Asistencia biventricular en el manejo de la disfunción ventricular izquierda secundaria a ECMO-VA periférica: a propósito de 2 casos / Peripheral VA-ECMO left ventricular dysfunction: A combined biventricular assistance two case-report

Presentamos a 2pacientes con shock cardiogénico que desarrollaron disfunción ventricular izquierda severa debido a una válvula aórtica disfuncionante mientras estaban en extra-corporeal membrane oxygenation (ECMO)-VA periférica. Los pacientes fueron tratados combinando un dispositivo de asistencia mecánica para el ventrículo izquierdo (VI) y ECMO-VA central para apoyar el ventrículo derecho, proporcionando así una asistencia respiratoria y circulatoria adecuada que les permitió optar a una recuperación completa, o bien llegar a ser candidatos a trasplante cardiaco. Por lo tanto, recomendamos dicha combinación en aquellos pacientes que desarrollan disfunción grave del VI mientras reciben apoyo de ECMO-VA periférica.(AU)

We report 2patients with cardiogenic shock that developed severe left ventricular dysfunction due to a non-opening aortic valve while on peripheral VA-ECMO (Veno-Arterial Extracorporeal Membrane Oxygenator). Patients were managed combining a LV (Left Ventricle) mechanical assist device, and central VA – ECMO to support the right ventricle, thus providing full circulatory and respiratory assistance. Patients were able to bridge to cardiac transplantation. We therefore recommend such combination in patients with severe LV dysfunction while on p-ECMO (peripheral ECMO) support.(AU)

Peripheral VA-ECMO left ventricular dysfunction: A combined biventricular assistance two case-report.

We report 2 patients with cardiogenic shock that developed severe left ventricular dysfunction due to a non-opening aortic valve while on peripheral VA-ECMO (Veno-Arterial Extracorporeal Membrane Oxygenator). Patients were managed combining a LV (Left Ventricle) mechanical assist device, and central VA - ECMO to support the right ventricle, thus providing full circulatory and respiratory assistance. Patients were able to bridge to cardiac transplantation. We therefore recommend such combination in patients with severe LV dysfunction while on p-ECMO (peripheral ECMO) support.

Peripheral VA-ECMO left ventricular dysfunction: A combined biventricular assistance two case-report. / Asistencia biventricular en el manejo de la disfunción ventricular izquierda secundaria a ECMO-VA periférica: a propósito de 2 casos.

We report 2patients with cardiogenic shock that developed severe left ventricular dysfunction due to a non-opening aortic valve while on peripheral VA-ECMO (Veno-Arterial Extracorporeal Membrane Oxygenator). Patients were managed combining a LV (Left Ventricle) mechanical assist device, and central VA - ECMO to support the right ventricle, thus providing full circulatory and respiratory assistance. Patients were able to bridge to cardiac transplantation. We therefore recommend such combination in patients with severe LV dysfunction while on p-ECMO (peripheral ECMO) support.

Effect of Shortened Light-Curing Modes on Bulk-Fill Resin Composites.

CLINICAL RELEVANCE: Shortened light curing does not affect volumetric polymerization shrinkage or cohesive tensile strength but negatively affects the shear bond strength of some bulk-fill resin composites. When performing shortened light curing, clinicians should be aware of the light output of their light-curing units. SUMMARY: Purpose: To evaluate volumetric polymerization shrinkage (VPS), shear bond strength (SBS) to dentin, and cohesive tensile strength (CTS) of bulk-fill resin composites (BFRCs) light activated by different modes.Methods and Materials: Six groups were evaluated: Tetric EvoCeram bulk fill + high mode (10 seconds; TEC H10), Tetric EvoFlow bulk fill + high mode (TEF H10), experimental bulk fill + high mode (TEE H10), Tetric EvoCeram bulk fill + turbo mode (five seconds; TEC T5), Tetric EvoFlow bulk fill + turbo mode (TEF T5), and experimental bulk fill + turbo mode (TEE T5). Bluephase Style 20i and Adhese Universal Vivapen were used for all groups. All BFRC samples were built up on human molar bur-prepared occlusal cavities. VPS% and location were evaluated through micro-computed tomography. SBS and CTS tests were performed 24 hours after storage or after 5000 thermal cycles; fracture mode was analyzed for SBS.Results: Both TEC H10 and TEE H10 presented lower VPS% than TEF H10. However, no significant differences were observed with the turbo-curing mode. No differences were observed for the same BFRC within curing modes. Occlusal shrinkage was mostly observed. Regarding SBS, thermal cycling (TC) affected all groups. Without TC, all groups showed higher SBS values for high mode than turbo mode, while with TC, only TEC showed decreased SBS from high mode to turbo modes; modes of fracture were predominantly adhesive. For CTS, TC affected all groups except TEE H10. In general, no differences were observed between groups when comparing the curing modes.Conclusions: Increased light output with a shortened curing time did not jeopardize the VPS and SBS properties of the BFRCs, although a decreased SBS was observed in some groups. TEE generally showed similar or improved values for the tested properties in a shortened light-curing time. The VPS was mostly affected by the materials tested, whereas the SBS was affected by the materials, curing modes, and TC. The CTS was not affected by the curing modes.

Transitando hacia el ejercicio de autonomía y liderazgo:… «para el posicionamiento hay que luchar¼ / Moving towards the practice of autonomy and leadership:… «Positioning requires striving¼ / Transitar para o exercício de autonomia e liderança:… «Para o posicionamento, tem que lutar¼

Resumen Introducción: En Chile, las enfermeras/os tienen respaldo legal para gestionar el cuidado, esto facilita el desarrollo de competencias para ejercer autonomía y liderazgo. Actualmente persisten barreras para transitar hacia un reconocimiento real de la independencia profesional. Objetivo: Develar la experiencia vivida de enfermeras con cargos en niveles de jefatura respecto al propio desarrollo para lograr el liderazgo y autonomía profesional. Metodología: Estudio cualitativo, descriptivo-interpretativo, desde la trayectoria fenomenológica de Edmund Husserl. Muestreo selectivo de caso homogéneo de tres enfermeras que desempeñaban rol de jefatura en instituciones de salud, región Valparaíso, Chile. Participación consentida. Entrevista no estructurada. Análisis del discurso utilizando el modelo de liderazgo integral de Ken Wilber. Resultados: Categorías: Conciencia del líder «ser inquieta...intelectualmente¼. Construyendo competencias «el liderazgo se aprende¼. Transitando hacia el ejercicio de la autonomía y el liderazgo, "para el posicionamiento hay que luchar". El peso de las estructuras organizacionales «tu rol es parte de un hospital¼. Interpretación: El ejercicio del liderazgo y la autonomía se fundamenta en competencias actitudinales por sobre las cognitivas y técnicas. Existe mayor apoyo y reconocimiento a nivel institucional, que al interior del equipo de salud. Persisten limitaciones para lograr máxima expresión del liderazgo y autonomía, por persistencia de modelos institucionales hegemónicos, centrados en decisiones médicas y desconocimiento del rol integrado. Conclusión: El líder se mueve en un escenario dual, entre un menor reconocimiento del equipo y un creciente empoderamiento del rol autónomo y visibilidad a nivel directivo institucional.

Abstract Introduction: In Chile, nurses have legal support to manage care, a situation which facilitates the development of competencies to perform with autonomy and leadership; however, barriers still persist while moving towards a real acknowledgement of professional independency. Objective: To unveil the lived experience of nurses in executive roles regarding their own development towards leadership and professional autonomy. Methodology: This is a descriptive and interpretative qualitative study framed by the Edmund Husserl phenomenological approach. The sample by homogeneous case included three nurses in executive roles in health institutions in Valparaiso, Chile. The participation was by consent. An unstructured interview was used. For the discourse analysis, the Ken Wilber integral leadership model was followed. Results: Categories: Leadership awareness <being inquiring… intellectually>… Building Competencies <leadership is learned>. Moving towards the practice of autonomy and leadership, "positioning requires striving". Weight of the organizational structures <your role is part of a hospital>. Interpretation: A practice of leadership and autonomy is based on attitude competencies over the cognitive and technical ones. Nevertheless, there still persist limitations to achieve a maximal expression of leadership and autonomy due to hegemonic institutional models which focus on medical decisions and neglect the integrated roles. Conclusion: The leader moves in a dual setting between a lower acknowledgement from the team, and a higher empowerment of the autonomous role and the visibility at the institutional directive level.

Resumo Introdução: No Chile, as enfermeiras/os têm apoio legal para gerenciar o cuidado, isto facilita o desenvolvimento de competências para exercer autonomia e liderança. Atualmente, persistem barreiras para transitar em direção a um reconhecimento real da independência profissional. Objetivo: Desvendar a experiência vivida de enfermeiras com cargos em níveis de chefia ao respeito do próprio desenvolvimento, para atingir a liderança e autonomia profissional. Metodologia: Estudo qualitativo, descritivo-interpretativo, desde a trajetória fenomenológica de Edmund Husserl. Amostragem seletiva de caso homogéneo de três enfermeiras que desempenhavam papel de chefia em instituições de saúde, região Valparaíso, Chile. Participação consentida. Entrevista não estruturada. Análise de discurso, utilizou-se o modelo de liderança integral de Ken Wilber. Resultados: Categorias: Consciência do líder «ser irrequieta...intelectualmente¼. Ir construindo competências «a liderança se aprende¼. Transitar em direção ao exercício da autonomia e a liderança, "para o posicionamento tem que lutar". O peso das estruturas organizacionais «seu rolo é parte de um hospital¼. Interpretação: O Exercício da liderança e a autonomia fundamenta-se em competências atitudinais, sobre as cognitivas e técnicas. Existe maior apoio e reconhecimento a nível institucional, que no interior da equipe de saúde. Persistem limitações para atingir a máxima expressão de liderança e autonomia, por persistência de modelos institucionais hegemónicos, centrados em decisões médicas e desconhecimento do rolo integrado. Conclusão: O líder movimenta-se em um cenário dual, entre um menor reconhecimento da equipe e um empoderamento crescente do rolo autónomo e visibilidade a nível diretivo institucional.

From 3D to 2D zeolite catalytic materials.

Research activities and recent developments in the area of three-dimensional zeolites and their two-dimensional analogues are reviewed. Zeolites are the most important industrial heterogeneous catalysts with numerous applications. However, they suffer from limited pore sizes not allowing penetration of sterically demanding molecules to their channel systems and to active sites. We briefly highlight here the synthesis, properties and catalytic potential of three-dimensional zeolites followed by a discussion of hierarchical zeolites combining micro- and mesoporosity. The final part is devoted to two-dimensional analogues developed recently. Novel bottom-up and top-down synthetic approaches for two-dimensional zeolites, their properties, and catalytic performances are thoroughly discussed in this review.

Caracterización clínica, serológica y patrón radiológico de una cohorte unicéntrica de pacientes con enfermedad pulmonar difusa / Clinical, serological and radiological pattern characterization of a monocentric cohort of patients with diffuse lung disease

Diffuse Lung Disease (DLD) is an important cause of morbidity and mortality, however in Chile we are lacking of epidemiological data on this condition. Our aim is communicate the first report of a prospective registry of DLD patients treated at bronchopulmonary unit of DIPRECA hospital. Methods: Cross-sectional study in patients referred to our bronchopulmonary unit under suspicion of DLD. Diagnosis was confirmed by chest computed tomography and informed consent was approved by patients. Data regarding clinical, serological, pulmonary function tests and echocardiography were collected from 2014 up to date. Results: 30 patients were analysed, their median of age was 76.5 years-old (Interquartile Range 68-80), 56.7% were women, median duration of disease: 4 years (IQR 1-10.6) and 43% has smoking history Most frequent signs and symptoms were crackles (97%), dyspnoea (90%) and cough (57%). Comorbidities: 3% had asthma, 3% chronic obstructive pulmonary disease and 6.7% connective tissue diseases. Radiological findings: 20% had DLD with usual interstitial pneumonia pattern (UIP), 23% DLD possible UIP, 30% DLD inconsistent with UIP, 14% chronic hypersensitivity pneumonitis and 13% nonspecific interstitial pneumonia. Serology: 18% had positive rheumatoid factor of which only one case had rheumatoid arthritis, 67% had positive antinuclear antibodies (ANA), 17% ANCA positive of which only one case of clinical vasculitis. Spirometry was mainly normal (52%) or restrictive (45%). Echocardiography showed pulmonary hypertension mainly mild in 52% of patients. No significant association was found between titles of ANA ≥ 1/320 and gender, smoking or radiological pattern. Conclusions: Our demographic and radiological findings are similar to those reported in literature; however, the highlights in our cohort are the increased frequency of female gender and positive ANA without history or clinical manifestation of connective tissue diseases.

La enfermedad pulmonar difusa (EPD) es causa importante de morbimortalidad; a pesar de esto no tenemos datos epidemiológicos en Chile. Nuestro objetivo es comunicar el primer reporte del registro prospectivo de pacientes con EPD atendidos en la unidad de broncopulmonar del hospital DIPRECA. Métodos: Estudio de corte transversal en pacientes derivados alpoliclínico broncopulmonar del hospital DIPRECA por sospecha de EPD. En caso de confirmación diagnóstica por tomografía computada de tórax y consentimiento informado aprobado por los pacientes, se compilaron datos clínicos, serológicos, pruebas de función pulmonar y ecocardiografía, desde 2014 hasta la fecha. Resultados: Se analizaron 30 pacientes la mediana de su edad fue 76,5 años (rango intercuartílico 68-80), 56,7% eran mujeres, duración mediana de la enfermedad: 4 años (RIC 1-10,6)y 43% con antecedentes de tabaquismo. Los síntomas y signos más frecuente fueron crujidos (97%), disnea (90%) y tos (57%). Comorbilidades: 3% tenía asma, 3% enfermedad pulmonar obstructiva crónica y 6,7% enfermedades del tejido conectivo. Hallazgos radiológicos: 20% tenía EPD con patrón de neumonía intersticial usual (UIP), 23% EPD posible UIP, 30% EPD inconsistente con UIP, 14% neumonitis por hipersensibilidad crónica y 13% neumonía intersticial no específica. Serología: 18% tenía factor reumatoide positivo de ellos sólo uno de los casos tenía artritis reumatoide, el 67% tenía anticuerpos antinucleares (ANA) positivos, 17% ANCA positivo de ellos sólo un caso tenía historia de vasculitis clínica. La espirometría fue mayoritariamente normal (52%) o restrictiva (45%). Ecocardiografía detectó hipertensión pulmonar mayoritariamente leve en 52% de los pacientes. No se encontró asociación significativa entre los títulos de ANA ≥ 1/320 en relación a género, tabaquismo o patrón radiológico. Conclusiones: Nuestros hallazgos demográficos y radiológicos son similares a los de la literatura; sin embargo, destaca en nuestra cohorte la mayor frecuencia de género femenino y ANA positivos sin historia o manifestación clínica de enfermedades del tejido conectivo.

Revisiting the BaO2/BaO redox cycle for solar thermochemical energy storage.

The barium peroxide-based redox cycle was proposed in the late 1970s as a thermochemical energy storage system. Since then, very little attention has been paid to such redox couples. In this paper, we have revisited the use of reduction-oxidation reactions of the BaO2/BaO system for thermochemical heat storage at high temperatures. Using thermogravimetric analysis, reduction and oxidation reactions were studied in order to find the main limitations associated with each process. Furthermore, the system was evaluated through several charge-discharge stages in order to analyse its possible degradation after repeated cycling. Through differential scanning calorimetry the heat stored and released were also determined. Oxidation reaction, which was found to be slower than reduction, was studied in more detail using isothermal tests. It was observed that the rate-controlling step of BaO oxidation follows zero-order kinetics, although at high temperatures a deviation from Arrhenius behaviour was observed probably due to hindrances to anionic oxygen diffusion caused by the formation of an external layer of BaO2. This redox couple was able to withstand several redox cycles without deactivation, showing reaction conversions close to 100% provided that impurities are previously eliminated through thermal pre-treatment, demonstrating the feasibility of this system for solar thermochemical heat storage.

Synthesis strategies in the search for hierarchical zeolites.

Great interest has arisen in the past years in the development of hierarchical zeolites, having at least two levels of porosities. Hierarchical zeolites show an enhanced accessibility, leading to improved catalytic activity in reactions suffering from steric and/or diffusional limitations. Moreover, the secondary porosity offers an ideal space for the deposition of additional active phases and for functionalization with organic moieties. However, the secondary surface represents a discontinuity of the crystalline framework, with a low connectivity and a high concentration of silanols. Consequently, hierarchical zeolites exhibit a less "zeolitic behaviour" than conventional ones in terms of acidity, hydrophobic/hydrophilic character, confinement effects, shape-selectivity and hydrothermal stability. Nevertheless, this secondary surface is far from being amorphous, which provides hierarchical zeolites with a set of novel features. A wide variety of innovative strategies have been developed for generating a secondary porosity in zeolites. In the present review, the different synthetic routes leading to hierarchical zeolites have been classified into five categories: removal of framework atoms, surfactant-assisted procedures, hard-templating, zeolitization of preformed solids and organosilane-based methods. Significant advances have been achieved recently in several of these alternatives. These include desilication, due to its versatility, dual templating with polyquaternary ammonium surfactants and framework reorganization by treatment with surfactant-containing basic solutions. In the last two cases, the materials so prepared show both mesoscopic ordering and zeolitic lattice planes. Likewise, interesting results have been obtained with the incorporation of different types of organosilanes into the zeolite crystallization gels, taking advantage of their high affinity for silicate and aluminosilicate species. Crystallization of organofunctionalized species favours the formation of organic-inorganic composites that, upon calcination, are transformed into hierarchical zeolites. However, in spite of this impressive progress in novel strategies for the preparation of hierarchical zeolites, significant challenges are still ahead. The overall one is the development of methods that are versatile in terms of zeolite structures and compositions, capable of tuning the secondary porosity properties, and being scaled up in a cost-effective way. Recent works have demonstrated that it is possible to scale-up easily the synthesis of hierarchical zeolites by desilication. Economic aspects may become a significant bottleneck for the commercial application of hierarchical zeolites since most of the synthesis strategies so far developed imply the use of more expensive procedures and reagents compared to conventional zeolites. Nevertheless, the use of hierarchical zeolites as efficient catalysts for the production of high value-added compounds could greatly compensate these increased manufacturing costs.

[Leptospirosis: a literature review]. / Leptospirosis: Puesta al día.

We review epidemiological, clinical, laboratory and therapeutic aspects of leptospirosis. In relation to the epidemiology it is worth noting the importance of recreational and occupational risk factors, as well as the lack of data available in Chile before the year 2000, when leptospirosis became the object of epidemiological surveillance. There are many forms of clinical presentations for this disease and often signs and symptoms may be nonspecific. Thus, differential diagnosis must include many clinical entities. Laboratory diagnosis, on the other hand, is complex and not widely available. Although still controversial, a literature review supports antimicrobial treatment, with different antibiotics to choose from.

Leptospirosis: puesta al día / Leptospirosis: a literature review

Se revisan los aspectos clínicos, diagnóstico de laboratorio y alternativas terapéuticas para la leptos-pirosis. Destaca en la epidemiología el riesgo ocupa-cional y laboral y la falta de datos, por no haber constituido en Chile tema de vigilancia epidemiológica hasta el año 2000. Los datos clínicos evidencian una notable heterogeneidad de manifestaciones, muchas veces inespecíficas. La complejidad del diagnóstico diferencial que plantea hace necesario incluirlo en el análisis causal de múltiples situaciones clínicas. El diagnóstico de laboratorio es aún complejo y poco accesible. Aunque es todavía controvertido, el análisis de la literatura apoya el beneficio del tratamiento antimicrobiano con varias alternativas de elección.

We review epidemiological, clinical, laboratory and therapeutic aspects of leptospirosis. In relation to the epidemiology it is worth noting the importance of recreational and occupational risk factors, as well as the lack of date available in Chile before the year 2000, when leptospirosis became the object of epidemiological surveillance. There are many forms of clinical presentations for this disease and often signs and symptoms may be nonspecific. Thus, differential diagnosis must include many clinical entities. Laboratory diagnosis, on the other hand, is complex and not widely available. Although still controversial, a literature review supports antimicrobial treatment, with different antibiotics to choose from.

[Severe thrombocytopenia and human immunodeficiency virus infection. Report of two cases and review]. / Trombocitopenia grave e infección por virus de inmunodeficiencia humana. Comunicación de dos casos y revisión de la literatura.

Thrombocytopenia is a relatively frequent complication in patients infected by human immunodeficiency virus (HIV). Most frequent mechanisms of thrombopenia are destruction of half-filled platelets by immunocomplex and defects in production. We present two cases of severe thrombocytopenia associated to HIV infection. Case 1: A male patient, 45 years old with fever and diarrhea that lasted for 1 month that presented with thrombopenia of 3,000 platelets/mm3. After beginning zidovudine and lamivudine therapy, he normalized the platelet count in 5 days. Case 2: A male patient of 30 years old, who suffered during one day migraine, nausea, vomits and then seizures. A criptococccal meningitis was confirmed. Concomitantly he had a platelet count of 59,000/mm3. He started antiretroviral therapy with zidovudina and lamivudina, then was changed to didanosine plus stavudine plus nevirapine. After 6 months of severe thrombocytopenia, platelets count was restored to normal values. A literature review is presented.

[Unusual presentation of bilateral bullous Pneumocystis jiroveci pneumonia complicated with pneumothorax]. / Presentación inhabitual de un caso de neumonía bulosa aguda bilateral por Pneumocystis jiroveci complicada con neumotórax.

In patients with human immunodeficiency virus infection, pneumothorax overcomes in advanced stages of the illness, associated with infections by Mycobacterium tuberculosis or Pneumocystis jiroveci, in smokers and intravenous drug users. We present a case with this unusual complication: homosexual man, 30 years of age, with a history of one month of cough, progressive dyspnea, weight loss and diarrhea. He was hospitalized with the diagnosis of atypical pneumonia, respiratory failure and a presumptive HIV infection. His clinical course was complicated by the presence of bullae and pneumothorax by day 15 of hospitalization. The existence of Pneumocystis jiroveci in sputum was confirmed by a direct immunofluorescence test. The patient was treated with sulpha-trimethoprim, steroids, oxygen, but he died 21 days after admittance. The strategies recommended for treatment of pneumothorax appeared during P. jiroveci pneumonia in HIV positive patients are summarized.

Trombocitopenia grave e infección por virus de inmunodeficiencia humana: Comunicación de dos casos y revisión de la literatura / Severe thrombocytopenia and human immunodeficiency virus infection: Report of two cases and review

La trombocitopenia es una complicación relativamente frecuente en los pacientes infectados por el virus de la inmunodeficiencia humana. Las mecanismos más frecuentes de génesis son la destrucción de trombocitos mediada por inmunocomplejos y los defectos en su producción. Presentamos dos casos de trombocitopenia grave asociados a infección por VIH. Caso 1. Varón de 45 años que consultó por cuadro febril y diarreico de un mes de evolución y trombocitopenia: 3.000 plaquetas/mm³. Normalizó su recuento plaquetario al 5° día de iniciar zidovudina + lamivudina. Caso 2. Varón de 30 años, consultó por cefalea, náuseas, vómitos y convulsiones. Se confirmó la presencia de meningitis por Cryptococcus sp. El recuento plaquetario era de 59.000/mm³. Recibió zidovudina + lamivudina, luego didanosina + stavudina + nevirapina; tras 6 meses de trombocitopenia grave, normalizó el recuento plaquetario. Se presenta revisión de la correspondiente literatura científica.

Thrombocytopenia is a relatively frequent complication in patients infected by human immunodeficiency virus (HIV). Most frequent mechanisms of thrombopenia are destruction of half-filled platelets by immunocomplex and defects in production. We present two cases of severe thrombocytopenia associated to HIV infection. Case 1: A male patient, 45 years old with fever and diarrhea that lasted for 1 month that presented with thrombopenia of 3.000 platelets/mm³. After beginning zidovudine and lamivudine therapy, he normalized the platelet count in 5 days. Case 2: A male patient of 30 years old, who suffered during one day migraine, nausea, vomits and then seizures. A criptococccal meningitis was confirmed. Concomitantly he had a platelet count of 59.000/mm³. He started antiretroviral therapy with zidovudina and lamivudina, then was changed to didanosine plus stavudine plus nevirapine. After 6 months of severe thrombocytopenia, platelets count was restored to normal values. A literature review is presented.

Presentación inhabitual de un caso de neumonía bulosa aguda bilateral por Pneumocystis jiroveci complicada con neumotórax / Unusual presentation of bilateral bullous Pneumocystis jiroveci pneumonia complicated with pneumothorax

En los pacientes con infección por el virus de la inmunodeficiencia humana (VIH), el neumotórax se observa generalmente en etapas avanzadas de la enfermedad, asociado a patógenos como Mycobacterium tuberculosis o Pneumocystis jiroveci, en individuos tabáquicos y drogadictos endovenosos. Presentamos un caso de presentación inhabitual: varón homosexual, 30 años de edad, con tos durante un mes, dificultad respiratoria progresiva y baja de peso, agregándose posteriormente diarrea. Fue hospitalizado con los diagnósticos de insuficiencia respiratoria, neumopatía atípica y observación de infección por VIH. Evolucionó mal, complicándose a los 15 días con neumotórax y bulas pulmonares. El LDH elevado y después la inmunofluorescencia directa (+) confirmaron la etiología: P. jiroveci. El test de ELISA confirmó la pre-existencia de una infección por VIH. A pesar de una terapia enérgica con cotrimoxazol, corticoesteroides y oxígeno, el paciente falleció a los 21 días de su ingreso. Se describen las estrategias recomendadas para el manejo del neumotórax que acontece durante la neumonía por P. jiroveci en los pacientes portadores de infección por VIH.

In patients with human immunodeficiency virus infection, pneumothorax overcomes in advanced stages of the illness, associated with infections by Mycobacterium tuberculosis or Pneumocystis jiroveci, in smokers and intravenous drug users. We present a case with this unusual complication: homosexual man, 30 years of age, with a history of one month of cough, progressive dyspnea, weight loss and diarrhea. He was hospitalized with the diagnosis of atypical pneumonia, respiratory failure and a presumptive HIV infection. His clinical course was complicated by the presence of bullae and pneumothorax by day 15 of hospitalization. The existence of Pneumocystis jiroveci in sputum was confirmed by a direct immunofluorescence test. The patient was treated with sulpha-trimethoprim, steroids, oxygen, but he died 21 days after admittance. The strategies recommended for treatment of pneumothorax appeared during P. jiroveci pneumonia in HIV positive patients are summarized.

Routes of entry of Piscirickettsia salmonis in rainbow trout Oncorhynchus mykiss.

Since 1989, Piscirickettsia salmonis, the causal agent of piscirickettsiosis, has killed millions of farmed salmonids each year in southern Chile. The portal of entry for the pathogen was investigated by use of selected experimental infections in juvenile rainbow trout (12 g). The methods used were intraperitoneal injection, subcutaneous injection, patch contact on skin, patch contact on gills, intestinal intubation and gastric intubation. Cumulative mortalities at Day 33 post-inoculation were 98, 100, 52, 24, 24, and 2%, respectively. It was shown that intact skin and gills could be penetrated by P. salmonis. The high mortality obtained in subcutaneously injected fish indicated that skin injuries could facilitate the invasion of this pathogen. Results suggested that the main entry sites are through the skin and gills and that the oral route may not be the normal method by which P. salmonis initiates infection of salmonids.

Marcación preoperatoria de lesiones mamarias no palpables: experiencia en Hospital Clínico FUSAT 1992 a 1997 / Preoperatory labeling of non palpable mammary lesions: experience in clinical hospital FUSAT 1992 to 1997

Se presenta la experiencia de la Unidad de Imagenología del Hospital Clínico FUSAT en la marcación pre-operatoria de lesiones mamarias no palpables, realizadas entre enero de 1992 y mayo de 1997. Se marcaron 125 lesiones en 119 pacientes; en 115 pacientes se realizó marcación mamográfica y en 4 bajo ecotomografía. Los hallazgos anátomo-patológicos fueron: lesiones malignas 12 (9,6 por ciento); lesiones benignas 113 (90,4 por ciento); lesiones benignas con atipia 24 (21,05 por ciento de las lesiones benignas). Se analizan los resultados obtenidos y se comparan con los publicados en la literatura norteamericana

Infección primaria por virus de inmunodeficiencia humana: descripción de cinco casos / Primary immunodeficiency human virus infection: description for five cases

La manifestación inicial de la infección VIH referida como el síndrome retroviral agudo, puede ser asintomática o presentarse como un cuadro clínico de fiebre, malestar general, odinofagía, múltiples adenopatías, exantema y síntomas neurológicos. Se estima que dos tercios de los individuos recientemente infectados desarrollarán este síndrome. Presentamos el cuadro clínico de cinco pacientes, cada uno con diferente presentación: Síndrome mononucleósico; Faringitis; Hepatitis aguda; Exantema similar al de causa herpética; Meningitis viral. Todos ellos seroconvirtieron en un período variable de tiempo después de su enfermedad

Infección de tejidos blandos por salmonella typhi y paratyphi / Soft tissue infection by salmonella typhi and paratyphi

Between 1979 and 1989 patients presented with soft tissue infections caused by salmonella typhi or paratyphi B, at the Infectious Diseases Hospital Dr. Lucio Cordova, Santiago, Chile. These complications appeared during or after the clinical course of an enteric fever, or without any antecedent illness. The patients were predominantly young and females. The lesions were mainly located in the lower extremities. 50 percent of the patients presented with a concommitant deep bone or joint infection. 11 patients were treated with cloramphenicol (average 22,8 days), 3 with TMP-SMX (average 23 days) and 4 whith a combination of drugs. 13 patients required surgical drainage. This unusual complication extended hospital stay convelescence, but all our patients had a complete recovery