ABSTRACT Introduction the autopsy is an essential medical procedure; however, its use has declined over the decades. In autoimmune and rheumatological diseases, anatomical and microscopic diagnosis is critical to diagnose of the cause of death. For this reason, our objective is to describe the cause of death in patients diagnosed with autoimmune and rheumatic diseases who underwent an autopsy in a Pathology reference center in Colombia. Materials and methods a retrospective and descriptive study of autopsy reports. Results between January 2004 and December 2019, 47 autopsies of patients with autoimmune and rheumatological diseases were performed. Systemic lupus erythematosus and rheumatoid arthritis were the most common diseases. The leading cause of death was related to infections, being opportunistic infections in the majority of the cases. Conclusions our autopsy-based study was focused on patients with autoimmune and rheumatological conditions. Infections are the leading cause of death, particularly opportunistic infections, diagnosed mainly by microscopy. Thus, the autopsy should continue to be considered the “gold standard” to determine the cause of death in this population.

Abstract INTRODUCTION: Benznidazole (BZL) and Nifurtimox (NFX) are the pharmacological treatment for acute phase Chagas Disease (CD); however, therapy resistance and residual mortality development remain important unresolved issues. Posaconazole (POS) has shown a trypanocidal effect in vivo and in vitro. Thus, this study aimed at comparing the T. Cruzi parasitic load-reducing effect of the combination of BZL+POS against that of monotherapy with either, during acute phase CD, in an experimental murine model. METHODS Nineteen Wistar rats were randomly allocated to four groups and inoculated with the trypomastigotes of T. cruzi strain´s JChVcl1. The rats were administered anti-parasites from day 20-29 post-infection. The Pizzi and Brener method was used for parasitemia measurement. Longitudinal data analysis for the continuous outcome of repeated measures was performed using parasitemia as the outcome measured at days 20, 22, 24, 27, and 29 post-infection. RESULTS All four groups had similar parasitic loads (p=0.143) prior to therapy initiation. Among the three treatment groups, the BZL+POS (n=5) group showed the highest mean parasitic load reduction (p=0.000) compared with the control group. Likewise, the BZL+POS group rats showed an earlier therapeutic effect and were the only ones without parasites in their myocardial samples. CONCLUSIONS: Treatment of acute phase CD with BZL+POS was more efficacious at parasitemia and myocardial injury reduction, compared with monotherapy with either.

Resumen Introducción: Es importante conocer las características demográficas y clínicas de las fracturas en niños para mejorar las estrategias de prevención y tratamiento en estos pacientes. Objetivos: Describir las fracturas en niños y sus características epidemiológicas. Metodología: Estudio tipo corte transversal desde enero 2014 hasta diciembre 2017. Pacientes menores de 18 años que consultaron por fracturas a una clínica en Colombia fueron incluidos. Se incluyeron datos demográficos, lugar donde ocurrió el trauma, huesos fracturados y tipo de tratamiento. Se evaluó la distribución por género y grupo etario. La fuente de información fue la historia clínica. Se utilizaron medidas de tendencia central y dispersión para agrupar los datos. Se calculó la incidencia de fracturas por cada 1000 niños/ año. Este estudio recibió aval del comité de ética de la institución. Resultados: Hubo 2436 niños fracturados, 65.6% (n=1597) ocurrieron en hombres. La mayoría fueron entre 6-11 años (40.7%, n=991), luego entre 12-17 años (36.4%, n=887) y finalmente, menores de 6 años (22.9%, n=558). La localización de la fractura más frecuente entre 0-5 años fue el húmero (30.6%, n=171), seguido por el radio (29%, n=162) y la clavícula (15.9%, n=89); entre 6-11 años fue el radio (45.2%, n=448), seguido por el húmero (18%, n=178) y el cúbito (16.6%, n=165); y entre 12-17 años fue el radio (34.6%, n=307), seguido por los huesos de la mano (22.7%, n=201) y los huesos del pie (10.8%, n=96). Requirieron manejo quirúrgico 30.9% de los niños fracturados (n=752). La incidencia de fracturas fue de 29.7/1000 niños por año. Conclusión: Las fracturas en niños se presentan con mayor frecuencia en el género masculino. Los huesos fracturados varían dependiendo del grupo etario, con un porcentaje importante del radio en todos los grupos. La mayoría se manejan de forma conservadora.

Abstract Introduction: It is important to know the demographic and clinical characteristics of fractures in children to improve prevention and treatment strategies in these patients. Objectives: To describe fractures in children and their epidemiological characteristics. Methodology: Cross-sectional study performed between January 2014 and December 2017. Patients under 18 years old with fractures who consulted to a hospital in Colombia were included. Demographic data, the location where the trauma occurred, fractured bones and type of treatment were included. Age and gender distribution were analyzed. Medical records were the source of information. Central tendency and dispersion measures were used to group the data. Incidence of fractures per 1000 children / year was calculated. This study received approval from the institution’s ethics committee. Results: There were 2436 children with fractures, 65.6% (n=1597) occurred in males. Most fractures were in children between 6-11 years old (40.7%, n=991), followed by 12-17 years old (36.4%, n=887) and finally by children under 6 years old (22.9%, n=558). For the group under 6 years, most fractures occurred in humerus (30.6%, n=171), followed by radius (29%, n=162) and clavicle (15.9%, n=89); between 6-11 years old it was in radius (45.2%, n=448), followed by humerus (18%, n=178) and ulna (16.6%, n=165); and between 12-17 years it was in radio (34.6%, n=307), followed by bones of the hand (22.7%, n=201) and bones of the foot (10.8%, n=96). Surgical treatment was required in 30.9% (n=752) of the patients. The incidence of fractures was 29.7/1000 children per year. Conclusions: Fractures in children occur more frequently in males. The fractured bones differ depending on the age group; however, radius fractures represent an important proportion in all groups. Most fractures in children are treated in a conservative manner.

BACKGROUND Topical treatment of New World cutaneous leishmaniasis can be affected by bacterial coinfection, hyperkeratosis, and transdermal drug delivery. OBJECTIVE The aim of this work was to evaluate the therapeutic response and safety of the topical, sequential use of antiseptic, keratolytic, and pentamidine isethionate (PMD) creams (3-PACK kit) on CL-infected BALB/c mice. METHODS A 0.5% chlorhexidine solution (CGH), 10% salicylic acid (SA), and 3% or 6% PMD were used as antiseptic, keratolytic, and antileishmanial drugs, respectively. During the first seven days, antiseptic, followed by 10% SA gel and PMD cream, were applied topically. Subsequently, treatment was performed only with the antiseptic and PMD creams. Skin irritation, reduction of lesion size (mm2), and parasitic load were observed until 30 days of treatment were completed. FINDINGS The 3-PACK treatment using 6% PMD induced a complete lesion reduction in 3/6 mice and a partial reduction in 1/6 mice, with no parasites observed. In contrast, CGH and SA alone, along with the vehicle, were not effective (p < 0.05). Moderate to severe erythema was observed at the application site. MAIN CONCLUSION The topical 3-PACK using 6% PMD was 67% effective in the treatment of CL by Leishmania (Viannia) braziliensis. Currently, work is ongoing to improve PMD isethionate formulation and to determine a dose-response.

Abstract: Paracoccidioidomycosis is the most important systemic and endemic mycosis in Latin America, Colombia is the second country with the highest number of cases. According to the clinical manifestations, the forms of presentation of this disease can be acute or chronic; the last one occurs in patients older than 30 years causing lung involvement, in skin and mucous membranes. The antifungal treatment is based on the administration of sulfa drugs and azole derivatives in cases of mild to moderate manifestations, and amphotericin B, which is reserved for patients with severe disease and requires in-hospital management. We present the case of a 66-year-old patient with severe pulmonary manifestations as the only manifestation of chronic paracoccidioidomycosis that did not respond initially to management with oral itraconazole, therefore management was offered with amphotericin B. In the absence of clear clinical criteria for hospitalization by pulmonary commitment, we consider that the clinical - radiological commitment must be taken into account when initiating early parenteral management.

Resumen: La paracoccidioidomicosis es la micosis sistémica y endémica más importante en Latinoamérica, Colombia es el segundo país con mayor número de casos. De acuerdo con las manifestaciones clínicas, las formas de presentación de esta enfermedad pueden ser aguda o crónica; esta última se presenta en pacientes mayores de 30 años ocasionando compromiso pulmonar, en piel y mucosas. El tratamiento antimicótico se basa en la administración de sulfas y derivados azólicos en casos de manifestaciones leves a moderada, y anfotericina B que se reserva para pacientes con enfermedad grave y requiere manejo intrahospitalario. Se presenta el caso de un paciente de 66 años con manifestaciones pulmonares severas como única manifestación de paracoccidioidomicosis crónica que no respondió inicialmente al manejo con itraconazol oral, por lo que se ofreció manejo con anfotericina B. Ante la ausencia de criterios clínicos claros de hospitalización por compromiso pulmonar, consideramos que el compromiso clínico-radiológico se debe tener en cuenta a la hora de iniciar el manejo parenteral de forma temprana.

Resumen Objetivo: Evaluar la permeabilidad, retención y biodistribución de los LUD-PcAlCl in vivo. Metodología: Los transferosomas fueron obtenidos mediante rehidratación de película lipídica. Ratas Wistar fueron tratadas tópica e intraperitonealmente con los transferosomas por 5 días. La penetración ex vivo fue determinada mediante el ensayo en celdas de Franz y la retención por el método de la cinta adhesiva. Cinco y treinta días postratamiento se obtuvo la piel y órganos para determinar la retención del compuesto y realizar estudios histopatológicos. La PcAlCl fue extraída con solventes y cuantificada por fluorometría. Los resultados se expresaron en nM PcAlCl/mg órgano. Resultados: La PcAlCl no penetró la piel en los ensayos ex vivo, reteniéndose principalmente en el estrato córneo. Cinco días post-tratamiento tópico la PcAlCl fue retenida en estrato córneo (41,76±0,02), mostrando concentraciones mínimas en bazo (0,09±0,02), epidermis-dermis (0,06±0,17), hígado (0,03±0,02) y pulmón (0,02±0,01 nM). Por vía intraperitoneal se encontró PcAlCl en bazo (0,58±0,4), cerebro (0,07±0,07), corazón (0,07±0,12), pulmón (0,012±0,01) y piel (0,021±0,02 nM). Treinta días postratamiento no se encontró PcAlCl en ningún órgano. Los estudios histopatológicos fueron negativos. Conclusión: La PcAlCl contenida en transferosomas fue retenida principalmente en estrato córneo, mostrando bajas concentraciones en la dermis, sitio donde se aloja el parásito. Se sugiere modificar los componentes vesiculares del sistema para aumentar la permeación del compuesto.

Abstract Objective: To assess the UDL-ClAlPc permeability, retention and biodistribution in vivo. Methods: Transferosomas were obtained by lipid film re-hydration method. Wistar rats were treated topically and intraperitoneally with UDL-ClAlPc for 5 days. Skin and organs were collected five and thirty days after-treatment to determine ClAlPc retention and histopatho-logical studies. The ClAlPc was extracted with solvents and quantified by fluorometry. The results were expressed in nM PcAlCl/mg organ. The permeation was tested ex vivo using Franz-diffusion cells and the retention in stratum corneum and epidermis-dermis by tape stripping. Results: In the ex vivo experiments ClAlPc-UDL was not able to penetrate rat skin and was retained mainly in the stratum corneum. In rat, five days after topical treatment ClAlPc was retained mainly in the stratum corneum (41.76±0.02) with minimum concentrations in spleen (0.09±0.02), epidermis-dermis (0.06±0.17), liver (0.03±0.02) and lung (0.02±0.01 nM). After intra peritoneal treatment, ClAlPc was found in spleen (0.58±0.4), brain (0.07±0.07), heart (0.07±0.12), lung (0.01±0.012) and skin (0.021±0.02 nM). Thirty days post-treatment ClAlPc was not found in any organ. Histopathological studies were negative. Conclusion: The ClAlPc contained in transferosomes was retained mainly in the stratum corneum. Low concentration was detected in dermis a place where the parasite survives. This vehicle needs to be improved to increase skin penetration.

RESUMEN Los pacientes trasplantados son susceptibles a complicaciones neurológicas derivadas entre otros aspectos, de las complicaciones mismas del procedimiento, el cuidado crítico que requieren los pacientes, y de los efectos secundarios a los medicamentos utilizados y el efecto inmunoderpresor de los mismos. Este último hace que los pacientes estén expuestos a infecciones oportunistas. Dentro de estas, las Infecciones del Sistema Nervioso Central en el paciente trasplantado constituyen un reto diagnóstico. Dentro de los procesos infecciosos es importante tener en cuenta aquellos relacionados con hongos, especialmente en los 3 primeros meses posterior al trasplante. Se presenta el caso de un paciente 67 años con antecedente de trasplante cardíaco, quien ingresa con un proceso febril y posterior compromiso neurológico.

SUMMARY Transplanted patients are susceptible to neurological complications arising, among other things, from the complications of the procedure itself, the critical care, and the side effects to the medications used and the immunodepressive effect thereof. It's causes patients to be exposed to opportunistic infections. Within these, Central Nervous System Infections in the transplanted patient constitute a diagnostic challenge. Within infectious processes it is important to take into account those related to fungi, especially in the first 3 months after transplantation. We present the case of a 67 years old patient with a history of heart transplantation, which enters with a febrile process and subsequent neurological compromise.

Introducción. El virus de la hepatitis E (HEV), agente etiológico de casos esporádicos y epidemias de hepatitis, es un virus emergente de importancia global. En Colombia se desconoce la epidemiología de la infección causada por este virus. Objetivo. Determinar la seropositividad para el virus de la hepatitis E en muestras de suero de pacientes con diagnóstico clínico de hepatitis viral en Colombia. Materiales y métodos. Se estudiaron muestras de pacientes remitidas al Instituto Nacional de Salud en el periodo 2005-2010 provenientes de 15 departamentos de Colombia (grupo 1) y muestras remitidas al Laboratorio Departamental de Salud Pública de Antioquia en el periodo 2008-2009 (grupo 2). Las muestras de suero se analizaron por inmunoensayo con estuches comerciales. Resultados. La frecuencia de seropositividad para el virus de la hepatitis E en las 344 muestras analizadas fue de 8,7 % (30/344); de estas, 1,74 % (6/344) presentó IgM anti-HEV y 7,5 % (26/344), IgG anti-HEV. Se observó una diferencia en el resultado positivo entre el grupo 1 (6,3 %) y el grupo 2 (15,3 %). Los casos provenían de nueve departamentos del país. Conclusiones. Este es el primer estudio de infección por el virus de la hepatitis E en muestras de pacientes con diagnóstico de hepatitis en Colombia. La seropositividad descrita en esta población de pacientes es similar a la descrita en otros países de América Latina, como Brasil, Perú y Uruguay. Teniendo en cuenta estos resultados, se debe considerar la inclusión de los marcadores de la infección por el virus de la hepatitis E en el diagnóstico diferencial de la hepatitis viral en Colombia.

Introduction: Hepatitis E virus (HEV) is an emergent virus of global importance; it is the etiological agent of sporadic cases and outbreaks of hepatitis. The epidemiology of this infection in Colombia is unknown. Objective: To determine the seropositivity for hepatitis E virus in Colombia in cases with clinical diagnosis of viral hepatitis. Materials and methods: Serum samples from patients that were sent to the Instituto Nacional de Salud during the period 2005-2010 (group 1) and samples sent to the Laboratorio Departamental de Salud Pública de Antioquia during the 2008-2009 period were included in this study (group 2). Serum samples were analyzed by immunoassay with commercial kits. Results: From the 344 analyzed samples, 8.7% were positive for anti-HEV; the frequency of anti-HEV IgM was 1.74% (6/344) and the frequency of anti-HEV IgG was 7.5% (26/344). A difference in frequency of anti-HEV between group 1 (6.3%) and group 2 (1.3%) was observed. The cases were identified in nine departments of Colombia. Conclusions: This is the first study of hepatitis E virus infection in patients with diagnosis of hepatitis in Colombia. The frequency of anti-HEV described in this population of patients in Colombia is similar to that described in other Latin American countries like Brazil, Perú and Uruguay. Considering the results of this study, it could be necessary to include hepatitis E virus infection serological markers in the differential diagnosis of viral hepatitis in Colombia.

Introducción: Las nanoemulsiones son excelentes sistemas de transporte y entrega de fármacos. La ftalocianina de aluminio clorada (PcAlCl) en terapia fotodinámica constituye una alternativa de tratamiento en leishmaniasis cutánea. Objetivo: Determinar la difusión y retención en piel humana de la PcAlCl contenida en una nanoemulsión (nano-PcAlCl) para su optimización en formulaciones tópicas. Materiales y métodos: Se prepararon y caracterizaron fisico-químicamente dos formulaciones (nano-PcAlCl y solución-PcAlCl) y sus vehículos sin-PcAlCl. La permeación se determinó en ensayos en celdas de difusión de Franz y la retención por el método de la cinta adhesiva. La concentración de PcAlCl fue determinada fluorométricamente (nM/cm2). Biopsias de piel fueron analizadas histotécnicamente. Resultados: El tamaño promedio, el potencial Z y el índice de polidispersión de la nano-PcAlCl en agua fue de 132,9 nm, -19,23 y 0,14 y diluida en PBS fue 125,33 nm, -13,69 y 0,139. Las concentraciones de PcAlCl se mantuvieron estables. La PcAlCl no atravesó la piel y fue retenida en sus capas, en estrato córneo y epidermis+dermis con valores de 44,17 nM y 8,48 nM postratamiento con nano-PcAlCl, y 96,90 nM y 9,80 nM postratamiento con solución-PcAlCl. Esta última promovió mayor retención en estrato córneo y ambas formulaciones promovieron similar retención en epidermis+dermis. Se observó desprendimiento del estrato córneo y fragmentación del colágeno. Conclusión: La PcAlCl no atravesó la piel, se retuvo en estrato córneo y epidermis+dermis. Se sugiere realizar ensayos de permeación utilizando piel humana desprovista de estrato córneo y ensayos de distribución en animales con leishmaniasis cutánea.

Introduction: The nanoemulsions constitute excellent drug delivery systems for carrying and delivering active drugs. Chloroaluminum phthalocyanine (ClAlPc) in photodynamic therapy constitutes an interesting alternative in cutaneous leishmaniasis treatment. Objective: To determine the diffusion and retention of ClAlPc contained in a nanoemulsion (nano-ClAlPc) in human skin membranes for optimization of topical formulations. Materials and methods: Two formulations (ClAlPc-nano- and ClAlPc-solution) and vehicles without ClAlPc were prepared and physicochemical characterized. The permeation was tested in Franz-diffusion cells and the retention by the tape stripping method. ClAlPc concentration was determined fluorometrically (nM/cm2). Skin biopsies were analyzed by histologic technics. Results: The ClAlPc-nano average size, zeta potential and polydispersity index diluted in water was 132.9 nm, -19.23 and 0.14 and diluted in phosphate-buffer-saline was 25.33 nm, -13.69 and 0.139. ClAlPc maintains its stability in each formulation. ClAlPc was unable to pass completely through the skin; it was retained in the different skin layers. A ClAlPc retention in stratum corneum and epidermis+dermis was observed with values of 44.17 nM and 8.48 nM after ClAlPc-nano treatment and 96.90 nM and 9.80 nM after ClAlPc-solution treatment. The ClAlPc-solution promoted greater retention in stratum corneum and both formulations showed similar ClAlPc-retention in epidermis+dermis. Histological changes as stratum corneum detachment and collagen-fragmentation were observed. Conclusion: ClAlPc was not able to cross completely the skin, it was retained in stratum corneum and epidermis+dermis Human permeation test using skin membranes without stratum corneum, and distribution assays in cutaneous leishmaniasis-infected animals, are suggested.

Introdução: as nanoemulsões são excelentes sistemas de transporte e entrega de fármacos. A ftalocianina de alumínio clorada (PcAlCl) em terapia fotodinâmica constitui uma alternativa de tratamento em leishmaniose cutânea. Objetivo: determinar a difusão e retenção em pele humana da PcAlCl contida em uma nanoemulsão (nano-PcAlCl) para sua otimização em formulações tópicas. Materiais e métodos: se prepararam e caracterizaram fisico-quimicamente duas formulações (nano-PcAlCl e solução-PcAlCl) e seus veículos sem-PcAlCl. A permeação determinou-se em ensaios em celas de difusão de Franz e a retenção pelo método da fita adesiva. A concentração de PcAlCl foi determinada fluorometricamente (nM/cm²). Biopsias de pele foram analisadas histotecnicamente. Resultados: o tamanho médio, o potencial Z e o índice de polidispersão da nano-PcAlCl em água foi de 132,9 nm, -19,23 e 0,14 e diluída em PBS foi 125,33 nm, -13,69 e 0,139. As concentrações de PcAlCl mantiveram-se estáveis. A PcAlCl não atravessou a pele, foi retido em suas capas. A PcAlCl foi retida em estrato córneo e epiderme+derme com valores de 44,17 nM e 8,48 nM pós-tratamento com nano-PcAlCl e 96,90 nM e 9,80 nM pós-tratamento com solução-PcAlCl. A solução-PcAlCl promoveu maior retenção em estrato córneo e ambas as formulações promoveram similar retenção em epiderme+derme. Observou-se desprendimento do estrato córneo e fragmentação do colágeno. Conclusão: a PcAlCl não atravessou a pele; reteve-se em estrato córneo e epiderme+derme. Sugere-se realizar ensaios de permeação utilizando pele humana desprovida de estrato córneo e ensaios de distribuição em animais com leishmaniose cutânea.

Objetivo: investigou a prevalência de pneumopatia causada por Pneumocystis jirovecii em pacientes com o Vírus da Imunodeficiência Humana (HIV). Os pacientes pesquisados foram aqueles tratados em clínicas de pneumologia de alguns hospitais da cidade do Rio de Janeiro, Estado do Rio de Janeiro, Brasil. Métodos: entre janeiro de 2009 e julho de 2010 foram examinadas 230 amostras de enxague brônquio alveolar obtidos de pacientes de ambos os sexos na faixa etária entre 14 e 41 anos. Os lavados obtidos foram corados pelo método de Giemsa e analisados por microscopia óptica. Resultados: A prevalência geral da infecção por P. jirovecii foi de 23,5 % (54 infectados de 230 amostras analisadas), sendo 22,3 % no sexo masculino (32 infectados de 142 examinados) e 25,6 % no feminino (21 mulheres infectadas de 82 examinadas), não demonstrando diferença significativa entre os gêneros (x²= 0.05, p> 0.05). A correlação entre a infecção e a faixa etária indicou que a infecção aumenta conforme o aumento da idade, porém de forma insignificante (rs= 0,78; p> 0,05). Esse aumento ocorre de tal forma que a prevalência nos grupos etários entre 26 e 41 anos representaram individualmente mais que o dobro da observada entre os pacientes mais jovens entre 15 e 25 anos. Conclusão: os pacientes com SIDA têm grande propensão a desenvolver pneumonia por Pneumocystis jirovecii, com risco especial de colapso respiratório.

Objective: a retrospective study was conducted to determine the prevalence of pneumopathy due to Pneumocystis jirovecii in patients with the human immunodefiency virus (HIV). The patients surveyed were being treated at pneumological clinics of several hospitals in the city of Rio de Janeiro, state of Rio de Janeiro, Brazil. Methods: 230 bronchoalveolar lavage samples from patients of both sexes aged 14-41 were examined from January 2009 to July 2010. The lavage samples were stained by Giemsa's method and analyzed by optical microscopy. Results: overall prevalence of infection due to Pneumocystis jirovecii was 23.5 % (54 infected of 230 examined), of whom 22.3 % were male (32 infected of 142 examined) and 25.6 % were female (21 infected of 82 examined), with no significant difference between the sexes (ײ= 0,05, p> 0,05). On the other hand, prevalence of the infection was found to increase with age, though not significantly (rs= 0,78; p> 0,05). This increase occurs in such a way that prevalence in the 26-41 age group more than doubles that of the 15-25 age group. Conclusion: AIDS patients are prone to develop Pneumocystis jirovecii pneumonia, with a marked risk of respiratory collapse.

Objetivo: este estudio retrospectivo investigó la prevalencia de neumopatía causada por Pneumocystis jirovecii en pacientes con el virus de la inmunodeficiencia humana (VIH). Los pacientes investigados fueron aquellos tratados en clínicas de neumología de algunos hospitales de la ciudad de Río de Janeiro, estado de Río de Janeiro, Brasil. Métodos: entre enero de 2009 y julio de 2010 se examinaron 230 muestras de lavado bronquioalveolar obtenidas de pacientes de los 2 sexos en la franja etaria entre 14 y 41 años. Los lavados obtenidos se colorearon por el método de Giemsa y se analizaron por microscopia óptica. Resultados: la prevalencia general de la infección por Pneumocystis jirovecii fue de 23,5 % (54 infectados de 230 muestras analizadas), con 22,3 % en el sexo masculino (32 infectados de 142 examinados) y 25,6 % en el femenino (21 mujeres infectadas de 82 examinadas), no demostrando diferencia significativa entre los géneros (ײ= 0,05, p> 0,05). La correlacción entre la infección y la franja etaria indicó que la infección aumenta conforme el incremento de la edad, sin embargo, de modo no significativo (rs= 0,78; p> 0,05). Ese aumento ocurre de tal forma que la prevalencia en los grupos etarios entre 26 y 41 años representó, individualmente, más que el doble de la observada entre los pacientes más jóvenes de 15 a 25 años. Conclusión: los pacientes con sida son propensos a desarrollar neumonía por Pneumocystis jirovecii, con riesgo especial de colapso respiratorio.

El pénfigo es una enfermedad vesículo-ampollosa autoinmune de la piel y mucosas, que puede comprometer grandes extensiones; los tipos vulgar y foliáceo son los más frecuentes, con diferencias inmunopatológicas entre ellas. El pénfigo es tratado con corticoides y Azatioprina pero en los últimos años se incluyeron nuevos medicamentos como inmunoglobulinas, Rituximab (anticuerpo monoclonal quimérico anti-CD20) entre otros, Mostramos un caso de pénfigo hiperpigmentado atípico, y revisamos el tema en especial sobre el tratamiento. Salud UIS 2012; 44 (3): 49-55

Pemphigus is a blistering autoimmune skin and mucous disease, wich can involve large areas; vulgar and foliaceus types are the most common, with immunological differences between them. The pemphigus is treated with corticoids and azathioprine but in recent years new drugs were included as immunoglobulins, Rituximab (Chimeric monoclonal anti-CD20), among others. We show a case of atypical hyperpigmented pemphigus appearance and the review of issue, especially on treatment. Salud UIS 2012; 44 (3): 49-55

El absceso encefálico es una infección focal localizada que puede afectar cualquier parte del sistema nervioso central, se caracteriza histopatológicamente por presentar un centro necrótico y un área perilesional de infiltrado inflamatorio mixto de linfocitos y polimorfonucleares en su etapa tardía. Entre los múltiples mecanismos etiopatogénicos se consideran como más importantes la diseminación por continuidad, por vía hematógena y la inoculación directa por trauma o por procedimientos quirúrgicos. Su sintomatología es inespecífica y depende de la localización, tamaño, número de lesiones, relación entre la virulencia del germen y el estado inmunológico del paciente, edema y grado de hipertensión asociado en dicha patología. El diagnóstico de absceso encefálico que se realiza mediante imágenes radiológicas como la tomografía axial computarizada o la resonancia magnética no resulta fácil debido a que puede confundirse con cualquier otra lesión ocupante de espacio, como por ejemplo un tumor cerebral. Se presenta un caso de absceso encefálico en un paciente masculino adulto mayor en el Hospital Universitario de Santander, Bucaramanga y se realiza correlación entre las manifestaciones clínicas y los hallazgos patológicos y radiológicos. (MÉD.UIS. 2012;25(3):259-63)

Brain abscess is a localized focal infection that can affect any part of the central nervous system, is characterized histopathologically by presenting a necrotic center and an area of perilesional inflammatory infiltrate of lymphocytes and polymorphonuclear late stage. Among the multiple pathogenetic mechanisms are considered most important for continuity spread by hematogenous and direct inoculation by trauma or surgical procedures. Its symptoms are nonspecific and depends on the location, size, number of lesions, relation between the virulence of the organism and the patient's immune status, edema and hypertension associated degree in this pathology. The diagnosis of brain abscess is performed by radiological imaging such as computerized tomography scan or magnetic resonance imaging is not easy because it can be confused with any other space-occupying lesion such as a brain tumor. We report a case of brain abscess in an elderly male patient at the Hospital Universitario de Santander, Bucaramanga and performs correlation between the clinical and pathological and radiological findings. (MÉD.UIS. 2012;25(3):259-63)

Introducción: describir tres casos fatales de tuberculosis meníngea y establecer correlación clinicopatológica. Materiales y métodos: revisión de protocolos de autopsia entre enero 1 y junio 30 de 2010 en el Departamento de Patología de la Universidad Industrial de Santander (UIS). Entre 121 protocolos de necropsias se encontraron 3 casos de tuberculosis meníngea, de los cuales se revisaron historias clínicas, preparaciones histopatológicas y fotografías. Resultados: tres casos de adultos con edad promedio de 39 años, sin inmunosupresión con tuberculosis meníngea. Las manifestaciones clínicas fueron cefalea, vómito, fiebre, disartria, compromiso de pares craneales, alteraciones motoras y del estado de conciencia. Conclusiones: la tuberculosis meníngea es la forma más grave de la enfermedad, con desenlace fatal en casos no diagnosticados. El bajo índice de sospecha y la similitud con otras infecciones del sistema nervioso central, no permiten diagnostico precoz ni tratamiento oportuno. Salud UIS 2012; 44 (1): 57-66

Introduction: to describe three fatal cases of tuberculous meningitis and to establish clinical pathological correlation. Materials and methods: Revision of autopsy protocols between 01 january and june 30 of 2010 in the Department of Pathology of the Industrial University of Santander (UIS). Between 121 protocols of autopsies were 3 cases of tuberculous meningitis, of which clinical histories, histopathological slides and photographies were rewieved. Results: three cases of adults with age average of 39 years, without inmunosupresión with tuberculous meningitis. The clinical manifestations were migraine, vomit, fever, disartria, commitment of cranial nerves, motor alterations and disorders of consciousness. Conclusions: the tuberculous meningitis is the most serious form of the disease, with fatal course in nondiagnosed cases. The low index of suspicion and the similarity with other infections of the central nervous system, do not allow early diagnostic and nor opportune treatment. Salud UIS 2012; 44 (1): 57-66