Validación de la reacción de polimerasa en cadena en tiempo real como herramienta diagnóstica en la aspergilosis asociada a COVID-19 en pacientes hospitalizados en Clínica Dávila de Santiago, Chile, durante los años 2020 y 2021

Introducción: Desde el inicio de la pandemia por COVID-19 se han registrado casos de infecciones de aspergilosis pulmonar asociada a esta infección, la cual tiene características diferentes a la aspergilosis pulmonar clásica y, por lo tanto, han significado un desafío diagnóstico. Objetivo: Validar una reacción de polimerasa en cadena (RPC) en tiempo real (sigla en inglés RT-PCR) comercial, como herramienta diagnóstica alternativa a la técnica de galactomanano (GM) en el diagnóstico de aspergilosis pulmonar asociada a COVID-19 (sigla en inglés CAPA). Pacientes y Método: Se analizaron resultados de RT-PCR de Aspergillus spp y GM en lavado bronco-alveolar (LBA) de 72 pacientes, hospitalizados por COVID-19 de Clínica Dávila entre los años 2020 y 2021. De estos pacientes, 33 presentaron CAPA. Resultados: La RT-PCR de Aspergillus y GM presentaron una correlación positiva (r = 0,6351, valor p < 0,0001). La técnica de RT-PCR presentó una sensibilidad (S), especificidad (E), valor predictor positivo (VPP) y valor predictor negativo (VPN) de 100, 44, 66 y 100%, respectivamente, mientras que en GM fueron de 64, 89, 84 y 73%, respectivamente para LBA. Al utilizar ambas técnicas en combinación se obtuvo una S, E, VPP y VPN de 100, 82, 88 y 100%, respectivamente. Conclusión: Este estudio concluyó que usar una técnica de RT-PCR de Aspergillus y GM en conjunto en LBA mejoraron los parámetros de desempeño de ambas técnicas usadas de manera individual para diagnosticar CAPA. Se requieren más estudios para evaluar el desempeño de técnicas combinadas en otros tipos de aspergilosis.

Background: Since the beginning of the COVID-19 pandemic, there have been cases of pulmonary aspergillosis infections associated with this infection, which has different characteristics from classical pulmonary aspergillosis and therefore, have been diagnostic challenges. Aim: To validate a commercial real-time PCR (RT-PCR) method as an alternative diagnostic tool to the galactomannan (GM) technique in the diagnosis of COVID-19-associated pulmonary aspergillosis (CAPA). Methods: Results of RT-PCR of Aspergillus spp and GM in broncho-alveolar lavage (BAL) of 72 patients hospitalized for COVID-19 at Clínica Dávila between 2020 and 2021 were analyzed. Of these patients, 33 presented CAPA. Results: The RT-PCR for Aspergillus and GM showed a positive correlation (r = 0.6351, p-value < 0.0001). The RT-PCR for Aspergillus technique presented a sensitivity (S), specificity (S), positive predictive value (PPV) and negative predictive value (NPV) of 100, 44, 66 and 100% respectively, while the GM technique presented 64, 89, 84 and 73%, respectively for BAL. Using both techniques in combination a S, E, PPV and NPV of 100, 82, 88 and 100% were obtained respectively. Conclusion: This study concluded that using RT-PCR and GM techniques in combination in BAL improved the performance parameters of both techniques from those used individually to diagnose CAPA. Further studies are required to evaluate the performance of combined techniques in other aspergillosis focus.

Evaluación de la prueba Aspergillus Galactomannan Ag VircliaR Monotest como alternativa a kit Platelia ™ Aspergillus EIA / Evaluation of the Aspergillus Galactomannan ag VircliaR Monotest test as an alternative to Platelia™ Aspergillus EIA kit

INTRODUCCIÓN: La prueba Aspergillus galactomannan Ag Virclia® (GM-VClia) es una técnica de galactomanano monotest, auto-matizada, basada en inmunoensayo quimioluminiscente (CLIA). OBJETIVO: Evaluar el desempeño del test de GM-VClia en muestras de suero y lavado bronquioalveolar (LBA) procesadas previamente con el kit Platelia™ Aspergillus EIA (GM-Plat). MATERIALES Y MÉTODOS: Se estudiaron 56 muestras de suero y 40 de LBA, correspondientes a un total de 59 pacientes (algunos con determinación de galactomamano en ambas muestras) con enfermedades pulmonares, hematológicas, LES, Covid-19 y tumores, entre otros. Trece pacientes tuvieron aspergilosis invasora (1 probada y 12 probables). RESULTADOS: La correlación entre ambos métodos para suero y LBA fue r = 0,8861 p < 0,0001 y r = 0,6368 p < 0,001, respectivamente. Hubo una concordancia global de 67,7% (65/96), siendo de 85,7% (48/56) en sueros y 42,5,0% (14/49) en LBA. Al subir el punto de corte en LBA por GM-VClia la concordancia aumentó a 85,7%. CONCLUSIONES: Se observó una mayor correlación y concordancia en sueros que en LBA. El kit GM-VClia presentó una mayor sensibilidad y valor predictor negativo (VPN), que el kit GM-Plat. Las desventajas de GM-VClia, la constituyen la categoría "dudoso", que dificulta la interpretación y que, con los puntos de corte actuales en LBA, la correlación con GM-Plat es menor. Las ventajas son su mayor sensibilidad, facilidad de procesamiento y una mayor rapidez en los resultados.

BACKGROUND: The Aspergillus Galactomannan Ag Virclia® (GMVClia) test is a monotest and automated galactomannan technique based on chemiluminescent immunoassay (CLIA). AIM: To evaluate the performance of the GM-VClia test in serum and bronchioalveolar lavage (BAL) samples previously processed with the Platelia ™ Aspergillus EIA kit (GM-Plat). METHODS: 56 samples of serum 40 from BAL (some of them with galactomaman determination in both samples), from patients with pulmonary diseases, hematological diseases, SLE, Covid-19 and tumors, among others, were studied. Thirteen patients had invasive aspergillosis (1 proven and 12 probable). RESULTS: The correlation between both methods for serum and BAL was r = 0.8861 p < 0.0001 and r = 0.6368 p < 0.001, respectively. There was a global concordance of 67.7% (65/96), being 85.7% (48/56) in sera and 42.5.0% (14/49) in BAL. By raising the cut-off point in LBA by GM-VClia, the agreement increased to 85.7%. CONCLUSION: A greater correlation and concordance was observed in sera than in BAL. The GM-VClia kit had a higher sensitivity and NPV than the GM-Plat kit. The disadvantages of GM-VClia are the "doubtful" category, which makes interpretation difficult and that with the current cut-off points in LBA the correlation with GM-Plat is lower. The advantages are its greater sensitivity, ease of processing and faster results.

Efecto del catéter de hemodiálisis en la permeabilidad de fístulas arteriovenosas / The impact of hemodialysis catheter on arteriovenous fistula permeability

Resumen Objetivo: Evaluar el impacto que tiene el uso de catéteres de hemodiálisis en la permeabilidad de fístulas arteriovenosas. Materiales y Método: Estudio observacional, analítico, tipo cohorte retrospectiva. Se calculó un tamaño muestral de 195 pacientes, seleccionados aleatoriamente a partir del total de pacientes diagnosticados con enfermedad renal crónica (ERC) terminal, a quienes se les realizó su primera fístula arteriovenosa (FAV) entre enero de 2014 y diciembre de 2018. Como variables resultado se consideraron la trombosis de FAV y el tiempo de permeabilidad. Para el análisis inferencial se utilizaron las pruebas de Chi cuadrado; RR (IC 95%); curvas Kaplan-Meier; regresión de Cox; considerando un valor de p significativo < 0,05. Resultados: El 52,3% utilizó catéter de hemodiálisis, de los cuales el 49,5% presentó trombosis de su FAV versus el 17,7% del grupo sin este antecedente (p < 0,001); estimándose en el análisis univariado un riesgo de trombosis 2,7 veces mayor en pacientes con catéter previo a la confección de su FAV (IC 95% 1,7 a 4,4). En el análisis multivariado, se identificó como único factor significativo el antecedente de catéter de hemodiálisis, estimándose que los pacientes usuarios de catéter previo a la confección de su FAV tienen 2,8 veces más riesgo de trombosis en el tiempo que quienes no utilizaron catéter (IC 95% 1,6 a 4,9), quienes además presentaron un tiempo de permeabilidad significativamente menor (p < 0,001) en comparación con pacientes sin antecedente de catéter (28,1 vs 43,9 meses). Conclusión: Identificamos el uso del catéter de hemodiálisis como un factor de riesgo de trombosis de fístulas arteriovenosas, afectando significativamente su permeabilidad en el tiempo.

Objective: To evaluate the effects of hemodialysis catheter on arteriovenous fistula (AVF) permeability. Materials and Method: We conducted a retrospective cohort study, including 195 patients randomly selected from all patients diagnosed with chronic renal failure, who had their first arteriovenous fistula between January 2014 and December 2018. The outcomes were arteriovenous fistula thrombosis and permeability. For data analysis we used Chi-square test; Relative-Risk (CI 95%); Kaplan-Meier analysis and Cox regression; p value less than 0.05 were considered as significant. Results: The 52.3% of the patients used hemodialysis catheter, from this group, the 49.5% had AVF thrombosis versus the 17.7% of the group without history of hemodialysis catheter (p < 0.001), estimating in the univariate analysis a risk of thrombosis 2.7 times higher in patients with catheter before the creation of their AVF (CI 95% 1.7 a 4.4), as well as, in the multivariate analysis the risk of AVF thrombosis was 2.8 times higher in this group of patients, being identified the history of hemodialysis catheter as the only significative risk factor for thrombosis. Additionally, the AVF permeability time in this group was significantly less (p < 0.001) than patients without history of hemodialysis catheter (28.1 vs 43.9 months). Conclusion: We identified the hemodialysis catheter as a risk factor of arteriovenous fistula thrombosis, decreasing significantly its permeability time.

Prevención en la transmisión de Coronavirus-19: ¿qué tan preparado está el personal de salud en Chile?

Background: COVID-19 is highly transmissible, thus requiring strict measures to prevent its propagation. Aim: To report a survey about self-reported adherence to recommendations aimed to reduce the transmission of COVID-19, among health care personnel. Material and Methods: A cross-sectional survey among health professionals about adherence to recommendations to prevent COVID-19 transmission was carried out in a public hospital in Chile. The survey had 11 questions and was developed using Delphi methodology, according to the recommendations of the World Health Organization and the Centers for Disease Control. Results: The survey was answered by 137 of 155 invited workers. Hand washing, use of personal protection equipment, use of the elbow or tissue to sneeze, out-of-hospital hand washing and exclusive use of the uniform in the hospital, had an adherence of over 90%. The adherence to face touching avoidance during working hours, and face mask use in the public areas, was over 50%. No statistical differences were observed between gender or professionals. Conclusions: The adherence reported by health care workers was adequate in most of the evaluated recommendations.

Adultos con influenza, evolución clínica, costos y grupos relacionados por el diagnóstico, resultados de 4 años. Clínica Dávila. Santiago de Chile / Adults patients with influenza, clinical evolution, cost and diagnosis related groups, four years results. Clinica Dávila, Santiago, Chile

Resumen Introducción: En 2009 la Influenza A H1N1pdm09 provocó en Chile 12.258 casos y 155 muertes. Objetivo: Analizar en adultos egresados de Clínica Dávila con influenza, en 2009, 2010, 2012 y 2014, soporte ventilatorio, costo de hospitalización, Grupos Relacionados por el Diagnóstico (GRD) y letalidad. Material y Método: Estudio descriptivo retrospectivo usando la ficha médica electrónica. Resultados: Egresaron 115.673 adultos, 338 (0,29%) con diagnóstico de Influenza, edad 56,5 ± 22 años, 59% mujeres, letalidad 4%. Hubo 3 grupos, Grupo 1: sin ningún soporte ventilatorio, 295 pacientes, edad 63 ± 20, estadía 6,6 ± 6,9 días, costo promedio de hospitalización $2.885.261, mediana peso GRD 0,41 (p25 = 0,38 y p75 = 0,62), letalidad 1,01% (3 pacientes). Grupo 2: Ventilación mecánica no invasiva (VMNI), 23 casos, edad 77,1 ± 13, letalidad 22% (5 casos), estadía 16,8 ± 12,4, costo $9.245.242, GRD 0,79 (p25 = 0,62 y p75=1,03). Grupo 3: Intubación y ventilación mecánica invasiva (VMI), 20 pacientes, edad 56,4 ± 15, estadía 36,9 ± 41,4, costo $38.681.099, GRD 5,86 (p25 = 5,82 y p75 = 5,86) y letalidad 30% (6 pacientes). Los GRD grupo VMI versus grupo VMNI y ningún soporte fueron diferentes (p < 0,0001 y p < 0,0001 respectivamente). La letalidad por influenza el 2014 fue de 8,5%, mientras que en los años 2012, 2010 y 2009 fue 1,5%, 3% y 2,5% respectivamente. La mediana de edad el año 2009 fue 37,5 años, menor que la de los otros años (p < 0,0001). Conclusiones: En 2009 los pacientes fueron más jóvenes, la necesidad de soporte ventilatorio provocó un peso GRD, estadía, costo y letalidad mayores que aquellos que no lo requirieron.

Introduction: In 2009 Influenza A H1N1pdm09 caused in Chile 12,258 cases and 155 deaths. Objective: To analyze ventilatory support, cost of hospitalization, Diagnosis Related Groups (DRG) and lethality in adults patients with influenza discharged from our institution, during 2009, 2010, 2012 and 2014. Patients and Method: Retrospective descriptive study using electronic medical records. Results: 115,673 adults were discharged, 338 (0.29%) with diagnosis of Influenza, age 56.5 ± 22 yr.o., 59% women, lethality 4%. There were 3 groups, Group 1: without any ventilatory support, 295 patients, age 63 ± 20, stay 6.6 ± 6.9 days, average cost of hospitalization 2,885,261 clp, medium weight DRG 0.41 (p25 = 0.38) andp75 = 0.62), lethality 1.01% (3 patients). Group 2: Non-invasive mechanical ventilation (NIMV), 23 cases, age 77.1 ± 13, lethality 22% (5 cases), stay 16.8 ± 12.4, cost 9,245,242 clp, DRG 0.79 (p25 = 0.62 and p75 = 1.03). Group 3: Intubation and invasive mechanical ventilation (IMV), 20 patients, age 56.4 ± 15, stay 36.9 ± 41.4, cost 38.681.099 clp, DRG 5.86 (p25 = 5.82 and p75 = 5,86) and lethality 30% (6 patients). The DRG group VMI versus group VMNI and no support were different (p < 0.0001 and p < 0.0001 respectively). The lethality for influenza in 2014 was 8.5%, while in 2012, 2010 and 2009 it was 1.5%, 3% and 2.5% respectively. The median age in 2009 was 37.5 yr.o significantly minor, than the other years (p < 0.0001). Conclusions: In 2009 the patients were younger, the need for ventilatory support led to a higher DRG weight, stay, cost and lethality than those who did not require it.

Estado de salud y autoeficacia en adultos mayores usuarios de atención primaria en salud / Health status and self -efficacy in elderly users in primary care

RESUMEN Objetivo: Identificar el nivel de autoeficacia percibida y su relación con variables biodemográficas y psicosociales en adultos mayores. Material y método: Diseño descriptivo correlacional, muestreo aleatorio estratificado, de 754 adultos mayores inscritos en centros de salud de Antofagasta, Chile. Mediciones: antecedentes socio-demográficos, estado de salud, autoeficacia percibida; Examen de Funcionalidad del Adulto Mayor (parte B); Calidad de vida relacionada con la salud, medida con el Cuestionario SF-12 y Fragilidad. Resultados: 61,4% de mujeres versus 38,6% de hombres; la edad osciló entre los 65 y 90 años, con una media de 73 años (DE= 6,0); el 78,9% declaró de dos a seis años de estudios. Los antecedentes mórbidos presentados con mayor frecuencia fueron: Hipertensión arterial, Dislipidemia y Diabetes Mellitus. El 86,3% no presentó depresión. La autopercepción de salud calificada como "excelente a buena" alcanzó sobre el 60%. La autoeficacia fue percibida alta en un 68,3%. La calidad de vida relacionada con salud global fue percibida con satisfacción por el 55,6%. Los niveles de fragilidad alcanzaron el 73,5%. El 59,3% de los adultos mayores fueron clasificados como autovalente sin riesgo. Se encontraron diferencias estadísticamente significativas entre las categorías de autoeficacia y temor a caerse, estado nutricional, depresión, calidad de vida relacionada con salud y la autopercepción de salud. Conclusión: Se identificó y relacionó una alta autoeficacia percibida, tanto en variables biodemográficas como psicosociales, que podría ser un factor facilitador para promover un envejecimiento activo.

ABSTRACT Objective: Identify the level of perceived self-efficacy and its relationship with biodemographic and psychosocial variables in older adults. Material and method: Descriptive correlational design, stratified random sampling, of 754 older adults registered in health centers of Antofagasta, Chile. Measurements : sociodemographic background, health status, perceived self-efficacy; Functional Test of the Elderly (part B); Quality of life related to health, measured with the SF-12 and Fragility Questionnaire. Results: 61.4% of participants were women and 38.6% were men; the ages ranged between 65 and 90 years, with an average of 73 years (SD = 6.0); 78.9% declared between two and six years of schooling. The morbid antecedents most frequently presented were: Arterial Hypertension, Dyslipidemia and Diabetes Mellitus. 86.3% did not present depression. Self-rated health rated "excellent to good" reached over 60%. Self-efficacy was perceived as high by 68.3% of participants. A 55.6% was satisfied with their quality of life in relation to global health. Fragility levels reached 73.5%. 59.3% of older adults were classified as self-reliant without risk. Statistically significant differences were found between the categories of self-efficacy and fear of falling, nutritional status, depression, quality of life related to health and self-perception of health. Conclusion: A high perceived self-efficacy was identified and related, both in biodemographic and psychosocial variables, which could be a facilitating factor to promote active aging.

Indicadores de fragilidad en adultos mayores del sistema público de salud de la ciudad de Antofagasta / Rates of frailty among older people ascribed to chilean primary care clinics

Background: Frailty is not universal among older people but increases the risk of dependence. Aim: To assess frailty among older people and its relationship with biological, psychological and social factors. Material and Methods: Seven hundred fifty four older people aged 73 ± 6 years (61% females), attending a public primary care were assessed. Frailty was defined according to Fried criteria that considers inexplicable weight loss, tiredness, muscle weakness and lack of physical activity. Results: Absence of frailty, pre-frailty and frailty was found in 26, 69 and 5% of participants, respectively. Significant differences between frailty groups were observed for age, gender, years of studies, minimental and self-efficacy scores. Among participants defined as being in a pre-frail condition, 59% were non-disabled without risk and 41% non-disabled in risk, according to the functional assessment for older people used in Chilean primary care clinics. Conclusions: Frailty among older people is associated with increasing age, education, cognitive status and self-efficacy.

Efecto del factor de crecimiento de fibroblastos 21 / Fibroblast growht factor 21 effects over phosphatase SHP-2 expression in Malme-3 cells

Almost 50 percent of Noonan syndrome patients, characterized by short stature, present activating mutations of the citoplasmatic phosphatase SHP-2, which induce hyperactivation of the Ras/MAPK pathway. On the other hand, the fibroblast growth factor 21 (FGF-21), recently suggested as a FGF with “endocrine” function, would affect longitudinal growth inhibiting growth hormone signaling at chondrocytes level. Union and activation of FGF-21 to its receptor is regulated by the co-factor beta Klotho (KLB). Aims: To determine if FGF-21 and/or FGF-21+KLB are able to modify the genetic expression of SHP-2 ina human skin fibroblast cell line (Malme-3). Methods: cells were incubated with or without FGF-21, FGF-21 + KLB. At 12 and 24 hours after induction total RNA was extracted andSHP-2 mRNA levels were determine by quantitative PCR. Expression of GADPH gene was employed for normalization. Results: Incubation with FGF-21 produce a 36 percent (p = < 0,05)increment in SHP-2 expression, which was not modified with KLB co-incubation. Discussion: it is shown by the first time that FGF-21 is able to produce an increase in SHP-2 gene expression in human fibroblast, which was independent of KLB presence...

Interacción Candida albicans-Hospedero: un proceso complejo en el que la inmunidad innata juega un importante papel / Candida albicans-host interaction: a complex process in which the innate immunity play an important role

Candida albicans es una levadura comensal, que bajo ciertas circunstancia puede convertirse en patógeno. La capacidad de cambiar se forma constituye un factor de virulencia, permitiéndole a la levadura invadir y diseminarse. El sistema inmune innato es capaz de reconocer las diferentes morfologías de C. albicans activando receptores (PRRs) que reconocen PAMPs o patrones moleculares conservados. Las células inmunes más importantes son los macrófagos y los neutrófilos que desencadenan una respuesta efectora a través de la fagocitosis y la activación de estrés oxidativo contra C. albicans. Las células dendríticas, por su parte expresan la mayoría de los PRRs involucrados en el reconocimiento de C. albicans activando la secreción de citoquinas hacia una respuesta tipo TH1 (inducida por INF tipo1, IL-12, INFγ, ), Treg (inducida por TGFβ, IL-10) y TH17 (inducida por IL-23, IL6). Las células epiteliales no sólo constituyen una barrera física frente a la infección por C. albicans, sino son fundamentales en el reconocimiento primario de este microorganismo. Mediante una respuesta bifásica estas células activan diferencialmente, vías de transducción de señales que determinan que no se active una respuesta de citoquinas frente a la presencia de blastoconidios (forma comensal) y que se active frente a presencia de hifas (forma invasora). Por su parte, C. albicans es capaz de desarrollar mecanismos evasivos de la respuesta inmune. Esta compleja interacción y hongo-hospedero determina si el hospedero será capaz de eliminar a este microorganismo o si éste finalmente invadirá expresando su virulencia.

Candida albicans is a comensal microorganism that under certain circumstances is able to transform into a pathogen. This ability to switch constitute a virulence factor that C. albicans uses to invade and spread. The innate immune system recognize the different forms of C. albicans activating receptors (PRRs) that recognize PAMPs or conserved molecular patterns. The most important immune cells are macrophages and neutrophils that generate an effector response through phagocytosis and oxidative burst against C. albicans. Dendritic cells express the most of PRRs involved in the recognition of C. albicans activating the cytokines synthesis forward to a TH1 (induced by INF tipo1, IL-12, INFγ), Treg (induced by TGFβ, IL-10) y TH17 (induced by IL- 23, IL6) immune response. Epithelial cells not only constitute a physical barrier against C. albicans, but they are crucial in the first recognition of this microorganism. Through a biphasic response these cells differentially activate pathways that determine a no cytokine response when blastoconidia (commensal form) is present and an inflammatory response in presence of hyphae (pathogenic form). C. albicans develops immune evasive mechanism. This complex host-fungi interaction determines if the host will eradicate the infection or if this microorganism will invade the host, expressing it virulence.

Central giant cell granuloma of the mandibular condyle: case-report

This case report describes a 19-year-old female patient with a central giant cell granuloma in the left mandibular condyle, treated with en bloc resection and reconstruction with fibula graft. This occurrence is considered very unusual.

Histología del anillo inguinal interno en pacientes con hernia inguinal indirecta: serie de casos observacional y descriptiva / Age associated changes in the histology of indirect inguinal hernia rings

Background: This study has the purpose to investigate the microscopic basic histological structure of the internal inguinal ring in patients operated on for primary indirect inguinal hernia. Patients and Methods: A sample of 72 consecutive male patients older than 15 years-of-age with unilateral inguinal hernia submitted to elective surgery was studied. The primary outcome measure was the histological findings of the internal inguinal ring. All samples were processed only by histochemical techniques. Patients were divided in 3 groups according to age. Group I: patients between 15 and 40 years-of-age. Group II: patients between 41 and 70 years-of-age. Group III: patients older than 71 years. Results: All samples from the internal inguinal ring were constituted by fibrous fascial tissue with elastic fibers which were thicker in younger patients and thinner in older patients. Adipose tissue between elastic fibers was absent in younger patients and was abundant in older patients. Vascular sclerosis was minimal in Group I, moderate in Group II, and important in Group III. Acute or chronic inflammatory cells were absent in all patients. Conclusions: The histological characteristics of the internal inguinal ring in patients with indirect inguinal hernia consist on reduced density and thickness of elastic fibers and increased adipose tissue between elastic fibers. Vascular sclerosis was more severe as the age of the patients increased. These histological changes were related to normal aging.

Introducción: El presente estudio tiene como objetivo investigar la estructura histológica básica del anillo inguinal interno en pacientes operados por hernia inguinal indirecta primaria. Pacientes y Métodos: Se estudió una muestra de 72 pacientes consecutivos mayores de 15 años de edad con hernia inguinal indirecta unilateral sometidos a cirugía electiva. El objetivo principal fue la histología básica del anillo inguinal interno. Las muestras fueron procesadas con técnicas histoquímicas. Los pacientes se dividieron en 3 grupos de acuerdo a la edad. Grupo I: pacientes entre 15 y 40 años de edad. Grupo II: pacientes entre 41 y 70 años. Grupo III: pacientes mayores de 71 años de edad. Resultados: Todas las muestras histológicas del anillo inguinal estuvieron constituidas por tejido fascial fibroso con fibras elásticas gruesas en pacientes jóvenes y delgadas en pacientes mayores. La esclerosis vascular fue mínima en el grupo I, moderada en el grupo II e importante en el grupo III. No se encontraron células inflamatorias agudas o crónicas. Conclusiones: Las características histológicas básicas del anillo inguinal interno consisten en fibras elásticas que disminuyen su densidad y se adelgazan con la edad y en un aumento simultáneo del tejido adiposo entre estas fibras. La esclerosis vascular se presenta y es más severa en la medida que la edad de los pacientes aumenta. Estos cambios histológicos se relacionan al envejecimiento normal.

Valoración multidimensional del envejecimiento en la ciudad de Antofagasta / Cross sectional geriatric assessment of free living older subjects from Antofagasta, Chile

Background: The effects of aging on people must be evaluated to adequate sanitary actions. Aim: To assess the characteristics of older subjects living in Antofagasta, Chile. Material and Methods: Cross sectional assessment of 602 subjects without dementia, aged more than 60 years (55 percent females). A socioeconomic and medical history was obtained and Barthel, Lawton, Yesavage depression, Tromp fall risk and Folstein Mini mental scales were applied. Results: Sixty eight percent of subjects had more than six years of studies. Forty six percent had hypertension, 28 percent had osteoarticular problems, 20 percent had hypercholesterolemia and 17 percent diabetes mellitus. Four percent had depression and falls were reported by 35 percent. Seventy four percent were independent in basic and instrumental activities. Ninety four percent had normal cognitive functions. Age was an important determinant of functional capacity. Conclusions: The main problems detected in this sample were the risk of falls and the presence of chronic diseases.

Recomendaciones para el análisis de datos acumulados de susceptibilidad antimicrobiana en instituciones de salud / Recommendations for the analysis of cumulated data in antimicrobial susceptibility in health institutions

Due to the great variability in antimicrobial resistance patterns, local reports of cumulative antimicrobial susceptibility data are necessary in every health center. The purpose is to guide clinical decisions and the early detection of patterns that allow preventive measures to avoid dissemination of resistant strains. The main objective of this guide is to provide recommendations for the analysis of antimicrobial susceptibility data and elaboration of a local report. Recommendations provided in this guide are based on the Clinical and Laboratory Standards Institute (CLSI) document "Analysis and Presentation of Cumulative Antimicrobial Susceptibility Test Data" (3). Key aspects related to information gathering and data processing, analysis and presentation are described.

Considerando la gran variabilidad en la distribución de la resistencia microbiana, es una necesidad que cada centro de salud genere reportes locales de datos acumulados de susceptibilidad, con el propósito de guiar las decisiones clínicas y detectar tendencias que permitan establecer medidas de prevención para evitar la diseminación de cepas resistentes. Esta guía tiene como objetivo entregar recomendaciones para el análisis de susceptibilidad antimicrobiana y aportar datos útiles para la elaboración del informe local. Las recomendaciones que contenidas em este documento están basadas en el documento "Analysis and Presentation of Cumulative Antimicrobial Susceptibility Test Data de Clinical and Laboratory Standards Institute (CLSI) (3). Se describen aspectos claves relacionados con los requerimientos de la información, el procesamiento de los datos, el análisis y presentación de éstos.

Efecto antifúngico de quitosán de alto peso molecular en cepas de Candida sp aisladas de muestras clínicas / Antifungal effect of high molecular weight chitosan on Candida spp isolated from clinical samples

Chitosan is a D-glucosamine polysaccharide derived from chitin that displays an antimicrobial activity against bacteria and fungi. Objective: to evaluate the antifungal effect of high molecular weight chitosan (HMWC) in clinical strains of Candida spp. Methodology: the susceptibility of forty strains of Candida spp. to HMWC was studied (16 C albicans, 11 C glabrata, 5 C. tropicalis, 5 C krusei, 2 C parapsilosis and 2 C.famatd) by broth microdilution at pH 7.0 and pH 4.0. Results: of 40 strains, only 2 were inhibited at pH 7.0 and corresponded to ATCC control strains (C. krusei 6258 and C parapsilosis 22019). On the other hand, 37/40 strains (92.5 percent) were inhibited by concentrations lower than 1.25 mg/mL of HMWC at pH 4.0. Conclusion: these results show that HMWC, presents activity against clinical Candida spp. strains, including C glabrata, and that this activity is present at acid pH (4.0). This compound could potentially be used in vulvovaginal candidiasis since it occurs at pH 4.0-4.5.

Distribución y susceptibilidad a fluconazol de levaduras del género Candida aisladas en pacientes hospitalizados y ambulatorios / Species distribution and fluconazole susceptibility of yeasts of genus Candida isolated from hospitalized and ambulatory patients

Most surveillance studies have included invasive candidiasis from hospitalized patients. However, no national study has evaluated the species distribution and susceptibility to fluconazole of Candida species isolated from hospitalized and ambulatory patients. Atotal of 166 strains were collected consecutively during a 6 month period. Strains were isolated from vaginal fluid (73.5 percent), uriñe (7.8 percent), lower respiratory tract samples (7.8 percent), blood cultures (4.2 percent), sterile fluids (2.4 percent) and wounds (1.8 percent). Most of the isolates were obtained from ambulatory patients (71.1 percent). The species found were Candida albicans (78.9 percent), C glabrata (8.4 percent), C. tropicalis (6.0 percento), C.famata (1.8 percent), C krusei (1.8 percent), C parapsilosis (1.8 percent) and C. sake (1.2 percent). Fluconazole susceptibility was: 92.3 percento for C. albicans, 85.7 percent for C glabrata (most strains being dose-dependent susceptible), 100 percent) for C parapsilosis and 80 percent) for C tropicalis. Only susceptible strains were isolated from hospitalized children, whereas more resistant strains were isolated from ambulatory adults, mainly from vaginal fluid. In order to identify probable reservoirs of less susceptible strains such as C. glabrata, it would be necessary to include ambulatory isolates in future surveillance studies.

La mayoría de los estudios de vigilancia de levaduras del género Candida se realizan en candidiasis invasora en pacientes hospitalizados; sin embargo, no existen estudios que evalúen simultáneamente la distribución global de especies y susceptibilidad a fluconazol de cepas de Candida aisladas de pacientes hospitalizados y ambulatorios. Se analizaron 166 cepas de Candida, recolectadas consecutivamente en un período de 6 meses, las cuales fueron aisladas de flujo vaginal (73,5 por ciento), orina (7,8 por ciento), muestras respiratorias bajas (7,8 por ciento), hemocultivos (4,2 por ciento), líquidos estériles (2,4 por ciento) y heridas (1,8 por ciento). Un 71,1 por ciento provenía de pacientes ambulatorios. La especies aisladas fueron Candida albicans (78,9 por ciento), C glabrata (8,4 por ciento), C tropicalis (6,0 por ciento), Cfamata (1,8 por ciento), C. krusei (1,8 por ciento), C parapsilosis (1,8 por ciento) y C. sake (1,2 por ciento). Los porcentajes de sensibilidad a fluconazol fueron: 92,3 por cientoo para C. albicans, 85,7 por cientoo para C glabrata (siendo la mayoría sensible dosis dependiente), 100 por ciento) para C parapsilosis y 80 por cientoo para C tropicalis. En los niños, todos hospitalizados, se aislaron sólo cepas sensibles, mientras que en adultos ambulatorios se aislaron más cepas resistentes, fundamentalmente de flujo vaginal. Considerar cepas ambulatorias en futuros estudios de vigilancia permitirían dar cuenta de probables reservónos de cepas más resistentes, como C. glabrata.

Infección rinosinusal por Scedosporium apiospermum en un hospedero inmunocompetente / Scedosporium apiospermum rhinosinusal infection in an immunocompetent host

Scedosporium species can cause colonization, superficial and deep localized infection or systemic disease, espe-cially in irnmunocompromised hosts. We report a case of localized infection due to Scedosporium apiospermum in a 47 year oíd woman, with previous nasal surgery. She consulted for recurrent mucopurulent post-nasal discharge not responding to antibiotics. Computed tomography showed opacification of right maxillary sinus. Surgery was performed to removed abnormal tissue from sinus; biopsy revealed chronic sinusitis with aggregate of tightly packed hyphae suggestive of filamentous fungi. The microbiology fungal culture reported Scedosporium apiospermum.

Las infecciones por Scedosporium sp pueden traducirse en colonización, infecciones localizadas superficiales y profundas, o enfermedad diseminada. Presentamos un caso clínico de infección rinosinusal por Scedosporium apiospermum en una paciente de 47 años, con antecedente de cirugía por cuerpo extraño en la fosa nasal derecha. Consultó por descarga posterior muco-purulenta y recurrente, sin respuesta a tratamiento antibacteriano. Las imágenes de cavidades paranasales mostraron opacidad del seno maxilar derecho. Se realizó cirugía de remoción de contenido sinusal cuyo estudio histológico reveló sinusitis crónica erosiva, colonias de hongos con morfología sugerente de hongo filamentoso y desarrollo de S. apiospermum en el cultivo.

Expresión de marcadores de proliferación celular e invasión tisular en cáncer papilar del tiroides y su asociación con metástasis ganglionares / Expression of proliferation and invasion markers in papilary thyroid carcinoma with and without lymph node involvement

Background: Several molecules that may have a role in tumor proliferation, differentiation and invasion, have been detected in thyroid carcinoma. Some of these molecules are NIS, c-MET, TIMP1 an ephrinB2. Aim: To detect the presence of these molecules in tissue samples of thyroid carcinoma and relate their expression to the biological behavior of the tumor. Material and Methods: Tissue samples were prospectively obtained from 35 patients operated for a papillary thyroid carcinoma. Twelve patients had regional lymph node involvement. NIS, c-MET, TIMP1 and EphrinB2 were detected by real time polymerase chain reaction(RT-PCR) and immunohistochemistry. Results: The expression of markers by RT-PCR was non significantly higher among tumors with lymph node involvement. Immunohistochemistryshowed a significantly lower nuclear expression and a higher cytoplasmatic expression of EphrinB2 in tumors with lymph node involvement. Conclusions: Immunohistochemical expression of EphrinB2 could be useful for the initial staging of papillary thyroid carcinoma.

Estudio multicéntrico de la vigilancia de la susceptibilidad in vitro a tigeciclina en Santiago de Chile / Multicenter study on the monitoring of in vitro susceptibility to tigeeyeline in Santiago, Chile

The objective of this multicenter study was to determine tigeeyeline susceptibility rates, measured by agar diffusion, in nine hospitals in Santiago and to compare these rates with other antimicrobials. Each center studied 20 strains per month. All intermedíate and fully resistant strains as well as 10 percent of susceptibile strains were also studied by the broth microdilution method. Overall, 2301 strains were studied displaying the foliowing susceptibility rates for tigeeyeline: 100 percent for Streptococcus sp, Enterococcus sp, and E. coli respectively, 99.8 percent for Staphylococcus sp, 93 percent for Klebsiella and 80 percent for Acinetobacter baumarmii. For Proteus, Providencia and Morganella the susceptibility rates were 4 percent. For cefotaxime-resistant Klebsiella and imipenem-resistant A. baumarmii susceptibility rates were 95 percent and 80 percent respectively. The agar diffusion and broth dilution method were 100 percent concordant for tigeeyeline susceptible strains but only 27 percent for resistant or intermedíate strains represented mostly by Acinetobacter baumannii. The majority of these strains (57/59) proved to be susceptible after retesting. The great majority (96,6 percent) of strains tested from nine Chilean hospitals proved to be susceptible to tigeeyeline with exception for Proteus, Providencia and Morganella (66 percent resistance). Using the agar diffusion method for measuring tigeeyeline susceptibility to A. baumannii may be misleading.

Para conocer la susceptibilidad a tigeciclina por difusión en agar en nueve hospitales de Santiago y comparar la susceptibilidad con otros antimicrobianos, se diseñó este estudio multicéntrico. Cada centro estudió 20 cepas mensualmente. Las intermedias, resistentes y 10 por cientoo de las susceptibles se re-testearon y estudiaron por microdilución en caldo. Se incluyeron 2.304 cepas. Fueron susceptibles a tigeciclina Strep-tococcus sp (100 por cientoo), Enterococcus sp (100 por ciento), E. coli (100 por cientoo), Staphylococcus sp (99,8 por ciento), Klebsiella pneumoniae (93 por ciento) y Acinetobacter baumannii (80 por ciento). En Proteus, Providencia y Morganella la susceptibilidad fue 4 por cientoo. Klebsiella resistente a cefotaxima y Acinetobacter resistente a imipenem, 95 por cientoo y 80 por cientoo fueron susceptibles a tigeciclina, respectivamente. La concordancia en cepas susceptibles y en las enviadas como resistentes o intermedias (A. baumannii) fue 100 por cientoo y 27 por cientoo respectivamente. El re-testeo confirmó que la mayoría eran susceptibles. Los patrones de susceptibilidad bacteriana muestran muy buena actividad in vitro a tigeciclina. La resistencia in vitro de A. baumannii por difusión en agar debe interpretarse con precaución.