Infecciones en pacientes con lupus eritematoso sistémico / Infections in patients with systemic lupus erythematosus

Despite the availability of newer therapeutic interventions to improve clinical outcome in patients with Systemic Lupus Erythematosus (SLE), the incidence of infections as a cause of morbidity and mortality has not changed over the past 30 years. SLE itself increases the risk of infection, due to genetic (complement deficiencies) and acquired factors such as functional asplenia (humoral immunodepression) and the use of immunosuppressive drugs. These medications increase the risk of opportunistic infections that are associated with an altered cellular immune response. The main etiologic infectious agents in SLE patients are common bacterial pathogens, especially capsulated ones. The most common sites are lung, skin, bladder, brain and systemic infections. The main risk factor for infection is the history of a previous one. The clinical approach to SLE patients with suspected infectious diseases must consider the possibility of a flare up of the underlying disease, posing an additional problem to the clinician.

Probióticos en diarrea aguda infecciosa / Probiotics in acute infectious diarrhea

Background: Acute infectious diarrhea in children represents a worldwide problem and it relates to desnutrition, morbility and death. Objective: Determine the usefulness of probiotics in the treatment of acute infectious diarrhea in children by reviewing the scientific information available in the form of meta-analysis. Methods: A detailed search was performed in electronic databases. Four of the articles found met inclusion criteria. Results: The four meta-analysis studied demonstrated that the administration of probiotics in children with acute infectious diarrhea decreased the episode duration in approximately one day with minimal adverse events. Conclusions: Despite methodological limitations of the analysed articles, the studies showed the same trend towards observing a benefit in the use of probiotics in acute infectious diarrhea in children. The latter supports the consistency of this association. In general, the use of probiotics in children with acute infectious diarrhea would be useful in general practice reducing diarrhea duration in approximately one day.

Antecedentes: La diarrea aguda infecciosa en niños constituye un problema a nivel mundial y se traduce en desnutrición, morbilidad y muerte. Objetivos: Determinar la utilidad de los probióticos en el tratamiento de la diarrea aguda infecciosa en los niños mediante la revisión de la información científica disponible en forma de meta-análisis. Material y Métodos: Se realizó una búsqueda detallada en bases de datos electrónicas de uso frecuente. Cuatro de los artículos encontrados cumplían con los criterios de inclusión. Resultados: Los cuatro meta-análisis revisados evidenciaron que la administración de probióticos en niños con diarrea aguda infecciosa disminuía la duración del cuadro en aproximadamente un día con mínimos efectos adversos. Conclusiones: A pesar de las limitaciones metodológicas de los trabajos analizados, la mayoría de los estudios presentan una misma tendencia al observar beneficio en el uso de los probióticos en diarrea aguda infecciosa en niños. Lo anterior le otorga mayor consistencia a la asociación. En general, el uso de probióticos en niños con diarrea aguda infecciosa sería útil en la práctica clínica diaria, disminuyendo la duración de la diarrea en aproximadamente un día.

Caracterización del tricograma en pacientes chilenos / Characterization of trichogram in Chilean patients

Introducción: El tricograma consiste en extraer pelos del cuero cabelludo que luego son examinados mediante un microscopio para determinar qué porcentaje de éstos se encuentra en telógeno, anágeno o catágeno. Objetivos: Caracterizar el tricograma en pacientes chilenos y determinar las diferencias existentes entre los porcentajes de anágeno y telógeno entre cuero cabelludo normal y la zona de menor densidad. Material y Métodos: Estudio observacional descriptivo y retrospectivo de análisis de tricogramas diferenciales de cuero cabelludo. Resultados: Las diferencias del porcentaje de anágeno y telógeno entre cuero cabelludo normal y la zona de menor densidad fueron estadísticamente significativas.

Introduction: Trichogram consists in removing hair follicles from the scalp and examining them under a microscope to determine the percentage of them that are in telogen, anagen or catagen. Aim: To characterize trichogram in chilean patients and determine the differences in anagen and telogen percentages between normal scalp and a lower density zone. Material and Methods: Observational, descriptive and retrospective study of the analysis of differential trichograms of the scalp. Results: The differences in anagen and telogen percentages between normal scalp and the lower density zone were statistically significant.Key words: Trichogram, anagen, telogen.

¿Son útiles los anticonceptivos orales en el tratamiento de los quistes ováricos funcionales? / Usefulness of oral contraceptives in the treatment of functional ovarian cysts

Objetivos: Determinar si los preparados de estrógenos y progestágenos orales, usados ampliamente en la práctica clínica, son realmente útiles en el manejo de quistes ováricos con características de benignidad en la ecografía transvaginal. Método: Se realizó una búsqueda detallada en bases de datos electrónicas de uso frecuente. Dos de los artículos encontrados cumplían con los criterios de inclusión. Resultados: Mackenna y cois trabajaron con un total de 50 mujeres con quistes funcionales inducidos farmacológicamente. Dividieron en forma aleatoria a las pacientes en dos grupos. Uno de ellos recibió anticonceptivos orales y el otro no. No se encontraron diferencias significativas en el tiempo de desaparición de las lesiones a la ecografía entre ambos grupos. Bayar y cois, siguieron a 141 mujeres en edad fértil que presentaban quistes simples en la ecografía. Conformaron dos grupos. El primero se manejó con anticonceptivos orales y el segundo de manera expectante. En ese estudio no se encontraron diferencias significativas en la reducción del tamaño de los quistes en el tiempo al comparar ambos grupos. Conclusiones: Sería adecuado que el médico al enfrentarse a mujeres premenopáusicas con quistes simples, considerase inicialmente el manejo conservador por al menos dos meses y luego evaluase la persistencia o desaparición de éstos con estudio de imágenes.

Objective: To establish if oral contraceptives composed by estrogens and progestogens are useful in the management of ovarian cysts that appear benign in transvaginal ultrasound. Method: A detailed search was performed in electronic data bases. Two of the articles found met the inclusion criteria. Results: Mackenna and cols, worked with fifty women with functional ovarian cysts pharmacologically induced. They divided their patients randomly in two groups. One of them received oral contraceptives and the other did not. There were no significant differences between the groups in the time of disappearance of the lesions in ultrasound. Bayar and cols, studied 141 fertile women with simple ovarian cysts in ultrasound. One group received oral contraceptives and the other did not. In this study there were no significant differences between groups in the reduction of the size of the cysts over time. Conclusions: In premenopausic women with simple ovarian cysts it would be adequate to considerate expectant management initially for at least two months.

Granulomatosis sarcoidea necrosante con compromiso sistémico / Necrotizing sarcoid granulomatosis with systemic involvement

A 70-year-old mapuche female presented with a 1 year history of weight loss, bilateral red painful eyes and corneal ulcer that evolved into perforation and uveal herniation with complete visual loss. Reddish and painful nodules appeared on the distal aspect of both lower extremities, that ulcerated after months. A thoracic CT scan showed multiple pulmonary nodules. Infectious diseases were ruled out. An open lung biopsy and a skin biopsy were performed and both showed non-caseating necrotizing granulomas and granulomatous arteritis. Steroids and cyclophosphamide were started with complete regression of skin and pulmonary lesions within a month. Corneal transplantation was done. After 6 months follow-up, the patient is on low-dose of steroids, free of disease with partial vision recovery.

Mujer mapuche de 70 años quien en el curso de 1 año presentó baja de peso, ojo rojo bilateral y úlcera corneal que evolucionó hacia la perforación con herniación uveal y pérdida de la visión. Posteriormente se agregaron lesiones nodulares, violáceas, sensibles, algunas ulceradas en las zonas distales de ambas extremidades inferiores. La TAC de tórax demostró múltiples nódulos pulmonares. Tras un estudio exhaustivo se descartaron la tuberculosis y otras infecciones. Tanto la biopsia de las lesiones cutáneas como la biopsia pulmonar obtenida mediante toracotomía confirmaron la presencia de granulomas necrotizantes no caseificantes y arteritis granulomatosa. Se trató con esteroides y ciclofosfamida con mejoría de su condición general y regresión de las lesiones cutáneas y pulmonares en menos de 1 mes. Se realizó un trasplante de cornea. A los seis meses de seguimiento continúa en tratamiento, no ha presentado recaídas y tiene recuperación parcial de la visión.

Enfermedades pulmonares en pacientes infectados con VIH hospitalizados en el Instituto Nacional del Tórax / Lung diseases among HIV infected patients admitted to the \"Instituto Nacional del Torax\" in Santiago, Chile

Background: Pulmonary diseases are common among HIV infected patients. The prevalence of the different diseases varies greatly. Aim: To identify the different pulmonary diseases that affect a Chilean population of HIV infected patients and to identify factors associated with in hospital mortality. Material and methods: Retrospective review of the clinical records of all HIV infected patients with lung diseases discharged from our institution during a period of 3.5 years. Collection of demographic and biomedical data. Results: One hundred seventy one patients (aged 35.7 years, 86% men) had 236 episodes of lung diseases. Only 13.5% of the patients were receiving antiretroviral therapy and 18% were on pneumocystis prophylaxis. Infectious diseases accounted for 87% of the discharges, neoplasm for 5.1%. Pneumocystis jirovecii infection was responsible for 37.7% of the episodes, community acquired pneumonia was seen in 24.1% and mycobacterial diseases in 14.4%. Two or more conditions were present in 13.6%. Death during hospital stay occurred in 19.5%. Multivariate analysis identified pneumothorax as the only significant independent predictor of in-hospital mortality in patients with pneumocystis pneumonia, while nosocomial pneumonia was the only predictor of death among patients with non-pneumocystis pulmonary diseases. Conclusions: Infectious diseases were the main cause of hospitalization among Chilean HIV infected patients. Mortality among these patients remains high. Appropriate antiretroviral therapy and prophylaxis may alter pulmonary disease prevalence in the future. Every effort should be made to avoid the development of pneumothorax and nosocomial pneumonia.