Avances sobre síndrome antifosfolípido / Advances in antiphospholipid syndrome

El Síndrome antifosfolípido (SAF) es una trombofilia adquirida, que se caracteriza por presentar eventos trombóticos recurrentes y complicaciones obstétricas en presencia de anticuerpos antifosfolípidos (aFL), los cuales son pesquisados por pruebas de laboratorio como anticoagulante lúpico y anticuerpos anticardiolipina. En esta revisión se muestran los aspectos más relevantes del SAF, destacando los avances en fisiopatología y criterios diagnósticos.

Factor V Leiden y mutación de la protrombina G20210A en pacientes con trombosis venosa y arterial / Factor V Leiden and prothrombin G20210A among Chilean patients with venous and arterial thrombosis

Background: Factor V Leiden and G20210A mutation of prothrombin gene are two important genetic polymorphisms associated with an increased risk for thrombosis. Aim: To establish the prevalence of factor V Leiden and prothrombin G20210A mutation in the Chilean population and their association to venous and arterial thromboembolism. Material and methods: A case-control study was conducted where 149 patients with thrombosis (87 with arterial and 62 with venous thrombosis) confirmed by CAT-scan, electrocardiogram and cardiac enzymes or Doppler depending on the case, and 160 healthy blood donors were genetically analyzed for the presence of both polymorphisms. Results: Factor V Leiden mutation was found in 5.4% of patients and in 1.3% of healthy controls (p=0.04). Heterozygosity for G20210A prothrombin mutation was found in 5.4% of patients and in 2.5% of the control group (p=NS). When arterial and venous thrombosis were considered as separate entities, 4.6% of patients with arterial thrombosis and 6.5% with venous thrombosis presented factor V Leiden (p=NS). Likewise, 8.1% of patients with venous thrombosis and 3.5% of patients with arterial thrombosis had G20210A prothrombin mutation (p=NS). Conclusions: In non selected consecutive Chilean patients with arterial and venous thrombosis the frequency of factor V Leiden and prothrombin G20210A is less than we could expect from their prevalence in the general population.

Utilización de ciprofloxacino tópico en el tratamiento de la otitis media crónica / Utilization of topical ciprofloxacin in the treatment of chronic otitis media

Se efectuó una experiencia clínica en el tratamiento de la otitis media crónica (OMC) supurada no colesteatomatosa con ciprofloxacino tópico. En 34 pacientes (38 oídos) con OMC se prescribió ciprofloxacino al 0,3 por ciento, siete gotas tres veces al día durante 10 días como única terapia. Previo al inicio del tratamiento se tomaron cultivos de la secreción ótica aislándose principalmente Proteus mirabilis, Klebsiella pneumoniae, Pseudomona aeruginosa y Staphilococcus aureus, todos los cuales, excepto un caso, fueron sensibles a ciprofloxacino. Se obtuvieron resultados buenos y muy buenos en un 79 por ciento de los casos, tan satisfactorios o mas que aquellos obtenidos en el grupo control de pacientes tratados con aminoglicósidos tópicos. Después de la aplicación de ciclofloxacino tópico no se observaron efectos ototóxicos en los pacientes. Los autores concluyeron que el uso de ciprofloxacino tópico en la OMC supurada no colesteatomatosa da resultados tan buenos o mejores que los obtenidos con aminoglicósidos tópicos y sin los potenciales efectos ototóxicos de estos últimos

Importancia del déficit de inhibidores de la cristalización en la etiopatogenia de la urolitiasis / Importance of crystallization inhibitors deficit in the etiopathogenic of urolithiasis

Background: five percent of consultations at the emergency room of Catholic University Hospital are due to nephrolithiasis. The causes of this high frequency remain unknown. Aim: to know the main metabolic and anatomic factors involved in the genesis of nephrolithiasis. Patients and methods: 41 patients (31 male) were studied presenting with a renal colic were studied as soon as the acute episode subsided and without diet modifications. Fasting blood calcium and creatinine and 24 h urine calcium, uric acid, citrate, magnesium and pH were measured and an intravenous pyelogram was performed. 21 subjects without a history of nephrolithiasis were used as controls. Results: Patients with nephrolithiasis did not differ from controls in urinary calcium (159 ñ 67 and 172 ñ 67 mg/24 h respectively), uricosuria (417 ñ 171 and 431 ñ 121 mg/24 h respectively) or urinary magnesium (55 ñ 19 and 62 ñ 21 mg/24 h respectively, whereas urinary citrate was lower (219 ñ 172 vs 319 ñ 179 mg/24 h in controls p <0.05). All patients had a normal renal functions, urinary acidification and intravenous pyelogram. Seven percent of patients with nephrolithiasis had hypercalciuria, 2.4 percent had hyperuricosuria, 68.3 percent had a low urinary citrate and 44.4 percent had low urinary magnesium. Conclusions: in this sample, there is a strong association of nephrolithiasis with low levels of crystallization inhibitors in special with urinary citrate, a crystallization inhibitor