Enmascaramiento clínico: una revisión de la literatura / Clinical masking: a literature review

Son diversos los métodos planteados para aplicar enmascaramiento, de esta forma es necesario revisar la literatura en búsqueda de consenso. Se revisaron críticamente los métodos utilizados y recomendados por la literatura y sociedades internacionales, en torno a la aplicación de enmascaramiento. Se consultó entre agosto y noviembre de 2015 en PUBMED, SciELO y Google Scholar por estudios acerca de métodos de enmascaramiento utilizados en audiometría. También se revisaron las guías de organizaciones internacionales y lo publicado en libros relacionados con el área de audiología. El método de "La Meseta" es el más referenciado, siendo modificado posteriormente. Existen variaciones en criterios de atenuación interaural, necesidad de enmascaramiento, enmascaramiento inicial, incrementos para obtener la meseta y niveles del efecto de oclusión. Se concluye que la literatura muestra diferencias al momento de decidir cuándo enmascarar y cómo hacerlo. No obstante, se puede establecer criterios comunes en relación a los niveles de atenuación interaural, cuándo enmascarar, valores de efecto de oclusión y metodología. El método de "La Meseta" sigue siendo el más recomendado. La modificación realizada por Yacullo es la más referenciada y recomendada en la literatura actual.

Adequate use of masking is key in the correct diagnosis of hearing loss. Various methods are suggested regarding the application of clinical masking, hence the need to review literature in order to reach a consensus. To critically review the specialized literature and international societies' recommendations regarding clinical masking. From August to November 2015, PUBMED, SciELO and Google Scholar articles on clinical masking methods used in tonal audiometries were consulted, as well as international organization guidelines, and literature in the area of Audiology. Hood's plateau method, later revised, received the most references. The modified versions consider the number of increments needed to determine the true threshold, and the occlusion effect. Optimized methods show the variations regarding interaural attenuation, need for masking, initial masking level, increments to reach "The Plateau", and the occlusion effect. Literature shows differences regarding when and how to use masking; however, common criteria can be established with reference to the levels of interaural attenuation, when to use masking, occlusion effect values and methodology. The plateau method proposed by Hood is still the most recommended. Yacullo's optimization is currently the one with the most references and recommendations in specialized literature.

Adherencia al control nutricional en varones con patologías crónicas / Adherence to nutritional check-up in men with chronic diseases

Introduction: One of the goals presented by the Cardiovascular Health Program (CHP) in Chile is the reduction of risk factors asso-ciated with metabolic syndrome. A part of the monitoring is achieved through check-ups and inquiries carried out by a multidisciplinary team, in which a nutritionist takespart. Objective: Interpret theperception of male adults, patients of the Boca Sur Cesfam and users of CHP, on the factors promoting attendance to nutritional check-ups. Subjects and methods: Using an interpretative quali-tative paradigm with a phenomenological approach, theoretical saturation was acomplished during the tenth interview to male adults who fulfiulled the selection criteria of the study. Results: It is interpreted that the interviewees have various motives and interests in attending nutritional check-ups of the CHP. The most prominent ones are taking care of theirgeneral health, and control of the underlying disease. Family, especially their partners; the relationship built between the nutritionist and the patient, strenghtened by communication and trust are found to have a positive effect on the patient attending regularly to check-ups. Conclusions: That adherence to nutritional check-ups is favored by motivated male adults who seek to improve their quality of life attending a nutritional consultation, usually encouraged by their families, especially their spouses or partners. Also, when the relationship established with the professional helping them is perceived as positive. Friends are not considered influential on the attendance and monitoring of their underlying disease.

Introducción: Entre las metas que presenta el Programa de Salud Cardiovascular (PSCV) en Chile están la disminución de los factores de riesgo asociados al síndrome metabólico. Parte de su seguimiento se realiza a través de controles y consultas realizadas por un equipo multidisciplinario, en el que participa el nutricionista. Objetivo: Interpretar la percepción de adultos de sexo masculino, atendidos en el Cesfam Boca Sur y usuarios del PSCV, sobre los factores que favorecen la concurrencia al control por nutricionista. Sujetos y métodos: Utilizando el paradigma cualitativo interpretativo con enfoque fenomenológico, se logra el punto de saturación del estudio en la décima entrevista de varones adultos que cumplieron con los criterios de selección del estudio. Resultados: Se interpreta que los sujetos entrevistados presentan diversas motivaciones e intereses en asistir a los controles nutricionales del PSCV, en el que predomina el cuidado de su estado de salud y el control de su patología de base. La familia, en especial la pareja, la relación que se establece entre el nutricionista y el paciente, fortalecido esto último por la comunicación y confianza que se estable, actúa positivamente en la asistencia a la consulta en forma regular. Conclusión: Los varones adultos que asisten a una consulta nutricional, están motivados en mejorar su calidad de vida, siendo apoyados por la familia en especial por su esposa o pareja estable y percibiendo positivamente la relación que se forja con el profesional que lo atiende, lo que favorece la adherencia a sus controles. Los amigos no son considerados como influyentes en la asistencia y el control de su patología de base.

Integrating chemohormonal therapy and surgery in known or suspected lymph node metastatic prostate cancer.

BACKGROUND: Prostate cancer persisting in the primary site after systemic therapy may contribute to emergence of resistance and progression. We previously demonstrated molecular characteristics of lethal cancer in the prostatectomy specimens of patients presenting with lymph node metastasis after chemohormonal treatment. Here we report the post-treatment outcomes of these patients and assess whether a link exists between surgery and treatment-free/cancer-free survival. METHODS: Patients with either clinically detected lymph node metastasis or primaries at high risk for nodal dissemination were treated with androgen ablation and docetaxel. Those responding with PSA concentration <1 ng ml(-1) were recommended surgery 1 year from enrollment. ADT was withheld postoperatively. The rate of survival without biochemical progression 1 year after surgery was measured to screen for efficacy. RESULTS: Forty patients were enrolled and 39 were evaluable. Three patients (7.7%) declined surgery. Of the remaining 36, 4 patients experienced disease progression during treatment and 4 more did not reach PSA <1. Twenty-six patients (67%) completed surgery, and 13 (33%) were also progression-free 1 year postoperatively (8 with undetectable PSA). With a median follow-up of 61 months, time to treatment failure was 27 months in the patients undergoing surgery. The most frequent patterns of first disease recurrence were biochemical (10 patients) and systemic (5). CONCLUSIONS: Half of the patients undergoing surgery were off treatment and progression-free 1 year following completion of all therapy. These results suggest that integration of surgery is feasible and may be superior to systemic therapy alone for selected prostate cancer patients presenting with nodal metastasis.

Caries e índice de higiene oral en niños con diabetes mellitus tipo 1 / Dental caries and hygiene oral index in children with diabetes mellitus type 1

Introducción: La diabetes mellitus tipo 1 (DM1) influye en la salud oral. Una alta glicemia podría asociarse a una disminución del flujo salival, acumulo de placa bacteriana y formación de caries. Nuestro objetivo fue determinar la prevalencia de caries e índice de higiene oral (IHO) en niños con DM1 de la Región del Maule-Chile del año 2008. Pacientes y Método: Se diseñó un estudio de corte transversal. Se examinó población menor de 15 años con DM1 del Hospital Regional de Talca. Se registró historia de caries (dientes cariados/obturados/ perdidos) según índice COPD-ceod; IHO (> 1,2 alto acumulo de placa) y potencial cariogénico de dieta (alto/ medio/bajo). Se analizó la relación estadística entre historia de caries con sexo, IHO y dieta. Resultados: 25 niños con DM1 fueron analizados. La prevalencia de caries fue 92 por ciento siendo mayormente en hombres (p = 0,03) y asociada a una mala higiene (p < 0,01). El promedio COPD-ceod fue 2,96 +/- 2,33 y 2 +/- 2,64 respectivamente. El IHO promedio fue 1,8 +/- 2,64 siendo 84 por ciento tipo mala. 21 niños (84 por ciento) tuvieron un potencial cariogénico de dieta bajo, no asociándose a la presencia de caries (p = 0,17). Conclusión: La salud oral de los niños DM1 fue precaria pudiendo corresponder directamente a la mala higiene oral y no con la dieta consumida.

Introduction: Type 1 Diabetes mellitus (DM1) undeniably affects oral health. High glucose levels may be associated with low salivary flow, accumulation of plaque and tooth decay. The objective of this study is to determine the prevalence of caries and Oral Hygiene Index (OHI) in children with DM1 in Maule Region, Chile during 2008. Patients and Method: A cross-sectional study was designed to examine patients under 15 years old with DM1, who were admitted to Talca Regional Hospital. History of caries (decayed, sealed and lost teeth) was registered according to the COPD-dmft index, OHI (> 1.2 high accumulation of plaque) and potential of cariogenic diet (high, medium or low). The statistical relationship between caries history and gender, OHI and diet was analyzed. Results: 25 children cases with DM1 were studied; the prevalence of caries was 92 percent, which was mostly in boys (p = 0.03) and associated with poor hygiene (p < 0.01). The average COPD- ceod index was 2.96 +/- 2.33 and 2 +/- 2.64 respectively. The average OHI was 1.8 +/- 2.64, 84 percent corresponded to bad oral hygiene. 21 children (84 percent had a diet with low cariogenic potential, not associated to the presence of caries (p = 0.17). Conclusion: The children oral health was precarious and it may be associated directly with poor oral hygiene and not with the food consumed.

Estudio cualitativo sobre la percepción de estudiantes universitarios sobre horario de almuerzo / Qualitative study on college student’s perceptions on lunch

Introducción: La alimentación saludable permite el óptimo crecimiento y desarrollo del individuo. Una dieta sana es el resultado de la combinación adecuada de macro y micronutrientes, la cual debe ser suficiente, moderada, equilibrada y variada. La dieta puede ser modificada a través del trascurso de la vida, considerándose el acceso a la universidad un momento crucial para el fortalecimiento de los hábitos alimentarios. Metodología: el objetivo de esta investigación es interpretar la percepción que poseen los estudiantes universitarios sobre el horario de almuerzo. Para obtener resultados se utilizó un diseño cualitativo con enfoque fenomenológico. La recolección de datos se realizó a través de una encuesta semiestructurada. Se entrevistó a 15 estudiantes que cumplían con los criterios de selección de la investigación. Los resultados fueron analizados por los investigadores principales mediante análisis de contenido. Resultados: los entrevistados identifican el almuerzo como uno de los principales horarios de comida y que su práctica habitual contribuye a la mejora de los hábitos alimentarios. Los entrevistados refieren que una de las principales causas para no cumplir con este horario de alimentación es la falta de tiempo debido a la carga académica. Conclusión: se concluye que los estudiantes perciben que es importante realizar el horario de almuerzo a diario, sin embargo declaran no consumir almuerzo durante gran parte de la semana académica.

Introduction. A healthy diet leads to optimal growth and development of the individual. A healthy diet is the result of the right combination of macro and micronutrients, which should be sufficient, moderate, balanced and varied. Diet can be modified through the course of life, while the university period is a crucial time to strengthen proper food habits. Methods. The purpose of this investigation is to interpret the perception that college students have about lunchtime. A qualitative design with a phenomenological approach was used. Data collection was conducted through a structured survey. We interviewed 15 students who met the selection criteria. The results were analyzed by the principal investigators using content analysis. Results. Respondents pointed out that lunch is one of the main meals and that a regular lunchtime helps to improve eating habits. Respondents report that one of the main causes for not complying with this feeding schedule is the lack of time due to academic burden. Conclusion. This study concludes that students perceive daily lunchtime to be important and yet claim that during much of the academic week they skip this meal.

Alimentación saludable en la formación de estudiantes de carreras del área pedagógica / Teaching healthy diet concepts during teacher training period

La malnutrición por exceso que se presenta en la población infanto-juvenil debe ser tratada a través de un equipo multidisciplinar, en el que además del cuerpo médico, la familia y la escuela, en especial los pedagogos, presentan un rol fundamental. Frente a esta situación es necesaria la formación de estos profesionales en la etapa universitaria en temas de alimentación saludable para cumplir con esta función. El objetivo de la investigación fue interpretar la percepción de la importancia de una alimentación saludable en estudiantes de carreras del área educacional. Para cumplir esta meta se utilizó un estudio cualitativo con enfoque fenomenológico, en una muestra de 40 estudiantes universitarios de carreras del área pedagógica que cumplían con los criterios de selección de la investigación. Para recolectar información se utilizó una entrevista semiestructurada y las respuestas se analizaron a través de análisis de contenido. Los estudiantes identificaron que es necesario realizar una alimentación sana durante su etapa de formación profesional, sin embargo, por diversas circunstancias no es desarrollada por los entrevistados. Los estudiantes que ejercerán sus competencias profesionales con menores de primer ciclo educacional codifican que sus programas de estudios deben incluir contenidos de alimentación saludable en asignaturas optativas, ya que lo utilizarán en su futuro laboral. Esta situación no es percibida por los estudiantes que trabajarán con adolescentes, ya que identifican que estos contenidos son necesarios para su autocuidado. Se concluye que los estudiantes de pedagogía que desarrollarán su futuro profesional con adolescentes no perciben su rol en la formación de hábitos alimentarios sanos. El carácter de optativo que identifican para alguna asignatura que incluya contenidos de alimentación saludable, no favorecen a la prevención o tratamiento de la malnutrición por exceso de niños y adolescentes.

Malnutrition by excess presented in the child-young population must be treated by a multidisciplinary team in which doctors, family and school, but specially teachers should play an essential role. Regarding this situation, student teachers need to acquire knowledge about healthy diet concepts during their training period in order to achieve this role. The aim of this research was to interpret the importance that students training to become teachers give to a healthy diet. For this purpose, a qualitative, phenomenological research was carried out with a sample consisting of 40 university students from different areas related to teaching. The data was collected using a semi-structured interview and the answers were analyzed with the content analysis methodology. The results showed that student teachers think it is necessary to have a healthy diet during their training period. However, this is not followed due to different circumstances. Student teachers who will work with elementary school children expressed that their study programs should include elective subjects related with healthy diet habits. This situation is not equally perceived by student teachers who will work with teenagers. They believe these contents are for self-care. It is concluded that student teachers who will work with teenagers do not perceive they play an education role concerning healthy diet habits. They do not consider the elective subjects related to healthy diet habits useful for preventing malnutrition by excess among children and teenagers.

Factors that affect concentrations of cyclosporine during the induction period of kidney transplantation: multivariate analysis.

OBJECTIVE: The pharmacokinetics of cyclosporine (CsA) depend on numerous factors over the transplantation course. The aim of this study was to evaluate the impact of several clinical variables on CsA concentrations during the induction period after kidney transplantation. METHODS: Potential variables were contrasted with CsA concentrations at 2 hours postdose (C(2)) and with the area under the concentration curve of CsA (AUC) at days 3 and 10 after transplantation. Evaluated variables were: recipient age, gender, body mass index (BMI), type/duration of previous dialysis, pretransplant serum creatinine (sCr), donor type, CsA dose, cold ischemia time, reduction of sCr, and use of other immunosuppressive drugs. RESULTS: This series included 112 patients who displayed an average age of 43 ± 13 years, including 62 men and 31 recipients of living donor organs. The induction dose of CsA was 8.36 ± 1.53 mg/kg. On day 3, the C(2) was related to the reduction of sCr (P = 0.034) and to the BMI (P = 0.033). There was an inverse correlation with pretransplant sCr (P = 0.012). The AUC correlated with BMI (P = 0.027) and living donor category (P = .002). Patients receiving rapamycin or a locally procured kidney showed a trend toward higher AUC values. On day 10, the CsA dose and use of rapamycin showed a trend to higher values of C(2); the AUC was related to the CsA dose (P = .034). None of the other variables showed significant effects. Analysis between variables showed that time on dialysis correlated with the pretransplant sCr (P = .002) and that the CsA dose was negatively associated with BMI (P = .009). CONCLUSION: Pretransplant sCr, BMI, living donor kidney category, better functional recovery, and the dose of CsA were predictors of CsA concentrations of clinical interest during this induction period. The effect of BMI was not related to higher doses of CsA.

Factores sociales que condicionan la asistencia de mujeres a la consulta nutricional / Social factors that influence the attendance of women at nutritional consultation

Nutritional consultation is one of the main professional activities of a nutritionist. The research was developed based on this activity, also considering the motivations presented by a group of women who were not referred to a consultation by a treating physician. The primary objective of the study is to interpret the social factors that condition the attendance of CESFAM Lagunillas users in Coronel, (Bio-Bio Region), to a nutritional consultation during the first semester of 2009. In order to achieve the primary objective, a qualitative phenomenological-type study was used as an investigative design. Information was collected through structured interviews with 17 women who met the selection criteria, that is to say, the total sample size determined through theoretical saturation. The greatest motivation presented by women who were interviewed about the attendance to a nutritionist consultation was their body image. Some social influences were also identified in this decision specially related to their families. Regarding this influences, they mentioned their partners and sometimes their mothers. Friends, means of communication, and the public opinion were also identified as an influence in their decision of attending to a nutritionist consultation. In conclusion, family is the greatest formal institution that conditions and directly influences the decision made by its members in attending a nutritional consultation.

La consulta nutricional es una de las actividades propias del quehacer profesional del nutricionista. Las motivaciones que presentan un grupo de mujeres que no fueron derivadas por médico tratante originó esta investigación, que tenía como objetivo el interpretar los factores sociales que condicionan la asistencia de usuarias del CESFAM Lagunillas de la comuna de Coronel, región del Bío-Bío a la consulta realizada por nutricionista durante el primer semestre del año 2009. Para lograr esta meta, se utilizó como diseño investigativo un estudio cualitativo de tipo fenomenológico. La obtención de la información se realizó a través de una entrevista estructurada a 17 mujeres que cumplían con los criterios de selección del estudio, correspondiendo al total de la muestra obtenida a través del punto de saturación. La imagen corporal es la mayor motivación que presentan las mujeres entrevistadas para asistir a la consulta nutricional. Se presentan influencias sociales en esta decisión, en especial las referidas a sus familias, en el que se identifican a sus parejas y en algunas instancias a las madres. Los amigos, los medios de comunicación o la opinión externa social también son identificados como influyentes en su decisión de asistir con el nutricionista a su consulta. Se concluye que la familia es la mayor institución formal que condiciona e influye directamente en las decisiones de sus miembros en diversas actividades, como es, la asistencia a la consulta nutricional.

Caracterización de las hospitalizaciones realizadas en la Unidad de Trastornos de Personalidad de la Clínica Psiquiátrica de la Universidad de Chile entre los años 2006 y 2008 / Characterization of admissions (hospitalizations) made in the Personality Disorders Unit of the Psychiatric Clinic of the University of Chile between 2006 and 2008

Introducción: Los Trastornos de Personalidad (TP) tienen una alta complejidad, impacto existencial, difícil vínculo terapéutico y cifras de prevalencia muy variables. La Clínica Psiquiátrica Universitaria de la Universidad de Chile (CPU) tiene desde 1997 la unidad multidisciplinaria para pacientes con TP Unidad de Trastornos de Personalidad (UTP). El objetivo de este trabajo es describir demográfica y psicopatológicamente a los pacientes con TP atendidos en la UTP. Método: Revisión de 174 fichas de pacientes atendidos en la UTP entre los años 2006 y 2008, con base de datos prediseñada y análisis estadístico de ella. Resultados: Existió una mayor proporción de pacientes de sexo femenino (3:1), solteros (48 por ciento), con hijos (56 por ciento), con estudios superiores (56 por ciento), trabajo estable (32 por ciento), con múltiples episodios previos (35 por ciento) y para la mayoría fue su primera hospitalización psiquiátrica (51,7 por ciento). El 71 por ciento de los pacientes tiene algún nivel de riesgo suicida. El diagnóstico de TP más frecuente fue el de Trastorno Límite de la Personalidad (48 por ciento). En Trastornos del Eje I un 30 por ciento presentó depresión, pero un 44 por ciento tenía varios trastornos. Conclusión: Los datos analizados son necesarios para la futura implementación y evaluación de intervenciones orientadas al mejor cuidado de los pacientes con TP de ésta y otras unidades especializadas en el tratamiento de este tipo de pacientes.

Introduction: Personality Disorders (PD) have a high complexity, existential impact, difficult therapeutic bond and prevalence values vary widely. University Psychiatric Clinic of the University of Chile (UPC) has since 1997 a multidisciplinary unit for patients with DP Personality Disorders Unit (PDU). The objective of this paper is to describe demographic and psychopathological patients treated with DP in the PDU. Methods: Review of 174 records of patients treated in the PDU between years 2006 and 2008, with predesigned database and statistical analysis of it. Results: There was a higher proportion of female patients (3:1), single (48 percent) with children (56 percent), highly educated (56 percent), stable job (32 percent) with multiple prior episodes (35 percent) and for most it was their first psychiatric hospitalization (51.7 percent). 71 percent of patients have any level of suicidal risk. The most frequent of PD diagnosis was Borderline Personality Disorder (48 percent). In Axis I disorders 30 percent had depression, but 44 percent had multiple disorders. Conclusion: The analyzed data are needed for future implementation and evaluation of interventions to better care for patients with PD from this and other specialized units created to treat such patients.

Prophylaxis and treatment of Chagas disease in renal transplant donor and recipient: case report.

Chagas disease is a prevalent zoonosis in Latin America, caused by the protozoa Trypanosoma cruzi and transmitted by Triatoma infestans. Part of the infectious cycle consists of chronic subclinical parasitemia, causing in the long term end-organ damage. Amastigotes have been isolated from various organs including native and allograft renal parenchyma; thus, transplantation plus immunosuppression therapy is another mode of disease transmission and reactivation. Herein, we report 2 successful kidney transplantations cases in which either infection or reactivation was averted using prophylactic nitroderivates.

The role of caveolin-1 in prostate cancer: clinical implications.

Caveolin-1 (cav-1) is reportedly overexpressed in prostate cancer cells and is associated with disease progression. Specific oncogenic activities of cav-1 associated with Akt activation also occur in prostate cancer. A membrane-associated protein, cav-1, is nonetheless secreted by prostate cancer cells; results of recent studies showed that secreted cav-1 can stimulate cell survival and angiogenic activities, defining a role for cav-1 in the prostate cancer microenvironment. Serum cav-1 levels were also higher in prostate cancer patients than in control men without prostate cancer, and the preoperative serum cav-1 concentration had prognostic potential in men undergoing radical prostatectomy. Secreted cav-1 is therefore a potential biomarker and therapeutic target for prostate cancer.

Factores sociales en las conductas alimentarias de estudiantes universitarios / Social factors in feeding behavior of university students

The feeding behavior has a direct influence on the nutritional status of individuals belonging to diverse age groups, among them, higher education students. The aim of this research was to interpret the perception of the influence exerted by the family environment, university peers and educational staff on the dietary behavior of university students belonging to the Universidad Católica de la Santísima Concepción. In order to achieve this aim, qualitative methodology through a phenomenological design was used. As a strategy to gather information, a semi-structured interview was applied to eight students, going into some of the results in depth with focus group composed by nine students of the university. Our results showed that the family, friends and university staff influenced the feeding behavior of the interviewed students. Moreover, these influences were found to be favourable regarding healthy feeding behavior in the case of student's family; and unfavourable in the case of friends and university staff.

Las conductas alimentarias influyen directamente en el estado nutricional de los individuos pertenecientes a diversos grupos etarios, entre ellos, los estudiantes de educación superior. El objetivo de esta investigación fue interpretar la percepción de los estudiantes universitarios pertenecientes a la Universidad Católica de la Santísima Concepción, de las condicionantes que el entorno familiar, social y plantel educacional ejercen en sus conductas alimentarias. Para el logro de este fin se utilizó la metodología cualitativa, a través de un diseño fenomenológico. Como estrategia de recolección de información se realizó una entrevista semi-estructurada a 8 estudiantes, profundizando algunos resultados con un grupo focal integrado por 9 alumnos de la Universidad. Por los resultados y en conclusión del estudio, la familia, amigos y plantel universitario condicionan las conductas alimentarias de los estudiantes entrevistados, interpretando estas influencias como favorables en el caso de la familia y desfavorables por parte del plantel universitario y los amigos de aulas para mantener conductas alimentarias saludables.

Factors that predict duration of delayed graft function in cadaveric kidney transplantation.

INTRODUCTION: We have previously shown that the duration of delayed graft function (DGF) is a significant predictor of serum creatinine concentration at 1 year posttransplantation, which may be a surrogate marker for kidney survival after renal transplantation. OBJECTIVE: To identify donor and recipient characteristics that influence the duration of DGF in a 2-center study. PATIENTS AND METHODS: This retrospective analysis of 212 consecutive cadaveric renal transplant procedures examined the following variables: donor and recipient age and sex, cause of death (cerebrovascular accident or trauma), donor creatinine and sodium concentrations, multiorgan or kidney-only donor use, type of vasoactive drugs, cold ischemia time, percent reactive antibodies, and HLA mismatch. RESULTS: Overall, 30.5% of recipients experienced DGF with a mean (SD) duration of 4.4 (8) days. At univariate analysis, the use of norepinephrine in the donor and increased cold ischemia time were associated with longer DGF duration. However, at multivariate analysis, none of the factors studied was significant. CONCLUSIONS: The duration of DGF may be associated with longer cold ischemia time, which emphasizes the need to shorten this period insofar as possible to improve long-term results. The association of use of norepinephrine and prolonged DGF should be observed carefully because it may be that use of this drug is related to worse hemodynamics in the donor and not to deleterious effects of the drug per se.

Strategies for prevention of cytomegalovirus infection in renal transplant patients.

OBJECTIVE: Cytomegalovirus (CMV) constitutes the principal viral infection in renal transplant patients. The indirect consequences of CMV infection increase the risks for acute and chronic rejection, secondary infections, lymphoproliferative disorders, atherosclerosis, and cardiovascular deaths. The direct effects depend on the affected organ. There have been strategies to prevent CMV disease: prophylaxis and preemptive strategy. The aim of this study was to compare the incidences of disease and infection due to CMV among our patients. PATIENTS AND METHODS: We performed a retrospective analysis of all our renal transplant patients between January 2000 and January 2008. RESULTS: Four groups were identified among 94 patients: without any preventive strategy; brief prophylaxis; formal prophylaxis; and preemptive treatment. There were no significant differences among the groups in the incidences of CMV disease, acute renal rejection, or survival. The greatest number of infections was registered in the group with brief prophylaxis (P = .006); 50% of the registered infections occurred before 150 days posttransplantation. CONCLUSIONS: We concluded that the preemptive strategy is appropriate for the low-risk patient, while prevention with antiviral drugs should be reserved for intermediate- and high-risk patients. A brief treatment for prevention is an alternative to prevent CMV disease, but it needs to be followed with serial, long-term evaluation of antigenemia for >150 days posttransplantation.

Hemorrhagic cystitis secondary to adenovirus infection in a kidney transplant recipient: case report.

Increasingly potent immunosuppressive agents have reduced the incidence of rejection of transplanted organs while increasing patient susceptibility to opportunistic infections and cancer. Adenoviruses are increasingly recognized as contributors to morbidity and mortality in stem cell and solid-organ transplant recipients. Clinical findings range from asymptomatic viremia to respiratory and gastrointestinal disease, hemorrhagic cystitis, and severe disseminated illness. We describe the first case in Chile of hemorrhagic adenovirus cystitis after renal transplantation in an adult.

Renal vein extension using gonadal vein: a useful strategy for right kidney living donor harvested using laparoscopy.

INTRODUCTION: 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. Based on experience in open donor nephrectomy, our unit has used the donor gonadal vein to obtain a longer renal vein in this setting. METHODS: Four consecutive living related donors with the indication for laparoscopic right nephrectomy underwent this procedure. Three donors were females and the overall average age was 48.5 years. The renal vein was controlled with a 30-mm stapler and we included 5-6 cm of the ipsilateral gonadal vein during the harvest. The donor kidney was perfused and renal vessels prepared under cold conditions. The gonadal vein was opened longitudinally and sutured to the donor right renal vein as a wide tube in 3 cases and as a spiral tube in 1 case with 6-0 monofilament suture. RESULTS: This procedure extended the bench work between 25 to 40 minutes permitting an 2.5- to 3.5-cm extension of the donor vein. The transplantations were performed in the usual mode and the vein enlargement enormously facilitated the implantation surgery. All recipients displayed immediate graft function; no complications were observed with this strategy. CONCLUSIONS: Vein extension with the gonadal vein was a simple, safe method to enlarge the renal vein among right living donor kidneys procured using laparoscopy.

Duration of delayed graft function is an important predictor of 1-year serum creatinine.

OBJECTIVE: The purpose of this study was to evaluate the importance of various factors on 1-year serum creatinine (SCr) as a surrogate endpoint for allograft survival among a series of kidney transplantations performed at 2 centers. PATIENTS AND METHODS: Two hundred sixty consecutive renal transplantations were included with overall mean age of 40 +/- 13 years, including 55% men and 19% living donor grafts. Factors considered for analysis were donor and recipient ages, and sexes, number of transplantations, panel-reactive antibodies, total number of HLA mismatches, cold ischemia time (CIT), acute rejection (AR) rate, and presence/duration of delayed graft function (DGF). Multiple regression analyses were performed for 1-year SCr, AR rate, and DGF duration. RESULTS: One-year SCr was 1.46 +/- 0.5 mg/dL, 6-month AR rate was 22%, and DGF rate was 29% of mean duration 3 +/- 8 days. Multiple regression analysis for lower 1-year SCr value identified as significant female recipient sex, lower donor age, absence of AR within 6 months, and decreased DGF duration (P < .05). The only significant factor affecting AR rate was DGF duration. Finally, prolonged CIT was associated with a longer DGF duration. CONCLUSIONS: We confirmed that 1-year SCr was primarily affected by well-known factors, such as AR incidence, donor age, and female recipient sex. However, we identified DGF duration as a significant factor affecting 1-year SCr. AR rate was also associated with DGF duration, which in turn depended upon longer CIT.

Abbreviated AUC monitoring of cyclosporine more adequately identified patients at risk for acute rejection during induction of immunosuppressive therapy after kidney transplantation than recommended C2 concentration values.

OBJECTIVE: Monitoring of cyclosporine (CsA) is critical during the induction of immunosuppressive therapy. Although most centers have incorporated C2 levels, our unit still uses an abbreviated AUC model which includes concentrations at C1, C2, and C6 post-dose (AUC(1-6)). The objective of this study was to compare both strategies of CsA monitoring during the first 30 days after kidney transplantation. PATIENTS AND METHODS: The study included 89 recipients induced with CsA microemulsion and steroids. AUC(1-6) profiles were performed around days 3, 10, and 30 after transplantation with a target of 5500 to 6000 ng*h/mL considered therapeutic. For comparison purposes, a value of C2 >/= 1500 ng/mL was also considered therapeutic. Mean C2 and AUC(1-6) values were low dated with biopsy-proven acute rejection episodes (BPAR) during the study period. RESULTS: Twenty patients received living donor kidneys and overall there were 46 females. During this period, 253 AUC(1-6) were performed including 44 (17.4%) below the therapeutic range. When the analysis included only C2, 171 (67.6%) were below the therapeutic target (P < .001). Five patients experience BPAR and only AUC(1-6) at day 10 discriminated rejectors versus nonrejectors (5645 +/- 1390 and 8221 +/- 2502, respectively; P = .008). C2 was not significantly different at any time in either group. CONCLUSIONS: In this study, abbreviated AUC monitoring more adequately identified patients at risk for acute rejection than C2. Recommended C2 concentration levels need to be redefined in our patients.

Interpretación de los conocimientos que influyen en la adherencia a la dietoterapia en adultos mayores con diabetes tipo 2 de una comuna rural / Interpretation of the knowledge about type 2 diabetes and compliance to dietotherapy among elderly living in rural areas suffering from this disease

Type 2 diabetes is one of the most prevalent chronic diseases in the country. Among the strategies for its treatment is education, a tool presented by the health team to modify risky behavior on these people, providing users information and some strategies for their self care. The objective of this study was to analyze the different factors associated to the knowledge of the pathology that influences the compliance to diet therapy treatment among elderly suffering from type 2 diabetes, who are regularly checked by a nutritionist in Yumbel’s Health Public System. Through a qualitative phenomenological-type study, a semi-structured interview was carried out to 14 people in standard conditions assessing the knowledge about the pathology in terms of the consequences and the treatment to follow. However, the knowledge does not determine whether people will choose to follow diet therapy, with the exception of people with knowledge of the consequences of the disease. In the final analysis, the knowledge of the pathology does not induce the majority of the elderly from rural areas to follow diet therapy.

La Diabetes tipo 2 es una de las enfermedades crónicas de gran prevalencia en el país. Entre las estrategias para su tratamiento se encuentra la educación, como herramienta que presenta el equipo de salud para modificar conductas de riesgo en estas personas, entregando a los usuarios conocimientos y otras estrategias para su autocuidado. El objetivo del estudio fue interpretar los factores asociados a los conocimientos que influyen en la adherencia al tratamiento dietoterapéutico en adultos mayores con Diabetes tipo 2 controlados por nutricionista en la Atención Primaria de Salud de la comuna de Yumbel. A través de un estudio cualitativo de tipo fenomenológico, se realizó una entrevista semiestructurada a 14 usuarios en condiciones estándar, obteniendo como resultado la presencia de conocimientos de su patología, referido a las consecuencias y los tratamientos a realizar. Sin embargo, estos conocimientos no determinan un alto nivel de adherencia a la dietoterapia, excepto en el caso de presentar algún tipo de secuela. Por lo tanto, se concluye que los conocimientos de la patología no favorecen una mayor adherencia a la dietoterapia por parte de adultos mayores de una zona rural del país.

Factores pronósticos en carcinoma de células renales: ¿son adecuadas las variables definidas por el actual TNM? / Prognosis factors in renal cells carcinoma: are the variables defined by TNM adequate?

Objetivo: Identificar aquellos factores pronósticos que influyen de manera independiente en la sobrevida y en caso de ser significativo el tamaño de la lesión, determinar cuál es el mejor punto de corte para esta variable. Materiales y métodos: Se revisaron los registros de 420 pacientes con diagnóstico de carcinoma de células renales estudiados entre enero de 1994 y junio de 2004 en dos centros. El análisis de sobrevida se efectuó a través de curvas de Kaplan-Meier. Se realizó estudio univariado y multivariado para determinar qué factores, clínicos e histológicos, tienen un impacto directo en la sobrevida de los pacientes con cáncer renal. El mejor punto de corte para el tamaño tumoral se determinó por medio de curvas ROC. Resultados: La sobrevida global de la serie fue 76,4 por ciento, con un seguimiento promedio de 30,8 meses (DS±24,5). El análisis demostró una tasa de sobrevida de 95,7 por ciento para T1, 58,5 por ciento para T2, 65,2 por ciento, 49,4 por ciento, 35,4 por ciento para T3 a, b y c, respectivamente y 44,4 porciento para T4. El análisis univariado mostró que la edad, al momento del diagnóstico, el valor del hematocrito y VHS preoperatorios, la presencia de fosfatasas alcalinas elevadas y el tamaño de la lesión influyen en la sobrevida (p <0,05). El análisis multivariado reveló que la presencia de fosfatasas alcalinas elevadas, el tamaño, la invasión de la vena renal (p <0,01) y la invasión de la cápsula renal (p <0,05) son variables con significativo valor pronóstico. El mejor punto de corte para el tamaño entregado por la curva ROC fue 6 cm, tanto para recidiva como para muerte por cáncer, alcanzado una sensibilidad de 80,6 por ciento y una especificidad de 68,1 por ciento.Conclusión: La actual etapificación TNM no se correlaciona certeramente con las sobrevidas obtenidas en esta serie de pacientes. En contraste con lo mencionado en la literatura internacional, el grado de Fuhrman, la invasión de la glándula suprarrenal y el tipo histológico...