First molecular characterization of Galba neotropica in Uruguay

Until recently, it was believed that only two lymnaeid species (i.e. Galba viatrix and Pseudosuccinea columella) occurred in Uruguay. However, based on a molecular approach, an additional species Galba cubensis, was recently discovered. The aim of this study was to molecularly characterize different lymnaeid populations from the northern region of Uruguay. The lymnaeids collections were carried out in two farms of the departments of Paysandú and Tacuarembó. The collected lymnaeids were divided in two fractions, one fraction was used for conchological analyses and detection of trematode larval stages, while the other fraction was used for molecular studies. Three PCRs targeting the 16S, ITS-2 and COI DNA regions were performed and the amplicons obtained were direct sequenced. The sequences were used for homology search and construction of phylogenetic trees by the maximum-likelihood method. The sequencing results revealed that both isolates corresponded to Galba neotropica. The phylogenetic analyses placed our isolates among the G. neotropica monophyletic group, closely related to other isolates of this species found in several South American countries. To our knowledge, this is the first record of G. neotropica in Uruguay and the confirmation as competent intermediate host of Fasciola hepatica. Further studies are needed to define the distribution and the role of each lymnaeid species in the transmission of F. hepatica in Uruguay.

Tradicionalmente se indicaba que existían dos especies de limneidos en Uruguay: Galba viatrix y Pseudosuccinea columella. Sin embargo, en los últimos años se identificó por medio de técnicas moleculares una tercera especie, Galba cubensis. El objetivo de los autores fue muestrear e identificar por medios moleculares poblaciones de limneidos del norte del país. Las colectas fueron realizadas en establecimientos rurales de los departamentos de Tacuarembó y Paysandú. Los caracoles colectados fueron divididos en dos fracciones, una de ellas fue destinada para el estudio morfológico de las conchillas y búsqueda de larvas de trematodos. La otra fracción se usó para la caracterización molecular. Tres genes fueron amplificados (ITS2, COI y 16S) utilizando protocolos de PCRs previamente descriptos. Las secuencias obtenidas se utilizaron para estudios de homología y construcción de árboles filogenéticos por medio del método de máxima verosimilitud. Por medio de la secuenciación se pudo confirmar que los dos aislamientos corresponden a Galba neotropica. Los estudios filogenéticos colocan ambos aislamientos dentro del grupo monofilético de G. neotropica junto a otros encontrados en distintas regiones de Sudamérica. Hasta lo que sabemos, el presente, es el primer registro de G. neotropica en Uruguay, además de comprobarse su capacidad para actuar como hospedero intermediario de Fasciola hepatica en condiciones de campo. Se sugieren futuros estudios para determinar la distribución y el rol de cada especie de limneido en la transmisión de F. hepatica.

Digeneos parásitos de Cyphocharax platanus (Günther, 1880) (Characiformes: Curimatidae) en el tramo inferior del río Uruguay en la zona de influencia de la represa de Salto Grande, Uruguay

Entre agosto de 2012 y junio de 2013 estudios parasitológicos fueron llevados a cabo en 76 ejemplares de Cyphocharax platanus procedentes del tramo inferior del río Uruguay en la zona de influencia de la represa de Salto Grande. Tres taxones de digeneos fueron identificados: Saccocoelioides spp. (Haploporidae) y Zonocotyle bicaecata (Zonocotylidae) en intestino, y metacercarias de Sphincterodiplostomum musculosum (Diplostomidae) en el interior de los ojos. El 69,7% de los peces analizados resultaron parasitados por al menos un taxón de digeneo. Saccocoelioides spp. mostro los mayores valores de prevalencia, intensidad media y abundancia media (43,4%, 5,45, 2,37 respectivamente) de infección, en relación a Z. bicaecata (28,9%, 1,32 y 0,38 respectivamente) y S. musculosum (13,2%, 2,82 y 0,37 respectivamente). Saccocoelioides spp. y S. musculosum mostraron un patrón de distribución agregado, en tanto que Z. bicaecata presentó una distribución aleatoria en la población de hospedadores. No se hallaron diferencias significativas en los índices de infección de ninguno de los taxones de digeneos en relación al sexo de los hospedadores, y sólo Saccocoelioides spp. presentó una asociación significativa con el tamaño, siendo más frecuente en peces pequeños. Los dos parásitos intestinales (Saccocoelioides spp. y Z. bicaecata) no presentaron una asociación significativa entre sus índices de infección. Los registros de Saccocoelioides spp. y Z. bicaecata corresponden a los primeros para este hospedador en el río Uruguay, y el hallazgo de las metacercarias de S. musculosum constituye una nueva relación parásito-hospedador.

Seventy six specimens of Cyphocharax platanus were collected downstream Salto Grande dam, lower Uruguay River, Uruguay, between August 2012 and June 2013 and examined for digenean parasites. Three digenean taxa were identified: Saccocoelioides spp. (Haploporidae), Zonocotyle bicaecata (Zonocotylidae) (both adult in intestine) and Sphincterodiplostomum musculosum (Diplostomidae) metacercariae inside eyes. We found that 69.7% of examined fish were parasitized by at least one digenean taxon. Saccocoelioides spp. showed highest values of prevalence, mean intensity and mean abundance (43.4%, 5.45, and 2.37, respectively) of infection throughout the study than Z. bicaecata (28.9%, 1.32 and 0.38, respectively) and S. musculosum (13.2%, 2.80 and 0.37, respectively). Saccocoelioides spp. and S. musculosum showed an aggregated distribution pattern, while Z. bicaecata presented a random distribution in the host population. No significant differences in infection indexes of any digenean taxa in relation to host sex were found, and only Saccocoelioides spp. showed a significant association with host size, being more frequent in small fish. The infection indexes of the two intestinal digeneans (Saccocoelioides spp. and Z. bicaecata) were not significantly associated. These are the first records of Saccocoelioides spp. and Z. bicaecata from C. platanus in the Uruguay River, and the finding of S. musculosum metacercariae is a new host-parasite relationship.

Caracterización físico-química y actividad antimicrobiana de la secreción mucosa de Achatina fulica / Mother-infant bonding disorders: prevalence, risk factors, diagnostic criteria and assessment strategies

Introducción: El caracol gigante africano Achatina fulica es reconocido como una plaga que afecta la biodiversidad, la Salud Pública y la productividad. Sin embargo, se ha demostrado que su secreción mucosa tiene propiedades cosméticas, cicatrizantes y antimicrobianas. Objetivo: Determinar las características físico-químicas y evaluar la actividad antimicrobiana de la secreción mucosa de Achatina fulica. Metodología: Se hicieron pruebas bioquímicas para la determinación cualitativa y cuantitativa de glúcidos, proteínas y lípidos. Se determinó el contenido de Calcio, Potasio, cloruros, Sodio y Magnesio. Se midieron los parámetros de conductividad eléctrica, potencial óxido-reducción, saturación de oxígeno, oxígeno total disuelto, pH, sólidos disueltos totales. Se realizó un ensayo de actividad antibacteriana por la técnica de microdilución en caldo. Resultados: Se encontraron glúcidos en concentraciones de 582 μg/mL en la fracción soluble y de 62.1 μg/mL en la fracción de mucinas, y proteínas en concentraciones de 836 μg/mL en la fracción soluble y de 1413 μg/mL en la fracción de mucinas. Se observó actividad antimicrobiana frente a las tres cepas ensayadas. Streptococcus agalactiae alcanzó un MIC90 a una concentración de 3,6 mg/mL con la fracción de mucinas; Staphylococcus aureus resistente a meticilina tuvo un MIC50 de 3,3 mg/mL y Escherichia coli un MIC 70 de 3.8 mg/mL. Conclusiones: Se reportan por primera vez las características físicas y los oligoelementos presente en la secreción de Achatina fulica. La actividad antibacteriana obtenida frente a cepas Gram positivas y Gram negativas plantea la necesidad de realizar estudios para purificar las moléculas con dicha actividad, conocer los mecanismos de acción y establecer la inocuidad, entre otros.

Introduction: The giant African snail Achatina fulica is recognized as a scourge affecting biodiversity, public health and productivity. However, it has been shown that the mucus has cosmetic, healing and antimicrobial properties. Objective: Determine physico-chemical characteristics and evaluate the antimicrobial activity of the mucus. Methodology: Qualitative and quantitative determinations of carbohydrates, proteins and lipids were made by biochemical tests. Using multiparameter meter parameters of electrical conductivity, redox potential, oxygen saturation, the total dissolved oxygen, pH, total dissolved solids were measured. Content of Calcium, Potassium, chloride, Sodium and Magnesium was determined. Antibacterial activity assay was performed by broth microdilution method against Gram positive and Gram negative bacteria. Results: Carbohydrates were found in concentrations of 582 μg/mL in soluble fraction and 62.1 μg/mL in mucin fraction, and protein concentration of 836 μg/mL in the soluble fraction and 1413 μg/mL in mucin fraction. Antimicrobial activity was demonstrated against the three strains tested. Streptococcus agalactiae reached MIC90 at a concentration of 3.6 μg/mL with mucin fraction; Methicillin-Resistant Staphylococcus aureus had a MIC50 of 3.3 mg / mL and Escherichia coli had a MIC70 of 3.8 mg / mL. Conclusions: This is the first report of the physical and trace elements in the secretion of Achatina fulica. The antibacterial activity obtained against Gram positive and Gram negative strains raises the need for studies to purify the molecules with such activity, understanding the mechanisms of action and establish the safety, among others.

Estado nutricional y características socioepidemiológicas de escolares chilenos, OMS 2007 / Nutritional status and socio-epidemiological features of schoolchildren, WHO 2007

Introducción: Actualmente, las cifras chilenas de obesidad infantil están dentro de las más altas del mundo. Objetivo: describir el estado nutricional de los escolares de Quilpué evaluados y su relación con variables demográficas y socioeconómicas. Pacientes y Método: Se analizó el estado nutricional (OMS, 2007) de 1091 escolares a partir de las mediciones de talla y peso obtenidas en el Programa Piloto de Salud Escolar llevado a cabo en los colegios de la Corporación Municipal de Quilpué a los alumnos entre kínder y cuarto básico. Se usaron las bases de datos de dicho programa y del Sistema Nacional de Asignación con Equidad (SINAE) para las variables de previsión de salud e índice de vulnerabilidad escolar (IVE), respectivamente, y a través de un cuestionario realizado en las escuelas se obtuvieron el número de horas de educación física, el tipo de colaciones y la presencia de quiosco. Resultados: Un 26,3% de los escolares tenían obesidad y un 27,7% sobrepeso. La obesidad fue más frecuente en niños (32,3%) que en niñas (20,1%; p < 0,01), en tercero básico (31,8%; p = 0,01), si las colaciones eran libre decisión de los padres (26,7%; p < 0,01) y si existía quiosco escolar (26,3%; p = 0,01). No se encontraron diferencias significativas según el nivel socioeconómico para el índice de masa corporal (IMC), pero los niños más vulnerables (colegios municipalizados, con elevado IVE, y Fondo Nacional de Salud de Chile [Fonasa] grupo A) obtuvieron menores promedios de talla y mayores porcentajes de desnutrición crónica (talla < -2 DE). Conclusiones: En este estudio se encontró una elevada prevalencia de obesidad que apunta a la necesidad de estrategias de control e intervención nutricional en la etapa escolar (durante la cual, una vez finalizado el Control del Niño Sano ya no se realizan más controles), teniendo en cuenta los sectores más vulnerables.

Introduction: Current Chilean childhood obesity figures are within the highest in the world. Objective: To describe the nutritional status of Quilpué schoolchildren and its relationship with demographic and socioeconomic variables. Methods: The nutritional status (OMS 2007) of 1091 schoolchildren was assessed using measurements of height and weight obtained in the "Pilot School Health Program" conducted in the schools of the Municipal Corporation of Quilpué, which included pupils from kindergarten to 4th grade. The program described above, as well as SINAE databases, were used for the Healthcare and School Vulnerability Index (SVI) variables, respectively, as well as the the number of hours of physical education, type of lunches, and the presence of vendors at school, were obtained using a questionnaire in schools. Results: Obesity was observed in 26.3% of students, and a further 27.7% were overweight. Obesity was more frequent in boys (32.3%) compared to girls (20.1%) (P<.01); in third grade (31.8%) (P=.01); if lunches were parental choices (26.7%) (P<.01); and with the presence of school vendors (26.3%) (P=.01). No significant differences in socioeconomic status regarding BMI were found, but the most vulnerable children (municipal schools, high SVI, Fonasa A healthcare) had lower average height and higher rates of chronic malnutrition (height <-2 SD). Conclusions: A high prevalence of obesity was found in this study, which highlights the need for monitoring and nutrtional intervention strategies at school age (which once finalized, the Healthy Child Surveillance does not carry out any more controls), taking into account the most vulnerable sectors.

¿Qué se sabe de bullying? / What is known about bullying?

Se define bullying como una dinámica de maltrato sistemática que ocurre entre iguales de manera persistente. Es considerado un problema de salud pública debido a su prevalencia y las consecuencias que tiene en todos sus participantes: en los agresores, en las víctimas, en los espectadores, en los padres y familias, en la comunidad escolar y en la sociedad en general. Las investigaciones muestran efectos a corto, mediano y largo plazo en el desarrollo emocional y social de niños y adolescentes. Se ha constatado una relación del acoso escolar con las patologías físicas, psicosomática y de salud mental en niños, adolescentes y en la vida adulta. En este artículo se describen las características individuales, las relacionales, los factores conocidos como de riesgo y factores protectores, la prevalencia y los programas de abordaje integral del fenómeno. Son múltiples los estudios que muestran la efectividad de la aplicación de estos programas de intervención, diseñados en función de los conocimientos acumulados.

We define School Bullying as a systematic and persistent dynamic of peer abuse. It is considered a public health problem because of its prevalence and consequences in all participants: bullies, victims, bystanders, parents and families, the school community and society in general. Research shows short-, medium-and long-term negative effects in social and emotional development of children and adolescents. There has been a relationship of bullying with physical, psychosomatic and mental health in children, adolescents and adulthood diseases. In this paper we describe the individual characteristics, relational, factors known as risk and protective factors, prevalence and comprehensive programs addressing the phenomenon. There are multiple studies showing the effectiveness of the implementation of these intervention programs, designed on the basis of accumulated knowledge.

Prevalencia y características morfométricas del foramen venoso en cráneos del Noreste de México / Prevalence and morphometric characteristics foramen venosum in Northeastern Mexico skulls

El foramen venoso es una estructura inconstante que se encuentra posterior al foramen redondo y medial al foramen oval, y da paso a una vena que anastomosa al plexo venoso pterigoideo con el seno cavernoso. La existencia de éste foramen puede ser motivo de complicaciones clínicas, entre ellas que es una potencial vía de acceso al seno cavernoso de trombos infectados y constituye una posible falsa vía durante la rizotomía percutánea del trigémino pudiendo puncionar la vena y ocasionar hematomas subdurales. Se utilizó la colección de cráneos del Departamento de Anatomía de la Facultad de Medicina UANL. Se observó la frecuencia y se midieron los siguientes parámetros del foramen: Ancho y largo; en la cara interna de la base del cráneo se midieron las distancias a: foramen redondo, foramen oval, plano sagital mediano y entre forámenes venosos; en la cara externa de la base del cráneo se midieron las distancias con: foramen oval, plano sagital medio y entre los forámenes venosos. Las medidas fueron llevadas a cabo por tres observadores distintos a través de medición directa con vernier y con microfotografías con escalas milimétricas. Se encontró una frecuencia del 20 por ciento con medidas medias de 1,66mm de largo, 1,06mm de ancho; en la cara interna de la base del cráneo: 11,31mm de distancia al foramen redondo, 4,13mm al foramen oval, 17,75mm al plano sagital medio y 31,91mm entre los forámenes; en la cara externa de la base: 2,50mm al foramen oval, 19,54mm al plano sagital medio y 36,05mm entre forámenes venoso. La distancia al foramen oval varía en la cara interna y la cara externa de la base del cráneo debido a un trayecto oblicuo del foramen que tiende a aproximarse al foramen oval y por tanto a separarse del plano sagital medio. Los forámenes derechos fueron generalmente más grandes.

Foramen venosum (foramen Vesalius) is an inconstant structure which is located posterior to the foramen rotundum and medial to the foramen ovale, and it gives pace to an emissary vein that communicates the plexus pterigoideus and the sinus cavernosus. The existence of this anatomical structure can be of interest in certain procedures like percutaneous trigeminal rhizotomy where this foramen can be the cause of a false pathway and be punctured causing a subdural hematoma. It also can be an access to the sinus cavernosus for infected thrombus coming from dental and facial infections. For this study the skull collection of the Anatomy Department, Faculty of Medicine UANL, was used. We observed the frequency and measured the following parameters: Length and width; in the basis cranii we measured: Distances to the foramen rotundum, foramen ovale, planum medianum and between two foramina venosum (one on each side). In basis cranii externa we measured: distances to foramen ovale, planum medianum, and between two foramina venosum. Three independent observers blinded among them, measured the parameters using a Vernier and microphotographs with milimetrical scales. A 20 percent frequency was found and the following median measures: Length 1.66mm, width 1.06mm; basis cranii: distance to foramen rotundum 11.31mm, distance to foramen ovale 4.13mm, distance to planum medianum 17.75mm and 31.91mm between both foramina venosum. Basis cranii externa: distance to foramen ovale 2.49mm, distance to planum medianum 19.54mm and distance between foramenina venosum 36.05. The distance to the foramen ovale varies between basis cranii and basis cranii externa because the foramen has an oblique trajectory and it approximates to the foramen ovale (from superior to inferior) and separates from the planum medianum. It was found bilaterally only in one skull. There are differences between the left and right foramens, the latter being generally larger.

Traqueostomía percutánea con asistencia fibrobroncoscópica: evaluación prospectiva de 100 casos consecutivos y revisión de la literatura / Fiberoptic bronchoscopy assisted percutaneous tracheostomy: report of 100 patients

Background: Development of percutaneous techniques for tracheostomy have facilitated its implementation in the intensive care unit (ICU). Aim: To evaluate the safety of performing percutaneous tracheostomy (PT) using the Ciaglia Blue Rhino thechnique with fiberoptic bronchoscopy assistance in patients with prolonged mechanical ventilation. Patients and methods: Prospective evaluation of 100 consecutive patients aged 62±16 years (38 women) subjected to percutaneous tracheostomy. AU the procedures were performed in the ICU. Demographic variables, APACHE II, days of mechanical ventilation before PT, operative and post operative complications were recorded. Results: Mean APACHE II score was 20±3. Patients required on average 16±7 days of mechanical ventilation before PT. Eight patients (8 percent) had operative complications. One had an episode of transitory desaturation, one had a transitory hypotension related to sedation and six had mild bleeding not requiríng transfusión. No patient required conversión to surgical tracheostomy. Four patients (4 percent) presentedpost operative complications. Two had a mild and transitory bleeding ofthe ostomy and two had a displacement ofthe cannula. No other complications were observed. Conclusions: PT using the Ciaglia Blue Rhino technique with fiberoptic bronchoscopy assistance is a safe procedure that can be performed in the ICU by trained intensivists.

Sedación guiada por protocolo versus manejo convencional en pacientes críticos en ventilación mecánica / Protocol based sedation versus conventional treatment in critically ill patients on mechanical ventilation

Background: Sedatives and analgesic drugs give comfort and allow adequate respiratory support to critically ill patients in mechanical ventilation (MV). Its improper use may increase the duration of MV. Clinical guidelines suggest implementation of protocols, however this is seldom done in clinical practice. Aun: To compare in MV patients, nurse-applied guided by protocol administration of sedatives and analgesic drugs (protocol: group P) with the habitual practice using physicians criteria (control: group C). Material and methods: Inclusión criteria was the need of MV more than 48 h. The exclusión criteria were acute neurological diseases, hepatic cirrhosis, chronic renal failure and limitation of therapeutic efforts. Midazolam and fentanyl were used in both groups. The level of sedation was monitored with the Sedation Agitation Scale (SAS). In the P group, trained nurses applied algorithms to adjust the sedative doses according to a predefined SAS goal. Results: Forty patients were included, 22 aged 65±19 years in group P and 18 aged 54±21 years in group C. Apache II scores were 16±8 and 19±8 in each group. SAS score was more frequently evaluated within goal boundaries in group P than in group C (44 percent and 32 percent, respectively p =0.001). No differences in the proportion of patients with inadequate sedation were observed between treatment groups. Midazolam doses were lower in P than in C group (0.04 (0.02-0.07) and 0.06 (0.03-0.08) mg/kg/h respectively, p =0.005). Conclusions: The implementation of sedation protocol applied by nurses improved the quality of sedation and reduced the doses of Midazolam in mechanically ventilated patients.

Acidosis láctica severa asociada a infusión de propofol: Caso clínico / Severe lactic acidosis caused by propofol infusion: Report of one case

Propofol infusion syndrome (PRIS) is a rare but potentially lethal complications. This disorder is triggered under unknown circumstances by a propofol infusion of more than 5 mg/kg/h for more than 48 h. PRIS is characterized by a multiorgan failure and rhabdomyolysis and is induced by a disturbance in mitochondrial long chain fatty acid oxidation. We report a 43 year-old woman who underwent brain surgery due to a vascular malformation. In the immediate postoperative period, she had an unexplained and severe lactic acidosis. During anaesthesia, she received a propofol infusion of 7 mg/kg/h that continued in the UCI at a rate of 3.5 mg/kg/h, for 8 hours more. The suspicion of PRIS motivated immediate discontinuation of propofol with rapid correction of lactic acidosis and full recovery of the patient.

Reanimación protocolizada del shcok séptico / Protocolized reanimation of septic shock

Severe sepsis and septic shock are pathologies with an increasing incidence in the world. Annually, in the USA 200.000 people die because of severe sepsis, the same number that die because of a myocardial infarction, being this last disease much more common. In Chile, a multicentric study found a 40 percent of prevalence of severe sepsis in critically ill patients, with amortality of 27 percent. In this scenario, it becomes of great importance the appropriate and integral management of this condition, by means of an early diagnosis and the implementation of anaggressive protocolized resuscitation, guided by clear goals. During the first stage of the resuscitation cristalloids and/ or colloids can be used, in order to expand the intravascular space, searching for CVP around 8 to 12 mmHg. In case of hypotension refractory to the administration of fluids, it is recommended to start with increasing doses of norepinephrin untila MAP of 65 - 75 mmHg is achieved. The intensity of the septic shock can be stratified according to the requirements of norepinephrine. It is of great importance to obtain blood cultures of the patients and to start with empiric antibiotic therapy as soon as possible. The initial metabolic goal must be the normalization of the central venous oxygen saturation. The implementation of the resuscitation bundle during the first six hours, since the diagnose of severe sepsis is done, increases the chances of surviving. Protocols of sedation and analgesia, and the use of protective mechanical ventilation is highly recommended. The use of hydrocortisone and human recombinant protein C in selected patients, may have a beneficial result in the outcome.Vasopressin, terlipressin and high-volume hemofiltration can be used as rescue measures for the most severe patients.

Estrés oxidativo y sepsis / Oxidative stress and sepsis

El Shock Séptico es una importante causa de morbi-mortalidad en pacientes críticos que podría ser explicado, al menos en parte, por una desregulación de la respuesta inmuno-inflamatoria. La liberación de componentes microbianos produciría un desbalance con predominio de agentes prooxidantes como las especies reactivas de oxigeno (EROS), sobre las defensas antioxidantes. Las EROS dañan directamente los tejidos al atacar las biomoléculas e indirectamente actuando como mediadores pro inflamatorios. Estudios efectuados en pacientes críticos que cursan con sepsis, han demostrado disminución de lasdefensas antioxidantes. Esto compete a mecanismos enzimáticos y no enzimáticos entre los que han sido estudiados: actividad de enzimas antioxidantes, niveles plasmáticos de vitaminas antioxidantes y capacidad antioxidante del plasma, parámetros que también han sido correlacionados con elpronóstico de sobrevida de estos pacientes. Además, se ha evidenciado un incremento de los niveles plasmáticos de productos de lipoperoxidación, lo que representa aumento del daño oxidativo en las membranas celulares. Los parámetros relacionados con el estrés oxidativo podrían ser, potencialmente, marcadores útiles, y los agentes antioxidantes podrían ser considerados como una nueva oportunidad terapéutica en el manejo médico de estos pacientes.

Septic Shock is an important cause of morbility and mortality in critically ill patients that might be explained, at least partly, by a dysregulation of immune/inflammatory response. The liberation of microbial components could lead to the development of animbalance between pro-oxidant agents as reactive oxygen species (ROS) and the antioxidants systems, with a prevalence of the first. ROS are known to exert tissue damage by direct attack to biomolecules as well as to act as proinflammatory mediators. Studies performed in critical patients that presented sepsis, have demonstrated a decrease in antioxidants defences in these patients. This effect is characterized by an alteration in the activity of the antioxidant enzymes, as well as a drop in plasma levels ofantioxidant vitamins associated with a decrease of antioxidant capacity of plasma, parameters that have also been related to the prognosis of these patients. In addition, increased plasma levels of lipid peroxidation products have been found, which represents anincrease of the tissue damage caused by oxidative stress, mainly in biological membranes. The oxidative stress related parameters could be potentially used as markers and antioxidant agents couldbe considered as new therapeutic opportunities in the medicalmanagement of these patients.

Características de niños y adolescentes atendidos en un consultorio psiquiátrico del sistema privado de salud en Chile / Characteristics of children and adolescents attended in a private psychiatric outpatient clinic in Chile

Background: There is a 7 percent up to 32 percent prevalence of psychiatric problems in the pediatric population. Aim: To study the epidemiological features of children and adolescents attended in a psychiatric outpatient clinic. Material and methods: All admissions to a psychiatric outpatient clinic, of people aged 18 years old or less, during 1998, were reviewed. The causes of consultation and the diagnoses were classified according to diagnostic manuals (ICPC-WONCA and DSM-IV respectively), by three experienced psychiatrists. Results: The files of 376 patients were reviewed (200 males, mean age of females 12 years old, mean age of males 10.5 years old). Seventy three percent consulted spontaneously. The main causes of consultation were anxiety disorders and adolescence problems (28 percent). The main diagnoses were attention deficit disorder and disruptive behavior, adaptative problems, mood and anxiety disorders. There were gender differences in the diagnoses. Women attended a mean of 6.3 sessions and men attended a mean of 4 sessions. Fifty nine percent abandoned treatment. Conclusions: There is a limited access to mental health care. The low compliance with treatments must be studied and improved

10 años de infecciones nosocomiales en el Hospital Santo Tomás / 10 years of nosocomial infections at the Santo Tomás Hospital

The incidence of nosocomial urinary tract infections (UTI) in the medical services of Santo Tomás Hospital from 1980 to 1985 was 56% in Neurology Section, 73% in cardiology and 74% in nephrology. These percentages declined, with epidemiological surveillance, to 21%, 31% and 53% respectively, for the period between 1986 and 1990. In the surgical services the incidence of nosocomial UTI was 85% in urology and 15% in general surgery, from 1980 to 1985. The incidence remained unchanged in urology (81%) and general surgery (17%) despite epidemiological surveillance, but decreased in neurosurgery (from 55% to 37%) for the period between 1986 and 1990. Between 1985 and 1990, Staphyloccocus aureus was the most frequently isolated bacterium from surgical wounds (34%) and from patients with intravenous catheters (23%). Pseudomonas aeruginosa was the most frequently isolated bacterium in nosocomial UTI (26%) and respiratory tract infections (45%) and in patients with nosocomial septicemia, it was a species of Klebsiella

Criterios de ingreso y egreso de una unidad de pacientes críticos / Admission and discharge criteria at an intensive care unit

Admission and discharge criteria for patients in an intensive care unt are controversial, especially in view of the fact that some patients derive no benefit from intensive care therapy while depriving others from a potential benefit. The general characteristics of patients in need of intensive care are discussed. Irreversibility of the underlyng condition, the quality of "terminal patient" and other factors that may contraindicate admission to an intensive care unit are analyzed. Discharge criteria for patients not expected to derive further benefit from a prolonged stay in unit are outlined

Formación de postgrado en psiquiatría, costo personal y fases críticas del proceso educativo para la atención psiquiátrica ambulatoria / Postgraduate training in psychiatry: personal cost and critical phases of the training process in ambulatory psychiatry

Participar en el proceso de formarse como psiquiatra competente se reconoce como complejo y con un alto costo personal. El candidato que toma el programa, vive experiencias emocionales y afectivas que pueden interferir con sus rendimientos y confundirlo hasta hacerlo dudar de sí, de su vocación y de la idoneidad de quienes lo forman. Estas vivencias las discutieron y analizaron 10 residentes en un taller ad hoc. En este informe los autores sistematizan sus experiencias y describen fases del proceso que, discriminados e integrados por los profesores que formulan programas, podrían mejorarlos, hacerlos menos costosos y obtener mejores productos