Aceptabilidad a usar profilaxis pre-exposición para VIH en hombres gay y otros hombres que tienen sexo con hombres: indagación en LAMIS 2018 Chile / Acceptability of pre-exposure prophylaxis for HIV prevention among gay men and other men who have sex with men: analysis of LAMIS 2018-Chile

INTRODUCCIÓN: Chile enfrenta una reemergencia de la epidemia del VIH concentrada en hombres gay y otros HSH. La profilaxis pre exposición (PrEP) es una intervención biomédica que ha resultado ser efectiva en la prevención del VIH en el grupo de HSH. OBJETIVO: Estimar niveles de aceptabilidad del uso de PrEP en hombres gay y otros HSH participantes en estudio LAMIS 2018 - Chile, identificando características y factores asociados a la aceptabilidad del uso de PrEP. MATERIAL Y MÉTODOS: Estudio basado en datos de LAMIS-2018 Chile, encuesta transversal por internet dirigida a hombres gay, bisexual, trans y otros HSH. La submuestra de este estudio consiste en 3.976 participantes que se auto-reportaron ser VIH negativos o desconocer su estado serológico, quienes respondieron preguntas sociodemográficas, de comportamiento, sobre su aceptabilidad a usar PrEP y otros aspectos relacionados. Se realizó análisis bivariados y regresión logística multivariable para identificar los factores asociados a la aceptabilidad a usar PrEP. RESULTADOS Y DISCUSIÓN: Se identificó que 55,7% de la muestra reportó una alta aceptabilidad a usar la PrEP. La regresión logística multivariable mostró que tener relaciones sexuales sin condón (ORa = 1,67, IC 95% 1,42-1,97) y haber intentado usar PrEP (ORa = 1,99, IC 95% 1,41-1, 62) se asociaron positivamente a la aceptabilidad a usar PrEP mientras que tener una relación con pareja estable, se asoció negativamente. Se identificó una aceptabilidad a usar la PrEP relativamente alta en los participantes. No obstante, se hace necesario considerar intervenciones relacionada a aumentar el conocimiento y promover la demanda de la PrEP. Además, el presente estudio muestra la necesidad de considerar la participación de las organizaciones de la sociedad civil en su implementación, fenómenos emergentes y la pertinencia territorial.

BACKGROUND: Chile is facing a re-emergence of the HIV epidemic, concentrated among men who have sex with men (MSM). Pre-exposure prophylaxis (PrEP) is a biomedical intervention that effectively prevents HIV transmission among MSM. AIM: The study was designed to estimate acceptability of PrEP and identify factors associated with PrEP-related attitudes and behaviors among MSM using LAMIS 2018 - Chile study data. Methods: Data were taken from the LAMIS 2018 - Chile study, a cross-sectional study of gay, bisexual, transgender, and other MSM. Our subsample included 3976 participants with self-reported HIV-negative or unknown status who responded to sociodemographic questions and items related to PrEP. Bivariate analysis and multivariate logistic regression analysis were performed to identify factors associated with acceptability of PrEP. RESULTS AND DISCUSSION: A total of 55.7% of the sample reported high PrEP acceptability. Logistic regression indicated that engaging in sex without a condom (ORa = 1.67, IC 95% 1.42-1.97) and having previously used PrEP (ORa = 1.99, IC 95% 1.41-1.62) were associated with high acceptability to use PrEP, while having a stable partner was associated with low acceptability. The estimate of PrEP acceptability was relatively high among participants. However, interventions to increase awareness and promote demand for PrEP may be beneficial. Furthermore, this study demonstrates the need for non-governmental organizations to participate in such strategies and for measures that address regionally-relevant emerging phenomena.

[Acceptability of pre-exposure prophylaxis for HIV prevention among gay men and other men who have sex with men: analysis of LAMIS 2018-Chile]. / Aceptabilidad a usar profilaxis pre-exposición para VIH en hombres gay y otros hombres que tienen sexo con hombres: indagación en LAMIS 2018 Chile.

BACKGROUND: Chile is facing a re-emergence of the HIV epidemic, concentrated among men who have sex with men (MSM). Pre-exposure prophylaxis (PrEP) is a biomedical intervention that effectively prevents HIV transmission among MSM. AIM: The study was designed to estimate acceptability of PrEP and identify factors associated with PrEP-related attitudes and behaviors among MSM using LAMIS 2018 - Chile study data. METHODS: Data were taken from the LAMIS 2018 - Chile study, a cross-sectional study of gay, bisexual, transgender, and other MSM. Our subsample included 3976 participants with self-reported HIV-negative or unknown status who responded to sociodemographic questions and items related to PrEP. Bivariate analysis and multivariate logistic regression analysis were performed to identify factors associated with acceptability of PrEP. RESULTS AND DISCUSSION: A total of 55.7% of the sample reported high PrEP acceptability. Logistic regression indicated that engaging in sex without a condom (ORa = 1.67, IC 95% 1.42-1.97) and having previously used PrEP (ORa = 1.99, IC 95% 1.41-1.62) were associated with high acceptability to use PrEP, while having a stable partner was associated with low acceptability. The estimate of PrEP acceptability was relatively high among participants. However, interventions to increase awareness and promote demand for PrEP may be beneficial. Furthermore, this study demonstrates the need for non-governmental organizations to participate in such strategies and for measures that address regionally-relevant emerging phenomena.

Correlates of condomless anal intercourse among men who have sex with men in Santiago de Chile.

Men who have sex with men (MSM) are disproportionally affected by the HIV epidemic globally. In Chile, HIV prevalence among MSM is estimated at 20%, and condomless anal intercourse is the predominant mode of HIV transmission. This cross-sectional study aimed to estimate a broad array of characteristics in a sample of Chilean MSM including condomless anal intercourse (CLAI), as well as to explore possible associations between these characteristics and CLAI. MSM were recruited through respondent-driven sampling between June and October of 2016. A final sample size of 246 MSM was analyzed using CLAI as the outcome and sociodemographic, clinical and sexual risk behavior characteristics as exposure variables. Results show that close to half of the participants reported CLAI with casual sex partners during the last six months, and this outcome had an increased risk associated with use of drugs prior to sex and having had >5 sexual partners.

Clinical and epidemiological features of myasthenia gravis in Chilean population.

OBJECTIVE: To provide an estimated prevalence and describe the clinical features of myasthenia gravis (MG) in Chile. METHOD: We carried out (i) a prevalence study of MG using the capture-recapture method and the hospital register of pyridostigmine prescription in South-East Santiago (ii) a nationwide survey of MG patients. RESULTS: Prevalence in adults in South-East Santiago was estimated to be 8.36/100 000 inhabitants (CI: 95%, 7.98-8.80). From the nationwide survey, 405 questionnaires were analysed, there was a female/male ratio of 2.2:1. The mean age of onset of symptoms was 38.7 years (range 1-89). The onset was ocular in 46.4%, oculobulbar in 11.6%, bulbar in 8.9%, limbs in 11.6% and generalized in 21.4%. Of the 13.3% of patients who had had a diagnosis of thymoma, only four of these patients were >60 years old at onset. Thymomas were commoner in patients living in mining counties. Patients ≥60 years old at onset of MG formed 19.5% of the sample, female/male ratio 0.97:1. Associated autoimmune diseases were reported in 14% of patients and in family members of 31.8% of patients. A total of 78 patients had to change work due to MG and 68 needed help in carrying out daily activities. CONCLUSIONS: This study reduces the gap in information about MG in South America. The prevalence of MG in Chile is within the range described worldwide. We did not see an increase in male frequency in the older age of onset group and thymoma was more frequent in the fifth and sixth decades.

Menarquia temprana y su asociación con conductas de riesgo en adolescentes / Early menarche and its association with risk behaviors in adolescents

ANTECEDENTES: La pubertad no está necesariamente asociada a un desarrollo psicosocial equivalente. La falta de madurez y las características de la adolescencia podrían favorecer la aparición de conductas de riesgo. OBJETIVO: Determinar la asociación entre la edad de la menarquia y presencia de conductas de riesgo en adolescentes. MÉTODO: Diseño de corte transversal. La muestra incluyó adolescentes postmenárquicas. El instrumento fue una encuesta semiestructurada. Se realizó análisis descriptivo bivariado y multivariado. RESULTADOS: La muestra correspondió a 1844 adolescentes, la mediana de edad fue de 16 años y 12 años para la menarquia. El 57% provino de nivel socioeconómico medio, el 98% estaba escolarizada y 52% vivía con ambos padres. El 35,1% presentó menarquia temprana. El abuso sexual se presentó en 26,0% en el grupo de menarquia temprana y en 21,4% en el de menarquia no temprana. El inicio de actividad sexual antes de los 15 años se presentó en un 39,4% y en 22,3% de adolescentes con menarquia temprana y no temprana respectivamente (OR: 1,88; IC95%: 1,46-2,43), asociándose con disfuncionalidad familiar (OR: 2,08; IC95%: 1,45-2,99) y ausencia de los padres (OR: 1,74; IC95%: 1,09-2,76). La frecuencia de consumo de alcohol se asoció a disfuncionalidad familiar severa (OR: 2,00; IC95%: 1,34-3,00). CONCLUSIÓN: La menarquia temprana se asoció al inicio precoz de actividad sexual. Es importante promover comportamientos seguros desde edades tempranas y acompañar a las niñas en su proceso de maduración.

BACKGROUND: Puberty is not necessarily associated with an equivalent psychosocial development. The lack of maturity and characteristics of adolescence may promote the emergence of risk behaviors. OBJECTIVE: To determine the association between age at menarche and presence of risk behaviors in adolescents. METHOD: Cross-sectional design study. The sample included postmenarchal adolescents. The instrument was a semistructured survey. Bivariate and multivariate descriptive analysis. RESULTS: The sample consisted of 1844 adolescents, the median age was 16 years and 12 years for menarche. 57% came from middle socioeconomic level, 98% attended school and 52% lived with both parents. 35.1% had early menarche. Sexual abuse occurred in 26.0% in the group of early menarche and 21.4% for no early menarche. The onset of sexual activity before age 15 occurred in 39.4% and 22.3% of adolescents with early and no early menarche respectively (OR: 1.88; 95%CI: 1.46-2.43), associated with family dysfunction (OR: 2.08; 95%CI: 1.45-2.99) and absence of parents (OR: 1.74; 95%CI: 1.09-2.76). The frequency of alcohol consumption was associated with severe family dysfunction (OR: 2.00; 95%CI: 1.34-3.00). CONCLUSION: Early menarche was associated with early onset of sexual activity. It is important to promote safe behavior from an early age and escort girls in their maturation process.

Cirugía endoscópica ginecológica: experiencia de 8 años / Gynecological endoscopic surgery: experience of 8 years

Se presenta la experiencia de 1046 cirugías laparoscópicas ginecológica del Servicio de Obstetricia y Ginecología del Hospital El Pino, desde julio de 1995 a diciembre de 2003. El 40,5 por ciento correspondieron a esterilizaciones tubarias, nivel de complejidad tipo 1 y las restantes a niveles de complejidad tipo 2 y 3. Se reportan los resultados y las complicaciones mayores.

Manejo laparoscópico conservador de embarazo cornual / Conservative laparoscopical handling of cornual pregnancy

Se presenta el abordaje laparoscópico conservador de un embarazo Cornual izquierdo, diagnosticado en forma precoz por ecotomografía transvaginal, en que se realiza una Cuernostomía, extracción del saco más embrión, raspado del cuerno y sutura con puntos laparoscópicos con nudos endoscópicos, se discute su cuadro clínico, complicaciones y tratamiento.

[Sympathetic denervation of an extremity as a presentation form of apical lung cancer]. / Denervación simpática de una extremidad como forma de presentación en cáncer del vértice pulmonar.

We report a 56 years old male patient presenting with a sympathetic denervation of the right upper limb due to an apical lung cancer. Vasomotor paralysis of the limb was objectively documented with a contact termography. The clinical presentation of this patient was unusual, considering that the alteration occurred without sensory or motor changes of the limb or autonomic disturbances of the face. The absence of clinical and neurophysiological involvement of large and small caliber fibres of the brachial plexus and the lack of autonomic dysfunction of the face was explained by a predominant tumoral infiltration of T2 and T4 ventral roots, which supply autonomic innervation to the upper limbs.

[Quadriceps myopathy: a type of late focal dystrophy in a case]. / Miopatía del cuádriceps: una forma de distrofia focal tardía en un caso.

A 62 years old male with a slowly progressive focal myopathy is presented. He had noticed weakness in the lower limbs for three years and weakness in the upper limbs for one year. He had bilateral atrophy of quadriceps and biceps muscles, absence of knee jerks and hypertrophy of the calves. Needle EMG showed myopathic motor units. Hystological study was compatible with muscular dystrophy. The clinical and laboratory characteristics of this patient are in keeping with what has been described as "Quadriceps Myopathy" as a form of a muscular dystrophy.

Inmunoterapía por vía cútanea con dinitroclorobenceno en infección del cuello uterino por virus papiloma / Immunotherapy by skin administration with dinitrochlorobenzene in uterine cervix infection by virus papiloma

Se presenta el resultado del tratamiento de 30 pacientes con dinitroclorobenceno (DNCB) por vía cútanea, portadoras de condilomatosis del cuello uterino, diagnósticadas por citología (Papanicolaou), colposcopia y biopsia. Se describe el método de sensibilización con dinitroclorobenceno por vía cutánea. Se revisa algunos aspectos de la infección por HPV su alta frecuencia entre consultantes en centros de ETS y la asociación de tipos 16 y 18 con cáncer cérvico uterino. Se analiza fundamentos de la terapia inmunológica. Los autores comunican un 87% de éxito terapéutico con curación total comprobada por colposcopia

Miopatia nemalinica en la infancia.Presentacion de un caso. / Nemaline myopathy in childhood. Report of a case.

Se presenta el caso de un nino, de tres anos de edad, con hiponia y debilidad muscular desde su nacimiento y en quien se hizo el diagnostico de miopatia nemalinica basado en las caracteristicas clinicas, electromiograficas y enzimaticas siendo confirmado por el estudio histopatologico de la biopsia muscular.

Tratamiento esteroidal en distrofia muscular de Duchenne. / Steroid treatment in Duchenne's muscular dystrophy

Ocho pacientes con distrofia muscular de Duchenne, diagnosticados por las manifestaciones clinicas, biopsia muscular, creatinfosfokinasa (CPK) y electromiografia, de edades entre 5 anos 1/12 y 11 anos 5/12, fueron tratados con prednisona (Laboratorio Chile) 3 mg por Kg de peso, en dias alternos, durante un periodo de un ano. Los pacientes no habian perdido la deambulacion. El seguimiento se realizo con medicion de fuerza muscular,actividad fisica, niveles de CPK y electromielografia. Este grupo de enfermos se compara al termino del tratamiento con un grupo de ninos portadores de DMD de edades similares que no recibieron tratamiento esteroidal. Los resultados muestran una significativa mejoria (P < 0,010), en fuerza muscular (medido por Score Muscular Total) y actividad fisica (P < 0,001) a los 6 meses de tratamiento. Al ano de tratamiento no hay diferencia significativa en ambos parametros con respecto al estado inicial. No se observaron diferencias en fuerza muscular y actividad fisica al ano de tratamiento con respecto al grupo sin tratamiento. Los valores de CPK no mostraron diferencias significativas respecto a los valores iniciales. La electromiografia no mostro variaciones significativas en el curso del tratamiento. Aunque el numero de paciente es reducido, nuestra experiencia muestra que los corticoides no tienen efectos beneficos en la evolucion clinica de la DMD