RESUMEN
BACKGROUND: Early recognition of rheumatoid arthritis (RA) provides clinical benefits in terms of remission induction, reduced disease progression, and eventually treatment free remission. AIM: To describe the setting of a Unit devoted exclusively to the recognition and treatment of early RA in patients referred from primary healthcare centers (PHC) in Chile. MATERIALS AND METHODS: Patients were referred from nine participating PHC from 2014 through 2016. PHC physicians received a formal training to enhance criteria recognition and program adherence. Mandatory referral criteria were an age above 17 years, and arthralgia of less than 1-year duration, plus at least one of the following: morning stiffness of more than 30 minutes, swelling involving more than 3 joints for more than 1 month, a positive squeeze test or abnormal inflammatory serum markers. RESULTS: One hundred twenty patients aged 45 ± 12 years (90% women) were assessed at the early rheumatoid arthritis unit. Median time to referral from PHC to the Unit was 14.6 days. The median duration of symptoms for the overall sample of patients was 10.8 months. RA was identified in 43 patients (36%), with a delay between onset of symptoms and diagnosis of 8.3 months. Regarding the performance of referral criteria, the most sensitive was morning stiffness (80%, sensitivity 95% confidence intervals (CI) 64-89%) and synovitis was the most specific (specificity 83%, 95% CI 72-90%). The positive predictive value of the three clinical criteria altogether was 68.1% (95% CI 47-83%). CONCLUSIONS: Institution of an early RA unit was feasible within the Chilean healthcare system enabling the identification of early RA in one-third of patients.
Asunto(s)
Artritis Reumatoide/diagnóstico , Atención Integral de Salud , Diagnóstico Precoz , Artritis Reumatoide/terapia , Chile , Femenino , Accesibilidad a los Servicios de Salud , Humanos , Masculino , Persona de Mediana Edad , Atención Primaria de Salud , Enfermedades Reumáticas/clasificación , Enfermedades Reumáticas/diagnóstico , Enfermedades Reumáticas/terapia , Sensibilidad y EspecificidadRESUMEN
Background: Early recognition of rheumatoid arthritis (RA) provides clinical benefits in terms of remission induction, reduced disease progression, and eventually treatment free remission. Aim: To describe the setting of a Unit devoted exclusively to the recognition and treatment of early RA in patients referred from primary healthcare centers (PHC) in Chile. Materials and Methods: Patients were referred from nine participating PHC from 2014 through 2016. PHC physicians received a formal training to enhance criteria recognition and program adherence. Mandatory referral criteria were an age above 17 years, and arthralgia of less than 1-year duration, plus at least one of the following: morning stiffness of more than 30 minutes, swelling involving more than 3 joints for more than 1 month, a positive squeeze test or abnormal inflammatory serum markers. Results: One hundred twenty patients aged 45 ± 12 years (90% women) were assessed at the early rheumatoid arthritis unit. Median time to referral from PHC to the Unit was 14.6 days. The median duration of symptoms for the overall sample of patients was 10.8 months. RA was identified in 43 patients (36%), with a delay between onset of symptoms and diagnosis of 8.3 months. Regarding the performance of referral criteria, the most sensitive was morning stiffness (80%, sensitivity 95% confidence intervals (CI) 64-89%) and synovitis was the most specific (specificity 83%, 95% CI 72-90%). The positive predictive value of the three clinical criteria altogether was 68.1% (95% CI 47-83%). Conclusions: Institution of an early RA unit was feasible within the Chilean healthcare system enabling the identification of early RA in one-third of patients.
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Artritis Reumatoide/diagnóstico , Atención Integral de Salud , Diagnóstico Precoz , Atención Primaria de Salud , Artritis Reumatoide/terapia , Chile , Enfermedades Reumáticas/clasificación , Enfermedades Reumáticas/diagnóstico , Enfermedades Reumáticas/terapia , Sensibilidad y Especificidad , Accesibilidad a los Servicios de SaludRESUMEN
Acute interstitial nephritis is a mononuclear and sterile inflammation of the renal interstice caused by drugs, infections or immune phenomena. The clinical presentation is characterized by the triad of rash, fever and eosinophilia. We report a 32 years old man, in treatment with lamotrigine for depression, admitted to the hospital due to fever, abdominal pain, jaundice, cutaneus rash and malaise. Due to an oliguric renal failure of acute onset, a renal biopsy was done. The pathological study showed a granulomatous acute interstitial nephritis. He was started on hemodialysis and treated with cessation of the drug and corticosteroids, with complete recovery of the renal function.
Asunto(s)
Antidepresivos/efectos adversos , Granuloma/inducido químicamente , Nefritis Intersticial/inducido químicamente , Triazinas/efectos adversos , Enfermedad Aguda , Adulto , Granuloma/patología , Humanos , Riñón/ultraestructura , Lamotrigina , Masculino , Nefritis Intersticial/patologíaRESUMEN
Hemolytic-uremic syndrome (HUS) is an uncommon complication of pneumococcal infection. Highly suggesting findings in a patient with Streptococcus pneumoniae infection are: microangyopatic hemolytic anemia, thrombocytopenia and acute renal failure. We report a 41 years old woman, admitted to the hospital due to a severe pneumonia, that required the surgical drainage of an empyema. On admission, a drop in packed red cell volume from 41 to 25%, the presence of schistocytes in the blood smear, an elevation of LDH to 1,700 IU/L, a fall in haptoglobin to 5.8 mg/dL and a thrombocytopenia of 72,000 per mm3 were detected. These alterations coincided with an oliguric acute renal failure. She was treated with hemodialysis and the hemolytic syndrome was managed with plasmapheresis. She was discharged 35 days after admission and in the follow up, after 2.5 months, her serum creatinine is 1.2 mg/dL and her packed red cell volume is 41%.
Asunto(s)
Síndrome Hemolítico-Urémico/etiología , Neumonía Neumocócica/complicaciones , Adulto , Femenino , Síndrome Hemolítico-Urémico/terapia , Humanos , Plasmaféresis , Neumonía Neumocócica/terapia , Diálisis RenalRESUMEN
The disease by Hanta virus has a recent diagnose in our country. 218 cases have been reported to date and given its high mortality of 44 percent, a great epidemiological campaign has been implemented, for its isolation and control. The most severe form of this disease, Hanta virus, is the cardio pulmonary syndrome which present characterics that difference it from other similar disorders. The more frequent hemodynamics patrons to find are low cardiac indexes (CI) with pulmonary vascular resistences and elevated (RVS) systemic. On the other hand, the respiratory disorders correspond to a pulmonary edema non cardiogenic, similar to acute respiratory distress syndrome (SDRA). There are few reports of Hanta in pregnant patients described in literature and case present a high rate of fetal and maternal mortality and there is not a clear description of the hemodynamic compromise, or certitude if there is vertical transmission of the virus from the infected mother to the fetus. We described the clinical case of a 12 weeks pregnant patient with cardio pulmonary syndrome due to Hanta virus (SCPH) which shws a different hemodynamics patron than which has been published and who survives both she as well as her child and do not present virus transmission to the fetus
Asunto(s)
Humanos , Adulto , Femenino , Embarazo , Recién Nacido , Orthohantavirus , Infecciones por Hantavirus , Complicaciones Infecciosas del Embarazo , Infecciones por Hantavirus , Hemodinámica , Complicaciones Infecciosas del Embarazo , Edema Pulmonar , Respiración Artificial , Población Rural , Choque Séptico/etiología , Síndrome de Dificultad Respiratoria/etiologíaRESUMEN
El golpe de calor es una entidad clínica que se clasifica dentro de los síndromes hipertérmicos. La hipertermia es el aumento de la temperatura corporal secundaria a un incremento en la producción de calor o a una disminución en su disipación. Presentamos el caso de un hombre joven intoxicado con insecticida organofosforado, que estando en tratamiento con atropina hace hipertermia severa con compromiso de conciencia y disfunción multiorgánica