[Hemophagocytic syndrome, current diagnostic and therapeutic approach]. / Síndrome hemafagocítico, enfrentamiento diagnóstico y terapéutico actual. Revisión a partir de un caso relacionado a virus Epstein-Barr.

Hemophagocytic syndrome or hemophagocytic lymphohistiocytosis (HLH) is a highly lethal hyper-inflammatory disorder that leads to a storm of cytokines, hemophagocytosis and multiple organ failure. It can be primary, which is inherited, or secondary. In the latter, virus infections are a frequent trigger, predominantly the family of herpes viruses, such as Epstein-Barr virus. An early treatment is recommended. Until recently there was no consensus about the management of secondary cases. The protocols for the treatment of primary HLH were used, which include cytotoxic agents and corticosteroids. We herein review the current diagnostic and therapeutic approach of HLH, based on a case associated with a reactivation of the Epstein-Barr virus in an immunocompetent adolescent. We highlight the importance of suspecting this disease in patients with a persistent inflammatory response state or with a fever of unknown origin, in order to carry out a timely treatment, with the least toxicity, and appropriate to the characteristics of each individual, which is the current therapeutic trend.

Síndrome hemafagocítico, enfrentamiento diagnóstico y terapéutico actual. Revisión a partir de un caso relacionado a virus Epstein-Barr / Hemophagocytic syndrome, current diagnostic and therapeutic approach

Hemophagocytic syndrome or hemophagocytic lymphohistiocytosis (HLH) is a highly lethal hyper-inflammatory disorder that leads to a storm of cytokines, hemophagocytosis and multiple organ failure. It can be primary, which is inherited, or secondary. In the latter, virus infections are a frequent trigger, predominantly the family of herpes viruses, such as Epstein-Barr virus. An early treatment is recommended. Until recently there was no consensus about the management of secondary cases. The protocols for the treatment of primary HLH were used, which include cytotoxic agents and corticosteroids. We herein review the current diagnostic and therapeutic approach of HLH, based on a case associated with a reactivation of the Epstein-Barr virus in an immunocompetent adolescent. We highlight the importance of suspecting this disease in patients with a persistent inflammatory response state or with a fever of unknown origin, in order to carry out a timely treatment, with the least toxicity, and appropriate to the characteristics of each individual, which is the current therapeutic trend.

Tiempos de llegada de pacientes con ataque cerebrovascular en un hospital regional de alta complejidad / Arrival times of patients with stroke to a public hospital

Background: Stroke is a time-dependent emergency. Most patients with acute ischemic stroke are excluded from reperfusion therapies due to late consultation. Aims: To estimate the arrival times of patients with stroke to the Emergency Room (ER) of a public hospital. To identify factors associated with early consultation. Material and Methods: A convenience sample, 583 patients aged 71 ± 13 years (55% males) consulting for stroke at an emergency room was analyzed in terms of delay between onset of symptoms and arrival to the ER, demographics and etiology of stroke. Results: The admission diagnoses were ischemic stroke in 76%, intracerebral hemorrhage in 12%, transient ischemic attack in 9% and subarachnoid hemorrhage in 3%. The median time of arrival was 8 hours and 11 minutes after the onset of symptoms. Nineteen percent of consultations for ischemic stroke occurred within 3 hours of symptom onset, and 38% within 6 hours. In the logistic regression analysis, having an address near the hospital and the severity of stroke were associated with early consultation with a combined odds ratio of 5.97 (95% confidence intervals 3.23-11.04). Conclusions: There were significant differences in the arrival times of patients with stroke. Only a low proportion of patients with ischemic stroke consulted within the window for reperfusion therapies. Severe strokes and living near the hospital were associated with early consultation.

Factores asociados a llegada y evaluación precoz de pacientes con ataque cerebrovascular en un hospital regional de alta complejidad / Factors associated with early arrival and evaluation of stroke patients in a regional tertiary hospital

Resumen Antecedentes: El ataque cerebrovascular (ACV) es una urgencia tiempo-dependiente. La mayoría de los pacientes con infarto cerebral quedan excluidos de las terapias de reperfusión por consultar tardíamente. Se desconocen los factores asociados a llegada y evaluación precoz de pacientes con ACV agudo en nuestra población. Objetivos: Identificar los factores asociados, llegada y evaluación precoz de pacientes con ACV agudo. Pacientes y Métodos: Muestra por conveniencia de las consultas por ACV realizadas en el Turno N° 1, del SU del Hospital Dr. Hernán Henríquez de Temuco, entre enero de 2016 y diciembre de 2017. El análisis estadístico se realizó con el software STATA 14.0. Resultados: Se registraron 584 consultas por ACV. La mediana del tiempo de llegada fue de 8 h y 11 min. La mediana del tiempo para la evaluación por neurólogo(a) fue de 66 min. Tener domicilio en Temuco-Padre Las Casas y una mayor severidad del ACV se asociaron a consultar precozmente con un OR = 5,97 (3,23-11,04). Para evaluación dentro de una hora, las variables severidad, llegada en ambulancia y consulta en menos de 3 h, fueron estadísticamente significativas, con un OR combinado de 10,86 (IC 95%: 5,15-22,94). Conclusiones: Los factores más fuertemente asociados a llegada y evaluación precoz incluyen residir en comunas cercanas al hospital y presentar síntomas más severos de ACV. Se sugiere implementar estrategias para aumentar el grado de reconocimiento de síntomas de ACV y para disminuir las barreras de acceso a hospitales que traten a este tipo pacientes.

Introduction: Stroke is a time-dependent emergency. The majority of patients with Acute Ischemic Stroke are excluded from reperfusion therapies due to late consultation. The factors associated with early arrival and evaluation of patients with acute stroke in our population are unknown. The aim of the study was to identify factors associated with early arrival and evaluation of patients with acute stroke. Methods: A convenience sample of the stroke consultations made during shift # 1 at the ER between January 2016 and December 2017, was analyzed. Results: There were 584 stroke consultations in the period. 55.1% were men. The median time of arrival was 8 hours and 11 minutes. The median time for evaluation by neurologist was 66 minutes. Having an address in Temuco-Padre Las Casas and the severity of stroke was associated with early consultation with a combined OR of 5.97 (CI 95% 3.23-11.04). For an evaluation within one hour, in the logistic regression model, the variables severity, arrival in ambulance and consultation in less than 3 hours were statistically significant with a combined OR of 10.86 (CI 95% 5.15-22.94). Conclusions: The factors associated with early consultation and evaluation include residing in communes near the hospital and presenting more severe symptoms of stroke. It is suggested to implement strategies to increase the degree of recognition of stroke symptoms and to reduce barriers to access hospitals that treat patients with stroke.

[Arrival times of patients with stroke to a public hospital]. / Tiempos de llegada de pacientes con ataque cerebrovascular en un hospital regional de alta complejidad.

BACKGROUND: Stroke is a time-dependent emergency. Most patients with acute ischemic stroke are excluded from reperfusion therapies due to late consultation. AIMS: To estimate the arrival times of patients with stroke to the Emergency Room (ER) of a public hospital. To identify factors associated with early consultation. MATERIAL AND METHODS: A convenience sample, 583 patients aged 71 ± 13 years (55% males) consulting for stroke at an emergency room was analyzed in terms of delay between onset of symptoms and arrival to the ER, demographics and etiology of stroke. RESULTS: The admission diagnoses were ischemic stroke in 76%, intracerebral hemorrhage in 12%, transient ischemic attack in 9% and subarachnoid hemorrhage in 3%. The median time of arrival was 8 hours and 11 minutes after the onset of symptoms. Nineteen percent of consultations for ischemic stroke occurred within 3 hours of symptom onset, and 38% within 6 hours. In the logistic regression analysis, having an address near the hospital and the severity of stroke were associated with early consultation with a combined odds ratio of 5.97 (95% confidence intervals 3.23-11.04). CONCLUSIONS: There were significant differences in the arrival times of patients with stroke. Only a low proportion of patients with ischemic stroke consulted within the window for reperfusion therapies. Severe strokes and living near the hospital were associated with early consultation.

[Waiting times for neurological emergencies in an emergency room]. / Tiempos de atención de urgencias neurológicas en un hospital regional de alta complejidad.

BACKGROUND: Neurological emergencies constitute 10-15% of medical emergencies. Doctor Hernán Henríquez Aravena Hospital has in house neurologists present permanently at the Emergency Room since July 2013. AIM: To estimate the waiting times for neurological consultations; to compare the waiting times between neurovascular (UV) and non-vascular (UNV) emergencies; and to compare the waiting times of two prioritization (triage) models. MATERIAL AND METHODS: A convenience sample of the consultations made during shift # 1 at the emergency room between January and December 2016, was analyzed. RESULTS: There were 859 consultations in the period, 570 for UNV and 289 for UV. Mean age of consultants was 57 years and 52% were women. The median time for having an evaluation by a neurologist was 106 min (132 and 81 min for UNV and UV respectively). Twenty seven percent of patients were evaluated in less than one hour (23 and 36% of UNV and UV, respectively). The change of the prioritization model decreased the waiting time by 81 and 32 min for UNV and UV, respectively. CONCLUSIONS: There were significant differences in waiting times between neurovascular and non-vascular emergencies. Most patients were not evaluated in less than 60 minutes. The change in the initial stratification model was associated with a significant reduction in the waiting times for neurological emergencies.

Inventario de sistema de creencias (SBI-15R) en Colombia: estructura factorial y confiabilidad en población universitaria y pacientes crónicos / System of belief inventory (SBI -15R) in Colombia: Factorial structure and reliability in university population and chronic patients / Inventário do sistema de crenças (SBI-15R) na Colômbia: estrutura dos fatores e confiabilidade na população universitária e pacientes crônicos

Estudio de corte psicométrico. Objetivo: analizar la estructura factorial y la consistencia interna del Inventario de sistema\r\nde creencias (SBI-15R) en universitarios y enfermos crónicos colombianos. Método: se aplicó el cuestionario SBI-15R a 265\r\nestudiantes universitarios adultos y 52 enfermos crónicos. Resultados: el análisis factorial muestra dos factores: Convicción religiosa y Soporte social religioso, sin hallar diferencias en la estructura para cada muestra, y un alfa de Cronbach total de 0,926.\r\nDespués de la eliminación de un ítem, se halló una alta confiabilidad y concordancia en la estructura factorial del inventario con\r\nla versión original mexicana. Conclusión: el Inventario de sistema de creencias (SBI-15R) presenta adecuada validez y confiabilidad\r\nen población colombiana.

Psychometric study. Objective: To analyze the factorial\r\nstructure and internal consistency of the System of Belief\r\nInventory (SBI-15R) in university students and chronic Colombian\r\npatients. Method: The SBI-15R questionnaire was given to\r\n265 adult university students and 52 chronic patients. Results:\r\nThe factorial analysis shows two factors: Religious Conviction\r\nand Religious social support, without finding differences in\r\nthe structure for each sample, and a total Cronbach's alpha\r\nof 0.926. After the elimination of an item, it was found that a\r\nhigh reliability and concordance in the factorial structure of\r\nthe inventory with the original Mexican version. Conclusion:\r\nThe System of Belief Inventory (SBI-15R) presents an adequate\r\nvalidity and reliability in the Colombian population.

Estudo de corte psicométrico. Objetivo: analisar a estrutura\r\ndos fatores e a consistência interna do Inventário do Sistema\r\nde Crenças (SBI-15R) em estudantes universitários e pacientes\r\ncolombianos crônicos. Método: o questionário SBI-15R foi\r\naplicado a 265 estudantes universitários adultos e 52 pacientes\r\ncrônicos. Resultados: a análise fatorial mostra dois fatores:\r\nConvicção religiosa e Suporte social religioso, sem encontrar\r\ndiferenças na estrutura para cada amostra e um alfa\r\ntotal de Cronbach de 0,926. Os resultados encontrados após\r\na eliminação de um item mostram uma alta confiabilidade e\r\nconcordância na estrutura fatorial do inventário com a versão\r\nmexicana original. Conclusão: os resultados encontrados\r\nimplicam validade e confiabilidade adequadas do teste na\r\npopulação colombiana.

Tiempos de atención de urgencias neurológicas en un hospital regional de alta complejidad / Waiting times for neurological emergencies in an emergency room

Background: Neurological emergencies constitute 10-15% of medical emergencies. Doctor Hernán Henríquez Aravena Hospital has in house neurologists present permanently at the Emergency Room since July 2013. Aim: To estimate the waiting times for neurological consultations; to compare the waiting times between neurovascular (UV) and non-vascular (UNV) emergencies; and to compare the waiting times of two prioritization (triage) models. Material and Methods: A convenience sample of the consultations made during shift # 1 at the emergency room between January and December 2016, was analyzed. Results: There were 859 consultations in the period, 570 for UNV and 289 for UV. Mean age of consultants was 57 years and 52% were women. The median time for having an evaluation by a neurologist was 106 min (132 and 81 min for UNV and UV respectively). Twenty seven percent of patients were evaluated in less than one hour (23 and 36% of UNV and UV, respectively). The change of the prioritization model decreased the waiting time by 81 and 32 min for UNV and UV, respectively. Conclusions: There were significant differences in waiting times between neurovascular and non-vascular emergencies. Most patients were not evaluated in less than 60 minutes. The change in the initial stratification model was associated with a significant reduction in the waiting times for neurological emergencies.

Probióticos en la avicultura: una revisión / Probiotics in poultry farming: A review / Probióticos na avicultura: uma revisão

Resumen Los probióticos y prebióticos actualmente se postulan como una alternativa potencial de reemplazo a los antibióticos utilizados como subterapéuticos, a modo de promotores de crecimiento. Su ventaja es que no dejan residuos en el huevo ni en la carne del ave, y no generan riesgo de resistencia antibiótica en la microbiota humana. El uso de los microorganismos probióticos, principalmente bacterias productoras de ácido láctico en la alimentación de las aves, contribuye al mantenimiento de la integridad y estabilidad de la flora intestinal. Esto dificulta la proliferación de microorganismos perjudiciales, lo cual ayuda a prevenir la aparición de enfermedades y a mejorar el rendimiento productivo. Sin embargo, en cuanto a su efecto como promotor de crecimiento, los resultados son contradictorios, en gran medida debido a la variedad de microorganismos y dosis que se pueden suministrar, al tipo de aves utilizadas, a los métodos de administración, a la composición de las dietas de alimentación de las aves y a las condiciones ambientales en que se realizan los bioensayos. Por lo tanto, y debido a la necesidad de prescindir de los antibióticos como promotores de crecimiento, es indispensable continuar investigando y ampliando el conocimiento de estos aditivos, mediante la realización de bioensayos que permitan determinar las cepas bacterianas y los métodos de administración más idóneos en los linajes de aves modernas bajo producción intensiva. El objetivo de esta revisión es presentar un análisis de las condiciones en las que estas sustancias actúan, y explicar por qué a veces sus efectos son insignificantes.

Abstract Probiotics and prebiotics are currently postulated as a potential replacement alternative to sub-therapeutic antibiotics as growth promoters. The advantage is that these agents do not leave residues in the egg or meat of the poultry, and do not cause risk of developing antibiotic resistance in human microbiota. The use of probiotic microorganisms, mainly lactic acid-producing bacteria in poultry feeding, contributes to maintaining the integrity and stability of the intestinal flora. This hampers the proliferation of harmful microorganisms, which helps to prevent the onset of disease and improves productive performance. Nevertheless, regarding their effect as growth promoters, results are contradictory, largely because of the variety of microorganisms and doses that can be administered, the type of poultry used, methods of administration, diet compositions, and environmental conditions in which bioassays are performed. Therefore, given the need to eliminate antibiotics as growth promoters, it is essential to continue researching and expanding our knowledge of these additives, by conducting bioassays to determine bacterial strains and the most suitable methods of administration in modern poultry lineages under intensive production. The objective of this review is to present an analysis of the conditions under which these substances work, and to explain why their effects are sometimes insignificant.

Resumo Os probióticos e prebióticos atualmente se postulam como uma alternativa potencial de substituição aos antibióticos utilizados como subterapêuticos, a modo de promotores de crescimento. Têm como vantagem que estes agentes não deixam resíduos no ovo nem na carne da ave, e não geram risco de resistência antibiótica na microbiota humana. O uso dos micro-organismos probióticos, principalmente bactérias produtoras de ácido láctico na alimentação das aves, contribui para a manutenção da integridade e estabilidade da flora intestinal. Isto dificulta a proliferação de micro-organismos prejudiciais, fator que ajuda a prevenir a aparição de doenças e a melhorar o rendimento produtivo. No entanto, em relação ao seu efeito como promotor de crescimento, os resultados são contraditórios, em grande medida devido à variedade de micro-organismos e doses que podem ser administradas, ao tipo de aves utilizadas, aos métodos de administração, à composição das dietas de alimentação das aves e às condições ambientais em que se realizam os bioensaios. Portanto, e devido à necessidade de prescindir dos antibióticos como promotores de crescimento, é indispensável continuar pesquisando e ampliando o conhecimento destes aditivos, mediante a realização de bioensaios que permitam determinar as cepas bacterianas e os métodos de administração mais idôneos nas linhagens de aves modernas sob produção intensiva. O objetivo desta revisão é apresentar uma análise das condições nas que estas substâncias atuam, e explicar por que às vezes os seus efeitos são insignificantes.

Fisiopatología de la migraña: Teoría vascular, ¿Cierta o no? / Pathophysiology of migraine: vascular theory, true or not?

La migraña es una enfermedad de alta prevalencia, incapacitante y en algunas ocasiones de difícil manejo. Desde hace décadas se han planteado múltiples teorías para explicar su curso, su componente genético y la asociación a distintos factores de riesgo. Actualmente se desconoce una fisiopatología única y exacta que implique los eventos, y se ha encontrado fuerte evidencia que muestra que la teoría más antigua y con mayor sustento, a saber la teoría vascular, es en realidad incorrecta, pues no explica la totalidad de los eventos. Sin embargo, se han probado distintos mecanismos que, en conjunto, permiten comprender las alteraciones presentes. Entre estas se cuentan cambios estructurales, implicación de neuropéptidos, sensibilización, e inflamación neurogénica.

Migraine is a highly prevalent disease; it is disabling, and sometimes difficult to manage. For decades, many theories have been proposed to explain its course, its association with a genetic component and with different risk factors. There is currently no single and exact pathophysiology that accounts for all events, and strong evidence has been showing that the oldest theory believed to be mostly true, i.e. the vascular theory, is actually incorrect, because it does not explain the totality of the events. However, various mechanisms have been proven to exist, which together, provide insight into alterations, such as structural changes involving neuropeptides, sensitization, and neurogenic inflammation.

Injection of Dicyandiamide-Treated Pig Slurry Reduced Ammonia Volatilization without Enhancing Soil Nitrous Oxide Emissions from No-Till Corn in Southern Brazil.

There is a lack of information on how placement in soil and nitrification inhibitors affects nitrous oxide (NO) and ammonia (NH) emissions from pig slurry (PS) applied under no-till (NT) conditions. Our objective was to determine the impact of injecting PS and treating it with the nitrification inhibitor dicyandiamide (DCD) on NH and NO emissions from soils under NT in subtropical southern Brazil. The emissions of these gases were compared for shallow (∼ 10 cm) injection and surface broadcasting of PS with and without DCD (8.1-10.0 kg ha; 6.5-8.4% of applied NH-N). Measurements were made at two sites during two summer growing seasons under NT corn crops. Injection reduced NH volatilization by 70% but increased NO emissions 2.4-fold (from 2628 to 6198 g NO N ha) compared with surface broadcast application. Adding DCD to PS inhibited nitrification and reduced NO emissions by an average of 28% (730 g NO-N ha) for surface broadcast and 66% (4105 g NO-N ha) for injection but did not increase NH volatilization. Consequently, NO emission factors were much higher for injection (3.6%) than for surface broadcast (1.3%) application and were reduced (0.9%) when DCD was added to injected PS. In conclusion, the injection of DCD-treated slurry is a recommendable practice for reducing NH and NO emissions when applying PS on NT corn in southern Brazil.

Hábitos alimentarios, actividad física y nivel socioeconómico en estudiantes universitarios de Chile / Eating habits, physical activity and socioeconomic level in university students of Chile

Introducción: Los estudiantes universitarios son vulnerables a una mala nutrición, no consumen meriendas entre las comidas, no desayunan, ayunan por largas horas, prefieren la comida rápida y además no realizan ejercicios físicos. La población universitaria es considerada la población adulto joven clave para la promoción y prevención de salud para las futuras generaciones, por lo que es trascendental identificar la situación actual nutricional y la frecuencia de actividad física de los universitarios. Objetivos: Determinar los factores que intervienen en la elección de los alimentos y la frecuencia de actividad física en estudiantes universitarios. Métodos: Se evaluaron 799 voluntarios de cuatro universidades de la quinta región de Chile. Se aplicó un instrumento para determinar el nivel de actividad física y de hábitos alimentarios, el test kidmed para determinar la adherencia a la dieta mediterránea y un instrumento Adimark para determinar el nivel socioeconómico de los sujetos. Finalmente se realizó una evaluación antropométrica para determinar IMC, masa grasa y masa muscular. Resultados: La inactividad física es mayor en mujeres que en hombres y plantean que la principal razón para no hacer ejercicio es la falta de tiempo y la pereza. En ambos sexos no leen las etiquetas nutricionales y tienen una media adherencia a la dieta mediterránea. Discusión: Existen bajos conocimientos de nutrición que provocan una mala calidad en la alimentación de los sujetos y no existe motivación para realizar mayor actividad física. El nivel socioeconómico no tiene relación con los hábitos alimentarios ni con la actividad física, por lo que es necesario integrar programas regulares y permanentes de vida sana en todas las universidades (AU)

Introduction: University students are vulnerable to poor nutrition; they don't eat snacks between meals, don't eat breakfast or fast for long hours, prefer fast food and don't exercise. University students is considered the key young adult population group for health promotion and prevention for future generations, so it's crucial identify the current nutritional status and frequency of physical activity. Objectives: To determine the factors involved in the choice of food and frequency of physical activity in university students. Methods: 799 volunteers were evaluated from four universities of the fifth region of Chile. Instrument was applied to determine the level of physical activity and eating habits, KIDMED test to determine adherence to the Mediterranean diet and Adimark instrument to determinate the socioeconomic status of the subjects. Finally, anthropometric evaluation to determinate BMI, fat mass and muscle mass. Results: Physical inactivity is higher in women than in men and that the main reason for not exercising is lack of time and laziness. In both sexes don't read nutrition labels and have a low and average adherence to the Mediterranean diet. Discussion: The low knowledge of nutrition is the cause of the poor food quality of subjects and there isn't greater motivation to perform physical activity. Socioeconomic status isn't related to eating habits and physical activity. It's necessary to integrate programs regular and permanent healthy lifestyle in all universities (AU)

Motivaciones y actitudes hacia la donación voluntaria de ovocitos: experiencia de la Unidad de Medicina Reproductiva de la Clínica Monteblanco / Motivations and attitudes toward voluntary donation of oocytes

Objetivos: Determinar las motivaciones de mujeres para donar óvulos, y las significaciones que le otorgan a la misma. Método: Entrevista semiestructurada, cualitativa, a 18 mujeres candidatas a donantes de óvulos. Los tópicos analizados incluyeron: experiencias pasadas, fantasías y expectativas en relación a la ovodonación. Resultados: Las edades de las entrevistadas fluctuaron entre 19 y 29 años; 13 eran solteras y 6 tenían al menos un hijo. Más de la mitad estaban estudiando y trabajando al momento de la entrevista. Ninguna tenía antecedente de patología psiquiátrica personal ni familiar. La compensación económica fue la principal motivación para donar, aunque la empatía con las parejas infértiles fue otro importante motivador. Las potenciales donantes refirieron que el anonimato como protector para la donante y la pareja receptora. Las donantes percibieron la maternidad más relacionada con la crianza que con el vínculo genético. Conclusiones: Encontramos que las candidatas para ovodonar perciben la maternidad en función de la crianza y no del vínculo genético. Por lo tanto, asimilaron la donación de ovocitos con la donación de cualquier órgano. Sin embargo, manifiestan su rechazo a tener contacto con la familia receptora. Como era de esperar, la motivación económica fue la principal razón para donar, sin embargo, sentían fuerte empatía con las parejas infértiles.

Aims: To identify the motivating factors of candidates to donate oocytes, and the significance they assign to oocyte donation. Methods: We evaluated 18 volunteers trough a semi-structured interview. Topics discussed included: past experiences, fantasies and expectations towards the process of oocyte donation. Results: The ages fluctuated between 19 and 29 years; 13 were single and 6 had one or more children. More than a half were studying and working at the moment of the interview. None had familiar or personal psychiatric disorders. The economical compensation was the most important reason for the intention to donate, though the empathy with infertile couples was a significant motivator too. Potential donors perceived anonymity as protective for both donor and receptor. They perceived motherhood as rising the child rather than having a genetic link. Conclusions: We found that potential donors perceive motherhood as linked to rising a child, rather than having a genetic link. Therefore, they assimilate oocyte donation to the donation of any other organ. However, they prefer to have no contact with the oocyte receptor. As expected, the main motivator is the economical compensation, however they have strong feelings of empathy towards infertile couples.

Asimetría en la función relativa en CR DMSA en riñones con doble sistema excretor no complicado: variante normal / Asymmetry in the relative function in CR DMSA in kidneys weith double non complicated excretor system: normal Variant

Introducción: El doble sistema excretor (DS) al Cintigrama Renal (CR) DMSA, con asimetría en la función relativa es un hallazgo relativamente frecuente. Evaluamos su incidencia, correlación con ecografía y valores de función relativa. Material y Método: Se seleccionaron los CR DMSA con diagnóstico cintigráfico de DS sin otras alteraciones. Ecografías sin otros hallazgos. Se comparó la función relativa entre riñones con y sin DS y entre riñones con y sin asimetría de tamaño. T-Test para muestras independientes. Se correlacionó el DMSA con la ecografía. Resultados: 79 pacientes en que se dispuso ecografía fueron estudiados. 17 con DS bilateral (21,5 por ciento). 72 por ciento mujeres, promedio de edad: 54,4 meses (1–204). Función relativa promedio en riñones con DS unilateral: 51,8 por ciento (43-61 por ciento) y 48,19 por ciento (39-57por ciento) en riñones sin DS. p<0,0001. En riñones con DS y aumentados de tamaño la diferencia con el contralateral fue mayor que en los de igual tamaño. Ecografía concordante con el CR DMSA en 52,63 por ciento. Conclusiones: 1.- La función relativa en riñones con Doble Sistema fue significativamente mayor que en riñones sin Doble Sistema, especialmente cuando existió asimetría en el tamaño renal. Esta condición debe considerarse variante normal para evitar la interpretación errada de riñones contralaterales hipofuncionantes. 2.- En la mitad de los pacientes hubo concordancia con la ecografía en diagnóstico de DS, hallazgo esperable.

Aim: Duplex system in DMSA with asymmetry in relative function it’s a frequent finding. We evaluated the incidence, correlation with sonography and the relative functions in these kidneys. Method: We selected patients with scintigraphic diagnosis of duplex system in the DMSA, without any other scintigraphic lesions and had a normal ultrasound. We compared the relative renal function in kidneys with and without duplex system and in kidney with and without size asymmetry. Independent samples t test was applied. DMSA results were compared with ultrasound. Results: 79 patients had ultrasound. 17 with bilateral DS (21.5 percent). 72 percent women; median age: 54.4 months (1–204). Relative function in unilateral DS kidney was 51.8 percent (43-61 percent) and 48.19 percent in kidneys without DS (39-57 percent), p< 0.0001. In kidneys larger and DS the difference in relative function with the contralateral kidney was more important than kidney with similar size. The ultrasound was concordant with DMSA in 52.63 percent of the patients. Conclusions: 1.- The relative function values were significantly higher in kidneys with Duplex System than kidneys without it, especially with asymmetry of the renal size .This condition should be consider a normal variant for to avoid the wrong interpretation of hipofunctioning contralateral kidney. 2.- Half of the patients had duplex system in DMSA scintigraphy and ultrasound, which was predictable.

[Risk factors associated to vancomycin-resistant enterococccus colonization in the Army Hospital in Santiago]. / Estudio de factores de riesgo para colonización por enterococo resistente a vancomicina en el Hospital Militar de Santiago.

Since the appearance of Vancomicin-resistant enterococci (VRE) in our country, the Chilean Ministry of Health recommended the surveillance of intestinal colonization in patients in critical wards. We report the results of surveillance in ICU and onco-hematological wards from 2002 to 2008, with analysis of possible risk factors: demographical data, use and type of antibiotic, days of hospitalization prior to sampling, and year of hospitalization. Colonization rate increased from 0.03 cases per 1000 bed-days in 2003 to 0.18 cases during 2008. Univariate analysis identified 7 risk factors associated with ERV colonization: hospitalization in ICU, use of antibiotics, use of 3 or more compounds, use of imipenem or colistin, >10 days of hospitalization prior to the study and year of hospitalization (before 2007 or after). Multivariate analysis by logistic binary regression showed that only the last two: >10 days of hospitalization prior to the study and year of hospitalization (before 2007 or after), were significantly associated to colonization by ERV.

Estudio de factores de riesgo para colonización por enterococo resistente a vancomicina en el Hospital Militar de Santiago / Risk factors associated to vancomycin-resistant enterococccus colonization in the Army Hospital in Santiago

Since the appearance of Vancomicin-resistant enterococci (VRE) in our country, the Chilean Ministry of Health recommended the surveillance of intestinal colonization in patients in critical wards. We report the results of surveillance in ICU and onco-hematological wards from 2002 to 2008, with analysis of possible risk factors: demographical data, use and type of antibiotic, days of hospitalization prior to sampling, and year of hospitaliza-tion. Colonization rate increased from 0.03 cases per lOOObed-days in2003 to 0.18 cases during2008. Univariate analysis identified 7 risk factors associated with ERV colonization: hospitalization in ICU, use of antibiotics, use of 3 or more compounds, use of imipenem or colistin, > 10 days of hospitalization prior to the study and year of hospitalization ( before 2007 or after). Multivariate analysis by logistic binary regression showed that only the last two: >10 days of hospitalization prior to the study and year of hospitalization (before 2007 or after), were significantly associated to colonization by ERV.

Desde la emergencia de Enterococcus resistente a vancomicina (ERV) en Chile, el Ministerio de Salud recomendó la vigilancia de colonización intestinal por ERV en pacientes hospitalizados en unidades de pacientes críticos. Describimos los resultados de vigilancia en UCI y Unidad de Aislamiento de Pacientes Hemato-oncológicos desde 2002 a 2008, analizando probables factores de riesgo: datos demográficos, uso y tipo de antimicrobiano, días de hospitalización previo a la toma de muestra y año de hospitalización. La tasa de colonización aumentó de 0,03 casos por 1000 días cama en 2003 a 0,18 durante 2008. El análisis univariado permitió identificar siete factores asociados al riesgo de colonización por ERV: hospitalización en UCI, uso previo o actual de antimicrobianos, haber recibido tres o más antibióticos, terapia con imipenem o colistin, más de 10 días de hospitalización y el año de hospitalización. El análisis multivariado mediante regresión logística binaria, señaló la duración de la hospitalización hasta el momento del estudio (> 10 días) y el año de hospitalización (2007 o después) como factores significativamente asociados al riesgo de colonización por ERV.

Efectos crónicos y tratamiento con litio sobre la anatomía y función renal / Chronic effects of lithium treatment in renal anatomy and function

Lithium is a drug widely used in clinical psychiatry, often as first-line treatment. However, it has generated much controversy because of the likely adverse effects of both acute and chronic use, mainly in the kidney. With respect to prolonged exposure to lithium, it would be detrimental to the kidneys at variable extent, depending on factors such as duration of treatment, dosage of drug, patient age, renal damage, prior comorbidities, among others not yet sufficiently elucidated. The principal mechanism of renal function changes was determined by morphological changes, such as interstitial nephritis, interstitial-medullar fibrosis and tubular atrophy, all irreversible phenomena that ultimately lead to a tubuloglomerular imbalance and commitment of the GFR. Other aspects of chronic nephropathy induced by lithium and their production mechanisms are being studied, also the search and advanced diagnostic techniques to predict and / or detect early changes. Among them have described the pathology (renal biopsy), although this form of diagnosis is very late. Thus it seeks the introduction of imaging and serological markers of kidney failure as tools that provide information about kidney condition earlier.

El Litio es un fármaco ampliamente utilizado en psiquiatría, muchas veces como tratamiento de primera línea. Existe en la actualidad una activa controversia acerca de sus probables efectos adversos a nivel renal, tanto agudos como crónicos, ya que la exposición prolongada al Litio sería deletérea para el riñón en una magnitud variable, dependiendo de factores como duración del tratamiento, dosis del fármaco, edad del paciente, daño renal previo y comorbilidad, entre otros aún no suficientemente dilucidados. El origen del mecanismo principal de alteración de la función renal estaría en alteraciones morfológicas como la Nefritis Intersticial, la Fibrosis Intersticio-Medular y la Atrofia Tubular, todos fenómenos irreversibles que finalmente conducirían a un desbalance tubuloglomerular y a un compromiso de la VFG. Otros aspectos de la Neuropatía Crónica inducida por Litio y de sus mecanismos de producción se encuentran en estudio, así como también la búsqueda y perfeccionamiento de técnicas diagnósticas que permitan predeciry/o detectar tempranamente los cambios mencionados. Entre estas últimas se ha descrito la anatomía patológica (biopsia renal), aunque esta es una forma de diagnóstico muy tardía. Es por ello que se busca la introducción de la imagenología y de marcadores serológicos de falla renal como herramientas que entreguen información sobre la condición del riñón más precozmente.

Depresión posparto en el embarazo adolescente: análisis del problema y sus consecuencias / Adolescent pregnancy and postpartum depression

El embarazo adolescente es un importante problema de Salud Pública, que se asocia a consecuencias biológicas, psicológicas y sociales negativas tanto para la madre como para el hijo. Uno de los riesgos frente a los que las madres adolescentes están particularmente vulnerables es a la depresión posparto (DPP). Existen extensas investigaciones sobre el fenómeno de la DPP, pero los estudios en madres adolescentes son limitados y suelen provenir de países desarrollados. En Chile no existen estudios publicados que se aboquen específicamente a la DPP en adolescentes. Por lo mismo, es que esta revisión pretende dar cuenta de los principales hallazgos internacionales y nacionales sobre prevalencia, factores de riesgo, consecuencias y abordaje de la DPP en general, y en madres adolescentes en particular, con el propósito de fortalecer el conocimiento de los profesionales que trabajan con estas jóvenes, ya sea en el área de salud mental, obstetricia o pediatría.

Adolescent pregnancy is an important public health issue associated with negative biological, psychological and social consequences for the mother and the child. One of the main risks adolescent mothers is particularly vulnerable to postpartum depression. Literature on postpartum depression is broad, but studies regarding the phenomenon in adolescent mothers are scarce, and come mostly from developed countries. In Chile there are no published studies centered on postpartum depression in adolescents. Therefore, this article aims to describe the main international and national findings on the prevalence, risk factors, consequences and management of postpartum depression in general, and in adolescents in particular, with the goal of strengthening the knowledge of professionals caring for adolescent mothers in mental health, obstetric and pediatric services.

Índice de cesárea e indicaciones médica de primera cesárea en el servicio de obstetricia del Hospital San Juan de Dios / Cesarean section ratio and medical indication for first c-section in obstetrics service of San Juan de Dios Hospital

International medical community has been concerned because the high rates of cesarian section in certain countries worldwide, being the chilean figures among the highest, exceeding WHO recommended rates. To decrease this so high rate in our country is an important public health goal of the Ministry of Health (MINSAL) for the current decade. Information about the last two years C-section rates in the hospitals depending on the Servicio de Salud Metropolitano Occidente was collected. Also, a review of the causes referred and indications for first C-section in San Juan de Dios Hospital during 2006 was performed. The overall ratio of C-section in the Servicio de Salud Metropolitano Occidente was 38,4 for cent. The lowest figure was that of San Juan de Dios Hospital, with 32,33 for cent. In this hospital a trend to increase in the rate of C-section was observed in 2003, followed by a decrease and further stabilization of the figures. First C -section accounted or 65,3 for cent. The main indications were: fetal distress, podalic presentation, fetal macrosomy, cephalo-pelvic incompatibility and stationary dilatation. The rate of C-section in the surveyed health service overcomes the limits recommended by WHO and the guidelines of MINSAL. The main diagnostics stated as indication or first C-section are susceptible of critical analysis according to the current guidelines bye the treating physical. This is an important group within the design of strategies or diminishing the rates of C-section. Generation of guidelines for labor care and the daily discussion of the clinical activities might be influencing the results achieved in San Juan de Dios Hospital.

Las altas tasas de cesárea alcanzadas en algunos países han sido motivo de preocupación por parte de la comunidad médica internacional, reconociéndose en Chile una de las más altas a nivel mundial, superando la recomendación establecida por la Organización Mundial de la Salud (OMS). La disminución de este índice en nuestro país constituye un importante objetivo sanitario del Ministerio de Salud (MINSAL) para la presente década. Se recabó información sobre los índices de cesárea de los hospitales pertenecientes al servicio de salud metropolitano occidente en los últimos dos años, Además, se realizó una revisión de las indicaciones referidas como causales de primera cesárea durante el año 2006 del Hospital San Juan de Dios. En el servicio de salud metropolitano occidente se registró un índice de cesárea global para el área de un 38,4 por ciento. El establecimiento que presentó la menor proporción de cesáreas fue el Hospital San Juan de Dios, con un 32,33 por ciento. Este hospital mostró un aumento del índice de cesárea hasta el año 2003, presentando luego una disminución y estabilización en los siguientes años. El porcentaje de primeras cesáreas correspondió a un 65,39 por ciento. Las principales indicaciones de primera cesárea en este período fueron: sufrimiento fetal agudo, presentación podálica, macrosomía, desproporción céfalo-pélvica y dilatación estacionaria. La tasa de cesárea consignada para el servicio de salud estudiado supera el límite recomendado por la OMS y los objetivos establecidos por el MINSAL. Los principales diagnósticos referidos como causales de indicación de primera cesárea son susceptibles a análisis crítico por el médico tratante de acuerdo a las recomendaciones actuales, siendo éste un grupo importante en el diseño de estrategias para la disminución de los índices de cesárea...

[Fusion of SPECT with computed tomography or magnetic resonance for the interpretation of abnormal tracer uptake]. / Utilidad clínica de la fusión SPECT/CT con marcadores externos en patología oncológica.

BACKGROUND: Interpretation of abnormal foci with high tracer uptake may require morphological correlation. Fusion of functional images obtained by single photon emission computed tomography (SPECT) and anatomical images obtained by computed tomography (CT) or magnetic resonance (RM) allows an integrated comprehension of complementary information. AIM: To demonstrate that SPECT/CT fusion with external markers is useful in clinical practice to clarify the location and pathological meaning of questionable foci. MATERIAL AND METHODS: Thirty four pairs of images from separate equipments (31 SPECT/CT and 3 SPECT/RM) pertaining to 29 patients, were fused. Fifty one foci of abnormal tracer uptake of uncertain pathological meaning were analyzed. These were classified before and after the fusion as probably malignant or probably benign. RESULTS: Seventy percent of patients had a differentiated thyroid carcinoma. The fusion localized 100% of foci. Nine percent had a normal and 26% an abnormal anatomy. Before fusion 82% of foci were classified as potentially malignant. This figure changed to 59% after the fusion (p <0.01). Therefore the suspicion of malignancy was presumptively confirmed in 72% of foci and fusion results would have reached a 27% of incremental diagnostic value in 14 cases that changed of category (11 with differentiated thyroid carcinoma, one with colorectal cancer, one with a nasal Ewing sarcoma and one with a brain tumor). CONCLUSIONS: The fusion of SPECT and CT is useful in selected patients, specially those with differentiated thyroid carcinoma. The fusion of SPECT and RM is also feasible.