Concentraciones de oxígeno intermitentes tienen impacto en el desarrollo postnatal temprano de ratas Sprague-Dawley: efectos en CA1 del hipocampo / Intermittent oxygen concentrations have an impact on the early postnatal development of Sprague-Dawley rats: effects on hippocampal CA1

El periodo postnatal temprano se caracteriza por rápido crecimiento cerebral, posiblemente relacionado con variaciones del oxígeno tisular. Esto ha motivado el estudio de protocolos que suministran diferentes concentraciones de oxígeno intermitentes, para observar sus efectos morfológicos y cerebrales. Se utilizaron 52 crías de ratas Sprague Dawley, distribuidas en igual número a cuatro grupos experimentales, Control (C, 21 %O2), Hipoxia Intermitente (HI, 11 %O2), Hiperoxia Intermitente (HOI, 30 %O2) e Hipoxia Hiperoxia Intermitente (HHI, 11 % -30 %O2). Los protocolos consideraron 5 ciclos de 5 minutos de dosificación, durante 50 minutos diarios. Se realizó en una cámara semihermética entre los días 5 al 11 postnatales. Las evaluaciones de crecimiento corporal y cuantificación neuronal, se realizaron en las crías macho, en el día 28 postnatal. El peso corporal en el grupo hipoxia intermitente mostró diferencias significativas respecto al grupo hiperoxia intermitente (HI vs HOI, p<0,01) y al grupo hipoxia-hiperoxia Intermitente (HI vs HHI, p< 0,001). La talla corporal disminuyó en el grupo hipoxia-hiperoxia intermitente con diferencias significativas respecto del grupo control (C vs HHI, p<0,05) y respecto del grupo hipoxia intermitente (HHI vs HI, p< 0,01). El conteo neuronal en el área CA1 del hipocampo aumentó en el grupo hipoxia intermitente con diferencias significativas respecto a los grupos control (C vs HI; p<0,05), al grupo hiperoxia intermitente (HI vs HOI; p<0,001) y al grupo hipoxia-hiperoxia intermitente (HI vs HHI; p<0,001). Finalmente, el grupo hipoxia- hiperoxia Intermitente disminuyó significativamente en la cantidad de neuronas en comparación al grupo hiperoxia intermitente (HHI vs HOI; p<0,001). La hipoxia intermitente mostró resultados beneficiosos en el crecimiento corporal y cantidad de neuronas en el área CA1 del hipocampo, en contraste, la hipoxia hiperoxia intermitente experimentó resultados adversos con disminución de estas variables, en el periodo postnatal temprano de la rata.

SUMMARY: The early postnatal period is characterized by rapid brain growth, possibly related to variations in tissue oxygen. This has motivated the study of protocols that supply different intermittent oxygen concentrations, to observe their morphological and cerebral effects. Fifty-two pups Sprague-Dawley rats were distributed in equal numbers into four experimental groups, Control (C, 21 %O), Intermittent Hypoxia (HI, 11 %O), Intermittent Hyperoxia (HOI, 30 %O2) and Intermittent Hypoxia Hyperoxia (HHI, 11 % - 30 %O2). The protocols considered 5 cycles of 5 min of dosing, for 50 min diary. It was performed in a semi- hermetic chamber between 5 to 11postnatal days. The evaluations of body growth and neuronal quantification were analyzed in male pups, on postnatal day 28. Body weight in the intermittent hypoxia group showed significant differences compared to the intermittent hyperoxia group (HI vs HOI, p<0.01) and the intermittent hypoxia- hyperoxia group (HI vs HHI, p<0.001). Body size decreased in the Intermittent hypoxia-hyperoxia group with significant differences compared to the control group (C vs HHI, p<0.05) and with respect to the intermittent hypoxia group (HHI vs HI, p<0.01). The neuronal count in the area CA1 of the hippocampus increased in the intermittent hypoxia group with significant differences compared to the control groups (C vs HI; p<0.05), to the intermittent hyperoxia group (HI vs HOI; p< 0.001) and the intermittent hypoxia-hyperoxia group (HI vs HHI; p<0.001). Finally, the intermittent hypoxia- hyperoxia group decreased significantly in the number of neurons compared with the intermittent hyperoxia group (HHI vs HOI; p<0.001). Intermittent hypoxia showed beneficial results in body growth and the number of neurons in the CA1 area of the hippocampus, in contrast, intermittent hypoxia-hyperoxia experienced adverse results with a decrease in these variables, in the early postnatal period of the rat.

¿Cómo realizar el seguimiento de los pacientes con fibrosis pulmonar idiopática? / How to monitor patients with idiopathic pulmonary fibrosis?

La fibrosis pulmonar idiopática (FPI) se ha clasificado en enfermedad leve o temprana-moderada-severa o Avanzada, sin puntos de corte en parámetros clínicos, funcionales o imagenológicos. No existe aún consenso en cual es el principal parámetro que se debe medir. Si bien las variables funcionales como la capacidad vital forzada (CVF), capacidad de difusión de monóxido de carbono (DLCO) y test de caminata de 6 minutos se han utilizado de forma rutinaria en la practica clínica y en los principales estudios clínicos de tratamiento muchas veces no son representativos de la evolución clínica. Por lo anterior se han desarrollado, índices o puntajes compuestos como la escala GAP (Gender-Age-Physiology) que podrían ser útiles en el seguimiento de los pacientes.

Idiopathic pulmonary fibrosis (IPF) has been classified as mild or early - moderate - severe or advanced disease, with no cut-off points in clinical, functional or imaging parameters. There is no consensus yet on which is the main parameter to be measured although the functional variables such as forced vital capacity (FVC), carbon monoxide diffusion capacity (DLCO) and 6-minute walk test, have been routinely used in clinical practice and in the main clinical studies of treatment, are often not representative of the clinical evolution. Therefore, composite indices or scores such as the GAP (Gender-Age-Physiology) scale have been developed that could be useful in the follow-up of patients.

Falla renal aguda en postoperatorio inmediato de cirugía correctiva de escoliosis / Case report of two cases: Acute renal failure adter scolisosis surgery

La cirugía correctiva de escoliosis es la alternativa terapéutica para los pacientes portadores de escoliosis severa con ángulos de Cobb > 40- 45º. La corrección ofrece solución a la deformidad estética, evita la progresión y/o corrige según sea el caso, el compromiso cardiopulmonar. Mejora además biomecánica de marcha y permite reintegración funcional de los pacientes. La artrodesis posterior con barras y tornillos es la técnica de elección, tiene un alto riesgo de hemorragia y de daño neurológico postoperatorio. En la actualidad, las estrategias de manejo anestésico ­ quirúrgico y la incorporación de neuromonitoreo continuo han disminuido la incidencia y el impacto clínico de estas complicaciones. Sin embargo, otras complicaciones como la falla renal aguda aún están presentes en pacientes de alto riesgo como portadores de patología neuromuscular. A continuación, se presenta un reporte y análisis de 2 casos clínicos de falla renal aguda en el postoperatorio inmediato en cirugía correctiva de escoliosis con artrodesis posterior, en pacientes portadores de escoliosis neuromuscular severa ocurridos durante el año 2015 en el hospital clínico San Borja Arriarán.

Corrective surgery is a therapeutic alternative for patients with scoliosis Cobb angle > 40-45ª. This surgery offers a solution to aesthetic deformities, prevents progression and in some cases can resolve the cardiopulmonary consequences. It also improves the ambulation biomechanics and allows the reintegration to total functionality. Posterior artrodesis with bars and pedicular screws is the technic of choice. It has a high risk of hemorrhagic complications and neurological damage. Presently, anaesthetic and surgical approaches, along with neurological somatosensitive monitoring, have decrease these complications. However, other complications, including acute renal failure are still present in high-risk cases such as patient with neuromuscular scoliosis. We present a case report including 2 patients with neuromuscular scoliosis that underwent posterior artrodesis in our hospital (Hospital Clinico San Borja Arriaran) during 2015. Both develop and acute renal failure in the early postoperative period.

Hipovitaminosis D en pacientes hospitalizados por trastornos por consumo de sustancias en Unidad de Adicciones del Hospital Clínico Universidad de Chile / Hypovitaminosis D in patients hospitalized for substance use disorders in the Addictions Unit of the Hospital Clínico Universidad de Chile

The pathological consumption of alcohol and other drugs is associated with calcium metabolism disfunction through different pathways. Hypovitaminosis D contributes to acute a chronic neuronal injury in alcohol dependent patients. We do not have national evidence regarding the presence of hypovitaminosis D in addicted patients and there is a lack of information in the literature regarding polysubstance users. In this retrospective study, we evaluate the presence of hypovitaminosis of D in Substance Use Disorder inpatients treated in the Psychiatric Clinic of the University during the months of August to November 2017 and we described their main characteristics. 24 patients were evaluated, 19 of whom presented levels lower than 30 ng/ml of Vitamin D. Of those patients with hypovitaminosis 79% were men and 90% of them consumed alcohol, although in only 26% alcohol was the main substance. The main substance reported by the patients was cocaine (37%), smokable cocaine (32%) and marijuana (5%). Despite the methodological limitations of the study and the high prevalence of Hypovitaminosis D reported in the Chilean population, the results of this study suggest the need for a systematic evaluation of Vitamin D levels in patients hospitalized for addictions to adequately supplement those who require it. (AU)

Eficiencia del forsus en el tratamiento de maloclusión clase II / Efficiency of forsus in the treatment of maloclusion class II

La maloclusión clase II es uno d los problemas más frecuentes de ortodoncia, ésta afecta a un tercio de los pacientes que buscan tratamiento ortodoncico. De acuerdo con McNamara, la causa más común de esta es la retrusión mandibular, más que el prognatismo maxilar. Entre los distintos aparatos ortopédicos funcionales removibles y dispositivos fijos, que no requieren la colaboración del paciente. El Forsus es uno de los aparatos fijos que se ha utilizado para mantener la mandíbula en un constante posición anterior y ha demostrado ser uno de los mejores métodos de tratamiento en maloclusiones Clase II. En el siguiente artículo se presenta el caso clínico de un paciente con maloclusión de Clase II esquelética y dentaria tratado con el aparato de Forsus para la corrección de la Clase II-1; lográndose mejorar notoriamente la relación esquelética y dentaria. El Forsus demostró ser una buena opción terapéutica en el tratamiento de las maloclusiones de Clase II. (AU)

Class II maloclusión is one of the most common problems in orthodontics, as it affects one third of the patients that are seeking for orthodontic treatment. According to McNamara, the cause most common is mandibular retrognatism had been used removable orthopedic appliances or fixes that don't need patient colaboration. The Forsus is one of the fixes appliances that had been used to keep the mandible in constant anterior position, it has been proved being one of the best treatment for class II malocclusion. In this case report, we show a patient with skeletal and dental class II treated with Forsus appliance for correction of class II-1, improving the dental and skeletal relationship. Forsus demonstrated be a good option in the treatment of class II malocclusion. (AU)

Trayectoria de vida de profesionales universitarios con déficit auditivo: estudio exploratorio de aspectos significativos para inclusión laboral / Life trajectories of university graduates with hearing impairments: exploratory study of meaningful aspects to labor inclusion

El presente estudio ha tenido como propósito conocer los aspectos significativos en el proceso de inclusión laboral de dos profesionales universitarios con hipoacusia severa de la Región Metropolitana, por medio de la realización de entrevistas focalizadas en el desempeño laboral, de manera de avanzar en el conocimiento de estrategias que permitan mejorar las oportunidades de empleo para esta población. Es un estudio de tipo exploratorio, retrospectivo y transversal. Para la recolección de datos se diseñó una entrevista semiestructurada, solicitando previamente el consentimiento informado. La entrevista abarca sus trayectorias de vida focalizándola en el desempeño laboral. Se identifican como aspectos significativos las siguientes categorías: familia nuclear, familia de origen, déficit auditivo, desempeño educativo, desempeño laboral y redes de apoyo. En base a éstas se observa la importancia del capital cultural y económico, las estrategias personales para acceder a la información oral, el origen del déficit, el grado de interacción requerido en sus puestos de trabajo actuales, entre otros aspectos.

This study aims to know the meaningful aspects to the process of labor inclusion to two college graduates with several hypoacusis in the Metropolitan Region, through interviews focused on job performance to advance the understanding of strategies to improve employment opportunities for this population. It is an exploratory, retrospective and transversal study. It has designed a semistructured interview, previously requesting informed consent, for to collect the data. The interview covers their life trajectories focuses on job performance. They are identified as respects the following categories: nuclear family, family of origin, hearing loss, educational performance, work performance and their social support network. As a result of the former to emerge the importance of cultural and economic capital, personal strategies to access oral information, the source of the deficit, the degree of interaction required in their current jobs, among others.

Feocromocitoma suprarrenal derecho: reporte de un caso y revisión de la literatura / Right adrenal pheochromocytoma: a case report and literature review

Presentar el caso clínico de una patología poco frecuente su manejo y su resolución quirúrgica, tratado en el Servico de Cirugía General IAHULA Mérida-Venezuela. Revisión de la literatura y descripción del caso clínico. El feocromocitoma es una enfermedad inusual y es causa de hipertensión arterial secundaria. Se presenta más frecuentemente como un tumor adrenal unilateral y en los mayores de 60 años. Las manifestaciones clínicas más comunes son cefalea paroxística, palpitaciones, diaforesis e hipertensión arterial paroxística o persistente. El diagnóstico se apoya en la clínica y en la determinación bioquímica, siendo el métdodo de elección la cuantificación de metanefrinas plasmáticas. Planteado el diagnósticio, es fundamental conocer la localización del tumor, lo que debe ser realizado mediante tomografía axial computada o resonancia nuclear magnética. El tratamiento consiste en el empleo de drogas antihipertensivas y la resección quirúrgica del tumor. Las drogas de elección son los antagonistas de los receptores alfa 2 adrenérgicos y/o bloqueadores de los canales de calcio, la resección puede ser realizada por laparotomía clásica como lo fue nuestro caso.

Cirugía laparoscópica electiva en enfermedad diverticular. Un estudio comparativo con la cirugía convencional / Elective laparoscopic surgery in diverticular disease. A comparative study with conventional operative surgery

BACKGROUND: Elective surgery in diverticular disease (DD) consists classically in performing an open sigmoidectomy. Laparoscopic surgery of the colon can have results that are comparable to those of open surgery. AIM: To compare the results of laparoscopic and conventional surgery for DD. MATERIALS AND METHODS: Retrospective review of preoperative, operative and postoperative variables of patients operated by laparoscopic surgery between the years 2000 and 20002. These results were compared with those of patients treated with conventional surgery in the same period. RESULTS: Thirty nine patients, mean age 59 years old, were operated via laparotomy and 18 patients, mean age 47 years old, were treated with laparoscopic surgery. Both groups were comparable in gender, amount of previous laparotomies, type of surgery performed and American Society of Anestesiologists classification. The operative time was significantly higher in the laparoscopic surgery group (230 v/s 130 min), but the opioid requirements, stay in an intensive surgical care ward, postoperative ileus and hospital stay were significantly shorter in the laparoscopic group. Eleven percent of the patients included in the laparoscopic group and 31 per cent of the patients treated with operative surgery had complications (p = 0.07). The length of the excised colon, the degree of inflammation and treatment costs were comparable. CONCLUSIONS: Laparoscopic surgery in DD is feasible, safe, requires less analgesia and allows a faster recovery of post-operative ileus and a lower hospital stay.

Tratamiento con metilprednisolona en pacientes con síndrome cardio pulmonar por hantavirus, XI Región de Aysén / Methylprednisolone treatment in patients with hantavirus cardio pulmonary syndrome, XI Aysén Region

The Hantavirus Cardio Pulmonary Syndrome (HCPS) was observed for first time in the Región of Aysén in December of 1996. The recommended treatment is guided to manage the shock and the Adult Respiratory Distress Syndrome(ARDS) with a 50 per cent of outcome in 1988, This illnes is produced as consequence of the guest's exaggerated immune answer before the presence of the virus. Many papers report clear benefits of the corticosteroids use in patient with severe sepsis and ARDS in bacterial meningitis, serious typhoid fever, in acute medullary lesion and P. carinii pneumonia. Theoretically, the guest's inflammatory answer in the systemic inflammatory response syndrome (SIRS) and ARDS is possible of being modified with the antiinflamatorios, inmuno-supresores or corticosteroids employment. Supposing that the corticosteroids use in early stages of the illnes could reduce the severity and to prevent the death of these patients, it took us to begin a protocol of the patients treatment with HCPS, using Methylprednisolone (MP) in high dose. A retrospective and prospective study of patients was admitted in the ICU of the Coyhaique Hospital with these inclusion approach: 1) fever, migraine, mialgias, diarrhea y/o vomits and lives in endemic area; 2) front chest film with bilateral interstitial edema; 3) blood count with deviation to left of the white series, trombocytophenia (<150,000/ml) and inmunoblasts greater than 10 per cent of the linfocyts. Dose of MP 1.000 mg/day EV x 3 days + 16 mg PO x 5 days. Since december 1996 the MP has been used in 27 patients with SPCH, half age 32,7 years old range 2 to 60 years. Since september 1997 the MP has been used in 15 patients, 2 women and 13 men, half age 36.3 years old and range among 19 to 57 years. All the cases were confirmed with presence of positive IgM. The general mortality is 37 per cent (10/27), of the group control 50 per cent (6/12) and of the group that use MP 26,6 per cent (4/15). 14.3 per cent of the group MP that make moderate shock (1/7) it dies, versus 50 per cent (3/6) of the group control. The patients that make ARDS 75 per cent die (6/8) in the group control and 33.3 per cent (4/12) in the group MP (p=0.08). According to the day of beginning of the MP, used the day 5° the patients don't make shock neither ARDS.

Monitorización electroencefalográfica mediante video prolongado: experiencia del Hospital Militar de Santiago: 1991-1996 / Prolonged electroencephalography and video monitoring: an experience at Hospital Militar de Santiago: 1991-1996

Background: Cerebral activity must be registered for prolonged periods in certain clinical situations that are not resolved with conventional electroencephalography. Aim: To report the experience with prolonged electroencephalographic and video monitoring at a Neurology Department, of a Military hospital in Santiago. Patients and methods: A retrospective analysis of patients referred for continuous electroencephalographic and video monitoring between 1991 and 1996. Three hundred thirty six patients, aged 3 months to 60 years old, were studied in the period and in 244, there was information about the diagnosis, treatment and evolution. Results: Monitoring was performed in an outpatient basis in 84 percent of subjects and lasted between 2 and 7 hours. One hundred ten patients were epileptics, 77 patients had a suspicion of epilepsy, 13 patients had possible pseudoseizures and 33 patients had miscellaneous diagnoses. In 154 patients, electroencephalographs recorded during wakefulness, somnolence and spontaneous dream, were normal. Intercritical recordings with epileptic activity were obtained in 76 patients and in 30 of these, critical epileptic activity was also recorded, not always associated to clinical manifestations. Unspecific electroencephalographic alterations were recorded in 14 patients. Conclusions: Prolonged electroencephalographic and video monitoring can be useful for patients with complex neurological problems

Excreción urinaria de albúmina en diabéticos no insulino-dependientes: efecto de un inhibidor de la enzima convertidora de angiotensina / Albumin urinary excretion in non insulin dependent diabetic patients: effects of an angiotensin converting enzyme inhibitor

Microalbuminuria in diabetic patients is diagnostic of early renal involvement and angiotensin converting enzyme inhibitors reduce albumin excretion in these subjects. To asses the effect of ACEI on urinary albumin excretion, non insulin dependent diabetic patients with normal blood pressure were randomly assigned to receive enalapril 10 mg/day or placebo and followed during 18 months. Those with high blood pressure were randomly assigned to receive enalapril or acebutolol in doses necessary to normalize blood pressure and followed during 12 months. Every 3 month, urinary albumin excretion was measured in a 4 hour urine sample by radioimmunoassay. One hundred fifty two patients were recruited for the study and 46 were lost from follow up. In 17 subjects with normal blood pressure initial urinary albumin excretion below cutoff values (30 mg/24 h) and treated with enalapril, this parameter did not change; in 20 treated with placebo, it incresed from 5.8ñ6.1 to 18.2ñ7.5 mg/24 h. In 11 patients with normal pressure and initial urinary albumin, this parameter did not change with enalapril and increased in 10 with placebo from 87.3ñ75.1 to 253.6ñ61.1 mg/24 h. In hypertensive patients with normal urinary albumin excretion, no changes in this parameter were observed in those treated with acebutolol (n=10) or enalapril (n=14). In hypertensive with high urinary albumin excretion, it decreased from 119.2ñ8.5 to 40.0ñ4.7 mg/24 h with enalapril treatment (n=12) and no change was observed in those treated with acebutolol (n=11). In Conclusion, enalapril decreases urinary albumin excretion in non insulin dependent diabetic patients

Ejercicio y diabetes no insulinodependiente / Exercise and non-insulin dependent diabetes

La activivdad física requiere de ajustes orgánicos que se logran mediante la interacción de respuestas cardiopulmonares y cambios en la secreción de insulina y hormonas contrarreguladoras, que permiten una mayor disponibilidad inicial de glucosa y luego de ácidos grasos libres como fuentes energéticas. En el diabético no insulinodependiente (DMNID) esta adaptación metabólica tiene algunas diferencias debido a la insulinorresistencia. El entrenamiento físico en DMNID es un importante elemento terapéutico y presenta diversos beneficios, tales como un mejor control metabólico por aumento de la sensibilidad insulínica, reducción de peso y disminución del riesgo de enfermedad cardiovascular. Está contraindicado en pacientes con retinopatía severa, nefropatía moderada a severa y en DMNID descompensada. Son recomendables las prácticas aeróbicas, en sesiones de 15 a 30 min 3 veces por semana. En general, no son necesarios los ajustes de la dieta, ya que no hay riesgo de hipoglicemia, salvo en los pacientes insulinorrequirentes

G2 repair and evaluation of the cytogenetic damage induced by low doses of X-irradiation during G0 in human lymphocytes [published erratum appears in Biol Res 1996; 29(1): 165]

In the present study two cytogenetic parameters were used to evaluate the DNA damage induced by low doses (1 up to 40 rad) of X-ray irradiation in G0 human lymphocytes. These parameters were the frequency of chromosomal lesions in G2 and the length of this cell cycle phase. The frequency of chromosomal lesions in G2 was determined by scoring the number of chromosomal aberrations in G0 irradiated lymphocytes post treated with two inhibitors of G2 repair mechanisms: caffeine and 3-aminobenzamide. A dose-dependent increase in chromosomal aberrations yield was detected in G0 lymphocytes X-ray irradiated with or without post treatment with these two DNA repair inhibitors during G2. Nevertheless, the dose response in this latter condition was higher than the one detected in control cells, indicating that the increase of irradiation dose in G0 lymphocytes produces an increment in the number of DNA lesions arriving to be repaired in G2. The analysis of the dose-response relationships for G2 length showed an statistically significant X-ray dose-dependent increase (G2 delay) from 2.5 up to 40 rad and a positive correlation between G2 delay and the frequency of chromosomal lesions in G2. These results suggest that the DNA lesions induced by low doses of X-irradiation in G0 lymphocytes may be higher than that detected by the standard method (control conditions) and may be responsible for an increase in G2 length. We propose, therefore, that an analysis of these two cytogenetic parameters can improve the evaluation of the DNA damage induced by low doses of X-rays irradiation in G0 cells

Diabetes post pancreatitis: experiencia clínica en 40 casos / Diabetes secondary to pancreatitis: clinical experience in 40 cases

The clinical features and evolution of 40 patients with diabetes mellitus secondary to chronic pancreatitis were reviewed and compared with 40 insulin dependent diabetics matched for the disease duration. The diagnosis of pancreatitis was confirmed by the existence of pancreatic calcifications, surgery or autopsy and was associated to alcoholism in males and biliary diseases in females. Diabetes appeared as a mean, 3 years after the diagnosis of pancreatitis. Ninety percent of subjects required insulin and, in males, these requirements were higher than their matched controls. Episodes of ketoacidosis were less frequent than in insulin dependent patients (8 vs 48 percent p<0.001) and pulmonary tuberculosis had a higher prevalence (22.5 vs 5 percent p<0.01). Nephropathy was observed with equal frequency in both groups but the incidence of retinopathy was higher on postpancreatic diabetics (38 vs 20 percent p<0.01). It is concluded that the features of diabetes secondary to chronic pancreatitis are similar to those of insulin dependent diabetes, with some quantitative differences