Incertidumbre frente a la enfermedad renal crónica / Uncertainty in chronic kidney disease

RESUMEN ElY objetivo de este estudio es reconocer las incertidumbres más comunes que presentan los pacientes con diagnóstico de enfermedad renal crónica. Se realizó revisión sistemática de la literatura científica de artículos publicados entre 2012 a 2018, en idioma español, portugués e inglés, y accesibles a texto completo. Búsqueda exhaustiva y reproducible de trabajos originales en las bases de datos Scielo, PubMed, Ebschost, Dialnet, Redalyc, con los descriptores (DeCS) "Renal Insufficiency Chronic", "Theory of uncertainty", "Renal Dialysis" y sus equivalentes en español, inglés y portugués, con valoración crítica de la calidad científica de los estudios aplicando lista de chequeo PRISMA (2009). Las incertidumbres fueron analizadas desde la teoría de enfermería de MIshel Merle. Los hallazgos muestran que las más comunes están relacionadas con la ambigüedad y falta de información; en la valoración del proceso se presenta mayormente la inferencia y el enfrentamiento de la enfermedad es visto como un peligro, manifestado con sentimientos de ansiedad y depresión.

ABSTRACT The aim of this study was to recognize the most common uncertainties presented by patients diagnosed with Chronic Kidney Disease. Systematic review was made of the scientific literature of articles published between 2012 to 2018, in Spanish, Portuguese and English, and accessible to text full. Comprehensive and reproducible search of original works in the Scielo, PubMed, Ebschost, Dialnet, Redalyc databases, with the descriptors (DeCS) "Renal Insufficiency Chronic", "Theory of uncertainty", "Renal Dialysis" and their equivalents in Spanish, English, and Portuguese with critical assessment of the scientific quality of the studies applying PRISMA checklist (2009). The uncertainties were analyzed from the nursing theory of MIshel Merle, the findings show that the most common are related to ambiguity and lack of information; Inference of the process, the inference is mostly presented and the confrontation of the disease is seen as a danger manifested with feelings of anxiety and depression.

Relación entre hallazgos radiológicos e inmunofenotipos tumorales de pacientes con cáncer de mama / Relationship between radiological findings and immunophenotyped in breast cancer

Resumen OBJETIVO: Evaluar la relación entre los hallazgos radiológicos e inmunofenotipos tumorales de pacientes con cáncer de mama. MATERIALES Y MÉTODOS: Estudio observacional, retrospectivo y transversal, efectuado en el Hospital ABC de la Ciudad de México, entre 2013 y 2017. Se incluyeron pacientes con diagnóstico de cáncer de mama establecido por biopsia percutánea o escisional, que contaran con estudios de inmunohistoquímica e imagen (mastografía, ultrasonido o ambos). Para evaluar la relación entre las características morfológicas de las lesiones observadas en los estudios radiológicos y el inmunofenotipo se utilizó la prueba de χ2. RESULTADOS: Se registraron 182 pacientes. En cuanto a las características de las lesiones se encontró relación significativa entre las masas de morfología irregular con bordes espiculados y las calcificaciones agrupadas con tumores luminales, y entre las calcificaciones de morfología amorfa con los tumores luminales A y las pleomórficas finas con los tumores luminales B. CONCLUSIÓN: Existe relación entre los hallazgos morfológicos por imagen y el inmunofenotipo de los tumores mamarios. Es importante que el médico radiólogo especialista en imagen mamaria conozca esta relación, con la finalidad de proporcionar información de la inmunohistoquímica al momento del estudio diagnóstico de imagen.

Abstratc OBJECTIVE: Establish if there is a relationship between the radiological findings and the immunophenotype of breast cancer. MATERIALS AND METHODS: An observational, cross-sectional, retrospective study realized at the ABC Medical Center, over a period of 4 years, that included patients diagnosed with breast cancer performed by percutaneous or excisional biopsy, with an immunohistochemical study and images (mammography and/or ultrasound). The relationship between the morphological characteristics of the lesions observed in the radiological studies and the immunophenotyped was studied by means of the χ2 test. RESULTS: We included 182 patients, among the characteristics of the lesions we found a significant relationship between the masses of irregular morphology with spiculate edges and the calcifications grouped with luminal tumors; calcifications of amorphous morphology with luminal A and pleomorphic fine tumors with luminal B. CONCLUSION: The results suggest that there is a relationship between the morphological findings by imaging and the immunophenotype of mammary tumors.

Histopathologic findings in uteri and ovaries collected from clinically healthy dogs at elective ovariohysterectomy: a cross-sectional study.

Opinions on ovariohysterectomy (OHE) of bitches vary depending on region and country. In this descriptive, prospective cross-sectional study, uterine tracts and ovaries exhibiting gross pathologic findings (n = 76) were collected post-surgery from a reference population of 3,600 bitches (2.11% incidence) that underwent elective OHE during September to November 2013 and evaluated by histopathology examination. Data were evaluated by using descriptive statistics and chi-squared tests. Bitches were of crossbred background with average age 5 years (range 0.6-8.0 years) and most were nulliparous (69.7%) with no anamnesis of reproductive diseases (81.6%). Frequencies of proestrus, estrus, and diestrus were 42.1%, 6.6%, and 19.7%, respectively. The presence of mammary gland masses (5.3%) significantly correlated with histopathologic findings in ovaries and age of the bitch (p ＜ 0.05). Predominant uterine histopathologies included cystic endometrial hyperplasia, periglandular fibrosis, lymphoplasmocytary endometritis, and adenomyosis (19.7%, 14.5%, 4.0%, and 2.6%, respectively). In ovaries, hyperplasia of rete ovarii, follicular cysts, oophoritis, adenoma of the rete ovarii, cysts of superficial structures, and granulosa cell tumors (10.5%, 10.5%, 7.9%, 4.0%, 2.6%, and 2.6%, respectively) were observed. The results reveal the presence of subclinical pathologies in healthy bitches, suggesting that OHE at an early age is beneficial for prevention of reproductive pathologies.

Mapping regions in Ste5 that support Msn5-dependent and -independent nuclear export.

Careful control of the available pool of the MAPK scaffold Ste5 is important for mating-pathway activation and the prevention of inappropriate mating differentiation in haploid Saccharomyces cerevisiae. Ste5 shuttles constitutively through the nucleus, where it is degraded by a ubiquitin-dependent mechanism triggered by G1 CDK phosphorylation. Here we narrow-down regions of Ste5 that mediate nuclear export. Four regions in Ste5 relocalize SV40-TAgNLS-GFP-GFP from nucleus to cytoplasm. One region is N-terminal, dependent on exportin Msn5/Ste21/Kap142, and interacts with Msn5 in 2 hybrid assays independently of mating pheromone, Fus3, Kss1, Ptc1, the NLS/PM, and RING-H2. A second region overlaps the PH domain and Ste11 binding site and 2 others are on the vWA domain and include residues essential for MAPK activation. We find no evidence for dependence on Crm1/Xpo1, despite numerous potential nuclear export sequences (NESs) detected by LocNES and NetNES1.1 predictors. Thus, Msn5 (homolog of human Exportin-5) and one or more exportins or adaptor molecules besides Crm1/Xpo1 may regulate Ste5 through multiple recognition sites.

Mucocutaneous manifestations of helminth infections: Nematodes.

In the 21st century, despite increased globalization through international travel for business, medical volunteerism, pleasure, and immigration/refugees into the United States, there is little published in the dermatology literature regarding the cutaneous manifestations of helminth infections. Approximately 17% of travelers seek medical care because of cutaneous disorders, many related to infectious etiologies. This review will focus on the cutaneous manifestations of helminth infections and is divided into 2 parts: part I focuses on nematode infections, and part II focuses on trematode and cestode infections. This review highlights the clinical manifestations, transmission, diagnosis, and treatment of helminth infections. Nematodes are roundworms that cause diseases with cutaneous manifestations, such as cutaneous larval migrans, onchocerciasis, filariasis, gnathostomiasis, loiasis, dracunculiasis, strongyloidiasis, ascariasis, streptocerciasis, dirofilariasis, and trichinosis. Tremadotes, also known as flukes, cause schistosomiasis, paragonimiasis, and fascioliasis. Cestodes (tapeworms) are flat, hermaphroditic parasites that cause diseases such as sparganosis, cysticercosis, and echinococcus.

Insulin secretion and sensitivity in healthy adults with low vitamin D are not affected by high-dose ergocalciferol administration: a randomized controlled trial.

BACKGROUND: Epidemiologic data suggest that low serum 25-hydroxyvitamin D [25(OH)D] increases insulin resistance and the risk of type 2 diabetes. Few interventional trials have assessed the effect of vitamin D on insulin metabolism, and published results are discordant. OBJECTIVE: The goal of this study was to perform a detailed assessment of the effect of ergocalciferol administration on glucose and insulin metabolism in healthy people with low total 25(OH)D(total). DESIGN: This was a 12-wk, double-blinded, randomized controlled trial. We enrolled 90 healthy volunteers aged 18-45 y with serum 25(OH)D ≤20 ng/mL (by immunoassay) and administered 50,000 IU ergocalciferol/wk or placebo for 12 wk. Primary endpoints were change in first-phase insulin response and insulin sensitivity as measured by intravenous glucose tolerance test. Secondary endpoints included change in homeostasis model assessment of insulin resistance; fasting glucose, insulin, and lipids; body mass index (BMI); and blood pressure. RESULTS: On-study 25(OH)D(total) was assessed by liquid chromatography-tandem mass spectrometry. In the treated group, 25(OH)D(total) rose from 18 ± 7 to 43 ± 12 ng/mL (P < 0.001) with no change in the placebo group. Despite this increase, at 12 wk, there were no between-group differences in either insulin response or insulin sensitivity; nor were there differences in any measured secondary endpoints. There was no evidence of effect modification by sex, race, glucose tolerance status, baseline 25(OH)D(total), or BMI. CONCLUSION: In healthy persons with low 25(OH)D(total), ergocalciferol administration for 12 wk normalizes 25(OH)D(total) but does not improve insulin secretion, insulin sensitivity, or other markers of metabolic health.

Antimicrobial susceptibility of Propionibacterium acnes isolates from acne patients in Colombia.

BACKGROUND: The increasing prevalence of antimicrobial resistance in Propionibacterium acnes poses a significant challenge to successful treatment outcomes in acne patients. Although P. acnes resistance has been demonstrated throughout the world, no previous data regarding the antimicrobial susceptibility of P. acnes in Colombia are available. OBJECTIVES: The aim of this study was to determine the antimicrobial susceptibility of P. acnes to common antibiotics used in the treatment of acne in a Colombian population. METHODS: Samples were collected from facial acne lesions of 100 dermatology patients. All samples were cultured in anaerobic conditions, and final identification of isolates was performed. Isolates of P. acnes were then subjected to antimicrobial susceptibility tests using erythromycin, clindamycin, tetracycline, doxycycline, and minocycline. RESULTS: Propionibacterium acnes isolates resistant to erythromycin (35%), clindamycin (15%), doxycycline (9%), tetracycline (8%), and minocycline (1%) were observed. Isolates with cross-resistance were also observed (to erythromycin and clindamycin [12%] and to doxycycline and tetracycline [6%]). Overall, 46% of isolates taken from patients with a history of antibiotic use demonstrated resistance, whereas 29% of isolates taken from patients who had never used antibiotics demonstrated resistance. CONCLUSIONS: Antimicrobial resistance in P. acnes in this Colombian population has a lower prevalence than those reported in Europe and follows a similar pattern to findings elsewhere in Latin America. Resistance is demonstrated even in isolates from patients with no previous history of antibiotic use. Resistance to erythromycin is most commonly observed. Minocycline emerges as the most effective antibiotic.

Fotodermatosis y terapia dedesensibilización / Photodermatosis and desensitization therapy

Las fotodermatosis son un grupo de desórdenes cutáneos causados o agravados por la radiación ultravioleta o la luz visible. Se dividen en cuatro grupos: I, fotodermatosis mediadas inmunológicamente (anteriormente llamadas idiopáticas); II, fotosensibilidad inducida por drogas y químicos; III, desórdenes de la reparación de excisión de nucleótidos del ADN y, IV, dermatosis fotoagravadas. Para llegar al diagnóstico correcto de estas enfermedades es necesario realizar un enfoque clínico adecuado, que esté apoyado en un interrogatorio y examen físico completos, además de exámenes especializados como la fotoprueba y fotoparche. En esta revisión se hace una recopilación de los aspectos epidemiológicos, clínicos, de diagnóstico y tratamiento de las fotodermatosis mediadas inmunológicamente, con mayor énfasis en la terapia de desensibilización con luz ultravioleta (PUVA, UVA, UVB), la cual ha mostrado resultados positivos en estas enfermedades, prefiriéndose la UVB por la mayoría de los autores, a excepción de la urticaria solar, en la cual la PUVA ha demostrado mejores resultados que la UVB a largo plazo. Para esto es fundamental determinar primero la dosis de eritema mínimo (DEM) y la dosis de urticaria mínima en el caso de la urticaria solar. La principal desventaja de la terapia de fotodesensibilización es que sus efectos son temporales y que los pacientes requieren terapia de mantenimiento para lograr un control duradero de la enfermedad, con el riesgo de los efectos carcinogénicos de la luz ultravioleta. Además, hasta el momento hay pocos estudios que evalúen la eficacia y seguridad de la fototerapia de desensibilización y en algunos casos las muestras son muy pequeñas.

Photodermatoses are a group of skin disorders caused or aggravated by ultraviolet radiation or visible light. They are divided in four groups: I, immunologically mediated photodermatoses (previously called idiopathic); II, drug- and chemical- induced photosensitivity; III, defective DNA repair disorders; and IV, photoaggravated dermatoses. To reach the correct diagnosis of these pathologies is necessary to make an appropriate clinical approach supported by a comprehensive interview and physical examination as well as specialized tests like photopatch and phototest. This review is a compilation of the epidemiological, clinical, diagnosis and treatment of immunologically mediated photodermatoses, with greater focus on desensitization therapy with ultraviolet light (PUVA, UVA and UVB), which has shown positive results in this pathologies, being UVB preferred by most authors except in solar urticaria, in which PUVA has displayed better results than UVB in the long term. Firstable, is essential to determine the minimal erythema dose and minimal urticarial dose for solar urticaria. The main disadvantages of photodesensitization therapy is the short therm effects and requirement of maintenance therapy to reach lasting control of disease with the risk of carcinogenesis of UVL. Further, there are few trials that study efficacy and security of desensitization phototherapy and some of these include small sample of patients corroborate this information.

Ceftaroline in complicated skin and skin-structure infections.

Ceftaroline is an advanced-generation cephalosporin antibiotic recently approved by the US Food and Drug Administration for the treatment of complicated skin and skin-structure infections (cSSSIs). This intravenous broad-spectrum antibiotic exerts potent bactericidal activity by inhibiting bacterial cell wall synthesis. A high affinity for the penicillin-binding protein 2a (PBP2a) of methicillin-resistant Staphylococcus aureus (MRSA) makes the drug especially beneficial to patients with MRSA cSSSIs. Ceftaroline has proved in multiple well-conducted clinical trials to have an excellent safety and efficacy profile. In adjusted doses it is also recommended for patients with renal or hepatic impairment. Furthermore, the clinical effectiveness and high cure rate demonstrated by ceftaroline in cSSSIs, including those caused by MRSA and other multidrug-resistant strains, warrants its consideration as a first-line treatment option for cSSSIs. This article reviews ceftaroline and its pharmacology, efficacy, and safety data to further elucidate its role in the treatment of cSSSIs.

HPV vaccine update: new indications and controversies.

Human papillomavirus (HPV) has a predilection for infecting epidermal and mucosal surfaces such as those of the anogenital region. HPV causes substantial pre-malignant, malignant, and benign disease in both women and men, ranging from cervical, vulvar, penile, and anal cancers to condyloma acuminata (genital warts). Although HPV vaccination is becoming more common, infection rates remain high in both genders. Perception of HPV vaccine has largely centered on its ability to prevent cervical cancer in women, though indication for its use in men is expanding. The benefits to men include prevention of genital warts and, more recently, regulatory approval was expanded in the US for prevention of anal cancer. Herein, we review HPV vaccine with a focus on its new indication in men and existing controversies.

Family history and herpes zoster risk in the era of shingles vaccination.

BACKGROUND: Herpes zoster is a common mucocutaneous infection caused by reactivation of latent varicella zoster virus previously introduced during a varicella infection. The epidemiology of the disease has changed since the approval of Zostavax(®) and the risk factors have been studied in depth. OBJECTIVES: To further assess the possibility of family history as a risk factor for herpes zoster, determine the age of herpes zoster onset and the rate of recurrence. STUDY DESIGN: A case-control study involved 1103 acute herpes zoster patients and 523 controls. RESULTS: Case patients were more likely to report blood relatives with a history of herpes zoster than controls (43.5% vs. 10.5%; P<0.001) (odds ratio for first-degree relatives, 4.44; 95% confidence interval 3.11-6.35). A dose-dependent effect was documented; risk was increased with multiple blood relatives (odds ratio, 17.15; 95% confidence interval, 7.50-39.18) compared with single blood relatives (odds ratio, 5.24; 95% confidence interval, 3.79-7.23). The mean age of herpes zoster onset was 51.7 (SD 19.0) years and the recurrence rate was 9.3%. CONCLUSIONS: The results indicate a stronger association between herpes zoster and family history of herpes zoster than previously reported in the literature and suggest a genetic predisposition to herpes zoster may be more frequently inherited along maternal lines. A lower mean age of herpes zoster onset than previously documented in the literature is reported, which has implications for vaccine timing.

Possible association of lower rate of postherpetic neuralgia in patients on anti-tumor necrosis factor-α.

Recently, a study of patients with rheumatoid arthritis who developed herpes zoster while taking a tumor necrosis factor (TNF)-α inhibitor reported a decreased incidence of postherpetic neuralgia. The objective of this study was to investigate whether patients on TNF-α inhibitors who developed herpes zoster have a lower incidence of subsequent development of postherpetic neuralgia. A retrospective review of herpes zoster patients on TNF-α inhibitors (infliximab, etanercept, or adalimumab) was conducted in 12 dermatology clinics. Medical records of such patients were reviewed thoroughly to confirm herpes zoster and TNF-α inhibitors and any subsequent development of postherpetic neuralgia (pain score ≥ 3 out of 10 after 90 days of shingles onset) was noted. A total of 206 cases were reviewed, of which only 2 cases (<1%) developed postherpetic neuralgia, a considerably lower incidence rate than noted in the literature. Increasing age is a known risk factor in the development of postherpetic neuralgia. However, of the 58 (28.1%) cases ≥ 70 years of age, only 1 patient (1.7%) developed neuralgia compared to approximately 50% of patients who develop postherpetic neuralgia in this age group as reported in the literature. Treatment with TNF-α inhibitors may be associated with a lower incidence of postherpetic neuralgia but further prospective large-scale studies are needed to confirm this data.

Incidence of postherpetic neuralgia after combination treatment with gabapentin and valacyclovir in patients with acute herpes zoster: open-label study.

OBJECTIVE: To evaluate the efficacy of treatment with gabapentin plus valacyclovir hydrochloride for the prevention of postherpetic neuralgia in patients with acute herpes zoster. DESIGN: Uncontrolled, open-label study. SETTING: A private dermatology clinic. PARTICIPANTS: Consecutive immunocompetent adults (age, ≥ 50 years) who presented with herpes zoster within 72 hours of vesicle formation with moderate to severe pain (≥ 4 on the 10-point Likert scale) were recruited for study participation. Intervention The patients received 1000 mg of valacylovir hydrochloride 3 times a day for 7 days plus gabapentin at an initial dose of 300 mg/d, titrated up to a maximum of 3600 mg/d, side effects permitting. MAIN OUTCOME MEASURES: Proportion of patients with zoster pain (pain > 0) at 3, 4, and 6 months as well as average pain severity, the proportion of patients with sleep disturbance, and quality-of-life measures (determined by the Medical Outcome Study Short Form 36-Item Health Survey). RESULTS: A total of 133 patients (mean age, 64.6 years) were enrolled in the study. The overall incidence of zoster pain at 6 months was 9.8%. CONCLUSION: The combination of gabapentin and valacyclovir administered acutely in patients with herpes zoster reduces the incidence of postherpetic neuralgia. Trial Registration clinicaltrials.gov Identifier: NCT01250561.

Staphylococcus aureus: sensibilidad y resistencia a los antibióticos en una muestra de pacientes con dermatitis atópica / Staphylococcus aureus: sensitivity and resistance to antibiotics in a sample of patients with atopic dermatitis. Bogota, Colombia

Introducción: El Staphylococcus aureus se presenta en el 90% de los niños con dermatitis atópica, siendo un factor de frecuentes exacerbaciones de la enfermedad. Objetivos: Buscamos determinar la frecuencia del Staphylococcus aureus en las lesiones de piel de pacientes con dermatitis atópica y de sus cuidadores, midiendo la sensibilidad y resistencia a los antibióticos convencionales. Metodología: Este es un estudio observacional descriptivo con una muestra de 100 pacientes y sus cuidadores. Se cultivaron las lesiones de los pacientes y las fosas nasales (reservorios) de sus cuidadores en el período comprendido entre mayo y julio de 2009. Resultados: Reclutamos 46 niñas y 54 niños con sus respectivos cuidadores. En total se obtuvieron 56 cultivos positivos con SA, 23 niños y 33 cuidadores, y de éstos, 9 eran concordantes cuidador-paciente. 3 cultivos fueron de SA meticilino resistente (SAMR). 51 cultivos fueron resistentes a cefalexina (91%), 56 resistentes a cefadroxilo (100%), 2 resistentes a oxacilina (3.5%), 1 resistente a clindamicina (1.7%), 1 resistente a gentamicina (1.7%), 2 resistentes a mupirocina (3.5%), y ninguna fue resistente a trimetropim sulfametoxazol o a ácido fusídico. Discusión: Consideramos una posible asociación entre cuidador y paciente como colonizadores para los pacientes de SA. Existe un buen perfil de sensibilidad general, pero llama la atención la alta resistencia a cefalosporinas y no a penicilinasas, lo que sugiere una posible inducción de resistencia dada la alta frecuencia en su uso. Los antibióticos tópicos en reservorios muestran en general una buena sensibilidad frente al S. aureus, incluso frente al SAMR. Llama la atención la presencia de éste en la población general (1.5% en nuestro estudio) lo que nos hace alertar sobre su adquisición en la comunidad.

A calcipotriene/betamethasone dipropionate two-compound scalp formulation in the treatment of scalp psoriasis in Hispanic/Latino and Black/African American patients: results of the randomized, 8-week, double-blind phase of a clinical trial.

The calcipotriene/betamethasone dipropionate two-compound scalp formulation has been shown to be safe and effective in the treatment of scalp psoriasis over 8 weeks, but the patients studied were mainly White and non-Hispanic. The aim of this study was to evaluate the efficacy and safety of the two-compound scalp formulation in the treatment of scalp psoriasis in Hispanic/Latino and Black/African American patients. A total of 99 Hispanic/Latino and 78 Black/African American patients were randomized double-blind in a 3:1 ratio to 8 weeks of once daily treatment of scalp psoriasis with either the two-compound scalp formulation (n=135) or its vehicle (n=42). In the two-compound group, 71.9% of patients had cleared or minimal disease at week 8 by the investigator's global assessment compared to 40.5% in the vehicle group (odds ratio 3.30; 95% CI 1.62-6.72; P<0.001). For the five secondary efficacy response criteria, three (total sign score, thickness of scalp psoriasis, patient's global assessment) showed that two-compound scalp formulation was statistically significantly more effective than its vehicle, and the other two (redness and scaliness of scalp psoriasis) approached statistical significance in favor of the two-compound scalp formulation. There was no statistically significant difference (P=1.00) between the percentage of patients with adverse reactions in the two-compound group (7.0%) and the vehicle group (7.9%). The two-compound scalp formulation is safe and effective in the treatment of scalp psoriasis over 8 weeks in Hispanic/Latino and Black/African American patients.

Liquen plano ungular tratado con isotretinoína: reporte de caso / Nail lichen planus treated with isotretinoin: a case report

El liquen plano ungular es una dermatosis inflamatoria crónica cuyo tratamiento es obligatorio para evitar la cicatrización de la matriz de la uña; sin embargo, no hay estándares definidos de tratamiento. En este artículo reportamos el caso de una mujer con liquen plano ungular con distrofia de las 20 uñas, tratada exitosamente con isotretinoína oral, biotina oral y lactato de amonio tópico al 12%.

Emerging drugs for complicated skin and skin-structure infections.

UNLABELLED: IMPORTANCE OF THE FILED: With the worldwide surge of MRSA, skin and skin-structure infection (SSTI) treatment has become a challenge for physicians. Cultures and antibiotic susceptibility tests for SSTIs are the rule due to the implication in morbidity and mortality rates associated with MRSA infections. The need for new antibiotics is evident and the effort to decrease antibiotic resistance is a world priority. AREAS COVERED IN THIS REVIEW: This manuscript accesses the actual treatments and the developing of antibiotics for MRSA SSTIs. WHAT THE READER WILL GAIN: This is a review of the data on the available and emerging treatments for MRSA SSTIs. TAKE HOME MESSAGE: There is an unmet medical need for new antibiotics in the new millennium. As physicians, we must assure all appropriate procedures are completed in order to reduce the bacterial resistance, especially for MRSA.

The expanding spectrum of eschar-associated rickettsioses in the United States.

BACKGROUND: Until recently, Rickettsia rickettsii was the only substantiated cause of tick-borne spotted fever group (SFG) rickettsiosis in humans in the United States. Rickettsia parkeri, originally thought to be nonpathogenic in humans, was recently proved to be another cause of tick-borne SFG rickettsiosis. OBSERVATIONS: We report 3 cases of SFG rickettsiosis and discuss the epidemiology, clinical presentation, histopathologic features, and laboratory findings that support confirmed or probable diagnoses of R parkeri infection and describe the expanding list of eschar-associated SFG rickettsioses recognized in US patients. CONCLUSIONS: The SFG rickettsioses share many clinical manifestations and extensive antigenic cross-reactivity that may hamper specific confirmation of the causative agent.

Shingles vaccine.

IMPORTANCE OF THE FIELD: Herpes zoster or shingles is a condition with the potential to result in severe debilitation. It affects approximately 10 - 30% of the population. Until recently there were only treatments to shorten the duration and lessen the symptoms of herpes zoster, but no practical or approved method of prevention for susceptible immunocompetent adults. The live attenuated zoster vaccine (Zostavax, Merck & Co., Inc.) is effective in preventing shingles in individuals 60 years of age and older and recommended by the Center for Disease Control's (CDC) Advisory Committee for Immunization Practices (ACIP). AREAS COVERED IN THIS REVIEW: Literature related to the live attenuated zoster vaccine is reviewed from its beginnings in the early 1970s through to the present. WHAT THE READER WILL GAIN: Background information on herpes zoster and up to date information on the live attenuated zoster vaccine including pharmacology, efficacy and safety are covered. New areas of research in zoster vaccination are also discussed. TAKE HOME MESSAGE: The live attenuated zoster vaccine is an effective and well-tolerated method of preventing zoster and the potentially debilitating sequelae and is recommended for immunocompetent patients 60 years of age and older. Ongoing clinical trials are investigating new means of effective prevention.

Filariasis: diagnosis and treatment.

Filariasis is an infectious disease of the lymphatics and subcutaneous tissues caused by nematodes or filariae. Carried by mosquito vectors, this disease causes millions of people to suffer from lymphedema and elephantiasis, characteristics of filariasis infection. This disease can be diagnosed through the identification of microfilariae in blood or skin samples, antigen detection, radiographic imaging, or polymerase chain reaction. Mass drug administration by the World Health Organization has helped to diminish the incidence of filariasis. However, continued research on new drugs and vaccinations will be needed to control and reduce the microfilarial levels in the human population.