Efectividad de un programa educativo sobre salud bucodental dirigido a familiares de niños en grado preescolar / Effectiveness of an educational program on oral health aimed at relatives of preschool children

RESUMEN Introducción: Las enfermedades bucales tienen su inicio en edades tempranas el accionar educativo de la familia es determinante, por ello resulta necesario contribuir a elevar su nivel de información en torno a la salud bucodental. Objetivo: Evaluar la efectividad de un programa educativo sobre salud bucodental dirigido a familiares de niños en grado preescolar. Métodos: Se realizó un estudio pre-experimental y prospectivo en la Escuela Primaria «Fe del Valle Ramos¼, de Sagua la Grande, en el período de marzo del 2017 a junio del 2018. La población estuvo constituida por 39 familias y la muestra por 36, seleccionadas por un muestreo no probabilístico intencional por criterios de inclusión y exclusión. Se utilizaron métodos teóricos, empíricos y estadísticos. Los empíricos utilizados fueron: cuestionario a las familias, criterio de especialistas y la observación participante. Se analizó como variables el nivel de información sobre salud bucodental y la efectividad del programa educativo. Resultados: La evaluación del nivel de información sobre salud bucodental dirigido a familiares de niños en grado preescolar fue de mal en 24 familias, para un 66,7 %. El programa educativo diseñado contiene 6 temas, distribuidos en 13 actividades; fue valorado por los especialistas de pertinente y factible para ser aplicado posteriormente. Conclusiones: El diseño de un programa educativo sobre salud bucodental dirigido a familiares de niños en grado preescolar contribuyó a elevar el nivel de información de los mismos lo que avala su efectividad y repercutirá positivamente para evitar enfermedades bucales.

ABSTRACT Introduction: oral diseases have their onset at an early age, the educational action of the family is decisive, that is why it is necessary to contribute to raising their level of information on oral health. Objective: to evaluate the effectiveness of an educational program on oral health aimed at relatives of preschool children. Methods: a prospective and pre-experimental was carried out at "Fe del Valle Ramos" school, in Sagua la Grande, from March 2017 to June 2018. The population consisted of 39 families and the sample was made up of 36, who were selected by an intentional non-probabilistic sampling based on inclusion and exclusion criteria. Theoretical, empirical and statistical methods were used. Family questionnaire, specialist criteria and participant observation were the empirical ones used. The level of information on oral health and the effectiveness of the educational program were analyzed as variables. Results: the evaluation of the level of information on oral health aimed at relatives of children in preschool grade was bad in 24 families (66.7%). The designed educational program contains 6 themes, distributed in 13 activities; it was assessed by the specialists as pertinent and feasible to be applied later. Conclusions: the design of an educational program on oral health aimed at relatives of preschool children contributed to raising their level of information, which supports its effectiveness and will have a positive impact on preventing oral diseases.

Evaluación del desempeño de una celda de combustible microbiana con electrodo de grafito modificado para el tratamiento de agua residual del procesamiento del café / Evaluation of the performance of a microbial fuel cell with modified graphite electrode for the treatment of wastewater from coffee processing / Avaliação do desempenho de uma célula combustível microbial com eletrodo de grafite modificado para o tratamento de águas residuais do processamento de café

Resumen La actividad cafetalera en Costa Rica procesa aproximadamente 69.000 toneladas de café mediante la técnica de beneficiado húmedo. Esta actividad conlleva un alto impacto ambiental debido a la generación de8Lde agua residual/kg de café oro producido. El presente trabajo tiene como objetivo utilizar el agua residual del procesamiento de café como sustrato en celdas combustibles microbianas (CCM), con el propósito de generar energía eléctrica a través de su uso y, a la vez, disminuir la carga orgánica del residuo. La CCM empleó un cátodo modificado con ftalocianinas de hierro (FePc), generó una eficiencia coulómbica de 0,7% y una densidad de potencia de 89 UW/ cm2 en un ciclo de operación de cinco días. Además, se determinó que la CCM disminuye la demanda química de oxígeno (DQO) del residuo hasta en 27% bajo las condiciones de operación nativas del sustrato, a temperatura ambiente, sin mediadores químicos para la reacción anódica y con el uso de electrodos de platino para el cátodo. El estudio confirma la oportunidad de emplear el sustrato con una flora microbiana nativa apta para la operación de la tecnología de la CCM, y así perfilar el dispositivo como una opción novedosa para el tratamiento de este residuo en Costa Rica.

Abstract In Costa Rica coffee production is the most traditional agroindustrial activity, each year approximately 69,000 tons of coffee are processed through the technique of wet processing. The process has a high environmental impact since it generates eight liters of wastewater/kg of produced coffee. Consequently, the main goal of this research was to evaluate the electric generation of a Microbial Fuel Cell (MFC) with two chambers, using coffee wastewater as a substrate, which would generate a sustainable solution with an added economic value to this waste in Costa Rica. The MFC with a cathode modified with iron phthalocyanines (FePc) generated a coulombic efficiency of 0.7% and a power density of 89 -uW/cm2 in a 5-day operation cycle. In addition, it was determined that the MFC decreases the COD of the waste by up to 27% under native substrate conditions, without the use of high temperatures, or chemical mediators for the anodic reaction and platinum electrodes for the cathode chamber. The efficiency of the device can be improved with changes at design level that reduce the ohmic internal resistance and improve electrical generation, the study confirms the potential of the substrate with a native microorganism suitable for the use of MFC technology, shaping the device as a novelty option for the treatment of the waste in Costa Rica.

Resumo A indústria do café na Costa Rica processa cerca de 69 000 toneladas de café por meio da técnica de moagem úmida, o que acarreta um alto impacto ambiental devido à geração de 8 L de água residual / kg de café dourado. O objetivo deste trabalho era usar águas residuais do processamento do café como substrato em Células de Combustível Microbianas (CCM) a fim de gerar energia elétrica por meio do seu aproveitamento e ao mesmo tempo reduzir a carga orgânica do resíduo. CCM usando cátodo modificado com ftalocianinas de ferro (FePc) gerou uma eficiência coulômbica de 0,7% e uma densidade de potência de 89 uW/cm2 em um ciclo operacional de cinco dias. Além disso, foi determinado que o CCM reduz a Demanda Química de Oxigénio (DQO) do resíduo em até 27% nas condições nativas de operação do substrato, à temperatura ambiente, sem mediadores químicos para a reação anódica e com a utilização de eletrodos de platina para o cátodo. O estudo confirma a oportunidade de utilizar o substrato com flora microbiana nativa adequada para o funcionamento da tecnologia CCM e, assim, delinear o dispositivo como uma nova opção para o tratamento desses resíduos na Costa Rica.

[Model of care for the treatment of patients with osteoarthritis from the first to the third level]. / Modelo de atención para el tratamiento de pacientes con osteoartritis del primer al tercer nivel.

INTRODUCTION: Osteoarthritis in Mexico is one of the ten most frequent causes of disability. Early diagnosis and detection of risk factors are determinant for treatment. The institutional organization establishes therapeutic guidelines according to each level of care, but effective management is not achieved. MATERIAL AND METHODS: A prospective, pilot, interventional, clinical study was conducted, which included patients diagnosed with different degrees of knee osteoarthritis in the first, second and third level of care, with an integrative model that includes a group of professionals for the intervention of nutritional, physiotherapeutic, social and psychological evaluation from the first level. RESULTS: The intervention of a multidisciplinary care group allows a correct evaluation and assignment of the level of care, optimizing human and material resources. The participation of different disciplines in nutrition, psychology, social work, physiotherapy and rehabilitation modifies the global lifestyle by involving the patients themselves in their treatment. The intervention group had improvements in the visual analog pain scale, mobility arcs, low body mass index and improvement in the psychological aspect. CONCLUSIONS: The proposed model of care demonstrates that implementation in the institution and in each clinical care unit should be considered to improve outcomes.

INTRODUCCIÓN: La osteoartritis en México es una de las 10 causas más frecuentes de discapacidad. El diagnóstico temprano y la detección de factores de riesgo son determinantes para el tratamiento. La organización institucional establece las pautas terapéuticas de acuerdo con cada nivel de atención, pero no se logra un manejo efectivo. MATERIAL Y MÉTODOS: Se realizó un estudio prospectivo, piloto, de intervención, clínico conformado por pacientes diagnosticados con diferentes grados de osteoartritis de rodilla en el primer, segundo y tercer nivel de atención, con un modelo integrador que incluyó un grupo de profesionales para la intervención de la evaluación nutricional, fisioterapéutica, social y sicológica desde el primer nivel. RESULTADOS: La intervención de un grupo de atención multidisciplinaria permite una correcta evaluación y asignación del nivel de atención optimizando los recursos humanos y materiales. La participación de diferentes disciplinas en nutrición, sicología, trabajo social, fisioterapia y rehabilitación modifica el estilo de vida global al involucrar a los propios pacientes en su tratamiento. El grupo de intervención tuvo mejoras en la escala de dolor análogo visual, arcos de movilidad, bajo índice de masa corporal y mejoría en el aspecto sicológico. CONCLUSIONES: El modelo de atención propuesto demuestra que la implementación en la institución y en cada unidad clínica de atención debe considerarse para mejorar los resultados.

Tratamiento quirúrgico de condroides en las bolsas guturales de un equino mediante abordaje Whitehouse modificado. Reporte de caso / Standing surgical treatment of chondroids in guttural pouches of a horse through a modified Whitehouse approach. Case report

RESUMEN Una yegua de raza caballo criollo colombiano (CCC) de 34 meses de edad fue remitida al Centro de Veterinaria y Zootecnia de la Universidad CES, en la ciudad de Medellín (Colombia), para la extracción quirúrgica de condroides en ambas bolsas guturales. La paciente se intervino en estación utilizando neuroleptoanalgesia y a continuación, se empleó la técnica Whitehouse modificado en cada bolsa gutural para extraer la totalidad de los condroides. Posteriormente, se realizó tratamiento antibiótico y antinflamatorio pre y post quirúrgico con trimetoprim-sulfadiazina y flunixin meglumine vía sistémica; además, penicilina G sódica local. Luego de la intervención la paciente fue dada de alta sin complicaciones y finalmente se evidenció la resolución completa de la condición respiratoria. El reporte de este caso permitirá conocer con detalle la técnica Whitehouse modificado, así como sus retos quirúrgicos y consideraciones, ya que a la fecha en Colombia no hay otros reportes al respecto en un CCC.

ABSTRACT A 34 months old Colombian creole mare was referred to veterinary clinic of CES University, in Medellin (Colombia), for the surgical extraction of chondroids in both guttural pouch. The patient was intervened by standing surgery using neuroleptanalgesia. The modified Whitehouse technique was subsequently performed on each guttural pouch to extract all the chondroids. Antibiotic and anti-inflammatory treatment, pre and postsurgical, was systemically administered using trimethoprim/sulfadiazine and flunixin meglumine, as well as local sodium penicillin G. After the intervention, the patient was discharged without complications and its respiratory condition came to complete solution. This case report will allow knowing in detail the modified Whitehouse surgical technique along with its surgical challenges and considerations. In Colombia, to date, there are no reports of its use in CCH.

Epstein-Barr virus-specific CD8(+) T lymphocytes from diffuse large B cell lymphoma patients are functionally impaired.

Epstein-Barr virus (EBV) is a persistent virus with oncogenic capacity that has been implicated in the development of aggressive B cell lymphomas, primarily in immunosuppressed individuals, although it can be present in immunocompetent individuals. Changes in the function and clonal diversity of T lymphocytes might be implied by viral persistence and lymphoma development. The aim of the present study was to evaluate the frequency, phenotype, function and clonotypical distribution of EBV-specific T cells after peripheral blood stimulation with a virus lysate in newly diagnosed patients with diffuse large B cell lymphoma (DLBCL) aged more than 50 years without prior histories of clinical immunosuppression compared with healthy controls. Our results showed impaired EBV-specific immune responses among DLBCL patients that were associated primarily with decreased numbers of central and effector memory CD8(+) T lymphocytes. In contrast to healthy controls, only a minority of the patients showed CD4(+)/tumour necrosis factor (TNF)-α(+) T cells expressing T cell receptor (TCR)-Vß17 and CD8(+)/TNF-α(+) T cells with TCR-Vß5·2, Vß9 and Vß18 in response to EBV. Notably, the production of TNF-α was undetectable among TCR-Vß5·3(+), Vß11(+), Vß12(+), Vß16(+) and Vß23(+) CD8(+) T cells. In addition, we observed decreased numbers of CD4(+)/TNF-α(+) and CD8(+)/TNF-α(+), CD8(+)/interleukin (IL)-2(+) and CD8(+)/TNF-α(+)/IL-2(+) T lymphocytes in the absence of T cells capable of producing TNF-α, IL-2 and IFN-γ after EBV stimulation simultaneously. Moreover, DLBCL patients displayed higher IL-10 levels both under baseline conditions and after EBV stimulation. These findings were also observed in patients with positive EBV viral loads. Prospective studies including a large number of patients are needed to confirm these findings.

Test de Parche como método diagnóstico de las reacciones adversas a medicamentos / Patch test as a diagnostic method for adverse drug reactions

Las reacciones adversas a medicamentos (RAM) son un motivo frecuente de consulta en la práctica dermatológica. La hipersensibilidad a fármacos es una causa común de RAM, y es de gran relevancia confirmar este mecanismo para que el paciente evite futuras exposiciones. El test de parche tiene un rol relevante en el proceso diagnóstico de las reacciones de hipersensibilidad no inmediatas, otros test como la intradermorreacción o el test de provocación son más invasivos o de alto riesgo, y los exámenes in vitro para reacciones tardías no se encuentran fácilmente disponibles. El problema es que existe escasa estandarización del procedimiento y el valor predictivo del examen es incierto. En esta revisión exponemos la mejor evidencia disponible, lo que permitirá al especialista decidir cuándo hacer este examen y cómo interpretar sus resultados.

Adverse drugs reactions (ADR) are a frequent diagnosis in dermatological practice. Drug hypersensitivity is a common ADR etiology, and it is greatly relevant to confirm this mechanism to avoid future exposures of the patient to the culprit drug. Patch test has an outstanding role in non-immediate hypersensitivity reactions diagnosis process, other tests like intradermal reaction or provocation test are more aggressive or implies more risk, and in-vitro test for non-inmediate reactions are not easily available. One of the main problems of patch test is the lack of standarization of the procedure and the uncertain predictive value. In this review is exposed the best evidence available, so the specialist could decide when to do the test and how interpret its results.

Foliculitis necrotizante herpética / Necrotizing herpes folliculitis. Report of one case

Herpes folliculitis is a rare manifestation of herpes virus infection. It usually represents a diagnostic challenge, due to the absence of characteristic skin manifestations such as vesicles or pustules. The reported cases are mainly associated with varicella zoster virus (VZV) and less commonly with herpes simplex viruses (HSV-1 y HSV-2). We report a 51-year-old male with a relapsing non-Hodgkin Lymphoma under chemotherapy, with history of extensive follicular lesions lasting one month. The pathologic study of the lesions was consistent with necrotizing herpes folliculitis. The patient was treated with Valacyclovir, achieving remission of the lesions. The appearance of folliculitis, especially in an immunocompromised patient, should raise the suspicion of herpes virus infection. Polymerase chain reaction may help to elucidate the diagnosis when pathologic findings are non-specific.

[AA amyloidosis with cutaneous manifestations. Report of one case]. / Manifestaciones cutáneas de amiloidosis sistémica como clave diagnóstica. Caso clínico.

BACKGROUND: Systemic amyloidosis is a rare disease that can affect any organ. Its clinical manifestations are varied and nonspecific. The skin involvement of this disease is common and can be easily recognized on physical examination. We report a 57-year-old male presenting with a two years history of malaise, dyspnea and myalgias. On physical examination, ungueal dystrophy, orange pigmentation of eyelids with periocular petechiae and mild macroglossia were observed. Incisional biopsies of the eyelids, cheeks and hands were obtained. The pathological study demonstrated amyloid deposits. Since protein electrophoresis was normal, the diagnosis of AA amyloidosis was postulated.

Manifestaciones cutáneas de amiloidosis sistémica como clave diagnóstica: Caso clínico / AA amyloidosis with cutaneous manifestations: Report of one case

Background: Systemic amyloidosis is a rare disease that can affect any organ. Its clinical manifestations are varied and nonspecific. The skin involvement of this disease is common and can be easily recognized on physical examination. We report a 57-year-old male presenting with a two years history of malaise, dyspnea and myalgias. On physical examination, ungueal dystrophy, orange pigmentation of eyelids with periocular petechiae and mild macroglossia were observed. Incisional biopsies of the eyelids, cheeks and hands were obtained. The pathological study demonstrated amyloid deposits. Since protein electrophoresis was normal, the diagnosis of AA amyloidosis was postulated.

Colagenosis perforante reactiva adquirida: Caso clínico / Acquired reactive perforating collagenosis: Report of two cases

Acquired reactive perforating collagenosis is a perforating dermatosis characterized by transepidermal elimination of collagen. It is frequently associated to diabetes mellitus and chronic renal insuffciency, but it is also related to other systemic diseases. The lesions tend to resolve once the underlying condition is treated. We report two patients with the condition. A 65 year-old diabetic female on hemodialysis consulted for multiple itching cutaneous ulcers lasting one year. On physical examination, hyperpigmented papules and nodules were observed. A 65 year-old female with chronic renal failure in hemodialysis consulted for itching lesions in hands, forearms and arms. On physical examination, hyperpigmented lesions with ulcers, erosions and crusts were observed. In both cases, the pathological study of the lesions disclosed a reactive perforating collagenosis.

Carcinoma basoescamoso: reporte de un caso con exposición crónica a arsénico ambiental / Basosquamous carcinoma: a case report with chronic environmental arsenic exposition

Basosquamous carcinoma is a relatively rare cutaneous tumour that shares some characteristics of both basal cell and squamous cell carcinoma. Currently most dermatologists consider that it represents a subtype of basal cell carcinoma with a more aggressive behaviour. The clinical presentation is non-specific and in general the diagnosis is made after the histopathological studies. The prevalence is higher in male patients, during the seventh decade and it tends to appear on sun exposed areas. Many authors compare its behaviour with squamous cell carcinoma. We present the case of a 44 years old male patient with a history of chronic arsenic exposure that presented a firm tumor in the left inguinal region and the biopsy showed basosquamous carcinoma with lymphatic involvement. This case shows an atypical presentation because of its localization and the appearance 20 years before the mean age reported in the literature. This could be explained by chronic environmental arsenic exposure, a well known risk factor for the development of cutaneous tumours.

El carcinoma basoescamoso es una neoplasia cutánea relativamente rara que reúne características de carcinoma basocelular y espinocelular. Actualmente la mayoría de los dermatólogos reconocen que este es un subtipo del carcinoma basocelular con comportamiento muchísimo más agresivo. Su presentación clínica es inespecífica y en general su diagnóstico se realiza sólo después de la biopsia. Predomina en pacientes de sexo masculino durante la séptima década de la vida y tiende a aparecer en regiones fotoexpuestas. Muchos autores igualan su comportamiento al del carcinoma espinocelular. Se presenta el caso de un paciente, de sexo masculino, de 44 años de edad, con antecedente de exposición a arsénico medioambiental crónica, que presentó aumento de volumen, duro en la región inguinal izquierda, cuya biopsia fue compatible con carcinoma basoescamoso con compromiso linfático. El caso de nuestro paciente muestra una presentación atípica por su localización y por la aparición 20 años antes de la media de edad reportada en la literatura. Esto podría ser explicado por la exposición crónica a arsénico, conocido factor de riesgo para carcinogénesis cutánea.

[Acquired reactive perforating collagenosis: report of two cases]. / Colagenosis perforante reactiva adquirida: Caso clínico.

Acquired reactive perforating collagenosis is a perforating dermatosis characterized by transepidermal elimination of collagen. It is frequently associated to diabetes mellitus and chronic renal insufficiency, but it is also related to other systemic diseases. The lesions tend to resolve once the underlying condition is treated. We report two patients with the condition. A 65 year-old diabetic female on hemodialysis consulted for multiple itching cutaneous ulcers lasting one year. On physical examination, hyperpigmented papules and nodules were observed. A 65 year-old female with chronic renal failure in hemodialysis consulted for itching lesions in hands, forearms and arms. On physical examination, hyperpigmented lesions with ulcers, erosions and crusts were observed. In both cases, the pathological study of the lesions disclosed a reactive perforating collagenosis.

Fístulas intestinales en el Servicio de Cirugía del Hospital del Salvador: casuística / Intestinal fistulas: a case review to surgery of Salvador Hospital, Santiago Chile

A study of patients with intestinal fístulas treated at the surgical clinic of the Hospital Salvador, Santiago de Chile, from January 2007 until June 2009. The sizes of the study were 26 patients in whom diagnosis was clinical and / or images and / or surgical condition. The average age at presentation was 54.8 years, of similar frequency in men and women (54 percent and 46 percent respectively). Postoperative fístulas occurred in 80 percent and 20 percent spontaneous. Postoperative fístulas were found in an early stage in 57 percent of cases (before 72 h postoperative). Predominance of high-flow fístulas (73 percent) and location in the small intestine 58 percent to 42 percent in colon. Surgical closure was performed in 52 percent of patients, spontaneous closure by 32 percent and 16 percent non-locking. 61.5 percent of patients experienced complications being the most frequent infectious cause. 54 percent of cases required nutritional support with total parenteral nutrition. In our study mortality was 15.3 percent.

Protocolo de farmacovigilancia a reacciones de hipersensibilidad a medicamentos: resultados de su aplicación en 5 centros de Santiago / Pharmacovigilance protocol for cutaneous drug hypersentivity reactions in Santiago, Chile

Introducción: Las Reacciones de Hipersensibilidad Medicomentosa (RHM) son un motivo de consulta muy común en Dermatología. Con el objetivo de implementar la farmacovigilancia dentro de la Sociedad Chilena de Dermatología (SOCHIDERM) se creó un Protocolo paro la notificación de RHM de tipo muco-cutáneo. Objetivo: Validar una propuesta de Protocolo de Farmacovigilancia de RHM de tipo mucocutáneo de la SOCHIDERM paro el uso de dermatólogos y médicos de nuestro país. Resultados: En nuestro estudio, la frecuencia de RHM fue 0,3% -0,5% del total de consultas ambulatorias y 5,2% 17,2% de las interconsultas a Dermatología. Los patrones más frecuentes fueron el urticarial, morbiliforme y la reacción medicamentosa fija. Los fármacos imputados con mayor frecuencia fueron los analgésicos/antiinflamatorios, los fármacos con acción en el sistema nervioso central, los antibióticos y los antihipertensivos. Discusión: Es importante tener un Protocolo de Farmacovigilancia. Esto nos permitirá obtener datos a nivel nacional. El desafío a corto plazo paro farmacovigilancia en SOCHIDERM es lograr notificar las RHM de tipo muco-cutáneo graves o con compromiso vital, que sean atendidas por dermatólogos en nuestro país, a través del Protocolo de Farmacovigilancia SOCHIDERM.

Introduction: Drug Hypersensitivity Reactions (DHR) are a common cause of consultation in dermatology. In order to implement fharmacovigilance in the Chilean Society of Dermatology (SOCHIDERM), we created a protocol for the notification of mucocutaneous DHR. Objective: To validate a SOCHIDERM mucocutaneous DHR pharmacovigilance protocol for dermatologists and physicians in our country. Results: In our study. DHR accounted for 0.3-0.5 % of all outpatient consultations, and 5,2-17,2% of interconsultations in dermatology. The most frequent patterns were urticarial, morbilliform and fixed drug reaction. The drugs most frequently involved were analgesics/anti-inflammatory drugs with action in the central nervous system, antibiotics and antihypertensives. Discussion: It is important to have a Pharmacovigilance Protocol since it will allow to obtain nationwide data. The short-term challenge for the SOCHIDERM pharmacovigilance is to notify serious or life-threatening mucocutaneous DHR that have been seen by dermatologists in our country, through this Protocol.

Mastocitosis en edad pediátrica / Mastocytosis in children

Las mastocitosis incluyen un amplio espectro de patologías que tienen en común la infiltración anormal de mastocitos en diversos órganos, siendo la piel el más frecuentemente comprometido. Se reconocen dos variantes principales de la enfermedad: la mastocitosis cutánea (MC), que sólo compromete la piel, y la mastocítosis sistémica (M S), donde hay compromiso de órganos extracutáneos. La sintomatología de ambas variantes es causada por la infiltración celular y daño directo sobre los tejidos, así como por la liberación de mediadores químicos a la circulación sistémica, lo que hace que su presentación clínica sea altamente variable. Las mastocitosis en niños se presentan generalmente como MC, son de buen pronóstico y evolucionan con remisión de las lesiones en la mayoría de los casos. Las MS son muy poco frecuentes en este grupo etario; sin embargo, su curso crónico y la agresividad que pueden adquirir ponen en relieve la importancia de considerarlas en el diagnóstico diferencial de estos cuadros. En la actualidad no existe tratamiento curativo para las mastocitosis y el manejo es fundamentalmente sintomático.

Mastocytosis is a heterogeneous group of diseases characterized by the abnormal infiltration of mast cells (MCs) in one or more organ systems, being the skin the most common organ affected. Two main variants of the disease are recognized: cutaneous mastocytosis (CM), if abnormal infiltrates are confined to the skin, and systemic mastocytosis (SM) , if extra-cutaneous tissues are involved. Symptoms are extremely variable and result from MC-derived mediators and from destructive infiltration of MCs. The typical presentation of pediatric-onset mastocytosis consists of cutaneous manifestations, and usually regresses spontaneously. SM is a chronic disease with variable clinical course ranging from asymptomatic to highly aggressive and rapidly devastating. SM is rare in children but should be considered in the differential diagnosis. No curative treatment has been yet reported for mastocytosis and only symptomatic therapy is available.

Psoriasis ungueal: experiencia con el tratamiento combinado de clobetasol al 8 por ciento en laca ungueal y calcipotriol / Combined clobetasol and calcipotriol treatment for nail psoriasis

La psoriasis ungueal es un problema común en los pacientes psoriáticos, con una incidencia de vida de 90%. A pesar de su alta incidencia y del gran impacto que produce en la calidad de vida, ha sido poco estudiada y el tratamiento óptimo aún no está bien dilucidado. Los corticoides tópicos y los análogos de la vitamina D son las terapias más usadas, pero no existe un esquema estándar para su uso. La combinación de estos agentes se ha estudiado en los últimos años para pacientes con afectación de la matriz y del lecho ungueal, mostrando muy buenos resultados. El caso que presentamos demuestra la sinergia entre estos agentes.

Nail psoriasis is a common problem among psoriatic patients, with a lifetime incidence of 90%. Despite its high incidence and severe impact on the quality of life, it has not been fully studied and the optimal treatment is still unclear. Topical glucocorticosteroids and vitamin D analogues are the most used therapies, but there is no standard therapeutic regimen for their use. The combination of both of these agents has been studied during the last years for the treatment of patients with matrix and bed nail compromise, showing very good results. The case that we present shows the synergy between these agents.