Dermatological adverse reactions after vaccination with BNT162b2 in a cohort of healthcare workers.

BACKGROUND: The description of the skin reactions produced by the different vaccines against SARS-CoV-2 has focused on the symptoms reported by the general population. There are few studies with very different measurement methods focused on healthcare workers. METHODS: A longitudinal observational study was conducted on all the healthcare workers from the Hospital Universitario San Cecilio that received vaccination against COVID-19 with BNT162b2. The recruitment period was from December 2020 to September 2021. The recommended regimen was double, with a minimum interval of 21 days between doses. All dermatological reactions reported as adverse effects of the vaccine were evaluated by the Staff of the Dermatology Unit of our center. RESULTS: A total of 3969 healthcare workers of our center were followed. Only 0.7% of them reported dermatological adverse reactions. The most frequently reported reactions were morbilliform rash and COVID arm. In the multivariate analysis, the vaccination regimen (one dose) and the history of COVID-19 infection remained the main factors associated with the report of dermatological adverse reactions. CONCLUSION: The rate of dermatological adverse reactions after vaccination with BNT162b2 (Pfizer-BioNTech) is extraordinarily low. No patient required hospitalization, which supports the safety of this vaccination in a population of healthcare workers.

[Severe congenital neutropenia]. / Neutropenia congénita grave.

Severe congenital neutropenia is a primary immunodeficiency; the lack of maturation of neutrophil precursor in bone marrow and severe neutropenia are the subjacent characteristics which explain a marked susceptibility to severe and recurrent infections; bacteria and fungi are the most common etiologic agents. We report the case of an infant with severe congenital neutropenia that began at 4 days from birth with perianal abscess infections, sepsis, liver abscess, gingivitis and oral ulcers; she required multiple hospitalizations because of the severity of the infections. Isolated agents were Pseudomonas aeruginosa, Staphylococcus hominis and Klebsiella sp. The bone marrow examination showed maturation arrest of myeloid forms, thus confirming the diagnosis of severe congenital neutropenia. Granulocyte colony-stimulating factor was started. The severe congenital neutropenia should be considered in patients with neutropenia and infections in the first month of life. Early diagnosis and treatment improve survival and quality of life of these patients.

Infectious pulmonary complications in patients treated with anti-TNF-alpha monoclonal antibodies and soluble TNF receptor.

Tumor necrosis factor (TNF)-alpha inhibitors (infliximab, adalimumab, and etanercept) used in immune-mediated inflammatory diseases such as rheumatoid arthritis, Crohn's disease, or psoriatic arthritis have the potential to increase the risk of infectious complications. Pulmonary infections are one of the most frequent complications associated with the use of TNF inhibitors. This article provides an overview of the distinct types of infectious pulmonary complications seen in patients using these anticytokine drugs.

Efectos de la alcalinización gástrica en pacientes críticos / Effects of gastric alkalization on bacterial colonization in critically ill patients

La alcalinización gástrica en los pacientes críticos se asocia con crecimiento bacteriano y micótico en el contenido gástrico. Nosotros estudiamos la incidencia de infecciones en 50 pacientes críticamente enfermos a los cuales se les realizó alcalinización gástrica para prevenir sangramiento por úlcera duodenal de stress. Todos los pacientes recibieron H2 receptor agonistas (Cimetidina o Ranitidina) y 15 pacientes recibieron Sucralfato. Todos los pacientes tuvieron colonización del contenido nasogástrico dentro de los 8 días de su ingreso en UCI y 11 pacientes tuvieron colonización por Cándida a los 15 días de ingreso. Fueron positivos 65 cultivos en contenido nasogástrico, 85 de secresiones respiratorias y 15 hemocultivo(AU)

Gastric alkalization of critically ill patients is associated with bacterial and fungal overgrowth in gastric contents. We studied the incidence of gastric colonization and its relation to the other infections and antibiotic therapy in 50 critically ill ICU patients. All patients received H2 receptor antagonist and 15 patients received Sucralfato. All patients had bacterial colonization of N G contents within 8 day. There were 65 N G isolates, 85 in tracheobronchial secretions and 15 in blood(AU)

Encefalitis por herpes simple (EHS) / EHS Simple herpes encephalitis

Se realizó un estudio descriptivo de un paciente al cual se le diagnosticó una encefalitis por herpes simple, con el objetivo de demostrar que aunque esta entidad en el adulto es poco frecuente tiene una morbilidad y mortalidad elevada por sus complicaciones a nivel del sistema nervioso central, destacando los siguientes datos: edad, sexo raza, procedencia, antecedentes patológicos personales (APP), signos y síntomas, tiempo de evolución así como el resultado de los complementarios. La electroencefalografía y el estudio del líquido cefalorraquideo fueron los elementos fundamentales en la detección de la enfermedad. La respuesta al aciclovir corroboró el diagnóstico clínico. El éxito de su evolución estuvo favorecido por el juicio médico preciso(AU)

A descriptive study was done to a patient to wnom a simple encephalitis herpes was diagnosis, with the objective of demonstrating that although this entity is not very frequent it has a high morbility and mortality due to its complications on the central nervous system. The following figures are taken in to account: age, sex, race, origin, personal pathological antecedents (APP), signs and symptoms, evolution time, and the result of the complementaries. The electroencefalography and the study of the liquid were fundamental tools in the disease detection of the illness. The answer to the aciclovir corroborated the clinical diagnosis. The success of its evolution was in favored by the precise doctorsopinions(AU)

Tórax Batiente: métodos de tratamiento: presentación de un caso / Flail Chest: methods of treatment: case presentation

A pesar de los avances alcanzados en el tratamiento intensivo del paciente quirúrgico, la introducción de nuevas alternativas terapéuticas y de la super especialización de los tratamientos la mortalidad continua siendo alta. Se realizó una revisión bibliográfica amplia del tema Tórax Batiente haciéndose énfasis en la necesidad de clasificarlo por grados para su adecuado manejo. Se concluyó que existen 4 grados bien definidos según gravedad del trauma y que cada uno de ellos requiere un manejo diferenciado; que el alivio del dolor con bloqueos neurolíticos y la fijación de la pared torácica son básicos y, finalmente, el apoyo ventilatorio garantiza la vida en los grados más avanzados(AU)

In spite of the reached advances in the intensive treatment of the surgical patient, the introduction of new therapeutic alternatives and treatment superspecialization, mortality continuous being high. A bibliographic revision about flail chest was made, putting emphasis in the necessity of classying it by degrees. It was concludes that there are four degrees. They have been well defined according to seriousness of the trauma. Each one requires a different management ; neurolitic blockade and the fixing of the thoracic wall are basically important. Finally the ventilating support guarantees life in the most advanced degrees(AU)

Rotura Esplénica Espontánea Asociada con Pancreatitis Aguda Severa: presentación de Caso / Spontaneous soleen ruptura associated to severe acute pancreatitis case presentation

Presentamos un caso de rotura esplénica espontánea sumamente raro que cursó con choque hipovolémico severo que puso en peligro la vida del paciente y que se presentó en el período de un cuadro de pancreatitis aguda grave. Hacemos la recomendación de tener en cuenta esta entidad en el diagnóstico diferencial y tratamiento de la pancreatitis aguda grave con síntomas y signos de choque(AU)

Spontaneous rupture of the spleen associated to acute Pancreatitis. A case of splenic rupture, an exceedingly unusual organic complication of acute Pancreatitis, is reported. This complication seriously threatered the patient's life and took place during the recovery period of acute Pancreatitis. It is recommended to consider splenic rupture in the differediagnosis of the complications of acute Pancreatitis with symptoms and signs of hipovolemic shock(AU)

Perforación del Colon Sigmoide por Embarazo Ectópico Roto / Perforation of sigmoid colon by broken ectopic pregnancy

Se presenta un caso de perforación de colon sigmoide por un embarazo ectópico roto. Los síntomas se iniciaron con fiebre, dolor abdominal y síntomas y signos de choque séptico. Junto a los datos clínicos se exponen los resultados de las exploraciones complementarias. El significado de las pruebas complementarias no fue claro del todo antes de la laparotomía exploradora. La salpingectomía parcial izquierda y la colostomía sigmoidea produjo la curación de la paciente. La calificación final del caso sería: Embarazo ectópico tubario roto hacia el colon sigmoide con supuración y perforación del mismo(AU)

One case of perforation of sigmoid colon by an apparently abdominal pregnancy is commented. The symptms appeared with fever, abdominal pain, and symptons and sing of septic shock. The results of complementary explorations are show here, together with clinical data. The significance of both these test and clinical data was not very clear before the examination of the surgical specimen. Left salpingectomy and colostomy cured the patient. Therefore the final diagnosis of the case would be ectopic pregnancy with suppuration and perforation the sigmoid colon(AU)

Infarto Miocárdico Biventricular: comportamiento en La Unidad de Cuidados Intensivos / Biventricular myocardial infarcton behaviour in the Intensive Care Unit

Se realizó un estudio observacional de tipo transversal a los pacientes con infractor agudo del miocardio (IAM) con extensión al ventrículo derecho (VD), ingresados en la Unidad de Cuidados Intensivos, en un período de dos años. Se pudo demostrar la asociación de IAM inferior con extensión al V D en 23 pacientes (38 por ciento). Los enfermos mayores de 50 años y del sexo masculino, fueron los más afectados. La Tríada de Cohn (hipotensión arterial, ingurgitación yugular y ausencia de humedad pulmonar) fue el trastorno hemodinámico más frecuente. El supradesnivel del segmento ST mayor de 1 mm en precordiales derechas (V 3 R y V 4 R ), constituyó el elemento electrocardiográfico más sugerente de diagnóstico. Ecocardiográficamente se encontró hipoquinesia y dilatación del V D en la totalidad de los casos. La disfunción del V D y la extrasistolia ventricular resultaron las complicaciones más frecuentes, que predominaron en los enfermos que no recibieron trombolisis. Como método de procesamiento estadístico, fue empleado el porcentual en todas las variables, el Chi cuadrado en los cuadros 1 y 6, y en los casos con frecuencias esperadas bajas (< 5) se empleó la técnica de Fisher Irving(AU)

A transversal and observatory study way to the patients with acute myocardial infarction (A M I), with extension to the right ventricular (R V) that were hospitalized in the intensive care united of our hospital, in a period of 2 years. It was demostrated the association of inferior A M I with extension to the R V in 23 patients (38 percent). The patients older than 50 years and of masculine sex were the most affected. The triad of Cohn (arterial hypotension, jugular dilatation and clear lungs) was the more frequently haemodynamic trouble. The ST segment elevation larger than 1mm in right precordial leads (V3R and V4R) was the electrocardiography element more suggesting of diagnosis. Echocardiography we found hypokinesis and dilatation of the RV in all the cases. The dysfunction of the R.V and the ventricular ectopic beats were the more frequently complication, that predominated in the patients that didn´t receive thrombolytic terapy. As a method of prosecution statistic, was utilized the percentage in all the variables, the Chi Square in the squares 1 and 6 and in the cases with down frequences (< 5), was utilized the method the Fisher Irving(AU)