Guía clínica GES de artritis idiopática juvenil 2014 / 2014 GES clinical guideline of juvenile idiopathic arthritis

La artritis idiopática juvenil (AIJ) ha sido definida por la Liga Internacional de Asociaciones de Reumatología (ILAR) como artritis de etiología desconocida que se inicia antes de los 16 años y dura por al menos seis semanas, habiendo excluido otras condiciones conocidas. La AIJ es una enfermedad cubierta por el sistema de Garantías Explícitas en Salud (GES) del Ministerio de Salud de Chile desde 2010. La presente guía, desarrollada por el Grupo Pediátrico de la Sociedad Chilena de Reumatología, consiste en una actualización de la Guía Clínica de AIJ 2010, incorporando nuevos protocolos terapéuticos y medicamentos que han demostrado un claro beneficio para niños con AIJ...

Juvenile idiopathic arthritis (JIA) has been defined by the International League of Associations for Rheumatology as arthritis of unknown etiology that begins before the sixteenth birthday and persists for at least 6 weeks with other known conditions excluded. JIA is a disease that is covered by the Explicit Health Guarantees system of the Chilean Ministry of Health since 2010. The present guideline developed by the Pediatric Group of the Chilean Rheumatology Society is an update of the 2010 JIA Clinical Guideline incorporating new treatment protocols and medications that have demonstrated clear benefits in children with JIA...

Linfoma de Hodgkin con compromiso hepático tratado con esquema gemcitabina, dexametasona y cisplatino como puente para terapia estándar: Caso clínico / Hodgkin lymphoma with hepatic involvement treated with dexametasone, gemcitabine and cisplatin as a bridge to standard therapy: Report of one case

Background: The initial presentation of Hodgkin lymphoma with liver involvement is rare. In these patients, the standard first-line therapy with ABVD (Adriamycin, Bleomycine, Vinblastine, Dacarbazine) imply an additional risk for liver toxicity. We report a 64-year-old woman who presented with jaundice, choluria, malaise and weight loss. In the initial evaluation she had jaundice and palpable groin lymph nodes. An obstructive biliary disease was ruled out with magnetic resonance imaging studies. A lymph node biopsy showed a Hodgkins lymphoma, Mixed-cellularity subtype. Considering the liver dysfunction, an alternative scheme of chemotherapy with dexamethasone, gemcitabine and cisplatin (GDP) was administered. After 4 cycles, a significant improvement in liver hepatic function tests was reached and a conventional chemotherapy (ABVD) was begun. While the literature provides some low toxicity protocols for patients with liver involvement, favorable results of our clinical case report allows us to postulate GDP as an alternative for salvage therapy in these patients.

Guía para definición y manejo del dolor neuropático localizado (DNL): consenso chileno / Guidelines for definition and management of localized neuropathic pain (LNP): Chilean consensus

En los últimos años, diversas Guías para el Manejo del Dolor Neuropático (DN) se han elaborado por grupos de expertos en Dolor. La Asociación Chilena para el Estudio del Dolor (ACHED), representada por diversos especialistas, se reunió los días 5 y6 de agosto para elaborar la “Guía para Definición y Manejo del Dolor Neuropático Localizado (DNL): Consenso Chileno”.Utilizando el Método Delphi, se establecieron consensos con respecto a la entidad Dolor Neuropático Localizado (DNL), tanto en su Definición, Diagnóstico, Manejo Farmacológico y No Farmacológico, constituyendo de este modo, cuatro (4) grupos de trabajo; se establecieron asimismo comisiones para Dolor Pediátrico y Procedimientos Intervencionistas. Los principales resultados permiten contar con una definición clara de DNL, innovaciones en su diagnóstico, algoritmos sencillos para su manejo y recomendaciones no farmacológicas de importancia. Esta Guía para la Definición, Diagnóstico y Manejo del DNL será una herramienta de mucha utilidad en la práctica clínica, especialmente para los médicos generales y para la conformación de equipos multidisciplinarios para la mejor atención de los pacientes de DNL. El Consenso, luego de revisar evidencias y por la experiencia clínica de los expertos, recomiendan las terapias tópicas como las más indicadas en tratamiento del DNL.

In recent years, several Guidelines for the Management of Neuropathic Pain (NP) have been developed by groups that specialize in pain. The Chilean Association for the Study of Pain (ACHED), represented by different specialists, met on the5th and 6th of August to develop the Guidelines for Definition and Management of Localized Neuropathic Pain (LNP): Chilean Consensus”. Using the Delphi method, a series of consensus have been established regarding the Localized Neuropathic Pain (LNP) entity, both in its definition, diagnosis, pharmacological and non pharmacological management, thus constituting four (4) workgroups; committees were also established for pediatric pain and interventional procedures. The main results allow us to have a clear definition of LPN, innovations in its diagnosis, simple algorithms for its management and important non-pharmacological recommendations. The Guidelines for Definition and Management of the LNP will be a very useful tool in clinical practice, especially for general practitioners and for the formation of multidisciplinary teams to improve healthcare for LNP patients. The Consensus, after reviewing evidence and clinical experience, recommends topical therapies as the most appropriate treatment in LPN.