Genomic comparison of two strains of Mycobacterium avium subsp. paratuberculosis with contrasting pathogenic phenotype.

In a previous study, we evaluated the degree of virulence of Mycobacterium avium subsp. paratuberculosis (Map) strains isolated from cattle in Argentina in a murine model. This assay allowed us to differentiate between high-virulent MapARG1347 and low-virulent MapARG1543 strains. To corroborate whether the differences in virulence could be attributed to genetic differences between the strains, we performed Whole Genome Sequencing and compared the genomes and gene content between them and determined the differences related to the reference strain MapK10. We found 233 SNPs/INDELS in one or both strains relative to Map K10. The two strains share most of the variations, but we found 15 mutations present in only one of the strains. Considering NS-SNP/INDELS that produced a severe effect in the coding sequence, we focus the analysis on four predicted proteins, putatively related to virulence. Survival of MapARG1347 strain in bMDM was higher than MapARG1543 and was more resistant to acidic pH and H2O2 stresses than MapK10. The genomic differences between the two strains found in genes MAP1203 (a putative peptidoglycan hydrolase), MAP0403 (a putative serine protease) MAP1003c (a member of the PE-PPE family) and MAP4152 (a putative mycofactocin binding protein) could contribute to explain the contrasting phenotype previously observed in mice models.

Utilidad de la microscopía confocal de reflectancia para el diagnóstico in vivo de los sebomatricomas / Usefulness of Reflectance Confocal Microscopy For in Vivo Diagnosis of Sebomatricomas

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Bone marrow trephine biopsy involvement by lymphoma: pattern of involvement and concordance with flow cytometry, in 10 years from a single institution

Purpose: To evaluate the features of bone marrow (BM) biopsy involvement by lymphoma, pattern of infiltration, morphological analysis and flow cytometry were reviewed at all lymphoma patients over a period of 10 years. Methods/patients: 413 cases were included in the study if BM biopsy slides were available. Only 356 patients had both BM trephine biopsy and flow cytometry. Results: The most frequent subtype was diffuse large B cell (31.2 %), followed by follicular lymphoma (18.9 %). The predominant pattern was mixed (nodular-interstitial) (9.2 %). Morphological marrow infiltration was found in 138 cases, and flow cytometry identified 117 cases with BM involvement. A concordance between the two methods was detected in 305 cases (85.7 %). There was discordance in 51 cases (14.3 %): morphology positive/FC negative in 33 cases and morphology negative/FC positive in 18. Conclusions: Flow cytometry is slightly more useful in detecting involvement when the BM is affected, but this finding is not conclusive (AU)

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Bone marrow trephine biopsy involvement by lymphoma: pattern of involvement and concordance with flow cytometry, in 10 years from a single institution.

PURPOSE: To evaluate the features of bone marrow (BM) biopsy involvement by lymphoma, pattern of infiltration, morphological analysis and flow cytometry were reviewed at all lymphoma patients over a period of 10 years. METHODS/PATIENTS: 413 cases were included in the study if BM biopsy slides were available. Only 356 patients had both BM trephine biopsy and flow cytometry. RESULTS: The most frequent subtype was diffuse large B cell (31.2%), followed by follicular lymphoma (18.9%). The predominant pattern was mixed (nodular-interstitial) (9.2%). Morphological marrow infiltration was found in 138 cases, and flow cytometry identified 117 cases with BM involvement. A concordance between the two methods was detected in 305 cases (85.7%). There was discordance in 51 cases (14.3%): morphology positive/FC negative in 33 cases and morphology negative/FC positive in 18. CONCLUSIONS: Flow cytometry is slightly more useful in detecting involvement when the BM is affected, but this finding is not conclusive.

Utilidad de la microscopia confocal en el diagnóstico diferencial de epiteliomas basocelulares y nevus melanocíticos intradérmicos de localización facial / Usefulness of Confocal Microscopy in Distinguishing Between Basal Cell Carcinoma and Intradermal Melanocytic Nevus on the Face

El diagnóstico clínico diferencial entre el epitelioma basocelular y el nevus melanocítico intradérmico facial puede ser a veces complicado, sobre todo en pacientes jóvenes o con múltiples nevus. La dermatoscopia es una herramienta útil que permite observar signos dermatoscópicos asociados a epitelioma como las ruedas de carro, las hojas de arce, los nidos y puntos azul grisáceos y la ulceración, además permite distinguir los vasos telangiéctasicos arboriformes y los vasos cortos curvados bien enfocados característicos de los epiteliomas basocelulares de los vasos en coma presentes en los nevus melanocíticos intradérmicos. Sin embargo, el diagnóstico diferencial clínico y dermatoscópico entre estas 2 afecciones dermatológicas puede ser complejo. Presentamos 2 lesiones faciales en 2 pacientes de 38 años de difícil diagnóstico clínico y dermatoscópico en los que la microscopia confocal mostró nidos celulares con separación entre los nidos y el estroma, y polarización de los núcleos de las células tumorales, que son signos confocales asociados a epitelioma basocelular

The clinical distinction between basal cell carcinoma (BCC) and intradermal melanocytic nevus lesions on the face can be difficult, particularly in young patients or patients with multiple nevi. Dermoscopy is a useful tool for analyzing characteristic dermoscopic features of BCC, such as cartwheel structures, maple leaf–like areas, blue-gray nests and dots, and ulceration. It also reveals arborizing telangiectatic vessels and prominent curved vessels, which are typical of BCC, and comma vessels, which are typical of intradermal melanocytic nevi. It is, however, not always easy to distinguish between these 2 conditions, even when dermoscopy is used. We describe 2 facial lesions that posed a clinical and dermoscopic challenge in two 38-year-old patients; confocal microscopy showed separation between tumor nests and stroma and polarized nuclei, which are confocal microscopy features of basal cell carcinoma

Usefulness of confocal microscopy in distinguishing between basal cell carcinoma and intradermal melanocytic nevus on the face.

The clinical distinction between basal cell carcinoma (BCC) and intradermal melanocytic nevus lesions on the face can be difficult, particularly in young patients or patients with multiple nevi. Dermoscopy is a useful tool for analyzing characteristic dermoscopic features of BCC, such as cartwheel structures, maple leaf-like areas, blue-gray nests and dots, and ulceration. It also reveals arborizing telangiectatic vessels and prominent curved vessels, which are typical of BCC, and comma vessels, which are typical of intradermal melanocytic nevi. It is, however, not always easy to distinguish between these 2 conditions, even when dermoscopy is used. We describe 2 facial lesions that posed a clinical and dermoscopic challenge in two 38-year-old patients; confocal microscopy showed separation between tumor nests and stroma and polarized nuclei, which are confocal microscopy features of basal cell carcinoma.

Trastornos psicopatológicos y calidad de vida en el infarto cerebral / Psychopathological disorders and quality of life in patients with brain infarction

Objetivos: Estudiar la influencia de diversos factores en la calidad de vida relacionada con la salud (CVRS) de los pacientes tras un infarto cerebral (IC), con especial atención a los trastornos psicopatológicos (TP). Pacientes y métodos: Estudio observacional prospectivo sobre 45 pacientes ingresados por IC, evaluados a las 4, 12 y 26 semanas del evento agudo. Se recogieron antecedentes y datos sociodemográficos previos, se utilizó la escala SF-36 para la valoración de la CVRS, para la valoración psicopatológica, cognitiva, neurológica y funcional se utilizó el inventario neuropsiquiátrico (NPI), MMSE, escala de Canadá, escala de Rankin modificada y otras escalas. Para determinar los posibles factores predictivos de las puntuaciones del SF-36 a las 26 semanas se realizó un estudio de regresión lineal, introduciendo como variables independientes los antecedentes médicos y psiquiátricos, las características sociodemográficas y la evaluación funcional, neuropsicológica y psicopatológica a las 4 semanas. Resultados: Se obtuvieron modelos predictivos válidos para todos los índices del SF-36, en los que el antecedente de depresión, las puntuaciones más altas en el NPI y la escala de Rankin, y más baja en la escala canadiense fueron los principales indicadores predictivos de una peor CVRS a largo plazo. El distrés del cuidador asociado a la psicopatología del paciente (medido a través del NPI) tuvo una influencia negativa sobre el índice de función social. Conclusiones: Los TP y la situación funcional fueron los principales determinantes de la CVRS de los pacientes tras un IC (AU)

Objectives: To study the influence of various factors on the health related quality of life (HRQOL) of patients who have suffered a brain infarction (BI), with special attention to psychopathological disorders (PD). Patients and methods: Prospective observational study on 45 patients admitted due to a BI, evaluated at 4, 12 and 26 weeks of the acute event. Social and demographic data, and medical history were collected; the SF-36 scale was used for the assessment of HRQOL, and the Neuropsychiatric Inventory (NPI), MMSE, Canadian Neurological Scale, Modified Rankin Scale and other instruments for assessing psychopathological, cognitive, neurological and functional status. A linear regression analysis was performed to identify potential predictors of the SF-36 scores at 26 weeks, introducing, as independent variables, medical and psychiatric history, demographic characteristics and the functional, neuropsychological and psychopathological assessments at 4 weeks. Results: Valid predictive models for all the SF-36 domains were obtained, in which a history of pre-morbid depression, higher scores in the NPI and Rankin Scale, and lowest in the Canadian Neurological Scale were the main predictors of a worse HRQOL in the long term. Psychopathology related caregiver's distress (assessed with the NPI) was associated with a lower score in the social function index. Conclusions: PDs and functional status were the main determinants of HRQOL in patients with BI (AU)

[Psychopathological disorders and quality of life in patients with brain infarction]. / Trastornos psicopatológicos y calidad de vida en el infarto cerebral.

OBJECTIVES: To study the influence of various factors on the health related quality of life (HRQOL) of patients who have suffered a brain infarction (BI), with special attention to psychopathological disorders (PD). PATIENTS AND METHODS: Prospective observational study on 45 patients admitted due to a BI, evaluated at 4, 12 and 26 weeks of the acute event. Social and demographic data, and medical history were collected; the SF-36 scale was used for the assessment of HRQOL, and the Neuropsychiatric Inventory (NPI), MMSE, Canadian Neurological Scale, Modified Rankin Scale and other instruments for assessing psychopathological, cognitive, neurological and functional status. A linear regression analysis was performed to identify potential predictors of the SF-36 scores at 26 weeks, introducing, as independent variables, medical and psychiatric history, demographic characteristics and the functional, neuropsychological and psychopathological assessments at 4 weeks. RESULTS: Valid predictive models for all the SF-36 domains were obtained, in which a history of pre-morbid depression, higher scores in the NPI and Rankin Scale, and lowest in the Canadian Neurological Scale were the main predictors of a worse HRQOL in the long term. Psychopathology related caregiver's distress (assessed with the NPI) was associated with a lower score in the social function index. CONCLUSIONS: PDs and functional status were the main determinants of HRQOL in patients with BI.

Toxicodermia por capecitabina. Presentación de dos casos clínicos y revisión de la literatura / Toxic Dermatitis Due to Capecitabine: Presentation of 2 Cases and Literature Review

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Linfoma cutáneo de células B del centro folicular tratado con rituximab intralesional / Cutaneous follicular center B-cell lymphoma treated with intralesional rituximab

Los linfomas cutáneos de células B del centro folicular son tumores indolentes compuestos por células neoplásicas del centro folicular. Están constituidos por una mezcla de centrocitos con un número variable de centroblastos. Los tratamientos habitualmente utilizados son la cirugía y la radioterapia, aunque se utilizan otros como el interferón-a (IFN-a), la quimioterapia y tratamientos biológicos (rituximab). El rituximab es un anticuerpo monoclonal quimérico anti-CD20. Puede utilizarse por vía intravenosa o intralesional. Presentamos el caso de un paciente varón de 41 años que consultó por lesiones nodulares violáceas en el área escapular izquierda y que, tras la realización de una biopsia, analítica, tomografía axial computarizada (TAC) toracoabdominopélvica, ecografía abdominal y biopsia de médula ósea fue diagnosticado de linfoma cutáneo de células B del centro folicular. Se decidió tratamiento con 30 mg de rituximab intralesional, tres veces a la semana, una vez al mes, durante 4 meses, con respuesta completa. Realizamos una revisión de los casos de linfoma cutáneo de células B tratados con rituximab intralesional (AU)

Cutaneous follicular center B-cell lymphomas are indolent tumors characterized by the presence of neoplastic follicular center cells. They contain a mixture of centrocytes with a variable number of centroblasts. The tumor is usually treated by surgery or radiotherapy, although other treatments may be used such as interferon-a, chemotherapy, and biological agents (rituximab). Rituximab is a chimeric monoclonal anti-CD20 antibody that can be administered intravenously or intralesionally. We report the case of a 41-year-old man who consulted for violaceous nodular lesions in the left scapular region and who was diagnosed with cutaneous follicular center B-cell lymphoma after biopsy, laboratory tests, thoracic-abdominal-pelvic computed tomography, abdominal ultrasound, and bone marrow biopsy. It was decided to treat him with 30 mg of intralesional rituximab administered for 1 week (3 times) every month for 4 months. Complete response was obtained. We also review the published cases of cutaneous B-cell lymphoma treated with intralesional rituximab (AU)

[Cutaneous follicular center B-cell lymphoma treated with intralesional rituximab]. / Linfoma cutáneo de células B del centro folicular tratado con rituximab intralesional.

Cutaneous follicular center B-cell lymphomas are indolent tumors characterized by the presence of neoplastic follicular center cells. They contain a mixture of centrocytes with a variable number of centroblasts. The tumor is usually treated by surgery or radiotherapy, although other treatments may be used such as interferon-alpha, chemotherapy, and biological agents (rituximab). Rituximab is a chimeric monoclonal anti-CD20 antibody that can be administered intravenously or intralesionally. We report the case of a 41-year-old man who consulted for violaceous nodular lesions in the left scapular region and who was diagnosed with cutaneous follicular center B-cell lymphoma after biopsy, laboratory tests, thoracic-abdominal-pelvic computed tomography, abdominal ultrasound, and bone marrow biopsy. It was decided to treat him with 30 mg of intralesional rituximab administered for 1 week (3 times) every month for 4 months. Complete response was obtained. We also review the published cases of cutaneous B-cell lymphoma treated with intralesional rituximab.

Nummular headache with trophic changes inside the painful area.

Nummular headache (NH) is a primary disorder characterized by chronic pain that is exclusively felt in a small area of the head surface. We describe five patients with circumscribed head pain and sensory dysfunction consistent with NH, who in addition developed colocalized trophic changes. All of them had a round or oval patch of skin depression (1-2 cm in diameter) inside of the painful area (2-4.5 cm in diameter). Three of them also showed hair loss, reddish colour, and local increased temperature. Skin biopsies were performed in three patients, and were not specific for any particular dermatological disease. Local trophic changes may be a clinical feature of NH. Together with pain and sensory disturbances, they could represent a restricted form of complex regional pain syndrome. This should be taken as a possible evolution of the underlying morbid process of NH.

[Cutaneous adverse reaction to Bio-Alcamid implant]. / Reacción cutánea tras implante con Bio-Alcamid.

In the last years new and numerous materials for the correction of defects and wrinkles have been developed. One of these materials is Bio-Alcamid, a non reabsorbable gel polymer constituted by meshes of poly-alkyl-imide, without known adverse effects. We report a 34-year-old woman that had Bio-Alcamid implants for acne scars and several months after presented nodular lesions together with a painful inflammatory nodule. The nodule was drained and culture of the purulent material yielded Streptococcus viridans. A cytology and a cellular block of that material showed a granulomatous inflammatory reaction together with a foreign body. The different types of reactions to implants and their pathogenic mechanism are discussed. It is important to know these possible reactions to filler materials given their increasing use and the potential medico-legal consequences.

Reacción cutánea tras implante con Bio-Alcamid® / Cutaneous adverse reaction to Bio-Alcamid® implant

En los últimos años se ha producido la aparición de nuevos y numerosos materiales para la corrección de defectos y arrugas. Uno de estos materiales es el Bio-Alcamid®, un gel polimérico gelatinoso no reabsorbible constituido por redes del grupo alquilimida, del cual no hay descritos efectos adversos. Presentamos una mujer de 34 años que recibió inyecciones de Bio-Alcamid® por cicatrices post-acné presentando varios meses después lesiones nodulares, junto con un nódulo inflamatorio muy doloroso. Fue drenado extrayéndose gran cantidad de material purulento y cultivándose un Streptococcus grupo viridans. Se realizó una citología y un bloque celular de ese material donde se objetivó una reacción inflamatoria granulomatosa junto con un material extraño. Se discuten los diversos tipos de reacciones a implantes y su mecanismo patogénico. Es importante el conocimiento de estas posibles reacciones a los materiales de relleno por el incremento debido a un mayor uso y por las consecuencias médicas y legales

In the last years new and numerous materials for the correction of defects and wrinkles have been developed. One of these materials is Bio-Alcamid®, a non reabsorbable gel polymer constituted by meshes of poly-alkyl-imide, without known adverse effects. We report a 34-year-old woman that had Bio-Alcamid® implants for acne scars and several months after presented nodular lesions together with a painful inflammatory nodule. The nodule was drained and culture of the purulent material yielded Streptococcus viridans. A cytology and a cellular block of that material showed a granulomatous inflammatory reaction together with a foreign body. The different types of reactions to implants and their pathogenic mechanism are discussed. It is important to know these possible reactions to filler materials given their increasing use and the potential medico-legal consequences

Hemicrania continua evolving from episodic paroxysmal hemicrania.

A 45-year-old woman, who had been diagnosed in our unit with episodic paroxysmal hemicrania, was seen 2 years later for ipsilateral hemicrania continua in remitting form. Both types of headache had a complete response to indomethacin and did not occur simultaneously. The patient had a previous history of episodic moderate headaches that met criteria for probable migraine without aura and also had a family history of headache. The clinical course in this case suggests a pathogenic relationship between both types of primary headache.

Sinonasal fibrosarcoma: a case report.

Sinonasal fibrosarcoma (SFS) is an infrequent malignant neoplasm. It usually presents as other sarcomas in this region, with nasal obstruction and epistaxis. The final diagnosis is based on the histopathology and immunohistochemistry. We report the case of a 58-year-old man with an 8-month history of left proptosis, recurrent epistaxis and nasal obstruction. Nasal endoscopy confirmed a left nasal neoplasia. CT and MRI showed the extension of the neoplasia, occupying the left nasal fossa and ethmoid sinuses, and eroding the medial wall of the orbit. Complete removal was achieved through endoscopic sinus surgery, preserving the orbit. SFS was found on histopathologic examination. After 4 years of follow-up, nasal endoscopy, CT and MRI imaging show no sign of recurrence.