La Relación médico paciente y algunos aspectos transculturales de salud y enfermedad / Doctor patient comunication and transcultural aspects of health and disease

La orientación científica de la medicina ha sido determinante en el progreso que ha alcanzado, pero la consideración de la persona, la unificación del sujeto en el objeto, es fundamental en la clínica, en el acto médico. Necesitamos una antro-pología médica en la que lo principal es la relación entre ambas, enfermedad y enfermo, que puedan distinguirse, compararse y ser posible, que cada una de las dos funciones relacionadas se unifiquen en un punto medio.El entendimiento entre paciente y médico pueden verse perturbado por malen-tendidos del lenguaje y del bagaje cultural, así como exigimos al paciente que notifique con claridad sobre su enfermedad, el médico quien tiene la mayor res-ponsabilidad en la relación con el enfermo debe preocuparse, a su vez, de notifi-car claramente al paciente de su acontecer, de su diagnóstico y de su pronóstico. Así lo destaca Victor von Weizsacker que expresa claramente la orientación que significa la Antropología Médica, "El hombre es un objeto que contiene un sujeto, y este no está por fuera de los dominios de la ciencia, sino que pertenece a la misma".

The scientific direction of the medicine has been determining in the progress that has reached, but the consideration of the person, the unification of the subject in the object, is fundamental in the clinic, the medical act. We needed a medical anthropology in which the main thing is the relation between both, disease and patient, that they can be distinguished, be compared and to be possible, that each one of the two related functions is unified in a midpoint. The understanding between patient and doctor can be seen disturbed by misun-derstanding of the language and the cultural baggage, as well as we demanded the patient who notifies with clarity on his disease, the doctor that has the great-er responsibility in the relation with the patient must worry, as well, to notify clearly to the patient of his to occur, its diagnosis and its prognosis. Thus it honors Victor von Weizsacker that expresses clearly the direction that means the Medical Anthropology, "the man is an object that contains a subject, and this it is not in favor of outside the dominions of science, but that belongs to the same one".

Inbreeding in Southeastern Spain : The Impact of Geography and Demography on Marital Mobility and Marital Distance Patterns (1900-1969).

In this paper, the structure of a southeastern Spanish population was studied for the first time with respect to its inbreeding patterns and its relationship with demographic and geographic factors. Data on consanguineous marriages (up to second cousins) from 1900 to 1969 were taken from ecclesiastic dispensations. Our results confirm that the patterns and trends of inbreeding in the study area are consistent with those previously observed in most non-Cantabrian Spanish populations. The rate of consanguineous marriages was apparently stable between 1900 and 1935 and then sharply decreased since 1940, which coincides with industrialization in Spain. A marked departure from Hardy-Weinberg expectations (0.25) in the ratio of first cousin (M22) to second cousin (M33) marriages in the study population (0.88) was observed. The high levels of endogamy (>80%) and its significant steadiness throughout the twentieth century is noteworthy. Accordingly, our results show that exogamous marriages were not only poorly represented but also that this reduced mobility (<6 km) suggests that the choice of a mate was preferentially local. We found higher mobility in M22 with respect to M33 cousin mating. The relationships between population size and consanguinity rates and inbreeding fit power-law distributions. A significant positive correlation was observed between inbreeding and elevation. Many Spanish populations have experienced a prolonged and considerable isolation across generations, which has led to high proportions of historical and local endogamy that is associated, in general, with high [Formula: see text] values. Thus, assessing genomic inbreeding using runs of homozygosity (ROH) in current Spanish populations could be an additional pertinent strategy for obtaining a more refined perspective regarding the population history inferred from the extent and frequency of ROH regions.

A new genus and species of Delphacini (Hemiptera: Fulgoroidea: Delphacidae) from Argentina.

A new genus of Delphacini is described from Argentina, Pyrophagus Remes Lenicov gen. n., with one new species, P. tigrinus Remes Lenicov & Varela sp. n. The new species, distributing over a wide cultivated area of Northwestern and Central Argentina and recently confirmed as a vector of MRCV (Rio Cuarto maize virus) in experimental conditions, is one of the most frequently found delphacid species on wheat, oat, maize, triticale, rye, barley and wild Gramineae. The main diagnostic features of the new genus and species are described and illustrated, and information on the host plants, geographical distribution and vector capacity of the new species is provided. 

N alpha methyl histamine versus propranolol in migraine prophylaxis.

OBJECTIVES: To compare the efficacy and tolerability of the subcutaneous administration of N alpha methyl histamine versus oral propranolol in the treatment of migraine prophylaxis. BACKGROUND: N alpha methyl histamine has a selective affinity for H3 receptors and could constitute a new therapeutic drug in migraine prophylaxis. METHODS: Sixty patients with migraine were selected and enrolled in a 12-week double-blind controlled clinical trial to evaluate the efficacy of subcutaneous administration of N-alpha methyl histamine (1 to 3 ug twice a week ) n=30, compared to administration of 120 mg/day of oral propranolol n=30. the variables were: headache intensity, frequency of attacks, duration of migraine attacks and analgesic intake. RESULTS: fifty five patients completed the study. the data collected during the 4th week of treatment revealed that N alpha methyl histamine and propranolol caused a significantly (p<0.01) greater reduction between the basal values and final values of every variable studied. CONCLUSIONS: Both N alpha methyl histamine and propranolol are similarly effective in reducing or eliminating the headache in migraine prophylaxis. low doses of N-alpha methyl histamine injected subcutaneously may represent a novel and effective therapeutic alternative in migraine patients and may lay the clinical and pharmacological groundwork for the use of H3 receptor agonist in migraine prophylaxis.

Entomofauna of a buried body: study of the exhumation of a human cadaver in Buenos Aires, Argentina.

This study focuses on insects and other arthropods sampled on the exhumation of an infant skeleton belonging to 'Prof. Dr. Rómulo Lambre' skeletal collection. The body was buried in soil inside a wooden coffin in a grave 40cm deep, in autumn, and stored in the cemetery deposit after exhumation. Death records were obtained from the cemetery archive. Samples of faunal remains were recovered from wrappings, clothes, bones and soil samples, and were identified at different taxonomic levels depending on the stage of conservation. The dominant taxon was the muscid fly Ophyra aenescens (Wiedemann). The relationships among the identified taxa and the moving of the corpse, from the burial context to the cemetery deposit, are discussed and used to create a hypothetical colonization sequence after death. The application of entomological data to anthropological research can provide valuable information for the interpretation of taphonomic processes and burial contexts.

Caregivers of Alzheimer's patients and factors influencing institutionalization of loved ones: some considerations on existing literature.

BACKGROUND: Informal caring or caregiving is very common in our postindustrial society. Caregiving burden grows with the worsening of cognitive impairment of the patient and is one of the factors influencing institutionalization. Alzheimer's disease (AD) is a type of dementia that is chronic and deteriorative. The symptoms of this neuropsychiatric disorder generally begin to manifest after the age of sixty and currently 8.9 million family caregivers provide assistance to someone with AD or a related dementia. As the patient's condition worsens, it increases the burden on the caregivers, due to the physical, psychological, and emotional stresses that result from caring for the patient. METHODS: A search of the literature was conducted on electronic database: PubMed, Google Scholar, Science direct, CINAHL in a exploratory way. Inclusion criteria were: articles in English and Italian published between 1999-2011 which mentioned Alzheimer's caregivers, burden, stressors, and institutionalization. The exclusion criterion was failure to mention the word "caregivers". About 100 titles were found and 30 articles abstracts with key words in the title were reviewed. Of the 30 articles selected for further review based on the relevance to the study purpose, 17 articles were finally selected for inclusion in this literature review. RESULTS: Results display that caregiver burden is influenced by patient behavioral and cognitive status, hours involved in care, stress, social isolation, gender, relationship to the patient, availability of support resources, and caregiver characteristics. Assessment tools available to assess and recognize risk factors and burden in caregivers are useful both in terms of caregivers health and decision on istitutionalization. CONCLUSION: Literature suggests to provide information for health care providers to reduce burden and support caregiver health and well-being. Assessment tools available to assess and recognize risk factors and burden in caregivers should be used more often to contribute to reducing caregiver stress and the impact of institutionalization.

Feasibility, safety, and preliminary proof of principles of autologous neural stem cell treatment combined with T-cell vaccination for ALS patients.

Uncontrolled activation of the innate immune system promotes the deterioration of neurons in different neurodegenerative diseases, including amyotrophic lateral sclerosis (ALS). T-cell vaccination (TCV) was developed by Irun Cohen and coworkers at the Weizmann Institute of Science (Israel) during the late 1970s and has been demonstrated to be an effective treatment for human autoimmune diseases and a regulator of macrophage activation in animal models. We treated seven ALS patients with this cell therapy and were able to slow or stop disease progression in the affected individuals. The median survival, which is 3.5 years, was extended to 6 years. They were also treated with autologous adult neural stem cells associated with effector T cells. The observed neurologic improvements after treatment lasted for at least 1 year. Clinical recovery in the treated ALS patients was confirmed by an independent, skilled neurologist using the ALS Functional Rating Scale-Revised (ALSFRS-R). TCV in conjunction with an autologous neural stem cell treatment might be a feasible, minimally invasive, safe, and effective approach to obtain enduring therapeutic effects in ALS patients.

Radiotherapy issues in non-small cell lung cancer: radiotherapy versus surgery in the treatment of early stage.

We discussed in this article about the role of surgery, in a broad sense, and radiotherapy for the treatment of early stage of non-small cell lung cancer (NSCLC), and we also examined if patients' outcomes after radiation therapy are comparable to the ones after surgery. Radiotherapy is at present a less attractive alternative to surgery in operable patients with early stage of NSCLC. Indeed, radiotherapy is frequently reserved for patients who are deemed unfit for surgery due to poor pulmonary function or other comorbidities. This introduces a large patient selection bias compared to surgery, rendering overall survival less suitable for comparison. When we compare patients who are deemed operable but refuse surgery, the 5-year overall survival rate observed, after a high effective dose, is equivalent to the outcome after surgery. On the other hand, it is difficult to enroll patients in randomized clinical trials for this purpose, propensity matched analysis allows to compares the effectiveness of radiotherapy and surgery using comparable series of patients, using this methodology two studies obtained similar results. This data support the need of continuous investigation for non-surgical alternatives in this disease, radiotherapy can be a good option. Until then, surgery remains the treatment of choice for early stage of NSCLC.

Efecto del consumo de harina de maíz fortificada con acido fólico sobre los niveles de folatos sanguíneos en mujeres de edad fértil / Effect of fortified flour consumption on blood folate levels in women of childbearing age

Fortification of foods is now widely used to prevent folate deficiency. Folic acid has been added to corn flour and its efficacy in the prevention of NTD has been proved. The aim of this study was to compare the effect of the intake of fortified corn-flour versus non fortified flour and to folic acid supplement, on blood folate levels in women of childbearing age. Forty-five women were randomized into three groups according to: (A) use of fortified flour (n=18), (B) non-fortified flour (n=17); (C) supplementation with 5 mg of oralfolic acid (n=10). All females answer a dietary and anthropometric questionnaire applied once a month during three months. Blood red cell (IE) and plasmatic (P) folate were measured at the beginning and at the end of the study; also the DNA analysis for the 677T mutation was performed. The corn flour was provided to groups A and B during three months, to be consumed as eight tortillas daily. Group C received 5.0 mg tablet of folic acid (Valdecasas®), once per week, during three months. IE and P folate and hematocrito were significantly increased in women from group C (p<0.05). Only plasmatic folic acid levels were significantly increased in women from groups A and B. Genotype distribution was: 15.6 percent homozygous TT, 42.2 percent C/C and 42.2 percent CT. Weekly administration of 5.0 mg of folic acid is an effective way to increase blood folate levels and shows to be more efficient than fortified corn flour.

La fortificación de alimentos con ácido fólico puede ser efectiva en la prevención de los defectos del tubo neural, aunque no existen estudios que demuestren la eficacia de esta medida en la harina de maíz. El objetivo del estudio fue evaluar el efecto del consumo de harina de maíz vitaminada sobre los niveles de folatos sanguíneos, en comparación con la suplementación oral. Se incluyeron 45 mujeres en edad fértil aleatorizadas en tres grupos; grupo A (n=18) harina vitaminada, grupo B (n=17) harina sin vitaminas, grupo C (n=10) suplemento oral 5.0 mg de ácido fólico una vez por semana, durante tres meses. A las participantes se les aplicó una encuesta nutricional y se les midió por radioinmunoensayo el folato intraeritrocitario (FIE) y plasmático (FP) al inicio y final del estudio y se determinó la presencia del polimorfismo C677T del gen MTHFR. En las mujeres con suplemento oral los niveles FIE y FP y el hematocrito se incrementaron significativamente (p< 0.05), mientras que en los grupos A y B se registró un incremento significativo en los valores de FP pero no IE ni hematocrito. La ingesta de otras fuentes de ácido fólico se incrementó significativamente en los grupos A y B. El 15.6 por ciento de las mujeres fueron homocigotas TT, 42.2 por ciento homocigotas CC y 42.2 por ciento heterocigotas CT. La administración de 5 mg de ácido fólico por semana es una medida más eficiente que la ingesta de harina de maíz vitaminada para elevar los niveles de folatos.

Lessons learned from the European thoracic surgery database: the Composite Performance Score.

BACKGROUND: This study reports the methods used to review the Composite Performance Score (CPS) along with a reference table, which will be used in the upcoming ESTS Quality Certification Program. METHODS: Data from 4303 patients who underwent pulmonary resection (July 2007-January 2010) were captured in the ESTS database and used for the present analysis. Only patients submitted from units contributing at least 100 consecutive lung resections were used for developing the score. According to the best available evidence the following measures were selected for each surgical domain: preoperative care (1. % of DLCO measurement in patients submitted to major anatomic resections; 2. % of preoperative invasive mediastinal staging in patients with clinically suspicious N2 disease), operative care (% of systematic lymph node dissection), outcomes (risk-adjusted cardiopulmonary morbidity and mortality rates). Morbidity and mortality risk-models were developed by logistic regression and validated by bootstrap analyses. Individual processes and outcomes scores were rescaled according to their standard deviations and summed to generate the CPS. Units were rated accordingly and a percentile reference table was produced. RESULTS: Risk-adjusted survival and absence of morbidity rates varied from 91.5% to 100%, and from 50.2% to 97.5%, respectively. CPS ranged from -4.038 to 1.24. The 50% percentile of CPS corresponded to 0.404. CONCLUSIONS: A revised Composite Performance Score was developed and a reference table presented to be used as a benchmark for the ESTS Quality Certification program.

Bacterial pathogens associated with bloody diarrhea in Uruguayan children.

Diarrheal disease continues to be a serious health problem, especially in developing countries. Bloody diarrhea represents approximately 20-30% of all cases and has higher morbidity and mortality. Treatment with antibiotics is beneficial in cases of Shigella, Campylobacter, Yersinia and Salmonella infection, principally in those children with a higher risk of invasive disease. The aims of this study were to detect the bacterial agents associated with bloody diarrhea in children and to determine their antimicrobial susceptibility patterns. Between June 2001 and January 2008, 249 children with bloody diarrhea were studied. Shigella and Shiga toxin-producing Escherichia coli (STEC) were recovered from 48 (19.3%) and 3 (1.2%) of the total of cases, respectively. In 49 out of 249 children, in whom other enteropathogens were investigated, we recovered Campylobacter jejuni from 7 children (14.3%), Salmonella spp. from 2 (4.1%) and Aeromonas spp. from 1 (2%) in addition to Shigella from 7 children (14.3%). Thirty-four (70%) Shigella isolates showed resistance to ampicillin and 13 (27%) to trimethoprim-sulfamethoxazole. All Shigella isolates were susceptible to nalidixic acid, ciprofloxacin and ceftriaxone. Salmonella and STEC isolates were susceptible to all antibiotics assayed. Thus, the use of trimethoprim-sulfamethoxazole or ampicillin would not be appropriate for the empirical treatment of Shigella - associated diarrhea.

ERS/ESTS clinical guidelines on fitness for radical therapy in lung cancer patients (surgery and chemo-radiotherapy).

A collaboration of multidisciplinary experts on the functional evaluation of lung cancer patients has been facilitated by the European Respiratory Society (ERS) and the European Society of Thoracic Surgery (ESTS), in order to draw up recommendations and provide clinicians with clear, up-to-date guidelines on fitness for surgery and chemo-radiotherapy. The subject was divided into different topics, which were then assigned to at least two experts. The authors searched the literature according to their own strategies, with no central literature review being performed. The draft reports written by the experts on each topic were reviewed, discussed and voted on by the entire expert panel. The evidence supporting each recommendation was summarised, and graded as described by the Scottish Intercollegiate Guidelines Network Grading Review Group. Clinical practice guidelines were generated and finalized in a functional algorithm for risk stratification of the lung resection candidates, emphasising cardiological evaluation, forced expiratory volume in 1 s, systematic carbon monoxide lung diffusion capacity and exercise testing. Contrary to lung resection, for which the scientific evidences are more robust, we were unable to recommend any specific test, cut-off value, or algorithm before chemo-radiotherapy due to the lack of data. We recommend that lung cancer patients should be managed in specialised settings by multidisciplinary teams.

Case report on the clinical results of a combined cellular therapy for chronic spinal cord injured patients.

OBJECTIVES: With the intention to ameliorate the clinical condition of patients with chronic spinal cord injury (SCI), a program that combines three cell therapies and an appropriate neurorehabilitation program were used to recreate and enhance the natural conditions of SCI repair. METHODS: Vascularization recovery is approached by selective artery infusion of BMMNCs (bone marrow mononuclear cells) to the disrupted area. Eighteen days later, with the aim to restore the specific inflammatory activity, an i.v. infusion of spinal cord specific ETCs (effector T cells) is carried out. With the intention of supplying cellular components for the process of repair, an infusion of autologous neural stem cells (NSCs) through selective feeding artery infusion is carried out, followed by an appropriate neurorehabilitation program. RESULTS: A total of eight ASIA (American Spinal Injury Association) A patients (five with jeopardized brachial plexus and three without) received the treatment. No severe adverse events was observed in any of the receptor patients: five patients evolved from ASIA A to ASIA D and regained the ability to stand up and, with varying effectiveness, to walk; two patients remained in the same condition, but exhibited motor and sensitive improvements; and one patient could not be evaluated. CONCLUSIONS: These reports suggest that the biological characteristics of acute SCI may be recreated in a comprehensive, safe and effective manner.

Brown Blotch Caused by Pseudomonas tolaasii on Cultivated Pleurotus eryngii in Spain.

In 2006, symptoms of brown blotch were observed on cultivated Pleurotus eryngii (king oyster mushroom) in Castilla-La Mancha (Spain). Subsequently, between January and May of 2008, brown blotch affected 39.75% of the blocks of substrate cultivated, resulting in a considerable loss of production. Symptoms observed were principally characterized by a yellowish brown-to-orangish color, first of the cap and then of the stalk. Some samples also showed a slightly concave cap. From samples collected from four different king oyster mushroom farms, a fluorescent gram-negative bacterium was recovered on King's B medium and identified as Pseudomonas tolaasii by the LOPAT scheme and other tests (2). The bacterium isolated had the following characteristics: oxidative, positive for oxidase and arginine dihydrolase, negative for levan production, pectinolitic activity on potato slices, and tobacco hypersensitivity. Results from other tests were as follows: negative for esculin hydrolysis and positive for gelatine, casein, and Tween 80 hydrolysis; mannitol, erythritol, sorbitol, m-inositol, and adonitol were used as a sole carbon source, but not sucrose, d-tartrate, or trigonelline. The white line test was performed (4) using P. reactans LPPA 540 and the presumptive isolates of P. tolaasii were positive. The gene encoding the 16S rRNA from two isolates (LPPA532 and LPPA533) was sequenced after PCR amplification (2) and their nucleotide sequences (1,400 bp; EMBL Accession No. FM864215 for LPPA 532) proved to be identical. The amplified sequences were compared with DNA sequences available in databases (GenBank, EMBL, DDBJ, and PDB) by using BLAST. An identity of 99% was obtained with 16S rDNA of three P. tolaasii strains (GenBank Accession Nos. AF320990, AF094750, and AF255336). Four isolates were selected for pathogenicity tests. Bacterial suspensions were grown for 16 h in yeast peptone glucose broth (approximately 108 CFU/ml) and were inoculated by puncture into 10 mushroom caps using sterilized wooden toothpicks (4). Sterilized distilled water was used as a control. These were then incubated at room temperature in glass dishes. Assays were conducted twice and the results were recorded after 10 days. The symptoms that developed after infection were similar to those observed in the crop, while the control mushrooms remained symptomless. Bacteria sharing the characteristics of the inoculated isolates were recovered from symptomatic caps. P. tolaasii has been described as causing brown blotch on Pleurotus eryngii (1,3), but to our knowledge, this is the first report of P. tolaasii causing brown blotch on Pleurotus eryngii in Spain. References: (1) J. F. Bradbury. No. 891 in: Descriptions of Pathogenic Fungi and Bacteria. CMI, Kew, Surrey, UK, 1987. (2) A. J. González et al. Appl. Environ. Microbiol. 69:2936, 2003. (3) A. Russo et al. Microbiol. Res. 158:265, 2003. (4) J. M. Wells et al. Phytopathology 86:1098, 1996.

Ascitis fetal transitoria: alerta al ultrasonografista / Prenatal diagnosis of isolated fetal ascites

We review our experience with the management and perinatal outcome in three cases of isolated fetal ascites detected prenatally at the San Camilo Hospital, San Felipe, Chile, in a period of seven years. Two cases were confirmed as being the result of meconium peritonitis and the remaining to a Klippel-Feil syndrome. We conclude that the detection of transient isolated fetal ascites warrants a close surveillance of the neonate looking for signs associated with intestinal rupture and non-chromosomal genetic syndromes.

Se presenta nuestra experiencia con el manejo y resultados perinatales de 3 casos de ascitis fetal aislados diagnosticados prenatalmente en el Hospital “San Camilo”, San Felipe, durante un período de 7 años. Dos casos correspondieron a peritonitis meconial y uno a un síndrome de Klippel-Feil. Se concluye que la detección de ascitis fetal aislada, aunque sea transitoria, obliga a realizar una observación acuciosa de la evolución neonatal, ya que puede ser el único indicio prenatal de una perforación intestinal o algún síndrome genético no cromosómico.

[Detection and characterization of Shiga toxin-producing Escherichia coli from clinical cases and food in Uruguay]. / Detección y caracterización de Escherichia coli productor de toxina Shiga a partir de casos clínicos y de alimentos en Uruguay.

We have assessed the frequency of Shiga toxin-producing Escherichia coil (STEC) in clinical and food samples as well as studied the genotypic and phenotypic characteristics of the recovered strains. One hundred ninety eight fecal samples from children with bloody diarrhea (BD), 14 from children with hemolytic uremic syndrome (HUS), 220 ground beef samples and 4 STEC isolates from other beef-derived products were analyzed. The STEC strains were isolated from 3 (1.5%) children with bloody diarrhea, 1 (7%) from a child with HUS and 4 (1.8%) from ground beef samples. All strains were eae and ehxA positive. The serotypes found were: O157:H7 (9 strains), O26:H11 (2), O111: NM (1) and O145:HNT (1). All O157:H7 STEC strains harbored the eae subtype gamma1, O26:H11 and O145:HNT strains, subtype beta1 and O111:NM strain, subtype gamma2/theta. The STEC strains of the same serogroup showed high genetic diversity. In Uruguay, STEC is not frequently isolated from cases of bloody diarrhea in children. However, all the recovered STEC strains carried the genes associated with severe disease and 2 out of 3 children infected with STEC developed HUS. Ground beef and other food products might be important vehicles for O157:H7 strains.

Detección y caracterización de Escherichia coli productor de toxina Shiga a partir de casos clínicos y de alimentos en Uruguay / Detection and characterization of Shiga toxin - producing Escherichia coli from clinical cases and food in Uruguay

Establecimos la frecuencia de aislamiento de Escherichia coli productor de toxina Shiga (STEC) a partir de muestras clínicas y de alimentos, así como las características fenotípicas y genotípicas de las cepas recuperadas. Se analizaron 198 muestras fecales de niños con diarrea sanguinolenta (DS), 14 muestras fecales de niños con síndrome urémico hemolítico (SUH) y 220 muestras de carne picada. También se estudiaron 4 cepas STEC aisladas de alimentos embutidos. Se recuperó STEC de 3 (1,5%) de los niños con DS, de 1 (7%) niño con SUH y de 4 (1,8%) de las muestras de carne picada. Todas las cepas fueron eae y ehxA positivas. Los serotipos detectados fueron: O157:H7 (9 cepas), O26:H11 (2 cepas), O111:NM (1 cepa) y O145:HNT (1 cepa). Todas las cepas O157:H7 portaron el subtipo eae-g1; las cepas O26:H11 y O145:HNT portaron el subtipo eae-b1 y la cepa O111:NM portó el subtipo eae-g2/q. Las cepas STEC del mismo serogrupo mostraron alta diversidad genética. En Uruguay STEC no sería agente frecuente de diarrea con sangre en niños. Sin embargo, las cepas recuperadas presentaron los genes asociados con enfermedad severa y 2 de los 3 niños infectados con STEC evolucionaron a SUH. La carne picada y otros alimentos serían vehículos importantes de O157:H7.

We have assessed the frequency of Shiga toxin-producing Escherichia coli (STEC) in clinical and food samples as well as studied the genotypic and phenotypic characteristics of the recovered strains. One hundred ninety eight fecal samples from children with bloody diarrhea (BD), 14 from children with hemolytic uremic syndrome (HUS), 220 ground beef samples and 4 STEC isolates from other beef-derived products were analyzed. The STEC strains were isolated from 3 (1.5%) children with bloody diarrhea, 1 (7%) from a child with HUS and 4 (1.8%) from ground beef samples. All strains were eae and ehxA positive. The serotypes found were: O157:H7 (9 strains), O26:H11 (2), O111: NM (1) and O145:HNT (1). All O157:H7 STEC strains harbored the eae subtype g1, O26:H11 and O145:HNT strains, subtype b1 and O111:NM strain, subtype g2/q. The STEC strains of the same serogroup showed high genetic diversity. In Uruguay, STEC is not frequently isolated from cases of bloody diarrhea in children. However, all the recovered STEC strains carried the genes associated with severe disease and 2 out of 3 children infected with STEC developed HUS. Ground beef and other food products might be important vehicles for O157:H7 strains.

Adenitis mesentérica por Yersinia enterocolítica / Mesenteric adenitis due to Yersinia enterocolitic

Se presenta por primera vez en nuestro país un caso de adenitis mesentérica en una niña de 3 años asociado a infección por Yersinia enterocolítica. La cepa recuperada del coprocultivo correspondió al bioserotipo patogénico 4/O:3 y presentó además el plásmido de virulencia.

Distribución geográfica de mortalidad por tumores malignos de estómago, tráquea, bronquios y pulmón, Chile 1997-2004 / Geographical distribution of mortality caused by stomach, trachea, bronchi and lung malignant tumors in Chile

Background: Maps have played a critical role in public health since 1855, when John Snow associated a cholera outbreak with contaminated water source in London. After cardiovascular diseases, cancer is the second leading cause of death in Chile. Cancer was responsible for 22.7 percent of all deaths in 1997-2004 period. Aim To describe the geographical distribution of stomach, trachea, bronchi and lung cancer mortality. Material and methods: Mortality statistics for the years 1997-2004, published by the National Statistics Institute and Chilean Ministry of Health, were used. The standardized mortality ratio (SMR) for sex and age quinquennium was calculated for 341 counties in the country. A hierarchical Bayesian analysis of Poisson regression models for SMR was performed. The maps were developed using adjusted SMR (or smoothed) by the Poisson model. Results: There is an excess mortality caused by stomach cancer in south central Chile, from Teno to Valdivia. There is an excess mortality caused by trachea, bronchi and lung cancer in northern Chile, from Copiapó to Iquique. Conclusions: The geographical analysis of mortality caused by cancer shows cluster of counties with an excess risk. These areas should be considered for health care decision making and resource allocation.

Lectura crítica como método docente en el postgrado de psiquiatría / Critical reading as a postgraduate teaching strategy in psychiatry

Introduction: Supervised critical reading of classic psychiatric texts and modern papers is a valida ted educational practice in postgraduate studies in psychiatry dating back to two centuries. There are experiences reported in international literature, in different psychiatry teaching centres. Material and Methods: Our department of psychiatry has included critical reading in its educational schedule. The reading time is sixty minutes, and our analysis includes 70 hours of reading. Results: Open discussion and teaching in small groups has been conducted, relating Spanish texts, and German texts translated to Spanish, with the analysis of patients attending our department. Conclusions: Critical reading allows discussion with the tutor, questioning, and the study of difficult cases, with psychopathological interest. Reading classic texts allows critical reading of modern literature.

Introducción: La lectura crítica de textos clásicos y modernos a cargo de un tutor docente es una práctica docente validada en la formación de postgrado de psiquiatría. Su inicio data desde hace dos siglos. Existen experiencias registradas en docencia en distintos centros formadores de psiquiatría en la literatura internacional. Método Docente: El departamento de psiquiatría ha establecido un horario en el curriculum de postgrado para lecturas críticas de textos. El grupo de 6 a 8 becados está a cargo de un profesor de psiquiatría. La duración es de 60 minutos aproximado. Se analizan 2 años de estudio restrospectivo con más de 70 horas. Resultados: Discusiones abiertas y docencia en grupos pequeños. Lectura de textos de psiquiatría clásica en español y traducción de textos alemanes. Dos presentaciones de pacientes con tema afín. Conclusiones: La lectura crítica permite un intercambio de opiniones, preguntas abiertas al tutor, estudio de casos clínicos de diagnóstico difícil y de interés psicopatológico. El conocimiento de los textos clásicos permite un análisis crítico de los textos modernos.