Conocimientos, actitudes y prácticas en pacientes con tuberculosis: una revisión sistemática de literatura / Knowledge, attitudes and practices in patients with tuberculosis: a systematic literature review

Introducción: La tuberculosis es una enfermedad infectocontagiosa de fácil tras-misión. Para su control, los conocimientos, actitudes y prácticas adecuadas son indis-pensables, así como los factores relevantes para la adherencia al tratamiento. Objetivo: Caracterizar las definiciones o los conceptos de las dimensiones de cono-cimientos, actitudes y prácticas en tuberculosis reportados en la literatura durante los últimos diez años. Materiales y métodos: Se realizó una revisión sistemática de la literatura bajo la metodología "Preferred Reporting Items for Systematic Reviews and Meta-Analy-ses". Inicialmente, se encontraron 1.720 posibles publicaciones, de las cuales, luego de la aplicación de los criterios de exclusión, quedaron 34 para ser incluidas en el análisis de esta revisión. Resultados: La mayoría de los estudios fueron publicados en el año 2018 y pre-dominaron las publicaciones en el continente africano. La caracterización de las di-mensiones se relaciona así: los conocimientos se definen como características de la enfermedad, las actitudes se relacionan con el estigma social hacia el paciente y las prácticas corresponden con la búsqueda de atención médica por parte del paciente. Conclusión: Se identificó la escasez de producción científica en donde se especifi-quen los conceptos de las dimensiones de conocimientos, actitudes y prácticas, que a su vez permitan el desarrollo de investigaciones de alto rigor y alcance metodológico, ya que las publicaciones realizadas e incluidas para este estudio tuvieron una evalua-ción de baja calidad.

Introduction: Tuberculosis is an infectious disease of easy transmission. For tuber-culosis's control, appropriate knowledge, attitudes, and practices are essential, as well as relevant factors for treatment adherence. Objective: To characterize the concepts of three dimensions ­knowledge, atti-tudes, and practices­ in tuberculosis reported in the literature during the last ten years. Materials and methods: A systematic review of the literature was carried out under the methodology "Preferred Reporting Items for Systematic Reviews and Me-ta-Analyzes". Initially, 1.720 possible publications were found, of which, after apply-ing the exclusion criteria, 34 remained to be included in this review. Results: Most studies were published in 2018, and publications on the African con-tinent predominated. The characterization of the dimensions is related as follows: knowledge was defined as the characteristics of the disease, attitudes were related with the social stigma towards the patient with TB, and practices were associated with seeking medical care by the patients with TB. Conclusion: There is a lack of publications on the definition of knowledge, atti-tudes and practices on tuberculosis, which hampers developing high impact research.

Mieloma múltiple. Experiencia de 9 años en el Hospital Naval Almirante Nef / Multiple myeloma. Nine years' experience at the Hospital Naval Almirante Nef

Introducción: el mieloma múltiple (MM) continúa siendo una enfermedad incurable sin embargo, el trasplante autólogo de médula ósea (TAH), y las drogas antineoplásicas han permitido mejorar la sobrevida global (SG) de los pacientes. Materiales y métodos: estudio de cohorte retrospectivo de 50 pacientes con diagnóstico de MM en el hospital Naval Almirante Nef, desde 2005 a 2013. Los pacientes se dividieron en dos cohortes, según la eligibilidad a trasplante, y analizados acordes a la primera línea de tratamiento y la sobrevida global (SG) hasta abril de 2019. Resultados: mediana de edad 73 años (47-88 años), SG 49 meses, y 50% en etapa-II del Sistema de Etapificación Internacional. La SG de los 39 no candidatos a TAH fue 46 meses; con un mayor número de respuestas completas y sobrevida, con el esquema melfalán-prednisona-talidomida. La SG de los 11 candidatos a TAH fue 66 meses, siendo el esquema bortezomib-ciclofosfamida-dexame-tasona el que concentró un mayor número de respuestas completas libres de progresión. Se trasplantó el 45% de los candidatos, con una mediana de sobrevida de 79 meses versus a los 51 meses de aquellos no trasplantados. Tres casos de neuropatía asociada a talidomida y uno a bortezomib. La SG a los seis meses y a los cinco años de todos los pacientes fue 86% y 44%, respectivamente. Conclusión: la incorpo-ración de nuevos fármacos permitió obtener mejores resultados de sobrevida lo que se condice con estudios nacionales e internacionales.

Introduction: Multiple myeloma (MM) is still an incurable disease however, autologous stem cell transplantation (ASCT), and antineo-plastic drugs have allowed improving the overall survival (OS) of patients. Materials and methods: A retrospective cohort study of 50 patients diagnosed with MM at the Hospital Naval Almirante Nef, from 2005 to 2013. The patients were divided into two cohorts according to transplantation eligibility and analyzed about first-line treatment and overall survival (OS) up to April 2019. Results: Median age 73 years (47-88 years), OS 49 months, and 50% in stage-II International Staging System. OS of the 39 non-candidates for ASCT was 46 months: with a higher number of complete responses and survival, with the melphalan-prednisone-thalidomide scheme. The OS of the 11 candidates for ASCT was 66 months, with the bortezomib-cyclophosphamide-dexamethasone scheme being the one with the highest number of progression-free complete responses. Forty-five percent of the candidates were transplanted, with a median survival of 79 months versus 51 months for those not transplanted. Three cases of neuropathy were associated with thalidomide and one with bortezomib. OS at six months and five years for all patients was 86% and 44%, respectively. Conclusion: The incorporation of new drugs allowed to obtain better survival results, which is by national and international studies.

Hemorragia fatal de una ulcera venosa crónica: Reporte de un caso / Fatal bleeding from a chronic venous ulcer: case report

Resumen La enfermedad venosa crónica es un trastorno común que se manifiesta con una amplia gama de signos. En casos en los que la enfermedad adquiere gravedad se le denomina insuficiencia venosa crónica y esta puede llevar al desarrollo de una úlcera venosa. Un trauma directo o la erosión de una vena varicosa pueden llevar a una hemorragia que, aunado a enfermedades crónicas concomitantes, factores toxicológicos, sociales o primeros auxilios inadecuados pueden llevar a la muerte en pocos minutos y en un escenario del crimen que puede ser confuso a primera vista para el equipo forense. Se reporta un caso valorado en la Sección de Patología Forense del Departamento de Medicina Legal del Poder Judicial de Costa Rica en el que se realizó una autopsia completa. Dentro de los hallazgos más importantes a nivel macróscopico se evidenció una úlcera cónica de características venosas en la pierna derecha en la cual, mediante la disección por planos y la inyección de colorante en la vena safena magna, se observó la salida de este por una vena varicosa relacionada con la úlcera.

Abstract Chronic venous disease is a common disorder that shows a large spectrum of signs. In cases in which the disease acquires severity it is named chronic venous insufficiency, and it can cause the development of a venous ulcer. Direct trauma to or erosion of a varicose vein can lead to a hemorrhage that, in combination with coexistent conditions, toxicologic or social factors, or inadequate first aid can produce death in few minutes and a crime scene which might be confusing at first sight to the forensics team. We present a case handled by the Forensic Pathology Section of the Department of Legal Medicine of the Judicial Power of Costa Rica in which a complete autopsy was performed. Among the most relevant macroscopic findings was evidence of a chronic ulcer with venous characteristics on the right leg, in which dissection by planes and dye injection into the great saphenous vein showed leakage of this dye out of a varicose vein related to the ulcer.

Fracturas atípicas de fémur asociadas al uso de bifosfonatos / Bisphosphonate associated atypical femur fractures

Resumen Los bifosfonatos son medicamentos ampliamente conocidos por su efecto antagonista de la resorción ósea y la consecuente reducción del riesgo de fracturas en los pacientes con osteoporosis. La literatura actual provee evidencia en términos de datos clínicos y experimentales que asocian el uso prolongado de estos medicamentos con un aumento en el riesgo de fracturas atípicas de fémur. Para establecer si esta asociación es clínicamente relevante, se requiere realizar estudios posteriores que incluyan la relación entre otros factores que podrían influir en la aparición de este tipo de fracturas como lo es la propia enfermedad osteoporótica, el tipo de bifosfonato utilizado, el mecanismo lesional que originó la fractura, medicamentos concomitantes y patologías asociadas.

Abstract Bisphosphonates are medications that are widely known for their antagonizing effect on bone resorption and their consequent reduction in the risk of fractures in patients with osteoporosis. Current literature provides evidence in terms of experimental and clinical data associating prolonged use of these drugs with an increase in the risk of atypical femur fractures. To establish if this association is clinically relevant, there lies a need for further studies that take into account other factors that might influence the occurrence of these type of fractures, like the osteoporotic disease itself, age, intake of other drugs and associated systemic illnesses.

Validación clínica de enfermería en cicatrización de úlceras venosas con miel nativa chilena suplementada / Clinical validation nursing in healing of venous ulcers with supplemented Chilean native honey / Validação clínica de enfermagem na cicatrização de úlceras venosas com mel nativo chileno suplementado

El objetivo de este estudio longitudinal fue validar clínica y planimétricamente la cicatrización de úlceras venosas con un prototipo de miel médica suplementada, nativa de Chile. La cicatrización de la úlcera venosa, demanda recursos sanitarios y tiempo de enfermería. Las terapias naturales, como la miel, son consideradas cicatrizantes, siendo el enfermero/a el profesional encargado de incorporarlas en la gestión del cuidado de personas con heridas. Participaron 22 pacientes con úlceras venosas, de centros de salud de Padre las Casas, Chile, voluntarios del proyecto CORFO 13IDL2-2329, tratados con un prototipo médico de miel nativa con actividad antibacteriana y suplementada con antioxidantes. Se realizó seguimiento clínico y planimétrico de la disminución del área y perímetro, asociados al uso del producto bajo un protocolo de gestión del cuidado de enfermería. El análisis de imágenes fue con el Software ImageJ®, cuyos datos fueron sometidos a estadística no paramétrica con el Software IBMSPSS-21.0. La reducción del área y perímetro fueron estadísticamente significativos para las úlceras tipo 3 y 4, con una mediana de reducción de área de 95.41 % y 84.40 % para perímetro, ambos entre el segundo y tercer contraste de mediciones. Destacó también la mediana de días de cicatrización en úlceras tipo 4 con 124 días. Se concluyó que la aplicación de miel clínica y un protocolo de gestión del cuidado de enfermería, basado en un tratamiento multifactorial y un criterio uniforme de curación, demostraron reducción de las áreas y perímetros de cicatrización, con énfasis en el desbridamiento.

The objective of the longitudinal study was to validate clinically and planimetrically the healing of venous ulcers with a prototype of upplemented medical honey, native to Chile. Healing of venous ulcer requires health resources and nursing time. Natural therapies, such as honey, are considered healing, and the nurse is responsible for incorporating them in the management of the care of people with injuries. 22 patients with venous ulcers participated, from health centers of Padre las Casas, Chile, volunteers of the CORFO 13IDL2-2329 project, treated with a medical prototype of native honey, supplemented with antioxidants and certified antibacterial activity. Clinical and planimetric follow-up of the area and perimeter decrease, associated with the use of the prototype was carried out under a nursing care management protocol. The analysis of images was with the Software ImageJ® , whose data were subjected to non-parametric statistics with the Software IBMSPSS-21.0. The area and perimeter reduction were statistically significant for type 3 and 4 ulcers, with a median area reduction of 95.41 % and 84.40 % for perimeter, both between the second and third measurements contrast. It also highlighted the median number of days of healing in type 4 ulcers with 124 days. It was concluded that the application of clinical honey and a nursing care management protocol, based on a multifactorial treatment and a uniform cure criterion, demonstrated reduction of the areas and perimeters of healing, with emphasis on debridement.

O objetivo deste estudo longitudinal foi validar clínica e planimetricamente a cicatrização de úlcerações venosas com um protótipo de mel medicinal suplementado, nativo do Chile. A cicatrização da úlcera venosa exige recursos de saúde e tempo de enfermagem. As terapias naturais, como o mel, são consideradas cicatrizantes, e o enfermeiro é o profissional encarregado de incorporá-las ao gerenciamento do cuidado de pessoas com feridas. Participaram 22 pacientes com úlcerações venosas dos centros de saúde de Padre las Casas, Chile, voluntários do projeto CORFO 13IDL2-2329, tratados com um protótipo médico de Mel nativo com atividade antibacteriana e suplementado com antioxidantes. Foi realizado monitoramento clínico e planimétrico da área e diminuição do perímetro, associado ao uso do produto sob um protocolo de gerenciamento de cuidados de enfermagem. A análise das imagens foi realizada com o software ImageJ®, cujos dados foram submetidos a estatística não paramétrica com o software IBMSPSS-21.0. A redução de área e perímetro foi estatisticamente significante para as úlceras tipo 3 e 4, com uma redução mediana da área de 95,41% e 84,40% para o perímetro, ambos entre o segundo e o terceiro contraste da medida. Também se destacaram os dias medianos de cicatrização em úlceras tipo 4 com 124 dias. Concluiu-se que a aplicação do mel clínico e um protocolo de gestão da assistência de enfermagem, baseado em tratamento multifatorial e critério uniforme de cicatrização, demonstraram redução das áreas e perímetros da cicatrização, com ênfase no desbridamento.

Análisis de los efectos del consumo de alcohol en la morbi-mortalidad por trauma craneoencefálico / Analysis of the effects of alcohol consumption in traumatic brain injury´s morbidity and mortality

Resumen La intoxicación con alcohol está frecuentemente asociada con trauma craneoencefálico (TCE), pero el impacto del alcohol en la patogénesis y el pronóstico del TCE sigue siendo poco clara. La literatura actual provee evidencia en términos de datos clínicos y experimentales que respaldan los efectos neuroprotectores del alcohol en pacientes con TCE. Para establecer de manera significativa esta relación es necesario el desarrollo de estudios prospectivos observacionales fuertes, con el fin de comprender los efectos del alcohol en los resultados clínicos a largo plazo (incluyendo el resultado neurológico) en pacientes con TCE con una apropiada selección y ajuste del riesgo basal.

Abstract Alcohol intoxication is often associated with traumatic brain injuries (TBIs), but the impact of alcohol on the pathogenesis and prognosis of TBIs remains unclear. Current literature provides evidence in terms of experimental and clinical data supporting alcohol's neuroprotective effects in patients with TBIs. To establish in a significative way this association, there lies a need for strong prospective observational studies, in order to comprehend the effects of alcohol on the long-term outcomes (including the neurological outcome) in patients with TBI with proper selection and baseline risk adjustment.

Medidas de protección respiratoria de tuberculosis en personal de salud: revisión integrativa / Respiratory protection measures anti-tuberculosis in health personnel: integrative review

Resumen Introducción: los trabajadores de la salud (TS) son vulnerables a la infección por tuberculosis. Se suma el desconocimiento de los TS de las medidas de protección respiratoria que puede aumentar el riesgo individual de adquirir tuberculosis en instituciones de salud. Objetivo: describir la producción de literatura científica en las bases de datos científicas sobre las medidas de protección respiratoria de la infección tuberculosa durante el periodo 20122018. Síntesis de contenido: revisión integrativa a través de: formulación de la pregunta de investigación, recolección de datos, evaluación, análisis e interpretación de datos y presentación de los resultados. 45 artículos cumplieron con los criterios de inclusión. Las características predominantes de los estudios fueron: año 2017 con mayor número de publicaciones, en el continente de África, la metodología de estudio cuantitativo cuasiexperimental. En los estudios se identificaron las características del respirador N95 y la mascarilla quirúrgica, los conocimientos, actitudes y prácticas de las medidas de protección respiratoria y programas educativos. Conclusiones: se evidenció que el respirador N95 es la medida de protección individual más eficiente para el control de la infección tuberculosa en los TS. También se identificó la necesidad del diseño de programas educativos sobre las medidas de protección de la infección tuberculosa.

Resumo Introdução: os trabalhadores de saúde (TS) são vulneráveis à infecção por tuberculosis. Além disso, há uma falta de conhecimento dos TS sobre medidas de proteção respiratória que podem aumentar o risco individual de adquirir tuberculose em instituições de saúde. Objetivo: Descrever a produção de literatura científica em bases de dados sobre medidas de proteção respiratória para infecção por tuberculose no período de 2012 e 2018. Síntese do conteúdo: revisão integrativa através de: formulação da questão da pesquisa, coleta de dados, avaliação, análise e interpretação dos dados e apresentação dos resultados. 45 artigos preencheram os critérios de inclusão. As características gerais dos estudos foram predominantes: ano de publicação em 2017, no continente africano, metodologia de estudo quantitativo quase experimental. Nos estudos, encontramos as características do respirador N95 e da máscara cirúrgica, conhecimentos, atitudes e práticas de medidas de proteção respiratória e programas educacionais. Conclusões: o presente estudo mostrou que o respirador N95 é a medida de proteção individual mais eficiente para o controle da infecção tuberculosa em profissionais da saúde. A necessidade de elaborar programas educacionais sobre medidas de proteção contra a infecção tuberculosa também foi identificada.

Abstract Introduction: health workers (TS) are vulnerable to tuberculosis infection. To this it is added the lack of knowledge of respiratory protection measures among TS, which can increase the individual risk of acquiring tuberculosis in health institutions. Objective: to describe the production of scientific literature in scientific databases about respiratory protection measures for tuberculosis infection during the period 2012 - 2018. Content synthesis: integrative review through: formulation of the research question, data collection, evaluation, analysis and interpretation of data, and presentation of results. 45 articles fulfilled the inclusion criteria. The predominant characteristics of the studies were: year 2017 with the largest number of publications, in the continent of Africa, the methodology of quasi-experimental quantitative study. The characteristics of the N95 respirator and surgical mask, the knowledge, attitudes and practice of respiratory protection measures and educational programs were identified in the studies. Conclusions: it was shown that the N95 respirator is the most efficient individual protection measure for the control of tuberculosis infection among TS. The need for the design of educational programs on protection measures for tuberculosis infection was also identified.

Factores ambientales en el desarrollo y evolución de la enfermedad inflamatoria intestinal / Environmental risk factors in the development and evolution of inflammatory bowel disease

Environmental factors may influence the development of Inflammatory Bowel Disease and modify its natural history. The objective of this review is to evaluate current evidence about environmental factors associated with the disease. A better knowledge about the pathogenesis of the disease can lead to better treatment strategies and suggestions to prevent the disease.

Free fatty acids reduce metabolic stress and favor a stable production of heterologous proteins in Pichia pastoris

ABSTRACT The growth of yeasts in culture media can be affected by many factors. For example, methanol can be metabolized by other pathways to produce ethanol, which acts as an inhibitor of the heterologous protein production pathway; oxygen concentration can generate aerobic or anaerobic environments and affects the fermentation rate; and temperature affects the central carbon metabolism and stress response protein folding. The main goal of this study was determine the implication of free fatty acids on the production of heterologous proteins in different culture conditions in cultures of Pichia pastoris. We evaluated cell viability using propidium iodide by flow cytometry and thiobarbituric acid reactive substances to measure cell membrane damage. The results indicate that the use of low temperatures and low methanol concentrations favors the decrease in lipid peroxidation in the transition phase from glycerol to methanol. In addition, a temperature of 14 ºC + 1%M provided the most stable viability. By contrast, the temperature of 18 ºC + 1.5%M favored the production of a higher antibody fragment concentration. In summary, these results demonstrate that the decrease in lipid peroxidation is related to an increased production of free fatty acids.

Utilidad de la monitorización terapéutica de infliximab en el manejo de la enfermedad inflamatoria intestinal / Usefulness of therapeutic monitoring of infliximab in the treatment of inflammatory bowel disease

Background: Primary non-response and secondary loss of response (LOR) are significant problems of biological therapy for inflammatory bowel disease (IBD). Therapeutic drug monitoring (TDM) in IBD patients receiving these drugs can improve outcomes. Aim: To measure serum infliximab levels and anti-infliximab antibodies (ATI) in patients with IBD post-induction phase and during maintenance therapy assessing the clinical course of IBD. Patients and Methods: Prospective study of IBD patients receiving infliximab between July 2016-May 2017. Group-A included patients who received induction therapy while Group-B included patients who were in maintenance therapy. TDM was performed in serum samples collected at weeks-14 and 30 in Group-A and before the infliximab maintenance dose in Group-B. Clinical scores, fecal calprotectin and endoscopic score were also evaluated. Results: Of 14 patients in Group-A, 57% achieved endoscopic response. Median serum infliximab concentrations at week-14 and 30 were 2.65 AU/mL (0.23-32.58) and 2.3 AU/mL (0.3-16.8), respectively. Patients with mucosal healing had non-significantly higher median infliximab concentrations at week- 14, as compared to week 30 (median 3.2 vs 2.2 AU/ml, respectively, p 0.6). ATI >10 ug/mL were found in one and seven patients at week-14 and 30, respectively. At 52 weeks of follow-up, four patients (31%) had LOR. Group-B included 36 patients, 33% had LOR. Median serum concentrations of infliximab were 1.4 AU/mL (0.27-7.03). No significant differences in serum infliximab concentration were observed between patients in remission and those with inflammatory activity. Seventeen patients had ATI >10 ug/mL. Conclusions: Clinical algorithms using TDM might help to optimize the pharmacological therapy of IBD.

Factores pronósticos en colitis ulcerosa de reciente diagnóstico / Prognostic factors of ulcerative colitis at the moment of diagnosis

The clinical presentation of ulcerative colitis at the moment of diagnosis is variable, and its clinical course is difficult to predict. It can range from a quiescent to a refractory chronic course that may require hospitalization and surgical procedures. It can also have complications such as colorectal cancer. In this review we discuss the role of demographic, clinical, endoscopic, histological and associated factors, which can help to predict the clinical course of the disease at the moment of diagnosis, and to individualize therapy according to this clinical risk. Accurate identification of patients with a newly diagnosed ulcerative colitis who are at high risk of an unfavorable outcome is still a challenge. However, an effective evaluation allows an early diagnosis, a timely and effective treatment.

Significado de ser padre siendo adolescente / Significado de ser pai sendo adolescente / Meaning of parenting as a teenager

Objective. Describe the meaning of parenting as a teenager. Methods. Study of the qualitative approach with phenomenological approach in the fourth village of San Cristobal (Bogotá, Colombia). The information was obtained by means of semi-structed interviews, participant observation, photos, daily and focal groups field. The information analysis was performed using the phenomenological method of Amadeo Giorgi. Results. The meaning of their parenthood in the adolescents revealed five units of sense: emotional ambivalence, paternity as a process of learning, changes in lifestyle, making a life project and support networks. Conclusion. Teenage fatherhood was interpreted by the participants as a positive change and assumed a patriarchal perspective.(AU)

Objetivo. Descrever os significados de ser padre sendo adolescente. Métodos. Estudo de enfoque qualitativo com abordagem fenomenológico realizado na Localidade Cuarta de San Cristóbal (Bogotá, Colômbia). A informação se obteve mediante entrevistas semiestruturadas, observação participante, fotografias, grupos focais e diários de campo. A análise da informação se realizou mediante o método fenomenológico de Amadeo Giorgi. Resultados. Os significados da sua paternidade nos adolescentes revelaram cinco unidades de sentido: ambivalência emocional, paternidade como processo de aprendizagem, mudança no estilo de vida, formação de projeto de vida, e redes de apoio. Conclusão. A paternidade adolescente foi interpretada pelos participantes como uma mudança positiva e é assumida desde uma visão patriarcal.(AU)

Objetivo. Describir los significados de ser padre desde la visión del adolescente mismo. Métodos. Estudio de enfoque cualitativo con abordaje fenomenológico realizado en la Localidad Cuarta de San Cristóbal (Bogotá, Colombia). La información se obtuvo mediante entrevistas semiestructuradas, observación participante, fotografías, grupos focales y diarios de campo. El análisis de la información se realizó mediante el método fenomenológico de Amadeo Giorgi. Resultados. Los significados de la paternidad en los adolescentes develaron cinco unidades de sentido: ambivalencia emocional, paternidad como proceso de aprendizaje, cambios en estilo de vida, formación de proyecto de vida, y redes de apoyo. Conclusión. La paternidad adolescente fue interpretada por los participantes como un cambio positivo y es asumida desde una visión patriarcal.(AU)

Presencia de Escherichia coli intracelular en mucosa intestinal de pacientes con Enfermedad Inflamatoria Intestinal y su asociación con características clínicas y el uso de corticosteroides / Presence of intracellular Escherichia coli in patients with inflammatory bowel disease

Background: Different strains of invasive Escherichia coli (E. coli), isolated from intestinal mucosa of patients, are related to the pathogenesis of inflammatory bowel diseases (IBD). Aim: To evaluate an association between intracellular E. coli and IBD; its clinical characteristics and use of steroids. Material and Methods: Sixty one patients with Crohn's disease and 83 with ulcerative colitis were studied. To determine the intracellular E. coli content, colonoscopy biopsies of these patients and 29 control subjects were processed using the gentamicin protection assay. Differences in the bacterial content between patient groups were evaluated using Mann-Whitney test, while the association between presence of E. coli with endoscopic activity, location/extension and use of corticosteroid as anti-inflammatory treatment were evaluated with Fisher's exact test or Chi-square test. Results: E. coli strains were detected in 36.1, 39.3 and 10.3% of patients with ulcerative colitis, Crohn's disease and controls, respectively. The number of bacteria per biopsy in Crohn's disease and ulcerative colitis was significantly higher than in controls (p < 0.01 between patients and controls). In ulcerative colitis, significant associations were found between the presence of bacteria and disease location and use of corticosteroids. In Crohn's disease, no association was found. Conclusions: IBD are associated with the presence of intracellular E. coli strains in the intestinal mucosa, suggesting an alteration in the microbiota or loss of integrity of the epithelial barrier. The association of intracellular E. coli with clinical features and the use of corticosteroids in ulcerative colitis suggests that different factors could promote colonization or proliferation of these bacteria.

Terapia de inducción acelerada con infliximab en paciente con colitis ulcerosa grave refractaria a corticoides: caso clínico / Acute severe ulcerative colitis treated with accelerated infliximab induction: case report

Acute severe ulcerative colitis (ASUC) is a potentially life-threatening condition that requires early recognition, hospitalization and adequate treatment. Currently, the use of infliximab in ulcerative colitis (UC) is recommended in the case of severe disease refractory to corticosteroids, once that superimposed bacterial or viral infections (such as cytomegalovirus or Clostridium difficile) have been excluded. However, conventional weight-based regimens of infliximab might be insufficient for patients with ASUC. Accelerated infliximab induction regimen may increase its serum concentration levels and efficacy by reducing early colectomy rates in these patients. We report a 34 year old female presenting with an ASUC. She was initially treated with hydrocortisone 300 mg/day and mesalazine enemas 4 g/day with an unfavorable clinical response. At the fifth day of therapy, an accelerated induction therapy with infliximab was started in doses of 10 mg/kg at weeks 0, 1 and 4. After the second dose, there was a favorable response with reduction of abdominal pain, stool frequency and hematochezia. She was discharged with prednisone and azathioprine. After a year of starting infliximab, the patient remains in clinical remission.

Experiencia local con natalizumab en pacientes con enfermedad de Crohn refractaria a anti-TNF: casos clínicos / Natalizumab for the treatment of Crohns disease: report of three cases

Anti-tumor necrosis factor-α (TNF) agents have dramatically changed the management of Crohn’s Disease (CD). However, a significant number of these patients do not respond at all or cease to respond to antibodies against TNF. In this clinical situation, the options include intensification of anti-TNF therapy by either increasing the dose or by shortening the administration interval, the use of a second anti-TNF or medications with a different mechanism of action. Among the later, Natalizumab, a humanized IgG4 monoclonal antibody against α4β1 and α4β7 integrins, is safe and effective in inducing and maintaining remission in active CD patient’s refractory to anti-TNF. In spite of this, Natalizumab use has been limited because of an increased risk of progressive multifocal leukoencephalophaty which results from reactivation of the John Cunningham (JC) virus. However, the presence of antibodies against JC virus in serum can be used to reduce the risk for this complication. We report three patients with Crohn’s disease refractory to treatment with infliximab, who responded successfully to the use of Natalizumab.

Desarrollo de neoplasia en pacientes con enfermedad inflamatoria intestinal / Development of malignant tumors in patients with inflammatory bowel disease

Background: The chronic inflammation of the intestinal mucosa, the extra-intestinal manifestations of the disease and the immunosuppressive treatment of inflammatory bowel disease may increase cancer risk. Aim: To report the demographic and clinical features of patients with IBD who developed a malignant tumor. Material and Methods: Retrospective analysis of an IBD patient registry of a private clinic, diagnosed between 1976 and 2014. Results: 437 subjects were included, aged 15-88 years (58% women). Seventy two percent of patients had ulcerative colitis. The median time of follow up was 6 years. Ten patients (2.3%) developed a malignant tumor. In four, the tumor could be related to IBD (two colorectal cancers, one cholangiocarcinoma and one chronic myeloid leukemia (CML)). Two of 45 patients treated with biological therapy developed a tumor (CML and hypernephroma). Three of 170 patients on immunosuppressive treatment developed tumors. Only one had a tumor possibly related with the use of azathioprine (non-melanoma skin cancer). In only two patients, the treatment was changed at the time of their cancer diagnosis, from immunosuppressive medications to mesalamine. Conclusions: Only a small proportion of these patients with IBD developed a malignant tumor. The treatment of IBD has to be determined by the severity of the disease and not by the fear of developing a neoplasia. Following recommendations is fundamental to decrease the possibility of developing this complication.

Combined therapy of Ulmo honey (Eucryphia cordifolia) and ascorbic acid to treat venous ulcers / Terapia combinada com mel de Ulmo (Eucryphia cordifolia) e ácido ascórbico para úlceras venosas / Terapia combinada con miel de Ulmo (Eucryphia cordifolia) y ácido ascórbico en úlceras venosas

OBJECTIVE: to assess the clinical effect of topical treatment using Ulmo honey associated with oral ascorbic acid in patients with venous ulcers. METHOD: longitudinal and descriptive quantitative study. During one year, 18 patients were assessed who were clinically diagnosed with venous ulcer in different stages, male and female, adult, with a mean injury time of 13 months. Ulmo honey was topically applied daily. The dressing was applied in accordance with the technical standard for advanced dressings, combined with the daily oral consumptions of 500 mg of ascorbic acid. The monitoring instrument is the assessment table of venous ulcers. RESULTS: full healing was achieved in 100% of the venous ulcers. No signs of complications were observed, such as allergies or infection. CONCLUSION: the proposed treatment showed excellent clinical results for the healing of venous ulcers. The honey demonstrated debriding and non-adherent properties, was easy to apply and remove and was well accepted by the users. The described results generated a research line on chronic wound treatment. .

OBJETIVO: avaliar o efeito clínico de tratamento tópico com mel de Ulmo associado à administração oral de ácido ascórbico em pacientes portadores de úlceras venosas. MÉTODO: estudo quantitativo descritivo longitudinal. Um total de 18 pacientes adultos, ambos os sexos, clinicamente diagnosticados com úlcera venosa em diferentes estágios e com duração de 13 meses em média, foram avaliados pelo período de um ano. A aplicação tópica diária de mel de Ulmo foi realizada de acordo com a norma técnica de tratamento avançado combinada com o consumo diário de 500 mg de ácido ascórbico. O instrumento usado para monitoramento foi a tabela de avaliação de úlceras venosas. RESULTADOS: cicatrização completa foi observada em 100% das úlceras venosas. Não foram observados sinais de complicação tais como alergias ou infecção. CONCLUSÃO: o tratamento proposto apresentou resultados clínicos excelentes na cicatrização das úlceras venosas. Além de favorecer o debridamento, o mel não é aderente, é fácil de aplicar e remover, e é de fácil aceitação por parte dos usuários. Os resultados descritos geraram uma linha investigativa no tratamento de feridas crônicas. .

OBJETIVO: evaluar el efecto clínico del tratamiento con miel de Ulmo tópico asociado a ácido ascórbico oral en pacientes portadores de úlceras venosas. MÉTODO: estudio cuantitativo descriptivo longitudinal. Durante el período de un año se evaluaron 18 pacientes diagnosticados clínicamente de úlcera venosa en sus diferentes estadios, de ambos sexos, adultos, con 13 meses promedio de antigüedad de la lesión. Se realizó la aplicación tópica diaria de miel de Ulmo con curación según la norma técnica de curaciones avanzadas, combinada con el consumo oral diario de 500 mg de ácido ascórbico. El instrumento de seguimiento es la tabla de valoración de úlceras venosas. RESULTADOS: se logró la cicatrización total en el 100% de las úlceras venosas. No se observaron signos de complicación, tales como alergias o infección. CONCLUSIÓN: el tratamiento propuesto mostró excelentes resultados clínicos en la cicatrización de úlceras venosas, presentando la miel propiedades debridantes, no adherentes, fácil de aplicar, remover y aceptación del usuario. Los resultados descritos generaron una línea investigativa en el tratamiento de heridas crónicas. .

Eventos adversos en la terapia farmacológica de la enfermedad inflamatoria intestinal / Adverse events associated with the treatment of inflammatory bowel disease

Background: The purpose of inflammatory bowel disease (IBD) treatment is to achieve resolution of symptoms and remission of disease with a minimum of adverse events (AE). Aim: To report AE of different prescriptions used for the treatment of IBD. Material and Methods: Analysis of a registry of patients with IBD held at a private clinic from 1976 to 2013. All used medications, the occurrence and severity of AE were recorded. Results: The records of 346 patients aged 16 to 86 years, 74% with ulcerative colitis, were analyzed. The most commonly type of medications prescribed were 5-aminosalicylates (5-ASAs) in 329 patients (92%), followed by adrenal steroids in 218 (61%). Forty nine AE were recorded in the same number of patents (14%). These were more common in patients with Crohn disease (n = 19, 21%). An univariate analysis, demonstrated that extra-intestinal manifestations, hospitalizations secondary to IBD crisis, requirement of surgery and treatment with steroids, immunosuppressants or biologic agents were significantly associated with the presence of AE. AEs were more common with immunosuppressants, followed by 5-ASAs and steroids. Discontinuation of therapy was required in 79, 100 and 43% of patients taking these medications, respectively. Twenty percent of AEs were severe. Leukopenia and pancytopenia along with alopecia were the most common AEs attributable to azathioprine. Conclusions: The occurrence of AEs in patients with IBD is uncommon. Even inmunosuppressants or biologic agents have a low rate of AE and most of them mild.

Enfermedad inflamatoria intestinal a partir de una experiencia local / Inflammatory bowel disease. Experience in 316 patients

Background: The incidence and prevalence of Inflammatory Bowel Disease (IBD) has increased. Aim: To determine demographic and clinical characteristics of patients with IBD in a Chilean private hospital. Patients and Methods: Review of a prospective registry of patients with IBD, started on 2012. It includes clinical, imaging, endoscopical and pathological information of patients. Results: Data of 316 patients with IBD, aged 16 to 86 years (56% females), were analyzed. Ulcerative Colitis (UC), Crohn´s and non-classifiable IBD were diagnosed in 230, 77 and 9 patients, respectively. The disease was diagnosed in 82% of patients in the period between 2002 and 2012. There was a peak in the diagnosis of both UC and CD between 20 and 39 years of age, without gender differences. The disease switched from UC to CD in six patients. In four, there was a change in disease behavior. Thirty eight patients were treated with biological therapy. The median lapse between the diagnosis and the use of biological therapy was 1 year in patients diagnosed after 2007, compared with 5.5 years among those patients diagnosed before 2007 (p = 0.001). There was a trend towards a higher requirement of surgery until 2006. Subsequently there was a stabilization of the requirement, concomitant with the incorporation of biological therapy. Conclusions: An adequate registry of IBD patients is necessary to improve demographic and clinical characteristics. A national registry is needed to assess the epidemiological changes of IBD in Chile.