Exfoliative cheilitis related to psychologic factors uncovered during primary immunodeficiency evaluation.

A 40-year-old previously healthy, non-atopic woman was referred for evaluation of a possible immunodeficiency disorder in the setting of an unusual erosive cheilitis and history of recurrent methicillin-resistant Staphylococcus aureus (MRSA) infection. Extensive work-up was non-diagnostic, including screening for immunologic disorders. She had failed multiple therapeutic modalities, including corticosteroid and immunosuppressive therapy. Tissue biopsy from the lip proved pivotal in demonstrating changes suggestive of factitial disease. This led to further detailed history-taking, yielding evidence of considerable psychologic distress. The patient was diagnosed with exfoliative cheilitis related to factitial disease in association with underlying untreated anxiety and psychologic trauma.

Cumplimiento de las precauciones de aislamiento de contacto por microorganismos multirresistentes en un hospital de tercer nivel / Compliance with contact isolation precautions of multidrug-resistant microorganisms in a tertiary hospital

Introducción. El aislamiento preventivo del paciente con microorganismos multirresistentes se considera una medida eficaz para evitar situaciones de brote epidémico en el ámbito hospitalario. El objetivo es evaluar el cumplimiento por parte de profesionales sanitarios y familiares de las precauciones de aislamiento de contacto en pacientes colonizados/infectados con microorganismos multirresistentes. Material y métodos. Estudio observacional desde octubre de 2014 a marzo de 2015. Se diseñó una lista de verificación de monitorización con variables de estructura (dotación material), conocimiento de la situación y cumplimiento de las precauciones por pacientes, familias y profesionales. Se realizó análisis univariante y bivariante. Se utilizaron las pruebas no paramétricas U de Mann-Whitney y KruskalWallis. Resultados. Se realizaron 467 monitorizaciones. El carro se encontraba correctamente ubicado en 453 ocasiones (97%). El tensiómetro individual estaba presente en 421 observaciones (90%), mientras que el fonendoscopio y el termómetro no superaban el 44% (43,9% de 205 y 16,5% de 77, respectivamente). El contenedor de residuos y el producto de base alcohólica se observaron bien ubicados en 461 (98,7%) de los casos. El jabón antiséptico para higiene del paciente se registró correctamente colocado en 348 ocasiones (74%). El 84,9% (305) de los pacientes y el 91,4% (234) de los familiares conocían la situación. El cumplimiento en los profesionales de colocación/retirada de bata desechable y guantes se situó próximo al 50% para la entrada a la habitación (49,5% de 56 y 53,0% de 60, respectivamente) y fue del 40% (28) para la salida. La higiene de manos se registró como realizada en 30 ocasiones (26,5%) a la entrada y 25 (35,2%) a la salida. Conclusiones. Existe un importante margen de mejora en el cumplimiento de las precauciones de aislamiento. El incumplimiento actual no puede ser imputado al déficit de materiales, sino a conductas individuales. Urge implementar y evaluar programas de intervención basados en modelos psicosociales, capaces de modificar la actitud y las conductas relacionadas con las precauciones de aislamiento de contacto por microorganismos multirresistentes (AU)

Introduction. Preventive isolation of patients with multidrug-resistant microorganisms is considered an effective measure to prevent outbreaks in hospitals. The objective of this study is to assess compliance by healthcare workers and family of contact isolation precautions in colonised/infected patients with multidrug-resistant microorganisms. Methods. An observational study was conducted from October 2014 to March 2015. A checklist with a structure was designed (equipment trolley), including knowledge of the situation and compliance by the patients, families, and healthcare workers. Univariate and bivariate analyses were performed. Non-parametric tests Mann-Whitney and Kruskal-Wallis were used. Results. Out of the 467 observations made, the equipment trolley was correctly situated in 97% (453) of cases, the sphygmomanometer in 90% (421), the stethoscope 43.9% (205), and thermometer 16.5% (77). A dustbin and the alcoholic solution were observed in over 98.7% (461) of cases. The antiseptic soap for patient hygiene was observed to be correctly placed in 348 (74%) of occasions. The situation was known by 84.9% (305) of patients and 91.4% (234) of families. As regards compliance by professionals with the placement/removal of disposable gowns and gloves was about 50% for entering the room (49.5%, 56 gown and 53.09%, 60 gloves), and 40% (28) for leaving the room by professionals. Hand hygiene compliance was 26.5% (30) for entering and 35.2% (25) when leaving. Conclusions. There is significant room for improvement in the compliance with isolation precautions. Non-compliance to isolation procedures is not due to a deficit of materials, but to individual behaviours. It is important to implement and evaluate programs based on psychosocial intervention models that can change attitudes and behaviours related to contact isolation precautions for multidrug-resistant microorganisms (AU)

Desensitization to Mycofenolate Mofetil: a novel 12 step protocol.

The use of MMF has become standard practice in many solid organ transplant recipients due its efficacy and favorable risk profile compared to other immunosuppressants. There has been a single case report of successful MMF desensitization. However, this protocol did not follow current Drug practice parameters. We report a successful desensitization to MMF in a double heart-kidney transplant recipient.

[Compliance with contact isolation precautions of multidrug-resistant microorganisms in a tertiary hospital]. / Cumplimiento de las precauciones de aislamiento de contacto por microorganismos multirresistentes en un hospital de tercer nivel.

INTRODUCTION: Preventive isolation of patients with multidrug-resistant microorganisms is considered an effective measure to prevent outbreaks in hospitals. The objective of this study is to assess compliance by healthcare workers and family of contact isolation precautions in colonised/infected patients with multidrug-resistant microorganisms. METHODS: An observational study was conducted from October 2014 to March 2015. A checklist with a structure was designed (equipment trolley), including knowledge of the situation and compliance by the patients, families, and healthcare workers. Univariate and bivariate analyses were performed. Non-parametric tests Mann-Whitney and Kruskal-Wallis were used. RESULTS: Out of the 467 observations made, the equipment trolley was correctly situated in 97% (453) of cases, the sphygmomanometer in 90% (421), the stethoscope 43.9% (205), and thermometer 16.5% (77). A dustbin and the alcoholic solution were observed in over 98.7% (461) of cases. The antiseptic soap for patient hygiene was observed to be correctly placed in 348 (74%) of occasions. The situation was known by 84.9% (305) of patients and 91.4% (234) of families. As regards compliance by professionals with the placement/removal of disposable gowns and gloves was about 50% for entering the room (49.5%, 56 gown and 53.09%, 60 gloves), and 40% (28) for leaving the room by professionals. Hand hygiene compliance was 26.5% (30) for entering and 35.2% (25) when leaving. CONCLUSIONS: There is significant room for improvement in the compliance with isolation precautions. Non-compliance to isolation procedures is not due to a deficit of materials, but to individual behaviours. It is important to implement and evaluate programs based on psychosocial intervention models that can change attitudes and behaviours related to contact isolation precautions for multidrug-resistant microorganisms.

Chronic elevation of liver enzymes in acute intermittent porphyria initially misdiagnosed as autoimmune hepatitis.

Autoimmune hepatitis is a disease characterized by an elevation of liver enzymes, as well as specific autoantibodies. It is more common in women than men. We describe a 32-year-old woman with elevated transaminases, autoantibodies, and a liver biopsy result suggestive of autoimmune hepatitis. The indicated treatment was administered without showing a satisfactory response. The patient had a family history of acute intermittent porphyria (AIP) so we decided to begin treatment with hematin, achieving a complete remission of the symptoms. Acute intermittent porphyria is a rare condition characterized by neurovisceral symptoms, abdominal pain being the most common of them. The disease has a higher prevalence among young women and certain European countries such as Sweden, Great Britain, and Spain. A correct diagnosis and prompt treatment are essential because patients affected by AIP must have a strict followup due to the fatal outcome of the outbreaks.