Neonatal Molluscum contagiosum: five new cases and a literature review.

Congenital or neonatal Molluscum contagiosum (MC) is an unusual infection, barely reported in the literature. In these patients a mechanism of transmission that is neither via contact or sexual transmission should be considered. We describe five cases of neonatal MC and review the cases already published to discuss the possible aetiopathogenic mechanism.

Severe complications of inflammatory bowel disease.

Patients who have inflammatory bowel disease occasionally develop severe complications or emergency situations that require expert and expedited medical care, including toxic colitis, fistulas, abdominal abscesses, malignancy, primary sclerosing cholangitis, and pouchitis. Morbidity and mortality rates of Crohn's disease and ulcerative colitis are increased over the expected rates in the unaffected population. Knowledge of the presenting features, natural history, and treatment of these complications should to lead to early and effective therapy and better outcomes.

Prolonged inflation of coronary angioplasty balloon as treatment for subocclusive dissection of the coronary sinus during implantation of a coronary sinus pacing lead.

Cardiac resynchronization therapy with biventricular stimulation is an accepted treatment procedure for patients with severe heart failure (NYHA class III/IV), low left ventricle ejection fraction, and left bundle branch block, in spite of optimal medical treatment (Smith, S. C. Jr, Feldman, T. E., Hirshfeld, J. W. Jr, Jacobs, A. K., Kern, M. J., King, S. B. et al. Circulation, 113(7), e166-e286, (2006)). In the ventricular resynchronization procedure, an electrode must be implanted, via the coronary sinus (CS), in a coronary vein of the left ventricle (LV). Insertion of guide catheters and guide wires through the CS towards the target vein may produce more or less extensive dissections and staining which makes visualizing the target vein opening difficult and gives rise to deferment of the procedure. We describe a case of CS dissection, produced by the catheter guide, resulting in a venous wall flap which impeded further advancement of the lead. This was treated with prolonged inflation of a coronary angioplasty balloon, which allowed completion of the procedure in the same surgical intervention. To our knowledge, this is the first report of the successful use of a coronary angioplasty balloon to resolve this complication of electrode implantation.

Cardiac Tamponade Associated with the Presentation of Anaplastic Large Cell Lymphoma in a 2-Year-Old Child.

The anaplastic large cell lymphoma is a rare entity in pediatric patients. We present an unusual case of pericardial involvement, quite uncommon as extranodal presentation of this type of disorder, that provoked a life-risk situation requiring an urgent pericardiocentesis. To our knowledge, this is the first report on a child with pericardial involvement without an associated cardiac mass secondary to anaplastic large cell lymphoma in pediatric age. We report the case of a 21-month-old Caucasian male infant with cardiac tamponade associated with the presentation of anaplastic large cell lymphoma. Initially, the child presented with 24-day prolonged fever syndrome, cutaneous lesions associated with hepatomegaly, inguinal adenopathies, and pneumonia. After a 21-day asymptomatic period, polypnea and tachycardia were detected in a clinical check-up. Chest X-ray revealed a remarkable increase of the cardiothoracic index. The anaplastic large cell lymphoma has a high incidence of extranodal involvement but myocardial or pericardial involvements are rare. For this reason, we recommend a close monitoring of patients with a differential diagnosis of anaplastic large cell lymphoma.

[Circadian variations in proinflammatory cytokine concentrations in acute myocardial infarction]. / Ritmo luz/oscuridad de las citocinas proinglamatorias en el infarto agudo de miocardio.

INTRODUCTION AND OBJECTIVES: The concentration of certain proinflammatory cytokines has been found to be elevated in patients with acute coronary syndrome. Many studies have shown that coronary ischemic accidents do not show a uniform distribution throughout the day, but instead exhibit rhythmic variations. The objective of this study is to determine whether there is a circadian pattern of variation in the concentrations of proinflammatory cytokines in patients with acute myocardial infarction. PATIENTS AND METHOD: The sample included 40 patients with acute myocardial infarction and 40 controls. Levels of interleukin 6 and 1 beta were determined in the first 24 hours after the acute coronary ischemic episode. Blood samples were extracted at 3:00 a.m. (period of darkness) and at 10:00 a.m. (period of daylight). RESULTS: Both groups were similar in age, sex distribution, and coronary risk factors. Interleukin 6 levels showed a significant variation between daylight and nighttime concentrations in patients with acute myocardial infarction and controls (41.93 5.90/100.39 13.60 vs 25.76 4.45/52.67 7.73 pg/ml). However, interleukin 6 concentrations were higher in the acute myocardial infarction group than in the control group. Interleukin 1 beta concentrations did not vary between daylight and darkness. CONCLUSIONS: In both the control group and acute myocardial infarction group, interleukin 6 concentrations varied between daylight and darkness. Patients with acute myocardial infarction shown a higher concentration of interleukin 6 secondary to the physiological response to tissue damage. Circadian variations can affect the measurements obtained for different physiological and biochemical parameters.

Guía clínica de urticaria en Atención Primaria / Clinical guidelines for urticaria in Primary Care

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Protocolo de actuación a la urticaria en urgencias / Protocol for managing urticaria in the emergency department

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Decreased nocturnal melatonin levels during acute myocardial infarction.

Acute myocardial infarction is accompanied by an increase in cellular oxidative stress in the pericardial coverings of the heart. Melatonin is a highly potent and efficient radical scavenger. Little research has been carried out concerning the relationship between this antioxidant and acute myocardial infarction in humans. In this work, serum levels of melatonin and parameters of oxidative stress, such as glutathione peroxidase and lipid peroxidation levels were examined in light/dark periods in patients with acute myocardial infarction. Twenty-five patients diagnosed with acute myocardial infarction were studied and 25 patients with no evidence of coronary artery disease served as controls. Venous blood samples were obtained from the patients and control subjects to determine melatonin, glutathione peroxidase and lipid peroxidation; the samples were collected at 10:00 hr (light period) and 03:00 hr (dark period) in the first 24 hr after admission to the coronary care unit. Our results demonstrate the existence of differences between changes in melatonin levels in control subjects and acute myocardial infarction patients, revealing a reduced nocturnal elevation in the acute myocardial infarction group. Glutathione peroxidase levels were lower after acute myocardial infarction and did not show diurnal variations. In the control group, lipid peroxidation levels presented a light/dark pattern but in the acute myocardial infarction group diurnal variations of this parameter were lost. Our data show that acute myocardial infarction is associated with a nocturnal serum melatonin deficit as well as increased oxidative stress, suggesting that melatonin is, at least in part, depleted during the dark phase to reduce the free radicals formed in acute myocardial infarction.

Ritmo luz/oscuridad de las citocinas proinflamatorias en el infarto agudo de miocardio / Circadian variations in proinflammatory cytokine concentrations in acute myocardial infarction

Introducción y objetivos. Determinadas citocinas proinflamatorias se han encontrado elevadas en pacientes con síndrome coronario agudo. En algunos estudios ha podido comprobarse que la distribución de los accidentes isquémicos coronarios a lo largo del día no es uniforme, sino que experimenta variaciones rítmicas. El objetivo de este estudio es determinar si existe un ritmo de luz/oscuridad de las citocinas proinflamatorias en los pacientes con infarto agudo de miocardio. Pacientes y método. Se incluyeron 40 pacientes con infarto agudo de miocardio y 40 controles. Se determinaron los valores de interleucina 6 y 1 en las primeras 24 h del episodio isquémico coronario agudo. Las muestras de sangre se extrajeron a las 03.00 (período oscuridad) y a las 10.00 h (período luz). Resultados. Ambos grupos fueron similares en edad, sexo y factores de riesgo coronario. Las concentraciones de la interleucina 6 demostraron un ritmo luz/oscuridad significativo, tanto en los pacientes con infarto agudo de miocardio como en los controles (41,93 ñ 5,90/100,39 ñ 13,60 frente a 25,76 ñ 4,45/52,67 ñ 7,73 pg/ml). Además, la interleucina 6 fue significativamente mayor en los pacientes con infarto agudo de miocardio que en los controles. La interleucina 1 no demostró un ritmo luz/oscuridad. Conclusiones. Tanto en el grupo control como en el de infarto agudo de miocardio, la interleucina 6 demostró un ritmo de luz/oscuridad. Los pacientes con infarto agudo de miocardio presentan concentraciones de interleucina 6 más altas, secundarias a una respuesta fisiológica a la lesión tisular. El ritmo luz/oscuridad puede afectar a diferentes parámetros fisiológicos y bioquímicos (AU)

Caracterización de los ecosistemas de la fiebre aftosa

Esta monografía ha sido preparada en el Centro Panamericano de Fiebre Aftosa tomando como base los estudios sobre el tema realizados por los Servicios Oficiales de Salud Animal de cada uno de los países sudamericanos bajo los auspícios del Programa de Adiestramiento de Profesionales Latinoamericanos en Salud Animal (PROASA), 1982-1985.