El Miedo en Relación a la Odontología Uso de la Escala del Miedo Dental / Fear in Relation to Dentistry Using the Dental Fear Scale

La atención odontológica despierta en numerosos pacientes, especialmente en los niños, miedo y ansiedad que pueden originar conductas de rechazo a la misma o dificultar el trabajo del profesional. Para registrar la prevalencia e identificar los miedos más frecuentes en relación a la atención odontológica, se realizó un estudio observacional, descriptivo y longitudinal en un trabajo interdisciplinario con Musicoterapia. Se utilizó la Escala del Miedo (CFSS-DS), Dental Subscale of the Childrens' Fear Survey. Los resultados en un promedio de edades en años 11,41; desvío = 2,80, registraron el 53% en la puntuación 38:39. Corresponde 54.34% al sexo femenino y 45.66% al sexo masculino. El mayor porcentaje de miedo se registró a los 10 años de edad 15.24% y en el sexo femenino 54.34%. En conclusión, registrar y reconocer los miedos dentales ofreció un espacio de reflexión y elaboración de los mismos, con docentes y alumnos de grado, para desarrollar, en un tratamiento interdisciplinario con musicoterapia, estrategias que favorezcan una mejor adherencia de los pacientes al tratamiento odontológico y habilidades inherentes y habilidades sociales inherentes a la relación odontólogo-paciente. El miedo manifiesto a la atención odontológica sin ser resuelto satisfactoriamente puede entorpecer las mejores intenciones del profesional en el desarrollo de su tarea (AU)

Nefropatía asociada a fosfatos posterior a preparación para colonoscopia: dos casos anátomo-clínicos / Acute phosphate nephropathy after bowel cleansing for colonoscopy: two clinical-pathological case reports

Oral sodium phosphate (OSP) solutions are widely used for bowel cleansing before colonoscopy, for stercoral retention phenomena and persistent chronic constipation. Its main risk, is acute phosphate nephropathy (APN), which is a clinic-pathological entity characterized by acute kidney disease secondary to deposition of calcium phosphate crystals in the renal tubules. Its recognition has been documented over the last decade in relation to case reports and the warning of the FDA. This report discusses two cases of APN certified by renal biopsy after the administration of OSP. One of them had an acute symptomatic presentation, and the other one, was a late finding. Both developed renal failure.

Las soluciones de fosfato de sodio oral (FSO) son ampliamente utilizadas para la preparación de colon previo a colonoscopia, para fenómenos de retención estercorácea y constipación crónica pertinaz. Su principal riesgo, la nefropatía aguda por fosfatos (NAF), es una entidad clínico-patológica caracterizada por falla renal aguda secundaria a depósito de cristales de fosfato de calcio en los túbulos renales. En la última década se han comunicado reportes de casos clínicos y una advertencia del uso de FSO por parte de la Food and Drug Administration de EE.UU. (FDA). En esta publicación se comunican dos casos de NAF, posterior a la administración de FSO, confirmadas por biopsia. Uno de ellos tuvo una presentación aguda y sintomática y el otro fue un hallazgo tardío. Ambos se acompañaron de falla renal.

1-42 ß-amyloid peptide requires PDK1/nPKC/Rac 1 pathway to induce neuronal death.

1-42 ß-Amyloid (Aß(1-42)) peptide is a key molecule involved in the development of Alzheimer's disease. Some of its effects are manifested at the neuronal morphological level. These morphological changes involve loss of neurites due to cytoskeleton alterations. However, the mechanism of Aß(1-42) peptide activation of the neurodegenerative program is still poorly understood. Here, Aß(1-42) peptide-induced transduction of cellular death signals through the phosphatidylinositol 3-kinase (PI3K)/phosphoinositol-dependent kinase (PDK)/novel protein kinase C (nPKC)/Rac 1 axis is described. Furthermore, pharmacological inhibition of PDK1 and nPKC activities blocks Rac 1 activation and neuronal cell death. Our results provide insights into an unsuspected connection between PDK1, nPKCs and Rac 1 in the same signal-transduction pathway and points out nPKCs and Rac 1 as potential therapeutic targets to block the toxic effects of Aß(1-42) peptide in neurons.

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

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

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

Uso de psicofármacos en adultos mayores institucionalizados en Sector Oriente de la Región Metropolitana / Prescription of psychiatric drugs in elderly patients in nursing homes in east side of Santiago, Chile

Introducción: La población de adultos mayores (AM) ha aumentado en los últimos años en nuestro país. Ellos presentan una alta prevalencia de patologías neuropsiquiátricas. Se sabe que el hecho de institucionalizar a un AM es un factor desencadenante o mantenedor de patología psiquiátrica. En relación al tratamiento de los ancianos, es conocido que éstos son más lábiles frente a fármacos, por lo que la prescripción debe ser indicada individual y apropiadamente, sopesando los beneficios y los riesgos. El objetivo de este estudio es evaluar los factores que influyen en el uso de psicofármacos en casas de reposo del sector oriente de Santiago de Chile. Metodología: Se recolectaron datos de fichas médicas de cuatro centros de la Región Metropolitana aprobados por MINSAL. Resultados: Influyen en el número de psicofármacos prescritos a los ancianos: costo mensual de la institución, número de ancianos a cargo de un funcionario de la casa de reposo, grado de autovalencia, meses institucionalizados y la edad del adulto mayor. Discusión: Los AM institucionalizados tienen una alta prevalencia de diagnósticos psiquiátricos (74,7 por ciento), así como indicación de psicofármacos (75,3 por ciento). Hay factores distintos al diagnóstico que influyen en el número de psicofármacos que se indican al AM.

Introduction: Elderly population has increased in Chile in the past years. Elderly people show a high prevalence of neuropsychiatric disorders. It is known that institutionalization of an elderly person is a triggering factor or a maintenance factor for psychiatric disorders. It is also known that old people have greater liability to present side effects of medications, thus the importance of individual appropriate prescription, considering benefits and risks. The objective of this study is to evaluate factors affecting the use of psychiatric drugs in nursing homes in the east side of the city of Santiago, Chile. Method: Data was obtained from the medical record of patients from four centers located in the city, all of them certified by the Ministry of Health. Results: Factors affecting the number of psychiatric drugs prescribed are: cost of the nursing home, number of elderly patients per caregiver at the nursing home, time elapsed since date of institutionalization, age and degree of self care capacity of elderly patients. Discussion: Elderly patients in nursing homes have a high prevalence of psychiatric disorders (74,7 percent), and also of psychiatric drug prescription(75,3 percent). There are factors other than the diagnosis, that affect the number of different psychiatric drugs prescribed to the elderly patient.

Evaluation of a PCR test for the diagnosis of Brucella ovis infection in semen samples from rams.

The sensitivity and specificity of a PCR assay with primers derived from the insertion sequence IS6501 was compared with that of bacteriological culture and serological tests for the diagnosis of Brucella ovis infection in rams. No amplifications were detected with DNAs from the strains phylogenetically related to Brucella and from the seven bacterial species considered as the main etiologic agents of epididymitis in rams. In addition, the specificity of the PCR was 100% when testing semen samples from Brucella-free rams. The comparison of the semen culture and PCR results from 192 semen samples tested, showed a proportion of agreement of 0.91 between both tests. The PCR-based test described has sensitivity similar to that of semen culture and could be used as a complementary test for the direct diagnosis of Brucella ovis in semen samples of rams.

Regulation of Brucella virulence by the two-component system BvrR/BvrS.

The Brucella BvrR/BvrS two-component regulatory system is highly similar to the regulatory and sensory proteins of Sinorhizobium and Agrobacterium necessary for endosymbiosis and pathogenicity in plants, and very similar to a putative system present in the animal pathogen Bartonella. Mutations in the bvrR or bvrS genes hamper the penetration of B. abortus in non-phagocytic cells and impairs intracellular trafficking and virulence. In contrast to virulent Brucella, BvrR/BvrS mutants do not recruit small GTPases of the Rho subfamily required for actin polymerization and penetration to cells. Dysfunction of the BvrR/BvrS system alters the outer membrane permeability, the expression of several group 3 outer membrane proteins and the pattern of lipid A acylation. Constructs of virulent B. abortus chimeras containing heterologous LPS from the bvrS(-) mutant demonstrated an altered permeability to cationic peptides similar to that of the BvrR/BvrS mutants. We hypothesize that the Brucella BvrR/BvrS is a system devoted to the homeostasis of the outer membrane and, therefore in the interface for cell invasion and mounting the required structures for intracellular parasitism.

The two-component system BvrR/BvrS essential for Brucella abortus virulence regulates the expression of outer membrane proteins with counterparts in members of the Rhizobiaceae.

The Brucella BvrR/BvrS two-component regulatory system is homologous to the ChvI/ChvG systems of Sinorhizobium meliloti and Agrobacterium tumefaciens necessary for endosymbiosis and pathogenicity in plants. BvrR/BvrS controls cell invasion and intracellular survival. Probing the surface of bvrR and bvrS transposon mutants with monoclonal antibodies showed all described major outer membrane proteins (Omps) but Omp25, a protein known to be involved in Brucella virulence. Absence of Omp25 expression was confirmed by two-dimensional electrophoresis of envelope fractions and by gene reporter studies. The electrophoretic analysis also revealed reduction or absence in the mutants of a second set of protein spots that by matrix-assisted laser desorption ionization MS and peptide mass mapping were identified as a non-previously described Omp (Omp3b). Because bvrR and bvrS mutants are also altered in cell-surface hydrophobicity, permeability, and sensitivity to surface-targeted bactericidal peptides, it is proposed that BvrR/BvrS controls cell envelope changes necessary to transit between extracellular and intracellular environments. A genomic search revealed that Omp25 (Omp3a) and Omp3b belong to a family of Omps of plant and animal cell-associated alpha-Proteobacteria, which includes Rhizobium leguminosarum RopB and A. tumefaciens AopB. Previous work has shown that RopB is not expressed in bacteroids, that AopB is involved in tumorigenesis, and that dysfunction of A. tumefaciens ChvI/ChvG alters surface properties. It is thus proposed that the BvrR/BvrS and Omp3 homologues of the cell-associated alpha-Proteobacteria play a role in bacterial surface control and host cell interactions.