Seropositividad a Chlamydophila psittaci en cotorras argentinas (Myiopsitta monachus) invasoras de la ciudad de Santiago de Chile

Introducción: Chlamydophila psittaci es una bacteria zoonótica e intracelular estricta, que provoca la psitacosis humana y su principal hospedero son las aves psitácidas. La cotorra argentina es un ave psitácida nativa de Sudamérica y actualmente considerada una especie invasora en 19 países, incluyendo Chile. Objetivo: Determinar positividad contra C. psittaci en muestras de suero y torulados de cotorras argentinas de vida libre capturadas en la Región Metropolitana de Chile. Métodos: Se analizaron 95 muestras de suero de pichones e individuos adultos de cotorras argentinas, a través de una prueba de ELISA indirecto utilizando un kit comercial. Posteriormente, se analizaron 40 tórulas nasotraqueales y cloacales de individuos adultos a través de una RPC en tiempo real específica para C. psittaci. Resultados: Se detectaron anticuerpos en muestras de suero de cinco individuos adultos de cotorras argentinas (n = 68), mientras que ninguno de los pichones analizados fue seropositivo (n = 27). Todas las muestras analizadas a través de RPC en tiempo real fueron negativas. Conclusión: Estos resultados demuestran por primera vez en Chile la exposición a C. psittaci en cotorras argentinas de vida libre, lo cual puede representar un riesgo importante para la transmisión de este patógeno a poblaciones humanas y animales.

Background: Chlamydophila psittaci is a zoonotic obligate intracellular bacterium that causes the human psittacosis, and its main host are psittacine birds. The monk parakeet is a psittacine bird native to South America, currently being considered an invasive species in 19 countries, including Chile. Aim: To determine positivity to C. psittaci in serum samples and swabs from free-ranging monk parakeets captured in the Metropolitan Region of Chile. Methods: Ninety-five serum samples from nestling chicks and adult monk parakeets were tested using an indirect ELISA test kit. Cloacal and nasotracheal swabs from 40 adult parakeets were further analyzed by C. psittaci-specific real-time PCR. Results: We found antibody titers in sera of five adult monk parakeets (n = 68) while none of the nestlings were seropositive (n = 27). All samples tested with real-time PCR were negative. Conclusions: Our results demónstrate for the first time in Chile the exposure to C. psittaci in free-ranging monk parakeets which may represent a significant risk of pathogen transmission to human and animal populations.

Caracterización fenotípica y molecular de cepas de Klebsiella pneumoniae productores de carbapenemasas tipo OXA-48 circulantes en Chile

Introducción: La aparición y diseminación de Enterobacterales resistentes a carbapenémicos ha generado un gran impacto en las infecciones asociadas a la atención de salud en el mundo. Recientemente, en Chile se detectó un brote por Klebsiella pneumoniae productora de carbapenemasas tipo oxacilinasas (OXA) de la subfamilia tipo OXA-48, reportándose los primeros casos en pacientes hospitalizados mayoritariamente en la zona norte del país. Objetivo: Determinar los perfiles fenotípicos, genotípicos y de susceptibilidad antimicrobiana de 16 cepas referidas durante mayo del año 2021 desde las regiones de Antofagasta y Metropolitana al Laboratorio de Referencia del Instituto de Salud Pública. Metodología: Las cepas provenientes de muestras clínicas fueron analizadas mediante técnicas tradicionales (Kirby-Bauer y epsilometría) y automatizadas, además de técnicas colorimétricas, inmunocromatográficas y moleculares (RPC y PFGE). Resultados: Se detectó la presencia de los genes blaoxa-48 y blaoxa-232 con una resistencia inusual, tanto a carbapenémicos (ertapenem, imipenem y meropenem) como a cefalosporinas (cefepime, cefotaxima y ceftazidima), además de piperacilina/tazobactam y temocilina. Se detectaron dos subtipos por PFGE, siendo predominante el clon CL-Kpn-Spe-329 (93,8%) con dos mecanismos de resistencia identificados: carbapenemasa y β-lactamasa de espectro extendido (BLEE). Conclusión: Ante esta alerta epidemiológica es necesario unificar criterios existentes en la red asistencial nacional para la oportuna detección, vigilancia y control de posibles brotes de cepas productores de oxacilinasa tipo OXA-48.

Background: The appearance and spread of carbapenems-resistant Enterobacterales have generated a major impact on health care-associated infections worldwide. Recently, a Klebsiella pneumoniae outbreak expressing OXA-48 like-carbapenemases was detected in Chile, the first reported cases corresponded to hospitalized patients mainly from northern Chile. Aim: To characterize the phenotypic and genotypic profiles of antimicrobial susceptibility of 16 clinical isolates referred during May 2021 from Antofagasta and Metropolitan regions to the Reference Laboratory of Instituto de Salud Publica. Methods: Antimicrobial susceptibility of all strains was analyzed using traditional (Kirby-Bauer and epsilometry) and automated methods, and complemented with colorimetric, immunochromatographic and molecular (PCR and PFGE) techniques. Results: As a result of the genetic characterization, blaoxa-48 and blaoxa-232 genes were detected, showing the isolates an unusual resistance profile to both carbapenems (ertapenem, imipenem, and meropenem) and cephalosporins (cefepime, cefotaxime, and ceftazidine), as well as piperacillin/ tazobactam and temocillin. Two subtypes were detected by PFGE, with a predominant clone CL-Kpn-Spe-329 (93.8%), with two resistance mechanisms identified: carbapenemase and extended-spectrum β-lactamase (ESBL). Conclusion: Due to this epidemiological alert, it is essential the establishment of national guidelines for early detection, surveillance, and control of future outbreaks of OXA-48 like carbapenemases isolates.

Análisis de la percepción de las madres frente a la estrategia comunicacional intramural para combatir la anemia en Perú. Estúdio de caso sobre la suplementación de micronutrientes a partir de un centro de salud en Lima / The analysis of the perception of mothers against the intramural communication as a strategy to combat anemia in Peru. A case study on micronutrient supplementation from a health center in Lima

RESUMEN Objetivo: Determinar sí la implementación de las estrategias comunicacionales influencian de manera efectiva para el posicionamiento de la suplementación en micronutrientes enmarcado en la normatividad peruana del tratamiento de anemia. Materiales y métodos: Se seleccionó una muestra de 27 madres, entre 20 a 30 años. Enfoque cualitativo. Entrevistas a profundidad, divididas en dos ejes de estudio: Posicionamiento (Recordación, Comportamiento, Actitud, Afecto y Atributo) y Estrategias (Sesiones Demostrativas, Sesiones Educativas, Persuasión y Atención del personal). Resultados: Las acciones comunicacionales generaron que las madres se informen sobre los micronutrientes, conozcan sus beneficios y efectos colaterales como la diarrea y estreñimiento. Respecto a la variable 'posicionamiento', sí existe recordación sobre el uso de los micronutrientes; y en el análisis de la variable 'estrategia' se generó conocimiento sobre la preparación de platos ricos en hierro, y mediante el uso de juegos educativos se persuadió la atención de los usuarios. Conclusión: Se evidenció la efectividad de la implementación de las estrategias comunicacionales. Los usuarios recibieron los mensajes durante su participación en las sesiones demostrativas que influenciaron en el empoderamiento de las madres con respecto a los cuidados que se debe tener para prevenir y combatir la anemia. Siendo evaluados mediante la percepción de las usuarias en cada uno de los criterios de posicionamiento.

ABSTRACT Objective: To determine if the implementation of communication strategies can influence effectively the positioning of micronutrient supplementation framed in the Peruvian regulations for the treatment of anemia. Resources and methods: We selected a group of 27 mothers, between 20 and 30 years. Qualitative approach. Interviews divided into two areas of study: Positioning (Reminder, Behavior, Attitude, Affection and Attribute) and Strategies (Demonstration Sessions, Educational Sessions, Persuasion and Staff Attention). Results: The actions of communication generated that the mothers are informed about the micronutrients, know their benefits and side effects such as diarrhea and constipation. Regarding the variable 'positioning' there is a recall about the use of micronutrients; and with the analysis of the 'strategy' variable, knowledge was generated about the preparation of iron-rich dishes and, through the use of educational games, users' attention was persuaded. Conclusion: It is an evidence that the efectiveness of implementation of communication strategies, where users received messages during their participations in demonstration sessions that influenced in empowement of the mothers regarding the cares they must have to prevent and fight the anemia being evaluated through the perception of users in each positioning criterion.

Arthroplasty of the distal ulna distal in managing patients with post-traumatic disorders of the distal radioulnar joint: measurement of quality of life / Artroplastia de ulna distal no manejo dos pacientes com distúrbios pós-traumáticos da articulação radioulnar distal: mensuração da qualidade de vida

To measure the quality of life and clinical-functional results from patients diagnosed with osteoarthrosis of the distal radioulnar joint who underwent surgical treatment using the technique of total arthroplasty of the ulna, with a total or partial Ascension(r) prosthesis of the distal ulna.METHODS:Ten patients were evaluated after 12 months of follow-up subsequent to total or partial arthroplasty of the distal ulna. All of them presented post-traumatic osteoarthrosis and/or chronic symptomatic instability of the distal radioulnar joint. The study was prospective. Seven patients had previously undergone wrist procedures (two cases with Darrach, three with Sauvé-Kapandji and two with ligament reconstruction of the fibrocartilage complex) and three presented fractures of the distal ulna that evolved with pain, instability and osteoarthrosis of the distal radioulnar joint. The following were assessed: quality of life (DASH scale); percentage degree of palm grip strength (kgf) and pronosupination range of motion in relation to the unaffected side; pain (VAS); return to work; subjective evaluation of radiography; and complications...

Mensurar a qualidade de vida e os resultados clínico-funcionais dos pacientes com diagnóstico de osteoartrose da radioulnar distal submetidos ao tratamento cirúrgico pela técnica de artroplastia total da ulna com a prótese total ou parcial Ascension(r)da ulna distal. MÉTODOS: Foram avaliados 10 pacientes com 12 meses de seguimento de artroplastia total ou parcial de ulna distal. Todos apresentavam osteoartrose pós-traumática e ou instabilidade crônica e sintomática da articulação radioulnar distal. O estudo foi prospectivo. Sete pacientes tinham procedimentos prévios no punho (2-darrach, 3-Sauvé-kapandji, 2-reconstruções ligamentares do complexo da fibrocartilagem) e três apresentaram fraturas da ulna distal que evoluíram com dor, instabilidade e osteoartrose da radioulnar distal. Foram analisados a qualidade de vida (DASH), a porcentagem do grau de força de preensão palmar (kgf) e o arco de movimento de pronossupinação em relação ao lado não afetado, a dor (VAS), o retorno ao trabalho e a avaliação subjetiva da radiografia e das complicações...

Ensaio experimental para tratamento cirúrgico das fraturas transversas da falange proximal - Técnica com parafuso intramedular cônico de compressão versus placa de compressão lateral / Experimental trial on surgical treatment for transverse fractures of the proximal phalanx: technique using intramedullary conical compression screw versus lateral compression plate

Comparar os parâmetros mecânicos entre dois métodos de estabilização por com pressão: placa de compressão axial de 1,5 mm com o parafuso cônico de compressão usado como tutor intramedular. Métodos: Foram usados modelos de poliuretano (Sawbone(r)) que simulam a fratura da falange proximal transversa, divididos em três grupos (placa lateral, parafuso cônico, sem implante). Resultados: Há necessidade de uma maior força para resultar na fadiga da síntese com para fuso intramedular. Comprova-se, assim, a supremacia mecânica desse sobre o modelo com a placa lateral. Conclusão: A estabilização com o parafuso Acutrak(r), no tratamento das fraturas no modelo adotado neste ensaio, apresenta resultados mecânicos superiores e estatisticamente sig nificativos em comparacão com a técnica de compressão axial com o uso da placa lateral (Aptus Hand (r)).

To compare the mechanical parameters between two methods for stabilization through compression: 1.5 mm axial compression plate versus conical compression screw used as an intramedullary tutor. METHODS: Polyurethane models (Sawbone(r)) that simulated transverse fractures of the proximal phalanx were used. The models were divided into three groups: lateral plate, conical screw and no implant. RESULTS: Greater force was needed to result in fatigue in the synthesis using an intramedullary plate. Thus, this model was proven to be mechanically superior to the model with the lateral plate. CONCLUSION: Stabilization using the Acutrak(r) screw for treating fractures in the model used in this trial presents mechanical results that are statistically significantly superior to those from the axial compression technique using the lateral plate (Aptus Hand(r)).

Randomized clinical trial on percutaneous minimally invasive osteosynthesis of fractures of the distal extremity of the radius / Ensaio clínico randomizado de osteossíntese percutânea e minimamente invasiva das fraturas da extremidade distal do rádio

OBJECTIVES: the purpose of this study was to compare the postoperative radiological and clinical outcomes with minimally invasive percutaneous osteosynthesis using three implants: volar locking plate, intramedullary nail system and nonbridging external fixator for distal radius fractures. METHODS: forty-eight patients (A group, 16; B group 16; C group 16) underwent minimally invasive percutaneous osteosynthesis of reductible and unstable displaced (Type IIB by Rayhack Classification) distal radius fractures. In B group intramedullary nail system was used, in A group the patients were treated with volar locking plate and in C group the patients were treated by nonbridging external fixator from January 2011 to December 2012. The mean follow-up period was 12 months. Radiologic parameters, range of motion, grip strength, and disability of the arm, shoulder, and hand score were evaluated at each examination (3rd and 6th week, and 12th months). The visual analog scale of wrist pain and complications were assessed at the final follow-up. RESULTS: the groups did not differ significantly in radiological outcomes after 12 months, but the clinical results, VAS scale and dash score in group A (volar locking plate) and B (nail intramedullary) were statistically significantly better than that of C group (nonbridging external fixator). One patient underwent an osteosynthesis with nail intramedullary and another with external fixator (C group) developed persistent pain near the site of the superficial radial nerve because of the distal's screw and pins, respectively. CONCLUSION: in clinical parameters, significant differences in outcomes were found between groups A and B after six weeks versus C group...

OBJETIVOS: comparar o resultado clínico funcional dos pacientes com diagnóstico de fratura com desvio, redutível e instável da extremidade distal do rádio submetidos ao tratamento cirúrgico pela técnica de osteossíntese percutânea e minimamente invasiva com o uso de três tipos de implante: placa volar bloqueada, haste intramedular bloqueada e fixador externo. Comparar os resultados quanto à melhoria da qualidade de vida pelo questionário Dash e ao tempo de retorno ao trabalho. MÉTODOS: divididos em três grupos (A, placa - 16; B, haste - 16; C, fixador externo - 16), 48 pacientes foram submetidos ao tratamento cirúrgico da fratura da extremidade distal do rádio, redutível e instável, classificação Rayhack (Tipo IIB), pelo método minimamente invasivo, com três tipos de implante: haste intramedular bloqueada, placa volar bloqueada e fixador externo radio-radial. Estudo feito de janeiro de 2011 a dezembro de 2012. O tempo de seguimento foi de 12 meses. Parâmetros radiográficos, dor (escala VAS), medida do arco de movimento, força de preensão palmar e o questionário Dash foram avaliados na terceira e sexta semana e no sexto mês de pós-operatório. RESULTADOS: numa análise vertical dos valores apresentados, observamos uma melhoria estatística significativa em todos os parâmetros clínicos analisados no estudo, nos três grupos. Em relação à análise horizontal, ou seja, na comparação dos grupos entre si, não houve diferenças estatísticas significativas quanto aos parâmetros radiográficos após o 12° mês de seguimento. O grau de força de preensão palmar, a medida do arco de movimento, VAS e Dash apresentaram, na terceira e sexta semana de pós-operatório, valores estatísticos...

Staphylococcus aureus comunitario resistente a cloxacilina: comunicación de los primeros cinco casos descritos en Chile / Community acquired infections with methicillin resistant strains of Staphylococcus aureus: report of five cases

Community acquired infections with methicillin resistant strains of Staphylococcus aureus (MRSA) infections have a more aggresive clinical course and involve mostly skin and lungs. These infections appear as outbreaks among prisoners, sportsmen, men having sex with men and military personnel. The higher aggressiveness of these strains is due to the production of several toxins, mainly Panton- Valentine leukocidine. The detection of the gene that codes for this toxin is a distinctive feature of these strains. We report five patients with community acquired MRSA infections. The clinical presentation was a skin infection in all. One patient had a pleuropneumonia in addition. Apart for resistance to beta-lactam antimicrobials, the strains were resistant to erythromycin and ciprofloxacin. Patients were treated with vancomycin, clotrimoxazole or intravenous clindamycin with a good evolution. An epidemiológical surveillance for community acquired MRSA strain infections should be started and measures to adequately treat infected patients and avoid dissemination should be implemented.