Background: Pityriasis rosea is an acute disseminated rash of unknown etiology and prolonged duration, characterized by erythematous-squamous plaques. Despite having an ostentatious clinical picture for both the patient and family, it is self-limited and usually resolves without sequelae. Pityriasis rosea is often erroneously diagnosed as mycosis and given unnecessary treatment. Objective: To describe the clinical and demographical features of pityriasis rosea in a group of Mexican pediatric patients. Patients and methods: Retrospective and descriptive study in which the clinical and demographic features of patients attended at the department of dermatology of the National Institute of Pediatrics with diagnosis of pityriasis rosea within a ten year period were analysed. Results: Thirty patients with pityriasis rosea, with a frequency of 3.6 per 1000 dermatological patients. Pityriasis rosea was more frequent in females with a ratio of 1.5 to 1 and a mean age of 10 years. More than half of the patients (56%) had an atypical presentation, and biopsy was mandatory in 7 patients to establish the final diagnosis. Conclusions: The knowledge of the clinical features of pityriasis rosea by primary care physicians will prevent from unnecessary work-up and treatments.

Antecedentes: la pitiriasis rosada es un exantema agudo diseminado de etiología desconocida y duración prolongada. Se caracteriza por placas eritematosas con un collarete de escama periférica. Aunque el cuadro clínico es aparatoso para el paciente y el familiar, la pitiriasis rosada es involutiva y generalmente remite sin secuelas. Frecuentemente es confundida con micosis y se prescriben tratamientos innecesarios. Objetivo: describir las características clínicas y demográficas de la pitiriasis rosada en un grupo de pacientes pediátricos mexicanos. Pacientes y métodos: estudio retrospectivo y descriptivo en el que se analizaron las características clínicas y demográficas de los pacientes evaluados en el Servicio de Dermatología del Instituto Nacional de Pediatría con diagnóstico de pitiriasis rosada en un periodo de 10 años. Resultados: se encontraron treinta pacientes con pitiriasis rosada para una frecuencia de 3.6 por cada 1 000 pacientes dermatológicos. Predominio en mujeres con una relación de 1.5:1 y edad promedio de 10 años. En más de la mitad de los casos (56%) se observaron formas atípicas que hicieron necesaria la toma de biopsia en 7 pacientes para establecer el diagnóstico definitivo. Conclusiones: el conocimiento de las características clínicas de la pitiriasis rosada, por médicos de primer contacto, evitará tratamientos y exámenes innecesarios.

FUNDAMENTO: A doença de Chagas afeta mais de 15 milhões de pessoas em todo o mundo. Embora a transmissão vetorial tenha diminuído, a transmissão oral tornou-se relevante. Recentemente, nosso grupo publicou as características clínicas e epidemiológicas do maior surto relatado até hoje da doença de Chagas transmitida oralmente. OBJETIVO: Descrever alterações eletrocardiográficas que ocorrem na população de estudo durante o surto causado pela ingestão de suco de goiaba contaminado. MÉTODOS: Avaliamos 103 casos positivos, dos quais 76 (74%) tinham <18 anos de idade (média das idades: 9,1 ± 3,1 anos) e 27 (26%) tinham >18 anos (média das idades: 46 ± 11,8 anos). Todos os pacientes foram submetidos a avaliações clínicas e ECG. Caso os pacientes apresentassem palpitações ou alterações evidentes do ritmo na linha basal, o monitoramento de ECG ambulatorial seria realizado. RESULTADOS: Um total de 68 casos(66%;53 crianças e15 adultos) apresentaram anormalidades no ECG. Além disso, 69,7% (53/76) daqueles com idade < 18anos e 56% (15/27) daqueles com idade >18 anos apresentaram alguma alteração no ECG(p = ns). Anormalidades de ST-T foram observadas em 37,86% casos (39/103) e arritmias foram evidente sem 28,16% casos(29/103). Alterações de ST ocorreram em 72% daqueles com idade < 18 anos em comparação aos de > 18 anos (p < 0,0001). CONCLUSÃO: Este estudo relata o maior número de casos no mesmo surto de doença de Chagas causada por contaminação oral, com ECGs relatados. As alterações no ECG que sugerem miocardite aguda e arritmias foram as anormalidades encontradas com maior frequência.

BACKGROUND: Chagas disease affects more than 15 million people worldwide. Although vector-borne transmission has decreased, oral transmission has become important. Recently, our group published the clinical and epidemiological characteristics of the largest outbreak of orally transmitted Chagas disease reported till date. OBJECTIVE: To describe electrocardiographic changes occurring in the study population during the outbreak caused by ingestion of contaminated guava juice. METHODS: We evaluated 103 positive cases, of which 76 (74%) were aged <18 years (average age: 9.1 ± 3.1 years) and 27 (26%) were aged > 18 years (average age: 46 ± 11.8 years). All patients underwent clinical evaluations and ECG. If the patients had palpitations or evident alterations of rhythm at baseline, ambulatory ECG monitoring was performed. RESULTS: A total of 68 cases (66%; 53 children and 15 adults) had ECG abnormalities. Further, 69.7% (53/76) of those aged < 18 years and 56% (15/27) of those aged >18 years showed some ECG alteration (p = ns). ST-T abnormalities were observed in 37.86% cases (39/103) and arrhythmias were evident in 28.16% cases (29/103). ST alterations occurred in 72% of those aged <18 years compared with 19% of those aged >18 years (p < 0.0001). CONCLUSIONS: This study reports the largest number of cases in the same outbreak of acute Chagas disease caused by oral contamination, with recorded ECGs. ECG changes suggestive of acute myocarditis and arrhythmias were the most frequent abnormalities found.

Diabetes confers a greater risk of developing coronary artery disease and harbors a worse long term prognosis with medical therapy compared to non-diabetic patients. Diabetic patients have a higher incidence and greater mortality from myocardial infarction compared to non-diabetics. Accordingly, myocardial revascularization is frequently required to treat diabetic patients with coronary artery disease. The long term outcomes of diabetic patients with coronary artery disease are worse than those of non-diabetic patients whether a medical, interventional or surgical approach is utilized. This is extremely important to recognize, because the presence of diabetes greatly increases the patient's risk for complications and restenosis. The long term follow-up of clinical trials comparing percutaneous transluminal coronary angioplasty (PTCA) versus surgical revascularization illustrates that surgical revascularization remains the recommended strategy for diabetic multivessel coronary heart disease (CHD). However, recent advances in percutaneous coronary interventions (PCI) have resulted in a changing paradigm for coronary artery revascularization in diabetic patients. The present article analyzes the outcomes of the clinical trials comparing CABGS versus PCI in the three different stages of the technological advance in the development of PTCA: balloon angioplasty, conventional stenting, and, more recently, drug eluting stents which seem to have improved the outcomes of PTCA in diabetic patients. In light of these results, current recommendations from international guidelines are discussed in order to choose the revascularization treatment in these patients. Finally, the results of recent studies, as the BARI 2D and CARDIA trials, are reported. Ongoing studies like the FREEDOM trial are mentioned, which will probably provide further evidence to define the indications of percutaneous revascularization in diabetic patients in a more accurate fashion.

Es bien conocido que la diabetes confiere un riesgo mayor de desarrollo de enfermedad coronaria y que conlleva un pronóstico adverso a largo plazo con tratamiento médico en comparación con los pacientes no diabéticos. Los diabéticos presentan además una incidencia mayor de infarto de miocardio con mayor mortalidad frente a los no diabéticos. En consecuencia, es frecuente que los diabéticos con enfermedad coronaria requieran tratamiento mediante revascularización miocárdica. Los resultados a largo plazo del tratamiento médico y de las estrategias intervencionistas o quirúrgicas en los pacientes diabéticos con enfermedad coronaria son peores que en los no diabéticos. Es sumamente importante reconocer este hecho porque la presencia de diabetes aumenta en extremo el riesgo de complicaciones y de reestenosis. El seguimiento a largo plazo de los ensayos clínicos que compararon los resultados de la angioplastia (ATC) con la cirugía de revascularización miocárdica (CRM) demuestran que la cirugía continúa siendo la estrategia recomendada para los pacientes diabéticos con enfermedad multivaso. Sin embargo, los recientes avances en las intervenciones coronarias percutáneas (ICP) han producido un cambio en el paradigma de la revascularización coronaria en los pacientes diabéticos. En el presente artículo de revisión se analizan los resultados de los estudios comparativos entre CRM e IPC realizados en tres etapas diferentes del desarrollo tecnológico de los métodos percutáneos: la angioplastia con balón, con stent convencional y los más recientes con stents farmacológicos, que parecen haber mejorado el pronóstico de la ATC en los pacientes diabéticos. A la luz de estos resultados, se discuten las indicaciones actuales de las guías internacionales para seleccionar el tratamiento de revascularización en estos pacientes. Finalmente, se comentan los resultados de estudios recientes, como BARI 2D y CARDIA, y los que se encuentran en curso (FREEDOM), que probablemente aportarán más evidencia para definir con más precisión las indicaciones de revascularización percutánea en los pacientes diabéticos.