Seroprevalencia de Toxoplasma gondii en estudiantes con riesgo ocupacional / Seroprevalence of Toxoplasma gondii in students with occupational risk

INTRODUCCIÓN: La toxoplasmosis es una enfermedad zoonótica cuyo contagio se produce por vía oral por ingestión de quistes al consumir carne contaminada o al tener contacto con heces de felinos contaminadas con ooquistes. Con menor frecuencia, se adquiere por transmisión vertical o por trasplante de órganos infectados. En Chile, existen estudios serológicos en personas sanas e inmunodeprimidas, pero no en grupos de riesgo ocupacional, como son los estudiantes de Medicina Veterinaria. OBJETIVO: Determinar la seroprevalencia para T. gondii en estudiantes de Medicina Veterinaria de una universidad ubicada en el centro-sur del país, y ver su asociación con variable intrínsecas. MÉTODOS. Se tomaron muestras de sangre a 74 estudiantes de una universidad del centro-sur de Chile. Se determinó la presencia de anticuerpos específicos clase IgG contra Toxoplasma gondii mediante la técnica de inmunoanálisis por quimioluminiscencia en fase solida secuencial. RESULTADOS. Del total de alumnos, 16 fueron seropositivos lo que equivale a 21,6%, el mayor número de estudiantes seropositivos fue de sexo femenino (75%), se encontraban en el rango etario entre 24 y 26 años de edad (43,7%), todos consumían carne y verduras (100%) y realizaban la recolección de heces de gatos sin protección 50 (68,7%). CONCLUSIONES. Los resultados obtenidos demuestran la presencia de anticuerpos contra T. gondii en alumnos de Medicina Veterinaria. Según el conocimiento de los autores, es el primer estudio serológico para toxoplasmosis realizado en estudiantes universitarios de Medicina Veterinaria en Chile.

BACKGROUND: Toxoplasmosis is a disease that results from infection with the Toxoplasma gondii parasite, one of the world's most common parasites. The zoonotic infection usually occurs by eating undercooked contaminated meat or by contact with contaminated cat feces. A few studies of toxoplasmosis in healthy and immuno-compromised persons were done in Chile, but investigations related to occupational risk groups, such as Veterinary Medicine students were not studied. AIM: Determine the seroprevalence for T. gondii in Veterinary Medicine students at a university located in the center-south of the country, and evaluated to association with intrinsic variables. METHODS: Peripheral blood samples were taken from 74 veterinary students from a university in south-central Chile. Immunoassay with sequential chemiluminescent was used as diagnostic technique. RESULTS. Of the total number of students, 16 were seropositive, which is equivalent to 21.6%, the largest number of seropositive students was female (75%), they were in the age range between 24 and 26 years of age (43.7%), all consumed meat and vegetables (100%) and collected pet cat feces without protection 50 (68,7%). CONCLUSIONS: The results obtained show the presence of antibodies against T. gondii in Veterinary Medicine students. To the authors' knowledge, it is the first serological study for toxoplasmosis performed in university students of Veterinary Medicine in Chile.

Hierro intravenoso en la terapia del síndrome de piernas inquietas / Intravenous iron for restless legs syndrome. Report of five cases

Restless legs syndrome (RLS) may severely affect the quality of life of patients. A deficient iron incorporation into the central nervous system has an important role in the pathophysiology of RLS. Severely affected patients may not respond to current therapeutic options. We report a preliminary experience with five patients with severe RLS and low serum ferritin levels who did not improve with oral iron. All were treated with 1 g of intravenous iron carboxymaltose. They experienced a marked improvement in symptoms, evident even during the first week of therapy that had persistent after up to two years of follow-up. A significant change in the RLS severity scale was observed after intravenous iron. Serum ferritin levels increased in all of them. Intravenous iron could be a therapeutic option for patients with severe RLS.

Atresia anal com fístula retovaginal em ovino: relato de caso / Anal Atresia with rectovaginal fistula in sheep: case report

A atresia anal com fístula retovaginal, é considerada uma afecção congênita rara nos ovinos. Em virtude disso, buscou-se descrever o reparo cirúrgico e cuidados pós-operatórios em uma borrega que apresentava essa afecção. Nesse sentido, uma borrega, sem raça definida, de 25 dias de idade e pesando 7,2kg, apresentou sinais de distensão abdominal e defecação pela vulva. A afecção foi diagnosticada por meio do exame clínico e confirmada radiograficamente, constatando-se atresia anal do tipo III em associação com a fístula.(AU)

Atresia ani associated with rectovaginal fistula is considered a rare congenital anomaly in sheep. Therefore, the surgical correction and post-operative care of a lamb presenting atresia ani with rectovaginal fistula has been detailed in this case report. A 25-days old, mixed breed lamb, weighing 7.2 kg, showing signs of abdominal bloating, and stool passage through the vulva was admitted at our hospital. An atresia ani type III condition associated with rectovaginal fistula was diagnosed by clinical examination and confirmed by radiographic examination.(AU)

Expansión anormal de hexanucleótido en gen C9orf72 en una familia con demencia frontotemporal y cuadros asociados / Abnormal expansion of C9orf72 gene in familial frontotemporal dementia

Frontotemporal Dementia (FTD) and Motor Neuron Disease (MND) may share similar pathogenic mechanisms. An abnormal hexanucleotide expansion in C9orf72 gene is the most common genetic abnormality of these conditions and explains their concurrence in the same family. We report a 77-year-old female presenting with non-fluent aphasia leading to mutism and a mild Parkinsonism. A magnetic resonance imaging showed a severe atrophy of frontal and temporal lobes. Several family members of the patient suffered of atypical Parkinsonism, lateral amyotrophic sclerosis and dementia. We identified an abnormal hexanucleotide expansion in the C9orf72 gene in the proband. To the extent of our knowledge, this is the first time that this diagnosis is confirmed in our country. The knowledge of the genetic basis of neuro degenerative disorders improves diagnosis and opens expectatives for future treatments of these disabling conditions.

El retículo endoplasmático liso en hepatocitos estimulados con distintas dosis de láser infrarrojo / The smooth endoplasmic reticulum in hepatocytes stimulated with different doses of infrared laser

Veinticuatro ratas hembras Sprague Dawley de 4 meses de vida con peso aproximado de 250 g, fueron divididas en cuatro grupos (A, B, C y D), donde el grupo A (control) no recibió estimulación infrarroja, B se irradió con láser infrarrojo 4 J/cm², C con dosis de 8 J/cm² y D con 16 J/cm². La estimulación infrarroja se realizó diariamente, por 15 días ininterrumpidos. Las ratas fueron sacrificadas y se extrajeron muestras tanto de hígado normal (control) como estimulado con las distintas dosis infrarrojas, las que fueron procesadas para microscopía electrónica de transmisión. De los hepatocitos normales y estimulados, se obtuvieron microfotografías con aumentos finales de hasta 36.500 X, que fueron sometidas a estudios morfométricos para determinar fracciones volumétricas con especial énfasis en el retículo endoplásmico liso (REL) y de los siguientes componentes celulares: retículo endoplasmático rugoso (RER), mitocondrias, glicógeno, eu y heterocromatina. De igual manera se cuantificaron las áreas celulares y nucleares. Del análisis de los resultados entre hepatocitos normales y estimulados con diferentes dosis infrarrojas, se visualiza que existen notables diferencias en todos los componentes celulares cuantificados particularmente el REL. Se concluye que las estimulaciones infrarrojas provocan una drástica transformación en la ultraestructura y morfología de los hepatocitos, lo que provocaría una variación funcional, representando de esta manera el efecto que estas estimulaciones provocan en este tipo celular.

A total of 24 female Sprague-Dawley rats aged 4 months and weighing approximately 250 g, were divided into four groups labeled A, B, C and D. Group A received no infrared stimulation and served as control. Group B was radiated with a dose of 4 J/cm² of infrared laser, Group C with doses of 8 J/cm² and Group D with 16 J/cm². This infrared stimulation was carried out daily for 15 days uninterrupted. The rats were then sacrificed and samples of both normal-control liver and liver stimulated with the different infrared doses were extracted for immediate processing via transmission electron microscopy. Transmission electron microphotographs were obtained at magnifications of 21300X from both normal and stimulated hepatocytes; these were subjected to morphometric studies to determine volumetric fractions with special emphasis on the smooth endoplasmic reticulum (SER) and the following cell components: rough endoplasmic reticulum (RER), mitochondria, glycogen, eu and heterochromatin. Likewise, cell and nuclear areas were quantified. Analysis of the results of normal and stimulated hepatocytes with different infrared doses showed considerable differences in all the quantified cell components and particularly from the SER it is concluded that the effects of these stimulations bring about a drastic transformation in the ultrastructure and morphology of the hepatocytes, which may ultimately translate into a functional variation, thus representing the effect that these stimulations cause in this cell type.

Análisis morfométrico de hepatoesteatosis microvesicular alcohólica de ratas / Morphometric analysis of alcoholic microvesicular hepatic steatosis in rats

Un total de 24 ratas hembras de 4 meses de vida con peso aproximado de 250 gramos fueron divididas en dos grupos de animales rotulados como A y B. El grupo A se mantuvo con pellet y agua ad libitum sirviendo como controles mientras que el grupo B conservaba el pellet y recibía una solución de alcohol 40% disuelto en agua lo cual derivó en una esteatosis alcohólica multivesicular. Ambos grupos se mantuvieron en estas condiciones por 60 días. Posteriormente las ratas fueron sacrificadas y se extrajeron muestras tanto de hígado normal-control como de hígado graso para enseguida ser procesadas para microscopía electrónica de transmisión. De hepatocitos normales y esteatósicos se obtuvieron microfotografías electrónicas de transmisión con aumentos finales de 9.500X, las cuales fueron sometidas a estudios morfométricos para determinar fracciones volumétricas de los siguientes componentes celulares: Retículo endoplasmático rugoso, mitocondrias, inclusiones lipídicas y de glicógeno, eu y heterocromatina. De igual manera se cuantificaron las áreas celulares y nucleares. Del análisis de los resultados entre hepatocitos normales y alcohólicos se visualiza que existen notables diferencias en todos los componentes celulares cuantificados. Se concluye que los efectos de la ingesta diaria de alcohol provoca en los hepatocitos una esteatosis microvesicular que genera una drástica transformación en su ultraestructura y en su morfología, situación que se traduciría, por ende, en una variación funcional, representando de esta manera el efecto que esta droga provoca en los hepatocitos.

A total of 24 female rats, aged 4 months and weighing approximately 250 g, were divided into two groups, called A and B. The group A animals were kept on pellets and water ad libitum and served as controls, while group B animals were fed pellets and given a solution of 40% alcohol dissolved in water, leading to alcoholic multivesicular steatosis. Both groups were kept under these conditions for 60 days. The rats were then euthanized and samples of normal-control and fatty liver were taken and processed for examination by transmission electron microscope. Transmission electron microscope microphotographs of normal and steatotic hepatocytes were obtained with final magnification of 9,500 X. They were subjected to morphometric studies to determine the volumetric fractions of the following cell components: Rough Endoplasmic Reticulum, mitochondria, lipid and glycogen inclusions, and eu- and heterochromatin. In addition, the cell and nucleus areas were quantified and the nucleo cytoplasmic ratio of each cell type was determined. Analysis of the results between normal and alcoholic hepatocytes shows that noticeable differences exist in all the cell components quantified. It is concluded that the effects of the daily consumption of alcohol provoke microvesicular steatosis in the hepatocytes, generating a drastic transformation of their ultrastructure and morphology. This finally leads to functional variations, representing the effects produced by this drug in the hepatocytes.

Infección del sitio de salida de los catéteres venosos centrales y su asociación con bacteriemia relacionada con catéter / Infection of the exit site central venous catheters and its association with bacteremia related to catheter

Introducción: Los catéteres venosos centrales (CVC) plantean un alto riesgo de infección. La infección del sitio de salida (ISS-CVC) es la menos estudiada, y se desconoce su asociación con la bacteriemia asociada a catéter (BAC) y su impacto en la evolución del paciente. Objetivo: Evaluar la asociación entre ISS-CVC, BAC y mortalidad. Materiales y métodos: Estudio prospectivo, de observación. Pacientes internados en una Unidad de Terapia Intensiva médico/quirúrgica que requirieron la colocación de CVC desde el 01/06/2010 hasta el 01/04/2012. Se evaluaron datos epidemiológicos, BAC (según criterios de los CDC) y gérmenes. Se utilizaron media ± DE, mediana y rango intercuartílico, y porcentajes. Resultados: Durante este período, ingresaron 575 pacientes, el 98% requirió CVC. Datos de los pacientes: edad 41 ± 26 años, APACHE II 15 ± 7, 96% con ventilación mecánica, días de ventilación mecánica 41 (33-63), días de internación 43 (25-67). Todos los CVC con ISS fueron retirados y cultivados. Se observaron 51 ISS: 5,5/1000-días-catéter: 33% subclavia, 38% yugular, 29% femoral. Seis pacientes con ISS (12%) tuvieron BAC (0,65/1000-días-catéter): 3 subclavias, 2 yugulares, 1 femoral; 2 con halo y 8 con secreción purulenta. Tiempo de permanencia del CVC: 7,5 días (5-10). Clínica al momento de la ISS: shock 50%, fiebre 83%, SOFA 6 ± 3. El 83% de las infecciones fueron monomicrobianas: 83% por bacilos gramnegativos (2 Klebsiella, 2 Pseudomonas, 1 Serratia y 1 Acinetobacter), 17% por enterococos resistentes a vancomicina. La mortalidad fue del 50%. Conclusión: Aunque la ISS provocó una baja incidencia de BAC, la mortalidad fue alta. Al parecer, la ISS no es un factor predictivo de BAC.(AU)

Introduction: Central venous catheters (CVC) are widely used and pose a high risk of infection. There are few studies on insertion site infection (ISI-CVC), and both its association with catheter-associated bloodstream infection (CABSI) and the outcome of patients are unknown. Objective: To determine the association between ISI-CVC, the presence of CABSI and mortality. Materials and methods: Prospective observational study. All patients admitted to a medical/surgical Intensive Care Unit requiring CVC insertion from 06/01/2010 to 04/01/2012 were included. Epidemiological data, CABSI (according to CDC criteria) and microorganisms involved were evaluated. Mean ± SD, median and interquartile range, and percentages were used. Results: During the period study, 575 patients were admitted, 98% required CVC. Patient´s data: age 41 ± 26 years, APACHE II 15 ± 7, 96% on mechanical ventilation, days on mechanical ventilation: 41 (33-63), length of stay 43 (25-67) days. All CVCs with ISI were removed and cultured. Fifty one ISI were observed (5.5/1000-catheter-day). Six patients with ISI (12%) presented CABSI (0.65/1000-catheter-day): 3 in subclavian, 2 in jugular, 1 femoral; 2 with erythema and 8 with purulent secretion. CVC permanence: 7.5 day (5-10). Signs and/or symptoms at the moment of ISI: shock 50%, fever 83%, SOFA 6 ± 3. The 83% of infections were caused by one microorganism: 83% due to gram-negative bacilli (2 Klebsiella, 2 Pseudomonas, 1 Serratia, and 1 Acinetobacter), 17% due to vancomycin-resistant enterococci. The mortality rate was 50%. Conclusion: Although ISI-CVC presented a low incidence of CABSI, mortality rate was high. The ISI-CVC might have a little predictable value for CABSI.(AU)

Respuesta a fluoxetina y polimorfismos del transportador de serotonina en trastorno límite de personalidad / Fluoxetine response and serotonin transporter polymorphism in borderline personality disorders

Introduction: Impulsiveness and aggressiveness are characteristics of borderline personality disorders. Aggressive and impulsive behaviors are associated to a serotoninergic system dysfunction and are treated with selective serotonin reuptake inhibitors (SSRJs). The short (S) allele of the serotonin transporter promoter (5-HTTPR) gene is associated to a worse response to SSRI in major depression. The objective of this work is to study the anti-impulsive effect of fluoxetine and his relation with short and long alleles of 5-HTTPR gene in borderline personality disordered patients. Method: 59 patients with DSM-IV borderline personality disorder were treated with fluoxetine for 12 weeks. Impulsivity was evaluated with the Overt Aggression Scale Modified (OAS-M). Polymorphisms L and S of the 5-HTTPR gene were determined. Results: S carriers (LS and SS) had a significantly minor response on OAS-M and Aggression subscale than LL carriers. Conclusions: S allele of the 5-HTTPR gene predicts poor response to anti-impulsive effect of fluoxetine in borderline personality disorder. It is likely that multiple genes contribute to a SSRI response.

Introducción: Los trastornos límite de personalidad se caracterizan por una elevada impulsividad y agresividad. Las conductas agresivas e impulsivas se han asociado a disfunciones del sistema serotoninérgico y responden a los inhibidores de la recaptura de serotonina (ISRS). En depresión mayor el alelo corto (S) del promotor del gene del transportador de serotonina se asocia a pobre respuesta a los ISRS. El objetivo de este trabajo es estudiar el efecto anti-impulsivo de serotonina y su relación con los alelos LyS en pacientes con trastorno límite de personalidad. Método: 59 pacientes con trastorno límite de personalidad fueron tratados por 12 semanas confluoxetina. Se evaluó la impulsividad mediante la Overt Aggression Scale Modified (OAS-M)y se determinó los polimorfismos LyS. Resultados: Los portadores de S (LS y SS) presentaron una menor reducción en la OAS-M total y en la subescala de agresividad que los homocigotos LL. Conclusiones: En trastorno límite de personalidad el alelo S del promotor del gene del transportador de serotonina predice pobre respuesta anti-impulsiva de la fluoxetina. Probablemente múltiples genes participen en la respuesta a los ISRS.

Robert Walser: el más solitario de los escritores: la influencia de su enfermedad en su creación literaria / Robert Walser: the loneliest writer: the influence of his disease on his literary work

Robert Walser (1878-1956) is an important but unknown European writer of the twentieth century. He was also a mysterious and solitary man who lived at the margins of society. After the questionable diagnosis of schizophrenia, he nearly stopped writing and spent almost three decades in two Swiss psychiatric hospitals. The originality of his work, undoubtedly conditioned by his mental disorder, renders interesting a review of his life and a discussion of the possible differential diagnosis of his disease.

Los diagnósticos de Gerard de Nerval: La influencia de la locura en la genialidad literaria / The influence of madness in the literary production of Gerard de Nerval

Gerard de Nerval was a French writer, poet and essayist, precursor of surrealism that used for the first time this word in literature and influenced many modern writers. Since the age of 32, Nerval had recurrent psychotic episodes mixed with a severe depression, leading to many hospitalizations, and finally to his death. This mental disease clearly influenced his works and provided originality to his prose and poetry. However no clear explanation has ever been given to his mental disorder. We analyzed the clinical data available from his own works and the opinion of his close friends and postulate the hypothesis that Nerval had a mood disorder.

Alteraciones cognitivas en trastorno de personalidad límite: relación con polimorfismos genéticos / Cognitive disturbances and genetic polymorphisms in borderline personality disorder

A partir del año 2000 la Universidad de Chile desarrolla el Programa de Doctorado en Ciencias Médicas y Especialidad, cuyo objetivo es formar un médico especialista y doctor en Ciencias Médicas competente para realizar investigación clínica del más alto nivel, integrando conocimientos y metodologías del área de las ciencias básicas con aquellas de las ciencias clínicas. El año 2002 se abrió por primera vez la posibilidad de desarrollar simultáneamente la formación como especialista en Psiquiatría de Adultos y como Doctor en Ciencias Médicas. Dados los espectaculares avances de la Neurociencia a nivel mundial, los cuales se habían traducido en importantes progresos en el diagnóstico y tratamiento de los enfermos mentales, parecía lógico invertir recursos orientados hacia el fortalecimiento del diálogo entre los médicos clínicos y los científicos básicos en el país. En el marco de este programa se desarrolló la tesis de doctorado cuyo resumen se presenta a continuación, la cual representa la unión de esfuerzos de profesionales y estudiantes de la Unidad de Trastornos de la Personalidad de la Clínica Psiquiátrica Universitaria y de los Programas de Genética Humana y de Biología Celular y Molecular del Instituto de Ciencias Biomédicas de la Facultad de Medicina de la Universidad de Chile.

Since 2000, University of Chile develops the Doctorate in Medical Sciences Program which is associated to a medical specialty. Its objective is to prepare a specialist MD and PhD capable of developing high quality clinical research, by integrating knowledge and methodologies of basic and clinical sciences. On 2002 the Program considered for the first time Psychiatry as the associated specialty. Given the spectacular progress of Neurosciences around the world, which have determined significant changes in the diagnosis and treatment of mental disorders, it seemed rational to invest resources destined to strengthen the dialog between clinical and basic scientists in Chile. The doctoral thesis that is hereby presented as a summary was developed in the context of this program. It was made possible by the joint efforts of professionals and students of the Personality Disorders Unit of the University Psychiatric Clinic and of the Programs of Human Genetics and of Cell and Molecular Biology of the Biomedical Sciences Institute of the Faculty of Medicine of University of Chile.

Autoanticuerpos dirigidos contra productos de glicación avanzada en pacientes con diabetes mellitus tipo 1 / Antibodies against advanced glycation end products in patients with type 1 diabetes mellitus

Background: Advanced glycation end products are associated with chronic complications of diabetes mellitus. This glycation process renders many proteins immunogenic. Aim: To detect the presence of antibodies against albumin, collagen and low density lipoprotein glycation products in boys and teenagers with diabetes mellitus. Patients and methods : Thirty one patients with diabetes mellitus type I, aged 11ñ3.8 years and with a mean duration of disease of 3.7ñ2.7 years and 31 healthy controls aged 12.4ñ5.3 years were studied. Antibodies against glycation end products were detected by ELISA and results were expressed as a ratio of the optical density of the glycated protein/optical density of the native protein. Results : Diabetic patients and healthy controls did not have antibodies against albumin glycation end products. Diabetics had higher levels of antibodies than controls for collagen glycation end products (2.6ñ0.4 and 1.8ñ0.2 respectively, p< 0.01) and low density lipoprotein glycation end products (3.07ñ0.92 and 2.2ñ0.72 respectively, p< 0.05). Conclusions: The biological role of these antibodies is not clear. They could be a depuration mechanism for glycation end products or contribute to chronic complications of diabetes mellitus

Efecto inmunosupresor in vitro de las lipoproteínas de baja densidad / In vitro inhibition of lymphocyte proliferation by low density lipoproteins

Background: immune cells participate in the formation of atheromatous plate, however little is known about the effects of native or oxidatively modified lipoproteins on these cells. Aim: To study the effects of lipoproteins on in vitro mononuclear cell proliferation. Material and methods: peripheral blood mononuclear cells were obtained from 10 patients with type 2 diabetes mellitus (aged 52 ñ 9 years old with a disease duration of 8.2 ñ 5.7 years and a mean glycosilated hemoglobin of 9.3 ñ 2.2 percent) and 10 non diabetic healthy controls (aged 50.3 ñ 7.1 years old). These were stimulated with phytohemagglutinin (PHA) alone or in the presence of native LDLS, malondialdehyde modified LDLs or glycated LDLs. Proliferation was measured as 3H-thymidine incorporation and expressed as Stimulation Index (SI). Results: SI of patients and healthy subjects, after PHA stimulation were similar: (57.5 ñ 29.8 and 61.1 ñ 23.5) respectively LDLs did not induce proliferation in neither group. Native LDLs produced a 98 percent inhibition of PHA induced proliferation. Malondialdehyde modified and glycated LDLs caused a 50 percent inhibition. The suppressive effect was maintained when lipoproteins were incorporated to culture media 60 min prior or after PHA stimulation. Conclusions: Lipoproteins inhibit in vitro PHA induced peripheral blood mononuclear cell proliferation both in diabetic and in non diabetic subjects

Epidemiologia del alcoholismo en el hospital de clinicas. Servicio de medicina varones II en los periodos de 1978-1987 / Epidemiology of alcoholism in the male patients of Hsopital de Clionicas

Histologicamente segun estudios hechos por Goncalvez y col. la necrosis e infiltrado inflamatorio se presento en todos los casos, mientras que la esteatosis en un 98 //. En los pacientes fallecidos se encontro con mas frecuencia la ictericia, hemorragia digestiva alta y la encefalopatia. La tasa de mortalidad especifica segun Dieter Gorenc y col., fue de 45,8/100.000. El estudio realizado en el Hospital de Clinicas permite demostrar tasas especificas de morbimortalidad en nuestro medio no estudiadas con anterioridad en este centro hospitalario, para hacer de este modo un estudio comparativo con el resto de paises latinos.