Human prostate epithelial cells and prostate-derived stem cells malignantly transformed in vitro with sodium arsenite show impaired Toll like receptor -3 (TLR3)-associated anti-tumor pathway.

A therapeutic strategy for prostate cancer (PCa) involves the use of 9-cis-retinoic acid (9cRA) to induce cancer stem cells (CSCs) differentiation and apoptosis. Polyinosinic:polycytidylic acid (PIC) is a Toll-like receptor 3 (TLR3) agonist that induces tumor cells apoptosis after activation. PIC+9cRA combination activates retinoic acid receptor ß (RARß) re-expression, leading to CSC differentiation and growth arrest. Since inorganic arsenic (iAs) targets prostatic stem cells (SCs), we hypothesized that arsenic-transformed SCs (As-CSCs) show an impaired TLR3-associated anti-tumor pathway and, therefore, are unresponsive to PIC activation. We evaluated TLR3-mediated activation of anti-tumor pathway based in RARß expression, on As-CSC and iAs-transformed epithelial cells (CAsE-PE). As-CSCs and CAsE-PE showed lower TLR3 and RARß basal expression compared to their respective isogenic controls WPE-Stem and RWPE-1. Also, iAs transformants showed reduced expression of mediators in TLR3 pathway. Importantly, As-CSCs were irresponsive to PIC+9cRA in terms of increased RARß and decreased SC-markers expression, while CAsE-PE, a heterogeneous cell line having a small SC population, were partially responsive. These observations indicate that iAs can impair TLR3 expression and anti-tumor pathway activated by PIC+9cRA in SCs and prostatic epithelial cells. These findings suggest that TLR3-activation based therapy may be an ineffective therapeutic alternative for iAs-associated PCa.

Simplified biplanar (0-90°) fluoroscopic puncture technique for percutaneous nephrolithotomy: the learning curve.

PURPOSE: To evaluate the learning curve of the simplified fluoroscopic biplanar (0-90º) puncture technique for percutaneous nephrolithotomy. METHODS: We prospectively evaluated patients with renal stones treated with percutaneous nephrolithotomy by a single institution's fellows employing the simplified bi-planar (0-90º) fluoroscopic puncture technique for renal access. The learning curve was assessed with the fluoroscopic screening time and the percutaneous renal puncture time. Data obtained were compared to a subset of patients operated by a senior surgeon. RESULTS: Eighty-nine patients were included in the study. Forty patients were operated by fellow-1, 39 by fellow-2, and 10 patients by the senior surgeon. Demographic data of all patients between groups were homogeneous, with no difference in gender (p = 0.432), age (p = 0.92), stone volume (p = 0.78), puncture laterality (p = 0.755), and body mass index (p = 0.365). The mean puncture time was 7.5, 4, and 3.1 min for fellow-1, fellow-2, and expert, respectively. The mean fluoroscopic screening time for the puncture was 10, 11, and 5.1 s for fellow-1, fellow-2, and the expert, respectively. Stone cases, both fellows needed to complete 10 procedures to match the senior surgeon in the mean puncture time (p = 0.046); meanwhile, the fluoroscopic screening time was equal even before to complete 10 procedures. CONCLUSION: This study suggests that with the simplified biplanar (0-90º) puncture technique, the fluoroscopic screening time used in the learning process is brief. A novice fellow could require to complete ten cases to flatten the learning curve treating complex stone cases, and a flat learning curve is seen since the beginning when treating simple renal stones.

Indoor radon exposure and excess of lung cancer mortality: the case of Mexico-an ecological study.

Radon is a radioactive gas that can migrate from soils and rocks and accumulate in indoor areas such as dwellings and buildings. Many studies have shown a strong association between the exposure to radon, and its decay products, and lung cancer (LC), particularly in miners. In Mexico, according to published surveys, there is evidence of radon exposure in large groups of the population, nevertheless, only few attention has been paid to its association as a risk factor for LC. The aim of this ecological study is to evaluate the excess risk of lung cancer mortality in Mexico due to indoor radon exposure. Mean radon levels per state of the Country were obtained from different publications and lung cancer mortality was obtained from the National Institute of Statistics, Geography and Informatics for the period 2001-2013. A model proposed by the International Commission on Radiological Protection to estimate the annual excess risk of LC mortality (per 105 inhabitants) per dose unit of radon was used. The average indoor radon concentrations found rank from 51 to 1863 Bq m-3, the higher average dose exposure found was 3.13 mSv year-1 in the north of the country (Chihuahua) and the mortality excess of LC cases found in the country was 10 ± 1.5 (range 1-235 deaths) per 105 inhabitants. The highest values were found mainly in the Northern part of the country, where numerous uranium deposits are found, followed by Mexico City, the most crowded and most air polluted area in the country. A positive correlation (r = 0.98 p < 0.0001) was found between the excess of LC cases and the dose of radon exposure. Although the excess risk of LC mortality associated with indoor radon found in this study was relatively low, further studies are needed in order to accurately establish its magnitude in the country.

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

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

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

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

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

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

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

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

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

The anti-thrombotic effects of vitamin D and their possible relationship with antiphospholipid syndrome.

The importance of the immunomodulatory effects of vitamin D has recently been associated with autoimmune and chronic inflammatory diseases. Vitamin D deficiency has been linked to the development of autoimmune conditions. Antiphospholipid syndrome is an autoimmune disease characterized by thrombotic events and obstetric complications in patients with antiphospholipid antibodies. Current data show that patients with antiphospholipid syndrome have a high prevalence of vitamin D deficiency even without classic risk factors. Several studies have suggested vitamin D may have anti-thrombotic functions. In antiphospholipid syndrome, low vitamin D serum levels have been associated with thrombotic manifestations, suggesting a possible protective role of vitamin D in antiphospholipid syndrome. This literature review presents current evidence on the haemostatic functions of vitamin D and their possible relationship with the clinical manifestations of antiphospholipid syndrome.

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

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

Factors of the epidemiological triad that influence the persistence of human papilloma virus infection in women with systemic lupus erythematosus.

We studied the epidemiologic triad-related factors influencing human papilloma virus (HPV) persistence in Mexican women with systemic lupus erythematosus (SLE). Patients aged ≥18 years with SLE (American College of Rheumatology criteria), with and without HPV persistence, were selected. Groups were analyzed by (1) host: clinical disease characteristics; (2) agent: (I) infectious (prevalence, incidence, HPV genotype and co-infections (≥2 HPV genotypes or mycoplasmas)), (II) chemical (contraceptives and immunosuppressive drugs) and (III) physical (vitamin D deficiency) and (3) environment. A total of 121 SLE patients were selected over a two-year period. (1) Host: mean age 45.8 years and disease duration 12.7 years. (2) Agent: (I) infectious. HPV infection prevalence in the second sample was 26.4%, high-risk HPV genotypes 21.5% and co-infections 7.4%. HPV infection incidence was 13.2%, persistence 13.2% and clearance 15.7%. (II) Chemical: use of oral hormonal contraceptives 5% and immunosuppressive treatment 97.5%. (III) Physical: Vitamin D levels were similar in both groups. (3) Environment: (I) natural. A total of 60.6% of patients were residents of Puebla City. (II) Social: The mean education level was 10.9. Poverty levels were: III degree 52.4%, IV degree 28% and II degree 17%. (III) Cultural behavioral: Onset of sexual life was 20.5 years, 10% had ≥3 sexual partners and 51.2% were postmenopausal. In conclusion, no factor of the epidemiologic triad was associated with HPV infection prevalence.

Validación de un Cuestionario para Evaluar Riesgo de Caries en Preescolares en Santiago, Chile / Validation of a Questionnaire to Assess Risk of Caries in Preschool-Age Children in Santiago, Chile

RESUMEN: La Caries Temprana de la Infancia (CTI) es una forma de caries dental agresiva que afecta a niños, y en el último reporte nacional reveló una prevalencia de caries del 50 % en niños de 4 años de edad de la Región Metropolitana de Santiago (Soto et al., 2007). El objetivo de este estudio es validar un cuestionario que permita recolectar información relacionada con diversos factores de riesgo de caries en niños preescolares. Para la validación del cuestionario se determinó la validez de convergencia y discriminación, la consistencia interna y la confiabilidad test retest del instrumento en dos muestras independientes. Se aplicó el instrumento al cuidador principal de 118 preescolares entre 24 a 71 meses de edad, que asisten a jardines infantiles de dependencia particular (bajo riesgo de caries) y la Fundación INTEGRA (alto riesgo de caries) en la Región Metropolitana de Santiago, Chile. Se realizaron exámenes clínicos dentales por 2 odontólogos calibrados utilizando en el criterio OMS e ICDAS II. Se estimó un modelo de regresión logística y se evalúo la capacidad de discriminación del puntaje a través de una curva ROC. El cuestionario mostró una validez de discriminación de 0,95 entre ambos grupos y de la pregunta global 0,61 y una consistencia interna del cuestionario de 0,72. En la validez de convergencia se encontró que no existe asociación estadísticamente significativa entre el puntaje del cuestionario y la pregunta global dicotomizada (OD) 1,061. No obstante, se evidenció que si existe asociación estadísticamente significativa entre el puntaje del cuestionario y el grupo riesgo de caries (bajo y alto) (OD) 1,961. La estabilidad temporal mediante comparaciones Test - Retest calculado con el índice de Kappa osciló entre 0,37 a 1. Por lo tanto, se puede concluir que el presente cuestionario es un instrumento válido para discriminar riesgo de caries, permitiendo un mejor análisis de los determinantes de la caries dental en la población preescolar chilena.

ABSTRACT: Early Childhood Caries (ECC) is an aggressive form of tooth decay, and the last national unpublished reports reveal a caries prevalence of 50 % at 4 years of age in children, in the Santiago Metropolitan Region (Soto et al., 2007). The objective of this study is to validate a questionnaire that allows the collection of information related to several caries risk factors in preschoolchildren. For the validation of the questionnaire, the convergence and discrimination validity, the internal consistency and the retest, test reliability of the instrument were determined in two independent samples. The instrument was applied to the main caregiver of 118 preschoolers between 24 and 71 months of age, who attend private childcare centers (low caries risk) and the INTEGRA Foundation childcare (high caries risk) in the Metropolitan Region of Santiago, Chile. Dental clinical examinations were performed by two calibrated dentists using the OMS and ICDAS II criteria. A logistic regression model was estimated and the ability to discriminate the score through an ROC curve was evaluated. The questionnaire showed a validity of discrimination of 0.95 between both groups and of the global question 0.61 and an internal consistency of the questionnaire of 0.72. In the convergence validity, it was found that there is no statistically significant association between the questionnaire score and the dichotomized global question (RE) 1.061. However, it was evidenced that there is a statistically significant association between the questionnaire score and the caries risk group (low and high) (OD) 1.961. Temporal stability by means of Test - Retest comparisons calculated with the Kappa index ranged from 0.37 to 1. Therefore, it can be concluded that the present questionnaire is a valid instrument for discriminating caries risk, allowing a better analysis of the determinants of dental caries in the Chilean preschool population.

Percepción de escolares chilenos de distinto nivel socioeconómico sobre la regulación de la publicidad de alimentos / Perception of Chilean schoolchildren from different socioeconomic status on food advertising regulation

El objetivo del estudio fue analizar la percepción de escolares de 8 a 12 años, de ambos sexos, distinto nivel socioeconómico (NSE) y estado nutricional, sobre la regulación de la publicidad de alimentos y bebidas azucaradas. En un estudio de corte transversal, se aplicó una encuesta previamente validada a 812 escolares (399 niños y 413 niñas) de NSE alto y bajo en 3 ciudades del país. Los datos se analizaron según NSE y estado nutricional. La obesidad fue más prevalente en los niños de NSE bajo, quienes veían más comerciales de alimentos y bebidas en televisión y los de NSE alto en Internet y celulares. Sobre el 65% de los escolares en ambos NSE llevaba dinero para comprar alimentos en el horario escolar. En los primeros meses de entrada en vigencia de la Ley 20.606, el 80% de los niños indicaron que les gustaba ser informados de lo que contenían los alimentos y los sellos Alto en Calorías, Alto en Grasas Saturadas y Alto en Sodio fueron significativamente más importantes para los de NSE alto. El sello Alto en Azúcares fue igualmente importante en ambos NSE. Estos resultados permitirán apoyar intervenciones de educación en nutrición y marketing social que motiven la alimentación saludable en niños, padres y profesores(AU)

The objective of this study was to analyze the perception of schoolchildren, 8 to 12 years, both sex, of different socioeconomic status (SES) and nutritional status, on food and sugary beverages advertising regulation. A cross-sectional study that used a previously validated survey to 812 schoolchildren (399 boys and 413 girls) of high and low SES in 3 Chilean cities was performed. The data was analyzed according to NSE and nutritional status. Obesity was more prevalent in low-SES children. These children watched significantly more food and beverages TV ads while high SES children do it more through Internet and cell phones. Over 65% of children of both SES brought money to school to buy food. In the first months after the 20.606 Law was implemented, 80% of the children indicated that they like to be informed on food content. On the other hand, the symbols "High in Calories", "High in Saturated Fats", and "High in Sodium", were significantly more relevant for children of high SES. The symbol "High in Sugars" was equally important for children of both SES. These results will support the design of nutrition education and social marketing interventions that promote healthy eating in children, parents and teachers(AU)

Prevalence of functional gastrointestinal disorders in adults with systemic lupus erythematosus.

Objective (a) to assess the prevalence of functional gastrointestinal disorders (FGIDs) in female Mexican systemic lupus erythematosus (SLE) patients using the Rome III criteria and (b) to examine the effect of disease duration on FGID prevalence. Methods Female SLE outpatients aged ≥18 years with no organic gastrointestinal disorder were included. Participants were invited to upper gastrointestinal endoscopy screening and a faecal immunochemical test. FGID symptoms were evaluated using the Rome III questionnaire. Results Eighty-six SLE patients with median age of 45 (interquartile range 34-54) years were included. At least one FGID was found in 76.7% (66/88) of patients with SLE. The most prevalent domains of FGID diagnosed were functional oesophageal, gastroduodenal disorders and bowel disorders, of which functional dyspepsia (72.7%), functional heartburn (68.1%) and bloating (63.8%) were the most frequent. Fifty-nine per cent of patients had overlapping FGIDs. The most prevalent overlap was the combination of functional dyspepsia and functional heartburn. Patients with longer disease duration had a higher prevalence of FGID than those with shorter disease duration. Conclusions There was a high prevalence of FGIDs in Mexican SLE women with low disease activity. Overlapping FGIDs were frequent. Longer disease duration may be associated with FGIDs in SLE patients.

Automated early detection of drops in commercial egg production using neural networks.

1. The purpose of this work was to support decision-making in poultry farms by performing automatic early detection of anomalies in egg production. 2. Unprocessed data were collected from a commercial egg farm on a daily basis over 7 years. Records from a total of 24 flocks, each with approximately 20 000 laying hens, were studied. 3. Other similar works have required a prior feature extraction by a poultry expert, and this method is dependent on time and expert knowledge. 4. The present approach reduces the dependency on time and expert knowledge because of the automatic selection of relevant features and the use of artificial neural networks capable of cost-sensitive learning. 5. The optimum configuration of features and parameters in the proposed model was evaluated on unseen test data obtained by a repeated cross-validation technique. 6. The accuracy, sensitivity, specificity and positive predictive value are presented and discussed at 5 forecasting intervals. The accuracy of the proposed model was 0.9896 for the day before a problem occurs.

[Intravenous thrombolysis for acute ischemic stroke. A four years’ experience in a Chilean public hospital]. / Evolución del protocolo de trombolisis endovenosa en ataque cerebrovascular isquémico agudo.

BACKGROUND: Intravenous thrombolysis (IVT) with alteplase (tissue plasminogen activator) is the standard pharmacological treatment in acute ischemic stroke (AIS), reducing disability in patients. AIM: To report the results a thrombolysis protocol during four years in a regional public hospital. MATERIAL AND METHODS: Data from 106 consecutive patients aged 68 ± 13 years (57% men) who were treated with IVT, from May 2012 until April 2016, was analyzed. RESULTS: The median door-to-needle time was 80 minutes (interquartile range = 57-113). The median National Institute of Health Stroke Scale (NIHSS) scores on admission and at discharge were was 11.5 and 5 points respectively. At discharge, 27% of hospitalized patients had a favorable outcome (n = 99), defined as having 0 to 1 points in the modified Rankin scale. Symptomatic intracerebral hemorrhage and mortality rates were 5.7 and 13.1%, respectively. The thrombolysis rate rose from 0.7% in 2012 to 6% in 2016. CONCLUSIONS: The implementation of 24/7 neurology shifts in the Emergency Department allowed us to increase the amount and quality of IVT in our hospital, as measured by the rate of thrombolysis and by process indicators such as door-to-needle time.

Evolución del protocolo de trombolisis endovenosa en ataque cerebrovascular isquémico agudo / Intravenous thrombolysis for acute ischemic stroke. A four years’ experience in a Chilean public hospital

Background: Intravenous thrombolysis (IVT) with alteplase (tissue plasminogen activator) is the standard pharmacological treatment in acute ischemic stroke (AIS), reducing disability in patients. Aim: To report the results a thrombolysis protocol during four years in a regional public hospital. Material and Methods: Data from 106 consecutive patients aged 68 ± 13 years (57% men) who were treated with IVT, from May 2012 until April 2016, was analyzed. Results: The median door-to-needle time was 80 minutes (interquartile range = 57-113). The median National Institute of Health Stroke Scale (NIHSS) scores on admission and at discharge were was 11.5 and 5 points respectively. At discharge, 27% of hospitalized patients had a favorable outcome (n = 99), defined as having 0 to 1 points in the modified Rankin scale. Symptomatic intracerebral hemorrhage and mortality rates were 5.7 and 13.1%, respectively. The thrombolysis rate rose from 0.7% in 2012 to 6% in 2016. Conclusions: The implementation of 24/7 neurology shifts in the Emergency Department allowed us to increase the amount and quality of IVT in our hospital, as measured by the rate of thrombolysis and by process indicators such as door-to-needle time.

Incidence of cervical human papillomavirus infection in systemic lupus erythematosus women.

Objectives Our objective was to study the incidence, persistence and clearance of human papillomavirus infection in systemic lupus erythematosus women and assess risk factors for persistence of human papillomavirus infection. Methods We carried out a prospective, observational cohort study of 127 systemic lupus erythematosus women. Patients were evaluated at baseline and at three years. Traditional and systemic lupus erythematosus women-related disease risk factors were collected. Gynaecological evaluations and cervical cytology screening were made. Human papillomavirus detection and genotyping were made by polymerase chain reaction and linear array. Results The cumulative prevalence of human papillomavirus infection increased from 22.8% at baseline to 33.8% at three years; p = < 0.001: 20.1% of patients experienced 43 incident infections. The risk of any human papillomavirus infection was 10.1 per 1000 patient-months. At three years, 47 (88.6%) prevalent infections were cleared. Independent risk factors associated with incident human papillomavirus infection included more lifetime sexual partners (odds ratio = 1.8, 95% confidence interval = 1.11-3.0) and cumulative cyclophosphamide dose (odds ratio = 3.9, 95% confidence interval = 1.2-12.8). Conclusions In systemic lupus erythematosus women, the cumulative prevalence of human papillomavirus infection, including high risk-human papillomavirus and multiple human papillomavirus infections, may increase over time. Most persistent infections were low risk-human papillomavirus. The number of lifetime sexual partners and the cumulative cyclophosphamide dose were independently associated with incident human papillomavirus infection.

Factors Associated with Health-Related Quality of Life in Mexican Lupus Patients Using the LupusQol.

INTRODUCTION: Health-related quality of life (HRQOL) is affected by numerous clinical variables, including disease activity, damage, fibromyalgia, depression and anxiety. However, these associations have not yet been described in Mexican patients with systemic lupus erythematosus (SLE). OBJECTIVE: To evaluate the relationship between disease activity, damage, depression and fibromyalgia and HRQOL measured by the LupusQoL-instrument in Mexican patients with SLE. METHODS: A cross-sectional study was conducted in women fulfilling the 1997 ACR classification criteria for SLE. HRQOL was evaluated using a disease-specific instrument for SLE, the LupusQoL (validated for the Spanish-speaking population). Patients were evaluated clinically to determine the degree of disease activity and damage using the Mexican Systemic Lupus Erythematosus Disease Activity Index (Mex-SLEDAI) and Systemic Lupus International Collaborating Clinics-Damage Index (SLICC), respectively. Fibromyalgia and depression were assessed using the ACR criteria and the CES-D scale, respectively. The relationship between HRQOL and these variables was measured using Spearman's rank correlation coefficient and linear regression analysis. RESULTS: A total of 138 women with SLE, age 40.3±11 years, disease duration 8.8±6.4 years, with disease activity in 51.4%, depression in 50%, damage in 43% and fibromyalgia in 19.6% were included. Poorer HRQOL correlated with depression (r = -0.61; p< 0.005), fibromyalgia (r = -0.42; p< 0.005), disease activity (r = -0.37; p < 0.005) and damage (r = -0.31; p < 0.005). In the multivariate linear regression analysis, damage (ß = -3.756, p<0.005), fibromyalgia (ß = -0.920, p<0.005), depression (ß = -0.911, p<0.005) and disease activity (ß = -0.911, p<0.005) were associated with poor HRQOL. CONCLUSION: SLE disease activity, damage, fibromyalgia and depression were associated with poor HRQOL in our sample of Mexican SLE patients.

Manejo endoscópico de litiasis en ureterocele / Endoscopic management of lithiasis in ureteroce

Introducción: El ureterocele corresponde a una dilatación sacular del uréter distal, la cual puede ser congénita o ectópica. Ocurren más frecuentemente en mujeres que hombres, presentándose de manera bilateral en el 10 por ciento de los casos. Su importancia radica en que son factores de riesgo tanto para infección como para la formación de cálculos. No existe consenso en el tratamiento de cálculos asociados a ureterocele, si bien el tratamiento endoscópico pareciera ser el de elección.(AU)

Introduction: The ureterocele corresponds to a saccular dilation of the distal ureter, which may be congenital or ectopic. They occur more frequently in women than men, presenting bilaterally in 10 pertcent of cases. Their importance lies in the fact that they are risk factors for both infection and stone formation. There is no consensus in the treatment of stones associated with ureterocele, although endoscopic treatment seems to be the one of choice Clinical Case: A 69-year-old patient was referred for a long-term illness characterized by repeated episodes of UTI, associated with 2 hematuria events. An imaging study was performed (UROTAC), and a large left ureterocele was documented with 3 cm stones in its interior

Análisis de las consultas neurológicas en el Servicio de Urgencia de un hospital terciario / Analysis of the neurologic consultations in the Emergency Deparment at a tertiary hospital

Introducción: Las urgencias neurológicas constituyen el 10-15% de las urgencias médicas. Los principales motivos de consulta son la enfermedad cerebrovascular, crisis epilépticas y cefalea. El Hospital Dr. Hernán Henríquez A. (HHHA) comenzó con neurólogos en el Servicio de Urgencia Adultos (SUA) en horario hábil, en abril de 2011. En julio de 2013 se iniciaron turnos con neurólogo 24/7, presenciales en el SUA. Objetivo: Describir el perfil clínico de las consultas neurológicas en el SUA de nuestro centro. Método: Muestra noprobabilística, por conveniencia, de las consultas realizadas en el Turno N°1, del SUA-HHHA, entre octubre de 2013 y septiembre de 2014. El análisis estadístico se realizó con el software STATA 12.0. Resultados: Se registraron 1.080 consultas en el período. 51,2% fueron mujeres. Promedio de edad = 58 años (DE = 20,2). El 36,7% de las consultas se realizó en horario inhábil. Los diagnósticos más frecuentes fueron infarto cerebral (30,7%), epilepsia (15%) y cefalea (11,3%). El 34,6% de los pacientes fue dado de alta; 25,8% se hospitalizó en el Servicio de Medicina Interna; 21% fue derivado a otros hospitales; 12% fue derivado a otros especialistas y 5,7% ingresó a la Unidad de Paciente Crítico. 0,83% de los pacientes falleció en el SUA. Conclusiones: Los principales motivos de consulta neurológica en nuestro Servicio de Urgencia fueron enfermedades cerebrovasculares, epilepsia y cefalea. Debido a que más de un tercio de las consultas ocurre en horario inhábil, se justifica el sistema de neurología 24/7 presencial en el Servicio de Urgencia.

Introduction: Neurological emergencies constitute 10-15% of medical emergencies. The main reasons for consultation are cerebrovascular disease, seizures and headaches. Dr. Hernan Henriquez Hospital (HHHA) began with neurologists in the Adult Emergency Service in April 2011. In July 2013 24/7 neurology shifts at emergency room were added. Objective: To describe the clinical profile of neurologic consultations at our emergency center. Method: A convenience sample of consultations on shift No. 1, at the Adult Emergency Service HHHA between October 2013 and September 2014. The statistical analysis was performed using STATA 12.0 software. Results: 1,080 consultations were recorded in theperiod. 51.2% were women. Mean age = 58 years (SD = 20.2). 36.7% of consultations are conducted in a non-business hour. The most frequent diagnoses were stroke (30.7%), epilepsy (15%) and headache (11.3%). 34.6% ofpatients were discharged; 25.8% were hospitalized in the Internal Medicine dept; 21% were referred to other hospitals; 12% were referred to other specialists and 5.7% were admitted to Critical Patient Unit. 0.83% of the patients died in the SUA. Conclusions: The main reasons for neurological consultation at our Emergency Service were cerebrovascular disease, epilepsy and headaches. Because more than a third of consultations occur on non-schedule hours, neurology system 24/7 shifts are justified in the Emergency Service.