Protomedicatos y lazaretos como instituciones de control de la higiene pública en Chile entre 1879 y 1920 / Colleges of royal physicians and isolation hospitals to control public hygiene in Chile from 1879 to 1920

El presente artículo indaga la aparición de dos instituciones de control de la higiene pública en Chile entre los años 1879 y 1920: los protomedicatos y lazaretos. El objeto de estudio utiliza como caso la presencia de la viruela en La Araucanía. Se abordan las características y contexto que adquirió la instalación de estos dispositivos que permitieron al Estado de Chile operacionalizar el asunto de la higiene pública, lo que interpeló a los profesionales de la salud para avanzar a mayores niveles de perfeccionamiento del ejercicio profesional de la medicina. El Estado liberal positivista de fines de siglo XIX comprendió que el tema de la higiene no era solamente una cuestión de responsabilidad individual, sino que tenía una dimensión social, pública y medio ambiental. No sólo había personas que eran higiénicas, sino también ambientes higiénicos y antihigiénicos. Por tanto, se estudia la higiene, el tribunal del protomedicato, la hoja sanitaria, lazaretos, médicos y vacunadores; quienes estuvieron en permanente tensión con las autoridades del gobierno central debido a los insuficientes recursos proporcionados por el Estado para la atención de los enfermos contagiados con viruela. El estudio se orienta desde una metodología cualitativa con un diseño historiográfico con alcances descriptivos densos. Se han utilizado fuentes primarias y secundarias disponibles en archivos en Chile y Alemania. Los resultados evidencian que la presencia de viruela apareció violentamente en el centro sur de Chile en la segunda mitad del siglo XIX y permaneció en la Araucanía hasta la primera mitad del siglo XX. La violencia con que se desarrolló la viruela generó miedo e incertidumbre afectando a personas de diferentes clases sociales, y tuvo como una de sus causas principales las precarias condiciones de salubridad de la población.

This article investigates the emergence of two institutions for the control of public hygiene in Chile between 1879 and 1920: colleges of royal physicians and isolation hospitals using the case of smallpox in La Araucanía, a region located in the South of Chile. We cover the characteristics and context of these institutions that allowed the State of Chile to address the problems of public hygiene and to prompt health professionals to professionalize the practice of medicine. The liberal positivist state of the late nineteenth century understood that the issue of hygiene was not only a matter of individual responsibility but had a social, public, and environmental dimension. People practiced hygiene alongside the existence of hygienic and anti-hygienic environments. Therefore, hygiene, the royal colleges of physicians, health records, isolation hospitals, doctors, and vaccinators are studied. All of these components of the health care system of the time were in permanent tension with the central government authorities due to the insufficient resources provided by the state for the care of infected patients with smallpox. The study follows a qualitative methodology with a descriptive historiographic design. We used archival primary and secondary sources available in Chile and Germany. The results show that the presence of smallpox appeared ferociously in South-Central Chile in the second half of the 19th century and remained in La Araucanía until the first half of the 20th century. The extent to which smallpox spread, spawning fear and insecurity in people of different social classes, had as one of its leading causes the precarious conditions of health and hygiene of the population.

Lección MOODLE de anatomía e histología de la placenta humana / MOODLE lesson of the anatomy and histology of the human placenta

RESUMEN: La falta de muestras biológicas humanas existentes, debido principalmente a las limitaciones ético-morales relacionadas con su obtención, ponen en relieve la necesidad de buscar otras alternativas de enseñanza y aprendizaje de las ciencias morfológicas. En este sentido, la implementación de lecciones a través de la plataforma MOODLE proporciona la oportunidad al estudiante de interactuar en un entorno que simula una situación de aprendizaje propio del laboratorio tradicional. El objetivo del presente trabajo fue generar una lección MOODLE sobre la anatomía e histología placentaria humana, como complemento a la clase teórica presencial, para estudiantes de la carrera de Obstetricia y Puericultura. Para tal cometido, se realizó búsqueda de información, imágenes y recursos TIC en bibliotecas e internet. Paralelamente, se llevó a cabo un proceso de captura fotográfica de muestras histológicas de placenta, así como también la grabación de un alumbramiento. Posteriormente, se procedió a la articulación y montaje de las actividades en la plataforma MOODLE con un enfoque constructivista. Además, se elaboró una encuesta de satisfacción, la cual fue validada por 3 expertos. La muestra estuvo constituida por 137 estudiantes de la carrera de Obstetricia. Se confeccionó un laboratorio virtual MOODLE de anatomía e histología de la placenta humana, el cual esta constituido por múltiples actividades con orientación clínica, las cuales permiten autoevaluarse. El laboratorio virtual nos ha ayudado ha subsanar la carencia de muestras humanas y los resultados de la encuesta de satisfacción aplicada a los estudiantes señalan una valoración positiva de la iniciativa.

SUMMARY: The lack of existing human biological samples, mainly due to the ethical-moral restrictions related to obtaining these, highlights the need to search for other teaching and learning alternatives in morphological science. In this sense, the implementation of lessons by means of the MOODLE platform provides the students with the opportunity to interact in a setting that simulates a learning situation that belongs to traditional laboratories. The purpose of this work was to generate a MOODLE lesson on the anatomy and histology of the human placenta, as a complement of the traditional theoretical classroom for students of Obstetrics. To that end, TIC information, images, and resources were sought in libraries and in the Internet, and at the same time a set of histological photographs of placenta samples was made, as well as a video recording of a placental delivery. Later, the coordination and set up of activities was made in the MOODLE platform with a constructivist approach. Furthermore, a satisfaction survey was prepared which was validated by three experts. The total sample consisted of 137 students in the 2th year of obstetrics. A virtual MOODLE laboratory of the anatomy and histology of the human placenta was made, which is constituted by multiple activities with a clinical orientation that allow self-evaluation. The virtual laboratory has helped overcome the lack of human samples, and results of the satisfaction survey applied to the students indicate a positive evaluation of this initiative.

Eritema multiforme asociado a herpes virus: reporte de caso / Erythema multiform associated with herpes virus: case report

El eritema multiforme (EM) es una reacción de hipersensibilidad que afecta a la piel y / oa las membranas mucosas, en respuesta a infecciones, fármacos u otras comorbilidades. La presentación de EM puede ser Menor (EM leve, caracterizada por presentar lesiones diana) o Mayor (EM severa, que también ocurre con afectación de las membranas mucosas). Se presenta el caso de un paciente varón de 36 años de edad que presenta una emergencia de HNAL con fiebre, malestar, prurito y lesiones dolorosas en la cavidad oral, lesiones múltiples en miembros superiores e inferiores, pene y región perianal. El diagnóstico fue EM Major. Las lesiones ulcerosas en la cavidad oral y las lesiones diana en las manos fueron las más destacadas.

Erythema multiforme (EM) is a hypersensitivity reaction that affects the skin and/or mucous membranes, in response to infections, drugs, or other comorbidities. Presentation of EM can be Minor (Mild EM, characterized for presenting target lesions) or Major (Severe EM, that occurs also with mucous membranes involvement). The case of a 36 year old male patient presenting to emergency of HNAL with fever, malaise, itching and painful ulcer type lesions in oral cavity, multiple target lesions in upper and lower limbs, penis, and perianal region is reported. The diagnosis was EM Major. Ulcerous lesions in oral cavity and target lesions in hands were the most salient.

Variabilidad genética de Aedes Aegypti en algunas áreas del Perú usando single stranded comformational polymorphism (SSCP) / Genetic variability of Aedes aegypti in some Peruvian areas using Single Stranded Conformational Polymosphism (SSCP)

Aedes aegypti es el vector responsable de la transmisión del virus del dengue, su distribución geográfica se haampliado rápidamente debido principalmente a la intervención de los seres humanos. Objetivo: Analizar la variabilidad genética de este mosquito mediante la comparación del Segundo Espaciador Transcrito Interno (ITS 2) perteneciente al ADN ribosomal (rADN). Materiales y Métodos: Se analizaron muestras de ocho localidades (Jaén, Tingo María, Iquitos, Lambayeque, el distrito de El Rimac, Sullana y Zarumilla) y uno de la provincia de Huaquillas (Ecuador). El análisis de la variabilidad se determinó usando la técnica conocida como SSCP (Single Stranded Conformation Polymorphism). Resultados: El estudio muestra que existe variabilidad genética entre las poblaciones analizadas, principalmente entre las muestras localizadas en la costa del Perú (Zarumilla, El Rímac, Sullana) y Huaquillas y las muestras del nororiente (Tingo María, Iquitos, Jaén y Lambayeque) Conclusión: Se determinaron dos variantes genéticas entre las poblaciones de Aedes aegypti: Costeña y Nororiental, que probablemente provienen de dos ancestros diferentes y cuyo ancestro común sufrió de aislamiento por distancia. Se observó que no existe relación entre las distancias genéticas y las distancias geográficas indicando que la migración de estas poblaciones es el resultado de la intervención de los seres humanos que diseminan al vector y no por la migración activa del mosquito. Se plantea el papel de la Cordillera de los Andes en la migración y separación de las poblaciones de Aedes.

Aedes aegypti is the responsible vector for transmission of dengue fever virus, and its geographical distribution has been widely broadened, mainly because of human intervention. Objectives: To analyze the mosquito genetic variability comparing the Second Internal Trascribed Spacer (ITS-2) from the ribosomal DNA (rDNA). Materials and Methods: Samples from seven Peruvian sites (Jaen, Tingo Maria, Iquitos, Lambayeque, Rimac district in Lima, Sullana, and Zarumilla) and one site from Ecuador (Huaquillas Province) were assessed. Variability analysis was determined using the SSCP (Single-Stranded Conformational Polymorphism) technique. Results: The study shows that there are genetic variability between the analyzed populations, mainly between the samples from the Peruvian northern and central coast (Zarumilla, Sullana, and Rímac) as well as in the Ecuador sample (Huaquillas) and the samples from the northeastern region in Peru (Tingo Maria, Iquitos, Jaen, and Lambayeque). Conclusions: Two genetic variants were determined for Aedes aegypti populations: Coastal and northeastern, which probably come from different lineages, and whose common ancestor became isolated because of the distance. It was observed that there is no relationship between genetic distances and geographical distances, indicating that the migration of the mosquito populations is a consequence of human intervention disseminating the vector and not because of active mosquito migration. We propose that there is a role for the Andes Mountains with respect to Aedes populations migration and separation.

Adaptación a un esquema de entrenamiento físico en pacientes con enfermedad pulmonar obstructiva crónica avanzada / Adaptation to a physical training protocol of severe chronic obstructive pulmonary disease patients

El ejercicio físico es un elemento básico en la rehabilitación en pacientes con EPOC. Sin embargo, los resultados son variables, lo que puede deberse a las diferentes estrategias de entrenamiento utilizadas. En 22 pacientes con EPOC avanzada (VEF, 35,6 ñ 15,7 por ciento: edad 63 ñ 15 años; x ñ DS) Evaluamos su adaptación a un esquema de entrenamiento (E) en bicicleta ergométrica que consistió en aplicar inicialmente una carga inicial de 30 por ciento de la máxima previamente determinada (CM) y aumentarla en 15 a 20 por ciento en las sesiones siguientes cuando el paciente era capaz de mantenerla por 45 minutos, hasta alcanzar la meta de 75 por ciento de la CM. La intensidad del E se midió en watts calculando el área bajo la curva de la relación entre las cargas aplicadas y el número de sesiones de entrenamiento. El efecto del E se evaluó a través de los cambios en la carga y el VO2 máximos, la duración de un ejercicio submáximo, la frecuencia cardíaca, (FC), disnea, fatiga de las extremidades inferiores y lactato sanguíneo para una misma carga y tiempo de ejercicio. La CM de E fue 61 ñ 23 por ciento (x ñ DS) del máximo. Seis pacientes no fueron capaces de alcanzar la carga establecida como meta. En los restantes ésta se alcanzó en un número variable de sesiones (12 ñ 7). La intensidad del entrenamiento fue de 952 ñ 325 watt. El E produjo un aumento de la CM (p<0,02) y del tiempo de ejercicio (p<0,0001) y una disminución significativa de la FC, disnea, fatigabilidad y lactato sanguíneo. La duración del ejercicio se correlacionó con la reducción de la disnea (r= -0,448; p<0,05) y la intensidad del entrenamiento con la disminución de la fatiga (r= -0,5176; p = 0,014) y también del lactato sanguíneo (r= -0,488; p = 0,021). Los resultados demuestran que aún cuando la adaptación al esquema de entrenamiento fue variable de acuerdo a la capacidad individual y no pudo ser aplicada a todos los pacientes, la mayoría de ellos obtuvo efectos beneficiosos

Calidad de vida en pacientes con enfermedad pulmonar obstructiva crónica e impacto del entrenamiento físico / Quality of life in patients with chronic pulmonary obstructive disease and the impact of physical training

Background: Health related quality of life (QoL) is severely impaired in COPD patients as a consequence of dyspnea and limited exercise tolerance, which lead to physical deconditioning and muscle atrophy resulting in weakness and fatigue. Psychosocial factors such as depression and anxiety also contribute to this impairment. Aim: To evaluate: a) the impact of COPD on quality of life, and b) the effect of 10 weeks of exercise training on exercise performance and on QoL. Patients and methods: The Spanish version of the Chronic Respiratory Questionnaire (CRQ) was applied to 55 COPD patients (FEV1 37 ñ 13 percent pred) for the assessment of QoL and in 30 of them submitted to exercise training for 10 weeks. Exercise performance was evaluated by measuring: six-minute walking distance, maximal workload (Wmax), maximal O2 consumption (VO2max) as well as endurance time, blood lactic acid, dyspnea and leg fatigue during a submaximal exercise. Trained patients were evaluated before and after training. Results : COPD patients showed a reduction (mean ñ SD) in the four domains of the CRQ: dyspnea (3.1 ñ 0.9); fatigue (4.3 ñ 1.3); mastery (4.65 ñ 1.3), emotional function (4.1 ñ 0.97), and in Wmax and VO2max (52 ñ 16 Watt and 970 ñ 301 ml/min). No significant relationship between the impairment in exercise tolerance and in QoL was observed. Exercise training significantly improved the four domains of QoL (p < 0.0001), Wmax (p < 0.05), VO2max (p < 0.02) and endurance time (p < 0.001). Isotime exercise measurements of dyspnea, leg fatigue and lactic acid decreased after training (p < 0.001, each). No significant relation between changes in QoL and changes in exercise performance were observed. Conclusions: Our results demonstrate that QoL is seriously impaired in patients with COPD and confirm: (a) the lack of relationship of QoL to the usually measured physiological parameters, and (b) the beneficial effect of exercise training on QoL through the reduction of symptoms. These findings stresses the need of measuring quality of life in our patients if we want to evaluate the impact of therapeutic procedures on well-being from the patients' perspective

Entrenamiento selectivo de los músculos respiratorios en pacientes con insuficiencia cardíaca crónica / Selective training of respiratory muscles in patients with chronic heart failure

Background: Patients with chronic heart failure have a lower inspiratory muscle strength and fatigue endurance. Aim: To assess the effects of selective training of respiratory muscles in patients with heart failure. Patients and methods : Twenty patients with stable chronic heart failure, aged 58.3 ñ 3 years with an ejection fraction of 28 ñ 9 percent, were subjected to respiratory muscle training with threshold valves. The load was fixed in 30 percent of maximal inspiratory pressure (PImax) in 11 and in 10 percent of PImax in nine. Two sessions of 15 minutes, 6 days per week, during 6 weeks were done. Degree of dyspnea (Mahler score), maximal oxygen uptake, distance walked in 6 minutes, respiratory muscle function and left ventricular ejection fraction were measured before and after training. Results: Both training loads were associated to an improvement in dyspnea (+2.7 ñ 1.8 and +2.8 ñ 1.8 score points with 30 percent Plmax and 10 percent PImax respectively), maximal oxygen uptake (from 19 ñ 3 to 21.6 ñ 5 and from 16 ñ 5 to 18.6 ñ 7 ml/kg/min with 30 percent PImax and 10 percent PImax respectively, p< 0.05), PImax (from 78 ñ 22 to 99 ñ 22 and from 72 ñ 34 to 82.3 cm H20 with 30 percent Plmax and 10 percent PImax respectively), sustained PImax (from 63 ñ 18 to 90 ñ 22 and from 58 ñ 3 to 69 ñ 3 cm H20 with 30 percent PImax and 10 percent PImax respectively), and maximal sustained load (from 120 ñ 67 to 195 ñ 47 and from 139 ñ 120 to 192 ñ 154 g with 30 percent PImax and 10 percent PImax respectively). The distance walked in 6 min only increased in subjects trained at 30 percent PImax (from 451 ñ 78 to 486 ñ 68 m). Conclusions: Selective training of respiratory muscles results in a functional improvement of patients with chronic heart failure

Potencia de los músculos inspiratorios en insuficiencia cardíaca crónica y en enfermedad pulmonar obstructiva crónica / Respiratory muscle power output in patients with chronic heart failure and patients with chronic pulmonary obstructive disease

Background: The maximal pressure generated by inspiratory muscles (PIMax) is an index of their strength which is diminished in both chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF). Although inspiratory muscle power output (IMPO), which includes both strength and velocity of shortening, has been shown to be reduced in COPD, there is no information regarding IMPO in CHF. Aim: To measure Impo in patients with CHF and COPD. Patients and methods: We studied 9 CHF patients with functional capacity II and III and 9 patients with severe COPD. Eight normal subjects of similar ages were included as controls. Power output was measured using the incremental threshold loading test. Results: Maximal IMPO was significantly reduced in both groups of patients. Power output developed with each increasing load was also diminished, basically as a consequence of a reduction in insp. The degree of dyspnea at the end of the test was greater in COPD than in CHF patients and normal subjects. For a given level of power, dyspnea was also greater in patients than in normals subjects. There was no decrease in SpO2 during the test. Conclusions: IMPO is equally reduced in COPD and CHF patients. Power output is better related to dyspnea than PIMax, probably because of the inclusion of shortening velocity

Efecto del entrenamiento muscular inspiratorio en el costo de oxígeno de la ventilación en pacientes con enfermedad pulmonar obstructiva crónica / Effects of inspiratory muscle training on the oxygen cost of breathing in patients with chronic obstructive pulmonary disease

Background: Patients with chronic obstructive pulmonary disease have an increased inspiratory work, since they must overcome high loads due to increased airway resistance. Aim: To determine if the reduction in the metabolic cost of exercise observed in patients with chronic obstructive pulmonary disease (COPD) after inspiratory muscle training, was due to a reduction in the oxygen cost of breathing. Patients and methods: Nine patients with COPD (FEV1 39 ñ 13 percent) subjected to inspiratory muscle training, using a training load of 30 percent of maximal inspiratory pressure, during 10 weeks; 5 patients with COPD (FEV1 44 ñ 18 percent) not subjected to training, and 7 healthy controls (FEV1 110 ñ 10 percent) were studied. The cost of breathing was calculated as the difference in VO2 measured at rest and after breathing a gas mixture containing air and 5 percent CO2. Exercise VO2 was measured at submaximal exercise. Results: Oxygen cost of breathing was increased in patients with COPD and it was inversely correlated with FEV1 (r= -0.86 p<0.001). Inspiratory muscle training increased maximal inspiratory pressure and decreased exercise VO2. Oxygen cost of breathing increased in six and decreased in three trained patients. Changes in this parameter after training did not correlate with the reduction in exercise VO2 or the increment in maximal inspiratory pressure. Conclusions: The reduction in exercise VO2 after inspiratory muscle training is not due to a reduction in the oxygen cost of breathing

Efectos clínicos del entrenamiento muscular inspiratorio en pacientes con limitación crónica del flujo aéreo / Clinical effects of inspiratory muscular training in patients with chronic airway flow limitation

The clinical role of inspiratory muscular training (IMT) in chronic obstructive pulmonary disease (COPD) has not been established, because data on its clinical effect is scarce and controversial. To further investigate these aspects we studied 20 COPD patients (FEV1 37ñ3 percent P) who were randomly and double blindy trained for 30 minutes a day during 10 weeks using a threshold inspiratory trainer with either 30 percent (group 1) or 10 percent (group 2) of PIMax as a training load. The training load was cossed after each patient completed 10 weeks of training. Effects were assessed through changes in PIMax, dyspnea through the transition dyspnea index (ITD) and the respiratory effort with Borg's score. Walking capacity was measured with the six minutes walking distance test (6WD) and depression symptoms with Beck's score. Daily life activities were also assessed. Results showed that after 10 weeks of IMT, PIMax increased in both groups (p<0.05), dyspnea improved in group 1 as compared to group 2 (p<0.04), 6WD increased significantly in group 1 disclosed a significant deterioration in PIMax whereas group 2 disclosed significant improvements in PIMax, dyspnea and 6WD. We conclude that IMT using a threshold device with 30 percent PIMax is a useful procedure for the treatment of severe COPD patients