Fitofotodermatosis: el peligro del sol y las plantas para la piel / Phytofotodermatosis: the danger of the sun and plants for the skin

Presentamos el caso de un paciente que padeció una reacción cutánea intensa tras el contacto con los frutos y las hojas de una higuera y posterior exposición solar. Se trata de una reacción no inmunológica llamada fitofotodermatosis. Es una erupción inflamatoria de la piel que se produce tras el contacto con sustancias fototóxicas (furocumarinas o psoralenos) y que puede llegar a ser de gran intensidad. Por ello requiere una anamnesis exhaustiva y su conocimiento por parte del equipo médico de Atención Primaria y pediatría, ya que su diagnóstico diferencial puede ser muy complejo.(AU)

We report the case of a patient who developed an intense skin reaction after contact with the fruits and leaves of a fig tree and subsequent sun exposure. This is a non-immunological reaction called phytophotodermatosis. It is an inflammatory skin rash that occurs after contact with phototoxic substances (furocoumarins or psoralens) and could be very intense. That is why it requires an in-depth history; its knowledge by primary care physicians and paediatricians, is important because the differential diagnosis could be very complex.(AU)

Lo que esconde un prurito de larga evolución / What is hidden by extended course itching

Se presenta el caso de una mujer de 74 años que refiere prurito leve generalizado de 3 meses de evolución con aumento progresivo del mismo. Tras un seguimiento por parte de su médico de familia por la gran sintomatología referida, a pesar de seguir tratamiento con antihistamínicos y pauta corticoidea, y habiendo descartado analíticamente patología orgánica, se decide derivar a dermatología, donde finalmente se diagnostica penfigoide ampolloso autoinmune.(AU)

We report a 74-year-old woman with a gradual increase in generalized itching over three months. After her doctor’s monitoring because of her major symptoms and despite having been treated with antihistamines and corticosteroids, organic pathology was ruled out analytically. The patient was referred to dermatology where she was diagnosed with autoimmune bullous pemphigoid.(AU)

A propósito de un caso: enfermedad IgA lineal de la infancia / Apropos of a case: Linear IgA bullous dermatosis of childhood

La enfermedad IgA lineal se trata de un trastorno autoinmune poco frecuente. En la infancia aparece sobre todo en edad preescolar, y en adultos es necesario realizar un buen diagnóstico diferencial con otras enfermedades ampollosas como la dermatitis herpetiforme o el penfigoide ampollar. Hasta un cuarto de los casos se relacionan con infecciones o con la toma de medicamentos entre los que destacan antibióticos y antiinflamatorios no esteroideos. El diagnóstico se basa en la clínica, biopsia cutánea e inmunofluorescencia. Típicamente se presenta como ampollas anulares tensas de morfología anular con imagen característica en collar de perlas. Al realizar el estudio de inmunofluorescencia directa se evidencia una banda lineal de IgA en la unión dermoepidérmica. Suele responder de forma completa a la retirada del fármaco causante y al tratamiento con Dapsona oral y glucocorticoides tópicos. (AU)

Uso de plata metálica y ácido hialurónico en paciente varón con quemadura de segundo grado / Use of metallic silver and hyaluronic acid in a male patient with a second degree burn

Dentro de las quemaduras que se producen en el ámbito domiciliario, una de las más frecuentes es la quemadura por aceite hirviendo; en este caso presentamos un paciente varón con quemadura de segundo grado superficial en la mano derecha con afectación del dorso de la mano, dedos y palma.Pasadas 24 horas de la primera cura es remitido a nuestra consulta por aparición de ampollas; a partir de ahí, el paciente es tratado exclusivamente en nuestra consulta hasta la resolución del proceso.El caso se soluciona llegando a una total curación con el uso de plata metálica combinada con ácido hialurónico en forma de spray, lo que agiliza y acorta el tiempo dedicado a las curas y consigue que el paciente apenas tenga dolor durante las mismas.La eficacia y la facilidad de aplicación de este nuevo apósito en spray, nos proporciona una nueva forma de tratamiento de quemaduras, sobre todo si estas se producen en zonas con pliegues complejos para su abordaje. (AU)

One of the most frequent accidents involving burns at home is burning oneself with cooking oil. In this article, we present the case of a male patient with a superficial second-degree burn on the right hand affecting the back of the hand, the fingers, and the palm.Twenty-four hours after the first treatment, he was referred to our office due to the appearance of blisters; from then on, the patient was treated exclusively in our office until the burn was healed.The patient was fully healed with metallic silver combined with hyaluronic acid in the form of spray, which shortens the time spent on the cures and ensures that the patient experiences little pain during the treatment.The efficacy and ease of application of this new spray-on plaster provides us with a new way of treating burns, especially if they occur in areas with complex folds that make them difficult to reach. (AU)

Microorganisms isolated from the bile of the patients who have undergone cholecystectomy and their antibiotic resistance pattern: multicenter prospective study / Microorganismos aislados de la bilis de los pacientes sometidos a colecistectomía y su patrón de resistencia antibiótica: estudio prospectivo multicéntrico

Background: Gallbladder and biliary tract infections are diseases with high mortality rates if they are not treated properly. Microbiological evaluation of perioperatively collected samples both ensures proper treatment of patients and guides empirical treatment due to the determination of microorganism susceptibility. Aims: This study aimed to isolate the microorganisms in bile cultures from patients who underwent cholecystectomy and to determine sensitivity results of these microorganisms. Methods: This study was a multi-center and prospective design, included 360 patients, and was performed between 2019 and 2020. Culture results of bile taken during cholecystectomy were evaluated. Results: Bacterial growth was found in the bile cultures of 84 out of 360 (23.3%) patients. Patients were divided into two groups according to whether they had risk factors for resistant microorganisms or not. While Escherichia coli (n = 11, 13%), Enterococcus spp. (n = 8, 9.5%), and Enterobacter spp. (n = 4, 4.7%) were detected most frequently in patients without risk. Staphylococcus spp. (n = 17, 20.2%), Enterococcus spp. (n = 16, 19%), and E. coli (n = 8, 9.5%) were the most frequently found microorganism at-risk patients. In multivariate analysis, bile culture positivity was found higher in patients who had history of biliary disease (p = 0.004), operation performed concurrently with a cholecystectomy (p = 0.035), and high rate of polymorphonuclear leukocytes (PNL) in total leukocyte count (p = 0.001). Conclusions: Our study shows that when starting empirical antibiotic treatment for bile ducts, whether patients are at risk for the development of resistant bacterial infection should be evaluated after which antibiotic selection should be made accordingly.(AU)

Angina bullosa haemorrhagica: A 14-year multi-institutional retrospective study from Brazil and literature review

Background: Angina bullosa haemorrhagica (ABH) is characterized by the recurrent appearance of blood blisters on the oral mucosa, mainly in adults' soft palate. In general, the blisters rupture spontaneously, lacking the necessity for biopsy. We report the clinical features of 23 ABH cases, emphasizing the clinical behavior and the management of these conditions. Material and Methods: A retrospective descriptive cross-sectional study was performed. A total of 12,727 clinical records of oral and maxillofacial lesions from four dental services in Brazil were analyzed. Clinical data were collected from the clinical records and evaluated. Results: The series comprised 12 males (52.2%) and 11 females (47.8%), with a mean age of 56.8 ± 14.6 years (ranging: 24-82 years) and a 1.1:1 male-to-female ratio. Most of the lesions affected the soft palate (n = 15, 65.2%). Clinically, the lesions presented mainly as an asymptomatic (n = 17, 73.9%) blood-filled blister that ruptured after a few minutes or hours, leaving an erosion. The masticatory trauma was the most frequent triggering event. No patient had coagulation disorders. A biopsy was performed in only four cases (17.4%). Treatment was symptomatic with a favorable outcome. Conclusions: ABH is still poorly documented in the literature, and its etiology remains uncertain. ABH mainly affects the soft palate of elderly adults and has a favorable evolution in a few days. The therapeutic approach is often focused only on the relief of symptoms. However, it can share some clinical features with more serious diseases. Therefore, clinicians must recognize these lesions to avoid misdiagnosis.(AU)

Endoftalmitis de inicio tardío asociada a ampolla de filtración por Moraxella nonliquefaciens / Delayed-onset bleb-related endophthalmitis caused by Moraxella nonliquefaciens

Las endoftalmitis asociadas a la ampolla de filtración tras cirugía filtrante de glaucoma son poco frecuentes, de inicio tardío y la mayoría están asociadas a una blebitis. Los agentes causales suelen ser estreptococos o bacterias gramnegativas. Existen pocos casos descritos en la literatura de endoftalmitis causada por Moraxella nonliquefaciens y la mayoría están asociados a una blebitis tras cirugía filtrante de glaucoma. Presentamos el caso de una paciente de 90 años con endoftalmitis en ojo derecho por Moraxella nonliquefaciens asociada a blebitis 10 años después de la cirugía de glaucoma. Tras el tratamiento, se observó la desaparición de la blebitis 2 semanas después y resolución de la vitritis 29 días después, con recuperación de la visión a valores previos (20/200). La endoftalmitis por Moraxella nonliquefaciens es rara y está asociada a blebitis de inicio tardío tras una cirugía filtrante de glaucoma. A pesar de la virulencia del cuadro, el pronóstico visual suele ser favorable

Bleb-related endophthalmitis is rare and appears months or years after surgery. The causative agents are usually streptococci or gram-negative bacteria. There are few cases in the literature of endophthalmitis caused by Moraxella nonliquefaciens, and most are delayed-onset associated with blebitis after glaucoma filtration surgery. The case is presented of a 90-year-old patient with endophthalmitis in the right eye due to Moraxella nonliquefaciens associated with blebitis 10 years after glaucoma surgery. After treatment, disappearance of blebitis is observed 2 weeks later and resolution of vitritis 29 days later, with recovery of vision to previous values (20/200). Endophthalmitis due to Moraxella nonliquefaciens is rare, and is associated with late onset blebitis after glaucoma filtration surgery. Despite the virulence of the clinical symptoms, the visual prognosis is usually favourable

Neumatosis quística intestinal: causa infrecuente de abdomen agudo / No disponible

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Manejo de la ampolla isquémica hiperfiltrante: crosslinking mediante el uso de riboflavina y radiación ultravioleta versus deslizamiento conjuntival y autotrasplante de conjuntiva / Management of the hyper-filtrating ischaemic bleb: crosslinking with riboflavin and UV radiation versus a conjunctival sliding flap and conjunctival autologous graft

INTRODUCCIÓN: En este estudio se com:para y evalúa la seguridad y los resultados clínicos de 3 técnicas para el manejo de las ampollas isquémicas hiperfiltrantes en glaucoma: el crosslinking con riboflavina (CXL) respecto al deslizamiento y el autotrasplante conjuntival. MÉTODOS: Se seleccionaron un total de 24 ojos de 18 pacientes con ampollas isquémicas intervenidos de cirugía filtrante de glaucoma entre 2012 y 2017. Fueron intervenidos de CXL mediante el uso de riboflavina (n = 4), autotrasplante conjuntival (n = 5) y deslizamiento conjuntival (n = 15). Se comparan los resultados de la presión intraocular (PIO) previa al procedimiento y a los 12 meses, así como de la agudeza visual y de la medicación antiglaucomatosa previa y a los 12 meses. RESULTADOS: Los 4 de la riboflavina pasaron de una PIO media previa de 12,11 ± 3,14 a una PIO al año de 12,32 ± 5,29 (p = 0,655). Los 5 ojos del autotrasplante de conjuntiva tuvieron una PIO previa media de 11,65 ± 5,76 y al año de 14,68 ± 7,21 (p = 0,273). Los 15 ojos tratados mediante deslizamiento conjuntival presentaron una PIO previa de 9,32 ± 5,34 y al año de 15,16 ± 9,24 (p = 0,021). No hubo efectos adversos ni complicaciones asociadas a ninguna de las 3 técnicas. CONCLUSIONES: El manejo de la ampolla isquémica hiperfiltrante resulta difícil. Los procedimientos quirúrgicos se asocian a incrementos tensionales y a necesidad de medicación, mientras que el CXL mediante el uso de riboflavina y radiación UV no parece tener un efecto sobre la revitalización de la ampolla

INTRODUCTION: This article compares and evaluates the safety and clinical results of 3 techniques for the management of hyper-filtrating ischaemic bleb in glaucoma, such as collagen crosslinking (CXL) with riboflavin versus conjunctival sliding and conjunctival autologous graft. METHODS: A total of 24 eyes were selected from 18 patients with ischemic blebs that underwent filtering glaucoma surgery between 2012 and 2017 and subjected them to crosslinking using riboflavin (n = 4), conjunctival autologous graft (n = 5), and conjunctival sliding (n = 15). The results of the intraocular pressure (IOP) prior to the procedure and at 12 months were compared, as well as visual acuity and previous anti-glaucoma medication at 12 months. RESULTS: The 4 eyes that underwent CXL, went from a previous mean IOP of 12.11 ± 3.14 to an IOP of 12.32 ±5.29 at one year (P = .655). Five eyes were treated by conjunctival autologous graft, had a previous mean IOP of 11.65 ± 5.76 and an IOP at one year of 14.68 ± 7.21 (P = .273). Fifteen eyes subjected to conjunctival sliding had a previous IOP of 9.32 ±5.34 and at one year it was 15.16 ± 9.24 (P =. 021). There were no adverse effects or complications associated with any of the 3 techniques. CONCLUSIONS: The management of the hyper-filtrating ischaemic bleb is difficult. Surgical procedures are associated with increased IOP and need for medication, while CXL using riboflavin and UV radiation does not seem to have an effect on the revitalisation of the bleb

Trombocitopenia trombótica inducida por heparina: una entidad rara potencialmente grave / Heparin-induced thrombotic thrombocytopenia: An uncommon potentially serious entity

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