Análisis dermatoscópico de 72 queratosis seborreicas "atípicas" / Dermoscopic Analysis of 72 "Atypical" Seborrheic Keratoses

Antecedentes: Las queratosis seborreicas (QS) son reconocidas con facilidad a través de una aproximación clínica y dermatoscópica, sin embargo, algunas lesiones presentan un comportamiento que simula distintas afecciones de la piel que carecen de criterios clínicos y dermatoscópicos típicos. Objetivo: El objetivo de este estudio fue encontrar características dermatoscópicas específicas o un patrón general que permita mejorar las habilidades diagnósticas en los casos de QS complejas. Materiales y métodos: Estudiamos 72 casos de QS atípicas extirpadas entre septiembre del 2014 y septiembre del 2017 utilizando para ello el algoritmo en 2 pasos modificado por Malvehy (2002) y Argenziano (2003). Resultados: En nuestra población de estudio, encontramos una media de 4,04 de los 15 criterios específicos dermatoscópicos de QS (por ejemplo, múltiples puntos similares a quistes tipo milium). Se identificaron los siguientes criterios adicionales no incluidos en el algoritmo en 2 pasos: velo azul-blanquecino (en 3 QS; 4,2%), patrón vascular polimorfo (18 QS; 25%), manchas/glóbulos (6 QS; 8,3%), manchas blancas brillantes (3 lesiones; 4,2%). Los patrones generales más representados fueron el patrón reticular (27 QS; 37,5%) y no específico (15 QS; 20,8%). Todas las lesiones exhibieron hallazgos peculiares de QS; además, en el 79,2% de todas las lesiones estudiadas se identificaron elementos indicativos de lesión melanocítica. Cuando comparamos la literatura con nuestros resultados, encontramos 3 diferencias significativas: a) una menor prevalencia de los criterios específicos de QS en nuestra población de estudio; b) la identificación de hallazgos generalmente no relacionados con la QS, como el velo azul-blanquecino, el patrón vascular polimorfo, las manchas/glóbulos y las manchas blancas brillantes, y c) también se describieron 2 patrones no definidos previamente representados por «patrón no específico» (20,9% de todas las lesiones examinadas) y "patrón vascular" (12,5% de todas las lesiones examinadas). No se encontró ninguna característica específica o patrón general estadísticamente significativo para el diagnóstico dermatoscópico de QS de diagnóstico difícil. Conclusión: A pesar de los hallazgos, no hemos encontrado ningún patrón específico o general estadísticamente significativo para el diagnóstico dermatoscópico de la QS de diagnóstico difícil. Conforme al algoritmo en 2 pasos y el sistema de puntuación dermatoscópica para lesiones melanocíticas y no melanocíticas, las QS con uno o varios hallazgos dermatoscópicos típicos de lesión melanocítica deberían ser extirpados quirúrgicamente para excluir el melanoma clásico o el melanoma que simula una QS

Background: Seborrheic keratoses (SK) are easily recognizable by clinical and dermoscopic approach, nevertheless, some lesions act as a simulator of different skin conditions lacking typical clinical and dermoscopic criteria. Objective: The aim of our study was to find specific dermoscopic features or a global pattern to improve diagnostic skills for challenging SK. Materials and methods: We examined 72 atypical SK excised from September 2014 up to September 2017 by using the 2-step algorithm modified by Malvehy (2002) and Argenziano (2003). Results: In our study population, an average of 4.04 out of 15 dermoscopic specific criteria for SK was found (for example, multiple milia-like cysts). Additional criteria not included in 2-step algorithm were blue-whitish veil (found in 3 SK; 4.2%), polymorphous vessels (18 SK; 25%), blotch/globules (6 SK; 8.3%), shiny white streaks (3 lesions; 4.2%). The most represented global patterns were reticular (27 SK; 37.5%) and not specific (15 SK; 20.8%). All lesions exhibited peculiar findings of SK, furthermore elements suggestive for melanocytic lesion were found in 79.2% of all lesions. Comparing the literature and our results, we found 3 significant differences: a) the less prevalence of SK specific criteria in our study population; b) the description of findings usually not related to SK, among which blue-whitish veil, polymorphous vessels, blotch/globules and shiny white streaks, and c) 2 patterns not previously defined represented by "not specific pattern" (20.9% of all lesions examined) and "vascular pattern" (12.5% of all lesions examined) were also described. No specific feature or global pattern, statistically significant for dermoscopic diagnosis of difficult-to-diagnose SK have been found. Conclusion. Nevertheless the useful findings, no specific feature or global pattern statistically significant for dermoscopic diagnosis of challenging SK have been found. According to the 2-step algorithm and the dermatoscopic scoring system for melanocytic and not melanocytic lesion, SK with one or more dermatoscopic findings typical of melanocytic lesion should be removed surgically to exclude classic melanoma or melanoma mimicking SK

Dermoscopic Analysis of 72 "Atypical" Seborrheic Keratoses. / Análisis dermatoscópico de 72 queratosis seborreicas «atípicas¼.

BACKGROUND: Seborrheic keratoses (SK) are easily recognizable by clinical and dermoscopic approach, nevertheless, some lesions act as a simulator of different skin conditions lacking typical clinical and dermoscopic criteria. OBJECTIVE: The aim of our study was to find specific dermoscopic features or a global pattern to improve diagnostic skills for challenging SK. MATERIALS AND METHODS: We examined 72 atypical SK excised from September 2014 up to September 2017 by using the 2-step algorithm modified by Malvehy (2002) and Argenziano (2003). RESULTS: In our study population, an average of 4.04 out of 15 dermoscopic specific criteria for SK was found (for example, multiple milia-like cysts). Additional criteria not included in 2-step algorithm were blue-whitish veil (found in 3 SK; 4.2%), polymorphous vessels (18 SK; 25%), blotch/globules (6 SK; 8.3%), shiny white streaks (3 lesions; 4.2%). The most represented global patterns were reticular (27 SK; 37.5%) and not specific (15 SK; 20.8%). All lesions exhibited peculiar findings of SK, furthermore elements suggestive for melanocytic lesion were found in 79.2% of all lesions. Comparing the literature and our results, we found 3 significant differences: a) the less prevalence of SK specific criteria in our study population; b) the description of findings usually not related to SK, among which blue-whitish veil, polymorphous vessels, blotch/globules and shiny white streaks, and c) 2 patterns not previously defined represented by "not specific pattern" (20.9% of all lesions examined) and "vascular pattern" (12.5% of all lesions examined) were also described. No specific feature or global pattern, statistically significant for dermoscopic diagnosis of difficult-to-diagnose SK have been found. CONCLUSION: Nevertheless the useful findings, no specific feature or global pattern statistically significant for dermoscopic diagnosis of challenging SK have been found. According to the 2-step algorithm and the dermatoscopic scoring system for melanocytic and not melanocytic lesion, SK with one or more dermatoscopic findings typical of melanocytic lesion should be removed surgically to exclude classic melanoma or melanoma mimicking SK.

Psoriasis ungueal tratada con certolizumab pegol en pacientes con artritis psoriásica: conclusión preliminar / Nail Psoriasis Treated With Certolizumab Pegol in Patients With Psoriatic Arthritis: Preliminary Observation

No disponible

Melanocitosis dérmica agminada en el territorio del nevus de Ota / Agminated Dermal Melanocytosis in the Territory of Ota's Nevus

No disponible

Virulence profile of Escherichia coli O157 strains isolated from surface water in cattle breeding areas.

Shiga toxin-producing Escherichia coli (STEC) O157:H7 is a worldwide concern. Cattle are their main reservoir and may contaminate watercourses through manure. We characterized a collection of 38 STEC O157:H7 strains isolated from surface water in feedlots areas (puddles inside pens formed after the rainfall or by spill around drinking troughs, and small water courses and lagoons, formed by runoff). Nineteen (50·0%) strains harboured stx2a /stx2c genes, 18 (47·4%) stx2c and one stx1a /stx2c . All strains harboured eae, ehxA, rfbO157 and fliCH7 genes, and the putative virulence determinants ECSP_0242, ECSP_2687 and ECSP_3620. All isolates tested as Lineage I/II by lineage-specific polymorphism assay-6. Nineteen (50%) belonged to the high virulent clade 8. The q21 allele was found in all strains and q933 /q21 alleles in 17 (44·7%). By XbaI-pulsed-field gel electrophoresis, 29 strains were grouped into seven clusters. Four clusters grouped isolates from distant places separated by 150-250 km. This may be related to vectors, like birds, involved in their spread. Otherwise, three clusters contained isolates recovered at same places with intervals of 1-9 months. This could be explained by the high environmental persistence of STEC O157:H7. These strains recovered from surface water showed similar genotypes to those found in the bovine reservoir and in human diseases, and could be linked to the high incidence of haemolytic uremic syndrome in Argentina. SIGNIFICANCE AND IMPACT OF THE STUDY: The challenge for the growing global demand for food is to find sustained production strategies without collateral effects. Intensive livestock operations generate large volumes of manure that can contaminate a finite resource, the water. This study shows how water contaminated by confined feeding operations can transport dangerous pathogens and warns to pay more attention to control and sanitation systems to prevent this type of pollution.

Genetic features of human and bovine Escherichia coli O157:H7 strains isolated in Argentina.

Shiga toxin-producing Escherichia coli (STEC) are important food-borne pathogens associated with human diseases. In Argentina, O157:H7 is the dominant serotype in hemolytic uremic syndrome (HUS) cases. Previously, we have described the almost exclusive circulation of human E. coli O157 strains belonging to the hypervirulent clade 8 in Neuquén Province. The aim of the present study was to investigate, by a broad molecular characterization, if this particular distribution of E. coli O157 clades in Neuquén is similar to the situation in other regions of the country and if it may be originated in a similar profile in cattle, its main reservoir. Two-hundred and eighty O157 strains (54 bovine and 226 human) isolated between 2006 and 2008 in different regions of Argentina were studied. All strains harbored rfbO157, fliCH7, eae, and ehxA genes. The predominant genotype was stx2a/stx2c in human (76.1%) and bovine (55.5%) strains. All human isolates tested by Lineage-Specific Polymorphism Assay (LSPA-6), were lineage I/II; among bovine strains, 94.1% belonged to lineage I/II and 5.9% to lineage I. No LSPA-6 lineage II isolates were detected. Single nucleotide polymorphism (SNP) analysis has revealed the existence of nine clade phylogenetic groups. In our clinical strains collection, 87.6% belonged to the hypervirulent clade 8, and 12.4% were classified as clade 4/5. In bovine isolates, 59.3% strains were clade 8, 33.3% clade 4/5 and 7.4% clade 3. More than 80% of human strains showed the presence of 6 of the 7 virulence determinants described in the TW14359 O157 strain associated with the raw spinach outbreak in the U.S. in 2006. More than 80% of bovine strains showed the presence of 3 of these factors. The q933 allele, which has been related to high toxin production, was present in 98.2% of clinical strains and 75.9% of the bovine isolates. The molecular characterization of human STEC O157 strains allows us to conclude that the particular situation previously described for Neuquén Province, may actually be a characteristic of the whole country. These genetic features are quite similar to those observed in the bovine reservoir and may be derived from it. This data confirms that, unlike the rest of the world, in Argentina most of the STEC O157 strains present in cattle may cause human infections of varying severity and the marked virulence described for these strains may be related to the high incidence of HUS in our country.

Yttrium and aluminium complexes bearing dithiodiolate ligands: synthesis and application in cyclic ester polymerization.

Yttrium and aluminium complexes of two dithiodiolate ligands that feature different bridges (CF3)2C(OH)CH2SRSCH2C(OH)(CF3)2 (L(1)-H2, R = CH2CH2 and L(2)-H2, R = C6H4) were synthesized in good yields by reacting tris(silylamide)yttrium or trimethylaluminium with one equivalent of the proligand. All complexes were characterized by NMR and elemental analysis, and single-crystal X-ray structural analysis was also performed for one of the yttrium complexes. The catalytic activities of the four complexes in the ring-opening polymerization of ε-caprolactone and rac-lactide have been investigated. Furthermore, DOSY experiment and DFT calculations have been carried out to determine the structure of the isopropoxo derivative of the complex L(2)Y amide.

Cumplimiento del tratamiento farmacológico en mujeres adultas con hipotiroidismo primario / Drug Treatment Adherence in Adult Women with Primary Hypothyroidism

Introducción: La falta de cumplimiento al tratamiento puede ser causa del fracaso terapéutico en pacientes hipotiroideos. Objetivos: Conocer en mujeres adultas hipotiroideas el cumplimiento al tratamiento farmacológico según el nivel de conocimiento de la enfermedad, los síntomas y signos que la caracterizan y la forma de controlarla. Material y Métodos: Diseño observacional transversal en muestra no probabilística de mujeres mayores de 40 años con hipotiroidismo primario tratadas con levotiroxina, que asistieron a realizarse prueba de laboratorio a un Instituto de Análisis de la Ciudad Autónoma de Buenos Aires (CABA) entre los meses de agosto y octubre de 2012. Variables: Por interrogatorio directo se estudió el conocimiento de la enfermedad medido por el Test de Batalla y cumplimiento al tratamiento farmacológico medida con el test de Morisky-Green. Estadística con el paquete estadístico SPSS 15.0 estableciendo medidas de tendencia central, Odds Rattio, X² o Prueba de Fisher según el tamaño muestral. Resultados: Se evaluaron 171 mujeres con edad promedio de 54,8 ± 7,2 años. El 57,3 % refiere un correcto conocimiento sobre la enfermedad. El 74,3 % cumple el tratamiento farmacológico. El 97,1 % de la muestra refiere tomar la levotiroxina en ayunas, el 19,9 % olvida alguna vez tomarla y solo el 5,8 % afirma abandonar el fármaco en caso de malestar. Al asociar el conocimiento de la enfermedad con el cumplimiento de la ad­ministración del fármaco, se observó que a pesar que un 42,7 % del total de mujeres no tienen conocimiento sobre la enfermedad, un 29,3 % de ellas igualmente cumple el tratamiento, no encontrándose asociación significativa entre ambas variables (OR = 1,68; IC95 % = 0,84-3,36; p = 0,15). Conclusiones: Poco más de la mitad de la muestra conoce acerca de la enfermedad. La mayoría cumple el tratamiento farmacológico. No se encontró asociación significativa entre el conocimiento de la enfermedad y el cumplimiento de su tratamiento.

Introduction: Non-adherence to treatment may be a cause of therapeutic failure in hypothyroid patients. Aims: To assess adherence to drug treatment in hypothyroid adult women by level of knowledge of the disease, signs and symptoms that characterize it and how to control it. Material and methods: Cross-sectional design; non-random sample of women aged 40 and older, with primary hypothyroidism treated with levothyroxine, who attended the Instituto de Análisis de la Ciudad Autónoma de Buenos Aires (CABA) for laboratory testing between August and October 2012. Variables studied: knowledge of the disease measured by Batalla´s Test and adherence to drug treatment measured by Morinsky Green's Test. Data collection was performed by direct questioning. Statistical analysis performed by SPSS 15.0 establishing measures of central tendency, Odds Ratio X² and Fisher test according to sample size. Results: We evaluated 171 women with an average age of 54.8 ± 7.2 years; 57.3 % reported a correct level of knowledge about the disease, 74.3 % adhered to drug treatment, 97.1 % of the sample reveals taking levothyroxine while fasting, 19.9 % admits sometimes forgetting to take it and only 5.8 % admitted to discontinuing the drug in case of discomfort. When associating knowledge of the disease with adherence to drug administration, we observed that although 42.7 % of women had no knowledge about the disease, 29.3 % of them also adhered to treatment, finding no significant association between the two variables (OR = 1.68; IC95 % = 0.84-3.36; p = 0.15). Conclusions: Just over half of the sample has knowledge about the disease. Most adhere to drug treat­ment. No significant association between knowledge of the disease and adherence to treatment was found.

A Prospective Screening of HLA-B*57.01 Allelic Variant for Preventing the Hypersensivity Reaction to Abacavir: Experience from the Laboratory of Molecular Biology of the Infectious Diseases Division at the University Hospital of Salerno.

Abacavir is a nucleoside reverse transcriptase inhibitor largely used as part of the antiretroviral therapy in Human Immunodeficiency Virus (HIV)-infected patients. Some individuals (2-9%) who start an abacavir treatment show an immunologic reaction indicated as hypersensitivity reaction syndrome (HSR) that is often responsible for therapy discontinuation and could represent a life-threatening event. Some studies demonstrated a correlation between this adverse reaction and the class I of the major histocompatibility complex (MHC) allele, HLA-B*57.01, in several populations, including Caucasians. Nowadays, International HIV treatment guidelines recommend the HLA-B*57.01 genotyping before abacavir administration to reduce the incidence of HSR. Both male and female HIV-infected patients were enrolled at the Infectious Diseases Division at the University Hospital of Salerno, and admitted to a prospective HLAB*57.01 screening. Genetic analysis was carried out through two sequential Real-Time PCR reactions in which Sybr-Green was used. Out of 248 patients, 215 were Italians from Southern Italy and 33 were coming from several non-EU members countries. All were genotyped: 6 Italians (2.8%) and 1 of the non-EU group (3%) were identified as HLAB*57.01 carriers. In this paper we present our experience in the field of abacavir pharmacogenetic and confirm the importance of Real Time PCR as a valid and cost-effective HLA-B*57.01 typing methodology.

The optimum cut-off value to differentiate Echinococcus granulosus sensu stricto from other species of E. granulosus sensu lato using larval rostellar hook morphometry.

Cystic echinococcosis caused by Echinococcus granulosus sensu lato is one of the most important helminth zoonoses in the world; it affects both humans and livestock. The disease is endemic in Argentina and highly endemic in the province of Neuquén. Considerable genetic and phenotypic variation has been demonstrated in E. granulosus, and ten different genotypes (G1-G10) have been identified using molecular tools. Echinococcus granulosus sensu lato may be considered a species complex, comprised of E. granulosus sensu stricto (G1-G3), E. equinus (G4), E. ortleppi (G5) and E. canadensis (G6-G10). In endemic areas, the characterization of cystic echinococcosis molecular epidemiology is important in order to apply adequate control strategies. A cut-off value for larval large hook total length to distinguish E. granulosus sensu stricto isolates from those produced by other species of the complex was defined for the first time. Overall, 1780 larval hooks of 36 isolates obtained from sheep (n= 11, G1), goats (n= 10, G6), cattle (n= 5, G6) and pigs (n= 10, G7) were analysed. Validation against molecular genotyping as gold standard was carried out using the receiver operating characteristic (ROC) curve analysis. The optimum cut-off value was defined as 26.5 µm. The proposed method showed high sensitivity (97.8%) and specificity (91.1%). Since in most endemic regions the molecular epidemiology of echinococcosis includes the coexistence of the widely distributed E. granulosus sensu stricto G1 strain and other species of the complex, this technique could be useful as a quick and economical tool for epidemiological and surveillance field studies, when fertile cysts are present.

Proteomic analysis of human nasal mucosa: different expression profile in rhino-pathologic states.

BACKGROUND: Rhinitis comprises several diseases with varying causes and different clinical manifestations and pathological features, but treated as a single clinical disorder. As heterogeneous disease, proper differential diagnosis is useful to delineate appropriate therapeutic intervention. Comparative proteomic investigation was aimed to provide information for specific differentially expressed proteins in rhino pathologic state, that could be used for diagnostic purpose and therapeutic monitoring. METHODS: Proteins extracted from nasal mucosa cells of patients with different features of rhinitis and from control subjects, were separated by 2-DE. Proteins differentially expressed were identified by mass spectrometry (MS). RESULTS: Comparative proteomic analyses led to the identification of eighteen proteins differentially expressed in patients with rhinitis, mainly related to cell defense and innate and acquired immunity. From that, at least one protein can be a possible candidate as biomarker of disease.

Pure optical nano-writing on light- switchable spiropyrans/merocyanine thin film.

We report optical writing at the nanometer scale of spin coated PMMA-spiropyran films. By using a near-field optical microscope, pure optical nano-writing with a resolution of 160 nm and writing speed of 0.4 µm/s was achieved. Simultaneous topographic and optical writing was also obtained by simply coupling to the near-field few more mW of laser power. Due to the fast optical response of the spiropyran molecule, nano-lithography on PMMA-spyropyran thin films appears to be very attractive for future photonics applications.

Bordetella holmesii in children suspected of pertussis in Argentina.

We describe nine patients (eight aged <1 year) clinically diagnosed with pertussis yet laboratory-confirmed with Bordetella holmesii infections, a human pathogen normally isolated from blood. Most patients reported cough and cold symptoms. No death was reported. We report B. holmesii isolation in infants with respiratory symptoms in Argentina.

AngioLab: integrated technology for patient-specific management of intracranial aneurysms.

AngioLab is a software tool developed within the GIMIAS framework and is part of a more ambitious pipeline for the integrated management of cerebral aneurysms. AngioLab currently includes three plug-ins: angio segmentation, angio morphology and stenting, as well as supports advanced rendering techniques for the visualization of virtual angiographies. In December 2009, 23 clinicians completed an evaluation questionnaire about AngioLab. This activity was part of a teaching course held during the 2(nd) European Society for Minimally Invasive Neurovascular Treatment (ESMINT) Teaching Course held at the Universitat Pompeu Fabra, Barcelona, Spain. The Automated Morphological Analysis (angio morphology plug-in) and the Endovascular Treatment Planning (stenting plug-in) were evaluated. In general, the results provided by these tools were considered as relevant and as an emerging need in their clinical field.

High-efficiency red phosphorescent electroluminescence devices based on mixed p/n host matrices.

In this Letter, we demonstrate a way to control the charge carrier transport mechanisms in phosphorescent organic light-emitting devices based on the mixing of two p and n host materials in the emissive layer (EML). The matrices have been selected in order to fulfill the requirements of the energy level mismatch with the transporting and emitting materials. By using the mixed-host approach in combination with a phosphorescent red emitter, namely (1-phenylisoquinoline) iridium (III) [Ir(piq)(3)], maximum external and power efficiencies of 14.3% and 10 lm/W, respectively, have been achieved, with an average external efficiency value of 12% in the luminance range 100-10,000 cd/m(2).