Cetoacidosis diabética como debut de diabetes mellitus inmunomediada en paciente en tratamiento con inhibidores de checkpoint / Diabetic ketoacidosis as debut of immune-mediated diabetes mellitus in a patient in treatment with immune checkpoint inhibitors

Los inhibidores de checkpoint (ICP) son anticuerpos usados en inmunoterapia contra el cáncer. Uno de sus blancos de acción es el receptor de muerte celular programada-1 (PD-1), el cual es importante para mantener la tolerancia inmunitaria. Sin embargo, este mecanismo se asocia a riesgo de eventos adversos relacionados a la inmunidad que pueden afectar a múltiples órganos incluyendo el sistema endocrino. Se describe el caso inhabitual de un paciente que a los 18 meses de terapia con ICP debutó con cetoacidosis diabética (CAD).

Immune checkpoint inhibitors consist in antibodies used in immunotherapy against cancer. One of their targets is the programmed cell death-1 (PD-1) receptor, which is important in maintaining self-tolerance. However, this mechanism is associated with a risk for immune-related adverse events potentially affecting multiple organs, including the endocrine system. We describe the unusual case of a patient who, after 18 months of treatment with an immune checkpoint inhibitor, debuted with diabetic ketoacidosis

Tasa de egreso hospitalario por episodio depresivo recurrente en los años 2018-2021 en Chile / Hospital discharge rate due to recurrent depressive episode in the years 2018-2021 in Chile

Introducción: La depresión es un trastorno del ánimo frecuente, cuya recurrencia altera su manejo y pronóstico. El objetivo del trabajo es describir la tasa de egreso hospitalario (TEH) por episodio depresivo recurrente (EDR) entre 2018-2021 en Chile, según sexo, edad y gravedad. Materiales y métodos: Estudio observacional y transversal que considera los egresos hospitalarios por EDR en el período 2018-2021 en Chile (N=1551). Se utilizaron las bases de datos del Departamento de Estadísticas e Información de Salud y el Instituto Nacional de Estadística. Las variables estudiadas fueron sexo, grupo etario y gravedad. No requirió aprobación de comité de ética. Resultados: Se observó la menor TEH en 2020 con 1,91 egresos por cada 100.000 habitantes. Las mujeres sobresalieron durante todo el período con una TEH de 3,68 egresos por cada 100.000 habitantes. Destacó el grupo de 15 a 19 años con la mayor TEH en ambos sexos con 5,3 egresos por cada 100.000 habitantes. Respecto a gravedad, las hospitalizaciones se concentraron en pacientes de diagnóstico no especificado. Discusión: La pandemia de COVID 19 podría explicar la disminución de la TEH en 2020, al reducirse el diagnóstico y hospitalización por EDR; presumiblemente debido al fenómeno de reconversión de camas. La TEH es mayor en el sexo femenino, lo cual es concordante con la literatura. El predominio del grupo de 15 a 19 años discrepa de la evidencia, la cual indica que suele concentrarse en individuos de 25 a 64 años. Conclusión: Las TEH por EDR se concentraron en mujeres jóvenes. Es relevante conocer la epidemiología local para focalizar los recursos en la detección oportuna de factores de riesgo, para evitar episodios graves y disminuir su recurrencia.

Introduction: Depression is a common mood disorder, whose recurrence alters its management and prognosis. The aim of the paper is to describe the hospital discharge rate (HED) for recurrent depressive episode (RDE) between 2018-2021 in Chile, according to sex, age and severity. Materials and methods: Observational and cross-sectional study considering hospital discharges due to DRE in the period 2018-2021 in Chile (N=1551). The databases of the Department of Health Statistics and Information and the National Institute of Statistics were used. The variables studied were sex, age group and severity. Ethics committee approval was not required. Results: The lowest HTE was observed in 2020 with 1.91 discharges per 100,000 inhabitants. Females stood out during the entire period with an HTE of 3.68 discharges per 100,000 population. The 15-19 years age group stood out with the highest HTE in both sexes with 5.3 admissions per 100,000 inhabitants. In terms of severity, hospitalizations were concentrated in patients with unspecified diagnosis. Discussion: The COVID 19 pandemic could explain the decrease in HTE in 2020, with a reduction in diagnosis and hospitalization for RDE, presumably due to the bed conversion phenomenon. HTE is higher in the female sex, which is consistent with the literature. The predominance of the 15 to 19 years age group disagrees with the evidence, which indicates that it tends to be concentrated in individuals aged 25 to 64 years. Conclusion: HTE due to DRE was concentrated in young women. It is important to know the local epidemiology in order to focus resources on the timely detection of risk factors to avoid serious episodes and reduce their recurrence.

Calidad de vida posterior a gastrectomía total laparoscópica versus abierta en cáncer gástrico / Quality of life after -laparoscopic versus open total gastrectomy in gastric cancer

Resumen Introducción: En los últimos años, la gastrectomía laparoscópica ha aparecido como una técnica quirúrgica con resultados oncológicos comparables a la técnica abierta, pero existe poca evidencia en cuanto a la calidad de vida posoperatoria de estos pacientes. Objetivo: Evaluar la calidad de vida posoperatoria de pacientes sometidos a gastrectomía total laparoscópica (GTL) en comparación a gastrectomia total abierta (GTA) en cáncer gástrico. Materiales y Método: Estudio retrospectivo, observacional en Hospital Militar de Santiago, entre enero de 2015 y junio de 2020. Se les aplicó 2 encuestas validadas para Chile: EORTC QLQ-30 y EORTC QLQ-OG25. Resultados: Se obtuvieron 60 pacientes; 30 sometidos a GTL y 30 a GTA. Promedio edad fue 66,3 ± 11 años para GTL y 68,2 ± 11 años en GTA (p = 0,5). Se obtuvo un score en GTL versus GTA: global 83,3 y 80,2 (p = 0,6), sintomático 17,1 y 25,5 (p = 0,2) y score funcional 87,9 y 70,9 (p = 0,03). Posterior a eso obtuvimos en funcionalidad GTL versus GTA; física 92,2 versus GTA 73,1 (p = 0,04), emocional 84,1 versus 78,5 (p = 0,6), cognitiva 84,9 versus 79,0 (p = 0,3) y social 80,9 versus 72,2 (p = 0,4). Al analizar síntomas destaco; fatiga 14,6 versus 33,1 (p = 0,04) y dolor 13,4 versus 24,3 (p = 0,05). Finalmente, en síntomas digestivos altos obtuvimos en disfagia 0,84 GTL versus 17,3 GTA (p = 0,04). Conclusión: La GTL logra resultados comparables a GTA en calidad de vida e incluso ofrece ventajas significativas en funcionalidad física como también en síntomas como dolor, fatiga y disfagia.

Introduction: In recent years, laparoscopic gastrectomy has appeared as a surgical technique with oncological results comparable to the open technique, but there is little evidence regarding the postoperative quality of life of these patients. Objective: To evaluate the postoperative quality of life of patients undergoing laparoscopic total gastrectomy (LTG) compared to open total gastrectomy (OTG) in gastric cancer. Materials and Method: Prospective, observational study at Hospital Militar of Santiago, between January 2015 and June 2020. Two surveys validated for Chile were applied: EORTC QLQ-30 and EORTC QLQ-OG25. Results: 60 patients were obtained; 30 subjected to LTG and 30 to OTG. Average age was 66.3 ± 11 years for LTG and 68.2 ± 11 years for OTG (p = 0.5). A score was obtained in LTG versus OTG: global 83.3 and 80.2 (p = 0.6), symptomatic 17.1 and 25.5 (p = 0.2) and functional score 87.9 and 70.9 (p = 0.03). After that we got LTG versus OTG functionality; physical 92.2 versus 73.1 (p = 0.04), emotional 84.1 versus 78.5 (p = 0.6), cognitive 84.9 versus 79.0 (p = 0.3) and social 80.9 versus 72.2 (p = 0.4). When analyzing symptoms I highlight; fatigue 14.6 versus 33.1 (p = 0.04) and pain 13.4 versus 24.3 (p = 0.05). Finally, in upper digestive symptoms, we obtained 0.84 LTG versus 17.3 OTG in dysphagia (p = 0.04). Conclusion: LTG achieves results comparable to OTG in quality of life and even offers significant advantages in physical functionality as well as symptoms such as pain, fatigue and dysphagia.

Características y resultados de pacientes COVID-19 tratados con ventilación mecánica invasiva en Hospital San Juan de Dios. Marzo-junio 2020 / Features and evolution of patients with COVID-19 who required mechanical ventilation

BACKGROUND: The overall mortality of patients with COVID-19 admitted to intensive care units is approximately 40%. Aim: To describe the characteristics of a cohort of patients with COVID-19 who required invasive mechanical ventilation due to severe hypoxemic acute respiratory failure at a general hospital in Santiago, Chile. MATERIAL AND METHODS: Review of medical records and follow up for 28 days of patients with COVID-19 confirmed by polymerase chain reaction who required invasive mechanical ventilation and who were admitted to the intensive care unit from March 24 to June 7, 2020. RESULTS: Data from 152 patients aged 58 (interquartile range (IQR) 47-65 years (66% men) was analyzed. As of July 5, 36 (24%) had died, 75 (49%) were discharged, 10 (7%) were still on invasive mechanical ventilation, 11 (7%) remained with tracheostomy but without invasive mechanical ventilation, and 20 (13%) were hospitalized in a basic unit. The median time on invasive mechanical ventilation among extubated patients was 14 days (IQR 10-21) and 121 (80%) were in the prone position. Patients who died were older, had a higher frequency of diabetes mellitus and a higher driving pressure at 7 days than those discharged alive from the intensive care unit. Conclusions: In this study mortality was lower than that reported in the first international studies, probably due to the selection of younger patients and greater knowledge of the disease.

An impressive case of chromoblastomycosis due to Fonsecaea pedrosoi in a patient with a long history of fungal infection.

Chromoblastomycosis is defined as a chronic cutaneous and subcutaneous fungal infection caused by melanized or brown-pigmented fungi. A 63-year-old man farmer showed on external and internal part of the right arm, a well-delimited verrucous and hyperkeratotic plaque, with atrophic and cicatricial areas. Direct examination of skin scrapings samples showed the presence of muriform cells, a classic feature of chromoblastomycosis. Fungal isolation was performed in Sabouraud dextrose agar, and dark olivaceous colonies were isolated. Skin biopsy samples were obtained for histopathological and molecular diagnosis. DNA extracted from both, paraffin-embedded skin biopsy samples and fungal colonies, was used for molecular identification by 18S-ITS1-5.8S-ITS2-28S rRNA amplification and sequencing. Fonsecaea pedrosoi was identified from paraffin-embedded skin samples and fungal colonies. A combined therapy with terbinafine and itraconazole, plus cryotherapy was applied with an important improvement. Herein, we report an impressive case of chromoblastomycosis due to Fonsecaea pedrosoi with a successful outcome.

Modificación del abordaje quirúrgico en tumores estromales gástricos posterior a neoadyuvancia con Imatinib / Change of surgical approach in gastrointestinal stromal tumors after neoadyuvant therapy with Imatinib

Resumen Introducción: El tratamiento de los tumores estromales gastrointestinales (GIST) de alto riesgo es quirúrgico. Su resultado podría variar al usarse neoadyuvancia. Objetivo: Evaluar si el uso de la terapia neoadyuvante con imatinib puede cambiar el abordaje quirúrgico en los tumores estromales gastrointestinales de alto riesgo. Materiales y Métodos: Se realizó un análisis retrospectivo en el Hospital Clínic de Barcelona entre enero de 2002 y mayo de 2016. Resultados: Se obtuvo un total de 8 pacientes. La edad media fue 66,1 ± 13,3 años. La ubicación del tumor fue de 37,5% (3) en el tercio superior, el 50% (4) en el tercio medio y el 12,5% (1) en el tercio inferior. Debido a la clasificación de riesgo alto, la ubicación y/o la necesidad de resecciones multiviscerales, se indicó, previa evaluación comité oncológico, realizar terapia neoadyuvante. La mediana de tiempo de neoadyuvancia fue de 30 semanas. En el 100% (8) de los casos se logró un cambio de enfoque quirúrgico después de la utilización de imatinib. En todos los casos se realizó un resección local (7 laparoscópica y 1 endolaparoscópica) con márgenes negativos La biopsia posoperatoria mostró un promedio de 51,2% de reducción del tamaño tumoral inicial, lo que resultó en una diferencia estadística (p < 0,01) con el tamaño inicial de las lesiones. Durante el seguimiento, tanto la sobrevida relacionada al tumor como la global, fue de un 100%. Conclusión: La terapia neoadyuvante podría cambiar el abordaje quirúrgico de los pacientes con GIST gástrico de riesgo intermedio o alto mediante la reducción del tamaño tumoral, permitiendo realizar cirugías más económicas y logrando resultados oncológicos adecuados.

Introduction: The treatment of high-risk gastrointestinal stromal tumors (GIST) is surgical. Results may change when using neoadjuvant. Objetive: To evaluated if the use of neoadjuvant therapy with imatinib can change the surgical approach in high risk gastrointestinal stromal tumors (GIST). Materials and Methods: A retrospective analysis was performed from a prospective collected database in Hospital Clinic of Barcelona between January 2002 and May 2016. Results: A total of 8 patients were analyzed with a mean age of 66.1 ± 13.3 years. The tumor location was upper third 37.5% (3) cases, 50% (4) in the middle third and 12.5% (1) in lower third. Because of high risk classification, location and the need of multivisceral resections, neoadjuvant therapy was indicated. The median time of neoadjuvant therapy was 30 weeks. In 87.5% (7) cases a change of surgical approach was achieved after the use of imatinib. In 100% of our series laparoscopic wedge resection was performed achieving negative margins of resection. The postoperative biopsy showed 51.2% of reduction of initial tumor size, resulting in statistical difference (p < 0.01). All patients are alive and 100% of tumor related survival was achieved. Conclusion: Neoadjuvant therapy maybe can change the surgical approach of patients with high-intermediate risk gastric GIST by reducing tumor size. This response also eventually can achieve optimal oncological outcome.

Vimentin and Notch as biomarkers for breast cancer progression.

Breast cancer, the most common spontaneous malignancy diagnosed in women, is a classical model of hormone dependency as it is associated with prolonged exposure to female hormones. Different cytoplasmic proteins are important in the transformation of a normal cell to an invasive tumor cell, and these include vimentin and Notch. To investigate the importance of these two genes and proteins in breast carcinogenesis, we used an in vitro breast cancer model system, in which an immortalized human breast epithelial cell line, MCF-10F, was malignantly transformed by exposure to low doses of high linear energy transfer α particle (150 keV/µm) radiation and subsequent growth in the presence or absence of 17ß-estradiol. This model consisted of human breast epithelial cells in different stages of transformation: i) a parental cell line (MCF-10F), ii) an Estrogen cell line (MCF-l0F continuously grown with estradiol at 10-8), iii) a malignant and non-tumorigenic cell line (Alpha3), iv) a malignant and tumorigenic cell line (Alpha5) and v) a Tumor2 cell line derived from a xenograft of the Alpha5 cell line injected into nude mice. Vimentin and Notch showed greater expression in the Alpha5 and Tumor2 cell lines compared with that in the non-tumorigenic cell lines, MCF-10F, Estrogen and Alpha3. In the present study, positive staining for vimentin was found in 21% of cases. Vimentin and Notch protein expression was negative in noninvasive ductal carcinoma biopsies from breast cancer patients. However, positive cell expression was observed in invasive ductal carcinoma biopsies. These biomarkers can be considered important indicators of breast cancer progression and can be added to the diagnostic panel when overall survival is a primary end-point.

Treatment of childhood acute lymphoblastic leukemia in central America: a lower-middle income countries experience.

BACKGROUND: Five Asociación de Hemato-Oncología de Centroamérica (AHOPCA) countries have used an adapted BFM-based protocol for childhood acute lymphoblastic leukemia (ALL). PROCEDURE: In the AHOPCA-ALL 2008 protocol, patients were stratified by age, white blood cell count, immunophenotype, central nervous system involvement, day 8 prednisone response, and morphologic bone marrow response to induction therapy. Patients at Standard Risk (SR) received a three-drug induction regimen, a reinduction phase, and maintenance with protracted intrathecal therapy. Those at Intermediate (IR) and High Risk (HR) received, in addition, daunorubicin during induction therapy, a consolidation phase and two or three reinduction phases respectively. RESULTS: From August 2008 through July 2012, 1,313 patients were enrolled: 353 in SR, 548 in IR, 412 in HR. During induction therapy, 3.0% of patients died, 2.7% abandoned treatment, 1.1% had resistant ALL, and 93.2% achieved morphological complete remission (CR). Deaths and abandonment in first CR occurred in 2.7% and in 7.0% of patients, respectively. The relapse rate at a median observation time of 2.1 years was 15.0%. At 3 years, the event-free survival (EFS) and overall survival (OS), with abandonment considered as an event, were 59.4% (SE 1.7) and 68.2% (SE 1.6). Three-year EFS was 68.5% (SE 3.0), 62.1% (SE 2.6), and 47.8% (SE 3.2) for SR, IR, and HR groups. Adolescents had a significantly higher relapse rate (P = 0.001). CONCLUSIONS: This experience shows that common international studies are feasible in lower-middle income countries. Toxic deaths, abandonment of treatment, and relapses remain major obstacles to the successful treatment. Alternative treatment strategies may be beneficial.

Diagnóstico y tratamiento de la polirradiculoneuropatía desmielinizante inflamatoria Crónica: reporte de un caso / Diagnosis and treatment of chronicinflammatory demyelinating polyradiculoneuro-pathy: a case report

La Polirradiculoneuropatía Desmielinizante Inflamatoria Crónica (PDIC) es un desorden adquirido de los nervios periféricos y las raíces nerviosas, que se desarrolla de forma continua durante ocho semanas o más. La forma clásica se caracteriza por compromiso simétrico sensitivo y motor, la debilidad está presente tanto en musculatura proximal como distal y es característico en el estudio electrofisiológico la desmielinización junto a disociación albúmino-citológica en Líquido Cefalorraquídeo (LCR). PRESENTACION DEL CASO. Mujer de 34 años con antecedente de depresión en tratamiento, inicia hace un año aproximadamente debilidad muscular de las cuatro extremidades, ascendente y progresiva, llegando a la incapacidad de la marcha. Ingresó al servicio de urgencia del hospital de Puerto Montt, con paraparesia predominante en extremidades inferiores, hipoestesia y ausencia de reflejos osteotendinosos. Estudio electrofisiológico evidencia severa polineuropatía sensitivamotora desmielinizante con degeneración axonal secundaria.LCR con proteinorraquia de 100 mg/dl y sin celularidad. Inició tratamiento con corticoides y luego plasmaféresis, evolucionando con mejoría significativa de la funcionalidad y marcha independiente. DISCUSIÓN. Las principales modalidades terapéuticas de PDIC son la inmunoglobulina intravenosa, glucocorticoides y plasmaféresis. Todos estos parecen ser igualmente efectivos de forma separada. La elección está influenciada por las preferencias del paciente, efectos adversos, costo, duración y disponibilidad. El uso de inmunoglobulina intravenosa es a veces limitado; los corticoides son económicos, pero con efectos adversos frecuentes y relevantes; y la plasmaféresis es cara, invasiva y solamente disponible en centros especializados. La mayoría de los pacientes, responden inicialmente, pero las recaídas son frecuentes...

INTRODUCTION. Chronic inflammatory demyelinating polyradiculoneuropathy(CIDP) is an acquired disorder of peripheral nerves and nerve roots that run continuously for 8 weeks or more. The classic form is characterized by symmetric sensory and motor involvement, weakness is present in both proximal and distal muscles and is characteristic in the electrophysiological study demyelination with albumin-cytological dissociation in cerebrospinal fluid (CSF). PRESENTATION OF THE CASE.34-year-old woman with a history of depression in treatment, started about a year ago muscle weakness of all limbs, ascending and progressive, leading to the inability of the march. Was admitted with paraparesis, predominantly in lower extremities, hypoesthesia and absence of tendon reflexes. Electrophysiological study evidence severe demyelinating motor sensory polyneuropathy with secondary axonal degeneration. CSF protein concentration of 100 mg / dL and no cellularity. Starts treatment with corticosteroids and plasmapheresis, evolving with significant improvement in functionality and independent walking. DISCUSSION. The main therapeutic modalities in CIDP are intravenous immunoglobulin, corticosteroids and plasmapheresis. All these seem to be equally effective separately. The choice is influenced by patient preference, adverse effects, cost, duration and availability. The use of intravenous immunoglobulinis sometimes limited; corticosteroids are inexpensive, but with frequent and significant side effects; and plasmapheresis is expensive, invasive and only available at specialized centers. Most patients respond initially but relapses are frequent...

Presencia de marcadores de las vías de activación de los macrófagos en periodontitis crónica / Presence of markers of activation pathways of macrophages in chronic periodontitis

La periodontitis crónica es una patología infecciosa, causada por un complejo de especies bacterianas, que afecta principalmente los tejidos de inserción de los dientes. La respuesta inmune-inflamatoria producida se caracteriza por la presencia de un infiltrado inflamatorio, en el cual los macrófagos representan entre 5 al 30 por ciento. Es sabido que los macrófagos se activan mediante dos vías: Clásica y Alterna, caracterizadas por la presencia de marcadores indirectos: IFN-y e IL-6 para la vía clásica e IL-4 para la vía alterna, ampliamente abordados. Recientemente, se ha descrito a la subunidad A del factor XIII de la coagulación (FXIII-A) como un buen marcador de la vía alterna. El objetivo de este estudio consiste en determinar la presencia de IFN-y, IL-6, FXIII-A e IL-4 como marcadores de las vías de activación de los macrófagos, en pacientes con periodontitis crónica. Para tal efecto, se realizó inmunohistoquímica y Western-Blot para los cuatro marcadores junto a CD-68, marcador de macrófagos, en 18 biopsias de tejido periodontal sano y 18 con periodontitis crónica. Se detectó la presencia de IFN-y, IL-6, IL-4 y FXIII-A junto a CD68+, en todas las muestras de pacientes sanos y con periodontitis. Los resultados obtenidos sugieren que al estar presente IFN-y, IL-6, IL-4 y FXIII-A, los macrófagos se activarían a través de ambas vías, lo cual, produciría una respuesta tanto proinflamatoria (Th1) como antinflamatoria (Th2). Son necesarios más estudios para determinar si existe una vía preferencial de activación.

Periodontitis is a chronic infectious disease caused by a bacterial species complex, which affects mainly the insertion tissues of the teeth. The immune-inflammatory response produced is characterized by an inflammatory infiltrate in which macrophages represent between 5 to 30 percent. It is known and has been widely discussed that macrophages are activated in two ways: Classical and Alterna, characterized by the presence of indirect markers: IFN-y and IL-6 for the classical pathway and IL-4 for the alternative pathway. Recently the subunit A of the clotting factor XIII (FXIII-A) has been described as a good marker of the alternative pathway. The objective of this study is to determine the presence of IFN-y, IL-6, IL-4 and FXIII-A as markers of the macrophage activation pathways in patients with chronic periodontitis. To this end, we performed immunohistochemistry and Western blot for the four markers with CD68 macrophage marker, in 18 healthy periodontal tissue biopsies and 18 with chronic periodontitis. We detected the presence of IFN-y, IL-6, IL-4 and FXIII-A with CD68 +, in all samples of healthy patients and periodontitis. The results suggest that when present, IFN-y, IL-6, IL-4 and FXIII-A, activate macrophages through both routes, which would produce a proinflammatory response (Th1) as antiinflammatory (Th2). Further studies are necessary to determine whether there is a preferential pathway activation.

Viabilidad y efectos del probiótico Lactobacillus paracasei ssp paracasei en queso gauda semidescremado chileno

El objetivo del estudio es conocer la sobrevivencia del probiótico Lactobacillus paracasei ssp paracasei agregado durante el procesamiento de Gauda semidescremado, durante maduración (21días) y en comercialización (14 días), así como la influencia de este organismo sobre la calidad del producto. Los tratamientos fueron: T1 (testigo): Gauda de contenido de grasa normal; T2: Queso Gauda semidescremado, QGS; T3: QGS, con probiótico adicionado junto al agregado del cultivo iniciador; T4: QGS, con probiótico adicionado al cocimiento de la cuajada. Para el recuento del probiótico se usó la metodología descrita por la Asociación de Salud Pública Americana (APHA), proteólisis por método de tirosina soluble en ácido tricloroacético (TCA) y, los análisis físicos y químicos por métodos estandarizados en Normas de la Federación Internacional de la Leche y Normas chilenas. Los recuentos obtenidos fueron de 108 ufc/g y 107 ufc/g en los quesos con adición del probiótico (T3 y T4, respectivamente) cerca del nivel de inóculo (108 ufc/g), durante el período de estudio (35días). La proteólisis se incrementó en forma normal y fue similar en todos los tratamientos durante los 35 días estudiados. Los tratamientos con reducción de grasa presentaron, aproximadamente, un 31% menos de grasa que el tratamiento testigo, y mayor humedad. Entre los tratamientos no se evidenció diferencias en sabor y apreciación general, en cambio los quesos con reducción de grasa resultaron más firmes, menos cohesivos y similares en elasticidad que el testigo.

The objective of this study is to infer the survival of the probiotic Lactobacillus paracasei ssp paracasei added during the processing of low-fat Gouda cheese during the maturation (21 days) and the commercialization (14 days), in order to see the influence that this organism has on the quality of the product. The treatments were: TI (control): Gouda with normal fat content; T2: Low fat Gouda cheese (QGS) T3: QGS, with additional probiotic added with the initial culture; T4: QGS, with the probiotic added in the cooking of the curd. For the count of the probiotic, the methodology was used set forth by the American Public Health Association, (APHA), proteolysis by the method of soluble tyrosine in trichloroacetic acid (TCA), and the physical and chemical analysis using the methods standardized by the International Dairy Federation, and Chilean normative. The counts obtained were from 108 ufc/g y 107 ufc/g in the cheeses that had the probiotic additive (T3 and T4, respectively) close to the level of innocuous (108 ufc/g) during the study period of 35 days. The proteolysis incremented normally, and was the same in all of the treatments during the 35 days studied. The treatments with fat-reduction presented approximately, 31% less fat than the control treatment, and also higher moistness. Within the treatments, there was no evidence of taste and general feel; in turn the cheeses with the reduction of fat resulted firmer, less cohesive, than the control, and with similar elasticity.

Bacillary angiomatosis with atypical clinical presentation in an immunocompetent patient.

Bacillary angiomatosis is a recently described infectious disease that usually affects immunosupressed hosts with a previous history of contact with cats. We report a rare case of bacillary angiomatosis in an immunocompetent 59-year-old woman with no history of previous exposure to cats, and atypical clinical features (fever and subcutaneous nodules with ulceration on the left ankle). Histopathology of the lesion showed extensive ulceration and reactive tumor-like vascular proliferation of the blood vessels with swollen endothelial cells and an inflammatory infiltrate including neutrophils and lymphocytes in the dermis and subcutis. Staining with the Warthin-Starry method demonstrated the presence of clustered bacilli located in the extracellular matrix adjacent to the proliferating endothelial cells. Diagnosis was confirmed with the detection of Bartonella spp. DNA in the affected skin and in bone marrow using polymerase chain reaction.

Acceso a la atención en salud en Colombia / Access to health care in Colombia

Objetivo Contribuir al conocimiento sobre el acceso a los servicios en Colombia tras la reforma del sistema de salud, exponiendo los principales resultados y vacíos en las investigaciones. Métodos Se realizó una revisión sistemática de la bibliografía, a través de la búsqueda exhaustiva y análisis de artículos originales publicados entre 1994 y 2009. Se incluyeron 27 investigaciones cuantitativas y cualitativas que cumplían los criterios de selección. El análisis se enmarcó en los modelos teóricos de Aday y Andersen y Gold, que diferencian entre acceso potencial y realizado y consideran las características de la población, proveedores y aseguradoras que influyen en la utilización. Resultados Los análisis explicativos de la utilización de los servicios de salud a partir de modelos de determinantes resultan escasos y parciales (limitados a áreas geográficas, patologías o colectivos específicos). Pocos estudios profundizan en factores de contexto -políticas y características de proveedores y aseguradoras- o en la perspectiva de los actores sobre los factores que influyen en el acceso. Los estudios no parecen indicar un aumento del acceso realizado -salvo en el régimen subsidiado- y, en cambio, señalan la existencia de importantes barreras relacionadas con factores poblacionales (aseguramiento, renta y educación) y características de los servicios (accesibilidad geográfica, organizativas y calidad). Conclusiones La revisión muestra limitaciones importantes en el análisis del acceso en Colombia que indican la necesidad de reorientar la evaluación hacia el acceso realizado, e incorporar variables de contexto y la perspectiva de los actores para comprender mejor el impacto de la reforma en el uso de servicios.

Objectives Contributing towards improving knowledge about access to health services in Colombia following health-sector reform, highlighting the main results and gaps in research. Methods Original papers were systematically reviewed through a comprehensive search and analysis of original papers published between 1994 and 2009. After selection criteria had been applied, 27 papers were included in the review. Analysis was based on Aday Aday & Andersen and Gold's theoretical frameworks, distinguishing between potential and actual healthcare access and considering the characteristics of the population, health services and insurers influencing service use. Results There was little explanatory analysis of service use applying determinant models; this was also partial (limited to geographical areas, diseases or specific groups). Likewise, only a few studies analysed contextual factors influencing service use (health policies and health providers and insures) or social actors' perspectives. The available studies did not seem to indicate increased actual access (except for subsidised system users) but, on the contrary the existence of barriers relating to population (insurance coverage, income and education) and health service factors (geographic and organizational accessibility and quality of care). Conclusions This review led to identifying important limitations in the analysis of healthcare access in Colombia and highlighted the need for further research on actual access and the better incorporation of context variables and actors perspectives in understanding the impact of reform on health service use.

La realidad virtual como arma terapéutica en rehabilitación / Virtual reality as a therapeutic tool in rehabilitation

The virtual reality is a technology that has about 50 years of evolution, but it’s in the last two decades that instances have been generated for its development in the medical scope, especially in cognitive and motor rehabilitation. It has made great advances in this field, for example at Laboratory of Innovations in Rehabilitation Technology (LIRT), University of Haifa, Israel, at the IREX platform. This paper provides an approach to this emergent technology; identify their strengths, weaknesses, opportunities and threats, giving some simple technical considerations, in order to promote its application and investigation.

La realidad virtual es una tecnología con cerca de 50 años de evolución, pero es en estas últimas dos décadas en que se han generado instancias para su desarrollo en el ámbito médico, en particular en lo referente a la rehabilitación motora y cognitiva. Se han efectuado grandes avances en este campo, como por ejemplo, en el grupo de trabajo del Laboratory of Innovations in Rehabilitation Technology (LIRT) de la Universidad de Haifa, Israel, fundamentalmente en la plataforma IREX. El presente artículo pretende hacer una aproximación a esta tecnología emergente; identificar sus fortalezas, oportunidades, debilidades y amenazas, entregando algunas consideraciones técnicas de manera simple, con el fin de promover su aplicación e investigación.

Variabilidad de la síntesis de RANKL por linfocitos T frente a distintos serotipos capsulares de Porphyromonas gingivalis / Variability in the RANKL synthesis by T Lymphocytes in response to different Porphyromonas gingivalis capsular serotypes

Propósito: Las periodontitis representan un grupo heterogéneo de infecciones periodontales cuya etiología son las bacterias residentes en el biofilm subgingival. Aunque este biofilm está constituido por una amplia variedad de especies bacterianas, sólo un número limitado de especies, como Porphyromonas gingivalis, se ha asociado a la etiología de la enfermedad. P. gingivalis expresa diversos factores de virulencia que pueden causar daño directo a los tejidos del hospedero; sin embargo, su mayor patogenicidad involucra la inducción de una respuesta inmuno-inflamatoria, durante la cual se secretan una amplia variedad de citoquinas, quimioquinas y mediadores inflamatorios que pueden inducir la destrucción de los tejidos de soporte de los dientes y la pérdida de ellos. Método: En esta investigación, se evaluó si los distintos serotipos capsulares (K) de P. gingivalis pueden determinar los niveles de síntesis de RANKL, citoquina clave en la destrucción del hueso alveolar durante la periodontitis. Para ello, se cuantificaron los niveles de expresión de RANKL mediante PCR cuantitativa y los niveles de secreción mediante ELISA en linfocitos T activados en presencia de los serotipos capsulares K1-K6 de P. gingivalis, y estos se correlacionaron a los niveles de expresión de los factores de transcripción asociados a cada uno de los fenotipos de linfocitos efectores: Th1 (T-bet), Th2 (GATA-3), Th17 (RORC2) y Treg (Foxp3). Resultados: Mayores niveles de expresión y secreción de RANKL fueron detectados en linfocitos T activados en presencia de los serotipos K1 y K2 de P. gingivalis, en comparación a los detectados ante los otros serotipos. Además, estos mayores niveles de RANKL se correlacionaron positivamente con los niveles de expresión de RORC2. Conclusión: Estos datos demuestran que la síntesis de RANKL por linfocitos T se restringe a ciertos serotipos capsulares de P. gingivalis (K1 y K2) y permiten sugerir que los serotipos K1 y K2 de P. gingivalis podrían asociarse...

Aim: Periodontitis represents a heterogenic group of periodontal infections elicited by bacteria residing at the subgingival biofilm. Although this biofilm is constituted by a broad variety of bacterial species, only a limited number has been associated with the periodontitis aetiology, among them Porphyromonas gingivalis. P. gingivalis express a number of virulence factors that contribute to direct tissue damage; however, their pathogenicity relies mainly on the induction of a host immuno-inflammatory response. This leads to the release of a broad array of cytokines, chemokines and inflammatory mediators, which cause destruction of the tooth-supporting alveolar bone and ultimately tooth loss. Method: In the present investigation, in order to determine whether different P. gingivalis serotypes might lead to a differential RANKL synthesis, a key cytokine involved in alveolar bone resorption, the mRNA expression and secretion of RANKL and the expression of transcription factors T-bet, GATA-3, RORC2 and Foxp3, the master-switch genes controlling the Th1, Th2, Th17, and Treg cell differentiation, respectively, were analyzed on human T cells activated with different P. gingivalis capsular (K) serotypes. Results: T lymphocytes responding to P. gingivalis serotypes K1 or K2, but not to the other serotypes, led to an increased expression and secretion of RANKL. In addition, these higher RANKL levels correlate with RORC2 expression upon activation with K1 or K2 serotypes. Conclusion: These data demonstrated that RANKL expression and secretion by T lymphocytes was restricted to particular P. gingivalis serotypes (namely K1 and K2), and allowed to suggest a link between these serotypes with alveolar bone destruction and teeth loosening during the periodontitis.

Docencia de pregrado en medicina interna en un hospital privado: Diez años de experiencia / Undergraduate teaching of internal medicine in a private hospital

There is a 10 years teaching experience for fourth year medical students and interns in a Chilean private hospital. The students attend an eight weeks practical course. The interns rotate during 16 weeks by specialties and make shifts. The hospital structure with Clinical Services and Medical-Surgical departments facilitates the teaching process. There are approximately 30,000 admissions per year with a mean stay of 3.7 days, that allow the students to be in touch with patients with different diseases that are managed with updated technology. We emphasize the ethical and clinical management of concrete problems of patients, self ¡earning and communication skills. The students evaluate their stay answering surveys and with semi structured interviews. Teaching is assessed by tutors and heads of departments, in clinical rounds, sometimes prepared by the students, by a thorough revision of problem oriented medical records and with practical and theoretical tests. The results of the program have been quite satisfactory for participants.

Analysis of human mammary fibroadenoma by Ki-67 index in the follicular and luteal phases of menstrual cycle.

OBJECTIVES: Fibroadenoma is the most common benign mammary condition among women aged 35 or younger. Expression of Ki-67 antigen has been used to compare proliferative activity of mammary fibroadenoma epithelium in the follicular and luteal phases of the menstrual cycle. MATERIALS AND METHODS: Ninety eumenorrheic women were selected for tumour excision; they were assigned to either of the two groups, according to their phase of menstrual cycle. At the end of the study, 75 patients with 87 masses were evaluated by epithelial cell Ki-67 expression, blind (no information given concerning group to which any lesion belonged). RESULTS: Both groups were found to be homogeneous relative to age, menarche, body mass index, previous gestation, parity, breastfeeding, number of fibroadenomas, family history of breast cancer and tabagism. Median tumour size was 2.0 cm and no relationship between proliferative activity and nodule diameter was observed. No typical pattern was observed in the expression of Ki-67 in distinct nodules of the same patient. Average values for expression of Ki-67 (per 1000 epithelial cells) in follicular and luteal phases were 27.88 and 37.88, respectively (P = 0.116). CONCLUSION: Our findings revealed that proliferative activities in the mammary fibroadenoma epithelium did not present a statistically significant difference in the follicular and luteal phases. The present study contributes to clarifying that fibroadenoma is a neoplasm and does not undergo any change in the proliferative activity during the menstrual cycle.