[Risk factors and clinical evolution of carbapenemase-producing Klebsiella pneumoniae infections in a university hospital in Spain. Case-control study]. / Factores de riesgo y evolución clínica de las infecciones causadas por Klebsiella pneumoniae productora de carbapenemasas en un hospital universitario de España. Estudio de casos y controles.

OBJECTIVE: Carbapenemase-producing Enterobacterias is a global health hazard due to their ease of transmission, difficulty of treatment, and their personal and economic impact. We analyze the factors associated with an increased risk of infection by Klebsiella pneumoniae carbapenemase-producing bacteria (KPC) and factors related to poor prognosis. METHODS: We designed a case-control study. KPC isolates were taken during an outbreak in a hospital in Madrid. A logistic regression was performed with the main variables. RESULTS: Sixteen cases of clinically documented infections were isolated. Overall mortality rates in the cases group was 25%. The most frequent location was blood (37.5%) followed by urine (25%). All but one were OXA-48. Regarding factors related to an increased risk of developing infection, only previous exposure to antibiotics presented statistical significance difference OR 13 (2.40-70.46). With respect to the overall mortality, the presence of pneumonia OR 25 (1.93-323.55) or the use of invasive mechanical ventilation was associated with greater risk 15 OR 33 (1.92-122.8) For attributable mortality only invasive ventilation had a significant association OR 18 (1.48-218.95). CONCLUSIONS: Exposure to previous antibiotics is an independent risk factor for developing KPC infection, adjusted for all other clinical and demographic variables. Risk factors such as the presence of pneumonia or the use of invasive mechanical ventilation were associated with a worse prognosis in terms of overall and attributable mortality.

Inmunohistoquímica en dermatopatología: revisión de los anticuerpos utilizados con mayor frecuencia (parte II) / Immunohistochemistry in Dermatopathology: A Review of the Most Commonly Used Antibodies (Part II)

La dermatopatología incluye una larga lista de entidades, algunas con una histopatología muy similar. La immunohistoquímica representa una importante herramienta de ayuda en el diagnóstico, diagnóstico diferencial y pronóstico de muchas de las neoplasias cutáneas. La inmunohistoquímica es también la mejor técnica para determinar el origen de un tejido o la diferenciación de las células neoplásicas. En muchos casos, la inmunohistoquímica permite un diagnóstico más preciso de los distintos procesos infiltrando la piel. Este artículo revisa el papel de la inmunohistoquímica en el estudio de la diferenciación y el comportamiento biológico de la mayoría de las neoplasias que pueden afectar a la piel. Se revisan las técnicas de inmunoperoxidasa, se discute la utilidad de los anticuerpos utilizados con mayor frecuencia y se presentan una serie de problemas diagnósticos en los que la immunohistoquímica puede resultar muy útil. En cada caso, la finalidad es llegar a un diagnóstico concreto y definitivo. En esta segunda parte de nuestra revisión se analizan los anticuerpos más útiles y específicos en el estudio de las infecciones cutáneas, así como de las neoplasias epiteliales, musculares, vasculares, linfohematológicas, neurales, neuroendocrinas y melanocíticas afectando a la piel. Al final, se incluye una breve revisión del perfil inmunohistoquímico de las metástasis cutáneas de neoplasias malignas viscerales (AU)

Dermatopathology includes a long list of disorders, some of which have very similar histopathology. Immunohistochemistry is an important auxiliary tool for diagnosis and differential diagnosis, and for predicting the outcome of many skin tumors. It is also the main technique for determining the origin of a tissue or the differentiation of neoplastic cells. In many cases, immunohistochemistry provides a more accurate diagnosis of the different processes that infiltrate the skin. This review examines the role of immunohistochemistry in studying the differentiation and biological behavior of the majority of tumors that can involve the skin. We review immunoperoxidase techniques, discuss the utility of the most commonly used antibodies, and highlight a number of diagnostic problems in which immunohistochemistry may be very useful. In each case, the goal is to reach a specific and definitive diagnosis. In the second part of our review, we examine the most useful and specific antibodies in the study of skin infections and of epithelial, muscular, lymphatic and hematologic, neural, neuroendocrine, and melanocytic neoplasms that affect the skin. Finally, we include a brief review of the immunohistochemical profile of skin metastases of malignant visceral tumors (AU)

Inmunohistoquímica en dermatopatología: revisión de los anticuerpos utilizados con mayor frecuencia (parte I) / Immunohistochemistry in Dermatopathology: A Review of the Most Commonly Used Antibodies (Part I)

La dermatopatología incluye una larga lista de entidades, algunas con una histopatología muy similar. La immunohistoquímica representa una importante herramienta de ayuda en el diagnóstico, diagnóstico diferencial y pronóstico de muchas de las neoplasias cutáneas. La inmunohistoquímica es también la mejor técnica para determinar el origen de un tejido o la diferenciación de las células neoplásicas. En muchos casos la inmunohistoquímica permite un diagnóstico más preciso de los distintos procesos infiltrando la piel. Este artículo revisa el papel de la inmunohistoquímica en el estudio de la diferenciación y el comportamiento biológico de la mayoría de las neoplasias que pueden afectar a la piel. Se revisan las técnicas de inmunoperoxidasa, se discute la utilidad de los anticuerpos utilizados con mayor frecuencia y se presentan una serie de problemas diagnósticos en los que la immunohistoquímica puede resultar muy útil. En cada caso, la finalidad es llegar a un diagnóstico concreto y definitivo. En la primera parte de esta revisión se estudian los anticuerpos que exploran las distintas líneas de diferenciación de las neoplasias cutáneas (AU)

Dermatopathology includes a long list of disorders, some of which have very similar histopathology. Immunohistochemistry is an important auxiliary tool for diagnosis and differential diagnosis, and for predicting the outcome of many skin tumors. It is also the main technique for determining the origin of a tissue or the differentiation of neoplastic cells. In many cases, immunohistochemistry provides a more accurate diagnosis of the different processes that infiltrate the skin. This review examines the role of immunohistochemistry in studying the differentiation and biological behavior of the majority of tumors that can involve the skin. We review the immunoperoxidase techniques, discuss the utility of the most commonly used antibodies, and highlight a number of diagnostic problems in which immunohistochemistry maybe very useful. In each case, the goal is to reach a specific and definitive diagnosis. In the first part of this review, we examine the antibodies that determine the different cell-differentiation profiles of skin tumors (AU)

Trombosis venosa profunda en paciente con lepra lepromatosa tratado con talidomida por leprorreacción / Deep Vein Thrombosis in a Patient With Lepromatous Leprosy Receiving Thalidomide to Treat Leprosy Reaction

La talidomida es el fármaco de elección en el tratamiento del eritema nodoso leproso severo/recurrente. Su uso ha sido relacionado con trombosis venosas profundas (TVP) en pacientes con enfermedades hematológicas (especialmente cuando se le asocia con corticoides y quimioterapia). Presentamos un caso de TVP en un hombre de 43 años, con lepra lepromatosa en tratamiento con talidomida y prednisona por una leprorreación tipo 2 (eritema nodoso leproso), con anticuerpos antifosfolípidos positivos transitorios. Resaltamos la importancia de tener en cuenta esta posible complicación, potencialmente fatal, en pacientes tratados con talidomida por enfermedades dermatológicas (AU)

Thalidomide is the treatment of choice for severe or recurrent erythema nodosum leprosum. Its use has been associated with deep vein thrombosis in patients with blood disorders, however, particularly when used in combination with corticosteroids or chemotherapy. We describe a case of deep vein thrombosis in a 43-year-old man with lepromatous leprosy who was being treated with thalidomide and prednisone for a type 2 leprosy reaction (erythema nodosum leprosum); the patient also had transiently positive antiphospholipid antibody results. We stress the importance of considering deep vein thrombosis, a potentially fatal complication, in dermatology patients treated with thalidomide (AU)

Immunohistochemistry in dermatopathology: a review of the most commonly used antibodies (part II).

Dermatopathology includes a long list of disorders, some of which have very similar histopathology. Immunohistochemistry is an important auxiliary tool for diagnosis and differential diagnosis, and for predicting the outcome of many skin tumors. It is also the main technique for determining the origin of a tissue or the differentiation of neoplastic cells. In many cases, immunohistochemistry provides a more accurate diagnosis of the different processes that infiltrate the skin. This review examines the role of immunohistochemistry in studying the differentiation and biological behavior of the majority of tumors that can involve the skin. We review immunoperoxidase techniques, discuss the utility of the most commonly used antibodies, and highlight a number of diagnostic problems in which immunohistochemistry may be very useful. In each case, the goal is to reach a specific and definitive diagnosis. In the second part of our review, we examine the most useful and specific antibodies in the study of skin infections and of epithelial, muscular, lymphatic and hematologic, neural, neuroendocrine, and melanocytic neoplasms that affect the skin. Finally, we include a brief review of the immunohistochemical profile of skin metastases of malignant visceral tumors.

Deep vein thrombosis in a patient with lepromatous leprosy receiving thalidomide to treat leprosy reaction.

Thalidomide is the treatment of choice for severe or recurrent erythema nodosum leprosum. Its use has been associated with deep vein thrombosis in patients with blood disorders, however, particularly when used in combination with corticosteroids or chemotherapy. We describe a case of deep vein thrombosis in a 43-year-old man with lepromatous leprosy who was being treated with thalidomide and prednisone for a type 2 leprosy reaction (erythema nodosum leprosum); the patient also had transiently positive antiphospholipid antibody results. We stress the importance of considering deep vein thrombosis, a potentially fatal complication, in dermatology patients treated with thalidomide.

Immunohistochemistry in dermatopathology: a review of the most commonly used antibodies (part I).

Dermatopathology includes a long list of disorders, some of which have very similar histopathology. Immunohistochemistry is an important auxiliary tool for diagnosis and differential diagnosis, and for predicting the outcome of many skin tumors. It is also the main technique for determining the origin of a tissue or the differentiation of neoplastic cells. In many cases, immunohistochemistry provides a more accurate diagnosis of the different processes that infiltrate the skin. This review examines the role of immunohistochemistry in studying the differentiation and biological behavior of the majority of tumors that can involve the skin. We review the immunoperoxidase techniques, discuss the utility of the most commonly used antibodies, and highlight a number of diagnostic problems in which immunohistochemistry may be very useful. In each case, the goal is to reach a specific and definitive diagnosis. In the first part of this review, we examine the antibodies that determine the different cell-differentiation profiles of skin tumors.

Episodios de flushing y ampollas / Episodes of flushing and blistering

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Lupus eritematoso cutáneo y vitíligo / Cutaneous Lupus Erythematosus and Vitiligo

No disponible