Nevus oligemicus: a case series.

BACKGROUND: Nevus oligemicus is a functional nevus caused by vasoconstriction of the cutaneous deep vascular plexus, and vasodilatation of vessels of the superficial dermis due to abnormal responses of adrenergic receptors. To the best of our knowledge, only 14 cases in 8 articles were reported in the revised indexed literature. Case report We present five cases of nevus oligemicus in two males and in three female patients. Common characteristics in all patients were overweight and sedentary habits. DISCUSSION: Nevus oligemicus is an uncommon condition characterized by livid and cyanotic patches with localized hypothermia as the key-diagnostic sign. It has been suggested that this entity is probably underdiagnosed, as it is asymptomatic and remains stable in its evolution.

Order-disorder, ferroelasticity and mobility of domain walls in multiferroic Cu-Cl boracite.

Domain walls in Cu-Cl boracite develop as a consequence of an improper ferroelastic, improper ferroelectric transition, and have attracted close interest because some are conductive and all can be mechanically written and repositioned by application of an electric field. The phase transition and its associated dynamical properties have been analysed here from the perspective of strain and elasticity. Determination of spontaneous strains from published lattice parameter data has allowed the equilibrium long-range order parameter for F [Formula: see text]3c → Pca21 to be modelled simply as being close to the order-disorder limit. High acoustic loss in the cubic phase, revealed by resonant ultrasound spectroscopy, is consistent with the presence of dynamical microdomains of the orthorhombic structure with relaxation times in the vicinity of ∼10-5-10-6 s. Low acoustic loss in the stability field of the orthorhombic structure signifies, on the other hand, that ferroelastic twin walls which develop as a consequence of the order-disorder process are immobile on this time scale. A Debye loss peak accompanied by ∼1% elastic stiffening at ∼40 K is indicative of some freezing of defects which couple with strain or of some more intrinsic freezing process. The activation energy of ⩾∼0.01-0.02 eV implies a mechanism which could involve strain relaxation clouds around local ferroelectric dipoles or freezing of polarons that determine the conductivity of twin walls.

[Quinacrine in the treatment of cutaneous lupus erythematosus: practical aspects and a case series]. / Aspectos prácticos de la quinacrina como tratamiento del lupus eritematoso cutáneo: serie de casos.

Hydroxychloroquine and chloroquine are antimalarials used as first-line treatment of cutaneous lupus. Quinacrine is not often employed by Spanish physicians due to a lack of information about its use and the fact that it is not marketed in Spain. It is effective in monotherapy or in combination therapy with other antimalarials. One of the advantages of quinacrine over chloroquine and hydroxychloroquine is that it does not appear to cause retinal toxicity. Quinacrine is used as second-line therapy in patients with pre-existing eye problems that contraindicate treatment with chloroquine or hydroxychloroquine (after evaluation of which drug has the better risk-benefit relationship), and in combination therapy with other antimalarials inpatients with resistance or only a partial response to chloroquine or hydroxychloroquine. We report 8 cases of patients with cutaneous lupus who received treatment with quinacrine in monotherapy or in combination with others antimalarials. Lesions resolved in 5 patients and improved in 3. Therapy had to be withdrawn in 1 patient due to an exacerbation of his psoriasis.

El dolor en pacientes hospitalizados en una institución de alta complejidad / Pain in hospitalized patients in a high complexity institution / Dor em pacientes internados em uma instituição de alta complexidade

Objetivo: el dolor se define como "una experiencia sensorial y emocional desagradable asociada o similar a la asociada con daño tisular real o potencial". El objetivo de este estudio es describir la prevalencia, evaluación y manejo del dolor, en pacientes hospitalizados en una institución de alta complejidad. Metodología: estudio observacional descriptivo longitudinal. Se incluyeron adultos hospitalizados en una institución de alta complejidad durante tres meses; excluyendo pacientes con <48h de hospitalización, alteración del estado de conciencia, diálisis extrainstitucional o historias clínicas incompletas para cumplir los objetivos. El análisis de la información se realizó aplicando métodos descriptivos. Los análisis fueron llevados a cabo en el paquete estadístico SPSSv.26(Inc, Chicago, IL). Resultados: se incluyeron 655 pacientes hospitalizados que cumplieron criterios de elegibilidad, con una edad promedio de 53.9 años. La mediana de días de estancia hospitalaria fue de 5 (RIQ 2­8). El número de tomas del dolor en relación con el número de tomas de signos vitales es de 1:4. Los pacientes recibieron entre 2 y 6 medicamentos diferentes para el control del dolor, siendo la dipirona, con el 68.5%, la más utilizada. Al egreso casi la totalidad de los pacientes presentó un adecuado control del dolor. Conclusiones: persiste una deficiencia en las tomas de la eva cada vez que se toman los signos vitales del paciente hospitalizado. La implementación de la política institucional "clínica que alivia el dolor" busca que se logre un adecuado control del dolor durante la hospitalización.

Objective: pain is defined as "an unpleasant sensory and emotional experience associated or similar to that associated with actual or potential tissue damage." The aim was to describe the prevalence, evaluation, and management of pain in patients hospitalized in a high complexity institution. Methodology: longitudinal descriptive observational study. Adults hospitalized from an overly complex institution for three months were included; excluding patients with <48h of hospitalization, altered state of consciousness, extra-institutional dialysis or incomplete medical records to meet the objectives. The information analysis was conducted by applying descriptive methods. The analyzes were carried out in the statistical package SPSSv.26 (Inc, Chicago, IL). Results: 655 hospitalized patients who met eligibility criteria were included, with a mean age of 53.9 years. The median days of hospital stay was 5 (IQR, 2­8). The number of shots of pain in relation to the number of vital signs shots is 1: 4. The patients received between 2 and 6 different medications for pain control, with dipyrone being the most widely used (68.5%). At discharge, almost all of the patients had adequate pain control. Conclusions: a deficiency persists in the VAS measurements each time the vital signs of the hospitalized patient are taken. The implementation of the institutional policy "clinic that relieves pain" seeks to achieve adequate pain control during hospitalization.

Objetivo: A dor é definida como "uma experiência sensorial e emocional desagradável associada ou semelhante àquela associada a dano tecidual real ou potencial". O objetivo deste estudo é descrever a prevalência, avaliação e manejo da dor em pacientes internados em uma instituição de alta complexidade. Metodologia:estudo observacional descritivo longitudinal. Foram incluídos adultos internados em instituição de alta complexidade por três meses; excluindo pacientes com menos de 48h de internação, estado alterado de consciência, diálise extrainstitucional ou prontuários incompletos para atender aos objetivos. A análise das informações foi realizada por meio de métodos descritivos. As análises foram realizadas no pacote estatístico SPSSv.26( Inc , Chicago, IL).Resultados: Foram incluídos 655 pacientes internados que preencheram os critérios de elegibilidade, com média de idade de 53,9 anos. O número médio de dias de internação foi de 5 (IQR 2-8). O número de injeções de dor em relação ao número de injeções de sinais vitais é 1:4. Os pacientes receberam entre 2 e 6 medicamentos diferentes para controle da dor, sendo a dipirona , com 68,5%, a mais utilizada. Na alta, quase todos os pacientes apresentavam controle adequado da dor. Conclusões: persiste uma deficiência nas medidasvas toda vez que se mede os sinais vitais do paciente hospitalizado. A implantação da política institucional "clínica que alivia a dor" busca alcançar o controle adequado da dor durante a internação.

New magnetostratigraphic evidence for the age of Acheulean tools at the archaeo-palaeontological site "Solana del Zamborino" (Guadix - Baza Basin, S Spain).

The sedimentary record in the Guadix-Baza Basin (southern Spain) has proved to be a great source of information for the Miocene through the Pleistocene periods, due to the abundant faunal remains preserved, in some cases associated with lithic tools. The Solana del Zamborino (SZ) section has been the subject of controversy ever since a magnetostratigraphic analysis resulted in an age of 750-770 Kyr for Acheulean tools, a chronology significantly older than the ~600 Kyr established chronology for the first Acheulean record in Europe. Although recent findings at the "Barranc de la Boella" site (north-east of the Iberian Peninsula) seem to indicate that an earlier introduction of such technique in Europe around 0.96-0.781 Ma is possible, the precise age of the classical site at SZ is still controversial. The aim of this paper is to constrain the chronology of the site by developing a longer magnetostratigraphic record. For this purpose, we carried out an exhaustive sampling in a new succession at SZ. Our results provide a ~65 m magnetostratigraphic record in which 4 magnetozones of normal polarity are found. Our new magnetostratigraphic data suggest an age range between 300-480 Kyr for the lithic tools, closer to the age of traditional Acheulean sites in Europe.

A motivational model for understanding moral action and moral development.

The neglected topic of moral action and the explanations given for such actions, with their shortcomings, are discussed. To avoid these limitations a new model is offered which integrates personal and situational variables, wherein motivation for moral action is the result of the interaction among moral motives, expectations about costs/benefits, and expectations about outcomes for self-evaluation. The numerical values for these variables are defined and support for this model is given through a reanalysis of Kohlberg's stages and some data from other researchers.

Concordancia en la realización del triaje entre enfermería y neurología en pacientes con accidente cerebrovascular isquémico en un hospital universitario: un estudio de corte transversal en un hospital de Bogotá / Agreement in the conduct of triage among nursing and neurology in ischemic stroke patients: a cross sectional study in a university hospital in Bogota / Acordo na avaliação da triagem entre enfermagem e neurologia em pacientes com acidente vascular cerebral isquêmico em hospital universitário: estudo de corte transversal em um hospital de Bogotá

El primer paso en el cuidado del accidente cerebrovascular isquémico es la clasificación (\r\ntriaje\r\n) en la sala de emergencias para \r\nidentificar rápidamente sujetos que sufran esta condición, con el fin de iniciar un tratamiento inmediato. El objetivo de esta inves\r\n-\r\ntigación fue evaluar la prioridad que se da en el \r\ntriaje\r\n a esta condición, la concordancia de los datos aportados por neurología y \r\nenfermería, así como su relación con la evaluación y tratamiento en la Fundación Santa Fe de Bogotá. Se trató de un estudio clínico \r\nde corte transversal. El tiempo de inicio de los síntomas se describió según datos de enfermería en el \r\ntriaje\r\n no estandarizado en \r\nel periodo 2007-2008 y con los datos reportados en la primera evaluación neurológica. Se incluyeron 86 pacientes. La correcta \r\nclasificación en el \r\ntriaje\r\n estuvo presente en 74,4% de los pacientes de acuerdo con los datos de enfermería y en el 64% según \r\nneurología, lo que muestra una concordancia moderada dado el coeficiente de correlación (coeficiente kappa = 0,48, p <0,001). \r\nLos datos recolectados en el \r\ntriaje\r\n no fueron homogéneos entre las enfermeras de \r\ntriaje\r\n y los médicos de guardia de neurología \r\n(residente de segundo año de neurología). La descripción del inicio de síntomas incluidos la fecha y hora es esencial para una \r\ncorrecta clasificación. El uso de un código de accidente cerebrovascular podría optimizar el tratamiento hospitalario, además de \r\nutilizar escalas de reconocimiento como Cincinnati.

The first step in ischemic stroke care is the triage classification at \r\nthe emergency room to quickly identify subjects who suffer this \r\ncondition in order to establish an immediate treatment. Objective:\r\nto assess the priority given to this condition in triage, the concor\r\n-\r\ndance to the data provided by the neurology and nursing \r\ndepartments, and its relationship with assessment and treat\r\n-\r\nment at the Fundación Santa Fe de Bogotá. Methods: A clinical \r\ncross-section study was performed. The symptom's onset time \r\nwas described according to nurse's non-standardized triage \r\ndata and data reported in the first neurological assessment \r\nthrough the study period 2007-2008. Results: 86 patients were \r\nincluded. According to nurses' records 74.4% of triage classifica\r\n-\r\ntions were correct and 64% according to neurology records; it \r\nshowed a moderate correlation agreement (kappa coefficient \r\n= 0.48, p <0.001). Conclusions: Stroke patient's data collected at \r\ntriage were not consistent between nurses and the attending \r\nneurologist (second year neurology resident). Description of \r\nthe symptoms' onset including date and time is essential for a \r\nproper triage classification. Use of stroke codes could optimize \r\nthe inpatient treatment, in addition to the use of recognition \r\nscales like Cincinnati's.

O primeiro passo no tratamento do acidente vascular cerebral \r\né a classificação dos doentes na triagem da sala de emergência, \r\npara identificar rapidamente indivíduos com esta condição, \r\nvisando o tratamento imediato. Objetivos: avaliar a prioridade \r\ndada a esta condição na triagem, a concordância dos dados \r\nfornecidos pela neurologia e enfermagem e sua relação com \r\na avaliação e tratamento, na Fundação Santa Fé de Bogotá. \r\nMétodos: estudo clínico de seção transversal. O tempo de \r\ninício dos sintomas foi descrito pelos dados da enfermagem \r\nna triagem, não padronizada, no período 2007 ­ 2008, e pelos \r\ndados da primeira avaliação da neurologia. Foram incluídos \r\n86 doentes. A classificação na triagem foi dada como apro\r\n-\r\npriada em 74,4% dos doentes, de acordo com os dados da \r\nenfermagem, e em 64% pela avaliação da neurologia, apre\r\n-\r\nsentando uma concordância moderada (coeficiente kappa = \r\n0,48, p <0,001). Conclusões: os dados coletados pelas enfer\r\n-\r\nmeiras da triagem e pelos neurologistas de plantão (residentes \r\nde segundo ano de neurologia) não foram homogêneos. A \r\ndescrição do tempo exato do inicio dos sintomas, incluindo \r\ndata e hora, é essencial para uma apropriada classificação dos \r\ndoentes com AVC.

[The complement system. Normal values and congenital deficiencies in the adult Mexican population]. / El sistema del complemento. Valores normales y deficiencias congénitas en población adulta en México.

Five hundred mexican mestizos, healthy blood donors were evaluated regarding the hemolytic activity of their serum, to assess the function of the complement (C) system. One of them was hypocomplementemic and his serum was unable to promote hemolysis by either classical or alternative pathway. It had normal protein concentrations of C3 and C4, as well as immunoreactive C1, C4, C5, C6, C7 and C8, and lytic factor D. Factor B was not recognizable. It is possible that a genetic deficiency linked to genes codifying for class III products of the major histocompatibility complex is responsible for our findings.

Mechanism of recovery from acute virus infection. IV. Questionable role of mononuclear phagocytes in the clearance of lymphocytic choriomeningitis virus from spleens of mice.

After intravenous infection of mice with 10(3) infectious units (IU) the WE strain lymphocytic choriomeningitis (LCM) virus multiplied in the spleens (as in all other major organs), reaching more than 10(8) IU/g of tissue on days 4 to 5. Subsequently, the virus was quickly eliminated, being below detectability usually by day 10. During the time of virus clearance, the mononuclear phagocytes (MNP) of the spleen were activated as revealed by suppression of growth of Listeria monocytogenes and increase of cell-associated hydrolytic enzymes. In athymic nude mice, in whom the MNP system is assumed to be permanently activated, the virus replicated slightly but reproducibly less than in their euthymic counterparts. However, when the MNP were activated by Corynebacterium parvum, virus in spleens attained higher concentrations than in mice not so treated, and the rate of elimination was not altered. In mice whose MNP had been damaged by injection of dextran sulfate 500, the spleen virus titers were also increased, but the subsequent immune elimination was slightly delayed. Activation of spleen MNP was not evident at the time virus was rapidly cleared as a result of transfusion of LCM-immune T lymphocytes. Adoptive immunization was as successful in mice that had been pretreated with gamma-rays or cyclophosphamide, suggesting that replicating cells or their descendants, in particular monocytes, did not participate measurably in the process of elimination. Pretreatments of recipients with dextran sulfate 500 reduced the efficacy of transfused LCM-immune T lymphocytes, but this compound probably directly affected the cells. We interpret these findings to mean that the LCM virus in the mouse's spleen is controlled by a mechanism in which MNP do not play an essential role.