Gangrena de Fournier secundaria a cuerpo extraño: Reporte de caso / Fournier's gangrene secondary to a foreign body: Case report

Introducción. La gangrena de Fournier es un proceso infeccioso progresivo que compromete piel, tejido celular subcutáneo, grasa y fascia subyacente, con una incidencia de 1,6 pacientes por cada 100.000 personas/año. Se considera una urgencia quirúrgica, que requiere de manejo oportuno, ya que puede llegar a ser fatal, con una tasa de mortalidad del 20 al 35 %, que es más alta en hombres, en la tercera década de la vida y en pacientes inmunocomprometidos. Caso clínico. Se presenta el caso clínico de un paciente masculino de 44 años de edad, quien cursó con gangrena de Fournier secundaria a una espina de pescado de 5 cm de largo, incrustada en la unión anorrectal. Resultados. El paciente fue manejado por urología y cirugía general, requirió hospitalización en la Unidad de Cuidados Intensivos y curaciones por parte de terapia enterostomal, con resultados satisfactorios. Conclusiones. Sus posibles causas son múltiples y en ocasiones puede ser desencadenada por un factor externo, como un cuerpo extraño. Uno de los factores predisponentes es la obesidad. El diagnóstico oportuno y un tratamiento con intervención multidisciplinaria mejoran la sobrevida y la calidad de vida de los pacientes.

Introduction. Fournier's gangrene is a progressive infectious process that involves skin, subcutaneous tissue, fat and underlying fascia, with an incidence of 1.6 per 100,000 people/year. It is considered a surgical emergency, which requires timely management since it can be fatal, with a mortality rate of 20 to 35%, which is higher in men, in the third decade of life and in immunocompromised patients. Clinical case. Clinical case. A 44-year-old male patient is presented with Fournier's gangrene secondary to a 5 cm long fishbone embedded in the anorectal junction. Results. The patient was managed by urology and general surgery, requiring hospitalization in the ICU and treated by enterostomal therapy with satisfactory results. Conclusions. Its possible causes are multiple and sometimes it can be triggered by an external factor, such as a foreign body. One of the predisposing factors is obesity. Timely diagnosis and treatment with multidisciplinary intervention improve survival and quality of life of patients

Does electrophysical agents work for cellulite treatment? a systematic review of clinical trials.

Cellulite, a perceived alteration in skin topography, is predominantly found in adipose tissue-rich body regions such as the hips, buttocks, thighs, and abdomen. Contrary to common belief, the etiology and pathophysiology of cellulite are not well-established or universally agreed upon. This lack of understanding about the actual etiology of cellulite directly influences the selection of suitable treatments that can address both the aesthetic and inflammatory aspects of the condition. Various treatment methods, including electrophysical agents like electric currents, radiofrequency, ultrasound, and photobiomodulation, have been tested. However, the questionable methodological quality of many studies complicates the determination of effective treatments for cellulite. In this study, we conducted a systematic review of clinical studies that utilized electrophysical agents in cellulite treatment. METHODS: We employed the PICO (population, intervention, control, and outcome) process to develop our search strategy and establish inclusion/exclusion criteria. We searched five databases: Medline, Central, Scopus, Lilacs, and PEDro, for studies conducted between 2001 and July 2021 that involved cellulite treatment with electrophysical agents. To ensure systematicity and guide study selection, we adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. RESULTS: Our initial search yielded 556 articles: 379 from Medline, 159 from Central, and 18 from Lilacs. After applying our inclusion criteria, only 32 studies remained. Of these, only two (6.2%) were evaluated as having strong and good methodology via the QualSyst tool. CONCLUSIONS: Our findings indicate that the quality of evidence from clinical studies on the use of electrophysical agents for cellulite treatment remains subpar. Further studies with robust experimental designs and more precise assessment techniques are necessary. While our study does not refute the effectiveness of the techniques used for cellulite treatment, it underscores the need for additional well-designed trials.

Safety and Efficacy Study of the Application of Redensified Cross-Linked Hyaluronic Acid for Filling Gluteal Volume and Cellulite Depressions.

PURPOSE: To test the efficacy and safety of cross-linked hyaluronic acid application for filling buttocks and cellulite depressions and its permanence over time. METHODS: For a period of a year, 25 patients were applied redensified cross-linked hyaluronic acid in the gluteal area. These patients were all 23-45-year-old women with little fat to be removed. The product used is composed of hyaluronic acid with high cross-linking and redensification which allows it to maintain shape and durability over time. All patients underwent tumescent anesthesia with neuroleptic sedation in the operating room. The procedure was regarded as minimal (container, sterile gloves, and surgical field). The amount applied for gluteal augmentation varied from 50 to 100 ml per application area and according to the patient's needs. For the filling of cellulite depressions, the application was up to 3 cc per depression and up to a total of 40 ml. The maximum volume used per patient in the buttocks did not exceed 200 ml, and it did not exceed 40 ml in cellulite depressions. RESULTS: A group of patients was treated in the upper and middle third of the buttocks in superficial and deep subcutaneous layers and in cellulite depressions. Very good results have been obtained without any major complications. CONCLUSIONS: The use of redensified cross-linked hyaluronic acid of non-animal origin is therefore an option for gluteal augmentation and cellulite depressions. Although the product degrades over time, after 12 months, 44% of treated patients rated their results as highly or very much improved, 36% as improved, 16% rated the improvement as poor, and one patient (4%) was dissatisfied. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Analgesic electrical currents associated with carboxytherapy in women with cellulite: A randomized controlled trial.

BACKGROUND: Pain is considered the main limiting factor in carboxytherapy. Electroanalgesia has gained recognition in the field of dermatology and to date, only transcutaneous electrical nerve stimulation (TENS) has proved to be effective at reducing pain associated with carboxytherapy; however, the effect of medium frequency currents has yet to be investigated. AIMS: Compare the effects of TENS, interferential current (IFC), and Aussie current on pain intensity associated with carboxytherapy and sensory comfort in the treatment of cellulite. PATIENTS/METHODS: Seventy-five women aged 18-49 years with moderate and/or severe gluteal cellulite were randomized into three groups: TENS (n = 25), IFC (n = 25), and Aussie current (n = 25), which underwent three sessions of carboxytherapy associated with an electrical current. Current amplitude was adjusted after each puncture, according to the maximum tolerance reported by participants, below the motor threshold. Pain intensity was measured using a numeric rating scale (0-10) and sensory comfort with the visual analogue scale (0-10). RESULTS: There was no significant intergroup difference in pain intensity (p > 0.05) and sensory comfort (p = 0.502) during the application of carboxytherapy throughout the three treatment sessions. CONCLUSION: TENS, IFC, and Aussie currents showed no difference in pain intensity reduction and no current was found to be more comfortable.

Development of SEDDS formulation containing caffeine for dermal delivery.

OBJECTIVE: The objective of this work was to develop a self-emulsifying drug delivery system (SEDDS) containing caffeine for the treatment of cellulite. METHODS: SEDDS were prepared using the solution method. 0.5% (w/v) caffeine was added to the previously selected excipients. The system was characterized by droplet size, zeta potential, emulsification time and long-term stability. In vitro release and skin permeation were investigated using Franz-type diffusion cells. The cytotoxicity was evaluated on normal human keratinocytes. RESULTS: Caffeine SEDDS were thermodynamically stable, with a zeta potential less than - 22 mV and droplet size around 30 nm, and were long-term stable. The permeation study showed that the formulation promoted caffeine accumulation in the skin layers, suggesting an increase in local circulation. Cytotoxicity studies on HaCaT cells were not conclusive as the surfactant used indicated false-positive results due to its high molar mass. CONCLUSION: It was possible to obtain a stable SEDDS that could cause an increase in blood flow in the applied area, resulting in cellulite reduction.

OBJECTIF: L'objectif de ce travail était de développer un système d'administration de médicaments auto-émulsifiants (SEDDS) contenant de la caféine pour le traitement de la cellulite. MÉTHODES: Les SEDDS ont été préparés par la méthode en solution. 0,5 % (p/v) de caféine a été ajouté aux excipients préalablement sélectionnés. Le système a été caractérisé par la taille des gouttelettes, le potentiel zêta, le temps d'émulsification et la stabilité à long terme. La libération in vitro et la perméation cutanée ont été étudiées dans des cellules de diffusion de type Franz. La cytotoxicité était évaluée sur des kératinocytes humains normaux. RÉSULTATS: Les SEDDS de caféine étaient thermodynamiquement stables, avec un potentiel Zeta inférieur à -22 mV et une taille de gouttelettes d'environ 30 nm, et stables à long terme. L'étude de perméation a montré que les formulations favorisent l'accumulation de caféine dans les couches de la peau, suggérant une augmentation de la circulation locale. Les études de cytotoxicité sur les cellules HaCaT n'ont pas été concluantes car le surfactant utilisé indique des résultats faussement positifs dus à une masse molaire élevée. CONCLUSION: Il a été possible d'obtenir un SEDDS stable qui peut provoquer une augmentation du flux sanguin dans la zone appliquée, entraînant une réduction de la cellulite.

Infrared thermography as valuable tool for gynoid lipodystrophy (cellulite) diagnosis.

Cellulite is a morphological alteration of the tegument tissue, directly interfering in self-esteem with etiology and pathophysiology far from being a consensus. Although the visual diagnosis of cellulitis is well known, it does not represent the real pathological condition of the subcutaneous tissue. The aim of the study was to investigate the hypothesis that the more heterogeneous tissue pattern analyzed by infrared thermography, the more severe is the cellulite grade. Forty female participants were selected and 60 thighs were analyzed by clinical anamnesis and infrared thermography. Classical visual analysis was correlated to the tissue heterogeneity measured by thermography. R Spearman's correlation between visual evaluation and thermography was 0.92. Phototype presented a negative significant correlation of 0.67 with classical visual analysis. In the present study, we presented a simple method based on infrared thermography that can be adopted in any esthetics office with a correlation of 0.92 with the visual classic evaluation, but, besides, may be very helpful to the clinician to decide which treatment will be adopted, i.e., an aggressive and inflammatory approach such as the radiofrequency of shockwave therapy or an anti-inflammatory approach such as photobiomodulation, depending on the inflammatory status of cellulite.

Vibration anesthesia during carboxytherapy for cellulite: a study protocol.

Background: To date, there has been no investigation addressing the effects of vibration anesthesia during carboxytherapy. Aim: Investigate the analgesic effect of different vibratory devices during carboxytherapy for the treatment of cellulite. Materials & methods: A total of 78 women between 18 and 49 years of age with cellulite in the gluteal region will be randomly allocated to three groups: Group A (carboxytherapy and vibratory device A), Group B (carboxytherapy and vibratory device B) and control group. Pain intensity will be assessed using a numerical rating scale after each puncture. Expected outcome: Vibration anesthesia is expected to be effective at diminishing the pain intensity caused by carboxytherapy comparison with the control group, with no differences between the vibratory devices. Trial registry: Brazilian Registry of Clinical Trials: ReBEC (RBR-8jcqy7c).

Vibrating anesthesia involves applying vibrations to the skin to reduce discomfort and pain during injections. So far, we do not know much about the therapeutic action of vibrating anesthesia on pain associated with carboxytherapy, a cosmetic treatment that involves injecting carbon dioxide into the fatty layer just beneath the surface of the skin. This article describes a plan to investigate the effect of vibration devices on pain reduction during the application of carboxytherapy in the treatment of cellulite. A total of 78 women between 18 and 49 years old with cellulite in the gluteal region (around the buttocks) will participate in the study and will be divided into three study groups; two groups will receive carboxytherapy with two different vibrating devices, and the third group will receive carboxytherapy without vibrational anesthesia. Pain intensity will be assessed by asking participants to rate their pain using a numerical rating scale after each puncture of carboxytherapy. Vibrational anesthesia is expected to decrease pain caused by carboxytherapy compared with the control group, and it is expected that there will be no differences in pain intensity relief between the two vibrating devices.

Considerations on zero-degree cellulite.

Cellulite affects almost all women, and it is characterized by surface relief alterations, mainly located on the thighs and buttocks, and other areas. Whereas depressed lesions occur due to the presence of thick subcutaneous fibrous septa that pull the skin surface down, raised areas result from the projection of underlying fat to the skin surface. We support that the absence of cellulite can be defined as the ideal balance between the mechanical forces that act between the subcutaneous structures, such as fat and fibrous septa and muscles, and the overlying skin.

Enfermedad invasiva por Streptococcus pyogenes con celulitis de manos bilateral: A propósito de un caso / Invasive Streptococcus pyogenes disease with bilateral cellulitis of the hands: A case report

El Streptococcus pyogenes o estreptococo B hemolítico Grupo A (EßHGA) suele ser una causa poco habitual de enfermedad invasiva en pediatría, la cual ha presentado un aumento en su incidencia en los últimos años. Se define como cualquier infección asociada al aislamiento de dicha bacteria de un sitio normalmente estéril y cuya presentación más frecuente es la bacteriemia. Los pacientes con EßHGA habitualmente se presentan con un sindrome febril asociado a manifestaciones clínicas relacionadas con el sitio primario de infección. Se presenta el caso de una paciente de 10 años, sin comorbilidades, que desarrolló enfermedad invasiva por EßHGA con bacteriemia e impacto secundario de piel y partes blandas resultando en una celulitis de manos bilateral

Streptococcus pyogenes or Group A Streptococcus (GAS) is an infrequent cause of invasive disease in pediatrics. Its incidence has increased in the last few years. It is defined as any infection associated with the isolation of GAS in a normally sterile site and its most frequent presentation is bacteremia. Patients with GAS bacteremia usually present with a febrile syndrome associated with clinical manifestations related to the primary site of infection. We present the case of a previously healthy, 10-year-old patient, who developed an invasive disease due to GAS with bacteremia and secondary impact of skin and soft tissues that developed in bilateral cellulitis of the hands

Co-relationship between Escherichia coli in broiler cellulitis and liver lesions / Correlação entre a presença de Escherichia coli em lesões de celulite e fígados de frango

Pathogenic strains of Escherichia coli may invade the subcutaneous tissue of poultry and cause cellulitis, whilst the pathogen may also cause lesions in internal organs such as the liver. Current paper co-relates Escherichia coli and virulence genes characteristic of Avian Pathogenic Escherichia coli (APEC) in broilers´ cellulitis and liver lesions. One hundred carcasses were retrieved from the production chain in an avian abattoir in the state of Bahia, Brazil, between August 2013 and January 2014, due to detection of cellulitis lesions. Cellulitis and liver samples were retrieved aseptically to quantify E. coli by Petrifilm count fast method (3M Company) (AOAC 998.8). Virulent genes iss and iutA were removed from E. coli isolates by Polymerase Chain Reaction (PCR). Escherichia coli was isolated from 82.0% of broilers removed from the production chain and the bacterium was concomitantly detected in cellulitis and liver lesions in 40.0% of broilers. E. coli counts ranged between 1.00 and 4.73 log CFU/g in liver lesions and between 2.00 and 9.00 log UFC/g in cellulitis lesions. Virulent genes iutA and iss were detected in 97.56% and 89.02% of E. coli isolates, respectively. Genotype analysis demonstrated the concomitant amplification of genes iutA and iss in 60.0% (n=40) of samples of cellulitis and liver lesions in which the simultaneous isolation of E. coli occurred. There was a positive and significant co-relationship (r=0.22; p 0.05) between the variables occurrence of E. coli isolated from liver samples and the occurrence of E. coli isolated from cellulitis lesions. There were also positive and significant co-relationships between populations of E. coli from liver isolates and cellulitis lesions (r=0.46; p 0.05) when E. coli isolated in the liver and in cellulitis lesions was detected. Since results showed a relationship between E. coli in cellulitis and liver lesions and possible systemic infection, the occurrence of cellulitis lesions as a criterion for total discarding of carcass may be suggested.(AU)

Cepas patogênicas de Escherichia coli podem invadir o tecido subcutâneo das aves e provocar celulite aviária e este patógeno pode provocar lesões nos órgãos internos, como o fígado. Desta forma, objetivou-se correlacionar a presença de Escherichia coli e os genes de virulência característicos de Escherichia coli Patogênica para Aves (APEC) nas lesões de celulite e nos fígados dos frangos. Entre agosto de 2013 a janeiro de 2014, foram retiradas 100 carcaças da linha de produção por apresentarem lesões de celulite em um matadouro avícola da Bahia (Brasil). Foram coletadas amostras de celulite e fígados de frango assepticamente para quantificação de E. coli pelo método rápido de contagem Petrifilm (3M Company) (AOAC 998.8). Em seguida foi realizada a pesquisa dos genes de virulência iss e iutA nos isolados de E. coli utilizando a Reação em Cadeia da Polimerase (PCR). Escherichia coli foi isolada em 82,00% das aves retiradas da linha de produção e a bactéria foi detectada concomitantemente nas lesões de celulite e fígado em 40,00% das aves. As contagens de E. coli variaram de 1,00 a 4,73 log UFC/g nos fígados e de 2,00 a 9,00 log UFC/g nas lesões de celulite. Os genes de virulência iutA e iss foram encontrados em 97,56% e 89,02% dos isolados de E. coli, respectivamente. A análise genotípica revelou a amplificação concomitante dos genes iutA e iss em 60,00% (n=40) das amostras de lesões de celulite e fígado nas quais houve o isolamento simultâneo de E. coli. Foi observada correlação positiva e significativa (r=0,22; p 0,05) entre as variáveis ocorrência de E. coli isolada das amostras dos fígados e ocorrência E. coli isolada das lesões de celulite e, nos casos em que foi detectada a ocorrência de E. coli isolada em fígado e lesões de celulite, correlações positivas e significativas também foram evidenciadas entre as populações de E. coli dos isolados dos fígados e das lesões de celulite, (r=0,46; p 0,05). Assim ficou evidenciada a relação entre E. coli presente nas lesões de celulite e no fígado e uma possível infecção sistêmica, desta forma, sugere-se que a presença de lesões de celulite seja utilizada como critério para o descarte total da carcaça.(AU)

Celulitis disecante del cuero cabelludo a propósito de un caso clínico / Dissecting cellulitis of the scalp a clinical case report

Celulitis disecante del cuero cabelludo (CDC) es una enfermedad inflamatoria crónica neutrofilica, clasificada dentro las alopecias cicatriciales, su etiopatogenia es desconocida, se manifiesta por nódulos en el cuero cabelludo de predominio en región occipital y vértice, si es muy extensa puede confluir y formar fistulas, predomina en descendientes afroamericanos, es de difícil tratamiento.

Dissecting cellulitis of the scalp (DCS) is a chronic inflammatory primary neutrophilic scarring alopecia, and its etiopathogenesis is yet only partly understood. DCS manifests with inflammatory nodules on the occipital scalp or vertex that may evolve to extensive confluent boggy plaques with sinus tract formation¹. predominantly affects young Afro-descendent men.Therapeutic management of DCS is often challenging1,6.

Síndrome larva migrans cutánea en pediatría / Cutaneous Larva Migrans Syndrome in Pediatrics

La dermatosis denominada larva migrans cutánea: (LMC) es una infección cutánea secundaria a infestación parasitaria por la migración de larvas de anquilostomas animales a la epidermis humana, frecuentemente por contacto directo con suelos contaminados, especialmente en zonas tropicales. Se caracteriza por la aparición de lesiones induradas, eritematosas con patrón irregular o serpiginoso acompañado de prurito. Describimos un caso de LMC en una niña, adquirido durante unas vacaciones en Colombia y tratado inicialmente como celulitis con antibióticos (AU)

Cutaneous larva migrans (CLM) is an infection secondary to parasitic infestation due to the migration of animal hookworm larvae into the human skin, frequently by direct contact with contaminated grounds, especially in the tropics. Clinically, it is characterized by the appearance of indurated, erythematous lesions with irregular or "creeping eruption" pattern and pruritus. This article describes a case of CLM infection in a pediatric patient, it was acquired during the holidays in Colombia, diagnosed as cellulitis and treated accordingly with antibiotics without success (AU)

Celulite juvenil canina relato de caso / Canine juvenile cellulite - case report

A celulite canina juvenil é uma afecção rara, que acomete, em sua maioria, filhotes entre três semanas e seis meses de idade, cuja patogênese não está completamente elucidada; entretanto, pressupõe-se estar relacionada à falha imunológica e a reações à vacina polivalente, podendo ocorrer predisposição racial. Como manifestações clínicas, o cão apresenta pápulas, pústulas, alopecia, edema, eritema, crostas e cicatrizes, especialmente em pálpebras, lábios e focinhos, sendo também acometido o pavilhão auricular. Além dessas alterações dermatológicas, nota-se linfoadenomegalia regional. O diagnóstico se baseia em exclusão de dermatopatias que mimetizam o quadro clínico, e o tratamento precisa ser realizado de forma precoce e adequada, normalmente se utilizando doses altas de glicocorticoides. Quando iniciada a terapia precoce, o prognóstico é bom, embora as cicatrizes possam ser permanentes. No presente estudo, foi relatado um caso de filhote fêma mestiça de poodle, que começou a apresentar sinais de otite purulenta, lesões edemaciadas, crostosas e supurativas em região periocular, perilabial, mentoniana, pápulas e pústula em pavilhão auricular, linfoadenomegalia de linfonodos submandibulares e poplíteos, sendo que os sintomas começaram após aplicação da vacina polivalente canina. Foi iniciado tratamento à base de glicocorticoide e, devido à resposta rápida à terapia, foi iniciado desmame da medicação, quando a paciente teve quadro de recidiva, que se resolveu após reajustes terapêuticos.(AU)

Canine juvenile cellulitis is a rare condition that affects, in its majority, puppies between three weeks and six months of age, whose pathogenesis has not been completely elucidated; however, it is assumed to be related to immunological failure and reactions to the polyvalent vaccine, which may lead to racial predisposition. As clinical manifestations, the dog presents papules, pustules, alopecia, edema, erythema, crusts and scars, especially on the eyelids, lips and snouts, and the ear pinna is also affected. In addition to these dermatological changes, regional lymphadenomegaly is noted. Diagnosis is based on the exclusion of dermatopathies that mimic the clinical picture, and treatment needs to be carried out early and properly, usually using high doses of glucocorticoids. When therapy is started early, the prognosis is good, although scarring may be permanent. In the present study, a case of a crossbred female poodle pup was reported, which began to show signs of purulent otitis, swollen, crusty and suppurative lesions in the periocular, perilabial, mental region, papules and pustules in the pinna, lymphadenomegaly of submandibular lymph nodes and poplites, and the symptoms started after application of the polyvalent canine vaccine. Glucocorticoid-based treatment was started and, due to the rapid response to therapy, weaning from the medication was started, when the patient had a relapse, which resolved after therapeutic adjustments(AU)

Celulite juvenil canina – relato de caso / Canine juvenile cellulite - case report

A celulite canina juvenil é uma afecção rara, que acomete, em sua maioria, filhotes entre três semanas e seis meses de idade, cuja patogênese não está completamente elucidada; entretanto, pressupõe-se estar relacionada à falha imunológica e a reações à vacina polivalente, podendo ocorrer predisposição racial. Como manifestações clínicas, o cão apresenta pápulas, pústulas, alopecia, edema, eritema, crostas e cicatrizes, especialmente em pálpebras, lábios e focinhos, sendo também acometido o pavilhão auricular. Além dessas alterações dermatológicas, nota-se linfoadenomegalia regional. O diagnóstico se baseia em exclusão de dermatopatias que mimetizam o quadro clínico, e o tratamento precisa ser realizado de forma precoce e adequada, normalmente se utilizando doses altas de glicocorticoides. Quando iniciada a terapia precoce, o prognóstico é bom, embora as cicatrizes possam ser permanentes. No presente estudo, foi relatado um caso de filhote fêma mestiça de poodle, que começou a apresentar sinais de otite purulenta, lesões edemaciadas, crostosas e supurativas em região periocular, perilabial, mentoniana, pápulas e pústula em pavilhão auricular, linfoadenomegalia de linfonodos submandibulares e poplíteos, sendo que os sintomas começaram após aplicação da vacina polivalente canina. Foi iniciado tratamento à base de glicocorticoide e, devido à resposta rápida à terapia, foi iniciado desmame da medicação, quando a paciente teve quadro de recidiva, que se resolveu após reajustes terapêuticos.

Canine juvenile cellulitis is a rare condition that affects, in its majority, puppies between three weeks and six months of age, whose pathogenesis has not been completely elucidated; however, it is assumed to be related to immunological failure and reactions to the polyvalent vaccine, which may lead to racial predisposition. As clinical manifestations, the dog presents papules, pustules, alopecia, edema, erythema, crusts and scars, especially on the eyelids, lips and snouts, and the ear pinna is also affected. In addition to these dermatological changes, regional lymphadenomegaly is noted. Diagnosis is based on the exclusion of dermatopathies that mimic the clinical picture, and treatment needs to be carried out early and properly, usually using high doses of glucocorticoids. When therapy is started early, the prognosis is good, although scarring may be permanent. In the present study, a case of a crossbred female poodle pup was reported, which began to show signs of purulent otitis, swollen, crusty and suppurative lesions in the periocular, perilabial, mental region, papules and pustules in the pinna, lymphadenomegaly of submandibular lymph nodes and poplites, and the symptoms started after application of the polyvalent canine vaccine. Glucocorticoid-based treatment was started and, due to the rapid response to therapy, weaning from the medication was started, when the patient had a relapse, which resolved after therapeutic adjustments

Infecciones graves de huesos, articulaciones y tejidos blandos adquiridas en la comunidad / Severe community-acquired bone, joint, and soft tissue infections

Introducción: Las infecciones de huesos, articulaciones y partes blandas, no solo han tenido una incidencia creciente en los últimos años en el Hospital Pediátrico Universitario Paquito González Cueto de Cienfuegos, sino también una evolución más grave. Objetivo: Describir aspectos clínicos y epidemiológicos de las infecciones graves de tejidos blandos, huesos y articulaciones. Métodos: Se revisó la base de datos computadorizada del Departamento de Estadística del Hospital Pediátrico Paquito González, para identificar todos los egresos de la Unidad de Cuidados Intensivos Pediátricos, con diagnóstico de celulitis o absceso de tejidos blandos, fascitis, miositis, osteomielitis, sepsis severa y shock séptico, en el periodo de enero de 2009 a diciembre de 2019. Se estudiaron las siguientes variables: localización de la infección de piel y tejidos blandos, grupo de edad, año del egreso y sitio de origen de la sepsis. Resultados: No hubo diferencias en la incidencia entre los grupos de edad. La celulitis de los miembros fue la forma clínica más frecuente. Se encontró una incidencia creciente de las infecciones de tejidos blandos. Las infecciones de huesos y articulaciones, representaron el segundo sitio de origen más frecuente de sepsis grave y el shock séptico. Conclusiones: Ha habido un aumento de las infecciones de piel y tejidos blandos que requieren ingreso en la unidad de cuidados intensivos del citado hospital en los últimos 11 años. Estas infecciones de conjunto con las infecciones de huesos y articulaciones, constituyen un problema de salud puesto que provocan sepsis grave y shock séptico con una incidencia significativa(AU)

Introduction: Infections of bones, joints and soft parts have not only had an increasing incidence in recent years at ¨Paquito González Cueto¨ University Pediatric Hospital in Cienfuegos, but also a more serious evolution. Objective: Describe clinical and epidemiological aspects of severe soft tissues, bones and joints infections. Methods: The computerized database of the Department of Statistics of ¨Paquito González¨ Pediatric Hospital was reviewed to identify all discharges from the Pediatric Intensive Care Unit with a diagnosis of cellulite or soft tissue abscess, fasciitis, myositis, osteomyelitis, severe sepsis and septic shock, in the period from January 2009 to December 2019. The following variables were studied: location of skin and soft tissue infection, age group, year of discharge, and sepsis origin location. Results: There were no differences in the incidence between age groups. Limb cellulite was the most common clinical form. An increasing incidence of soft tissue infections was found. Bone and joint infections represented the second most frequent origin location of severe sepsis and septic shock. Conclusions: There has been an increase in skin and soft tissue infections that require admission to the intensive care unit of the aforementioned hospital in the last 11 years. These infections, together with bone and joint infections, constitute a health problem since they cause severe sepsis and septic shock with a significant incidence(AU)

Celulite em frangos de corte por Escherichia coli revisão / Cellulitis in broilers caused by Escherichia coli review / Celulitis en pollos de engorde causada por Escherichia coli revision

A avicultura brasileira alcançou, nos últimos anos, níveis de produtividade e de ajuste na sua organização que a colocam como uma das mais competitivas do mundo. O resultado é um produto com qualidade, sanidade e sustentabilidade, que, aliado a preços competitivos, levou o frango brasileiro a estar presente em mais de 150 países. O objetivo deste trabalho é proceder a uma revisão sobre a celulite aviária associada à ocorrência de Escherichia coli, destacando-se a etiopatogenia, o diagnóstico e a prevenção. Devido à fina espessura da pele dos frangos, vários fatores como deficiência nutricional, substâncias irritantes, toxinas, infecções e problemas de manejo podem, potencialmente, levar a lesões cutâneas. A Escherichia coli é uma bactéria do grupo coliforme que fermenta a lactose e o manitol, com produção de ácido e gás a 44,5 ± 0,2oC em 24 horas, produz indol a partir do triptofano, oxidase negativa, não hidrolisa a uréia e apresenta atividade das enzimas ß galactosidase e ß glucoronidase, sendo considerada o indicador mais específico de contaminação fecal recente e de eventual presença de organismos patogênicos. Portanto, a celulite, tendo a E. coli como agente causador, pode ser considerada como uma das mais importantes causas de condenação da carne de frango, gerando interesses em termos econômicos por conta das perdas financeiras impostas aos produtores. Além das perdas econômicas, há os riscos relativos à saúde pública, tornando-se necessária a reavaliação dos critérios de condenação em casos de celulite aviária determinados na legislação.(AU)

The Brazilian poultry industry has reached, in recent years, levels of productivity and adjustment in its organization that place it as one of the most competitive in the world. The result is a product with quality, health, sustainability, which, combined with competitive prices, has led Brazilian chicken to be present in more than 150 countries. The aim of this work was to review avian cellulite associated with the occurrence of Escherichia coli, highlighting its etiopathogenesis, diagnosis and prevention. Due to the thin skin of chickens, several factors such as nutritional deficiency, irritants, toxins, infections and handling problems can potentially lead to skin lesions. Escherichia coli is a coliform group bacteria that ferment lactose and mannitol, producing acid and gas at 44.5 ± 0.2oC in 24 hours, producing indole from tryptophan, negative oxidase, do not hydrolyze urea and have activity enzymes ß galactosidase and ß glucoronidase, being considered the most specific indicator of recent fecal contamination and the possible presence of pathogenic organisms. Therefore, cellulite with E. coli as the causative agent can be considered as one of the most important causes of condemnation of chicken meat, generating interests in economic terms due to the financial losses imposed on producers. In addition to economic losses, there are risks related to public health, making it necessary to reassess the condemnation criteria in cases of avian cellulite determined by law.(AU)

La avicultura brasileña ha alcanzado, en los últimos años, niveles de productividad y ajuste en su organización que la ubican como una de las más competitivas del mundo. El resultado es un producto con calidad, salud y sostenibilidad que, combinado con precios competitivos, ha llevado a la gallina brasileña a estar presente en más de 150 países. El objetivo de este trabajo fue revisar la celulitis aviar asociada con la aparición de Escherichia coli, destacando su etiopatogenia, diagnóstico y prevención. Debido al grosor delgado de la piel del pollo, varios factores como la deficiencia nutricional, irritantes, toxinas, infecciones y problemas de manejo pueden conducir a lesiones en la piel. Escherichia colies una bacteria del grupo coliforme que fermenta la lactosa y el manitol, con producción de ácido y gas a 44.5 ± 0.2oC en 24 horas, produce indol a partir de triptófano, oxidasa negativa, no hidroliza la urea y tiene actividad enzimas ß galactosidasa y ß glucoronidasa, considerándose el indicador más específico de contaminación fecal reciente y la posible presencia de organismos patógenos. Por lo tanto, la celulitis con E. colicomo agente causal puede considerarse como una de las causas más importantes de condena de la carne de pollo, generando intereses en términos económicos debido a las pérdidas financieras impuestas a los productores. Además de las pérdidas económicas, existen riesgos relacionados con la salud pública, por lo que es necesario reevaluar los criterios de condena en casos de celulitis aviar determinados por la ley.(AU)

Electroanalgesia during a carboxytherapy procedure for cellulite: a study protocol for a randomized controlled trial.

The aim of the present study is to describe a study protocol to compare different types of analgesic electrical currents on pain intensity and sensory comfort during the application of carboxytherapy for the treatment of cellulite. Seventy five women with the presence of moderate and/or severe gluteal cellulite will be randomly allocated into three groups: carboxytherapy plus transcutaneous electrical nerve stimulation, carboxytherapy plus interferential current or carboxytherapy plus Aussie current. Pain intensity, which is the primary outcome, will be measured by a numeric rating scale (0-10). The secondary outcome is sensory comfort, which will be measured using the visual analogue scale (0-10). Trial registration: Brazilian Clinical Trials Registry: ReBEC (RBR-6z82zb) www.ensaiosclinicos.gov.br/rg/RBR-6z82zb/.