DRESS and Stevens-Johnson Syndrome Overlap Secondary to Allopurinol in a 50-Year-Old Man-A Diagnostic and Treatment Challenge: Case Report.

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a drug reaction commonly related to eosinophilia, from uncertain epidemiology, and without consensus for diagnosis and treatment globally. It presents a great challenge in its management and is characterized by fever, lymphadenopathy, skin rash, and multisystemic involvement. An aggressive and difficult-to-manage clinical case is presented in a 50-year-old man with chronic kidney disease due to diabetes mellitus type 2 and systemic arterial hypertension, who developed an unusual variant similar to DRESS and Stevens-Johnson syndrome (SJS) overlap secondary to allopurinol, with skin manifestations without eosinophilia, but fulfilling clinical and laboratory criteria for DRESS and SJS syndrome.

Experiencia sobre el proceso de salud-enfermedad-atención en pacientes con artritis reumatoidea pertenecientes a la comunidad Wichí de Misión Chaqueña "El Algarrobal", Salta / Experience on the health-disease-care process in patients with rheumatoid arthritis belonging to the Wichí community of Mission Chaqueña "El Algarrobal", Salta

Introducción: se ha reportado que la prevalencia de artritis reumatoidea (AR) en la comunidad Wichí representa la más alta informada por el Grupo Latinoamericano para el Estudio de las Enfermedades Reumáticas en los Pueblos Originarios (GLADERPO). El objetivo de este estudio fue describir la experiencia sobre el proceso de salud-enfermedad-atención de pacientes con AR de la comunidad Wichí de Misión Chaqueña "El Algarrobal", Salta. Materiales y métodos: estudio narrativo. Diseño de corte etnográfico. Se realizaron entrevistas semi-estructuradas y observaciones registradas. Se utilizaron guías de entrevistas y observación. Los aspectos incluidos fueron: concepción del proceso salud-enfermedad, percepción de la AR en la vida diaria, el acceso al sistema de salud, utilización de recursos tradicionales y de medicina tradicional. Resultados: se realizaron 10 entrevistas. Los aspectos más relevantes fueron la concepción del proceso salud-enfermedad asociado al trauma social pasado y al concepto de voluntad Wichí. Se evidenció la combinación de estrategias para mejorar el dolor (biomedicina, medicina tradicional y acompañamiento religioso). Además, se observó una relación unidireccional con el sistema de salud. Conclusiones: la AR es una enfermedad con un impacto negativo en la comunidad Wichí. Se requieren otras actividades, desde otras disciplinas, para mejorar el acceso al sistema de salud y la continuidad de los tratamientos.

Introduction: the prevalence of rheumatoid arthritis (RA) in the Wichí community has already been published, representing the highest reported by the Grupo Latinoamericano para el Estudio de las Enfermedades Reumáticas en los Pueblos Originarios (GLADERPO). The objective was to describe the experience of the health-disease-care process of patients with RA from the Wichí community of Misión Chaqueña "El Algarrobal", Salta. Materials and methods: study with ethnographic design. Semi-structured interviews and recorded observations were conducted. Interview and observation guides were used. The aspects included were: conception of the health-disease process; perception of RA in daily life, access to the health system, use of traditional resources and traditional medicine. Results: ten interviews were conducted. The most relevant aspects were the conception of the health-disease process, associated with past social trauma and the concept of "Wichí good will". The combination of strategies to improve pain (biomedicine, traditional medicine and religious accompaniment) was evidenced. In addition, a unidirectional relationship with the health system was observed. Conclusions: RA is a disease with a negative impact on the Wichí community. Other activities from other disciplines are necessary to improve access to the health system and continuity of treatment.

Oral Supplementation with Hydrolyzed Fish Cartilage Improves the Morphological and Structural Characteristics of the Skin: A Double-Blind, Placebo-Controlled Clinical Study.

Collagen and its peptides are natural ingredients used in food supplements and nutricosmetics with the claim of providing benefits for skin health and beauty. In this context, the aim of the present study was to evaluate the clinical efficacy of oral supplementation with hydrolyzed fish cartilage for the improvement of chronological and photoaging-induced skin changes. A total of 46 healthy females aged 45 to 59 years were enrolled and divided into two groups: G1-placebo and G2-oral treatment with hydrolyzed fish cartilage. Measurements of skin wrinkles, dermis echogenicity and thickness, and morphological and structural characteristics of the skin were performed in the nasolabial region of the face before and after a 90-day period of treatment using high-resolution imaging, ultrasound, and reflectance confocal microscopy image analyses. A significant reduction in wrinkles and an increase of dermis echogenicity were observed after a 90-day period of treatment with hydrolyzed fish cartilage compared to the placebo and baseline values. In addition, reflectance confocal microscopy (RCM) image analysis showed improved collagen morphology and reduced elastosis after treatment with hydrolyzed fish cartilage. The present study showed the clinical benefits for the skin obtained with oral supplementation with a low dose of collagen peptides from hydrolyzed fish cartilage.

Prevalence of musculoskeletal disorders and rheumatic diseases in an Argentinean indigenous Wichi community.

OBJECTIVE: To estimate the prevalence of musculoskeletal disorders (MSK) and rheumatic diseases in an indigenous Wichi population in Argentina. METHODS: This is a cross-sectional, community-based study using the Community-Oriented Program for the Control of Rheumatic Diseases (COPCORD) methodology in ≥ 18-year-old subjects. Validated surveys were conducted by trained interviewers. Subjects with MSK pain (positive cases) were evaluated by internists and rheumatologists for diagnosis and treatment. RESULTS: A total of 648 interviews were performed (90.4% of the census population). Mean age was 37.5 years (SD 14.8), and 379 (58.5%) were female. The mean years of education was 7.0 (SD 3.7); 552 subjects (85.2%) were covered by the public health care system. A total of 216 (33.3%) subjects had MSK pain in the last 7 days. Rheumatic disease prevalence was as follows: mechanical back pain (19.0%), rheumatic regional pain syndrome (5.2%), osteoarthritis (3.2%), rheumatoid arthritis (RA) (3.2%), inflammatory back pain (1.2%), undifferentiated arthritis (0.3%), Sjögren syndrome (0.15%), and fibromyalgia (0.15%). RA patients included 19 (90.5%) women and 9 (42.9%) with RA family history. One hundred percent were seropositive and 66.7% showed radiologic erosions. The mean of Disease Activity Score [DAS-28 (ESR)] at the time of diagnosis was 5.1 (SD 1.5) and the Health Assessment Questionnaire Disability Index (HAQ-DI) was 0.8 (SD 0.4). CONCLUSION: RA prevalence was 3.2%, one of the highest reported using the COPCORD methodology in indigenous and non-indigenous peoples in Latin America, with a high percentage of family cases. Pain and functional capacity were the variables allowing patients' early referral to a specialist. Key Points • The RA prevalence was 3.2%, one of the highest reported using COPCORD methodology in indigenous and non-indigenous peoples in Latin America. • The patients with RA had high percentage of familiar history of RA. • The pain and functional capacity were the variables associated with a diagnosis of any rheumatic disease and should be considered for early referral. • The mean of the delay in the diagnosis was 5.8 years. In this community, the lack of the "migration health" phenomenon may be a social determinant that negatively impacts their health.

Ciclismo urbano como direito humano à mobilidade ativa na cidade de São Paulo / Urban bicycling as a human right to active mobility in the city of Sao Paulo / Ciclismo urbano como derecho humano a la movilidad activa en la ciudad de São Paulo

O ciclismo urbano é um fenômeno recente valorizado como alternativa ao transporte motorizado individual. O objetivo do artigo é compreender os processos educativos do ciclismo urbano, decorrentes da prática social do cicloativismo atuante na cidade de São Paulo. Realizamos quatro entrevistas com pessoas que habitam e se locomovem de bicicleta neste município. A trajetória metodológica seguiu a modalidade fenômeno situado da Fenomenologia. Na construção dos resultados, as unidades de significado: a) luta por reconhecimento no direito de fruir o território em bicicleta; b) solidariedade com outrem no compartilhamento seguro das vias públicas; c) percepção do entorno e d) comunicação do movimento cicloativista resultaram na categoria "Pedalar como direito humano à mobilidade ativa na cidade". Constatamos que, apesar do processo legítimo de diálogo, as demandas cicloativistas são pouco incorporadas às políticas públicas de mobilidade urbana por falta de representação institucional

Urban bicycling is a recent phenomenon valued as an alternative to individual transportation by motor vehicles. This article looks into the educational processes of urban bicycling that resulted from the social practice of bicycling activism in the city of Sao Paulo. We conducted four interviews with people who live and use bicycles in that city. The methodological trajectory followed Phenomenology's view on situated phenomena. In the construction of results, the units of meaning a) fight for recognition of the right to enjoy territory by bicycle; b) solidarity with others in safe sharing of public roads; c)perception of the environment; and d) communication of the bicycling activist movement resulted in the category "Pedaling as a human right to active mobility in the city". We found that, despite the legitimate process of dialogue, the demands of bicycling activism are not highly incorporated into public policies for urban mobility due to lack of institutional representation

El ciclismo urbano es un fenómeno reciente valorado como alternativa al transporte motorizado individual. El objetivo del artículo es comprender los procesos educativos del ciclismo urbano, derivados de la práctica social del cicloactivismo que actúa en la ciudad de São Paulo. Realizamos cuatro entrevistas con personas que habitan y se desplazan en bicicleta en este municipio. La trayectoria metodológica siguió la modalidad fenómeno situado, de la Fenomenología. En la construcción de los resultados,las unidades de significado: a) lucha por reconocimiento en el derecho de disfrutar del territorio en bicicleta; b) solidaridad con otros al compartir de manera segura las vías públicas; c) percepción del entorno y d) comunicación del movimiento cicloactivista, resultaron la categoría "Pedalear como derecho humano a la movilidad activa en la ciudad". Constatamos que, a pesar del proceso legítimo de diálogo, las demandas cicloactivistas son poco incorporadas a las políticas públicas de movilidad urbana por falta de representación institucional

LC-MS/MS methods for sulfadimethoxine and ormetoprim analysis in feed and fish fillet and a leaching study for feed after alternative procedures for the incorporation of drugs.

This paper describes the method development for sulfadimethoxine (SDM) and ormetoprim (OMP) quantitation in fish feed and fish fillet employing LC-MS/MS. In order to assess the reliability of the analytical method, valuation was undertaken as recommended by guidelines proposed by the Brazilian Ministry of Agriculture. The calibration curve for the quantification of both drugs in feed showed adequate linearity (r > 0.99), precision (CV < 12%) and trueness ranging from 97% to 100%. The method for the determination of SDM and OMP residues in fish fillet involved a simple sample preparation procedure that had adequate linearity (r > 0.99), precision (CV < 16%) and trueness around 100%, with CCα < 100.2 ng g-1 and CCß < 100.4 ng g-1. With a goal of avoiding the risk of drug leaching from feed into the aquatic environment during fish medication via the oral route, different procedures for drug incorporation into feed were evaluated. Coating feed pellets with ethyl cellulose polymer containing the drug showed promising results. In this case, medicated feed released drugs to water at a level below 6% when the medicated feed stayed in the water for up to 15 min.

[Adolescent with paraovarian cyst. Surgycal treatment]. / Adolescente con quiste paraovárico. Tratamiento quirúrgico.

BACKGROUND: Adnexal paraovarian cysts are not frequently seen during teen development, their incidence is around 10% and usually benign. CLINICAL CASE: Adolescent female 15 years old with no pathological family and personal history relevant to her current condition. Chief complaint: Six months ago she complained with abdominal pain in meso, hypogastrium and right iliac fossa. Later, she observed an increased volume on her lower quadrant of the abdomen, mostly on her right side. During physical examination an abdominal tumor was palpated. By an abdominal-rectal manouvre, the presence of tumor was confirmed and located in front of the rectum and no implants. Imaging studies confirmed a paraovarian cyst. She underwent on surgical laparatomy and a paraovarian cyst was found. The histological diagnosis was a cystadenoma. The postoperative course was satisfactory. DISCUSSION: Epidemiological data and ultrasonographic findings are examined to confirm the diagnosis of paraovarian cyst. The laparoscopic treatment for adnexal problems is described.

[National Registry of Cardiac Rehabilitation Programs in México]. / Registro Nacional sobre Programas de Rehabilitación Cardíaca en México (RENAPREC).

Cardiac Rehabilitation and secondary prevention programs are a group of therapeutic maneuvers that can reduce the adverse impact of cardiovascular disease, by using the cardiovascular risk factors reduction, through secondary prevention and exercise training therapy programs. This program started in Mexico in 1944, since then, several health institutions are working on a public or private basis, mainly in an isolated way. This article presents data about fourteen cardiac rehabilitation institutions that answered the first national registry of cardiac rehabilitation programs (RENAPREC) in 2007. On this study, we observed that these centers were mainly private; nevertheless, almost all of the referred population was attended in public health institutions. The core-components for an adequate cardiac rehabilitation attention were satisfied by almost all these centers. The patients used to pay, by their own, this kind of medical practice. In our country, only the 0.58% of the population, that needed to be included on a cardiac rehabilitation program, was covered. This phenomena is due, in one hand, to the reduced number of cardiac rehabilitation centers in Mexico, but on the other hand, it happens because the primary physician do not refer all the eligible patients to this kid of programs. RENAPREC can be one first attempt to consolidate all the activities around the inter-institutional cardiac rehabilitation and secondary prevention programs in our country.

Registro Nacional sobre Programas de Rehabilitación Cardíaca en México (RENAPREC) / National Registry of Cardiac Rehabilitation Programs in México

Cardiac Rehabilitation and secondary prevention programs are a group of therapeutic maneuvers that can reduce the adverse impact of cardiovascular disease, by using the cardiovascular risk factors reduction, through secondary prevention and exercise training therapy programs. This program started in Mexico in 1944, since then, several health institutions are working on a public or private basis, mainly in an isolated way. This article presents data about fourteen cardiac rehabilitation institutions that answered the first national registry of cardiac rehabilitation programs (RENAPREC) in 2007. On this study, we observed that these centers were mainly private; nevertheless, almost all of the referred population was attended in public health institutions. The core-components for an adequate cardiac rehabilitation attention were satisfied by almost all these centers. The patients used to pay, by their own, this kind of medical practice. In our country, only the 0.58% of the population, that needed to be included on a cardiac rehabilitation program, was covered. This phenomena is due, in one hand, to the reduced number of cardiac rehabilitation centers in Mexico, but on the other hand, it happens because the primary physician do not refer all the eligible patients to this kid of programs. RENAPREC can be one first attempt to consolidate all the activities around the inter-institutional cardiac rehabilitation and secondary prevention programs in our country.

Taponamiento cardíaco recidivante secundario a síndrome postpericardiotomía / Recidivant cardiac tamponade secondary to postpericadrdiotomy syndrome

Mujer de 22 años de edad, con diagnóstico de comunicación interauricular ostium secundum sometida a corrección quirúrgica. Treinta y cinco días después reingresa con síntomas de congestión venosa sistémica y pulmonar, fiebre y dolor precordial. Por ecocardiografía se demostraron derrame pericárdico de aproximadamente 3500 cc y datos de taponamiento cardíaco, por lo que requirió pericardiocentesis. Se diagnosticó como síndrome postpericardiotomía y se manejó con prednisona 10 mg cada 24 horas con evolución satisfactoria. Dos semanas después reingresó por presentar disnea y nuevo derrame pericárdico con taponamiento incipiente demostrado por ecocardiografía. Se incremento la dosis de prednisona hasta 40 mg al día. El control ecocardiográfico 10 días después reportó derrame de 600 cc, con notable mejoría clínica. A los tres meses estuvo asintomática y ecocardiográficamente sin datos de derrame pericárdico

Evaluación nutricional y clase funcional del cardiópata hospitalizado / Correlation between nutritional state and functional class in hospitalized patients with heart disease

La evaluación del estado nutricio del paciente cardiópata debe incluir las medidas y antropométricas, pruebas debe incluir las medidas antropométricas, pruebas de metabolismo orgánico y de inmunidad celular, Evaluamos el estado nutricio de 75 pacientes cardiópatas internados, se correlacionó con las clase funcional y la patología de base. Se encontraron 36 pacientes (48 por ciento) con estado nutricional normal, 24 (32 por ciento) con desnutrición leve, 12 (16 por ciento) con desnutrición moderada, 3 (4 por ciento) con desnutrición moderada, 3, (4 por ciento) con desnutrición severa, De 23 pacientes con cardiopatía isquemica, 25 por ciento estaban desnutridos, de 4 con cardiopatía hipertensiva 50 por ciento estaban desnutridos, en 4 pacientes, con cardiomiopatía el 75 por ciento cursó con desnutrición y en 7 pacientes con otras patologías cardiovasculares, el 83 por ciento tenía desnutrición. Existe correlación directa entre el grado de desnutrición y la clase funcional. No encontramos ningún paciente con clase funcional IV con buen estado nutricional, ni en los que tenían desnutrición leve