Juan Cristóbal Gana A

Síndrome hemolítico urémico en Chile: presentación clínica, evolución y factores pronósticos

A cohort of 587 patients aged 2 to 8 years, 48% males, wasanalyzed. Ninety two percent had diarrhea. At the moment of diagnosis, anuria was observed in39% of the patients, hypertension in 45% and seizures in 17%. Forty two percent required renalreplacement therapy (RRT) and peritoneal dialysis was used in the majority of cases (78%). The mostfrequently isolated etiological agent was Escherichia coli. Mortality rate was 2.9% in the acute phaseof the disease and there was a positive correlation between mortality and anuria, seizures, whiteblood cell count (WCC) >20.000/mm

Síndrome hemolítico urémico en Santiago de Chile: Evolución de la función renal y factores pronósticos

Introduccion: El Sindrome Hemolitico Uremico (SHU) se caracteriza por falla renal aguda, anemia hemolitica microangiopatica y trombocitopenia; es la causa mas frecuente de insuficiencia renal aguda en la infancia. Objetivo: a) Describir las caracteristicas actuales del cuadro inicial de SHU en nuestro medio y comparar con lo descrito anteriormente; b) Describir la evolucion a 1 ano plazo y evaluar posibles factores pronosticos de funcion renal. Sujetos y Metodos: Se estudiaron variables demograficas, presentacion clinica, examenes bioquimicos y hematologicos, en 374 pacientes con SHU diagnosticados entre Enero 1990 a Diciempe 2002 en 9 hospitales de la Region Metropolitana; se evaluo ademas funcion renal al ano de seguimiento en una muestra de 213 pacientes y se identificaron factores pronosticos de insuficiencia renal cronica y mortalidad utilizando el analisis de regresion logistica. Resultados: Se analizaron 374 pacientes, 50,5% mujeres, 65,5% de la Region Metropolitana, edad promedio 1,5 ± 1,4 anos (0,2 a 8); 91% presento diarrea, 31% ocurrio en verano, al ingreso 57% presento anuria, 43,3% hipertension arterial y convulsiones 23%. Al alta 28% persistia hipertenso. Las terapias de sustitucion renal utilizadas fueron: dialisis peritoneal (50%), hemodiafiltracion (6%) y hemodialisis (3%); recibio plasmaferesis 1%. Se aislo agente etiologico en 17%, siendo en 69% E. coli enterohemorragica. La mortalidad fue de 2,7%, siendo la causa principal la falla organica multiple. En el seguimiento al ano: 80% mantuvo funcion renal normal, 14% presento deterioro de la funcion renal, 6% proteinuria y 4% hipertension. Se encontro significativo como factor pronostico de dano renal: hipertension arterial (p < 0,0001), necesidad de peritoneodialisis y hemodialisis (p: 0,001, p: 0,0015 respectivamente), anuria (p: 0,005) y convulsiones (p: 0,01). Se correlaciono con mortalidad en la etapa aguda: convulsiones, requerimiento de hemodiafiltracion y plasmaferesis, (p < 0,0001, p: 0,0001 y p < 0,0001 respectivamente). Conclusiones: a) La presentacion clinica de SHU no ha variado en los ultimos 36 anos; b) ha habido una disminucion importante de la mortalidad en la etapa aguda; c) la presencia de hipertension, necesidad de dialisis, anuria y compromiso neurologico fueron factores que se asociaron a mayor morbilidad al ano de seguimiento

Síndrome hemolítico urémico: Experiencia de un centro pediátrico

During the period, 58 patients were admitted with thediagnosis of HUS but only 43 (age range 1 month to 6 years, 22 females) had complete medicalrecords for review. Ninety five percent presented with prodromic diarrhea, mainly dysenteric.Antibiotics were administered to 70%, in the previous days. Acute renal replacement, mainlyperitoneal dialysis, was required in 40%. The clinical signs and laboratory parameters thatcorrelated better with the indication for dialysis were anuria, hypertension, initial andpermanently high serum creatinine and blood urea nitrogen. Four patients with blood ureanitrogen over 100 mg/dl but without anuria or hyperkalemia, were treated conservatively, andexperienced an uneventful course (permissive azotemia). Hospital stay was almost 3 timesgreater in dialyzed than in non dialyzed children. No deaths related to HUS were reported inthe study period. In an average follow up of 54 months, 11.6% of the patients developed chronicrenal failure of diverse magnitude.

Evaluación prospectiva de la seguridad y tolerancia de los procedimientos colonoscópicos en pacientes pediátricos

Prospective study of 123 children referred for colonoscopy. Demographic data,type of colon preparation, sedation, type of endoscope and endoscopic results were obtained.The following day, a phone interview was carried out inquiring about duration, quality andadverse effects of the sedation and procedure.

Enfrentamiento de pacientes pediátricos con várices esofágicas

Background: There is a paucity of good quality research about the diagnosis of esophageal varices and the prophylaxis and treatment of variceal bleeding in pediatric patients with portal hypertension There is little consensus and practically no evidence-based approach about the management of these patients. Aim: To describe the behavior and preferences of pediatric gastroenterologists in Chile in the management of portal hypertension in children. Material and Methods: An online survey was sent to Chilean pediatric gastroenterologists, with questions evaluating the physicians’ approaches to screening of esophageal varices in children with portal hypertension, and their preferred methods of prophylaxis and initial management of variceal bleeding. Results: Thirty five of 69 contacted physicians answered the survey (51%). Twenty nine pediatric gastroenterologists (83%) screen for esophageal varices in patients with clinical evidence of portal hypertension, and 12 (34%) in every patient with chronic liver disease. Twenty eight respondents (80%) use primary prophylaxis, mainly beta blockers. Octreotide, proton pump inhibitors and endoscopy are the most common practices in the initial management of an esophageal varix bleed. The methods mostly used as secondary prophylaxis are band ligation and beta blockers. In the case of recurrent hemorrhage, besides band ligation, management with Transjugular Intrahepatic Portosystemic Shunt (TIPS) and hepatic transplantation are more likely. Conclusions: Even though most pediatric gastroenterologists in this survey are inclined to offer endoscopic screening of esophageal varices and prophylaxis to patients with portal hypertension, this is not a universal behavior. There are different approaches mainly in the election of secondary prophylaxis and the initial management of variceal bleeding.

Evaluación de los índices de monitoreo de pH esofágico y su relación con indicaciones clínicas: MePeache Fase I

Objetivos: Establecer valores promedio y rangos de normalidad de parametros pHmetricos diferentes al Indice de Reflujo (IR) en monitoreos de pH esofagico (MpHe), segun nuevos valores de IR y correlacionarlos con el diagnostico clinico. Pacientes y Metodo: Estudio retrospectivo de parametros de MpHe incluyendo IR, no y duracion de episodios (DPE), no episodios > 5 min y duracion episodio mayor. Se reagrupo a los 153 pacientes segun edad (Grupo I 1 ano) y segun IR como: Grupo Normal (NL) a aquellos con IR en rango fisiologico (IR < 12% GI y < 6% GII) y Grupo Patologico (PT), cuando el IR superaba estos valores. Resultados: Las indicaciones mas frecuentes fueron estudio de RGE (41,7%), patologia de vias aereas (19,9%) y otorrinolaringologicas (17,2%). Al comparar MpHes en GI (n = 53) no se encontraron diferencias significativas segun genero, medico referente o indicacion. En el Grupo NL de GII (n = 100) se encontro un IR en ninos referidos por pediatras mayor al de aquellos referidos por gastroenterologos (p = 0,002). Segun grupos NL y PT, todos los parametros pHmetricos resultaron significativos (p < 0,005), excepto la DPE. 84,9% y 77% de los MpHes en GI y GII, respectivamente fueron normales. Conclusion: Los indices de MpHe permiten separar los grupos NL y PT bajo los nuevos puntos de corte del IR. Existe escaso correlato entre sospecha clinica y diagnostico pHmetrico lo que sugiere la necesidad de reevaluar sus indicaciones clinicas