Motion-induced inertial effects and topological phase transitions in skyrmion transport.

When the skyrmion dynamics beyond the particle-like description is considered, this topological structure can deform due to a self-induced field. In this work, we perform Monte Carlo simulations to characterize the skyrmion deformation during its steady movement. In the low-velocity regime, the deformation in the skyrmion shape is quantified by an effective inertial mass, which is related to the dissipative force. When skyrmions move faster, the large self-induced deformation triggers topological transitions. These transitions are characterized by the proliferation of skyrmions and a different total topological charge, which is obtained as a function of the skyrmion velocity. Our findings provide an alternative way to describe the dynamics of a skyrmion that accounts for the deformations of its structure. Furthermore, such motion-induced topological phase transitions make it possible to control the number of ferromagnetic skyrmions through velocity effects.

Elevación de enzimas hepáticas inducida por COVID-19 en embarazada / Elevated liver enzimes induced by COVID-19 in pregnancy

INTRODUCCIÓN: Las alteraciones del perfil hepático durante el embarazo ocurren en 3-5% de las gestantes. Una nueva etiología que se ha presentado en el contexto de pandemia actual es el síndrome respiratorio agudo severo relacionado con el nuevo coronavirus (SARS-CoV-2). Éste es responsable de alteraciones hepáticas en 2 a 11% de la población general infectada por este virus, y de hasta un 30% en las embarazadas que se infectan con SARS-CoV-2. Con el objetivo de mostrar una presentación poco frecuente del SARS-CoV-2 se expone un caso clínico de elevación de transaminasas en embarazada inducida por este nuevo virus. CASO CLÍNICO: Paciente de 36 años, cursando embarazo de 20+6 semanas, consulta por dolor abdominal asociado a ictericia y coluria. Se solicita estudio donde destaca elevación de transaminasas. Ecografía abdominal con vía biliar fina. Se descartan diferentes etiologías de hepatitis aguda y crónica (dada la falta de antecedentes). Finalmente se solicita PCR para COVID-19 que resulta positiva. CONCLUSIÓN: Luego de un estudio exhaustivo de diferentes etiologías de elevación de transaminasas, se atribuye esta alteración enzimática a SARS-CoV-2. Se decide seguimiento ambulatorio estricto con pruebas hepáticas cada dos semanas. La paciente evoluciona estable con exámenes normales luego de un mes desde que se indica el alta hospitalaria. Después de descartar etiologías frecuentes de elevación de transaminasas durante el embarazo, sugerimos solicitar el estudio de este virus con PCR para COVID-19, ya que podría ser una presentación poco frecuente de SARS-CoV-2.

INTRODUCTION: Approximately 3-5% of women present alterations of hepatic enzymes during pregnancy. Under the new circumstances that the world is facing with the SARS-COV2 pandemic, a new etiology for hepatic enzyme alterations has risen. The severe acute respiratory syndrome that the novel coronavirus causes is responsible for hepatic enzyme alterations in 2 to 11% of the sick population that did not have a previous underlying hepatic condition. Furthermore, hepatic enzyme alterations in pregnant women infected with SARS-COV2 presents in up to 30% of the cases. An infrequent presentation of SARS-COV2 is presented as our clinical case. CLINICAL CASE: A 36-year-old patient with a 20+6 week pregnancy presents abdominal pain, jaundice and choluria. General blood workup shows elevated transaminases. The abdominal ultrasound revealed a thin bile duct. Acute and chronic hepatitis etiologies were discarded. Finally, a PCR of COVID-19 was solicited, which turned out to be positive. CONCLUSIÓN: After an exhaustive study to determine the etiology of the elevated transaminases, the hepatic alterations were attributed to SARS-COV2 infection. A conservative management was adopted, with outpatient follow-up with liver testing every two weeks. The patient progresses with a stable steady decline in hepatic enzyme levels, and one-month post hospital discharge, her transaminases had reached normal values. Based on this clinical case, after ruling out frequent etiologies for elevated transaminases during pregnancy, it seems reasonable to request a PCR for COVID-19, since it could be a rare presentation of SARS-CoV-2.

Incremental novelty detection and fault identification scheme applied to a kinematic chain under non-stationary operation.

Classical methods for monitoring electromechanical systems lack two critical functions for effective industrial application: management of unexpected events and the incorporation of new patterns into the knowledge database. This study presents a novel, high-performance condition-monitoring method based on a four-stage incremental learning approach. First, non-stationary operation is characterised using normalised time-frequency maps. Second, operating novelties are detected using multivariate kernel density estimators. Third, the operating novelties are characterised and labelled to increase the knowledge available for subsequent diagnosis. Fourth, operating faults are diagnosed and classified using neural networks. The proposed method is validated experimentally with an industrial camshaft-based machine under a variety of operating conditions.

Flat Bands, Indirect Gaps, and Unconventional Spin-Wave Behavior Induced by a Periodic Dzyaloshinskii-Moriya Interaction.

Periodically patterned metamaterials are known for exhibiting wave properties similar to the ones observed in electronic band structures in crystal lattices. In particular, periodic ferromagnetic materials are characterized by the presence of bands and band gaps in their spin-wave spectrum at tunable GHz frequencies. Recently, the fabrication of magnets hosting Dzyaloshinskii-Moriya interactions has been pursued with high interest since properties, such as the stabilization of chiral spin textures and nonreciprocal spin-wave propagation, emerge from this antisymmetric exchange coupling. In this context, to further engineer the magnon band structure, we propose the implementation of magnonic crystals with periodic Dzyaloshinskii-Moriya interactions, which can be obtained, for instance, via patterning of periodic arrays of heavy metal wires on top of an ultrathin magnetic film. We demonstrate through theoretical calculations and micromagnetic simulations that such systems show an unusual evolution of the standing spin waves around the gaps. We also predict the emergence of indirect gaps and flat bands, effects that depend on the strength of the Dzyaloshinskii-Moriya interaction. Such phenomena, which have been previously observed in different systems, are observed here simultaneously, opening new routes towards engineered metamaterials for spin-wave-based devices.

The STIM1 inhibitor ML9 disrupts basal autophagy in cardiomyocytes by decreasing lysosome content.

Stromal-interaction molecule 1 (STIM1)-mediated store-operated Ca2+ entry (SOCE) plays a key role in mediating cardiomyocyte hypertrophy, both in vitro and in vivo. Moreover, there is growing support for the contribution of SOCE to the Ca2+ overload associated with ischemia/reperfusion injury. Therefore, STIM1 inhibition is proposed as a novel target for controlling both hypertrophy and ischemia/reperfusion-induced Ca2+ overload. Our aim was to evaluate the effect of ML9, a STIM1 inhibitor, on cardiomyocyte viability. ML9 was found to induce cell death in cultured neonatal rat cardiomyocytes. Caspase-3 activation, apoptotic index and release of the necrosis marker lactate dehydrogenase to the extracellular medium were evaluated. ML9-induced cardiomyocyte death was not associated with increased intracellular ROS or decreased ATP levels. Moreover, treatment with ML9 significantly increased levels of the autophagy marker LC3-II, without altering Beclin1 or p62 protein levels. However, treatment with ML9 followed by bafilomycin-A1 did not produce further increases in LC3-II content. Furthermore, treatment with ML9 resulted in decreased LysoTracker® Green staining. Collectively, these data suggest that ML9-induced cardiomyocyte death is triggered by a ML9-dependent disruption of autophagic flux due to lysosomal dysfunction.

Interfacial Dzyaloshinskii-Moriya Interaction in Pt/CoFeB Films: Effect of the Heavy-Metal Thickness.

We report the observation of a Pt layer thickness dependence on the induced interfacial Dzyaloshinskii-Moriya interaction in ultrathin Pt(d_{Pt})/CoFeB films. Taking advantage of the large spin-orbit coupling of the heavy metal, the interfacial Dzyaloshinskii-Moriya interaction is quantified by Brillouin light scattering measurements of the frequency nonreciprocity of spin waves in the ferromagnet. The magnitude of the induced Dzyaloshinskii-Moriya coupling is found to saturate to a value of 0.45 mJ/m^{2} for Pt thicknesses larger than ∼2 nm. The experimental results are explained by analytical calculations based on the three-site indirect exchange mechanism that predicts a Dzyaloshinskii-Moriya interaction at the interface between a ferromagnetic thin layer and a heavy metal. Our findings open up a way to control and optimize chiral effects in ferromagnetic thin films through the thickness of the heavy-metal layer.

Colgajo bilobulado en epiteliomas basocelulares nasales / Repair of nasal defects secondary to excision of basal-cell epitheliomas

Background: The repair of defects secondary to excision of basal-cell epitheliomas can be a challenge. Aim: To report the experience with the repair of nasal defects using bilobed flaps. Material and Methods: Review of medical records of 10 patients in whom a basal-cell epithelioma was excised and the nasal defect was repaired using a bilobed flap. Results: In all patients, the flap allowed the repair of the defect using the own patient nasal skin, without complications. Conclusions: The bilobed flap is an excellent technique for the repair of medium size nasal defects secondary to excision of basal-cell epitheliomas.

Objetivo: La nariz es el área corporal con mayor incidencia de epiteliomas basocelulares y la reparación de los defectos secundarios a su resección, puede ser un desafío. El objetivo es presentar nuestra experiencia en la reparación de defectos nasales, empleando colgajos bilobulados. Material y Método: Se realizó una revisión retrospectiva de 10 pacientes con epiteliomas basocelulares nasales en que empleamos este colgajo. Resultados: En todos los pacientes el colgajo bilobulado permitió la reparación del defecto, con la propia piel nasal y sin complicaciones. Conclusiones: Consideramos al colgajo bilobulado como una excelente técnica para la reparación de defectos nasales de mediano tamaño, secundarios a la resección de epiteliomas basocelulares.

Efectividad del tratamiento médico con misoprostol según dosis administrada en aborto retenido menor de 12 semanas / Effectiveness of medical treatment with misoprostol as abortion retained dose administered in less than 12 weeks

Antecedentes: El manejo terapéutico del aborto retenido consiste en evacuar la cavidad uterina espontáneamente o utilizando misoprostol previo al legrado quirúrgico. Objetivo: Evaluar la necesidad de dilatación mecánica post maduración cervical con misoprostol y la tasa de perforación uterina post legrado, utilizando diferentes dosis de misoprostol en pacientes con diagnóstico de aborto retenido menor a 12 semanas. Métodos: Se registraron datos demográficos y ginecológicos de una cohorte retrospectiva de pacientes con diagnóstico de aborto retenido menor a 12 semanas, entre enero de 2008 y diciembre de 2010. Se establecieron 3 grupos de trabajo según la dosis de misoprostol administrada vía vaginal, siendo de 100 (n=131), 200 (n=231) y 400 micrones (n=230), y se observaron las complicaciones asociadas al procedimiento. Resultados: La necesidad de dilatación mecánica fue significativamente mayor en el grupo que recibió 100 micrones de misoprostol al compararlo con el de 200 micrones y 400 micrones (p<0,01). No hubo diferencias estadísticamente significativas entre las que recibieron 200 versus 400 micrones de misoprostol. No hubo diferencias significativas respecto a perforación uterina. Conclusión: En el aborto retenido menor a 12 semanas, la necesidad de dilatación mecánica post maduración cervical, es menor si se utiliza 200 o 400 micrones de misoprostol, sin diferencias en la tasa de perforación uterina.

Background: The therapeutic management of missed abortion consists on evacuating the uterine cavity, spontaneously or by administration of misoprostol previous to curettage. Objectives: Evaluate the need of mechanical dilatation after cervical maturation with misoprostol and the rate of uterine perforation before curettage, using different doses of misoprostol in patients with diagnosis of missed abortion before 12 weeks. Methods: Demographic and gynecologic data were registered of a retrospective cohort of patients with the diagnosis of missed abortion before 12 weeks, between January 2008 and December 2010. Three groups were established according to the dose of misoprostol: 100 (n=131), 200 (n=231) and 400 microns (n=230). Complications associated to the procedure were observed. Results: The need of mechanical dilatation was significant higher for the group with 100 microns of misoprostol in comparison with 200 and 400 microns (p<0.001). There was no statistical significance among who received 200 versus 400 microns of misoprostol. No statistical significance was found for uterine perforation. Conclusion: In the missed abortion before 12 week, the need of mechanical dilatation is lower with 200 or 400 microns of misoprostol, without difference in uterine perforation rate.

Pronóstico reproductivo posterior a un embarazo ectópico según modalidad de tratamiento / Subsequent reproductive prognosis ectopic pregnancy according to treatment modality

Introducción: Entre un 20 - 60 por ciento de las pacientes que presentan un embarazo ectópico (EE) desarrollarán infertilidad en el futuro. Objetivo: Comparar las tasas de fertilidad posterior a un EE según tipo de tratamiento: médico con Metotrexato o quirúrgico, en un grupo de pacientes sin acceso a técnicas de fertilización asistida. Métodos: Presentamos un estudio de cohorte retrospectivo de pacientes con diagnóstico de EE tratadas en el Servicio de Ginecología del Hospital Padre Hurtado, entre enero de 2002 y diciembre de 2007. Se excluyeron pacientes con EE cervical o cornual, las de manejo expectante, y pacientes esterilizadas. El seguimiento mínimo fue de 4 años posterior al EE. Resultados: Se diagnosticaron 288 EE. Se excluyeron del estudio 69 pacientes. De los 219 casos restantes, se obtuvo seguimiento completo en 193 casos (88,1 por ciento). De los 193 casos analizados, 128 fueron pacientes sometidas a resolución quirúrgica, consistente en una salpingectomía de la tuba comprometida y 65 pacientes se trataron con Metotrexato. En 18 de éstas últimas, fracasó el tratamiento médico, requiriendo de una salpingectomía diferida. Excluyendo a estas 18 pacientes, la tasa de embarazo para el grupo de resolución quirúrgica fue de 83,6 por ciento (107 de 128 pacientes) y para el grupo de manejo médico con Metotrexato fue de 80,9 por ciento (38 de 47 pacientes), sin diferencia estadísticamente significativa entre ambos grupos (p=0,67). Conclusión: En este estudio, las tasas de embarazo para ambos grupos de manejo fueron similares, siendo mayores que las reportadas por la literatura.

Introduction: It is estimated that 20-60 percent of patients with ectopic pregnancy, will develop infertility on the future, but knowledge about this matter is scarce. Aims: To compare fertility rates after ectopic pregnancy, among medical treatment with methotrexate and surgery, in patients without opportunity for assisted reproductive techniques. Methods: Retrospective cohort study of patients diagnosed with ectopic pregnancy, treated in Hospital Padre Hurtado's gynecology service, Santiago - Chile, between January 2002 and December 2007. Patients with cervical or cornual ectopic pregnancy, expectant management, or patients, who didn't want future pregnancies, were excluded from the analysis. Follow up was for at least 4 years. Results: 288 ectopic pregnancies were diagnosed; 69 patients were excluded. From the 219 participants, 193 cases (88.1 percent) with complete follow, were included for analysis. Surgical management, which consisted of salpingectomy of the compromised tube, was done on 128 patients. Medical management was done on 65 patients, but 18 patients required differed salpingectomy for treatment failure. Excluding those 18 patients, the pregnancy rates for the surgical management group was of 83.6 percent (107/128) and 80.9 percent (38/47) for the medical management group, not statistically significant (p=0.67). Conclusion: There are similar pregnancy rates for surgical and medical management for patients with ectopic pregnancy history; although these were higher than those reported in literature.

Participación estudiantil en el proceso de reforma curricular del pregrado de Medicina en la Universidad de Chile: evaluación y desafíos / Student participation in the process of curricular reform undergraduate Medicine in the University of Chile: evaluation and challenges

In recent years, students have been steadily gaining a much more active role in the process of curriculum reform of undergraduate medical studies which has been conducted at the University of Chile, participating in different stages of curriculum transformation, generating discussion and demanding greater incidence on decision-making arenas. Such participation has led to students’ diagnoses and proposals that have been presented in institutional democratic spaces. Nevertheless, there are still some pending challenges in this reform, like: improving the quality of teaching in all clinical campus, studying and implementing measures to reduce the impact of a negative environment, improving the monitorization of its alumni and the compliance of the graduates’ profile, deepening the process of professionalization of teaching and promoting a democratic culture by encouraging the inclusion of all clinical campus in decision making spaces. Despite all the difficulties identified, ongoing curricular reform process is perceived by the students as an opportunity to move forward in the building of a participatory Medical School, which can respond with excellence to the needs and demands Chile makes to its largest and oldest public university.

FPGA-based architecture for real-time data reduction of ultrasound signals.

This paper describes a novel method for on-line real-time data reduction of radiofrequency (RF) ultrasound signals. The approach is based on a field programmable gate array (FPGA) system intended mainly for steel thickness measurements. Ultrasound data reduction is desirable when: (1) direct measurements performed by an operator are not accessible; (2) it is required to store a considerable amount of data; (3) the application requires measuring at very high speeds; and (4) the physical space for the embedded hardware is limited. All the aforementioned scenarios can be present in applications such as pipeline inspection where data reduction is traditionally performed on-line using pipeline inspection gauges (PIG). The method proposed in this work consists of identifying and storing in real-time only the time of occurrence (TOO) and the maximum amplitude of each echo present in a given RF ultrasound signal. The method is tested with a dedicated immersion system where a significant data reduction with an average of 96.5% is achieved.

Cardiomyocyte death: mechanisms and translational implications.

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality worldwide. Although treatments have improved, development of novel therapies for patients with CVD remains a major research goal. Apoptosis, necrosis, and autophagy occur in cardiac myocytes, and both gradual and acute cell death are hallmarks of cardiac pathology, including heart failure, myocardial infarction, and ischemia/reperfusion. Pharmacological and genetic inhibition of autophagy, apoptosis, or necrosis diminishes infarct size and improves cardiac function in these disorders. Here, we review recent progress in the fields of autophagy, apoptosis, and necrosis. In addition, we highlight the involvement of these mechanisms in cardiac pathology and discuss potential translational implications.

Análisis crítico de guía clínica GES gran quemado versión 2007 / Critical appraisal of clinical guideline

Objective: Critical appraisal of the clinical practice guideline (CPG) "Gran Quemado-Extensive Burn Patients"(2007 issue) corresponding to "Garantías Explícitas en Salud- Explicit Health Guarantees" (GES). Material and Methods: The CPG was evaluated using the previously validated AGREE instrument. This instrument evaluates a series of items organized in 6 domains, that capture different dimensions of the guidelines quality comparing the scores obtained with a maximum theoretical score. The CPG was evaluated by three independent and masked authors applying the AGREE instrument. Results: Stratified by domain, in the "scope and purpose" domain there was an 88.9 percent of compliance; in "stakeholder involvement" 47.9 percent; in the "rigour of development" 47.6 percent; in "clarity and presentation" 79.2 percent; in "applicability" 30.6 percent and 75 percent in the "editorial independence" domain; reaching a 44.9 percent final score of compliance. Conclusions: The score obtained was below 50 percent of the optimum for a CPG. The detailed analysis by domain makes evident the areas that may be subject of improvement, so as to optimize the applicability of the CPG and therefore guarantee better health care and treatment results for all burn patients benefiting from the "Explicit Health Guarantees".

Objetivo: Evaluar críticamente la guía de práctica clínica (GPC) de Gran Quemado correspondiente a las Garantías Explícitas en Salud (GES) versión 2007. Material y Método: La evaluación se realizó con el instrumento AGREE el cual ha sido previamente validado. El instrumento AGREE evalúa una serie de ítems en 6 dominios entregando un puntaje específico que se compara con un máximo teórico. Tres autores en forma independiente y enmascarada evaluaron la GPC y puntuaron de acuerdo al instrumento utilizado. Resultados: Estratificando por dominio, en "alcance y objetivo" se obtuvo un 88,9 por ciento de cumplimiento; en participación de los implicados 47,9 por ciento; en rigor en la elaboración 47,6 por ciento; en claridad y presentación 79,2 por ciento; en aplicabilidad 30,6 por ciento y 75 por ciento en independencia editorial; entregando un puntaje final de 44,9 por ciento de cumplimiento. Conclusiones: El puntaje obtenido fue menor al 50 por ciento del óptimo para una GPC. El análisis detallado por dominio entrega en forma detallada las áreas susceptibles de perfeccionar para optimizar la aplicabilidad de la guía clínica y de tal forma garantizar la mejoría en el cuidado y los resultados del tratamiento de los pacientes quemados beneficiarios de las Garantías Explícitas en Salud.

Prevalencia de incontinencia fecal en pacientes ginecológicas y uroginecológicas / Prevalence of fecal incontinence in gynecological and urogynecological patients

Antecedentes: La incontinencia fecal (IF), definida como el paso involuntario de heces en sus formas sólida, líquida o gaseosa por el conducto anal, constituye un problema social o de higiene, alcanzando una prevalencia desde un 0,2 por ciento en población general hasta un 30 por ciento en pacientes con defectos de piso pélvico. Objetivo: Determinar la prevalencia y severidad de la IF. Método: Se estudia a 859 pacientes referidas por primera vez a los policlínicos de Ginecología General (PGG) y Uroginecología del Hospital Padre Alberto Hurtado, a las que se aplica una encuesta validada para diagnóstico y severidad de IF. Resultados: Una de cada cinco pacientes que consultan por primera vez al PGG y una de cada dos pacientes que consultan al policlínico de Uroginecología, refieren algún grado de IF, además, 1 de cada 30 pacientes y una de cada 7, respectivamente, refieren un episodio de deposiciones líquidas al menos una vez al mes. El riesgo de padecer IF a líquidos es 6 veces mayor en un policlínico de Uroginecología que en un PGG. Conclusión: La prevalencia de la IF es difícil de determinar. La información nacional es escasa y los trabajos internacionales presentan resultados muy difusos. Las pacientes consultan muy raramente en forma espontánea. Nuestros resultados muestran que la prevalencia en un policlínico de ginecología general y sobre todo en uno de uroginecología es significativa, por lo que su búsqueda activa puede traducirse en una mejoría en la calidad de vida para estas pacientes.

Background: According to the International Continence Society, fecal incontinence (Fl) is defined as the involuntary loss of flatus, liquid or solid stool that is a social or hygienic problem. It reaches 0.2 percent in general population and up to 30 percent in women with pelvic floor disorders. Objectives: To determine the prevalence and severity of Fl in a general gynecological setting and at a pelvic floor disorders unit. Method: 859 first consultant patients referred to our general gynecological unit (GGU) and pelvic floor disorders units (PFDU) were studied with a validated Fl score for severity and grading. Results: One out every five patients attending our GGU and one out two attending our PFDU complains of any kind of Fl. Almost 1 out 30 patients attending GGU and 1 out of 6 attending PFDU complains of at least one liquid stool incontinence episode once a month. The risk of having Fl to liquids is 6 times higher in PFDU than at a GGU. Conclusions: Fl prevalence is hard to assess. National data is scarce and the international experience the results are very diffuse. However, above patients rarely ask for medical help spontaneously. Our results show a significant Fl prevalence in a general gynecology and uro-gynecology setting. In our view, in order to improve our patient's quality of life, Fl should be sought and evaluated, especially in those with pelvic floor dysfunction.

[Outpatient parenteral antimicrobial therapy: an alternative to hospitalization in a pediatric emergency department]. / Terapia antimicrobiana endovenosa ambulatoria: Alternativa a la hospitalización en un servicio de urgencia pediátrico.

UNLABELLED: Outpatient parenteral antimicrobial therapy (OPAT) was first introduced in 1973 as an alternative treatment. Since then, there have been numerous international case based studies including both children and adults with significant bacterial infections using this strategy. The protocol requires a careful screening and evaluation process of the patient. There must be no other motive for hospitalization other than the need for parenteral antibiotics. OBJECTIVE: To describe the results of OPAT during a period of 26 months in emergency department of a Chilean pediatric public hospital. RESULTS: During the study period 228,144 patients received medical care in the Emergency Department (ED) and 380 patients were admitted to the OPAT program after clinical evaluation and based on the socioeconomic and cultural conditions of their parents. The major indications of OPAT were skin and soft tissues infections (50%) and pneumonia (28%) respectively. (beta-lactamic antibiotics the were most commonly prescribed. Thirty eight patients (10%) required hospitalization, mostly because of clinical deterioration. There were no deaths. CONCLUSION: In our public hospital OPAT for treatment of significant bacterial infections constitutes an efficient and safe alternative to hospitalization allowing the child to remain in his home.

Terapia antimicrobiana endovenosa ambulatoria: Alternativa a la hospitalización en un servicio de urgencia pediátrico / Outpatient parenteral antimicrobial therapy: An alternative to hospitalization in a pediatric emergency departament

Outpatient parenteral antimicrobial therapy (OPAT) was first introduced in 1973 as an alternative treatment. Since then, there have been numerous international case based studies including both children and adults with significant bacterial infections using this strategy. The protocol requires a careful screening and evaluation process of the patient. There must be no other motive for hospitalization other than the need for parenteral antibiotics. Objective: To describe the results of OPAT during a period of 26 months in emergency department of a Chilean pediatric public hospital. Results: During the study period 228,144 patients received medical care in the Emergency Department (ED) and 380 patients were admitted to the OPAT program after clinical evaluation and based on the socioeconomic and cultural conditions of their parents. The major indications of OPAT were skin and soft tissues infections (50 percent) and pneumonia (28 percent) respectively. (ß-lactamic antibiotics the were most commonly prescribed. Thirty eight patients (10 percent) required hospitalization, mostly because of clinical deterioration. There were no deaths. Conclusión: In our public hospital OPAT for treatment of significant bacterial infections constitutes an efficient and safe alternative to hospitalization allowing the child to remain in his home.

La terapia antimicrobiana endovenosa ambulatoria (TAEA) surgió como una alternativa de tratamiento en 1973, publicándose numerosas experiencias internacionales en niños y adultos para diversas infecciones bacterianas de importancia mayor. Requiere seleccionar a cada paciente considerando que no hay otro motivo de hospitalización, salvo la administración del fármaco. Objetivo: Sistematizar la experiencia de TAEA efectuada durante 26 meses en el servicio de urgencia (SU) de un hospital pediátrico público de Chile. Resultados: De un total de 228.144 pacientes consultantes al SU en el período elegido, un total de 380 pacientes ingresaron al programa de TAEA luego de una evaluación clínica y de las condiciones socioeconómicas y culturales de sus apoderados. La principal indicación de TAEA fueron las infecciones de piel y tejidos blandos (50 por ciento), seguida de neumonía (28 por ciento), utilizándose en su mayoría ß-lactámicos solos o asociados. Diez por ciento de los pacientes requirió hospitalización, en su mayoría por deterioro de su condición clínica. Ninguno falleció. Conclusión: En nuestro medio, la TAEA es una alternativa eficiente y segura a la hospitalización, que permite tratar pacientes pediátricos con infecciones bacterianas mayores en su entorno familiar.

Reinserción umbilical en abdominoplastia: técnica en Y con colgajos desepidermizados / Umbilical reinsertion during abdominoplasty: y technique using flaps without epidermis: report of five cases

El ombligo es una unidad estética fundamental del abdomen y es la única cicatriz que normalmente existe en todas las personas. Su ausencia o distorsión anatómica puede causar graves problemas psicológicos. Uno de los objetivos de la abdominoplastía es obtener un ombligo que resulte estéticamente atractivo. Se han descrito numerosas técnicas para la reinserción umbilical en abdominoplastías. Sin embargo, con las técnicas clásicas no siempre se obtiene un ombligo de apariencia natural. Presentamos una nueva alternativa para la reinserción umbilical, que denominamos técnica en Y con colgajos desepidermizados. Hemos empleado esta técnica en 5 abdominoplastías consecutivas, siendo fácil de realizar y con resultados reproducibles, permitiéndonos obtener ombligos de aspecto natural y con un alto nivel de satisfacción por parte de las pacientes.

Reparación laparoscópica de defectos paravaginales: eficacia y complicaciones a corto plazo / Laparoscopic paravaginal repair: efficacy and short-term complication

Objetivo: Reportar nuestros primeros casos de reparación laparoscópica de defectos paravaginales y evaluar la eficacia y complicaciones a corto plazo. Método: Entre enero de 2005 y mayo de 2006, se realizó un estudio prospectivo observacional de 12 pacientes sometidas a reparación laparoscópica de defecto paravaginal por cistocele paravaginal sintomático, y corrección por técnica de Burch laparoscópico de incontinencia urinaria de esfuerzo genuina. Todos los parámetros epidemiológicos habituales fueron evaluados y la tasa de éxito fue evaluada según análisis de sobrevida y Kaplan Meier. Resultados: La media de edad de las pacientes fue 45,2 + - 6,3 años, media tiempo operatorio 71,3 + - 13,2 minutos y media de hospitalización de 1,2 + - 0,4 días. No hubo complicaciones intraoperatorias y en el postoperatorio hubo un caso de retención urinaria, un caso de infección urinaria baja y un caso de incontinencia urinaria postoperatoria. La tasa de éxito a corto plazo fue de un 80 por ciento (según curvas de sobreviva a 10 meses promedio) por dos pacientes con cistocele intravaginal asintomático. Conclusiones: La reparación laparoscópica de defectos paravaginales es factible de ser realizada en nuestro servicio en forma segura y con una adecuada tasa de éxito. Mayor casuística y seguimiento se requieren para confirmar estos resultados.

Queloides auriculares: tratamiento quirúrgico y comprensivo / Surgical and comprenssive treatment of ear lobe keloids

Los queloides son el resultado de un proceso de cicatrización patológico, en el que los fibroblastos sintetizan colágeno en forma excesiva. Aunque se han descrito algunos factores predisponentes, su etiología es desconocida. Los queloides auriculares se asocian al empleo de aros, piercing, traumatismos, quemaduras y cirugías. Además de las repercusiones estéticas y psicológicas, suelen causar dolor, prurito y parestesias. Su manejo es controvertido, habiéndose descrito modalidades quirúrgicas y no quirúrgicas de tratamiento. Aunque ninguna de ellas es efectiva en todos los casos, su asociación parece tener mejores resultados. Se presenta una serie de 9 pacientes, con 13 queloides auriculares, en los que empleamos cirugía y comprensión, como pilares del tratamiento. Finalmente proponemos un algoritmo terapéutico.