[Artificial intelligence and its applications in medicine I: introductory background to AI and robotics]. / La inteligencia artificial y sus aplicaciones en medicina I: introducción antecedentes a la IA y robótica.

Technology and medicine follow a parallel path during the last decades. Technological advances are changing the concept of health and health needs are influencing the development of technology. Artificial intelligence (AI) is made up of a series of sufficiently trained logical algorithms from which machines are capable of making decisions for specific cases based on general rules. This technology has applications in the diagnosis and follow-up of patients with an individualized prognostic evaluation of them. Furthermore, if we combine this technology with robotics, we can create intelligent machines that make more efficient diagnostic proposals in their work. Therefore, AI is going to be a technology present in our daily work through machines or computer programs, which in a more or less transparent way for the user, will become a daily reality in health processes. Health professionals have to know this technology, its advantages and disadvantages, because it will be an integral part of our work. In these two articles we intend to give a basic vision of this technology adapted to doctors with a review of its history and evolution, its real applications at the present time and a vision of a future in which AI and Big Data will shape the personalized medicine that will characterize the 21st century.

A new scenario in metastatic renal cell carcinoma: a SOG-GU consensus.

BACKGROUND: This article describes and compares approved targeted therapies and the newer immunotherapy agents. MATERIALS AND METHODS: This article especially performs an in-depth review of currently available data for tivozanib, explaining its mechanism of action, its safety profile and its role as an efficacy drug in the management of renal cancer. RESULTS: Despite the fact that the treatment of advanced RCC has been dramatically modified in recent years, durable remissions are scarce and it remains a lethal disease. For first- and second-line therapy, there is now growing evidence to guide the selection of the appropriate treatment. CONCLUSIONS: Several TKIs are standard of care at different settings. Among those approved TKIs, tivozanib has similar efficacy than others with a better safety profile. The use of prognostic factors is critical to the selection of optimal therapy.

Estado de salud y autoeficacia en adultos mayores usuarios de atención primaria en salud / Health status and self -efficacy in elderly users in primary care

RESUMEN Objetivo: Identificar el nivel de autoeficacia percibida y su relación con variables biodemográficas y psicosociales en adultos mayores. Material y método: Diseño descriptivo correlacional, muestreo aleatorio estratificado, de 754 adultos mayores inscritos en centros de salud de Antofagasta, Chile. Mediciones: antecedentes socio-demográficos, estado de salud, autoeficacia percibida; Examen de Funcionalidad del Adulto Mayor (parte B); Calidad de vida relacionada con la salud, medida con el Cuestionario SF-12 y Fragilidad. Resultados: 61,4% de mujeres versus 38,6% de hombres; la edad osciló entre los 65 y 90 años, con una media de 73 años (DE= 6,0); el 78,9% declaró de dos a seis años de estudios. Los antecedentes mórbidos presentados con mayor frecuencia fueron: Hipertensión arterial, Dislipidemia y Diabetes Mellitus. El 86,3% no presentó depresión. La autopercepción de salud calificada como "excelente a buena" alcanzó sobre el 60%. La autoeficacia fue percibida alta en un 68,3%. La calidad de vida relacionada con salud global fue percibida con satisfacción por el 55,6%. Los niveles de fragilidad alcanzaron el 73,5%. El 59,3% de los adultos mayores fueron clasificados como autovalente sin riesgo. Se encontraron diferencias estadísticamente significativas entre las categorías de autoeficacia y temor a caerse, estado nutricional, depresión, calidad de vida relacionada con salud y la autopercepción de salud. Conclusión: Se identificó y relacionó una alta autoeficacia percibida, tanto en variables biodemográficas como psicosociales, que podría ser un factor facilitador para promover un envejecimiento activo.

ABSTRACT Objective: Identify the level of perceived self-efficacy and its relationship with biodemographic and psychosocial variables in older adults. Material and method: Descriptive correlational design, stratified random sampling, of 754 older adults registered in health centers of Antofagasta, Chile. Measurements : sociodemographic background, health status, perceived self-efficacy; Functional Test of the Elderly (part B); Quality of life related to health, measured with the SF-12 and Fragility Questionnaire. Results: 61.4% of participants were women and 38.6% were men; the ages ranged between 65 and 90 years, with an average of 73 years (SD = 6.0); 78.9% declared between two and six years of schooling. The morbid antecedents most frequently presented were: Arterial Hypertension, Dyslipidemia and Diabetes Mellitus. 86.3% did not present depression. Self-rated health rated "excellent to good" reached over 60%. Self-efficacy was perceived as high by 68.3% of participants. A 55.6% was satisfied with their quality of life in relation to global health. Fragility levels reached 73.5%. 59.3% of older adults were classified as self-reliant without risk. Statistically significant differences were found between the categories of self-efficacy and fear of falling, nutritional status, depression, quality of life related to health and self-perception of health. Conclusion: A high perceived self-efficacy was identified and related, both in biodemographic and psychosocial variables, which could be a facilitating factor to promote active aging.

Bone Density and Clinical Periodontal Attachment in Postmenopausal Women: A Systematic Review and Meta-Analysis.

Osteoporosis is a systemic skeletal disease characterized by low bone mineral density (BMD) and has been considered a risk factor for periodontal disease. The aim of this systematic review and meta-analysis was to verify the scientific evidence for the association of periodontal attachment loss with low BMD in postmenopausal women. A systematic search of the literature was performed in databases until August 2016, in accordance with Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Eligibility criteria included studies that compared clinical attachment loss (CAL) between postmenopausal women with low and normal BMD. Studies using similar methodology, with lower and higher risk of bias, were pooled into 3 different meta-analyses to compare CAL among women with normal BMD, osteoporosis, and osteopenia. In the first meta-analysis, mean CAL was compared among groups. In the other 2 meta-analyses, the mean percentages of sites with CAL ≥4 mm and ≥6 mm were respectively compared among groups. From 792 unique citations, 26 articles were selected for the qualitative synthesis. Eleven of the studies were appraised as presenting low risk of bias, and the association between low BMD and CAL was observed in 10 of these studies. Thirteen cross-sectional articles were included in the meta-analysis for osteoporosis and 9 in the osteopenia analysis. Women with low BMD presented greater mean CAL than those with normal BMD (osteoporosis = 0.34 mm [95% confidence interval (CI), 0.20-0.49], P < 0.001; osteopenia = 0.07 mm [95% CI, 0.01-0.13], P = 0.02). Only studies with lower risk of bias were available for the analysis of CAL severity. Women with low BMD presented more severe attachment loss, represented as mean percentage of sites with CAL ≥4 mm (osteoporosis = 3.04 [95% CI, 1.23-4.85], P = 0.001; osteopenia = 1.74 [95% CI, 0.36-3.12], P = 0.01) and CAL ≥6 mm (osteoporosis = 5.07 [95% CI, 2.74-7.40], P < 0.001). This systematic review and meta-analysis indicates that postmenopausal women with osteoporosis or osteopenia may exhibit greater CAL compared with women with normal BMD.

Indicadores de fragilidad en adultos mayores del sistema público de salud de la ciudad de Antofagasta / Rates of frailty among older people ascribed to chilean primary care clinics

Background: Frailty is not universal among older people but increases the risk of dependence. Aim: To assess frailty among older people and its relationship with biological, psychological and social factors. Material and Methods: Seven hundred fifty four older people aged 73 ± 6 years (61% females), attending a public primary care were assessed. Frailty was defined according to Fried criteria that considers inexplicable weight loss, tiredness, muscle weakness and lack of physical activity. Results: Absence of frailty, pre-frailty and frailty was found in 26, 69 and 5% of participants, respectively. Significant differences between frailty groups were observed for age, gender, years of studies, minimental and self-efficacy scores. Among participants defined as being in a pre-frail condition, 59% were non-disabled without risk and 41% non-disabled in risk, according to the functional assessment for older people used in Chilean primary care clinics. Conclusions: Frailty among older people is associated with increasing age, education, cognitive status and self-efficacy.

Cirugía no cardíaca en angioplastia coronaria reciente: alta utilidad de ecocardiografía transesofágica para monitorización intraoperatoria / No disponible

No disponible

[Cross sectional geriatric assessment of free living older subjects from Antofagasta, Chile]. / Valoración multidimensional del envejecimiento en la ciudad de Antofagasta.

BACKGROUND: The effects of aging on people must be evaluated to adequate sanitary actions. AIM: To assess the characteristics of older subjects living in Antofagasta, Chile. MATERIAL AND METHODS: Cross sectional assessment of 602 subjects without dementia, aged more than 60 years (55% females). A socioeconomic and medical history was obtained and Barthel, Lawton, Yesavage depression, Tromp fall risk and Folstein Mini mental scales were applied. RESULTS: Sixty eight percent of subjects had more than six years of studies. Forty six percent had hypertension, 28% had osteoarticular problems, 20% had hypercholesterolemia and 17% diabetes mellitus. Four percent had depression and falls were reported by 35%. Seventy four percent were independent in basic and instrumental activities. Ninety four percent had normal cognitive functions. Age was an important determinant of functional capacity. CONCLUSIONS: The main problems detected in this sample were the risk of falls and the presence of chronic diseases.

Valoración multidimensional del envejecimiento en la ciudad de Antofagasta / Cross sectional geriatric assessment of free living older subjects from Antofagasta, Chile

Background: The effects of aging on people must be evaluated to adequate sanitary actions. Aim: To assess the characteristics of older subjects living in Antofagasta, Chile. Material and Methods: Cross sectional assessment of 602 subjects without dementia, aged more than 60 years (55 percent females). A socioeconomic and medical history was obtained and Barthel, Lawton, Yesavage depression, Tromp fall risk and Folstein Mini mental scales were applied. Results: Sixty eight percent of subjects had more than six years of studies. Forty six percent had hypertension, 28 percent had osteoarticular problems, 20 percent had hypercholesterolemia and 17 percent diabetes mellitus. Four percent had depression and falls were reported by 35 percent. Seventy four percent were independent in basic and instrumental activities. Ninety four percent had normal cognitive functions. Age was an important determinant of functional capacity. Conclusions: The main problems detected in this sample were the risk of falls and the presence of chronic diseases.

Effect of different nitrogen sources on plant characteristics and yield of common bean (Phaseolus vulgaris L.).

Wastewater sludge can be used to fertilize crops, especially after vermicomposting (composting with earthworms to reduce pathogens). How wastewater sludge or vermicompost affects bean (Phaseolus vulgaris L.) growth is still largely unknown. In this study the effect of different forms of N fertilizer on common bean plant characteristics and yield were investigated in a Typic Fragiudepts (sandy loam) soil under greenhouse conditions. Beans were fertilized with wastewater sludge, or wastewater sludge vermicompost, or urea, or grown in unamended soil, while plant characteristics and yield were monitored (the unamended soil had no fertilization). Yields of common bean plants cultivated in unamended soil or soil amended with urea were lower than those cultivated in wastewater sludge-amended soil. Application of vermicompost further improved plant development and increased yield compared with beans cultivated in wastewater amended soil. It was found that application of organic waste products improved growth and yield of bean plants compared to those amended with inorganic fertilizer.

Emission of CO2 and N2O from soil cultivated with common bean (Phaseolus vulgaris L.) fertilized with different N sources.

Addition of different forms of nitrogen fertilizer to cultivated soil is known to affect carbon dioxide (CO(2)) and nitrous oxide (N(2)O) emissions. In this study, the effect of urea, wastewater sludge and vermicompost on emissions of CO(2) and N(2)O in soil cultivated with bean was investigated. Beans were cultivated in the greenhouse in three consecutive experiments, fertilized with or without wastewater sludge at two application rates (33 and 55 Mg fresh wastewater sludge ha(-1), i.e. 48 and 80 kg N ha(-1) considering a N mineralization rate of 40%), vermicompost derived from the wastewater sludge (212 Mg ha(-1), i.e. 80 kg N ha(-1)) or urea (170 kg ha(-1), i.e. 80 kg N ha(-1)), while pH, electrolytic conductivity (EC), inorganic nitrogen and CO(2) and N(2)O emissions were monitored. Vermicompost added to soil increased EC at onset of the experiment, but thereafter values were similar to the other treatments. Most of the NO(3)(-) was taken up by the plants, although some was leached from the upper to the lower soil layer. CO(2) emission was 375 C kg ha(-1) y(-1) in the unamended soil, 340 kg C ha(-1) y(-1) in the urea-amended soil and 839 kg ha(-1) y(-1) in the vermicompost-amended soil. N(2)O emission was 2.92 kg N ha(-1) y(-1) in soil amended with 55 Mg wastewater sludge ha(-1), but only 0.03 kg N ha(-1) y(-1) in the unamended soil. The emission of CO(2) was affected by the phenological stage of the plant while organic fertilizer increased the CO(2) and N(2)O emission, and the yield per plant. Environmental and economic implications must to be considered to decide how many, how often and what kind of organic fertilizer could be used to increase yields, while limiting soil deterioration and greenhouse gas emissions.

La tiroides como modelo de mecanismos moleculares en enfermedades geneticas / The thyroid as a model for molecular mechanisms in genetic diseases

Las enfermedades tiroideas constituyen una heterogénea colección de anormalidades asociadas a mutaciones en los genes responsables en el desarrollo de la tiroides: factor de transcripción tiroideo 1 (TTF-1), factor de transcripción tiroideo 2 (TTF-2) y PAX8, o en uno de los genes que codifican para las proteínas involucradas en la biosíntesis de hormonas tiroideas como tiroglobulina (TG), tiroperoxidasa (TPO),sistema de generación de peróxido de hidrógeno (DUOX2), cotransportdor de Na/I¹ (NIS), pendrina (PDS), TSH y receptor de TSH. El hipotiroidismo congénito ocurre con una prevalencia de 1 en 4.000 nacidos. Los pacientes coneste síndrome pueden ser divididos en dos grupos: con hipotiroidismo congénito sin bocio (disembriogénesis) o con bocio (dishormonogénesis). El grupo de disembriogénesis, que corresponde al 85% de los casos, resulta de ectopía,agenesia o hipoplasia. En una minoría de estos pacientes, el hipotiroidismo congénito está asociado con mutaciones en los genes TTF-1, TTF-2, PAX-8, TSH o TSHr. La resencia de bocio congénito (15% de los casos) se ha asociado a mutaciones en los genes NIS, TG, TPO, DUOX2 o PDS. El hipotiroidismo congénito por dishormonogénesis es trasmitido en forma autonómica recesiva. Mutaciones somáticas en el TSHr han sido identificadas en adenomas tiroideos hiperfuncionantes. Otra enfermedad tiroidea bien establecida es la resistencia a hormonas tiroideas(RTH). Es un síndrome de reducida respuesta tisular a la acción hormonal causado por mutaciones localizadas en el gen del receptor de hormonas tiroideas (TR). Mutantes de TRinterfieren con la función del receptor normal por un mecanismo de dominancia negativa. En conclusión, la identificación de mutaciones en los genes de expresión tiroidea ha permitido un mayor entendimiento sobre la relación estructura-función de los mismos. La tiroides constituye un excelente modelo para el estudio molecular de las enfermedades genéticas. (AU)

La tiroides como modelo de mecanismos moleculares en enfermedades geneticas / The thyroid as a model for molecular mechanisms in genetic diseases

Las enfermedades tiroideas constituyen una heterogénea colección de anormalidades asociadas a mutaciones en los genes responsables en el desarrollo de la tiroides: factor de transcripción tiroideo 1 (TTF-1), factor de transcripción tiroideo 2 (TTF-2) y PAX8, o en uno de los genes que codifican para las proteínas involucradas en la biosíntesis de hormonas tiroideas como tiroglobulina (TG), tiroperoxidasa (TPO),sistema de generación de peróxido de hidrógeno (DUOX2), cotransportdor de Na/I– (NIS), pendrina (PDS), TSH y receptor de TSH. El hipotiroidismo congénito ocurre con una prevalencia de 1 en 4.000 nacidos. Los pacientes coneste síndrome pueden ser divididos en dos grupos: con hipotiroidismo congénito sin bocio (disembriogénesis) o con bocio (dishormonogénesis). El grupo de disembriogénesis, que corresponde al 85% de los casos, resulta de ectopía,agenesia o hipoplasia. En una minoría de estos pacientes, el hipotiroidismo congénito está asociado con mutaciones en los genes TTF-1, TTF-2, PAX-8, TSH o TSHr. La resencia de bocio congénito (15% de los casos) se ha asociado a mutaciones en los genes NIS, TG, TPO, DUOX2 o PDS. El hipotiroidismo congénito por dishormonogénesis es trasmitido en forma autonómica recesiva. Mutaciones somáticas en el TSHr han sido identificadas en adenomas tiroideos hiperfuncionantes. Otra enfermedad tiroidea bien establecida es la resistencia a hormonas tiroideas(RTH). Es un síndrome de reducida respuesta tisular a la acción hormonal causado por mutaciones localizadas en el gen del receptor de hormonas tiroideas (TR). Mutantes de TRinterfieren con la función del receptor normal por un mecanismo de dominancia negativa. En conclusión, la identificación de mutaciones en los genes de expresión tiroidea ha permitido un mayor entendimiento sobre la relación estructura-función de los mismos. La tiroides constituye un excelente modelo para el estudio molecular de las enfermedades genéticas.

Onicomicosis: consideraciones epidemiológicas de nuestra casuítica / Onychomicosis: etiologycal considerations

El objetivo del trabajo es el análisis de la frecuencia de onicomicosis y sus agentes etiológicos en un centro privado dermatológico de la ciudad de Resistencia y la revisión del tema. Se examinaron 300 pacientes de los cuales fueron seleccionados 200, de ambos sexos, con lesiones clínicamente compatibles con onicomicosis, examen micológico directo y cultivo positivos. En el análisis se determinó la frecuencia según sexo, edad, localización y etiología de las micosis ungulares. La prevalencia fue 69 por ciento en mujeres y 31 por ciento en hombres. El agente patógeno predominante fue Trichophyton rubrum. Hemos determinado además una alta frecuencia de onicomicosis por hongos filamentosos no dermatófitos (HFND) (21,5 por ciento), mayor que la informada en la bibliografía consultada (AU)

Onicomicosis: consideraciones epidemiológicas de nuestra casuítica / Onychomicosis: etiologycal considerations

El objetivo del trabajo es el análisis de la frecuencia de onicomicosis y sus agentes etiológicos en un centro privado dermatológico de la ciudad de Resistencia y la revisión del tema. Se examinaron 300 pacientes de los cuales fueron seleccionados 200, de ambos sexos, con lesiones clínicamente compatibles con onicomicosis, examen micológico directo y cultivo positivos. En el análisis se determinó la frecuencia según sexo, edad, localización y etiología de las micosis ungulares. La prevalencia fue 69 por ciento en mujeres y 31 por ciento en hombres. El agente patógeno predominante fue Trichophyton rubrum. Hemos determinado además una alta frecuencia de onicomicosis por hongos filamentosos no dermatófitos (HFND) (21,5 por ciento), mayor que la informada en la bibliografía consultada

[Molecular genetics of the thalassemias in Argentina]. / Genética molecular de las talasemias en Argentina.

PURPOSE: Was to establish the molecular genetics of thalassemias in Argentina. PATIENTS AND METHODS: Genomic DNA was amplified by PCR and six point mutations in the beta-globin gene were investigated by Dot Blot hybridization using oligonucleotide probes. The most frequent alpha-thalassemia deletions were studied by Southern Blotting. Patients were distributed in 4 groups: a) 109 beta-thalassemic carriers; b) 15 thalassemia major patients; c) 2 thalassemia intermedia patients and d) 14 probable alpha-thalassemic carriers. RESULTS: The distribution of mutated alleles in the group a) was: IVS-1 nt 1: 13.76%, IVS-1 nt 6: 7.34%, IVS-1 nt 110: 23.85%, codon 39: 39.45%, IVS-2 nt 1: 3.68% e IVS-2 nt 745: 1.83%, 10.01% could not be determined with the probes used; in the group b) the allelic distribution was similar and the compound genetic genotype were predominant related to homocygous ones; in the group c): we confirmed the presence of one beta-thalassemia mutation and a alpha gene triplication (alpha alpha alpha) in the 2 patients studied. The alpha-thalassemia character was confirmed in 8 patients of the group d) (6 had -alpha 3,7/alpha alpha genotype and 2,-alpha 3,7/-alpha 3,7 genotype). CONCLUSIONS: This study indicates that the analysis of 6 mutations in the beta-globin gene and the alpha-globin gene deletions are an effective strategy to identify thalassemias in Argentina.

Protective effects of zinc in indomethacin-induced gastric mucosal injury: evidence for a dual mechanism involving lipid peroxidation and nitric oxide.

BACKGROUND: Indomethacin causes gastric mucosal injury, although the pathogenesis is not fully understood. Zinc, is known to have gastroprotective effects in both humans and experimental animals. AIM: To determine (i) the protective effects of zinc in indomethacin-induced gastric mucosal injury in rats, and (ii) whether these cytoprotective effects are mediated by changes in gastric lipid peroxidation and/or nitric oxide synthase activity. METHODS: Gastric lesions were induced in rats by the intragastric administration of indomethacin. Morphological changes, lipid peroxidation (malondialdehyde levels) and nitric oxide synthase activity were determined in animals pre-treated with zinc sulphate and in controls. RESULTS: Indomethacin significantly increased malondialdehyde levels and decreased NOS activity. These effects were attenuated by pre-treatment with zinc (P < 0.005 and 0.0001, respectively). The protective effects of zinc were readily abolished in animals pre-treated with N-nitro-L-arginine methyl ester (L-NAME). Morphologically, indomethacin induced large areas of mucosal ulcerations, which were completely prevented by zinc pre-treatment. CONCLUSIONS: Zinc provides protection against indomethacin-induced gastric mucosal injury. These protective effects result from the inhibition of lipid peroxidation and the preservation of mucosal nitric oxide synthase.

Intoxicación con ion cobre en ratas preñadas y su efecto en formación de centros primarios de osificación en fetos / Cooper ion intoxication in pregnant rats and their effects on the primary ossification center in fetus

La actividad socioeconómica de la II Región de Chile es la minería del cobre, generándose subproductos que son eliminados al medio. Se ha informado en centros industrializados, que los metales pesados se transfieren de las madres a los fetos, vía placenta. Se propone conocer la bioacumulación de cobre en órganos y fluidos en ratas gestantes y su efecto en la formación de centros primarios de osificación (CPO). Hembras de tres meses Sprague Dowley, se ciclan y se cruzan en estro. Al octavo día de gestación, se inyectan i.p. con 1 ml de CuSO en concentraciones 1024, 512, 256, 128 y 64 ppm y suero fisiológico, el grupo control. A los 18 días, se sacrifican y se evalúan los fetos, procesándose por técnicas de tinción, diafanización e histológica. Secciones de 5 um se tiñen con azul de Alcian /Azul de Toluidina. Se recupera sangre materna, membranas amniocoriónica, líquido amniótico y placenta, entre grupos tratados y controles. Una diferencia significativa en la formación de los CPO en vértebras y dorsales, se encontró con el tratamiento de 256 ppm, en comparación con el control (p<0.05). No se observaron anomalías externas. Se infiere que ión cobre se transfiere a los fetos vía placenta, bioacumulándose en el hígado e induciendo alteraciones o retardo en la formación de CPO, especialmente a nivel de vértebras cervicales y dorsales; observándose microscópicamente en dichas zonas, ausencias de tejido cartilaginoso característico