Prevalencia y factores de riesgo asociados a infección por virus SARS-CoV-2 en trabajadores del Instituto Nacional de Salud del Niño de Perú, abril 2020 a marzo 2021

Objetivo: Determinar la prevalencia y factores de riesgo asociados a la infección por virus SARS-CoV-2 en trabajadores del Instituto Nacional de Salud del Niño (INSN), en el periodo de abril 2020 a marzo 2021. Materiales y métodos: Estudio no experimental, descriptivo, transversal. La muestra corresponde a 608 trabajadores de salud que resultaron positivos a la prueba serológica rápida. Se revisaron las fichas de investigación clínica epidemiológica COVID-19 elaboradas por el Ministerio de Salud de Perú, que fueron autoadministradas por los trabajadores de salud, y el personal de Epidemiología del INSN verificó el llenado de la ficha. Los datos se introdujeron en una base de datos que sirvió para el análisis estadístico respectivo. El estudio fue aprobado por el Comité Institucional de Ética en Investigación del INSN (código de registro: PI-17/21). Resultados: La prevalencia fue de 7,24 % de COVID-19 en trabajadores del INSN entre abril del 2020 y marzo del 2021. El 71,4 % fueron mujeres, los participantes presentaron una media de edad de 44,71 años, mayoritariamente en el rango de los 30 a 59 años (83,4 %); el 65,6 % fueron asistenciales, de los cuales la mayoría fueron técnicos en enfermería. El 56,9 % de los trabajadores presentaron síntomas, principalmente fiebre/escalofríos (12,2 %), tos (8,9 %), malestar general (7,7 %), dolor de garganta (6,7 %), congestión nasal (2,5 %) y cefalea (1,3 %) . La mayoría de trabajadores residían en los distritos de Lima . Se encontró asociación significativa por sexo y grupos de edad, tipo de trabajador y perfil del trabajador. Conclusiones: La prevalencia de COVID-19 entre los trabajadores del INSN fue del 7,24 %; las características más frecuentes que mostraron diferencias significativas con el resto de los factores fueron el ser mujer, trabajador asistencial y técnica de enfermería. El 56,9 % de los trabajadores presentó síntomas, solo el 20,9 %, signos clínicos y el 10,9 % tuvo comorbilidades.

Objective: To determine the prevalence and risk factors associated with SARS-CoV-2 infection among workers of Instituto Nacional de Salud del Niño (INSN) from April 2020 to March 2021. Materials and methods: A non-experimental, descriptive, cross-sectional study. The sample consisted of 608 workers who tested positive for COVID-19 using a rapid antigen test. The COVID-19 clinical-epidemiological research sheets prepared by the Ministry of Health of Peru and self-administered by the workers were reviewed. The INSN Department of Epidemiology staff verified the completion of the sheets. The data was entered into a database, which was used for the respective statistical analysis. The study was approved by the INSN Institutional Research Ethics Committee (registration code: PI-17/21). Results: COVID-19 prevalence among INSN workers was 7.24 % from April 2020 to March 2021. Out of the workers with COVID-19, 71.4 % were women; 83.4 % were in the 30 to 59 age range with an average age of 44.71 years; 65.6 % were healthcare workers, most of whom were nursing technicians; and 56.9 % experienced symptoms, mainly fever/chills (12.2 %), cough (8.9 %), malaise (7.7 %), sore throat (6.7 %), stuffy nose (2.5 %) and headache (1.3 %). Most workers lived in Lima Centro districts (33.2 %). A significant association between sex, age groups, worker type and worker profile was found. Conclusions: COVID-19 prevalence among INSN workers was 7.24 %; the most frequent characteristics, which showed significant differences with the rest of the factors, were being a woman, healthcare worker and nursing technician. A total of 56.9 % of the workers experienced symptoms, only 20.9 % developed clinical signs and 10.9 % had comorbidities.

Adenopathy and extensive skin patch overlying plasmacytoma syndrome-the clue to early diagnosis of polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes: A case series and literature review.

Importance: Adenopathy and extensive skin patch overlying plasmacytoma syndrome is a paraneoplastic syndrome characterized by a cutaneous vascular patch overlying a plasmacytoma and systemic manifestations. It is thought to be an early stage of polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes syndrome, which is a rare, but potentially fatal multisystemic disease that is associated with plasma cell dyscrasia. Thus, a high index of suspicion is required to identify patients with adenopathy and extensive skin patch overlying plasmacytoma as they may present with early polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes, which is curable if detected early. Objective: To report additional cases of adenopathy and extensive skin patch overlying plasmacytoma syndrome, describe dermatoscopic and histologic findings of the cutaneous patch and review all up to date literature on adenopathy and extensive skin patch overlying plasmacytoma syndrome. Design: Case series from a single tertiary care center. Participants: Here, we present the second case series of three patients with adenopathy and extensive skin patch overlying plasmacytoma syndrome who all meet the diagnostic criteria for polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes. The diagnosis was suspected based on the presence of the violaceous cutaneous patch along with symptoms of systemic involvement (fatigue, weight loss, weakness). Dermoscopy revealing regular dilated parallel capillaries was suggestive of a benign/reactive vascular process. Histopathology in all three cases showed reactive vascular proliferation with a characteristic 90° branching. To date only 20 cases of adenopathy and extensive skin patch overlying plasmacytoma have been published, including ours. All patients presented with cutaneous lesions (violaceous patch and others) and most, at least 15/20, met the diagnostic criteria for polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes. When clinical follow-up was reported, most patients had a favorable prognosis with partial or complete symptom resolution following treatment of the underlying plasmocytoma.

Dronabinol en manejo de apetito y pérdida de peso en pacientes con cáncer terminal, VIH, cuidados paliativos y vejez. Revisión de la literatura / Dronabinol in appetite management and weight loss in patients with terminal cancer, HIV, palliative care and old age. Literature review

Resumen: Introducción: La caquexia es un síndrome asociado al cáncer avanzado, VIH, pacientes en quimioterapia y quienes tienen seguimiento en cuidados paliativos. La prevalencia es de 25% de los pacientes con diagnóstico de cáncer, 26% en quienes reciben quimioterapia y de 14 a 38% de pacientes con VIH. Un pilar para el manejo es el cannabis debido al efecto del delta-9-tetrahidrocanabinol (THC), del cual se derivó el dronabinol, un fármaco desarrollado para estimular apetito y ganancia de peso. El objetivo de esta revisión bibliográfica es obtener la información sobre los cannabinoides y la evidencia más sólida existente con respecto al uso del dronabinol en pacientes que han presentado pérdida de peso y apetito. Material y métodos: Revisión de la bibliografía con buscador PubMed con las palabras clave Palliative care (cuidados paliativos), Cannabinoids (cannabinoides), cachexia (caquexia), Dronabinol (dronabinol), Appetite (apetito), de 1990 a 2018, limitado a humanos, obteniendo 259 artículos, eliminando 222 por repetirse o tener poca relevancia, dejando 37 artículos para análisis. Resultados: De 37 artículos revisados, nueve fueron estudios experimentales, 10 revisiones sistematizadas, un metaanálisis y 16 artículos de recomendaciones y sugerencias de manejo. Conclusión: El manejo del apetito y pérdida de peso en pacientes en cuidados paliativos, VIH, ancianos o en quimioterapia debe ser multidisciplinario, involucrando nutriólogos, psicólogos y médicos, ajustando el manejo a las características individuales que manifiesten. El dronabinol es un fármaco de primera elección para el manejo de dichos síntomas cuando la historia natural de la enfermedad se acompaña de náusea, vómito o dolor.

Abstract: Introduction: Cachexia is a syndrome associated with advanced cancer, HIV, patients on chemotherapy and those who are followed in palliative care. The prevalence is 25% of patients diagnosed with cancer, 26% in those receiving chemotherapy and 14 to 38% of patients with HIV. A mainstay for management is cannabis, due to the effect of delta-9-tetrahydrocannabinol (THC) from which dronabinol, a drug developed to stimulate appetite and weight gain, was derived. The aim of this literature review is to obtain information on cannabinoids and the strongest existing evidence regarding the use of dronabinol in patients who have presented weight and appetite loss. Material and methods: Literature review with PubMed search engine with the keywords Palliative care, Cannabinoids, cachexia, Dronabinol, Appetite, from 1990 to 2018, limited to humans, obtaining 259 articles, eliminating 222 for repetition or low relevance, leaving 37 articles for analysis. Results: Out of 37 articles reviewed 9 were experimental studies, 10 systematized reviews, 1 meta-analysis and 16 articles of recommendations and management suggestions. Conclusion: The management of appetite and weight loss in palliative care, HIV, elderly or chemotherapy patients should be multidisciplinary, involving nutritionists, psychologists and physicians, adjusting the management to the individual characteristics manifested. Dronabinol is a drug of first choice for the management of these symptoms when the natural history of the disease is accompanied by nausea, vomiting or pain.

Ceftriaxone-based Schiff base transition metal(II) complexes. Synthesis, characterization, bacterial toxicity, and DFT calculations. Enhanced antibacterial activity of a novel Zn(II) complex against S. aureus and E. coli.

From the reaction of ceftriaxone 1 antibiotic with 2,6-diaminopyridine 2 a ceftriaxone-based Schiff base (H2L,3) was obtained and its transition metal complexes were synthesized. Spectroscopic and physicochemical techniques, namely, UV-visible, FT-IR, 1H NMR, EPR, mass spectrometry, molar conductance, magnetic susceptibility and density functional theory (DFT) calculations, together with elemental and thermal analyses, were used to find out the binding mode and composition of these complexes. The ceftriaxone-based Schiff base 3 behaves as a monoanionic tridentate N,N,O ligand. Spectral and magnetic data suggest an octahedral geometry for all complexes and the general formulae [M(HL)(OAc)(H2O)2] (M(II) = Mn2+4, Co2+5, Ni2+6, Cu2+7, Zn2+8), are proposed for them. All compounds were screened for antibacterial activity using both the agar disc diffusion method and the minimal inhibitory concentration (MIC). It was found that complex 8 exhibited the most promising bactericidal activity against S. aureus (MIC = 0.0048 µmol/ml) and E. coli (MIC = 0.0024 µmol/ml). It is more active than the free ligand 1 (MIC = 0.0560 µmol/ml for S. aureus and 0.0140 µmol/ml for E. coli). These MIC results were compared with those obtained using similar zinc(II) Schiff base complexes, and with the values obtained using ceftriaxone conjugated with silver and gold nanoparticles (NPs), using earlier published data. Synthesized metal complexes exhibited LC50 values >1000 ppm indicating their nontoxicity against brine shrimp nauplii (Artemia Salina).

Eruptive disseminated pyogenic granulomas following lightning injury.

BACKGROUND: Pyogenic granuloma (PG) is a common benign acquired vascular tumor. It classically presents as a solitary friable nodule on the face or distal extremities. Disseminated eruption is rare and can occur spontaneously or secondary to various triggers, including burn injury. To date, the literature reports only 13 cases of eruptive PGs following burn injury, most from exposure to boiling milk or water. We report the first case of disseminated eruptive PGs following a lightning injury. CASE: A 17-year-old previously healthy boy developed second- and third-degree burns following lightning injury. Two weeks later, he developed widespread dark-purple polypoid exophytic tumors ranging from 1 to 10 cm in diameter extending beyond the limits of the initial burn injury. The lesions were friable and often formed erosions and crusts. The patient was otherwise well and laboratory and microbiological investigations were normal. Excisional biopsy of a lesion was diagnostic of PG and the patient was treated with surgical excision of the lesions, without recurrence. CONCLUSION: The exact pathogenesis of multiple PGs remains unknown. Several pathogenic mechanisms have been suggested, including production of angiogenic factors that stimulate endothelial proliferation and formation of minute arteriovenous fistulas by trauma.

HTLV-1-associated infective dermatitis demonstrates low frequency of FOXP3-positive T-regulatory lymphocytes.

BACKGROUND: Human T-lymphotropic virus (HTLV)-1-associated infective dermatitis (ID) is a rare severe chronic eczema, considered as a harbinger for the development of cutaneous adult T-cell leukemia/lymphoma (ATLL) and/or HTLV-1-associated myelopathy (HAM)/tropical spastic paraparesis (TSP). The pathogenesis of ID remains unclear. High numbers of peripheral blood CD4+ CD25+ FoxP3+ regulatory T cells (Tregs) have been reported in ATLL and HAM/TSP. OBJECTIVE: To investigate the status of Tregs, unknown to date, and the histopathological features of ID. METHODS: We studied 16 skin biopsies from 15 Peruvian adults and children with ID by immunohistochemistry. RESULTS: Histopathological patterns were seborrheic dermatitis-like and lichenoid. Intraepidermal lymphocytes were conspicuous. The infiltrate was composed of a CD3+ T cell infiltrate with a predominance of CD8+ over CD4+ cells. CD4+ CD25+ FoxP3+ Tregs were rare and their numbers were significantly lower than those reported in other inflammatory dermatoses. CONCLUSION: Tregs have an essential role in maintaining immune homeostasis of skin. Treg dysregulation ends in severe clinical manifestations. The clinical presentation of ID, with lesions resembling those seen in patients with atopic dermatitis and with mutations in the FoxP3 gene, is in agreement with a common Treg-deficient skin environment in these disorders, possibly secondary to HTLV-1 infection.

Avaliação de técnicas de obturação para canais instrumentados pelo Sistema Reciproc© / Evaluation of filling techniques for canals instrumented with the Reciproc© System

Objetivo: Investigar se a modelagem do sistema Reciproc interfere na realizaçÆo da técnica Sistema (TC) e compará-las com outras duas técnicas: Cone énico sistema Reciproc (CU) e McspaddenModificada(MC), quanto à porcentagem da área preenchida por gutapercha,cimento Ahplus e áreas vazias, no terço apical em canais instrumentados pelo sistema Reciproc©. Metodologia: Quinze raízes mesiais de molares inferiores foram instrumentadas por instrumento único recíproco R25 e separadas nosgrupos: CU, TC e MC. Após as obturaçães os dentes foram seccionadosnos níveis de 2mm e 4mm do forame e imagens foram obtidas para medir a porcentagem da área do canal obturada com os materiais obturadores e os espaços vazios, sendo os dados submetidos ao teste estatístico de Kruskal-Wallis. Resultados: Comparando-se as técnicas sem distinçÆo dos níveis, verificou-se que, para o preenchimento Guta Percha, TC se diferenciou de CU e de MC, apresentando média maior que ambas. Para o Cimento, novamente as diferenças surgiram entre TC e as outras duas, mas com TC apresentando média menor que elas. Com relaçÆo à µrea Vazia nÆo foi encontrada diferença estatisticamente significativa entre TC, CU e MC. Conclusães: A modelagem proporcionada pela lima R25 do SistemaReciproc nÆo interfere no emprego da técnica TC. O preenchimento com Guta Percha apresentou maior media na técnica TC, em conseqüência, o Cimento apresentou a menor média, ambos comdiferenças significantes para MC e CU. Com relaçÆo à µrea Vazia o comportamento foi igual para todas as técnicas...

Objective: To investigate whether the shaping promoted by the Reciproc© system interferes with performing the System technique (TC) in comparison with two other techniques - Single Cone Reciproc© system (CU) and Modified Mcspadden (MC) -, relative to the percentage of the area filled by gutta-percha and Ahplus sealer and non-filled areas in the apical third of canals instrumented with the Reciproc© system. Methods: Fifteen mesial roots of mandibular molars were instrumented by a single reciprocate R25 file and assigned to three groups: CU, TC and MC. After root filling, the teeth were sectioned at 2 and 4 mm short of the apical foramen. Images were captured to calculate the percentages of canal area occupied by and free of filling material. Data were analyzed statistically by the Kruskal-Wallis test. Results: Comparison of the techniques regardless of apical levels revealed that for gutta-percha filling, TC presented significantly greater means than CU and MC. For the sealer, TC presented significantly lower means than CU and MC. Regarding the area free of filling material, no statistically significant difference was found among TC, CU and MC. Conclusions: Canal shaping produced by the Reciproc© system?s R25 file does not interfere with the use of the TC technique. Gutta-percha filling presented the greatest mean value with the TC technique and sealer filling presented the lowest mean value, both with significant differences from MC and CU. Regarding the empty area (no filling), the same outcome was observed for all techniques...

Cutaneous gnathostomiasis: report of 6 cases with emphasis on histopathological demonstration of the larva.

BACKGROUND: Cutaneous gnathostomiasis is an emerging food-borne parasitic zoonosis. Histopathological demonstration of the larva on random biopsy specimen of erythematous plaques is infrequent because of its migrating nature. OBJECTIVE: We sought to determine whether medical treatment with albendazole or ivermectin increases the diagnostic yield of skin biopsy specimen. METHODS: A retrospective chart review was conducted in a private dermatology practice in Lima, Peru. Cases with a clinical diagnosis of nodular migratory panniculitis and pathological diagnosis of eosinophilic panniculitis or gnathostomiasis were reviewed. Only cases with definitive diagnosis confirmed by histopathology or parasite isolation were included in the study. RESULTS: A definitive diagnosis of gnathostomiasis was rendered in 6 of 55 reviewed cases. Histopathological or gross identification of the nematode's larva was made obtaining a biopsy specimen of papules or pseudofuruncles that developed after oral antiparasitic treatment. LIMITATIONS: This is a retrospective case series study and no serologic testing was available. CONCLUSION: Biopsy of a papule or pseudofuruncle subsequent to oral treatment increases the likelihood of demonstrating the larva on skin biopsy specimen, which allows definitive diagnosis and may have therapeutic benefit.

A arte (en)cena: humanização & loucura / The art (en)cena: humanization & madness / El arte (en)cena: la humanización y desmadre

O portal "(En)Cena: a saúde mental em movimento", lançado em 18/05/2011, é idealizado pelos cursos de Psicologia, Comunicação Social e Sistemas de Informação do CEULP/ULBRA, tem por objetivo intervir na cultura e divulgar material referente ao campo da saúde, em especial, o da Saúde Mental. Apesar de um tema específico, o portal abarca uma ampla gama de assuntos e experiências, visto que dessa temática subentende-se um conhecimento transdisciplinar que extrapola as disciplinas mais comumente a ela ligadas, abrindo espaço para além do campo da saúde. O (En)Cena possui nove seções que estimulam produções que ultrapassem a ordem técnico-acadêmica, incluindo, portanto, manifestações artístico-culturais originadas nos e relacionadas aos serviços de saúde. O portal (http://www.ultra-to.br/encena) promove discussões de relevância social, fruto das práticas nas quais os colaboradores estão inseridos. O resultado se traduz em novos olhares e novas formas de pensar, de pesquisar, de ensinar e de atuar no campo da Saúde Mental que fomentam a transversalidade, o protagonismo e a tríplice inclusão; princípios esses estruturantes da Política Nacional de Humanização.(AU)

The website “(En)Cena: a saúde mental em movimento”, inaugurated on May 18, 2011, conceived by professors of Psychology, Social Communication and Information Systems of Centro Universitário Luterano de Palmas (CEULP/ULBRA), aims to act in culture and disclose material related to the field of Health, in particular to Mental Health field. Although it is devoted to a specific theme, the website covers a wide range of issues and experiences, since this theme requires a transdisciplinary knowledge, opening up a space beyond the boundaries of disciplines commonly related the field of health. The (En)Cena website consists of nine sections that stimulate productions that go beyond the academic matter and include cultural expressions that come from mental health services. The website (http://www.ulbra-to.br/encena) promotes socially relevant discussions, which are the result of practices in which collaborators are involved. The results are new perspectives and new ways of thinking, researching, teaching and acting in the field of Mental Health that promote mainstreaming, involvement and triple inclusion, principles that build the Política Nacional de Humanização.(AU)

El sitio web "(En) Cena: a saúde mental em movimento", concebido por profesores de Psicología, Comunicación Social y Sistemas de Información del Centro Universitario Luterano de Palmas (CEULP / ULBRA), inaugurado el 18 de mayo de 2011, tiene como objetivo actuar en la cultura y divulgar material relacionado con el campo de la salud, en particular com el campo de la Salud Mental. Aunque este espacio está dedicado a uno solo asunto, él cubre una amplia gama de temas y experiencias, ya que este tema requiere un conocimiento transdisciplinario, que abre un espacio más allá de los límites de las disciplinas comúnmente relacionadas con el campo de la salud. El sitio web (En)Cena consta de nueve secciones que estimulan producciones que van más allá de la cuestión académica e incluyen expresiones culturales procedentes de los servicios de salud mental. El sitio web (http://www.ulbra-to.br/encena) promueve discusiones de relevancia social, que son el resultado de prácticas en que sus colaboradores están insertados. Los resultados son nuevas perspectivas y nuevas formas de pensar, investigar, enseñar y actuar en el campo de la Salud Mental que promueven la integración, la participación y la inclusión triple, principios que conforman la Política Nacional de Humanização.(AU)

Manifestaciones cutáneas de pacientes en hemodiálisis crónica intermitente (HDCI) en 3 centros de Lima Metropolitana / Cutaneous manifestations of patients who are in intermittent chronic hemodialysis (ICHD) in 3 centers of metropolitan Lima

Objetivo: Describir la frecuencia y características de las manifestaciones cutáneas de pacientes en HDCI y su asociación con variables demográficas, clínicas, de laboratorios e impacto en calidad de vida. Material y métodos: Estudio descriptivo y transversal. Se revisaron las historias clínicas, se realizó un examen físico dermatológico y aplicó la encuesta SF36. Resultados: Todos tuvieron al menos una manifestación cutánea atribuida a enfermedad renal crónica (ERC) y/o HDCI. Los cambios más frecuentes fueron: alteraciones en la pigmentación (100%), alteraciones ungueales (85%), prurito y xerosis (ambos 68%). En alteraciones ungueales: onicolisis (23%), uñas mitad y mitad (16%) y estrías longitudinales (15%). En cambios en cabello: cabello fino, opaco y quebradizo (20%) y alopecia difusa (18%). El prurito y la xerosis fueron más frecuentes en diabéticos y pacientes de edad promedio mayor. Las alteraciones ungueales estuvieron asociadas a diabetes y el cambio más frecuente fue onicolisis. La calidad de vida mental fue menor en pacientes con prurito. Conclusión. Todos los pacientes en HDCI tienen al menos una manifestación cutánea. El prurito y la xerosis fueron el síntoma y el signo más importantes, relacionados uno con el otro, diabetes y edad. Además el prurito se asoció a reducción en la calidad de vida mental.

Objective: To describe the frequency and characteristics of the cutaneous manifestations of HDCI patients and its association with demographic, clinical, laboratory and impact on quality of life. Methods: Descriptive and transversal. We reviewed the medical records, physical examination was performed and applied dermatological SF36 survey. Results: all had at least one cutaneous manifestation attributed to chronic kidney disease (CKD) and/or HDCI. The most frequent changes were alterations in pigmentation (100%), nail changes (85%), pruritus and xerosis (both 68%). Changes in nails: onycholysis (23%), half and half nail (16%), longitudinal grooves (15%). Changes in hair: fine hair, dull and brittle (20%), alopecia (18%). Xerosis and pruritus were more frequent in diabetic patients, and average age older. The nail changes were associated with diabetes and onycholysis was the most frequent change. The quality of mental life was lower in patients with pruritus. Conclusion: All patients in HDCI have at least one skin manifestation. Pruritus and xerosis were the most important symptom and sign, related to each other diabetes and age. Besides pruritus associated with reduced quality of mental life.

Enfermedad del suero / Serum sickness

La enfermedad del suero es una enfermedad alérgica rara que se produce por la administración de material antigénico exógeno. Históricamente causada por suero heterólogo; corresponde a una reacción de hipersensibilidad tipo III mediada por depósitos de complejos inmunes circulantes en los pequeños vasos sanguíneos, la cual induce la activación del complemento y subsecuente inflamación. Las características clínicas son fiebre, erupción cutánea, artralgias y linfadenopatías, pudiendo llegar a producir glomerulonefritis o compromiso de otro órgano. Presentamos el caso de un paciente que desarrolló enfermedad del suero posterior a la administración de suero antiofídico.

Serum sickness is a rare allergic disease, produced by the administration of exogenous antigenic material. Historically caused by heterologous serum, it corresponds to a type III hypersensitivity reaction mediated by deposits of circulating immune complexes in small blood vessels, which induces complement activation and subsequent inflammation. Clinical features are fever, rash, arthralgia and lymphadenopathy; this pathology may lead to glomerulonephritis or other organ involvement. We report a patient who developed serum sickness after antivenom administration.

Leishmaniasis cutánea zosteriforme: reporte de un caso / Zosteriform cutaneous leishmaniasis: report of a case

La leishmaniasis cutánea es una enfermedad por protozoarios muy común en nuestro país, causada por diferentes especies de Leishmania. La presentación clínica tipo nódulo y pápula es la más común, aunque también se reportan variantes clínicas poco frecuentes. Las lesiones inusuales se atribuyen a alteraciones en la respuesta del huésped y a la cepa del parásito involucrado. Se reporta el caso de un paciente quien presentó compromiso en la región frontal, unilateral, con histopatología confirmatoria de leishmaniasis cutánea; lo cual ha sido descrito en la literatura como leishmaniasis cutánea variedad zosteriforme y es una forma poco frecuente de presentación.

Cutaneous leishmaniasis is a common protozoal disease very common in our country, caused by several species of Leishmania. The usual clinical presentations are the nodular and papular types, but rare variants have also been reported. Unusual lesions are attributed to alterations in host response and to an atypical strain of parasites involved. We report the case of a patient with unilateral compromise of the forehead with confirmatory histopathology of cutaneous leishmaniasis, which has been described in the literature as zosteriform type cutaneous leishmaniasis and is a rare form of presentation.

Sarcoidosis: síndrome de Lõfgren / Sarcoidosis: LõfgrenÆs syndrome

La sarcoidosis es una enfermedad sistémica, inmunológica y de etiología desconocida, caracterizada por la presencia de granulomas no caseificantes. Todos los tejidos pueden verse afectados, pero el órgano que se daña con más frecuencia es el pulmón, seguido de los ganglios linfáticos, piel, ojos, aparato locomotor y sistema nervioso. Habitualmente tiene un curso agudo o subagudo que suele remitir, pero puede ser crónico, progresivo y dejar graves secuelas. El diagnóstico se basa en la combinación de datos clínicos, radiológicos e histológicos, junto con la exclusión de otras afecciones granulomatosas. El síndrome de Lõfgren es una presentación aguda de sarcoidosis, caracterizada por la presencia de artritis, artralgia, eritema nodoso y linfadenopatías. Se presenta el caso de una paciente joven con clínica compatible con síndrome de Lõfgren.

Sarcoidosis is a systemic and immunologic disease of unknown etiology, characterized by the presence of noncaseating granulomas. Any tissue can be affected, but the lung is the most frequently compromised organ, followed by lymph nodes, skin, eyes, musculoskeletal and nervous system. Usually it has an acute or subacute course that heals itself, but it may also have a chronic and progressive course, causing serious consequences. Diagnosis is based on the combination of clinical, radiological and histological studies, along with the exclusion of other granulomatosus diseases. LõfgrenÆs syndrome is an acute presentation of sarcoidosis, characterized by the presence of arthritis, arthralgia, erythema nodosum and lymphadenopathy.

Queratoacantomas múltiples: un reto diagnóstico y terapéutico / Multiple keratoacanthoma: a diagnostic and therapeutic challenge

El queratoacantoma (QA) es una neoplasia cutánea que por lo usual remite espontáneamente. Muchos queratoacantomas son solitarios pero también se conocen las formas múltiples: del tipo Ferguson Smith, QA eruptivos, QA múltiples persistentes, QA en el síndrome de Muir-Torre y QA centrifugum marginatum, entre otros. Se reporta el caso de una estudiante mujer de 20 años, sin antecedentes patológicos de importancia, que presentó lesiones nodulares de base eritematosa y centro costroso en ambas piernas, de tres meses de evolución. Dada la clínica e histopatología compatible se realizó el diagnóstico de queratoacantomas múltiples recibiendo diferentes tratamientos sin éxito, para finalmente responder a acitretin en una dosis de 0.5mg/kg/día, con involución de las lesiones después de cuatro semanas.

Keratoacanthoma (KA) is a cutaneous neoplasm that usually heals spontaneously. Most KA lesions are unique, but there can also occur as multiple lesions: Ferguson Smith type KA, eruptive KA, multiple persistent KA, KA in Muir-Torre syndrome, and KA centrifugum marginatum, among others. We report the case of a 20 year-old female student, with no significant previous medical history, who presented nodular lesions with erythematous base and crusted center in both legs, for the past three months. Given both the clinical and histological evidence, a diagnosis of multiple keratoacanthomas was made. The patient received different treatments without success until acitretin was administered at a dose of 0.5mg/kg/day, with involution of lesions after four weeks.

Leishmaniasis cutánea difusa transformada por corticoides / Cutaneous leishmaniasis diffuse transformed by corticoids

Las leishmaniasis cutáneas son un grupo de enfermedades parasitarias con gran polimorfismo clínico, producidas por protozoarios del género Leishmania; los cuales son transmitidos al hombre por la picadura de un mosquito (Lutzomia). El Perú sigue siendo una zona endémica, por lo que se presenta el caso de un paciente cuya enfermedad tuvo una evolución prolongada, con cuadro clínico atípico, el cual fue modificado por el uso de corticoides. El caso constituyó un reto diagnóstico, que requirió del estudio histopatológico de las lesiones, donde se observaron múltiples macrófagos vacuolados conteniendo amastigotes de Leishmania. El paciente recibió tratamiento con anfotericin B con remisión del cuadro.

Cutaneous leishmaniasis is a parasitic disease with great clinical polymorphism, caused by protozoa of the genus Leishmania, which is transmitted to humans through the bite of mosquito (Lutzomia). Peru remains an endemic area, and for that reason we present the case of a patient whose disease had a prolonged course, with atypical clinical picture sintomatology, which was modified by the use of corticosteroids. The case was a diagnostic challenge, requiring the histopathology study of the lesions, which showed multiple vacuolated macrophages containing amastigots of Leishmania. The patient was treated with amphotericin B with remission of the lesions.

Reacción a drogas con eosinofilia y compromiso sistémico (DRESS) / Drug reaction with eosinophilia and systemic symptoms syndrome (DRESS)

Desde que se definió la reacción a drogas con eosinofilia y síntomas sistémicos (DRESS) como un síndrome asociado a una gran variedad de medicamentos y de etiología multifactorial, se han reportado numerosos casos. Dicho síndrome cumple con criterios clínicos, alteraciones hematológicas y compromiso sistémico, con una tasa de mortalidad del 10%, secundaria a toxicidad hepática o miocarditis. En nuestro país se encuentra generalmente asociado a fármacos antituberculosos, como es el caso que presentamos a continuación.

Since the drug reaction with eosinophilia and systemic symptoms (DRESS) was first described as syndrome associated with a variety of medications of diverse etiology, numerous cases have been reported. This syndrome meets clinical, haematological and systemic involvement, with a mortality rate of 10%, secondary to liver toxicity, or myocarditis. In our country it is generally associated with antituberculosis drugs, as is the case presented below.