Enfermedad relacionada a IgG4. Serie clínica de pacientes chilenos / IGG4-related disease. Report of 52 patients

BACKGROUND: IgG4-related disease (IgG4 RD) is an immune-mediated fibro-inflammatory disorder, with tissue infiltration of IgG4+ plasma cells. It causes pseudotumors, tumors, and a wide spectrum of clinical manifestations. AIM: To report the clinical, laboratory, histopathological and treatment characteristics of a group of Chilean patients with IgG4 RD. MATERIAL AND METHODS: Review of medical records of 52 patients aged 18 to 76 years with IgG4 RD seen at six medical centers. RESULTS: Elevated IgG4 serum levels (> 135 mg/dl) were found in 18 of 44 (41%) patients. There was histological confirmation of the disease in 46 patients. The most common sites of involvement were lungs, eyes and kidneys. Eighteen (35%) patients had only one organ involved, 34 (65%) patients had two organs and 13 (25%) patients had three or more organs. The involvement of two organs was significantly more common in men (p < 0.05). In patients with only one organ involvement, the most frequent location was orbital and meningeal. All patients with kidney or lung disease had multiorgan involvement. All patients received corticosteroid therapy, 67% synthetic immunosuppressants, and 16% rituximab. CONCLUSIONS: ER-IgG4 can affect any tissue. Multiorgan involvement was more common in this series, with preference for lungs, eyes and kidneys. An excellent response to steroids is characteristic of the disease, but with a high relapse rate that requires additional immunosuppression.

Incidencia de complicaciones post quirúrgicas en cirugía bucal / Incidence of post-surgical complications in oral surgery

OBJETIVO: El objetivo principal de este estudio fue determinar la incidencia de complicaciones post cirugía bucal. METODOLOGÍA: Se desarrolló un estudio observacional, descriptivo, con el uso del registro prospectivo de la totalidad de pacientes ingresados para cirugía bucal del Complejo Hospitalario San Borja-Arriarán durante doce meses de observación (abril 2017 a marzo 2018). RESULTADOS: La muestra estuvo conformada por 532 pacientes sometidos a procedimientos quirúrgicos de cirugía bucal y 29 casos de complicación postquirúrgica. La incidencia de complicaciones alcanzó un 5,5% y se observó de manera predominante en intervenciones de tipo exodoncia. La complicación mayormente observada fue la alveolitis alcanzando un 2,5% de las cirugías de terceros molares y un 3,7% de las exodoncias de otros dientes. Las hemorragias postoperatorias se observaron en un 1,1% de las cirugías de terceros molares. Otras complicaciones postquirúrgicas fueron abscesos de espacios faciales, parestesia del nervio alveolar inferior, hematomas, equimosis y periostitis. CONCLUSIÓN: Los resultados fueron similares a los reportados en la literatura tanto en su frecuencia como en el tipo de complicación.

OBJECTIVE: The main objective of this investigation was to determine the incidence of postoperative complications in oral surgery. MATERIALS AND METHODS: An observational and descriptive study was developed with the use of the prospective registry of the patients admitted for oral surgery in the San Borja Arriarán Hospital Complex for a twelve-month period of observation (April 2017 to March 2018). RESULTS: The sample consisted of 532 patients undergoing surgical procedures of oral surgery and 29 cases of postoperative complications. The incidence of complications reached 5,5% and it was observed predominantly in interventions of tooth extraction. The most commonly observed complication was dry socket, reaching 2,5% of third molar surgeries and 3,7% of extractions of other teeth. Postoperative hemorrhages were observed in 1,1% of third molar surgeries. Other postoperative complications were facial spaces abscesses, paresthesia of the inferior alveolar nerve, bruising, ecchymosis and periostitis. CONCLUSIONS: The results were similar to those reported in the literature both in their frequency and in the type of complication.

Hemoptisis como manifestación inicial de la enfermedad de Behçet: casos clínicos / Hemoptysis as the initial manifestation of Behçet's disease: report of two cases

Arterial involvement in Behçet's disease (BD) is less common than venous lesions. The most commonly affected arteries are: the aorta, lower extremity arteries, mesenteric, femoral, coronary, renal, subclavian and pulmonary arteries. The rupture of pulmonary arteries is the main cause of death of patients with EB and the presence of aneurysms is a bad prognostic factor. We report two patients with arterial involvement in BD. A 14 years old male presenting with hemoptysis lasting three days. A chest computed tomography showed an aneurismal dilatation of the right interlobar artery, bilateral intramural thrombi and alveolar hemorrhage. A right lobar pulmonary resection was performed but hemoptysis recurred. Suspecting a BD, prednisone was started and hemoptysis subsided. A 42 years old male presenting with chest pain and hemoptysis. A chest CT scan showed thrombi in pulmonary veins and anticoagulant therapy was started. Two months later he was admitted again due to a massive hemoptysis. The CT scan showed aneurisms in pulmonary arteries, mural thrombi and pulmonary infarction. With the diagnosis of BD, methylprednisolone, followed by prednisone and cyclophosphamide were used, with a good clinical response.

Prevalence of oral lesions and chronic non-communicable diseases in a sample of chilean institutionalized versus non-institutionalized elderly

Chile is experiencing a process of demographic aging with an increase in the number of elderly people, a percentage of which resides in long-term establishments for the elderly (LEE). however, there is little information on the reality of the elderly in these long-term care facilities, so this study was conducted to compare the epidemiological profile of the prevalent oral pathologies as well as chronic non-communicable diseases (NCDs), of institutionalized versus non-institutionalized elderly subjects. seventy-six institutionalized and forty-three non-institutionalized subjects were examined intraorally, and their clinical health record, gender and age were obtained, according to inclusion/exclusion criteria. the results indicate that female gender is the most common, with an average age of 78.5 year, with those 80 years old and above comprising the predominant group. the most prevalent oral lesions within the institutionalized group were denture stomatitis and irritative hyperplasia, while in the non-institutionalized these two lesions were found less frequently. as for the presence of xerostomia, there was no difference between the groups. the most common condition in both groups was total maxillary and mandibular edentulous, with the latter variable present more frequently in the institutionalized group (p<0.05). the predominant NCD for both groups were arterial hypertension, arthritis-osteoarthritis and diabetes mellitus (p>0.05), and depression was the most prevalent NCD in the non-institutionalized group (p<0.05). this study provides valuable information on the epidemiology of elderly´s oral lesions and NCDs to inform the decision-making process of public health policies.

Prótesis y ortodoncia: rehabilitación de fisurado bilateral: caso clínico / Prosthesis and orthodontics: bilateral fissure repair: a clinical case

RESUMEN: El paciente fisurado labiopalatino muestra una falta de fusión de los procesos palatinos presentando una comunicación de la cavidad buconasal, anomalías de forma y/o la agenesia de los dientes cercanos a la fisura y un deficiente crecimiento sagital y transversal maxilar, esto es más complejo en la fisura bilateral, por ser el más severo de los subtipos de fisura. Se dificultan las funciones básicas como comer, hablar y relacionarse con los demás. Su tratamiento requiere del trabajo de un equipo transdisciplinario, coordinado y organizado, conformado por todos aquellos profesionales que colaboren en proporcionar un resultado integral. El objetivo de este artículo es exponer un caso clínico de rehabilitación protésica en conjunto con un tratamiento de ortodoncia en un paciente que presenta labio leporino bilateral y fisura palatina, además de una premaxila móvil, severamente extruida.

ABSTRACT: The cleft lip and palate patient is mainly characterised by the presence of an oronasal communication, malformation or agenesis of the teeth close to the cleft, and deficient sagittal and transverse growth of the maxilla. These patients require various treatments involving a multidisciplinary team, which may include a maxillofacial surgeon, an orthodontist, a speech therapist, a paediatrician, plastic surgeon, a general dentist, a prosthodontist, an ENT specialist, a psychologist, and all those professionals who can help provide functional, aesthetic and psychological improvement. This report describes a case of prosthetic rehabilitation in a patient with cleft lip and palate without alveolar bone in the cleft area, which prevented rehabilitation with an osseointegrated implant, in addition to a mobile and severely extruded pre-maxilla, which required an orthopaedic repositioning.

Determinación de anticuerpos totales (IgG/IgM) y específicos (IgM) para el virus de la hepatitis E y detección molecular del virus en heces de humanos con o sin exposición ocupacional a porcinos en 10 municipios de Antioquia / Determination of total (IgG/IgM) and specific (IgM) antibodies to Hepatitis E Virus and molecular detection of the virus in feces of humans with or without occupational exposure to pigs in 10 municipalities of Antioquia, Colombia / Determinação de anticorpos totais (IgG/IgM) e específicos (IgM) para o vírus da hepatite E e detecção molecular do vírus em fezes de humanos com ou sem exposição ocupacional a porcinos em 10 municípios de Antioquia

En 10 municipios de Antioquia se determinó la seropositividad para anticuerpos totales (IgG/ IgM) y específicos (IgM) para el virus de la hepatitis E (VHE), y se buscó identificar el RNA del virus en heces de personas positivas para IgM. Se evaluaron dos grupos: uno de individuos expuestos a cerdos y otro sin dicha exposición, este último dividido en dos subgrupos (convivientes de expuestos y población general). La frecuencia de anticuerpos totales en los expuestos fue del 15,7% y la de IgM, del 2,5% (p < 0,001). En el grupo sin exposición ocupacional pero convivientes de expuestos, los anticuerpos totales se hallaron en el 5,9% y no se detectó IgM. En el subgrupo de población general la seropositividad fue del 7,2% para IgG/IgM y del 0,81% para IgM (p < 0,001). En ninguna de las muestras de heces de individuos positivos para IgM se halló el RNA del VHE. Los resultados muestran que los individuos expuestos ocupacionalmente a cerdos tienen mayor riesgo (RP: 2,42) de presentar anticuerpos anti-VHE que aquellos sin dicha exposición (CI95%: 1,66-3,53) (p < 0,001). También indican que en Antioquia el VHE circula en personas con y sin exposición a cerdos. Se requieren más estudios sobre el VHE en Colombia.

Em 10 municípios de Antioquia se determinou a seropositividade para anticorpos totais (IgG/IgM) e específicos (IgM) para o vírus da hepatite E (VHE), e se procurou identificar o RNA do vírus em fezes de pessoas positivas para IgM. Avaliaram-se dois grupos: um de indivíduos expostos a porcos e outro sem dita exposição, este último dividido em dois subgrupos (conviventes de expostos e população geral). A frequência de anticorpos totais nos expostos foi de 15,7% e a de IgM, do 2,5% (p < 0,001). No grupo sem exposição ocupacional, mas conviventes de expostos, os anticorpos totais se acharam em 5,9% e não se detectou IgM. No subgrupo de população geral a seropositividade foi de 7,2% para IgG/IgM e de 0,81% para IgM (p < 0,001). Em nenhuma das mostras de fezes de indivíduos positivos para IgM se achou o RNA do VHE. Os resultados mostram que os indivíduos expostos ocupacionalmente a porcos têm maior risco (RP: 2,42) de apresentar anticorpos anti-VHE que aqueles sem dita exposição (CI95%: 1,66-3,53) (p < 0,001). Também indicam que em Antioquia o VHE circula em pessoas com e sem exposição a porcos. Requerem-se mais estudos sobre o VHE na Colômbia.

Enfermedad por depósito de cristales de pirofosfato de calcio como ejemplo de forma de manifestación de la enfermedad en el adulto mayor / Calcium pyrophosphate dihydrate crystal deposition disease as an example of illness presentation in the elderly

Illness presentation in the elderly may be entirely non-specific, with fatigue, loss of function or the presence of geriatric syndromes. We report a 90 years old male consulting in the emergency room for delirium that persisted throughout hospitalization without finding a cause. During the course of hospitalization mild fever appeared and a left knee swelling became apparent. A synovial fluid aspiration showed a leukocyte count of 360 per field with 60% polymorphonuclear cells. The culture was negative. With a presumptive diagnosis of pseudogout, cochicine and celecoxib were started with remission of the confusional state. The patient was discharged 13 days after admission in good conditions.

Serological and molecular detection of Hepatitis E virus in pig farms of Antioquia / Detección serológica y molecular del virus de la Hepatitis E en cerdos de granjas antioqueñas / Detecção serológica e molecular do vírus da hepatite E em suínos no departamento de Antioquia, Colômbia

Hepatitis E virus (HEV) is the viral agent that produces most cases of acute hepatitis worldwide. Four genotypes and 24 subtypes of HEV have been identified. Presence of viral strains in pigs suggests this species is a reservoir for HEV. A case of Hepatitis E in humans has been reported in Antioquia, the largest pig producer and pork consumer province in Colombia. This study investigated the presence of HEV in pigs from several swine farms in Antioquia by looking for anti-HEV antibodies and viral RNA in pig feces. Serological tests were performed for detecting IgG and IgM anti-HEV. Molecular assays (RT-PCR) were also used for detecting the ORF-1 marker of HEV viral genome. These procedures were performed on 210 animals from 30 pig farms. Presence of antibodies and molecular analysis were organized by frequencies and analyzed using the R software (version 2.15.2). 100% of the samples were positive for IgG antibodies, while 57% of the samples were positive for IgM antibodies. According to the molecular analysis, 26% of pig feces had genetic material from HEV. This study demonstrates exposure and circulation of HEV in pig farms of Antioquia.

La Hepatitis E es una enfermedad producida por el Virus de Hepatitis E (HEV), considerado el agente vírico con mayor producción de hepatitis agudas alrededor del mundo. Se han determinado 4 genotipos y 24 subtipos de HEV. La presencia de cepas virales tanto en humanos como en otras especies, ha sugerido que existen reservorios animales para HEV, entre los cuales el cerdo juega un papel importante. En Antioquia se ha reportado un caso de Hepatitis E en humanos. Teniendo en cuenta que este departamento es el principal productor y consumidor de cerdos en Colombia, se investigó la presencia de este virus en los cerdos de diferentes granjas porcícolas, con el fin de determinar anticuerpos anti-HEV y RNA viral en heces porcinas. Para lograr esto, se realizaron pruebas serológicas para la detección de anticuerpos IgG e IgM anti-HEV, y pruebas moleculares (RT-PCR) para la detección del marcador ORF-1 del genoma viral de HEV. Estos procedimientos se realizaron en 210 animales de 30 granjas porcícolas de Antioquia. La presencia de anticuerpos y análisis moleculares en los cerdos, se determinaron por frecuencias y se analizaron mediante el software R versión 2.15.2. El 100% de las muestras fueron positivas para anticuerpos IgG; mientras que para anticuerpos IgM, los positivos representaron el 57% de las muestras evaluadas. El análisis molecular determinó que el 26% de los cerdos presentó material genético de HEV en sus heces. Esta información demuestra la exposición y la circulación de HEV en cerdos de las granjas evaluadas en municipios de Antioquia.

A hepatite E é uma doença produzida pelo vírus da hepatite E (HEV), considerado o agente virulento com maior produção de hepatites agudas ao redor do mundo. Tem se determinado quatro genótipos e 24 subtipos de HEV. A presença de cepas virais tanto em humanos quanto em outras espécies, tem sugerido que existem reservatórios animais para HEV, entre os quais o suíno tem grande importância. Em Antioquia tem se reportado um caso de hepatite E em humanos. Tendo de presente que este departamento é o principal produtor e consumidor de suínos na Colômbia, pesquisou-se a presença deste vírus em suínos de diferentes granjas suínas, com o fim de determinar anticorpos anti-HEV e RNA viral em fezes porcinas. Para lograr isto, realizaram-se testes serológicos para a detecção de anticorpos IgG e IgM anti-HEV e testes moleculares (RT-PCR) para a detecção do marcador ORF-1 do genoma viral de HEV. Estes procedimentos realizaram-se em 210 animais de 30 granjas suínas em Antioquia. A presença de anticorpos e as análises moleculares nos suínos, determinaram-se por frequências e se analisaram mediante o software R Versão 2.15.2. O 100% das amostras foram positivas para anticorpos IgG; enquanto que para anticorpos IgM os positivos representaram o 57% das amostras avaliadas. O analise molecular determinou que o 26% dos suínos apresentou material genético de HEV em suas fezes. Esta informação demonstra a exposição e circulação de HEV em suínos das granjas avaliadas em municípios de Antioquia, Colômbia.

¿Han ocurrido cambios biodemográficos en los pacientes fallecidos en un serviciode medicina interna en la última decada? / Biodemographic changes have ocurred in patients who died in an internal medicine unit in the last decade

En las últimas décadas, las expectativas de vida en la población chilena han aumentado en forma significativa, incrementando el número de personas con múltiples patologías crónicas, las que se hospitalizan en forma recurrente por el agravamiento de las mismas o por la aparición de patologías agudas que las descompensan. Objetivos: el objetivo primario de este trabajo fue conocer, si en los últimos años se ha producido en los pacientes hospitalizados en un Servicio de Medicina Interna (SMI) un aumento en la edad al momento de fallecer. Los objetivos secundarios fueron conocer si han existido en estos pacientes cambios en la prevalencia de enfermedades crónicas no transmisibles (ECNT) y en los motivos de ingreso al hospital. Material y Métodos: estudio retrospectivo efectuado en 539 pacientes consecutivos, fallecidos en un servicio de medicina. Los pacientes se agruparon en dos grupos, según si su fallecimiento ocurrió durante los años 2001-2002 o durante los años 2006-2007. Se registraron los datos demográficos, el motivo de ingreso y las ECNT presentes en su último ingreso al hospital. Resultados: la edad al fallecimiento aumentó en cuatro años entre estos dos períodos (75,7 +/- 12.2ª 79.7 +/- 10.6; p=0.0001). Las mujeres > 80 años aumentaron de un 45.1 por ciento a 61.7 por ciento (p=0.01) y los hombres > 80 años de 37.6 por ciento a 48.6 por ciento (p=0.08). Las enfermedades infecciosas (principalmente neumonías) fueron el motivo más frecuente de ingresos al hospital, aumentando su frecuencia desde 33.2 por ciento a 44.4 por ciento (p=0.01) entre ambos períodos. El cáncer, por el contrario, redujo su participación como motivo de ingreso de 23 por ciento a 14.2 por ciento (p=0.01). Las ECNT más prevalentes fueron la hipertensión arterial, el cáncer, el deterioro cognitivo y las diabetes mellitus y no hubo cambios significativos en su prevalencia entre ambos períodos.

In recent decades, life expectancy of Chilean population has increased significantly, increasing the number of peaple with multiple chronic diseases who are hospitalized due to recurrent aggravation of these diseases of the occurrence of acute problems that worsen these conditions. Objectives: the primary objective of this study was to determine if in recent years, the age of death of patients hospitalized in an Internal Medicine ward (SMI) has increased. Secondary objectives were to determine if changes have occurred in the prevalence of chronic noncommunicable diseases (CND) and the causes of hospital admission. Material and Methods: a retrospective study was conducted in 539 consecutive patients that died in internal medicine wards. Patients were grouped into 2 groups depending on whether their death occurred during 2001-2002 or 2006-2007. Results: The age at death increased in four years between these two periods (75.7 + / - 12.2 to 79.7 + / - 10.6, p = 0.0001), Women > 80 years increased from 45.1 percent to 61.7 percent (p= 0.01) and men > 80 years increased from 37.6 per cent to 48.6 percent (p= 0.08). Infectious diseases (mainly pneumonia) were the most frequent causes for hospital admission, increasing its frequency from 33.2 percent to 44.4 percent (p = 0.01) between both periods. Cancer, however, reduced its participation as the cause of admission from 23 percent to 14.2 percent (p = 0.01). The most prevalent chronic deseases were hypertension, cancer, cognitive impairment and diabetes mellitus, and there were no significant changes in their prevalence between these two periods.