Perfil de consulta ambulatoria otorrinolaringológica en pandemia por COVID-19 / Profile of patients in otorhinolaryngological consultation in a COVID-19 pandemic

Introducción: La patología otorrinolaringológica (ORL) presenta alta incidencia en atención primaria, alcanzando hasta 49% de las consultas, sin embargo, la pandemia por SARS-CoV-2 repercutió de manera transversal en los servicios sanitarios, pudiendo haber influido en el perfil de consulta, por lo que se requiere un análisis para la elaboración de estrategias que permitan asegurar la atención sanitaria ante eventos de esta magnitud. Objetivo: Analizar el perfil de consulta libre por patología ORL ambulatoria en un centro médico privado en La Serena durante los años 2019 y 2020. Material y Método: Estudio analítico de corte transversal sobre consultas ambulatorias durante los años 2019 y 2020 realizadas en un centro privado de atención abierta en La Serena. Se estimaron frecuencias en números absolutos y proporciones, estimación de promedios y medianas. Resultados: Durante 2019 hubo un total de 11.932 consultas y en 2020 hubo 9.576. Se observó un predominio de sexo femenino en las consultas de 51% en ambos años. La mediana en 2019 fue de 35 años y en 2020 de 39 años. En 2020 las patologías con mayor consulta fueron nariz (44%), oído (37%) y faringolaringe (14%). Existió un aumento significativo en la consulta por patología cocleovestibular durante 2020. Conclusión: En 2020 hubo una disminución del 19,7% de las consultas dado, probablemente, a las restricciones de movilidad y aforos. Existió un aumento significativo en la proporción de consultas por patologías cocleovestibulares, como vértigo periférico, hipoacusia súbita y tinnitus, atribuido probablemente al estrés emocional generado por la pandemia.

Introduction: Otolaryngological (ENT) pathology presents high incidence in primary care reaching up to 49% of morbidity consultations, however, the pandemic by SARS-CoV-2 had a transversal impact on health services, and may have influenced the consultation profile, so an analysis is required for the development of strategies to ensure health care in the face of events of this magnitude. Aim: To analyze the profile of spontaneous consultation for outpatient ENT pathology in a medical center in La Serena city during 2019 and 2020. Material and Methods: Cross-sectional analytical study of outpatient consultations during the years 2019 and 2020 performed in a private open care center in the commune of La Serena. Frequencies were estimated in absolute numbers and proportions; averages and medians were estimated. Results: During 2019 there were a total of 11,932 consultations and in 2020 there were 9,576. There was a predominance of female sex in the consultations of 51%. The median in 2019 was 35 years and in 2020 it was 39 years. In 2020, the pathologies with the highest number of consultations were nose (44%), ear (37%) and laryngopharynx (14%). There was an increase in consultation for cochleovestibular pathology during 2020. Conclusion: In 2020 there was a 19.7% of consultation decrease probably due to mobility and capacity restrictions. There was a significant increase in the proportion of consultations for cochleovestibular pathologies such as peripheral vertigo, hearing loss and tinnitus, probably attributed to the emotional stress generated by the pandemic.

Amiloidosis por cadenas livianas de inmunoglobulina con compromiso gástrico al debut: revisión de la literatura basada en un caso clínico / Gastric AL amyloidosis as initial manifestation: literature review from a case report

Systemic amyloidosis comprises a group of diseases characterized by low molecular weight subunit protein deposit in organs, including the gastrointestinal tract. The most frequent clinical manifestations are gastrointestinal bleeding, malabsorption syndrome, protein-losing enteropathy and chronic intestinal dysmotility. The diagnosis is confirmed with gastrointestinal tissue biopsy positive to Congo red stain or recognizing the amyloid fibrils by electron microscopy. The treatment is based in the management of gastrointestinal symptoms and chemotherapeutic drugs, including melphalan and prednisone or cyclophosphamide, bortezomib and prednisone. The bone marrow transplant is reserved for 70-year-old patients or younger without advanced comorbidities. We present a case of a patient with weight loss, anorexia, nausea and early satiety.

La amiloidosis sistémica a un conjunto de enfermedades caracterizadas por el depósito de subunidades fibrilares proteicas de bajo peso molecular en órganos, incluyendo el sistema digestivo. Sus manifestaciones clínicas más frecuentes son la hemorragia digestiva, síndrome malabsortivo, gastro-enteropatía perdedora de proteínas y dismotilidad gastrointestinal crónica. El diagnóstico se confirma con una biopsia de tejido gastrointestinal positiva a tinción rojo Congo o la visualización de fibrillas de amiloide mediante microscopia electrónica. El tratamiento está basado el manejo de los síntomas gastrointestinales y el oncológico, donde destacan esquemas quimioterapéuticos que incluyen melfalan y prednisona o ciclofosfamida, bortezomib y prednisona. El trasplante de médula ósea está reservado a pacientes menores de 70 años sin comorbilidades avanzadas. Presentamos en este artículo el caso de un paciente con baja de peso, anorexia, náuseas y saciedad precoz.

Calidad de vida en mujeres con alteraciones del piso pélvico: revisión de la literatura / Quality of life in women with pelvic floor disorders: literature review

Antecedentes: El riesgo de desarrollar prolapso genital aumenta con la edad, con un efecto negativo en la calidad de vida. Objetivo: Describir el efecto de los trastornos del piso pélvico en la calidad de vida en las distintas dimensiones, sin mediar intervenciones. Método: Se realizó una búsqueda en las bases de datos Pubmed, Cinhal, Proquest y Scielo durante mayo de 2011. Resultados: Los síntomas generan un gran impacto en la calidad de vida afectando la función sexual, actividades cotidianas y generando efectos negativos en aspectos psicosociales, como la imagen corporal y el desempeño de las mujeres. Conclusión: Es necesario generar una atención integral centrada en síntomas, función sexual, educación y apoyo emocional.

Background: The risk of develop genital prolapse increases with age, with a negative effect in quality of life. Objective: The aim of this review is to describe the effect of pelvic floor disorders on quality of life in the different dimensions in women, without any interventions. Method: It developed a review in Pubmed, Cinhal, Proquest and Scielo database during may of 2011. Results: The symptoms produce a great impact on quality of life affecting sexual function, daily activities and it produce negative psychosocial effects like body image and women's performance. Conclusion: Must be necessary generate a integral attention to women, focused on symptoms, sexual function, education and emotional support.

Prevalence of celiac disease in Argentina: screening of an adult population in the La Plata area.

OBJECTIVES: Up to now, the epidemiological characteristic of celiac disease among adults in South America remains unknown. The present prospective screening was designed to determine the prevalence of celiac disease in adults from the general population in an urban area of Argentina. METHODS: Between January. 1998, and May, 2000, all couples attending a centralized laboratory for an obligatory prenuptial examination in the La Plata area were offered participation in a screening program for celiac disease. The study included 2000 subjects (996 women; median age 29 yr, range 16-79 yr). All individuals completed a clinical questionnaire at the time that serum samples were obtained. A three-step screening protocol was used, as follows: 1) all samples were tested for antigliadin antibodies (AGAs) (type IgA and IgG); 2) samples that were IgA AGA positive were tested for antiendomysial antibody (EmA type IgA); samples that were positive for AGA-G but negative for IgA AGAs were tested for total IgA serum levels and EmA type IgG; and 3) subjects who were EmA-positive were referred for intestinal biopsy. RESULTS: At the end of the screening we detected 10 subjects who were EmA-A positive and two others who were IgA-deficient (both were EmA-G positive). Up to now, 11 of the 12 subjects (including nine EmA-positive and two IgA-deficient subjects) had endoscopic intestinal biopsies showing the characteristic celiac histology. The remaining EmA-positive individual was considered to be affected by celiac disease. The overall prevalence assessed was 1:167 (6.0 x 1000 subjects; 95% CI = 3.1-10.5). Eight of the 12 (67%) subjects were female (1:124; 8.0 x 1000; 95% CI = 3.5-15.8) and four (33%) were male (1:251; 4.0 x 1000; 95% Cl = 1.1-10.2). Although eight new patients were considered to be asymptomatic, three presented with a subclinical course and one was classically symptomatic. Only one patient had been previously diagnosed with celiac disease. CONCLUSIONS: Our screening protocol showed a very high prevalence of celiac disease for an urban area of Argentina that is ethnically similar to 90% of the general population of the country. The prevalence among women was double that for men, and the heterogeneous clinical picture of new patients showed predominance of asymptomatic cases.

Tissue transglutaminase antibodies in celiac disease: assessment of a commercial kit.

OBJECTIVE: Tissue transglutaminase was identified as the autoantigen eliciting endomysial antibody. A homemade enzyme-linked immunosorbent assay (ELISA)-based test was recently developed to determine quantitative titers of IgA antitissue transglutaminase antibody. Our objective in this study was to assess the suitability of a newly developed commercial kit for quantitative determination of antibody in patients with untreated celiac disease. MATERIALS: We tested serum samples from 79 untreated celiac patients, 42 healthy blood donors, and 18 patients with nonceliac intestinal disorders evaluated in two different centers. Samples were tested for antitissue transglutaminase, and antiendomysial and antigliadin antibodies in the center where diagnosis was performed. To assess interlaboratory variability of methods, 24 samples randomly selected were blindly tested in both centers. Antitissue transglutaminase antibodies were determined using a commercial kit (INOVA Diagnostics, Inc., San Diego, CA). RESULTS: Untreated celiac patients had significantly higher titers of antitissue transglutaminase than healthy and disease controls (p < 0.00001). According to the cut-off provided by the manufacturers (20 AU/mL), overall sensitivity was 92% (85% for one center and 100% for the other) and specificity was 98% (100% and 95%, respectively). Antiendomysial antibody was 86% sensitive and 100% specific. Discordance between antitissue transglutaminase and antiendomysial antibodies was detected in 13% of patients. Although two antitissue transglutaminase-negative cases had a positive antiendomysial antibody, the inverse situation was found in eight cases. A blind determination of antitissue transglutaminase on the same samples evidenced a good agreement (kappa statistic: 0.66) between both centers when assessment was qualitative (based on the decision of positive or negative). Although correlation of titers for both determinations was highly significant (r: 0.902, p < 0.00001), a very wide interlaboratory variability (median: 50%) was detected when absolute values were considered. CONCLUSIONS: The quantitative determination of antitissue transglutaminase using a commercial kit was highly sensitive and specific for detection of celiac disease. We observed an incomplete overlapping with antiendomysial antibody. The very high variability of values between laboratories still remains to be solved so as to propose the commercial ELISA assay for the screening of celiac disease.

[Celiac disease in adolescents]. / Enfermedad celíaca en la adolescencia.

Nutritional status, sexual maturation and intestinal absorption were assessed in 16 adolescent celiac patients (12 females) at ages 12 and 18 year. Weight/age, height/age and weight/height were 75.5% (51.6-94.8), 90.3% (76.8-104.6) and 99.1% (76.3-112.9) at 12 years and 85.6% (64.0-105.2), 93.8% (85.9-101.2) and 110% (76.5-121.9) at 18 years of age, respectively. Sexual maturation (Tanner) was at stage I in 31%, and at stage II in 43.7% of patients at age 12 years and it had reached maturity in 75% of them at 18 years. Menarche occurred between 12 and 14 years of age, except in 3 patients in whom it was retarded. Mean serum carotene levels were 125 and 108.5 ug/dl at ages 12 and 18 years respectively. Delayed weight and height progress in this particular group of patients might be explained by low socio-economic conditions, late diagnosis, and poor adherence to gluten-free diet.