[The long and winding road of the clinical pharmacy in Chile]. / El largo y sinuoso camino de la farmacia clinica en Chile.

Clinical pharmacy is a health discipline in which pharmacists provide patient care that optimizes rational medication use and promotes health, wellness and disease prevention. The beginnings of clinical pharmacy in Chile were inspired by the origin in the School of Pharmacy of the University of California, San Francisco (UCSF), in the mid-1960s. However, the historical development in our country, both in teaching and in the professional field, was accompanied by difficulties and success, which became a long and winding road. This article shares the events that gave rise to its beginnings in Chile, first through teaching, then in pharmacovigilance and clinical pharmacokinetics, to later describe its professional expansion and recognition as a specialty of pharmacy. This article briefly recounts the history of the Chilean clinical pharmacy to this day. Some names of people or institutions were not mentioned. Therefore the authors apologize in advance to pharmacists and organizations whose contribution cannot be recognized in this way. However, we know that this specialty has not been forged only by the names that appear, but by all those who love and respect the work of the clinical pharmacy.

Consenso de la Sociedad Chilena de Infectología para el manejo de episodios de neutropenia febril en adultos y niños con cáncer

El Comité de Infecciones en Inmunocomprometidos de la Sociedad Chilena de Infectología presenta aquí una actualización en el Manejo de episodios de neutropenia febril en adultos y niños con cáncer, derivado de los grandes cambios ocurridos en los últimos años en el enfrentamiento de estos pacientes. Para estos efectos, un grupo multidisciplinario desarrolló recomendaciones en relación a: su enfrentamiento inicial, exámenes de laboratorio requeridos, el tratamiento antimicrobiano inicial empírico y frente a focos infecciosos conocidos, las infecciones fúngicas invasoras y profilaxis antimicrobiana.

The Committee of Infections in Immunocompromised Patients of the Chilean Society of Infectious Diseases presents an update in the Management of febrile neutropenia in adults and children with cancer. It comes from the significant changes that occurred in recent years in the confrontation of these patients. For which a multidisciplinary task force group developed recommendations in relation to their initial handling, laboratory exams required, the initial empirical antimicrobial treatment and in front of known infectious focus, invasive fungal infections and antimicrobial prophylaxis.

DDC_Calc, software para diagnosticar la displasia del desarrollo de cadera en lactantes (versión 1)

Fundamento la displasia del desarrollo de la cadera constituye la afección más frecuente del desarrollo del sistema musculoesquelético. En el contexto del diagnóstico radiográfico de esta enfermedad en el lactante, las radiografías digitales ofrecen ventajas que pudieran ser aprovechadas para un diagnóstico más preciso. Objetivo describir el funcionamiento del software DDC_Calc para realizar mediciones radiográficas en formato digital. Métodos se realizó un estudio de innovación tecnológica durante el año 2019, en el Hospital Pediátrico Universitario Paquito González Cueto, de Cienfuegos, concretamente en el Servicio de Ortopedia y con la contribución de personal de la Facultad de Matemática, Física y Computación, de la Universidad Central "Marta Abreu", de Las Villas. Se utilizó el algoritmo de visión artificial Viola-Jones para la detección de las estructuras, así como un sistema basado en reglas con vistas a una sugerencia del diagnóstico. Resultados el software integró las herramientas necesarias para la realización de las mediciones utilizadas (ángulos, distancias, posiciones) en el diagnóstico radiográfico de la displasia del desarrollo de cadera. Fueron descritas sus funcionalidades, requisitos y funcionamiento de la aplicación, partiendo de un caso clínico real, todo esto ilustrado con imágenes. Conclusiones el empleo del software facilita la realización de mediciones más exactas por parte del médico, de modo que garantiza mayor calidad en el diagnóstico y la preservación de los hallazgos radiográficos iniciales, los cuales resultan de gran utilidad en el seguimiento radiográfico de la afección en el tiempo.

Background developmental dysplasia of the hip constitutes the most frequent affection for the development of the musculoskeletal system. In the context of radiographic diagnosis of this disease in infants, digital radiographs offer advantages that could be used for a more accurate diagnosis. Objective to describe the DDC_Calc software operation to perform radiographic measurements in digital format. Methods a technological innovation study was carried out during 2019, at the Paquito González Cueto University Pediatric Hospital, in Cienfuegos, specifically in the Orthopedics Service and with the specialists' contribution from the "Marta Abreu" Central University' Mathematics, Physics and Computing Faculty, Las Villas. The Viola-Jones artificial vision algorithm was used for the detection of the structures, as well as a rule-based system with a view to a diagnostic suggestion. Results the software integrated the necessary tools to carry out the measurements used (angles, distances, positions) in the radiographic diagnosis of developmental dysplasia of the hip. Its functionalities, requirements and operation of the application were described, based on a real clinical case, all illustrated with images. Conclusions the use of the software facilitates the performance of more accurate measurements by the doctor, thus guaranteeing higher quality in the diagnosis and the preservation of the initial radiographic findings, which are very useful in the radiographic follow-up of the condition in time.

El largo y sinuoso camino de la farmacia clinica en Chile / The long and winding road of the clinical pharmacy in Chile

Clinical pharmacy is a health discipline in which pharmacists provide patient care that optimizes rational medication use and promotes health, wellness and disease prevention. The beginnings of clinical pharmacy in Chile were inspired by the origin in the School of Pharmacy of the University of California, San Francisco (UCSF), in the mid-1960s. However, the historical development in our country, both in teaching and in the professional field, was accompanied by difficulties and success, which became a long and winding road. This article shares the events that gave rise to its beginnings in Chile, first through teaching, then in pharmacovigilance and clinical pharmacokinetics, to later describe its professional expansion and recognition as a specialty of pharmacy. This article briefly recounts the history of the Chilean clinical pharmacy to this day. Some names of people or institutions were not mentioned. Therefore the authors apologize in advance to pharmacists and organizations whose contribution cannot be recognized in this way. However, we know that this specialty has not been forged only by the names that appear, but by all those who love and respect the work of the clinical pharmacy.

Mediciones radiográficas y diagnóstico de la displasia de cadera del lactante mediante visión computacional y sistema basado en reglas / Radiographic Measurements and Diagnosis of Hip Dysplasia in Infants Using Computer Vision and a Rule-Based System

RESUMEN Fundamento el uso de radiografías digitales para el diagnóstico de la displasia del desarrollo de la cadera permite, además del diagnóstico precoz y mayor eficiencia del trabajo, realizar mediciones más precisas, el seguimiento del paciente y la planificación quirúrgica. Objetivo describir una herramienta capaz de detectar estructuras y puntos de interés de forma semiautomática para realizar las mediciones y cálculos necesarios con vistas al diagnóstico de la displasia de cadera en lactantes. Métodos estudio de innovación tecnológica, donde se utilizó el algoritmo de visión artificial Viola-Jones para la detección de las estructuras, así como un sistema basado en reglas con vistas a una sugerencia del diagnóstico. La herramienta propuesta (Software para las mediciones radiográficas con vistas al diagnóstico de la displasia del desarrollo de cadera en lactantes) se encuentra en fase de prueba y explotación en el Hospital Pediátrico Universitario Paquito González Cueto, de Cienfuegos. Para validar los resultados se tomaron estudios radiográficos de 12 casos, a los cuales se aplicaron las mediciones con el método tradicional y luego mediante el software. Resultados se obtuvo un sistema con vistas a determinar estructuras en las imágenes de radiografía de cadera, las cuales permiten obtener puntos y líneas para calcular los indicadores de displasia. La tasa de acierto al detectar las estructuras fue del 100 %. Conclusión existió una alta coincidencia entre las medidas calculadas por el algoritmo y las calculadas manualmente. La correspondencia entre el diagnóstico predicho por el sistema y el emitido por los médicos especialistas también fue elevada.

ABSTRACT Background the use of digital radiographs for the diagnosis of developmental dysplasia of the hip allows, in addition to early diagnosis and greater work efficiency, more precise measurements, patient monitoring and surgical planning. Objective to describe a tool capable of detecting structures and points of interest in a semi-automatic way to carry out the necessary measurements and calculations with a view to diagnosing hip dysplasia in infants. Methods study of technological innovation, where the Viola-Jones artificial vision algorithm was used for the detection of structures, as well as a rule-based system with a view to a diagnosis suggestion. The proposed tool (Software for radiographic measurements for diagnosing developmental dysplasia of the hip in infants) is in the testing and exploitation phase at the Paquito González Cueto University Pediatric Hospital, in Cienfuegos. To validate the results, radiographic studies of 12 cases were chosen, to which measurements were applied using the traditional method and then using the software. Results a system was obtained with a view to determining structures in hip radiography images, which allow points and lines to be obtained to calculate dysplasia indicators. The success rate in detecting the structures was 100%. Conclusion there was a high coincidence between the measures calculated by the algorithm and those calculated manually. The correspondence between the diagnosis predicted by the system and that issued by specialist doctors was also high.

Consenso de farmacia clínica intensiva a nivel nacional / Consensus about the duties of pharmacists in intensive care units in Chile

In 2015, the directors of the Clinical Pharmacists Division of the Chilean Society of Intensive Care Medicine (SOCHIMI) organized a collaborative work along the country to define the minimum activities and duties that a pharmacist should perform in an Intensive Care Unit in Chile, according to the Ministry of Health and SOCHIMI guidelines and recommendations. This document summarizes the agreements on three priority areas of pharmacists' duties in intensive care: a) pharmacotherapy follow-up; b) pharmacological surveillance and security management of medications, and c) data recording and documentation. The recommendations collect the experiences from Chilean pharmacists along the country and provide information and support for future consensus for other specialties.

[Consensus about the duties of pharmacists in intensive care units in Chile]. / Consenso de farmacia clínica intensiva a nivel nacional.

In 2015, the directors of the Clinical Pharmacists Division of the Chilean Society of Intensive Care Medicine (SOCHIMI) organized a collaborative work along the country to define the minimum activities and duties that a pharmacist should perform in an Intensive Care Unit in Chile, according to the Ministry of Health and SOCHIMI guidelines and recommendations. This document summarizes the agreements on three priority areas of pharmacists' duties in intensive care: a) pharmacotherapy follow-up; b) pharmacological surveillance and security management of medications, and c) data recording and documentation. The recommendations collect the experiences from Chilean pharmacists along the country and provide information and support for future consensus for other specialties.

Pharmacokinetic Assessment of Vancomycin Loading Dose in Critically Ill Patients.

The vancomycin loading dose (LD) of 25 to 30 mg/kg is a frequently practiced strategy to achieve effective concentrations from the first-treatment dose. However, considering only the body weight for dosing might be inadequate in critically ill patients due to pharmacokinetics changes. We sought to assess achieving optimal trough serum levels of vancomycin and AUC0-24/MIC in the first 24 h of treatment by using an LD based on population pharmacokinetic parameters of critically ill patients. We performed a concurrent cohort study over 22 months of patients with severe sepsis who received intravenous vancomycin. The patients were treated with three different strategies to initiate vancomycin: without an LD (group A), with an LD of 25 to 30 mg/kg (group B), and with an LD based on population pharmacokinetic parameters of the critically ill patient (group C). An optimal trough serum concentration was achieved in 5, 9, and 83% of patients in groups A, B, and C, respectively. The number of patients that reached optimal AUC0-24 was 2 of 18 (11%), 5 of 11 (46%), and 11 of 12 (92%) in groups A, B, and C, respectively. The statistical analysis for both parameters revealed significant differences in group C with respect to other groups. The administration of the LD calculated from population pharmacokinetic parameters from the beginning of therapy is a more efficient strategy to obtain adequate trough serum concentrations and AUC0-24/MIC in critical patients.

[Assessment of an active pharmacovigilance system carried out by a pharmacist]. / Impacto clínico de un sistema de farmacovigilancia activa realizado por un farmacéutico en el reporte y subnotificación de reacciones adversas a medicamentos.

BACKGROUND: Despite the importance of notifying and preventing adverse drug reactions (ADRs), they are under reported and their consequences are not adequately evaluated. AIM: To assess the impact of a pharmacovigilance system carried out by a pharmacist. MATERIAL AND METHODS: In an internal medicine service, the spontaneous report of ADRs was compared blindly with an active pharmacovigilance system in which a pharmacist detected, monitored and prevented ADRs. RESULTS: A total of 1,196 patients was included. Of these 604 were hospitalized in intervened wards, where 50 suspected ADRs in 47 patients were reported. In non-intervened wards, only three ADRs were spontaneously reported. Therefore, the pharmacovigilance system significantly improved the detection and report of ADRs with a risk ratio of 15.4 (95% confidence intervals 4.8-49.1). Sixty six percent of ADRs were classified as severe. Antimicrobials were the main group of medications causing ADRs in 44% of reports. Forty three percent of ADRs were preventable and prolonged hospital stay by a mean of eight days. CONCLUSIONS: An active pharmacovigilance system carried out by pharmacists improves the detection of ADRs and promotes its prevention.

Impacto clínico de un sistema de farmacovigilancia activa realizado por un farmacéutico en el reporte y subnotificación de reacciones adversas a medicamentos / Assessment of an active pharmacovigilance system carried out by a pharmacist

Background: Despite the importance of notifying and preventing adverse drug reactions (ADRs), they are under reported and their consequences are not adequately evaluated. Aim: To assess the impact of a pharmacovigilance system carried out by a pharmacist. Material and Methods: In an internal medicine service, the spontaneous report of ADRs was compared blindly with an active pharmacovigilance system in which a pharmacist detected, monitored and prevented ADRs. Results: A total of 1,196 patients was included. Of these 604 were hospitalized in intervened wards, where 50 suspected ADRs in 47 patients were reported. In non-intervened wards, only three ADRs were spontaneously reported. Therefore, the pharmacovigilance system significantly improved the detection and report of ADRs with a risk ratio of 15.4 (95% confidence intervals 4.8-49.1). Sixty six percent of ADRs were classified as severe. Antimicrobials were the main group of medications causing ADRs in 44% of reports. Forty three percent of ADRs were preventable and prolonged hospital stay by a mean of eight days. Conclusions: An active pharmacovigilance system carried out by pharmacists improves the detection of ADRs and promotes its prevention.

Estilo cognitivo predominante en estudiantes de Fisioterapia de la Universidad Nacional de Colombia / Predominant cognitive style in Physiotherapy students of the Universidad Nacional de Colombia

Antecedentes. El estilo cognitivo es un modo habitual de procesar la información y resulta ser una característica consciente y estable del individuo que se trasluce en todas las tareas. Objetivo. Determinar los estilos de aprendizaje de estudiantes de Fisioterapia de la Universidad Nacional de Colombia y su correspondencia con el tipo de habilidades cognitivas consideradas como necesarias en esta área del conocimiento. Materiales y métodos. Se aplicó la prueba de figuras enmascaradas, utilizada para la determinación del estilo cognitivo en la dimensión de independencia-dependencia de campo. Además, se aplicó una encuesta para caracterizar los entornos socioculturales y un cuestionario para identificar preferencias de aprendizaje y estudio. Resultados. En la prueba de estilos cognitivos, la mayoría de los estudiantes de Fisioterapia se caracterizó por ser dependiente de campo (65,8%). De acuerdo con el semestre, el 60% de los estudiantes de segundo semestre fueron clasificados como sensibles o dependientes de campo y los de sexto semestre fueron caracterizados por tener un estilo cognitivo muy sensible a las influencias del medio. Según el análisis de correspondencias múltiples se encontró que la mayoría de los estudiantes de sexto semestre, que eran muy sensibles al medio, casi nunca realizaron actividades deportivas antes de su ingreso a la universidad, disponían de computador e internet para llevar a cabo sus actividades académicas y casi siempre preparaban previamente su lugar de estudio. Por el contrario, los estudiantes de segundo semestre se caracterizaban por realizar actividades deportivas antes de su ingreso a la universidad. Conclusiones. El estilo cognitivo predominante en los estudiantes de la carrera de Fisioterapia fue el de dependencia de campo, lo cual puede facilitar el aprendizaje, si se correlaciona esta característica con el perfil del egresado.

Background. Cognitive style is a common way to process information and it is a conscious and stable individual that comes through in all tasks feature. Objective. The purpose of this paper is to define the learning styles of physiotherapy students of the Universidad Nacional de Colombia and the link with the type of cognitive skills considered as necessary within this knowledge area. Materials and methods. A masked figure test was used for determining cognitive style in the field independence-dependence dimension. A socio cultural survey and a questionnaire were also used for identifying learning and studying preferences. Results. Most of the physiotherapy students were field-dependent students (65.8%). According to the semester, 60% of the second semester students were classified as sensitive or field-dependent students in the cognitive styles test. The sixth semester students were characterized by having a sensitive cognitive style to environmental influences. According to the link analysis, most of the sixth semester students, sensitive to the environment, hardly ever exercised before getting into university; they got computers and the internet to do homework and they the most of the time got a good place to study. On the other hand, the second semester students practiced sports before admission to university. Conclusions. The field-dependent cognitive style predominated in the Physiotherapy students, which could make learning easier if this is correlated with the graduate profile.

Síndrome de DRESS: eritema cutáneo, fiebre y hepatitis asociado a lamotrigina: reporte de dos casos y revisión de la literatura / DRESS syndrome: skin rash, fever and acute hepatitis associated to lamotrigine: report of two cases and review of the literature

DRESS syndrome is an infrequent adverse drug reaction but in some cases may be life-threatening. It is characterized by cutaneous rash, systemic symptoms and eosinophilia. It is usually caused by aromatic anticonvulsants, sulfonamides and some antiviral drugs, among others. In this article we present two cases of drug induced hypersensitivity syndrome with rash, systemic symptoms (DRESS) associated to lamotrigine therapy with hepatic involvement and a review of the literature. The first case is a 78 year-old woman, presenting with myalgia, fever, abdominal pain and skin rash on her face and extremities. Labora¬tory tests revealed alteration of hepatic profile with hepatocellular pattern. After ruling out other causes, she recognized recent use of lamotrigine. The drug was withdrawn and she had a favourable evolution. The second case is a 30 year-old woman being treated for depression who presented with rash, adenopathies, fever and alteration of hepatic profile twenty four days after starting lamotrigine. Infectious causes were ruled out and she had a good response to corticosteroid treatment.

El síndrome de DRESS es una reacción adversa a medicamentos, poco frecuente pero potencialmente letal. Se caracteriza por eritema cutáneo, síntomas sistémicos y eosinofilia. Suele ser producido por los anticonvulsivantes aromáticos, sulfonamidas y algunos fármacos antivirales, entre otros. En este artículo presentamos dos casos de DRESS secundario a lamotrigina con compromiso hepático y revisión de la literatura. El primero de ellos, una mujer de 78 años, consulta por mialgias, fiebre, dolor abdominal y eritema maculopapular en cara y extremidades. Los exámenes de laboratorio revelaron alteración de pruebas de función hepática con patrón hepatocelular. Luego de descartar otras causas, la paciente reconoció uso reciente de lamotrigina. Se suspendió la droga y evolucionó favorablemente. El segundo caso es una mujer de 30 años en tratamiento por trastorno depresivo quien, veinticuatro días post-inicio de lamotrigina, comienza con eritema, adenopatías, fiebre y alteración de pruebas de función hepática, excluyéndose etiologías infecciosas; se inicia tratamiento corticoesteroidal con buena respuesta.

High yield selective acylation of polyamines: proton as protecting group.

An advance in the selective acylation of polyamines having identical or similar amine functions is reported. While nucleophilicity differences between the various amine functions are slight, the corresponding conjugate acids exhibit pKa values over a significant range. We have used proton as polyamine protecting group: the monoamine resulting from single deprotonation of a polyammonium compound has allowed for high yields of selective acylation.

Synthetic vaccine update: applying lessons learned from recent SPf66 malarial vaccine physicochemical, structural and immunological characterization.

The SPf66 synthetic malaria vaccine, developed and obtained almost 2 decades ago, represents the first approach towards developing a multi-antigenic, multi-stage synthetic malarial vaccine composed of subunits derived from different Plasmodium falciparum stage proteins. It is shown here that batches 03, 04, 05, 06, 07, 08, 09, 10, 11, 12, 13, 14, 15 and 16 produced from a few milligrams to kilogram amounts and used in assays on monkeys and humans showed high reproducibility in physicochemical analysis. (1)H NMR two-dimensional studies also revealed high similarity, even in non-oxidized batches. Reproducibility was also high, especially in preclinical studies carried out on Aotus, clinical trials Phase I, IIa and IIb and field-studies carried out in La Tola, Rio Rosario (Colombia), Majadas (Venezuela), La Te (Ecuador), Ifakara (Tanzania) in which there was high antibody titer production, having similar population distribution when done with different batches. These results provide great support for peptide-synthesized vaccines containing minimal epitopes from protection-inducing antigens which have several advantages, such as low cost, safety, reproducibility, stability, being straightforwardly scaled-up from milligram to kilogram amounts; make them the vaccines of choice for the future in a worldwide attempt to scourge diseases such as malaria.

Solid-phase parallel synthesis of 4-beta-D-ribofuranosylpyrazolo[4,3-d]pyrimidine nucleosides.

The synthesis of pyrazolo[4,3-d]pyrimidine nucleoside library using solid-phase parallel synthesis methodology is described. Glycosylation of the trimethylsilyl (TMS) derivative of 1- and 2-(methyl)-1H and 2H-pyrazolo[4,3-d]pyrimidine-5,7-(4H, 6H)-dione (5) with 1-O-acetyl-2,3,5-tri-O-benzoyl-D-ribofuranose in the presence of TMS triflate provided two novel protected nucleosides 6 and 7. The structures of 6 and 7 were assigned by 1H and 2D NMR experiments. Nucleosides 6 and 7 were then transformed to the key intermediates 12 and 15 respectively. Reaction of 12 and 15 with MMTCl resin in the presence of 2,6-lutidine afforded the necessary scaffolds B and C. Different amines (96) were introduced selectively by nucleophilic substitution on scaffolds B and C using solid-phase parallel semi-automated synthesizer. Cleavage of the products from the solid support with 30% HFIP in a parallel fashion yielded nucleoside libraries simultaneously, and they were analyzed and characterized by high-throughput LC-MS.

Synthesis of nucleoside libraries on solid support. I. N2,N6-disubstituted diaminopurine nucleosides.

Starting with 2-iodo-6-chloro-9-(beta-D-ribofuranosyl)purine, a library of more than 1,300 N2,N6-polysubstituted diaminopurine nucleosides was created. The starting material was condensed with a polystyrene monomethoxytrityl resin and a pool of primary and secondary amines was used to displace the 6-chloro atom with high regioselectivity. The 2-iodo was subsequently displaced by various primary amines. Nucleosides were cleaved from the resin with hexafluoroisopropanol solutions. A majority of compounds reached a purity of more than 80% without the need for any type of purification.

Synthesis of nucleoside libraries on solid support. II. 2,6,8-Trisubstituted purine nucleosides using 8-bromoguanosine as precursor.

A series of 2,6,8-trisubstituted purine nucleoside libraries was prepared by parallel solid-phase synthesis using 8-bromoguanosine as a common synthetic precursor. Polystyrene-methoxytrityl chloride resin was linked to the N2 or O5' position of the guanosine analogues. 8-Bromoguanosine was derivatized at the C8 position via carbon-carbon bond formation. Nucleophilic aromatic substitution at C2 and/or C6 positions with various amines produced two series of purine nucleoside libraries with very diverse substitution.

Synthesis of stable derivatives of c(62): the first nonclassical fullerene incorporating a four-membered ring.

A rational synthetic approach to the first four-membered ring-containing derivatives of C(62) is reported. They were synthesized by an inverse electron demand Diels-Alder reaction of 3,6-diaryl-1,2,4,5-tetrazines with C(60) in o-dichlorobenzene, followed by visible light irradiation at reflux. The structure of these nonclassical fullerenes derivatives was determined by X-ray single-crystal diffraction.

Safety, tolerability and immunogenicity of new formulations of the Plasmodium falciparum malaria peptide vaccine SPf66 combined with the immunological adjuvant QS-21.

SPf66 is a synthetic malaria peptide vaccine, which has been widely tested in combination with aluminium hydroxide (alum) as the adjuvant. Since this formulation is weakly immunogenic, we sought to improve its immunogenicity by using the saponin adjuvant QS-21. SPf66/QS-21 vaccines were evaluated for safety, tolerability and immunogenicity in healthy adults. The vaccines were found to be safe in 87/89 (97.8%) volunteers studied. However, two individuals developed severe vaccine allergy following the third dose of 1/3 SPf66/QS-21 formulations tested. Vaccine formulations containing QS-21 induced a 45- to over 200-fold increase in anti-SPf66 IgG titres over the alum formulation after the second and third doses, respectively. Anti-SPf66 antibody from some subjects reacted against asexual blood stage parasites, as demonstrated by immunofluorescence and immunoblotting. Antibody responses generated by the QS-21 formulations were of longer duration compared to those evoked by the alum formulation. While SPf66/alum has been found to induce only CD4+ T cell response, the QS-21 formulations exhibited the potential to also elicit SPf66-specific CD8+ responses. These observations demonstrate that the use of QS-21 can substantially enhance the immunogenicity of peptide vaccines, such as SPf66.

Los síndromes de lesión talámica

En la unidad de Neurología del Centro Hospitalario San Juan de Dios de Bogotá, durante cuatro años (1986 a 1989), se estudiaron en forma consecutiva 25 pacientes con lesiones talámaticas no fatales. Se registraron los hallazgos neurológicos, neurosicológicos y neurooftalmológicos y los diagnósticos se confirmaron por tomografía computarizada (TC). Fueron 14 mujeres y 11 varones con una edad promedio de 52.5 y un rango de 25 a 84 años. La lesión talámica fue de origen vascular en 24 casos, ocho por infarto isquémico, cuatro por infarto hemorrágico y 12 con hematomas parenquimatosos. Diecisiete pacientes tenían hipertensión arterial sistémica y el único factor de riesgo en otros dos era el consumo de cocaína base (basuco). Ocho infartos se presentaron en el tálamo derecho, 12 en el izquierdo y cinco pacientes tuvieron lesiones bilaterales, uno de ellos con un glioma complobado por biopsia. En 5 pacientes con lesiónes bilateral se observó el síndrome del "Tope" de la arteria basilar, por compromiso del pedículo retromamilar; en todos ellos encontramos alteraciones sensitivomotoras, cerebelosas, oculomotoras bilaterales y demencia. Solamente un paciente presentó el clasicó síndrome de hiperpatía (Dejerine-Roussy). En los restantes se observaron asociaciones de síndromes sensitivomotores, cerebelosos, neurooftalmológicos, neuropsicológicos, y del comportamiento motor que remedan con frecuencia los hallazgos clínicos de la alteración cortical frontal, temporal o parietal.