Construcción de redes sociales en el lugar de destino: las experiencias de venezolanos, colombianos y españoles en una ciudad intermedia de Chile / Construção de redes sociais no país de destino: as experiências de venezuelanos, colombianos e espanhóis em uma cidade intermediária no Chile / Building social networks in the destination country: experiences of Venezuelans, Colombians and Spaniards in a medium-sized city in Chile

Resumen Se analiza la construcción, por parte de inmigrantes internacionales, de redes sociales en el país de destino, y las características de estas redes según el país de origen. Se estudia el caso de tres colectivos residentes en Chile, utilizando metodología cualitativa basada en entrevistas semiestructuradas, que se analizan mediante análisis narrativo. Los resultados muestran que quienes tienden a incorporarse con mayor rapidez en el lugar de destino, suelen establecer redes de vínculos débiles. Por el contrario, quienes tienen más dificultades para incorporarse en el lugar de destino, o lo hacen solo parcialmente, establecen redes densas más cerradas en lo cultural.

Resumo Este artigo analisa a construção, por imigrantes internacionais, de redes sociais no país de destino e as características dessas redes de acordo com o país de origem. O caso de três grupos residentes no Chile é estudado por meio de um desenho metodológico qualitativo baseado em entrevistas semiestruturadas, que são abordadas a partir da análise sociológica do discurso. Os resultados mostram que aqueles que se incorporam com mais facilidade e rapidez no local de destino tendem a estabelecer redes de vínculos fracos. Ao contrário, aqueles que têm mais dificuldade em se incorporar ao local de destino, ou o fazem apenas parcialmente, tendem a estabelecer redes culturalmente fechadas e coesas.

Abstract This article analyzes international immigrants' construction of social networks in the country of destination, and the characteristics of these networks according to the country of origin. The case of three groups residing in Chile is studied through a qualitative methodological design based on semi-structured interviews, examined by means of narrative analysis. Results show that those who adapt more easily and quickly to the place of destination tend to establish networks with weak ties. Conversely, those who have more difficulties in adapting to the place of destination, or do so only partially, tend to establish closed, tightly-knit cultural networks.

Reflexiones frente al acceso a los servicios de audiología en el sistema de salud colombiano: una mirada desde los Determinantes sociales de la salud

La audiología, como campo profesional reciente, ha estado profundamente arraigada al paradigma positivista y a las lógicas de la biomedicina que no permiten superar la visión asistencial, clínica, terapéutica e individualista de la salud. Esto ha dificultado intentar desplazamientos teóricos, epistemológicos y ético-políticos que permitan entender la salud auditiva desde perspectivas que se preocupen por trascender el individuo y su esencia biológica, así como entrar en los debates contemporáneos de la salud. Los Determinantes Sociales de la Salud, como corriente de pensamiento fundamentada en la epidemiología clásica, propone un marco interpretativo social que avanza al estudio de las desigualdades injustas y evitables, entre ellas las que se producen en el acceso y uso a los servicios de salud, los cuales operan de manera desigual en los sistemas sanitarios. Colombia no es la excepción, el asunto es que poco se estudian estas realidades en el sistema de salud desde la audiología, lo cual pone en evidencia las deudas en este campo que requiere de atención urgente de cara a lo que la misma organización propone frente a mejorar las condiciones de vida y luchar por la distribución desigual del dinero, los recursos y el poder.

Audiology, as a recent professional field, has been deeply rooted in the positivist paradigm and the logic of biomedicine that does not allow us to overcome the healthcare, clinical, therapeutic and individualistic vision of health. This has made it difficult to attempt theoretical, epistemological and ethical-political shifts that allow hearing health to be understood from perspectives that are concerned with transcending the individual and its biological essence, as well as entering contemporary health debates. The Social Determinants of Health as a current of thought based on classical epidemiology, proposes a social interpretive framework that advances the study of unfair and avoidable inequalities, including those that occur in access to and use of health services, which operate unequally in health systems. Colombia is no exception, the issue is that these realities are little studied in the health system from audiology, which highlights the debts in this field that requires urgent attention in the face of the recommendations of the Determinants Commission Social Health of the World Health Organization, confront, improve living conditions, and fight for the unequal distribution of money, resources and power. Joint efforts are needed to transform realities that pass through the health system every day.

Colangiocarcinoma y hepatocolangiocarcinoma combinado en pacientes con cirrosis / Cholangiocarcinoma and combined hepatocellular-cholangiocarcinoma in cirrhotic patients

Background: Cholangiocarcinoma (CCA) is a primary hepatic tumor, frequently found in patients with liver cirrhosis and biliary tract diseases. Its varieties include isolated CCA or "combined hepatocellular-cholangiocarcinoma" (cHCC-CCA). The latter is uncommon, with poorly defined diagnostic criteria and natural history. Aim: To characterize patients with cirrhosis with a pathological diagnosis of CCA and cHCC-CCA. Material and Methods: Forty-nine liver biopsies with a pathological diagnosis of CCA were reviewed. The clinical records of patients were reviewed to fetch demographic variables, etiology of cirrhosis and clinical presentation. Results: Eight of the 49 patients had cirrhosis (16% of CCA biopsies reviewed). Their median age was 64 (27-71) years and five were females. Four patients had CCA, three patients cHCC-CCA and one had a bifocal tumor. Patients in the CCA group were more commonly symptomatic. Alpha-fetoprotein and CA 19-9 levels were elevated in one of eight and four of six patients, respectively. Within 12 months from diagnosis, five of eight patients died. Conclusions: In most of these cases, the diagnosis of cHCC-CCA and CCA was made in the liver explant study without previous imaging diagnosis. This reinforces the usefulness of the histological study, in specific cases, prior to liver transplantation and emphasizes the importance of systematic explant exploration in these cases.

Cirugía en el paciente cirrótico: características clínicas y complicaciones en una cohorte de pacientes chilenos / Surgical complications in cirrhotic patients: analysis of 102 cases

Background: Cirrhotic patients have an increased surgical risk due to potential intra and postoperative complications. Aim: To describe the clinical characteristics and surgical complications of cirrhotic patients undergoing surgery in a Chilean university hospital. Patients and Methods: Review of medical records of 102 cirrhotic patients aged 60 ± 11 years (52% males) who underwent elective or urgency surgery at an university hospital between 2010 and 2016. General, pre-surgical, and post-surgical complications were recorded. Results: The main etiologies of cirrhosis were non-alcoholic steatohepatitis (31%), and alcoholic cirrhosis (28%). Child-Pugh scores were A, B and C in 50, 28 and 22% of cases respectively. Median MELD (Model for End-stage Liver Disease) score was 11 (interquartile range: 10-15). The surgical procedure was elective in 71% of cases, with predominance of abdominal surgery (86%). The American Society of Anesthesiologists (ASA) score was three or more in 52% of patients. The frequency of any adverse outcome was 62%. The frequency increased along with the severity of cirrhosis and when surgery was urgent. The most common complications were acute renal failure (24%), increased ascites (23%) and encephalopathy (22%). Admission to intensive care unit occurred on 26% of patients, with six hospital deaths. Conclusions: In these patients, surgical complications were common, although with low mortality.

Retos de la terapia ocupacional en salud pública / Challenges of Occupational Therapy in Public Health

Resumen En el marco de la conmemoración de los 50 años de la institucionalización de la terapia ocupacional en el país, el presente escrito pretende reflexionar sobre algunos retos que deben enfrentar los profesionales del desempeño ocupacional en el futuro próximo; se pone énfasis en elementos que pueden aportar a la salud pública para repensar el saber y la práctica, tanto académica como profesional. Al considerar la herencia del paradigma positivista y el modelo biomédico que ha inspirado el conocimiento y hacer de la terapia ocupacional alrededor de la rehabilitación, se plantea que parte de los desafíos involucran concebir la salud como algo más que el opuesto de enfermedad; estudiar y comprender el desempeño ocupacional de todos los seres humanos, no solo de aquellos con discapacidad en procesos de rehabilitación; posicionar la ocupación como determinante fundamental de la promoción de la salud y la prevención de enfermedades, tanto en individuos como en poblaciones sanas; participar de la formulación e implementación de políticas y programas de salud, y comprender la influencia que tiene la organización económica, política y social de la sociedad sobre el quehacer humano. Estas deudas pendientes se corresponden con oportunidades de una comunidad receptiva, dispuesta a crecer día a día para consolidarse socialmente.

Abstract Within the framework of the commemoration of the 50th anniversary of Occupational Therapy in Colombia, this article aims to reflect on some challenges that occupational therapists may face in the near future, emphasizing on public health elements that may contribute to reconsider both academic and professional knowledge and practice. Considering the legacy of positivism and the biomedical model that has inspired the knowledge and construction of Occupational Therapy around rehabilitation, some of said challenges involve conceiving health as something more than the opposite of illness; studying and understanding occupational performance in all human beings, not only in people with disabilities undergoing rehabilitation processes; positioning occupation as a fundamental determinant of health promotion and disease prevention, both in healthy individuals and populations; participating in the formulation and implementation of health policies and programs; and understanding the influence of the economic, political and social organization of society on human activity. These debts are opportunities for a receptive community, willing to grow and consolidate socially.

Conocimiento de las oportunidades perdidas de vacunación en profesionales no PAI (Programa Ampliado de Inmunizaciones) de Bogotá, D.C. / Knowledge of vaccination lost opportunities in non PAI (Spanish for Extended Immunization Program) professionals in Bogotá, D.C.

Antecedentes. Las oportunidades perdidas de vacunación (OPPV) son todas las circunstancias por las cuales un niño menor de cinco años o una mujer en edad fértil no reciben las vacunas necesarias al acudir a un establecimiento o servicio de salud. Objetivos. Comprender el nivel de conocimiento en OPPV en profesionales no PAI (PNP) de las localidades de San Cristóbal, Suba y Usaquén en Bogotá, D.C. Materiales y métodos. Se realizó un estudio cualitativo, descriptivo e interpretativo con 9 entrevistas realizadas a profesionales no PAI de las tres localidades seleccionadas en el año 2012. Se empleó el método de análisis de contenido. Resultados. Los profesionales entrevistados manifiestan no tener conocimiento acerca de las OPPV, pese a que mencionan elementos fundamentales que hacen parte de estas, tales como restricciones en los horarios, desperdicio de biológicos, difícil localización de los usuarios para sus vacunas y errores del personal médico, entre otras. Conclusión. Este estudio permite hacer un urgente llamado de atención a las instituciones de salud, a la academia y a las autoridades sanitaras del distrito capital respecto a la formación de los profesionales de la salud en tema de OPPV, dado que el desconocimiento de las mismas puede conllevar a no identificarlas, controlarlas, reducirlas ni evitarlas oportunamente.

Background. Missed opportunities for vaccination (MOV) are all the circumstances in which a child who is younger than five years old or a fertile age woman do not receive the necessary vaccinations when arriving at a health service facility. Objective. To understand the level of knowledge in MOV in non PAI (Spanish for Extended Immunization Program) professionals (NPP) belonging to the localities of San Cristobal, Suba and Usaquén, located in Bogotá D.C. Materials and Methods. A qualitative, descriptive and interpretative study was conducted with 9 interviews applied in 2012 to professionals non PAI professionals belonging to these three localities. The content analysis method was used. Results. The interviewed professionals affirmed they don't have any knowledge about MOV, although they mentioned fundamental elements that are part of these MOV such as schedule restrictions, biological wastes, difficult location of users for administering their vaccinations and medical staff errors, including others. Conclusions. This study allows for an urgent wake-up call to health institutions and sanitary authorities of Bogotá regarding the training of health professionals in MOV aspects, provided that the lack of awareness on this regard can lead to not identify, control, reduce or avoid these MOV at the right time.

Manifestaciones cutáneas en adultos con trasplante hepático del Hospital Clínico de la Universidad de Chile / Skin manifestations in adults with a liver allograft

Background: Skin manifestations after liver transplantation are increasing due to long term immunosuppressive therapy along with an increase in patient survival. Several studies have reported dermatologic complications following renal transplant, but few have studied dermatologic problems after liver transplantation. Aims: To describe the different types of cutaneous lesions encountered in adults receiving a liver allograft. To evaluate the frequency of cutaneous manifestations of patients in the liver transplant waiting list. Material and Methods: Eighty patients submitted to a liver transplant and 70 patients in the liver transplant waiting list were evaluated with a complete dermatological physical examination. Results: Sixty one percent of patients with a liver allograft had at least one skin manifestation. Of these, 34% had superficial fungal infections, 31% had viral infections, 20% had cutaneous side effects due to immunosuppressive treatment, 10% had malignant lesions, 2% had bacterial infections and one patient had a graft versus host disease. Only 28% of patients in the liver transplant waiting list had dermatologic problems, and the vast majority were lesions linked to liver cirrhosis. Conclusions: Cutaneous infections were the most common skin problems in liver transplant patients. Although neoplastic lesions are the most commonly mentioned lesions in the literature, only a 10% of our liver transplant patients presented these type of lesions.

Eliminación espontánea de virus hepatitis C en trasplantado hepático: a propósito de dos casos / Spontaneous clearance of hepatitis C virus after liver transplantation: Report of two cases

The spontaneous clearance of hepatitis C virus infection is rare, especially after liver transplantation, condition in which recurrence is almost universal. We report two cases in which clearance of the virus was achieved after liver transplantation. We reviewed the literature and described possible mechanisms explaining this phenomenon, with emphasis on therapeutic implications.

Enfermedad de Ménétrier con compromiso gástrico difuso y duodenal: Caso clínico / Ménétrier disease: Report of one case

Background: Ménétrier disease is a rare disorder of the stomach, characterized by giant hypertrophic folds that usually involve the gastric body and fundus, associated to hypoalbuminemia due to serum protein loss across the gastric mucosa. We report a 55-years-old male presenting with abdominal pain, vomiting, weight loss and hypoalbuminemia. Diffuse hypertrophic gastric folds, elevated ulcerated sessile lesions and focal duodenal involvement were seen at endoscopy. Biopsies showed foveolar hyperplasia and glandular atrophy with cystic dilatation. A total gastrectomy was performed with a good outcome.

Trasplante hepático en cirrosis por virus B: profilaxis con gammaglobulina antiHBs en dosis a "demanda" / Hepatitis B virus immunoglobulin on demand to prevent infection recurrence among liver allograft recipients: Report of three cases

Infection recurrence rates among hepatitis B virus infected liver allograft recipients, may be as high as 80%. Immunoprophylaxis with anti HBVgammaglobulin may reduce these rates and improve survival. The dose of anti HBV gammaglobulin that must be used is not clearly defined. The most commonly accepted protocol uses 10,000 units during the anhepatic phase and 10,000 units daily during one week, followed by weekly doses of 10,000 units during one month and maintenance with 10,000 units monthly, without measuring anti hepatitis B surface antigen antibodies (antiHBs). Some reports recommend the use of immunoglobulin on demand, to maintain antiHBs titers between 100 and 250 U/l. The infection recurrence rates among patients treated with immunoglobulin and Lamivudine fluctuates between 0 and 10%, during follow up periods of 13 to 30 months. We report three liver allograft recipients that received immunoglobulin on demand, using a mean of41,000 units, maintaining adequate antiHBs titers.

Estudio del polimorfismo MTHFR C677T en recién nacidos con cardiopatías congénitas aisladas, en una población colombiana / Study of MTHFR C677T polymorphism in neonates with isolated congenital heart disease in a Colombian population

Introducción: El estudio del papel de polimorfismos en genes de las vías metabólicas de la homocisteína-metionina y el ácido fólico en anomalías congénitas, es cada vezmás importante debido a que sus efectos podrían ser modulados.Objetivo: Determinar si la presencia del polimorfismo C677T en el gen de lametilentetrahidrofolato reductasa (MTHFR) se asocia con el desarrollo de cardiopatías congénitas aisladas.Métodos: Se compararon las frecuencias alélicas y genotípicas del polimorfismo en 34 recién nacidos con cardiopatías congénitas aisladas y en 102 individuos sanos. La genotipificación se hizo mediante la reacción en cadena de la polimerasa (PCR) y se determinó el genotipo por medio de la técnica de polimorfismo de longitud de los fragmentos de restricción (RFLP). Resultados: No se encontraron diferencias estadísticamente significativas en lasfrecuencias alélicas ni genotípicas entre los grupos de casos y controles. Sin embargo, se observó una tendencia estadística para un posible efecto protector del genotipo TT...

The research of the role of gene polymorphisms in the metabolic pathways of homocysteine-methionineand folic acid in congenital malformations is very important because its effect could be modulated.Objetive: The aim of this study was to determine whether the C677T polymorphism in the gene ofthe enzyme methylenetetrahydrofolate reductase(MTHFR) was associated with the development of isolated congenital heart disease. Methodology: We compared the allele and genotypefrequencies of this polymorphism in 34infants with isolated congenital heart defects and 102 healthy individuals. Genotyping was performedby Polymerase Chain Reaction (PCR)and with the technique Restriction Fragment Length Polymorphism (RFLP). Results: There were no statistically significant differences in allele or genotype frequencies between case and control groups. Although our results show no statistically significant differencesbetween the groups assessed there was a statistical trend for a possible protective effect of TT genotype against the development of congenitalheart disease...

Enfermedad linfoproliferativa difusa postrasplante en adultos: comunicación de un caso y revisión de la literatura / Post-transplant lymphoproliferative disorder in adults: case report and review of the literature

The post-transplant lymphoproliferative disorder (PTLD) corresponds to a heterogeneous group of lymphoproliferative diseases that develop in solid organ and bone marrow transplant recipients. It occurs in 3-10 percent of patients receiving solid organ transplants, mostly children. It is called early PTLD if it occurs in the first year after transplantation, if it affects B-cell lymphocytes and is associated with infection by Epstein-Barr virus. Late presentation occurs after the first year of transplantation and its pathogenesis is less clear. Clinical manifestations vary from a benign mononucleosis-like clinical setting to high-grade tumors with high mortality (40-60 percent). Treatment depends on the extent of the disease, including reduction of immunosuppressive therapy, radiotherapy, surgery and, more recently, the use of anti-CD20 monoclonal antibody. We report the case of a 67 year-old woman presenting with PTLD on the eighth month after receiving a liver graft.

La enfermedad linfoproliferativa difusa postrasplante (ELDP), corresponde a un grupo heterogéneo de desórdenes linfoproliferativos que se desarrollan en receptores de órganos sólidos y médula ósea. Ocurre en 3 a 10 por ciento de los pacientes receptores de órganos sólidos, fundamentalmente pediátricos. Se denomina ELDP precoz si se presenta en el primer año posterior al trasplante, afecta a los linfocitos de estirpe B y se asocia a la infección por virus Epstein-Barr. La presentación tardía ocurre luego del primer año de trasplante y su etiopatogenia es menos clara. Las manifestaciones clínicas varían desde un cuadro benigno similar a la mononucleosis a neoplasias de alto grade, con elevada mortalidad (40-60 por ciento). El tratamiento dependerá de la extensión de la enfermedad, incluyendo reducción del tratamiento inmunosupresor, radioterapia, cirugía y más recientemente el uso de anticuerpos monoclonales anti CD20. Presentamos el caso clínico de una mujer de 67 años, que al octavo mes de recibir un injerto hepático presenta ELDP.

Análisis descriptivo de los niveles de homocisteína, polimorfismos C699T, C1080T y 844Ins68pb de la CBS, C677T de la MTHFR y otros factores de riesgo cardiovascular en una población colombiana con síndrome coronario agudo / Descriptive analysis of homocysteine levels, polymorphisms C699T, C1080T and 844Ins68pb of CBS, C677T from the MTHFR, and other cardiovascular risk factors in a Colombian population with acute coronary syndrome

La enfermedad cardiovascular es la primera causa de muerte en el mundo occidental. Por esta razón, es necesario describir los factores de riesgo conocidos, al igual que los factores genéticos, nutricionales y ambientales emergentes, como la hiperhomocisteinemia y la deficiencia de la vitamina B12 y de ácido fólico en la población colombiana, que permitan proponer estrategias comunitarias de control de la enfermedad. El objetivo de este estudio fue describir los factores de riesgo conocidos y los emergentes,principalmente la hiperhomocisteinemia y los polimorfismos relacionados con ella en pacientes con síndrome coronario agudo. El estudio incluyó 156 pacientes, a quienes se les cuantificó perfil lipídico, glucosa, creatinina, urea, homocisteína, vitamina B12 y ácido fólico, y se describieron las frecuencias de las variantes polimórficas c.677C/T, de la MTHFR (5,10-methylenetetrahydrofolate reductase y c.699C/T, c.1080 C/T y c.844ins68pb de CBS (Cystathionine â-Synthase). El 43,6% de los pacientes con síndrome coronario agudo correspondió a las mujeres y el 56,4% a los hombres. Los valores medios de colesterol total, cLDL, cHDL, glucosa, homocisteína, vitaminas B12 y ácido fólico, se encontraron en el rango normal. Sin embargo, se pudo observar que la homociste ína presentaba una tendencia al aumento con la edad, tanto en hombres como en mujeres. Los niveles de cHDL en el grupo de hombres y de mujeres, presentaron diferencia significativa (p=0,0379) e, igualmente, la diferencia fue significativa en los niveles de creatinina (p=0007), de vitamina B12 (p=0,0341) y en la diabetes mellitus (p=0,0436). Con este estudio se realizó una aproximación a la descripción de los niveles del perfil lipídico, glucemia, hiperhomocisteinemia y de polimorfismos en genes involucrados en la vía de la homocisteínametionina, en pacientes con enfermedad cardiovascular en la población colombiana...

Cardiovascular diseases are the main cause of death in the western world. Therefore, it is necessary to describe the associated genetic, nutritional and environmental risk factors, including hyperhomocysteinemia, vitamin B12 and folic acid deficiencies in the Colombian population. Through this survey we want to propose strategies to the community in order to control cardiovascular diseases. The goal of this study was to describe the known risk factors and also the emerging ones such as hyperhomocysteinemia and some polymorphisms, in a Colombian population Our study included 156 patients with acute coronary artery syndrome, whose lipid, glucose, creatinine, homocysteine, vitamin B12 and folic acid levels were measured and the identification of polymorphisms 677C/T, from the MTHFR and 699C/T, 1080C/T, 844ins68pb of CBS. Overall, 43.6% of patients with acute coronary artery syndrome corresponded to women, and 56.4% to men who participated in this study. The results of cholesterol CLDL, CHDL, glucose, homocysteine, vitamin B12 and folic acid levels were found in normal ranges. However, we were able to observe that the homocysteine presented a tendency to increase with age in men and women,the CHDL levels within the group of men and women showed a significant difference (p=0.0379)as well as in the levels of creatinine (p=0.0007) of vitamin B12 (p=0.0341) and diabetes mellitus (p=0.0436). In this study, we propose a rough description of the lipid, glycemia, and hyperhomocysteinemia levels and polymorphisms in genes involved the homocysteine-methionine metabolism in patients with cardiovascular disease in the population of Colombia...

Primaridad tardía / Delayed primiparity

Se analizan las fichas clínicas de 167 primíparas tardías (P.T.), e igual número de pacientes controles, que resolvieron su parto en la maternidad del Hospital Clínico de la Universidad Católica, entre los años 1978 y 1983. Se demuestra que las P.T. tenían entre sus antecedentes mayor incidencia de infertilidad, abortos previos, hipertensión arterial crónica y mioma uterino. Durante el embarazo estas pacientes presentaron, con mayor frecuencia, síndrome hipertensivo del embarazo, diabetes gravídica, meconio y distocias de presentación al término. 55% de ellas cursó un embarazo fisiológico. La vía de parto en P.T. fue cesárea electiva en 40,7% de los casos; de las pacientes que tuvieron trabajo de parto, 69% logró parto vaginal (40% del total de P.T.). No hubo diferencias en el puerperio, salvo una disminución de la lactancia exclusiva. En cuanto al RN, no se demostraron diferencias en el índice de Apgar, morbilidad, prematurez y mortalidad perinatal. Existió mayor incidencia de bajo peso de nacimiento y de malformaciones congénitas, así como menor peso promedio en los RN de las P.T.. Se concluye que una buena parte de las P.T. tiene embarazo normal, y que con un buen control antenatal y un manejo juicioso de la cesárea y el trabajo de parto condicionan un pronóstico materno y perinatal semejante a primigestas más jóvenes