Dermatomyositis induced by the secretion of Phyllomedusa bicolor or Kambô frog - A case report.

The Amazonian Kambô frog, Phyllomedusa bicolor, is commonly known for the potential benefits of its secretion. The Kambô ritual consists in applying the toxin directly to a freshly burnt skin area, since it is believed by natives and shamans to purify and strengthen the body and mind of the user. We describe a 33-year old female with a history of periodic use of Kambô toxin who presented with a 3-week course of asthenia, malaise, myalgia, and proximal muscle weakness predominantly in the lower limbs. She had elevated muscle enzymes and an abnormal electromyography. We used the 2017 European League Against Rheumatism and American College of Rheumatology classification criteria to establish the diagnosis of dermatomyositis. The patient demonstrated clinical response to prednisone, with a complete recovery of signs and symptoms after 8 weeks of treatment. To our knowledge, this is the first case report of dermatomyositis possibly associated with the use of Kambô. The Kambô cleansing ritual is becoming popular in first world countries, but its use may lead to serious side-effects, sometimes life-threatening. In patients presenting with signs and symptoms suggestive of dermatomyositis and a skin line of circle-shaped burns, Phyllomedusa bicolor skin secretion exposure should be suspected.

Clinical Considerations in Physician-Assisted Death for Probable Alzheimer's Disease: Decision-Making Capacity, Anosognosia, and Suffering.

BACKGROUND: Requests for physician-assisted death (PAD) in patients with cognitive impairment are complex and require careful consideration. Of particular difficulty is determination of whether the request is voluntary and well considered. RESULTS: Euthanasia and physician-assisted suicide (PAS) are both legal in The Netherlands, Luxemburg, Colombia, and Canada. Euthanasia is legal in Belgium, while PAS is legal in Switzerland and Oregon, Washington, Montana, Vermont, and California (USA). Upon a PAD request, evaluation of the capacity to consent medical treatment is relevant for the decision-making process, while evaluation of testamentary capacity is appropriate before an advance euthanasia directive is written. Anosognosia assessment throughout the Alzheimer's disease continuum provides essential and relevant information regarding the voluntary and well-considered nature of the PAD request; meanwhile, early assessment of hypernosognosia or subjective cognitive decline assists in formulation of a clinical prognosis. Furthermore, the assessment of physical and psychological suffering should incorporate verbal and nonverbal cues as well as consideration of the psychosocial factors that might affect due care criteria. CONCLUSION: The clinical approach to a PAD request should consider the legal framework and the decision-making capacity, assess memory deficit awareness and the perception of suffering, and evaluate mental competency when considered pertinent.

Por qué ser médico hoy: puentes entre la formación y la práctica de la medicina

Contenido: Más allá del arte de curar. El desafío de formarse como médico. Formación de un espíritu científico. Carta a un joven estudiante de medicina. Entre la evidencia y la narrativa. Medicina, "edad de oro" y después... Reflexiones sobre el ser médico. ¿Tratamiento de algo o tratamiento de alguien?. Escuchar. El médico: ¿operario o artesano de la salud?. Recuperar el humanismo. Los territorios ignotos de nuestra mente. Vocación en el siglo XXI. Luces y sombras de una decisión crucial. Los cambios en el ejercicio de la medicina, su influencia en la profesión médica y en el cuidado de la salud. Una apasionante decisión...

Por qué ser médico hoy: puentes entre la formación y la práctica de la medicina

Contenido: Más allá del arte de curar. El desafío de formarse como médico. Formación de un espíritu científico. Carta a un joven estudiante de medicina. Entre la evidencia y la narrativa. Medicina, "edad de oro" y después... Reflexiones sobre el ser médico. ¿Tratamiento de algo o tratamiento de alguien?. Escuchar. El médico: ¿operario o artesano de la salud?. Recuperar el humanismo. Los territorios ignotos de nuestra mente. Vocación en el siglo XXI. Luces y sombras de una decisión crucial. Los cambios en el ejercicio de la medicina, su influencia en la profesión médica y en el cuidado de la salud. Una apasionante decisión...(AU)

Ethics and communication between physicians and their patients with cancer, HIV/AIDS, and rheumatoid arthritis in Mexico.

BACKGROUND: Despite evidence that open communication concerning diagnosis of a disease substantially improves the doctor-patient relationship, in developing countries physicians often provide partial information. METHODS: We carried out a cross-sectional study with 379 physicians practicing at 11 hospitals in Mexico City and in the central Mexican state of Morelos to quantify their communication patterns with patients with cancer, HIV/AIDS, and rheumatoid arthritis. Communication patterns were defined as physician self-reported communication with patients with regard to their diagnosis, prognosis, and treatment. Logistic, ordinal, multivariate models were constructed for analysis. RESULTS: Assigning a high level of value to communication (odds ratio [OR] 5.5, 95% confidence interval [95% CI] 2.1-14.8), and bioethics training (OR 1.5, 95% CI 1.0-2.3) were principal predictors of explicit communication with cancer patients. We found a very strong association between explicit communication with HIV/AIDS patients and an accepting attitude of the physician toward death (OR 34.6, 95% CI 8.5-141.0). As for communication with rheumatoid arthritis patients, we observed an association between a very paternalistic attitude on the part of the physician (OR 6.8, 95% CI 1.9-24.1) and complete communication. CONCLUSIONS: In Mexico, physicians exercise power and authority over patients in an effort that they perceive as beneficial or preventing harm. In most cases, physicians do not seem to recognize or respect their patients' autonomy; therefore, communication is generally partial and vague. Our study established the need among physicians for bioethics and communication training. A discussion of this topic is necessary to transform the doctor-patient relationship and to establish a consensus for policies and norms for communication that benefits patients.

The oral side of Sjögren syndrome. Diagnosis and treatment. A review.

Sjögren syndrome (SS) is an inflammatory disease of the exocrine glands. Although not always present, signs and symptoms of dry eyes and xerostomia are characteristic features of SS. Oral dryness is one of the most important data of patients with SS. Several sets of criteria have been published; however, there is no definitive agreement concerning which is the most useful. In addition to its various clinical manifestations, lack of understanding of the causes of SS delays prompt diagnosis. Histologically, the salivary gland shows a characteristic lymphocytic infiltrate, which is implicated in the destruction of gland cells. Saliva performs an important role in maintaining and protecting oral health. Deficient quality and quantity of saliva have a detrimental consequence for dental and oral health. In some patients, appropriate information regarding dry mouth care is not offered because most professionals either neglect or ignore adequate attention to oral health. Therefore, lack of treatment is frequent. Medical and dental studies that focus on the oral aspects of diagnosis, consequences, and treatment of SS are commented on. Diagnostic methods used for the oral component are also reviewed. The role of the oral tests developed to diagnose SS is assessed, especially tests used by the majority of criteria. Impairment of salivary secretion increases the risk of developing oral diseases; the therapeutic modalities designed to ameliorate these damages by increasing salivary output or by substitution of saliva are reviewed. We discuss published prevention techniques to diminish dental, periodontal, and soft tissue infections.

Drug-induced amyopathic dermatomyositis.

Amyopathic dermatomyositis is a rare condition. We describe the clinical and histopathologic findings of a 53-year-old woman who developed cutaneous lesions similar to those described in dermatomyositis after fibrate therapy for hypertriglyceridemia. Our patient fits the proposed criteria for amyopathic dermatomyositis, and after 8.5 years, muscular involvement has not been detected, although the dermatologic lesions are still present despite different treatments reported to treat this condition (steroids, antimalarials, methotrexate, dapsone). However, an initial good response has been observed with thalidomide, a drug used increasingly in the dermatologic field. As far as we know, this case is the first of drug-induced amyopathic dermatomyositis.

Tratamiento del síndrome de sjögren primario con ciclosporina-A: efectos clínicos y biológicos / Treatment of primary sjogren syndrome with ciclosporine-A: clinical an biological effects

Objetivo: Evaluar el efecto de la ciclosporina A (CsA) en el tratamiento del síndrome de Sjögren primario (SSP). Métodos: Se incluyeron nueve pacientes con SSP. Se les suministró CsA (2 mg/kg de peso) durante seis meses. Todos los pacientes fueron evaluados clínicamente cada mes. Se realizó la prueba de Schirmer y la respuesta a CsA se registró por medio de la escala visual análoga durante y después del tratamiento. En suero se determinó el factor reumatoide y los niveles de inmunoglobulinas por nefelometría y los anticuerpos anti-Ro y anti-La por análisis inmunoenzimático. En sobrenadantes de células mononucleares cultivadas por 24 y/o 48 horas. Se cuantificó la producción espontánea de IL-10 e inmunoglobulinas. La IL-10 intracelular en las subpoblaciones CD4+, CD8+, CD19+ y CD14+ fue detectada mediante citometría de flujo. Resultados: El tratamiento fue bien tolerado y sin efectos colaterales. Las manifestaciones oculares mejoraron notablemente en cinco pacientes, en forma moderada en dos, en una no hubo respuesta y en otra no fue evaluable. Las manifestaciones orales mejoraron notablemente en tres pacientes, moderadamente en cinco y en otra no hubo respuesta. Los niveles de inmunoglobulinas tanto en suero como en sobrenadante, se normalizaron en los cinco pacientes que presentaron hipergamaglobulinemia al inicio del estudio. Los niveles de IL-10 disminuyeron en siete pacientes a expensas de las células CD19+. Conclusiones: El tratamiento del SSP con CsA mostró efectos benéficos en la xerostomía y xeroftalmia, aunado a la corrección de los parámetros biológicos estudiados. Por ello la CsA podría ser una alternativa terapéutica promisoria para pacientes con SSP.

En torno a la muerte. Una revisión y una propuesta / On death. A brief review and proposal

En este ensayo se analiza, desde el punto de vista histórico, médico y psicológico, entre otros, la experiencia del ser humano ante la muerte. Inquieta y sorprende que el tema de la muerte, así como la experiencia del enfermo ante su propio fin, sean tópicos soslayados e incluso, en ocasiones, vetados. Consideramos oportuno -e importante- reflexionar sobre la muerte, pues el avance tecnológico en la medicina debe caminar en forma paralela a la relación médico-paciente. ¿Quién, si no el galeno, es el indicado para ayudar a su enfermo a bien morir?

Antiinflamatorios no esteroideos: una revisión práctica / Non-steroidal anti-inflammatory drugs

El propósito del presente trabajo es revisar en forma somera los mecanismos de acción de los principales antiinflamatorios no esteroides de uso común en México. Se analizan la estructura, farmacocinética, indicaciones, efectos tóxicos y colaterales, así como las contraindicaciones y dosis de cada uno de ellos. Asimismo, se enlistan algunas consideraciones pertinentes en cuanto al balance riesgo-beneficio de estos medicamentos