Objective This PUBA study aimed to assess the efficacy of fractional CO2 laser in the treatment of genitourinary syndrome of menopause (GSM). Methods GSM symptoms were assessed before, 1 month after the first session and 1 month after the third session of laser (3 sessions with a 30 days interval between them) in 60 women (median, interquartile range: 55, 49–69). Subjective (visual analog scale) and objective (Vaginal Health Index, VHIS; Vaginal Maturity Index/Frost Index; Spanish Overactive Bladder Questionnaire‐Short Form, USMEX Spanish OAB‐qSF and Female Sexual Function Index, FSFI) measures were used during the study period to assess CO2 fractionated laser treatment outcomes compared to baseline. Results Fractional CO2 laser treatment was effective to improve GSM symptoms (vaginal dryness, vaginal itching, vaginal burning, dyspaurenia, dysuria, urinary urgency; P < 0.001) after three sessions, as well as VHIS (median, interquartile range: 13, 10–15 at baseline vs. 21, 20–23 at the fourth month follow up; P < 0.001), Frost Index (median, interquartile range: 28, 24–31 at baseline vs. 8, 6–10 at the fourth month follow up; P < 0.001), USMEX (median, interquartile range: 56, 46–68 at baseline vs 14, 13–16 at the fourth month follow up: P < 0,001) and FSFI (median, interquartile range: 5, 2–14 at baseline vs 30, 28–32). Conclusions In this sample, the data suggests that fractionated CO2 laser is an effective alternative for GSM treatment with positive outcomes that persists over time. Lasers Surg. Med. 51:509–515, 2019. © 2019 Wiley Periodicals, Inc.

El impacto que ha originado la enfermedad por coronavirus 2019 (COVID-19) en diferentes partes del mundo, alcanza en la actualidad 597, 072 personas contagiadas y 27,364 fallecidas según los últimos reportes. En ese contexto, en nuestro país, una zona de relevancia epidemiológica es la amazonia peruana, debido a la distribución de enfermedades endémicas como las enfermedades metaxénicas (Dengue, Malaria entre otras), en donde el problema se incrementa debido a que la infección por COVID-19 puede llevar a falsos positivos en las pruebas de cribado para Dengue. Conllevando de esa forma a un retraso en el diagnóstico de la infección por COVID-19 y una mayor diseminación del virus, debido a que en la mayor parte de los casos de Dengue no se presentan signos de alarma y el tratamiento es ambulatorio. Este artículo busca emitir una opinión sobre la necesidad del abordaje de casos de coinfección entre Dengue y Covid-19 en zonas endémicas.

Background: Penile necrosis is a rare condition that may present in patients with diabetes mellitus or chronic kidney disease (CKD). The recommended treatment is controversial. We report a case of penile necrosis in a diabetic patient caused by episode of paraphimosis associated with uremic arteriopathy treated with partial amputation. Clinical Case: A 53-year-old male with a background of arterial hypertension, diabetes mellitus and CKD in hemodialysis. The patient presented with paraphimosis and glans necrosis. An emergency circumcision was carried out. A doppler ultrasound found fluid collection in the left corpus cavernosum, parietal vascular calcifications and vascular insufficiency in the corpus cavernosum that suggested necrosis. A partial amputation of the penis was carried out. After three years of follow-up, the outcome has remained favorable. Conclusions: Penile necrosis is a rare but serious complication of terminal CKD. In these patients, systemic calciphylaxis is usually observed. The main take-away lesson is that a multidisciplinary approach is necessary.

a Médico residente de Enfermedades Infecciosas y Tropicales; b Médico infectólogo; c Médico anátomo-patólogo; d Médico internista; e Médico-cirujano.Mucormicosis diseminada en un paciente diabético: un reporte de caso Disseminated mucormycosis in a diabetic patient: a case report RESUMEN La mucormicosis es una infección fúngica altamente mortal que se presenta en pacientes con algún grado de inmunosupresión, siendo la forma rinocerebral la más común. Es el primer reporte en el Perú de mucormicosis diseminada con compromiso multisistémico en un paciente con cetoacidosis diabética. Se presenta el caso de un varón de 47 años diabético procedente de la selva peruana con cuadro de insuficiencia respiratoria en ventilación mecánica. A su ingreso presenta leucocitosis, acidosis metabólica anion gap elevado, hiperglicemia e hipoalbuminemia. Posteriormente, es intervenido quirúrgicamente en tres oportunidades por presentar abdomen agudo con hallazgos en la patología de necrosis y perforación de varios órganos, falleciendo a los pocos días. Paciente se encontraba recibiendo su quinta dosis de anfotericina B deoxicolato. Se observaron hifas con angulación recta compatible con mucormicosis en estómago, intestino y pulmón. ABSTRACTMucormycosis is a highly lethal fungal infection occurring in patients with some degree of immunosuppression. The rhinocerebral form is the most frequent presentation. This is the first report in Peru of a case of disseminated mucormycosis in a patient with diabetic ketoacidosis. This is a 47-year-old diabetic male subject who was referred from the Amazon jungle and presented with respiratory insufficiency receiving mechanical ventilation. On admission, the patient had leukocytosis, metabolic acidosis with high anion gap, hyperglycemia, and hypoalbuminemia. Soon afterwards, the patient underwent surgery because of acute abdomen, and the anatomopathological examination revealed necrosis and hollow viscus perforation, and he ultimately died. At this time, he was receiving amphotericin B deoxycholate. Straight angle hyphae compatible with mucormycosis were found in stomach, intestine, and lungs.

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