Is orofacial granulomatosis a distinct clinical disorder?

Orofacial granulomatosis is a rare disorder that is heterogeneously defined in the published literature. Herein, we describe a patient with orofacial granulomatosis with clinical and histologic evidence, discuss differential diagnoses, and offer clinical pearls for diagnosing and assessing this disorder. Our case provides support that orofacial granulomatosis is a distinct disorder as opposed to a sequela of other systemic granulomatous diseases. This information will aid dermatologists in decision making and diagnosing the disorder.

The Intersection of Workplace and Environmental Exposure on Health in Latinx Farm Working Communities in Rural Inland Southern California.

Workplace and environmental exposures pose health risks for racial/ethnic minorities in rural agricultural communities, placing them at a disadvantage in accessing needed health care. Over three fourths (76%) of the 2.4 million farmworkers in the United States are immigrants, mostly from Mexico. However, little is known of the community health concerns and barriers to care of Latinx farmworkers in inland southern California. This qualitative study used a community-based participatory research approach, conducting nine in-home meetings to obtain meaningful community input on health concerns and barriers to access healthcare services among rural residents of the Eastern Coachella Valley, who are also located near the desert-bound Salton Sea of inland southern California. All interviews were audio-recorded and analyzed via listening to the audio recordings and summarizing data in templates and matrices. Participants discussed health concerns related to agricultural labor, including heat-related illness, musculoskeletal ailments and injuries, skin disorders, respiratory illness, and trauma. Participants raised concerns about environmental exposures related to agriculture and the nearby Salton Sea, a highly saline lakebed, and proposed solutions to improve the health of their communities. The findings from this study suggest farmworkers are aware of the health risks posed by living and working in rural farmlands but lack resources and information to act upon and advocate for improved public health.

Relaciones de la deontología en ciencias de la salud: cuatro principios más alcance / Relationships of ethics in health sciences: four more principles reach

Los profesionales de distintas áreas de salud han fortalecido hábitos relacionados con faltas de consideración y trato cordial con pacientes y colegas, sugiriendo que la práctica de la ética profesional no se aplica como cualidad relevante en la atención sanitaria. Por otra parte, en Ecuador se han registrado innumerables demandas por causa de mala praxis médica y falta de valores éticos y morales en el ejercicio de la salud. Se realizó un estudio descriptivo y transversal en 47 estudiantes y 10 docentes de la Facultad de Ciencias Médicas de una universidad de Ecuador, a quienes se les aplicó un instrumento con la finalidad de conocer la práctica de los 4 principios básicos de bioética (autonomía, beneficencia, no ­ maleficencia y justicia) y analizar la importancia que tiene la deontología en la formación universitaria. Se observó que una alta proporción de docentes de odontología aplican la bioética en su labor profesional, con menos énfasis en el principio de no-maleficencia, refieren no recordar los derechos del paciente ante una demanda de mala práctica y desconocer la responsabilidad civil y penal. Mientras que, los estudiantes mostraron un nivel aceptable en los principios de autonomía y beneficencia pero pocos aplican los principios de no-maleficencia y justicia, asimismo, en su mayoría carecen de conocimientos sobre la deontología, códigos de ética médica en Ecuador y leyes que rigen el ejercicio profesional de la odontología, siendo necesario fortalecer la formación docente universitaria en bioética y optimizar programas y estrategias de aprendizaje en bioética y deontología odontológica(AU)

Professionals from different health areas have strengthened habits related to lack of consideration and cordial treatment with patients and colleagues, suggesting that the practice of professional ethics is not applied as a relevant quality in health care. On the other hand, in Ecuador there have been countless lawsuits due to medical malpractice and lack of ethical and moral values in the exercise of health. A descriptive and cross-sectional study was carried out in 47 students and 10 teachers from the Faculty of Medical Sciences of a university in Ecuador, to whom an instrument was applied in order to know the practice of the 4 basic principles of bioethics (autonomy, beneficence, no ­ maleficence and justice) and analyze the importance of ethics in university education. It was observed that a high proportion of dentistry teachers apply bioethics in their professional work, with less emphasis on the principle of non-maleficence, they refer not to remember the rights of the patient in the event of a malpractice claim and to ignore civil and criminal liability. While the students showed an acceptable level in the principles of autonomy and beneficence but few apply the principles of non-maleficence and justice, likewise, most of them lack knowledge about deontology, codes of medical ethics in Ecuador and laws that govern the professional practice of dentistry, being necessary to strengthen university teaching training in bioethics and optimize programs and learning strategies in bioethics and dental ethics(AU)

Eficacia clínica del extracto de Matico (Piper angustifolium) en la evolución de la cicatrización de heridas por estomatitis aftosa recidivante / Clinical efficacy of Matico extract (Piper angustifolium) in the evolution of wound healing due to recurrent aphthous stomatitis

La estomatitis aftosa recurrente (EAR) es un trastorno ulcerativo doloroso cíclico que comúnmente afecta la mucosa oral. Factores locales y sistémicos como trauma, sensibilidad alimentaria, deficiencias nutricionales, condiciones sistémicas y desórdenes inmunológicos están asociados con el desarrollo de la enfermedad. Debido a las similitudes en las características de las úlceras pépticas y las úlceras aftosas orales, parece razonable suponer que Helicobacter pylori podría desempeñar un papel en el desarrollo de la EAR. Las especies de Piper son plantas aromáticas que se utilizan como especias en la cocina, pero sus metabolitos secundarios también han mostrado efectos biológicos sobre la salud humana. El objetivo del presente estudio fue determinar la relación entre H. pylori y EAR y el efecto cicatrizante del extracto Matico sobre las ulceras bucales. Se reclutó a cuarenta sujetos con EAR. Los participantes fueron asignados al azar al grupo de prueba o al grupo de control. El tamaño y número de las úlceras se registraron el día 1 (valor inicial) y el día 30 (valor final). El tamaño de la ulceras, presencia de pseudomembranas y halos eritematosos fueron estadisticamente significativas en relación a la positividad de H. pylori (p <0,05). No hubo diferencias significativas entre la morfología, número y localización de las aftas (p> 0,05). El grupo que recibió el extracto tuvo un porcentaje de mejoría en la reducción del número de aftas del 65% el día final de evaluación en comparación de sólo un 25% del grupo que no recibió el extracto Matico(AU)

Recurrent aphthous stomatitis (RAS) is a cyclic painful ulcerative disorder that commonly affects the oral mucosa. Local and systemic factors such as trauma, food sensitivity, nutritional deficiencies, systemic conditions, immunological disorders and genetic polymorphisms are associated with the development of the disease. Because of similarities in the characteristics of peptic ulcers and oral aphthous ulcers, it seems reasonable to hypothesize that Helicobacter pylori could play a role in the development of RAS. Piper species are aromatic plants used as spices in the kitchen, but their secondary metabolites have also shown biological effects on human health. The aim of the present study was to determine the relationship between H. pylori and RAS and the healing effect of Matico extract on mouth ulcers. Fuorty subjects with RAS were recruited. The participants were randomly allocated to the test group or the control group. The size and number of ulcers were recorded on day 1 (initial value) and day 30 (final value). The size of the ulcers, the presence of pseudomembranes and erythematous halos were statistically significant in relation to the positivity of H. pylori (p <0.05). There were no significant differences between the morphology, number and location of the canker sores (p> 0.05). The group that received the extract had a percentage improvement in the reduction of the number of canker sores of 65% on the final day of evaluation compared to only 25% of the group that did not receive the Matico extract(AU)

Caracterización epidemiológica de pacientes con miopatía inflamatoria en un hospital de cuarto nivel en Cali, Colombia / Epidemiological characterization of patients with inflammatory myopathy in a fourth level hospital in Cali, Colombia

Introducción: Las miopatías inflamatorias idiopáticas (MII) constituyen un grupo heterogéneo de enfermedades que comprometen la musculatura esquelética y se manifiestan por debilidad y signos inflamatorios en la biopsia muscular. El objetivo de este estudio es hacer una caracterización epidemiológica de una cohorte de pacientes con MII en una población del suroccidente colombiano. Metodología: De forma retrospectiva, se revisaron las historias clínicas de pacientes con diagnóstico de MII que fueron tratados en un hospital de cuarto nivel de complejidad en Cali, Colombia, entre el 2011 y el 2017. Se recolectaron variables demográficas, clínicas, serológicas y de tratamiento. Resultados: Se identificaron 72 pacientes con MII, mayoritariamente mujeres (n = 54, 75%). La media de edad al inicio de los síntomas fue de 37,11 ± 19,18 años. Las principales MII fueron dermatomiositis (DM) y polimiositis, las cuales se presentaron en 35 (48,6%) y 25 pacientes (34,7%), respectivamente. Veintiocho pacientes (38,8%) presentaban enfermedad autoinmune asociada, siendo el lupus eritematoso sistémico la más frecuente, al presentarse en7 (9,72%) pacientes. La biopsia de músculo se realizó en 25 pacientes (34,7%), mientras que28 (38,8%) tenían anticuerpos antinucleares positivos. La mediana de la creatinfosfoquinasa fue de 877,5 mg/dL (163,5-4.358,3). Sesenta y siete pacientes (93,1%) fueron tratados con glucocorticoides y 18 (25%) con rituximab (RTX) como monoterapia o combinado con otro fármaco inmunosupresor. Conclusiones: La DM es la condición clínica más frecuente, es común en mujeres y se presenta en la cuarta década de vida. Los tratamientos con los que más se obtuvo mejoría clínica fueron los glucocorticoides, seguidos del RTX en monoterapia o combinado con otros inmunosupresores.

Background: Idiopathic inflammatory myopathies (IIM) are a heterogeneous group of diseases characterised by skeletal muscle involvement, manifested by weakness and inflammatory signs in the muscle biopsy. The objective of this article is to describe the clinical, laboratory, and treatment features of a cohort of patients with IIM in southwest Colombia. Methods: A retrospective review was conducted on the medical records of patients diagnosed with IIM treated at a fourth-level complexity hospital in Cali, Colombia, from 2011 to 2017. Demographic, clinical, serological, and treatment data were collected. Results: A total of 72 patients with IIM were identified, mostly women (n = 54,75%). The mean age at onset of symptoms was 37.11 ± 19.18 years. The main subtypes of IIM were dermatomyositis (DM) and polymyositis, occurring in 35 patients (48.6%) and 25 patients (34.7%), respectively. Twenty-eight patients (38.8%) had associated autoimmune disease, with syste mic lupus erythematosus being the most frequent in 7 (9.72%) patients. Muscle biopsy was performed in 25 patients (34.7%), while 28 (38.8%) had positive antinuclear antibodies. The median creatine phosphokinase was 877.5 mg/dL (163.5-4358.3). Sixty-seven patients (93.1%) were treated with glucocorticoids, and 18 (25%) patients were treated with rituximab (RTX) as monotherapy or combined with another immunosuppressant drug. Conclusions: DM is the most frequent subtype of IIM, being common in women and occurring in the fourth decade of life. The most used treatments were glucocorticoids, followed by RTX monotherapy, or combined with other immunosuppressants.

Rituximab for Inflammatory Myopathies in a Colombian Cohort.

INTRODUCTION/OBJECTIVES: Rituximab (RTX) is a treatment for refractory inflammatory myopathies, such as dermatomyositis (DM) and polymyositis (PM). This study describes the characteristics of patients receiving RTX for myositis in our institution to evaluate its efficacy. METHOD: We collected demographic data from all patients diagnosed with DM or PM who received RTX between 2011 and 2018. Clinical and serological variables (including creatine phosphokinase [CPK] levels) were analyzed. Remission of disease was defined as no evidence of disease activity (active myositis) for longer than a 6-month continuous period while undergoing myositis therapy or no medication. RESULTS: Eighteen patients who had received first-line immunosuppressants were included. Fifteen (83%) had DM, 2 (11%) had PM, 1 had juvenile dermatomyositis, and 14 (77%) were women. All patients received glucocorticoids. Three patients (16.6%) were treated with RTX as monotherapy, and 15 (83.3%) were treated with RTX combined with other immunosuppressants. On average, there were 2 RTX treatment cycles. Improved muscular weakness was found in 13 cases (72%), and improved serum CPK levels were found in 15 cases (83%). Twelve patients (66%) achieved remission. CONCLUSIONS: Most patients experienced an objective improvement, as reflected in their serum CPK values and degree of muscular weakness. This suggests that RTX could be helpful in treating refractory myositis.

Therapeutic Plasma Exchange as Management of Complicated Systemic Lupus Erythematosus and Other Autoimmune Diseases.

INTRODUCTION: Autoimmune diseases include a diverse and complex group of pathologies with a broad clinical spectrum due to the production of autoantibodies, which generates multisystemic compromise. Therapeutic plasma exchange (TPE) is a good additive treatment for immunosuppression due to its action over the autoantibodies. OBJECTIVES: To describe the main clinical characteristics and outcomes of patients with systemic lupus erythematosus and other systemic autoimmune diseases managed with TPE. METHODOLOGY: This descriptive retrospective study enrolled patients with systemic autoimmune diseases who received TPE. RESULTS: In total, 66 patients with a median age of 33.5 years (24-53 years) were included; the majority were females [n=51 (77.27%)]. Forty (60.61%) patients were diagnosed with systemic lupus erythematosus. In these cases, the main indication for TPE was diffuse alveolar hemorrhage (DAH; n=20, 30.3%) and neurolupus (n=9, 13.6%). No TPE-related deaths occurred, and the main complication was hemorrhage, without significant differences among the four types of TPE solutions used. The overall outcome was improvement in 41 (62.12%) patients. CONCLUSION: TPE is safe and effective in patients with severe manifestations of autoimmune diseases.

Experiencias de participación de los hombres en el cuidado de su pareja gestante / The participatory experiences of men in the care for pregnant women

Se realizó un estudio cualitativo fenomenológico con nueve hombres entre 19 y 36 años en un programa materno de Cúcuta, que buscó comprender sus experiencias de participación en el cuidado de su pareja gestante. En las narrativas emergen construcciones frente al embarazo y su aceptación, emocionalidad, cambios asociados, significados en torno a la paternidad y al cuidado, enmarcados en el deber ser masculino. Cuidar a su pareja les genera satisfacción porque cumplen con el rol social esperado. Emergen significados del cuidado a su pareja asociados a "responsabilidad" y "deber", sustentados en el rol de proveedores y protectores de su pareja gestante y del hijo por venir. Los hombres vivencian diversos cambios: suspenden proyectos planteados, se reconocen más tiernos, maduros y vinculados a sus parejas, reducen sus espacios sociales y perciben trasformaciones en la gestante y en la relación afectiva y sexual. Actúa como barrera principalmente su trabajo, debido a horarios, condiciones laborales y autoexigencia. Se hace necesario involucrar a los hombres en mayor medida en los espacios reproductivos de atención en salud para conocer sus experiencias, ofrecerles información y para que, junto a la gestante, puedan vivir el embarazo fortalecidos en esta nueva etapa.

A phenomenological qualitative study was carried out in nine men, between 19 and 36 years old, in a maternal program in Cucuta, to understand their experiences of participation in caring their pregnant partner. In the narratives, constructions around pregnancy emerge, as well as its acceptance, emotionality and associated changes, meanings attributed to fatherhood and care framed by the duty to be masculine. Caring for their partners generates satisfaction because it fulfills the expected social role. Meanings of caring their partners, associated to "responsibility" and "sense of duty", sustained in the role of providers and protectors to their gestating couple and in the son to come, emerge. Men experience various changes: they suspend proposed projects, they are more tender and linked to their partners, they reduce their social spaces and perceive transformations in the pregnant woman and in the affective and sexual relationship. Their principal barrier is their work, due to schedules, working conditions and self-demand. It is necessary to involve men in reproductive health care spaces to know their experiences, to give them information, so that, together with pregnant women, they can be stronger to live the pregnancy.

Utilidad de la plasmaféresis en pacientes con lupus eritematoso sistémico en un centro de alta complejidad del suroccidente colombiano / Utility of plasma exchange in patients with systemic lupus erythematosus in a centre of high complexity of the Colombian Southwest

Introducción y Objetivo: El lupus eritematoso sistémico (LES) es una enfermedad multiorgánica mediada principalmente por el depósito de complejos inmunes en órganos blanco, los cuales pueden ser removidos rápidamente mediante plasmaféresis, considerándose esta modalidad terapéutica clave para el manejo de pacientes críticos, sumado al tratamiento inmunosupresor. Nuestro objetivo es describir las principales características clínicas y desenlaces de pacientes con LES quienes recibieron manejo con recambio plasmático terapéutico (PEX) en un hospital de alta complejidad del suroccidente colombiano. Métodos: Se realizó un estudio descriptivo, donde se incluyeron pacientes con diagnóstico de LES quienes hayan recibido PEX. Resultados: Un total de 40 pacientes fueron incluidos.

Valuing blue carbon: carbon sequestration benefits provided by the marine protected areas in Colombia.

Marine protected areas are aimed to protect and conserve key ecosystems for the provision of a number of ecosystem services that are the basis for numerous economic activities. Among the several services that these areas provide, the capacity of sequestering (capturing and storing) organic carbon is a regulating service, provided mainly by mangroves and seagrasses, that gains importance as alternatives for mitigating global warming become a priority in the international agenda. The objective of this study is to value the services associated with the capture and storage of oceanic carbon, known as Blue Carbon, provided by a new network of marine protected areas in Colombia. We approach the monetary value associated to these services through the simulation of a hypothetical market for oceanic carbon. To do that, we construct a benefit function that considers the capacity of mangroves and seagrasses for capturing and storing blue carbon, and simulate scenarios for the variation of key variables such as the market carbon price, the discount rate, the natural rate of loss of the ecosystems, and the expectations about the post-Kyoto negotiations. The results indicate that the expected benefits associated to carbon capture and storage provided by these ecosystems are substantial but highly dependent on the expectations in terms of the negotiations surrounding the extension of the Kyoto Protocol and the dynamics of the carbon credit's demand and supply. We also find that the natural loss rate of these ecosystems does not seem to have a significant effect on the annual value of the benefits. This approach constitutes one of the first attempts to value blue carbon as one of the services provided by conservation.