Reflejo olivococlear contralateral y su relación con ansiedad y calidad de vida en pacientes con tinnitus

Resumen Introducción: La presencia de tinnitus se asocia a un incremento del nivel de ansiedad y empeoramiento de la calidad de vida, sin embargo, aún no existe claridad de si el sistema eferente auditivo podría influir en estas relaciones. Objetivo: Determinar si las amplitudes de las emisiones otoacústicas por producto de distorsión (EOAPD) y el efecto supresor del reflejo olivococlear gatillado con ruido contralateral (ROC) se asocian al grado del impacto psicoemocional y nivel de ansiedad en pacientes con tinnitus. Material y Método: Se evaluaron las amplitudes de EOAPD y magnitud del ROC para cada oído de manera independiente en una cohorte de 32 sujetos tinnitus y 26 controles, cuyos valores fueron correlacionados con State-Trait Anxiety Inventory (STAI) y Tinnitus Handicap Inventory (THI). Resultados: Los pacientes con tinnitus tuvieron una correlación significativa entre la magnitud del ROC del oído izquierdo y los puntajes en las pruebas de STAI y THI. Conclusión: Una mayor carga de ansiedad y peor calidad de vida en sujetos con tinnitus puede estar asociada con un empeoramiento del efecto supresor del ROC de la vía eferente auditiva.

Abstract Introduction: Tinnitus is associated with an increase in the degree of anxiety and with worse quality of life. However, whether there are relations between the function of the auditory efferent system and anxiety and tinnitus distress levels is not known. Aim: To determine possible associations between the distortion product otoacoustic emission (DPOAE) amplitudes and the suppressing effect of the olivo-cochlear reflex (OCR) with anxiety and psycho-emotional impact in tinnitus. Material and Method: DPOAE amplitudes and OCR strength were evaluated for each ear independently in a cohort of 32 tinnitus and 26 controls, whose values were correlated with the State-Trait Anxiety Inventory (STAI) and Tinnitus Handicap Inventory (THI). Results: A significant correlation of STAI and THI scales with the OCR strength measured in the left ear was found in subjects with tinnitus. Conclusion: A higher anxiety load and worse quality of life in subjects with tinnitus may be associated with an impaired olivocochlear reflex suppressing effect.

Tinnitus: una patología cerebral / Tinnitus: a brain pathology

RESUMEN El tinnitus es un síntoma caracterizado por la percepción de un sonido en ausencia de un estímulo externo. Si bien su fisiopatología puede involucrar una alteración a nivel del funcionamiento del oído interno, la percepción de éste y el grado de molestias asociadas dependen de modificaciones de redes cerebrales cognitivas y emocionales. En la presente revisión, se abordan los cambios que existen a nivel coclear, de tronco encefálico, tálamo y la extensa red cerebral que dan cuenta del tinnitus, discutiendo como esta nueva conceptualización tiene importantes implicancias clínicas, permitiendo una mejor comprensión de los síntomas asociados al tinnitus, sus comorbilidades, y el desarrollo de nuevas estrategias terapéuticas.

ABSTRACT Tinnitus is a symptom characterized by the perception of a sound without an external stimulus. Although the pathophysiology of tinnitus initially involves an alteration of the inner ear function, the perception of it and the degree of distress associated with it depends on changes in cognitive and emotional brain networks. In this article, we review the changes that exist at the cochlea, brainstem, thalamus and a widespread cerebral networks that account for tinnitus, discussing how this new conceptualization has significant clinical implications and allows a better understanding of the symptoms associated with tinnitus, its co-morbidities, and how this view has allowed the development of new therapies.

El aborto en Chile: aspectos epidemiológicos, históricos y legales

Antecedentes: En Chile, el aborto es ilegal en cualquier circunstancia. Objetivos: Describir la evolución epidemiológica del aborto en Chile, su relación con la introducción de los métodos anticonceptivos (MAC) y los cambios históricos de su legalidad. Adicionalmente, revisar los aspectos metodológicos de las estimaciones del aborto ilegal en Chile. Resultados: La tasa de mortalidad materna por aborto se ha reducido drásticamente en Chile, desde una de las más altas en Latinoamérica a principios del siglo XX a una de las más bajas en la actualidad. La importante reducción observada después de la introducción de los MAC refleja los cambios culturales y avances en el desarrollo económico y sanitario del país. El cambio de status del aborto legal a ilegal no se asoció a un aumento de las muertes maternas relacionadas a aborto que mantienen una reducción sostenida. Se desconoce con certeza la magnitud del aborto ilegal en Chile, metodologías utilizadas para su estimación podrían sobrestimarlo ampliamente si no se consideran factores condicionantes. Conclusión: Chile ha logrado descender drásticamente la mortalidad materna por aborto sin recurrir a la legalización o su despenalización, respetando al embrión humano desde la concepción. Se requiere considerar una metodología apropiada para el monitoreo de la prevalencia y causas de aborto ilegal que permita focalizar las intervenciones preventivas en la población vulnerable.

Background: In Chile abortion is illegal in any circumstance. Objectives: To describe epidemiological evolution of abortion in Chile, its relationship with the introduction of contraceptive methods (CM) and historical changes on its legal status. In addition, we review methodological issues of estimates of illegal abortion in Chile. Results: Maternal mortality rate to abortion have been reduced drastically in Chile, from one of the highest in Latin America at the beginning of the XX century to one of the lowest rates currently. The important reduction observed after the introduction of CM reflects cultural changes as well as economical and sanitary progress of the country. Legal status change from legal to illegal was not related to an increase in maternal mortality rate due to abortion that maintains a sustained reduction. Magnitude of illegal abortion in Chile is unknown; methodologies used for estimation may largely overestimate prevalence if conditionings factors are not taken into account. Conclusion: Chile has managed to drastically reduce maternal mortality due to abortion without recourse to legalization or decriminalization, respecting the human embryo from conception. A proper methodology is required to monitoring prevalence and causes of illegal abortion in order to focusing preventive interventions in the vulnerable population.

Trastornos del lenguaje en el adulto / Language disorders in adults

El presente trabajo tiene por objetivo principal describir los trastornos del lenguaje en el adulto a consecuencia de un daño cerebral. Las alteraciones del lenguaje oral se abordarán considerando los siguientes tópicos: Algunos conceptos lingüísticos básicos para describir con exactitud las alteraciones del lenguaje; el sistema funcional del lenguaje en el que participan áreas persilvianas, hemisferio derecho y zonas prefrontales; las afasias que son un trastorno parcial o total del lenguaje; los pacientes afásicos considerando sus antecedentes clínicos, la actitud frente al defecto, el deterioro intelectual y otros defectos asociados; el tratamiento de las afasias que tiene por objetivo que el paciente logre una comunicación funcional y una adaptación psicosocial en relación a la alteración de lenguaje y por último, los trastornos del discurso que comprometen especialmente su contenido y su uso. En relación a las alteraciones del lenguaje lectoescrito se describirán los diferentes tipos de agrafias y alexias. Finalmente, cabe señalar dos aspectos, el primero, es que además de las afasias existen otros trastornos del lenguaje y el segundo, es que la evaluación del lenguaje es fundamental para el manejo y la rehabilitación del paciente.

The main purpose of the current review is to describe the language disorders in adult as a consequence of brain damage. The oral language disorders will be approached regarding the following topics: some basic linguistic concepts to describe language disturbances accurately; the functional language system involving perisylvian areas, right hemisphere and prefrontal areas; aphasia that represent a total or partial language impairment; the patient with aphasia, regarding their clinical background, their attitude towards the alteration, the cognitive impairment and other associated disorders; the aphasia treatment which has for purposes to achieve a functional communication and psychological and social adaptation considering their language impairment and, at last, the discourse impairment which affects their use and content. Regarding the reading and writing impairment, agraphia and alexia types will be described. Finally, it is important to mention two aspects: first, besides aphasia there are other language disorders and, second, language assessment is essential to the management and rehabilitation of the patient.

El cambio del perfil epidemiológico de la mortalidad materna en Chile dificultará el cumplimiento del 5° objetivo del Milenio / The change in the epidemiological profile of maternal mortality in Chile will hinder the fulfillment of the Millennium 5th goal

Background: The death of women during pregnancy, childbirth or puerperium, remains a serious public health problem worldwide. Chile is committed to comply with the Millennium 5th Goal of reducing maternal mortality to 9.9/100,000 live births in 2015. Aim: To analyze trends in maternal mortality in Chile during 2000-2009. Material and Methods: A descriptive population analysis using raw data obtained from the yearbooks of the National Institute of Statistics of Chile. Maternal mortality, causes of death and age of the dead mothers were evaluated. The causes of maternal death were classified according to the tenth revision of International Classification of Diseases. Trend studies were performed using Pearson correlation analysis. Results: In the studied period there were no significant changes in maternal mortality and fertility. The five major causes of maternal death were concurrent diseases, hypertension, abortion, obstetric embolism and postpartum hemorrhage. Mortality associated with concurrent illness showed a significant upward trend (r = 0.656, p = 0.035). Abortion associated mortality had a significant downward trend (r = -0.712, p = 0.023). The group of women 40 years and older significantly increased its birth rate (r = 0.930, p < 0.001), this group showed the highest maternal mortality, especially in association with concurrent diseases. Conclusions: The increased birth rate occurring in women over 40 years old and its larger maternal mortality rate, probably will hinder the fulfillment of the Millennium 5th goal in Chile.

El aborto eugenésico podría explicar la menor mortalidad infantil existente en Cuba comparada con la de Chile / Eugenic abortion could explain the lower infant mortality in Cuba compared to that in Chile

Background: Cuba and Chile have the lower infant mortality rates of Latin America. Infant mortality rate in Cuba is similar to that of developed countries. Chilean infant mortality rate is slightly higher than that of Cuba. Aim: To investigate if the lower infant mortality rate in Cuba, compared to Chile, could be explained by eugenic abortion, considering that abortion is legal in Cuba but not in Chile. Material and Methods: We compared total and congenital abnormalities related infant mortality in Cuba and Chile during 2008, based on vital statistics of both countries. Results: In 2008, infant mortality rates in Chile were significantly higher than those of Cuba (7.8 vs. 4.7per 1,000 live born respectively, odds ratio (OR) 1.67; 95% confidence intervals (Cl) 1.52-1.83). Congenital abnormalities accounted for 33.8 and 19.2% of infant deaths in Chile and Cuba, respectively. Discarding infant deaths related to congenital abnormalities, infant mortality rate continued to be higher in Chile than in Cuba (5.19 vs. 3.82 per 1000 live born respectively, OR 1.36; 95%CI 1.221.52). Conclusions: Considering that antenatal diagnosis is widely available in both countries, but abortion is legal in Cuba but not in Chile, we conclude that eugenic abortion may partially explain the lower infant mortality rate observed in Cuba compared to that observed in Chile.

Parálisis general sifilítica: presentación de 5 casos / Paretic neurosyphilis: report of five patients

We report five male patients, aged 35 to 63 years who suffered from paretic neurosyphilis. The clinical course was that of a subacute dementia with a frontal syndrome, with more apathy than euphoria. All were HIV negative and four were heterosexual. In all, the cerebrospinal fluid had a mononuclear pleocytosis and a positive VDRL. EEG was abnormal in the 3 cases in whom it was performed. One patient in whom a brain angiography was performed, had images of vasculitis. Treatment with 18-24 million units of penicillin per day during two weeks or more, was partially effective.

Púrpura trombocitopénico inmune asociado a infección por virus hepatitis C en paciente hemofílico: Caso clínico / Immune thrombocytopenic purpura associated to hepatitis C virus infection: Report of one case

Hepatitis C Virus (HCV) is a cause of secondary chronic immune thrombocytopenic purpura (ITP). We report a 43 year old man with mild Hemophilia A, who received blood transfusions during childhood, that consulted for epistaxis and ecchymoses. The laboratory showed a platelet count of 23.000/mm³, positive HCV serology and elevated transaminases. Steroids administered in pulses followed by oral doses resulted in a partial response requiring a second pulse and association of azathioprine. A steroidal diabetes appeared. Given his refractoriness, splenectomy and liver biopsy were performed. He continued on azathioprine maintaining a platelet count near 50.000/mm³ but continued with bleeding episodes. Liver biopsy showed a chronic active hepatitis.