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La hepatitis autoinmunitaria es una enfermedad inflamatoria crónica del hígado caracterizada por una interacción compleja entre factores genéticos, respuesta inmunitaria a antígenos presentes en los hepatocitos y alteraciones de la regulación inmunitaria. Presenta una distribución global, con predominio en individuos de sexo femenino. Se clasifica en dos grupos, según el tipo de autoanticuerpos séricos detectados. La forma de presentación más frecuente es la hepatitis aguda (40 %), con síntomas inespecíficos, elevación de aminotransferasas e hipergammaglobulinemia. El tratamiento estándar consiste en la administración de fármacos inmunosupresores. Es una patología compleja, a veces difícil de diagnosticar. Si no se trata de manera adecuada, la mortalidad puede alcanzar el 75 % a los 5 años de evolución.

Autoimmune hepatitis (AIH) is a chronic inflammatory condition of the liver characterized by a complex interaction among genetic factors, immune response to antigens present in hepatocytes, and immune regulation alterations. Its distribution is global and there is a female predominance. AIH is divided into 2 groups, depending on the type of serum autoantibodies detected. The most common presentation is acute hepatitis (40%), with nonspecific symptoms, high aminotransferase levels, and hypergammaglobulinemia. Standard treatment consists of the administration of immunosuppressive drugs. It is a complex condition, often difficult to diagnose. If not managed adequately, the 5-year mortality rate may reach 75%.

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Autoimmune hepatitis (AIH) is a chronic inflammatory condition of the liver characterized by a complex interaction among genetic factors, immune response to antigens present in hepatocytes, and immune regulation alterations. Its distribution is global and there is a female predominance. AIH is divided into 2 groups, depending on the type of serum autoantibodies detected. The most common presentation is acute hepatitis (40%), with non-specific symptoms, high aminotransferase levels, and hypergammaglobulinemia. Standard treatment consists of the administration of immunosuppressive drugs. It is a complex condition, often difficult to diagnose. If not managed adequately, the 5-year mortality rate may reach 75%.

La hepatitis autoinmunitaria es una enfermedad inflamatoria crónica del hígado caracterizada por una interacción compleja entre factores genéticos, respuesta inmunitaria a antígenos presentes en los hepatocitos y alteraciones de la regulación inmunitaria. Presenta una distribución global, con predominio en individuos de sexo femenino. Se clasifica en dos grupos, según el tipo de autoanticuerpos séricos detectados. La forma de presentación más frecuente es la hepatitis aguda (40 %), con síntomas inespecíficos, elevación de aminotransferasas e hipergammaglobulinemia. El tratamiento estándar consiste en la administración de fármacos inmunosupresores. Es una patología compleja, a veces difícil de diagnosticar. Si no se trata de manera adecuada, la mortalidad puede alcanzar el 75 % a los 5 años de evolución.

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Resumen: Actualmente estamos viviendo una pandemia causada por un nuevo agente infeccioso, coronavirus SARS-CoV-2, también conocido como COVID-19. Agente de alta contagiosidad y moderada letali dad, se ha diseminado rápidamente alrededor del mundo. Los pacientes con patología crónica y el personal de salud son grupos particularmente vulnerables frente a este agente. De ahí la relevancia de desarrollar estrategias preventivas y difundirlas ampliamente. El presente documento generado a solicitud del Directorio de la Rama de Gastroenterología infantil de la SOCHIPE tiene como objetivo entregar herramientas a los profesionales de la salud que trabajan con niños para tomar la mejor de cisión al momento de enfrentar a un paciente que requiera un procedimiento endoscópico o maneje a un paciente con sospecha o diagnóstico de enfermedad inflamatoria intestinal poder realizar en forma correcta la prevención de COVID-19.

Abstract: A pandemic disease caused by a new infectious agent, SARS-CoV-2 coronavirus, also known as CO- VID-19 is currently an urgent Public Health problem. This highly contagious and moderate lethal agent is rapidly spreading worldwide. Patients with chronic diseases and health care personnel are particularly vulnerable groups to this virus. Hence the importance of developing preventive strategies and disseminating them widely. This document, generated at the request of the Pediatric Gastroen terology Branch Directory of SOCHIPE, aims to provide tools for health care professionals working with children to make the best decision when faced with a patient requiring an endoscopic procedure or managing a patient with suspected or diagnosed Inflammatory Bowel Disease to properly prevent COVID-19.

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Resumen: El brote del virus SARS-CoV-2 que comenzó a fines del año 2019 en China, se ha expandido a Chile y al mundo rápidamente. Hasta la fecha, en Chile, ha afectado a 18.435 personas con una letalidad en adultos de 1,4%. Los pacientes pediátricos con enfermedades hepáticas crónicas son también susceptibles a COVID-19 y podrían tener una peor evolución. El objetivo es entregar recomendaciones sobre el tratamiento médico de pacientes pediátricos con daño hepático crónico (DHC), hepatitis autoinmune (HAI), Enfermedad de hígado graso no alcohólico (EHGNA) y trasplantados hepáticos (TH) en relación a COVID-19. Lo primordial es evitar el contagio y para esto, lo más importante es el lavado de manos, uso de mascarilla en espacios públicos y cerrados, como el distanciamiento social y evitar contacto con personas sintomáticas. Los pacientes con DHC, HAI, EHGNA y TH deben evitar los controles presenciales y favorecer la telemedicina. No existe evidencia que recomiende la modifi cación del tratamiento basal en estos casos. En pacientes COVID-19 (+) se recomienda medidas de aislamiento, preferir uso de paracetamol como antipirético y analgésico y en el manejo de la inmunosupresión, debe considerarse cada caso de forma individual, según gravedad y con evaluación del especialista. Además, se revisan las actuales terapias específicas para COVID-19 y sus precauciones en pacientes con hepatopatías. Las medidas de prevención del contagio, aislamiento social y diagnóstico precoz son fundamentales en pacientes con enfermedad hepática y el riesgo de infección por SARS- CoV-2.

Abstract: The SARS-CoV-2 virus outbreak, which began in late 2019 in China, has spread very quickly to Chile and worldwide. In Chile, we currently have around 18,435 people infected with 1.4% of adult mor tality. Pediatric patients with chronic liver diseases (CLD) are susceptible as well to COVID-19 and could have a worse prognosis. The objective is to give recommendations about medical treatment to pediatric patients with chronic liver disease (CLD), autoimmune hepatitis (AIH), Non- Alcoholic fatty liver disease (NAFLD), and liver transplant in the context of COVID-19. The most important issue in the management of these patients is to avoid exposure to the virus, hand washing, the use of face masks in public and closed places, as well as social distancing, and avoiding contact with positive COVID-19 patients. In Children with CLD, AIH, NAFLD, and liver transplant, outpatient follow-up should be avoided when possible and replaced with videoconference consultation. No evidence re commends modifications to their baseline treatment. Positive COVID-19 patients should be isolated, the use of paracetamol as an antipyretic and analgesic and modifications to immunosuppressant drugs should be seen by the specialist in a case to case basis according to its severity. In addition, we reviewed current specific therapies for COVID-19 and their precautions in patients with liver disease. Protective measures, social distancing, and early diagnosis are very important in patients with liver disease to decrease the risk of SARS-CoV-2 infection.

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Resumen: SARS-CoV-2 es un virus de alta estabilidad ambiental. Es principalmente un patógeno respiratorio que también afecta el tracto gastrointestinal. El receptor ACE2 es el principal receptor de SARS- CoV-2, hay evidencia de su elevada presencia en intestino, colon y colangiocitos; igualmente se en cuentra expresado en hepatocitos pero en menor proporción. SARS-CoV-2 tiene un tropismo gas trointestinal que explica los síntomas digestivos y la diseminación viral en deposiciones. Las caracte rísticas de SARS-CoV-2 incluyen a la proteína S (Spike o Espícula) que se une de forma muy estable al receptor ACE2. La infección por SARS-CoV-2 produce disbiosis y alteraciones en el eje pulmón- intestino. A nivel intestinal y hepático produce una respuesta Linfocitos T evidente y una respuesta de citocinas que producirían daño intestinal inflamatorio. Las manifestaciones a nivel intestinal en orden de frecuencia son pérdida de apetito, diarrea, náuseas, vómitos y dolor abdominal. Éste último podría ser un marcador de gravedad. En niños la diarrea es habitualmente leve y autolimitada. A nivel hepático la hipertransaminasemia ocurre en 40-60% de los pacientes graves. SARS-CoV-2 puede per manecer en deposiciones un tiempo más prolongado que en secreciones respiratorias, este hallazgo influiría en la diseminación de enfermedad. En esta revisión se destaca la importancia de efectuar un reconocimiento precoz de las manifestaciones gastrointestinales y hepáticas, aumentar el índice de sospecha, efectuar un diagnóstico oportuno y reconocer eventuales complicaciones de la enferme dad. La potencial transmisión fecal oral puede influir en la diseminación de enfermedad. Reconocer este hallazgo es importante para definir aislamiento.

Abstract: SARS-CoV-2 is a high environmental stable virus. It is predominantly a respiratory pathogen that also affects the gastrointestinal tract. The ACE 2 receptor is the main receptor of SARS-CoV-2, with evidence of its high presence in the intestine, colon and cholangiocytes, and, in smaller proportion, in hepatocytes. SARS-CoV-2 has a gastrointestinal tropism that explains digestive symptoms and viral spread in stools. The characteristics of this virus include the S (Spike) protein that binds very stably to the ACE-2 receptor and, at the same time, SARS-CoV-2 produces dysbiosis and alterations in the gut-lung axis. It produces a clear T-cell response and a cytokines storm in the intestine and liver that would produce inflammatory bowel damage. Intestinal manifestations by order of frequency are loss of appetite, diarrhea, nausea and vomiting, and abdominal pain, where the latter could be a severity marker. In children, diarrhea is the most frequent symptom, usually mild and self-limiting. In the liver, hypertransaminasemia occurs in severe patients ranging from 40 to 60%. SARS-CoV-2 can re main in stools longer than in respiratory secretions, which would influence the spread of disease. This article highlights the importance of an early diagnosis of gastrointestinal and hepatic manifestations, increase the index of suspicion, make a timely diagnosis, and recognize eventual complications of the disease. The potential oral-fecal route of transmission may influence the disease spread. Recognizing this finding is important to define isolation.

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SARS-CoV-2 is a high environmental stable virus. It is predominantly a respiratory pathogen that also affects the gastrointestinal tract. The ACE 2 receptor is the main receptor of SARS-CoV-2, with evidence of its high presence in the intestine, colon and cholangiocytes, and, in smaller proportion, in hepatocytes. SARS-CoV-2 has a gastrointestinal tropism that explains digestive symptoms and viral spread in stools. The characteristics of this virus include the S (Spike) protein that binds very stably to the ACE-2 receptor and, at the same time, SARS-CoV-2 produces dysbiosis and alterations in the gut-lung axis. It produces a clear T-cell response and a cytokines storm in the intestine and liver that would produce inflammatory bowel damage. Intestinal manifestations by order of frequency are loss of appetite, diarrhea, nausea and vomiting, and abdominal pain, where the latter could be a severity marker. In children, diarrhea is the most frequent symptom, usually mild and self-limiting. In the liver, hypertransaminasemia occurs in severe patients ranging from 40 to 60%. SARS-CoV-2 can re main in stools longer than in respiratory secretions, which would influence the spread of disease. This article highlights the importance of an early diagnosis of gastrointestinal and hepatic manifestations, increase the index of suspicion, make a timely diagnosis, and recognize eventual complications of the disease. The potential oral-fecal route of transmission may influence the disease spread. Recognizing this finding is important to define isolation.

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Resumen Gleditsia amorphoides (Griseb.) Taub. es una especie arbórea nativa de Sudamérica, conocida por su madera de buena calidad y por los frutos que contienen una goma de utilización industrial. Una de las causas de la disminución de la producción de semillas viables en árboles forestales es el daño ocasionado por depredadores de frutos y semillas. La relación entre producción de frutos y depredadores no es conocida para G. amorphoides. Por lo tanto, en este trabajo se evaluó la producción de frutos en árboles de esta especie y la abundancia de ejemplares pertenecientes a la Subfamilia Bruchinae asociada a la misma. El estudio se efectuó en tres localidades ubicadas en la provincia de Formosa en el noreste de Argentina durante tres años consecutivos. Se halló una especie de Bruchinae, identificada como Bruchidius endotubercularis Arora. Los resultados mostraron la existencia de variabilidad en la producción de frutos entre los años, no así entre localidades, mientras que la abundancia de insectos se mantuvo constante, no respondiendo a la variación en la producción de frutos entre años. En este trabajo se reporta por primera vez la presencia de B. endotubercularis asociado a G. amorphoides en Argentina.

Abstract Gleditsia amorphoides (Griseb.) Taub. is a tree species native to South America. It is known for its good quality wood and for its fruits that contain a rubber for industrial uses. One of the causes for the reduction of the production of viable seeds in forest trees is the damage caused by predators of fruits and seeds. The relationship between fruit production and predators is not known for G. amorphoides. Therefore, in this study, we evaluated the fruit production in this three species and the abundance of specimens of the Subfamily Bruchinae associated to G. amorphoides. The study was carried out in three localities of the Formosa Province in the Northeast of Argentina for three consecutive years. We found a single species of Bruchinae, identified as Bruchidius endotubercularis Arora. The results showed the existence of variability in the production of G. amorphoidesfruits between years, but not between locations. The abundance of insects remained constant, not responding to the variation in the production of fruits between years. In this study, we report for the first time, the occurrence of B. endotubercularis associated with G. amorphoides in Argentina. Rev. Biol. Trop. 66(3): 1046-1054. Epub 2018 September 01.

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Pediatric acute liver failure is a syndrome ofsevere and sudden dysfunction of the hepatocytes which produces a failure in synthetic and detoxifyingfunction. It is an infrequent and severe disease butpotentiallyfatal, occurring in children with no prior history of liver disease. Etiology is related to the age and geographic region of the patient, recognizing the origin: metabolic, infectious, drug exposure, autoinmune, vascular and oncologic. Indeterminate cause where all the etiological search is negative, can range between 18 and 47%, depending on the center and access to the realization of etiological studies. The process which determines the liver injury is still not well known and is considered multifactorial. Essentially, it depends on host susceptibility, the cause and severity of the damage and the ability of liver regeneration. The clinical presentation depends on the etiology, which usually begins with an episode ofacute hepatitis, that in the following days or weeks presents unfavorable outcome, deepening jaundice, affecting the general state and presenting severe coagulopathy that characterizes the syndrome. The treatment consists of general measures which take into account the metabolic disorders, nutritional aspect, and the prevention and treatment of all complications that occur in the evolutionary course (infectious, neurological, etc). Besides it is also vital to implement the specific treatment of those diseases which can benefit from it (alloimmune hepatitis, galactosemia, tyrosinemia, herpes simplex infection, Wilson's disease, etc.). However, despite therapeutic advances, acute liver failure results in death or liver transplantation in over 45% ofcases.

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El uso de estrógeno en pacientes con Lupus Eritematoso Sistémico (LES) sigue siendo un tema en discusión, debido a los múltiples efectos que esta hormona puede tener en el sistema inmune; entre los cuales incluso se ha postulado un rol promotor de esta enfermedad. Se presenta el caso de una paciente de 28 años con diagnóstico de LES, asociado a falla ovárica y osteoporosis en la cual se debe utilizar terapia de reemplazo hormonal (TRH) y se discuten sus posibles consecuencias.

Estrogen use in patients with Systemic Lupus Erythematosus (SLE) is still a matter under discussion, due to the multiple effects that this hormone can have on the immune system; it has been postulated a promoter role of this disease. The case of a patient of 28 years with a diagnosis of SLE associated with ovarian failure and osteoporosis in which to use hormone replacement therapy (HRT) and its possible consequences are discussed is presented.

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Presents a case of a young woman with a recent diagnose of systemic lupus erythematosus (SLE), with a sligth initial skin condition that envolves into toxic epidermal necrolysis (TENS): On account of this case, areview is presented of the physiopathology, clinical presentation and treatment of this infrequent form of dermatological manifestation of (SLE).

Se presenta el caso de una joven con diagnóstico reciente de lupus eritematoso sistémico (LES), con compromiso cutáneo inicial leve que evoluciona hacia necrolisis epidérmico tóxica (NET). A propósito de ello, se revisa la fisioptología, presentación clínica y tratamiento de esta infrecuente forma de manifestación dermatológica de LES.

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This study is part of the Floristic and Forest Inventory of Santa Catarina, conceived to evaluate forest resources, species composition and structure of forest remnants, providing information to update forest conservation and land use policy in Southern Brazilian State of Santa Catarina (95 000 km2). In accordance to the Brazilian National Forest Inventory (IFN-BR), the inventory applies systematic sampling, with 440 clusters containing four crosswise 1 000m2 plots (20 x 50m) each, located on a 10 x 10km grid overlaid to land use map based on classification of SPOT-4 images from 2005. Within the sample units, all woody individuals of the main stratum (DBH > or = 10cm) are measured and collected (fertile and sterile), if not undoubtedly identified in field. Regeneration stratum (height > 1.50m; DBH < 10cm) is registered in 100m2 in each sample unit. Floristic sampling includes collection of all fertile trees, shrubs and herbs within the sample unit and in its surroundings. This study performs analysis based on 92 clusters measured in 2008 within an area of 32320km2 of mixed ombrophyllous forests with Araucaria angustifolia located at the state's high plateau (500m to 1 560m above sea level at 26 degrees 00'-28 degrees 30' S and 49 degrees 13'-51 degrees 23' W). Mean density (DBH > or = 10cm) is 578 individuals/ha (ranging from 85/ha to 1 310/ha), mean species richness in measured remnants is 35 (8 to 62), Shannon and Wiener diversity index (H') varies between 1.05 and 3.48. Despite high total species diversity (364 Magnoliophyta, five Coniferophyta and one tree fern) and relatively high mean basal area (25.75m2/ha, varying from 3.87 to 68.85m2/ha), the overwhelming majority of forest fragments are considered highly impacted and impoverished, mostly by logging, burning and extensive cattle farming, turning necessary more efficient protection measures. Basal area was considered an appropriate indicator for stand quality and conservation status.

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This study is part of the Floristic and Forest inventory of Santa Catarina, conceived to evaluate forest resources, species composition and structure of forest remnants, providing information to update forest conservation and land use policy in Southern Brazilian State of Santa Catarina (95 000km²). In accordance to the Brazilian National Forest inventory (IFN-BR), the inventory applies systematic sampling, with 440 clusters containing four crosswise 1 000m² plots (20x50m) each, located on a 10x10km grid overlaid to land use map based on classification of SPOT-4 images from 2005. Within the sample units, all woody individuals of the main stratum (DBH≥10cm) are measured and collected (fertile and sterile), if not undoubtedly identified in field. Regeneration stratum (height>1.50m; DBH<10cm) is registered in 100m² in each sample unit. Floristic sampling includes collection of all fertile trees, shrubs and herbs within the sample unit and in its surroundings. This study performs analysis based on 92 clusters measured in 2008 within an area of 32 320km² of mixed ombrophyllous forests with Araucaria angustifolia located at the state’s high plateau (500m to 1 560m above sea level at 26º00’-28º30’ S and 49º13’-51º23’ W). Mean density (DBH≥10cm) is 578 individuals/ha (ranging from 85/ha to 1 310/ha), mean species richness in measured remnants is 35 (8 to 62), Shannon and Wiener diversity index (H’) varies between 1.05 and 3.48. Despite high total species diversity (364 Magnoliophyta, five Coniferophyta and one tree fern) and relatively high mean basal area (25.75m²/ha, varying from 3.87 to 68.85m²/ ha), the overwhelming majority of forest fragments are considered highly impacted and impoverished, mostly by logging, burning and extensive cattle farming, turning necessary more efficient protection measures. Basal area was considered an appropriate indicator for stand quality and conservation status. Rev. Biol. Trop. 59 (3): 1371-1387. Epub 2011 September 01.

Este estudio es parte del inventario Florístico Forestal de Santa Catarina, realizado para evaluar los recursos forestales, la composición de especies y la estructura de remanentes de bosque, y proporciona información para actualizar la conservación de los bosques y políticas de uso de la tierra en el estado brasileño de Santa Catarina (95 000km²). El inventario se aplica al muestreo sistemático, de 440 conglomerados en cuatro parcelas de 1 000m² cada una, situados en una red de 10x10km. Dentro de las parcelas, todos los individuos leñosos (DAP≥10cm) fueron medidos. El estrato de regeneración (altura>1.50m, DAP<10cm) se registra en 100m² en cada conglomerado. Este estudio realiza un análisis de 92 conglomerados medidos en 2008 dentro de un área de 32 320km² de bosques ombrófilos mixtos con Araucaria angustifolia ubicados en el altiplano del estado. La densidad media (DAP≥10cm) es de 578 individuos/ha (desde 85/ha hasta 1 310/ha), la media de la riqueza de especies en los remanentes es de 35 (8-62), la diversidad (H’) de Shannon y Wiener varía entre 1.05 y 3.48. A pesar de la alta diversidad total de especies (364 Magnoliophyta, cinco Coniferophyta y un helecho arborescente) y el alto promedio del área basal (25.75m²/ha, variando de 3.87 a 68.85m²/ha), la mayoría de los fragmentos de bosque se consideran altamente impactados por la tala, quema y ganadería extensiva, por lo tanto es necesario más medidas eficaces de protección.

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The purpose of the study was to describe the demographics, the causes of amputations, the amputation levels, the clinical outcomes, the durability of prostheses in unilateral lower limb amputee among workers entitled to non-state related work insurance, the ACHS, Chile, between 1974 and 2001. It was a retrospective descriptive study based on selected clinical files. One hundred files, with the minimal data required, were selected with a diagnosis of traumatic lower limb amputation, the levels ranging from Boyd's foot amputation to hip disarticulation, as defined by the Occupational Accidents Act from 1974 to December 2001. The mean age was 35.5 years, 96% were males, with an average follow-up of 7.7 years. In 50% of the cases the education level did not exceed elementary school. Ninety-eight percent were blue collar workers. The traumatic injury resulting in amputation took place during work in 89% of the cases the main causes being crushing injury (50%), traffic accident (19%), run over by car (14%) and burns (6%). The most common amputation levels were trans-femoral (40%) and trans-tibial (47%). Amputations were performed within the first 24 h in 49% of the cases. The hospitalization stay reached 8 weeks in 56.7%. Early complications were dehiscence (9.4%), superficial infection, (14.6%) and deep infection (26%). Late complications detected were soft tissue lesions (34.1%), exostosis (3.6%), painful neuroma (12.5%) and phantom limb pain (12.5%). Prostheses durability was on average 3 years. The average period to resume work was 1 year for 60% of the cases.

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BACKGROUND: Pediatric noninvasive ventilation (NIV) is infrequently used for acute respiratory failure (ARF), BiPAP/CPAP applied through nasal mask can be attempted if strict selection rules are defined. AIM: To evaluate the outcome of NIV in a Pediatric Intermediate Care Unit. MATERIAL AND METHODS: The medical records of 14 patients (age range 1 month-13 years, six female), who participated in a prospective protocol of NIV from January to October 2004, were reviewed. Oxygen therapy, delivered through a reservoir bag attached to the ventilation circuit, was used to maintain SaO2 over 90%. RESULTS: The main indication of BiPAP, in 80% of cases, was pulmonary restrictive disease. Indications of NIV were acute exacerbations in patients with chronic domiciliary NIV in three patients, hypoxic ARF in six and hypercapnic ARF in five. The diagnoses were pneumonia/atelectasis in seven patients, bilateral extensive pneumonia in three, RSV bronchiolitis in two, apnea in one, and asthma exacerbation in one. Only one patient required intubation for mechanical ventilation, all others improved. The procedures did not have complications. NIV lasted less than three days in 5 patients, 4 to 7 days in four patients and more than 7 days in five. One third of the patients required fiberoptic bronchoscopy for massive or lobar atelectasis and one third remained on domiciliary NIV program. CONCLUSIONS: NIV can be useful and safe in children with ARF admitted to a Pediatric Intermediate Care Unit. If strict inclusion protocols are followed, NIV might avoid mechanical ventilation.

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