Both genital and non-genital treponematoses are overtly similar in pathogenesis, natural history and histologic features. In the head and neck, a relatively small percentage of untreated, infected patients may progress from latency to tertiary disease, with perforation or collapse of the palate and nasal septum. Due to the rarity of tertiary disease and the non-specific histomorphologic features, the disease may go undiagnosed, often with dire consequences. Clinicopathological correlation, a high index of suspicion and a judicious mix of histological and immunohistochemical stains may help the pathologist in arriving at the correct diagnosis. In this article, we report a unique case of nasal treponematosis in a young South African male, discussing the clinical findings, histological features and diagnostic methods of detection.

Abstract Dowling-Degos disease (DDD) is an uncommon genodermatosis. The most closely associated disorder is Galli-Galli disease (GGD). Both conditions are considered on the same disease spectrum, with the differentiating factor being the presence of acantholysis in GGD. A 51-year-old female with a 21-year history of pruritic eruption in flexural areas progressing to the trunk and limbs presented to our dermatology consult. Physical examination revealed reddish-to-dark brown hyperkeratotic papules and reticulated confluent macules. Dermoscopy showed irregular star-shaped brown mottled areas and yellow-brown polygonal structures. Histopathology confirmed features consistent with GGD. Genetic screening identified a mutation in the POGLUT1 gene. Treatment with topical clobetasol propionate 0.05% and oral antihistamines decreased pruritus, but the skin eruption persisted. We present a rare case of GGD describing clinical, genetic, dermoscopy, and histopathological features. Clinicopathological correlation and good cooperation between dermatologists and histopathologists are essential to make the correct diagnosis of GGD.

Resumo A doença de Dowling-Degos (DDD) é uma genodermatose rara, associada à doença de Galli-Galli (GGD). O fator de diferenciação entre as duas doenças é um critério histopatológico com a presença de acantólise no caso da GGD. Mulher de 51 anos, fototipo de Fitzpatrick II, recorreu à consulta de Dermatologia por uma dermatose generalizada e pruriginosa com 21 anos de evolução, com início nas pregas e progressão o tronco e membros. Ao exame objetivo observaram-se máculas e pápulas, castanho-alaranjadas, confluentes, de aspecto reticulado que predominavam no tronco e membros. A dermatosocopia das lesões mostrou áreas irregulares em estrela de coloração castanha e estruturas poligonais amareloacastanahdas, circundadas por halos esbranquiçados. A biópsia cutânea foi compatível com GGD. O estudo genético identificou uma mutação no gene POGLUT1. Este artigo ilustra um caso raro de GGD, descrevendo suas características clínicas, genéticas, dermatoscópicas e histopatológicas. A correlação clinicopatológica é essencial para o diagnóstico de GGD.

Abstract Based on an oral account of the history of Casabindo and the construction of its church, the article explores in various sources the probable course taken by the comunal lands of Casabindo and Cochinoca from the 17th to the 19th centuries. This process has been widely studied by historiography, but an attempt is made here to provide new data, especially those referring to the location and extension of these lands, their relationship with the brotherhoods and the posible strategies of the former community members to avoid losing them during the firs thalf of the 19th century

Resumen A partir de un relato oral sobre la historia de Casabindo y la construcción de su iglesia, el artículo explora en diversas fuentes el probable derrotero tomado por las tierras comunales de Casabindo y Cochinoca desde los siglos XVII hasta el XIX. Este proceso ha sido estudiado ampliamente por la historiografía pero se intenta acá aportar nuevos datos, especialmente los referidos a la ubicación y extensión de estas tierras, su relación con las cofradías y las posibles estrategias de los antiguos comuneros para evitar perderlas durante la primera mitad del siglo XIX.

Abstract Introduction and Objectives: Oral food challenges (OFC) are the gold standard for the diagnosis of food allergy. The aim of this study was to characterize and analyze the OFCs performed in the Pediatric Department of the study hospital. Material and Methods: Retrospective analysis of all patients who underwent OFCs in the pediatric department of the study hospital from October 2016 to December 2021. All non-IgE-mediated reactions were excluded. Statistical analysis was performed using IBM Statistical Package for Social Sciences®. Results: A total of 301 OFCs were performed on a total of 172 patients during the study period. Most patients were preschool children (<6 years; 79.4%) and 40.1% had more than one OFC. The most frequently tested allergens were hen’s egg (26.2%), tree nuts (16.9%), and cow’s milk (16.7%). The positivity rate was 23.2%. Tests for milk and wheat were significantly associated with a positive result. The main reason for OFC testing was to establish a diagnosis (60.1%), but also to assess tolerance (25.6%) and to document the responsiveness threshold (14.3%). Most positive reactions were local/grade I (25.7%) or moderate/grade II (58.6%). Patients with a personal history of atopic comorbidities were more likely to have a positive test result (p=0.022), especially those with atopic dermatitis (p=0.022). Discussion and Conclusion: Most OFCs in this analysis were negative. Early recognition of food allergy resolution is essential to prevent unnecessary allergen avoidance. An increased risk of positive reactions to milk or wheat, or in the setting of a personal history of atopic dermatitis, should be considered.

Resumo Introdução e Objetivos: A prova de provocação oral é o gold standard para o diagnóstico de alergia alimentar. Este estudo pretendeu caracterizar e analisar as provas efetuadas no Serviço de Pediatria de um hospital de nível II. Material e Métodos: Estudo retrospetivo dos doentes submetidos a provas de provocação oral entre outubro 2016 e dezembro 2021 num hospital de nível II. As reações não mediadas por IgE foram excluídas. A análise estatística foi realizada através do software IBM Statistical Package for Social Sciences®. Resultados: Foram realizadas 301 provas num total de 172 doentes. A maioria dos doentes eram crianças com idade <6 anos (79,4%) e 40,1% realizou duas ou mais provas. Os alergénios mais frequentemente testados foram ovo (26,2%), frutos secos (16,9%) e leite de vaca (16,7%). Constatou-se que 23,2% das provas foram positivas. Verificou-se uma associação estatisticamente significativa entre as provas realizadas para o leite e trigo e a obtenção de um resultado positivo. Relativamente ao objetivo das provas, 60,1% destinavam-se a estabelecer o diagnóstico, 25,6% a avaliar a tolerância e 14,3% a documentar o limiar de reatividade. A maioria das reações positivas foram locais/grau I (25,7%) ou moderadas/grau II (58,6%). Foi identificada uma associação estatisticamente significativa entre antecedentes de atopia e um resultado positivo nas provas (p=0,022), particularmente antecedentes de dermatite atópica (p=0,022). Discussão: A maioria das provas realizadas foram negativas. O reconhecimento atempado da resolução de uma alergia alimentar permite suspender a evicção desnecessária de alergénios suspeitos. Deve ser considerado o risco acrescido de uma reação positiva com leite, trigo ou em contexto de antecedentes pessoais de dermatite atópica.

ABSTRACT Infective endocarditis (IE) is a disease caused by microorganisms that settle mainly in the heart valves. They frequently occur due to oral, gastrointestinal and urogenital lacerations, in addition to medical procedures that can cause bacteremia which leads to bacterial adhesion and local inflammation and these to valve destruction(1,2).. Gram-positive bacteria are mostly associated with IE, and to a lesser extent, those of the HACEK group, saprophytes of the oropharynx, which are responsible for less than 5% of cases(2-4). We present the case of a 23-year-old man with a 1-month history of fever, sweating, and asthenia; to which a productive cough is later added. A probable cardiological focus is proposed due to history and physical findings, returning isolation of the Haemophilus aphrophilus germ, an unusual microorganism.

RESUMEN La endocarditis infecciosa (EI) es una enfermedad causada por microorganismos que se asientan principalmente en las válvulas cardiacas. Frecuentemente ocurren por laceraciones orales, gastrointestinales y urogenitales, además de procedimientos médicos que pueden causar bacteriemia la cual conlleva a adherencia bacteriana e inflamación local y éstas a destrucción valvular(1,2). Las bacterias grampositivas son mayoritariamente asociadas a EI, y en menor proporción, las del grupo HACEK, saprofitos de la orofaringe, que son responsables de menos del 5% de casos(2-4). Se presenta el caso de un varón de 23 años con cuadro de 1 mes de evolución de sensación febril, sudoración y astenia; al que posteriormente se agrega tos productiva. Se plantea foco probable cardiológico por antecedentes y hallazgos físicos, retornando aislamiento del germen Haemophilus aphrophilus, microorganismo poco habitual.

Abstract Background: Long QT syndrome is a channelopathy that affects ventricular repolarization and increases the risk of severe ventricular arrhythmias. It can be congenital or acquired, and is a known cause of sudden cardiac death. Case report: A 28-year-old primigravida with no significant medical history. Prenatal ultrasounds revealed sustained fetal sinus bradycardia from week 28, without hemodynamic repercussion, which persisted until the end of gestation (at 37+3 weeks). Serial electrocardiograms were performed after birth, showing repolarization abnormalities with prolonged corrected QT interval. A genetic study confirmed long QT syndrome type 1, and oral treatment with beta-blockers was initiated, showing a positive response. Conclusions: Long QT syndrome is often diagnosed postnatally. It is important to be aware of his prenatal clinical features in order to establish an early diagnosis and minimize the risk of sudden death in these patients.

Resumen Antecedentes: El síndrome de QT largo es una canalopatía que afecta a la repolarización ventricular y aumenta el riesgo de sufrir arritmias ventriculares graves. Puede ser congénito o adquirido, y es una causa conocida de muerte súbita. Caso clínico: Gestante primigesta, de 28 años, sin antecedentes de interés. En ecografías prenatales se objetivó en el feto bradicardia sinusal mantenida desde la semana 28, sin repercusión hemodinámica, que persistió hasta la finalización de la gestación (semana 37+3). Al nacimiento se realizaron electrocardiogramas seriados que mostraron alteraciones en la repolarización con alargamiento del intervalo QT corregido. Se realizó estudio genético que confirmó síndrome de QT largo tipo 1 y se inició tratamiento oral con beta-bloqueantes, con buena respuesta. Conclusiones: El síndrome de QT largo suele diagnosticarse posnatalmente. Es importante conocer sus características clínicas prenatales para poder establecer un diagnóstico precoz y minimizar así el riesgo de muerte súbita de estos pacientes.

Abstract: The aim of this contribution is to present a corpus of data for the study of the current Spanish of Equatorial Guinea that was collected during a research stay on the island of Bioko and the mainland region of Rio Muni in February and March 2022. This corpus contains oral and written data from men and women who belong to different ethnic and age groups, live in different parts of the country, and have varying levels of education. After providing an overview of the geography, ethnic composition, history and sociolinguistic landscape of Equatorial Guinea, the article delves into the data collection process and the analysis tools used. It then describes the properties of the sample, the programs used in the data analysis, as well as the planned studies.

Resumen: El objetivo de esta contribución es presentar un corpus de datos para el estudio del español actual de Guinea Ecuatorial que fue recogido durante una estancia de investigación en la isla de Bioko y la región continental de Río Muni en febrero y marzo de 2022. Este corpus contiene datos orales y escritos de hombres y mujeres que pertenecen a diferentes etnias y grupos etarios, viven en distintas partes del país y poseen niveles de instrucción variados. Después de ofrecer una visión de conjunto de la geografía, la composición étnica, la historia y el panorama sociolingüístico de Guinea Ecuatorial, el artículo ahonda en el proceso de recogida de datos y los instrumentos de análisis empleados. A continuación, se describen las propiedades de la muestra, los programas empleados en el análisis de los datos, así como los estudios previstos.

BACKGROUND: Dentistry is regarded as a high-risk profession due to increased levels of exposure to oral secretions, aerosols and fomites that harbour infectious microorganism. Yet evidence indicates poor uptake of vaccines against HBV and, most recently, Covid-19. This study sought to investigate the predictors of Covid-19 vaccination intention among oral health professionals in South Africa. METHODOLOGY: In 2022, a representative national sample of oral health professionals was surveyed using an online questionnaire. Consenting practitioners provided demographic data, information on vaccination history and five psychological antecedents of Covid-19 vaccine. Data analysis was undertaken using SPSS ver. 29.0. RESULTS: Our findings indicate high vaccination intention rate among the OHPs (77.9%), especially those with history of influenza vaccination (OR=2.65, p=0.003). The was a positive correlation between the 5C psychological antecedents (confidence and collective benefit) and intention to vaccinate. Positive Covid-19 diagnosis did not affect vaccination intention. CONCLUSION: Most oral health professionals intended to get the Covid-19 vaccination. For those showing low willingness to vaccinate, psychological antecedent factors such as complacency and calculation should be addressed to improve vaccination intention and uptake.

Abstract Background: Benign migratory glossitis can be easily confused with differential diagnoses that have a potential unfavorable prognosis if not identified in a timely manner - although it is a common finding in the general population, with an estimated prevalence of up to 3% in healthy individuals in the general population worldwide - being early recognition is important. Case description: A 22-year-old man, with a personal history of generalized anxiety disorder and panic attacks, seeks an acute illness consultation in primary health care due to complaints of lesions on the upper face and lateral edges of the tongue with approximately two months of evolution with sensation burns with hot foods and with fluctuating evolution. The patient presented an extensive analytical study without relevant changes and on physical examination the changes in the buccal mucosa were visible. Having already been treated with oral antifungals without success and given the characteristic appearance, the diagnosis of benign migratory glossitis was made, and the patient was reassured. Comment: Benign migratory glossitis (BMG) is a relatively common clinical entity in the healthy general population (prevalence of 1 to 3%), with a chronic inflammatory basis that affects the tongue and adjacent buccal mucosa, usually with a fluctuating and chronic evolution. Despite its benignity and generally being asymptomatic, the associated signs can be a significant cause of concern and anxiety in patients, contributing to a decrease in quality of life in the absence of reassurance from the attending physician.

Resumo Introdução: A glossite migratória benigna pode ser facilmente confundida com diagnósticos diferenciais que mimetiza com potencial prognóstico desfavorável se não identificados atempadamente - embora seja um achado comum na população geral, com uma prevalência estimada de até 3% em indivíduos saudáveis na população geral a nível mundial -, sendo importante o seu reconhecimento precoce. Descrição do caso: Homem de 22 anos, com antecedentes pessoais de perturbação de ansiedade generalizada e ataques de pânico, recorre a consulta de doença aguda nos cuidados de saúde primários por queixas de lesões na face superior e bordos laterais da língua com cerca de dois meses de evolução, com sensação de queimadura perante alimentos quentes e com evolução flutuante. O utente apresentava estudo analítico extenso sem alterações relevantes e ao exame físico eram objetiváveis as referidas alterações na mucosa jugal. Tendo sido já tratado com antifúngicos orais sem sucesso e dado o aspeto característico foi assumido o diagnóstico de exclusão de glossite migratória benigna e tranquilizado o utente. Comentário: A glossite migratória benigna (GMB) é uma entidade clínica relativamente comum na população geral saudável (prevalência de 1 a 3%), de base inflamatória crónica que afeta a língua e mucosa jugal adjacente, habitualmente com evolução flutuante e crónica. Apesar da sua benignidade e de geralmente ser assintomática, os sinais associados podem ser uma causa significativa de preocupação e ansiedade nos doentes, contribuindo para uma diminuição na qualidade de vida na ausência de tranquilização por parte do médico assistente.

Abstract Introduction: Erythema nodosum is a rare disease whose pathophysiology is based on a type 4 delayed hypersensitivity response and its most common form of presentation is in the form of bilateral and symmetrical nodules and cutaneous plaques, predominantly affecting the pre-tibial region. Although the idiopathic etiology is still quite frequent, close to half of the cases are of secondary etiology, with oral contraceptives being amongst the most associated drugs with this entity, and this causal relationship being described for a greater number of estroprogestative associations. A rare case of erythema nodosum secondary to the association of ethinyl estradiol 0.03 mg + levonorgestrel 0.15 mg is described. Case description: We report a case of a 20-year-old woman who developed painful unilateral nodules in the pre-tibial region, related to the initiation of the combination of ethinyl estradiol 0.03 mg, and levonorgestrel 0.15 mg. The user describes the injuries as being longstanding, although she has never sought medical care in the past. After further investigation of the clinical history and suspicion of the causal relationship between the combined oral contraceptive and the appearance of lesions compatible with erythema nodosum, it was decided to suspend the same and start prednisolone 20 mg/day, with the user having a very favorable evolution. After discussing the existing therapeutic options, the user chose to switch to Implanon®. Conclusion: The literature is increasingly reporting the causal relationship between oral contraceptives, not only the combined type but also the isolated type, and the appearance of erythema nodosum. This is a rare and complex relationship. When a patient starts with painful nodules, a case of erythema nodosum must be considered, being aware of potential triggers - as combined oral contraceptives. In these cases, options must be explained to the user; therapeutic suspension is not the only way.

Resumo Introdução: O eritema nodoso é uma doença rara cuja fisiopatologia assenta numa resposta de hipersensibilidade tardia do tipo 4 e o seu modo de apresentação mais comum é sob a forma de nódulos e placas cutâneas bilaterais e simétricas, afetando predominantemente a região pré-tibial. Apesar da etiologia idiopática ainda ser bastante frequente, perto de metade dos casos são de etiologia secundária, estando os anticoncecionais orais entre os fármacos mais associados a esta entidade e sendo descrita esta relação causal para um número crescente de associações estroprogestativas. Descreve-se um caso raro de eritema nodoso secundário à associação de etinilestradiol 0,03 mg + levonorgestrel 0,15 mg. Descrição do caso: Relata-se o caso de uma mulher de 20 anos, que desenvolveu nódulos dolorosos na região pré-tibial do membro inferior direito, relacionando com o início da toma da associação de etinilestradiol 0,03 mg e levonorgestrel 0,15 mg. A utente descreve as lesões como sendo já crónicas, embora nunca tenha procurado cuidados médicos no passado. Após investigação mais aprofundada da história clínica e suspeição da relação causal entre o fármaco e o aparecimento das lesões compatíveis com um eritema nodoso optou-se por suspender o mesmo e iniciar prednisolona 20 mg/dia, tendo a utente evoluído no sentido da resolução clínica. Após discussão das opções terapêuticas existentes, a utente optou pela colocação de Implanon®. Conclusão: Na literatura é cada vez mais relatada a relação causal entre a toma de contracetivos orais, não só do tipo combinado como também do tipo isolado, e o aparecimento de eritema nodoso. Esta relação é rara e complexa. Perante um quadro de nódulos dolorosos dever-se-á considerar a hipótese de se tratar de um caso de eritema nodoso, estando atentos a potenciais triggers - caso dos contracetivos orais combinados. Nestes casos dever-se-á explicar à utente quais as suas opções, não sendo a suspensão terapêutica o único caminho a seguir.

RESUMEN Introducción: las lesiones premalignas y malignas del complejo bucal se incrementan en la población, lo que demanda una correcta ejecución del Programa de Detección Precoz del Cáncer Bucal (PDCB). En el trabajo se exponen las transformaciones en el nivel de conocimientos de pacientes y estomatólogos acerca de las afecciones concernientes al PDCB para perfeccionar su ejecución. Método: se realizó una intervención educativa en el área de salud Julio Antonio Mella del municipio Camagüey desde mayo de 2022 hasta junio de 2023, con la participación de 36 pacientes y 30 estomatólogos. Las fuentes de información fueron la historia clínica, un cuestionario y una prueba de entrada y salida, aplicados a pacientes y estomatólogos respectivamente, antes y después de la intervención; para constatar las transformaciones. Resultados: antes de la intervención los pacientes estaban mal informados sobre las consecuencias nocivas de hábitos tóxicos, higiénicos y dietéticos, así como desconocimiento de la importancia del correcto autoexamen bucal; los que alcanzaron en su mayoría un alto nivel de conocimientos con la intervención. Los estomatólogos mejoraron sus conocimientos sobre diagnóstico y seguimiento de lesiones pre malignas y malignas del complejo maxilofacial. Discusión: la adecuada ejecución del PDCB descansa tanto en pacientes como en estomatólogos y aunque las investigaciones se enfocan a los primeros por los beneficios reportados; la superación de posgrado constituye una vía para sistematizar conocimientos y fortalecer competencias profesionales que impacten de manera positiva en el PDCB. La intervención educativa se considera satisfactoria al elevar el nivel de conocimientos de pacientes y estomatólogos, lo que demuestra sus potencialidades para perfeccionar la ejecución del PDCB.

ABSTRACT Introduction: premalignant and malignant lesions of de oral area increase in the population which demands a correct implementation of the Early Detection of Oral Cancer Program. In this work transformations are exposed knowledge level of both patients and dentists regarding lesions concerning the Early Detection of Oral Cancer Program (EDOCP). Method: educational intervention was carried out in Julio Antonio Mella health area of Camaguey municipality from May 2022 to June 2023 which 36 patients and 30 Deontologists. Information sources were the Clinical History, a questionnaire and a test applied to patients and Deontologists respectively, before and after the intervention, to confirm the transformations in the sample. Results: Prior to intervention patients were poorly informed about consequences of toxic, hygienic and dietetic habits combined with lack of knowledge regarding importance of a correct oral self-examination whose knowledge improved to reach a high level in most of them after the intervention. Deontologists improved their knowledge on diagnosis and follow-up of premalignant and malignant lesions affecting the maxillofacial complex. Discussion: correct application of the EDOCP depends on both patients and deontologists, however reserchers focus on the former due to the reported benefits; the postgraduate training is a way to systematize knowledge and strengthen professional competences with positive impact on EDOCP. The educational intervention was satisfactory since it improved the level of knowledge of both patients and dentists which shows its potential on a correct implementation of the Early Detection of Oral Cancer Program.

Abstract: The exclusion of the historical-cultural knowledge of native peoples in the teaching of history is something that has been verified in most countries with a colonial matrix. Despite the advances from the last decade of the last century around the demands of the original peoples, the evaluation of the educational policy in Chile indicates that the challenge of developing culturally sensitive pedagogies that make memories visible -culture, history and traditions - of the native peoples. Based on this background, the research was configured as a qualitative investigation with a case study approach. The research methodology involved fieldwork conducted within a segment of the Wallmapu territory (Chile and Argentina) in which interviews were administered to lonkos, kimches and kimeltuchefes. The data were subjected to open categorical analysis and account for the perspective of these traditional authorities on the need to incorporate knowledge about territorial dispossession, genocide and cultural aspects that are key to rethinking teaching from interculturality in the teaching of history. The conclusions leave in tension the monoculturality of the Chilean curricular design and the initial teacher training in contexts of cultural diversity.

Resumen: La exclusión de los conocimientos históricos-culturales de los pueblos originarios en la enseñanza de la historia, es algo que se ha constatado en la mayoría de los países con una matriz colonial. A pesar de los avances a partir de la última década del siglo pasado en torno a las demandas de los pueblos originarios, la evaluación de la política educativa en Chile indica que todavía persiste el desafío de desarrollar pedagogías culturalmente sensibles que visibilicen las memorias -cultura, historia y tradiciones- de los pueblos originarios. A partir de estos antecedentes, la investigación se configuró como una indagación cualitativa en un enfoque de estudios de casos cuyo propósito fue analizar los conocimientos históricos-culturales en la memoria social del pueblo mapuche, para repensar la enseñanza de la historia desde una perspectiva intercultural. El proceso de investigación se desarrolló a través de un trabajo de campo en parte del territorio del wallmapu (Chile y Argentina) en el cual se aplicaron entrevistas a lonkos, kimches y kimeltuchefes. Los datos fueron sometidos a análisis categorial abierto y dan cuenta de la perspectiva de estas autoridades tradicionales sobre la necesidad de incorporar en la enseñanza de la historia conocimientos sobre el despojo territorial, el genocidio y aspectos culturales que son claves para repensar la enseñanza desde la interculturalidad. Las conclusiones dejan en tensión la monoculturalidad del diseño curricular chileno y la formación inicial docente en contextos de diversidad cultural.

Resumen La historia de la fisiología experimentó una división en el siglo XIX en dos corrientes que fueron poco conocidas: la corriente analítica y la sintética o nervismo, cuyo origen se da en Occidente y en Rusia, respectivamente. Estas sostuvieron coetáneamente una marcada cercania conceptual en torno al sistema nervioso a pesar de sus diferentes origenes. La corriente sintética también recibió el nombre de nervismo debido a su eje conceptual que sostenía que el sistema nervioso era el coordinador de todos los estados fisiopatológicos del organismo. En el presente artículo se pretende establecer una descripción comparativa en estas escuelas enfatizando en siete aspectos de correlación entre las dos escuelas que incluyen la superación del dualismo cartesiano, la inclusión de la cavidad oral y consideraciones embriológicas, entre las más importantes.

Abstract History of physiology experienced a division in XIX century into two trends which are little known: analytic and synthetic trend, which originated in West and Russia, respectively. Synthetic trend also received the name of Nervism due to its conceptual core held that nervous system was the coordinator of all physio-pathological states of organism. In this paper, it is intended to stablish a comparative description between Russian Nervism school and another school that originated in Great Britain, at the head of Head and Mackenzie who held closely concepts despite its occidental origin. It was found 7 aspects of correlation between two schools which include overcoming of cartesian dualism, inclusion of oral cavity and embryological considerations, among most important.

Resumo Descreve-se o caso de uma doente do sexo feminino de 41 anos, previamente saudável, sem antecedentes de dermatite atópica ou dermatite alérgica. A doente é avaliada na consulta de dermatologia por uma erupção pruriginosa recorrente, mensal, com 3 anos de evolução. Essas lesões geralmente apareciam 5 a 7 dias antes do início da menstruação e desapareciam aproximadamente 3 a 4 dias após o período menstrual. A doente referiu que quando esteve 2 vezes grávida e não teve sintomas nesse período. Ela tinha sido previamente tratada com anti-histamínicos e corticosteroides orais, com apenas alívio temporário. Ao exame físico, durante a fase lútea do período menstrual, a doente apresentava múltiplas maculopápulas eritematoedematosas, pruriginosas, distribuídas por todo o corpo. Vários estudos laboratoriais foram realizados e todos estavam normais ou negativos, incluindo testes de autoanticorpos e análises hormonais. Testes epicutâneos com a série padrão do Grupo Português de Dermatite de Contato (GPEDC), série de corticosteróides e série de metais revelaram reações positivas ao sulfato de níquel (++) e cloreto de paládio (+) às 72 horas. Foi realizado um teste intradérmico com medroxiprogesterona nas concentrações de 0.1 e 10 mg/mL no 7o dia do ciclo menstrual. O teste foi positivo 2 horas após a injeção e persistiu por 24 horas. Foi feito o diagnóstico de dermatite autoimune à progesterona e a doente foi tratada com tamoxifeno 40 mg/dia, com praticamente completa resolução clínica. Quatro meses após, a dose foi reduzida, sem recaída. Seis meses depois a doente continua sem sintomas ou efeitos adversos.

Abstract A 41-year-old female patient presents to the dermatology department with a 3-year history of a monthly relapsing pruritic eruption. These lesions appear 5-7 days before the onset of menses and resolve 3-4 days after menstruation. During her two previous pregnancies, she had no symptoms. She had been previously treated with antihistamines and oral corticosteroids with only temporary relief. On examination, during the luteal phase, the patient presented multiple maculopapular pruritic wheals distributed throughout the body. Several laboratory studies were performed and were all normal or negative, including auto-antibodies tests and hormonal analysis. Patch tests with the standard series of the Portuguese Contact Dermatitis Group, corticosteroid series, and metal series revealed positive reactions to nickel sulfate (++) and palladium chloride (+) at 72 h. An intradermal test with medroxyprogesterone at concentrations of 0.1 and 10 mg/mL was performed on the 7th day of the menstrual cycle. The test was positive 2 h after the injection and persisted for 24 h. The diagnosis of autoimmune progesterone dermatitis was made and the patient started tamoxifen 40 mg/day, with almost complete clinical clearing. Four months after, the dose was reduced, with no relapsing. Six months later, the patient remains free of symptoms.

Abstract Omalizumab is approved as third-line therapy for patients older than 12 years with antihistamine-refractory chronic spontaneous urticaria. The authors present the case of an eight-year-old boy with a history of migratory maculopapular skin lesions, arthralgias, and conjunctival hyperemia. Laboratory findings were unremarkable. Skin biopsy was consistent with urticaria. Treatment with oral betamethasone and quadruple dose of bilastine was initiated, with clinical resolution of arthralgias and conjunctival hyperemia, but no improvement in skin lesions. After five months of illness, the patient developed several side effects of corticosteroids and was started on cyclosporine, with no clinical response after four weeks of treatment. At this point, he was started on off-label omalizumab 300 mg every four weeks, and corticosteroid therapy was discontinued after one month of treatment. After the third administration of omalizumab, the boy achieved complete clinical resolution. Omalizumab may be an effective and safe treatment for antihistamine-refractory chronic spontaneous urticaria in pediatric age.

Resumo Omalizumab está aprovado como terapêutica de terceira linha em doentes a partir dos 12 anos de idade com urticária crónica espontânea refratária a anti-histamínicos. É apresentado o caso de um rapaz de oito anos de idade com história de lesões cutâneas maculopapulares migratórias, artralgias e hiperemia conjuntival. Os resultados analíticos não demonstraram alterações relevantes e a biópsia cutânea foi compatível com urticária. Foi iniciado tratamento com betametasona e bilastina em dose quádrupla, com resolução das artralgias e da hiperemia conjuntival, mas sem melhoria das lesões cutâneas. Após 5 meses de doença, foi iniciada ciclosporina devido ao desenvolvimento de efeitos secundários associados à corticoterapia sistémica, sem resposta clínica ao fim de quatro semanas de tratamento. Nesta altura, foi iniciada terapêutica off-label com omalizumab 300 mg a cada quatro semanas, com suspensão da corticoterapia após a primeira administração de omalizumab. Após a terceira administração de omalizumab, a criança atingiu controlo total da doença. Omalizumab parece ser uma terapêutica efetiva e segura na urticária crónica espontânea refratária a anti-histamínicos na população pediátrica.