Estado nutricional de gestantes adolescentes assistidas pela Atenção Básica: um estudo de série temporal com dados do estado de Minas Gerais / Nutritional status of pregnant adolescents assisted in Primary Care: A time series study with data from the state of Minas Gerais

Estudo ecológico, de série temporal, que teve como objetivo analisar a tendência do estado nutricional de gestantes adolescentes assistidas pela atenção primária à saúde em Minas Gerais. Os dados foram provenientes do Sistema de Vigilância Alimentar e Nutricional, referente ao estado nutricional de 140.969 gestantes adolescentes entre os anos de 2010 a 2019; apresentados em variação percentual anual por meio da regressão linear simples. O baixo peso mostrou tendência decrescente nas macrorregiões Sul e Triângulo do Norte com variação anual de -0,88% (IC95% -1,67; -0,09) e -0,79% (IC95% -1,06; -0,51) e o excesso de peso registrou tendência crescente nas macrorregiões Nordeste, Noroeste, Norte, Triângulo do Sul e Vale do Aço com a variação anual de 0,28% (IC95% 0,04;0,52), 0,37% (IC95% 0,23;0,51), 0,64% (IC95% 0,32;0,95), 0,44% (IC95% 0,18;0,70) e 0,57% (IC95% 0,26;0,88), respectivamente. Conclui-se que, no período avaliado, houve a tendência de aumento do excesso de peso entre as gestantes adolescentes no estado de Minas Gerais, acompanhando o processo de transição nutricional no país (AU).

An ecological and time-series study to analyze trends in the nutritional status of pregnant adolescents assisted in Primary Health Care in Minas Gerais. The data came from the Food and Nutrition Surveillance System, referring to the nutritional status of 140,969 pregnant adolescents between 2010 and 2019, presented in annual percentage change using simple linear regression. Low weight showed a decreasing trend in the South and Northern Triangle macro-regions with annual variations of -0.88% (95% CI: -1.67;-0.09) and -0.79% (95% CI: -1.06;-0.51); in turn, excess weight recorded an increasing trend in the Northeast, Northwest, North, Southern Triangle and Vale do Aço macro-regions, with annual variations of 0.28% (95% CI: 0.04;0.52), 0.37% (95% CI: 0.23;0.51), 0.64% (95% CI: 0.32;0.95), 0.44% (95% CI: 0.18;0.70), and 0.57% (95% CI: 0.26;0.88), respectively. It is concluded that, during the evaluated period, there was an increasing trend in excess weight among pregnant adolescents in the state of Minas Gerais, following the nutritional transition process in the country (AU).

Food consumption in early childhood: contribution to food and nutritional surveillance / Consumo alimentar na primeira infância: contribuição para vigilância alimentar e nutricional

Introduction: Objectives: To analyze food consumption and factors associated with the nutritional status of children aged less than two years old.Methods: A cross-sectional study with a sample of 344 infants under two years of age and their mothers, followed-up at Family Health Units. The mothers' and infants' sociodemographic and anthropometric variables and the food consumption of these children were assessed with structured questionnaire. The association strength between the dependent and independent variables was assessed by the Odds Ratio, both in the univariate and in the multiple analysis, with a 5% significance level.Results: The prevalence of inadequate nutritional status was 38.08%. It was observed that 29.09% of the children under six months of age were not offered breast milk exclusively or that it was offered for less than 30 days. Consumption of ultra-processed foods was noticed, mainly industrialized juice in the last month [OR: 1.96, CI: 1.05-3.65], as well as low fruit intake and the habit of eating while watching television in infants older than six months of age. After adjusting for confounding variables, the following remained associated with nutritional status: gestational anemia [OR: 3.58, CI: 1.46-8.77] and maternal work [OR: 0.38, CI: 0.18-0.80].Conclusion: Inadequate nutritional status, characterized by low or excess weight, was associated with the fact that the mother worked and to gestational anemia. In addition, there was early introduction of ultra-processed food products in the diet of children under 24 months of age, replacing food considered natural and healthy, thus showing inappropriate eating practices in view of the recommendations for the age group.

Introdução: Objetivos: analisar o consumo alimentar e os fatores associados ao estado nutricional de crianças menores de dois anos de vida.Método: Estudo de corte transversal realizado com uma amostra de 344 lactentes menores de dois anos de idade e suas respectivas mães, acompanhadas em Unidades de Saúde da Família. As variáveis sociodemográficas, antropométrica das mães e dos lactentes e o consumo alimentar dessas crianças foram avaliadas por meio de questionário estruturado. A força de associação entre as variáveis dependente e as independentes foi avaliada pelo odds ratio, tanto na análise univariada quanto na múltipla, com nível de significância de 5%.Resultados: A prevalência do estado nutricional inadequado foi de 38,08%. Observou que 29,09% das crianças menores de seis meses de idade não chegaram a receber leite materno de forma exclusiva ou o tempo de oferta foi inferior a 30 dias. Notou-se o consumo de alimentos ultraprocessados, principalmente, do suco industrializado no último mês [OR:1,96, IC 95%: 1,05-3,65], baixa ingestão de frutas e o hábito de comer assistindo televisão nos lactentes maiores de seis meses. Após ajuste para variáveis de confusão, permaneceram associadas ao estado nutricional: anemia gestacional [OR: 3,58 IC: 1,46-8,77] e trabalho materno [OR, 0,38, IC 95%: 0,18-0,80].Conclusão: A presença do estado nutricional inadequado, caracterizado pelo baixo ou excesso de peso, associou-se ao fato de a mãe trabalhar e à anemia gestacional. Ademais, constatou-se a participação precoce de alimentos ultraprocessados na alimentação das crianças menores de 24 meses de idade, substituindo alimentos considerados naturais e saudáveis, evidenciando assim práticas alimentares inadequadas frente às recomendações para a faixa etária.

Consumo infantil de alimentos: ¿relación con el estado nutricional materno? / Food consumption of infants: Is there a relationship with maternal nutritional status? / Consumo alimentar infantil: relação com o estado nutricional materno?

Introducción: La figura materna tiene una fuerte influencia en la salud del niño, el estado nutricional y la formación de los hábitos alimentarios del niño, ya que es la principal cuidadora de su hijo. Objetivo: determinar el estado nutricional de las madres y su asociación con el consumo de alimentos de los niños. Materiales y Métodos: Estudio transversal realizado con 163 binomios madre-hijo menores de 24 meses atendidos en Unidades de Salud de la Familia. Se utilizó un cuestionario para recolectar las variables sociodemográficas y antropométricas de madres e infantes. El estado nutricional de los lactantes se clasificó por el índice de masa corporal por indicador de edad y el diagnóstico del estado nutricional de las madres por el índice de masa corporal. La práctica de alimentación del lactante se analizó utilizando formas de marcadores de consumo de alimentos propuesto por el Ministerio de Salud de Brasil. Resultados: Se observó que el 51,53% de las madres tenían sobrepeso y el 30,06% de los niños tenían sobrepeso, según IMC/Edad. En cuanto al consumo de alimentos infantiles, hubo una marcada presencia de alimentos ultraprocesados. El estado nutricional materno inadecuado se asoció con el consumo de snacks envasados ​​el día anterior a la encuesta (p = 0,002). Conclusión: El perfil materno tiene una gran influencia en el consumo de alimentos del lactante, por lo que es necesario implementar actividades de educación en salud para asesorar a las familias, reforzando la importancia de introducir adecuadamente los alimentos complementarios.

Introduction: As the primary caregiver of her child, the mother figure has a strong influence on the child's health, nutritional status, and formation of eating habits. Objective: To determine the nutritional status of mothers and its association with children's food consumption. Objective: To determine the nutritional status of mothers and its association with children's food consumption. A cross-sectional study was conducted with 163 mother-child pairs at <24 months of age attended in Family Health Units. Materials and Methods: A questionnaire was used to collect sociodemographic and anthropometric variables of mothers and infants. The nutritional status of the infants was determined using the body mass index by age; the diagnosis of the nutritional status of the mothers was determined by body mass index. Infant feeding practice was evaluated using the Food Intake Markers proposed by the Brazilian Ministry of Health. Results: 51.53% of the mothers were overweight, and 30.06% of the children were overweight, according to BMI/age. In terms of children's food consumption, there was a marked presence of ultra-processed foods. Inadequate maternal nutritional status was associated with consuming packaged snacks the day before the survey (p = 0.002). Conclusion: The maternal profile significantly influences infant food consumption; therefore, it is necessary to implement health education activities to advise families and reinforce the importance of adequately introducing complementary foods.

Introdução: A figura materna exerce forte influência na saúde da criança, no estado nutricional e na formação dos hábitos alimentares da criança, visto que ela é a principal cuidadora de seu filho. Objetivo: determinar o estado nutricional de mães e sua associação com o consumo alimentar de crianças. Materiais e Métodos: Estudo transversal realizado com 163 duplas mãe-filho menores de 24 meses atendidas em Unidades de Saúde da Família. Um questionário foi utilizado para coletar as variáveis ​​sociodemográficas e antropométricas de mães e bebês. O estado nutricional dos lactentes foi classificado pelo índice de massa corporal por indicador de idade e o estado nutricional das mães diagnosticadas pelo índice de massa corporal. A prática de alimentação infantil foi analisada por meio de formulários de marcadores de consumo alimentar propostos pelo Ministério da Saúde do Brasil. Resultados: Observou-se que 51,53% das mães estavam acima do peso e 30,06% das crianças estavam acima do peso, segundo IMC/Idade. Em relação ao consumo de alimentos infantis, houve presença marcante de alimentos ultraprocessados. O estado nutricional materno inadequado foi associado ao consumo de salgadinhos embalados no dia anterior à pesquisa (p = 0,002). Conclusão: O perfil materno tem grande influência no consumo alimentar do lactente, por isso é necessário implementar ações de educação em saúde para orientar as famílias, reforçando a importância da introdução adequada dos alimentos complementares.

Severe blistering eruptions induced by immune checkpoint inhibitors: a multicentre international study of 32 cases.

Among dermatologic adverse events induced by immune checkpoint inhibitors (ICI), bullous life-threatening reactions are rare. To better define the clinical and histological features, treatment, and prognosis of ICI-related severe blistering cutaneous eruptions. This retrospective case series was conducted between 2014/05/15 and 2021/04/15 by the dermatology departments of four international registries involved in drug reactions. Inclusion criteria were age ≥18 years old, skin eruption with blisters with detachment covering ≥1% body surface area and at least one mucous membrane involved, available pictures, and ICI as suspect drug. Autoimmune bullous disorders were excluded. Each participant medical team gave his own diagnosis conclusion: epidermal necrolysis (EN), severe lichenoid dermatosis (LD), or unclassified dermatosis (UD). After a standardized review of pictures, cases were reclassified by four experts in EN or LD/UD. Skin biopsies were blindly reviewed. Thirty-two patients were included. Median time to onset was 52 days (3-420 days). Cases were originally diagnosed as EN in 21 cases and LD/UD in 11 cases. After review by experts, 10/21 EN were reclassified as LD/UD. The following manifestations were more frequent or severe in EN: fever, purpuric macules, blisters, ocular involvement, and maximal detachment. Most patients were treated with topical with or without systemic corticosteroids. Eight patients (25%) died in the acute phase. The culprit ICI was not resumed in 92% of cases. In three patients, another ICI was given with a good tolerance. Histology did not reveal significant differences between groups. Severe blistering cutaneous drug reactions induced by ICI are often overdiagnosed as EN. Consensus for management is pending.

Reacción a fármacos con eosinofilia y síntomas sistémicos (DRESS) / Drug reaction with eosinophilia and systemic symptoms (DRESS)

La reacción a fármacos con eosinofilia y síntomas sistémicos (del acrónimo en inglés DRESS: drug reaction with eosinophilia and systemic symptoms) o síndrome de hipersensibilidad inducida por fármacos (del acrónimo en inglés DIHS: drug induced hypersensitivity syndrome), es una reacción adversa a fármacos (RAF) grave e infrecuente. Los mecanismos involucrados en su fisiopatogenia incluyen diversas alteraciones de las enzimas metabolizadoras de fármacos, con la consecuente acumulación de metabolitos reactivos, la reactivación secuencial de virus de la familia del herpes, la predisposición genética asociada a ciertos alelos de antígenos leucocitarios humanos (HLA) y una respuesta de hipersensibilidad retardada de tipo IV. En la actualidad, se han ido incorporando nuevos fármacos responsables de este cuadro como medicamentos biológicos, inmunosupresores y quimioterápicos. La presentación clínica del DRESS es variable. Tiene una morbimortalidad alta y supone costos elevados en la atención médica. Su tratamiento consiste, en primer lugar, en la suspensión de los fármacos causales o sospechosos de desencadenar el síndrome. Luego, según la gravedad del cuadro, se pueden indicar corticosteroides sistémicos o inmunoglobulina (IGIV) combinada con corticosteroides, plasmaféresis, ciclosporina, micofenolato de mofetilo y rituximab. El objetivo de este trabajo fue realizar una revisión sobre el DRESS y destacar los aspectos nuevos y relevantes de los últimos 5 años.

Drug reaction with eosinophilia and systemic symptoms (DRESS) or drug-induced hypersensitivity syndrome (DIHS), is a serious and rare adverse drug reaction. Among the mechanisms involved in its pathophysiology, there are various alterations in drugmetabolizing enzymes with the consequent accumulation of reactive metabolites, sequential reactivation of viruses of the herpes family, genetic predis-position associated with certain HLA, and a type IV hypersensitivity response. Currently, new drugs responsible for this pathology have been incorporated, such as biologicals, immunosuppressants and chemotherapy. The clinical presentation of DRESS is variable. It has a high morbidity and mortality and involves high costs in medical care. Its treatment consists, in the first place, in the suspension of the causal or suspected drugs. Then, depending on severity, systemic corticosteroids or IVIG combined with corticosteroids, plasmapheresis, cyclosporine, mycophenolate mofetil, and rituximab may be indicated.The objective of this work was review DRESS and highlight the new and relevant aspects of the last 5 years.

Hand, foot, and mouth disease in adults caused by Coxsackievirus B1-B6

Abstract Hand, foot, and mouth disease is a viral rickettsial disease caused by Coxsackievirus A16 and Enterovirus 71 in most cases. It is commonly seen in children under ten years old, who present oral enanthema and a macular, maculopapular, or vesicular rash on their hands and feet. However, an increase in cases caused by other viral serotypes was observed in adults in recent years with various clinical presentations and a troublesome diagnosis. Three cases of hand, foot, and mouth disease are reported to show the clinical variability and diagnostic complexity that this disease may present in adult patients.

Telemedicina: validación de un cuestionario para evaluar la experiencia de los profesionales de la salud / Telemedicine: validation of a questionnaire to evaluate the experience of health professionals / Telemedicina: validação de um questionário para avaliar a experiência dos profissionais de saúde

RESUMEN Objetivo. El siguiente trabajo tiene como objetivo desarrollar y validar un cuestionario para evaluar la experiencia de los profesionales de la salud con los sistemas de telemedicina. Métodos. A partir de la versión abreviada en español y validada localmente del cuestionario para pacientes desarrollado por Parmanto y col., un grupo de expertos consensuó una versión para evaluar la experiencia de profesionales de la salud que brindan servicios de telemedicina. El comportamiento psicométrico de los ítems se testeó en una primera muestra de 129 profesionales a través de un análisis factorial exploratorio. Luego, se evaluó su comprensibilidad a través de entrevistas cognitivas. Por último, en una nueva muestra de 329 profesionales, se evaluó la validez de constructo del cuestionario mediante un análisis factorial confirmatorio (AFC), y su validez de criterio externo, mediante la evaluación de su puntaje con el de una pregunta de resumen. Resultados. Se obtuvo un cuestionario de 12 ítems con una estructura de dos factores con indicadores de ajuste aceptables, documentada mediante AFC. La fiabilidad, la validez convergente y la validez discriminante fueron apropiadas. La validez de criterio externo mostró resultados óptimos. Conclusiones. El instrumento obtenido cuenta con propiedades psicométricas adecuadas y contribuirá a la evaluación objetiva de la experiencia de los profesionales que realizan telemedicina.

ABSTRACT Objective. This objective of this work is to develop and validate a questionnaire to evaluate health professionals' experience with telemedicine systems. Methods. Based on an abbreviated, locally validated Spanish-language version of the patient questionnaire developed by Parmanto et al., a group of experts developed a version to evaluate the experience of health professionals who provide telemedicine services. The psychometric behavior of the items was tested in an initial sample of 129 professionals, using exploratory factor analysis. The comprehensibility of the items was then assessed through cognitive interviews. Finally, in a new sample of 329 professionals, the construct validity of the questionnaire was evaluated by means of confirmatory factor analysis (CFA); its criteria of external validity were assessed by comparing the score with that of a summary question. Results. A 12-item questionnaire was obtained, with a two-factor structure and acceptable adjustment indicators documented through CFA. Reliability, convergent validity, and discriminant validity were appropriate. The criteria of external validity showed optimal results. Conclusions. The instrument obtained has adequate psychometric properties and will contribute to the objective evaluation of the experience of health professionals who perform telemedicine.

RESUMO Objetivo. Desenvolver e validar um questionário para avaliar a experiência dos profissionais de saúde com os sistemas de telemedicina. Métodos. Com base na versão abreviada em espanhol - e validada localmente - do questionário para pacientes desenvolvido por Parmanto et al., um grupo de especialistas gerou uma versão de consenso para avaliar a experiência de profissionais de saúde que prestam serviços de telemedicina. O comportamento psicométrico dos itens foi testado em uma primeira amostra de 129 profissionais, por meio de análise fatorial exploratória. Em seguida, sua compreensibilidade foi avaliada por meio de entrevistas cognitivas. Por fim, em uma nova amostra de 329 profissionais, avaliou-se a validade de construto do questionário por meio de uma análise fatorial confirmatória (AFC), e sua validade de critério externo, mediante a avaliação de sua pontuação com a de uma pergunta resumo. Resultados. Obteve-se um questionário de 12 itens com estrutura de dois fatores, com indicadores de ajuste aceitáveis, documentados pela AFC. A confiabilidade, a validade convergente e a validade discriminante foram adequadas. A validade de critério externo apresentou ótimos resultados. Conclusões. O instrumento obtido possui propriedades psicométricas adequadas e contribuirá para a avaliação objetiva da experiência dos profissionais que realizam telemedicina.

El sistema del complemento y su papel en las enfermedades cutáneas / The complement system and its role in skin diseases

El sistema del complemento es un conjunto de proteínas asociadas a la regulación de la inmunidad y a la protección del huésped. Existen tres vías de activación llamadas clásica, alternativa y asociada a las lectinas, que culminan en la producción de opsoninas, de anafilotoxinas y del complejo de ataque a la membrana. La activación del sistema del complemento es fundamental en la defensa cutánea contra agentes microbiológicos, como también en la regulación de la inflamación y de la lesión tisular. En diversas enfermedades cutáneas puede constatarse hiperactividad, deficiencia o anomalías en el control del sistema del complemento. Mediante mecanismos autoinmunitarios con depósito de anticuerpos, o por efecto citotóxico sobre la epidermis o las células vasculares, se observa un efecto inflamatorio directo como ocurre en el lupus eritematoso sistémico o en las enfermedades ampollares autoinmunes. Además, las deficiencias en la regulación del sistema del complemento generan la activación de vías colaterales proinflamatorias como en el caso del sistema calicreínacinina (quinina) en el angioedema hereditario. En este trabajo se describe la fisiología del sistema del complemento, su relevancia en algunas patologías cutáneas frecuentes y las alteraciones en los estudios de laboratorio.

The complement system is a set of proteins associated with the regulation of immunity and the host protection. There are three activation pathways called classical, alternative, and lectin-associated, which culminate in the production of opsonins, anaphylatoxins, and the membrane attack complex. The activation of the complement system plays a fundamental role in the cutaneous defense against microbiological agents, as well as in the regulation of inflammation and tissue injury. In severalskin diseases, hyperactivity, deficiency or abnormalities in the control of the complement system can be observed. Through autoimmune mechanisms with antibody deposition or by cytotoxic effect on the epidermis or vascular cells, a direct inflammatory effect is observed, as occurs in systemic lupus erythematosus or in autoimmune bullous diseases. Moreover, deficiencies in the regulation of the complement system lead to the activation of pro-inflammatory collateral pathways, as in the case of the kallikrein-kinin system in hereditary angioedema. In this manuscript, we describe the physiology of the complement system, its relevance in common skin pathologies, and alterations in laboratory studies.

Herpes zóster. Actualización y manejo / Herpes zoster. Management and treatment update

El herpes zóster es una enfermedad infecciosa producida por el virus de la varicela zóster, caracterizada por la aparición de vesículas que suelen presentarse en una disposición metamérica. Su incidencia se encuentra en aumento y es un motivo de consulta frecuente en la práctica cotidiana. En este artículo se ofrece información actualizada acerca de su diagnóstico, tratamiento y prevención, así como sobre otros aspectos controvertidos de su manejo.

Herpes zoster is an infectious disease caused by varicella zoster virus, characterized by the development of vesicles, which usually present with a metameric arrangement. Its incidence is increasing and is a frequent reason for consultation in daily practice. This article offers updated information on its diagnosis, treatment and prevention, as well as controversial aspects of the management of this pathology.

Erupción variceliforme de Kaposi y enfermedad de Darier / Kaposi's varicelliform rash and Darier's disease

La erupción variceliforme de Kaposi es una infección cutánea diseminada, causada en la mayor parte de los casos por el virus Herpes simple tipo 1. Se suele presentar en pacientes con alteraciones preexistentes de la barrera cutánea, especialmente en niños con dermatitis atópica. Se comunica el caso de un paciente de 84 años, quien negaba enfermedades cutáneas previas, que consultó por lesiones dolorosas y pruriginosas, en la piel del tórax y el abdomen, de 3 semanas de evolución. Con sospecha de una enfermedad infecciosa viral, bacteriana, ampollar o neutrofílica, se realizó inmunofluorescencia directa para herpes, cultivo y biopsia de piel para estudio histológico. La inmunofluorescencia fue positiva para Herpes simple tipo 1 y el estudio histopatológico mostró cambios compatibles con infección herpética y enfermedad de Darier. La enfermedad de Darier es una genodermatosis infrecuente que se suele manifestar en la adolescencia. Si bien su diagnóstico en la ancianidad es excepcional, este caso ilustra que se debe considerar en todos los pacientes que presenten erupción variceliforme. (AU)

Kaposi's varicelliform rash is a disseminated cutaneous infection, caused by Herpes virus 1. It usually presents in patients with pre-existing skin barrier disorders, especially in children with atopic dermatitis. We report the case of an 84-year-old patient, who reported having no previous skin diseases, who consulted for painful, itchy, 3-week-old skin lesions. As we suspected viral, bacterial, bullous or neutrophilic disease, direct immunofluorescence, culture, and skin biopsy for histological study were performed. Immunofluorescence was positive for Herpes simplex type 1 and the histopathological study showed changes compatible with herpetic infection and Darier's disease. Darier's disease is a rare genodermatosis that usually manifests in adolescence. Although its diagnosis in old age is anecdotal, it should be considered in patients with a varicelliform rash. (AU)

Devolución facilitadora, la clave de una evaluación formativa en la enseñanza clínica: lo necesario, lo real, lo posible / Facilitating return, the key to a formative evaluation in clinical education: the necessary, the real, the possible

La devolución facilitadora, también conocida como feedback, es una herramienta fundamental de la evaluación formativa, mediante la cual el docente le acerca al alumno información sobre su desempeño con el objetivo de destacar fortalezas, identificar debilidades y planificar cómo superarlas. La forma en la cual se lleva a cabo es fundamental y tiene un impacto directo sobre el resultado del proceso. El objetivo de este trabajo es abordar conceptualizaciones sobre la retroalimentación formativa a partir de un relato autobiográfico de una docente en el ámbito de la salud que involucra la enseñanza clínica en la sala de internación de residentes de Dermatología. El análisis de las experiencias previas de la evaluación formativa a la luz de los conocimientos construidos durante la formación como docente, pone en evidencia que es crucial que se aprenda a educar y a dar feedback para poder contar con herramientas que permitan acompañar a los alumnos en la construcción del conocimiento. (AU)

Formative feedback is considered an important tool of formative evaluation, that allows the teacher to provide information to the students about their performance, in order to highlight their strengths, identify weaknesses and plan how to overcome them. The way in which this is carried out is fundamental and has a direct impact on the outcome of the process. We sought to evaluate the perceptions and ideas on the training feedback loop, based on the autobiographical report of a Senior Faculty whose core activities are directed towards the teaching of Medical Residents and Dermatology trainees. The analysis of past experiences in light of knowledge constructed while becoming a Teacher shows the crucial need and interrelationship of teaching and timely feedback. The latter provide much needed tools for Students during their learning process. (AU)

Chagas disease reactivation: cutaneous manifestations in a transplanted patient

Abstract: Chagas disease is an endemic zoonosis caused by a protozoan agent called Trypanosoma cruzi. It is mainly transmitted by a hematophagous vector, and less frequently by blood transfusion, transplacental and solid organ transplant. In most cases, primary infection is not diagnosed and the disease progresses to a chronic phase. Immunosuppressed patients are a vulnerable population that may present an acute, atypical and severe reactivation of the chronic form of this disease. We hereby report a case of a female patient, who received a renal transplant with immunosuppressive treatment, who was diagnosed with a chagasic hypodermitis secondary to an acute reactivation of a chronic phase of this disease. We describe the clinical features, epidemiological and histopathological findings, treatment and course.

Dermatosis autoinfligida: presentación de un caso y revisión / Self-inflicted dermatosis: presentation of a case and review

Las dermatosis autoinfligidas representan un motivo habitual de consulta, así como un desafío diagnóstico y terapéutico. Se caracterizan por la autoprovocación de lesiones cutáneas de manera consciente o inconsciente en el contexto de trastornos psiquiátricos complejos. Comunicamos el caso de una paciente que consultó al Servicio de Dermatología por úlceras irregulares y sobreinfectadas localizadas en rostro, de 2 meses de evolución. El caso representó una dificultad diagnóstica ya que solo a partir del interrogatorio exhaustivo y los exámenes complementarios, que descartaron otras patologías, se arribó al diagnóstico de úlceras autoprovocadas en contexto de patología psiquiátrica que requirió manejo interdisciplinario. (AU)

Self-inflicted dermatoses are a frequent cause for consultation and represent a diagnostic and therapeutic challenge. They are characterized by the conscious or unconscious self-generation of cutaneous lesions in the context of complex psychiatric disorders. We report the case of a patient who consulted at the dermatology department with two months history of irregular and superinfected ulcers located on the face. This case represented a diagnostic difficulty since only from an exhaustive interrogation and complementary examinations, which ruled out other pathologies, we arrived at the diagnosis of self-inflicted ulcers in the context of psychiatric pathology that required interdisciplinary management. (AU)

Bullous pyoderma gangrenosum as a predictor of hematological malignancies.

Pyoderma gangrenosum may precede, coexist or follow diverse systemic diseases. The bullous variety is usually associated with hematologic disorders. From 31 patients with pyoderma gangrenosum diagnosed in our hospital during 10 years, only 2 presented with the bullous type. One patient had previous diagnosis of chronic myeloid leukemia. Both had fast-progressive, painful lesions, and both showed an excellent response to systemic corticosteroids. In less than 3 months the lesions recurred simultaneously with the progression of chronic myeloid leukemia in one patient and with the initial diagnosis of acute myeloid leukemia in the other one. They died in less than four weeks. These findings emphasize the importance of its timely diagnosis. Cutaneous lesions could be the first predictor of an underlying disease.

Bullous pyoderma gangrenosum as a predictor of hematological malignancies

Abstract: Pyoderma gangrenosum may precede, coexist or follow diverse systemic diseases. The bullous variety is usually associated with hematologic disorders. From 31 patients with pyoderma gangrenosum diagnosed in our hospital during 10 years, only 2 presented with the bullous type. One patient had previous diagnosis of chronic myeloid leukemia. Both had fast-progressive, painful lesions, and both showed an excellent response to systemic corticosteroids. In less than 3 months the lesions recurred simultaneously with the progression of chronic myeloid leukemia in one patient and with the initial diagnosis of acute myeloid leukemia in the other one. They died in less than four weeks. These findings emphasize the importance of its timely diagnosis. Cutaneous lesions could be the first predictor of an underlying disease.