Pilot study: specific immunotherapy in patients with Papular urticaria by Cimex lectularius.

Summary: Background. Papular urticaria is a chronic allergic reaction induced by insect bites. In México the most common causative arthropods reported are bed bugs, fleas and mosquitoes. Approximately 70% of people who are bitten by Cimex lectularius experience hypersensitive reactions, papular urticaria, extensive erythema, urticaria, and even anaphylaxis has been reported, pruritus is the major complaint, impairing quality of life and sleep. Immunotherapy has been used in mosquito bite papular urticaria resulting in improvement of skin lesions and possibly protecting against reactions to subsequent exposures to mosquitoes. Methods. Children, 4-10 years of age, with recurrent papular urticaria due to bedbugs not responsive to multiple treatments were included. An initial allergy assessment included clinical history, skin prick test (SPT), and specific IgE sensitisation was performed to confirmed bedbug sensitization. Twenty children were randomized to receive subcutaneous specific immunotherapy (SSI) with whole body bed bug extract or conventional treatment. The treatment was carried out over twelve months and the response was assessed using the Dermatology Quality of Life Index (DLQ), the immunotherapy satisfaction questionnaire (ESPIA questionnaire) and the 12-Item Pruritus Severity Scale (12-IPSS). The results from both the treated and control groups were compared. Results. The twenty patients were randomized, 12 to receive immunotherapy and 8 to receive conventional treatment for 12 months. Quality of life improved with a reduction in the DLQI score of 19.83 in the immunotherapy group versus 9 in the conventional treatment group (p = 0.03). Itch improved with a reduction in the 12-IPSS of 16.5 in the immunotherapy group versus 9.63 in the conventional treatment group (p = 0.02). After twelve months of treatment, all 12 patients who received immunotherapy, reported a decrease of persistent cutaneous lesions but the 8 on conventional treatment did not. A mean score of 95.75 (SD 3.3) was recorded for satisfaction with immunotherapy. Conclusions. Patients with papular urticaria by Cimex lectularius receiving allergen immunotherapy for 1 year showed a significant improvement compared with baseline and patients receiving conventional treatment regarding skin lesions, quality of life impairment, intensity of pruritus and satisfaction with immunotherapy.

Relationships between abstract features and methodological quality explained variations of social media activity derived from systematic reviews about psoriasis interventions.

OBJECTIVES: The aim of this study was to describe the relationship among abstract structure, readability, and completeness, and how these features may influence social media activity and bibliometric results, considering systematic reviews (SRs) about interventions in psoriasis classified by methodological quality. STUDY DESIGN AND SETTING: Systematic literature searches about psoriasis interventions were undertaken on relevant databases. For each review, methodological quality was evaluated using the assessing the methodological quality of systematic reviews tool. Abstract extension, structure, readability, and quality and completeness of reporting were analyzed. Social media activity, which consider Twitter and Facebook mention counts, as well as Mendeley readers and Google scholar citations were obtained for each article. Analyses were conducted to describe any potential influence of abstract characteristics on review's social media diffusion. RESULTS: We classified 139 intervention SRs as displaying high/moderate/low methodological quality. We observed that abstract readability of SRs has been maintained high for last 20 years, although there are some differences based on their methodological quality. Free format abstracts were most sensitive to the increase of text readability as compared with more structured abstracts (Introduction, Methods, Results, and Discussion or eight headings), yielding opposite effects on their quality and completeness depending on the methodological quality: a worsening in low quality reviews and an improvement in those of high quality. Both readability indices and preferred reporting items of systematic reviews and meta-analyses for Abstract total scores showed an inverse relationship with social media activity and bibliometric results in high methodological quality reviews but not in those of lower quality. CONCLUSION: Our results suggest that increasing abstract readability must be specially considered when writing free format summaries of high-quality reviews because this fact correlates with an improvement of their completeness and quality, and this may help to achieve broader social media visibility and article usage.

Mesenteric venous thrombosis. Associated systemic disorders and hypercoagulability status of 21 surgical patients.

BACKGROUND/AIMS: Mesenteric venous thrombosis (MVT) is a rare condition with a challenging diagnosis. The aim of this study was to evaluate its association with systemic diseases and coagulation disorders. METHODOLOGY: Out of 132 patients operated on because of mesenteric ischemia between 1988 and 2002, all patients with a documented MVT were retrospectively recorded. Epidemiological and clinical data, complications and perioperative mortality were analyzed. RESULTS: Twenty-one patients, 10 male and 11 female, had MVT. Mean age was 63.8 years (SD: +/- 20.9). Arterial hypertension (57.1%) was the most prevalent associated condition. Other associated disorders were neoplasms (3 cases), liver cirrhosis (1 case), recurrent pulmonary thromboembolism (1 case), and one or more coagulation disorders (7 cases): lupus anticoagulant (2 cases); factor V Leiden (2 cases); protein S deficiency (3 cases); antithrombin III deficiency (1 case) and disseminated intravascular coagulation (1 case). Perioperative mortality was 33.3% (7 patients). Mean survival at the end of the study was 65.73 months (EE: 13.82). Patients with a coagulation disorder had a higher survival rate than those presenting without it (p = 0.02). CONCLUSIONS: MVT is still a lethal condition with a high morbidity that could be associated to systemic disorders and hypercoagulability syndromes in more than 50% of the cases.

Hemoperitoneo: una rara complicación de la perforación de la vesícula biliar / Haemoperitoneum: unusual complication of the gallbladder perforation

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¿Se diferencian los partos en clínicas públicas y privadas? / Are deliveries of babies different in public and private clinics?

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[An adrenal carcinoma producing androgens, estrogens and cortisol]. / Carcinoma suprarrenal productor de andrógenos, estrógenos y cortisol.

Carcinoma of the adrenal cortex is a fairly rare entity, usually with a somber prognosis. The efficacy of treatment depends on early prognosis. We are reporting here a case of carcinoma of the adrenal cortex producing androgens, estrogens and cortisol, in which diagnosis was not achieved until two years after the onset of symptoms. Morphologic studies by CT showed local extension and metastases. After mass-reduction surgery, the patient died due to respiratory failure. This case remarks the importance of early diagnosis in this syndrome.

Anastomotic stricture with the EEA-Stapler after colorectal anastomosis.

OBJECTIVE: Analysis of colorectal anastomosis stricture incidence after anterior resection of the rectum performed with the EEA-Stapler. To find out if differences existed in stricture incidence considering factors such, as age, neoplasia, postoperative radiotherapy, tumor stage and anastomic level. DESIGN: Longitudinal descriptive study. PATIENTS AND METHOD: 67 patients who underwent rectal anterior resection using the EEA-Stapler were evaluated. Data from sex, age, indication for operation, postoperative radiotherapy, tumor staging and anastomic level were recorded and compared with presence of stricture anastomosis. Stenosis was evaluated and graded as follows: grade O, no stenosis; grade I, no symptoms, X-ray or endoscopic finding; grade II, symptoms, the patients require ballon catheter dilation; and grade III, invalidant symptoms, the patients require surgery. RESULTS: Twelve patients (20%) were recorded as grade II and 3 patients (5%) as grade III. There were no statistically significant differences between prevalence of stricture and sex, age, neoplasic or non-neoplasic conditions, previous radiotherapy, level of anastomosis, and tumor stage. CONCLUSION: Stenosis after colorectal anastomosis with stapler devices must not be considered as an uncommon complication. In 20% of patients it may be a serious state that may require repeated catheter balloon dilations or surgery. Such condition is not dependent on diverse factors studied.

Colorectal carcinomas: diagnosis and preoperative staging by hydrocolonic sonography.

BACKGROUND: The aim of this study was to determine the sensitivity, specificity, and predictive value of hydrocolonic sonography (HS) in the detection and preoperative staging of colonic carcinomas. METHODS: One hundred four patients referred to our department for colorectal disease were examined in a prospective study with conventional transabdominal sonography followed by HS and other well-established means for detection of colorectal cancer. In all diagnosed colorectal carcinomas, surgical resection and histologic examination were carried out, and the histologically confirmed tumor stage was then compared with the stage predicted by HS. RESULTS: HS staged and made a correct diagnosis of carcinoma in 39 of 40 patients, with a sensitivity of 97.5% and a specificity of 98%. Positive predictability was 97.5% and negative predictability 98%. In the evaluation of cancer depth invasion, HS staging was correct in all but one case, in which a T3 tumor was incorrectly judged to be T2. In the assessment of the presence or absence of peritumor metastatic lymph nodes, HS had a sensitivity of 50% and a specificity of 100%. CONCLUSIONS: HS allows the diagnosis and preoperative staging of colorectal carcinomas with high sensitivity, specificity, and predictive value. We highly recommend its preoperative use because of its definitive influence on surgical approach.

[Torsion of an ectopic spleen as a cause of acute abdomen]. / Torsión de bazo errante como causa de abdomen agudo.

A case of torsion of an ectopic spleen is presented. Diagnosis was obtained by echography, CAT and arteriography. We review the cases reported in literature and discuss the diagnostic and therapeutic problems raised by this rare condition as the cause of acute abdomen as well as for the differential diagnosis of abdominal masses.