ABSTRACT
SUMMARY: The variations knowledge of the cerebral arterial circle (CAC) is relevant due to its influence on the development of ischemic encephalic disorders. Among these variations, when the external diameter of the posterior communicating artery exceeds the posterior cerebral artery caliber, we have a fetal conformation of this circle. The aim of this study was to describe the variations of the CAC in Chilean individuals and to know the type of arterial conformation. Thirty adult brains were used to measure lengths and caliber of the pre-communicating segments of the anterior (A1) and posterior (P1) cerebral arteries, and the anterior (ACoA) and posterior (PCoA) communicating arteries. The arterial conformation type was established, and the length and caliber of these vessels were compared according to the right or left side. It was observed that 76.6 % of the CACs presented aplasia and / or hypoplasia. Of its components, PCoA was hypoplasic in 53.3 %, appearing bilaterally in 40 % of the subjects. The comparison according to the side, indicated that the mean length of A1 and PCoA on the right side was slightly higher. In the case of caliber, the mean of A1, P1 and PCoA was higher on the left side. Regarding P1 and PcoA caliber, 33 % of the CACs presented unilateral fetal conformation. Regardless of the variability presented by the CAC, there is consensus that PCoA exhibits the greatest variability. The understanding of this variability requires an analysis of the embryonic aspects that can explain the fetal conformation of the CAC in the adult.
RESUMEN: El conocimiento de las variaciones del círculo arterial cerebral (CAC) resultan relevantes por su influencia en el desarrollo de trastornos isquémicos encefálicos. De estas variaciones, los cambios del calibre de la arteria comunicante posterior (ACoP) determinan una conformación fetal de este círculo. El objetivo de este estudio fue describir las variaciones del CAC en individuos chilenos y conocer el tipo de conformación arterial. Se utilizaron 30 encéfalos adultos a los que se midieron las longitudes y calibres de los segmentos precomunicante de las arterias cerebrales anteriores (A1) y posteriores (P1), y de las arterias comunicante anterior (ACoA) y ACoP. Se estableció el tipo de conformación arterial y se comparó la longitud y calibre de estos vasos según lateralidad. Se observó que el 76,6 % de los CAC presentaron agenesias y/o hipoplasias. De sus componentes, la ACoP fue hipoplásica en el 53,3 %, presentándose bilateral en el 40 %. La comparación según lateralidad indicó que la longitud media de A1 y ACoP del lado derecho fueron levemente superiores. En el caso de los calibres, la media de A1, P1 y ACoP fue superior en el lado izquierdo. Respecto de los calibres de P1 y ACoP, el 33 % de los CAC presentaron conformación fetal unilateral. Independientemente de la variabilidad que presenta el CAC, existe consenso de que la ACoP exhibe la mayor variabilidad. La comprensión de esta variabilidad requiere un análisis de los aspectos embrionarios que pueden explicar la conformación fetal de esté círculo arterial en el adulto.
Subject(s)
Humans , Male , Female , Adult , Brain/blood supply , Circle of Willis/anatomy & histology , Anatomic VariationABSTRACT
Background: Neurological emergencies constitute 10-15% of medical emergencies. Doctor Hernán Henríquez Aravena Hospital has in house neurologists present permanently at the Emergency Room since July 2013. Aim: To estimate the waiting times for neurological consultations; to compare the waiting times between neurovascular (UV) and non-vascular (UNV) emergencies; and to compare the waiting times of two prioritization (triage) models. Material and Methods: A convenience sample of the consultations made during shift # 1 at the emergency room between January and December 2016, was analyzed. Results: There were 859 consultations in the period, 570 for UNV and 289 for UV. Mean age of consultants was 57 years and 52% were women. The median time for having an evaluation by a neurologist was 106 min (132 and 81 min for UNV and UV respectively). Twenty seven percent of patients were evaluated in less than one hour (23 and 36% of UNV and UV, respectively). The change of the prioritization model decreased the waiting time by 81 and 32 min for UNV and UV, respectively. Conclusions: There were significant differences in waiting times between neurovascular and non-vascular emergencies. Most patients were not evaluated in less than 60 minutes. The change in the initial stratification model was associated with a significant reduction in the waiting times for neurological emergencies.
Subject(s)
Humans , Male , Female , Referral and Consultation/statistics & numerical data , Emergency Service, Hospital , Time-to-Treatment , Nervous System Diseases , Time Factors , Prospective Studies , Neurologic ExaminationABSTRACT
OBJETIVO: Determinar la efectividad de la profilaxis antibiótica con Cefazolina en pacientes sometidos a colecistectomía laparoscópica por Colecistitis Aguda MATERIAL Y MÉTODOS: Cohorte Prospectiva POBLACIÓN: Pacientes mayores de 18 años, con patología litiásica vesicular aguda, sometidos a colecistectomía laparoscópica. SEDE Y TEMPORALIDAD: Hospital Obrero Nº 1 de la Caja Nacional de Salud La Paz Bolivia. Período comprendido entre el 1 de Julio de 2016 al el 31 de Diciembre de 2016. RESULTADOS: Se incluyeron 95 pacientes con Colecistitis Aguda divididos en dos grupos, el Grupo A (SIN profilaxis antibiótica) compuesto por 50 sujetos y el Grupo B (CON profilaxis antibiótica) de 45 sujetos. La edad promedio fue de 48 años, el peso de 70 kilos, la talla de 165 cm y el IMC de 27,4 km/ m2. El tiempo operatorio promedio fue de 50 (±22,815) minutos en el total del grupo, 45 min. (±18,460) en el grupo A y 60 min (±24,862) en el grupo B. La conversión a cirugía abierta fue de 9 sujetos (9,5%). La infección del sitio operatorio se presentó en 47 sujetos (49,5%), 30 sujetos (60%) EN EL GRUPO A y 18 en el grupo B (40%). El OR calculado es de 0,444 (IC 95% 0,195 1,011). CONCLUSIONES: La administración de Cefazolina en forma profiláctica, parece no disminuir la probabilidad de infección del sitio operatorio en colecistitis aguda abordada por laparoscopía
OBJECTIVE: To determine the effectiveness of antibiotic prophylaxis with Cefazolin in patients undergoing laparoscopic cholecystectomy due to Acute Cholecystitis. METHODS: Prospective Cohort POPULATION: Adult patients (older than 18 years), with acute lithiasic cholecystitis, who underwent laparoscopic cholecystectomy. PLACE AND TEMPORALITY: Hospital Obrero No. 1 of the Caja Nacional de Salud La Paz Bolivia, from July to December 2016. RESULTS: A total of 95 patients with Acute Cholecystitis were enrolled and divided in to two groups, group A (without antibiotic prophylaxis) composed of 50 subjects and Group B, (with antibiotic prophylaxis) 45 subjects. The mean age was 48 years old, weight 70 Kg, hight 165 cm and a BMI of 27.4 kg/M2. The mean operating time was 50 minutes (+- 22.185), group A 45 minutes and group B 60 min. Conversion to open surgery happened in 9 patients (9,5%), all in group B. Surgical Site infection (SSI) occurred in 47 patients (49.5%), of whom 30 patients belong to group A (60%) and 18 patients to group B (40%). The calculated Odds ratio is 0.444 (IC 95% 0,195-1.011). There were no bile duct injuries or morality in this study. CONCLUSIONS: The prophylactic administration of Cefazolin does not seems to decrease the probability of SSI in acute cholecystitis treated laparoscopically.
Subject(s)
Humans , Middle Aged , Lithiasis/diagnosis , Cholecystitis, Acute/drug therapy , Cholecystectomy, Laparoscopic , Antibiotic ProphylaxisABSTRACT
Este estudio de caso tiene como objetivo general, escribir las características laborales asociadas al Síndrome de Burnout en un Equipo de Cuidados Paliativos Oncológicos del Servicio de Salud Metropolitano Norte, en el año 2013 Las variables evaluadas son Síndrome de Burnout, carga mental y factores de riesgo psicosociales, las que fueron evaluadas mediante pautas estandarizadas: Maslach Burnout Inventory (MBI), NASA-TLX e ISTAS 21, respectivamente, además de un cuestionario de datos personales. La población de estudio está conformada en su mayoría por mujeres. Seis son médicos, cuatro son enfermeras y dos son técnicos en enfermería. Los principales hallazgos son que: todos los participantes tienen Síndrome de Burnout o se encuentran en riesgo de padecerlo, las principales fuentes de carga mental son las exigencias mentales y temporales, y los principales factores de riesgo psicosociales se relacionan con las exigencias psicológicas y la doble presencia. De los resultados obtenidos se concluye la importancia de intervenir no sólo con pacientes oncológicos, sino también con los equipos de salud, ya que este puesto de trabajo se ve expuesto a altas exigencias que pueden perjudicar la calidad de vida laboral y personal de los trabajadores.
The main purpose of this case study is to describe the work conditions related to the development of Burnout Syndrome in an Oncology and Palliative Care unit of the North Metropolitan Health Service, in the year 2013. This study evaluated the presence of Burnout Syndrome, Mental Workload and Psychosocial Risk Factors, which were assessed with three standardized tests: Maslach Burnout Inventory, NASA TLX and ISTAS 21, respectively, besides a personal data questionnaire. The study population was formed by twelve people, mainly women. Six were doctors, four were nurses and two were nursing technicians. The main results are: all individuals suffered from Burnout Syndrome or were in risk of developing it. The main mental workload causes were mental and timing requirements, and exposition to psychosocial risk factors related to psychological requirements and double presence. These results highlight the importance of making an intervention not only with oncology patients, but also with the health team, who are exposed to many requirements, which can affect the professionals work and personal quality of life.
Subject(s)
Humans , Male , Female , Burnout, Professional , Health Personnel , Occupational Diseases , Occupational Therapy , Palliative Care , Ergonomics , Oncology Service, Hospital , Professional Practice , Professional-Patient Relations , Risk Factors , Social Support , Surveys and Questionnaires , WorkloadABSTRACT
INTRODUCCIÓN: El trauma vesical es escaso, representa el 2-3 por ciento de traumatismos abdominales y es frecuente su asociación a fractura de pelvis. Con diagnóstico precoz tiene baja tasa de mortalidad. OBJETIVO: Describir el manejo de los pacientes con trauma vesical en el Hospital de Urgencia Asistencia Pública, Santiago, Chile. MATERIAL Y MÉTODO: Estudio retrospectivo, descriptivo de los registros de 16 pacientes con diagnóstico de egreso de trauma vesical, durante periodo 2005-2009. Los datos recopilados fueron sometidos a análisis estadístico simple en Microsoft Office® Excel 2010. RESULTADOS: El promedio de edad fue 29 años. Del total de pacientes, 13 son de sexo masculino. El mecanismo de lesión fue de tipo contuso en 11, siendo el accidente de tránsito el más frecuente con nueve. Los traumas penetrantes se presentaron en cinco pacientes, de los cuales cuatro fueron por arma de fuego. La hematuria es un signo frecuente, en nueve de ellos se presentó. El diagnóstico se realizó con ecotomografía abdominal en ocho y en cinco fue intraoperatorio. El manejo realizado fue quirúrgico en 15 casos, que abarca la totalidad del trauma penetrante, sólo tres pacientes presentaron complicaciones que correspondieron a sangrado activo. El trauma vesical se sospechó al ingreso en tres pacientes. DISCUSIÓN: El trauma vesical se presenta en pacientes jóvenes de sexo masculino, el mecanismo más frecuente es el contuso por accidente de tránsito. El diagnóstico se realiza principalmente con ecotomografía abdominal. El manejo es quirúrgico. La sospecha de trauma vesical es baja y se requieren exámenes de imágenes para confirmar.
INTRODUCTION: Bladder trauma is infrequent. Its incidence is estimated at 2-3 percent of all abdominal trauma and is strongly associated with pelvic fracture. If bladder trauma is suspected and identified, it has low mortality rate. OBJECTIVE: To describe the management of patients with bladder trauma in Hospital de Urgencia Asistencia Pública. MATERIAL AND METHOD: Descriptive, retrospective study of patients with discharge diagnosis of bladder trauma, between 2005 2009. RESULTS: Mean age was 29 years. Of all patients, 13 were male. Eleven patients presented blunt trauma, being traffic accidents the most frequent in nine. Penetrating trauma was present in five patients, of which four were by firearm. Hematuria is a frequent sign, being present in nine patients. For diagnosis, abdominal ultrasonography was used in eight cases and in five was made intraoperatively. Surgery was performed in 15 patients, which covers all cases of penetrating trauma. Three patients resented complications, all of them secondary to active bleeding. On admission, only three patients had suspicion of bladder trauma. DISCUSSION: Bladder trauma mainly occurs in young male patients and the most frequent injury mechanism are traffic accidents. Abdominal ultrasonography is the main diagnostic tool and it requires surgical resolution. Bladder trauma requires a high level of suspicion and imaging studies to make the diagnosis.
Subject(s)
Humans , Male , Adolescent , Adult , Female , Middle Aged , Wounds and Injuries/epidemiology , Hospitals, Packaged/statistics & numerical data , Urinary Bladder/injuries , Accidents, Traffic , Chile , Firearms , Hematuria , Wounds, Penetrating/epidemiology , Wounds and Injuries/etiology , Retrospective StudiesABSTRACT
El trauma renal es una patología que se presenta con frecuencia en pacientes politraumatizados. Los accidentes de tránsito son la causa más frecuente de trauma renal, debido principalmente al impacto contuso que reciben las estructuras renales. El trauma penetrante es menos frecuente, aunque con mayor frecuencia causa lesiones graves que requieren de cirugía para su resolución. La evaluación inicial del estado hemodinámico de estos pacientes en el momento de ingreso hospitalario es el gran determinante para definir la conducta terapéutica a seguir: los pacientes que ingresen estables pueden ser manejados conservadoramente obteniendo buenos resultados y los pacientes inestables deben ser explorados quirúrgicamente con el fin de descartar lesiones renales graves que sean causa de su inestabilidad. En los últimos años, los centros de trauma han adoptado conductas de manejo conservador en las lesiones traumáticas de órganos sólidos, basadas principalmente en el uso de imágenes (Ecotomografía de Urgencia y Tomografía Computarizada de abdomen)para determinar la presencia de lesiones o líquido libre intra-abdominal, lo que permite diferenciar con mayor certeza los pacientes que requieren cirugía de urgencia. Si bien las lesiones renales graves son las menos frecuentes, en el contexto de un paciente politraumatizado que ingrese hemodinámicamente inestable, se debe tener una alta sospecha y descartarlas en el menor tiempo posible. Las complicaciones son infrecuentes, siendo la extravasación urinaria la de mayor presentación y en la mayoría de los casos revierte espontáneamente.
Renal trauma is a condition that occurs frequently in trauma patients. Motor vehicle accidents are the most common cause of renal trauma, mainly due to the blunt impact that kidney receives. Penetrating trauma is less common, but most often causes serious injuries that require surgery. The initial evaluation of the hemodynamic status of these patients is the major determinant in defining the proper course of action: stable patients can be managed conservatively with good results and unstable patients should be surgically explored to rule out severe renal lesions that may cause the instability. In recent years, trauma centers have adopted conservative behavior in traumatic injuries of solid organs, mainly based on the use of images (abdominal Ultrasoundand Computerized Tomography) to determine the presence of injuries or intra-abdominal free fluid, allowing to differentiate patients that require emergency surgery or not. Even though severe renal lesions are less frequent, in the context of a hemodynamically unstable trauma patient, these lesions should be suspected and ruled out promptly. Complications are infrequent, being urinary extravasation the more prevalent and in most cases reverts spontaneously.
Subject(s)
Humans , Kidney Diseases/surgery , Kidney Diseases/diagnosis , Kidney/injuries , Kidney Diseases/classification , Kidney Diseases/complicationsABSTRACT
La toxina botulínica (BTX) es una neurotoxina que inhibe la liberación de acetilcolina en la unión neuromuscular, provocando relajación del músculo. En urología ha sido utilizada en disinergia vecesicoesfintenaria e hiperactividad del detrusor con buenos resultados. El objetivo de este trabajo es evaluar la eficacia y seguridad de Botox en el tratamiento de la hiperactividad del detrusor. Realizamos una revisión retrospectiva de resultados obtenidos en pacientes sometidos a inyección intradetrusor de BTX por hiperactividad del detrusor entre diciembre de 2007 y julio de 2009.Se realizaron 20 tratamientos en 18 pacientes (4hombres y 14 mujeres).La edad promedio de los pacientes fue 60.4 años. Todos los pacientes tenían demostración urodinámica de hiperactividad del detrusor con un promedio de amplitud de las contracciones de 50 cm. de agua. El 100 por ciento había recibido diversos tratamientos previos con antimuscarínicos. Tres casos eran de causa neurogénica. La dosis de inyección varió de 100 a 300 UI. A las dos semanas del tratamiento 14 pacientes tuvieron remisión completa de los síntomas. El tiempo de efectividad fue variable de 1 a 14 meses (4 pacientes con menos de 2 meses de seguimiento) En un paciente de origen neurogénico fue necesaria una segunda inyección para lograr la desaparición completa de síntomas. La inyección de BTX es un procedimiento simple y de bajo riesgo con buenos resultados en el tiempo y debe ser considerado como una importante herramienta en Hipercactividad del Detrusor.
Introduction: Botulinum toxin is a neurotoxin that inhibits the release of acetylcholine causing muscle relaxion. Is has used en Urology showing adequate safety and efficacy for neurogenic and idiopathic detrusor overactivity. We decided evaluate our outcomes in the treatment of detrusor hyperactivity. This is a board approved retrospective study.We research our database for patients treated with BTX-A for overactive detrusor between. December 2007 and July 2009.We identified 18 patients (14 women and 4 males) with a mean age 60.2 years in whom detrusor overactivity was confirmed on urodynamics and who were refractory to or intolerant of antimuscarinics and treated with intravesical BTX-A. After weeks from treatment 147 (77.8 percent) patients reported improvement of symptoms. There were no treatment ralated complications. According our result, BTX-A treatment a simple and low-risk procedure with adecuate safety and efficacy in the onset of overactive detrusor.
Subject(s)
Humans , Male , Female , Middle Aged , Botulinum Toxins/therapeutic use , Urinary Bladder, Overactive/drug therapyABSTRACT
Objetivo: Determinar los factores asociados al embarazo adolescente, en el Hospital Santo Tomás, Panama del 2001 al 2007. Materiales y métodos: Estudio descriptivo, retrospectivo de embarazos atendidos del 2001 al 2007 registrados en la base de datos del Sistema Informático Perinatal. Se compararon las embarazadas adultas con las adolescentes y sus productos durante este periodo Se utilizó el Sistema Informático Perinatal versión 1.4 para el análisis de información. Resultados: Se registraron 91944 embarazadas de las cuales 21495 (23.38%) fueron adolescentes, divididas en dos sub-grupos, de 10-14 años 785 (3.65%) y de 15-19 años 20710 (96.35%). El grupo control fue conformado por las pacientes de 20-34 años. Las pacientes adolescentes presentaron un menor control prenatal antes de las 20 semanas, 10-14 años (48.07%) y 15-19 años (56.47%) vs (60.75%) . También presentaron un menor porcentaje de abortos (10.72%) vs (12.84%), así como un menor porcentaje de primera cesárea, 10-14 años (15.64%) y 15-19 años (13.81%) vs (17.87%). Se encontró un mayor riesgo en partos prematuros por FUM en 10-14 años ( 22.3%) vs (14%) y producto con Bajo Peso al Nacer en 10-14 años (20.07%) vs (10.84%) Conclusiones: Las adolescentes embarazadas en este grupo estudiado no impresionan representar un mayor riesgo para la salud materna o para abortos y tienen menor riesgo de cesárea. En las madres con 10-14 años existe un riesgo mayor de productos con bajo peso al nacer, prematurez y menor valor APGAR. Las pacientes entre 15-19 años no representan un mayor riesgo obstétrico.
Objetives: Determine factors associated with adolescent pregnancies in the Hospital Santo Tomás, Panamá from 2001 to 2007. Material and methods: A retrospective and descriptive study of pregnancies attended during the years 2001 to 2007 that were recorded in the Perinatal Information System database. We compared pregnant adolescents with pregnant adults and their products. Adolescents were divided in two sub-groups, 10-14 years and 15-19 years, Analysis of the information was made using the Perinatal Information System version 1.4. Results: 91944 pregnancies were recorded, of which 21495 (23.38%) were adolescents, range from 10-14 years 785 (3.65%) and from 15-19 years 20710 (96.35%). Adolescent pregnant were found to receive less prenatal care before 20 weeks gestation, 10-14 year (48.07%) and 15-19 years (56.64%), than the control group (60.75%). Less percentage of abortions (10.72%) vs ( 12.84%), and less percentage of first time cesarean sections, 10-14 years (15.64%) and 15-19 years (13.81%) vs (17.87%). There was a increased risk for patients with 10-14 years for premature deliveries ( Measured by Last Menstrual Period) (22.03%) vs (14%) ad for Low Birth Weight (20.07%) vs (10.84%). Conclusions: Being an adolescent mother doesn't imply a higher risk for the mothers health or a higher risk for abortion and it has been demonstrate that they have fewer cesarean sections. Adolescent mothers with ages between 10-14 years have a higher risk of having a preterm delivery, low birth product and products with lower APGAR score.
ABSTRACT
Objetivo: Realizar la validación de la encuesta para diagnóstico indirecto de abuso/dependencia al alcohol en la sierra peruana. Material y método: Se usó la base de datos del Estudio Epidemiológico de Salud Mental 2003 realizado en la sierra peruana que contenía módulos que evaluaban la situación de salud mental. Se utilizó el módulo de diagnóstico directo de abuso/dependencia al alcohol, aplicado al adulto y la encuesta diagnóstico indirecto de abuso/dependencia al alcohol, aplicado a la mujer unida. La muestra fue de 1 302 parejas mujer unida û adulto. Para hallar la confiabilidad se utilizó el coeficiente alfa de Cronbach. Se realizó la validez de criterio comparándola con el cuestionario directo y la de constructo utilizando el análisis factorial. Resultados: Se obtuvo una coherencia interna de 93,1 por ciento. La probabilidad estimada de que el criterio externo y el cuestionario coincidan en el diagnóstico es 77 por ciento. Siendo el punto de mejor sensibilidad (70,4 por ciento) y especificidad (74,9 por ciento) en 2 ítems. El análisis factorial indica que la mayoría de ítems satura a un factor predominante. Conclusiones: El cuestionario indirecto para diagnóstico de abuso/ dependencia de alcohol es parcialmente válido para poblaciones con características similares a las de la sierra peruana.
Objective: Validation of a survey for making an indirect diagnosis of abuse/dependence of alcohol survey in the Peruvian Andes. Material and method: We used the database of The Mental Health Epidemiological Study conducted in the Peruvian Andes in 2003, which includes surveys assessing mental health. We used the direct diagnosis of alcohol abuse/dependence module in adult males, and indirect diagnosis of alcohol abuse/dependence survey in their spouses. The sample size was 1,302 adult couples. CronbachÆs Alpha coefficient was used in order to verify reliability of the tests. Validity of criteria was obtained by comparing them with the direct questionnaire and the validity of the construct was determined by using a factorial analysis. Results: The internal consistency of the questionnaire was 93.1 percent. The estimated probability of matching between the indirect survey and the external criteria is 77 percent. Best sensitivity (70.4 percent) and specificity (74.9 percent) values were located in 2 positive items. The factorial analysis indicated that most of the items saturate one predominant factor. Conclusions: The questionnaire for indirect diagnosis of alcohol abuse/ dependence is partially valid in populations with similar characteristics to those from the Peruvian Andes.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Alcoholism , Alcoholism/diagnosis , Data CollectionABSTRACT
El objetivo del estudio fue comparar peso, talla, índice de masa corporal (IMC) y consumo de oxígeno (VO2 max) en una muestra de 73 alumnos de 10 a 12 años del poblado de Putre a 3500 metros de altitud (n=31) y del pueblito de San Miguel de Azapa, que lo hacen a 500 metros de altitud (n=42). Los sujetos fueron evaluados según, procedencia, sexo y etnia aymará y No aymará. Los resultados muestran una disminución significativa de los patrones antropométricos de niños y niñas de Putre en comparación con los de San Miguel de Azapa. Los aymará de Putre damas y varones presentan un IMC bajo lo normal (<20). Los varones aymará de San Miguel de Azapa presentan un peso significativamente mayor que los varones no aymará, sin embargo todos los alumnos de San Miguel expresan un IMC de normales. La distancia recorrida en metros (Test de 6 minutos de carrera continua) y el consumo máximo de oxígeno expresado en litros por minuto (VO2), no presentan diferencias significativas según sexo, etnia y localidad de origen de los niños y niñas en estudio. Se concluye que el ambiente multiestresante de la altura (hipoxia hipobárica, bajas temperaturas y el nivel socioeconómico), tendría un gran impacto en el crecimiento infantil y el consumo máximo de oxígeno, lo que posiblemente reflejarían mecanismos adaptativos de los niños y niñas de Putre.
The objective of this study was to evaluate weight, height, body mass index (BMI) and oxygen consumption (VO2 max) in a sample of 73 students of 10 to 12 years from Putre to 3500 meters of altitude (n = 31) and San Miguel de Azapa, 500 meters of altitude (n = 42). Subjects were grouped according origin, gender, and aymara and non-aymara ethnic. The results show a significant decrease in anthropometric patterns in children of Putre compared with students from San Miguel de Azapa. Girls and boys Aymara of Putre have a BMI below normal (<20). Boys Aymara from San Miguel de Azapa have a significantly greater weight than boys non-aymara, however all students from San Miguel express a normal BMI. The distance traveled in meters (Test of 6 minutes of continuous running) and maximal oxygen consumption in liters per minute (VO2), not show significant differences by gender, ethnicity and geographic origin. We conclude that multistressful environment of the high altitude (hypobaric hypoxia, low temperatures and socioeconomic status), would have a major impact on child growth, and maximum oxygen consumption, possibly reflecting adaptive mechanisms of boys and girls from Putre.
Subject(s)
Humans , Male , Female , Child , Altitude , Anthropometry , Oxygen Consumption/physiology , Indians, South American , Adaptation, Physiological , Body Height , Body Mass Index , Body Weight , Chile/ethnology , Growth/physiology , Socioeconomic FactorsABSTRACT
El embarazo localizado dentro de una cicatriz de cesárea previa es el menos frecuente de los embarazos ectópicos y no existe un tratamiento estándar. Se presenta el caso clínico de una paciente con embarazo ectópico ístmico-cervical sobre una cicatriz de cesárea. Se hospitaliza por el riesgo de ruptura uterina, evolucionó con invasión trofoblástica de la histerorrafia culminando en muerte embrionaria. No hubo complicaciones maternas. Se trató con metotrexato para evitar la progresión de la invasión trofoblástica, con buen resultado materno.
Subject(s)
Female , Pregnancy , Adult , Humans , Cesarean Section/adverse effects , Cicatrix/complications , Pregnancy, Ectopic/etiology , Pregnancy, Ectopic/drug therapy , Methotrexate/therapeutic use , Abortifacient Agents, Nonsteroidal/therapeutic useABSTRACT
Objetivos: Identificar conocimientos y opiniones de estudiantes Medicina acerca de las Medicinas Alternativas y Complementarias (MAC). Material y Métodos: Se aplicó una encuesta autoadministrada a 106 estudiantes de quinto año de Medicina de la Pontificia Universidad Católica de Chile en 2005. Esta encuesta incluyó estimadores de nivel de conocimientos, percepción de utilidad e interés por adquirir conocimientos sobre cuatro terapias: medicina mapuche, homeopatía, acupuntura y reiki. También incluyó una medición del nivel de acuerdo con doce afirmaciones generales sobre MAC. Resultados: La tasa de respuesta fue de 90,5%. El porcentaje de personas que desconocían o sólo reconocían el nombre de las distintas terapias fue variable: 11,3% para homeopatía, 19,8% para acupuntura, 54,1% para reiki y 55,2% para medicina mapuche. La mejor percepción sobre utilidad fue para la acupuntura (78,7% la considera útil o muy útil), siendo semejante para hombres y mujeres. Las otras terapias tuvieron fueron evaluadas como útiles principalmente por mujeres, con diferencias estadísticamente significativas. Se identificó un amplio interés por adquirir conocimientos generales sobre el tema. Las mujeres mostraron mayor acuerdo con las afirmaciones generales favorables hacia las MAC y mayor desacuerdo hacia las afirmaciones críticas. Discusión: Los estudiantes de Medicina presentan conocimientos limitados sobre las MAC, pero un elevado interés en el tema. Las mujeres tienen una actitud más favorable hacia las MAC que los hombres. (AU)
Subject(s)
Humans , Male , Female , Students, Medical/statistics & numerical data , Complementary Therapies , Chile , AcupunctureABSTRACT
The mechanisms of congenital transmission of Chagas disease remain largely unknown. To better understand the role of maternal immunology during pregnancy in congenital Chagas transmission, we studied the cytokine production and the parasitic load in three groups of mothers: infected mothers who transmitted the disease to their babies (M+B+-), infected mothers who did not transmit the disease to their babies (M+B-) and not infected mothers as a control group (M-B-). M+B+ mothers produced less IFNgamma and more IL-10 than the M+B- mothers, and they are not able to produce IL-2. M+B+ mothers showed a higher parasitic load. These results, indicated that the congenital Chagas transmission is associated with an immunological imbalance and a high parasitic load in the M+B+ mothers.
Subject(s)
Animals , Female , Humans , Pregnancy , Cytokines/biosynthesis , Pregnancy Complications, Infectious/immunology , Chagas Disease/immunology , Chagas Disease/transmission , Infectious Disease Transmission, Vertical , Trypanosoma cruzi/physiology , Cytokines/immunology , Chagas Disease/parasitology , Immunity, Cellular , Interferon-gamma/biosynthesis , Interferons/biosynthesis , Carrier State/immunologyABSTRACT
We have investigated if maternal T. cruzi infection could induce in utero innate and/or adaptive immune responses in uninfected neonates by measuring specific IgM and IgA antibodies in cord blood plasma, and by performing phenotypic and functional studies of umbilical cord blood cells of their newborns (M+B- group). We detected T. cruzi-specific IgM and IgA antibodies in M+B- cord blood, indicating they had mounted in utero a strong B cell response, although they are not infected. On the other hand, circulating T cells of such uninfected neonates displayed a low level of activation, as seen bya slightly increased expression of the activation markers CD45RO on CD4+ T cells and HLA-DR on CD8+ T cells, although the proportion of CD4+ and CD8+ T cells was unmodified as compared to newborns from uninfected mothers (MB- group). This activation did not give rise to a proliferative response upon stimulation by T. cruzi antigens in vitro. However, M+B- cells produced low levels of lymphokines (IFN-gamma and IL-13) upon mitogenic stimulation, which was not the case of M-B- newborn cells. Beside this, M+B- blood cells produced higher levels of inflammatory cytokines (IL-1b, IL-6, TNF-alpha) than M-B- cells when stimulated with the T. cruzi lysate or LPS, suggesting the over-activation of the innate response in M+B- newborns. Monocytes participated in such inflammatory response since M+B- purified cord blood monocytes produced higher levels of TNF- when incubated with LPS or a T. cruzi lysate than M-B- cells. Altogether, these results show that, even in the absence of congenital infection, maternal T. cruzi infection triggers in utero both adaptive and innate immune responses in their babies. This indicates that parasite circulating antigens have been transferred from mothers to their fetuses.
Subject(s)
Animals , Female , Humans , Infant, Newborn , Pregnancy , Chagas Disease/immunology , Chagas Disease/transmission , Infectious Disease Transmission, Vertical , Immunity, Maternally-Acquired/immunology , B-Lymphocytes/immunology , T-Lymphocytes/immunology , Fetal Blood/immunology , Cytokines/biosynthesis , Pregnancy Complications, Parasitic/diagnosis , Chagas Disease/congenital , Immunity, Cellular , Immunoglobulin A , Immunoglobulin MABSTRACT
This histopathological study analyzes placentas of babies congenitally infected with T. cruzi (M+B+), or babies not infected but born from infected- (M+B-), or non infected-mothers (M-B-). Placentas M+B+ showed lesions of chorionitis, chorioamnionitis and cord edema with lymphocyte infiltration, whereas such lesions were infiltrated only with polymorphonuclear cells in M+B- and M-B- placentas. Parasites were found in M+B+ placentas, in fibroblasts and macrophages of chorion, membranes, chorionic plate, mainly in the area of membrane insertion, as well as in cells of Wharton jelly and myocytes of umbilical cord vessels. These results suggest that the materno-fetal transmission of parasites occurs mainly through the marginal sinus, spreading into the chorionic plate infecting fibroblasts and macrophages so far as to found a fetal vessel, inducing a fetal infection by hematogenous route.
Subject(s)
Female , Humans , Pregnancy , Animals , Pregnancy Complications, Parasitic/pathology , Chorioamnionitis/pathology , Chagas Disease/transmission , Infectious Disease Transmission, Vertical , Placenta/pathology , Trypanosoma cruzi , Chorioamnionitis/parasitology , Chorion/parasitology , Chorion/pathology , Chagas Disease/pathology , Pregnancy Outcome , Placenta/parasitology , Trypanosoma cruzi/isolation & purificationABSTRACT
Congenital transmission of T. cruzi in Cochabamba affects 6% of newborns from infected mothers. Only limited information is available on the type of transmitted parasites. However, it is well established that T. cruzi isolated from various vectors as well from host animals are highly heterogeneous. In our presentation we analyse aspects of molecular heterogeneity of T. cruzi and we review methods used for the molecular typing of T. cruzi lineages. Experimentally, we performed the PCR amplification of [quot ]Sequence-characterised region Markers[quot ] for typing T. cruzi isolated from umbilical blood of newborns in Cochabamba. We compared these results with those we obtained from general infected population. All 16 analysed, congenitally infected samples were of lineage IId. Our data also indicated that this lineage was found in about 80% of samples originated from general infected population in Cochabamba.
Subject(s)
Animals , Humans , Chagas Disease/congenital , Genetic Heterogeneity , Trypanosoma cruzi/genetics , DNA, Protozoan/analysis , Chagas Disease/diagnosis , Polymerase Chain Reaction/methods , Trypanosoma cruzi/classification , Trypanosoma cruzi/isolation & purificationABSTRACT
PCR is a potentially interesting diagnostic tool to detect congenital T. cruzi infection. We have compared the sensitivity and capacity of a battery of T. cruzi PCR primers to detect the complete spectrum of known T. cruzi lineages, in order to improve and simplify the detection of infection in neonatal blood. We found that the primers Tcz1/Tcz2, targeting the 195 bp satellite repeat, detected all the parasitic lineages with the same sensitivity For all other tested primers (nDNA primers: BP1/BP2, 01/02, Pon1/ Pon2 and Tca1/Tca2; kDNA primers: S35VS36, 121/122), either, the intensity of amplicons varied according to T. cruzi lineages, or the assess were less sensitive. In order to better assess such PCR protocol, we assayed 311 samples of neonatal blood previously tested with parasitological methods. Reliability of our PCR test was demonstrated since all the 18 blood samples from newborns with congenital T. cruzi infection were positive, whereas the remaining samples (30 from control newborns of uninfected mothers and 262 out of 263 from babies, parasitologically negative, born from infected mothers) were negative. As our PCR method is simple, reliable, robust and cheap, it appears suitable for the detection of T. cruzi infection in neonatal blood.
Subject(s)
Animals , Humans , Infant, Newborn , Chagas Disease/congenital , Chagas Disease/diagnosis , Polymerase Chain Reaction/standards , Trypanosoma cruzi/isolation & purification , DNA, Protozoan/blood , Infectious Disease Transmission, Vertical , DNA Primers , Reproducibility of Results , Sensitivity and Specificity , Fetal Blood/parasitology , Trypanosoma cruzi/geneticsABSTRACT
This study compares the levels of specific antibodies IgM and IgA for Chagas in samples of blood from newborns. Three groups of cord blood samples have been analysed: a group of 42 samples from newborns, displaying positive parasitemia, of seropositive mothers (M+B+), 68 samples from newborns with negative parasitemia whose mothers were seropositive (M+B-) and a group of 45 control newborns coming from mothers with negative serology for Chagas. From the 42 M+B+ samples with congenital Chagas disease, 81 and 82.9% displayed detectable levels of IgM and IgA antibodies, respectively In the M+B- group, 70.6 and 33.8% presented antibodies of IgM and IgA classes, respectively, whereas in the control group M-B-, we detected 6% and 11.1% of IgM and IgA antibodies, respectively. The calculated sensitivity of detection of congenital cases using IgM or IgA antibodies was of 82.9% and 80.9% respectively, whereas the specificity of detection was of 29.4% for IgM antibodies and of 66.1% for IgA antibodies.
Subject(s)
Animals , Humans , Infant, Newborn , Chagas Disease/congenital , Chagas Disease/diagnosis , Immunoglobulin A/blood , Immunoglobulin M/blood , Trypanosoma cruzi/immunology , Case-Control Studies , Chagas Disease/immunology , Enzyme-Linked Immunosorbent Assay , Sensitivity and SpecificityABSTRACT
The aim of this study was to validate the method of microhematocrit tube, as a rapid method to estimate the parasitemia in blood and to associate the parasites concentration with the morbidity and mortality of new born children with congenital Chagas diseases. Our results were determined experimentally and shown that the detection limit of the microhematocrit tube method is 40 parasites/ml when at least one of the four observed tubes is positive. Besides, it was also established that when the four examined tubes are positive the parasitemia in blood reaches more than 100 parasites/ml. It is important to highlight the modification made by our laboratory in the microscopic observation of the microhematocrit tubes with respect to the methodology used by previous investigators. A positive association exists between a high number of parasites in blood and the morbi-mortality of the newly born children with congenital chagas. The results of positive association between the parasitic load and the morbility and mortality could constitute an argument to understand the possible role of the parasite in the pathology of the disease.
Subject(s)
Humans , Animals , Male , Female , Infant, Newborn , Mice , Parasite Egg Count/methods , Chagas Disease/congenital , Chagas Disease/parasitology , Parasitemia , Trypanosoma cruzi/isolation & purification , Birth Weight , Bolivia/epidemiology , Chagas Disease/diagnosis , Hematocrit/instrumentation , Hematocrit/methods , Parasitemia/mortality , Sensitivity and Specificity , Umbilical CordABSTRACT
We have analyzed the response to the treatment with benznidazol in newborns and nurslings in the Hospital Materno Infantil Germán Urquidi of Cochabamba, Bolivia, between 1999 and 2002. It is important an integral treatment of the nursling with a subsequent information directed to the family. The response was close to 100% when the treatment was correctly administrated. They were not adverse effects and the detected biochemical alterations did not present clinical significance.