[Prognosis of urinary tract infections with discordant antibiotic treatment]. / Pronóstico de las infecciones urinarias con tratamiento antibiótico discordante.

INTRODUCTION: This study aims to evaluate the prognosis of urinary tract infections (UTI) treated empirically with inadequate antibiotic treatment. MATERIAL AND METHODS: Prospective cohort study of patients over 18 years of age, attended in the hospital emergency service between 01/02 and 31/05 of 2007, due to micturation symptoms, accompanied by pyuria (>10 leukocytes/mm(3) of uncentrifuged urine) or positive reactive strip for nitrites-leukocytes and urine culture with >10(3) colony forming units. It was considered that the antibiotic treatment prescribed empirically was adequate if the bacteria isolated was sensitive and had been prescribed for the correct time. It was considered that there was therapeutic failure when the symptoms persisted after 5 days of treatment. Age, gender, presence of indwelling bladder catheter, type of UTI, hospitalization in the previous 3 months, origin of the patient and associated diseases were recorded. RESULTS: A total of 177 bacteria were isolated in 168 patients. In 29 cases (17.3%), the microorganism isolated was resistant to the antibiotic prescribed. There was thereaputic failure in only 6 patients, although they did not required hospital admission. The patients who lived in a residential home for the elderly (13.7% vs 2.2%, P = 0.015) or who had been hospitalized during the previous 3 months (20.6% vs 4.3%, p = 0.039) had a greater risk of receiving inadequate treatment. CONCLUSIONS: The prognosis of the patients attended in the emergency hospital service due to UTI with discordant antibiotic treatment is favorable in most of the cases. Performing urine culture in patients with greater risk of suffering UTI due to a resistant microorganism would be recommendable.

[Contact dermatitis due to dimethyl fumarate]. / Dermatitis de contacto por dimetilfumarato.

Dimethyl fumarate is a fumaric acid ester. It been used for some years to treat psoriasis and also as a preservative in desiccant sachets in the transport of furniture and footwear. Its irritant properties and sensitizing potential in contact with the skin were recently highlighted when it was implicated as the causative agent in 2 epidemics of severe acute eczema: sofa dermatitis in northern Europe and shoe dermatitis in Spain. The present article aims to guide dermatologists in the diagnosis and management of patients allergic to dimethyl fumarate. We review the clinical manifestations, results of patch tests, possible cross-reactions, and sources of exposure to dimethyl fumarate responsible for these skin reactions.

Is p-Phenylenediamine Still a Prevalent Contact Allergen in Spain? / ¿Sigue siendo la parafenilendiamina un alérgeno de contacto prevalente en España?

OBJECTIVES: To analyze trends in the prevalence of contact sensitization to p-phenylenediamine between 2004 and 2014, taking into consideration that the concentration of this product in cosmetics was regulated in 2009. To explore risk factors for contact allergy to p-phenylenediamine. MATERIAL AND METHODS: Retrospective observational study of patients suspected of having contact dermatitis from allergy to p-phenylenediamine during the years between 2004 and 2015 in 8 tertiary level hospitals. The patients underwent patch testing (TRUE-test) with the standard series of the Spanish Research Group on Contact Dermatitis and Skin Allergies. This series included p-phenylenediamine 1%. We followed international recommendations for the statistical analysis of data related to contact allergies. RESULTS: Three hundred eighty-six out of 9341 patients (4.1%) had positive reactions to p-phenylenediamine. The prevalence tended to decrease in the early years (2004-2007) and then leveled off at around 4%. Risk factors for developing contact dermatitis from p-phenylenediamine were sex, age over 40 years, multiple sensitivities, and profession, notably workers in hair salons and those who handle rubber and plastics. CONCLUSIONS: The prevalence of p-phenylenediamine allergy remains high among patients with contact eczema. Risk factors for p-phenylenediamine contact allergy are consistent with previous reports.

[Clinical follow-up and presence of visceral tumors in 12 patients with sebaceous gland tumors]. / Tumores sebáceos: seguimiento clínico y presencia de neoplasias en una serie de 12 pacientes.

BACKGROUND: Sebaceous gland tumors are a rare type of neoplasm. In some cases they have been associated with visceral tumors in patients with Muir-Torre syndrome, a hereditary form of nonpolyposis colorectal cancer. The aim of this study was to review the diagnosis and follow-up of a series of patients with sebaceous gland tumors to assess how many met the criteria for Muir-Torre syndrome. PATIENTS AND METHODS: A search was performed of records from 1990 to 2005 in the database of the Department of Dermatology of the Consorcio Hospital General Universitario de Valencia in Valencia, Spain, to identify patients with sebaceous gland tumors. The biopsy material was reviewed to confirm the diagnosis. We also searched the patient histories for information suggestive of a diagnosis of Muir-Torre syndrome; when the histories were incomplete, we contacted the patients by telephone. RESULTS: We identified 20 patients diagnosed with sebaceous gland tumors, but after reviewing the biopsy material diagnosis was only confirmed in 12. Two patients belonged to a family with a history of visceral tumors that met the clinical criteria for hereditary nonpolyposis colorectal cancer syndrome. Follow-up was not uniform in all patients and not all underwent the same tests. CONCLUSIONS: It is essential to rule out the presence of Muir-Torre syndrome in patients with sebaceous gland tumors. The use of new techniques such as immunohistochemistry or detection of microsatellite instability may help to identify families at increased risk of Muir-Torre syndrome.

Genetic studies in variegate porphyria in Spain. Identification of gene mutations and family study for carrier detection.

BACKGROUND: First, to establish the mutations of the protoporphyrinogen-oxidase (PPOX) gene in four Spanish patients with variegate porphyria (VP). Second, study of carrier status detection in the families, including a four-generation Balearic family. Third, evaluation of the results of carrier detection screening methods. DESIGN: Blood samples of four patients and of 139 members belonging to four families, including four generations of a Balearic family were processed for mutation analysis of the 13 exons of PPOX gene. Biochemical studies were performed together (blood and faecal porphyrin analysis) and plasma fluorescence scanning for 626 nm peak emission detection. A questionnaire regarding clinical manifestations was submitted to all family members studied. RESULTS: Single strand conformational analysis (SSCP) of DNA allowed the detection of the following mutations: W224R, 746delT: exon 7, 1077-1082insC: exon 10, and IVS6+2T-->A. Mutation was present in 19 of the 139 members of the families studied. Clinical manifestations or biochemical alterations were checked in the carriers detected and found as not relevant or not present. Only 11 members of the 19 mutation-bearing individuals showed plasma fluorescence PV peak positivity. CONCLUSION: Demonstration of gene mutation is the most reliable means of detecting carriers in studies of variegate porphyria families. DNA analysis is the most sensitive carrier detection method and also allows transmission behaviour of the genetic defect to be established in successive generations of the affected families.

[Serratia marcescens and neonatal sepsis]. / Serratia marcescens y sepsis neonatal.

Authors review infections produced by Serratia marcescens which arose in our neonatal unit from 1982 to 1984, both inclusive. From a total of 4.353 newborns admitted, Serratia marcescens was isolated in 51 newborns; 26 of them exhibited a clinical picture of sepsis, remaining 25 being considered as contaminated. By comparing various characteristics of the contaminated and septic newborns, no difference was found related to sex, gestational age, prenatal pathology, type of delivery, Apgar score, birth-weight or time of diagnosis. Only difference between both groups was severity of intercurrent process and consequently, whether or not were they subject to previous antibiotic treatment and invasive therapeutic maneuvers. Authors conclude that perinatal factors seem to be not so important, as far as supporting a disseminated infection by this organism in concerned, in contrast to former observation by the others authors.

Kaposi's varicelliform eruption in an HIV-positive patient after laser resurfacing.

Kaposi's varicelliform eruption (KVE) is an infection produced by the cutaneous dissemination of herpes virus type 1 or 2. Usually this disease has been described in atopic patients. In this report we present an HIV-positive woman with a Kaposi's varicelliform eruption that started after skin resurfacing with a laser. This is the first report, to the best of our knowledge, of Kaposi's varicelliform eruption after laser resurfacing. The immunodepressed status of the patient may have played a role in her infection.