Bullous Lupus: An Atypical Case of Refractory Disease in a Patient with Sulfa Allergy.

Bullous systemic lupus erythematosus (BSLE) is a rare cutaneous autoimmune disorder characterized by rapid, widespread vesiculobullous lesions in patients with Systemic Lupus Erythematosus (SLE). BSLE can present as the initial manifestation of SLE and may be a marker of severe disease. In this case report, we present a case of a 22-year-old African American woman with BSLE and impaired renal function with subsequent nephrotic range proteinuria concerning for lupus nephritis and autoimmune hemolytic anemia, refractory to systemic corticosteroids, immunoglobulin, and mycophenolate mofetil, requiring dapsone after careful desensitization due to prior history of angioedema with sulfa drugs. This case highlights the importance of the prompt recognition of BSLE as the initial manifestations of SLE and illustrates the association of BSLE with severe disease and the benefit of concomitant use of dapsone with corticosteroids and other immunosuppressant drugs, even in patients with a history of sulfa allergy.

Haemophagocytic lymphohistiocytosis with collapsing lupus podocytopathy as an unusual manifestation of systemic lupus erythematosus with APOL1 double-risk alleles.

Haemophagocytic lymphohistiocytosis (HLH) is a potentially life-threatening syndrome caused by excessive immune activation. Secondary HLH has been described in autoimmune diseases. We detail the case of a 28-year-old African American woman who developed HLH in the setting of systemic lupus erythematosus with collapsing lupus podocytopathy superimposed on mesangial proliferative lupus nephritis class II. Genotyping for APOL1 risk alleles revealed the presence of double (G1/G2) risk alleles. Our patient achieved a complete renal recovery and resolution of HLH within 1 month of treatment with steroids and mycophenolate mofetil, highlighting the importance of prompt, aggressive therapy.

Unusual case of levamisole-induced dual-positive ANCA vasculitis and crescentic glomerulonephritis.

Cocaine adulterated levamisole is an increasingly reported cause of skin necrosis, arthralgia and systemic vasculitis, but renal involvement is uncommon. We present a case of a 40-year-old Hispanic man with a history of cocaine abuse who presented with acute kidney injury to the rheumatology clinic where he was being treated for chronic inflammatory arthritis. He was found to have a serum creatinine of 2.5 mg/dL, microscopic haematuria and subnephrotic proteinuria, along with positive proteinase 3, myeloperoxidase, anticardiolipin antibodies and an elevated antinuclear antibody titre. The renal pathology revealed focal necrotising glomerulonephritis with crescentic features and mild immune type deposition. The patient was treated with cocaine abstinence, pulse dose steroids followed by maintenance prednisone, rituximab and cyclophosphamide. His renal function subsequently improved but did not normalise. We believe that his incomplete improvement was due to the degree of kidney injury on presentation as well as recidivism with cocaine use.

Salud ambiental para estudiantes de Sistema de Información en Salud / Environmental Health in students of Information System

Se realizó un estudio cualitativo de corte transversal cuyo objetivo fue elaborar un programa de estudio sobre Salud Ambiental para el desarrollo de habilidades en las técnicas de las ciencias ambientales que permitan la solución de problemas ambientales con una concepción científica del mundo sobre la base de una formación Integral en la carrera Sistema de Información en salud 2013. El universo estuvo constituido por 14 estudiantes de 4to año, coincidiendo con la muestra. Se emplearon métodos: Histórico-lógico, Estudio documental, modelación, observación, encuesta y matemático o estadístico. Al analizar los diferentes criterios se demuestra un predominio de estudiantes para un 100 por ciento, que consideran que existe poco conocimiento sobre salud ambiental, que existe la vinculación de la asignatura con las disciplinas que integran la carrera por lo cual consideran importante para su futura profesión la impartición del programa electivo Salud Ambiental. Se emitieron conclusiones y recomendaciones(AU)

A qualitative cross-sectional study is done its objective was to develop a curriculum on Environmental Health for the development of skills in the techniques of environmental sciences that allow solving environmental problems with a scientific world on the basis of training performed Integral career in health Information System 2013. The universe was composed of 14 students from 4th year, coinciding with the sample. Historical and logical, documentary research, modeling, observation, and mathematical or statistical survey and methods were used. Analyzing the different criteria a predominance of students to 100 percent, they consider that there is little knowledge about environmental health, which exists linking the subject to the disciplines that make up the race for which they consider important for their future profession demonstrates the Environmental Health delivery elective program. Conclusions and recommendations were issued

Prevention and treatment in utero of autoimmune-associated congenital heart block.

Transplacental transfer of maternal anti-Ro and/or anti-La autoantibodies can result in fetal cardiac disease, including congenital heart block and cardiomyopathy, called cardiac neonatal lupus (NL). Thousands of women are faced with the risk of cardiac NL in their offspring, which is associated with significant morbidity and mortality. There are no known therapies to permanently reverse third-degree heart block in NL, although several treatments have shown some effectiveness in incomplete heart block and disease beyond the atrioventricular node. Fluorinated steroids taken during pregnancy have shown benefit in these situations, although adverse effects may be concerning. Published data are discordant on the efficacy of fluorinated steroids in the prevention of mortality in cardiac NL. ß-agonists have been used to increase fetal heart rates in utero. The endurance of ß-agonist effect and its impact on mortality are in question, but when used in combination with other therapies, they may provide benefit. No controlled experiments regarding the use of plasmapheresis in cardiac NL have been performed, despite its theoretical benefits. Intravenous immunoglobulin was not shown to prevent cardiac NL at a dose of 400 mg/kg, although it has shown effectiveness in the treatment of associated cardiomyopathy both in utero and after birth. Retrospective studies have shown that hydroxychloroquine may prevent the recurrence of cardiac NL in families with a previously affected child, and a prospective open-label trial is currently recruiting patients in order to fully evaluate this relationship.

Comportamiento de dolor pelviano en adolescentes / Behaviour of pelvis pain in teenagers

Se realiza un estudio en el Hospital General Docente Dr Agostinho Neto de Guantánamo en el período enero-diciembre de 2008, con el objetivo de determinar la incidencia del dolor pelviano en la población adolescente que acude a consulta de ginecología infanto-juvenil atendido en esta institución. El universo está constituido por 165 pacientes que acudieron a la consulta. Las variables estudiadas son: edad, inicio de relaciones sexuales, causas más frecuentes del dolor y comienzo del mismo relacionado con la menarquia, principales factores de riesgo y síntomas más frecuentes asociados. Se observa que el dolor pélvico es frecuente en el 26.6 por ciento de las consultas. El 75 por ciento de las adolescentes había iniciado las relaciones sexuales. El aborto es el principal factor de riesgo, seguido por trastornos menstruales. El síntoma más asociado es el dolor (AU)