Apendicitis aguda perforada con diagnóstico prequirúrgico y hernia inguinal bilateral en recién nacido de pretérmino / Acute perforated appendicitis with pre-surgical diagnosis and bilateral inguinal hernia in preterm infants

INTRODUCCIÓN: La apendicitis aguda neonatal es una patología de muy baja frecuencia, con escasos reportes en los últimos 30 años. La clínica e imágenes son inespecíficas, diagnosticándose la mayoría de las veces durante el procedimiento quirúrgico. OBJETIVO: Presentar un caso de apendicitis aguda perfora da en paciente prematura, con diagnóstico prequirúrgico y resolución laparoscópica, asociada a aparición posterior de hernia inguinal. CASO CLÍNICO: Recién nacido femenino de 34 semanas que a los 17 días de vida presentó fiebre, irritabilidad y aumento del residuo lácteo. Al examen físico destacaba distensión y sensibilidad del abdomen y tanto la radiografía como ecografía abdominales eran compatibles con apendicitis aguda perforada, por lo cual ingresó a pabellón para laparoscopía. Confirmado el diagnóstico, se realizó apendicectomía. Dos semanas después en consulta ambulatoria, se evidenció y confirmó con ecografía una hernia inguinal bilateral que se corrigió quirúrgicamente. CONCLUSIÓN: La apendicitis aguda debe considerarse dentro de los diagnósticos diferenciales en neonatos con clínica de abdomen agudo, principalmente en prematuros. En este caso, la ecografía permitió realizar el diagnóstico pre-operatorio. La posible asociación con hernia inguinal, debiera motivar a examinar siempre conductos inguinales durante la evaluación con imá genes y en el procedimiento quirúrgico.

INTRODUCTION: Acute neonatal appendicitis is a rare pathology, with few reports in the last 30 years. Since its clinical presentation and imaging studies are non-specific, most cases are diagnosed during a surgical pro cedure. OBJECTIVE: To describe a neonatal case of acute perforated appendicitis associated with later appearance of inguinal hernia, with pre-surgical diagnosis and treated through laparoscopy. CLINICAL CASE: A 17-day-old preterm female newborn presented with fever, irritability, and increased milk intolerance. Physical examination showed abdominal distention, tenderness and both, abdominal X- ray and ultrasound showed compatible images with acute perforated appendicitis. Once the diagnosis was confirmed, we performed an appendicectomy through laparoscopy. Two weeks later, during an outpatient visit, we observed a bilateral inguinal hernia which was confirmed by ultrasound, and then it was surgically corrected. CONCLUSION: Acute appendicitis should be considered within the differential diagnosis in neonates with acute abdominal symptoms, mainly in premature infants. In this case, ultrasound scan allowed us to make the pre-operative diagnosis. The possible association with inguinal hernias should motivate to examine inguinal ducts during imaging assessment and surgical procedure.

Evaluación de la infección por VIH en Chile: pronunciamiento del Comité VIH de la Academia Chilena de Medicina / Evaluation of HIV epidemic in Chile: a statement of the Chilean Academy of Medicine

The Chilean Academy of Medicine convened a commission to evaluate the status of HIV epidemic and the national response to it, regarding its achievements, gaps and challenges, aiming to recommend actions to optimize assessment quality and national response. This publication summarizes the agreed upon opinion of its members. The epidemic is overwhelmingly sexually transmitted, predominant in homo/bisexual men. Vertical transmission is very low. An increasing number of new diagnoses is occurring, with relative over representation of foreign people lately. There is a legal guarantee of confidentiality, nondiscrimination and treatment for those affected, both in the private and public sector. All public health services have active HIV care units. Modern antiviral drugs and monitoring tests are also available. Despite these clear achievements, insufficient, occasionally inadequate public policies and certain rigid regulations thwart optimal effectivity and efficiency of the programs, contributing to the slow and incomplete compliance with international commitments. Shortcomings worth highlighting are: suboptimal educational and preventive programs directed to youngsters, vulnerable and general population; persistent underdiagnosis of infected population; cumbersome requirements to request and inform diagnostic tests, thus discouraging testing; excessive centralization and long latency of diagnosis confirmation and monitoring tests; incomplete epidemiologic analysis and public reporting of findings; non flexibility and slow updating of therapeutic guidelines; insufficient adaptation of care and drug delivery modalities to patients' needs; excessive administrative requirements at care centers and restrictive legislation for outcome and interventional clinical research. Recommendations to deal with these issues were proposed.

Polivictimización y su relación con las conductas autoagresivas y con la depresión en adolescentes / Polyvictimization and its relation with self-aggressive behaviors and with depression in adolescents

Resumen Introducción: La acumulación de experiencias de distinto tipo de maltrato o violencia durante la infancia ha sido nominada como polivictimización. Se ha documentado que la polivictimización genera consecuencias negativas en la salud mental de las personas. En Chile, no existe suficiente investigación respecto de este fenómeno, únicamente se conocen algunas cifras que muestran que es prevalente. El objetivo del estudio es evaluar la frecuencia con que adolescentes han sido sometidos a diferentes niveles de polivictimización y su relación con los niveles de sintomatología depresiva y con la frecuencia de conductas autolesivas. Método: El estudio, descriptivo correlacional, encuesta a 114 adolescentes de entre 17 y 18 años de edad. Resultados: Se aprecia que el 40,3% de la muestra habría sufrido al menos 2 tipos diferentes de victimización y que la polivictimización se asocia a la sintomatología depresiva y a la frecuencia de las autoagresiones. Conclusión: Se concluye que los profesionales de salud mental debieran evaluar la posibilidad de que la psicopatología de sus pacientes específicos pudiese estar relacionados con experiencias de victimización infantojuvenil que debieran ser consideradas en los tratamientos.

Introduction: The accumulation of experiences of abuse or violence during childhood has been nominated as a polyvictimization. It has been documented that the polyvictimización generates negative consequences in the mental health of the people. In Chile there is not enough research on this phenomenon, only there is known that it is prevalent. The objective of the study is to evaluate the frequency of polyvictimization in the adolescents and its relation with the levels of depressive symptomatology and with the frequency of self-injurious behaviors. Method: This is a descriptive correlational study. We survey 114 adolescents between 17 and 18 years of age. Results: It was observed that 40.3% of the sample had suffered at least 2 different types of victimization and that polyvictimization is associated with depressive symptoms and with the frequency of self-harm. Conclusion: It is concluded that mental health professionals should evaluate the possibility that the mental health problems of their specific patients may be related to experiences of child and adolescent victimization, which should be considered in the treatments.

Caracterización de indicadores de detección de glaucoma con los equipos OCT Spectralis y campímetro Humphrey II en pacientes altos miopes y altos miopes glaucomatosos del Hospital Clínico Universidad de Chile / Characterization of glaucoma detection indicators with OCT Spectralis equipment and Humphrey II campimeter in patients with high myopia and high myopia glaucomatous at the Hospital Clínico Universidad de Chile

Purpose: Characterize and describe glaucoma index parameters of the results of visual exams, Optical Coherence Tomography and Visual Field, in high myopic subjects with and without the pathology. Method: Cross sectional and observational study of 39 eyes, 15 high myopic with glaucoma y 24 high myopic without it. Visual Field (VF) were performed, where the global index between both groups were analyzed; Mean Deviation (MD), Model Standard Deviation (MSD) and Visual Field Index (VFI), beside Optical Coherence Tomography (OCT), in which the thickness of the ganglion cells layer (GCL) inside 3 central mm was compared. Results: The results were satisfactory, demonstrating different characteristics between the high myopic group with glaucoma and without it, both in VF and OCT exams. It was obtained in the VF analysis difference in average MD of -4,92 dB + 3,71 (p<0,05); difference in average DSM of 2,01 dB + 2,85 (p>0,05) and VFI with Friedman Test 10,29 (p>0,05). The statistical OCT analysis, when comparing GCL, observed that the Temporary sector (T) had a statistically significant decrease (p<0,05). Conclusions: To continue studies in this investigative line, can expand the knowledge in this area, mainly in the study of the GCL. (AU)

Injerto costal para reconstrucción nasal: experiencia de 6 años en el Hospital San Juan de Dios / Costal graft for nasal reconstruction: 6 years experience in San Juan de Dios Hospital

Introducción: El injerto de preferencia para cirugía nasal es el cartílago septal. El Injerto de cartílago costal otorga gran material para trabajo ya que posee características similares al cartílago septal. Este injerto se utiliza generalmente para cirugías de dorso nasal, nariz en silla de montar, laterorrinias, disfunciones de la válvula nasal interna y/o externa, poca proyección nasal y rinoplastías de revisión. Objetivo: Conocer las características, resultados y complicaciones de las rinoplastías con injerto de cartílago costal realizadas en el Hospital San Juan de Dios (HSJD) entre los años 2010 y 2016. Material y método: Estudio retrospectivo con revisión de fichas clínicas de pacientes sometidos a cirugías de reconstrucción nasal con injerto de cartílago costal en el HSJD entre enero 2010 y agosto 2016. Resultado: Entre los años 2010 y 2016 se realizaron 20 rinoplastías con uso de cartílago costal: 14 eran hombres (70%) y 6 eran mujeres (30%). En 14 pacientes se usó el cartílago costal en la primera cirugía. No se presentaron complicaciones a corto, mediano y largo plazo. Conclusión: El injerto de cartílago costal es una herramienta útil a la hora de enfrentarse a cirugías complicadas. La técnica quirúrgica no es dificultosa y tiene una baja tasa de complicaciones.

Introduction: The ideal graft for nasal surgery is septal cartilage. The costal cartilage has similar characferistics to the septal cartilage. This particular graft is generally used for nasal dorsum, saddle nose, nasal deviations, dysfunctions of the internal or external nasal valve, poor nasal projection and revision rhinoplasty. Aim: Determine the characteristics, outcomes and complications of rhinoplasty with costal cartilage graft made in the San Juan de Dios Hospital (HSJD) between 2010 and 2016. Material and method: Retrospective study with reviewing medical records of all patients underwent nasal surgery reconstruction with costal cartilage graft in the HSJD between January 2010 and August 2016. Results: Between 2010 and 2016 a total of 20 rhinoplasties were performed with use of costal cartilage. Of these 14 were men (70%) and 6 were women (30%). In 14 patients we used the costal cartilage in the first surgery. No complications in short, medium and long term were presented. Conclusion: The rib cartilage graft is a useful tool when dealing with complicated surgeries. The surgical technique is not difficult and has a low complication rate.

Two common species dominate the species-rich Euglossine bee fauna of an Atlantic Rainforest remnant in Pernambuco, Brazil

Abstract Nowadays, the northern part of the Atlantic Rainforest of Brazil is largely destroyed and forest remnants rarely exceed 100 ha. In a 118 ha forest fragment within a state nature reserve of Pernambuco (Reserva Ecológica Gurjaú), we surveyed the orchid bee fauna (Apidae, Euglossini) using eight different scent baits to attract males. Once a month during one year, the bees were actively collected with entomological nets, from November 2002 to October 2003 by two collectors. We collected 2,908 orchid bee males belonging to 23 species, one of the highest richness values of the Northern Atlantic Rainforest. Bees of only two species, Euglossa carolina (50%) and Eulaema nigrita (25%), which occurred throughout the year, accounted for three quarter of the collected individuals. Both species are typical for open or disturbed areas. Rainforest remnants like those of Gurjaú within the predominant sugar cane monocultures in the coastal plains of the northern Atlantic Rainforest play an important role in orchid bee conservation and maintenance of biodiversity.

Resumo Atualmente, a porção norte da Floresta Atlântica brasileira está drasticamente destruída e os remanescentes florestais raramente excedem 100 hectares. Com uso de iscas odoríferas atrativas aos machos, amostramos a fauna de abelhas-das-orquídeas (Hymenoptera: Apidae: Euglossini) em um fragmento florestal de 118 ha na Reserva Ecológica de Gurjaú, Pernambuco. As abelhas foram ativamente coletadas com redes entomológicas por dois coletores, uma vez por mês, de novembro de 2002 a outubro de 2003. Coletamos 2908 machos de Euglossini pertencentes a 23 espécies, um dos mais altos valores de riqueza registrados para a Floresta Atlântica nordestina. Três quartos das abelhas coletadas pertenceram a apenas duas espécies, Euglossa carolina (50%) and Eulaema nigrita (25%), típicas de áreas abertas e perturbadas e ativas ao longo de todo ano. Remanescentes de floresta como os de Gurjaú, em meio às monoculturas de cana-de-açúcar, podem desempenhar um importante papel na conservação das abelhas-das-orquídeas em ambientes fragmentados como os da Mata Atlântica do nordeste do Brasil.

Two common species dominate the species-rich Euglossine bee fauna of an Atlantic Rainforest remnant in Pernambuco, Brazil / Duas espécies comuns dominam a rica fauna de Euglossini em um remanscente de Floresta Atlântica em Pernambuco, Brasil

Abstract Nowadays, the northern part of the Atlantic Rainforest of Brazil is largely destroyed and forest remnants rarely exceed 100 ha. In a 118 ha forest fragment within a state nature reserve of Pernambuco (Reserva Ecológica Gurjaú), we surveyed the orchid bee fauna (Apidae, Euglossini) using eight different scent baits to attract males. Once a month during one year, the bees were actively collected with entomological nets, from November 2002 to October 2003 by two collectors. We collected 2,908 orchid bee males belonging to 23 species, one of the highest richness values of the Northern Atlantic Rainforest. Bees of only two species, Euglossa carolina (50%) and Eulaema nigrita (25%), which occurred throughout the year, accounted for three quarter of the collected individuals. Both species are typical for open or disturbed areas. Rainforest remnants like those of Gurjaú within the predominant sugar cane monocultures in the coastal plains of the northern Atlantic Rainforest play an important role in orchid bee conservation and maintenance of biodiversity.

Resumo Atualmente, a porção norte da Floresta Atlântica brasileira está drasticamente destruída e os remanescentes florestais raramente excedem 100 hectares. Com uso de iscas odoríferas atrativas aos machos, amostramos a fauna de abelhas-das-orquídeas (Hymenoptera: Apidae: Euglossini) em um fragmento florestal de 118 ha na Reserva Ecológica de Gurjaú, Pernambuco. As abelhas foram ativamente coletadas com redes entomológicas por dois coletores, uma vez por mês, de novembro de 2002 a outubro de 2003. Coletamos 2908 machos de Euglossini pertencentes a 23 espécies, um dos mais altos valores de riqueza registrados para a Floresta Atlântica nordestina. Três quartos das abelhas coletadas pertenceram a apenas duas espécies, Euglossa carolina (50%) and Eulaema nigrita (25%), típicas de áreas abertas e perturbadas e ativas ao longo de todo ano. Remanescentes de floresta como os de Gurjaú, em meio às monoculturas de cana-de-açúcar, podem desempenhar um importante papel na conservação das abelhas-das-orquídeas em ambientes fragmentados como os da Mata Atlântica do nordeste do Brasil.

Síndromes geriátricos en pacientes con fractura de cadera no reciente en una unidad de primer nivel de atención médica / Geriatric syndromes in patients with a non-recent hip fracture seen at a primary health care unit

Objetivo: Identificar la frecuencia de síndromes geriátricos en pacientes que sufrieron fractura de cadera no reciente en una unidad de primer nivel de atención médica en el estado de Puebla, México. Material y métodos: Estudio transversal realizado en 376 pacientes que sufrieron fractura de cadera no reciente, a los que se les evaluó la presencia de síndromes geriátricos. Incluimos variables demográficas, incontinencia urinaria, polifarmacia, trastornos del sueño, estado nutricional, así como depresión y autonomía. La depresión y autonomía fueron evaluadas por las escalas de Yesavage y Katz. Utilizamos estadística descriptiva. Resultados: Fueron un total de 376 pacientes, 219 (58%) femeninos, 157 (42%) masculinos; edad promedio 72.57, (65-95, ± 7.08) años, 98.7% presentó al menos un síndrome geriátrico. La depresión se detectó en 303 (80.9%), la polifarmacia se observó en 282 (75%), en cuanto a los trastornos del sueño se encontraron en 262 (69.7%), las caídas se encontraron en 63 (16.8%), la incontinencia urinaria en 19 (5.1%), en cuanto a la obesidad en 15 (4%) y pérdida de la autonomía en 3 (0.8%). Conclusión: 98.7% padecen por lo menos un síndrome geriátrico, el género femenino es el más afectado, el síndrome más frecuente es depresión, seguida de polifarmacia, trastorno del sueño, caídas, incontinencia urinaria, obesidad y pérdida de la autonomía.

Objective: To identify the frequency of geriatric syndromes in patients with a non-recent hip fracture seen at a primary health care unit in the state of Puebla, Mexico. Material and methods: Cross-sectional study conducted in 376 patients with a non-recent hip fracture screened for geriatric syndromes. We included demographic variables, urinary incontinence, polypharmacy, sleep disorder, nutritional status, depression and autonomy. The two latter were assessed using the Yesavage geriatric depression scale and the Katz index. We used descriptive statistics. Results: The total number of patients was 376; 219 (58%) were females and 157 (42%) were males; mean age was 72.57 years (65-95 ± 7.08), and 98.7% had at least one geriatric syndrome. Depression was detected in 303 (80.9%), 282 (75%) were on polypharmacy, 262 (69.7%) had sleep disorders, 63 (16.8%) had experienced falls, 19 (5.1%) had urinary incontinence, 15 (4%) were obese, and 3 (0.8%) had loss of autonomy. Conclusion: 98.7% of the patients had at least one geriatric syndrome; females were the most affected sex; depression was the most frequent syndrome, followed by polypharmacy, sleep disorders, falls, urinary incontinence, obesity and loss of autonomy.

Participación paterna en la experiencia del parto / Father involvement in childbirth

Introduction: Recent initiatives have promoted the participation of fathers in the early care of their children. Objective: To assess the results of a program to encourage parental involvement in childbirth. Parents of healthy term newborns were randomly allocated to participate either in the birth experience or control. Patients and Methods: The protocol included: to dry the skin, umbilical cord cutting off, weight, height, and finally give him/her to the mother for the skin-to-skin contact. Heart rate (HR), respiratory (RR) and temperature were evaluated one hour later. In the first outpatient clinic assessment, mothers completed a questionnaire. 127 fathers participated either in the birth experience or control. Results: 62 followed the protocol and 65 the control. Both newborn groups were comparable. Also were fathers in age, education and rurality; mothers in primiparity. Significant differences: night care (37/62, 10/65 59.6% vs 15.4%, p < 0.01); post prandial assistance (50/62, 14/65 80.6% vs 21.5%, p < 0.01); participation in bathing (38/62, 61.3% vs 15/65, 23.1%, p < 0.01); newborn visit upon arrival at home (46/62, 74.2% vs 22/65, 33.8%, p < 0.01); helping in crying episodes (42/62, 67.7% vs 17/65, 26.1%, p < 0.01). There was stability in HR, RR and temperature one hour postpartum. Only one case of complication among parents (fainting). Conclusions: There were more cases of early care behaviors among participating fathers at birth, even belonging to a discouraging socio cultural environment.

Introducción: Recientes iniciativas, han promovido la participación de los padres en los cuidados tempranos de sus hijos. Objetivo: Evaluar los resultados de un programa de estímulo a la participación paterna en el parto. Se incluyeron padres de RN de término sanos, asignados aleatoriamente para participar en la experiencia del parto o control. Pacientes y Metodos: El protocolo incluyó: secado de la piel, corte de cordón umbilical, peso, estatura, y finalmente, entrega a la madre para el contacto piel a piel. Se evaluó frecuencia cardiaca (FC), respiratoria (FR) y temperatura una hora después. En el primer control ambulatorio, las madres completaron un cuestionario. 127 padres participaron en la experiencia del parto o control. Resultados: 62 asignados al protocolo y 65 al control. Ambos grupos de RN resultaron comparables. También los padres, en edad, escolaridad, ruralidad, y las madres, en primiparidad. Diferencias significativas: asistencia nocturna (37/62, 59,6% vs 10/65, 15,4%, p < 0,01); post prandial (50/62, 80,6% vs 14/65, 21,5%, p < 0,01); participación en el baño (38/62, 61,3% vs 15/65, 23,1%, p < 0,01); visita al RN al llegar al domicilio (46/62, 74,2% vs 22/65, 33,8%, p < 0,01); ayuda ante episodios de llanto (42/62, 67,7% vs 17/65, 26,1%, p < 0,01). Hubo estabilidad en FC, FR y temperatura una hora post-parto. Sólo un caso de complicación entre los padres (lipotimia). Conclusiones: Hubo más conductas de interés en cuidados tempranos, entre los padres participantes en el parto, aún perteneciendo a un medio sociocultural que no las promueve ni facilita.

Diagnóstico y tratamiento temprano de la maloclusión clase III / Early diagnosis and treatment of class III malocclusion

El objetivo del presente artículo es hacer una revisión de un tema muy importante como es el diagnóstico y tratamiento de la mal oclusión clase III en etapas tempranas, para lograr este objetivo se reunió a un grupo de residentes de Odontopediatría de diferentes universidades durante 6 meses, el cual realizó una búsqueda de información en las principales revistas y textos llegando a la conclusión de que la mal oclusión clase III es un síndrome dentofacial que genera mucha controversia en la odontología actual debido básicamente a la pregunta constante de los clínicos de cuándo será el momento oportuno para iniciar el tratamiento. La respuesta a esta interrogante dependerá de la gravedad de la mal oclusión y del estadío de crecimiento óseo en el que se encuentre el paciente; pero existen otras dimensiones a considerar como: las características clínicas, el correcto diagnóstico y las alternativas posibles de tratamiento (que serán necesarias para poder decidir acertadamente cuándo y cómo será el tratamiento de nuestro paciente). El objetivo de esta revisión bibliográfica es orientar al clínico sobre diversos aspectos; de esta maloclusión, existentes en la literatura...

The aim of this article is to make a review of a very important theme as is the diagnosis and treatment of Class III malocclusion in early stages. To achieve this goal, we gather a group of residents in pediatric dentistry from different universities during six months, this group per formed a search for information in the most important journals and texts, coming to the conclusion that Class III malocclusion is a dentofacial syndrome that generates a lot of controversy in dentistry today, basically due to the constant question of clinicians about when is the correct time to treat this malocclusion. The answer to this question will depend on the severity of the malocclusion and on the bone growth stage of the patient; but there are other dimensions to consider such as: clinical characteristics, the correct diagnosis and possible treatment alternatives (that will be necessary to take into consideration in order to correctly choose when and how the treatment of our patient will be). The aim of this review is to guide clinicians through all the different aspects of this malocclusion that may exist in literature...

Prótesis total de rodilla por gonartrosis grado IV / Total knee replacement due to grade IV gonarthrosis

Objetivo: Describir la evolución clínica de pacientes operados de prótesis total de rodilla por gonartrosis grado IV secundaria a enfermedad angular en varo. Material y métodos: Estudio descriptivo, incluimos pacientes operados de artroplastía total de rodilla por gonartrosis secundaria a enfermedad angular en varo. Utilizamos las siguientes variables: género, edad, lado afectado, tipo de abordaje, tipo de prótesis, tipo de marcha postquirúrgica, infección, estado vascular, dolor postquirúrgico, rechazo de material protésico, deformidad angular en varoflexión pre- y postquirúrgicas. Resultados: Revisamos 13 expedientes, 69.2% hombres y 30.8% mujeres, la edad media 72.38, mínima 56-máxima 82, DE 7.11 años. Seis (46.2%) rodillas izquierdas y 7 (53.8%) derechas. A todos los pacientes se les realizó abordaje para-rotuliano medial y balance óseo, al 23.1% se le realizó balance capsuloligamentario; a 7.6% se les colocó prótesis total de rodilla posteroestabilizada y al 93.3% no posteroestabilizada; 1 (7.6%) paciente presentó infección, ninguno presentó compromiso vascular, 76.9% presentaron marcha asistida con bastón, 15.4% marcha independiente y 7.6% no presentó marcha. El grado promedio de deformidad angular prequirúrgico fue 15.77 y el postquirúrgico promedio menor o igual a 5º, la diferencia de promedios grados pre- y postquirúrgicos fue 36.719 y en flexión 0.439, p = 0.00 y p = 0.669 respectivamente (t pareada). Conclusión: Podemos concluir que la evolución clínica de los pacientes con gonartrosis secundaria a enfermedad angular en varo postoperados de ATR es buena, las complicaciones son similares a la literatura.

Objective: To describe the clinical evolution of patients with total knee replacement surgery due to grade IV gonarthrosis secondary to varus angular deformity. Material and methods: A descriptive trial where we included patients who underwent total knee arthroplasty due to gonarthrosis secondary to varus angular deformity. We used the following variables, sex, age, affected side, type of approach, type of prosthesis, type of gait post-surgically, infection, vascular status, post-surgical pain, rejection of prosthetic material, varus-flection angular deformity pre and post-surgically. Results: We reviewed 13 files, 69.2% men and 30.8% women, the mean age was 72.38, minimum 56, maximum 82, DE 7.11 years. Six (46.2%) left knees and 7 (53.8%) right knees. All patients had a medial parapatellar approach and bone balancing, 23.1% had ligament balancing; 7.6% had a total knee replacement stabilized posteriorly and 93.3% not stabilized posteriorly; 1 (7.6%) patient had infection, none had vascular involvement, 76.9% had to walk with a cane, 15.4% walked on their own and 7.6% had no gait. The average grade of the angular deformity pre-surgery was 15.77 and the average post-surgery was less than or equal to 5º, the difference of average grades pre and post-surgery was 36.719 and in flection 0.439, p= 0.00 and p= 0.669 respectively (paired t). Conclusion: We can conclude that the clinical evolution of patients with gonarthrosis secondary to varus angular deformity who underwent TKA is good, complications are similar to those in the literature.

Resultados del manejo quirúrgico en fracturas parciales de la tibia proximal / Results of surgical management in proximal partial tibia fractures

Introducción: Las fracturas parciales articulares proximales de la tibia son un gran desafío para el ortopedista por la sintomatología y la complejidad de su manejo. Objetivo: Describir los resultados del tratamiento quirúrgico de las fracturas articulares proximales de la tibia. Material y métodos: Se realizó un estudio descriptivo en un Hospital de Tercer Nivel de Atención. Se incluyó a pacientes con fractura articular parcial proximal tibial (Müeller AO/ASIF 41-B), ambos géneros, evolución postquirúrgica a seis meses, con expediente clínico completo. La evaluación postquirúrgica fue mediante la escala Orfaly & Keating. Utilizamos estadística descriptiva con medidas de tendencia central y dispersión, prueba de Fischer para riesgo relativo y regresión logística. Resultados: Fueron 25 pacientes. Edad promedio 41.6, (16-81), DE 17.03 años; 15 (60%) hombres, 10 (40%) mujeres; 1 (4%) con DM2; el lado más afectado fue el izquierdo 17 (68%); todos manejados quirúrgicamente con osteosíntesis; hubo concordancia al 100% del diagnóstico preoperatorio con el postoperatorio (Kappa 1.0); la evolución fue satisfactoria en 76%, aceptable en 24% (Orfaly & Keating), 16% con deformidad angular en valgo y 12% rigidez articular; mujeres con RR 1.33 (IC 0.869-2.045) deformidad angular en valgo, RR 0.22 (IC 0.27-1.846) rigidez articular, la osteosíntesis con placa en palo de hockey RR 2.68, osteosíntesis mínima RR 1.088 (IC 95% 0.7-3.1) para escala Orfaly & Keating no satisfactoria. Conclusión: Existe riesgo relativo positivo del género femenino para deformidad angular en valgo y del tratamiento con placa en palo de hockey y osteosíntesis mínima para evolución no satisfactoria de acuerdo a la escala Orfaly & Keating seis meses después de realizado el tratamiento quirúrgico.

Introduction: Proximal partial articular tibia fractures represent a great challenge for orthopedic surgeons due to their symptoms and complex management. Objective: To describe the results of surgical treatment of proximal articular fractures of the tibia. Material and methods: Descriptive study conducted at a tertiary care hospital. We included patients with proximal partial articular tibia fracture (Müeller AO/ASIF 41-B), of both sexes, with a six-month postoperative follow-up and a complete clinical record. Postoperative assessment was conducted with the Orfaly & Keating scale. We used descriptive statistics with central trend and scatter measurements, Fischer test for the relative risk and logistic regression. Results: The total number of patients was 25. Mean age was 41.6 (16-81), SD was 17.03 years; 15 patients were males (60%) and 10 females (40%); 1 (4%) had type-2 diabetes mellitus; the left side was affected in 17 (68%) patients; all patients underwent surgery with osteosynthesis; there was 100% match between the preoperative and postoperative diagnoses (Kappa 1.0); patient course was appropriate in 76% and acceptable in 24% (Orfaly & Keating); 16% had angular valgus deformity and 12% had joint stiffness. Females with RR 1.33 (CI 0.869-2.045) had angular valgus deformity; those with RR 0.22 (CI 0.27-1.846) had joint stiffness, RR was 2.68 for hockey stick plate osteosynthesis, and RR was 1.088 (CI 95%, 0.7-3.1) for the unsatisfactory course according to the Orfaly & Keating scale. Conclusion: A positive relative risk was found among females for angular valgus deformity, and in hockey stick plate osteosynthesis and minimal osteosynthesis for an unsatisfactory course, according to the Orfaly & Keating scale, six months after surgical treatment.

Várices gástricas: un reto para el manejo endoscópico / Gastric varices: a challenge for endoscopic management

La hemorragia de vías digestivas altas por várices gástricas, aunque menos frecuente que la secundaria a lasesofágicas, es una causa de alta mortalidad en los pacientes cirróticos. La ligadura es el tratamiento óptimoen las várices esofágicas, pero este tratamiento para las gástricas es todavía muy discutido.Presentamos el caso de una anciana, con antecedente de cirrosis hepática secundaria a esteatosis hepáticano alcohólica (NASH), que ingresa, con hemorragia de vías digestivas altas, evidenciándose en laesofagogastroduodenoscopia una várice fúndica subcardial con sangrado activo, para la cual se decide manejocon ligadura con banda de caucho con resultado exitoso y desaparición de la várice en control posterior

Upper digestive tract bleeding due to gastric varices, although less common than bleeding secondary toesophageal varices, is one of the causes of high mortality in cirrhotic patients. Although band ligation is theoptimal treatment for esophageal varices, its use for gastric varices is still hotly debated.We report the case of an elderly woman with a history of hepatic cirrhosis secondary to nonalcoholicsteatohepatitis (NASH) and obesity who was admitted to the hospital with upper digestive tract bleeding.An esophagogastroduodenoscopy showed an actively bleeding subcardial varice in the gastric fundus. Thedecision was made to manage the bleeding with rubber band ligation. The outcome was successful outcome,and the varice had disappeared in subsequent check-ups

Correlación microbiológica en cultivo de adenoides y glue en pacientes con OME / Microbiological correlation between adenoid and glue ear cultures in patients with OME

Introducción: La otitis media con efusión (OME) sigue siendo la patología otológica más prevalente en los preescolares de Chile; su etiología y factores predisponentes aún no están del todo claro; por ende su tratamiento es controversial. Objetivo: Demostrar una correlación microbiológica en cultivos de tejido adenoídeo y glue de ambos oídos en pacientes con OME. Material y método: Estudio prospectivo caso/control, donde se analizaron los cultivos bacterianos de tejido adenoideo y glue de ambos oídos en 40 pacientes con OME y cultivos bacterianos de tejido adenoídeo de 40 pacientes con hiperplasia adenoídea sin OME. Resultados: Casos: Cinco cultivos negativos de adenoides (12,5%), 28 positivos a comensales (70%) y 7 positivos a gérmenes no habituales (17,5%). El glue presentó cultivo negativo en 72,5% OD y 77,5% OI. Los cultivos de adenoides en los controles no difieren mayormente a los casos. Discusión: No se pudo establecer una correlación microbiológica entre glue y adenoides en pacientes con OME. Conclusiones: El número de cultivos de glue negativos se correlaciona con la literatura mundial. No existe un patrón que permita correlacionar los cultivos de adenoides de los casos con los cultivos de glue, ni con los cultivos de adenoides de los controles.

Introduction: Otitis Media with Effusion is still the most prevalent otological pathology in preschool children in Chile. Its etiology and predisposing factors are not entirely clear yet. Hence, its treatment is controversial. Aim: To demonstrate a microbiological correlation in adenoid tissue and glue ear cultures in both ears in patients with OME. Material and method: Prospective case control study, which analyzed bacterial adenoid tissue cultures and glue ear cultures in both ears in 40 patients with OME, and a second control group of bacterial cultures in 40 patients with adenoid hyperplasia without ear effusion. Results: Cases: Five negatives in adenoid cultures (12.5%), 28 positive to guest bacteria (70%) and 7 positive at unusual germs (17.5%). The glue ear presented negative culture at 72.5% in the right ear and 77.5% in the left ear. Adenoid control cultures did not differ with OME studied cases. Discussion: A microbiological glue ear and adenoid correlation could not be established. Conclusions: The number of negative glue ear cultures is similar to published literature. There is not a pattern which allows a positive correlation between adenoid cases cultures and glue ear cultures or with control adenoid cultures.

Caso clínico-radiológico: sífilis congénita / Clinical and radiological case: congenital syphilis

La sífilis es una infección potencialmente devastadora en el recién nacido, cuya incidencia ha ido aumentando. Se presenta el caso de un prematuro que evoluciona con falla respiratoria y compromiso multisistémico precoz secundario a sífilis congénita. Se comentan hallazgos en el examen físico, laboratorio e imágenes. Se discute sobre las formas de presentación en el niño, pruebas diagnósticas y diagnóstico diferencial.

Syphilitic infection in newborn could be a devastating disease with up ward trend in incidence. We present a case of newborn with congenital syphilis with early respiratory distress and multisystemic failure. Clinical, laboratory and imaging findings are commented. Clinical presentation, diagnostic test and differential diagnosis are discussed.

Resultados de la vigilancia de susceptibilidad antimicrobiana en Chile: Consolidando una red / Results of antimicrobial susceptibility surveillance in Chile: Consolidating a network

La resistencia antimicrobiana es un problema de salud pública en aumento. La generación de redes de vigilancia es una necesidad para la correcta comprensión y seguimiento de este fenómeno, además de ayudar a orientar las medidas para el control de su aparición y diseminación. En Chile, desde el año 2007 se constituyó un grupo colaborativo de resistencia antimicrobiana de centros de salud de varias regiones, que ha generado información respecto a la frecuencia de resistencia antimicrobiana de distintas especies bacterianas. En este artículo se presentan los resultados de la vigilancia del año 2009, con énfasis en su interpretación, limitaciones y perspectivas a futuro.

Antimicrobial resistance is an increasing public health issue. Creation of surveillance networks is a matter of major importance for antimicrobial resistance understanding and monitoring. Also, they contribute to design actions for controlling its appearance and dissemination. In 2007 a colaborative group in antimicrobial resistance was formed, representing several health institutions across the country. In this paper we report the results of 2009 surveillance with emphasis in its interpretation, limitations and future perspectives.

Novas metodologias analíticas para avaliação da eficácia fotoprotetora (in vitro) - revisão / New analytical methods for photoprotection effectiveness testing (in vitro) - a review

Atualmente, são utilizadas técnicas in vitro e in vivo para a avaliação do Fator de Proteção Solar (FPS) e do Fator de Proteção de UVA (FPA). O presente trabalho propõe a revisão das técnicas para as avaliações desses fatores in vitro preconizadas por FDA (Food and Drug Administration Agency) e COLIPA (European Cosmetic, Toiletry and Perfumery Association). O enfoque maior foi direcionado à análise espectrofotométrica de soluções diluídas e à espectrofotometria de reflectância com esfera integrada.

Currently, both in vitro and in vivo techniques are used to measure Sun Protection Factor (SPF) and UVA Protection Factor (APF). This paper reviews the in vitro techniques to test these factors, recommended by the FDA (USA Food and Drug Administration) and COLIPA (European Cosmetic, Toiletry and Perfumery Association). The main focus is on the spectrophotometric analysis of dilute solutions and the use of reflectance spectrophotometry with an integrating sphere.

Effect of (-)- Δ9 -tetrahydrocannabinoid on the hepatic redox state of mice

(-)-∆9-Tetrahydrocannabinol (∆9-THC), a psychoactive component of marijuana, has been reported to induce oxidative damage in vivo and in vitro. In this study, we administered (∆9-THC to healthy C57BL/6J mice aged 15 weeks in order to determine its effect on hepatic redox state. Mice were divided into 3 groups: (∆9-THC (N = 10), treated with 10 mg/kg body weight (∆9-THC daily; VCtrl (N = 10), treated with vehicle [1:1:18, cremophor EL® (polyoxyl 35 castor oil)/ethanol/saline]; Ctrl (N = 10), treated with saline. Animals were injected ip twice a day with 5 mg/kg body weight for 10 days. Lipid peroxidation, protein carbonylation and DNA oxidation were used as biomarkers of oxidative stress. The endogenous antioxidant defenses analyzed were glutathione (GSH) levels as well as enzyme activities of superoxide dismutase, catalase, glutathione S-transferase, glutathione reductase, and glutathione peroxidase (GPx) in liver homogenates. The levels of mRNA of the cannabinoid receptors CB1 and CB2 were also monitored. Treatment with ∆9-THC did not produce significant changes in oxidative stress markers or in mRNA levels of CB1 and CB2 receptors in the liver of mice, but attenuated the increase in the selenium-dependent GPx activity (∆9-THC: 8 percent; VCtrl: 23 percent increase) and the GSH/oxidized GSH ratio (∆9-THC: 61 percent; VCtrl: 96 percent increase), caused by treatment with the vehicle. ∆9-THC administration did not show any harmful effects on lipid peroxidation, protein carboxylation or DNA oxidation in the healthy liver of mice but attenuated unexpected effects produced by the vehicle containing ethanol/cremophor EL®.

Declaración del Comité Consultivo de Inmunizaciones de la Sociedad Chilena de Infectología acerca de la eficacia de la vacuna anti-neumocóccica 23 valente en el adulto mayor: Febrero 2010 / 23-Valent Pneumococcal Vaccine: Statement of the Consultive Committee of Immunizations on behalf of the Chilean Infectious Diseases Society: February 2010

The article summarizes the scientific evidence related with protection conferred by the 23 valent polysacchar-die vaccine against invasive pneumococcal disease, non bacteriemic pneumococcal pneumonia, and probable pneumococal pneumonia in the elderly. Eider patients with and without risk factors are considered. The impact of herd immunitty conferred by vaccination of children with conjugated pneumococcal vaccine in reduction of penumonia in adults is discussed. Based on this analysis, the Advisory Committee on Immunizations of the Chilean Infectious Disease Society makes recommendations on the most efficient vaccine strategy for reduction of pneumococcal pneumonia in the elderly.

El artículo resume los hallazgos de la evidencia científica en relación a la protección que confiere la vacuna neumocóccica polisacárida 23 valente contra la enfermedad neumocóccica invasora, las neumonías neumocóccicas no bacteriémicas y las neumonías probablemente de etiología neumocóccica en el adulto mayor, estableciendo una categorización entre adultos mayores con factores de riesgo y sin ellos. Se documenta a la vez, el impacto que ha tenido la vacuna neumocóccica conjugada en la población infantil, en reducir las neumonías en el adulto mayor. Basados en la información disponible, el Comité Consultivo de Inmunizaciones de la Sociedad Chilena de Infectología, realiza recomendaciones sobre cuál sería la mejor forma de prevenir las enfermedades neumocóccicas en el adulto mayor.

Avaliação da interação de compostos ativos hidratantes com modelo de biomembrana de Crotalus durissus por meio de calorimetria exploratória diferencial e espectroscopia RAMAN / Study of the interaction of moisturizers with a Crotalus durissus biomembrane by differential scanning calorimetry and RAMAN spectroscopy

O objetivo foi verificar as alterações no estrato córneo em modelos alternativos de membrana após a aplicação de ativos hidratantes envolvendo métodos biofísicos. O modelo de biomembrana utilizado foi a muda de pele de Crotalus durissus e os ativos hidratantes foram: uréia, silício orgânico, extrato vegetal de Imperata cylindrica, reação de xilitol e glicose e componentes de NMF. Os resultados da avaliação das alterações do modelo por meio de Espectroscopia Raman com Transformada de Fourier sugerem que os ativos hidratantes confirmam segurança necessária, pois não alteraram de forma acentuada a estrutura do estrato córneo. Utilizando-se Calorimetria Exploratória Diferencial pode-se indicar que a solução de silício orgânico e o gel hidrofílico com uréia apresentaram melhor poder hidratante.

The objective of this research was to use biophysical techniques to investigate the alterations induced in a biomembrane model of the stratum corneum by the application of moisturizers. The biomembrane was obtained from the skin shed by the rattlesnake Crotalus durissus and the active moisturizing compounds were: urea, dimethylsilanol hyaluronate, Imperata cylindrical plant extract, carbohydrates and natural moisturizing factors (NMF components). Results from FT-Raman spectroscopy suggested that the moisturizers were safe, since they did not promote modifications in the structure of the stratum corneum. Differential scanning calorimetry results indicated that the solution containing the organic silicon compound and the gel with urea showed the best hydrating effects on the stratum corneum.