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INTRODUCTION: We describe a series of pediatric cases of bacteremia, all of them with a history of heart disease, use of central venous catheter and coinfections. A review of the published literature was carried out in order to enrich the available information. MATERIAL AND METHODS: Pediatric observational retrospective study in which three cases of catheter-related bloodstream infection due to Chryseobacterium indologenes were reported in a period of two years in a tertiary care hospital. The analysis was performed with the cases previously reported in the literature. RESULTS: Three cases were reported in our center in a period of two years. We found 26 cases reported in the literature. Overall mortality was 26.92% (7/26). CONCLUSIONS: This microorganism with characteristics of multidrug resistance is associated with the use of medical devices in hospitalized patients. Early identification of this pathogen is crucial to starting treatment.
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INTRODUCTION: Surgery is performed more frequently now at days, due to the increasing incidence of melanoma and no-melanoma skin cancer. There are different opinions among dermatologic surgeons between to continue or discontinue antithrombotic therapy prior to the procedure, which increases the risk of thromboembolic events. Prophylaxis with oral antibiotics in the postsurgical period is controversial. OBJECTIVE: To report the safety of surgery without suspending antithrombotic therapy and without oral antibiotic prophylaxis in dermatology surgery of patients with multiple comorbidities and polypharmacy. METHOD: We designed a retrospective study. We included a total of 655 patients; 96.6% had at least one comorbidity; 27.7% used aspirin and 4.3% some type of antithrombotic therapy. The most common type of skin tumor was basal cell carcinoma with 69.8. RESULTS: The complication rate was 4.2%; the most was wound dehiscence (1.1%), followed by partial necrosis (0.9%), infection (0.9%), reaction to foreign body (0.6%), complete necrosis (0.3%), bleeding (0.2%) and fistulae (0.2%). CONCLUSIONS: Based on the literature and our experience, dermatologic surgery is safe without suspending antithrombotic therapy or antibiotic prophylaxis in patients with multiple comorbidity.
INTRODUCCIÓN: La cirugía es uno de los procedimientos que se realizan con mayor frecuencia en dermatología debido a la mayor incidencia de cáncer de piel melanoma y no melanoma. Se han encontrado distintas posturas entre los cirujanos dermatólogos sobre continuar o suspender antiagregantes y anticoagulantes antes del procedimiento, lo cual incrementa el riesgo de eventos tromboembólicos, además de la preferencia de utilizar profilaxis antibiótica de forma posquirúrgica por algunos dermatólogos. OBJETIVO: Reportar nuestra experiencia en cuanto a la seguridad de la cirugía dermatológica sin la suspensión de anticoagulantes/antiagregantes y sin profilaxis antibiótica en pacientes con múltiple comorbilidad y polifarmacia. MÉTODO: Se revisaron 655 pacientes. El 96.6% tenían al menos otra enfermedad. El 27.7% utilizaba ácido acetilsalicílico y el 4.3% algún tipo de anticoagulante. El tipo de neoplasia más frecuente fue el carcinoma basocelular con 69.8%. RESULTADOS: La tasa total de complicaciones fue del 4.2%. La complicación más frecuente fue la dehiscencia de la herida (1.1%), seguida de la necrosis parcial (0.9%), la infección (0.9%), la reacción a cuerpo extraño (0.6%), la necrosis total (0.3%), la hemorragia (0.2%) y la fístula cutánea (0.2%). CONCLUSIONES: Basándonos en la literatura y nuestra experiencia, la cirugía dermatológica es segura sin suspender antitrombóticos ni indicar profilaxis antibiótica en pacientes con múltiple comorbilidad.
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Anticoagulantes/uso terapêutico , Melanoma/cirurgia , Inibidores da Agregação Plaquetária/uso terapêutico , Complicações Pós-Operatórias/epidemiologia , Neoplasias Cutâneas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hospitais , Humanos , Incidência , Masculino , Melanoma/complicações , Pessoa de Meia-Idade , Estudos Retrospectivos , Neoplasias Cutâneas/complicações , Fatores de Tempo , Adulto JovemRESUMO
BACKGROUND: Connective tissue autoimmune diseases (CTADs) constitute a group of conditions, including rheumatoid arthritis; systemic lupus erythematosus; mixed connective tissue disease; calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia (CREST) syndrome; scleroderma; dermatomyositis; and Sjögren syndrome. There are few studies on the alterations in filiform papillae in CTAD. Thus, the objective of this work was to determine whether there are changes in the macroscopic and dermoscopic patterns of filiform papillae. METHODS: This case-control study included patients who were diagnosed with CTAD. The dependent variable was the dermoscopic pattern of filiform papillae of the tongue, and the independent variables were age, gender, time of evolution, and current treatment. A photograph of the back of the tongue was taken, and subsequently, the same site was examined by dermatoscopy. The microscopic and dermoscopic patterns of filiform papillae were classified (Maeda). RESULTS: We included 50 cases and 50 controls, 94% of whom were female. The mean age was 43.96 ± 14.65 years. Of the cases with CTAD, 25% presented with a normal macroscopic pattern, versus 36% (18) with pattern II, 12% (6) with pattern III, and 20% (10) with pattern IV. The dermoscopic pattern was type I in 23 cases (46%), type II in 16 (32%), type III in 10 (20%), and type IV in one patient (2%). CONCLUSIONS: We have noted alterations in filiform papillae in CTADs, which emphasizes the importance of a detailed intraoral exploration and the macroscopic and dermoscopic evaluation of the dorsum of the tongue, specifically the filiform papillae.
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Doenças Autoimunes/diagnóstico por imagem , Doenças do Tecido Conjuntivo/diagnóstico por imagem , Dermoscopia , Língua/diagnóstico por imagem , Adolescente , Adulto , Idoso , Estudos de Casos e Controles , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
Introduction: Surgery is performed more frequently now at days, due to the increasing incidence of melanoma and no-melanoma skin cancer. There are different opinions among dermatologic surgeons between to continue or discontinue antithrombotic therapy prior to the procedure, which increases the risk of thromboembolic events. Prophylaxis with oral antibiotics in the postsurgical period is controversial. Objective: To report the safety of surgery without suspending antithrombotic therapy and without oral antibiotic prophylaxis in dermatology surgery of patients with multiple comorbidities and polypharmacy. Method: We designed a retrospective study. We included a total of 655 patients; 96.6% had at least one comorbidity; 27.7% used aspirin and 4.3% some type of antithrombotic therapy. The most common type of skin tumor was basal cell carcinoma with 69.8% . Results: The complication rate was 4.2%; the most was wound dehiscence (1.1%), followed by partial necrosis (0.9%), infection (0.9%), reaction to foreign body (0.6%), complete necrosis (0.3%), bleeding (0.2%) and fistulae (0.2%). Conclusions: Based on the literature and our experience, dermatologic surgery is safe without suspending antithrombotic therapy or antibiotic prophylaxis in patients with multiple comorbidity.
Introducción: La cirugía es uno de los procedimientos que se realizan con mayor frecuencia en dermatología debido a la mayor incidencia de cáncer de piel melanoma y no melanoma. Se han encontrado distintas posturas entre los cirujanos dermatólogos sobre continuar o suspender antiagregantes y anticoagulantes antes del procedimiento, lo cual incrementa el riesgo de eventos tromboembólicos, además de la preferencia de utilizar profilaxis antibiótica de forma posquirúrgica por algunos dermatólogos. Objetivo: Reportar nuestra experiencia en cuanto a la seguridad de la cirugía dermatológica sin la suspensión de anticoagulantes/antiagregantes y sin profilaxis antibiótica en pacientes con múltiple comorbilidad y polifarmacia. Método: Se revisaron 655 pacientes. El 96.6% tenían al menos otra enfermedad. El 27.7% utilizaba ácido acetilsalicílico y el 4.3% algún tipo de anticoagulante. El tipo de neoplasia más frecuente fue el carcinoma basocelular con 69.8%. Resultados: La tasa total de complicaciones fue del 4.2%. La complicación más frecuente fue la dehiscencia de la herida (1.1%), seguida de la necrosis parcial (0.9%), la infección (0.9%), la reacción a cuerpo extraño (0.6%), la necrosis total (0.3%), la hemorragia (0.2%) y la fístula cutánea (0.2%). Conclusiones: Basándonos en la literatura y nuestra experiencia, la cirugía dermatológica es segura sin suspender antitrombóticos ni indicar profilaxis antibiótica en pacientes con múltiple comorbilidad.
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Anticoagulantes/efeitos adversos , Carcinoma Basocelular/cirurgia , Carcinoma de Células Escamosas/cirurgia , Melanoma/cirurgia , Inibidores da Agregação Plaquetária/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Neoplasias Cutâneas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibioticoprofilaxia , Anticoagulantes/uso terapêutico , Comorbidade , Feminino , Humanos , Incidência , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Inibidores da Agregação Plaquetária/uso terapêutico , Hemorragia Pós-Operatória/induzido quimicamente , Hemorragia Pós-Operatória/epidemiologia , Estudos Retrospectivos , Deiscência da Ferida Operatória/epidemiologia , Tromboembolia/epidemiologia , Tromboembolia/prevenção & controle , Adulto Jovem , Melanoma Maligno CutâneoRESUMO
BACKGROUND: Scalp involvement is not directly evaluated in patients with dermatomyositis (DM). Therefore, the exact frequency of scalp dermatomyositis (SDM) and its clinical and trichoscopic characteristics have been poorly described. OBJECTIVE: The aim of this study was to determine the frequency and clinical and dermoscopic features of SDM in patients diagnosed with DM. METHODS: We performed a descriptive prospective, cross-sectional observational study that included all patients diagnosed with DM at a Mexican academic institute over the course of a year. RESULTS: Twenty-four out of 31 patients with DM had scalp involvement at clinical examination, with a prevalence of 77.4%. SDM was clinically characterized by erythema in all cases, scales in 20 (83.3%) patients, nonscarring alopecia in 21 (87.5%) patients, pruritus in 17 (70.8%) patients, and poikiloderma of the scalp in 16 (51.6%) patients. Twenty-eight patients were evaluated by trichoscopy. The most consistent finding was the presence of enlarged capillaries, found in 20 (71.4%) cases, followed by peripilar casts (57.1%) and tufting and interfollicular scales in 14 (50%) cases. Twenty-two patients also had positive nail fold capillaroscopic features similar to those observed by trichoscopy. LIMITATIONS: The simple size was limited. CONCLUSIONS: Scalp involvement and alopecia are common in patients with DM, and trichoscopy shows features similar to those found at capillaroscopy. Trichoscopy is a very important tool for diagnosis of scalp involvement in patients with DM.
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The proliferation of Pacinian corpuscles is a rare benign lesion that occurs frequently in the fingers of hands, with the only clinical sign of pain when a drastic temperature change happens. A case of an extremely rare lesion in which we observed hypertrophy and hyperplasia of Pacinian corpuscles has been reported.
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Dermatoses da Mão/patologia , Corpúsculos de Pacini/patologia , Feminino , Dedos , Humanos , Hiperplasia/patologia , Hipertrofia/patologia , Pessoa de Meia-IdadeRESUMO
Uno de los pilares fundamentales en el tratamiento conservador de las fracturas diafisarias del húmero ha sido el uso del yeso colgante como método de inmovilización, por lo que se decició aplicar dicho tratamiento en un paciente después de haber realizado el diagnóstico de dicha afección. Se evaluó la eficacia del método empleado a través del seguimiento periódico de la evolución clínica e imaginológica de la lesión, obteniéndose la consolidación de la fractura sin que se apreciara complicación alguna, resultado que concuerda con la literatura mundial, la cual refiere la importancia y resultados positivos del método empleado. Teniendo en cuenta lo práctico, económico y útil que resulta el mismo los autores consideraron oportuno presentar esta experiencia con el objetivo de promover la extensión práctica del tratamiento conservador de la fractura diafisaria del húmero.
One of the main pillars of the humerus dyaphisial fracture conservative treatment has been the usage of the hanging plaster cast as an immobilization method, so we decided to use that treatment in a patient after diagnosing that condition. We evaluated the efficacy of the used method periodically following the clinical and imaging evolution of the lesion, obtaining the consolidation of the fracture without any complication, result agree with the international literature that refers the importance and positive outcomes of the used method. Taking into account its suitability, effectiveness, and usefulness we considered it opportune to present this experience with the objective of promoting the practical extension of the humerus dyaphisial fracture conservative treatment.
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Humanos , Adulto , Feminino , Fraturas do Úmero , Fraturas do Úmero/terapia , Sulfato de Cálcio/uso terapêutico , Relatos de CasosRESUMO
Skin cancer is the most common malignant neoplasm reported worldwide. Over the last 20 years, skin cancer has been recognized in a high proportion among young people not associated with genetic disorders or other diseases. In Mexico there is no epidemiological information about this topic, so we made a retrospective study from 2006 to 2009 in the Dermatology service of the General Hospital of Mexico. We included 730 patients with diagnosis of primary skin cancer; 51 cases occurred in people younger than 40 years with an average age of 38 years, and with an estimated accumulated incidence of 6.8% for the elapsed time. In this study, skin cancer in young people showed a predominance of women (67% of patients); basal cell carcinoma was the most common type. Most of the lesions were found in sun-exposed areas. Skin cancer in people younger than 40 years is increasing dramatically, so we recommend avoiding ultraviolet radiation exposure in childhood and adolescence, and implementing sun-protection campaigns in order to educate this sector of the population and make them more aware of the potential dangers.
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Neoplasias Cutâneas/epidemiologia , Adolescente , Adulto , Criança , Feminino , Hospitais Gerais , Humanos , Incidência , Masculino , México , Estudos Retrospectivos , Adulto JovemRESUMO
OBJECTIVE: To develop guidelines for the appropriate use of NSAIDs in rheumatology. METHODS: We used a methodology modified from the one developed by RAND/UCLA. Two groups of panellists were selected, one by the CMR and another by the SER. Recommendations were proposed from nominal groups and the agreement to them was tested among rheumatologists from both societies by a tworound Delphi survey. The analysis of the second Delphi round supported the generation of the final set of recommendations and the assignment of a level of agreement to each of them. Systematic reviews of five recommendations in which the agreement was low or was divided were also carried out. RESULTS: Here we present recommendations for the safe use of NSAIDs in rheumatic diseases, based on the best available evidence, expert opinion, the agreement among rheumatologists, and literature review. The trend is to reduce the frequency, duration and dose of NSAIDs in favour of non-pharmacological measures, analgesic drugs or disease modifying drugs. In addition, the recommendations help to identify profiles for increased toxicity, with an emphasis on gastrointestinal and cardiovascular risks. The recommendations deal with the course of action and monitoring in different risk groups and in patients using antiplatelet or anticoagulant drugs. The overall level of agreement is high. CONCLUSIONS: The NSAIDs are safe and effective drugs for the treatment of rheumatic diseases. However, it is necessary to individualize its use according to their risk profile.