Las mujeres en la medicina chilena: desde los tiempos de Eloísa Díaz a la actualidad / The presence of women in Chilean medicine: from the times of Eloísa Díaz to this day

Though the presence of many women in medicine goes unnoticed today, their incorporation to the field was slow and difficult. It took until the end of the nineteenth century for women to be finally allowed to study at the University in Chile, being Eloísa Díaz the first woman to become a medical doctor in 1887. In that century, only six women became medical doctors. However, throughout the twentieth century, this small proportion of women in medicine increased at a similar rate as tuition did in the schools of medicine, especially from the 1960's when limited quotas for women were abolished. At present, women doctors constitute 40% of the total pool of medical doctors in Chile, being present in all specialties, though preferably found as general practitioners, family doctors and pediatricians. While many women have stood out in academia and in politics, they have also successfully reached high positions in scientific societies (and other offices such in the Health Ministry, and even the country's presidency) their participation is still limited in these areas. It is only fair to conclude that the outstanding participation that women in Chilean medicine enjoy today is not solely due to their long-lasting efforts, but more importantly, to their tireless struggle to overcome prejudice, discrimination and misunderstanding; the latter being especially represented by pioneer women of medicine.

La innovación curricular en la Facultad de Medicina de la Universidad de Chile / Curricular innovation at the Faculty of Medicine, University of Chile

This article describes the process of curricular innovation iniciated by the University of Chile Faculty of Medicine in 2006. It uses as a core document the “Educational Model of the University of Chile Faculty of Medicine”, published in 2012, where the main principles of the innovation are declared.

Accidentes de riesgo biológico entre estudiantes de carreras de la salud: Cinco años de experiencia / Biological risk accidents among undergraduate healthcare students: Five years experience

Undergraduate healthcare students are exposed to bloodborne pathogens, and data from developing countries is scarce. We report the experience of a comprehensive program dedicated to the management of this risk. The program includes financial coverage, a 24-hour attention system, HIV, HBV, HCV testing, and free provisión of post-exposure antiretroviral drugs. During 2003-2007, incidence rates of these exposures reached 0.9 per 100 student-years. Events were only observed among medicine, nursing, and midwifery students, with rates highest among nursing students (RR 3.5 IC95 1.93 - 6.51). Cuts andneedle stick injuries predominated (74.7 percent of accidents). Three students were exposed to HIV patients (1.9 percent), all of them received prophylactic drugs, infection was discarded after follow up, and also discarded after exposures to HBV or HCV (0.6 percent of all accidents). Cost per 1000 student-year was less than 2000 USD. Healthcare students are exposed to biological risks during their studies and a comprehensive program is feasible in a developing country.

Los estudiantes de pregrado de las carreras de la salud están expuestos a riesgos biológicos con agentes de transmisión sanguínea. En este trabajo se reporta la experiencia acumulada con un programa integral para este tipo de accidentes y que incluye atención gratuita las 24 horas, estudio serológico de la fuente para VIH, VHC y VHB, y entrega de anti-retrovirales post-exposición a pacientes infectados por VIH. Desde el año 2003 al 2007 la tasa de incidencia alcanzó una cifra de 0,9 eventos por 100 estudiantes-año. Las exposiciones de riesgo fueron observadas sólo entre estudiantes de medicina, enfermería y obstetricia, siendo la mayor tasa en alumnos de enfermería (RR 3,5 IC95 1,93 a 6,51). Tres alumnos estuvieron expuestos a pacientes con infección por VIH (l,9 por cientoo de todos los accidentes), todos ellos recibieron profilaxis, descartándose seroconversión en el seguimiento, al igual que en casos con exposición ante VHB y VHC (0,6 por cientoo del total de accidentes). El costo del programa fue menor a US$ 2000 por 1.000 estudiantes-año. Los estudiantes de las carreras de la salud están expuestos a riesgos biológicos durante sus estudios y requieren de un programa de manejo, el que es posible de lograr en un país en desarrollo.

Restauración de la inmunidad innata en pacientes con infección por VIH/SIDA después de inicio de terapia antirretroviral / Innate immunity restoration in patients with HIV/AIDS infection associated with antiretroviral therapy

Background: Highly active antiretroviral therapy (HAART) in HIV/AIDS infection induces an important reduction of the viral load (VL) and an immune system reconstitution. CD4+ T lymphocyte count is the immunological measurement commonly used for the follow up of HIV/AIDS patients. Aim: To study prospectively the restoration of the innate immune system in patients with HIV/AIDS infection during their first year on HAART. Patients and Methods: 25 naive HIV/AIDS patients, from San José Hospital and University of Chile Clinical Hospital, Santiago, Chile, were studied between years 2002-2003. Every 4 months after HAART initiation, CD3+, CD4+, CD8+ T lymphocytes and CD16/56+ natural killer (NK) cells were quantified by flow cytometry. NK cell cytotoxicity was measured using radioactive chrome liberation (Cr51). Tumor necrosis factor alpha (TNF-a) and interleukin-10 (IL-10) were measured in peripheral blood mononuclear cells and viral load was determined using Amplicor HIV-1 from Roche Diagnostics Systems. Results: Thirteen of the 25 patients continued in the study. They were all males, average age 35 years old (23-50). At baseline average CD4+ count was 146 cells/µL (31-362) and average viral load was 82.000 copies/mL (4.000-290.000). A raise in CD3+, CD4+, CD8+, and CD16/56 cells was noted at months 9-12 of therapy. Viral load became undetectable in the same period. NK cell function was decreased at the beginning of the therapy (1-4 months), reaching its highest values at months 9-12. There was no significant change in IL-10. TNF-a increased in six patients during the study. Conclusions: In this group of patients, innate immunity was restored during HAART. These results should be confirmed in studies with a longer follow up period and also measuring cytokines such as MIP-1a, MIP-1ß and RANTES.

Alteraciones inmunológicas en endocarditis infecciosa / Immunological alterations in infectious endocarditis

La EI es una patología compleja, en cuya patogenia convergen factores de diversa naturaleza: infecciosos, hemodinámicos, inmunológicos, entre otros. La infección crónica constituye un estímulo antigénico persistente que induce una respuesta inmune que resulta ineficiente frente al agresor, llevando a la aparición de múltiples alteraciones inmunológicas, entre ellas alteraciones autoinmunes. Estas pueden tener o no una traducción clínica, incluso pueden simular una enfermedad autoinmune o de base inmune, por lo que el diagnóstico diferencial preciso y oportuno es fundamental. Si bien condiciones coexistentes, asociadas a inmunodeficiencia, pueden favorecer la aparición de la EI, o incidir en una mayor mortalidad, no se ha encontrado un defecto inmunológico específico en esta patología.

Infección primaria por el VIH: características clínicas y serológicas / Primary HIV infection: clinical and serological characteristics

An acute clinical picture of variable intensity may occur during the initial primary phase of HIV infection, it may however pass unnoticed. We report 12 seronegative subjects (11 male homosexuals, 1 female heterosexual, aged 18 to 44 years old), that sembling an acute clinical picture preceding seroconversion. All had a sudden beginning, reduration were variable, lasting a mean of 14 (range 5-44) days an remaining asymptomatic thereafter. Most patients presented a discrete leukopenia with lymphopenia at the expense of CD4 lymphocytes, followed by an absolute lymphocytosis in some, with an increase in CD8 lymphocytes. All became positive for HIV; circulating HIV antigen was identified in 3 and IgM anti-HIV antibodies were detected during the symptomatic period by third generation ELISA in other 3. It is concluded that the clinical picture of primary HIV infection has identificable clinical serological and immunological features and its recognition has diagnostic and preventive implications

Neurosífilis e infección por el virus de inmunodeficiencia humana (VIH-1): experiencia en 6 casos / Neurosyphilis and infection by immunodeficiency human virus (HIV-1): experience in 6 cases

HIV infected population has a higher incidence of syphilis, being this an independent risk factor for HIV infection. We report 88 HIV infected patients seen during the last three years. Fourteen (16 percent) had reactive serum VDRL and FTA-ABS and neurosyphilis was diagnosed in six (6,8 percent). Three had a treponemal uveitis-retinitis, one a meningovascular syphilis and one a secondary syphilis with meningeal and otological involvement. Patients were treated with penicillin 20 million UI/day for 14 days with good clinical and laboratory response and CFS normalization in those subjected to a second lumbar puncture. It is concluded that neurosyphilis must be considered in the differential diagnosis of neurological complications of HIV infections

Defectos inmunológicos en el shock séptico: deficiencia de células natural killer y de linfocitos T / Immunological defects in septic shock: deficiency of natural killer cells and T-lymphocytes

It is well fnown that an immunosuppresive rsponse occuts after acute trauma. Some cellular mediators participate in the pathogenesis of septic shock. However, the exact role of the lymphocyte subsets and natural killer (NK) activity in this condition is not clear. We studied NK cytolytic activity through a 51Cr liberation assay using K-562 target cells in 20 patients with initial septic shock (10 men and 10 females, mean age 41 years old). Lymphocyte subsets CD3 (T3), CD4 (T4), CD8 (T8), CD16 (Leu-11) and CD56 (Leu-19) wetre also studied by indirect immunofluorescence. Compared to tesults obtained in 20 healthy volunteers, patient's NK activity was decreased (4.6 ñ 3.9 vs 26.1 ñ 10, p < 0.025), CD16 was lower (10%/187 vs 15%/280 per ul) and CD56 was also lower (6%/120 vs 12%/224 per ul), p < 0,05. T lymphocyte subsers were also decreased: CD3 cells (1100 vs 1352 per ul) and CD4 cells (634 vs 873 per ul), p < 0.05. Thus, a severe decrease in NK cells and NK cell function as well as decreases in CD3 and CD4 lymphocyte subsets are present in the initial stages of septic shock. The predictive value of these findings is currently under study

Evaluación inmunológica e inmunogenética de pacientes con cáncer de la vesícula biliar: comunicación preliminar / Immunologic and immunogenetic evaluation of the patients with gallbladder cancer: preliminary comunication

Se estudiaron cinco pacientes con cáncer de la vesícula biliar (CV) con prolongada sobrevida postoperatoria (4-12 años): Grupo A. Se compara este grupo con cinco pacientes intervenidos recientemente, cuya enfermedad está avanzada: Grupo B y con cinco enfermos sometidos a colecistectomía por litiasis y sin cáncer: Grupo C (control). En el Grupo A hubo 2 casos con antecedentes de cáncer en otras localizaciones (mama, útero y recto), lo que hace suponer una predisposición neoplásica y una especial inmunidad contra el cáncer. En este estudio preliminar, la respuesta inmunitaria de los pacientes del Grupo A y C fue similar. En los enfermos del Grupo B, se observó reducción de la inmunocompetencia con la progresión de la enfermedad, especialmente en los test cutáneos. En el estudio histoquímico, en los Grupos A y B, las poblaciones celulares relacionadas con la inmunidad se situaron en la periferia del tumor pero sólo en las del Grupo A se encontraron en el interior de la masa tumoral. En la investigación inmunogénetica se observó que el antígeno HLA-DR4 se encuentra en una proporción mayor en los pacientes con CV (38%), en comparación con la población chilena nornal (29%). Se incluye que es necesario: a. Proseguir la investigación, aumentando el número de casos; b. trabajar en el estudio inmuno histoquímico sólo con vesículas frescas, y c. Seguir investigando los antígenos del sistema HLA, tanto en pacientes portadores de cáncer vesícular, como en aquéllos con simple colelitiasis