Antimicrobial resistance, pathogenic potential, and genomic features of carbapenem-resistant Klebsiella pneumoniae isolated in Chile: high-risk ST25 clones and novel mobile elements.

Multidrug- and carbapenem-resistant Klebsiella pneumoniae (CR-Kp) are critical threats to global health and key traffickers of resistance genes to other pathogens. Despite the sustained increase in CR-Kp infections in Chile, few strains have been described at the genomic level, lacking details of their resistance and virulence determinants and the mobile elements mediating their dissemination. In this work, we studied the antimicrobial susceptibility and performed a comparative genomic analysis of 10 CR-Kp isolates from the Chilean surveillance of carbapenem-resistant Enterobacteriaceae. High resistance was observed among the isolates (five ST25, three ST11, one ST45, and one ST505), which harbored 44 plasmids, most carrying genes for conjugation and resistance to several antibiotics and biocides. Ten plasmids encoding carbapenemases were characterized, including novel plasmids or variants with additional resistance genes, a novel genetic environment for blaKPC-2, and plasmids widely disseminated in South America. ST25 K2 isolates belonging to CG10224, a clone traced back to 2012 in Chile, which recently acquired blaNDM-1, blaNDM-7, or blaKPC-2 plasmids stood out as high-risk clones. Moreover, this corresponds to the first report of ST25 and ST45 Kp producing NDM-7 in South America and ST505 CR-Kp producing both NDM-7 and KPC-2 worldwide. Also, we characterized a variety of genomic islands carrying virulence and fitness factors. These results provide baseline knowledge for a detailed understanding of molecular and genetic determinants behind antibiotic resistance and virulence of CR-Kp in Chile and South America. IMPORTANCE In the ongoing antimicrobial resistance crisis, carbapenem-resistant strains of Klebsiella pneumoniae are critical threats to public health. Besides globally disseminated clones, the burden of local problem clones remains substantial. Although genomic analysis is a powerful tool for improving pathogen and antimicrobial resistance surveillance, it is still restricted in low- to middle-income countries, including Chile, causing them to be underrepresented in genomic databases and epidemiology surveys. This study provided the first 10 complete genomes of the Chilean surveillance for carbapenem-resistant K. pneumoniae in healthcare settings, unveiling their resistance and virulence determinants and the mobile genetic elements mediating their dissemination, placed in the South American and global K. pneumoniae epidemiological context. We found ST25 with K2 capsule as an emerging high-risk clone, along with other lineages producing two carbapenemases and several other resistance and virulence genes encoded in novel plasmids and genomic islands.

Arginine Homopeptide of 11 Residues as a Model of Cell-Penetrating Peptides in the Interaction with Bacterial Membranes.

Cell-penetrating peptides rich in arginine are good candidates to be considered as antibacterial compounds, since peptides have a lower chance of generating resistance than commonly used antibiotics. Model homopeptides are a useful tool in the study of activity and its correlation with a secondary structure, constituting an initial step in the construction of functional heteropeptides. In this report, the 11-residue arginine homopeptide (R11) was used to determine its antimicrobial activity against Staphylococcus aureus and Escherichia coli and the effect on the secondary structure, caused by the substitution of the arginine residue by the amino acids Ala, Pro, Leu and Trp, using the scanning technique. As a result, most of the substitutions improved the antibacterial activity, and nine peptides were significantly more active than R11 against the two tested bacteria. The cell-penetrating characteristic of the peptides was verified by SYTOX green assay, with no disruption to the bacterial membranes. Regarding the secondary structure in four different media-PBS, TFE, E. coli membrane extracts and DMPG vesicles-the polyproline II structure, the one of the parent R11, was not altered by unique substitutions, although the secondary structure of the peptides was best defined in E. coli membrane extract. This work aimed to shed light on the behavior of the interaction model of penetrating peptides and bacterial membranes to enhance the development of functional heteropeptides.

Self-Organization Dynamics of Collagen-like Peptides Crosslinking Is Driven by Rose-Bengal-Mediated Electrostatic Bridges.

The present work focuses on the computational study of the structural micro-organization of hydrogels based on collagen-like peptides (CLPs) in complex with Rose Bengal (RB). In previous studies, these hydrogels computationally and experimentally demonstrated that when RB was activated by green light, it could generate forms of stable crosslinked structures capable of regenerating biological tissues such as the skin and cornea. Here, we focus on the structural and atomic interactions of two collagen-like peptides (collagen-like peptide I (CLPI), and collagen-like peptide II, (CLPII)) in the presence and absence of RB, highlighting the acquired three-dimensional organization and going deep into the stabilization effect caused by the dye. Our results suggest that the dye could generate a ternary ground-state complex between collagen-like peptide fibers, specifically with positively charged amino acids (Lys in CLPI and Arg in CLPII), thus stabilizing ordered three-dimensional structures. The discoveries generated in this study provide the structural and atomic bases for the subsequent rational development of new synthetic peptides with improved characteristics for applications in the regeneration of biological tissues during photochemical tissue bonding therapies.

Effect of Warning Labels on Consumer Motivation and Intention to Avoid Consuming Processed Foods.

Nutritional warnings (NWs) as a front-of-package label were implemented as a public policy aiding consumers with recognizing processed foods with high levels of critical nutrients (sodium, saturated fats, carbohydrates, and calories). However, in spite of this tool being well positioned in consumer decision making, there is little extant knowledge about the relationship between the message sent by NW, nutritional knowledge, consumer motivation, and the intention to avoid consuming processed foods. To understand these dimensions' relations, a theoretical model was created and subsequently tested through structural equations. We applied a survey to 807 home food purchasing decision makers. The results show that the direct effect of NW messages raises the intention to avoid processed foods, while eating motivation is negative in its direct effect on the same avoidance intention. However, the message sent by NWs had a mediating effect between the intentions to avoid processed food and eating motivation but showed no such effect on nutritional knowledge. This suggests that the message sent by NWs was able to turn negative eating motivation into positive eating motivation to avoid processed foods. In conclusion, NWs help mitigate eating motivations, as well as boost the intention to avoid processed foods.

PPI-MASS: An Interactive Web Server to Identify Protein-Protein Interactions From Mass Spectrometry-Based Proteomics Data.

Mass spectrometry-based proteomics methods are widely used to identify and quantify protein complexes involved in diverse biological processes. Specifically, tandem mass spectrometry methods represent an accurate and sensitive strategy for identifying protein-protein interactions. However, most of these approaches provide only lists of peptide fragments associated with a target protein, without performing further analyses to discriminate physical or functional protein-protein interactions. Here, we present the PPI-MASS web server, which provides an interactive analytics platform to identify protein-protein interactions with pharmacological potential by filtering a large protein set according to different biological features. Starting from a list of proteins detected by MS-based methods, PPI-MASS integrates an automatized pipeline to obtain information of each protein from freely accessible databases. The collected data include protein sequence, functional and structural properties, associated pathologies and drugs, as well as location and expression in human tissues. Based on this information, users can manipulate different filters in the web platform to identify candidate proteins to establish physical contacts with a target protein. Thus, our server offers a simple but powerful tool to detect novel protein-protein interactions, avoiding tedious and time-consuming data postprocessing. To test the web server, we employed the interactome of the TRPM4 and TMPRSS11a proteins as a use case. From these data, protein-protein interactions were identified, which have been validated through biochemical and bioinformatic studies. Accordingly, our web platform provides a comprehensive and complementary tool for identifying protein-protein complexes assisting the future design of associated therapies.

TMPRSS11a is a novel age-altered, tissue specific regulator of migration and wound healing.

Aging is a gradual biological process characterized by a decrease in cellular and organism functions. Aging-related processes involve changes in the expression and activity of several proteins. Here, we identified the transmembrane protease serine 11a (TMPRSS11a) as a new age-specific protein that plays an important role in skin wound healing. TMPRSS11a levels increased with age in rodent and human skin and gingival samples. Strikingly, overexpression of TMPRSS11a decreased cell migration and spreading, and inducing cellular senescence. Mass spectrometry, bioinformatics, and functional analyses revealed that TMPRSS11a interacts with integrin ß1 through an RGD sequence contained within the C-terminal domain and that this motif was relevant for cell migration. Moreover, TMPRSS11a was associated with cellular senescence, as shown by overexpression and downregulation experiments. In agreement with tissue-specific expression of TMPRSS11a, shRNA-mediated downregulation of this protein improved wound healing in the skin, but not in the skeletal muscle of old mice, where TMPRSS11a is undetectable. Collectively, these findings indicate that TMPRSS11a is a tissue-specific factor relevant for wound healing, which becomes elevated with aging, promoting cellular senescence and inhibiting cell migration and skin repair.

Structural Determinants of the Dopamine Transporter Regulation Mediated by G Proteins.

Dopamine clearance in the brain is controlled by the dopamine transporter (DAT), a protein residing in the plasma membrane, which drives reuptake of extracellular dopamine into presynaptic neurons. Studies have revealed that the ßγ subunits of heterotrimeric G proteins modulate DAT function through a physical association with the C-terminal region of the transporter. Regulation of neurotransmitter transporters by Gßγ subunits is unprecedented in the literature; therefore, it is interesting to investigate the structural details of this particular protein-protein interaction. Here, we refined the crystal structure of the Drosophila melanogaster DAT (dDAT), modeling de novo the N- and C-terminal domains; subsequently, we used the full-length dDAT structure to generate a comparative model of human DAT (hDAT). Both proteins were assembled with Gß1γ2 subunits employing protein-protein docking, and subsequent molecular dynamics simulations were run to identify the specific interactions governing the formation of the hDAT:Gßγ and dDAT:Gßγ complexes. A [L/F]R[Q/E]R sequence motif containing the residues R588 in hDAT and R587 in dDAT was found as key to bind the Gßγ subunits through electrostatic interactions with a cluster of negatively charged residues located at the top face of the Gß subunit. Alterations of DAT function have been associated with multiple devastating neuropathological conditions; therefore, this work represents a step toward better understanding DAT regulation by signaling proteins, allowing us to predict therapeutic target regions.

Ultrasonido para la evaluación de la deglución: una revisión narrativa / Ultrasound for swallowing asessment: narrative review

El presente estudio explora evidencia sobre la evaluación de la deglución, usando la técnica de ultrasonido. En relación a la estrategia búsqueda, la revisión se desarrolló en PubMed y Scielo, utilizando una adaptación de las recomendaciones del manual Cochrane para revisiones sistemáticas. Se seleccionaron los términos "Deglutition" "Swallowing", "Ultrasonography" y "Ultrasound" en inglés y en español. Se incluyeron inicialmente estudios originales publicados entre enero del 2000 y enero del 2019. De acuerdo con los criterios de elegibilidad, se incluyeron 24 artículos originales sobre el uso de ultrasonido para evaluar algún aspecto de la deglución en las etapas oral y faríngeas. Los artículos seleccionados ofrecen datos cuantitativos de parámetros e indicadores de la deglución. A partir de estos estudios, se recogió información cualitativa y cuantitativa sobre la movilidad lingual, la elevación laríngea, la movilidad faríngea lateral, la movilidad del hioides, la movilidad del músculo genihioideo, la apertura del esfínter esofágico superior, el cierre glótico, además de estudios sobre la posibilidad de detectar episodios de penetración laríngea y aspiración. Los resultados sugieren que existe evidencia positiva sobre la utilidad del ultrasonido para evaluar la deglución, sin embargo, se requiere de más estudios que analicen la eficiencia diagnóstica en población con disfagia.

The present study explores evidence on swallowing assessment using ultrasound technique. Regarding the search strategy, the review was carried out in PubMed and Scielo, using an adaptation of the recommendations from the Cochrane manual for systematic reviews. The terms "Deglutition" "Swallowing", "Ultrasonography" and "Ultrasound" were selected in English and Spanish. Original studies published between January 2000 and January 2019 were initially selected. According to the elegibility criteria, 24 original studies dealing with the use of ultrasound to evaluate some aspect of swallowing in both oral and pharyngeal stages. Selected articles offer quantitative data on swallowing parameters and indicators. From these studies, qualitative and quantitative information on lingual mobility, laryngeal elevation, lateral pharyngeal mobility, hyoid mobility, genihyoid muscle mobility, upper esophageal sphincter opening, glotic closure was collected, in addition to studies on the possibility of detecting episodes of laryngeal penetration and aspiration. The results suggest that there is positive evidence on the usefulness of ultrasound to assess swallowing, however, more studies are required to analyze diagnostic efficiency in a population with dysphagia.

ß-lactamasas de espectro extendido tipo CTX-M en aislamientos clínicos de Escherichia coli y Klebsiella pneumoniae en el Instituto Nacional de Salud del Niño-Breña, Lima, Perú / Extended spectrum type CTX-M ß-lactamases in clinical infections caused by Escherichia coli y Klebsiella pneumoniae at the Instituto Nacional de Salud del Niño-Breña, Lima, Peru

Objetivo: Determinar la frecuencia de β-lactamasas de espectro extendido (BLEE) en Escherichia coli y Klebsiella pneumoniae y la frecuencia de CTX-M en las productoras de BLEE en el Instituto Nacional de Salud del Niño - Breña (INSN-B). Material y métodos: Se analizaron enterobacterias productoras de BLEE del INSN-B entre los meses de agosto de 2012 y enero del 2013. Se incluyeron 724 aislamientos de Escherichia coli y 181 aislamientos de Klebsiella pneumoniae, consecutivos no repetidos, de pacientes hospitalizados y de la comunidad. La identificación se realizó por bioquímica convencional. la detección fenotípica de BLEE se hizo por el método de Jarlier y la detección genotípica de CTX-M mediante reacción en cadena de la polimerasa (PCR). Resultados: 281 (31%) de los aislamientos de ambas enterobacterias fueron productoras de BLEE; 207/724 (28,6%) E. coli y 74/181 (40,9%) K. pneumoniae. Se detectó el gen bla en 256 de los aislamientos productores de BLEE (91,1%). Conclusiones: Las BLEE de tipo CTX-M están presentes en nuestra institución, a pesar que nuestros datos representan una sola institución, brinda parte del panorama nacional sobre la resistencia a los antimicrobianos; por lo tanto, el enfoque de epidemiológico molecular es importante para desarrollar más y mejores estrategias de control y manejo de estos patógenos en nuestro país.

Objective: To determine the frequency of extended spectrum β-lactamases (ESBL) in clinical infections caused by Escherichia coli y Klebsiella pneumoniae and the frequency of CTX-M among them at the Instituto Nacional de Salud del Niño-Breña, Lima, Peru. Methods: ESBL producing strains of E. coli and K. pneumoniae collected from August 2012 and January 2013 were analyzed; a total of 724 E. coli and 181 K. pneumoniae consecutive, non- repeated isolates from community and hospital acquired infections were included. Identification was performed by conventional biochemistry, ESBL phenotype was detected following the Jarlier´s method and PCR was used to detect CTX-M. Results: overall prevalence of ESBL was 31% (281 strains); 207/724 (28.6%) E. coli and 74/181 (40.9%) K. pneumoniae. The bla gene was detected in 256 of ESBL producing strains (91.1%). Conclusions: The CTX-M phenotype of ESBL producing strains is present in our institution. Despite of showing information of a single institution, these data bring a glance of what the antimicrobial resistance pattern may be at a national level and underscores the utility of molecular biology in designing preventing measures.

The role of farmers' intrinsic motivation in the effectiveness of policy incentives to promote sustainable agricultural practices.

This paper examines the effectiveness of intrinsic and extrinsic motivations on the adoption intensity of sustainable agricultural practices (SAPs) among annual crop farmers in Chile. We use the farmers' attitude towards SAPs as a proxy of intrinsic motivation, while extrinsic motivation is represented by an economic incentive to promote the use of SAPs. The policy program we studied is administered by the Chilean Ministry of Agriculture under the name System of Incentives for the Agro-Environmental Sustainability of Degraded Soils (SIRSD-S. Sustainable behaviour was defined as the adoption of (1) minimum tillage, (2) improved fallow, (3) stubble incorporation, (4) use of manure, and (5) use of compost. A count model was estimated that showed that both sources of motivation, and the interaction between them, significantly predicted the adoption of SAPs. Farmers with low levels of intrinsic motivation depended largely on the SIRSD-S to adopt SAPs, while the incentive was ineffective for intrinsically motivated farmers who adopted more SAPs regardless the presence of extrinsic motivation. Finally, the perception of risk of soil erosion and perceived behavioural control of this risk were found to play a positive role in the adoption of SAPs.

Primer caso de hipotiroidismo congénito diagnosticado por el Centro Municipal de Pesquisa de Tacajó / First Case of Congenital Hypothyroidism Diagnosed by the Municipal Screening Center of Tacajó

El hipotiroidismo congénito es la deficiencia de hormonas tiroideas presente al nacimiento, con una frecuencia mundial aproximada de 1:4000; en Cuba es menor que 1 x 4 500 con predominio del sexo femenino como característica interesante. Se presentó una niña nacida a término en el Hospital Vladimir Ilich Lenin, Holguín, la cual fue remitida para evaluación endocrinológica como un caso sospechoso de hiperplasia suprarrenal congénita debido a que presentaba una hipertrofia del clítoris como principal hallazgo clínico. Los valores de 17-OH progesterona resultaron normales y a los seis días del nacimiento el Centro de Pesquisa Activa Integral de Tacajó del municipio Báguanos, determinó que el valor de la hormona estimulante de la tiroides determinado a partir de sangre seca sobre papel de filtro, resultó en el límite superior para esta prueba, lo cual fue confirmado por el Hospital Pediátrico Provincial, que obtuvo un valor similar para la detección serológica de la hormona estimulante de la tiroides, por lo que se llegó a la conclusión que la hipertrofia del clítoris observada en la niña era debida a un hipotiroidismo congénito. Luego de recibir tratamiento sustitutivo con levo-tiroxina, la niña ha llevado un desarrollo normal y se recupera satisfactoriamente.

Congenital Hypothyroidism is the deficiency of Thyroids Hormones at birth, with a global frequency of approximately 1: 4000; in Cuba it is less than 1: 4500. Female predominance is an interesting feature. A newborn baby girl who was born at Vladimir Lenin Hospital, Holguín, was referred to a pediatric endocrine evaluation as suspicious case of congenital adrenal hyperplasia (CAH), because the physical exam showed an evident clitoral hypertrophy. The serum concentration of 17-OH-progesterone was normal, nevertheless when baby girl was six days old underwent a neonatal screening by Municipal Screening Center of Tacajó and the results showed that TSH concentration measured in dry blood on filter paper was in the highest limit for this test. The case was confirmed in the Provincial Pediatric Hospital by serum TSH determination, whose concentration was highest for this test too. The findings showed that clitoris hypertrophy was associated to congenital hypothyroidism. The girl is undergoing medical treatment with levothyroxine at present, and she is recovering satisfactorily.

Primer caso de hipotiroidismo congénito diagnosticado por el Centro Municipal de Pesquisa de Tacajó / First Case of Congenital Hypothyroidism Diagnosed by the Municipal Screening Center of Tacajó

El hipotiroidismo congénito es la deficiencia de hormonas tiroideas presente al nacimiento, con una frecuencia mundial aproximada de 1:4000; en Cuba es menor que 1 x 4 500 con predominio del sexo femenino como característica interesante. Se presentó una niña nacida a término en el Hospital Vladimir Ilich Lenin, Holguín, la cual fue remitida para evaluación endocrinológica como un caso sospechoso de hiperplasia suprarrenal congénita debido a que presentaba una hipertrofia del clítoris como principal hallazgo clínico. Los valores de 17-OH progesterona resultaron normales y a los seis días del nacimiento el Centro de Pesquisa Activa Integral de Tacajó del municipio Báguanos, determinó que el valor de la hormona estimulante de la tiroides determinado a partir de sangre seca sobre papel de filtro, resultó en el límite superior para esta prueba, lo cual fue confirmado por el Hospital Pediátrico Provincial, que obtuvo un valor similar para la detección serológica de la hormona estimulante de la tiroides, por lo que se llegó a la conclusión que la hipertrofia del clítoris observada en la niña era debida a un hipotiroidismo congénito. Luego de recibir tratamiento sustitutivo con levo-tiroxina, la niña ha llevado un desarrollo normal y se recupera satisfactoriamente.(AU)

Congenital Hypothyroidism is the deficiency of Thyroids Hormones at birth, with a global frequency of approximately 1: 4000; in Cuba it is less than 1: 4500. Female predominance is an interesting feature. A newborn baby girl who was born at Vladimir Lenin Hospital, Holguín, was referred to a pediatric endocrine evaluation as suspicious case of congenital adrenal hyperplasia (CAH), because the physical exam showed an evident clitoral hypertrophy. The serum concentration of 17-OH-progesterone was normal, nevertheless when baby girl was six days old underwent a neonatal screening by Municipal Screening Center of Tacajó and the results showed that TSH concentration measured in dry blood on filter paper was in the highest limit for this test. The case was confirmed in the Provincial Pediatric Hospital by serum TSH determination, whose concentration was highest for this test too. The findings showed that clitoris hypertrophy was associated to congenital hypothyroidism. The girl is undergoing medical treatment with levothyroxine at present, and she is recovering satisfactorily.(AU)

Revascularización coronaria incompleta y eventos cardíacos posteriores a intervencionismo coronario percutáneo / Incomplete coronary revascularization and cardiac events following percutaneous coronary intervention

No hay datos concluyentes para evaluar la ventaja de la revascularización coronaria completa en el intervencionismo coronario percutáneo. Objetivo general: determinar si la revascularización incompleta se asocia con la incidencia de eventos cardíacos posteriores al intervencionismo coronario percutáneo. Métodos: se realizó una investigación observacional prospectiva con 192 pacientes con enfermedad coronaria multivaso, sin antecedentes de revascularización coronaria, tratados mediante intervencionismo coronario percutáneo con implantes de stents en el Instituto de Cardiología desde el 1 de enero del 2003 hasta el 31 de diciembre del 2005. Análisis estadístico: para determinar la asociación de la revascularización incompleta con eventos cardíacos se calculó el riesgo relativo. Resultados: al analizar la asociación de la revascularización incompleta con los eventos clínicos y los procederes cardíacos posteriores al intervencionismo coronario percutáneo, no se obtuvo relación alguna. Conclusiones: la revascularización coronaria incompleta no se asocia con mayor incidencia de eventos cardíacos posteriores a un intervencionismo coronario percutáneo con implantes de stents convencionales(AU)

No conclusive data are available to evaluate the advantages of complete coronary revascularization in percutaneous coronary intervention. General objective: Determine whether incomplete revascularization is associated with the incidence of cardiac events following percutaneous coronary intervention. Methods: A prospective observational study was conducted with 192 patients with multivessel coronary disease and no history of coronary revascularization, treated by percutaneous coronary intervention with stent implantation at the Institute of Cardiology from 1 January 2003 to 31 December 2005. Statistical analysis: Relative risk was estimated to determine the association of incomplete revascularization with cardiac events. Results: On analyzing the association of incomplete revascularization with clinical events and cardiac procedures following percutaneous coronary intervention, no relation was obtained. Conclusions: Incomplete coronary revascularization is not associated with a higher incidence of cardiac events following percutaneous coronary intervention with conventional stent implantation(AU)

Revascularización coronaria incompleta y eventos cardíacos posteriores a intervencionismo coronario percutáneo / Incomplete coronary revascularization and cardiac events following percutaneous coronary intervention

No hay datos concluyentes para evaluar la ventaja de la revascularización coronaria completa en el intervencionismo coronario percutáneo. Objetivo general: determinar si la revascularización incompleta se asocia con la incidencia de eventos cardíacos posteriores al intervencionismo coronario percutáneo. Métodos: se realizó una investigación observacional prospectiva con 192 pacientes con enfermedad coronaria multivaso, sin antecedentes de revascularización coronaria, tratados mediante intervencionismo coronario percutáneo con implantes de stents en el Instituto de Cardiología desde el 1 de enero del 2003 hasta el 31 de diciembre del 2005. Análisis estadístico: para determinar la asociación de la revascularización incompleta con eventos cardíacos se calculó el riesgo relativo. Resultados: al analizar la asociación de la revascularización incompleta con los eventos clínicos y los procederes cardíacos posteriores al intervencionismo coronario percutáneo, no se obtuvo relación alguna. Conclusiones: la revascularización coronaria incompleta no se asocia con mayor incidencia de eventos cardíacos posteriores a un intervencionismo coronario percutáneo con implantes de stents convencionales

No conclusive data are available to evaluate the advantages of complete coronary revascularization in percutaneous coronary intervention. General objective: Determine whether incomplete revascularization is associated with the incidence of cardiac events following percutaneous coronary intervention. Methods: A prospective observational study was conducted with 192 patients with multivessel coronary disease and no history of coronary revascularization, treated by percutaneous coronary intervention with stent implantation at the Institute of Cardiology from 1 January 2003 to 31 December 2005. Statistical analysis: Relative risk was estimated to determine the association of incomplete revascularization with cardiac events. Results: On analyzing the association of incomplete revascularization with clinical events and cardiac procedures following percutaneous coronary intervention, no relation was obtained. Conclusions: Incomplete coronary revascularization is not associated with a higher incidence of cardiac events following percutaneous coronary intervention with conventional stent implantation

Assistência circulatória mecânica / Mechanical circulatory support

A assistência circulatória mecânica é importante porque representa as técnicas e equipamentos capazes de substituírem temporariamente ou até definitivamente as condições cardiocirculatórias de pacientes com afecções ventriculares agudas ou crõnicas, oriundas de cardiomiopatia de diferentes etiologias. Dessa forma é possível oferecer repouso relativo ao coração permitindo sua recuperação; ou servirá de suporte até a realização do transplante cardíaco; ou ainda como suporte definitivo em situações especiais...

[Complaints from medical care in obstetrics and gynecology]. / La queja médica derivada de la atención en ginecoobstetricia.

BACKGROUND: The fulfillment and satisfaction regarding the expectations of the patients at services of obstetrics and gynecology, it is related to the quality of care. Failure to meet these expectations will rise to the dissatisfaction and enhances the culture of demand, with these considerations this presents study were developed, researching the patients complaints reported by the State Commission o Medical Arbitration of Oaxaca in 2007 with the aim of identifying the medical complaint emphasis on obstetrics care. OBJECTIVE: To identify the medical lawsuits to Gineco-obstetricians in Oaxaca. MATERIAL AND METHOD: We conducted a documentary research, descriptive, transversal, retrospective and without ethical implications, through analysis of databases of the State Commission of Medical Arbitration of Oaxaca, corresponding to 2007 activity report; 100% of selected records were medical complaints in the specialty of gynecology-obstetrics. RESULTS: The attention given to 10.5% are disagreements or complaints which medical complaints in gynecology-obstetrics specialty are second with 21% and the report file complaints state ranks first with 12.3% of cases, 70% of medical care is provided by gynecologists and total complaints, 40% were confined to expert medical advice. CONCLUSIONS: Complaints in gynecological and obstetric care rank first places relative to other specialties, the attention given in the two-thirds is provided by medical specialists in obstetrics and gynecology, and less than the half were certified by the Board and expert medical opinions reported evidence of malpractice and corporate responsibility in the complaints.

[Continent urinary diversion after complete urethral resection: the Mitrofanoff technique]. / Derivación urinaria continente después de resección completa de uretra: técnica de Mitrofanoff.

OBJECTIVE: To describe our experience using the Mitrofanoff procedure in adult patients after a complete urethral resection. METHODS AND RESULTS: We describe 2 clinical cases, both with neoplastic lesions in the urethra. Once completed the urethral resection, we made a continent urinary diversion using the Mitrofanoff procedure with the cecal appendix, applying a few technical variations. CONCLUSIONS: The Mitrofanoff procedure is a simple technique, applicable to both pediatric and adult patients and it should be considered a good urinary diversion after complete urethral resection.

Prevalencia de diabetes mellitus en la VII Región de Chile / Prevalence of diabetes in the seventh Region of Chile

Background: The prevalence of diabetes mellitus in Latin America is not well known. Aim: To study the real prevalence of diabetes mellitus (DM) and its associated risk factors in the VII region of Chile. Material and Methods: A probabilistic sample of 1,325 subjects over the age of 20, stratified by age and differentiated by place of residence was studied. The criteria of the World Panel of Experts convened by the World Health Organization in 1997, was used to define the presence of diabetes (two fasting blood glucose values over 126 mg/dl or a blood glucose over 200 mg/dl, 2 hours after a 75 g carbohydrate oral load). Results: The global prevalence estimated for DM in this population was 5.39 percent. The calculated prevalence in subjects between 20 and 44 years was 1.88 percent (CI 0.39-3.37); between 45 and 64 years, 10.75 percent (CI 8.35-13.14); 65 years or older 11.30 percent (CI 8.00-14.60), p <0.05. The prevalence was 5.8 percent in urban areas and 4.5 percent in rural areas. Forty five percent of diabetics were not aware of their condition. Forty eight percent of diabetics and 31 percent of non diabetics were hypertensive (p <0.01), whereas 47.8 percent of diabetics and 24.6 percent of non diabetics had at least one diabetic parent (p <0.01). Smoking was less frequent in diabetics than in non diabetics (15.7 and 24.3 percent respectively, p <0.05). Ninety percent of both diabetics and non diabetics were sedentary. Discussion: Health care systems require an epidemiological monitoring system to provide information about the prevalence of diabetes mellitus and to control the evolution of patients