whitney. Resultados: Se obtuvo una muestra de 36 pacientes, la edad media fue 67.24 ± 18.83 años, el 62.2% fueron del género femenino. El 29.7% correspondía a TEP de riesgo bajo, 51.4% riesgo intermedio y 18.9% a riesgo alto. El 70.3% se dio ACO y ACP, 8.1% TBTP, 8.1% TBLSIS, 10.8% TBLSIS + TBTP y 2.7% TBTP + TBLSU. Existe mayor riesgo de muerte en el grupo de falta de apego a guías OR = 2.63 (IC 95% 0.45-16.08), sin embargo, no es significativo (p= 0.255). Conclusiones: La falta de apego a guías clínicas confiere mayor riesgo de muerte en pacientes con TEP aguda, esta diferencia no es estadísticamente significativa.

Prevalence and Clinical Significance of FLT3 Mutation Status in Acute Myeloid Leukemia Patients: A Multicenter Study.

BACKGROUND AND AIMS: FLT3-ITD mutations in acute myeloid leukemia (AML) are associated with a poor prognosis. In Latin America, little epidemiological data exist about these mutations and their influence on clinical evolution and prognosis. Standardization and well-established clinical correlation make FLT3 mutational analysis by molecular methods an invaluable tool to decide among treatment options and to determine AML prognosis. METHODS: We assessed the prevalence of FLT3-ITD mutations in 138 patients with AML at four hematology referral centers from Mexico and Colombia. Molecular methods based on polymerase chain reaction (PCR) were employed for determining FLT3-ITD status. RESULTS: Mutations were present in 28 patients indicating a prevalence of 20.28%. Median age was 47 years (5-96). The FLT3 mutation positive group was older, had higher WBC and hemoglobin values and lower platelet counts but without statistical significance. A not previously described mutation in the FLT3 gene was found in one patient involving a nucleotide exchange of timine for cytosine at the 66608 position. A high mortality was found in the FLT3-mutated group, 67.8 vs. 42.72% in the non-mutated group and median survival was 4.9 months vs. 20.4 months, p = 0.009. A mutated FLT3 did not confer poor prognosis to those with M3 AML. The mutated FLT3 population had poor overall survival (OS) despite hematoprogenitor stem cell transplantation (HSCT). CONCLUSION: Prevalence of FLT3-ITD mutation in AML was present in a proportion comparable to other populations and, when present, was associated with a very poor prognosis.

Feasibility of an outpatient HLA haploidentical stem cell transplantation program in children using a reduced-intensity conditioning regimen and CD3-CD19 depletion.

Haploidentical hematopoietic stem cell transplantation (haplo-HSCT) has been developed as an alternative transplant strategy for children with hematological disorders who do not have an HLA-matched donor. We report the analysis of the outcome for 18 consecutive pediatric patients with various hematological diseases, who underwent haplo-HSCT using a reduced-intensity conditioning regimen and CD3/CD19 depletion in an outpatient setting. Twelve of the 18 patients (66.6%) engrafted either transiently or definitively (9 patients engrafted with full donor chimerism and 3 with mixed chimerism). Six patients with acute lymphoblastic leukemia were disease-free between 2 and 35 months (median 25 months) post-HSCT. The overall survival was 33.3% with a median of 25 months (range 2-35). Our results suggest that haplo-HSCT can be a feasible therapeutic alternative for children who do not have a suitable family donor or available cord blood units. These results also demonstrate that it is possible to perform this regimen on an outpatient basis.

Impacto de los trastornos afectivos de los padres en la progenie: factores protectores y de riesgo: revisión bibliográfica / Impact of affective disorders of parents in offspring: protective and risk factors: bibliographic review

Mediante una revisión se procedió a analizar el tema de los trastornos efectivos y su impacto en la familia. Se vió que los trastornos del ánimo constituyen un importante problema de salud en Chile. Estudios epidemiológicos muestran cifras de prevalencia de vida de alrededor de 70 por ciento en la población adulta. Esta enfermedad es más frecuente en mujeres y especialmente en los períodos en que están criando. Estudios en las familias de estos pacientes describen un alto grado de estrés y los hijos muestran interferencia en sus procesos de desarrollo, configurando psicopatologías generales y especificas más frecuentemente que la población general. Poco se sabe acerca de los procesos resilientes de los hijos que no son afectados, los cuales pueden ser de gran interés en el campo de la salud mental y sus estrategias de prevención

Trastorno obsesivo compulsivo en un adolescente con síndrome de Asperger / Obsessive compulsive disorder in an adolescent with Asperger's syndrome

Se presenta el caso clínico de adolescente de 14 años con síndrome de Asperger quien desarrollo en su período puberal, un trastorno obsesivo compulsivo. Se discute la relación de estos trastornos y se plantean interrogantes en esta asociación

Programa Horizontes, una alternativa de rehabilitación a adolescentes con severos problemas psiquiátricos / Horizons program: an alternative of rehabilitation to adolescents with acute psychiatric problems

El presente trabajo reúne antecedentes históricos respecto al paso de la psiquiatría asilar a la psiquiatría comunitaria y muestra la tendencia actual en EEUU y Canadá de explotar al máximo las posibilidades de tratamiento psiquiátrico para adolescentes basado en la comunidad. Presenta luego un programa de rehabilitación social ("Horizontes") para pacientes adolescentes con severas alteraciones psiquiátricas, su organización y su puesta en marcha, destacando un apoyo terapéutico novedoso en nuestro medio, cual es la "tutoría". Finalmente, el trabajo entrega un comentario breve acerca del tema