Criptococosis mucocutánea : reporte de un caso y revisión bibliográfica

La criptococosis es una infección micótica grave que suele presentarse en pacientes con inmunocompromiso, especialmente VIH. Suele afectar predominantemente pulmón y sistema nervioso central, siendo las manifestaciones cutáneas y mucosas infrecuentes. Existen múltiples métodos diagnósticos; y la terapéutica dependerá de la forma de presentación de la infección y el compromiso o no de la inmunidad del paciente al momento del contacto con el hongo. Se presenta un paciente inmunosuprimido con diagnóstico de criptococosis mucocutánea por diseminación hematógena.Cryptococcosis is a serious fungal infection that usually occurs in patients with immunocompromise, especially HIV. It usually affects predominantly the lung and the central nervous system, whyle cutaneous and mucous manifestations are infrequent. There are multiple diagnostics methods; and the therapeutic will be decided based on the form of presentation of the infection and the commitment or not of the inmunity of the patient at the time of contact with the fungus. We present an inmunosuppressed patient with mucocutaneous cryptococcosis due to hematogenous spread.Fil: Gentile, Brenda. Hospital Luis Lagomaggiore (Mendoza, Argentina). Servicio de DermatologíaFil: Senarega, Adriana. Hospital Luis Lagomaggiore (Mendoza, Argentina). Servicio de DermatologíaFil: Vidal, Jorgelina Natalí. Hospital Luis Lagomaggiore (Mendoza, Argentina). Servicio de DermatologíaFil: Cantú Parra, Laura. Hospital Luis Lagomaggiore (Mendoza, Argentina). Servicio de DermatologíaFil: Rivarola, Emilce. Hospital Luis Lagomaggiore (Mendoza, Argentina). Servicio de DermatologíaFil: Parra, Viviana. Hospital Luis Lagomaggiore (Mendoza, Argentina). Servicio de Dermatologí

Cutaneous infiltration by blast cells : a case report

La leucemia cutis consiste en la infiltración cutánea por células blásticas. Se produce en menos del 30% de los pacientes con leucemia, más frecuentemente dentro del primer año de diagnóstico de la enfermedad hematológica. Se considera un signo de mal pronóstico ya que se asocia a mayor afectación extramedular (especialmente de sistema nervioso central), mayor tasa de recidiva y mayor mortalidad. El tratamiento consiste en quimioterapia sistémica asociada a radioterapia de baño de electrones. Debe tenerse en cuenta la posibilidad de realizar además quimioterapia intratecal. Se presenta una paciente de género femenino de 42 años de edad, con diagnóstico de leucemia mieloide aguda indiferenciada (M0) con lesiones compatibles clínica e histológicamente con leucemia cutis. Destacamos la importancia del diagnóstico temprano y tratamiento adecuado.Leukemia cutis is the cutaneous infiltration by blast cells. It is seen in less than 30% of the patients with leukemia, more often during the first year since the diagnosis of the hematological disease. It is considered a sign of poor prognosis since it is associated with greater extramedullary involvement (especially of the central nervous system), higher recurrence rates, and higher mortality. The treatment is systemic chemotherapy associated to electron bean radiotherapy. Intrathecal chemotherapy should be considered as a therapeutic option. We present a 42-year-old woman with diagnosis of undifferentiated acute myeloid leukemia (M0) with lesions clinically and histologically compatible with leukemia cutis. We highlight the value of an early diagnosis and the appropriate treatment.Fil: Vidal, Jorgelina Natalí. Hospital Luis Lagomaggiore (Mendoza, Argentina). Servicio de DermatologíaFil: Gentile, Brenda. Hospital Luis Lagomaggiore (Mendoza, Argentina). Servicio de DermatologíaFil: Senarega, Adriana. Hospital Luis Lagomaggiore (Mendoza, Argentina). Servicio de DermatologíaFil: Cheseé, Carla. Hospital Luis Lagomaggiore (Mendoza, Argentina). Servicio de DermatologíaFil: Innocenti, Carolina. Hospital Luis Lagomaggiore (Mendoza, Argentina). Servicio de Dermatologí

Consensus guidelines for the use and interpretation of angiogenesis assays

The formation of new blood vessels, or angiogenesis, is a complex process that plays important roles in growth and development, tissue and organ regeneration, as well as numerous pathological conditions. Angiogenesis undergoes multiple discrete steps that can be individually evaluated and quantified by a large number of bioassays. These independent assessments hold advantages but also have limitations. This article describes in vivo, ex vivo, and in vitro bioassays that are available for the evaluation of angiogenesis and highlights critical aspects that are relevant for their execution and proper interpretation. As such, this collaborative work is the first edition of consensus guidelines on angiogenesis bioassays to serve for current and future reference

Achieving the "triple aim" for inborn errors of metabolism: a review of challenges to outcomes research and presentation of a new practice-based evidence framework

Across all areas of health care, decision makers are in pursuit of what Berwick and colleagues have called the “triple aim”: improving patient experiences with care, improving health outcomes, and managing health system impacts. This is challenging in a rare disease context, as exemplified by inborn errors of metabolism. There is a need for evaluative outcomes research to support effective and appropriate care for inborn errors of metabolism. We suggest that such research should consider interventions at both the level of the health system (e.g., early detection through newborn screening, programs to provide access to treatments) and the level of individual patient care (e.g., orphan drugs, medical foods). We have developed a practice- based evidence framework to guide outcomes research for inborn errors of metabolism. Focusing on outcomes across the triple aim, this framework integrates three priority themes: tailoring care in the context of clinical heterogeneity; a shift from “urgent care” to “opportunity for improvement”; and the need to evaluate the comparative effectiveness of emerging and established therapies. Guided by the framework, a new Canadian research network has been established to generate knowledge that will inform the design and delivery of health services for patients with inborn errors of metabolism and other rare diseases.This work was supported by a CIHR Emerging Team Grant (“Emerging team in rare diseases: acheiving the ‘triple aim’ for inborn errors of metabolism,” B.K. Potter, P. Chakraborty, and colleagues, 2012– 2017, grant no. TR3–119195). Current investigators and collaborators in the Canadian Inherited Metabolic Diseases Research Network are: B.K. Potter, P. Chakraborty, J. Kronick, D. Coyle, K. Wilson, M. Brownell, R. Casey, A. Chan, S. Dyack, L. Dodds, A. Feigenbaum, D. Fell, M. Geraghty, C. Greenberg, S. Grosse, A. Guttmann, A. Khan, J. Little, B. Maranda, J. MacKenzie, A. Mhanni, F. Miller, G. Mitchell, J. Mitchell, M. Nakhla, M. Potter, C. Prasad, K. Siriwardena, K.N. Speechley, S. Stocker, L. Turner, H. Vallance, and B.J. Wilson. Members of our external advisory board are D. Bidulka, T. Caulfield, J.T.R. Clarke, C. Doiron, K. El Emam, J. Evans, A. Kemper, W. McCormack, and A. Stephenson Julian. J. Little is supported by a Canada Research Chair in Human Genome Epidemiology. K. Wilson is supported by a Canada Research Chair in Public Health Policy

Medical Student Mental Health Services: Psychiatrists Treating Medical Students

Medical school is a stressful and challenging time in the academic career of physicians. Because of the psychological pressure inherent to this process, all medical schools should have easily accessible medical student mental health services. Some schools of medicine provide these services through departments of psychiatry or other associated training programs. Since this stressful lifestyle often continues through residency training and life as a physician, this is a critical period in which to develop and utilize functional and effective coping strategies. When psychiatrists provide the mental health treatment to medical students, it is important to consider transference and countertransference issues, over intellectualization, and instances of strong idealization and identification

Medical Student Mental Health Services: Psychiatrists Treating Medical Students

Medical school is a stressful and challenging time in the academic career of physicians. Because of the psychological pressure inherent to this process, all medical schools should have easily accessible medical student mental health services. Some schools of medicine provide these services through departments of psychiatry or other associated training programs. Since this stressful lifestyle often continues through residency training and life as a physician, this is a critical period in which to develop and utilize functional and effective coping strategies. When psychiatrists provide the mental health treatment to medical students, it is important to consider transference and countertransference issues, over intellectualization, and instances of strong idealization and identification