Reconstrucción lingual con colgajo libre radial: A propósito de un caso

Resumen El cáncer de lengua es una patología con una importante morbilidad e impacto en la calidad de vida del paciente, afectando la masticación, deglución, comunicación y gusto, por lo que requiere de un equipo multidisciplinario para establecer la rehabilitación adecuada. Se necesita realizar resecciones amplias para asegurar márgenes negativos, y si el cirujano considera que existe un volumen remanente insuficiente para obliterar la cavidad oral, la realización de un colgajo será necesario para mantener la función deglutoria. Se presenta el caso de un paciente de 76 años, masculino, con antecedentes de tabaquismo suspendido hace 23 años, que presenta una lesión ulcerada dolorosa en el borde derecho de la lengua móvil, la biopsia informa un carcinoma epidermoide, etapificado T2N0M0, por lo que se decide realizar hemiglosectomía derecha más disección cervical y reconstrucción con colgajo libre radial.

Abstract Tongue cancer is a pathology with significant morbidity and impact on the quality of life of the patients. It affects chewing, swallowing, communication, and taste. Therefore, a multidisciplinary team is required to establish adequate rehabilitation. Extensive resections are needed to ensure negative margins. If the surgeon considers that there is insufficient remaining volume to obliterate the oral cavity, flap surgery will be carried out to maintain the swallowing function. We present a case report of a 76-year-old male patient with a history of smoking cessation of 23 years. He presents a painful ulcerated lesion on the right edge of the mobile tongue. The biopsy reports an epidermoid carcinoma, staged T2N0M0 which led to perform a right hemiglosectomy, cervical dissection, and reconstruction with free radial forearm flap.

Puntos críticos en la evaluación y tratamiento de octogenarios con colecistolitiasis / Critical points in the evaluation and treatment of octogenarians with colecistolitiasis

Resumen Introducción: Existe una tendencia global al envejecimiento y con ello un aumento de patologías asociadas. En Chile la prevalencia de la colelitiasis o colecistolitiasis aumenta con la edad, siendo la cole-cistectomía una de las cirugías más frecuentes. Existen escasos estudios latinoamericanos referentes a la realidad de la población octogenaria expuesta a este problema. Objetivo: Estudiar la morbimortalidad posoperatoria en pacientes octogenarios operados de colecistectomía. Definir la precisión de distintas herramientas diagnósticas preoperatorias, estudiar variables operatorias y precisar costos hospitalarios. Materiales y Método: Estudio observacional retrospectivo de la ficha clínica electrónica del Hospital Clínico de la Universidad de Chile, entre enero de 2012 y mayo de 2017. Se incluyeron pacientes con edad igual o mayor a 80 años, en quienes se realizó una colecistectomía electiva o de urgencia por patología benigna. Resultados: Se incluyeron 145 pacientes, 51,7% fueron mujeres, el promedio de edad fue de 84,1 años y un 74,5% presentaba comorbilidades. El 62,1% de los casos ingresó por urgencia. 26,2% de toda la muestra presentó coledocolitiasis. La colecistectomía fue laparoscópica en 73,8% de la muestra global, la tasa de conversión fue de 14,5% en población de urgencia y 1,8% en población electiva (p = 0,009). La población operada totalmente por vía laparoscópica con coledocolitiasis fue resuelta en un 95,2% a través de Rendez-vous, con una tasa de éxito del 100%. La tasa de complicaciones fue de 17,9% siendo en su mayoría médicas, la mortalidad quirúrgica fue de 2,1%, siendo todos casos de urgencia. El costo promedio de atención en salud hospitalaria fue de $5.888.104 pesos chilenos (U$9.000). Conclusión: El paciente octogenario con colecistolitiasis representa un desafío quirúrgico, dado un mayor número de comorbilidades, un cuadro clínico más agresivo y una elevada tasa de coledocolitiasis. Es aconsejable valorar el abordaje mínimamente invasivo y realizar una colangiografía intraoperatoria de rutina.

Introduction: There is a global tendency to aging and associated pathologies. In Chile, the prevalence of cholecystolithiasis increases with age, cholecystectomy is one of the most frequent surgeries in the contry. There are few latinamerican studies regarding the reality of the elderly exposed to this problem. Objective: Study postoperative morbimortality in octogenarian patients undergoing cholecystectomy. Define the accuracy of different preoperative diagnostic tools, study operative variables and specify hospital costs. Materials and Method: Retrospective observational study of the Clinical Hospital of the University of Chile, between January 2012 and May 2017. Patients with age equal to or greater than 80 years were included, in whom an elective or emergency cholecystectomy was performed for benign pathology. Results: A total of 145 patients were included, 51.7% were women, the average age was 84.1 years, and 74.5% had comorbidities. The admission was throw the emergency department in 62.1% of the cases. Choledocholithiasis was diagnosed in 26.2% of the entire sample. Cholecystectomy was fully laparoscopic in 73.8% of the overall sample, the conversion rate was 14.5% in the emergency population and 1.8% in the elective population (p = 0.009). The population operated fully laparoscopically, that had choledocholithiasis, was resolved in 95.2% through Rendezvous technique, with a 100% clearance rate of common bile duct. The complication rate was 17.9%, most being medical. The surgical mortality was 2.1%, all cases operated from emergency. The average cost of hospital health care was $5,888,104.3 Chilean pesos (U$9.000). Conclusion: The octogenarian patient with cholecystolithiasis represents a surgical challenge, given a greater number of comorbidities, a more aggressive clinical setting and a high rate of choledocolithiasis. It is advisable to assess the minimally invasive approach and perform routine intraoperative cholangiography. In the postoperative period, the cardiopulmonary status and the infectious complications of the surgical site should be monitored closely.

Correction to: Comparison of healing of full-thickness skin wounds grafted with multidirectional or unidirectional autologous artificial dermis: differential delivery of healing biomarkers.

In the original article text presenting and discussing results shown in Fig. 6 omitted to mention that quantification of TGF-ß2 and TGF-ß3 was not included in Fig. 6a, c, e.

Comparison of healing of full-thickness skin wounds grafted with multidirectional or unidirectional autologous artificial dermis: differential delivery of healing biomarkers.

Cytokines, chemokines, and growth and remodeling factors orchestrate wound healing when skin damage occurs. During early stages, when the wound is still open, detection and quantification of these compounds might provide biomarkers of skin wound healing, which could aid to complete the scenario provided by clinical follow-up data and histological and histomorphometric analyses. This work assessed and compared the healing of full-thickness skin wounds grafted with artificial dermis made with autologous skin fibroblasts and unidirectional or multidirectional type I collagen scaffolds to test this hypothesis. Biomarkers of healing were detected and quantified in the culture medium of artificial dermis and exudates from the grafted wounds. Clinical follow-up of animals and histological and histomorphometric analysis showed differences in graft integration, wound closure, and histological and histomorphometric parameters. Surface plasmon resonance quantification of 13 healing biomarkers indicated differential secretion of most of the quantified factors in culture medium by the multidirectional and unidirectional artificial dermis. Also, there were significant differences between the concentration of some of the factors analyzed in the exudates of wounds grafted with the evaluated artificial dermis. These findings suggest that differential delivery of healing biomarkers induced by the directionality of the scaffold used to produce the multidirectional and unidirectional dermis was sufficient to create two skin wound microenvironments that determined a different outcome of healing. Overall, data indicate that healing of wounds grafted with multidirectional autologous artificial dermis is better than that of the wounds grafted with the unidirectional one.

Dominant and sensitive control of oxidative flux by the ATP-ADP carrier in human skeletal muscle mitochondria: Effect of lysine acetylation.

The adenine nucleotide translocase (ANT) of the mitochondrial inner membrane exchanges ADP for ATP. Mitochondria were isolated from human vastus lateralis muscle (n = 9). Carboxyatractyloside titration of O2 consumption rate (Jo) at clamped [ADP] of 21 µM gave ANT abundance of 0.97 ±â€¯0.14 nmol ANT/mg and a flux control coefficient of 82% ±â€¯6%. Flux control fell to 1% ±â€¯1% at saturating (2 mM) [ADP]. The KmADP for Jo was 32.4 ±â€¯1.8 µM. In terms of the free (-3) ADP anion this KmADP was 12.0 ±â€¯0.7 µM. A novel luciferase-based assay for ATP production gave KmADP of 13.1 ±â€¯1.9 µM in the absence of ATP competition. The free anion KmADP in this case was 2.0 ±â€¯0.3 µM. Targeted proteomic analyses showed significant acetylation of ANT Lysine23 and that ANT1 was the most abundant isoform. Acetylation of Lysine23 correlated positively with KmADP, r = 0.74, P = 0.022. The findings underscore the central role played by ANT in the control of oxidative phosphorylation, particularly at the energy phosphate levels associated with low ATP demand. As predicted by molecular dynamic modeling, ANT Lysine23 acetylation decreased the apparent affinity of ADP for ANT binding.

Immunogenicity in Protein and Peptide Based-Therapeutics: An Overview.

Currently it is well known that all biological drugs, including those with a fully human structure, are capable of inducing a host immune response known as immunogenicity [1]. The presence of ADAs can condition the drug´s level and action, thus modifying the therapeutic effect and even the safety profile by its mechanism of action - neutralizing or non-neutralizing - and / or an increase in its clearance. Immunogenicity is a dynamic factor to be taken into account in biological therapy, especially in long-term treatments, and as a relevant aspect in the assessment of secondary response loss [2]. With the above, not only the knowledge but also the management of the immunogenicity of the different biological treatments, represent a useful instrument for optimization of the strategies of use for each drug, and in the design of predictive models of response, which finally permits a significant improvement in the efficacy and safety profile, aiming to a personalization of the therapies, especially in patients with autoimmune diseases, genetic disorders and cancer [3]. This review summarizes the events of immunogenicity that produce the biological drug, the factor that influence to immunogenicity and the assessment of immunogenicity.

Diaphragmatic thickness ratio (inspiratory/expiratory) as a diagnostic method of diaphragmatic palsy associated with interescalene block. / La ratio de grosor diafragmático (inspiratorio/espiratorio) como método diagnóstico de parálisis diafragmática asociada al bloqueo interescálenico.

INTRODUCTION: Diaphragmatic paralysis is a side-effect associated with interscalene block. Thickness index of the diaphragm muscle (inspiratory thickness/expiratory thickness) obtained by ultrasound has recently been introduced in clinical practice for diagnosis of diaphragm muscle atrophy. Our objective was to evaluate this index for the diagnosis of acute phrenic paresis associated with interscalene block. PATIENTS AND METHODS: We designed an observational study in 22 patients scheduled for shoulder arthroscopy. Spirometry was performed (criteria of phrenic paresis was a decrease in FVC and FEV1 ≥20%). Ultrasound apposition zone was assessed in anterior axillary line and diaphragmatic displacement was evaluated on inspiration and expiration (number of intercostal spaces; phrenic paresis considered a reduction ≥25%) and thickness of the diaphragm muscle (a phrenic paresis was considered an index <1.2). These determinations were performed before and at 20min after interscalene block at C5-C6 with 20ml of 0.5% ropivacaine. RESULTS: Twenty-one patients (95%) presented phrenic nerve block according to one or more of the methods used. One patient did not show any symptoms or signs suggestive of phrenic paralysis and was excluded. All the patients presented phrenic paresis based on the diaphragmatic thickness index, with the pre-block index being 1.8±0.5 and post-block of 1.05±0.06 (P<0.001). Ninety percent of the patients (19) presented phrenic paresis according to spirometry and all the patients had a reduction in diaphragmatic movement after the block (from 1.9±0.5 intercostal spaces to 0.5±0.3; P<0.001). CONCLUSION: The index of inspiratory / expiratory diaphragmatic thickness at cut-off <1.2 seems to be useful in the diagnosis of phrenic paresis associated with interscalene block. This index does not require a baseline pre-assessment.

Prevalencia de hipotiroidismo subclínico en pacientes con síndrome coronario agudo / Prevalence of subclinical hypothyroidism in patients with acute coronary syndrome

INTRODUCTION: Subclinical hypothyroidism (SH) is characterized by elevation of thyroid stimulating hormone (TSH) with normal free thyroxine (FT4). SH has been associated with cardiovascular risk factors (CVRF) such as increased blood pressure, lipid level and atherosclerosis; however, its association with coronary heart disease is controversial. OBJECTIVES: The primary objective was to know the prevalence of SH in patients with acute coronary syndrome (ACS) in 3 hospitals of the Viña del Mar-Quillota Health Service. The secondary objective was to know the prevalence of CVRF in patients with SH and euthyroidism. MATERIAL AND METHOD: A cross-sectional study that included patients admitted for ACS. CVRF and thyroid hormone levels were recorded. RESULTS: Of the 81 patients recruited, 11 (13.6 percent) had SH. AHT was present in 68.3 percent of euthyroid and 90.9 percent of SH (p = 0.16). 55 percent of euthyroid and 63.6 percent of SH had dyslipidemia (p = 0.74). Overweight or obesity was found in 76.6 percent of euthyroid and 54.5 percent of SH (p = 0.15). The median CVRF was 3 (IQR 2-4) in euthyroid and 3 (IQR 3-4) in SH (p = 0.78). CONCLUSIONS: The prevalence of SH in patients with ACS was not higher than that reported in the general population and there were no differences in CVRF between SH and euthyroid. We require prospective cohort studies with a larger sample size to establish incidence and risk of adverse cardiovascular outcomes in SH.

Comparación de criterios para determinar la edad de adquisición de fonemas lateral y róticos / Comparison of criteria for determining the age of acquisition of lateral phonemes and rhotic

El desarrollo fonético-fonológico es abordado de diferentes formas cuando se estudia el tema. Una de ellas se basa en el establecimiento de edades de adquisición de los fonemas de una lengua. Una revisión de la literatura al respecto evidencia que las distintas investigaciones en esta temática no siempre utilizan los mismos criterios en el análisis de los datos, en la selección de la muestra o en el juicio clínico para definir adquisición, entre otros puntos relevantes. Por esta razón, los objetivos del presente artículo son comparar distintos criterios de análisis y determinar de qué manera la elección de uno u otro influye en la edad de adquisición de los fonemas estudiados. Para llevar a cabo los objetivos, se evaluaron 84 niños de entre 3 años y 4 años 11 meses, organizados en cuatro grupos de 21 niños según rango etario. En todos ellos se evaluó la producción de los fonemas lateral / l / y róticos / ɾ / y / r / en distintos contextos fonológicos. Luego, a la muestra de fonemas obtenida, se le aplicaron los diferentes criterios que se pretendía comparar. Los resultados muestran que la edad de adquisición de los fonemas estudiados varía según el criterio utilizado, incluso en algunos casos existen al menos dos años de diferencia. A partir de los resultados, se discute la importancia de explicitar los criterios que se utilizan para estudiar edades de adquisición y, sobre todo, la implicancia que puede tener seleccionar uno u otro criterio en el ejercicio fonoaudiológico.

Phonological development is approached in different ways in the literature. One is based on the establishment of the age of acquisition of the phonemes of a language. A review of the literature showed that in this area researchers do not always use the same criteria in the analysis of data in the selection of the sample or clinical judgment to determine acquisition, among other important points. Therefore, the aim of this study is to compare different approaches and determine how the choice of one or the other influences the age of acquisition of the phonemes studied. To accomplish the objectives, 84 children aged between 3 and 4 organized into 4 groups of 21 children were evaluated according to age range. They were evaluated in the production of the lateral / l / and rhotic phonemes / ɾ / and / r / in different phonological contexts. Then different criteria were applied to the sample of obtained phonemes to compare them. The results showed that the age of acquisition of phonemes studied varies according to the criteria used, in some cases up to two years apart. From the results, there is a discussion of the importance of explaining the criteria used when considering the age of acquisition and especially the implications it may have when different criteria is chosen for a speech therapy exercise.

Colposacropexia abdominal abierta con malla mixta en el prolapso de cúpula vaginal: experiencia en el Hospital de Quilpué, Chile / Open abdominal colposacropexy with mixed mesh in vaginal vault prolapse: experience in the Hospital of Quilpué, Chile

INTRODUCCIÓN: La colposacropexia por vía abdominal abierta (CSPA) es el gold standard para el tratamiento del prolapso de la cúpula vaginal (PCV). OBJETIVO: Mostrar nuestra experiencia, en un Hospital de mediana complejidad, en los primeros siete casos sometidos a un CSPA, reportando las complicaciones intra y post operatorias. MÉTODO: Se realizó un estudio prospectivo descriptivo en nuestras siete primeras pacientes portadoras de un prolapso de cúpula vaginal estadio III o IV (POP-Q) sintomáticas, sin incontinencia urinaria y sometidas a una CSPA, con una malla mixta en el Servicio de Obstetricia y Ginecología del Hospital de Quilpué. RESULTADOS: Se reclutaron 7 pacientes. Ninguna de ellas presentaba complicaciones con riesgo vital peri-operatorio, en un período de seguimiento de 33 meses. En el 100% de las pacientes se logró cura objetiva definida como un POP-Q estadio 0 o I, y buena calidad de vida según el Cuestionario de Impacto del Piso Pélvico (PFIQ-7, versión validada en español). Durante el seguimiento, sólo una paciente presentó exposición asintomática de 5 mm de la malla, resuelta con su resección por vía vaginal. Ninguna paciente requirió de una cirugía por prolapso de órganos pélvicos después de la CSPA. CONCLUSIÓN: Los resultados obtenidos concuerdan con la literatura. La CSPA sigue siendo el gold standard para el tratamiento del PCV, no siendo superada por el momento, por ninguna otra técnica, incluso la colposacropexia laparoscópica. Estimamos que el uso de mallas parcialmente reabsorbibles pueden disminuir la exposición de mallas, sin embargo se requieren de más estudios.

INTRODUCTION: The abdominal sacral-colpopexy is currently considered the gold standard for the management of (CSPA) vaginal vault prolapse (PCV). OBJECTIVE: To report our surgical experience at a county hospital with our first seven abdominal sacral-colpopexy cases. Reporting intra and post-operative complications. METHODS: We conducted a prospective descriptive study involving our first seven cases of patients with symptomatic vaginal vault prolapse stage III or IV (POP-Q) without urinary incontinence. All patients were undergoing CSPA with a partially absorbable mesh in the Obstetrics and Gynecology Department at the Quilpué Hospital. RESULTS: Seven patients were recruited. None of them presented a life threatening complication during a mean follow up period of 33 months. A hundred percent of patients achieved objetive cure defined as POP-Q stage 0 or I and subjective cure defined as a significant improvement in a validated questionnaire (PFIQ-7 spanish version). During patients follow up, only one patient had an asymptomatic 5 mm mesh exposure, resolved with a vaginal resection. None of the patients required surgery for pelvic organ prolapse after the CSPA. CONCLUSION: These results are in agreement with the international literature. The CSPA continues to be the gold standard for the PCV treatment of vaginal vault prolapse and has not been surpassed by either vaginal technique or the laparoscopic sacral-colpopexy. We believe that the use of partially reabsorbable meshes can decrease the rate of mesh exposure, however further studies are required.

[A prolonged capillary refill is predictor of low central venous oxygen saturation]. / El tiempo de llene capilar prolongado es predictor de una saturación venosa central de oxígeno disminuida.

INTRODUCTION: Educational programs in pediatric life support endorse a capillary refill time>2 s as an indicator of shock. In the emergency room, a barrier to the implementation of an early goal directed therapy, aiming at central venous oxygen saturation (ScvO2)≥70% is the insertion of central venous catheter (CVC). OBJECTIVE: To establish the predictive value of capillary refill time>2 s to detect ScvO2<70% in children admitted to Intensive Care Units. PATIENTS AND METHOD: Prospective study. We included 48 children admitted in the first 24 hours in ICU with superior vena cava CVC. Simultaneously, we measured ScvO2 and capillary refill time in the heel of upper extremity or toe. RESULTS: There were 75 paired measurements ScvO2 (75,9±8,4%) and capillary refill capillary (1,9±1,0 s). We found an inverse correlation between capillary refill time and ScvO2 (r-0,58). The ROC curve analysis revealed an excellent ability for the capillary fill time>2 s to predict ScvO2<70% (AUC 0,94) (95% CI 0,87-0,98). CONCLUSIONS: A prolonged capillary refill time>2 s, is a predictor of ScvO2<70% in children admitted to ICU, which supports the current recommendations. This finding may be relevant in emergency units where the use of CVC is limited and ScvO2 is not available.

INTERACCIÓN ENTRE DOS ÁCAROS DEPREDADORES DE Tetranychus urticae KOCH (ACARIFORMES: TETRANYCHIDAE) EN LABORATORIO / Interaction Between Two Predator Mites of Tetranychus urticae Koch (Acariformes: Tetranychidae) in Laboratory

Tetranychus urticae (Acari: Tetranychidae) es una de las principales plagas de cultivos ornamentales, entre las especies más utilizadas para su control se encuentran Neoseiulus californicus y Phytoseiulus persimilis (Parasitiformes: Phytoseiidae). En el presente trabajo se propone el manejo de la plaga mediante el empleo de liberaciones simultáneas de los dos fitoseidos. Se evaluaron varias situaciones, por un lado se estudiaron las interacciones cuando un depredador se encuentra en una densidad baja mientras que el otro depredador se presenta en alta densidad (esta situación se analizó tanto en presencia como en ausencia de la presa). Por otro lado, se evaluaron las interacciones cuando los P. persimilis y N. californicus dos están presentes en igual densidad y en presencia de T. urticae. Cuando uno de los depredadores está en mayor densidad y hay presencia de la presa, se observa que al incrementar la edad del depredador que tiene menor densidad, aumenta también la interferencia en el consumo de presas por parte de los depredadores que están en mayor densidad. Además cuando disminuye el consumo de T. urticae se incrementa el consumo intraguilda. Phytoseiulus persimilis en ausencia de T. urticae y en presencia de N. californicus adopta un comportamiento de depredación intraguilda sobre todos los estados de desarrollo de su conespecifico, mientras que N. californicus únicamente consume larvas de conespecíficos en ausencia del fitófago y en presencia de P. persimilis. Cuando se encontraban los dos depredadores en el mismo montaje y la misma densidad de población, no se observó un mayor consumo de T. urticae que cuando cada depredador es empleado por separado.

Tetranychus urticae (Acari: Tetranychidae) is an important pest of ornamental crops. A species of predatory mite used for its control is Neoseiulus californicus and Phytoseiulus persimilis (Acari: Phytoseiidae). This research proposes the use of joint releases of the two cited predators for the control of the pest. Several situations leading to interaction were evaluated: High density of one predator and low density of the other one, being the prey present or absent. The scenario with predators in equal densities and in presence of the prey was also evaluated. When a predator is in higher density and the prey present, the predator with the lower density increases the interference with the comsumption of preys by the predator with higher density. On the other hand, when the comsumption of T. urticae reduces, intraguild predation increases. P. persimilis shows intraguild predation behaviour when T. urticae is absent and N. californicus is present, consuming all developmental stages of its conspecific. Instead, N. californicus only feed on conspecific larvae, when the fitofagous was absent and P. persimilis was present. When the two predators were present in the same assemblage and with the same population density, the quantity of T. urticae consumed by both of them was not higher than the consumed one when each predator was present in separate way.

Afasia logopénica: presentación de un caso y revisión de la literatura / Logopenic Aphasia: a case report an review of the literature

With the progressive aging of the Chilean population the diagnosis of neurodegenerative disorders is increasingly common, and among them is Primary Progressive Aphasia (PPA), with specific symptoms but late consultation. PPA is a clinical syndrome characterized by the degeneration of language regions in the dominant hemisphere that determines an insidious and progressive loss of language. Two types of PPA were recognized: Progressive non-fluent Aphasia (APnF) and Progressive Semantic Aphasia (DS), and was recently identified as a new type, Logopénica Progressive Aphasia (APL). We describe a case evaluated at the University of Chile Clinical Hospital of a woman of 54 years who have a history of 2-3 years of fluent speech with reduced speed due to the difficulty in finding words, had shortcomings in repetition of complex words, phrases and sentences, presence of phonemic paraphasias and impaired episodic memory. What in the phonological assessment supports a diagnosis of APL. Despite the above, the neurological examination was normal. The APL has been associated with Alzheimer's disease because it presents impaired episodic memory and the neuropathological changes most frequently encountered are amyloid plaques and neurofibrillary tangles. Through this article you may learn more about this disease and who to go if you or some colleague have symptoms to receive some guidance.

Con el progresivo envejecimiento de la población Chilena el diagnóstico de enfermedades neurodegenerativas es cada vez más com ún, y entre ellas está la afasia progresiva primaria (PPA), de síntomas específicos pero consulta tardía. PPA es un síndrome clínico caracterizado por la degeneración de las regiones del lenguaje en el hemisferio dominante que determina una pérdida insidiosa y progresiva del lenguaje. Fueron reconocidos dos tipos de PPA: Afasia Progresiva no fluente (APnF) y Afasia Progresiva Semántica (DS), y recientemente fue identificado un nuevo tipo como, Afasia Progresiva Logopénica (APL). Se describe un caso evaluado en el Hospital Clínico Universidad de Chile de una mujer de 54 años que presenta una historia de 2-3 años de habla fluida, con disminución de la velocidad debido a la dificultad para encontrar palabras, presentaba fallas en repetición de palabras complejas, frases y oraciones, presencia de parafasias fonémicas y problemas de memoria episódica. Lo que en la evaluación fonológica es compatible con un diagnóstico de APL. A pesar de todo lo anterior el examen neurológico fue normal. La APL se ha asociado con la enfermedad de Alzheimer, ya que presenta deterioro de la memoria episódica y los cambios neuropatológicos más frecuentes son las placas amiloides y los ovillos neurofibrilares. A través de este artículo podrán conocer más acerca de esta enfermedad y a quien acudir en caso de presentar síntomas usted o algún conocido para recibir alguna orientación.

Hipotermia terapéutica en la parada cardiorrespiratoria pediátrica / Therapeutic hypothermia after pediatric cardiac arrest

Introducción: La hipotermia terapéutica (HT) como neuroprotección ha demostrado ser efectiva en la parada cardiorrespiratoria en adultos y en recién nacidos con asfixia. El efecto de la HT en pediatría se encuentra bajo investigación. Objetivos: Describir la viabilidad, la eficacia y la seguridad de un programa piloto de HT en la parada cardiorrespiratoria (PCR) pediátrica. Material y métodos: Estudio prospectivo en una unidad de cuidados intensivos pediátricos. En todos los pacientes se usó un método de enfriamiento externo con sistema servo según protocolo preestablecido. Los valores son expresados en mediana (rango intercuartil). Resultados: Se incluyó a seis pacientes. Cinco presentaron un PCR extrahospitalario. Edad 33 meses (16-120), escala de Glasgow al ingreso 6 (4-7). La T.a previa a la inducción de la HT fue de 39,2ºC (39,1-39,4). La mediana de la T.a empleada fue 34.0ºC (33.5-34.8ºC), la que se alcanzó 4hrs. (3-7) después del inicio y mantenida por 48h (45-54). El recalentamiento se realizó en un lapso de 14h (12-16). La hipocaliemia fue el evento adverso más frecuentemente encontrado. Cinco de los pacientes sobrevivieron al alta hospitalaria con una escala de Glasgow de 13 (11-14). Se observó a los 6 meses de seguimiento un pronóstico neurológico favorable, en 3 de los sobrevivientes según la escala de discapacidad Pediatric Cerebral Performance Category (menor o igual 2). Conclusión: En este estudio piloto, el uso de HT con un protocolo que incluyó inducción rápida y una técnica de enfriamiento externo es viable, eficaz y seguro en la PCR pediátrica(AU)

Introduction: Therapeutic hypothermia (TH) improves neurological outcome in adults after ventricular fibrillation cardiac arrest and in neonates with hypoxic ischemic encephalopathy. The effect of TH in children is under investigation. Objectives: To assess the feasibility, efficacy and safety of a pilot program of TH in pediatric cardiac arrest. Material and methods: Prospective study in a pediatric intensive care unit. An external cooling method with a servo system was used on all patients according to an established protocol. Values expressed as median (IQ range). Results: Six patients were included, of whom 5 had an out of hospital cardiac arrest. The mean age was 33 months (16-120) and Glasgow coma scale 6 (4-7). The Tº prior to the induction of TH was 39.2ºC (39.1-39.4). The median Tº used was 34.0ºC (33.5-34.8ºC), which was reached in 4h. (3-7) after the start and maintained for 48h. (45-54). The rewarming was carried out over a period of 14h. (12-16). Hypokalemia was the most common adverse event found. Five patients survived to hospital discharge with a Glasgow Coma Scale of 13 (11-14). At 6 months follow up the Pediatric Cerebral Performance Category score was menor 2 in three patients. Conclusion: In this pilot study, the use of mild therapeutic hypothermia with a protocol that included rapid sequence induction with an external surface cooling technique was feasible, effective and safe in children with cardiac arrest(AU)

[Therapeutic hypothermia after pediatric cardiac arrest]. / Hipotermia terapéutica en la parada cardiorrespiratoria pediátrica.

INTRODUCTION: Therapeutic hypothermia (TH) improves neurological outcome in adults after ventricular fibrillation cardiac arrest and in neonates with hypoxic ischemic encephalopathy. The effect of TH in children is under investigation. OBJECTIVES: To assess the feasibility, efficacy and safety of a pilot program of TH in pediatric cardiac arrest. MATERIAL AND METHODS: Prospective study in a pediatric intensive care unit. An external cooling method with a servo system was used on all patients according to an established protocol. Values expressed as median (IQ range). RESULTS: Six patients were included, of whom 5 had an out of hospital cardiac arrest. The mean age was 33 months (16-120) and Glasgow coma scale 6 (4-7). The T° prior to the induction of TH was 39.2° C (39.1-39.4). The median T° used was 34.0° C (33.5-34.8° C), which was reached in 4h. (3-7) after the start and maintained for 48h. (45-54). The rewarming was carried out over a period of 14h. (12-16). Hypokalemia was the most common adverse event found. Five patients survived to hospital discharge with a Glasgow Coma Scale of 13 (11-14). At 6 months follow up the Pediatric Cerebral Performance Category score was ≤ 2 in three patients. CONCLUSION: In this pilot study, the use of mild therapeutic hypothermia with a protocol that included rapid sequence induction with an external surface cooling technique was feasible, effective and safe in children with cardiac arrest.

CRITERIOS PARA LA PRODUCCIÓN DE Phytoseiulus persimilis (PARASITIFORMES: PHYTOSEIIDAE) BAJO CONDICIONES DE INVERNADERO / Criteria or the production of phytoseiuls persimilis (parasitiformes: pphytoseiidae) under greenhouse conditinns

El ácaro depredador Phytoseiulus persimilis ha sido usado con éxito para el control del ácaro fitófago Tetranychus urticae, el cual constituye una de las plagas mas importantes en los cultivos de rosa de la Sabana de Bogotá. En Colombia esta estrategia de control se ha visto limitada por la falta de disponibilidad de los depredadores en el comercio del producto. En el presente trabajo se proponen criterios para estandarizar las bases para la producción de P. persimilis en plantas de frijol infestadas con poblaciones de T. urticae de diferentes tiempos de desarrollo, utilizando una proporción constante de depredadores liberados. Se encontró que plantas infestadas con poblaciones de T. urticae por más de tres semanas permiten obtener mayores incrementos de población de los depredadores y que aproximadamente a los 25 días después de realizada la liberación, de los depredadores en las plantas infestadas, se obtienen los mayores poblaciones del depredador en estado de ninfa y adulto para cosechar y usar como estrategia de control en los cultivos.

The predatory mite Phytoseiulus persimilis has been used successfully to control the phytophagous mite Tetranychus urticae in rose crops, in what is one of the most important pests. In Colombia , this control strategy has been limited by the lack of predators in the trade of the product. Here was proposed to standardize the basis for the production of P. persimilis on bean plants infested with populations of T. urticae of different development times, using a constant proportion of predators released. We found that populations of plants infested with T. urticae for more than three weeks resulted in higher population increase of predators and at approximately 25 days after the release of predators on plants infested, you get the largest predator populations in a state of nymph and adult to harvest and use as a strategy control in crops.

Persistence of herpes simplex virus DNA in cerebrospinal fluid of neonates with herpes simplex virus encephalitis.

OBJECTIVE: The significance of detecting herpes simplex virus (HSV) DNA in the cerebrospinal fluid (CSF) of infants with HSV encephalitis after receipt of prolonged therapy with high-dose (60 mg kg(-1) day(-1)) acyclovir is unknown. We report the clinical and laboratory characteristics, neuroimaging studies and outcomes of four neonates with HSV encephalitis who had persistence of CSF HSV DNA, by polymerase chain reaction (PCR) after 15 to 21 days of high-dose acyclovir therapy. STUDY DESIGN: Retrospective chart review. RESULTS: All four infants had abnormal neuroimaging studies and subsequently experienced severe developmental delay or death. CONCLUSION: A persistently positive CSF HSV PCR in neonates may be another risk factor for worse neurodevelopmental outcome. Prospective studies are needed to document how often HSV DNA persists in CSF, elucidate whether it represents an initially high CSF viral load, ongoing viral replication or viral resistance, and determine its possible association with neurodevelopmental impairment.

Evaluación de la prevención y manejo de úlceras por decúbito en pacientes hospitalizados en unidad de cuidados especiales de un servicio de medicina / Evaluation of the prevention and management of decubitus ulcers in patients admitted to a medical special care

Las úlceras por decúbito son una patología frecuente dentro de los hospitales, especialmente dentro de ciertos servicios y en pacientes con factores de riesgo. Son un factor importante de descompensación, llevando incluso a la muerte en algunos casos, además de prolongar la estadía hospitalaria y elevar sus costos. Por esta razón decidimos evaluar la eficacia de la prevención y el manejo de esta patología en nuestro hospital. Se realizó un estudio descriptivo ciego para los médicos que incluyó a todos los pacientes que ingresaron durante el mes de Noviembre de 2007 a una sala de cuidados especiales del servicio de medicina del Hospital Naval Almirante Nef. Se evaluó el riesgo de dichos pacientes de presentar este tipo de úlceras, se vio si ingresaban por esta causa o desarrollaban estas lesiones durante su hospitalización, y las medidas preventivas y de tratamiento recibidas. Se estudió un total de 44 pacientes de los cuales 54,5 por ciento fue evaluado como de alto riesgo. Se vio en este grupo que sólo el 50 por ciento recibió algún tipo de cuidado preventivo extra, el resto tuvo el mismo manejo que aquellos pacientes considerados de bajo riesgo. Del total de pacientes 40,9 por ciento ingresaron con úlceras por decúbito de algún grado y 25 por ciento la desarrolló durante su estadía. Al cabo de una semana de tratamiento 13,7 por ciento mejoró, 17,2 por ciento empeoró y 65,5 por ciento se mantuvo igual. La prevalencia de úlceras por decúbito es elevada en este grupo de pacientes y dado el bajo rendimiento de su terapia es necesario enfocarse en la prevención, lo que hace recomendable que el equipo de salud se capacite y mantenga una vigilancia cercana, habiendo estratificado bien a los pacientes en bajo y alto riesgo.

Decubitus ulcers are frequent in admitted patients, especially in some clinical units and among patients with the presence of risk factors. These ulcers are an important element of decompensation of chronic ailments, extending hospital stay and costs, even causing death in some cases. To evaluate the efficacy of their prevention and management in our hospital, we carried out a blind descriptive study that includes all patients admitted to the special care unit of the Medical Service at the Almirante Nef Naval Hospital during November 2007. We measured the risk to present these ulcers, their presence or absence at admission, their development during hospital stay, the significance of the preventive measures and treatments given. We studied 44 patients, 54,5 per cent categorized as high risk. Only 50 percent of this group received adequate preventive measures, the rest receive similar care as the low risk's patients. Considering all patients, 40,9 percent entered with decubitus ulcers and 25 percent developed them during the stay. After one week of management 13,7 percent were better, 17,2 percent were worse and 65,5 were the same. The prevalence of ulcers is high in this group of patients, and since the results for therapy are poor, prevention is fundamental. Correct classification of the risk, and education of health teams are considered important.