Levetiracetam-induced pediatric toxic epidermal necrolysis successfully treated with etanercept.

Successful management of toxic epidermal necrolysis (TEN) with tumor necrosis factor-α inhibitors has been described in adults, but few cases have been reported in children. To date, only four pediatric cases of TEN treated with infliximab and one with etanercept have been published. We present the case of an 8-year-old boy diagnosed with TEN induced by levetiracetam, successfully treated with etanercept, systemic corticosteroids, and intravenous immunoglobulin.

Improving the outcome of acute cholecystitis: the non-standardized treatment must no longer be employed.

PURPOSE: Therapeutic recommendations of acute cholecystitis are not consistently implemented, which generates greater patient morbidity and higher health care costs. The aim of this article is to evaluate the burden of acute cholecystitis, to detect potentially modifiable variables, and to propose a therapeutic strategy that will allow us to improve the quality of care. METHODS: We carried out a retrospective study of patients who were admitted to the hospital from January 2010 to December 2012 using a univariate analysis of parameters including the admitting department, age, treatment administered, and length of stay. RESULTS: A total of 967 patients were admitted to the hospital with a diagnosis of acute cholecystitis, 692 (72%) to the Surgery Department, 257 (26%) to Internal Medicine-Digestive, and 18 (2%) to other departments. Four hundred ninety-eight (51.5%) were operated on: 107 (21%) on an urgent basis, 111 (22%) at an early stage (<96 h at diagnosis), 152 (30%) at a late stage (>96 h at diagnosis), and 128 (26%) at a delayed date (other admission). Patients who were admitted into the surgery department were five times more likely to be operated on than patients admitted into other departments (p<0.01). Patients operated on at a late stage had a longer length of stay than early stage surgery patients (p<0.05) and than non-operated ones (p<0.05). Patients<74 years old were more frequently operated than older ones (p<0.05). CONCLUSIONS: The non-standardized treatment of acute cholecystitis causes high clinical and surgical variability, long average stay, more readmissions, and high hospital costs. Therefore, patients with a diagnosis of acute cholecystitis should be admitted to the Surgery Department, thereby increasing the probability of receiving definite treatment.

In Vitro Evaluation of Postbiotics Produced from Bacterial Isolates Obtained from Rainbow Trout and Nile Tilapia against the Pathogens Yersinia ruckeri and Aeromonas salmonicida subsp. salmonicida.

The use of antibiotics in aquaculture leads to the proliferation of multidrug-resistant bacteria, and an urgent need for developing new alternatives to prevent and control disease has, thus, arisen. In this scenario, postbiotics represent a promising tool to achieve this purpose; thus, in this study, isolation and selection of bacteria to further produce and evaluate their postbiotics antibacterial activity against fish pathogens was executed. In this respect, bacterial isolates from rainbow trout and Nile tilapia were obtained and tested in vitro against Yersinia ruckeri and Aeromonas salmonicida subsp. salmonicida. From 369 obtained isolates, 69 were selected after initial evaluation. Afterwards, additional screening was carried out by spot-on-lawn assay to finally select twelve isolates; four were identified as Pediococcus acidilactici, seven as Weissella cibaria, and one as Weissella paramesenteroides by matrix assisted laser desorption/ionization, time-of-flight mass spectrometry (MALDI-TOF MS). Selected bacteria were used to obtain postbiotic products to test their antagonistic activity through coculture challenge and broth microdilution assays. The influence of incubation time prior to postbiotic production on antagonistic behavior was also recorded. Two isolates identified as W. cibaria were able to significantly reduce (p < 0.05) A. salmonicida subsp. salmonicida's growth in the coculture challenge up to 4.49 ± 0.05 Log CFU/mL, and even though the reduction in Y. ruckeri was not as effective, some inhibition on the pathogen's growth was reported; at the same time, most of the postbiotic products obtained showed more antibacterial activity when obtained from broth cultures incubated for 72 h. Based on the results obtained, the preliminary identification of the isolates that expressed the highest inhibitory activity was confirmed by partial sequencing as W. cibaria. Through our study, it can be concluded that postbiotics produced by these strains are useful to inhibit the growth of the pathogens and could, thereby, be applicable in further research to develop suitable tools as feed additives for disease control and prevention in aquaculture.

Development and results of a novel pancreas transplant program in Spain: the surgeon's point of view. / Desarrollo y resultados de un nuevo programa de trasplante de páncreas en España: la visión del cirujano.

INTRODUCTION: Simultaneous kidney-pancreas transplantation for patients with type 1 diabetes and end-stage chronic renal disease is widely performed. However, the rate of surgical morbidity from pancreatic complications remains high. The aim of this study was to describe the development and results of a new program, from the point of view of the pancreatic surgeon. METHODS: We analyzed 53 simultaneous kidney-pancreas transplantations performed over a period of seven years (2009-2016), with a median follow up of 39 months (range: 1-86 months). RESULTS: Out of the total of this series, two patients died: one patient because of cardiac arrest immediately after surgery; and another patient due to traffic accident, complicated by pneumonia. Among the 51 living patients, two grafts were lost: one due to chronic rejection four years after transplantation; and the other due to arterial thrombosis 20 days after transplantation (the only case requiring transplantectomy). In ten patients, one or more re-operations were necessary due to the following: graft pancreatitis (n=4), small intestinal obstruction (n=4), arterial thrombosis (n=1), fistula (n=1) and hemoperitoneum (n=1). Overall patient and graft survival rates after 1, 3 and 5 years were 98, 95 and 95% and 96, 93 and 89%, respectively. CONCLUSIONS: This study has shown that the results of a new pancreas transplant program, which relies on the previous experience of other groups, do not demonstrate a learning curve. Adequate surgeon education and training, as well as the proper use of standardized techniques, should ensure optimal results.

Blastocystis: estudio coproparasitológico, clínico-epidemiológico y de prevalencia de subtipo 3 en pacientes de hospitales de Bahía Blanca, Argentina / Blastocystis: coproparasitological, clinical-epidemiological and prevalence study of subtype 3 in patients from hospitals in Bahía Blanca, Argentina

Resumen Blastocystis es el parásito unicelular del intestino del hombre y de otros animales más prevalente en seres humanos. Presenta gran variedad genética con múltiples subtipos (ST). Aunque se ha asociado a desórdenes intestinales y extraintestinales, su patogenicidad es discutida. Se analizaron 461 muestras de materia fecal de pacientes sintomáticos (n=380) y asintomáticos (n=81) de hospitales de Bahía Blanca, Argentina; se solicitó consentimiento informado y se completó una ficha epidemiológica. Se realizaron análisis coproparasitológicos, morfometría, recuento y tipificación de Blastocystis ST3 por PCR. La población fue: 57,3% de sexo femenino y 42,7% masculino. La prevalencia de Blastocystis fue de 31% y de Blastocystis ST3 62%. Se hallaron formas vacuolares, granulares y quísticas; las vacuolares fueron las más frecuentes. En el 64,8% de las muestras los Blastocystis fueron pequeños y escasos. El 88,4% de los pacientes sintomáticos presentó trastornos gastrointestinales, el 4% urticaria y el 7,6% fiebre, anemia y bajo peso. El 66,7% de los pacientes con urticaria presentó Blastocystis. La presencia de síntomas se asoció significativamente con Blastocystis (p<0,002). No se hallaron asociaciones estadísticas entre Blastocystis, la edad, el sexo, la disponibilidad de agua potable, de cloacas y el contacto con animales. Dentro de los síntomas sólo se encontró asociación estadística de Blastocystis con urticaria (p<0,007). No hubo asociación entre Blastocystis ST3 y sintomatología. Los resultados destacan la alta prevalencia de Blastocystis y de Blastocystis ST3, la necesidad de hacer un coproparasitológico minucioso, su asociación estadística con urticaria y la importancia de no ignorarlo en el proceso salud-enfermedad.

Abstract Blastocystis is the unicellular parasite of the intestine of man and other animals,most prevalent in humans. It has a great genetic variety with multiple subtypes (ST). Although it has been associated with intestinal and extraintestinal disorders, its pathogenicity remains unclear. Four hundred and sixty one stool samples from symptomatic (n=380) and asymptomatic(n=81) patients from hospitals in Bahía Blanca, Argentina were analysed; informed consent was requested and an epidemiological file was completed. Coproparasitological analysis, morphometry, counting and typing of Blastocystis ST3 were performed by PCR. The population was: 57.3% female and 42.7% male.The prevalence of Blastocystis was 31.0% and that of Blastocystis ST3 62%. Vacuolar, granular and cystic forms were found, with vacuolar forms being the most frequent. Blastocystis were small and scarce in 64.8% of the samples. Most of the symptomatic patients (88.4%) presented gastrointestinal disorders, urticaria 4% and fever, anemia and low weight 7.6%; 66.7% of the urticaria patients presented Blastocystis. The presence of symptoms was significantly associated with Blastocystis (p<0.002). No statistical associations were found between Blastocystis, age, sex, availability of drinking water, sewage, and contact with animals. Within the symptoms, only statistical association of Blastocystis with urticaria was found (p<0.007). There was no association between Blastocystis ST3 and symptomatology. The results highlight the high prevalenceof Blastocystis and Blastocystis ST3, the need for a thorough coproparasitology, their statistical association with urticaria and the importance of not ignoring it in the health-disease process.

Resumo Blastocystis é o parasita unicelular do intestino do homem e outros animais, mais prevalente em seres humanos. Apresenta grande variedade genética com múltiplos subtipos (ST). Embora tenha sido associada a distúrbios intestinais e extraintestinais, sua patogenicidade é debatida. Foram analisadas 461 amostras de fezes de pacientes sintomáticos (n=380) e assintomáticos (n= 81) de hospitais de Bahía Blanca, Argentina; foi solicitado consentimento informado e preenchida uma ficha epidemiológica. Foram realizadas análises coproparasitológicas, morfometria, contagem e tipificação de Blastocystis ST3 por PCR. A população era: 57,3% sexo feminino e 42,7% masculino. A prevalência de Blastocystis foi de 31,0% e de Blastocystis ST3 62%. Foram encontradas formas vacuolares, granulares e císticas, sendo as vacuolares as mais frequentes. Em 64,8% das amostras, os Blastocystis foram pequenos e escassos; 88,4% dos pacientes sintomáticos apresentaram distúrbios gastrointestinais, 4% urticária e 7,6% febre, anemia e baixo peso; 66,7% dos pacientes com urticária apresentaram Blastocystis. A presença de sintomas foi associada significativamente com Blastocystis (p˂0,002). Não foram encontradas associações estatísticas entre Blastocystis, a idade, sexo, a disponibilidade de água potável, de esgoto e o contato com animais. Dentro dos sintomas, só foi encontrada associação estatística de Blastocystis com urticária (p˂0,007). Não houve associação entre Blastocystis ST3 e sintomatologia. Os resultados destacam a alta prevalência de Blastocystis e Blastocystis ST3, a necessidade de fazer um coproparasitologico minucioso, sua associação estatística com urticária e a importância de não ignorá-lo no processo saúde-doença.

Osteotomía en Scarf: estudio de 25 casos / Scarf osteotomy: a report of 25 cases

Evaluar los resultados clínicos y radiográficos de la osteotomía en Scarf para el tratamiento del hallux valgas moderado-severo. Material y métodos: Realizamos un estudio retrospectivo con 25 osteotomías en Scarf realizadas desde marzo de 2009 a junio de 2011 con un seguimiento medio de 11 meses para el tratamiento del hallux valgus moderado-severo. Se realizó una valoración clínica de forma pre y postoperatoria según la escala funcional de la American Orthopaedic Foot and Ankle Society (AOFAS) y una valoración radiográfica, mediante la medición de los ángulos intermetatarsiano (IMA), de hallux valgus (HVA) y distal de la articulación metatarsofalángica (DMAA), también de forma pre y postoperatoria. Resultados: En el estudio, 19 pacientes fueron mujeres y 6 hombres, siendo la edad media de 45 años. La estancia media de ingreso fue de 1.2 días. Según la escala AOFAS, se obtuvo una puntuación global preoperatoria de 34.44 y postoperatoria de 92.4. En cuanto a los resultados radiológicos postoperatorios, obtuvimos un IMA medio de 8.84° y un HVA medio de 18.2°. El DMAA fue menor de 10° excepto en 1 paciente. Conclusión: La osteotomía en Scarf ofrece al paciente un apoyo temprano, una movilidad metatarso-falángica precoz y una rápida consolidación de la osteotomía. Obtuvimos unos buenos resultados a corto-medio plazo para el tratamiento del hallux valgus moderado-severo(AU)

To assess the clinical and radiographic results of the Scarf osteotomy in the treatment of moderatesevere hallux valgus. Patients and methods: We performed a retrospectiva study of 25 Scarf osteotomies from March 2009 to June 2011 with an average follow up of 11 months for the treatment of the moderate-several hallux valgus. We assessed the clinical outcome pre and postoperative according to the American Orthopaedic Foot and Ankle Society (AOFAS) scale and radiological outcome, with measuring the angles intermetatarsal (IMA), of hallux valgus (HVA) and distal of metatarsal-phalang joint (DMAA), pre and postoperative. Results: In the study, 19 patients were women and 6 men with average age of 45 years. Tbe average stay of revenue was 1.2 days. According to the AOFAS scale, we obtained a global preoperative score of 34.44 and postoperative of 92.4. About the postoperative radiological findings, we obtained an average IMA of 8.84° and HVA of 18.2 °. Ttle DMAA was less than 10° except in 1 patient. Conclu ion: The Scarf osteotomy offers an early load, an early metatarsal-phalang joint mobility and an early osteotomy consolidation. We performed a good results in the short-medium term for the treatment of the moderate-severe hallux valgus(AU)

[Giant splenic hydatid cyst]. / Quiste hidatídico esplénico gigante.

Hydatidosis is a relatively frequent parasitic disease in some geographical areas and is caused by infection with Echinococcus granulosus larvae leading to the development of cysts. The most frequently affected organs are the liver and lungs. Splenic involvement alone is rare and produces mild abdominal discomfort and a palpable mass in the left hypochondriac region. The treatment of choice is surgery. Radical surgery (splenectomy) is recommended, especially in large cysts. Conservative procedures are employed in pediatric patients or unresectable cysts. Laparoscopic techniques have had limited success.