Proctitis y enfermedad perianal de causa infecciosa: una mirada más allá de la enfermedad inflamatoria intestinal / Infectious proctitis and perianal disease: a gaze beyond inflammatory bowel disease

Resumen La proctitis infecciosa secundaria a una enfermedad de transmisión sexual ha aumentado en incidencia y deben ser consideradas especial-mente en varones homosexuales o bisexuales con síntomas rectales. Presentamos un paciente con una proctitis y enfermedad perianal por Chlamydia trachomatis que podría haber sido diagnosticado con otra enfermedad ano-rectal como es la enfermedad inflamatoria intestinal, si la historia clínica no hubiese sido considerada. Un alto nivel de sospecha es necesario para evitar un diagnóstico incorrecto, retrasar el tratamiento antimicrobiano y el desarrollo de complicaciones.

Abstract Infectious proctitis by sexually transmitted diseases are increasing in incidence and should be considered in homosexual patients with rectal symptoms. In this case, we show a patient with proctitis and perianal disease caused by Chlamydia trachomatis that could be diagnosed as another anorectal disease such as inflammatory bowel disease if the clinical history is not taken into account. A high level of suspicion is crucial, in order to avoid an incorrect diagnosis, delayed antibiotic therapy and the development of complications.

Secuelas físicas y emocionales en pacientes post hospitalización por COVID-19 / Physical and emotional sequelae after hospitalization for COVID-19

Background: Facing a severe life-threatening disease has physical and emotional consequences for patients. Aim: To evaluate the physical and emotional sequelae in patients who survived COVID-19 pneumonia. Material and Methods: This cross-sectional study collected data from post-COVID-19 pneumonia patients admitted to an outpatient follow-up program in a public hospital in Chile. One month after hospital discharge, the evaluation of physical capacity was carried out through the 1-minute sit-to-stand test (1STST). In addition, the Clinical Frailty Scale (CFS) and the Hospital Anxiety and Depression scale were applied. Results: We included 70 patients aged 63 ± 13 years (54% women). Eighty-five percent of the patients were able to execute the 1STST with an average of 20.6 ± 4.8 repetitions. Forty-eight percent of the patients had a performance below the 2.5th percentile according to the reference values and 28% of patients had exertional desaturation. The CFS classified as mildly vulnerable or with some degree of frailty to 33% of patients. Twenty-five percent of the patients presented symptoms of depression and 33% of anxiety. Conclusions: Patients who survived COVID-19 have a decrease in physical capacity and a significant proportion of depression and anxiety one month after hospital discharge.

Ileostomía en asa derivativa y lavado colónico intraoperatorio como alternativa de tratamiento en un caso de colitis grave por Clostridium difficile / Treatment of a severe Clostridium difficile infection with colonic lavages. Report of one case

A loop ileostomy with intraoperative anterograde colonic lavage has been described as an alternative to colectomy in the management of cases of Clostridium difficile infection refractory to medical treatment. We report a 69 years old diabetic women admitted with a septic shock. An abdominal CAT scan showed a pan-colitis that seemed to be infectious. A polymerase chain reaction was positive for Clostridium Difficile. Due to the failure to improve after full medical treatment, a derivative loop ileostomy and intra-operatory colonic lavage were performed, leaving a Foley catheter in the proximal colon. In the postoperative period, anterograde colonic instillations of Vancomycin flushes through the catheter were performed every 6 hours. Forty eight hours after surgery, the patient improved. A colonoscopy prior to discharge showed resolution of the pseudomembranous colitis.

Miocardiopatía dilatada secundaria a enfermedad celíaca: Caso clínico / Dilated cardiomyopathy in celiac disease: Report of one case

There is an increased incidence of celiac disease in patients with idiopathic dilated cardiomyopathy. We report a 4 7 year-old female presenting with heart failure secondary to dilated cardiomyopathy of unknown etiology. During the five months following the first hospitalization the patient had multiple hospital admissions due to decompensate heart failure. Due to a history of intermittent diarrhea and weight loss, a celiac disease was suspected. Antiendomysial antibodies were positive and there was a villous atrophy in duodenal mucosa. A gluten free diet was started with a concomitant recovery of her functional capacity. After one month of gluten free diet a new echocardiogram showed a normal left ventricle and systolic function.