Hiperferritinemia: Experiencia de un Centro Universitario en Chile / Hyperferritinemia in a Chilean Academic Healthcare Network: A Retrospective Study

INTRODUCTION: The distribution of causes of hyperferritinemia in international series is heterogeneous. Also, the association between ferritin and prognosis is controversial. This study aims to describe the diagnosis associated with hyperferritinemia in a retrospective cohort at an academic healthcare network in Chile. METHODS: A retrospective review of adult patients admitted to our academic medical center from June 2014 to February 2017 with ferritin ≥3,000 ng/mL. All patients were classified into nine diagnostic categories. Then, the association between ferritin level and disease category, as well as mortality, was evaluated. RESULTS: Ninety-nine patients were identified. The mean age was 50.8 ± 19.9 years, 54.5% were men. The most frequent categories were "inflammatory and autoimmune diseases" (21.2%) and "hematological malignancies" (19.2%). The average ferritin was 10,539 ± 13,016.9 ng/mL, while the higher mean was 16,707 ng/mL in the "inflammatory and autoimmune diseases" category. There was a statistically significant association between the ferritin value and age but not between ferritin and diagnostic categories. In the group over 50, hematologic neoplasms (19%) and infections (19%) were more frequent. In those under 50, inflammatory and autoimmune diseases were more frequent (26.8%). There was no association between the ferritin level and mortality at 1, 3, and 12 months. CONCLUSIONS: The most frequent categories were "inflammatory and autoimmune diseases" and "hematological malignancies", but ferritin level was similar in both. Further research could validate a prognostic role.

Linfoma tiroideo en paciente con tiroiditis de Hashimoto / Thyroid lymphoma in patient with Hashimoto´s thyroiditis

INTRODUCCIÓN: El linfoma tiroideo (LT) es una neoplasia infrecuente(menos del 1 por ciento de linfomas y menos del 2 por ciento de neoplasias tiroideas). Su incidencia es mayoritaria en mujeres, entre 60 y 75 años. La tiroiditis de Hashimoto es un importante factor de riesgo. El objetivo es destacar la importancia del estudio precoz del bocio rápidamente progresivo. PRESENTACIÓN DEL CASO: Hombre de 63 años, con antecedentes de hipertensión arterial, tabaquismo crónico activo e hipotiroidismo por tiroiditis de Hashimoto sin tratamiento, consultó por aumento de volumen cervical anterior progresivo, asociado a disfonía, disfagia y disnea, de tres meses de evolución. Ecografía cervical evidenció bocio multinodular difuso de predominio izquierdo. Se decidió intentar tiroidectomía total, constatándose gran tumor duro, extendido a nivel infraparatiroideo, con adherencia marcada a laringe, tráquea, vasos y tejido muscular, que no se pudo extirpar completamente. Biopsia compatible con Linfoma no Hodgkin difuso de células grandes B, tipo centro germinal. Se decidió traslado a centro de referencia para manejo por especialista. DISCUSIÓN: El LT se presenta clínicamente de forma similar a otras neoplasias tiroideas con bocio rápidamente progresivo y sintomatología compresiva. Es importante considerar su asociación con tiroiditis de Hashimoto, pese a que es improbable que ésta evolucione a linfoma (0,1 por ciento), se encuentra en la mayoría de los casos de LT (80 a 90 por ciento); ambas patologías son infrecuentes en hombres.

INTRODUCTION: Thyroid lymphoma (LT) is a rare neoplasm; it represents less than 1 percent of lymphomas and less than 2 percent of thyroid neoplasms. It occurs mainly in women between 60 and 75 years. Hashimoto's thyroiditis is an important risk factor. The aim is to illustrate the importance of early study of rapidly enlarging goiter. CASE REPORT: A 63-year-old male with a history of arterial hypertension, chronic active smoking and untreated hypothyroidism secondary to Hashimoto's thyroiditis, consulted by progressive cervical volume increase, associated with dysphonia, dysphagia and dyspnea, with three months of duration. Cervical ultrasound showed diffuse multinodular goiter with left predominance. It was decided to try a total thyroidectomy, which confirmed a large and indurated tumor, spread to infra-parathyroid level, with strong adherence to larynx, trachea, blood vessels and muscle tissue, which could not be completely removed. Biopsy was compatible with diffuse large B-cell lymphoma, germinal center type. It was decided to transfer the patient to a referral center for handling by a specialist. DISCUSSION: Thyroid Lymphoma presents clinical similarities to other thyroid malignancies with rapidly enlarging goiter and compression symptoms such as dysphagia, dyspnea, stridor, dysphonia, headache, facial and upper extremities edema; in case of suspicion a biopsy is required. The association with Hashimoto's thyroiditis is very important, although it is unlikely to evolve lymphoma (0.1 percent), is present in most cases of LT (80 to 90 percent). Both conditions are rare in men. Surgical treatment is usually associated with chemotherapy with or without local radiotherapy.

Alteraciones posturales en niños escolares de la Ciudad de Talca de distinto nivel socioeconómico / Postural alterations in scholastic children of the City of Talca of different socioeconomic level

Introducción: Conocer la prevalencia de alteraciones posturales en escolares de distinto nivel socioeconómico permite detectar, oportunamente, anomalías posturales.Método: Se realizó un examen postural estático a dos grupos de escolares de Talca, de 10 a 12 años de edad. Un grupo formado por 75 escolares de nivel socioeconómico medio-alto y el otro por 80 escolares de nivel socioeconómico medio-bajo. Se calculó el porcentaje de niños con y sin alteraciones, estableciendo luego las diferencias entre los grupos para alteraciones a nivel segmentario, utilizando la prueba de diferencia de proporciones (p 0.05).Resultados: En el grupo de nivel socioeconómico medio-bajo existe mayor porcentaje de escolares que presentan alteraciones posturales; obteniendo diferencias significativas en la presencia de pie plano, genu valgo, escoliosis y actitudes escolióticas, lordótica y cifótica.Conclusiones: Los escolares de nivel socioeconómico medio-bajo presentan, con mayor frecuencia, alteraciones en la postura.

Otomicosis. / Otomycosis

Se presentan 44 casos de otomicosis en Valdivia, Chile. Se destaca el facil diagnostico otologico como micologico en que el examen microscopico directo es por lo general diagnostico de genero. Se describe la aparencia de los tipos de muestras. No se observa distribucion por edad ni sexo.De los pacientes tratados, la mayoria lo fue con Clotrimazol. obteniendose exito en todos los casos

Otomicosis en el sur de Chile. / Otomycosis in the Southern Chile

Se estudian 11 casos de otomicosis producidas fundamentalmente por especies del genero Aspergillus y uno por Monosporium apiospermum. Se analizan los aspectos clinicos y micologicos de esta micosis. Los pacientes fueron tratados con clotrimazol y miconazol respectivamente