Photobiomodulation Therapy to Treat Snakebites Caused by Bothrops atrox: A Randomized Clinical Trial.

Importance: Bothrops venom acts almost immediately at the bite site and causes tissue damage. Objective: To investigate the feasibility and explore the safety and efficacy of low-level laser therapy (LLLT) in reducing the local manifestations of B atrox envenomations. Design, Setting, and Participants: This was a double-blind randomized clinical trial conducted at Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, in Manaus, Brazil. A total of 60 adult participants were included from November 2020 to March 2022, with 30 in each group. Baseline characteristics on admission were similarly distributed between groups. Data analysis was performed from August to December 2022. Intervention: The intervention group received LLLT combined with regular antivenom treatment. The laser used was a gallium arsenide laser with 4 infrared laser emitters and 4 red laser emitters, 4 J/cm2 for 40 seconds at each application point. Main Outcomes and Measures: Feasibility was assessed by eligibility, recruitment, and retention rates; protocol fidelity; and patients' acceptability. The primary efficacy outcome of this study was myolysis estimated by the value of creatine kinase (U/L) on the third day of follow-up. Secondary efficacy outcomes were (1) pain intensity, (2) circumference measurement ratio, (3) extent of edema, (4) difference between the bite site temperature and that of the contralateral limb, (5) need for the use of analgesics, (6) frequency of secondary infections, and (7) necrosis. These outcomes were measured 48 hours after admission. Disability assessment was carried out from 4 to 6 months after patients' discharge. P values for outcomes were adjusted with Bonferroni correction. Results: A total of 60 patients (mean [SD] age, 43.2 [15.3] years; 8 female individuals [13%] and 52 male individuals [87%]) were included. The study was feasible, and patient retention and acceptability were high. Creatine kinase was significantly lower in the LLLT group (mean [SD], 163.7 [160.0] U/L) 48 hours after admission in relation to the comparator (412.4 [441.3] U/L) (P = .03). Mean (SD) pain intensity (2.9 [2.7] vs 5.0 [2.4]; P = .004), circumference measurement ratio (6.6% [6.6%] vs 17.1% [11.6%]; P < .001), and edema extent (25.8 [15.0] vs 40.1 [22.7] cm; P = .002) were significantly lower in the LLLT group in relation to the comparator. No difference was observed between the groups regarding the mean difference between the bite site temperature and the contralateral limb. Secondary infections, necrosis, disability outcomes, and the frequency of need for analgesics were similar in both groups. No adverse event was observed. Conclusions and Relevance: The data from this randomized clinical trial suggest that the use of LLLT was feasible and safe in a hospital setting and effective in reducing muscle damage and the local inflammatory process caused by B atrox envenomations. Trial Registration: Brazilian Registry of Clinical Trials Identifier: RBR-4qw4vf.

Combination of Shengji ointment and bromelain in the treatment of exposed tendons in diabetic foot ulcers: study protocol for a non-blind, randomized, positive control clinical trial.

BACKGROUND: Diabetic foot ulcers often affect tendon tissue. Consequently, the infection may spread proximally along the tendon, leading to amputation or even the death of patients. Exposed, degenerated, and necrotic tendons are key factors affecting the healing of diabetic foot ulcers. The effective treatment of the tendon involvement may positively affect the prognosis. In clinical practice, treatment with Shengji ointment and bromelain induces islands of granulation tissue on the denatured tendon surface, which gradually grows and merges. Ideally, the exposed tendon is covered entirely by granulation tissue. This trial aims to assess the effect of a combined treatment regime of Shengji ointment, which has been shown to regenerate muscle tissue and pineapple protease in preventing the loss of function and amputation caused by tendon necrosis. This trial will provide high-quality evidence for the effectiveness of this combination in healing diabetic ulcers with tendon necrosis. METHODS: The sample size will be 180 patients who will be randomly assigned 1:1 to a treatment group (90 patients) using Shengji ointment combined with bromelain and a control group (90 patients) using hydrocolloid dressing. Both groups will continue their conventional treatments, such as blood glucose and blood pressure medication, lipid regulation, antiplatelets, and others. The primary outcome will be the wound coverage with granulation tissue. Secondary outcomes will be the wound healing rate, amputation extent (where needed), time to granulation, and the Maryland Foot Score. Other efficacy outcomes will be the time to debridement of necrotic tendon tissue and granulation tissue score. DISCUSSION: This study will treat patients with diabetic foot ulcers with exposed, degenerated, and necrotic tendons with Shengji ointment and bromelain. The trial aims to promote regeneration and healing, to preserve the limb and its function, and to develop a comprehensive and effective protocol that can be applied to promote the healing of exposed tendons in diabetic foot wounds. TRIAL REGISTRATION: ChiCTR2000039327 ; date of registration: 2020-10-23.

Efeitos adversos locorregionais da terapêutica oncológica em mulheres com câncer de mama avançado: revisão integrativa / Efectos adversos locorregionales de la terapia oncológica en mujeres con cáncer de mama avanzado: una revisión integradora / Locoregional adverse effects of cancer therapy in women with advanced breast cancer: an integrative review

RESUMO Objetivo: identificar os efeitos adversos locorregionais da administração da terapêutica oncológica endovenosa em mulheres com câncer de mama avançado. Metodo: revisão integrativa da literatura, que utilizou as bases de dados PubMed/MEDLINE, CINAHL, LILACS e EMBASE, sem recorte temporal, além de busca reversa dos artigos selecionados, atualizada até maio de 2022 A população contemplou mulheres com câncer de mama avançado submetidas à intervenção com terapêutica oncológica endovenosa com quimioterapia ou hormonioterapia ou anticorpo monoclonal, e o desfecho avaliou efeitos adversos locorregionais Resultados: identificaram-se 2.789 estudos, e a amostra final foi composta por 8 ensaios clínicos e 1 estudo observacional retrospectivo, sendo todos estudos internacionais e publicados no período de 1986 a 2018. Predominantemente, as pacientes tinham câncer de mama em estádio IV, idade de 50 anos ou mais e múltiplas metástases. Os efeitos adversos locorregionais foram: flebite, ulceração e/ou necrose, dor, eritema e reação no local da injeção não especificada. Os estudos não trazem detalhamento do tipo de cateter venoso, osmolaridade dos fármacos e cuidados preventivos para diminuição desses efeitos adversos. Conclusão: as evidências desses artigos mostraram que os efeitos adversos locorregionais estão presentes em estudos de eficácia dos fármacos oncológicos em mulheres com câncer de mama avançado. No entanto, destaca-se que a segurança da administração dos fármacos oncológicos não se apresenta elucidada nessa revisão, indicando necessidade de estudos de acompanhamento dos efeitos adversos.

RESUMEN Objetivo: identificación de los efectos adversos locorregionales de la administración de la terapia oncológica intravenosa en mujeres con cáncer de mama avanzado. Método: revisión bibliográfica integradora, que utilizó las bases de datos PubMed/MEDLINE, CINAHL, LILACS y EMBASE, sin corte de tiempo, además de una búsqueda inversa de los artículos seleccionados, actualizada hasta mayo de 2022 La población incluyó mujeres con cáncer de mama avanzado, sometidas a intervención con terapia oncológica endovenosa con quimioterapia u hormonoterapia o anticuerpo monoclonal y el resultado evaluó los efectos adversos locorregionales Resultados: se identificaron 2.789 estudios y la muestra final se compuso de ocho ensayos clínicos, un estudio observacional retrospectivo, todos estudios internacionales, publicados desde 1986 hasta 2018. Predominantemente, las pacientes tenían cáncer de mama en estadio IV, edad de 50 años o más y metástasis múltiples. Los efectos adversos locorregionales fueron flebitis, ulceración y/o necrosis, dolor, eritema y reacción en el lugar de la inyección no especificada. Los estudios no detallan el tipo de catéter venoso, la osmolaridad de los fármacos y los cuidados preventivos para reducir estos efectos adversos. Conclusión: las pruebas de estos artículos mostraron que los efectos adversos locorregionales están presentes en los estudios de eficacia de los fármacos oncológicos en mujeres con cáncer de mama avanzado. Sin embargo, cabe destacar que la seguridad de la administración de los fármacos contra el cáncer no se dilucida en esta revisión, lo que indica la necesidad de realizar estudios de seguimiento sobre los efectos adversos.

ABSTRACT Objective: to identify the locoregional adverse effects of administering intravenous oncologic therapy in women with advanced breast cancer. Method: this was an integrative literature review using the PubMed/MEDLINE, CINAHL, LILACS, and EMBASE databases, without a time cut, in addition to a reverse search of the selected articles updated until May 2022. The population included women with advanced breast cancer undergoing intervention with intravenous oncologic therapy with chemotherapy, hormone therapy, or monoclonal antibody, and the outcome assessed locoregional adverse effects. Results: 2,789 studies were identified, and the final sample consisted of 8 clinical trials and 1 retrospective observational study, all of which were international studies published from 1986 to 2018. Predominantly, patients with stage IV breast cancer, were aged 50 years or older, and had multiple metastases. Locoregional adverse effects were phlebitis, ulceration and/or necrosis, pain, erythema, and unspecified injection site reaction. The studies did not detail the type of venous catheter, the osmolarity of the drugs, and preventive care to reduce these adverse effects. Conclusion: the evidence from these articles showed that locoregional adverse effects are present in efficacy research of oncologic drugs in women with advanced breast cancer. Nonetheless, the safety of administering cancer drugs is not elucidated in this review, indicating the need for follow-up studies of adverse effects.

Anterior Scleral and Limbal Inflammatory Necrosis After Adjuvant Miltefosine for Recalcitrant Acanthamoeba Keratitis.

PURPOSE: The purpose of this study was to report a retrospective case series of anterior scleral and limbal inflammatory necrosis after adjuvant miltefosine for recalcitrant Acanthamoeba keratitis (AK). METHODS: A case series and literature review. RESULT: Four eyes of 3 patients with recalcitrant AK developed anterior scleral and limbal inflammatory necrosis with significant scleral-limbal thinning after treatment with miltefosine. The average age was 38 years, and the average duration of infection before miltefosine treatment was 239 days. All cases required urgent surgical intervention to either prevent or mitigate corneal-limbal perforation. CONCLUSIONS: Miltefosine has been observed to result in the resolution of AK when used as an adjunctive therapy. It may also lead to a consecutive inflammatory necrosis of the anterior sclera and limbus. This inflammatory response may be significant enough to cause rapid scleral-limbal thinning with subsequent perforation.

A 55-Year-Old Man With Cough and Hematochezia.

CASE PRESENTATION: A 55-year-old man presented to the ED with a 3-week history of worsening cough and shortness of breath. He had blood-tinged sputum, fever, night sweats, and a 2.7 kg weight loss within the same period. For the past few days, he had taken amoxicillin-clavulanate for presumed sinusitis. Despite this, his symptoms persisted, prompting him to seek further evaluation. His medical history was significant for ulcerative colitis and he had some bloody diarrhea for the past few weeks. Medications included aspirin, mesalamine, multivitamins, folic acid, and herbal supplements including gingko biloba, ginseng, and turmeric-ginger. He never smoked and drank alcohol occasionally. Family history was notable for stroke and myocardial infarction.

Continuous venovenous hemodiafiltration using cytokine-adsorbing hemofilters as adjuvant therapy for anaerobic descending necrotizing mediastinitis: a case report.

BACKGROUND: We describe a combinatorial intensive care approach and discuss the critical factors that allowed us to successfully manage a life-threatening case of acute anaerobic septic shock triggered by descending necrotizing mediastinitis. CASE PRESENTATION: We admitted a 38-year-old critically ill Kosovar Albanian man to our intensive care unit because of clinical manifestations of severe sepsis. His condition had worsened in the previous 2 weeks following unsuccessful antibiotic therapy for tonsillitis complicated by retropharyngeal abscesses. Computed tomography and intraoperative observations identified abscesses in the anterior and middle mediastinum regions and the distal part of the neck, directly on the border with the left lobe of the thyroid gland. Cultures indicated infections with α-hemolytic Streptococcus and Clostridium species: High procalcitonin and lactate levels, blood gas analysis, poor peripheral capillary oxygen saturation, and severe hemodynamic instability pointed to a case of acute septic shock. The entire treatment consisted of an aggressive antibiotic regimen, transthoracic and mediastinal surgical evacuation of the abscess, vacuum sealing drainage with a pleural chest tube, continuous venovenous hemodiafiltration using cytokine-adsorbing hemofilters, and extracorporeal blood hyperoxygenation. CONCLUSIONS: Efficient treatment of severe anaerobic sepsis resulting from descending necrotizing mediastinitis should build on a multidisciplinary approach. In support of first-line therapies with targeted antibiotics and surgical debridement, clinicians should consider alternative therapies such as continuous venovenous hemodiafiltration with cytokine-adsorbing hemofilters and hyperoxygenation.

Bilateral Striatal Necrosis with Polyneuropathy with a Novel SLC25A19 (Mitochondrial Thiamine Pyrophosphate Carrier OMIMI*606521) Mutation: Treatable Thiamine Metabolic Disorder-A Report of Two Indian Cases.

BACKGROUND: SLC25A19 gene mutations cause Amish congenital lethal microcephaly and bilateral striatal necrosis with polyneuropathy. We are reporting two cases of bilateral striatal necrosis with polyneuropathy due to SLC25A19 gene mutations. METHODS: A 36-month-old boy and a 5-year-old girl, unrelated, presented with recurrent episodes of flaccid paralysis and encephalopathy following nonspecific febrile illness. Examination showed dystonia and absent deep tendon reflexes. RESULTS: Nerve conduction studies showed an axonal polyneuropathy. Magnetic resonance imaging (MRI) of the brain in both cases showed signal changes in the basal ganglia. Next-generation sequencing revealed a novel homozygous missense variation c.910G>A (p.Glu304Lys) in the SLC25A19 gene in the boy and a homozygous mutation c.869T > A (p. Leu290Gln) in the SLC25A19 gene in the girl. Mutations were validated by Sanger sequencing, and carrier statuses of parents of both children were confirmed. Both children improved with thiamine supplementation. CONCLUSION: If any child presents with recurrent encephalopathy with flaccid paralysis, dystonia, and neuropathy, a diagnosis of bilateral striatal necrosis with polyneuropathy due to SLC25A19 mutations should be considered and thiamine should be initiated.

Ischemic necrosis of the digits and hyperlipidemia associated with atherosclerosis in a Miniature American Shepherd.

CASE DESCRIPTION A 2.5-year-old 12-kg (26.4-lb) castrated male Miniature American Shepherd was referred because of a 3-week history of a localized crusted skin lesion on the digital pad of digit 3 of the right hind limb. CLINICAL FINDINGS Skin lesions were noted on the digital pads of the right hind limb. Serum biochemical analyses indicated severe hypercholesterolemia and hypertriglyceridemia. Ultrasonography of the terminal portion of the aorta and other major arterial vessels revealed substantial arteriosclerotic change. TREATMENT AND OUTCOME Medical treatments included administration of atorvastatin calcium, a low-fat diet, and omega-3 fatty acids to reduce serum lipids concentration; clopidogrel to prevent thrombosis; pentoxifylline to improve microcirculatory blood flow; clomipramine hydrochloride and trazodone hydrochloride to help with the behavioral problems; and gabapentin to help with pain management and behavioral problems. Surgical management included amputation of the initial digit involved, then eventually the entire initial limb involved. The response to treatment was poor, and euthanasia was elected. Postmortem findings revealed severe, widespread, and chronic intimal atherosclerosis; mild, widespread, and degenerative changes in the cerebral cortex; and edema and vascular congestion in the meninges. CLINICAL RELEVANCE To the authors' knowledge, this was the first report of skin necrosis secondary to atherosclerosis in a dog. Although the incidence of atherosclerosis has been considered very low in dogs, it should be investigated in dogs with severe hyperlipidemia. Primary hyperlipidemia has not been previously described in Miniature American Shepherd dogs but was the suspected underlying metabolic disorder.

Bacillus licheniformis normalize the ileum microbiota of chickens infected with necrotic enteritis.

Necrotic enteritis (NE) is a severe intestinal disease, which can change gut microbiota and result in a high cost for the poultry industry worldwide. However, little is known regarding how the gut microbiota of NE chicken ileum are changed by Bacillus licheniformis. This study was conducted to investigate how ileum microbiota structure was changed by B. licheniformis in broiler chickens challenged with Clostridium perfringens-induced NE through Illumina MiSeq sequencing. The broilers were randomly separated into four groups: the negative control group (NC), the positive control group (PC), the fishmeal and coccidia group (FC), and the PC group supplied with feed containing B. licheniformis (BL). Compared to the PC and FC, alpha diversity, beta diversity, and the bacterial taxa of the ileum microbiota were more similar in BL and NC. Some genera, which were related to the NE control, became insignificant in BL with NC, such as Lactobacillus, Lactococcus, Bacteroides, Ruminococcus and Helicobacter. The PICRUSt analysis revealed that a tumour suppressor gene, p53, which was negatively correlated with Helicobacter, was enriched in the BL group. Our findings showed that the ileum microbiota disorder caused by NE in chickens was normalized by dietary B. licheniformis supplementation.

Úlcera por presión en talón, en paciente frágil multirresistente a antibióticos / Pressure ulcer in heel, in fragile patient multiresistant to antibiotics

Objetivo: describir el proceso de curación de una úlcera en un paciente frágil. Metodología: antes de realizar el artículo se llevó a cabo la información previa a la familia y la obtención del consiguiente consentimiento informado. Una vez hecho esto, se procedió a la elaboración del mismo sobre los datos ya obtenidos de la práctica enfermera llevada en el centro hasta la curación de la lesión. Resultados: tras 11 meses, se completó el proceso de curación de la úlcera. Conclusiones: en pacientes con procesos crónicos en los que se ve afectado el estado físico y el deterioro es paulatino en todos los ámbitos, es muy probable la aparición de estas lesiones. No obstante, con una buena actuación del equipo de enfermería es posible la curación, a pesar de barreras como fue la multirresistencia a antibióticos de la residente

Objective: To describe the healing process of an ulcer in a fragile patient. Methodology: prior to the completion of the article the previous information was carried out to the family and the consequent informed consent. Once this was done, it was elaborated; On data already obtained from the nurse practice carried out in the center until the lesion was healed. Results: after 11 months, the healing process of the ulcer was completed. Conclusions: in patients with chronic processes in which physical condition is affected and deterioration is gradual in all areas is very likely the appearance of these lesions. However, with a good performance of the nursing team is possible the cure, despite barriers such as multiresistance to antibiotics of the resident

Evaluation of Biological Effects of Hydroalcoholic Extract of Hibiscus Rosa Sinensis Flowers on Alloxan Induced Diabetes in Rats.

Aim and Objective The current study sought to investigate antidiabetic, hypolipidimic, antioxidant and histopathological effects of floral extract of Hibiscus rosa sinensis in Alloxan induced Diabetes in rats. Materials and Methods Study was conducted on 6 groups with 6 wistar rats in each group for the period of 4 weeks. Group I: served as normal control (NC), rats administered with gum acacia 1 ml daily, group II: consider as diabetic control (DC) treated with alloxon 150 mg/kg body wt. Whereas Hibiscus rosa-sinensis flower extract was given orally in group III (DE1), group IV (DE2), group V (DE3) at doses of 50, 100 and 200 mg/kg body weight dissolved in distilled water respectively. Group VI (DG) was given glibenclamide (5 mg/kg) as a standard drug and results were compared in reference to it. Results The results indicate that the test compound HEFHR (Hydroalcoholic extract of flower Hibiscus rosa-sinensis) has significant and sustained oral antidiabetic activity, comparable with the hypoglycemic effect of Glibenclamide and Sulphonylurea. Flower extract of HRS was more efficacious in lipid lowering effect and in antioxidative activity than glibenclamide. After 28 day treatment with flower extract, size of islets was significantly increased and necrosis and atrophy of islets were significantly improved; also increase in number and diameter of cell islets appeared to be regular as compared to the diabetic group. Conclusion HEFHR possesses significant antidiabetic, hypolipidemic and antioxidant properties as well as regeneration of beta cells in rats. Further evaluation of HEFHR is in progress.

Temporomandibular joint involvement as a positive clinical prognostic factor in necrotising external otitis.

OBJECTIVE: Necrotising otitis externa is associated with high morbidity and mortality rates. This study investigated whether temporomandibular joint involvement had any prognostic effect on the course of necrotising otitis externa in patients who had undergone hyperbaric oxygen therapy after failed medical and sometimes surgical therapy. METHODS: A retrospective case series was conducted of patients in whom antibiotic treatment and surgery had failed, who had been hospitalised for further treatment and hyperbaric oxygen therapy. RESULTS: Twenty-three patients with necrotising otitis externa were identified. The temporomandibular joint was involved in four patients (17 per cent); these patients showed a constant gradual improvement in C-reactive protein and were eventually discharged free of disease, except one patient who was lost to follow up. Four patients (16 per cent) without temporomandibular joint involvement died within 90 days of discharge, while all patients with temporomandibular joint involvement were alive. Three patients (13 per cent) without temporomandibular joint involvement needed recurrent hospitalisation including further hyperbaric oxygen therapy; no patients with temporomandibular joint involvement required such treatment. CONCLUSION: Patients with temporomandibular joint involvement had lower rates of recurrent disease and no mortality. Therefore, we suggest considering temporomandibular joint involvement as a positive prognostic factor in necrotising otitis externa management.

Necrose facial após enxerto de gordura e tratamento com oxigenioterapia hiperbárica / Facial necrosis after fat grafting and treatment with hyperbaric oxygen therapy

A lipoenxertia de face, apesar de consagrada, não é isenta de riscos e complicações. Neste relato de caso, descrevemos de forma inédita uma complicação isquêmica local, causada por enxerto de gordura. Simultaneamente, propomos a terapêutica com Oxigenioterapia Hiperbárica para o tratamento desta situação, não se limitando exclusivamente à gordura, mas principalmente ao PMMA, em que esta complicação é muito mais frequente.

Facial fat grafting is not devoid of risks and complications, despite being a widely practiced procedure. In this case report, we describe a novel form of local ischemic complication that occurred secondary to fat grafting. Simultaneously, we propose Hyperbaric Oxygen therapy for the treatment of this situation. We propose that Hyperbaric Oxygen therapy should not be limited solely to fat graft-related ischemia, but should be effective in the management of the more frequently encountered complications associated with polymethylmethacrylate fillers.

Thalamic lesions: a radiological review.

BACKGROUND: Thalamic lesions are seen in a multitude of disorders including vascular diseases, metabolic disorders, inflammatory diseases, trauma, tumours, and infections. In some diseases, thalamic involvement is typical and sometimes isolated, while in other diseases thalamic lesions are observed only occasionally (often in the presence of other typical extrathalamic lesions). SUMMARY: In this review, we will mainly discuss the MRI characteristics of thalamic lesions. Identification of the origin of the thalamic lesion depends on the exact localisation inside the thalamus, the presence of extrathalamic lesions, the signal changes on different MRI sequences, the evolution of the radiological abnormalities over time, the history and clinical state of the patient, and other radiological and nonradiological examinations.

Necrolytic acral erythema.

Necrolytic acral erythema is a rare, cutaneous manifestation of hepatitis C virus infection that is characterized by erythematous, violaceous or dusky papules, blisters, and/or erosions in the early stages and by well-demarcated, hyperkeratotic, targetoid plaques with a peripheral rim of macular erythema, secondary lichenification and hyperpigmentation, and overlying fine micaceous or necrotic-appearing scale in the later stages. Because most topical modalities prove ineffective, treatment of the underlying viral infection or therapeutic zinc supplementation are required for clinical improvement.

Consecuencias del seudofisiculturismo en adolescentes / Conséquences du pseudo-culturisme chez les adolescents / Consequences of seuophysiculturism in adolescents

En la actualidad en Cuba algunos adolescentes y jóvenes, en su afán de aumentar rápido el tamaño de sus músculos se están inyectando aceite de soya de uso doméstico, lo cual les ha conducido a graves lesiones que incluso han puesto en peligro sus vidas. El objetivo de este trabajo es presentar una nueva afección, mostrar las características de las lesiones y divulgar los resultados con fines educativos y de prevención. Se presentaron 3 casos sobre los efectos nocivos de la inyección de aceite de uso doméstico en músculos, en pacientes ingresados en el Hospital Pediátrico Eliseo ¨Noel¨ Caamaño de Matanzas de diciembre 2010 a mayo 2011. Sus características clínicas son gran aumento de volumen en músculos inyectados, el calor, rubor, intenso dolor e impotencia funcional con toma del estado general. El tratamiento quirúrgico fue incisión, desbridamiento y drenaje, que mostró abundante aceite, pus, sangre y fibras musculares necrosadas; proceder que se debe realizar múltiples veces. Las lesiones no ocurren de inmediato sino con intervalos variables, no al unísono sino desorganizadamente, con gran dificultad para su cicatrización. Se utilizó además tratamiento antibiótico de amplio espectro y cámara hiperbárica. Se concluye que la utilización de aceite de uso doméstico trae graves consecuencias a la salud, como la sepsis y necrosis severa de los músculos, hepatitis C, septicemia y peligro para la vida de quienes lo usan(AU)

At present, some teenagers and young people in Cuba, in their desire to quickly increase the size of their muscles, are injecting soybean oil for domestic use, which has led them to serious injuries and even risk to their lives. The aim of this work is to present this new condition, to show the characteristics of the lesions and spread the results for education and prevention. We presented three cases on the adverse effects of oil injection into muscles in patients who were admitted to the Paediatric Hospital Eliseo ¨Noel¨ Caamaño of Matanzas from December 2010 to May 2011. Their clinical features were a high increase in volume of the injected muscles, heat, redness, intense pain and functional impotence with general malaise. The surgical treatment consisted on the incision, debridement and drainage which showed abundant oil, pus, blood and necrotic muscle fibres, procedure that had to be performed many times. The lesions did not occur immediately, but with varying intervals and not in unison but in a disorganized form with great difficulty in healing. Treatment with broad-spectrum antibiotic was also used as well as hyperbaric chamber. We conclude that the use of domestic oil provokes serious consequences to health such as sepsis and serious muscle necrosis, Hepatitis C, septicaemia and danger to the lives of those who use it(AU)

Afin de développer rapidement leur masse musculaire, les adolescents et jeunes gens à Cuba ont l'habitude de s'injecter par voie intramusculaire de l'huile de soya à usage domestique, résultant en graves lésions et mettant même leurs vies en péril. Le but de ce travail est de présenter cette nouvelle affection, de montrer les caractéristiques des lésions, et de diffuser les résultats à des fins éducative et préventive. Les cas des trois jeunes patients hospitalisés à l'hôpital pédiatrique Eliseo Noel Camaño, à Matanzas, depuis décembre 2010 jusqu'à mais 2011, montrant les effets néfastes de l'injection intramusculaire de l'huile à usage domestique, sont présentés. Les caractéristiques cliniques comprennent une grande augmentation du volume des muscles injectés, chaleur, douleur intense, rougeur, impotence fonctionnelle, et malaise générale. Le traitement chirurgical a consisté en incision, débridement et drainage, montrant une quantité excessive d'huile, pus, sang et fibres musculaires nécrosées; cette opération a été répétée plusieurs fois. Les lésions ne se produisent pas d'immédiat, mais en intervalles variables et de façon désorganisée, rendant la cicatrisation difficile. Les patients ont été aussi traités par des antibiotiques à large spectre et par oxygénothérapie hyperbare. On conclu que l'emploi de l'huile à usage domestique a des conséquences nuisibles pour la santé telles que l'infection et la nécrose sévère des muscles, hépatite C, septicémie et danger pour la vie de ceux qui l'utilisent(AU)

Prompt and successful toxin-targeting treatment of three patients with necrotizing pneumonia due to Staphylococcus aureus strains carrying the Panton-Valentine leukocidin genes.

Three patients with extensive necrotizing pneumonia due to Panton-Valentine leukocidin-positive Staphylococcus aureus strains and with aggravating factors (leukopenia count of less than 3x10(9)/liter in all three cases and hemoptysis in two cases) were successfully treated with toxin-suppressing agents introduced rapidly after hospital admission.

Colonic mucosal necrosis following administration of calcium polystryrene sulfonate (Kalimate) in a uremic patient.

Colonic necrosis is known as a rare complication following the administration of Kayexalate (sodium polystryrene sulfonate) in sorbitol. We report a rare case of colonic mucosal necrosis following Kalimate (calcium polystryrene sulfonate), an analogue of Kayexalate without sorbitol in a 34-yr-old man. He had a history of hypertension and uremia. During the management of intracranial hemorrhage, hyperkalemia developed. Kalimate was administered orally and as an enema suspended in 20% dextrose water to treat hyperkalemia. Two days after administration of Kalimate enema, he had profuse hematochezia, and a sigmoidoscopy showed diffuse colonic mucosal necrosis in the rectum and sigmoid colon. Microscopic examination of random colonic biopsies by two consecutive sigmoidoscopies revealed angulated crystals with a characteristic crystalline mosaic pattern on the ulcerated mucosa, which were consistent with Kayexalate crystals. Hematochezia subsided with conservative treatment after a discontinuance of Kalimate administration.

Oxigenoterapia hiperbárica. Indicaciones otorrinolaringológicas / Hyperbaric oxygen therapy. Otorhinolaryngological indications

El tratamiento con oxigenoterapia en cámara hiperbárica (OHB) se basa en el aumento de la presión parcial de oxígeno en los tejidos facilitado por la difusión de éste desde el plasma. Dicho aumento conlleva repercusiones fisiológicas positivas sobre los tejidos, como son el aumento de la regeneración celular, el incremento de la acción bactericida de los leucocitos polimorfonucleares, una acción bactericida directa y la neovascularización. El gran aumento de la presión parcial de O2 en el plasma permite la difusión directa a través de los tejidos, llegando a zonas de escasa permeabilidad capilar e hipóxicas. En los últimos 40 años se han investigado sus posibles aplicaciones también en el ámbito otorrinolaringológico, en el que destacan los procesos hipóxicos secundarios a la radioterapia (radionecrosis, osteonecrosis, osteomielitis), las infecciones (otitis externa maligna, fascitis) o los trastornos vasculares (síndrome de la hipoacusia súbita). Realizamos una introducción a los mecanismos fisiológicos de su aplicación y revisamos sus indicaciones en otorrinolaringología (AU)

Hyperbaric oxygen therapy is based on the increase in partial pressure of oxygen in the tissues through oxygen diffusion from plasma. This increase has positive physiological effects on tissues, such as an increase in cell renewal and the bactericidal action of polymorphonuclear leukocytes, a direct bactericidal action, and neovascularization. The large increase in partial pressure of oxygen in plasma allows direct diffusion through tissues, reaching hypoxic areas and regions with little capillary permeability. In the last 40 years, the possible applications of hyperbaric oxygen therapy in otorhinolaryngology (ORL) have been investigated. Possible areas of application are hypoxic processes secondary toradiotherapy (radionecrosis, osteonecrosis, osteomyelitis), infections (malignant otitis externa, fasciitis) or vascular disorders (sudden hearing loss syndrome). We describe the physiological mechanisms of the application of hyperbaric oxygen therapy and review its indications in ORL (AU)