Invasive pneumococcal disease in hospitalised children from Lima, Peru before and after introduction of the 7-valent conjugated vaccine.

The objective of this study was to determine the serotype distribution and antibiotic resistance of invasive pneumococcal disease (IPD) strains in children from Lima, Peru, before and after the introduction of the 7-valent pneumococcal conjugate vaccine (PCV7), which was introduced in the national immunisation program on 2009. We conducted a prospective, multicentre, passive surveillance IPD study during 2006-2008 and 2009-2011, before and right after the introduction of PCV7 in Peru. The study was performed in 11 hospitals and five private laboratories in Lima, Peru, in patients <18 years old, with sterile site cultures yielding Streptococcus pneumoniae. In total 159 S. pneumoniae isolates were recovered. There was a decrease in the incidence of IPD in children <2 years old after the introduction of PCV7 (18.4/100 000 vs. 5.1/100 000, P = 0.004). Meningitis cases decreased significantly in the second period (P = 0.036) as well as the overall case fatality rate (P = 0.025), including a decreased case fatality rate of pneumonia (16.3% to 0%, P = 0.04). PCV7 serotypes showed a downward trend. Vaccine-preventable serotypes caused 78.9% of IPD cases, mainly 14, 6B, 5, 19F and 23F. A non-significant increase in erythromycin resistance was reported. Our findings suggest that the introduction of PCV7 led to a significant decrease of IPD in children under 2 years old and in the overall case fatality rate.

Diagnostic accuracy of lumbar CT and MRI in the evaluation of chronic low back pain without red flag symptoms.

BACKGROUND: Low back pain (LBP) is one of the most frequent reasons for medical consultation. Most of the patients will have nonspecific LBP, which usually are self-limited episodes. It is unclear which of the diagnostic imaging pathways is most effective and costeffective and how the imaging impacts on patient treatment. Imaging techniques are usually indicated if symptoms remain after 6 weeks. Magnetic resonance imaging (MRI) is the diagnostic imaging examination of choice in lumbar spine evaluation of low back pain; however, availability of MRI is limited. OBJECTIVES: To evaluate the diagnostic accuracy of computed tomography (CT) with MRI (as standard of reference) in the evaluation of chronic low back pain (LBP) without red flags symptoms. To compare the results obtained by two radiologists with different grades of experience. MATERIALS AND METHODS: Patients with chronic low back pain without red flags symptoms were retrospectively reviewed by two observers with different level of experience. Patients included had undergone a lumbar or abdominal CT and an MRI within a year. Once the radiological information was collected, it was then statistically reviewed. The aim of the statistical analysis is to identify the equivalence between both diagnostic techniques. To this end, sensitivity, specificity and validity index were calculated. In addition, intra and inter-observer reliability were measured by Cohen's kappa values and also using the McNemar test. RESULTS: 340 lumbar levels were evaluated from 68 adult patients with chronic low back pain or sciatica. 63.2% of them were women, with an average age of 60.3 years (SD 14.7). CT shows high values of sensitivity and specificity (>80%) in most of the items evaluated, but sensitivity was low for the evaluation of density of the disc (40%) and for the detection of disc herniation (55%). Moreover, agreement between MRI and CT in most of these items was substantial or almost perfect (Cohen's kappa-coefficient > 0'8), excluding Modic changes (kappa = 0.497), degenerative changes (kappa0.688), signal of the disc (kappa = 0.327) and disc herniation (kappa = 0.639). Finally, agreement between both observers is mostly high (kappa > 0.8). Foraminal stenosis, canal stenosis and the grade of the canal stenosis were overdiagnosed by the inexperienced observer in the evaluation of CT images. CONCLUSIONS AND SIGNIFICANCE: CT is as sensitive as lumbar MRI in the evaluation of most of the items analysed, excluding Modic changes, degenerative changes, signal of the disc and disc herniation. In addition, these results are obtained regardless the experience of the radiologist. The rising use of diagnostic medical imaging and the improvement of image quality brings the opportunity of making a second look of abdominal CT in search of causes of LBP. Thereby, inappropriate medical imaging could be avoided (2). In addition, it would allow to reduce MRI waiting list and prioritize other patients with more severe pathology than LBP.

Chronic cholangitides: Differential diagnosis and role of MRI. / Colangitis crónicas: diagnóstico diferencial y papel de la resonancia magnética.

The idiopathic chronic cholangitides comprise a group of hepatobiliary diseases of probable autoimmune origin that are usually asymptomatic in the initial stages and can lead to cirrhosis of the liver. Elevated cholestatic enzymes on blood tests raise suspicion of these entities. Among the idiopathic cholangitides, the most common is primary sclerosing cholangitis, which is associated with inflammatory bowel disease and with an increased incidence of hepatobiliary and digestive tract tumors. It is important to establish the differential diagnosis with IgG4-associated cholangitis, primary biliary cholangitis, and secondary cholangitides, because the therapeutic management is different. Magnetic resonance cholangiopancreatography (MRCP) is the best test to evaluate the intrahepatic and extrahepatic biliary tract, and MRI also provides information about the liver and other abdominal organs. An appropriate MRCP protocol and knowledge of the different findings that are characteristic of each entity are essential to reach the correct diagnosis.

Myriapod haemocyanin: the first three-dimensional reconstruction of Scolopendra subspinipes and preliminary structural analysis of S. viridicornis.

Haemocyanins (Hcs) are copper-containing, respiratory proteins that occur in the haemolymph of many arthropod species. Here, we report the presence of Hcs in the chilopode Myriapoda, demonstrating that these proteins are more widespread among the Arthropoda than previously thought. The analysis of transcriptome of S. subspinipes subpinipes reveals the presence of two distinct subunits of Hc, where the signal peptide is present, and six of prophenoloxidase (PPO), where the signal peptide is absent, in the 75 kDa range. Size exclusion chromatography profiles indicate different quaternary organization for Hc of both species, which was corroborated by TEM analysis: S. viridicornis Hc is a 6 × 6-mer and S. subspinipes Hc is a 3 × 6-mer, which resembles the half-structure of the 6 × 6-mer but also includes the presence of phenoloxidases, since the 1 × 6-mer quaternary organization is commonly associated with hexamers of PPO. Studies with Chelicerata showed that PPO activity are exclusively associated with the Hcs. This study indicates that Scolopendra may have different proteins playing oxygen transport (Hc) and PO function, both following the hexameric oligomerization observed in Hcs.

Lacrain: the first antimicrobial peptide from the body extract of the Brazilian centipede Scolopendra viridicornis.

Antimicrobial activities have previously been described by traditional Eastern medicine in Chilopoda body extracts, but until now no bioactive peptides have been described. In this study, a novel antimicrobial peptide, lacrain, was isolated from the body extract of the Brazilian Chilopoda Scolopendra viridicornis. The peptide was isolated by reverse-phase high-performance liquid chromatography (RP-HPLC). Its activity was tested using a liquid growth inhibition assay and the peptide was characterised using mass spectrometry. Lacrain has a sequence composed of eight amino acid residues and a molecular mass of 925.5 Da. A synthetic peptide of the native lacrain had identical characteristics to those of the isolated material, confirming its sequence. The synthetic peptide was active only against Gram-negative bacteria, showing strong bactericidal activity. Moreover, the peptide did not present haemolytic activity against human erythrocytes. Lacrain represents a novel molecule with powerful antibacterial activity that could be used as a new template for the development of drugs against clinically resistant bacterial strains.

[Pott's disease in children]. / Mal de Pott en niños.

Twenty seven cases of Pott's disease in children between 6 months and 14 years of age are reported. They were observed during a two years period, with a follow-up time till 18 months. In report to their ages 67% were lower than 6 years old and two of them lower than one year old. There was a male sex predominance. The 'hump' sign was the most frequently observed. The most frequent damage localization was at dorsal level. All patients received treatment with four drugs, 14 of them needed orthopedic methods, and only 6 were submitted to surgical correction. In more than 50% of the patients there was good outcome toward cure or improvement with sequelae.

[Non tumor intracranial expansive processes: clinico-topographical correlation]. / Procesos expansivos intracraneanos no tumorales. Correlato clínico-tomográfico.

Presentation of clinical-tomographic correlation in 111 cases of non tumoral intracranial expansive processes seen between 1984-1988 in the Hospital Cayetano Heredia (Lima, Peru). Emphasis is given fundamentally to: (1) the importance of establishing the organicity of partial and late epilepsy; (2) the high incidence rate of inflammatory infectious processes with CNS compromise in underdeveloping countries; (3) the necessity of making public the importance of two parasitic diseases in the differential diagnosis of non tumoral intracranial expansive processes: free living amebiasis, and toxoplasmosis (especially in association with AIDS).

[Tuberculous meningoencephalitis]. / Meningoencefalitis tuberculosa.

Tuberculosis (TBC) in children is still a public health problem in developing countries. Its most serious complication in children is meningo-encephalitis (ME TBC), which is one of the main causes of death from TBC. The objective of this review is to outline its aetiopathological, clinical and prognostic characteristics and compare these with three studies made in our University between 1984 and the present time. METBC is always a complication secondary to an unknown (but often pulmonary) focus. The morbid anatomy of the deposit of basal exudate explains all the subsequent clinical findings. The data given in the literature regarding the commonest presentation, that of subacute or chronic meningo-encephalitis, is similar to our findings. However there are some differences. These are: a tendency to presentation in older children, much lower mortality, a long-term incidence of sequelae of less than 50% which is much less than would be expected (especially in certain areas of superior nerve function). With regard to treatment, we emphasize that the standard recommendation is still to use four drugs for twelve mouths. Although steroids have not been shown to be of use with regard to either mortality or morbidity, they continue to be given.

Sistema intrauterino liberador de levonorgestrel en el tratamiento del sangrado uterino anormal secundario a miomatosis uterina / Levonorgestrel-releasing intrauterine system in the treatment of abnormal uterine bleeding secondary to uterine leiomyomas

Resumen ANTECEDENTES: el sangrado uterino anormal por miomatosis intramural de pequeños elementos es una indicación frecuente de histerectomía; el tratamiento hormonal puede disminuir la necesidad de esta cirugía. OBJETIVO: evaluar si con el sistema liberador de levonorgestrel disminuye el sangrado uterino anormal por miomatosis intramural de pequeños elementos. MATERIALES Y MÉTODOS: ensayo clínico fase II de un solo brazo al que se incluyeron mujeres de 35 a 45 años de edad, con diagnóstico de sangrado uterino anormal por miomatosis intramural de pequeños elementos, con útero menor a 12 cm (eje longitudinal por ultrasonido) y biopsia de endometrio sin enfermedad maligna; a todas se les colocó el sistema liberador de levonorgestrel. Se evaluó: el sangrado con la escala PBACs (Pictorial Blood Assessment Chart score), el dolor pélvico con escala de EVA, la recuperación hematológica (hemoglobina sérica), volumen uterino (mm3) y recuperación de la actividad física y sexual antes de la colocación del sistema liberador de levonorgestrel y a los 3, 6 y 9 meses posteriores. RESULTADOS: se estudiaron 20 pacientes, de éstas 3 con histerectomía antes de cumplir los tres meses de seguimiento. A los tres meses 76.4% (IC 95%: 55.9-97) redujeron el sangrado en más de 50% del basal, a los seis meses todas habían reducido más de 50% el sangrado y a los nueve meses, nueve eran amenorreicas, el resto con reducción promedio de 90%. El dolor se redujo y permitió recuperar la actividad física y sexual en 90% de los casos. Las concentraciones de hemoglobina se incrementaron, en promedio, 0.8 g/dL, y no hubo reducción clínicamente significativa del tamaño uterino. CONCLUSIONES: el sistema liberador de levonorgestrel disminuyó de manera muy significativa el sangrado uterino anormal por miomatosis intramural de pequeños elementos a partir de los tres meses de tratamiento.

Abstract BACKGROUND: abnormal uterine bleeding due to small intramural leiomyomas is a frequent indication of hysterectomy; hormone treatment may decrease the need for this surgery. OBJECTIVE: to evaluate if using the levonorgestreal-releasing system decreases abnormal uterine bleeding caused by small intramural leiomyomas. MATERIALS AND METHODS: a phase II single arm clinical trial that included women from 35 to 45 years with a diagnosis of abnormal uterine bleeding caused by small intramural leiomyomas in less than 12 cm uteri (longitudinal axis on ultrasound) and endometrial biopsy with no malignant disease; all the women had the levonorgestrel-releasing system placed. We evaluated: bleeding with the PBAC scale (Pictorial Blood Assessment Chart score), pelvic pain with the EVA scale, hematological recovery (serum hemoglobin), uterine volume (mm3) and recovery of physical and sexual activity before placement of the levonorgestrel-releasing system 3, 6 and 9 months later. RESULTS: 20 patients were studied, 3 of these had a hysterectomy before the three month follow up period. After three months 76.4% % (IC 95%: 55.9-97) decreased bleeding more than 50% compared to baseline, after six months, all had decreased bleeding more than 50% and at nine months, nine had amenorrhea and the rest had an average reduction of 90%. Pain decreased and allowed them to recover physical and sexual activity in 90% of cases. Concentrations of hemoglobin increased an average of 0.8 g/dL and there was no clinically significant reduction of the uterine size. CONCLUSIONS: the levonorgestrel-releasing system significantly decreased abnormal uterine bleeding caused by small intramural leiomyomas after three months of treatment.

Metástasis testicular de cáncer prostático: reporte de un caso y revisión de literatura / Testicular metastasis from prostate cancer: report of a case and review of the literature

Introducción: El cáncer de próstata es la neoplasia más frecuente en hombres, y en Chile representa la tercera causa de mortalidad por cáncer en el sexo masculino. Cuando presenta metástasis, lo hace más frecuentemente a ganglios ilíacos, hueso, pulmón e hígado y muy raramente a testículo. Caso clínico: Hombre de 80 años sometido a una prostatectomía radical hace 11 años por adenoarcinoma próstatico con Score de Gleason 8. Asintomático, presenta aumento de volumen testicular izquierdo, pétreo e indoloro. Los marcadores tumorales testiculares resultaron normales, elantígeno prostático (APE) elevado y ecodoppler sugerente de tumor testicular. Tras orquiectomía radical, la biopsia con tinción inmunohistoquímica detecta APE intenso en las células tumorales, develando su origen. La tomografía computarizada abdominal y cintigrafía ósea descartan diseminación a otros órganos. Discusión: A pesar de la alta incidencia del cáncer prostático, las metástasis a testículo son muy raras. Desde 1938, se han reportado en la literatura internacional poco menos de 200 casos. Pueden detectarse como hallazgo o simulando un tumor primario testicular. Para diferenciarlos es necesaria una adecuada historia, examen físico y marcadores tumorales, sobre todo en el examen histológico. El pronóstico del cáncer prostático con metástasis testicular es desconocido, pero en estudios recientes se ha establecido que conferiría un peor pronóstico, debiéndose considerar como signo de enfermedad diseminada y por lo tanto, instaurar tratamiento sistémico y controlar estrictamente a estos pacientes. El caso expuesto ilustra la infrecuente presentación de una metástasis de cáncer de próstata como masa testicular. Además, sin metástasis en otros órganos, lo cual es aún más infrecuente. Además, recalca la necesidad de una evaluación adecuada para asegurar el estadio tumoral. Conclusión: Aunque la metástasis testicular es infrecuente, y no ha sido descrita previamente en nuestro medio, debiese...

Introduction: Prostate cancer (PCa) is the most frequent neoplasia in males. In Chile, PCa is the third cause of mortality by cancer in males. The most frequent metastatic sites are iliac lymphnodes, bone, lungs and liver. Testes are rarely affected. Case report: An 80 year old male submitted to radical prostatectomy 11 years ago for Gleason 8 adenocarcinoma. He was asintomatic until he presented with a painless hard left testicular mass. Serum tumor markers were negative. PSA level was elevated and a testicular Doppler ultrasonogram was consistent with a testicular tumor. Radical orquiectomy was performed. Immunohistochemistry on the biopsy material showed strong staining for PSA. Thus, a metastatic PCa was confirmed. Abdominal CT scan and bone scans ruled out involvement of other organs. Discussion: Despite the high incidence of PCa, testicular metastases are rare. Since 1938, less than 200 cases have been internationally reported. These cases might be an incidental finding or they may simulate a primary testicular tumor. Differential diagnosis can be achieved with an adequate clinical history, physical exam and tumor markers, including immunohistochemistry in the biopsy material. The prognosis of PCa with testicular metastasis is unknown. Recent studies suggest poor prognosis. This should be considered a sign of systemic disease. This report shows a rare presentation of metastatic PCa without metastases in other organs. Also, we emphasize the need for thorough evaluation to ensure adequate staging. Conclusion: Testicular metastases from PCa are infrequent; no other cases have been reported in Chile. It should be considered in the differential diagnosis of patients with a testicular mass especially if they have a history of PCa.

La terapia ocupacional en la intervención en salud comunitaria: el modelo educativo y la práctica profesional / The ocupational therapy in the intervention of communitary health: the educational model and the professional practice

La meta sanitaria del Gobierno de Chile para la década comprendida entre los años del 2000 al 2010, ha puesto todos sus esfuerzos en mejorar la salud de los chilenos, prolongando los años de vida saludable y reduciendo las desigualdades en el acceso a ésta, en la población de distinto nivel socioeconómico. Es decir, los objetivos en salud están encaminados a la promoción de la salud y a la prevención de la enfermedad. El presente artículo describe el modelo educativo y la estrategia pedagógica utilizada en la Carrera de Terapia Ocupacional de la Universidad de Playa Ancha de Valparaíso, Chile, para implementar la capacitación de los estudiantes en el desempeño profesional en el nivel primario de atención en salud. La formación en esta área de la disciplina culmina con el desarrollo y ejecución de un Proyecto de Intervención, acorde con los objetivos del Plan Nacional del Gobierno de Chile, en la Comunidad. Es por esta razón que, a modo de ejemplo, se presenta un Proyecto Comunitario ejecutado el año 2004, en la ciudad de Valparaíso, Chile, por estudiantes de 4º año de la carrera, en el contexto de la asignatura Práctica Comunitaria.

The sanitary goal for the Chilean Government for the decade of 2000 - 2010 is to make the biggest effort to improve the health of the chilean people, prolonging their years into healthy ones and reducing the inequality in the access to it in the population of different economic and social levels. It means, the goals in health are directed to promote health and to prevent illnesses. In this context it’s shown that the educational model and the pedagogic strategy used in the professional formation of occupational therapy in the University of Playa Ancha in Valparaiso, Chile to implement the preparation of the students in the professional development in this primary level of health service. The formation in this area of such discipline culminates with the development and the fulfillment of a project of intervention, agreed with the goals of the national plan of the Chilean Government in the community. For this reason, and as an example, it was presented a communitary project achieved in the year 2004 in the city of Valparaiso, Chile, by students of the 4tth. Year of the professional formation, in the context of the subject communitary practice.

Procesos expansivos intracraneanos no tumorales: correlato clínico-tomográfico / Non tumor intracranial expansive processes: clinico-topographical correlation

Se presentan 159 casos de procesos expansivos de los cuales se revisan 111 catalogados como no neoplásicos vistos durante los años 1984-1988 en el HGBCH, lhamando la atención fundamentalmente sobre 3 aspectos: (1) la importancia de establecer organicidad en la epilepsia parcial y la epilepsia tardía; (2) la incidencia cada vez mayor de procesos infecciosos e inflamatorios intracraneanos en países en desarrollo; (3) la existencia de dos procesos parasitarios que deben encontrarse en el diagnóstico diferencial de procesos expansivos no tumorales: amebiasis de vida libre, y toxoplasmosis (especialmente en pacientes con SIDA)

Complicaciones y procesos asociados a fiebre tifoidea en ninos. / Complications and associated processes to typhoid fever in children

Se revisan las historias clinicas de 225 ninos con fiebre tifoidea, observados en un periodo de 10 anos, encontrandose que 75 de ellos (33.3%) presentaron por lo menos una complicacion o proceso asociado a dicha enfermedad, siendo las mas frecuentes las siguientes: hepatitis, neumonia, sangrado digestivo y perforacion intestinal

El epidurograma: un método de verificación del espacio epidural en un modelo animal / The epidurogram: a method of validation of epidural space an animal model

El cada vez más frecuente abordaje del espacio epidural o intratecal con fines diagnósticos, pronósticos y/o terapéuticos, que permitan la invasión de éstos en forma aguda o crónica obligan a identificar la ubicación de los catéteres instalados y la posible distribución de los agentes depositados a través de ellos; por lo que nos propusimos evaluar experimentalmente si el epidurograma cumple esta función, además de conocer algunas particularidades de la vía espinal. Con base a este objetivo se implantan 64 ratas Wistar con catéteres epidurales por microcirugía, administrando material radiopaco, efectuando estudio radiológico y evaluación neuroconductal (tiempo de retiro de las patas y cola) al frió y calor, encontrando hallasgos radiológicos que se corroboraron con el estudio necrológico, y a su vez correlacionando resultados con las estimaciones neurofuncionales, lo que sugiere que la epidurografía es un método consistente y confiable; resultando una herramienta eficaz para la exploración del espacio epidural