Intercostal celiotomy for removal of proventriculus foreign body in muscovy duck (Cairina moschata): case report / Celiotomia intercostal para remoção de corpo estranho do proventrículo de pato-do-mato (Cairina Moschata): relato de caso]

Ducks, geese and swans are included in the Anatidae family, Anseriformes order. The leading injuries causes to waterfowl are tangling in fishing materials and foreign bodies ingestion. A muscovy duck (Cairina moschata) was referred for treatment at Veterinary Teaching Hospital and a radiographic examination showed the presence of a hook in the coelom. Surgical exposure and incision of the proventriculus was made through left intercostal access and the hook along with a fishing line were gently removed. The animal began to feed voluntarily at the fourth post-operative day and two weeks after the procedure the patient was clinically well and was released to wild. This surgical approach differs in some aspects from the listed techniques in the known literature. It proved to be a viable and appropriate alternative to treat this affection since it did not cause any trans- or post-operative complications and enabled rapid recovery and subsequent patient release.(AU)

Patos, gansos e cisnes estão incluídos na família Anatidae, ordem Anseriformes. Entre as principais causas de ferimentos em aves aquáticas, o embaraço com materiais de pesca e a ingestão de corpos estranhos são os mais citados. Um pato-do-mato (Cairina moschata) foi encaminhado para tratamento no Hospital Veterinário e, mediante exame radiográfico, verificou-se a presença de um anzol na cavidade celomática, provavelmente no proventrículo. Utilizando-se o acesso intercostal esquerdo, foi feita a exposição e a incisão do proventrículo. Por meio dessa incisão, o anzol com um segmento de linha de pesca foi delicadamente retirado. O animal começou a se alimentar voluntariamente no quarto dia pós-operatório e duas semanas após o procedimento o paciente se encontrava clinicamente bem e apto à soltura. Esta abordagem cirúrgica difere, em alguns aspectos, das técnicas listadas na literatura e provou ser uma alternativa viável e adequada ao caso, não causando complicações e permitindo recuperação rápida, com posterior soltura do animal.(AU)

Impacto de la hipertensión arterial como factor de riesgo cardiovascular / Burden of hypertension as a cardiovascular risk factor

La Hipertensión Arterial (HTA) continúa siendo un problema de Salud Pública relevante a nivel mundial. En Chile es la principal causa de morbimortalidad y el factor de riesgo de mayor carga atribuible para la patología cardiovascular isquèc)mica y el accidente cerebrovascular. En este artículo se revisa su prevalencia, el grado de conocimiento, el logro de su control y tratamiento, así como su riesgo atribuible analizando la carga de enfermedad y la pèc)rdida de años por discapacidad. Se presentan estudios del impacto de su inclusión en el AUGE, resultados de la intervención multidisciplinaria, su interacción con otros factores de riesgo cardiovascular y se comentan algunos aspectos de las actualizaciones de las guías internacionales para su manejo.

Hypertension (HT) remains as an important public health problem worldwide. In Chile constitutes the leading cause of morbidity and mortality and the risk factor with the highest attributable risk burden for ischemic heart disease and stroke. This article reviews HT??s prevalence, degree of knowledge, achievement of its control and treatment. Also the risk burden of disease and disability loss years due to this pathology is analyzed. The results of studies after the inclusion of HT as explicit guaranteed health problem, multidisciplinary approach and its interaction with other cardiovascular risk factors is presented. Finally, some aspects of international updates guidelines for its management are discussed.

Listeria monocytogenes: informe de un aumento de casos en mujeres embarazadas y revisión de la literatura / Listeria monocytogenes: report of a rise in pregnant women and literature review

Listeria monocytogenes, rare pathogen in the general population, causes serious infections in patients at the extreme ages of life, pregnant woman, and those with immunosuppression. The clinical manifestations are essential to suspect the disease in patients at risk, allowing an early prescription of antimicrobial therapy, before the results of the cultures are available. Clinical course and prognosis depends on how early treatment is started and, in pregnant women, the gestational age. In Clínica Alemana, at Santiago, we detected a 15 fold rate rise of neonatal listeriosis between year 2007 and 2008. Ten cases were diagnosed between January and July 2008 and the seven cases occurring in pregnant women are reported here. All these patients were in their first pregnancy, which could be associated with similar lifestyle and food habits. Considering this new epidemiological scenario, it is important to educate the population, and to conduct an epidemiological study in order to determine the national situation of Listeria monocytogenes infection.

Listeria monocytogenes, es un patógeno poco frecuente en la población general, causante de infecciones graves en pacientes en edades extremas de la vida, mujeres embarazadas e inmunodeprimidos. La sospecha de la enfermedad en pacientes de riesgo se basa principalmente en el cuadro clínico, lo que permite iniciar un tratamiento empírico antes de contar con los resultados de los cultivos. La evolución y pronóstico dependen de la precocidad con que se inicia la terapia y de la edad gestacional. En Clínica Alemana de Santiago detectamos un aumento de 15 veces en la tasa de listeriosis comparando el año 2007 con el 2008. Entre enero y julio 2008, se diagnosticaron 10 casos, de los cuales siete fueron en primigestas, lo que podría tener relación con un hábito alimentario y características de vida similar. Es fundamental, a la vista de esta nueva realidad epidemiológica, educar a la población en hábitos alimentarios y de higiene, como también realizar un estudio epidemiológico que determine la situación nacional de infección por L. monocytogenes.

Scintigraphic lymph node mapping in malignant vulvar melanoma

Nodal status is an important prognosticating factor in patients with melanoma. Metastasis to the lymph nodes would affect surgical treatment plan. Sentinel node mapping, otherwise known as lymphoscintigraphy, has become an integral part in the management of melanoma. This is a case report of the use of scintigraphic lymph node mapping in a patient with a very rare case of vulvar melanoma. The protocols and principles utilized in routine lymph node mapping have been applied in this case. The patient's lymphoscintigraphy revealed unilateral nodal drainage to the left, probably, corresponding to the obturator or internal and external iliac chains. This guided the attending physician to perform unilateral, left-sided nodal dissection only, as opposed to the usual bilateral nodal dissection. Thus, the possibility for post-operative morbidity was greatly minimized in this patient.

Efeitos agudos da aplicação endovenosa do cogumelo-do-sol (Agaricus blazei Murill) sobre a pressão arterial média e a freqüência cardíaca de ratos anestesiados / Acute effects of the endovenous application of the royal mushroom (Agaricus blazei Murill) on mean arterial pressure and heart rate of anesthetized rats

Este trabalho objetivou verificar os efeitos agudos da aplicação endovenosa do extrato aquoso do Agaricus blazei Murill sobre a pressão arterial média (PAM) e a freqüência cardíaca (FC) de ratos anestesiados. Foram usados Rattus novergicus albinus, n = 6, anestesiados com tiopental sódico, traqueostomizados e canulados através da veia jugular e da artéria carótida. Foram injetadas as concentrações de 1,25 mg/kg, 2,50 mg/kg e 5,00 mg/kg do extrato aquoso em volume de 0,2 mL. A PAM foi registrada com um sistema Biopac, modelo MP100, e a FC com um eletrocardiógrafo ECG-4 Funbec. Os resultados foram obtidos no controle e nos tempos 15, 30, 45, 60 e 120s após a aplicação dos extratos. Os valores foram expressos em média ± EPM e analisados estatisticamente pelos testes "t" de Student-Newman-Keuls e Tukey (p<0,05). O extrato aquoso de A. blazei reduziu a PAM de maneira concentração dependente, sendo que a concentração de 1,25 mg/kg não provocou modificações significativas na PAM nem na FC; a de 2,50 mg/kg provocou diminuição da PAM aos 15s (p<0,01) e da FC aos 30s (p<0,001) e a de 5,00 mg/kg diminuiu a PAM aos 15s (p<0,001) e a FC aos 15 e 30s (p<0,001).

The aim of this paper was to verify the acute effects of the endovenous application of the aqueous extract of Agaricus blazei Murill on mean arterial pressure and heart rate of the anesthetized rats. The injected concentrations were: 1.25 mg/kg, 2.50 mg/kg and 5.00 mg/kg, in volume of 0.2 mL. The rats were anesthetized with sodium thiopental and, after tracheotomy, both jugular vein and carotid artery were cannulated. The MAP was recorded with a Biopac System, model MP100. The HR was obtained with an electrocardiograph model ECG-4 (Funbec). The records were made in the control and 15, 30, 45, 60 and 120s after the application of the different concentrations of the extracts. The values were expressed by mean ± SEM and by paired "t"-Student-Newman-Keuls and Tukey tests (p<0.05). The aqueous extract of the A. blazei decreased the MAP of dependent manner. The concentration of 1.25 mg/kg did not provoke effects; 2.50 mg/kg provoked decrease of the PAM at 15s (p<0.01) and of the HR at 30s (p<0.001) and 5.00 mg/kg provoked decrease of the PAM at 15s (p<0.001) and of the HR at 15 and 30s (p<0.001).

Valor del autoreporte como método para estimar la prevalencia de factores de riesgo en prevención primaria: resultados del proyecto RICAR / Accuracy of the self report method for establishing the prevalence of cardiovascular risk factors in healthy adults: results of the RICAR project

Antecedentes: El autoreporte se ha utilizado frecuentemente como método para estudiar la prevalencia de los factores de riesgo cardiovascular (FRCV), por lo que es crucial conocer su grado de certeza. Objetivos: Determinar en una población de adultos aparentemente sanos la validez del autoreporte como método paraestimar la prevalencia de hipertensión arterial, hipercolesterolemia e hiperglicemia, comparando estos resultados con los obtenidos a través de la medición objetiva de estos parámetros. Método: En el proyecto RICAR, un total de 12.190 adultos sanos (6.320 mujeres, 5.870 hombres, edad 47,6 +/- 12 años) respondieron un cuestionario acerca de su presión arterial sistólica y diastólica (PAS, PAD), colesterol total (CT) y glicemia(GL). Conocían su PA 2.430, su CT 1.163 y su GL 1.556 personas. A ellos se les preguntó si los valores que estaban reportando eran normales o anormales, y se compararon estas apreciaciones con mediciones objetivas de estos parámetros. Resultados: Un 18,2 por ciento y un 15,6 por ciento refirió incorrectamente su PAS y su PAD como normales, mientras que el error fue de 44,9 por ciento y 15,8 por ciento respecto de CT y GL, respectivamente. Las mujeres tuvieron autoreportes de valores normales significativamente más precisos que los hombres para PAS, PAD y GL: 84,3 vs 77,6 por ciento, 88,7 vs 77 por ciento y 97,5 vs 94 por ciento respectivamente (p<0,0001), a pesar de tener un nivel educacional inferior a los hombres. El VP Positivo para el reporte de valores anormales de la PAS, PAD, CT y GL fue 54.3 por ciento, 46.7 por ciento, 75.1 por ciento y 41.8 por ciento respectivamente. El VP Negativo de los mismos parámetros fue 81.7 por ciento, 84.4 por ciento, 55.1 por ciento y 96.4 por ciento, respectivamente. La prevalencia verdadera versus la aparente en hipertensión sistólica fue de 30 vs 32,6 por ciento, hipertensión diastólica de 25,7 vs 32,6 por ciento y GL elevada de 10 vs 16,7 por ciento (índice de Kappa < 0.6)...

Background: Accuracy and validity of self reported data is a crucial aspect as massive populations´ surveys had become a common method of establishing population’s cardiovascular risk factors (CVRF) prevalence. Objective: To determine in a healthy adult population the accuracy of their self reported normal or abnormal values of Blood Pressure (BP), Total Cholesterol (TC) and Blood Sugar (BS), compared with clinical findings. Methods: A questionnaire about their own BP, TC and BS was answered by 12,190 healthy adults from the RICAR Project, (6320 women and 5870 men, mean age 47.6 +/- 12 y). Those who knew their parameters (BP n= 2,430, TC n= 1,163 and BS n = 1,556) were asked if they had normal or abnormal values. Using standardized methods we measured Systolic (SBP) and Diastolic Blood Pressure (DBP), Total Cholesterol and Blood Sugar (BS) and compare the referred data of normality/abnormality with clinical findings. Results: SBP and DBP were respectively uncorrectly reported as normal in 18,2 percent and 15,6 percent of the population. For TCand BS the mistaken reported normal values were 44,9 percent y 15,8 percent respectively. Women had significant more accurate selfreported normal values than men for SBP, DBP and BS: 84,3 vs 77,6 percent; 88,7 vs 77 percent y 97,5 vs 94 percent respectively (p<0,0001), eventhough they had a significant less educational level than men. Positive PV for abnormal SBP, DBP, TC and BS were 54.3 percent, 46.7 percent, 75.1 percent and 41.8 percent respectively. Negative PV for the same parameters were 81.7 percent, 84.4 percent, 55.1 percent and 96.4 percent respectively. True versus apparent prevalences evidenced differences with an overestimation of systolic hipertension 30 vs 32,6 percent, diastolic hipertension 25,7 vs 32,6 percent and high BS 10 vs 16,7 percent. Kappa index was low between these methods...

Prevensión cardiovascular y actitud de cambio frente a los factores de riesgo: un análisis crítico del estado actual / Cardiovascular prevention and attitude of people towards behavior changes: state of the art

In recent years the main focus of cardiovascular prevention has been to identify people without clinical evidence of coronary disease, but with a high risk of developing a clinical event. Long term follow up studies show that a young person with a high "Relative Risk" of presenting a cardiovascular event becomes an adult with a high "Absolute Risk" of suffering it. The aim of primary prevention is to avoid the appearance of cardiovascular diseases, delaying the development of atherosclerosis and its consequences. In this scenario, the first step is to increase awareness among healthy people of their own cardiovascular risk, enhancing their knowledge of their risk parameter values and generating a correct perception of the risk burden that those values mean. Literature review reveals that significant percentages of healthy individuals are unaware of their own values of blood pressure, total cholesterol and blood glucose. Furthermore, people aware of having abnormal parameters have low treatment compliance rates or evidence inconsistency between knowledge and behavior. This paper reviews educational strategies and other factors that influence this knowledge-behavior gap, such as the stages of behavior changes of the Prochaska and Diclemente Model. Evidence has shown that knowledge about cardiovascular risk factors is not enough to influence behavior and that the degree of preparation of people towards behavior changes is a strong predictor of the success of educational and counseling interventions. Local Chilean data from the RICAR project also shows that the profile of behavior change is different for each modifiable cardiovascular risk factor.

Insuficiente control de factores de riesgo en prevención secundaria cardiovascular / Prevalence of cardiovascular risk factors among patients suffering vascular events on admission and one year later

Background: International studies show a low compliance with norms for the management of cardiovascular risk factors. Aim: To assess the prevalence of risk factors in patients admitted for a coronary or vascular event and to evaluate the proportion of patients that normalize these factors after one year of follow up. Material and Methods: Three hundred and fifty seven patients aged 64±13 years (264 males), admitted to a University Clinical Hospital for a coronary or vascular event were studied. They were educated about cardiovascular risk factors and followed by their treating physicians for a mean of 11.9±2 months. During this period, smoking habits, body mass index. blood pressure, serum lipid levels, blood glucose and the appearance of new cardiovascular events were registered. Results: One year survival was 96% (all 13 deaths were of cardiac origin). Eighty seven percent of patients were free of major cardiovascular events. At discharge from hospital and at the end of follow up 49% and 44% had a total cholesterol over 200 mg/dl respectively, 9,6% and 20,8% had systolic pressure over 140 mmHg. There was no diastolic hypertension in these patients, 27% and 31% had a body mass index over 25 kg/m2 and 2% smoked (versus 32% before the event). Conclusions: After one year of follow up, the prevalence of risk factors in patients that had suffered a cardiovascular event, continues to be high.

Un caso de malformacion en Pachycheles serratus (Decapoda: Porcellanidae) / A case of malformation in Pachycheles serratus (Decapoda: Porcellanidae)

An adult male of Pachycheles serratus with a malformation on the right cheliped was found during a collection of anomuran crabs in coastal waters of the peninsula de Macanao, Margarita island, Venezuela. The specimen was found at La Carmela beach (11 degrees 04'N-64 degrees 20'W), and featured a bifurcated fixed finger on the right cheliped.

Estado actual de la incompatibilidad al factor Rh / Actual status of the incompatibility to Rh factor

Se estudia una población de 1.352 embarazadas Rh negativas en el Centro, que para tal efecto funciona en el Hospital Paula Jaraquemada, asistidas entre 1981 y 1984. Se hace notar que 107 de ellas (7,92%) estaban sensibilizadas, correspondiendo 46 (43%) a títulos de anticuerpos anti-Rh hasta 1 x 16, que no presentaron mayores problemas para sus productos. La frecuencia de sensibilización severa y la mortalidad perinatal descendieron, comparadas con un estudio anterior (1978-1980) del mismo centro, de 6,25% a 3,1% y de 14,28% a 5,55%, respectivamente, lo que es reflejo de la disminución de las formas clínicas graves y el aumento de las benignas. Se describe el método de estudio del problema Rh, se analiza la correlación, título anticuerpo materno, curva espectrofotométrica del líquido amniótico y estado del recién nacido. Un total de siete transfusiones intraperitoneales se realizó en cuatro pacientes altamento sensibilizadas, lográndose éxito con dos recién nacidos. Se plantean las limitaciones, con nuestros actuales, de mejorar los resultados perinatales en los casos de severidad extrema. Se sugiere el grado de sensibilización, con título 1 x 16, como punto inicial para estudio espectrofotométrico de líquido amniótico. Finalmente, se revisa con espíritu crítico el manejo de la profilaxis con Gama Globulina Anti-D