Vitamina d: su implicancia en la infección por SARS-CoV-2 y su rol en el desarrollo y prevención de la enfermedad / Vitamin d: the implications in SARS-CoV-2 infection and its role in the development and prevention of the disease

Introducción: La pandemia del SARS-CoV-2 ha sido un desafío para la medicina en estos últimos años por su alta tasa de contagios y muertes asociadas. Progresivamente los investigadores han ido dilucidando vías de transmisión y manifestaciones clínicas más frecuentes, que han facilitado la detección el virus. Con el objetivo de optimizar la prevención y tratamiento en pacientes infectados, investigadores de todo el mundo han evaluado la importancia de la respuesta inmune frente al virus, destacando la acción de algunos inmunomoduladores, como por ejemplo, la vitamina D. Desarrollo: Tras invadir el organismo, el SARS-CoV-2 se une a receptores de las células epiteliales del tracto respiratorio, específicamente en el neumocito tipo II, disminuyendo la producción de surfactante y provocando una producción desregulada de citocinas proinflamatorias, principal responsable de los casos más severos. Se ha demostrado que la Vitamina D puede modular la respuesta inmune tras unirse a su receptor VDR, disminuyendo la liberación de citocinas proinflamatorias. Algunos estudios han determinado que el uso de suplementos de vitamina D en dosis altas pudieran producir efectos protectores frente a infecciones respiratorias agudas. Conclusión: Finalmente, pese a los estudios realizados que relacionan el déficit de vitamina D con casos más severos de COVID-19, aún se requiere más evidencia para recomendar suplementación.

Introduction: The SARS-CoV-2 pandemic has been a challenge for medicine in recent years, due to its high contagion rate and associated deaths. Researchers have progressively elucidated transmission methods and most frequent clinical manifestations, that helps the virus detection. With the objective of optimizing prevention and treatment of infected patients, researchers all over the world have evaluated the importance of the immune system response against the virus, highlighting some immunomodulators, such as vitamin D. Body: After SARS-CoV-2 invades the organism, it binds to the receptor located on the respiratory tract epithelial cells, specifically type 2 pneumocyte, decreasing surfactant production and increasing the production of pro inflammatory cytokines, being the main reason for severe cases. Vitamin D has been shown to modulate the immune response after binding to its receptor, decreasing the release of proinflammatory cytokines. Some studies have shown that vitamin D supplementation in high doses may produce protective effects against acute respiratory infections. Conclusion: Finally, even the studies that correlate vitamin D deficiency and COVID-19 severe cases, we still need more evidence to recommend Vitamin D supplementation.

Alta frecuencia de pancreatitis aguda asociada a patología biliar en niños chilenos / Elevated frequency of acute pancreatitis associated to biliary illness in Chilean children

Acute Pancreatitis (AP) in children presents significant morbimortality. Most common etiologies in this age group are trauma, systemic illness and idiopathic pancreatitis. This is different from adult AP, where lithiasis and alcohol consumption are the predominant causes. In Chile, where billiary disease is highly prevalent, there is little information regarding AP among children. Objective: To determine the main clinical characteristics of acute pancreatitis in a group of Chilean children. Patients and Methods: A retrospective study (1998-2008) of patients hospitalized with the diagnosis of AP. The diagnosis was confirmed by elevation of pancreatic enzymes and through images. Demographic data, etiology, complications and resolutions, need for parenteral nutrition, and use of antibiotics were examined. Results: Eighteen patients were identified (8,3 +/- 4 y.o.). Etiology of AP was listed as: lithiasis and alterations of biliary duct: 38,8 percent, idiopathic: 22,2 percent, secondary to medications: 22,2 percent and other: 16.8 percent. Two patients presented peripancreatic infected collections; a similar number formed pancreatic pseudocysts. Six patients (33,3 percent) required one type of surgical procedure as part of their treatment. Two-thirds of all patients required treatment in ICU. One half of the patients required parenteral nutrition, and two thirds received IV antibiotics. The median length of hospital stay was 20 days (ave 24,9 +/- 14,3 ds). There was no mortality in this serie. Conclusions: Unlike previously described, biliary AP was the most common cause in this serie. Biliary pathology should be actively studied among Chilean children with AP.

La pancreatitis aguda (PA) en niños presenta una morbimortalidad considerable. Las etiologías más frecuentes en este grupo etario son la PA secundaria a trauma, por enfermedades sistémicas y la PA idiopática, a diferencia de la población adulta en que predomina la litiasis biliar y el consumo de alcohol. En Chile, donde la patología biliar es altamente prevalente, existe escasa información clínica respecto de la PA en niños. Objetivo: Determinar las características clínicas de la pancreatitis aguda en un grupo de niños chilenos. Método: Estudio retrospectivo (1998-2008) de pacientes hospitalizados con PA. Se confirmó el diagnóstico por elevación de enzimas pancreáticas e imágenes; se obtuvieron los datos demográficos y se analizó: etiología, complicaciones y su resolución, necesidad de nutrición parenteral y uso de antibióticos. Resultados: Se identificaron 18 pacientes (8,3 +/- 4 años). Etiología de la PA: litiasis y alteraciones anatómicas de la vía biliar (38,8 por ciento), idiopática (22,2 por ciento), drogas (22,2 por ciento), otras (16.8 por ciento). Dos pacientes presentaron colecciones peripancreáticas infectadas; igual número evolucionó con formación de pseudoquistes pancreáticos. Seis pacientes (33,3 por ciento) requirieron algún tipo de procedimiento quirúrgico como parte de su tratamiento. Dos tercios de los pacientes ingresaron a la Unidad de Pacientes Críticos. La mitad de los pacientes recibió nutrición parenteral y dos tercios antibióticos endovenosos. La mediana de hospitalización fue de 20 días (promedio 24,9 +/- 14,3 días). No hubo mortalidad en la serie. Conclusiones: A diferencia de lo descrito en la literatura, la PA biliar fue la etiología más frecuente en esta serie. La patología biliar debe ser estudiada activamente en niños chilenos con PA.

Esclerectomía profunda no perforante: esclero-trabeculectomía no perforante / Non perforating deep sclerectomy: non perforating sclero-trabeculectomy

Se presenta la experiencia de los autores en 30 ojos de 24 pacientes operados de esclerectomía profunda no perforante (EPNP), es un estudio prospectivo realizado en los años 1998 y 1999. El promedio de observación postoperatorio fue de 7,3 meses, variando entre 2 y 18 meses. No se utilizó implante de colágeno. Se practicó impregnación de Mitomicima C diluida al 0,01 por ciento durante 3 mn., antes de realizar el colegio escleral. Se observaron escasas complicaciones postoperatorias, siendo la más frecuente las goniosinequias presentes en cinco ojos (17 por ciento), que excepto en un caso, fueron pequeñas y no significativas. La presión preoperatoria promedio sin tratamiento fue de 34 mmHg. En el postoperatorio se obtuvieron presiones de 20 mmHg, o menos, sin tratamiento, a los 4 meses en el 80 por ciento, a los 6 meses en el 80 por ciento y a los 8 meses en el 64 por ciento de los ojos. Se estima que con la técnica realizada la presencia de vesícula de filtración es un factor importante en la normalización de la presión postoperatoria

[Comparison of the effects of digoxin or enalapril in the treatment of heart failure due to mitral insufficiency]. / Comparación de digoxina y enalapril en insuficiencia cardíaca secundaria a insuficiencia mitral.

BACKGROUND: There is not much evidence about the usefulness of digoxin or enalapril in the treatment of heart failure due to mitral insufficiency. AIM: To compare digoxin and enalapril in the treatment of heart failure due to mitral insufficiency. PATIENTS AND METHODS: Patients with mitral insufficiency, in sinus rhythm, with a heart failure grade II or III and with echocardiographic left ventricular dilatation were eligible for the study. They received sequentially, during 12 weeks each, digoxin 0.25 mg/day or enalapril in doses up to 20 mg/day, with a washout in-between period of 2 weeks. The order of the sequence was determined randomly. At the start and end of treatment, functional class according to NYHA and maximal exercise tolerance in the treadmill were assessed and a color Doppler echocardiogram was done to measure ventricular dimensions, function and degree of mitral insufficiency. RESULTS: Nine patients on enalapril and 12 on digoxin improved their functional capacity. Digoxin improved exercise time in 76 +/- 168 sec (p = 0.022), whereas this change was not significant with enalapril (38 +/- 158 sec; p = 0.2). With enalapril treatment, ventricular diastolic dimension decreased from 59.3 +/- 8.1 to 58 +/- 9.3 mm and the area of mitral insufficiency decreased from 8.1 +/- 3.5 to 6.6 +/- 3.1 cm2. Digoxin did not induce any significant echocardiographic change. CONCLUSIONS: In these patients, digoxin and enalapril improved functional class. Digoxin improved exercise time and enalapril reduced ventricular dimensions and mitral insufficiency.

Frecuencia y clasificación del riesgo de glaucoma en la comuna de Florida VIII región / Frecuency and classification of glaucoma risk at Florida community, VIII region

Se examinaron 807 ojos de 404 pacientes que representan el 9,68 por ciento de la población mayor de 40 años de la comuna de Florida. Se practicó examen oftalmológico completo que incluía medición de la profundidad de la cámara anterior y gonioscopía a todos los pacientes. Del análisis de datos se descartaron 30 ojos, 2 por glaucoma y catarata, 10 casos de catarata densa y 2 leucomas que no permitieron evaluar el fondo de ojo. Además de 16 casos por examen incompleto debido a la mala cooperación de los pacientes, quedando un total de 777 casos (ojos). Un 3,60 por ciento presentó presiones de 26 mm de Hg o más; de ellos el 0.51 por ciento con gonoscopía de cierre angular; 3,09 por ciento con ángulos abiertos a la gonioscopía; de éstos, 1 caso de glaucoma pseudoexfoliativo (0,13 por ciento) y 4,64 por ciento con presiones entre 21 y 25 mmHg. En el 91,8 por ciento la presión se encontró entre 10 y 20 mmHg

Incidence of insulin-dependent diabetes mellitus in the IX region of Chile: ethnic differences.

We studied the incidence of insulin-dependent diabetes mellitus (IDDM) among children up to 15 years old of Caucasian and Mapuche origin, in the IX Region of Chile between 1980 and 1993. The Mapuche, or native Chileans, have their own culture, language an distinctive ethnic characteristics. Data were collected according to the methods recommended by the Diabetes Epidemiology Research International Group. We diagnosed IDDM in 47 children, 22 boys and 25 girls. The average annual incidence was 1.27/100,000 inhabitants (95% confidence intervals (C.I.) 0.83-1.71/100,000). The highest incidence along this period was during winter and spring. There was significant difference (P < 0.0016) in the IDDM incidence in Caucasians (1.58/100,000, 95% C.I. 1.11-2.04) compared with Mapuche (0.42/100,000, 95% C.I. 0-0.95). These results show that Mapuche children have less chance of developing diabetes.

[Comparison between digoxin and atenolol in chronic atrial fibrillation]. / Comparación de digoxina y atenolol en fibrilación auricular crónica.

The benefits of digoxin in patients with atrial fibrillation may be reduced due to its limited effect on atrioventricular conduction. The aim of this work was to compare digoxin and atenolol on functional class, resting and exercise heart rate and exercise capacity in patients with atrial fibrillation. Thirteen subjects with this condition, normal echocardiographic left ventricular function and size, a resting heart rate less than 80 beats/min and with no contraindication for beta blocker or digoxin use were studied. Patients were randomly assigned to receive initially digoxin 0.25 mg o.d. or atenolol 100 mg o.d. in a double blind fashion. The doses were adjusted to obtain a heart rate between 60 and 80 beats/min at the end of the first week of treatment. After two weeks of treatment, outcomes were assessed, patients were left without treatment for one week and crossed over to the other drug after that. Resting heart rates achieved with digoxin and atenolol were similar (67 +/- 11 and 65 +/- 23 beats/min respectively). However, maximal exercise heart rates and maximal exercise time were higher during digoxin treatment (166 +/- 23 vs 135 +/- 27 beats/min and 9.95 +/- 1.68 vs 8.5 +/- 2 min respectively). NYHA functional class deteriorated in three patients receiving atenolol. We conclude that atenolol achieves a better control of heart rate during exercise but also reduces maximal exercise capacity.

[Digoxin is effective in th treatment of patients with heart failure and sinus rhythm]. / La digoxina es efectiva en el tratamiento de pacientes con insuficiencia cardiaca y ritmo sinusal.

Due to differences in treatment effect in studies on the effectiveness of digoxin in patients with congestive heart failure in sinus rhythm, a cross-over placebo-controlled, randomized double blind clinical trial was performed. Thirty one patients, without previous treatment with digoxin, in New York Heart Association (NYHA) functional class II to IV, with a dilated left ventricle and/or ventricular systolic dysfunction were included. Patients received digoxin, adjusted for blood levels, or placebo, during an 8 week period, prior to crossing over to the other treatment for another 8 weeks. The order of treatments was randomly allocated. Outcome measurement were performed at the end of each 8 week period. Digoxin, compared with placebo, improved NYHA class, 6.9% vs 41.4% (p = 0.013) and increased the treadmill exercise time, 406 +/- 204 s vs 484 +/- 185 s (p = 0.003). During the digoxin treatment the left ventricular and systolic diameter was reduced from 52.9 +/- 8.9 to 50.1 +/- 9.7 mm (p = 0.016) and the shortening fraction increased from 21.4 +/- 8.3 to 24.8 +/- 8.1% (p = 0.009). No significant difference was observed in the left ventricular end diastolic diameter (LVED) of the left ventricle and in a estimation of quality of life. In conclusion, digoxin treatment produced a significant improvement in functional capacity, exercise time, and left ventricular performance.

[Podalic version in multiparae. Vaginal or cesarean?]. / Parto en podálica en multíparas. Vaginal o cesárea?

A review of maternal and perinatal results of multiparous patients with breech presentation was done during two period; two years before and two years after establishing the rule of cesarean section for all multi-parous with breech presentation. Seventy cases were considered at the first period in which 47.1% were vaginal delivery, proportion that significantly decreased (15%) at the second period. No significant differences on maternal results by delivery form were found and the same was found in perinatal results at comparing vaginal delivery and cesarean section. A different situation was reported studying only elective cesarean section, in which a significant decrease of severe neonatal depression was found comparing to vaginal delivery (24.2% and 0%). Because of rapid recovery there were no differences at fifth minute. As a conclusion, it appears as an exaggeration the option of cesarean section for all multiparous with breech presentation. Secondly, the adequate selection of cases to resolve by vaginal delivery may not produce adverse maternal and perinatal results.

Secretion of multiple forms of human luteinizing hormone by cultured fetal human pituitary cells.

Previous studies of the heterogeneity of human LH have employed LH stored within the pituitary gland. In this study we characterized LH secreted by dispersed fetal human pituitary cells. Chromatofocusing across a pH 9-6 gradient of the medium in which fetal pituitary cells had been grown yielded at least eight distinct peaks of LH immunoreactivity. The more basic LH peaks bound more strongly to Concanavalin-A-Sepharose than did the more acidic ones, suggesting that the more basic LH molecules contain more hybrid oligosaccharides, in which one antenna terminates in a mannose, and that the more acidic human LH molecules contain more complex oligosaccharides, in which both antennae terminate in negatively charged groups, sialic acid and/or N-acetylgalactosamine-sulfate. The biological/immunological activity (B/I) ratios of the secreted LH varied directly and dramatically with the pI, from 8.1 at pI 8.4 to 1.1 at pI 6.3. Secreted LH, therefore, exhibits similar heterogeneity of glycosylated forms as does stored LH, raising the possibility that the hormones that control overall LH secretion could affect the secretion of some isohormones more than others and thereby influence LH biological activity to a degree not predicted by measuring total LH immunoreactivity.