Manejo avanzado del infarto cerebral en un hospital público chileno: trombectomía mecánica en el Hospital Barros Luco Trudeau / Mechanical thrombectomy in a Chilean public hospital. Experience in 149 patients

BACKGROUND: Mechanical thrombectomy is the accepted treatment for acute ischemic stroke in Large Vessel Occlusion. The Barros Luco Trudeau hospital developed endovenous thrombolysis in 2010, and since 2012, implemented endovascular management, becoming the neurovascular center in the southern area of the metropolitan region. AIM: To describe endovascular management of acute ischemic stroke in a Chilean public hospital. Material and Methods: Analysis of patients with acute ischemic stroke that were treated with mechanical throm-bectomy from 2012 to 2019 in the Barros Luco Hospital. RESULTS: In the study period, a mechanical thrombectomy was carried out in 149 patients aged 61 ± 15 years (46% females). The average National institute of Health Stroke Scale (NIHSS) at presentation was 19 ± 4-5. Anterior or posterior circulation involvement was present in 89.9 and 10.1 % of patients. Twenty-five percent of patients were referred from other public centers. The mean lapse between onset of symptoms and thrombectomy was 266 ± 178 in. Ninety days after the procedure, 58% of patients had minimal or absent disability (Modified Ranson score of 0-2), and 19,2% died. CONCLUSIONS: Mechanical thrombectomy, according to this experience, has favorable clinical outcomes in patients with high NIHSS scores at entry.

[Mechanical thrombectomy in a Chilean public hospital. Experience in 149 patients]. / Manejo avanzado del infarto cerebral en un hospital público chileno: trombectomía mecánica en el Hospital Barros Luco Trudeau.

BACKGROUND: Mechanical thrombectomy is the accepted treatment for acute ischemic stroke in Large Vessel Occlusion. The Barros Luco Trudeau hospital developed endovenous thrombolysis in 2010, and since 2012, implemented endovascular management, becoming the neurovascular center in the southern area of the metropolitan region. AIM: To describe endovascular management of acute ischemic stroke in a Chilean public hospital. MATERIAL AND METHODS: Analysis of patients with acute ischemic stroke that were treated with mechanical throm-bectomy from 2012 to 2019 in the Barros Luco Hospital. RESULTS: In the study period, a mechanical thrombectomy was carried out in 149 patients aged 61 ± 15 years (46% females). The average National institute of Health Stroke Scale (NIHSS) at presentation was 19 ± 4-5. Anterior or posterior circulation involvement was present in 89.9 and 10.1 % of patients. Twenty-five percent of patients were referred from other public centers. The mean lapse between onset of symptoms and thrombectomy was 266 ± 178 in. Ninety days after the procedure, 58% of patients had minimal or absent disability (Modified Ranson score of 0-2), and 19,2% died. CONCLUSIONS: Mechanical thrombectomy, according to this experience, has favorable clinical outcomes in patients with high NIHSS scores at entry.

El ojo seco está relacionado con un aumento intrasujeto de la variabilidad de osmolaridad lagrimal confirmado por tecnología de aprendizaje de máquinas / Dry eye is matched by increased intrasubject variability in tear osmolarity as confirmed by machine learning approach

Objetivo: La medición de la osmolaridad lagrimal en pacientes con ojo seco ha sido cuestionada debido a su alta variabilidad. El entendimiento del origen de dicha variabilidad ayudaría a la interpretación clínica de los valores obtenidos. Esta investigación evalúa la medición de la variabilidad lagrimal en la práctica clínica. Material y métodos: Veinte pacientes con ojo seco y 20 controles fueron evaluados. Fueron realizadas 3 mediciones consecutivas de osmolaridad a intervalos de 5min. La variabilidad fue definida como la diferencia entre las mediciones más extremas obtenidas en cada ojo. Se utilizaron técnicas de aprendizaje de máquinas para evaluar la capacidad discriminadora de la osmolaridad lagrimal. Resultados: La osmolaridad promedio en el grupo control y ojo seco fueron 295,1 ± 7,3 mOsm/L y 300,6 ± 11,2 mOsm/L, respectivamente (p = 0,004). La variabilidad de la osmolaridad lagrimal fue 7,5 ± 3,6 mOsm/L en el grupo control y 16,7 ± 11,9 mOsm/L en los pacientes con ojo seco (p < 0,001). Basado en la osmolaridad, un clasificador logístico obtuvo un 85% de precisión. Conclusiones: La osmolaridad promedio y la variabilidad fueron significativamente más altas en pacientes con ojo seco. Por otra parte, las técnicas de aprendizaje de máquina demostraron buena precisión para clasificar a los pacientes. Por tanto, la alta variabilidad parece ser característica propia de la enfermedad de ojo seco

Objective: Because of high variability, tear film osmolarity measures have been questioned in dry eye assessment. Understanding the origin of such variability would aid data interpretation. This study aims to evaluate osmolarity variability in a clinical setting. Material and methods: Twenty dry eyes and 20 control patients were evaluated. Three consecutive osmolarity measurements per eye at 5min intervals were obtained. Variability was represented by the difference between both extreme readings per eye. Machine learning techniques were used to quantify discrimination capacity of tear osmolarity for dry eye. Results: Mean osmolarities in the control and dry eye groups were 295.1 ± 7.3 mOsm/L and 300.6 ± 11.2 mOsm/L, respectively (P=.004). Osmolarity variabilities were 7.5 ± 3.6 mOsm/L and 16.7 ± 11.9 mOsm/L, for the control and dry eye groups, respectively (P < .001). Based on osmolarity, a logistic classifier showed an 85% classification accuracy. Conclusions: In the clinical setting, both mean osmolarity and osmolarity variability in the dry eye group were significantly higher than in the control group. Machine learning techniques showed good classification accuracy. It is concluded that higher variability of tear osmolarity is a dry eye feature

Dry eye is matched by increased intrasubject variability in tear osmolarity as confirmed by machine learning approach. / El ojo seco está relacionado con un aumento intrasujeto de la variabilidad de osmolaridad lagrimal confirmado por tecnología de aprendizaje de máquinas.

OBJECTIVE: Because of high variability, tear film osmolarity measures have been questioned in dry eye assessment. Understanding the origin of such variability would aid data interpretation. This study aims to evaluate osmolarity variability in a clinical setting. MATERIAL AND METHODS: Twenty dry eyes and 20 control patients were evaluated. Three consecutive osmolarity measurements per eye at 5min intervals were obtained. Variability was represented by the difference between both extreme readings per eye. Machine learning techniques were used to quantify discrimination capacity of tear osmolarity for dry eye. RESULTS: Mean osmolarities in the control and dry eye groups were 295.1±7.3mOsm/L and 300.6±11.2mOsm/L, respectively (P=.004). Osmolarity variabilities were 7.5±3.6mOsm/L and 16.7±11.9mOsm/L, for the control and dry eye groups, respectively (P<.001). Based on osmolarity, a logistic classifier showed an 85% classification accuracy. CONCLUSIONS: In the clinical setting, both mean osmolarity and osmolarity variability in the dry eye group were significantly higher than in the control group. Machine learning techniques showed good classification accuracy. It is concluded that higher variability of tear osmolarity is a dry eye feature.

Evaluation of the bioaccessible gastric and intestinal fractions of heavy metals in contaminated soils by means of a simple bioaccessibility extraction test.

A study is made to evaluate the bioaccessibility of heavy metals in contaminated soils through a simple bioaccessibility extraction test (SBET), applied to the analysis of both the gastric and intestinal phases. Soils with high metal content of the Mapocho, Cachapoal, and Rancagua series were studied; they are located in suburban areas of large cities in the central valley of Chile. The bioaccessible concentrations of Cd, Cr, Cu, Ni, Pb, and Zn were related to the main physicochemical characteristics of the soils and to the chemical forms obtained by sequential extraction. The elements Cd, Cu, Ni, and Zn are distributed in the soils between the exchangeable fractions, bound to oxides, to organic matter, and in the residual fraction. On the other hand, Cr and Pb are found mainly in the fractions bound to organic matter and in the residual fraction. The three soils have a high Cu content, (640-2060 mg/kg), in the order Cachapoal > Rancagua > Mapocho. The SBET test allowed establishing a different bioaccessibility for the elements in the soil. Cu was notoriously bioaccessible in both the gastric and intestinal phases in the three soils, reaching more than 50% in the Cachapoal and Rancagua soils. The other elements, regardless of the soil, were bioaccessible only in one of the phases, more frequently in the gastric phase. The multiple correlation study indicates that the metal forms have a higher incidence than the soil's physicochemical factors on the extractability to evaluate the human oral bioaccessibility of the metals.

Experimental study showed that adding fortifier and extra-hydrolysed proteins to preterm infant mothers' milk increased osmolality.

AIM: Measuring milk osmolality after adjustable fortification is clinically relevant, as values exceeding recommended safety thresholds might result in gastrointestinal consequences. The aim of this study was to evaluate the effect of four fortification levels and storage time on the osmolality of human milk. METHODS: This was an experimental study using 71 spare samples of fresh breastmilk collected from 31 mothers of preterm infants. Osmolality was measured before and after adding commercial human milk fortifier containing dextrinomaltose and hydrolysed proteins at four different concentrations. Measurements were performed at various points during the 23 hours after fortification. RESULTS: The mean basal osmolality of the 71 human milk samples was 296 ± 14 milliosmoles (mOsm)/kg, and these remained stable over a period of 23 hours. Just after fortification, the four fortified formulas showed higher osmolalities than the nonfortified human milk, ranging between 384 ± 14 and 486 ± 15 mOsm/kg, respectively (p < 0.01). This osmolality increased significantly from 20 minutes to 23 hours after fortification (p < 0.05). CONCLUSION: Adding fortifier and extra-hydrolysed proteins to human preterm milk increased osmolality, and these osmolality levels also increased with time. We recommend evaluating the risk of hyperosmolality when a higher fortification level is needed, to avoid gastrointestinal problems.

The global threat of antimicrobial resistance: science for intervention.

In the last decade we have witnessed a dramatic increase in the proportion and absolute number of bacterial pathogens resistant to multiple antibacterial agents. Multidrug-resistant bacteria are currently considered as an emergent global disease and a major public health problem. The B-Debate meeting brought together renowned experts representing the main stakeholders (i.e. policy makers, public health authorities, regulatory agencies, pharmaceutical companies and the scientific community at large) to review the global threat of antibiotic resistance and come up with a coordinated set of strategies to fight antimicrobial resistance in a multifaceted approach. We summarize the views of the B-Debate participants regarding the current situation of antimicrobial resistance in animals and the food chain, within the community and the healthcare setting as well as the role of the environment and the development of novel diagnostic and therapeutic strategies, providing expert recommendations to tackle the global threat of antimicrobial resistance.

Corrigendum to "The global threat of antimicrobial resistance: science for intervention" [New Microbes New Infect 6 (2015): 22-29].

[This corrects the article DOI: 10.1016/j.nmni.2015.02.007.].

Rendezvous laparoendoscópico secuencial en colelitiasis con cálculos en colédoco / Simultaneous endoscopio cholangiography and laparoscopic cholecystectomy: a rendezvous technique

Con el objeto de mejorar el manejo de pacientes con colelitiasis y coledocolitiasis, en los cuales la conducta más usada es la colangiografía endoscópica (CE) previa a la colecistectomía laparoscópica, se presenta un protocolo de tratamiento llevado a cabo en el Hospital de Carabineros de Chile en que se realiza colecistectomía laparoscópica y CE en un mismo tiempo anestésico, efectuado por un equipo de cirujanos laparo-endoscopistas. Para esto se utiliza la técnica de "Rendezvous" modificada, realizando primero la colecistectomía y luego la CE. Resultados: Se presenta los primeros 18 pacientes con alta sospecha de coledocolitiasis, de los cuales sólo en 14 se objetivó la presencia de cálculos por colangiografía intraoperatoria realizando la técnica "rendezvous" en 13 de ellos. Se logró un 100 por ciento de éxito, sin complicaciones y con tiempos quirúrgicos y de estadía postoperatorio muy adecuados.

Background: The usual management of patients with cholelithiasis in whom a choledocholithiasis is suspected, is to perform en endoscopio cholangiography prior to laparoscopic cholecystectomy. However a new approach is to perform both procedures simultaneously using a rendezvous technique, to reduce complications and improve the rate of successful bile duct cannulation. Aim: To report the experience with simultaneous endoscopio cholangiography and laparoscopic cholecystectomy. Material and Methods: Eighteen patients with cholelithiasis and a high suspicion of choledocholithiasis were considered eligible for the study. The technique was modified, performing first the cholecystectomy and afterwards the endoscopio cholangiography. Results: In four patients, the intraoperative cholangiography did not show the presence of choledocholithiasis. In the rest, the presence of choledocholithiasis was confirmed and 13 were subjected to the rendezvous technique, that was successful in all. Conclusions: Simultaneous endoscopio cholangiography during laparoscopic cholecystectomy is feasible and safe.

Tests for screening olfactory and gustatory function in school-age children.

OBJECTIVE: Determine the suitability of three tests based on the identification of familiar odors and tastes for the clinical assessment of olfaction and gustation in children. STUDY DESIGN AND SETTING: A total of 232 children aged 5 to 7 years from Sydney public schools and 56 adults aged 18 to 51 years participated in a cross-sectional study. RESULTS: The children demonstrated they can identify the majority of the 16 test odorants and 4 common tastes that describe gustatory function. The response distributions obtained for each test provide the basis for a set of normative data for young children. CONCLUSION: Olfactory and gustatory function can be determined in school-age children using the three tests described. SIGNIFICANCE: Currently no satisfactory clinical tests of olfaction and gustation for children or normative data are available. The present study resolves these shortcomings and provides normative data that can be used in the diagnosis of olfactory and gustatory impairment in school-age children.

Effect of telmisartan 80 mg once daily on 24-h blood pressure profile in patients with mild-to-moderate hypertension failing to respond to prior antihypertensive therapy.

Blood pressure is not adequately controlled in almost 50% of patients with hypertension who are in receipt of antihypertensive therapy. This multicentre, prospective, open-label trial was designed to determine whether or not once-daily telmisartan 80 mg reduced blood pressure during the last 6 h of the 24-h dosing interval in patients with mild-to-moderate hypertension who were unresponsive to previous antihypertensive therapy. The study comprised 100 patients (47 males, 53 females) who had failed to respond satisfactorily to prior treatment given for a minimum of 3 months. At screening, 24-h ambulatory blood pressure monitoring (ABPM) was conducted after the patient had been treated with the currently prescribed antihypertensive medication. Following 5 weeks of telmisartan 80 mg treatment, ABPM was repeated. Telmisartan significantly reduced mean systolic blood pressure, diastolic blood pressure (DBP) and pulse pressure compared with previous antihypertensive therapy over each time interval (24-h, morning, night-time and the last 6 h of the dosing interval [2.00 a.m.-8.00 a.m.]) analysed. In addition, more than 90% of patients responded successfully (clinic DBP <90 mmHg or a >10 mmHg reduction in clinic DBP) at the end of telmisartan treatment. In conclusion, telmisartan provides effective blood pressure control throughout the 24-h dosing interval in patients with mild-to-moderate hypertension who were unresponsive to previous antihypertensive medication.

Presentación de la Organización Nacional de Trasplantes / Introduction of the National Transplant Organization (ONT)

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Coordinación de las actividades de donación y trasplantes: alarmas de donación / Coordination of donation and transplantation activities. Donation alarm

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No disponible

Evaluación del manejo multidisciplinario en el diagnóstico de fibroadenoma mamario / Evaluation of multidisciplinary management in the diagnosis of fibroadenoma of the breast

Objetivo. Demostrar que la punción aspirativa con aguja fina es un método fiable para el manejo de lesiones sólidas que clínica y/o radiológicamente son probablemente benignas y señalar las características de la valoración diagnóstica multidisciplinaria. Material y métodos. Se estudian 160 fibroadenomas comprobados histológicamente. Se valoran los hallazgos clínicos, radiológicos y de la punción aspirativa con aguja fina, así como los valores predictivos positivos para benignidad de los diferentes métodos diagnósticos, por separado y de forma combinada. Resultados. En lesión palpable, el mayor valor predictivo positivo corresponde a la punción aspirativa con aguja fina (99,12 por ciento) y el menor a la ecografía (78,84 por ciento). La concordancia de benignidad más observada corresponde a palpación asociada con punción aspirativa con aguja fina (94,64 por ciento) y el menor ha sido la combinación de palpación, mamografía, ecografía y punción aspirativa con aguja fina (67,34 por ciento). En lesión no palpable la punción aspirativa con aguja fina obtiene el valor predictivo positivo más alto (94,87 por ciento) y la mamografía el más bajo (44,44 por ciento). Combinando las diferentes técnicas diagnósticas, la concordancia de ecografía y punción aspirativa con aguja fina es la más observada (50 por ciento) y la mamografía asociada con punción aspirativa con aguja fina la de menor observación (11,11 por ciento).Conclusiones: a) La punción aspirativa con aguja fina ha resultado ser el test más fiable para el diagnóstico de fibroadenoma. b) La concordancia plena de benignidad se observa con frecuencia variable. c) La concordancia plena de benignidad en los diversos test realizados no es frecuente en este tipo de patología (AU)

The catecholaminergic stimulation of gonadotropin-releasing hormone release by GT1-1 cells does not involve phosphoinositide hydrolysis.

Gonadotropin-releasing hormone (GnRH) secretion is modulated by a large number of neuromediators, among which catecholamines play a central role. Previous results have shown that both dopamine (DA) and norepinephrine (NE) stimulate GnRH secretion in GT1 neuronal cell lines. These stimulatory effects appear to involve D1-dopaminergic and beta 1-adrenergic receptors positively coupled to adenylate cyclase. However, in spite of a similar efficacy of these catecholamines to stimulate GnRH secretion, DA is two-fold more efficacious than NE to stimulate the formation of cyclic AMP. This rises the possibility that other signaling pathways and other receptor subtypes could be involved in the catecholaminergic stimulation of GnRH release. Since the signaling pathway triggered by phosphoinositide hydrolysis is a potent stimulator of GnRH secretion and appears to mediate the releasing actions of neuromediators such as histamine and endothelin, we investigated if this signaling pathway was also involved in the catecholaminergic stimulation of GnRH release in GT1 cells. Both DA and NE stimulated inositol phosphates production in GT1-1 cells with a very low potency and long latency with respect to GnRH secretion. Inositol phosphates production was stimulated by DA and NE only at a concentration of 100 microM, i.e. two to three orders of magnitude higher than the effective concentrations to maximally stimulate GnRH secretion. The effects of both catecholamines do not appear to be secondary to the stimulation of cyclic AMP production, since treatment of GT1-1 cells with forskolin did not affect inositol phosphates production. The effects of DA and NE on inositol phosphates production were blocked by specific antagonists such as SCH-23390, spiroperidol and phentolamine. However, specific dopaminergic agonists such as SKF-38393 and bromocriptine, or adrenergic agonists such as clonidine, methoxamine and isoproterenol were not capable of stimulating inositol phosphates production. Thus, due to the low potency and apparent non-specificity of these effects, we conclude that inositol phosphates production is not involved in the catecholaminergic stimulation of GnRH release.