Fístula utero-yeyunal secundaria a migración de dispositivo intrauterino: reporte de un caso / Utero-jejunal fistula secondary to intrauterine device migration: a case report

RESUMEN El dispositivo intrauterino (DIU) es un método anticonceptivo muy popular, eficaz y seguro. Aunque posee complicaciones bien descritas como es la migración, la que puede ser a otros órganos dentro de la cavidad peritoneal. La fístula uteroyeyunal es un evento clínico poco frecuente, pero de gran repercusión si no es diagnosticada y tratada. Se presenta el caso de una paciente usuaria de DIU, el que migra a cavidad abdominal, con posterior formación de fístula uteroyeyunal.

ABSTRACT The intrauterine device is a popular, efficient and safe contraceptive. Although it has some well described complications, such as migration, which may be to the different organs inside of the peritoneal cavity. The uterus-jejunal fistula is a rare clinical event, but with great repercussion if it is not well assessed and treated properly. We present the clinical case of a patient with a migrated intrauterine device and a fistula uterus-jejunal formation.

[Beliefs, perceptions and experiences in sexuality of Chilean adolescents with HIV acquired by vertical transmission]. / Creencias, percepciones y experiencias en sexualidad de adolescentes chilenos con infección por VIH adquirida por transmisión vertical.

BACKGROUND: Since the incorporation of antiretroviral therapy (ART) HIV has become a chronic condition, improving survival and allowing children with the virus to come in better conditions to adolescence, where they are faced with a series of changes, among them, to sexual awakening. AIM: To explore the main beliefs, perceptions and experiences in sexuality of a group of adolescents with HIV infection acquired through vertical transmission. METHODS: A qualitative research was carried out with exploratory and descriptive scope. Semi-structured interviews were applied to 28 adolescents, under control in hospitals in Santiago and Valparaíso, with HIV infection. The analysis was carried out according to the Grounded Theory. RESULTS: There was a lack of sexual education and a vision that focuses on risks, such as sexually transmissible infections or teenage pregnancy. There are fears about the possibility of rejection by others and of transmitting the virus to the couple or the children and they are invaded by feelings of shame and anger. CONCLUSION: It is important to train health professionals who work with this group, because they are identified as a reliable source of information and education.

Creencias, percepciones y experiencias en sexualidad de adolescentes chilenos con infección por VIH adquirida por transmisión vertical / Beliefs, perceptions and experiences in sexuality of Chilean adolescents with HIV acquired by vertical transmission

Resumen Introducción: Desde la incorporación de la terapia anti-retroviral (TAR) la infección por VIH ha pasado a ser una condición crónica, mejorando la sobrevida y permitiendo que los niños que han sido infectados con el virus lleguen en mejores condiciones a la adolescencia, donde se ven enfrentados a una serie de cambios, entre ellos, al despertar sexual. Objetivo: Explorar las principales creencias, percepciones y experiencias en sexualidad de un grupo de adolescentes con infección por VIH adquirida por transmisión vertical. Pacientes y Métodos: Se realizó una investigación cualitativa con alcance exploratorio y descriptivo. Se aplicaron entrevistas semiestructuradas a 28 adolescentes, bajo control en hospitales de Santiago y Región de Valparaíso, con infección por VIH. El análisis se realizó de acuerdo a la Teoría Fundamentada. Resultados: Se observó falta de educación sexual y una visión que se centra en los riesgos, tales como contagio de infecciones de transmisión sexual o embarazo adolescente. Existen temores frente a la posibilidad de rechazo de los otros y a transmitir el virus a la pareja o a los hijos y los invaden sentimientos de vergüenza y rabia. Conclusión: Es importante capacitar a los profesionales de salud que trabajan con este grupo, pues son identificados como fuente confiable de información y educación.

Background: Since the incorporation of antiretroviral therapy (ART) HIV has become a chronic condition, improving survival and allowing children with the virus to come in better conditions to adolescence, where they are faced with a series of changes, among them, to sexual awakening. Aim: To explore the main beliefs, perceptions and experiences in sexuality of a group of adolescents with HIV infection acquired through vertical transmission. Methods: A qualitative research was carried out with exploratory and descriptive scope. Semi-structured interviews were applied to 28 adolescents, under control in hospitals in Santiago and Valparaíso, with HIV infection. The analysis was carried out according to the Grounded Theory. Results: There was a lack of sexual education and a vision that focuses on risks, such as sexually transmissible infections or teenage pregnancy. There are fears about the possibility of rejection by others and of transmitting the virus to the couple or the children and they are invaded by feelings of shame and anger. Conclusion: It is important to train health professionals who work with this group, because they are identified as a reliable source of information and education.

The Geographic Structure of Viruses in the Cuatro Ciénegas Basin, a Unique Oasis in Northern Mexico, Reveals a Highly Diverse Population on a Small Geographic Scale.

The Cuatro Ciénegas Basin (CCB) is located in the Chihuahuan desert in the Mexican state of Coahuila; it has been characterized as a site with high biological diversity despite its extreme oligotrophic conditions. It has the greatest number of endemic species in North America, containing abundant living microbialites (including stromatolites and microbial mats) and diverse microbial communities. With the hypothesis that this high biodiversity and the geographic structure should be reflected in the virome, the viral communities in 11 different locations of three drainage systems, Churince, La Becerra, and Pozas Rojas, and in the intestinal contents of 3 different fish species, were analyzed for both eukaryotic and prokaryotic RNA and DNA viruses using next-generation sequencing methods. Double-stranded DNA (dsDNA) virus families were the most abundant (72.5% of reads), followed by single-stranded DNA (ssDNA) viruses (2.9%) and ssRNA and dsRNA virus families (0.5%). Thirteen families had dsDNA genomes, five had ssDNA, three had dsRNA, and 16 had ssRNA. A highly diverse viral community was found, with an ample range of hosts and a strong geographical structure, with very even distributions and signals of endemicity in the phylogenetic trees from several different virus families. The majority of viruses found were bacteriophages but eukaryotic viruses were also frequent, and the large diversity of viruses related to algae were a surprise, since algae are not evident in the previously analyzed aquatic systems of this ecosystem. Animal viruses were also frequently found, showing the large diversity of aquatic animals in this oasis, where plants, protozoa, and archaea are rare.IMPORTANCE In this study, we tested whether the high biodiversity and geographic structure of CCB is reflected in its virome. CCB is an extraordinarily biodiverse oasis in the Chihuahuan desert, where a previous virome study suggested that viruses had followed the marine ancestry of the marine bacteria and, as a result of their long isolation, became endemic to the site. In this study, which includes a larger sequencing coverage and water samples from other sites within the valley, we confirmed the high virus biodiversity and uniqueness as well as the strong biogeographical diversification of the CCB. In addition, we also analyzed fish intestinal contents, finding that each fish species eats different prey and, as a result, presents different viral compositions even if they coexist in the same pond. These facts highlight the high and novel virus diversity of CCB and its "lost world" status.

Impaired hypothalamic cocaine- and amphetamine-regulated transcript expression in lateral hypothalamic area and paraventricular nuclei of dehydration-induced anorexic rats.

Negative energy balance promotes physiological adaptations that ensure the survival of animals. The hypothalamic-pituitary-thyroid axis regulates basal energy expenditure and its down-regulating adaptation to negative energy balance is well described: in fasting, the serum content of thyrotrophin (TSH) and thyroid hormones (TH) decreases, enhancing the survival odds of individuals. By contrast, dehydration-induced anorexic (DIA) rats present an impaired hypothalamic-pituitary-thyroid (HPT) axis adaptation despite their negative energy balance: increased circulating TSH levels. The implication of cocaine- and amphetamine-regulated transcript (CART), an anorexic peptide, in HPT axis function impairment and food-avoidance behaviour displayed by DIA animals is unknown. Because CART is co-expressed with the peptide that regulates the HPT axis in hypophysiotrophic paraventricular nucleus (PVN) neurones (TSH-releasing hormone), we analysed CART expression and possible implications with respect to high TSH levels of DIA animals. We examined whether changes in CART expression from the lateral hypothalamic area (LHA) and arcuate nucleus (ARC) could participate in food-avoidance of DIA rats. DIA and forced-food restricted (FFR) animals reduced their body weight and food intake. FFR rats had a down-regulation of their HPT axis (reduced serum TH and TSH content), whereas DIA animals had reduced TH but increased TSH levels. CART mRNA expression in the ARC decreased similarly between experimental groups and diminished in anterior, medial PVN and in LHA of FFR animals, whereas DIA animals showed unchanged levels. This impaired CART mRNA expression in the anterior PVN and LHA could be related to the aberrant feeding behaviour of DIA rats but not to their deregulated HPT axis function.

Prepuberal light phase feeding induces neuroendocrine alterations in adult rats.

Feeding patterns are important factors in obesity evolvement. Time-restricted feeding schedules (tRF) during resting phase change energy homeostasis regulation, disrupting the circadian release of metabolism-regulating hormones, such as leptin, insulin and corticosterone and promoting body weight gain. Thyroid (HPT) and adrenal (HPA) axes exhibit a circadian regulation and are involved in energy expenditure, thus studying their parameters in tRF paradigms will elucidate their role in energy homeostasis impairments under such conditions. As tRF in young animals is poorly studied, we subjected prepuberal rats to a tRF either in light (LPF) or in darkness phase (DPF) and analyzed HPT and HPA response when they reach adulthood, as well as their arcuate (ARC) and paraventricular (PVN) hypothalamic nuclei neurons' sensitivity to leptin in subsets of 10-week-old animals after fasting and with i.p. leptin treatment. LPF group showed high body weight and food intake, along with increased visceral fat pads, corticosterone, leptin and insulin serum levels, whereas circulating T4 decreased. HPA axis hyperactivity was demonstrated by their high PVN Crf mRNA expression; the blunted activity of HPT axis, by the decreased hypophysiotropic PVN Trh mRNA expression. Trh impaired expression to the positive energy balance in LPF, accounted for their ARC leptin resistance, evinced by an increased Npy and Socs3 mRNA expression. We concluded that the hyperphagia of prepuberal LPF animals could account for the HPA axis hyperactivity and for the HPT blocked function due to the altered ARC leptin signaling and impaired NPY regulation on PVN TRH neurons.

Cuerpos extraños (CE) en el tracto digestivo / Foreign bodies in the digestive tract

Foreign bodies can be of organic or inorganic nature. Ten to 20 percent of the foreign bodies occurring in the digestive tract require an endoscopic procedure. Public health reports identify the pediatric population, no sex-based prevalence, as the one with the highest risk. In adults, these typically correspond to men swallowing fish bones or dental prostheses. The elderly mainly swallow dental prostheses and also they are individuals with clinical pathologies. The increased risk of suspicion is relevant for diagnostic in children, because 40 percent of them swallow the foreign body on absence of adults and seem asymptomatic. Progress of the symptoms and physical examination are the base for clinical diagnostic. The locations where the foreign bodies may impact the esophagus, stomach and small intestine, are know, as well as the associated pathologies. Sixty percent of the foreign bodies are radiopaque; simple X-ray in two views (AP and lateral) is the main tool for diagnosis. Forty percent of the foreign bodies are radiolucid; the most effective tool for identification is endoscopy. Therapy, whether observation and clinical surveillance, endoscopic or surgical extraction, will depend on the type, size and shape of the foreign body, its location, time since swallowed, toxicity, capability of producing electricity or causing mechanical damage, the quantity and if it was swallowed together with other foreign bodies (batteries/magnet), radiotransparency, and the patient’s age and associated pathologies. Complications are acute obstruction, perforation, fistula and digestive hemorrhage.

Los cuerpos extraños pueden ser de naturaleza orgánica o inorgánica. El 10 a 20 por ciento de los cuerpos extraños que ingresan al tracto digestivo requieren algún procedimiento endoscópico. Informes de salud pública definen a la población pediátrica, sin prevalencia de sexo, como la de mayor riesgo. En adultos clásicamente corresponden a hombres que ingieren espinas de pescado o prótesis dentarias. Los ancianos, ingieren prótesis dentarias y son individuos con alguna patología médica. El alto índice de sospecha es relevante en la determinación del diagnóstico en niños, ya que el 40 por ciento de ellos, los ingieren en ausencia de adultos y están asintomáticos. La evaluación de la sintomatología y el examen físico son la base para el diagnóstico clínico. Son conocidos los segmentos del tracto digestivo y las patologías asociadas al lugar en que normalmente se impactan los cuerpos extraños en el esófago, estómago e intestino delgado. El 60 por ciento de los cuerpos extraños son de tipo radiopaco; la radiografía simple en dos proyecciones (AP y lateral) es la principal herramienta diagnóstica. El 40 por ciento de los cuerpos extraños es radiolúcido; la herramienta más eficiente para su identificación es la endoscopia. La conducta terapéutica, sea esta la observación y control clínico, la extracción por endoscopia o la cirugía, dependerá del tipo de cuerpo extraño, de su tamaño, forma, localización, tiempo post-ingesta, toxicidad, capacidad para generar electricidad o daño mecánico, su número o co-ingesta con otros cuerpos extraños (pilas e imanes), radiotransparencia, y la edad del paciente y sus patologías asociadas. Sus complicaciones son la obstrucción aguda, la perforación, la fistulización y la hemorragia digestiva.

[Renal compromise in HIV/AIDS in patients attended at a Chilean children hospital]. / Compromiso renal e infección por VIH/SIDA en pacientes atendidos en un hospital pediátrico chileno.

UNLABELLED: The aim of this study was to determine the frequency of renal abnormalities in HIV positive children hospitalized in one pediatric hospital in Chile. METHOD: a cross sectional study was performed during April 2007. RESULTS: A total of 18 patients were evaluated, ten male and eight female ranging in age from 4 to 19 years. The average age at the time of HIV diagnosis and nephrologic evaluations were 2,69 and 10,7 years respectively. All patients had acquired HIV infection by vertical transmission. Uriñe samples of two children had microalbuminuria; two had monosymptomatic hematuria, and ten had ¿squamous? cells. Hypercalciuria was detected in one patient, renal lithiasis in another and two patients had abnormal renal ultrasonography. All 19 patients had normal blood pressures. Overall 7 patients (39%) had a renal abnormality. CONCLUSIONS: The relatively high incidence of renal abnormalities in our series support the need for a nation-wide screening program to assess the incidence of renal impairment in pediatric HIV positive patients.

Compromiso renal e infección por VIH/SIDA en pacientes atendidos en un hospital pediátrico chileno / Renal compromise in HIV/AIDS in patients attended at a Chilean children hospital

The aim of this study was to determine the frequency of renal abnormalities in HIV positive children hospitalized in one pediatric hospital in Chile. Method: a cross sectional study was performed during April 2007. Results: A total of 18 patients were evaluated, ten male and eight female ranging in age from 4 to 19 years. The average age at the time of HIV diagnosis and nephrologic evaluations were 2,69 and 10,7 years respectively. All patients had acquired HIV infection by vertical transmission. Uriñe samples of two children had microalbuminuria; two had monosymptomatic hematuria, and ten had ¿squamous? cells. Hypercalciuria was detected in one patient, renal lithiasis in another and two patients had abnormal renal ultrasonography. All 19 patients had normal blood pressures. Overall 7 patients (39 percent) had a renal abnormality. Conclusions: The relatively high incidence of renal abnormalities in our series support the need for a nation-wide screening program to assess the incidence of renal impairment in pediatric HIV positive patients.

El objetivo de este estudio fue evaluar la función renal de pacientes infectados con virus de inmuno-deficiencia humana (VIH) que se controlan en un hospital pediátrico chileno. Método: estudio de corte transversal. Resultados: Se evaluaron 18 pacientes, 10 varones y 8 mujeres; edad: entre 4 y 19 años, la edad promedio al diagnóstico de la infección por VIH y al momento de la evaluación fue 2,69 y 10,7 años, respectivamente. Todos nuestros pacientes adquirieron la infección vía vertical. Dos presentaron microalbuminuria y dos hematuria monosintomática. En 10 (55 por ciento) se encontraron células descamativas, en uno hiper-calciuria y en otro litiasis renal. Todos tuvieron presión arterial normal. La ecotomograña renal fue anormal en dos. Se han descrito varias anormalidades renales en pacientes con infección por VIH; en nuestro estudio, 7 pacientes (39 por ciento) tuvieron alteraciones en los exámenes de laboratorio. Conclusión: La alta frecuencia de afectación renal encontrada en pacientes pediátricos con infección por VIH hace necesario plantear un tamizaje nacional para determinar la incidencia de nefropatía asociada en nuestros pacientes.

Tuberculosis hepática pseudotumoral: reporte de caso / Hepatic Tuberculosis pseudotumoral: case report

El compromiso hepático por tuberculosis es una presentación rara de la enfermedad. Su espectro clínico es variado; siendo una de las formas el tuberculoma hepático o tuberculosis pseudotumoral entidad poco frecuente que no muestra sintomatología específica, por lo que es difícil diagnosticarla. Se reporta el caso de un paciente con tuberculosis hepática pseudotumoral, cuyos síntomas de presentación fueron dolor en hipocondrio derecho y pérdida de peso. La tomografía computarizada mostró presencia de una lesión hepática sólida hipodensa que captaba sustancia de contraste de forma heterogénea. Fue sometido a hepatectomia segmentaria con la sospecha clínica de neoplasia maligna, sin embargo el estudio anatomopatológico confirmó el diagnóstico de tuberculosis. No se encontró foco primario en otras localizaciones. El paciente posteriormente recibió tratamiento antibiótico específico y evolucionó clínicamente bien.

Tuberculosis y SIDA en Pediatría: A propósito de cinco casos / Tuberculosis and AIDS in Pediatrics: on account of five cases

La reemergencia de la tuberculosis (TBC) a nivel mundial se vincula a diferentes factores, como la infección por VIH y la inmunosupresión a la cual ésta conduce. Este comportamiento epidemiológico también se aprecia en la población infantil. Describimos la evolución clínica, inmunológica y tratamiento recibido por seis niños con infección VIH de transmisión vertical, controlados por el Comité Nacional de SIDA pediátrico, que presentaron tuberculosis. Se efectúa, además, una revisión de la literatura médica.

The worldwide reemergence of tuberculosis (TB) is related to different factors, being one of them HIV infection and its immune suppressive effect. This epidemiological pattern is also observed in pediatric population. We describe the clinical/immunological evolution, and treatment administered to six children under control by the Chilean Pediatric AIDS Committee with vertically transmitted HIV infection, who acquired tuberculosis. A review of the literature is carried out in addition.

Enfermedad por citomegalovirus en niños chilenos infectados por el virus de la inmunodeficiencia humana-1 / Cytomegalovinas disease in HIV-1 infected Chilean children

Citomegalovirus (CMV) es una infección oportunista frecuente en niños infectados con el virus de la inmunodeficiencia humana tipo 1 (VIH 1) y produce altas tasas de morbilidad y mortalidad. El objetivo de este estudio fue determinar la frecuencia y trascendencia de la enfermedad por CMV en la cohorte de niños chilenos infectados con VIH-1. Se encontró enfermedad por CMV en 28 de 222 niños infectados con VIH-1 (12,6 por cientoo); 92 por cientoo fue clasificado en etapa C y 61 por cientoo en categoría 3 (CDC 1994). La enfermedad pulmonar fue la manifestación más común (25). Las muestras clínicas se obtuvieron de tracto respiratorio, sangre, orina y biopsia. Para la detección de CMV se utilizó, preferentemente, el cultivo acelerado (shell vial), (20/28). Todos fueron tratados con ganciclovir ev. El tiempo promedio de sobrevida fue 42 meses hasta el momento de esta evaluación. Conclusión: La enfermedad por CMV causó morbilidad y mortalidad en los niños chilenos infectados por VIH-1. El diagnóstico y tratamiento precoces son la base para un resultado exitoso.

Cytomegalovirus (CMV) is a frequent opportunistic infection in human inmunodeficiency virus type 1 (HIV-1) infected children associated with significant morbidity and mortality. The aim of this study was to determine the frequency and impact of CMV disease in a prospective ly followed cohort of HIV-1 infected Chilean children. CMV disease was diagnosed in 28 out of 222 HIV infected children (12.6 percent); 92 percent of them were classified in category C and 61 percent in category 3 (CDC, 1994). Lung disease was the most common manifestation (25 children). Samples were obtained from the respiratory tract, blood, urine and tissue biopsies. Shell vial for CMV early antigen detection was the most commonly used diagnostic technique (20/ 28). All patients were treated with iv.ganciclovir and two children died during the CMV episode. The mean survival time for the remaining children is currently 42 months. Conclusion: CMV disease was frequent and caused mortality in HIV-1 infected Chilean children. Early diagnosis and treatment are key for clinical success.

[Changes in vertically transmitted human immunodeficiency virus infection Chile]. / Evolución de la transmisión vertical de la infección por virus de inmunodeficiencia humana en Chile.

The identification of various risk factors of vertical human immunodeficiency virus (HIV) transmission resulted in the development of strategies whose aim was to decrease the mother's viral load, to reduce her child's exposure to it during delivery, and to avoid the subsequent viral exposure due to breastfeeding. The administration of antiretroviral treatment during pregnancy, delivery and to the neonate (PACTG 076) proved to be useful. At a first stage, zidovudine was used. A triple combination therapy was then administered. Initially, the viral transmission in mothers who were enrolled in protocols for vertically transmitted HIV prophylaxis was reduced to 9.5%, whereas the last measurement carried out between 1998 and 2005, the initial figure was brought down to 2%. Nevertheless, the delivery of infected children whose mother's HIV status was unknown is still considered likely to happen. The main step to be taken to reduce HIV infection among children is to perform universal HIV tests during pregnancy, so that HIV positive pregnant patients conveniently receive proper prophylaxis. We look forward to achieving this by following the new prevention guidelines of vertically-transmitted HIV infection, developed by the Comisión Nacional del SIDA of the Chilean Health Ministry.

Evolución de la transmisión vertical de la infección por virus de inmunodeficiencia humana en Chile / Changes in vertically transmitted human immunodeficiency virus infection Chile

La identificación de diversos factores que inciden en el riesgo de la transmisión madre-hijo del virus de inmunodeficiencia humana (VIH), permitió diseñar estrategias dirigidas a disminuir su transmisión, entre ellas, medidas destinadas a disminuir la carga viral de la madre, disminuir la exposición del niño al VIH durante el parto y eliminar la exposición al mismo a través de la leche materna. Destaca la administración de anti-retrovirales durante el embarazo, parto y en el recién nacido, inicialmente, como protocolo PACTG 076 que utilizaba zidovudina y, posteriormente, el uso de trite-rapia. De esta manera, en las madres incorporadas en protocolos de profilaxis de transmisión vertical (TV) del VIH se logró reducir la transmisión de este virus, inicialmente, a 9,5 por ciento y en la última evaluación, realizada entre 1998 y julio 2005, a 2 por ciento. Sin embargo, han continuado naciendo niños infectados hijos de madres en las que no se conocía su condición serológica, lo que reafirma que la medida fundamental para disminuir los casos de infección por VIH en niños, es la pesquisa universal de la infección en las mujeres embarazadas, de manera que accedan en forma oportuna a protocolos de profilaxis, lo que se espera lograr con la nueva norma de prevención de TV del VIH, promulgada en agosto de 2005, por la Comisión Nacional del SIDA del Ministerio de Salud.

The identification of various risk factors of vertical human immunodeficiency virus (HIV) transmission resulted in the development of strategies whose aim was to decrease the mother's viral load, to reduce her child's exposure to it during delivery, and to avoid the subsequent viral exposure due to breastfeeding. The administration of antiretroviral treatment during pregnancy, delivery and to the neonate (PACTG 076) proved to be useful. At a first stage, zidovudine was used. A triple combination therapy was then administered. Initially, the viral transmission in mothers who were enrolled in protocols for vertically transmitted HIV prophylaxis was reduced to 9.5 percent, whereas the last measurement carried out between 1998 and 2005, the initial figure was brought down to 2 percent. Nevertheless, the delivery of infected children whose mother's HIV status was unknown is still considered likely to happen. The main step to be taken to reduce HIV infection among children is to perform universal HIV tests during pregnancy, so that HIV positive pregnant patients conveniently receive proper prophylaxis. We look forward to achieving this by following the new prevention guidelines of vertically-transmitted HIV infection, developed by the Comisión Nacional del SIDA of the Chilean Health Ministry.

Results of directly observed treatment for tuberculosis in Ensenada, Mexico: not all DOTS programs are created equally.

SETTING: Tuberculosis (TB) program in Ensenada, Mexico. OBJECTIVE: To evaluate the impact of the DOTS strategy on adherence and cure rates in everyday practice. DESIGN: Retrospective analysis of 629 patients diagnosed with TB. MEASUREMENTS AND RESULTS: A total of 70% of the patients under directly observed treatment (DOT) were cured vs. 72.8% of those under self-administered treatment (SAT, P = 0.57). There was no difference on the length of therapy according to treatment regimen (4.82 +/- 2.41 for DOT vs. 4.93 +/- 2.16 for SAT, P = 0.61); 16.8% of patients under DOT abandoned treatment vs. 14.1% in the SAT group (P = 0.40). Logistic regression analysis confirmed the previous findings, with length of treatment under 6 months being the strongest predictive variable for treatment failure (OR 18.8, P < 0.00). The type of regimen (DOT vs. SAT) was not predictive of treatment failure (OR for failure for SAT regimen 0.65, P = 0.14). CONCLUSIONS: Cure and completion of treatment rates in our population under study did not differ significantly when comparing DOT vs. SAT. Those in charge of the DOTS programs in a given country need to assess which are the most important ingredients for success in their particular program.

Prevalencia y factores de riesgo de la incontinencia de orina / Prevalence and risk factors of urinary incontinence

La incontinencia urinaria (IU) es una patología de alta prevalencia en la mujer, la que varía según distintos estudios entre 11 por ciento y 72 por ciento. Los factores de riesgo más conocidos son el género femenino, la obesidad y los partos. El objetivo de este trabajo fue determinar la prevalencia de IU en una población cerrada y analizar los factores de riesgo más conocidos. Se realiza una encuesta a mujeres mayores de 30 años que consultan en Hospital FACH en consultorio de medicina general, excluyendo a aquellas que consultan por patología urológica. Se incluyen preguntas sobre edad, partos vaginales, peso, talla, cirugías pelvianas previas, episodios de incontinencia y factores desencadenantes. Se encuestaron 180 pacientes con un promedio de edad de 52,8 años. Se encontró IU en 112 pacientes (62,2 por ciento) que se distribuyó según tipo de incontinencia: incontinencia urinaria de esfuerzo (IOE) en 40,2 por ciento, incontinencia de orina mixta (IOM) en 34,8 por ciento e incontinencia urinaria de urgencia (IOU) en 25 por ciento de las pacientes, no hubo diferencia estadísticamente significativa en la edad de los tres tipos de pacientes incontinentes. No hubo diferencia significativa en la edad y promedio de partos vaginales entre las mujeres continentes e incontinentes. En promedio las mujeres continentes caen en el rango de estado nutricional normal y las mujeres incontinentes en el rango de sobrepeso. Encontramos una prevalencia relativamente alta de incontinencia que cae dentro de los rangos publicados internacionalmente.

Mucormicosis en Pediatría / Mucormycosis in Pediatrics

La mucormicosis es una infección infrecuente causada por hongos oportunistas que pertenecen al orden Mucorales, familia Mucoraceae, cuyas características son invasión vascular por hifas, lo que determina trombosis e infartos. En general afecta pacientes con enfermedades subyacentes y produce infecciones severas invasoras y a menudo fulminantes. Algunas condiciones de riesgo para contraer la mucormicosis son: cetoacidosis diabética, terapia inmunosupresora, leucemia y linfomas con neutropenia prolongada. Se describen varias presentaciones clínicas, según su localización anatómica, siendo la forma rinocerebral la más frecuente, especialmente en pacientes diabéticos. Aunque esta infección tiene una alta morbimortalidad, su pronóstico ha mejorado los últimos años, en base a medidas terapeuticas como la oportuna corrección de los factores predisponentes, uso de anfotericina B y una cirugía precoz y agresiva. Es muy importante sospechar esta infección en pacientes con factores predisponentes de manera de hacer un diagnóstico precoz.

Mucormicosis rinocerebral en un niño diabético: Tratamiento conservador / Rhinocerebral mucormycosis in a diabetic child: Conservative treatment

Se presenta el caso de un niño de 14 años, con diabetes mellitus sin control clínico adecuado, con un cuadro rinosinusal de evolución progresiva, sin respuesta a diversos esquemas antibióticos, en el que el diagnóstico de mucormicosis rinocerebral se planteó en forma tardía, cuando ya existía compromiso intracraneano, demostrado por tomografía. Considerado fuera de alcance quirúrgico, se trató con anfotericina B y aseos quirúrgicos seriados, vía endoscópica, con buena evolución clínica e imagenológica. El diagnóstico de mucor se comprobó mediante examen directo y estudio histopatológico que revelaron la presencia de hifas características.

Manifestaciones neurológicas asociadas a infección por Mycoplasma pneumoniae / Neurological clinical manifestations associated to Mycoplasma pneumoniae infection

Mycoplasma pneumoniae, reconocido patógeno respiratorio, es también responsable de numerosas y variadas manifestaciones extrapulmonares, siendo las neurológicas las más frecuentes. Se presenta el caso de una escolar de 8 años, con un síndrome febril prolongado asociado a infección por M. pneumoniae que se complicó con encefalomielitis diseminada aguda. Se reportan otros seis casos con manifestaciones neurológicas: meningitis aséptica (1), meningoencefalitis (1), síndrome de Guillain Barré (1) y parálisis facial (3). La patogenia de las complicaciones neurológicas asociadas con infección por M. pneumoniae es aún desconocida, planteándose que algunas se deben a invasión directa del SNC y aquellas con pródromo prolongado, como encefalomielitis diseminada aguda, síndrome de Guillain Barré y mielitis transversa, obedecerían probablemente a fenómenos autoinmunes. En nuestro medio, en ausencia de RPC para confirmar el diagnóstico de esta infección, éste se fundamenta en la presencia de anticuerpos IgM o ascenso de IgG específica. La utilidad de los antimicrobianos en el control de estas manifestaciones neurológicas es discutida postulándose el uso de terapia inmunomoduladora.

[Three-dimensional echocardiography: technique, clinical applications, and perspectives]. / Ecocardiografía tridimensional: técnica, aplicaciones clínicas y perspectivas.

OBJECTIVE: Three-dimensional echocardiography represents a new era in the contemporary cardiology, because depicts the cardiac structures in their realistic forms. This information can not be obtained using a two-dimensional perspective. Although two-dimensional (2D) and M-mode echocardiography has greatly enhanced the ability to visualize the functioning heart for more than 30 years, 3D interpretative mental skills are necessary to compile the 2D slices of the complex 3D anatomy, particularly in congenital heart disease. CONCLUSIONS: At present, its additional morphological and functional information in surgical decision-making and the increasing number of clinical questions than can be answered justify the clinical use of this technique. In the future it will the study of "virtual" pathologic anatomy.