[Deep brain stimulation in Parkinson's disease]. / Estimulación cerebral profunda en enfermedad de Parkinson.

BACKGROUND: Deep brain stimulation is an essential therapeutic tool in Parkinson's disease. AIM: To assess the results of a series of patients with Parkinson's disease treated with micro-electrode guided subthalamic nucleus stimulation. MATERIAL AND METHODS: Twenty patients with idiopathic Parkinson's disease were studied (10 males). Three months after surgery, we analyzed the change in motor disturbances, medication need to control symptoms and quality of life. RESULTS: We observed a significant improvement in all the assessed variables. Motor involvement determined as OFF hours and expressed as percentage of the day changed from 30 ± 15 to 10 ± 7% in the preoperative and postoperative periods, respectively. ON hours without dyskinesia changed from 17 ± 16 to 78 ± 21%. ON hours with dyskinesia changed from 53 ± 23 to 12 ± 15%. Medication need changed from 1,505 ± 499 to 1,214 ± 528 levodopa equivalents. Parkinson's Disease Questionnaire 39 score changed from 62.9 ± 22.7 to 34.3 ± 18.5. During the 5-year follow-up a continuous improvement of symptoms was observed. CONCLUSIONS: Micro-electrode guided subthalamic nucleus functional surgery in patients with Parkinson's disease has good immediate and late results.

Outcome of patients with primary glioblastoma in Chile: single centre series.

BACKGROUND: Glioblastoma (GBM) is the most common and most aggressive primary malignant brain tumour. The standard of care is surgical resection, followed by radiotherapy with concurrent and adjuvant temozolomide. In Latin America, there is scarcity of information about the incidence of GBM and even less data regarding outcomes. In this study, we describe the clinicopathologic features, management and outcomes of GBM patients. METHODS: We describe a single-centre multidisciplinary team experience in managing GBM patients over an 11-year period (Jan 2005 to Dec 2016). Pathology was reviewed by the pathology collaborator and retrospective chart review performed for treatment and clinical outcomes. RESULTS: We identified 74 patients (50 males) with diagnosis of GBM. Median age at diagnosis was 58 years (range 24-79 years), and median Karnofsky performance status was 80%. Forty-three (58.1%) went to gross total resection, 20 (27%) partial resection and 11 (14.9%) biopsy. Sixty-four (87%) patients received Stupp regimen. The median overall survival (OS) was 13.9 months (standard error (SE) 1.71; 95% confidence interval (CI), 10.56-17.23). In patients treated according to Stupp regimen, the progression-free survival (PFS) was 10 months (SE 1.8; 95% CI, 6.481-13.519), the selfcare survival was 11.8 months (SE 1.61; 95% CI, 8.632-14.968) and the OS was 16.1 months (SE 1.53; 95% CI, 13.01-19.099). CONCLUSIONS: This study reports the most complete analysis of epidemiology, clinical management and outcomes of patients with diagnosis of GBM in Chile treated with Stupp regimen. The PFS and OS are consistent with reports of US and Europe.

Synthesis of Lactulose in Continuous Stirred Tank Reactor With ß-Galactosidase of Apergillus oryzae Immobilized in Monofunctional Glyoxyl Agarose Support.

Lactulose synthesis from fructose and lactose in continuous stirred tank (CSTR) reactor operation with glyoxyl-agarose immobilized Aspergillus oryzae ß-galactosidase is reported for the first time. The effect of operational variables: inlet concentrations of sugar substrates, temperature, feed substrate molar ratio, enzyme loading and feed flow rate was studied on reactor performance. Even though the variation of each one affected to a certain extent lactulose yield (Y Lactulose ), specific productivity (π Lactulose ) and selectivity of the reaction (lactulose/transgalactosylated oligosaccharides molar ratio) (S Lu/TOS ), the most significant effects were obtained by varying the inlet concentrations of sugar substrates and the feed substrate molar ratio. Maximum Y Lactulose of 0.54 g⋅g-1 was obtained at 50°C, pH 4.5, 50% w/w inlet concentrations of sugar substrates, feed flowrate of 12 mL⋅min-1, fructose/lactose molar ratio of 8 and reactor enzyme load of 29.06 IU H ⋅mL-1. At such conditions S Lu/TOS was 3.7, lactose conversion (X Lactose ) was 0.39 and total transgalactosylation yield was 0.762 g⋅g-1, meaning that 76% of the reacted lactose corresponded to transgalactosylation and 24% to hydrolysis, which is a definite advantage of this mode of operation. Even though X Lactose in CSTR was lower than in other reported modes of operation for lactulose synthesis, transgalactosylation was more favored over hydrolysis which reduced the inhibitory effect of galactose on ß-galactosidase.

Continuous enzymatic synthesis of lactulose in packed-bed reactor with immobilized Aspergillus oryzae ß-galactosidase.

Lactulose synthesis from fructose and lactose in continuous packed-bed reactor operation with glyoxyl-agarose immobilized Aspergillus oryzae ß-galactosidase is reported for the first time. Alternative strategies to conventional batch synthesis have been scarcely explored for lactulose synthesis. The effect of flow rate, substrates ratio and biocatalyst-inert packing material mass ratio (MB/MIM) were studied on reactor performance. Increase in any of these variables produced an increase in lactulose yield (YLu) being higher than obtained in batch synthesis at comparable conditions. Maximum YLu of 0.6 g·g-1 was obtained at 50 °C, pH 4.5, 50% w/w total sugars, 15 mL·min-1, fructose/lactose molar ratio of 12 and MB/MIM of 1/8 g·g-1; at such conditions yield of transgalactosylated oligosaccharides (YTOS) was 0.16 g·g-1, selectivity (lactulose/TOS molar ratio) was 5.4 and lactose conversion (XLactose) was 28%. Reactor operation with recycle had no significant effect on yield, producing only some decrease in productivity.

Delirio en el paciente crítico pediátrico: impacto de las escalas de valoración en la detección y manejo precoz / Delirium in the pediatric critical care patient: impact of screening tools on early detection and management

En Chile la valoración del delirio en las unidades pediátricas de paciente crítico es una actividad dependiente de cada profesional de enfermería por lo que la prevención, valoración y el manejo viene siendo un desafío para enfermería. OBJETIVO: Analizar la efectividad de la aplicación de la escala Cornell Assessment of Pediatric Delirium (CAPD) en la detección y el manejo precoz del delirio. METODOLOGÍA: Se realizó una búsqueda bibliográfica sistematizada utilizando las siguientes bases de datos Cochrane, Biblioteca digital Universidad de Chile, PubMed, Lilacs, EBSCOHost y Epistemonikos, en idioma inglés y español, entre los años 2012 y 2020. Los resultados fueron analizados con matrices CASPe o STROBE según el tipo de estudio. Se utilizaron 13 artículos que cumplen con los criterios de inclusión y exclusión. RESULTADOS: La evidencia muestra por un lado que la utilización de escalas de valoración contribuye a una detección precoz del delirio y, por otro lado, que la escala CAPD es un instrumento con alta evidencia que sustenta su utilización por sobre otras escalas. CONCLUSIÓN: La utilización de la escala CAPD genera un impacto positivo en la detección y el manejo precoz del delirio, sin embargo, se recomienda que además exista un proceso de educación y acompañamiento a los profesionales de enfermería sobre prevención, detección y manejo del delirio.

In Chile, the assessment of delirium in pediatric critical care units is a dependent activity from nurses, thus prevention, assessment and management it comes challenging to this units. OBJECTIVE: To analyze the effectiveness of the application of the Cornell Assessment of Pediatric Delirium (CAPD) scale in the detection and early management of delirium. METHODOLOGY: A systematic bibliographic search was carried out using the following databases: Cochrane, Biblioteca digital Universidad de Chile, PubMed, Lilacs, EBSCOHost and Epistemonikos, in English and Spanish, between 2012 and 2020. The results were analyzed with CASPe or STROBE tools according to the study type. 13 articles that meet the inclusion and exclusion criteria were used. RESULTS: The evidence shows, on the one hand, that the use of screening tools contributes to an early detection of delirium and, on the other hand, CAPD scale is an instrument with high evidence that supports its use over other scales. CONCLUSION: The use of the CAPD scale has a positive impact on the detection and early management of delirium, however, it is recommended that there is also an education process and support for nurses on prevention, detection and management of delirium.

Glioma difuso de línea media H3K27M positivo en adulto. Caso clínico / H3K27 positive diffuse midline glioma. Report of one case

The 2016 WHO Classification of Tumours of the Central Nervous System incorporates a new diagnostic entity: the mutant diffuse midline glioma H3K27, a tumor with a characteristic location and special molecular biology. We report the case of a 51-year-old male patient with progressive diplopia. The imaging study showed a mesencephalic tumor; the stereotacic biopsy disclosed an Anaplastic Astrocytoma Isocitrate dehydrogenase (IDH) wild type. The molecular study concludes H3K27 mutation. The patient was treated with radiotherapy with concurrent and adjuvant chemotherapy (temozolomide) with partial recovery of the diplopia.

Estimulación cerebral profunda en enfermedad de Parkinson / Deep brain stimulation in Parkinson's disease

Background: Deep brain stimulation is an essential therapeutic tool in Parkinson's disease. Aim: To assess the results of a series of patients with Parkinson's disease treated with micro-electrode guided subthalamic nucleus stimulation. Material and Methods: Twenty patients with idiopathic Parkinson's disease were studied (10 males). Three months after surgery, we analyzed the change in motor disturbances, medication need to control symptoms and quality of life. Results: We observed a significant improvement in all the assessed variables. Motor involvement determined as OFF hours and expressed as percentage of the day changed from 30 ± 15 to 10 ± 7% in the preoperative and postoperative periods, respectively. ON hours without dyskinesia changed from 17 ± 16 to 78 ± 21%. ON hours with dyskinesia changed from 53 ± 23 to 12 ± 15%. Medication need changed from 1,505 ± 499 to 1,214 ± 528 levodopa equivalents. Parkinson's Disease Questionnaire 39 score changed from 62.9 ± 22.7 to 34.3 ± 18.5. During the 5-year follow-up a continuous improvement of symptoms was observed. Conclusions: Micro-electrode guided subthalamic nucleus functional surgery in patients with Parkinson's disease has good immediate and late results.

Semiología del sistema nervioso autónomo / Semiology of the autonomic nervous system

El ácido pipemídico es un nuevo antibacteriano de acción bactericida, químicamente emparentado con el ácido nalidíxico y el oxolínico. Se concentra en el parénquima renal y en la orina, siendo eficaz en más del 80% de las infecciones urinarias altas y bajas, especialmente producidas por bacilos Gram negativos