Asociación entre gastritis biliar y gastritis por Helicobacter pylori en pacientes con reflujo duodenogástrico en el Hospital Central Militar / Association between biliary gastritis and gastritis by Helicobacter pylori in patients with duodenogastric reflection in the Military Central Hospital

Resumen Introducción: Esta investigación está orientada a conocer si existe una asociación (directa o indirecta) entre el reflujo duodenogástrico y las gastritis crónicas por Helicobacter pylori. Material y Metodo: Se recolectaron los datos de pacientes a quienes se les realizó panendoscopía diagnóstica en el departamento de endoscopia del Hospital Central Militar desde marzo del 2018 a febrero del 2019, por medio de una entrevista clínica y una hoja de recolección de datos. Resultados: Del grupo evaluado con reflujo duodenogástrico, el 44.1% (202 casos) presentaron gastritis química por reporte histopatológico. En el grupo de pacientes con reflujo duodenogástrico y gastritis química o biliar (n=202), el 22.7% (46 casos) presentó en el reporte histopatológico gastritis por Helicobacter pylori. En los pacientes con reflujo duodenogástrico y sin gastritis biliar (n=256), el 92.57% (237 casos) presentó gastritis por Helicobacter pylori en el reporte histopatológico. Discusión: Existe una asociación alta de tipo indirecto entre la gastritis biliar y gastritis por Helicobacter pylori en pacientes con reflujo duodenogástrico o biliar. Aproximadamente la mitad de los pacientes con reflujo duodenogástrico presentan gastritis biliar con el riesgo de desarrollar metaplasia intestinal. La gastropatía mixta (gastritis biliar y por Helicobacter pylori) es un factor de riesgo para mayor daño a la mucosa gástrica, como es la expresión de metaplasia intestinal.

Abstract Introduction: This research is oriented to know if there is an association (direct or indirect) between duodenogastric reflux and chronic gastritis by Helicobacter pylori. Material and Method: We collected data from patients who underwent diagnostic panendoscopy in the endoscopy department of the Central Military Hospital from March 2018 to February 2019, through a clinical interview and a data collection sheet. Results: Of the group evaluated with duodenogastric reflux, 44.1% (202 cases) presented chemical gastritis due to histopathological report. In the group of patients with duodenogastric reflux and chemical or biliary gastritis (n = 202), 22.7% (46 cases) presented gastritis due to Helicobacter pylori in the histopathological report. In patients with duodenogastric reflux and without biliary gastritis (n = 256), 92.57% (237 cases) presented gastritis due to Helicobacter pylori in the histopathological report. Discussion: There is a high association of indirect type between biliary gastritis and gastritis due to Helicobacter pylori in patients with duodenogastric or biliary reflux. Approximately half of the patients with duodenogastric reflux present biliary gastritis with the risk of developing intestinal metaplasia. Mixed gastropathy (biliary gastritis and Helicobacter pylori) is a risk factor for greater damage to the gastric mucosa, such as the expression of intestinal metaplasia.

Reporte de caso: manejo multidisciplinario en gestante con embarazo de 31 semanas y COVID-19 positivo con evolución grave / Case report: multidisciplinary management in case of 31 weeks pregnant woman and COVID 19 infection with severe disease presentation

INTRODUCCIÓN: En diciembre de 2019 se reporta un brote de neumonía atípica causada por un nuevo coronavirus: SARS-CoV-2 (Severe Acute Respiratory Syndrome-Coronavirus-2), cuya enfermedad se denomina COVID-19 (Coronavirus Disease 2019). Desde entonces su distribución se ha ampliado mundialmente causando una emergencia en los sistemas de salud. MÉTODO: Corresponde al reporte de caso clínico. Este estudio es descriptivo y se basa en el manejo realizado a paciente embarazada con COVID-19 confirmado. Esta publicación cuenta con la autorización del comité de ética local para la revisión de ficha clínica. CASO: Mujer de 40 años con un embarazo de 31 semanas, se le diagnostica COVID-19 tras contacto estrecho con caso confirmado. Evoluciona con disnea y por posibilidad de interrupción del embarazo se traslada a centro de mayor complejidad. Allí se pesquisa compromiso de función pulmonar, uso de musculatura accesoria y alteración sensorial, requiriendo oxigenoterapia. Se evalúa interdisciplinariamente decidiendo intubar y realizando manejo en unidad de cuidados intensivos (UCI). Se realiza cesárea de urgencia a las 31+4 semanas debiendo realizarse histerectomía total por inercia uterina. Tras el procedimiento evoluciona tórpidamente con deterioro de función pulmonar, describiéndose un pronóstico catastrófico con probabilidad de fallecer por insuficiencia respiratoria. Un mes después despierta con una mejoría en su función pulmonar, sin otra falla orgánica. Actualmente se encuentra en buenas condiciones y es tratada multidisciplinariamente para lograr una rehabilitación integral. DISCUSIÓN: En epidemias pasadas, las embarazadas mostraron altas tasas de letalidad y riesgo de ingreso a UCI. Basados en una revisión de reportes de casos, parece ser que COVID-19 durante el embarazo se asocia a morbilidad materna severa, riesgo que aumenta en mujeres con comorbilidades, lo cual hace cuestionarnos si la infección por COVID-19 intensifica el riesgo materno o estos casos ya eran embarazos de riesgo. Se necesitan futuras investigaciones al respecto.

INTRODUCTION: The coronavirus disease 2019, caused by severe acute respiratory syndrome coronavirus 2, was first reported in december 2019 in China as an atypipical pneumonia. Since then its distribution has globally expanded causing a public health emergency. METHOD: Corresponds to a case report. A descriptive study about the management of a pregnant woman whith COVID-19. CASE: A 40 year old pregnant woman, 31 weeks gestational age, was admitted with a diagnosis of COVID-19. She developed dyspnea and preterm birth risk that needed a more complex hospital level. Thereafter, the patient developed respiratory distress, use of accessory breathing muscles and neurological alteration, requiring oxygen therapy. An interdisciplinary medical team evaluation decided to manage her condition at intensive care unit (ICU). Cesarean delivery was performed at 31+4 weeks. After the procedure, the pulmonary function declined to a life threatening condition. A month later, the patient woke up with improved pulmonary function, without any organ failure. Currently the patient is in a good general condition with a multidisciplinary rehabilitation treatment ongoing. DISCUSSION: In previous epidemic outbrakes, pregnant women presented high fatality rates and intensive care tratment risk. Based on a case report review, COVID-19 in pregnancy is associated with severe maternal morbidity, specially in women with associated comorbidities. This situation raises the question whether the COVID-19 infection intensifies the maternal risk or whether these cases were already a high risk pregnancies. Additional studies are needed to answer this issue.

Propuestas para ampliar la cobertura de salud mental infantil en Chile / Proposals to expand the coverage of Child Mental Health in Chile / Propostas para expandir a cobertura de saúde mental infantil no Chile

Las experiencias tempranas de vida impactan de manera significativa en la arquitectura del cerebro del infante, pudiendo fortalecerla o debilitarla permanentemente. La sintomatología psicológica presente en la infancia no es transitoria, por lo que la intervención temprana supone beneficios directos, tanto sociales como económicos. El presente trabajo propone fundamentar, con base en los hallazgos de la literatura más reciente, la incorporación en Chile de nuevas Garantías Explícitas en Salud, destinadas específicamente a tratar patologías mentales de la infancia. Se argumenta que se trata de una política pública altamente eficiente, capaz de aportar significativamente en la disminución tanto de los costes asociados a Salud Mental como de las brechas de equidad en salud.

Early life experiences can make an important impact in the architecture of the infant's brain, which can strengthen or weaken it permanently. The childhood psychological symptomatology is not fleeting, so early intervention involves direct social and economic benefits. This paper offers, based on the most recent findings, the addition of new Health Care Guarantees specifically aimed to treating mental pathologies in childhood. This public policy has been shown to be highly efficient and capable to make a real contribution to the reduction of both, the costs associated with Mental Health and the equity gaps in child health care.

As experiências iniciais da vida afetam significativamente a arquitetura do cérebro da criança, que pode fortalecê-lo ou enfraquecê-lo permanentemente. A sintomatologia psicológica presente na infância não é transitória, portanto a intervenção precoce envolve benefícios sociais e econômicos diretos. O presente trabalho propõe basear, com base nos achados da literatura mais recente, a incorporação no Chile de novas Garantias Explícitas de Saúde especificamente voltadas ao tratamento de patologias mentais da infância. Argumenta-se que se trata de uma política pública altamente eficiente, capaz de contribuir significativamente para a redução tanto dos custos associados à Saúde Mental quanto das disparidades de equidade em saúde.

Disintegrins extracted from totonacan rattlesnake (Crotalus totonacus) venom and their anti-adhesive and anti-migration effects on MDA-MB-231 and HMEC-1 cells.

Disintegrins are low molecular weight cysteine-rich proteins (4-14 kDa) that are isolated mainly from viperid snake venom. Due to their potential as lead compounds for binding and blocking integrin receptors, snake venom disintegrins have become one of the most studied venom protein families. The aim of this study was to obtain disintegrins from C. totonacus venom and evaluate their capability to bind and block integrin receptors. The C. totonacus disintegrin fraction (totonacin) represents two disintegrin isoforms obtained from C. totonacus venom. These disintegrins showed extracellular-matrix (ECM) protein adhesion and migration inhibitory effects on MDA-MB-231 and HMEC-1 cells. Totonacin (3 µM) inhibited MDA-MB-231 cell adhesion to the ECM proteins, fibronectin, vitronectin, and laminin by 31.2, 44.0, and 32.1, respectively. Adhesion inhibition to fibronectin, vitronectin, and laminin observed on HMEC-1 cells was 42.8, 60.8, and 51%, respectively. In addition, totonacin (3 µM) significantly inhibited MDA-MB-231 and HMEC-1 cell migration (41.4 and 48.3%, respectively). Totonacin showed more potent cell adhesion inhibitory activity toward vitronectin in both cell lines. These results suggest a major affinity of totonacin toward αVß3, α8ß1, αVß5, αVß1, and αIIbß3 integrins. In addition, the inhibitory effect observed on MDA-MB-231 and HMEC-1 cell migration reinforces the evidence of an interaction between these disintegrins and αVß3 integrin, which plays a key role in migration and angiogenesis.

[Presumed consent and reciprocity as means to increase organ availability for transplantation]. / El consentimiento presunto y la reciprocidad como mecanismos para aumentar la donación de órganos.

Chile became the third country in the world (after Israel and Singapore) to introduce the rule of reciprocity to receive an allograft. This means that if an individual opts for not being an organ donor, loses priority to receive a transplant. Despite the difficulties associated with its implementation, the recent Chilean reform that also incorporated the presumed consent, should be studied by those countries that are trying to overcome the severe lack of organ availability for transplantation.

Gastrectomía en manga: estudio por imágenes de sus complicaciones / Laparoscopic sleeve gastrectomy: imaging study of its complications

The incidence of obesity in Chilean adult population reaches up to 25.1 percent, according to statistics from 2013. Bariatric surgery is an alternative that has proven weight loss and resolution of comorbidities significant long term. For this reason are routine procedures in different health institutions. However, its massification and safety are not free of complications, which can be detected and treated early with the help of radiological images. The aim of this paper is to describe the most common postoperative complications of the sleeve gastrectomy and its diagnosis using different imaging techniques, mainly fluoroscopic study contrasted of the the esophagus-stomach-duodenum and contrasted enhanced computed tomography (CT) of the abdomen and pelvis. Bariatric surgeries are now routine procedures for treatment of morbid obesity. Knowledge of early and late complications and diagnosis of these using different imaging techniques allow adequate treatment, control and decreased postoperative morbidity and mortality.

La incidencia de obesidad en la población adulta chilena alcanza hasta un 25,1 por ciento, de acuerdo a cifras del año 2013. Las cirugías bariátricas son una alternativa que ha demostrado una baja de peso y resolución de comorbilidades significativas a largo plazo. Por este motivo son procedimientos rutinarios en las diferentes instituciones de salud. No obstante su masificación y seguridad, no están exentas de complicaciones, las que se pueden detectar y tratar precozmente con la ayuda de imágenes radiológicas. El objetivo de este trabajo es describir las complicaciones postquirúrgicas más frecuentes de la gastrectomía en manga y el diagnóstico mediante diferentes técnicas de imagen, principalmente el estudio fluoroscópico contrastado del esófago-estómago-duodeno y tomografía computada (TC) contrastada de abdomen y pelvis. El conocimiento de las complicaciones tempranas y tardías, así como el diagnóstico de éstas mediante las diferentes técnicas de imagen permitirá un adecuado tratamiento, control post operatorio y disminución de la morbimortalidad.

El consentimiento presunto y la reciprocidad como mecanismos para aumentar la donación de órganos / Presumed consent and reciprocity as means to increase organ availability for transplantation

Chile became the third country in the world (after Israel and Singapore) to introduce the rule of reciprocity to receive an allograft. This means that if an individual opts for not being an organ donor, loses priority to receive a transplant. Despite the difficulties associated with its implementation, the recent Chilean reform that also incorporated the presumed consent, should be studied by those countries that are trying to overcome the severe lack of organ availability for transplantation.

[A proposal for the definitive reform of the private health insurance system in Chile]. / Propuesta para la reforma definitiva del sistema privado de salud chileno.

Private health insurance should be able to provide coverage to people considered as high risk, such as women and the elderly. The only way to do that is to organize implicit or explicit cross-subsidies from low to high-risk individuals. This paper examines how European private health insurance companies introduced regulatory measures that could be introduced in Chile such as open enrollment, community-rated premiums, lifetime coverage, a package of minimum benefits and a risk equalization scheme.

Lemon grass (Cymbopogon citratus (D.C) Stapf) polyphenols protect human umbilical vein endothelial cell (HUVECs) from oxidative damage induced by high glucose, hydrogen peroxide and oxidised low-density lipoprotein.

The aromatic herb Cymbopogon citratus Stapf is widely used in tropical and subtropical countries in cooking, as a herbal tea, and in traditional medicine for hypertension and diabetes. Some of its properties have been associated with the in vitro antioxidant effect of polyphenols isolated from their aerial parts. However, little is known about C. citratus effects on endothelial cells oxidative injury. Using chromatographic procedures, a polyphenol-rich fraction was obtained from C. citratus (CCF) and their antioxidant properties were assessed by cooper-induced LDL oxidation assay. The main constituents of the active CCF, identified by high-performance liquid chromatography with diode-array detection and mass spectrometry (HPLC-DAD-MS), were chlorogenic acid, isoorientin and swertiajaponin. CCF 10 and 100 µg/ml diminishes reactive oxidative species (ROS) production in human umbilical vein endothelial cell (HUVECs), challenged with high D-glucose (60% inhibition), hydrogen peroxide (80% inhibition) or oxidised low-density lipoprotein (55% inhibition). CCF 10 or 100 µg/ml did not change nitric oxide (NO) production. However, CCF was able to inhibit vasoconstriction induced by the thromboxane A2 receptor agonist U46619, which suggest a NO-independent vasodilatador effect on blood vessels. Our results suggest that lemon grass antioxidant properties might prevent endothelial dysfunction associated to an oxidative imbalance promoted by different oxidative stimuli.

[Strengths and difficulties in emotional adjustment of Aymara children from the perspective of children, parents and teachers]. / Fortalezas y dificultades para el ajuste emocional en niños aymara desde la perspectiva de los menores, padres y profesores.

OBJECTIVE: To describe capabilities and difficulties in emotional adjustment experienced by children living in the Chilean Aymara city of Arica. PATIENTS AND METHOD: 610 students between 5th and 8th grade, in addition to their parents and teachers were surveyed using the Strengths and Difficulties Questionnaire (SDQ), comparing Aymara children to those without indigenous heritage. 25 items divided into five scales were evaluated: Emotional, behavioral problems, hyperactivity, relationship problems with peers and prosocial behaviors, classifying the respondents into three levels, Normal, Border and Abnormal. RESULTS: There were no significant differences among the groups studied, where discrepancies in almost all cases show a slight effect (d≥|0.2|). Also, no relevant effects were observed regarding the type of assessor on the assessment of each dimension. Despite this, it was observed that Aymara children showed lower scores than their peers in "behavioral problems" according to their teachers, but this difference was also mild (partial η2>0.01). CONCLUSIONS: Aymara Children showed similar strengths and difficulties than non-Aymara students in situations that require emotional adjustment.

[Private health insurance systems, constitution and the right to receive an equitable health care]. / Isapres, tribunal constitucional y distribución del derecho a cuidado sanitario.

This paper analyzes the constitutional problems that the private health system has faced as a result of the recent decisions of the Constitutional Court and the Supreme Court of Chile in defense of the right to health care and nondiscrimination. It also reviews the comparative literature on health systems that have been successful in the task of reconciling the demands of equity and efficiency in the delivery of health care in the private health sector, in accordance with the constitutional principles of equality and nondiscrimination.

Vitamin C transporters.

Vitamin C is a wide spectrum antioxidant essential for humans, which are unable to synthesize the vitamin and must obtain it from dietary sources. There are two biologically important forms of vitamin C, the reduced form, ascorbic acid, and the oxidized form, dehydroascorbic acid. Vitamin C exerts most of its biological functions intracellularly and is acquired by cells with the participation of specific membrane transporters. This is a central issue because even in those species capable of synthesizing vitamin C, synthesis is restricted to the liver (and pancreas) from which is distributed to the organism. Most cells express two different transporter systems for vitamin C; a transporter system with absolute specificity for ascorbic acid and a second system that shows absolute specificity for dehydroascorbic acid. The dehydroascorbic acid transporters are members of the GLUT family of facilitative glucose transporters, of which at least three isoforms, GLUT1, GLUT3 and GLUT4, are dehydroascorbic acid transporters. Ascorbic acid is transported by the SVCT family of sodium-coupled transporters, with two isoforms molecularly cloned, the transporters SVCT1 y SVCT2, that show different functional properties and differential cell and tissue expression. In humans, the maintenance of a low daily requirement of vitamin C is attained through an efficient system for the recycling of the vitamin involving the two families of vitamin C transporters.

Simple intratesticular cysts in children: preoperative sonographic diagnosis and histological correlation.

BACKGROUND: Simple intratesticular cysts are rare in children and have been considered the most uncommon cause of scrotal cystic masses in this age group. The exact etiology of these lesions is still unclear. High-resolution ultrasonography has been proved to be a reliable and accurate imaging modality in the evaluation of scrotal abnormalities in children. PATIENTS AND METHODS: We report the sonographic findings in five boys aged from 4 to 10 months who presented with a scrotal mass and had a simple intratesticular cyst. Ultrasonography showed that all of them displayed a characteristic appearance and provided the necessary information to perform conservative surgery, with testicular preservation in four infants. In one infant, the cyst involved most of the testis, and an orchiectomy was performed. RESULTS: Pathological examination revealed a single smooth-walled cystic structure, with clear and serous fluid, lined with flattened epithelial cells in all of the infants. CONCLUSION: Our findings appear to support the hypothesis that these cysts could correspond to mesothelial inclusions. Sonographically, differential diagnosis should include mainly epidermoid cysts of the testis, which are mostly cystic but characteristically contain some echoes within them, in contrast to simple cysts and cysts of the tunica albuginea, which lie outside the testicular parenchyma.

Digesto de jurisprudencia boliviana

Contiene: Prologo al digesto de jurisprudencia boliviana de los Dres. F. Yves Ortiz Zuniga y Carlos Hugo Pinilla O. Jurisprudencia de la (A - N)

Colecistectomía laparoscópica en menores de 15 años de edad / Laparoscopic cholecystectomy in patients under 15 years old

La colecistectomia laparoscópica es hoy el tratamiento de elección en el tratamiento quirúrgico de la colelitiasis. Esta patología es poco frecuente en niños. De un total de 1205 pacientes operados en el período mayo de 1994 hasta mayo 1996, 10 eran menores de 15 años. Edad promedio de 9,9 años; 4 de sexo masculino y 6 de sexo femenino. El motivo de consulta fue dolor abdominal en todos los casos, 2 pacientes se presentaron como colecistitis aguda y se intervinieron de urgencia, el resto en forma electiva. Todos se operaron usando técnica francesa. Se realizó colangiografía intraoperatoria en 2 pacientes. Su evolución postoperatoria fue satisfactoria en todos los casos. No hubo complicaciones. El alta fue a los 1,9 dias en promedio y se reintegraron a sus actividades normales precozmente luego del alta

Red asistencial extrapsiquiátrica: tratamiento de pacientes psicóticos de evolución prolongada / Extrapsychiatric assistance net: treatment of psychotic patients of prolonged evolution

El trabajo da cuenta de la experiencia adquirida por la unidad de psicofármacos del Servicio de Psiquiatría de Valdivia al implantar en el curso de una década (1986-1996) una red asistencial extrapsiquiátrica para la mantención del tratamiento de sostén con neurolépticos de depósito de pacientes psicóticos de larga evolución. La consideración de las características geográfico-climatológicas y viales de la provincia de Valdivia, centros de atención del nivel primario de salud, subcentrales de neurolépticos de depósito, atención ambulatoria constituyen los fundamentos de la puesta en práctica y desarrollo de un modelo de atención descentralizado

Estudio clínico y epidemiológico de un brote de beriberi húmedo en Cartagena de Indias, Colombia, 1992-1993 / Clinical and epidemiologic study of an outbreak of wet beriberi in Cartagena the Indias, Colombia, 1992-1993

La presente investigación ha tenido como objetivo primordial aclarar la etiología de un cuadro clínico caracterizado por edema de las piernas, disestesias con déficit motor en miembros inferiores que, en dos casos, incluyó una cardiopatía que llevó a insuficiencia cardiaca irreversible. Este brote ocurrió entre julio de 1991 y junio de 1993; afectó selectivamente infantes de marina de la Escuela Naval Almirante Padilla en Cartagena de Indias. La metodología se centró en un estudio de casos y controles en el cual se sometió a cada grupo a un cuidadoso interrogatorio, examen clínico, medición por el laboratorio de metales pesados en sangre y orina de 24 horas y estudio de niveles de tiamina en muestras de suero,; se analizaron cuatro biopsias de nervio sural y en el estudio postmorten de los fallecidos se puso especial atención a las alteraciones de miocardio. En muestras ambientales y biológicas, se analizó mercurio, plomo, arsénico y talio. Los resultados totalizan un grupo de 22 infantes de marina con un cuadro muy uniforme sobre todo por las manifestaciones de una neuropatía periférica nutricional, lo cual sumado a la cardiopatía fatal en dos pacientes, cuyo estudio tanto en microscopia de luz como electrónica demostró cambios en todo compatibles con lo observado en beriberi, permiten que se considere que el problema de fondo reune las características del beriberi humedo. Después de concluir que el problema tenía como fondo un origen nutricional basado, en primer lugar, en una falla de tiamina, se hicieron las recomendaciones y ajustes dietéticos indicados para estos casos con una respuesta inmediata y enteramente satisfactoria