Sensibilidad al contraste en un grupo de diabéticos mexicanos / Contrast sensitivity in a group of Mexican diabetics

RESUMEN Objetivo: Comparar la sensibilidad al contraste evaluada en un grupo de mexicanos con diabetes mellitus contra uno sin diabetes como control. Métodos: Un total de 31 voluntarios, 14 participantes con DM con un tiempo de diagnóstico entre 2 y 20 años (sin retinopatía diabética), y 17 en el grupo control iniciaron el estudio; 4 diabéticos y 5 no diabéticos fueron excluidos por no cumplir con los criterios de inclusión. Por lo tanto, los datos analizados fueron de un grupo de 10 diabéticos (52 ± 10 años) y otro de 12 no diabéticos (52 ± 6 años). Se evaluó la sensibilidad al contraste con la cartilla Vector Vision CSV1000E a una distancia de 2,5 metros con una iluminación de 85 cd/m2. Resultados: Un mayor porcentaje de ojos diabéticos alcanzaron un mejor umbral de contraste en 3, 6 y 18 ciclos por grado en comparación con el grupo control. En 12 ciclos por grado solamente en los umbrales 1 y 5. Conclusiones: La sensibilidad al contraste de la población mexicana con diabetes mellitus presenta mejor percepción de contraste en las frecuencias evaluadas que el grupo control(AU)

ABSTRACT Objective: Compare contrast sensitivity as measured in a group of Mexican diabetes mellitus patients versus a control non-diabetic group. Methods: A group of 31 volunteers, 14 participants with DM with a diagnosis time between 2 and 20 years (without diabetic retinopathy), and 17 in the control group started the study; 4 diabetics and 5 non-diabetics were excluded because they did not meet the inclusion criteria. Therefore, the data analyzed were from a group of 10 diabetics (52 ± 10 years) and another of 12 non-diabetics (52 ± 6 years). Contrast sensitivity was evaluated with a Vector Vision CSV1000E chart at a distance of 2.5 meters and a luminance of 85 cd/m2. Results: A higher percentage of diabetic eyes reached a better contrast threshold at 3, 6 and 18 cycles per degree in comparison with the control group. At 12 cycles per degree only at thresholds 1 and 5. Conclusions: Contrast sensitivity in the Mexican population with diabetes mellitus displays better contrast perception at the frequencies evaluated than the control group(AU)

Cambia el color y el riesgo… Nuevo escenario para el cáncer de próstata en Chile / Prostate cancer in african american immigrants in Chile

In 2017, migrants were 4.35% of the Chilean population, mainly from Peru and Colombia. From 2015, the amount of migrants from Central America, particularly from Haiti increased notably. This process changed the phenotype of the male population, increasing the proportion of black men, mainly between 20 and 50 years. Afro-descendant men have a higher risk for prostate cancer, and the tumor can appear as early as 40 years of age among them. This increase will have future repercussions on the public health system, since part of these men have low income and poor living conditions. Therefore, it is necessary to discuss early detection strategies focused on this population, including education for both patients and health professionals. This review includes data on the reality of migration in Chile and its impact on the health system. The higher incidence and mortality of prostate cancer in the migrant population is reviewed and risk-adjusted screening strategies are proposed.

Nefrolitectomía endoscópica transpiélica durante pieloplastía laparoscópica asistida por robot: Combinación de técnicas endourológicas para la resolución de un caso de estenosis pieloureteral asociado a nefrolitiasis / Endoscopic nephrolithotomy transpielic during a robot assisted laparoscopic pyeloplasty: Combination of endourological techniques for solving a case of pelvi-ureter stenosis associated with nephrolithiasis

La estenosis pieloureteral (EPU) puede predisponer al desarrollo de nefrolitiasis debido a estasis urinaria. Inicialmente la endopielotomía percutánea fue la alternativa mínimamente invasiva de elección frente a la cirugía abierta para la resolución de los casos de EPU con nefrolitiasis concomitante. Sin embargo, el bajo éxito de la endopielotomía percutánea ha favorecido el uso de la laparoscopía convencional o asistida por robot para el tratamiento de las EPU. Se han reportado casos de pieloplastías laparoscópicas en los cuales se ha introducido un nefroscopio flexible a través de un trócar para resolver la nefrolitiasis por vía transpiélica. Acá reportamos nuestra experiencia en un caso.(AU)

The pelvi-ureter stenosis may predispose to the development of nephrolithiasis due to urinary stasis. Initially, a percutaneous endopyelotomy was minimally invasive alternative of choice versus open surgery for resolving cases of EPU with concomitant nephrolithiasis. However, the low success of percutaneous endopyelotomy has favored the use of conventional laparoscopy or robot-assisted treatment of the pelvi-ureter stenosis. There have been reports of laparoscopic pyeloplasty in which a flexible nephroscope is inserted through a trocar to solve nephrolithiasis by a transpielic via. Here we report our experience in one case.(AU)

Utilidad del tacto rectal en pacientes con cáncer de próstata y antígeno prostático menor a 4 ng/ml / Usefulness of DRE in patients with prostate cancer and PSA less than 4ng / ml

Actualmente la necesidad de incorporar el tacto rectal en protocolos de tamizaje ha sido tema de debate. Existe una gran proporción de cáncer de próstata (CaP) que son diagnosticados solo con tacto rectal (TR) sospechoso, aportando además importante información pronostica. En nuestro trabajo, evaluaremos la utilidad que tiene el tacto rectal sospechoso en aquellos pacientes con cáncer de próstata y APE < 4 ng/ml. MATERIALES Y MÉTODOS: Se realiza un estudio transversal y se registran pacientes de un hospital público que fueron controlados entre los años 2010 y 2012 con sospecha de CaP. Resultados: De un total de 268 pacientes que fueron sometidos a biopsia prostática por sospecha de CaP se obtuvo lo siguiente: 8 pacientes con APE < 2.5 ng/ml. cuya media de edad fue 70 años (61-82;7.4), destacó que el 87.5 por ciento tenía TR alterado y un 25 por ciento se confirmó cáncer, otorgando al TR una sensibilidad de 100 por ciento y valor predictivo positivo (VPP) 28.5 por ciento. 17 pacientes con APE 2.5-4.0 ng/ml. cuya media de edad fue 64.7 años (55-74;6.9), en donde un 29.4 por ciento tenía TR alterado y en un 35.3por ciento se confirmó cáncer, la sensibilidad del TR resultó 33por ciento y el VPP de 40 por ciento. 243 pacientes con APE 4.1-10 ng/ml. cuya media de edad fue 66.7 años (44-84;7.1), tenían TR alterado en 17.3porciento y confirmación de cáncer en un 27.3 por ciento, la sensibilidad del TR fue un 28.3 por ciento y el VPP 38 por ciento. CONCLUSIONES: La probabilidad de tener cáncer prostático con tacto rectal alterado es mayor a medida que aumenta el APE, destacando un VPP de 28.5 por ciento y VPN de un 100 por ciento en pacientes con APE < 2.5por ciento. En los pacientes con APE de 2.5-4.0 ng/ ml., el tacto rectal obtiene un VPP 40 por ciento y VPN 66.6 por ciento. Estos valores sugieren que aún es importante realizar el TR de manera rutinaria, ya que aproximadamente un tercio tendrá o desarrollara un cáncer de próstata.

Currently the need to include a rectal examination in screening protocols has been the subject of debate. There is a large proportion of prostate cancer (CaP) who are diagnosed only with suspicious digital rectal examination (DRE), also providing important prognostic information. In our work, we will evaluate the usefulness suspicious digital rectal examination in patients with prostate cancer and PSA <4 ng / ml. MATERIALS AND METHODS: A cross-sectional study was conducted and a public hospital patients who were followed between 2010 and 2012 with suspected PCa are recorded. RESULTS: From the 268 patients who underwent prostate biopsy for suspected CaP the following was obtained: From 8 patients with PSA <2.5 ng / ml. whose average age was 70 years (61-82; 7.4), it was noted that 87.5 percent had altered DRE and in 25 percent cancer is confirmed, giving DRE a 100 percent sensitivity and a positive predictive value of (PPV) 28.5 percent. 17 patients with APE 2.5-4.0 ng / ml. whose mean age was 64.7 years (55-74; 6.9), where 29.4 percent had altered DRE and in 35.3 percent cancer is confirmed, the sensitivity of DRE was 33 percent and a PPV of 40 percent. 243 patients with APE 4.1-10 ng/ml. whose mean age was 66.7 years (44-84; 7.1) DRE was altered in 17.3 percent and confirmation of cancer was 27.3 percent, sensitivity was 28.3 percent and PPV 38 percent. CONCLUSIONS: The chance of having prostate cancer with altered DRE is greater with increasing PSA, highlighting a PPV of 28.5 percent and NPV of 100 percent in patients with PSA <2.5 percent. In patients with PSA of 2.5-4.0 ng / ml., DRE get a PPV 40 percent and NPV 66.6 percent. These values suggest that it is still important to the TR routinely, because approximately one third have or develop prostate cancer.

Molecular signature of cancer stem cells isolated from prostate carcinoma and expression of stem markers in different Gleason grades and metastasis

Prostate cancer (PCa) is the most frequently diagnosed malignancy in men worldwide. Chemotherapy response is very poor and resistance to hormone-based treatments is frequent in advances stages. Recently, tumor-initiating cells or cancer stem cells (CSCs) have been identified in several cancers, including PCa. These cells are thought to be responsible for therapy resistance, relapse and metastasis. In the present work, enriched populations of CSCs were obtained using a mixed procedure that included differential clone-forming ability, sphere growing induction (prostatospheres) and magnetic-associated cell sorting (MACS). Also, stem marker expression was determined in PCa biopsies of different histological grades and metastasis samples. The signature for stem markers of the isolated CSCs was CD133+/CD44+/ABCG2+/ CD24-. Expression of stem markers (CD133, CD44, and ABCG2) was higher in medium Gleason biopsies than in lower and higher grades, and lymph-node and bone metastasis samples. These results suggest that the CSCs in PCa reach an important number in medium Gleason grades, when the tumor is still confined into the gland. At this stage, the surgical treatment is usually with curative intention. However, an important percentage of patients relapse after treatment. Number and signature of CSCs may be a prognosis factor for PCa recurrence.

Joubert syndrome: respiratory failure requiring home mechanical ventilation

Un caso del síndrome Joubert con insuficiencia respiratoria y necesidad de asistencia mecánica respiratoria y necesidad de asistencia mecánica respiratoria es presentado. El caso ilustra los complejos aspectos clínicos, éticos y técnicos de este sindrome y la adaptabilidad del tratamiento ventilatorio mecánico al ambiente del hogar. El cuido de estos pacientes en el hogar requiere un enfoque multidisciplinario por un grupo de salud competente y el apoyo de una familia cariñosa

Round pneumonia in a child

Un niño de 8 años de edad presentó un cuadro clínico de neumonía aguda; hemocultivo positivo para Streptococcus pneumoniae, una densidad redonda en el lóbulo superior izquierdo y mejoría rápida con ampicilina. Este cuadro clínico se denomina neumonía redonda o esférica; no es común y se confunde con otras infeccions y con procesos malignos. Es importante establecer un diagnóstico precoz para instaurar la antibioticoterapia curativa y evitar realizar pruebas de diagnóstico costosas, invasoras e innecesarias