Angiomiolipoma hepático epitelioide: reporte de un caso / Hepatic epithelioid angiomyolipoma: Case Report

Angiomyolipomas (AML) are mesenchymal tumors belonging to the group of perivascular epithelioid cell tumors, which, rarely, can display a malignant behavior. They are composed of adipose tissue, vessels, and muscle tissue in different proportions, and constitute a differential diagnosis for other focal liver lesions. We report a 34-year-old woman in whom a focal hepatic lesion was discovered incidentally. The pathology report of an ultrasound guided biopsy informed an epithelioid angiomyolipoma, a rare variant of these lesions. During ten years of imaging follow, the size and features of the lesion has not changed. The patient rejected a surgical excision.

Clinical Efficacy of SARS-CoV-2 Vaccination in Hemodialysis Patients.

Introduction: The COVID-19 pandemic is a global public health problem. Patients with end-stage renal disease on hemodialysis are at a higher risk of infection and mortality than the general population. Worldwide, a vaccination campaign has been developed that has been shown to reduce severe infections and deaths in the general population. However, there are currently limited data on the clinical efficacy of vaccinations in the hemodialysis population. Methods: A national multicenter observational cohort was performed in Chile to evaluate the clinical efficacy of anti-SARS-CoV-2 vaccination in end-stage renal disease patients on chronic hemodialysis from February 2021 to August 2021. In addition, the BNT162b2 (Pfizer-BioNTech) and CoronaVac (Sinovac) vaccines were evaluated. The efficacy of vaccination in preventing SARS-CoV-2 infection, hospitalizations, and deaths associated with COVID-19 was determined. Results: A total of 12,301 patients were evaluated; 10,615 (86.3%) received a complete vaccination (2 doses), 490 (4.0%) received incomplete vaccination, and 1196 (9.7%) were not vaccinated. During follow-up, 1362 (11.0%) patients developed COVID-19, and 150 died (case fatality rate: 11.0%). The efficacy of the complete vaccination in preventing infection was 18.1% (95% confidence interval [CI]:11.8-23.8%), and prevention of death was 66.0% (95% CI:60.6-70.7%). When comparing both vaccines, BNT162b2 and CoronaVac were effective in reducing infection and deaths associated with COVID-19. Nevertheless, the BNT162b2 vaccine had higher efficacy in preventing infection (42.6% vs. 15.0%) and deaths (90.4% vs. 64.8%) compared to CoronaVac. Conclusion: The results of our study suggest that vaccination against SARS-CoV-2 in patients on chronic hemodialysis was effective in preventing infection and death associated with COVID-19.

[Hepatic epithelioid angiomyolipoma: Case Report]. / Angiomiolipoma hepático epitelioide: reporte de un caso.

Angiomyolipomas (AML) are mesenchymal tumors belonging to the group of perivascular epithelioid cell tumors, which, rarely, can display a malignant behavior. They are composed of adipose tissue, vessels, and muscle tissue in different proportions, and constitute a differential diagnosis for other focal liver lesions. We report a 34-year-old woman in whom a focal hepatic lesion was discovered incidentally. The pathology report of an ultrasound guided biopsy informed an epithelioid angiomyolipoma, a rare variant of these lesions. During ten years of imaging follow, the size and features of the lesion has not changed. The patient rejected a surgical excision.

Condicionantes de la retención estudiantil en«escuelas de segunda oportunidad¼ en Chile / Determinants of student retention in "second chance schools" in Chile / Determinantes da retenção de alunos em "escolas de segunda oportunidade" no Chile

Resumen (analítico) El artículo busca comprender las percepciones que estudiantes, docentes y directivos tienen respecto de los aspectos que inciden en la retención de adolescentes atendidos en «escuelas de segunda oportunidad¼ en Santiago de Chile. La información proviene de 56 entrevistas semiestructuradas, aplicadas a tales actores en los Centros de Educación Integrada de Jóvenes y Adultos seleccionados. Las entrevistas fueron sometidas a un análisis narrativo etnográfico y, para su codificación, se utilizó el software Atlas.ti. Los actores identificaron como las condicionantes más importantes la contextualización en la exigencia académica y evaluativa, el acompañamiento afectivo a estudiantes y que la escuela sea acogedora. Finalmente, se vislumbra la necesidad de revisar los procesos de reinserción escolar para ungrupo no menor de niños y jóvenes que no se adaptan a condiciones «normales¼. Palabras clave: Chile, educación alternativa, educación compensatoria, joven sin escolaridad, retención, abandono escolar (Tesauro de Ciencias Sociales de la Unesco).

Abstract (analytical) The purpose of this article is to understand the perceptions that students, teachers and principals have regarding the aspects that affect the educational retention of adolescents who attend "second chance schools" in Santiago, Chile. The information collected for the study comes from 56 semi-structured interviews with students, teachers and principals in each of the selected Integrated Education Centers for Young People and Adults. The transcripts of the interviews were subject to an ethnographic narrative analysis and, for the codification and construction of categories the Atlas.ti software was used with all materials. The actors identified the most important determinants to promote educational retention and avoid students dropping out of school: the academic demands of students; affective accompaniment for students; and that the school is a welcoming. Place Finally, the authors identified the need to review the school reintegration processes for children and adolescents who do not adapt to "normal" conditions in the schools. Keywords: Chile, alternative education, compensatory education, youth not in school, retention, school drop-outs.

Resumo (analítico) O objetivo do artigo é compreender as percepções que os alunos, professores e diretores têm sobre os aspectos que afetam a retenção de adolescentes atendidos em "escolas de segunda oportunidade" em Santiago, no Chile. A informação vem de 56 entrevistas semi-estruturadas, aplicadas a estudantes, professores e representantes da equipe de gestão em cada um dos Centros de Educação Integrada para Jovens e Adultos selecionados. As entrevistas foram submetidas a uma análise narrativa etnográfica e, para a codificação e construção de categorias, utilizou-se o software Atlas TI. Os atores identificaram como as condições mais importantes para incentivar a retenção e evitar o abandono precoce: a exigência acadêmica e avaliativa, o acompanhamento afetivo aos alunos e o acolhimento da escola. Finalmente, é necessário rever os processos de reinserção escolar para um grupo de crianças e jovens que não se adaptam às condições "normais". Palavras-chave: Chile, educação alternativa, educação compensatória, jovens sem escolaridade, retenção, abandono escolar.

Crecimiento físico de niños con hiperplasia suprarrenal congénita perdedora de sal durante los dos primeros años de vida en el Instituto Nacional de Salud del Niño / Physical growth in children with salt-wasting adrenal hyperplasia during their first two years of life in the Peruvian National Children's Health Institute

Objetivo: Describir el crecimiento físico de niños con hiperplasia suprarrenal congénita (HSC) perdedora de sal durante los dos primeros años de vida, evaluados en el Servicio de Endocrinología del Instituto Nacional de Salud del Niño (INSN), Lima-Perú. Materiales y métodos: Es un estudio observacional, descriptivo y retrospectivo. Se incluyeron 55 niños con HSC que tuvieron seguimiento en el Servicio de Endocrinología del INSN del 2000 al 2016; se recopilaron datos como peso y talla al nacer y cada 6 meses, edad al diagnóstico, dosis de hidrocortisona y fludrocortisona y velocidad de crecimiento. Resultados: Se analizaron 55 niños con HSC perdedora de sal siendo el diagnóstico más precoz en mujeres (mediana: 21 días) que en varones (mediana: 52 días). Al nacimiento, su longitud promedio fue 0,07 + 0,75 DE; a los 6 meses fue -1,67 + 1,33 DE con mayor compromiso en varones (-2,29 + 1,18 DE; p=0,022); a los 12 meses fue -1,84 + 1,27 DE, con recuperación a los 24 meses (-1,51 + 1,10 DE). La velocidad de crecimiento fue -1,03 + 1,62 DE y -0,89 + 1,06 DE en el en el primer y segundo año, respectivamente. Conclusiones: Los niños con HSC perdedora de sal que tuvieron seguimiento en el INSN, tuvieron menor longitud a los 6 y 12 meses de edad y lograron recuperarse a los 24 meses.

Objective: To describe physical growth features in children with salt-wasting congenital adrenal hyperplasia (CAH) during their first two years of life, in the Endocrinology Service of the Peruvian National Children's Health Institute (CHI) in Lima, Peru. Materials and Methods: This is a retrospective, observational, and descriptive study. Fifty-five children with CAH underwent follow-up in the Endocrinology Service of the CHI from 2000 to 2016; data such as body weight and height were collected at birth time and every six months, as well as age at diagnosis, hydrocortisone and fludrocortisone doses, and growth velocity. Results: Fifty-five children with salt-wasting CAH were assessed, the diagnosis was more promptly made in females (median: 21 days) compared to males (median: 52 days). At birth, their average length was 0.07 ± 0.75 SD; at 6 months it was -1.67 ± 1.33 SD, and male subjects were more affected (-2.29 ± 1.18 SD; p= 0.022); at 12 months, this parameter was -1.84 ± 1.27 SD, and recovery was observed at 24 months (-1.51 ± 1.10 SD). Growth velocity values were -1.03 ± 1.62 SD and -0.89 ± 1.06 SD in the first and second years of life, respectively. Conclusions: Children with salt-wasting CAH who were followed-up at CHI had shorter length at 6- and 12- months of age, and their recovered at 24-monbths.

Central diabetes insipidus: clinical profile that suggests organicity in Peruvian children: Lima - Peru 2001-2013.

BACKGROUND: Central diabetes insipidus (CDI) is a heterogeneous disease caused by arginine vasopressin deficiency; its management implies a profound understanding of the pathophysiology and the clinical spectrum. The aim of the study was to describe the clinical characteristics that indicate organicity in children and adolescents with central diabetes insipidus treated at the Department of Endocrinology from The Child Health's Institute during 2001 to 2013. METHODS: Cross-sectional, retrospective study. 79 cases of patients diagnosed with CDI (51 males and 28 females) from 1 month to 16 years of age were reviewed. For the descriptive analysis, measures of central tendency and dispersion were used; groups of organic and idiopathic CDI were compared using χ2-test and t-test. A p-value<0.05 was considered significant. RESULTS: The average age of patients was 8.1±4.2 years. Organic causes were intracranial tumors, 44 (55.7%), Langerhans cell histiocytosis (LCH), 11 (13.9%) and cerebral malformations in 7 (8.9%) patients, while the idiopathic group was 14 (17.7%) patients. Regarding clinical characteristics suggestive of organicity, headache (p=0.02) and visual disturbances (p=0.01) were found statistically significant. The anterior pituitary hormonal abnormalities were documented in 34 (52.3%) organic CDI patients. Furthermore, we did not find a significant difference in the average daily dose of desmopressin between patients with permanent vs. transitory CDI (0.81±0.65 vs. 0.59±0.62; p=0.363). CONCLUSIONS: The main clinical features suggestive of organicity in pediatric patients with central diabetes insipidus were headache and visual disturbances; furthermore, anterior pituitary hormonal abnormalities suggest an underlying organic etiology.

[Long-term outcomes with expanded criteria donors in kidney transplantation]. / Resultados a largo plazo en trasplante renal de donantes con criterios expandidos.

BACKGROUND: Kidney transplantation of expanded criteria deceased donors (DCE) has become a common clinical practice. However, DCE outcomes are inferior compared to kidney transplants from standard criteria donors (DCS). AIM: To evaluate intermediate and long-term outcomes of DCE transplanted patients. MATERIAL AND METHODS: Cadaveric kidney transplants were evaluated using a retrospective cohort of eight consecutive years. Complications and long-term function of the transplant were assessed in DCE and DCS kidney recipients. RESULTS: Of 213 patients analyzed, 34 (16%) underwent DCE transplantation. DCS recipients spent more time on the waiting list for transplantation (p = 0.04). DCE recipients showed higher frequency of surgical complications (p = 0.04), vascular complications (p = 0.02), acute transplant rejection (p = 0.05), and hospitalizations (p = 0.01). Creatinine (mg/dL) in DCE and DCS recipients was 2.3 and 1.5 respectively at year one (p < 0.01) and 2.6 and 1.6 respectively at year five (p < 0.01). Graft survival in the DCE group was significantly lower at 5 years (61 and 89% respectively, p < 0.01). CONCLUSIONS: DCE grafts are associated with lower survival, higher hospitalization rate and commonly develop surgical complications and rejections.

Resultados a largo plazo en trasplante renal de donantes con criterios expandidos / Long-term outcomes with expanded criteria donors in kidney transplantation

Background: Kidney transplantation of expanded criteria deceased donors (DCE) has become a common clinical practice. However, DCE outcomes are inferior compared to kidney transplants from standard criteria donors (DCS). Aim: To evaluate intermediate and long-term outcomes of DCE transplanted patients. Material and Methods: Cadaveric kidney transplants were evaluated using a retrospective cohort of eight consecutive years. Complications and long-term function of the transplant were assessed in DCE and DCS kidney recipients. Results: Of 213 patients analyzed, 34 (16%) underwent DCE transplantation. DCS recipients spent more time on the waiting list for transplantation (p = 0.04). DCE recipients showed higher frequency of surgical complications (p = 0.04), vascular complications (p = 0.02), acute transplant rejection (p = 0.05), and hospitalizations (p = 0.01). Creatinine (mg/dL) in DCE and DCS recipients was 2.3 and 1.5 respectively at year one (p < 0.01) and 2.6 and 1.6 respectively at year five (p < 0.01). Graft survival in the DCE group was significantly lower at 5 years (61 and 89% respectively, p < 0.01). Conclusions: DCE grafts are associated with lower survival, higher hospitalization rate and commonly develop surgical complications and rejections.

[National congenital hypothyroidism screening in Peru: a broken program]. / Tamizaje nacional unificado de hipotiroidismo congénito en el Perú: un programa inexistente.

Congenital hypothyroidism (CH) is the most important cause of preventable mental retardation. The prevalence of CH varies by geographic region, race and ethnicity. In the countries of the Northern hemisphere, the prevalence has been reported as 1:4,000 live newborns. The prevalence is remarkably different among the countries of Latin America not only because of their different races and ethnicities but also because of the heterogeneous social-economic development. The prevalence of CH in 1984 in Peru was reported as 1:1250. In 2007, the reported incidence by the Instituto Nacional Materno Perinatal was 1:1638. A recent retrospective study performed by the Instituto Nacional de Salud del Niño in Lima, Peru described the average age of diagnosis of CH as 5,9 months +/- 5,28. This late age of CH diagnosis certainly suggests the poor efficiency of the current neonatal CH screening programs in Peru. Every Peruvian infant deserves a timely newborn screening and treatment for CH. The Peruvian government is responsible for ensuring this mandatory goal is achieved promptly.

Tamizaje nacional unificado de hipotiroidismo congénito en el Perú: un programa inexistente / National congenital hypothyroidism screening in Peru: a broken program

El hipotiroidismo congénito (HC) es la principal causa prevenible de retardo mental. La prevalencia de HC varía de acuerdo con la región geográfica y la población racial. En el hemisferio norte, la incidencia es 1:4000 recién nacidos vivos. En Latinoamérica, la incidencia varía debido a la heterogeneidad racial/étnica y al nivel de desarrollo. En el Perú, un estudio realizado en 1984 describió esta prevalencia como 1:1250. En el 2007, esta prevalencia fue reportada como 1:1638 por el Instituto Nacional Materno Perinatal. Un reciente estudio del Instituto Nacional de Salud del Niño durante 1995û2005, describió la edad promedio de diagnóstico de HC como 5,9 meses +/- 5,28. Esta tardía edad de diagnóstico sugiere la poca eficiencia de los actuales programas de tamizaje. Todo niño peruano tiene derecho a recibir diagnóstico oportuno y tratamiento de HC y es el Estado Peruano, el responsable principal de asegurar que esta meta se cumpla...

Congenital hypothyroidism (CH) is the most important cause of preventable mental retardation. The prevalence of CH varies by geographic region, race and ethnicity. In the countries of the Northern hemisphere, the prevalence has been reported as 1:4,000 live newborns. The prevalence is remarkably different among the countries of Latin America not only because of their different races and ethnicities but also because of the heterogeneous social-economic development. The prevalence of CH in 1984 in Peru was reported as 1:1250. In 2007, the reported incidence by the Instituto Nacional Materno Perinatal was 1:1638. A recent retrospective study performed by the Instituto Nacional de Salud del Niño in Lima, Peru described the average age of diagnosis of CH as 5,9 months +/- 5,28. This late age of CH diagnosis certainly suggests the poor efficiency of the current neonatal CH screening programs in Peru. Every Peruvian infant deserves a timely newborn screening and treatment for CH. The Peruvian government is responsible for ensuring this mandatory goal is achieved promptly...

Acceso a las acciones de prevención y control de la hipertensión arterial: una responsabilidad compartida / Accessibility to action for prevention and control of hypertension: a shared responsibility

La hipertensión arterial es un problema de salud que cada vez tiene mayor impacto en la sociedad dado que es considerada como una de las principales causas de muerte e invalidez. Se realizó una revisión de la literatura con el objetivo de estudiar el acceso a las acciones de prevención y control de esta enfermedad, principalmente de tipo no farmacológico. Los factores asociados a los pacientes corresponden a creencias, desconocimiento de la enfermedad o de estrategias para su manejo. A nivel de los servicios de salud se encuentran factores relacionados con la capacidad de los profesionales para dar educación o fomentar estilos de vida saludable, y aspectos organizativos de las instituciones de salud. Se recalca la importancia de la participación de otros sectores de la sociedad para el control de esta condición, basados en el hecho de que muchas de las acciones sobrepasan los límites del sector salud.

Hypertension is an increasing health problem with a great impact on society as it is considered one of the leading causes of death anddisability. A literature review was made in order to study the accessibility to mainly non-pharmacologic prevention and control actions for this morbid condition. Patient-related factors are beliefs, unawareness of the disease or strategies for its control. At the health services level, it was found that the main factors are related to health practitioners’ abilities to give education or to promote healthy life styles, besides the organization of health institutions. Attention is called about the importance of the involvement of other society sectors to control this health issue, based on the fact that many proposed interventions go beyond the health services field of action.

Respuesta al tratamiento con análogos de hormona liberadora de gonadotrofinas de pacientes con pubertad precoz central en el Instituto Nacional de Salud del Niño / Response to treatment with analogues of gonadotrophin releasing hormone in patient with central precocious puberty in the Instituto Nacional de Salud del Niño

Los análogos de hormona liberadora de gonadotrofinas (GnRHa), son el tratamiento de elección de la pubertad precoz central (PPC) y a pesar de las diversas experiencias reportadas hay aspectos clínicos y auxológicos por responder. Objetivo: Describir la respuesta al tratamiento...

The analogues of gonadotrophin releasing hormone (GnRHa) are the preferred treatment for central precocious puberty (CPP); despite the various reported experiences, there are clinical and auxological issues unanswered. Objective: To describe the response to GnRHa therapy in patients with central precocious puberty, followed in the Endocrine Unit at the Instituto Nacional de Salud del Niño (INSN), Lima, Perú, between 1998 and 2008...

Cirugía mayor ambulatoria / Major ambulatory surgery

En el Servicio de Cirugía del Hospital del Salvador se está desarrollando un programa de cirugía mayor ambulatoria (CMA). Desde el 1 de marzo de 1990 al 28 de febrero de 1995 se han operado 477 pacientes. Se analiza selección preoperatoria, morbimortalidad, resultados postoperatorios y de seguimiento a largo plazo. Se comenta sobre los beneficios quirúrgicos y económicos, recomendando la implementación del programa en todos los servicios quirúrgicos del país

Laparatomía contenida en pacientes portadores de Peritonitis graves / Laparotomy in patients with severe peritonitis

En nuestro medio, por razones socio culturales de nuestrapoblación, por las distancias y el dificil acceso a los centros médicos que prestan servicios de buena calidad, otras veces por inadecuado manejo de patología intraabdominal, nos llegan a la consulta de emergencia, pacientes en muy mal estado general con alteraciones hidro-electrolíticas, ácido-básica y algunos presentando sepsis que tienen como punto de partida una peritonitis grave con varias horas o dias de evolución .

Abceso Pancreático, nuestra experiencia Hospital Japonés 1990 / Pancreatic abcess: Experience in the Hospital Japones in 1990;

En el presente la Inflamación pancreática es designada como aguda crónica segun la clasificación de Marcella (1983) y la necrosis peripancreatica (Flemon) y el absceso son bien reconocidas como complicaciones de la pancreatitis aguda a partir de la 2da. y 3ra. Semana de evolución .

Soporte espiratorio no valvular para sistema Bain / Non valvular exhalation support for Bain system

Se llevó a cabo un estudio clínico para valorar la oxigenación y eliminación de bióxido de carbono, con un soporte no valvular, con función espiratoria, diseñado para el sistema Bain. Se tomó una muestra de 108 pacientes desde lactantes mayores a adultos, sometidos a cirugía electiva, la ventilación fue controlada manualmente. El flujo de gas fresco para los niños fue de 3.5 lts. y para los adultos fue de 70 ml/kg. Se tomaron determinaciones de gases en sangre arterial para determinar pH, PO2, EB, BA, CO2 y PaCO2, después de la intubación y 1 hora posterior a ventilación manual con FiO2 de 40%. Los resultados obtenidos fueron analizados mediante la "t" de Student y la X2 mostrando tendencia a la normocarbia