Pathological Skin Picking: Case Presentation and Review of the Literature

Pathological skin picking is a condition in which patients induce skin lesions through repetitive, compulsive excoriations of normal skin or skin with minor surface irregularities and they admit their role in the production of the lesions, but are unable to stop their behavior. Psychiatric comorbidities most often associated with skin picking include obsessive-compulsive disorder (OCD), anxiety disorders, mood disorders, body dysmorphic disorders, trichotillomania and compulsive-buying disorder. We report the case of a 17 year old female patient who addressed the dermatology department of our hospital with an eruption consisting of erythematous papules and plaques. The local examination revealed several clues of paramount importance in drawing the final conclusion and the psychiatric examination helped establish the diagnosis of pathological skin picking in a patient with obsessive-compulsive disorder

Dischinezia ciliară primară (DCP) la copii

Departamentul Pediatrie, USMF „Nicolae Testemiţanu”, IMSP Institutul Mamei și CopiluluBackground.Primary ciliary dyskinesia (PCD) is a rare congenital disease characterized by defective ciliary function of respiratory tract epitheliocytes, which affects mucociliary clearance and contributes to recurrent and chronic upper and lower respiratory tract infections. Objective of the study. Elucidation of clinical signs and exploratory criteria for ciliary dyskinesia in children. Material and Methods. There are 3 confirmed cases of DCP confirmed in the Pneumology Clinic of the Mother and Child Insitute. Patients were investigated by ECG, pulmonary radiography, pulmonary computed tomography (CT), saccharin test. Of these children with DCP, two have Kartagener syndrome (sinusitis, bronchiectasis and situsinversus). Results. Morbid history of persistent wet cough with mucopurulent sputum, nasal voice and difficult nasal breathing. In 2 patients, imaging examination confirmed complex inverse situs. Radiography of the paranasal sinuses showed signs of pansinusitis in all children in the study. Imaging research by pulmonary CT showed signs characteristic of chronic broncho-pulmonary processes: varicose and sac-shaped bronchiectasis, tractionbronchiectasis, pleuro-pulmonary adhesions, fibro-atelectatic areas in various segments. The spirometric functional examination confirmed in these children the presence of restrictive and obstructive disorders of moderate and severe degree. Conclusion. Disorders of mucociliary clearance in children with ciliary dyskinesia due to frequent respiratory infections lead to chronic rhinosinusal and pulmonary processes with the formation of bronchiectasis, fibroelectasis.Introducere. Dischinezia ciliară primară este o boală congenital rară, caracterizată prin funcția ciliară defect a epiteliocitelor tractului respirator, care duce la afectarea clearance-ului mucociliar și contribuie la unele infecții recurente și cronice ale căilor respiratorii superioare și inferioare. Scopul lucrării. Elucidarea semnelor clinice și a criteriilor explorative ale dischineziei ciliare la copii. Material și metode. Sunt prezentate 3 cazuri de DCP, confirmate în Clinica Pneumologie a Institutului Mamei și Copilului. Pacienții au fost investigați prin ECG, radiografie pulmonară, computer tomografie (CT) pulmonară, testul cu zaharină. Dintre acești copii cu DCP, doi prezintă sindromul Kartagener (sinuzită, bronșiectazii și situs inversus). Rezultate. Antecedentele morbide pun în evidență persistența tusei umede cu expectorații mucopurulente, voce nazonată și respirație nazală dificilă. La 2 pacienți explorările imagistice au confirmat situs inversus complex. Radiografia sinusurilor paranazale a depistat, la toți copiii din studiu, semne de pansinuzită. Cercetările imagistice prin CT pulmonară au evidențiat semne caracteristice unor procese bronhopulmonare cronice: bronșiectazii varicoase și sacciforme, bronșiectazii tracționale, aderențe pleuropulmonare, arii fibro-atelectatice în diverse segmente. Examenul funcțional spirometric a confirmat prezența dereglărilor restrictive și obstructive de grad moderat și sever. Concluzii. Dereglările clearanceului mucociliar la copiii, cu dischinezie ciliară prin infecții respiratorii frecvente, conduc la procese cronice rinosinusale și pulmonare, cu formarea bronșiectaziilor şi fibro-atelectaziilor

Infecţia retrovirală acută

Se apreciază că între 40 şi 90% din infecţiile retrovirale acute (primo-infecţia HIV) sunt simptomatice. Identificarea pacienţilor în stadiile iniţiale ale infecţiei HIV are o importanţă deosebită, atât din punct de vedere medical (iniţierea precoce a terapiei antiretrovirale), cât şi din punct de vedere epidemiologic (întreruperea lanţului epidemiologic). Manifestările clinice ale infecţiei retrovirale acute (sindromul retroviral acut) apar la 3-6 săptămâni de la infectare. Acestea includ febră (80-90%), astenie (70-90%), erupţii morbiliforme (40-80%), cefalee (30-70%), limfadenopatie (40-70%), faringită (50-70%), mialgii şi artralgii, meningită aseptică (24%), dureri retro-orbitare, ulceraţii orale şi/sau genitale (5-20%), manifestări gastro-intestinale etc. Deoarece multe dintre aceste simptome sunt nespecifice, diagnosticul poate fi omis, chiar şi atunci când există un grad mare de suspiciune. Severitatea şi durata infecţiei retrovirale acute au valoare prognostică, manifestările severe şi prelungite corelându-se cu o progresie rapidă a bolii. Diagnosticul este sugerat de apariţia unor manifestări clinice compatibile la un pacient cu comportament sexual riscant sau cu o infecţie transmisibilă sexual recentă şi este confirmat de un test virusologic pozitiv (şi anticorpi negativi) sau prin documentarea seroconversiei. S-a demonstrat că iniţierea tratamentului antiretroviral reduce morbiditatea şi mortalitatea legate de boală; însă, o condiţie esenţială pentru realizarea acestui obiectiv o reprezintă stricta aderenţă la regimul terapeutic. De asemenea, prin scăderea încărcăturii virale, reduce considerabil şi contagiozitatea

Mycosis fungoides foliculotrop – prezentare de caz

Clinica de Dermatovenerologie, Spitalul Clinic de Boli Infecţioase şi Tropicale „Victor Babeş”, Bucureşti, România, Congresul V Naţional de Dermatologie cu participare internaţională Chişinău, 9-11 iunie 2016, Chişinău, Republica MoldovaMycosis fungoides foliculotrop (Piper, 1960) este o formă rară de limfom cutanat cu limfocite T, reprezentând sub 10% din cazurile de Mycosis fungoides. Clinic se caracterizează prin leziuni acneiforme sau comedoniene, papule foliculare, keratoză foliculară, chisturi epidermale, noduli sau plăci eritematoase însoţite frecvent de alopecie, cu afectare preferenţială a capului, gâtului şi trunchiului superior. Spre deosebire de mycosis fungoides clasic, pruritul este frecvent sever, reprezentând un marker al bolii. Diseminarea viscerală reprezintă un factor de prognostic important, motiv pentru care trebuie investigate chiar şi cazurile cu leziuni cutanate minime. Prezentăm cazul unui pacient în vârstă de 49 de ani, care s-a prezentat pentru plăci şi papule foliculare eritematoase localizate cervical şi însoţite de o placă alopecică situată cervical posterior, cu evoluţie de aproximativ 1 an. Leziunile au debutat laterocervical stâng sub forma unei plăci eritemato-papuloase, pruriginoase, cu extensie progresivă. A urmat un tratament topic cu corticosteroizi, fără ameliorare semnificativă. Nu a fost pusă în evidenţă adenopatia palpabilă clinic, iar investigaţiile de rutină de laborator au fost în limite normale. Biopsia tegumentară a evidenţiat în derm infiltrate limfoide cu celule mici-medii clivate, cu epidermo- şi foliculotropism. Imunohistochimic, limfocitele atipice şi infiltratele limfoide exprimă CD3, CD4, CD5, CD7, CD8 şi CD30. Aspectele histopatologic şi imunohistochimic sunt compatibile cu diagnosticul de limfom malign non-Hodgkin cu celulă mică-medie T de tip mycosis fungoides foliculotrop. Pacientul a fost îndrumat către serviciul de Hematologie pentru investigaţii şi tratament de specialitate

Global Impact of COVID-19 on Stroke Care and IV Thrombolysis

Objective To measure the global impact of COVID-19 pandemic on volumes of IV thrombolysis (IVT), IVT transfers, and stroke hospitalizations over 4 months at the height of the pandemic (March 1 to June 30, 2020) compared with 2 control 4-month periods. Methods. We conducted a cross-sectional, observational, retrospective study across 6 continents, 70 countries, and 457 stroke centers. Diagnoses were identified by their ICD-10 codes or classifications in stroke databases. Results. There were 91,373 stroke admissions in the 4 months immediately before compared to 80,894 admissions during the pandemic months, representing an 11.5% (95% confidence interval [CI] −11.7 to −11.3, p \u3c 0.0001) decline. There were 13,334 IVT therapies in the 4 months preceding compared to 11,570 procedures during the pandemic, representing a 13.2% (95% CI −13.8 to −12.7, p \u3c 0.0001) drop. Interfacility IVT transfers decreased from 1,337 to 1,178, or an 11.9% decrease (95% CI −13.7 to −10.3, p = 0.001). Recovery of stroke hospitalization volume (9.5%, 95% CI 9.2–9.8, p \u3c 0.0001) was noted over the 2 later (May, June) vs the 2 earlier (March, April) pandemic months. There was a 1.48% stroke rate across 119,967 COVID-19 hospitalizations. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was noted in 3.3% (1,722/52,026) of all stroke admissions. Conclusions. The COVID-19 pandemic was associated with a global decline in the volume of stroke hospitalizations, IVT, and interfacility IVT transfers. Primary stroke centers and centers with higher COVID-19 inpatient volumes experienced steeper declines. Recovery of stroke hospitalization was noted in the later pandemic months

Global Impact of the COVID-19 Pandemic on Stroke Volumes and Cerebrovascular Events: One-Year Follow-up.

BACKGROUND AND OBJECTIVES Declines in stroke admission, intravenous thrombolysis, and mechanical thrombectomy volumes were reported during the first wave of the COVID-19 pandemic. There is a paucity of data on the longer-term effect of the pandemic on stroke volumes over the course of a year and through the second wave of the pandemic. We sought to measure the impact of the COVID-19 pandemic on the volumes of stroke admissions, intracranial hemorrhage (ICH), intravenous thrombolysis (IVT), and mechanical thrombectomy over a one-year period at the onset of the pandemic (March 1, 2020, to February 28, 2021) compared with the immediately preceding year (March 1, 2019, to February 29, 2020). METHODS We conducted a longitudinal retrospective study across 6 continents, 56 countries, and 275 stroke centers. We collected volume data for COVID-19 admissions and 4 stroke metrics: ischemic stroke admissions, ICH admissions, intravenous thrombolysis treatments, and mechanical thrombectomy procedures. Diagnoses were identified by their ICD-10 codes or classifications in stroke databases. RESULTS There were 148,895 stroke admissions in the one-year immediately before compared to 138,453 admissions during the one-year pandemic, representing a 7% decline (95% confidence interval [95% CI 7.1, 6.9]; p<0.0001). ICH volumes declined from 29,585 to 28,156 (4.8%, [5.1, 4.6]; p<0.0001) and IVT volume from 24,584 to 23,077 (6.1%, [6.4, 5.8]; p<0.0001). Larger declines were observed at high volume compared to low volume centers (all p<0.0001). There was no significant change in mechanical thrombectomy volumes (0.7%, [0.6,0.9]; p=0.49). Stroke was diagnosed in 1.3% [1.31,1.38] of 406,792 COVID-19 hospitalizations. SARS-CoV-2 infection was present in 2.9% ([2.82,2.97], 5,656/195,539) of all stroke hospitalizations. DISCUSSION There was a global decline and shift to lower volume centers of stroke admission volumes, ICH volumes, and IVT volumes during the 1st year of the COVID-19 pandemic compared to the prior year. Mechanical thrombectomy volumes were preserved. These results suggest preservation in the stroke care of higher severity of disease through the first pandemic year. TRIAL REGISTRATION INFORMATION This study is registered under NCT04934020