Porfirias agudas en la unidad de cuidados intensivos / Acute porphyria in an intensive care unit

Las porfirias son enfermedades metabólicas hereditarias muy raras, causadas por la hipoactividad de determinadas enzimas implicadas en la síntesis del grupo hemo. Presentamos tres casos de pacientes jóvenes que debutaron con crisis de porfiria aguda, y en los que, como es frecuente, se retrasó el diagnóstico y llegaron a precisar ingreso en la unidad de cuidados intensivos (UCI) por encefalopatía grave. Tras realizar el tratamiento con hemina, la clínica mejoró rápidamente, pero en un paciente persistió una polineuropatía periférica grave como secuela durante meses. Además, comunicamos el primer caso de desencadenamiento de crisis porfírica por el uso de la "píldora del día después" (levonorgestrel) (AU)

Porphyrias are rare hereditary metabolic disorders caused by the inactivity of certain enzymes that participate in hemesynthesis. We report 3 cases in which porphyria debuted with acute episodes in young patients. As is often the case, diagnosis was delayed, and intensive care was required for severe encephalopathy. Symptoms improved rapidly after hemintherapy was started, but peripheral polyneuropathy persisted for several months in 1 patient. We report the first case of aporphyria-related seizure triggered by use of the morning-after pill (levonorgestrel) (AU)

Piomiositis pectoral por Staphylococcus aureus / Staphylococcus aureuspectoral pyomyositis

La piomiositis es una infección bacteriana espontánea de los músculos esqueléticos, que no es secundaria a una infección de tejidos contíguos (piel, huesos, etc.). Existen diversos factores predisponentes para la misma, que incluyen la diabetes mellitus, neoplasias, conectivopatías, infección por virus de la inmunodeficiencia humana, o cirugía/traumatismos previos. En un tercio de los casos no existe un factor predisponente. Dada su relativa poca frecuencia, su diagnóstico puede retrasarse si no existe un alto grado de sospecha clínica. Se presenta un caso de piomiositis de músculo pectoral mayor (AU)

Pyomyositis is a spontaneous bacterial infection of the skeletal muscles which is not secondary to infection of adjoining tissues (skin, bone, etc.) there are a number of predisposing factors including diabetes mellitus, neoplasms, connective tissue diseases, human immunodeficiency virus (HIV) infection or previous surgery/trauma. In one-third of the cases no predisposing factor is discerned. Because of its relatively low frequency, the diagnosis may be delated if there is not a high degree of clinical suspicion. We report one case of M. pectoralis major pyomyositis (AU)

Systemic infection by Pasteurella canis biotype 1 in newborn puppies.

Pasteurella canis biotype 1, usually associated with the oral cavity of dogs and cats, or with human wound infections following dog bites, was isolated from newborn puppies with a fatal systemic infection. The identity of P. canis was confirmed by arbitrarily primed polymerase chain reaction and the organism was susceptible to all the penicillins, cephalosporins, tetracyclines and fluoroquinolones tested and to most of the aminoglycosides tested. This represents the first report of systemic pasteurellosis caused by P. canis in dogs.

[Kaposi's sarcoma: a sexually transmitted cancer?]. / Sarcoma de Kaposi: un cáncer de transmisión sexual?

Kaposi's sarcoma is a lymphoproliferative opportunistic tumor associated with acquired immunodeficiency syndrome whose frequency is going down due to the use of combined therapies including proteases and others antivirals. During the last years, it has been postulated that it's origin is in the oncogenic potential of HVH-8; however, for the development of the disease, it's necessary the presence of some coadjuvant factors including immunodeficiency and probably a propicious hormonal status. We practiced a bibliographic review of some recent works related with it's etiology and coadyuvant factors implicated in the development of this neoplasia, phrasing some questions that should be answered in the light of future investigative works.

[Genotypes of hepatitis C virus: their relationship with risk factors, the severity of liver disease, and the serologic response]. / Genotipos del virus de la hepatitis C: relación con los factores de riesgo, con la gravedad de la enfermedad hepática y con la respuesta serológica.

BACKGROUND: The objective of our study was to ascertain the prevalence of different HCV genotypes between the hepatitis C patients in the health area of Monforte de Lemos, Spain, as well as the possible influence of risk factors on their distribution and their relation with hepatic disease and with the serologic response. PATIENTS AND METHODS: We have studied 128 patients with hepatitis C. Of these, 41 were intravenous drug users (IVDU), 19 had received transfusions, 7 were hemodialyzed and in 61 the risk factors were unknown. Antibodies against HCV were detected by second-generation enzyme immunoassay (EIA) and confirmed by immunoblot. RNA-HCV presence was studied by reverse transcription-PCR (RT-PCR), and a reverse hybridization test of the amplifications was used for the genotyping. RESULTS: Hepatitis C genotypes 1b (46.1 [8.6%]), 1a (23.4 [7.3%]) and 3a (13.3 [5.9%]) were the most frequently encountered genotype. Genotype 1a (48.8 [15.3%]) was the most prevalent genotypes in IVDU patients, while 1b was the most frequent in patients of unknown risk factors (62.3 [12.1%]). Alanine-aminotransferase (ALT) was elevated in 66.6 (17.7%) of patients with genotype 1a, in 87.5 (8.6%) of patients with genotype 1b (p = 0.0367) and in 94.1 (11.2%) of patients with genotype 3a (p = 0.0347). Subtype 1b was present in 6 of 7 cases of cirrhosis (85.7%) and in 7 of 12 cases of active chronic hepatitis (58.3%). No significant statistical differences were observed between the genotypes and the specific IgM response against core antigen of HCV, neither we observed differences in the serologic response against C1, C2, NS3 and NS4 peptides. CONCLUSIONS: Hepatitis C genotypes 1a and 3a were the most prevalent genotypes between IVDU patients while genotype 1b was the most frequent between non-IVDU patients. Genotype 1b was associated to severe liver disease. Percentage of positivity or the reactivity against HCV peptides was independent of the genotype encountered in the patient.

Relation of hepatitis C virus genotypes to risk factors and hepatic disease in Spanish patients.

OBJECTIVE: To ascertain the prevalence of hepatitis C virus (HCV) genotypes in Spain and their distribution by risk factors. METHODS: The study covered 216 patients with hepatitis C. Of these, 63 were intravenous drug users (IVDU), 44 had received transfusions, and 30 were hemodialyzed, and in 79 the risk factors were unknown. Antibodies against HCV were detected by second-generation enzyme immunoassay (EIA) and confirmed by immunoblot. HCV RNA presence was investigated by reverse transcription---polymerase chain reaction (RT-PCR), and a reverse hybridization test of the amplifications was used for the genotyping. RESULTS: The most frequently encountered genotypes were 1b (48.1%), 1a (21.3%) and 3a (11.1%). HCV genotypes 1a (42.8%) and 3a (20.6%) were the most prevalent genotypes in IVDU patients, while 1b was the most frequent in patients with unknown risk factors (62.0%), transfused patients (68.1%) and hemodialyzed patients (50.0%). Mixed infections were detected in nine cases (4.1%); three appeared in IVDU patients (4.7% of the total IVDUs), two in transfused patients (4.5%) and four (50%) in patients with unknown risk factors. No statistically significant differences were found in average ages of the IVDU patients with different genotypes. Non-IVDU patients having genotype 3a presented the lowest average age of all. No significant statistical differences were observed in alanine aminotransferase levels among patient groups with different genotypes (p>0.05 in all cases). Subtype 1b was present in six of the seven cases of cirrhosis (85.7%) and in nine of the 18 cases of active chronic hepatitis (50.0%).