Emerging species in pediatrics: a case of Acinetobacter johnsonii meningitis.

BACKGROUND: Among the microorganisms corresponding to the genus Acinetobacter, Acinetobacter johnsonii is a species of low epidemiological incidence compared to Acinetobacter baumannii. However, it has a comparable infectious capacity since it can be involved in severe diseases like bacteremia or meningitis. Its habitat is variable, usually found in humid tropical climates (as is the case in Colombia), soil, water, or animal reservoirs. It is still an unknown germ for most health personnel, as there are not many reported cases, and information about its microbiological and epidemiological characteristics is still scarce, making its identification and treatment difficult. CLINICAL CASE: We describe the case of A. johnsonii infection of the central nervous system in a 15-year-old female, as well as the diagnostic method used, the course of the disease, medical management, and clinical outcome. CONCLUSIONS: It is of utmost importance to report this type of microorganisms to facilitate early diagnosis and appropriate treatment. More scientific publications of this type are needed to broaden the knowledge about these microorganisms.

INTRODUCCIÓN: Dentro de los microorganismos correspondientes al género Acinetobacter, Acinetobacter johnsonii es una especie de poca frecuencia epidemiológica en comparación con Acinetobacter baumannii. Sin embargo, posee una capacidad infecciosa equiparable, ya que se puede ver involucrado en patologías graves, como bacteriemia o meningitis. Su hábitat es variable y suele encontrarse en climas tropicales húmedos (como es el caso de Colombia), suelos, aguas o reservorios animales. Actualmente sigue siendo un patógeno desconocido por gran parte del personal de salud, pues no existen muchos casos reportados, y la información acerca de sus características microbiológicas y epidemiológicas aún es escasa, lo que dificulta su identificación y tratamiento. CASO CLÍNICO: Se describe una infección del sistema nervioso central por A. johnsonii en una paciente de sexo femenino de 15 años, así como el método diagnóstico utilizado, el curso de la enfermedad, el manejo médico y el desenlace clínico. CONCLUSIONES: Es de suma importancia dar a conocer la existencia de estos microorganismos para facilitar el diagnóstico temprano y el tratamiento apropiado. Se requieren más publicaciones científicas de este tipo para ampliar el conocimiento acerca de estos microorganismos.

Femtosecond Laser-Assisted Membranectomy of Retained Host's Descemet's Membrane Postpenetrating Keratoplasty.

We report the two cases in which femtosecond laser (FSL) technology used to manage visually significant retained host's Descemet's membrane (RHDM) after penetrating keratoplasty (PKP). FSL-assisted descemetorhexis was done first, then membrane removal with intraocular forceps. Both patients had advanced keratoconus and were managed with PKP. In the first patient, FSL descemetorhexis of RHDM was incomplete. It was augmented manually, and then, the removal of the retained membrane was done with an intraocular forceps, whereas, a complete and central 5.5 mm FSL descemetorhexis was created in the second case. Then, it was pulled out with intraocular forceps. Postoperatively, the best-corrected visual acuity was 20/40, with an intraocular pressure (IOP) of 18 mmHg. In the second case, best-corrected visual acuity and IOP were 20/70 and 16 mmHg, respectively. In conclusion, FSL technology can be an alternative to manual or neodymiumdoped yttrium - aluminum garnet membranotomy for the management of RHDM after PKP.

A Case of Implantable Collamer Lens (ICL) with Reverse Orientation for 10 Years.

BACKGROUND: Implantable collamer lens (ICL) might rarely cause complications that warrant explantation. Here, we presented a case of inverted ICL that has undergone explantation after a 10-year duration. Case Presentation. A 49-year-old male with past ocular history of ICL implantation 10 years ago presented complaining of progressive decrease of visual acuity in the left eye for a long time. On examination, decreased visual acuity, anterior subcapsular cataract, and low ICL vault were noted. The anterior segment optical coherence tomography (AS OCT) showed inverted ICL. The ICL was explanted, and cataract surgery was done. CONCLUSION: Inverted ICL should be kept in mind as a rare cause of long-term poor visual acuity in patient with a history of ICL surgery.

Effectiveness of 0.15% hylan A eye drops in ameliorating symptoms of severe dry eye patients in Saudi Arabia.

PURPOSE: The aim of the HYLAN A study was to investigate if symptoms and/or signs of patients suffering from severe dry eye disease (DED) in Saudi Arabia can be improved by substituting individually optimized artificial tear therapy by high molecular weight hyaluronan (HMWHA) eye drops. METHODS: The HYLAN M study, a multicenter prospective randomized open-label study, was performed in 11 centers in eight countries. Patients suffering from severe DED were electronically randomized in two parallel arms. patients with symptoms of at least ocular surface disease index (OSDI) 33 and corneal fluorescein staining (CFS) of at least Oxford grade 3 were included . The patients in the control group continued with their individual optimized therapy as by the time of inclusion. The patients in the hylan A group replaced their individual lubricant eye drops by preservative-free eye drops containing 0.15% hylan A. The total OSDI scores as well as the OSDI subscores for pain and for visual disturbances of each patient at baseline, at 4 weeks, and at 8 weeks of treatment was used to analyse the improvement of symptoms. We focus and report the results obtained at the two study centers in Riyadh ,Saudi Arabia (King Khaled Eye Specialist Hospital and Riyadh Military Hospital). RESULTS: A total of 13 patients were included in the study. The majority of the study participants were middle aged (40-65 years). Overall, female patients accounted for 76.9% of all study participants. At the initiation of the study, both hylan A and control groups had relatively similar total OSDI scores together with pain and vision subscores. At 4-week follow-up, both groups demonstrated a noticeable decrease in all study variables. Nevertheless, the OSDI scores improved significantly in the group of patients treated with hylan A eye drops at 8 weeks, whereas the scores increased in the control group. CONCLUSION: Saudi Arabia has a very high prevalence of patients with severe dry eye disease. Ethnicity, climate, and a high incidence of diabetes mellitus may contribute to this situation. Lubricant eye drops frequently do not provide adequate relief from ocular pain and instable vision in severe chronic ocular surface disease. High molecular weight hyaluronan (HMWHA) eye drops provide superior relief of symptoms of patients suffering from severe DED. This includes ocular pain as well as unstable vision.

The Potential of Algal Biotechnology to Produce Antiviral Compounds and Biopharmaceuticals.

The emergence of the Coronavirus Disease 2019 (COVID-19) caused by the SARS-CoV-2 virus has led to an unprecedented pandemic, which demands urgent development of antiviral drugs and antibodies; as well as prophylactic approaches, namely vaccines. Algae biotechnology has much to offer in this scenario given the diversity of such organisms, which are a valuable source of antiviral and anti-inflammatory compounds that can also be used to produce vaccines and antibodies. Antivirals with possible activity against SARS-CoV-2 are summarized, based on previously reported activity against Coronaviruses or other enveloped or respiratory viruses. Moreover, the potential of algae-derived anti-inflammatory compounds to treat severe cases of COVID-19 is contemplated. The scenario of producing biopharmaceuticals in recombinant algae is presented and the cases of algae-made vaccines targeting viral diseases is highlighted as valuable references for the development of anti-SARS-CoV-2 vaccines. Successful cases in the production of functional antibodies are described. Perspectives on how specific algae species and genetic engineering techniques can be applied for the production of anti-viral compounds antibodies and vaccines against SARS-CoV-2 are provided.

Congenital hyperinsulinism: characterization of patients treated in a pediatric university hospital in Colombia.

Background: Congenital hyperinsulinism is a disease of the glucose metabolism, relevant in pediatric endocrinology because of the elevated production of insulin according to blood glucose level, which leads to persistent severe hypoglycemia. This condition can produce important neurological sequelae in the patient due to the irreversible damage that occurs in the neuron caused by the exposure to hypoglycemia for short periods of time. Congenital hyperinsulinism diagnosis is not simple and it requires a high index of suspicion. The treatment should be established sequentially, in several steps, noticing the response to each possible medication used. If the pharmacological management fails, surgical procedures are required occasionally. Case series report: Seven cases of congenital hyperinsulinism diagnosed in the last seven years at the Instituto Roosevelt in Bogotá, Colombia are presented. In this country, the radiotracer used internationally during positron emission tomography/computed tomography (PET/CT) is not available. However, was possible to use an alternative radiotracer in one of the cases, which led to an adequate diagnosis and a successful surgical treatment. Conclusions: Congenital hyperinsulinism is a complex clinical condition, which requires proper diagnosis and treatment, with the aim of avoiding any neurological damage caused by persistent hypoglycemia. PET/CT can be used with an appropriate radiotracer for a timely diagnosis and to provide the best available therapeutic option.

Introducción: El hiperinsulinismo congénito es una enfermedad del metabolismo de la glucosa, fundamental en la endocrinología pediátrica, ya que se refiere a la producción de mayor cantidad de insulina de la necesaria según la glucemia, lo cual produce hipoglucemias graves persistentes. Esta alteración puede tener importantes secuelas neurológicas debido al daño irreversible que se produce en la neurona por la exposición a la hipoglucemia por cortos periodos de tiempo. Su diagnóstico no es sencillo y requiere un alto índice de sospecha. El tratamiento se establece de manera secuencial, en varias etapas, observando la respuesta a cada uno de los posibles medicamentos empleados. En caso de que falle el manejo farmacológico, se requieren procedimientos quirúrgicos. Serie de casos: Se presentan siete casos de hiperinsulinismo congénito que fueron diagnosticados en los últimos 7 años en el Instituto Roosevelt en Bogotá, Colombia. En este país, el radiotrazador empleado usualmente durante la tomografía por emisión de positrones (PET/TC) no se encuentra disponible. Sin embargo, en uno de los casos descritos fue posible emplear otro radiotrazador alternativo que permitió un adecuado diagnóstico y un tratamiento quirúrgico exitoso. Conclusiones: El hiperinsulinismo congénito es una condición clínica compleja que amerita un correcto diagnóstico y un apropiado manejo, con el objetivo de evitar el daño neurológico que producen las hipoglucemias persistentes. Es posible emplear PET/TC con un radiotrazador adecuado para realizar un diagnóstico oportuno y proporcionar la mejor opción terapéutica disponible.

Hiperinsulinismo congénito: caracterización de pacientes atendidos en un hospital universitario pediátrico en Colombia / Congenital hyperinsulinism: characterization of patients treated in a pediatric university hospital in Colombia

Resumen Introducción: El hiperinsulinismo congénito es una enfermedad del metabolismo de la glucosa, fundamental en la endocrinología pediátrica, ya que se refiere a la producción de mayor cantidad de insulina de la necesaria según la glucemia, lo cual produce hipoglucemias graves persistentes. Esta alteración puede tener importantes secuelas neurológicas debido al daño irreversible que se produce en la neurona por la exposición a la hipoglucemia por cortos periodos de tiempo. Su diagnóstico no es sencillo y requiere un alto índice de sospecha. El tratamiento se establece de manera secuencial, en varias etapas, observando la respuesta a cada uno de los posibles medicamentos empleados. En caso de que falle el manejo farmacológico, se requieren procedimientos quirúrgicos. Serie de casos: Se presentan siete casos de hiperinsulinismo congénito que fueron diagnosticados en los últimos 7 años en el Instituto Roosevelt en Bogotá, Colombia. En este país, el radiotrazador empleado usualmente durante la tomografía por emisión de positrones (PET/TC) no se encuentra disponible. Sin embargo, en uno de los casos descritos fue posible emplear otro radiotrazador alternativo que permitió un adecuado diagnóstico y un tratamiento quirúrgico exitoso. Conclusiones: El hiperinsulinismo congénito es una condición clínica compleja que amerita un correcto diagnóstico y un apropiado manejo, con el objetivo de evitar el daño neurológico que producen las hipoglucemias persistentes. Es posible emplear PET/TC con un radiotrazador adecuado para realizar un diagnóstico oportuno y proporcionar la mejor opción terapéutica disponible.

Abstract Background: Congenital hyperinsulinism is a disease of the glucose metabolism, relevant in pediatric endocrinology because of the elevated production of insulin according to blood glucose level, which leads to persistent severe hypoglycemia. This condition can produce important neurological sequelae in the patient due to the irreversible damage that occurs in the neuron caused by the exposure to hypoglycemia for short periods of time. Congenital hyperinsulinism diagnosis is not simple and it requires a high index of suspicion. The treatment should be established sequentially, in several steps, noticing the response to each possible medication used. If the pharmacological management fails, surgical procedures are required occasionally. Case series report: Seven cases of congenital hyperinsulinism diagnosed in the last seven years at the Instituto Roosevelt in Bogotá, Colombia are presented. In this country, the radiotracer used internationally during positron emission tomography/computed tomography (PET/CT) is not available. However, was possible to use an alternative radiotracer in one of the cases, which led to an adequate diagnosis and a successful surgical treatment. Conclusions: Congenital hyperinsulinism is a complex clinical condition, which requires proper diagnosis and treatment, with the aim of avoiding any neurological damage caused by persistent hypoglycemia. PET/CT can be used with an appropriate radiotracer for a timely diagnosis and to provide the best available therapeutic option.

A Foldable Nonpenetrating Keratoprosthesis: Medium to Long-Term Clinical Results in Patients with Corneal Blindness due to Noninflammatory Anterior Cornea Disease.

PURPOSE: To report the medium to long-term safety and performance outcomes of the KeraKlear nonpenetrating artificial cornea (KeraKlear) as the primary procedure in patients with corneal blindness due to noninflammatory anterior cornea disease. METHODS: Fifteen patients with corneal blindness (preoperative visual acuity [VA] of ≥20/200) due to a non-inflammatory anterior corneal condition were included in this prospective, single-center study. Preoperative diagnoses included corneal scars, keratoconus, and corneal dystrophies. Diseased corneas were implanted with the KeraKlear (KeraMed Inc., Irvine, California, USA) by a single surgeon (JMV) using a femtosecond laser to create all incisions. Participants were followed up with for as long as 64 months. Uncorrected Snellen VA and postoperative complications were recorded. RESULTS: The average age at the time of surgery was 49.6 years old and 67% of patients were female. The patients experienced an average improvement in uncorrected Snellen VA of 7.6 lines (-1.17 logMAR). Average uncorrected vision at the last visit was 20/100 (0.73 logMAR), and median uncorrected vision at the last visit was 20/70 (0.54 logMAR). One patient experienced extrusion of the KeraKlear due to infection. There were no cases of glaucoma, retroprosthetic membrane, or endophthalmitis, the three most common complications of penetrating keratoprostheses (KPro). CONCLUSIONS: Medium and long-term outcomes of the KeraKlear indicate that this device is a viable alternative to corneal transplantation as a primary procedure in patients with non-inflammatory causes of corneal blindness, especially when corneal tissue is not available. The KeraKlear does not penetrate into the anterior chamber, and therefore, is less susceptible to the most common complications of penetrating KPro including endophthalmitis, glaucoma, and retroprosthetic membrane. The KeraKlear also has a comparable or improved adverse event rate compared to penetrating keratoplasty.

Supernumerary lacrimal puncta: Case series.

Supernumerary lacrimal punctum is rare, and very few cases have been reported. Most patients are asymptomatic, but in some excessive tearing could be a symptom. In addition, obstruction of the canaliculi causing canaliculitis has been reported. We describe four cases in detail with their presentations and diagnosis. The first patient presented with a right eye lesion and during examination, the left eye was less than mid dilated compared to that of the right eye. Further examination of the left eye revealed two left lower lid puncta. In another patient who was evaluated for diabetic retinopathy, two left lower lid puncta that shared the same canaliculus were noted. Furthermore, two lower lid puncta were found in a patient who came for cataract follow-up. Finally, in a patient who was following up in the retinal clinic, two lower lid puncta were documented. Probing to the accessory punctum showed that the canaliculus had an immediate horizontal course, unlike the rest of the puncta which showed a vertical then a horizontal course. Furthermore, in the accessory punctum, there was a soft stop, around 4 mm of the inserting probe. In summary, supernumerary lacrimal punctum is rare, and ophthalmologists need to be aware of this abnormality.

Use of the ptxD gene as a portable selectable marker for chloroplast transformation in Chlamydomonas reinhardtii.

Synthetic biology and genetic engineering in algae offer an unprecedented opportunity to develop species with traits that can help solve the problems associated with food and energy supply in the 21st century. In the green alga Chlamydomonas reinhardtii, foreign genes can be expressed from the chloroplast genome for molecular farming and metabolic engineering to obtain commodities and high-value molecules. To introduce these genes, selectable markers, which rely mostly on the use of antibiotics, are needed. This has risen social concern associated with the potential risk of horizontal gene transfer across life kingdoms, which has led to a quest for antibiotic-free selectable markers. Phosphorus (P) is a scarce nutrient element that most organisms can only assimilate in its most oxidized form as phosphate (Pi); however, some organisms are able to oxidize phosphite (Phi) to Pi prior to incorporation into the central metabolism of P. As an alternative to the use of the two positive selectable makers already available for chloroplast transformation in C. reinhardtii, the aadA and the aphA-6 genes, that require the use of antibiotics, we investigated if a phosphite-based selection method could be used for the direct recovery of chloroplast transformed lines in this alga. Here we show that following bombardment with a vector carrying the ptxD gene from Pseudomonas stutzeri WM88, only cells that integrate and express the gene proliferate and form colonies using Phi as the sole P source. Our results demonstrate that a selectable marker based on the assimilation of Phi can be used for chloroplasts transformation in a biotechnologically relevant organism. The portable selectable marker we have developed is, in more than 18 years, the latest addition to the markers available for selection of chloroplast transformed cells in C. reinhardtii. The ptxD gene will contribute to the repertoire of tools available for synthetic biology and genetic engineering in the chloroplast of C. reinhardtii.

Efficient Editing of the Nuclear APT Reporter Gene in Chlamydomonas reinhardtii via Expression of a CRISPR-Cas9 Module.

The clustered regularly interspaced short palindromic repeat/CRISPR-associated protein 9 (CRISPR/Cas9) technology is a versatile and useful tool to perform genome editing in different organisms ranging from bacteria and yeast to plants and mammalian cells. For a couple of years, it was believed that the system was inefficient and toxic in the alga Chlamydomonas reinhardtii. However, recently the system has been successfully implemented in this model organism, albeit relying mostly on the electroporation of ribonucleoproteins (RNPs) into cell wall deficient strains. This requires a constant source of RNPs and limits the application of the technology to strains that are not necessarily the most relevant from a biotechnological point of view. Here, we show that transient expression of the Streptococcus pyogenes Cas9 gene and sgRNAs, targeted to the single-copy nuclear apt9 gene, encoding an adenine phosphoribosyl transferase (APT), results in efficient disruption at the expected locus. Introduction of indels to the apt9 locus results in cell insensitivity to the otherwise toxic compound 2-fluoroadenine (2-FA). We have used agitation with glass beads and particle bombardment to introduce the plasmids carrying the coding sequences for Cas9 and the sgRNAs in a cell-walled strain of C. reinhardtii (CC-125). Using sgRNAs targeting exons 1 and 3 of apt9, we obtained disruption efficiencies of 3 and 30% on preselected 2-FA resistant colonies, respectively. Our results show that transient expression of Cas9 and a sgRNA can be used for editing of the nuclear genome inexpensively and at high efficiency. Targeting of the APT gene could potentially be used as a pre-selection marker for multiplexed editing or disruption of genes of interest.

Síndrome de Sweet en una niña preescolar / Sweet syndrome in a 5-year-old girl

El síndrome de Sweet, también conocido como dermatosis neutrofílica febril, es un trastorno dermatológico poco frecuente en pediatría. Clínicamente, se caracteriza por la aparición de lesiones papulares y/o nodulares de una coloración rojiza-violeta con hipersensibilidad local. Se reporta el caso de una paciente femenina de 5 años, quien consultó por un cuadro clínico de 10 días de evolución de aparición de lesión forunculosa en el arco nasal. Se realizó una biopsia de piel, que reportó dermatitis difusa con predominio de polimorfonucleares neutrófilos, necrosis epidérmica y ausencia de vasculitis. No se identificaron microorganismos. Se consideró el cuadro compatible con síndrome de Sweet. Es importante tener en cuenta este diagnóstico en cuadros clínicos similares y se deben descartar otros diagnósticos más frecuentes primero.

Sweet syndrome, also known as acute febrile neutrophilic dermatosis, is an infrequent dermatological disorder in pediatrics. Clinically it is characterized by the development of papular and/or nodular lesions of a reddish-violet coloration with local hypersensitivity. We report the case of a 5-year-old female who consulted 1 month after the appearance of the lesion in the nasal arch. A skin biopsy was performed and it reported diffuse dermatitis with a predominance of neutrophil polymorphonuclear cells, epidermal necrosis and absence of vasculitis. No microorganisms were identified. It was considered compatible with Sweet syndrome. It is important to consider this diagnosis in similar clinical cases and other more frequent diagnoses must be ruled out first.

[Sweet syndrome in a 5-year-old girl]. / Síndrome de Sweet en una niña preescolar.

Sweet syndrome, also known as acute febrile neutrophilic dermatosis, is an infrequent dermatological disorder in pediatrics. Clinically it is characterized by the development of papular and/or nodular lesions of a reddish-violet coloration with local hypersensitivity. We report the case of a 5-year-old female who consulted 1 month after the appearance of the lesion in the nasal arch. A skin biopsy was performed and it reported diffuse dermatitis with a predominance of neutrophil polymorphonuclear cells, epidermal necrosis and absence of vasculitis. No microorganisms were identified. It was considered compatible with Sweet syndrome. It is important to consider this diagnosis in similar clinical cases and other more frequent diagnoses must be ruled out first.

El síndrome de Sweet, también conocido como dermatosis neutrofílica febril, es un trastorno dermatológico poco frecuente en pediatría. Clínicamente, se caracteriza por la aparición de lesiones papulares y/o nodulares de una coloración rojiza-violeta con hipersensibilidad local. Se reporta el caso de una paciente femenina de 5 años, quien consultó por un cuadro clínico de 10 días de evolución de aparición de lesión forunculosa en el arco nasal. Se realizó una biopsia de piel, que reportó dermatitis difusa con predominio de polimorfonucleares neutrófilos, necrosis epidérmica y ausencia de vasculitis. No se identificaron microorganismos. Se consideró el cuadro compatible con síndrome de Sweet. Es importante tener en cuenta este diagnóstico en cuadros clínicos similares y se deben descartar otros diagnósticos más frecuentes primero.

Síndrome de sensibilidad a fármacos con eosinofilia y síntomas sistémicos debido a la carbamazepina: Caso pediátrico / Drug reaction with eosinophilia and systemic symptoms due to carbamazepine: Pediatric case

Entre las reacciones medicamentosas graves en la piel, se encuentran el síndrome de Stevens-Johnson, la necrólisis epidérmica tóxica y el síndrome de sensibilidad a fármacos con eosinofilia y síntomas sistémicos (drug reaction with eosinophilia and systemic symptoms; DRESS, por sus siglas en inglés), que son poco comunes en la población pediátrica (incidencia: 1/1000-10 000 niños), sin embargo, tienen mal pronóstico. El síndrome de sensibilidad a fármacos con eosinofilia y síntomas sistémicos consiste en erupciones cutáneas, alteraciones hematológicas, linfadenopatía y afectación de órganos. Se presenta el caso de un paciente masculino de 12 años que desarrolló esta patología después de iniciar el tratamiento anticonvulsivo con carbamazepina. Se considera que es importante que el personal de la salud tenga conocimiento de esta enfermedad para que sea incluida entre los diagnósticos diferenciales de pacientes con afecciones similares, ya que este síndrome es potencialmente mortal.

Severe skin reactions include Stevens-Johnson Syndrome, toxic epidermal necrolysis and Drug reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome, which are uncommon in the pediatric population (incidence 1/1000-10 000 children), but they have bad prognosis. Drug-sensitive Syndrome with eosinophilia and systemic symptoms consists in rash, hematological abnormalities, lymphadenopathy and organ involvement. We report the case of a 12-year-old male patient who developed this pathology after initiating anticonvulsant therapy with carbamazepine. We consider that it is important to be aware of this disease and to include it among the differential diagnoses in patients with similar conditions because this syndrome is life-threatening.

[Drug reaction with eosinophilia and systemic symptoms due to carbamazepine. Pediatric case]. / Síndrome de sensibilidad a fármacos con eosinofilia y síntomas sistémicos debido a la carbamazepina. Caso pediátrico.

Severe skin reactions include Stevens-Johnson Syndrome, toxic epidermal necrolysis and Drug reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome, which are uncommon in the pediatric population (incidence 1/1000- 10 000 children), but they have bad prognosis. Drug-sensitive Syndrome with eosinophilia and systemic symptoms consists in rash, hematological abnormalities, lymphadenopathy and organ involvement. We report the case of a 12-year-old male patient who developed this pathology after initiating anticonvulsant therapy with carbamazepine. We consider that it is important to be aware of this disease and to include it among the differential diagnoses in patients with similar conditions because this syndrome is life-threatening.

Entre las reacciones medicamentosas graves en la piel, se encuentran el síndrome de Stevens-Johnson, la necrólisis epidérmica tóxica y el síndrome de sensibilidad a fármacos con eosinofilia y síntomas sistémicos (drug reaction with eosinophilia and systemic symptoms; DRESS, por sus siglas en inglés), que son poco comunes en la población pediátrica (incidencia: 1/1000- 10 000 niños), sin embargo, tienen mal pronóstico. El síndrome de sensibilidad a fármacos con eosinofilia y síntomas sistémicos consiste en erupciones cutáneas, alteraciones hematológicas, linfadenopatía y afectación de órganos. Se presenta el caso de un paciente masculino de 12 años que desarrolló esta patología después de iniciar el tratamiento anticonvulsivo con carbamazepina. Se considera que es importante que el personal de la salud tenga conocimiento de esta enfermedad para que sea incluida entre los diagnósticos diferenciales de pacientes con afecciones similares, ya que este síndrome es potencialmente mortal.

Pancreatitis aguda secundaria a un trauma abdominal: reporte de caso de una niña de 7 años / Acute pancreatitis secondary to an abdominal trauma: case report of a 7-year-old child

La pancreatitis consiste en la inflamación aguda del páncreas, que se caracteriza, clínicamente, por dolor abdominal. Para realizar el diagnóstico, es necesario que se presente la elevación de marcadores bioquímicos, como amilasa o lipasa pancreáticas. Esta afección es la enfermedad pancreática más frecuente tanto en niños como en adultos. Su presentación en la población pediátrica está en aumento y tiene varias etiologías, como infecciones, trauma, intoxicación y enfermedades metabólicas. Entre los mecanismos de trauma, se han descrito maltrato infantil, caídas, trauma con el manubrio de la bicicleta y accidentes de tránsito. En este artículo, se presenta un caso de pancreatitis secundaria a un trauma abdominal con el manubrio de una bicicleta en una paciente de 7 años.

Pancreatitis consists in acute inflammation of the pancreas that is clinically characterized by abdominal pain. To make the diagnosis it is necessary the elevation of biochemical markers like pancreatic amylase or lipase. It is the most frequent pancreatic disease in both children and adults. Its presentation in the pediatric population is increasing and has several etiologies such as: infections, trauma, intoxication and metabolic diseases. Trauma mechanisms have been described: child maltreatment, falls, trauma with the bicycle handle and traffic accidents. In this article, we present a case of pancreatitis secondary to an abdominal trauma with the handle of a bicycle in a patient of 7 years.

[Acute pancreatitis secondary to an abdominal trauma: case report of a 7-year-old child]. / Pancreatitis aguda secundaria a un trauma abdominal: reporte de caso de una niña de 7 años.

Pancreatitis consists in acute inflammation of the pancreas that is clinically characterized by abdominal pain. To make the diagnosis it is necessary the elevation of biochemical markers like pancreatic amylase or lipase. It is the most frequent pancreatic disease in both children and adults. Its presentation in the pediatric population is increasing and has several etiologies such as: infections, trauma, intoxication and metabolic diseases. Trauma mechanisms have been described: child maltreatment, falls, trauma with the bicycle handle and traffic accidents. In this article, we present a case of pancreatitis secondary to an abdominal trauma with the handle of a bicycle in a patient of 7 years.

La pancreatitis consiste en la inflamación aguda del páncreas, que se caracteriza, clínicamente, por dolor abdominal. Para realizar el diagnóstico, es necesario que se presente la elevación de marcadores bioquímicos, como amilasa o lipasa pancreáticas. Esta afección es la enfermedad pancreática más frecuente tanto en niños como en adultos. Su presentación en la población pediátrica está en aumento y tiene varias etiologías, como infecciones, trauma, intoxicación y enfermedades metabólicas. Entre los mecanismos de trauma, se han descrito maltrato infantil, caídas, trauma con el manubrio de la bicicleta y accidentes de tránsito. En este artículo, se presenta un caso de pancreatitis secundaria a un trauma abdominal con el manubrio de una bicicleta en una paciente de 7 años.

[Labial adhesions: review of the literature]. / Sinequia vulvar: revisión de literatura.

INTRODUCTION: Fusion of the labia or sinequia vulvae is a common and benign finding in the pediatric female population. The reported incidence is 0.3-3.3% with a greater incidence between 3 months and 6 years old. OBJETIVE: Extensive review of the current international literature regarding the risk factors, etiology, treatment and prognosis. MATERIALS AND METHODS: A systematic search in medical databases as PubMed, Embase and Science Direct for the papers published between January 1999 and October 2016. RESULTS AND CONCLUSIONS: Labial adhesion is a multicausal benign pathology and there were very few published studies in Latin America. The proposed lines of treatment are observation and periodic follow up, topical treatment and manual or surgical separation. Topical conjugated estrogens have a success rate of 50-90% with recurrence of 30% and topical corticoids reported 68-80% of success with 23% of recurrences. Surgical intervention has a success rate of 100% and recurrence of 10%.

INTRODUCCIÓN: La fusión de los labios menores o sinequia vulvar es un hallazgo común y benigno. La incidencia se encuentra entre 0,3% y 3,3%. La edad de mayor incidencia es de los 3 meses a los 6 años. OBJETIVO: Realizar una revisión de la literatura internacional sobre factores de riesgo, etiología, tratamiento y pronóstico de la sinequia vulvar. MATERIALES Y MÉTODOS: Búsqueda sistemática en bases de datos PubMed, Embase y ScienceDirect con revisiónde artículos de enero de 1999 a octubre de 2016. RESULTADOS Y CONCLUSIONES: La sinequia vulvar es una patología benigna multifactorial y existen pocos estudios en Latinoamérica. Las líneas de tratamiento son observación y seguimiento, medicación tópica y separación manual o quirúrgica. Los estrógenos conjugados presentan una tasa de éxito del 50-90% con recurrenciadel 30%; los corticoides tópicos tienen una tasa de éxito del68-80% yrecurrencia del 23%. La intervención posee una tasa de éxito del 100% y de recurrencia de 10%.

Neisseria gonorrhoeae: un agente causal infrecuente de celulitis periorbitaria en un niño / Neisseria gonorrhoeae: an infrequent causal agent of periorbital cellulitis in a child

La celulitis periorbitaria es una patología muy frecuente en la población pediátrica. Se define como la infección que compromete los tejidos blandos adyacentes a la órbita sin atravesar el septum orbitario. Después de la introducción de la vacuna contra Haemophilus influenzae, los patógenos involucrados, generalmente, son cocos Gram-positivos. A continuación, se presenta un caso de celulitis periorbitaria asociada a conjuntivitis purulenta por Neisseria gonorrhoeae en un niño de 2 años y 10 meses. Existen pocos casos descritos en la literatura en los que este microorganismo aparece como agente causal de celulitis periorbitaria. Con este caso, se quiere resaltar la importancia de la toma de cultivo en los pacientes que concomitantemente presenten conjuntivitis bacteriana y secreción purulenta, ya que esto facilitó el diagnóstico de esta patología por un agente etiológico poco frecuente.

Periorbital cellulitis is a very common disease in pediatric population, it describes an infection involving the adjacent soft tissues anterior to the orbital septum. Pathogens involved are generally Gram-positive cocci after introduction of Haemophilus influenzae vaccine. We report a case of Neisseria gonorrhoeae periorbital cellulitis associated with bacterial conjunctivitis in a child. There are few cases reported in the literature with this microorganism as the causal agent. With this case, we would like to emphasize the importance to do a culture of the ocular secretion (if it exists) because this allowed us to determine an infrequent agent of this disease.

[Neisseria gonorrhoeae: an infrequent causal agent of periorbital cellulitis in a child]. / Neisseria gonorrhoeae: un agente causal infrecuente de celulitis periorbitaria en un niño.

Periorbital cellulitis is a very common disease in pediatric population, it describes an infection involving the adjacent soft tissues anterior to the orbital septum. Pathogens involved are generally Gram-positive cocci after introduction of Haemophilus influenzae vaccine. We report a case of Neisseria gonorrhoeae periorbital cellulitis associated with bacterial conjunctivitis in a child. There are few cases reported in the literature with this microorganism as the causal agent. With this case, we would like to emphasize the importance to do a culture of the ocular secretion (if it exists) because this allowed us to determine an infrequent agent of this disease.

La celulitis periorbitaria es una patología muy frecuente en la población pediátrica. Se define como la infección que compromete los tejidos blandos adyacentes a la órbita sin atravesar el septum orbitario. Después de la introducción de la vacuna contra Haemophilus influenzae, los patógenos involucrados, generalmente, son cocos Gram-positivos. A continuación, se presenta un caso de celulitis periorbitaria asociada a conjuntivitis purulenta por Neisseria gonorrhoeae en un niño de 2 años y 10 meses. Existen pocos casos descritos en la literatura en los que este microorganismo aparece como agente causal de celulitis periorbitaria. Con este caso, se quiere resaltar la importancia de la toma de cultivo en los pacientes que concomitantemente presenten conjuntivitis bacteriana y secreción purulenta, ya que esto facilitó el diagnóstico de esta patología por un agente etiológico poco frecuente.