Compromiso renal en vasculitis asociadas a anticuerpos anticitoplasma de neutrófilos. Recomendaciones de consenso de las Sociedades Chilenas de Nefrología y Reumatología / Renal involvement in antineutrophil cytoplasmic antibodies (ANCA) associated vasculitides. Recommendations of the Chilean Societies of Nephrology and Rheumatology

Renal involvement is a frequent complication in antineutrophil cytoplasmic antibodies (ANCA)associated vasculitides, adding morbidity and mortality, such as chronic kidney disease and the need for renal replacement therapy. With the aim of reaching a consensus on relevant issues regarding the diagnosis, treatment and follow-up of patients with these diseases, the Chilean Societies of Nephrology and Rheumatology formed a working group that, based on a critical review of the available literature and their experience, raised and answered consensually a set of questions relevant to the subject. This document includes aspects related to the clinical diagnosis, the histological characteristics, the therapeutic alternatives to induce and maintain the remission of the disease, relapse surveillance strategies and complementary therapies.

Recomendaciones sobre el manejo del compromiso renal del lupus eritematoso sistémico: Documento de Consenso de las Sociedades Chilenas de Nefrología y Reumatología / A consensus of the Chilean Nephrology and Rheumatology Societies on renal involvement in systemic lupus erythematosus

Renal involvement affects over one half of patients with Systemic Lupus Erythematosus increasing their mortality and morbidity, including chronic renal disease and the need of renal replacement therapies. Aiming to achieve a consensus in the most relevant topics on diagnosis, therapy and follow-up of patients with lupus renal disease, the Chilean Societies of Nephrology and Rheumatology constituted a workgroup that, based on a critical review of the available literature and their experience, raised and answered by consensus a set of relevant questions. This document includes aspects related to the clinical diagnosis, the importance of a suitable histological classification, therapeutic alternatives to induce and maintain disease remission, strategies for follow-up, additional therapies and ginecological-obstetric issues.

Comparación de dos accesos venosos para el implante de dispositivos de estimulación cardíaca / Comparison of two poisonous gateways for implanting cardiac stimulation devices

Introducción: se pretende comparar las complicaciones del implante con abordaje venoso percutáneo versus uno por venodisección. Materiales y métodos: se incluyó implantes entre enero 2010 y diciembre 2012. Se excluyó los cambios de generador, implantes no exitosos, aquellos por vía yugular o femoral y los realizados fuera del laboratorio de electrofisiología. Evaluamos las complicaciones, tales como: hematoma, infección, neumotórax, desplazamiento de lead, reintervención y muerte. Resultados: se analizó 161 implantes. La infección de bolsillo se presentó en 3,7% del acceso percutáneo y 1,25% con el cefálico (p: 0,27). El hematoma de bolsillo se presentó en 2,49% con el acceso percutáneo y 1,25% con el cefálico (p: 0.57). Hubo desplazamiento de lead auricular en 2,5% del acceso cefálico vs 1,23% con el percutáneo (p: 0.56). El desplazamiento de lead ventricular se presentó en el 1,23% del grupo percutáneo vs 1,25% con el cefálico (p: 0.99). Hubo neumotórax en el 2,49% del grupo subclavio vs 0% con cefálico (p: 0.29). Se reportó una muerte en el grupo cefálico 1,25% (p: 0.49). La reintervención fue requerida en 6,1% del grupo percutáneo vs 3,75% con cefálico (p: 0.48). Conclusión: no existió diferencia en la presentación de complicaciones en el abordaje percutáneo en comparación con la venodisección cefálica.

Introduction: we intend to compare the complications related to the subclavian/axilar puncture versus cephalic vein cut down in pacemaker implantation. Materials and methods: all procedures between january 2010 and december 2013 were included. We excluded pulse generator substitution, unsuccessful implantations, jugular or femoral access and implantation performed outside the electrophysiology laboratory. We analyzed early complications such as pocket hematoma, pocket infection, pneumothorax, lead displacement, re intervention and death. Results: 161 procedures were analyzed. Pocket infection presented in 3,7% with subcalvian/axilar access and in 1,25% with cephalic access (p:0,27). Pocket hematoma presented in 2,49% with subclavian/axilar access vs 1,25% with cephalic access (0,57). There were atrial lead displacement in 2,5% with cephalic access vs 1,23% with subcalvian/axilar access (p:0,56). Ventricular lead displacement presented in1,23% with subclavian/axilar access vs 1,25% with cephalic access (p:0,99). Pneumothorax presented in 2,49% with subclavian/axilar access vs 0% with cephalic access (p:0,29). We reported one death with cephalic access (p: 0,49). Re intervention was needed in 6,1% with subclavian/axilar access vs 3,75% with cephalic access (p:0.48). Conclusion: complication rates presented no differences between subclavian/axilar access and cephalic access.

Revascularización percutánea en hipertensión renovascular: reporte de un caso clínico y revisión de la literatura / Percutaneous revascularization in renovascular hypertension: clinical case report and literature review

Introducción de caso: presentamos el caso de un varón de 63 años con diagnóstico de estenosis renal severa unilateral, hipertensión renovascular, con fracaso del tratamiento clínico y evidencia de insuficiencia renal inicial, quien fue sometido a angioplastia y colocación de Stent en el tercio proximal de arterial renal derecha, sin complicaciones y con adecuado flujo distal. Las cifras tensionales en el post procedimiento inmediato y luego de un año, demuestran adecuado control con dos fármacos y los valores séricos muestran normalización de la función renal. La estenosis de la arterial renal representa la primera causa de hipertensión secundaria, se relaciona con altas tasas de desenlaces cardiovasculares adversos, por cuanto su sospecha e identificación es importante. Varias técnicas de imagen permiten confirmar la impresión diagnóstica, de ellas se destaca el ultrasonido doppler de arterias renales, la angiotomografía y la angiografía selectiva. Conclusiones: el tratamiento de estos pacientes se encuentra aún en discusión y la evidencia actual indica que el manejo clínico presenta iguales desenlaces en términos de morbimortalidad comparado con la revascularización percutánea, sin embargo críticas en relación al diseño de los estudios impiden que haya un consenso sobre este tema a nivel mundial.

Case presentation: we report the case of a 63 year-old male with unilateral severe renal artery stenosis diagnosis, renal vascular hypertension, with clinical treatment failure and evidence of initial renal failure, who underwent angioplasty and Stent implantation in the third proximal of the renal right artery, without complications and adequate distal fow. Blood pressure control improved immediately after procedure and one year after adequate control is achieved with two medications and serum values for renal function are normal. Renal artery stenosis is the leading cause of secondary hypertension, and it is related with high rates of adverse cardiovascular consequences; which is why its suspicion and identifcation is important. Several imaging techniques are used to confrm the diagnosis; Doppler ultrasound, angio CT and selective angiography are the most used. Conclusions: current evidence shows that clinical management is the most adequate therapy in these cases, however there is much criticism about recent trials design. A larger, unbiased trial is needed in order to reach a general consensus worldwide.

Hallazgos histopatólogicos de lesiones Hepáticas Biopsiadas en el servicio de Radiología del Hospital Carlos Andrade Marín realizadas de mayo a septiembre de 2011 / Histopathologic findings in biopsied liver lesion in the Radiology department at Carlos Andrade Marin Hospital carried out from May to September 2013

Introducción: la biopsia hepática es un método diagnóstico de gran utilidad para determinar la etiología y progresión de enfermedades hepáticas crónicas; así como para investigar la naturaleza de lesiones nodulares hepáticas y de esta manera elegir su manejo. Ha permitido obtener un mejor conocimiento de las bases anátomo-patológicas de las distintas hepatopatías. Materiales y métodos: es un estudio retrospectivo, longitudinal, descriptivo y observacional. Se recogieron 69 biopsias hepáticas de pacientes tanto hospitalizados como ambulatorios durante los meses mayo a septiembre de 2011. Resultados: se realizaron 69 biopsias, de ellas 36 procedimientos se los realizó en mujeres y 33 en varones, 52% y 48% respectivamente. Sus edades comprendían entre 11 meses y 94 años con una media de 34 años y una mediana de 62 años. El hallazgo histopatológico más frecuente es la metástasis (23%), dentro de éstas las más frecuente es la metástasis por adenocarcinoma con 11.6%, la segunda entidad más frecuente es la cirrosis con 17.4%. Conclusiones: la biopsia hepática es un método diagnóstico de gran utilidad tanto para determinar hepatopatías primarias, enfermedades sistémicas con afectación hepática, así como la etiología de lesiones nodulares como neoplasias primarias como las metastásicas.

Introduction: liver biopsy is a useful diagnostic method to determine the etiology and progression of chronic liver disease, and to investigate the nature of hepatic nodular lesions and its management. It has achieved a better understanding of the pathological basis of various liver diseases. Materials and methods: this is a retrospective, longitudinal, descriptive and observational study. Liver biopsies were collected from 69 patients, both hospitalized and outpatients, during the months of may to september 2011. Results: 69 biopsies were performed, of which 36 procedures were performed on women and 33 on men, 52% and 48% respectively. Their ages ranged from 11 months to 94 years with a mean of 34 and a median of 62 years. The most common histopathological findings was metastases (23%), the most frequent being the metastatic adenocarcinoma with 11.6%, and the second most common condition with cirrhosis with 17.4%. Conclusions: liver biopsy is a useful diagnostic method to determine both primary liver diseases, systemic diseases with liver involvement, and the etiology of nodular lesions such as metastatic solid tumors.

Meningitis bacteriana aguda por Streptococcus suis en criadores de cerdos: comunicación de los primeros dos casos en Chile / Streptococcus suis meningitis in pig farmers: report of first two cases in Chile

Human infection by Streptococcus suis is a zoonosis with a known occupational risk. Meningitis is its most frequent clinical manifestation. We present the first two cases in Chile. First case: 54-year-old female patient, pig-farmer. She presented headache, vomiting, confusion and meningismus. She presented septic shock. Second case: 48-year-old male patient, also pig farmer, presented headache, vomiting and meningismus. A Gram's staining of cerebrospinal fluid (CSF) showed gram-positive cocci in both cases. Ceftriaxone and dexamethasone treatment was administered. The CSF cultures were positive for Streptococcus suis serotype 2. The patients experienced a good outcome, without neurological sequelae at the time of discharge. It is considerable to evaluate epidemiologic factors in order to suspect this etiological agent in cases of meningitis. These cases enhance the need of heighten awareness of potential for occupational exposure and infection by this emerging human pathogen. Educating population at risk about simple preventive measures must be considered.

La infección humana por Streptococcus suis es una zoonosis con riesgo ocupacional conocido, siendo la meningitis aguda su manifestación clínica más frecuente. Se presentan los dos primeros casos en Chile. Primer caso: Mujer de 54 años con un cuadro de cefalea y vómitos, confusión y signos meníngeos. Evolucionó con un shock séptico. Segundo caso: Varón de 48 años, refirió cefalea y vómitos. Presentó signos meníngeos al examen físico. En ambos casos en la tinción de Gram de líquido cefalorraquídeo (LCR) se observaron cocáceas grampositivas. Fueron tratados con ceftriaxona y dexametasona. El cultivo de LCR fue positivo en ambos casos para S. suis serotipo 2. En los dos pacientes la evolución clínica fue favorable, sin alteraciones neurológicas al alta. En ambos casos se obtuvo en forma retrospectiva el antecedente de realizar labores de crianza de ganado porcino. Se destaca la importancia de investigar los antecedentes epidemiológicos para sospechar este agente etiológico en meningitis aguda. Se debe considerar el riesgo ocupacional en una posible infección por este patógeno humano emergente y educar a la población en riesgo sobre medidas preventivas simples.

Farmer strategies to face labor shortages in Chilean agriculture / Estratégias dos agricultores para enfrentar a escassez de mão de obra no setor agrícola chileno

This study analyzes the strategies that farmers in the south of Chile use to face current labor shortages and identify the variables that determine each of these strategies. A multinomial logit model and odds ratios plots with predicted probabilities were applied to a sample of 384 farmers. Interviews and focus groups were applied to specific producers, professionals and public officials. The main results show that only 32.3% of farmers declared that labor shortage is a problem. Of this percentage 52% chose the strategy of paying better, 13.8% chose improve the workers' working conditions, 9.5% chose to mechanize, and 24.1% did not follow a strategy. The production of labor-intensive products (e.g., exportable fruit) determines the strategy of paying better; the farmer's educational level influences the strategy of improving the working conditions, and the farmer's age affects the strategy of mechanizing. However, the production of labor-intensive products exhibits the greater effect. The main disadvantage of the "pay better" strategy is that workers do not want to commit to their job.

O objetivo deste estudo foi analisar as estratégias utilizadas pelos agricultores do sul do Chile para enfrentar a escassez de mão de obra e identificar as variáveis que determinam cada uma dessas estratégias. Foram aplicados um modelo de logística multinomial e razões de chance com probabilidades previstas a uma amostra de 384 agricultores, além de entrevistas e grupos focais para determinados produtores, profissionais e funcionários públicos. Os principais resultados mostram que 32,3% dos produtores afirmaram que a escassez de mão de obra é um problema. Desse percentual, 52% optaram pela estratégia de melhorar a remuneração, 13,8% escolheram melhorar as condições de trabalho dos trabalhadores, 9,5% escolheram usinar e 24,1% não seguem nenhuma estratégia. A produção de culturas que requer mão de obra intensiva (por exemplo, a fruta exportável) escolhe a estratégia de melhorar o salário; o nível de escolaridade dos agricultores influencia a estratégia para melhorar as condições de trabalho; e a idade dos agricultores determina a estratégia de usinagem. No entanto, a produção de culturas com mão de obra intensiva apresenta o maior efeito. A principal desvantagem da estratégia de "melhores salários" é que os trabalhadores não querem se comprometer com o seu trabalho.