Ectima gangrenoso, manifestación cutánea infrecuente de una infección por diversos agentes / Ecthyma gangrenosum, a rare cutaneous manifestation of infection by various agents

El ectima gangrenoso es un trastorno infeccioso infrecuente clásicamente relacionado a bacteriemia, descrito principalmente en poblaciones inmunodeprimidas. El agente más comúnmente relacionado es Pseudomonas aeruginosa, sin embargo, se han descrito otras etiologías bacterianas, hongos filamentosos y levaduras. Su patogénesis está dada por la invasión de la pared de los vasos sanguíneos, causando trombosis arterial y venosa, desencadenando necrosis de epidermis y tejidos subdérmicos. Clínicamente, se manifiesta como máculas, vesículas o pústulas hemorrágicas que evolucionan a úlceras de superficie necrótica rodeadas por un halo eritematoso característico, habitualmente en un contexto clínico de sepsis. El diagnóstico de este cuadro es clínico, sin embargo, el estudio microbiológico es clave en la identificación del agente etiológico y un posterior tratamiento dirigido. En su manejo es esencial una alta sospecha clínica y el inicio de tratamiento antibiótico en forma precoz. La duración del tratamiento es variable y en algunos casos debe asociarse a debridación quirúrgica. El pronóstico es variable dependiendo de múltiples factores: estado inmunológico, agente etiológico, presencia de sepsis y el tiempo de inicio de tratamiento.(AU)

Ecthyma gangrenosum is an infrequent infectious disorder classically related to bacteremia, described mainly in immunosuppressed populations. The most related agent is Pseudomonas aeruginosa, however other bacterial etiologies, filamentous fungi and yeasts have been described. Its pathogenesis is given by the invasion of the blood vessel wall, causing arterial and venous thrombosis, triggering necrosis of epidermis and subdermal tissues. Clinically, it manifests as hemorrhagic macules, vesicles or pustules that evolve into ulcers with a necrotic surface surrounded by a characteristic erythematous halo, usually in a clinical setting of sepsis. The diagnosis of this condition is clinical, however the microbiological study is key in the identification of the etiological agent and a subsequent directed treatment. In its management, a high clinical suspicion and an early start of antibiotic treatment are essential. The duration of treatment is variable and in some cases it must be associated with surgical debridement. The prognosis is variable depending on multiple factors: immunological status, etiological agent, presence of sepsis and time of initiation of treatment.(AU)

[Progress in medical treatment of heart failure]. / Avances en el tratamiento médico de la insuficiencia cardiaca.

Heart failure is one of the most important diseases in the recent years. Because of the advances in the cardiological practice, it can be identified frequently knowing much better pathophysiological mechanism and the investigation of different drugs for the improvement in symptomatology and the functional class of this patients. The first step is taking care about the diet, which it has to be sodium free, a restrictive about intake. The second step is the use of diuretics and digitalis that has been used for many years. About the new treatment in the medical therapy is the point that we analyze in the present work and we think that in the future this alternatives will be much better and incorporated to the basic therapeutics.

[Urinary excretion of N-acetyl-beta-D-glucosaminidase and microglobulin 2 in type I diabetes mellitus]. / Estudio de la eliminación urinaria de N-acetil-beta-D-glucosaminidasa y beta 2 microglobulina en la diabetes mellitus tipo I.

We studied the urinary elimination of two indicators of renal proximal tubular function. N-Acetyl-Gluosaminidase (NAG) and beta 2 microglobulin (beta 2m) in 23 healthy and 67 diabetic children aged 2-15 years and with disease evolution times between 1 month and 12 years. In order to obviate the variations of glomerular filtration present in the diabetes, both proteins were evaluated in the form of indices of excretion (IE). It was found that the diabetic children as a whole presented higher values of NAGIE than the controls (p less than 0.001), and that this increased as the degree of metabolic control worsened, the latter being judged by either fructosamin or HbA C (r = 0.59 for both). The increase in the urinary elimination of NAG had a directly proportional relation with the evolution time of the diabetes. With respect to the beta 2mIE, no significant differences were found on dividing the children according to the degree of metabolic control, although the values did increase with longer evolution times. Thus it may be concluded that NAGIE was shown to be a more useful parameter than beta 2m for evaluating the renal proximal tubular function in infant and juvenile diabetes.