Hemorragia digestiva alta como complicação de esofagite eosinofílica / Upper gastrointestinal bleeding as a complication of eosinophilic esophagitis

A hemorragia digestiva alta (HDA) é uma condição médica comum, que permanece com uma taxa de mortalidade aproximadamente de 10%. Doenças alérgicas habitualmente não configuram risco para HDA. Entretanto, o aumento recente de doenças alérgicas que afetam cronicamente o trato digestório poderia mudar esse cenário. Este artigo relata um caso de HDA após hematêmese provocada por impactação alimentar. Realizada endoscopia digestiva alta (EDA) e diagnosticada esofagite eosinofílica (EoE), que após tratamento adequado, apresentou melhora dos sintomas. A EoE é uma doença inflamatória crônica esofágica emergente, com aumento do número de casos diagnosticados ao redor do mundo. Atualmente, considera-se a causa mais prevalente de disfagia e impactação alimentar em crianças e adultos jovens. Os sintomas de EoE não são específicos para cada faixa etária, e podem variar desde sintomas mais leves, como sintomas de doença do refluxo gastroesofágico, até disfagia e impactação alimentar. Existe atraso no diagnóstico e tratamento, propiciando um aumento de complicações, cujo risco mais temido seria rotura do esôfago. Revisando a literatura até o presente relato, constatamos que a EoE nunca foi descrita como uma causa de HDA. Além da apresentação incomum da HDA levando ao diagnóstico de EoE, esse caso ressalta a importância do atendimento multidisciplinar e cooperação entre especialidades. Portanto, há necessidade de diagnóstico mais precoce e preciso, buscando ampliar o conhecimento para não negligenciar características específicas da disfagia, e evitar complicações com o tratamento adequado.

Upper gastrointestinal bleeding (UGIB) is a common medical condition whose mortality rate remains at about 10%. Allergic diseases are no usual risk for UGIB. However, the recent increase in allergic diseases that chronically affect the gastrointestinal tract could change this scenario. This article reports a case of UGIB after hematemesis caused by food impaction. Upper gastrointestinal endoscopy was performed and eosinophilic esophagitis (EoE) was diagnosed. EoE is an emerging chronic esophageal inflammatory disease with an increasing number of diagnosed cases around the world. Currently, it is considered the most prevalent cause of dysphagia and food impaction in children and young adults. EoE symptoms are not specific to each age group and may range from mild symptoms such as those of gastroesophageal reflux disease to dysphagia and food impaction. There is a delay in diagnosis and treatment that leads to increased complications, including esophageal rupture, the most feared risk. Our literature review showed that EoE had never been described as a cause of UGIB. In addition to the unusual presentation of UGIB leading to the diagnosis of EoE, this case highlights the importance of multidisciplinary care and cooperation between specialties. Therefore, there is a need for earlier and more accurate diagnosis, which would lead to expanded knowledge that could be used to not disregard specific characteristics of dysphagia and avoid complications with appropriate treatment.

Epidemiological characterization of oral cancer: literature review / Caracterización epidemiológica del cáncer oral: revisión de la literatura

Oral cancer is a disease of high impact globally. It ranks as the sixth more frequent one among all types of cancer. In spite of being a widely known pathology and easy access to the diagnosis, the lack of epidemiological data reported in the last 10 years in Chile called attention to. At the global level, the World Health Organization (WHO) has developed a project called “GLOBOCAN” in order to collect epidemiological data of the global cancer, between its data, highlights the high incidence and high rate of mortality in the male sex, parameter that shows tendency to replicate in both America and Chile. In consequence to these data, a narrative review of the literature concerning the epidemiological profile of the different forms of oral cancer in the past 15 years was done. The diagnosis of oral cancer crosses transversely the Dental Science, forcing us to establish triads of work between oral and maxillofacial surgeons, pathologists and dentists of the various specialties, so as to allow a timely research, appropriate biopsies and histopathological studies finishes with the purpose of, on the one hand, obtain timely and accurate diagnostics, in addition, maintaining the epidemiological indicators...

El cáncer oral es una patología de alto impacto a nivel mundial, ocupando el sexto lugar más frecuente entre todos los tipos de cáncer. A pesar de unapatología ampliamente conocida y de fácil acceso al diagnóstico, llama la atención la falta de datos epidemiológicos reportados en los últimos 10 años en Chile. A nivelmundial, la Organización Mundial de Salud (OMS) ha desarrollado un proyecto denominado “GLOBOCAN”con el fin de recolectar datos epidemiológicos mundiales del cáncer, entre sus datos, destaca la gran incidencia y elevada tasa de mortalidad en el sexo masculino, parámetro que muestra tendencia a replicarse en tanto América como en Chile. En consecuencia a estos datos, se realizóuna revisión narrativa de la literatura, referente al perfil epidemiológico de las diferentes formas de cáncer oral enlos últimos 15 años. El diagnóstico del cáncer oral cruza de manera transversal a la Odontología, obligándonos a establecer triadas de trabajo entre cirujanos orales y maxilofaciales,patólogos y odontólogos de las diversas especialidades, para permitir así una oportuna pesquisa, biopsias adecuadas y estudios histopatológicos acabados con la finalidad de, por una parte, obtener diagnósticos oportunos y certeros, además, mantener actualizados los indicadores epidemiológicos...

Oral lichen planus: a look from diagnosis to treatment / Liquen plano oral: una mirada desde el diagnóstico al tratamiento

Oral lichen planus (OLP) is a chronic mucocutaneous disease of unknown etiology. Its pathogenesis is multifactorial and it may affect the oral mucosa, skin and other mucous membranes. Diagnosis is based on clinic and histopathology; direct immunofluorescence techniques can also be of use. It affects about one to two percent of the population, mainly women between the fifth and sixth decades of life. In the mouth, the most affected area is the buccal mucosa, followed by the gums, tongue and/or palate. Its three most representative clinical forms are reticular, erythematous and erosive; evolution depends on the type it is. Lesion treatment is determined by the clinical form and, since no fully effective treatment has been found yet, it is directed towards controlling the disease. The treatment of choice involves topical or systemic corticosteroids, but other drugs may also be used. The aim of this paper is to gather current and relevant information about oral lichen planus: its pathogenesis, diagnosis, treatment and management.

El liquen plano oral (LPO) es una enfermedad crónica mucocutánea de etiología poco conocida, cuya patogénesis es multifactorial, y puede afectar a la mucosa oral, piel y otras mucosas. El diagnóstico está basado en la clínica y la histopatología. Además, técnicas como la inmunofluorescencia directa pueden contribuir al diagnóstico de la enfermedad. Afecta del 1 al 2 por ciento de la población, principalmente mujeres, entre la quinta y sexta décadas de la vida. En boca, la zona más afectada es la mucosa yugal, seguido de encías, lengua y/o paladar. Las tres formas clínicas más representativas son: reticular, eritematosa y erosiva, cuya evolución varía según el tipo. El tratamiento de las lesiones depende de la forma clínica y está dirigido hacia un control de la enfermedad, ya que en la actualidad no se conoce un tratamiento del todo efectivo. El tratamiento de elección es la utilización de corticoides, en forma tópica o sistémica, aunque otros fármacos también pueden ser utilizados para el manejo de la enfermedad. El objetivo del presente artículo es recopilar información actualizada y relevante del liquen plano oral en su etiopatogenia, diagnóstico, tratamiento y manejo de la enfermedad.

Neuropatía epidémica cubana: algunos factores de riesgo en la población / Cuban epidemic neuropathy: the risk factors in the population

A cross-sectional study was conducted in 1995 in a representative sample of the Cuban population aged 15 years or over with the objective of describing prevalence and characteristics of smoking, alcohol consumption, and physical inactivity in the urban population which could have been affected by epidemic neuropathy from 1991-1993. The sampling was stratified at provincial and municipal levels and then by cluster samplings. 93 of the sample was surveyed (14 300 people). 30 of the population aged 17 years and over smoked; the highest proportion of smokers was located in 40-49 years age group; men smoked more than woman regardless of age. The prevalence of alcohol consumption was 45.2 in which Eastern provinces exceeded the domestic average with males predominating. The prevalence of physical inactivity at national level was 33, 25.7 for males and 39.8 for females. 47.3 of males and 25.4 of females classified as physically active because of their useful extra activity. It was considered that irregular relationships between these 3 risk factors and the incidence of epidemic neuropathy at the ecological level make it think that, although they have a real influence on the determinants of the disease, other factors may also better account for the occurrence of these cases.

Quiste hidatídico / Hydatid cyst

Como quiste hidatídico se conoce a la parasitosis ocasionada por los céstodos del género Echinococcus ya sea de las especies E. granulosus ó E.vogeli, este último distribuido exclusivamente en América del sur.Se caracteriza por no dar manifestaciones clínicas hasta que los quistes hayan alcanzado el suficiente tamaño para provocar complicaciones por la compresión que ejercen.Se reporta el caso de una paciente de sexo femenino de 84 años de edad, que es ingresada a la sala Santa Teresa del Hospital Luis Vernaza, por presentar dolor en hipocondrio derecho, ictericia, mareos, nausea, vómito, meteorismo y prurito anal. Se le efectuaron exámenes tomográficos y ecográficos, donde se detectó la presencia de una imagen patológica compatible con el diagnóstico de quiste, a nivel del lóbulo izquierdo del hígado. Por estar dentro del diagnóstico diferencial de “masa” en el hígado, se sospecha hidatidosis, por lo que se ordenan pruebas serológicas que resultan positivas para Echinococcus. Se empleó tratamiento farmacológico (albendazol-mebendazol), por ser una paciente de elevado riesgo quirúrgico, obteniéndose mejoría del cuadro, pero sin la desaparición del quiste.

The hydatid cyst is known as a parasitosis caused by cestodes of the Echinococcus genus that can belong to the E. granulosus or E. vogeli species, the last one exclusively distributed in South America.The mentioned illness is characterized by the absence of clinical signs until the cyst had the enough size to brought complications because of the compression.We reported the case of a female patient, 84 years old, who was admitted at the Luis Vernaza Hospital, Santa Teresa´s ward, by de presence of the following symptoms: pain in the right hypocondric area, jaundice, dizziness, nauseas, vomits, meteorism and anal pruritus.Patient was submitted to CAT and ultrasound scan exams, which detected the presence of a pathologic image compatible with the cyst in the left liver lobe. We ordered serologic exams that resulted positive to Echinococcus. We used pharmacologic treatment (albendazol-mebendazol) because the patient had high surgical risks, caused by the age. There has been a significant improvement in the patient’s condition, but without the dissappearence of the cyst

Evaluación de la exposición a plaguicidas organofosforados y carbamatos según índice de colinesterasa sanguínea / Assessment of exposure to organophosphate and carbamate pesticides according to the blood cholinesterase index

La media de la actividad colinesterásica en sangre total se utilizò como indicador de exposición de los grupos de riesgo (niños, mujeres y ancianos) de una comunidad situada a 2 km de un plan arrocero que recibe fumigaciones aéreas de organofosforados y carbamatos, se comparan con los resultados obtenidos en estos grupos de población de otra comunidad no expuesta. La mayoría de los casos estudiados presentan valores normales, pero se evidencia una tendencia a menor actividad de la colinesterasa en la muestra estudiada de la comunidad vecina a la zona arrocera