Bocavirus humano: Estudios en la literatura médica y en Chile / Human bocavirus: Studies in the literature and in Chile

The human bocavirus (HBoV), virus of the Parvoviridae family, discovered by molecular methods in 2005,has been reported in respiratory samples, stool, urine and blood, both in children and adults. Prevalence ratesrange from 0.8% in fecal samples of individuals with acute diarrhea, up to 19% in respiratory samples and blood.HBoV has been detected in up to 43% of nasopharyngeal samples in asymptomatic children. In Chile, HBoV wasdetected in 24.2% of nasopharyngeal swabs in children under 5 years of age with respiratory symptoms of which74% had coinfection with other viruses. In asymptomatic children under 5 years of age, 37.5% of NP sampleswere positive for HBoV. We discuss the role of HBoV as a causal agent of respiratory and/or enteric disease inlight of the high rates of coinfection and asymptomatic infections.

Técnica inhalatoria en lactantes hospitalizados / Evaluation of the inhalatory technique in hospitalized infants

Background: The quality of the inhalatory technique (IT) is a factor on which its therapeutic success relies. Objective: Evaluate the quality of the IT performed by mothers of hospitalized infants due to acute respiratory infections, identifying possible mistakes. Method: 10 steps of an optimal IT were evaluated through a numerical scale previously designed, each step qualified with score 0 or 1 according to its accomplishment (maximum 10 points). The IT of each mother was evaluated and the correct accomplishment percentage of each step was calculated. Results: Mothers' IT scores presented a range of 4 to 10 points, where 12.5 percent reached the maximum score. The steps with the least accomplishment percentages were: appropriate waiting time between 2 inhalations (17.2 percent), performance of a second inhalation (83.6 percent) and holding the mouth and nose inside the inhalatory chamber for 10 seconds or 10 respiratory cycles once the inhalation had been administrated (89.1 percent). Conclusion: Although the majority of mothers had received IT instruction and are familiarized with it, certain steps are still performed in a deficient way, compromising the therapy success.

La calidad con que se realiza la técnica inhalatoria (TI) es un factor condicionante de su éxito terapéutico. Objetivo: Evaluar la calidad de la TI realizada por madres de lactantes hospitalizados por infecciones respiratorias agudas, identificando posibles errores. Pacientes y Métodos: Mediante una escala numérica previamente diseñada que incluyó 10 pasos de una TI óptima (calificada con puntaje 0 ó 1 según cumplimiento, puntaje máximo 10), se evaluó la TI de cada madre y el porcentaje de cumplimiento de cada paso. Resultados: El rango de calificaciones de las madres fue 4 a 10 puntos, obteniendo 12,5 por ciento el puntaje máximo. Los pasos que obtuvieron los menores porcentajes de cumplimiento fueron: tiempo de espera entre dos ciclos inhalatorios (17,2 por ciento), realización de un segundo ciclo inhalatorio (83,6 por ciento) y mantenimiento por 10 segundos o 10 respiraciones de la boca y nariz del lactante dentro de la aerocámara una vez administrada la inhalación (89,1 por ciento). Conclusión: A pesar de que la mayoría de las madres ha recibido instrucción y están familiarizadas con el uso de inhaladores, algunos pasos son realizados en forma deficiente por un elevado número de ellas, comprometiendo el éxito de la terapia.

Adherencia a las inmunizaciones en niños con necesidades de cuidado médico especial / Adherence to immunization among children with special health care needs

Los niños con necesidades de cuidado médico especial (NECMES) son una población creciente en pediatría y su riesgo de complicaciones asociadas a enfermedades infecciosas es alto. Objetivo. En niños con NECMES, describir la adherencia al Programa Nacional de Inmunizaciones (PNI) y al uso de vacunas adicionales recomendadas. Pacientes y Métodos. En forma retrospectiva se registró en niños con NECMES, hospitalizados: vacunas PNI administradas, retrasos y causas de éstos, prescripción y administración de vacunas adicionales. Resultados. Se analizaron 70 niños: 30 presentaron al menos un atraso en las vacunas PNI, 40,0 por ciento por hospitalizaciones previas, 26,7 por ciento por morbilidad menor y 20 por ciento por otras causas no justificadas. Se prescribió vacunas adicionales al PNI a 49 niños (70 por ciento) pero sólo 25 las recibieron. Conclusiones. Esta población presentó baja adherencia al esquema de vacunación PNI y extra PNI. Cualquier contacto con el personal de salud, incluyendo la hospitalización, debe constituir una oportunidad para actualizar las inmunizaciones.

The proportion of children with special health care needs (CSHCN) due to chronic illness is increasing. They have a high risk of complications due to infectious diseases. Objective. To describe adherence to the Expanded Program of Immunization (EPI) and administration of other expert recommended vaccines in CSHCN. Patients and methods. In a retrospective manner information on chronic disease, EPI vaccines administration, reasons for delays, prescription and administration of additionally recommended vaccines was registered in a cohort of hospitalized CSHCN. Results. Seventy children were analyzed. Thirty (42.9 percent) had at least one delay in EPI immunization schedule; 40 percent due to previous hospitalizations, 26.7 percent due to minor morbidity and 20 percent due to other unjustified reasons. Forty-nine (70.0 percent) received prescriptions for additional vaccines, but only 25 actually received them. Conclusions. CSHCN showed low adherence to EPI and received few additionally recommended vaccines. Every contact with these patients, including hospitalization should be used to update immunizations.

Test de estimulación intraarterial selectiva con calcio en el diagnóstico de localización de insulinomas: Casos clínicos / Selective intra arterial calcium stimulation for the localization of insulinomas: Report of two cases

Insulinoma is the most common neuroendocrine tumor. Its clinical manifestations are frequently confounded with neuropsychiatric symptoms, and definitive diagnosis can be delayed for a long time. These tumors are usually small, of less than 2 cm. Thus, their preoperative localization is difficult. We report two patients with a clinical diagnosis of insulinoma, in whom the preoperative imaging study was negative. Both fulfilled diagnostic criteria, with high serum insulin levels in the presence of a blood glucose of less than 45 mg/dl. The imaging study, including abdominal computed tomography and pancreatic endoscopic ultrasonography did not disclose the location of the tumor. A pancreatic angiography with selective stimulation with intra arterial calcium and venous sampling for insulin measurements, was performed in both patients. This test allowed the exact localization of the tumors and their successful excision. A review of other localization diagnostic tests is done (Rev Méd Chile 2004; 132: 71-5).

Remisión parcial del hipercortisolismo en una enfermedad de Cushing posterior a una apoplejia hipofisiaria: caso clínico / Partial remission of Cushing disease after pituitary apoplexy: report of 1 case

ACTH secreting macroadenomas and pituitary apoplexy are unusual in Cushing disease. In the few cases reported in the literature, they have been found in long term hypercortisolism. We communicate a 43 yr old woman with a 4 year evolution Cushing syndrome, who developed sudden cephalea and oftalmoplejia. A Computed Tomography of the pituitary fossa disclosed a macroadenoma with intracapsular hemorrhage and suprasellar expansion. In the functional tests, serum cortisol was suppressed with dexamethasone in a dose of 1 and 8 mg and responded to the desmopressin stimulus. Nevertheless, cortisol levels were lower than those observed in Cushing syndrome of similar magnitude. The tumor was resected by transphenoidal surgery and immunohistochemistry to ACTH was positive. In this case, the laboratory results suggest a partial remission of the hypercortisolism after pituitary apoplexy

Endocarditis infecciosa: factores pronósticos de mortalidad en 131 casos / Infectious endocarditis: prognostic factors of mortality in 131 cases

We followed during their hospital stay, 129 patients aged 14 to 74 years old, who had 131 episodes of infective endocarditis. Clinical assessment, echocardiography and microbiological study was done to all patients. Surgical indications were those derived from complications. Thirty three patients died during hospital stay (25.2 percent). There were no differences between survivors and deceased patients in the lapse between onset of symptoms and hospital admission, presence of fever, dyspnea or heart murmurs. Skin and mucosal septic manifestations occured with higher frequency in deceased patients (57.1 and 24.3 percent respectively). Blood cultures were positive in 55 percent in survivors and 48 percent in those who died. The most frequent infecting organisms were staphilococci and streptococci. Vegetations were found with greater frequency in aortic position in both groups of patients. Deceased patients had a higher frequency of cardiac failure (84 and 65 percent respectively) and embolic episodes (77 and 46 percent respectively) than survivors. Antimicrobial treatment was successfull in 94 percent of survivors and 15 percent of those who died. Forty percent of survivors and 54 percent of deceased patients were subjected to surgical procedures. The most important predictor of hospital mortality in this series of patients with infective endocarditis was antimicrobial treatment failure

Leiomiosarcoma del intestino delgado.Contribucion de la tomografia computada para su diagnostico. / Leiomyosarcoma of the small bowel. Contribution to the computed tomography for its diagnosis

Se presenta el caso de una paciente con un leiomiosarcoma del intestino delgado, en la cual se logro un diagnostico preoperatorio correcto gracias a los datos aportados por la tomografia computada. Se analizan estos hallazgos y se sugiere que este nuevo metodo diagnostico puede ser muy util para el estudio de pacientes con tumores intramurales del intestino delgado en los cuales otros estudios usualmente no son concluyentes