Prevalence and risk factors for complicated immuno-mediated uveitis: experience in a tertiary hospital.

OBJECTIVE: To describe the characteristics of patients with uveitis and ocular complications in a tertiary hospital. As well as to determine the risk factors for the development of an ocular complication. METHODS: Retrospective study of patients with uveitis evaluated in a Uveitis Unit of the Virgen de las Nieves Hospital from January 2018 to October 2022. A descriptive and analytical study was carried out using logistic regression to know the predictive factors of a poor ocular prognosis. RESULTS: A total of 127 patients were studied, of which 63% were women and 83.5% were Caucasian. The median age was 51 years IQR (15-88) years. Following the SUN classification, uveitis was predominantly bilateral (55.1%) and anterior (52%), had a recurrent evolution in 51,2% and only 12,6% were granulomatous. Of the total uveitis, 74,2% of the sample turned out to have an immune-mediated profile, although a final diagnosis was only reached in 46,1% of the patients. A total of 17,3% patients suffer from loss of vision. Visual complications in decreasing order were: posterior synechiae (15,6%), cystic macular edema (14.8%), cataracts (13,1%), glaucoma (8,2%), epiretinal membranes (4,9%) and neovascular membranes (1,7%) and retinal detachment (4%). In the bivariate analysis, ethnicity other than Caucasian was significant, p = 0,024, and a number of outbreaks greater than 2, p = 0,045. The rest of the variables analyzed were not significant. In the multivariate analysis, they were significant outbreaks OR: 1,2 CI (1,051-1,426) and ethnicity OR: 0,11 CI (0,014-0,938). CONCLUSIONS: The number of outbreaks and non-Caucasian race were related to a greater probability of presenting an ocular complication. An earlier and more specific diagnosis of the etiology, especially in these patients, would allow earlier treatment and improve their prognosis.

Actualización en tratamiento de pioderma gangrenoso: revisión de la literatura / Update on the treatment of pyoderma gangrenosum: literature review

Pioderma gangrenoso es una patología inflamatoria crónica, poco frecuente, de probable etiología autoinmune. Se asocia en 50 por ciento de los casos a múltiples enfermedades sistémicas. En su forma clásica, se presenta como una lesión ulcerativa, dolorosa, habitualmente en extremidades inferiores. El diagnóstico es clínico. La histología es inespecífica, pero permite descartar otras patologías como infecciones o neoplasias. No existe hasta el momento un único tratamiento efectivo para esta enfermedad. Los corticoides sistémicos en dosis continua o en pulsos, son efectivos en la mayoría de los casos. Se reserva el uso de inmunosupresores para los casos refractarios a tratamiento. Las nuevas terapias biológicas han mostrado buenos resultados, especialmente en pacientes con enfermedad inflamatoria intestinal asociada.

Pyoderma gangrenosum is a chronic inflammatory disease of probable autoimmune etiology. It is associated in 50 percent of cases to multiple systemic diseases. It usually presents as a painful ulcerative lesion. The legs are most commonly affected. The diagnosis is based on the clinical presentation. The objective of biopsy is to rule out other causes of ulceration, such as infections or malignancies. There is no specific and uniformly effective therapy for this disease. Systemic corticosteroids, administered continuously or in pulses, have been an effective treatment in most cases. We reserve the use of immunosuppressant for cases refractory to treatment. New biological therapies have shown good results, especially in patients with inflammatory bowel disease.

Detección de lesiones premalignas y malignas en población de la isla Robinson Crusoe, archipiélago Juan Fernández / Malignant and premalignant lesions in Juan Fernández Archipelago

Numerosos estudios demuestran que el cáncer de piel ha aumentado su incidencia en las últimas décadas a nivel nacional. El Archipiélago Juan Fernández, se encuentra a 674 km. del continente. Se estudió el 44,5 por ciento de sus habitantes (334 personas), no encontrándose lesiones malignas, pero con una tasa de incidencia de lesiones premalignas de 7,5 por ciento, destacando un alto porcentaje de hombres (68 por ciento) de edad avanzada (84 por ciento) y de actividad laboral pescadores (82,3 por ciento). Se concluye que existe una tasa importante de lesiones premalignas correlacionadas con los principales factores de riesgo para desarrollar un cáncer de piel.

Several studies show that skin cancer has increased its incidence en recent decades at national level. Juan Fernández Archipielago, is 674 km from the continent. 44,5 percent of the inhabitants (334 people) were studied and no malignant lesions were found, but a 7,5 percent incidence rate of premalignant lesions was observed showing a higher percentage of males (84 percent) and fishermen (82,3 percent). It is concluded that there is a significant rate of premalignant lesions correlated with the principal risk factors to develop skin cancer.

Experiencia clínica de un tratamiento a base de vitamina C glicosilada, ácido salicílico y zincadone ATM en hombres chilenos con piel mixta a grasa hasta acné inflamatorio leve / Action and tolerance of a formulation with glycosylated vitamin C, zincadone ATM and salicylic acid on Chilean male patients with greasy or mixed normal/greasy skin and/or mild inflammatory acne

Con el fin de evaluar la acción y tolerancia de una formulación a base de vitamina CG, Zincadone ATM y ácido salicílico se reclutaron 65 hombres con piel facial mixta, seborreica y/o con acné inflamatorio leve. Durante un período de 60 días se realizó un estudio clínico abierto y prospectivo en el cual se cuantificó clínicamente el número de lesiones no inflamatorias e inflamatorias, se evaluó el grado de dilatación de los poros a través de escala visual y con lente 30X, se cuantificó la presencia de sebo mediante sebumetría y el porcentaje de hidratación de la piel del rostro. Adicionalmente se utilizó el sistema VISIA para realizar un análisis de la dilatación de los poros, porfirinas cutáneas y textura de la piel. Se observó una mejoría significativa en cada uno de los parámetros medidos.

An open and prospective study was performed in order to evaluate the action and tolerance of a formulation with Glycosylated Vitamin C, Zincadone ATM and Salicylic Acid on 65 male patients with greasy or mixed normal/greasy skin and/or mild inflammatory acne during a period of sixty days. The degree of dilated pores was evaluated both visually and through a 30X lens. The number of inflammatory and non inflammatory lesions, sebumetry and moisture percentage were clinically quantified. Additionally, the VISIA system was utilized to evaluate dilated pores, cutaneous porphyrines and skin texture. There was a significant improvement in each one of the parameters studied.

Cirugía micrográfica de Mohs / Mohs micrographic surgery

Se revisa en detalle la Cirugía micrográfica de Mohs, tanto en sus aspectos históricos como técnicos. La Cirugía micrográfica es una técnica quirúrgica que permite la extirpación de tumores cutáneos con los siguientes lineamientos centrales: extirpación secuenciada en secciones horizontales de tejido cuidadosamente mapeado. Procesamiento mediante corles de tejido congelado. Análisis histopatológico del 100% del margen de resección. Respeto del tejido sano peritumoral. La anterior permite una alta probabilidad de que la resección tumoral haya sido completo en comparación con técnicas quirúrgicas tradicionales la menor herida operatoria libre de tumor posible de obtener y una alta tasa de curación.

Mohs micrographic surgery is reviewed in historical and technical aspects Mohs micrographic surgery is a surgical procedure allowing excision of cutaneous tumours with the following central characteristics horizontal resections of tissue with very precise mapping, horizontal section, of frozen tissue developed by mean of a cryostate immediate histopathological analysis' of 100% of surgical margins, high preservation of normal peritumoral. These characteristics allow high probability of total tumor resection, a smaller surgical wound, and high cure rates.

Adenofibroma metanéfrico asociado a carcinoma papilar de células renales / Metanephric Adenofibroma Associated with Papillary Renal Cell Carcinoma

El adenofibroma metanéfrico es un tumor renal bifásico estromal-epitelial infrecuente, que ocasionalmente se asocia a carcinoma papilar de células renales. Se describe el caso de una niña con un cuadro clínico de cuatro años de evolución de hematuria intermitente, a quien se le diagnosticó, en una biopsia renal izquierda por trucut, un tumor de Wilms con componente estromal y epitelial, sin evidencia de anaplasia. Posteriormente, en el producto de la nefrectomía izquierda, realizada en el Instituto Nacional de Cancerología, se le diagnosticóadenofibroma metanéfrico asociado a un carcinoma papilar de células renales.

Tricoepitelioma desmoplásico múltiple de mejillas: a propósito de un caso / Multiple desmoplastic trichoepithelioma: a case report

El tricoepitelioma es una neoformación benigna diferenciada hacia el folículo piloso. Clínicamente puede presentarse en forma múltiple, solitaria o desmoplásica. Histológicamente plantea algunas dificultades para diferenciarlos del carcinoma basocelular (CSC). Se comunica el caso de una mujer de 28 años de edad y se revisa brevemente la literatura.

Trichoepithelioma is a benign neoformation differentiated from the hair follicle, clinical manifestations can be solitary, multiple or desmoplastic lesions. Histologically, it is not easy to differentiate from basal cell carcinoma. We report the case of a 28-year-old woman, and short review.

Hamartoma angiomatoso ecrino: a propósito de dos casos / Eccrine angiomatous hamartoma: two case reports

El Hamartoma Angiomatoso Ecrino /HAE) es una malformación combinada: vascular y ecrina, benigna, poco frecuente, que se presenta al nacimiento o en la infancia, ubicada generalmente en las extremidades. Es de crecimiento lento, proporcional al crecimiento del niño, generalmente único. Se presenta habitualmente como una placa o nódulo de color rojo, violáceo o color piel. Puede presentar dolor, hipertricosis e hiperhidrosis local, características que lo diferencian de otras malformaciones vasculares. A la histología se observa un aumento de glándulas ecrinas, maduras, en la dermis, acompañadas de acúmulos de vasos sanguíneos (capilares) dilatados. El tratamiento de elección del HAE es la resección quirúrgica. Describimos dos casos de HAE diagnosticados en un periodo de tres años en el Servicio de Dermatología del Hospital Barros Luco-Trudeau.

Two cases of catastrophic antiphospholipid syndrome.

Catastrophic antiphospholipid syndrome (CAPS) is a rare complication of antiphospholipid syndrome. It is a disseminated severe vascular pathology which presents with multi-organic dysfunction that progresses rapidly. Prognosis ends up being fatal in half of the cases. It may appear during pregnancy, surgery, infection, or after suspension of anticoagulation therapy. We studied two female patients with CAPS who survived after treatment with anticoagulation therapy and intravenous corticosteroids. The evolution of our two patients, after 17 months of follow-up under oral anticoagulant treatment was favourable and they are currently asymptomatic. In these patients the early diagnosis and treatment were essential to enhance their possibilities of survival.

Seropervalencia de la infección por virus herpes simplex tipo 2 en pacientes atendidos en centros de referencia de ETS de Santiago / Seroprevalence of herpes simplex virus type 2 (HSV-2) infection in two clinics for sexually transmitted diseases in Santiago, Chile

Background: Genital herpes, a sexually transmitted disease caused by herpes simplex virus type 2 (HSV-2), is found in 3.8percent of all sexually transmitted diseases (STD) in Chile. Aim: To determine the seroprevalence of herpes simplex virus type 2 (HSV-2) and to identify an association between HSV-2 and HIV-1, other STD, and to study its demographic characteristics. Material and methods: A cross-sectional study at two STD public clinics in Santiago was conducted among 200 consecutive patients. Samples were tested for HSV-2, HIV-1, syphilis and hepatitis B virus surface antigen. Results: The seroprevalence for HSV-2 was 43percent. Four patients had a history of genital herpes. There was a strong association between HSV-2 infection and HIV-1 positivity (OR=8.7, 95percent CI 3.4-22.4, p <0.001) and the condition of being a sexual worker (OR=4.5, 95percent CI 1.7-11.9, p <0.01). Conclusions: The high association with HIV-1 and sexual workers, emphasizes the need of having HSV-2 specific diagnostic tests, counseling on sign and symptom recognition and taking preventive measures.