Uso do procedimento de bissecção temporal na avaliação de idosos com doença de Alzheimer: uma revisão sistemática / Using the temporal bisection procedure in the evaluation of elderly with Alzheimer's disease: a systematic review

OBJETIVO: Realizar revisão sistemática de artigos que utilizaram o método de bissecção, para avaliar a percepção de tempo em idosos com doença de Alzheimer e analisar seus parâmetros. MÉTODO: As buscas dos artigos foram conduzidas no período de março a maio de 2011, nas seguintes bases de dados: Web of Science, Science Direct on Line, Biological Abstracts, PsychoInfo e Medline. As palavras-chave e operadores booleanos foram: "interval timing" ou "perception of time" ou "time discrimination" ou "reproduction of time" e "Alzheimer's disease". Também foram realizadas buscas manuais nas referências dos artigos selecionados. RESULTADOS: Quatro artigos contemplavam todos os critérios de inclusão, nos quais foram encontradas grandes variações nos parâmetros utilizados no método. CONCLUSÃO: Pacientes com doença de Alzheimer apresentam prejuízos nas tarefas de bissecção de tempo, que podem ser explicados pelo declínio gradual nas habilidades que são utilizadas no teste de percepção de tempo. Há grandes variações nos intervalos de tempo utilizados. Neste contexto, há necessidade de mais estudos, controlados e randomizados, para investigar potenciais efeitos das variações nos intervalos de tempo do método de bissecção. Os resultados de tais estudos poderão contribuir para o estabelecimento de parâmetros mais adequados e fidedignos.

OBJECTIVE: Perform a systematic review of articles that used the bisection time method to assess the perception of time in patients with Alzheimer's disease by means of the bisection-of-time method, and to analyze its parameters. METHOD: Searches were conducted from March to May, 2011, in the following databases: Web of Science, Science Direct On Line, Biological Abstracts, Medline and PsychoInfo. Keywords and boolean operators were: "interval timing" or "perception of time" or "time discrimination" or "reproduction of time" and "Alzheimer's disease". Additionally, a manual search was conducted in the references of the selected articles. RESULTS: Four studies fulfilled all inclusion criteria, and large variations in the parameters of the method were found. CONCLUSION: Patients with Alzheimer's disease show difficulty in performing the task of bisection of time, which can be explained by the gradual decline on the abilities required in the perception of time test. There are large variations regarding the time intervals applied in the method. In such context, controlled-and-randomized future studies are required, in order to investigate the potential effects of time-intervals variations in the bisection-of-time method. The results of such studies would contribute to establish most suitable and reliable parameters.

Aplicacion de SIG en el mantenimiento preventivo del sistema de agua potable. Tiquipaya, caso viejo / sss

En los mas de cuarenta sistemas de agua potable en Tiquipaya (como en otras en el departamento de Cochabamba), se realiza el tradicional mantenimiento correctivo ante contingencias en las redes de distribución, que supone perjuicios y perdidas y economicas (y de recurso agua) para usuarios y operadores. Con el uso y aplicacion de SIG, se propone un manejo adecuado de la informacion de los componentes de las redes de distribución (tuberías y accesorios) y la elaboración de un análisis de riesgo-prevención que permita la aplicación de distintos niveles de mantenimiento "preventivo" en las redes que permita reducir las pérdidas a usuarios y a quienes administran los sistemas (en este caso de Tiquipaya-Casco Viejo), logrando a demas optimizar el uso del "liquido elemento"...

Aplicación de SIG en el mantenimiento preventivo del sistema de agua potable Tiquipaya, Casco Viejo / sss

En los mas de cuarenta sistemas de agua potable en Tiquipaya (como en otras del departamento de Cochabamba), se realiza el tradicional mantenimiento correctivo, ante contingencias en las redes de distribución, que supone perjuicios y pérdidas económicas (y el recurso "agua") para usuarios y operadores. Con el uso y aplicacion de SIG, se propone un manejo adecuado de la información de los componentes de las redes de distribucón (tuberías y accesorios) y la elaboración de un análisis de riesgo-prevención que permita la aplicación de distintos niveles de mantenimiento preventivo en las redes que permitan reducir las pérdidas a usuarios y quienes administran los sistemas (en este caso el de Tiquipaya-Casco Viejo), logrando ademas optimizar el uso del "líquido elemento"...

Cambios epidemiológicos en las enfermedades infecciosas en Chile durante la década 1990-2000 / Changes in the epidemiology of infectious diseases in Chile: 1990-2000

In the last decade in Chile, there was a large reduction in the rate of communicable diseases, especially typhoid fever, and those preventable through the universal vaccination programs. Exceptions were hepatitis A and Pertussis. The reduction in tuberculosis, has lead the country to a threshold in which the elimination of tuberculosis as a public health problem is reachable. The HIV epidemic is still expanding, at higher rate among women and heterosexual men, keeping drug addiction as a low ranked risk factor. At the end of the century, universal or expanded access to HIV therapy was still not a reality. Cholera was a well controlled emerging infection, but Hantavirus infection has become a major threat in many regions. Syphilis and especially gonorrhea have decreased, but condyloma has increased dramatically. The nosocomial infection scenario has changed somehow, due to more severely ice and complex patients admitted to hospitals. Multiresistant nosocomial pathogens continue expanding (S aureus, fermentor and non fermentor gram negative rods, especially A baumannii). The country has been able to expand control programs to almost all hospitals. Antimicrobial resistance has continued growing. The massive and indiscriminate use of antibiotics, largely responsible for the resistance, grew worse until the sale of antimicrobials in pharmacies was restricted by law. This had a major impact, with important reduction in sales of most, but not all, antibiotics. The impact in resistance rate of this reduction, if any, has yet to be assessed

Consecuencias adversas inesperadas durante el uso de antimicrobianos: cuándo el tratamiento puede ser peligroso para la salud / Adverse consequences due to use of antimicrobials: when the treatment can be hazardous to the patientïs health

Los efectos adversos de medicamentos en general y antimicrobianos en particular, son comunes y esperados de enfrentar durante la atención de los pacientes. La mayoría de ellos consiste en intolerancia, efectos colaterales y secundarios, alergia, idiosincrasia, sobredosis o interacciones farmacológicas indeseables. Durante el empleo de antimicrobianos con fines terapéuticos o preventivos en infecciones documentadas o sospechadas, pueden presentarse efectos adversos inesperados o consecuencias lamentables. Esta publicación revisa siete situaciones en que esto puede acontecer. La terapia antimicrobiana agrava una enfermedad infecciosa o empeora su daño (i.e., tratamiento antimicrobiano precoz de la infección intestinal por Escherichia coli O157:H7); el antimicrobiano al ejercer su efecto causa daño al huésped (reacción de Jarisch Herxheimer en el tratamiento de la sífilis); el antimicrobiano por sí solo es insuficiente para curar la infección ( absceso no drenados, infección relacionada a prótesis sin remoción del cuerpo extraño), el tratamiento antimicrobiano de infecciones no significativas o autolimitadas, el riesgo de efectos secundarios sobrepasa a los beneficios (tratamiento de bacteriuria asintomática en mayores con bajo riesgo de morbiilidad); el tratamiento antimicrobiano temprano en infecciones crónicas no aporta mayor beneficio que una terapia diferida y arriesga las opciones futuras (enfermedad por VIH, hepatitis B); la terapia antimicrobiana restaura la inmunidad deprimida gatillando una respuesta inflamatoria dañina para el huésped (terapia antiretroviral durante una fase precoz de terapia antituberculosa); la terapia antimicrobiana de infecciones intratables o condiciones no infecciosas (Enfermedad de Chagas, condiciones alérgicas o autoinmunes). Además, población especial, más proclive a efectos adversos de fármacos son: el adulto mayor, pacientes con afecciones renales o hepáticas, enfermedad por VIH, mujeres embarazadas y, en general, pacientes que reciben varios medicamentos en forma concomitante

Seguimiento prospectivo de una población infectada por VIH con y sin posibilidades de terapia anti retroviral: impacto en sobrevida y complicaciones / Prospective follow up of HIV positive patients with and without access to antiretroviral therapy: survival and complications

Background: Three-drug antiretroviral therapy (ART-3) has reduced complications and improved survival in HIV+ patients. The Chilean Public Health System began dual therapy (ART-2) in 1997, covering approximately 40 percent of patients in need. Aim: To report the results of a follow-up of patients with and without access to ART in a Chilean public hospital. Patient and Methods: Prospective follow-up of patients with ART-2 and 3 (cases) and patients with no access to ART (controls). All patients needed ART but it was available to a minority of them. Selection for ART was at random. Follow-up was between 6-24 months (11/96 to 3/99). Basal and periodic clinical and laboratory parameters were determined. Mortality and occurrence of new AIDS-defining events (ADE) were compared statistically using chi square. Results: One hundred and fifty cases (106 ART2, 28 ART3 and 16 ART2 expanded to ART3) and 166 controls were studied. Basal parameters were similar except prior ART (32.7 and 18.7 percent in cases and controls respectively). Close to 1/3 patients had AIDS. Cases had a mean follow up of 527 days; controls, 478. Six cases (4 percent) (5 in ART-2) and 17 controls (10 percent) died. Mortality x 100/pts/yr was 2.7 in cases and 7.7 in controls, p <0.05. ADE per 100/pts/yr was 21 in cases (24.4 in ART2, 15.1 in TAR3) and 54.5 in controls, p <0.05. Cases had a reduction of: esophageal candidiasis (84 percent), tuberculosis (75 percent), cryptococcosis and toxoplasmosis (66 percent), P carinii pneumonia (55 percent) and bacterial pneumonia (46 percent) and they had fewer hospitalizations (73 percent). Late assessment: 70 of 101 ART-2 patients had changed to ART-3 (1 death); 22 of 101 kept original ART-2 (12 dead, 10 alive), 39 of 43 ART-3 patients were alive and 1 died. Conclusions: Short-term ART-2 and 3 significantly reduced mortality (60 percent and 73 percent) ADE (65 percent and 76 percent respectively) and hospitalizations. Benefits of ART-2 were short lived. Resource-constrained countries cannot depend on weaker than standard ART for proper care of people with HIV disease

Hemodiálisis y embarazo: experiencia clínica de 6 embarazos con recién nacido vivo / Hemodyalisis and pregnancy: clinical experience of 6 alive newborns

Se analiza el total de nueve embarazos en pacientes hemodializadas ocurridos desde 1990 hasta septiembre del año 2001. Se hace referencia especialmente a las seis gestaciones con feto vivo. De un total de 9 embarazos hubo 3 abortos, lo que equivale a un 33 por ciento, y 6 casos con feto vivo, 66 por ciento. El tiempo de diálisis fluctuó entre los 12 y 78 meses, con un promedio de 46. La edad gestacional al término osciló entre las 30 y las 37 semanas, y todas las gestaciones fueron de pretérmino. En el 66 por ciento (4) de las pacientes el parto se resolvió por cesárea. Hubo 5 RN con RCIU, 83,3 por ciento. El peso de los RN fluctuó entre los 1100 y los 2800 gramos con un promedio de 1948 gramos. En 5 pacientes hubo presencia de polihidroamnios. No hubo malformaciones congénicas de los RN ni mortalidad materna

Impacto de la terapia anti retroviral en la mortalidad de pacientes VIH+ chilenos: estudio caso control MORTAR / Impact of antiretroviral therapy in mortality of chilean HIV+ patients: a case control study

Background: Combined antiretroviral therapy (AVR) has shown a protective effect (PE) on morbidity and survival in HIV (+) patients of industrialised countries where triple-drug therapy (ARV-3) is standard. In Chile the public health system began providing double-drug therapy in 1997 (ARV-2) with 2 reverse transcriptase inhibitors. Aim: To assess the impact of ARV in morbimortality of HIV (+) patients in Chile after a year of follow up. Patients and methods: Retrospective case-control (1:1) study. Cases were 97 patients followed during 1997 for 6 or more months and dying during that period. Each case had a control of the same gender and CDC stage, similar age and CD4 count, but surviving a same period of follow up. A comparison of ARV before and during follow up (rate and type) was done. P carinii prophylaxis, pneumococcal immunization at baseline or follow up, frequency of hospital admissions and occurrence of opportunistic infections in both groups were assessed. Odds ratio (OR) for mortality, hospitalisation and opportunistic infections in ARV user, as well as treatment PE were calculated. Results: Twenty four (24.7 percent) cases and sixty six (68 percent) controls received ARV during follow up (p< 0.001), OR was 0.15 (CI 95 percent 0.08-0.3), p < 0.001, the PE was 6.6 for ARV users versus non users, among cases 19 patients received ARV-2 and five received ARV-3. Among controls, 41 patients received ARV-2 and 25 received ARV-3. These differences established an OR of 0.20 (CI 95 percent 0.09-0.04) and a PE of 5 for ARV-2 versus no ARV. For ARV-3 compared with no ARV the OR was 0.08 (CI 95 percent 0.003-0.26), and the PE 12.5. Fifty three (54.6 percent) cases and 13 (13.4 percent) controls required hospital admission, OR 0.49 (CI 95 percent 0.25-0.94), p=0.03, and PE of 2.04 of ARV versus no ARV; 82 (85.3 percent) cases and 50 (51 percent) controls had opportunistic infections, OR 0.5 (CI 95 percent 0.26-0.96), p=0.03 and PE of 2 for ARV versus no ARV. There were no significant differences in prior ARV, prophylaxis and immunisation between cases and controls. Conclusions: This study showed the high impact of ARV in short term morbimortality of HIV(+) patients and the need to implement antiretroviral therapy to all patients as an official health policy. This study did not answer the question of the role, if any, of weaker-than standard antiretroviral therapy

Estudio prospectivo, randomizado, comparativo de la eficacia, seguridad y costos de cefuroxima vs cefradina en la pielonefritis aguda del embarazo / Efficacy, safety and cost of cefuroxime compared with cephradine in the treatment of acute pyelonephritis during pregnancy

Background: Second generation cephalosporins (CFPs) are more active in the treatment of acute pyelonephritis during pregnancy but their cost is considerably higher than their predecessors. Cefuroxime, a second generation CFP with oral and parenteral presentations, might offer significant advantages and become a first choice antimicrobial in this setting. Aim: To compare the efficacy, safety and cost of cefuroxime and cephradine in the treatment of acute pyelonephritis in pregnancy. Patients and methods: Hospitalized women with 12 to 34 weeks of pregnancy, with clinical and bacteriological diagnosis of acute pyelonephritis, were randomly assigned to receive cefuroxime (Curocef (r), GlaxoWellcome) 750 mg t.i.d, i.v or cephradine 1 g q.i.d., i.v. If the isolated organism was resistant to the assigned drug the patient was excluded. Once patients were afebrile, they were switched to an oral form of the same antimicrobial. They were discharged according to the clinical status and treated for a total of 14 days. Laboratory tests, including urine culture were requested during controls and at the end of follow-up at 28 days. Results: One hundred and one patients were randomized: 49 to receive cephradine and 52 to receive cefuroxime. Patients in the cefuroxime group had fewer febrile days (mean 1.7 vs 2.2, p<0.05), faster clinical recovery (mean 2.7 vs 3.1 days, p<0.05), a higher rate of bacteriological cure at 28 days (78.8 percent and 59.2 percent, p<0.05) and lower rate of failure (21.2 percent vs 40.8 percent p<0.05). The rate of resistance of isolated uropathogens was l4 percent to cephradine and 1 percent to cefuroxime. Conclusions: Cefuroxime can be considered as a first choice option in the treatment of acute pyelonephritis during pregnancy due to its tolerance, microbiological activity and efficacy

Brote de histoplasmosis aguda en viajeros chilenos a la selva ecuatoriana: un ejemplo de medicina geográfica / Outbreak of acute histoplasmosis in chilean travelers to the Ecuadorïs jungle: report of 6 cases as an example of geographic medicine

Eight chilean teenagers traveled to Ecuador in january 1999, where they were bitten by mosquitoes, had contact with parakeets and lodged in poorly hygienic places; 6/8 visited for 5-10 minutes the interior of a bat cave. About a week later these 6 began with headache, myalgia and fever that lasted 2-3 weeks. 5/6 had dry cough with no respiratory distress. The index case was seen in the 2nd week of symptoms. A chest x-ray showed multiple nodular infiltrates as in the other five. Two had histoplasma serology, one was negative and the other positive at a low titer; histoplasmine skin test showed induration of 17-27 mm in all six. An acute histoplasmosis with massive exposure was diagnosed and treated with itraconazole for 3 weeks. All became asymptomatic and chest x-rays returned to normal. Histoplasmosis (non existent endogenously in Chile) is, among other geographic and tropical diseases, a risk for chilean travelers. Awareness of this in the general population and development of expertise in these diseases by local health care providers is required

Sepsis: enfoque terapéutico antimicrobiano de infecciones graves / Sepsis: antimicrobial therapeutic approach of severe infections

El término sepsis es amplio y algo vago, en general se refiere a infecciones graves. Afortunadamente se ha llegado a un grado de consenso de las distintas entidades y se está empezando a hablar en un lenguaje común. Esta revisión, más que analizar esta terminología de consenso y su cada vez mejor caracterización fisiopatológica, se abocará al problema práctico del enfoque terapéutico de infecciones graves, aquellas que habitualmente son vistas en las unidades de cuidados intensivos, con el propósito de fijar un marco de referencia que permita tratar adecuadamente las patologías, optimizar los recursos y analizar críticamente algunos conceptos y prácticas de la especialidad

Infección por VIH y embarazo / VIH infection and pregnancy

El objetivo de este trabajo fue estudiar las características clínicas del embarazo con infección por virus de inmunodeficiencia humana (VIH) y la transmisión vertical. Se analizaron embarazadas con esta infección, controladas en la Fundación Arriarán, cuya gestación y parto fueron atendidos en la Maternidad del Hospital San Borja Arriarán. Durante la gestación se hizo pesquisa de otras infecciones. La zidovudina (AZT) fue usada según protocolo ACTG 076 en 6 mujeres. En el parto se prefirió la cesárea electiva. Se impidió la lactancia. Se hizo seguimiento de los niños. Diecisiete mujeres tuvieron 19 partos. Presentaron infección genitourinaria 4 pacientes (21,1 por ciento); infecciones no ginecológicas 5 (26,3 por ciento); patología del embarazo 4 (21,1 por ciento); rotura prematura de membranas de término 1 (5,3 por ciento); parto prematuro 3 (15,8 por ciento). El parto fue por cesárea en 15 casos (78,9 por ciento). La transmisión vertical fue 26,3 por ciento (5/19), 33,3 por ciento (5/15) en la cesárea y 16,7 por ciento con tratamiento de AZT. Un niño presentó muerte fetal y trece (68,4 por ciento) están sanos. Ocho mujeres están asintomáticas, tres sintomáticas, cuatro abandonaron controles y dos fallecieron. Es conveniente que la embarazada con infección por VIH use AZT y sea controlada por especialistas para disminuir los factores de riesgo en la transmisión vertical. La cesárea facilita la administración de AZT durante el parto. La lactancia materna debe suprimiese

Síndrome shock tóxico estreptocóccico puerperal / Puerperal streptococcal toxic shock syndrome

En las infecciones puerperales, ha habido un resurgimiento de la virulencia del Streptococcus pyogenes, con la variedad llamada síndrome shock tóxico. Se presenta como severa sepsis con falla orgánica múltiple y generalmente conduce a la muerte de la paciente. La variedad M que produce exotoxina A, B o ambas ha sido el serotipo más frecuentemente aislado en esta infección invasiva. Comunicamos un caso de sepsis puerperal, con síndrome shock tóxico. Esta publicación pretende alertar sobre el posible retorno de esta infección y recordar al obstetra esta grave forma de presentación