Enfermedad celíaca, sensibilidad no celíaca al gluten y alergia al trigo: comparación de patologías diferentes gatilladas por un mismo alimento / Celiac disease, non celiac gluten sensitivity and wheat allergy: comparison of 3 different diseases triggered by the same food

El gluten y otras proteínas relacionadas del trigo, centeno y cebada, tienen propiedades antigénicas que pueden desencadenar reacciones adversas en individuos susceptibles. La enfermedad celíaca fue la primera patología en que se estableció relación causal con estas proteínas alimentarias. Recientemente se han descrito la alergia al trigo y la sensibilidad no celíaca al gluten. Si bien sus formas de presentación clínica y su relación con la ingesta pueden ser similares, sus mecanismos patogénicos, forma de diagnóstico y tratamiento difieren. Dado que su prevalencia en conjunto es relativamente alta, resulta necesario que los médicos de atención primaria y pediatras se familiaricen con estas patologías, sepan cómo diferenciarlas y enfrentarlas. El objetivo de esta revisión es comparar los principales aspectos de epidemiología, fisiopatología, diagnóstico y tratamiento de estas 3 condiciones.

Gluten and other related proteins of the wheat, rye and barley, have antigenic properties that may trigger adverse reactions in susceptible individuals. Celiac disease was the first pathology with clear causal association related to the intake of these proteins. Recently, wheat allergy and non celiac gluten sensitivity have been described. Although, clinical presentation and its relation with protein ingestion may be similar and elicit confusion, their pathogenic mechanism, diagnosis and treatment are quite different. Since the prevalence of these diseases is relatively high as a whole, it is essential that these become familiar to primary care doctors and general pediatricians, thus they will know how to differentiate and face them. The aim of this review is to compare the main aspects of epidemiology, pathofisiology, diagnosis and treatment of these 3 conditions.

Enuresis en niños: frecuencia y antecedentes familiares / Enuresis in children: frequency and family history

La enuresis es una patología frecuente en pediatría, con potencial impacto en la calidad de vida del niño y sus padres. En Chile no existe literatura respecto al potencial efecto de esta patología en la dinámica familiar. El objetivo de este trabajo fue estimar la frecuencia de enuresis en una población de nivel socioeconómico medio-alto y describir los factores de riesgo familiares asociados y grado de preocupación de los padres respecto al tema. Método. Entre 2010 y 2011 se aplicó una encuesta voluntaria a los padres de pacientes atendidos ambulatoriamente en Clínica Las Condes. Se registraron los antecedentes de enuresis de los padres, número y edad de los hijos, número de hijos con enuresis, preocupación de los padres al respecto. Resultados. Se analizaron 334 familiares, que correspondieron a 499 niños mayores de cinco años, de los cuales 91 (18,2%) presentaron enuresis. El 57% de los pacientes con enuresis tenía antecedentes familiares, 58% correspondía al padre, 36% a la madre y 6% a ambos padres. El 51% de los padres reveló preocupación por este hecho. El grupo etario más afectado correspondió a niños de entre cinco y nueve años con un 38,8% de frecuencia, porcentaje bastante mayor al señalado por la literatura. Respecto a la herencia, un 57% tenía antecedentes familiares de padre y/o madre con enuresis.

Enuresis is a common condition in children, with potential impact on quality of life of children and their parents. In our country there is no literature on the potential impact of this disease on family dynamics. The aim of this study was to estimate the frequency of bedwetting in a population of middle-high socioeconomic level and describe the risk factors associated, family and degree of parental concern regarding the issue. Method: between 2010 and 2011 were surveyed parents of voluntary outpatients seen at Clinica Las Condes. We recorded the history of bedwetting parents, number and age of children, number of children with enuresis, parental concern about it. Results: We analyzed 334 families, which corresponded to 499 children over five years old., Ninety one (18.2%) had enuresis. 57% of patients with enuresis had a family history, 58% belonged to the father, the mother 36% and 6% both parents. 51% of parents showed concern about this. The most affected age group accounted for children between 5 and 9 years with a 38.8% rate, far higher percentage than that reported by the literature. Regarding inheritance, 57% had a family history of father and/or mother with enuresis.

Resultado del tratamiento con Láser Fraxel Dual 1927 en pacientes con melasma / Laser treatment outcome with Fraxel Dual 1927 laser in patients with melasma

Introducción: Melasma es un trastorno adquirido, caracterizado por la aparición de máculas simétricas de color marrón, principalmente en áreas fotoexpuestas (centrofacial, malar y mandibular). Esta condición tiene potencial efecto sobre la autoestima y calidad de vida de quien lo porta. Objetivo: evaluar el efecto del Láser Fraxel Dual 1927 como tratamiento del melasma. Pacientes y método: revisión retrospectiva de fichas clínicas y fotografías de pacientes mujeres con melasma tratadas con 1 dosis de Láser Fraxel Dual 1927 entre los años 2010 y 2011 en el Centro Dermatológico de Clínica Las Condes. Se obtuvieron de las fichas clínicas la edad, género, fototipo de piel y niveles de energía utilizados. Se tomaron fotografías antes y después de la sesión de láser y se aplicó el score de severidad de melasma, previamente validado ( MASI modificado). Resultados: se estudiaron 10 pacientes mujeres, cuyo promedio de edad fue de 37.5 años (DE 5,15).Luego de la sesión con láser, se evidenció una disminución significativa del score MASI de 6.78 (DE 4,84) a 5.09 (DE 4,81) (p= 0.049). Conclusiones: nuestros resultados sugieren que el Laser Fraxel Dual 1927 sería una alternativa efectiva en el tratamiento del melasma. Por lo anterior, es necesario realizar nuevos estudios prospectivos para comprobar estos hallazgos y evaluar efectos adversos.

Background: Melasma is an acquired disorder, characterized by the appearance of symmetric brown patches, mainly on sunlight exposed areas of the face (midfacial, malar and mandibular areas). This condition could eventually impact on patients’ self-esteem and quality of life, encouraging the search for an effective therapy. Objective: To determine the effect of Fraxel Dual 1927 laser as treatment for melasma. Patients and method: Clinical records and pictures of patients with melasma treated with Fraxel Dual 1927 laser between 2010 and 2011 at the Dermatology Department of Clínica Las Condes, were retrospectively reviewed. Data related with age, gender, skin Fitzpatrick´s phototype, treatment energy and level used were registered from clinical records. Photos were taken before and after the laser treatment session and a previously validated severity score (modified MASI Score) was applied. Results: 10 female patients with a mean age 37.5 years old (SD 5.15 years) were studied. After laser therapy, there was evidence of statistically significant reduction of MASI score from 6.78 (SD 4.84) to 5.09 (SD 4.81) (p=0.049). Conclusions: Our results suggest Fraxel Dual 1927 laser as an effective alternative to treat melasma. It would be necessary to carry on new prospectives studies to ratify these findings and assess adverseeffects.

effect of combined supplementation of iron and zinc versus iron alone on anemic pregnant patients in Dohuk

Combined supplementation with iron and zinc during pregnancy may be effective in preventing deficiencies of these micronutrients. To assess the effect of combined supplementation of Iron and Zinc versus Iron alone on anemic pregnant patients. Single blind randomized clinical control trial. This study was carried out in Kurdistan region, Dohuk city/Iraq from 1st of November 2005 to 31st of October 2006. Hundred anemic pregnant patients completed their first trimester assigned and divided randomly into two groups. First group [A] supplemented daily with 120 mg Iron. Second group [B] received 120mg iron + 22.5 mg zinc. The therapy continued for six months. Three Venous blood samples were collected ruing the study. At time of booking, a baseline blood sample was collected, in which we estimated the hemoglobin, PVC, serum Iron, total serum iron binding capacity and serum zinc. Another two samples were collected three months apart. Collected data were analyzed by SPSS software; independent t-test was applied. Hemoglobin, PCV and serum iron had significantly influenced by the supplement therapy in both groups [p < 0.001]. Group B had a significant improvement in their serum iron status [p < 0.0001]. A desirable response in hemoglobin and PCV values have been observed in group B three months after treatment. This, however, did not stand between the two groups by the end of the study. A sustained significant rise in zinc level was achieved in group B [p<0.00]. On the contrary, there was a decline in zinc level in group A, especially in the first three months. After that, zinc level started to build up again and showed a significant improvement in respect to the second reading but did not approach the first booking level. The study clearly demonstrated the efficacy of the combined therapy for treating anemia and improving zinc status in pregnancy

Uterine rupture in Dohuk, Iraq

Rupture of the uterus is a serious obstetric emergency endangering the life of both mother and fetus. In a study at the general hospital in Dohuk, Iraq, from January 2003 to December 2004, the incidence of ruptured uterus was 0.2% [42 out of 20 574 deliveries]. The majority of these women [81%] were unbooked and had had no antenatal care. The range of parity was 1-13, median 7. The main causes were obstructed labour and previous caesarean scar [36% of cases each]. The maternal mortality rate among these cases was 5% and the perinatal mortality rate was 62%. Improvements are needed in antenatal care and labour guidelines and emergency drill training for staff

[Post-exposure prophylaxis of blood-borne pathogens]

Considering the rising prevalence of HIV infection, hepatitis Band hepatitis C epidemics in our country and other developing countries, and given that these blood-borne pathogens could be acquired through occupational exposure as a major professional hazard among healthcare workers, such as physicians, nurses, dentists, laboratory workers, and cleaning service employees by needle stick injury or splashing of infected fluid to mucosal surfaces, doctors, nurses and other health-care providers are worried about HIV, HBV and HCV exposure and, after such accidents, they ask "is this disease transmitted to me?". So, all of healthcare workers should be educated for post-exposure prophylaxis of blood-borne pathogens. This review is based on the last recommendations and current protocols for prompt reporting, evaluation, counseling, treatment, and follow-up of occupational exposure to blood-borne pathogens

[Detection of intracytoplasmic Th1/Th2 cytokine profiles in patients with sepsis and severe sepsis]

Sepsis is the leading cause of death in critically ill patients throughout the world. The incidence is increasing despite the major advances in the development of antimicrobial agents and other supportive treatments. Based on multiple studies, it has been shown that patient outcome depends on Th1 and Th2 cytokine response. Moreover, whenever the Th2 response is predominant, the sepsis is more severe. The aim of this study was to evaluate the correlation between cytokine levels and the severity of sepsis in patients. A cross-sectional study on the cellular levels of several pro-inflammatory cytokines was carried out in patients with sepsis and severe sepsis. The study included 37 patients [24 men and 13 women], 26 of them had sepsis and 11 had the severe form of sepsis Thirty-seven healthy volunteers served as controls. The average age of the patients was 57 years [ +/- 23.3 years], with a range of 21 to 92 years. From the whole blood of the subjects, we separated the monocytes and leukocytes, which were then cultured. Using an ELISA method, we measured levels and IL-12 [associated with Th1], and IL-4 and IL-10 [associated with gamma of IFN- Th2] in the cultured cells with and without cell stimulation. No gamma production in the cells of patients with sepsis gamma correlation was found for IFN- and severe sepsis, regardless of whether the patients had died or survived. However, IL-12 levels were significantly decreased in severe sepsis compared with those of sepsis patients [P=0.048]. Furthermore, the cells of expired patients also had significantly decreased IL-12 levels compared with those of, IL-4, and surviving patients [P=0.028]. We also found that the levels of IFN- IL-10 were decreased in patients compared with those of controls, which correlated to their production. However, there was no correlation for IL-12 production between the cells of the patients compared with those of the controls. There was also no correlation for cytokine production between men and women with sepsis and in adults compared with that of elderly patients [>55 years old]. We have shown that the predominating T helper cell subset in patients with severe sepsis, as well as expired patients, is Th2. In conclusion, the correlation of Th1 cytokine production and progression of sepsis was demonstrated. Most probably IL-12 levels would be significantly lower in patients with severe sepsis and those who expired

[Infectious diseases and traveling]

As international travels have become increasingly common for both business and tourism, physicians are confronted with innumerable travelers suffering from unknown syndromes and infectious diseases, thus it is necessary for physicians to maintain familiarity with current guidelines and recommendations about travel medicine and prevention of related infectious diseases. Fever, travelers' diarrhea, skin eruptions, respiratory and CNS involvement are diseases seen among travelers on return which make them visit the physicians. Consultation and a checkup prior to traveling with the aim of immunization, recommendations about traveler's diarrhea, malaria and diseases transmitted by blood or sexual contacts are steps that could be taken by the physicians before travel. Knowledge about the epidemiology and etiology of traveler's diseases, destination and immunization status of travelers can prevent complications, morbidity and mortality attributed to infectious diseases in travelers

Study on human taeniasis by administering anti-taenia drug

Mazandaran province, northern Iran, has been an area with highest prevalence of infectivity with human taeniasis during past decades. In order to assess current situation of taeniasis in the province by a method which can yield a correct estimation of infection rate, this study was performed by administrating anti-Taenia drug, during 2003-2004. A total of 417 people were randomly selected from rural areas of Mazandaran province. All of them were at first given a dose of niclosamide [2-4 500 mg tablets] and bisacodile [1-3 5 mg tablets]; then their 36 h stool passage was collected and examined macroscopically and microscopically. The results revealed that 2 individuals [0.5%] were infected with Taenia saginata. Compared with previous decades, there is a sharp drop on human taeniasis in the study area. Infected peoples were followed up till complete treatment

Perfil epidemiológico y clínico de la invaginación intestinal en lactantes de la Región Metropolitana / Clinical and epidemiological profile of intestinal intussusception among infants of Metropolitan Santiago

Background. Intussusception (IS) is a potentially severe disease that affects an undetermined number of Chilean infants. The withdrawal of a rotavirus vaccine in 1999 due to its association with IS, highlighted the need for updated information on IS worldwide including Chile, before introduction of new vaccines. Aim: To estimate the incidence and to describe the epidemiology and clinical presentation of IS in the Metropolitan Area of Chile. Material and methods. IS cases occurring between 1996 and 2001 in the seven public pediatric hospitals and in six private clinics (during 2000 and 2001) were identified. Incidence rates were calculated using updated population estimates. A systematic review of the medical charts of IS cases occurring in the public hospitals for 2000-2001 was performed. Results. IS incidence rates for the Public Sector ranged from 32 to 39 per 100.000 children < 2 years of age. These figures did not vary significantly among the different Health Care Services, nor after inclusion of the private clinics. IS was more common in males (66%) and infants younger than 12 months (83%), with 67% of cases occurring between 3 and 8 months of age. The most common presenting symptoms were abdominal pain (90%), vomiting (86%), and rectal bleeding (75%). Ileocolic IS predominated (83%) and surgical correction was the preferred treatment (81%). No death occurred in this series. Conclusions: IS incidence rates were intermediate compared to other series, stable over time, and similar between the public and private sector. Clinical characteristics were similar to those previously reported with a disproportionately high use of surgical correction over enema, currently considered the preferred treatment option. (Rev MÚd Chile 2004; 132: 565-72).

Adecuado uso del perímetro cefálico de lactantes en sus controles de salud / Adequate use of head circumference measurement in infants during health controls

Introducción: La evaluación del perímetro cefálico (PC) constituye una valiosa herramienta que alerta sobre alteraciones del desarrollo del lactante. Objetivo: Conocer la situación de medición del PC en los controles de salud. Método: Revisión retrospectiva de todos los registros de PC en los controles de niños de 18 a 24 meses de edad, de julio de 2002 a la fecha, atendidos en dos centros de salud de Colina, consignando el PC, el diagnóstico y las indicaciones y reclasificándolo (NCHS) para diagnóstico comparativo. Resultados: Se revisaron 424 controles de salud contenidos en 58 fichas, de los cuales 85,3% tenían registro del PC. De ellos el 17.7% tenía consignado el diagnóstico. Al clasificar nuevamente los diagnósticos encontrados según las curvas del NCHS, se encontró que 14% de los registros correspondía a un PC fuera del rango normal y no tenía diagnóstico registrado, el único caso en que se registró diagnóstico de alteración del PC no se registró la conducta tomada. Un 92.2% de los diagnósticos fueron catalogados concordante con el equipo investigador. Conclusiones: La medición del PC se realiza en la mayoría de los controles, pero no conduce a un diagnóstico y manejo terapeutico. Falta reforzar la importancia y utilidad de esta herramienta antropométrica para una adecuada pesquisa diagnóstica y una derivación oportuna a especialista.

Infección micótica profunda en niños con cáncer, neutropenia y fiebre, en Chile / Invasive fungal infections in children with cancer and febrile neutropenia, in Chile

Background: Invasive fungal infections (IFI) cause prolonged hospitalizations and increase the possibility of death among patients with cancer and febrile neutropenia (FN). Up to 10 percent of febrile neutropenic episodes may be caused by IFI. Aim: To estimate the incidence of IFI among a large group of Chilean children with cancer and FN. Patients and Methods: Clinical and laboratory information was collected from a data base provided by the "Programa Infantil Nacional de Drogas Antineoplásicas" (PINDA) that included 445 FN episodes occurring in five hospitals in Santiago, Chile. This information was used to identify children that presented with signs and symptoms compatible with an IFI. According to predefined criteria based on a literature review, IFI episodes were categorized as "proven", "probable" or "possible". Results: A total of 41/445 episodes (9.2 percent) were compatible with an IFI of which 4 (0.9 percent) were proven, 23 (5.2 percent) probable, and 14 (3.1 percent) possible. Hospitalization was longer (27 vs 8 days, p <.01), new infectious foci appeared with higher frequency (71 vs 38 percent, p <.01), and mortality was higher (10 vs 1.6 percent, p <.001) in children with IFI compatible episodes, when compared to children who did not have an IFI. Conclusions: The estimated incidence of IFI in Chilean children with cancer and FN ranged between 6-9 percent depending on the stringency of criteria selection used for classification. This estimate is similar to that reported by other studies. The low detection yield of clinically compatible IFI underscores the need of improved diagnosis of fungal infections in this population