Tumores fibroóseos de cavidades paranasales: experiencia en el Hospital Clínico de la Universidad de Chile y revisión de la literatura / Fibro-osseous tumors of paranasal cavities: experience in the Hospital Clínico de la Universidad de Chile and review of the literature

Los tumores de cavidades paranasales presentan una baja frecuencia. Dentro de éstos, entre los benignos destacan las lesiones fibroóseas que se caracterizan por el reemplazo de hueso normal por estroma celular fibroso. Dentro de estas lesiones se describen osteoma, displasia fibrosa y fibroma osificante. Se revisan 3 casos de pacientes del Hospital Clínico de la Universidad de Chile y se presenta una revisión bibliográfica en cuanto a las lesiones fibroóseas, su clínica, diagnóstico, imagenología y tratamiento.

The tumors of paranasal cavities present a low frequency. Among the benign tumors are fibro-osseous lesions characterized by the replacement of normal bone by fibrous cell stroma. Osteoma, fibrous dysplasia, and ossifying fibroma are described within these lesions. Three cases of patients from the Hospital Clínico de la Universidad de Chile are reviewed and a bibliographic review is presented regarding the fibro-osseous lesions, their clinical features, diagnosis, imaging and treatment.

Estudio cualitativo de la práctica fonoaudiológica en el contexto de rehabilitación basada en la comunidad, en la Quinta Región de Valparaíso / Community based speech and language rehabilitation qualitative study, in the fifth Region of Valparaíso

El enfoque de Rehabilitación Basada en la Comunidad (RBC) representa una estrategia cuyo propósito es lograr la plena integración e inclusión de las personas en situación de discapacidad (PsSD) a nivel social. Considerando que la comunicación y el lenguaje humano representan herramientas de expresión del pensamiento, la Asociación Americana de Habla, Lenguaje y Audición (ASHA) insta a promover el desarrollo de una comunicación efectiva como un derecho humano accesible para todas las personas, en consideración de su dignidad inherente. OBJETIVO: conocer el quehacer de fonoaudiólogos(as) que se desempeñan en el contexto de RBC, en la Quinta Región de Valparaíso. MÉTODO: investigación de tipo cualitativa, con enfoque fenomenológico. Se realizó una entrevista semiestructurada y posteriormente se procedió a realizar un análisis de contenido. RESULTADOS: Los fonoaudiólogos(as) ejecutan acciones atingentes a los cinco pilares de la RBC y se observa la práctica de actos vinculados a la gestión del intersector. CONCLUSIONES: Los profesionales adoptan la estrategia RBC incorporada en la visión de la institución en la que se encuentran insertos, adoptando un perfil orientado a la transdisciplina.

The Community Based Rehabilitation (CBR) approach represents a strategy whose purpose is to achieve full social integration and inclu sion of people with disabilities. Considering that communication and human language represent tools of expression of thought, the American Speech, Language and Hearing Association (ASHA) advo cates the development of effective communication promotion, as a human right accessible to all people, considering its inherent dignity. OBJECTIVE: to analyze speech and language pathologist's CBR prac tices in the fifth region of Valparaíso. METHOD: qualitative research, with a phenomenological approach. A semi-structured interview was conducted followed by a content analysis. RESULTS: speech and Language pathologists carry out actions related to the five CBR key components and also the practice of actions in accord to intersector. CONCLUSIONS: The professionals adopt the CBR approach incorporat ing the institutional vision of service in which they are inserted and adopting a profile oriented to transdisciplinary.

Effect of watershed land use on water quality: a case study in Córrego da Olaria Basin, São Paulo State, Brazil / Efeito do uso do solo em sub-bacias na qualidade da água: um estudo de caso na Bacia do Córrego da Olaria, Estado de São Paulo, Brasil

Abstract The water quality is related to the hydrologic and limnologic properties of ground and surface water, and significant efforts have been made to monitor water sources to understand the effects of land use changes in agricultural areas, with significant socioeconomic activities. The objective of this study was to evaluate the qualitative aspects of surface water in subbasins related to land use. Samples were analyzed in terms of physical and chemical parameters on monthly discrete water quality sampling in four representative sites at first order subbasin streams, located at the Polo Regional Centro Norte, Pindorama County, State of São Paulo, Brazil. The land use classification was made by visual detection technique in a multispectral satellite data obtained from LandSat8- spectral bands of the OLI sensor. The watershed was classified into major land cover/use classes and overlay maps generated in ArcGIS 10 indicated a significant shift from natural vegetation to agriculture activities. Water quality monitoring was according to the brazilian protocol and the results were submitted to analysis of variance (ANOVA). The values obtained differ significantly at each sampling point - subbasins, reflecting the effects of land use on water quality. Soil conservation management is important to optimize soil use in order to contribute to the control of water pollution and the formulation of a public policy is necessary for the conservation of water and soil resources.

Resumo A qualidade da água está relacionada com as propriedades hidrológicas e limnológicas das águas subterrâneas e superficiais, e esforços significativos devem ser realizados para monitorar as nascentes no intuito de compreender os efeitos das mudanças no uso da terra em áreas agrícolas, com atividades socioeconômicas significativas. O objetivo deste estudo foi avaliar os aspectos qualitativos das águas superficiais de bacias hidrográficas e correlacionar com o uso do solo. As amostras foram analisadas em termos dos parâmetros físicos e químicos na amostragem mensal discreta da qualidade da água, em quatro locais representativos de nascentes em microbacias de primeira ordem, localizadas no Polo Regional Centro Norte, Pindorama, Estado de São Paulo, Brasil. A classificação do uso do solo foi feita por técnica de detecção visual em uma imagem multiespectral de satélite LandSat8- bandas espectrais, sensor OLI. O uso do solo foi classificado nas principais classes de uso e os mapas de sobreposição gerados no ArcGIS 10 indicaram uma mudança significativa da vegetação natural para as atividades agrícolas. O monitoramento da qualidade da água foi realizado de acordo com o protocolo brasileiro e os resultados foram submetidos à análise de variância (ANOVA). Os valores obtidos diferem significativamente em cada ponto de amostragem, refletindo os efeitos do uso do solo sobre a qualidade da água. A gestão do solo e da água é importante para aperfeiçoar as práticas agrícolas, no intuito de contribuir para o controle da poluição da água e para a formulação de uma política pública necessária para a conservação dos recursos hídricos e do solo.

Effect of watershed land use on water quality: a case study in Córrego da Olaria Basin, São Paulo State, Brazil

Abstract The water quality is related to the hydrologic and limnologic properties of ground and surface water, and significant efforts have been made to monitor water sources to understand the effects of land use changes in agricultural areas, with significant socioeconomic activities. The objective of this study was to evaluate the qualitative aspects of surface water in subbasins related to land use. Samples were analyzed in terms of physical and chemical parameters on monthly discrete water quality sampling in four representative sites at first order subbasin streams, located at the Polo Regional Centro Norte, Pindorama County, State of São Paulo, Brazil. The land use classification was made by visual detection technique in a multispectral satellite data obtained from LandSat8- spectral bands of the OLI sensor. The watershed was classified into major land cover/use classes and overlay maps generated in ArcGIS 10 indicated a significant shift from natural vegetation to agriculture activities. Water quality monitoring was according to the brazilian protocol and the results were submitted to analysis of variance (ANOVA). The values obtained differ significantly at each sampling point - subbasins, reflecting the effects of land use on water quality. Soil conservation management is important to optimize soil use in order to contribute to the control of water pollution and the formulation of a public policy is necessary for the conservation of water and soil resources.

Resumo A qualidade da água está relacionada com as propriedades hidrológicas e limnológicas das águas subterrâneas e superficiais, e esforços significativos devem ser realizados para monitorar as nascentes no intuito de compreender os efeitos das mudanças no uso da terra em áreas agrícolas, com atividades socioeconômicas significativas. O objetivo deste estudo foi avaliar os aspectos qualitativos das águas superficiais de bacias hidrográficas e correlacionar com o uso do solo. As amostras foram analisadas em termos dos parâmetros físicos e químicos na amostragem mensal discreta da qualidade da água, em quatro locais representativos de nascentes em microbacias de primeira ordem, localizadas no Polo Regional Centro Norte, Pindorama, Estado de São Paulo, Brasil. A classificação do uso do solo foi feita por técnica de detecção visual em uma imagem multiespectral de satélite LandSat8- bandas espectrais, sensor OLI. O uso do solo foi classificado nas principais classes de uso e os mapas de sobreposição gerados no ArcGIS 10 indicaram uma mudança significativa da vegetação natural para as atividades agrícolas. O monitoramento da qualidade da água foi realizado de acordo com o protocolo brasileiro e os resultados foram submetidos à análise de variância (ANOVA). Os valores obtidos diferem significativamente em cada ponto de amostragem, refletindo os efeitos do uso do solo sobre a qualidade da água. A gestão do solo e da água é importante para aperfeiçoar as práticas agrícolas, no intuito de contribuir para o controle da poluição da água e para a formulação de uma política pública necessária para a conservação dos recursos hídricos e do solo.

Rol de anticuerpos anti- Toxoplasma gondii en la activación de la respuesta inmune en mujeres embarazadas / Role of anti-Toxoplasma gondii antibodies in immune responses in pregnant women

Objetivos: el estudio tuvo como objetivo evaluar in vitro el rol de anticuerpos anti T. gondii en la activación de la respuesta inmune en mujeres embarazadas. Métodos: el estudio se realizó con células mononucleares de sangre periférica (PBMC) de mujeres embarazadas con toxoplasmosis crónica (n=15) que fueron estimuladas en presencia y ausencia de plasma autólogo (PA) (anticuerpos anti T. gondii). Resultados: los datos muestran que en PBMC estimuladas en ausencia de plasma autólogo existe mayor proliferación celular (P<0.05) que células en presencia de plasma autólogo. Niveles de IFN-y producidos en ambas condiciones (PA y SBF) fueron similares. Comparando la producción de IFN-y vs IL-10 muestra mayor producción de citoquinas Th1. Conclusiones: en general nuestros resultados sugieren que los anticuerpos presentes en el plasma autólogo modulan la respuesta inmune en mujeres embarazadas con toxoplasmosis crónica, de tal modo que el sistema inmune no exacerbe o inhiba esta respuesta específica. La presencia de anticuerpos anti T. gondii no influyen en producción de IFN-y en mujeres embarazadas con toxoplasmosis crónica, pero si en la proliferación celular.

Objectives: the study aimed to evaluate in vitro the role of anti T. gondiiin activating immune responses in pregnant women. Methods: the study was performed with peripheral blood mononuclear cells (PBMC) of pregnant women with chronic toxoplasmosis (n = 15) were stimulated in the presence and absence of autologous plasma (PA) (anti T. gondii antibody). Results: the data show that in PBMC stimu-lated in the absence of autologous plasma there is increased cell proliferation (P < 0.05) than cells in the presence of autologous plasma. Levels of IFN- y produced in both conditions (PA and SBF) were similar. Comparing the production of IFN- y vs IL - 10 shows increased production of Th1 cytokines. Conclusions: in general, our results suggest that the antibodies present in autologous plasma modulate the immune response in pregnant women with chronic toxoplasmosis, such that the immune system does not exacerbate or inhibit this specific response. The presence of antibodies to T. gondii not affecting IFN- y production in pregnant women with chronic toxoplasmosis, but if cell proliferation.

Linfoma de células cutáneas de células T, tipo micosis fungoide folicular: reporte de un caso / Cutaneous T-cell lymphoma type mycosis fungoides follicular: case report

La Micosis Fungoide (MF) es el linfoma cutáneo más común de células T. Tiene un comportamiento indolente, llevando a algunos a utilizar el término de linfoma cutáneo de células T (LLCT) como sinónimo de la MF. Se caracteriza por una erupción cutánea crónica, generalizada, y clínicamente por la evolución de los parches en placas y tumores. A continuación se presentará un caso clínico que tras un diagnóstico de liquen plano refractario a tratamiento, se diagnostica micosis fungoide folicular.

Mycosis fungoides (MF) is recognized as the most common cutaneous T-cell lymphoma (CTCL). It has an indolent behavior, leading some to use the term cutaneous T-cell lymphoma as synonymous of MF. It is characterized by chronic, widespread rash, and clinically by the evolution of patches in plaques and tumors. We describe our experience with a case that after a diagnosis of lichen planus refractory to treatment, we diagnosed follicular mycosis fungoides.

Resultados del tratamiento con revascularización distal y ligadura intermedia, de la isquemia de mano después de acceso vascular para hemodiálisis / Distal revascularization-interval ligation for ischemic steal syndrome after hemodialysis access: experience in 23 patients

Background: The creation of vascular accesses for hemodialysis can cause distal ischemia and steal syndromes. Aim: To assess the effectiveness of the technique of distal revascularization-interval ligation to alleviate distal ischemia and preserve vascular access. Material and Methods: Retrospective review of medical records, identifying 23 patients (13 women, aged between 24 and 79 years), with distal ischemia secondary to a vascular access for hemodialysis, that were treated with distal revascularization-interval liga-tion. Patient characteristics and outcome of the surgical procedure were recorded. Results: Fourteen patients were diabetic and 15 had high blood pressure. All had the vascular access in the elbow, 20 were done with vein and three were prosthetic. Steal appeared in a lapse ranging from hours to six years after performing the procedure. In 14 patients it appeared before 12 months. Revascularization was performed between 1 day and three months after the appearance of the steal syndrome. Seventeen patients (74 percent) had a substantial relief of ischemic symptoms, with healing of ulcers and digital amputations. Three patients died soon after the procedure (13 percent). In two the pain persisted, requiring a banding of the access, that finally became thrombosed. One patient required a distal forearm amputation. Thirteen patients (56 percent) had a late death after the procedure. After revascularization, the vascular accesses were used for a mean of two years. Conclusions: Revascularization-interval ligation relieves distal ischemia and maintains the patency of the vascular access for hemodialysis. Patients with steal syndrome secondary to vascular access are of high risk.

Objetivo: Investigar la efectividad de la técnica de revascularización distal y ligadura intermedia (RDLI) en aliviar la isquemia y preservar el acceso arteriovenoso. Material y Métodos: Una revisión retrospectiva de fichas clínicas (1990-2010), identificó 26 pacientes con robo. Se excluyen 3, que se sometieron a ligadura del acceso; 23 fueron tratados con RDLI. Se obtuvo información demográfica, comorbilidades, antecedentes del acceso, morbimortalidad y respuesta al tratamiento. Resultados: De los 23 pacientes, 13 eran mujeres y 10 hombres, con edad promedio de 59 años (24-79 años). Catorce (61 por ciento) eran diabéticos y quince (65 por ciento) hipertensos. Todos con acceso en pliegue del codo, 20 con vena y 3 protésicos. La latencia en aparición del robo ocurrió antes de 12 meses, en 14 pacientes (78 por ciento); con rango desde horas a 6,5 años. La revascularización se realizó en tiempo variable entre 1 día y 13 meses; sólo 8 pacientes antes de los 30 días. El 74 por ciento de los pacientes (17), tuvo mejoría sustancial o completa de manifestaciones isquémicas, cicatrizando úlceras y amputaciones digitales. Tres fallecieron precozmente; en 2 pacientes, persistió el dolor, requiriendo banding del acceso, que finalmente se trombosó; un paciente debió ser amputado del antebrazo distal, pese a revascularización, al no ceder cuadro infeccioso. La mortalidad operatoria fue de 13 por ciento, correspondiendo a 3 pacientes muy deteriorados con isquemia severa. La mortalidad tardía fue de 56,5 por ciento (13 pacientes). El tiempo promedio de uso del acceso fue de 2 años, post revascularización. Conclusión: La RDLI es el procedimiento de elección en el tratamiento del robo, ya que elimina efectivamente la isquemia y mantiene en uso el acceso. Los pacientes con robo, especialmente diabéticos, representan un grupo de alto riesgo y mortalidad.

Evaluación de la efectividad del renikan: extracto del pelargonium sidoides estandarizado EPs7630 en el tratmiento de las infecciones de las vías respiratorias superiores de etiología viral / Evaluation of the effectiveness of renikan: standardized extract of Pelargonium sidoides tratmiento EPs7630 in infections of the upper respiratory tract viral etiology

Las infecciones respiratorias, uno de los síndromes más frecuentes a nivel comunitario pueden ser de dos tipos: infecciones del tracto respiratorio superior o inferior. En su gran mayoría son inicadas por una infección viral transformando el terreno vulnerable a la sobre infección bacteriana. Hasta 2/3 de los pacientes son tratados desde el inicio de los síntomas con antibióticos, aunque este tratamiento no influye positivamente sobre el curso de la enfermedad. Renikan, fitofármaco extraído de la raíz del Pelargonium Sidoides, posee un triple mecanismo de acción: antiviral, antibacteriano y mucolítico, antiviral, porque activa los mecanismos de defensa antivirales orgánicos, antibacetriano, por su actividad bacteriostática directa e indirecta, y mucolítico, por sus propiedades secretomotoras y expectorantes. El objetivo fue comprobar la efectividad y tolerabilidad de Renikan en el tratamiento de las infecciones respiratorias. Diseño abierto y multicéntrico. Se seleccionaron niños de 6 a12 años y adultos de cualquier sexo o raza, con infecciones del tracto respiratorio superior. A los cuales se le suministró Renikan durante 7 días continuos, se evaluó: evolución de los síntomas, necesidad de uso de antibióticos y la escala de resultados integraticos IMOs. Ingreason un total 305 pacientes, 156 adultos y 149 niños distribuidos en tres grupos de estudio: Rinosinusitis, 97 pacientes, los cuales presentaron mejoría de sus síntomas en un 86% en los adultos y no utilizaron antibióticos en un 86%; los niños mejoraron en un 80%, y no usaron antibióticos en 91%. En el caso de las Amigdalitis hubo 108 pacientes con una mejoría sintomatológica en adultos del 92% y en los niños el 89%, no antibióticoterapia en el 86% de los adultos y 93% de los niños. El uso de Renikan en pacientes con infecciones del tracto respiratorio superior, demuestra ser seguro y efecivo tanto en adultos como en niños mayores de 6 años

Respiratory tract infections are the most common syndromes at community, there are two types: upper and lower respiratory tract infections. The vast majoritary are stared by a viral infection transforming the land vulnerable into a bacterial infection. The 2/3 o patients is treated from the onset of symptoms with antibiotics, although it is known that this treatment not positively influences the course of the disease. Renikan, herbal extrated fron the root of pelargonium sidoides has a threefold mechanism of action: antibiotic and mucolytic, antiviral, because it activates the natural antiviral mechanism of defense; antibacterial, due to its direct and indirect bacterostatic action and mucolytic, owing to its secretomotory and expectorant properties. To test the effectiveness and tolerability of renikan in the treatment of respiratory infections. Open desing, multicenter study. We selected children 6-12 years'age and adults of any sex orrance with upper respiratory tract infecctions. Theyreceived renikan for 7 consecutive days, changes in symptoms; necessity of antibiotic use and the integrative medicine outcome scale (IMOS) were evaluated. Of total of 305 patients, 156 adults and 149 children were divided into three groups: 97 rhinosinusitis patients, who showed symptoms improvement in 86% of adults and 91% of children, in 108 tonsillitis patients, an improvement of symptoms was found in 92% of adults and 89% of children, no antibiotic use were in 86% of adults and 93% of children, and, in a third group consistng of 100 patients with bronchitis, improvement was report in 98% od adults and in 73% of children, no antibiotics were used in 88% of adults and 96% of children. The use of concomitant therapy decreasedin 50% of cases and only 0.02% of patients had adverse events. The use of renikan use in patients with upper respiratory tract infections was shown to be safe and effective in both adults and children over 6 years of age

Composition, diversity and short-term temporal fluctuations of zooplankton communities in fish culture ponds (Pindamonhangaba), SP / Composição, diversidade e flutuações temporais de curto prazo da comunidade zooplanctônica de viveiros de piscicultura (Pindamonhangaba), SP

The present study aimed at evaluating the composition, diversity and short-term temporal fluctuations of zooplankton communities in fish ponds. The study was carried out in two fish ponds, with 180 m² of water surface (6 × 30 m) each, located in the Aquiculture Centre of the Pindamonhangaba Fisheries Institute - São Paulo. The study was developed over eight weeks, from February 16 to April 6, 1998. The physical and chemical conditions of the water in the fish ponds were adequate for zooplankton development. The zooplanktonic community was characterised by high richness of species and a greater diversity was observed in the first fish pond, with a superior density of Rotifera. Temporal changes in zooplankton composition occurred in both ponds with Cladocera appearing in abundance later, in the fourth week, whereas copepods and rotifers were well represented since the beginning. Many species found are typical of fish ponds and are considered to constitute an excellent food source, showing high nutritional value for fish larvae, a good example being individuals from the Rotifera group and the micro-crustacean species Moina minuta and Thermocyclops decipiens.

O presente estudo visou avaliar a composição, a diversidade e a flutuação do zooplâncton em dois viveiros escavados na terra com 180 m² de espelho d'água (6 × 30 m) cada um, no Núcleo de Aquicultura do Instituto de Pesca de Pindamonhangaba-SP. O estudo foi realizado durante oito semanas, no período de 16 de fevereiro a 6 de abril de 1998. As condições observadas, em relação às características físicas e químicas da água dos viveiros, foram adequadas ao desenvolvimento dos organismos zooplanctônicos. A comunidade zooplanctônica foi caracterizada por elevada riqueza de espécies, com maiores densidades de organismos pertencentes ao grupo Rotifera. Mudanças temporais na composição do zooplâncton ocorreram em ambos os tanques, com Cladocera aparecendo em maior abundância mais tarde, na quarta semana, enquanto que copepodos e rotíferos foram bem representados desde o início. Muitas espécies encontradas são típicas de viveiros de piscicultura e constituem excelente fonte alimentar, apresentando alto valor nutritivo para larvas de peixes, como por exemplo os indivíduos do grupo Rotifera e as espécies Moina minuta e Thermocyclops decipiens.

Calidad de vida de los médicos residentes del programa de formación de especialistas en pediatría / Quality of life of physicians from pediatrics training programs

Background: In the quest to improve their professional opportunities and quality of life (QOL), physicians enter to Specialty Residency Training Programs. However, the process confronts them to a series of stressing factors that could, in short term, affect their health and wellbeing. Objective: To explore aspects related to professional QOL and stressing factors experienced by pediatric residents trained in public universities at Chile. Methods: A semi-structure survey was designed, validated and administered to pediatric residents from Chilean public universities, contacted in specialty meetings and visits to their training hospitals, between November 2006 and March 2007. Results: 79 pediatric residents were contacted, 65 percent) belonging to training centers located at the Metropolitan Region and 35 percent> to centers from provinces. The residents were thankful for the opportunity to express their opinions. 78.5 percent> were female and their average age was 29 years (range 25-40). 6/10 worked after hours, with an average of 18.5 hours/week and 5/ 10 worked night shifts. 50 percent> reported physical health problems and 30 percent> reported mental health problems, not related to the socio-demographic factors analyzed. In regard to stressing factors, 53 percent> of residents mentioned the excessive work load related to patient care and 33 percent> the lack of teaching and adequate supervision. In terms of career goals, 71 percent reported interest in continuing a subspecialty; although 50 percent> of residents would like to work in a hospital, only 25 percent> believe they would be able to do so. Conclusions: The current exploratory study analyzes into aspects related to QOL and mental health of pediatric residents in Chile. It would be of great interest to continue this line of research, adding the use of standardized tools and qualitative aspects, to further investigate the stressing factors and strengths of the residency training programs that could he...

Introducción: En busca de mejorar las oportunidades laborales y calidad de vida (CDV), los médicos optan por los Programas de Formación de Especialistas (PFE); no obstante, este proceso los enfrenta a una serie de factores estresantes que podrían afectar, a corto plazo su salud y bienestar. Objetivo: explorar aspectos relacionados con la CDV profesional y factores estresantes de los residentes de PFE de Pediatría de las Universidades Públicas Chilenas. Metodología: Se diseñó, validó y aplicó una encuesta semiestructurada a una muestra de oportunidad de residentes de pediatría de las universidades públicas chilenas, los que fueron contactados en congresos de la especialidad y en visitas en sus centros de formación, entre noviembre/ 2006 y marzo/ 2007. Resultados: Se contactaron 79 residentes de pediatría (39,5 por ciento del universo), 65 por ciento provenían de Centros Formadores de la Región Metropolitana 35 por ciento de provincia. Los residentes se sintieron agradecidos de poder emitir su opinión. El 78,5 por ciento de los encuestados era de sexo femenino, edad promedio 29 años (rango 25 a 40). Seis de cada 10 trabajaba horario extra, promedio de 18,2 horas semanales y 5 de cada 10 realizaba guardias nocturnas. La mitad declaró tener algún problema de salud física y un tercio problemas de salud mental, sin relación con los factores sociodemográficos estudiados. Respecto a los factores estresantes, 53 por ciento de los encuestados mencionó la carga asistencial excesiva y 33 por ciento la falta de docencia y de adecuada supervisión. En cuanto a la proyección laboral, 71 por ciento refirió interés por continuar con una subespecialidad y, pese a que a uno de cada dos residentes le gustaría trabajar en hospitales, sólo uno de cada cuatro pensaba que efectivamente lo haría. Conclusiones: El presente estudio, de carácter exploratorio, nos brinda una visión sobre aspectos relacionados con la CDV y salud mental de los residentes de pediatría de nuestro país.

Dificultades de lenguaje en preescolares: concordancia entre el test TEPSI y la evaluación fonoaudiológica / Language difficulties in pre-scholars: concordance between TEPSI test and speech therapist evaluation

Background: Language deficits cause difficulties in the family, school and social settings, so early detection and intervention are crucial. In Primary Care, children undergo developmental screening using the TEPSI test, which includes language at 4 years-old. Objective: Establish the frequency of language delay in children at pre-school, determined by specific language tests, in order to establish their concordance with TEPSI test. Method: Children between 3 and 5 years-old, attending 2 low-income pre-school facilities from the North Metropolitan Area, were evaluated during 2006. The information was obtained in a blind and simultaneous mode through TEPSI test performed by nurses and 3 specific language tests performed by speech therapists. A performance < p10 or < 2SD in one or was more language tests was considered a deficit. The concordance and discordance between both evaluations were established. Results: From a total of 219 children, 194 (89 percent) completed the evaluation. 48 percent had a language deficit by speech evaluation and 13,9 percent by TEPSI test. The concordance between both evaluations was poor (Kappa 0,2), with a significant discordance (p < 0,0000) by Mc NemarÆs X². Conclusion: The frequency of language problems in this population is high; a poor concordance between the tests used in Primary Care and language evaluations performed by speech therapists was found. The differences could be caused by the different aspects of language being evaluated. The findings lead to reconsider the screening strategies used in Primary Care and to implement language stimulation programs directed to low-income populations at high risk for language deficits.

Introducción: Los déficit del lenguaje conllevan dificultades en el contexto familiar, escolar y social, siendo fundamental la pesquisa e intervención precoz. En la atención primaria (APS) el lenguaje se evalúa en el marco del desarrollo psicomotor (DSM), a los 4 años mediante el test de TEPSI. Objetivo: Describir la frecuencia de déficit de lenguaje en preescolares asistentes a jardín infantil según pruebas de lenguaje específicas y establecer la concordancia entre estas pruebas y el TEPSI. Metodología: Se evaluó a todos los niños entre 3 y 5 años, asistentes a dos jardines infantiles de nivel socioeconómico bajo, del área Norte de la Región Metropolitana. La información se obtuvo en forma simultánea y ciega mediante la aplicación del TEPSI por enfermeras y la evaluación del lenguaje con dos pruebas específicas aplicadas por fonoaudiólogos. Se consideró un desempeño deficitario cuando el rendimiento en una o más pruebas de lenguaje fue < p10 ó < 2DS para la edad. Se estableció la concordancia y discordancia entre ambas evaluaciones. Resultados: De un total de 219 niños, 194 (89 por ciento) completaron la evaluación con los instrumentos señalados. 48,8 por ciento presentó dificultades del lenguaje según la evaluación fonoaudiológica y 13,9 por ciento según TEPSI. La concordancia entre ambas evaluaciones fue pobre (Kappa 0,2), con una discordancia altamente significativa p < 0,0000 según X² de Mc Nemar. Conclusión: Destaca la alta frecuencia de problemas de lenguaje en la población estudiada y la pobre concordancia entre las pruebas aplicadas en APS y la evaluación fonoaudiológica. Las diferencias podrían deberse a los distintos aspectos del lenguaje considerados en las evaluaciones. Los hallazgos invitan a replantear las estrategias de pesquisa utilizadas en APS y a la implementación de programas integrales de estimulación en poblaciones desfavorecidas, consideradas de riesgo para problemas de lenguaje.

Factores de riesgo asociados a déficit del desarrollo psicomotor en preescolares de nivel socioeconómico bajo: comuna urbano rural: Región Metropolitana, 2003 / Risk factors associated with developmental delay in pre-school children from a low income urban/rural community of Santiago, Chile

Introducción: La ciencia ha demostrado la importancia del desarrollo infantil temprano. En nuestro país se realizan evaluaciones seriadas y estandarizadas del desarrollo psicomotor (DSM) en lactantes y preescolares, con el propósito de pesquisar e intervenir precozmente trastornos del desarrollo. Objetivo: Identificar factores de riesgo (FR) para déficit DSM en preescolares de bajo nivel socioeconómico, pertenecientes a un centro de salud familiar (CESFAM), comuna urbano rural, área norte, Región Metropolitana. Metodología: Revisión retrospectiva de 159 fichas individuales y familiares de preescolares sanos, con TEPSI correspondiente a los 4 años, realizado, según programa, el 2003. Grupo estudio (GE): todos los niños con déficit del DSM. Grupo comparación (GC): selección secuencial de fichas con test normal realizado durante el último trimestre. Resultados: El 2003 se realizó TEPSI a 541/610 niños en control en el CESFAM. GE 76 niños con déficit, GC 83 preescolares con DSM normal. 23 por ciento GC tenía algún subtest alterado, generalmente lenguaje. FR déficit DSM: varones (p 0,0006), familias de mayor pobreza (p 0,0018), captación en CESFAM posterior a 12 meses de edad (p 0,0075), no asistencia a educación preescolar (p 0,0075), sospecha de déficit DSM en evaluaciones previas (p 0,0013) y madres analfabetas (p 0,018). Conclusiones: Se identifican los factores de riesgo de déficit del desarrollo psicomotor en la infancia, destacando el bajo nivel socioeconómico y las acciones de prevención y educación. La importancia de conocer los FR es identificar aquellos niños que requieren de una intervención más dirigida, para favorecer la expresión de su potencial.

Estandarización de un método diagnóstico diferencial no invasivo para la detección de enfermedad celíaca / Standardization of a method diagnoses differential non invasive for the detection of disease celiaca

La transglutaminasa tisular (tTG) se conoce como el autoantígeno más específico en pacientes con enfermedad celíaca. Por ello, nuestro objetivo fue estandarizar un ensayo ELISA para detectar anticuerpos específicos anti-tTG en pacientes con dicha patología. Se purificó la tTG a partir de hígado de cobayo y compararla con la tTG de una casa comercial, comprobando su eficacia en la inducción de anticuerpos en conejos inmunizados. La tTG procesada en el laboratorio se purificó unas 100 veces respecto al extracto original, conservando una elevada actividad tTG; además se demostró que la tTG purificada estaba en condiciones más puras que la de la casa comercial. El método ELISA para detección de anticuerpos IgA anti tTG se probó con ambas tTG (purificada y comercial) en 5 pacientes celíacos, 15 controles de diagnóstico diferencial y 8 controles sanos. A pesar de lo bajo de la muestra se observó una diferencia significativa (p=0.019) en el grupo de celíacos respecto a los sanos empleando la tTG purificada, no así en los otros grupos ni con la tTG comercial. La tTG purificada es mejor con relación a los resultados obtenidos con la tTG comercial, a pesar de la ausencia de estandarización del ensayo por la baja muestra de pacientes con enfermedad celíaca activa

Ruptura espontánea de aorta abdominal infrarrenal no aneurismática / Spontaneous rupture of the infrarenal abdominal aorta, non aneurysmal

Un hombre de 24 años, previamente sano y sin factores de riesgo conocidos, ingresa al servicio de urgencias con abdomen agudo, anemia y lipotimia. La exploración quirúrgica de emergencia revela ruptura de aorta abdominal infrarrenal. El manejo consistió en resección de pared aórtica y revascularización aórtica con tubo de dacrón, bajo arterias renales y sobre bifurcación aórtica. No se realizan exámenes imagenológicos previos a la cirugía por la urgencia del cuadro. Biopsia de pared aórtica mostró disminución de fibras elásticas en la túnica media y hematoma disecante en organización, no encontrándose necrosis quística. Evoluciona posteriormente sin complicaciones, quedando asintomático. Cuatro meses después, reingresa con dehiscencia de anastomosis proximal aortoprotésica y hemoperitoneo, falleciendo en shock y trastorno de la coagulación, posterior a exploración quirúrgica de urgencia. Se considera a la disección como factor etiológico, en la ruptura espontánea de aorta abdominal infrarrenal, con extensión proximal que explicaría la dehiscencia tardía. Esfuerzos diagnósticos y manejo de factores de riesgo, deben ser considerados en pacientes sintomáticos, en los cuales la intervención quirúrgica es necesaria, dada la alta mortalidad de la ruptura.

Necesidades de adiestramiento en gerontología y geriatría del personal que ofrece servicios en una institución de cuidado geriátrico / The need for training in gerontology and geriatrics among the staff providing services at a geriatric care institution

The purpose of this qualitative study was to explore and identify the basic training needs of nursing home staff, in terms of attitudes, knowledge and skills required to work effectively with geriatric patients. Three focus groups were performed, two groups of employees, and a group of elderly residents of the institution, in order to explore issues pertaining to the following topics: personal attributes required to work with geriatric patients, basic knowledge and skills needed to provide effective services. Group discussions were transcribed and themes were extracted through consensus reached by the investigators. Results indicated that the interviewed staff lack of formal preparation or continuing education in gerontology or geriatrics. Needs identified were the following: the aging process, caring behaviors, management of common health conditions, administration of medications, transference and mobility of residents, among others. Finding were use to design an educational program aimed in assisting nursing home staff in providing an effective service to their geriatric patients.

Malformaciones del sistema nervioso central en el Hospital Clínico de la Universidad de Chile y maternidades chilenas participantes en el estudio colaborativo lationamericano de malformaciones congénitas, ECLAMC / Central nervous system malformations in Chilean hospitals participating in the Latin American collaborative study of congenital malformations, ECLAMC

Background: In Chile, the rates of central nervous system congenital malformations at birth remain high, when compared with the rest of the world. Aim: To report the rates of central nervous system congenital malformations in Chilean hospitals. Material and methods: Using the ECLAMC protocol, every malformed newborn or stillbirth, weighing more than 500 g at birth is registered using a standard protocol, and the next non malformed child of the same sex born in the same hospital is assigned as control. Results: The rates of central nervous system congenital malformations are higher at the University of Chile Clinical Hospital than in the rest of Chilean hospitals or Latin American Hospitals. There are significantly higher rates of anencephalia in Concepcion and spina bifida in Valdivia, Rancagua and Concepcion. In the University of Chile Clinical Hospital, global annual rates have a negative slope of -0.0259 per 1000 born alive, with a correlation coefficient of -0.125 (p <0.05). The slope is positive among children born alive, with an annual rate increase of 0.071. Among stillbirths, the slope is -0.47 per 1000 born alive. Sixty two percent of malformed children were female. Among children with neural tube defects, 30 per cent had a malformed relative and, of these, 66 per cent had the same malformation. Conclusions: Family clustering of neural tube defects, supports the influence of a genetic factor influencing their appearance

The effect of abiotic factors on the hatching of Moina micrura Kurz, 1874 (Crustacea: Cladocera) ephippial eggs

The roles of some abiotic factors in controlling the hatching rates of Moina micrura ephippial eggs were investigated. Determination of optimum hatching conditions would be important in developing the use of this species as a food for fish larvae in aquaculture. Ephippia were exposed to different treatments in the laboratory, and monitored for hatching over a period of seven days. Optimum hatching conditions were: pH 5-9, temperature 25ºC, photoperiod eight or more hours light per day and light intensity equal to or greater than 850 lux. Differences in water ionic concentrations (from deionized water to 880 mg.L FONT FACE=Symbol>- /FONT>1 of selected salts) had no effect.

Foram investigados os efeitos de alguns fatores abióticos na taxa de eclosão dos ovos efipiais de Moina micrura. O conhecimento das melhores condições para a eclosão desses ovos pode ser importante na utilização dessa espécie para a aqüicultura, como alimento para larvas de peixes. Os efípios foram expostos a diferentes experimentos em laboratório por um período de sete dias. As melhores condições de eclosão foram: pH de 5 a 9, temperatura de 25ºC, fotoperíodo de oito ou mais horas de luz e intensidade luminosa igual ou maior que 850 lux. Diferentes concentrações de íons na água (de água deionizada e até 880 mg.L FONT FACE=Symbol>- /FONT>1 de sais selecionados) não influenciaram a eclosão.

The effect of abiotic factors on the hatching of Moina micrura Kurz, 1874 (Crustacea: Cladocera) ephippial eggs

The roles of some abiotic factors in controlling the hatching rates of Moina micrura ephippial eggs were investigated. Determination of optimum hatching conditions would be important in developing the use of this species as a food for fish larvae in aquaculture. Ephippia were exposed to different treatments in the laboratory, and monitored for hatching over a period of seven days. Optimum hatching conditions were: pH 5-9, temperature 25ºC, photoperiod eight or more hours light per day and light intensity equal to or greater than 850 lux. Differences in water ionic concentrations (from deionized water to 880 mg.L-1 of selected salts) had no effect

Malformaciones invalidantes en Chile: estudio ECLAMC 1982-1997 / Disabling congenital defects in Chile: ECLAMC 1982-1997

Background: The ECLAMC (Estudio Colaborativo Latinoamericano de Malformaciones Congénitas) is an epidemiological surveillance program for congenital defects that operates in Chile since 1969. Aim: To communicate the frequency of disabling congenital defects in Chile in the period 1982-1997. Material and methods: A review of the ECLAMC registry, choosing 12 congenital defects: amelia, limb amputations, limb reductions, arthrogryposis, hip luxation and subluxation, spina bifida, hydrocephaly, microcephaly, cephalocele, talipes equinovarus, Down syndrome and multiple abnormalities. Results: In the study period, 283,403 births occurred and 7,917 newborns were malformed (7,654 born alive and 263 stillbirths). The congenital defects prevalence rates appeared higher in Chile than in other Latin American countries, specially among stillbirths. Among the studied maternity hospitals, the Clinical Hospital of the University of Chile, showed the higher prevalence of congenital defects. Rancagua and the Navy Hospital in Valparaiso have a high frequency of Down syndrome. Global rates in Chile and in the rest of ECLAMC for specific defects, do not have significant differences, except for hip subluxation, that has a lower incidence in Chile. Conclusions: The ECLAMC allows to have a good knowledge of the prevalence of congenital malformations in Latin America

Isquemia aguda de la mano secundaria a la admmnistración intraarterial de cloxacilina / Hand acute ischemia secondary to the intraarterial administration of cloxaciline

La isquemia aguda de la mano, luego de la inyección intraarterial de medicamentoses un problema frecuente, de difícil manejo, y que requiere tratamiento médico urgente. Este reporte describe un caso de inyección inadvertido de cloxacilina en arteria humeral, con isquemia grave de mano, que llegó a la amputación digital. Se discute patogénesis y opciones de tratamiento