[Chronic obstructive pulmonary disease (COPD): eosinophilia and novel drug therapies]. / Chronisch-obstruktive Lungenerkrankung (COPD) ­ Eosinophilie und neue Arzneimitteltherapien.

BACKGROUND: The phenotyping of chronic obstructive pulmonary disease (COPD) has increasingly gained attention in recent years, as it leads to new and individualized therapeutic concepts. OBJECTIVE: The aim is to provide an overview of the heterogeneity of COPD and to summarize current drug therapy concepts, particularly in the context of eosinophilic airway inflammation. DATA: Several prospective, randomized, placebo-controlled studies have shown a reduction in exacerbations and overall mortality with inhaled triple therapy using an inhaled corticosteroid and dual bronchodilation. The higher the eosinophils in the blood, the greater the expected effect. In addition, a reduction in exacerbations with biologics in COPD with eosinophilia has been demonstrated for dupilumab. Eosinophil-guided therapy for acute exacerbations is the subject of current research. CONCLUSION: For COPD without exacerbations, dual bronchodilation forms the basis of inhaled therapy. With exacerbations, inhaled triple therapy is indicated for patients with a blood eosinophil count of ≥ 300/µl. This type of treatment may also be useful when eosinophils are between 100 and 300/µl. Therapy with dupilumab is a possible option for the eosinophilic phenotype in the near future.

Association of proangiogenic and profibrotic serum markers with lung function and quality of life in sarcoidosis.

BACKGROUND: Sarcoidosis is a systemic inflammatory granulomatous disease, frequently affecting the lung. If left untreated, it may end in lung fibrosis. Proangiogenic and profibrotic vascular endothelial growth factor (VEGF), transforming growth factor (TGF)-ß1, fibroblast growth factor (FGF)-2 and platelet-derived growth factor (PDGF)-AB are a known therapeutical target in pulmonary fibrosing diseases, e.g. IPF, but there is no targeted therapy option for pulmonary fibrosis in sarcoidosis. OBJECTIVES: The aim of our study was to determine the association of these markers' serum levels on lung function and the patients' quality of life in a long-term follow-up of sarcoidosis patients, to provide further information for finding targeted therapy options for pulmonary sarcoidosis. METHODS: 54 patients with sarcoidosis underwent blood sampling, pulmonary function testing and answered the King's Brief Interstitial Lung Disease (K-BILD) questionnaire at baseline and at three-years follow-up. Serum levels of profibrotic and angiogenic markers were assessed at baseline by enzyme-linked immunosorbent assay. RESULTS: Between 2015 and 2018, 54 patients with biopsy proven sarcoidosis were enrolled. Throughout the observation period, there was a significant decrease in the diffusion capacity for carbon monoxide (DLCO) [%] (-6.5504 ± 13,39, p = 0.001) and forced expiratory volume in one second predicted (FEV1) [%] (-6.07 ± 12.09, p = 0.001). Patients with greater impairment of forced vital capacity (FVC) did have significantly higher serum levels of VEGF (p = 0.03) and PDGF-AB (p<0.001). The K-BILD questionnaire did not change significantly during follow-up. However, patients with worsening K-BILD scores did have significantly higher serum-levels of PDGF-AB (2.67 pg/ml ± 0.93 vs. 1.88 pg/ml ± 0.60, p = 0.004) at baseline, compared to those with unchanged or increasing K-BILD scores. CONCLUSIONS: Among patients with pulmonary sarcoidosis, baseline serum levels of VEGF and PDGF-AB were associated with pulmonary function impairment. Furthermore, PDGF-AB was associated with worsening K-BILD scores. No such association was observed for FGF-2 and TGF-ß1. VEGF and PDGF-AB may be possible prognostic and therapeutic targets in sarcoidosis as a fibrosing ILD beyond IPF.

Perfil de población con baja visión que asiste a la unidad de baja visión y rehabilitación visual en un hospital clínico de Chile / Low vision population assisting a unit of low vision and visual rehabilitation in a clinical hospital from Chile

El objetivo de este trabajo fue caracterizar epidemiológica y sociodemográficamente a las personas atendidas en la Unidad de Baja Visión y Rehabilitación Visual del Hospital Clínico de la Universidad de Chile. El método utilizado fue un estudio descriptivo, transversal y retrospectivo de los registros clínicos de las personas atendidas en la Unidad, entre marzo de 2015 a octubre de 2016. Para el análisis se utilizó el software MS Excel, calculando las frecuencias relativas y medidas de posición central y dispersión. En los resultados se observaron un mayor número de pacientes de sexo femenino (55,5%), y adultos mayores de 60 años o más (53,3%). El 73,3% de los pacientes pertenecieron al sistema de salud público y un 35,6% poseían menos de 8 años de estudio. El 80 % de las personas atendidas se encuentra en edad laboral, de éstos un 63,9% se encontraban laboralmente inactivos. Las enfermedades oftalmológicas con mayor frecuencia correspondieron a las enfermedades genéticas del ojo (22,2%) y la degeneración macular relacionada con la edad (17,8%). Un 57,8% de los pacientes presentó alguna patología sistémica asociada a baja visión. Sólo un 6,0% recibió rehabilitación visual anteriormente. Se concluyó que la mayor prevalencia de enfermedades oculares asociadas al envejecimiento como la degeneración macular relacionada con la edad y enfermedades genéticas del ojo, sumado a las características sociodemográficas y en particular a que un 94% de los pacientes no habían tenido acceso a rehabilitación visual, constituyen un perfil que desafía al desarrollo de medidas de salud pública que resguarden la prevención, acceso y rehabilitación, siendo la formación de equipos multidisciplinarios especialistas una necesidad imperiosa.

This work aimed to do a characterization, epidemiological and socio demographical, to the people attended in a Low Vision and Rehabilitation Unit from a Clinical Hospital of the Universidad de Chile. A descriptive, transversal and retrospective method was used for the clinical registers of the people attended in the Unit, between March 2015 to October 2016. For the analysis, a MS Excel software was used, calculating the relative and measured frequencies of central position and dispersion. In the results, a greater number of feminine patients (55. 5%) were observed, and seniors of 60 years or more (53.3%). 73.3% of the patients belonging to the Public Health Care System and 35.6% had less than 8 years of studies. The 80% of attended patients were in working age, from this 63,9% were unemployed. The ophthalmological diseases with more frequency belonged to eye genetic diseases (22.2%) and macular degeneration related to age (17.8%). 57.8% of the patients presented a systematic pathology associated with low vision. Just 6.0% received previous visual rehabilitation. We concluded that the greater prevalence of ocular diseases associated to aging such as macular degeneration related to age and eye genetic diseases added to the sociodemographic features and particularly a 94% of the patients did not have access to visual rehabilitation, represent a profile that challenges the development public health care measures that safeguard the prevention, access, and rehabilitation, being an imperative need the making of specialist multidisciplinary teams.

Actinomicosis pélvica: a propósito de un caso que simula un tumor de recto / Pelvic actinomycosis: from a case that simulates rectal tumor

Resumen Introducción: La actinomicosis, es una infección crónica rara producida por bacterias del género Actinomyces sp. La afectación pélvica es una de sus formas más infrecuentes y en gran parte de los casos se relaciona al uso de un dispositivo intrauterino de larga data o a una cirugía previa. Como otras enfermedades raras, la infección es conocida como "la gran imitadora" por su variada forma de presentación y particular comportamiento pudiendo simular una neoplasia. El tratamiento es fundamentalmente médico y de buenos resultados. Caso Clínico: Damos a conocer el caso de una paciente que se presentó con un cuadro compatible con un tumor de recto, pero que resultó ser actinomicosis. El diagnóstico se realizó en base a la tinción de Gram, el cuadro clínico y el antecedente de un dispositivo intrauterino abandonado por más de 25 años. Fue corroborado posteriormente mediante anatomía patológica y tratada en forma exitosa con antibióticos por un periodo extendido. Conclusión: Si bien la actinomicosis es una patología infrecuente, debe ser considerada en el diagnóstico diferencial de los pacientes que se presentan con tumores de la pelvis. Un alto índice de sospecha y una actitud diagnóstica activa son fundamentales para un tratamiento oportuno, seguro y eficaz de esta enfermedad.

Introduction: Actinomycosis is a rare chronic infection caused by bacterias of the genus Actinomyces sp. Pelvic involvement is one of its most infrequent forms and in many cases it is related to the use of a longstanding intrauterine device or a previous surgery. Like other rare diseases, the infection is known as "the great imitator" because of its varied form of presentation and its particular behavior, which can simulate a neoplasm. The treatment is fundamentally medical with good results. Case Report: We present the case of a patient who presented with a rectal tumor but that turned out to be Actinomycosis. The diagnosis was made based on the Gram stain, the clinical presentation and the history of an intrauterine device left for more than 25 years. It was subsequently corroborated by pathological anatomy and successfully treated with antibiotics for an extended period. Conclusion: Although actinomycosis is an infrequent pathology, it should be considered in the differential diagnosis of patients who present with tumors of the pelvis. An active diagnostic attitude and a high index of suspicion are fundamental for the timely, safe and effective treatment of this disease.

Angiosarcoma de cuero cabelludo. revisión de la literatura actual a propósito de un caso / Angiosarcoma of the scalp. a case report and review of the literature

RESUMEN El angiosarcoma es un tumor de células neoplásicas de origen vascular, cuya presentación clínica es variada y su diagnóstico es tardío. Se presenta el caso de una paciente de 83 años, con múltiples úlceras dolorosas en cuero cabelludo, con diagnóstico incierto, por lo que se realiza biopsiaincisional de la lesión, detectándose un angiosarcoma. La inmunohistoquímica de la lesión fue positiva para CD34 y vimentina, negativo para S-100 y Melan-A. Este tumor se presenta en adultos mayores, siendo altamente invasivo y de mal pronóstico. Su diagnóstico requiere un alto índice de sospecha y a la fecha, no existe un tratamiento definido para esta patología.

SUMMARY Angiosarcoma is an aggressive malignant tumor of the vascular endothelial cells, and its clinical presentation is varied and of late diagnosis. The present case has a female patient, aged 83 who has multiple painful ulcers in scalp, whose lack of treatment response required a biopsy, where it was found an angiosarcoma. The immunohistochemistry of the lesion was positive for CD34 and vimentin, and negative for S-100 and Melan-A. This tumor develops in older people and is highly invasive withpoor prognosis. Its diagnosis requires high rates of suspicion and todate there is not a defined treatment for this pathology.

Alergia a la proteína de lentejas en el sur de Chile: Reporte de un caso y revisión de la literatura / Allergenicity of lentils in the south of Chile: Reporting a case and Review

El término alergia alimentaria, involucra entidades tan diversas como la proteína de leche de vaca hasta alergias al maní y a las legumbres. La prevalencia mundial de esta entidad ha ido en aumento y en Chile, no existen casos reportados en la literatura que orienten el diagnóstico. Por lo general el médico general es el primero en enfrentarse a estos casos, por lo tanto, deberá conocer muy bien su red de derivación, para dar una solución expedita a cada paciente que lo visita, por una alergia alimentaria. Se presenta el caso de un infante de 3 años, que presentó una reacción urticarial posterior a la ingesta de lentejas cocidas, por tercera vez. Requirió manejo con corticoides y anti-histamínicos para disminuir las molestias. Se concluye que el tratamiento indicado para la alergia alimentaria a lentejas, es la exclusión de la dieta, sin conocer la temporalidad de ésta ni su reinicio, aunque varias guías sugieren intentar realimentación a la edad de 4 a 5 años del infante.

The food allergy, involves entities as diverse as cow's milk protein to peanut allergies as to legumes. The global prevalence of this entity has been increasing. In general, the medical doctor is the first to face these cases, therefore, should know very well their referral network to give an expeditious approach to each patient who visits him for a food allergy. We present the case of a 3-year-old infant who presented an urticarial reaction after the third ingestion of cooked lentils. He required corticosteroids and antihistamine management to reduce discomfort. The treatment indicated for food allergy to lentils is the exclusion of the diet, without knowing the temporality of this or its re-initiation, although several guides suggest attempting feedback at the age of 4 to 5 years.

Raman spectroscopy for wine analyses: A comparison with near and mid infrared spectroscopy.

Routine wine analysis are commonly employed to ensure the quality and safety standards, and to meet consumers' demands and legal requirements. In the last decades, efforts have been done in order to replace the traditional analytical techniques by vibrational spectroscopic techniques such as near infrared (NIR) and mid infrared (MIR) spectroscopy. The potential of these techniques has already been proved by several studies that revealed their ability for the determination of several wine parameters with high levels of precision and accuracy. Raman spectroscopy, (which is also a vibrational technique), was much less explored in the wine industry. In this work, the ability of Raman spectroscopy for routine wine analysis was evaluated and compared to NIR and MIR spectroscopy. Several calibration models were developed aiming the quantitative assessment of alcoholic strength, density, total acidity, volatile acidity, total sugars and pH in white wines. For this purpose, partial least squares (PLS) regression was employed, enabling the correlation between reference results and spectral information obtained by NIR, MIR and Raman spectroscopy. Results revealed the better performance of MIR spectroscopy for the measurement of alcoholic strength (R2P = 0.99, RMSEP=1.77%, and RER=56.41), and total acidity (R2P = 0.98, RMSEP=2.02%, and RER=49.46). Raman spectroscopy was pointed out as the most suitable for the determination of total sugars (R2P = 0.97, RMSEP=5.12%, RER=19.52), and pH (R2P = 0.90, RMSEP=4.92%, RER=20.34). The three techniques presented similar results in what referred the assessment of density (R2P = 0.96, 0.98, and 0.97, RMSEP=4.72%, 3.90%, and 3.80%, for Raman, MIR, and NIR respectively). None of the three techniques seemed to be suitable for the accurate determination of volatile acidity (R2P <0.78, RMSEP>14.32%, and RER<6.98).

Proangiogenic and Profibrotic Markers in Pulmonary Sarcoidosis.

The aim of our study was to determine the blood levels of vascular endothelial growth factor (VEGF), transforming growth factor (TGF)-ß1, fibroblast growth factor (FGF)-2, and platelet-derived growth factor (PDGF)-AB in different stages of pulmonary sarcoidosis. There were 92 patients in sarcoidosis stages I + II, III, and IV enrolled into the study. All the patients underwent lung diffusing capacity and blood sampling. We found that VEGF levels differed significantly between the stage groups with the peak VEGF concentrations in stage III. TGF-ß1 levels were similar in stages I + II and III, and tended to be lower in stage IV. The analysis of the subgroups showed increased VEGF and FGF-2, and reduced TGF-ß1 concentration in stages I + II patients with relevantly reduced lung diffusing capacity or increased sarcoidosis activity compared to patients with normal lung diffusing capacity or inactive sarcoidosis. A tendency towards increased VEGF, PDGF-AB and TGF-ß1 levels was observed in the analogical subgroup analysis within the stage III. We conclude that proangiogenic VEGF, and profibrotic FGF-2 and PDGF-AB may contribute to the progression of sarcoidosis, whereas TGF-ß1, with its dual anti-inflammatory and profibrotic actions, may play a dichotomous protective or deleterious role. Reduced diffusing capacity and active sarcoidosis are associated with an unfavorable constellation of the markers studied, which predicts a progressive disease course.

Merging vibrational spectroscopic data for wine classification according to the geographic origin.

The wine making procedure is no longer a secret and it is nowadays well described and repeated around the world. Nevertheless, wines present unique features, strongly associated with their geographic origin. Classification systems were developed to catalogue wines according to the provenance, and are currently established by official authorities in order to ensure wine authenticity. The use of near-infrared (NIR), mid-infrared (MIR) and Raman spectroscopy for tracing the origin of wine samples, has been reported with different levels of success. This work evaluated and compared the performance of these techniques, as well as their joint use, in terms of geographic origin classification. NIR, MIR and Raman spectra of wine samples belonging to four Portuguese wine regions (Vinhos Verdes, Lisboa, Açores and Távora-Varosa) were analyzed by partial least squares discriminant analysis (PLS-DA). Results revealed the better suitability of MIR spectroscopy (87.7% of correct predictions) over NIR (60.4%) and Raman (60.8%). The joint use of spectral sets did not improve the predictive ability of the models. The best models were achieved by combining MIR and NIR spectra resulting in 86.7% of correct predictions. Multiblock partial least squares (MB-PLS) models were developed to further explore the combination of spectral data. Although these models did not improve the percentage of correct predictions, they demonstrated the higher contribution of MIR spectroscopic data, in the development of the models.

Cirugía profiláctica en cáncer medular de tiroides hereditario / Prophylactic surgery in hereditary medullary thyroid cancer

Introducción: Se estima que del total de los cánceres, el 5-10% tendría una base genética. Actualmente es posible identificar a los individuos con predisposición genética en algunos cánceres como manera de intervenir precozmente en el desarrollo de esta enfermedad. Objetivos: Evaluar la utilidad de la cirugía profiláctica en el cáncer medular de tiroides hereditario. Material y métodos: Este trabajo es una revisión de literatura de diferentes estudios extraídos de bibliotecas electrónicas como Scientific Electronic Library Online (SciELO), MedLine-PubMed y UpToDate, mediante la construcción de preguntas clínicas y términos MeSH enfocados principalmente en la búsqueda específica de información sobre el cáncer medular de tiroides hereditario. Resultados: Los estudios revisados demuestran que la tiroidectomía profiláctica con resección linfática cervical representa el único tratamiento eficaz en el caso del cáncer medular de tiroides hereditario. Conclusiones: La cirugía profiláctica ha demostrado una importante disminución del riesgo de cáncer de tiroides y se considera una conducta de rigor en portadores del gen RET en el cáncer medular de tiroides.

Introduction: Approximately 5-10% of global cancer has a genetic base. Nowadays it is possible to identify those who have a genetic predisposition for some cancers, so they can be treated in short term. Objectives: Evaluate how useful is prophylactic surgery on hereditary Medullary Thyroid Cancer. Materials and methods: This investigation is a literature review of different research papers from electronic databases such as Scientific Electronic Library Online (SciELO), MedLine-PubMed and UpToDate. The research was made with clinical queries and MeSH terms, specially focused on hereditary Medullary Thyroid Cancer. Results: This research shows that prophylactic Thyroidectomy with cervical lymph node resection is the only effective and curative treatment for hereditary Medullary Thyroid Cancer. Conclusions: Prophylactic surgery has proof an important role decreasing the risk on Hereditary Thyroid cancer Syndrome and in RET carriers surgery is considered a must.

Impaired Vascular Function in Sarcoidosis Patients.

A common feature of sarcoidosis and atherosclerosis is a chronic systemic inflammatory reaction. Our hypothesis was that sarcoidosis may negatively influence the vessel status. We addressed the issue by examining preatherosclerotic vascular alternations using an ultrasound-based speckle-tracking method in 72 sarcoidosis patients and 15 matched controls. To find potential factors which may have a deleterious influence on arterial performance, different subgroups of sarcoidosis, such as sarcoidosis with or without cortisone therapy, pulmonary sarcoidosis in early and advanced stages, pulmonary sarcoidosis alone or combined with extrapulmonary sarcoidosis, and sarcoidosis with or without elevated blood levels of angiotensin converting enzyme (ACE)/soluble interleukin 2 receptor (sIL-2R) were investigated. We found in the general collective of sarcoidosis patients that circumferential strain (2.68 ± 0.19%), circumferential strain rate (0.21 ± 0.01 1/s), and radial displacement (0.10 ± 0.01 mm) were significantly decreased compared to controls (3.77 ± 0.35%, 0.28 ± 0.02 1/s, and 0.14 ± 0.02 mm, respectively). Vascular strains were more impaired in patients with cortisone therapy, pulmonary sarcoidosis in stages III-IV, and in pulmonary sarcoidosis accompanied by extrapulmonary involvement. The level of ACE/sIL-2R had no relevant influence on the angiological parameters. In conclusion, sarcoidosis is associated with increased vascular stiffness. Cortisone therapy and advanced stages of pulmonary sarcoidosis with extrapulmonary manifestations may account for the impaired vascular function in this patient collective.

Cirugía profiláctica en síndrome de cáncer hereditario de mama / Prophylactic surgery in breast hereditary cancer syndrome

Introducción: Se estima que del total de los cánceres, el 5-10% tendría una base genética. Actualmente es posible identificar a los individuos con predisposición genética a desarrollar cáncer de mama, una manera de intervenir precozmente en el desarrollo de esta enfermedad. Objetivos: Evaluar la utilidad de la cirugía profiláctica en el síndrome de cáncer hereditario de mama. Material y métodos: Este trabajo es una revisión de literatura de diferentes estudios extraídos de bibliotecas electrónicas como Scientific Electronic Library Online (SciELO), MedLine-PubMed y UpToDate, mediante la construcción de preguntas clínicas y términos MeSH enfocados principalmente en la búsqueda específica de información del síndrome de cáncer hereditario de mama. Resultados: Los estudios revisados demuestran que la mastectomía bilateral profiláctica (MBP) disminuye en un 90% el riesgo de desarrollar cáncer de mama en las mujeres portadoras de BRCA1 o BRCA2. En cuanto a la salpingooferectomía (SO), reduciría entre un 50-56% el riesgo de cáncer de mama dependiendo de la mutación a la que se asocie. Conclusiones: La cirugía profiláctica ha demostrado importante disminución del riesgo de cáncer de mama, por lo que su uso es recomendado al hallazgo de las mutaciones BRCA1 y BRCA2.

Introduction: Approximately 5-10% of global cancer has a genetic base. Nowadays it is possible to identify those who have a genetic predisposition for breast cancer, so they can be treated in short term. Objectives: Evaluate how useful is prophylactic surgery on Hereditary Breast cancer Syndrome. Materials and methods: This investigation is a literature review of different research papers from electronic databases such as Scientific Electronic Library Online (SciELO), MedLine-PubMed and UpToDate. The research was made with clinical queries and MeSH terms, specially focused on Hereditary Breast cancer Syndrome. Results: This research shows that prophylactic bilateral mastectomy (PBM) decreases 90% risk of developing breast cancer in BRCA1 and BRCA2 carriers. On the other hand, Salpyngo-oophoferectomy (SO) technique decreases around 53% chances of breast cancer, depending on the associated mutation. Conclusion: Prophylactic surgery has shown an important role decreasing the risk on Hereditary Breast cancer Syndrome. So on, in cases of BRCA1 and BRCA2 carriers we suggest to perform prophylactic surgery.

Intermittent Hypoxia Contributes to the Lung Damage by Increased Oxidative Stress, Inflammation, and Disbalance in Protease/Antiprotease System.

INTRODUCTION: Intermittent hypoxia as a surrogate of obstructive sleep apnea is associated with different cardiovascular complications. However, the effects of intermittent hypoxia on the lung tissue are less known. Therefore, the aim of our present study was to investigate if intermittent hypoxia may influence oxidative stress, inflammation, and protease/antiprotease system in the lung. Additionally, potential protective properties of anti-inflammatory and anti-oxidative drugs have been evaluated. METHODS: 32 mice were divided into four groups: (1) intermittent hypoxia, (2) intermittent hypoxia with infliximab, (3) intermittent hypoxia with L-glutathione, and (4) normoxia. After 4 weeks, lungs and blood were collected. Levels of reactive oxygen species in the lung were calculated by L-O12-enhanced chemiluminescence. CD68-positive lung macrophages were detected by immunofluorescence. Concentrations of elastase and desmosine in lung and of alpha-1-antitrypsin in blood were calculated by means of enzyme-linked immunosorbent assay. RESULTS: Compared to a control, intermittent hypoxia augmented the release of free oxygen radicals, expression of CD68+ macrophages, and concentration of elastase in the lung tissue. Despite increased blood levels of protective alpha-1-antitrypsin, concentrations of desmosine-degradation product of elastin were higher versus control. The application of anti-inflammatory infliximab und anti-oxidative L-glutathione prevented at least partly the above-observed hypoxia-associated changes. CONCLUSIONS: Intermittent hypoxia contributes to the lung damage by increased oxidative stress, inflammation, and disbalance in protease/antiprotease system. Infliximab and L-glutathione may prevent adverse hypoxia-induced lung alternations.

Determinación de habilidades cognitivas en distintas asignaturas clínicas del Departamento de Odontología, Universidad de Antofagasta, Chile / Determination of cognitive skills in differents clinics courses of dentistry of the University of Antofagasta, Chile

El objetivo fue determinar las habilidades cognitivas más frecuentemente evaluadas en las pruebas escritas de final de unidad aplicadas durante el año 2013, en algunas asignaturas clínicas del Departamento de Odontología de la Universidad de Antofagasta. Se realizó un estudio de naturaleza cuantitativa, de diseño observacional, prospectivo, transversal y analítico que analizó las pruebas escritas de final de unidad en las asignaturas de periodoncia, rehabilitación, operatoria, cirugía y endodoncia en el Departamento de Odontología de la Universidad de Antofagasta. En el análisis y determinación de las habilidades cognitivas de cada pregunta participaron dos evaluadores en forma independiente. Se utilizó un protocolo de determinación de habilidades cognitivas, instrumento que fue validado por expertos. Las observaciones realizadas fueron promediadas y expresadas según frecuencias relativas (%), se utilizó software SPSS (v.22). El 95,8 % de las preguntas analizadas evaluaron habilidades cognitivas inferiores y el 4,12 % superiores. La mayor proporción de las preguntas analizadas corresponden al nivel cognitivo conocimiento (71,9 %) y la menor al de la evaluación (1,5 %). De las 5 asignaturas analizadas las que desarrollan más frecuentemente habilidades cognitivas superiores son periodoncia (12 %), endodoncia (3,3 %) y operatoria (2.1%).

The aims was to determine cognitive skills most frequently evaluated in the written tests final drive applied during 2013, in some clinicalcourses in the Department of Dentistry at the University of Antofagasta. A quantitative study of an observational, prospective, transversal and analytical which analyzed the written tests final drive in the courses of Periodontics, Rehabilitation, Operative, Surgery and Endodontics in the Department of Dentistry the University of Antofagasta. In the analysis and determination of the cognitive abilities of each question two evaluators participated independently. A protocol for determining cognitive abilities, an instrument that was validated by experts was used. The observations made by the evaluators were averaged and expressed as relative frequencies (%), was used SPSS software (v.22). 95.8 % of the questions analyzed evaluated lower cognitive abilities and 4.12 % higher. The largest proportion of the questions analyzed correspond to the cognitive and knowledge level (71.9 %) lower than the evaluation (1.5 %). Of the 5 subjects analyzed which develop most often they are Periodontology higher Cognitive Skills (12 %), Endodontics (3.3 %) and Operatoria (2.1 %).

Heart Rate Variability and Arrhythmic Burden in Pulmonary Hypertension.

A growing body of evidence indicates that sudden cardiac death constitutes a major cause of mortality in pulmonary hypertension (PH). As validated method to evaluate cardiac autonomic system dysfunction, alterations in heart rate variability (HRV) are predictive of arrhythmic events, particularly in left ventricular disease. Here, we sought to determine the clinical value of HRV assessment in PH. Sixty-four patients were allocated to different PH-subgroups in this prospectively conducted trial: 25 patients with pulmonary arterial hypertension (PAH), 11 patients with chronic thromboembolic PH (CTEPH), and 28 patients with COPD-induced PH. All patients underwent 24-h Holter electrocardiogram for HRV assessment by time- and frequency-domain analysis. Arrhythmic burden was evaluated by manual analysis and complementary automatic measurement of premature atrial and ventricular contractions. The results were compared to 31 healthy controls. The PAH patients offered a significantly higher mean heart rate (78.6 ± 10.4 bpm vs. 70.1 ± 10.3 bpm, p = 0.04), a higher burden of premature ventricular contractions (p < 0.01), and decreases in HRV (SDNN: p < 0.01; SDANN: p < 0.01; very low frequency: p < 0.01; low frequency/high frequency ratio: p < 0.01; total power: p = 0.02). In CTEPH patients, only the amount of premature ventricular contractions differed from controls (p < 0.01), whereas in COPD both premature atrial contraction count and frequency-domain-based HRV manifested significant differences. In conclusion, PAH appears to be primarily affected by HRV alterations and ventricular arrhythmic burden, indicating a high risk for malignant arrhythmic events.

Determination of kinetic parameters for biomass combustion.

The aim of this work is to provide a wide database of kinetic data for the most common biomass by thermogravimetric analysis (TGA) and differential thermogravimetry (DTG). Due to the characteristic parameters of DTG curves, a two-stage reaction model is proposed and the kinetic parameters obtained from model-based methods with energy activation values for first and second stages in the range 1.75·10(4)-1.55·10(5)J/mol and 1.62·10(4)-2.37·10(5)J/mol, respectively. However, it has been found that Flynn-Wall-Ozawa and Kissinger-Akahira-Sunose model-free methods are not suitable to determine the kinetic parameters of biomass combustion since the assumptions of these two methods were not accomplished in the full range of the combustion process.

[Diagnostic and Therapeutic Implications of Elevated Plasma Troponin in Acute Exacerbated Chronic Obstructive Pulmonary Disease]. / Diagnostische und therapeutische Implikationen der Troponinerhöhung bei akut exazerbierter chronisch obstruktiver Lungenerkrankung.

AIMS: Cardiovascular comorbid conditions are frequent in chronic obstructive pulmonary disease (COPD) and substantially influence morbidity and mortality. Elevated plasma levels of cardiac troponin have been detected in up to 74 % of patients with acute exacerbated COPD (AECOPD), pointing at concomitant myocardial damage that can primarily be ascribed to systemic inflammatory processes. The mechanisms promoting troponin release in AECOPD are manifold and comprise: type 1 myocardial infarction as a consequence of intraluminal thrombus formation, type 2 myocardial infarction due to an imbalance between myocardial oxygen supply and demand, as well as right and left heart failure. Given its multifactorial aetiology, no standardized diagnostic and therapeutic approach are as yet available. MATERIAL AND METHODS: On the basis of current literature, we propose a potential diagnostics and therapeutics algorithm for AECOPD patients with elevated troponin levels. RESULTS: Clinical presentation, electro- and echocardiogram, as well as cardiac troponin levels and their dynamics represent sufficient risk stratifiers that permit evaluation and timing of invasive coronary strategy. CONCLUSION: The necessity for a standardized approach to elevated troponin during AECOPD arises from the frequent presence of concomitant coronary heart disease and the potential risk of oversight of type 1 myocardial infarction.