Cell-Based Therapies Induce Tolerance of Vascularized Composite Allotransplants: A Systematic Review.

INTRODUCTION: Vascularized composite allotransplantation (VCA) is the transplantation of multiple tissue types as a solution for devastating injuries. Despite the highly encouraging functional outcomes of VCA, the consequences of long-term immunosuppression remain the main obstacle in its application. In this review, we provide researchers and surgeons with a summary of the latest advances in the field of cell-based therapies for VCA tolerance. METHODS: Four electronic databases were searched: PubMed, Scopus, Cumulative Index to Nursing and Allied Health Literature , and Web of Science. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analysis as the basis of our organization. RESULTS: Hematopoietic stem cells prolonged VCA survival. A combination of immature dendritic cells and tacrolimus was superior to tacrolimus alone. T cell Ig domain and mucin domain modified mature dendritic cells increased VCA tolerance. Bone marrow-derived mesenchymal stem cells prolonged survival of VCAs. A combination of adipose-derived mesenchymal stem cells, cytotoxic T-lymphocyte antigen 4 immunoglobulin, and antilymphocyte serum significantly improved VCA tolerance. Ex-vivo allotransplant perfusion with recipient's bone marrow-derived mesenchymal stem cells increased VCA survival. Recipient's adipose-derived mesenchymal stem cells and systemic immunosuppression prolonged VCA survival more than any of those agents alone. Additionally, a combination of peripheral blood mononuclear cells shortly incubated in mitomycin and cyclosporine significantly improved VCA survival. Finally, a combination of donor recipient chimeric cells, anti-αß-T cell receptor (TCR), and cyclosporine significantly prolonged VCA tolerance. CONCLUSIONS: Evidence from animal studies shows that cell-based therapies can prolong survival of VCAs. However, there remain many obstacles for these therapies, and they require rigorous clinical research given the rarity of the subjects and the complexity of the therapies. The major limitations of cell-based therapies include the need for conditioning with immunosuppressive drugs and radiation, causing significant toxicity. Safety concerns also persist as most research is on animal models. While completely replacing traditional immunosuppression with cell-based methods is unlikely soon, these therapies could reduce the need for high doses of immunosuppressants and improve VCA tolerance.

Ultrasensitive detection of Ag+and Ce3+ions using highly fluorescent carboxyl-functionalized carbon nitride nanoparticles.

The fluorescence quenching of carboxyl-rich g-C3N4nanoparticles was found to be selective to Ag+and Ce3+with a limit of detection as low as 30 pM for Ag+ions. A solid-state thermal polycondensation reaction was used to produce g-C3N4nanoparticles with distinct green fluorescence and high water solubility. Dynamic light scattering indicated an average nanoparticle size of 95 nm. The photoluminescence absorption and emission maxima were centered at 405 nm and 540 nm respectively which resulted in a large Stokes shift. Among different metal ion species, the carboxyl-rich g-C3N4nanoparticles were selective to Ag+and Ce3+ions, as indicated by strong fluorescence quenching and a change in the fluorescence lifetime. The PL sensing of heavy metal ions followed modified Stern-Volmer kinetics, and CNNPs in the presence of Ag+/Ce3+resulted in a higher value ofKapp(8.9 × 104M-1) indicating a more efficient quenching process and stronger interaction between CNNP and mixed ions. Sensing was also demonstrated using commercial filter paper functionalized with g-C3N4nanoparticles, enabling practical on-site applications.

Analyte-dependent Rabi splitting in solid-state plexcitonic sensors based on plasmonic nanoislands strongly coupled to J-aggregates.

A key challenge in the field of plexcitonic quantum devices is the fabrication of solid-state, device-friendly plexcitonic nanostructures using inexpensive and scalable techniques. Lithography-free, bottom-up nanofabrication methods have remained relatively unexplored within the context plexcitonic coupling. In this work, a plexcitonic system consisting of thermally dewetted plasmonic gold nanoislands (AuNI) coated with a thin film of J-aggregates was investigated. Control over nanoisland size and morphology allowed for a range of plasmon resonances with variable detuning from the exciton. The extinction spectra of the hybrid AuNI/J-aggregate films display clear splitting into upper and lower hybrid resonances, while the dispersion curve shows anti-crossing behavior with an estimated Rabi splitting of 180 eV at zero detuning. As a proof of concept for quantum sensing, the AuNI/J-aggregate hybrid was demonstrated to behave as a plexcitonic sensor for hydrochloric acid vapor analyte. This work highlights the possibility of using thermally dewetted nanoparticles as a platform for high-quality, tunable, cost-effective, and scalable plexcitonic nanostructures for sensing devices and beyond.

Identification of Potential Factors Associated with Cellulitis Following Lymphovenous Bypass Surgery in Breast Cancer Survivors.

BACKGROUND: Breast cancer is one of the most common types of cancer, with around 2.3 million cases diagnosed in 2020. One in five cancer patients develops chronic lymphedema caused by multifactorial triggers and treatment-related factors. This can lead to swelling, skin infections, and limb dysfunction, negatively affecting the patient's quality of life. This retrospective cohort study aimed to determine the associations between demographic and breast cancer characteristics and postoperative cellulitis in breast cancer survivors who underwent lymphovenous bypass surgery (LVB) at Mayo Clinic, Florida. METHODS: We performed a retrospective chart review. Data were collected retrospectively from 2016 to 2022. Sixty adult breast cancer survivors who underwent LVB were included in the final analysis based on specific inclusion and exclusion criteria. Patients were excluded if they did not meet the inclusion criteria or had incomplete follow-up data. Demographic and surgical data were extracted, including body mass index (BMI), type of anastomosis, number of anastomoses, and preoperative cellulitis status. Lymphedema measurements were performed using tape measurements. Fisher's exact test was used to determine statistically significant associations between variables and postoperative cellulitis. RESULTS: Postoperative cellulitis was more common in patients aged 60 to 69 years (43.2%), whites (75.0%), overweight or obese (90.9%), with one to four anastomoses (81.8%), and nonsmokers (79.5%). The mean International Society of Lymphology (ISL) criteria for both postoperative cellulitis and no postoperative cellulitis was 1.93. Statistically significant associations with postoperative cellulitis were found for the number of anastomoses (p = 0.021), smoking status (p = 0.049), preoperative cellulitis (p = 0.04), and the length of years with lymphedema diagnosis variable (p = 0.004). CONCLUSION: Our results suggest that a greater number of anastomoses, smoking, preoperative cellulitis, and years with lymphedema are significantly associated with an increased risk of postoperative cellulitis. Awareness of these risk factors is crucial for monitoring and early treatment of infections following surgery.

CAR-T cell manufacturing landscape-Lessons from the past decade and considerations for early clinical development.

CAR-T cell therapies have consolidated their position over the last decade as an effective alternative to conventional chemotherapies for the treatment of a number of hematological malignancies. With an exponential increase in the number of commercial therapies and hundreds of phase 1 trials exploring CAR-T cell efficacy in different settings (including autoimmunity and solid tumors), demand for manufacturing capabilities in recent years has considerably increased. In this review, we explore the current landscape of CAR-T cell manufacturing and discuss some of the challenges limiting production capacity worldwide. We describe the latest technical developments in GMP production platform design to facilitate the delivery of a range of increasingly complex CAR-T cell products, and the challenges associated with translation of new scientific developments into clinical products for patients. We explore all aspects of the manufacturing process, namely early development, manufacturing technology, quality control, and the requirements for industrial scaling. Finally, we discuss the challenges faced as a small academic team, responsible for the delivery of a high number of innovative products to patients. We describe our experience in the setup of an effective bench-to-clinic pipeline, with a streamlined workflow, for implementation of a diverse portfolio of phase 1 trials.

Feasibility and Effects of a Neuromuscular Warm-Up Based on the Physical Literacy Model for 8-12-Year-Old-Children.

Background: Physical literacy and injury prevention strategies use similar movement-related constructs and can be connected to develop comprehensive interventions. We aimed to test the feasibility and effects of a neuromuscular warm-up based on physical literacy and injury prevention strategies for 8-12-year-old children. Methods: We conducted a cluster non-randomized controlled trial. We defined a priori feasibility criteria and studied the effects of the intervention on physical literacy constructs, movement competence, and neuromuscular performance. We used generalized linear mixed models controlling for covariates and clustering with a significance level of 0.001. Results: We recruited 18 groups (n = 363) and randomly allocated nine to intervention (n = 179; female = 63.7%, age = 9.8 ± 1 years) and nine to control (n = 184, female = 53.3%, age = 9.9 ± 0.9 years). We met four of seven feasibility criteria (i.e. recruitment, adherence, enjoyment, perceived exertion). The three feasibility criteria that were not met (i.e. compliance, fidelity, follow-up) were slightly below the predefined threshold (90%). Model-adjusted mean differences for physical literacy constructs, movement competence, vertical jump height, horizontal jump distance, 20-m sprint time, and dynamic balance favored the intervention (p < .001). Conclusion: The feasibility evidence indicates that the intervention should be slightly modified before implementing it in a larger study. The observed mean differences are promising and can be used in planning future interventions.

A narrative review of telemedicine and its adoption across specialties.

Background and Objective: Telemedicine and video consultation are crucial advancements in healthcare, allowing remote delivery of care. Telemedicine, encompassing various technologies like wearable devices, mobile health, and telemedicine, plays a significant role in managing illnesses and promoting wellness. The corona virus disease 2019 (COVID-19) pandemic accelerated the adoption of telemedicine, ensuring convenient access to medical services while maintaining physical distance. Legislation has supported its integration into clinical practice and addressed compensation issues. However, ensuring clinical appropriateness and sustainability of telemedicine post-expansion has gained attention. We south to identify the most friendly and resistant specialties to telemedicine and to understand areas of interest within those specialties to grasp potential barriers to its use. Methods: We aimed to identify articles that incorporated telemedicine in any medical or surgical specialty and determine the adoption rate and intent of this new form of care. Additionally, a secondary search within these databases was conducted to analyze the advantages, disadvantages, and implementation of telemedicine in the healthcare system. Non-English articles and those without full text were excluded. The study selection and data collection process involved using search terms such as "medicine", "surgery", "specialties", "telemedicine", and "telemedicine". Key Content and Findings: Telemedicine adoption varies among specialties. The pandemic led to increased usage, with telemedicine consultations comprising 30.1% of all visits, but specialties like mental health, gastroenterology, and endocrinology showed higher rates of adoption compared to optometry, physical therapy, and orthopedic surgery. Conclusions: The data shows that telemedicine uptake varies by specialty and condition due to the need for physical exams. In-person visits still dominate new patient visits despite increased telemedicine use. Telemedicine cannot fully replace in-person care but has increased visit volume and is secure. The adoption of telemedicine is higher in medical practices than in surgical practices, with neurosurgery and urology leading. Further research is needed to assess telemedicine's suitability and effectiveness in different specialties and conditions.

Social marketing and the challenges of participant recruitment.

Recruitment of research participants often has not obtained a desired sample size, thereby becoming a major problem inhibiting investigators' ability to adequately test the specified hypotheses. Social marketing with its four Ps, originally developed by the business world to sell products and adapted for public health initiatives, is proposed as a dynamic comprehensive conceptual framework to apply marketing principles and practices to enhance participant recruitment. Applying a social marketing approach to research recruitment would require initial investigation to understand the motivations of the target audience in regard to research participation, and continued research throughout the main project to adapt the recruitment efforts as limitations arise. Additional funding would be needed for successful social marketing research recruitment programs to be systematically implemented and evaluated as part of research projects. In this paper, we define social marketing concepts, briefly review the available literature supporting social marketing applied to recruitment for research studies, and consider ethical issues that may arise when using a social marketing approach.

Recruitment for research projects has been challenging, putting studies at risk of not being able to adequately test a priori hypotheses. Social marketing, an adaptation of traditional marketing principles and practices, may provide a solution. Marketing was developed to sell commercial products to consumers, and the strategies and practices therein could be applied to selling participation in the "intervention" (the health program) to "end users" (participants). The four Ps, product, price, place, and promotion, are the conceptual elements considered in a marketing plan. Applying a social marketing approach to recruitment for research projects has been demonstrated to be successful in a small number of cases. Implementing this approach would require preimplementation research to specify the key characteristics of the target audience; continuous monitoring of recruitment success during the research to assess changes in strategies, as needed; and enhanced funding to accommodate the additional research within an expanded early project time frame.

Development and evaluation of best practice advisory alert for patient eligibility in a hospital-at-home program: A multicenter retrospective study.

BACKGROUND: Hospital-at-home (HaH) is a growing model of care that has been shown to improve patient outcomes, satisfaction, and cost-effectiveness. However, selecting appropriate patients for HaH is challenging, often requiring burdensome manual screening by clinicians. To facilitate HaH enrollment, electronic health record (EHR) tools such as best practice advisories (BPAs) can be used to alert providers of potential HaH candidates. OBJECTIVE: To describe the development and implementation of a BPA for identifying HaH eligible patients in Mayo Clinic's Advanced Care at Home (ACH) program, and to evaluate the provider response and the patient characteristics that triggered the BPA. DESIGN, SETTING, AND PARTICIPANTS: We conducted a retrospective multicenter study of hospitalized patients who triggered the BPA notification for ACH eligibility between March and December 2021 at Mayo Clinic in Jacksonville, FL and Mayo Clinic Health System in Eau Claire, WI. We extracted demographic and diagnosis data from the patients as well as characteristics of the providers who received the BPA notification. INTERVENTION: The BPA was developed based on the ACH inclusion and exclusion criteria, which were derived from clinical guidelines, literature review, and expert consensus. The BPA was integrated into the EHR and displayed a pop-up message to the provider when a patient met the criteria for ACH eligibility. The provider could choose to refer the patient to ACH, dismiss the notification, or defer the decision. MAIN OUTCOMES AND MEASURES: The main outcomes were the number and proportion of BPA notifications that resulted in a referral to ACH, and the number and proportion of referrals that were accepted by the ACH clinical team and transferred to ACH. We also analyzed the factors associated with the provider's decision to refer or not refer the patient to ACH, such as the provider's role, location, and specialty. RESULTS: During the study period, 8962 notifications were triggered for 2847 patients. Providers opted to refer 711 (11.4%) of the total notifications linked to 324 unique patients. After review by the ACH clinical team, 31 of the 324 referrals (9.6%) met clinical and social criteria and were transferred to ACH. In multivariable analysis, Wisconsin nurses, physician assistants, and in-training personnel had lower odds of referring the patients to ACH when compared to attending physicians.

The usefulness of artificial intelligence in breast reconstruction: a systematic review.

BACKGROUND: Artificial Intelligence (AI) offers an approach to predictive modeling. The model learns to determine specific patterns of undesirable outcomes in a dataset. Therefore, a decision-making algorithm can be built based on these patterns to prevent negative results. This systematic review aimed to evaluate the usefulness of AI in breast reconstruction. METHODS: A systematic review was conducted in August 2022 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. MEDLINE, EMBASE, SCOPUS, and Google Scholar online databases were queried to capture all publications studying the use of artificial intelligence in breast reconstruction. RESULTS: A total of 23 studies were full text-screened after removing duplicates, and twelve articles fulfilled our inclusion criteria. The Machine Learning algorithms applied for neuropathic pain, lymphedema diagnosis, microvascular abdominal flap failure, donor site complications associated to muscle sparing Transverse Rectus Abdominis flap, surgical complications, financial toxicity, and patient-reported outcomes after breast surgery demonstrated that AI is a helpful tool to accurately predict patient results. In addition, one study used Computer Vision technology to assist in Deep Inferior Epigastric Perforator Artery detection for flap design, considerably reducing the preoperative time compared to manual identification. CONCLUSIONS: In breast reconstruction, AI can help the surgeon by optimizing the perioperative patients' counseling to predict negative outcomes, allowing execution of timely interventions and reducing the postoperative burden, which leads to obtaining the most successful results and improving patient satisfaction.

Allostatic load and physiological responses to work stress: an integrative review.

Assessing the allostatic load of workers in the context of COVID -19 is of vital importance to elucidate the physiological responses to social and work stress. This is an integrative review of the literature including seven established steps: 1) identification of the topic and the guiding question; 2) definition of MeSH terms and search equations; 3) search in databases following defined criteria; 4) data collection according to inclusion criteria; 5) evaluation of the studies included in the integrative review; 6) discussion of results; and 7) presentation of the review/synthesis of knowledge. Seventeen studies were included, of which 15 were cross-sectional observational studies and two were longitudinal studies. Heterogeneity in the measurement of allostatic load was the common denominator of the studies. Allostatic load is mentioned in all of them as a parameter of measurement, but they measured it diferently; therefore, the relationship between burnout, work environment, and allostatic load, although positive in most studies, was highly variable. In conclusion, it is necessary to conduct studies that combine both biological markers and clinimetric tests, trying to standardize the batery of tests of allostatic load, so that the correlation with work stress is significant and reliable. Similarly, allostatic load requires a systemic and interdisciplinary approach, since this condition puts chronic stress on all organs and physiological compensation mechanisms. Therefore, the allostatic load invites to a comprehensive care of people, considering the work, social, psychological, and biological domains.

Valorar la carga alostática de los trabajadores en el contexto de la Covid-19 es de vital importancia para dilucidar las respuestas fisiológicas al estrés social y laboral. Esta es una revisión integrativa de la literatura, de siete pasos establecidos: 1) identificación del tema y de la pregunta orientadora; 2) definición de términos MeSH y ecuaciones de búsqueda; 3) búsqueda en bases de datos siguiendo criterios definidos; 4) recopilación de datos acorde a criterios de inclusión; 5) evaluación de los estudios incluidos en la revisión integradora; 6) discusión de resultados; 7) presentación de la revisión/síntesis de conocimientos. Se incluyeron 17 estudios, de los cuales 15 fueron estudios observacionales transversales y dos estudios longitudinales. La heterogeneidad en la medición de la carga alostática fue el común denominador de los estudios. En todos se menciona la carga alostática como parámetro de medición. Sin embargo, todos la midieron de formas diferentes, por lo que la relación entre desgaste ocupacional y carga alostática, aunque positiva en la mayoría de los estudios, fue muy variable. Se concluye que es necesario realizar estudios que combinen tanto los marcadores biológicos como las pruebas clinimétricas, tratando de estandarizar la batería de exámenes de la carga alostática, para que la correlación con estrés laboral sea significativa y confable. De igual forma, la carga alostática requiere un abordaje sistémico e interdisciplinario, dado que se ponen en tensión crónica todos los órganos y mecanismos de compensación fisiológicos. Por lo tanto, la carga alostática hace una invitación a un cuidado integral de las personas, desde los ámbitos laboral, social, psicológico y biológico.

Technical consideration for breast reconstruction in patients requiring neoadjuvant or adjuvant radiotherapy: a narrative review.

Background and Objective: Surgical considerations for breast reconstruction (BR) in patients requiring neoadjuvant radiotherapy (NART) or adjuvant radiotherapy (ART) cannot be understated. The management of irradiated tissue leads surgeons to face several challenges. Therefore, it is essential to comprehensively understand the proper patient selection and preoperative planning to ensure the best outcomes and minimize the risk of complications. This narrative review aims to provide an update and summary of the most important technical considerations every breast surgeon must contemplate reconstructing the irradiated breast. Methods: The search strategy was performed on January 10th, 2023. The PubMed, Embase, Cochrane Library, and Web of Science databases were queried to capture all publications regarding surgical considerations in BR of patients undergoing NART and ART. Key Content and Findings: This review shows that the effects of radiotherapy (RT) on BR are still being studied. RT represents an essential factor for overall patient survival, and its use is increasing. However, the range of RT treatments across different cancer centers complicates the creation of a single treatment protocol. BR improves women's quality of life, so finding the proper integration of BR and RT is essential. When deciding on the reconstructive method, there are several factors to consider, such as the patient's body characteristics, tumor stage, RT protocol, and chemotherapy. To achieve the best surgical results and the most satisfied patient, using less aggressive and safer RT methods in the treatment sequence is recommended. Conclusions: The timing of the radiation will influence the selection of the best reconstructive methods to be employed in the breast cancer patient. However, there is clear evidence of preference for immediate autologous-based BR in cases due to the low rate of complications in the long term. But patient individualization is the key. Therefore, the benefits and risks of immediate versus delayed and autologous versus implant-based reconstruction must be weighed in every single case.

Mesenchymal Stromal Cell Healing Outcomes in Clinical and Pre-Clinical Models to Treat Pressure Ulcers: A Systematic Review.

BACKGROUND: Despite numerous measures used to prevent pressure ulcers, their growing prevalence in recent years is expected to continue as the population ages. This review aims to report the outcomes of the regenerative potential of MSCs in treating pressure ulcers, assessing the effectiveness of MSCs in treating pressure ulcers. METHODS: A computerized search for articles on animal models that use MSCs as primary therapy to treat pressure ulcers, published from conception to present, was conducted using PubMed, MEDLINE, Embase, and CINAHL. Our search yielded 52 articles, narrowed to 44 after excluding duplicates. RESULTS: Out of 52 articles collected from four databases, 11 met the inclusion criteria. A total of 11 articles published between 2008 and 2020 met the inclusion criteria. Eight studies were observational descriptive papers in animal models, and three were prospective. Six studies used autologous MSCs, while five used allogenic MSCs. Three studies were conducted in humans, and the remaining eight were conducted in animals. The most common method of cell delivery was an intradermal injection in the margins of the ulcer. All studies reported positive results, including improved wound healing, reduced inflammation, and improved tissue regeneration. CONCLUSIONS: MSCs have shown promising results in treating pressure ulcers in animal and clinical trials. The combination of MSCs and scaffold materials has also been studied and found to be effective in wound healing. A standardized human wound model has been proposed further to investigate the efficacy of cell-based therapies for chronic wounds. However, more research is needed to determine the best quantity of cells to apply for pressure ulcers and to ensure the safety and efficacy of these treatments in clinical settings.

Metástasis cutánea de adenocarcinoma de próstata: reporte de un caso / Cutaneous metastasis of prostate adenocarcinoma: a case report

RESUMEN Las metástasis cutáneas son eventos muy infrecuentes que corresponden a una invasión tumoral a distancia. Las metástasis de próstata tienen un orden de aparición de 1%; las localizaciones más comunes incluyen la región genital o suprapúbica y muy raramente se ubican a distancia. Reportamos el caso de un paciente varón con metástasis cutánea de adenocarcinoma de próstata de localización cervical y torácica superior, el cual presentaba además antecedente de tuberculosis pulmonar. La tomografía reveló la presencia de metástasis ósea, derrame pleural e infiltración de tejidos blandos del cuello. El estudio histopatológico confirmó la presencia de metástasis cutánea de neoplasia de próstata primaria. Presentamos el caso debido a su presentación inusual y por su importancia en el diagnóstico diferencial de esta patología.

ABSTRACT Cutaneous metastases are very rare events and are related to a distant tumor invasion. Prostate metastases have a 1% appearance rate; the most common locations include the genital or suprapubic region and are very rarely located at a distance. We report the case of a male patient with cutaneous metastasis of prostate adenocarcinoma located in the cervical and upper thoracic area. The patient also had a history of pulmonary tuberculosis. A CT scan revealed the presence of bone metastasis, pleural effusion, and infiltration of the soft tissues of the neck. The histopathological study confirmed the presence of cutaneous metastasis of primary prostate neoplasia. We present this case due to its unusualness and its importance in the differential diagnosis of this pathology.

Síndrome de Stevens-Johnson y necrólisis epidérmica tóxica: experiencia clínica en el Hospital Nacional Guillermo Almenara Irigoyen, Lima - Perú / Stevens-Johnson Syndrome and toxic epidermal necrolysis: clinical experience at the Hospital Nacional Guillermo Almenara Irigoyen, Lima-Peru

Objetivo: Describir las características clínicas de un grupo de pacientes diagnosticados de síndrome de Stevens-Johnsons (SSJ) y necrólisis epidérmica tóxica (NET). Material y métodos: Estudio retrospectivo, transversal y descriptivo realizado en el Hospital Nacional Guillermo Almenara Irigoyen entre junio de 2004 y mayo del 2007. Se revisó las historias clínicas de los casos hospitalizados, recogiendo la información sobre drogas responsables, tratamiento y resultado final. Resultados: Se estudiaron siete pacientes, cinco con diagnóstico de NET, uno con SSJ y uno con síndrome SSJ-NET. Cinco pacientes fueron mujeres y dos varones, con una edad media de 47 años.Los fármacos asociados fueron los anticonvulsivantes (fenitoína y lamotrigina) en tres pacientes, metamizol en dos, cotrimoxazol en uno y fluconazol también en uno. La mucosa oral fue afectada en todos los casos, la mucosa genital en cuatro y la mucosa conjuntival en tres. El tratamiento de elección fueron los corticoides en seis pacientes y se inicio de forma rápida en cuatro, evolucionando con mínimas complicaciones y solo uno de ellos presento secuelas oculares. Solo hubo un deceso en este grupo. Conclusiones: El SSJ y la NET en nuestros casos fueron causados principalmente por anticonvulsivantes y metamizol, fueron tratados en su mayoría con corticoides sistémicos. Drogas de uso creciente como fluconazol y lamotrigina también deben considerarse entre los medicamentos de riesgo.

Neumatosis quistica intestinal / Pneumatosis intestinalis

La neumatosis quística intestinal es una afección rara, benigna, caracterizada por quistes intramurales, localizados principalmente en la pared intestinal, de la cual aún no se conoce una causa definida, pero en su mayoría asociada otra enfermedad sistémica. Se presenta el caso de una mujer anciana con esta patología, quien recibió tratamiento quirúrgico y cuyos hallazgos macroscópicos y microscópicos fueron compatibles con una neumatosis quística intestinal. Además, se realiza una revisión actualizada de la literatura, incluyendo patogénesis, diagnóstico y opciones de tratamiento

Lupus eritematoso sistémico buloso de la infancia / Childhood bullous systemic lupus erythematosus

El lupus eritematoso sistémico de la infancia es una rara enfermedad ampollar subepidermal mediada por autoanticuerpos. Se caracteriza por una erupción con ampollas y vesiculas tensas con un fondo eritematoso. El prurito está presente en una severidad variable. Se produce principalmente en la segunda y tercera década de la vida. Reportamos el caso de una niña de 14 años de edad quien presenta un tiempo de enfermedad de cinco meses, con erupción ampollar generalizada, además de fiebre, prurito y úlceras en mucosa oral. Los estudios de inmunofluorescencia directa y coloración con hematoxilina-eosina fueron coherentes con lupus eritematoso sistémico bulloso. Después de una evolución tórpida, correlacionamos la historia clínica, examen físico y pruebas de laboratorio, llegando al diagnóstico de lupus eritematoso sistémico buloso de la infancia.

Bullous systemic lupus erythematosus in childhood is a rare subepidermal blistering disease mediated by autoantibodies. It is characterized by a rash with blisters and strained vesicles with an erythematosus base. Pruritus is present in variable severity. It occurs mainly in the second and third decades of life. We report a case of a 14-year-old child who presented symptoms for five months, including a widespread pruritic blistering eruption, in addition to fever, itching, and ulcers in oral mucosa. Direct immunofluorescence studies, and staining with hematoxylin-eosin were consistent with bullous systemic lupus erythematosus. After a torpid evolution, we correlate the clinical history, physical examination and laboratory tests which led to the diagnosis of childhood bullous systemic lupus erythematosus.

Hipoqueratosis palmar circunscrita: reporte de un primer caso / Circumscribed palmar hypokeratosis: report of a clinical case

Una paciente de 63 años de edad, presentó por seis años una placa deprimida circunscrita en la región tenar de palma derecha, la cual va incrementando paulatinamente de tamaño. Histológicamente se observó una disminución abrupta en el grosor de la capa córnea, con un área central de estrato córneo adelgazado y una capa granular disminuida; no se evidenció inflamación. La paciente tuvo muchos diagnósticos y tratamientos previos con corioterapia tópica y calcitriol, sin obtener mejoría evidente. Es el primer caso reportado en nuestro país de esta reciente enfermedad llamada hipoqueratosis palmar o plantar circunscrita, que correspondió a lo descrito en la literatura como propio de mujeres de edad mayor y con evolución crónica y persistente. Actualmente recién está siendo descrita y probando nuevos esquemas terapéuticos.

Pénfigo crónico benigno familiar (enfermedad de Hailey-Hailey) con bartonelosis (enfermedad de Carrión) / Familial benign chronic pemphigus (Hailey-Hailey disease) with bartonellosis (Carrion´s disease)

La enfermedad de Hailey-Hailey o pénfigo familiar es una enfermedad ampollar rara. El inicio es usualmente en la adolescencia o inicios de la segunda década. Es heredado en una manera autosómica dominante. La enfermedad de Carrión fue llamada así desde que Daniel Alcides Carrión se autoinoculó con una lesión de verruga peruana y murió en la fase de la fiebre de la Oroya en 1885, demostrando que ambas entidades son producidas por un mismo agente. Presentamos el caso de un hombre de 66 años con pénfigo benigno familiar crónico (enfermedad de Hailey-Hailey) que fue referido a nuestro servicio con una historia de cuatro semanas de erupción continua en sus manos, pies y piernas. No tuvo fiebre ni malestar previo a la erupción en la piel. Presentaba pápulas angiomatosas y nódulos múltiples en sus extremidades. Además tenía erosiones y costras en la flexura inguinal desde los 40 años. Respondió a terapia antibiótica con ciprofloxacino por seis semanas con completa regresión de las lesiones cutáneas. Sus lesiones en ingles aclararon en forma parcial con soluciones astringentes y antibióticos. Estas dos enfermedades se presentan raramente de forma simultánea en un mismo paciente.