[Sociodemographic risk factors of hantavirus cardiopulmonary syndrome]. / Factores de riesgo socio-demográficos del síndrome cardiopulmonar por hantavirus.

BACKGROUND: Hantavirus cardiopulmonary syndrome (HCPS) is caused by new world hantaviruses, among which Andes hantavirus (ANDV) is endemic to Chile and Southern Argentina. The disease caused by ANDV produces plasma leakage leading to enhanced vascular permeability and has a high case fatality rate (35%), mainly due to respiratory failure, pulmonary edema and myocardial dysfunction, hypoperfusion and shock. Host sociodemographic and genetic factors might influence the course and outcome of the disease. Yet, they have not been thoroughly characterized. AIM: To evaluate sociodemographic factors as risk factors in severity of HCPS. PATIENTS AND METHODS: Study period: 2004-20013, attending in eight collaborative centers, etiological diagnosis was performed by serology or molecular biology, mild and severe HCPS were compared.139 Chilean patients were analyzed, 64 (46%) with severe disease among which 12 (19 %) died. RESULTS: European ethnicity had 5,1 times higher risk than Amerindian ethnic group to develop a severe HCPS, greater seriousness that was also associated with an urban residence. CONCLUSION: It was observed that ethnicity and type of residence were significant risk factors for HCPS severity. Hypotheses explaining these findings are discussed.

Factores de riesgo socio-demográficos del síndrome cardiopulmonar por hantavirus / Sociodemographic risk factors of hantavirus cardiopulmonary syndrome

Resumen Introducción: El síndrome cardiopulmonar por hantavirus (SCPH) es causado en Chile y en el sur de Argentina por el Andes hantavirus (ANDV), el que es endémico en esta zona. La enfermedad causada por ANDV produce un aumento de permeabilidad vascular y filtración de plasma con una alta tasa de letalidad (35%), debido principalmente a insuficiencia respiratoria por edema pulmonar y al desarrollo en los casos graves de compromiso miocárdico, hipoperfusión y shock. Aunque se sabe que los factores socio-demográficos del hospedero pueden influir en el curso y el resultado de la enfermedad, estos no se han caracterizado previamente en la población chilena. Objetivo: Evaluar la relación entre los factores socio-demográficos y la gravedad del SCPH. Pacientes y Métodos: Período de análisis 2004-20013, pacientes atendidos en ocho centros colaboradores, diagnóstico etiológico serológico o por biología molecular, se comparan SCPH leve y grave. Se analizaron 139 pacientes chilenos, 64 (46%) con enfermedad grave, entre los cuales 12 murieron (19%). Resultados: La etnia europea tuvo un riesgo 5,1 veces mayor de desarrollar un SCPH grave que la etnia amerindia, gravedad mayor que también se asoció a una residencia urbana. Conclusiones: Se observó una asociación estadísticamente significativa entre etnia, lugar de residencia y evolución de SCPH. Se discuten hipótesis que expliquen estos hallazgos.

Background: Hantavirus cardiopulmonary syndrome (HCPS) is caused by new world hantaviruses, among which Andes hantavirus (ANDV) is endemic to Chile and Southern Argentina. The disease caused by ANDV produces plasma leakage leading to enhanced vascular permeability and has a high case fatality rate (35%), mainly due to respiratory failure, pulmonary edema and myocardial dysfunction, hypoperfusion and shock. Host sociodemographic and genetic factors might influence the course and outcome of the disease. Yet, they have not been thoroughly characterized. Aim: To evaluate sociodemographic factors as risk factors in severity of HCPS. Patients and Methods: Study period: 2004-20013, attending in eight collaborative centers, etiological diagnosis was performed by serology or molecular biology, mild and severe HCPS were compared.139 Chilean patients were analyzed, 64 (46%) with severe disease among which 12 (19 %) died. Results: European ethnicity had 5,1 times higher risk than Amerindian ethnic group to develop a severe HCPS, greater seriousness that was also associated with an urban residence. Conclusion: It was observed that ethnicity and type of residence were significant risk factors for HCPS severity. Hypotheses explaining these findings are discussed.

Embarazo triple monocorial triamniótico: experiencia de dos casos y revisión de la literatura / Triamniótico triple monochorionic pregnancy: experience of two cases and literature review

Los embarazos múltiples se consideran una entidad de alto riesgo obstétrico. Su incidencia ha ido en aumento debido a la utilización de técnicas de reproducción asistida y el aumento de la edad materna. Se presentan 2 casos de embarazos triples monocoriales triamnióticos, de sexo femenino y masculino. En ambos embarazos se manifestaron complicaciones, principalmente fetales y neonatales, atribuidas a embarazos múltiples descritas en la literatura.

Multiple pregnancies are considered a high-risk obstetric entity. Their incidence has been increasing due to the use of assisted reproductive techniques and increased maternal age. Here, we describe two cases of triamniotic monochorionic triplet pregnancies, female and male respectively. Both pregnancies demonstrated complications, mainly fetal and neonatal, attributed to multiple pregnancies reported in the literature.

Monthly variation of Dermatophagoides allergens and its influence on respiratory allergy in a high altitude environment (Quito, 2800ma.s.l. in Andean Ecuador)

Background: Seasonal variation of Dermatophagoides allergens and its influence in allergic respiratory airway diseases has not been investigated in Andean cities. The objective of this study was to evaluate those parameters in a city located in the Andean mountains. Methods: Der p1 and Der f1 were measured in dust samples from mattresses in 13 houses in Quito (2800m above sea level). Samples were collected monthly from August 2004 to July 2005. Patients presenting to a local outpatient allergy clinic with asthma and rhinitis and isolated allergy to Dermatophagoides were analysed to determine if a correlation existed between seasonal Der allergen levels and the number of patients presenting with allergies. Results: High levels of dust mites and humidity were observed throughout the year. The highest geometrical mean values of allergens were detected in April (Der p1, 10.15ìg/g) and May (Der f1, 13.03ìg/g), whilst the lowest levels were detected in August (Der p1, 4.26ìg/g), and September (Der f1, 1.4ìg/g). Of the 361 patients examined, 182 were allergic to Dermatophagoides, (45.6% asthmatics, 97.8% rhinitics, and 43.4% with both diseases). Patient presentation spiked in August, and from February to May. However, there was not a significant correlation between mite allergen concentrations and humidity or the number of patients presenting with allergies. Conclusions: Dust samples from mattresses in Quito revealed high concentrations of Der p1 and Der f1. We observed a trend towards increased presentation of asthmatic and rhinitic patients in the months with highest levels of allergens (AU)

Monthly variation of Dermatophagoides allergens and its influence on respiratory allergy in a high altitude environment (Quito, 2800 m a.s.l. in Andean Ecuador).

BACKGROUND: Seasonal variation of Dermatophagoides allergens and its influence in allergic respiratory airway diseases has not been investigated in Andean cities. The objective of this study was to evaluate those parameters in a city located in the Andean mountains. METHODS: Der p1 and Der f1 were measured in dust samples from mattresses in 13 houses in Quito (2800 m above sea level). Samples were collected monthly from August 2004 to July 2005. Patients presenting to a local outpatient allergy clinic with asthma and rhinitis and isolated allergy to Dermatophagoides were analysed to determine if a correlation existed between seasonal Der allergen levels and the number of patients presenting with allergies. RESULTS: High levels of dust mites and humidity were observed throughout the year. The highest geometrical mean values of allergens were detected in April (Der p1, 10.15 µg/g) and May (Der f1, 13.03 µg/g), whilst the lowest levels were detected in August (Der p1, 4.26 µg/g), and September (Der f1, 1.4 µg/g). Of the 361 patients examined, 182 were allergic to Dermatophagoides, (45.6% asthmatics, 97.8% rhinitics, and 43.4% with both diseases). Patient presentation spiked in August, and from February to May. However, there was not a significant correlation between mite allergen concentrations and humidity or the number of patients presenting with allergies. CONCLUSIONS: Dust samples from mattresses in Quito revealed high concentrations of Der p1 and Der f1. We observed a trend towards increased presentation of asthmatic and rhinitic patients in the months with highest levels of allergens.

Bronchial asthma, sensitisation and exposure to Der p1 and Der f1 in an Andean Ecuadorian school

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Cirugía endoscópica transgástrica: experiencia inicial en modelos animales / Transgastric endoscopic surgery: initial experience in animal model

Natural orifice transluminal endoscopic surgery (notes), is a novel approach to the peritoneal cavity, that has been used for both diagnostic and surgical procedures. Aims: to evaluated the safety and feasibility of per-oral transgastric route for peritoneal approach and for several basic surgical techniques in a porcine experimental model. Material and methods: five pigs entered in the study. Under general anesthesia , a conventional endoscope was passed into the stomach, the gastric wall was punctured by mean of a sphincterotome and the size of the gastric incision was increased with a cholecystectomy and intestinal loops mobilization were attempted. Gastric incision closure was performed with endoloops. Results: a good observation of the peritoneal cavity was achieved. Liver samples were obtained in all procedures as well as mobilization of small intestinal loops. Cholecystectomy was possible in only three cases. Conclusion: transgastric approach to the peritoneal cavity seems to be a potential alternative to the classical laparotomy and laparoscopic technique.

La cirugía endoscópica transluminal por orificios naturales (NOTES) es un nuevo abordaje a la cavidad peritoneal que ha sido utilizada ya sea como procedimiento diagnóstico o quirúrgico. Objetivos: Evaluar la seguridad y factibilidad de la ruta per-oral transgástrica para el acceso a la cavidad peritoneal , y para la realización de técnicas quirúrgicas básicas en un modelo experimental porcino. Material y métodos: Se utilizaron cinco cerdos. Bajo anestesia general mediante un endoscopio convencional se accedió al estómago y se puncionó la pared gástrica mediante un papilótomo. La abertura se amplió ya sea con papilótomo o con balón. Se exploró la cavidad peritoneal y se intentó realizar: biopsias hepáticas en todos los procedimientos, lo mismo ocurrió con la movilización de asas intestinales. La colecistectomía fue posible en sólo tres ocasiones. Conclusión: el abordaje transgástrico de la cavidad peritoneal pareciera ser una potencial alternativa a la laparotomía clásica y laparoscópica.

Inmunogenicidad y reactogenicidad de una vacuna de difteria, tétanos, pertussis acelular de contenido antigénico reducido, dTpa, en niños de 10 a 11 años de edad y en adultos / Immunogenicity and reactogenicity of a reduced antigen content diphteria, tetanus, acellular pertussis vaccine, dTpa, in 10 to 11 years old children and in adults

Background: New vaccination strategies are needed to control the increasing problem of pertussis in teenagers and adults. Aim: To determine the immunogenicity and reactogenicity of a diphtheria-tetanus-acellular pertussis (dTpa) vaccine with reduced antigen content. Material and Methods: A single dose of the dTpa vaccine was administered to 60 children 10 to 11 years old and 60 healthy adults. At the moment of vaccination and one month later, antibody levels were measured against 3 B pertussis antigens: anti-pertussis toxin (PT), anti-pertactin (PRN) and anti-filamentous hemagglutinin (FHA), as well as anti-tetanus and anti-diphtheria antibodies. Local and general symptoms were registered during 14 days following vaccine administration. Results: Antibody response for PT, FHA and PRN was 98.3 percent, 100 percent and 100 percent in adults and 98.2 percent, 100 percent and 98.2 percent in children. Seropositivity for all pertussis antigens was 100 percent in adults and in children one month after vaccination. Geometric mean titers (GMT) significantly increased in adults and children. The seroprotection level achieved for tetanus and diphtheria antibodies one month after vaccination was 96.7 percent for adults and 100 percent for children, respectively. No serious adverse events were reported during the study. Among local symptoms pain was the most frequent (88-90 percent), but it was mostly mild or moderate. Solicited general symptoms observed for children and adults, respectively, included headache (37 percent and 53 percent), fatigue (18 percent and 35 percent) gastrointestinal symptoms (18 percent and 25 percent) and fever (8 percent and 3 percent). Only one vaccinee had fever above 39­C. Conclusions: the dTpa vaccine showed an adequate safety profile and induced an intense immunological response to all antigens in adults and children aged 10-11

Dust mites but not grass pollen are important sensitizers in asthmatic children in the Ecuadorian Andes.

Grass pollen is an important cause of asthma and rhinoconjunctivitis in Europe and the United States. In the high Andes however, the role this pollen plays in respiratory allergies is unknown. In this study, we tested the prevalence of grass pollen sensitization in comparison to other aeroallergens on 433 asthmatic children living in Quito, Ecuador (the Andes mountain range, 2,800 m above sea level). The skin prick test technique was used. We found that the least sensitizing allergens of all were grass pollen (12.2%) and molds (7.4%) with p < 0.0001. A clear predominance of sensitization to the house dust mite Dermatophagoides pteronyssinus (77.8%) and Dermatophagoides farinae (76.9%), in comparison to the other aeroallergens tested, in terms of sensitization (p = 0.00000) and papule size (p < 0.0002), was observed. The most highly sensitized group consisted of asthmatics between 5 and 15 years of age (D. pteronyssinus 90.7%, D. farinae 87.5%, dog hair 37.4%, cat hair 43%, grass pollen 15.9% and molds 9.9%). In the total study group, males were only more sensitive than females to D. pteronyssinus (82.1% vs. 71.6%, p = 0.0009). We concluded that in the group of asthmatic children studied, grass pollen showed a low capacity of sensitization, even though it is widely found all over our city. The most sensitizing allergens were D. pteronyssinus and D. farinae, followed by cat and dog hair.

Emergencia de resistencia a macrólidos en streptococcus pyogenes / Emergence of macrolide resistant streptococcus pyogenes strains

Background: Diseases produced by Streptoccocus pyogenes are still a problem in Chile, as in the rest of the world. It exhibits in vitro susceptibility to different antimicrobials, but penicillin continues to be the treatment of choice. Alternative drugs have been developed for allergic patients, such as erythromycin, new macrolides and cephalosporins. Nevertheless, resistant strains are appearing due to the indiscriminate use of macrolides. Aim: To assess present antimicrobial susceptibility of S Pyogenes strains isolated from chilean patients. Material and Methods: The susceptibility to penicillin, macrolides, clindamycin, cephalotin and vancomycin of 153 S Pyogenes strains, obtained from different health centers of the Metropolitan Region and isolated between 1996 and 1998, was assessed using the Kirby-Bauer method. Agar dilution minimal inhibitory concentration was then determined to macrolide resistant strains. Results: All strains were susceptible to penicillin. There was a 7.2 percent cross-resistance to macrolides. Conclusions: These results confirm that S Pyogenes resistance to macrolides has increased considerably in the Metropolitan Region of Chile during the last years

Atresia intestinal yeyuno ileal: experiencia en 20 años / Jejuno ileal intestinal atresia: experience in 20 years

La estenosis y atresia jejunoileal (AYI) es la malformación congénita más común del tubo digestivo, siendo el síndrome de intestino corto congénito su consecuencia más extrema. Se realiza una revisión de las fichas de 26 pacientes con el diagnóstico de AYI en nuestro hospital entre los años 1980 y 1999 registrando el método de diagnóstico, el tratamiento quirúrgico y sus resultados. En esta serie el diagnóstico se realizó principalmente con los hallazgos clínicos, complementados con radiología simple del abdomen, y en algunos casos mejoró con ultrasonido prenatal. El 42 por ciento de los pacientes presentó eliminación de meconio o deposiciones; esta observación refuerza la teoría de un evento tardío en la gesta ción como mecanismo etiopatogénico. Se presenta una proporción mayor del tipo IIIb comparado con otras series. La nutrición patenteral total es fundamental como parte del tratamiento pero tiene complicaciones infecciosas y metabólicas que deben ser prevenidas, en especial en los menores con intestino corto

Resistencia a los antimicrobianos en agentes causantes de infección del tracto urinario en 11 hospitales chilenos: proyecto PRONARES / Antimicrobial resistance of agents causing urinary tract infections in 11 chilean hospitals: PRONARES project

Background: the computer program WHONET generates a common database to analyze local or general antimicrobial resistance of bacteria. A surveillance of agents causing urinary tract infections in Chile has been performed using this program. Aim: to report the results after 12 months of urinary tract infection agent surveillance. Material and methods: since november, 1997, a surveillance of in vitro antimicrobial resistance, using agar diffusion techniques, has been performed in 20 to 40 bacterial strains per month, isolated from 11 hospitals in the country. Results have been analyzed using WHONET program. Results: in first 12 months, 3144 strains, 1625 coming from outpatients, have been studied. Seventy four percent of isolated strains were E. coli, 19 percent were other enterobacteria, 4.1 percent were non fermenting bacilli and 2.1 percent were Gram (+) cocci. Sixty five percent of E coli strains were resistant to ampicillin, 11 percent to cefazolin, 2.5 percent to cefuroxime, 19 percent to ceftriaxone, 9 percent to ceftazidime, 4.2 percent to gentamicin 1.3 percent to amikacin, 5.6 percent to ciprofloxacin, 8.4 percent to grepafloxacin, 4.3 percent to nitrofurantoin and 43 percent to trimeproprim/sulphamethoxazole. Eighty two percent of other enterobacteria strains were resistant to ampicillin, 45.5 percent to cefazolin, 33.5 percent to cefuroxime, 26.6 percent to ceftriaxone, 21.5 percent to ceftazidime, 30.3 percent to gentamicin 17.2 percent to amikacin, 21 percent to ciprofloxacin, 16.3 percent to grepafloxacin, 48.2 percent to nitrofurantoin and 44.6 percent to trimeproprim/sulphamethoxazole. There were differences in betalactamic resistance among hospitals. Conclusions: noteworthy is the high resistance rates to third generation cephalosporins, evidenced when the new cutoff values for E coli and klebsiella spp are used. This national surveillance provides updated information on antimicrobial resistance of agents causing urinary tract infections

Severe allergic conjunctivitis and chemosis caused by disodium cromoglycate.

A 63-year-old man with chronic, nonallergic rhinoconjunctivitis presented immediate adverse reactions, such as intense itching, burning, redness and severe swelling of both conjunctivae after using disodium cromoglycate eye drops. Skin prick tests and conjunctival provocation tests were positive with pure disodium cromoglycate. Circulating IgE-specific antibodies to disodium cromoglycate in serum were demonstrated by RAST. We suggest that the acute ocular reaction was caused by disodium cromoglycate and that the underlying mechanism was probably an IgE-mediated immunological reaction.

[Diagnostic difficulties in the narcolepsy-catalepsy syndrome: with reference to our series of cases]. / Dificultades diagnósticas en el síndrome narcolepsia-cataplejía: a propósito de nuestra casuística.

The narcolepsy-cataplexy syndrome is a disorder of unknown aetiology, characterized by excessive daytime sleepiness associated with cataplexy and other REM sleep phenomena. Diagnosis is based on the clinical findings, although this may be difficult especially with respect to confirming the cataplexy. Objective tests, such as typing for HLA, DR2DQ1 (DRw15DQw6, WHO90) and above all TMLS (average latency < 5 mn and two or more onsets of sleep in the phases REM and SOREMP's) is of great help. However, the exact diagnostic significance of some aspects of these tests and their parameters is still under discussion. In this paper we review our series of cases consisting of fourteen patients who fulfil the clinical diagnostic criteria required in the ICSD-1990. TMLS and HLA typing was done for all. Of the HLA types, DQ1 was present in all our patients, unlike DR2 which was not found in two patients. Regarding TMLS, the average latency < 5 mn is a parameter met by all cases, although one did not have SOREMP's. The findings of the objective tests done on our patients are in agreement with those described by other authors. They underline the significance of the support they lend to the diagnosis. However, they are not the definite answer to the problem.

Asthma and its relation with Dermatophagoides pteronyssinus and Dermatophagoides farinae in Andean altitudes (Quito, Ecuador).

Previous investigations in alpine altitudes suggest a very low etiopathogenic relation between house-dust mites and bronchial asthma in these geographical zones. Our purpose was to analyze the relationship between asthma and sensitization to the house-dust mites D. pteronyssinus and D. farinae in Andean altitudes. We studied 587 asthmatic patients, residents in Quito, Ecuador, (2800 m above sea level), ranging in age from 8 months to 84 years. The patients were divided into five age groups. We investigated the prevalence of house-dust mite sensitization by skin prick tests in each group. Fifty asymptomatic students with ages between 6 to 20 years old were studied as a control group. Three hundred and thirty asthmatic patients (56.2%) were sensitized to house-dust mites while only 15 (30%) of the 50 asymptomatic students were sensitized (p < 0.01). The percentage of asthmatics sensitized followed an age-dependent curve that began with the children under 6 years old (45.1%), reached its maximum between 12 and 19 years old (79.0%) and decreased to 25.8% in asthmatics older than 40 years. The differences among these groups were statistically significant (p < 0.01). Also, we observed a significant prevalence in sensitization (p < 0.01) in males versus females. The mean size of the skin reaction obtained with D. pteronyssinus and D. farinae was larger (p < 0.001) in the 12-19 year olds than in the group of asthmatics over 40 years old. It was also greater in the asthmatics with chronic rhinitis than in the group of asthmatics without nasal symptoms (p < 0.01). We suggest that the house-dust mites D. pteronyssinus and D. farinae are an important source of allergens in the pathogenesis of bronchial asthma in patients who live in the high Andes.