Características radiográficas de la neumonía adquirida en la comunidad en el adulto inmunocompetente hospitalizado según el agente causal / Radiographic characteristics of community-acquired pneumonia in the immunocompetent adult hospitalized according to the etiologic agent

Resumen En la práctica clínica, la radiografía de tórax permite confirmar el diagnóstico y la extensión de la neumonía adquirida en la comunidad (NAC). Objetivos: Examinar las características radiográficas de la NAC según el agente causal y el grado de concordancia interobservador (CI) en la descripción de los hallazgos radiográficos. Métodos: Se evaluaron las radiografías de tórax de 300 pacientes adultos inmunocompetentes hospitalizados por NAC, tres residentes de radiología consignaron el patrón de los infiltrados pulmonares, su localización anatómica y extensión, la presencia de derrame pleural y otros hallazgos radiográficos. Se realizaron cultivos de esputo, hemocultivos, pruebas serológicas y técnicas de biología molecular de hisopado nasofaríngeo para identificar los principales patógenos respiratorios. Resultados: Las manifestaciones clínicas y los hallazgos de la radiografía de tórax fueron similares en las neumonías causadas por diferentes patógenos respiratorios: bacterias clásicas, virus respiratorios y microorganismos atípicos. En las neumonías bacterianas predominó el patrón de relleno alveolar de distribución lobar, en las neumonías vírales y atípicas predominó el patrón intersticial o mixto alvéolo-intersticial con opacidades en vidrio esmerilado. La CI fue satisfactoria (kappa > 0,6) para determinar el patrón principal de los infiltrados pulmonares, su localización anatómica y la presencia de derrame pleural, su localización y extensión. La CI fue moderada (kappa 0,4-0,6) para definir la extensión de la neumonía y detectar signos radiológicos asociados a congestión pulmonar. Conclusión: Los hallazgos de la radiografía de tórax no permitieron identificar con precisión el agente causal de la neumonía, siendo útil en la caracterización de los infiltrados pulmonares y para detectar complicaciones como el derrame paraneumónico.

In a clinical setting the chest radiograph is the reference standard in establishing the diagnosis of community-acquired pneumonia (CAP). Objectives: This study aimed to assess interobserver reliability (IR) of radiographic findings and the relationship to different respiratory pathogens in CAP. Methods: Chest radiographs of 300 immunocompetent adult patients hospitalized with pneumonia, obtained from a database, were reviewed by three residents of radiology without specific clinical information. Main pattern of pulmonary infiltrates, topographic localization, extent of pneumonia, presence of pleural fluid, thickened bronchial walls, lymphadenopathy and air bronchogram were scored. Sputum and blood cultures, serological tests and nasopharyngeal swab for respiratory virus detection by molecular diagnostic techniques were performed to identify the causative pathogen. Results: Clinical manifestations and chest X-ray findings were similar in pneumonias caused by different respiratory pathogens: classic bacteria, respiratory viruses and atypical microorganisms. The alveolar pattern of lobar distribution predominated in bacterial pneumonia; meanwhile, interstitial or mixed alveolar-interstitial pattern with ground glass opacities predominated in viral and atypical pneumonias. IR was fair to good (kappa > 0.6) for determining the main pattern of infiltrates, anatomical location and the presence of pleural effusion, their anatomical location and extension. IR was moderate (kappa 0.4-0.6) for determining the extent of pneumonia and signs of congestive heart failure. Conclusion: Simple features such as main pattern description, anatomical location, identifying the involved lobes and pleural fluid recognition showed fair to excellent interobserver reliability. Chest radiographs was of limited value in predicting the causative pathogen but were of beneficial use to characterize pulmonary infiltrates and to detect complications such as parapneumonic effusion.

The EMA assessment of avapritinib in the treatment of gastrointestinal stromal tumours harbouring the PDGFRA D842V mutation.

Avapritinib is a protein kinase inhibitor designed to selectively inhibit oncogenic KIT and platelet-derived growth factor receptor alpha (PDGFRA) mutants by targeting the active conformation of the kinase. On 24 September 2020, a marketing authorisation valid through the European Union was issued for avapritinib as treatment of adult patients with unresectable or metastatic gastrointestinal stromal tumours (GIST) harbouring the PDGFRA D842V mutation. The drug was evaluated in an open-label, phase I, first-in-human, dose-escalation, open-label study to evaluate the safety, tolerability, pharmacokinetics, pharmacodynamics, and efficacy of avapritinib in adults with unresectable or metastatic GIST. The benefit of avapritinib was observed in patients with GIST harbouring the PDGFRA D842V mutation. The overall response rate was 95% (95% confidence interval 82.3%-99.4%), with a median duration of response of 22.1 months (95% confidence interval 14.1-not estimable months). The most common adverse events were nausea, fatigue, anaemia, periorbital and face oedema, hyperbilirubinaemia, diarrhoea, vomiting, increased lacrimation, and decreased appetite. Most of the reported cognitive effects were mild memory impairment. Rarer events were cases of severe encephalopathy and intracranial or gastrointestinal bleeding. The aim of this manuscript is to summarise the scientific review of the application leading to regulatory approval in the European Union.

Delayed lower extremity paresis following iliosacral screws: Atypical complication and treatment.

Percutaneous iliosacral screw placement has become the technique of choice for treating injuries to the posterior pelvis. However, the technique requires an understanding of the anatomy surrounding the bone corridors to avoid complications and detect them early if they occur. We present the clinical case of a patient with a U-shaped fracture of the sacrum that evolves with gluteal pain and left foot equine paresis after percutaneous fixation with iliosacral screws. Angio-CT of the pelvis shows active arterial bleeding from the superior gluteal artery associated to extensive hematoma in the thickness of the gluteus medius muscle. Emergency embolization is performed by installing coil and gelatin. Successful control of bleeding is achieved. To avoid this complication, a complete imaging study is recommended in planning the surgery and to avoid multiple repositioning of the guide or screw. Arterial injury should be suspected in case of increasing pain despite analgesia, functional impairment or neurological deficit and the angiographic study and resolution by selective embolization of the bleeding vessels must be performed.

Combined HIV Adolescent Prevention Study (CHAPS): comparison of HIV pre-exposure prophylaxis regimens for adolescents in sub-Saharan Africa-study protocol for a mixed-methods study including a randomised controlled trial.

BACKGROUND: HIV remains a major public health issue, especially in Eastern and Southern Africa. Pre-exposure prophylaxis is highly effective when adhered to, but its effectiveness is limited by cost, user acceptability and uptake. The cost of a non-inferiority phase III trial is likely to be prohibitive, and thus, it is essential to select the best possible drug, dose and schedule in advance. The aim of this study, the Combined HIV Adolescent PrEP and Prevention Study (CHAPS), is to investigate the drug, dose and schedule of pre-exposure prophylaxis (PrEP) required for the protection against HIV and the acceptability of PrEP amongst young people in sub-Saharan Africa, and hence to inform the choice of intervention for future phase III PrEP studies and to improve strategies for PrEP implementation. METHODS: We propose a mixed-methods study amongst young people aged 13-24 years. The first component consists of qualitative research to identify the barriers and motivators towards the uptake of PrEP amongst young people in South Africa, Uganda and Zimbabwe. The second component is a randomised clinical trial (ClinicalTrials.gov NCT03986970, June 2019) using a novel ex vivo HIV challenge method to investigate the optimal PrEP treatment (FTC-TDF vs FTC-TAF), dose and schedule. We will recruit 144 amongst HIV-negative uncircumcised men aged 13-24 years from voluntary male medical circumcision clinics in two sites (South Africa and Uganda) and randomise them into one of nine arms. One group will receive no PrEP prior to surgery; the other arms will receive either FTC-TDF or FTC-TAF, over 1 or 2 days, and with the final dose given either 6 or 20 h prior to surgery. We will conduct an ex vivo HIV challenge on their resected foreskin tissue. DISCUSSION: This study will provide both qualitative and quantitative results to help decide the optimum drug, dose and schedule for a future phase III trial of PrEP. The study will also provide crucial information on successful strategies for providing PrEP to young people in sub-Saharan Africa. TRIAL REGISTRATION: ClinicalTrials.gov NCT03986970 . Registered on 14 June 2019.

Eficacia de la cirugía bariátrica-metabólica en pacientes con obesidad y diabetes mellitus tipo 2 / Efficacy of bariatric-metabolic surgery in patients with obesity and type 2 diabetes mellitus

La prevalencia de la diabetes mellitus tipo 2 está incrementando rápidamente a nivel mundial de manera paralela a la epidemia de obesidad. El número de personas con diabetes, alrededor del mundo, se ha duplicado en los últimos 20 años; una de las características más preocupantes de este rápido crecimiento es el aparecimiento de diabetes tipo 2 en niños, adolescentes y adultos jóvenes. Debido a la reducción de la esperanza de vida causada por las morbilidades producidas por la diabetes, los pacientes que sufren de esta patología requieren un manejo integral. La cirugía bariátrica / metabólica ha demostrado que: • Mejora significativamente el control glucémico. • Reduce los factores de riesgo cardiovasculares. • Incluso ha demostrado la posibilidad de producir remisión de la diabetes tipo 2, hipertensión arterial y otras comorbilidades asociadas con la obesidad. Los resultados de múltiples estudios demuestran claramente la eficacia de la cirugía metabólica en el control glucémico y de otras comorbilidades asociadas con la diabetes tipo 2 y la obesidad; se observa, con mucha frecuencia, casos de remisión de la diabetes, incluso hasta 5 años después de la intervención quirúrgica. Por esta razón, la Asociación Americana para la Diabetes (ADA) considera a la cirugía bariátrica como una opción terapéutica viable en pacientes obesos con diabetes mellitus tipo 2.Las cirugías gastrointestinales diseñadas para controlar la obesidad pueden mejorar la homeostasis de la glucosa más efectivamente que el tratamiento farmacológico-clínico y producir cambios importantes en el estilo de vida; incluso, en un considerable número de pacientes, se logra la remisión de la diabetes tipo 2. (AU)

The prevalence of type 2 diabetes mellitus is rapidly increasing to global level parallel to the epidemic that obesity. The number of people with diabetes, around the world, have doubled in the last 20 years; one of the most worrisome features of this rapid growth It is the appearance of type 2 diabetes in children, adolescents and young adults. Due to the reduction in life expectancy caused by morbidities produced by diabetes, patients suffering from this pathology require comprehensive management bariatric / metabolic surgery has shown that: • Significantly improves glycemic control. • Reduces cardiovascular risk factors. • It has even demonstrated the possibility of producing diabetes remission type 2, arterial hypertension and other comorbidities associated with obesity. The results of multiple studies clearly demonstrate the effectiveness of the metabolic surgery in glycemic control and other associated comorbidities with type 2 diabetes and obesity; cases are very often observed of remission of diabetes, even up to 5 years after the intervention surgical For this reason, the American Diabetes Association (ADA) considers bariatric surgery as a viable therapeutic option in obese patients with type 2 diabetes mellitus. Gastrointestinal surgeries designed to control obesity can improve glucose homeostasis more effectively than treatment clinical pharmacological and produce important changes in lifestyle; even, in a considerable number of patients, remission of the type 2 diabetes. (AU)

Frecuencia de diabetes mellitus en pacientes con tratamiento para tuberculosis en Colombia / Prevalence of diabetes mellitus in patients with treatment for tuberculosis in a public hospital in Colombia

RESUMEN Introducción: La tuberculosis es una enfermedad infectocontagiosa causada por el Mycobacterium tuberculosis; entre los factores de riesgo para su desarrollo se encuentra la diabetes mellitus. Las personas con Tuberculosis activa y diabetes pueden complicarse negativamente en los resultados del tratamiento de la Tuberculosis, retrasando el tiempo de respuesta microbiológica, lo que aumenta la probabilidad de un resultado no favorable y aumenta el riego de recaídas, la resistencia a fármaco y la muerte en algunos casos. Objetivo: Establecer la frecuencia de diabetes mellitus en pacientes con tuberculosis que estaban en tratamiento en un Hospital público en Valledupar, Colombia; y su correlación con los factores de riesgo. Material y Métodos: Se efectuó un estudio descriptivo transversal, en todos los casos diagnosticados con Tuberculosis que asistieron al tratamiento en un Hospital. El diagnostico de diabetes se realizó con prueba de glicemia basal, con la historia clínica de los pacientes y encuestas. A todos los participantes se le realizó una encuentra para evaluar los factores de riesgos. Resultados: De 70 pacientes con tuberculosis, 8 (11,4 %) fueron diagnosticados con DM. Se observó que la edad > 40 años (p= 0,030) constituye un factor de riesgo para el binomio Tuberculosis-diabetes; pero no hubo diferencia estadísticamente significativa con respecto al sexo, consumo de alcohol y tabaco, VIH, índice de masa corporal (p > 0,05). Conclusiones: La prevalencia del binomio diabetes mellitus y tuberculosis en el Hospital estudiado coincide con las cifras establecida por la OMS.

ABSTRACT Introduction: Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis. Diabetes Mellitus is among the risk factors for the development of Tuberculosis. People with active Tuberculosis and diabetes can be negatively complicated by the results of Tuberculosis treatment, delaying the time of microbiological response which increases the probability of an unfavorable result and the risk of relapse, drug resistance, and death in some cases. Objective. To establish the prevalence of Diabetes mellitus and its correlation with risk factors in patients with Tuberculosis who underwent treatment in a public Hospital in Valledupar, Colombia. Material and Methods. A cross-sectional descriptive study was carried out in all cases diagnosed with Tuberculosis that underwent treatment in a public Hospital in Valledupar, Colombia. The diagnosis of diabetes was made with the use of a test to measure basal glycemia, the clinical histories of the patients, and surveys. All participants were surveyed for the evaluation of risk factors. Results. Of the 70 patients with Tuberculosis, 8 (11.4%) were diagnosed with DM. It was observed that the age> 40 years (p = 0.030) constitutes a risk factor for the TB-DM binomial; but there was no statistically significant difference with regard to sex, alcohol consumption, tobacco consumption, HIV, and body mass index (p> 0.05). Conclusions . The prevalence of Diabetes mellitus-Tuberculosis binomial in the Hospital studied corresponds to the figures established by the World Health Organization (WHO).

Lupus eritematoso sistémico asociado a síndrome de McCune-Albright: reporte de un caso / Systemic lupus erythematosus associated a McCune-Albright syndrome: case report

RESUMEN El Síndrome de McCune-Albright (SMA) es una enfermedad poco frecuente compuesta por una tríada clásica: displasia fibrosa poliostótica (DFP), manchas cutáneas de color café con leche y alteraciones endocrinas, siendo la más frecuente la pubertad precoz. Este síndrome no se ha visto asociado a enfermedades autoinmunes. Reportamos el primer caso de una paciente con SMA y lupus eritematoso sistémico.

ABSTRACT McCune-Albright Syndrome (MAS) is a rare disease characterized by a classical triad: polyostotic fibrous dysplasia (PFD), cafe-au-lait macules and endocrine abnormalities, most frequently precocious puberty. This syndrome has not been associated with autoimmune diseases. We report the first case of a patient with MAS and systemic lupus erythematosus.

The use of female estrogenized goats as sexual stimulator of crossbred dairy males subsequently exposed to acyclic goats during two phases of the anestrous season.

This research evaluated the possible influence of exposure of male goats to estrogenized female goats ("female effect") upon males' sexual behavior [appetitive (ASB) & consummatory (CSB)], as well as the induction of reproductive activity of crossbred dairy female goats exposed to such treated males ("male effect") during the early and deep anestrous periods. Crossbred dairy adult male goats (n = 12; 24-48 mo. old) and 80 anovulatory crossbred dairy adult female goats (34-50 mo. old) were used during two experimental periods: March to April and April to May. First, males were separated into four groups (n = 3 each), roughly homogeneous regarding body weight and body condition score and randomly assigned to four experimental groups. The first two groups included males + estrogenized females, then such males were exposed to anestrous females either during March (group 1: three males; 20 females; EFEM-MAR), or during April (group 2: three males; 20 females; EFEM-APR). The second two groups were respective control groups: Males + non-treated-anestrous females, and then such males exposed to acyclic females either during March (group 3: three males; 20 females; CONT-MAR) or April (group 4: three males; 20 females; CONT-APR). Once the male-to-female contact was established, both odor (ODT) and behavior (BEHT) tests (2 d × 2 h) were performed during both anestrous periods. On day 10 after introduction of the males, in both anestrous periods, one ultrasonography scanning ("US") was performed to quantify the presence, number and size of corpus luteum (US-CL) to determine the effectiveness of the "male effect" and indicators of ovarian activity. Then, on day 45 after introduction of the males, a second US was performed to evaluate pregnancy rate (US-PREG). The EFEM-males, regardless of the phase of the anestrous cycle, had an increased (P < 0.05) odor intensity with respect to the control groups. In addition, while an increased (P < 0.05) ASB occurred in the EFEM-males, no CSB differences (P > 0.05) arose when treatments were compared, neither in March-April nor in April-May. The EFEM-males exposed to acyclic goats in March-April (i.e. early anestrous period), promoted not only the largest estrus and ovulatory responses (P < 0.05), but also the largest pregnancy rate (P < 0.05) in these previously anestrus goats, suggesting that in April-May (i.e. profound anestrous), the presence of active males was not enough to completely suppress cyclic reproductive arrest. This study generates interesting out-of-season reproductive outcomes in a goat population with a large proportion of highly seasonal dairy breeds (i.e. Alpine, Saanen and Toggenburg), augmenting the possibility to expand milk production and the economic income of goat producers across the year. Besides, this practice may serve as an interesting reproductive tool to increase the sustainability of marginal goat production systems under semiarid conditions.

Pancreatoyeyunoanastomosis con técnica de Blumgart modificada para reconstrucción post-pancreatoduodenectomía: estudio de serie de casos con seguimiento / Pancreatojejunostomy with modified Blumgart technique for post-pancreatoduodenectomy reconstruction

Resumen Introducción: La pancreatoduodenectomía es una cirugía compleja, con cifras de morbilidad cercanas a 30% y mortalidad entre 1 a 5%. El principal factor responsable de morbilidad y mortalidad es la fístula pancreática posoperatoria (FPPO). En la actualidad no existe una técnica universalmente estandarizada para la reconstrucción pancreática. Objetivo: Determinar la prevalencia de FPPO clínicamente relevante en una serie de pacientes en los que se realizó reconstrucción pancreática con pancreatoyeyunoanasto- mosis con técnica de Blumgart modificada para reconstrucción post-pancreatoduodenectomía en Hospital Hernán Henríquez Aravena entre los años 2014-2017. Material y Método: Serie de casos con seguimiento de julio de 2014 a abril de 2017. Se incluyeron pacientes a quienes se realizó reconstrucción pancreática con técnica de Blumgart modificada. La modificación consistió en el uso de pledgets® (poli-tetrafluoro- etileno) en los puntos iniciales en el páncreas con la idea de disminuir la posibilidad de desgarro del tejido. Se excluyeron pacientes a quienes se realizó otra técnica de reconstrucción. Se consideró FPPO clínicamente relevante (grado B/C) para evaluar morbilidad. Se utilizó estadística descriptiva con medidas de tendencia central y dispersión. Resultados: Serie de casos de 12 pacientes, 9 (75%) de género femenino y 3 (25%) de género masculino. La edad promedio fue de 59 ± 8,5 años. La morbilidad fue de 25% y la tasa de fístula grado B/C fue 0%. Todas las fístulas pancreáticas fueron grado A (33,3%), sin relevancia clínica. Conclusión: La técnica de Blumgart modificada parece ser una técnica segura y reproducible para pancreato-yeyuyoanastomosis.

Introduction: Pancreatoduodenectomy is a complex surgery, with morbidity close to 30% and mortality between 1% and 5%. The main contributing factor to morbidity and mortality is postoperative pancrea- tic fistula (POPF). At present, there is no globally standardized technique for pancreatic reconstruction. Aim: To determine the prevalence of clinically relevant POPF in a sample of patients who underwent pancreaticojejunal anastomosis reconstruction with Blumgart's modified technique for post-pancreato- duodenectomy reconstruction at Hospital Hernán Henríquez Aravena between 2014 and 2017. Material and Method: Case series with follow-up from july 2014 to april 2017. Patients who underwent pancreatic reconstruction with Blumgart's modified technique were included. The modification consisted of the use of Pledgets® (poly-tetrafluoro-ethylene) at the inicial points in páncreas with the idea of reducing the possibility of tissue tearing. We excluded patients who underwent another reconstruction technique. Clinically relevant POPF (grade B/C) was considered to asses morbidity. Descriptive statistics were used with measures of central tendency and dispersion. Results: Case series of 12 patients, 9 (75%) were female and 3 (25%) were male. The mean age was 59 ± 8.5 years. The morbidity was 25% and the rate of grade B/C fistula was 0%. All pancreatic fistulas were grade A, not clinically relevant. Conclusion: The Blumgart's modified technique seems to be a safe and reproducible technique for pancreticojejunal anastomosis.

Expansión anormal de hexanucleótido en gen C9orf72 en una familia con demencia frontotemporal y cuadros asociados / Abnormal expansion of C9orf72 gene in familial frontotemporal dementia

Frontotemporal Dementia (FTD) and Motor Neuron Disease (MND) may share similar pathogenic mechanisms. An abnormal hexanucleotide expansion in C9orf72 gene is the most common genetic abnormality of these conditions and explains their concurrence in the same family. We report a 77-year-old female presenting with non-fluent aphasia leading to mutism and a mild Parkinsonism. A magnetic resonance imaging showed a severe atrophy of frontal and temporal lobes. Several family members of the patient suffered of atypical Parkinsonism, lateral amyotrophic sclerosis and dementia. We identified an abnormal hexanucleotide expansion in the C9orf72 gene in the proband. To the extent of our knowledge, this is the first time that this diagnosis is confirmed in our country. The knowledge of the genetic basis of neuro degenerative disorders improves diagnosis and opens expectatives for future treatments of these disabling conditions.

Oral diseases: a 14-year experience of a Chilean institution with a systematic review from eight countries.

BACKGROUND: Retrospective studies to assess the distribution of oral diseases (ODs) are helpful in estimating the prevalence of oral diagnoses in the population, and thus help in preventive and curative services. Prevalence and frequency data for ODs are available from many countries, but information from Chile is scarce. MATERIAL AND METHODS: This study investigated the frequency of OD in a Chilean population. For this, we included all patients treated at the University of Talca (UTALCA, Chile) between 2001 and 2014. Patient characteristics were retrieved from medical files. To contextualize our results, we conducted a systematic review (SystRev) using Publish or Perish software (PoP), Google Scholar and MEDLINE/PubMed. RESULTS: One hundred sixty-six ODs were diagnosed, and the most prevalent groups were soft tissue tumours, epithelial pathology and salivary gland pathology. Individually, irritation fibroma, oral lichen planus (OLP) and mucocele were the most common diagnoses. ODs frequently affected unspecified parts of the mouth (including cheek, vestibule and retromolar area), gum, lips, tongue and palate. In the SystRev, the more studied diagnoses were leukoplakia, OLP and recurrent aphthous stomatitis; prevalent lesions included Fordyce's spots, recurrent aphthous stomatitis and fissured tongue. Chilean patients and SistRev shared almost all ODs. CONCLUSIONS: The results reflect ODs diagnosed in a specialized service of oral pathology and medicine in Chile and will allow the establishment of preventive/curative policies, adequate health services and dentistry curriculum.

The Evidence-Informed Policy Network (EVIPNet) in Chile: lessons learned from a year of coordinated efforts

Informing the health policymaking process with the best available scientific evidence has become relevant to health systems globally. Knowledge Translation Platforms (KTP), such as the World Health Organization's Evidence Informed Policy Networks (EVIPNet), are a recognized strategy for linking research to action. This report describes the experience of implementing EVIPNet in Chile, from its objectives, organizational structure, strategy, activities, and main outputs, to its evolution over the course of its first year. Lessons learned are also covered. Of the activities initiated by EVIPNet-Chile, the Rapid Response Service proved to be a good starting point for engaging policymakers. Capacity building workshops and policy dialogues with relevant stakeholders were also successful. Additionally, EVIPNet-Chile developed a model for engaging academic institutions in policymaking through a network focused on preparing evidence briefs. A number of challenges, such as changing methods for producing rapid evidence syntheses, were also identified. This KTP implementation model located in a Ministry of Health could contribute to the development of similar initiatives in other health systems.

Síndrome de Hallermann-Streiff y embarazo: manejo de la vía aérea difícil en embarazadas / Hallermann-Streiff syndrome and pregnancy: management of difficult airway in pregnant women

El síndrome de Hallermann-Streiff es una rara entidad asociada a hipoplasia del tercio inferior de la cara, determinando así una vía aérea de difícil manejo. Se presenta el caso de una mujer de 21 años con ese síndrome, acondroplasia, escoliosis severa e infección respiratoria los días previos a la interrupción exitosa de su embarazo mediante cesárea. El manejo requirió una cuidadosa evaluación preoperatoria y disponibilidad inmediata de dispositivos alternativos para el manejo de la vía aérea en caso necesario. La gravidez, así como ciertas comorbilidades asociadas, aumentan la posibilidad de una intubación fallida con morbi-mortalidad secundaria importante, dado ello, es necesaria la preparación e implementación de algoritmos atingentes para el manejo de la vía aérea en casos como el presentado.

The Hallermann-Streiff syndrome is a rare entity associated to hypoplasia of the lower third of the face, determining a difficult airway management. We report the case of a 21 years female with this syndrome, achondroplasia, severe scoliosis and respiratory infection at the days prior to the interruption of her preg-nancy by cesarean section. Her management required a carefully preoperative evaluation and availability of alternative devices to secure her airway. Pregnancy and certain comorbidities increase the chance of a failed intubation with severe secondary morbidity and mortality, given this, the correct preparation and implementation of difficult airway algorithms in pregnancy if it’s necessary.

Síndrome de dehiscencia del canal semicircular superior: a propósito de un caso / Canal dehiscence syndrome of the superior semicircular: in a case purpose

El síndrome de dehiscencia de canal semicircular superior (DCSS) es una patología descrita en 1998 por Minor y cols, presenta síntomas diversos incluido vértigo inducido por el sonido, hipoacusia y autofonía por la falta de cobertura ósea en dicho canal. El diagnóstico se basa en la clínica y la confirmación se obtiene mediante la tomografía computarizada de peñasco. El tratamiento será expectante o reparación quirúrgica de la continuidad si la clínica es incapacitante. En este artículo se presenta un caso clínico de DCSS con síntomas auditivos y vestibulares al emitir el fonema "mmm".

The superior semicircular dehiscence síndrome is a pathology described en 1998 by Minor et al. Which presents several symptoms incluid sound induced vértigo, hearing loss and autophony due to bone dehiscense of this semicircular canal. The diagnosis was based on clinical and confirmation is given by the temporal bone CT. Treatment is expectant or surgical repair of continuity if the clinic is disabling. In this paper we present a case of DCSS with auditory and vestibular symptoms in issuing the phoneme "mmm".

Reproductive outcomes of Alpine goats primed with progesterone and treated with human chorionic gonadotropin during the anestrus-to-estrus transition season.

This study aimed to determine the possible effects of a single injection of human chorionic gonadotropin (hCG) as a means for estrus induction in acyclic French-Alpine goats during the reproductive transition period at 25°N, 103°W. The potential effects of hCG upon ovarian function and reproductive performance of goats were also assessed. Multiparous acyclic French-Alpine goats (n = 39; 37.4 ± 8 .5 kg) were primed with 20mg progesterone (P4) 1 day prior to hCG administration. Thereafter, does were treated either with saline (hCG-0; n = 10), 50 (hCG-50; n = 9), 100 (hCG-100; n = 10), or 300 IU of hCG (hCG-300; n = 10). Ovarian structures and pregnancy were monitored by transrectal ultrasonography. In addition, after hCG application, goats were monitored twice daily (0800 and 1800 h) to detect estrus signs, with the use of aproned, sexually active bucks treated with testosterone. Goats were bred 12h after the onset of estrus. Two days after hCG administration, the number of large follicles was higher (P < 0.05) in the hCG-50 and hCG-300 groups (1.7 ± 0.1 and 1.8 ± 0.2, respectively) compared with the hCG-100 and hCG-0 groups (1.4 ± 0.2 and 1.1 ± 0.1, respectively). Although none of the hCG-0-goats depicted estrus, the estrus response from the hCG-50, hCG-100, and hCG-300 groups over the 7-d breeding period was 67%, 100%, and 90%, respectively (P > 0.05), being always accompanied by ovulation. Pregnancy rate (67, 100, and 70%), kidding rate (55%, 80%, and 70%), and litter size (1.6 ± 0.5, 1.5 ± 0.5, and 1.5 ± 0.5) for hCG-50, hCG-100, and hCG-300, respectively, did not differ among the hCG-treated does. Therefore, the combined use of P4-priming plus a 100-IU hCG injection is an effective protocol for inducing estrus in non-cycling Alpine goats during the anestrus-to-estrus transition period, which is of key importance for both goat producers and industrializers.

Conjugation of SUMO to p85 leads to a novel mechanism of PI3K regulation.

Class IA phosphatidylinositol 3-kinases (PI3Ks) are composed of p110 catalytic and p85 regulatory subunits. How regulatory subunits modulate PI3K activity remains only partially understood. Here we identified SUMO (small ubiquitin-related modifier) as a new player modulating this regulation. We demonstrate that both p85ß and p85α are conjugated to SUMO1 and SUMO2. We identified two lysine residues located at the inter-SH2 domain on p85ß, a critical region required for inhibition of p110, as being required for SUMO conjugation. A SUMOylation-defective mutant p85ß shows higher activation of the PI3K pathway, and increased cell migration and transformation. Moreover, the cancer-related KS459del mutant in p85α was less efficiently SUMOylated compared with the wild-type protein. Finally, our results show that SUMO modulates p85 tyrosine phosphorylation, a modification correlating with PI3K pathway activation. Thus, SUMO reduces the levels of tyrosine-phosphorylated-p85 while loss of SUMOylation results in increased tyrosine phosphorylation of p85. In summary, we identify SUMO as a new important player in the regulation of the PI3K pathway through modulation of p85.

Fundamentos de la intervención temprana en niños con trastornos del espectro autista / Basics of early intervention in children with autism spectrum disorders

Los trastornos del espectro autista (TEA) consisten en una diada caracterizada por deficiencias en la comunicación e interacción social y patrones restrictivos y repetitivos de comportamiento. En conjunto tienen una prevalencia del 0,6% en la población general, aunque no se cuenta con estadísticas nacionales. Si bien la evolución es variable, se ha visto que la intervención temprana es un factor importante en la determinación del pronóstico. El objetivo del presente trabajo ha sido actualizar conceptos respecto a la evidencia actual disponible sobre la relevancia de intervenir tempranamente este tipo de trastornos. Con el análisis de la información recopilada se confirma la importancia de la intervención temprana en niños con TEA, como así también, el rol de pediatras y otros profesionales de la salud en la detección precoz de estos trastornos.

Autism Spectrum Disorders (ASD) are characterized by impairments in communication and social interaction, as well as restricted and repetitive patterns of behavior. They have a prevalence of 0.6% in the general population, although there are no national statistics. Even though their evolution is variable, it has been observed that early intervention is an important factor determining prognosis. The aim of this study is to update concepts regarding the current available evidence on the importance of early intervention. After analyzing the collected information, the importance of early intervention programs for children with ASD is confirmed, as well as the role of pediatricians and other health professionals in the early detection of these disorders.

Algunas amenazas actuales a la confidencialidad en medicina / Some current threats to confidentiality in medicine

Social, technical and legal conditions of the current practice of medicine make it necessary to insist on certain actions and circumstances that may jeopardize the confidentiality of information, offered by patients to their health providers. Therefore, some effects of the current Chilean law are analyzed in this respect, regarding access to data from the clinical record of a patient. Also, the risks of putting certain data on social networking sites are analyzed, as well as some of its effects on clinical practice. The reasons because of mandatory reporting of diseases, meaning danger to public health, is allowed, are mentioned. We also discuss the difficulties involved in managing the results of preventative health screenings and its knowledge by third parties, as well as some possible violations of personal privacy, regarding dissemination of some people health information and its further mention or figuration in mass media. We conclude that it is a must for both physicians and other health team members, to safeguard confidentiality of data to which they have had access, as well as the need to know the relevant law, in order to respect human dignity of patients, each one as a person. We address the attention to the possibility that, practicing in a different way, it could endanger the reliability of clinical records, also impairing the quality of people’s health care.

SUMOylation regulates AKT1 activity.

Serine threonine kinase AKT has a central role in the cell, controlling survival, proliferation, metabolism and angiogenesis. Deregulation of its activity underlies a wide range of pathological situations, including cancer. Here we show that AKT is post-translationally modified by the small ubiquitin-like modifier (SUMO) protein. Interestingly, neither SUMO conjugation nor activation of SUMOylated AKT is regulated by the classical AKT targeting to the cell membrane or by the phosphoinositide 3-kinase pathway. We demonstrate that SUMO induces the activation of AKT, whereas, conversely, down-modulation of the SUMO machinery diminishes AKT activation and cell proliferation. Furthermore, an AKT SUMOylation mutant shows reduced activation, and decreased anti-apoptotic and pro-tumoral activities in comparison with the wild-type protein. These results identify SUMO as a novel key regulator of AKT phosphorylation and activity.