Coincidencia de Rhupus y embarazo. Reporte de caso / Coincidence of Rhupus and pregnancy. Case report

Resumen ANTECEDENTES: Si bien el lupus eritematoso sistémico y la artritis reumatoide son enfermedades suficientemente descritas, no lo es la asociación de estas, que se denomina rhupus, que hace referencia a la manifestación clínica resultante de ambas enfermedades enmascaradas que dificulta el diagnóstico y tratamiento. CASO CLÍNICO: Paciente de 37 años que inició con un cuadro con características de lupus eritematoso sistémico y artritis reumatoide hacía 16 años. Se encontró con alteraciones en los estudios de laboratorio y con hallazgos radiológicos que apoyaron el cuadro de rhupus. Por lo anterior se documenta la evolución de este padecimiento, que coincide con su embarazo y después de éste. CONCLUSIONES: La aparición simultánea de lupus eritematoso sistémico y artritis reumatoide, aun cuando fue reportada desde hace décadas, es una enfermedad rara en frecuencia, por lo que hay escasa información del rhupus solo y más aún en coincidencia con el embarazo.

Abstract BACKGROUND: Although systemic lupus erythematosus and rheumatoid arthritis are sufficiently described diseases, the association of these is not, and is called rhupus, which refers to the clinical manifestation resulting from both diseases masked, making diagnosis and treatment difficult. CLINICAL CASE: 37-year-old patient who started with a clinical picture with features of systemic lupus erythematosus and rheumatoid arthritis 16 years ago. She was found to have alterations in laboratory studies and radiological findings that supported the diagnosis of rheupus. Therefore, the evolution of this condition is documented, which coincides with and after her pregnancy. CONCLUSIONS: The simultaneous occurrence of systemic lupus erythematosus and rheumatoid arthritis, even though it was reported decades ago, is a rare disease in frequency, so there is scarce information on rhupus alone and even more so in coincidence with pregnancy.

Perception of family doctors about the online courses offered by the Division of Educational Innovation. / Percepción de los médicos familiares sobre los cursos en línea que ofrece la División de Innovación Educativa.

BACKGROUND: The Division of Educational Innovation offers open courses training, updating and training courses that promote self-taught learning. It is important to take the user´s perspective into account in the evaluation to improve educational quality. OBJECTIVE: Analyze the perception of family doctors about the online courses of the platform of The Division of Educational Innovation. METHOD: Qualitative study, descriptive. Included family doctors who took at least one online course. Their opinion on online courses was asked and the questionnaire MOOC (Massive Online Open Courses) was applied. An analysis of the content of the open questions was carried out, the questionnaire was evaluated globally and by sections. RESULTS: 19 doctors included, 58% women, the majority have taken the online course for updating and professional and personal interest, the main limitation is the lack of time. Registration restrictions, platform failure, course duration time and disinterest are also mentioned. The quality of the courses was measured as regular by 36.8% and low quality by 26.3%, with adaptation to the user and didactic planning being the lowest scores. CONCLUSIONS: The perception of online courses is good, considering the to be of regular quality, with time being the main limiting factor.

INTRODUCCIÓN: La División de Innovación Educativa ofrece cursos abiertos de formación, actualización y capacitación que favorecen el aprendizaje autodidacta. Es importante tomar en cuenta la perspectiva del usuario en la evaluación para mejorar la calidad educativa. OBJETIVO: Analizar la percepción de los médicos familiares sobre los cursos en línea de la plataforma de la División de Innovación Educativa. MÉTODO: Estudio cualitativo, descriptivo, que incluyó médicos familiares que tomaron como mínimo un curso en línea. Se preguntó su opinión sobre los cursos en línea y se aplicó el cuestionario MOOC (Massive Online Open Courses). Se realizó un análisis de contenido de las preguntas abiertas, y el cuestionario se evaluó de forma global y por dimensiones. RESULTADOS: El estudio incluyó a 19 médicos de los cuales el 58% fueron mujeres. La mayoría tomó los cursos en línea por actualización e interés profesional y personal, y señalan como principal limitación la falta de tiempo. También se mencionan restricciones en el registro, fallas en la plataforma, tiempo de duración del curso y desinterés. La calidad de los cursos fue calificada como regular por el 36.8% y baja por el 26.3%, siendo la adaptación al usuario y la planeación didáctica las puntuaciones más bajas. CONCLUSIÓN: La percepción de los cursos en línea es buena, considerándolos de regular calidad, y el factor tiempo es la principal limitante.

Prevalence of cutaneous findings in Spanish neonates and relationships to obstetric and parental factors.

Two hundred forty-seven healthy newborns were investigated in a prospective cohort descriptive study. Information on phenotype and obstetric and parental history was collected. A positive association was found between erythema toxicum neonatorum and season of birth (spring and summer), whereas parental history of any skin disease was related to a lower frequency of this eruption.

[Weight loss in overweight or obese patients and family functioning]. / Disminución de peso y funcionalidad familiar en sujetos con obesidad o sobrepeso.

OBJECTIVE: to determine the association between weight loss and family functioning. METHODS: a cohort of 168 persons with overweight or obesity from 20-49 years, either sex, with no comorbidity was studied at the nutrition department. A sociodemographic data was obtained and FACES III instrument to measure family functioning was applied. At the third month a new assessment of the body mass index was measured. Descriptive statistical analysis and relative risk were done. RESULTS: obesity presented in 50.6 %, 59.53 % of them did not lose weight. Family dysfunction was present in 56.6 % of which 50 % did not lose weight. From 43.4 % of functional families, 9.52 % did not lose weight (p = 0.001). The probability or risk of not losing weight was to belong to a dysfunctional family is 4.03 % (CI = 2.60-6.25). CONCLUSIONS: A significant association was found between the variables: weight loss and family functioning. Belonging to a dysfunctional family may be a risk factor for not losing weight.

Aplasia cutis congenita and other anomalies associated with methimazole exposure during pregnancy.

Aplasia cutis congenita (ACC) is a congenital defect consisting of a circumscribed absence of skin that usually involves the scalp. The etiology is uncertain, and several teratogenic agents such as methimazole have been involved. We report two cases of ACC and other anomalies in newborns exposed to methimazole during pregnancy.

Facial self-induced paraffinoma in an elderly woman.

A 72-year-old Caucasian woman without remarkable medical history presented with an asymptomatic bilateral periocular swelling, which had been present for 2 months. Physical examination showed symmetric indurated periocular erythematous plaques (Figure 1). Biopsy of a skin lesion revealed aggregates of vacuoles of different sizes (Figure 2) surrounded by a prominent inflammatory infiltrate constituted by macrophages, lymphocytes, neutrophils, and granulomatous foreign body reaction throughout the reticular dermis and hypodermis. These histological findings were consistent with the injection of an oily foreign substance. The patient denied the self-induced nature of the lesions, so she was referred for psychiatric evaluation and admitted having self-injected mineral oil as an impulsive attempt to get attention from her family. She was diagnosed with borderline personality disorder (BPD) and started treatment with oral fluoxetine, showing a rapid decrease of impulsive behavior and anxiety from the second week with a mean dose of 80 mg/d.

Influence of the germline sequence on the thermodynamic stability and fibrillogenicity of human lambda 6 light chains.

Light chain-associated amyloidosis is a fatal disease characterized by the aggregation and pathologic deposition of monoclonal light chain-related fragments as amyloid fibrils in organs or tissues throughout the body. Notably, it has been observed that proteins encoded by the lambda variable light chain (V(L)) gene segment 6a are invariably associated with amyloid deposition; however, the contribution of the gene to this phenomenon has not been established. In this regard, we have determined the thermodynamic stability and kinetics of in vitro fibrillogenesis of a recombinant (r) V(L) protein, designated 6aJL2, which contains the predicted sequences encoded by the 6a and JL2 germline genes. Additionally, we studied a 6a mutant (6aJL2-Arg25Gly), that is present in approximately 25% of all amyloid-associated lambda6 light chains. Remarkably, the wild-type 6aJL2 protein was more stable than were all known amyloidogenic kappa and lambda light chains for which stability parameters are available; more importantly, it was even more so (and less fibrillogenic) than the only clinically proven nonamyloidogenic lambda6 protein, Jto. Conversely, the mutated 6aJL2-R25G molecule was considerably less stable and more fibrillogenic than was the native 6aJL2. Our data indicate that the propensity of lambda6 light chains to form amyloid can not be attributed to thermodynamic instability of the germline-encoded Vlambda6 domain, but rather, is dependent on sequence alterations that render such proteins amyloidogenic.

The change of the scFv into the Fab format improves the stability and in vivo toxin neutralization capacity of recombinant antibodies.

The antigen-binding fragment (Fab) has been considered a more functionally stable version of recombinant antibodies than single chain antibody fragments (scFvs), however this intuitive consideration has not been sufficiently proven in vivo. This communication shows that three out of four specific scFvs against a scorpion toxin, with different affinities and stabilities, become neutralizing in vivo when expressed as Fabs, despite the fact that they are not neutralizing in the scFv format. A scFv fragment previously obtained from a neutralizing mouse antibody (BCF2) was used to produce three derived scFvs by directed evolution. Only one of them was neutralizing, however when expressed as Fab, all of them became neutralizing fragments in vivo. The initial scFvBCF2 (earlier used for directed evolution) was not neutralizing in the scFv format. After expressing it as Fab did not become a neutralizing fragment, but did reduce the intoxication symptoms of experimental mice. The stability of the four Fabs derived from their respective scFvs was improved when tested in the presence of guanidinium chloride. The in vitro stability of the Fab format has been shown earlier, but the physiological consequences of this stability are shown in this communication. The present results indicate that improved functional stability conferred by the Fab format can replace additional maturation steps, when the affinity and stability are close to the minimum necessary to be neutralizing.

(1)H, (13)C and (15)N resonance assignment of 6aJL2(R25G), a highly fibrillogenic lambdaVI light chain variable domain.

An allotypic variation at position 25 influences the fibrillogenicity of lambdaVI light chains, which are related to humoral immune response and have been associated with AL amyloidosis. The full resonance assignment and a preliminary structural characterization of 6aJL2(R25G) are reported.

Pápulas pruriginosas en axilas / Pruritic papules in the axillae

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The Pseudomonas aeruginosa RhlA enzyme is involved in rhamnolipid and polyhydroxyalkanoate production.

Pseudomonas aeruginosa produces the biosurfactant rhamnolipid, which has several potential biotechnological applications. The synthesis of this surfactant is catalyzed by rhamnosyltransferase 1, composed of the proteins RhlA and RhlB. Here we report that RhlA plays a role not only in surfactant synthesis, but also in the production of polyhydroxyalkanoates, polymers that can be used for the synthesis of biodegradable plastics.

Mastocitosis sistémica con hiperpigmentación cutánea difusa / Systemic mastocytosis: An unusual etiology for cutaneous hyperpigmentation

Presentamos un caso de mastocitosis sistémica que mostraba una importante y progresiva hiperpigmentación melánica cutánea a lo largo de los últimos 8 años. La llamativa hiperpigmentación cutánea de nuestro paciente podía estar en relación con factores estimuladores del desarrollo de mastocitos y melanocitos (AU)

Citrobacter koseri in scalp folliculitis.

Gram-negative folliculitis, an uncommon condition, is most often seen in older patients who have acne and who either have received prolonged courses of antibiotic therapy or have used antibacterial cleansers that selectively inhibit gram-positive organisms. Citrobacter infections are uncommon, and dermatologists seldom encounter them. In the past, these infections occurred in hospitals, particularly in neonatal intensive care units. Bacteremias also occur in elderly or immunocompromised patients. In this article, we present a case of Citrobacter koseri scalp folliculitis in an otherwise healthy patient.