Characteristics of Medically Transported Critically Ill Children with Respiratory Failure in Latin America: Implications for Outcomes.

Several challenges exist for referral and transport of critically ill children in resource-limited regions such as Latin America; however, little is known about factors associated with clinical outcomes. Thus, we aimed to describe the characteristics of critically ill children in Latin America transferred to pediatric intensive care units for acute respiratory failure to identify risk factors for mortality. We analyzed data from 2,692 patients admitted to 28 centers in the Pediatric Collaborative Network of Latin America Acute Respiratory Failure Registry. Among patients referred from another facility (773, 28%), nonurban transports were independently associated with mortality (adjusted odds ratio = 9.4; 95% confidence interval: 2.4-36.3).

Effect of melatonin administration on the PER1 and BMAL1 clock genes in patients with Parkinson's disease.

Sleep disorders are a widespread condition in patients with Parkinson's disease (PD), which has been linked to a deregulation of the circadian cycle and therefore of the clock genes. The aim of this study was to evaluate the effect of melatonin (MEL) on the PER1 and BMAL1 clock genes in patients with PD. A double-blind, cross-over, placebo-controlled randomized clinical trial pilot study was conducted in 26 patients with stage 1-3 PD according to the Hoehn & Yahr scale, who received either 25 mg of MEL or a placebo at noon and 30 min before bedtime for three months. The relative expression of the PER1 and BMAL1 genes was measured, as well as the presence of daytime, nocturnal, and global sleepiness, and the progression of PD. The levels of the PER1 and BMAL1 genes at baseline were 0.9 (0.1-3) vs. 0.56 (0.1-2.5), respectively; while after the intervention with MEL or placebo the BMAL1 levels increased to 2.5 (0-3.70) vs. 2.2 (0.10-3.30), respectively (d = 0.387). Fifty percent (50 %) of patients had daytime sleepiness and sixty-five percent (65 %) had abnormal nighttime sleepiness, yet neither group showed changes after the intervention. Patients with PD exhibited an alteration in the levels of the clock genes: MEL increased the levels of BMAL1, but the PER1 levels remained unchanged.

Effect of bioactive compounds extracted from Cordyceps nidus ANDES-F1080 on laccase activity of Pleurotus ostreatus ANDES-F515.

Laccases are ligninolytic enzymes produced by different microorganisms, especially by fungi such as the white-rot fungus Pleurotus ostreatus. Chemical inductors have been used to promote laccase secretion due to the application of these enzymes in lignocellulosic biomass pretreatment. Cordyceps nidus ANDES-F1080 was previously described as a source of bioactive compounds that could influence the enzymatic production system of other fungi. For that reason, this study evaluates the effect of C. nidus' ANDES-F1080 extracts on the laccase activity of P. ostreatus ANDES-F515. To achieve this objective, C. nidus ANDES-F1080 was grown in four different substrates: two artificial-based and two natural-based culture media. Metabolites were extracted from C. nidus ANDES-F1080 using water and methanol as solvents. Biochemical characterization of these extracts was performed to complement the analysis of their effect on laccase activity. Our results revealed an enhancement on the laccase activity of P. ostreatus ANDES-F515 grown in natural-based cultures when C. nidus' ANDES-F1080 extracts were supplemented. The best laccase activities registered values around 10,575 ±â€¯813 U·L-1.

Portación de Staphylococcus Aureus en manipuladores de alimentos de servicios gastronómicos de Asunción, Paraguay (2017) / Staphylococcus Aureus in food manipulators of gastronomic services of Asunción, Paraguay (2017)

Introducción: El Staphylococcus Aureus constituye un agente etiológico frecuente de intoxicaciones alimentarias y se encuentra asociado a diversos alimentos. Objetivo: Describir la frecuencia de portación de Staphylococcus Aureus en manipuladores de alimentos de restaurantes de Asunción durante el 2017. Metodología: Se realizó un estudio observacional, prospectivo, descriptivo de corte transversal a manipuladores de alimentos de restaurantes de Asunción durante los meses de mayo a junio del 2017. Se realizaron tres hisopados nasales a cada uno de los 30 manipuladores de alimentos para determinar si la portación era intermitente, permanente u ocasional. Al mismo tiempo fueron realizadas encuestas donde se midieron variables demográficas. Resultados: La prevalencia de portación de Staphylococcus Aureus fue del 33,3 % (10), siendo el 40% (4) esporádica e intermitente y el 20% (2) permanente. En cuanto a las características demográficas de los manipuladores,el 56,66% (17) fueron del sexo masculino, eran solteros 43,33% (13) y el 50% (15) contaban con estudios secundarios completos. El promedio de edad de 29 de los manipuladores fue de 39,5 años con un rango comprendido entre 18 y 85 años. El 23,33% (7) utilizaban guantes a la hora de manipular los alimentos. Además, se pudo observar que el 26,66% (8) utilizaba gorros. Llamó la atención que el 30% (9) de los encuestados no presentaban uñas limpias durante la manipulación. Palabras clave: Staphylococcus Aureus; manipuladores; alimentos.

Introduction: Staphylococcus Aureus is a frequent etiologic agent of food poisoning and is associated with various foods. Objective : To describe the frequency of Staphylococcus Aureus in food handlers of restaurants in Asunción during 2017. Methodology: An observational, prospective, descriptive, cross-sectional study was carried out on food handlers in restaurants in Asuncion during the months of May to June 2017. Three nasal swabs were made to each of the 30 food handlers to determine if the carriage was intermittent, permanent or occasional. At thesame time, surveys were carried out where demographic variables were measured. Results: The prevalence of carrying Staphylococcus Aureus was 33.3% (10), being 40% (4) sporadic and intermittent and 20% (2) permanent. Regarding the demographic characteristics of the manipulators, 56.66% (17) were male, were single 43.33% (13) and 50% (15) had complete secondary education. The average age of 29 of the manipulators was 39.5 years with ranger between 18 and 85 years. 23.33% (7) used gloves when handling food. In addition, it was observed that 26.66% (8) used caps. It was noted that 30% (9) of theres pondents did not have clean nails during handling. Keywords: Staphylococcus Aureus; manipulators; food.

Atrial fibrillation with high ventricular rate in emergency room: What's the best strategy for treatment? / Fibrilação atrial de alta resposta ventricular na sala de emergência: qual é a melhor estratégia de tratamento?

SUMMARY Atrial fibrillation (AF) is the most common arrhythmia in clinical practice and can lead to significant decline in functional status and quality of life among affected patients. The risk of developing AF increases with age and the presence of structural heart disease. Thus, the attendance of patients with high ventricular response to AF is common, which makes knowledge of its management mandatory. In this context, the choice of heart rate and/or rhythm control therapy is fundamental and complex, with multiple possibilities. Thus, this review aims to assist in the management of these patients, systematizing their care.

RESUMO A fibrilação atrial (AF) é a arritmia mais comum da prática clínica e pode levar à redução significativa do estado funcional e da qualidade de vida dos pacientes acometidos. O risco de desenvolvimento de AF aumenta com a idade e com a presença de doença cardíaca estrutural. Dessa forma, o comparecimento de paciente com AF de alta resposta ventricular é frequente, o que torna o conhecimento de seu manejo obrigatório. Nesse âmbito, a escolha da terapia de controle de frequência cardíaca e/ou ritmo é fundamental e complexa, com múltiplas possibilidades. Esta revisão tem o objetivo de auxiliar a abordagem desses pacientes, sistematizando o atendimento.

[Genital tuberculosis: atypical manifestation in the pregnancy. Case report]. / Tuberculosis genital: manifestacián atípica durante el embarazo. Reporte de un caso.

BACKGROUND: In the last years has been an increase in cases of tu- berculosis, representing a global health problem that is also reflected in an increased of cases in pregnant population. Especially in developed countries has been observed a direct relation with VIH patients,and groups of immigrants from countries where the infection is endemic. Tuberculous disease during pregnancy presents good outcome if it is diagnosed and treated properly. CASE REPORT: We present the case of a romanian patient with uncon- trolled 23 weeks gestation that enters with the suspicion of chorioam- nionitis and after late septic miscarriage and clinical sepsis criteria, leaks out of the hospital reentering with signs of neurologic involvement and pelviperitonitis as a result of genital tuberculous. Diagnosed with tuber- culous meningitis and disseminated with a grim evolution until death.

Nonvibrating granular model for a glass-forming liquid: Equilibration and aging.

We studied experimentally a model of a glass-forming liquid on the basis of a nonvibrating magnetic granular system under an unsteady magnetic field. A sudden quenching was produced that drove the system from a liquid state to a different final state with lower temperature; the latter could be a liquid state or a solid state. We determined the mean-squared displacement in temporal windows to obtain the dynamic evolution of the system, and we determined the radial distribution function to obtain its structural characteristics. The results were analyzed using the intermediate scattering function and the effective potential between two particles. We observed that when quenching drives the system to a final state in the liquid phase far from the glass-transition temperature, equilibration occurs very quickly. When the final state has a temperature far below the glass-transition temperature, the system reaches its equilibrium state very quickly. In contrast, when the final state has an intermediate temperature but is below that corresponding to the glass transition, the system falls into a state that evolves slowly, presenting aging. The system evolves by an aging process toward more ordered states. However, after a waiting time, the dynamic behavior changes. It was observed that some particles get close enough to overpass the repulsive interactions and form small stable aggregates. In the effective potential curves, it was observed that the emergence of a second effective well due to the attraction quickly evolves and results in a deeper well than the initial effective well due to the repulsion. With the increase in time, more particles fall in the attractive well forming inhomogeneities, which produce a frustration in the aging process.

Tuberculosis gástrica que simula otra patología: caso clínico / Gastrointestinal tuberculosis that mimics other pathologies: A clinical case / Tuberculose gástrica que simula outra patologia: caso clínico

La tuberculosis gástrica es una entidad rara que simula otras patologías. Suele asociarse con diagnósticos tardíos debido a sus características clínicas y forma de presentación atípica en este tipo de órganos. Se extrajeron los datos de la historia de una paciente, previo consentimiento informado. Se describen las características clínicas, el enfoque inicial, los hallazgos endoscópicos y la similitud con otras patologías, para terminar con una revisión del tema en la literatura. La tuberculosis gástrica simuló, inicialmente, otras patologías, lo que generó retraso y algunas dificultades en el diagnóstico y manejo. Se trata de una entidad con manifestaciones clínicas variables e inespecíficas, que se confunden con otras entidades, dada su similitud clínica y poca frecuencia de presentación. Existe poca literatura y la mayoría se limita a reportes de casos aislados, con comportamiento benigno y respuesta adecuada al manejo médico con fármacos antituberculosos.

Gastrointestinal tuberculosis is a rare entity that mimics other pathologies. It is commonly associated with late diagnosis due to its clinical characteristics and atypical presentation in these types of organs. Data were taken from the medical record of a patient following informed consent. Clinical characteristics, initial focus, endoscopic findings, and similarities with other pathologies are described, and a topic review was done. Initially, gastric tuberculosis mimicked other pathologies causing a delay and difficulty to issue correct diagnosis and treatment. This entity has variable and nonspecific clinical manifestations which can be confused with other entities due to clinical similarities and infrequent presentation. There is scarce literature and most is limited to isolated case reports with benign behavior and adequate response to TB treatment.

A tuberculose gástrica é uma entidade rara que simula outras patologias. Acostuma associar-se com diagnósticos tardios devido a suas características clínicas e forma de apresentação atípica neste tipo de órgãos. Se extraíram os dados da história de uma paciente, prévio consentimento informado. Se descrevem as características clínicas, o enfoque inicial, os descobertas endoscópicos e a similitude com outras patologias, para terminar com uma revisão do assunto na literatura. A tuberculose gástrica simulou, inicialmente, outras patologias, o que gerou retraso e algumas dificuldades no diagnóstico e manejo. Se trata de uma entidade com manifestações clínicas variáveis e inespecíficas, que se confundem com outras entidades, dada sua similitude clínica e pouca frequência de apresentação. Existe pouca literatura e a maioria se limita a reportes de casos isolados, com comportamento benigno e resposta adequada ao manejo médico com fármacos antituberculosos.

A prognostic score to identify low-risk outpatients with acute deep vein thrombosis in the upper extremity.

BACKGROUND: No studies have identified which patients with upper-extremity deep vein thrombosis (DVT) are at low risk for adverse events within the first week of therapy. METHODS: We used data from Registro Informatizado de la Enfermedad TromboEmbólica to explore in patients with upper-extremity DVT a prognostic score that correctly identified patients with lower limb DVT at low risk for pulmonary embolism, major bleeding, or death within the first week. RESULTS: As of December 2014, 1135 outpatients with upper-extremity DVT were recruited. Of these, 515 (45%) were treated at home. During the first week, three patients (0.26%) experienced pulmonary embolism, two (0.18%) had major bleeding, and four (0.35%) died. We assigned 1 point to patients with chronic heart failure, creatinine clearance levels 30-60 mL min(-1) , recent bleeding, abnormal platelet count, recent immobility, or cancer without metastases; 2 points to those with metastatic cancer; and 3 points to those with creatinine clearance levels < 30 mL min(-1) . Overall, 759 (67%) patients scored ≤ 1 point and were considered to be at low risk. The rate of the composite outcome within the first week was 0.26% (95% confidence interval [CI] 0.004-0.87) in patients at low risk and 1.86% (95% CI 0.81-3.68) in the remaining patients. C-statistics was 0.73 (95% CI 0.57-0.88). Net reclassification improvement was 22%, and integrated discrimination improvement was 0.0055. CONCLUSIONS: Using six easily available variables, we identified outpatients with upper-extremity DVT at low risk for adverse events within the first week. These data may help to safely treat more patients at home.

Purinergic signaling modulates human visceral adipose inflammatory responses: implications in metabolically unhealthy obesity.

Obesity is accompanied by chronic inflammation of VAT, which promotes metabolic changes, and purinergic signaling has a key role in a wide range of inflammatory diseases. Therefore, we addressed whether fat inflammation could be differentially modulated by this signaling pathway in the MUO and in individuals who remain MHO. Our results show that the necrotized VAT of both groups released greater levels of ATP compared with lean donors. Interestingly, MUO tissue SVCs showed up-regulation and engagement of the purinergic P2X7R. The extracellular ATP concentration is regulated by an enzymatic process, in which CD39 converts ATP and ADP into AMP, and CD73 converts AMP into adenosine. In VAT, the CD73 ectoenzyme was widely distributed in immune and nonimmune cells, whereas CD39 expression was restricted to immune CD45PAN+ SVCs. Although the MUO group expressed the highest levels of both ectoenzymes, no difference in ATP hydrolysis capacity was found between the groups. As expected, MUO exhibited the highest NLRP3 inflammasome expression and IL-1ß production. MUO SVCs also displayed up-regulation of the A2AR, allowing extracellular adenosine to increase IL-1ß local secretion. Additionally, we demonstrate that metabolic parameters and BMI are positively correlated with purinergic components in VAT. These findings indicate that purinergic signaling is a novel mechanism involved in the chronic inflammation of VAT underlying the metabolic changes in obesity. Finally, our study reveals a proinflammatory role for adenosine in sustaining IL-1ß production in this tissue.

Exploring the reasons why Barbadian mothers consent, or do not consent for their preteen daughters to receive the HPV vaccine

OBJECTIVE: The aim of this qualitative study was to explore the reasons why Barbadian mothers consented or did not consent for their pre-teen daughters to receive the human papilloma virus (HPV) vaccine. DESIGN AND METHODS: Four focus groups, totaling 25 Barbadian mothers whose pre-teen daughters were eligible for the HPV vaccine during the 2013-2014 school year were conducted. The groups were homogenous with two groups consisting of mothers who consented, and two groups of mothers who did not consent. Each session was audio-recorded, and data were analyzed to examine emerging themes. RESULTS: A lack of information from the Ministry of Health and an inadequate time frame to make an informed decision were the most common reasons for parental non-consent to the HPV vaccine. Other reasons included: a fear of side-effects of the vaccine, a low perceived risk of persons within the 10 to 12 age group of contracting the HPV virus, negative advice (particularly from medical practitioners), and a lack of trust and confidence in the information provided by the Ministry of Health. The most common reasons for giving consent were: positive advice (especially from health care professionals), having had a past experience with the Human Papilloma Virus, a family history of cancer, or knowing someone diagnosed with a HPV infection or cervical cancer. CONCLUSION: There is a need for more public information in relation to the Human Papilloma Virus and the HPV vaccine. This will allow for informed decision making, which may contribute to an increased uptake of the HPV vaccine.

A decrease in galectin-1 (Gal-1) levels correlates with an increase in anti-Gal-1 antibodies at the synovial level in patients with rheumatoid arthritis.

BACKGROUND: Several studies have confirmed that galectin-1 (Gal-1) plays a role in controlling the immune response because of its pro-apoptotic effect. Although studies based on a rheumatoid arthritis (RA) mouse model have suggested a crucial role for Gal-1 in inflammation, clinical data are lacking. We have detected the presence of autoantibodies against galectins in blood, but their physiological meaning remains unknown. OBJECTIVES: To compare plasma and synovial levels of Gal-1 in RA patients and in healthy controls, and correlate them with clinical parameters. METHODS: Plasma and synovial (non-arthritic knee effusion) samples were collected from RA patients and healthy donors. All patients were receiving treatment with steroids and/or disease-modifying anti-rheumatic drugs (DMARDs). A blood sample was taken at a baseline visit to determine plasma anti-cyclic citrullinated peptide (anti-CCP) antibodies, tumour necrosis factor alpha (TNF-α), Gal-1, and anti-Gal-1 autoantibodies. RESULTS: Although plasma levels of Gal-1 were similar in patients and controls, the concentration of Gal-1 was significantly reduced in the synovial fluid of patients with RA. This reduction was not correlated with TNF-α or C-reactive protein (CRP) levels. However, the decrease in synovial Gal-1 correlated with a significant increase in anti-Gal-1 autoantibodies and anti-CCP antibody titres, suggesting a physiological effect of autoantibodies limiting the amount Gal-1 and potentially blocking its biological effect in RA patients. CONCLUSION: Gal-1 levels were significant reduced at the synovial level in RA patients, possibly as a consequence of the increase in anti-Gal-1 autoantibodies.

Phenotypic and genotypic evaluation of 18 Nocardia isolates from human clinical samples in Mexico.

BACKGROUND: Mexico has the largest number of clinical cases of actinomycetoma in North and South America. Species originally identified by less specific methods have been recently reclassified as other known species or as new species. OBJECTIVE: To assess, by 16S rRNA gene sequencing and phenotypic methods, the species distribution of 18 human clinical isolates originally identified as N. brasiliensis, some of them isolated between 1947 and 1959 in Mexico City. METHODS: Clinical isolates came from the Hospital General, "Dr. Manuel Gea Gonzalez", and Instituto Nacional de Diagnóstico y Referencia Epidemiológica (INDRE) in Mexico, D.F. The strains used in this study included 15 clinical strains isolated between 1947 and 1959 that were originally identified as N. brasiliensis and three more strains obtained in 2007 identified as Nocardia spp. The isolates were identified genotypically by sequencing the 16S rRNA gene, and their phenotypic profiles were obtained with the API Coryne(®) system. Antibiotic susceptibility patterns were tested according to the protocol of the Comité de l'antibiogramme de la Société française de microbiologie[4]. RESULTS: According to 16S rRNA gene, sequencing were identified among 18 human clinical isolates as Nocardia farcinica (n=11) and Nocardia brasiliensis (n=7). A high number of the strains were susceptible to the majority of the antibiotics tested. The phenotypic profiles of the strains were quite uniform for N. farcinica and some variability was observed for N. brasiliensis strains. CONCLUSION: N. farcinica was the most prevalent species identified. Modern methodologies should be applied in clinical laboratories to accurately identify etiological agents.

La coccidioidomicosis en Argentina, 1892-2009 / Coccidioidomycosis in Argentina, 1892-2009

Los casos clínicos de coccidioidomicosis en Argentina son pocos y han tenido lugar fundamentalmente en la extensa región árida precordillerana. Este trabajo tiene como objetivos realizar una revisión retrospectiva del total de casos de coccidioidomicosis documentados en Argentina desde el año 1892 hasta 2009 y describir una serie de casos ocurridos en los últimos 4 años. En 117 años se documentaron 128 casos. Desde la primera descripción de la enfermedad en 1892 hasta 1939 se registraron 6 casos; desde 1940 hasta 1999, 59 casos (6-14 casos cada 10 años); y los 63 casos restantes (49% del total histórico) se produjeron en el último decenio. La mediana de edad de los 34 pacientes registrados en el período 2006-2009 fue de 31 años (rango: 7-89), la relación hombre:mujer fue 1,3:1; 12 de estos individuos eran inmunocomprometidos. Veintiséis casos se confirmaron por examen microscópico, por cultivo o por ambos procedimientos; los casos restantes se confirmaron por serología. Todos los aislamientos recuperados fueron identificados como Coccidioides posadasii. Treinta pacientes residían en una amplia área geográfica con epicentro en el valle de Catamarca. Entre 2006 y 2009, la tasa de incidencia en la provincia de Catamarca se incrementó desde valores históricos inferiores a 0,5 casos cada 100 000 habitantes hasta 2,0 casos cada 100 000 habitantes. Este aumento sugiere una emergencia de la coccidioidomicosis en el área.

Clinical cases of coccidioidomycosis are rare in Argentina and are generally found in the large arid precordilleran area of the country. This study aims to perform a retrospective review of all coccidioidomycosis cases documented in the country from 1892 to 2009, and to describe those occurring in the last 4 years. One hundred and twenty eight cases were documented in the 117 year-period. Since the original description of the disease in 1892 until 1939, only 6 cases were registered; between 1940 and 1999, 59 (6-14/10 yrs) and the remaining 63 (49% of total cases) occurred in the last decade. The median age of 34 patients registered in 2006-2009 was 31 years (range: 7-89), male/female ratio was 1.3:1 and 12 patients were immunocompromised. Twenty-six cases were confirmed by direct microscopy and/or culture whereas the remaining ones by serology. All isolates were identified as Coccidioides posadasii. Thirty patients lived in a vast geographic region with epicenter in Catamarca Valley. Between 2006 and 2009, annual disease incidence rates in Catamarca Province increased from historical values below 0.5/100,000 to 2/100,000 inhabitants. Such increase suggests an emergency of coccidioidomycosis in that region.

[Coccidioidomycosis in Argentina, 1892-2009]. / La coccidioidomicosis en Argentina, 1892-2009.

Clinical cases of coccidioidomycosis are rare in Argentina and are generally found in the large arid precordilleran area of the country. This study aims to perform a retrospective review of all coccidioidomycosis cases documented in the country from 1892 to 2009, and to describe those occurring in the last 4 years. One hundred and twenty eight cases were documented in the 117 year-period. Since the original description of the disease in 1892 until 1939, only 6 cases were registered; between 1940 and 1999, 59 (6-14/10 yrs) and the remaining 63 (49% of total cases) occurred in the last decade. The median age of 34 patients registered in 2006-2009 was 31 years (range: 7-89), male/female ratio was 1.3:1 and 12 patients were immunocompromised. Twenty-six cases were confirmed by direct microscopy and/or culture whereas the remaining ones by serology. All isolates were identified as Coccidioides posadasii. Thirty patients lived in a vast geographic region with epicenter in Catamarca Valley. Between 2006 and 2009, annual disease incidence rates in Catamarca Province increased from historical values below 0.5/100,000 to 2/100,000 inhabitants. Such increase suggests an emergency of coccidioidomycosis in that region.

The role of invasive therapies in elderly patients with acute myocardial infarction

INTRODUCTION: In elderly patients with acute myocardial infarction, very little is known about the role of surgical myocardial revascularization and percutaneous coronary intervention (invasive therapies - IT), especially in the context of long-term outcomes after hospital discharge. METHODS: We analyzed 1588 patients with MI who had been included prospectively in a databank and followed for up to 7.5 years. In this population, 548 patients were ¡Ý70 years old (elderly group - EG), and 1040 were <70 years of age (younger group - YG); 1088 underwent IT during hospitalization, and the remaining 500 were treated medically (conservative therapy - CT). Patients were monitored either by visit or by phone at least once a year. A standard questionnaire was administered to all patients. The impact of IT was analyzed with both non-adjusted and adjusted models. RESULTS: By the end of the follow-up period, the survival rates for the IT and CT groups were, respectively, 71.9% versus 47.2% in the global population (hazard ratio=0.55, P<0.001), 81.5% versus 66.6% in the YG (hazard ratio=0.68, P=0.018) and 48.8% versus 20.3% in the EG (hazard ratio=0.58, P<0.001). In the adjusted models, the hazard ratios were 0.62 (P<0.001) in the global population, 0.74 in the YG (P=0.073) and 0.64 (P=0.001) in the EG. CONCLUSION: Long-term follow-up of patients with myocardial infarction revealed that IT during the in-hospital phase was at least as effective in elderly patients as in younger patients.

Fibrohistiocitoma maligno (fibroxantosarcoma) de cuero cabelludo: a propósito de un caso / Histiocytoma malignant fibrous (Fibroxantosarcoma) of scalp: a purpose of a case

Los tejidos blandos comprenden los músculos, tendones, la grasa, el tejido fibroso, el tejido sinovial, los vasos y los nervios. Alrededor del 60 por ciento de los sarcomas de tejidos blandos se originan en los miembros, siendo 3 veces más frecuentes en los miembros inferiores que en los superiores. En 30 por ciento de los casos se localiza en el tronco y en 40 por ciento son retroperitoneales. En el resto del 10 por ciento se trata de tumores de cabeza y cuello. La entidad denominada fibrohistiocitoma comprenden un gran número de tumores calcificados anteriormente como fibrosarcomas o como variedades polimorfas de otras sarcomas, y se caracteriza por una mezcla de células fusiformes (fibrosas) y células redondas (histiocitarias) dispuestas en un patrón estoriforme, junto con abundantes células gigantes y zonas de polimorfismo. La importancia de los estudios de inmunohistoquímica en los tumores de partes blandas radica en la necesidad que tiene el patólogo de precisar el diagnóstico histopatológico de lesiones benignas y malignas pseudosarcomatosas o sarcomatosas y poder diferenciarlas de neoplasias de otro origen. Se trata de paciente masculino de 65 años quien consulta por presentar desde agosto del 2006, caracterizado por lesiones ulcerosa en cuero cabelludo sangrantes quién se le tomo una primera biopsia que reporta. La nueva Biopsia tomada en enero en este centro reporta Carcinoma Epidermoide moderadamente a poco diferenciado en región fronto parietal de cuero cabelludo recibe 1 ciclo de quimioterapia, se toma una biopsia nueva reportando su inmunohistoquímica Fibrohistiocitoma Maligno (fibroxantosarcoma)/Tumor de Cuero Cabelludo, en vista de resultado se planifica nueva quimioterapia, se observo mejoría satisfactoria en la lesión en cuero cabelludo, por lo que decide oncología y el servicio de Medicina Interna dar de alta y seguir sus quimioterapias por consulta externa.

Síndrome de Rendu Osler Weber o telangiectasia hemorrágica hereditaria: presentación de un caso y revisión de la literatura / Rendu Osler Weber syndrome or hereditary hemorrhagic telangiectasia: case report and literature review

Paciente femenina de 57 años portadora de Telagiectasia hemorragia hereditaria con antecedentes de padre y dos hermanos portadores de igual patología. Enfermedad genética con transmisión dominante caracterizada por telangiectasias (malformaciones vasculares pequeñas) en la piel y en el revestimiento de las mucosas, epistaxis y malformaciones arteriovenosas en varios órganos internos incluyendo cerebro y pulmones. En 1909, Hanes le da el nombre de HHT. En 1999 se definió los criterios diagnósticos: epistaxis, Telangiectasias, lesiones viscerales, historia familiar. Se han descrito cuatro tipos: HHT1, HHT2, HHT3, poliposis juvenil y HHT4. El TGFâ-1 ha sido más comúmente en su fisiopatología.

High prevalence of infections in patients with systemic lupus erythematosus and pulmonary haemorrhage.

The main objective of this study is to describe the presence of infections in patients with pulmonary haemorrhage and systemic lupus erythematosus. Patients with systemic lupus erythematosus and pulmonary haemorrhage were thoroughly evaluated in the first 48 hours with imaging plus bronchoscopy and bronchoalveolar fluid analysis. If needed, videoassisted thoracoscopy and lung biopsy were performed too. In all, search for bacterial, mycobacterial and fungal infections proceeded. Appropriate blood, bronchoalveolar fluid and tissue cultures were taken. Patients were treated with antibiotics and corticosteroids in case of infection. Otherwise, they received initial intravenous methylprednsiolone pulses for 3 days as standard therapy for pulmonary haemorrhage in systemic lupus erythematosus. Additional treatment with immunosuppressives was further decided by the treating physicians. Fourteen events in 13 patients were evaluated. In eight events (57%), an infection was demonstrated. Aetiological agents included Pseudomonas sp. and Aspergillus fumigatus. Four patients died, three of them because of the pulmonary infection and one because of cerebral haemorrhage secondary to severe systemic hypertension, 48 hours after methylprednisolone treatment. Patients with systemic lupus erythematosus and pulmonary haemorrhage have a high prevalence of infections. The influence of pulmonary haemorrhage in the setting of systemic lupus erythematosus needs further study to establish adequate treatment and to reduce the high mortality of this complication.