Efectos adversos secundarios a Anfotericina B Liposomal

La anfotericina B liposomal se ha utilizado en reemplazo de la anfotericina B desoxicolato para disminuir sus efectos adversos asociados, especialmente la nefrotoxicidad. Presentamos el caso de un paciente masculino de 47 años, sin enfermedad cardíaca previa, con diagnóstico de leishmaniasis visceral, que presentó miocarditis, rabdomiólisis y polineuropatía periférica posterior al tratamiento con anfotericina B liposomal. Este caso resalta la importancia de considerar los efectos adversos tras la administración de anfotericina B liposomal.

Liposomal amphotericin B has been used to replace amphotericin B deoxycholate to reduce its associated adverse effects, especially nephrotoxicity. We present the case of a 47-year-old male patient without known previous heart disease with a diagnosis of visceral leishmaniasis, who presented myocarditis, rhabdomyolysis and peripheral polyneuropathy after starting treatment with liposomal amphotericin B. This case highlights the importance of other adverse effects to consider, such as cardiotoxicity, related to the administration of liposomal amphotericin B and other effects not previously reported such as peripheral polyneuropathy.

Chronic nonbacterial osteomyelitis in children: a multicenter case series.

Chronic nonbacterial osteomyelitis (CNO) is a primary autoinflammatory bone disease that presents more frequently in children and is characterized by inflammatory bone lesions in the absence of an infectious etiology. There is little information of this disease in Latin America. The objective of the study was to evaluate demographic, clinical, laboratory, imaging, histopathology characteristics, and treatment responses of pediatric CNO patients. The clinical records of 19 patients with CNO diagnosed between 2007 and 2019 at three tertiary centers in Santiago, Chile were reviewed. The median age of onset was 10 years and 47% were female. Median delay in diagnosis was 12 months. All patients had a pattern of recurrent multifocal disease. 37% of patients had positive antinuclear antibodies and 16% HLA-B27 positivity. 21% of patients presented arthritis or other rheumatologic comorbidity, although no association with psoriasis, inflammatory bowel disease (IBD) or palmoplantar pustulosis (PPP) was observed. Eighteen patients received treatment with nonsteroidal anti-inflammatory drugs with partial response. Twelve patients received methotrexate, and half of them received steroids at the same time reaching remission in 50%. Of the five patients who received bisphosphonates, 60% achieved remission. All four patients who received adalimumab had comorbid arthritis and 75% achieved remission. In a series of Chilean children with CNO, all patients presented with multifocal lesions. Comorbid autoimmune diseases including arthritis were frequent, but no association was observed with psoriasis, IBD, or PPP.

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...

Tablas percentiles de peso al nacer y diagnóstico de retardo de crecimiento intrauterino en el Hospital Regional de Ica, 2010-2011 / Percentile tables weight at birth and diagnosis of intrauterine growth retardation in the Regional Hospital in Ica, 2010-2011

Objetivo: Con el objeto de valorar las diferentes tablas de curvas percentiles de peso usadas en nuestro medio para el diagnóstico nutricional de los recién nacidos en el Hospital regional de Ica, sobre todo de los desnutridos. Material y métodos. Fueron evaluadas 830 madres con sus recién nacidos, a los que se pesó, tallo y calculó su edad gestacional; catalogandolos luego como: con peso adecuado, pequeño o grande para su edad gestacional, priorizando pequeños para Edad Gestacional; para ello se usaron 6 tablas percentiles, posteriormente se compararon los resultados con cada una de ellas. Resultados. Hubieron diferencias significativas en el diagnostico nutricional, la tabla NACIONAL permitió identificar 16, 36% PEG, la concordancia fue alta entre las tablas NACIONAL con las de LIMA Y TACNA (0,87 Y 0,90), al usar la tabla NACIONAL como patrón de oro la de TACNA y de LIMA dieron los más adecuados cocientes de probabilidad positivo y negativo (CP+ 45,93 y CP- 0,08 la de TACNA); las  reas bajo la curva ROC fueron también mayores con las tablas de TACNA (0,986) y LIMA (0,980). Conclusión: Podría adoptarse la tabla percentilar NACIONAL o la de TACNA, aunque se debe considerar la elaboración de tablas locales dadas las diferencias encontradas.

Objective. With the objective of assessing the different tables of percentile curves used in our circlefor the nutritional diagnostic of newborns in the Regional Hospital in Ica, Especially for the undernourished. Material and methods: Were evaluated 830 mothers with their newborns, who are weight, stem and calculated their gestational age; cataloguethen as: with proper weight, small or large for gestational age, prioritizing small for gestational age; for it were used 6 percentile tables were then compared the results with each one of them. Results: There were significant differences in the nutritional diagnostic, the NATIONAL table allowed us to identify 16,36% PEG, the concordance was high among the tables with the national of Lima and Tacna (0.89 and 0.90), when using the tables as NATIONAL pattern of the gold of Tacna and LIMA gave the most were also higher with the tables of Tacna (0.986) and LIMA (0.980). Conclusion: The percentile table could be taken or the NATIONAL percentile of Tacna, although it should beconsidered the development of local tables given the differences found.

Erase una vez un niño. El valor del juego en la cura / There was once a child. The value of the Cure Game

A través del presente trabajo, planteamos la eficacia del juego como herramienta terapéutica a partir de un caso clínico de un niño de 5 años al momento de la consulta. El juego tiene una función de estructuración subjetiva mediante el cual se puede transformar el padecimiento. Gracias a esta función, el juego es un medio del que el analista se sirve para realizar el pasaje de la identificación de mente a la identificación lúdica. Para realizar este pasaje, es necesario poder desidentificarse de esos lugares signados por los otros (Mannoni, O., 1979), ya que estos asignan al sujeto un lugar en el deseo del otro. El juego, en tanto instrumento entre el sujeto y el mundo, le permite al sujeto historizarse, y al mismo tiempo separarse de esos lugares signados.

Through this work we question the effectiveness of play as therapeutic tool from acase of a 5 year old at the time of consultation. The game has a subjective structuring function by which you can transform the suffering. With this feature, the game is half of the analyst is served for the passage of identifying mind to identification playful. To make this passage, it is necessary to dis-identify with these places marked by the other (Mannoni, O., 1979), because these map to the subject a place in the other's desire. The game, as an instrument between the subject and the world, allows the subject historicizing, while unsigned separated from those places.

Erase una vez un niño. El valor del juego en la cura / There was once a child. The value of the Cure Game

A través del presente trabajo, planteamos la eficacia del juego como herramienta terapéutica a partir de un caso clínico de un niño de 5 años al momento de la consulta. El juego tiene una función de estructuración subjetiva mediante el cual se puede transformar el padecimiento. Gracias a esta función, el juego es un medio del que el analista se sirve para realizar el pasaje de la identificación de mente a la identificación lúdica. Para realizar este pasaje, es necesario poder desidentificarse de esos lugares signados por los otros (Mannoni, O., 1979), ya que estos asignan al sujeto un lugar en el deseo del otro. El juego, en tanto instrumento entre el sujeto y el mundo, le permite al sujeto historizarse, y al mismo tiempo separarse de esos lugares signados.(AU)

Through this work we question the effectiveness of play as therapeutic tool from acase of a 5 year old at the time of consultation. The game has a subjective structuring function by which you can transform the suffering. With this feature, the game is half of the analyst is served for the passage of identifying mind to identification playful. To make this passage, it is necessary to dis-identify with these places marked by the other (Mannoni, O., 1979), because these map to the subject a place in the others desire. The game, as an instrument between the subject and the world, allows the subject historicizing, while unsigned separated from those places. (AU)

Guía de tratamiento de la artritis idiopática juvenil / Treatment guide of juvenile idiopathic arthritis

Las artritis inflamatorias del niño constituyen un grupo heterogéneo de enfermedades de presentaciones clínicasdiversas y distintas bases genéticas. Esto ha hecho necesario desarrollar protocolos para el mejor manejo de estos cuadros. En este artículo el Grupo Pediátrico de la Sociedad Chilena de Reumatología ha propuesto una Guía clínica de tratamiento de la Artritis Idiopática Juvenil según los actualesCriterios de Clasificación de ILAR (International League of Associatons for Rheumatology), Edmonton 2001.

Inflammatory arthritis in children is a heterogeneous disease group with several clinical signs and different genetic background. This has brought about the need to develop clinical trials to improve disease management. In this article, the Pediatric Group of the Chilean Rheumatology Society has proposed a Clinical Guide for the medical treatment of Juvenile Idiopathic Arthritis, based on the latest Classification Criteria of the International League of Associations for Rheumatology, ILAR, Edmonton 2001.

[Skin prick test of immediate hypersensitivity in a selected Chilean pediatric population sample]. / Pruebas cutáneas de hipersensibilidad inmediata en una población pediátrica seleccionada.

BACKGROUND: Skin prick test (SPT) of immediate hypersensitivity is a main instrument in the diagnosis of allergy. AIM: To demonstrate the applicability of skin prick test in different age groups. PATIENTS AND METHODS: We studied children and adolescents with the diagnosis of allergy in the Pediatric Respiratory Laboratory of the Catholic University of Chile, from January 2001 to March 2002. The SPT was performed using a standardized technique. The allergens were applied on the volar surface of the forearm in children older than 4 years of age and in younger children it was applied on their back. For study purposes we separated them into three age groups: GI < or =2 years and 11 months, GII from 3 to 4 years and 11 months, GIII > or =5 years. RESULTS: We studied 408 children, aged between 8 months and 15 years. The SPT was applied to all patients with no adverse effects of any kind. There was a positive reaction in 57.7% of children. The reaction was positive in 37% in G1, 39% in GII and 65% in GIII (p <0.001). The predominant allergens for each group were dust mites (Dermatophagoides pteronissinus and farinae). CONCLUSIONS: SPT was useful when used on a selected pediatric population. The frequency of sensitization increased significantly with age. However, more than one third of children between 2 and 4 years of age tested positive to one or more allergen, demonstrating its applicability in this age group.

[Clinical findings and immunologic variability in 9 patients with DiGeorge syndrome]. / Manifestaciones clínicas y variabilidad inmunológica en nueve pacientes con síndrome de DiGeorge.

BACKGROUND: DiGeorge syndrome is characterized by developmental defects of the heart, parathyroid glands and thymus. AIM: To describe the clinical variability of DiGeorge syndrome and its relation with immunodeficiency. PATIENTS AND METHODS: A three years retrospective chart review from three hospitals of Santiago, Chile was conducted. We included patients with neonatal diagnosis of DiGeorge syndrome. Clinical and immunologic data were collected from their initial evaluation. RESULTS: We found 9 patients with DiGeorge syndrome. All had dysmorphic facies, hypocalcemia and congenital heart disease. Three patients had hypoparathyroidism, 4 had interrupted aortic arch type B, 4 had tetralogy of Fallot and 1 had coarctation of aorta. Six patients had other malformations and associated diseases. FISH studies, performed in 8 patients, found the 22q11.2 microdeletion in all. Most patients had low CD3, CD4 and CD8 T cell counts, that ranged for CD3 T cells, between 256/mm3 and 3,664/mm3, for CD4 T cells, between 224/mm3 and 2,649/mm3, for CD8 T cells, between 26/mm3 and 942/mm3. Three patients had CD4 T cells counts <400/mm3 and one had a phytohemagglutinin stimulation index <10. Airway malformations and primary hypoparathyroidism were present in 3 out of 4 patients that died before 18 months compared with the surviving patents (p=0.048). CONCLUSIONS: We found variable clinical manifestations as well as CD3, CD4 and CD8 T cell counts in patients with DiGeorge syndrome. Airway malformations were associated with a higher mortality.