Prevalencia y tratamiento del asma en adultos: análisis descriptivo de la encuesta nacional de salud de Chile 2016-2017 / Prevalence and treatment of asthma in adults: descriptive analysis of the Chilean National Health Survey 2016-2017

Objetivo: Describir la prevalencia de diagnóstico autorreportado de asma, comorbilidades, patrones de tratamiento y calidad de vida (CdV) autopercibida en la población chilena, utilizando datos de la Encuesta Nacional de Salud (ENS) de 2016-2017. Métodos: Se analizó la población de la ENS 2016-2017 con ≥ 15 años. Los individuos con asma fueron identificados por autorreporte. Se evaluaron variables sociodemográficas, CdV y salud (autopercepción y/o EQ-5D-3L), estado nutricional, comorbilidades y patrón de tratamiento. Resultados: La prevalencia de asma fue de 5,4% (IC 95%: 4,5-6,5). Se reportó una frecuencia casi 2 veces mayor de CdV autopercibida (6,3% [IC 95%: 3,4-11,3] frente a 3,6% [IC 95%: 2,8-4,5]) y de salud (16,4% [IC 95%: 11,4-23,1] frente a 7,7% [IC 95%: 6,6-8,9]) muy mala/mala/menos que regular en el grupo con asma en comparación con el total de individuos de la ENS. El grupo de asma tuvo mayor frecuencia de al menos algunos problemas en todos los dominios EQ-5D-3L. La comorbilidad más frecuente fue la sintomatología depresiva. El 63% de los encuestados que reconocían tener asma no recibían ningún tratamiento en el momento de la encuesta. Con mayor frecuencia el tratamiento para el asma fue prescrito por un médico general (62,4%/55,4%, medicación de rescate/controlador) y el acceso fue a través del sistema público (65,9%/82,5%, medicación de rescate/controlador). Alrededor de un tercio de la población utilizaba monoterapia con SABA (32,8%). Conclusión: La prevalencia de asma fue del 5,4% y los asmáticos relataron peor CdV y salud. Se observó una baja tasa de tratamiento y de los tratados la mayoría usaba solo medicación de rescate.

Objective: To describe diagnosed asthma prevalence, self-reported comorbidities, treatment patterns and self-perceived quality of life (QoL) in Chilean population, using National Health Survey (NHS) data from 2016-2017. Methods: 2016-2017 NHS population aged ≥ 15 years was analyzed. Asthma individuals were identified by self-report. Sociodemographic variables, QoL and health (self-perception and/or EQ-5D-3L), nutritional status, comorbidities and treatment pattern were evaluated. Results: Asthma prevalence was 5.4% (95% CI: 4.5-6.5). Compared with NHS total individuals, asthma group showed almost 2 times higher frequency of self-perceived QoL (6.3% [95% CI: 3.4-11.3] vs 3.6% [95% CI: 2.8-4.5]) and health (16.4% [95% CI: 11.4-23.1] vs 7.7% [95% CI: 6.6-8.9]) named as very bad/bad/less than regular. In addition, asthma group had a greater frequency of at least some problems in all EQ-5D-3L domains. Depressive symptoms were the most frequently observed comorbidity. 63% of respondents who acknowledged having asthma were not receiving any treatment at the time of the survey. Asthma treatment was most frequently prescribed by a general physician (62.4%/55.4%, rescue/controller medication) and the access occurs in the public system (65.9%/82.5%, rescue/controller medication). About one third of the population used SABA monotherapy (32.8%). Conclusion: Asthma prevalence was 5.4% and asthmatics reported worse QoL and health. A very low treatment rate was observed and those treated, most were under rescue medication.

Síntesis en fase sólida de un neuropéptido cosmecéutico y su microencapsulación en un sistema liposomal / Solid phase synthesis of a cosmeceutical neuropeptide and its microencapsulation in a liposomal system / Síntese de fase sólida de um neuropeptídeo cosmecêutico e sua microencapsulação em um sistema lipossomal

RESUMEN Introducción: Actualmente los péptidos sintéticos se han constituido en una novedosa alternativa para el tratamiento de la piel envejecida. Acetilhexapéptido-3 (Ac-EEMQRR-NH2) ha sido utilizado para inducir reducción de líneas de expresión de manera análoga a la toxina botulínica, pero sin efectos tóxicos. Objetivo: Sintetizar el acetilhexapéptido-3 y desarrollar un sistema liposomal para su encapsulación y favorecer su paso a través de una membrana modelo. Metodología: El péptido fue obtenido mediante síntesis en fase sólida (SFS) empleando la estrategia Fmoc/tBu, fue purificado y plenamente caracterizado. El sistema liposomal con acetilhexapéptido-3 encapsulado fue desarrollado mediante la formación de una emulsión con posterior inversión de fase por evaporación del solvente orgánico. Los sistemas fueron caracterizados en su tamaño, potencial zeta, eficiencia de encapsulación del neuropéptido y de manera preliminar se realizó un estudio de permeabilidad ex vivo. Resultados: Es posible sintetizar péptidos cortos con alto grado de pureza y buen rendimiento, utilizando la metodología de SFS Fmoc/tBu. De acuerdo con la caracterización, el sistema liposomal adelantado sugiere una buena estrategia para la encapsulación del acetilhexapéptido-3 y su potencial aplicación en el desarrollo un novedoso producto cosmecéutico.

SUMMARY Introduction: Currently synthetic peptides have become a novel alternative for the treatment of aging skin. Acetylhexapeptide-3 (Ac-EEMQRR-NH2) has been used to induce reduction of expression lines in a manner analogous to botulinum toxin, but without toxic effects. Aim: To synthesize acetylhexapeptide-3 and to develop a lipo-somal system for its encapsulation and favor its passage through a model membrane. Methodology: The peptide was obtained by solid phase synthesis (SFS) using the Fmoc / tBu strategy, it was purified and fully characterized. The liposomal system with encapsulated acetylhexapeptide-3 was developed by forming an emulsion with subsequent phase inversion by evaporation of the organic solvent. The systems were characterized in their size, zeta potential, neuropeptide encapsulation efficiency and a preliminary ex vivo permeability study was carried out. Results: It is possible to synthesize short peptides with a high degree of purity and good yield, using the SFS Fmoc / tBu methodology. According to the characterization, the advanced liposomal system suggests a good strategy for the encapsulation of acetylhexapeptide-3 and its potential application in the development of a novel cosmeceutical product.

RESUMO Introdução: Atualmente os peptídeos sintéticos têm se tornado uma nova alternativa para o tratamento do envelhecimento cutâneo. O acetilhexapeptídeo-3 (Ac-EEMQR-R-NH2) tem sido usado para induzir a redução das linhas de expressão de maneira análoga à toxina botulínica, mas sem efeitos tóxicos. Objetivo: Sintetizar acetilhe-xapeptídeo-3 e desenvolver um sistema lipossomal para seu encapsulamento e favorecer sua passagem por uma membrana modelo. Metodologia: O peptídeo foi obtido por síntese em fase sólida (SFS) utilizando a estratégia Fmoc / tBu, foi purificado e totalmente caracterizado. O sistema lipossomal com acetilhexapeptídeo-3 encapsulado foi desenvolvido pela formação de uma emulsão com subsequente inversão de fase por evaporação do solvente orgânico. Os sistemas foram caracterizados quanto ao tamanho, potencial zeta, eficiência de encapsulação de neuropeptídeos e um estudo preliminar de permeabilidade ex vivo foi realizado. Resultados: É possível sintetizar peptídeos curtos com alto grau de pureza e bom rendimento, utilizando a metodologia SFS Fmoc / tBu. De acordo com a caracterização, o sistema lipossomal avançado sugere uma boa estratégia para a encapsulação do acetilhexapeptídeo-3 e seu potencial aplicação no desenvolvimento de um novo produto cosmecêutico.

Homologación lingüística al idioma español, en población chilena, de la herramienta Sunnybrook Facial Grading System para evaluar parálisis facial. Estudio piloto

Resumen Introducción: La parálisis facial es una patología muy común. La escala "Sunnybrook Facial Grading System" (SFGS) se ha posicionado como una herramienta útil y confiable para su evaluación y evolución. Objetivo: Homologar lingüísticamente desde el idioma inglés al español la escala SFGS en una muestra de población chilena. Material y Método: Tres kinesiólogos chilenos con dominio comprobado del idioma inglés tradujeron la escala SFGS al español. Un comité creó una primera versión de la SFGS en español. Posteriormente, un profesional del Instituto Chileno-Británico tradujo la primera versión nuevamente al inglés (retrotraducción). El comité definió la segunda versión de la SFGS. Finalmente, los investigadores llevaron a cabo los pilotajes. Resultados: En dos pruebas piloto, veinte sujetos respondieron correctamente el total de las expresiones solicitadas. Conclusión: Esta versión de la escala SFGS homologada lingüísticamente al español puede ser aplicada a la población chilena.

Abstract Introduction: Facial paralysis is a very common pathology. The Sunnybrook Facial Grading System (SFGS) scale has positioned itself as a useful and reliable tool for its evaluation and follow up. Aim: To linguistically homologate the SFGS scale in a sample of the Chilean population from English to Spanish. Material and Method: Three Chilean kinesiologists with English proficiency translated the SFGS scale into Spanish. A committee developed a first version of the SFGS in Spanish. Subsequently, a professional from the Chilean-British Institute translated the first version back into English (back-translation). The committee defined the second version of the SFGS. Finally, the investigators carried out the pilots. Results: In two pilot tests, twenty subjects correctly answered the total of the expressions requested. Conclusion: This version of the SFGS scale linguistically homologated to Spanish can be applied to the Chilean population.

Hipertensión intracraneal idiopática asociada a nitrofurantoína. Caso clínico / Idiopathic intracranial hypertension associated with nitrofurantoin. Case report

Resumen Introducción: La Hipertensión Intracraneal Idiopática (HICI) es un síndrome neurológico caracterizado por un aumento de la presión intracraneal en ausencia de lesión estructural o hidrocefalia. Los síntomas incluyen cefalea, tinnitus pulsátil, oscurecimientos visuales transitorios y pérdida visual. Dentro de los signos destacan diplopía por parálisis del VI par, edema de papila y disminución de la agudeza visual. Los pacientes no tienen compromiso de conciencia ni signos neurológicos focales. La principal complicación es la pérdida visual que puede ser irreversible. La asociación entre HICI y nitrofurantoína (NTF) se reportó en 1974. Caso clínico: Mujer de 42 años, con sobrepeso, que desarrolló una HICI aproximadamente 18 meses posterior al inicio de nitrofurantoína profiláctica. Consultó por cefalea frontal, opresiva que aumentaba con la maniobra de Valsalva, asociada a disminución fluctuante de la agudeza visual y episodios de oscurecimiento. Al examen destacó edema de papila bilateral, sin déficit neurológico focal. La presión del líquido cefalorraquídeo (LCR) fue de 25,5 cm de agua. La resonancia magnética mostró signos de aumento de la presión del LCR, sin lesiones estructurales ni hidrocefalia. El cuadro se recuperó concomitantemente a la suspensión de la NTF y el uso de topiramato. No se constató daño visual permanente. Conclusiones: Se debe sospechar la HICI en mujeres en edad fértil con sobrepeso. Dentro de los gatillantes del síndrome destacan varios fármacos, entre ellos la NTF. El principal objetivo del tratamiento de la HICI es preservar la función visual.

Abstract Introduction: Idiopathic intracranial hypertension (IIH) is a syndrome characterized by increased intracranial pressure without a space occupying lesion or hydrocephalus. The symptoms are headache, pulsatile tinnitus, transient visual obscurations, and visual loss. Signs are diplopia caused by sixth cranial nerve paresis and papilledema with its associated loss of sensory visual function. The patient maintains an alert and oriented mental state, but has no localizing neurologic findings. The only major morbidity with IIH is visual loss. The association between IIH and nitrofurantoin was reported in 1974. Case: A 42 years old female, overweighed, who developed IIH 18 months after the start of prophylactic nitrofurantoin. She had frontal oppressive headache that increased with the Valsalva maneuver, fluctuant visual loss and transient visual obscurations. She had bilateral papilledema without localizing neurologic findings. The cerebrospinal fluid (CSF) pressure was 25.5 cm H2O. Magnetic resonance imaging showed signs of increased CSF pressure without structural lesions or hydrocephalus. IIH recovered with the withdrawal of nitrofurantoin and the use of topiramate. There was not permanent visual loss. Conclusions: It is recommendable to suspect IIH in obese women in the childbearing years. There are several drugs associated with IIH including nitrofurantoin. The main objective of treatment is to prevent visual loss.

Diarrea crónica como manifestación de un tumor neuroendocrino / Chronic diarrhea as a manifestation of a neuroendocrine tumor

Resumen Las neoplasias neuroendocrinas (Neuroendocrine Neoplasms, NEN) constituyen un grupo heterogéneo de neoplasias poco frecuentes, que se originan en las células endocrinas, con la capacidad de secretar aminas y polipéptidos hormonales. Las NEN de localización pancreática (pNEN) pueden ser funcionales o no funcionales. Las pNEN funcionales secretan hormonas como la gastrina, la insulina y el glucagón y otras menos frecuentes como el péptido intestinal vasoactivo (PIV), por lo que sus características sindromáticas dependen del péptido secretado. Los vipomas se manifiestan con diarrea crónica de características secretoras, que usualmente conducen a trastornos hidroelectrolíticos e incluso a complicaciones serias asociadas como la falla renal. A continuación, se describe el caso de un hombre de 37 años con diarrea crónica de 6 meses de evolución y frecuentes hospitalizaciones por trastornos hidroelectrolíticos, generados por hipocalemia severa y lesión renal aguda por deshidratación. Después de múltiples estudios, se considera el diagnóstico de una diarrea secretora por NEN funcional, secretora de PIV. Por tanto, se inicia una terapia empírica con octreotida y se logra controlar la diarrea, así como corregir el trastorno hidroelectrolítico. Además, se amplían los estudios, para documentar las pNEN tratadas mediante intervención quirúrgica, con respuesta clínica favorable y remisión completa de la sintomatología.

Abstract Neuroendocrine tumors (NETs) are a heterogeneous group of rare neoplasms that originate in endocrine cells with the ability to secrete amines and hormonal polypeptides. Pancreatic neuroendocrine tumors (PNETs) can be functional or non-functional. Functional PNETs secrete common hormones such as gastrin, insulin and glucagon and much less frequent hormones such as vasoactive intestinal peptide (VIP). Their characteristics depend on the peptide secreted. Vipomas are characterized by chronic diarrhea of ​​secretory characteristics that usually lead to hydroelectrolytic disorders and can lead to serious complications associated with renal failure. This article describes the case of a 37-year-old man who had suffered chronic diarrhea with frequent hospitalization for hydroelectrolytic disorders for six months due to severe hypokalemia and acute renal damage due to dehydration. After multiple studies, a diagnosis of secretory diarrhea due to a VIP secretory functional NET was considered. Empirical therapy with Octreotide was begun to control diarrhea and correct the hydroelectrolytic disorder. More studies of PNETS are being published. They have been treated surgically intervention with favorable clinical results and complete remission of symptoms.

Vivencias y expectativas de los actores sociales partícipes en evaluación del desarrollo psicomotor, en relación a las escalas EEDP y TEPSI utilizadas en la Araucanía, Chile, durante los años 2017-2018 / Vivências e expectativas dos acionistas sociais partícipes na avaliação do desenvolvimento do psicomotor, em relação às escalas EEDP e TEPSI usadas no Araucania, Chile, durante o ano 2017-2018 / Experiences and expectations of the social actors participating in the evaluation of psychomotor development, in relation to the EEDP and TEPSI scales used in la Araucania, Chile, in 2017-2018

Resumen: En Chile, la Escala de Evaluación del Desarrollo Psicomotor (EEDP) y Test de Desarrollo Psicomotor (TEPSI) son herramientas no actualizadas, que carecen de confiabilidad y validación internacional conocida; por ello se hace necesario analizar el proceso evaluativo desde los actores de salud y educación, Enfermeras y Educadoras de párvulos respectivamente. El objetivo fue develar las vivencias de estos actores sociales, partícipes en el proceso evaluativo del desarrollo psicomotor en menores de tres años, según determinantes sociales. Se trata de un estudio cualitativo exploratorio, basado en la fenomenología de Alfred Schütz, realizado en siete informantes claves, cinco enfermeras y dos educadoras de párvulos, por medio de la entrevista semiestructurada. El análisis se circunscribió a transcripción, codificación, agrupamiento en categorías y síntesis. Se develan las metacategorías: A: Dilemas e incertidumbres por nudos críticos y categorías intermedias: a) Brecha entre políticas públicas y realidad local, no favorece el desarrollo de los niños, b) Instrumentos desactualizados y descontextualizados, c) Mitos y expectativas de los padres frente a la evaluación, d) Instrumentos sin pertinencia social; y B: Expectativas y categorías intermedias: a) Actualización del marco político para un avance continuo y efectivo, b) Incorporación y empoderamiento de los padres en el proceso, c) Capacitación y perfeccionamiento de profesionales. Se concluye que es necesario la actualización de las estrategias evaluativas y disponer de instrumentos validados, actualizados, con pertinencia social y que consideren a los padres

Resumo: No Chile, as Escala de Avaliação do Desenvolvimento Psicomotor (EEDP) e Teste de Desenvolvimento Psicomotor (TEPSI) não são ferramentas atualizadas, que carecem de confiabilidade e validação internacionalmente conhecidas, por essa razão, é necessário analisar o processo de avaliação dos atores de saúde e educação, enfermeiros e educadoras de creches, respectivamente. Lo objetivo foi revelar as experiências dos atores sociais participantes, enfermeiros e educadoras de creches, no processo de avaliação do desenvolvimento psicomotor em crianças menores de 3 anos, segundo os determinantes sociais. Foi realizado um estudo qualitativo exploratório baseado na fenomenologia de Alfred Schütz, realizado em 7 informantes-chave, 5 enfermeiros e 2 educadoras de creches, por meio de entrevista semiestruturado. A análise foi limitada à transcrição; codificação; agrupamento em categorias e síntese. Dilemas e incertezas de nós críticos e categorias intermediárias: a) lacuna entre política pública e da realidade local, não favorece o desenvolvimento das crianças, b) instrumentos desatualizados e, c) Mitos descontextualizadas e expectativas dos metacategorias são revelados os pais na frente da avaliação, d) Instrumentos sem relevância social; e B: Expectativas e categorias intermediárias: a) Atualização do arcabouço político para o progresso contínuo e efetivo, b) Incorporação e empoderamento dos pais no processo, c) Treinamento e aperfeiçoamento dos profissionais. É necessário atualizar as estratégias de avaliação e validar instrumentos atualizados e de relevância social que considerem os pais

Abstract: In Chile, the Psychomotor Development Evaluation Scale (EEDP in Spanish) and the Psychomotor Development Test (TEPSI in Spanish) are outdated tools that lack international reliability and validation. It is necessary to analyze the evaluation process from the point of view of the health and education professionals, that is, nurses and early childhood educators. The purpose was to reveal the experiences of these actors in the evaluation process of psychomotor development in children under three years of age, according to social determinants. This is a qualitative exploratory study based on the Alfred Schütz phenomenology, carried out in seven key informants, five nurses and two educators, through semi-structured interviews. The analysis was limited to transcription, coding, grouping into categories and synthesis. The meta categories revealed are: A: Dilemmas and uncertainties by critical nodes and intermediate categories: a) The gap between public policies and local reality does not favor the development of children, b) Outdated and decontextualized instruments, c) Myths and expectations of the parents regarding the evaluation, d) Instruments without social relevance; and B: Expectations and intermediate categories: a) Political framework update for continuous and effective progress, b) Parents incorporation and empowerment in the process, c) Professionals training and improvement. It was concluded that it is necessary to update the evaluation strategies and have validated, updated and socially relevant instruments that include the parents

[Use of complementary tests in emergencies and their relation with patient safety incidents]. / Uso de pruebas complementarias en urgencias y su relación con incidentes de seguridad.

OBJECTIVE: To analyse the use of complementary tests and their relationship with safety incidents in hospital emergency departments. METHODOLOGY: An analysis was performed on 935 patients seen in the 9 hospital emergency departments. The source of data used for the detection of incidents were: emergency department clinical record and reports, together with face-to-face observation in the department, plus a telephone survey of the patient or family member at one week after the care. Statistical tests used: The Student t test for quantitative variables, Chi squared test for qualitative variables, and the ANOVA test. RESULTS: A peripheral venous catheter was used in 397 patients (42.4% (95% CI; 39.3-45.5%)), with a variability with significant differences between hospitals (P<.01), with a range of use from 37% to 81.8%. It was also observed that in 23.4% (95% CI; 19.2-27.6%) of the cases, the catheter was not used after the first blood draw. Radiological tests were requested for 351 patients, 37.7% (95% CI; 34.6-40.8%), also with significant differences between hospitals (P<.01), ranging from 24.6 to 65, 1%. Incidents were detected in 95 (10.2%) patients (95% CI; 8.3-12.1%) in the all the study centres. A higher proportion of safety incidents have been observed in patients where peripheral venous catheter has been used (12.8%) than in those in whom they had not been used (8.5%) (P=.03), as well as in patients on whom an x-ray was requested (12.8%) compared to those who did not (8.64%) (P=.04). A longer stay was also observed in cases with an incident (mean 248.9minutes) than in those where there were none (mean 164.1minutes) (P<.001). No statistically significant differences were found in the other parameters studied. CONCLUSION: A relationship was observed between the use of a peripheral venous catheter (many of them without use) and radiological tests and the occurrence of safety incidents in the Emergency Departments.

Quality Index Method developed for gutted and ungutted red tilapia (Oreochromis ssp) / Esquema del método índice de calidad desarrollado para tilapia roja (Oreochromis ssp) eviscerada y sin eviscerar

Objective. To develop a Quality Index Method (QIM) for gutted and ungutted red tilapia from aquaculture ponds. Materials and methods. 40 specimens of gutted red tilapia and 40 ungutted ones were located in foam polyethylene boxes within layers of ice and storage at 4°C. Three fish were randomly sampled on days 0, 3, 5, 8, 11, 14 and 17 for gutted tilapia, and on days 0, 3, 6, 9, 11, 14 and 16 for ungutted tilapia. A sensorial panel of 8 experts was formed to evaluate the product. With three samples each day with average points of the sensorial attributes proposed in the method, the quality index for gutted and ungutted red tilapia was obtained based on the storage time on ice. Results. The Quality Index Method obtained for gutted and ungutted red tilapia showed maximum values of 21 and 29, respectively. It was adjusted in an increasing lineal model with high correlation between the Quality Index and the storage time on ice. Conclusions. The developed model is useful to determine deterioration levels and to define storage and consumption time. For gutted red tilapia the panel rejected the fish after 8 - 11 days of storage whereas the ungutted red tilapia was rejected after 6 - 9 days.

Objetivo. Desarrollar los esquemas del Método de Índice de Calidad (MIC) para la tilapia roja de piscifactoría eviscerada y sin eviscerar. Materiales y métodos. 40 especímenes de tilapia roja eviscerados y 40 sin eviscerar, fueron ubicados en cajas de polietileno expandido entre capas de hielo y almacenadas a 4°C; se realizaron muestreos los días 0, 3, 5, 8, 11, 14 y 17 para tilapia eviscerada, mientras en la tilapia sin eviscerar los días 0, 3, 6, 9, 11, 14 y 16; se conformó un panel de 8 expertos para la evaluación sensorial de tres ejemplares en cada día de muestreo; con los puntajes promedio de los atributos sensoriales propuestos en el esquema, se obtuvo el índice de calidad para la tilapia roja eviscerada y sin eviscerar en función del tiempo de almacenamiento en hielo. Resultados. Los esquemas del Método índice de Calidad desarrollados para tilapia roja entera eviscerada y sin eviscerar, obtuvieron valores máximos de Índice de Calidad de 21 y 29 puntos respectivamente, ajustados a un modelo lineal creciente con alta correlación entre el Índice de Calidad y el tiempo de almacenamiento en hielo. Conclusiones. Los esquemas del MIC desarrollados son útiles para determinar el nivel de deterioro y definir los tiempos de almacenamiento y consumo. En la tilapia roja eviscerada los panelistas rechazaron el pescado para consumo entre los días 8 y 11 de almacenamiento, mientras que para la tilapia sin eviscerar el producto fue rechazado entre los días 6 y 9 de almacenamiento.

Trypanosoma cruzi induces trophoblast differentiation: a potential local antiparasitic mechanism of the human placenta?

INTRODUCTION: The congenital transmission of Trypanosoma cruzi (T. cruzi) is responsible for one-third of new Chagas disease cases each year. During congenital transmission, the parasite breaks down the placental barrier formed by the trophoblast, basal laminae and villous stroma. The observation that only 5% of infected mothers transmit the parasite to the fetus implies that the placenta may impair parasite transmission. The trophoblast undergoes continuous epithelial turnover, which is considered part of innate immunity. Therefore, we propose that T. cruzi induces differentiation in the trophoblast as part of a local antiparasitic mechanism of the placenta. METHODS: We analyzed ß-human chorionic gonadotropin (ß-hCG) and syncytin protein expression in HPCVE and BeWo cells using immunofluorescence and western blotting. Additionally, ß-hCG secretion into the culture medium was measured by ELISA. We assessed the differentiation of trophoblastic cells in BeWo cells using the two-color fusion assay and by determining desmoplakin re-distribution. RESULTS: T. cruzi trypomastigotes induce ß-hCG secretion and protein expression as well as syncytin protein expression in HPCVE and BeWo cells. Additionally, the parasite induces the trophoblast fusion of BeWo cells. DISCUSSION: T. cruzi induces differentiation of the trophoblast, which may contribute to increase the trophoblast turnover. The turnover could be a component of local antiparasitic mechanisms in the human placenta.

Ortner's syndrome: a case report and review of the literature.

We present a case of a 67-year-old man who was an active smoker, with a clinical history of ischaemic cardiopathy, hypertension, who presented to the emergency room with hoarseness of voice of 2 weeks duration. No other neurological or cardiorespiratory symptoms were found. Physical examination revealed an aortic regurgitation murmur with radial pulse difference between the upper limbs and femoral pulse difference on lower limbs. Laryngoscopy examination revealed a left vocal cord paralysis in the paramedian position, without signs of malignancy. Thoracoabdominal CT angiography was performed to rule out an aortic dissection. CT revealed a dissection in the descending thoracic aortic arch and abdominal aorta. Cardiovascular surgery was consulted and decided to place endoprosthesis at the thoracic and abdominal aortic area. Hoarseness eventually resolved during the following weeks. Ortner's syndrome is described as hoarseness of voice caused by compression of the left recurrent laryngeal nerve of cardiovascular origin.

[Bisphosphonate-related osteonecrosis of the jaw]. / Osteonecrosis de los maxilares relacionada con el tratamiento con bifosfonatos.

The bisphosphonates are stable inorganic pyrophosphate analogs that have demonstrated their efficacy in treatment of osteolytic lesions associated with bony metastases, and multiple myeloma, malignant hypercalcemia, Paget's disease, and osteoporosis. Several publications within the last few years have suggested that osteonecrosis of the jaw is associated with bisphosphonate therapy. The diagnosis and management strategies of the patients with bisphosphonate-related osteonecrosis of the jaw is very difficult. It is important for patients to be informed of the risk of this complication, so that they have the opportunity to assess the need for dental treatment before starting therapy. Preventive measures must be taken before, during, and after treatment with bisphosphonates. If osteonecrosis of the jaw is present, management should be conservative: oral chlorhexidine and antibiotics. Surgical treatment should be reserved for those patients who are symptomatic.

A headache presenting in the emergency room, a clinical manifestation of an unfortunate diagnosis (grade III left frontal anaplastic ependymoma with 1p deletion).

An 18-year-old girl presented with a headache and behavioural changes. She was found to have a frontal mass. Neuroimaging revealed an intra-axial mass, located at the left frontal cortical/subcortical region approximately 6×7, 5×7, 5 cm (TxApxL), having a heterogeneous density with cysts and calcification. She had total gross excision of the neoplasm. Histopathological examination revealed an anaplastic ependymoma. Fluorescence in situ hybridisation, a molecular cytogenetic test, reported deletion of 1p without deletion of 19q. The patient had a good postoperative improvement.

Primary pulmonary botryomycosis: a bacterial lung infection mimicking lung cancer.

Primary pulmonary botryomycosis, or bacterial pseudomycosis, is an unusual bacterial infection characterised by the formation of eosinophilic granules that resemble those of Actinomyces species infection. The diagnosis of botryomycosis is based on culture of the granules revealing gram-positive cocci or gram-negative bacilli. The bacterial pathogen most frequently found is Staphylococcus aureus. The pathobiology remains unknown. Pulmonary botryomycosis can resemble actinomycosis, tuberculosis or invasive carcinoma. Definitive treatment requires a combination of both surgical debridement and long-term antimicrobial therapy. We present a case of primary pulmonary botryomycosis in an immunocompetent patient.

Haemobilia due to iatrogenic portobiliary fistula after cholecystectomy.

Haemobilia, defined as bleeding into the biliary tree is a rare condition. We describe a case report of a patient who presented it as a complication of iatrogenic portobiliary fistula, followed after an open cholecystectomy. The patient presented to the emergency department with late onset symptoms of haematemesis and melena a month after surgery. Findings were confirmed by Doppler ultrasound that showed the appearance of intragallbladder mass with high echogenicity representing a blood clot. Also, next to the portal vein and the biliary duct a lesion with mixed blood flow was detected confirming a portobiliary fistula. This case was successfully managed by angiography and selective embolisation.

Necrotising pneumonia caused by Lactococcus lactis cremoris.

Lactococcus lactis cremoris is a facultative anaerobic, gram-positive coccus whose natural host is bovine livestock. It may form part of the normal human bacterial flora found in the oropharynx, the gastrointestinal tract and the vagina. This bacterium is essential in the food industry, where it is used in milk fermentation to obtain cheese, yoghurt, etc. Exposure to unpasteurised dairy products has thus been recognised as a risk factor for infection by this organism. It is generally considered to be non-pathogenic, although it appears that pathogenicity may be emerging. We present an atypical case of necrotising pneumonia caused by L. lactis cremoris.

[Etiology and biomarkers of systemic inflammation in mild to moderate COPD exacerbations]. / Etiología y biomarcadores de inflamación sistémica en las exacerbaciones leves a moderadas de la enfermedad pulmonar obstructiva crónica.

BACKGROUND: The etiology of acute exacerbations of chronic obstructive pulmonary disease (COPD) is heterogeneous and still under discussion. Inflammation increases during exacerbation of COPD. The identification of inflammatory changes will increase our knowledge and potentially guide therapy. AIM: To identify which inflammatory parameters increase during COPD exacerbations compared to stable disease, and to compare bacterial and viral exacerbations. MATERIAL AND METHODS: In 85 COPD patients (45 males, mean age 68 ± 8 years, FEV1 46 ± 17% of predicted) sputum, nasopharyngeal swabs and blood samples were collected to identify the causative organism, during a mild to moderate exacerbation. Serum ultrasensitive C reactive protein (CRP), fibrinogen and interleukin 6 (IL 6), neutrophil and leukocyte counts were measured in stable conditions, during a COPD exacerbation, 15 and 30 days post exacerbation. RESULTS: A total of 120 mild to moderate COPD exacerbations were included. In 74 (61.7%), a microbial etiology could be identified, most commonly Mycoplasma pneumoniae (15.8%), Rhinovirus (15%), Haemophilus influenzae (14.2%), Chlamydia pneumoniae (11.7%), Streptococcus pneumoniae (5.8%) and Gram negative bacilli (5.8%). Serum CRP, fibrinogen and IL 6, and neutrophil and leukocyte counts significantly increased during exacerbation and recovered at 30 days post exacerbation. Compared to viral exacerbations, bacterial aggravations were associated with a systemic inflammation of higher magnitude. CONCLUSIONS: Biomarkers of systemic inflammation increase during mild to moderate COPD exacerbations. The increase in systemic inflammation seems to be limited to exacerbations caused by bacterial infections.

Etiología y biomarcadores de inflamación sistémica en las exacerbaciones leves a moderadas de la enfermedad pulmonar obstructiva crónica / Etiology and biomarkers of systemic inflammation in mild to moderate COPD exacerbations

Background: The etiology of acute exacerbations of chronic obstructive pulmonary disease (COPD) is heterogeneous and still under discussion. Inflammation increases during exacerbation of COPD. The identification of inflammatory changes will increase our knowledge and potentially guide therapy. Aim: To identify which inflammatory parameters increase during COPD exacerbations compared to stable disease, and to compare bacterial and viral exacerbations. Material and Methods: In 85 COPD patients (45 males, mean age 68 ± 8 years, FEV1 46 ± 17% of predicted) sputum, nasopharyngeal swabs and blood samples were collected to identify the causative organism, during a mild to moderate exacerbation. Serum ultrasensitive C reactive protein (CRP), fibrinogen and interleukin 6 (IL 6), neutrophil and leukocyte counts were measured in stable conditions, during a COPD exacerbation, 15 and 30 days post exacerbation. Results: A total of 120 mild to moderate COPD exacerbations were included. In 74 (61.7%), a microbial etiology could be identified, most commonly Mycoplasma pneumoniae (15.8%), Rhinovirus (15%), Haemophilus influenzae (14.2%), Chlamydia pneumoniae (11.7%), Streptococcus pneumoniae (5.8%) and Gram negative bacilli (5.8%). Serum CRP, fibrinogen and IL 6, and neutrophil and leukocyte counts significantly increased during exacerbation and recovered at 30 days post exacerbation. Compared to viral exacerbations, bacterial aggravations were associated with a systemic inflammation of higher magnitude. Conclusions: Biomarkers of systemic inflammation increase during mild to moderate COPD exacerbations. The increase in systemic inflammation seems to be limited to exacerbations caused by bacterial infections.

[Validation of a Spanish questionnaire to evaluate habits, attitudes, and understanding of exposure to sunlight: "the beach questionnaire"]. / Validación de un cuestionario en español sobre comportamientos, actitudes y conocimientos relacionados con la exposición solar: <>

BACKGROUND: Questionnaires are the usual method for investigating sun-related behavior. However,such tools must be validated through evaluation of their measurement properties.The aim of the present study was to assess the validity and reliability of a Spanish questionnaire evaluating habits, attitudes, and understanding of exposure to sunlight. PATIENTS AND METHODS: In a cross-sectional study, the questionnaire was administered to a sample of 422 participants found on beaches. For the test-retest analysis, 70 hospital-based health professionals were interviewed on 2 separate occasions.The construct validity, internal consistency, and reproducibility were analyzed. RESULTS: Factorial analysis of the principal components confirmed the construct validity with commonalities and factor saturations > 0.50, and revealed multiple dimensions with Cronbach a values > 0.70.The items on habits and understanding showed intraclass correlation and d coefficient values > 0.70, but those on attitude had lower stability values (0.50-0.80). CONCLUSIONS: This is the first Spanish questionnaire with demonstrated validity and reliability for evaluating habits, attitudes, and understanding of exposure to sunlight. It will be a useful instrument for future epidemiologic studies and research into the prevention of skin cancer in Spain.

La enfermería en salud pública: el caso de la Influenza / The public health nursing: the case of influenza

Ante un brote de una enfermedad infecto-contagiosa, el estudio de contactos limita la transmisión de esta. El objetivo de este trabajo fue identificar a los contactos de los posibles casos de influenza en trabajadores de la UNAM para establecer una comunicación y proporcionar educación para la salud sobre medidas higiénicas. Material y métodos: Se elaboró un cuestionario, se estableció contacto con los casos por vía telefónica y se llevó a cabo una visita domiciliaria. Se llevó a cabo un análisis descriptivo de los datos y una descripción de las experiencias y percepciones durante las visitas. Resultados: Se identificó que la mayoría de los contactos eran familiares directos de los casos, que no contaban con un esquema de vacunación completo, ni contra la influenza y la frecuencia de síntomas varió de 1 hasta 4. Comentarios finales: Ante una situación de este tipo (la Pandemia del Virus de la Influenza Humana A (H1N1)) el papel de la enfermera en salud pública es de suma importancia no solo en la búsqueda de los casos y sus contactos, sino también en la orientación y educación de la población en relación a las medidas preventivas.

In the view of an infectious and contagious disease epidemic, the identification of the contacts limits its transmission. The objective of this work was to identify the contacts of the possible cases of UNAM workers in order to establish communication and provide health education about hygiene measures. Material and methods: A questionnaire was prepared, telephone contact was established with the cases, and a home visit was arranged. A descriptive analysis of the data was carried out, as well as, a description of the experiences and perception during the home visit. Results: Most identified contacts were relatives of the cases, which did not have a complete vaccine scheme, no even against influenza, and the frequency of symptoms varied between 1 a 4. Final comments: In a situation like this (A(H1N1) human influenza virus pandemic) the public health nurse roll is of great importance, not just in the identification of the cases and its contacts, but also in the orientation and education of the population in relation to preventive measures.