Insects associated to ephemeral pools in Huentelauquén (29ºS Coquimbo Region, Chile)

Abstract In northern central Chile, ephemeral pools constitute shallow isolated water bodies with a favourable habitat for fauna adapted to seasonal changes. Based on the limited knowledge about the faunaparticularly insectsassociated to these ecosystems, the objective of this study was to characterize the richness, composition, structure and similarity of the insect communities associated with ephemeral pools in Huentelauquén (29º S, Coquimbo Region, Chile). By using pitfall traps, 10,762 individuals were captured, represented by 7 orders, 27 families, and 51 species. Coleoptera and Hymenoptera were the best represented orders, with Neuroptera, Orthoptera and Plecoptera being poorly represented groups. The non-parametric estimators evaluated showed wealth values above those observed for all the studied pools, and their accumulation curves suggest the existence of an incomplete species inventory in the studied community. Additionally, the hierarchical and ordering analysis showed groupings of pools located in the northwest and southeast of Huentelauquén. Preliminarily we found a negative correlation between the area of the pools and the richness (species) and abundance of insects. Additional studies (on other arthropod groups and other seasons of the year) could provide a better understanding of the local processes of extinction and colonization of the species inhabiting these fragile coastal environments.

Resumo No norte central do Chile, lagoas efêmeras constituem corpos de água isolados e pouco profundos, com um habitat favorável para a fauna adaptada as mudanças sazonais que as zonas úmidas estão sujeitas. Com relação a estes ecossistemas, sabe-se pouco sobre sua fauna, principalmente a de insetos. O objetivo do presente estudo foi caracterizar a riqueza, composição, estrutura e similaridade das comunidades de insetos que habitam as lagoas temporárias de Huentelauquén (29º S, Região de Coquimbo, Chile). Usando armadilhas de interceptação, se capturou um total de 10.762 indivíduos, pertencentes a 7 ordens, 27 famílias e 51 espécies. Coleoptera e Hymenoptera foram as ordens mais representativas, enquanto Neuroptera, Orthoptera e Plecoptera foram grupos pouco representativos. Os estimadores não paramétricos avaliados mostraram valores de riqueza superiores ao observados para todas as lagoas estudadas, e suas curvas de acumulação parecem indicar que o inventario da comunidade estudada está incompleto. A análise hierárquica e de ordenamento revelou agrupamentos de lagoas correspondentes a zona nordeste e sudeste de Huentelauquén. Preliminarmente encontramos uma correlação negativa entre a área de lagoas efêmeras e a riqueza (espécies) e abundância de insetos. É necessário realizar estudos adicionais (sobre outros grupos de artrópodes e em outras estações do ano) para melhor compreensão dos processos locais de extinção e colonização das espécies que habitam estes frágeis ambientes costeiros estudados.

Insects associated to ephemeral pools in Huentelauquén (29ºS Coquimbo Region, Chile) / Insetos associados a lagoas temporárias em Huentelauquén (29ºS Região de Coquimbo, Chile)

Abstract In northern central Chile, ephemeral pools constitute shallow isolated water bodies with a favourable habitat for fauna adapted to seasonal changes. Based on the limited knowledge about the fauna—particularly insects—associated to these ecosystems, the objective of this study was to characterize the richness, composition, structure and similarity of the insect communities associated with ephemeral pools in Huentelauquén (29º S, Coquimbo Region, Chile). By using pitfall traps, 10,762 individuals were captured, represented by 7 orders, 27 families, and 51 species. Coleoptera and Hymenoptera were the best represented orders, with Neuroptera, Orthoptera and Plecoptera being poorly represented groups. The non-parametric estimators evaluated showed wealth values above those observed for all the studied pools, and their accumulation curves suggest the existence of an incomplete species inventory in the studied community. Additionally, the hierarchical and ordering analysis showed groupings of pools located in the northwest and southeast of Huentelauquén. Preliminarily we found a negative correlation between the area of the pools and the richness (species) and abundance of insects. Additional studies (on other arthropod groups and other seasons of the year) could provide a better understanding of the local processes of extinction and colonization of the species inhabiting these fragile coastal environments.

Resumo No norte central do Chile, lagoas efêmeras constituem corpos de água isolados e pouco profundos, com um habitat favorável para a fauna adaptada as mudanças sazonais que as zonas úmidas estão sujeitas. Com relação a estes ecossistemas, sabe-se pouco sobre sua fauna, principalmente a de insetos. O objetivo do presente estudo foi caracterizar a riqueza, composição, estrutura e similaridade das comunidades de insetos que habitam as lagoas temporárias de Huentelauquén (29º S, Região de Coquimbo, Chile). Usando armadilhas de interceptação, se capturou um total de 10.762 indivíduos, pertencentes a 7 ordens, 27 famílias e 51 espécies. Coleoptera e Hymenoptera foram as ordens mais representativas, enquanto Neuroptera, Orthoptera e Plecoptera foram grupos pouco representativos. Os estimadores não paramétricos avaliados mostraram valores de riqueza superiores ao observados para todas as lagoas estudadas, e suas curvas de acumulação parecem indicar que o inventario da comunidade estudada está incompleto. A análise hierárquica e de ordenamento revelou agrupamentos de lagoas correspondentes a zona nordeste e sudeste de Huentelauquén. Preliminarmente encontramos uma correlação negativa entre a área de lagoas efêmeras e a riqueza (espécies) e abundância de insetos. É necessário realizar estudos adicionais (sobre outros grupos de artrópodes e em outras estações do ano) para melhor compreensão dos processos locais de extinção e colonização das espécies que habitam estes frágeis ambientes costeiros estudados.

Pathophysiological Role of Genetic Factors Associated With Gestational Diabetes Mellitus.

Gestational Diabetes Mellitus (GDM) is a highly prevalent maternal pathology characterized by maternal glucose intolerance during pregnancy that is, associated with severe complications for both mother and offspring. Several risk factors have been related to GDM; one of the most important among them is genetic predisposition. Numerous single nucleotide polymorphisms (SNPs) in genes that act at different levels on various tissues, could cause changes in the expression levels and activity of proteins, which result in glucose and insulin metabolism dysfunction. In this review, we describe various SNPs; which according to literature, increase the risk of developing GDM. These SNPs include: (1) those associated with transcription factors that regulate insulin production and excretion, such as rs7903146 (TCF7L2) and rs5015480 (HHEX); (2) others that cause a decrease in protective hormones against insulin resistance such as rs2241766 (ADIPOQ) and rs6257 (SHBG); (3) SNPs that cause modifications in membrane proteins, generating dysfunction in insulin signaling or cell transport in the case of rs5443 (GNB3) and rs2237892 (KCNQ1); (4) those associated with enzymes such as rs225014 (DIO2) and rs9939609 (FTO) which cause an impaired metabolism, resulting in an insulin resistance state; and (5) other polymorphisms, those are associated with growth factors such as rs2146323 (VEGFA) and rs755622 (MIF) which could cause changes in the expression levels of these proteins, producing endothelial dysfunction and an increase of pro-inflammatory cytokines, characteristic on GDM. While the pathophysiological mechanism is unclear, this review describes various potential effects of these polymorphisms on the predisposition to develop GDM.

Insects associated to ephemeral pools in Huentelauquén (29ºS Coquimbo Region, Chile).

In northern central Chile, ephemeral pools constitute shallow isolated water bodies with a favourable habitat for fauna adapted to seasonal changes. Based on the limited knowledge about the fauna-particularly insects-associated to these ecosystems, the objective of this study was to characterize the richness, composition, structure and similarity of the insect communities associated with ephemeral pools in Huentelauquén (29º S, Coquimbo Region, Chile). By using pitfall traps, 10,762 individuals were captured, represented by 7 orders, 27 families, and 51 species. Coleoptera and Hymenoptera were the best represented orders, with Neuroptera, Orthoptera and Plecoptera being poorly represented groups. The non-parametric estimators evaluated showed wealth values above those observed for all the studied pools, and their accumulation curves suggest the existence of an incomplete species inventory in the studied community. Additionally, the hierarchical and ordering analysis showed groupings of pools located in the northwest and southeast of Huentelauquén. Preliminarily we found a negative correlation between the area of the pools and the richness (species) and abundance of insects. Additional studies (on other arthropod groups and other seasons of the year) could provide a better understanding of the local processes of extinction and colonization of the species inhabiting these fragile coastal environments.

Incontinencia urinaria de urgencia en mujeres adultas: ¿Qué tratamientos ofrecer en APS? / Emergency Urinary Incontinence in Adult Women: what treatments do we offer at PHC?

La incontinencia urinaria de urgencia corresponde a la pérdida involuntaria de orina, cuya causa es presumida multifactorial: hiperactividad del detrusor, hipersensibilidad vesical y distensibilidad reducida del detrusor. Esta patología es bastante frecuente tanto en Chile como en el mundo, con una prevalencia local entre 10% y 15%, a su vez genera un gran impacto en el bienestar físico, mental y socioeconómico del paciente. El diagnóstico es clínico, con apoyo en el uroanálisis y su tratamiento de primera línea puede ser realizado en APS. En cuanto al tratamiento existen tanto terapias no farmacológicas como farmacológicas; correspondiendo las técnicas de reentrenamiento vesical, los cambios de estilo de vida y los fármacos anticolinérgicos a tratamientos efectivos de primera línea. Existen, además, otros fármacos que pueden ser utilizados para el tratamiento de la IUU, cuya evidencia será igualmente revisada en este artículo.

Urge incontinence is defined as an involuntary leakage of urine, presumably with a multifactorial cause: detrusor overactivity, bladder hypersensibility and a reduced bladder compliance. It's a common disease worldwide, with local studies reporting a prevalence around 10-15%, causing a great impact in the physical, mental and socioeconomic well-being of the affected patients. Diagnosis is mainly based on the clinical history, supporting it with laboratory tests to rule out other conditions, and uncomplicated cases can be treated and followed in a primary care setting. There are pharmacologic and non-pharmacologic therapies, being healthy lifestyles changes, bladder retraining programs and anticholinergic drugs the first line of treatment. Additional pharmacologic treatments will be revised in this article.

Guía de recomendación ACCHED-SCHGE para el funcionamiento de las unidades de endoscopia durante el brote de coronavirus (COVID-19) / Guideline recommendations ACHED-SCHGE for the endoscopy units during the Coronavirus outbreak (COVID-19)

The outbreak of COVID-19 disease has recently spread from its original place in Wuhan, Hubei province, China, to the entire world, and has been declared to be a pandemic by the World Health Organization in March 2020. All countries in America, in particular Chile, show an important increase in COVID-19 cases and deaths. The clinical manifestations of COVID-19 are a broad spectrum, from asymptomatic mild disease, to severe respiratory failure, shock, multiorgan dysfunction and death. Thus, high clinical suspicion and appropriate structure risk stratification are needed. Health care teams in endoscopy units, are at an increased risk of infection by COVID-19 from inhalation of droplets, mucosae contact, probably contamination due to contact with stools. Endoscopic aerosolized associated infections have also been reported. Different societies' recommendations, have recently placed digestive endoscopy (especially upper) among the high risk aerosol generating procedures (AGPs). In addition, live virus has been found in patient stools. On top of this, the infected health professionals may transmit the infection to their patients. Health care infection prevention and control (HCIPC), has been shown to be effective in assuring the safety of both health care personnel and patients. This is not limited to the correct use of personal protective equipment (PPE), but is based on a clear, detailed and well communicated HCIPC strategy, risk stratification, use of PPE, and careful interventions in patients with moderate and high risk of COVID-19. A conscientious approach regarding limited resources is important, as the simultaneous outbreak in all countries heavily affects the availability of health supplies. The Chilean Gastroenterology Society (SChGE) and Digestive Endoscopy Association of Chile (ACHED) are joining to provide continued updated guidance in order to assure the highest level of protection against COVID-19, for both patients and health care workers. This guideline will be updated online as needed.

El brote de la enfermedad denominada COVID-19, se ha extendido desde su origen en Wuhan, provincia de Hubei, China, a todo el mundo. La Organización Mundial de la Salud lo declaró pandemia en marzo de 2020. Todos los países de América, en especial Chile, presentan incremento de casos y fallecidos. Las manifestaciones clínicas de COVID-19 van desde una enfermedad leve, hasta insuficiencia respiratoria severa, shock, disfunción orgánica y muerte. Se necesita una alta sospecha clínica y una adecuada estratificación del riesgo. El equipo de salud en las unidades de endoscopia, tiene un mayor riesgo de COVID-19 que otras unidades clínicas y de apoyo diagnóstico, dada la mayor exposición a inhalación de gotas, contacto posible con mucosas y contaminación por contacto con deposiciones. Recomendaciones de diferentes sociedades colocan la endoscopia digestiva (especialmente la esofagogastroscopia o endoscopia digestiva alta, EDA) entre los procedimientos generadores de aerosoles (PGA) de alto riesgo. Además, se han encontrado virus viables en las deposiciones de los pacientes. Potencialmente, los profesionales de la salud infectados podrían contagiar a los pacientes. Se ha demostrado que la prevención y control de infecciones asociadas a la atención de salud (IAAS), son efectivos para garantizar la seguridad tanto del personal de salud, como de los pacientes. Esto no es solamente el correcto uso del equipo de protección personal (EPP), sino que se basa en una clara estrategia de IAAS, bien comunicada, con estratificación de riesgo, uso de EPP e intervenciones correctas en pacientes con riesgo moderado y alto. Es relevante un enfoque sobre los limitados recursos, dado la simultaneidad del brote en todos los países, que afecta la disponibilidad de insumos. La Sociedad Chilena de Gastroenterología (SChGE) y la Asociación Chilena de Endoscopia Digestiva (ACHED) publican esta guía actualizada para apoyar las buenas prácticas contra COVID-19, tanto para pacientes como para el equipo de salud. Esta guía podrá tener actualizaciones según avance la información disponible.

Isolation on a remote island: genetic and morphological differentiation of a cosmopolitan odonate.

Although low levels of genetic structure are expected in highly widespread species, geographical and/or ecological factors can limit species distributions and promote population structure and morphological differentiation. In order to determine the effects of geographical isolation on population genetic structure and wing morphology, 281 individuals of the cosmopolitan odonate Pantala flavescens were collected from four continental (Central and South America) and five insular sites (Polynesian islands and the Maldives). COI sequences and eight microsatellite loci were used to characterize genetic diversity and genetic structure between and within locations. Linear and geometric morphometry were used to evaluate differences in the size and shape of wings. Genetic analysis showed a global genetic difference between the continental and insular sites. American locations did not show genetic structure, even in locations separated by a distance of 5000 km. Easter Island showed the lowest values of genetic diversity (mainly mitochondrial diversity) and the highest values of genetic differences compared to other insular and continental sites. Individuals from Easter Island showed smaller forewings, a different abdomen length to thorax length ratio, and a different configuration of anal loop in the hindwings. Thus, the greater isolation, smaller area, and young geological age seem to have determined the genetic and morphological differences in P. flavescens of Easter Island, where selection could promote a loss of migratory behavior and may improve other life history traits, such as reproduction. This work provides new insight into how microevolutionary processes operate in isolated populations of cosmopolitan species.

Sequential ozone advanced oxidation and biological oxidation processes to remove selected pharmaceutical contaminants from an urban wastewater.

Sequential treatments consisting in a chemical process followed by a conventional biological treatment, have been applied to remove mixtures of nine contaminants of pharmaceutical type spiked in a primary sedimentation effluent of a municipal wastewater. Combinations of ozone, UVA black light (BL) and Fe(III) or Fe3O4 catalysts constituted the chemical systems. Regardless of the Advanced Oxidation Process (AOP), the removal of pharmaceutical compounds was achieved in 1 h of reaction, while total organic carbon (TOC) only diminished between 3.4 and 6%. Among selected ozonation systems to be implemented before the biological treatment, the application of ozone alone in the pre-treatment stage is recommended due to the increase of the biodegradability observed. The application of ozone followed by the conventional biological treatment leads high TOC and COD removal rates, 60 and 61%, respectively, and allows the subsequent biological treatment works with shorter hydraulic residence time (HRT). Moreover, the influence of the application of AOPs before and after a conventional biological process was compared, concluding that the decision to take depends on the characterization of the initial wastewater with pharmaceutical compounds.

Epidemiology of pediatric facial trauma in Chile: a retrospective study of 7,617 cases in 3 years.

OBJECTIVES: To describe the epidemiology of facial trauma injuries in a group of Chilean children aged 15 years or less. STUDY DESIGN: Retrospective study of case series. Between 2006 and 2009, clinical records of 293,090 patients were reviewed. Data of patients with trauma injuries to the face were collected and evaluated for: age, sex, day and month of hospital admission, cause of injury, anatomical location, type of injury and presence of associated injuries. RESULTS: A total of 7,617 patients with 8,944 injuries were found. Boy to girl ratio was 1,7:1. Preschool age children were most frequently affected. Main cause of injury were falls, soft tissue injuries the most common type of injury. Associated injuries occurred in 11% of cases. CONCLUSIONS: Facial trauma presents a significant frequency in the group of Chilean children studied. Preeschool age boys were prone to present facial trauma of mild severity associated to falls.

Aspectos relevantes en la realización de la endoscopia digestiva: propuestas basadas en la evidencia. Curso ACHED 2013 / Relevant aspects of digestive endoscopy. Evidence-based suggestions. Chilean Association of Digestive Endoscopy (ACHED), Course 2013

Digestive endoscopy is a complex tool for diagnosis and treatment, with continuous development both in technical aspects and in their application for the different pathologies where this technique is required. Therefore, a continuous education program is necessary for the practitioner using this technique. With the purpose of reaching an agreement between different aspects of the performance of these procedures and also generating proposals for its application that are useful for the physicians of this area of expertise, during 2013 the Chilean Association of Digestive Endoscopy (ACHED) developed a workshop called ‘Relevant aspects of digestive endoscopy. Evidence-based suggestions’. This workshop was attended by gastroenterologists and trainee practitioners, who worked in groups during a period of two months where they reviewed available evidence to answer several questions relating to milestones and lesions that need to be described in upper gastrointestinal endoscopy, the preparation of the GI endoscopy report, technical aspects and quality measures in colonoscopy. This review resulted in proposals that were analyzed and agreed on in the form of recommendations presented for further analysis and discussion amongst endoscopic teams in our country.

La endoscopia digestiva es una herramienta de diagnóstico y tratamiento médico compleja, en continuo desarrollo tanto en lo técnico como en los conceptos de manejo de las patologías en las que se utiliza.Por lo tanto, es deseable una estrategia de formación continua del profesional que la realiza. Con el objetivode consensuar diferentes aspectos en la realización de estos procedimientos y generar propuestas de manejoque sean de utilidad para todos los médicos involucrados en esta especialidad, la Asociación Chilenade Endoscopia Digestiva (ACHED) realizó durante el año 2013 un curso taller denominado “Aspectosrelevantes en la realización de la endoscopia digestiva. Propuestas basadas en la evidencia”. Este cursoconvocó a gastroenterólogos y médicos en formación de la especialidad que conformaron grupos de trabajoque durante 2 meses revisaron la evidencia disponible para responder diversas preguntas en relación a los hitos y lesiones a describir en endoscopia digestiva alta (EDA), la realización del informe en EDA, aspectos técnicos y medidores de calidad en colonoscopia. La revisión les permitió generar propuestas que fuerondiscutidas y consensuadas en recomendaciones que se proponen para su discusión por los equipos endoscópicos de nuestro país.

First annual register of allergenic pollen in Talca, Chile

Background: There are no data on atmospheric pollen in Talca. In the present work, our aim is to describe the amount of pollen grain in the atmosphere of the city of Talca likely to cause pollinosis of its inhabitants. Methods: A volumetric Hirst sampler (Burkard seven-day recording device) was used to study pollen levels. It was placed in the centre of Talca from May 2007 to April 2008. Results: The highest airborne presence of pollen, as measured in weekly averages, was Platanus acerifolia with a maximum weekly daily average of 203 grains/m3 registered during September and October. The second highest was Acer pseudoplatanus with a maximum weekly daily average of 116 grains/m3. Populus spp. had a maximum weekly daily average 103 grains/m3. Olea europaea reached 19 grains/m3 in November. Grasses presented high levels of pollen counts with a maximum weekly daily average of 27 grains/m3 from the end of August until the end of January. Pollens of Plantago spp. Rumex acetosella and Chenopodium spp. had a similar distribution and were present from October to April with maximum weekly daily average of 7 grains/m3, 7 grains/m3 and 3 grains/m3 respectively. Significant concentrations of Ambrosia artemisiifolia were detected from February until April. Conclusion: The population of Talca was exposed to high concentrations of allergenic pollen, such as P. acerifolia, A. pseudoplatanus, and grasses in the months of August through November. The detection of O. europaea and A. artemisiifolia is important as these are emergent pollens in the city of Talca. Aerobiological monitoring will provide the community with reliable information about the level of allergenic pollens, improving treatment and quality of life of patients with respiratory allergy (AU)

Corticosteroids plus long-acting ß2-agonists prevent double-stranded RNA-induced upregulation of B7-H1 on airway epithelium.

BACKGROUND: Airway viral infections provoke exacerbations of asthma and chronic obstructive pulmonary disease. B7-H1 is a costimulatory molecule that is implicated in an escape mechanism of viruses from host immune systems. This escape may be associated with the persistence of viral infection and lead to exacerbation of underlying diseases. We have shown that an analog of viral double-stranded RNA, polyinosinic-polycytidylic acid (poly IC), upregulated the expression of B7-H1 on airway epithelial cells, an effect which was corticosteroid-resistant. We investigated the effects of corticosteroids plus long-acting ß(2)-agonists (LABAs; fluticasone/salmeterol or budesonide/formoterol) on the expression of B7-H1. METHODS: BEAS-2B cells and primary airway epithelial cells were stimulated with poly IC or respiratory syncytial virus. The expression of B7-H1 was assessed by flow cytometry. RESULTS: Poly IC upregulated the expression of B7-H1, which was suppressed by high-concentration corticosteroids but not by LABAs. The upregulation was suppressed by very low-concentration corticosteroids when used in combination with LABAs. Their combination also suppressed the virus-induced upregulation of B7-H1. Poly IC stimulation induced the nuclear translocation of nuclear factor ĸB (NF-ĸB). Inhibitors of NF-ĸB activation prevented the poly IC-induced upregulation of B7-H1. Low-concentration corticosteroids in combination with LABAs enhanced the de novo induction of IĸBα, the endogenous inhibitor of NF-ĸB activation. CONCLUSIONS: Fluticasone/salmeterol or budesonide/formoterol attenuate the virus-associated upregulation of B7-H1 on airway epithelial cells via suppression of NF-ĸB activation.

First annual register of allergenic pollen in Talca, Chile.

BACKGROUND: There are no data on atmospheric pollen in Talca. In the present work, our aim is to describe the amount of pollen grain in the atmosphere of the city of Talca likely to cause pollinosis of its inhabitants. METHODS: A volumetric Hirst sampler (Burkard seven-day recording device) was used to study pollen levels. It was placed in the centre of Talca from May 2007 to April 2008. RESULTS: The highest airborne presence of pollen, as measured in weekly averages, was Platanus acerifolia with a maximum weekly daily average of 203 grains/m³ registered during September and October. The second highest was Acer pseudoplatanus with a maximum weekly daily average of 116 grains/m³. Populus spp. had a maximum weekly daily average 103 grains/m³. Olea europaea reached 19 grains/m³ in November. Grasses presented high levels of pollen counts with a maximum weekly daily average of 27 grains/m³ from the end of August until the end of January. Pollens of Plantago spp. Rumex acetosella and Chenopodium spp. had a similar distribution and were present from October to April with maximum weekly daily average of 7 grains/m³, 7 grains/m³ and 3 grains/m³ respectively. Significant concentrations of Ambrosia artemisiifolia were detected from February until April. CONCLUSION: The population of Talca was exposed to high concentrations of allergenic pollen, such as P. acerifolia, A. pseudoplatanus, and grasses in the months of August through November. The detection of O. europaea and A. artemisiifolia is important as these are emergent pollens in the city of Talca. Aerobiological monitoring will provide the community with reliable information about the level of allergenic pollens, improving treatment and quality of life of patients with respiratory allergy.

Colitis ulcerosa corticorrefractaria en puerperio: reporte de un caso clínico / Corticorefractary ulcerative colitis in a puerperal woman: clinical report

For patients with bloody diarrhea, one of the possible diagnoses is ulcerative colitis. The case under analysis corresponds to a puerperal 19 year old woman, without any known medical record, presenting a fulminant pancolitis 40 days after delivery. The patient was admitted in the emergency room of “Hospital Militar” of Santiago, as a consequence of an important bloody diarrhea. She had hypotension, tachycardia and anemia, without fever so she was admitted into the Critical Care Unit. Abdominal CT showed that the colon was entirely dilated. Furthermore, the complete colonoscopy revealed pancolitis and pseudopolyps. There was no clinic improvement with the use of antibiotics, systemic steroids, oral 5-ASA, 5-ASA enemas and steroid enemas. The patient remained with bloody diarrhea; hence, infliximab treatment was started. She presented a satisfactory evolution, reducing the number of bowel movements and bleeding episodes. The biopsy confirmed ulcerative colitis. Treatment options for severe colitis that do not respond to steroids after 72 hours are: ciclosporin, anti-tumor necrosis factor therapy (infliximab) and surgery (colectomy). Anti-TNF, specifically infliximab, has shown response in 70 percent of fulminant colitis. For this purposes, the use of infliximab resulted in positive evolution with resolution of symptoms.

La colitis ulcerosa (CU) constituye parte del diagnóstico diferencial de diarrea con sangre. A continuaciónse presenta un caso de CU fulminante en una mujer de 19 años, puérpera de 40 días, sin antecedentes mórbidos conocidos. Inició diarrea con sangre porlo que consultó en el Hospital Militar de Santiago. Al momento de consultar se encontraba con hipotensión, taquicardia, anemia y sin fiebre por lo que ingresó a la Unidad de Paciente Crítico. En la Tomografía Computada de abdomen se informa dilatación pancolónica. En la colonoscopía se informa como pancolitis con presencia de pseudopólipos. Se inició terapiacon antibióticos, corticoides sistémicos, salicilatos (5 ASA) oral y en enemas, y esteroides en enemas; sin respuesta clínica, por lo que se decide iniciarinfliximab. Evolucionó con progresiva disminución de diarrea. Finalmente la biopsia fue compatible con colitis ulcerosa. Las alternativas terapéuticas frente a colitis grave que no responde a esteroides en 72 h son: ciclosporina, terapia con anticuerpos monoclonales(infliximab) y cirugía (colectomía). Específicamente, los anticuerpos contra factor de necrosis tumoral (anti-TNF) han mostrado una respuesta clínica de 70 por ciento de las colitis fulminantes. En este caso, el uso de infliximabpermitió una adecuada evolución con resolución de los síntomas.

Seguimiento de pólipos de colon / Surveillance of colorectal polyps

The colorectal cancer (CRC) is the second cause of death by digestive tumors. Colonic polyps can benon-neoplastic and neoplastic, where the adenomatous are premalignant lesions given their potential adenoma-carcinoma sequence and associated genetic factors that favor their occurrence. Most polyps are casual findings in: a colonoscopy performed due to nonspecific symptoms or signs, without a clear association with the presence of the polyps; as result of CRC screening programs; patients with positive fecal occult bleeding tests; individuals belonging to CRC risk groups such as inflammatory bowel disease or a family history of intestinal polyposis syndrome. For these reasons consensus guides and protocols have been developed for the follow-up of these injuries, being colonoscopy under quality parameters the recommended procedure, where polypectomy of the polyps encountered must be performed. This allows for histopathological study and depending on the results, the patients are referred to a monitoring program with variable periods of time, according to size, number, tubular or hairy adenoma (histological findings), degree of dysplasia or the existence or not of in situ or invasive carcinoma.

El cáncer colorrectal (CCR) es la segunda causa de muerte por tumores digestivos. Los pólipos colónicos pueden ser no neoplásicos y neoplásicos, donde los adenomatosos son lesiones premalignas, dada su potencial secuencia adenoma carcinoma y los factores genéticos asociados que lo favorecen. La mayoría de los pólipos son hallazgos casuales en: una colonos-copia efectuada por síntomas o signos inespecíficos sin relación clara con la presencia de los mismos; como resultado de programas de tamizaje (cribado o screening) para CCR; pacientes estudiados por test de hemorragias ocultas fecales positivas; individuos pertenecientes a grupos de riesgo para CCR como son las enfermedades inflamatorias intestinales; o por antecedentes familiares de síndromes de poliposis intestinal. Por tales motivos se han consensuado guías y protocolos de seguimiento de estas lesiones, siendo la colonoscopia bajo parámetros de calidad el procedimiento recomendado, donde siempre debe efectuarse la polipectomía del o los pólipos encontrados. Esto permite su estudio histopatológico y de acuerdo al resultado se integraran los pacientes a un programa de vigilancia con rangos o intervalos de tiempo variables, según tamaño, número, histología tubular o vellosa, grado de displasia o la existencia o no de carcinoma in situ o invasor.

Two new phospholipase D isoforms of Loxosceles laeta: cloning, heterologous expression, functional characterization, and potential biotechnological application.

Toxin phospholipases-D present in the venom of Loxosceles spiders is the principal responsible for local and systemic effects observed in the loxoscelism. In this study, we describe the cloning, expression, functional evaluation, and potential biotechnological application of cDNAs, which code for two new phospholipase D isoforms, LIPLD1 and LIPLD2, of the spider Loxosceles laeta. The recombinant protein rLIPLD1 had hydrolytic activity on sphingomyelin and in vitro hemolytic activity on human red blood cells, whereas rLIPLD2 was inactive. The purified recombinant proteins and the venom are recognized by polyclonal anti-rLIPLD1 and rLIPLD2 sera produced in animals and conferred immunoprotection against the venom. These new isoforms reinforce the importance of the multigene family of phospholipases-D present in Loxosceles spiders. A highly immunogenic inactive isoform such as rLIPLD2 raises important expectation for its use as a potential immunogenic inducer of the immunoprotective response to the toxic action of the venom of Loxosceles laeta.