Dermatitis de contacto por proteínas, una entidad poco conocida como enfermedad profesional. A propósito de un caso / Protein Contact Dermatitis, a Little-Known Entity as Occupational Disease. About a case

INTRODUCCIÓN: La dermatitis de contacto por proteínas es una patología infrecuente poco conocida, de curso crónico y recurrente, generalmente en contexto de patología laboral. MÉTODOS: Se informa de un caso de dermatitis de contacto por proteínas en un sujeto adulto. RESULTADOS: Paciente masculino de 42 años, sin antecedentes médicos de importancia. Trabaja en jornada completa como panadero en un supermercado desde hace 5 años. Presenta lesiones no pruriginosas de 20 días de evolución, caracterizadas por placas y pápulas eritematosas, descamativas en ambos antebrazos, que se acompañan de prurito durante el desempeño de su labor (imagen nº 1 y nº 2). Se realiza test de parche estándar que resulta positivo a níquel. El test de parche laboral da positivo a jabón triclosán, desmoldante y harina de trigo. Prick test negativo e IgE específica positiva para harina de trigo en grado moderado. Estos hallazgos son compatibles con diagnóstico de DCP. DISCUSIÓN: Es una patología sub diagnosticada por muchos dermatólogos, por lo cual es fundamental un alto índice de sospecha. Se postula que se daría por una combinación de HS tipo I y IV. Muchos trabajadores están expuestos al contacto con proteínas, siendo los más afectados aquellos que manipulan alimentos. Clínicamente se caracterizan por placas eritematosas, asociado a prurito intenso, en los sitios de contacto con la proteína. El estudio se debe hacer principalmente con pruebas de HS tipo I (prick test e IgE específica). El test de parche es negativo. El tratamiento consiste en evitar el contacto con proteínas y tratamiento tópico (corticoides tópicos o inhibidores de la calcineurina) para bajar inflamación. CONCLUSIONES: Se presenta un caso clínico de paciente con DCP, diagnosticado mediante la anamnesis y pruebas alergológicas cutáneas y no cutáneas, junto con un diagnóstico correcto y oportuno, puesto que la DCP provoca un impacto negativo importante para el trabajador con inactividad laboral prolongada y readecuación en su puesto de trabajo

INTRODUCTION: protein contact dermatitis is a chronic and recurrent, uncommon condition, usually in context of occupational pathology. METHODS: A case of protein contact dermatitis is reported in an adult subject. RESULTS: Male patient 42 years, with no significant medical records. He works full time as a baker in a supermarket since 5 years. He has nonpruritic lesions of 20 days of evolution, characterized by erythematous plaques and papules, scaly on both forearms, accompanied by itching during the course of their job (picture No. 1 and No. 2). Standard patch test is positive to nickel. Patch test positive to triclosan soap, mold release and wheat flour. Negative Prick test and positive specific IgE to wheat flour in moderate degree. These findings are consistent with a diagnosis of protein contact dermatitis. DISCUSSION: By many dermatologists it is a underdiagnosed pathology, so a high rate of suspicion is crucial. It is postulated that it would arise by a HS combination of type I and IV. Many workers are exposed to contact with proteins; food handlers are the most affected workers. Clinically are characterized by erythematous plaques associated with intense itching at the areas in contact with the protein. The study should be done primarily with type I HS tests (prick test and specific IgE). The patch test is negative. The treatment involves avoiding the contact with protein and topical treatment (topical corticosteroids or calcineurin inhibitors) in order to lower inflammation. CONCLUSIONS: clinical case of a patient with protein contact dermatitis is presented, diagnosed by anamnesis and skin and non-skin allergological tests, emphasizing the importance of an accurate and proper diagnosis. The PCD causes a significant negative impact for the worker with prolonged inactivity and adjustments in the workplace

Sensibilidad y especificidad de pruebas inmunocromatográficas utilizadas en el nuevo algoritmo de diagnóstico de VIH en Bolivia / Sensitivity and specificity of inmunocromatographic tests used in the new algorithm of HIV diagnosis in Bolivia

OBJETIVO: evaluar la sensibilidad y especificidad de dos pruebas rápidas utilizadas en el nuevo algoritmo de diagnóstico de VIH en Bolivia, Alere Determine TM HIV 1/2 como prueba de tamizaje y Uni-Gold TM HIV como prueba confirmatoria. MÉTODOS: estudio descriptivo, no experimental. Se utilizaron 60 muestras de suero provenientes de diferentes establecimientos de salud de Cochabamba con resultados reactivos para VIH, enviadas a LABIMED desde enero a junio de 2016 para confirmación. Las 60 muestras (27 positivas y 33 negativas para VIH) fueron procesadas con Alere Determine TM HIV 1/2 y Uni-Gold TM HIV. RESULTADOS: alere Determine TM HIV 1/2 presentó una sensibilidad del 100% y una especificidad del 54,5%. Uni-Gold TM HIV reportó una especificad del 97% y una sensibilidad del 92,6% Conclusiones: la sensibilidad de Alere Determine TM HIV 1/2 cumplió con el criterio del Ministerio de Salud y Deportes de Bolivia (Prueba rápida de tamizaje debe tener una sensibilidad ≥ 99,8%). La especificidad de Uni-Gold TM HIV en este estudio no alcanzó el criterio de especificidad del Ministerio (Prueba rápida de confirmación debe tener una especificidad ≥ 99,9%).

OBJECTIVE: to evaluate the sensitivity and specificity of the two rapid tests used in the new algorithm of HIV diagnosis in Bolivia, Alere DetermineTM HIV 1/2 as a screening test and Uni-Gold TM HIV as a confirmatory test. METHODS: this is a descriptive and non-experimental study. Sixty serum samples were used with reactive results for HIV from different health establishments in Cochabamba sent to LABIMED from January to June 2016 for HIV confirmation. The 60 samples (27 positive and 33 negative for HIV) were tested with Alere DetermineTM HIV 1/2 and Uni-GoldTM HIV. RESULTS: Alere DetermineTM HIV 1/2 presented a sensitivity of 100 % and a specificity of 54,5%. Uni-GoldTM HIV reported a sensitivity of 92,6% and a specificity of 97%. Conclusions: the sensitivity of Alere Determine TM HIV 1/2 fulfilled the criteria of the Ministry of Health and Sports of Bolivia (rapid screening test must have a sensitivity ≥ 99.8%). The specificity of Uni-GoldTM HIV in this study did not fulfill the Ministry's specificity criterion (rapid confirmation test must have a specificity ≥99.9%).

Comparación del algoritmo nuevo con el algoritmo convencional para diagnóstico de VIH en Bolivia / Comparison of new algorithm with the conventional algorithm for diagnosis of HIV in Bolivia / Comparação do novo algoritmo com o algoritmo convencional para o diagnóstico do HIV na Bolívia

En Bolivia, el algoritmo diagnóstico convencional para VIH utiliza como prueba confirmatoria el Western blot; debido a dificultades con el costo, tiempo y centralización del diagnóstico confirmatorio, el Programa Nacional ITS/VIH/SIDA-HV propuso un algoritmo nuevo que utiliza solo dos pruebas rápidas y ELISA Ag/Ac. Sesenta muestras de suero fueron procesadas con ambos algoritmos y se determinó el resultado verdadero de las muestras de acuerdo con ambos algoritmos y la carga viral. La sensibilidad, especificidad, valores predictivos, índice Kappa y chi-cuadrado de Pearson fueron calculados. El algoritmo convencional reportó: sensibilidad 96,3%, especificidad 100%, valor predictivo positivo 100% y valor predictivo negativo 97% el algoritmo nuevo presentó sensibilidad, especificidad, valores predictivos positivo y negativo del 100%. El índice Kappa fue 0,966 y chi-cuadrado de Pearson 56,078 con p<0,01; es así que el grado de concordancia entre ambos algoritmos es "muy bueno" y estadísticamente significativo. Aunque el número de muestras procesadas en este estudio fue reducido, el algoritmo nuevo parece ser mejor que el convencional debido a que acorta el tiempo de detección de VIH y reporta resultados iguales a la carga viral.

In Bolivia, the conventional diagnostic algorithm for HIV uses Western blot as a confirmatory test. Due to difficulties with cost, time and centralization of the confirmatory diagnosis, the National STI/HIV/AIDS-HV Program proposed a new algorithm, which uses only two rapid tests and ELISA Ag/Ac. A total of 60 serum samples were processed with both algorithms and the true result of the samples was determined according to the results of both algorithms and viral load. Sensitivity, specificity, predictive values, Kappa and chi-square Pearson index were determined. The conventional algorithm reported sensitivity of 96,3%, specificity of 100%, positive predictive value of 100 % and negative predictive value of 97%. The new algorithm presented sensitivity, specificity, positive and negative predictive values of 100%. The Kappa index was 0.966 and chi-square Pearson 56.078 with p <0.01, so the degree of agreement between both algorithms is "very good" and statistically significant. Although the number of samples processed in the present work was reduced, the new algorithm seems to be better than the conventional algorithm because it shortens the period in the detection of HIV and reports results equal to the viral load.

Na Bolívia, o algoritmo de diagnóstico convencional para HIV usa como teste de confirmação o Western blot; devido a dificuldades com custo, tempo e centralização do diagnóstico de confirmação, o Programa Nacional de ITS/HIV/AIDS-HV propôs um algoritmo que usa apenas dois testes rápidos e ELISA Ag/Ac. Foram processadas 60 amostras de soro com ambos os algoritmos e o resultado verdadeiro das amostras foi determinado de acordo com os algoritmos e a carga viral. A sensibilidade, especificidade, valores preditivos, índice de Kappa e qui-quadrado de Pearson foram calculados. O algoritmo convencional reportou: sensibilidade 96,3%, especificidade 100%, valor preditivo positivo 100% e valor preditivo negativo 97%, o novo algoritmo apresentou sensibilidade, especificidade, valores preditivos positivo e negativo de 100%. O índice Kappa foi 0.966 e qui-quadrado de Pearson 56.078 com p<0.01, de modo que o grau de concordância entre os algoritmos é "muito bom" e estatisticamente significativo. Embora o número de amostras processadas neste estudo tenha sido pequeno, o novo algoritmo parece ser melhor do que o convencional porque reduz o tempo de detecção do HIV e relata resultados iguais à carga viral.

Eruptive Facial Postinflammatory Lentigo: Clinical and Dermatoscopic Features.

The face has not been considered a common site of fixed drug eruption, and the authors lack dermatoscopic studies of this condition on the subject. The authors sought to characterize clinical and dermatoscopic features of 8 cases of an eruptive facial postinflammatory lentigo. The authors conducted a retrospective review of 8 cases with similar clinical and dermatoscopic findings seen from 2 medical centers in 2 countries during 2010-2014. A total of 8 patients (2 males and 6 females) with ages that ranged from 34 to 62 years (mean: 48) presented an abrupt onset of a single facial brown-pink macule, generally asymmetrical, with an average size of 1.9 cm. after ingestion of a nonsteroidal antiinflammatory drugs that lasted for several months. Dermatoscopy mainly showed a pseudonetwork or uniform areas of brown pigmentation, brown or blue-gray dots, red dots and/or telangiectatic vessels. In the epidermis, histopathology showed a mild hydropic degeneration and focal melanin hyperpigmentation. Melanin can be found freely in the dermis or laden in macrophages along with a mild perivascular mononuclear infiltrate. The authors describe eruptive facial postinflammatory lentigo as a new variant of a fixed drug eruption on the face.

Manejo despigmentante de vitiligo generalizado con monobenzil eter de hidroquinona / Depigmenting management of generalized vitiligo with hydroquinone monobenzyl ether

El vitiligo es una patología crónica, recidivante y difícil de tratar. El objetivo primario del tratamiento es inducir la repigmentación, sin embargo, en casos extensos refractarios a tratamiento, se puede realizar despigmentación para corregir la discromía. Dentro de los tratamientos despigmentantes en vitiligo, a la fecha el único aprobado por la FDA es el Monobenzil éter de hidroquinona (monobenzona). Se expone el caso de una paciente con vitiligo extenso y refractario a tratamiento que fue manejado con monobenzona. El resultado fue exitoso durante tiempo prolongado, con recaída parcial al suspender el medicamento. La recaída remitió con el reinicio de la monobenzona. Sin nueva recaída actualmente con tratamiento de mantención 3v/semana. La monobenzona induce acromía secundaria a necrosis de los melanocitos. Se requiere su uso 1 a 2 veces al día por 6-12 meses para lograr la despigmentación. En pacientes adecuadamente seleccionados, es una alternativa válida para el manejo del vitiligo. Se presenta un caso exitoso de despigmentación con monobenzona. Actualmente, la paciente está muy satisfecha con los resultados.

Vitiligo is a chronic, recurrent pathology, difficult to treat. The primary goal of treatment is to induce repigmentation, however, in extensive cases refractory to treatment depigmentation of surrounding skin may be performed to correct the cosmetic misbalance. To date the only depigmenting treatment for vitiligo approved by the FDA is the hydroquinone monobenzyl ether (monobenzone). We report the case of a patient with extensive vitiligo refractory to treatment managed with monobenzone. The result was successful for a long time, with partial relapse when the drug was discontinued. The relapse ended with the restart of the monobenzone. No new relapse seen with maintenance treatment 3 times a week. Monobenzone induces acromy due to melanocyte necrosis. To achieve depigmentation, it is used 1 to 2 times a day for 6 to 12 months. In adequately selected patients, it is a valid alternative for the management of vitiligo. A successful case of monobenzone depigmentation in dyschromia due to extensive vitiligo. Patient currently very satisfied with the results.

Suction-assisted lipectomy fails to improve cardiovascular metabolic markers of disease: a meta-analysis.

BACKGROUND: The purpose of this study was to determine whether suction-assisted lipectomy (SAL) decreases the incidence of early cardiovascular disease risk factors or its biochemical and clinical risk indicators. METHODS: A systematic review of the literature was performed by conducting a predefined, sensitive search in MEDLINE without limiting the year of publication or language. The extracted data included the basal characteristics of the patients, the surgical technique, the amount of fat extracted, the cardiovascular risk factors and the biochemical and clinical markers monitored over time. The data were analysed using pooled curves, risk ratios and standardised means with meta-analytical techniques. RESULTS: Fifteen studies were identified involving 357 patients. In all of the studies, measurements of predefined variables were recorded before and after the SAL procedure. The median follow-up was 3 months (interquartile range (IQR) 1-6, range 0.5-10.5). The mean amount of extracted fat ranged from 2063 to 16,300 ml, with a mean ± standard deviation (SD) of 6138 ± 4735 ml. After adjusting for time and body mass index (BMI), leptin and fasting insulin were the only markers that were significantly associated with the amount of aspirated fat. No associations were observed for high sensitive C-reactive protein (hCRP), interleukin-6 (IL-6), adiponectin, resistin, tumour necrosis factor-α (TNF-α), Homeostasis Model of Assessment (HOMA), total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides, free fatty acids or systolic blood pressure. CONCLUSIONS: Based on the results of our analysis, we conclude that there is no evidence to support the hypothesis that subcutaneous fat removal reduces early cardiovascular or metabolic disease, its markers or its risk factors.

Índice cintura estatura como predictor de riesgo de hipertensión arterial en población adulta joven: ¿Es mejor indicador que la circunferencia de cintura?

El objetivo de este estudio fue estimar la asociación entre los valores de circunferencia de cintura (CC) y del índice cintura estatura (C/E) con la presión arterial (PA) y determinar cual de estos indicadores presenta la mejor asociación en una población adulta joven de una zona semi-rural de Chile. Se realizó un estudio transversal analítico en 998 personas entre 22 y 28 años nacidas en el Hospital de Limache, V Región del país quienes fueron encuestados sobre antecedentes socioeconómicos y familiares, junto con mediciones de PA y antropometría entre los años 2000 y 2003. Se realizó un modelo de regresión lineal de asociación univariada entre distintas variables de control y PA; luego se construyó un modelo entre CC y C/E con PA con ajuste por variables de control. El promedio de PA fue 114,6/72,5 mmHg (± 13,5/8,8), CC 83,9 cm (±11,3), C/E 0,52 (±0,07). La edad, sexo masculino, peso, talla y consumo de alcohol aumentaron la PA (p<0,05), la escolaridad en cambio la disminuyó (p<0,05). Se obtuvo una asociación directa entre CC y PA (β=0,27 para la PAS y 0,33 para la PAD) y entre C/E y PA (β=32,7 para PAS y 23,9 para PAD) (p<0,01). Al ajustar, esta asociación disminuye pero persiste significativa y es similar entre CC con la PA en comparación con C/E y PA (R2 0,20 y 0,37 para PAS; 0,20 y 0,36 para PAD respectivamente). En nuestra población la CC y C/E se asociaron significativamente con la PA, con una fuerza similar entre ambas.

Waist: height ratio as a predictor of risk of hypertension in young adults: Is it better indicator that waist circumference?. The objective was to determine the association between values of waist circumference (WC) and waist: height ratio (W/H) with blood pressure (BP) and to estimate which of these indicators present the best association with BP in a young adult population of a semi-rural area of Chile. We performed a cross sectional study in 998 people between 22 and 28 years, born in the Limache Hospital, V Region of the country who were surveyed for socioeconomic and family background, BP and anthropometric measurements were also taken during 2000 and 2003. Linear regression model was apply between control variables and BP, then models between WC and W/H and BP were built adjusting by control variables. The mean of BP was 114,6 / 72,5 mmHg (± 13,5/8,8), WC 83,9 cm (± 11,3), W/H 0,52 (± 0,07). Age, being male, weight, height and alcohol consumption increased the BP (p < 0,05), scholarity instead decreased it (p <0,05). A direct association was observed between WC and BP (β = 0,7for SBP and 0,33 for DBP) and between W/H and BP (β = 32,75 for SBP and 23,90 for DBP) (p <0.01). These association decreases but remain significant after adjustement. There was a similar association between WC with BP compared with W/H (R2 0,20 and 0,37 for SBP; 0,20 y 0,36 for DBP respectively). In our population WC and W/H were significantly associated with BP, with a similar force between them.

[Relationship of consumption of high glycemic index food in the diet and levels of HbA1c in type 2 diabetic patients treated with diet and/or metformin]. / Relación del consumo de alimentos de alto indice glicémico en la dieta y los niveles de HbA1c en individuos diabéticos tipo 2 en tratamiento con dieta y/o metformina.

At present there is still no clear consensus on recommendations on the use of GI of foods for the dietary management of T2DM. Rather different entities propose the use of carbohydrate counting, because there is not even enough evidence for dietary planning based on this index. The aim of this study was to relate consumption of high GI food with glycemic control of type 2 diabetes patients from the cardiovascular health program of 3 CESFAM (Family Health Centers) in Santiago, Chile. Forty individuals were selected, anthropometric measurements were conducted as well as a modified poll of frequency of food consumption of 30 days. Data from GI, GL, number of servings with high GI consumed per day and total amount of CARB consumed per day. Correlations were determined with values of HbA1c of the last 3 month obtained from the medical record. The average age was 58.6 +/- 9.5 years. The percentage of obesity was 62.5% and the average BMI was 32.5. The average HbA1c value was 7.08 +/- 1.6, for HbA1c < 7% it was 57.5%. The total amount of CARB ingested/day was 403.8 g. The average of GI and GL was 78.5 and 317.5 respectively. The total number of servings of food with high GI ingested per day was 21.8. There was a statistically significant correlation between HbA1c and number of servings with high GI (r = 0.56 p = 0.002). For the remaining variables there was no statistically significant correlation (p > 0.05). For each extra serving of high GI food there was an increase of 0.9% of HbA1c. In our research population the amount of food with high GI ingested per day was significantly correlated with values of HbA1c.

[Waist:height ratio as a predictor of risk of hypertension in young adults: is it better indicator that waist circumference]. / Indice cintura estatura como predictor de riesgo de hipertensión arterial en población adulta joven: ¿Es mejor indicador que la circunferencia de cintura?

The objective was to determine the association between values of waist circumference (WC) and waist: height ratio (W/H) with blood pressure (BP) and to estimate which of these indicators present the best association with BP in a young adult population of a semi-rural area of Chile. We performed a cross sectional study in 998 people between 22 and 28 years, born in the Limache Hospital, V Region of the country who were surveyed for socioeconomic and family background, BP and anthropometric measurements were also taken during 2000 and 2003. Linear regression model was apply between control variables and BP, then models between WC and W/H and BP were built adjusting by control variables. The mean of BP was 114.6/72.5 mmHg (+/- 13.5/8.8), WC 83.9 cm (+/- 11.3), W/H 0.52 (+/- 0.07). Age, being male, weight, height and alcohol consumption increased the BP (p < 0.05), scholarity instead decreased it (p < 0.05). A direct association was observed between WC and BP (beta = 0.7 for SBP and 0.33 for DBP) and between W/H and BP (beta = 32.75 for SBP and 23.90 for DBP) (p < 0.01). These association decreases but remain significant after adjustement. There was a similar association between WC with BP compared with W/H (R2 0.20 and 0.37 for SBP; 0.20 and 0.36 for DBP respectively). In our population WC and W/H were significantly associated with BP, with a similar force between them.

Is the Androgen Deficiency of Aging Men (ADAM) questionnaire useful for the screening of partial androgenic deficiency of aging men?

BACKGROUND: Androgen serum levels significantly decrease in older men, causing quality of life impairment and increasing the risk of chronic disease. This disorder is defined as PADAM (Partial Androgen Deficiency of Aging Men). OBJECTIVE: To evaluate a PADAM screening tool and determine the prevalence of this disorder in healthy adult men. METHODS: This was a cross-sectional study in which 96 men aged 40 or more of the South Metropolitan Region of Santiago de Chile were surveyed with the Androgen Deficiency of Aging Men (ADAM) questionnaire of the Saint Louis University and sampled for the serum determination of total testosterone, sexual hormone binding globulin (SHBG) and albumin. Also free and bioavailable testosterone were calculated. PADAM was considered present if items 1 or 7 or any 3 other questions of the ADAM questionnaire were positive. An available testosterone of <198.4 ng/dL was used as a gold standard for the diagnosis of PADAM. RESULTS: A total of 78 men (81.3%) were identified as possible PADAM according to the ADAM questionnaire. Total testosterone levels fell from 503.6+/-180.1 ng/dL in men aged 40 to 54 years to 382.1+/-247.3 in those >70 years; however this was not statistically significant (ANOVA, p=0.06). In the same age groups, SHBG significantly increased (31.0+/-15.0 to 47.5+/-15.0 nmol/L, p<0.001) whereas free and available testosterone significantly decreased (10.6+/-3.2 to 6.4+/-3.6 ng/dL and 266.6+/-81.2 to 152.2+/-97.6 ng/dL, respectively, p<0.0001). Overall (n=96), available testosterone confirmed PADAM diagnosis in 27 cases (28.1%). The ADAM tool rendered a 83.3% sensitivity and 19.7% specificity in the detection of PADAM. Item 1 (decreased sexual desire) was a better predictor of hypogonadism than the complete questionnaire (63.3% sensitivity and 66.7% specificity). CONCLUSION: In this series, in accordance to available testosterone, the prevalence of PADAM was determined to be high, in which the ADAM questionnaire rendered a low diagnostic efficiency. PADAM diagnosis could be clinically suspected when symptoms of sexual dysfunction are present.