ABSTRACT
Resumen: Introducción: Al menos 50% de los pacientes pediátricos portadores de artritis idiopática juvenil (AIJ) continuará control en reumatología adulto. La clasificación de la Liga Internacional de Asociaciones de Reumatología (ILAR) vigente, actualmente en revisión, difiere de la clasificación de las artritis inflamatorias del adulto. Se ha reportado cambios de categoría en 10,8% de los pacientes durante el seguimiento. Objetivo: Analizar los pacientes con AIJ seguidos al menos 7 años para objetivar cambios de diagnós tico en la transición, e identificar factores de mal pronóstico funcional. Pacientes y Método: Estudio retrospectivo en base a registros clínicos. Se incluyó a la totalidad de los pacientes con AIJ controla dos en policlínico pediátrico del Hospital de Puerto Montt entre el año 2005 y 2017, que cumplieron siete o más años de seguimiento. Se realizó análisis descriptivo en base a variables clínicas: categoría diagnóstica, tiempo de evolución al diagnóstico, actividad clínica y serológica, y tiempo de evolución al inicio de la terapia farmacológica. Resultados: Se evaluaron 18 pacientes, 3 Oligo-articular (OA) persistente, 1 OA extendida, 4 Poli-articular (PA) factor reumatoide (FR) negativo, 4 PA FR positivo, 5 Sistémicas, 1 Psoriática, todos con seguimiento mayor a 7 años. Once de 18 niños fueron transfe ridos a adultos. Tres de 11 cambiaron de diagnóstico a Artritis Reumatoide (AR) más otra enferme dad autoinmune: Síndrome de Sjögren + Lupus eritematoso sistémico, Púrpura trombocitopénico inmune, Enfermedad autoinmune no clasificada y cinco de 11 niños de categoría ILAR: OA a Artritis reumatoide juvenil, OA extendida a PA FR negativo, 3 Sistémicas a PA FR negativo. Edad de inicio, formas poli-articulares, retrasos en diagnóstico y comienzo de terapia se asociaron a secuelas e infla mación persistente. Conclusiones: Ocho de once pacientes transferidos cambiaron denominación diagnóstica y/o presentaron otras enfermedades autoinmunes. Algunos factores de mal pronóstico deben mejorar.
Abstract: Introduction: At least 50% of pediatric patients with Juvenile Idiopathic Arthritis (JIA) will require continued fo llow-up in adult rheumatology. The present International League of Associations for Rheumatology (ILAR) classification, currently under revision, differs from its classification of inflammatory arthritis in adults. Category changes have been reported in 10.8% of patients during follow-up. Objective: To analyze JIA patients in follow-up for at least 7 years to detect diagnosis changes during transition to adult care, identifying factors of poor functional prognosis. Patients and Method: Retrospective study based on medical records of JIA patients seen at the pediatric polyclinic of the Puerto Montt Hospital between 2005 and 2017, who were monitored for at least 7 years. Descriptive analysis was performed according to clinical variables: diagnostic category, evolution before diagnosis, clinical and serological activity, and evolution before starting drug therapy. Results: We evaluated 18 pa tients, corresponding to 3 patients with persistent oligoarticular arthritis (OA), 1 with extended OA, 4 with polyarticular arthritis (PA) rheumatoid factor (RF) negative, 4 with PA RF positive, 5 with syste mic JIA, and 1 with psoriatic arthritis, all have had follow-up more than 7 years. 11 out of 18 patients transitioned to adult care. Three out of 11 patients changed diagnosis to Rheumatoid Arthritis (RA) plus another autoimmune disease such as Sjögren's Syndrome + Systemic Lupus Erythematosus, Immune thrombocytopenia, or unclassified autoimmune disease, and 5 out of 11 children changed ILAR category from OA to Juvenile Rheumatoid Arthritis, extended OA to PA RF negative, and 3 from Systemic arthritis to PA RF negative. Age of onset, polyarticular forms, delay in diagnosis, and the start of therapy were associated with sequelae and persistent inflammation. Conclusions: Eight of the eleven JIA patients who transitioned to adult care changed their diagnosis or presented other autoimmune diseases. Some factors of poor prognosis must improve.
Subject(s)
Humans , Male , Female , Young Adult , Arthritis, Juvenile/diagnosis , Transition to Adult Care , Arthritis, Juvenile/classification , Arthritis, Juvenile/complications , Arthritis, Juvenile/therapy , Arthritis, Rheumatoid/classification , Arthritis, Rheumatoid/complications , Arthritis, Rheumatoid/diagnosis , Arthritis, Rheumatoid/therapy , Prognosis , Arthritis, Psoriatic/complications , Arthritis, Psoriatic/diagnosis , Arthritis, Psoriatic/therapy , Retrospective Studies , Follow-Up Studies , Purpura, Thrombocytopenic, Idiopathic/complications , Purpura, Thrombocytopenic, Idiopathic/diagnosis , Purpura, Thrombocytopenic, Idiopathic/therapy , Aftercare , Disease Progression , Lupus Erythematosus, Systemic/complications , Lupus Erythematosus, Systemic/diagnosis , Lupus Erythematosus, Systemic/therapyABSTRACT
INTRODUCTION: At least 50% of pediatric patients with Juvenile Idiopathic Arthritis (JIA) will require continued fo llow-up in adult rheumatology. The present International League of Associations for Rheumatology (ILAR) classification, currently under revision, differs from its classification of inflammatory arthritis in adults. Category changes have been reported in 10.8% of patients during follow-up. OBJECTIVE: To analyze JIA patients in follow-up for at least 7 years to detect diagnosis changes during transition to adult care, identifying factors of poor functional prognosis. PATIENTS AND METHOD: Retrospective study based on medical records of JIA patients seen at the pediatric polyclinic of the Puerto Montt Hospital between 2005 and 2017, who were monitored for at least 7 years. Descriptive analysis was performed according to clinical variables: diagnostic category, evolution before diagnosis, clinical and serological activity, and evolution before starting drug therapy. RESULTS: We evaluated 18 pa tients, corresponding to 3 patients with persistent oligoarticular arthritis (OA), 1 with extended OA, 4 with polyarticular arthritis (PA) rheumatoid factor (RF) negative, 4 with PA RF positive, 5 with syste mic JIA, and 1 with psoriatic arthritis, all have had follow-up more than 7 years. 11 out of 18 patients transitioned to adult care. Three out of 11 patients changed diagnosis to Rheumatoid Arthritis (RA) plus another autoimmune disease such as Sjögren's Syndrome + Systemic Lupus Erythematosus, Immune thrombocytopenia, or unclassified autoimmune disease, and 5 out of 11 children changed ILAR category from OA to Juvenile Rheumatoid Arthritis, extended OA to PA RF negative, and 3 from Systemic arthritis to PA RF negative. Age of onset, polyarticular forms, delay in diagnosis, and the start of therapy were associated with sequelae and persistent inflammation. CONCLUSIONS: Eight of the eleven JIA patients who transitioned to adult care changed their diagnosis or presented other autoimmune diseases. Some factors of poor prognosis must improve.
Subject(s)
Arthritis, Juvenile/diagnosis , Transition to Adult Care , Adolescent , Aftercare , Arthritis, Juvenile/classification , Arthritis, Juvenile/complications , Arthritis, Juvenile/therapy , Arthritis, Psoriatic/complications , Arthritis, Psoriatic/diagnosis , Arthritis, Psoriatic/therapy , Arthritis, Rheumatoid/classification , Arthritis, Rheumatoid/complications , Arthritis, Rheumatoid/diagnosis , Arthritis, Rheumatoid/therapy , Disease Progression , Female , Follow-Up Studies , Humans , Lupus Erythematosus, Systemic/complications , Lupus Erythematosus, Systemic/diagnosis , Lupus Erythematosus, Systemic/therapy , Male , Prognosis , Purpura, Thrombocytopenic, Idiopathic/complications , Purpura, Thrombocytopenic, Idiopathic/diagnosis , Purpura, Thrombocytopenic, Idiopathic/therapy , Retrospective Studies , Young AdultABSTRACT
BACKGROUND: Helicobacter pylori (HP) is the most widespread chronic human infection worldwide and the most important pathogenic factor of gastric cancer. The calculated prevalence at the Clinical Hospital of the University of Chile from 2002 to 2005 was 44.9%. AIM: To determine the current prevalence of HP in patients undergoing an upper gastrointestinal endoscopy (UGI) and analyze its distribution according to age and endoscopic findings. MATERIAL AND METHODS: We reviewed 3.433 UGI performed during the year 2015, selecting those in which rapid urease test (RUT) was done. A positive RUT or a positive gastric biopsy (GB) were considered as HP infection. RESULTS: RUT was done in 1862 UGI (55%) performed in patients aged 51 ± 17 years, (66% women). In 23% of these endoscopies, the RUT was positive. A GB was obtained 43% of endoscopies and 30% were positive for HP. In 105 patients the RUT was negative and the GB positive (rendering a 19.5% false negative rate). HP was detected by RUT and GB in 29% of endoscopies. The highest prevalence of infection (38.1%) was found between 40 and 49 years. HP infection had odds ratio of 4.24 for nodular gastropathy, 2.63 for gastric ulcer and 2.14 for duodenal ulcer (p < 0.05). CONCLUSIONS: HP prevalence in our center decreased significantly from 44.9% to 28.9% in 11 years. False negative RUT results may bias this finding. The use of proton pump inhibitors and antimicrobials that can interfere with the detection of HP should be registered to properly analyze the results of the RUT.
Subject(s)
Gastrointestinal Diseases/microbiology , Helicobacter Infections/diagnosis , Helicobacter pylori/isolation & purification , Adolescent , Adult , Age Distribution , Aged , Aged, 80 and over , Biopsy , Chile/epidemiology , Cross-Sectional Studies , Endoscopy, Gastrointestinal , Female , Gastrointestinal Diseases/diagnosis , Gastrointestinal Diseases/epidemiology , Helicobacter Infections/epidemiology , Humans , Male , Middle Aged , Prevalence , Retrospective Studies , Young AdultABSTRACT
Background: Helicobacter pylori (HP) is the most widespread chronic human infection worldwide and the most important pathogenic factor of gastric cancer. The calculated prevalence at the Clinical Hospital of the University of Chile from 2002 to 2005 was 44.9%. Aim: To determine the current prevalence of HP in patients undergoing an upper gastrointestinal endoscopy (UGI) and analyze its distribution according to age and endoscopic findings. Material and Methods: We reviewed 3.433 UGI performed during the year 2015, selecting those in which rapid urease test (RUT) was done. A positive RUT or a positive gastric biopsy (GB) were considered as HP infection. Results: RUT was done in 1862 UGI (55%) performed in patients aged 51 ± 17 years, (66% women). In 23% of these endoscopies, the RUT was positive. A GB was obtained 43% of endoscopies and 30% were positive for HP. In 105 patients the RUT was negative and the GB positive (rendering a 19.5% false negative rate). HP was detected by RUT and GB in 29% of endoscopies. The highest prevalence of infection (38.1%) was found between 40 and 49 years. HP infection had odds ratio of 4.24 for nodular gastropathy, 2.63 for gastric ulcer and 2.14 for duodenal ulcer (p < 0.05). Conclusions: HP prevalence in our center decreased significantly from 44.9% to 28.9% in 11 years. False negative RUT results may bias this finding. The use of proton pump inhibitors and antimicrobials that can interfere with the detection of HP should be registered to properly analyze the results of the RUT.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Helicobacter pylori/isolation & purification , Helicobacter Infections/diagnosis , Gastrointestinal Diseases/microbiology , Biopsy , Chile/epidemiology , Prevalence , Cross-Sectional Studies , Retrospective Studies , Endoscopy, Gastrointestinal , Helicobacter Infections/epidemiology , Age Distribution , Gastrointestinal Diseases/diagnosis , Gastrointestinal Diseases/epidemiologyABSTRACT
El uso etnomédico de matico (Buddleja globosa Hope) es común a Chile, Argentina y Perú, y se remonta a tiempos precolombinos. En Chile, en las culturas mapuche ( pañil) y aymara (palquin), esta planta se utilizó principalmente por su efecto cicatrizante. En medicina popular su uso es variado: aplicación de cataplasmas de hojas y tallos para la curación de heridas y úlceras de todo tipo, la infusión de sus hojas para tratar el dolor de hígado y de vesícula, los ardores o dolencias internas, la disentería, las úlceras de estómago, la sarna y la sífilis. Se han identificado gran variedad de compuestos químicos, siendo los principales flavonoides, terpenos y feniletanoides. Sus propiedades farmacológicas han sido ampliamente estudiadas, destacando su efecto analgésico y antiinflamatorio, inhibiendo tanto COX como 5-LOX, con afinidades muy cercanas a las de ibuprofeno; también posee efectos antioxidantes. Sus efecto farmacológico más destacado (cicatrizante, antiulceroso y gastroprotector) solo tienen evidencia indirecta en el ser humano. El Ministerio de Salud de Chile reconoce al matico como medicamento herbario tradicional, basado en el conocimiento ancestral y la evidencia preclínica. Como actualmente está en desarrollo un estudio clínico pionero en Chile con B. globosa Hope como cicatrizante de heridas, patrocinado por FONIS, consideramos importante reunir en esta revisión un esquema de los sitios de acción putativos de matico en el proceso de cicatrización y reparación de tejidos, en base al conocimiento fitoquímico y farmacológico que sustenta el planteamiento de sus propiedades cicatrizantes y antiulcerosas en seres humanos (AU)
O uso etnomedicinal de matico (Buddleja globosa Hope) é comum para o Chile, Argentina e Peru, e remonta aos tempos pré-colombianos. No Chile, a cultura Mapuche (Pañil) e aymara (Palquin) usam esta planta especialmente por seu efeito de cura de feridas. Em medicina popular usos são variados: Aplicar cataplasma de folhas e caules para a cura de todos os tipos de feridas e úlceras, a infusão de suas folhas para tratar a dor de fígado e vesícula biliar, para a azia ou doenças internas, disenteria, úlceras estomacais, sarna e sífilis. Eles identificaram uma série de compostos químicos, principalmente flavonóides, terpenos e fenileta-nóides. As suas propriedades farmacológicas foram amplamente estudados, destacando a sua analgésica e anti-inflamatória, inibir tanto a COX e LOX-5, com afinidades muito próxima da que de ibuprofeno; Ele também tem efei-tos antioxidantes. A sua mais importante efeito farmacológico (cicatrização de feridas, anti-úlcera e gastro) apenas foi demonstrada indirectamente. O Ministério da Saúde do Chile reconhece a matico como medicina tradicional à base de plantas, a partir do conhecimento ancestral e evidências pré-clínicas. Como estamos actualmente a desenvolver um estudo inovador clínica no Chile com Buddleja globosa es-perança para a cura de feridas, patrocinado pela FONIS, consideramos importante reunir nesta revisão um esboço do suposto locais matico ação no processo de cicatrização e reparação tecidual, com base em o conhecimento fito-químico e farmacológico que sustenta suas propriedades curativas e anti-úlcera em humanos
The ethnomedical use of matico (Buddleja globosa Hope) is common to Chile, Argentina and Peru, and dates back to pre-Columbian times. In Chile, the Mapuche culture (Pañil) and Aymara (palquin) use this plant especially as wound healing. Several uses have been described in folk medicine: as poultice, leaves and stems are applied for healing all kinds of wounds and ulcers, whereas the infusion of the leaves is used for the treatment of liver and gallbladder pain, heartburn and other internal ailments, dysentery, stomach ulcers, scabies and syphilis. A variety of chemical compounds have been identified, mainly flavonoids, terpenes and phenylethanoids. The pharmacological properties have been widely studied: it has analgesic and antiinflammatory properties, inhibiting both COX and 5-LOX, with affinities very close to that of ibuprofen, and It also has antioxidant effects. Its main pharmacological effects as wound healing, anti-ulcer and gastro-protector, have only been demonstrated indirectly in humans. The Ministry of Health of Chile recognizes the matico as traditional herbal medicine, based on the ancestral knowledge and preclinical evidence. A pioneering clinical study is currently being developed in Chile with B. globosaas wound healing, sponsored by FONIS. In this paper the possible sites of action of matico in the wound healing and tissue repair processes are reviewed, based on the phytochemical and pharmacological knowledge that sustains its potential healing and anti-ulcer effects in humans (AU)
Subject(s)
Buddleja , Plant Extracts/pharmacokinetics , Wound Healing , Phytotherapeutic Drugs , Phytochemicals/pharmacokinetics , PhytotherapyABSTRACT
Esta investigación tiene por propósito describir las indicaciones terapéuticas, prescritas por médicos otorrinolaringólogos a pacientes diagnosticados con pólipo cordal. Se describen las etapas de evaluación, reposo vocal e indicaciones terapéuticas. El estudio intenta develar la presencia de una sistematización en el proceso anterior. Dicha información es recabada a partir de una encuesta vía mail aplicada a 29 médicos pertenecientes a la Sociedad Chilena de Otorrinolaringología (N=205). Los datos obtenidos permiten concluir que no existe un estándar en las indicaciones que se preguntan en la encuesta. Sin embargo, el total de médicos consultados manifiesta que sería útil la elaboración de protocolos para la evaluación y tratamiento de los pacientes con alteración vocal.
This research is aimed at describing the therapeutic indications, prescribed by otorhynolaryngologists polyp patients diagnosed with tailpiece, including assessment, voice rest and therapeutic indications. The study attempts to reveal the presence of systematization in the previous process. This information is collected from a survey via e-mail applied to 29 physicians belonging to the Chilean Society of Otolaryngology (n =205). The data obtained indicate that there is no standard in the information asked for in the survey. However, the total number of doctors surveyed stated that the development of protocols for assessment and treatment of patients with vocal alteration would be useful.
Subject(s)
Humans , Laryngeal Diseases/therapy , Vocal Cords/pathology , Polyps/therapy , Chile , Data Collection , Laryngeal Diseases/diagnosis , Otolaryngology/methods , Polyps/diagnosisABSTRACT
Palatability and variety of foods are major reasons for "hedonic" eating, and hence for overeating and obesity. Palatable food and drugs of abuse share a common reward mechanism, and compounds that block the reinforcing effect of drugs of abuse preferentially suppress the intake of palatable foods. This research was aimed at studying the influence of the gamma-hydroxybutyrate analogue N-(4-trifluoromethylbenzyl)-4-methoxybutanamide (GET73) - that inhibits alcohol consumption - on consumption and reinforcing effect of palatable food. Adult male rats were used. For place preference conditioning, sweetened corn flakes were used as the reinforcer, and GET73 (50, 100 and 200mgkg(-1)) or vehicle were orally (p.o.) administered either 30min before each training session and the test session, or only before the test session. To study the influence on consumption, GET73 was given p.o. at the same doses once daily for 12 days to rats given free access to both palatable and varied food (cafeteria diet) or to standard chow. Both acquisition and expression of palatable food-induced conditioned place preference were inhibited by GET73, either administered throughout the conditioning period or only before the test session. GET73 reduced also the consumption of cafeteria food, while that of standard chow was increased. At these doses, GET73 had no detrimental effect on open-field behaviour. GET73 seems to specifically attenuate the gratification produced by varied and palatable food, without affecting the consumption of not particularly palatable chow. Since, overweight and obesity are mostly due to the overeating of palatable and varied foods, drugs like GET73 could represent a somewhat ideal and rational approach to obesity treatment.
