Nevo melanocítico congénito gigante: presentación de tres casos / Giants congenital melanocytic nevus: Report of three cases

Los Nevos Melanocíticos Congénitos (NMC) son lesiones pigmentarias, que pueden aparecer en el nacimiento, aunque hay casos comunicados hasta el primer año de vida (Nevo Melanocítico Congénito Tardío). Presentan ciertas características clínicas y evolutivas de gran importancia: el compromiso estético de las formas gigantes, la asociación con melanocitosis meníngea y su transformación maligna de la lesión cutánea o meníngea. Presentamos tres casos de nevos melanocíticos congénitos gigantes. Cabe destacar, que el objetivo de este artículo es realizar una revisión del tema, orientar al seguimiento y control de los mismos y destacar la dificultad para su tratamiento debido a su gran tamaño.

The Congenital Melanocytic Nevus are lesions melanocytic pigmented. Already apparent at birth but there are cases reported to the first year of life (Late Congenital Melanocytic Nevus). Certain features and evolution clinics that are important: the great compromise of aesthetic forms giant, meningeal melanocitosis association and its malignant transformation. We present three cases of Giants Congenital Melanocytic Nevus. It should be noted, that the purpose of this article is a review of the issue and guide the monitoring and control of them and point out the difficult treatment.

Nevo melanocítico congénito gigante: presentación de tres casos / Giants congenital melanocytic nevus: Report of three cases

Los Nevos Melanocíticos Congénitos (NMC) son lesiones pigmentarias, que pueden aparecer en el nacimiento, aunque hay casos comunicados hasta el primer año de vida (Nevo Melanocítico Congénito Tardío). Presentan ciertas características clínicas y evolutivas de gran importancia: el compromiso estético de las formas gigantes, la asociación con melanocitosis meníngea y su transformación maligna de la lesión cutánea o meníngea. Presentamos tres casos de nevos melanocíticos congénitos gigantes. Cabe destacar, que el objetivo de este artículo es realizar una revisión del tema, orientar al seguimiento y control de los mismos y destacar la dificultad para su tratamiento debido a su gran tamaño.(AU)

The Congenital Melanocytic Nevus are lesions melanocytic pigmented. Already apparent at birth but there are cases reported to the first year of life (Late Congenital Melanocytic Nevus). Certain features and evolution clinics that are important: the great compromise of aesthetic forms giant, meningeal melanocitosis association and its malignant transformation. We present three cases of Giants Congenital Melanocytic Nevus. It should be noted, that the purpose of this article is a review of the issue and guide the monitoring and control of them and point out the difficult treatment.(AU)

Factores que afectan las mediciones de monóxido de carbono en el aire exhalado como biomarcador del consumo de tabaco / No disponible

Introducción. Dos trabajos previos exploraron la prevalencia de tabaquismo en estudiantes de medicina en Argentina (FUMAr) y en médicos de planta de hospitales de Buenos Aires (FUMAHBA), utilizando el monóxido de carbono en aire espirado (COesp) como biomarcador de consumo de tabaco. Recientemente, otro estudio exploró la prevalencia de tabaquismo en diferentes carreras de una Universidad (FUMUnCo). Se realizó un análisis post-hoc de COesp de estos estudios para explorar factores que podrían modificar los valores de COesp como biomacardor de consumo de tabaco. Objetivos. 1) Determinar el valor de corte de COesp para diferenciar categorías de fumadores en un contexto epidemiológico. 2) Explorar otros factores que podrían afectar las mediciones de COesp. Métodos. Se realizaron estudios de corte transversal: en 12 facultades de medicina en Argentina (agosto a noviembre 2003), en 7 hospitales de Buenos Aires (noviembre 2004 a octubre 2005) y en 6 carreras de la Universidad Nacional del Comahue (2008-2009), utilizando el mismo cuestionario y mediciones de COesp (Smokelizer Bedfont® and Jarvis technique). Resultados. El análisis incluyó a 3.455 estudiantes FUMAr, 1.911 estudiantes FUMUnCo y 1.333 médicos FUMAHBA. Dos facultades de medicina fueron excluidas debido a la alta polución ambiental durante el muestreo y el retraso en el reclutamiento. Entre los encuestados, en el 98,5% se realizó la medición de COesp. La prevalencia de tabaquismo y fumador diario fue de 34,7, 33,5 y 32,7% y 24,5, 23,8 y 25,1%, respectivamente. La edad (22,6, 22,9 y 42,6 años) y representación del género masculino (43,1, 31,1 y 54,8%) fue menor entre los estudiantes. El COesp discriminó correctamente las categorías de fumador diario (X· = 17,7; CI 17,13-18,34), fumador actual (X· = 14, 7; CI 14,0-15,0) y no fumadores (X· = 4,8; CI 4,7-5,0), se correlacionó con el número de cigarrillos por día (Pearson 0,309 p<0,001) y en el análisis univariado se observó que hay influencias significativas por otros factores. El modelo de regresión logística identificó que la COesp se asoció no solo con la categoría de fumador, consumo de cigarrillos, sino también con el área geográfica donde se realizaron las mediciones. Conclusiones. La medición de COesp es biomarcador útil para detectar el tabaquismo y discrimina adecuadamente las categorías de fumadores; sin embargo, en estudios epidemiológicos se debe considerar que hay otros determinantes que pueden modificar el valor de COesp(AU)

Introduction. Two previous reports, explored smoking prevalence among medical students in Argentina (FUMAr) and staff physicians from Buenos Aires’ hospitals (FUMAHBA) using carbon monoxide (COexh) as a biomarker of smoking. Recently another study that explored smoking prevalence in different carriers of one university (FUMUnCo) was reported. A "post hoc" analysis of COexh of samples of these studies was performed to explore factors that may modify the COexh values as tobacco consumption biomarker. Objectives. 1) To determine the COexp cutoff values for different categories smoking in a epidemiological setting. 2) To explore other factors that may affect COexp measurement. Methods. Cross sectional studies were performed in 12 medical schools in Argentina (August and November 2003), 7 hospitals in Buenos Aires province (November 2004 and October 2005) and 6 careers in Universidad Nacional del Comahue (2008 and 2009), using the same questionnaire and COexp measurements (Jarvis technique with Smokelizer Bedfont®). Results. The analysis included 3,455 medical students in FUMAR study, 1,911 students from UNComahue and 1,333 medical doctors. Two medical schools were excluded from analysis because high air pollution environment during sampling and delay in recruitment. Among surveyed 98.5% performed COexp measurement. The prevalence of smoking and daily smoking among students and physicians was 34.7, 33,5 and 32.7% and 24.5, 23,8 and 25.1% respectively. The age (22.6, 22.9 and 42.6 years) and male gender (43.1, 31.1 and 54.8%) distribution was lower among students. The COexp discriminate properly daily smoker (X· =17.7; CI 17.13-18.34), current smoker (X· =14.7; CI 14.0-15.0) and non-smokers (X· =4.8; CI 4.7-5.0) categories, correlated as well with number of cigarettes per day (Pearson 0.309 p<0.001), but univariate analysis observed significant differences among other factors.A logistic regression model identified that COexp was associated not only with smoker category, cigarette consumption but geographic area where the measurement was performed and the study as well. Conclusions. Measurement of COexp is useful as a biological marker of smoking and properly discriminate smoking categories, however there are other determinants that may modify COexp values that must be considered for epidemiological studies (AU)

Predicting mortality in hospitalized patients with 2009 H1N1 influenza pneumonia.

BACKGROUND: Community-acquired pneumonia (CAP) severity scores can identify patients at low risk for mortality who may be suitable for ambulatory care. Here, we follow the clinical course of hospitalized patients with CAP due to 2009 H1N1 influenza. OBJECTIVE: To evaluate the role of CAP severity scores as predictors of mortality. METHODS: This was a secondary data analysis of patients hospitalized with CAP due to 2009 H1N1 influenza confirmed by reverse transcriptase polymerase chain reaction enrolled in the CAPO (Community-Acquired Pneumonia Organization) international cohort study. CAP severity scores PSI (Pneumonia Severity Index), CURB-65 (confusion, urea, respiratory rate, blood pressure, age ≥ 65 years) and CRB-65 (confusion, respiratory rate, blood pressure, age ≥ 65 years) were calculated. Actual and predicted mortality rates were compared. A total of 37 predictor variables were evaluated to define those associated with mortality. RESULTS: Data from 250 patients with CAP due to 2009 H1N1 influenza were analyzed. Patients with low predicted mortality rates (0-1.5%) had actual mortality rates ranging from 2.6% to 17.5%. Obesity and wheezing were the only novel variables associated with mortality. CONCLUSIONS: The decision to hospitalize a patient with CAP due to 2009 H1N1 influenza should not be based on current CAP severity scores, as they underestimate mortality rates in a significant number of patients. Patients with obesity or wheezing should be considered at an increased risk for mortality.

Serie de paciente con escabiosis tratados con azufre precipitado al 6% / Series of patient with scabies treated with 6% precipitated sulfur

OBJETIVOS: reportar los resultados de la estrategia que incluye "el tratamiento tópico con azufre precipitado al 6% sumado a medidas no farmacológicas" en la población de Villa Verde, Pilar, Buenos Aires, Argentina. MÉTODOS: Serie de casos tratados entre Marzo de 2007 y marzo de 2008 de una muestra de conveniencia integrada por toda la población con signos y síntomas sugestivos de escabiosis durante dicho período. RESULTADOS: Fueron incluidos 161 pacientes, pero sólo se pudo realizar la evaluación completa en 110 de ellos (68,3%). De éstos, 74 se encontraba curado a los 15 días de iniciado el tratamiento y otros 23, al mes, lo que implica una tasa global de curación de 88%. Sólo 12,7% de la muestra evaluada presentó efectos adversos. El 20% de los encuestados percibió la intervención como de bajo costo, el 32,6 de costo moderado y el 47,5 alto. El autorreporte de adherencia al tratamiento farmacológico fue de 95% y del no farmacológico, 96%. CONCLUSIONES: Estos resultados contribuyen a avalar una estrategia terapéutica ampliamente utilizada en nuestro medio (por su bajo precio y amplia disponibilidad), que por el momento posee escasa evidencia científica y es utilizada por motivos fundamentalmente empíricos.

OBJECTIVES: Report the results of the strategy that includes "the topical treatment with precipitated sulfur at 6% plus non-pharmacological measures" in the population of Villa Verde, Pilar, Buenos Aires, Argentina. METHODS: A series of cases treated between March 2007 and March 2008 of a sample of convenience integrated by the entire population with signs and symptoms suggestive of scabies during this period. RESULTS: A total of 161 patients were included, but only 110 of them could complete the complete evaluation (68.3%). Of these, 74 were cured 15 days after starting treatment and another 23, a month, which implies an overall cure rate of 88%. Only 12.7% of the sample evaluated had adverse effects. 20% of respondents perceived the intervention as low cost, 32.6 moderate cost and 47.5 high. Self-reported adherence to pharmacological treatment was 95% and non-pharmacological self-report was 96%. CONCLUSIONS: These results contribute to endorse a therapeutic strategy widely used in our environment (due to its low price and wide availability), which at the moment has little scientific evidence and is used for fundamentally empirical reasons.

Effect of dietary fat saturation on lipid metabolism, arachidonic acid turnover and peritoneal macrophage oxidative stress in mice.

We investigated the effects of a saturated fat diet on lipid metabolism and arachidonic acid (AA) turnover in mouse resident peritoneal macrophages. The pro-oxidative effect of this diet was also studied. Female C57BL/6 mice were weaned at 21 days of age and assigned to either the experimental diet containing coconut oil (COCO diet), or the control diet containing soybean oil as fat source (10 mice per group). The fat content of each diet was 15% (w/w). Mice were fed for 6 weeks and then sacrificed. The concentration of total lipids, triglycerides, (LDL+VLDL)-cholesterol, thiobarbituric acid-reactive substances (TBARS) and reduced glutathione were increased in the plasma of mice fed the COCO diet, without changes in phospholipid or total cholesterol concentrations compared to control. The concentrations of total cholesterol, free and esterified cholesterol, triglycerides, and TBARS were increased in the macrophages of COCO-fed mice, while the content of total phospholipids did not change. The phospholipid composition showed an increase of phosphatidylcholine and a decrease of phosphatidylethanolamine. The [3H]-AA distribution in the phospholipid classes showed an increase in phosphatidylcholine and phosphatidylethanolamine. Incorporation of [3H]-cholesterol into the macrophages of COCO-fed mice and into the cholesterol ester fraction was increased. The COCO diet did not affect [3H]-AA uptake but induced an increase in [3H]-AA release. The COCO diet also enhanced AA mobilization induced by lipopolysaccharide. These results indicate that the COCO diet, high in saturated fatty acids, alters the lipid metabolism and AA turnover of peritoneal macrophages in female mice and also produces a significant degree of oxidative stress.

Effect of dietary fat saturation on lipid metabolism, arachidonic acid turnover and peritoneal macrophage oxidative stress in mice

We investigated the effects of a saturated fat diet on lipid metabolism and arachidonic acid (AA) turnover in mouse resident peritoneal macrophages. The pro-oxidative effect of this diet was also studied. Female C57BL/6 mice were weaned at 21 days of age and assigned to either the experimental diet containing coconut oil (COCO diet), or the control diet containing soybean oil as fat source (10 mice per group). The fat content of each diet was 15 percent (w/w). Mice were fed for 6 weeks and then sacrificed. The concentration of total lipids, triglycerides, (LDL + VLDL)-cholesterol, thiobarbituric acid-reactive substances (TBARS) and reduced glutathione were increased in the plasma of mice fed the COCO diet, without changes in phospholipid or total cholesterol concentrations compared to control. The concentrations of total cholesterol, free and esterified cholesterol, triglycerides, and TBARS were increased in the macrophages of COCO-fed mice, while the content of total phospholipids did not change. The phospholipid composition showed an increase of phosphatidylcholine and a decrease of phosphatidylethanolamine. The [ H]-AA distribution in the phospholipid classes showed an increase in phosphatidylcholine and phosphatidylethanolamine. Incorporation of [ H]-cholesterol into the macrophages of COCO-fed mice and into the cholesterol ester fraction was increased. The COCO diet did not affect [ H]-AA uptake but induced an increase in [ H]-AA release. The COCO diet also enhanced AA mobilization induced by lipopolysaccharide. These results indicate that the COCO diet, high in saturated fatty acids, alters the lipid metabolism and AA turnover of peritoneal macrophages in female mice and also produces a significant degree of oxidative stress.

Community-acquired pneumonia: etiology, epidemiology, and outcome at a teaching hospital in Argentina.

OBJECTIVE: To survey the etiology and epidemiology of community-acquired pneumonia (CAP) in relation to age, comorbidity, and severity and to investigate prognostic factors. DESIGN: Prospective epidemiologic study, single center. SETTING: University hospital at Buenos Aires, Argentina. PATIENTS: Outpatients and inpatients fulfilling clinical criteria of CAP. INTERVENTIONS: Systematic laboratory evaluation for determining the etiology, and clinical evaluation stratifying patients into mild, moderate, and severe CAP (groups 1 to 3), a clinical rule used for hospitalization. RESULTS: During a 12-month period, 343 patients (mean age, 64.4 years; range, 18 to 102 years) were evaluated. We found 167 microorganisms in 144 cases (yield, 42%). Streptococcus pneumoniae, the most common pathogen, was isolated in 35 cases (24%). Mycoplasma pneumoniae, present in 19 (13%), was second in frequency in group 1; Haemophilus influenzae, present in 17 cases (12%), was second in group 2; and Chlamydia pneumoniae, present in 12 cases (8%), was second in group 3. Etiology could not be determined on the basis of clinical presentation; identifying the etiology had no impact on mortality. Some findings were associated with specific causative organisms and outcome. A significantly lower number of nonsurvivors received adequate therapy (50% vs 77%). CONCLUSIONS: Age, comorbidities, alcohol abuse, and smoking were related with distinct etiologies. PaO(2) to fraction of inspired oxygen ratio < 250, aerobic Gram-negative pathogen, chronic renal failure, Glasgow score < 15, malignant neoplasm, and aspirative pneumonia were associated with mortality by multivariate analysis. Local microbiologic data could be of help in tailoring therapeutic guidelines to the microbiologic reality at different settings. The stratification schema and the clinical rule used for hospitalization were useful.

Blood cultures have limited value in predicting severity of illness and as a diagnostic tool in ventilator-associated pneumonia.

STUDY OBJECTIVES: To define the usefulness of blood cultures for confirming the pathogenic microorganism and severity of illness in patients with ventilator-associated pneumonia (VAP). DESIGN: Prospective observational study using BAL and blood cultures collected within 24 h of establishing a clinical diagnosis of VAP. SETTING: A 15-bed medical and surgical ICU. PATIENTS: One hundred and sixty-two patients receiving mechanical ventilation hospitalized for > 72 h who had new or progressive lung infiltrate plus at least two of three clinical criteria for VAP. INTERVENTIONS: BAL and blood culture performed within 24 h of establishing a clinical diagnosis of VAP. MEASUREMENTS AND RESULTS: Ninety patients were BAL positive (BAL+), satisfying a microbiological definition of VAP (>/= 10(4) cfu/mL), 72 patients were BAL negative (BAL-). Bacteremia was diagnosed when at least two sets of blood cultures yielded a microorganism or when only one set was positive, but the same bacteria was present at a concentration >/= 10(4) cfu/mL in the BAL fluid. Bacteremia was significantly more frequent in the BAL+ than in the BAL- group (22/90 patients vs 5/72 patients; p = 0.006). In 6 of 22 BAL+ patients with bacteremia, an extrapulmonary site of infection was the source of bacteremia. Sensitivity of blood culture for disclosing the pathogenic microorganism in BAL+ patients was 26%, and the positive predictive value to detect the pathogen was 73%. Factors associated with mortality were age > 50 years, simplified acute physiology score > 14, prior inadequate antibiotic therapy, PaO(2)/fraction of inspired oxygen < 205, and use of H(2) blockers. By multivariate analysis, only the use of prior inadequate antimicrobial therapy (odds ratio [OR], 6.47) and age > 50 years (OR, 5.12) were independently associated with higher mortality. The rate of complications was not different in patients with bacteremia. CONCLUSIONS: Blood cultures have a low sensitivity for detecting the same pathogenic microorganism as BAL culture in patients with VAP. The presence of bacteremia does not predict complications, it is not related to the length of stay, and it does not identify patients with more severe illness. Inadequacy of prior antimicrobial therapy and age > 50 years were the only factors associated with mortality in a multivariate analysis. Blood cultures in patients with VAP are clearly useful if there is suspicion of another probable infectious condition, but the isolation of a microorganism in the blood does not confirm that microorganism as the pathogen causing VAP.