First report of survival in two patients with hematologic malignancy and Stenotrophomonas maltophilia hemorrhagic pneumonia treated with trimethoprim-sulfamethoxazole-based combination antibiotic therapy

Stenotrophomonas maltophilia has become a common cause of opportunistic infections in immunocompromised hosts and critical care patients. The most common disease manifestations are pneumonia and bacteremia, with a mortality ranging from 9% to 60.5% depending of the type of infection and host related underlying risk factors. Patients with hematological malignancies may develop a hemorrhagic pneumonia with a rapidly progressive and universally fatal disease course, despite appropriate treatment with trimethoprim/sulfamethoxazole or combination therapy. We report the first two patients with hematologic malignancies and hemorrhagic pneumonia due to S. maltophilia with successful treatment outcomes after early institution of combination therapy with TMP/SMX, polymyxin, and/or moxifloxacin.

Validation of trauma scales: ISS, NISS, RTS and TRISS for predicting mortality in a Colombian population

BACKGROUND

Our purpose was to validate the performance of the ISS, NISS, RTS and TRISS scales as predictors of mortality in a population of trauma patients in a Latin American setting.

MATERIALS AND METHODS

Subjects older than 15 years with diagnosis of trauma, lesions in two or more body areas according to the AIS and whose initial attention was at the hospital in the first 24 h were included. The main outcome was inpatient mortality. Secondary outcomes were admission to the intensive care unit, requirement of mechanical ventilation and length of stay. A logistic regression model for hospital mortality was fitted with each of the scales as an independent variable, and its predictive accuracy was evaluated through discrimination and calibration statistics.

RESULTS

Between January 2007 and July 2015, 4085 subjects were enrolled in the study. 84.2% (n = 3442) were male, the mean age was 36 years (SD = 16), and the most common trauma mechanism was blunt type (80.1%; n = 3273). The medians of ISS, NISS, TRISS and RTS were: 14 (IQR = 10-21), 17 (IQR = 11-27), 4.21 (IQR = 2.95-5.05) and 7.84 (IQR = 6.90-7.84), respectively. Mortality was 9.3%, and the discrimination for ISS, NISS, TRISS and RTS was: AUC 0.85, 0.89, 0.86 and 0.92, respectively. No one scale had appropriate calibration.

CONCLUSION

Determining the severity of trauma is an essential tool to guide treatment and establish the necessary resources for attention. In a Colombian population from a capital city, trauma scales have adequate performance for the prediction of mortality in patients with trauma.

Colaboración Cochrane Iberoamericana-Colombia región Antioquia y viejo Caldas. Identificación y descripción de los ensayos clínicos controlados publicados durante el período 1948 -1998

Entidades: Escuela de Investigaciones Médicas Aplicadas, Biblioteca Médica, Facultad de Medicina; Sistema de Bibliotecas, Universidad de Antioquia. Objetivo: localizar y describir los ensayos clínicos (EC) con distribución aleatoria publicados en la región. Se pretende que esta información permita un mayor conocimiento de este tipo de actividad científica, así como que constituya la base de partida para los trabajos de la Colaboración Cochrane Iberoamericana. Metodología: búsqueda manual en los principales títulos de revistas médicas de la región de los posibles ensayos clínicos controlados. Resultados: se revisaron 23 revistas, en las cuales se encontraron 52 ensayos clínicos controlados y tres ensayos clínicos aleatorizados. Conclusiones: este trabajo es pionero en Antioquia y el viejo Caldas en la búsqueda de ensayos clínicos controlados en las principales publicaciones entre 1948-1998. Hace parte del estudio “Identificación de los estudios clínicos controlados y meta-análisis en las revistas de salud en Colombia 1948-1998”, iniciado con el fin de crear una base latinoamericana de datos especializada en ensayos clínicos.

On the pathogenesis of idiopathic guttate hypomelanosis

Idiopathic guttate hypomelanosis is a common leukodermic dermatosis of obscure origin, consisting of small 2- to 5-mm achromic or hypopigmented macules, mainly affecting the exposed upper and lower extremities. In a group of 400 consecutive dermatologic patients, idiopathic guttate hypomelanosis was much more prevalent in women than in men. However, in both sexes this prevalence became more common with advancing age. In another group of fifteen patients with idiopathic guttate hypomelanosis and fifteen normal controls matched by age, sex, and skin type, the following was found: A cause-effect relationship between chronic actinic exposure and the development of idiopathic guttate hypomelanosis could not be established by statistical studies. A family aggregation survey disclosed a higher prevalence of idiopathic guttate hypomelanosis in the family of patients with idiopathic guttate hypomelanosis than in the control group. Epithelial atrophy, patchy absence of melanocytes and melanin, flattening of the rete pegs, and basket weave hyperkeratosis were the most prominent histologic findings of idiopathic guttate hypomelanosis. Minigrafts of normal skin implanted in idiopathic guttate hypomelanosis lesions did not modify the achromic defects, whereas intralesional triamcinolone with or without grafts improved the appearance of these lesions.

Islet cell transplantation

Images