Practice makes the expert: The importance of training volunteers in the generation of phenological data from photographs of biodiversity observation platforms.

Phenology studies the time at which events in the life cycle of a species occur sand how they are related to environmental cues. Patterns of change in phenology at different scales can be used as an indicator of ecosystem changes and climate change, but the data necessary to detect these changes can be difficult to obtain due to their temporal and regional dimensions. Citizen science can contribute to generate large amounts of data on phenological changes at wide geographical scales that would be almost impossible for professional scientists to generate, but the quality and reliability of these data are often questioned. The objective of this study was to evaluate the use of a biodiversity observation citizen science platform based on photographic information as a potential source of large-scale phenological information, and to identify the key benefits and limitations of this type of information source. We used the Naturalista photographic databases for two invasive species in a tropical region: Leonotis nepetifolia and Nicotiana glauca. The photographs were classified into different phenophases (initial growth, immature flower, mature flower, dry fruit) by three groups of volunteers: a group of experts, a trained group with information on the biology and phenology of both species, and an untrained group. The degree of reliability of the phenological classifications was estimated for each group of volunteers and each phenophase. The degree of reliability of the phenological classification of the untrained group was generally very low for all phenophases. The group of trained volunteers showed accuracy levels for the reproductive phenophases that equaled the degree of reliability among the expert group, regardless of species, and was consistent across phenophases. We conclude that volunteer classification of photographic information contained in biodiversity observation platforms can provide phenological information with high geographic coverage and an increasing temporal coverage on general phenological patterns of species with wide distributions but has limited applicability in the identification of exact start and end dates. and peaks of the different phenophases.

Concentration and environmental fate of ivermectin in floodplain wetlands: An ecosystem approach.

Ivermectin (IVM) is commonly used for broad control of endo- and ecto- parasites in cattle. In wetlands of the Parana Medio River, cattle has been treated repeatedly with IVM for years and concerns have been raised on possible presence of the drug in these ecosystems. A field study was conducted to assess concentration of IVM in two wetlands subjected to different cattle use and frequency of IVM injection. Concentration of IVM in roots of macrophytes, Chironomus sp., Coelotanypus sp., Brachymesia furcata (larvae), Dero sp., Hyalella sp., Hirudinea, Planorbidae, Boana pulchella (larvae), Aphyocharax anisitsi and Serrapinnus calliurus were shown for the first time. Total concentration of IVM in the wetlands, and concentration in cattle manure, sediment, water and macrophytes increased with the number of treated cattle and frequency of IVM injections. Accumulation of IVM in aquatic assemblages is alarming because these organisms fulfill a key role in food webs, constituting a serious risk to human health. Management strategies should be implemented by farmers to keep recently treated animals away from watercourses to reduce the introduction of IVM into aquatic systems.

B subset cells in patients with chronic granulomatous disease in a Mexican population

Introduction: Chronic granulomatous disease (CGD) is a disorder of phagocyte function, characterized by pyogenic infections and granuloma formation caused by defects in NADPH oxidase complex activity. Although the effect of CGD mainly reflects the phagocytic compartment, B cell responses are also impaired in patients with CGD. Materials and methods: Flow cytometric analysis was performed on peripheral blood samples from 35 CGD patients age-matched with healthy controls (HC). The target cells of our study were the naive (IgD+/CD27-), memory (IgD-/CD27+), and B1a (CD5+) cells. Immunoglobulins (Igs) were also measured. This study was performed in a Latin American cohort. Results: We found significantly higher levels of naive B cells and B1a cells, but lower levels of memory B cells were found in CGD patients compared to HC. There was no significant difference of cell percentages per inheritance type. Discussion: Our findings suggest that the deficiency of NADPH oxidase components can affect the differentiation of naive B cells to memory B cells. Consequently, memory cells will be low, which also influenced the expression of CD27 in memory B cells and as a result, the percentage of naive cells increases. An altered phenotype of B lymphocytes in CGD patients may contribute to the opportunistic infections and autoimmune disorders that are seen in this disease

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Hiperfrecuentación en un servicio de urgencias pediátricas de un hospital general universitario / Hyperfrequentation in a pediatrics hospital emergency department

Objetivo: Medir la magnitud de la hiperfrecuentación en un servicio de urgencias pediátricas de un hospital general universitario público de primer nivel y las características de los niños hiperfrecuentadores (HF). Método: Estudio prospectivo, descriptivo y no experimental. Se cuantifica el número de visitas durante 12 meses. Se define como HF al niño con un número de consultas al año ≥ p85%. De cada uno se recogieron las variables demográficas y sociales para un análisis multivariante. Resultados: Se reclutaron 406 niños; 49 (12,1%) eran HF y generaron el 36,6% de todas las consultas en urgencias. Estos niños consultaron 4,21 veces más que los niños no HF e ingresaron 3,08 veces más. Se registraron más niños HF entre los menores de 3 años. Los niños con enfermedades crónicas no fueron más HF. Conclusión: En las urgencias pediátricas hospitalarias, al igual que en atención primaria, un pequeño porcentaje de pacientes consumen un gran número de recursos

Objective: To measure the magnitude of hyperfrequent users in a pediatric hospital emergency department of a general department hospital and the characteristics of children who are frequent users. Method: Prospective, descriptive, non-experimental study. The number of visits over 12 months is quantified. Hyperfrequent users are defined as these children with a number of consultations/year ≥p85%. From each child demographic and social variables were collected for a multivariate analysis. Results: 406 children were recruited; 49 (12.1%) were hyperfrequent users and generated 36.6% of all emergency room consultations. These children consulted 4.21 times more than non-hyperfrequent users and were hospitalized 3.08 times more. Children under 3 years of age were more hyperfrequent utilizers. We not found that children with chronic diseases were hyperfrequent utilizers. Conclusion: In pediatric hospital emergencies, as in primary care, a small percentage of patients consume a large amount of resources

Reacción adversa cutánea asociada al empleo de ketamina intravenosa en urgencias pediátricas / Cutaneous adverse reaction associated with intravenous ketamine in pediatric emergency department

El empleo de sedoanalgesia no invasiva se ha convertido en una herramienta de uso habitual en el manejo del dolor y la ansiedad asociados a la realización de una gran variedad de procedimientos dolorosos en el contexto de urgencias pediátricas. Sin embargo, ciertos procedimientos particularmente dolorosos, como la cura de quemados o la reducción cerrada de fracturas desplazadas, si-guen precisando un grado de sedación más profundo y el empleo de sedoanalgesia invasiva. La ketamina ha demostrado su seguridad y utilidad en el manejo del dolor asociado a procedimientos especialmente agresivos. Presentamos 2 casos de reacción cutánea transitoria secundaria al uso intravenoso de ketamina para el manejo del dolor durante la reducción de fracturas

The employment of noinvasive analgesia has become a common tool in the management of pain and anxiety associated with painful procedures in pediatric emergency department. However some particularly painful procedures such as cure of burned or closed reduction of displaced fractures still required deeper degree of sedation and the use of invasive sedoanalgesia. Ketamine has proved its safety and usefulness in management of pain caused by aggressive procedures. We present two cases of transient skin reactions associated with intravenous use of ketamine in the management of pain associated with the reduction of fractures

Utilidad de la punción lumbar y el urocultivo en el estudio de la fiebre sin foco en niños menores de 1 mes en el servicio de urgencias pediátricas: estudio descriptivo / Utility of lumbar puncture and urine culture for the study of fever without source in neonates in pediatric emergency departments: A descriptive study

Introducción: La fiebre sin foco en el recién nacido constituye un motivo de consulta frecuente en los servicios de urgencias pediátricas. En los últimos años han surgido diferentes enfoques sobre su manejo, y se tiende a un abordaje conservador en cuanto a la realización de exploraciones complementarias. Materiales y métodos: Estudio descriptivo retrospectivo de las historias clínicas de los menores de 1 mes atendidos en nuestro servicio de urgencias pediátricas por fiebre sin foco durante los años 2011-2013. Resultados: Se analizaron 146 casos. Se realizó urocultivo en el 98,6% de los casos y un cultivo del líquido cefalorraquídeo (LCR) en el 91,1%. En el 13,6%, el urocultivo resultó positivo, y el microorganismo más frecuente fue Escherichia coli (75%). El 28,8% presentó un LCR positivo, lo que supone el 95,2% de los casos de infecciones por enterovirus, sin aislarse ningún agente bacteriano. Hemos encontrado una relación estadísticamente significativa (p < 0,002) entre los pacientes que presentaron valores más elevados de temperatura y los cultivos de LCR positivos para enterovirus, así como entre los que presentaron mayores recuentos de leucocitos en sangre con cultivo de orina y LCR patológicos (p < 0,001 y p = 0,019, respectivamente). Conclusión: Los neonatos febriles suponen un grupo de riesgo para el desarrollo de una infección bacteriana grave, por lo que es importante realizar una búsqueda etiológica exhaustiva, con estudio de sangre, orina y LCR, independientemente de su rango de edad. La indicación de las exploraciones complementarias no puede basarse exclusivamente en los hallazgos obtenidos en la anamnesis y la exploración física (AU)

Introduction: Unexplained fever in newborn infants represents a common visit to the pediatric emergency departament (ED). In the last few years different views about its management had arosen, with a tendency towards being conservative about complementary exams. Materials and methods: Descriptive, retrospective study based on clinical data of newborn infants (less than 1 month old) in our ED department with unexplained fever between 2011-2013. Results: Data for 146 patients were analyzed. Urine culture was done in 98.6% of the patients and cerebrospinal fluid culture in the 91.1%. Urine culture turned out positive in the 13.6%, being Escherichia coli the most common microorganism (75%). In the 28.8% of the cases, the sample of cerebrospinal fluid turned up positive, assuming in the 95.2% of the cases, enterovirus infections without a bacterial agent being isolated. We have found a statistical significative relation (p < 0.002) between patients with higher temperature levels and cerebrospinal fluid positive cultures for enterovirus as well as between the ones with higher white blood cell count with positive cerebrospinal fluid and urine cultures (p < 0.001 y p = 0.019, respectively). Conclusion: Febrile newborn infants are a risk group for developing serious bacterial infections, highlighting the importance of an exhaustive etiological study, with blood, urine and cerebrospinal fluid studies, regardless their age group. The indication of complementary exams must not be based only on anamnesis or physical examination (AU)

Effects of docosahexanoic acid on metabolic and fat parameters in HIV-infected patients on cART: A randomized, double-blind, placebo-controlled study.

BACKGROUND: Hypertriglyceridemia is common in HIV-infected patients. Polyunsaturated fatty acids reduce fasting serum triglyceride (TG) levels in HIV-infected patients. It is not known whether docosahexanoic acid (DHA) supplementation can reduce hypertriglyceridemia and modify fat distribution in HIV-infected patients. METHODS: We conducted a randomized, double-blind, placebo-controlled trial with 84 antiretroviral-treated patients who had fasting TG levels from 2.26 to 5.65 mmol/l and were randomized to receive DHA or placebo for 48 weeks. TG levels were assessed at baseline, week 4 and every 12 weeks. Body composition was assessed at baseline and at week 48. Registered under ClinicalTrials.gov Identifier no. NCT02005900. RESULTS: Patients receiving DHA had a 43.9% median decline in fasting TG levels at week 4 (IQR: -31% to -56%), compared with -2.9% (-18.6% to 16.5%) in the placebo group (P < 0.0001). DHA levels and decrease in TG at week 4 in the DHA arm correlated significantly (r = 0.7110, P < 0.0001). The median reduction in TG levels in the DHA arm was -43.7% (-32.4% to -57.5%), and in the placebo arm +2.9% (-21.3% to +30.1%) at week 12. The difference remained statistically significant at week 48 (P = 0.0253). LDL cholesterol levels significantly increased at week 4 by 7.1% (IQR: -4.8% to +35.3%) in the DHA arm but not in the placebo group. No significant changes were observed in HDL cholesterol, insulin, and HOMA-IR during the study. Limb fat significantly increased in both arms, without statistically significant differences between groups (P = 0.3889). DHA was well tolerated; only 3 patients experienced treatment-limiting toxicity. CONCLUSIONS: Supplementation with DHA reduced fasting TG levels in antiretroviral-treated HIV-infected patients with mild hypertriglyceridemia. DHA was well tolerated with minor GI symptoms. Peripheral fat significantly increased in the DHA group but did not increase significantly compared with placebo.

Épulis del recién nacido / Newborn epulis

Niña de siete días de edad, cuya madre refiere que "nació con un bulto en la boca". Durante la lactancia materna perdía leche por el labio superior en poca cantidad. En la inspección clínica se encontraron tres lóbulos (uno palatino y dos vestibulares) en el rodete maxilar superior del lado izquierdo. Diagnóstico presuntivo: épulis congénito del recién nacido. Después de 27 días del diagnóstico regresó a consulta. No presentaba a la inspección el lóbulo palatino. Se realizó cirugía convencional para el caso, extirpando de manera total la tumoración. Se envió la pieza quirúrgica a patología resultando como diagnóstico definitivo: épulis congénito del recién nacido (AU)

A seven-day-old girl whose mother says she was "born with a lump in her mouth". During breastfeeding some milk came out from her upper lip in small quantities. At the clinical examination, three lobes (one palatine and two vestibular) were found in the left maxilla. Suspected diagnosis: congenital epulis of the newborn. After 27 days, when she returned to consultation, it was observed that the palatine lobule had disappeared spontaneously. Conventional surgery was performed for the case, removing the tumor completely. The surgical part was sent to pathology resulting in definitive diagnosis: congenital epulis of the newborn (AU)

High FGF21 levels are associated with altered bone homeostasis in HIV-1-infected patients.

BACKGROUND: Fibroblast growth factor-21 (FGF21) has emerged as an important regulator of glucose, lipid, and body weight homeostasis. However, recent experimental studies have reported that increased FGF21 levels may lead to bone loss. OBJECTIVE: To assess the relationship of serum FGF21 levels and altered bone homeostasis in HIV-1-infected patients. DESIGN: Cross-sectional study of 137 HIV-1-infected patients and 35 healthy controls conducted at the Hospital de la Santa Creu i Sant Pau, Barcelona. Among HIV-1-infected patients, 35 were untreated (naïve), 43 were treated with antiretrovirals (HIV-1/ART) with no lipodystrophy, and 59 patients were HIV-1/ART and experienced lipodystrophy. Bone mineral density (BMD) and content (BMC) were assessed using dual-energy X-ray absorptiometry. Serum levels of FGF21, receptor activator of nuclear factor (NF)-KB ligand (RANKL), and C-telopeptide of type-I collagen (CTX-1) were measured by enzyme-linked immunosorbent assays. Serum levels of osteocalcin, osteoprotegerin, leptin, tumor necrosis factor-α, interleukin-6, interleukin-8, and monocyte chemoattractant protein-1 were determined using an antibody-linked, fluorescently labeled microsphere bead-based multiplex analysis system. RESULTS: Alterations in bone parameters and bone homeostasis marker levels were consistent with higher turnover and bone loss in HIV-1 infected patients. FGF21 correlated negatively with BMD and BMC. FGF21 correlated positively with serum levels of osteoprotegerin and CTX-1, as well as with the CTX-1/osteocalcin ratio. CONCLUSIONS: Elevated FGF21 levels are associated with poor bone homeostasis in HIV-1-infected patients. Increases in FGF21 serum level may be an indicator not only of metabolic derangement but it may also serve as a biomarker of altered bone homeostasis in HIV-1 infected patients.

Eccema coxsackium y otra presentación atípica de la enfermedad de mano-pie-boca / Eczema coxsackium and another atypical presentation of hand, foot and mouth disease

La enfermedad de mano-pie-boca (EMPB) es una de las enfermedades exantemáticas más frecuentes en niños menores de cinco años, generalmente producida por los virus Coxsackie A16 y enterovirus 71. En los últimos años se están observando manifestaciones dérmicas diferentes a la habitual causadas por serotipos menos frecuentes como el Coxsackievirus A6. Los pacientes con la EMPB por Coxsakievirus A6 presentan fiebre y síntomas sistémicos como la EMPB típica, pero tienen una manifestación cutánea más grave, pudiendo simular un cuadro Gianotti Crosti-like, o, incluso, un eccema herpeticum. En estos casos, recomendamos analizar el serotipo de enterovirus para prevenir pruebas diagnósticas innecesarias o tratamientos antivirales inapropiados. Presentamos dos casos en niños menores de cinco años, de presentación atípica de EMPB, atendidos en nuestro Servicio de Urgencias. Ambos referían como antecedente padecer dermatitis atópica (AU)

Hand, foot and mouth disease (HFMD) is one of the most frequent exanthematic disease in children younger than five years. It is usually caused by Coxsackievirus A16 and enterovirus 71. Last years, other different skin presentations are observed and they are produced by less common serotypes of enterovirus such as Coxsackievirus A6. Patients with Coxsackievirus A6 HFMD present with fever and systemic symptoms as in typical HFMD, but usually have a more severe cutaneous involvement, being able to pretend a Giannotti Crosti-like symptoms, or even, an eczema herpeticum. In this cases, we recommend to analyze coxsackievirus A6 HFMD to prevent unnecessary diagnostic tests and inappropriate antiviral treatment. We report two cases of atypical hand, foot and mouth disease in children younger of five years. Both of them referred atopic dermatitis as precedent (AU)

Susceptibilidad in vitro de Candida albicans y no albicans Aisladas de Prótesis Dentales de Pacientes con Estomatitis Protésica a Tres Sustancias de Desinfección / In vitro Susceptibility of Candida albicans and Non-albicans Isolated fro Dental Prothesis in Patients with Denture Stomatitis to Three Disinfectants

A pesar del gran número de productos disponibles para la limpieza de prótesis dentales, el 60% de los portadores hace uso de ellos, posiblemente por la situación económica. El objetivo fue determinar la susceptibilidad antifúngica in vitro que presenta Candida y sus especies a tres sustancias utilizadas para la desinfección de prótesis (hipoclorito de sodio, ácido acético y solución de superoxidación). Se obtuvieron aislados clínicos de Candida de pacientes portadores de prótesis diagnosticados con estomatitis protésica, para su posterior estudio de susceptibilidad in vitro a las diferentes sustancias. El hipoclorito de sodio al 0,5% mostró in vitro una mayor inhibición para las cepas de Candida albicans y Candida no albicans. El ácido acético y la solución de superoxidación no mostraron inhibición in vitro frente a ambas cepas. El hipoclorito de sodio al 0,5% tiene un efecto inhibitorio in vitro sobre las cepas de C. albicans y Candida no albicans.

Despite the large number of products available for denture cleaning, less than 60% of denture wearers use them, possibly due to the economic situation. The aims were to determine the in vitro anti-fungal susceptibility of Candida species to three denture disinfectants (Sodium hypochlorite, acetic acid and super oxidized solution). Clinical isolates were obtained from denture wearers diagnosed with denture stomatitis for its posterior in vitro susceptibility study to the different substances. 0.5% Sodium hypochlorite showed the higher in vitro inhibitory effect on Candida albicans and non-albicans. Acetic acid and super oxidized solution showed no inhibition in both species. 0.5% Sodium hypochlorite has an in vitro inhibitory effect on Candida species.

Púrpura de Schölein-Henoch ampollosa, una forma de presentación poco frecuente / Bullous Henoch Schölein purpura, an infrequent form of presentation

La púrpura de Schölein-Henoch (PSH) es la vasculitis sistémica más frecuente de la infancia. Al contrario que en adultos, la aparición de ampollas hemorrágicas en niños es infrecuente. Presentamos el caso de un varón de tres años de edad que acudió a Urgencias tras la aparición de forma aguda de lesiones ampollosas asociadas a púrpura palpable y afectación sistémica. El paciente precisó ingreso hospitalario y tratamiento sistémico con corticoides, con evolución favorable (AU)

Henoch Schölein Purpura (HSP) is the most common systemic vasculitis of childhood. In contrast to adults, the occurrence of blood blisters is uncommon in children. We report the case of a male 3 years old who came to the emergency room after the onset of an acute form of bullous lesions associated to palpable purpura and systemic involvement. The patient required hospitalization and systemic corticosteroid treatment, with favourable progress (AU)

Enfermedades metabólicas congénitas en un servicio de urgencias pediátricas / Inherited metabolic disorders in pediatric emergency services

Introducción: Los avances en el diagnóstico precoz y tratamiento han propiciado una mayor supervivencia, y en mejores condiciones, de los pacientes con enfermedades metabólicas congénitas (EMC). Estos pueden acudir a los Servicios de Urgencias Pediátricas (SUP) por motivos relacionados o no con su enfermedad. El propósito de este trabajo fue revisar las características de las visitas al SUP de estos pacientes, en un hospital de tercer nivel. Material y métodos: Se desarrolló un estudio observacional retrospectivo en el que se analizaron todas las visitas al SUP del Hospital Infantil La Paz durante los años 2011 y 2012 de pacientes con EMC. Se registraron el tipo de EMC, el motivo de consulta, el tiempo de evolución de los síntomas, la necesidad de ingreso hospitalario y la presencia de descompensación metabólica. Resultados: En total, fueron analizadas 107 visitas, siendo el motivo de consulta más frecuente los procesos respiratorios (30,8%). Cuando la consulta fue por vómitos, los pacientes con trastornos relacionados con las proteínas fueron los que menos tardaron en acudir al SUP. Un tercio de las visitas se siguió de ingreso, siendo la mitad de ellas por descompensación metabólica de la patología de base. Conclusiones: Los pacientes con EMC acudieron al SUP por motivos muy diversos, que en algunos casos fueron causa o consecuencia de una descompensación metabólica aguda que motivó el ingreso hospitalario. Al tratarse de enfermedades con baja prevalencia individual, resulta de interés contar con protocolos diagnóstico-terapéuticos que faciliten una atención óptima (AU)

Introduction: Advances in the early diagnosis and treatment have led to improved survival, and a better quality of life for patients with inherited metabolic disorders (IMD). They can go to the Pediatric Emergency Services (PES) for reasons unrelated to their disease. The purpose of this study was to review the characteristics of visitors to the PES of these patients in a tertiary hospital. Material and methods: A retrospective observational study was conducted on all visits from patients with IMD to the PES of Hospital Infantil La Paz over the years 2011 and 2012. IMD type, complaint, duration of symptoms, need for hospitalization, and presence of metabolic decompensation was recorded. Results: A total of 107 visits were analyzed, with the most frequent reason being for consultation of respiratory processes (30.8%). When the consultation was for vomiting, patients with protein-related disorders were those who delayed less in going to PES. One third of visitors were admitted, half of them due to metabolic decompensation of the underlying pathology. Conclusions: Patients with IMD came to PES for many different reasons, which in some cases were the cause or consequence of an acute metabolic decompensation that led to hospitalization. Being diseases with low prevalence, it would be useful to have diagnostic and therapeutic protocols in order to provide optimal care (AU)

Convulsión febril típica en paciente inmigrante / Typical febrile seizures in an immigrant patient

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Intoxicación por Spartium junceum (Spanish broom) / Spartium junceum (Spanish broom) poisoning

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Caso de intoxicación por ciguatera en paciente pediátrico / A case of ciguatera poisoning in a paediatric patient

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Etiología de la ataxia aguda en urgencias pediátricas: experiencia de 11 años / Etiology of acute ataxia in pediatric emergencies: 11 years experience

Las alteraciones en la marcha son un motivo de consulta habitual en las urgencias pediátricas; sin embargo, los casos de verdadera marcha atáxica son muy infrecuentes en los pacientes pediátricos. La principal preocupación del profesional de urgencias radica en excluir las causas graves de este síndrome clínico; afortunadamente, en la mayoría de casos en la infancia, su origen suele ser un proceso benigno y autolimitado. Dentro de las ataxias adquiridas, la forma más habitual de presentación en los servicios de urgencias suele ser la aguda, cuya evolución es menor de 72 horas en un niño previamente sano. En esta revisión hemos analizado los casos de ataxia adquirida valorados en nuestro servicio de urgencias pediátricas durante un periodo de 11 años, así como su enfoque diagnóstico. En nuestra serie, la causa más frecuente de ataxia aguda fue la postinfecciosa (un 39,13% del total), seguida de las de origen tumoral (17,39%) y las intoxicaciones (13,04%) (AU)

Changes in gait are a common reason for consultation in pediatric emergencies, however cases of true gait ataxia are rare in pediatric patients. The main concern of professional emergency lies in the exclusion of serious causes of this clinical syndrome, fortunately in most cases the origin in childhood is usually benign and self-limiting process. Among the acquired ataxias, the most common form of presentation in the pediatric emergency is usually that of acute ataxia, which are those whose evolution is less than 72 hours in a previously healthy child. In this review we have analyzed the cases of acquired ataxia evaluated in our pediatric emergency department during a period of 11 years and what was the diagnostic approach. In our series of cases the most common cause of acute ataxia was postinfectious (39.13% of total), followed by the tumoral origin (17.39%) and secondary to ingestion of toxic agents (13.04%) (AU)

Hipertrofia de labios menores. A propósito de un caso / Hypertrophy of labia minora. A case report

La hipertrofia de labios menores es una patología poco frecuente, que puede presentarse a cualquier edad, si bien es más frecuente su detección durante la pubertad. Se trata de una variante anatómica cuya etiología aún es incierta, que se describe como el tejido protuberante localizado tras los labios mayores. Actualmente no existen criterios clínicos objetivos consensuados para definirla. Se trata de una entidad de carácter benigno cuya sintomatología es muy variada, abarcando desde síntomas leves tales como irritación local o problemas con la higiene local, hasta infecciones crónicas, dolor al caminar, dispareunia o problemas psicológicos y estéticos. Una sencilla exploración física desde la consulta pediátrica de Atención Primaria permitirá reconocer fácilmente esta patología, y su posterior derivación al Servicio de Ginecología para su corrección quirúrgica (AU)

Labia minora hypertrophy is an uncommon condition that can occur at any age, but is most common during puberty. It is an anatomical variant of uncertain etiology, described as protruding tissue behind labia minora. Currently there are no agreed clinical criteria to define this condition. It is a benign entity whose symptoms are very varied, ranging from mild symptoms such as local irritation or problems with local hygiene, to chronic infections, pain when walking, dyspareunia or psychological and aesthetic problems. A simple physical examination from a pediatric primary care will easily recognize this disease for the subsequent referral to the gynecology department for surgical correction (AU)

Stavudine extended release (once-daily, Bristol-Myers Squibb) for the treatment of HIV/AIDS.

INTRODUCTION: Stavudine extended release (d4T XR) was a formulation which tried to solve the two main problems associated with the use of stavudine immediate release (d4T IR). These were twice daily dosing schema at a time when most formulations were long-life allowing once daily dosing; and that the use of d4T IR was associated with long-term toxicity through mitochondrial toxicity clinically expressed as peripheral neuropathy, pancreatitis and above all, lipodystrophy. The link between stavudine exposure and lipodystrophy had a great negative impact on its use in clinical practice. AREAS COVERED: The authors cover the most relevant papers related to the efficacy and safety of d4T XR-based antiretroviral therapy. EXPERT OPINION: The development of d4T XR has only been partially successful with regard to its objectives. Improved pharmacokinetic properties allow its once daily dosing, and although it exhibits less mitochondrial toxicity it is still hampered by its development in a significant proportion of patients. This has caused its use to be almost residual in industrialised countries. As of now, d4T XR has not been made available in developing countries, despite the extended use of the immediate-release formulation. Currently, if there is no other chance of starting combination antiretroviral therapy, d4T XR could play a role in the treatment of HIV infection.

Cefalea y dolor ocular en urgencias / Migraine and eye pain in the emergency department

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