Skin eruption and thrombocytopaenia in a woman with glaucoma: a case report

Antibiotic and non-antibiotic sulphonamides are often prescribed. Although chemical differences make cross-reactivity rare, reactions may be severe in patients allergic to sulphur. Adverse reactions are common with sulphonamides but low platelets and skin changes are rarely associated with eye-drops for glaucoma. A woman treated with dorzolamide and timolol presented with disseminated eruption. On admission, her physical examination was unremarkable except for the skin changes and severe thrombocytopaenia was detected. Skin biopsy showed hyperkeratosis, acanthosis, perivascular and periadnexal infiltrates with no vasculitis. After discontinuation of eye-drops, the eruption improved but low platelets persisted. Skin changes reappeared with use of dapsone which suggested sulphonamide cross-reactivity.

[Evaluation of motherś knowledge about oral rehydration therapy and sodium concentration in homemade sugar salt solutions]

OBJECTIVE: To evaluate motherś knowledge about oral rehydration therapy and to determine the concentration of sodium in sugar salt solutions prepared by the interviewed mothers. METHODS: Cross-sectional study of low-income families from the suburbs of Natal, a city in the state of Rio Grande do Norte. One hundred and thirty six households with children younger than 5 years were visited. The information on when to use the solution, how to administrate it and how to prepare it was provided by the interviewed mothers. The concentration of sodium was determined in 100 solutions prepared by those mothers. RESULTS: Only 9.0% of mothers had appropriate knowledge about when to use the solution and 21.0% knew how to administer it correctly. The error rates regarding the measurement of ingredients were: 2.5% for salt, 22.2% for water and 43.2% for sugar, according to the answers given by 81 mothers, who used a double-ended spoon made of plastic to measure quantities. In fifty percent of the analyzed samples, sodium was within safe limits (30 mmol/l to 100 mmol/l). Those considered dangerous (>100 mmol/l) or inefficient solutions (<30 mmol/l) reached the percentage of 47.0% and 3.0%, respectively. Out of the 69 solutions prepared with the double-ended spoon, 63.8% were found appropriate in terms of sodium concentration, while only 19.3% of the 31 solutions prepared using other measuring utensils were within acceptable limits (P=0.0001). CONCLUSION: Motherś knowledge about oral rehydration therapy was considered poor. Moreover, the concentration of sodium in sugar salt solutions seldom remains within safe limits, particularly those solutions in which the double-ended spoon was not used for preparation. These conclusions should be considered in future educational programs on oral rehydration.

[Celiac disease: clinical characteristics and methods used in the diagnosis of patients registered at the Brazilian Celiac Association]

OBJECTIVE: To evaluate the clinical characteristics and methods used in the diagnosis of patients registered at the Brazilian Celiac Association (BCA). METHODS: A questionnaire about clinical characteristics and diagnostic methods in celiac disease was mailed to 584 members of the BCA. RESULTS: We received 292 responses for 584 questionnaires mailed (49.5%). The clinical characteristics of celiac disease in the sample we analyzed showed that the most frequent type was the classical mode (88.9%), while the atypical mode was present in only 11.1% of patients at the time of diagnosis. Increased incidence of both late diagnosed classical mode (44.5% to 64.2%; P=.004) and atypical mode (5.2% to 16.8%; P=.005) has been observed in the last 5 years. Duration of symptoms before diagnosis was greater than 1 year in 75% patients with atypical manifestation. Intestinal biopsy was not performed in 19% of the cases at the time of diagnosis. It was observed that in the last 5 years intestinal biopsy was not performed for a larger number of patients (24.4%) than in the previous period (only 11.1%) (P=.007). CONCLUSIONS: Classical mode is still the most frequent clinical manifestation of celiac disease. The late diagnosed classical mode is predominant, but our findings show an increase in the proportion of the atypical mode. Although characterization of subtotal or total villous atrophy of the intestinal mucosa is of paramount importance to the diagnosis of celiac disease, 19% of the patients diagnosed for celiac disease did not undergo intestinal biopsy at the time of diagnosis, most notably in the last 5 years.