摘要
RESUMEN Latinoamérica presenta una alta prevalencia de infección por Helicobacter pylori (Hp). Entre 1996-2003 la prevalencia en Santiago de Chile fue del 70%; estudios recientes presentan una disminución en esta infección. Actualizar la frecuencia de Hp es fundamental debido a su impacto en la salud asociado. Objetivo: Nuestro objetivo fue describir la tendencia de la infección por Hp en pacientes que asisten a endoscopía digestiva alta (EDA) ambulatoria en una población chilena. Materiales y métodos: Se realizó un estudio observacional retrospectivo de pacientes mayores de 18 años que asistieron a una primera EDA con test rápido de ureasa entre 2010-2020. La tendencia en el tiempo fue descrita mediante análisis de series de tiempo. Se construyó un modelo Poisson para estimar el riesgo de infección, ajustado por edad y sexo. Resultados: Se incluyeron 11 355 pacientes [66,9% mujeres; edad media 52 años; Hp 41,6%]. El sexo masculino presentó una mayor frecuencia de infección por Hp [RR 1,13; (IC95%:1,08-1,18)]. La frecuencia de Hp disminuyó significativamente desde 45,1% en 2010 hasta 29% en 2020, con 36% menor probabilidad de presentar infección por Hp en 2020 con respecto al 2010 [RR 0,64; (IC95%:0,55-0,74)]. Se proyectó un descenso progresivo en la tendencia de infección por Hp hasta valores cercanos al 25% para el año 2025. Conclusión: Se observó una reducción significativa en la infección por Hp entre los años 2010-2020. Esta disminución pudiese ser explicada mediante la incorporación de políticas públicas de salud en la última década asociadas a cambios sociosanitarios.
ABSTRACT Latin America presents a high prevalence of Helicobacter pylori (Hp) infection. Between 1996-2003, the prevalence in Santiago, Chile, was 70%; recent studies indicate a decrease in this infection. Updating the frequency of Hp is crucial due to its associated health impact. Objective: Our objective was to describe the trend in Hp infection in patients undergoing ambulatory esophagogastroduodenoscopy (EGD) in a Chilean population. Materials and methods: A retrospective observational study was conducted on patients over 18 years old who attended a first EGD with a rapid urease test between 2010-2020. Time trends were described through time series analysis. A Poisson model was constructed to estimate the risk of infection, adjusted for age and gender. Results: 11,355 patients were included [66.9% females; mean age 52 years; Hp 41.6%]. Male gender presented a higher frequency of Hp infection [RR 1.13; (95% CI: 1.08-1.18)]. Hp frequency infection decreased significantly from 45.1% in 2010 to 29% in 2020, with a 36% lower probability of Hp infection in 2020 compared to 2010 [RR 0.64; (95% CI: 0.55-0.74)]. A progressive decline in Hp infection trend was projected, reaching values close to 25% by year 2025. Conclusion: A significant reduction in Hp infection was observed between 2010-2020. This decrease could be explained by the implementation of public health policies in the last decade associated with socio-sanitary changes.
摘要
Pancreatic cystic neoplasms (PCN) are frequently detected on abdominal images performed for non-pancreatic indications. Their prevalence in asymptomatic population ranges from 2.7 to 24.8%, and increases with age. There are several types of pancreatic cysts. Some may contain cancer or have malignant potential, such as mucinous cystic neoplasms, including mucinous cystadenoma (MCN) and intraductal papillary mucinous neoplasms (IPMN). In contrast, others are benign, such as serous cystadenoma (SCA). However, even those cysts with malignant potential rarely progress to cancer. Currently, the only treatment for pancreatic cysts is surgery, which is associated with high morbidity and occasional mortality. The Board of the Chilean Pancreas Club of the Chilean Gastroenterology Society developed the first Chilean multidisciplinary consensus for diagnosis, management, and surveillance of PCN. Thirty experts were invited and answered 21 statements with five possible alternatives: 1) fully agree; 2) partially agree; 3) undecided; 4) disagree and 5) strongly disagree. A consensus was adopted when at least 80% of the sum of the answers "fully agree" and "partially agree" was reached. The consensus was approved by the Board of Directors of the Chilean Pancreas Club for publication.
Subject(s)
Humans , Pancreatic Cyst/diagnosis , Pancreatic Cyst/therapy , Pancreatic Neoplasms/diagnosis , Pancreatic Neoplasms/pathology , Pancreatic Neoplasms/therapy , Chile/epidemiology , ConsensusSubject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Peptic Ulcer/drug therapy , Zinc/adverse effects , Zinc/therapeutic use , Zinc Sulfate/adverse effects , Zinc Sulfate/therapeutic use , Peptic Ulcer/complications , Zinc/administration & dosage , Drug Administration Schedule , Reproducibility of Results , Helicobacter pylori , Helicobacter Infections , Treatment Outcome , Zinc Sulfate/administration & dosage , Evidence-Based MedicineSubject(s)
Humans , Male , Female , Bismuth/therapeutic use , Helicobacter pylori/drug effects , Helicobacter Infections/drug therapy , Clarithromycin/therapeutic use , Pantoprazole/therapeutic use , Amoxicillin/therapeutic use , Metronidazole/therapeutic use , Anti-Bacterial Agents/therapeutic use , Tetracycline/therapeutic use , Remission Induction , Drug Administration Schedule , Reproducibility of Results , Clarithromycin/administration & dosage , Evidence-Based Medicine , Drug Therapy, Combination , Pantoprazole/administration & dosage , Amoxicillin/administration & dosage , Metronidazole/administration & dosage摘要
Background: The availability of direct-acting antivirals (DAA) for the treatment of chronic hepatitis C virus (HCV) infection is just starting to expand in Chile. Aim: To report the initial experience of patients treated with DAA and their evolution after treatment. Material and Methods: Prospective cohort study, from June 2013 to August 2016 of patients treated with DAA for HCV in three clinical centers. The presence of cirrhosis, clinical and laboratory features; adverse events (AE) and post-treatment changes in liver function were evaluated. Sustained viral response at 12 weeks post-treatment (SVR12) was determined. Results: One hundred six patients aged 58 ± 13 years, 54% males, were included. HCV genotype 1b was present in 88% and 47% had cirrhosis. Treatment regimens were asunaprevir + daclatasvir (DCV) in 17% of patients, paritaprevir / ritonavir / ombitasvir + dasabuvir in 33%, sofosbuvir (SOF) + DCV in 19%, and SOF + ledipasvir in 30%. Twenty five percent of patients used generic drugs. SVR12 was 92.1%, with no differences between generic and brand-name drugs. Serious AE were recorded in 22% of patients, being more common in those with cirrhosis (34% vs 11.5%, p < 0.01). At 12 weeks post-treatment follow-up, there was a decrease in aminotransferase values (p < 0.01), improvement in Child-Pugh score (5.9 vs. 5.5, p = 0.03) and decreased presence of ascites (p = 0.02). Conclusions: In our setting, DAA for HCV was highly effective and safe in non-cirrhotic patients. Hepatic function and inflammation improved at 12 weeks of follow-up. AE were common in patients with cirrhosis, suggesting that these patients should be treated by experienced teams. Generic drugs had similar effectiveness compared to originals.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Antiviral Agents/therapeutic use , Drugs, Generic/therapeutic use , Hepatitis C, Chronic/drug therapy , Sustained Virologic Response , Antiviral Agents/adverse effects , Prospective Studies , Follow-Up Studies , Drugs, Generic/adverse effects , Hepatitis C, Chronic/complications , Hepatitis C, Chronic/physiopathology , Alanine Transaminase/blood , Liver Cirrhosis/complications , Liver Cirrhosis/physiopathology摘要
Introducción: En pacientes VIH (+) se han descrito marcadores predictores de enfermedades asociadas a etapa SIDA, sin embargo no existe claridad respecto factores asociados enfermedades no SIDA. Una relación CD4/CD8 baja se ha identificado como marcador de inmunosenescencia y aumento de morbimortalidad en la población general, sin embargo aún está en estudio su utilidad en pacientes VIH (+). Objetivo: Determinar si una relación CD4/CD8 baja se asocia a mayor morbilidad no relacionada a etapa SIDA en pacientes VIH (+). Material y métodos: Estudio observacional de cohorte retrospectivo. Se seleccionaron pacientes VIH (+) que ingresaron un programa de vacunación contra VHB del Hospital Dr. Gustavo Fricke desde octubre de 2012. Se dividieron en grupos con relación CD4/CD8 < 0.6 y CD4/CD8 > 0.6 y se analizó la aparición de enfermedades no relacionadas a etapa SIDA en ambos grupos durante su seguimiento hasta mayo de 2016. Resultados: En la muestra de 79 pacientes, 54 (68%) tuvieron una relación CD4/CD8 < 0.6 y 25 (32%) tuvieron un CD4/CD8 > 0.6. La incidencia de enfermedades no relacionadas a etapa SIDA fue 39 (72%) pacientes en el grupo con relación CD4/CD8 baja y 13 (52%) en el grupo con relación CD4/CD8 alto (p=0.06). En 15 (19%) pacientes la relación CD4/CD8 disminuyó, esto se asoció a educación hasta enseñanza básica (p=0.01), viraje a carga viral detectable (p<0.01) y enfermedad hepática (p=0.02) Conclusión: La relación CD4/CD8 es un marcador emergente y prometedor, pero aún falta evidencia para determinar su utilidad.
Introduction: Although biomarkers predicting AIDS-associated pathology have been described, there is little clarity with respect to the markers for non AIDS-associated pathology. A low CD4/CD8 ratio has been seen to be a marker of immunesenescence and raised morbi-mortality in the general population, however its usefulness in HIV (+) patients is still being studied. Objective: To determine whether a low CD4/CD8 ratio is associated with increased AIDS-unrelated morbidity in the AIDS stage of HIV (+) patients. Materials and Methods: Observational study with retrospective cohort. HIV (+) patients were selected from patients admitted to a HBV vaccination program in Dr. Gustavo Fricke Hospital from October 2012 on. They were divided into two groups: CD4/CD8 < 0.6 and CD4/CD8 > 0.6 and followed until May 2016, analyzing the appearance of AIDS-unrelated illnesses in both groups. Results: In the 79 patient sample, 54 (68%) had CD4/CD8 ratio < 0.6 and 25 (32%) had a CD4/CD8 ratio > 0.6. The incidence of non AIDS-related illnesses in the AIDS stage was 39 (72%) in patients with a low CD4/CD8 ratio and 13 (52%) in the group with a high CD4/CD8 ratio (p=0.06). Conclusion: The CD4/CD8 ratio fell in 15 (19%) of patients, this being associated with primary education only, (p=0.01), virologic rebound (p<0.01) and liver disease.