Clinical course of patients with severe COVID-19 pneumonia treated with remdesivir: A real-life study.

BACKGROUND: There is currently much uncertainty regarding the most optimal treatment for COVID-19. This study analyze the change in the clinical condition of patients hospitalized for severe COVID-19 pneumonia and treated with remdesivir in a real-life setting, based on the WHO Ordinal Scale. Clinical complications, treatment safety, and impact of other associated drugs were also analyzed. METHODS: We conducted an observational, retrospective study including patients treated with remdesivir. The need for admission to the ICU, the length of ICU and hospital stay, and the need for ventilatory support were analyzed. The laboratory parameters, drugs administered concomitantly, and difference in the length of hospital stay according to the concomitant treatment received were also evaluated. A univariate and multivariate Cox regression analysis was performed to analyze associated factors. RESULTS: A total of 92 patients were included. The mean length of hospital stay was 15 days, and 90% of the patients had been discharged from the hospital 28 days after starting treatment with remdesivir. The likelihood of hospital discharge among patients not presenting with hypertension as a comorbidity was significantly higher than that of those with this condition (HR = 3.19, P = 0.008). Nineteen patients had to be admitted to the ICU (mean of 18 days). Approximately 11% required invasive mechanical ventilation (mean of 22 days). Almost 37% of the patients received high-flow oxygen therapy and 14% non-invasive mechanical ventilation. Four deaths were recorded within the first week. Main adverse events were increases in transaminase and creatinine levels. Nosocomial infections were more frequent when remdesivir was combined with immunosuppressive drugs. CONCLUSIONS: Patients with severe COVID-19 pneumonia and treated with remdesivir require relatively prolonged hospital stays, many with a need for ventilatory support and, in a considerable proportion of cases, admission to the ICU. However, the observed survival rate is high, and the drug is well tolerated.

Actitudes sexuales de acuerdo con el nivel de severidad del trauma craneoencefálico / Sexual attitudes according to the level of severity of the cranioencephalic trauma

El objetivo de esta investigación fue analizar la actitud hacia la sexualidad en pacientes con antecedentes de trauma craneoencefálico (TCE), de acuerdo al nivel de severidad presentado. Método: se llevó a cabo un estudio de tipo descriptivo en una muestra de 126 personas, con edades comprendidas entre los 18 y 49 años, con antecedente de trauma craneoencefálico leve, moderado y severo, a quienes se les aplicó la Escala de Actitudes hacia la Sexualidad Ampliada (ATSS) y una encuesta de actitudes hacia la sexualidad. Resultados: se encontró que la mayoría de los participantes manifestaron haber sufrido cambios en su sexualidad tras el TCE, caracterizados por la disminución de la frecuencia de las relaciones y el deseo sexual, sin embargo, evidencian una actitud positiva frente a la sexualidad. Conclusiones: si bien la sexualidad es considerada importante por los participantes del estudio, no se evidenció una conducta tendiente a la erotofilia. No se encontraron diferencias significativas respecto al nivel de severidad del trauma craneoencefálico

The objective of this research was to analyze the attitude towards sexuality in patients with a history of cranioencephalic trauma (TCE), according to the level of severity presented. Method: a descriptive study was carried out in a sample of 126 people, aged between 18 and 49 years, with a history of mild, moderate, and severe head trauma, to whom the Scale of Attitudes towards Extended Sexuality -ATSS and a Survey of Attitudes towards Sexuality were applied. Results: it was found that most of the participants reported having suffered changes in their sexuality after TCE, characterized by a decrease in the frequency of relationships and sexual desire, however, they show a positive attitude towards sexuality. Conclusions: although sexuality is considered important by the study participants, there was no evidence of behavior tending to erotophilia. No significant differences were found regarding the level of severity of cranioencephalic trauma

Body image, perceived stress, and resilience in military amputees of the internal armed conflict in Colombia.

The objective of this study was to determine the levels and the relationship between body image satisfaction, perceived stress and resilience in soldier amputee victims of the internal armed conflict in Colombia. It was a quantitative, cross-sectional study of correlational scope, with the participation of 22 Colombian soldiers who were victims of the internal armed conflict and with some degree of amputation. For each soldier, the Multidimensional Body Self-relations Questionnaire (MBSRQ), Perceived Stress (EEP-14) and the Connor-Davidson Resilience Scale (CD-RISC 10) were applied. The results show high scores in behaviors aimed at maintaining physical fitness, self-assessed physical attractiveness and physical appearance, low scores in stress and scores with high trends in resilience, as well as a negative correlation between stress and conducts aimed to maintain physical fitness.

El objetivo del presente estudio fue determinar los niveles y la relación entre satisfacción de la imagen corporal, estrés percibido y resiliencia en soldados con amputación víctimas del conflicto armado interno colombiano. Fue un estudio cuantitativo, transversal, de alcance correlacional, se contó con la participación de 31 soldados colombianos víctimas del conflicto armado interno y con algún grado de amputación, a quienes se les aplicó el Multidimensional body self relations questionnaire (MBSRQ), la Escala de estrés percibido (EEP-14) y el Connor-Davidson Resilience Scale (Cd-Risc 10). Los resultados muestran altas puntuaciones en conductas orientadas a mantener la forma física, atractivo físico autoevaluado y cuidado del aspecto físico, puntuaciones bajas en estrés y puntuaciones con tendencias altas en Resiliencia, así como una correlación negativa entre el estrés y las conductas orientadas a mantener la forma física.

Microsporum spp. onychomycosis: disease presentation, risk factors and treatment responses in an urban population

BACKGROUND: Dermatophytes are the main causative agent of all onychomycosis, but genus Microsporum is infrequent and the risk of acquiring the infection is often associated with exposure to risk factors. OBJECTIVES: To describe clinical characteristics of onychomycosis due to Microsporum onychomycosis in an urban population. METHODS: This was a retrospective analysis of the epidemiological and clinical features of 18Microsporum onychomycosis cases of a total of 4220 of onychomycosis cases diagnosed between May 2008 and September 2011 at the tertiary referral center for mycology in Guatemala. RESULTS: Eighteen cases of Microsporum onychomycosis (M. canis, n=10; M. gypseum, n=7; M. nanum, n=1) were identified (prevalence=0.43%). Infection was limited to nails only and disease duration ranged from 1 month to 20 years (mean=6.55 years). The toenails were affected in all cases except for a single M. gypseum case of fingernail. The most common clinical presentation was distal lateral subungual onychomycosis (12/18) followed by total dystrophic onychomycosis (5/18), and superficial white onychomycosis (1/18). M. gypseumpresented in 6 cases as distal lateral subungual onychomycosis and in 1 case like total dystrophic onychomycosis. Five cases (27.78%) were associated with hypertension, diabetes, and psoriasis. Treatment with terbinafine or itraconazole was effective. Two cases of M. canisdistal lateral subungual onychomycosis responded to photodynamic therapy. CONCLUSION: This is the largest reported series of Microsporum onychomycosis and demonstrates such a disease in an urban population. In 27.78% of the cases risk factors for infection were associated to comorbid states. We also report the first 2 cases of successfully treated M. canis onychomycosis with photodynamic therapy and a rare case of M. canis associated dermatophytoma. .

Microsporum spp. onychomycosis: disease presentation, risk factors and treatment responses in an urban population.

BACKGROUND: Dermatophytes are the main causative agent of all onychomycosis, but genus Microsporum is infrequent and the risk of acquiring the infection is often associated with exposure to risk factors. OBJECTIVES: To describe clinical characteristics of onychomycosis due to Microsporum onychomycosis in an urban population. METHODS: This was a retrospective analysis of the epidemiological and clinical features of 18 Microsporum onychomycosis cases of a total of 4220 of onychomycosis cases diagnosed between May 2008 and September 2011 at the tertiary referral center for mycology in Guatemala. RESULTS: Eighteen cases of Microsporum onychomycosis (M. canis, n=10; M. gypseum, n=7; M. nanum, n=1) were identified (prevalence=0.43%). Infection was limited to nails only and disease duration ranged from 1 month to 20 years (mean=6.55 years). The toenails were affected in all cases except for a single M. gypseum case of fingernail. The most common clinical presentation was distal lateral subungual onychomycosis (12/18) followed by total dystrophic onychomycosis (5/18), and superficial white onychomycosis (1/18). M. gypseum presented in 6 cases as distal lateral subungual onychomycosis and in 1 case like total dystrophic onychomycosis. Five cases (27.78%) were associated with hypertension, diabetes, and psoriasis. Treatment with terbinafine or itraconazole was effective. Two cases of M. canis distal lateral subungual onychomycosis responded to photodynamic therapy. CONCLUSION: This is the largest reported series of Microsporum onychomycosis and demonstrates such a disease in an urban population. In 27.78% of the cases risk factors for infection were associated to comorbid states. We also report the first 2 cases of successfully treated M. canis onychomycosis with photodynamic therapy and a rare case of M. canis associated dermatophytoma.

Dermatitis perioral en la infancia: presentación de dos casos e importancia de la correlación clínico patológica / Perioral dermatitis in childhood: report of two cases and importance of clinical pathological correlation

Con el nombre de dermatitis periororal se conocen a un grupo de dermatosis inflamatorias y eruptivas que predominan en mujeres jóvenes, y con menos frecuencia en niños. Se caracterizan por pápulas y pústulas pequeñas en una distribución periorificial, predominantemente alrededor de la boca. Puede estar relacionada con el uso de esteroides tópicos. Se presentan dos casos clínicos: Caso 1. Paciente de sexo masculino, de 12 años de edad, con lesiones papulopustulares periorales, de un mes de evolución. Se realizó el diagnóstico de foliculitis por Malassezia sp. en base a la histopatología y la tinción de Gram. Se dio tratamiento con Itraconazol, 200 mg, por vía oral, durante 14 días (5 mg/kg), y crema de ketoconazol al 2%, dos veces al día. Se obtuvo resolución completa en dos meses. Caso 2. Paciente de sexo femenino, de nueve años de edad, con dos meses de evolución con pápulas periorales tratadas con betametasona, con posterior diseminación a nariz y párpados. Se realizó diagnóstico de dermatitis granulomatosa periorificial en base a la histopatología y tinción de Gram. Se inició tratamiento con eritromicina, vía oral, y metronidazol, gel 1%. Se observó resolución casi completa en seis semanas. Ambos casos muestran que el diagnóstico, la etiología y el manejo de dermatitis periorales en niños son un verdadero reto, por lo tanto es de crucial importancia realizar una correlación clínico patológica.

Perioral dermatitis was described as an inflammatory rash in young women, but also present in children. It is characterized by periorificial papules and pustules predominantly around themouth. It can be related with the use of topical corticosteroids. We report two cases: A 12 year-old male patient, with a one month history of perioral papulopustular lesions. Diagnosis offolliculitis Malassezia sp. was supported on histopathology and Gram stain. Itraconazole therapy was given, 200 mg orally for 14 days (5 mg/kg) and ketoconazole cream 2% twice daily. Complete resolution was obtained within two months. A 9 year-old female patient, with a two months history of perioral papules treated with betamethasone, later spreading to nose and eyelids. Diagnosis of periorificial granulomatous dermatitis was based on histopathology and Gram stains. Treatment with oralerythromycin and metronidazole gel 1%, showed an important improvement after six weeks. Both cases show that the diagnosis, etiology and management of perioral dermatitis in children is a challenge, so it is crucial to make a clinic pathologic correlation.

Piedra blanca y efluvio telógeno: una rara asociación / White piedra and telogen effluvium: an unusual association

Antecedentes: La piedra blanca es una infección fúngica, superficial del tallo piloso que se describe como nódulos asintomáticos, en ocasiones numerosos, blandos adheridos a la superficie del pelo. Caso clínico: Se presenta paciente femenino de 30 años de edad, con caída de cabello de casi 1 año de evolución, asociado a puntos blancos adheridos al pelo. En el cultivo se aisló Trichosporon sp. Se realizó biopsia de piel cabelluda, en la cual se observó una infiltración de linfocitos e histiocitos alrededor de paredes foliculares altas y algunos folículos en fase telógena. Con estos hallazgos se estableció el diagnóstico de piedra blanca asociada a efluvio telógeno. El tratamiento fue con champú anti caída y de ketoconazol al 2% con mejoría del cuadro. Conclusión: Existe un subdianóstico de casos de piedra blanca, que podría deberse a la falta de conocimiento de esta entidad y más excepcional su asociación con efluvio telogénico.

Dermatofitoma en tinea corporis con onicomicosis de pies y manos causados por Trichophyton rubrum / Dermatofitoma in tinea corporis with hand and foot onychomycosis caused by Trichophyton rubrum

Las dermatofitosis son infecciones crónicas de distribución mundial, las cuales pueden presentar ocasionalmente conglomerados de esporas, filamentos o ambos, denominadas ¨dermatofitomas¨. Se presentan un paciente que refiere tinea corporis de brazo derecho automedicado con corticosteroides tópicos, onicomicosis subungueal distal de manos y onicomicosis distrófica total de pies. En la observación microscópica directa se observaron dermatofitomas en el brazo y uñas de manos, y filamentos en las uñas de pies. Se identificó Trichophyton rubrum en brazo, unas de manos y pies.