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Crohn's disease (CD) is a chronic, inflammatory disorder that can involve any part of the gastrointestinal tract, from the mouth to the anus. Although CD mainly affects the terminal ileum and colon, the involvement of the upper gastrointestinal tract rarely occurs. Diagnosis is based on clinical, endoscopic and histological features. Treatment for CD of the upper gastrointestinal tract is similar to distal CD therapy. Corticosteroids added to proton pump inhibitors are usually used. The case of a 42-year-old female patient with CD located in the oesophagus, stomach and duodenum is presented. Among the complementary tests, an endoscopic evaluation of the upper gastrointestinal tract with biopsies was essential to support CD diagnosis.

Resumen La enfermedad de Creutzfeldt-Jakob (ECJ) es la encefalopatia espongiforme transmisible mas frecuente en humanos. Se caracteriza clinicamente por una demencia rapidamente progresiva, mioclonias y ataxia. Las formas familiares son poco frecuentes (5-15% de los casos) y se presentan en ocasiones con sintomas atipicos y con un curso clinico mas prolongado que la forma esporadica. Las pruebas complementarias recomendadas ante la sospecha clinica de ECJ son la resonancia magnetica craneal, el electroencefalograma, la determinacion de la proteina 14-3-3 en liquido cefalorraquideo (LCR) y el estudio del gen de la proteina prionica (PRNP). Se expone el caso de una paciente de 54 anos que presento un trastorno depresivo prolongado asociado a un deterioro neurologico progresivo. Entre las pruebas complementarias, la elevacion de la proteina 14-3-3 en LCR y el hallazgo de la mutacion E200K en el estudio genetico fueron esenciales para llegar al diagnostico de una ECJ familiar.

Resumen El penfigo vulgar es una enfermedad ampollosa caracterizada por la fragilidad de la piel y las mucosas, que afecta sobre todo a pacientes adultos y ancianos. El diagnostico precoz es muy importante porque puede comprometer la vida del paciente, debido a infecciones o complicaciones secundarias al tratamiento. Sobre piel normal aparecen ampollas flaccidas que se rompen con facilidad, dejando grandes erosiones. En ocasiones, las lesiones aparecen sobre piel alterada. Se expone el caso clinico de una mujer de 76 anos, que presento una quemadura por aceite caliente en region toracica anterior. La evolucion clinica atipica de la quemadura oriento el diagnostico de penfigo vulgar.

La inmunodeficiencia comun variable (ICV) es un trastorno inmunologico primario, caracterizado por niveles disminuidos de inmunoglobulinas y una mayor susceptibilidad a las infecciones. Su diagnostico suele ser tardio, y la primera manifestacion clinica habitualmente es una infeccion bacteriana recurrente. Aunque la mayoria de los pacientes con ICV presentan infecciones del tracto respiratorio, tambien pueden tener otras infecciones, como meningitis recurrentes, que pueden ser graves y presentar complicaciones. Se expone el caso clinico de una paciente de 34 anos que, tras presentar una meningitis neumococica recurrente, fue diagnosticada de ICV. La ICV es una alteracion inmunologica infrecuente que, ademas, no suele sospecharse en la practica habitual. Es recomendable tener en cuenta esta entidad y otros trastornos del sistema inmune ante la aparicion de infecciones bacterianas de repeticion no explicadas. Mediante la realizacion de una prueba sencilla y de facil acceso, como el proteinograma, se puede descartar la presencia de una ICV que, sin tratamiento sustitutivo, podria tener graves complicaciones y un pronostico desfavorable.

Background Compared to men, women report greater morbidity and make greater use of health-care services. This study examines potential determinants of gender differences in the utilization of health-care services among the elderly. Methods Cross-sectional study covering 3030 subjects, representative of the non-institutionalized Spanish population aged 60 years and over. Potential determinants of gender differences in the utilization of health services were classified into predisposing factors (age and head-of-family status), need factors (lifestyles, chronic diseases, functional status, cognitive deficit and health-related quality of life (HRQL)) and enabling factors (educational level, marital status, head-of-family employment status and social network). Relative differences in the use of each service between women and men were summarized using odds ratios (OR), obtained from logistic regression. The contribution of the variables of interest to the gender differences in the use of such services was evaluated by comparing the OR before and after adjustment for such variables. Results As compared to men, a higher percentage of women visited a medical practitioner (OR: 1.24; 95% confidence limits (CL): 1.07–1.44), received home medical visits (OR: 1.67; 95% CL: 1.34–2.10) and took ≥3 medications (OR: 1.54; 95% CL: 1.34–1.79), but there were no gender differences in hospital admission or influenza vaccination. Adjustment for need or enabling factors led to a reduction in the OR of women compared to men for utilization of a number of services studied. On adjusting for the number of chronic diseases, the OR (95% CL) of women versus men for ingestion of ≥3 medications was 1.24 (1.06–1.45). After adjustment for HRQL, the OR was 1.03 (0.89–1.21) for visits to medical practitioners, 1.24 (0.98–1.58) for home medical visits, 0.71 (0.58–0.87) for hospitalization, and 1.14 (0.97–1.33) for intake of ≥3 medications. After adjustment for the number of chronic diseases and HRQL, the OR of hospitalization among women versus men was 0.68 (0.56–0.84). Conclusion The factors that best explain the greater utilization of health-care services by elderly women versus men are the number of chronic diseases and HRQL. For equal need, certain inequality was observed in hospital admission, in that it proved less frequent among women.