Evaluación funcional con la escala KSS (Knee Society Score) a tres y seis meses de la reconstrucción ligamentaria en pacientes con lesiones multiligamentarias de rodilla en un hospital de tercer nivel / Functional evaluation with the KSS (Knee Society Score) scale at 3 and 6 months after ligament reconstruction in patients with multi-ligament knee injuries in a third level hospital

Resumen: Las lesiones multiligamentarias de la articulación de la rodilla se caracterizan por la afección de dos o más ligamentos principales, ligamento cruzado anterior (LCA), ligamento cruzado posterior (LCP), ligamento colateral medial (LCM), ligamento colateral lateral (LCL), esquina posteromedial (EPM) y esquina posterolateral (EPL). Estadísticamente, las lesiones multiligamentarias son poco frecuentes, ya que se encuentran en menos de 0.02% de todas las lesiones traumáticas de rodilla; sin embargo, diferentes lesiones agregadas son las que hacen de esta patología un estado grave para salud y funcionalidad. Tomando en cuenta que la mayoría de los pacientes son personas jóvenes en edad altamente productiva, es de vital importancia observar la evolución de los mismos a corto y largo plazo, así como su reincorporación a su vida cotidiana. Se ha descrito que las lesiones vasculares se presentan aproximadamente en 32% de los casos, lesiones meniscales en 35% y hasta 60% con algún tipo de lesión ósea. Estas lesiones afectan principalmente al sexo masculino con más frecuencia entre la tercera y cuarta década de la vida, lo cual hace a este tipo de lesiones de gran importancia, ya que este grupo de pacientes se encuentran en su mayor período de producción laboral. El objetivo principal del tratamiento de estas lesiones, además de resolver los daños agregados que suelen ser los agravantes del estado de salud, es lograr una pronta recuperación y posterior reincorporación a sus actividades laborales y en algunos casos deportivas.

Abstract: Multiligament injuries of the knee joint are characterized by the involvement of two or more major ligaments, anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), lateral collateral ligament (LCL), posteromedial corner (PMC) and posterolateral corner (PLC). Statistically, multiligament injuries are rare as they are found in less than 0.02% of all traumatic knee injuries; however, different aggregate injuries are what make this pathology a serious health and functional condition. Taking into account that most of the patients are young people of highly productive age, it is of vital importance to observe their short and long term evolution, as well as their reincorporation to their daily life. It has been reported that vascular lesions are present in approximately 32% of cases, meniscal lesions in 35% and up to 60% with some type of bone lesion. These injuries mainly affect the male sex most commonly between the third and fourth decade of life, which makes this type of injury of great importance, since this group of patients are in their greatest period of labor production. The main objective of the treatment of these injuries, in addition to resolving the aggregate damage that usually aggravates the state of health, is to achieve a speedy recovery and subsequent reincorporation to their work activities and in some cases sports.

Calcifilaxis / Calciphylaxis

Resumen La calcifilaxis es una enfermedad poco frecuente, aunque presenta una elevada tasa de mortalidad debido sobre todo a complicaciones como sepsis o gangrena. Generalmente se asocia a insuficiencia renal severa. Se define como la calcificación de la capa media de vasos de pequeño y mediano tamaño de la dermis y tejido celular subcutáneo. Clínicamente se manifiesta como un síndrome de livedoracemosa que progresa a púrpura retiforme y necrosis cutánea. La primera línea de tratamiento es el tiosulfato sódico.

Abstract Calciphylaxis is a rare disease, although it has a high mortality rate due mainly to complications such as sepsis or gangrene. It is usually associated with severe renal failure. It is defined as the calcification of the middle layer of small and medium-sized vessels of the dermis and subcutaneous cellular tissue. Clinically it manifests as a livedoracemosa syndrome that progresses to retinal purpura and cutaneous necrosis. The first line of treatment is sodium thiosulfate.

Identificación Estable de Fuentes Asociadas a Focos Epilépticos Ubicadas sobre la Corteza / Stable Identification of Sources Associated with Epileptic Focus on the Cerebral Cortex

Resumen Objetivo: Presentar un algoritmo estable que determina, a partir de mediciones electroencefalográficas, los parámetros de fuentes de tipo dipolar asociadas a focos epilépticos ubicados sobre la superficie de la corteza cerebral. Metodología: Se utiliza un problema de contorno para establecer correlaciones entre la fuente y la medición. El problema se divide en dos subproblemas lineales y en cada uno de ellos, se utilizan el método de mínimos cuadrados y la regularización de Tikhonov para encontrar soluciones estables. Estos subproblemas son problemas mal planteados en el sentido de Hadamard, debido a la inestabilidad numérica que presentan, es decir, pequeños cambios en las mediciones pueden producir grandes variaciones en la solución de cada problema. El parámetro de regularización de Tikhonov fue elegido usando el método de la curva L. Para hallar la solución del problema de contorno se utiliza el método de las series de Fourier y el Método del Elemento Finito. Resultados: Se propuso un tipo de fuente para representar a los focos epilépticos en la corteza cerebral y un algoritmo estable para el problema de identificación de los parámetros de dichas fuentes. Se desarrollaron ejemplos sintéticos y programas en MATLAB para el caso de geometría simple bidimensional. Originalidad: La separación del problema original en dos subproblemas así como los ejemplos sintéticos son producto de esta investigación. Conclusión general: Se propuso un algoritmo estable que determina a los parámetros de fuentes de corriente dipolar definidas en la corteza cerebral.

Abstract Objective: To present a stable algorithm that determines, from electroencephalographic measurements, the parameters of dipolar sources associated with epileptic foci located on the cerebral cortex. Methodology: A boundary value problem is used to establish correlations between the sources and the measurements. The problem is divided into two linear subproblems and in each one, the method of Minimum Square and the Tikhonov regularization are used for finding stables solutions. These subproblems are an ill-posed problem in the Hadamard sense, which is due to the numerical instability, that is, small changes in the data can produce substantial variations in the solution of each problem. The Tikhonov regularization parameter was chosen using the L curve method. To find the solution of the boundary value problem are used the Fourier series method and the Finite Element Method. Results: A type of source that represents the epileptic foci on the cerebral cortex and a stable algorithm for finding the parameter of these sources were proposed. Synthetics examples and MATLAB programs were developed for the case of bidimensional geometry. Originality: The separation of the original problem into two subproblems and the synthetics examples are a product of this research. Conclusion: A stable algorithm was proposed for determining the parameters of the dipolar current defined on the cerebral cortex.

Prototipo de Silla de Ruedas Dirigida Usando Parpadeos / A Wheel Chair Prototype Moved by means of Eye Blinks

Resumen El presente trabajo describe un prototipo de una silla de ruedas que es dirigido hacia enfrente y hacia atrás usando 2 o 3 parpadeos, respectivamente, y es detenido cuando se alcanzan ciertos niveles de atención. El objetivo principal es que las personas que tienen discapacidad motora en sus extremidades puedan usarlo para desplazarse y les brinde autonomía. Para captar la señal de los parpadeos, se utilizó la diadema MindWave Mobile de Neurosky. Se implementó un circuito electrónico en conjunto con Arduino que permite complementar la ejecución del accionamiento del prototipo. El prototipo se probó con 10 personas cuyas edades oscilan entre 20 y 35 años. Los resultados muestran que, en un 80% de los casos, el prototipo se mueve correctamente. La gran ventaja del presente trabajo es que la interfaz cerebro-computadora con la que cuenta este prototipo no requiere entrenamiento previo del sistema, por lo cual, puede ser usado por cualquier persona. Además, su costo es más accesible comparado con otros dispositivos para el mismo fin.

Abstract The present work describes a prototype of a wheel chair directed by means of eye blinks, which can be moved forwards, and backwards using 2 or 3 eye blinks, respectively, and stopped when a certain attention level is met. The main objective of this work is to help people, who have motor disabilities on their arms and legs, move and have autonomy. In order to register the eye blinking signals, the MindWave Mobile device from Neurosky was used. Moreover, an electronic circuit in combination with Arduino has been used to make the prototype work. This prototype has been tested in 10 healthy people from 20 to 35 years old. According to the results, in 80% of the cases the prototype worked correctly. The main advantage of the present work is that the brain-computer interface, which is part of the prototype, does not require training, and hence, it could be used by most of the people. Moreover, its cost is less than similar devices.

Ideas, necesidades y afrontamiento de adolescentes en tratamiento oncológico / Ideas, needs, and coping of adolescents receiving cancer treatment

Introducción: La adolescencia es una etapa de importantes cambios biopsicosociales: imagen corporal, ideales, proyecto vital, roles intrafamiliares y sociales sufren redefiniciones tendientes a la autonomía y el fortalecimiento de la identidad. El proceso en su conjunto implica desafíos y conquistas, pero también un grado importante de vulnerabilidad psicológica. La enfermedad oncológica tiene un alto impacto socio emocional, afectando todos los procesos adolescentes. Objetivos: Explorar las problemáticas que enfrentan los adolescentes durante el tratamiento oncológico y conocer los recursos psicológicos, sociales e institucionales que utilizan para transitar los procesos de la adolescencia en dicha situación. Material y métodos: estudio observacional, transversal y prospectivo. Para la recolección de datos se utilizó un cuestionario para adolescentes, un cuestionario para cuidadores, y la Escala de Afrontamiento para adolescentes (ACS) de Frydenberg y Lewis. Los cuestionarios fueron elaborados para este estudio y contenían preguntas con respuestas abiertas y cerradas. Para el procesamiento de datos, se registraron todas las respuestas cerradas y con las respuestas abiertas se formaron categorías por consenso siempre que una misma idea fuera referida por al menos el 10% de los entrevistados. Resultados: 42 adolescentes y 32 cuidadores participaron del estudio. Mediana de edad: 15,04 años (13,08-18,09). Tiempo desde el diagnóstico: mediana 6 meses (1-24). El 81% de los adolescentes contaba con comprensión adecuada de la enfermedad y el 19% con comprensión parcial. El 57% refirió preocupaciones vinculadas con la enfermedad y/o el tratamiento. El síntoma físico más reportado fue el cansancio; respecto al estado emocional fue la alternancia de momentos buenos y momentos malos. Los principales recursos de ayuda fueron la familia y los amigos. Presentaron variabilidad en el uso de estrategias de afrontamiento, mayor uso de estrategias eficaces y menor uso de disfuncionales. Conclusiones: Los adolescentes en tratamiento oncológico requieren del apoyo y aliento de la familia, amigos y equipo de salud. Mejorar la infraestructura y el equipamiento electrónico del hospital facilitaría que se mantengan activos y comunicados. Crear espacios asistenciales y recreativos diferenciales para adolescentes favorecería el encuentro e intercambio entre ellos. Estimular la participación activa de los adolescentes en el diálogo con los médicos y en el tratamiento permitiría dar lugar a sus preocupaciones y que recobren algo de la autonomía perdida (AU)

Introduction: Adolescence is a stage of important biopsychosocial changes: Body image, ideals, project of life, intra-family and social roles are subject to redefinitions related to autonomy and identity strengthening. Taken together, this process implies challenges and achievements, but also a considerable degree of psychological vulnerability. Oncological disease has a strong socio-emotional impact, affecting all processes of adolescence. Aims: To assess problems that affect adolescents during oncology treatment and determine psychological, social, and institutional resources they use to go through the processes of adolescence in this situation. Material and methods: Prospective, observational, and cross-sectional study. For data collection a survey for adolescents, a survey for caregivers, and the Adolescent Coping Scale (ACS) by Frydenberg and Lewis were used. The surveys were developed for this study and had open-ended and closedended questions. For data processing all closed-ended questions were recorded and categories were developed for the openended questions based on consensus when the same idea was expressed by at least 10% of the interviewees. Results: 42 adolescents and 32 caregivers participated in the study. Median age was 15.04 years (13,08-18,09). Median time from diagnosis was 6 months (1-24). Overall, 81% of the adolescents had an adequate understanding of the disease and 19% a partial understanding. Of the adolescents, 57% reported worries related to the disease and/or the treatment. The most commonly reported physical symptom was fatigue; emotional state was alternating between good and bad moments. The main support resources were the family and friends. The adolescents used a variability of coping strategies, with more use of efficacious than dysfunctional strategies. Conclusions: Adolescents receiving oncology treatment need support and encouragement from the family, friends, and the health-care team. Improving the infrastructure and electronic equipment of the hospital may be helpful in keeping them active and connected. Creating differential care and recreational spaces for adolescents will favor meetings and exchange among them. Stimulating active participation of the adolescents in the dialogue with physicians and in the treatment will allow them to reveal their worries and recover some of their lost autonomy (AU)

REPRODUCTIVE ACTIVITY AFTER INDUCED ANESTRUS USING ALTRENOGEST IN Tursiops truncatus FEMALES IN CAPTIVITY IN MARINE ENVIRONMENT / ACTIVIDAD REPRODUCTIVA DESPUÉS DEL ANESTRO INDUCIDO CON ALTRENOGEST EN HEMBRAS DE Tursiops truncatus EN CAUTIVERIO EN AMBIENTE MARINO

Interest to reproduce Bottlenose dolphin (Tursiops truncatus) in captivity has increased due to the international restrictions for its commercialization and the risks and logistical difficulties for transporting specimens. Therefore, it has become important to study its reproductive biology in captivity. The objective of the present study was to determine altrenogest (Regumate ®) post-treatment indicators of vaginal cytology, estradiol levels and restarting of reproductive activity of T truncatus females in captivity in marine environment. Twelve females received altrenogest at a daily dose of 0.07mg kg-1 for a year. A total 420 slides of vaginal cytology of each female were performed to determine the percentage of cornified cells. Also, 60 blood samples of each animal were analyzed to determine estradiol levels. Regarding the vaginal cytology; percentage of cornified cells increased between 60 and 70% from day 4 to day 9 after removing the altrenogest treatment and between 70 and 80% from day 12 to day 19. Estradiol levels were in the range of 16 to 1l4pg ml-1 during the entire monitoring period. A positive correlation (r = 0.7062; P<0.05) was found between these indicators. Therefore, we conclude that treatment with altrenogest and monitoring the estrous cycle with simple techniques such as vaginal cytology might be used for designing protocols for assisted reproduction for groups of T truncatus in captivity.

La necesidad de reproducir delfín nariz de botella (Tursiops truncatus) en cautiverio se ha incrementado debido a las restricciones internacionales para su comercialización y por el riesgo y dificultad logística para el traslado de ejemplares. Por lo anterior, se hace importante conocer su biología reproductiva en cautiverio. El objetivo de este trabajo, fue conocer los indicadores post tratamiento con altrenogest (Regumate®), de citología vaginal, niveles de estradiol y reinicio de la actividad reproductiva en cautiverio de hembras de T truncatus en ambiente marino. Por un año, 12 hembras recibieron diariamente una dosis de 0,07mg kg-1 de altrenogest. Se realizaron un total 420 citologías vaginales, una diaria de cada hembra, para determinar el porcentaje de células cornificadas. También se obtuvieron de la red vascular, 60 muestras sanguíneas, en las que se determinó los niveles de estradiol. En cuanto a la citología vaginal, al cuarto día de retirar la administración de altrenogest, el porcentaje total de células cornificadas incrementó del 60% a 70% hasta el día nueve y continuó ascendiendo al 80% entre los días 12 al 19. Los niveles de estradiol, presentaron un rango de 16 a 114pg ml-1. Se encontró una correlación (r = 0,7062 P<0.05) positiva entre estos indicadores. Se concluye que es posible la manipulación con altrenogest y el monitoreo del ciclo estral de las hembras mediante técnicas simples como la citología vaginal para el diseño de protocolos de reproducción asistida específicos para grupos en cautiverio de T truncatus.

Evaluación del sangrado y tiempo quirúrgico en artroplastía total de rodilla con y sin torniquete: Estudio comparativo / Assessment of bleeding and operative time in total knee arthroplasty with and without tourniquet: Comparative study

Antecedentes: La utilización de torniquete neumático (TN) en la artroplastía total de rodilla (ATR) ha sido tema de controversia, describiendo ventajas, desventajas y complicaciones asociadas. Con la finalidad de evaluar los beneficios de su utilización se estudió el tiempo quirúrgico, volumen de sangrado transquirúrgico, postquirúrgico y total, así como los valores de hemoglobina y hematocrito pre y postquirúrgicos de pacientes a los que se les realizo ATR primaria utilizando TN y se compararon con un grupo control. Material y métodos: Se realizó un análisis retrospectivo de expedientes clínicos de casos sometidos a ATR; en apego a los criterios de inclusión se obtuvo un grupo de estudio (n = 19) y control (n = 19) según la utilización o no de TN. Se compararon el tiempo quirúrgico, el sangrado transquirúrgico y postquirúrgico así como el sangrado total; valores de hemoglobina y hematocrito iniciales y finales. Resultados: Se obtuvieron diferencias significativas a favor del grupo en quienes se utilizó TN en 7 de 8 variables estudiadas, siendo el tiempo empleado (t = 2.08 p < 0.050); sangrado transquirúrgico (t = -6.44, p < 0.010); postquirúrgico (t = -2.170 p < 0.050) y total (t = /7.52, p < 0.010), las más relevantes. Conclusiones: Los resultados mostraron que los sujetos a quienes se les aplicó TN durante la ATR requirieron menos tiempo quirúrgico y que el sangrado total, trans y postquirúrgico, así como la perdida sanguínea calculada fueron menores que los controles. Mayores conjeturas sobre los beneficios del TN ameritan la realización de más investigaciones prospectivas.

Background: The use of the pneumatic tourniquet (PT) in total knee arthroplasty (TKA) has been controversial; its advantages, disadvantages and associated complications have been described. In order to assess its benefits we analyzed operative time; intraoperative, postoperative and total bleeding volume, as well as pre- and postoperative hemoglobin and hematocrit values in patients who had undergone primary TKA using the PT, and they were compared with a control group. Material and methods: A retrospective analysis of the clinical records of cases who underwent TKA was conducted. Based on the inclusion criteria and the use or non-use of PT, two groups were formed: a study group (n = 19) and a control group (n = 19). The following variables were compared: operative time, intra and postoperative bleeding and total bleeding; initial and final hemoglobin and hematocrit values. Results: Significant differences in favor of the group with PT use were obtained in 7 out of the 8 variables studied. The most relevant ones were operative time (t = 2.08 p < 0.050); intraoperative bleeding (t = -6.44, p < 0.010); postoperative bleeding (t = -2.170 p < 0.050) and total bleeding (t = /7.52, p < 0.010). Conclusions: The results showed that patients in whom PT was used during TKA had a shorter operative time, and their total, intra- and postoperative bleeding and the estimated blood loss were lower than in controls. Additional suppositions on the benefits of PT warrant the conduction of more prospective research studies.

Parámetros hemaoológicos en polluelos de psitácidos en cautiverio de origen silvestre / Hematologial parrameters of wild parrot chicks kept in captivity

El objetivo de este estudio fue describir los parámetros hematológicos en 69 polluelos en cautiverio de origen silvestre, clínicamente sanos, menores de tres meses de edad, en cuatro especies de psitácidos: Pionus senilis (n = 18), Amazona albifrons (n = 15), Amazona autumnalis (n = 25) y Amazona oratrix (n = 11), procedentes de la región central de México. Para determinar dichos parámetros, de cada ejemplar se obtuvieron 500 µl de sangre por punción de la vena braquial. En las cuatro especies citadas, el porcentaje del hematocrito fue de 56,4 ± 3,36; 51 ± 6,52; 47,6 ± 6,47 y 53,8 ± 9,26; el VCM en fl fue de 184,6 ± 13,4; 142,0 ± 25,4; 106,3 ± 11,7 y 162,3 ± 71,9; la cuenta eritrocítica fue de 4,7 ± 2,1 x10(6)/µl; 6,1 ± 8,2 x10(6)/µl; 6,9 ± 1,2 x10(6)/µl y 5,4 ± 1,1 x10(6)/µl; y la cuenta leucocitaria de 3,06 ± 0,15 x10³/µl; 3,62 ± 0,24 x10³/µl; 4,48 ± 0,36 x10³/µl y 3,56 ± 0,71 x10³/µl respectivamente para P. senilis, A. albifrons, A. autumnalis y A. oratrix. Se constató tendencia a la heterofilia en A. albifrons y A. oratrix, lo cual puede ser de gran utilidad para un diagnóstico cada vez más preciso en la clínica de aves en cautiverio.

The aim of this study, conducted in central Mexico, was to describe the hematological parameters in 69 wild chicks of psittacine kept in captivity, younger than three months of age of four different species: Pionus senilis (n = 18), Amazona albifrons (n = 15), Amazona autumnalis (n = 25) and Amazona oratrix (n = 11). All parrots were sampled to obtaind 500 µl of blood for quantifying hematological parameters. Hematocrit percentage was 56.4 ± 3.36, 51 ± 6.52, 47.6 ± 6.47 and 53.8 ± 9.26; the MCV (fl) was 184.6 ± 13.4, 142.0 ± 25.4, 106.3 ± 11.7 and 162.3 ± 71.9; the erythrocyte count was, 4.7 ± 2.1x10(6)/μl, 6.1 ± 8.2 x10(6)/μl, 6.9 ± 1.2 x10(6)/μl and 5.4 ± 1.1 x10(6)/μl, and leukocyte count was of 3.06 ± 0.15 x10³/µl, 3.62 ± 0.24 x10³/µl, 4.48 ± 0.36 x10³/µl y 3.56 ± 0.71 x10³/µl respectively for P. senilis, A. albifrons, A. autumnalis y A. oratrix. There was a trend to heterophilia in A. oratrix and A. albifrons, which represents a contribution that may be useful for more precise diagnosis in avian clinical practice.

Visión general de la reumatología en Chile / Overview of the rheumatology in Chile

El inicio de la Reumatología en nuestro país data del año 1873 con la primera publicación dedicada a la especialidad, pero no es hasta el año 1944 con la creación de la primera clínica en que la Reumatología nace formalmente. El segundo hito es la creación de la Sociedad Chilena de Reumatología en 1950, que desde esa fecha se ha preocupado de mantener actualizada a la comunidad científica y como apoyo constante a los pacientes. Desde el punto de vista de las patologías observadas son diferentes las frecuencias en complejos de atención primaria versus complejos de atención terciaria. En el año 2007 se incorpora el sistema Auge, que otorga a pacientes con algunas patologías reumatológicas garantías de atención y tratamiento, incluyendo biológicos en algunos casos. Se intenta en este artículo dar una revisión general a la historia y actualidad reumatológica chilena.

The start of Rheumatology in our country dates back to 1873 with the first publication devoted to the specialty, but not until 1944 with the creation of the first clinic in Rheumatology that the specialty formally born, the 2nd milestone was the creation of the Chilean Society of Rheumatology in 1950 which since then, has been concerned for keeping the scientific community update and give an ongoing support to patients. From the point of view of the observed diseases there are different frequencies when we compare the primary care vs. tertiary care health systems. In 2007 the AUGE system starts. This system gives to patients with specific rheumatologic diseases warranty of attention and treatment, including biologics therapies in some cases. We attempted in this paper give an overview of the history and current Chilean Rheumatology.

Perfil de presión arterial e historia familiar de hipertensión en niños escolares sanos de Santiago de Chile / Blood pressure and family history of hypertension in children from Santiago, Chile

Background: The prevalence of pediatric arterial hypertension (AHT) is approximately 1% to 2%. In the last ten years, mean blood pressure levels (BP) have raised due to obesity and changes in lifestyles. Family history (FH) of AHT is a risk factor to develop AHT inchildren. Aim: To assess blood pressure, cardiovascular risk factors and family history in healthy children of Santiago. Material and methods: Blood pressure, family history of AHT, birth weight(BW), gestational age, puberal stage, blood glucose, serum lipids and ultrasensitive Reactive C Protein (usCRP) were analyzed, using data from a study of early markers of atherosclerosis in children. Results: Data of 112 children aged between 6-12 years was analyzed. Hypertension (BP >percentile 95) was detected in 2.7% and pre hypertension (BP in percentiles 90-95) in 3.6% of thesample. Children with abnormal BP had higher levels of usCRP (p <0.05) and a non significant tendency towards a higher body mass index. All hypertensive and one pre hypertensive children had FH of AHT. Eleven percent of parents, had high blood pressure. In no children, both parents werehypertensive. Children with a family history of hypertension had higher concentrations of total serum cholesterol (p <0.05). Conclusions: The abnormal prevalence of AHT found in this study is comparable to other studies. FH associated to higher levels of BP in children. Children withabnormal BP had a higher subclinical level of inflammation.

Arterioesclerosis subclinica, factores de riesgo cardiovascular clásicos y emergentes en niños obesos chilenos / Subclinical atherosclerosis, traditional cardiovascular risk factors in obese children and emerging Chilean

La arteriosclerosis puede comenzar en la niñez y desarrollarse crónicamente dependiendo de la carga de factores de riesgo (FR) cardiovascular. Comparar niños obesos con eutrófilos en cuanto a FR clásicos, emergentes (proteina C Reactiva ultrasensible: PCRus) y arteriosclerosis subclínica, mediante dos nuevas técnicas no invasivas.

Arterioesclerosis subclínica, factores de riesgo cardiovascular clásicos y emergentes en niños obesos chilenos / Subclinical atherosclerosis: classic and emerging cardiovascular risk factors in Chilean obese children

La arteriosclerosis puede comenzar en la niñez y desarrollarse crónicamente dependiendo de la carga de factores de riesgo (FR) cardiovascular. Objetivo: Comparar niños obesos con eutróficos en cuanto a FR clásicos, emergentes (Proteína C Reactiva ultrasensible: PCRus) y arteriosclerosis subclínica, mediante dos nuevas técnicas no invasivas: dilatación mediada por flujo de la arteria braquial (DMF) y grosor de la íntima-media carotídea (IMT). Método: Se estudiaron 26 niños obesos (IMC ³ Pc95) y 57 eutróficos (IMC: Pc10 - Pc85). Se evaluó antropometría, presión arterial (PA), DMF, IMT, y se determinó de PCRus, perfil lipídico y glicemia de ayunas. Resultados: El 50 por ciento fueron mujeres y 41 por ciento prepúberes. Con edad de 9,9 + - 1,6 y 9,8 + - 1,8 años (ns), zIMC: 2,0 + - 0 2 y 1,7 + - 0,6, perímetro de cintura (por ciento Media): 133,5 + - 16 y 100,5 + -1 0 por ciento en obesos y eutróficos respectivamente. Los obesos tuvieron mayor Colesterol Total, CLDL, Triglicéridos, PCRus y menor CHDL (p < 0,005). No hubo diferencia significativa en DMF: 9,03 + - 5,2 por ciento vs 9,3 + - 4,2 por ciento, IMT: 0,49 + - 0,03 vs 0,50 + - 0,03 mm, glicemia ni PA. Conclusión: Este grupo de niños obesos chilenos presenta mayor carga de FR clásicos y nivel de PCRus que los eutróficos, pero no se encontró diferencia significativa en marcadores sustitutos de arteriosclerosis subclínica.

Tumor growth parameters of in-vivo human breast carcinoma: a proposed mathematical model for tumor growth kinetics

Many mathematical models have been proposed to study tumor growth parameters in vivo. Nevertheless most of the medical models have given variable results even when experimental conditions are exactly the same. There are multiple factors that are capable of affecting tumor growth that should be taken into account when proposing a mathematical model for tumor growth in vivo. We discuss here own proposed model for tumor growth kinetics utilizing a modified Gompertz function that better responds to the growth characteristic of in [quot ]vivo[quot ] tumors.

Effect of a dietary supplement combination on weight management, adipose tissue, cholesterol and triglycerides in obese children

A dietary supplement combination consisting of vitamins, minerals and fibers was studied to determine its safety and efficacy on weight/fat loss, cholesterol and triglycerides in children between ages 7-13. This open label trial measured total body weight, body fat percentage, waist circumference, total cholesterol, triglycerides before and after 6 weeks of treatment. The study population consisted of 25 mildly to moderate obese, otherwise healthy children of both sexes. After 6 weeks of treatment, the combination supplement had a statistically significant (p < 0.05) weight reducing effect. This weight reduction was associated with a corresponding statistically significant (p < 0.0001l) decrease in body fat percentage. In addition, significant decreases in total cholesterol (p < 0.0001) and triglycerides (p < 0.0001) were obtained, plus reductions in waist measurements. We conclude that the combination supplement studied herein is a safe and effective way to assist children in weight, fat percentage, cholesterol and triglyceride reduction.

Improving access to liver transplantation: the University of Puerto Rico experience

Liver transplantation is the only treatment for end-stage liver disease. It is costly, difficult, and not performed in Puerto Rico. For these reasons, it has been a limited option for Puerto Ricans with advanced cirrhosis, especially for those with no medical insurance to cover for the procedure. In an effort to improve access to the procedure and offer this chance of life to more Puerto Ricans facing death from complications of advanced liver disease, the Gastroenterology and Liver Diseases Division of the University of Puerto Rico, in collaboration with LifeLink Transplant Institute in Tampa, Florida and the Office of Catastrophic Funds of the Commonwealth of Puerto Rico, opened a clinic for liver transplant evaluation at the Medical Sciences Campus. The purpose of this clinic is to coordinate the pre-transplant evaluation of candidates for this therapy, provide the evaluation by the transplant surgeon in Puerto Rico, expedite the process in seriously ill patients, and offer post-transplant follow-up upon the patient's return to Puerto Rico. The purpose of this article is to describe the experience in this clinic from 1999 to 2003. One hundred ninety-three patients were seen from September 1999 to January 2003. The most common causes for liver disease were hepatitis C and alcohol, alone or in combination. One hundred thirty four were accepted as candidates for evaluation. Of these, 63 had completed the process, 33 were listed for transplantation and 21 had been transplanted by January 2003. Neither education level, marital status, health insurance nor Child score were associated with successful outcome. This clinic offers Puerto Ricans, especially those with limited resources, with a viable access to liver transplantation.

Response to combination therapy of interferon alfa-2b plus ribavirin in Hispanics with chronic hepatitis C

OBJECTIVE: To evaluate the response rate of Hispanics with chronic hepatitis C to combination therapy of interferon alfa-2b plus ribavirin and to assess its adverse events. BACKGROUND: Hepatitis C virus may lead to chronic infection and multiple complications. Response to combination therapy of interferon plus ribavirin has been studied in many populations. African Americans have been found to have a lower response rate than Caucasians. However, little data exist for Hispanics. METHODS: Hispanic patients from Puerto Rico with chronic hepatitis C were eligible for the study between November 1997 and February 2000. The Institutional Review Boards of the participating institutions approved the study. Written informed consents were obtained. Combination therapy was given for 48 weeks and patients were followed for 24 weeks after treatment. Analysis of response to therapy was performed in an intention-to-treat basis. RESULTS: The most frequent adverse event was anemia (89%), associated to ribavirin. Sustained response was 23% for naive patients, 45% for relapsers, and 8% for non-responders to previous interferon monotherapy (p < 0.001). Data to analyze response was not available in 27% of patients. Hispanic patients had a low response rate to combination therapy. CONCLUSIONS: Response rates to combination therapy for Hispanic naive and previously non-responder patients are lower than in other reported populations. This may be due to a high prevalence of genotype 1 in Puerto Rico, which is associated to poor response. The higher response rate of relapsers, similar to those reported previously, was expected since these patients showed a previous response to interferon monotherapy. Ethnic factors may play a role in the response to therapy and should be further studied to determine proper treatment strategies for this population.

Costo-efectividad de la promoción de la salud en Chile: experiencia del programa íMirame! / Cost-effectiveness of health promotion in Chile: experience with íMirame! Program

Background : íMirame! program was launched in Chile in 1993, to promote a healthy life style at school age. Aim: To evaluate cost-effectiveness of this program. Material and methods: Fifth and sixth grade school children, from 5 selected municipalities of the Metropolitan Region were studied. The design was a quasi-experiment with an intervention (IP, 1,435 children) and reference population (RP, 1,246 children). Tobacco (T-C) and alcohol (OH-C) consumption were the indicators. A baseline survey was done in 1993 and repeated in 1996 in both groups. The criterion of Net Change was applied to assess effectiveness. For cost evaluation, an institutional perspective was considered. Direct municipal administration and "íMirame!" program costs were analyzed and incremental costs were calculated, using reference municipalities as controls. A univariate sensitivity analysis was done based on the beneficial discount rate and cost discount rate. Cost effectiveness coefficient was calculated. Results: The incremental cost per each boy and girl prevented from OH-C was US$ 112 (103.6-114.3) and US$ 132 (129.9-133.3) respectively. The figures for each boy and girl prevented from T-C was US$ 154 (142.7-157.4) and US$ 130 (122.5-135.2) respectively. The program caused an additional cost per child, for the city hall of US$ 11.7 in two years. Conclusions: It is possible to apply health promotion interventions in schools with a good cost effectiveness in the short run (Rev MÚd Chile 2004; 132: 361-70).

Valoracion nutricional de 10 variedades de Quinua Chenopodium quinoa Willd del altiplano boliviano / Nutricional valuation of 10 varieties of Quinua Chenopodium quinoa Willd of the Bolivian plateau

El presente trabajo de investigación se desarrollo con el propósito de dar a conocer y difundir las características y propiedades nutritivas de 10 variedades de quinua (chenopodiurn qtunoa) propias de nuestra región (altiplano boliviano). La valoración comprendió el estudio de la naturaleza bioquímica el producto mediante evaluaciones de las propiedades químicas y nutritivas. Los resultados de este estudio muestran que estas, son mayores en rendimientos de proteínas (14 -18 porciento) en referencia a los reportados en la bibliografía (6) (13 porciento) como promedio. Se destaca que la Variedad REAL BLANCA presenta un 17 porciento y AJARA 18 porciento en proteínas, asimismo presentan los mas altos rendimientos respecto a la composición de sus macro nutrientes y micro nutrientes como Vitaminas como la tiamina 0.56mg/ lOOg en la REAL BLANCA y Oligoelementos como el Calcio, Magnesio, Manganeso en la variedad AJARA