Análisis de los pacientes con diabetes controlados a nivel primaria en el Servicio de Salud Concepción / Analysis of diabetic patients controlled at primary level in Concepcion Health Service

To evaluate diabetic patients in control in Concepcion Health Service, evaluating coverage, metabolic control and complications. Material: A retrospective analysis of the statistical record of 2011 (REM) using the CIE-10 classification was done. Estimation is performed with the National Health Survey of 2010. Results: 26,638 patients are controlled, achieving a 67.9 percent coverage (point estimate based on the National Health Survey of 2010), being lower in the group between 15 and 44 years old (34 percent). 38.4 percent had good metabolic control (HbA1C less than 7) and 20.8 percent poor control (HbA1C greater than 9). According to age, the group over 65 had better control and the group between 15 and 44 years worse control. The complication described was diabetic foot (51.9 percent), retinopathy (5 percent) and nephropathy (4.6 percent). Discussion: The prevalence of diabetes is increasing every year in Chile. There is acceptable coverage and early diagnosis, but still are poorly controlled cases and require a multifactorial management that begins with a self-care of their diabetes...

[Colorectal polyps: update on diagnosis]. / Pólipos colorectales: actualización en el diagnóstico.

Histological diagnosis determines the clinical behavior of colorectal polyps. Recently new types of polyps have been described and the classification has become wider and more complex. Our aim is update the current concepts in the knowledge of colorectal polyps.

Pólipos colorectales: actualización en el diagnóstico / Colorectal polyps: update in the diagnosis

El diagnóstico histológico de los pólipos colorrectales determina la conducta que tomará el médico especialista con el paciente. Con la aparición de nuevos pólipos en los últimos años, la clasificación histológica se ha tornado más compleja y amplia. Nuestro objetivo es actualizar los conceptos en el diagnóstico histológico de pólipos de colon de una manera clara y de fácil comprensión, especialmente para gastroenterólogos y patólogos.

Histological diagnosis determines the clinical behavior of colorectal polyps. Recently new types of polyps have been described and the classification has become wider and more complex. Our aim is update the current concepts in the knowledge of colorectal polyps.

Incremento de linfocitos intraepiteliales en pacientes con sindrome de intestino irritable / Increase of intraepithelial lymphocytes in patients with irritable bowel syndrome

Diversos trabajos reportan aumento en el número de linfocitos intraepiteliales (LIE), mastocitos y células enterocromafines en pacientes con Sindrome de Intestino Irritable (SII). Muchos de estos hallazgos se basan en el uso de inmunohistoquímica que son de poca disponibilidad en hospitales generales. El objetivo del presente trabajo es estudiar los hallazgos histológicos en la biopsia de colon sólo con histoquimica en pacientes con SII comparándolos con un grupo sin SII. Fueron incluidos 25 pacientes: 16 (64%), con criterios diagnósticos de SII y 9 (36%), sin SII. Se encontró un mayor número de LIE en el grupo de SII (p=0,002). Un grupo de pacientes con criterios Roma III (41,9%) presentó LIE en el rango de Colitis Linfocitica por lo que fueron excluidos de este estudio. No se encontró diferencia estadísticamente significativa en el número de mastocitos, células enterocromafines y eosinofilos.

Several studies have shown increased numbers of intraepithelial lymphocytes (IEL), mast cells, enterochromaffin cells in colonic mucosa of patients with Irritable Bowel Syndrome (IBS). Many of these findings are based is based on immunohistochemistry results, which is not available in general hospitals. Our objective is to study the histological findings observed in colon biopsies from patients with IBS compared with a group without IBS, using only histochemistry. Twenty five (25) patients were included: 16 with IBS and 9 without IBS. We found increased numbers of IEL in patients with IBS (p=0,002). A group of patients with IBS(41.9%) who fulfilled histological criteria for lymphocytic colitis were excluded. There was no significant difference in mast cells, enterochromaffin cells or eosinophils.

[Increase of intraepithelial lymphocytes in patients with irritable bowel syndrome]. / Incremento de Linfocitos Intraepiteliales en Pacientes con Sindrome de Intestino Irritable.

Several studies have shown increased numbers of intraepithelial lymphocytes (IEL), mast cells, enterochromaffin cells in colonic mucosa of patients with Irritable Bowel Syndrome (IBS). Many of these findings are based is based on immunohistochemistry results, which is not available in general hospitals. Our objective is to study the histological findings observed in colon biopsies from patients with IBS compared with a group without IBS, using only histochemistry. Twenty five (25) patients were included: 16 with IBS and 9 without IBS. We found increased numbers of IEL in patients with IBS (p=0,002). A group of patients with IBS (41.9%) who fulfilled histological criteria for lymphocytic colitis were excluded. There was no significant difference in mast cells, enterochromaffin cells or eosinophils.

Low serological positivity in patients with histology compatible with celiac disease in Perú.

OBJECTIVE: To study the frequency of positive serology for celiac disease (CD) in patients with duodenal biopsies suggestive of this disease. MATERIAL AND METHODS: Cross sectional study. We included patients with duodenal biopsies histologically compatible with CD and antigliadin, antiendomysial and IgA antitransglutaminase antibodies. We defined a "case" of CD if there was a positive biopsy and either antiendomisial or antitransglutaminase positive antibodies. RESULTS: Thirty one patients were included in our study. Six were antiendomysial positive and 5 antitransglutaminase positive while the antigliadin was positive in 14 cases. Therefore, out of 31 patients only 10 had a serology compatible with CD and only one had positive both antibodies, antiendomysial and antitransglutaminase. CONCLUSIONS: a) We have found that most of the duodenal biopsies compatible with CD are not diagnosed with positive serology; and b) we found a low correlation between serological diagnostic tests.

¿Cuántas víctimas se necesitan para definir un desastre? / How many victims are needed to define a disaster?

Objetivo. Describir una situación de atención de víctimas múltiples. Analizar las características particulares del síndrome de inhalación de humo (SIH). Material y Métodos. Se evaluaron 5 pacientes (pts), ingresados al Servicio de Emergencias del HRRG en Noviembre del 2006, de los cuales tres ingresaron al Servicio de Terapia Intensiva (STI), único en la zona norte de la Provincia de Tierra del Fuego. La capacidad instalada del Hospital es de 5 camas de Terapia Intensiva con 5 respiradores microprocesador y con un ingreso anual de 300 pts con un índice de ocupación de camas de 5.4 pts/día. Los motivos de ingreso al STI fueron: Síndrome de Inhalación de Humo (SIH) e Insuficiencia Respiratoria Aguda. Se dividió a las Lesiones de la Inhalación de Humo (LIH) en: Lesión Térmica de la Vía Aérea (LTVA), Asfixia (A) y Lesiones por Gases Irritantes (LGI)*. Se evaluaron: Índice Trauma Pediátrico (ITP), APACHE II, características demográficas, estadía en TI (ETI), déficit de base en las 48 hs (DB/48) y mortalidad (M). Resultados. De los 5 pts (2 mujeres y 3 hombres), la edad promedio fue 8,6 años (rango 3-16), el APACHE II (promedio): 24.6 puntos (rango 2230), la ETI (promedio): 11,6 días (rango 1-18), ITP (promedio): 0 (-4 a +4) y el DB 48 (promedio) 11.4 mEq (rango -6 a -19). La mortalidad global fue del 40%. Tres pacientes presentaron LTVA, A y LGI, mientras que los dos restantes presentaron LTVA y A. Conclusión. La recepción de los 5 pts superó, en forma inmediata, los recursos en el sistema local hospitalario, cumpliendo con la definición de desastre. La acidosis metabólica durante las primeras 48 hs en el contexto del SIH se acompañó de mayor morbimortalidad.(AU)

How many victims are necessary to define a disaster? Objective. Describe a situation of care of multiple victims. Analyse the particular characteristics of smoke inhalation syndrome (SIH). Material and methods. 5 patients (pt) admitted to the Emergency Service of HRRG in November 2006 were evaluated. Three patients were admitted to the Intensive Care Unit, the only Service in the northern province of Tierra del Fuego. The Intensive Care Unit has 5 beds and 5 critical care ventilators to assit patients with respiratory failure. We admitted roughly 300 patients each year. The reasons for the admision were: Smoke inhalation Syndrome (SIH) and acute respiratory failure Injuries because inhaling smoke (LIH) were classified in: Thermal Injury of the Air (LTVA), Asphyxia (A) and Gas Injures Irritants (LGI). We consigned Pediatric Trauma Index (ITP), Apache II score, demographics, length of stay in STI, the basic deficit within 48 hours (DB/48) and mortality (M). Results. Of the 5 pt (2 women and 3 men), age was 8.6 years (range 3-16), the Apache II: 24.6 (range 22-30), length of stay 11.6 days (range 1-18), ITP: 0 (-4 to +4) and DB 48 (average) - 11.4 mEq (-6 to -19 range). The mortality rate was 40%. Three patients had LTVA, A and LGI, while the remaining two, both presented LTVA and A Conclusion. The admission of the 5 pt exceeded, immediately, resources in the local hospital system, fulfilling with the definition of disaster. The metabolic acidosis during the first 48 hours in the context of SIH was associated with increased morbidity and mortality(AU)

Prevention of clinical mastitis with barium selenate in dairy goats from a selenium-deficient area.

Mastitis is one of the most negative factors involved in the economy of dairy goat farms. The effect of selenium on mammary gland resistance to infectious diseases has been demonstrated. This work evaluates the efficacy of a slow-release Se salt (barium selenate) to reduce the incidence of clinical mastitis in goats reared on Se-deficient areas. Six hundred milking goats of the Malagueña breed, from 4 commercial dairy farms located in a Se-deficient area, were randomly allotted to 2 groups: treated group (given a subcutaneous injection of barium selenate at a dose of 1 mg of Se/kg of body weight 15 d before mating) and control group (no supplement). During the lactation the does were monitored to assess the occurrence of clinical mastitis by physical examination, California Mastitis Test performance, and microbiological study. The Se content of the ration consumed previously by the animals did not meet the requirements for dairy goats. The Se injection significantly increased glutathione peroxidase activity in the treated group and had evident beneficial effects in the subsequent lactation. The somatic cell count and the incidence of clinical mastitis were significantly lower in the treated group than in the control group. However, no significant differences were found for milk composition. Thus, in Se-deficient areas, the supplementation with Se of any source in programs for prevention of clinical mastitis and improvement of milk quality is strongly recommended.

Evaluation of the flora of northern Mexico for in vitro antimicrobial and antituberculosis activity.

The aim of the present study was to evaluate the potential antimicrobial activity of 14 plants used in northeast México for the treatment of respiratory diseases, against drug-sensitive and drug-resistant strains of Streptococcus pneumoniae, Staphylococcus aureus, Haemophilus influenzae type b and Mycobacterium tuberculosis. Forty-eight organic and aqueous extracts were tested against these bacterial strains using a broth microdilution test. No aqueous extracts showed antimicrobial activity, whereas most of the organic extracts presented antimicrobial activity against at least one of the drug-resistant microorganisms tested. Methanol-based extracts from the roots and leaves of Leucophyllum frutescens and ethyl ether extract from the roots of Chrysanctinia mexicana showed the greatest antimicrobial activity against the drug-resistant strain of Mycobacterium tuberculosis; the minimal inhibitory concentration (MIC) were 62.5, 125 and 62.5 microg/mL, respectively; methanol-based extract from the leaves of Cordia boissieri showed the best antimicrobial activity against the drug-resistant strain of Staphylococcus aureus (MIC 250 microg/mL); the hexane-based extract from the fruits of Schinus molle showed considerable antimicrobial activity against the drug-resistant strain of Streptococcus pneumoniae (MIC 62.5 microg/mL). This study supports that selecting plants by ethnobotanical criteria enhances the possibility of finding species with activity against resistant microorganisms.

[Medical-surgical experience of intestinal intussusception. Experience of a university institution]. / Enfrentamiento médico quirúrgico de la invaginación intestinal. Experiencia de una institución universitaria.

BACKGROUND: Management of intestinal intussusception in children has evolved from exclusively surgical treatments to nonoperative reduction under fluoroscopic monitoring. AIM: To report a 10 year experience in a University Hospital in the management of intestinal intussusception. PATIENTS AND METHODS: Seventy two patients, aged 2 to 72 months of age, with an uncomplicated intussusception, that were treated by barium or air enema, were studied. RESULTS: The success rate was 73% with barium reductions, and 100% with air reductions. In 17 patients (24%), enema reduction was unsuccessful and were subjected to a surgical reduction. CONCLUSIONS: Nonsurgical reduction is safe and effective as the initial treatment of uncomplicated intussusception in children.

[Difficulties of the methods for studying environmental exposure and neural tube defects]. / Dificultades en los métodos de estudio de exposiciones ambientales y defectos del tubo neural.

OBJECTIVE: To discuss the attitudes in the assessment of environmental exposures as risk factors associated with neural tube defects, and to present the main risk factors studied to date. RESULTS: Environmental exposures have been suggested to have a roll in the genesis of birth defects. However, studies conducted in human populations have found difficulties in the design and conduction to show such an association for neural tube defects (anencephaly, espina bifida and encephalocele) because of problems raised from: a) the frequency measures used to compare time trends and communities, b) the classification of heterogeneous malformations, c) the inclusion of maternal, paternal and fetal factors as an integrated process and, d) the assessment of environmental exposures. CONCLUSIONS: Hypothetically both maternal and paternal environmental exposures can produce damage before and after conception by direct action on the embryo and the fetus-placenta complex. Therefore, in the assessment of environmental exposures we need to take into account: a) both paternal and maternal exposures; b) the critical exposure period, three months before conception for paternal exposures and one month around the conceptional period for maternal exposures; c) quantitatively evaluate environmental exposures when possible, avoiding a dichotomous classification; d) the use of biological markers of exposure is highly recommended as well as markers of genetic susceptibility.

[Hydrostatic reduction of intestinal intussusception in children. Experience in 43 cases]. / Reducción hidrostática como método terapéutico de la invaginación intestinal en el niño: experiencia en 43 pacientes.

BACKGROUND: Intestinal intussusception, a medical emergency, is more commonly idiopathic and ileocolic and occurs with higher frequency in children aged 6 months to 2 years. Barium enema confirms the diagnosis and allows its hydrostatic reduction, that is the treatment of choice of this condition. AIM: To report our experience with hydrostatic reduction of intestinal intussusception in children. PATIENTS AND METHODS: Hydrostatic reduction was attempted in 43 children with intestinal intussusception: 20 male, aged 2 to 48 months, that consulted at the Clinical Hospital of the Catholic University in Santiago. RESULTS: Hydrostatic reduction was successful in 33 children (77%) that were discharged from the hospital 24 to 96 hours after the procedure. A partial reduction was achieved in 10 patients (23%) who required surgery and were discharged from the hospital 5 to 8 days after the procedure. CONCLUSIONS: Our results are similar to those reported abroad and allow the recommendation of hydrostatic reduction as the treatment of choice for intestinal intussusception.

[The case-control design in medical research]. / El diseño de casos y controles en la investigación médica.

The aim of this paper is to present a conceptual and practical framework of the case-control design in medical research. To illustrate this method, practical examples directed to clinicians and other health professionals interested in medical research are presented. The case-control method is very versatile and allows for multiple applications. Guidelines for the selection of cases and controls, and some considerations on sample size are presented. In the statistical analysis we use concrete examples of how to estimate odds ratios, confidence intervals, and methods to control for potential confounders, from stratified analysis to logistic regression.

[Congenital stenosis of pulmonary veins in the adult]. / Estenosis congénita de venas pulmonares en el adulto.

We report a case of congenital bilateral pulmonary vein stenosis associated with a double-chambered right ventricle, ventricular septal defect and persistence of the ductus arteriosus in a 29 year-old female. The angiographic, echocardiographic and surgical findings are discussed. A precise diagnosis, the utility of the echocardiography and the surgical correction of this type of ostial stenosis is also reported.

[Syncope associated with glossopharyngeal neuralgia and parapharyngeal tumor]. / Síncope asociado a neuralgia del glosofaríngeo y tumoración parafaríngea.

The reflex-induced cardiovascular syncope is rarely associated with facial neuralgia and neck neoplasms. We report the case of a male with vasopressor and cardioinhibitor syncopes, despite the implantation of a pacemaker. Because of a glossopharyngeal neuralgia, a neoplasm of the left parapharyngeal fossae is diagnosed. The pathophysiology and the therapeutic approach is discussed.

[Thrombocytosis and coronary disease. Report of a case]. / Trombocitosis y enfermedad coronaria. A propósito de un caso.

We report the case of a young male with an inferior myocardial infarction who was treated with fibrinolytic agents and displayed a good evolution. The only cardiovascular risk factor that this patient had was an idiopathic thrombocytosis with abnormal platelet hyperreactivity tests. The angiogram showed an eccentric lesion of 60% in the left main coronary artery. A week later, after treatment based on anticoagulants and antithrombotic agents the angiogram was normal, and the lesion had disappeared. The association between these conditions is discussed the therapeutic approach is also discussed. A review of the literature is conducted.

[Results of surgical treatment of metastases of renal carcinomas in 65 operated cases]. / Résultats du traitement chirurgical des métastases de cancer du rein -A propos de 65 métastases opérées.

Several reports have assessed that the prognosis of metastatic renal cell carcinoma was better if patient's general condition was good, if primary tumor had been resected, if the time between nephrectomy and metastasis was long, if metastases are only pulmonary and bone marrow was not involved. The bone metastases of renal cell cancer have a bad reputation because of their haemorragic caracteristics and their resistance to radiotherapy.In the Orthopaedic and Traumatologic Department of the University hospital in Strasbourg, the authors had operated on 65 metastatic renal cell cancers. There were 55 patients (41 were men and 14 female), aged of 60 (range 41-84). Eight of them had 2 operations and 1 had 3 metastatic localisations.In 23% the metastases were present at the time of primary tumor diagnosis; in 17% the metastasis was even a signal metastasis. There were pathologic fractures in half of the cases (33 cases) and in the other half the metastasis had not fractured. The commonest site was the femur (40 of the 65 cases). The second site was the humerus (15 cases). There were also 7 vertebrae, 6 of them with neurologic deficit.The authors performed closed osteosynthesis in 27 cases (15 intramedullary nails, 7 Ender nails, 4 bipolar pinnings, 1 gamma nail), arthroplasty in 19 cases (6 standard prosthesis and 13 reconstruction prostheses) and an open osteosynthesis in 12 cases. They performed also 3 vertebrectomies by an anterior approach and 4 posterior decompressions and stabilisations.The average post operative survival was 15 months (range 0-109). Six patients died in the first post-operative month. Three non specific complications were observed: 2 prosthetic dislocations and one infected nail failure. 6 tumor extensions were observed on 2 prostheses, 3 intramedullary nails and 1 open osthesynthesis.The results were good for pain in 83% of the patients, the functional result good or fair in 78%.The efficacy of adjuvant medications was discussed, based on the literature data. Two groups of metastatic renal cell cancer were studied: the first with multiple metastases and a high speed progressive disease, the other with single metastasis and a low speed progressive disease. The surgical indications should be different in the two groups.

Edad de la corrección quirúrgica del testículo no descendido / The moment of surgical correction of undescended testis

El momento de la corrección quirúrgica de los testículos no descendidos ha variado en la última década. En la actualidad se recomienda la intervención entre el primer y segundo año de vida. Para evaluar si esta recomendación es practicada, hemos realizado un estudio retrospectivo de todos los pacientes pediátricos que fueron sometidos a una intervención por testículo no descendido en nuestra Institución, los últimos 6 años. La serie comprende 208 pacientes, con testículo no descendido a derecha 41,8 por ciento, a izquierda 39,4 por ciento y compromiso bilateral 18,8 por ciento. En un 10.6 por ciento se presentaron como testículo no palpable. En un 96 por ciento de los casos se realizó una orquidopexia clásica, 8/22 (36,4 por ciento) de los testículos no palpables fueron extirpados y biopsiados. La edad de la intervención de la serie total fue de 5 años y 3 meses. Dividimos la serie en dos grupos: Grupo A pacientes en control pediátrico en nuestra Institución y cuya edad de intervención fue de 4 años y 3 meses y grupo B pacientes derivados al especialista del extrasistema. La edad de intervención de este grupo fue de 6 años. Sólo 10 por ciento de los pacientes fueron operados antes de los 2 años. Pese a conocer cuál es la edad recomendada para la corrección quirúrgica de los testículos no descendidos, en nuestro medio estamos muy lejos de ello. Es importante crear conciencia especialmente en los pediatras de las ventajas de una cirugía precoz