Impacto en el patrón de atención en cirugía de cabeza y cuello y las medidas sanitarias adoptadas durante los primeros 150 días de la era COVID-19 / Impact on the pattern of care in Head and Neck Surgery and the regional and institutional policy changes adopted during the first 150 days of the COVID-19 era

Resumen Introducción: La pandemia COVID-19 generó una reestructuración en la atención quirúrgica mundialmente debido a su alta transmisibilidad y la inherente limitación de los recursos humanos y materiales disponibles. Objetivo: Describir el impacto de la pandemia COVID-19 en el Equipo de Cirugía Cabeza y Cuello del Complejo Asistencial Barros Luco Trudeau (CABL) en su ejecución clínico-quirúrgica y la secuenciación organizada de las medidas sanitarias aplicadas a lo largo del tiempo durante los primeros 150 días de iniciada la pandemia en Chile. Materiales y Método: Realizamos una revisión retrospectiva de los pacientes sometidos a cirugía y/o evaluados ambulatoriamente durante el período COVID-19 comprendido entre el 3 de marzo y el 31 de julio de 2020, comparado con el mismo intervalo de tiempo de 2019. Características clínicas y medidas sanitarias empleadas durante este período fueron sintetizadas. Resultados: Detectamos un descenso del 64% en atención ambulatoria y un descenso del 58% en la carga quirúrgica, comparado con el año 2019. Durante el período COVID-19 de 2020, un total de 61 pacientes fueron sometidos a intervención quirúrgica. La principal indicación de cirugía fue cáncer en un 75,4% (46). No se reportaron pacientes contagiados por COVID-19 en los 14 días siguientes a la hospitalización. Se discuten las consideraciones perioperatorias empleadas y restricciones nacionales/institucionales sanitarias. Conclusión: La crisis sanitaria mundial secundaria al COVID-19 generó una reducción en las atenciones ambulatorias y cirugías realizadas por Equipo de Cabeza y Cuello CABL. A pesar de las restricciones sanitarias, organizamos estratificadamente la atención para preservar la resolución de casos críticos no diferibles en cabeza y cuello.

Introduction: The COVID-19 pandemic generated a restructuring of surgical care worldwide due to the disease's high transmissibility and the inherent limitation of available human and material resources. Aim: The study's aim was to describe the impact of the COVID-19 pandemic on the head and neck surgery team at Complejo Asistencial Barros Luco Trudeau (CABL) in clinical-surgical execution and organization of sanitary sequencing measures implemented over time during the first 150 days after the pandemic started in Chile. Materials and Method: We performed a retrospective review of patients undergoing surgery or outpatient evaluation during the COVID-19 period from 03-03-2020 to 07-31-2020, compared to the same time interval in 2019. Clinical characteristics and sanitary measures used during this period were synthesized. Results: We detected a 64% decrease in outpatient care and a 58% decrease in surgical load from 2019. During the COVID-19 period of 2020, a total of 61 patients underwent surgical intervention. The main indication for surgery was cancer, in 75.4% of patients (46). COVID-19 was not reported in any patients in the 14 days following hospitalization. We discussed the perioperative considerations used and the national/institutional sanitary restrictions. Conclusions: The global health crisis to COVID-19 generated a reduction in outpatient care and surgeries performed by the CABL head and neck team. Despite health restrictions, we organized care stratified to preserve critical head and neck non-deferrable cases.

Beta-haemolytic streptococci in farmed Nile tilapia, Oreochromis niloticus, from Sullana-Piura, Peru / Estreptococos beta-hemolítico en tilapias del Nilo ( Oreochromis niloticus ) cultivadas en Sullana, Piura - Perú

ABSTRACT Objective. This investigation aimed to study the presence of Streptococcus spp. in tilapia (Oreochromis niloticus) from fish farm located in ​​Sullana-Piura, Peru. Materials and methods. 150 fish with clinical signs of streptococcal disease were sampled, and the bacterium isolation was performed on blood agar, correlated to histopathological lesions description and molecular confirmation by real-time PCR. Results. The necropsy revealed exophthalmia, hyphema, congestion and/or haemorrhagic meninges, ascites, splenomegaly, hepatomegaly and diffuse haemorrhagic zones throughout the body. 102 isolated positives (54 tilapias) to Streptococcus spp. were identified in the microbiological analysis (prevalence of 26%), the brain was the organ with the highest percentage of this bacteria (34.31%), and 19 isolates were beta-haemolytic (18.63%) with prevalence of 10.12%. Fish beta-haemolytic streptococci presented epicarditis, perisplenitis and chronic meningitis, panophthalmitis, coagulative necrosis of skeletal muscle and granulomas formation. In the confirmatory test by real-time PCR, any positive tilapia to S. iniae was obtained. The results were analysed using a stochastic simulation of beta distribution using @Risk program uncertainty, reporting an average prevalence of 0.66% in sick tilapias. Conclusions. The analysed fishes were positive to bacteria of the genus Streptococcus, which confirms its presence in the fish farm. However, 19 isolates were beta-haemolytic, and the presence of S. iniae was not positive to the limit prevalence of 2.7% in real-time PCR.

RESUMEN Objetivo. Esta investigación objetivó estudiar la presencia de Streptococcus spp. en tilapia (Oreochromis niloticus) de la piscifactoría localizada en Sullana-Piura, Perú. Materiales y Método. . 150 peces con signos clínicos de la enfermedad estreptocócica fueron analizados, el aislamiento bacteriano se realizó en agar sangre, en correlación con las lesiones histopatológicas y diagnóstico molecular mediante PCR en tiempo real. Resultados. A la necropsia se observó exoftalmia, hifema, congestión y/o meninges hemorrágicas, ascitis, esplenomegalia, hepatomegalia y zonas hemorrágicas difusas en todo el cuerpo. 102 aislados positivos (54) tilapias para Streptococcus spp. fueron identificados en el análisis microbiológico (prevalencia del 26%), el cerebro fue el órgano con el más alto porcentaje del género de esta bacteria (34.31%), 19 aislados fueron beta-hemolítico (18.63%), con prevalencia de 10.12%. Peces con Streptococcus beta-hemolíticos presentaron epicarditis, perisplenitis y meningitis crónica, panoftalmitis, necrosis coagulativa del músculo esquelético y formación de granulomas. En el análisis de PCR en tiempo real, no se obtuvo ninguna tilapia positiva para S. iniae. Los resultados se analizaron mediante una simulación estocástica de la distribución beta usando el programa de incertidumbre @Risk, reportando una prevalencia media de 0.66% en tilapias enfermas. Conclusiones. Los peces analizados fueron positivos para bacterias del género Streptococcus, lo que confirma su presencia en la piscifactoría. Sin embargo, 19 aislados fueron beta-hemolíticos, y la presencia de S. iniae no fue positiva para la prevalencia límite de 2.7% en PCR en tiempo real.

Hígado graso no alcohólico / Non-alcoholic fatty liver disease

La esteatosis hepática no alcohólica es la acumulación excesiva de grasa en el hígado, en ausencia de causas secundarias y constituye la etiología frecuente de enfermedad hepática crónica sin terapia efectiva demostrada. La enfermedad incluye esteatosis, inflamación, fibrosis/cirrosis y hepatocarcinoma. El fenómeno inicial ocurre en la grasa corporal, con hipertrofia adipocitaria, liberación de adipoquinas y citoquinas pro-inflamatorias, que inducirán resistencia a la insulina. Este fenómeno provocará liberación de ácidos grasos a la circulación, captados por hepatocitos. En su evaluación clínica existen diferentes algoritmos con múltiples variables, limitando la biopsia hepática solo a casos excepcionales. Es esencial modificar el estilo de vida y bajar de peso. En diabéticos, metformina y pioglitazona son de primera elección. Los bloqueadores de la angiotensina son útiles en hipertensos con EHNA. Para prevenir la progresión de la enfermedad y en pacientes no diabéticos, asociar vitamina E. Las estatinas pueden utilizarse dada la asociación con patología cardiovascular.

Nonalcoholic fatty liver disease is characterized by excessive hepatic fat accumulation in the abscence of secundary causes. It is the most common cause of chronic liver disease. The spectrum ranges from benign steatosis, steatohepatitis, cirrhosis and hepatocarcinoma. The initial event is the hyperthofied adipocytes, and the release of adipokines and chemokines, that induce insulin resistance, and then free fatty acids into the circulation that accumulate in the liver. Algorithms have been proposed to target liver biopsy only to select patients. Lifestyle modifications to achieve weight loss are essential for all patients with NAFLD. For diabetics treatment should be with metformin and pioglitazone if glycaemic control is not achieved. Angiotensin receptor blockers are the antihypertensive agent of choice in patients with nonalcoholic steatohepatitis (NASH). If lifestyle changes and metabolic syndrome are unsuccessful in preventing disease progression, vitami E should be considered, also in non-diabetic patients with advance (NASH).

Estudio epidemiológico de la pediculosis en escuelas básicas del extremo norte de Chile / Epidemiological study of pediculosis in elementary schools of Arica, northern Chile

Introducción: La Pediculosis es una ectoparasitosis que ha recibido poca atención en el norte de Chile, a pesar de que es recurrente en la población infantil escolar. Nuestro objetivo fue determinar la prevalencia de Pediculus humanus capitis, en la población escolar básica de la Provincia de Arica. Pacientes y Método: Se estudió un grupo de 665 alumnos de enseñanza básica del sistema municipalizado, de la Provincia de Arica, durante agosto a noviembre de 2010. Se seleccionaron 467 niños que cumplían con los criterios de inclusión. Previo consentimiento informado de los alumnos y apoderados, el diagnóstico se llevó a cabo a través de la revisión a ojo descubierto de la cabeza de los escolares participantes, en dependencias de cada establecimiento, registrando la presencia de Pediculus humanus capitis, grado de infestación y estadio del ectoparásito. Resultados: De la población analizada, el 40,3 por ciento (188/467) presentó Pediculosis, afectando a las seis escuelas estudiadas. Las mujeres presentaron Pediculosis en un 55,2 por ciento (138/250) y los hombres un 23 por ciento (50/217). Conclusión: La población escolar de la Provincia de Arica está significativamente afectada por Pediculosis y su prevalencia es similar a otras regiones del país.

Pediculosis is an ectoparasitosis infestation that has not received much attention in northern Chile despite it is a common reoccurring condition among school-age children. The objective of this study is to determine the prevalence of Pediculus humanus capitis infestation in elementary schools of Arica. Patients and Method: A group of 665 elementary school students from the Province of Arica were screened between August and November 2010; 467 children who met the inclusion criteria were selected. After parents and students signed an informed consent, the diagnosis was carried out through examination of the head with naked eye in each participating school, recording the presence of Pediculus humanus capitis, infestation level and parasite stage. Results: 40.3 percent (188) of the children presented Pediculosis; the six schools studied were affected. Pediculosis infestation in girls reached 55.2 percent (138/250) and 23 percent (50/217) in boys. Conclusion: The school population of Arica is significantly affected by Pediculosis and its prevalence is similar to other regions.

Transforming growth factor-β (TGF-β) maintains follicular ultrastructure and stimulates preantral follicle growth in caprine ovarian tissue cultured in vitro / Fator de crescimento transformante-β (TGF-β) mantém a ultraestrutura folicular e estimula o crescimento de folículos pré-antrais caprinos inclusos em tecido ovariano cultivado in vitro

The objectives of this study were to investigate whether TGF-β affect the survival, activation and further growth of goat primordial follicles enclosed in ovarian cortex after in vitro culture. Goat ovaries were collected from an abattoir and pieces of ovarian tissues were cultured for one or seven days in a supplemented alpha Minimum Essential Medium, alone or containing TGF-β (1, 5, 10 or 50ng/mL). Ovarian tissues from the fresh control as well as those cultured were processed for histological and ultrastructural studies. The results showed that when compared with fresh control, there was decrease in the percentages of histologically normal follicles in all treatments only after seven days culture. TGF-β did not affect the activation of preantral follicles regardless of its concentration, however, larger follicles diameter (P<0.05) was observed using 10ng/mL TGF-β than in the fresh control and other treatments. Moreover, this concentration maintained the normal ultrastructure after seven days of culture. In conclusion, TGF-β showed additional effect on the follicle growth and the maintenance of ultrastructural integrity of goat preantral follicles enclosed in ovarian tissue when used at 10ng/mL during seven days of culture...

O objetivo desse estudo foi investigar se o TGF-β afeta a sobrevivência, ativação e crescimento de folículos primordiais caprinos inclusos no córtex ovariano após o cultivo in vitro. Ovários de cabras foram coletados em abatedouro e fragmentos de tecido ovariano foram cultivados por um e sete dias em meio essencial mínimo alfa (α-MEM+) sozinho ou suplementado com TGF-β (1, 5, 10 ou 50ng/mL). Fragmentos ovarianos não cultivados e cultivados foram processados para análise histológica e ultraestrutural. Os resultados mostraram que, comparado ao controle fresco, houve diminuição no percentual de folículos morfologicamente normais em todos os tratamentos somente após sete dias de cultivo. O TGF-β não afetou a ativação folicular independente da concentração testada, contudo, o diâmetro folicular foi superior (P<0.05) no tratamento com 10ng/mL de TGF-β quando comparado ao controle fresco e aos demais tratamentos. Além disso, essa mesma concentração manteve a ultraestrutura normal dos folículos após sete dias de cultivo. Em conclusão, o TGF-β apresentou efeito adicional no crescimento folicular e na manutenção da integridade ultraestrutural de folículos pré-antrais caprinos inclusos no tecido ovariano quando utilizado na concentração de 10ng/mL durante sete dias de cultivo...

Neumonía criptogénica organizada como diagnóstico diferencial de neumonía que no responde a tratamiento / Cryptogenic organizing non-resolving pneumonia.Report of one case

Non-resolving pneumonia is a common clinical problem that prolongs morbidity and increases hospitalization costs. We report an 82 year-old non-smoking female who was admitted with chronic diarrhea and later developed nosocomial pneumonia. Lung infiltrates did not resolve despite sequential antibiotic treatments. Infectious causes such as resistant nosocomial pathogens, respiratory viruses, tuberculosis, Legionellosis, cytomegalovirus or agents associated with HIV infection were discarded. Non-infectious causes such as thromboembolic lung disease, neoplasms and rheumatic disorders were also ruled out. An exudative pleural effusion was detected, but the study was unremarkable. Fiberoptic bronchoscopy and a transbronchial biopsy, revealed nonspecific findings. The patient persisted febrile, required non-invasive mechanical ventilation and displayed a migratory pattern of lung infiltrates that motivated a second biopsy, this time by open thoracotomy, showing a cryptogenic organizing pneumonia. The patient's conditions improved after treatment with adrenal steroids. In patients with non-resolving pneumonia, a dedicated and comprehensive study should be done using invasive procedures and considering both infectious and non-infectious causes. Cryptogenic organizing pneumonia is one of the alternatives that is potentially treatable, but often underdiagnosed.

Co-simulación del Diseño Biomecánico para un Exoesqueleto Robótico del Miembro Inferior / Co-simulation of Biomechanical Design for a Robotic Exoskeleton for the Lower Limb

Este trabajo muestra como la co-simulación incrementa las ventajas y decrementa las desventajas para el diseño del exoesqueleto. La metodología propuesta tiene tres estados: el diseño de la parte biomecánica, el diseño mecánico y el sistema de control Para el análisis biomecánico, OpenSim® resuelve el sistema musculo-esquelético e incluye modelos para diferentes condiciones que pueden ser usados en el diseño de procesos. SolidWorks® que es aplicado en diseños asistidos por computadora evalúa la parte mecánica y Matlab® resuelve el sistema de control del exoesqueleto. Esto permite conseguir un diseño personalizado, que simula los movimientos de una marcha completa cubriendo las restricciones cinemáticas para lograr un movimiento natural y las limitaciones del usuario cuando tienen algún problema para caminar. El resultado muestra como es aplicada la co-simulación para hacer un prototipo virtual, como se unen y dependen los programas uno del otro. Aunque la simulación convencional de cada programa puede ahorrar dinero y tiempo, estos no resuelven completamente los problemas de diseño del exoesqueleto; por lo tanto la co-simulación es una excelente opción para la biomecánica, la mecánica y los sistemas de control que necesitan exactitud y rapidez en cada parte del proceso de diseño.

This work shows how the co-simulation increases the advantages and decreases the drawbacks for exoskeleton design. The proposed methodology has three stages: the design of a biomechanical part, the mechanical design and the control system. For the biomechanical analysis, OpenSim ® solves the muscle-skeleton system and includes models for different conditions that can be used in the design process. SolidWorks® that is applied in assistive computer design evaluates the mechanical part of the exoskeleton and Matlab® solves the control system that takes over the exoskeleton. It allows getting a personalized design which simulates the complete walking movements, covering the kinematic restrictions to achieve a natural human movement and the user limitations when they have any problem for to walk. The results show how the co-simulation is applied to complete a virtual prototype and the programs are linked hand in hand. Although conventional simulation by one program can save money and time, it cannot solve the entire exoskeleton design problem; as a result the co-simulation is an excellent option in biomechanical, mechanical and control systems that need accurate and swift results in each part of the design process.

Manejo de la colitis ulcerosa grave: experiencia a partir de un hospital ministerial / Management of severe ulcerative colitis: experience from a national health service hospital

Introduction: Ulcerative colitis (UC) may present, or evolve as severe crisis. Although guidelines have defined its management and timing in decision-making, this has not been implemented at national level. Objective: To describe the clinical characteristics and management of patients with severe UC in our hospital. Patients and Methods: Retrospective review of medical records of 116 patients with inflammatory bowel disease during the period 1975-2012. Of 97 patients with UC, 21 patients with at least one severe crisis were identified. Results: The median age among patients with UC crisis was 34 years (17-43). Ten patients debuted with severe crisis. Eleven were in maintenance treatment, all with 5-aminosalicylates (5- ASA), eight with systemic steroids and five with immunomodulators. During the crisis, colonoscopy was performed to 13 patients, 11 with extensive involvement and two left colitis. All patients received steroids and 5-ASA, 14 antibiotics, and seven immunomodulators. No patient received medical rescue therapy (cyclosporine/biological therapy). Nine patients required surgery, two due to toxic megacolon and seven due to intravenous-steroid refractory episode. Five patients received parenteral nutrition and six were hospitalized in the critical patients unit. The range of stay in the hospital was 9-51 days. Conclusions: In this study, a significant percentage of patients with CU presented a severe crisis without having a standardized management. It is necessary to establish a consensus for the multidisciplinary management of severe UC. No patient had access to cyclosporine/biological therapy, more than 40 percent of the cases required surgery. These therapeutic strategies should be incorporated into the therapeutic arsenal in hospitals.

La colitis ulcerosa (CU) puede debutar, o evolucionar, como crisis grave. Aunque guías han definido su manejo y temporalidad en la toma de decisiones,esto no ha sido masificado a nivel nacional. Objetivo: Describir las características clínicas y manejo de pacientes con CU grave en nuestro centro. Pacientes y Métodos: Revisión retrospectiva de fichas clínicas de 116 pacientes con enfermedad inflamatoria intestinal, durante el período 1975-2012. De 97 pacientes con CU se identifican 21 pacientes con al menos una crisis grave. Resultados: La mediana de edad en la crisis fue 34 años (17-43). Diez pacientes debutaron con crisis grave. Once estaban en tratamiento de mantención, todos con 5-aminosalicilatos (5-ASA), ocho con esteroides sistémicos y cinco con inmunomoduladores. Durante la crisis, se realizó colonoscopia a 13 pacientes, 11 con compromiso extenso y dos con colitis izquierda. Todos recibieron esteroides y 5-ASA, 14 antibióticos y siete inmunomoduladores. Ningún paciente recibió terapia médica de rescate (ciclosporina/terapia biológica). Nueve pacientes requirieron cirugía, dos por megacolon tóxico y siete por cortico-refractariedad. Cinco pacientes recibieron nutrición parenteral y seis fueron hospitalizados en una Unidad de Pacientes Críticos. El rango de estadía hospitalaria fue de 9-51 días. Conclusiones: En este estudio un porcentaje importante de los pacientes con CU presentó una crisis grave, sin tener un manejo estandarizado. Es necesario establecer un consenso para el manejo multidisciplinario de la CU grave. Ningún paciente tuvo acceso a ciclosporina/ terapia biológica, requiriendo cirugía más de 40 por ciento de los casos. Estas estrategias terapéuticas deben ser incorporadas al arsenal terapéutico hospitalario.

Diverticulitis vesical: reporte de un caso y revisión de la literatura / Bladder diverticulitis: case report and literature review

Se presenta un caso de diverticulitis vesical en un paciente de 60 años con antecedente de obstrucción crónica al tracto de salida vesical (estenosis uretral), quien consulta por dolor pelviano inespecífico. Por lo anterior se realiza Resonancia Magnética (RM) de pelvis, que demuestra la presencia de un divertículo vesical de pared engrosada con cambios inflamatorios, los que comprometen además, la grasa peri-vesical. Este divertículo había sido detectado en RM pelviana un año antes. Se comenta el caso clínico, sus hallazgos a la RM y revisión de la literatura...

We report a case of bladder diverticulitis in a 60 years old patient with a history of chronic lower urinary tract obstruction (urethral stricture), who consulted for nonspecific pelvic pain. Pelvic magnetic resonance imaging (MRI) was obtained, demonstrating the presence of a bladder diverticulum with a thick wall and inflammatory changes involving the perivesical fat. The diverticulum had been detected on pelvic MRI a year earlier. We discuss the clinical case, the MRI findings and a review of the literature....

Salmonelosis neonatal: reporte de un caso y revisión de la literatura / Neonatal Salmonella infections: a case report and literature review

En Chile aún existe la salmonelosis como causal de enfermedad entérica, prevaleciendo el serotipo Enteritidis. En sepsis neonatal el germen más frecuente es Streptococcus grupo B (SGB); los bacilos Gram negativos entéricos ocupan el segundo lugar. La Salmonella spp. es infrecuente. Las vías de transmisión pueden ser hematógena, canal del parto, ascendente u horizontal. CASO CLÍNICO: Mujer sana, 31 años, embarazo de 39 semanas. Cultivo de SGB negativo. Presenta cuadro diarreico el día previo al parto, el cual fue vaginal, dilatación de cuatro horas, expulsivo de 15 minutos, líquido amniótico claro, destaca temperatura (T°) intraparto de 38,3°C. Recién nacido (RN)sexo masculino, adecuado para la edad gestacional, Apgar 9/9,con T° rectal 38,1°C al nacer. Al segundo día de vida presenta deposiciones líquidas verdosas con estrías de sangre, descenso de peso de 10,6 por ciento (367,82 gr) y T° rectal 37,7°C. Ingresa a neonatología, destacando Proteína C Reactiva elevada de 2,7 mg/dL. Por persistir cuadro se solicitan cultivos previo a antibioterapia con Ampicilina y Gentamicina. Test APT-Downey positivo, cultivo orina y líquido cerebroespinal negativos, hemocultivo y coprocultivo positivo a Salmonella tipo D subtipo Panamá. Evoluciona favorablemente, es dado de alta al noveno día con diagnóstico de sepsis por Salmonella tipo D connatal. Coprocultivo de madre positivo para Salmonella. DISCUSIÓN: La prevalencia de infecciones por Salmonella se ha incrementado en neonatos. Es importante realizar prevención durante el embarazo además de un diagnóstico y tratamiento precoz. Se debe considerar este agente según factores de riesgo y como diagnóstico diferencial de hemorragia digestiva baja en el RN...

Salmonella infections are still a cause of entericdisease in Chile, with a predominance of the Enteritidis serotype. In neonatal sepsis the most frequent etiology is Group B Streptococcal (GBS) infection; enteric Gram-negative bacilli occupy second place. Salmonella spp. is infrequent. The transmission routes can be hematogenous, by birth canal, vertical, or horizontal. CASE REPORT: Healthy 31 year old female, 39 week pregnancy. Negative GBS culture. Presents with diarrhea the day before labor, with vaginal delivery, four hour dilation period,15 minute expulsion period, clear amniotic fluid, intra delivery temperature (T°) of 38.3°C. Male, adequate for gestational age newborn, Apgar 9/9, with rectal T° of 38.1°C at birth. During second day of life, presents green liquid stools with blood streaks, weight loss of 10.6 percent (367.82 gr), and rectal T° of 37.7°C. Patient is admitted to neonatology service, where he presents elevated C-Reactive Protein of 2.7 mg/dL. Cultures were taken due to persistent findings, before antibiotic therapy with Ampicillinand Gentamicin. Positive APT-Downey test, negative urine and cerebrospinal fluid cultures, positive blood and stool cultures for type D, subtype Panama Salmonella. Favorable evolution, discharged on day nine with diagnosis of sepsis due to connatal type D Salmonella. Mother’s stool culture is positive for same bacteria. DISCUSSION: The prevalence of Salmonella infections has increased in neonates. Prevention during pregnancy, along with early diagnosis and treatment, are important. This agent should be considered according to risk factors, and as a differential diagnosis of lower gastrointestinal bleeding in newborns...

Confiabilidad y validez de la escala de impulsividad de Barratt (BIS-11) en adolescentes / Reliability and validity of Barratt impulsiveness scale (BIS-11) in adolescents

Introducción: La Escala de Impulsividad de Barratt (BIS) es uno de los instrumentos más frecuentemente usados para evaluar la impulsividad. Este artículo describe la confiabilidad y validez de la BIS-11 en adolescentes chilenos. Sujetos y Métodos: El estudio se efectuó en estudiantes de enseñanza media (n = 763). La confiabilidad se evaluó con análisis de consistencia interna y homogeneidad de los ítems. Para la validez se empleó coeficiente de correlación de Pearson y prueba t de student para muestras independientes. Resultados: La escala obtuvo un coeficiente alfa de Cronbach de 0,77 y su puntaje total correlacionó significativamente con impulsividad según DSM IV, impulsividad según reporte del profesor, intento de suicidio y consumo de alcohol. Conclusiones: La BIS-11 es una medida de impulsividad con adecuada confiabilidad y validez en esta población.

Background: The Barratt Impulsivity Scale (BIS) is one of the most commonly used scales for the assessment of impulsiveness. This report describes the reliability and validity of the BIS-11. Subjects and Methods: The study was conducted in high school students (n = 763). The reliability was evaluated with analysis of internal consistency and homogeneity of the items. For the validity Pearson coefficient of correlation and the student t-test for independent sample were used. Results: The scale obtained a Cronbach alpha coefficient of 0,77, and the total scores of the scale correlated significantly with impulsivity according to DSMIV, impulsivity according to the teacher, suicide attempt and alcohol consumption. Conclusions: The BIS-11 is a valid and reliable measure of impulsivity in this population.

Soledad, impulsividad, consumo de alcohol y su relación con suicidalidad en adolescentes / Association of loneliness, impulsivity and alcohol use with suicidal behavior in adolescents

Background: Suicide and suicide attempts are public health problems. Their prevention requives the detection ofpredictorfactors. Aim: To determine the predictive valué of loneliness, impulsivity and alcohol use on suicidal behavior in adolescents. Subjects and Methods: Suicidal behavior, Loneliness (UCLA), Impulsivity (Barratt) scales and the Alcohol Use Disorders Identification Test (AUDIT), were applied to 763 high school students aged 14 to 19years (49% males), livingin Chillan, Chile. Results: Nineteen percent of participants had attempted suicide and 34.3% had suicidal ideation. Loneliness, impulsivity and alcohol use were directly related to suicidal behavior. These predictors explained 31 % ofthe suicidal behavior. The most important risk factor was loneliness, followed by femóle gender, impulsivity and alcohol use. Conclusions: Loneliness, impulsivity and alcohol use are risk factors for suicide among adolescents. Women are at higher risk than men.

Performance and egg quality of laying hens fed with dietary levels of digestible lysine and threonine / Desempenho e qualidade de ovos de poedeiras alimentadas com dietas contendo níveis de lisina e treonina digestíveis

The present study was developed using 864 Hy-Line W36 laying hens (42 to 58 weeks of age) with a randomized experimental design in a 4x3 factorial arrangement, with five replicates and 12 birds per experimental unit and 4 evaluation periods of 28 days each. The digestible lysine levels studied were 0.675%, 0.743%, 0.811% and 0.879%, and the digestible threonine levels were 0.542%, 0.596% and 0.650%. The performance and egg quality was evaluated. There were no significant effects on the egg production, specific gravity, albumen and yolk percentage and total solids in albumen and yolk for birds submitted to the different dietary digestible lysine and threonine levels. There was significant interaction between these amino acids on the egg shell percentage and Haugh unit in fresh eggs. There was a decreasing linear effect on the feed intake with increase of digestible lysine level. Egg weight, egg mass and feed conversion demonstrated a quadratic effect with the increase of the digestible lysine level with the best results in the diets with 0.754, 0.772 and 0.795% of digestible lysine, respectively.

O presente trabalho foi desenvolvido utilizando 864 poedeiras Hy-Line W36 (42 a 58 semanas de idade) em um delineamento inteiramente casualizado no esquema fatorial 4x3 com 5 repetições e 12 aves por parcela e 4 períodos de avaliação de 28 dias cada. Os níveis de lisina digestível estudados foram 0,675%; 0,743%; 0,811% e 0,879%, e os de treonina digestível de 0,542%, 596% e 0,650%. Foram avaliados o desempenho e a qualidade dos ovos. Não houve efeitos significativos sobre a produção de ovos, gravidade específica, proporção de clara ou albúmen e seus respectivos teores de sólidos totais para poedeiras submetidas aos respectivos níveis de lisina e treonina na ração. Houve interação entre os níveis de treonina e lisina, para porcentagem de casca e unidade Haugh. Houve redução linear no consumo de ração em função do aumento dos níveis de lisina digestível na ração. Houve comportamento quadrático para peso dos ovos, massa dos ovos e conversão alimentar em função dos níveis de lisina digestível, estimando-se níveis ótimos para respectivas características em 0,754; 0,772 e 0,795%, respectivamente.

Neurocisticercosis: una enfermedad desatendida en Chile / Neurocysticercosis: an neglected disease in Chile

Neurocysticercosis (NCC) is not a notifiable disease in Chile and has received little attention on the national medical literature. In order to evaluate the relevance and clinical features of the disease, we performed a retrospective analysis in a general hospital of five cases of NCC during a 11 years period. Age ranged from 3 to 63 years and all had history of living or visiting southern Chile. Three patients had a solitary parenchymal cyst in vesicular or granulomatous stages and presented with generalized seizures. Their outcome was favorable after anticonvulsant and albendazole therapy and cysts reduced in size and calcified during follow-up. The other 2 patients had extra-parenchymal or mixed forms, including a pregnant woman with intraventricular cysts who developed endocraneal hypertension and recurrent dysfunction of her ventriculoperitoneal shunt. This patient died after discharge despite an initial favorable evolution with steroids and high-dose albendazole. This case series showed that NCC is still an epidemiological and clinical problem in Chile, affects patients within a wide range of age including children, requires multidisciplinary therapeutic interventions, and has two clinical presentations with different prognosis including one malignant form. To control this infection, a surveillance or reporting system should be initiated.

La neurocisticercosis (NCC) no es una enfermedad de notificación obligatoria en Chile y ha recibido poca atención en la literatura médica local. Para evaluar su importancia y perfil clínico se hizo un análisis retrospectivo en un hospital general. Cinco casos de NCC fueron identificados en un período de 11 años. El rango de edad fue de 3 a 63 años y todos tenían antecedentes de visita o residencia en el sur del país. Tres pacientes tenían quistes únicos parenquimatosos en etapas granulomatosas o vesiculares y se presentaron con convulsiones generalizadas. Su evolución fue favorable con terapia anticonvulsivante y albendazol y los quistes se redujeron de tamaño y calcificaron durante el seguimiento. Los otros pacientes presentaron formas extra-parenquimatosas o mixtas e incluían a una mujer embarazada con quistes intraven-triculares quien desarrolló hipertensión endocraneana y disfunción recurrente de su válvula. Ella falleció después del alta a pesar de una evolución inicial favorable con corticoesteroides y albendazol. La NCC es un problema vigente en nuestro país pero de epidemiología desconocida, afecta a un amplio grupo etario, requiere múltiples intervenciones terapéuticas y presenta dos formas de diferente pronóstico, una de ellas maligna. Para controlarla es necesario incluirla en las enfermedades notificables.

The potential of secondary metabolites from plants as drugs or leads against protozoan neglected diseases - part I

Infections with protozoan parasites are a major cause of disease and mortality in many tropical countries of the world. Diseases caused by species of the genera Trypanosoma (Human African Trypanosomiasis and Chagas Disease) and Leishmania (various forms of Leishmaniasis) are among the seventeen "Neglected Tropical Diseases" (NTDs) defined as such by WHO due to the neglect of financial investment into research and development of new drugs by a large part of pharmaceutical industry and neglect of public awareness in high income countries. Another major tropical protozoan disease is malaria (caused by various Plasmodium species), which -although not mentioned currently by the WHO as a neglected disease- still represents a major problem, especially to people living under poor circumstances in tropical countries. Malaria causes by far the highest number of deaths of all protozoan infections and is often (as in this review) included in the NTDs. The mentioned diseases threaten many millions of lives world-wide and they are mostly associated with poor socioeconomic and hygienic environment. Existing therapies suffer from various shortcomings, namely, a high degree of toxicity and unwanted effects, lack of availability and/or problematic application under the life conditions of affected populations. Development of new, safe and affordable drugs is therefore an urgent need. Nature has provided an innumerable number of drugs for the treatment of many serious diseases. Among the natural sources for new bioactive chemicals, plants are still predominant. Their secondary metabolism yields an immeasurable wealth of chemical structures which has been and will continue to be a source of new drugs, directly in their native form and after optimization by synthetic medicinal chemistry. The current review, published in two parts, attempts to give an overview on the potential of such plant-derived natural products as antiprotozoal leads and/or drugs in the fight against NTDs.

¿Debemos seguir haciendo salpingoooforectomía como profilaxis de cáncer de ovario? / Should we continue prophylactic salpingo-oophorectomy for ovarian cancer?

Hasta hace algunos años en las mujeres sometidas a histerectomía por patología benigna, que tuvieran 45 o más años, se efectuaba de regla una salpingoooforectomía (SOB) bilateral, como prevención de cáncer de ovario. Esto está actualmente en discusión. Hay dos grandes estudios de cohortes poblacionales y un estudio prospectivo observacional que analizan los efectos adversos cardiovasculares y el cáncer de ovario en mujeres sometidas a SOB. Basados en estos análisis y otros datos de la literatura, se pueden plantear algunas conclusiones. En mujeres premenopáusicas y hasta los 50 años la conducta óptima es preservar los ovarios, entre 51 y 65 años no está claro que lo mejor sea extirparlos y en mayores de 65 aún no se ha probado efectos deletéreos a raíz de la intervención.

The age to perform prophylactic oophorectomy at the time of hysterectomy for benign conditions is being actually discussed. Two population based cohorts studies and one prospective observational study evaluate cardiovascular disease and ovarian cancer with a history of oophorectomy. Some conclusions can be drawn. Until 50 years or premenopausal women, ovarian conservation should be the norm, between 51 and 65 there are no clear indications for removal and in older than 65 no negative effects have been described.

Eficácia e toxicidade do pó comercial de Hoodia gordonii (Masson) swet ex decne utilizado no tratamento da obesidade / Efficacy and toxicity of Hoodia gordonii commercial powder used to combat obesity

A obesidade é atualmente o principal problema de saúde em países desenvolvidos e em desenvolvimento. Diversos recursos terapêuticos têm sido empregados para o tratamento da obesidade destacando-se os fitoterápicos, consagrados pelo conhecimento popular. Nesse contexto, a planta Hoodia gordonii tem despertado atualmente grande interesse mundial, principalmente pelas recentes descobertas e comprovações científicas da inibição do apetite e da sede pelo glicosídeo ativo P57 isolado de espécies da planta. Apesar disso, tais efeitos ainda não foram avaliados e comprovados em amostras comerciais do pó de H. gordonii (PHG), não existindo evidências científicas que garantam a sua eficácia e segurança. Portanto, o objetivo deste trabalho foi realizar ensaios biológicos com ratos para avaliar a atividade farmacológica e a toxicidade de amostras comerciais do pó de H. gordonii. As amostras foram administradas por gavagem em doses equivalentes a 20 vezes as recomendadas para humanos em ratas Wistar durante 4 semanas sendo avaliados os parâmetros indicadores do efeito terapêutico. Após as 4 semanas, os animais foram sacrificados, e amostras de sangue e órgãos foram coletados e submetidos à avaliação dos indicadores metabólicos, endócrinos, hematológicos e histopatológicos. Os resultados demonstraram que para todos os parâmetros avaliados não houve diferenças significativas entre o grupo controle que recebeu somente solução salina estéril e os grupos tratados com PHG indicando que os mesmos, apesar de não apresentarem quaisquer indícios de toxicidade, são incapazes de produzir os supostos efeitos de inibição de apetite e consequente tratamento da obesidade.

Obesity is currently the main health problem in developed and developing countries. Several therapeutic methods have been employed for the treatment of obesity, especially herbal medicines, highlighted by popular knowledge. In this context, the plant Hoodia gordonii has currently aroused great interest worldwide, especially for recent discoveries and scientific proof of inhibition of appetite and thirst by the active glycoside P57 isolated from plant species. Nevertheless, such effects have not been evaluated and proven for commercial samples of H. gordonii powder (PHG), with no scientific evidence to ensure its effectiveness and safety. Therefore, the aim of this study was to conduct biological tests with rats to evaluate the pharmacological activity and toxicity of commercial samples of H. gordonii powder. The samples were administered through gavage, at doses equivalent to 20 times those recommended for humans, in female Wistar rats during 4 weeks for evaluation of the parameters indicative of therapeutic efficacy. After 4 weeks, the animals were sacrificed and blood and organ samples were collected and subjected to the evaluation of metabolic, endocrine, hematological and histopathological indicators. Results showed that for all evaluated parameters, there were no significant differences between the control group that only received sterile saline solution and the groups treated with PHG, indicating that the latter, although presenting no evidence of toxicity, are unable to produce the alleged effects of appetite inhibition and subsequent obesity treatment.

Hematoma retroperitoneal de causa infrecuente: a propósito de un caso / Retroperitoneal hematoma of unusual cause: a case report

The spontaneous retroperitoneal hematoma (SRH) is defined as a spontaneous hematic collection located in any of the retroperitoneal compartments. The most frequently encountered cause of retroperitoneal hemorrhage is a ruptured abdominal aortic aneurysm, followed by renal and adrenal tumors, along with some other less common causes. Performing accurate diagnosis of patients at admission has proven to be difficult, given that the clinical presentation is ample and variable and may mimic other pictures of abdominal or lower back pain. Imaging techniques, mainly angiography, computed tomography, and MR Imaging, represent a fundamental tool for both timely diagnosis and proper management of the condition. We report the case of a 56-year-old male patient with diagnosis of HIV, who presented with a history of abdominal pain and palpable abdominal mass. After a thorough imaging evaluation, patient was diagnosed with retroperitoneal hematoma, whose histological analysis revealed a Burkitt lymphoma.

El hematoma retroperitoneal espontáneo (HRE) se define como una colección hemática espontánea, situada en cualquiera de los compartimentos retroperitoneales. Dentro de las causas más frecuentes se encuentran las roturas de aneurisma de aorta abdominal, tumores renales y suprarrenales, entre otras. Habitualmente es difícil realizar el diagnóstico al ingreso del paciente, ya que la presentación clínica es variable y puede simular otros cuadros de dolor abdominal o lumbar. Las técnicas de imagen, especialmente la angiografía, tomografía computada y resonancia magnética, son una herramienta fundamental en el diagnóstico y manejo oportuno del cuadro. Presentamos el caso de un varón de 56 años de edad con diagnóstico de VIH en tratamiento, que debutó como un cuadro de dolor y masa abdominal palpable. Luego de un acabado estudio de imágenes, se diagnosticó un HRE cuyo estudio histológico reveló un Linfoma de Burkitt.

¿Qué espera el clínico del informe radiológico? / What does the clinician expect from the radiological report?

Introduction: The written radiology report is the most relevant component of any radiological examination. Few studies about referring clinicians opinion concerning structure and contents of radiology reports have been conducted. Objective: To investigate which radiology report issues are significant to the clinician. Methodology: One hundred and sixty-four physicians, among surgeons, internists, residents, and general practitioners were surveyed. Results: According to surveyed clinicians the most important element in any radiologic examination is the reporting radiologist (67.7 percent); 93.9 percent of them expect the radiology report to address the referral diagnosis; 95.7 percent expects the report to present a conclusion, whilst 73 percent of referring clinicians consider ultrasonography as the imaging procedure that commonly exhibits more errors. Surgeons, generally understimate radiologists recommendations for complementary studies. Conclusion: An experienced reporting radiologist is considered the most significant element of any imaging procedure. The radiology report should be problem-oriented (answering clinical question), and contain a conclusion, which should begin by answering the clinician s concerns. General practitioners, internists and residents value further studies reccommended by radiologists.

Introducción. El informe es lo más relevante de un examen radiológico. Escasas publicaciones han estudiado la opinión del clínico. Objetivo. Establecer qué aspectos del informe son relevantes para el clínico. Metodología. Se aplicó una encuesta a cirujanos, internistas, residentes y médicos generales. Resultados. Se encuestó a 164 médicos. Al pedir un examen radiológico, lo más relevante (67,7 por ciento) fue el radiólogo informante; 93,9 por ciento considera importante que se haga referencia al diagnóstico de derivación; 95,7 por ciento estima que debe haber conclusión. El 73 por ciento cree que el examen en el que se cometen más errores es la ecotomografía. Los cirujanos son los que menos valoran las recomendaciones de estudios posteriores. Conclusión. El radiólogo que informa es considerado lo más importante en un examen. El informe debe hacer referencia al diagnóstico, tener conclusión, la que debe comenzar respondiendo la inquietud del clínico. Los médicos generales, internistas y residentes valoran que se sugieran estudios complementarios.

Impacto de la inmunoprofilaxis en una población de lactantes prematuros con y sin displasia broncopulmonar / Impact of immunoprophylaxis in a population of preterm infants with and without bronchopulmonary dysplasia

Con el fin de objetivar el impacto de la infección por Virus Sincicial Respiratorio (VSR) se analizó una cohorte de prematuros (PT) atendidos en nuestro consultorio de seguimiento de alto riesgo (CSAR) entre los años 1998 y 2004. A par tir del año 2006 el Hospital incorpora el anticuerpo monoclonal Palivizumab (PVZ) para la profilaxis de VSR en esta población vulnerable. Objetivo: analizar el impacto de la profilaxis con PVZ en la población de lactantes PT con y sin displasia broncopulmonar (DBP). Población: PT atendidos en el CSAR del Hospital Garrahan entre los años 1998- 2004 y 2006-2010. Diseño y Método: estudio longitudinal y observacional mediante comparación de riesgo de hospitalización por VSR entre la cohor te retrospectiva que no recibió PVZ (SP) vs una cohor te prospectiva que recibió profilaxis (CP) Resultados: SP: 154 pacientes, CP: 99 pacientes. La tasa de internación en el grupo SP fue 26% (21% en el grupo sin DBP y 28% para el grupo con DBP); la tasa de internación en el grupo CP disminuyó a 6% (5% y 6,3% para los PT sin y con DBP). Estas diferencias resultaron significativas (RR 0,22 IC95% 0,10 a 0,51); el NNT (número necesario a tratar) fue de 5. Conclusiones: la incorporación de inmunoprofilaxis en este grupo de riesgo produjo un impor tante descenso de la tasa de internación. El impacto en nuestra población fue mayor que el repor tado, incluso en la población de pacientes mas graves como los lactantes con DBP...