Concentraciones de oxígeno intermitentes tienen impacto en el desarrollo postnatal temprano de ratas Sprague-Dawley: efectos en CA1 del hipocampo / Intermittent oxygen concentrations have an impact on the early postnatal development of Sprague-Dawley rats: effects on hippocampal CA1

El periodo postnatal temprano se caracteriza por rápido crecimiento cerebral, posiblemente relacionado con variaciones del oxígeno tisular. Esto ha motivado el estudio de protocolos que suministran diferentes concentraciones de oxígeno intermitentes, para observar sus efectos morfológicos y cerebrales. Se utilizaron 52 crías de ratas Sprague Dawley, distribuidas en igual número a cuatro grupos experimentales, Control (C, 21 %O2), Hipoxia Intermitente (HI, 11 %O2), Hiperoxia Intermitente (HOI, 30 %O2) e Hipoxia Hiperoxia Intermitente (HHI, 11 % -30 %O2). Los protocolos consideraron 5 ciclos de 5 minutos de dosificación, durante 50 minutos diarios. Se realizó en una cámara semihermética entre los días 5 al 11 postnatales. Las evaluaciones de crecimiento corporal y cuantificación neuronal, se realizaron en las crías macho, en el día 28 postnatal. El peso corporal en el grupo hipoxia intermitente mostró diferencias significativas respecto al grupo hiperoxia intermitente (HI vs HOI, p<0,01) y al grupo hipoxia-hiperoxia Intermitente (HI vs HHI, p< 0,001). La talla corporal disminuyó en el grupo hipoxia-hiperoxia intermitente con diferencias significativas respecto del grupo control (C vs HHI, p<0,05) y respecto del grupo hipoxia intermitente (HHI vs HI, p< 0,01). El conteo neuronal en el área CA1 del hipocampo aumentó en el grupo hipoxia intermitente con diferencias significativas respecto a los grupos control (C vs HI; p<0,05), al grupo hiperoxia intermitente (HI vs HOI; p<0,001) y al grupo hipoxia-hiperoxia intermitente (HI vs HHI; p<0,001). Finalmente, el grupo hipoxia- hiperoxia Intermitente disminuyó significativamente en la cantidad de neuronas en comparación al grupo hiperoxia intermitente (HHI vs HOI; p<0,001). La hipoxia intermitente mostró resultados beneficiosos en el crecimiento corporal y cantidad de neuronas en el área CA1 del hipocampo, en contraste, la hipoxia hiperoxia intermitente experimentó resultados adversos con disminución de estas variables, en el periodo postnatal temprano de la rata.

SUMMARY: The early postnatal period is characterized by rapid brain growth, possibly related to variations in tissue oxygen. This has motivated the study of protocols that supply different intermittent oxygen concentrations, to observe their morphological and cerebral effects. Fifty-two pups Sprague-Dawley rats were distributed in equal numbers into four experimental groups, Control (C, 21 %O), Intermittent Hypoxia (HI, 11 %O), Intermittent Hyperoxia (HOI, 30 %O2) and Intermittent Hypoxia Hyperoxia (HHI, 11 % - 30 %O2). The protocols considered 5 cycles of 5 min of dosing, for 50 min diary. It was performed in a semi- hermetic chamber between 5 to 11postnatal days. The evaluations of body growth and neuronal quantification were analyzed in male pups, on postnatal day 28. Body weight in the intermittent hypoxia group showed significant differences compared to the intermittent hyperoxia group (HI vs HOI, p<0.01) and the intermittent hypoxia- hyperoxia group (HI vs HHI, p<0.001). Body size decreased in the Intermittent hypoxia-hyperoxia group with significant differences compared to the control group (C vs HHI, p<0.05) and with respect to the intermittent hypoxia group (HHI vs HI, p<0.01). The neuronal count in the area CA1 of the hippocampus increased in the intermittent hypoxia group with significant differences compared to the control groups (C vs HI; p<0.05), to the intermittent hyperoxia group (HI vs HOI; p< 0.001) and the intermittent hypoxia-hyperoxia group (HI vs HHI; p<0.001). Finally, the intermittent hypoxia- hyperoxia group decreased significantly in the number of neurons compared with the intermittent hyperoxia group (HHI vs HOI; p<0.001). Intermittent hypoxia showed beneficial results in body growth and the number of neurons in the CA1 area of the hippocampus, in contrast, intermittent hypoxia-hyperoxia experienced adverse results with a decrease in these variables, in the early postnatal period of the rat.

COVID prolongado / Long COVID

Existen múltiples reportes de manifestaciones persistentes en pacientes que cursaron infecciones por SARS-CoV-2, independiente de su gravedad, configurando el síndrome de COVID-19 prolongado. No existe una definición consensuada de este síndrome, cuya patogenia pareciera ser multifactorial. Considerando las más de 500 millones de infecciones en todo el mundo, este síndrome pudiese incidir en una insospechada y prolongada carga sobre los sistemas sanitarios. Reportes recientes han asociado a la vacunación con esquema primario completo como una asociación protectora para el desarrollo de COVID-19 prolongado, transformándose en otro beneficio poblacional asociado a las vacunas.(AU)

There are multiple reports of persistent manifestations in patients who had SARS-CoV-2 infections, regardless of their severity, configuring the prolonged COVID-19 syndrome. There is no agreed definition of this syndrome whose pathogenesis seems to be multifactorial. Considering the more than 500 million infections worldwide, this syndrome could have an unsuspected and prolonged burden on health systems . Recent reports have associated vaccination with a complete primary schedule as a protective association with the development of prolonged COVID-19, becoming another population benefit associated with vaccines.(AU)

Variante Ómicron SARS-CoV-2: una nueva variante de preocupación / Ómicron SARS-CoV-2 variant: anew variant of concern

Ha surgido una nueva variante de preocupación de SARS-CoV-2, cuyos efectos en la evolución de la pandemia parecen inciertos. Sin embargo, ha comenzado a surgir evidencia con respecto al comportamiento viral en cuanto a su transmisibilidad, unión a receptor de la célula hospedadora y escape del sistema inmune. Presentamos una revisión actualizada de los datos existentes en la literatura respecto a los aspectos microbiológicos y epidemiológicos que pueden ayudarnos a comprender las futuras investigaciones en esta variante.(AU)

A new variant of concern for SARS-CoV-2 has emerged, the effects of which on the evolution of the pandemic appear uncertain. However, evidence has begun to emerge regarding viral behavior in terms of its transmissibility, receptor binding on the host cell, and escape from the immune system. We present an updated review of the existing data in the literature regarding the microbiological and epidemiological aspects that can help us understand future research on this variant.(AU)

Operación de Bascom para el tratamiento de la enfermedad pilonidal sacrococcígea abscedada: experiencia inicial / Bascom operation for the treatment of abscessed pilonidal sacrococcygeal disease: initial experience

Resumen Introducción: Una de las formas de presentación de la enfermedad pilonidal sacrococcígea (EPSC) es el absceso, para el que existen distintas alternativas de tratamiento. Objetivo: Presentar nuestra experiencia con la técnica de Bascom para el tratamiento de la EPSC abscedada. Material y Método: Serie prospectiva, consecutiva y no aleatoria. Incluye todos los pacientes mayores de 15 años que presentan un absceso o supuración masiva al momento de la cirugía. Resultados: La serie corresponde a 10 pacientes, 7 de género masculino. No se encuentran los factores de riesgo reconocidos por la literatura como riesgo de EPSC. Ocho pacientes mejoran completamente en un período máximo de 18 días y 2 presentan supuración persistente, por lo que se considera fracaso del tratamiento. Estos son sometidos a una segunda cirugía con otra técnica, con curación de la enfermedad. Conclusión: La técnica de Bascom es sencilla, segura y ofrece una curación de un 80% en un período corto de cicatrización.

Introduction: One of the form of presentation of the sacral coccygeal pilonidal disease is the abscess, for this cases there are various treatment alternatives. Objective: We present our experience with Bascom technique for the treatment of pilonidal abscess. Material and Method: Prospective, consecutive, non-randomized series. It includes all patients older than 15 years who have an abscess or mass discharge at the time of surgery. Results: The series consists of 10 patients, 7 males. They are not risk factors recognized in the literature as risk of pilonidal disease. Eight patients completely better within a maximum period of 18 days and two with persistent discharge by what is considered treatment failure. They were subjected to a second surgery treatment with another technique with good results. Conclusion: Bascom's technique is simple, safe and offers a 80% cure in a short period of healing.

Tratamiento quirúrgico de la colitis grave por Clostridium difficile / Surgical treatment of severe Clostridium difficile colitis

Introduction: Clostridium difficile infection is the most common healthcare associated infection (HCAI). In few severe cases it may need surgical treatment. Objectives: To show the results of a series treated by us. Materialand Methods: Retrospective descriptive series of patients treated for severeC. difficile colitis from 2010 to 2013. Results: The series corresponds to 6 patients in whom severe C. difficile colitis was demonstrated. All had significant co-morbidities or had undergone major surgical procedures prior to infection. All showed a leukocyte count of 15,000 and hadclinical or radiological evidence of colitis. Five patients were receiving specific treatment without success. The surgery performed was a total colectomy with ileostomy and closure of the rectal stump. The major morbidity was found in 4 patients with extended hospital stay for more than 15 days. Surgical mortality was two cases. Two patients were reconstituted and one of them had a second C. difficile infection in post operative with successful treatment. Conclusion: Colitis is a severe complication of C. difficileinfection. The most recommended surgery is still total colectomy withoutanastomoses. Surgical mortality remains high despite advances in intensive care so HCAI control is essential in preventing it.

Introducción: La infección por C. difficile es la más frecuente de las infecciones asociadas a la atención de salud (IAAS). En algunos casos muy graves puede ser necesario el tratamiento quirúrgico. Objetivos: Mostrar los resultados de la serie tratada por nuestro grupo. Material y Método: Serie retrospectiva descriptiva de los pacientes operados por colitis grave por C. difficile desde el 2010 al 2013. Resultados: La serie corresponde a 6 pacientes en los que se demostró la presencia de una colitis grave por C.difficile. Todos presentaban comorbilidades importantes o habían sido sometidos a procedimientos quirúrgicos mayores previos a la infección. Los estudios de laboratorio mostraban un recuento de leucocitos sobre 15.000 y evidencia clínicao radiológica de colitis en todos los casos. Cinco pacientes se encontrabanrecibiendo tratamiento específico sin éxito. La cirugía efectuada fue una colectomía total con ileostomía terminal y cierre del muñón rectal. La morbilidad mayor se encuentra en 4 casos con prolongación de la estadía hospitalaria por sobre los 15 días. La mortalidad quirúrgica es de dos casos. Dos pacientes ya fueron reconstituidos, uno de ellos presentó una segunda infección por C. difficile en el post operatorio, tratada exitosamente. Conclusión: La colitis es una complicación grave de la infección por C. difficile. La cirugía más aceptada continúa siendo la colectomía total sin anastomosis. La mortalidad quirúrgica continúa alta, pese a los adelantos en la terapia intensiva por lo que el control de las IAAS es fundamental en su prevención.

Programa de incentivo de la actividad física apoyado con contadores de pasos en la enfermedad pulmonar obstructiva crónica / A program of physical activity enhancement using pedometers in chronic obstructive pulmonary disease

Introducción: La actividad física diaria está reducida en la EPOC lo que se asocia a una mayor morbimortalidad. La indicación médica de caminar más se ha demostrado poco eficaz y, en nuestro medio, se desconoce el beneficio del uso de los contadores de pasos en la EPOC. Objetivo: Determinar el efecto de los contadores de pasos para incentivar la actividadfísica en la EPOC. Método: 55 Pacientes con EPOC fueron incorporados a un programa de tres meses destinado a aumentar su actividad física y fueron asignados aleatoriamente a dos grupos: en uno el paciente autocontroló su actividad con un contador de pasos (grupo experimental) y en el otro se siguió el manejo habitual (grupo control). Al comienzo y al final del estudio se realizaron las siguientes mediciones: promedio de pasos caminados por día medidos en una semana, espirometría, caminata de seis minutos (C6M), disnea con escala de la Medical Research Council Modificada (mMRC) y calidad de vida mediante cuestionario de Saint George (SGRQ) y COPD Assessment Test (CAT). Resultados: 69 por ciento de los pacientes eran hombres, edad promedio 68 años, VEF1ICVF = 55 por ciento, VEF(1)63 por ciento predicho. El grupo experimental (n = 29) y el control (n = 26) presentaron características basales comparables. El grupo experimental presentó una diferencia significativa en el incremento de los pasos por día en comparación con el grupo control (mediana de 2073,5 versus -68, p < 0,001). También hubo diferencia en la reducción del componente síntomas del SGRQ (promedio de -9,65 versus 0,05 puntos, grupo experimental versus control, p = 0,048). Conclusión: Un programa de incentivo de la actividad física apoyado con contadores de pasos es útil para incentivar la actividad física en la EPOC.

Introduction: The level of daily physical activity is reduced in COPD and has a negative effect on the morbidity and mortality of this condition. Usual advice is not sufficient to reverse the sedentary condition. Pedometers are widely used but their effects in COPD have not been tested in our country. Aim: To determine the effect of pedometers on physical activity in COPD patients. Method: 55 COPD patients were recruited for a 3 months individual program promoting daily physical activity enhancement and were randomly assigned either to a pedometer-based program (experimental group) or to usual care (control group). At the beginning and at the end of the intervention period we measured the average daily steps over one week, exercise capacity using the six-minute walking test (6MWT), the MMRC dyspnoea score, the Saint George Respiratory Questionnaire (SGRQ) and the COPD assessment Test (CAT) to estimate quality of life. Results: 69% of the subjects were male, mean age 68 years, mean FEV1IFVC 55%, mean FEV163% of predicted value. Experimental (n = 29) and control group (n = 26) had comparable baseline characteristics. There was a significant difference in the increase of steps/day in the experimental group in comparison with the control group (median value = 2073.5 versus -68, p < 0.001). Also, a significant difference was observed in the symptoms subscale score of the SGRQ (reduction of 9.65 versus 0.05points, experimental versus control group, p = 0.048). Conclusions: Pedometers are a useful tool to increase physical activity level in COPD.

Métodos de medición de la sensibilidad a la insulina y otros parámetros relacionados: correlación con la clínica / Methods to measure insulin sensitivity in the clinical setting: an update

Insulin resistance appears in several pathological conditions but unfortunately a simple, low cost, reproducible and easy to perform method to measure it isstill lacking. This method should resemble as closely as possible the physiological response to insulin and should be able to evaluate the sensitivity to the hormone of different tissues and systems. We herein analyze the factors that modify basal insulin determinations and the different methods available to measure insulin resistance.

Cistatina C y adiponectina en pacientes diabéticos tipo 2 coronarios y no coronarios / Cystatin C and adiponectin in diabetics with and without coronary artery disease

Background: Patients with type 2 diabetes have a high incidence of coronary artery disease, which is even higher among those with renal failure. A serum level of cystatin C are used to assess renal function and is a potential cardiovascular risk factor. Adiponectin is an anti-atherogenic factor. Aim: To measure cystatin C and adiponectin in type 2 diabetic patients with and without coronary artery disease. Material and methods: Nine diabetic patients with coronary artery disease aged 76± 10 years, 20 diabetics without coronary artery disease aged 61 ±5 years and 20 non diabetic subjects aged 57±10 years, were studied. Results: Serum levels of cystatin C (mg/L) were 1.5 (range 0.89-219), 0.81 (range 0.71-1.08) and 0.68 mg/L (range 055-0.75) in diabetics with and without coronary artery disease and controls, respectively (p <0.0001). No differences in adiponectin between groups and no association between cystatin C and adiponectin, were observed. No association between both parameters and body mass index orglycosilated hemoglobin Ale was observed. Cystatin C had a positive correlation with serum creatinine (r =0.57p <0.001). Conclusions: Diabetics with coronary artery disease have higher levels of cystatin C, that are closely correlated with serum creatinine levels.

Consenso elaborado por la Sociedad Chilena de Endocrinología y Diabetes sobre resistencia a la insulina(RI) y síndrome metabólico (SM): aspectos clínicos y terapéuticos / Chilean society of endocrinology and diabetes consensus on clinical and therapeutic aspects of insulin resistance and metabolic syndrome

Background: The concept insulin resistance as the basis for a series of metabolic alterations and diseases was introduced by Gerald Reaven in 1988, when he described a cluster of alterations that named syndrome X. Aim: To review and discuss the present information about insulin resistance (IR) and metabolic syndrome (MS). Material and methods: The IR concept is defined,the affected metabolic ways, its consequences and relationship with different diseases are presented. The importance of central obesity with its metabolic, inflammatory and prothrombotic consequences playing a key role in cardiovascular risk, is discussed. The cluster of factors focused on cardiovascular disease and eventually diabetes is named MS. Several definitions of MS are analyzed and compared. A proposition is made about the definition to be used in the Chilean population. Differences between IR syndrome and MS are discussed. Diagnostic methods of IR and MS are presented, recommendations are made about their usefulness and reliability. Non pharmacological and pharmacological treatments of IR and MS are analyzed. Other related diseases, such as polycystic ovary syndrome, non alcoholic steatohepatitis and sleep apnea are discussed. Conclusions. Until further studies are made to define a local waist circumference cut-off associated with high risk, the ATPIII MS definition is preferred. A clinical approach is recommended for diagnosis. A search for all components of the MS is important. There is no evidence about the benefits of MS treatment on the prevention of cardiovascular diseases or diabetes. Evidence supports the use of lifestyle changes and some drugs, such as metformin on the prevention of diabetes in prediabetic states.

Ajuste a la ventilación mecánica guiado por curvas presión-volumen de flujo lento en pacientes con síndrome de distress respiratorio agudo e injuria pulmonar aguda / Mechanical ventilatory parameters guided by the low flow pressure-volume curve in patients with acute lung injury/acute respiratory distress syndrome

Background: Mechanical ventilation may contribute to lung injury and then enhance systemic inflammation. Optimal ventilatory parameters such as tidal volume (V T) and positive end expiratory pressure (PEEP) can be determined using different methods. Low flow pressure volume (P/V-LF) curve is a useful tool to assess the respiratory system mechanics and set ventilatory parameters. Aim: To set V T and PEEP according P/V-LF curve analysis and evaluate its effects on gas exchange and hemodynamic parameters. Materials and methods: Twenty seven patients underwent P/V-LF within the first 72 hours of acute lung injury/acute respiratory distress syndrome (ALI/ARDS). P/V-LF curves were obtained from the ventilator and both lower and upper inflexion points determined. Gas exchange and hemodynamic parameters were measured before and after modifying ventilator settings guided by P/V-LF curves. Results: Ventilatory parameters set according P/V-LF curve, led to a rise of PEEP and reduction of V T: 11.6±2.8 to 14.1±2.1 cm H2O, and 9.7±2.4 to 8.8±2.2 mL/kg (p <0.01). Arterial to inspired oxygen fraction ratio increased from 158.0±66 to 188.5±68.5 (p <0.01), and oxygenation index was reduced, 13.7±8.2 to 12.3±7.2 (p <0.05). Cardiac output and oxygen delivery index (IDO2) were not modified. Demographic data, gas exchange improvement and respiratory system mechanics showed no significant difference between patients with extra-pulmonary and pulmonary ALI/ARDS. There was no evidence of significant adverse events related with this technique. Conclusion: P/V-LF curves information allowed us to adjust ventilatory parameters and optimize gas exchange without detrimental effects on oxygen delivery in mechanically ventilated ALI/ARDS patients.

Adición de un cortocircuito arterio-venoso durante el soporte vital extracorpóreo veno-arterial de un paciente con síndrome cardiopulmonar por Hantavirus: Caso clínico / Addition of an arterio-venous shunt during veno-arterial extracorporeal life support in a patient with Hantavirus pulmonary syndrome

A subgroup of patients infected with the Hantavirus develops a pulmonary syndrome (HPS) characterized by severe acute respiratory failure and myocardial depression, that has a high mortality rate. Extracorporeal life support (ECLS) could be a valuable therapeutic tool in such patients. We report a 24 years old male with HPS that was successfully managed when an arterio-venous shunt was added to a conventional veno-arterial ECLS technique. Precise criteria have been developed to predict which patients should be considered for this treatment.

Volumen sanguíneo intratorácico versus presión arterial de oclusión pulmonar como estimadores de precarga cardíaca en pacientes críticos / Intrathoracic blood volume versus pulmonary artery occlusion pressure as estimators of cardiac preload in critically ill patients

Background:Monitoring of cardiac preload by determination of pulmonary artery occlusion pressure (PAOP) has been traditionally used to guide fluid therapy to optimize cardiac output (CO). Since factors such as intrathoracic pressure and ventricular compliance may modify PAOP, volumetric estimators of preload have been developed. The PiCCO system is able to measure CO and intrathoracic blood volume (ITBV) by transpulmonary thermodilution. Aim: To compare a volumetric (ITBV) versus a pressure (PAOP) determination to accurately estimate cardiac preload in severely ill patients. Patients and Methods: From June 2001 to October 2003, 22 mechanically ventilated patients with hemodynamic instability underwent hemodynamic monitoring with pulmonary artery catheter (PAC) and PiCCO system. ITBV index (ITBVI), PAOP and CI were measured simultaneously by both methods. One hundred thirty eight deltas (D) were obtained from the difference of ITBVI, PAOP, CI-PAC and CI-PiCCO between 6-12 am and 6-12 pm. Linear regression analysis of DITBVI versus Ð CI-PiCCO and Ð PAOP versus DCI-PAC were made. Results: Mean age of patients was 60.8 ± 19.4 years. APACHE II was 23.9 ± 7. Fifteen patients met criteria for acute respiratory distress syndrome (ARDS). Delta ITBVI significantly correlated with DCI-PiCCO (r=0.54; 95% confidence interval = 0.41-0.65; p <0.01). There was no correlation between DPAOP and Ð CI-PAC. Conclusion: ITBVI correlated better with CI than PAOP, and therefore it seems to be a more accurate estimator of preload in unstable, mechanically ventilated patients.

Beneficios independientes de la reducción de la presión arterial en pacientes tratados con nifedipina en microgránulos / Independent benefits of the reduction of the arterial pressure in patients treaties with nifedipine in micro-granules

El estado dippers es un factor de riesgo independiente en los pacientes hipertensos (Risers-R-) Non-dippers-ND-> Dippers-D>Dippers extremos-DE). Se evaluó el efecto de la nueva nifedipina en microgránulos (NMG) una vez al día en la disminución de la presión arterial nocturna medida a través del MAPA con Mobil-o-Graph-CE0434-(I.E.MGmbh-Cockerillstr. 69 D-Stolberg. Germany). Se incluyeron pacientes hipertensos (PAS mayor igual 140 y/o PAD mayor igual 90 mmHg, medidas con esfigmomanómetro de Hg) que recibieron de 30 a 60 mgrs/día de NMG, en un estudio prospectivo abierto comparativo y cruzado en time-doses 8 am ó 8 pm; que luego de 6 semanas de tratamiento mantuvieran PAS < 140 mmHg. Se reclutaron 73 pacientes. 40 pacientes (54.8 por ciento), mantuvieron su estado: NDn = 22 (disminución de la PAS nocturna entre 0 y 10 por ciento), D n= 16 (disminución de PAS nocturna entre 10 y 20 por ciento) y Rn = 2 (incremento de la PAS nocturna). Los otros 33 pacientes (45.2 por ciento) modificaron su estado: cinco: 3D y 2ND cambiaron a DE (disminución de la PAS nocturna > 20 por ciento), once: 2DE y 9ND se transformaron en D, catorce: 6R, 1DE y 7D hacia ND y 3D cambiaron a R. No hubo diferencias significativas en el cambio de estado dippers en ambos grupos (30 ó 60 mgrs), 17 pacientes mejoraron su estado (9ND y 2DE) se transformaron en D y 6R pasaron a ND; 16 pacientes dipper se mantuvieron. Estos resultados sugieren que la NMG ofrece en el 45 por ciento de los pacientes estudiados un beneficio independiente de la reducción de la presión arterial, manteniendo o mejorando el estado dippers ofreciendo una mejor predicción en la disminución de eventos cardiovasculares y del pronóstico de los accidentes cerebrovasculares

Acerca de la muerte del rey Herodes el Grande / About the death of Herod the Great

Herod the Great was the founder of a dynasty that reigned on Judea for several generations. His birth date is estimated on year 73 AC and died at 70 years old. Descriptions of the final disease of Herod were obtained from the classical chronicles of Flavius Josephus, The Jewish war and Jewish Antiquities. A medical explanation for his death is attempted. A parasitism caused by Schistosoma haematobium is suggested as the etiology for chronic renal failure (edema, halitosis and orthopnea) and a "gangrene of genitalia that engendered worms" in the words of Josephus. This would be explained by the formation of genital and urinary fistulae, observed in such disease. The asseveration that Herod was attacked by black bilis is also discussed, based on the concepts of the Hippocratic medicine of that time.

Síndrome hemolítico urémico y streptococcus pneumoniae / Hemolytic uremic syndrome after an infection caused by streptococcus pneumoniae

Hemolytic-uremic syndrome (HUS) is an uncommon complication of pneumococcal infection. Highly suggesting findings in a patient with Streptococcus pneumoniae infection are: microangyopatic hemolytic anemia, thrombocytopenia and acute renal failure. We report a 41 years old woman, admitted to the hospital due to a severe pneumonia, that required the surgical drainage of an empyema. On admission, a drop in packed red cell volume from 41 to 25 percent, the presence of schistocytes in the blood smear, an elevation of LDH to 1,700 IU/L, a fall in haptoglobin to 5.8 mg/dL and a thrombocytopenia of 72,000 per mm3 were detected. These alterations coincided with an oliguric acute renal failure. She was treated with hemodialysis and the hemolytic syndrome was managed with plasmapheresis. She was discharged 35 days after admission and in the follow up, after 2.5 months, her serum creatinine is 1.2 mg/dL and her packed red cell volume is 41 percent

Monitoreo de la volemia y el agua pulmonar extravascular en UCI / Monitoring of blood volume and the extravascular lung water in intensive care units

Traditionally Pulmonary wedge pressure (PWP) determination with Swan-Ganz catheter has been the gold standard to estimate ventricular preload in critically ill patients. However, the correlation between PWP and left ventricular telediastolic volume is poor, and the tecnique does not allow any estimation of extravascular lung water (EVLW). In the last years, several techniques have been developed to improve assessment of intra and extravascular volumes. Two tracers transcardiopulmonary dilution method was developed by Pearce et al in the early 60ïs. It used a thermal tracer to estimate intrathoracic total volumen (ITTV), and a colorimetric tracer for estimting intrathoracic blood volume (ITBV). The difference between ITTV and ITBV is called EVLW. Recently, the technique has been simplified to use just the thermal tracer. The Pulse Contour Cardiac Output computer (PiCCO, Pulsion Medizintechnik, Germany), allows a continous measurement of cardiac output and an intermittent measurement of ITTV, ITBV and EVLW. The use of this new technique could improve patient management, allowing optimal fluids administration without producing lung edema. Besides the PiCCO computer, both a standard central venous line in an upper body vein and a specially designed femoral artery line to measure thermal tracer dissipation are required. Preliminary experience has shown that it is a reliable method, with low morbidity and easy implementation, and may be a promising and useful tool in critical care patients

Brote epidémico de neumonía por mycoplasma pneumoniae en un campamento minero / Epidemic outbreak of pneumonia by mycoplasma pneumoniae a mining camp

Entre febrero y mayo del año 2000 se registró 22 hospitalizaciones de pacientes con neumonía por Mycoplasma pneumoniae en el Hospital de Toquepala SPCC, en Tacna. La prevalencia de enfermedades respiratorias es un problema de salud en el campamento minero de Toquepala. Por ello decidimos describir las característica de este brote epidémico, inusual en el campamento de Toquepala. Se definió como caso: paciente con infección del tracto respiratorio de inicio insidioso, con cuadro clínico de fiebre mayor de 39°C, tos seca, malestar general, dolor faríngeo, rinorrea y/o dolores osteomusculares, con escasos signos pulmonares luego de 3 a 5 días consistente en crepitantes. El diagnóstico fue confirmado a los 15 días de iniciada la enfermedad mediante serología. Se observó que la neumonía tuvo una mayor incidencia en mayo, correspondiendo a una disminución de la temperatura ambiental máxima. Predominó en el grupo de trabajadores varones mayores de 25 años. El total de pacientes hospitalizados no presentó inicialmente crepitantes en el examen clínico. Tos seca solo lo encontramos en el 68 por ciento de los pacientes hospitalizados. Los examenes auxiliares de rutina no fueron de ayuda en el diagnóstico. Las radiografías mostraron predominantemente un infiltrado difuso heterogéneo, no característico de consolidación. La respuesta terapéutica a betalactámicos fue nula pero hubo buena respuesta a los macrólidos.