Concordancia diagnóstica entre atención primaria y psiquiatra en derivaciones a Centro Comunitario de Salud Mental en Talca / Diagnostic Concordance between Primary Care and psychiatrist in Communitary Mental Health Center in Talca

Psychiatric diseases have a high presence in Chilean population. Most of the cases are treated in the primary care. Despite this, and because of their complexity, some cases need specialist care. Is important the appropriate referral to secondary care which can be measured by the diagnostic concordance. The purpose of this study is to analyze the diagnostic concordance between primary care and the evaluation of Psychiatrists in secondary level at Communitary Mental Health Center (COSAM) in Talca. METHODOLOGY: Cross-sectional descriptive study. All medical files of the patients older than 15 years old treated at COSAM were examined from August 2012 to November 2013. Moreover, the diagnostics of both primary care derivation and Psychiatrists of COSAM were compared with Kappa Index. RESULTS: The general concordance between the diagnostics of primary care level and COSAM was moderated (kappa index: 0.54). Higher in men than in women. The results showed a high concordance in the diagnostic of eating disorders and Dementia, a moderated concordance in the diagnostic of Bipolar Disorder and Panic Disorder. Finally, a low concordance in the diagnostic of General Anxiety Disorder (GAD), Personality Disorder and Major Depressive Disorder.Although the concordance in the derivations to COSAM is moderated, higher than international studies, the concern is in the failure in the diagnostic of the Bipolar Disorder, an inappropriate treatment can be prescribed if there is not a correct diagnostic.

Serological evidence of Hepatitis E Virus infection in Antioquia, Colombia slaughtered pigs / Evidencia serológica de infección por el Virus de Hepatitis E en cerdos faenados en Antioquia, Colombia

Objective. To detect the presence of specific antibodies against Hepatitis E virus (HEV) in pigs slaughtered in Antioquia, the department where the greatest amount of pork is produced and consumed in Colombia. Materials and methods. Between September 2011 and May 2012, blood samples from pigs were obtained in five slaughterhouses of Antioquia, four of them located in the Aburrá Valley subregion and other located in northern subregión. Serum were evaluated with a commercial ELISA kit for diagnosing HEV in humans but adapted to detect IgG and IgM antibodies in pigs. Results. A 100.0% seropositivity for IgG antibodies was found in 1000 samples evaluated, and 82.06% for IgM antibodies were found in 740 samples. Conclusions. These results indicate that pigs in slaughter age in Antioquia, and possibly in Colombia, have been exposed to HEV at some point in their production process and a high percentage of them can arrive to slaughterhouses with recent infection.

Objetivo. Detectar la presencia de anticuerpos específicos contra el virus de la Hepatitis E (HEV) en cerdos faenados en Antioquia, departamento donde se produce y consume la mayor cantidad de carne de cerdo en Colombia. Materiales y métodos. Entre septiembre de 2011 y mayo de 2012, se obtuvieron muestras de sangre de cerdos en cinco plantas de faenado, cuatro de ellas ubicadas en el Valle de Aburrá y una en la subregión Norte del departamento de Antioquia, las cuales fueron evaluadas mediante un kit de ELISA comercial para diagnóstico de HEV en humanos pero adaptado para la detección de anticuerpos tipo IgG e IgM en cerdos. Resultados. Se encontró una seropositividad de 100.0% para anticuerpos tipo IgG en 1000 muestras evaluadas y de 82.06% para anticuerpos tipo IgM en 740 muestras. Una muestra de heces positiva para la detección del genoma HEV es similar al genotipo 3 encontrada en Estados Unidos. Conclusiones. Estos resultados indican que los cerdos en edad de faenado en Antioquia y posiblemente en Colombia, han tenido exposición a HEV del, un virus zoonótico emergente a nivel mundial, en algún momento de su proceso productivo.

Causas de fiebre en pacientes hospitalizados en la unidad de cuidados intensivos del hospital naval almirante nef / Causes of fever In patients hospitalized in the ICU of hospital naval almirante nef

La fiebre es una anormalidad común en los pacientes hospitalizados en la unidad de cuidados intensivos. Encontrar la etiología del cuadro significa una alta demanda de recursos materiales y humanos que podrían afectar el pronóstico del paciente. Los objetivos de este trabajo fueron identificar las causas actuales de fiebre desarrollada en pacientes durante su hospitalización en la Unidad de Cuidados Intensivos Generales (UCIGEN) y describirlas según su prevalencia; categorizarlas en etiología infecciosa y no infecciosa; determinar el pronóstico según su etiología y buscar la existencia de elementos clínicos y de laboratorio que orienten a una causa infecciosa o no infecciosa. Se realizó un estudio de cohorte retrospectiva que consideró a todos los pacientes hospitalizados por7 o más días en la UCIGEN del Hospital Naval Almirante Nef y que egresaron de ella entre julio del año 2007 y julio del año 2012. De un total de 386 pacientes, 82 presentaron fiebre (21,24 por ciento) y en 10 de ellos (12,20 por ciento) no se logró determinar la causa. En los 72 pacientes (87,80 por ciento) que tuvieron una causa conocida, 67 casos fueron de etiología infecciosa y 5 de etiología no infecciosa. La principal causa de fiebre fue la neumonía asociada a ventilación mecánica (31,76 por ciento), seguida de la infección con uno o más microorganismos diferentes en más de un foco infeccioso (12,20 por ciento). No hubo relación estadísticamente significativa entre la etiología de la fiebre y elementos clínicos ni de laboratorio, como tampoco entre el pronóstico y la etiología (OR =0,684; IC 95 por ciento = 0,073 - 8.816). En conclusión, la fiebre desarrollada en los pacientes de la UCIGEN es predominantemente de origen infeccioso cuya causa más frecuente es la neumonía asociada a ventilación mecánica. Se recomienda orientar la búsqueda hacia una etiología infecciosa,...

Fever is a common abnormality in the ICU patients. Finding the fever etiology means a high demand of material and human resources that could affect the patient prognosis. The objectives of this investigation were to identify the actual causes of fever developed in patients during their hospitalization in the ICU and describe them according to their prevalence; categorize them according in infectious and noninfectious etiology; determinate their prognosis according to their etiology and find the existence of clinical and laboratory elements to guide a cause infectious or noninfectious. A retrospective cohort study was realized that considered 386 patients hospitalized for 7 or more days at the Hospital Naval Almirante Nef ICU and were discharged from it in July of 2007 and July of 2012. From a total of 386 patients, 82 did fever (21.24 percent) and in 10 of them (12.20 percent) were not able to determine the cause, of the 72 patients (87.80 percent) who had a known cause, 67 cases were due to infection and only 5 cases due to a non-infectious cause. Of all patients who developed fever, the leading cause was mechanical ventilation-associated pneumonia (31.76 percent), followed by infection with one or more isolated microrganism (12.20 percent). There was no statistically significant relationship between the etiology of fever and clinical or laboratory items, nor there was between the prognosis and etiology (OR = 0.684, 95 percent CI = 0.073-8.816). In conclusion the currently fever developed in ICU patients is predominantly due to an infectious cause and is most often caused by mechanical ventilation-associated pneumonia. It is recommended to guide the search for an infectious etiology,...

Percepción y cumplimiento del consentimiento informado anestesiológico para cirugías electivas en un hospital del norte del Perú / Perception and compliance with anesthesiological informed consent for elective surgeries in a hospital in northern Peru

Introducción: El consentimiento informado es uno de los pilares fundamentales de la relación médico-paciente, por ello este estudio busca determinar el grado del cumplimiento y el grado de percepción del Consentimiento Informado Anestesiológico (CIA) brindado a los pacientes sometidos a cirugía electiva en el Hospital III José Cayetano Heredia-EsSalud (HJCH) durante Febrero del 2013. Material y métodos: Se llevó a cabo un estudio descriptivo, prospectivo, transversal y observacional en el HJCH-(Piura), en Febrero del 2013. Se elaboró y validó una encuesta para evaluar la percepción del CIA en cuatro dimensiones: información, entendimiento, autonomía y valores. Se aplicó dicha encuesta a los pacientes programados a cirugías electivas en el periodo de estudio. De estos mismos se revisó las historias clínicas para evaluar el cumplimiento de la documentación del CIA, a través de una lista de chequeo. Resultados: 131 pacientes fueron encuestados, la edad promedio fue de 49,98 años, el 67,2% eran mujeres. El 29,8% tenían nivel de estudios secundario, y el 67,2% presentaron cirugías previas. El grado de percepción total del CIA fue malo, según 52,7% de los encuestados. La percepción de la información, el entendimiento y la autonomía fue mala en un 67,9%, 54,2% y 70,2% respectivamente; mientras que los valores fueron percibidos como regulares en un 58,8%. El cumplimiento de la documentación del CIA se calificó como malo en un 49,6% de las historias clínicas revisadas. Conclusión: La percepción de los pacientes acerca del CIA y el grado de cumplimiento de la documentación del CIA es mala. (AU)

Introduction: The consent is part of the medical act that arises from the doctor-patient relationship; because this study aims to determine the degree of compliance and the degree of perception of anesthesiologist informed consent (AIC) given to hospitalized patients for elective surgery in Jose Cayetano Heredia-Essalud III-Hospital in February the 2013. Material and methods: a study descriptive, prospective, and observational and cross was performed at Jose Cayetano Heredia Hospital III-EsSalud, in Piura, during February in 2013 for which was developed and validated a questionnaire to evaluate AIC in four dimensions: information, understanding, autonomy and values. This questionnaire was applied to hospitalized patients for elective surgery during study period. Also the medical records of these patients were reviewed to know the degree of compliance of the documentation of process of AIC, for this was elaborated a check list. Results:131 patients were surveyed, the average age was 49,98 years, 67,2% were female. The 29.8% had secondary level of education, and 67,2% of the total had previous surgeries. The degree of global perception CIA was wrong, by 52,7% of respondents. The perception of information, understanding and autonomy was wrong in 67,9%, 54,2% and 70,2% respectively, while the values were perceived as fair by 58,8%. The degree of compliance the CIA documentation was scored as wrong in 49,6% of medical records reviewed. Conclusion:The perception of patients about of CIA and the degree of compliance with the documentation of the CIA is bad. (AU)

Lesiones en órganos de cerdos posdestete, inducidas por el lipopolisacárido de E. coli / Injuries in post-weaning pig organs, induced by the E. coli lipopolysaccharide

Objetivo. Evaluar el efecto de la ingestión de varios niveles de Lipopolisacárido (LPS) de E. coli sobre las manifestaciones clínicas y lesiones en órganos de cerdos recién destetados. Materiales y métodos. El trabajo de campo se realizó en el Centro San Pablo, perteneciente a la Universidad Nacional de Colombia. El estudio se realizó con 52 cerdos destetados (6.5±0.5 kg) a los 21 días de edad. Los animales fueron alimentados durante 10 días con una dieta basal compuesta de leche y algunos de sus derivados, adicionada con cuatro niveles de LPS (0, 0.3, 0.5 y 1.0 μg/ml de alimento). Los cerdos se sacrificaron escalonadamente los días 1, 5, 7 y 10 posdestete y se tomaron muestras de intestino delgado, estómago, hígado, páncreas, corazón, pulmón, riñón y bazo. El monitoreo clínico y paraclínico se realizó diariamente durante la investigación. Para determinar la ganancia de peso, los animales fueron pesados el día del destete y el día del sacrificio. Resultados. Hubo diferencia (p<0.01) en las variables peso de los órganos y ganancia de peso, donde los animales que consumieron el mayor nivel de LPS presentaron los menores valores, llegando a su mínimo nivel el día 10 posdestete. Las variables presentación de: lesiones macroscópicas, diarreas, y temperatura rectal, aumentaron con el nivel de inclusión de LPS en la dieta, llegando a su máximo nivel el día 10 posdestete (p<0.01). Conclusiones. El LPS de E. coli provoca la inhibición del crecimiento corporal y de los órganos en estudio y una alta incidencia de diarreas.

Objective: To evaluate the effects of the intake of several levels of lipopolysaccharides (LPS) from E. coli on clinical manifestations and injuries in organs of newly weaned pigs. Materials and methods. The experiment was conducted at the San Pablo Production Center of the Universidad Nacional de Colombia. 52 weaned pigs at 21 days of age were used. The animals were fed a basal diet composed of milk and some of its derivatives, and an addition of four LPS levels (0, 0.3, 0.5 and 1.0 μg / mg of feed) during 10 days. The pigs were sequentially sacrificed on days 1, 5, 7, and 10 after weaning, and samples of the small intestine, stomach, liver, pancreas, heart, lungs, kidney and spleen were extracted. Clinical and laboratory monitoring was performed daily during the investigation. To determine weight gain, the animals were weighed on weaning day, and on slaughter day. Results: There were statistical differences (p<0.01) in organ weights and weight gain, where animals that consumed the highest levels of LPS showed the lowest values, reaching the lowest level on day 10 post-weaning. The variables: macroscopic lesions, diarrhea, and rectal temperature increased with the increase in LPS levels in the diet, reaching their peaks on day 10 post-weaning (p<0.01). Conclusions: E. coli LPS causes inhibition of the studied body and organ growth parameters, and a high incidence of post-weaning diarrhea.

Comparación de los costos reales anuales asociados al manejo ambulatorio de pacientes hipertensos del programa cardiovascular en el Hospital Comunitario de Bulnes con el pago de prestaciones de Fonasa / Cost of ambulatory care of hypertensive subjects in a community hospital (bulnes): comparison of activity associated costs to the national health fund (fonasa) estimated payments in the setting of a national cardiovascular care program

Antecedentes: El financiamiento de las prestaciones entregadas a los usuarios de atención primaria portadores de Hipertensión Arterial, esta determinado por un arancel definido por el Fondo Nacional de Salud (FONASA), el cual ha estimado montos a pagar a la institución prestadora, basados en estudios realizados a nivel nacional, los cuales difieren de las estimaciones de gasto real de cada prestación, para lo cual se hace necesario objetivar dicha diferencia de estimación a nivel local. Objetivo: Determinar los costos directos e indirectos reales de las prestaciones entregadas a los usuarios hipertensos de control ambulatorio en atención primaria de salud mediante la metodología de costos asociados a actividades (ABC), para compararlos con los valores asignados por FONASA. Diseño: Estudio Analítico no experimental de enfoque cuantitativo de corte transversal, en que se revisaron 290 tarjetas de control de usuarios hipertensos bajo control en el Hospital Comunitario de Salud Familiar de Bul-nes. Se analizaron específicamente los valores del control Médico, control Enfermera, control Nutricionista, y valores de exámenes: hematocrito, perfil lipídico, glicemia, creatinina plasmática, orina completa, potasio plasmático, electrocardiograma, atención farmacéutica. Resultados: Los costos reales de las prestaciones incluidas en la Guía Clínica GES para el manejo ambulatorio de la Hipertensión Arterial, obtenidos mediante el uso de la metodología ABC fueron significativamente mayores a los establecidos por el FONASA (promedio miles de pesos: Fonasa 21.370; Costo real 39.991,7 +/- 11.999,4; p <0,001). Conclusión: Estos resultados sugieren que existe una diferencia entre lo que FONASA cancela por estas prestaciones y el gasto real en que se incurre por su atención. Si estos valores se acercan, podría obtenerse un mejor financiamiento del programa.

Background: Payments for ambulatory care of hypertensive patients in the national cardiovascular program is defined by FONASA based on national studies. Considerable differences are observed upon confrontation with the real costs involved in a given place. Aim: to determine direct and indirect costs of health care actions in the ambulatory care of hypertensive patients through an activity based cost (ABC) methodology and to compare these with the corresponding payments defined by FONASA Method: In a cross sectional design, 290 records of hypertensive subjects under control at the Community Hospital in Bulnes were analyzed. Costs of doctor, nurse and nutritionist controls were determined along with those related to laboratory tests including hematocrit, lipid profile, glycemia, plasma creatinine, urine analysis, plasma K level and electrocardiogram. Cost of pharmacy was also included. Results: a monthly mean of $ 39 992 +/- 12 000 per hypertensive patient cared was determined through ABC based costs. This is considerable greater than de $ 21 370 determined by FONASA (p<0.001). Conclusion: Payments considered by FONASA are insufficient to cover real costs involved in ambulatory care of hypertensive patients. A better financing of the cardiovascular care program requires these costs and payments to converge.

Dosagem sérica de troponina I em cães com desnível do segmento ST utilizando quimioluminescência / Serum determination of troponin I in dogs with ST deviation by chemiluminescent

Com o intuito de verificar algum dano nas células do miocárdio, utilizaram-se 38 cães, 20 com traçado eletrocardiográfico normal, grupo 1, e 18 com desníveis do segmento ST, grupo 2, em registro na derivação II, velocidade de 50mm/s e sensibilidade N (1mV=1cm). No grupo 1, a dosagem sérica da troponina I (cTnI) destinou-se à obtenção dos valores referenciais (ng/mL) que seriam confrontados com os obtidos no grupo 2. A média e o desvio-padrão foram, respectivamente, 0,16ng/mL e 0,11ng/mL e 0,20ng/mL e 0,11ng/mL, nos grupos 1 e 2. A cTnI não apresentou evidências de associação com idade, massa corpórea, creatinafosfoquinase total e potássio nos dois grupos. Não houve diferenças significativas nos valores de cTnI entre os grupos. Conclui-se que é possível a utilização do kit de ensaio imunométrico quimioluminescente humano para a espécie canina e que a hipóxia-isquemia, revelada pelo desnível do segmento ST não acarreta dano miocárdico ou este é mínimo e indetectável.

In order to investigate myocardial cells injury, 38 dogs were evaluated, being 20 with a normal electrocardiogram (group 1) and 18 with ST segment elevation or depression (group 2), recorded in lead II, at paper speed of 50 mm/sec and N sensibility (1 mV = 1cm). Serum measurement of troponin I (cTnI) in group 1 was determined to obtain reference values (ng/mL). These values were compared to those obtained in dogs from group 2, to confirm or not myocardial injury. Mean cTnI values in groups 1 and 2 were 0.16ng/mL (SD±0.11ng/mL) and 0.20ng/mL (SD±0.11ng/mL), respectively. Three cTnI null values were found in group 1. cTnI was not related to age, mass, CK-T or serum potassium concentration in both animal groups, for each level varied in the group. There was no difference in cTnI values between groups 1 and 2. In conclusion, it is possible to use the human chemiluminescent immunometric assay kit in canine species and hypoxia/ischemia revealed by ST segment deviation does not mean significant myocardium injury.

Participation of neuronal nitric oxide synthase in experimental neuropathic pain induced by sciatic nerve transection

Nerve injury leads to a neuropathic pain state that results from central sensitization. This phenomenom is mediated by NMDA receptors and may involve the production of nitric oxide (NO). In this study, we investigated the expression of the neuronal isoform of NO synthase (nNOS) in the spinal cord of 3-month-old male, Wistar rats after sciatic nerve transection (SNT). Our attention was focused on the dorsal part of L3-L5 segments receiving sensory inputs from the sciatic nerve. SNT resulted in the development of neuropathic pain symptoms confirmed by evaluating mechanical hyperalgesia (Randall and Selitto test) and allodynia (von Frey hair test). Control animals did not present any alteration (sham-animals). The selective inhibitor of nNOS, 7-nitroindazole (0.2 and 2 µg in 50 µL), blocked hyperalgesia and allodynia induced by SNT. Immunohistochemical analysis showed that nNOS was increased (48 percent by day 30) in the lumbar spinal cord after SNT. This increase was observed near the central canal (Rexed’s lamina X) and also in lamina I-IV of the dorsal horn. Real-time PCR results indicated an increase of nNOS mRNA detected from 1 to 30 days after SNT, with the highest increase observed 1 day after injury (1469 percent). Immunoblotting confirmed the increase of nNOS in the spinal cord between 1 and 15 days post-lesion (20 percent), reaching the greatest increase (60 percent) 30 days after surgery. The present findings demonstrate an increase of nNOS after peripheral nerve injury that may contribute to the increase of NO production observed after peripheral neuropathy.

Sinovitis villonodular pigmentada de rodilla: resultado en el tratamiento artroscópico en 10 pacientes / Pigmented villonodular synovitis of the knee: arthroscopic treatment in 10 patients

Objective: To report our experience in the diagnosis, treatment and follow up of patients with clinical and histopathological diagnosis of knee pigmented villonodular synovitis (PVNS). We performed a descriptive retrospective study of a consecutive series of 10 patients treated by knee PVNS in a ten years period. The mean follow-up was 39 months. Clinical records and surgery protocols were reviewed; functional clinical results were documented using the Lysholm score. Results: Nine patients consulted by pain and one case corresponded a incidental finding. All patients were initially treated with an arthroscopic synovectomy. Two patients presented relapse and as a final treatment they underwent total knee arthroplasty. The mean post-operative Lysholm score at follow up was 95 (90-100) points. Conclusion: We documented low incidence of knee PVNS. The total recurrence in our series was of 20 percent.

Objetivo: Reportar nuestra experiencia en el diagnóstico, tratamiento y evolución de pacientes con diagnóstico clínico-histopatológico de sinovitis villonodular pigmentada (SVNP) de rodilla tratados en nuestro centro. Métodos: Estudio retrospectivo, descriptivo, de una serie consecutiva de diez pacientes tratados por SNVP de rodilla en un período 10 años con un seguimiento promedio de 39 meses. Se revisaron fichas clínicas, protocolos quirúrgicos y documentamos los resultados funcionales subjetivos mediante el puntaje de Lysholm. Resultados: Nueve pacientes consultaron por dolor y en un caso correspondió a un hallazgo. A todos los pacientes se les realizó inicialmente una sinovectomía artroscópica. Dos pacientes presentaron recidiva y como tratamiento final se les realizó una artrosplastía total de rodilla. El promedio del puntaje Lysholm postoperatorio consignado durante el seguimiento fue 95 (90-100). Conclusión: La SVNP de rodilla corresponde a una patología de baja frecuencia, que presenta una recidiva de un 20 por ciento tras un tratamiento artroscópico.

Evaluación de la actividad hipotensora del Maytenus krukovii (chuchuhuasi) en rata conciente / Maytenus krukovii (chuchuhuasi) effects on blood pressure and cardiac frequency in conscious rats

Maytenus krukovii (chuchuhuasi), oriunda de la amazonía sudamericana, tradicionalmente se le atribuye acción analgesica, antiinflamatoria, afrodisíaca entre otros; investigaciones reportan acción analgésica con intermediación de receptores opiáceos, efecto antipirético, antiinflamatorio y gastroprotector. El presente estudio experimental indagó acerca de la acción sobre la presión arterial y frecuencia cardiaca del chuchuhasi en rata conciente. Se utilizaron 10 ratas albinas machos, a las que se les administró vía oral, 1000 mg/kg de extracto metanolico de chuchuhuasi, se registraron básales y controles de presión arterial y frecuencia cardiaca a las 1, 3, 4 y 24 horas, utilizando el LE 5000 Meter Pressure. Los resultados obtenidos muestran comparados con los valores basáles, actividad hipotensora del Maytenus Krukovii destacándose el máximo efecto a la hora de administración arterial sistólica (238 vs. 181 mmhg), diastolica (200 vs 129 nmhg) y media (299 vs 187 mmhg); respecto a la frecuencia cardiaca Maytenus Krukovii mostró actividad bradicárdica, siendo su máximo efecto a las 3 horas de administrar el chuchuhuasi (430 vs 386 latidos por minutos). Se concluye en que Maytenus krukovii presenta acción hipotensora y cronotropa negativa.

Maytenus krukovii (chuchuhuasi), is originary from the South America Amazonian Forest, traditionally anti-inflammatory, analgesic, aphrodisiac proporties are atributed to this plant. Research reports suggest analgesic action by intermediation of opioid receptors, antipyretic effect, antiinflammatory and gastro protective actions. The presente experimental study inquited about the action of chuchuhuasi on blood pressure and cardiac frequency on conscious rats. Ten male albino rats were administered orally with 1000 mg/kg of methanolic extract of chuchuhuasi. Basal blood pressure and cardiac frequency were registared alt hour 1, 3, 4 and 24, using LE 5000 Meter Pressure. Results obtained show comparative values regarding basal values, with hipontensive activity of Maytenus krukovii. The maximum values is detected at the first hour of administration, systolic blood pressure (238 vs. 181 mmHg), diastolic (200 vs. 129 NMHG) and media (299 vs. 187 mmHg); were obtained. Redarding cardiac frequency, Maytenus krukowii showed bradychardic activity the highest effect recorded after 3 hours (430 vs. 386 beats/minute). We conclude that Maytenus krukovii has hypotensive action and negative chronotropic effects.

Mola incompleta, eclampsia y síndrome de HELLP: un caso clínico / Partial mole, eclampsia and HELLP syndrome: a clinical case

Presentamos un caso clínico de mola parcial de 14 semanas, que debuta con crisis eclámptica y síndrome de HELLP. La paciente fue ingresada a la Unidad de Emergencia Obstétrica de nuestro hospital con crisis hipertensiva y eclámptica. Se realizó manejo de urgencia de la crisis eclámptica. La ecotomografía Doppler demostró feto único acorde a amenorrea, vivo y gran masa placentaria compuesta por infinidad de vesículas de aspecto hidatídico. La paciente evoluciona con un síndrome de HELLP, por lo que se decidió interrupción inmediata del embarazo por microcesárea tipo Pfannestiel, en la cual se extrajo gran masa placentaria molar y feto sin signos de vida. La paciente evolucionó favorablemente y fue dada de alta al décimotercer día postoperatorio. Se hace una discusión del caso.

Estudio comparativo entre los efectos de la DL-4-hidroxi, 4-etil, 4-fenil butiramida (HEPB) y fenobarbital sobre la memoria espacial dependiente del hipocampo / Comparative study of the effects of Dl-4-hydroxy, 4-ethil, 4-phenyl butyramide (HEPB) and phenobarbital on hippocampal dependent spacial memory

Este estudio farmacológico conductual fue llevado a cabo para determinar las acciones de los anticonvulsionantes HEPB y fenobarbital sobre los procesos de adquisición y retención de la memoria espacial dependiente de la integridad anatómica-funcional del hipocampo en la rata, utilizando un laberinto radial elevado de ocho brazos, y mediante la estrategia "acierto cambio". La administración diaria de estos fármacos, es un intervalo de dosis de 10 a 100 mg/kg-1, durante 25 días consecutivos, no afectó el curso temporal del proceso de adquisición de la información especial. Sin embargo, a la dosis de 100 mg/kg-1 de fenobarbital las máximas calificaciones obtenidas fueron consistentemente bajas (menores de 7.6). después de un periodo de ocho días sin entrenamiento, los grupos tratados con fenobarbital mostraron una extinción total de la información espacial similar a la obtenida para los grupos testigo, mientras que todos los grupos tratados con HEPB mantuvieron una retención total de dicha información. Estos resultados son indicativos de que HEBP puede ejercer una acción protectora sobre los procesos de extinción de memoria espacial a través de mecanismos neuronales que pueden involucrar una retención del mapa cognoscitivo adquirido

Artritis seronegativas: reexamen del diagnóstico inicial y pronóstico al cabo de 10 años / Seronegative arthritis: diagnosis and prognostic reassessment after 10 years

Seronegative arthritides are a heterogeneous group of diseases that includes rheumatoid arthritis with negative rheumatoid factor. Between 1980 and 1984 we studied 38 patients with seronegative arthritis. Thirty of these patients were reassessed in 1994 after 9 or 20 years of evolution. Seventeen patients had a diagnosis of seronegative rheumatoid arthritis; this diagnosis was maintained in 12, changed to seropositive rheumatoid arthritis in 3, to psoriatic arthritis in 1 and connective tissue disease in 1. Thirteen patients had a diagnosis of undifferentiated arthritis; in 1994 the diagnosis was maintained in 3, 7 patients were diagnosed as having a sppondyloarthropathy, 2 as having a reactive arthritis and 1 as having a connective tissue disease. In 1994, nine patients fulfilled the 1991 criteria for spondyloarthritis and 6 of these did so on admission. Six of 12 patients with seronegative rheumatoid arthritis had an active disease or used antiinflammatory drugs and 64 percent had erosions on hand X ray examination. These figures are in contrast with the enigm evolution classically attributed to this disease and agree with recent reports. The usefulness of classification criteria for rheumatoid arthritis and spondyloarthritis in the initial assessment of patients with seronegative arthritis is emphasized