Presiones de la vía biliar en pacientes con y sin colelitiasis

Introducción: El reflujo de enzimas pancreáticas hacia la vía biliar extra-hepática y la vesícula biliar es un fenómeno anormal que tiene un rol en la litogénesis y carcinogénesis. Debido a que la presión de la vía biliar depende entre otros factores, de las presiones del esfínter de Oddi. La disfunción de éste se vería reflejada en presiones elevadas de la vía biliar en pacientes con colelitiasis. Objetivo: El objetivo de este estudio es el de medir las presiones de la vía biliar extra-hepática en pacientes con y sin colelitiasis y relacionarlas con la presencia de reflujo pancreáticobiliar. Material y Método: Se diseñó un estudio pros-pectivo de casos y controles. La muestra está constituida por todos los pacientes operados con gastrectomía total por cáncer gástrico estadios I y II durante 30 meses. La medida de resultado primaria fue establecer diferencias en las presiones de la vía biliar entre pacientes con y sin colelitiasis. Resultados: Las presiones de la vía biliar extra-hepática en pacientes con colelitiasis fueron más elevadas (16,9 mmHg) que en los pacientes sin colelitiasis (3,3 mmHg) (p < 0,0001). Estas presiones se correlacionan con la presencia de amilasa y lipasa en la bilis de la vesícula; se encontraron niveles elevados de enzimas pancreáticas en pacientes con colelitiasis (p < 0,0001). Conclusiones: Las presiones de la vía biliar en pacientes con colelitiasis fueron, significativamente, mayores comparadas con las presiones de la vía biliar en pacientes sin colelitiasis. En los pacientes con colelitiasis, la presión elevada de la vía biliar se asocia a la presencia de reflujo pancreáticobiliar.

Background: The reflux of pancreatic enzymes into the bile duct and the gallbladder is an abnormal phenomenon that plays a role in lithogenesis and carcinogenesis. Because the pressure of the common bile duct depends on the pressures of the sphincter of Oddi, its dysfunction would be reflected in an increase in the pressure of the common bile duct in patients with cholelithiasis. Aim: The objective of this study was to measure the pressures of the common bile duct in patients with and without cholelithiasis and to relate them to the presence of pancreatobiliary reflux. Material and Method: A prospective case-control study was designed. The universe was constituted by all patients undergoing total gastrectomy for gastric cancer stages I and II during 30 months. The primary outcome measure was to establish differences between common bile duct pressures in patients with and without cholelithiasis. Results: Common bile duct pressures in patients with gallstones showed a significant elevation (16.9 mmHg) compared to patients without gallstones (3.3 mm Hg) (p < 0.0001). These pressures correlated with the levels of amylase and lipase in gallbladder bile; higher levels were found in patients with gallstones compared to patients without gallstones (p < 0.0001). Conclusions: Common bile duct pressure in patients with cholelithiasis was significantly higher compared to patients without cholelithiasis leading to pancreatobiliary reflux.

Anaerobic RSH-dependent tellurite reduction contributes to Escherichia coli tolerance against tellurite

BACKGROUND: Tellurium is a rare metalloid that exerts high toxicity on cells, especially on bacteria, partly due to reactive oxygen species (ROS) generation. Moreover, it has also been observed that tellurite can target free cell thiols groups (RSH) (i.e. reduced glutathione (GSH)), enhancing the cellular redox imbalance. Additionally, in vitro experiments have suggested that several enzymes can reduce tellurite (IV) to its elemental form (0); where RSH present on their active sites may be responsible for the process. Nevertheless, the mechanisms implemented by bacteria for tellurite reduction and its role in resistance have not been evaluated in vivo. RESULTS: This work shows that tellurite reduction to elemental tellurium is increased under anaerobic conditions in E. coli cells. The in vivo tellurite reduction is related to the intracellular concentration of total RSH, in the presence and absence of oxygen. This metabolization of tellurite directly contributes to the resistance of the bacteria to the oxyanion. CONCLUSIONS: We demonstrated that in vivo tellurite reduction is related to the intracellular thiol concentration, i.e. large availability of cellular RSH groups, results in a more significant reduction of tellurite. Furthermore, we observed that, when the bacterium exhibits less resistance to the oxyanion, a decreased tellurite reduction was seen, affecting the growth fitness. Together, these results let us propose that tellurite reduction and the intracellular RSH content are related to the oxyanion bacterial resistance, this tripartite mechanism in an oxygen independent anaerobic process.

Understanding gold toxicity in aerobically-grown Escherichia coli

BACKGROUND: There Is an emerging field to put Into practice new strategies for developing molecules with antimicrobial properties. In this line, several metals and metalloids are currently being used for these purposes, although their cellular effect(s) or target(s) in a particular organism are still unknown. Here we aimed to investigate and analyze Au3+ toxicity through a combination of biochemical and molecular approaches. RESULTS: We found that Au3+ triggers a major oxidative unbalance in Escherichia coli, characterized by decreased intracellular thiol levels, increased superoxide concentration, as well as by an augmented production of the antioxidant enzymes superoxide dismutase and catalase. Because ROS production is, in some cases, associated with metal reduction and the concomitant generation of gold-containing nanostructures (AuNS), this possibility was evaluated in vivo and in vitro. CONCLUSIONS: Au3+ is toxic for E. coli because it triggers an unbalance of the bacterium's oxidative status. This was demonstrated by using oxidative stress dyes and antioxidant chemicals as well as gene reporters, RSH concentrations and AuNS generation.

Nivel de dependencia, autocuidado y calidad de vida del adulto mayor / Level of dependency, self-care, and quality of life in the elder adult / Nível de dependência, autocuidado e qualidade de vida do idoso

Introducción: El envejecimiento es un proceso natural. La calidad e independencia con que se vive esta etapa depende no solo de la estructura genética de los seres humanos, sino también de lo que se realiza durante el curso de vida. Objetivo: Establecer la relación entre calidad de vida del adulto mayor y su nivel de dependencia y autocuidado. Métodos: Estudio transversal, descriptivo y correlacional. Fueron entrevistados 116 adultos mayores que acudieron a consulta en una unidad de salud. Las variables estudiadas fueron: dependencia, autocuidado y calidad de vida. Se utilizaron la Escala de Barthel, la Escala de capacidades de autocuidado y el Cuestionario SF-36 de calidad de vida. Se realizó un análisis descriptivo de las variables y correlación de Pearson y Spearman. El presente proyecto fue revisado y aprobado por un Comité de Investigación. Resultados: El 54.3% de los participantes fueron mujeres. El 80.2% de los adultos mayores encuestados presentaron independencia para realizar las actividades de la vida diaria y el 19.8% presentaron dependencia leve. En la calificación global de las actividades de autocuidado el 22.4% tuvieron buena capacidad y el 76.6%, muy buena capacidad. En la percepción de calidad de vida en la dimensión física, el 24% de los entrevistados consideran que su salud es buena y el 56%, regular. En las pruebas de correlación se encontró mínima relación entre las variables de autocuidado y dependencia; escasa entre autocuidado y grado de escolaridad; correlación positiva entre la dependencia y la calidad de vida, así como la calidad de vida y la edad, aunque el valor de todas las correlaciones fue bajo.

Introduction: Getting old is a natural process. The quality of life and independency lived during this stage depend not only on the genetic structure, but also on what is done throughout the entire life. Objective: To explore the relationship among the levels of quality of life, dependency, and self-care in the elder adult. Methods: This is a transversal, descriptive, and correlational study. One hundred and sixteen elder adults who attended consultation visits at a health unit were interviewed. The variables studied were: dependency, self-care, and quality of life. The Barthel scale, the Self-Care Capacities Scale, and the SF-36 Quality of Life Questionnaire were used. The Pearson and Spearman correlations were calculated. This project was reviewed and approved by a Research Committee. Results: Fifty four point three percent of the participants were female. The 80.2% of the elder adults interviewed showed independence to perform their daily life activities, while the rest (19.8%) showed a mild level of dependency. In relation to the self-care activities, 22.4% showed a good capacity, while 76.6% showed a very good capacity. In relation to their perception of quality of life, in the physical dimension, 24% of the participants considered their health as good, while 56% consider it as more or less good. In the correlation tests, a minimal relationship was found between the variables of self-care and dependency, also, a low relationship was found between the self-care and the school levels. A positive correlation was found between dependency and quality of life, and also between quality of life and age, though their values were low.

Introdução: O envelhecimento é um processo natural. A qualidade e independência com que se vive esta etapa depende não só da estrutura genética dos seres humanos, senão também do que se realiza durante o curso de vida. Objetivo: Estabelecer a relação entre a qualidade de vida do idoso e o seu nível de dependência e autocuidado. Métodos: Estudo transversal, descritivo e de correlação. Foram entrevistados 116 idosos que acudiram a consulta em uma unidade de saúde. As variáveis estudadas foram: dependência, autocuidado e qualidade de vida. Utilizou-se a escala de Barthel, Escala de capacidades de autocuidado e Questionário SF-36 de qualidade de vida. Realizou-se uma análise descritiva das variáveis e correlação de Pearson e Spearman. O presente projeto foi revisado e aprovado por um Comité de Pesquisa. Resultados: 54.3% dos participantes era mulher. O 80.2% dos idosos respondentes apresentou independência para realizar as atividades da vida diária e o 19.8% apresentou dependência leve. Na qualificação global das atividades de autocuidado, 22.4% teve boa capacidade e 76.6% muito boa capacidade. Na percepção de qualidade de vida na dimensão física, 24% dos entrevistados considera que sua saúde é boa e o 56% regular. Nas provas de correlação encontrou-se mínima relação entre as variáveis de autocuidado e dependência, escassa entre autocuidado e grau de escolaridade, correlação positiva entre a dependência e a qualidade de vida, bem como a qualidade de vida e a idade, ainda assim, o valor de todas as correlações foi baixo.

Adelantamiento rotuliano tipo Bandi versus limpieza articular artroscópica para el manejo de la artrosis patelofemoral: Seguimiento a un año / Bandi tibial tubercule osteotomy vs artrhroscopy lavage in patelo femoral arthritis: 1 year follow-up

Introducción: La osteoartritis (OA) es una artropatía degenerativa que modifica las propiedades mecánicas y biológicas, del cartílago articular y del hueso subcondral, su tratamiento va encaminado hacia el alivio del dolor, mantener la función articular y reducir la progresión de la enfermedad. El objetivo de este trabajo es comparar los resultados quirúrgicos de la limpieza articular artroscópica y adelantamiento rotuliano utilizando la escala WOMAC. Metodología: Estudio transversal en el que se compara el resultado funcional del tratamiento de la OA patelofemoral en pacientes operados por limpieza articular artroscópica y pacientes operados por adelantamiento rotuliano con técnica de Bandi. Las variables fueron, género, edad, lado afectado, técnica quirúrgica e índice de WOMAC prequirúrgico y a los 12 meses de seguimiento. Utilizamos estadística descriptiva así como t de Student para la diferencia de promedios de WOMAC entre ambos grupos de pacientes. Resultados: n = 37 pacientes, la edad promedio fue 53.48 años (28-82), ± 12.55, el género 11 (29.7%) hombres y 26 (70.3%) mujeres, el lado afectado: 19 (51.35%) derecho y 18 (48.65%) izquierdo. Técnica quirúrgica: 45.9% artroscópico y 54.1% con técnica de Bandi. Los pacientes operados mediante Bandi y adelantamiento rotuliano tuvieron mejoría del dolor, rigidez articular y de la función física (p = 0.00); la comparación del puntaje global de WOMAC para ambas técnicas al año no mostró diferencias estadísticamente significativas (p = 0.78). Conclusión: Ambas técnicas (Bandi y limpieza artroscópica) ofrecen buenos resultados a los 365 días de operados, sin embargo, los pacientes manejados por limpieza artroscópica presentan menor dolor comparados con los de adelantamiento rotuliano tipo Bandi.

Introduction: Osteoarthritis is a degenerative joint disease that modifies the mechanical and biological properties of articular cartilage and subchondral bone, treatment is aimed at relieving pain, maintain joint and reduce disease progression function. The aim of this paper is to compare the surgical outcomes of the arthroscopic articular cleaning and Bandi procedure by using the WOMAC scale. Methods: Cross-sectional study, functional outcome of treatment of patellofemoral ostheoarthritis by arthroscopic articular cleaning and Bandi procedure are compared. Variables were gender, age, affected side, surgical technique and preoperative and 12 months follow up WOMAC evaluation. We used descriptive statistics and t-test for mean difference in WOMAC between both groups of patients. Results: n = 37 patients, the mean age was 53.48 (28-82), ± 12.55 years; 11 (29.7%) males and 26 (70.3%) women, the affected side: 19 (51.35%) right and 18 (48.65%) left. Surgical technique: 45.9% arthroscopic articular cleaning and 54.1% Bandi procedure. Patients operated by both technics: Bandi and arthroscopic articular cleaning had improvement in pain, stiffness and physical function (p = 0.00); comparison of global WOMAC score for both techniques a year after showed no statistically significant differences (p = 0.78). Conclusion: Both techniques (Bandi and arthroscopic articular cleaning) offer good results at 365 days of surgery, however patients managed by arthroscopic articular cleaning have less pain compared with Bandi procedure.

Tromboprofilaxis en pacientes médicos hospitalizados. ¿A todos por igual? / Thromboprophylaxis in hospitalized medical patients. Do all alike?

Venous thromboembolic disease is the leading preventable cause of hospital mortality. Up to 75 percent of these are in non - surgical patients. This is a large, heterogeneous group of patients; so to know the risk factors for deep venous thrombosis crucial to provide a correct prevention. This article reviewed the indications, contraindications and complications of thromboprophylaxis. Difficult cases in elderly, obese, chronic kidney disease, critical care and cirrhotic patients were reviewed. The purpose of this article is to support decision – making on dvt prevention in hospitalized medical patients...

Tromboprofilaxis farmacológica en pacientes oncológicos quirúrgicos en el Hospital Clínico de la Universidad de Chile / Pharmacological thromboprophylaxis in surgical oncology patients in Hospital Clínico Universidad de Chile

The aim of this study is to evaluate the use of thromboprophylaxis in surgical oncology patients in HCUCH in 2011. Method: Retrospective analysis of patients with cancer undergoing surgery in 2011. Was defined as adequate pharmacological thromboprophylaxis the correct dose, mechanical prophylaxis in case of drug contraindications and beginning on day 0 or 1. Results: 131 medical records were reviewed. Main neoplasms were colorectal (21.3 percent), prostate (12.9 percent), gallbladder (8.3 percent) and stomach (6.9 percent). Of the patients requiring pharmacologic thromboprophylaxis (n = 110) were rated as adequate 52 patients (47 percent), 47 inadequate (43 percent) and 11 absent (10 percent). The causes of inappropriate use of pharmacological thromboprophylaxis included 27 late onset (58 percent), 10 lower doses (21 percent), 3 late onset associated with lower dose (6 percent), 6 incomplete thromboprophylaxis (13 percent) and 1 dose increased (2 percent). Factors significantly associated with pharmacological thromboprophylaxis absent were: <40 years of age (p = 0.002), head and neck cancer (p < 0.001), and hospital stay <7 days (p < 0.001). Conclusions: The absence of pharmacological thromboprophylaxis is associated with lower absolute risk factors for VTE: Age less than 40 years old, head and neck cancer, hospital stay less than 7 days...

Epidemiologia de candidemia en Córdoba Republica Argentina. Estudio de vigilancia de cinco instituciones / [Candidemia epidemiology in Córdoba Argentina. Surveillance study of five institutions].

UNLABELLED: The incidence rate of invasive infections due to Candida species has increased drastically in the last 20 years, causing a 40

mortality rate in hospitalized patients. In order to comprehend the epidemiology of Candida bloodstream infection, the study was carried out. MATERIALS AND METHODS: A retrospective study was done based on microbiology laboratory reports from five terciary care hospitals from the city of Cordoba between January 2010 and August 2012. RESULTS: 158 patients had candidemia, the average age was 55,8 years, and 54

of patients were in the intensive care unit. Candida albicans (44

) and Candida tropicalis (12

) were the main fungi isolated. Candida parapsilosis was commonly associated with catether infections. CONCLUSIONS: The data from the city of Cordoba showed that C. albicans, C. parapsilosis y C. tropicalis were the more frequent species isolated from blood cultures. This is similar to what is seen in other series published from Argentina and Latinamerica. This study may have implications when it comes to deciding which empiric antifugal agent is best for the treatment of candidemia.

Manejo multidisciplinario: una propuesta para mejorar la calidad de vida del paciente oncológico en quimioterapia / Multidisciplinary management: a proposal to improve the quality of life of cancer patient in chemotherapy

Cancer is a disease that impairs health of those who suffer it, affecting their quality of life. Chemotherapy produces deterioration on functional capacity as a result of the effects of therapy. Particularly affected are those patients who have to be admitted to receive treatment, by the very effects of hospitalization and prolonged rest. The deterioration of functional capacity (quality of life indicator) is explained by the alteration of physical capacity and ability to perform activities of daily living (ADLs) in an independent fashion, constituent elements of functional capacity. Given the prevalence of this disease, and the disability associated with both the disease and treatment, it is necessary to incorporate into daily practice interventions to reduce the impact on functionality, favoring the adequate reintegration of the person into his or her environment. The aim of this review is to describe the mechanisms that alter functional capacity, and the effects of physical training programs, complementary therapies and multidimensional interventions on symptomatology, well-being and quality of life of cancer patients in medical treatment. (AU)

Gastrectomía en manga transumbilical con técnica simplificada: técnica y resultados quirúrgicos en 100 pacientes / Simplifi ed transumbilical sleeve gastrectomy: technique and surgical results in 100 patients

Background: The use of transumbilical approach for sleeve gastrectomy has been recently reported, using different technique variations. Aim: To report the technique and surgical results of a transumbilical approach simplified sleeve gastrectomy, using rigid instruments. Material and Methods: Ninety four women and six men, selected by a multidisciplinary team, underwent transumbilical sleeve gastrectomy. The operative technique involved a transumbilical incision, introduction of a SILS® or GelPoint® multiport, and a 5mm metallic accessory trocar laterally in the left flank. Rigid instruments were used in all patients. The greater curvature was dissected from 4-5 cm above the pylorus to the angle of His. Gastric transection was completed with a stapler, and calibrated with a 36 French tube advanced through the pylorus. Hemostasis of the staple line was carried out with metallic clips. A barium swallow was performed in ten randomly chosen patients, confirming the correct tubular shape of the stomach. Results: Body mass index of operated patients ranged from 30 to 43 kg/m². Mean operative time was 56.4 +/- 16.7 minutes. During the early postoperative period, two patients had a hemoperitoneum, one had an antral leak and one had an intestinal perforation. No conversion to conventional laparoscopy or open technique was required. No patient died. The mean length of hospital stay was 2.3 +/- 0.5 days. The cosmetic result was satisfactory for all patients. Conclusions: Transumbilical sleeve gastrectomy is a safe and feasible procedure with the reported technique. The insertion of an accessory 5mm trocar in the left flank simplifies the procedure, allowing the use of rigid instruments.

Introducción: El abordaje transumbilical, ha demostrado ser seguro en diferentes procedimientos. Se han reportado series de casos de gastrectomía en manga transumbilical (GMTU), con diferentes variaciones. Objetivo: Es presentar la técnica y resultados quirúrgicos de una técnica de GMTU simplificada, utilizando instrumental rígido. Material y Métodos: 94 mujeres y seis hombres, fueron sometidos a GMTU, seleccionados por un equipo multidisciplinario. La técnica quirúrgica consiste en una incision transumbilical, introducción de dispositivo SILS® o GelPoint®, y un trocar de 5 mm metálico en el flanco izquierdo. Se utilizó instrumental rígido en todos los pacientes. La disección de la curvatura mayor se realiza desde 4-5 cm proximal al píloro, hasta el pilar izquierdo. La sección gástrica se completa con stapler, calibrando con una sonda de 36 fr transpilórica. Se realiza hemostasia selectiva con clips metálicos. Se realizó estudio baritado a diez pacientes aleatorios, confirmando forma tubular adecuada. Resultados: El rango de IMC preoperatorio fue de 30-43 kg/m². El tiempo operatorio promedio fue de 56,4 +/- 16,7 min. No se requirió conversión a técnica multitrocar o laparotómica. Cuatro pacientes presentaron complicaciones precoces: dos hemoperitoneos, una filtración antral y una enterotomía inadvertida. Se reintervino a dos pacientes. No hubo mortalidad. El tiempo de hospitalización fue de 2,3 +/- 0,5 días. El resultado cosmético fue satisfactorio para todos los pacientes. Conclusión: La GMTU es un procedimiento factible y seguro con la técnica expuesta. La inserción del trocar de 5 mm accesorio, simplifica el procedimiento, permite el uso de instrumental rígido, y lo convierte en un procedimiento reproducible.

Hemofilia adquirida tratada con anti CD20, un anticuerpo anti linfocito B / Acquired hemophilia a treated with rituximab. Report of one case

We report a 54-year-old male presenting with a history or recurrent nose bleeds and ecchymoses. The coagulation study showed a prolongedpartial thromboplastin time, a factor VIII of 8 percent and a high inhibitor titer (193 Bethesda units). A diagnosis of acquired hemophilia A was reached. The patient was initially treated with cyclophosphamide for seven months without response. Therefore rituximab in doses of 375 mglm²Iweek for four weeks was started. After starting treatment, the patient had a hematoma in the psoas muscle with a concomitantfactor VIII ofless than 5 percent, thatwas treated with local measures. Thereafter, aprogressive reduction in inhibitor titers was observed, until its disappearance atfive months of treatment. Factor VIII levéis normalized and the patient has not experienced abnormal bleeding episodes. The patient remains in remission after 67 months offollow up. Rituximab, a chimeric monoclonal antibody against theprotein CD 20 is an effective treatment in acquired hemophilia A.

Frecuencia de tromboembolismo venoso en pacientes hospitalizados con cáncer: factores de riesgo y eficacia de la tromboprofilaxis farmacológica / Frequency of venous thromboembolism among hospitalized patients with cancer

Background: Hospitalized patients with cancer have a high risk of venous thromboembolism (VTE). Aim: To study the frequency of VTE and its risk factors in hospitalized patients with cancer. Material and methods: Retrospective analysis of clinical records of patients with cancer, hospitalized at a university hospital between 2002 and 2004. Patients with the diagnosis of VTE at admission or using anticoagulants, were excluded from the analysis. Results: The medical records of 366 patients were reviewed. Fifty three percent had a digestive cáncer, 19 percent lung cáncer, 10 percent breast cancer and 18 percent had a tumor of other origin. In 77 percent, the tumor was in an advanced stage. The most common admission diagnoses were pneumonía, vomiting and dehydration, gastrointestinal bleeding and urinary infection. In 125 patients (34 percent) pharmacological thrombo-prophylaxis was not used and 242 (66 percent) received regular or low molecular weight heparin. VTE was detected in 11 patients (3 percent) and was significantly more common among patients not receiving thrombo prophylaxis compared to those receiving heparin (6.4 percent and 1.2 percent, respectively p =0.014). Factors associated to VTE were a history ofprevious VTE with an odds ratio (OR) of 12.9 (p <0.01), obesity with an OR of 13.3 (p <0.01), recent chemotherapy with an OR of 6.9 (p =0.01). The use of pharmacological thromboprophylaxis had an OR of 0.24 (p =0.05). Conclusions: Three percent of patients in this series had VTE during the hospitalization. Pharmacological thrombo-prophylaxis significantly reduced the risk of VTE.

Valor pronóstico del nuevo sistema de etapificación internacional en mieloma múltiple: Comparación con el sistema de Durie-Salmon / Prognostic value of the new international staging system in multiple myeloma: Comparison with Durie-Salmon staging system

Background: Since 1975, the Durie-Salmon staging system (D&S) has been a widely accepted prognostic classification of multiple myeloma (MM) patients. Recently, the new International Staging System (ISS) was developed using only the values of albumin and betaZ-microglobulin. Aim: To compare survival of patients with MM treated in six medical centers in Chile according to the D&S system and the new ISS. Material and methods: Retrospective analysis of demographic information, clinical features and survival rate of patients treated between 1998 and 2002, and grouped according to both systems. Results: Information of 81 patients aged 38 to 90 years (43 women) was retrieved. According D&S system 11 percent were in stage I 12 percent in stage II and 73 percent in stage III According to ISS, 34 percent were in stage I 35 percent in stage II and 31 percent in stage III Median of survival of all patients was 32 months. Both staging systems had a prognostic value. However, median survival for the three stages of the ISS system was significantly different (67, 29 and 14 months in stages III and III, respectively, p =0.02). Patients in advanced stages II and III of the ISS, had a higher frequency of anemia, hypercalcemia, renal failure and hypoalbuminemia. In stages II and III of ISS the presence of renal failure was associated with a non significantly different lower survival. Conclusions: The ISS is a simple and effective grouping method for patients with MM, that predicts survival. The presence of renal insufficiency might identify a subgroup of patients included in stages II and III of ISS with a higher mortality.

Mieloma múltiple en Chile: características clínicas y sobrevida / Clinical features and survival of Chilean patients with multiple myeloma

Background: Mortality rate records are the only data available in Chile about the prognosis of patients with multiple myeloma (MM). Aim To characterize clinical features, survival rate and factors related to mortality in cases with MM treated in six large medical centers in Chile. Material and Method: Retrospective analysis of demographic data, clinical features and survival rate records of patients with MM, collected between 1998 and 2002. Survival curves were generated and a multivariate analysis of factors associated to early mortality was carried out. Results: Data from 245patients aged 38 to 95years (129 women) was collected. Fifty two percent had an IgG myeloma, 25 percent had and IgA and 6.1 percent had light chains myeloma. According to Durie and Salmon staging system, 8,2 percent were in Stage 112.6 percent in Stage II, 60.5 percent in Stage III and in 18.8 percent the information about staging was not available. Fifty percent had an hemoglobin level below 10 g/dL, 30 percent had a serum creatinine over 2 mg/dL and 28 percent had a serum calcium level over 10.5 mg/dL. Median survival was 33 months. Twenty percent of patients died within the first six months after diagnosis (early mortality). Predictive factors for early mortality were male sex, thrombocytopenia, anemia, renal failure, hypercalcemia, a beta2-microglobulin >5.5 mg/L and a serum albumin level <3.5 g/dL. There was a correlation between the number of bad prognosis factors present and the probability of early mortality. Conclusions: This group of Chilean patients with MM presented a short survival time, and 20 percent died within the first six months after diagnosis. More than a half of cases were diagnosed at an advanced stage (Durie and Salmon Stage III). Several factors were associated to early mortality, two of which (beta 2-microglobulin and serum albumin), are included in the new International Staging System for MM.

Terapia transfusional: criterios de indicaciones de componentes sanguíneos / Transfusion therapy: criteria for indications of blood components

The new development in transfusion medicine has allowed that blood component would be available safely for patients. However, like other medical therapies, we should establish clearly the indications based on the best benefit/risk relationship. In the following paragraphs the indications for red cells, platelets, fresh frozen plasma and cryoprecipitate will be shown. Finally, the risks and adverse events to blood transfusion will be reviewed.

Trabajo en turnos en el sector de la salud chileno: una comparación entre el sector público y privado / Shiftwork in chilean health sector: a comparison between public and private sectors

En el sector de la salud chileno, un esquema de turnos tradicional es el denominado “cuarto turno”. Si bien este sistema es preferido por una proporción significativa de enfermeras y técnicos paramédicos, habitualmente se presume que el sector público presentaría alteraciones significativamente superiores a las que presenta el personal que se desempeña en el sector privado. La necesidad de respaldo científico al respecto, motivó esta investigación. En esta investigación, se aplicaron metodologías publicadas en la literatura científica (BESIAK, Standart Shiftwork Index y escala de hipersomnia de Epworth). Se encuestó una muestra de 44 trabajadores pertenecientes a un hospital privado y 43 trabajadores de un hospital público, ambos localizados en Santiago de Chile. La evaluación de la arquitectura de este sistema de turnos permite concluir que no representa riesgo significativo para las personas en los ámbitos de la salud, bienestar, vida social, adaptación y rendimiento. No existen diferencias significativas en la percepción de fatiga física, alteraciones sociales y presencia de trastornos del sueño entre el personal del sector privado y público. Las principales debilidades del sistema de cuarto turno son su alta irregularidad. Sus principales fortalezas son el alto número de días libres por semana, moderado impacto sobre el ritmo sueño-vigilia y moderada desvinculación social y familiar.

Efecto de la dipirona sobre la agregación plaquetaria / Effect of dipyrone on platelet aggregation

El presente estudio se realizó con la finalidad de determinar si la Dipirona altera la agregación plaquetaria. Para ello, se seleccionaron 30 voluntarios sanos, los cuales fueron divididos en dos grupos y asignados al azar a recibir 1 g de Dipirona o 100 mg de Acido Acetilsalicílico. Se determinó la agregación plaquetaria a través del método turbidimétrico; utilizando adenosin difosfato, colágeno y adrenalina. En el grupo Dipirona, se observó una reducción estadísticamente significativa de la agregación plaquetaria a las 72 horas, frente a los 3 estímulos; que revirtió a las 24 horas. En el grupo Acido Acetilsalicílico, disminuyó significativamente la agregación plaquetaria a las 24 horas. Al comparar ambos grupos no hubo diferencia significativa en la muestra basal pero si a las 24 horas. Podemos concluir que la Dipirona, al igual que el resto de los antiinflamatorios no esteroideos, inhibe la agregación plaquetaria de forma reversible, al contrario del Acido Acetilsalicílico.

Estudio de cepas nativas amilolíticas / Study of amilolytic native microbial stocks

En el presente trabajo se realiza el estudio de cepas microbianas aisladas de diferentes nichos ecológicos, productoras de las enzimas amilolíticas, así: procesado de maíz, de papa y de yuca. Los criterios utilizados para el aislamiento de las cepas amilolíticas, son el crecimiento sobre los medios modificados con almidón y la positividad frente al Test de Lugol. Los medios empleados fueron CZAPEK, PCA y MRS modificados. Las cepas obtenidas son debidamente purificadas, crío conservadas e identificadas bioquímicamente, obteniendo un total de 103 cepas nativas. De éste total de cepas, se seleccionan debido a la similitud fisiológica entre microorganismos aislados, 9 cepas. Estas últimas son identificadas bioquímicamente y se obtienen los géneros Bacillus sp ,Clostridium sp y Kurthia sp. Las enzimas amilolíticas obtenidas a partir de las cepas nativas presentan pesos moleculares que oscilan entre 30 y 150 kDa aproximadamente

Hallazgos histopatólogicos en 1181 apendicectomías / Histopathological findings in 1181 appendectomies

El apéndice cecal es asiento de variada patología, desde la apendicitis aguda a una serie de otras enfermedades y procesos no inflamatorios. El objetivo de este estudio fue la revisión retrospectiva de los hallazgos histológicos, etiología, edad, género y diagnóstico de las apendicectomías realizadas en el Hospital Militar de Santiago desde Enero 2000 a Febrero 2004. Se revisaron 1181 casos. El 95 por ciento de las apendicectomías se realizaron con el diagnóstico preoperatorio de apendicitis aguda. El 83 por ciento del total presentó apendicitis aguda histológica y el 9 por ciento de estas perforada. El promedio de edad fue de 22,7 años y el 57 por ciento eran hombres. Un 13 por ciento de las intervenciones resultaron de etiología no apendicular, de éstas el 73 por ciento fue en mujeres. Del total de los apéndices vermiformes estudiados el 5 por ciento eran normales, un 9 por ciento presentaba hiperplasia linfoide, un 10 por ciento fecalito, un 3 por ciento Enterobius vermicularis y un 4 por ciento presentó otros diagnósticos. De las neoplasias encontradas las más frecuentes fueron carcinoides apendiculares en un 0,67 por ciento. En conclusión, la patología apendicular es importante en la práctica quirúrgica de urgencia, siendo la apendicitis aguda la más frecuente de ellas. Sin embargo, existe un porcentaje no despreciable de otras patologías que afectan o coexisten en este órgano y que deben ser incluidas en la lista de diagnósticos diferenciales.

Prevalencia de estrés en estudiantes del área de la salud de la Universidad de los Andes y su relación con enfermedades infecciosas / Prevalence of stress in health sciences students at Los Andes University and its relation to infectious diseases

Objetivos. Conocer la prevalencia de estrés en estudiantes del área de salud de la Universidad de los Andes (UANDES) y comparar subgrupos por género, carrera y año de estudio. Determinar si existe correlación entre estrés y enfermedad infecciosa. Método. 438 estudiantes de todos los cursos de Medicina, y estudiantes de primer año de Enfermería, Psicología y Odontología de la UANDES. En octubre de 2002 (período de pruebas) se aplicó una encuesta sobre estrés y se evaluó si en los últimos 10 días la persona reportaba alguna enfermedad infecciosa. Resultados. Se encontró una prevalencia de estrés de 36,3 por ciento, mayor en mujeres que en hombres (p<0,05). Medicina tiene significativamente más estrés que el resto de las carreras, en tanto Psicología la menor prevalencia (p<0,005). El primer año de Medicina tiene más estrés que el resto de los cursos de la carrera (p < 0,01). Por último, se encontró una correlación positiva entre estrés y enfermedad infecciosa (0,05). Conclusiones. Un importante porcentaje de estudiantes del área de salud de la UANDES tienen estrés, por lo que es importante identificarlos para ayudarlos a manejar sus consecuencias deletéreas.

Objective. To determine the prevalence of stress among Health Sciences students at Los Andes University (UANDES) and to compare subgroups according to gender, major, and year of college. To determine if there is a link between stress and infectious diseases. Methods. 438 students from all seven years of Medical School and first year Nursing, Psychology and Dentistry students at UANDES. In October 2002 (test period) we administrered a stress survey and checked for any symptoms of infectious disease during the previous 10 days. Results. We found a 36,3 percent stress prevalence, greater among women than men (p < 0,05). Medical students have significantly higher rates of stress than those in the other degree programs, and Psychology is the field of study with the least stress prevalence (p < 0,005). The first year of Medicine has significantly greater stress than the remaining years (p < 0,01). We found that stress is linked to infectious diseases (0,05). Conclusions. A significant percentage of Health Sciences students at UANDES suffer stress; it is therefore important to help them cope with stress and its causes.