Calidad de vida en pacientes con disfagia neurogénica / Quality of life in patients with neurogenic dysphagia

Resumen Introducción: La disfagia o trastorno de la deglución es un síntoma frecuente de diferentes enfermedades neurológicas. La evaluación tradicionalmente se enfoca en describir el mecanismo de alteración y el grado de severidad, pero pocas veces se explora el impacto que tiene en la calidad de vida de la persona. Método: Se evaluaron 27 personas con disfagia neurogénica (60,04 ± 14,14 años, 10 hombres) con el cuestionario autoadministrado de calidad de vida en disfagia (SWAL-QOL-Ch), el cual fue adaptado en Chile. Se comparó con un grupo control de 113 participantes (51,42 ± 7,62 años, 46 hombres) y se determinó la influencia del sexo y etiología. Resultados: Los pacientes con disfagia neurogénica presentan diferencias significativas en todas las escalas del SWAL-QOL-Ch en relación al grupo control. Por sexo se observa diferencia solo en "duración de la alimentación", no encontrándose diferencias por etiología. Conclusiones: Los pacientes con disfagia neurogénica ven alterada su calidad de vida, especialmente en relación al tiempo que demoran en alimentarse.

Introduction: Dysphagia or swallowing disorder is a common symptom of different neurological diseases. The assessment traditionally focuses on describing the mechanism of alteration and the degree of severity, but rarely does it explore the impact it has on the quality of life of the person. Method: Twenty-seven people with neurogenic dysphagia (60.04 ± 14.14 years, 10 men) were assessment with the self-administered quality of life questionnaire (SWAL-QOL-Ch), which was adapted in Chile. It was compared with a control group of 113 participants (51.42 ± 7.62 years, 46 men) and the influence of sex and etiology was determined. Results: Patients with neurogenic dysphagia presented significant differences in all SWAL-QOL-Ch scales in relation to the control group. In the variable sex, difference is observed only in "duration of feeding", no differences were observed by etiology. Conclusions: Patients with neurogenic dysphagia have altered their quality of life, especially in relation to the time they take to eat.

Malignant Triton Tumors in Sisters with Clinical Neurofibromatosis Type 1.

Malignant triton tumors (MTTs) are rare and aggressive sarcomas categorized as a subgroup of malignant peripheral nerve sheath tumors (MPNSTs). MTTs arise from Schwann cells of peripheral nerves or existing neurofibromas and have elements of rhabdomyoblastic differentiation. We report the occurrence of MTTs in two sisters. The first patient is a 36-year-old female who presented with left sided chest wall swelling. She also had clinical features consistent with neurofibromatosis type 1 (NF-1). Debulking of the mass showed high-grade malignant peripheral nerve sheath tumor with skeletal muscle differentiation (MTT). The patient was treated with ifosfamide and adriamycin along with radiation. Four years after treatment, she still has no evidence of disease recurrence. Her sister subsequently presented to us at the age of 42 with left sided lateral chest wall pain. Imaging showed a multicompartmental retroperitoneal cystic mass with left psoas involvement. The tumor was resected and, similarly to her sister, it showed high-grade malignant peripheral nerve sheath tumor with rhabdomyoblastic differentiation (MTT). The patient was started on chemotherapy and radiation as described above.

Violencia escolar y su relación con síntomas ansiosos / Bullying and its association with anxiety symptoms

INTRODUCCIÓN: Violencia escolar es la persecución física o psicológica de un alumno o alumna contra otro, convirtiéndolo en víctima de repetidos ataques. Es un importante marcador de riesgo de conductas antisociales futuras, y se relaciona con mayor prevalencia de síntomas ansiosos. OBJETIVO: Establecer si existe asociación entre la presencia de ansiedad patológica y la práctica de violencia escolar. MATERIAL Y MÉTODOS: Estudio descriptivo observacional y transversal. Se estudió a 166 alumnos de cuarto a octavo básico, de un colegio particular subvencionado de la comuna de Lo Barnechea, en Santiago de Chile. De ellos, 77 fueron hombres y 89 mujeres, entre 9 y 16 años. Se aplicó la escala de Autoreporte de Ansiedad para Niños y Adolescentes (AANA) y el cuestionario de Maltrato entre Iguales por Abuso de Poder (MIAP). Además, se recopilaron datos tales como sexo, edad, número de personas que viven en el hogar y si vive o no con sus padres. RESULTADOS: De los estudiantes evaluados, el 46,99 por ciento clasificó como testigo de violencia escolar, 19,28 por ciento víctima, 10,84 por ciento agresor, 10,84 por ciento víctima-agresor, y un 12,05 por ciento no clasificó en ninguna categoría. Se obtuvo un 36,1 por ciento de prevalencia de ansiedad patológica en el total de individuos; un 41,67 por ciento en agresores y 30,61 por ciento en no agresores, con chi-cuadrado P > 0,05.DISCUSIÓN: La prevalencia de ansiedad patológica en agresores de violencia escolar es mayor que en quienes no la practican; sin embargo, esta asociación no llega a valores estadísticamente significativos.

INTRODUCTION: Bullying is the physical or psychological persecution of one student against another, making him a victim of recurrent attacks. It is one of the most important risk markers for future antisocial behavior, which has also been associated with higher prevalence of anxiety symptoms. OBJECTIVE: Establish if there is an association between pathological anxiety and bullying. METHODS: This is a descriptive, observational and transversal study. 166 students from fourth to eight grades were studied from a semi private school from Lo Barnechea, Santiago, Chile. From this population, 77 were male and89 female, between 9 and 16 years old. The Anxiety Scale for Children and Adolescents (AAA) and the Survey of High School Bullying Abuse of Power questionnaires were applied. Also, data such as sex, age, number of people who are living in their homes and whether they live with their parents or not was collected. RESULTS: From the students evaluated, 46.99 percent classified as bullying witnesses, 19.28 percent as victims, 10.84 percent as aggressors, 10.84 percent aggressor-victim and 12.05 percent didn't classify in any category. A 36.1 percent prevalence of pathologic anxiety was obtained from the totality of individuals. In the aggressor category 41.67 percent had pathological anxiety and 30.61 percent in non-aggressors, with a chi-square P > 0.05. DISCUSSION: Prevalence of pathological anxiety is higher in the aggressor than in the non-aggressor group, however this association is statistically non-significant

Impact of different cryoprotectants on the survival of freeze-dried Lactobacillus rhamnosus and Lactobacillus casei/paracasei during long-term storage.

The production of long shelf-life highly concentrated dried probiotic/starter cultures is of paramount importance for the food industry. The aim of the present study was to evaluate the protective effect of glucose, lactose, trehalose, and skim milk applied alone or combined upon the survival of potentially probiotic Lactobacillus rhamnosus CTC1679, Lactobacillus casei/paracasei CTC1677 and L. casei/paracasei CTC1678 during freeze-drying and after 39 weeks of storage at 4 and 22 °C. Immediately after freeze-drying, the percentage of survivors was very high (≥ 94%) and only slight differences were observed among strains and cryoprotectants. In contrast, during storage, survival in the dried state depended on the cryoprotectant, temperature and strain. For all the protectants assayed, the stability of the cultures was remarkably higher when stored under refrigeration (4 °C). Under these conditions, skim milk alone or supplemented with trehalose or lactose showed the best performance (reductions ≤ 0.9 log units after 39 weeks of storage). The lowest survival was observed during non-refrigerated storage and with glucose and glucose plus milk; no viable cells left at the end of the storage period. Thus, freeze-drying in the presence of appropriate cryoprotectants allows the production of long shelf-life highly concentrated dried cultures ready for incorporation in high numbers into food products as starter/potential probiotic cultures.

Cardiac troponin T and illness severity in the very-low-birth-weight infant.

Introduction. Respiratory distress are very common in Very-low-birth-weight (VLBW) infants and Myocardial injury may play a role in the disease outcome. Cardiac troponin T (cTnT) is the most useful marker of injury in adult population, but has not been extensively studied in this population. Aim. To study the role of cTnT in VLBW infants and its association with clinical outcomes. Methods. All VLBW infants admitted to our NICU were included in the study. Echocardiography and blood samples for cTnT determination were collected at 24 and 48 hours of life, and values >0.1 ng/mL were considered CTnT-positive values. Results. A total of 116 neonates had their blood samples collected. The median cTnT concentration within 24 hours was 0.191 (0.1-0.79) ng/mL and within 48 hours was 0.293 (0.1-1.0) ng/mL. A logistic regression analysis showed that PDA, low GA, and use of dopamine were independently associated with positive cTnT and abnormal Dopplerfluxometry and diuretics use had protective effects and was independently associated with troponin values. Conclusion. We observed a high prevalence of positivecTnT values in VLBW infants associated with illness severity. Our findings suggest that cTnT may be a useful and early marker of myocardial injury in VLBW infants.

Conformational diversity of short DNA duplex.

Two 25 base-pair cDNA strands are encapsulated within an optically trapped nanodroplet, and we observe the kinetics of their hybridization in dynamic equilibrium via single-molecule fluorescence resonance energy transfer (FRET) as a function of temperature and of the solution's NaCl concentration. We have observed the duplex unfolding and refolding, and we have observed quasistable partially unfolded states under low salinity conditions. Furthermore, our measurements reveal that, even in conditions under which the duplex is stable, it undergoes conformational fluctuations in solution.

Amphiphilic block copolymer nanotubes and vesicles stabilized by photopolymerization.

We report on a new method to stabilize nanotube and vesicle structures created from amphiphilic diblock copolymers by means of photopolymerization. Cross-linking with UV light exposure minimizes fluid disruption during stabilization. Additionally, the spatial control afforded by focusing or masking the initiating light source enables stabilization of distinct segments of individual nanostructures. This contribution demonstrates (1) that vesicles and nanotubes formed from poly(ethylene oxide)-block-polybutadiene are stabilized by exposure to UV light in the presence of a water-soluble photoinitiator and (2) that new nanotube geometries can be constructed by means of spot-curing, and (3) it reveals an application for photopolymerized nanotubes by showing electrophoresis of DNA through a UV-stabilized nanotube.

La toma de decisiones en salud y el modelo conceptual de Ottawa / Decision-making in health and the Ottawa decision-support framework

Objetivo: Realizar un análisis del Modelo de Toma de Decisiones en Salud de Ottawa, planteado por la enfermera canadiense Annette M. O’Connors, como una estrategia para resolver conflictos decisionales en salud. Se plantea su utilidad en la intervención que hace enfermería en la comunidad y la familia. Se concluye que el conflicto decisional surge frente a la toma de decisiones y los profesionales de la salud deben adoptar un rol protagónico en él, desarrollando habilidades para apoyar a sus pacientes o usuarios en los conflictos que deben enfrentar, teniendo el Modelo de toma de decisiones de Ottawa como un referencial útil para ayudarles, especialmente a las mujeres, a asumir un rol más activo en las decisiones que afectan su propia salud...

Burnout en personal de enfermería de la Unidad de Cuidados Intensivos Pediátricos / Burnout in nursing staff of the Pediatric Intensive Care Unit

El síndrome de Burnout (SB) se utiliza para hacer referencia a un tipo de estrés laboral institucional generado en profesiones que mantienen una relación constante y directa con personas, como es el caso del personal de enfermería; en él se distinguen tres dimensiones: cansancio emocional, despersonalización y realización personal.El objetivo de este estudio fue determinar la prevalencia del SB en el personal de enfermería de la Unidad de Cuidados Intensivos Pediátricos (UCIP) del Hospital Guillermo Grant Benavente de Concepción, Chile, y los factores que se relacionan con él.En este estudio descriptivo exploratorio se aplicó un cuestionario de datos sociodemográficos y el inventario de Burnout de Maslach a una muestra en un periodo de tres meses.Para el análisis de los datos se utilizó estadística descriptiva y pruebas no paramétricas para variables categóricas.Los puntajes obtenidos en las dimensiones del SB en el personal de enfermería de la UCIP evidenciaron mayores porcentajes de niveles de Burnout bajo; más de la mitad de la población en estudio presentó un alto logro personal.El conocimiento de las variables relacionadas con el Burnout permitirá diseñar estrategias preventivas y de tratamiento para finalmente mejorar la salud laboral y la calidad asistencial

Toma de decisiones en salud en mujeres cuidadoras informales / Health decision-making in woman's informal caretakers

Estudio descriptivo y transversal que se propuso conocer las características biosociodemográficas y los determinantes de la toma de decisiones en salud de las mujeres cuidadoras informales del sector urbano de la comuna de Hualqui, Chile. Las muestra accidental fue de 55 mujeres (62 por ciento del universo), a las cuales se les aplicaron dos instrumentos: cuestionario para recolectar antecedentes biosociodemográficos y un cuestionario de valoración de necesidades de apoyo decisional a nivel poblacional basado en el Modelo de Ottawa de O’Connors. Para la tabulación de los datos y análisis descriptivo se utilizó SPSS. Los principales resultados fueron: el cuidado informal lo realizan mujeres entre 41 y 64 años, con educación básica incompleta, que sostienen en un 43 por ciento enfermedades crónicas; sus principales conflictos decisionales respecto a salud se refieren a seguir o no conductas curativas y preventivas por la necesidad de estar bien para cuidar a otros.

Quantification of Listeria monocytogenes in fermented sausages by MPN-PCR method.

AIMS: To combine the principles of most-probable-number (MPN) statistics and the conventional PCR technique to enumerate Listeria monocytogenes in fermented sausages. METHODS AND RESULTS: A simple method to enumerate L. monocytogenes in fermented sausages was developed and compared with direct plating in Palcam agar. Species-specific MPN-PCR, but not direct plating, made the enumeration of L. monocytogenes possible in all assayed samples. CONCLUSIONS: MPN-PCR proved to be a rapid and reliable method for enumerating L. monocytogenes in fermented sausages, including low contaminated samples. SIGNIFICANCE AND IMPACT OF THE STUDY: This MPN-PCR technique may facilitate the enumeration of L. monocytogenes for routine analyses in fermented sausages without excessive work.

Large accumulation of mRNA and DNA point modifications in a plant senescent tissue.

Although nucleic acids are the paradigm of genetic information conservation, they are inherently unstable molecules that suffer intrinsic and environmental damage. Oxidative stress has been related to senescence and aging and, recently, it has been shown that mutations accumulate at high frequency in mitochondrial DNA with age. We investigated RNA and DNA modifications in cork, a senescent plant tissue under high endogenous oxidative stress conditions. When compared to normally growing young tissue, cork revealed an unexpected high frequency of point modifications in both cDNA (Pn = 1/1784) and nuclear DNA (Pn = 1/1520). Cork should be viewed as a mosaic of genetically heterogeneous cells. This has biological implications: it supports somatic mutation models for aging and challenges 'single cDNA clone' as descriptor for the molecular genetics of senescent tissues.

Inmunosenescencia: pruebas cutáneas de hipersensibilidad retardada en adultos mayores chilenos autovalentes / Immunosenescence: delayed cutaneous hypersensitivity test in free living chilean elderly individuals

Background: Delayed cutaneous hypersensitivity tests are a globally accepted test to assess cellular immunity in vivo. The quality and quantity of the response to these type of tests, varies in different populations. Aim: To study delayed cutaneous hypersensitivity in a group of healthy Chilean elders. Material and methods: Forty two elders (32 male), aged 60 to 76 years old were studied. Multitest-CMI(r) was applied in the left forearm. This test allows the subcutaneous administration of seven antigens and a glycerin control. Results were compared with those of a group of young adults studied by the authors. Results: Among males there was a mean of 2.7 ñ 1.4 positive responses compared with women, that had 1.7 ñ 1 positive responses (p= 0.016). The sum of response diameters was 4.2 ñ 1.5 and 3.6 ñ 1.9 mm in men and women respectively (p = NS). Compared to young adults, elderly women had a lower response to tetanus and diphtheria toxoids and men had a lower response to diphtheria and Proteus mirabilis. Conclusions: Elderly people have a less intense response to delayed cutaneous hypersensitivity tests than young adults. This response must be assessed in each population to account for regional variability

Effect of arginine and ornithine infusions on luteinizing hormone secretion in prepubertal ewes.

Although activation of the hypothalamic GnRH pulse generator is known to initiate the onset of puberty in immature animals, the metabolic cues by which information about the stage of body growth and development are translated into central nervous activity remain obscure. In the present study, the function of L-arginine (ARG) or L-ornithine (ORN) as promoters of pulsatile LH secretion was investigated in 2-mo-old prepubertal ewes. Suffolk ewe lambs (n = 17) fitted with intrajugular catheters were divided into three groups. Saline (200 mL) was infused for 1 h into all lambs. In Group 1, saline infusion was continued for another hour. In Group 2, 200 mL of an ARG solution (350 mM, pH 7.4) was infused for 1 h, and in Group 3, ORN was infused (200 mL, 350 mM, pH 7.4) for 1 h. Blood samples were collected at 15-min intervals from 60 min before until 285 min after the end of infusions. The Pulsar program was used to identify significant LH episodes during 285 min after infusions. Mean LH concentrations during the 285-min period after infusion were greater (P < .05) in Group 2 than in Groups 1 and 3. The mean LH pulse frequencies and amplitudes did not differ among the groups. However, in lambs infused with ARG, 13 of their 17 LH pulses had amplitudes > 1 ng/mL, whereas in control ewes only 5 of 20 pulses had amplitudes > 1 ng/mL. All of the ARG-infused ewes had two or more LH pulses with amplitudes > 1 ng/mL; only 1 of 6 control lambs had two pulses. Results indicate that ARG stimulates LH secretion in prepubertal ewes.

[Evaluation of a triatoma infestans eradication program in rural dwellings from the IV region, Chile, by means of serology for Chagas disease in 0-10 years old children]. / Evaluación de un programa de erradicación del Triatoma infestans en viviendas rurales de la IV región, Chile, mediante serología para la enfermedad de Chagas en niños de 0-10 años de edad.

The present study deals with the evaluation of the effectiveness of the measures employed in the control of Triatoma infestans, the vector of Trypanosoma cruzi infection (Chagas' disease), in the IV region of Chile through a serological follow up program. For this reason, a serological survey has been carried out in 2,783 children, from 0 to 10 years, who live in rural high endemic areas of the region. The sera were tested using an indirect hemagglutination test (IHAT) and ELISA techniques with results agreeing in 99.9% of the samples. In children with positive serology xenodiagnosis was performed and blood samples from the corresponding mothers were submitted to serology for Chagas' disease. These additional tests should allow to distinguish between congenital infection and vectorial transmission. It was observed that vectorial transmission of T. cruzi was interrupted in some localities where entomological control has been applied for 10 years, or lowered in those which have been submitted to desinsectations in the last 5 years. On the other hand, a relatively high prevalence of the infection has been detected in some localities. These results suggest an apparent increase of vectorial transmission, indicating the need of readjusting the dwellings insecticide sprayings activities to improve the measures against the vector.

Epignathus gigante no recém-nascido: relato de um caso e revisäo da literatura / Giant Epignathus in the newborn: report of a case and review of the literature

Epighatrus é um tumor teratóide congênito que se projeta através da boca. É extremamente raro e geralmente fatal se näo tratado adequadamente. Relatamos um caso tratado com sucesso. Aspectos importantes do diagnósticopré-natal, manuseio clínico pré-operatório e tratamento definitivo säo discutidos. Extensa revisäo de literatura é apresentada

Diffusion of medicaments within root canal dentin. A scanning electron microscopic study.

Root canals of 21 maxillary human teeth were enlarged with reamers and flushed alternatively with sodium hypochlorite and hydrogen peroxide. After its mechanical preparation, root canals were dressed with camphorated paramonochloropherol and/or formocresol delivered by paper points. All three medicaments crystallize both on dentin walls and inside dentinal tubules. The clinical implications of these findings are discussed.

The risk of intentional dissolution of the smear layer after mechanical preparation of root canals.

The root canals of 27 caries-free human cuspids were divided into 3 groups of 9 teeth each. Group I was mechanically prepared with reamers and files. Alternate irrigation with 5.25% NaOCl and 3% hydrogen peroxide was used between each instrument. The group II root canals were prepared with the use of alternate irrigation with the same concentrations of NaOCl and hydrogen peroxide and finally flushed with 17% EDTA and NaOCl solution. Group III was prepared mechanically with the use of sterile distilled water as an irrigant followed by a final flush with 17% EDTA solution. The root canals of all specimens were obturated with gutta-percha points and Tubliseal by means of the lateral condensation technique. After the root canals were obturated, samples of each of the three groups were immersed in separate flasks containing Streptococcus mutans, Staphylococcus epidermidis, and Corynebacterium hofmannii. All the microorganisms tested invaded the coronal dentin--where the access cavity had been sealed with Fynal--and/or the main foramen.

Scanning electron microscope study on the action of endodontic irrigants on bacteria invading the dentinal tubules.

Three groups of 10 maxillary anterior teeth each, which had been exposed to oral media, were flushed with 9 ml of tap water, physiologic saline solution, and alternating irrigation with NaOCl and hydrogen peroxide respectively. Residual caries, necrotic tissue remnants, intertubular cavitation, and dentinal tubule invasion by bacteria were searched for by means of the scanning electron microscope. Cuboidal sodium chloride crystals were very frequently found deposited in the main root canal, in lateral canals, and inside the dentinal tubules. This study discusses the important role NaOCl may play as a solvent of dental plaque and necrotic tissue remnants in the clinical endodontic treatment of infected teeth that had been exposed to oral media.

Substance P-like immunoreactivity in sympathetic ganglion from toad.

Substance P-like immunoreactivity cellular in toad sympathetic ganglia was studied in normal and capsaicin-treated ganglia. In the eighth sympathetic ganglion substance P-like immunoreactive are found in mast cells and SIF cells. The effect of substance P (0.001-0.003 mM) caused increase of compound action potential during tetanical stimulation (50 Hz by 40 sec.) and post-tetanic potentiation (0.1 Hz). Our results show that substance P facilitates synaptic transmission in the sympathetic ganglia from Caudiverbera caudiverbera.