[Evaluation of the Aspergillus Galactomannan ag VircliaR Monotest test as an alternative to Platelia™ Aspergillus EIA kit]. / Evaluación de la prueba Aspergillus Galactomannan Ag VircliaR Monotest como alternativa a kit Platelia™ Aspergillus EIA.

BACKGROUND: The Aspergillus Galactomannan Ag Virclia® (GMVClia) test is a monotest and automated galactomannan technique based on chemiluminescent immunoassay (CLIA). AIM: To evaluate the performance of the GM-VClia test in serum and bronchioalveolar lavage (BAL) samples previously processed with the Platelia ™ Aspergillus EIA kit (GM-Plat). METHODS: 56 samples of serum 40 from BAL (some of them with galactomaman determination in both samples), from patients with pulmonary diseases, hematological diseases, SLE, Covid-19 and tumors, among others, were studied. Thirteen patients had invasive aspergillosis (1 proven and 12 probable). RESULTS: The correlation between both methods for serum and BAL was r = 0.8861 p < 0.0001 and r = 0.6368 p < 0.001, respectively. There was a global concordance of 67.7% (65/96), being 85.7% (48/56) in sera and 42.5.0% (14/49) in BAL. By raising the cut-off point in LBA by GM-VClia, the agreement increased to 85.7%. CONCLUSION: A greater correlation and concordance was observed in sera than in BAL. The GM-VClia kit had a higher sensitivity and NPV than the GM-Plat kit. The disadvantages of GM-VClia are the "doubtful" category, which makes interpretation difficult and that with the current cut-off points in LBA the correlation with GM-Plat is lower. The advantages are its greater sensitivity, ease of processing and faster results.

Evaluación de la prueba Aspergillus Galactomannan Ag VircliaR Monotest como alternativa a kit Platelia ™ Aspergillus EIA / Evaluation of the Aspergillus Galactomannan ag VircliaR Monotest test as an alternative to Platelia™ Aspergillus EIA kit

INTRODUCCIÓN: La prueba Aspergillus galactomannan Ag Virclia® (GM-VClia) es una técnica de galactomanano monotest, auto-matizada, basada en inmunoensayo quimioluminiscente (CLIA). OBJETIVO: Evaluar el desempeño del test de GM-VClia en muestras de suero y lavado bronquioalveolar (LBA) procesadas previamente con el kit Platelia™ Aspergillus EIA (GM-Plat). MATERIALES Y MÉTODOS: Se estudiaron 56 muestras de suero y 40 de LBA, correspondientes a un total de 59 pacientes (algunos con determinación de galactomamano en ambas muestras) con enfermedades pulmonares, hematológicas, LES, Covid-19 y tumores, entre otros. Trece pacientes tuvieron aspergilosis invasora (1 probada y 12 probables). RESULTADOS: La correlación entre ambos métodos para suero y LBA fue r = 0,8861 p < 0,0001 y r = 0,6368 p < 0,001, respectivamente. Hubo una concordancia global de 67,7% (65/96), siendo de 85,7% (48/56) en sueros y 42,5,0% (14/49) en LBA. Al subir el punto de corte en LBA por GM-VClia la concordancia aumentó a 85,7%. CONCLUSIONES: Se observó una mayor correlación y concordancia en sueros que en LBA. El kit GM-VClia presentó una mayor sensibilidad y valor predictor negativo (VPN), que el kit GM-Plat. Las desventajas de GM-VClia, la constituyen la categoría "dudoso", que dificulta la interpretación y que, con los puntos de corte actuales en LBA, la correlación con GM-Plat es menor. Las ventajas son su mayor sensibilidad, facilidad de procesamiento y una mayor rapidez en los resultados.

BACKGROUND: The Aspergillus Galactomannan Ag Virclia® (GMVClia) test is a monotest and automated galactomannan technique based on chemiluminescent immunoassay (CLIA). AIM: To evaluate the performance of the GM-VClia test in serum and bronchioalveolar lavage (BAL) samples previously processed with the Platelia ™ Aspergillus EIA kit (GM-Plat). METHODS: 56 samples of serum 40 from BAL (some of them with galactomaman determination in both samples), from patients with pulmonary diseases, hematological diseases, SLE, Covid-19 and tumors, among others, were studied. Thirteen patients had invasive aspergillosis (1 proven and 12 probable). RESULTS: The correlation between both methods for serum and BAL was r = 0.8861 p < 0.0001 and r = 0.6368 p < 0.001, respectively. There was a global concordance of 67.7% (65/96), being 85.7% (48/56) in sera and 42.5.0% (14/49) in BAL. By raising the cut-off point in LBA by GM-VClia, the agreement increased to 85.7%. CONCLUSION: A greater correlation and concordance was observed in sera than in BAL. The GM-VClia kit had a higher sensitivity and NPV than the GM-Plat kit. The disadvantages of GM-VClia are the "doubtful" category, which makes interpretation difficult and that with the current cut-off points in LBA the correlation with GM-Plat is lower. The advantages are its greater sensitivity, ease of processing and faster results.

Association between adiposity levels and cognitive impairment in the Chilean older adult population.

Although both obesity and ageing are risk factors for cognitive impairment, there is no evidence in Chile on how obesity levels are associated with cognitive function. Therefore, the aim of the present study was to investigate the association between adiposity levels and cognitive impairment in older Chilean adults. This cross-sectional study includes 1384 participants, over 60 years of age, from the Chilean National Health Survey 2009-2010. Cognitive impairment was evaluated using the Mini-Mental State Examination. BMI and waist circumference (WC) were used as measures of adiposity. Compared with people with a normal BMI, the odds of cognitive impairment were higher in participants who were underweight (OR 4·44; 95 % CI 2·43, 6·45; P < 0·0001), overweight (OR 1·86; 95 % CI 1·06, 2·66; P = 0·031) and obese (OR 2·26; 95 % CI 1·31, 3·21; P = 0·003). The associations were robust after adjustment for confounding variables. Similar results were observed for WC. Low and high levels of adiposity are associated with an increased likelihood of cognitive impairment in older adults in Chile.

[Rehabilitation of hip fractures. Systematic review]. / Rehabilitación de las fracturas de cadera. Revisión sistemática.

INTRODUCTION: Hip fractures are considered among one of the most disabling injuries in patients older than 60 years of age. This fractures are associated with a high incidence of mortality and it is the leading cause of hospital admission that requires surgical treatment in Orthopaedic Trauma Centers. METHODS: This systematic review aimed to group, classify and report the best level of evidence of physical therapy and rehabilitation of patients that have been treated with osteostynthesis after trochanteric or subtrochanteric fracture. The outcomes of efficacy and safety were return to activities of daily living, independence and rate of complications. RESULTS: We identified 3,889 abstracts from PubMed, and 1,567 abstracts from other sources, after eliminating duplicates, and posterior to a thorough screening 378 abstracts were read. From these, 316 abstracts were excluded, and 62 articles were considered eligible. After reading for relevant outcomes 41 articles were excluded. Synthesis was based in 21 studies. CONCLUSIONS: Long term results of specialized physical therapy, appear to be crucial in the first months after surgery, and not that important after the four months after surgery. Recent literature supports that the differences of daily activities and independence of the patients that survive a hip fracture tend to be similar with no difference in the type of physical therapy.

INTRODUCCIÓN: Las fracturas de cadera se consideran entre las lesiones incapacitantes más comunes en mayores de 60 años. Se asocian a un alto índice de mortalidad y es la causa más frecuente de internamiento que requiere tratamiento quirúrgico en unidades médicas dedicadas a la traumatología. MÉTODOS: Esta revisión sistemática tiene como objetivo agrupar, clasificar y reportar el mejor nivel de evidencia en el manejo de terapia física y rehabilitación en los pacientes con fractura pertrocantérica y subtrocantérica de cadera después de la cirugía de osteosíntesis en desenlaces de actividades de la vida diaria, independencia y complicaciones. RESULTADOS: Se identificaron 3,389 resúmenes y a través de otras fuentes 1,567 resúmenes, se eliminaron duplicados en la búsqueda y posterior a un cribado se obtuvieron 378 artículos para la eliminación adicional. De los 62 ensayos restantes se incluyeron 21 y 41 fueron excluidos. CONCLUSIONES: Los resultados a largo plazo de la terapia física especializada parecen ser cruciales en los primeros meses y no tan importantes al cabo de cuatro meses. La literatura actual sostiene que las diferencias en las capacidades de la vida diaria e independencia de los pacientes que sobreviven, el tratamiento de una fractura de cadera tiende a ser similar independientemente del programa de rehabilitación que se tenga.

Rehabilitación de las fracturas de cadera. Revisión sistemática / Rehabilitation of hip fractures. Systematic review

Resumen: Introducción: Las fracturas de cadera se consideran entre las lesiones incapacitantes más comunes en mayores de 60 años. Se asocian a un alto índice de mortalidad y es la causa más frecuente de internamiento que requiere tratamiento quirúrgico en unidades médicas dedicadas a la traumatología. Métodos: Esta revisión sistemática tiene como objetivo agrupar, clasificar y reportar el mejor nivel de evidencia en el manejo de terapia física y rehabilitación en los pacientes con fractura pertrocantérica y subtrocantérica de cadera después de la cirugía de osteosíntesis en desenlaces de actividades de la vida diaria, independencia y complicaciones. Resultados: Se identificaron 3,389 resúmenes y a través de otras fuentes 1,567 resúmenes, se eliminaron duplicados en la búsqueda y posterior a un cribado se obtuvieron 378 artículos para la eliminación adicional. De los 62 ensayos restantes se incluyeron 21 y 41 fueron excluidos. Conclusiones: Los resultados a largo plazo de la terapia física especializada parecen ser cruciales en los primeros meses y no tan importantes al cabo de cuatro meses. La literatura actual sostiene que las diferencias en las capacidades de la vida diaria e independencia de los pacientes que sobreviven, el tratamiento de una fractura de cadera tiende a ser similar independientemente del programa de rehabilitación que se tenga.

Abstract: Introduction: Hip fractures are considered among one of the most disabling injuries in patients older than 60 years of age. This fractures are associated with a high incidence of mortality and it is the leading cause of hospital admission that requires surgical treatment in Orthopaedic Trauma Centers. Methods: This systematic review aimed to group, classify and report the best level of evidence of physical therapy and rehabilitation of patients that have been treated with osteostynthesis after trochanteric or subtrochanteric fracture. The outcomes of efficacy and safety were return to activities of daily living, independence and rate of complications. Results: We identified 3,889 abstracts from PubMed, and 1,567 abstracts from other sources, after eliminating duplicates, and posterior to a thorough screening 378 abstracts were read. From these, 316 abstracts were excluded, and 62 articles were considered eligible. After reading for relevant outcomes 41 articles were excluded. Synthesis was based in 21 studies. Conclusions: Long term results of specialized physical therapy, appear to be crucial in the first months after surgery, and not that important after the four months after surgery. Recent literature supports that the differences of daily activities and independence of the patients that survive a hip fracture tend to be similar with no difference in the type of physical therapy.

Análisis de factores asociados a la detección de cáncer en la primera biopsia prostática / Associated factors analysis in the detection of cancer in the first prostatic biopsy

Introducción. La biopsia prostática transrectal ecoguiada (BxP) es la técnica más utilizada para el diagnóstico de cáncer. El objetivo de este estudio fue analizar los factores asociados a la de detección de cáncer en la primera BxP en nuestro centro. Métodos. Se incluyeron BxP primarias entre 2008 y 2014. La indicación para BxP se clasificó como: (I) APE normal y velocidad elevada, (II) APE normal con tacto rectal sospechoso, (III) valor único de APE elevado, (IV) APE repetido elevado y (V) APE ≥10 ng/ml. Resultados Serie de 917 pacientes. Un 41 por ciento de las BxP incluyeron 12 a 19 muestras y un 44 por ciento 20 a 22. La tasa de detección global fue 43 por ciento. Se encontraron diferencias significativas al relacionar la tasa de detección con el valor del APE, tacto rectal sospechoso, edad, densidad de APE y volumen prostático. La tasa de detección en el grupo de 12 a 19 muestras fue 34 por ciento y un 41 por ciento con 20 a 22 muestras (p=0,092). Se reportaron 7 complicaciones mayores. Conclusiones. La tasa de detección en esta serie es alta al compararla con lo publicado. Los factores asociados a mayor detección son similares a lo descrito habitualmente. El templado con más muestras se asocia a una tendencia más alta en la tasa de detección, aunque no significativa, sin encontrar mayor proporción de cáncer de bajo riesgo y con una frecuencia de complicaciones comparable con lo reportado. (AU)

Introduction. Transrectal ultrasound guided prostate biopsy is the most widely used method for the diagnosis of prostate cancer. The goal of this study was to analyse the variables associated with the detection of cancer in the first biopsy. Primary biopsies of our centre dating between 2008 and 2014 were included. Biopsy indications were classified as: (I) Normal PSA with elevated growth rate, (II) Normal PSA with suspicious digital rectal examination, (III) Isolated elevation of PSA, (IV) Persistent elevation of PSA and (V) PSA ≥10 ng/ml. Results. Among 917 patients, 41pertcent of biopsies included between 12 and 19 samples, 44 percent ranged from 20 to 22 samples. Global detection rate was 43 pertcent. Significant differences were found when correlating detection rate with PSA value, suspicious digital rectal examination, patient age, PSA density and prostate volume. Detection rate in the 12 to 19 samples group was 34 pertcent and 41 pertcent in the 20 to 22 samples group (p=0,092). 7 mayor complications were reported. Conclusion. In this series the detection rate is higher than the reported in published literature. Variables associated with a higher detection rate were similar as those reported by literature. A higher number of samples template is associated with a higher detection rate, nevertheless the differences were not statistically significant, it did not have a higher low risk cancer detection rate and had an incidence of complications similar to the previously reported. known risk factors of upgrading are a high level of PSA and the prostate volumen. Interesting is that we encounter asociation between of CAPRA score => 2 and upgrading, this is other element to consider in the evaluation of the patient prior to treatment. (AU)

Neutrophilic figurate erythema of infancy associated with juvenile myelomonocytic leukemia / Eritema figurado neutrofílico de la infancia asociado a Leucemia Mielomonocítica Juvenil

No disponible

[Emphysematous cystitis: Report of one case]. / Cistitis enfisematosa: una inusual forma de presentación de la infección del tracto urinario bajo.

Emphysematous cystitis is found in diabetic patients and in individuals with urinary stasis and immunosuppression. We report a 58-year-old male with hypertension, type 2 Diabetes on insulin treatment and central nervous system vasculitis on immunosuppressive therapy. He was admitted with weight loss and gait instability. A PET-CT showed a circumscribed image of air in the bladder contour without involving the upper urinary tract, suggesting emphysematous cystitis. Re-interrogated, the patient referred pneumaturia, dysuria and febrile sensation one week before admission. Urine culture showed Enterobacter aerogenes. He was treated with a urinary catheter, metabolic control and parenteral antimicrobials. The patient was discharged without symptoms 21 days after admission, with the bladder catheter.

Cistitis enfisematosa: una inusual forma de presentación de la infección del tracto urinario bajo / Emphysematous cystitis: Report of one case

Emphysematous cystitis is found in diabetic patients and in individuals with urinary stasis and immunosuppression. We report a 58-year-old male with hypertension, type 2 Diabetes on insulin treatment and central nervous system vasculitis on immunosuppressive therapy. He was admitted with weight loss and gait instability. A PET-CT showed a circumscribed image of air in the bladder contour without involving the upper urinary tract, suggesting emphysematous cystitis. Re-interrogated, the patient referred pneumaturia, dysuria and febrile sensation one week before admission. Urine culture showed Enterobacter aerogenes. He was treated with a urinary catheter, metabolic control and parenteral antimicrobials. The patient was discharged without symptoms 21 days after admission, with the bladder catheter.

Neoplasia mucinosa gigante de páncreas: presentación de caso clínico y revisión de la literatura / Giant mucinous neoplasm of the pancreas: presentation of a case and review of the literature

Female, 34 year-old patient with diffuse abdominal pain, bloating, and early satiety. Results from a study performed show a complex cystic mass in the pancreas with positive pancreatic mucinous cystadenoma histology. Cystadenoma/Mucinous cystadenocarcinoma represent 10 percent of cystic tumors within the pancreas, which occurr almost exclusively in women. Grossly they are uni or multilocular and contain dense, rich in mucinous matter. Histologically they exhibit columnar epithelium with presence of ovarian stroma. They vary in size, with a 10 cm average. Given their malignancy risk, surgical resection is recommended. Ultrasonography (US) helps to identify these lesions, however fails to provide a definitive diagnosis. Computed tomography (CT) and Magnetic resonance imaging (MRI) have higher accuracy, helping to identify aggressive nature in 75-90 percent. MRI is the test of choice for its resolution capacity. Endoscopic US allows for better characterization and for conducting fine-needle aspiration (FNA) for biochemical and cytological analysis of the liquid, achieving a significant increase in the diagnosis specificity. The differential diagnosis must be performed with other cystic lesions, considering that the final diagnosis is histological. The American College of Radiology suggests the use of surgical resection of mucinous neoplasms of the pancreas, Intraductal papillary or mucinous tumors the IPMT main duct and branch (if symptomatic, growing progressively, > 3 cm, have solid component and/or main duct dilation associated)...

Paciente 34 años, femenino, con dolor abdominal difuso, meteorismo y saciedad precoz. Se realiza estudio con imágenes que demuestran una gran masa quística compleja del páncreas cuya histología fue positiva para cistoadenoma mucinoso de páncreas. Los cistoadenomas/cistoadenocarcinomas mucinosos representan el 10 por ciento de los tumores quísticos del páncreas y se presentan casi exclusivamente en mujeres. Macroscópicamente son uni o multicavitados y contienen material denso, rico en mucina. Histológicamente presentan epitelio cilíndrico con presencia de estroma ovárico. Su tamaño es variable con promedio de 10 cm. Dado el riesgo de malignización se prefiere resección quirúrgica. La ultrasonografía (US) identifica estas lesiones, sin embargo, no llega a diagnóstico definitivo. La tomografía computarizada (TC) y la resonancia magnética (RM), presentan una precisión mayor, ayudando a diferenciar el carácter agresivo en 75-90 por ciento. La RM es el examen de elección por su capacidad de resolución. La US endoscópica permite una mejor caracterización y la realización de punción-aspiración con aguja fina (PAAF) para el estudio bioquímico y citológico del líquido, consiguiendo aumentar considerablemente la especificidad del diagnóstico. El diagnóstico diferencial debe realizarse con otras lesiones quísticas, teniendo en cuenta que el diagnóstico definitivo es histológico. El American College of Radiology sugiere resección quirúrgica de las neoplasias mucinosas de páncreas, y de los tumores papilares mucinosos intraductales (TPMI) de ducto principal y de rama (si son sintomáticos, crecen en forma progresiva, presentan un diámetro > 3 cm, presentan componente sólido y/o se asocian dilatación del conducto principal)...

Angiomiolipoma renal: ¿es siempre un tumor benigno? / Renal angiomyolipoma: Is it always a benign tumor?

El angiomiolipoma (AML) renal es un tumor sólido compuesto por células de músculo liso, vasos sanguíneos dismórfi cos y tejido adiposo. Esta lesión ha sido considerada siempre como una neoplasia benigna. Reportamos a una paciente de 44 años, asintomática, con una lesión sugerente de AML mayor a 4 cm en el TAC que fue sometida a nefrectomía parcial abierta. La biopsia definitiva informó un angiomiolipoma con componente epiteloídeo focal (AMLE). Controles de imágenes posteriores de esta paciente no han evidenciado recidivia. El angiomiolipoma epiteloídeo (AMLE) es una variante descrita en los últimos años y que sugiere un cambio en el paradigma clásico de “benignidad” asociada al AML Las guías para el manejo de los AML no toman en cuenta la posibilidad de que se trate de un AMLE en sus recomendaciones. Existe muy poca información respecto al manejo de este tipo de lesiones, sólo hay series de casos publicadas. Faltan estudios prospectivos que otorguen herramientas para la toma de decisiones terapéuticas adecuadas en estos pacientes.

Renal angiomyolipoma (AML) is a solid tumor formed by smooth muscle cells, dimorphic blood vessels and adipose tissue. This lesion has been always considered as a benign neoplasm. We report an asymptomatic 44 year-old female patient, with a tumor suggesting an AML in a CT scan greater than 4 cms, who had an open partial nephrectomy. The biopsy report showed an AML with a focal epithelioid component. Follow-up imaging in this case has not showed any recurrence. Epithelioid angiomyolipoma (EAML) is a variant with malignant potential that must be considered when a patient with a renal AML is been evaluated. Guidelines for AML management do not take AMLE as a differential diagnosis. Few studies have been published regarding the management of this kind of lesion, only consisting of case series. There is lack of prospective studies that could give tools for the decision-making process in the treatment of these patients.

Rotura vesical intraperitoneal y reparación laparoscópica: ¿es éste el nuevo gold standard? / Intraperitoneal bladder rupture and laparoscopic repair: is this the new gold standard?

Introduction: Nowadays laparoscopy is the new paradigm in many surgical treatments; however, its role in urological trauma is barely emerging. The aim of this article is to show a laparoscopic repair technique of an intraperitoneal bladder rupture secondary to a blunt abdominal trauma, its feasibility and safety. Case: We present a 28 year old man who consulted with 6 hours of hypogastric pain, absence of micturition and vesical globe, after alcoholic consumption. He presented high blood both creatini-ne and inflammatory parameters. A Foley catheter was installed, the pain increased progressively, with Blumberg sign and tachycardia. Looking back again, he told about a blow in the hypogastric region with full bladder. A non-contrasted CT of the pelvis showed the catheter's end into peritoneal cavity. A successfully three port laparoscopic repair was made using intracorporeal double layer suturing technique with poliglactin, an intraoperative cystoscopic check was performed. The patient was discharged at sixth day without complications. Discussion: Classically surgical treatment for intraperitoneal bladder rupture has been laparotomy with double layer closure of the lesion. However, there are no randomized control trials comparing this technique with other methods. Also, there is a lack of laparoscopic repair reports, probably due to most bladder ruptures are extraperitoneal (managed with non-surgical treatment) or associated with other organs injury (needing laparotomy). Although more evidence is needed, we believe that laparoscopic repair of intraperitoneal bladder rupture could be considered as an option in stable patients and without important associated injuries, achieving better cosmetic outcomes and faster recovering.

Introducción: Actualmente la laparoscopia es el nuevo paradigma en muchos tratamientos quirúrgicos, pero su rol en trauma urológico es incipiente. Nuestro objetivo es mostrar una técnica factible y segura de cistorrafia laparoscópica por ruptura vesical intraperitoneal contusa. Caso: Un hombre de 28 años consulta por 6 horas de dolor hipogástrico, retención y globo vesical, después de una transgresión alcohólica. Ingresa con creatininemia y parámetros inflamatorios elevados. A pesar de un sondeo vesical exitoso, evoluciona con más dolor, Blumberg y taquicardia. Revisando la anamnesis, refiere un golpe en hipogastrio, con vejiga llena. En pieloTAC se observa el extremo de la sonda en cavidad peritoneal. En pabellón, se realiza una reparación laparoscópica mediante tres trócares, usando sutura de poliglactina en doble capa, con revisión cistoscópica intraoperatoria. El paciente se da de alta al sexto día postoperatorio, sin complicaciones. Discusión: Clásicamente, el tratamiento quirúrgico de la ruptura vesical intraperitoneal, ha sido la laparotomía exploradora con cierre de la lesión en doble capa. Sin embargo, esta técnica no ha sido comparada en estudios randomizados con otras modalidades. Además, hay escasos reportes de la técnica laparoscópica, probablemente porque la mayoría de las lesiones son extraperitoneales (con manejo conservador) o con lesión de otros órganos (requiriendo laparotomía). Se necesita más evidencia, pero creemos que la cistorrafia laparoscópica de lesiones intraperitoneales, es una buena conducta en pacientes estables sin otros daños asociados, alcanzando mejores resultados estéticos y una recuperación más rápida.

Experiencia de transferencia tecnológica de la Consejería Telefónica para Cuidados Crónicos de Salud, a equipos de Atención Primaria / Experience of technology transfer from telephone Counseling for Chronic Conditions to Primary Care Teams

El proceso de transferencia tecnológica exige capacitar en conocimientos y habilidades específicas a los futuros usuarios, así como también la realización de adecuaciones administrativas para la incorporación efectiva de la innovación en la estructura del sistema y en la atención profesional. La Escuela de Enfermería a la que pertenecen los autores, desarrolló un modelo de Apoyo Tecnológico para el Autocuidado en Salud que incluye el uso de consejerías telefónicas para apoyar a personas con enfermedades crónicas en el automanejo y autocuidado de su condición. Se presenta a continuación la experiencia llevada a cabo para transferir esta tecnología a profesionales del Programa de Salud Cardiovascular en Centros de Atención Primaria públicos de una comuna de bajos recursos en Chile, para su incorporación en la atención de pacientes con diabetes tipo 2 adscritos a dicho programa. Este proceso se realizó en dos etapas: 1. Realización de un taller teórico práctico en apoyo a la toma de decisiones en salud y estrategias motivacionales para el cambio de conducta en salud (talleres y demostraciones) y 2. Demostración en terreno, y seguimiento con supervisión y reuniones a nivel local. Los profesionales que participaron del programa de transferencia tecnológica, lograron desarrollar las destrezas esperadas en la herramienta de Consejería Telefónica de Apoyo al Auto-Manejo de Personas con DM2. Finalmente, para incorporar las consejerías telefónicas en la práctica clínica, los centros de salud reestructuraron el sistema de prestación de servicios, integrando así dichas consejerías a su quehacer profesional (AU)

The technology transfer process requires training future users in specific knowledge and skills, as well as performing administrative adjustments for an effective incorporation of innovation into the structure of the system and into the professional care. Pontificia Universidad Católica de Chile's School of Nursing developed a model of Technological Support for Health Self-Care, which includes the use of telephone counseling to help people who suffer from chronic diseases manage their condition and look after themselves by teaching them techniques which alleviate their disease. Here, we present an experience that was carried out to transfer this technology to professionals related to the Cardiovascular Health Program in Chilean Public Primary Healthcare Centers located in a low-income district of Chile's capital city, Santiago, so that the technology could be applied to patients with type 2 diabetes who had joined such program. This process was conducted in two stages: 1. Making of a theoretical-practical workshop to support health decision-making and motivational strategies for health behavior change (workshops and demonstrations); and 2. Field demonstration, and monitoring with supervision and meetings at local level. The professionals who participated in the technology transfer program succeeded in developing the skills expected in the Telephone Counseling Tool to Support Self-Management of People suffering from DM2. Finally, to enable telephone counseling in clinical practice, healthcare centers restructured their system of service provisions, incorporating such counseling into their professional duties (AU)

Segregation of secondary metabolite biosynthesis in hybrids of Fusarium fujikuroi and Fusarium proliferatum.

Fusarium fujikuroi and Fusarium proliferatum are two phylogenetically closely related species of the Gibberella fujikuroi species complex (GFC). In some cases, strains of these species can cross and produce a few ascospores. In this study, we analyzed 26 single ascospore isolates of an interspecific cross between F. fujikuroi C1995 and F. proliferatum D4854 for their ability to produce four secondary metabolites: gibberellins (GAs), the mycotoxins fusarin C and fumonisin B(1), and a family of red polyketides, the fusarubins. Both parental strains contain the biosynthetic genes for all four metabolites, but differ in their ability to produce these metabolites under certain conditions. F. fujikuroi C1995 produces GAs and fusarins, while F. proliferatum D4854 produces fumonisins and fusarubins. The segregation amongst the progeny of these traits is not the expected 1:1 Mendelian ratio. Only eight, six, three and three progeny, respectively, produce GAs, fusarins, fumonisin B(1) and fusarubins in amounts similar to those synthesized by the producing parental strain. Beside the eight highly GA(3)-producing progeny, some of the progeny produce small amounts of GAs, predominantly GA(1), although these strains contain the GA gene cluster of the non-GA-producing F. proliferatum parental strain. Some progeny had recombinant secondary metabolite profiles under the conditions examined indicating that interspecific crosses can yield secondary metabolite production profiles that are atypical of the parent species.

Evaluación preoperatoria / Preoperative evaluation

El texto que sigue muestra el enfrentamiento que tradicionalmente un anestesiólogo hace durante la evaluación preoperatoria de un paciente sea éste de urgencia o electivo. Esto consiste en interiorizarse de la historia, obteniendo la mayor cantidad de información de la condición médica actual y pasada del paciente, un examen físico dirigido, efectuar un análisis sistémico del paciente, solicitar y leer los exámenes pertinentes y dejar las indicaciones apropiadas. Toda la información anterior permitirá clasificar al enfermo de acuerdo a su condición física, evaluar su riesgo y planificar la conducta periopertoria.

These document lineament is given by the traditionally way for an anesthetist to perform the preoperative evaluation of a pacient even if he is an urgency or an elective pacient. This consists in reviewing the history, getting the most information about the present and past medical condition of the pacient, running a guided fisical exam, a sistemic analisis of the pacient, after wich the pertinent exams should be asked and read, then the appropiate indications should de made. All of the previous information will allow a clasification of the pacient acording to his physical condition, evaluate his risk and planning the perioperative.

Co-detección de patógenos periodontales en pacientes chilenos con periodontitis crónica / Co-detection of periodontal pathogens in Chilean patients with chronic periodontitis

Las enfermedades periodontales asociadas a la placa dental son un importante problema de salud pública. La etiología de estas patologías es de origen multifactorial e involucra factores del hospedero, medio ambiente y de carácter infeccioso asociados a bacterias embebidas en la placa dental. Las principales bacterias asociadas a la periodontitis crónica son Porphyromonas gingivalis, Treponema denticola y Tannerella forsythia, mientras que Aggregatibacter actinomycetemcomitans se ha asociado principalmente a la periodontitis agresiva. Otro microorganismo clave en el desarrollo de la enfermedad es Fusobacterium nucleatum, el cual tiene la capacidad de co-agregarse con los patógenos periodontales y así facilitar su colonización. Para demostrar la prevalencia de estas bacterias, la co-detección y la asociación entre pacientes chilenos fumadores y no fumadores, se analizaron 67 muestras mediante PCR convencional. Los resultados mostraron que un 90 por ciento de las muestras fueron positivas para F. nucleatum, siendo la bacteria más detectada. Al analizar la co-detección entre las distintas bacterias se observa que F nucleatum está presente en más de un 80 por ciento de los casos cuando se detecta cualquiera de las cuatro bacterias restantes, mientas que A. actinomycetemcomitans se detecta en no más de un 20 por ciento al amplificar cualquiera de las bacterias restantes. Por otra parte, los resultados por género indican que existen diferencias significativas en la detección de T. forsythia, F. nucleatum y A. actinomycetemcomitans. Al considerar el factor de tabaquismo se observó que ninguna de las muestras de pacientes fumadores resultó ser positiva para A. actinomycetemcomitans.

Periodontal disease associated with dental plaque is a major public health problem. The etiology of these disorders is multifactorial involved seeing host factors, environmental factors and infectious nature associated with the presence of bacteria belonging to the plaque. The main bacteria associated with chronic periodontitis are Porphyromonas gingivalis, Treponema denticola and Tannerella forsythia, while Aggregatibacter actinomycetemcomitans is mainly associated with aggressive periodontitis. Another key organism in the development of the disease is Fusobacterium nucleatum, which has the ability to co-aggregate with other periodontal pathogen. To demonstrate the prevalence of these bacteria and the association between Chilean smokers and nonsmokers patients, 67 samples were analyzed by conventional PCR. The results showed that 90 percent of the samples were positive for F nucleatum being the most commonly detected bacteria. By analyzing the co-detection between different bacteria shows that F nucleatum is present in more than 80 percent of cases when it detects any of the four remaining bacteria, which lie A. actinomycetemcomitans was detected in no more than 20 percent by amplifying any remaining bacteria. Moreover the results by gender indicate that significant differences exist in the detection of T forsythia, F. nucleatum and A. actinomycetemcomitans. In considering the factor of smoking was observed that none of the samples from smokers was found to be positive for A. actinomycetemcomitans.

Extensión de la vena renal derecha en trasplante renal / Lengthening of the right renal vein in renal transplants

El riñón donante del lado derecho puede presentar una vena renal de longitud limitada, existiendo técnicas que facilitan su alargamiento. Este trabajo muestra nuestra experiencia en el uso de técnicas de extensión de la vena renal empleadas en donante vivo y cadavérico. Material y método: Se revisaron en forma retrospectiva todos los pacientes que requirieron extensión de la vena renal derecha en los últimos diez años. Se registró la técnica utilizada y la evolución posoperatoria de estos pacientes. Resultados: La serie analizada estuvo compuesta por veinticuatro pacientes receptores de trasplante renal, 11 mujeres y 13 hombres, con un edad promedio de 44,4 años. Veintiún pacientes fueron receptores de donante cadáver a quienes se les realizó la extensión venosa con vena cava en forma de un tubo longitudinal. En tres pacientes receptores de un riñón donante vivo la nefrectomía fue laparoscópica y la extensión venosa se efectuó con un parche de la vena gonadal del donante en forma de un tubo en espiral. La anastomosis venosa en el receptor se facilitó enormemente por la extensión de la vena renal y se efectuó en la forma habitual término-lateral a la vena ilíaca. No hubo mortalidad operatoria ni complicaciones relacionadas a la extensión de la vena en el posoperatorio. Conclusión: La extensión de la vena renal derecha es una opción simple y segura en aquellos casos de longitud limitada y facilita la anastomosis venosa durante la cirugía del trasplante renal.

Right side donor kidneys may have a short renal vein (RV). Techniques for lengthening right RV have been described. We present our experience using lengthening techniques for RV of both living and cadaveric donors. Material and method: This is a retrospective study that included all patients who require lengthening of the right RV in the last ten years. The type of technique and post-operative course of all patients were recorded. Results: The series is composed of 24 patients who were receptors of a kidney transplant. There were 11 females and 13 males with an average age of 44.4 years. A total of 21 patients were receptors of a cadaveric transplant; in them, lengthening of the RV was done using vena cava shaped as a longitudinal tube. Three patients were receptors of a living donor kidney. Nefrectomy was performed by laparoscopy and venous lengthening was performed with a donor gonadal vein patch shaped as a spiral tube. An end-to-lateral anastomosis to the iliac vein was performed by the standard technique. Lengthening of the RV helped enormously the surgical procedure. There was no operative mortality or complications related to lengthening of the vein. Conclusion: Lengthening of the right RV is a simple and safe alternative in cases with short RV. This technique facilitates venous anastomosis during renal transplant surgery.

Una alternativa de extensión de la vena renal derecha en donante vivo laparoscópico / An alternative for enlargement of right renal vein in laparoscopic living donor nephrectomy

El manejo de la vena renal derecha en la nefrectomía laparoscópica del donante vivo puede en ocasiones representar un problema como consecuencia de la longitud limitada de este vaso. El caso clínico que se presenta muestra una técnica de extensión de la vena renal utilizando la vena gonadal del donante.

Vascular management of the right renal vein during laparoscopic living donor nephrectomy is still an unsolved problem. This short vessel has limited the use of right kidneys. However, the right kidney should be harvested in some instances. A renal vein enlargement technique using the donor gonadal vein is presented which may facilitate the use of right kidneys in this setting.