Clinical, Endoscopic, and Histologic Benefit With Comprehensive Type IV Hypersensitivity Patch Testing in Adults With Eosinophilic Esophagitis.

Eosinophilic esophagitis (EoE) is a chronic, immune-mediated disorder of increasing incidence.1 Although empiric elimination diets are commonly used EoE therapies, adoption of allergy testing to guide elimination diets has been more limited.2,3 This likely stems from testing that has often focused on immediate type I hypersensitivity (ie, skin-prick or serum-specific IgE testing) rather than comprehensive type IV hypersensitivity patch tests (CPT), which identify delayed-type allergens.4 Although atopy patch tests have been less successful for food triggers, CPTs can evaluate the potential role of additives and aeroallergens in EoE.5 Our study aimed to determine if avoiding aeroallergens and additives to everyday products based on a CPT would lead to symptomatic and histologic improvement in patients with EoE who had not responded to proton pump inhibitors (PPIs) alone.

Index Case of Cutaneous Follicular Mycosis Fungoides With Central Nervous System Involvement and Review of Literature.

Central nervous system involvement by mycosis fungoides (MF) is rare and is usually seen in advanced stages of the disease. We describe a patient with early-stage follicular MF who presented with changes in mental status. Despite an initial diagnosis of vasculitis based on clinical and brain biopsy results, the postmortem examination revealed extensive infiltration of MF cells throughout the brain with leptomeningeal involvement. This case in addition to the accompanied review of literature illustrates the importance of the awareness of central nervous system involvement by MF and highlights the need for an urgent neurologic evaluation in patients with a history of MF now presenting with neurologic signs or symptoms.

Eventos adversos en un hospital pediátrico de tercer nivel de Bogotá / Adverse Events in a third level pediatric hospital in Bogotá / Eventos adversos num hospital pediátrico de terceiro nível de Bogotá

Resumen En Colombia la seguridad del paciente es una prioridad en la atención en salud; los eventos adversos e incidentes son una muestra de atención insegura en las instituciones. El compromiso interdisciplinario es fundamental para trabajo proactivo en promoción de prácticas seguras, prevención y detección de fallas latentes y activas en un hospital. Objetivo: determinar la frecuencia de eventos adversos mediante revisión de historias clínicas de un hospital pediátrico de tercer nivel de Bogotá, con el fin de fomentar prácticas seguras. Metodología: Investigación cuantitativa, transversal y descriptiva, dirigida a pacientes hospitalizados el 16 de mayo de 2013, sobre factores de riesgo, antecedentes hospitalarios, eventos adversos y complicaciones relacionados al cuidado de la salud. Resultados: Hubo 169 casos clasificados para algún suceso, de los cuales 59 Eventos Adversos, 57 incidentes, y 53 descartados por falsos positivos. Discusión: Se evidencia responsabilidad de prevención y control de infecciones por los profesionales de la salud, encargados de minimizar el riesgo del paciente vulnerable y, ante todo, proporcionar un manejo y mantenimiento adecuado de dispositivos médicos invasivos. Conclusiones: El 34,4% de historias clínicas presentaban algún tipo de evento adverso o incidente, revelando que algunos de estos fueron causados por la asistencia hospitalaria.

Abstract In Colombia, patients' safety is a priority in healthcare. Adverse events and incidents are an example of unsafe healthcare in institutions. An interdisciplinary commitment is fundamental in proactive work to promote safe practices, prevention, and detection of latent and active failures in hospital. Objective: To determine the frequency of Adverse Events by reviewing clinical histories in a third level pediatric hospital in Bogotá to foster safe practices. Methodology: A descriptive cross-sectional quantitative research was conducted focusing on hospitalized patients on May 16, 2013, working risk factors, hospital backgrounds, adverse events, and healthcare related complications. Results: There were 169 cases classified for a given event, of which 59 were Adverse Events, 57 were incidents and 53 were discarded as false positives. Discussion: Researchers evidenced the responsibility in infection prevention and control by healthcare professionals in charge of minimizing a vulnerable patient's risk, and above all, they provided a suitable use and maintenance of invasive medical devices. Conclusions: 34.4% of the clinical histories show some type of adverse event or incident, revealing evidence that in some cases they were caused by hospital care.

Resumo Na Colômbia a seguridade do paciente é uma prioridade na atenção em saúde; os eventos adversos e incidentes são uma mostra de atenção insegura nas instituições. O compromisso interdisciplinar e fundamental para trabalho proativo em promoção de práticas seguras, prevenção e detecção de falhas latentes e ativas num hospital. Objetivo: Determinar a frequência de eventos adversos mediante revisão de histórias clínicas dum hospital pediátrico de terceiro nível de Bogotá, com o fim de fomentar práticas seguras. Metodologia: Investigação quantitativa, transversal e descritiva, dirigida a pacientes hospitalizados o 16 de maio de 2013, sobre fatores de risco, antecedentes hospitalários, eventos adversos e complicações relacionados ao cuidado da saúde. Resultados: Houve 169 casos classificados para algum acontecimento, dos quais 59 Eventos Adversos, 57 incidentes, e 53 descartados por serem falsos positivos. Discussão: Se evidencia responsabilidade de prevenção e controle de infecções pelos professionais da saúde, encarregados de minimizar o risco do paciente vulnerável e, por acima de todo, proporcionar um manejo e mantimento adequado de dispositivos médicos invasivos. Conclusões: O 34.4% das histórias clínicas apresentavam algum jeito de Evento Adverso ou incidente, revelando evidência de que alguns destes foram causados pela assistência hospitalar.

Unusual findings in the male breast patient: a case series.

In this case series, we present the history and imaging of several male patients with breast complaints. Given the rise in men presenting with breast cancer, from 1 in 100,000 in the 1970s to 1.5 in 100,000 in 2012 [1,2], these cases presented here together provide the useful reminder that a comprehensive clinical history and focal physical examination is critical when assessing the symptomatic male (as well as female) patient with a breast complaint.

Earlier development of the accumbens relative to orbitofrontal cortex might underlie risk-taking behavior in adolescents.

Adolescence has been characterized by risk-taking behaviors that can lead to fatal outcomes. This study examined the neurobiological development of neural systems implicated in reward-seeking behaviors. Thirty-seven participants (7-29 years of age) were scanned using event-related functional magnetic resonance imaging and a paradigm that parametrically manipulated reward values. The results show exaggerated accumbens activity, relative to prefrontal activity in adolescents, compared with children and adults, which appeared to be driven by different time courses of development for these regions. Accumbens activity in adolescents looked like that of adults in both extent of activity and sensitivity to reward values, although the magnitude of activity was exaggerated. In contrast, the extent of orbital frontal cortex activity in adolescents looked more like that of children than adults, with less focal patterns of activity. These findings suggest that maturing subcortical systems become disproportionately activated relative to later maturing top-down control systems, biasing the adolescent's action toward immediate over long-term gains.