Calidad de vida relacionada con la salud en pacientes pediátricos con enfermedad inflamatoria intestinal / Health related quality of life in pediatric patients with inflammatory bowel disease

INTRODUCCIÓN: La Enfermedad Inflamatoria Intestinal (EII) es un grupo de patologías crónicas que tiene implicancias en diversos factores que afectan la calidad de vida en el paciente pediátrico. OBJETIVOS: Describir la calidad de vida relacionada con la salud (CVRS) en pacientes pediátricos con Enfermedad Inflamatoria Intestinal (EII). Pacientes y MÉTODOS: Estudio multicéntrico descriptivo transversal. Entre septiembre de 2015 y enero de 2017, en pacientes con diagnóstico de EII, edades 8-18 años, se aplicó la encuesta de calidad de vida IMPACT III para pacientes pediátricos con EII. Se evaluaron los ámbitos: síntomas intestinales, sistémicos, imagen corporal, funcionamiento/limitaciones sociales, afectación emocional e intervenciones/tratamientos. Rango de puntaje: 35-175, a mayor puntaje mejor calidad de vida y un cuestionario sociodemográfico. RESULTADOS: Se reclutaron 30 pacientes con EII, 60% de sexo masculino, edad promedio de 13,6 años, un 80% de los pacientes con el diagnóstico de Colitis Ulcerosa (CU). El tratamiento farmacológico predominante correspondió a terapia combinada en un 63,3%, siendo la combinación aminosalicilatos e inmunomoduladores la más frecuente. La mediana de calidad de vida del IMPACT III fue de 129,5 puntos y al realizar el análisis por cada ámbito de la encuesta, no hubo diferencias estadísticamente significativas entre ellas. En nuestra muestra no se encontró correlación entre CVRS y número de crisis, duración de enfermedad ni sexo. CONCLUSIONES: Esta es una primera aproximación al estudio de CVRS en pacientes pediátricos en Chile. La CVRS es un aspecto fundamental a explorar en la evaluación rutinaria de los pacientes con EII y la identificación de una menor CVRS es el primer paso para realizar intervenciones en estos pacientes, por lo que recomendamos realizar esta medición como método de tamizaje en todos ellos.

INTRODUCTION: Inflammatory bowel disease (IBD) is a group of chronic pathologies that have impli cations in several factors that affect the quality of life in pediatric patients. OBJECTIVES: To describe the health related quality of life (HRQL) in pediatric patients with IBD. PATIENTS AND METHODS: A Multicenter cross-sectional descriptive study was conducted. Patients aged between 8-18 and with IBD diagnosis were included; IMPACT III quality of life questionnaire and a sociodemographic questionnaire were applied between September 2015 and January 2017. RESULTS: A total of 30 pa tients were recruited, 60% male, with an average age of 13.6 years. 80% of patients were diagnosed with Ulcerative Colitis (UC). The predominant pharmacological treatment was combined therapy in 63.3%, being the most frequent aminosalicylates and immunomodulator. The IMPACT III quality of life score had an average of 129,5 points and when analyzing by section, there was no statistically significant difference between the averages. In our sample, there was no correlation between HRQoL and the number of flares, disease duration gender. CONCLUSIONS: This is a first approach to the study of HRQoL in pediatric patients in Chile. Since HRQoL is an important aspect to be explored in the routine evaluation of IBD patients, the identification of a lower HRQoL is the first step to perform interventions in these patients, thus we recommend performing this measurement as a screening method in all of them.

Diagnóstico de diarrea por clostridium difficile: en busca de un enfoque clínico más eficiente / Clinical diagnosis of clostridium difficile diarrhea: searching a more efficient clinical view

Background: The clinical parameters for the suspicion of Clostridium difficile infections, namely the use of antimicrobials and diarrhea, have a low predictive value for the diagnosis. Aim: To search other clinical variables and determine a clinical prediction model for (Clostridium difficile diarrhea. Patients and methods: All patients to whom a Clostridium difficile study was requested, were prospectively studied during 5 months. Clinical variables of these patients were registered. The diagnosis of Clostridium difficile was done using the cytotoxicity test in fibroblast cultures. Results: Ninety two patients were analyzed and in 26, the diagnosis of Clostridium difficile was confirmed. A logistic regression model disclosed an age over 60 years old, the presence of mucus in the stools and a temperature over 37.8 ­C in the previous 24 h, as significant predictors of the infection. The correlation of the model, between the predicted probability and the observed condition, was 81.5 per cent. Conclusions: The presence of the clinical variables identified in this study are associated with a high probability of an infection by Clostridium difficile in patients with diarrhea and the recent use of antimicrobials