Complicaciones quirúrgicas intraoperatorias en laparoscopía ginecológica en el Hospital Padre Hurtado / Intraoperative surgical complications in gynecological laparoscopy at Padre Hurtado Hospital

INTRODUCCIÓN: Actualmente la cirugía laparoscópica es el gold standard de la mayoría de las cirugías ginecológicas benignas. Se estima una tasa de complicaciones en cirugía ginecológica por laparoscopía de 3.2 por 1000 pacientes, donde alrededor del 50% ocurren al momento de la primera entrada. Existen numerosas clasificaciones de las complicaciones quirúrgicas, entre ellas, la clasificación Clavien-Dindo se centra en el tratamiento postquirúrgico y tiene como objetivo unificar criterios y hacerlas comparables entre distintos centros. OBJETIVO: Describir las complicaciones en cirugía laparoscópica ginecológica en el Hospital Padre Hurtado, destacando el subgrupo de primera entrada y su clasificación Clavien-Dindo. METODOLOGÍA: Cohorte retrospectiva que incluyó a todas las pacientes operadas por laparoscopía en el pabellón de ginecología del Hospital Padre Hurtado desde el año 2014 al 2017. Se utilizó el software SPSS statistics v25, con prueba X2 para el análisis de las variables no paramétricas y t de Student para las variables paramétrica, considerando una significación estadística con p<0,05. RESULTADOS: De las 513 cirugías laparoscópicas ginecológicas realizadas en el período evaluado, sólo el 4,3% del total de las pacientes tuvieron complicaciones. De éstas, un 9% fueron de primera entrada, y en todos los casos fueron complicaciones menores o Clavien-Dindo I y II. Hubo 2 complicaciones Clavien-Dindo >III B, lo que correspondió a un 0,39%. CONCLUSIÓN: En nuestro grupo hubo una baja incidencia de complicaciones quirúrgicas y de primera entrada lo que es comparable con otras series publicadas.

INTRODUCTION: Laparoscopic surgery is currently the gold standard of most benign gynecological surgeries. A complication rate in gynecological laparoscopy is 3.2 per 1000 patients, where around 50% occur at the time of the first entry. There are numerous classifications of surgical complications, among them, Clavien-Dindo classification focuses on post-surgical treatment and aims to unify criteria and lets compare between different centers. OBJECTIVE: To describe the complications in gynecological laparoscopic surgery at the Padre Hurtado Hospital, highlighting the first entry subgroup and Clavien-Dindo classification. METHODOLOGY: Retrospective cohort that included all gynecological laparoscopy patients in Padre Hurtado Hospital from 2014 to 2017. The SPSS statistics v25 software was used, with X2 test for the analysis of non-parametric variables and t Student for the parametric variables, considering a statistical significance with p <0.05. RESULTS: 513 gynecological laparoscopic surgeries was performed in the evaluated period, only 4.3% of the total patients had complications. Of these, 9% were first entry, and in all cases were minor complications or Clavien-Dindo I and II. There were 2 patients with Clavien-Dindo complications > III B, which corresponded to 0.39%. CONCLUSION: In our group there was a low incidence of surgical complications and first entry which is comparable with other published series.

¿Es suficiente la base moral de los médicos? / Moral judgment of physicians is insufficient as a framework for medical ethics

Physicians values are largely supported by a socio-cultural moral basis, also known as "classical utilitarianism". Technological advances and social questions to physicians show their paucity of an ethical conceptualization in medicine. A new way of approaching ethical conflicts in medicine should be constructed. Training should promote ethical reflection about these conflicts and about the actions of physicians. Ontogenetic and phylogenetic research on human nature, and the advances in moral psychology, could allow us to understand the construction of our judgment of values. An introspective emotional and rational effort to understand "how we are" and from there, to "how we act" lacks among physicians. This issue is even more complex in a political-social model which does not stimulate this type of analysis. The university space is a privileged opportunity to educate. The student must be envisioned as a human being whose professional acts should consider the needs of our society, aiming at a new ethical conceptualization in medicine.

Exploring the prevalence of substance-induced neurocognitive disorder among polysubstance users, adding subjective and objective evidence of cognitive impairment.

The objective of this study was to explore the prevalence of substance-induced neurocognitive disorder (NCD) in a sample of polysubstance users, adding both objective- and subjective cognitive impairment. METHOD: We collected cross-sectional data from 33 community-based residential facilities in Mexico City. Montreal Cognitive Assessment was used for measurement of objective cognitive impairment, and a DSM-5-based interview for subjective impairment. Years and days of recent use of alcohol, marijuana, cocaine and inhalants were collected for regression analyses. RESULTS: 753 participants were analyzed; from these, 50.5% show objective impairment, 71% and 58.5% self-reported any cognitive deficit and cognitive decline, respectively. Between 21.8%-36.5% would qualify for NCD when integrating both objective- and subjective impairment (deficit or decline). Significant weak associations were found between objective impairment and subjective deficits in all cognitive domains except social cognition. Regression models adding both objective- and subjective measures explained more variation in the years of alcohol, inhalant and cocaine use, and in recent marijuana use, than the objective measure alone, but associations were inconsistent. CONCLUSION: Though significant in proportion, the prevalence of NCD in this population can only be partially related to substance use. Further integrative approaches are needed to refine the epidemiology of this disorder.

[Moral judgment of physicians is insufficient as a framework for medical ethics]. / ¿Es suficiente la base moral de los médicos?

Physicians values are largely supported by a socio-cultural moral basis, also known as "classical utilitarianism". Technological advances and social questions to physicians show their paucity of an ethical conceptualization in medicine. A new way of approaching ethical conflicts in medicine should be constructed. Training should promote ethical reflection about these conflicts and about the actions of physicians. Ontogenetic and phylogenetic research on human nature, and the advances in moral psychology, could allow us to understand the construction of our judgment of values. An introspective emotional and rational effort to understand "how we are" and from there, to "how we act" lacks among physicians. This issue is even more complex in a political-social model which does not stimulate this type of analysis. The university space is a privileged opportunity to educate. The student must be envisioned as a human being whose professional acts should consider the needs of our society, aiming at a new ethical conceptualization in medicine.

El debate del Bosniak 3 o 4 y la vigente nosología quística / The current nosology on renal cysts: Bosniak III or IV?

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Participation of the autonomic cardiac system in dogs with chronic myxomatous degeneration of the mitral valve / Participação do sistema autonômico cardíaco em cães com degeneração mixomatosa da válvula mitral

An exploratory multivariate analysis of factors of echocardiographic variables and those of the Holter test of 38 dogs with MVMD staged in three classes (class 1a, class 1b, class 2) of congestive heart failure proposed by the ISACHC. The purpose of this analysis was learning the processes that would explain the behavior of the variables described, using exploratory multivariate techniques of factors. Five independent factors were determined (PNS to SF) which altogether explain 82.17% of the shared variance of the data. It was identified that among the five factors, the first process (PNS) is the first factor in importance, recruiting the highest percentage of variance (37.96%) and represents the participation of the cardiac autonomic nervous system.(AU)

Foi realizada análise multivariada exploratória de fatores das variáveis ecocardiográficas e do exame Holter de 38 cães com DMVM estadiados em três classes (classe 1a, classe 1b, classe 2) da insuficiência cardíaca congestiva proposta pela ISACHC. O objetivo desta análise foi conhecer os processos que explicariam o comportamento das variáveis descritas, utilizando-se para esse fim técnicas multivariadas exploratórias de fatores. Foram determinados cinco fatores independentes (PNS até SF) que, em conjunto, explicam 82,17% da variância compartilhada dos dados. O primeiro processo (PNS) é o primeiro fator em importância, recrutando a maior porcentagem da variância total (37,96%) e representa a participação do sistema nervoso autônomo cardíaco.(AU)

Polycystosis of the renal sinus or polycystic kidney disease Controversies, challenges and history of a shared discovery. / Poliquistosis del seno renal o hilioquistosis. Controversias, retos e historia de un descubrimiento compartido.

OBJECTIVE: To recall the history of the discovery of non-nephron cystic disease, detected simultaneously in 2 hospitals in Madrid, and the vicissitudes that the authors endured during the process of recognising this disease, while being ignored by the international scientific literature. MATERIAL AND METHOD: We analysed the authors' first publications and presentations, their correspondence relaying the difficulties in reporting the confusion with adult polycystic kidney disease (APKD) and the subsequent nosological identification of the process. We consulted with individuals who worked with the 2 authors to increase the accuracy and objectivity of the history report. RESULTS: We confirmed the authors' remarkable efforts in getting the process definitively recognised despite the notable difficulties. CONCLUSIONS: Rigorous clinical observation recognises processes ignored by the medical literature, and the correct application of the scientific method helps identify and reveal new nosological entities, confirming with this story's example that, in medicine, there are no exhausted issues.

Poliquistosis del seno renal o hilioquistosis. Controversias, retos e historia de un descubrimiento compartido / Polycystosis of the renal sinus or polycystic kidney disease Controversies, challenges and history of a shared discovery

Objetivo: Recordar la historia del descubrimiento de la enfermedad quística no nefronal, detectada simultáneamente en 2 hospitales madrileños y las vicisitudes que sufrieron los autores para que el proceso, ignorado en la literatura mundial, fuese reconocido. Material y método: Se han analizado las primeras publicaciones y presentaciones de los autores, la correspondencia entre ellos con el relato de las dificultades habidas para denunciar la confusión con la enfermedad renal poliquística del adulto y la posterior identificación nosológica del proceso. Se han consultado colaboradores de ambos autores para mayor precisión y objetividad del relato histórico. Resultados: Se confirma el notable esfuerzo de los autores hasta conseguir el definitivo reconocimiento del proceso a pesar de señaladas dificultades. Conclusiones: La observación clínica rigurosa reconoce procesos ignorados por la literatura médica y la correcta aplicación del método científico permite identificar o desvelar nuevas entidades nosológicas, confirmando con la ejemplaridad de este relato que en Medicina no hay temas agotados

Objective: To recall the history of the discovery of non-nephron cystic disease, detected simultaneously in 2 hospitals in Madrid, and the vicissitudes that the authors endured during the process of recognising this disease, while being ignored by the international scientific literature. Material and method: We analysed the authors’ first publications and presentations, their correspondence relaying the difficulties in reporting the confusion with adult polycystic kidney disease (APKD) and the subsequent nosological identification of the process. We consulted with individuals who worked with the 2 authors to increase the accuracy and objectivity of the history report. Results. We confirmed the authors' remarkable efforts in getting the process definitively recognised despite the notable difficulties. Conclusions: Rigorous clinical observation recognises processes ignored by the medical literature, and the correct application of the scientific method helps identify and reveal new nosological entities, confirming with this story's example that, in medicine, there are no exhausted issues

Cigarette smoke increases pro-inflammatory markers and inhibits osteogenic differentiation in experimental exposure model.

Tobacco smokers have slowed bone growth and regeneration and more frequent implant failures than non-smokers, but the effect of cigarette smoking on the host response to bone-dwelling biomaterials is poorly understood. Macrophages and mesenchymal stem cells (MSCs) are essential in the healing response after implant placement. This study examined the effects of an experimental model of cigarette smoke exposure using cigarette smoke extract (CSE) on bone architecture in vivo and differentiation and inflammatory cytokine production on clinically relevant microstructured surfaces in vitro. CSE was prepared by bubbling mainstream smoke from one research cigarette (3R4F) in 1 mL phosphate-buffered saline. For in vivo studies, bone morphometry was examined in femurs isolated from mice injected with diluted CSE for 25 days. For in vitro studies, osteogenic markers and interleukins were measured in human MSCs and murine macrophages cultured on rough or rough-hydrophilic titanium (Ti) surfaces in culture media ±â€¯CSE for seven days. In vivo, CSE exposure decreased in bone area, volume, and interconnectivity in a dose-dependent manner. In vitro, macrophages exposed to CSE increased production of pro-inflammatory cytokines, abolishing the increase in anti-inflammatory cytokines typically seen on rough-hydrophilic surfaces. MSCs exposed to CSE had lower mRNA expression of osteoblast differentiation markers, increased levels of pro-inflammatory mRNA, and reduced production of osteogenic proteins. Our results demonstrate that CSE decreases osteogenic differentiation and anti-inflammatory interleukin production while increasing pro-inflammatory interleukin production in macrophages and MSCs, suggesting that compounds in CSE strongly affect stem cell differentiation and may compromise bone formation following biomaterial placement. STATEMENT OF SIGNIFICANCE: The study of implantable materials' interaction with biological systems occurs nearly exclusively in healthy cell and animal models. However, 15% of the US population smokes cigarettes, which is known to modulate immune response and tissue regeneration. To explore this interaction, we created a method of capturing smoke compounds as CSE for in vivo and in vitro use. We found chronic injection into mice produced an osteoporotic, pro-inflammatory phenotype similar to direct smoke models. Furthermore, CSE attenuated osteogenic differentiation and promoted a pro-inflammatory profile in MSCs and macrophages, respectively, when cultured on titanium surfaces. These results demonstrate that this CSE model may be useful for predicting how chronic tobacco exposure may adversely affect the outcome of biomedical implants in pre-clinical models.

[Thyroid hormone Levels in very preterm neonates and extremely preterm]. / Niveles de hormonas tiroideas en recién nacidos muy prematuros y prematuros extremos.

INTRODUCTION: The thyroid function of the pretern infant is altered by the relative immaturity of the hypothalamus-pituitary thyroid gland axis, along with other factors such as the incidence of diseases or the use of some drugs. Currently, there is controversy over normal levels of free thyroxine (FT4) in preterm infants. Our objective was to determine the distribution of FT4 and TSH values in newborn younger than 32 weeks or 1500 g of birth weight at 15 days of chronological age, in the neonatology service at Dr. Hernán Henríquez Aravena Hospital, Temuco. PATIENTS AND METHOD: Cross-sectional study; the results of FT4 and TSH from a database of 308 newborns, were analyzed, which were categorized into three gestational age ranges, 31-34, 28-30 and 23-27 weeks. It was used Pearson Chi-square for comparisons between categorical variables, and T-Test or ANOVA for categorical-variable ratios. RESULTS: Significant differences were observed between the average values of FT4 by gestatio nal age ranges (p = 0.000), these were 1.13 ng/dl for the range of 31 to 34 weeks, 1.03 ng/dl for the range of 28 to 30 weeks and 0.92 ng/dl for the range of 23 to 27 weeks; we did not observe significant differences in TSH levels by gestational age categories (p = 0.663). CONCLUSIONS: We established the distribution of FT4 and TSH levels in our population of very preterm and extremely preterm infants, finding differences with previous papers.

Niveles de hormonas tiroideas en recién nacidos muy prematuros y prematuros extremos / Thyroid hormone Levels in very preterm neonates and extremely preterm

INTRODUCCIÓN: La función tiroidea del prematuro se ve alterada por la relativa inmadurez del eje hipotálamo-hipófisis-tiroides, junto a otros factores como la incidencia de enfermedades o el uso de algunos fármacos. Actualmente existe controversia sobre los niveles normales de tiroxina libre (T4L) en recién nacidos prematuros. Nuestro objetivo fue determinar la distribución de los valores de hormonas T4L y TSH, en recién nacidos menores de 32 semanas o 1.500g de peso al nacer, a los 15 días de edad cronológica, en el servicio de neonatología Hospital Dr. Hernán Henríquez Aravena, Temuco. Pacientes y MÉTODO: Estudio de corte trasversal, se analizaron los resultados de T4L y TSH desde una base de datos a 308 recién nacidos, los que fueron categorizados en tres rangos de edad gestacional: 31 a 34, 28 a 30 y 23 a 27 semanas. Se utilizó Chi-cuadrado de Pearson para asociaciones entre variables categóricas, y T-Test o ANOVA para comparaciones entre variables continuas. RESULTADOS: Observamos diferencias significativas entre los valores promedio de T4L por rangos de edad gestacional (p = 0,000), estos fueron 1,13 ng/dl para el rango de 31 a 34 semanas, 1,03 ng/dl para el rango de 28 a 30 semanas y 0,92 ng/dl para el rango de 23 a 27 semanas; no observamos diferencias significativas en los niveles de TSH por categorías de edad gestacional (p = 0,663). CONCLUSIONES: Establecimos la distribución de los niveles de T4L y TSH en nuestra población de recién nacidos muy prematuros y prematuros extremos, encontrando diferencias con reportes anteriores.

INTRODUCTION: The thyroid function of the pretern infant is altered by the relative immaturity of the hypothalamus-pituitary thyroid gland axis, along with other factors such as the incidence of diseases or the use of some drugs. Currently, there is controversy over normal levels of free thyroxine (FT4) in preterm infants. Our objective was to determine the distribution of FT4 and TSH values in newborn younger than 32 weeks or 1500 g of birth weight at 15 days of chronological age, in the neonatology service at Dr. Hernán Henríquez Aravena Hospital, Temuco. PATIENTS AND METHOD: Cross-sectional study; the results of FT4 and TSH from a database of 308 newborns, were analyzed, which were categorized into three gestational age ranges, 31-34, 28-30 and 23-27 weeks. It was used Pearson Chi-square for comparisons between categorical variables, and T-Test or ANOVA for categorical-variable ratios. RESULTS: Significant differences were observed between the average values of FT4 by gestatio nal age ranges (p = 0.000), these were 1.13 ng/dl for the range of 31 to 34 weeks, 1.03 ng/dl for the range of 28 to 30 weeks and 0.92 ng/dl for the range of 23 to 27 weeks; we did not observe significant differences in TSH levels by gestational age categories (p = 0.663). CONCLUSIONS: We established the distribution of FT4 and TSH levels in our population of very preterm and extremely preterm infants, finding differences with previous papers.

Linfoma mediastinal em equino - relato de caso / Equine mediastinal lymphoma - case report

Uma égua SRD, com 20 anos de idade, foi encaminhada ao hospital veterinário com histórico de emagrecimento, perda de apetite e aumento de volume na região peitoral e no pescoço. Aos exames físico e laboratorial, constatou-se que o animal apresentava taquicardia, taquipneia, hiperproteinemia, hiperfibrinogenemia e hipoalbuminemia. À auscultação cardíaca, os sons das válvulas pulmonar e aórtica não foram audíveis. Realizaram-se as avaliações eletrocardiográfica e ecodopplercardiográfica transtorácica bilateral, nas quais se observaram presença de efusão pleural e deslocamento caudal do coração. Na varredura ultrassonográfica ao redor do coração, constatou-se a presença de uma massa na base do coração. Para tentar amenizar o quadro respiratório, foi realizada drenagem torácica. A efusão pleural apresentava característica serossanguinolenta, com padrão citológico inflamatório. Algumas horas após retornar a baia, o animal veio a óbito. Realizou-se a necropsia, na qual pôde ser observada a presença da massa posicionada ao redor do tronco braquiocefálico. Na análise histopatológica, diagnosticou-se o linfoma difuso de células pequenas e médias.(AU)

A 20-year-old mixed breed mare was referred to the veterinary hospital with history of weight loss, loss of appetite, and swelling of the chest and neck. On physical exam the patient was in tachycardia and tachypnea and laboratory results indicated hyperproteinemia, hyperfibrinogenemia and hypoalbuminemia. On cardiac auscultation, the pulmonary and aortic valves sounds were not audible. Presence of pleural effusion and heart caudal displacement were identified on electrocardiographic and Doppler echocardiography evaluation and a mass at the base of the heart was oberved through ultrasound scanning around the heart. To alleviate the respiratory condition, thoracic drainage was performed. The pleural effusion presented characteristic serosanguineous with cytologic inflammatory. After returning to stall, the animal died. In necropsy, the presence of a mass positioned around the brachiocephalic trunk was identified and histopathology results were compatible with diffuse small and medium cell lymphoma.(AU)

¿Es efectivo el ustekinumab para la artritis psoriásica que no responde a tratamiento inicial? / Is ustekinumab effective for psoriatic arthritis with insufficient response to initial treatment?

INTRODUCCIÓN: La artritis psoriásica es una artritis inflamatoria sin una clara etiología, con el tratamiento biológico como un pilar fundamental en pacientes más complejos. Existen varias alternativas para tratamiento biológico, debido a su alto costo, es importante evaluar la real efectividad de estos para un buen tratamiento. MÉTODOS: Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud a nivel mundial, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, reanalizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos 12 revisiones sistemáticas que en conjunto incluyen tres ensayos aleatorizados. Concluimos que el ustekinumab logra una mejoría clínica en pacientes con psoriasis, y probablemente no se asocia a efectos adversos graves.

INTRODUCTION: Psoriatic arthritis is an inflammatory arthritis without a clear etiology. Biological therapy is key for its treatment, especially in more complex patients. There are several alternatives for biological treatment, but due to its high cost, it is important to evaluate their real effectiveness. METHODS: To answer this question we used Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified 12 systematic reviews including three randomized trials overall. We concluded ustekinumab leads to clinical improvement in psoriatic arthritis, and probably is not associated to severe adverse effects.

Secukinumab para psoriasis en placa / Secukinumab for plaque psoriasis

INTRODUCCIÓN: Los tratamientos biológicos han aparecido como principal alternativa para el manejo de los pacientes con psoriasis en placa que no responden a tratamiento convencional, resultando necesario evaluar su real efectividad y seguridad. MÉTODOS: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos 21 revisiones sistemáticas que en conjunto incluyeron diez estudios primarios, todos correspondientes a ensayos aleatorizados. Concluimos que secukinumab logra mejoría clínica en pacientes con psoriasis en placa, aunque probablemente se asocia a efectos adversos graves.

INTRODUCTION: Biological treatments have appeared as the main alternative for the management of patients with plaque psoriasis that do not respond to conventional treatment. So, evaluating its actual efficacy and safety is needed. METHODS: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified 21 systematic reviews including ten studies overall, of which all were randomized trials. We concluded secukinumab achieves clinical improvement in patients with plaque psoriasis, although it is probably associated with serious adverse effects.

Evaluación del resultado de las acciones de detección, diagnóstico y tratamiento del Episodio Depresivo realizada en pacientes consultantes en el primer nivel de atención de la Provincia de Concepción, Chile / Evaluation of the results of the actions of detection, diagnosis and treatment of the Depressive Episode carried out in patients attended in primary care from the Province of Concepción, Chile

Resumen El Ministerio de Salud de Chile implementó, a partir del año 2001, el programa de tratamiento de la depresión en la Atención Primaria en Salud (APS). Objetivo general: Evaluar el resultado de las acciones de detección, diagnóstico y tratamiento del episodio depresivo realizadas en consultantes del primer nivel de atención de la Provincia de Concepción, Chile. Método: Seguimiento de seis meses de muestra aleatoria de usuarios consultantes por morbilidad general en centros APS Provincia de Concepción, Chile. Se ingresaron al estudio 307 usuarios, con diagnóstico positivo de depresión (DSM-IV), usando la entrevista psiquiátrica estructurada Composite International Diagnostic Interview 2.1 (CIDI). Se realizaron análisis de regresión logística binaria y ordinal para predecir la detección del trastorno, el tipo de tratamiento aplicado y el curso de la enfermedad a partir de las variables sociodemográficas, clínicas y de estructura. Resultados: La prevalencia de seis meses de depresión fue de 16.7% (n = 431), previo criterios de exclusión. Los médicos detectaron el 31,6% de los casos, existiendo marcadas diferencias por centro. En su mayoría las intervenciones fueron de tipos psicosociales (18,6%), seguidas por las farmacológicas(9,4%) y un 3,6% con ambos tipos. Al cabo de seis meses, el diagnóstico había remitido en un 60.7% de los usuarios. Sin embargo, esta evolución no estaba asociada a las intervenciones recibidas, ni al diagnóstico previo, sino a variables personales de los usuarios. Conclusiones: La capacidad de detección de los profesionales en APS es baja, las intervenciones son escasas y no parecen incidir sobre la evolución del diagnóstico.

The Chilean Ministry of Health implemented since 2001 the program for treating depression in primary health care (PCH). General objective: To evaluate the result of detection, diagnostic and treatment of depressive episodes performed by consultants of the first level of care in the Province of Concepción, Chile. Method: Follow-up of six months of a random sample of users consulting for general morbidity in PHC of the Province of Concepción, Chile. A total of 307 users with positive diagnosis of depression (DSM-IV) using the psychiatric structured Composite International Diagnostic Interview 2.1 (CIDI) were admitted to the study. Regression analyses, binary and ordinal logistic were performed to predict the detection of the disorder, the type of treatment applied and the course of the disease, from sociodemographic, clinical and structure variables. Results: The prevalence of six months of depression reached 16.5% (n=431), prior to exclusion criteria. Doctors detected the 31.6% of the cases, with significant differences per center. Most of the interventions were of the psychosocial type (18.6%), followed by pharmacological interventions (9.4%) and 3.6% of both types. After six months, the diagnosis had remitted in 60-7% of the users. However, this evolution was not linked to the interventions received or previous diagnosis, but to personal variables of the users. Conclusions: The detection capacity of the professionals in PHC is low, interventions are scarce and probably, the evolution of the diagnosis is not affected by the intervention.

Corynebacterium urealyticum: trascendencia histórica de su descubrimiento / Corynebacterium urealyticum: the historical importance of its discovery

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Hemodinámica en vena cava y hemorragia durante trombectomía en la cirugía del tumor renal / Vena cava haemodynamics and haemorrhage during thrombectomy in renal tumour surgery

No disponible