Úlcera vulvar aguda de Lipschütz / Acute vulvar ulcer of Lipschütz

RESUMEN La úlcera de Lipschütz es una entidad poco frecuente e infradiagnosticada. Se presenta el caso de una paciente de 24 años sin antecedente de contacto sexual que consultó por aparición súbita de úlceras vulvares dolorosas, en el contexto de un cuadro pseudogripal. Se discuten los principales diagnósticos diferenciales, dado que es una enfermedad no relacionada con enfermedades de transmisión sexual y poco reconocida por los profesionales de la salud, que precisa de manejo conservador.

ABSTRACT Lipschütz ulcer is a rare underdiagnosed entity. We present the case of a 24-year-old patient without history of sexual contact who consulted for sudden occurrence of painful vulvar ulcers, in the context of flu-like symptoms. The main differential diagnoses are discussed, as it is a disease unrelated to sexually transmitted diseases and little recognized by health professionals, which requires conservative management.

Influence of age on tolerability, safety and effectiveness of subdermal contraceptive implants.

The use of long-acting contraceptive methods is on the rise. The aim of this study was to describe the main variables (effectiveness, tolerability, menstrual bleeding) associated with the use of subdermal contraceptive implants and to investigate the influence of age on these variables. This was a descriptive, retrospective, observational study of 221 cases of contraceptive implants inserted at a Spanish hospital between 2006 and 2015. The mean age of implant users was 31.2 ± 7.5 years. Effectiveness was 100% and good tolerability was recorded for 86.5%. Infrequent bleeding was the most common bleeding pattern, followed by amenorrhoea. Of the 221 implants inserted, 47.5% were removed. The main reasons were expiration (54.3%) and discomfort due to bleeding alterations and other adverse effects (25.7%). Nulliparity and weight gain were significantly associated with an increased probability of implant removal. This study shows that implants were highly effective, safe and well-tolerated in our population. The age of users had no influence on any of the study variables analysed. Impact Statement What is already known on this subject? Subdermal contraceptive implants are long-acting reversible contraceptives which are both safe and effective. What do the results of this study add? The age of users had no influence on any of the study variables analysed. Nulliparity and weight gain were significantly associated with an increased probability of implant removal. What are the implications of these findings for clinical practice and/or further research? Subdermal contraceptive implants were a safe and effective long-acting progestin contraceptive method for women from all age groups in our series because no significant age-related differences were observed for the tolerability, vaginal bleeding patterns, the effectiveness, the adverse effects or any other variables.

Impact of Economic Hardship and Financial Threat on Suicide Ideation and Confusion.

The present study tested the extent to which perceived economic hardship is associated with psychological distress (suicide ideation and confusion) after controlling for personal characteristics. It also explored whether perceived financial threat (i.e., fearful anxious-uncertainty about the stability and security of one's personal financial situation) mediates the relationship between economic hardship and psychological distress outcomes. The theoretical model was tested in a sample of Canadian students (n = 211) and was validated in a community sample of employed Portuguese adults (n = 161). In both samples, the fit of the model was good. Parameter estimates indicated that greater experience of economic hardship increased with financial threat, which in turn increased with levels of suicide ideation and confusion. We discuss the practical implications of these results, such as for programs aimed at alleviating the burden of financial hardship, in our concluding remarks.

Linfoma cervical primario: presentación de un caso y revisión de la literatura / Primary lymphoma of the uterine cervix: a case report and literature review

El linfoma primario cervical es una enfermedad muy infrecuente que se presenta clínicamente como un carcinoma de cérvix. El diagnóstico del linfoma de cérvix requiere una biopsia profunda, ya que la citología puede ser negativa. Aunque no existe consenso en el tratamiento, tradicionalmente se empleaba radioterapia. Sin embargo, últimamente se sugiere realizar tratamiento quimioterápico, pudiendo completarse con cirugía. Se presenta el caso de una paciente con linfoma cervical que requirió varias tomas de biopsia para su diagnóstico y en la que se empleó con éxito quimioterapia neoadyuvante seguida de cirugía (AU)

Primary lymphoma of the uterine cervix is extremely rare and the clinical presentation is similar to that of carcinoma of the cervix. Diagnosis is made with a deep cervical biopsy because smear tests can show false negative results. The standard treatment has not yet been established but used to be radiotherapy. Currently, combination chemotherapy is used with or without surgery. We report a case of cervical lymphoma that needed several biopsies to establish the diagnosis and was successfully treated with neoadjuvant chemotherapy and surgery (AU)

Enfermedad de Chagas y gestación / Chagas’ disease and pregnancy

La enfermedad de Chagas puede transmitirse porvía vertical y transplacentaria en áreas noendémicas. Las migraciones ofrecen la oportunidadde ver enfermedades nuevas en estas zonas, queen muchas ocasiones pueden ser de gran interésdesde el punto de vista diagnóstico y terapéuticoen la gestación. Las principales afectaciones en elrecién nacido recogidas en la bibliografía sonprematuridad, bajo peso al nacimiento y bajapuntuación en la prueba de Apgar. La afectaciónplacentaria no implica afectación fetal en todos loscasos. El tratamiento se ha de posponer a finalizarla gestación por los posibles efectos teratogénicos

Chagas’ disease can be transmitted through verticaltransmission and breast feeding in non-endemicareas. Migration is spreading new diseases in theseareas, which may have diagnostic and therapeuticimplications in pregnancy. The main effects innewborns reported in the literature are prematurity,low birth weight, and low Apgar score. Placentalinvolvement does not imply fetal disease in allcases. Treatment must be postponed until the endof pregnancy due to the possibility of teratogenic effects (AU)