Sistema de selección de sistemas elastocompresivos en personas con cáncer de mama de un hospital con recursos limitados / Selection system for elastocompressive systems in people with breast cancer from a hospital with limited resources

El cáncer de mama es un problema de salud pública en Chile. El linfedema es un trastorno linfovascular secundario a la extirpación de los ganglios linfáticos por cirugía en el cáncer de mama, que produce un aumento del volumen y la fibrosis en el miembro superior. Diferentes prendas de compresión son usadas para la prevención y el tratamiento del linfedema. Por eso, el programa de Garantías Ex-plícitas en Salud garantiza la entrega de sistemas elastocompresivos a las personas con diagnóstico de cáncer de mama para prevenir y tratar el linfedema. Sin embargo, en hospitales públicos los sistemas elastocompresivos pueden ser recursos limitados, por eso, muchas veces se deben priorizar. Este artículo tiene por objetivo describir un sistema de selección de sistemas elastocompresivos en personas con diagnóstico de cáncer de mama en el modelo de atención kinesiológico temprano y prospectivo.

Breast cancer is a public health problem in Chile. Lymphedema is a lymphovascular disorder secondary to the removal of lymph nodes by surgery in breast cancer, resulting in increased volume and fibrosis in the upper limb. Different compression garments are used for the prevention and treatment of lymphedema. Therefore, the "Garantías Explícitas en Salud" program guarantees the delivery of compression garments to people diagnosed with breast cancer to prevent and treat lymphedema. However, in public hospitals, the compression garments can be limited resources, so they often need to be prioritized. This article aims to describe the selection system for compression garments in people diagnosed with breast cancer in the early and prospective physical therapy care model.

Telerehabilitation for people with breast cancer through the COVID-19 pandemic in Chile.

Adapting face-to-face physical therapy consultations in cancer care to a model of telerehabilitation has been necessary, given the imminent spread of the COVID-19 pandemic. In this respect, the current model of telerehabilitation for people with breast cancer can be described as a method of continuing physical therapy treatment, in a public hospital with limited resources.

Síndrome de trabajador quemado: Existencia del Burnout sector salud / Burnout syndrome: Existence of Burnout in the health sector

En tiempos donde nuestra vida laboral ocupa la mayor parte del tiempo y en el menor de los casos, pasamos mínimo una tercera parte del día en nuestro trabajo o desa-rrollando actividades asociadas con el mismo, además, de manera personal y profesional buscamos ser más productivos, eficientes y porque no decirlo, competitivos; y es así como de manera inevitable se pueden presentar efectos secundarios, que de alguna manera irán manifestándose de manera física y/o psicologica. Por eso hemos decidido compartir un poco acerca de un síndrome que cada día adquiere más fuerza y se hace común en la población trabajadora, el cual, desde el momento en que fue considerada su existencia ha adquirido varias maneras para referírsele como son síndrome de desgaste profesional, síndrome de sobrecarga emocional, síndrome de la cabeza quemada, quemarse en el tra-bajo, síndrome del quemado o síndrome de fatiga en el trabajo, del trabajador desgastado y cualquier otro sinónimo de agotamiento o desgaste mental, su nombre: Síndrome de Burnout.Es importante lograr comprender en qué consiste dicho síndrome, tanto para las empre-sas como para los colaboradores que se pueden ver afectados por dicha enfermedad; los primeros desde un alto ausentismo laboral que se convierte es un elevado costo finan-ciero y los segundos con una sensación de infelicidad con aquello que antes generaba motivación, desinterés laboral, derivando en productividad y rendimientos bajo sumán-dose a ello las manifestaciones físicas como la cefalea, fatiga, irritabilidad, etc.; teniendo en cuenta y como se indicó anteriormente, son aquellos trabajadores que pasaron de un extremo a otro de manera progresiva.El síndrome de Burnout es una enfermedad moderna que afecta al individuo en el plano mental, es decir, un riesgo psicosocial para los colaboradores y es por esta razón, que al igual que los otros de los riesgos ocupacionales que se presentan en las organizaciones, debe ser tratado desde la promoción y la prevención, además, de implementar estrategias de intervención y tratamientos sobre los colaboradores.

In times during which our work life occupies a majority of our time where at the very least we spend a third of the day working or developing skills related to our jobs, we seek to be more productive, efficient, and why not admit, competitive, in personal and professional manners; this is how inevitably the side effects present themselves, whether manifesting physically and/or psychologically. Due to this we have decided to share a bit about an illness that has become more common in the working population and gains strength every day. An illness which has since the day it was recognized, obtained several names such as professional attrition syndrome, emotional overdose symptom, burned head syndrome, work burnout, burnout syndrome or work fatigue syndrome or any oth-er synonym for exhaustion and mental fatigue: Burnout Syndrome.It is important to understand what this syndrome consists of, both for employers/compa-nies and employees who may be affected by it; the former affected due to an increase in absenteeism that translates into a large financial cost due to lost labor and the latter due to a sensation of unhappiness with what used to generate motivation and lack of interest in work, which results in low productivity in addition to physical manifestations such as headaches, fatigue, irritability, etc. Understanding this and taking into account the above, these workers are the ones who changed from one extreme to the other progressively.Burnout Syndrome is a modern illness that affects individuals in the mental plane, that is to say, a psychological risk for employees and for that reason, just like other occupational risks that are found in the workplace, it should be treated with awareness and prevention strategies in addition to intervention and treatment for affected employees.

Restoration and conservation of anatomic pieces.

In this study, a restoration process was developed with potassium hydroxide (KOH), in order to improve each of the structures for their posterior fixation, through the use of new methods such as the Chilean conservative fixative solution (SFCCh), with exceptional results. Restore anatomical pieces corresponding to corpse and organs, being these last set with the SFCCh. In this work dealt with processes of restoration with potassium hydroxide, sodium chloride, and sodium hypochlorite, the process began with the cleanliness and suture of the structures for subsequent fixing in Chilean conservative fixative solution, making use of a corpse and different anatomical parts. Work based on items found in the database, Elsevier, Science Direct, ProQuest, and MEDLINE. At the end of the process of restoration and conservation of the anatomical pieces, was observed an improvement in muscle pigment with decrease of rigidity in the specimen, additionally a recovery of appearance in the vascular-nervous elements was achieved. The organs were much more malleable and the structures facilitate the identification of specific details, its subsequent immersion in SFCCh allows the longer preservation of the obtained results. The restoration with potassium hydroxide allows the improvement in the appearance of the different anatomical structures and simultaneously to facilitate its study. The SFCCh is an alternative that replaces partially the use of formaldehyde. In addition, it presents toxicity reduction.

Improvement and validation of d-xylose determination in urine and serum as a new tool for the noninvasive evaluation of lactase activity in humans.

BACKGROUND: The phloroglucinol assay is the current method for d-xylose determination in urine/plasma/serum. However, its sensitivity is limited when low amounts of d-xylose are to be measured, such as in the noninvasive evaluation of intestinal lactase with 4-galactosylxylose (gaxilose). An improved assay was therefore needed. METHODS: We developed and validated a modified version of the phloroglucinol-based assay for quantification of d-xylose in urine/serum samples. A method for gaxilose determination by gas chromatography (GC) was also optimized. RESULTS: Linearity ranged from 0.125 to 5.0 mg/l (5-200 mg/l in original sample). Accuracy at LOQ (0.125 mg/l) was 0.97/2.49% in spiked urine/serum; for other quality controls (QC), it was <1.27%. Intra- and interassay precision at LOQ were 6.02% and 6.45% for urine, and 8.86% and 10.00%, respectively, for serum; for other QC, precision was <2.15%. Linearity of gaxilose determination by GC was 3.90-195.17 for urine and 9.75-195.17 mg/l for serum with acceptable sensitivity and reproducibility. The method proved adequate for the d-xylose determination in healthy and hypolactasic subjects after oral administration of gaxilose. CONCLUSIONS: The modified method provides high sensitivity and robustness for d-xylose quantification in urine/serum for routine clinical use especially in the noninvasive diagnosis of intestinal lactase deficiency with the gaxilose test.

Noninvasive diagnosis of hypolactasia with 4-Galactosylxylose (Gaxilose): a multicentre, open-label, phase IIB-III nonrandomized trial.

GOALS AND BACKGROUND: Hypolactasia affects over half of the world population. Diagnosis remains problematic as currently available tests, such as the hydrogen breath test, have low reliability and lactose intolerance symptoms are unspecific. We evaluated the diagnostic performance and safety of a new noninvasive diagnostic test based on urine or serum measurement of D-xylose after lactase cleavage of orally administered 4-galactosylxylose (gaxilose). STUDY: In a multicentre, open-label, nonrandomized, phase IIb-III study, consecutive patients with symptoms suggestive of lactose intolerance sequentially underwent intestinal biopsy for direct measurement of lactase activity (reference standard), hydrogen breath test, and blood glucose test after lactose challenge, 4- and 5-hour urine-based gaxilose test, and blood-based gaxilose test. For the gaxilose tests, 0 to 4 and 4 to 5 hours urine samples were taken after a 0.45 g gaxilose dose, whereas serum samples were taken 90 minutes after a 2.7 g dose for D-xylose determination. Genetic testing of hypolactasia was also assessed. RESULTS: Of the 222 patients enrolled, 203 completed all diagnostic tests; 108 were hypolactasic according to biopsy. The sensitivities and specificities and positive and negative predictive values of the gaxilose tests were all >90% versus 69% to 85% for the hydrogen breath test and the blood glucose test. The area under the ROC curve was significantly higher for the gaxilose tests (>0.9, P≤0.007). These tests also had higher sensitivity than genetic testing for hypolactasia and were well tolerated. CONCLUSIONS: The diagnostic performance of the gaxilose tests is excellent and can substantially improve the diagnosis of hypolactasia.

Phase I and phase IB clinical trials for the noninvasive evaluation of intestinal lactase with 4-galactosylxylose (gaxilose).

GOALS AND BACKGROUND: Hypolactasia is widespread, yet reliable diagnostic tests are lacking. A new test based on oral administration of 4-galactosylxylose (gaxilose) and urine or serum measurement of D-xylose after cleavage by intestinal lactase is under clinical development. We investigated the optimal dose of gaxilose and calculate cutoff values of D-xylose for that dose. STUDY: In the randomized, dose-finding, phase I study, urine and serum pharmacokinetics of D-xylose were determined after oral administration of 6 ascending doses of gaxilose (and placebo) to 12 healthy adult volunteers. In the open, parallel, phase Ib study, 30 volunteers received the doses established for the urine and blood tests and D-xylose was measured. Cutoff values were calculated as 1.96 × SD below the mean value. Safety was assessed through reporting of adverse events. RESULTS: Gaxilose administration showed a progressive, dose-dependent increase in D-xylose in urine and serum. An optimal gaxilose dose of 0.45 g and urine collection periods of 4 and 5 hours were selected for further studies. For the blood test, a 2.7 g dose was selected and C max measured at 90 minutes. The calculated cutoff values of D-xylose for normal lactase activity were 27.58 and 37.87 mg for the 4- and 5-hour urine tests, respectively, and 0.97 mg/dL for the blood test. There were no treatment-related adverse events. CONCLUSIONS: The methodology described provides a simple, safe test for the evaluation of lactase activity in vivo. Further evaluation of the test as a noninvasive diagnosis of hypolactasia is ongoing in patients with lactose intolerance.

Celulitis facia odontogénica severa infrecuent causada por citrobacter freunddii productora de ampc en un paciente con diabetes mellitus 2. reporte de caso / Uncmmon severe oodontogenic facial cellulitis caused by ampcproducing citrobacter freundii in a patient with type 2 diabetes mellitus. case report / Celulite facial odontogênica sevea infrequente causada por citrobacter freundii produtora de ampc em um paciente com diabetes mellitus 2. relatório e caso

El manejo de la celulitis facial odontogénica no deja de ser un tema controversial en el campo de la cirugía oral y maxilofacial; los principios quirúrgicos y terapéuticos han sido sometidos a modificacio nes basadas en los hallazgos clínicos, imagenológicos y microbiológicos a través del tiempo. En pacientes con diabetes mellitus 2 se incrementa el riesgo a sufrir infecciones bacterianas oportunistas con tiempos de hospitalización más prolongados que la población no diabética. La literatura es clara estableciendo las diferencias clínicas y microbiológicas de la celulitis facial odontogénica en este grupo de pacientes, sin embargo, no existe un protocolo médico quirúrgico destinado a ellos. El microorganismo comúnmente aislado es Klebsiella pneumoniae, mientras Citrobacter freundii es inusual en las infecciones odontogénicas, su capacidad para producir betalactamasas de amplio espectro (AmpC) le permite bloquear la acción de los antibióticos de uso empírico en Cirugía Oral y Maxilofacial. A continuación, presentamos el caso de una paciente de 61 años con diabetes Mellitus tipo 2 y celulitis facial odontogénica por Citrobacter freundii productora de AmpC.

The management of odontogenic facial cellulitis is still a controversial issue in the field of Oral and Maxillofacial Surgery. Surgical and therapeutic principles have undergone modifications based on clinical findings, imaging and microbiological over time. In patients with type 2 Diabetes Mellitus the risk of opportunistic bacterial infections is increased thus suffering longer hospitalization periods than the nondiabetic population. The literature is clear by setting the clinical and microbiological differences of odontogenic facial cellulitis in this group of patients, but there is no surgical medical protocol for them. Klebsiella pneumoniae is the most common microorganism isolated while Citrobacter freundii is unusual in relation to oral infections; their ability to produce ESBLs (AmpC) allows them to block the action of empirical antibiotics used in Maxillofacial Surgery. We present the case of a 61 year old patient with type 2 Diabetes Mellitus and odontogenic facial cellulitis caused by AmpCproducing Citrobacter freundii.

O tratamento da celulite facial odontogênica não deixa de ser um tema controverso no campo da Cirurgia Oral e Maxilofacial; os princípios cirúrgicos e terapêuticos foram submetidos a modificações baseadas nos descobrimentos clínicos, imagenológicos e microbiológicos através do tempo. Em pacientes com Diabetes Mellitus 2 aumenta o risco de sofrer infecções bacterianas oportunistas com tempos de hospitalização mais prolongados que na população não diabética. A literatura é clara estabelecendo as diferenças clínicas e microbiológicas da Celulite Facial Odontogênica neste grupo de pacientes; porém, não existe um protocolo médico cirúrgico destinado a eles. O microrganismo comunmente isolado é o Klebsiella pneumoniae, enquanto que o Citrobacter freundii é inusual nas infecções odontogênicas, sua capacidade para produzir betalactamases de amplo espectro (AmpC) lhe permite bloquear a ação dos antibióticos de uso empírico em Cirurgia Oral e Maxilofacial. A seguir apresentamos o caso de uma paciente de 61 anos com Diabetes Mellitus tipo 2 e celulite facial odontogênica por Citrobacter freundii produtora de AmpC.

Distinct functional roles of the two terminal halves of eukaryotic phosphofructokinase.

Eukaryotic PFK (phosphofructokinase), a key regulatory enzyme in glycolysis, has homologous N- and C-terminal domains thought to result from duplication, fusion and divergence of an ancestral prokaryotic gene. It has been suggested that both the active site and the Fru-2,6-P2 (fructose 2,6-bisphosphate) allosteric site are formed by opposing N- and C-termini of subunits orientated antiparallel in a dimer. In contrast, we show in the present study that in fact the N-terminal halves form the active site, since expression of the N-terminal half of the enzymes from Dictyostelium discoideum and human muscle in PFK-deficient yeast restored growth on glucose. However, the N-terminus alone was not stable in vitro. The C-terminus is not catalytic, but is needed for stability of the enzyme, as is the connecting peptide that normally joins the two domains (here included in the N-terminus). Co-expression of homologous, but not heterologous, N- and C-termini yielded stable fully active enzymes in vitro with sizes and kinetic properties similar to those of the wild-type tetrameric enzymes. This indicates that the separately translated domains can fold sufficiently well to bind to each other, that such binding of complementary domains is stable and that the alignment is sufficiently accurate and tight as to preserve metabolite binding sites and allosteric interactions.

Chimeric phosphofructokinases involving exchange of the N- and C-terminal halves of mammalian isozymes: implications for ligand binding sites.

Two phosphofructokinase (PFK) chimeras were constructed by exchanging the N- and C-terminal halves of the mammalian M- and C-type isozymes, to investigate the contribution of each terminus to the catalytic site and the fructose-2,6-P(2)/fructose-1,6-P(2) allosteric site. The homogeneously-purified chimeric enzymes organized into tetramers, and exhibited kinetic properties for fructose-6-P and MgATP similar to those of the native enzyme that furnished the N-terminal domain in each case, whereas their fructose-2,6-P(2) activatory characteristics coincided with those of the isozyme that provided the C-terminal half. This reflected the role of each domain in the formation of the corresponding binding site. Grafting the N-terminus of PFK-M onto the C-terminus of the fructose-1,6-P(2) insensitive PFK-C restored transduction of this signal to the catalytic site, which significance is also discussed.

The dimorphic yeast Yarrowia lipolytica possesses an atypical phosphofructokinase: characterization of the enzyme and its encoding gene.

The phosphofructokinase from the non-conventional yeast Yarrowia lipolytica (YlPfk) was purified to homogeneity, and its encoding gene isolated. YlPfk is an octamer of 869 kDa composed of a single type of subunit, and shows atypical kinetic characteristics. It did not exhibit cooperative kinetics for fructose 6-phosphate (Hill coefficient, h 1.1; S0.5 52 microM), it was inhibited moderately by MgATP (Ki 3.5 mM), and it was strongly inhibited by phosphoenolpyruvate (Ki 61 microM). Fructose 2,6-bisphosphate did not activate the enzyme, and AMP and ADP were also without effect. The gene YlPFK1 has no introns, and encodes a putative protein of 953 aa, with a molecular mass consistent with the subunit size found after purification. Disruption of the gene abolished growth in glucose and Pfk activity, while reintroduction of the gene restored both properties. This indicates that Y. lipolytica has only one gene encoding Pfk, and supports the finding that the enzyme consists of identical subunits. Glucose did not interfere with growth of the Ylpfk1 disruptant in permissive carbon sources. The unusual kinetic characteristics of YlPfk, and the intracellular concentrations of glycolytic intermediates during growth in glucose, suggest that YlPfk may play an important role in the regulation of glucose metabolism in Y. lipolytica, different from the role played by the enzyme in Saccharomyces cerevisiae.