Evaluación de presencia y severidad de periodontitis en pacientes chilenos con artritis reumatoide atendidos en el Hospital Padre Hurtado / Frequency and severity of periodontitis among patients with rheumatoid arthritis

Background: Periodontitis may have a triggering and aggravating role of various medical conditions, including rheumatoid arthritis. Aim: To evaluate the periodontal status in Chilean patients with rheumatoid arthritis (RA), treated in a public hospital. Patients and Methods: A trained professional conducted a periodontal examination in 40 patients with RA aged 23 to 73 years (85% women). When present, the severity of periodontitis and its relationship with gender, smoking, age, corticosteroids dose and AR activity were assessed. AR activity was evaluated using the Disease Activity Score Calculator for Rheumatoid Arthritis (DAS 28). Results: Thirty five of the 40 patients had periodontitis and in 13, it was severe. Men, smokers, and older patients had more severe stages. Patients using higher doses of corticosteroids had lower severity of periodontitis. No relationship between the severity of periodontitis and AR activity was found. Conclusions: Periodontitis is common and severe in patients with RA, and is influenced by gender, age, smoking and corticosteroid dose.

Neumomediastino y necrosis cutánea en asociación a dermatomiositis: presentación de un caso clínico y revisión de la literatura / Pneumomediastinum and cutaneous necrosis in dermatomyositis: Report of one case

We report a 37 years old male with a dermatomyositis treated with oral cyclophosphamide. He was admitted to the hospital due to a zone of skin necrosis with purulent exudate, located in the second left toe. A complete blood count showed a leukocyte count of 2,600 cells/mm³. A Chest CAT scan showed a pneumomediastinum with emphysema of adjacent soft tissue. Cyclophosphamide was discontinued and leukocyte count improved. The affected toe was amputated and a chest CAT scan showed a partial resolution of the pneumomediastinum. We discuss and review the pathogenesis, clinical presentation and management of pneumomediastinum and cutaneous necrosis in association with dermatomyositis.

Listeria monocytogenes: informe de un aumento de casos en mujeres embarazadas y revisión de la literatura / Listeria monocytogenes: report of a rise in pregnant women and literature review

Listeria monocytogenes, rare pathogen in the general population, causes serious infections in patients at the extreme ages of life, pregnant woman, and those with immunosuppression. The clinical manifestations are essential to suspect the disease in patients at risk, allowing an early prescription of antimicrobial therapy, before the results of the cultures are available. Clinical course and prognosis depends on how early treatment is started and, in pregnant women, the gestational age. In Clínica Alemana, at Santiago, we detected a 15 fold rate rise of neonatal listeriosis between year 2007 and 2008. Ten cases were diagnosed between January and July 2008 and the seven cases occurring in pregnant women are reported here. All these patients were in their first pregnancy, which could be associated with similar lifestyle and food habits. Considering this new epidemiological scenario, it is important to educate the population, and to conduct an epidemiological study in order to determine the national situation of Listeria monocytogenes infection.

Listeria monocytogenes, es un patógeno poco frecuente en la población general, causante de infecciones graves en pacientes en edades extremas de la vida, mujeres embarazadas e inmunodeprimidos. La sospecha de la enfermedad en pacientes de riesgo se basa principalmente en el cuadro clínico, lo que permite iniciar un tratamiento empírico antes de contar con los resultados de los cultivos. La evolución y pronóstico dependen de la precocidad con que se inicia la terapia y de la edad gestacional. En Clínica Alemana de Santiago detectamos un aumento de 15 veces en la tasa de listeriosis comparando el año 2007 con el 2008. Entre enero y julio 2008, se diagnosticaron 10 casos, de los cuales siete fueron en primigestas, lo que podría tener relación con un hábito alimentario y características de vida similar. Es fundamental, a la vista de esta nueva realidad epidemiológica, educar a la población en hábitos alimentarios y de higiene, como también realizar un estudio epidemiológico que determine la situación nacional de infección por L. monocytogenes.