According to the World Health Organization, 98% of fatal dengue cases can be prevented; however, endemic countries such as Colombia have recorded higher case fatality rates during recent epidemics. We aimed to identify the predictors of mortality that allow risk stratification and timely intervention in patients with dengue. We conducted a hospital-based, case-control (1:2) study in two endemic areas of Colombia (2009-2015). Fatal cases were defined as having either 1) positive serological test (IgM or NS1), 2) positive virological test (RT-PCR or viral isolation), or 3) autopsy findings compatible with death from dengue. Controls (matched by state and year) were hospitalized nonfatal patients and had a positive serological or virological dengue test. Exposure data were extracted from medical records by trained staff. We used conditional logistic regression (adjusting for age, gender, disease's duration, and health-care provider) in the context of multiple imputation to estimate exposure to case-control associations. We evaluated 110 cases and 217 controls (mean age: 35.0 versus 18.9; disease's duration pre-admission: 4.9 versus 5.0 days). In multivariable analysis, retro-ocular pain (odds ratios [OR] = 0.23), nausea (OR = 0.29), and diarrhea (OR = 0.19) were less prevalent among fatal than nonfatal cases, whereas increased age (OR = 2.46 per 10 years), respiratory distress (OR = 16.3), impaired consciousness (OR = 15.9), jaundice (OR = 32.2), and increased heart rate (OR = 2.01 per 10 beats per minute) increased the likelihood of death (AUC: 0.97, 95% confidence interval: 0.96, 0.99). These results provide evidence that features of severe dengue are associated with higher mortality, which strengthens the recommendations related to triaging patients in dengue-endemic areas.

Despite the introduction of new and more expensive anticonvulsant drugs, phenytoin (PHT) is still a first-line medication for common types of epilepsy such as tonic-clonic and complex partial seizures but not for absence seizures. PHT shows a nonlinear kinetics and a narrow therapeutic range, thus a fine balance must be found between efficacy and toxic effects. Since the free (unbound) drug is responsible for producing the pharmacological effect, the concentration in a novel biological fluid more closely related to arterial free plasma drug concentrationsaliva-is used in this study as part of the monitoring strategy. Therefore, in order to optimize therapy in epileptic patients under PHT treatment, plasma and saliva concentrations of PHT were measured, and adverse drug reactions were registered during a 2-year follow-up. CYP2C9, CYP2C19, and epoxide hydrolase polymorphisms (enzymes involved in PHT metabolism) were also analyzed using, in this way, pharmacogenetics for drug safety. The two PHT brands commercially available in our country and used in this study demonstrated similar pattern of efficacy and safety.

In the medical literature, the skin reactions related to the acute respiratory distress syndrome have been fully described. There are few reports of the skin diseases indirectly related to the pandemic, which have increased in incidence. This review focuses on skin problems related with COVID-19, including adverse drug reaction to its treatments, personal protective equipment skin reactions and secondary cutaneous involvements due to circumstances during the pandemic, including acne, rosacea, seborrheic dermatitis and herpes zoster.

El exantema maculopapular es la manifestación más frecuente relacionada con la enfermedad COVID-19, lamentablemente los exantemas han sido descritos de tantas maneras que la incidencia exacta la desconocemos. La mayoría de los autores incluyen en este rubro los exantemas morbiliformes, los maculopapulares, los eritematoescamosos, los pitiriasis rosada-like y los eritema polimorfo like. En la última revisión de la literatura hasta julio de 2021 elaborada por Li y colaboradores el exantema eritematoso maculopapular es la manifestación más frecuente de COVID-19 con un 38.4%. En un estudio de vigilancia de pruebas positivas en China con 678 pacientes, el exantema eritematoso ocupó 70% de las lesiones cutáneas. El promedio de edad es de 61.1 años con similar afectación en ambos sexos. Las erupciones maculopapulares y morbiliformes pueden ser localizados o diseminados, simétricos o confluentes. Se inician en el tronco y diseminan a las extremidades. Aún no comprendemos completamente su fisiopatología, si todos ellos están asociados directamente al SARS-CoV-2, si algunos son reacciones a medicamentos o si se deben a reactivación de otros virus.