Implementación del diagnóstico molecular del VPH: experiencia chilena en curso / Molecular diagnosis of human papillomavirus infection: the Chilean experience

Cervical Cancer (CaCu) has a heterogeneous epidemiological behavior throughout the planet, depending on regional socioeconomic development level. Some developed countries predict a potential eradication of this cancer in the next 100 years, while in Chile it still constitutes a pending challenge. Incidence rates show a slow but sustained downward prob, however, mortality has continued to fluctuate between 500-600 cases per year. A few years ago, vaccination against Human Papillomavirus (HPV), the main causal agent for this tumor, was consolidated as a public policy, both in girls and in boys. However, the technological leap in the screening prob was pending, from cytology to molecular diagnosis of the agent (HPV). In this report, we update our most recent data (2018) regarding CaCu mortality, then review global guidelines and experiences in HPV screening. Finally, we offer an account of the strategies that our health system is promoting to address the screening of the disease and whose molecular approach generates the widest worldwide scientific consensus. We also recognize the main barriers and future challenges, which, if overcome, would allow us to be in line with the mandate of WHO to control this women's health problema.

Hemoperitoneo masivo como presentación de un caso de percretismo placentario / Massive hemoperitoneum as a rare presentation of placental percretism

El acretismo placentario se define como la invasión anómala de la placenta al miometrio, denominado percretismo en su forma más severa. En la actualidad se describe la coexistencia de placenta previa con cicatriz de cesárea, como el principal factor de riesgo. Siendo esta última variable la que explica su incidencia al alza en los últimos años. El pronóstico depende mayoritariamente del grado de adherencia, del diagnóstico prenatal y del adecuado manejo multidisciplinario. Con el objetivo de mostrar una presentación poco frecuente de percretismno placentario se presenta a continuación un caso clínico sin diagnóstico prenatal con requerimiento de cirugía de urgencia y su respectivo outcome.

Placental acretism is defined as an abnormal invasion of the placenta to the myometrium, it's most severe presentation being placenta percreta. The main risk factor for this disease is the coexistence of placenta previa and previous cesarean section. Its incidence has been progressively rising, mainly because of the increase in cesarean sections. Extent of adherence, prenatal vs intra surgery diagnosis, and multidisciplinary management are accountable for the prognosis of placental acretism. A case report with no prenatal diagnosis, which required emergency surgery, and its outcome is presented.

Decoloración en proliferaciones de microalgas como parámetro bioindicador en la Bahía de Mazatlán, México / Discoloration of microalgal blooms as a bioindicating parameter of Bahia de Mazatlan, Mexico

Hace 25 años la UNAM desarrolló un programa de observación y muestreo de mareas rojas en la Bahía de Mazatlán (1979-2003), con el propósito de conocer su evolución a través del tiempo. Se apoyó en observaciones diarias de las decoloraciones (manchas) y los resultados indican cinco tendencias: I) Años sin días de manchas, los cuales están asociados al fenómeno de El Niño; II) Años de días con manchas súbitas; III) Años con un número similar de días de manchas; IV) Años con una disminución progresiva de los días de manchas; V) Años con un aumento gradual de manchas. El promedio anual es de 25.3 días de decoloraciones. En el año 2000 hubo 96 días de decoloraciones y representa el más alto en los 25 años de registros. En marzo es donde existen mas frecuentemente las manchas de mareas rojas (174 días) incluyendo las tóxicas. Estas tendencias nos indican un comportamiento continuo de la máxima concentración de las microalgas y por lo tanto desempeñan un papel muy importante para conocer el deterioro ambiental que sufren las zonas costeras por aumento de microalgas nocivas y tóxicas

In order to verify whether harmful algal blooms increased since 1979, a long-term project for the study of harmful algal blooms in Mazatlán Bay began 25 years ago (1979-2003). Observations were done daily and results indicate five trend types: I) years without discoloration related to El Niño events; II) years with days of sudden occurrence of discoloration, related to the release of accumulated energy after El Niño events; III) years with similar number of discoloration events (days); IV) years with a progressive decrease of the occurrence (days) of discoloration events; V) years with gradual increase of discoloration events. The annual mean average of discoloration is of 25.3 days. Ninety-six discoloration events were recorded during year 2000, and represent the highest number of events in the last 25 years. Discoloration events are more common in March (174 days), harmful and toxic blooms included. This indicates continuity in the occurrence of the highest content of microalgae, and therefore, it is concluded that they play an important role for a better understanding of the environmental deterioration undergone by the coastal zone due to an increase of harmful and toxic microalgae blooms

Presencia de Cochlodinium catenatum (Gymnodiniales: Gymnodiniaceae) en mareas rojas de Bahía de Banderas, Pacífico mexicano / Presence of Cochlodinium catenatum (Gymnodiniales: Gymnodiniaceae) in red tides of Bahia de Banderas, Mexican Pacific

Se describe la evolución de una proliferación algal ictiotóxica (julio a diciembre del 2000) causada por el dinoflagelado Cochlodinium catenatum. La multiplicación anormal de este dinoflagelado se presentó a manera de decoloraciones dispersas dentro de un intervalo de temperatura de 25-32 º C y salinidades de 33-35 ups. La densidad de C. catenatum fue desde no detectable hasta 10 841 éls ml-1 . El evento se presentó en grandes extensiones en la Bahía de Banderas, afectando a 13 especies de peces, cuya muerte masiva se debió a sofocación por la obstrucción en las agallas y por excesiva producción de mucus. La población humana aledaña no presentó afecciones respiratorias ni irritaciones en la piel. Las dimensiones de C. catenatum sugieren que pueda presentar una reproducción hologámica y heterotálica. Por sus características morfológicas se sugiere que C. polykrikoides, C. heterolobatum y C. catenatum son una única especie. Esta última parece de reciente introducción en el Pacífico mexicano

The evolution of an ichthiotoxic algal bloom caused by the dinoflagellate Cochlodinium catenatum was studied from July to December 2000. The abnormal multiplication of this dinoflagellate occurred in the form of a discoloration spreading between a temperature and salinity interval of 25-32°C and 33-35 ups, respectively. The density of C. catenatum reached 10 841 cells ml-1 . The event was observed in large areas of Banderas Bay affecting 13 fish species, whose massive killing was due to suffocation (gill obstruction and excessive mucus production). The human population around the area did not present respiratory affections or skin irritation. The C. catenatum measurements suggest a hologamic and heterothalic reproduction. Their morphological characteristics suggest that C. polykrikoides, C. heterolobatum and C. catenatum are the same species. It is estimated that the species could be a recent introduction in the Mexican Pacific

La marea roja causada por el dinoflagelado Alexandrium tamarense en la costa Pacífica colombiana (2001) / The red tide caused by the dinoflagellate Alexandrium tamarense in the Colombian Pacific coast (2001)

El 26 de marzo de 2001 se registró por primera vez en las aguas del Pacífico colombiano, en el área de la Ensenada de Tumaco, la aparición de una marea roja producida por la especie Alexandrium tamarense con valores que superaron las 7.5 x 106 céls l-1 , la marea se mantuvo hacia la región oceánica, derivando en sentido sur-norte por efecto de las corrientes, hasta ser vista por ultima vez cerca a la Isla Gorgona, casi tres semanas después. Un año mas tarde, en marzo de 2002, una segunda proliferación, conformada por la misma especie, se reportó cerca de Cabo Corrientes con una concentración de 1.6 x 106 céls l -1 . Ambos casos estuvieron relacionados con la presencia de bajas temperaturas en la superficie del mar y no estuvieron asociadas con fenómenos de intoxicación y mortalidad

From April 26th to May 15th 2001, a large algae bloom was observed off Tumaco Bay on the Pacific coast of Colombia. This was the first harmful algae bloom (HAB) reported in the region, and reached Gorgona Island, about 120 km north. Ayear later, starting March 2002, an offshore HAB developed from Cabo Corrientes North to Solano Bay. The typical abundance during the blooms reached 7.5 x 106 cells l-1 for the 2001 event and 1.6 x 106 cells l-1 for the 2002 event. During both events, low temperature and high salinity were recorded. Typical measurements in the area are 27-27.5°C and 30-31.5 psu. Values observed during the two events were 24-24.6°C and 33-34 psu; 3°C below normal and more than 2.5 psu above average values. These conditions are indicative of local upwelling processes at the time of the events. On both occasions, cells corresponding to the Alexandrium catenella/fundeyense/tamarense complex represented 99-100% of the biomass. It was difficult to differentiate the cells from A. catenella, but the presence of short chains of only 4 cells (single cells represented most of the biomass) was suggestive of A. tamarense. Shape, dimensions, and detailed structure of the apical pore complex, first apical plate, posterior sulcal plate, and position of the ventral pore on plate 1’ of cells were consistent with the description of A. tamarense, which has not been reported in the tropical East Pacific. The Control Center of Pacific Contamination of the Maritime General Direction of the Colombian Navy has been monitoring the area since 1994 without finding this species or HABs. This leads us to consider the two events as caused by recently introduced species, where local upwelling processes favor permanent and cyclic HABs. However, during these two events, there were no reports of effects on marine biota or of human poisoning, probably because the blooms occurred some distance offshore and far from exploited shellfish beds