Luxación expuesta de rodilla: ¿Qué hemos aprendido en los últimos 20 años? / Open knee dislocations: what have we learn about it in the last 20 years?

INTRODUCCIÓN: La luxación expuesta de rodilla es compleja, de incidencia baja con grandes secuelas funcionales. Existen escasos reportes de series en la literatura relativos a su manejo y resultados. OBJETIVO: El objetivo de este trabajo fue describir los resultados obtenidos de todos los pacientes con luxación expuesta de rodilla tratados durante las últimas dos décadas en nuestro hospital bajo un mismo estándar de tratamiento. MÉTODO: Estudio descriptivo retrospectivo en una serie quirúrgica de 11 pacientes con luxación expuesta de rodilla, tratados entre 1994 y 2015. Todos fueron estudiados y manejados según esquema estandarizado: Angiografía/ angioTC, aseo quirúrgico, fijador externo y reparación neurovascular en casos necesarios. Revisión de registros clínicos e imagenológicos consignando datos demográficos, lesiones concomitantes, número y tipo de cirugías, y complicaciones asociadas. Seguimiento promedio fue de 10,7 años con evaluación mediante encuesta funcionales SF-12/IKDC durante el mes de marzo de 2015. RESULTADOS: Diez pacientes eran hombres, 1 mujeres. Edad promedio al accidente 38,6 años. Mecanismo lesional de alta energía; como referencia la clasificación de Schenck, 1 lesión III-M, 4 tipo IV y los 6 restantes una tipo V. 4 lesiones vasculares (36.4%) y 7 lesiones neurológicas (63.6%). Tratamiento definitivo consistió en 4 reconstrucciones ligamentarias, 2 prótesis, 3 artrodesis y 2 amputaciones supracondíleas. Evaluaciones funcionales dieron como resultados un puntaje promedio de 37 y 48,5 para SF-12 físico y mental respectivamente, y de 44,1 para IKDC. CONCLUSIÓN: La luxación expuesta de rodilla es una lesión infrecuente, muy compleja, asociada a accidentes de alta energía, con complicaciones severas, lo que determina resultados funcionales relativamente malos. La estandarización permite sistematizar las distintas etapas de atención, racionalizar los recursos disponibles evitando la improvisación en momentos críticos, lo que podría incidir en la obtención de resultados.

INTRODUCTION: Open knee dislocation is a complex lesion of low incidence and large functional sequelae. There are few series reports in the literature regarding its management and outcomes. OBJECTIVE: Describe the results obtained from all patients with open knee dislocation treated during the last two decades in our hospital under the same treatment standard. METHOD: Retrospective descriptive study in a surgical series of 11 patients with open knee dislocation, treated between 1994 and 2015. All were studied and managed according to a standardized protocol: Angiography/angioCT, surgical debridement, external fixation and neurovascular repair in necessary cases. Review of clinical and imaging records, recording demographic data, concomitant injuries, number and type of surgeries and associated complications. Average follow-up was 10.7 years, with an evaluation through functional surveys SF-12/IKDC during March 2015. RESULTS: 10 patients were men, 1 woman. Average age at accident 38.6 years. High-energy trauma mechanism of injury; Schenk classification as reference, 1 lesion type III-M, 4 type IV and the remaining 6 type V. 4 vascular lesions (41.7%) and 7 neurological lesions (63.6%). Definitive treatment consisted in 4 ligamentous reconstructions, 2 prostheses, 3 arthrodesis and 3 supracondylar amputations. Functional evaluations showed an average score of 37 and 48.5 for SF-12 physical and mental respectively, and 44.1 for IKDC. CONCLUSION: Open knee dislocation is a rare, very complex, associated to high-energy trauma, with severe complications, which determines relatively poor functional outcomes. Standardization allows to systematize the different stages of attention and rationalize available resources avoiding improvisation at critical moments, which could affect the results.

Perfil de morbilidad otorrinolaringológica en niños con síndrome de Down / Ear, nose and throat disease profile in children with Down syndrome

Introducción: Los niños con síndrome de Down (SD) tienen mayor riesgo de desarrollar enfermedad otorrinolaringológica (ORL). Recomendaciones internacionales sugieren realizar tamizaje auditivo precoz y control periódico por especialista. Nuestro objetivo fue caracterizar la enfermedad ORL en niños con SD y proponer una recomendación adaptada a nuestra realidad. Pacientes y método: Estudio transversal, descriptivo, en niños de 6 meses a 15 años con SD. Los datos se obtuvieron por medio de entrevista a los padres y revisión de fichas clínicas. Resultados: Se analizaron 134 pacientes, con una edad promedio de 44,5 meses. El 78,8% de ellos presentaba enfermedad ORL, siendo la más frecuente la rinitis alérgica y otitis con efusión. El tamizaje auditivo estaba alterado en un 25% de ellos, el 50% de los mayores de 3 años con estudio de sueño tenían apnea obstructiva del sueño. Los niños de mayor edad tuvieron estadísticamente mayor frecuencia de enfermedad ORL. Conclusiones: Esta serie muestra una alta frecuencia de enfermedad ORL en niños con SD, lo que refuerza la necesidad de realizar tamizaje auditivo, sospechar e identificar las apneas obstructivas del sueño y derivación rutinaria al especialista para optimización de las condiciones auditivas que permitan el mejor desarrollo del niño con SD.

Introduction: The children with Down syndrome (DS) are at increased risk of ear-nose-throat (ENT) disorders. International recommendations suggest early hearing screening and periodic specialist evaluation. Our goal was to characterize ENT disorders in children with DS, and propose recommendations for the Chilean population. Patients and method: Cross-sectional, descriptive study, of children with DS, between 6 months and 15 years of age. The data was obtained by a health interview to the parents and review of medical records. Results: We analyzed 134 patients with an average age of 44.5 months. The 78.8% had ENT disorders, the most frequent ENT disorders was allergic rhinitis and otitis media with effusion. Hearing screening was abnormal in a quarter of the patients, 50% of children over 3 years of age had obstructive sleep apnea diagnosed by polysomnogram. Older children had a statistically higher frequency of ENT disorders. Conclusions: This series shows a high rate of ENT disorders in children with DS, which supports recommendations for hearing screening, high suspicion of obstructive sleep apnea and routine referral to an ENT specialist for prevention and aggressive therapy in order to reduce hearing loss and improve development of the child with DS.

[Ear, nose and throat disease profile in children with Down syndrome]. / Perfil de morbilidad otorrinolaringológica en niños con síndrome de Down.

INTRODUCTION: The children with Down syndrome (DS) are at increased risk of ear-nose-throat (ENT) disorders. International recommendations suggest early hearing screening and periodic specialist evaluation. Our goal was to characterize ENT disorders in children with DS, and propose recommendations for the Chilean population. PATIENTS AND METHOD: Cross-sectional, descriptive study, of children with DS, between 6 months and 15 years of age. The data was obtained by a health interview to the parents and review of medical records. RESULTS: We analyzed 134 patients with an average age of 44.5 months. The 78.8% had ENT disorders, the most frequent ENT disorders was allergic rhinitis and otitis media with effusion. Hearing screening was abnormal in a quarter of the patients, 50% of children over 3 years of age had obstructive sleep apnea diagnosed by polysomnogram. Older children had a statistically higher frequency of ENT disorders. CONCLUSIONS: This series shows a high rate of ENT disorders in children with DS, which supports recommendations for hearing screening, high suspicion of obstructive sleep apnea and routine referral to an ENT specialist for prevention and aggressive therapy in order to reduce hearing loss and improve development of the child with DS.

Nacer con tres cromosomas 21 en el siglo 21 / Born with trisomy 21 in 21st century

En este artículo se resume diversos aspectos asociados al nacimiento de un niño con Síndrome de Down en Chile. La frecuencia de estos nacimientos, el enfrentamiento a la noticia, los principales mitos y la realidad asociados a este síndrome son enfocados desde una perspectiva actual...

This article outlines various aspects related to a child born with Down Syndrome in Chile. The frequency of these births, how we respond to diagnosis, the myths and the true associated are updated...

[Recommendations for health care of people with Down syndrome from 0 to 18 years of age]. / Recomendaciones de cuidados en salud de personas con síndrome de Down: 0 a 18 años.

People born with Down syndrome have an increased risk of birth defects and are more vulnerable to certain illnesses. Health care for them should emphasize prevention, early diagnosis and early treatment of their most common health conditions. A healthy lifestyle promotes future physical and intellectual development. The purpose of this review is to update health care recommendations for individuals with Down syndrome from 0 to 18 years of age. The health professionals members involved in the care of these patients should be aware of these guidelines.

Recomendaciones de cuidados en salud de personas con síndrome de Down: 0 a 18 años / Recommendations for health care of people with Down syndrome from 0 to 18 years of age

People born with Down syndrome have an increased risk of birth defects and are more vulnerable to certain illnesses. Health care for them should emphasize prevention, early diagnosis and early treatment of their most common health conditions. A healthy lifestyle promotes future physical and intellectual development. The purpose of this review is to update health care recommendations for individuals with Down syndrome from 0 to 18 years ofage. The health professionals members involved in the care of these patients should be aware of these guidelines.

Expression of BCL-2 family genes in germ cells undergoing apoptosis during the first wave of spermatogenesis in the rat.

Apoptosis is a key event controlling sperm output both in normal and pathological conditions. However, the mechanisms involving germ cell apoptosis is far from being understood. In this work, we have immunoisolated germ cells undergoing apoptosis by taking advantage of the up-regulation of Fas, a dead receptor involved in apoptosis induction in these cells. Analysis of specific markers showed that this cell population is composed of spermatogonia and meiotic spermatocytes. We measured the mRNA levels of several apoptosis-inducing proteins belonging to the BCL-2 family (BAX, BAD, PUMA, BOK and BAK) as well as those that prevent apoptosis (BCL-2, BCL-W and BCL-XL). Results showed that apoptotic germ cells have elevated mRNA levels of all studied genes (both pro and anti-apoptotic) compared with non-apoptotic cells. Our data would help to define the molecular mechanisms involving germ cell apoptosis under physiological conditions.

Morbilidad y mortalidad durante el primer año de vida en pacientes con síndrome de Down / Down' syndrome patient morbidity and mortality during the first year of life

Objective: Down' Syndrome (DS) is the most common chromosomal abnormality. It carries an increased risk of concurrent congenital malformations as well as increased risk of mortality when compared to the general population. Objective: To determine the characteristics of morbidity and mortality in patients with DS during the first year of life. Patients and Methods: A prospective study of a cohort of children born with DS was performed. All children born in 2006 in two Chilean hospitals who were given a clinical diagnosis of DS were included. Infant mortality, morbidity and nutritional diagnosis were determined and recorded every two months. Results: 33 patients were included, 78.8 percent were full term newborns. Average age of the mother at childbirth was 33.2 +/- 7.8 years. Among the 33 patients, 64.5 percent had congenital heart disease, the most common cause being atrio-ventricular defects (25 percent), 35 percent of the patients with CHD required cardiac surgery. Gastrointestinal disorders were diagnosed among 35 percent of these children, atresia or intestinal stenosis being the most frequent diagnosis. 25.8 percent of the population suffered from hypothyroidism. Follow-up showed that after two months, 54.8 percent of these children were malnourished, however at one year old, 22.5 percent were overweight. By the first year, children had shown 5.38 +/- 1.83 episodes of Acute Respiratory Tract Infections per patient per year, and 1.22 +/- 1.14 non neonatal hospitalizations per child/year. Half of these hospitalizations were due to lower respiratory tract infection. Two patients died during the study due to infectious disorders, resulting on a survival rate of 93.6 percent at 12 months. Conclusions: This information should assist physicians in improving patient follow-up. The study should also make evident the need to create national standards to supervise the care of patients with DS.

Objetivos: El Síndrome de Down (SD) corresponde a la anomalía cromosómica más frecuente, con mayor riesgo de malformaciones asociadas y mortalidad que la población general. Nuestro objetivo fue caracterizar la morbimortalidad durante el primer año de vida en pacientes con SD. Material y Método: Estudio de cohorte prospectivo en niños con SD. Se incluyeron todos los niños nacidos durante el año 2006 con diagnóstico clínico de SD en dos hospitales chilenos. Se realizó registro de morbimortalidad, hospitalizaciones y diagnóstico nutricional cada 2 meses hasta los 12 meses de vida. Resultados: Se incluyeron 33 pacientes. El 78,8 por ciento fueron recién nacidos de término. La edad materna promedio fue de 33,2 +/- 7,8 años. El 64,5 por ciento presentó cardiopatía congénita, siendo más frecuentes los defectos aurículo-ventriculares (25 por ciento). El 35 por ciento requirió cardiocirugía. Las patologías digestivas asociadas se presentaron en el 35 por ciento. El 25,8 por ciento presentó hipotiroidismo. A los 2 meses el 54,8 por ciento tenía desnutrición. El 22,5 por ciento tenía obesidad/sobrepeso a los 12 meses. Hubo un promedio de 5,38 +/- 1,83 infecciones respiratorias agudas (IRA) por paciente/año y 1,22 +/- 1,14 hospitalizaciones no neonatales por niño/año. El 50 por ciento de las hospitalizaciones fueron por IRA baja. Dos pacientes fallecieron, ambos por causa infecciosa, con una sobrevida de 93,6 por ciento a 12 meses. Conclusiones: El conocimiento de esta información nos permitirá mejorar el seguimiento actual de este grupo de niños, además de hacer evidente la necesidad de crear un programa nacional de evaluación y supervisión estandarizado de salud para niños con SD.

Diabetes insípida en pediatría: serie clínica y revisión de la literatura / Diabetes insipidus in pediatrics

Introduction: Diabetes insipidus (DI) is a syndrome characterized by polyuria and polydipsia secondary to a decreased secretion or action of the antidiuretic hormone (ADH). An early diagnosis is essential. Diagnosis is made by measuring plasma and urinary osmolarity and their changes under water deprivation and after DDAVP administration. Objective: Lo describe the clinical, radiological characteristics as well as the initial treatment of eight children with DI, 3 of them nephrogenic DI (DIN) and 5 with central DI. Methods: A Retrospective, descriptive study in DI patients under control at the Catholic University of Chile and Sotero del Rio Hospital between 1998-2008 is presented. Clinical files were evaluated collecting clinical, epidemiologic, biochemical and image data. Serum (Sosm) and urinary osmolarity (Uosm) were registered. DI was diagnosed with a Sosm > 300 and Usm < 600 mOsm/L. Central DI was defined as the inability to reach a Uosm > 600 or a 50 percent-increase after DDAVP treatment. Otherwise DI was classified as DIN. Results: Eight patients (5 males) were studied. Chief complaints were polydipsia/polyuria (5/8), hyperthermia (2/8), and failure to grow (1/8). MRI showed endocraneal lesion in all patients with Central DI. All of these utilized oral or inhalatory DDAVP treatment. Patients with Nephrogenic DI were trated with Hydrochlrothiazide. Conclusion: Polydipsia, polyuria, hyperthermia with hypernatremia are suggestive of DI in the first year of life. Water deprivation test is diagnostic in differentiating Central and Nephrogenic DI. MRI is an essential diagnostic tool in CDI. Manegement should be multidisciplinary, including a pediatician, nephrologist, endocrinologist and nutricionist.

Introducción: La diabetes insípida (DI) se caracteriza por poliuria y polidipsia, secundario a una disminución de la secreción o acción de la hormona antidiurética. Su diagnóstico precoz es fundamental. Objetivo: Describir las características clínicas, radiológicas y tratamiento inicial de una serie de ocho pacientes con DI. Diseño: Estudio descriptivo-restrospectivo. Universo: Pacientes con DI evaluados en la Universidad Católica de Chile y Hospital Dr. Sótero del Río entre 1998-2008. Pacientes y Métodos: Desde la ficha clínica se analizaron variables clínicas, epidemiológicas, bioquímicas e imágenes. Se determinó Osmolaridad sérica (OsmS) y urinaria (OsmU). Se consideró DI sí la OsmS > 300 mOsm con OsmU < 600 mOsm, Di-central (DIC) sí posterior a DDAVP la OsmU aumento > 50 por ciento ó > 600 mOsm, de los contrario se clasificó como nefrogénica (DIN). Resultados: Se reclutaron ocho pacientes con DI (5 varones), fueron DIN 3/8. El motivo de consulta fue: polidipsia-poliuria (5/8), hipertermia (2/8) y talla baja (1/8). La RNM mostró lesión intracraneana en todos los pacientes con DIC: nodulo hipofisiario, aracnoidocele selar, Histiocitosis X, germinoma y un paciente sin se±al de neurohipófisis. Los sujetos con DIC usaron DDAVP inhalatoria (4) y oral (1). Los sujetos con DIN usaron hidroclorotiazida. Conclusión: Polidipsia, poliuria, hipertermia con hipernatremia y falla de medro en lactantes son sugerentes de DI. La prueba de deprivación hídrica es fundamental en la diferenciación de DIC y DIN. La RNM cerebral es una herramienta diagnóstica imprescindible en la DIC. El tratamiento de estos pacientes debe ser multidiciplinario interactuando pediatra, nefrólogo, endocrinólogo y nutricionista.

Haliotrematoides spp. (Monogenoidea: Dactylogyridae) infecting the gills of grunts (Perciformes: Haemulidae) from the southern coast of Quintana Roo, Mexico.

One previously described species, Haliotrema striatohamus Zhukov, 1981, found off the coast of Cuba and Campeche (Gulf of Mexico), is redescribed and transferred to Haliotrematoides Kritsky, Yang and Sun, 2009, as Haliotrematoides striatohamus ( Zhukov, 1981) n. comb. This transfer is based on the study of new specimens of this species found in the gill lamellae of grunts, i.e., Haemulon aurolineatum Cuvier, Haemulon plumierii (Lacepède), and Haemulon sciurus (Shaw) (Haemulidae), all from the southern coast of Quintana Roo, Mexico. In addition, another previously described species, Haliotrema brevispirocirrus Zhukov, 1981 from Haemulon striatum (Linnaeus) from Havana, Cuba, is also transferred to Haliotrematoides based on the comparative morphology of its original description. Data are provided for prevalence and mean intensity as well as for the morphologic and biometric variability of H. striatohamus from different hosts. The new replacement of H. striatohamus ( Zhukov, 1981) n. comb. and H. brevispirocirrus (Zhukov, 1981) n. comb. infecting these taxa represents the first known species of Haliotrematoides on these fishes and new geographical records for these dactylogyrid monogenoids.

[Short duration of initial intravenous treatment in 70 pediatric patients with osteoarticular infections]. / Tratamiento intravenoso inicial abreviado en 70 pacientes pediátricos con infecciones osteo-articulares.

UNLABELLED: Osteoarticular infections (OAI) are infrequent in pediatrics and there is controversy on the need for prolonged use of intravenous antimicrobials. OBJECTIVE: To characterize and describe evolution and complications of a regimen of 7 days initial intravenous antibiotic treatment for OAI in children, completing 4-6 weeks of total treatment. PATIENTS AND METHODS: In a large pediatric hospital, 70 children younger than 15 years of age were diagnosed with OAI between March 2003 and December 2004. Children received 7 days of intravenous antibiotics followed by 3 to 5 weeks of oral treatment. RESULTS: Incidence of OAI in this hospital was 1.8:10000. Patients mean age was 6.4 +/-4.4 years and 60% presented with septic arthritis, 36% osteomyelitis and 4% osteoarthritis. In 80% of cases, the infection was located in the lower extremity. Positive cultures were obtained in 59% predominating Staphylococcus aureus (46.5%). Seven patients had prolonged pain or persistently high or increasing serum C reactive protein levels and were maintained on prolonged intravenous therapy. None of the 63 children with 7 day intravenous antimicrobials nor the 7 children with prolonged intravenous use developed a complication in the short-term follow up. CONCLUSIONS: Seven days of intravenous antibiotic for the initial phase of OAI treatment was effective in a majority of children and may be recommended.

Tratamiento intravenoso inicial abreviado en 70 pacientes pediátricos con infecciones osteo-articulares / Short duration of initial intravenous treatment in 70 pediatric patients with osteoarticular infections

Osteoarticular infections (OAI) are infrequent in pediatrics and there is controversy on the need for prolonged use of intravenous antimicrobials. Objective: To characterize and describe evolution and complications of a regimen of 7 days initial intravenous antibiotic treatment for OAI in children, completing 4-6 weeks of total treatment. Patients and methods: In a large pediatric hospital, 70 children younger than 15 years of age were diagnosed with OAI between March 2003 and December 2004. Children received 7 days of intravenous antibiotics followed by 3 to 5 weeks of oral treatment. Results: Incidence of OAI in this hospital was 1.8:10000. Patients mean age was 6.4 ±4.4 years and 60 percent presented with septic arthritis, 36 percent osteomyelitis and 4 percent osteoarthritis. In 80 percent of cases, the infection was located in the lower extremity. Positive cultures were obtained in 59 percent predominating Staphylococcus aureus (46.5 percent). Seven patients had prolonged pain or persistantly high or increasing serum C reactive protein levels and were maintained on prolonged intravenous therapy. None of the 63 children with 7 day intravenous antimicrobials nor the 7 children with prolonged intravenous use developed a complication in the short-term follow up. Conclusions: Seven days of intravenous antibiotic for the initial phase of OAI treatment was effective in a majority of children and may be recommended.

Las infecciones osteoarticulares (IOA) son poco frecuentes en pediatría. Existe controversia acerca de la óptima duración y la vía de administración de la terapia antimicrobiana. Objetivo: Caracterizar y describir la evolución y complicaciones en niños con IOA que recibieron 7 días iniciales de terapia endovenosa, completando 4 a 6 semanas de terapia total. Pacientes y Métodos: Estudio descriptivo, que incluyó a 70 niños con diagnóstico de IOA, entre marzo de 2003 y diciembre de 2004 en un hospital pediátrico, quienes recibieron tratamiento endovenoso abreviado a 7 días, seguido de terapia oral por 3 a 5 semanas. Resultados: La incidencia de IOA fue de 1,8: 10.000 niños bajo 15 años de edad. El promedio de edad fue 6,4 ± 4,4 años. Sesenta por ciento presentaba artritis séptica, 36 por ciento osteomielitis y 4 por ciento osteoartritis. En 80 por ciento la infección se localizó en extremidades inferiores. Los cultivos fueron positivos en 59 por ciento. En 46,5 por ciento se aisló Staphylococcus aureus. Siete niños evolucionaron con dolor persistente o elevación significativa de PCR y requirieron prolongar la terapia endovenosa y/o total, sin presentar complicaciones a corto plazo. Conclusiones: Siete días de terapia antimicrobiana intravenosa parece ser efectivo y recomendable para el tratamiento, en su fase inicial, de las infecciones osteo-articulares.

[Ramsay Hunt syndrome in children: four cases and review]. / Síndrome de Ramsay-Himt en pediatría: reporte de cuatro casos y revisión de la literatura.

Ramsay-Hunt Syndrome (RHS) is a rare affection characterized by peripheral facial paralysis (PFP), skin eruption in the auricular canal and cochleovestibular symptoms. It is produced by varicella-zoster virus (VZV) reactivation at the geniculate ganglia. We report four patients between 3 and 17 years-old with RHS. Earache was the first symptom in two cases and three had cochleovestibular compromise. The direct immunofluorescence from the vesicular lesion was positive for VZV in two of them. All patients received treatment with aeyelovir and in three cases, this was associated with steroids. Three children had complete resolution of the PFP. RHS is an infrequent disease in the pediatric population and it should be suspected in children with PFP, erythema, vesicles and/or auricular pain. Early treatment with aeyelovir therapy could improve the recovery rate of facial nerve palsy.

Impacto en las áreas de desempeño ocupacional como consecuencia de una fobia social / Impact of social phobia in occupational performance’s areas

Dentro de los trastornos de ansiedad se encuentra la fobia social, cuya sintomatología se caracteriza por: angustia anticipatoria, ansiedad de exposición y evitación, frente a las situaciones sociales. Considerando las características de la patología, la hipótesis de esta investigación es que la fobia social provoca un impacto en la ocupación de las personas afectadas, y por ende en las áreas de desempeño, lo cual repercute negativamente en la calidad de vida de los individuos. Los objetivos del trabajo son por un lado determinar cómo se alteran las áreas de desempeño ocupacional en personas con fobia social. Además, se desea también establecer funciones del Terapeuta Ocupacional en el tratamiento de personas con este trastorno. Se trata de una investigación de tipo cualitativo utilizando una entrevista semi estructurada para la recolección de datos y a través del relato de historia de vida, se determinan ejes de análisis para comprender el impacto de la Fobia Social.

Social phobia is included on the anxiety disorders group, with symptoms like: advance anguish, exposure anxiety and avoidance, in all social situations. Considering symptoms of this disorder, research’s hypothesis is social phobia affects patient’s occupations and therefore performance’s areas, which strikes in a negative way on his or her life’s quality. The aims of the work are on the one hand to determine how there are altered the areas of occupational performance in persons by social phobia. In addition, one wants to establish also functions of the Occupational Therapist in the persons' treatment with this disorder. It is a question of an research of qualitative type using an interview semi constructed for the compilation of information and across the statement of history of life, axes of analysis decide to understand the impact of the Social Phobia.

Insuficiencia suprarrenal primaria de etiología autoinmune: dos casos clínicos / Autoimmune primary adrenal failure: 2 cases report

Introducción: La insuficiencia suprarrenal primaria (ISRP) es producida por diversas etiologías, congénitas o adquiridas. Su sintomatología es poco específica, exigiendo un alto índice de sospecha. Objetivo: Presentación de dos casos clínicos y revisión de ISRP. Casos Clínicos: Dos niños de 9 y 6 años, ambos con astenia y adinamia, dolor abdominal, baja de peso y vómitos, con avidez por la sal, con mal estado general, lipotimia, hiperpigmentación de piel y mucosas. Se confirmó el diagnóstico de ISRP con compromiso en la secreción de cortisol, y mineralocorticoides. Ambos tuvieron anticuerpos antiadrenales positivos. Conclusiones: La ISRP es poco frecuente en pediatría, sin embargo, es potencialmente de riesgo vital, de manera que reconocer precozmente sus síntomas permitirá realizar un diagnóstico y tratamiento oportuno.