Caracterización de la mortalidad por fractura de cadera como causa básica en el periodo 2017-2022 en Chile / Characterization of mortality due to hip fracture as the underlying cause in the period 2017-2022 in Chile

Introducción: La fractura de cadera (FC) es una solución de continuidad en el extremo proximal del fémur, con consecuencias significativas para quien la padece. Este estudio busca comparar descriptivamente la tasa de mortalidad por FC en el periodo 2017-2022, en Chile. Metodología: Estudio descriptivo observacional sobre defunciones por FC entre 2017 y 2022, en Chile (n= 3.190), según datos del Departamento de Estadísticas e Información de Salud de Chile. Se calcularon tasas de mortalidad por FC por variable, índice de sobremortalidad e índice de Swaroop, utilizando datos del Censo 2017. No requirió comité de ética. Resultados: La mayor tasa de mortalidad por FC se observó en el año 2018 (3,23), en el grupo de 100 años y más (2.264,15), la región de Valparaíso (28,31) y el sexo femenino (4,32) reflejandose en su índice de sobremortalidad (2,589). La menor tasa de mortalidad por FC ocurrió en el año 2021 (2,76), en el grupo de entre 0 y 19 años (0,04) y en la región de Atacama (12,58). El índice de Swaroop fue 100% en la mayoría de las regiones. Discusión: La tendencia a la baja desde el año 2019 podría explicarse por el confinamiento por COVID-19 que limitó la movilidad de las personas mayores. Los cambios postmenopausicos y un mayor riesgo de caídas podrían explicar una mayor tasa de mortalidad por FC en mujeres y pacientes de edad avanzada, respectivamente. El análisis por región podría relacionarse con la proporción demográfica de personas mayores.

Introduction: The hip fracture (HF) is a discontinuity in the proximal end of the femur, with significant consequences for those who suffer from it. This study aims to descriptively compare the HF mortality rate in the period 2017-2022 in Chile. Methodology: This is an observational descriptive study on deaths due to HF between 2017 and 2022 in Chile (n=3,190), according to data from the Department of Statistics and Health Information of Chile. HF mortality was calculated by variable, excess mortality rate, and Swaroop index, using data from the 2017 Census. No ethics committee was required. Results: The highest HF mortality rate was in 2018 (3,23), in the age group of 100 years and older (2.264,15), the Valparaíso region (28,31) and the female sex (4,32) reflected in its excess mortality rate (2,589). The lowest HF mortality rate occurred in 2021 (2,76), in the group between 0 and 19 years (0,04) and in the Atacama region (12,58). The Swaroop index was 100% in most regions. Discussion: The downward trend since 2019 could be explained by the COVID-19 lockdown that limited the mobility of elderly adults. Postmenopausal changes and a higher risk of falls could explain higher HF mortality rate in women and old people patients, respectively. The regional analysis could be related to the demographic proportion of elder people.

Tendencia de egresos hospitalarios con diagnóstico de accidente cerebrovascular agudo entre los años 2018-2021 en Chile: análisis descriptivo / Hospital discharge trend with diagnosis of acute stroke between the years 2018 and 2021 in Chile: descriptive analysis

Introducción: El accidente cerebrovascular (ACV) es una afección con alta morbimortalidad, producida por la interrupción de la perfusión cerebral. Este artículo tiene como objetivo analizar la tendencia de egresos hospitalarios por ACV agudo en el periodo 2018-2021 en Chile. Metodología: Estudio descriptivo observacional, que incluyó egresos hospitalarios con diagnóstico de ACV agudo en el periodo 2018-2021, en Chile (n=19.274), según datos del Departamento de Estadísticas e Información de Salud de Chile. Se calculó la tasa de egreso hospitalario (TEH) según variable, utilizando datos del censo chileno 2017. No requirió comité de ética. Resultados: El 2018 tuvo la mayor TEH por ACV agudo (28,99) y el 2021 la menor (26,39). El grupo de "80 años y más" presenta la mayor TEH, mientras que el de "5-9 años" la menor. La mayor y menor TEH las tienen las regiones de Ñuble (263,00) y Tarapacá (10,29), respectivamente. Discusión: La disminución de TEH durante dicho periodo podría deberse al fortalecimiento de la Ley de Urgencia, al Programa Nacional de Telesalud y el impacto de la reciente pandemia. A mayor edad, aumenta la prevalencia y gravedad de las comorbilidades, lo cual explicaría la mayor TEH en el grupo más longevo. La mayor TEH masculina podría ser porque los hombres presentan mayor cantidad y severidad de factores de riesgo. La mayor TEH en la región del Ñuble posiblemente sea por los elevados niveles de pobreza y ruralidad, y la menor TEH en Tarapacá podría relacionarse con la presencia de una población nacional más joven.

Introduction: Stroke (CVA) is a condition with high morbidity and mortality, produced by the interruption of cerebral perfusion. This article aims to analyze the trend of hospital discharges for acute stroke in the period 2018-2021 in Chile. Methodology: Descriptive observational study, which included hospital discharges with a diagnosis of acute stroke in the period 2018-2021, in Chile (n=19,274), according to data from the Chilean Department of Health Statistics and Information. The hospital discharge rate (HTE) was calculated according to variable, using data from the 2017 Chilean census. No ethics committee was required. Results: 2018 had the highest HTE for acute stroke (28.99) and 2021 the lowest (26.39). The group aged "80 years and older" had the highest TEH, while the group aged "5-9 years" had the lowest TEH. The regions of Ñuble (263.00) and Tarapacá (10.29) have the highest and lowest HTE, respectively. Discussion: The decrease in HTE during this period could be due to the strengthening of the emergency law, the National Telehealth Program and the impact of the recent pandemic. The higher the age, the higher the prevalence and severity of comorbidities, which would explain the higher HTE in the older group. The higher male HTE may be due to the fact that men have a greater number and severity of risk factors. The higher HTE in the Ñuble region is possibly due to the high levels of poverty and rurality, and the lower HTE in Tarapacá would be related to having a younger national population.

Cementoma Gigantiforme Mandibular en Paciente Pediátrico: Reporte de Caso y Revisión de la Literatura

RESUMEN: El cementoma gigantiforme (CG) es una lesión fibrocemento-ósea benigna de muy baja prevalencia y de etiología desconocida que se presenta con mayor frecuencia en pacientes jóvenes y que se caracteriza por generar movilidad de dientes y asimetrías faciales importantes. Radiográficamente se expresa como una lesión mixta, con presencia de áreas radiopacas y algunas radiolúcidas, bien circunscrita, que se observa principalmente en la mandíbula. El CG se comporta de manera similar a otras lesiones de los maxilares, tanto en su clínica como en la histopatología, lo que podría dificultar y confundir su diagnóstico. Debido a su comportamiento localmente agresivo y deformante, el tratamiento sugerido es la resección de la lesión con márgenes de seguridad.

ABSTRACT: The gigantiform cementoma (GC) is a benign bone-fibrocement lesion of very low prevalence and of unknown etiology that occurs more frequently in young patients and is characterized by generating mobility of teeth and significant facial asymmetries. Radiographically it is expressed as a mixed lesion, with the presence of radiopaque and some radiolucent areas, well circumscribed, which is observed mainly in the mandible. GC behaves in a similar way to other maxillary lesions, both clinically and in histopathology, which could make its diagnosis difficult and confusing. Due to its locally aggressive and deforming behavior, the suggested treatment is resection of the lesion with safety margins.

Tratamiento Conservador del Fibroma Desmoplásico Maxilar en Paciente Pediátrico. Seguimiento a Dos Años: Reporte de Caso y Revisión de la Literatura

RESUMEN: El fibroma desmoplasico (FD) es una neoplasia intraósea benigna, localmente agresiva, de muy baja frecuencia - especialmente en niños pequeños - y es considerada la contraparte ósea de la fibromatosis tipo desmoide. Se han descrito tratamientos que van desde la enucleación y legrado hasta la resección del segmento óseo afectado, debido a su alta tasa de recidiva. Sin embargo, se ha establecido un consenso para evitar dichas recidivas, que consiste en realizar una resección segmentaria con márgenes de seguridad. En este reporte de caso se decidió realizar un tratamiento conservador debido a la edad de la paciente, siendo el caso más joven reportado en la literatura con un FD maxilar y, de esta manera, evitar mutilaciones y necesidad de reconstrucción ósea a tan corta edad, considerando también su estado de crecimiento, generación de potenciales asimetrías o desarrollo facial anormal que podría generar secuelas estéticas y funcionales, alterando su calidad de vida.

ABSTRACT: Desmoplastic fibroma (DF) is a benign, locally aggressive, intraosseous neoplasm of very low frequency - especially in young children - and is considered the bony counterpart of desmoid-type fibromatosis. Treatments ranging from enucleation and curettage to resection of the affected bone segment have been described, due to its high recurrence rate. However, a consensus has been established to avoid such recurrences, which consists in performing a segmental resection with safety margins. In this case report, it was decided to carry out a conservative treatment due to the age of the patient, being the youngest case reported in the literature with a maxillary DF and, in this way, avoiding mutilations and the need for bone reconstruction at such a young age. Also considering their growth status, generation of potential asymmetries or abnormal facial development that could generate aesthetic and functional sequelae, altering their quality of life.

Manejo Quirúrgico del Queratoquiste Odontogénico con Invasión al Seno Maxilar: Reporte de Serie Casos y Revisión de la Literatura

RESUMEN: El queratoquiste odontogénico (QQO) es una quiste intraóseo poco frecuente que varía entre un 3 a 11% de todos los quistes odontogénicos, su ubicación en el maxilar es rara y la invasión al seno maxilar lo es aún más. El QQO es una patología benigna, localmente agresiva que tiene una alta tasa de recidiva. Se han descrito diversas técnicas quirúrgicas para su tratamiento, las cuales van desde lo más conservador como la enucleación a lo más radical como una resección. El uso de agentes coadyuvantes químicos o cauterizantes han logrado disminuir la tasa de recidiva en conjunto con tratamientos más conservadores, disminuyendo la morbilidad y secuelas asociada a una resección. El objetivo de este trabajo es presentar una serie de casos clínicos de QQO que invaden el seno maxilar, su tratamiento de manera conservadora y una revisión de la literatura comparando los diversos tratamientos y su tasa de recidiva.

ABSTRACT: Odontogenic keratocyst (OC) is a rare intraosseous pathology that varies between 3 % and 11 % of all odontogenic cysts, its location in the maxilla is rare, and invasion of the maxillary sinus is even more so. OC is a benign, locally aggressive pathology that has a high recurrence rate. Various surgical techniques have been described for its treatment, ranging from the most conservative, such as enucleation, to the most radical, such as resection. The use of chemical or cauterizing adjuvant agents has managed to reduce the recurrence rate in conjunction with more conservative treatments, reducing the morbidity and sequelae associated with a resection. The objective of this work is to present a series of clinical cases of OC that invade the maxillary sinus, their treatment being carried out in a conservatively manner, and a review of the literature comparing the various treatments and their recurrence rate.

Salud sexual y reproductiva en tiempos del COVID-19: accesibilidad de mujeres sordas y con discapacidad auditiva / Access of chilean deaf women to healthcare information and reproductive care

Background: The COVID-19 pandemic threatened the accessibility and response of healthcare systems worldwide. People with disabilities face specific access challenges to healthcare services and to healthcare information in accessible formats. Aim: To explore how deaf women acceded to information and sexual and reproductive health care during the first wave of COVID-19. Material and Methods: Sixty-one women with a median age of 32 years diagnosed with deafness and hearing loss were surveyed using an online questionnaire about access to healthcare information and midwifery care during the COVID-19 pandemic. Results: Forty-nine percent of respondents lived in the Metropolitan Region. Sixty-eight percent of respondents mentioned that information about COVID-19 was not accessible for them. The main source of information that they used to learn about the pandemic were videos made by deaf people available on the internet. Seventy-five percent of women reported that they had not received accessible information about sexual and reproductive health, and 70.0% of women requiring midwife care could not book an appointment. Conclusions: The pandemic generated a crisis in the Chilean healthcare system that demands a new strategy to ensure people's healthcare access. People with disabilities such as those herein studied are marginalized when these new policies are being discussed and implemented. Decision-makers and sexual and reproductive health services must improve their strategies to allow women with disabilities, particularly deaf women gain access.

[Access of chilean deaf women to healthcare information and reproductive care]. / Salud sexual y reproductiva en tiempos del COVID-19: accesibilidad de mujeres sordas y con discapacidad auditiva.

BACKGROUND: The COVID-19 pandemic threatened the accessibility and response of healthcare systems worldwide. People with disabilities face specific access challenges to healthcare services and to healthcare information in accessible formats. AIM: To explore how deaf women acceded to information and sexual and reproductive health care during the first wave of COVID-19. MATERIAL AND METHODS: Sixty-one women with a median age of 32 years diagnosed with deafness and hearing loss were surveyed using an online questionnaire about access to healthcare information and midwifery care during the COVID-19 pandemic. RESULTS: Forty-nine percent of respondents lived in the Metropolitan Region. Sixty-eight percent of respondents mentioned that information about COVID-19 was not accessible for them. The main source of information that they used to learn about the pandemic were videos made by deaf people available on the internet. Seventy-five percent of women reported that they had not received accessible information about sexual and reproductive health, and 70.0% of women requiring midwife care could not book an appointment. CONCLUSIONS: The pandemic generated a crisis in the Chilean healthcare system that demands a new strategy to ensure people's healthcare access. People with disabilities such as those herein studied are marginalized when these new policies are being discussed and implemented. Decision-makers and sexual and reproductive health services must improve their strategies to allow women with disabilities, particularly deaf women gain access.

Functional redundancy and compensation: Deletion of multiple murine Crisp genes reveals their essential role for male fertility.

Mammalian Cysteine-RIch Secretory Protein (CRISP) family includes four members present in sperm and reported to regulate Ca2+ channels and fertilization. Based on our previous observations using single knockouts models and suggesting the existence of functional compensation among CRISP proteins, we investigated their relevance for male fertility by generating multiple Crisp gene mutants by CRISPR/Cas9 technology. Whereas targeting of Crisp1 and Crisp3 yielded subfertile males with early embryo developmental defects, the same deletion in zygotes from fertile Crisp2-/- .Crisp4-/- mice led to the generation of both triple and quadruple knockout mice exhibiting a complete or severe disruption of male fertility due to a combination of sperm transport, fertilization, and embryo developmental defects linked to intracellular Ca2+ dysregulation. These observations reveal that CRISP proteins are essential for male fertility and organize in functional modules that contribute distinctly to fertility success, bringing insights into the mechanisms underlying functional redundancy/compensation in protein families and emphasizing the importance of generating multiple and not just single knockout which might be masking the true functional relevance of family genes.

Histeroscopía quirúrgica: experiencia, resultados y complicaciones según clasificación Clavien-Dindo / Surgical hysteroscopy: experience, results and complications according to Clavien-Dindo classification

OBJETIVO: Describir y analizar la experiencia clínica, resultados y complicaciones según Clavien-Dindo de las histeroscopías quirúrgicas realizadas en pabellón. MÉTODOS: Estudio descriptivo retrospectivo de las histeroscopías quirúrgicas realizadas entre el 1 de enero de 2012 y 1 de enero de 2018 en el Hospital Clínico de la Universidad de Chile. RESULTADOS: Hubo 613 histeroscopías quirúrgicas en el período analizado, de las cuales 593 cumplieron con los requisitos para incluirse en este estudio. Las indicaciones para realizar el procedimiento fueron: pólipo endometrial (56,3%), miomas uterinos (22,1%), sangrado uterino anormal (4,3%) y otras (17,7%). Hubo un 89,2% de concordancia entre el diagnóstico intraoperatorio y el estudio histopatológico. Se pesquisaron 11 hiperplasias endometriales sin atipías, 3 con atipías y 10 neoplasias malignas. Cabe destacar que, del total de pólipos resecados, hubo 8 casos (2,5%) con potencial malignidad (atipías o neoplasia maligna). Según la clasificación Clavien Dindo, hubo 22 complicaciones intraoperatorias (3,7%) grado I o II, cuyo diagnóstico fue realizado en el acto quirúrgico. No hubo complicaciones grado III o más (severas, con reintervención). CONCLUSIÓN: La tasa de éxito, correlación histeroscópica - anatomopatológica final y complicaciones fue similar a lo publicado en la literatura disponible. El diagnóstico intraoperatorio de la lesión y su reparación en el mismo acto quirúrgico, disminuye el riesgo de morbimortalidad de las pacientes, haciéndolo similar al de una paciente sin complicación. Utilizar la clasificación Clavien Dindo para evaluar las complicaciones nos permitirá en adelante, objetivar, mejorar aspectos del procedimiento quirúrgico y plantear estrategias de prevención y manejo de dichos eventos adversos.

OBJECTIVE: To describe and analyze the clinical experience, results and complications according to Clavien-Dindo of surgical hysteroscopies performed in the ward. METHODS: Retrospective descriptive study of surgical hysteroscopies performed between January 1, 2012 and January 1, 2018 at the Hospital Clinico of the University of Chile. RESULTS: There were 613 surgical hysteroscopies in the analyzed period of which 593 fulfilled the requirements to be included in this study. The indications to perform the procedure were: endometrial polyp (56.3%), uterine fibroids (22.1%), abnormal uterine bleeding (4.3%) and others (17.7%). There was an 89.2% agreement between the intraoperative diagnosis and the histopathological study. Eleven endometrial hyperplasias without atypia, 3 with atypia and 10 malignant neoplasms were investigated. It should be noted that, of the total of resected polyps, there were 8 cases (2.5%) with potential malignancy (atypia or malignant neoplasm). According to the Clavien Dindo classification, there were 22 intraoperative complications (3.7%) grade I or II, the diagnosis of which was made during surgery. There were no grade III or more complications (severe, with reoperation). CONCLUSION: The success rate, final hysteroscopic-pathological correlation and complications was similar to that published in the available literature. The intraoperative diagnosis of the lesion and its repair in the same surgical act, reduces the risk of morbidity and mortality of the patients, making it similar to that of a patient without complication. Using the Clavien Dindo classification to assess complications will henceforth allow us to objectify, improve aspects of the surgical procedure and propose strategies for the prevention and management of such adverse events.

A severe case of Ramsay Hunt Syndrome treated with acupuncture and related techniques.

Ramsay-Hunt syndrome presents with a vesicular eruption in the ear canal or oral cavity associated with ipsilateral peripheral facial paralysis. The cause is reactivation of the herpes zoster virus in the geniculate ganglion. It is the second most frequent cause of non-traumatic peripheral facial paralysis. Acupuncture is a medical procedure endorsed by the WHO with a wide range of indications. It consists of the application of very fine needles in certain points of the body to relieve pain and relieve certain diseases. We present a case of a young woman with unilateral facial paralysis as part of Ramsay Hunt syndrome. She received conventional treatment with acyclovir, analgesics, corticosteroids and eye protection measures 48 h after the onset of symptoms. At three weeks, due to the lack of improvement of the facial paralysis, manual acupuncture was started along with electroacupuncture, plum blossom hammer for facial stimulation and Chinese herbal medicine. An almost complete improvement was obtained at 14 weeks since the onset of the condition. Acupuncture and related techniques may be an effective intervention for this type of condition, and are associated with very few adverse effects.

Relevance of CRISP proteins for epididymal physiology, fertilization, and fertility.

BACKGROUND: The molecular mechanisms involved in the acquisition of mammalian sperm fertilizing ability are still poorly understood, reflecting the complexity of this process. OBJECTIVES: In this review, we describe the role of Cysteine RIch Secretory Proteins (CRISP1-4) in different steps of the sperm journey to the egg as well as their relevance for fertilization and fertility. MATERIALS AND METHODS: We analyze bibliography reporting the phenotypes of CRISP KO mice models and combine this search with recent findings from our team. RESULTS: Generation of individual KO for CRISP proteins reveals they are key mediators in different stages of the fertilization process. However, in spite of their important functional roles, KO males for each of these proteins remain fertile, supporting the existence of compensatory mechanisms between homologous CRISP family members. The development of mice lacking epididymal CRISP1 and CRISP4 simultaneously (DKO) revealed that mutant males exhibit an impaired fertility due to deficiencies in the sperm ability to fertilize the eggs in vivo, consistent with the proposed roles of the two proteins in fertilization. Interestingly, DKO males show clear defects in both epididymal epithelium differentiation and luminal acidification known to be critical for sperm maturation and storage. Whereas in most of the cases, these epithelium defects seem to specifically affect the sperm fertilizing ability, some animals exhibit a disruption of the characteristic immune tolerance of the organ with clear signs of inflammation and sperm viability defects. DISCUSSION AND CONCLUSION: Altogether, these observations confirm the relevance of CRISP proteins for male fertility and contribute to a better understanding of the fine-tuning mechanisms underlying sperm maturation and immune tolerance within the epididymis. Moreover, considering the existence of a human epididymal protein functionally equivalent to rodent CRISP1 and CRISP4, DKO mice may represent an excellent model for studying human epididymal physiology and pathology.

Assessment of X-ray Computed Tomography to characterize filtering media from Vertical Flow Treatment Wetlands at the pore scale.

Computed Tomography is a non-destructive technique often used in earth sciences for the description of porous media at the pore scale. This paper shows the feasibility of this technique to obtain 3D descriptions of filtering media in Vertical Flow Treatment Wetlands (VFTW). Three different samples from two full-scale VFTW were scanned. The samples vary in moisture content and gravel size distribution. The 3D images show three characteristic phases of unsaturated media: voids, fouling material and gravel. The gray contrast level is good enough to perform phase segmentation successfully using region growing algorithms. In this study the results from segmentation are used (i) to compute profiles of phase volume fraction and specific surface at high resolution, (ii) to observe 3D distribution of isolated elements, (iii) and to draw the void's skeleton and to perform a percolation pathway study. This method highlights the presence of a transition zone between the deposit cake and the dense gravel layer. In this zone, mechanical interactions between gravels and filtered solids tend to promote a heterogeneous layer of gravel, fouling material and open porosity. The presence of isolated gravels in the deposit layer is clearly evidenced. The effect of drying to enhance the contrast between phases has been analyzed for one sample by a direct comparison of images obtained before and after drying. The resulting opening of the void phase tends to increase significantly the void-fouling material specific surface and the number and size of percolating pathways computed as the skeleton of the void phase. Finally, a first analysis of filtration processes is proposed. It consists in analyzing the percolation pathways for a class of void size by applying the distance map and skeleton concepts to the void phase.

Desempeño de las funciones ejecutivas según estado cognitivo en adultos mayores / Performance of the executive functions according to cognitive state in elderly adults

Resumen Introducción: De acuerdo al envejecimiento que ha experimentado la población a causa de un aumento en la expectativa de vida y las repercusiones que ello ha conllevado a nivel cognitivo, se ha observado un aumento en el número de adultos mayores que presentan dificultades cognitivas. La presente investigación aborda el desempeño de las funciones ejecutivas según el estado cognitivo en adultos mayores de la ciudad de Puerto Montt. Método: Se realizó un estudio correlacional comparativo en una muestra de 34 adultos mayores entre 60 y 90 años de la ciudad de Puerto Montt. Se evaluó el nivel cognitivo de los participantes y el desempeño de las funciones ejecutivas, para luego estimar el nivel de correlación de ambas variables con la prueba de Pearson y se compararon los grupos con ANOVA. Resultados: El análisis de los datos da cuenta de una alta correlación entre el deterioro del estado cognitivo y el desempeño de las funciones ejecutivas igualmente disminuiría (valor de correlación = 0,636). Por otra parte, al comparar el grupo de adultos mayores sin deterioro cognitivo y el grupo con deterioro cognitivo leve, no se observaron diferencias significativas en ambos grupos (p > 0,05). Discusión: Los resultados indican que hay una correlación significativa entre el deterioro de las funciones ejecutivas y el deterioro cognitivo general, sin embargo, parece ser que el desempeño de las funciones ejecutivas permanece estable durante el estado cognitivo conservado como en el estado de deterioro cognitivo leve en el adulto mayor.

Introduction: According to the aging of the population due to an increase in life expectancy and the repercussions that this has led to a cognitive level, an increase in the number of older adults with cognitive difficulties has been observed. The present investigation approaches the performance of the executive functions according to the cognitive state in older adults of the city of Puerto Montt. Method: A comparative correlation study was carried out in a sample of 34 older adults between 60 and 90 years old from the city of Puerto Montt. The cognitive level of the participants and the performance of the executive functions were evaluated to then estimate the level of correlation of both variables with the Pearson test and the groups with ANOVA were compared. Results: The analysis of the data shows a high correlation between the deterioration of the cognitive state and the performance of the executive functions would also decrease (correlation value = 0.636). On the other hand, when comparing the group of older adults without cognitive impairment, and the group with mild cognitive impairment, no significant differences were observed in both groups (p > 0.05). Discussion: The results indicate that there is a significant correlation between the deterioration of the executive functions and the general cognitive deterioration, however it seems that the performance of the executive functions remains stable during the conserved cognitive state as in the state of mild cognitive deterioration in the adult higher.

Evolución de síntomas a corto plazo y grado de satisfacción del paciente tras hemorroidectomía convencional / Evolution of short-term symptoms and degree of patient satisfaction after conventional hemorrhoidectomy

Resumen Introducción La hemorroidectomía es el tratamiento de elección para las hemorroides sintomáticas, reservado para pacientes con hemorroides grado III o IV o sin respuesta a tratamiento conservador. Existen diversas técnicas quirúrgicas, cuyo grado de resolución de síntomas y satisfacción por parte del paciente posee resultados variados. Objetivos Evaluar al corto plazo la sintomatología y grado de satisfacción de los pacientes operados de hemorroidectomía convencional en el Complejo Asistencial Dr. Sótero del Río. Materiales y Métodos Se realizó una encuesta telefónica retrospectiva a pacientes operados de hemorroidectomía convencional durante junio de 2015 a enero de 2016. Se preguntó por síntomas en el preoperatorio, al mes y a los 6 o más meses posoperados. Se evaluó sangrado, prurito, dolor, sensación de prolapso e incontinencia. El análisis estadístico consideró los resultados según los 5 síntomas evaluados y luego dicotomizados según relevancia clínica. Se consideró un valor p significativo < 0,01. Resultados Cuarenta y tres pacientes respondieron la encuesta, con una mediana de edad de 55 años (17-80). La mediana de evaluación fue de 8 meses (6-12). Considerando los síntomas: sangrado, prurito, dolor y prolapso, 35 pacientes (79%) presentaban 3 o más síntomas preoperatorios considerados significativos. La persistencia al seguimiento varía entre un 9 a un 28%. En el análisis estadístico con síntomas dicotomizados, existe una disminución estadísticamente significativa al mes y a los 6 o más meses posoperados. Discusión La hemorroidectomía convencional es bien evaluada por los pacientes en relación a una resolución significativa de síntomas de la enfermedad hemorroidal.

Background Hemorrhoidectomy is the treatment of choice for symptomatic hemorrhoids, reserved for patients with grade III or IV hemorrhoids or no response to conservative treatment. There are several surgical techniques, whose degree of resolution of symptoms and patient satisfaction has varied results. Objectives To evaluate in the short term the symptomatology and degree of satisfaction of patients undergoing conventional hemorrhoidectomy in Complejo Asistencial Dr. Sótero del Río. Material and Methods A retrospective telephone survey was applied to patients undergoing conventional hemorrhoidectomy from June 2015 to January 2016. The survey includes questions about symptoms in the pre-operative, at the month and at 6 or more months post-operated. Bleeding, pruritus, pain, prolapsed sensation and incontinence were evaluated. The statistical analysis considered the results according to the 5 symptoms evaluated in the survey and then dichotomized according to clinical relevance. A significant p value < 0.01 was considered. Results 43 patients answered the survey, with a median age of 55 years (17-80). The median evaluation was 8 months (6-12). Considering the symptoms: bleeding, pruritus, pain and prolapse, 35 patients (79%) had 3 or more preoperative symptoms considered significant. Persistent follow-up ranges from 9 to 28%. In the statistical analysis with dichotomized symptoms, there is a statistically significant decrease at one month and at 6 or more months post-surgery. Conclusion Conventional hemorrhoidectomy is well evaluated by patients in relation to a significant resolution of hemorrhoidal disease symptoms.

Análisis de casos de adenocarcinoma apendicular y su manejo en una serie de 10 años en el Hospital Doctor Sótero del Río / Analysis of cases of appendicular adenocarcinoma and its management in a series of 10 years in Hospital Doctor Sótero del Río

Introducción: Los tumores del apéndice cecal son una patología infrecuente. De ellos, los adenocarcinomas apendiculares no superan el 0,1% de las apendicectomías. Objetivos: Describir el manejo y la sobrevida de pacientes con diagnóstico de adenocarcinoma apendicular en el Complejo Asistencial Dr. Sótero del Río. Materiales y métodos: Análisis retrospectivo descriptivo de pacientes operados de apendicectomía y diagnóstico patológico de adenocarcinoma apendicular entre enero de 2003 y diciembre de 2013. Se evaluaron características demográficas, síntomas, manejo y sobrevida. Resultados: Se analizaron un total de 14.582 apendicectomías. Se obtuvieron 84 biopsias positivas para tumores apendiculares primarios (0,58%). De este grupo, 9 biopsias correspondían a un adenocarcinoma apendicular (0,06%). Siete de los 9 pacientes poseían registro completo. La mediana de edad fue de 53 años. Seis pacientes cursaron con un cuadro de abdomen agudo. Se realizó una hemicolectomía derecha en 6 pacientes posterior al diagnóstico de adenocarcinoma. De ellos, 4 recibieron quimioterapia adyuvante. La sobrevida a 3 años fue del 58%. Conclusiones: El adenocarcinoma apendicular es un hallazgo poco frecuente durante una apendicectomía y se asocia a una sobrevida similar a la reportada internacionalmente.

Introduction: Appendiceal tumors are a rare pathology, not exceeding 0.1% of appendectomies. Objectives: Describe the management and survival of patients diagnosed with appendiceal adenocarcinoma at the Complejo Asistencial Doctor Sótero del Río. Materials and methods: Descriptive retrospective analysis of patients underwent appendectomy, with histopathologic diagnosis of appendiceal adenocarcinoma, in the period from January 2003 to December 2013. Demographic characteristics, symptoms, management and survival were evaluated. Results: Data from 14,582 appendectomies was analyzed; 84 positive biopsies for primary appendiceal tumors (0.58%) were obtained. Of this group, 9 biopsies corresponded to an appendiceal adenocarcinoma (0.06%). Seven of the 9 patients had complete record. The median age was 53 years. Six patients presented with an acute abdomen. Right hemicolectomy underwent 6 patients. Of these, 4 received adjuvant chemotherapy. The 3-year survival was 58%. Conclusions: Appendiceal adenocarcinoma is a rare finding during an appendectomy and is associated with a low overall survival.

[Parasitic dermoid cyst of the omentum. Case presentation]. / Quiste dermoide parasítico en el epiplón. Reporte de un caso.

BACKGROUND: Benign parasitic cystic teratomas or extragonadal tumors are relatively rare representing 0.4% of all tumors. Its most common site is the omentum. CASE REPORT: A 32-year-old women. Obstetric historial: 3 pregnancies, 2 deliveries, and 1 abortion. She was admitted with a 7 x 6 cm pelvic cystic mass meassured by ultrasound, laparoscopy was performed removing a pelvic cystic mass localized in omentum. The patient was discharged uneventful. Histological finding was a benign parasitic dermoid cyst of omentum. A literature review indicates that only 29 cases are reported.

Abordaje vaginoscópica para la realización de histeroscopía oficinal: experiencia, resultados y revisión de la literatura / Vaginoscopic approach to perform officinal hysteroscopy: experience, results and literature review

OBJETIVO: Presentar nuestra experiencia y una revisión de la literatura sobre la utilización de la vaginohisteroscopia oficinal. Describir las principales indicaciones, su tolerancia, los procedimientos realizados y las complicaciones resultantes. MÉTODO: Estudio descriptivo de todos los procedimientos vaginohisteroscópicos ambulatorios realizados en la Unidad de Medicina Reproductiva e Infertilidad del Departamento de Obstetricia y Ginecología del Hospital Clínico de la Universidad de Chile, entre el 1° de enero de 2008 y el 31 de enero de 2014. RESULTADOS: Se realizaron un total de 632 vaginohisteroscopias: 63,7% diagnósticas y 36,2% quirúrgicas. El tiempo promedio de realización fue de 13 ± 8 minutos. La percepción de dolor presentó una mediana de EVA 4 con intercuartiles de 3 y 6. La principal indicación fue por sospecha de pólipos endometriales (33%) y engrosamiento endometrial en un 12%. El hallazgo histeroscópico más frecuente fue cavidad endometrial normal (27%) y pólipos endometriales (27%). Los procedimientos más frecuentes fueron polipectomías (27%) y biopsias endometriales (20%). Se registraron 17 complicaciones (2,6%): 14 reacciones vasovagales (2,2%) y 3 lipotimias (0,4%). CONCLUSIONES: El abordaje vaginohisteroscópico ha demostrado ser una técnica segura, resolutiva, bien tolerada por las pacientes y de menor costo.

OBJECTIVE: To present our experience and a review of the literature of the vaginohysteroscopic technique. To describe the main indications, the tolerance, the procedures performed and their complications. METHOD: This is a descriptive study of all outpatient procedures performed with the vaginohysteroscopic technique in the Reproductive Medicine and Infertility Unit of the Department of Obstetrics and Gynecology at University Hospital of Chile between 1st January of 2008 and 31st January of 2014. RESULTS: A total of 632 vaginohysteroscopys were performed: 63.7% diagnostic and 36.2% surgical. The average procedure time was 13 ± 8 minutes. Pain showed a median of VAS of 4. The main indication was suspected endometrial polyps (33%) and endometrial thickening (12%). The most frequent finding was normal endometrial cavity (27%) and endometrial polyps (27%). The most common procedures were polypectomy (27%) and endometrial biopsies (20%). We registered 17 complications (2.6%): 14 vasovagal reactions (2.2%) and 3 lipothymias (0.4%). CONCLUSIONS: vaginohisteroscopy approach has proven to be a safe and very resolutive technique, well tolerated by patients and considerably cost-effective.

Occurrence of toxic cyanobacterial blooms in rio de la plata estuary, Argentina: field study and data analysis.

Water samples were collected during 3 years (2004-2007) at three sampling sites in the Rio de la Plata estuary. Thirteen biological, physical, and chemical parameters were determined on the water samples. The presence of microcystin-LR in the reservoir samples, and also in domestic water samples, was confirmed and quantified. Microcystin-LR concentration ranged between 0.02 and 8.6 µg.L(-1). Principal components analysis was used to identify the factors promoting cyanobacteria growth. The proliferation of cyanobacteria was accompanied by the presence of high total and fecal coliforms bacteria (>1500 MNP/100 mL), temperature ≥25°C, and total phosphorus content ≥1.24 mg·L(-1). The observed fluctuating patterns of Microcystis aeruginosa, total coliforms, and Microcystin-LR were also described by probabilistic models based on the log-normal and extreme value distributions. The sampling sites were compared in terms of the distribution parameters and the probability of observing high concentrations for Microcystis aeruginosa, total coliforms, and microcystin-LR concentration.

Espectro fenotípico del síndrome de ovario poliquístico / Phenotypic spectrum of polycystic ovary syndrome

Antecedentes: El síndrome de ovario poliquístico (SOP) es la endocrinopatía más frecuente en la mujer de edad reproductiva, de etiología incierta y presentación clínica heterogénea. Su diagnóstico y defnición es aún controversial. La introducción de los criterios del Consenso de Rotterdam generó nuevos fenotipos al incorporar la ecografía transvaginal como elemento diagnóstico, aumentando aún más la heterogeneidad del síndrome. Objetivo: Determinar en una cohorte consecutiva de 102 pacientes con diagnóstico de SOP, su frecuencia, las características clínicas, hormonales y metabólicas, de los cuatro fenotipos posibles según Rotterdam. Resultados: Fenotipo A 62 por ciento, Fenotipo B 21 por ciento, Fenotipo C 9 por ciento y Fenotipo D 8 por ciento. El síndrome metabólico se presentó en 29 por ciento de las pacientes, siendo mayor en los fenotipos A (30 por ciento) y B (43 por ciento) que en los fenotipos C (11 por ciento) y D (13 por ciento). El 82 por ciento presentaba sobrepeso, siendo signifcativamente mayor en los fenotipos A (88 por ciento) y B (90 por ciento). Hubo diferencias signifcativas al comparar las variables puntaje de hir-sutismo, SHBG, testosterona total, IAL, volumen ovárico, colesterol total, colesterol HDL, colesterol LDL y glicemia en ayuno. No existieron diferencias signifcativas entre los grupos al comparar las variables edad, IMC, DHEA-SO4 y triglicéridos. Conclusión: El consenso de Rotterdam agruparía a diferentes fenotipos en un mismo síndrome, que podrían representar distintos grados de severidad de una misma enfermedad. Se desconoce si estos fenotipos poseen los mismos riesgos a largo plazo y sería apresurado tratarlos como una misma entidad.

Background: Policystic ovary syndrome (PCOS) is a very common endocrine disease in women of reproductive age, of uncertain etiology and heterogeneous clinical presentation. The introduction of the Rotterdams Consensus criteria generated new phenotypes by incorporating transvaginal ultrasound, thus increasing the heterogenity of PCOS. Objectives: To determine in a cohort of 102 patients with the diagnosis of PCOS the prevalence, clinical, hormonal and metabolic profle according to Rotterdam. Results: It was determined the Phenotype A 62 percent Phenotype B 21 percent, Phenotype C 9 percent and Phenotype D 8 percent of the patients. The metabolic syndrome was present in 29 percent of the PCOS patients, being it more frequent in the phenotypes A (30 percent) and B (43 percent) than C (11 percent) and D (13 percent). The 82 percent of the patients were overweigth, especially in the phenotypes A (88 percent) and B (90 percent). Also, statistically signifcant differences were observed when comparing the variables score of hirsutism, free androgen index, total testosterone, HDL cholesterol SHBG, ovarian volume, total cholesterol, glycemia and LDL cholesterol. There were no signifcant differences between the groups to compare variables such as age, BMI, DHEA and triglycerides. Conclusion: These fndings indicate that the consensus of Rotterdam would agroup different phenotypes in the same syndrome and that it may represent different degrees of severity of the same disease. Even though, we do not know if these phenotypes posses the same health risks, therefore it is soon to manage the phenotypes as equal entities.