Improvements in the Management of Patients With Generalized Pustular Psoriasis in Spain: Recommendations From a Group of Experts. / Mejoras en la atención al paciente con psoriasis pustulosa generalizada en España: recomendaciones de un grupo de expertos.

This consensus document analyzed the management and emotional journey of patients with GPP (generalized pustular psoriasis), and the desirable course of the disease while detecting critical points and translating them into needs and recommendations. This project was conducted in 3 phases with participation from an advisory committee (n = 8), an expert panel (n = 15) and patients with GPP (n = 6). The patients' disease progression was heterogeneous due to disease variations, different health care models implemented and available resources, and the lack of diagnostic and treatment guidelines. A total of 45 different recommendations have been made to optimize management and address the emotional component of these patients. Five of them stand out for their impact and viability. Therefore, a roadmap of priorities has been made generally available to improve the management of patients with GPP.

Improvements in the Management of Patients With Generalized Pustular Psoriasis in Spain: Recommendations From a Group of Experts. / Mejoras en la atención al paciente con psoriasis pustulosa generalizada en España: recomendaciones de un grupo de expertos.

This consensus document analyzed the management and emotional journey of patients with GPP (generalized pustular psoriasis), and the desirable course of the disease while detecting critical points and translating them into needs and recommendations. This project was conducted in 3 phases with participation from an advisory committee (n=8), an expert panel (n=15) and patients with GPP (n=6). The patients' disease progression was heterogeneous due to disease variations, different health care models implemented and available resources, and the lack of diagnostic and treatment guidelines. A total of 45 different recommendations have been made to optimize management and address the emotional component of these patients. Five of them stand out for their impact and viability. Therefore, a roadmap of priorities has been made generally available to improve the management of patients with GPP.

Efectos psiquiátricos de la hipoxia normobárica intermitente. Un Estudio prospectivo

Introducción: La hipoxia intermitente consiste en la administración de aire reducido en oxígeno por episodios, para lograr hipoxia en sangre, alternados con intervalos de normoxia. Tiene uso terapéutico en varias patologías médicas, pero sus efectos psiquiátricos no han sido estudiados. Se han descrito efectos neurogénicos y en modelos animales puede ayudar a prevenir depresión y ansiedad en respuesta al estrés. Objetivo: Determinar la existencia de efectos psiquiátricos de la hipoxia normobárica intermitente en seres humanos. Método: Estudio prospectivo descriptivo. Se incluyeron pacientes mayores de 18 años, que tuvieran programado un plan de hipoxia normobárica intermitente en la clínica Hipoxykine. Se utilizó una ficha de registro y la escala breve de síntomas (BSI) que fue realizada al inicio, mitad (segunda semana) y finalizado el tratamiento (cuarta semana). Resultados: Se incluyeron 22 participantes (50% mujeres) con una mediana de edad de 46 años. Hubo una reducción del índice global de gravedad del BSI estadísticamente significativo (p <0.05) al comparar tanto la primera como la segunda medición respecto a la final. Respecto al análisis según género, esta diferencia fue estadísticamente significativa (p <0.05) en hombres. Conclusiones: La hipoxia normobárica intermitente no produce ni empeora síntomas psiquiátricos y podría tener potencial terapéutico. Se requieren nuevos estudios prospectivos.

Introduction: Intermittent normobaric hypoxia consists of the administration of air reduced in oxygen by episodes, to achieve hypoxia in blood alternated with intervals of normoxia. It has a role in brain development and neuroprotection. However, in the literature there are only studies in animal models. Objective: To determine the existence of psychiatric effects of intermittent normobaric hypoxia in humans. Method: Prospective descriptive study. We included patients over 18 years of age who had an intermittent normobaric hypoxia plan scheduled at the Hipoxykine clinic. A record sheet and the brief symptom inventory (BSI) were carried out at the beginning, middle (second week) and end of treatment (fourth week). Results: We included 22 participants (50% women) with a median age of 46 years. There was a reduction in the overall severity index of the statistically significant (p <0.05) when comparing both the first and second measurements with respect to the final. Regarding the analysis according to gender, this difference was statistically significant (p <0.05) in men. Conclusions: Intermittent normobaric hypoxia does not produce or worsen psychiatric symptoms. It could have therapeutic potential. Further prospective studies are required.

Hematoma orbitario secundario a cirugía endoscópica nasosinusal / Orbital hematoma secondary to endoscopic sinus surgery

Resumen Durante la cirugía endoscópica nasosinusal, la sección inadvertida y retracción hacia la órbita de la arteria etmoidal anterior (AEA) es el mecanismo habitual del hematoma orbitario (HO); éste se manifiesta con proptosis, dolor y déficit visual potencialmente irreversible. El déficit visual es secundario a isquemia del nervio óptico por aumento de la presión intraocular, siendo suficientes treinta minutos para que ocurra daño visual permanente. Por sus secuelas el tratamiento del HO debe ser rápido y agresivo. Presentamos el caso de un varón de 72 años con diagnóstico de rinosinusitis crónica con pólipos nasales refractaria a tratamiento médico que se sometió a cirugía endoscópica nasal y que desarrolló en el posoperatorio inmediato con un HO. Se manejó precozmente con cantotomía-cantolisis, descompresión orbitaria medial endoscópica y control vascular de la AEA. El paciente evoluciona favorablemente, sin déficit visual. En este artículo se discutirán el diagnóstico y manejo oportunos del hematoma orbitario iatrogénico.

Abstract During endoscopic sinonasal surgery, inadvertent section of the anterior ethmoidal artery (AEA) with retraction into the orbit is the usual mechanism of orbital hematoma (OH), leading to proptosis, pain, and potentially irreversible visual loss. Thirty minutes is sufficient for retinal ischemia and permanent visual loss. The explanation for blindness is due to increased intraorbital pressure. The treatment of iatrogenic HO must be quick and aggressive, because if it is not managed in time, it can cause a permanent visual deficit. We present the case of a 72-year-old man with a diagnosis of chronic rhinosinusitis with nasal polyps refractory to medical treatment who underwent nasal endoscopic surgery, evolving in the immediate postoperative period with an HO, requiring canthotomy - cantolysis and early surgical reintervention for endoscopic medial orbital decompression and vascular control of AEA. The patient evolves favorably, without visual deficit. This article will discuss the timely diagnosis and management of iatrogenic orbital hematoma.

Body dysmorphic disorder in patients with acne: a multicentre study.

BACKGROUND AND OBJECTIVE: Body dysmorphic disorder (BDD) is a mental disorder that is difficult to diagnose, causes a lot of suffering and is more prevalent in dermatology patients than in the general population. Our objective was to screen for possible cases of BDD in patients with acne and to determine the prevalence according to DSM-IV and DSM-5 criteria, as well as to analyse the relationship between dermatological and sociodemographic variables. METHODS: A total of 245 patients diagnosed with acne in 11 dermatological centres in Spain were included in the study by members of the Aragon Psychodermatology Research Group and Spanish Research Group of Psychiatric Dermatology. We used the Body Dysmorphic Disorder Questionnaire (BDDQ) as a screening tool. RESULTS: In our sample, we obtained a prevalence for BDD of 10.6% (95% CI: 7.6-13.6%). The prevalence was the same with DSM-IV or DSM-5 criteria. Possible cases of BDD were predominantly women (P = 0.021), and 56% had non-inflammatory lesions vs. 30% of negative patients (P = 0.002). Positive patients as possible cases of BDD spent more than two hours on average a day worrying about their appearance. Most people only worried about one part of their body (86%), and in 95% of the cases, the part of their body that worried them was the face. The three most frequent compulsive behaviours in patients who screened positive for BDD were mirror checking (90.7%), camouflaging (79.1%) and using make-up (72.1%). CONCLUSIONS: As a consequence of the high prevalence of possible cases of BDD in patients with acne observed in our study, there is a need for dermatologists to screen for BDD so that they can be referred to a mental health unit to confirm the diagnosis and be offered treatment to reduce the progression of psychosocial deterioration and the development of comorbid disorders.

Adenoma pleomorfo originado en pared lateral nasal: reporte de un caso clínico / Pleomorphic adenoma of lateral nasal wall: a case report

RESUMEN El adenoma pleomorfo constituye la neoplasia benigna más frecuente de las glándulas salivales mayores, y puede también presentarse en otros sitios con mucha menor frecuencia como orofaringe, hipofaringe y nasofaringe. El adenoma pleomorfo intranasal es muy infrecuente y los casos descritos en la literatura local se refieren a tumores septales. Se presenta un caso clínico de una paciente que consulta por obstrucción nasal unilateral a derecha asociado a, epistaxis y epífora ipsilateral con estudio imagenológico y biopsia que sugiere adenoma pleomorfo de la pared lateral nasal. Se realiza revisión bibliográfica al respecto.

ABSTRACT The pleomorphic adenoma is the most frequent benign neoplasm of the major salivary glands. It can also present itself in other places with much less frequency such as oropharynx, hypopharynx and nasopharynx. The intranasal pleomorphic adenoma is very unusual and the cases described in the local literature address septal tumors. A clinical case is presented of a patient who consulted for unilateral right nasal obstruction associated with epistaxis and ipsilateral epiphora with imaging study and biopsy suggesting pleomorphic adenoma of the lateral nasal wall. A bibliographic review is made in this regard.

Fasceítis necrotizante cervical: consideraciones para el manejo precoz / Cervical necrotizing fascitis: considerations for early management

RESUMEN La fasceítis necrotizante cervical (FNC) es una infección que afecta la fascia cervical y tejido subcutáneo, diseminándose rápidamente a través de los planos fasciales con una alta tasa de mortalidad. Si bien, las imágenes son una herramienta de apoyo fundamental para el diagnóstico, éste sigue siendo eminentemente clínico, presentando una rápida progresión de síntomas en pocas horas. El objetivo de esta presentación fue identificar factores descritos con peor pronóstico en el diagnóstico precoz de la FNC. Se realizó un estudio descriptivo de serie de casos de pacientes con diagnóstico de FNC en los últimos 10 años en el Servicio de Otorrinolaringología del Hospital Barros Luco Trudeau (HBLT). Se identificaron 5 pacientes, dentro de los cuales, los parámetros clínicos y de laboratorio a destacar fueron el dolor desproporcionado y rápido deterioro de exámenes de laboratorio. En los casos que había signos sugerentes de FNC en la tomografía computarizada, se favoreció el manejo quirúrgico agresivo, mientras que, en quienes no había imágenes sugerentes de FNC, se postergó el diagnóstico y su manejo precoz, provocando un desenlace fatal. La FNC constituye un cuadro grave en el que la sospecha clínica y rapidez de inicio del tratamiento resultan fundamental en el pronóstico.

ABSTRACT Cervical necrotizing fasciitis (CNF) is an infection that affects the cervical fascia and subcutaneous tissue. It is characterized by a rapid dissemination trough the fascial planes, with a high rate of mortality. Even tough imaging results a fundamental diagnostic tool, it is still made by clinic signs with rapid progression of symptoms in few hours. Here, we identify worse prognostic factors in the precocious diagnosis of CNF, from five cases presented in our center. A descriptive case-series study was performed in patients with CNF in the last ten years in the Otolaryngology Department of Barros Luco Trudeau Hospital. Five patients were identified, between the clinical and laboratory parameters. A disproportional pain and rapid deterioration of the laboratory exams were the most highlighted features. In the cases with suggestive signs of CFN in the CT scan, allowed an aggressive surgical management, while in those that had no suggestive images the diagnosis was delayed and therefore their management ended in a fatal outcome. CFN constitutes a severe picture in wich clinical suspicion and a prompt initiation of treatment are fundamental in its prognosis.

Hemangioma cavernoso laríngeo en adultos: reporte de un caso y revisión de la literatura / Cavernous hemangioma of the larynx in adults: case report and literature review

RESUMEN Los hemangiomas son uno de los tumores más frecuentes en cabeza y cuello. Los hemangiomas de laringe se pueden dividir clínicamente en formas infantiles y adultas. En niños es una patología frecuente, mientras que en adultos es muy infrecuente. En adultos, tiene mayor incidencia en hombres y su ubicación más frecuente es supraglótica. Su histología más frecuente es el hemangioma cavernoso (HC), que corresponde a una malformación de origen venoso, con paredes delgadas y vasos dilatados. La presentación más habitual es con disfonía o ronquera de meses o años de evolución y se sospecha mediante la nasofaringolaringoscopía o el estudio de imágenes (TC y/o RM). Existen distintas formas de tratamiento, incluidas la observación, la corticoterapia, la radioterapia, la cirugía láser, la cirugía abierta, etc., sin existir un consenso sobre la mejor opción. Se presenta el caso de un paciente de 43 años con antecedentes de tabaquismo que consultó por una historia de disfonía de un año de evolución. Se diagnosticó mediante nasofaringolaringoscopía y TC de cuello una gran masa supraglótica que se extirpó mediante un abordaje de laringofisura. La biopsia diferida informó un HC.

ABSTRACT Hemangiomas are one of the most frequent head and neck tumors. Clinically, they can be divided into childish and adult forms. In children it is a frequent pathology, whereas in adults it is very rare. In adults, it has a higher incidence in men and its more frequent location is supraglottic. Its most frequent histology is the cavernous hemangioma, which corresponds to a malformation of venous origin, with thin walls and dilated vessels. The most common presentation is with the disphony or hoarseness lasting from months to years of evolution and suspicion is made through nasofibroscopy or the imaging study (CT and / or MRI). There are different forms of treatment, including observation, corticotherapy, radiotherapy, laser surgery, open surgery, etc., without a consensus on the best option. We present the case of a 43 year old male with a history of smoking who consulted for dysphonia of a year of evolution. A large supraglottic mass was diagnosed through nasofibroscopy and CT of the neck, which is removed by a laryngopharyngeal approach. Deferred biopsy reported a cavernous hemangioma.

Use of Neo-melubrina, a banned antipyretic drug, in San Diego, California: a survey of patients and providers.

BACKGROUND: Dipyrone is an antipyretic drug that has been associated with agranulocytosis. It is banned in the United States but is available in Mexico under the name Neo-melubrina. OBJECTIVES: To define the use of Neo-melubrina in the Hispanic population of 2 San Diego, California, community clinics and to determine local physicians' and nurse practitioners' awareness of the drug and its risks. DESIGN: Patient survey and provider survey. PATIENTS: 200 parents of Hispanic pediatric patients. Providers: members of San Diego chapters of the American Academy of Pediatrics, the American Academy of Family Physicians, and the California Coalition of Nurse Practitioners. MAIN OUTCOME MEASURES: Self-reported use of Neo-melubrina by patients, and provider awareness of Neo-melubrina and its most significant side effects. RESULTS: Of the 200 patients, 76 (38.0%) reported a lifetime use of Neo-melubrina. Most (56%) used it for both pain and fever. Most providers were unable to correctly identify why Neo-melubrina might be used or its adverse effects. Physicians answered correctly more often than nurse practitioners and pediatric providers more often than family medicine providers. Providers who trained within 75 miles of the US-Mexico border, who reported a patient population of more than 50% Hispanic, and who were resident physicians at the time of the survey were most likely to answer correctly. CONCLUSIONS: Neo-melubrina has been used by a substantial percentage of Hispanic patients in the community clinics surveyed. Many San Diego health care providers are unaware of this medication and may, therefore, miss opportunities to educate patients about safer alternatives.

Leptospirosis sistémica: una etiología de falla multiorgánica en un caso / Systemic leptospirosis: an etiology of de multiple organ failure in 1 case

Leptospirosis is a world-spread zoonosis that is incidentally acquired by humans. It causes a diphasic febrile illness in which the Weil syndrome is its severest form, with renal, hepatic, clotting and central nervous system involvement. We report a 73 years old male, that was admitted to an intensive care unit with multiple organ failure due to leptospirosis. The clinical picture initially resembled a sepsis due to biliary tract obstruction and was operated, not finding a biliary tract obstruction. Considering the history of a fall to sewed waters, leptospirosis was suspected and treatment with penicillin was started, obtaining a full recovery of the patient

Cholesterol metabolism in rat adrenal gland during reversible endotoxic shock.

The adrenal glands have a crucial role for survival during endotoxic shock. Cholesterol is the obligatory intermediary in corticosteroid biosynthesis; thus any alteration in either the availability of cholesterol or in the ability of the adrenal gland to use cholesterol would have a profound effect on corticosteroid production. We have studied the effect of Escherichia coli endotoxin on cholesterol metabolism, injecting lipopolysaccharide (1.6 mg/100 g body) from E. coli 0111:B4 into the tail vein of male Wistar rat. Previous studies from this laboratory have shown that this dose of lipopolysaccharide induces a reversible endotoxic shock. During reversible endotoxic shock there is an alteration in plasma cholesterol; plasma total-cholesterol levels increase mainly at 6-24 h post-lipopolysaccharide injection, whereas cholesterol in high-density lipoproteins shows no significant variations, except a slight but significant decrease at 24 h. The cholesterol content in adrenal gland is diminished in endotoxemic rat, this decrease is more important at 6-24 h after endotoxin injection. We have also measured the acyl-CoA:cholesterol O-acyltransferase (ACAT) and cholesterol-esterase (CEH) activity during endotoxic shock. ACAT activity decreases after lipopolysaccharide injection. ACAT activity in endotoxemic rats is approximately 35-40% of the activity in control rats. This decrease is due to a defect in the functional capacity of the enzyme, since with exogenous cholesterol there is no significant variation in the ACAT activity. CEH activity, in contrast, increases during endotoxic shock; it shows a maximum (twofold the activity seen in control rats) at 6 h after lipopolysaccharide injection. These results show that lipopolysaccharide injection modifies cholesterol metabolism in plasma and in the adrenal gland, either directly or by mediators.

Adrenal gland function in reversible endotoxic shock.

Because adrenal participation in the defense mechanisms against endotoxic shock is essential for survival, adrenal gland function during reversible endotoxicosis was studied. The injection of E. coli LPS into rats produces an increase in plasma corticosteroids (maximum at 2-4 hr post-endotoxin injection) and ACTH levels (maximum at 2 hr post-endotoxin injection), which return to control values at the recovery phase. Nevertheless, ACTH-induced steroidogenesis in cells isolated from adrenal glands of endotoxemic rats is clearly impaired, even at 2 hr post-endotoxin injection when corticosteroid levels are maximal. During reversible endotoxic shock there is also a depletion of adrenal ascorbic acid (maximum at 2-4 hr post-endotoxin injection) and a decrease in adrenal cytochrome P-450 levels. These data suggest that impairment of the adrenal gland function could involve mechanisms at the receptor level (desensitization by the high plasma ACTH levels or a direct effect of LPS) and/or at post-receptor steps (decrease in adrenal cytochrome P-450 levels related to the diminution in adrenal ascorbic acid content).

Morphological studies of cytotoxic lesions in reversible endotoxic shock.

Reversible endotoxic shock was induced in adult rats by intravenous injection of E. coli 0111:B4 lipopolysaccharide (LPS) and the progression of metabolic and morphological alterations was evaluated. Serum samples and biopsies from adrenal gland, liver and lung were studied at different times after LPS injection. Histological changes in these tissues were observed after endotoxin administration, coinciding with both the acute-phase and the recovery-phase of shock (24-72h after LPS injection). Signs of tissue regeneration can be correlated with the regression of some serum parameters to their normal values. All these results indicate that in this experimental model of endotoxic shock, a reversible status was established, which will allow further studies of the endotoxic pathophysiological mechanisms in vivo, avoiding the complexity of the non-reversible process.

Induction of reversible shock by Escherichia coli lipopolysaccharide in rats. Changes in serum and cell membrane parameters.

Reversible endotoxic shock was induced in adult rats by i.v. injection of Escherichia coli O111:B4 lipopolysaccharide (1.6 mg/100 g). The shock progression was evaluated by measuring serum glucose levels as well as activities of aspartate aminotransferase (GOT) and alkaline phosphatase in serum. A rapid increase of serum glucose levels occurs, after LPS injection, followed by hypoglycaemia (minimum values at 6 h) with progressive reversion to control values. Serum GOT activity increased (twofold) 6 h after endotoxin administration and returned to control values at 72 h. No appreciable changes occurred in serum alkaline phosphatase activity. Endotoxaemia produced a decrease in the cytochrome P-450 levels in all target organs considered: lung, adrenal glands and liver. The progressive decrease in the serum albumin concentration as well as changes of the physical properties of the plasma membranes observed in vivo, can not be explained only by direct interaction of endotoxin with the target organs, underlining the importance of serum mediators in the induction of the shock response.

Measurement of gentamicin by radioimmunoassay.

A sensitive, specific and precise procedure for the measurement of serum gentamicin by radioimmunoassay is presented. The method is rapid, convenient, and highly reliable for this very important measurement. Studies designed to evaluate the validity and reproducibility of the assay are presented and discussed.

Evaluation of serum digoxin and serum cortisol by radioimmunoassay with the Concept-4.

The solid-phase radioimmunoassay procedures for serum digoxin and cortisol with the Concept-4 were evaluated for specificity, correlation with other radioimmunoassay procedures, parallelism, recovery, carryover, and precision. 1. The detection limits of the digoxin and cortisol assays were 10 pg/tube and 40 pg/tube, respectively. These detections correspond to serum concentrations of 0.25 micrograms/liter and 20 micrograms/liter, respectively, for digoxin and cortisol. 2. Specificity of the digoxin assay was characterized by a 18.3% cross reaction with digitoxin. The anti-cortisol with 11-deoxycortisol, cross reaction with 11-deoxycortisol. 3. The values obtained with the Concept-4 for both procedures demonstrated acceptable correlations with other existing RIA procedures. 4. Dilution studies conducted to determine the parallelism of the 2 assays indicated that both assays demonstrated excellent proportionality between the volume of specimen and the quantity of analyte measured. 5. Analytical recoveries of digoxin and cortisol added to the individual assays average 95% and 101%, respectively. 6. Carryover studies indicated a routine sample-to-sample interaction of less than 0.05% for both assays. 7. The digoxin assay routinely demonstrated intra- and inter-assay variations of less than 7.4% and less than 10.0%, respectively. The precision data for cortisol indicated intra- and inter-assay variations of less than 6.7% and less than 9.1%, respectively.

[Endouterine fibrinolytic activity in users of intrauterine devices]. / Actividad fibrinolítica endouterina en usuarias de dispositivos intrauterinos.

PIP: A study of 51 endometrial samples extracted from 142 IUD users was made; 92 of these users had normal menstrual cycles and 50 had polymenorrhea or hypermenorrhea. 71 samples were extracted during menstrual bleeding and 71 during the intermenstrual period. The IUD and endometrial samples were set down in fibrin plaques and maintained at 37 degrees Celsius for 18 hours. The fibrinolytic activity was evaluated in degrees from 0-4. Bacteriologic and histopathologic analysis was made in 13 of 21 endometrial samples extracted in the intermenstrual period from polymenorrheic women. The results obtained were compared considering the average of degrees and the relative frequency of high and low degrees in each group. The results indicate that in the samples obtained during menstrual bleeding, there was no statistically significant difference between the normal bleeding and the hypermenorrheic or polymenorrheic women, but that there are statistically significant differences when the results obtained with samples extracted during the intermenstrual period are compared. The conclusion is that in 78.79% of the cases of polymenorrheic or hypermenorrheic women studied, there exists an increase in the intrauterine fibrinolytic activity. (author's)^ieng