Hipertricosis lanuginosa adquirida localizada, manifestación paraneoplásica. Presentación de un paciente

Acquired hypertrichosis lanuginosa is a rare paraneoplastic manifestation is the formation of fine hair, long and non-pigmented lanugo type, which are mainly distributed on the face and affects the ears, nose and forehead and other parts can take the body as may be localized or generalized. A male patient aged 57 who developed localized hypertrichosis lanuginosa box diarrhea presenting as well-differentiated squamous cell carcinoma of the lung is presented.La hipertricosis lanuginosa adquirida es una infrecuente manifestación paraneoplásica que consiste en la formación de vello tipo lanugo fino, largo y no pigmentado, que se distribuye principalmente por la cara y que afecta a las orejas, la nariz y la frente y que puede tomar otras partes del cuerpo según sea localizada o generalizada. Se presenta un paciente masculino de 57 años de edad que desarrolló hipertricosis lanuginosa localizada con cuadro de diarreas como forma de presentación de carcinoma escamoso bien diferenciado de pulmón

Reverse-flow anterolateral thigh flap for knee soft-tissue reconstruction: case report

The reconstruction of the injured tissue around the knee is a complex procedure for the plastic and orthopaedic surgeon. The objective is to provide an acceptable function and aesthetic result. Successful wound management includes meticulous debridement, planning and proper execution of the surgical procedure. An 11-year-old male patient with a right patellar fracture using an anterolateral thigh flap with reverse flow to cover the skin defect. For such purposes, the reverse flow anterolateral flap is an effective, trustworthy and well-documented option. The correct obtaining and implantation of the flap reduces the morbidity of the donor site, offers options in size and design, an adequate length of the pedicle and the possible combination with the fascia lata in case it is required. The versatility of the reverse flow anterolateral flap makes it a possible therapeutic alternative in reconstructive surgery since it is aesthetic and functional for the reconstruction of tissue near the knee joint

Non-invasive clinical and microscopic evaluation of the response to treatment with clobetasol cream vs. calcipotriol/betamethasone dipropionate foam in mild to moderate plaque psoriasis : an investigator-initiated, phase IV, unicentric, open, randomized clinical trial

Treatment response for psoriasis is typically evaluated using clinical scores. However, patients can relapse after clinical clearance, suggesting persistent inflammation. Dermoscopy, reflectance confocal microscopy (RCM) and optical coherence tomography (OCT) can non-invasively improve treatment response assessment. To compare the clinical and non-invasive microscopic features in a psoriatic target lesion treated with clobetasol cream or calcipotriol/betamethasone dipropionate foam (Cal/BD foam). Prospective, unicentric, open, randomized clinical trial comparing clinical data [total clinical score (TCS)] and microscopic data (dermoscopy, RCM and OCT) in psoriasis patients treated with clobetasol or Cal/BD foam. We included 36 adult patients (22 men). At week 4, more patients treated with Cal/BD foam achieved TCS ≤1 than with clobetasol (63.2% vs. 18.8%, P = 0.016). Treatment satisfaction was higher with Cal/BD foam (P < 0.03). Microscopically, Cal/BD foam induced more reduction in epidermal thickness at week 4 (P < 0.049). Dilated horizontal blood vessels were more common with clobetasol than with Cal/BD foam at week 8 (69.2% vs. 31.2%, P = 0.159). If epidermal hyperplasia was noted at baseline, the response was poorer with clobetasol (P = 0.029). Small sample size, open study, imaging sampling bias. Cal/BD foam is more effective than clobetasol, has better patient satisfaction and induces greater reduction in the hyperkeratosis/acanthosis, regardless of baseline epidermal hyperplasia

Stevens-Johnson syndrome and toxic epidermal necrolysis: a review

Stevens Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are considered a single entity with variability in the extent of the lesions, characterized by erythema multiforme that may involve mucosa. Severe cutaneous reactions secondary to medications are classified according to the area of epidermal detachment. The activation of cytotoxic T cells and macrophages is mediated mainly by IL-2 and interferon gamma secreted by Th1 lymphocytes, and the activation of eosinophils and B lymphocytes in IgE is mediated by secreted IL-4, IL-5, IL-10 and IL13 by B lymphocytes. The topography of SJS is predominantly central, affecting the trunk and sometimes a generalized dissemination is shown that affects a body surface area of less than 10%, characterized by irregular violaceous erythematous macules of target shooting, which can form confluent blisters. TEN is characterized by a skin detachment greater than 30% of the body surface, whose predominant lesion is diffuse erythema with individual macules, which give rise to detachment surfaces greater than 5 cm. The treatment is symptomatic, nonspecific, and aimed at avoiding complications, carried out in specialized intensive care units, due to ignorance of the pathogenesis. Integral management with different therapeutic alternatives can represent a crucial part in the multisystemic management of SJS and TEN

Angiosome study of the first digital feet space, for reconstruction of the digital tip

Background: The concept of angiosome explains the anatomical variations that exist between the vessels of different regions of the body and helps to understand the contributions of arterial blood supply to the skin and adjacent structures, dividing the human body into three-dimensional vascular blocks.Methods: This was an observational and descriptive study. In both lower extremities of 5 corpses with adequate tissue preservation in the operating room attached to the teaching area of the National Institute of Forensic Sciences in Mexico City. Angiosome study of the medial neurocutaneous flap of the second toe of both feet was performed.Results: The average, in centimeters, of the surface of the flaps was 1.57 cm x 2.47 cm, the average diameter of the inter-metatarsal digital artery was 1.1 millimeters and the average diameter of the veins draining the angiosome was 1.4 millimeters. The most constant anatomy was that of the nerve, which was present in all cases, with the digital nerve forming the neurosome of the flap.Conclusions: To obtain optimal results in microsurgery transfers, it is necessary to have a technique that is quick for harvesting the flap and with adequate systematization so as not to injure the neurovascular bundle, this is achieved through complete anatomical knowledge, without forgetting the main variants

Antebrachial microvascular flap for reconstruction of the pelvic limb: case report

Complex defects in the soft tissues of the foot and ankle caused by high-energy trauma, infection, cancer or diabetes require rapid and effective treatment which decreases the risk of infection, bone healing time, hospital stay and number total of surgical approaches. Authors report a clinical case of a 23-year-old female patient who suffers high-energy trauma due to a motorcycle accident which causes exposure of the distal third of the tibia, loss of the tibial joint face, and loss of tissue throughout the region of the malleolus medial of the right pelvic extremity. Tissue transfer to the pelvic limb is performed using left contralateral radial antebrachial free flap as donor area. This case report aims to emphasize the key aspects of the high energy trauma approach by using microvascular flaps, as well as the satisfactory evolution of the patient that directly affects the prognosis for life and function

Aspergilosis invasiva neuropulmonar

This is a 68 year old male patient, white, with a history of bronchial asthma , hypothyroidism, benign prostatic hyperplasia, chronic liver  and chronic renal disease monitoring by Nephrology Specialist . Presented various income for respiratory diagnosed with bronchopneumonia plus low hemoglobin, the proteinuria was found in nephrotic range and the possibility of renal biopsy was assessed. Immunological studies and microbiological hemochemical and included  tests, with blood cultures positive for Staphylococcus aureus. It evolved unfavorably with acid-base imbalance and marked general malaise to extreme bradycardia and death. At autopsy the presence of membranoproliferative glomerulonephritis secondary to hepatotropic viruses with chronic liver damage leading to immunosuppression and the resulting Aspergillus infestation with meningoencephalic invasion and lung was found . Invasive aspergillosis is a major cause of morbidity and mortality in immunocompromised patients.Se trata de un paciente de 68 años, masculino, blanco, con antecedentes de asma bronquial, hipotiroidismo, hiperplasia benigna de próstata, hepatopatía crónica y enfermedad renal crónica con seguimiento por el Especialista en Nefrología. Presentó varios ingresos por cuadro respiratorio con diagnóstico de bronconeumonía además de cifras bajas de hemoglobina, se constató proteinuria en rango nefrótico y se valoró la posibilidad de realizar biopsia renal. Se incluyen en los exámenes estudios inmunológicos y hemoquímicos así como microbiológicos, con hemocultivos positivos para estafilococo aureus. Evolucionó desfavorablemente con desequilibrio ácido básico y marcada toma del estado general hasta la bradicardia extrema y la muerte. En la autopsia se encontró la presencia de una glomerulonefritis membranoproliferativa secundaria a virus hepatotropos con daño hepático crónico que llevó a la consiguiente inmunosupresión y a la infestación por aspergilus, con invasión meningoencefálica y pulmonar. La aspergilosis invasora es una causa importante de morbilidad y mortalidad en enfermos inmunosuprimidos

Supplemental Information 5: Raw data

The fishery for octopus in Northwest Mexico has increased to over 2,000 tons annually, but to date the specific composition of the catch has been ignored. With at least three main species targeted by artisanal fisheries in the region with distinct life histories, the lack of basic biological information about the distribution, metapopulation size and structure of each species could impede effective fisheries management to avoid overexploitation. We tested if different life histories of three species of octopus could help predict observed patterns of genetic diversity, population dynamics, structure and connectivity and how this information could be relevant to the sustainable management of the fishery. We sequenced two mitochondrial genes and genotyped seven nuclear microsatellite loci to identify the distribution of each species in 20 locations from the Gulf of California and the west coast of the Baja California peninsula. We tested five hypotheses derived from population genetic theory based on differences in the fecundity and dispersal potential for each species. We discovered that Octopus bimaculoides with low fecundity and direct development (without a planktonic phase) had lower average effective population size and genetic diversity, but higher levels of kinship, population structure, and richness of private alleles, than the other two species. These features indicated limited dispersal and high local recruitment. In contrast, O. bimaculatus and O. hubbsorum with higher fecundity and planktonic phase as paralarvae had higher effective population size and genetic diversity, and overall lower kinship and population structure than O. bimaculoides. These observations supported higher levels of gene flow over a larger geographical scale. O. bimaculatus with the longest planktonic paralarval duration and therefore larger dispersal potential had differences in the calculated parameters possibly associated with increased connectivity. We propose O. bimaculoides is more susceptible to over exploitation of small, isolated populations and could have longer recovery times than the other two species. This species may benefit from distinct fishery management within each local population. O. bimaculatus and O. hubbsorum may benefit from fishery management that takes into account metapopulation structure over larger geographic scales and the directionality and magnitude of larval dispersal driven by ocean currents and population connectivity among individuals of each locality. The distribution of each species and variations in their reproductive phenology is also important to consider when establishing marine reserves or seasonal fishing closures

La Comisión de la Verdad en Colombia: conocimiento, percepción, eficacia y emociones asociadas

La Comisión de la Verdad en Colombia se estableció a partir del modelo de justicia transicional. Su función es servir como medida de reconocimiento de los hechos violentos durante el conflicto armado, que han dejado más de nueve millones de víctimas. En este marco, se realizó un estudio descriptivo correlacional (N=1166) con una muestra de 22 departamentos del país para evaluar el conocimiento, la aprobación y la efectividad percibida de los primeros años de la Comisión a partir de aspectos psicosociales: victimización, emociones colectivas, reconciliación, memoria colectiva. El 58% eran víctimas directas. Los resultados indican altos niveles de aprobación y de disposición a participar en las actividades de la Comisión, así como cierto escepticismo sobre su utilidad y una baja confianza en las disculpas oficiales de los grupos en conflicto. También se encuentra un alto índice de emociones positivas relacionadas con la comisión y una baja confianza en las instituciones gubernamentales. Lo encontrado en este estudio, coincide con experiencias previas de comisiones de la verdad en Latinoamérica, y abre el debate sobre las especificidades del contexto colombiano en la búsqueda de paz y las implicaciones del trabajo de la comisión en el proceso de reparación

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

Meeting abstrac