Eczema herpeticum with herpetic folliculitis after bone marrow transplant under prophylactic acyclovir: are patients with underlying dermatologic disorders at higher risk?

We present an unreported coexistence: eczema herpeticum (EH) with histopathological findings of herpetic folliculitis (HF) after allogeneic bone marrow transplantation (BMT). A patient with atopic dermatitis (AD) underwent allogeneic BMT for idiopathic acquired aplastic anemia. She had been receiving cyclosporine (150 mg/12 h) and acyclovir (400 mg/12 h) for 6 months. A facial rash was observed, composed of monotonous erythematous, umbilicated papulo-vesicles and papulo-crusts <4 mm in size. The histopathological study showed herpetic cytopathic changes within the epidermis that extended into the hair follicle epithelium. Interestingly, microscopic HF has not previously been associated with post-transplant patients or EH. However, it is reasonable to hypothesize that the coexistence of these herpes simplex virus-related events may be underreported in the literature. Although further studies are necessary, we suggest that the prophylactic antiviral dose after BMT be enhanced in patients with underlying dermatologic diseases, especially in those with AD.

Surgical lung biopsy for diffuse lung disease. Our experience in the last 15 years.

INTRODUCTION: Surgical lung biopsy is a technique that presents a morbi-mortality rate of considerable importance. We analyze our experience with surgical lung biopsies for the diagnosis of diffuse lung disease and the effect produced on the indications for surgical biopsy in these pathologies after the publication of the consensus of the ATS (American Thoracic Society) and ERS (European Respiratory Society) for Idiopathic Pulmonary Fibrosis (IPF). PATIENTS AND METHODS: We performed a retrospective review of 171 patients operated between January 1997 and December 2011. We divided the series into 2 groups: group 1 (operated between 1997 and 2002) and group 2 (operated between 2003 and 2011). Suspected preoperative diagnosis, respiratory status, pathological postoperative diagnoses, percentage of thoracotomies, mean postoperative stay and perioperative morbidity and mortality were analyzed. RESULTS: Group 1 consisted of 99 patients and group two 72. The most frequent postoperative diagnoses were: usual interstitial pneumonia and extrinsic allergic alveolitis. There were ten (5.84%) deaths. Death was caused by progressive respiratory failure that was related to interstitial lung disease in 7 (70%) of 10 cases, alveolar haemorrhage in 2 (20%) and heart failure in 1 (10%). CONCLUSIONS: Since the publication of the ATS and ERS consensus on the IPF, we have observed a noticeable decrease in the number of indications for surgical lung biopsy. This technique, though simple, has a considerable morbidity and mortality.

Towards establishing MS prevalence in Latin America and the Caribbean.

A very high prevalence of multiple sclerosis (MS) has been reported in some Western European and North American countries. The few surveys of MS epidemiology in South America reveal lower prevalence rates, implying that susceptibility varies between distinct ethnic groups, thus forming an important determinant of the geographic distribution of the disease. The objective of this study is to review MS prevalence estimates in different Latin American and Caribbean countries. We reviewed surveys of regional MS prevalence from 1991 to 2011. Sources included an online database, authors' reports and proceedings or specific lectures from regional conferences. We obtained a total of 30 prevalence surveys from 15 countries, showing low/medium MS prevalence rates. Both the number and the quality of prevalence surveys have greatly improved in this region over recent decades. This is the first collaborative study to map the regional frequency of MS. Establishment of standardized methods and joint epidemiological studies will advance future MS research in Latin America and the Caribbean.

Clinical and epidemiological characteristics of adult patients hospitalized for erysipelas and cellulitis.

The purpose of this investigation was to analyze the clinical and epidemiological aspects of all cases of erysipelas and infectious cellulitis admitted to a tertiary hospital during a period of five years. All patients admitted with the main diagnosis of erysipelas or cellulitis to the Department of Dermatology of the author's institution from January 2005 to May 2010 were included. Seventy patients were identified and their medical records were retrospectively reviewed so as to record the epidemiological and clinical data. Univariate and multivariable analyses were performed to analyze variables that predicted longer length of stay. The frequency of cellulitis in the lower limbs was higher in men and patients older than 65 years. Moderate/severe cellulitis in patients with basal comorbidity followed by a poor response to oral antibiotic therapy for 48 h were the most common reasons for admission. At arrival, four patients had abscessed areas. Fourteen patients developed local complications and 18 cases developed general in-hospital complications. Most patients improved or were healed with intravenous amoxicillin-clavulanate 1 g-200 mg/8 h. Intravenous amoxicillin-clavulanate 1 g-200 mg/8 h may be a good choice for empiric treatment in our setting. The development of in-hospital complications and the need for changing empiric antibiotic therapy were significant and independent variables associated with longer length of stay.

Estudio de pacientes polimedicados mayores de 65 años en un centro de asistencia primaria urbano / Study of polymedicated patients over 65 years-old in an urban primary care centre

Objetivo. Identificar y tipificar a la población mayor de 65 años polimedicada y determinar los medicamentos y las enfermedades más prevalentes en este subgrupo de población. Diseño. Estudio descriptivo transversal. Emplazamiento. Centro de Salud Zaidín-Centro de Granada. Atención Primaria de Salud. Sistema Sanitario Público de Andalucía (SSPA). Participantes. Trescientos cinco pacientes mayores de 65 años y polimedicados (que utilizan cinco o más medicamentos, durante un periodo ≥ 6 meses, por cualquier vía), elegidos por muestreo estratificado por sexo, edad y número de medicamentos. Mediciones principales. Las variables recogidas y analizadas fueron el sexo, la edad, el número de enfermedades, el número de medicamentos y el profesional médico. Resultados. La prevalencia de polimedicados en mayores de 65 años fue de 33,77%. Estos pacientes utilizaban un número medio de medicamentos de 8,7±2,5 y presentaban un número medio de enfermedades de 5,56±1,89. La prevalencia de polimedicación fue mayor en las mujeres, pero las diferencias disminuyen en mayores de 85 años. El grupo terapéutico más utilizado fue el de antihipertensivos, en concordancia con la enfermedad más frecuente, la hipertensión arterial. Se comprueba la existencia de una fuerte relación entre el número de medicamentos y el número de enfermedades (p=0,05). Conclusiones. El consumo crónico de medicamentos en las personas mayores es de considerable magnitud y afecta a uno de cada tres mayores. La polimedicación de los mayores es un problema frecuente y grave que precisa revisión y evaluación continuas(AU)

Objective. To identify and characterise the polymedicated population over 65 years-old; and to determine the prevalence of drugs and the diseases in this population subgroup. Design. Cross-sectional study. Setting. A primary care centre Zaidín-Centro in Granada. Andalusian Public Health Service. Participants. A total of 305 patients over 65 years-old taking polypharmacy (defined as use of five or more drugs, during a period equal to or greater than six months by any route) selected by stratified sampling by sex, age and number of drugs consumed. Principal measurements. The analysed variables were sex, age, number of diseases, number of drugs and medical doctor. Results. The prevalence of polypharmacy in patients over 65 years-old was 33.77%. These patients were using an average number of drugs of 8.7±2.5 and had an average number of diseases of 5.56±1.89. The prevalence of polypharmacy was greater among women, but differences decreased in people more than 85 years old. The antihypertensive pharmacological group was the most commonly used, in accordance with the most frequent disease, arterial hypertension. We found a strong relationship between the number of drugs and the number of diseases (p=0.05). Conclusions. Chronic use of drugs in the elderly is of considerable magnitude, affecting one out of every three. Polypharmacy in the elderly is a common and serious problem that needs to be reviewed and evaluated continuously(AU)

[Study of polymedicated patients over 65 years-old in an urban primary care centre]. / Estudio de pacientes polimedicados mayores de 65 años en un centro de asistencia primaria urbano.

OBJECTIVE: To identify and characterise the polymedicated population over 65 years-old; and to determine the prevalence of drugs and the diseases in this population subgroup. DESIGN: Cross-sectional study. SETTING: A primary care centre Zaidín-Centro in Granada. Andalusian Public Health Service. PARTICIPANTS: A total of 305 patients over 65 years-old taking polypharmacy (defined as use of five or more drugs, during a period equal to or greater than six months by any route) selected by stratified sampling by sex, age and number of drugs consumed. PRINCIPAL MEASUREMENTS: The analysed variables were sex, age, number of diseases, number of drugs and medical doctor. RESULTS: The prevalence of polypharmacy in patients over 65 years-old was 33.77%. These patients were using an average number of drugs of 8.7±2.5 and had an average number of diseases of 5.56±1.89. The prevalence of polypharmacy was greater among women, but differences decreased in people more than 85 years old. The antihypertensive pharmacological group was the most commonly used, in accordance with the most frequent disease, arterial hypertension. We found a strong relationship between the number of drugs and the number of diseases (p=0.05). CONCLUSIONS: Chronic use of drugs in the elderly is of considerable magnitude, affecting one out of every three. Polypharmacy in the elderly is a common and serious problem that needs to be reviewed and evaluated continuously.

Compliance with an oral hyperproteic supplement with fibre in nursing home residents.

BACKGROUND: Undernutrition is a common problem in older individuals that may be related to a low protein dietary intake. Oral supplements may improve the health status in this population, but their use may be limited by compliance and side effects. OBJECTIVES: To evaluate effects of an oral supplement of protein and fibre on compliance, on nutritional status, and on intestinal habits in nursing home residents. METHOD: A prospective observational study was carried out in 66 Spanish nursing homes. 358 subjects undernourished or at risk of undernutrition requiring nutritional supplements. After informed consent was given, subjects received 2 daily cartons (400 ml) of a liquid oral supplement rich in protein and fibre along 3 months. Supplement intake compliance was measured at baseline and after 6 and 12 weeks. Nutritional status was assessed using the Mini- Nutritional Assessment (MNA), weight, and Body Mass Index (BMI). Changes in intestinal habits and digestive symptoms were also recorded, as well as subject's supplement acceptance. RESULTS: Compliance with the supplement intake was 97.46% at 6 weeks and 96% at 12 weeks of follow-up. Significant changes (p<0.0001) were found in nutritional status: mean value of MNA improved from baseline (MNA=14.0+/-3.9) after 12 weeks (MNA=17.0+/-4.0), as well as weight (+2.1 kg, a 4.1% increase). The BMI did not change significantly (BMI=21.43 at baseline; BMI=21.78 at 12 weeks). Undernutrition prevalence (MNA<17) decreased from 76.4 to 46.6% (p<0.0001). Intestinal habits showed a significant improvement in defecation frequency (from 4.7 to 6.1 stools per week, p<0.0001) and faeces consistency (from 53.2% to 74.5% reporting formed soft stools, p<0.0001). 48.9% of the subjects considered to have better intestinal habits after 6 weeks and 50.5% after 3 months of supplementary food intake, the rest reporting no change. Vomits and flatulence were also significantly reduced (p<0.0001). CONCLUSION: The administration of an oral hyperproteic supplement with fibre in aged subjects who are undernourished or at risk of malnutrition can be done in nursing homes with a high level of compliance. Supplements improve their nutritional status and their intestinal habits.

Siringomas eruptivos familiares / Familial eruptive syringomas

Los siringomas eruptivos generalizados son tumores relativamente raros que afectan a la superficie anterior del cuerpo. Generalmente aparecen en lainfancia y son de curso benigno. De forma ocasional regresan espontáneamente y presentan pobre respuesta a los tratamientos.La forma familiar de siringomas eruptivos es una manifestación aún más rara. Es aconsejable tenerlos en cuenta entre los diagnósticos diferencialescuando se observen lesiones papulosas en niños, con el fin de identificarlos e instaurar el tratamiento más adecuado.Presentamos el caso de una mujer de 25 años con siringomas eruptivos familiares en el cuello, pared anterior del tórax y axilas. Las lesiones se iniciaroncon la primera gestación, exacerbándose durante la segunda gestación de forma considerable (AU)

Generalized eruptive syringoma is a relatively rare popular dermatosis, involving anterior surface of the body. Usually arise in childhood, with a benignevolution. Occasionally spontaneous regression is reported as well as a poor response to treatments.Familiar eruptive syringoma is a rare clinical form, differential diagnosis of papular eruptions are observed in childhood.A 25-year-old woman with familial eruptive syringomas on the neck, anterior thorax and axillae is reported. The lesions had appeared after the firstgestation, and during the second gestation its have been increased (AU)

[Pachydermoperiostosis (Touraine-Solente-Golé syndrome). Case report]. / Paquidermoperiostosis (síndrome de Touraine-Solente-Golé). Descripción de un caso.

Pachydermoperiostosis or primary hypertrophic osteoarthropathy, also known as Touraine-Solente-Golé syndrome, is a rare process, frequently inherited. In its complete form it is characterized by pachydermia (thickening of the skin), skeletal changes (periostosis) and acropachia (digital clubbing). We report a patient that consulted for skeletal symptoms, as the acropachia and cutaneous manifestations (thickening of the skin of the face, scalp, hands and feet) went unnoticed due to their slow and progressive development. We review the characteristic features of this syndrome. We highlight the importance of ruling out secondary forms of hypertrophic osteoarthropathy and of a close follow-up of these patients because of complications that might develop on the long-term.

Pitiriasis liquenoide y varioliforme aguda (enfermedad de Mucha-Haberman) / Pityriasis lichenoides et varioliformis acuta (Mucha-Habermann disease)

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[Spontaneous cutaneous umbilical endometriosis]. / Endometriosis cutánea umbilical espontánea.

Endometriosis consists of extrauterine endometrial growths. Although it is usually located in the pelvis it can also be found in other sites. Endometriosis of the skin is rare and the most frequent form develops over gynecologic or obstetric scars, although it may also appear spontaneously in the umbilical area. We present a 39-years-old woman with an umbilical nodule as a clinically characteristic form of spontaneous cutaneous endometriosis. The histopathological examination confirmed the clinical diagnosis.

Endometriosis cutánea umbilical espontánea / Spontaneous cutaneous umbilical endometriosis

La endometriosis consiste en la presencia de tejido endometrial extrauterino. Aunque su localización habitual es intrapélvica, puede localizarse en otros lugares. La localización cutánea es rara, y la forma más frecuente aparece sobre cicatrices ginecológicas u obstétricas, aunque puede manifestarse de forma espontánea en la zona umbilical. Presentamos una mujer de 39 años con un nódulo en la región umbilical como forma clínica característica de la endometriosis cutánea espontánea. El examen histopatológico permitió confirmar el diagnóstico de endometriosis

Endometriosis consists of extrauterine endometrial growths. Although it is usually located in the pelvis it can also be found in other sites. Endometriosis of the skin is rare and the most frequent form develops over gynecologic or obstetric scars, although it may also appear spontaneously in the umbilical area. We present a 39-years-old woman with an umbilical nodule as a clinically characteristic form of spontaneous cutaneous endometriosis. The histopathological examination confirmed the clinical diagnosis

Carcinoma basocelular vulvar: una rara localización del cáncer de piel más frecuente / Basocellular cancer of the vulva: a rare location for one of the most frequent types of skin cancer

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