Mucosal leishmaniasis mimicking squamous cell carcinoma in a liver transplant recipient.

Organ transplant recipients living in endemic regions are at increased risk of Leishmania infections. Visceral leishmaniasis is the most common kind of presentation in the Mediterranean basin. Rarely, Leishmania infantum may cause localized mucosal disease. We present the first case, to our knowledge, of a liver transplant recipient with localized mucosal leishmaniasis. Twenty-two years after transplantation, a painless, very slow growing ulcer appeared on the inner side of the patient's upper lip. A biopsy performed in the community hospital showed non-specific chronic inflammation without neoplastic signs. Because of a high suspicion of malignancy, the patient was transferred to the referral hospital to consider complete excision. The excisional biopsy revealed a granulomatous inflammatory reaction together with intracellular Leishmania amastigotes within macrophages. Leishmaniasis was confirmed by the nested polymerase chain reaction assay. The clinical and laboratory findings did not suggest visceral involvement. The patient received meglumine antimoniate for 21 days without relevant adverse effects.

Application of real-time PCR for the differentiation of Entamoeba histolytica and E. dispar in cyst-positive faecal samples from 130 immigrants living in Spain.

In an effort to improve the diagnosis of intestinal amoebiasis, a real-time PCR has been used for the detection and differentiation of Entamoeba histolytica and E. dispar infections in African or South American immigrants who live in Spain. Faecal samples from all of the 130 subjects had apparently been found to contain E. histolytica/E. dispar cysts by microscopical examination. Using the real-time PCR, E. histolytica DNA was detected in faecal samples from only 10 (7.7%) of the immigrants, with E. dispar DNA detected in the samples from another 117 (90.0%) of the subjects. The use of such PCR in the routine investigation of patients found positive for E. histolytica/E. dispar cysts (by microscopy) is recommended, especially in non-endemic areas.

[Primary localized amyloidosis of glans penis. A new case and review of the literature]. / Amiloidosis primaria localizada en glande peneano. Caso clínico y revisión de la literatura.

Primary localized amyloidosis urinary tract is rare. Localized amyloidosid only glands is a very rare entity. The clinical impression may resemble neoplastic disease but the diagnosis is confirmed by histochemical study. Biopsy of the lesion revealed dermal deposits of amorphous eosinophilic material. A case of patient with primary amyldosis of glands penis is reported. The literature is reviewed and the diagnostic and therapeutic options are discussed. This is the seventh reported case of localized amyloidosis of the glands penis.

Amiloidosis primaria localizada en glande peneano. Caso clínico y revisión de la literatura / Primary localized amyloidosis of glans penis. A new case and review of the literature

La amiloidosis primaria del tracto genitourinario es rara siendo aún más excepcional la afectación única del glande. Generalmente la clínica apunta al diagnóstico de carcinoma de pene y es el examen histológico el que indicará definitivamente el diagnóstico. La Biopsia de la lesión revela depósitos dérmicos de material amorfo eosinofílico. Se presenta el caso de un paciente con amiloidosis primaria en glande. Se realiza revisión de la literatura y se analizan las diferentes actitudes diagnósticas y terapéuticas. Éste es el séptimo caso de amiloidosis primaria localizada en glande descrito en la literatura

Primary localized amyloidosis urinary tract is rare. Localized amyloidosid only glands is a very rare entity. The clinical impression may resemble neoplastic disease but the diagnosis is confirmed by histochemical study. Biopsy of the lesion revealed dermal deposits of amorphous eosinophilic material. A case of patient with primary amyldosis of glands penis is reported. The literature is reviewed and the diagnostic and therapeutic options are discussed. This is the seventh reported case of localized amyloidosis of the glands penis

[Haemophilus spp. antimicrobial susceptibility in Health Area 6 in Madrid, Spain (2000-2004)]. / Sensibilidad antibiotica de Haemophilus spp. en el Area 6 de la Comunidad de Madrid (2000-2004).

The aim of this study was to assess the antimicrobial susceptibility of 1370 Haemophilus spp. (1051 H. influenzae and 319 H. parainfluenzae) isolated during a 4-year period (July 2000 to June 2004) and to compare the results with other nationwide Spanish surveillance studies. The rate of isolation of H. parainfluenzae was significantly higher in clinical samples from the genitourinary tract (p <0.00001) and skin and soft tissues (p <0.00001), whereas H. influenzae was significantly more frequent in clinical respiratory tract samples (p <0.00001). A total of 46.2% and 31.8% of H. influenzae were isolated in infants and children of 2-6 years old, respectively; whereas 73.3% of H. parainfluenzae was isolated in patients older than age 14. Overall, 22.2% and 18.5% of the H. influenzae and H. parainfluenzae, respectively, were found to produce betalactamase. A total of 1.9% of betalactamase-negative H. influenzae were found to be resistant to ampicillin. Four strains (0.4%) of betalactamase-producing H. influenzae were resistant to amoxicillin-clavulanic acid, all isolated from infants. The rate of ampicillin susceptibility was significantly higher (p <0.01) in H. parainfluenzae than in H. influenzae. All of the 1370 strains of Haemophilus spp. were susceptible to cefotaxime and ciprofloxacin. The susceptibility to clarithromycin, trimethoprim-sulfamethoxazole, tetracycline, chloramphenicol and rifampin were 86.9%, 61.5%, 96.7%, 99.1% and 95.2% for H. influenzae versus 81.2%, 55.8%, 76.5%, 90,9% and 733% for H. parainfluenzae. In conclusion, H. influenzae is more resistant to ampicillin and H. parainfluenzae to non-betalactam antimicrobials. All isolates were susceptible to cefotaxime and ciprofloxacin.

Sensibilidad antibiótica de Haemophilus spp. en el Área 6 de la Comunidad de Madrid (2000-2004) / Haemophilus spp. antimicrobial susceptibility in Health Area 6 in Madrid, Spain (2000-2004)

El objetivo de este estudio retrospectivo fue evaluar la sensibilidad antibiótica de 1370 cepas de Haemophilus spp. (1051 H. influenzae y319 H. parainfluenzae) aisladas durante cuatro años (julio de 2000 a junio de 2004), y comparar estos datos entre sí y con los resultadosobtenidos en otras zonas de España. En las muestras del aparato genitourinario (p <0.00001) y de piel y tejidos blandos (p <0.00001) seaisló con más frecuencia H. parainfluenzae, mientras que en las procedentes del aparato respiratorio y anejos predominó H. influenzae(p <0.00001). El 46,2% y el 31,8% de H. influenzae se aislaron en lactantes y niños de 2 a 6 años, respectivamente, mientras que el 73,3%de H. parainfluenzae se aisló en pacientes mayores de 14 años. La prevalencia de la producción de betalactamasas fue del 22,2% en H. influenzaey el 18,5% en H. parainfluenzae. La resistencia a la ampicilina sin producción de betalactamasas se encontró en el 1,9% de H. influenzae.Cuatro cepas (0,4%) de H. influenzae productoras de betalactamasas fueron resistentes a amoxicilina-ácido clavulánico, todas aisladas de lactantes.La sensibilidad a la ampicilina es mayor (p <0.01) en H. parainfluenzae que en H. influenzae. Las 1370 cepas de Haemophilus spp.fueron sensibles a cefotaxima y ciprofloxacino. La sensibilidad a claritromicina, cotrimoxazol, tetraciclina, cloranfenicol y rifampicina fue del86,9%, 61,5%, 96,7%, 99,1% y 95,2% en H. influenzae, y del 81,2%, 55,8%, 76,5%, 90,9% y 73,3% en H. parainfluenzae, respectivamente.En conclusión, H. influenzae es más resistente a la ampicilina y H. parainfluenzae es más resistente a los antimicrobianos no betalactámicos.Todas las cepas de Haemophilus spp. fueron sensibles a cefotaxima y ciprofloxacino

The aim of this study was to assess the antimicrobial susceptibility of 1370 Haemophilus spp. (1051 H. influenzae and 319 H. parainfluenzae)isolated during a 4-year period (July 2000 to June 2004) and to compare the results with other nationwide Spanish surveillance studies. Therate of isolation of H. parainfluenzae was significantly higher in clinical samples from the genitourinary tract (p <0.00001) and skin and softtissues (p <0.00001), whereas H. influenzae was significantly more frequent in clinical respiratory tract samples (p <0.00001). A total of46.2% and 31.8% of H. influenzae were isolated in infants and children of 2-6 years old, respectively; whereas 73.3% of H. parainfluenzaewas isolated in patients older than age 14. Overall, 22.2% and 18.5% of the H. influenzae and H. parainfluenzae, respectively, were foundto produce betalactamase. A total of 1.9% of betalactamase-negative H. influenzae were found to be resistant to ampicillin. Four strains(0.4%) of betalactamase-producing H. influenzae were resistant to amoxicillin-clavulanic acid, all isolated from infants. The rate of ampicillinsusceptibility was significantly higher (p <0.01) in H. parainfluenzae than in H. influenzae. All of the 1370 strains of Haemophilus spp.were susceptible to cefotaxime and ciprofloxacin. The susceptibility to clarithromycin, trimethoprim-sulfamethoxazole, tetracycline, chloramphenicoland rifampin were 86.9%, 61.5%, 96.7%, 99.1% and 95.2% for H. influenzae versus 81.2%, 55.8%, 76.5%, 90,9% and 733%for H. parainfluenzae. In conclusion, H. influenzae is more resistant to ampicillin and H. parainfluenzae to non-betalactam antimicrobials.All isolates were susceptible to cefotaxime and ciprofloxacin

[Bacterial conjunctivitis: most prevalent pathogens and their antibiotic sensitivity]. / Conjuntivitis bacteriana: patógenos más prevalentes y sensibilidad antibiótica.

INTRODUCTION: Bacterial conjunctivitis is a self-limiting process, but topical antibiotic treatment is recommended to eradicate the pathogen and reduce symptom duration. Since this treatment is usually empirical and prior cultures are not normally taken, the etiological agents involved in the process are unknown. PATIENTS AND METHODS: A total of 596 conjunctival exudates from pediatric outpatients with a diagnosis of acute conjunctivitis in Medical Area 6 of Madrid, Spain, were studied over 3 years (from 2000 to 2002 inclusive). The patients were divided into three age groups: group 1 (infants), group 2 (2- to 6-year-olds) and group 3 (7- to 14-year-olds). RESULTS: A total of 428 bacteria were isolated. The most prevalent bacteria were Haemophilus influenzae (44.8 %) and Streptococcus pneumoniae (30.6 %) followed by Staphylococcus aureus (7.5 %), S. viridans (7.2 %), Moraxella catarrhalis (6.8 %) and Enterobacteriaceae (4.2 %). In 56 exudates (15.1 %), two or more bacteria were isolated and S. pneumoniae 1 H. influenzae were found in 8.1 % of the cases. By age group, S. aureus was significantly more prevalent (p < 0.0001) in group 3 than in groups 1 and 2. Isolation of Enterobacteriaceae, S. viridans and non-fermentative Gram negative bacilli was significantly more frequent (p < 0.05) in group 1 and isolation of S. pneumoniae (p < 0.05) was significantly more frequent in group 2. S. pneumoniae showed the greatest level of resistance to antibiotics used in eye drops and ophthalmic ointments. Ciprofloxacin, chloramphenicol and rifampin were active in the most prevalent pathogens. CONCLUSIONS: The most prevalent bacteria were H. influenzae and S. pneumoniae. The most active antibiotics in these pathogens were ciprofloxacin, chloramphenicol and rifampin.

Conjuntivitis bacteriana: patógenos más prevalentes y sensibilidad antibiótica / Bacterial conjunctivitis: most prevalent pathogens and their antibiotic sensitivity

Introducción. La conjuntivitis bacteriana es un proceso autolimitado, pero se recomienda antibioticoterapia tópica para erradicar el patógeno y acortar la duración de los síntomas. Este tratamiento habitualmente es empírico, sin cultivo previo y por lo tanto sin conocer los agentes etiológicos implicados en el proceso. Pacientes y métodos. Se revisaron los aislamientos de 596 exudados conjuntivales de los últimos 3 años (2000-2002), procedentes de pacientes pediátricos extrahospitalarios del área 6 de Madrid, con diagnóstico de conjuntivitis aguda. Los pacientes se dividieron en tres grupos de edades: grupo 1, lactantes; grupo 2, entre 2 y 6 años, y grupo 3, entre 7 y 14 años. Resultados. Se aislaron un total de 428 bacterias: Haemophilus influenzae (44,8 por ciento) y Streptococcus pneumoniae (30,6 por ciento) fueron las bacterias más prevalentes, seguidas por Staphylococcus aureus (7,5 por ciento), Streptococcus grupo viridans (7,2 por ciento), Moraxella catarrhalis (6,8 por ciento) y Enterobacteriaceae (4,2 por ciento). En 56 exudados (15,1 por ciento) se aislaron dos o más bacterias, siendo en el 8,1 por ciento de los casos S. pneumoniae + H. influenzae. Por grupos de edades se encontró que S. aureus fue significativamente más frecuente (p < 0,0001) en los niños del grupo 3 que en los de los grupos 1 y 2. Enterobacteriaceae, Streptococcus grupo viridans y los bacilos gramnegativos no fermentadores (BGNNF) se aíslan significativamente con más frecuencia (p < 0,05) en el grupo 1 y S. pneumoniae (p < 0,05) en el grupo 2. S. pneumoniae ha sido la bacteria que ha presentado un mayor nivel de resistencia a los antimicrobianos de uso en colirios o pomadas oftálmicas. Ciprofloxacino, cloranfenicol y rifampicina fueron activos en la mayoría de los patógenos más prevalentes. Conclusiones. H. influenzae y S. pneumoniae fueron las bacterias más prevalentes. Ciprofloxacino, cloranfenicol y rifampicina fueron los antibióticos más activos frente a estos patógenos (AU)

Escabiosis en lactante / Scabies in infant

No disponible

Litotricia extracorpórea por ondas de choque. Un tratamiento establecido / Extracorporeal shock wave lthotripsy. A well established therapeutic approach

La litotricia extracorpórea por ondas de choque (ESWL) es la forma de tratamiento de la litiasis urinaria más demandada en nuestro país y en el resto del mundo. Prácticamente ha sustituido a las otras formas de terapia (cirugía convencional, ureteroscopia, nefrolitectomía percutánea). Sin embargo éstas aun tienen sus indicaciones. Aunque no hay un consenso definitivo, sería deseable demarcar el terreno de cada una de las modalidades de tratamiento a fin de un mayor aprovechamiento de los potenciales de cada terapia que en muchos casos pueden ser complementarios. En este artículo se revisan los aspectos técnicos de la ESWL, las indicaciones más aceptadas en la literatura en cálculos renales y ureterales, los efectos adversos de este tratamiento y, por último, se consideran las mejoras futuras en su aplicación (AU)

[Extracorporeal shock-wave lithotripsy. An established treatment]. / Litotricia extracorpórea por ondas de choque. Un tratamiento establecido.

Extracorporeal shock wave lithotripsy (ESWL) is the most required urinary stone therapy in our country and in the rest of the world. In a way it has replaced the alternative treatments (open surgery, percutaneous nephrolithectomy, ureteroscopy). Nevertheless these therapeutic approaches have still its own indications. Although there is no a definitive agreement, it should be desirable a world-wide consensus where each therapy will have a exactly defined land with all potential of each management improved. We review ESWL technical aspects, its literature-based most accepted indications, adverse bioeffects and last, future improvements are considered.

Inhaled nitric oxide improves survival rates during hypoxia in a sickle cell (SAD) mouse model.

BACKGROUND: The hallmark of sickle cell disease (SCD) is erythrocyte sickling during deoxygenation of the abnormal hemoglobin S (HbS). When HbS is deoxygenated, it aggregates into polymers, resulting in distortion of the erythrocyte structure, producing microvascular thrombosis and ischemia. The transgenic SAD mouse produces three types of human hemoglobin: S, Antilles, and D-Punjab (HbSAD) and provides an animal model for SCD. We studied the effects of nitric oxide (NO) breathing at various doses and time regimens in the presence of severe hypoxia (6% oxygen) using the SAD mouse model. METHODS: Age- and sex-matched control and SAD mice were exposed to 6% oxygen breathing in an environmental chamber and assessed for survival up to 1 h. Animals received different inhaled NO concentrations before and/or during hypoxia. Blood was obtained to evaluate the oxyhemoglobin dissociation curve and measure methemoglobinemia. RESULTS: Pretreatment by breathing NO at 20 ppm by volume in air for 30 min, and continuing to breathe 20 ppm NO during hypoxia resulted in improvement in survival rates in the SAD mouse (75%, n = 8) as compared with control SAD mice (11%, n = 9; P < 0.001). Pretreatment alone or breathing lower doses of NO were not protective. Changes in HbSAD oxygen affinity were not detected with NO breathing, and methemoglobin levels were low in all surviving mice. CONCLUSIONS: Breathing NO produced a rapid, protective effect to severe hypoxic stress in SAD mice. There appears to be a required loading period between NO breathing and its beneficial effect during hypoxic stress, possibly because of the total amount of NO delivered to SAD hemoglobin, blood cell components, and endothelium. NO breathing may be beneficial as a therapeutic intervention in SCD.

[Results of the application of a health test in a population of immigrants]. / Resultados de la aplicación de un examen de salud en población inmigrante.

OBJECTIVE: To describe the demographic characteristics and the results of a healthcare exam of immigrants. DESIGN: A retrospective descriptive study. SETTING: Rural doctor office of Villafranca del Castillo. Madrid. PATIENTS: All immigrants (n = 76) that came for care between May of 1996 and May of 1998. INTERVENTIONS: History, physical exam and basic laboratory tests. RESULTS: Demographic data: 82% are women with a medium age of 33 years (SD 8.49). Their places of origin are Central America: 70%, Philippines: 20%, Africa: 5% and South America: 3%. 97% of them work as household employees or gardeners. They have been living in Spain for an average time of 56 months. Health data: 21.1% are smokers and 17.1% low risk drinkers. 64.5% lack tetanus vaccine and 11.8% lack both tetanus and rubeola vaccines. Serologic test for HBV are negative in 68.4%. 14.5% have past infection and there are no cases of chronic or active infection. PPD is over 10 mm in 35.5%, and between 5 and 10 mm in 7.9%. Prevalence of active TBC is 0%. Stool culture is positive in 6.5%. Salmonella tiphy is identified in one case. Stool examination for ova and parasites is positive in 42.1% of the patients. Protozoos (88%) are more common than helminths (12%). CONCLUSIONS: This study reveals a selective young and healthy immigrant group. The low presence of hepatitis B and tuberculosis infections are notable. The majority present parasites in stool samples.

Resultados de la aplicación de un examen de salud en población inmigrante / Results of a healthcare exam of inmigrants

Objetivo. Describir las características demográficas y los resultados de un examen de salud a inmigrantes. Diseño. Estudio descriptivo retrospectivo Emplazamiento. Consultorio médico rural de Villafranca del Castillo. Madrid. Pacientes. Todos los inmigrantes (n = 76) con historia clínica abierta y activa entre mayo de 1996 y mayo de 1998. Intervenciones. Examen de salud de salud consistente en: encuesta de salud, exploración física y pruebas complementarias. Mediciones y resultados principales. Datos demográficos: un 82 por ciento son mujeres. Tienen una edad media de 33 años (DE, 8,49) y proceden de: América Central, 69 por ciento; Filipinas, 20 por ciento; África, 5 por ciento, y Sudamérica, 3 por ciento. Un 97 por ciento trabaja como empleados/as de hogar o jardineros y llevan residiendo en España un tiempo medio de 56 meses. Datos de salud: El 21,1 por ciento es fumador y un 17,1 por ciento bebedor de bajo riesgo. Un 64,5 por ciento presenta una cobertura vacunal deficiente de tétanos y un 11,8 por ciento de tétanos y rubéola. La serología del VHB (virus hepatitis B) es negativa en el 68,4 por ciento. No se detecta ningún caso de hepatitis activa o crónica por VHB y un 14,5 por ciento presenta serología de infección pasada. Un 35,5 por ciento presenta Mantoux > 10 mm (infección tuberculosa) y un 7,9 por ciento Mantoux de 5-10 mm (probable origen vacunal). La prevalencia TBC activa es del 0 por ciento. El coprocultivo es positivo en un 6,5 por ciento. Se detecta un caso de Salmonella tiphy. Se detectan parásitos o huevos en heces en el 42,1 por ciento. De ellos un 88 por ciento, protozoos, y el 12 por ciento, helmintos. En un 17,1 por ciento de los casos se encuentra más de un parásito. Conclusiones. El estudio muestra una inmigración selectiva joven y sana. Destaca la baja prevalencia de hepatitis B y de infección tuberculosa y la presencia de parásitos en heces en la mayor parte de los inmigrantes (AU)

High-speed running performance is largely unaffected by hypoxic reductions in aerobic power.

We tested the importance of aerobic metabolism to human running speed directly by altering inspired oxygen concentrations and comparing the maximal speeds attained at different rates of oxygen uptake. Under both normoxic (20.93% O2) and hypoxic (13.00% O2) conditions, four fit adult men completed 15 all-out sprints lasting from 15 to 180 s as well as progressive, discontinuous treadmill tests to determine maximal oxygen uptake and the metabolic cost of steady-state running. Maximal aerobic power was lower by 30% (1.00 +/- 0.15 vs. 0.77 +/- 0.12 ml O2. kg-1. s-1) and sprinting rates of oxygen uptake by 12-25% under hypoxic vs. normoxic conditions while the metabolic cost of submaximal running was the same. Despite reductions in the aerobic energy available for sprinting under hypoxic conditions, our subjects were able to run just as fast for sprints of up to 60 s and nearly as fast for sprints of up to 120 s. This was possible because rates of anaerobic energy release, estimated from oxygen deficits, increased by as much as 18%, and thus compensated for the reductions in aerobic power. We conclude that maximal metabolic power outputs during sprinting are not limited by rates of anaerobic metabolism and that human speed is largely independent of aerobic power during all-out runs of 60 s or less.