Prevalencia de diabetes mellitus en un servicio de medicina interna: causas de hospitalización y factores asociados a morbimortalidad / Prevalence of diabetes mellitus among patients admitted to a medical service of a general hospital

Background: Hyperglycemia among hospitalized patients is a common finding as is associated with a worse prognosis in patients with an without a history of diabetes. An optimal control of blood glucose reduces complications in these patients. Although the national prevalence of diabetes in Chile is well know, data on its prevalence among hospitalized patients is scanty. Aim: To assess the prevalence of diabetes and its association with hospital evolution among patients admitted to a medical service of a public hospital. Patients and Methods: In a prospective study from august to october of 2006 period, the cause of admission and the presence of diabetes mellitus was registered for every patient admitted to the medicine service. Among diabetics, the type of diabetes and the length of disease was recorded. Patients were followed during hospital stay, registering length of hospitalization, complications and mortality. Results: A total of 367 patients were studied and 92 (26 percent) were diabetics. Among the latter, 96 percent had type 2 diabetes and the main causes of admission were cardiovascular diseases in 38 (40 percent), infections in 18 (19 percent) and acute complications of diabetes in 13 (13 percent). Hospital mortality among diabetic and non diabetic patients was 6 and 4 percent, respectively (p = NS). Complications during hospital stay among diabetic and non diabetic patients, occurred in 15 and 9 percent, respectively (p = 0.064). The length of hospital stay was 8.8 and 9.2 days in diabetic and non diabetic patients, respectively (p = NS). Those patients with a diabetes lasting for more than 10 years had a higher rate of complications. Conclusions: The prevalence diabetes mellitus among hospitalized diabetic patients is higher than registered in national statistics. Patients with a diabetes lasting more than 10 years have more complications during hospital stay.

[Anesthetic management during removal of a giant intrathoracic mass]. / Manejo anestésico en la exéresis de un tumor intratorácico gigante.

We report the case of a young woman with a giant intrathoracic angiomyolipoma accounting for 10% of her weight and occupying 75% of the right hemithorax and 30% of the left. Before anesthetic induction, an arterial line and a central venous catheter were applied for monitoring; neck and thoracic punctures were avoided. The trachea was intubated with a double lumen tube after provision of sedation and analgesia with remifentanil-midazolam and topical anesthesia of the larynx. A rigid bronchoscope and extracorporeal circulation were available at all times and muscle relaxants were avoided. Ventilation was maintained with pressure support until the mass effect was resolved. The patient was transferred to the intensive care unit, extubated after 24 hours, and discharged 5 days after surgery. We describe the recommendations for perioperative management in cases involving this type of tumor and the complications that can develop. Recent symptoms, diagnostic images, and the results of lung function tests provide information for guiding the anesthetic approach. The obstructive ventilatory compromise caused by a giant mass depends more on location than size. Extracorporeal circulation or rigid bronchoscopy might be needed at any time during surgery.

Modulation of renal kallikrein by a high potassium diet in rats with intense proteinuria.

Injury of the renal tubulointerstitial compartment is recognized to play an important role in hypertension. Its damage may in turn, impair the activity of vasodepressor systems, like the kallikrein-kinin, in blood pressure regulation. The overload proteinuria model induces tubulointerstitial injury with activation of the renin-angiotensin system, but renal kallikrein and the development of hypertension have not received special attention. Sprague-Dawley rats received seven intraperitoneal doses of bovine serum albumin (BSA) 2 g/day under normosodic diet and were hydrated ad libitum. A second group received a high potassium diet to stimulate kallikrein production during the previous four weeks and while under BSA administration. A third one received potassium and BSA in the same schedule, but with the kinin B2 receptor antagonist, HOE140, added during the protein load phase. A control group received seven saline injections. Kallikrein protein was detected by immune labeling on renal sections and enzymatic activity in the urine. The BSA group showed massive proteinuria followed by intense tubulointerstitial damage. Blood pressure increased after the third dose in BSA animals, remaining elevated throughout the experiment, associated with significant reductions in renal expression and urinary activity of kallikrein, compared with controls. An inverse correlation was found between blood pressure and immunohistochemistry and urinary activity of kallikrein. Potassium induced a significant increase in both urinary activity and renal kallikrein expression, associated with significant reduction in blood pressure. The HOE140 antagonist blunted the antihypertensive effect of kallikrein stimulation in proteinuric rats. Loss of renal kallikrein, produced by tubulointerstitial injury, may participate in the pathogenesis of the hypertension observed in this model.

Desafiando la realidad laboral: programa de capacitación laboral para personas con discapacidad intelectual / Labor program for the congnitive disabled: defying laboral reality

Este artículo se propone presentar el Programa de Capacitación Laboral para Personas con Discapacidad Intelectual que se lleva a efecto en la Escuela Gabriela Mistral. Su objetivo es favorecer la integración sociolaboral de los alumnos en la comunidad. Se intenta demostrar que, aunque los recursos sean escasos, un equipo de trabajo interdisciplinario logra establecer redes que acojan a este sector de la sociedad y le permitan acceder al mundo laboral en buenas condiciones.

This paper presents a Labor Program for the Intelectual Disability that is taking place at the Escuela Gabriela Mistral. Its goal is to favor the sociolaboral integration of its students inside the community. It tries to demonstrate that, even with low resources, an interdisciplinary working group may establish nets that will accept this people, thus allowing them to join the labor world in good conditions.

Tratamiento de la incontinencia con el cabestrillo sin tensión en forma económica / Treatment of the incontinence with the tension sling in economic form

La incontinencia de esfuerzo tiene una alta prevalencia en las mujeres y puede condicionar problemas sociales. Una amplia variedad de técnicas se han usado, pero en la actualidad los expertos han determinado que el procedimiento con mejores resultados a largo plazo son los sling. Los cuales se han realizado con materiales como la fascia aponeurótica autologa, pero con cierta morbilidad de las zonas dadoras. En los últimos años los materiales sintéticos y de ellos el polipropilene como cintas sin tensión (TVT) han demostrado durabilidad, menos morbilidad. pero su inconveniente ha sido que los set comercialmente disponibles tienen un costo de aproximadamente 800 dólares por paciente. Nosotros presentamos nuestra experiencia en 42 pacientes con incontinencia de esfuerzo, en el servicio de urología del Hospital Nacional Guillermo Almenara Irigoyen, con el uso de estas mallas de polipropilene auto fabricadas con un costo promedio de 20 dólares por paciente, desde enero del 2000 a enero del 2002. Describimos nuestra técnica, así como el modo de fabricación de las cintas para el cabestrillo o sling, demostrando su fácil reproducibilidad en cualquier centro de EsSALUD. Todas nuestras pacientes tuvieron estudios urodinámicos, valoración de cistoceles asociados, cistoscopía y en los casos de inestabilidad patrón miccional diario. El tiempo promedio de cirugía fue de 38 minutos, el seguimiento promedio fue de 16 meses y el resultado exitoso en 41 pacientes (97.3 por ciento). La técnica de cabestrillo sin tensión a bajo costo para la realidad de nuestro país es factible, eficaz, reproducible y significará un ahorro para la institución sin disminuir la calidad de atención a nuestras pacientes.

Influencia del alojamiento conjunto en la lactancia humana en madres cesareadas. Estudio randomizado. Hospital Regional del Cusco. 1994 / Influence of the joint precocious housing in the human lactation in mothers cesareans. I study randomizado. Regional hospital of the Cusco. 1994

Los partos por cesárea representan al 9 por ciento del total de partos. Las madres cesareadas tienen dificultades en el inicio y establecimiento de la lactancia por prácticas hospitalarias inadecuadas. Es un estudio comparativo en el primer grupo el alojamiento conjunto y amamantamiento, se inician dentro de las tres horas posparto y en el grupo control a las 12 horas del mismo. Se hace seguimiento por cuatro días midiendo la frecuencia de tetadas y al cuarto día se mide el volúmen de secreción láctea por el método de la doble pesada. El grupo en alojamiento conjunto precoz tuvo mayor frecuencia de tetadas al día (11,3 vs. 7,3) en los 4 días de seguimiento y mayor volúmen de secreción láctea al cuarto día (230 ml vs. 158ml). El alojamiento conjunto precoz en cesareadas es posible y es aceptado por las madres, induce mayor frecuencia de tetadas y mayor volúmen de secreción láctea lo cual facilita el establecimiento de la lactancia humana.

Incidence and studies on antigenic specificities of antineutrophil-cytoplasmic autoantibodies (ANCA) in poststreptococcal glomerulonephritis.

Sera from 210 patients with Acute Poststreptococcal Glomerulonephritis (APSGN) and 14 patients with streptococcal impetigo without glomerular disease were tested for the presence of IgG-ANCA using an indirect immunofluorescence assay (IIF) on ethanol fixed normal human neutrophils. In the group of nephritic patients, ANCA were detected by IIF in 9% (18 out of 210 cases) in an atypical diffuse cytoplasmic pattern (a-ANCA) in 14 cases and in a (p-ANCA) perinuclear staining in the remaining 4 cases. Longitudinal studies performed on six IIF positive patients, showed persistence of the phenomenon for up to six months, without relationship with activity of disease. No patient with streptococcal impetigo showed positivity on the IIF assay. Positive sera were analyzed on ELISA plates for their IgG reactivity against specific purified ANCA antigens: Proteinase-3 (PR3), Myeloperoxidase (MPO). Cathepsin-G and Bactericidal/Permeability Increasing Protein (BPI). Anti-MPO antibodies were present in 4 cases (3 a-ANCA and 1 p-ANCA). No reactivity was identified against PR-3, BPI and Catepsin-G in any of the samples. The presence of ANCA was significantly associated with a more severe glomerular disease as assessed by the serum creatinine and the crescents formation. Further studies are required to identify other antigenic specificities of these autoantibodies. Their absence in the streptococcal impetigo control group might suggest that their presence in APSGN could play some pathogenic role in kidney disease.

[Antineutrophil cytoplasmic antibodies and nonspecific ulcerative colitis]. / Anticuerpos anticitoplasma de neutrófilos y colitis ulcerosa inespecífica.

We studied the presence of antineutrophil cytoplasmic antibodies in 16 patients with idiopathic ulcerative colitis, using an indirect immunofluorescence technique and specific ELISA for myeloperoxidase and proteinase 3. Twelve patients had an active disease and in ten, antineutrophil cytoplasmic antibodies were positive, with a predominantly perinuclear distribution and without specificity for myeliperoxidase or proteinase 3. These antibodies were negative in the four patients with inactive disease. It is concluded that antineutrophil cytoplasmic antibodies could be serologic indicators of disease activity in patients with ulcerative colitis.

[Rapidly progressive glomerulonephritis without immune deposits: detection of neutrophil anticytoplasmic antibodies]. / Glomerulonefritis rápidamente progresiva sin depósitos inmunes: detección de anticuerpos anticitoplasma de neutrófilos.

Antineutrophil cytoplasmic autoantibodies (ANCA), are serologic markers of disease in rapidly progressive glomerulonephritis without immune deposits (pauci-immune) and vasculitis, and could play a pathogenic role in these diseases. We communicate 5 patients with pauci-immune rapidly progressive glomerulonephritis; four of them in the evolution of necrotizing systemic vasculitis (Wegener's granulomatosis and microscopic polyarteritis) and one case with lesions limited to the kidney. All of them were associated with the presence of ANCA. The immunofluorescence pattern (cytoplasmic and perinuclear) and the antigenic specificity of ELISA assay, [antiproteinase-3 (PR-3) and antimyeloperoxidase (MOP)], are useful laboratory tools for the diagnosis and clinical management of these patients.

Antineutrophil-cytoplasmic-autoantibodies in poststreptococcal nephritis.

Sera from 210 patients with APSGN, were tested for the presence of ANCA (IgG-isotype). Indirect immunofluorescence (IF) on ethanol fixed human PMNs was used, and for those positive sera, ELISA kits for PR3 (Proteinase 3) and MPO (Myeloperoxidase) was performed. ANCA were detected in 9% (18 out of 210 cases) in a predominantly diffuse cytoplasmic staining pattern in 14 cases (77%), and in a perinuclear pattern in the remaining 4 cases (22%). Anti-MPO was found in 4 cases (C-ANCA 3; P-ANCA 1) and anti-PR3 was always negative. The presence of ANCA was significantly associated with a more severe glomerular disease as assessed by the serum creatinine value and the crescents formation. Longitudinal studies performed in 11 cases have shown that raised levels of these autoantibodies may persist for at least six months, without relationship with disease activity. Further studies are required to dilucidate the specificity of these autoantibodies, and if its presence is either an epiphenomenon of the heterogeneous humoral immune response in streptococcal infection, or they play some pathogenic role in APSGN.

Consideraciones sobre esquizofrenia. / Schizophrenia

Enfoque clinico-antropologico del esquizofrenico. Condicion unitaria para la psicosis incluyendo la esquizofrenia. Causa y mejoria de la psicosis esperada desde la bioquimica. Revitalizacion de la rehabilitacion del enfermo mental a traves de la "comunicacion psicoterapeutica"

Reflexiones en torno a la psicoterapia. / Reflections on psychotherapy

Se puntualizam los cuantro enfoques basicos en el estudio de las "enfermedades mentales" : psicoanalitico, fenomenologico, reflexologico y neurofisiologico. Se hace hincapie en la importancia fundamental de la psicoterapia en el tratamiento de los "enfermos mentales". Se centra el valor de la psicoterapia en la capacidad del psicoterapeuta para establecer y saber conducir la compleja y peculiar vinculacion, que requiere este tratamiento con el enfermo, por sobre las "tecnicas" psicoterapeuticas