Aumento de la lipocalina orosomucoide-1 (ORM1) en sujetos con hiperaldosteronismo primario / Increase of lipocalin ORM1 in primary aldosteronism

El hiperaldosteronismo primario (HAP) es la causa más común de hipertensión arterial secundaria. A pesar de la prevalencia del HAP (6-10%) y sus consecuencias, los mecanismos que median los efectos deletéreos renales y extrarenales originados por la aldosterona más allá de la hipertensión arterial (ej. inflamación renal, alteraciones cardiacas y disfunción vascular), siguen siendo poco conocidos. Estudios previos sugieren que el exceso de aldosterona aumentaría proteínas sensibles a la activación del receptor de mineralocorticoides (MR), como las lipocalinas LCN2 (NGAL) y ORM1. OBJETIVO: Determinar la concentración de las lipocalinas ORM1, NGAL y NGAL-MMP9 en sujetos HAP. SUJETOS Y MÉTODOS: Estudio de cohorte transversal en sujetos adultos (similares en sexo, edad e IMC) separados en controles normotensos (CTL), hipertensos esenciales (HE) y con screening positivo de HAP (aldosterona ≥9 ng/dL y ARP < 1 ng/mL*h acorde a las guías internacionales de HAP). Se determinó la presión arterial sistólica (PAS) y diastólica (PAD), aldosterona plasmática, actividad renina plasmática (ARP) y la relación aldosterona / actividad de renina plasmática (ARR). Se determinó la concentración de NGAL, NGAL-MMP9 y ORM1 en suero por ELISA. RESULTADOS: Detectamos mayores niveles de ORM1 en sujetos HAP. No se detectaron diferencias en NGAL ni NGAL-MMP9 entre los grupos. Detectamos una asociación positiva de ORM1 con ARP (rho= -0,407, p=0,012) y con ARR (rho= 0,380 p= 0,021). CONCLUSIÓN: La mayor concentración de ORM1 en sujetos HAP y las asociaciones de ORM1 con aldosterona, ARP y ARR, proponen a esta proteína como un potencial biomarcador de HAP y de utilidad en el desarrollo de algoritmos diagnósticos de HAP.

Primary hyperaldosteronism (PA) is the most common cause of secondary hypertension. Despite the prevalence of PA (6-10%) and its consequences, the mechanisms that mediate the deleterious renal and extrarenal effects caused by aldosterone beyond arterial hypertension (eg renal inflammation, cardiac alterations and vascular dysfunction), remain barely known. Previous studies suggest that excess aldosterone would increase proteins sensitive to activation of the mineralocorticoid receptor (MR), such as lipocalins LCN2 (NGAL) and ORM1. AIM: To determine the concentration of the lipocalins ORM1, NGAL and NGAL-MMP9 in PA subjects. SUBJECTS AND METHODS: Cross-sectional study in adult subjects (similar in sex, age and BMI) grouped as normotensive controls (CTL), essential hypertensive (HE) and subjects with positive PA screening (aldosterone ≥ 9 ng/dL and PRA <1 ng/mL*h, according to international PA guidelines). Systolic (SBP) and diastolic (DBP) blood pressure, plasma aldosterone, plasma renin activity (PRA), and plasma aldosterone renin ratio (ARR) were determined. The concentration of NGAL, NGAL-MMP9 and ORM1 in serum was determined by ELISA. RESULTS: We detected higher levels Recibido: 03-09-2021 of ORM1 in PA subjects. No differences in NGAL or NGAL-MMP9 were detected between the groups. We detected a positive association of ORM1 with ARP (rho = -0.407, p < 0.05) and with ARR (rho = 0.380 p <0.05). CONCLUSION: The high levels of ORM1 in PA subjects and the associations of ORM1 with aldosterone, ARP and ARR, suggest ORM1 is a potential biomarker of PA, and useful in the development of a diagnostic algorithm for PA.

Estudio de frecuencia y asociación de los polimorfismos RS965513 y RS1867277 del gen FOXE1 con el carcinoma papilar de tiroides y su riesgo de recurrencia en población chilena / Frequency and association of the polymorphisms RS965513 and RS1867277 of the FOXE1 gene with papillary thyroid carcinoma and its risk of recurrence in Chilean population

Introducción: El gen FOXE1 (Forkhead box E1) codifica para un factor de transcripción involucrado en la morfogénesis tiroidea. El cáncer papilar de tiroides (CPT) se ha asociado con polimorfismos (SNP) de FOXE1 rs1867277 y rs965513 en población asiática y europea. Nuestro objetivo fue investigar la frecuencia y asociación de SNP rs1867277 y rs965513 con CPT y el riesgo de recurrencia de CPT en sujetos chilenos. Métodos: Se reclutaron sujetos con y sin CPT, se describieron sus características epidemiológicas y la forma de presentación clínica (AJCC VIII y MINSAL 2013). Se aisló ADN de leucocitos periféricos y evaluó ambos SNP mediante PCR-HRM y secuencia. Se compararon las frecuencias alélicas y genotípicas entre casos CPT y controles, y entre pacientes CPT de distintos riesgos de recurrencia. Se compararon frecuencia y se estimó el riesgo con test de Fisher y cálculo de odds-ratio (OR). Resultados: De los 184 sujetos, 156 (85%) eran mujeres, edad 39,3±12,3 años; 90 con CPT y 94 sin CPT 26 (28,9%) pacientes eran de riesgo muy bajo, 45 (50%) bajo, 16 (17,8%) intermedio y 3 (3,3%) alto según MINSAL 2013. En relación a la frecuencia de alelo menor (MAF) calculada en sujetos control y CPT, fue 31,7% y 24,5% (SNP rs965513), y 36,7% y 30,1% 8 (rs1867277), respectivamente (p NS). Tampoco fueron diferentes las MAF calculados y comparados entre pacientes con CPT de riesgo bajo e intermedio/alto. Sin embargo, la combinación de los genotipos rs1867277GG y rs965513AA se asoció a mayor riesgo de CPT. Conclusiones: En pacientes chilenos, se describe una frecuencia MAF de los SNP rs1867277 y rs965513 cercana a un 30%, las cuales no se asocian a CPT ni riesgo de recurrencia, sin embargo, sujetos con una combinación genotípica particular podrían tener mayor riesgo de CPT.

FOXE1 gene (Forkhead E1 box) codes for a transcription factor involved in thyroid morphogenesis. Papillary thyroid cancer (PTC) has been associated with FOXE1 polymorphisms (SNPs) rs1867277 and rs965513 in Asian and European population. Our aim was to investigate the frequency and the association of SNPs rs1867277 and rs965513 with PTC and the risk of recurrence of PTC in Chilean subjects. Methods: We recruited subjects with and without PTC. In those with PTC, their epidemiological characteristics and clinical features presentation are described according to AJCC VIII and MINSAL 2013 scales. Peripheral leukocyte DNA was isolated and both SNPs were evaluated using PCR-HRM and sequencing. Allelic and genotypic frequencies were compared between PTC cases and controls, and between PTC patients with different recurrence risks. Results: Of the 184 subjects, 156 (85%) were women, age 39.3 ± 12.3 years; 94 (51%) without PTC and 90 with PTC (49%): 26 (28.9%) patients had very low, 45 (50%) low, 16 (17.8%) intermediate and 3 (3.3%) high risk of recurence according to MINSAL 2013. Regarding the minor allele frequency (MAF) calculated on control and PTC subjects, was 31.7% and 24.5% (SNP rs965513), and 36.7% and 30.1% (rs1867277), respectively (p NS). In patients with PTC, MAFs were not different between patients with low and intermediate/high risk PTC. However, the combination of rs1867277GG and rs965513AA genotypes were associated with an increased risk of PTC. Conclusions: In Chilean patients, the MAF frequency of SNPs rs1867277 and rs965513 is near 30%, and they are are not associated with PTC or its risk of recurrence. However, subjects with a particular genotypic combination may have an increased risk of PTC.

Estudio e identificación de microRNA en exosomas urinarios en hipertensión arterial mineralocorticoide / Study and identification of microRNA in urinary exosomes in mineralocorticoid arterial hypertension

About 15% of the essential hypertensive patients would have a low activity of the 11ßHSD2 enzyme, which inactivates cortisol (F) to cortisone (E). Gene expression can be negatively regulated by miRNA. Urinary exosomes and their specific content (miRNA/proteins) represent a valuable tool as a biomarker for the diagnosis and prognosis of the disease. Aim: To evaluate the expression of miRNA specific for 11ßHSD2 in samples of urinary exosomes and to determine its association with biochemical variables associated with mineralocorticoid metabolism. Subjects and Methods: Cross-sectional study in subjects between 10-60 years. They were classified into subjects with high F/E (> p75) and low cortisone (< p25) and control subjects. The urinary exosomes were isolated with the Invitrogen kit. Bioinformatic analysis was performed with Mir Walk to identify specific miRNAs of HSD11B2. The expression of miRNA was evaluated by qRT PCR. The comparisons were made with the Mann-Whitney test. Results: 7.1% of the subjects are suggestive of a partial deficiency of 11ßHSD2 (NC-AME). The expression of miR-488 was higher in NC-AME than in controls (5839 ± 1719 vs 3,437 ± 2,581; p = 0.01). We found positive associations between mir-615 and ARP; miR-488 and the sodium/potassium ratio; miR-1205 with age and urinary sodium excretion; miR-494 with age, activity MMP9 and NGAL. Conclusion: We identified high expression of miR488 in NC-AME subjects and associations of miRNAs with biochemical variables associated with mineralocorticoid metabolism. Thus, exosomes and their miRNA content could be potential regulators and biomarkers of 11ßHSD2 activity.

Impacto de la docencia en el tiempo de estadía hospitalaria de pacientes con patologías prevalentes en un hospital universitario / The impact of teaching on hospital stay duration in patients with common pathology in a university hospital

INTRODUCCIÓN: Desde la creación de la primera Escuela de Medicina en Chile, tanto hospitales públicos y establecimientos de atención primaria, han desarrollado la relación "docente-asistencial". Ésta relación se ha visto afectada, ya que actualmente las hospitalizaciones reflejan patologías graves y complejas, requiriendo mayor trabajo y tiempo por paciente, en desmedro del tiempo dedicado a la docencia o viceversa, si se dedica más tiempo a la docencia sería en desmedro de la evaluación clínica del paciente. OBJETIVO: Conocer el impacto de la relación docente asistencial en el tiempo de estadía de los pacientes en el servicio de Medicina del Hospital Carlos Van Buren (HCVB). Pacientes y métodos: Estudio descriptivo, que incluyó los egresos hospitalarios del HCVB del periodo Enero/2015-Agosto/2016 con diagnósticos de 4 patologías prevalentes, tanto del 4° piso (área no docente) como 7° piso (área docente) del establecimiento. Los datos se obtuvieron con la herramienta GRD y fueron analizados con el programa STATA/MP 14.0. RESULTADOS: El promedio general de días de estadía del 7° piso fue menor al del 4° piso, con un p value=0.0000. Discusión: El obtener un resultado positivo en cuanto a la disminución de estadía hospitalaria en un piso docente, alejaría el planteamiento de un impacto negativo para el paciente de la relación docente-asistencial. CONCLUSIONES: Los resultados obtenidos en este trabajo hay que interpretarlos con cuidado, ya que se hace difícil plantear que la disminución de estadía hospitalaria se deba sólo a la presencia de docencia, por lo que es necesario la realización de más estudios similares.

INTRODUCTION: Ever since the establishment of the first medical school in Chile, public hospitals and primary care establishments have combined healthcare and teaching. Hospitals nowadays handle more serious and complex pathologies, placing more demand on time and care spent on the patient, thereby reducing the time available for teaching, or if teaching time is maintained, reducing time spent on the patient´s clinical evaluation. OBJECTIVE: To elucidate the impact of healthcare combined with teaching on the length of stay in the general medicine service of Carlos van Buren Hospital. Patients and Methods:Adescriptive study of patients discharged from Carlos van Buren Hospital between January 2015 and August 2016 using diagnoses of four frequent pathologies and comparing the 4th floor (non-teaching) with the 7th floor (teaching). Data was obtained using the tool GRD (Grupos Relacionados a Diagnósticos) and analyzed using the Stata/MP 14.0 program. RESULTS: The average length of stay for patients on the 7th floor (teaching area) was shorter than that of patients on the 4th floor (non-teaching), with a p value = 0.0000. DISCUSSION: A positive result in reducing hospital stay in the teaching floor helps to dismiss the idea that combining healthcare with teaching has a negative effect on the patient. Conclusions: These results should be interpreted with care as it is unlikely the reduced stay was attributable solely to the teaching. More similar studies should be carried out.

Aldosterona e IL-17 en la génesis de la hipertensión arterial mineralocorticoídea, un estudio ex vivo / Aldosterone and il-17 in the genesis of mineralocorticoid arterial hypertension: an ex vivo study

Background: Treatment of dendritic cells (DC) with aldosterone induces the secretion of IL-6 and TGF-beta. The polarization of naïve T cells to helper 17 T lymphocytes with DCs pre-incubated with aldosterone, has been described in vivo, generating an IL-17 hyper-secreting phenotype, a cytokine associated with cardiac and renal fibrosis. There are mineralocorticoid receptors (MR) in immune cells and their activation may determine the inflammatory (M1) or adaptive (M2) macrophage phenotype. Aldosterone levels could regulate immunogenic gene expression in these cells, modulating the liberation of specific cytokines. Aim: To assess in humans the association of aldosterone levels and IL-17 with inflammatory markers in peripheral blood mononuclear cells (PBMC). Material and Methods: In blood samples of 176 participants aged 18 to 67 years (61 percent women) with a body mass index of 27.1 +/- 4.8 kg/m2, aldosterone, plasma renin activity (ARP), cortisol, C reactive protein, andIL-17 were measured. mRNA was isolated from PBMCs to measure the expression of MR RAC-1, HO-1, TLR-4, CD-14, NGAL and IL-17 by real time polymerase chain reaction. Results: Aldosterone correlated positively with ARP and the expression of CD-14 in PBMCs. Plasma levels of IL-17 were positively associated with the expression of MR, Rac1a and NGAL. Conclusions: Aldosterone and IL-17 levels were associated with inflammatory activation markers in PBMC, which could activate MRand promote a subclinical inflammatory status inducing hypertension.

Abordaje vaginoscópica para la realización de histeroscopía oficinal: experiencia, resultados y revisión de la literatura / Vaginoscopic approach to perform officinal hysteroscopy: experience, results and literature review

OBJETIVO: Presentar nuestra experiencia y una revisión de la literatura sobre la utilización de la vaginohisteroscopia oficinal. Describir las principales indicaciones, su tolerancia, los procedimientos realizados y las complicaciones resultantes. MÉTODO: Estudio descriptivo de todos los procedimientos vaginohisteroscópicos ambulatorios realizados en la Unidad de Medicina Reproductiva e Infertilidad del Departamento de Obstetricia y Ginecología del Hospital Clínico de la Universidad de Chile, entre el 1° de enero de 2008 y el 31 de enero de 2014. RESULTADOS: Se realizaron un total de 632 vaginohisteroscopias: 63,7% diagnósticas y 36,2% quirúrgicas. El tiempo promedio de realización fue de 13 ± 8 minutos. La percepción de dolor presentó una mediana de EVA 4 con intercuartiles de 3 y 6. La principal indicación fue por sospecha de pólipos endometriales (33%) y engrosamiento endometrial en un 12%. El hallazgo histeroscópico más frecuente fue cavidad endometrial normal (27%) y pólipos endometriales (27%). Los procedimientos más frecuentes fueron polipectomías (27%) y biopsias endometriales (20%). Se registraron 17 complicaciones (2,6%): 14 reacciones vasovagales (2,2%) y 3 lipotimias (0,4%). CONCLUSIONES: El abordaje vaginohisteroscópico ha demostrado ser una técnica segura, resolutiva, bien tolerada por las pacientes y de menor costo.

OBJECTIVE: To present our experience and a review of the literature of the vaginohysteroscopic technique. To describe the main indications, the tolerance, the procedures performed and their complications. METHOD: This is a descriptive study of all outpatient procedures performed with the vaginohysteroscopic technique in the Reproductive Medicine and Infertility Unit of the Department of Obstetrics and Gynecology at University Hospital of Chile between 1st January of 2008 and 31st January of 2014. RESULTS: A total of 632 vaginohysteroscopys were performed: 63.7% diagnostic and 36.2% surgical. The average procedure time was 13 ± 8 minutes. Pain showed a median of VAS of 4. The main indication was suspected endometrial polyps (33%) and endometrial thickening (12%). The most frequent finding was normal endometrial cavity (27%) and endometrial polyps (27%). The most common procedures were polypectomy (27%) and endometrial biopsies (20%). We registered 17 complications (2.6%): 14 vasovagal reactions (2.2%) and 3 lipothymias (0.4%). CONCLUSIONS: vaginohisteroscopy approach has proven to be a safe and very resolutive technique, well tolerated by patients and considerably cost-effective.

Selección de ovocitos competentes, utilizando el factor de crecimiento nervioso (NFG) y el factor de crecimiento vascular endotelial (VEGF), con el fin de aumentar las posibilidades de embarazo en pacientes que se encuentran en tratamientos de fecundación in vitro: [revisión] / Competent oocytes selection, using nerve growth factor (NGF) and vascular endothelial growth factors (VEGF), with the purpose of to increase the possibilities of pregnancy in patients who are in treatments of fertilization in vitro: [review]

The attention from embryologist toward the assessment of oocyte quality in human in vitro fertilization (IVF) is increasing every day. Oocyte selection and the identification of the best oocytes, in fact, would help to limit embryo overproduction and to improve the results of oocyte cryostorage programs. Multiple methods have been proposed; but a good correlation between specific biochemical characteristics and measurable oocyte quality-linked, embryo-related variables has not been established to date. In IVF programs that include oocyte selection, levels of vascular endothelial growth factor (VEGF) and neural growth factor (NGF) could be used as an index to exclude oocytes that developed in a hypoxic follicle. The presence of both ovarian angiogenic factors provides an ideal environment to maintain the cyclical changes in vascular density that occurs during follicular development. NGF would act within a short time-frame to replenish the supply of VEGF required for the vascularization of growing preovulatory follicles and perhaps newly formed corpora lutea. Levels of these angiogenic factors can predict the necessary vascular changes within the follicles and the competence of the oocytes. A hypoxic status at this level could be responsible for the high intrafollicular and plasma concentrations of VEGF and for the low quality of the oocytes.

Vaginohisteroscopia en consultorio: histeroscopio de Bettocchi, nueva técnica de diagnóstico y tratamiento ginecológico / Vaginal hysteroscopy in medical center: hysteroscope of Bettocchi, new diagnosis technique and gynecologic treatment

The global trend in surgical procedures is to be as least invasive as possible, causing minor injury to tissues, to reduce the days of hospitalization, to minimize post-operative pain and an early work reintegration. With endoscopy this has achieved and particularly with the hysteroscopy, which is a surgical procedure that allows you to visualize the uterine cavity, to diagnose and resolve the pathologies. The use of the Bettocchi hysteroscope, has revolutionized the gynecological diagnosis and treatment, because it is an ambulatory procedure, without hospitalization nor use of anesthesia. This article aims to describe this technique, its indications and contraindications.

Endometriosis e la pared abdominal / Endometriosis and the abdominal wall

ANTECEDENTES: La presencia de endometriosis de la pared abdominal (EPA) suele confundirse con otras patologías médico-quirúrgicas que aparecen en la misma zona. OBJETIVO: Evaluar las características clínicas de la EPA. MÉTODO: Se realizó un estudio retrospectivo de todas las pacientes hospitalizadas con el diagnóstico histopatológico de EPA entre enero de 1997 y diciembre de 2005. RESULTADOS: Se encontraron 14 pacientes, con edad promedio de 33,2 años. Los principales síntomas fueron: dolor cíclico (71,4%), masa abdominal (100%), dispareunia (21,4%) y dismenorrea (42,8%). Todas la pacientes tuvieron al menos una cirugía ginecológica (2 con procedimientos laparoscópicos) u obstétrica (85,7% cesárea). Sólo una paciente se había diagnosticado previamente de endometriosis. Los síntomas comenzaron en promedio 3,5 años posteriores a la última cirugía. Las EPA tenían un tamaño promedio de 3,2 cm. El diagnóstico pre-operatorio fue correcto en el 64,3% de las pacientes. Los diagnósticos incorrectos correspondieron a 3 granulomas, una hernia inguinal y un lipoma. Todas las pacientes requirieron cirugía y en el 64,3% fue necesario la utilización de mallas polytetrafluoethyleno. Cuatro pacientes (28,5%) presentaron recurrencias. 60% de los diagnósticos iniciales incorrectos v/s 11,1% de los acertados recurrieron. CONCLUSIONES: La EPA puede encontrarse en cicatrices tanto ginecológicas como obstétricas. Los síntomas comunes son masas con dolor cíclico. La ecografía de pared abdominal fue suficiente para enfrentar el diagnóstico diferencial. El diagnóstico pre-operatorio es importante para planificar la cirugía porque redujo las recurrencias. El tratamiento de elección es la cirugía con resección amplia de los bordes.

BACKGROUND: The presence of abdominal wall endometriosis (AWE) used to be confused with other surgical pathologies that may appear in these zones. Objective: To evaluate the AWE clinical characteristics. METHOD: Retrospective study of all the patients hospitalized with the histopathologycal diagnosis of AWE, between January 1997 and December 2005. RESULTS: There was found AWE only in 14 patients. Their mean age was 33.2 years old. The symptoms were: cyclic pain (71.4%), abdominal wall mass (100%), dyspareunia (21.4%) and dysmenorrhea (42.8%). All patients had at least one gynecologic (2 patients with laparoscopic procedures) or obstetric surgery (85.7% had previous cesarean section). Only one patient had previously been diagnosed with pelvic endometriosis. Their symptoms started after an average of 3.5 years after surgery. The AWE had a mean size of 3.2 cm. The preoperative diagnosis was correct in 64.3%. The incorrect preoperative diagnoses were 3 granuloma, 1 inguinal hernia and 1 lipoma. All patients required surgery. 64.3% of the patients it was necessary a polytetrafluoethylene mesh. Four patients (28.5%) had AWE recurrences. 60% of the wrong initial diagnosis recurred versus 11.1% of the correct ones. CONCLUSION: AWE may be present in gynecologic or obstetric scars. Their common symptoms are masses with cyclic pain. Ultrasonography is enough to approach the differential diagnosis. The correct preoperative diagnosis is important to plan surgery and reduce recurrences. The surgical wide excision is the preferable treatment. Establishing clear endometriosis limits reduce the recurrences.

Actividad de 11 beta hidroxiesteroide dehidrogenasa tipo 2 en hipertensos chilenos / 11 B-hydroxysteroid dehydrogenase activity in patients with hypertension and low plasma renin activity

Background: Half of hypertensive patients with low plasma renin activity have a primary hyperaldosteronism. Among the remaining half, 11ß-hydroxysteroid dehydrogenase type 2 (11ßHSD2) deficiency plays an important role. This enzyme catalyzes the conversion of cortisol to cortisone, avoiding the interaction of cortisol with the mineralocorticoid receptor. If the enzyme fails, cortisol will stimulate sodium and water reabsorption and increase blood pressure. Aim: To determine biochemical alterations, suggestive of 11ßHSD2 deficiency, in low-renin hypertensive patients. Patients and Methods: Twenty eight hypertensive patients with a plasma renin activity of less than 0.5 ng/ml/h and with a plasma aldosterone of less than 5 ng/dl were studied. Twenty eight normotensive patients were studied as controls. Serum cortisol (RIA), cortisone (ELISA) and the serum cortisol/cortisone ratio were determined in all of them, between 9 and 10 AM. Measurements were confirmed by high pressure liquid chromatography. The serum cortisol/cortisone ratio was considered abnormal when its Ln (cortisol/cortisone) value was over 2 standard deviations of the mean. Results: Serum cortisol was higher in hypertensive subjects than in controls (11.1ñ3.3 and 9.2ñ2.8 µg/dl, respectively; p <0.05). No differences were observed in serum cortisone (3.4ñ1.3 and 3.7ñ1.2 µg/dl, respectively). Four hypertensive subjects had an abnormally high Ln (cortisol/cortisone) value (1.86; 1.73; 2.07 and 2.01, considering a normal value of less than 1.61). Conclusions: Four of 28 hypertensive subjects with low plasma renin activity and aldosterone had biochemical alterations suggestive of 11ßHSD2 deficiency

Ventriculectomía parcial izquierda en un paciente con miocardiopatía dilatada terminal: ¿una alternativa para el trasplante cardíaco? / Partial left ventriculectomy for end stage dilated cardiomyopathy: report of one case

We present a case of a 60 year old male with end stage dilated cardiomyopathy in NYHA functional class IV in whom a partial left ventriculectomy was performed, a new surgical procedure developed in Brazil and done for the first time in Chile. Left ventricular size reduction produced an objective improvement on echocardiographic parameters of left ventricular function as well as in patient's NYHA functional class in the early post operative period

Tolerancia de la ketamina como anestésico general en pacientes adultos / Ketamine tolerance as general anesthetic in adults patients

Con el objetivo de estudiar la tolerancia de la ketamina como anestesico general en pacientes adultos, escogimos 80 pacientes en los diferente hospitales y clinicas privadas de la ciudad de la Romana. EN este estudio se escogieron los pacientes que oscilan entre 18 y 52 años de edad que iban a ser sometidos a diferentes tipos de cirugias tanto del sexo femenino como del masculino, durante el periodo de abril-diciembre de 1986. La ketamina se administra por vias IV.IM El mayor numero de cirugia correspondio al sexo femenino (64 casos). La ketamina actua sobre SNC estimulando y desprimiendo simultaneamente en el trans-operatorio. Los aparatos respiratorios y renales no se alteran, los reflejos faringeos no se alteran

Crecimiento y desarrollo del preescolar de familias en pobreza urbana / Preschool children's growth and development in urban poor families

En una muestra de 851 familias con 1 ó 2 hijos preescolares, provenientes de poblaciones pobres de Santiago de Chile, se evaluó el estado nutricional y el desarrollo psicomotor de los niños y se entrevistó a las madres, indagando condiciones familiares, de la interacción madre-hijo y relación con el entorno social. Se entregan algunos resultados descriptivos y se señala las variables que mostraron asociarse al nivel de desarrollo y estado nutricional del preescolar, en la perspectiva de aportar criterios para la planificación de programas

Resultados de la estimulación manual del feto como prueba de bienestar fetal / Results of the manual stimulation of the fetus as a probe of fetal well being

1. Se presenta el test de Estimulación Manual como test de screening fetal. 2. Se analiza su sensibilidad, especificidad, falsos negativos y positivos respecto del registro basal no estresante. 3. Se encuentra una alta sensibilidad del método respecto al registro basal no estresante (100%) con una buena especificidad (98%). 4. Dados los antecedentes presentados se recomienda su uso a nivel primario de atención de salud en aquellos casos en que los métodos tradicionalmente aceptados para evaluar la unidad feto placentaria están ausentes