Asociación entre enfermedad de Crohn y colangitis esclerosante primaria en una niña de 10 años / Association between Crohn's disease and primary sclerosing cholangitis in a 10 year old girl

Niña de 10 años con diarrea, abdominalgia, pérdida de peso y febrícula de un mes y medio de evolución. Los hallazgos analíticos y ecográficos hicieron sospechar una enfermedad inflamatoria intestinal. La endoscopía y la histología mostraron hallazgos compatibles con la enfermedad de Crohn. Se inició un tratamiento con mesalazina y nutrición enteral exclusiva, y se anadieron corticoides, inmunosupresores y ácido ursodesoxicólico por la persistencia de colestasis e hipergammaglobulinemia. La colangiorresonancia y la biopsia hepática confirmaron el diagnóstico de colangitis esclerosante primaria concomitante. La asociación entre la enfermedad de Crohn y la colangitis esclerosante primaria es muy poco frecuente; predomina en varones de entre los 20 y los 40 años de edad; y presenta una gran variabilidad clínica. El diagnóstico de confirmación requiere la realización de una colangiorresonancia o colangiopancreatografía retrógrada endoscópica. El pronóstico es malo y no existe ningún tratamiento capaz de frenar la progresión de la enfermedad.

A 10 year old girl with diarrhea, abdominal pain, weight loss and fever of one month and a half of evolution. Analytical and sonographic findings raised the possibility of inflammatory bowel disease. Endoscopy and histology showed findings consistent with Crohn's disease. Treatment was initiated with mesalazine and exclusive enteral nutrition. Later corticosteroid treatment, immunosuppressive drugs and ursodeoxycholic acid were added due to cholestasis and persistent hypergammaglobulinemia. Magnetic resonance cholangiography and liver biopsy confirmed the diagnosis of concomitant primary sclerosing cholangitis. The association between Crohn's disease and primary sclerosing cholangitis is rare, predominantly in males between 20 and 40 years old and it presents a great clinical variability. The confirmation of the diagnosis requires magnetic resonance cholangiography or endoscopic retrograde cholangiopancreatography. The prognosis is poor and there is no treatment to slow the progression of the disease.

[Association between Crohn's disease and primary sclerosing cholangitis in a 10 year old girl]. / Asociación entre enfermedad de Crohn y colangitis esclerosante primaria en una niña de 10 años.

A 10 year old girl with diarrhea, abdominal pain, weight loss and fever of one month and a half of evolution. Analytical and sonographic findings raised the possibility of inflammatory bowel disease. Endoscopy and histology showed findings consistent with Crohn's disease. Treatment was initiated with mesalazine and exclusive enteral nutrition. Later corticosteroid treatment, immunosuppressive drugs and ursodeoxycholic acid were added due to cholestasis and persistent hypergammaglobulinemia. Magnetic resonance cholangiography and liver biopsy confirmed the diagnosis of concomitant primary sclerosing cholangitis. The association between Crohn's disease and primary sclerosing cholangitis is rare, predominantly in males between 20 and 40 years old and it presents a great clinical variability. The confirmation of the diagnosis requires magnetic resonance cholangiography or endoscopic retrograde cholangiopancreatography. The prognosis is poor and there is no treatment to slow the progression of the disease.

Niña de 10 años con diarrea, abdominalgia, pérdida de peso y febrícula de un mes y medio de evolución. Los hallazgos analíticos y ecográficos hicieron sospechar una enfermedad inflamatoria intestinal. La endoscopía y la histología mostraron hallazgos compatibles con la enfermedad de Crohn. Se inició un tratamiento con mesalazina y nutrición enteral exclusiva, y se anadieron corticoides, inmunosupresores y ácido ursodesoxicólico por la persistencia de colestasis e hipergammaglobulinemia. La colangiorresonancia y la biopsia hepática confirmaron el diagnóstico de colangitis esclerosante primaria concomitante. La asociación entre la enfermedad de Crohn y la colangitis esclerosante primaria es muy poco frecuente; predomina en varones de entre los 20 y los 40 años de edad; y presenta una gran variabilidad clínica. El diagnóstico de confirmación requiere la realización de una colangiorresonancia o colangiopancreatografía retrógrada endoscópica. El pronóstico es malo y no existe ningún tratamiento capaz de frenar la progresión de la enfermedad.

Knowledge, attitudes and practices on HIV/AIDS and prevalence of HIV in the general population of Sucre, Bolivia

Background: To analyse knowledge, attitudes and sexual practices on HIV/AIDS, and estimate HIV prevalence among residents of Sucre (Bolivia).Methodology: Population-based survey of residents aged 15-49 randomly selected during 2008/2009. Blood samples were collected on Whatman-filter paper and tested with enzyme-linked immunosorbent assay. Knowledge on HIV/AIDS, sexual risk practices and discriminatory attitudes against people living with HIV/AIDS (PLWHA) were modelled with multiple logistic regression.Results: Of 1499 subjects, 59% were women. All subjects were HIV-negative. Inadequate knowledge of HIV/AIDS transmission and prevention was observed in 67% and risk factors varied by gender (interaction p-value < 0.05). Discriminatory attitudes were displayed by 85% subjects; associated factors were: rural residence, low educational level and low income. Unsafe sex was reported by 10%; risk factors varied by residence area (interaction p-value < 0.05). In urban areas, risk factors were male sex, younger age and being in common-law union.Conclusions: Prevalence of HIV infection is very low and unsafe sex is relatively uncommon. Inadequate knowledge on HIV/AIDS and discriminatory attitudes towards PLWHA are extremely high and are associated to gender, ethnic and economic inequalities.

Knowledge, attitudes and practices on HIV/AIDS and prevalence of HIV in the general population of Sucre, Bolivia.

BACKGROUND: To analyse knowledge, attitudes and sexual practices on HIV/AIDS, and estimate HIV prevalence among residents of Sucre (Bolivia). METHODOLOGY: Population-based survey of residents aged 15-49 randomly selected during 2008/2009. Blood samples were collected on Whatman-filter paper and tested with enzyme-linked immunosorbent assay. Knowledge on HIV/AIDS, sexual risk practices and discriminatory attitudes against people living with HIV/AIDS (PLWHA) were modelled with multiple logistic regression. RESULTS: Of 1499 subjects, 59% were women. All subjects were HIV-negative. Inadequate knowledge of HIV/AIDS transmission and prevention was observed in 67% and risk factors varied by gender (interaction p-value<0.05). Discriminatory attitudes were displayed by 85% subjects; associated factors were: rural residence, low educational level and low income. Unsafe sex was reported by 10%; risk factors varied by residence area (interaction p-value<0.05). In urban areas, risk factors were male sex, younger age and being in common-law union. CONCLUSIONS: Prevalence of HIV infection is very low and unsafe sex is relatively uncommon. Inadequate knowledge on HIV/AIDS and discriminatory attitudes towards PLWHA are extremely high and are associated to gender, ethnic and economic inequalities.

[Necrotizing pancreatitis in a 11 year-old boy. Case report]. / Pancreatitis necrohemorrágica en un niño de 11 años. Caso clínico.

Acute pancreatitis is an emerging problem with an incidence between 3.6 and 13.2 cases/100,000 children. However, necrotizing pancreatitis (necrosis greater than 30% of the pancreas and/or greater than 3 cm in an area of the pancreas) is a rare condition (<1% of acute pancreatitis), with a presentation similar to not complicated pancreatitis cases and with high morbidity and mortality. Computed tomography allows an assessment of the severity of the disease and the risk of complications (Balthazar Score). Not complicated pancreatitis cases have a favorable outcome, but necrotizing pancreatitis cases require intensive medical treatment and sometimes surgical treatment. We report the case of an 11 year-old boy with clinical presentation compatible with acute pancreatitis and confirmed by abdominal ultrasonography. Due to worsening of laboratory test, an abdominal computed tomography was performed showing a necrotizing pancreatitis and large pseudocysts. Close monitoring and a conservative approach was adopted, with clinical and analytical improvement. After one year follow-up, the patient is asymptomatic, normal ancillary tests and no evidence of pancreatic pseudocyst. The pediatric necrohaemorragic pancreatitis is an uncommon and potentially severe entity; we must keep this complication in mind for an adequate differential diagnosis of acute abdomen.

Pancreatitis necrohemorrágica en un niño de 11 años: Caso clínico / Necrotizing pancreatitis in a 11 year-old boy: Case report

La pancreatitis aguda es un problema emergente, con una incidencia de 3,6-13,2 casos/100000 niños. Sin embargo, la pancreatitis necrotizante (necrosis mayor del 30% del páncreas y/o mayor de 3 cm de un área del páncreas) es un proceso poco frecuente (< 1% de las pancreatitis agudas), con presentación similar a los casos de pancreatitis no complicada y con una elevada morbimortalidad. La tomografía axial computada permite valorar, en estos casos, la gravedad del cuadro y el riesgo de complicaciones (puntaje de Balthazar). Las pancreatitis no complicadas tienen una evolución favorable, pero los casos de pancreatitis necrotizante precisan tratamiento médico intensivo y, en ocasiones, cirugía. Presentamos el caso de un varón de 11 años con clínica compatible con una pancreatitis aguda confirmada mediante ecografía abdominal. Ante el empeoramiento analítico, se realizó una tomografía axial computada, que mostró una pancreatitis necrotizante y pseudoquistes de gran tamaño. Se decidió la monitorización estrecha y la adopción de una actitud conservadora, con mejoría clínico-analítica. Después de un año de seguimiento, el paciente permanece asintomático y han desaparecido los pseudoquistes. La pancreatitis necrohemorrágica es una entidad infrecuente en la edad pediátrica pero potencialmente grave que debemos tener presente en el diagnóstico diferencial de un abdomen agudo.

Acute pancreatitis is an emerging problem with an incidence between 3.6 and 13.2 cases/100,000 children. However, necrotizing pancreatitis (necrosis greater than 30% of the pancreas and/or greater than 3 cm in an area of the pancreas) is a rare condition (< 1% of acute pancreatitis), with a presentation similar to not complicated pancreatitis cases and with high morbidity and mortality. Computed tomography allows an assessment of the severity of the disease and the risk of complications (Balthazar Score). Not complicated pancreatitis cases have a favorable outcome, but necrotizing pancreatitis cases require intensive medical treatment and sometimes surgical treatment. We report the case of an 11 year-old boy with clinical presentation compatible with acute pancreatitis and confirmed by abdominal ultrasonography. Due to worsening of laboratory test, an abdominal computed tomography was performed showing a necrotizing pancreatitis and large pseudocysts. Close monitoring and a conservative approach was adopted, with clinical and analytical improvement. After one year follow-up, the patient is asymptomatic, normal ancillary tests and no evidence of pancreatic pseudocyst. The pediatric necrohaemorragic pancreatitis is an uncommon and potentially severe entity; we must keep this complication in mind for an adequate differential diagnosis of acute abdomen.

Pancreatitis necrohemorrágica en un niño de 11 años: Caso clínico / Necrotizing pancreatitis in a 11 year-old boy: Case report

La pancreatitis aguda es un problema emergente, con una incidencia de 3,6-13,2 casos/100000 niños. Sin embargo, la pancreatitis necrotizante (necrosis mayor del 30% del páncreas y/o mayor de 3 cm de un área del páncreas) es un proceso poco frecuente (< 1% de las pancreatitis agudas), con presentación similar a los casos de pancreatitis no complicada y con una elevada morbimortalidad. La tomografía axial computada permite valorar, en estos casos, la gravedad del cuadro y el riesgo de complicaciones (puntaje de Balthazar). Las pancreatitis no complicadas tienen una evolución favorable, pero los casos de pancreatitis necrotizante precisan tratamiento médico intensivo y, en ocasiones, cirugía. Presentamos el caso de un varón de 11 años con clínica compatible con una pancreatitis aguda confirmada mediante ecografía abdominal. Ante el empeoramiento analítico, se realizó una tomografía axial computada, que mostró una pancreatitis necrotizante y pseudoquistes de gran tamaño. Se decidió la monitorización estrecha y la adopción de una actitud conservadora, con mejoría clínico-analítica. Después de un año de seguimiento, el paciente permanece asintomático y han desaparecido los pseudoquistes. La pancreatitis necrohemorrágica es una entidad infrecuente en la edad pediátrica pero potencialmente grave que debemos tener presente en el diagnóstico diferencial de un abdomen agudo.(AU)

Acute pancreatitis is an emerging problem with an incidence between 3.6 and 13.2 cases/100,000 children. However, necrotizing pancreatitis (necrosis greater than 30% of the pancreas and/or greater than 3 cm in an area of the pancreas) is a rare condition (< 1% of acute pancreatitis), with a presentation similar to not complicated pancreatitis cases and with high morbidity and mortality. Computed tomography allows an assessment of the severity of the disease and the risk of complications (Balthazar Score). Not complicated pancreatitis cases have a favorable outcome, but necrotizing pancreatitis cases require intensive medical treatment and sometimes surgical treatment. We report the case of an 11 year-old boy with clinical presentation compatible with acute pancreatitis and confirmed by abdominal ultrasonography. Due to worsening of laboratory test, an abdominal computed tomography was performed showing a necrotizing pancreatitis and large pseudocysts. Close monitoring and a conservative approach was adopted, with clinical and analytical improvement. After one year follow-up, the patient is asymptomatic, normal ancillary tests and no evidence of pancreatic pseudocyst. The pediatric necrohaemorragic pancreatitis is an uncommon and potentially severe entity; we must keep this complication in mind for an adequate differential diagnosis of acute abdomen.(AU)

Pancreatitis necrohemorrágica en un niño de 11 años: Caso clínico / Necrotizing pancreatitis in a 11 year-old boy: Case report

La pancreatitis aguda es un problema emergente, con una incidencia de 3,6-13,2 casos/100000 niños. Sin embargo, la pancreatitis necrotizante (necrosis mayor del 30% del páncreas y/o mayor de 3 cm de un área del páncreas) es un proceso poco frecuente (< 1% de las pancreatitis agudas), con presentación similar a los casos de pancreatitis no complicada y con una elevada morbimortalidad. La tomografía axial computada permite valorar, en estos casos, la gravedad del cuadro y el riesgo de complicaciones (puntaje de Balthazar). Las pancreatitis no complicadas tienen una evolución favorable, pero los casos de pancreatitis necrotizante precisan tratamiento médico intensivo y, en ocasiones, cirugía. Presentamos el caso de un varón de 11 años con clínica compatible con una pancreatitis aguda confirmada mediante ecografía abdominal. Ante el empeoramiento analítico, se realizó una tomografía axial computada, que mostró una pancreatitis necrotizante y pseudoquistes de gran tamaño. Se decidió la monitorización estrecha y la adopción de una actitud conservadora, con mejoría clínico-analítica. Después de un año de seguimiento, el paciente permanece asintomático y han desaparecido los pseudoquistes. La pancreatitis necrohemorrágica es una entidad infrecuente en la edad pediátrica pero potencialmente grave que debemos tener presente en el diagnóstico diferencial de un abdomen agudo.(AU)

Acute pancreatitis is an emerging problem with an incidence between 3.6 and 13.2 cases/100,000 children. However, necrotizing pancreatitis (necrosis greater than 30% of the pancreas and/or greater than 3 cm in an area of the pancreas) is a rare condition (< 1% of acute pancreatitis), with a presentation similar to not complicated pancreatitis cases and with high morbidity and mortality. Computed tomography allows an assessment of the severity of the disease and the risk of complications (Balthazar Score). Not complicated pancreatitis cases have a favorable outcome, but necrotizing pancreatitis cases require intensive medical treatment and sometimes surgical treatment. We report the case of an 11 year-old boy with clinical presentation compatible with acute pancreatitis and confirmed by abdominal ultrasonography. Due to worsening of laboratory test, an abdominal computed tomography was performed showing a necrotizing pancreatitis and large pseudocysts. Close monitoring and a conservative approach was adopted, with clinical and analytical improvement. After one year follow-up, the patient is asymptomatic, normal ancillary tests and no evidence of pancreatic pseudocyst. The pediatric necrohaemorragic pancreatitis is an uncommon and potentially severe entity; we must keep this complication in mind for an adequate differential diagnosis of acute abdomen.(AU)

Pancreatitis necrohemorrágica en un niño de 11 años. Caso clínico. / [Necrotizing pancreatitis in a 11 year-old boy. Case report].

Acute pancreatitis is an emerging problem with an incidence between 3.6 and 13.2 cases/100,000 children. However, necrotizing pancreatitis (necrosis greater than 30

of the pancreas and/or greater than 3 cm in an area of the pancreas) is a rare condition (<1

of acute pancreatitis), with a presentation similar to not complicated pancreatitis cases and with high morbidity and mortality. Computed tomography allows an assessment of the severity of the disease and the risk of complications (Balthazar Score). Not complicated pancreatitis cases have a favorable outcome, but necrotizing pancreatitis cases require intensive medical treatment and sometimes surgical treatment. We report the case of an 11 year-old boy with clinical presentation compatible with acute pancreatitis and confirmed by abdominal ultrasonography. Due to worsening of laboratory test, an abdominal computed tomography was performed showing a necrotizing pancreatitis and large pseudocysts. Close monitoring and a conservative approach was adopted, with clinical and analytical improvement. After one year follow-up, the patient is asymptomatic, normal ancillary tests and no evidence of pancreatic pseudocyst. The pediatric necrohaemorragic pancreatitis is an uncommon and potentially severe entity; we must keep this complication in mind for an adequate differential diagnosis of acute abdomen.